-
[show abstract]
[hide abstract]
ABSTRACT: This project investigated influences (environmental, personal, and behavioral) on body mass index (BMI) and acculturation of Hmong children born in the United States (US) using the social cognitive theory as the theoretical framework. Using formative information from 12 child focus groups (n = 68) and a review of the literature, a quantitative survey was developed and administered to Hmong children (n = 300) ≥ 9 ≤ 18 years-old. Heights, weights, and acculturation level were measured. B-US(1) were raised in the US and 9-13 years-old (n = 144) and B-US(2) were raised in the US and 14-18 years-old (n = 156). Approximately 50 % of children were classified as overweight/obese (BMI ≥ 85th percentile). Across age and gender sub-groups, questions from the environmental construct appeared to be the most predictive of variances in BMI percentiles (50-60 %). In contrast, acculturation scores were equally predicted by environmental, behavioral, and personal constructs for age and gender sub-groups. Sum acculturation score was significantly higher for B-US(2) compared to B-US(1), with B-US(2) being more acculturated in language use and thought, overall dietary acculturation, and foods eaten at lunch. The high prevalence of obesity in Hmong children suggests that future studies investigate factors influencing obesity to identify the most effective method to reduce/prevent this problem. In particular, acculturation level of the child should be assessed to determine changed dietary behavior and possible risk for obesity.
Maternal and Child Health Journal 02/2013; · 2.24 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Determine how dietary acculturation, anthropometric measures (height, weight, circumferences, and skinfolds), body mass index (BMI), and waist hip ratios (WHRs) are associated with blood pressure (BP) measures in Hmong children living in Minnesota.
Acculturation was measured using responses to questions regarding language usage, social connections, and diet. Dietary assessment was completed using the multiple-pass 24-h dietary recall method on two different days. Anthropometric and BP measurement were taken using standard procedures, and BMI and WHR were calculated. Data analyses included descriptive statistics, ANOVA, and stepwise regression analyses.
Using stepwise regression analysis, hip circumference (HC) predicted boys' systolic (S)BP (R(2) = 0.55). For girls' SBP, mid-upper arm circumference, WHR, low calcium consumption, and height percentile jointly explained 41% of the total variation. Mid upper arm circumference (MAC) and carbohydrate consumption predicted 35% of the variance for boys' diastolic (D)BP, and HC, dairy consumption, and calcium intake predicted 31% of the total variance for girls' DBP. Responses to dietary acculturation questions revealed between group differences for breakfast with half of the younger Born-Thailand/Laos (Born-T/L) consuming mostly Hmong food, while at dinner Born-US consumed a mixed diet and Born-T/L were more likely to consume Hmong food.
Dietary acculturation and body composition predict Hmong children's BP.
American Journal of Human Biology 07/2012; 24(5):666-74. · 2.27 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The objective of this study was to examine how language contraction, acculturation, and perception of modernity impact medicinal practices among younger and older generations of Hmong. Focus groups were conducted with newly immigrated and well established Hmong adults (n = 69) and children (n = 68) in St. Paul/Minneapolis, MN, USA. Dominant themes were language contraction and cultural loss, with subthemes on household dynamics, the educational system, and Western versus traditional Hmong medicinal practices. As younger generations acculturate to the United States (US) environment, there is potential for a restructuring of their medical culture resulting in a loss or silencing of pertinent cultural information regarding traditional medicine and therapies. The information from this study will be useful for educators, community leaders and health professionals to better understand changes occurring within the Hmong culture as traditions and cultural practices acculturate to the US environment.
