Michelle B. Stockton

Prevalence and Characteristics of Energy Underreporting in African-American Girls

Objective: To determine the frequency and characteristics of energy intake underreporting in African‐American preadolescent girls as part of the Girls health Enrichment Multi‐site Studies (GEMS).

Measurement of body composition in 8-10-year-old African-American girls: a comparison of dual-energy X-ray absorptiometry and foot-to-foot bioimpedance methods.

OBJECTIVE The purpose of this study was to evaluate body composition outcomes of foot-to-foot (FF) bioelectrical impedance (BIA) and dual-energy x-ray (DEXA) in 8 to 10-year-old African-American girls and, if different, to develop and cross-validate specific BIA prediction equations for this at-risk group. METHODS DEXA and FF-BIA body composition outcomes were analyzed in 183, 8-10-year-old African-American girls from the Memphis site of the Girls health Enrichment Multi-site Study (GEMS). RESULTS Mean body composition outcomes by FF-BIA and DEXA were significantly different (p<0.0001); therefore, population-specific equations were developed and cross-validated using split-sample, cross-validation methods. When equations were used, BIA and DEXA outcomes were significantly correlated (percent body fat [r=0.931], fat mass [r=0.985], and fat-free mass [r=0.944]). Mean predicted BIA measurements for body fat, fat mass, and fat-free mass were essentially equal to their counterpart DEXA measurements (t[182]=- 0.013, p = 0.897, t[182]=- 0.06, p=0.956, and t[182]=- 0.26, p=0.792, respectively). The Bland-Altman analysis revealed a significant slope for percent fat (p=0.009) and slopes approaching significance for fat mass (p=0.07) and fat-free mass (p=0.06). CONCLUSION Although FF-BIA and DEXA are not directly interchangeable in young African-American girls, these equations accurately estimated average percent fat, fat mass, and fat-free mass of the cross-validation sample of African-American girls. However, the application of this equation may result in potential underestimation or overestimation of fat with respect to DEXA measures in some populations.

Identification of facilitators and barriers to participation in weight gain prevention research by African American girls.

OBJECTIVE The purpose of the current study is to describe the development, implementation, and success of recruitment and adherence strategies of 303 African American preadolescent girls and their primary caregiver in the Girls health Enrichment Multi-site Studies (GEMS) program. METHODS A socio-ecologic model was used to guide selection and implementation of recruitment and retention strategies which were continuously monitored and revised in response. Strategy mode and frequency associated with program enrollment, engagement, and retention were analyzed. RESULTS Successful recruitment approaches included radio messages (23.1%), school fliers (20.1%), and friend referral (15%). Initially 463 potential participants responded, 320 girls were screened, and 303 enrolled. Significant increases in participant accrual were observed between Wave 4 (n=28) and Wave 5 (n=91) after using a team recruitment approach. Implementing case management strategies and providing make-up sessions also served to keep participants current and engaged in the program. In year 2, community field trips replaced the more structured sessions providing participants with experiential learning opportunities. Overall intervention attendance rates ranged from 79.7% to 90.5% among waves. Further, 75.9% and 80.2%, respectively, of participants attended 1-year and 2-year follow-ups. CONCLUSION Multiple recruitment strategies and flexible, responsive approaches to recruitment and retention guided by the socio-ecologic model facilitated optimal implementation of an intervention for preadolescent girls. Through the application of the socio-ecologic model researchers and program leaders will be able to identify strategies to enhance the probability of successful outcomes.

Predicting postprandial oxidative stress using serum triglycerides following oral fat tolerance testing.

Background: The topic of postprandial oxidative stress continues to receive considerable attention, with elevations in oxidative stress biomarkers associated with human disease (e.g., insulin resistance, atherosclerosis). The predictable rise in serum triglyceride (TAG) following high fat meal ingestion is strongly correlated to the increase in circulating oxidative stress biomarkers. Our intent with the present study was two-fold: 1) To further characterize the postprandial response to high fat feeding and 2) to develop regression models that could be used to predict the oxidative stress response to high fat feeding. Methods: 154 men and women reported to the lab in the morning hours following an overnight fast and consumed a high fat liquid meal. Blood samples were collected before meal ingestion and at 2 and 4 hours following meal ingestion. Samples were analyzed for TAG and oxidative stress biomarkers (hydrogen peroxide [H2O2], malondialdehyde [MDA], advanced oxidation protein Original Research Article Bloomer et al; BJMMR, 5(12): 1514-1526, 2015; Article no.BJMMR.2015.171 1515 products [AOPP]). Simple linear regression analyses were used for model development to predict the oxidative stress response to feeding. In addition, biochemical variables were analyzed using an analysis of variance (ANOVA) to present response to feeding data across time. Results: In all of the regression models, TAG explained a significant portion of the outcome variables (H2O2, MDA, and AOPP) and predictor models were created for each variable. In addition, values for TAG and all oxidative stress biomarkers increased following meal ingestion. A time effect was noted where all values were higher post meal ingestion as compared to pre meal for all biochemical variables (p<0.05). Conclusion: Obtaining serum TAG values in response to a high fat meal challenge may provide investigators with the ability to predict postprandial oxidative stress using regression equations.

