[Show abstract][Hide abstract] ABSTRACT: Introduction:
Given the high prevalence of childhood obesity in the United States, we aimed to investigate youth's understanding of obesity and to investigate gaps between their nutritional knowledge, dietary habits, and perceived susceptibility to obesity and its co-morbidities.
A marketing firm contracted by Children's Healthcare of Atlanta facilitated a series of focus group discussions (FGD) to test potential concepts and sample ads for the development of an obesity awareness campaign. Data were collected in August and September of 2010 with both overweight and healthy weight 4th-5th grade and 7th-8th grade students. We conducted a secondary analysis of the qualitative FGD transcripts using inductive thematic coding to identify key themes related to youth reports of family eating habits (including food preparation, meal frequency, and eating environment), perceived facilitators and barriers of healthy diet, and knowledge about obesity and its complications.
Across focus group discussions, mixed attitudes about healthy eating, low perceived risk of being or becoming obese, and limited knowledge about the health consequences of obesity may contribute to the rising prevalence of obesity among youth in Georgia. Most youth were aware that obesity was a problem; yet most overweight youth felt that their weight was healthy and attributed overweight to genetics or slow metabolism.
Our analysis suggests that urban youth in Georgia commonly recognize obesity as a problem, but there is less understanding of the link to lifestyle choices or the connection to future morbidities, suggesting a need for education to connect lifestyle behaviors to development of obesity.
Full-text · Article · Jul 2013 · Journal of obesity
[Show abstract][Hide abstract] ABSTRACT: Despite the recognition that environments play a role in shaping physical activity and healthy eating behaviors, relatively little research has focused on rural homes and neighborhoods as important settings for obesity prevention. This study, conducted through community-based participatory research, used a social ecological model to examine how home and neighborhood food and physical activity environments were associated with weight status among rural-dwelling adults. Data were from a cross-sectional survey of White and African American adults (n = 513) aged 40-70 years living in rural southwest Georgia. Data were analyzed using measured variable path analysis, a form of structural equation modeling. The results support a social ecological approach to obesity prevention. Physical activity had a direct effect on BMI; self-efficacy, family support for physical activity, and household inventory of physical activity equipment also had direct effects on physical activity. Neighborhood walkability had an indirect effect on physical activity through self-efficacy and family social support. Although neither fruit and vegetable intake nor fat intake had direct effects on BMI, self-efficacy and household food inventories had direct effects on dietary behavior. Perceived access to healthy foods in the neighborhood had an indirect effect on healthy eating and a direct effect on weight; neighborhood cohesion had an indirect effect on healthy eating through self-efficacy. Overall, individual factors and home environments tended to exhibit direct effects on behavior, and neighborhood variables more often exhibited an indirect effect.
No preview · Article · Feb 2013 · Prevention Science
[Show abstract][Hide abstract] ABSTRACT: Objective:
Both underweight and obese mothers have an increased risk for adverse offspring outcomes. Few studies have examined the association between prepregnancy body mass index (BMI) and children's neurodevelopment.
We used data from the nationally representative Early Childhood Longitudinal Study-Birth Cohort (ECLS-B; n=6850). Children were classified according to their mother's prepregnancy BMI (kg m(-2)) status: underweight (BMI <18.5), normal weight (BMI 18.5-24.9), overweight (BMI 25.0-29.9), obese class I (BMI 30.0-34.9), and obese class II and III (BMI ≥35.0). Children's age-adjusted mental development index (MDI) and psychomotor development index (PDI) T-scores (mean 50, s.d. 10) were obtained using a validated shortened version of the Bayley Scales of Infant Development-II at approximately 2 years of age. While adjusting for sociodemographics, we estimated the average MDI and PDI scores or the risk of delayed (<-1 s.d. vs >1 s.d.) mental or motor development, relative to children of normal weight mothers.
Compared with children of normal weight mothers, MDI scores were lower among children of mothers of all other prepregnancy BMI categories, with the greatest adjusted difference among children of class II and III obese mothers (-2.13 (95% CI -3.32, -0.93)). The adjusted risk of delayed mental development was increased among children of underweight (risk ratio (RR) 1.36 (95% CI 1.04, 1.78)) and class II and III obese (RR 1.38 (95% CI 1.03, 1.84)) mothers. Children's PDI scores or motor delay did not differ by maternal prepregnancy BMI.