Journal of Immigrant and Minority Health 06/2012; · 1.16 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Qualitative and quantitative methods were used to investigate how shopping behaviors and environment influence dietary intake
and weight status among homeless Minnesotans living in food deserts. Seven focus groups (n=53) and a quantitative survey (n=255), using the social cognitive theory as the theoretical framework, were conducted at two homeless shelters (S1 and S2)
in the Twin Cities area. Heights, weights, and 24-h dietary recalls were also collected. Food stores within a five-block radius
of the shelters were evaluated for the price and availability of foods and compared to the Thrifty Food Plan’s market basket
prices (MBP). Results showed that almost 80% of the sample was overweight or obese, with women consuming less than the recommended
level for the fruits, vegetables, and milk food groups and excess for the fats/oils/sweets food group. Focus groups and participant
surveys indicated that the shelter infrastructure and surrounding community influenced the types of foods available, food
store access, and the foods purchased and consumed. Participants relied on food assistance programs, including food stamps,
to supplement their food supply; however, some felt the high food prices at neighboring stores limited food choice and that
food stamps did not adequately cover food costs. Results from the food store survey found the majority of food prices exceeded
Midwest or national MBP. To promote healthier dietary intake and weight status, community-based interventions and city planners
should aim to increase access to food through improved food availability and food access within the shelter environment and
surrounding community.
KeywordsHomeless-Food access-Shopping-Dietary behavior-Food deserts-Obesity
Agriculture and Human Values 04/2012; 27(2):141-161. · 1.54 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Hmong are one of the immigrant Asian subgroups with increasing rates of obesity, type 2 diabetes and CVD. Despite their population growth in the USA and declining health status, no research has investigated the appropriateness of dietary assessment measures, including FFQ and 24 h dietary recalls among Hmong. The present study compared the nutrient information obtained through a 24 h dietary recall method with that collected using the Block Kid's Food Frequency Questionnaire (Block FFQ) among Hmong-American children (n 335) of 9-18 years of age. For this purpose, two 24 h dietary recalls were collected during non-consecutive days and averaged for comparison. The Block FFQ was administered on the day of the second 24 h recall and the two methodologies were also compared using t tests. Among all children, Block FFQ nutrient estimates for vitamin A, vitamin C and food group servings for vegetables and fruits were significantly higher than those assessed through the 24 h dietary recalls (P < 0·001). Nutrient estimates for protein and food group servings for grains and meat and beans were significantly higher among all participants when assessed through the 24 h dietary recalls than through the Block FFQ (P < 0·05). The results suggest that the Block FFQ does not appear to be a good measure of protein, grain, and meat and bean intake among Hmong children of 9-18 years of age, and the 24 h dietary recall offers a better account of the Hmong diet and is inclusive of ethnic food options otherwise missed in the Block FFQ. We recommend the modification of the current Block FFQ to appropriately reflect cultural food/beverage items of the population in interest.
The British journal of nutrition 04/2012; · 3.45 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Explore how urban and rural Minnesotans access the food system and to investigate whether community infrastructure supports a healthful food system.
Eight (4 urban and 4 rural) focus groups were conducted.
Eight counties with urban influence codes of 1, 2, 4, 5, 8, and 10. Fifty-nine (urban, n = 27; rural, n = 32) adults. The sample was of mixed race and had a range of incomes. Almost half of the sample was obese.
Food systems access and the role of community infrastructure, civic engagement, and reciprocal relationships in food provisioning in counties with different urban influence codes.
Themes and subthemes were identified through emerging concepts.
Food access varied based on rurality and community infrastructure. Three themes emerged: community infrastructure around the conventional food system and food provisioning, alternative food resources, and perceptions of the effect food and of the influence diet and exercise have on health.
Civic engagement and community infrastructure affected food access. Rural residents rely more on retail grocery stores, gardening, hunting, and informal food exchange systems, whereas urban residents rely more on the retail grocery stores and food safety net systems. Hunting and gardening may contribute valuable nutrients to the diet.
