Students' perceptions of the impact of nutrition policies on dietary behaviors.

Poor dietary habits, rising rates of overweight students, and lack of oversight of vending contracts prompted the Los Angeles Unified School District (LAUSD) to develop and implement 2 of the most comprehensive nutrition policies in the country. The Healthy Beverage Resolution and Obesity Prevention Motion limit the types of and access to beverages and snacks on school campuses. This study used qualitative and quantitative methods to document the development, implementation, and impact of the LAUSD nutrition policies. Questionnaires were administered to 399 12th-grade students in 2 LAUSD high schools to determine knowledge of the policies, perceptions of the impact of the policies on student dietary behaviors, and attitudes toward the policies and the school nutrition environment. Over one half of all students indicated that the policies impacted the foods and beverages they consumed at school, whereas only about one fifth indicated the policies impacted what they ate or drank at home/outside of school. However, for those students who indicated the policies had an impact, they reported they ate or drank fewer of the banned items both at school and at home/outside of school. These results point to the need for additional research to determine if school policies impact student behaviors outside of the school setting. Removing unhealthy food items from schools may not be enough to improve student's overall dietary behaviors. A coordinated multilevel approach including nutrition education, physical education, and parental involvement along with policies and modifications in food service is recommended.

Improved speech perception in adult congenitally deafened cochlear implant recipients.

OBJECTIVE: To determine whether congenitally deafened adults achieve improved speech perception when auditory and visual speech information is available after cochlear implantation. STUDY DESIGN: Repeated-measures single subject analysis of speech perception in visual-alone, auditory-alone, and audiovisual conditions. SETTING: Neurotologic private practice and research institute. SUBJECTS: Eight subjects with profound congenital bilateral hearing loss who underwent cochlear implantation as adults (aged 18-55 years) between 1995 and 2002 and had at least 1 year of experience with the implant. MAIN OUTCOME MEASURES: Auditory, visual, and audiovisual speech perception. RESULTS: The median for speech perception scores were as follows: visual-alone, 25.9% (range, 12.7-58.1%); auditory-alone, 5.2% (range, 0-49.4%); and audiovisual, 50.7% (range, 16.5-90.8%). Seven of eight subjects did as well or better in the audiovisual condition than in either auditory-alone or visual-alone conditions alone. Three subjects had audiovisual scores greater than what would be expected from a simple additive effect of the information from the auditory-alone and visual-alone conditions alone, suggesting a superadditive effect of the combination of auditory-alone and visual-alone information. Three subjects had a simple additive effect of speech perception in the audiovisual condition. CONCLUSION: Some congenitally deafened subjects who undergo implantation as adults have significant gains in speech perception when auditory information from a cochlear implant and visual information by lipreading is available. This study shows that some congenitally deafened adults are able to integrate auditory information provided by the cochlear implant (despite the lack of auditory speech experience before implantation) with visual speech information.

A community health worker-led lifestyle behavior intervention for Latina (Hispanic) women: feasibility and outcomes of a randomized controlled trial.

BACKGROUND: Low-income Latinas (Hispanics) face risk for cardiovascular disease due to high rates of overweight/obesity, sedentary lifestyle, and other factors. Limited access to health care and language barriers may prevent delivery of health promotion messages. Targeted approaches, including the integration of community health workers, may be required to promote healthy lifestyle and prevent chronic disease in underserved ethnic minority groups. The term commonly used to refer to female community health workers in Latino communities is "promotora(s)." OBJECTIVES: This study evaluates the outcomes and feasibility of a promotora-led lifestyle behavior intervention for overweight, immigrant Latinas. METHODS: A community prevention model was employed in planning and implementing this study. A randomized controlled trial design was used. A Community Advisory Board provided expertise in evaluating feasibility of study implementation in the community and other important guidance. The sample was comprised of 223 women aged 35-64 years, predominantly with low income and ≤8th grade education. The culturally tailored Lifestyle Behavior Intervention included group education (8 classes based upon Su Corazon, Su Vida), followed by 4 months of individual teaching and coaching (home visits and telephone calls). The control group received a comparable length educational program and follow-up contacts. Evaluations were conducted at baseline and at 6 and 9 months using a dietary habits questionnaire, accelerometer readings of physical activity, and clinical measures (body mass index, weight, waist circumference, blood pressure, lipids, blood glucose). Data were collected between January 2010 and August 2012. RESULTS: Women in the intervention group improved significantly in dietary habits, waist circumference, and physical activity in comparison to those in the control group. A treatment dosage effect was observed for weight and waist circumference. Knowledge about heart disease increased. High attendance at classes and participation in the individual teaching and counseling sessions and high retention rates support the feasibility and acceptability of the promotora-led lifestyle behavior intervention. CONCLUSIONS: Our findings demonstrate that lifestyle behaviors and other risk factors of overweight Latina women may be improved through a promotora-led lifestyle behavior intervention. Feasibility of implementing this intervention in community settings and engaging promotoras as facilitators is supported.