Community-based physical activity as adjunctive smoking cessation treatment: Rationale, design, and baseline data for the Lifestyle Enhancement Program (LEAP) randomized controlled trial

Despite advances in behavioral and pharmacological treatment for tobacco use and dependence, quit rates remain suboptimal. Increasing physical activity has shown some promise as a strategy for improving cessation outcomes. However, initial efficacy studies focused on intensive, highly structured exercise programs that may not be applicable to the general population of smokers. We describe the rationale and study design and report baseline participant characteristics from the Lifestyle Enhancement Program (LEAP), a two-group, randomized controlled trial. Adult smokers who engaged in low levels of leisure time physical activity were randomly assigned to treatment conditions consisting of an individualized physical activity intervention delivered by health fitness instructors in community-based exercise facilities or an equal contact wellness control. All participants received standard cognitive behavioral smoking cessation counseling combined with nicotine replacement therapy. The primary outcomes are seven-day point prevalence abstinence at seven weeks, six- and 12 months. Secondary outcomes include self-reported physical activity, dietary intake, body mass index, waist circumference, percent body fat, and nicotine withdrawal symptoms. Participants consist of 392 sedentary smokers (mean [standard deviation] age = 44.6 [10.2] = years; 62% female; 31% African American). Results reported here provide information regarding experiences recruiting smokers willing to change multiple health behaviors including smoking and physical activity.

Effects of Disasters on Smoking and Relapse: An Exploratory Study of Hurricane Katrina Victims.

Abstract Background: Psychosocial stress maintains cigarette use and precipitates relapse, but little is known about how natural disasters in particular affect smoking. Purpose: To determine the feasibility of recruiting victims soon after a natural disaster for a survey study, and to assess the types and determinants of changes in smoking behavior resulting from exposure to the disaster. Methods: A convenience sample of 35 Hurricane Katrina refugees who had smoked more than 100 cigarettes in their lifetime were surveyed one month after the storm to evaluate changes in smoking behavior. Results: Among a small sample of former smokers, more than half relapsed after Katrina, citing stress, urge, and sadness. Among current smokers, 52% increased their smoking after Katrina by more than half a pack per day on average. Most individuals who increased their smoking or relapsed expressed interest in receiving cessation assistance within the next month. Discussion: Stress-related increases in smoking and relapse may be common after a natural disaster. Translation to Health Education Practice: Health education professionals have an important role to play in responding to changes in tobacco use in the aftermath of disasters. Educational interventions to discourage tobacco use as a coping strategy may be especially warranted given the high level of interest expressed in smoking cessation.

Race differences in depression vulnerability following Hurricane Katrina.

Objective: This study investigated whether racial disparities in depression were present after Hurricane Katrina. Method: Data were gathered from 932 New Orleans residents who were present when Hurricane Katrina struck, and who returned to New Orleans the following year. Multiple logistic regression models evaluated racial differences in screening positive for depression (a score ≥16 on the Center for Epidemiologic Studies Depression Scale), and explored whether differential vulnerability (prehurricane physical and mental health functioning and education level), differential exposure to hurricane-related stressors, and loss of social support moderated and/or reduced the association of race with depression. Results: A univariate logistic regression analysis showed the odds for screening positive for depression were 86% higher for African Americans than for Caucasians (odds ratio [OR] = 1.86 [1.28–2.71], p = .0012). However, after controlling simultaneously for sociodemographic characteristics, preexisting vulnerabilities, social support, and trauma-specific factors, race was no longer a significant correlate for screening positive for depression (OR = 1.54 [0.95–2.48], p = .0771). Conclusions: The racial disparity in postdisaster depression seems to be confounded by sociodemographic characteristics, preexisting vulnerabilities, social support, and trauma-specific factors. Nonetheless, even after adjusting for these factors, there was a nonsignificant trend effect for race, which could suggest race played an important role in depression outcomes following Hurricane Katrina. Future studies should examine these associations prospectively, using stronger assessments for depression, and incorporate measures for discrimination and segregation, to further understand possible racial disparities in depression after Hurricane Katrina.

