Abstract A26: Relative influence of home and school environments on specific dietary behaviors among postpartum, high-risk teens

Background: Nearly one third of adolescent girls are overweight or obese, and this risk is significantly heightened for postpartum, high-risk teenagers. Interventions among this difficult to reach population are critical for the prevention of obesity and related health effects, including several types of epithelial cancers. Targeting the home and school environment, where teens spend most of their time, may be particularly effective at reducing behaviors associated with obesity. Previously, in a study of high-risk postpartum teens, we found a greater influence of the perceived home food environment (vs. school) on total calories consumed from food and beverage groups. Here we aim to build upon these findings, looking at consumption of specific food and beverage items and the relative influence of school and home food environments, and whether relationships vary by baseline body mass index (BMI).

Methods: This is a cross-sectional, baseline analysis of 875 girls enrolled in the Balance Adolescent Lifestyle Activities and Nutrition Choices for Energy (BALANCE) study, a weight loss intervention designed to prevent obesity among postpartum, high-risk adolescents across 26 states. A total of 8 items were used to assess perceived healthful school and home food environments, respectively, on a 5-point Likert Scale. Ratings were averaged and dichotomized to generate an overall environment score. To assess the relative influence of home and school environment, we created the following categories: 0,“negative school & home”; 1, “positive school only” 2, ”positive home only” 3, ”positive school & home”. Frequency of specific food and beverage items were collapsed into binary categories to reflect infrequent (0-3 days/week) and frequent (4-7 days/week) consumption. Height and weight were obtained by trained staff and used to calculate BMI-for-age (dichotomized as normal [<85th %tile] and overweight/obese [≥85th %tile]). Relationships between environment and dietary behaviors were assessed using chi-square tests. To assess the relative influence of home and school environments, we used logistic regression with generalized estimating equations (GEE) to account for clustering within state. Regression models were adjusted for race, age, and postpartum status (results reported as GEE OR, 95% CI). All models were stratified by baseline BMI.

Results: Among 875 postpartum teens, a positive home environment was significantly associated with decreased consumption of chips and increased consumption of fruit and vegetables (p <0.05). A positive school environment was associated with increased fruit consumption (p <0.05). In terms of beverage items, only a positive home environment was significantly associated with increased consumption of water and milk and a decreased consumption of regular soda (chi-sq p <0.05). Results from the regression analyses indicated significant relationships between a positive home, and both positive home & school environments and healthy food items (i.e., fruit: 2.9, 1.6 – 5.6 and 2.9, 1.6 – 5.4, respectively) and decreased consumption of unhealthy food items (i.e., chips: 0.5, 0.3 – 0.8 and 0.8, 0.5 – 1.1, respectively). Similar findings were observed for beverage items (i.e., water: 2.6, 1.7 – 4.0 and 1.8, 1.2-2.6, respectively) and (i.e., regular soda: 0.5, 0.3 – 0.7 and 0.7, 0.5 – 1.0, respectively). In general, patterns did not differ significantly by baseline BMI.

Conclusions: In this understudied population of postpartum teens, the home environment was associated with healthy dietary behaviors. Results indicated that having a positive home environment was enough to influence behavior and for many items, the added benefit of a positive school environment was relatively low. Improving the home environment may be particularly important among this population of teen moms who are at increased risk for obesity and who are in a position to pass down their food behaviors to their children.

Citation Format: Megan A. Clarke, Rachel G. Tabak, Cynthia D. Schwarz, Debra L. Haire-Joshu, Corinne E. Joshu. Relative influence of home and school environments on specific dietary behaviors among postpartum, high-risk teens. [abstract]. In: Proceedings of the Thirteenth Annual AACR International Conference on Frontiers in Cancer Prevention Research; 2014 Sep 27-Oct 1; New Orleans, LA. Philadelphia (PA): AACR; Can Prev Res 2015;8(10 Suppl): Abstract nr A26.

