Nancy Cotugna

Evaluation of literacy level of patient education pages in health-related journals.

The purpose of this study was to evaluate the reading level of patient education material from selected current health care journals. Ten patient education pages from a variety of health care journals were entered into a Microsoft Word program. Applying the Flesch–Kincaid readability formula available from Microsoft Word, a reading level for each page was established and compared to recommended standards. Only 2 of 10 patient education pages fell within the recommended reading levels for health-related materials, and 5 of 10 were above the estimated mean U.S. reading level of 8th grade. A 5th to 6th grade level is recommended for patient education materials. This study suggests that although it is known that low health literacy is a widespread problem, it is not always considered when patient-targeted materials are developed. Health care professionals need to become more active in addressing the literacy needs of the intended receiver of written health-related information.

Higher Healthy Eating Index-2005 Scores Associated with Reduced Symptoms of Depression in an Urban Population: Findings from the Healthy Aging in Neighborhoods of Diversity Across the Life Span (HANDLS) Study

BACKGROUND Depression affects more than 15 million Americans in a given year. Compared to physical health, less is known about the affect of diet quality on symptoms of depression. OBJECTIVE This study investigated the relationship between diet quality and reported symptoms of depression in a low-income urban population. SUBJECTS/SETTING Subjects included 1,118 African-American and white adults, aged 30 to 64 years, living in Baltimore, MD, and represented a subsample of the initial examination and recruitment phase of the Healthy Aging in Neighborhoods of Diversity across the Life Span study. METHODS Nutrition data were based on two 24-hour dietary recalls collected by trained interviewers using the US Department of Agriculture Automated Multiple Pass Method. Diet quality was calculated using the US Department of Agriculture Healthy Eating Index (HEI)-2005. Depressive symptoms were assessed by a trained interviewer using the Center for Epidemiologic Studies Depression scale. STATISTICAL ANALYSIS Both linear and logistic regression analyses were used to examine whether or not diet quality was associated with depressive symptoms. The dependent variable was depressive symptoms and independent variables included HEI-2005, race, sex, age, education, income, and food-assistance program participation. RESULTS Mean HEI-2005 score was 52.17+/-0.40 (out of 100). Mean Center for Epidemiologic Studies Depression scale score was 11.64+/-0.25 (out of 40). Diet quality was significantly associated with reported symptoms of depression. However, income was a significantly stronger predictor of depression compared to diet quality, education, and sex. CONCLUSIONS Registered dietitians should be aware of relationships between psychological status and nutritional health when assisting clients to better manage their food choices to improve their overall health and quality of life.

Effect of race and predictors of socioeconomic status on diet quality in the HANDLS Study sample.

PURPOSE To examine effects of race and predictors of socioeconomic status (SES) on nutrient-based diet quality and their contribution to health disparities in an urban population of low SES. DESIGN Data were analyzed from a sample of the Healthy Aging in Neighborhoods of Diversity Across the Life Span (HANDLS) Study participants examining effects of age, sex, race, income, poverty income ratio, education, employment, and smoking status on nutrient-based diet quality as measured by a micronutrient composite index of nutrient adequacy ratios and a mean adequacy ratio. Regression models were used to examine associations and t tests were used to look at racial differences. SUBJECTS African American and white adults ages 30 to 64 years residing in 12 predefined census tracts in Baltimore, Maryland. RESULTS Sex, age, education, poverty income ratio, and income were statistically significant predictors of diet quality for African Americans, while sex, education, and smoking status were statistically significant for whites. African Americans had lower mean adequacy ratio scores than whites (76.4 vs. 79.1). Whites had significantly higher nutrient adequacy ratios scores for thiamin, riboflavin, folate, B12, vitamins A and E, magnesium, copper, zinc, and calcium, while African Americans had higher vitamin C scores. CONCLUSION Education significantly impacted diet quality in the HANDLS sample, but race cannot be discounted. Whether the racial differences in diet quality are indicative of cultural differences in food preferences, selection, preparation, and availability, or disparities in socioeconomic status remains unclear.

Sports Nutrition for Young Athletes

Nutritional needs for peak athletic performance include sufficient calorie intake, adequate hydration, and attention to timing of meals. Student athletes and their advisors often are misinformed or have misconceptions about sports nutrition. This paper identifies nutritional needs of young athletes, reviews common misconceptions, and examines the nutrition knowledge of athletes and their sources of nutrition information. Topics covered include energy, carbohydrate, protein, fat and micronutrient needs, hydration requirements, timing of meals, and issues related to age, gender, and specific sports. Other issues addressed include “making weight” and ergogenic aids. Proper nutrition for young athletes is critical not only to their athletic success, but more importantly to their growth, development, and overall health. Nutritional recommendations should be based on the most current scientific data; we provide information about appropriate resources for the school nurse when advising student athletes and their coaches and parents.

Food commercials during television soap operas: What is the nutrition message?

