An Examination of Factors That Influence Receipt of Reproductive Health Screenings Among Female Veterans.

INTRODUCTION: As the number of women veterans grows, so does the need to ensure they receive timely health care, including preventive reproductive health screenings such as cervical cancer screenings and mammograms. However, little is known about the rates of reproductive health screenings among veterans and what factors may be related to screening. The objectives of this cross-sectional study were to (1) understand healthcare treatment-seeking experiences among women veterans, (2) determine the rate of adherence to screening guidelines for cervical and breast cancers, and (3) examine potential correlates of adherence to clinical reproductive health screening guidelines. MATERIALS AND METHODS: Women veterans completed an electronically administered survey, which assessed personal characteristics, psychological health symptoms, military service history, health insurance status, healthcare-seeking experiences (e.g., barriers to and satisfaction with care), and receipt of cervical and breast cancer screenings. Multivariable logistic regression identified factors associated with adherence to clinical guidelines for cervical and breast cancer screening. RESULTS: Of the 90 women (mean age = 38.78; SD = 12.19) who participated, 64 (71.10%) reported meeting all age-applicable screening guidelines. The most common barriers to obtaining women's healthcare were availability of convenient appointment times, finding time in your schedule to make and go to an appointment, and long wait times for appointments. Multivariable logistic regression revealed veterans without a regular women's health provider were less likely to adhere to guidelines than those with a regular provider (OR = 0.16; 95% CI, 0.04-0.57). DISCUSSION: Many women veterans are unable to receive reproductive health screenings; continued efforts are needed to determine how to increase adherence in this unique population.

Two-year outcomes of Faith in Action/Fe en Acción: a randomized controlled trial of physical activity promotion in Latinas.

BACKGROUND: Latina women are less likely to report engaging in leisure-time physical activity (PA) than non-Latina white women. This study evaluated the 24-month impact of a faith-based PA intervention targeting Latinas. METHODS: The study is a cluster randomized controlled trial of a PA intervention or cancer screening comparison condition, with churches as the randomization unit. A total of 436 Latinas (aged 18-65 years) from 16 churches who engaged in low levels of self-report and accelerometer-based PA were enrolled. The experimental condition was a 24-month PA intervention, with in-person classes, social support, and environmental changes, led by community health workers (i.e., promotoras). At baseline, 12-, and 24 months, we assessed changes in accelerometer-based and self-reported moderate to vigorous physical activity (MVPA; primary outcomes). Secondary outcomes were light intensity activity, sedentary time, body mass index (BMI), and waist circumference. RESULTS: After adjusting for sociodemographic factors, a mixed effects analysis found significant increases in self-reported leisure time MVPA (p < 0.005) and marginal increases in accelerometer-assessed MVPA (p < 0.08) 24 months post-baseline in the intervention compared to the attention-control condition. Data showed significant associations between PA class attendance and engaging in MVPA as assessed by self-report and accelerometry. No significant changes were found for light activity, sedentary time, BMI, or waist circumference. CONCLUSIONS: Participants who attended the PA classes at least once a month engaged in significantly higher MVPA compared to those who did not. Maximizing engagement and maintenance strategies to enhance PA maintenance could contribute to important long-term health benefits. TRIAL REGISTRATION: NCT01776632 , Registered March 18, 2011.

Process Evaluation of an Early Care and Education Intervention: The California Childhood Obesity Research Demonstration Study (CA-CORD).

Given the widespread use of out-of-home child care in the United States, early care and education (ECE) providers offer ideal settings to promote health behaviors among Hispanic/Latino children whose obesity prevalence remains high. This study details the process evaluation of ECE intervention strategies of a childhood obesity research demonstration study (California Childhood Obesity Research Demonstration [CA-CORD]) to prevent and control obesity among Hispanic/Latino children aged 2 to 12 years. Participating ECE providers received the Nutrition and Physical Activity Self-Assessment for Child Care (NAP SACC) materials and action planning sessions with a trained interventionist; Sports, Play, and Active Recreation for Kids (SPARK) physical activity (PA), health behavior, and body mass index assessment trainings; and health behavior toolkit, cooking kit, water dispensers, and posters to promote healthy eating, PA, water consumption, and quality sleep. Intervention logs and director/lead teacher interviews evaluated how well 14 center-based and 9 private ECE providers implemented policy, system, and environmental changes. NAP SACC was implemented with higher fidelity than other strategies, and participation in SPARK trainings was lower than health behavior trainings. ECE directors/lead teachers reported that the intervention activities and materials helped them promote the targeted behaviors, especially PA. Results demonstrated that the use of NAP SACC, trainings, and toolkit had high fidelity and were potentially replicable for implementation in ECE settings among Hispanic/Latino communities.