Dissemination of health-related research among scientists in three countries: access to resources and current practices

OBJECTIVES

In public health and clinical settings insufficient dissemination of evidence-based practices limits the reach of new discoveries to broad populations. This study aimed to describe characteristics of the dissemination process by researchers across three countries (Brazil, United Kingdom, and United States), explore how designing for dissemination practices has been used, and analyze factors associated with dissemination.

METHODS

A similar online survey was used to query researchers across the three countries; data were pooled to draw cross-country conclusions.

FINDINGS

This study identified similarities and differences between countries. Importance of dissemination to nonresearcher audiences was widely recognized as important; however, traditional academic venues were the main dissemination method. Several factors were associated with self-rated dissemination effort in the pooled sample, but these predictive factors (e.g., support and resources for dissemination) had low prevalence. Less than one-third of researchers rated their level of effort for dissemination as excellent. Respondents reported limited support and resources to make it easier for researchers who might want to disseminate their findings.

CONCLUSION

Though intentions show the importance of dissemination, researchers across countries lack supports to increase dissemination efforts. Additional resources and training in designing for dissemination along with improved partnerships could help bridge the research-practice gap.

Food Service Perspectives on National School Lunch Program Implementation

OBJECTIVES

Explore barriers and facilitators to implementation of the new National School Lunch Program (NSLP) policy guidelines.

METHODS

Interviews with eight food service directors using an interview guide informed by the Consolidated Framework for Implementation Research.

RESULTS

Food service personnel; parents, teachers, school staff; and students were important stakeholders. Characteristics of the new NSLP policy guidelines were reported to create increased demands; resources alleviated some barriers. Directors reported increased food and labor costs, food sourcing challenges, decreased student participation, and organizational constraints as barriers to implementation. Creativity in menu planning facilitated success.

CONCLUSIONS

Factors within the food service department, characteristics of implementing individuals and the new NSLP policy guidelines, and stakeholder involvement in the implementation process relate to successful implementation.

Postpartum Teens' Perception of the Food Environments at Home and School

BACKGROUND

An environment that supports healthy eating is one factor to prevent obesity. However, little is known about postpartum teen's perceptions of their home and school environments and how this relates to dietary behaviors.

PURPOSE

This study explores the relationship between home and school environments and dietary behaviors for postpartum teens.

DESIGN

Conducted cross-sectionally during 2007-2009 across 27 states and included 889 postpartum teens enrolled in Parents as Teachers Teen Program. Data included measures of sociodemographics and perceptions of school and home food environments. A 7-day recall of snack and beverage frequency assessed dietary behaviors. Logistic regression explored associations between baseline environment measures and dietary behaviors at baseline and postintervention (approximately 5 months after baseline) for the control group.

RESULTS

Respondents reported greater access and selection (i.e., variety of choices) of healthy foods and beverages at home than school. At baseline, fruit and vegetable intake was associated with home selection (1.9, 95% confidence interval [CI: 1.3, 2.9]) and availability (1.8, 95% CI [1.3, 2.6]), sweet snack consumption was associated with selection (1.5, 95% CI [1.0, 2.1]), and total snack consumption and sugar-sweetened beverage intake were associated with selection (snack: 2.1, 95% CI [1.5, 3.0]; beverage: 1.7, 95% CI [1.2, 2.4]) and availability (snack: 2.1, 95% CI [1.4, 3.1]; beverage: 1.5, 95% CI [1.0, 2.3]). Water intake at baseline and at the postintervention for control group teens was associated with selection (1.6, 95% CI [1.1, 2.2]). No significant associations were identified between the school environment and dietary behaviors.

CONCLUSIONS

Interventions should target improvements in the home environment for high-risk, postpartum teens.

Implementing administrative evidence based practices: lessons from the field in six local health departments across the United States

BACKGROUND

Administrative evidence based practices (A-EBPs) are agency level structures and activities positively associated with performance measures (e.g., achieving core public health functions, carrying out evidence-based interventions). The objectives of this study were to examine the contextual conditions and explore differences in local health department (LHD) characteristics that influence the implementation of A-EBPs.

