Trina Aguirre

Food-related behavior and intake of adult main meal preparers of 9–10 year-old children participating in iCook 4-H: A five-state childhood obesity prevention pilot study

It is important to understand adult outcomes in childhood obesity prevention programs as parents and caregivers have a significant influence on the eating and physical activity habits of youth. Grounded in the social cognitive theory, the iCook 4-H study was centered on a dyad model (9-10 year-olds and their primary meal preparers) to teach healthy cooking skills, shopping and meal habits, and being active as a family. The program took place in five states and dyads (n = 54) were recruited through flyers, e-mails, and in-person contact. The focus of this article is to provide findings from adult program participants. Demographics and self-reported food intake, procurement, preparation and safety practices, feeding relationships, mealtime routines, and height and weight were collected through surveys at baseline and program completion, which spanned 3 months. Descriptive statistics including two-related samples tests and paired samples t tests were used to assess pre- and post-program survey data responses at p < 0.05 significance level. Most had a bachelors degree (31%) or some college (29%), about half were white, 66% were married, about 30% of households participated in assistance programs, and 82% were female. At program conclusion, participants significantly improved meal planning, prioritizing healthy meal choices, shopping with a grocery list, and reading Nutrition Facts Labels. There were also significant, positive differences noted in cooking skill confidence (p = 0.015), desire to cook more meals at home, and fewer fast food meals. Adult-youth feeding interactions also significantly improved. There were also significant increases in fruit juice (100%), vegetable soup, and whole grain consumption. Based on results, adults reported improvements in meal planning, cooking, and purchasing skills that were taught in classes.

Assessment of technology access and preference for health education of a rural Hispanic community

In the United States, Hispanic populations tend to have higher incidences of chronic disease such as diabetes, cardiovascular disease, hypertension, obesity and hyperlipidemias [1]. They are also more likely to be underinsured or uninsured than other populations [2]. The purpose of this descriptive technology assessment survey study was to determine computer and internet access, skill level and health education information preferences of a rural Hispanic (primarily Mexican-American) population in the United States. Among the sample, 81% of individuals who answered the survey had a computer and internet access in their home. Nineteen percent did not have computers or internet access in their homes. Compared to the average 54% home internet access found by the Pew Hispanic Research Center the rural convenience sample in this study had a high percentage of technology access. Recommendations include using multimedia to improve the health information accessability among Hispanic persons.

An Interactive, Bilingual Touch Screen Program to Promote Breastfeeding Among Hispanic Rural Women: Usability Study

Background Computer technology can be effectively used to educate patients and improve knowledge and attitudes, leading to healthier behavior. Among rural women, breastfeeding outcomes seem to be worst compared to women living in urban areas. The implementation of a bilingual computer mediated health education program to disseminate information and improve outcomes among users with low literacy levels has proven to be successful. Objective The objective of this pilot study was to examine the usability of an interactive, bilingual touch screen computer-based educational program to promote breastfeeding practices among Hispanic women living in rural settings. Methods A convenience sample of 10 Hispanic rural women at the Regional West Medical Center (RWMC), Scottsbluff was enrolled during May 2013. Information about this cross-sectional study was made available through the flyers at the RWMC. A brief introduction of the prototype was given and study subjects were then asked to complete a predefined set of tasks by interacting with the prototype. Users were assigned 6 tasks and information was gathered about the time taken to complete the tasks, number of attempts, and if assistance was needed. Notes and test sessions were audiotaped. Usability assessment was performed using the System Usability Scale (SUS). Results The mean age of the study participants was 28 years (SD 3.6), the majority of them had 12 or more years of education (90%, 9/10), and 60% (6/10) had breastfed less than 6 months. There were 90% (9/10) of the study participants that had no prior history of taking prenatal classes and 80% (8/10) that did not intend to take any prenatal classes in the future. The average SUS scores were 90 and SD was 10.5. There were three participants that had average SUS scores of 100, followed by scores of 97.5 (1/10), 95 (1/10), 87.5 (1/10), 85 (2/10), 82.5 (1/10), and one participant had a score of 67.5 (1/10). No assistance was needed to complete any of the tasks. Conclusions The study participants were able to navigate through the multimedia program with ease and obtain relevant breastfeeding related health information. The interactive, touch screen computer-based breastfeeding program had high acceptance among 10 Hispanic women living in rural settings.

Mexican American mothers' eating and child feeding behaviors.

