Knowledge, skills, and behavior improvements on peer educators and low-income Hispanic participants after a stage of change-based bilingual nutrition education program

Personal development, wellbeing and empowerment gains for nutrition peer educators: a South Australian perspective

This study aimed to explore the experience of being a Community Foodies (CF) peer educator with respect to personal benefits, specifically, personal development, wellbeing and empowerment. Qualitative semi-structured telephone interviews conducted with metropolitan and country peer educators of the CF programme. The CF programme in South Australia (SA) delivers nutrition education to disadvantaged communities. Ten adult peer educators from the CF programme: seven from country SA and three from Adelaide. Phenomenon of interest is that peer educators' perceptions of personal growth and development from involvement in the CF programme. The interviews were audiotaped and analysed thematically. The experience of being a nutrition peer educator improved personal skills and knowledge, dietary habits, self-esteem, confidence, sense of belonging and civic engagement. Peer educators felt that the CF programme was run in a straightforward, easy to understand way, with a welcoming environment and abundant support from the coordinators. Apart from benefits to themselves, peer educators appeared to be most proud of their capacity to contribute to the nutritional health of the broader community. Peer education programmes in disadvantaged communities provide policy makers with valuable and cost-effective approaches to improve health, build self-efficacy, strengthen community engagement, and, foster active participation and trust.

Rationale and study protocol for Unidas por la Vida (United for Life): A dyadic weight-loss intervention for high-risk Latina mothers and their adult daughters

BACKGROUND

Half of Mexican-American women are under-active and nearly 78% are overweight/obese. The high lifetime risk of developing type 2 diabetes necessitates a culturally appropriate lifestyle intervention.

PURPOSE

Unidas por la Vida is a novel dyadic intervention that capitalizes on the centrality of family in Latino culture to mobilize an existing family dyad as a resource for health behavior change. The intervention aims to improve health behaviors and promote weight loss in two at-risk members of the same family: mothers with type 2 diabetes and their overweight/obese adult daughters who are at risk for developing diabetes.

METHODS

Participants (N = 460 mother-adult daughter dyads) will be randomized into one of three conditions: 1) dyadic participation (mothers-daughters) in a lifestyle intervention; 2) individual participation (mothers alone; unrelated daughters alone) in a lifestyle intervention; and 3) mother-daughter dyads in a minimal intervention control group.

RESULTS

The primary outcome is weight loss. Secondary outcomes include physical activity, dietary intake, physiological measures (e.g. HbA1c), and body composition. Both the dyadic and individual interventions are expected to produce greater weight loss at 6, 12, and 18 months than those in minimal intervention control group, with women assigned to the dyadic intervention expected to lose more weight and to maintain the weight loss longer than women assigned to the individual intervention.

CONCLUSION

Because health risks are often shared by multiple members of at-risk families, culturally appropriate, dyadic interventions have the potential to increase the success of behavior change efforts and to extend their reach to multiple family members.

TRIAL REGISTRATION

ClinicalTrials.gov identifier NCT02741037.

Evaluation of a Childhood Obesity Prevention Online Training Certificate Program for Community Family Educators

Community family educators have the opportunity to incorporate childhood obesity prevention concepts in their programming with families of young children, but often lack formal health and nutrition education. The purpose of this feasibility study was to create an online training certificate program for community family educators and assess the program's effectiveness at improving participant's knowledge, attitudes, and intended and actual behaviors related to healthy lifestyles. Community family educators (n = 68) completed an online pretest, viewed 13 brief videos (8-15 min) focused on childhood obesity related topics and took mini-knowledge self-checks after each video followed by an online posttest. At posttest, paired t tests showed participants' childhood obesity prevention related knowledge (i.e., nutrition, physical activity, screen time and sleep) improved significantly (p < 0.001). Participants' attitudes toward parenting behaviors related to feeding practices, family meals, physical activity, screen time control and parent modeling significantly (p < 0.05) improved. Improvements also were seen in participants' intentions to promote obesity prevention behaviors (i.e., age appropriate portions sizes, adequate physically active, and parental role modeling). Furthermore, changes in personal health behaviors at posttest revealed participants had significantly (p < 0.05) greater dietary restraint, improvements in sleep quality, and reductions of use of electronic devices during meals and snacks. Overall, participants were very satisfied with the training program, felt comfortable with skills acquired, and enjoyed the program. Findings suggest this online training program is a feasible and effective method for improving community family educators' knowledge, attitudes, and intentions for obesity-prevention related parenting practices.

Dietitians' Attitudes and Beliefs Regarding Peer Education in Nutrition

PURPOSE

Peer education (PE) has been used effectively in nutrition; however, research examining dietitians' attitudes regarding PE is lacking.

METHODS

An online survey was sent to a random sample of 1198 Dietitians of Canada members to assess attitudes regarding PE by practice area.

RESULTS

A representative sample of dietitians by practice area and location was obtained (n = 229; 19%). Their total attitude score (TAS) was 226 ± 26 (mean ± SD) out of 295 (maximum). Community/public health dietitians had significantly higher TASs compared with clinical dietitians (234 ± 23 vs. 221 ± 27, respectively; P = 0.03). Dietitians believed PE to be most useful in community settings (P < 0.001), with cultural groups or adolescents (P < 0.001), and for healthy eating program goals (P < 0.001). The barrier most agreed with was limited financial resources, whereas the highest perceived benefits were social support and experience/employment for participants and peer educators, respectively. Overall, 63% agreed PE is an effective model, and 59% agreed that PE should be used more often in nutrition.

