My Child at mealtime parent self-assessment of food related behaviors: Validation with mealtime behaviors.

My Child at Mealtime (MCMT) is a visually enhanced, self-assessment tool designed to measure parent food related behaviors of low-income caregivers of preschool-aged children. The current study examined the factor structure of MCMT and the correspondence between MCMT parent- and child-centered food related behaviors with observed behaviors during a mealtime with their preschool aged child. Caregivers (N = 175) completed MCMT, and a subsample (n = 60) had a mealtime videotaped in their home. Exploratory and confirmatory factor analysis supported a two-factor structure resulting in parent-centered and child-centered MCMT subscales. There was a significant association between parent-centered MCMT scores and observed parent-centered behaviors at mealtime. Behavioral correspondence of MCMT child-centered behaviors was generally weaker. Overall, the findings suggest that caregivers' MCMT responses provide a valid measure of parent food related behaviors.

My child at mealtime: A visually enhanced self-assessment of feeding styles for low-income parents of preschoolers.

The importance of caregiver feeding styles on children's dietary outcomes is well documented. However, the instruments used to assess feeding style are limited by high literacy demands, making selfassessment with low-income audiences challenging. The purpose of the current study is to report on the development of My Child at Mealtime (MCMT), a self-assessment tool with reduced literacy demands, designed to measure feeding styles with parents of preschool-aged children. Cognitive interviews were conducted with 44 Head Start parents of 2-5 year old children to develop question wording and identify appropriate visuals. The resulting tool was administered to 119 ethnically diverse, low-income parents of 2-5 year old children. Factor analysis resulted in a two-factor structure that reflects responsiveness and demandingness in a manner consistent with existing assessment tools. Results indicate the final visually enhanced MCMT self-assessment tool provides a measure of parenting style consistent with existing measures, while reducing the literacy demand.

Vegetable behavioral tool demonstrates validity with MyPlate vegetable cups and carotenoid and inflammatory biomarkers.

Young children are not meeting recommendations for vegetable intake. Our objective is to provide evidence of validity and reliability for a pictorial vegetable behavioral assessment for use by federally funded community nutrition programs. Parent/child pairs (n=133) from Head Start and the Special Supplemental Nutrition Program for Women, Infants and Children [WIC] provided parent-administered vegetable tools, three child 24-hour diet recalls, child blood sample and measured heights/weights. The 10-item Focus on Veggies scale, with an alpha of .83 and a stability reliability coefficient of .74, was positively related to vegetables in cup equivalents [p≤.05]; dietary intakes of folate, vitamin C, ß-carotene, potassium and magnesium [p≤.05-.01]; and soluble fiber [p≤.001]. The child vegetable scores were related to the parent's mediators [p≤.00001] and vegetable behaviors [p≤.00001]. Children's plasma inflammatory markers were negatively related to the 10 item scale [p≤.05] and are indicators of the child's health status. The positive relationship between the serum carotenoid index and a sub-scale of child vegetable behaviors offered additional support for criterion validity [p≤.05]. Finally, the inverse relationship of BMI-for-age percentile one year post baseline and a sub-scale of child vegetable behaviors supported the predictive validity [p≤.05]. Focus on Veggies, a simple assessment tool, can inform practitioners about the child's health status. A child with a high score, shows a healthful profile with a lower inflammation index, higher carotenoid index, lower BMI and higher vegetable intake. In conclusion, validity of Focus on Veggies has been demonstrated using vegetable cup equivalents and micronutrient intakes, anthropometry and blood biomarkers.

Cross-Cultural Adaptation and Initial Validation of Mi Niño: A Tool to Measure Food-Related Parenting Practices of Spanish-Speaking Parents with Young Children.