METHODS

Qualitative case studies were conducted based on data from 35 practitioners in six LHDs across the United States. The sample was chosen using an A-EBP score from our 2012 national survey and was linked to secondary data from the National Public Health Performance Standards Program. Three LHDs that scored high and three LHDs that scored low on both measures were selected as case study sites. The 37-question interview guide explored LHD use of an evidence based decision making process, including A-EBPs and evidence-based programs and policies. Each interview took 30-60 min. Standard qualitative methodology was used for data coding and analysis using NVivo software.

RESULTS

As might be expected, high-capacity LHDs were more likely to have strong leadership, partnerships, financial flexibility, workforce development activities, and an organizational culture supportive of evidence based decision making and implementation of A-EBPs. They were also more likely to describe having strong or important relationships with universities and other educational resources, increasing their access to resources and allowing them to more easily share knowledge and expertise.

CONCLUSIONS

Differences between high- and low-capacity LHDs in A-EBP domains highlight the importance of investments in these areas and the potential those investments have to contribute to overall efficiency and performance. Further research may identify avenues to enhance resources in these domains to create an organizational culture supportive of A-EBPs.

Choice of commuting mode among employees: Do home neighborhood environment, worksite neighborhood environment, and worksite policy and supports matter?

BACKGROUND

Promoting the use of public transit and active transport (walking and cycling) instead of car driving is an appealing strategy to increase overall physical activity.

PURPOSE

To quantify the combined associations between self-reported home and worksite neighborhood environments, worksite support and policies, and employees' commuting modes.

METHOD

Between 2012 and 2013, participants residing in four Missouri metropolitan areas were interviewed via telephone (n = 1,338) and provided information on socio-demographic characteristics, home and worksite neighborhoods, and worksite support and policies. Commuting mode was self-reported and categorized into car driving, public transit, and active commuting. Commuting distance was calculated using geographic information systems. Commuters providing completed data were included in the analysis. Multivariate logistic regression models were used to examine the correlates of using public transit and active commuting.

RESULT

The majority of participants reported commuting by driving (88.9%); only 4.9% used public transit and 6.2% used active modes. After multivariate adjustment, having transit stops within 10-15 minutes walking distance from home (p=0.05) and using worksite incentive for public transit (p<0.001) were associated with commuting by public transit. Commuting distance (p<0.001) was negatively associated with active commuting. Having free or low cost recreation facilities around the worksite (p=0.04) and using bike facilities to lock bikes at the worksite (p<0.001) were associated with active commuting.

CONCLUSION

Both environment features and worksite supports and policies are associated with the choice of commuting mode. Future studies should use longitudinal designs to investigate the potential of promoting alternative commuting modes through worksite efforts that support sustainable commuting behaviors as well as the potential of built environment improvements.

Cultural Adaptation and Implementation of Evidence-Based Parent-Training: A Systematic Review and Critique of Guiding Evidence

With advances in knowledge regarding efficacious evidence-based interventions, there have been significant attempts to culturally adapt, implement, and disseminate parent training interventions broadly, especially across ethnic and cultural groups. We sought to examine the extent to which researchers and developers of evidence-based parent training programs have used cultural adaptation models, tested implementation strategies, and evaluated implementation outcomes when integrating the interventions into routine care by conducting a systematic review of the literature for four evidence-based parent training interventions: Parent-Child Interaction Therapy (PCIT), The Incredible Years (IY), Parent Management Training-Oregon Model (PMTO™), and the Positive Parenting Program (Triple P). A total of 610 articles across the four programs were identified. Of those, only eight documented a rigorous cultural adaptation process, and only two sought to test the effectiveness of implementation strategies by using rigorous research designs. Our findings suggest that there is much work to be done to move parent-training intervention research towards a more rigorous examination of cultural adaptation and implementation practices.

Influence of home and school environments on specific dietary behaviors among postpartum, high-risk teens, 27 States, 2007-2009

Introduction

The objective of this study was to determine whether perceptions of the home and school food environments are related to food and beverage intakes of postpartum teens.

Methods

Our study was a baseline, cross-sectional analysis of 853 postpartum teens enrolled in a weight-loss intervention study across 27 states from 2007 through 2009. Eight-item scales assessed perceived accessibility and availability of foods and beverages in school and home environments. Associations between environments and intakes were assessed by using χ² and using logistic regression with generalized estimating equations (GEE), respectively.

