Psychosocial measures used to assess the effectiveness of school-based nutrition education programs: review and analysis of self-report instruments for children 8 to 12 years old.

OBJECTIVE: To identify the psychometric properties of evaluation instruments that measure mediators of dietary behaviors in school-aged children. DESIGN: Systematic search of scientific databases limited to 1999-2010. MAIN OUTCOME MEASURES: Psychometric properties related to development and testing of self-report instruments for children 8-12 years old. ANALYSIS: Systematic search of 189 articles and review of 15 instruments (20 associated articles) meeting the inclusion criteria. Search terms used included children, school, nutrition, diet, nutrition education, and evaluation. RESULTS: Fourteen studies used a theoretical framework to guide the instrument's development. Knowledge and self-efficacy were the most commonly used psychosocial measures. Twelve instruments focused on specific nutrition-related behaviors. Eight instruments included over 40 items and used age-appropriate response formats. Acceptable reliability properties were most commonly reported for attitude and self-efficacy measures. Although most of the instruments were reviewed by experts (n = 8) and/or pilot-tested (n = 9), only 7 were tested using both rigorous types of validity and with low-income youth. CONCLUSIONS AND IMPLICATIONS: Results from this review suggest that additional research is needed to develop more robust psychosocial measures for dietary behaviors, for low-income youth audiences.

A content analysis of nutrition education curricula used with low-income audiences: implications for questionnaire development.

In developing recommendations for core measures/items for the evaluation of the Youth Expanded Food and Nutrition Education Program (EFNEP), three nutrition education curricula, implemented by land grant universities, were content analyzed. Selection criteria included the following: Curriculum content must include all EFNEP core content areas and must be implemented in more than one state with school children in third through fifth grades. Content analysis strategies were employed to identify and describe common areas/themes and mediators of behaviors addressed across the selected curricula. Content analysis coding was based on a list of behavioral mediators, which have empirical associations with nutrition, physical activity, and food safety. The most evident approaches identified across the three curricula were to enhance motivation, teach cognitive knowledge, and practice behavioral skills. The presence of self-regulation and environmental theory-based strategies was limited in all three curricula. In addition, multiple themes for nutrition, physical activity, and food safety were commonly addressed across curricula with multiple educational strategies. Based on these findings, recommendations for developing content appropriate measures and items for an outcome evaluation tool for Youth EFNEP are provided.

Diseño y evaluación de una intervención de orientación alimentaria en un grupo de migrantes de retorno a Yucatán, México / Development and assessment of nutrition education intervention in a group of migrants who returned to Yucatán, México

El objetivo de este trabajo fue diseñar y evaluar el efecto de una intervención de orientación alimentaria en un grupo de migrantes de retorno en el área rural de Yucatán, México. Se trabajó con 54 sujetos seleccionados a través de un muestreo no probabilístico entres comunidades del centro el Estado. Se desarrolló un material didáctico que constó de siete lecciones de nutrición en las cuales se incluyeron conceptos referidos en el Modelo Creencias en la Salud y la Teoría Social Cognitiva. Las lecciones se aplicaron a un grupo de intervención (n=27), teniendo otro como testigo(n=27). El efecto pre y post test de la intervención, fue evaluado mediante un cuestionario de conocimientos, cuyos datos se analizaron con la prueba de Wilcoxon. Para comparar las diferencias entre grupos, antes y después de intervención se utilizó el estadístico UMann-Whitney. La orientación alimentaria propició un incremento significativo (p < 0,05) en las calificaciones finales del grupo de intervención después de haber sido instruido. Así mismo, las puntuaciones de este grupo fueron superiores (p < 0,05) en el post test al compararlas con las del grupo testigo, lo cual demuestra la efectividad de la intervención (AU)

