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Ho YCL, Mahirah D, Ho CZH, Thumboo J. The role of the family in health promotion: a scoping review of models and mechanisms. Health Promot Int 2022; 37:daac119. [PMID: 36398941 PMCID: PMC9673498 DOI: 10.1093/heapro/daac119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2023] Open
Abstract
The family is an important contributor to the cultural conditions that support health. Current challenges in family health promotion interventions include programme design that is not always guided by theory and change mechanisms. Multifaceted programmes also make it hard to examine what works for whom, given different family roles and the range of lifestyle behaviour and mechanisms examined within diverse conceptual frameworks and cultures. We performed a scoping review on the heterogeneous literature to map and categorize the models and mechanisms by which a family may promote health behaviours among its members. We searched five electronic databases and grey literature up to 2020. Publications were included if they examined health-promoting behaviours, influences at the family level, and outlined the behavioural mechanisms involved. Two hundred and forty studies were identified. Ecological systems theory, social cognitive theory, family systems theory and the theory of planned behaviour were the frameworks most widely used in explaining either study context and/or mechanism. The most frequently studied family mechanisms involved aspects of family support, supervision and modelling, while some studies also included individual-level mechanisms. Majority of the studies investigated parental influence on the child, while few studies assessed the elderly family member as a recipient or actor of the influences. Studies on African, Asian and Middle Eastern populations were also in the minority, highlighting room for further research. Improving the understanding of context and behavioural mechanisms for family health promotion will aid the development of public health policy and chronic disease prevention programmes, complementing efforts targeted at individuals.
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Affiliation(s)
- Yi-Ching Lynn Ho
- Centre for Population Health Research and Implementation (CPHRI), Singapore Health Services, Singapore
- Programme in Health Services & Systems Research, Duke-NUS Medical School, Singapore
| | - Dhiya Mahirah
- Centre for Population Health Research and Implementation (CPHRI), Singapore Health Services, Singapore
| | - Clement Zhong-Hao Ho
- Centre for Population Health Research and Implementation (CPHRI), Singapore Health Services, Singapore
| | - Julian Thumboo
- Centre for Population Health Research and Implementation (CPHRI), Singapore Health Services, Singapore
- Department of Rheumatology & Immunology, Singapore General Hospital, Singapore
- Medicine Academic Clinical Programme, Duke-NUS Medical School, Singapore
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Horan MK, Donnelly JM, McGowan CA, Gibney ER, McAuliffe FM. The association between maternal nutrition and lifestyle during pregnancy and 2-year-old offspring adiposity: analysis from the ROLO study. JOURNAL OF PUBLIC HEALTH-HEIDELBERG 2016; 24:427-436. [PMID: 27695668 PMCID: PMC5025498 DOI: 10.1007/s10389-016-0740-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 05/25/2016] [Indexed: 11/26/2022]
Abstract
Aim To examine the association between maternal nutrition and lifestyle factors and offspring adiposity, using baseline and 2-year postpartum follow-up data from a randomised control trial of low glycaemic index diet. Subject and methods Food diaries and lifestyle questionnaires were completed during pregnancy and infant feeding and maternal lifestyle questionnaires 2 years postpartum for 281 mother and infant pairs from the ROLO study. Maternal anthropometry was measured throughout pregnancy and infant and maternal anthropometry was measured 2 years postpartum. Results Maternal 2 year postpartum body mass index (BMI) was positively associated with offspring BMI-for-age z-score (B = 0.105, p = 0.015). Trimester 2 saturated fat intake was positively associated with offspring subscapular:triceps skinfold ratio (B = 0.018, p = 0.001). Trimester 1 glycaemic index was also positively associated with offspring sum of subscapular and triceps skinfolds (B = 0.009, p = 0.029). Conclusions Maternal BMI 2 years postpartum was positively associated with offspring BMI. Pregnancy saturated fat intake was positively and polyunsaturated fat negatively associated with offspring adiposity. While further research is necessary, pregnancy and the postpartum period may be early opportunities to combat childhood obesity. Electronic supplementary material The online version of this article (doi:10.1007/s10389-016-0740-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Mary K. Horan
