An ecological approach to understanding contributions to disparities in diabetes prevention and care

Diet and exercise adherence and practices among medically underserved patients with chronic disease: variation across four ethnic groups

Many factors interact to create barriers to dietary and exercise plan adherence among medically underserved patients with chronic disease, but aspects related to culture and ethnicity are underexamined in the literature. Using both qualitative (n = 71) and quantitative (n = 297) data collected in a 4-year, multimethod study among patients with hypertension and/or diabetes, the authors explored differences in self-reported adherence to diet and exercise plans and self-reported daily diet and exercise practices across four ethnic groups-Whites, Blacks, Vietnamese, and Latinos-at a primary health care center in Massachusetts. Adherence to diet and exercise plans differed across ethnic groups even after controlling for key sociodemographic variables, with Vietnamese participants reporting the highest adherence. Food and exercise options were shaped by economic constraints as well as ethnic and cultural familiarity with certain foods and types of activity. These findings indicate that health care providers should consider ethnicity and economic status together to increase effectiveness in encouraging diverse populations with chronic disease to make healthy lifestyle changes.

The use of mentoring programs to improve energy balance behaviors in high-risk children

This study tested the impact of a multicomponent intervention entitled "Partners of all Ages Reading About Diet and Exercise" (PARADE) a child-focused energy balance intervention incorporated into mentoring programs. We used a group randomized nested cohort design randomizing mentoring program sites (n = 119) and children (N = 782; females = 49%; African American = 37%; mean (s.d.) age = 8.5 (1.5) years) to intervention or usual care conditions. PARADE mentors delivered eight lesson plans addressing key concepts related to diet and activity; eight child-focused computer-tailored storybooks with messages targeting that child's diet and activity patterns and eight parent action support newsletters. When compared to the control group, PARADE children were more knowledgeable of diet and activity guidelines (P < 0.01), challenged themselves more to eat five fruits and vegetables (FV) (P < 0.01) and be active 1 h daily (P < 0.01), and to ask for FV for snack (P = 0.015). Calories from high fat foods decreased in overweight/obese children, but not for normal weight children (P = 0.059). There were no significant differences in fruit and vegetable intake, total calories, percent time being active, or BMI z-score. The combination of one-to-one mentoring, child-focused computer based tailoring, and parent support may impact important behavioral change precursors in environments over which the child has control, especially among normal weight children. Further, work is needed to evaluate the impact of family-focused multicomponent interventions, including computer-tailored approaches, directed toward both the parent and the child.

Glycemic control and the injured brain

The interaction between glycemic control and critical neurologic illness and injury is complex. Hyperglycemia can be either the cause or the result of severe brain injury. Hyperglycemia in acute neurologic injury is associated with worse neurologic outcomes. Demographic patterns, including an aging population and shifts in racial and ethnic representation, contribute to the increasing prevalence of hyperglycemia and diabetes among victims of the most common neurologic emergencies. This article reviews the epidemiology of the problem, relevant pathophysiology, the use of tight glycemic control therapy in other populations, and the potential for tight glycemic control as a way to improve outcomes after acute neurologic illness and injury.

Contextualizing the effects of yoga therapy on diabetes management: a review of the social determinants of physical activity

This article provides a review of literature both to identify the effects of yoga-based therapy on the management of type 2 diabetes mellitus and to examine the social context of physical activity. Findings from the review indicate that yoga has a positive short-term effect on multiple diabetes-related outcomes; however, long-term effects of yoga therapy on diabetes management remain unclear. The context of the social environment, including interpersonal relationships, community characteristics, and discrimination, influences the adoption and maintenance of health behaviors such as physical activity, including yoga practice. Further research is necessary to determine the extent of this influence.

The use of inappropriate feeding practices by rural parents and their effect on preschoolers' fruit and vegetable preferences and intake

OBJECTIVE

To describe the frequency of inappropriate feeding practices used by parents of preschoolers and the impact on a child's preference for and intake of fruits and vegetables (FV).

DESIGN

Cross-sectional analysis of baseline data from a telephone interview.

SETTING

A community-based program in rural southeastern Missouri.

PARTICIPANTS

1555 rural parents participating in the High 5 for Kids project. The mean age of parents was 28.9 years, the mean age for children was 38.0 months, and 52.1% of children were male.

VARIABLES MEASURED

Demographic characteristics; intake and preferences for FV; inappropriate child feeding practices.

ANALYSIS

Inappropriate feeding practices, preferences for and intake of FV were examined using Kruskal-Wallis tests and Spearman's correlations. Logistic regression was used to assess the relationships between FV intake and preference and inappropriate feeding practices.

RESULTS

An increasing number of inappropriate feeding practices negatively impacted FV preference of children but positively impacted FV intake.

CONCLUSIONS AND IMPLICATIONS

This study documents the public health need to develop programs that guide and advise rural parents on information about how children develop patterns of intake, and how to foster children's preferences and acceptance of healthful food.