An Examination of Health-Promoting Behaviors Among Hispanic Adults Using an Activation and Empowerment Approach

BACKGROUND

Obesity is a national epidemic in the United States. Racial/ethnic minorities are disproportionately affected by this obesity epidemic. Hispanic adults have a higher prevalence of obesity compared to non-Hispanic White adults. Levels of engagement in healthy eating and physical activity have been found to be associated with obesity. Research suggests that culturally informed, person-centered factors may influence engagement in healthy eating and physical activity.

PURPOSE

The purpose of the present study was to examine the association between person-centered, modifiable variables (i.e., activation, empowerment, and self-praise) and health-promoting behaviors (i.e., healthy eating and physical activity) among a cross-sectional sample of predominantly overweight/obese Hispanic adults (N = 87) recruited from two Hispanic churches and their surrounding communities in the Bronx, New York.

RESULTS

A series of hierarchical regressions revealed that empowerment and self-praise were significant and positively associated with greater levels of engagement in healthy eating. Additionally, self-praise was significant and positively associated with greater levels of engagement in physical activity.

CONCLUSIONS

The current findings suggest that these modifiable factors may be useful in informing intervention programs designed to improve healthy eating and physical activity among Hispanic adults.

Perception of Body Weight Status Is Associated With the Health and Food Intake Behaviors of Adolescents in the United States

The purpose of this study was to determine the associations among body weight status perception, health status, diet quality, and consumption of fruits and vegetables within the adolescent population in the United States. A cross-sectional study was conducted with 1737 adolescents (12-17 years) participating in the Family Life, Activity, Sun, Health, and Eating study, an internet-based survey study sponsored by the National Cancer Institute. Adolescents reported their perception of their weight status, diet quality, health status, and the frequency with which they consumed common fruits and vegetables in a week. Results showed that 62% of the adolescents reported perceiving their weight as "just right," and 10.9%, 22.4%, and 4.7% perceived their weight to be "underweight," "a little overweight," and "very overweight," respectively. Those who perceived their weight status as "just right" also reported their health to be "very good" or "excellent" and that their diet was good. Similarly, adolescents who perceived their weight to be just right consumed significantly more fruits and vegetables than those who perceived their weight as "underweight" or "overweight." Results of this study have important implications for future research on weight and health status, diet quality, and healthy eating behaviors among adolescents.

Association of health self-empowerment with health-promoting behaviors among chronically ill African American and non- Hispanic White adolescents

OBJECTIVE

Health Self-Empowerment Theory (health motivation, health self-efficacy, health self-praise, and active coping) was examined as a predictor of levels of engagement in four health-promoting behaviors (health responsibility behaviors, regular exercise, healthy eating, and stress management behaviors) among low-income African American adolescents and non-Hispanic White American adolescents living with at least one chronic illness.

METHODS

Eighty-seven participants completed measures of the Health Self-Empowerment Theory variables and of level of engagement in each of the four health-promoting behaviors.

RESULTS

Regression analyses revealed that the combined Health Self-Empowerment Theory variables significantly predicted level of engagement in the four examined health-promoting behaviors. Additionally, active coping, health self-praise, and health motivation each significantly predicted one or more of the examined health-promoting behaviors.

CONCLUSIONS

Health self-empowerment may be useful for informing interventions designed to foster engagement in health-promoting behaviors among low-income adolescents living with one or more chronic illnesses

Motivators of and Barriers to Engagement in Healthy Eating Behaviors among non-Hispanic Black Adults

OBJECTIVES

The objective of this study was to determine if non-Hispanic Black adults' levels of endorsement of motivators and barriers related to healthy eating are significantly associated with their level of engagement in healthy eating and their perceived importance of healthy eating and if these investigated variables differ by gender, income, and/or age.

METHOD

An assessment battery was completed by a cross-sectional sample of 207 non-Hispanic Black adults in Bronx, NY (54.1 % female; age: M = 38, SD = 14.12). Participants were recruited by culturally diverse data collectors at community-based locations within Bronx.

RESULTS

Building healthy eating into a routine was a significant motivator of healthy eating (p < 0.001), and having low self-control over eating behaviors was a significant barrier to healthy eating (p < 0.05). Importance ratings of healthy eating were positively associated with motivators to engaging in healthy eating (routine: p < 0.001; availability of healthy foods: p < 0.001; addressing medical issues: p < 0.001; convenience of eating healthy foods: p < 0.01). There were age and income differences in several motivators and barriers.

IMPLICATIONS

Intervention programs to increase healthy eating among adults similar to those in this study may benefit from including a focus on increasing self-control of eating behaviors and incorporating healthy eating into one's routine.

