Tom Baranowski

A motivational interviewing intervention to increase fruit and vegetable intake through Black churches: Results of the Eat for Life trial.

OBJECTIVES This study reports on Eat for Life, a multicomponent intervention to increase fruit and vegetable consumption among African Americans that was delivered through Black churches. METHODS Fourteen churches were randomly assigned to 3 treatment conditions: (1) comparison, (2) self-help intervention with 1 telephone cue call, and (3) self-help with 1 cue call and 3 counseling calls. The telephone counseling in group 3 was based on motivational interviewing. The primary outcome, assessed at baseline and 1-year follow-up, was fruit and vegetable intake as assessed by 3 food frequency questionnaires. RESULTS Change in fruit and vegetable intake was significantly greater in the motivational interviewing group than in the comparison and self-help groups. The net difference between the motivational interviewing and comparison groups was 1.38, 1.03, and 1.21 servings of fruits and vegetables per day for the 2-item, 7-item, and 36-item food frequency questionnaires, respectively. The net difference between the motivational interviewing and self-help groups was 1.14, 1.10, and 0.97 servings for the 2-item, 7-item, and 36-item food frequency questionnaires, respectively. CONCLUSIONS Motivational interviewing appears to be a promising strategy for modifying dietary behavior, and Black churches are an excellent setting to implement and evaluate health promotion programs.

Observations on Physical Activity in Physical Locations: Ager Gender, Ethnicity, and Month Effects

The level of physical activity of 3- and 4-year-old children was assessed in alternative physical locations by month and time of day and by age, gender, and ethnicity. Physical activity was assessed by observation with the Childrens Activity Rating Scale (CARS) for up to 12 hours from 7:00 am to 7:00 pm. A sample of 191 three- and four-year-old children was observed for up to four times in the course of a year. The sample was tri-ethnic. Boys were significantly more active than girls. Activity was consistently higher outside than inside. There were significant differences in the amount of time children in this age group spent inside versus outside by time of year; the activity levels of boys and girls differed by time of year, particularly when outside. A model including gender, month, and location terms accounted for 75% of the variance in physical activity. These data further documented gender differences in physical activity among very young children using measures not subject to self-report biases but did not explain or clarify the gender differences. The substantial differences by physical location and time of year deserve future attention, but more refined methods will be needed to balance data by location and important seasonal times. An inference from these results is that activity levels among young children may be increased by encouraging them to spend more time outdoors.

Increasing fruit and vegetable consumption among 4th and 5th grade students: results from focus groups using reciprocal determinism

Abstract The Year 2000 Goals for the U.S. identify a goal of five servings per day of fruits and vegetables (F&V), which is roughly double what children are currently eating. Focus group discussions (based on the reciprocal determinism concept in social learning theory) were conducted with 4th and 5th grade students, their parents, teachers, and school food service workers, in preparation for the design of a school nutrition education program to increase consumption of F&V. A social learning theory perspective was taken because it has been demonstrated to be useful in the design of effective school nutrition education programs. A theory-based protocol delineating the sequence of questions to be asked in each focus group was designed before each group met. Discussions were conducted with ten groups of students, two groups each of teachers and of parents, and one of school food service employees. Three general factors appeared to be most likely to increase F&V consumption in these children: increasing availability of F&V in the home, enhancing liking for vegetables, and providing skills in increasing F&V availability and in preparing F&V.

Children's fruit and vegetable intake: Socioeconomic, adult-child, regional, and urban-rural influences

Abstract National objectives for fruit and vegetable (F&V) consumption have been set at five or more servings per day. The National Cancer Institute funded three interventions aimed at increasing F&V consumption among elementary school children. Focus group discussions were held with fourth- and fifth-grade students, their parents, teachers, and food service workers in three regions to determine if environmental, personal, and behavioral influences differed across socioeconomic status (SES), regional, urban-rural, adult-child, and ethnic groups. Discussion guides for focus group sessions were based on the three domains of social cognitive theorys reciprocal determinism: environmental, behavioral, and personal characteristics. Discussions were conducted with groups of students (15), parents (11), teachers (6), and food service workers (6). A systematic content analysis was conducted with THE ETHNOGRAPH,® a software system. Differences in the three major components of reciprocal determinism were found across SES, urban-rural, regional, and adult-child factors. Middle to high SES groups reported a much larger variety of F&Vs available in their homes. Children from low and very low SES groups appeared to be responsible for preparing more meals alone. Children, not adults, thought of vegetables as “grown-up” foods.

Development and evaluation of a school intervention to increase fruit and vegetable consumption among 4th and 5th grade students

THOMPSON,3 SANDRA B. LEONARD,4 PATRICIA RILEY,2 JANICE BARANOWSKI,3 BONNIE DUDOVITZ, 6 AND MARY SMYTH 6 lGeorgia Prevention Institute, Department of Pediatrics, Medical College of Georgia, Augusta, Georgia 30912-3715; 2Division of Behavioral Sciences and Health Education, School of Public Health, Emory University, Atlanta, Georgia 30329; 30fIice of Biostatistics, Medical College of Georgia, Augusta, Georgia 30912-4900; 4Georgia Institute of Human Nutrition, Department of Medicine, Medical College of Georgia, Augusta, Georgia 30912-3102; sOfIice of Public Health Practice, School of Public Health, Emory University, Atlanta, Georgia 30329; and 6Department of Epidemiology, University of Minnesota, Minneapolis, Minnesota, 55454.