Results

Overall, 52% of teens perceived their school food environment as positive, and 68% of teens perceived their home food environment as positive. A positive school environment was independently associated with fruit consumption and 100% fruit juice consumption. A positive home environment was independently associated with fruit, vegetable, and water consumption and infrequent consumption of soda and chips (χ²P < .05). Having only a positive school environment was associated with fruit consumption (GEE odds ratio [OR], 3.1; 95% confidence interval [CI], 1.5–6.5), and having only a positive home environment was associated with fruit (GEE OR, 2.9; 95% CI, 1.6–5.6), vegetable (GEE OR, 3.1; 95% CI, 1.5–6.2), and water (GEE OR, 2.6; 95% CI, 1.7–4.0) consumption and infrequent consumption of soda (GEE OR, 0.5; 95% CI, 0.3–0.7). Results for positive home and school environments were similar to those for positive home only.

Conclusion

Home and school environments are related to dietary behaviors among postpartum teens, with a positive home environment more strongly associated with healthful behaviors.

Workplace social and organizational environments and healthy-weight behaviors

BACKGROUND

The workplace is an important setting for health promotion including nutrition and physical activity behaviors to prevent obesity. This paper explores the relationship between workplace social environment and cultural factors and diet and physical activity (PA) behaviors and obesity among employees.

METHODS

Between 2012 and 2013, telephone interviews were conducted with participants residing in four Missouri metropolitan areas. Questions included demographic characteristics, workplace socio/organizational factors related to activity and diet, and individual diet and PA behaviors, and obesity. Multivariate logistic regression was used to examine associations between the workplace socio/organizational environment and nutrition, PA, and obesity.

RESULTS

There were differences in reported health behaviors and socio/organizational environment by gender, race, age, income, and worksite size. For example, agreement with the statement the 'company values my health' was highest among Whites, older employees, and higher income workers. As worksite size increased, the frequency of reporting seeing co-workers doing several types of healthy behaviors (eat fruits and vegetables, doing PA, and doing PA on breaks at work) increased. In adjusted analyses, employees agreeing the company values my health were more likely to engage in higher PA levels (aOR=1.54, 95% CI: 1.09-2.16) and less likely to be obese (aOR=0.73, 95% CI: 0.54-0.98). Seeing co-workers eating fruits and vegetables was associated with increased reporting of eating at least one vegetable per day (aOR=1.43, 95% CI: 1.06-1.91) and seeing co-workers being active was associated with higher PA levels (aOR 1.56, 95% CI: 1.19-2.05).

CONCLUSIONS

This research suggests that social/organizational characteristics of the workplace environment, particularly feeling the company values the workers' health and to seeing co-workers engaging in healthy behaviors, may be related to nutrition and PA behaviors and obesity. These findings point to the potential for intervention targets including environment and policy changes.

Support for physical activity policies and perceptions of work and neighborhood environments: variance by BMI and activity status at the county and individual levels

PURPOSE

To examine support for local policies encouraging physical activity and perceived neighborhood environment characteristics by physical activity and weight status of respondents across U.S. counties.

DESIGN

We used a random-digit-dial, computer-assisted telephone interview (CATI) to conduct a cross-sectional telephone questionnaire in selected U.S. counties in 2011.

SETTING

Counties with high prevalences of obesity and sedentary behavior (HH; n = 884) and counties with low prevalences of obesity and sedentary behavior (LL; n = 171) were selected nationally.

SUBJECTS

Adult respondents from HH (n = 642) and LL (n = 566) counties.

MEASURES

Questions were asked of respondents, pertaining to support for physical activity policies in various settings, neighborhood features, time spent in physical activity and sedentary behaviors, self-reported weight and height, and personal demographic information.

ANALYSIS

Means and frequencies were calculated; bivariable and multivariable linear and logistic regression models, developed. Models were adjusted for individual characteristics and county HH/LL status.

