Mei-Wei Chang

Participant recruitment and retention in a pilot program to prevent weight gain in low-income overweight and obese mothers

BackgroundRecruitment and retention are key functions for programs promoting nutrition and other lifestyle behavioral changes in low-income populations. This paper describes strategies for recruitment and retention and presents predictors of early (two-month post intervention) and late (eight-month post intervention) dropout (non retention) and overall retention among young, low-income overweight and obese mothers participating in a community-based randomized pilot trial called Mothers In Motion.MethodsLow-income overweight and obese African American and white mothers ages 18 to 34 were recruited from the Special Supplemental Nutrition Program for Women, Infants, and Children in southern Michigan. Participants (n = 129) were randomly assigned to an intervention (n = 64) or control (n = 65) group according to a stratification procedure to equalize representation in two racial groups (African American and white) and three body mass index categories (25.0-29.9 kg/m2, 30.0-34.9 kg/m2, and 35.0-39.9 kg/m2). The 10-week theory-based culturally sensitive intervention focused on healthy eating, physical activity, and stress management messages that were delivered via an interactive DVD and reinforced by five peer-support group teleconferences. Forward stepwise multiple logistic regression was performed to examine whether dietary fat, fruit and vegetable intake behaviors, physical activity, perceived stress, positive and negative affect, depression, and race predicted dropout as data were collected two-month and eight-month after the active intervention phase.ResultsTrained personnel were successful in recruiting subjects. Increased level of depression was a predictor of early dropout (odds ratio = 1.04; 95% CI = 1.00, 1.08; p = 0.03). Greater stress predicted late dropout (odds ratio = 0.20; 95% CI = 0.00, 0.37; p = 0.01). Dietary fat, fruit, and vegetable intake behaviors, physical activity, positive and negative affect, and race were not associated with either early or late dropout. Less negative affect was a marginal predictor of participant retention (odds ratio = 0.57; 95% CI = 0.31, 1.03; p = 0.06).ConclusionDropout rates in this study were higher for participants who reported higher levels of depression and stress.Trial registrationCurrent Controlled Trials NCT00944060

Design and Outcomes of a "Mothers In Motion" Behavioral Intervention Pilot Study.

OBJECTIVE This paper describes the design and findings of a pilot Mothers In Motion (P-MIM) program. DESIGN A randomized controlled trial that collected data via telephone interviews and finger stick at 3 time points: baseline and 2 and 8 months post-intervention. SETTING Three Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) sites in southern Michigan. PARTICIPANTS One hundred and twenty nine overweight and obese African-American and white mothers, 18-34 years old. INTERVENTION The 10-week, theory-based, culturally sensitive intervention messages were delivered via a series of 5 chapters on a DVD and complemented by 5 peer support group teleconferences. MAIN OUTCOME MEASURES Dietary fat, fruit, and vegetable intake; physical activity; stress; feelings; body weight; and blood glucose. ANALYSIS General linear mixed model was applied to assess treatment effects across 2 and 8 months post-intervention. RESULTS No significant effect sizes were found in primary and secondary outcome variables at 2 and 8 months post-intervention. However, changes in body weight and blood glucose showed apparent trends consistent with the studys hypotheses. CONCLUSIONS AND IMPLICATIONS The P-MIM showed promise for preventing weight gain in low-income overweight and obese women. However, a larger experimental trial is warranted to determine the effectiveness of this intervention.

Clinical outcomes for low-income adults with hypertension and diabetes.

BackgroundLong-term management of hypertension and diabetes, which are more prevalent in minority and socioeconomically disadvantaged populations, presents challenges for healthcare providers in community health centers. ObjectivesThe purpose of the study was twofold: to examine health outcomes for persons with hypertension and diabetes and to compare these outcomes for disparities in patients who were Black, Hispanic, or White. MethodsMedical records (N = 280) from an urban community health center that serves predominantly uninsured adults were reviewed for selected clinical outcomes of primary care. Measures included outcomes of hypertension and diabetes control, lifestyle behaviors, preventive care, and patient status. Chi-square tests, t tests, and one-way analysis of covariance were used to analyze racial/ethnic group differences. ResultsData revealed significant differences in smoking status, influenza immunization, and blood pressure. Racial/ethnic group differences were minimal compared with the overall high prevalence of risk factors such as smoking and obesity. Regular access to primary care did not result in improved clinical outcomes. ConclusionThe findings support the need for more effective interventions that promote healthy lifestyle if health disparities in low-income populations with chronic conditions are to be reduced.

