SisterTalk: final results of a culturally tailored cable television delivered weight control program for Black women.

BACKGROUND: Obesity among Black women continues to exceed that of other women. Most weight loss programs created without reference to specific cultural contexts are less effective for Black than White women. Weight control approaches accessible to Black women and adapted to relevant cultural contexts are important for addressing this problem. This paper reports the final results of SisterTalk, the randomized controlled trial of a cable TV weight control program oriented toward Black women. METHODS: A five group design included a comparison group and a 2 × 2 factorial comparison of a) interactive vs. passive programming and b) telephone social support vs no telephone support, with 12 weekly initial cable TV programs followed by 4 monthly booster videos. At baseline, 3, 8, and 12 months post randomization, telephone and in person surveys were administered on diet, physical activity, and physical measurements of height and weight were taken to calculate body mass index (BMI). Analysis of variance (ANOVA) was used to examine differences over time, and between treatment and comparison groups. Dose variables reflecting use of the TV/video and written materials were also assessed. RESULTS: At 3 months, BMI, weight, and dietary fat were significantly lower and physical activity significantly higher among women exposed to the Cable TV intervention compared to the wait-list comparison group. Significant dietary fat differences were still observed at 8 and 12 month evaluations, but not BMI or physical activity differences. Main effects were not observed for interactive programming or enhanced social support at any time point. Within the intervention group, higher watching of the TV series and higher reading of educational materials were both (separately) associated with significantly lower dietary fat. CONCLUSIONS: Cable TV was an effective delivery channel to assist Black women with weight control, increasing physical activity and decreasing dietary fat during an initial intervention period, but only dietary changes persisted Enhanced social support and the ability to interact with others during the show were not effective complementary intervention components as conducted in this trial. Future research to strengthen the ability of this approach to achieve long term effects may offer even more promising outcomes.

Association of perceived racial discrimination with eating behaviors and obesity among participants of the SisterTalk study.

The purpose of this study was to assess the association of perceived racial discrimination with emotional eating behaviors, weight status, and stress levels among obese African-American women, who volunteered to enter a weight control study (SisterTalk) in the New England region of the United States. The sample of women was taken from the baseline data of participants in SisterTalk, a randomized, controlled trial of a cable TV-delivered weight control program. Using the Krieger instrument, telephone and in-person surveys were used to assess perceived discrimination, emotional eating behaviors, and stress. Height and weight were measured to calculate BMI in order to assess weight status. ANOVA models were constructed to assess the association of discrimination with demographics. Correlations were calculated for discrimination, stress, emotional eating, and weight variables. ANOVA models were also constructed to assess discrimination with emotional eating, after adjusting for appropriate demographic variables. Perceived discrimination was associated with education and stress levels but was not associated with weight status (BMI). The frequency of eating when depressed or sad, and eating to manage stress, were both significantly higher among women who reported higher perceived discrimination and higher stress levels. Discrimination may contribute to stress that leads to eating for reasons other than hunger among African-American women, although the causal direction of associations cannot be determined with cross sectional data. Associations of discrimination with weight status were not found, although it is likely that emotional eating behaviors related to perceived discrimination are unhealthy. Future research should examine these relationships more closely in longitudinal studies.

Effectiveness of different methods for delivering tailored nutrition education to low income, ethnically diverse adults.

BACKGROUND: Computer-tailored written nutrition interventions have been shown to be more effective than non-tailored materials in changing diet, but continued research is needed. Your Healthy Life/Su Vida Saludable (YHL-SVS) was an intervention study with low income, ethnically diverse, English and Spanish-speaking participants to determine which methods of delivering tailored written nutrition materials were most effective in lowering fat and increasing fruit and vegetable (F&V) intake. METHODS: YHL-SVS was a randomized controlled trial with four experimental conditions: 1) Nontailored (NT) comparison group; 2) Single Tailored (ST) packet; 3) Multiple Tailored (MT) packet mailed in four installments; 4) Multiple Re-Tailored (MRT) MT packets re-tailored between mailings via brief phone surveys. A baseline telephone survey collected information for tailoring as well as evaluation. Follow-up evaluation surveys were collected 4- and 7-months later. Primary outcomes included F&V intake and fat related behaviors. Descriptive statistics, paired t-test and ANOVA were used to examine the effectiveness of different methods of delivering tailored nutrition information. RESULTS: Both the ST and MT groups reported significantly higher F&V intake at 4-months than the NT and MRT groups. At 7 months, only the MT group still had significantly higher F&V intake compared to the NT group. For changes in fat-related behaviors, both the MT and MRT groups showed more change than NT at 4 months, but at 7 months, while these differences persisted, they were no longer statistically significant. There was a significant interaction of experimental group by education for change in F&V intake (P = .0085) with the lowest educational group demonstrating the most change. CONCLUSION: In this study, tailored interventions were more effective than non-tailored interventions in improving the short-term dietary behaviors of low income, ethnically diverse participants. Delivery of information in multiple smaller doses over time appeared to improve effectiveness. Future studies should determine which variables are mediators of dietary change and whether these differ by participant demographics. Moreover, future research should differentiate the effects of tailoring vs. cultural adaptation in ethnically diverse populations and study the dissemination of tailored interventions into community-based settings. TRIAL REGISTRATION: Current Controlled Trials # NCT00301691.