The aim of this work was to develop and evaluate the effect of a nutrition education intervention in a group of return migrants workers at rural areas of the State of Yucatán, México. The study included 54 subjects who were selected through non-probabilistic sampling in three communities in the center of the State. Didactic material was developed which consisted of seven lessons in nutrition including concepts mentioned in the Health Belief Model and the Social Cognitive Theory. The lessons were applied to an intervened group (n = 27), taking other as control (n = 27).The pre and post test effect of the intervention was evaluated using a questionnaire, which was tested statistically with the Wilcoxon test. To compare differences between groups before and after intervention Mann-Whitney U statistic test was used. The didactic material produced a significant increase (p < 0,05) in the knowledge ratings in the intervention group after being instructed. In addition, this group scores were higher (p < 0,05) in the post test when compared with the control group, demonstrating the effectiveness of the intervention (AU)

Evaluación del estado de salud y nutrición de un grupo de emigrantes de retorno a Yucatán, México / Assessment of health and nutritional status in a group of migrants returning to Yucatán, México

El objetivo de este trabajo fue realizar un diagnóstico del estado de salud y nutrición en un grupo de migrantes de retorno en el área rural de Yucatán. Ochenta y cuatro migrantes que regresaron de EE.UU., fueron seleccionados a través de un muestreo aleatorio con estratificación en tres comunidades del centro del Estado, en quienes se aplicaron métodos antropométricos, técnicas clínicas y encuestas dietéticas. Los resultados revelaron una media del IMC de 30,2 ± 4,8 kg/m2, correspondiendo a la clasificación de obesidad tipo I. Los datos hallados de circunferencia de cintura denotaron adiposidad central excesiva en la mayoría de los sujetos, donde el 66,7% presentó un perímetro de cintura mayor a los límites establecidos de alto riesgo. Las enfermedades cardiometabólicas de mayor presencia fueron la hipertrigliceridemia e hipertensión arterial con una prevalencia del 36,9% y 33,3%, respectivamente. Más del 50% de la muestra presentó una dieta de alta densidad energética y una desproporción en la ingesta de macro nutrimentos, sobresaliendo el consumo deficiente en proteínas y fibra dieté- tica, con exceso en la ingesta de colesterol y sodio, según la IDR. En conclusión, se puede considerar un grupo de riesgo nutricio de acuerdo a los problemas de peso, adiposidad central elevada y comorbilidades encontradas, así como, por el desequilibrio en el patrón alimentario hallado (AU)

The aim of this work was to diagnose the state of health and nutrition in a group of return migrants in rural areas of the State of Yucatán. Eighty-four migrants who returned of U.S., were selected through stratified random sampling in three communities in the center of the State, in whom anthropometric methods, clinical techniques and dietary surveys were applied. The results indicate a mean BMI of 30,2 ± 4,8 kg/m2 corresponding to a type I obesity. The data found on waist circumference denote excessive central adiposity in most subjects, so that 66,7% had a waist circumference greater than the limits of high risk. The prevalence of cardiometabolic diseases like hypertriglyceridemia and arterial hypertension was 36,9 and 33,3%, respectively. More than 50% of the sample presented a diet of high energy density and disproportion in the intake of macro nutrients; poor consumption in proteins and fiber with excess cholesterol and sodium intake according to DRI. In conclusion, it can be considered a nutritional risk group according to weight problems, high central adiposity and comorbidities encountered, as well for the imbalance in the dietary patterns found (AU)

"You had peas today?": a pilot study comparing a Head Start child-care center's menu with the actual food served.

This study explored the types of food served at a Head Start child-care center compared with that center's monthly menus. The study design was direct observation of the food provided by a Head Start center throughout the school day (Monday through Friday; 8:45 am to 2:30 pm) from January 4 to June 20, 2002, and analysis of this center's monthly menus. The numbers of meals directly observed for each type of meal service were: breakfast (n=96), lunch (n=95), and afternoon snack (n=78). These meals were compared with six monthly menus. Of the 269 meals and snacks compared, only three breakfast meals and an "ethnic day" matched the meals described on the provided menu. These findings illustrate that this center's menu was not consistently followed and therefore could not be used as an estimate of the preschoolers' intake or used as an educational or informational tool for parents/caregivers. Future research should verify how common these findings are among other Child and Adult Care Food Program child-care centers. Results may provide direction for development of the US Department of Agriculture's Child and Adult Care Food Program training for foodservice workers and educational materials focusing on menu development, appropriate substitutions, and the importance of using menus as a nutrition education tool.