Predictors of Cancer Screening Among Culturally Diverse Men

Men have higher rates of all cancers and are more likely to die from cancer than women; however, men are less likely to utilize disease prevention services. African American/Black men and Hispanic men have lower cancer survival rates and are less likely to utilize health care services than non-Hispanic White men. The present study examined demographic variables (age, household income, education, marital status, race/ethnicity, health insurance status), motivators to engage in healthy eating, and motivators to engage in physical activity as predictors of culturally diverse, medically underserved men's likelihood of getting a cancer screening (a) at the present time, (b) if no cancer symptoms are present, and (c) if a doctor discovers some cancer symptoms. Analyses were conducted using data from 243 men (47.3% non-Hispanic Black, 29.5% Hispanic, 16.5% non-Hispanic White, and 6.8% "other") recruited at the Men's Health Forum in Tampa, Florida. Age, having a medical or health condition that benefits from eating healthy, and having a commitment to physical activity were significant positive predictors of the likelihood of receiving a cancer screening. Motivation to engage in physical activity because of a personal priority was a significant negative predictor of the likelihood of getting a cancer screening. The findings from this study suggest that interventions to increase cancer screenings among culturally diverse, medically underserved men should be informed at least in part by an assessment of participating men's motivators for engaging in health promoting lifestyle behaviors such as physical activity and healthy eating.

Frequency of visits to a health care provider, health promoting behaviors, and perceived health status among African American women

The primary purpose of this study was to examine whether the self-reported number of health care visits over a 1-year period was associated with engagement in health promoting behaviors (i.e., healthy eating and physical activity) and perceived health status among a cross-sectional sample of African American women who were pre-hypertensive/hypertensive and/or overweight or obese (N = 180). The study participants were recruited in predominantly African American churches and had their data collected in April and May of 2009. Age, income, and education were also examined as moderators in the aforementioned relationships. Results revealed that the self-reported number of health care visits was significantly positively associated with healthy eating and perceived health status. Income moderated the relationship between self-reported number of health care visits and engagement in healthy eating. These results provide support for health promotion programs for African American women with program components that explain the relationships among routine care from a health care provider, engagement in health promoting behaviors, and prevention of chronic health conditions.

Impact of a University-Community Partnership Approach to Improving Health Behaviors and Outcomes Among Overweight/Obese Hispanic Adults

Objective. To examine the impact of a community-informed and community-based Health-Smart Church (HSC) Program on engagement in health promoting behaviors (healthy eating and physical activity) and health outcomes (body mass index, weight, and systolic and diastolic blood pressure). Design. A total of 70 overweight/obese Hispanic adults participated in an intervention group (n = 37) or a waitlist control group (n = 33) in 2 Hispanic churches in Bronx, New York. Results. Post-intervention the intervention group significantly increased in frequency of healthy eating and physical activity compared to the waitlist control group. Although no significant changes in body mass index or systolic blood pressure were found for either group, the intervention group decreased significantly in weight from pre-intervention to post-intervention. Conclusions. The results of the present study add to the growing body of literature evidencing the successful use of community-engaged and community-based participatory health promotion interventions with racial/ethnic minority populations and highlight important practices and considerations for similar health promotion interventions with these communities.

A Novel Catastrophic Presentation of X-Linked Adrenoleukodystrophy

OBJECTIVE

We report a novel presentation of childhood cerebral X-linked adrenoleukodystrophy: status epilepticus followed by abrupt and catastrophic neurologic deterioration.

METHODS

A description of the clinical presentation, laboratory evaluation, and imaging findings leading to a diagnosis of X-linked adrenoleukodystrophy.

RESULTS

A 3-year-old male with prior history of autism presented with fever, diarrhea, and status epilepticus requiring a pentobarbital coma. Admission labs were notable only for a glucose level of 22 mg/dL, which stabilized after correction. The child never returned to his prior neurologic baseline, with complete loss of gross motor, fine motor, and speech skills. Serial brain magnetic resonance imaging (MRI)/magnetic resonance spectroscopy (MRS) was notable for progressive diffuse cortical signal changes with swelling, diffusion restriction, and ultimately laminar necrosis. Nine months after presentation, CSF (cerebrospinal fluid) protein and MRS lactate were persistently elevated, concerning for a neurodegenerative disorder. This led to testing for mitochondrial disease, followed by lysosomal and peroxisomal disorders. Very long-chain fatty acids were elevated. Identification of a pathogenic ABCD1 mutation confirmed the diagnosis of X-linked adrenoleukodystrophy.