In this nationally representative sample of 2-year-old US children, low and very-high maternal prepregnancy BMI were associated with increased risk of delayed mental development but not motor development.
Full-text · Article · Sep 2012 · International journal of obesity (2005)
[Show abstract][Hide abstract] ABSTRACT: There are inconsistencies in the literature regarding the association between gestational weight gain (GWG) and child adiposity. GWG is hypothesized to act on child adiposity directly through intrauterine programming and indirectly through birth weight. It is unclear if the relative importance of these pathways differs by prepregnancy BMI status. We analyzed data from 3600 participants of the nationally representative Early Childhood Longitudinal Study-Birth Cohort. Child BMI Z-score was calculated from height and weight measured at 5 y. Using linear regression, controlling for sociodemographics and family lifestyle, we examined prepregnancy BMI-specific associations between GWG and child BMI Z-score. There was a nonlinear association among normal (P < 0.001) and overweight mothers only (P = 0.013), such that GWG beyond the midpoint of the 2009 Institute of Medicine recommendations was associated with a significant increase in child BMI Z-score. After the addition of birth-weight-for-gestational-age and breastfeeding to the model, the association remained among normal-weight mothers (P = 0.005) and was slightly attenuated among overweight mothers (P = 0.09). No significant association was observed between GWG and child BMI Z-score among underweight or obese mothers. We used path analysis to decompose the total effect into direct and indirect effects. This indicated the presence of a stronger direct than indirect effect. In conclusion, low GWG is not associated with BMI Z-score among any prepregnancy BMI group. Excess GWG is associated with an increase in child BMI Z-score among normal and overweight mothers only. Prevention of excess GWG may be a strategy to prevent childhood obesity.
Preview · Article · Sep 2012 · Journal of Nutrition
[Show abstract][Hide abstract] ABSTRACT: This study examines the relative contribution of social (eg, social support) and physical (eg, programs and facilities) aspects of worksite, church, and home settings to physical activity levels among adults in rural communities.
Data are from a cross-sectional survey of 268 African American and Caucasian adults, ages 40-70, living in southwest Georgia. Separate regression models were developed for walking, moderate, vigorous, and total physical activity as measured in METs-minutes-per-week.
Social support for physical activity was modest in all 3 settings (mean scores 1.5-1.9 on a 4-point scale). Participants reported limited (<1) programs and facilities for physical activity at their worksites and churches. An interaction of physical and social aspects of the home setting was observed for vigorous and moderate physical activity and total METs. There were also interactions between gender and social support at church for vigorous activity among women, and between race and the physical environment at church for moderate physical activity. A cross-over interaction was found between home and church settings for vigorous physical activity. Social support at church was associated with walking and total METs.
Homes and churches may be important behavioral settings for physical activity among adults in rural communities.
No preview · Article · Sep 2012 · Journal of Physical Activity and Health
[Show abstract][Hide abstract] ABSTRACT: Gestational weight gain (GWG) is an important predictor of short- and long-term adverse maternal and child outcomes. As interest in long-term outcomes increases, utilization of maternal postpartum report is likely to also increase. There is little data available examining the reliability and identifying predictors of bias in GWG recalled by mothers postpartum. We used data from the Early Childhood Longitudinal Study-Birth Cohort, a national study of U.S. children born in 2001, to compare GWG recalled by mothers approximately 10 months postpartum to GWG recorded on the birth certificate, among 5,650 records. On average, the postpartum estimates were 2.1 lbs higher (standard error, 0.2 lbs.) than the birth certificate report; 54.7 % were within 5 lbs, 27.2 % were overreported by more than 5 lbs, and 18.2 % were underreported by more than 5 lbs. The difference between the two sources increased with GWG reported postpartum and was significantly greater among mothers who were obese prior to pregnancy, had inadequate prenatal care, or were multiparous. Bias also differed by birth outcome, indicating the potential for recall bias. When categorized by adequacy of the 2009 Institute of Medicine GWG recommendations, 70 % of women were similarly categorized, and associations between GWG adequacy and small- and large-birthweight-for-gestational-age did not differ meaningfully by source of GWG data. These results suggest that for future studies, mothers' estimates of their GWG, obtained within approximately 1 year postpartum, may be a reliable substitute when birth certificate GWG data are unavailable.
