Objectives Multilevel, multicomponent (MLMC) interventions are a promising strategy to address obesity, yet they are complex to implement with sufficient intensity. We report on the process evaluation of a MLMC to prevent/reduce obesity... more
Objectives Multilevel, multicomponent (MLMC) interventions are a promising strategy to address obesity, yet they are complex to implement with sufficient intensity. We report on the process evaluation of a MLMC to prevent/reduce obesity in Native American (NA) adults. Methods OPREVENT2 is a recently completed MLMC intervention in six NA communities (3 intervention, 3 comparison). OPREVENT2 worked with food stores to increase access to and promote healthy food choices, worksites to provide nutrition education and to improve physical activity (PA) opportunities, schools to educate children (grades 2–6) to act as change agents, media to reinforce key messages, and through a policy-oriented community action committee (CAC). OPREVENT2 was implemented in six phases targeting various foods, PA strategies and related behaviors. Implementation standards were set for each component and assessed reach, dose delivered, and fidelity. Data were collected using a combination of REDCap-programmed t...
Research Interests:
Research Interests: Program Evaluation, Health Promotion, Gerontology, Obesity, Environmental Health, and 15 moreHealth Education, Diet, Religion and medicine, Medicine, Attendance, Humans, Baltimore, Exercise, Psychosocial, African Americans, Public health systems and services research, Curriculum and Pedagogy, Snacking, Fidelity, and Guidance and Counseling Intervention Programs
Training in portion-size estimation is known to improve the accuracy of dietary self-reporting in adults, but there is no comparable evidence for children. To obtain this information, we studied 110 second- and third-grade American Indian... more
Training in portion-size estimation is known to improve the accuracy of dietary self-reporting in adults, but there is no comparable evidence for children. To obtain this information, we studied 110 second- and third-grade American Indian schoolchildren (34 control subjects were not trained), testing the hypotheses that a 45-min portion-size estimation training session would reduce children's food quantity estimation error, and that the improvement would be dependent on food type, measurement type, or both. Training was a hands-on, 4-step estimation and measurement skill-building process. Mixed linear models (using logarithmic-transformed data) were used to evaluate within- and between-group differences from pre- to posttest. Test scores were calculated as percentage estimation errors by difference and absolute value methods. Mean within-group estimation error decreased significantly (P<0.05) from pre- to posttest for 7 of 12 foods (trained group) by both calculation methods,...
Research Interests:
The food environment has a great impact on the nutritional health of the population. Food environment interventions have become a popular strategy to address the obesity epidemic. However, there are still significant gaps in our... more
The food environment has a great impact on the nutritional health of the population. Food environment interventions have become a popular strategy to address the obesity epidemic. However, there are still significant gaps in our understanding of the most effective strategies to modify the food environment to improve health. In this review, we examine key gaps in the food environment intervention literature, including the need for: developing appropriate formative research plans when addressing the food environment; methods for selecting intervention domains and components; incorporating food producers and distributors in intervention strategies; strengthening evaluation of environmental interventions; building the evidence base for food environment interventions in diverse settings; engaging policy makers in the process of modifying the food environment; and creating systems science models to examine the costs and benefits of a potential program or policy on the food environment pri...
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Disparities in healthy food access commonly exist in urban low-income neighborhoods, where small food stores predominate. What is not commonly understood is the supply network of these small food s...
Research Interests:
OPREVENT2 was a multilevel, multicomponent (MLMC) adult obesity prevention that sought to improve access and demand for healthier food and physical activity opportunities in six Native American communities in the Southwest and Midwest.... more
OPREVENT2 was a multilevel, multicomponent (MLMC) adult obesity prevention that sought to improve access and demand for healthier food and physical activity opportunities in six Native American communities in the Southwest and Midwest. OPREVENT2 worked with worksites, food stores, schools (grades 2–6), through social media and mailings, and with a local community action committee (CAC), in each of the three intervention communities, and was implemented in six phases. We conducted a process evaluation to assess implementation of each intervention component in terms of reach, dose delivered and fidelity. Implementation of each component was classified as high, medium or low according to set standards, and reported back at the end of each phase, allowing for improvements. The school and worksite components were implemented with high reach, dose delivered and fidelity, with improvement over time. The school program had only moderate reach and dose delivered, as did the social media comp...
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Research Interests:
This case–control study compares the home garden and animal husbandry practices of households with and without xerophthalmic children in south-central Nepal, focusing on the relationship between these practices and household intake of... more
This case–control study compares the home garden and animal husbandry practices of households with and without xerophthalmic children in south-central Nepal, focusing on the relationship between these practices and household intake of vitamin A–rich foods. Eighty-one households with a child between the ages of one and six years diagnosed with xerophthalmia (cases) and 81 households with an age-matched, non-xerophthalmic child (controls) were studied. There was little difference between case and control households in the size of their gardens. However, case households were significantly less likely to plant carotenoid-rich vegetables from October to March than were control households (odds ratio, 0.39; 95% confidence interval, 0.16 to 0.96). The mean consumption of non-carotenoid-rich vegetables, but not of carotenoid-rich vegetables, increased linearly with garden size. Case households were significantly more likely than control households to rent domesticated animals from others (χ...