Family environment, children's acculturation and mothers' dietary intake and behaviors among Latinas: An autoregressive cross-lagged study.

BACKGROUND: Many Latinos in the U.S. do not meet dietary recommendations for healthy eating. Family systems theory posits that the family environment affects family members' dietary behaviors. Moreover, research suggests that children's acculturation is associated with Latina mothers' dietary intake and behaviors. PURPOSE: This longitudinal study examined the effect of the family environment on Latina mothers' dietary intake and behaviors. Further, we examined whether these effects differed between mothers of assimilated versus bicultural children. METHODS: Secondary data were collected at three time points (baseline, and four and 10 months' post-baseline) from 162 culturally traditional and bicultural Latina mothers residing in Imperial County, California, U.S. Participants were enrolled in the delayed treatment group of a randomized controlled trial. Mothers' daily fruit, vegetable, and sugary beverages intake, percent of calories from fat, weekly away-from-home eating, and percent of weekly grocery dollars spent on fruits and vegetables were examined. The family environment was measured by family expressiveness and family interactions around food. Separate autoregressive cross-lagged models examined the effects of the family environment on dietary outcomes, adjusting for sociodemographic variables. Interactions between the family environment and children's acculturation were also tested. RESULTS: Less positive family interactions around food at baseline predicted more frequent away-from-home eating four months later among mothers of assimilated children. More family expressiveness at four months predicted more grocery dollars spent on fruits and vegetables at ten months among mothers of bicultural children. CONCLUSIONS: Findings suggest the importance of a positive family environment on socially-bound dietary behaviors (e.g., away-from-home eating) exhibited by the mother. Family interventions aimed at improving dietary intake and associated behaviors should promote a positive family environment around food and consider the moderating role of children's acculturation.

Fe en Acción: Promoting Physical Activity Among Churchgoing Latinas.

OBJECTIVES: To evaluate the impact of a faith-based intervention to promote physical activity in Latinas. METHODS: We randomized 16 churches in San Diego County, California, to a physical activity intervention or cancer screening comparison condition (n = 436). The intervention followed an ecological framework and involved promotoras. We examined 12-month intervention effects, including accelerometer-based moderate-to-vigorous physical activity (MVPA; primary outcome) and secondary outcomes. We conducted the study from 2010 to 2016. RESULTS: Mixed effects analyses showed significant increases in accelerometer-based MVPA (effect size = 0.25) and self-report leisure-time MVPA (effect size = 0.38) among Latinas in the intervention versus comparison condition. Participants in the intervention condition had about 66% higher odds of meeting the 2008 Physical Activity Guidelines, had reduced body mass index (effect size = 0.23), and used more behavioral strategies for engaging in physical activity (effect size = 0.42). Program attendance was associated with increased self-reported leisure-time MVPA and the number of motivational interviewing calls was associated with meeting the 2008 Physical Activity Guidelines. CONCLUSIONS: A faith-based intervention was effective in increasing MVPA and decreasing body mass index among participants. Process analyses showed the value of program attendance and motivational interviewing calls.

Factors Affecting Implementation of the California Childhood Obesity Research Demonstration (CA-CORD) Project, 2013.