Predictors of fat intake behavior differ between normal-weight and obese WIC mothers.

Purpose. To determine whether predictors of fat intake behavior were the same for normal-weight and obese WIC mothers when applying the PRECEDE-PROCEED model and to identify predictors for each group. Design. Proportional stratified convenience sampling. Subjects. Five hundred eighty-one nonpregnant, black and white normal-weight (n = 180) or obese (n = 401) women. Settings. The Special Supplemental Nutrition Program for Women, Infants and Children in six counties in southern Wisconsin. Measures. The independent variables were predisposing, enabling, and reinforcing factors. Predisposing factors included beliefs in diet and health, beliefs in diet and body shape, health concerns in food choice, health concerns in nutrition, and eating habits. Enabling factors were cost of food, availability of time to prepare food, and accessibility to purchase food. Reinforcing factors were weight control intentions, sensory appeal, and mood. The dependent variable was fat intake behavior. Structural equation modeling was performed. Results. When controlling for covariates, certain factors affecting fat intake behavior differed between the normal-weight and the obese groups. For the normal-weight group, only reinforcing factors were positively associated with fat intake behavior. For the obese group, reinforcing and enabling, but not predisposing, factors were positively associated with fat intake behavior. Conclusions. Interventions to modify low-income womens fat intake behavior might benefit from targeting behavioral predictors that differ with body size. Messages that emphasize weight control intentions, sensory appeal, and mood are likely to affect both normal-weight and obese women. Information about cost of food, availability of time to prepare food, and accessibility to purchase food is likely to be more effective with obese women.

Development and Validation of a Self-Efficacy Measure for Fat Intake Behaviors of Low-Income Women

OBJECTIVE To develop a valid self-efficacy measure for eating low-fat diets in low-income women. DESIGN Cognitive interviews followed by self-administered questionnaires. PARTICIPANTS/SETTINGS 206 (6 + 200) nonpregnant black and white women participating in Head Start and the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) in Wisconsin. VARIABLES MEASURES: A 13-item self-efficacy measure for eating low-fat diets. ANALYSIS Content analysis and factor analyses. RESULTS After cognitive interviews, 3 items were removed from a draft instrument. Factor analyses were carried out using data from 200 questionnaires that were randomly selected from a pool of 487 respondents: 100 for exploratory factor analysis (EFA) and 100 for confirmatory factor analysis (CFA). Based on EFA, the 10-item pool was further reduced to 8 items, and 3 domains emerged: negative affect, positive affect, and availability. The results of CFA showed excellent model fit to the data (chi 2/df = 1.2, non-normed fit index = 1.0, comparative fit index = 1.0, incremental fit index = 1.0, root mean square error of approximate =.046). This measure demonstrated excellent reliabilities (Cronbach alpha : .82-.92; composite reliability: .92-.99) and construct and convergent validities. CONCLUSIONS AND IMPLICATIONS Information obtained from this revised instrument can be used among low-income women to measure self-efficacy for eating low-fat diets. This is an important step in developing more targeted and thus more effective education messages to help low-income women modify their fat intake behaviors.

Development of an Instrument to Assess Predisposing, Enabling, and Reinforcing Constructs Associated with Fat Intake Behaviors of Low-Income Mothers

OBJECTIVE To establish reliability and construct and discriminant validity of selected factors adapted from the Health and Taste Attitudes Questionnaire developed in Finland and the Food Choice Questionnaire developed in England for use with low-income mothers in the United States. DESIGN Cross-sectional. SETTING Head Start and the Special Supplemental Nutrition Program for Women, Infants and Children sites in south-central Wisconsin. PARTICIPANTS A convenience sample of 211 nonpregnant non-Hispanic black and white women. VARIABLES MEASURED Predisposing, enabling, and reinforcing constructs of the PRECEDE-PROCEED model. ANALYSIS Factor analyses. RESULTS After modification, the resulting measurement models of predisposing, enabling, and reinforcing constructs demonstrated good reliability and construct and discriminant validity. These models showed excellent model fit (chi-square/df range 1.5-2.0, root mean square error of approximate range.05-.07, non-normed fit index range.97-1.0, comparative fit index range.98-1.0, incremental fit index range.98-1.0), with all factor loadings significant (P <.001). Items previously developed with European adults demonstrated different pattern structures in predisposing and enabling constructs but the same structures for reinforcing construct when applied to low-income mothers in the United States. CONCLUSION AND IMPLICATION This modified instrument provides a tool for researchers and educators to further explore factors affecting fat intake behaviors in low-income mothers.