- UCD Obstetrics and Gynaecology, School of Medicine and Medical Science, University College Dublin, National Maternity Hospital, Dublin 2, Ireland
| | - Jean M. Donnelly
- UCD Obstetrics and Gynaecology, School of Medicine and Medical Science, University College Dublin, National Maternity Hospital, Dublin 2, Ireland
| | - Ciara A. McGowan
- UCD Obstetrics and Gynaecology, School of Medicine and Medical Science, University College Dublin, National Maternity Hospital, Dublin 2, Ireland
| | - Eileen R. Gibney
- Science Centre – South, University College Dublin School Of Agriculture & Food Science, Belfield, Dublin 4 Ireland
| | - Fionnuala M. McAuliffe
- UCD Obstetrics and Gynaecology, School of Medicine and Medical Science, University College Dublin, National Maternity Hospital, Dublin 2, Ireland
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Crawford TW, Jilcott Pitts SB, McGuirt JT, Keyserling TC, Ammerman AS. Conceptualizing and comparing neighborhood and activity space measures for food environment research. Health Place 2014; 30:215-25. [PMID: 25306420 DOI: 10.1016/j.healthplace.2014.09.007] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Revised: 09/04/2014] [Accepted: 09/09/2014] [Indexed: 10/24/2022]
Abstract
Greater accessibility to geospatial technologies has led to a surge of spatialized public health research, much of which has focused on food environments. The purpose of this study was to analyze differing spatial measures of exposure to supermarkets and farmers׳ markets among women of reproductive age in eastern North Carolina. Exposure measures were derived using participant-defined neighborhoods, investigator-defined road network neighborhoods, and activity spaces incorporating participants׳ time space behaviors. Results showed that mean area for participant-defined neighborhoods (0.04 sq. miles) was much smaller than 2.0 mile road network neighborhoods (3.11 sq. miles) and activity spaces (26.36 sq. miles), and that activity spaces provided the greatest market exposure. The traditional residential neighborhood concept may not be particularly relevant for all places. Time-space approaches capturing activity space may be more relevant, particularly if integrated with mixed methods strategies.
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Affiliation(s)
- Thomas W Crawford
- Banpu Endowed Chair, 3694 West Pine Mall, Center for Sustainability, Saint Louis University, St. Louis, MO 63108, United States.
| | - Stephanie B Jilcott Pitts
- East Carolina University, Department of Public Health, 600 Moye Blvd, MS 660, Greenville, NC 27834, United States.
| | - Jared T McGuirt
- University of North Carolina at Chapel Hill, Department of Nutrition Chapel Hill, NC 27599, United States.
| | - Thomas C Keyserling
- Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, United States.
| | - Alice S Ammerman
- Department of Nutrition, Gillings School of Global Public Health Director, Center for Health Promotion, Disease Prevention University of North Carolina at Chapel Hill, CB# 7426, Chapel Hill, NC 27599-7426, United States.
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Robles B, Frost S, Moore L, Harris CV, Bradlyn AS, Kuo T. Overweight and obesity among low-income women in rural West Virginia and urban Los Angeles County. Prev Med 2014; 67 Suppl 1:S34-9. [PMID: 24589440 DOI: 10.1016/j.ypmed.2014.02.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Revised: 02/12/2014] [Accepted: 02/23/2014] [Indexed: 11/26/2022]
Abstract
We described the prevalence of overweight and obesity among low-income women in rural West Virginia (WV) and urban Los Angeles County (LA County). Both communities participated in the national Communities Putting Prevention to Work program during 2010-2012. In each community, we completed health assessments on adult women recruited from public-sector clinics serving low-income populations. All participants answered survey questions regarding socio-demographics and diets. In both jurisdictions, we assessed obesity using objectively measured height and weight (calculated BMI). As part of each community case study, we performed multivariable regression analyses to describe the relationships between overweight and obesity and selected covariates (e.g., dietary behaviors). Overweight and obesity were prevalent among low-income women from WV (73%, combined) and LA County (67%, combined). In both communities, race and ethnicity appeared to predict the two conditions; however, the associations were not robust. In LA County, for example, African American and Hispanic women were 1.4 times (95% CI=1.12, 1.81) more likely than white women to be overweight and obese. Collectively, these subpopulation health data served as an important guide for further planning of obesity prevention efforts in both communities. These efforts became a part of the subsequent Community Transformation Grants portfolio.