CONCLUSIONS

Dietitians have a positive attitude towards PE, with community/public health dietitians having the most positive attitudes. Dietitians believe PE is useful with specific target populations and particular program goals/strategies; however, they could be challenged to consider PE in a greater variety of programs.

EFNEP's Impact on Exemplary Educators' Quality of Life

OBJECTIVE

To determine how the Expanded Food and Nutrition Education Program (EFNEP) affects the quality of life (QoL) of its exemplary paraprofessional educators.

METHODS

Qualitative telephone interviews with EFNEP supervisors (15), educators (28), and agency partners (15). Template analysis based on the University of Toronto's QoL constructs.

RESULTS

The EFNEP had a positive impact on 6 of 9 a priori categories: physical being, psychological being, social belonging, community belonging, practical becoming, and growth becoming.

CONCLUSIONS AND IMPLICATIONS

The EFNEP enhances the QoL of its exemplary educators, which suggests that the program's benefits go beyond those documented in participants.

Computer-Based Training for Immigrant Latinos with Limited Formal Education

Mexican immigrants working at a wholesale nursery were involved in developing user instructions for a computer-based instruction system. Sixty-one Latinos with 0 to 16 years of education completed user instructions delivered on the computer, and all but 3 completed training content about the nursery. Based on objective criteria, program use was rated as “somewhat easy” to “easy” for most participants with more than 3 years of education, whereas 50% of those with 0 to 2 years of education completed content with “difficulty” or “struggled.” Participants who completed the computer-based posttest (n =22) had a mean performance of 96%, which was significantly better than the performance of 87% (n = 18) on an oral pretest (p = .003, d = 1.02). Thus, computer-based instruction can effectively train immigrant Latinos who have very limited formal education.

Assessment of a Refined Short Acculturation Scale for Latino Preteens in Rural Colorado

Acculturation level was assessed among 137 fourth- and fifth-grade children in rural, southern Colorado, using the Short Acculturation Scale for Hispanic Youth (SASH-Y), a 12-point, unidimensional instrument adapted for this audience. Reliability was determined by test-retest (70.8% agreement) with a small subsample of this population. Eleven children were considered Mexican, 33 Mexican American, and 93 Euro-American. Analysis of the sample yielded a strong internal consistency (α=.89) and split-half reliability (.84). Based on factor analysis, personal language use, external language use, and ethnic social relations accounted for 82.6%, 13.5%, and 5.9% of all variance, respectively. Latino self-identification did not correlate with acculturation. The findings demonstrate that the SASH-Y, especially questions related to language use, is robust with a young, rural-based Latino population.

Demographic and Behavioral Factors Linked to Obesity Among Inner-City Latino New Yorkers in the Bronx Community

New York City (NYC) Latinos are disproportionately affected by obesity. However, little information is available on demographic and behavioral factors linked to body mass index (BMI) in this population. A community-based survey was conducted in the inner-city Bronx community of NYC to evaluate these factors among Latino New Yorkers. 738 Latinos completed the survey. 241 (32.7 %) participants were obese (BMI > 30 kg/m(2)) and 302 (41 %) individuals were overweight (BMI 25-30 kg/m(2)). Adjusted regression analyses show that Latinos who are overweight or obese were found at greater odds of being men, residing in the US for >10 years, in early stages 1-3 of change of physical activity behavior, and at lower odds of being young adults aged <35 years or with college education. Analysis of factors associated stages of change (SOC) revealed that subjects in these preliminary SOC related to physical activity were at greater odds of speaking Spanish alone, in the same SOC with respect to diet, and at lower odds of living >10 years in the US. With respect to diet, subjects in preliminary stages were at greater odds of being young adults <35 years of age or in early SOC of physical activity and at lower odds of low income <20  dollars per year. The survey shows that Latino New-Yorkers in the Bronx with high prevalence of overweight status and obesity have unique demographic, socio-economic, behavioral and cultural factors that can be linked to excessive body weight.

Apoyo con Cariño: a pilot randomized controlled trial of a patient navigator intervention to improve palliative care outcomes for Latinos with serious illness

CONTEXT

Latinos experience significant health disparities at the end of life compared with non-Latinos.

OBJECTIVES

To determine the feasibility of a patient navigator intervention to improve palliative care outcomes for Latino adults with serious illness.

METHODS

This was a pilot randomized controlled trial that included 64 Latino adults with life-limiting illness randomized to an intervention or a control group. All participants received a packet of linguistically matched materials on palliative care. In addition, intervention participants received up to five home visits from the bilingual, bicultural patient navigator. Visits focused on addressing barriers to palliative care through education, activation, and culturally tailored messaging. Outcomes included feasibility and advance care planning rates, documentation of pain management discussions in the medical record, and hospice utilization.

RESULTS

Of the 32 patients randomized to the intervention arm, 81% had at least one home visit (range 1-5) with the patient navigator. Overall, advance care planning was higher in the intervention group (47% [n = 15] vs. 25% [n = 8], P = 0.06), and 79% of intervention participants had a discussion about pain management documented in their medical record vs. 54% of control patients (P = 0.05). Hospice enrollment between the two groups (n = 18 decedents) was similar (n = 7 intervention vs. n = 6 control); length of stay in the intervention group was 36.4 ± 51.6 vs. 19.7 ± 33.6 days for control patients (P = 0.39).

CONCLUSION

A culturally tailored patient navigator intervention was feasible and suggests improved palliative care outcomes for Latinos facing advanced medical illness, justifying a fully powered randomized controlled trial.