RESULTS

Respondents in LL counties perceived their neighborhood and work environments to be more supportive of healthy behaviors and were more supportive of local physical activity policies than respondents in HH counties (p < .001 for all). Positive neighborhood environment perceptions were related to reduced body mass index, increased physical activity, and decreased sedentary behavior.

CONCLUSION

Policy support and neighborhood environments are associated with behaviors. Results can inform targeting policy agendas to facilitate the improvement of environments (community, work, and school) to be more supportive of physical activity.

Accessing evidence to inform public health policy: a study to enhance advocacy

OBJECTIVES

Improving population health often involves policy changes that are the result of complex advocacy efforts. Information exchanges among researchers, advocates, and policymakers is paramount to policy interventions to improve health outcomes. This information may include evidence on what works well for whom and cost-effective strategies to improve outcomes of interest. However, this information is not always readily available or easily communicated. The purposes of this paper are to describe ways advocates seek information for health policy advocacy and to compare advocate demographics.

STUDY DESIGN

Cross-sectional telephone survey.

METHODS

Seventy-seven state-level advocates were asked about the desirable characteristics of policy-relevant information including methods of obtaining information, what makes it useful, and what sources make evidence most reliable/trustworthy. Responses were explored for the full sample and variety of subsamples (i.e. gender, age, and position on social and fiscal issues). Differences between groups were tested using t-tests and one-way analysis of variance.

RESULTS

On average, advocates rated frequency of seeking research information as 4.3 out of five. Overall, advocates rated the Internet as the top source, rated unbiased research and research with relevancy to their organization as the most important characteristics, and considered information from their organization as most reliable/believable. When ratings were examined by subgroup, the two characteristics most important for each question in the total sample (listed above) emerged as most important for nearly all subgroups.

CONCLUSIONS

Advocates are a resource to policymakers on health topics in the policy process. This study, among the first of its kind, found that advocates seek research information, but have a need for evidence that is unbiased and relevant to their organizations and report that university-based information is reliable. Researchers and advocates should partner so research is useful in advocating for evidence-based policy change.

What predicts dissemination efforts among public health researchers in the United States?

OBJECTIVES

We identified factors related to dissemination efforts by researchers to non-research audiences to reduce the gap between research generation and uptake in public health practice.

METHODS

We conducted a cross-sectional study of 266 researchers at universities, the National Institutes of Health (NIH), and CDC. We identified scientists using a search of public health journals and lists from government-sponsored research. The scientists completed a 35-item online survey in 2012. Using multivariable logistic regression, we compared self-rated effort to disseminate findings to non-research audiences (excellent/good vs. poor) across predictor variables in three categories: perceptions or reasons to disseminate, perceived expectation by employer/funders, and professional training and experience.

RESULTS

One-third of researchers rated their dissemination efforts as poor. Many factors were significantly related to whether a researcher rated him/herself as excellent/good, including obligation to disseminate findings (odds ratio [OR] = 2.7, 95% confidence interval [CI] 1.1, 6.8), dissemination important for their department (OR=2.3, 95% CI 1.2, 4.5), dissemination expected by employer (OR=2.0, 95% CI 1.2, 3.2) or by funder (OR=2.1, 95% CI 1.3, 3.2), previous work in a practice/policy setting (OR=4.4, 95% CI 2.1, 9.3), and university researchers with Prevention Research Center affiliation vs. NIH researchers (OR=4.7, 95% CI 1.4, 15.7). With all variables in the model, dissemination expected by funder (OR=2.0, 95% CI 1.2, 3.1) and previous work in a practice/policy setting (OR=3.5, OR 1.7, 7.1) remained significant.

CONCLUSIONS

These findings support the need for structural changes to the system, including funding agency priorities and participation of researchers in practice- and policy-based experiences, which may enhance efforts to disseminate by researchers.

Communication about childhood obesity on Twitter

OBJECTIVES

Little is known about the use of social media as a tool for health communication. We used a mixed-methods design to examine communication about childhood obesity on Twitter.