How children remember what they have eaten

OBJECTIVES To determine whether students could verbalize, within 1 1/2 hours, how they remembered items eaten at the school lunch; to determine whether the categories of self-reported retrieval mechanisms were similar for two interview styles, integrated and nonintegrated; and to determine the effect of the two interview style on the accuracy of reporting items eaten by comparing reports with direct observation. DESIGN Two styles of dietary intake interviews were compared with observed intake in a school lunch setting. SETTING Two elementary schools in Georgia. SUBJECTS/SAMPLES Eighty-two of 106 fourth graders from four classes volunteered; 24 (six per class) were randomly selected and assigned to an interview style. Students interviewed using a nonintegrated style verbalized how they remembered after they had reported everything eaten. Students interviewed using an integrated style verbalized how they remembered at the same time they reported eating each item. Both interview styles included free report followed by prompted report. MAIN OUTCOME MEASURES Reported retrieval mechanisms were coded into 13 categories. Five measures of performance (specific match rate, general match rate, intrusion rate, omission rate, and overall match rate) were calculated by interview style for free report and prompted report separately. STATISTICAL ANALYSES PERFORMED We analyzed the effect of interview style on the number of students reaching 100% accuracy after prompting and on accuracy of reporting condiments using Fishers exact test. RESULTS Most students could articulate how they remembered items eaten. Reported retrieval mechanism categories were comparable for both interview styles. Visual imagery, usual practice, behavior chaining, and preference were the most commonly reported retrieval mechanisms. Accuracy of free reports did not differ by interview style; however, the nonintegrated interview style produced dietary self-reports with fewer condiment omissions during free report and higher accuracy after prompting. APPLICATIONS Determining what retrieval mechanisms children commonly use for remembering items eaten may help researchers design cues to improve the accuracy of dietary self-reports. More accurate dietary self-reports could markedly affect the many types of research that use dietary assessment.

Acculturation and the initiation of breastfeeding

Despite the fact that breastfeeding is the most appropriate form of nutrition for the healthy term infant, the rate of initiation in the U.S. is declining. One demographic factor associated with this low rate is ethnicity and so in this study we measured acculturation (one aspect of ethnicity) into the U.S. and its relationship to the successful initiation of breastfeeding in a sample of women recruited approximately 2 months prenatally in a U.S.-Mexico border city. Interviews were administered in English or Spanish by bilingual interviewers prenatally (n = 906), natally (n = 788), and postnatally (n = 715). Acculturation (measured with a 20 item instrument) was strongly related to the intent to (p < 0.001) or the successful initiation of breastfeeding (p < 0.001). Marital status (p = 0.014) and education (p = 0.002) were related to breastfeeding prenatally and natally. Initiation of breastfeeding was highest among those women least acculturated (52.9%) and lowest in those most acculturated (36.1%) indicating an inhibiting effect of acculturation. To improve the rate of initiation of breastfeeding in the U.S. (a national health goal) intervention programs must consider cultural factors.

Comparison of a Web-Based versus Traditional Diet Recall among Children

Self-administered instruments offer a low-cost diet assessment method for use in adult and pediatric populations. This study tested whether 8- to 13-year-old children could complete an early version of the Automated Self Administered 24-hour diet recall (ASA24) and how this compared to an interviewer-administered 24-hour diet recall. One-hundred twenty 8- to 13-year-old children were recruited in Houston from June through August 2009 and randomly assigned to complete either the ASA24 or an interviewer-administered 24-hour diet recall, followed by the other recall mode covering the same time interval. Multivariate analysis of variance, testing for differences by age, sex, and ethnic/racial group, were applied to percentages of food matches, intrusions, and omissions between reports on the ASA24 and the interviewer-administered 24-hour diet recall. For the ASA24, qualitative findings were reported regarding ease of use. Overall matches between interviewer-administered and ASA24 self-administered 24-hour diet recall was 47.8%. Matches were significantly lower among younger (8- to 9-year-old) compared with older (10- to 13-year-old) children. Omissions on ASA24 (18.9% overall) were most common among 8-year-olds and intermediate among 9-year-olds. Eight- and 9-year-olds had substantial difficulties and often required aid in completing ASA24. Findings from this study suggest that a simpler version of an Internet-based diet recall program would be easier for children to use.

Beliefs as motivational influences at stages in behavior change.

A problem for health education practice is how to interest people in making a health behavior change and maintain that interest throughout the behavior change process. Beliefs can provide motivational force for people to perform health behaviors. Five theories: 1) Diffusion of Innovations (DIT); 2) Health Belief Model (HBM); 3) Reasoned Action (TRA); 4) Locus of Control (LOC); and 5) Social Learning (SLT), are reviewed for motivational factors in promoting health behavior changes at each of six stages in the behavior change process: precontemplation, decision, training, initiation, and maintenance. A degree of overlap and complementariness are identified among the theories resulting in a syntheoretical model of beliefs as motivators in the behavior change process. The common emphasis among the theories on expectancies or cost-benefit calculations is highlighted, suggesting several strategies for employing these considerations in health education campaigns. The paucity of motivational ideas for promoting change among the externally controlled—late majority is noted. Further research must be conducted before these ideas should be generally implemented in practice.

Teach Well: The Relation of Teacher Wellness to Elementary Student Health and Behavior Outcomes: Baseline Subgroup Comparisons

Abstract A teacher wellness program was hypothesized to improve school health education provided by elementary school classroom teachers through increasing their health knowledge, motivating and enhancing their skills to promote student behavior change, and improving their health role modeling. This project tests whether a wellness program (Teach Well) offered to teachers has an impact on both teacher and student cardiovascular health (CVH), especially diet. Teach Well employs the modular programming of Johnson & Johnsons Live for Life® program, demonstrated to be effective in worksite settings. Thirty-two participating schools were matched and randomly assigned within pairs to treatment (Teach Well) or control (no wellness program) conditions. Because of clustered data and administrative factors, schools are the unit of assignment and of analysis. Outcome evaluation measures included physiologic (resting heart rate, blood pressures), behavioral (diet), and organizational (school climate, organizational ...