INTRODUCTION: Ecological approaches to health behavior change require effective engagement from and coordination of activities among diverse community stakeholders. We identified facilitators of and barriers to implementation experienced by project leaders and key stakeholders involved in the Imperial County, California, Childhood Obesity Research Demonstration project, a multilevel, multisector intervention to prevent and control childhood obesity. METHODS: A total of 74 semistructured interviews were conducted with project leaders (n = 6) and key stakeholders (n = 68) representing multiple levels of influence in the health care, early care and education, and school sectors. Interviews, informed by the Multilevel Implementation Framework, were conducted in 2013, approximately 12 months after year-one project implementation, and were transcribed, coded, and summarized. RESULTS: Respondents emphasized the importance of engaging parents and of ensuring support from senior leaders of participating organizations. In schools, obtaining teacher buy-in was described as particularly important, given lower perceived compatibility of the intervention with organizational priorities. From a program planning perspective, key facilitators of implementation in all 3 sectors included taking a participatory approach to the development of program materials, gradually introducing intervention activities, and minimizing staff burden. Barriers to implementation were staff turnover, limited local control over food provided by external vendors or school district policies, and limited availability of supportive resources within the broader community. CONCLUSION: Project leaders and stakeholders in all sectors reported similar facilitators of and barriers to implementation, suggesting the possibility for synergy in intervention planning efforts.

What influences Latino grocery shopping behavior? Perspectives on the small food store environment from managers and employees in San Diego, California.

To inform the design of a multilevel in-store intervention, this qualitative study utilized in-depth semistructured interviews with 28 managers and 10 employees of small-to-medium-sized Latino food stores (tiendas) in San Diego, California, to identify factors within the tienda that may influence Latino customers' grocery-shopping experiences and behaviors. Qualitative data analysis, guided by grounded theory, was performed using open coding. Results suggest that future interventions should focus on the physical (i.e., built structures) and social (i.e., economic and sociocultural) dimensions of store environments, including areas where the two dimensions interact, to promote the purchase of healthy food among customers.

Validation of the modified Parenting Strategies for Eating and Physical Activity Scale-Diet (PEAS-Diet) in Latino children.

Research shows that Latino parenting practices influence children's dietary and weight outcomes. Most studies use parent-reported data, however data from children may provide additional insight into how parents influence their children's diet and weight outcomes. The Parenting Strategies for Eating and Activity Scale (PEAS) has been validated in Latino adults, but not in children. This study evaluated the factor structure and concurrent and predictive validity of a modified version of the PEAS (PEAS-Diet) among Latino children. Data were collected from 361 children ages 7-13 from Imperial County, California, enrolled in a randomized controlled trial to promote healthy eating. The PEAS-Diet included 25 candidate items targeting six parenting practices pertaining to children's eating behaviors: (a) monitoring; (b) disciplining; (c) control; (d) permissiveness; (e) reinforcing; and (f) limit-setting. Children were on average ten years old (±2), 50% boys, 93% self-identified as Latino, 81% were US-born, and 55% completed English versus Spanish-language interviews. Using varimax rotation on baseline data with the total sample, six items were removed due to factor loadings <.40 and/or cross-loading (>.32 on more than one component). Parallel analysis and interpretability suggested a 5-factor solution explaining 59.46% of the variance. The subscale "limit-setting" was removed from the scale. The final scale consisted of 19 items and 5 subscales. Internal consistency of the subscales ranged from α = .63-.82. Confirmatory factor analyses provided additional evidence for the 5-factor scale using data collected 4 and 6 months post-baseline among the control group (n = 164, n = 161, respectively). Concurrent validity with dietary intake was established for monitoring, control, permissiveness, and reinforcing subscales in the expected directions. Predictive validity was not established. Results indicated that with the reported changes, the interview-administered PEAS-Diet is valid among Latino children aged 7-13 years.

Fe en Accion/Faith in Action: Design and implementation of a church-based randomized trial to promote physical activity and cancer screening among churchgoing Latinas.