Use of song as an effective teaching strategy for nutrition education in older adults

The objective of this study was to explore whether singing an educational song would be effective in improving older adults' knowledge about nutrition. We used a randomized controlled design to determine whether singing an educational song would result in increased nutrition knowledge in a low-income population of older adults compared to a control group of similar adults who did not sing the song. Eighteen congregate nutrition sites were randomly assigned to the treatment or control group. Analysis via independent samples t -test showed the knowledge gain mean scores for the treatment group were significantly ( P  < 0.05) greater than those of the control group. This study supports a unique new approach to increasing nutrition knowledge of older adults by using music.

Addressing language barriers in client-centered health promotion: lessons learned and promising practices from Texas WIC

The growing population of nonnative English speakers in the United States challenges program planners to offer services that will effectively reach limited English proficiency (LEP) audiences. This article presents findings from evaluation research conducted with the Special Supplemental Program for Women, Infants, and Children (WIC) to identify best practices and areas of concern for working with LEP clients. Data were collected through online surveys of 338 WIC teaching staff in 2010 and 65 WIC local agency directors in 2011 as part of an implementation evaluation of client-centered nutrition education. Data identified current practices, facilitating factors, and challenges in working with LEP clients. Facilitating factors included cultural competency, material and translation resources, linguistic competency, professional development opportunities, and rapport with clients. Challenges cited included linguistic challenges, lack of cultural competencies, issues related to the client-staff interaction, and insufficient time, materials, and staffing. Best practices inferred from the data relate to developing linguistic standards for bilingual staff, considerations for translating written materials, interpretation services, cultural competency, and staff training. Findings may help inform the development of this and other linguistically and culturally appropriate health promotion programs.

Evaluation of a peer-led hypertension intervention for veterans: impact on peer leaders

Volunteer peer leaders (PLs) benefit from their involvement in health interventions but we know little about how they compare with other non-PL volunteers or with the intervention recipients themselves. We randomized 58 veterans' service organizations' posts (e.g. VFW) to peer- versus professionally led self-management support interventions. Our primary research questions were whether hypertensive PLs changed over the course of the project, whether they changed more than hypertensive volunteers who were not randomized to such a role [i.e. post representatives (PRs)] and whether they changed more than the intervention recipients with respect to health knowledge, health beliefs and health outcomes from baseline to 12 months. After the intervention, PLs provided open-ended feedback and participated in focus groups designed to explore intervention impact. Hypertensive PLs improved their systolic blood pressure and hypertension knowledge and increased their fruit/vegetable intake and pedometer use. We found no differences between PLs and PRs. PLs improved knowledge and increased fruit/vegetable intake more than intervention recipients did; they provided specific examples of personal health behavior change and knowledge acquisition. Individuals who volunteer to be peer health leaders are likely to receive important benefits even if they do not actually take on such a role.

The transtheoretical model as applied to dietary behaviour and outcomes

The transtheoretical model (TTM) is a behavioural theory that describes behaviour change as occurring in five stages, ranging from precontemplation to maintenance. The purpose of the present paper is to review and synthesise the literature published since 1999 on applications of the TTM to dietary behaviour so that the evidence for the use of assessment tools and interventions based on this model might be evaluated. Six databases were identified and searched using combinations of key words. Sixty-five original, peer-reviewed studies were identified and summarised in one of three tables using the following categories: population (n 21), intervention (n 25) and validation (n 19). Internal validity ratings were given to each intervention, and the body of intervention studies as a whole was rated. The evidence for using stage-based interventions is rated as suggestive in the areas of fruit and vegetable consumption and dietary fat reduction. Valid and reliable staging algorithms are available for fruit and vegetable consumption and dietary fat intake, and are being developed for other dietary behaviours. Few assessment tools have been developed for other TTM constructs. Given the popularity of TTM-based assessments and interventions, more research is warranted to identify valid and reliable assessment tools and effective interventions. While the evidence supports the validity of the TTM to describe populations and to form interventions, evidence of the effectiveness of TTM-based interventions is not conclusive.

Healthy Eating for Life English as a second language curriculum: primary outcomes from a nutrition education intervention targeting cancer risk reduction

We conducted a pre-post feasibility trial of Healthy Eating for Life, a theory-based, multimedia English as a second language curriculum that integrates content about healthy nutrition into an English language learning program to decrease cancer health disparities. Teachers in 20 English as a second language classrooms delivered Healthy Eating for Life to 286 adult English as a second language students over one semester. Postintervention data are available for 227 students. The results indicated that Healthy Eating for Life is effective for increasing fruit and vegetable intake as well as knowledge, action planning, and coping planning related to healthy eating. Participants also achieved higher reading scores compared to the state average.

Peer education for secondary stroke prevention in inner-city minorities: design and methods of the prevent recurrence of all inner-city strokes through education randomized controlled trial

BACKGROUND

The highest risk for stroke is among survivors of strokes or transient ischemic attacks (TIA). However, use of proven-effective cardiovascular medications to control stroke risk is suboptimal, particularly among the Black and Latino populations disproportionately impacted by stroke.

METHODS

A partnership of Harlem and Bronx community representatives, stroke survivors, researchers, clinicians, outreach workers and patient educators used community-based participatory research to conceive and develop the Prevent Recurrence of All Inner-city Strokes through Education (PRAISE) trial. Using data from focus groups with stroke survivors, they tailored a peer-led, community-based chronic disease self-management program to address stroke risk factors. PRAISE will test, in a randomized controlled trial, whether this stroke education intervention improves blood pressure control and a composite outcome of blood pressure control, lipid control, and use of antithrombotic medications.

