Paulette Johnson

Eat Better & Move More: A Community-Based Program Designed to Improve Diets and Increase Physical Activity Among Older Americans

OBJECTIVES We assessed outcomes of an integrated nutrition and exercise program designed for Older Americans Act Nutrition Program participants as part of the Administration on Agings You Can! campaign. METHODS A 10-site intervention study was conducted. Preintervention and postintervention assessments focused on nutrition and physical activity stages of change, self-reported health status, dietary intakes, physical activity, and program satisfaction. RESULTS Of 999 enrollees, the 620 who completed the program were aged 74.6 years on average; 82% were women, and 41% were members of racial/ethnic minority groups. Factors associated with program completion were site, health conditions, and nutrition risk. Seventy-three percent and 75% of participants, respectively, made a significant advance of 1 or more nutrition and physical activity stages of change; 24% reported improved health status. Daily intake of fruit increased 1 or more servings among 31% of participants; vegetables, 37%; and fiber, 33%. Daily steps increased 35%; blocks walked, 45%; and stairs climbed, 24%. Program satisfaction was 99%. CONCLUSIONS This easy-to-implement program improves diets and activity levels. Local providers should offer more such programs with the goal of enabling older Americans to take simple steps toward successful aging.

Comprehensive Nutrition and Lifestyle Education Improves Weight Loss and Physical Activity in Hispanic Americans Following Gastric Bypass Surgery: A Randomized Controlled Trial

BACKGROUND As morbid obesity increasingly affects Hispanic Americans, the incidence of bariatric procedures among this population is rising. Despite this, prospective research on the effects of comprehensive postoperative education-centered interventions on weight loss and physical activity focused on Hispanic Americans is lacking. OBJECTIVE To examine whether a comprehensive nutrition education and behavior modification intervention improves weight loss and physical activity in Hispanic Americans with obesity following Roux-en-Y gastric bypass surgery (RYGB). METHODS A prospective randomized-controlled trial was conducted between November 2008 and April 2010. At 6 months following RYGB, 144 Hispanic Americans with obesity were randomly assigned to a comprehensive nutrition and lifestyle educational intervention (n=72) or a noncomprehensive approach (comparison group n=72). Those in the comprehensive group received education sessions every other week for 6 weeks in small groups and frequent contact with a registered dietitian. Those in the comparison group received brief, printed healthy lifestyle guidelines. Patients were reassessed at 12 months following surgery. Main outcome measures were excess weight loss and physical activity changes over time. Statistical analyses used t test, ?(2) test, Wilcoxon signed rank, Mann-Whitney U test, and intent-to-treat analysis, significance P<0.05. RESULTS Participants (mean age 44.5 ± 13.5 years) were mainly Cuban-born women (83.3%). Mean preoperative excess weight and body mass index (calculated as kg/m(2)) were 72.20 ± 27.81 kg and 49.26 ± 9.06, respectively. At 12 months following surgery, both groups lost weight significantly, but comprehensive group participants experienced greater excess weight loss (80% vs 64% from preoperative excess weight; P<0.001) and greater body mass index reduction (6.48 ± 4.37 vs 3.63 ± 3.41; P<0.001) than comparison group participants. Comprehensive group participants were significantly more involved in physical activity (+14 min/wk vs ?4 min/wk; P<0.001) than comparison group participants. Mean protein intake was significantly lower in the comparison group than that in the comprehensive group (P<0.024). CONCLUSIONS Findings support the importance of comprehensive nutrition education for achieving more effective weight reduction in Hispanic Americans following RYGB.

A simple procedure for testing linear hypotheses about the parameters of a nonlinear model using weighted least squares

Suppose the same nonlinear function involving k parameters is fit to each of t populations. Suppose further it is of interest to compare a specific parameter of the models across the populations. Such comparisons can be expressed as linear hypotheses about the parameters of the nonlinear models. A weighted linear least squares (WLLS) procedure is proposed to test these linear hypotheses. The advantages and disadvantages of the WLLS procedure are discussed. This procedure is also compared to a nonlinear least squares procedure for testing these hypotheses in nonlinear models.

A cross-sectional study of Jamaican adolescents' risk for type 2 diabetes and cardiovascular diseases.

Objectives To compare obese versus non-obese Jamaican adolescents’ risk for type 2 diabetes (T2D) and cardiovascular diseases (CVDs); and to explore a suitable and economical method of screening for these risk factors in the school settings. Design A descriptive cross-sectional study of adolescents’ risk for T2D and CVD. All the participants were examined at their respective schools. Setting Jamaica, West Indies. Population 276 Jamaican adolescents aged 14–19 years, randomly selected from grades 9 to 12 from 10 high schools on the island and included both boys and girls. All ethnicities on the island were represented. Main outcome measures High fasting blood glucose, total cholesterol, glycated haemoglobin (HbA1c), blood pressure, body mass index (BMI), waist circumference, waist-to-hip ratio, family history of obesity, T2D and CVDs, low physical activity, and presence of Acanthosis Nigricans. All blood measures were analysed using the finger prick procedure. Results Waist circumference, waist-to-hip ratio, Acanthosis Nigricans, total cholesterol, family history of T2D and blood pressure were the strongest predictors of BMI (p=0.001). Over one-third of the participants were overweight. Jamaican adolescent females had a significantly higher number of risk factors and were less physically active than males (p<0.05). Over 80% of participants reported ≥3 risk factors for T2D and CVD. Participants with BMI ≥25 reported five or more risk factors. One-third of the overweight participants were classified with metabolic syndrome. Conclusions Jamaican adolescents are at risk of T2D and CVD. Family history of disease and anthropometric measures identified more participants at risk than did the blood measures. Jamaican adolescent females reported more risk factors for T2D and CVD as compared to males. Collection of this type of data was feasible within the school settings. All data were collected in 1 day per school. Intervention measures are needed to educate Jamaican adolescents to reduce overweight and subsequently the risk factors.