Body satisfaction effect on thorough skin self-examination.

BACKGROUND: Melanoma and obesity have both increased in recent years. Given the propensity of body dissatisfaction among the obese, the objectives of this paper were to determine how body satisfaction might influence skin examination and to examine differences in this relationship by gender among the participants of Check-It-Out, a study to increase thorough skin self-examination (TSSE). METHODS: Through primary care offices, 2126 participants were recruited from April 2000 to November 2001 for the baseline cross-sectional telephone data from the Check-It-Out study. TSSE was defined as the self-reported examination of all seven key areas of the body. Body satisfaction was reported based on the degree of disagreement or agreement with the statement I like the way my body looks. Analyses were conducted in 2005 and 2006. RESULTS: Among participants, 18% reported performing TSSE, 34% were normal or underweight, 36% were overweight, and 30% were obese. Overall, 23% strongly agreed, 45% somewhat agreed, 19% somewhat disagreed, and 12% strongly disagreed with the statement I like the way my body looks. Body satisfaction was less common among women than men. The odds of conducting TSSE were 1.6 for the total sample (1.9 for women and 1.2 for men) for those with strong agreement that they like the way their body looks. In multivariate analysis, body satisfaction was associated with TSSE performance for women and both genders together, along with the availability of a partner (both genders together and men), the availability of a wall mirror, the advice of a physician, and the use of glasses or contacts(women only). CONCLUSIONS: Body satisfaction is an important factor in TSSE performance, especially among women, and should be considered along with other risk factors.

Assessing fat-related dietary behaviors among black women: reliability and validity of a new Food Habits Questionnaire.

OBJECTIVE: To describe the development of the SisterTalk Food Habits Questionnaire (STFHQ). DESIGN: Formative research was conducted to adapt previous tools for the study's target population. A pilot tool (168 questions) was tested. The new 94-question tool was then used for evaluation of the SisterTalk project. Lastly, a 4-week reliability calibration study of the revised STFHQ was conducted in comparison with a food frequency questionnaire (FFQ). ANALYSIS: Reliability was assessed using test-retest correlations. Validity was assessed by correlations between STFHQ scores with FFQ calculated calories, total fat (g) and percentage of calories from fat. Three scoring methods (ie, introductory, product, and detail) were calculated along with inclusion or exclusion of dining out questions and alternate methods of scoring for food items not consumed. RESULTS: Reliability (correlation) was 0.87. Inclusion of dining out questions and imputation of zero for food items never consumed were more highly associated with fat intake than other scoring methods. The introductory score was most highly correlated with fat (g), whereas the product and detail scoring methods correlated highest with percentage of calories from fat. Responsiveness to the SisterTalk intervention was highest with the detail score. CONCLUSIONS AND IMPLICATIONS: The STFHQ is a reliable and valid tool that may be useful for evaluating dietary change for black women.

Effect of a web-based curriculum on primary care practice: basic skin cancer triage trial.

BACKGROUND AND OBJECTIVES: Primary care physicians (PCPs) are uniquely positioned to detect melanoma. Effective educational interventions targeted at PCPs may improve early melanoma detection. A previous in-person Basic Skin Cancer Triage (BSCT) 2-hour course demonstrated significant short-term improvement in provider practices, attitudes, ability, confidence, and knowledge. We conducted a randomized trial to test the efficacy of the BSCT course implemented as a web-based learning program, compared to a similar (control) web-based course on weight assessment. METHODS: We recruited a sample of 57 PCPs and 3,341 of their patients from four geographically diverse centers. Skin cancer control activities by PCPs were assessed by physician survey and by chart review and patient telephone interview about their recent visit to their PCP at baseline and at 1--2 months and 12 months after course completion. RESULTS: Some effect of intervention on skin cancer parameters was self-reported by physicians; this was not confirmed by patient survey or chart-extracted data. Rates of skin cancer control practices by PCPs were low across both groups before and after intervention. The positive changes in physician-reported behaviors (total body skin examination [TBSE]), intentions (discuss skin cancer detection), confidence (performing TBSE), office practices, and knowledge (58% skin versus 49% control) were neither matched by differences in practice reported by their patients, nor persisted in a longer term follow-up, hence may be attributable to physician recall bias due to the experience of the course or desire to please study investigators and were less dramatic as compared to our previously reported in-person BSCT intervention. Thus this approach by itself appears unlikely to result in improved PCP handling of skin cancer issues. CONCLUSIONS: Given previous success with our in-person course, the features required to make WBL a more effective tool for medical education must be further explored.

How is food insecurity associated with dietary behaviors? An analysis with low-income, ethnically diverse participants in a nutrition intervention study.