Studies have examined food commercials appearing during daytime, prime time, and Saturday morning programming; none have evaluated commercials aired during soap operas. The purposes of this study were to examine the dietary composition of food products advertised during soap operas and the health and nutrition claims made on their behalf, using current dietary recommendations as a basis of evaluation. A total of 508 commercials videotaped during the top nine daytime serials for five consecutive days, were for food or beverage products. Most foods advertised were rated low in sugar, fat, sodium, and dietary fiber, and health and/or nutrition appeals occurred frequently. However, of the foods advertised as “low cholesterol,” 77% were high in fat. Similarly, those foods advertised as low in saturated fat were high in total fat content. Forty-three percent of the food commercials promoting nutrition were for items such as flavored drinks with little nutrient value. Generally, the nutrition messages conveyed in these commercials supported current dietary recommendations, but the way in which the food products were promoted was often inconsistent and confusing, particularly in the area of fat. Nutrition educators need to address these inconsistencies when assisting consumers in interpreting television food advertising messages.

An outcome evaluation of a food bank program

Nonprofit organizations such as the Food Bank of Delaware rely heavily on contributions as they strive to create a hunger-free society. To demonstrate to donors and the public at large the positive difference made by the Food Bank of Delaware, we developed an outcome evaluation method that would measure success in terms other than the amount of food distributed. A detailed list of foods available for 1 month was evaluated item by item in terms of the US Department of Agricultures Food Guide Pyramid. From this list, we calculated the number of people who could potentially be provided with the minimum recommended number of servings per day for each food group. The highest amount of food distributed was from the Bread, Cereal, Rice, and Pasta Group; food items from this group could potentially meet recommended servings for more than 6,000 persons a day. The food bank distributed the least amount of food from the Milk, Yogurt, and Cheese Group. Food bank programs can use outcome evaluations to demonstrate to contributors and product providers the potential impact of the program and the qualitative and quantitative use of their donations. Results also identify areas for nutrition education and improved menu planning for the provider organizations who distribute these foods.

Community Health and Nutrition Screening for Special Olympics Athletes

Since 1961, Special Olympics has provided sports training and athletic competition for people with mental retardation. A recent addition to these Olympics has been the Healthy Athletes Program, designed to help the athletes improve their health and fitness, leading to enhanced sports experiences and well being. Original health services included dental and eye screening. In 2002, Special Olympics Delaware piloted a Wellness Park to add nutrition, blood pressure, and flexibility screening. Faculty from a universitys health college trained discipline-specific students to conduct the screenings. Thirty nutrition and dietetics students measured height, weight, waist circumference, and calculated body mass index (BMI) for the athletes. Figures and risk-assessments were recorded on a “health report card.” Two hundred ten athletes attended the nutrition screening. Ages ranged from 8 to 63 years; 81 percent males and 19 percent females. According to BMI standards, 32 percent of the athletes were overweight; 17 percent were obese. Twenty-five percent of adult males and 73 percent of adult females had a high risk waist circumference. Athletes at high risk for obesity-related diseases were referred to their primary physician for follow up. Nutrition education handouts included a simplified Food Guide Pyramid, tips for healthy eating in restaurants, 5 A Day information, and healthful hydration guides. Approximately 1,250 athletes participate in Special Olympics Delaware each year, providing a great opportunity to do some much needed health screening and improve access to health care for this often neglected population.

Impact of the Use of Produce Grown in an Elementary School Garden on Consumption of Vegetables at School Lunch

Low consumption of fruits and vegetables has been implicated as a factor in the increasing childhood obesity seen over the past 2 decades. The use of school gardens is a relatively new nutrition education strategy that may provide some additional benefit in getting children to consume the recommended amount of vegetables. Previous research into the effectiveness of school gardens has shown that they have positive impacts on childrens vegetable preferences, and they can have a positive impact on childrens consumption of vegetables at school lunch. However, no research has examined using school garden produce at school lunch to determine whether that tactic would have an additional impact on childrens consumption of vegetables at school lunch, so that is the purpose of this study. A quasi-experimental design was used along with cafeteria observations. The results showed that offering garden produce at school lunch had a small positive impact on childrens food choices.

Fighting Hunger Through Innovation: Evaluation of a Food Bank's Social Enterprise Venture

Innovative solutions are required to overcome increasing demands on food bank resources. A social enterprise venture in the form of an agency-run grocery store called “The Market” was developed by the Food Bank of Delaware (FBD) with the goal of bringing food to the citizens of an inner-city neighborhood. The project began with a pilot store and a feasibility study evaluated the challenges and successes. The evaluation generated recommendations for development of a permanent store and future research. The Market is one model of social enterprise in the area of nutrition and food security.

Vending Machine Policies and Practices in Delaware

Overweight has reached alarming proportions among America’s youth. Although the cause of the rise in overweight rates in children and adolescents is certainly the result of the interaction of a variety of factors, the presence of vending machines in schools is one issue that has recently come to the forefront. Many states have passed or proposed legislation that limits student access to vending machines in schools or require that vending machines in schools offer healthier choices. The purposes of this study were (a) to assess the food and beverage vending machine offerings in the public school districts in the state of Delaware and (b) to determine whether there are any district vending policies in place other than the current U.S. Department of Agriculture regulations. The results of this study indicate the most commonly sold food and drink items in school vending machines are of minimal nutritional value. School administrators are most frequently in charge of the vending contract, as well as setting and enforcing vending machine policies. Suggestions are offered to assist school nurses, often the only health professional in the school, in becoming advocates for changes in school vending practices and policies that promote the health and well-being of children and adolescents.