Journal of nutrition education and behavior 11/2011; 43(6):492-504. · 1.36 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: OBJECTIVE: The Hmong are a growing population of South-East Asian immigrants with increasing rates of obesity and diabetes, yet little is known about their dietary consumption patterns. The present study aimed to investigate the dietary intake of Hmong children and whether acculturation and/or time lived in the USA influences dietary intake, BMI and nutritional status. DESIGN: Two 24 h dietary recalls were collected on non-consecutive days using the multiple-pass interviewing method and were averaged. Heights and weights were measured, from which BMI was calculated. An acculturation score was computed. SETTING: Schools, churches, Hmong organizations, and community centres. SUBJECTS: Three hundred and thirty-five Hmong children aged 9-18 years from Twin Cities, Minnesota, USA. RESULTS: Approximately half of our participants were either overweight or obese. US-born children were significantly heavier, taller, had a higher BMI, and in general consumed more energy, saturated fat and Na than those who were born in Thailand/Laos and were living in the USA for <5 years. Children who were more acculturated to US norms including language use, social connections and dietary habits had higher BMI-for-age and consumed significantly more saturated fat, trans fatty acids, Na and Ca compared with their less acculturated counterparts. CONCLUSIONS: Diets of most Hmong children appear below the recommendations for fibre, vitamins A, D and E, Ca, P, Mg and K, and are higher in fats, sugars and Na. Living in an obesogenic US environment is a probable reason for poor dietary quality of Hmong and may be a contributing factor to the rising rates of obesity and diabetes in this population.
Public Health Nutrition 08/2011; · 2.17 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: To examine racial/ethnic differences in relationships between food-related environmental, behavioral and personal factors and low-income women's weight status using Social Cognitive Theory (SCT) as a framework.
Cross-sectional survey.
Community sites and low-income housing developments in the Twin Cities metropolitan area.
Low-income African-American, American Indian, and Caucasian women ≥18 years old (n = 367).
Participants completed a survey including demographic, food security, and theoretically based questions. Heights and weights were measured to determine body mass index (BMI).
Data were split by race/ethnicity and reduced by examining Pearson coefficients for SCT survey questions significantly correlated with BMI (p < .05). Separate environmental, behavioral, and personal multiple linear regression models for each racial/ethnic group were run to explore the proportion of variance in BMI explained by each SCT construct and which questions were significant predictors.
All regression models were statistically significant, although the personal regression models predicted the greatest proportion of the variance in BMI for African-American (15% of the variance), American Indian (22% of the variance), and Caucasian women (37% of the variance).
Effective nutrition education and intervention efforts to control the obesity epidemic among urban, low-income women may call for a tailored approach with noted consideration of their racial/ethnic identity. Although broader changes to the food environment are necessary, the importance of addressing personal factors such as nutrition knowledge, self-efficacy, and emotional coping responses to stress, in the context of income constraints, food insecurity, and health beliefs, is also implicated.
American journal of health promotion: AJHP 07/2011; 25(6):e1-e10. · 2.37 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: After immigrating to the United States (US), obesity and diabetes have increased among the Hmong. Therefore, this study investigated how Hmong children perceive health and diabetes risk so that appropriate interventions may be planned. Hmong children (N = 335), ages 9-18 years participated in this study. A survey used Social Cognitive Theory (SCT) as the theoretical framework and silhouette drawing instrument. Heights and weights were measured and body mass indexes (BMIs) were calculated. About half of the children were either overweight (BMI ≥ 85th < 95th percentile) or obese (BMI ≥ 95th percentile). About 75% chose average sized silhouettes as healthiest and heaviest silhouettes as diabetic shape. Environmental influences including food availability, parents, and media influenced children's health perceptions. Results suggest a need for culturally appropriate interventions, aiming towards a child's environment and educating them about risks associated with obesity and diabetes.
Journal of Immigrant and Minority Health 06/2011; 13(3):470-7. · 1.16 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The purpose of this study was to examine low-income mothers' perceptions of their children's height and weight in relation to actual measures, and perceptions of dietary quality and health status. Demographic, anthropometric, and dietary quality/health status data were collected during a multi-phase nutrition research project with low-income Minnesotans, and a sub-set of non-pregnant mother-child dyads (mothers ages ≥ 18 years, children ages 9-13 years) were analyzed (n = 257). Participants were Caucasian, African American, American Indian, Hispanic, Asian, or Other/mixed race, and most were homeless. Relationships between maternal perceptions of their child's height and weight and the actual measures, and maternal perceptions of dietary quality and health status for the dyad, were examined using independent and paired samples t-tests, ANOVA, and paired samples correlations. Comparisons were also made by maternal and child body mass index (BMI) status and living situation. Mothers significantly underestimated their child's height and weight (-4.8 ± 13.9 cm, P = 0.000; -5.3 ± 8.5 kg, P = 0.000); greatest misperceptions of weight were among mothers of overweight/obese children (P = 0.000). Mothers not reporting estimates of their child's height and weight (n = 53) had higher BMIs (P = 0.029), and their children were younger (P = 0.000) and lighter (P = 0.021) compared to mothers who provided estimates. Inability to objectify children's weight status may contribute to the obesity epidemic affecting low-income minority populations. Underestimation of weight status may be influenced by cultural perceptions of body image and socioeconomic status.