No preview · Article · Jun 2012 · Maternal and Child Health Journal
[Show abstract][Hide abstract] ABSTRACT: The objective of this study was to examine the cumulative effect of smoke-free policies and social support for smoking cessation in the home, at church, and at work on smoking levels and quit attempts in the context of a community-based study of rural African Americans and whites in the Southeast.
We conducted a baseline survey to assess sociodemographics, smoking behavior, level of social support for smoking cessation, and smoke-free policies at home, church, and work. We created a variable for a weighted "dose" of smoking restrictions on the basis of the existence of policies in the 3 settings and a weighted score for social support and used bivariate analyses and multivariate regression to analyze data.
Of 134 survey participants, 18.7% had complete restrictions at home. Among church attendees, 39.4% had complete restrictions at church, and among those employed outside the home, 15.4% had complete restrictions at work. After controlling for age, sex, race, and education, the weighted dose of smoking restrictions was significantly related to having made a quit attempt in the past 12 months (odds ratio, 2.2; 95% confidence interval, 1.1-4.3) but not number of cigarettes smoked per day. Social support for cessation had no effect on recent quit attempts or number of cigarettes smoked per day.
Smoke-free policies have a cumulative effect on smoking behavior. These findings may inform interventions aimed at promoting comprehensive community-wide smoke-free policies.
Preview · Article · Jan 2012 · Preventing chronic disease
[Show abstract][Hide abstract] ABSTRACT: Background: While research suggests that community violence shapes sexual risk behavior among African-American adolescents, no research has explored this relationship among adults. Here we investigate the relationship between perceived community violence and consistent condom use with a primary partner in a high-risk sample of African-American adults.
Methods: The sample consisted of adult African-American residents of five Atlanta public housing communities (N=92). All participants were sexually active in the past year; substance abusers were oversampled. Community violence was defined as a fight in the neighborhood that involved a weapon during the 6-month reporting period. The outcome assessed consistent (100%) condom use with a primary partner during that period. We used generalized estimating equations to analyze the relationship of community violence to this outcome. Two mediators of this relationship (drug dependence and depression) were explored.
Results: Only 12% of participants reported that they had not witnessed community violence during the reporting period. Multivariate results indicate that, compared to individuals reporting no community violence, the odds of consistent condom use with a primary partner were 93% lower among adults who reported community violence at least monthly (p=0.007), and 78% lower among adults who reported community violence less than monthly (p=0.02). Drug dependence and depression mediated this relationship among men.
Conclusions: Perceived community violence was associated with reduced adult condom use. If future studies substantiate these findings, safer sex interventions should address perceived community violence, and other structural interventions should seek to improve access to drug treatment and mental health services in violent communities.
[Show abstract][Hide abstract] ABSTRACT: Community coalitions have the potential to enhance a community's capacity to engage in effective problem solving for a range of community concerns. Although numerous studies have documented correlations between member engagement and coalition processes and structural characteristics, fewer have examined associations between coalition factors and community capacity outcomes. The current study uses data from an evaluation of the California Healthy Cities and Communities program to examine pathways between coalition factors (i.e. membership, processes), member engagement (i.e. participation, satisfaction) and community capacity as hypothesized by the Community Coalition Action Theory (CCAT). Surveys were completed by 231 members of 19 healthy cities and communities coalitions. Multilevel mediation analyses were used to examine possible mediating effects of member engagement on three community capacity indicators: new skills, sense of community and social capital. Results generally supported CCAT. Member engagement mediated the effects of leadership and staffing on community capacity outcomes. Results also showed that member engagement mediated several relationships between process variables (i.e. task focus, cohesion) and community capacity, but several unmediated direct effects were also observed. This suggests that although member engagement does explain some relationships, it alone is not sufficient to explain how coalition processes influence indicators of community capacity.
Preview · Article · Sep 2011 · Health Education Research
[Show abstract][Hide abstract] ABSTRACT: To examine hope in relation to alcohol use, binge drinking, smoking, exercise, and limiting of dietary fat among college students.
Undergraduate students (N=2265) completed an online survey.
Lower hope scores were related to binge drinking and smoking in the past month and more frequent drinking and binge drinking, controlling for sociodemographics. Higher hope scores were related to greater likelihood of and more frequent exercising and fat limitation in the past month.
Interventions to improve college student health behaviors should target hope.