Background: Accurate measurement of food-related parenting practices is necessary to inform related interventions and program evaluation. Valid tools reflect cultural attributes that affect household food environments and feeding practices. Simple, unidirectional language adaptation approaches are insufficient to capture these attributes in assessment tools. My Child at Mealtime (MCMT) is a 27-item, validated, visually enhanced self-assessment tool to measure food-related parenting practices of low-income English-speaking parents of preschoolers. Objectives: The aim of this study was to describe the cross-cultural adaptation of MCMT into its Spanish version Mi Niño a la Hora the Comer (Mi Niño) and to establish its face validity, factor structure, and internal consistency. Methods: MCMT was adapted into its Spanish version after an iterative process that triangulated cognitive interviews with verification of conceptual equivalence by content experts to establish face validity and semantic equivalence. The resulting tool underwent confirmatory factor analysis to determine whether internal consistency was equivalent across the 2 versions. Results: Four rounds of cognitive interviews (n = 5, n = 6, n = 2, and n = 4, respectively) with Spanish-speaking women caregivers of children aged 3-5 y recruited from Head Start were conducted. Ten items were modified throughout the adaptation process. Modifications included improved clarity (6 items), comprehension (7 items), appropriateness (4 items), suitability (4 items), and usefulness (2 items) of text and/or accompanying visuals. Confirmatory factor analysis with a sample of Spanish-speaking caregivers (n = 243) resulted in 2 reliable factors representing "child-centered" (α = 0.82) and "parent-centered" (α = 0.87) food-related parenting practices. Conclusions: Face validity, semantic equivalence, and internal consistency of Mi Niño were established. This tool can be used in community settings to inform program content and measure changes in food-related parenting practices of Spanish-speaking parents and assist in setting food-related parenting goals. The next steps include exploring the correspondence of Mi Nino with mealtime behaviors observed through video recording.

Obesity Risk Assessment for Spanish-Speaking Immigrant Families with Young Children in the United States: Reliability and Validity with Nutrient Values.

The purpose is to examine validity and reliability for an obesity risk assessment tool developed in Spanish for immigrant families with children, 3-5 years old using an 8-week cross-sectional design with data collected over 1 year at Head Start and Special Supplemental Nutrition Program for Women, Infants and Children [WIC]. Parent/child dyads (206) provided a child obesity risk assessment, three child modified 24 h dietary recalls, three child 36+ h activity logs and one parent food behavior checklist. Main outcome measures were convergent validity with nutrients, cup equivalents, and diet quality and three assessments of reliability that included item difficulty index, item discrimination index, and coefficient of variation. Validity was demonstrated for assessment tool, named Niños Sanos. Scales were significantly related to variables in direction hypothesized [p ≤ 0.05]: Healthy Eating Index, fruit/vegetable cup equivalents, folate, dairy cup equivalents, vitamins D, ß-carotene, fiber, saturated fat, sugar, time at screen/ sleep/physical activity and parent behaviors. Three measures of reliability were acceptable. The addition of nutrient values as an analytical validation approach adds strength and consistency to previously reported Niños Sanos validation results using children's blood biomarkers and body mass index. This tool can be used by health professionals as an assessment of obesity risk in several capacities: (1) screener for counseling in a clinic, (2) large survey, (3) guide for participant goal setting and tailoring interventions, and (4) evaluation.

Acculturation, physical activity and television viewing in Hispanic women: findings from the 2005 California Women's Health Survey.

OBJECTIVE: To assess the relationship of acculturation with physical activity and sedentary behaviours among Hispanic women in California. DESIGN: Data from the 2005 California Women's Health Survey (CWHS) - a cross-sectional telephonic survey of health indicators and health-related behaviours and attitudes - were used. SETTING: Using a random-digit dialling process, data were collected monthly from January to December 2005. SUBJECTS: A total of 1298 women aged ≥18 years in California who self-identified as Hispanic. RESULTS: Of the participants included in the analysis, 49 % were adherent to physical activity recommendations (with 150 min of weekly activity signifying adherence). There was no significant association between language acculturation and moderate or vigorous physical activity after controlling for potential confounders such as smoking, age and employment status. There was also no association between duration of residence in the USA and moderate or vigorous physical activity. Language acculturation was positively associated with television (TV) viewing, with highly acculturated women reporting more hours of TV viewing compared with women with an intermediate acculturation score (P = 0·0001), and those with an intermediate score reporting more hours of TV viewing compared with those with a low score (P = 0·003). This relationship persisted after inclusion of smoking, employment status, age and education in the model. CONCLUSIONS: Higher levels of language acculturation may be associated with increased sedentary behaviours because of the influence of US culture on those women who have assimilated to the culture. Acculturation is an important factor to be taken into account when designing health education interventions for the Hispanic female population.

