Shreela V. Sharma

Nutrition Knowledge Predicts Eating Behavior of All Food Groups "except" Fruits and Vegetables among Adults in the Paso del Norte Region: Que Sabrosa Vida.

OBJECTIVE To examine the association between nutrition knowledge and eating behavior in a predominantly Mexican American population on the Texas-Mexico border. DESIGN Cross-sectional using data from the baseline survey of the Qué Sabrosa Vida community nutrition initiative. SETTING El Paso and surrounding counties in Texas. PARTICIPANTS Data gathered in 2000 using random-digit dialing telephone survey. Response rate was 42.6% and final sample size was 963. MAIN OUTCOME MEASURES Knowledge of recommended servings of food items was the independent variable and number of servings of food items consumed was the dependent variable. DATA ANALYSIS Multiple logistic regression was used to examine the association between nutrition knowledge and eating behavior. RESULTS 74% of the population was Mexican American. Nutrition knowledge was a significant predictor of eating behavior for grains (odds ratio [OR] = 6.42; 95% confidence interval [CI]: 2.4, 17.1), dairy (OR = 2.25; 95% CI: 1.5, 3.4), meats (OR = 2.02; 95% CI: 1.5, 2.8), beans (OR = 8.18; 95% CI: 5.1, 13.0), water (OR = 2.49; 95% CI: 1.7, 3.6), but not for fruits and (nonstarchy) vegetables (OR = 1.69; 95% CI: 0.89, 3.2). CONCLUSIONS AND IMPLICATIONS Nutrition knowledge predicts eating behavior for all food groups except fruits and vegetables. The role of cultural factors in eating behavior should be investigated to elucidate this finding. Results have implications for developing nutrition education programs for Mexican Americans.

Increasing physical activity and decreasing sedentary activity in adolescent girls – The Incorporating More Physical Activity and Calcium in Teens (IMPACT) study

BackgroundLack of regular physical activity and consequent sub-optimal bone mass acquisition in youth has been implicated as a primary cause of adult-onset osteoporosis. IMPACT was a behavioral theory-based 1 1/2 year randomized controlled field study aimed at increasing bone accretion in middle school girls. The objective of this study was to determine the intervention effects of the IMPACT program upon key physical and sedentary activity endpoints among schools that participated in the IMPACT study. Endpoints examined included weight bearing physical activity (WBPA); moderate to vigorous physical activity (MVPA); vigorous physical activity (VPA); MET (metabolic equivalent) – weighted WBPA and MVPA; sedentary activity; before/after-school physical activity; and weekend physical activity.MethodsPrimary data analysis using a pretest-posttest control group design was conducted utilizing mixed model analysis of covariance. Data gathered from the IMPACT cohort from 2000–2002 were analyzed to determine baseline versus follow-up differences in activity endpoints. Confounders investigated included ethnicity, body mass index, menarcheal status, participation in 7th grade PE/athletics, friend/familial support and neighborhood safety.ResultsFollow-up means were higher for participating intervention schools relative to control schools for all physical activity variables but were statistically significant only for the following variables: daily minutes of vigorous physical activity (mean difference between Intervention (I) and Control (C) = 6.00↑ minutes, 95% CI = 5.82–6.18, p = 0.05), daily after school activity minutes (mean difference between I and C = 8.95↑ minutes, 95% CI = 8.69–9.21, p = 0.04), and daily weekend activity minutes (mean difference between I and C = 19.00↑ minutes, 95% CI = 18.40–19.60, p = 0.05). The intervention significantly reduced duration of student daily TV/Video watching (mean difference between I and C = 12.11↓ minutes, 95% CI = 11.74–12.48, p = 0.05) and total daily sedentary activity minutes (mean difference between I and C = 16.99↓ minutes, 95% CI = 16.49–17.50, p = 0.04).ConclusionA well designed and implemented school based health and physical activity intervention can result in a positive influence upon increasing physical activity levels and decreasing sedentary activity. Future interventions should consider a more structured intervention component to obtain significant changes in WBPA.