Food Customs of Alaska Women of Childbearing Age: The Alaska WIC Healthy Moms Survey

A survey of 60 rural, 62 urban Alaska women (64% Alaska Native) indicated positive dietary and lifestyle habits. Diets were characterized by boiled meats, high intakes of omega-3 fish, sea mammals and few desserts. Food insecurity reported by 39% rural and 7% of urban. Hunger was reported by 16% of rural and 5% of urban women. Traditional activities were walking, harvesting fish and picking berries. One third of calories came from non-traditional sugared and fruit juice beverages. Few respondents reported chronic diseases. Nutrition and health educational interventions in Alaska Native communities should reinforce existing positive lifestyle habits, involve Elders and tribal leaders, and incorporate Native values, customs and traditions.

Association of Supplemental Nutrition Assistance Program (SNAP) with food security and nutrition status among persons living with HIV.

Aims: Nutritional status can be compromised by food insecurity which is common among HIV infected persons. Providing food assistance is expected to improve food insecurity and nutritional status among persons infected with HIV. This study aimed at examining the relationship of participating in the Supplemental Nutrition Assistance Program (SNAP), the largest food assistance program in the United States, with food security and nutritional status among HIV infected adults. Study Design : A cross - sectional study de sign was used in this study. Place and Duration of Study: This study was conducted in Miami, FL, USA, between April 2011 and August 2012. Methodology: We included 159 HIV infected individuals in this study, 113 participants were SNAP recipients while 46 w ere not. All study participants were, however, eligible to participate in SNAP. Each participant completed demographic and food security surveys as well as dietary and nutrition status assessment. Statistical analyses were conducted using univariate and mu ltivariate analyses.

Acanthosis Nigricans: relation to risk of Type 2 diabetes and cardiovascular diseases among Jamaican adolescents

Type 2 diabetes (T2D) and risk for cardiovascular diseases (CVDs) have been reported among Jamaican adolescents. Detection of Acanthosis Nigricans (AN), a dark line around the neck signifying insul...

Physical Activity and Metabolic Risk Factors among Jamaican Adolescents

The study examined relationships between physical activity (PA) and Metabolic Syndrome (METS) in Jamaican adolescents. A descriptive, cross-sectional survey examined 276 students from 10 Jamaican high schools. The National Cholesterol Education Program (NCEP) Adult Treatment Panel III and the International Diabetes Federation (IDF) criteria determined the metabolic risks. The Physical Activity Questionnaire for Children measured PA levels. Mean age was 15.6 (± 1.2). Percentage of subjects classified with METS varied by criterion used; IDF (6.9%) and NCEP (12.4%). While 56% of the subjects classified with METS were physically inactive, logistic regression showed no relationships between PA and individual METS risk factors overall (p>0.05). Females were 15 times less physically active and had significantly (p<0.05) higher waist circumference (WC) than males, whereas, males had significantly (p<0.05) higher fasting blood glucose levels. Although urban adolescents had higher PA than rural adolescents, they had significantly (p<0.05) higher WC; one of the determinants of METS by IDF’s standard. Similarly, under the IDF’s classification, Blacks had significantly higher numbers of METS risk factors (p<0.05) compared to non-Blacks. Jamaican adolescents are at risk for METS irrespective of levels of PA. Living in urban areas, being female, and being Black increased the risk for METS. NCEP guidelines classified more subjects with METS compared with IDF’s. Intervention measures are needed to reduce METS risk factors among this population.

THE RELATIONSHIP OF SPIRITUALITY AND HEALTH PROMOTING BEHAVIORS IN AFRICAN AMERICAN WOMEN

TEXT: Public health data show that African-Americans have not adopted health-promoting behaviors of diet and exercise. In an effort to find other motivating or moderating variables, this study was designed to determine how spirituality relates to health promoting behaviors in African-American women. Burkhardts theoretical framework for spirituality is referred to as harmonious interconnectedness. This was adopted and measures were selected for the three elements of the framework: connectedness with self, others, and environment. African-American women (n=286) residing in Florida between 18 and 82 years of age completed questionnaires: Rosenbergs SelfEsteem Scale, Health Promoting Lifestyle Profile II, Spiritual Perspective Scale, Brief Block Food Frequency, and socio-demographic information. Hierarchical multivariate multiple regression identified 40% of the variability of diet to be explained by socio-demographic (education) and spirituality variables (stress management and health responsibility) (p<.001). Twenty-nine percent of the variability of exercise was explained by socio-demographic (education) and spirituality variables (stress management) (p<.001). Canonical correlation analysis identified a significant pair of canonical variables which indicated those individuals with good nutrition (.95), physical activity (.79), and healthy eating (.42) are associated with stress management (.88), health responsibility (.67), spiritual growth (.66), interpersonal relations (.50), education (.49), and self-esteem (.33). The set explained 57% of the variability (p<.001). Attendance at health educational seminars was not common, but using church or social group venues to reach this audience was successful. Incorporating the message of spirituality along with health promoting behaviors is recommended.