Food insecurity has been associated with lower nutrient intake as well as lower intake of fruits and vegetables. However, little is known about the association of food insecurity and dietary behaviors, including food choices and preparation methods. This study examines the relationship between food insecurity and dietary behaviors of low-income adults (N = 1,874; 55% Hispanic) who completed the baseline telephone survey for a nutrition education study. From April 2003 to August 2004, data were collected on demographics and food-security status and validated dietary measures: fruit and vegetable screener and Food Habits Questionnaire were used to assess fat-related behaviors (food choices or preparation methods that lead to an increase or decrease in fat intake). χ² tests were conducted to compare each demographic variable by food-security status. Univariate linear regression models examined dietary variables by food-security status in univariate models initially, then in multivariable models adjusting for demographics. Half of participants reported food insecurity. Food Habits Questionnaire scores were significantly greater in the food-insecure group, reflecting a higher fat intake (P < 0.05). Fruit (with juice) intake was significantly greater in the food-insecure participants reflecting increased juice intake (P < 0.05). Food-insecure individuals reported a higher juice intake and a lower frequency of fat-lowering behaviors. Future interventions with food-insecure individuals should include nutrition education as well as efforts to increase access and availability to healthier foods. Further qualitative and quantitative research is needed on the relationship between diet and food insecurity.

Dietary behaviors and portion sizes of black women who enrolled in SisterTalk and variation by demographic characteristics.

OBJECTIVE: To describe the dietary behaviors of black women who enrolled in the SisterTalk weight control study. DESIGN: Baseline data collected via telephone survey and in-person screening. SETTING: Boston, Massachusetts and surrounding areas. PARTICIPANTS: 461 black women completed the baseline assessments. MAIN OUTCOME MEASURES: Measured height and weight; self-reported demographics, risk factors, and dietary variables including fat-related eating behaviors, food portion size, and fruit, vegetable, and beverage intake. ANALYSIS: Analysis of variance (ANOVA) models with food habits questionnaire (FHQ) scores as the dependent variable and demographic categories as the independent variables; ANOVA models with individual FHQ item scores as the dependent variable and ethnic identification as the independent variable. RESULTS: More than 60% reported eating < 5 servings of fruits and vegetables/day. Self-reported portion sizes were large for most food items. Older age, being born outside the United States, living without children, and being retired were significantly associated with a higher prevalence of fat-lowering behaviors. The frequency of specific fat-lowering behaviors and portion size also differed by ethnic identification. CONCLUSIONS AND IMPLICATIONS: The findings support the need for culturally appropriate interventions to improve the dietary intake of black Americans. Further studies should examine the dietary habits, food preparation methods, and portion sizes of diverse groups of black women.

Birth order and breastfeeding initiation: results of a national survey.

BACKGROUND: Because of numerous health benefits for both mothers and babies, breastfeeding is the recommended method of infant feeding. We sought to determine the association between birth order and breastfeeding practices in families with multiple children. METHODS: The 2002 National Survey of Family Growth was used to analyze the demographic characteristics of a national probability sample of 2,115 U.S. mothers aged 15 to 44 with two, three, four, and five or more children younger than age 19. In-person, computer-assisted interviews were conducted by trained female interviewers. The main variable of interest was birth order; the main outcome measure was breastfeeding initiation for each mother-child pair. We used multiple logistic regression models to determine the demographic predictors of breastfeeding the second child in families with two children. RESULTS: Mothers with two, three, four, and five or more children breastfed all of their children 52.6%, 48.4%, 44.7%, and 57.1% of the time, respectively (p = 0.46). In families with multiple children, more than 70% of women made the same feeding choice for each of their children, whether it was breastfeeding or bottlefeeding. After controlling for demographic factors, Hispanic women and women with more than a high school education were significantly more likely to breastfeed their second child if they had breastfed the first child. CONCLUSION: U.S. mothers are likely to choose the same feeding method for each of their children, independent of the number of children they have. Breastfeeding promotion must take into consideration previous infant feeding experiences, if any.

Duration of breastfeeding among first-time mothers in the United States: results of a national survey.

AIM: To determine the characteristics of primiparous women who breastfeed for only short periods of time. METHODS: The 2002 National Survey of Family Growth was used to analyze the characteristics of a national probability sample of 3229 first-time US mothers aged 15 to 44 y with children ages 1 to 18 y old, 1960 of whom breastfed. Main outcome measures in the cross-sectional study included breastfeeding at birth and at 3 mo as determined by in-person, computer-assisted interviews conducted by trained female interviewers. RESULTS: Sixty-two percent of first-time mothers with singleton live births initiated any breastfeeding and 36% were still breastfeeding at 3 mo. Those who were older, married, and at higher educational levels were significantly more likely to continue breastfeeding beyond 3 mo. These same demographic factors were associated with differences in breastfeeding rates both early (within the first week of life) and consistently over the first 3 mo. In multivariate analyses, only educational level remained as a predictor of breastfeeding. CONCLUSION: Targeted breastfeeding interventions for young, single, less-educated women are warranted in a culturally sensitive context, both prenatally and immediately postpartum, to improve the duration of breastfeeding among first-time mothers in the US.