Self‐efficacy and Dietary Fat Reduction Behaviors in Obese African‐American and White Mothers

This study examined the influence of weight management and education on five types of fat reduction behaviors mediated through three task‐specific domains of self‐efficacy among young, low‐income obese African‐American and white mothers. It also investigated interaction of race with the relationships between weight management, education, self‐efficacy, and fat reduction behaviors. A sample of obese African‐American and white mothers was recruited from the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in Wisconsin. Participants reported their weight management status, education, self‐efficacy for eating low‐fat food, and fat reduction behaviors. For both racial groups, weight management status predicted low‐fat food substitution and meat modification behaviors; education predicted meat modification behavior. Three task‐specific domains of self‐efficacy (negative mood, positive mood, and food availability) predicted different types of fat reduction behaviors and differed by race. Weight management influenced behaviors of low‐fat food substitution, meat modification, and fried‐food avoidance, mediated partially through self‐efficacies of negative mood (African Americans), positive mood (African Americans, whites), and food availability (African Americans). Race affected the relationships between weight management, education, three task‐specific domains of self‐efficacy, and five types of fat reduction behaviors. Self‐efficacies operated differentially for African Americans and whites. Thus, strategies to address specific fat reduction behaviors have the potential to be more effective when tailored to specific individual characteristics such as racial background, history of weightmanagement strategies and task‐specific domains of self‐efficacy.

Scale Development: Factors Affecting Diet, Exercise, and Stress Management (FADESM)

BackgroundThe objective of this study was to develop scales measuring personal and environmental factors that affect dietary fat intake behavior, physical activity, and stress management in low-income mothers.MethodsFADESM (factors affecting diet, exercise, and stress management) scales were developed using the Social Cognitive Theory to measure personal (outcome expectancies, self-efficacy, emotional coping response) and environmental (physical environment, social environment, situation) factors affecting dietary fat intake behavior, physical activity, and stress management. Low-income African American and white mothers were recruited from the Special Supplemental Nutrition Program for Women, Infants, and Children in three counties in Michigan. In Phase one, 45 mothers completed individual cognitive interviews. Content analyses were performed. In Phase two, items modified from the cognitive interviews were administered to 216 mothers. Factor analysis and multiple indicators/multiple causes were performed.ResultsResults of cognitive interviews were used to revise items for the instrument that was tested in Phase two. The factor solution revealed 19 dimensions to measure personal and environmental factors affecting dietary fat intake behavior (three dimensions), physical activity (eight dimensions), and stress management (eight dimensions). Results of multiple indicators/multiple causes model showed scale invariance. Of 19 dimensions, 15 had Cronbach alpha between 0.76 and 0.94 and four were between 0.66 and 0.69. All dimensions had composite construct reliability scores between 0.74 to 0.97 and satisfactory construct and discriminant validities.ConclusionThe theory-based FADESM scales have documented good validity and reliability for measuring factors affecting dietary fat intake behavior, physical activity, and stress management in low-income women. Results of this study support the use of these scales with low-income African American and white mothers in community settings.

Reversing Harmful Developmental Origins of Health and Disease Effects

Abstract This chapter describes the design of a Mothers in Motion (MIM) intervention aimed to prevent weight gain among low-income overweight and obese mothers by promoting stress management, healthy eating, and physical activity. Eligible participants are randomly assigned to an intervention or comparison group. The intervention group watches 10 DVD chapters at home and joins 10 peer support group teleconference (PSGT) sessions in a 16-week period. The comparison group reads printed educational materials. The MIM DVDs are theory based, culturally sensitive, and feature four low-income African American and white overweight or obese mothers. Peer educators and dietitians working in the community are trained in motivational interviewing to lead the PSGTs. The primary outcome is body weight. MIM DVDs, materials, and resources are available to any WIC clinic in the United States.