Assessing Writing in Elementary Schools: Moving Away From a Focus on Mechanics

ABSTRACT Many students struggle with writing; however, curriculum-based measures (CBM) of writing often use assessment criteria that focus primarily on mechanics. When academic development is assessed in this way, more complex aspects of a student’s writing, such as the expression and development of ideas, may be neglected. The current study was a preliminary analysis of viability of the words per thought unit (T-unit) as an alternative to traditional approaches to writing assessment. Participants included 167 children enrolled in the fourth and fifth grade, ages 9–11, in a rural southeastern U.S. school district. Writing samples were collected in three probes across the school year (fall, winter, and spring) and analyzed by using a variety of measures. Words per T-unit were positively linearly correlated with other measures of literary proficiency. A repeated measures analysis of variance (ANOVA) assessed growth in writing across time and grade. Results indicated a statistically significant time effect within subjects for words per T-unit across grades. Thus, the analysis of words per T-unit yielded promising results as an efficient means of measuring writing skills independently of mechanics.

Relationship Between Dental Health and Nutrition Risk Factors in Homebound Older Adults

To the Editor: Adequate nutrition intake is vital for elderly individuals in order for them to maintain good health. With the ever-increasing number of older adults signing up for government-funded nutrition programs such as Meals on Wheels, it is thought that the health of the general population may be deteriorating. One program specifically, Metropolitan Inter-Faith Association (MIFA) Meals on Wheels, located in Memphis, Tennessee, provides elderly individuals with one meal each day that meets at least one-third of the daily recommended nutrient requirements. There are several barriers to an elderly person receiving optimal nutrition, such as the inability to consume enough fruits and vegetables, which may be due to poor dental health or inadequate dentition. Several articles have reported that elderly individuals commonly have numerous health problems, specifically oral health, including missing teeth, mastication difficulties, and gingivitis. If homebound elderly individuals are not receiving adequate oral health care, they could be at risk for severe malnutrition and vitamin deficiencies. Older adults have been found to have micronutrient deficiencies consisting of 33% to 55% of their Dietary Reference Intakes. One study working with a new Meals on Wheels program found that only 11% of screened participants were well nourished. The purpose of this project was to determine whether there is any correlation between dental health and nutrition risk for homebound older adults who participate in Meals on Wheels programs. A quantitative survey was designed to address questions regarding the dental health of elderly homebound individuals (independent variable) receiving homebound meals and relate it to their nutrition risk (dependent variable) (Table 1). The first questionnaire, the “Nutritional Counseling Mini Assessment,” was used to assess participants’ risk of malnutrition. It included questions regarding how many fruits and vegetables they consumed daily and whether respondents were physically able to shop or cook for themselves. Valerie King, the Aging Commission of Tennessee state dietitian, modified this questionnaire. The second questionnaire, which one of the researchers developed, was used to assess the overall dental health of participants in the program. Fifty Meals on Wheels clients were randomly selected and added to 50 previously assessed clients following the same guidelines. Participants included men (n = 14) and women (n = 36) aged 60 and older. The clients used for this study received one meal a day at home. Participants were ineligible for the study if they were younger than 60, were bed ridden, or had severe dementia and were not capable of answering questions. The researcher conducting the study, was also the MIFA-registered dietitian, who completed the interviews. At the end of both questionnaires, total scores were calculated. The independent variable, dental health, was used to determine whether nutrition status affects overall dentition. The questions asked were pertinent because many older adults participating in the MIFA Meals on Wheels program are on Medicare or Medicaid, which do not cover dental treatment. This can be a major barrier for older adults in need of dentures or a replacement of dentures because of improper fit. The number of teeth also tends to decrease with age, so missing teeth may lead to further problems with chewing raw foods, which tend to be nutrient rich. Fruit and vegetable intake is another dependent variable that is used to observe how many fruits and vegetables are consumed daily. Financial difficulty is one main barrier to obtaining fruits and vegetables, although the focus of the study was to observe the direct relationship between dental health and fruit and vegetable intake. No significant relationship was found between nutrition and dental health (correlation coefficient = 0.262, P = .07), although the results indicated this relationship approached significance. A correlation was used to assess for a significant relationship between nutrition and dental health, but the results were not significant (P = .48). T-tests did not show a significant difference between men and women in dental health (P = .61) of nutrition status (P = .22). The literature supports that malnutrition is an increasing risk factor for individuals aged 60 and older. If these individuals do not receive proper oral health care, this may lead to further problems leading to malnutrition. Table 1. Participant Nutritional and Dental Risk Factors

A Culturally Tailored, Faith-Based Approach to Reducing Pediatric Obesity in Minority Families: Strong Me!

Ruth Williams1*, Michelle B Stockton1,2, K. Brooke Beck1,3, Robin Roach1,4, Marian Levy5 and Janice Pride-Boone6 1Health and Sports Science, Field House 106,The University of Memphis, Memphis, USA 2Associate Professor, The University of Memphis, Memphis, USA 3Clinical Dietitian, The Church Health Center, Memphis, USA 4Associate Professor, The University of Memphis, Memphis, USA 5Associate Professor and MPH Director, School of Public Health, The University of Memphis, USA 6Medical Director of Strong Me, USA