OBJECTIVES: To describe both conditions of a two-group randomized trial, one that promotes physical activity and one that promotes cancer screening, among churchgoing Latinas. The trial involves promotoras (community health workers) targeting multiple levels of the Ecological Model. This trial builds on formative and pilot research findings. DESIGN: Sixteen churches were randomly assigned to either the physical activity intervention or cancer screening comparison condition (approximately 27 women per church). In both conditions, promotoras from each church intervened at the individual- (e.g., beliefs), interpersonal- (e.g., social support), and environmental- (e.g., park features and access to health care) levels to affect change on target behaviors. MEASUREMENTS: The study's primary outcome is min/wk of moderate-to-vigorous physical activity (MVPA) at baseline and 12 and 24 months following implementation of intervention activities. We enrolled 436 Latinas (aged 18-65 years) who engaged in less than 250 min/wk of MVPA at baseline as assessed by accelerometer, attended church at least four times per month, lived near their church, and did not have a health condition that could prevent them from participating in physical activity. Participants were asked to complete measures assessing physical activity and cancer screening as well as their correlates at 12- and 24-months. SUMMARY: Findings from the current study will address gaps in research by showing the long term effectiveness of multi-level faith-based interventions promoting physical activity and cancer screening among Latino communities.

Baseline Depressive Symptoms, Completion of Study Assessments, and Behavior Change in a Long-Term Dietary Intervention Among Breast Cancer Survivors.

BACKGROUND: Depressive symptoms can lower adherence and change in dietary studies. Behavioral activation may reduce these effects. PURPOSE: This study aims to assess relationships among depressive symptoms on adherence and dietary change in the Women's Healthy Eating and Living (WHEL) Study METHODS: Secondary analyses from the WHEL Study, which achieved major dietary change in breast cancer survivors (N = 2817), were conducted. Logistic regressions were undertaken of baseline depressive symptoms (six-item Center for Epidemiologic Studies Depression Scale (CES-D)) with (1) completion of 1- and 4-year study assessments and (2) validated change in dietary behavior in the intervention group. RESULTS: In the comparison group (vs. intervention), depressive symptoms lowered completion of dietary recalls and clinic visits [4 years: odds ratio (OR) = 2.0; 95 % confidence interval (CI) = 1.4-3.0]. The behaviorally oriented intervention achieved major change in those furthest from study targets, although changes were lower in those with depressive symptoms: fruit/vegetable (+37.2 %), fiber (+49.0 %), and fat (-22.4 %). CONCLUSIONS: Behavioral activation in dietary change interventions can overcome the impact of depressive symptoms.

Food and physical activity environments: an energy balance approach for research and practice.

Increases in the prevalence of overweight and obesity are a function of chronic, population-level energy imbalance, whereby energy intakes exceed energy expenditures. Although sometimes viewed in isolation, energy intakes and expenditures in fact exist in a dynamic interplay: energy intakes may influence energy expenditures and vice versa. Obesogenic environments that promote positive energy balance play a central role in the obesity epidemic, and reducing obesity prevalence will require re-engineering environments to promote both healthy eating and physical activity. There may be untapped synergies in addressing both sides of the energy balance equation in environmentally focused obesity interventions, yet food/beverage and physical activity environments are often addressed separately. The field needs design, evaluation, and analytic methods that support this approach. This paper provides a rationale for an energy balance approach and reviews and describes research and practitioner work that has taken this approach to obesity prevention at the environmental and policy levels. Future directions in research, practice, and policy include moving obesity prevention toward a systems approach that brings both nutrition and physical activity into interdisciplinary training, funding mechanisms, and clinical and policy recommendations/guidelines.

Evidence supporting a promotora-delivered entertainment education intervention for improving mothers' dietary intake: the Entre Familia: Reflejos de Salud Study.

Entertainment education and the promotora model are 2 evidence-based health communication strategies. This study examined their combined effect on promoting healthy eating among mothers in a family-based intervention. Participants were 361 Mexican-origin families living in Imperial County, California, who were randomly assigned to an intervention or delayed treatment condition. The intervention involved promotoras (community health workers) who delivered 11 home visits and 4 telephone calls. Home visits included a 12-minute episode of a 9-part situation comedy depicting a family struggling with making healthy eating choices; an accompanying family workbook was reviewed to build skills and left with the family. Baseline and immediate postintervention data were collected from the mothers, including the primary outcome of daily servings of fruits and vegetables. Other dietary and psychosocial factors related to healthy eating were examined. At postintervention, mothers in the intervention reported increases in daily vegetable servings (p ≤ .05); however, no changes were observed in fruit consumption. Improvements were observed in behavioral strategies to increase fiber (p ≤ .001) and to decrease fat intake (p ≤ .001), unhealthy eating behaviors (p ≤ .001), and individual (p ≤ .05) and family-related (p ≤ .01) perceived barriers to healthy eating. Entertainment education and promotoras engaged families and improved mothers' diets. Further research should examine the dose needed for greater changes.