Assessing factorial and convergent validity and reliability of a food behaviour checklist for Spanish-speaking participants in US Department of Agriculture nutrition education programmes.

OBJECTIVE: To assess convergent validity, factorial validity, test-retest reliability and internal consistency of a diet quality food behaviour checklist (FBC) for low-literate, low-income Spanish speakers. DESIGN: Participants (n 90) completed three dietary recalls, the Spanish-language version of the US Department of Agriculture (USDA) Household Food Security Survey Module (HFSSM) and the Spanish-language FBC. Factor structure was examined using principal component analysis. Spearman correlation coefficients between FBC item responses and nutrient intakes from 24 h recalls were used to estimate convergent validity. Correlation coefficients were also calculated between FBC item responses at two time points in another group of participants (n 71) to examine test-retest reliability. Cronbach's α coefficient was determined for items within each sub-scale. SETTING: Non-profit community agencies serving low-income clients, migrant farm worker camps and low-income housing sites in four California counties. SUBJECTS: Spanish-speaking women (n 161) who met income eligibility for the SNAP-Ed (Supplemental Nutrition Assistance Program-Education). RESULTS: Factor analysis resulted in six sub-scales. Responses to nineteen food behaviour items were significantly correlated with hypothesized 24 h recall data (with a maximum correlation of 0·44 for drinking milk and calcium) or the USDA HFSSM (0·42 with the food security item). Coefficients for test-retest reliability ranged from 0·35 to 0·79. Cronbach's α ranged from 0·49 for the diet quality sub-scale to 0·80 for the fruit and vegetable sub-scale. CONCLUSIONS: The twenty-two-item FBC and instruction guide will be used to evaluate USDA community nutrition education interventions with low-literate Spanish speakers. This research contributes to the body of knowledge about this at-risk population in California.

Feasibility of Colocating a Nutrition Education Program into a Medical Clinic Setting to Facilitate Pediatric Obesity Prevention.

PURPOSE: Within a medical clinic environment, pediatric obesity prevention education for families faces challenges. Existing long-term government-funded nutrition education programs have the expertise and staff to deliver. The purpose is to determine feasibility of colocating the Expanded Food and Nutrition Education Program (EFNEP) into a medical clinic setting to support pediatric obesity prevention. METHODS: Physicians from a large university teaching and research hospital (n = 73) and 4 small Medicaid-serving community clinics (n = 18) in the same geographic area in northern California were recruited and trained in the patient-referral protocol for a primary prevention intervention provided by EFNEP. The 8-week intervention deployed in the medical clinics, included general nutrition, physical activity and parenting topics anchored with guided goal setting and motivational modeling. Referral, enrollment, and attendance data were collected for 2 years. Parent and physician feasibility surveys, parent interviews and parent risk assessment tools were administered. Paired-sample t-test analysis was conducted. RESULTS: Twenty intervention series with parents of patients (n = 106) were conducted at 5 clinics. Physicians (n = 92) generated 686 referrals. Every 6 referrals generated 1 enrolled parent. Physicians (91%, n = 34) reported the intervention as useful to families. Parents (n = 82) reported improved child behaviors for sleep, screen time, physical activity, and food and beverage offerings (P < .0001) and at family mealtime (P < .001). Focus group interviews (n = 26) with 65 participants indicated that parents (97%) reacted positively to participating in the intervention with about a third indicating the classes were relevant to their needs. CONCLUSION: The intervention is a feasible strategy for the 5 medical clinics. Physicians referred and parents enrolled in the intervention with both physicians and parents indicating positive benefits. Feasibility is contingent upon physician awareness of the intervention and motivation to refer patients and additional EFNEP and clinic staff time to enroll and keep parents engaged.