RESULTS

Of the 582 survivors of stroke and TIA enrolled thus far, 81% are Black or Latino and 56% have an annual income less than $15,000. Many (33%) do not have blood pressures in the target range, and most (66%) do not have control of all three major stroke risk factors.

CONCLUSIONS

Rates of stroke recurrence risk factors remain suboptimal in the high risk, urban, predominantly minority communities studied. With a community-partnered approach, PRAISE has recruited a large number of stroke and TIA survivors to date, and may prove successful in engaging those at highest risk for stroke and reducing disparities in stroke outcomes in inner-city communities.

Dietary goal attainment measures and psychosocial factors among Mexican Americans and non-Hispanic whites with type 2 diabetes

Diabetes education programs need improved measures of goal setting for dietary control of diabetes. Additionally, measures of patient experiences with dietary goal setting are needed to better prepare patients for diabetes self-management. Measures of dietary goals and strategies were investigated via survey of 100 Mexican Americans and non-Hispanic whites with type 2 diabetes at a community clinic. Analyses tested novel goal measures as stages of change and goal attainment with a food plan compared to a traditional measure of food plan adherence. Ethnic groups varied in some reported experiences with goal setting education and goal attainment, but did not differ in most clinical characteristics of diabetes. Results indicated that different measures of goal setting vary in their psychosocial predictors, suggesting changes in how health care providers use and monitor goal setting for patients. At the time this research was conducted, Dr. Briggs Early was a doctoral candidate in the Department of Food Science and Human Nutrition at Washington State University. She is currently an Assistant Professor of Biochemistry and Nutrition at Pacific Northwest University of Health Sciences - College of Osteopathic Medicine, and a certified diabetes educator, and insulin pump trainer in Yakima, Washington.

Salud Sí: a case study for the use of participatory evaluation in creating effective and sustainable community-based health promotion

Participatory evaluation can be an essential tool for community-based organizations in tailoring programs to the needs of the populations they serve. This article provides a case study of Salud Sí, a promotora-driven health promotion program designed to encourage physical activity, fruit and vegetable consumption, and stress reduction among Mexican American women. Through a partnership between a community health center and an academic institution, we describe how the participatory evaluation framework is applied over a 10-year period throughout the stages of program development, implementation, and sustainability. Partners used the results to identify the essential elements of the health promotion program.

East meets West: a brief report of a culturally sensitive breast health education program for Chinese-Australian women

Chinese-Australian women are less likely to undergo breast health examination compared to women born in Australia, and cultural beliefs have been identified as a barrier to screening participation and breast health practices. We sought to promote awareness using trained lay health advisers (breast health advocates). This paper discusses the impact of the training program on advocate knowledge and beliefs, and women's experience as advocates. Thirty-seven of 50 women approached participated in an education program. The education was delivered over one full day and one half-day follow-up. Data were collected using questionnaires, focus groups and interviews. The program increased participant knowledge of breast health, decreased misperceptions about breast cancer and enhanced participants' readiness to discuss these topics with other Chinese women. Advocates enjoyed the role but did not always remember to promote awareness. The program appears effective and is suitable for further, more widespread testing.

Project HEAL: peer education leads to weight loss in Harlem

BACKGROUND

Obesity and diabetes are epidemic in the predominantly minority Harlem community. To address them, a coalition of community and academic leaders tested the effectiveness of a peer-led weight loss course.

METHODS

The coalition developed Project HEAL: Healthy Eating, Active Lifestyles through extensive collaboration with community members and experts in nutrition, exercise, and peer education. We piloted the course in a local church and assessed its impact through pre and post course weights, self-reported behaviors and quality of life.

RESULTS

Twenty-six overweight and obese African American adults lost a mean of 4.4 pounds at 10 weeks, 8.4 pounds at 22 weeks, and 9.8 pounds at 1 year. Participants reported decreased fat consumption and sedentary hours, and improved health related quality of life.

CONCLUSIONS

A peer-led, community-based course can lead to weight loss and behavior change. The minority communities most affected by obesity and diabetes may benefit from this low-cost, culturally appropriate intervention.

Cost-effectiveness model for youth EFNEP programs: what do we measure and how do we do it?

The Youth Expanded Food and Nutrition Education Program (EFNEP) is one of the United States Department of Agriculture's hallmark nutrition education programs for limited-resource youth. The objective of this study was to gather opinions from experts in EFNEP and related content areas to identify costs, effects (impacts), and related instruments to develop a cost-effectiveness model (instrument) for youth EFNEP, which does not exist. A cost-effectiveness model determines the economic or financial cost of producing an impact. The findings highlight several challenges in identifying inputs through consensus and provide a roadmap for the creation of a model that can be adopted by state EFNEP coordinators.

A randomized controlled trial of home visits by neighborhood mentor mothers to improve children's nutrition in South Africa

Malnourished children and babies with birth weights under 2500 g are at high risk for negative outcomes over their lifespans. Philani, a paraprofessional home visiting program, was developed to improve nutritional outcomes for young children in South Africa. One "mentor mother" was recruited from each of 37 neighborhoods in Cape Town, South Africa. Mentor mothers were trained to conduct home visits to weigh children under six years old and to support mothers to problem-solve life challenges, especially around nutrition. Households with underweight children were assigned randomly on a 2:1 ratio to the Philani program (n = 500) or to a standard care condition (n = 179); selection effects occurred and children in the intervention households weighed less at recruitment. Children were evaluated over a one-year period (n = 679 at recruitment and n = 638 with at least one follow-up; 94%). Longitudinal random effects models indicated that, over 12 months, the children in the intervention condition gained significantly more weight than children in the control condition. Mentor mothers who are positive peer deviants may be a viable strategy that is efficacious and can build community, and the use of mentor mothers for other problems in South Africa is discussed.