METHODS

NodeXL was used to collect tweets sent in June 2013 containing the hashtag #childhoodobesity. Tweets were coded for content; tweeters were classified by sector and health focus. Data were also collected on the network of follower connections among the tweeters. We used descriptive statistics and exponential random graph modeling to examine tweet content, characteristics of tweeters, and the composition and structure of the network of connections facilitating communication among tweeters.

RESULTS

We collected 1110 tweets originating from 576 unique Twitter users. More individuals (65.6%) than organizations (32.9%) tweeted. More tweets focused on individual behavior than environment or policy. Few government and educational tweeters were in the network, but they were more likely than private individuals to be followed by others.

CONCLUSIONS

There is an opportunity to better disseminate evidence-based information to a broad audience through Twitter by increasing the presence of credible sources in the #childhoodobesity conversation and focusing the content of tweets on scientific evidence.

Development of HomeSTEAD's physical activity and screen time physical environment inventory

BACKGROUND

The home environment has a significant influence on children's physical activity, sedentary behavior, dietary intake, and risk for obesity and chronic disease. Our understanding of the most influential factors and how they interact and impact child behavior is limited by current measurement tools, specifically the lack of a comprehensive instrument. HomeSTEAD (the Home Self-administered Tool for Environmental assessment of Activity and Diet) was designed to address this gap. This new tool contains four sections: home physical activity and media equipment inventory, family physical activity and screen time practices, home food inventory, and family food practices. This paper will describe HomeSTEAD's development and present reliability and validity evidence for the first section.

METHODS

The ANGELO framework guided instrument development, and systematic literature reviews helped identify existing items or scales for possible inclusion. Refinement of items was based on expert review and cognitive interviews. Parents of children ages 3-12 years (n = 125) completed the HomeSTEAD survey on three separate occasions over 12-18 days (Time 1, 2, and 3). The Time 1 survey also collected demographic information and parent report of child behaviors. Between Time 1 and 2, staff conducted an in-home observation and measured parent and child BMI. Kappa and intra-class correlations were used to examine reliability (test-retest) and validity (criterion and construct).

RESULTS

Reliability and validity was strong for most items (97% having ICC > 0.60 and 72% having r > 0.50, respectively). Items with lower reliability generally had low variation between people. Lower validity estimates (r < 0.30) were more common for items that assessed usability and accessibility, with observers generally rating usability and accessibility lower than parents. Small to moderate, but meaningful, correlations between physical environment factors and BMI, outside time, and screen time were observed (e.g., amount of child portable play equipment in good condition and easy to access was significantly associated with child BMI: r = -0.23), providing evidence of construct validity.

CONCLUSIONS

The HomeSTEAD instrument represents a clear advancement in the measurement of factors in the home environment related to child weight and weight-related behaviors. HomeSTEAD, in its entirety, represents a useful tool for researchers from which they can draw particular scales of greatest interest and highest relevance to their research questions.

Designing for dissemination among public health researchers: findings from a national survey in the United States

OBJECTIVES

We have described the practice of designing for dissemination among researchers in the United States with the intent of identifying gaps and areas for improvement.

METHODS

In 2012, we conducted a cross-sectional study of 266 researchers using a search of the top 12 public health journals in PubMed and lists available from government-sponsored research. The sample involved scientists at universities, the National Institutes of Health, and the Centers for Disease Control and Prevention in the United States.

RESULTS

In the pooled sample, 73% of respondents estimated they spent less than 10% of their time on dissemination. About half of respondents (53%) had a person or team in their unit dedicated to dissemination. Seventeen percent of all respondents used a framework or theory to plan their dissemination activities. One third of respondents (34%) always or usually involved stakeholders in the research process.

CONCLUSIONS

The current data and the existing literature suggest considerable room for improvement in designing for dissemination.

Active living collaboratives in the United States: understanding characteristics, activities, and achievement of environmental and policy change

Introduction

Changing the built environment to promote active lifestyles requires collaboration among diverse sectors. Multisectoral collaborative groups in the United States promote active lifestyles through environmental and policy changes. The objective of this study was to examine the characteristics of these collaborative groups and the extent to which they have achieved change.