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Affiliation(s)
- Brenda Robles
- Division of Chronic Disease and Injury Prevention, Los Angeles County Department of Public Health, 3530 Wilshire Blvd, 8th Floor, Los Angeles, CA 90010, USA.
| | - Stephanie Frost
- ICF International, 3 Corporate Square, Atlanta, GA 30329, USA.
| | - Lucas Moore
- College of Education and Human Services, West Virginia University, P.O. Box 9102, Morgantown, WV 26506-9102, USA.
| | - Carole V Harris
- ICF International, 3 Corporate Square, Atlanta, GA 30329, USA.
| | | | - Tony Kuo
- Division of Chronic Disease and Injury Prevention, Los Angeles County Department of Public Health, 3530 Wilshire Blvd, 8th Floor, Los Angeles, CA 90010, USA; Department of Family Medicine, David Geffen School of Medicine at UCLA, 10880 Wilshire Blvd, Suite 1800, Los Angeles, CA 90024-4142, USA.
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Robles B, Smith LV, Ponce M, Piron J, Kuo T. The influence of gender and self-efficacy on healthy eating in a low-income urban population affected by structural changes to the food environment. J Obes 2014; 2014:908391. [PMID: 24800064 PMCID: PMC3985319 DOI: 10.1155/2014/908391] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Accepted: 01/09/2014] [Indexed: 11/17/2022] Open
Abstract
Although U.S. obesity prevention efforts have begun to implement a variety of system and environmental change strategies to address the underlying socioecological barriers to healthy eating, factors which can impede or facilitate community acceptance of such interventions are often poorly understood. This is due, in part, to the paucity of subpopulation health data that are available to help guide local planning and decision-making. We contribute to this gap in practice by examining area-specific health data for a population targeted by federally funded nutrition interventions in Los Angeles County. Using data from a local health assessment that collected information on sociodemographics, self-reported health behaviors, and objectively measured height, weight, and blood pressure for a subset of low-income adults (n = 720), we compared health risks and predictors of healthy eating across at-risk groups using multivariable modeling analyses. Our main findings indicate being a woman and having high self-efficacy in reading Nutrition Facts labels were strong predictors of healthy eating (P < 0.05). These findings suggest that intervening with women may help increase the reach of these nutrition interventions, and that improving self-efficacy in healthy eating through public education and/or by other means can help prime at-risk groups to accept and take advantage of these food environment changes.
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Affiliation(s)
- Brenda Robles
- Division of Chronic Disease and Injury Prevention, Los Angeles County Department of Public Health, 3530 Wilshire Boulevard, 8th Floor, Los Angeles, CA 90010, USA
| | - Lisa V. Smith
- Office of Health Assessment and Epidemiology, Los Angeles County Department of Public Health, 313 North Figueroa Street, Room 127, Los Angeles, CA 90012, USA
- Department of Epidemiology, UCLA Jonathan and Karin Fielding School of Public Health, Box 951772, 71-254 CHS, Los Angeles, CA 90095-1772, USA
| | - Mirna Ponce
- Division of Chronic Disease and Injury Prevention, Los Angeles County Department of Public Health, 3530 Wilshire Boulevard, 8th Floor, Los Angeles, CA 90010, USA
| | - Jennifer Piron
- Office of Health Assessment and Epidemiology, Los Angeles County Department of Public Health, 313 North Figueroa Street, Room 127, Los Angeles, CA 90012, USA
| | - Tony Kuo
- Division of Chronic Disease and Injury Prevention, Los Angeles County Department of Public Health, 3530 Wilshire Boulevard, 8th Floor, Los Angeles, CA 90010, USA
- Department of Family Medicine, David Geffen School of Medicine at UCLA, 10880 Wilshire Boulevard, Suite 1800, Los Angeles, CA 90024-4142, USA
- *Tony Kuo:
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Jilcott SB, Laraia BA, Evenson KR, Ammerman AS. Perceptions of the community food environment and related influences on food choice among midlife women residing in rural and urban areas: a qualitative analysis. Women Health 2009; 49:164-80. [PMID: 19533508 PMCID: PMC2743920 DOI: 10.1080/03630240902915085] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Qualitative research on food choice has rarely focused on individuals' perceptions of the community food environment. Women remain gatekeepers of the family diet and food purchasing. Therefore we assessed midlife, Southern women's perceptions of the food environment. Related influences on food choices at work and at