Maternal and Child Health Journal 01/2011; 15(1):106-14. · 2.24 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Observance of the hunger-obesity paradox in urban Minnesota has ignited interest in the quality of low-income households' food purchases. This cross-sectional study investigated low-income, urban Minnesotan women's past-month food purchases and their associations with race, homelessness, and aspects of the food system, including food shelf (ie, food pantry) and food store usage, factors believed to influence food choice and grocery shopping behavior. The survey included demographics, the US Department of Agriculture's 18-item Household Food Security Survey Module, and grocery shopping questions related to food purchases and food stores visited in the past month. Participants were a convenience sample of 448 low-income, urban Minnesotan women, and data were collected from February through May 2008. The sample was 44% African American, 35% American Indian, 10% white, and 11% other/mixed race; 37% were homeless. Rates of "less healthy" food group purchases were higher compared to "healthy" food group purchases. Significant racial differences were found with respect to purchasing healthy protein food groups (P<0.05 to P<0.01) but not fruits, vegetables, or whole grains. Homelessness reduced the odds of purchasing most food groups, regardless of nutrient density (P<0.05 to P<0.001). Food shelf and food store usage mainly increased the odds of purchasing "less healthy" food groups (P<0.05 to P<0.01). These findings may help registered dietitians strategize with low-income, urban women how to make best use of food resources within their local food system.
Journal of the American Dietetic Association 09/2010; 110(9):1351-6. · 3.59 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: This study investigated body image issues and the usefulness of self-reported measurements among Hmong American children, 9-18 years using mixed methodology. Twelve focus groups were conducted (n=68) and a silhouette drawing instrument and six questions pertaining to body image were administered (n=335). About 50% of the children were either overweight or obese and 23% were short statured relative to US norms. About 70% of the girls and 53% of the boys selected smaller body ideals than their perceived body sizes. Further, 21% of the girls and 31% of the boys were satisfied with their bodies. Children underestimated their weights and overestimated their heights. During focus groups children reported that parents, peers, and media influenced their body image perceptions. Our results indicate that the majority of Hmong children are dissatisfied with their bodies and tend to endorse American ideals of beauty and attractiveness rather than the heavier, traditional Hmong body ideals supported by their parents.
Body image 09/2010; 7(4):341-8. · 2.19 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: A 264-item survey evaluated how two shelter environments influenced homeless women's health (n = 259). Measured heights and weights determined obesity prevalence. Nonparametric tests evaluated body mass index (BMI) and dietary intake data. Principle components analysis reduced the data and correlations were made to BMI and dietary intake. Almost 80% had a BMI ≥ 25 and 67% were food insecure. Median milk intake was significantly different between shelters (1.0 [S1] vs 0.5 [S2], P < 0.05). Most servings were from the fats/sugars group (median servings: 19.6 [S1]; 15.1 [S2], P = 0.73). Obesity is a public health problem among homeless women, with shelter environments limiting the modification of associated risk factors.
Journal of Hunger & Environmental Nutrition 07/2010; 5(3):339-359.
-
[show abstract]
[hide abstract]
ABSTRACT: This study investigated how acculturation influences diet, cultural practices related to cooking and food preparation knowledge, and stature and body mass index (BMI) of Hmong children. Focus groups (n=12) were conducted during the spring of 2008 in St. Paul/Minneapolis, Minnesota with those born in the US and 9-13 years old (n=22), those born in the US and 14-18 years old (n=25), and those born in Thailand or Laos, who had lived in the US< or =5 years, and 14-18 years old (n=21). Respondents also completed a survey instrument to assess acculturation level which was evaluated by questions about social connections, language use, and dietary habits. Compared to those born in the US, those born in Thailand or Laos were significantly shorter and leaner. Those born in the US also showed elevated acculturation levels in language use, social connections, and gender-oriented tasks compared to those born in Thailand or Laos. Themes from focus group discussions were mealtime patterns, determinants of food health, future health concerns, and changing cultural traditions. Acculturation, years lived in the US, and birth place may play an important role in stature and BMI, food and physical activity habits, cooking and food preparation knowledge, and perceptions of health.