Research Interests:
The Mortality (Pathway) Survey Manual describes a methodology for capturing quantitative and qualitative data on care giving and care seeking during a catastrophic illness (death). The methodology is based on a conceptual model for care... more
The Mortality (Pathway) Survey Manual describes a methodology for capturing quantitative and qualitative data on care giving and care seeking during a catastrophic illness (death). The methodology is based on a conceptual model for care seeking called the Pathway to Survival. The Pathway delineates all the steps that may occur during a child’s illness—the decisions made the different actors involved the care provided at home and in facilities and whether providers and care takers complied with recommendations and standards. By evaluating each of the steps in the Pathway the methodology can clarify the public health importance of different interventions and health sector investments. The Manual contains guidelines and all of the materials a survey planner will need for implementing a mortality (pathway) survey. From questionnaires to how to do the sampling or set up a mortality surveillance the manual contains materials and step by step instructions for doing the survey at national and district levels. (authors)
Research Interests:
Research Interests:
Research Interests:
OBJECTIVES: The objective of this study was to evaluate a 12-session home/community-based health promotion/obesity prevention program (Challenge!) on changes in BMI status, body composition, physical activity, and diet. METHODS: A total... more
OBJECTIVES: The objective of this study was to evaluate a 12-session home/community-based health promotion/obesity prevention program (Challenge!) on changes in BMI status, body composition, physical activity, and diet. METHODS: A total of 235 black adolescents (aged 11–16 years; 38% overweight/obese) were recruited from low-income urban communities. Baseline measures included weight, height, body composition, physical activity (PA), and diet. PA was measured by 7-day play-equivalent physical activity (≥1800 activity counts per minute). Participants were randomly assigned to health promotion/obesity prevention that is anchored in social cognitive theory and motivational interviewing and was delivered by college-aged black mentors or to control. Postintervention (11 months) and delayed follow-up (24 months) evaluations were conducted. Longitudinal analyses used multilevel models with random intercepts and generalized estimating equations, controlling for baseline age/gender. Stratifi...
Research Interests:
This article presents the results of applied ethnographic research aimed at developing a community-based diabetes prevention program in an isolated Ojibway-Cree community in northern Ontario. Using qualitative techniques, the authors... more
This article presents the results of applied ethnographic research aimed at developing a community-based diabetes prevention program in an isolated Ojibway-Cree community in northern Ontario. Using qualitative techniques, the authors describe diabetes in its sociocultural context and underlying belief systems that affect related activity and dietary behaviors. Local concepts of food and illness are dichotomized into "Indian" and "white man's" groupings, with Indian foods perceived as healthy and white man's foods felt to be unhealthy. Diabetes is believed to result from consumption of white man's "junk foods" (sugar, soda); some believe the disease can be avoided by eating traditional Indian foods such as game animals (moose, beaver, duck). While dietary linkages to diabetes are recognized, physical activity as a means of controlling obesity and decreasing the risk for diabetes is not part of the local ethnomedical model. This information is...
Research Interests:
Research Interests: Health Promotion, Focus Groups, Intrapersonal Communication, Health Education, Diet, and 15 morePublic Health, Medicine, Humans, Child, Guatemala, Smoking, Chronic Disease, Focus Group, Psychological Intervention, Risk factors, School health services, Adult, Risk Factors, Motor activity, and Interviews as topic
Research Interests:
Small food store interventions show promise to increase healthy food access in under-resourced areas. However, none have tested the impact of price discounts on healthy food supply and demand. We tested the impact of store-directed price... more
Small food store interventions show promise to increase healthy food access in under-resourced areas. However, none have tested the impact of price discounts on healthy food supply and demand. We tested the impact of store-directed price discounts and communications strategies, separately and combined, on the stocking, sales and prices of healthier foods and on storeowner psychosocial factors. Factorial design randomized controlled trial. Twenty-four corner stores in low-income neighbourhoods of Baltimore City, MD, USA. Stores were randomized to pricing intervention, communications intervention, combined pricing and communications intervention, or control. Stores that received the pricing intervention were given a 10-30 % price discount by wholesalers on selected healthier food items during the 6-month trial. Communications stores received visual and interactive materials to promote healthy items, including signage, taste tests and refrigerators. All interventions showed significant...