Nutrition-Related Knowledge, Attitudes, and Dietary Behaviors among Head Start Teachers in Texas: A Cross-Sectional Study

Head Start teachers are responsible for providing nutrition education to over 1 million low-income children annually, yet little is known about their nutrition-related knowledge, attitudes, and behaviors. The purpose of this study is to assess the self-reported nutrition knowledge, attitudes, and behaviors among Head Start teachers from one urban Head Start organization in Harris County, TX. A cross-sectional, descriptive analysis was conducted using baseline surveys in the 2008-2009 school year. One hundred eighty-one Head Start teachers completed self-reported surveys of their nutrition knowledge, attitudes, behaviors, weight status, and other weight-related behaviors. The sample was predominantly female (97%) and minority (93%); 24% were overweight and 55% were obese. One fourth of the sample did not consume fruit (26%) or vegetables (23%) the previous day. Half of the teachers reported consuming french fries (52%) and soda (44%), and one fourth consumed fried meat (28%) at least once on the previous day. Only four teachers (3%) answered at least four of the five nutrition knowledge questions correctly. Half of the teachers (54%) agreed that it was hard to know which nutrition information to believe, and only 9% reported that their nutrition habits were healthy. A majority of teachers were trying to lose weight (71%) and said they would like to weigh less (81%). This study underscores the importance of providing nutrition education and wellness opportunities to Head Start teachers to better enable them to teach nutrition education to their students and to improve their own health.

Pilot-Testing CATCH Early Childhood: A Preschool-Based Healthy Nutrition and Physical Activity Program.

Abstract Background: The literature on theoretically-based programs targeting healthy nutrition and physical activity in preschools is scarce. Purpose: To pilot test CATCH Early Childhood (CEC), a preschool-based nutrition and physical activity program among children ages three to five in Head Start. Methods: The study was conducted in two Head Start centers (N=75 children, their parents; 9 teachers). CEC was implemented by trained teachers over six weeks in fall 2008. Qualitative data on feasibility and acceptability was collected using post-intervention parent and teacher focus groups and lesson plan evaluation forms. Pre-to-post intervention changes in childrens fruit and vegetable intake and physical activity at school were evaluated. Results: Results showed good feasibility and acceptability for the classroom curriculum, activity box and parent tip-sheets. There was a trend towards an increase in childrens fruit, 100% fruit juice and vegetable intake and mean minutes of physical activity at school pre-to-post intervention. However, this increase was not significant. Discussion: The CEC program showed good feasibility and acceptability in the study population. Further evaluation of behavioral outcomes using a larger sample and a prospective design is needed. Translation to Health Education Practice: These results provide information important for developing and implementing evidence-based programs in preschools.

Increasing access to healthful foods: a qualitative study with residents of low-income communities

BackgroundInadequate access to healthful foods has been identified as a significant barrier to healthful dietary behaviors among individuals who live in low-income communities. The purpose of this study was to gather low-income community members’ opinions about their food purchasing choices and their perceptions of the most effective ways to increase access to healthful foods in their communities.MethodsSpanish and English focus groups were conducted in low-income, ethnically-diverse communities. Participants were asked about their knowledge, factors influencing their food purchasing decisions, and their perceptions regarding solutions to increase access to healthful foods.ResultsA total of 148 people participated in 13 focus groups. The majority of participants were female and ethnically diverse (63% Hispanic, 17% African American, 16% Caucasian, and 4% “other”). More than 75% of the participants reported making less than

Incorporating primary and secondary prevention approaches to address childhood obesity prevention and treatment in a low-income, ethnically diverse population: study design and demographic data from the Texas Childhood Obesity Research Demonstration (TX CORD) study.

1999 USD per month. Participants reported high levels of knowledge and preference for healthful foods. The most important barriers influencing healthful shopping behaviors included high price of healthful food, inadequate geographical access to healthful food, poor quality of available healthful food, and lack of overall quality of the proximate retail stores. Suggested solutions to inadequate access included placement of new chain supermarkets in their communities. Strategies implemented in convenience stores were not seen as effective. Farmers’ markets, with specific stipulations, and community gardens were regarded as beneficial supplementary solutions.ConclusionThe results from the focus groups provide important input from a needs assessment perspective from the community, identify gaps in access, and offer potential effective solutions to provide direction for the future.