The influence of family functioning on the consumption of unhealthy foods and beverages among 1- to 12-y-old children in Victoria, Australia.

OBJECTIVE: Family functioning, which reflects how well family members communicate and interact with each other, is associated with childhood overweight and obesity, but its association with children's eating behaviors remains unclear. The aim of this study was to examine the association between family functioning and unhealthy food and beverage consumption among children ages 1 to 12 y old. METHODS: As part of the Victorian Child Health and Wellbeing study, a random sample of 4602 caregivers of children completed an interview during a single telephone interview in 2006. Caregivers reported on their child's consumption of three types of unhealthy foods and beverages, and responses were recoded into weekly consumption of potato crisps and chips, monthly consumption of takeaway foods, and daily consumption of sweet beverages. Family functioning included general functioning (α = 0.89) and parental psychological distress (α = 0.78). RESULTS: Consumption of potato crisps and chips occurred, on average, twice a week, while takeaway foods were consumed an average of three times per month. Consistently and controlling for other covariates, male caregivers had children who consumed takeaway foods more frequently and who drank more daily cups of sweet beverages. Caregiver education and living in a single-parent household were consistently associated with poorer eating habits. In all models, general family functioning and parental psychological distress were associated with poorer eating habits. CONCLUSIONS: In addition to traditional methods for improving diet, family-based interventions need to target more general aspects of the family's and caregiver's functioning to improve dietary intake.

Social network characteristics associated with health promoting behaviors among Latinos.

OBJECTIVE: This study examined the relationship between social network characteristics and health promoting behaviors (having a routine medical check-up, consuming no alcohol, consuming no fast food, and meeting recommendations for leisure-time physical activity and sleep duration) among Latinos to identify potential targets for behavioral interventions. METHOD: Personal network characteristics and health behavior data were collected from a community sample of 393 adult Latinos (73% women) in San Diego County, California. Network characteristics consisted of size and composition. Network size was calculated by the number of alters listed on a name generator questionnaire eliciting people with whom respondents discussed personal issues. Network composition variables were the proportion of Latinos, Spanish-speakers, females, family, and friends listed in the name generator. Additional network composition variables included marital status and the number of adults or children in the household. RESULTS: Network members were predominately Latinos (95%), Spanish-speakers (80%), females (64%), and family (55%). In multivariate logistic regression analyses, gender moderated the relationship between network composition, but not size, and a health behavior. Married women were more likely to have had a routine medical check-up than married men. For both men and women, having a larger network was associated with meeting the recommendation for leisure-time physical activity. CONCLUSION: Few social network characteristics were significantly associated with health promoting behaviors, suggesting a need to examine other aspects of social relationships that may influence health behaviors.

Food-group and nutrient-density intakes by Hispanic and Latino backgrounds in the Hispanic Community Health Study/Study of Latinos.

BACKGROUND: Hispanics are a heterogeneous group of individuals with a variation in dietary habits that is reflective of their cultural heritage and country of origin. It is important to identify differences in their dietary habits because it has been well established that nutrition contributes substantially to the burden of preventable diseases and early deaths in the United States. OBJECTIVE: We estimated the distribution of usual intakes (of both food groups and nutrients) by Hispanic and Latino backgrounds by using National Cancer Institute methodology. DESIGN: The Hispanic Community Health Study/Study of Latinos is a population-based cohort study that recruited participants who were 18-74 y of age from 4 US cities in 2008-2011 (Miami, Bronx, Chicago, and San Diego). Participants who provided at least one 24-h dietary recall and completed a food propensity questionnaire (n = 13,285) were included in the analyses. Results were adjusted for age, sex, field center, weekend, sequencing, and typical amount of intake. RESULTS: Overall, Cubans (n = 2128) had higher intakes of total energy, macronutrients (including all subtypes of fat), and alcohol than those of other groups. Mexicans (n = 5371) had higher intakes of vitamin C, calcium, and fiber. Lowest intakes of total energy, macronutrients, folate, iron, and calcium were reported by Dominicans (n = 1217), whereas Puerto Ricans (n = 2176) had lowest intakes of vitamin C and fiber. Food-group servings reflected nutrient intakes, with Cubans having higher intakes of refined grains, vegetables, red meat, and fats and Dominicans having higher intakes of fruit and poultry, whereas Puerto Ricans had lowest intakes of fruit and vegetables. Central and South Americans (n = 1468 and 925, respectively) were characterized by being second in their reported intakes of fruit and poultry and the highest in fish intake in comparison with other groups. CONCLUSION: Variations in diet noted in this study, with additional analysis, may help explain diet-related differences in health outcomes observed in Hispanics and Latinos.