Understanding the nutrition information needs of migrant communities: the needs of African and Pacific Islander communities of Logan, Queensland

OBJECTIVE

The purpose of the present study was to investigate the nutrition information needs of the Pacific Islander and African migrant communities of Logan.

DESIGN

The present study was structured as a needs assessment and used qualitative research methods. An integrative review was used to gather and analyse data relating to comparative and normative needs, while semi-structured interviews were undertaken for the felt and expressed needs.

SETTING

Logan City, Queensland, Australia.

SUBJECTS

African and Pacific Islander migrants and health and social service providers within the Logan region.

RESULTS

The study identified the need for more accessible means of information delivery such as visual and face-to-face methods or hands-on demonstrations. The study found that information should be delivered in a staged approach on topics including food safety, Australian foods, healthy eating and diet-disease relationships, according to a migrant's length of residence in Australia.

CONCLUSIONS

The present study contributes to our understanding of the nutrition information needs of African and Pacific Islander migrant communities of Logan. These findings will enable the development of more appropriate nutrition information and health services for these Logan communities and other similar communities across Australia.

Outcome effectiveness of the lay health advisor model among Latinos in the United States: an examination by role

The objective of this study was to examine lay health advisor (LHA) programs designed to promote health among US Latinos and the extent to which educator-only versus educator-plus-bridge programs differed in designs and outcomes achieved. Two independent coders reviewed 128 published articles on LHAs yielding information at two levels: (i) study design and participant and LHA characteristics from 61 studies that broadly compared educator-only versus educator-plus-bridge programs and (ii) implementation features and outcomes from 17 randomized controlled trials or quasi-experimental studies with outcome data. LHA programs have been widely used with Latinos in certain US regions; our findings indicate that LHAs are effective intervention agents. We identified differences between educator-only and educator-plus-bridge LHA programs, although the small number of educator-plus-bridge programs with outcome data limited comparisons. Major gaps remain in research targeting Latino subgroups other than Mexican immigrants/Mexican Americans. Sufficient research has evaluated LHA programs among Latinos on their ability to achieve health behavior and/or health status changes. In the future, more of a focus on organizational and policy changes is warranted. Questions remain about diversity in LHAs' characteristics and roles, which influence not only outcomes but also program sustainability and dissemination.

Effectiveness of peer education for breast cancer screening and health beliefs in eastern Turkey

BACKGROUND

The primary site of cancer in Turkish women is breast cancer. The incidence of breast cancer is increasing in Turkey.

OBJECTIVE

The aim of the research was to educate women 40 years and older to increase their awareness on early detection and diagnosis, to facilitate the use of the early diagnosis methods, to improve the women's beliefs in relation breast cancer, and to increase the use of Cancer Early Diagnosis and Screening Centers available in the city.

METHODS

The target population of the research was 5000 women. Forty selected women were educated as peer educators. Twenty-five of them were selected as principal peer educator. Each peer educator was expected to educate 200 women. Peer trainers educated their peer and also arranged for the mammography appointment of the women who decided to have theirs taken. Data were obtained before and after the training by Champion's Health Belief Model Scale, questionnaire forms, and Cancer Early Diagnosis and Screening Centers data for mammography practice.

RESULTS

Breast cancer was detected in 8 women. Statistical analyses showed positive changes in women's health beliefs and breast self-examination knowledge. There were 20.4% of women (n = 1040) who did get mammograms, and 8% (n = 8) of women were found to have cancer in all of those screened.

CONCLUSION

Peer education was found to be effective for increasing the knowledge, beliefs, and practice of women related to breast cancer.

IMPLICATIONS FOR PRACTICE

Peers can reinforce learning through ongoing contact. Peer education can be used to improve early diagnosis of breast cancer and breast cancer awareness in asymptomatic women.

Teachers' delivery skills and substance use prevention program outcomes: the moderating role of students' need for cognition and impulse decision making

The purpose of this study was to extend the literature in both substance use implementation and persuasive health communication by examining the extent to which students' need for cognition and impulsive decision-making moderated the relationship between teachers' classroom communication behavior and program outcomes in an evidence-based middle school substance use prevention curriculum. Participants included 48 teachers and their respective 7th grade students who participated in a randomized trial testing the effectiveness of personal coaching as a means to improve the quality with which teachers implemented the All Stars curriculum. Need for cognition and impulse decision-making were both associated with positive changes in lifestyle incongruence and commitments to not use substances for students whose teachers displayed greater interactive teaching. Further, need for cognition was associated with lower alcohol use rates while impulse decision making related to lower rates of marijuana use in classes with interactive teaching.

Health Promotion in Latinos

This article provides a review of health promotion research conducted among Latinos. The authors examined 31 intervention studies promoting physical activity and/or healthy diet in Latino samples. Overall, findings suggested that Latinos are responsive to interventions promoting physical activity and healthy diet, despite facing numerous barriers to health promotion. In fact, 12 of the 21 studies that measured physical activity and 19 of the 26 studies that measured dietary behavior reported that the intervention produced significant improvements in those health behaviors. Design strengths of these studies included the high rates of retention and large number of randomized controlled trials. However, there were concerns regarding the lack of diversity in the samples (mostly Mexican American women), limiting the generalizability of the findings and the underutilization of objective measures of physical activity and diet behavior in intervention studies.

