Nutrition knowledge and behavioral assessment of participants of Aid for Families with Dependent Children: telephone vs mail data collection methods

Nutrition knowledge of low-income parents of obese children

Minority and low-income children are overrepresented among obese US children. Lack of basic nutrition knowledge among parents may contribute to this disparity. The purpose of this study is to measure nutrition knowledge of parents of Medicaid-insured obese children using a simple low-literacy tool. Parents, recruited from pediatric clinics, demonstrated their nutrition knowledge by placing food stickers into cells on a printed grid with food groups displayed in columns and three nutrition categories displayed in rows. In general, parents (n = 135; 74.8 % black; 79.2 % income of ≤$25,000/year) correctly identified food groups (median = 90.5 % correct). Nutritional categories were more commonly misidentified (median = 67 % correct), with parents mostly believing foods were healthier than they were. Multivariable linear regression revealed black race (p = 0.02), no college education (p = 0.02) and income of <$15,000 (p = 0.03) independently predicted misidentification of nutritional categories. Parents' understanding of food's nutritional value is variable. Black race, less education, and very low income are associated with poorer nutrition knowledge.

Measuring stroke impact with the stroke impact scale: telephone versus mail administration in veterans with stroke

OBJECTIVES

The purpose of this study was to examine response rate, mode effects, and reliability of the Stroke Impact Scale (SIS) in a veteran stroke population using mail and telephone modes of administration.

METHODS

Patients who had suffered a stroke were identified using national VA administrative data and International Classification of Diseases, 9th Revision codes in 13 participating Veterans Affairs hospital. Stroke was confirmed by reviewing electronic medical records. Patients were randomized to SIS administration by mail or telephone at 12-weeks after their stroke. Comparison of response rate, nonresponse bias, domain scores, administration costs, and instrument reliability were performed.

RESULTS

Four hundred fifty-eight patients with stroke were identified, validated, and randomly assigned into 2 administration groups. No significant cluster effect was observed. Response rates for mail and telephone were 45% and 69%, respectively. Mail nonresponders were more likely to have had severe stokes, cognitive deficits, and be unmarried. No difference was observed between telephone responders and nonresponders. Responders in mail and telephone modes were not different, and the SIS score distribution did not indicate the presence of mode effects. Test-retest reliability was good to excellent in the mail group (0.77-0.99) except social participation (0.62). Test retest reliability was excellent in the telephone mode (0.90-0.99) except emotion (0.68).

CONCLUSIONS

Telephone mode of survey administration yielded a higher response rate, less bias in responder selection, and higher test-retest reliability. The cost of telephone administration was 2 times the cost of mail. Mode effects in SIS score distribution were not observed in this study but additional research with larger sample sizes is needed to provide more definitive evidence.

Lessons learned from the "Spend Less. Eat Well. Feel Better." program efficacy trial

"Spend Less. Eat Well. Feel Better." (SLEWFB) is a 3-hour intervention designed to improve food resource management ability, health, and food security status. This program efficacy trial targeted clients seeking financial aid to prevent homelessness. A randomized controlled design using a 1-hour food safety intervention as a control group was used. Four variables were targeted over a 30-day time period: (1) food security status, (2) basic financial management, (3) average fruit and vegetable intake, and (4) goal accomplishment. Repeated-measures analysis of variance and chi-square analysis were used. Compared with control group participants (n = 47), SLEWFB graduates (n = 48) were less likely to have to choose between food and rent expenses (chi2 = 16.5, P =.00005) and improved their fruit and vegetable intake (F of time = 8.03, P <.006) regardless of financial assistance received. The findings imply that further investigation of coupling financial aid with effective life skills education is warranted.

An assessment of various household food security measures in Hawaiì has implications for national food security research and monitoring

The Core Food Security Module (CFSM), the national food security monitoring tool, requires three affirmative responses to categorize households as food insecure. If this tool is unreliable or inaccurate, vulnerable segments of our population may be adversely affected. The objectives of the present study were to assess the credibility of applying the CFSM categorical measure to a population sample from Hawaiì and to assess the concurrent validity of the CFSM, the new face-valid measure and measures adapted from the Radimer/Cornell (RC) measure and Community Childhood Hunger Identification Project. The sample included 1469 respondents gathered through a statewide telephone sample and 144 food pantry recipients. Responses to the 18 CFSM questions were used to create all four measures. The credibility of the CFSM categorical measure was also assessed via comparisons with individual items and with the 1995 national modal CFSM response pattern. Categorical measures were compared across food security prevalence estimates and indices of income and vegetable intake and with the CFSM scale measure. Differences in the modal response pattern between samples affected CFSM categorization. Only 36% of households followed the Hawaiì modal response pattern, and categorization was not consistent with the content of key items. Although 85% of the households were classified as food secure by the CFSM, only 78% were classified as food secure with each of the other food security measures. Concurrent validity of all measures was confirmed. A reassessment of the national CFSM categorical measure appears warranted.

The core food security module scale measure is valid and reliable when used with Asians and Pacific Islanders

The Core Food Security Measure (CFSM) is used nationally to assess the extent and severity of household food insecurity in the previous 12 mo due to inadequate money for food. Both a scale measure and a categorical measure were developed from a national cross-sectional sample. The objective of this research was to determine whether the CFSM scale measure is a reliable and valid food security measure for use in Hawaii, where at least 50% of the population is of Asian or Pacific Islander descent. We completed an independent assessment of the robustness of the internal scale construct validity of the CSFM scale measure and hierarchical order of items using the same Rasch methods used previously to develop the CSFM. From a sample of 1664 respondents, data from 362 were used in the Rasch analysis. Item goodness-of-fit statistics indicated that responses to the "adults cut the size or skip meals" item and its follow-up item were redundant [outfit mean-square residual (MnSq) = 0.6, z = -2]. Responses to the "(un)able to eat balanced meals" item were erratic (outfit MnSq = 2.1, z = 2). Findings pertaining to goodness-of-fit of the respondents indicated an acceptable rate of misfit (4.7%). Rate of misfit did not vary with family status or with any ethnic group except the Samoans. Overall, the CFSM scale measure fit as well with the Hawaii data as it did with national data, although identified limitations may affect food security monitoring and research.

The use of telephone interview methodology to obtain 24-hour dietary recalls

OBJECTIVE

To compare 24-hour dietary recalls collected over the telephone to in-person recalls collected in the 1994-1996 Continuing Survey of Food Intakes by Individuals (CSFII).

DESIGN

Trained interviewers collected 24-hour dietary recalls over the telephone using the multiple-pass approach. These results were compared to in-person interviews from a pooled subsample of CSFII respondents.

SUBJECTS/SETTING

List-assisted random-digit dialing was used to identify 700 women between the ages of 20 and 49 years. One eligible woman per household was selected to participate.

STATISTICAL ANALYSES

Approximate t tests to examine differences in average nutrient and energy intakes were conducted on weighted data.

RESULTS

The reported intakes of most nutrients in the current 24-hour dietary recalls collected over the telephone were significantly higher than those reported in the 1994 and 1995 CSFII, but there were no significant differences between the telephone survey and 1996 CSFII results. The 24-hour dietary recalls collected over the telephone yielded consistently greater mean nutrient intake per respondent compared with a comparable pooled subsample from the 1994, 1995, and 1996 CSFII. Generally, no significant differences were found in the food group data between the telephone survey and the CSFII survey. Mean dietary intakes reported by the comparable CSFII subsample increased from 1994 to 1996.

APPLICATIONS

Collecting 24-hour dietary recalls over the telephone is a practical and valid data collection tool for use in national food consumption surveys.