Objective: The purpose of this study of Mexican-American mothers of 2–6 year old children was to explore the relationships among maternal attitude, perceived behavioral controls, mother’s intent, mother’s regulation of her own Simple Carbohydrate Intake (SCI), and mother’s child feeding behaviors. The overall objective was to increase understanding of the complex process of intention to eat healthy. Methods: A prospective exploratory design using a convenience sample of a cohort of 82 Mexican-American mothers was used in this study. Structured questionnaires were selected to measure cognitive restraint, disinhibition, hunger, intent to regulate SCI, and mothers’ monitoring, restricting, and pressuring of children’s diets. Descriptive statistics and correlations were analyzed for each relationship. Results: The relationships between disinhibition, hunger, cognitive restraint, and the intent variable were significant. More than half of these mothers reported limiting soda and candy for themselves. According to the Food Frequency Questionnaire, mothers were regulating only one-third of simple carbohydrate items they intended to regulate. Significant relationships were found between mothers’ regulation of her specific SCI and her control of child feeding behaviors including pressuring, monitoring, and restricting. Conclusion: The findings support the idea that mother’s eating behaviors, attitudes, and intent may affect how they feed their pre-school children. Nurses need to develop and test interventions targeted at educating Mexican-American mothers about healthy food choices and healthy child feeding behaviors.

Recruitment and retention challenges and successes

ABSTRACT Objective: Addressing health disparities requires well designed, culturally adapted research. However, recruiting/retaining minority participants has often been challenging. We present strategies used to successfully recruit and retain rural Hispanic women during a breastfeeding education intervention. Design: This study involved a two-group repeated measures quasi-experimental design with assessments at seven intervals between enrollment and 6 months postpartum. Participants (Hispanic women ≥ 15 years old) were recruited through a regional hospital. Results: We successfully met our recruitment goals, most women contacted were enrolled (46 of 58), and 100% completed the study. Discussion: Research staff with ties within the community helped establish trust. Using bilingual study materials, simple language, and an interpreter addressed language/literacy concerns. Phone assessments facilitated participation as transportation was an issue. Accommodating requests to deliver or mail study materials and providing incentives were important. Extra effort was needed to maintain contact when phone service was disrupted or participants moved. Keys to success were persistence, flexibility, and alleviating barriers to participation.

Evaluating Motivational Interviewing to Promote Breastfeeding by Rural Mexican-American Mothers: the Challenge of Attrition

Although most Hispanic/Latino-American mothers initiate breastfeeding, duration and exclusivity of breastfeeding remain low. We explored whether a motivational interviewing (MI) intervention could help rural Mexican-American mothers continue breastfeeding. We used a two-group (MI intervention n = 26, attention control [AC] n = 27) repeated measures experimental design. Assessments and interventions occurred at 3 days, 2 weeks, and 6 weeks postpartum (time points when mothers are particularly vulnerable to discontinuing breastfeeding), with a final phone assessment at 6 months postpartum. We collected demographic data and measured intent to breastfeed for 6 months (intent question), self-efficacy (Breastfeeding Self-Efficacy Scale-Short Form), and collected breastfeeding information (breastfeeding assessment questionnaire). Independent t-tests and Mann Whitney U non-parametric tests were used to evaluate group differences (α = 0.05). High levels of attrition by week 6 impaired our ability to evaluate the potential of our MI intervention. No significant differences were found between groups for any of the outcome variables (intent to breastfeed for 6 months, breastfeeding self-efficacy, and duration of breastfeeding). Though the mothers intended to breastfeed for 6 months and were confident in their ability to do so, most did not breastfeed for 6 months. At 6 months, mothers receiving the MI intervention had breastfed an average of 90 days compared to 82 days for those receiving the AC sessions and 22% of the mothers in each group were still breastfeeding at some level. Because of the impact of attrition during this study, we discuss factors that contributed to attrition and approaches to lessen this problem in future studies. Such efforts may require a greater investment of time and resources and should be budgeted accordingly. Culturally appropriate interventions are needed to help rural Mexican-American mothers meet their breastfeeding goals, thus providing an opportunity to reduce their childrens risk of multiple diseases and obesity. Only when we address these considerations will we have an opportunity to decrease health disparities, promote healthy behaviors, and be trusted health care partners.

Quality of Life Associated with Physical Activity but not Sedentary Time in Youth

Purpose: It has been reported that youth who engaged in more screen time had lower quality of life scores compared to those that were more physically active. Furthermore, increased sedentary behavior increases health risks particularly the risk for obesity. A cross-sectional analysis was completed to examine the relationship between healthrelated quality-of-life (HRQOL) and accelerometer-measured sedentary time (ST) and physical activity (PA) in 9-10-yearold youth who were recruited for the family-based, childhood obesity intervention, iCook 4-H. It was hypothesized that objectively measured ST would be negatively correlated and PA would be positively correlated with HRQOL. Methods: A subset of participants (n=118) wore Actigraph GT3X+ accelerometers for 7 days and completed the Pediatric Quality of Life survey (PedsQLTM, version 4.0) to assess HRQOL. Mean daily minutes of accelerometermeasured ST (547 ± 60) and PA including light-intensity (LPA=240 ± 49), moderate-intensity (MPA=35 ± 11), vigorous-intensity (VPA=17 ± 9), and moderate-to vigorousintensity (MVPA=52 ± 19) were evaluated during waking hours. Multiple linear regressions were used to assess relationship between ST and PA intensities with HRQOL. Statistical significance was set at p ≤ 0.05. Results: There were no significant associations between ST or LPA with HRQOL. MPA, VPA and MVPA were positively associated with multiple HRQOL domains. Conclusion: The lack of relationship between objectively measured ST and LPA with the total HRQOL score and subscales merits further investigation. The findings of the current study support the need for lifestyle interventions that engage families in behavior that increases MVPA.