Parent Food-Related Behaviors and Family-Based Dietary and Activity Environments: Associations with BMI z-Scores in Low-Income Preschoolers.

Background: In early childhood, the family dietary and activity environment and parent food-related practices have been found to be important predictors of children's weight. However, few studies account for both of these factors, or the interaction between the 2, when assessing BMI in early childhood. This study aims to examine the association between the family-based dietary and activity environment (including intake, physical activity, and structure) and children's BMI z-scores in the context of parent food-related behaviors in low-income families during the preschool years. Methods: Parents (n = 111) completed questionnaires assessing the family-based dietary and activity environment, including diet, physical activity, screentime and sleep, and their use of parent food-related behaviors including parent-centered (i.e., controlling) and child-centered (i.e., autonomy supportive) practices. Children's BMI z-scores were calculated from researcher-measured height and weight. Results: Parent-centered food-related behaviors were directly related to children's BMI z-scores and moderated the association between the family-based dietary and activity environment and children's BMI z-scores. Family-based behaviors were associated with lower BMI only when parents used fewer parent-centered behaviors. Conclusions: Findings indicate that programs working with low-income families to prevent child obesity should stress both the creation of a healthy home environment and the use of positive parent food-related behaviors with preschool aged children.

Obesity Risk Assessment Tool among 3-5 Year Olds: Validation with Biomarkers of Low-Grade Chronic Inflammation.

Background: Many families with young children practice nutrition, parenting, and lifestyle behaviors that set their children on trajectories for unhealthful weight gain. Potential adverse health effects of excessive body fat can result in the secretion of proinflammatory molecules and increased risk of inflammation and metabolic diseases. A pediatric obesity risk assessment tool named Healthy Kids (HK), demonstrated validity in a longitudinal study with child's measured BMI and 36-hour diet, screen, sleep, and activity logs. Our objective was to provide additional evidence of validity with low-income families with literacy issues using an inflammation index composed of four proinflammatory biomarkers. Methods: Parent/child pairs (n = 104) from Head Start and Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) provided HK, blood samples, and measured heights/weights. Select child inflammatory markers were discretized into two groups of HK scores. Data were analyzed with a mixed model adjusted for children's age and BMI. Results: A significant HK-time interaction effect was shown for the child inflammation index with two data collection points 1 year apart (pdid = 0.039). This index increased over 12 months in children with less healthful behaviors (p = 0.007), but not in children with more healthful profiles (p = 0.58). Conclusions: Children with less healthful HK scores had an elevated inflammation index indicating a low-grade chronic systemic inflammatory state. Taken together with our previously published findings, the HK tool has potential as a rapid and easy-to-administer assessment of the family environment and the child's obesity risk. HK can be useful for federal nutrition programs for evaluation, risk assessment, goal setting, and/or program planning in clinical and community environments.

Obesity Risk Assessment Tool for Low-Income Spanish Speaking Immigrant Parents with Young Children: Validity with BMI and Biomarkers of Obesity.