Healthy Eating and Harambee: curriculum development for a culturally-centered bio-medically oriented nutrition education program to reach African American women of childbearing age

The purpose was to develop, implement and evaluate a peer-led nutrition curriculum Healthy Eating and Harambee that addresses established objectives of maternal and infant health and to shift the stage for African American women of childbearing age in Genesee County toward healthier dietary patterns using a socio-cultural and biomedical orientation. The PEN-3 model, which frames culture in the context of health promotion interventions, was integrated with the Transtheoretical Model to guide this 13-week pre-test/post-test curriculum. Materials developed included soul food plate visuals, a micronutrient availability worksheet, a fruit stand, and gardening kits. Learning activities included affirmations, stories, case-scenarios, point-of-purchase product recognition, church health teams, and community health fairs. We investigated health-promoting dietary behaviors (consumption of more fruits and vegetables (F&V), serving more F&V to their families, and moderating dietary sodium and fat intakes), and biomedical behaviors (self-monitoring blood pressure and exercising) across five stages of change. Session attendance and program satisfaction were assessed. N = 102 women participated (mean age = 27.5 years). A majority (77%) reported adopting at least one healthy eating behavior (moderating sodium, serving more F&V to their families), 23% adopted at least two such behaviors (reading food labels for sodium; using culinary herbs/spices; serving more F&V to their families), and 45% adopted both dietary (moderating sodium; eating more fruits) and biomedical behaviors. Participants and facilitators favorably evaluated the curriculum and suggested improvements. A multi-conceptual approach coupled with cultural and biomedical tailoring has potential to promote young African American women's movement to more advanced stages of change and improve self-efficacy for fruit and vegetable intake, dietary sodium moderation, and self-monitoring blood pressure and physical activity.

Impact of peer nutrition education on dietary behaviors and health outcomes among Latinos: a systematic literature review

OBJECTIVE

This systematic review assesses the impact of peer education/counseling on nutrition and health outcomes among Latinos and identifies future research needs.

DESIGN

A systematic literature search was conducted by: (1) searching Internet databases; (2) conducting backward searches from reference lists of articles of interest; (3) manually reviewing the archives of the Center for Eliminating Health Disparities among Latinos; (4) searching the Journal of Nutrition Education and Behavior; and (5) directly contacting researchers in the field. The authors reviewed 22 articles derived from experimental or quasi-experimental studies.

OUTCOME MEASURES

Type 2 diabetes behavioral and metabolic outcomes, breastfeeding, nutrition knowledge, attitudes and behaviors.

RESULTS

Peer nutrition education has a positive influence on diabetes self-management and breastfeeding outcomes, as well as on general nutrition knowledge and dietary intake behaviors among Latinos.

CONCLUSIONS AND IMPLICATIONS

There is a need for longitudinal randomized trials testing the impact of peer nutrition education interventions grounded on goal setting and culturally appropriate behavioral change theories. Inclusion of reliable scales and the construct of acculturation are needed to further advance knowledge in this promising field. Operational research is also needed to identify the optimal peer educator characteristics, the type of training that they should receive, the client loads and dosage (ie, frequency and amount of contact needed between peer educator and client), and the best educational approaches and delivery settings.

Operation Frontline: assessment of longer-term curriculum effectiveness, evaluation strategies, and follow-up methods

OBJECTIVES

To determine the effectiveness of a traditional pretest versus a retrospective pretest, the stability of self-reported behavior changes at 3 or 6 months post-class series, and the most effective method for longer-term follow-up assessment of Operation Frontline's Eating Right class series.

DESIGN

Longitudinal study; subjects surveyed at some combination of traditional pretest, retrospective pretest/posttest after the last class, and at 3 or 6 months.

SETTING

Communities in the metropolitan Denver area.

PARTICIPANTS

Of the 53 participants, 90% were women, 70% were of Hispanic descent, 49% were between the ages of 20 and 29, and 64% had at least a twelfth-grade education or General Educational Development diploma.

MAIN OUTCOME MEASURES

Contrast results from a traditional pretest with a retrospective pretest; assess temporal stability of self-reported behavior changes; and contrast response rates for multiple follow-up methods (mail, telephone, or reunion class).

ANALYSIS

Item and scale scores were compared across various time points using repeated-measures analysis of variance.

RESULTS

No significant differences were found for 6 of 7 variables between the traditional pretests and retrospective pretests. Most self-reported behavior changes were retained at 3 and 6 months post-class. Mail had the best response rate (62%) for this limited-resource population.

CONCLUSIONS AND IMPLICATIONS

The maintenance of behavior changes at 3 or 6 months post-intervention supports the effectiveness of the Eating Right series. Mail follow-up achieved higher response rates than telephone. The lack of significant differences (except 1 variable) between the traditional pretest and the retrospective pretests does not support the retrospective pretest as being more accurate. However, the retrospective pretest may be more desirable for educators, as it eliminates the need to test participants twice.

Not lost in translation: nutrition education, a critical component of translational research

Translational research is an emerging field of science, embracing disciplines in medicine and public health to create a full-spectrum research agenda. Often described as science "from bench to bedside and back again," translational research may be better described as "from bench to behavior," as it strives to apply laboratory results to clinical settings. Because the demand for translational research has emerged, it is critical for nutrition educators to ensure that translational research includes community and policy areas and to recognize themselves as translation researchers. The purpose of this report is to provide a framework for nutrition educators to better understand translational research and to recognize their role in translational research, using type 2 diabetes as an example.