CONCLUSIONS

Boys with childhood cerebral X-linked adrenoleukodystrophy typically present with gradual behavioral changes. Rare reports of boys presenting with transient altered mental status or status epilepticus describe a recovery to their pre-presentation baseline. To our knowledge this is the first X-ALD patient to present with status epilepticus with abrupt and catastrophic loss of neurologic function. X-linked adrenoleukodystrophy should be suspected in young males presenting with seizures, acute decline in neurologic function, with persistently elevated CSF protein and MRS lactate.

A Community-Level Assessment of Barriers to Preventive Health Behaviors Among Culturally Diverse Men

There are significant gender disparities in health outcomes and health care utilization in the United States, with men experiencing more of these disparities. It is critical to ascertain the interplay between societal conditions, health behaviors, and access to services and the impact of these factors on health outcomes and utilization of health care. The present study is part of a larger initiative titled, The Men's Health Study: Addressing Healthy Lifestyle Behaviors, which has two purposes-to annually assess the motivators of and barriers to health-promoting behaviors among culturally diverse men attending the Men's Health Forum (MHF) and to use this information to develop an intervention program that facilitates healthy lifestyle behaviors among men. The MHF is a community-driven initiative for medically underserved men in Tampa, Florida that offers free health screenings and wellness exhibitors in order to empower men to lead a healthy lifestyle. The purpose of this article is to identify barriers to engaging in health-smart behaviors (e.g., cancer screenings, physical activity) among culturally diverse men who participated in the MHF and to detect any demographic differences among these barriers. A total of 254 men participated in the study. Findings identify that age was the only demographic variable that had a statistically significant association with any of the cancer-screening barriers. Some cancer-screening barriers appear to exist among all demographic groups since no statistical demographic differences were discovered. Income and education were significantly associated with barriers to engaging in health-smart behaviors. This may give researchers, health educators, and providers information needed to customize interventions to promote health and preventive health care among culturally diverse men.

Patient-Centered, Culturally Sensitive Health Care

In recent years, there have been increasing national calls for patient-centered, culturally sensitive health care (PC-CSHC). The impetus for these calls include (a) the reality that health care providers are increasingly having to provide health care to a more culturally diverse patient population without the necessary training to do so effectively, (b) the growing evidence that culturally insensitive health care is a major contributor to the costly health disparities that plague our nation, and (c) the fact that racial/ethnic minorities and individuals with low household incomes are more likely than their non-Hispanic white and higher-income counterparts to experience culturally insensitive health care and dissatisfaction with health care—health care experiences that have been linked to poorer health outcomes. This article (a) presents literature on the definition of PC-CSHC and the need for this care, (b) presents research on assessing and promoting this care, and (c) offers research-informed strategies and future directions for customizing and institutionalizing this care.

Prevalence and level of Escherichia coli O157:H7 in feces and on hides of feedlot steers fed diets with or without wet distillers grains with solubles

The objective of this study was to determine if wet distillers grains with solubles (WDGS) from corn in diets affected Escherichia coli O157:H7 in growing and finishing cattle; steers (n = 603) were randomly assigned to diets with or without WDGS. Hide and fecal samples were collected monthly (October through June) from each animal for enumeration and enrichment of E. coli O157:H7. In the growing phase (0 or 13.9% WDGS diets), fecal prevalence for E. coli O157:H7 in steers fed a diet with WDGS was twice that of the prevalence in control steers (P < 0.001). In the finishing phase (0 or 40% WDGS diets), the average prevalence in feces (P < 0.001) and on hides (P < 0.001) was higher for cattle fed WDGS. The average percentage of fecal E. coli O157:H7 enumerable samples during the finishing phase for cattle fed WDGS was 2.7% compared with 0.1% for control steers (P < 0.001). The average percentage of E. coli O157:H7 enumerable hide samples was not different between diets, but the cattle fed WDGS had higher levels (P < 0.05) of the pathogen. Animals fed WDGS had higher levels of E. coli (P < 0.001), higher pH values (P < 0.001), and lower concentrations of L-lactate (P < 0.001) in feces than those values of the control steers. These results indicate that feeding 40% WDGS could increase the level and prevalence of E. coli O157:H7 in and on feedlot cattle when E. coli O157:H7 is seasonally low.

