Susan P. Himburg

Asian Students Change their Eating Patterns After Living in the United States

OBJECTIVE To collect information on changes in dietary patterns among Asian students before and after immigration to the United States. DESIGN A questionnaire designed to collect information about background, changes in food habits, and frequency of food consumption from a 72-item food list was mailed to subjects. SUBJECTS/SETTING Potential participants were students of local universities and junior colleges who were born in China, Taiwan, Hong Kong, Japan, or Korea and were aged 18 years or older. All subjects were required to have been residing in the United States for at least 3 months before the start of the study. Questionnaires were mailed to 120 potential participants. STATISTICAL ANALYSIS Paired t tests were used to determine differences in eating patterns and frequency of food consumption of subjects before and after immigrating to the United States. RESULTS Seventy-one questionnaires were returned. Because of missing information on 8 of these questionnaires, only 63 were used in the analysis, which gave a response rate of 53%. The number of students consuming only 2 meals per day increased significantly; 29 (46%) respondents skipped breakfast because of their school schedules. Despite no significant change in the frequency of snack consumption, a majority (n = 46; 73%) of the respondents were consuming more salty and sweet snack items. Subjects were eating out less often, but they were selecting more American-style fast foods when they did eat out. Significant increases were noted in consumption of fats/sweets, diary products, and fruits, and significant decreases were noted in the consumption of meat/meat alternatives and vegetables after immigration to the United States. APPLICATIONS/CONCLUSIONS Results of this study could be useful to dietetics practitioners as they observe changes in dietary patterns of Asian immigrants. These health professionals can use this information to plan nutrition education programs for Asian groups so that they can make informed decisions in adapting to new eating patterns and make wise food choices in their new environment. It is important to help Asian immigrants retain healthful food habits from their original country and to encourage them to choose eating patterns of the new culture that are nutritionally sound.

The Professional Development Portfolio Process:Setting Goals for Credentialing

Professional Development Portfolio (PDP), the new credentialing system for dietetics professionals, places the responsibility for learning, professional development, and career direction on the individual practitioner. This study used questionnaires and focus group interviews to determine whether dietitians engage in reflection, self-assessment, and goal setting, the critical components of PDP recertification. Volunteers (n = 132) participated in 16 focus groups held during 8 state dietetic association meetings. Content analysis was conducted. Some subjects reflected using an informal non-structured process (42 text units), almost half (41%) performed annual self-assessments, and 25% set goals. Job availability, new practice areas, family obligations, and employer needs were key factors in goal formulation. Opportunities for self-direction, independent decision-making, and application of technical expertise were also considered in career choices and goal setting. Although few participants were currently performing PDP critical components, we conclude dietetic practitioners can gain the necessary skills for professional development with the newly available PDP Guide to support the portfolio process. We recommend that dietitians (a) allow sufficient time for the reflection process, including the use of additional tools; (b) develop personal mission statements to drive the goal-setting process; and (c) use effectiveness criteria to critique their goals.

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.

Theory-driven Intervention Improves Calcium Intake, Osteoporosis Knowledge, and Self-efficacy in Community-Dwelling Older Black Adults

OBJECTIVE To assess the effectiveness of an osteoporosis education program to improve calcium intake, knowledge, and self-efficacy in community-dwelling older Black adults. DESIGN Randomized repeated measures experimental design. SETTING Churches and community-based organizations. PARTICIPANTS Men and women (n = 110) 50 years old and older from 3 south Florida counties. INTERVENTION Participants randomly assigned to either of 2 groups: Group 1 (experimental group) or Group 2 (wait-list control group). Group 1 participated in 6 weekly education program sessions immediately following baseline assessment, and Group 2 started the program following Group 1s program completion. A tested curriculum was adapted to meet the needs of the target population. MAIN OUTCOME MEASURES Dietary calcium intake, osteoporosis knowledge, health beliefs, and self-efficacy. ANALYSIS Descriptive and summary statistics, repeated measures analysis of variance, and regression analysis. RESULTS Of the total participants, 84.6% completed the study (mean age = 70.2 years). Overall, an educational program developed with a theoretical background was associated with improvement in calcium intake, knowledge, and self-efficacy, with no effect on most health belief subscales. Assigned group was the major predictor of change in calcium intake. CONCLUSIONS AND IMPLICATIONS A theory-driven approach is valuable in improving behavior to promote bone health in this population. Health professionals should consider using more theory-driven approaches in intervention studies.