Lexical and talker effects on word recognition among native and non-native listeners with normal and impaired hearing.

Evidence suggests that word recognition depends on numerous talker-, listener-, and stimulus-related characteristics. The current study examined the effects of talker variability and lexical difficulty on spoken-word recognition among four groups of listeners: native listeners with normal hearing or hearing impairment (moderate sensorineural hearing loss) and non-native listeners with normal hearing or hearing impairment. The ability of listeners to accommodate trial-to-trial variations in talkers' voice was assessed by comparing recognition scores for a single-talker condition to those obtained in a multiple-talker condition. Lexical difficulty was assessed by comparing word-recognition performance between lexically "easy" and "hard" words as determined by frequency of occurrence in language and the structural characteristics of similarity neighborhoods formalized in the Neighborhood Activation Model. An up-down adaptive procedure was used to determine the sound pressure level for 50% performance. Non-native listeners in both normal-hearing and hearing-impaired groups required greater intensity for equal intelligibility than the native normal-hearing and hearing-impaired listeners. Results, however, showed significant effects of talker variability and lexical difficulty for the four groups. Structural equation modeling demonstrated that an audibility factor accounts for 2-3 times more variance in performance than does a linguistic-familiarity factor. However, the linguistic-familiarity factor is also essential to the model fit. The results demonstrated effects of talker variability and lexical difficulty on word recognition for both native and nonnative listeners with normal or impaired hearing. The results indicate that linguistic and indexical factors should be considered in the development of speech-recognition tests.

Physical activity and cardiometabolic characteristics in overweight Latina women.

This community-based study examined physical activity (PA) in relation to cardiometabolic risk factors among 223 adult, immigrant Latina women who were overweight or obese. Participants were predominantly of Mexican descent, married and low-income. Data were obtained through accelerometer readings and clinical measures (e.g., BMI, waist circumference, blood pressure, lipid profile, fasting blood sugar). Findings showed that many women were active (mean step count = 8,575 ± 3,191); 27.6 % achieved 10,000 steps per day, and only 11 % were sedentary. They engaged in short bouts of moderate PA rather than long-sustained moderate-to-vigorous activity. Three or more MetS traits were present in 45.3 % of the women, raising concerns about risk for diabetes and cardiovascular disease. More active women had lower BMI, weight, waist circumference, and triglycerides levels. Results point to the importance of targeting maintenance of PA in active women and intervening with culturally tailored programs to promote healthier behavior in those who are sedentary or somewhat active.

CNE article: pain after lung transplant: high-frequency chest wall oscillation vs chest physiotherapy.

Background Chest physiotherapy and high-frequency chest wall oscillation (HFCWO) are routinely used after lung transplant to facilitate removal of secretions. To date, no studies have been done to investigate which therapy is more comfortable and preferred by lung transplant recipients. Patients who have less pain may mobilize secretions, heal, and recover faster. Objectives To compare effects of HFCWO versus chest physiotherapy on pain and preference in lung transplant recipients. Methods In a 2-group experimental, repeated-measures design, 45 lung transplant recipients (27 single lung, 18 bilateral) were randomized to chest physiotherapy (10 AM, 2 PM) followed by HFCWO (6 PM, 10 PM; group 1, n=22) or vice versa (group 2, n=23) on postoperative day 3. A verbal numeric rating scale was used to measure pain before and after treatment. At the end of the treatment sequence, a 4-item patient survey was administered to assess treatment preference, pain, and effectiveness. Data were analyzed with χ(2) and t tests and repeated-measures analysis of variance. Results A significant interaction was found between mean difference in pain scores from before to after treatment and treatment method; pain scores decreased more when HFCWO was done at 10 AM and 6 PM (P =.04). Bilateral transplant recipients showed a significant preference for HFCWO over chest physiotherapy (11 [85%] vs 2 [15%], P=.01). However, single lung recipients showed no significant difference in preference between the 2 treatments (11 [42%] vs 14 [54%]). Conclusions HFCWO seems to provide greater decreases in pain scores than does chest physiotherapy. Bilateral lung transplant recipients preferred HFCWO to chest physiotherapy. HFCWO may be an effective, feasible alternative to chest physiotherapy. (American Journal of Critical Care. 2013;22:115-125).