Social Science [?] Medicine 06/2009; 69(3):442-50. · 2.70 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Amidst a hunger-obesity paradox, the purpose of the present study was to examine the grocery shopping behaviour and food stamp usage of low-income women with children to identify factors influencing their food choices on a limited budget.
Focus groups, which included questions based on Social Cognitive Theory constructs, examined food choice in the context of personal, behavioural and environmental factors. A quantitative grocery shopping activity required participants to prioritize food purchases from a 177-item list on a budget of $US 50 for a one-week period, an amount chosen based on the average household food stamp allotment in 2005.
Ninety-two low-income women, with at least one child aged 9-13 years in their household, residing in the Twin Cities, Minnesota, USA.
Participants' mean age was 37 years, and 76% were overweight or obese (BMI> or =25.0 kg/m2). Key findings suggest that their food choices and grocery shopping behaviour were shaped by not only individual and family preferences, but also their economic and environmental situation. Transportation and store accessibility were major determinants of shopping frequency, and they used various strategies to make their food dollars stretch (e.g. shopping based on prices, in-store specials). Generally, meat was the most important food group for purchase and consumption, according to both the qualitative and quantitative data.
Efforts to improve food budgeting skills, increase nutrition knowledge, and develop meal preparation strategies involving less meat and more fruits and vegetables, could be valuable in helping low-income families nutritionally make the best use of their food dollars.
Public Health Nutrition 01/2009; 12(10):1726-34. · 2.17 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Focus groups (n=65) were conducted with Hmong adults in St. Paul/Minneapolis, MN to determine how environmental factors, acculturation, and food insecurity influence dietary behavior, body mass index (BMI), and health. Acculturation was assessed by examining linguistic, social, and eating behavior, length of time in the US, and BMI for B-TL(1) (born in Thailand/Laos and in US < or =5 years), B-TL(2) (in Thailand/Laos through adolescence, had food memories, and in US >5 years), and B-US (born in US or in Thailand/Laos less than 8 years and no food memories from there). Acculturation was associated with years lived in the US, household size and income, and food assistance usage. Years lived in the US was correlated with food assistance usage, education, household size and income, and perception of diet. B-TL(1) and B-TL(2) were on average overweight (BMI> or =25<30), US men were obese (mean BMI=32.4+/-7.4), and women were overweight (mean BMI=29.1+/-6.8). Themes identified were cultural values impact eating and lifestyle behaviors, food insecurity history influences post-migration behavior, acculturation impacts BMI through diet and exercise, and health status is influenced by changed environments. Environmental changes and increased acculturation have negatively impacted the weight and health of Hmong adults.
Appetite 09/2008; 52(1):173-83. · 2.59 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Youth, 9-18 years (n = 202), living in homeless shelters in Minneapolis, Minnesota, were assessed for height, weight, dietary intake, and perceptions of food insecurity. Perceptions of food security were measured by asking youth to respond to the statements (1) "There are times when we do not have enough food in the house," (2) "I go to bed hungry at night," (3) "I do not get enough to eat at home," and (4) "Have you ever had to miss a meal (or not been able to eat) because there was no food at home?" Additionally, questions evaluated coping mechanisms used by children to ward off hunger. Fifty-five percent of the children reported not enough food in the house and 25% reported going to bed hungry. Youth had inadequate intakes of vitamin D, calcium, and potassium and the majority consumed less than the estimated average requirements (EAR) for vitamins A, C, and E, phosphorus, folate, and zinc. Fruits, vegetables, and dairy were also consumed below recommended levels. Forty-five percent of boys and 50% of girls were at risk-for-overweight or were overweight. Overeating, eating anything, eating disliked foods, and eating at the homes of family and friends were identified as strategies to cope with food insecurity. Overeating when food is available may explain why we see a hunger-obesity paradigm to the magnitude that we do among the poorest Americans. These strategies protect children from the immediate negative associations of poverty and hunger, but they may contribute to long-term weight problems currently found in the US.