Psychosocial Factors Influencing Calcium Intake and Bone Quality in Middle School Girls

BACKGROUND There is consensus that development and evaluation of a systems-oriented approach for child obesity prevention and treatment that includes both primary and secondary prevention efforts is needed. This article describes the study design and baseline data from the Texas Childhood Obesity Research Demonstration (TX CORD) project, which addresses child obesity among low-income, ethnically diverse overweight and obese children, ages 2-12 years; a two-tiered systems-oriented approach is hypothesized to reduce BMI z-scores, compared to primary prevention alone. METHODS Our study aims are to: (1) implement and evaluate a primary obesity prevention program; (2) implement and evaluate efficacy of a 12-month family-centered secondary obesity prevention program embedded within primary prevention; and (3) quantify the incremental cost-effectiveness of the secondary prevention program. Baseline demographic and behavioral data for the primary prevention community areas are presented. RESULTS Baseline data from preschool centers, elementary schools, and clinics indicate that most demographic variables are similar between intervention and comparison communities. Most families are low income (≤

Psychosocial, environmental and behavioral factors associated with bone health in middle-school girls

25,000) and Hispanic/Latino (73.3-83.8%). The majority of parents were born outside of the United States. Child obesity rates exceed national values, ranging from 19.0% in preschool to 35.2% in fifth-grade children. Most parents report that their children consume sugary beverages, have a television in the bedroom, and do not consume adequate amounts of fruits and vegetables. CONCLUSIONS Interventions to address childhood obesity are warranted in low-income, ethnically diverse communities. Integrating primary and secondary approaches is anticipated to provide sufficient exposure that will lead to significant decreases in childhood obesity.

Ethnic Differences in the Home Environment and Physical Activity Behaviors among Low-Income, Minority Preschoolers in Texas:

Calcium intake has been associated with promoting bone health in children and adolescents, thus preventing osteoporosis later in life. Behavior change such as increased calcium intake, as well as physiological factors such as bone quality, may be facilitated by psychosocial and environmental factors. The purpose of this study was to identify pathways by which psychosocial factors influence calcium intake and bone quality in middle school girls. The study design was cross-sectional. Baseline data from the Incorporating More Physical Activity and Calcium in Teens (IMPACT) study, collected in 2001-2003, were used. IMPACT was a 1.5-year nutrition and physical activity intervention study, designed to improve bone density in 717 middle school girls in Texas. Main outcome measures were calcium intake determined using mean milligrams of calcium consumed per day and number of glasses of milk consumed per day, and bone quality determined using a calcaneal stiffness index. Confirmatory factor analysis and path analysis were performed to identify the direct and indirect pathways used by various psychosocial factors such as knowledge, self-efficacy, outcome expectations, and milk availability at home, to influence calcium intake and bone quality. Results showed that knowledge of osteoporosis and calcium-rich foods had an indirect effect on calcium intake, with outcome expectations as the mediating variable (beta=.035 and beta=.03, respectively; P<0.05). Calcium self-efficacy had a significant indirect effect on calcium intake, with outcome expectations as the mediator (beta=.085, P<0.05). None of the variables significantly influenced bone quality. Thus, several direct and indirect pathways used to influence calcium intake among adolescent girls were identified. These findings are critical for the development of effective interventions to promote calcium intake in this population.

An evidence-based conceptual framework of healthy cooking

The purpose of this study was to identify the psychosocial, environmental and behavioral factors associated with calcium intake, physical activity and bone health in a cohort of adolescent girls. Baseline data (N = 718 girls, mean age: 11.6 +/-0.4 years) from the Incorporating More Physical Activity and Calcium in Teens (IMPACT) study conducted in Texas, 2001-03, were utilized for the analyses. Hierarchical linear regression was used to examine the associations of interest. Confounders adjusted for included ethnicity, menarchal status, body mass index and lactose intolerance. Several psychosocial and behavioral factors were significantly associated with bone quality. These included knowledge of calcium content of foods (beta = 0.08, P = 0.016), self-efficacy toward consuming calcium-rich foods (beta = 0.16, P = 0.047), physical activity self-efficacy (beta = 0.20, P = 0.002), physical activity outcome expectations (beta = 0.5, P = 0.004), family encouragement to do physical activity (beta = 0.96, P = 0.027), friend engagement in physical activity (beta = 1.3, P = 0.001) and participation in sports teams (beta = 1.7, P < 0.001). Self-efficacy, social support and participation in sports teams appear to be strongly associated with bone health in adolescent girls. Future health education/health promotion programs need to address these factors for effective primary prevention of osteoporosis in this population.