No preview · Article · Jul 2011 · American journal of health behavior
[Show abstract][Hide abstract] ABSTRACT: The Community Coalition Action Theory (CCAT) blends practice wisdom with empirical data to explain how community coalitions achieve community change and community capacity outcomes. The current study uses data from an evaluation of 20 California Healthy Cities and Communities coalitions to test relationships between coalition factors and outcomes as predicted by CCAT in two stages of coalition development. Data are from two rounds of coalition member surveys, interviews with local coalition coordinators, and semiannual progress reports. Consistent with CCAT predictions and prior research, shared decision making and leadership were correlated with participation; staff competence, task focus, and cohesion were correlated with member satisfaction. Coalition size was associated with participation and dollars leveraged. Also, consistent with CCAT, diversity of funding sources was associated with new leadership opportunities and program expansion; dollars leveraged was correlated with new leadership opportunities and new partners. Findings provide preliminary support for many, but not all, of the relationships predicted by CCAT.
No preview · Article · Mar 2011 · Health Education & Behavior
[Show abstract][Hide abstract] ABSTRACT: Given the previously documented higher rates of smoking among 2-year college students in comparison with 4-year university
students, this study compares smoking patterns, attitudes and motives among 2-year and 4-year college students. Two thousand
two hundred and sixty-five undergraduate students aged 18–25 years at a 2-year college and a 4-year university completed an
online survey in 2008. Current (past 30-day) smoking was reported by 43.5% of 2-year and 31.9% of 4-year college students,
and daily smoking was reported by 19.9% of 2-year and 8.3% of 4-year college students. Attending a 2-year college was associated
with higher rates of current smoking [odds ratio (OR) = 1.72] and daily smoking (OR = 2.84), and with less negative attitudes
regarding smoking, controlling for age, gender, ethnicity and parental education. Also, compared with 4-year college student
smokers, 2-year college smokers had lower motivation to smoke for social reasons, but more motivation to smoke for affect
regulation, after controlling for age, gender, ethnicity and parental education. Two- and 4-year college students report different
smoking patterns, attitudes and motives. These distinctions might inform tobacco control messages and interventions targeting
these groups of young adults.
Full-text · Article · Mar 2011 · Health Education Research
[Show abstract][Hide abstract] ABSTRACT: Research on home environments suggests both social and physical aspects of the environment influence eating behavior. Few interventions, however, have attempted to promote healthy eating in adults by targeting the home environment. The Emory Prevention Research Center, in collaboration with community partners in rural southwest Georgia, designed and pilot tested an intervention that used local residents trained as coaches to promote five healthy actions to make the home more supportive of healthy eating. The intervention consisted of a tailored home environment profile, goal-setting and behavioral contracting provided in two home visits and two telephone coaching calls over a six week period. Participants were recruited by local staff through a variety of local outlets such as libraries, businesses, health departments and word of mouth. Primary participants (mean age=53) lived in one of three rural counties (two treatment and one control), lived with at least one other adult, and had lived in the area for at least five years. At three months post-baseline, families (n=66) reported more healthy foods and fewer unhealthy foods and beverages in the home, healthier food preparation methods, fewer meals and snacks with the TV on, and more frequent purchasing of healthier foods relative to comparison families (n=36). No changes were found for fruit and vegetable intake or fat intake. Results suggest that coaching, combined with a focus on the home environment may be a promising strategy, but it may take longer than a few months for changes in home food environments to influence eating habits.
[Show abstract][Hide abstract] ABSTRACT: Total dietary fat and saturated fat intake are associated with obesity, elevated cholesterol, and heart disease. This study tested a multi-group structural equation model to explore differences in the relative influence of individual, social, and physical environment factors on dietary fat intake amongst adults aged 40-70 years. Participants from four rural Georgia, U.S., counties (n=527) completed a cross-sectional survey that included questions about eating patterns and individual and social influences on healthy eating. Observational measures of nutrition environments in stores and restaurants in these counties also were completed. Models for both women and men found significant positive relationships between self-efficacy for healthy eating and perceived nutrition environments and family support for healthy eating. The association between self-efficacy for eating a low-fat diet and frequency of eating out and grocery shopping was negative for both genders. The home nutrition environment was associated with dietary fat intake for women but not men. The results indicate that the influence of individual and environmental factors on dietary fat intake differs for men and women, with the home environment playing a larger role for women in rural communities.
No preview · Article · Jul 2010 · Social Science [?] Medicine