Couple-focused human immunodeficiency virus prevention for young Latino parents: randomized clinical trial of efficacy and sustainability.

OBJECTIVE: To evaluate the efficacy and sustainability of a couple-focused human immunodeficiency virus (HIV) prevention intervention in reducing unprotected sex and increasing intent to use condoms and knowledge about AIDS. DESIGN: Randomized controlled trial. SETTING: Urban community settings in Southern California. PARTICIPANTS: Primarily Latino couples (168 couples; 336 individuals) who were aged 14 to 25 years, English or Spanish speaking, and coparenting a child at least 3 months of age. INTERVENTION: A 12-hour theory-based, couple-focused HIV prevention program culturally tailored for young Latino parents, with emphasis on family protection, skill building, and issues related to gender and power. The 1½-hour control condition provided basic HIV-AIDS information. MAIN OUTCOME MEASURES: Primary outcome measures included self-report of condom use during the past 3 months; secondary, intent to use condoms and knowledge about AIDS. RESULTS: The HIV prevention intervention reduced the proportion of unprotected sex episodes (odds ratio, 0.87 per month from baseline to 6 months; 95% confidence interval [CI], 0.82-0.93) and increased intent to use condoms (slope increase, 0.20; 95% CI, 0.04-0.37) at the 6-month follow-up; however, these effects were not sustained at 12 months. Knowledge about AIDS was increased in both groups from baseline to 6 months (slope estimate, 0.57; 95% CI, 0.47-0.67) and was maintained in the intervention group only through 12 months. Female participants in both groups had higher intent to use condoms and knowledge about AIDS than male participants (P ≤ .01). CONCLUSIONS: The couple-focused HIV prevention intervention reduced risky sexual behaviors and improved intent to use condoms among young Latino parents at the 6-month evaluation. A maintenance program is needed to improve the sustainability of effects over time.

Parental protectiveness and unprotected sexual activity among Latino adolescent mothers and fathers.

Latino pregnant and parenting adolescents living in inner cities are one of the populations at risk for acquiring HIV. Although teen parenthood has been predominantly looked at with a focus on potential adverse physical, emotional, and socioeconomic outcomes for the mother and child; a growing body of literature has documented the strengths and resiliency of young parents. Respeto/Proteger: Respecting and Protecting Our Relationships is a culturally rooted couple-focused and asset-based HIV prevention program developed for young Latino parents. In this program, parental protectiveness (defined as the parent-child emotional attachment that positively influences parental behavior) is viewed as an intrinsic and developing critical factor that supports resiliency and motivates behavioral change. The primary purpose of this article is to describe the longitudinal randomized study evaluating the effect of this intervention on unprotected vaginal sex 6 months post intervention and to determine whether parental protectiveness had a moderating effect on the intervention. The unique features of our database allow for examination of both individual and couple outcomes.

Young parents' relationship characteristics, shared sexual behaviors, perception of partner risks, and dyadic influences.

Rising rates of heterosexually transmitted HIV among youth and young adults, particularly from ethnic minorities, create an urgent need to understand risk factors and perceptions of risk within the context of couple relationships. This study examined reports of young mothers and fathers (predominantly Latino) about background characteristics, relationship quality and length, HIV-related risk factors, and perceptions of partners' behaviors and personal history. Higher concordance was found for relationship characteristics and partners' personal history (e.g., incarceration) than on shared sexual behaviors. Most males and females stated that they were monogamous; however, those whose partners reported concurrency were unaware of this. Many were unaware of their partners' HIV testing status. Relationship quality was higher when females accurately perceived their partners' self-reported HIV-related risk behaviors. Length of the relationship did not influence concordance. Findings support the need for HIV prevention programs to promote open discussion about condom use and HIV testing within sexual partnerships.