The reliability of a questionnaire-based metabolic syndrome surveillance tool

BACKGROUND

The objectives of this study were to report measures of internal consistency and test-retest reliability for a proxy method of detecting the metabolic syndrome with a questionnaire-based Metabolic Syndrome Surveillance tool (Met-X StL).

METHODS

The Met-X StL was constructed to obtain information concerning metabolic syndrome risk factors, and added to a population-based survey targeting rural, mid-western communities in three states with above average risk for chronic disease. Two to four weeks following individual completion of the survey, we re-administered the Met-X StL to a group of one-hundred randomly selected participants and assessed the tool for internal consistency and test-retest reliability.

RESULTS

Study participants were mostly females (70%), and of Caucasian ethnicity (97%), with an average age of 60.7 yrs. and some college education (65%). Our proxy method of detecting the metabolic syndrome revealed a prevalence of 31% in a population with mixed awareness concerning their current health status. The measures of internal consistency were acceptable (test = 0.75 | retest = 0.73). The retest reliability for each risk factor of the metabolic syndrome ranged from moderate (0.50-Physical Activity) to almost perfect agreement (0.97-BMI), while the reliability of the proxy metabolic syndrome diagnosis was substantial (0.77).

CONCLUSIONS

The Met-X StL is reliable in a rural population with an above average risk profile. This method may have application in population-based surveillance or intervention projects that wish to consider the metabolic syndrome, but are lacking the resources for clinical testing.

Factors influencing the implementation of school wellness policies in the United States, 2009

Introduction

The quality of school wellness policy implementation varies among schools in the United States. The objective of this study was to characterize the school wellness policy environment nationally and identify factors influencing the quality and effectiveness of policy implementation.

Methods

We invited school administrators from 300 high schools to complete a questionnaire; 112 administrators responded. We performed a 2-step cluster analysis to help identify factors influencing the implementation of school wellness policies.

Results

Eighty-two percent of schools reported making staff aware of policy requirements; 77% established a wellness committee or task force, 73% developed administrative procedures, and 56% trained staff for policy implementation. Most commonly reported challenges to implementation were lack of time or coordination of policy team (37% of respondents) and lack of monetary resources (33%). The core domains least likely to be implemented were communication and promotion (63% of respondents) and evaluation (54%). Cluster 1, represented mostly by schools that have taken action toward implementing policies, had higher implementation and effectiveness ratings than Cluster 2, which was defined by taking fewer actions toward policy implementation. In Cluster 1, accountability was also associated with high ratings of implementation quality and effectiveness.

Conclusion

The development of organizational capacity may be critical to ensuring an environment that promotes high-quality policy implementation. Assessing, preventing, and addressing challenges; establishing clear definitions and goals; and requiring accountability for enacting policy across all core domains are critical to ensuring high-quality implementation.

The quality of school wellness policies and energy-balance behaviors of adolescent mothers

INTRODUCTION

In this study, we 1) compared the quality of school wellness policies among schools participating in Moms for a Healthy Balance (BALANCE), a school- and home-based weight loss study conducted with postpartum adolescents in 27 states; and 2) assessed the relationship between policy quality with energy-balance behaviors and body mass index z scores of postpartum adolescents.

METHODS

As a part of BALANCE, we collected data on high-calorie food and beverage consumption, minutes spent walking, and height and weight for 647 participants. The School Wellness Policy Coding Tool was used to assess the strength and comprehensiveness of school district wellness policies from 251 schools attended by participating adolescent mothers.

RESULTS

Schools averaged low scores for wellness policy comprehensiveness and strength. When compared with participants in schools with the lowest policy comprehensiveness scores, adolescent mothers in schools with the highest scores reported consuming significantly fewer daily calories from sweetened beverages while reporting higher consumption of water (P = .04 and P = .01, respectively). School wellness policy strength was associated with lower BMI z scores among adolescent mothers (P = .01).

CONCLUSION

School wellness policies associated with BALANCE may be limited in their ability to promote a healthy school environment. Future studies are needed to evaluate the effect of the strength and comprehensiveness of policy language on energy balance in high-risk postpartum adolescents. Evidence from this work can provide additional guidance to federal or state government in mandating not only policy content, but also systematic evaluation.