home were also examined. METHODS We recruited 28 low- and moderate-income, midlife (37-67 years) women from rural and urban areas of southeastern North Carolina, using typical case and snowball sampling. They responded to questions about multilevel influences on food choice in semi-structured, in-depth interviews. RESULTS Women perceived differences between urban and rural food environments, with rural areas having fewer supermarkets and fast food restaurants compared to urban areas, which had fewer produce stands. Workplace food choices were affected by the social environment (co-workers), personal health concerns, and the surrounding food environment. Food chosen at home was primarily influenced by family members, health concerns, and convenient food sources. DISCUSSION While future studies should explore findings in more representative populations, potential intervention strategies can be inferred, including emphasizing healthful aspects of the food environment. Intervention and advocacy efforts are needed to improve aspects of the food environment that make healthy choices difficult.
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Affiliation(s)
- Stephanie B. Jilcott
- Stephanie B. Jilcott, PhD, Assistant Professor, Department of Public Health, Brody School of Medicine, East Carolina University, 1709 West Sixth Street, Greenville, NC 27834;
| | - Barbara A. Laraia
- Barbara A. Laraia, PhD, MPH, RD, Assistant Professor, Department of Medicine, University of California, San Francisco, 3333 California Street, Suite 465, San Francisco, CA 94118;
| | - Kelly R. Evenson
- Kelly R. Evenson, PhD, Research Associate Professor, University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Department of Epidemiology, Suite 306, 137 E Franklin St, CB 8050, Chapel Hill, NC, 27599−8050;
| | - Alice S. Ammerman
- Alice S. Ammerman, RD, DrPH, University of North Carolina at Chapel Hill, Director, Center for Health Promotion and Disease Prevention, Professor, Gillings School of Global Public Health, Department of Nutrition, 1700 Martin Luther King, Jr Blvd, CB 7426, Chapel Hill, NC, 27599−7426;
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Burke V, Beilin LJ, Simmer K, Oddy WH, Blake KV, Doherty D, Kendall GE, Newnham JP, Landau LI, Stanley FJ. Predictors of body mass index and associations with cardiovascular risk factors in Australian children: a prospective cohort study. Int J Obes (Lond) 2005; 29:15-23. [PMID: 15314630 DOI: 10.1038/sj.ijo.0802750] [Citation(s) in RCA: 109] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To examine predictors of body mass index (BMI) at the age of 8 y in a prospective study of Australian children. DESIGN Longitudinal survey of a cohort of Australian children followed from the 16th week of gestation to 8 y. SUBJECTS In total, 741 boys and 689 girls who attended the survey as 8 y olds. MEASUREMENTS Weight and height, blood pressure measured by automated oscillometry, fasting blood lipids and glucose. Questionnaire assessment of activity and diet. RESULTS Proportions of overweight including obesity in boys and girls were, respectively, 22 and 25% at 1 y, 14 and 14% at 3 y, 13 and 18% at 5 y and 15 and 20% at 8 y. At the age of 1, 3, 6 and 8 y, children with overweight including obesity showed significantly more adverse cardiovascular risk factors. Blood pressure (BP) was significantly higher by 2/3 mmHg (systolic/diastolic) at 1 y, 3/2 mmHg at 3 y, 4/2 mmHg at 5 y and 6/2 mmHg at 8 y; HDL was significantly lower (P=0.002) by 8% and triglycerides were significantly higher by 27% (P<0.001). In multivariate regression, BMI at the age of 8 y was significantly predicted positively by birth weight, mother's BMI and hours spent in watching television at the time of the survey of 6 y olds. Mothers being ex-smokers or non smokers and children being 'slightly active' and 'active' negatively predicted BMI in 8 y olds. In a subset of 298 children with information about fathers, paternal BMI was an additional independent predictor. Maternal or paternal overweight including obesity each independently increased risk of overweight including obesity at the age of 8 y three-fold. A food factor with consumption of cereals and breads as the major components derived from a Food Frequency Questionnaire in a subset of 340 children was also an independent negative predictor of BMI in multivariate models. CONCLUSION The increasing rate of overweight including obesity, particularly in girls, is associated with an increase in cardiovascular risk factors very early in life. Improvement of health-related behaviours within the family and a focus on promotion of activity in children should be priorities in achieving weight control.