Computer-Assisted Education for Dietetics Students: A Review of Literature and Selected Software

Abstract Current technology gives us the opportunity to integrate interactive media into nutrition education. In this review, we illustrate how computer-assisted instruction (CAI) and computer-assisted learning (CAL) can be used to complement formal instruction for general didactic curriculum requirements and to meet the new American Dietetic Association Standards of Education for Foundation Knowledge and Skills for Entry-Level Dietitians. To facilitate this review, we selected software from 276 currently available software packages listed by the Food and Nutrition Information Center at the National Agriculture Library in Beltsville, MD. Selection was based on range of function, cost, and compatibility with educational objectives. This review is intended to be a useful resource for educators on available software for CAI and CAL. Nutrition educators have the challenge to prepare students to function in a health care system that demands more and more technological literacy. The key to this involves greater exposure to technology and the development of effective software.

Obesity Indicators and C - reactive Protein in African and Haitian Americans with and without Type 2 Diabetes

Purpose: High sensitivity C-reactive protein (CRP) is a risk factor for cardiovascular disease based on finding in primarily non-Hispanic White populations. Obesity, another risk factor for cardiovascular disease, is higher in Blacks as compared to non-Hispanic Whites. The objective of this study was to assess the relationship between CRP, a marker of systemic inflammation, and obesity indicators by ethnicity, diabetes status and gender for two Black ethnicities. Methods: Anthropometrics and venous blood were collected for African and Haitian Americans with and without type 2 diabetes in a cross-sectional study. A total of 434 participants; 190 African Americans, 244 Haitian Americans, met the inclusion criteria of CRP ≤10 mg/L. Main effects and interactions of ethnicity, diabetes status, gender, and each obesity indicator (waist circumference, waist-to-height ratio, and body mass index) were performed using General Linear Models. Results: African Americans were more likely to be obese, have higher CRP, and smoke as compared to Haitian Americans. Haitian Americans has a lower rate of health care coverage than African American. Having a higher education level than Haitian Americans was a protective health factor for African Americans; whereas, Haitian Americans were protected by a higher percent married as compared to African Americans. All obesity indicators were associated with CRP. All differences in CRP by ethnicity and diabetes status were negated by obesity indicators. Being female was associated with higher CRP for waist circumference and BMI models. Adjusting for health insurance, smoking, marital status and education negated the relationship of gender and CRP for waist-toheight ratio. Conclusion: Being African American as opposed to Haitian American was a greater risk factor for obesity and inflammation. Obesity was associated with elevated CRP levels in African and Haitian Americans regardless of diabetes status. Inflammation constitutes a serious health problem for minorities with high rates of obesity.

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.

Facing a paradigm shift in professionalcredentialing preparedness of registered dietitians for professional development

OF THE DISSERTATION FACING A PARADIGM SHIFT IN PROFESSIONAL CREDENTIALING: PREPAREDNESS OF REGISTERED DIETITIANS FOR PROFESSIONAL DEVELOPMENT 2001 by Nancy Collins Florida International University, 2000 Miami, Florida Professor Susan P. Himburg, Co-Major Professor Professor Dian 0. Weddle, Co-Major Professor In the year 2001, the Commission on Dietetic Registration (CDR) will begin a new process of recertifying Registered Dietitians (RD) using a self-directed lifelong learning portfolio model. The model, entitled Professional Development 2001 (PD 2001), is designed to increase competency through targeted learning. This portfolio consists of five steps: reflection, learning needs assessment, formulation of a learning plan, maintenance of a learning log, and evaluation of the learning plan. By targeting learning, PD 2001 is predicted to foster more up-to-date practitioners than the current method that requires only a quantity of continuing education hours. This is the first major change in the credentialing system since 1975. The success or failure ofthe new system will impact the future of approximately 60,000 practitioners. The purpose of this study was to detennine the readiness of RDs to change to the new system. Since the model is