Family support is associated with behavioral strategies for healthy eating among Latinas.

BACKGROUND: Healthy eating is important for obesity control. Dietary interventions target the adoption of behavioral strategies to increase fiber and decrease fat consumption. However, little is known about the contributions of psychosocial factors to the use of these strategies. PURPOSE: This study examined psychosocial correlates of behavioral strategies for healthy eating among Latinas. METHOD: Participants included 361 Latino mothers living along the U.S.-Mexico border in California. Data included measures of sociodemographics, acculturation, and psychosocial determinants of healthy eating. A 30-item dietary behavioral strategies scale assessed strategies to increase fiber and decrease fat consumption. RESULTS: Family interactions regarding dietary habits (ß = .224, p < .001) and financial status (ß = .148, p = .029) were associated with the use of strategies to decrease fat consumption. Positive family interactions regarding dietary habits (ß = .226, p < .001), fewer barriers to obtaining fruits and vegetables (ß = -.207, p < .001), and more family support for vegetable purchasing (ß = .070, p = .047) were associated with use of strategies to increase fiber consumption. CONCLUSIONS: Future interventions would benefit from improving family systems associated with healthy eating.

Efficacy of a store-based environmental change intervention compared with a delayed treatment control condition on store customers' intake of fruits and vegetables.

OBJECTIVE: The present store-based intervention was designed to promote sales of fruits and vegetables (F&V) to increase intake among store customers--specifically customers of tiendas, small-to-medium-sized Latino food stores. DESIGN: Four tiendas were randomized to a 2-month environmental change intervention or a delayed treatment control condition. Employees and managers were trained to promote F&V sales, including how to implement a food marketing campaign and installing store equipment to promote fresh fruits and vegetables. The primary outcome was self-reported daily intake of F&V among a convenience sample of customers (at least forty per store) collected at baseline prior to randomization and then 4 months later. In addition, changes in availability of F&V in the tiendas, using unobtrusive observational methods, provided evidence of intervention fidelity. SETTING: Tiendas in central North Carolina. SUBJECTS: Participants included 179 customers who were recent immigrants from Mexico and Central America. RESULTS: A group-by-time interaction approached significance on daily servings of F&V; intervention customers reported an increase in F&V intake over time and as a function of the intervention (P < or = 0.06). Unexpectedly, self-efficacy for consuming more fruits (P < or = 0.01) and more vegetables (P < or = 0.06) decreased. In our store-level analyses, a group-by-time interaction was observed for availability of fresh and canned vegetables; the intervention increased availability of vegetables but not fruit. CONCLUSIONS: Environmental change strategies to promote healthy eating are needed given the rates of obesity and diabetes in the Latino population. A store-based intervention was moderately effective at increasing customers' reported F&V intake. Such strategies can have a public health impact on underserved populations.

Targeting children's dietary behaviors in a family intervention: 'Entre familia: reflejos de salud' / Enfoque en hábitos alimenticios de los hijos en una intervención familiar: 'Entre familia: reflejos de salud'

Objective. This intervention sought to promote healthy eating with the ultimate goal of reducing childhood obesity risk. Materials and methods. Three hundred and sixty-one Latino families living on the US-Mexico border with at least one child between 7-13 years of age were eligible to participate. Families randomly assigned to the four-month intervention received 14 contacts with a promotora (community health worker), consisting of 11 home visits and three telephone calls; the control condition was a delayed treatment intervention. Children reported on their dietary intake at baseline, immediately post-intervention and at the six month follow-up visit. Results. The intervention reduced weekly consumption of fast food (p<0.05). A dose-response relationship was observed such that for every seven hours of promotora contact, monthly variety of fruits (p<0.01) and vegetables (p<0.01) increased by one. No other intervention effects were observed. Conclusions. Family-based interventions can improve children's eating habits, with the amount of contact with the promotora being key to success.