Prevalence of Mycobacterium avium subsp. paratuberculosis in ileocecal lymph nodes and on hides and carcasses from cull cows and fed cattle at commercial beef processing plants in the United States

Clinical associations between Crohn's disease in humans and Mycobacterium avium subsp. paratuberculosis (MAP) have been suggested but not confirmed. Cattle could be sources for MAP, but little information on MAP prevalence with beef has been reported. Samples of ileocecal lymph nodes and swabs of hides and carcasses from 343 animals at cull cattle slaughtering facilities and 243 animals at fed cattle slaughtering facilities across the United States were analyzed for the presence of MAP. Amplification of genetic sequences detected MAP DNA predominantly on hides and in lymph nodes of samples taken at both types of processing facilities. More than 34% of the cattle at cull cow slaughtering facilities had ileocecal lymph nodes that tested positive for MAP DNA. From these same cattle, hide prevalence was more than twofold greater than the prevalence in ileocecal lymph nodes, suggesting that cross-contamination could be occurring during transport and lairage. The prevalence of MAP DNA decreased during processing, and less than 11% of the carcasses tested positive after interventions in the cull cow processing facilities. Using standard double-decontamination and culture techniques, less than 1% of the postintervention carcasses tested positive for viable MAP at cull cow facilities. In samples from the facilities processing only fed cattle, MAP prevalence of 1% or less was detected for ileocecal lymph node, hide, and carcass samples, and viable MAP was not detected. Based on this study, fed cattle carcasses are unlikely sources of MAP, and carcasses at cull cow plants have only a slight risk for transmitting viable MAP, due to current interventions.

Interventions to reduce/eliminate Escherichia coli O157:H7 in ground beef

The Escherichia coli O157:H7 (E. coli O157:H7) outbreak in the Northwestern United States ushered in an era that has dramatically changed the way beef processors in the United States convert live cattle into meat. Unprecedented cooperation among the beef processors and massive investment in research by the US government and the beef industry have resulted in an acceptable level of control of E. coli O157:H7 in ground beef. The evidence to support the progress in control of E. coli O157:H7 is the CDC data for reduction in human illness as well as the dramatic reduction in the number of E. coli O157:H7-positive samples in USDA-FSIS ground beef monitoring. This manuscript highlights some of the recent findings from our laboratory on the control of E. coli O157:H7 in ground beef. We have also summarized the key events/decisions/milestones that have contributed to the control of E. coli O157:H7 in ground beef in the United States. While there is much to be done to bring E. coli O157:H7 under complete control in the beef sector of the food industry, E. coli O157:H7 also is becoming a major issue in the fresh vegetable sector, as evidenced by the 2006 outbreaks in the United States. We have discussed how the fresh vegetable industry can benefit from the beef industry's experience to expedite the control of E. coli O157:H7 in their products.

Genotypic analyses of Escherichia coli O157:H7 and O157 nonmotile isolates recovered from beef cattle and carcasses at processing plants in the Midwestern states of the United States

Escherichia coli O157:H7 and O157 nonmotile isolates (E. coli O157) previously were recovered from feces, hides, and carcasses at four large Midwestern beef processing plants (R. O. Elder, J. E. Keen, G. R. Siragusa, G. A. Barkocy-Gallagher, M. Koohmaraie, and W. W. Laegreid, Proc. Natl. Acad. Sci. USA 97:2999-3003, 2000). The study implied relationships between cattle infection and carcass contamination within single-source lots as well as between preevisceration and postprocessing carcass contamination, based on prevalence. These relationships now have been verified based on identification of isolates by genomic fingerprinting. E. coli O157 isolates from all positive samples were analyzed by pulsed-field gel electrophoresis of genomic DNA after digestion with XbaI. Seventy-seven individual subtypes (fingerprint patterns) grouping into 47 types were discerned among 343 isolates. Comparison of the fingerprint patterns revealed three clusters of isolates, two of which were closely related to each other. Remarkably, isolates carrying both Shiga toxin genes and nonmotile isolates largely fell into specific clusters. Within lots analyzed, 68.2% of the postharvest (carcass) isolates matched preharvest (animal) isolates. For individual carcasses, 65.3 and 66.7% of the isolates recovered postevisceration and in the cooler, respectively, matched those recovered preevisceration. Multiple isolates were analyzed from some carcass samples and were found to include strains with different genotypes. This study suggests that most E. coli O157 carcass contamination originates from animals within the same lot and not from cross-contamination between lots. In addition, the data demonstrate that most carcass contamination occurs very early during processing.

Binding of the initiation factor sigma(70) to core RNA polymerase is a multistep process

The interaction of RNA polymerase and its initiation factors is central to the process of transcription initiation. To dissect the role of this interface, we undertook the identification of the contact sites between RNA polymerase and sigma(70), the Escherichia coli initiation factor. We identified nine mutationally verified interaction sites between sigma(70) and specific domains of RNA polymerase and provide evidence that sigma(70) and RNA polymerase interact in at least a two-step process. We propose that a cycle of changes in the interface of sigma(70) with core RNA polymerase is associated with progression through the process of transcription initiation.