Children of Hispanic origin bear a high risk of obesity. Child weight gain trajectories are influenced by the family environment, including parent feeding practices. Excessive body fat can result in unhealthful metabolic and lipid profiles and increased risk of metabolic diseases. The objective was to estimate criterion validity of an obesity risk assessment tool targeting Spanish-speaking families of Mexican origin using anthropometric measures and blood values of their young children. A cross-sectional study design with five data collection sessions was conducted over an eight-week period and involved 206 parent/child dyads recruited at Head Start and the Special Supplemental Nutrition Program for Women, Infants and Children in Northern California. Main outcome measures were criterion validity of Niños Sanos, a pediatric obesity risk assessment tool, using anthropometric measures and blood biomarkers. Niños Sanos scores were inversely related to child BMI-for-age percentiles (p = 0.02), waist-for-height ratios (p = 0.05) and inversely related to blood biomarkers for the metabolic index (p = 0.03) and lipid index (p = 0.05) and positively related to anti-inflammatory index (p = 0.047). Overall, children with higher Niños Sanos scores had more healthful lipid, metabolic and inflammatory profiles, as well as lower BMI-for-age percentiles and waist-to height ratios, providing evidence for the criterion validity of the tool. Niños Sanos can be used by child obesity researchers, by counselors and medical professionals during clinic visits as a screening tool and by educators as a tool to set goals for behavior change.

Guided goal setting: effectiveness in a dietary and physical activity intervention with low-income adolescents.

OBJECTIVE: Determining the effectiveness of the guided goal setting strategy on changing adolescents' dietary and physical activity self-efficacy and behaviors. DESIGN: Adolescents were individually assigned to treatment (intervention with guided goal setting) or control conditions (intervention without guided goal setting) with data collected before and after the education intervention. SETTING: Urban middle school in a low-income community in Central California. PARTICIPANTS: Ethnically diverse middle school students (n = 94, 55% male) who were participants of a USDA nutrition education program. INTERVENTION: Driven by the Social Cognitive Theory, the intervention targeted dietary and physical activity behaviors of adolescents. MAIN OUTCOME MEASURES: Dietary self-efficacy and behavior; physical activity self-efficacy and behavior; goal effort and spontaneous goal setting. ANALYSIS: ANCOVA and path analysis were performed using the full sample and a sub-sample informed by Locke's recommendations (accounting for goal effort and spontaneous goal setting). RESULTS: No significant differences were found between groups using the full sample. Using the sub-sample, greater gains in dietary behavior (p < .05), physical activity behavior (p < .05), and physical activity self-efficacy (p < .05) were made by treatment participants compared to control participants. Change in physical activity behaviors was mediated by self-efficacy. CONCLUSIONS AND IMPLICATIONS: Accounting for goal effort and spontaneous goal setting, this study provides some evidence that the use of guided goal setting with adolescents may be a viable strategy to promote dietary and physical activity behavior change.

An Obesity Risk Assessment Tool for Young Children: Validity With BMI and Nutrient Values.

OBJECTIVE: Demonstrate validity and reliability for an obesity risk assessment tool for young children targeting families' modifiable home environments. DESIGN: Longitudinal design with data collected over 100 weeks. SETTING: Head Start and the Special Supplemental Nutrition Program for Women, Infants, and Children. PARTICIPANTS: Parent-child pairs (n = 133) provided food behavior assessments; 3 child-modified, 24-hour dietary recalls; 3 ≥ 36-hour activity logs; and measured heights and weights. MAIN OUTCOME MEASURE: Five measures of validity and 5 of reliability. RESULTS: Validity was excellent for the assessment tool, named Healthy Kids, demonstrating an inverse relationship with child body mass index percentile-for-age (P = .02). Scales were significantly related to hypothesized variables (P ≤ .05): fruit or vegetable cup equivalents; folate; vitamins A, C, and D; ß-carotene; calcium; fiber; sugar; screen, sleep, and physical activity minutes; and parent behaviors. Measures of reliability were acceptable. CONCLUSIONS AND IMPLICATIONS: Overall, children with higher Healthy Kids scores had a more healthful profile as well as lower body mass index percentiles-for-age 1.5 years later. Healthy Kids has potential for use by nutrition professionals as a screening tool to identify young children most at risk for excess weight gain, as an evaluation to assess intervention impact, and as a counseling tool to tailor intervention efforts. Future research should include validation in other settings and with other populations.

Brief psychosocial fruit and vegetable tool is sensitive for the US Department of Agriculture's Nutrition Education Programs.