Fit WIC: attitudes, perceptions and practices of WIC staff toward addressing childhood overweight

OBJECTIVE

To assess the attitudes, perceptions, and practices of staff of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in providing nutrition education on childhood overweight topics with WIC participants.

DESIGN

Descriptive and correlational study.

SETTING

WIC clinics in Virginia.

PARTICIPANTS

106 employees working in direct contact with WIC participants.

MEAN OUTCOME MEASURE(S)

Demographic information; comfort level and frequency of discussing childhood overweight-related topics with participants; perception of WIC's ability to prevent and help address overweight among children and adults; body mass index (BMI); and attitudes toward personal weight.

ANALYSIS

Descriptive statistics, regression, and analysis of variance.

RESULTS

WIC staff in this study reported a lack of comfort, practice, and confidence in addressing and/or preventing childhood overweight with WIC participants, with differences existing based on job title (P < .05). Barriers to implementing programs included perceived attitudes of participants, transportation, time, cultural issues, and childcare. Staff BMIs were significantly correlated to ethnicity, age, feeling overweight, unhappiness with current weight, and comfort level discussing fruit and vegetable intake and physical activity (P < .05).

CONCLUSIONS AND IMPLICATIONS

Staff training, health promotion programs, and culturally relevant educational materials are warranted for WIC staff to build a strong knowledge base and promote self-efficacy about childhood overweight-related topics.

Addressing health disparities in highly specialized minority populations: case study of Mexican Mennonite farmworkers

The Kansas Statewide Farmworker Health Program (KSFHP) has developed a unique set of culturally competent health interventions in response to the pressing public health needs of the state's underserved farmworker population. Key among these are its health education and translation efforts on behalf of the fast-growing Low German-speaking Mexican Mennonite farmworker population. Linguistic, religious, and cultural values have created unique and complex health disparities and barriers to care that can be broken down only through innovative approaches. KSFHP first conducted a health needs assessment survey of the farmworker population in 2003, which indicated prenatal care practices as a significant health disparity, especially among the Low German-speaking Mexican Mennonite population. In response, KSFHP successfully lobbied the state health department to implement a new standard of health behavior data collection that includes primary language data as a method of delineating population subgroups, making Kansas one of the first two states in the country to collect this information. KSFHP also developed culturally competent Low German-language recordings on health topics such as prenatal care in accordance with the information delivery needs of the Low German-speaking Mexican Mennonite farmworker population. Currently, a pilot program is in progress that offers additional outreach, health education, and interpretation, among other services. The work of the KSFHP has significant implications for further research into health disparities, specialized minority populations, and culturally competent data collection methods.

eHealth Technology and Internet Resources

Disparities in accessing health information exist for various vulnerable populations. Reviewing access issues for those seeking and/or needing health information suggests that there are many factors that may inhibit access. These include a wide diversity in the education, background, and needs of those seeking information, and the distribution of information among many disciplines and information sources. The most needy among this group may require extensive, multispecialty healthcare and may have particular problems with access, treatment adherence, and working within the healthcare system.

Improvement in diabetes care of underinsured patients enrolled in project dulce: a community-based, culturally appropriate, nurse case management and peer education diabetes care model

OBJECTIVE

To improve clinical diabetes care, patient knowledge, and treatment satisfaction and to reduce health-adverse culture-based beliefs in underserved and underinsured populations with diabetes.

RESEARCH DESIGN AND METHODS

A total of 153 high-risk patients with diabetes recruited from six community clinic sites in San Diego County, California were enrolled in a nurse case management (NCM) and peer education/empowerment group. Baseline and 1-year levels of HbA(1c), lipid parameters, systolic and diastolic blood pressure, knowledge of diabetes, culture-based beliefs in ineffective remedies, and treatment satisfaction were prospectively measured. The NCM and peer education/empowerment group was compared with 76 individuals in a matched control group (CG) derived from patients referred but not enrolled in Project Dulce.

RESULTS

After 1 year in Project Dulce, the NCM and peer education/empowerment group had significant improvements in HbA(1c) (12.0-8.3%, P < 0.0001), total cholesterol (5.82-4.86 mmol/l, P < 0.0001), LDL cholesterol (3.39-2.79 mmol/l, P < 0.0001), and diastolic blood pressure (80-76 mmHg, P < 0.009), which were significantly better than in the CG, in which no significant changes were noted. Accepted American Diabetes Association standards of diabetes care, knowledge of diabetes (P = 0.024), treatment satisfaction (P = 0.001), and culture-based beliefs (P = 0.001) were also improved.

CONCLUSIONS

A novel, culturally appropriate, community-based, nurse case management/peer education diabetes care model leads to significant improvement in clinical diabetes care, self-awareness, and understanding of diabetes in underinsured populations.

Using self-efficacy and a transtheoretical model to develop a physical activity intervention for obese women

PURPOSE

To assess the effectiveness of applying behavior change theory to a physical activity intervention for obese, sedentary women.

DESIGN

A 48-week randomized controlled trial. Subjects were randomized to one of two intervention groups.

SETTING

A university classroom and a local health club.

SUBJECTS

Fifty-eight sedentary, obese women.

INTERVENTIONS

A 24-week theory-based physical activity program that aims to change the way subjects think and behave in relation to physical activity (treatment group, n = 29) and a traditionally structured exercise program (control group, n = 29).

MEASURES

Questionnaires on physical activity, stage of change, processes of change, and self-efficacy were completed at baseline, 24 weeks, and 48 weeks.