Methods

We identified, recruited, and interviewed the coordinators of active living collaborative groups in the United States. We used descriptive statistics to characterize groups by composition, stakeholder engagement, and the extent of environmental and policy change in 8 strategic areas.

Results

Fifty-nine groups from 22 states participated in the study. Most groups had a diverse set of partners and used a range of activities to advance their agendas. Most groups achieved some form of environmental or policy change. On average, groups reported working on 5 strategy areas; parks and recreation (86%) and Safe Routes to School (85%) were named most frequently. More than half of groups reported their environmental initiatives as either in progress or completed. Groups reported the most success in changing policy for public plazas, street improvements, streetscaping, and parks, open space, and recreation. Complete Streets policy and zoning ordinances were the most frequently cited policy types. Engaging in media activities and the policy-making process in addition to engaging stakeholders appear to influence success in achieving change.

Conclusion

Although many groups successfully worked on parks and recreation improvements, opportunities remain in other areas, including transit and infill and redevelopment. Additional time and resources may be critical to realizing these types of changes.

Measuring parent food practices: a systematic review of existing measures and examination of instruments

During the last decade, there has been a rapid increase in development of instruments to measure parent food practices. Because these instruments often measure different constructs, or define common constructs differently, an evaluation of these instruments is needed. A systematic review of the literature was conducted to identify existing measures of parent food practices and to assess the quality of their development. The initial search used terms capturing home environment, parenting behaviors, feeding practices and eating behaviors, and was performed in October of 2009 using PubMed/Medline, PsychInfo, Web of knowledge (ISI), and ERIC, and updated in July of 2012. A review of titles and abstracts was used to narrow results, after which full articles were retrieved and reviewed. Only articles describing development of measures of parenting food practices designed for families with children 2-12 years old were retained for the current review. For each article, two reviewers extracted data and appraised the quality of processes used for instrument development and evaluation. The initial search yielded 28,378 unique titles; review of titles and abstracts narrowed the pool to 1,352 articles; from which 57 unique instruments were identified. The review update yielded 1,772 new titles from which14 additional instruments were identified. The extraction and appraisal process found that 49% of instruments clearly identified and defined concepts to be measured, and 46% used theory to guide instrument development. Most instruments (80%) had some reliability testing, with internal consistency being the most common (79%). Test-retest or inter-rater reliability was reported for less than half the instruments. Some form of validity evidence was reported for 84% of instruments. Construct validity was most commonly presented (86%), usually with analysis of associations with child diet or weight/BMI. While many measures of food parenting practices have emerged, particularly in recent years, few have demonstrated solid development methods. Substantial variation in items across different scales/constructs makes comparison between instruments extremely difficult. Future efforts should be directed toward consensus development of food parenting practices constructs and measures.

Policy perceptions related to physical activity and healthy eating in Mississippi

OBJECTIVE

Determine the public perceptions about policies related to physical activity and healthy eating to inform efforts to change policy for these important public health issues.

DESIGN

Cross-sectional, structured phone interview survey.

SETTING

Ten counties in Mississippi (5 counties with the highest and 5 with the lowest obesity prevalence).

PARTICIPANTS

: Random sample of 2800 adults.

MAIN OUTCOME MEASURE

Level of support for each individual policy and summary of support for 10 policies related to healthy eating and activity and 4 related to local funding for infrastructure for physical activity.

RESULTS

This survey showed strong policy support among Mississippi residents for a diverse set of policies aimed at promoting healthy eating and physical activity behaviors. This was particularly true for those in counties with the highest levels of obesity. Support for policies related to healthy eating and activity was highest for the following: requiring at least 30 minutes of physical activity or physical education everyday for children in kindergarten through 12th grade (93%) and lowest for the following: taxing soda and soft drinks and using the money for public education campaigns to fight obesity in children (65%). Support for the use of local government funds to build and maintain infrastructure for physical activity was high across all categories, ranging from 86% (recreation centers) to 74% (swimming pools). The levels of support for each policy varied according to several demographic characteristics; in general, support for nearly every policy was greater among African Americans, females, and those in counties with higher levels of obesity. Logistic models predicting level of support for healthy eating and physical activity found significant associations with several demographic factors.