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Affiliation(s)
- V Burke
- School of Medicine and Pharmacology, The University of Western Australia, Royal Perth Hospital and Western Australian Institute for Medical Research, Perth, Australia.
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Jilcott SB, Macon ML, Rosamond WD, Garcia BA, Jenkins LK, Cannon PM, Townsend CR, Tawney KW, Keyserling TC, Will JC, Ammerman AS. Implementing the WISEWOMAN Program in Local Health Departments: Staff Attitudes, Beliefs, and Perceived Barriers. J Womens Health (Larchmt) 2004; 13:598-606. [PMID: 15257851 DOI: 10.1089/1540999041281089] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Although most health departments recognize the need for programs to reduce the risk of cardiovascular disease (CVD) among older, low-income women, they face numerous barriers to successfully implementing such programs. This paper explores counselors' attitudes and beliefs about patients and perceived barriers to implementing the North Carolina Well-Integrated Screening and Evaluation for Women Across the Nation (WISEWOMAN) program. METHODS Health departments were assigned to provide patients with either an enhanced intervention (EI) or a minimum intervention (MI). Cross-sectional baseline and 12-month follow-up surveys were completed by health department counselors designated to deliver the MI or EI. Both surveys addressed counselors' beliefs about patients' motivation and attitudes, their counseling practices, and their personal diet and physical activity behaviors and attitudes. The follow-up survey also addressed opinions about the feasibility of long-term WISEWOMAN implementation. RESULTS Counselors were skeptical about patients' motivation to improve their lifestyle, citing high perceived cost and burden. At follow-up, EI counselors reported having higher self-efficacy for counseling, incorporating more behavioral change strategies, and spending more time counseling than did counselors at MI sites. They were also more likely to report making healthful personal lifestyle choices. All counselors identified lack of time as a major barrier to counseling, and most cited obtaining low-cost medications for patients, ensuring that patients made follow-up visits, and implementing the program with existing staff as key challenges to the long-term sustainability of WISEWOMAN. CONCLUSIONS Our findings provide insight into the organizational challenges of implementing a CVD risk-reduction program for low-income women. We discuss ways in which intervention and training programs can be improved.
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Affiliation(s)
- Stephanie B Jilcott
- Department of Nutrition, University of North Carolina, Chapel Hill, 27599, USA
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Stevens VJ, Glasgow RE, Toobert DJ, Karanja N, Smith KS. One-year results from a brief, computer-assisted intervention to decrease consumption of fat and increase consumption of fruits and vegetables. Prev Med 2003; 36:594-600. [PMID: 12689805 DOI: 10.1016/s0091-7435(03)00019-7] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Current cancer prevention recommendations include reducing consumption of fat and increasing consumption of fruits and vegetables. METHODS Healthy women health maintenance organization members (n = 616) ages 40-70 were randomly assigned to either a nutrition intervention or a control intervention unrelated to diet. Intervention included two 45-min counseling sessions plus two brief follow-up telephone contacts. Counseling sessions included a 20-min, interactive, computer-based intervention using a touch-screen format. Intervention goals were reducing dietary fat and increasing fruit and vegetable consumption. Outcome measures included a food frequency questionnaire and the Fat and Fiber Behavior Questionnaire (FFBQ). Total serum cholesterol was also measured at baseline and 12 months. RESULTS Twelve-month follow-up data showed improvements on all dietary outcome variables. Compared to the control, intervention participants reported significantly less fat consumption (3.75 points less for percentage of energy from fat), significantly greater consumption of fruit and vegetables combined (0.93 more servings per day), and a significant reduction in a behavioral measure of fat consumption (0.20 point change in the FFBQ). Group differences in total serum cholesterol, while in the desired direction, were not significant. CONCLUSIONS In appropriate circumstances, moderate-intensity dietary interventions can show significant effects for periods of at least 1 year.