A coiled-coil from the RNA polymerase beta' subunit allosterically induces selective nontemplate strand binding by sigma(70)

For transcription to initiate, RNA polymerase must recognize and melt promoters. Selective binding to the nontemplate strand of the -10 region of the promoter is central to this process. We show that a 48 amino acid (aa) coiled-coil from the beta' subunit (aa 262--309) induces sigma(70) to perform this function almost as efficiently as core RNA polymerase itself. We provide evidence that interaction between the beta' coiled-coil and region 2.2 of sigma(70) promotes an allosteric transition that allows sigma(70) to selectively recognize the nontemplate strand. As the beta' 262--309 peptide can function with the previously crystallized portion of sigma(70), nontemplate recognition can be reconstituted with only 47 kDa, or 1/10 of holoenzyme.

Phenotypic stability of chick cardiomyocytes in serum-free media. Preservation of muscarinic receptor expression

Chick cardiomyocytes cultured in fetal bovine serum (FBS)-supplemented media are phenotypically unstable, becoming noncontractile and unresponsive to stimuli after several days. We report a culturing protocol that preserves the differentiated cardiomyocyte phenotype for at least 9 days in culture. Cardiomyocytes isolated from 11-day chicken embryos, and cultured in either Dulbecco's Modified Earle's Medium (DMEM)/Ham's F12 medium with N-2 supplement or Medium 199 (M199) with 10% FBS continued to beat spontaneously for 4-5 days; only cells cultured in N-2-supplemented medium exhibited spontaneous beating beyond 5 days. Immunostaining for alpha-actinin after 9 days in culture revealed that myofibrils persisted in N-2-supplemented cells, while no myofibrils were observed in the FBS-supplemented cells. For cells in FBS-supplemented media, [3H]thymidine incorporation rates were 7.5 and 3 times greater than that of cells in N-2-supplemented media at Days 4 and 9 in culture, respectively. The effect of growth media on the binding parameters of the muscarinic antagonist, [3H]N-methyl-scopolamine (NMS), was also compared. While B(max) decreased 34% between Days 4 and 9 for cells maintained in N-2-supplemented media, a 77% decrease was observed for cells cultured in FBS-supplemented media. The phenotypic stability of this preparation makes it feasible for the first time to use these cells in experiments that require more than 4 days to complete.

Mutational analysis of beta '260-309, a sigma 70 binding site located on Escherichia coli core RNA polymerase

In eubacteria, the final sigma subunit binds to the core RNA polymerase and directs transcription initiation from any of its cognate set of promoters. Previously, our laboratory defined a region of the beta' subunit that interacts with final sigma(70) in vitro. This region of beta' contained heptad repeat motifs indicative of coiled coils. In this work, we used 10 single point mutations of the predicted coiled coils, located within residues 260-309 of beta', to look at disruption of the final sigma(70)-core interaction. Several of the mutants were defective for binding final sigma(70) in vitro. Of these mutants, three (R275Q, E295K, and A302D) caused cells to be inviable in an in vivo assay in which the mutant beta' is the sole source of beta' subunit for the cell. All of the mutants were able to assemble into the core enzyme; however, R275Q, E295K, A302D were defective for Efinal sigma(70) holoenzyme formation. Several of the mutants were also defective for holoenzyme assembly with various minor final sigma factors. In the recently published crystal structure of Thermus aquaticus core RNA polymerase (Zhang, G., Campbell, E. A., Minakhin, L., Richter, C., Severinov, K. , and Darst, S. A. (1999) Cell 98, 811-824), the region homologous to beta'(260-309) of Escherichia coli forms a coiled coil. Modeling of our mutations onto that coiled coil places the most defective mutations on one face of the coiled coil.

Localization of a sigma70 binding site on the N terminus of the Escherichia coli RNA polymerase beta' subunit

The Escherichia coli genome encodes genes for seven different sigma subunit species while only having single genes for the alpha, beta, and beta' subunits that make up the RNA polymerase core enzyme. The various sigma factors compete for binding to the core enzyme, upon which they confer promoter DNA-specific transcription initiation to the polymerase. We have mapped a major interaction site between one of the sigma species, sigma70, and beta'. Using far-Western blotting analysis of chemically cleaved and genetically engineered protein fragments, we have identified a N-terminal fragment of beta' (residues 60-309) that could bind sigma70. We were able to more precisely map the interaction domain to amino acid residues 260-309 of beta' using nickel nitrilotriacetic acid co-immobilization assays.