Bridging research and practice: models for dissemination and implementation research

CONTEXT

Theories and frameworks (hereafter called models) enhance dissemination and implementation (D&I) research by making the spread of evidence-based interventions more likely. This work organizes and synthesizes these models by (1) developing an inventory of models used in D&I research; (2) synthesizing this information; and (3) providing guidance on how to select a model to inform study design and execution.

EVIDENCE ACQUISITION

This review began with commonly cited models and model developers and used snowball sampling to collect models developed in any year from journal articles, presentations, and books. All models were analyzed and categorized in 2011 based on three author-defined variables: construct flexibility, focus on dissemination and/or implementation activities (D/I), and the socioecologic framework (SEF) level. Five-point scales were used to rate construct flexibility from broad to operational and D/I activities from dissemination-focused to implementation-focused. All SEF levels (system, community, organization, and individual) applicable to a model were also extracted. Models that addressed policy activities were noted.

EVIDENCE SYNTHESIS

Sixty-one models were included in this review. Each of the five categories in the construct flexibility and D/I scales had at least four models. Models were distributed across all levels of the SEF; the fewest models (n=8) addressed policy activities. To assist researchers in selecting and utilizing a model throughout the research process, the authors present and explain examples of how models have been used.

CONCLUSIONS

These findings may enable researchers to better identify and select models to inform their D&I work.

Family ties to health program: a randomized intervention to improve vegetable intake in children

OBJECTIVE

Evaluate a home-based intervention targeted toward parents to improve vegetable intake in preschool-aged children.

METHODS

Four-month feasibility study of home-based intervention consisting of 4 tailored newsletters and 2 motivational phone calls compared to control; 4 children's books for the control group; and measured pre and post parent-reported physical and social home environment and child vegetable intake in 22 intervention and 21 control homes with a child 2-5 years old assessed with linear regression of group predicting home environment and diet characteristics post-intervention, adjusting for baseline (P < .05 significant).

RESULTS

Intervention increased availability of vegetables (+1.5 ± 2.5 vegetable types vs -0.3 ± 2.7 vegetable types, P = .02), offering fruits and vegetables for snacks (+0.95 ± 1.5 d/wk vs -0.05 ± 1.9 d/wk, P = .04), and self-efficacy (+2.4 ± 4.1 vs -0.3 ± 2.0, P = .02).

CONCLUSIONS AND IMPLICATIONS

The data suggest potential for home-based interventions to alter parent behaviors such as feeding practices and the home physical environment, which may be steps toward increasing vegetable intake in children.

Reliability and validity of the Healthy Home Survey: a tool to measure factors within homes hypothesized to relate to overweight in children

Background

The contribution of the environment to the obesity epidemic is well recognized. Parents have control over their home environment and can, therefore, support healthy dietary and activity habits in their children by manipulating factors such as access to energy-dense foods, availability of physical activity equipment, and restricting screen time. This paper describes the development of the Healthy Home Survey and its reliability and validity. The Healthy Home Survey was designed to assess characteristics of the home environment that are hypothesized to influence healthy weight behaviors in children including diet and physical activity.

Methods

We recruited 85 families with at least one child between 3–8 years. The Healthy Home Survey was administered to parents via telephone and repeated in a random sample of 45 families after 7 days. In-home observations were performed within 14 days of the first Healthy Home Survey interview. Percent agreement, Kappa statistics, Intra-class correlation coefficients and sensitivity analyses were used to evaluate reliability and validity evidence.

Results

Reliability and validity estimates for the Healthy Home Survey were varied, but generally high (0.22–1.00 and 0.07–0.96 respectively), with lower scores noted for perishable foods and policy items. Lower scores were likely related to actual change in the perishable foods present and the subjective nature or clarity of policy questions and response categories.

Conclusion

Initial testing demonstrated that the Healthy Home Survey is a feasible, reliable, and valid assessment of the home environment; however, it has also highlighted areas that need improvement. The Healthy Home Survey will be useful in future research exploring the relationship between the home environment and child weight.