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Affiliation(s)
- Victor J Stevens
- Kaiser Permanente Center for Health Research, Portland, OR 97227, USA.
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Stevens VJ, Glasgow RE, Toobert DJ, Karanja N, Smith KS. Randomized trial of a brief dietary intervention to decrease consumption of fat and increase consumption of fruits and vegetables. Am J Health Promot 2002; 16:129-34. [PMID: 11802257 DOI: 10.4278/0890-1171-16.3.129] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE This study tested the efficacy of a computer-assisted counseling intervention to reduce diet-related cancer risk. DESIGN Randomized controlled trial. SUBJECTS Healthy women HMO members (n = 616) aged 40 to 70. INTERVENTION Participants were randomly assigned to nutrition intervention or an attention-control intervention unrelated to diet. Intervention consisted of two 45-minute counseling sessions plus two 5- to 10-minute follow-up telephone contacts. Counseling sessions included a 20-minute, interactive, computer-based intervention using a touchscreen format. Intervention goals were reducing dietary fat and increasing consumption of fruit, vegetables, and whole grains. MEASURES Twenty-four hour diet recalls and the Fat and Fiber Behavior Questionnaire (FFB). RESULTS Four-month follow-up data were collected from 94% of the intervention participants and 91% of the controls. Testing with a multivariate general linear models analysis showed improvements on all dietary outcome variables. Compared to the control, intervention participants reported significantly less fat consumption (2.35 percentage points less for percentage of energy from fat), significantly greater consumption of fruit and vegetables combined (1.04 servings per day), and a significant reduction in a behavioral measure of fat consumption (.24 point change in the FFB). CONCLUSIONS These 4-month results are comparable to several other moderate-intensity studies showing that, in the appropriate circumstances, moderate-intensity dietary interventions can be efficacious. Study limitations include the short follow-up period and the use of self-reported outcome measures.
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Affiliation(s)
- Victor J Stevens
- Kaiser Permanente Center for Health Research, Portland, Oregon, 3800 N. Interstate Avenue, Portland, Oregon 97227, USA
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Zive MM, Frank-Spohrer GC, Sallis JF, McKenzie TL, Elder JP, Berry CC, Broyles SL, Nader PR. Determinants of dietary intake in a sample of white and Mexican-American children. JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION 1998; 98:1282-9. [PMID: 9813584 DOI: 10.1016/s0002-8223(98)00288-0] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To assess the influence of several potential psychosocial determinants on children's eating behavior. PARTICIPANTS Three hundred fifty-one Mexican-American and non-Hispanic white children (mean age = 4.4 years old at baseline) participated in the San Diego Study of Children's Activity and Nutrition for up to 2.5 years. METHODS Child's eating behavior was described by 3 dependent variables: total energy, percentage energy from fat, and sodium intake per 1,000 kcal. Dietary information was collected 4 days a year using a 24-hour food intake record, which was a combination of direct observation and interviews with food preparers. The 35 predictor variables from child, parental, demographic, and environmental domains were collected by behavioral observation, interviewer-administered questionnaires, and physical measurements. STATISTICAL ANALYSES Bivariate and regression analyses via mixed linear models were performed. RESULTS Variables from the children's domain (such as skinfold thickness and weight) had the strongest associations with energy intake; parental variables (such as fat avoidance behavior and prompts to increase children's food intake) were associated with child's percentage energy from fat and sodium intake. In regression analyses, parsimonious subsets of variables accounted for 46% of variance in energy intake (3 variables), 40% of the variance in percentage of energy from fat (4 variables), and 44% of variance in sodium intake per 1,000 kcal energy (1 variable) in between-subject variance components. CONCLUSIONS Fat and sodium intake of children may be improved by improving parents' nutrition habits and by having parents encourage children to eat a healthful diet. Few modifiable correlates of children's energy intake were identified.