The usefulness of an evaluation instrument is dependent on its reliability, validity, and ability to capture change. The latter psychometric characteristic is particularly important, yet is often neglected. The purpose of this study was to assess the sensitivity of a psychosocial fruit and vegetable evaluation tool for use by two US Department of Agriculture community-based programs. As part of a prospective randomized controlled trial, a sample of limited-resource women (n=93), recruited from eight counties, provided dietary recalls, behavioral assessments, and psychosocial assessments. A randomly selected subsample was used for venipuncture (n=55). Sensitivity of the tool was estimated using serum carotenoids, selected micronutrients, fruit/vegetable servings, and fruit/vegetable behaviors. Controlling for energy intake at baseline and change in energy intake, the change scores for the tool were correlated with reported changes in fruit and vegetable behaviors (r=0.28, P=0.01), vitamin C (r=0.25, P=0.02), and the biomarker serum carotenoids (r=0.31, P=0.02). This systematic process yielded a moderately sensitive evaluation tool useful with a limited-resource audience participating in two US Department of Agriculture programs. This is the first study to estimate sensitivity of a psychosocial tool for a fruit and vegetable intervention.

Evaluating food stamp nutrition education: process for development and validation of evaluation measures.

The purpose of this paper is to describe a process for developing and validating outcome measures relevant to dietary quality behaviors targeted by Food Stamp Nutrition Education (FSNE). The ultimate goal is a measure that is valid, reliable, sensitive to change, and practical for use for a wide variety of FSNE evaluation purposes. The development process has incorporated input from FSNE stakeholders at the federal and state level and follows a systematic, research-driven approach that incorporates both qualitative and quantitative research and includes methods for identification of subject domains, selection of evaluation items, initial pretesting, and reduction of items. This type of research establishes the trustworthiness of new evaluation measures.

Evaluation of a USDA nutrition education program for low-income youth.

OBJECTIVE: Examine effectiveness of a state's Youth Expanded Food and Nutrition Education Program (EFNEP) and assess the validity of the federal impact indicator method for reporting program outcomes. DESIGN: A randomized, controlled field trial of 229 groups with 5,111 youth, 9-12 years old, in community settings. INTERVENTION: 6- to 8- hour, 7-lesson education experience with food preparation and tasting, an education experience typical of EFNEP in California. OUTCOME MEASURES: US Department of Agriculture (USDA) impact indicators: nutrition knowledge, eating a variety of foods, food selection, and food preparation and safety practices. ANALYSIS: Analysis of covariance model controlling for pretest, gender, age, and ethnicity, with group nested in condition. RESULTS: Organizing responses by impact indicators, treatment participants made significant gains on the posttest compared to controls for 3 of 4 indicators (P < .008 to P < .0001). Gains were made by 34 to 68% of youth participants for 4 indicators. The impact indicator method for federal reporting compared favorably with results from a randomized controlled trial with groups nested in conditions. CONCLUSION AND IMPLICATIONS: This is the first report in the literature of (1) a large evaluation study of Youth EFNEP and (2) an estimate of the validity of the USDA impact indicator method for reporting program outcomes.

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.

Low mineral intake is associated with high systolic blood pressure in the Third and Fourth National Health and Nutrition Examination Surveys: could we all be right?