Research Interests:
Research Interests:
Research Interests:
Research Interests: Engineering, Biology, Diet, Developing Countries, Health, and 15 moreCarotenoids, Humans, Child, Food Consumption, Infant, Food Frequency Questionnaire, Fruit, Dietary Assessment, Food habits, Beta Carotene, Dietary pattern, Case Control Study, Case Control Studies, Child preschool, and Dietary intake
Research Interests: Program Evaluation, Health Promotion, Health Behavior, Food, Capacity Building, and 15 moreMedicine, Commerce, Humans, Program Development, Food supply, Baltimore, North Carolina, Minnesota, Philadelphia, Information Dissemination, Curriculum and Pedagogy, Environment Design, Nutrition Policy, Organizational case studies, and Administrative Personnel
Research Interests:
Community-based, quantitative studies of dietary intake by 5- to 28-months-old Nigerian children were conducted during episodes of diarrhoea and subsequent convalescent and healthy periods. Energy intakes during diarrhoea (85.3 kcal/kg... more
Community-based, quantitative studies of dietary intake by 5- to 28-months-old Nigerian children were conducted during episodes of diarrhoea and subsequent convalescent and healthy periods. Energy intakes during diarrhoea (85.3 kcal/kg per d) were slightly lower than during health (95.9 kcal/kg per d, P less than 0.05), using paired analysis of intra-individual differences. When intake was disaggregated by food source, no differences by illness status were found in energy intake from breast milk or liquid pap. There were no differences in frequency or duration of breastfeeding by illness status, but pap was provided more frequently and in smaller amounts during illness. Energy intake from other foods, including solids, was greater during health than diarrhoea (P less than 0.05) with an increase in number of servings per day. There was no evidence of caretakers either withholding food during illness or providing extra food during the convalescent phase. The magnitude of illness-assoc...
Research Interests:
Research Interests:
To improve diet and reduce risk for obesity and chronic disease, we developed, implemented and evaluated a pilot intervention trial with 23 large and small food stores in the Republic of the Marshall Islands (12 intervention, 11 control).... more
To improve diet and reduce risk for obesity and chronic disease, we developed, implemented and evaluated a pilot intervention trial with 23 large and small food stores in the Republic of the Marshall Islands (12 intervention, 11 control). The intervention included both mass media (radio announcements, newspaper ads, video) and in-store (cooking demonstrations, taste tests, shelf labeling) components. Consumer exposure to the mass media components was high (65% had heard half or more of the radio announcements, 74% had seen at least one of the newspaper ads). Consumer exposure to the in-store components of the intervention was moderate (61% attended at least one cooking demonstrations, 59% received at least one recipe card). After adjustment for age, sex and education level, increased exposure to the intervention was associated with higher diabetes knowledge (p<0.05) and label reading knowledge (p<0.05), but not with increased self-efficacy for performing promoted healthy behav...
Research Interests:
Community engagement efforts are key to the design of effective health promotion programs. We describe our partnership with a community organization as part of the formative research to inform the ...
Research Interests:
Research Interests:
Effective approaches for the prevention and reduction of obesity and obesity-related chronic diseases are urgently needed. Food store-centered programs represent one approach that may be both effective and sustainable. The authors... more
Effective approaches for the prevention and reduction of obesity and obesity-related chronic diseases are urgently needed. Food store-centered programs represent one approach that may be both effective and sustainable. The authors developed a food store-based intervention in the Marshall Islands using qualitative and quantitative formative research methods, including a store usage survey (n = 184) and in-depth interviews with large-store managers (n = 13), small-store managers (n = 7), customers (n = 10), and community leaders (n = 4). This process was followed up by development and piloting of specific intervention components and workshops to finalize materials. The final intervention combined mass media (newspaper articles, video, radio announcements) and in-store components (shelf labels, cooking demonstrations, posters, recipe cards) and had high store-owner support and participation. High levels of exposure to the intervention were achieved during the 10-week period of implemen...
Research Interests:
Research Interests: International Development, Biology, Developing Countries, Health, Early Childhood, and 15 moreHuman Nutrition, Factor analysis, Humans, Child, Female, Infant, Exploratory Factor Analysis, Infant feeding, European, Food habits, Food Sciences, Case Control Study, Case Control Studies, Child preschool, and Infant nutritional physiological phenomena
Research Interests:
ABSTRACT Public markets serve many consumers and play a role in the food environment, yet few studies have assessed the foods commonly offered in them. This study examined prepared food sources (PFSs; n = 100) at Baltimore&amp;#39;s... more
ABSTRACT Public markets serve many consumers and play a role in the food environment, yet few studies have assessed the foods commonly offered in them. This study examined prepared food sources (PFSs; n = 100) at Baltimore&amp;#39;s public markets by direct observations and gauged intention to sell healthy items through lease agreement review. A healthy food availability (HFA) score was created for standardized comparisons and 41% of PFSs scored below 1, indicating few healthier options. The findings suggest that urban public market PFSs currently offer few but showed intention to sell healthy items. Programs aimed to increase healthy food availability should include public markets.