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Affiliation(s)
- M M Zive
- Division of Community Pediatrics, University of California, San Diego 92093-0927, USA
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Burke V, Gracey MP, Milligan RA, Thompson C, Taggart AC, Beilin LJ. Parental smoking and risk factors for cardiovascular disease in 10- to 12-year-old children. J Pediatr 1998; 133:206-13. [PMID: 9709707 DOI: 10.1016/s0022-3476(98)70221-5] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Smokers have multiple adverse health-related behaviors and an increased risk of cardiovascular disease. We examined whether health behaviors in parents who smoke may influence children's health behaviors. STUDY DESIGN Cross-sectional data from 10- to 12-year-olds (n = 800) entering a trial of health promotion programs. RESULTS Smoking in children was independently associated with maternal (odds ratio 2.1, confidence interval 1.2, 3.8) and paternal smoking (odds ratio 2.1, confidence interval 1.2, 3.7) and was less likely in girls (odds ratio 0.4, confidence interval 0.2, 0.6). Maternal smoking and paternal smoking were additive predictors in children of lower physical activity (P = .0013 for mothers; P = .0476 for fathers) and more television watching (P = .0335 for mothers; P = .0241 for fathers). Children's fat intake was significantly greater if either parent smoked. Children's body mass index (P = .0183) and waist-to-hip ratio (P = .0009) were significantly greater if mothers smoked. CONCLUSIONS Poor health behaviors associated with smoking in parents, particularly mothers, are likely to influence children's long-term risk of having lifestyle diseases. The results may also explain some of the apparent effects attributed to passive smoking in families.
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Affiliation(s)
- V Burke
- University Department of Medicine, Royal Perth Hospital, Australia
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Abstract
This article reviews current concepts regarding the prevention of cardiovascular disease for women, with particular attention to modifiable risk factors. The background describes the magnitude of the problem, assesses the quality of the data with respect to risk factor reduction, and emphasizes several important concepts. Changes at menopause, states of endocrine aberration, and benefits and risks of hormone substitution need to be understood in conjunction with all other potentially modifiable and nonmodifiable cardiovascular risk factors. Primary care physicians have a window of opportunity to prevent this number one women's health problem. Integrating behavior modification is the key to prevention as part of the regular gynecologic visit.
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Affiliation(s)
- R A Wild
- Department of Obstetrics and Gynecology, University of Oklahoma Health Sciences Center
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Wild RA, Taylor EL, Knehans A. The gynecologist and cardiovascular disease: a window of opportunity for prevention. JOURNAL OF THE SOCIETY FOR GYNECOLOGIC INVESTIGATION 1994; 1:107-17. [PMID: 9419757 DOI: 10.1177/107155769400100203] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE We present current concepts and assess the quality of information available for the prevention of cardiovascular disease in women. METHODS This article reviews research bearing on the prevention of cardiovascular disease in women, with particular attention to modifiable risk factors. We describe the magnitude of the problem and assess the quality of the data with respect to the classic risk factors. The concept is emphasized that changes at menopause, states of endocrine aberration, and benefits and risks of hormone substitution and oral contraception must be understood in conjunction with all other potentially modifiable and nonmodifiable risk factors. CONCLUSIONS Primary care physicians, especially obstetrician/gynecologists, have a pivotal role to play in the reduction of this disease. Behavior modification is the key to integrating prevention into the regular annual visit.
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Affiliation(s)
- R A Wild
- Department of Obstetrics and Gynecology, University of Oklahoma Health Sciences Center, Oklahoma City, USA
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