Perceptions of older, low-income women about increasing intake of fruits and vegetables.

Focus groups were conducted with 28 older, low-income women in order to identify factors that affected their fruit and vegetable (F&V) consumption. Themes emerging from data analysis include barriers to making dietary changes, specifically to increasing F&V consumption; beliefs about benefits of consuming F&V as compared with other dietary changes; and use of supplements as a substitution for eating F&V. A prominent subtheme concerned the conflict women felt between their desire to consume more F&V and their desire not to waste food. Focus group participants gave concrete suggestions on how to help older, low-income women increase F&V consumption, which included environmental supports.

Consumption and perceptions of soy among low-income adults.

OBJECTIVE: To assess the consumption and perceptions of soy among low-income adults. DESIGN: A survey, which included demographic items, Likert scales for items on perceived benefits and barriers to soy consumption and factors that may increase soy consumption, and a soy food consumption frequency questionnaire. SUBJECTS/SETTING: A convenience sample of 353 adults enrolled in either the Pennsylvania Expanded Food and Nutrition Education Program or the Pennsylvania Food Stamp Nutrition Education Program. STATISTICAL ANALYSES: Descriptive statistics. RESULTS: Few participants (13%; n = 44) reported currently consuming soy foods. The percentage of respondents recognizing potential health benefits of soy ranged from 53% to 57%. The major barriers to soy consumption were a lack of knowledge on how to use soy (87%), cost (55%), and unavailability (45%). Participants indicated that education on how to use and incorporate soy into the diet (88%) and addition of soy into familiar foods (82%) may increase their soy consumption. APPLICATIONS/CONCLUSIONS: The findings suggest that this population would benefit from exposure to soy foods and instruction on preparing low-cost soy foods that can easily be included in their diet, in addition to education on the potential health benefits of soy foods. The results may provide direction for the development of curricula that educate this population on the potential benefits and uses of soy.

Dietary pattern change and acculturation of Chinese Americans in Pennsylvania.

OBJECTIVE: To obtain information about dietary pattern change of Chinese Americans in Pennsylvania and its relationship with demographic characteristics and acculturation indicators. DESIGN: A cross-sectional self-administered survey. SUBJECTS: A convenience sample of 399 Chinese Americans. Statistical analyses performed t Tests, analysis of variance with Tukey post-hoc tests, Spearman rank correlation, and chi(2) test. RESULTS: After immigration, Chinese Americans increased consumption frequency of all seven food groups (grains, vegetables, fruits, meat/meat alternatives, dairy products, fats/sweets, and beverages) and Western foods while consumption frequency of traditional Chinese foods decreased. Dietary variety also increased after immigration. Higher education and higher income levels were associated with a larger increase in consumption frequency of grains, vegetables, and fruits. Persons who resided in the United States for a longer period of time shared a greater increase in their consumption frequencies of vegetables, fats/sweets, and beverages. Persons with better English proficiency had a greater increase in their consumption frequency of grains, fruits, meat/meat alternatives, and fats/sweets. CONCLUSIONS: This study can help nutrition educators design appropriate educational programs for first-generation Chinese Americans that can facilitate the adoption of more healthful dietary practices. Nutrition educators should consider the dietary changes of Chinese-American participants, such as skipping breakfast and increased consumption frequency of fats, sweets, and soft drinks, which were observed in this study. For example, acculturated first-generation Chinese Americans should be encouraged to decrease fats, sweets, and soft-drink consumption. Less-acculturated persons should be encouraged to maintain their healthful dietary pattern and increase consumption of vegetables and fruits.