Postpartum teens' breakfast consumption is associated with snack and beverage intake and body mass index

Addressing high-risk dietary patterns among postpartum teens may help reduce weight retention and prevent intergenerational obesity. The objective of this study was to describe the relationship between breakfast consumption and outcomes of snack and beverage intake and body mass index (BMI) among postpartum teens. During 2007-2009, 1,330 postpartum teens across 27 states participated in a cross-sectional, baseline assessment of a group-randomized, nested cohort study. Participants were enrolled in the Parents as Teachers Teen Program and completed a 7-day recall of breakfast, snack, and beverage consumption. BMI was calculated from heights and weights obtained by on-site staff. Sample descriptives were compared across breakfast consumption frequency groupings by one-way analysis of variance tests or χ² tests. General linear models assessed relationships between breakfast consumption and measures of snack and sweetened beverage intake, water consumption, and BMI-for-age percentile. Almost half (42%) of the sample consumed breakfast fewer than 2 days per week. Those who ate breakfast 6 to 7 days/week consumed 1,197 fewer kilocalories per week from sweet and salty snacks, 1,337 fewer kilocalories per week from sweetened drinks, and had a lower BMI compared to those who ate breakfast fewer than 2 days per week (P < 0.05). Consumption of fruit, vegetables, milk, water, and cereal as a snack were higher among regular breakfast consumers (P < 0.05). Although breakfast consumption among postpartum teens is low, those who regularly consume breakfast had healthier snacking behaviors and weight. Interventions are needed to encourage breakfast consumption among teen mothers.

Consumption of whole-grain cereals during weight loss: effects on dietary quality, dietary fiber, magnesium, vitamin B-6, and obesity

OBJECTIVE

While various weight-management approaches produce weight loss, they may differ in dietary quality. We monitored changes in nutrient intakes in overweight and obese subjects on three different weight-management programs.

DESIGN

Randomized clinical trial (pilot study) with two 12-week phases: phase 1, weekly counseling; phase 2, monitoring only.

SUBJECTS/SETTING

One hundred eighty nonsmoking, sedentary overweight and obese adults began this outpatient study; 134 (body mass index [calculated as kg/m(2)]=30.9+/-2.4; age=42.3+/-1.2 years) were used in analyses.

INTERVENTION

Twenty-four weeks of exercise only (control group), hypocaloric diet plus exercise, or hypocaloric diet with fiber-rich whole-grain cereals plus exercise.

MAIN OUTCOME MEASURES

At weeks 0, 12, and 24, diet quality was assessed by 3-day food records and body weight was measured.

STATISTICAL ANALYSES PERFORMED

Three-way analysis of variance with repeated measures.

RESULTS

The hypocaloric diet with fiber-rich whole-grain cereals plus exercise decreased energy intake more than exercise only (P=0.032). By week 12, the hypocaloric diet with fiber-rich whole-grain cereals plus exercise and the hypocaloric diet plus exercise decreased total fat more than exercise only, which was sustained in the hypocaloric diet with fiber-rich whole-grain cereals plus exercise at 24 weeks (P<0.001). At weeks 12 and 24, the hypocaloric diet with fiber-rich whole-grain cereals plus exercise reduced saturated fat intake more than exercise only. The hypocaloric diet with fiber-rich whole-grain cereals plus exercise increased total fiber, insoluble fiber (both P<0.001), magnesium (P=0.004), and vitamin B-6 (P=0.002) intakes more than the hypocaloric diet plus exercise and exercise only. Calcium and vitamin E intakes were inadequate in all groups. Weight loss was similar in the hypocaloric diet with fiber-rich whole-grain cereals plus exercise and the hypocaloric diet plus exercise.

CONCLUSIONS

Weight-reduction strategies may be associated with reduced intake of micronutrients, such as calcium and vitamin E. However, a hypocaloric diet with fiber-rich whole-grain cereal is effective for improving or maintaining other aspects of dietary quality during weight loss.