Analysis of the first National Health and Nutrition Examination Survey (NHANES) in 1984 revealed that a dietary pattern low in mineral intake, specifically calcium, potassium, and magnesium, was associated with hypertension in American adults. Using more recent survey data from NHANES III and NHANES IV, we re-examined the validity of this relationship. Blood pressure (BP) and nutrient intake data from 10,033 adult participants in NHANES III and 2311 adults in NHANES IV revealed findings similar to those of the earlier analysis, demonstrating that the association between inadequate mineral consumption and higher BP is valid and has persisted over two decades. Exploring this relationship further, we separated untreated hypertensive persons by hypertension type (systolic, diastolic, or both), and observed that the BP effect of low mineral intake was most pronounced in those with only systolic hypertension. We also observed that sodium intake was significantly lower in the systolic hypertension group and significantly higher in the diastolic hypertension group compared with the other groups. The nutrient pattern in the combined hypertension group was similar to that of the normotensive group. These findings may help to explain the inconsistent responses generally observed in dietary intervention studies, and they highlight the possible importance of tailored nutritional recommendations for hypertension based on hypertension category and individual dietary practices. Although randomized controlled trials are needed to characterize further the relationship between nutrient intake and hypertension type, these findings indicate that dietary management of hypertension may be more effective if the focus is on the overall nutritional profile rather than single-nutrient intake as currently recommended for most patients.

Development of a tool to assess psychosocial indicators of fruit and vegetable intake for 2 federal programs.

OBJECTIVE: Development of an evaluation tool of psychosocial constructs for use by participants in 2 federal programs, Food Stamp Nutrition Education and the Expanded Food and Nutrition Education Program. DESIGN: Cross-sectional data from a longitudinal study. PARTICIPANTS: Limited-resource women (n = 111) living in low-income communities. MEASURES: Test-retest reliability, internal consistency, ethnic differences, convergent validity. ANALYSIS: Spearman rank order correlation, analysis of variance, principal components analysis. RESULTS: Reliability coefficients ranged from a low of r = .18 (not significant) to r = .74 (P < .0001). Two items were deleted for not meeting criteria for reliability and 2 for redundancy. Ethnic differences at baseline were significant for 1 item. Domain constructs loaded on 4 to 5 factors for the biopsychosocial framework. Estimates of convergent validity of 9 constructs led to the deletion of 3 (ie, perceived barriers, social support, and perceived norms), with retention of perceived benefits, perceived control, self-efficacy, readiness to eat more fruit, readiness to eat more vegetables, and perceived diet quality. As an estimate of convergent validity, the final version of the tool with 6 constructs remaining showed significant correlations with indicators of diet quality: serum carotenoid values (r = .38, P < .001); hypothesized nutrients calculated from the mean of 3 24-hour dietary recalls (vitamin C, r = .47, P < .0001; vitamin A, r = .39, P < .0001; folate, r = .37, P < .0001; beta-carotene, r =.31, P < .001; and fiber, r = .46, P < .0001); fruit and vegetable servings (r = 0.55, P < .0001); Healthy Eating Index (r = .27, P < .05); and a fruit and vegetable behavioral scale (r = .60, P < .0001). CONCLUSION AND IMPLICATIONS: This systematic process yielded a fruit and vegetable evaluation tool useful for practitioners and researchers. This is the first validation study of this type to estimate convergent validity with 5 indicators of diet quality, including a biomarker.

Portrayals of food practices and exercise behavior in popular American films.

OBJECTIVE: To describe depictions of food, alcohol, and exercise and sport in popular films. DESIGN: Content analysis of the 10 top-grossing films each year from 1991 to 2000 (N = 100 films). ANALYSIS: Coding reliabilities were assessed with Cohen's kappa. Research questions were addressed with basic descriptive statistics. Associations among variables were examined through a cross-tabulation procedure that corrects for the clustering of exercise and food depictions within movies. RESULTS: Food and drink appeared regularly in the films analyzed, typically as a background element or prop. On average, food appeared on the screen once every 4.2 minutes. The foods shown were most likely to be fats, oils, and sweets; fruits, vegetables, and dairy products were rarely seen. More than 20% of the food items shown were alcoholic beverages, which were nearly 2 times more likely to be ingested as nonalcohol food items. Planned exercise and sports appeared at a rate of about 2 incidents per hour. These activities rarely received explicit evaluation by characters. CONCLUSIONS AND IMPLICATION: Films frequently portray foods and exercise. These depictions have the potential to cultivate beliefs about normative eating and exercise behavior, suggesting a need for public health professionals to encourage the media to offer healthier images.