Development of a tool to assess past food insecurity of immigrant latino mothers.

OBJECTIVE: The purpose is to describe the development and validation of a tool to measure the degree of past food insecurity in an immigrant US population. DESIGN: Focus group discussions and a structured interview. As a first step, focus group discussions were conducted among immigrant Latino mothers. Based on these discussions, an 8-item tool was developed and pilot-tested in a convenience sample of mothers. SETTING: California. PARTICIPANTS: Twenty-two low-income Latino mothers with children, ages 4 to 5 years, in the focus groups and 85 low-income Latino and white mothers of young children in the structured interviews. ANALYSES: Constant comparative analysis, Cronbach alpha, Spearman correlations, Chi-square, and Kruskal-Wallis test. RESULTS: Internal consistency of the remaining 7 items was good (Cronbach alpha = 0.84). Evidence of convergent validity included significant correlations between past food insecurity and maternal education (r = -0.45, p < .0001), crowding in the mother's childhood household (r = +0.30, p < .006), and past food insufficiency (r = +0.74, p < .0001). Foreign-born Latino mothers reported significantly greater levels of past food insecurity than US-born mothers, demonstrating discriminant validity (p < .01). CONCLUSIONS AND IMPLICATIONS: This tool may be useful to determine how past deprivation influences current food choices and other nutrition-related behaviors in low-income Latino immigrants.

A "contract for change" increases produce consumption in low-income women: a pilot study.

This study determined whether a "Contract for Change" goal-setting exercise enhanced the effectiveness of the Expanded Food and Nutrition Education/Food Stamp Nutrition Education programs to increase produce consumption in low-income (<130% of poverty) women after 4 weeks. Thirty-eight participants were randomized in this three-group parallel arm study: (a) control group participants received life-skills lessons, (b) the education group received the Expanded Food and Nutrition Education/Food Stamp Nutrition Education "Food Guide Pyramid" lessons, and (c) the contract group also received the "Food Guide Pyramid" series and completed a "Contract for Change." It was hypothesized that the contract group would have the greatest increases in advancement toward dietary change and produce consumption. Compared with controls, the contract group significantly moved toward acceptance of vegetable consumption (P < or = .05). Compared with the education group, the contract group significantly increased fruit consumption. Results suggest that nutrition professionals can effectively use goal-setting to assist low-income populations with dietary change.

A randomized trial of the Little by Little CD-ROM: demonstrated effectiveness in increasing fruit and vegetable intake in a low-income population.

INTRODUCTION: Research indicates that low fruit and vegetable intake is a risk factor for many chronic diseases. Despite large-scale education campaigns, the great majority of Americans do not consume recommended levels. We tested the ability of a single brief interactive experience of the Little by Little CD-ROM to increase fruit and vegetable intake in low-income women. METHODS: A randomized placebo-controlled, parallel-group trial included 481 low-income, female participants: mean age 50.1 years, 48.4% African American, 51.6% non-Hispanic white, and 92.5% below 185% of the federally designated poverty level. Participants received one of three conditions: 1) a one-time experience with the Little by Little CD-ROM, 2) the Little by Little CD-ROM plus two reminder telephone calls, or 3) a stress management CD-ROM (control condition). We assessed baseline and follow-up dietary intake with a modified 24-hour recall. RESULTS: Two months after the one-time experience with the CD-ROMs, both intervention groups reported significantly higher intakes of fruits and vegetables than the control group. The Little by Little group with reminder calls increased daily intake by 1.32 fruits/vegetables, an 86% greater increase than the control group (P = .016). The Little by Little group without reminder calls increased daily intake by 1.20 fruits/vegetables, a 69% greater increase than the control group (P = .052). Significantly greater movement in Stage of Readiness for Change also occurred in the Little by Little groups compared with the control group. CONCLUSION: The Little by Little CD-ROM may be useful in public health and clinical situations to increase fruit and vegetable intake.

Improving readability of an evaluation tool for low-income clients using visual information processing theories.

Literacy is an issue for many low-income audiences. Using visual information processing theories, the goal was improving readability of a food behavior checklist and ultimately improving its ability to accurately capture existing changes in dietary behaviors. Using group interviews, low-income clients (n = 18) evaluated 4 visual styles. The text plus color photographs style was preferred over the other 3 visual styles: text only, text plus black and white line drawings, and text plus gray-scale photographs. Employing cognitive interviewing in an iterative process, clients (n = 25) recommended simplifying text for 10 items, modifying content for 15 of 16 visuals, and replacing text with visual content for 7 of 16 items. Professional staff (n = 7) and educators (n = 10) verified that visuals and revised text accurately reflected the content of each item. Clients reported that the revised checklist captured their attention, added pleasure to the evaluation process, improved their understanding of the behaviors in question, and facilitated comprehension of text. Readability scores improved by more than 2 grades. This process can be duplicated by others interested in enhancing the quality of existing evaluation tools.