Feasibility of a Bilingual, Interactive, Computer‐Based Breastfeeding Support Program for Rural Hispanic Women

Paper Presentation Objective To develop and evaluate the acceptance and usability of a bilingual, interactive, touch screen, computer‐based breastfeeding education program for rural Hispanic women. Design Focus groups were used to explore factors influencing breastfeeding practices among rural Hispanic women. Quantitative data were collected using sociodemographic questionnaires, the Breastfeeding Self‐Efficacy Scale Short Form (BFSE‐SF), and the revised Breastfeeding Attrition Prediction Tool (BAPT). Setting Regional West Medical Center in rural western Nebraska. Sample Participants included convenience samples of self‐described Hispanic women age ≥ 19 years old (focus groups n = 12, usability assessments n = 10). Methods Qualitative data were collected using open‐ended questions based on predicting and changing behavior theory. Univariate statistical analyses were performed to describe quantitative data, and framework analysis was used to thematically analyze narrative data. A prototype program was developed by modifying a Patient Education and Motivation Tool that integrates several cognitive‐behavioral theories and utilizes multimedia formats. To evaluate usability, participants were given a brief introduction to the program and then asked to perform a predefined set of tasks. Data included the time to complete each task, number of attempts, and need for assistance. System usability was assessed using the System Usability Scale (SUS). Results The majority of participants (83%) had not taken prenatal breastfeeding classes nor did they intend to. Although BAPT results indicated above average intention to breast feed, 33% of the participants had BFSE‐SF scores indicating they were at greater risk for early discontinuation of breastfeeding. Most mothers (67%) decided to breastfeed because of perceived benefits for infant health. Feedback obtained during the focus groups and the results of the BAPT and BFSE‐SF guided the development of content for the computer‐based breastfeeding education program. Participants navigated through the prototype program with ease and no assistance was needed. Average SUS scores were high (90, SD = 10.5). Conclusion/Implications for Nursing Practice We identified factors that affect breastfeeding practices among rural Hispanic women, which were then used to guide the development of a bilingual, interactive, touch screen, computer‐based, breastfeeding education program. The prototype was well accepted, and participants were able to navigate through the program with ease. Based on these assessments, the program has been further refined and is currently being evaluated to determine whether it is effective in changing breastfeeding behavior in this population.

Bio-Impedance Analysis Measures in a Rural Latina Community

Obesity is an ever-growing epidemic that is accompanied by numerous comorbidities and exorbitant health care expenditures. The rural community in which this minority population was studied has the 7 th fattest population in the United States and is approximately 40% Hispanic 1 . In order to focus on interventions, bio-impedance analysis (BIA) was completed on a segment of the population as part of a community health assessment used in the Public Health Nursing Model. Forty-nine Latina women ages 20-80, attending a Latina Red Dress Event that targeted Heart Health of Latina women, were consented and measured for body composition on a bio-impedance analyzer. The items measured were BMI, body fat percentage, weight, height, body fat mass, fat free mass, visceral fat rating, body water percentage, body water mass, muscle mass, bone mass, basal metabolic rate, and metabolic age. Correlations and frequencies were analyzed for the variable data. State statistics indicate that approximately 60% of the population in this area is overweight or obese. The study findings show the rate is much higher in this segment of the population. Obesity is an ever-growing epidemic that is accompanied by numerous comorbidities and exorbitant health care expenditures. Rural areas in this country have higher rates of obesity than those of urban areas. Mexican Americans are at a higher risk for overweight and obesity and its comorbidities such as hypertension, diabetes, cardiovascular disease, joint disorders, psychological disorders, hyperlipidemia, cancers and asthma (1). This study was conducted in a rural mid-western area that has approximately 40% Mexican-American (2). The rural community where the study took place has the 7 th highest occurrence of obesity in the United States (3). In order to focus on obesity prevention interventions for this Hispanic population, bio-impedance analysis (BIA) was completed on a cohort of Hispanic mothers and abuelas (respected grandmothers) who attended a community health event. Hispanic mothers and abuelas were selected for this community health assessment. Significant relationships have been found between obese mothers and the risk for obesity in their children. The mothers and abuelas are also the primary caregivers who determine child feeding behaviors. The Public Health Nursing Model was used to guide the study design. Data from this study will be used to determine the need and direction for a future Hispanic abuela/mother intervention that will encourage healthy child feeding behaviors including limiting low nutrient carbohydrate intake and increasing body water. The overall objective is to help mothers eat, and drink healthier and feed their children in a similar manner to help prevent obesity in themselves and their children.

Abuela to mother motivational interviewing intervention to reduce low-nutritive simple carbohydrate intake

Abstract Background: Mexican-American children have the highest rates of childhood obesity of any ethnic group [1]. Because Mexican-American mothers follow the advice of abuelas (respected