American Journal of Human Biology 06/2008; 20(5):550-63. · 2.27 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: In-depth interviews were conducted with homeless children (n=56, aged 6-13 years) in an urban center in Minnesota, USA, to determine factors influencing food choice, food access, and weight status, with interview questions developed using the Social Cognitive Theory. Interview transcripts were coded and then evaluated both collectively and by weight status (<85th percentile=normal weight vs. > or = 85th percentile=overweight). Forty-five percent of children were overweight. Environmental, parental, and personal factors emerged as common themes influencing food access and choice. Despite children's personal food preferences, homelessness and the shelter environment created restrictive conditions that influenced food choice and access. Shelter rules, lack of adequate storage and cooking facilities, and limited food stores near the shelter, impacted the type and quality of food choices, ultimately affecting hunger, weight status, and perceived health.
Social Science [?] Medicine 10/2007; 65(8):1572-83. · 2.70 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Sedentary lifestyles, along with diets low in fruits, vegetables, and complex carbohydrates, and high in fat and total energy are increasing among youth. These unhealthy behaviors contribute to an increase in childhood overweight, which is associated with type 2 diabetes, hypertension, and heart disease. Healthful dietary behaviors, such as eating a balanced and varied diet may be addressed in garden-based programs for youth. Therefore, this project assessed the influence of a garden program, with a newly developed nutrition curriculum, on youth's eating and gardening behavior using the Theory of Planned Behavior. The model included the constructs of attitude, subjective norm, and perceived behavioral control (PBC). Youth (age 8-15 years) involved in a garden program in Minneapolis/St. Paul, Minnesota completed a pre- (n=96) and a post-survey (n=66) assessing the theory's constructs with regard to eating and gardening behaviors. Fruit and vegetable consumption were assessed using survey questions and a 24-h recall. In addition to finding gender differences regarding associations between intention and behavior and the constructs correlated with behavior, results indicated that attitude was most predictive of intention at both pre- and post-survey for both boys and girls with behavior associated to PBC in girls, but not for boys. A high level of intention for boys pre-survey marginally predicted some behavioral change post-survey, but girls with high levels of intention at pre-survey did not show positive behavioral changes at post-survey. Additionally, the garden program positively impacted youth fruit and vegetable consumption, as determined from a mean computed from the responses to the fruit and vegetable behavior survey questions and the 24-h recall food group data. Because youth in the garden program consumed more fruit and vegetables at post-survey compared to pre-survey, we conclude that garden programs may be a viable way to assist youth in making healthy lifestyle changes.
Appetite 08/2007; 49(1):122-30. · 2.59 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: In Africa, the human immunodeficiency virus and acquired immunodeficiency syndrome (HIV/AIDS) complex is commonly referred to as "slim disease" because, as the disease progresses, food intake and metabolism are altered, leading to visible body weight loss. In this descriptive, cross-sectional pilot study, 50 HIV-seropositive adults attending the Korle Bu Teaching Hospital in Accra, Ghana, were interviewed during the late spring of 2003. Demographics, medical HIV history and current status of their HIV disease, food safety, and food security information were collected. One 24-hour dietary recall was completed, height and weight were measured, and body mass index (BMI) was calculated for each participant. Results show that women participants had a higher mean BMI and maintained it through disease progression compared with men (P<0.02). The majority of the participants cited cost as a barrier in purchasing adequate amounts of food (92%). Fruit and vegetable intake was low overall (<three servings/day). The foods contributing most to daily energy intake were fried fish, white rice, kenkey, white bread, and fufu. In fighting the global HIV/AIDS epidemic, registered dietitians must consider barriers to achieving optimal nutritional status in a cultural context to enhance feasibility and ensure the effectiveness of dietary interventions.
Journal of the American Dietetic Association 07/2007; 107(6):1008-13. · 3.59 Impact Factor