RESULTS

Twenty-seven of the 29 participants in the treatment group and 17 participants in the control group completed the study. Analysis of variance revealed significant and positive changes in measures of eight processes of change, self-efficacy, physical activity, and cardiorespiratory fitness in the treatment group at 24 weeks. All but one of these changes were maintained at 48 weeks. In the control group, significant changes occurred in only two processes of change, and no change occurred in self-efficacy, physical activity, or cardiorespiratory fitness at 24 or 48 weeks.

CONCLUSION

A theory-based intervention is more likely to change the way obese women think and behave in relation to physical activity than a traditional exercise program that does not incorporate behavior change theory.

Personal attributes and job competencies needed by EFNEP paraprofessionals as perceived by EFNEP professionals

OBJECTIVE

To determine the personal attributes and job competencies that are necessary for the job success of Expanded Food and Nutrition Education Program (EFNEP) paraprofessionals as perceived by EFNEP professionals.

DESIGN

A qualitative descriptive design and a 3-round modified Delphi methodology was used.

PARTICIPANTS

A convenience sample of 14 state and 20 county EFNEP professionals participated in all 3 Delphi rounds. The response rates for state and county professionals for all 3 Delphi rounds were 70% and 91%, respectively.

VARIABLES MEASURED

Personal attributes and job competencies were generated and the level of importance was determined.

ANALYSIS

An independent t test was employed to determine differences between importance scores by professional position.

RESULTS

Thirty-seven personal attributes, 18 job competencies prior to hire, and 43 job competencies after training were generated and the majority were very important to important. County EFNEP professionals tended to score personal attributes and job competencies as more important than state EFNEP professionals.

IMPLICATIONS

These personal attributes and job competencies prior to hire can guide hiring decisions and initial training content. The job competencies after training can shape content for inservice training.

Economic analysis of bilingual interactive multimedia nutrition education

CONTEXT

Interactive multimedia (IMM) provides a means to deliver accurate, consistent, and convenient nutrition education.

OBJECTIVE

To compare direct costs of bilingual IMM and peer nutrition education methods.

DESIGN

Cost per unit of nutrition education for each delivery method was calculated.

SETTING

Touch-screen computer kiosk systems in food assistance programs.

PARTICIPANTS

Approximately 727 low-income and Hispanic persons.

INTERVENTION

Bilingual IMM and nutrition education classes taught by peer educators.

MAIN OUTCOME MEASURES

Cost per unit of nutrition education delivered.

ANALYSIS

Descriptive: to compare costs and determine break-even points.

RESULTS

Initially, costs for both methods dropped and then nearly leveled for the peer method at a break-even point of 633 units, whereas those for IMM continued to decrease.

CONCLUSIONS

Interactive multimedia is a cost-effective method of delivering nutrition education, especially to large numbers of people.

IMPLICATIONS

Use of this technology could reach additional low-income persons at decreasing costs.

Using computer-based assessments to evaluate interactive multimedia nutrition education among low-income predominantly Hispanic participants

OBJECTIVE

This research was conducted to measure the effectiveness of interactive multimedia (IMM) with low-income Hispanic persons.

DESIGN

The effectiveness of the program was examined using a quasi-experimental pretest/post-test control group design.

SETTING

Subjects were recruited from nutrition, health, and English as a Second Language (ESL) programs in Colorado.

PARTICIPANTS

Thirty-six intervention and 34 control participants formed a convenience sample of low-income and predominantly Hispanic persons.

INTERVENTION

Intervention participants received a 15-minute module about breakfast. Control participants received a non- nutrition-related IMM module.

MAIN OUTCOME MEASURES

Primary variables included knowledge, attitude, and stage of change scores.

ANALYSIS

Paired and independent sample t tests, chi-square analysis, and repeated-measures analysis of covariance (ANCOVA) were used.

RESULTS

Intervention participants significantly increased knowledge, attitude, and total scores (P <.001) between pretest and post-test and had significantly greater increases than the control group (P <.001).

CONCLUSIONS

The results support using IMM to disseminate nutrition education to the target population and the feasibility of using computer-based questionnaires to evaluate the effectiveness of IMM nutrition education programs.

IMPLICATIONS

This research provides the basis for the continued development of computer-based assessment tools.

The road to obesity or the path to prevention: motorized transportation and obesity in China

OBJECTIVE

Dependence on motorized forms of transportation may contribute to the worldwide obesity epidemic. Shifts in transportation patterns occurring in China provide an ideal opportunity to study the association between vehicle ownership and obesity. Our objective was to determine whether motorized forms of transportation promote obesity.

RESEARCH METHODS AND PROCEDURES

A multistage random-cluster sampling process was used to select households from eight provinces in China. Data were included on household vehicle ownership and individual anthropometric and sociodemographic status. Cross-sectional data (1997) from 4741 Chinese adults aged 20 to 55 years were used to explore the association between vehicle ownership and obesity. Cohort data (1989 to 1997) from 2485 adults aged 20 to 45 years in 1989 (59% follow-up) were used to measure the impact of vehicle acquisition on the odds of becoming obese.

RESULTS

Our main outcome measure was current obesity status and the odds of becoming obese over an 8-year period. In 1997, 84% of adults did not own motorized transportation. However, the odds of being obese were 80% higher (p < 0.05) for men and women in households who owned a motorized vehicle compared with those who did not own a vehicle. Fourteen percent of households acquired a motorized vehicle between 1989 and 1997. Compared with those whose vehicle ownership did not change, men who acquired a vehicle experienced a 1.8-kg greater weight gain (p < 0.05) and had 2 to 1 odds of becoming obese.

DISCUSSION

Encouraging active forms of transportation may be one way to protect against obesity.