Objetivo. Promover una alimentación saludable con el objetivo final de reducir el riesgo de obesidad infantil. Material y métodos. Trescientas sesenta y una familias latinas que viven en la frontera de EU y México, y que cuentan con por lo menos un hijo entre 7 y 13 años, fueron elegibles para participar. Las familias asignadas al azar a la intervención de cuatro meses tuvieron contacto 14 veces (11 visitas familiares y tres llamadas telefónicas) con una promotora; el grupo de control recibió el tratamiento de intervención al final del programa. Los niños reportaron su ingesta alimenticia al inicio, inmediatamente después de la intervención y en la visita de seguimiento a los seis meses. Resultados. La intervención redujo el consumo semanal de comida rápida (p<0.05). Se observó una relación dosis-respuesta tal que por cada siete horas de contacto con la promotora, la variedad mensual de frutas (p<0.01) y verduras (p<0.01) tuvo un incremento de uno. No se observaron otros efectos de intervención. Conclusiones. Las intervenciones basadas en la familia pueden mejorar los hábitos alimenticios de los niños, siendo la cantidad de contacto con la promotora clave para el éxito.

Engaging community businesses in human immunodeficiency virus prevention: a feasibility study.

PURPOSE: To explore the feasibility of engaging community businesses in human immunodeficiency virus (HIV) prevention. DESIGN: Randomly selected business owners/managers were asked to display discreetly wrapped condoms and brochures, both of which were provided free-of-charge for 3 months. Assessments were conducted at baseline, mid-program, and post-program. Customer feedback was obtained through an online survey. SETTING: Participants were selected from a San Diego, California neighborhood with a high rate of acquired immune deficiency syndrome. PARTICIPANTS: Fifty-one business owners/managers who represented 10 retail categories, and 52 customers. MEASURES: Participation rates, descriptive characteristics, number of condoms and brochures distributed, customer feedback, business owners'/managers' program satisfaction, and business owners'/managers' willingness to provide future support for HIV prevention were measured. ANALYSIS: Kruskal-Wallis, Mann-Whitney U, Fisher's exact, and McNemar's tests were used to analyze data. RESULTS: The 20 business owners/managers (39%) who agreed to distribute condoms and brochures reported fewer years in business and more employees than those who agreed only to distribute brochures (20%) or who refused to participate (41%; p < .05). Bars were the easiest of ten retail categories to recruit. Businesses with more employees and customers distributed more condoms and brochures (p < .05). More than 90% of customers supported distributing condoms and brochures in businesses, and 96% of business owners/managers described their program experience as positive. CONCLUSION: Businesses are willing to distribute condoms and brochures to prevent HIV. Policies to increase business participation in HIV prevention should be developed and tested.

Factors associated with asthma management self-efficacy among 7th and 8th grade students.

OBJECTIVE: Examine correlates of asthma self-management among 12,154 adolescents with physician-diagnosed asthma. METHODS: All 7th and 8th grade students in North Carolina completed a survey to assess asthma prevalence and self-management behaviors among those with asthma. RESULTS: Adolescents who were allowed to carry their inhaled medication at school, shown how to use a peak flow meter, and had access to more asthma care resources were more confident that they could prevent an asthma exacerbation. Adolescents who were allowed to carry their inhaled medication at school and who had a private doctor were more confident that they could control their symptoms. Adolescents taking anti-inflammatory medicine were less confident that they could prevent an exacerbation and control their symptoms. CONCLUSIONS: Various indicators of autonomy and control were associated with greater self-efficacy for managing asthma. Adolescents who require anti-inflammatory medicines would benefit from additional intervention efforts to improve their asthma management self-efficacy.