Communication Between Low Income Hispanic Patients and Their Healthcare Providers Regarding Physical Activity and Healthy Eating

U.S. Hispanics disproportionately show health burdens that may be decreased by discussing physical activity (PA) and healthy eating with their healthcare providers (HCPs). We examined the perceptions of both HCPs and low-income Hispanic patients regarding the dynamics of these communications. We surveyed 295 low-income Hispanic patients and interviewed 14 HCPs at three community health clinics. Patients were asked about their comfort level with HCPs, how often their HCP discussed PA and healthy eating, and the likelihood of following advice on PA and healthy eating. HCPs were asked about their delivery (frequency/duration) and perceived effectiveness in providing such advice. Patients reported feeling “most comfortable” with their physicians (57%) with a lower proportion (19%) feeling “most comfortable” with nurses. Nearly all patients (95%) reported being very likely to follow the advice of their physician. On average, HCPs (physicians and nurses) reported discussing PA and healthy eating with 85% and 80% of their patients, respectively. In contrast, a fewer proportion of patients (65.8%) reported that their physician discussed PA and healthy eating “some” or “a lot” of the time. Overall, physicians reported discussing PA and healthy eating for an average of 5 and 6 min, respectively; whereas nurses reported discussing PA and healthy eating for an average of 12 and 19 min, respectively. Further study on the content and delivery of conversations between HCPs and their low-income Hispanic patients regarding PA and healthy eating could be vital to optimally impact health behaviors.     

Development of Educational Modules for the Promotion of Healthy Eating and Physical Activity Among Immigrant Older Adults

Abstract

For healthy and successful aging, remaining active and eating well appear to be very important. These two behaviors need to be supported and maintained through educational interventions. This paper describes the development of teaching modules for nutrition education and physical activity, based on needs assessment and identified barriers, facilitators and motivational factors among four groups of immigrant older adults. Seven modules on nutrition education and six modules on physical activity are described, including textual content and educational goals. Modifying behaviors related to nutrition and physical activity can have profound effects on the health status of the older population.     

Barriers and Facilitators to Healthy Eating and Physical Activity Postpartum: A Qualitative Systematic Review

BackgroundPostpartum weight retention increases the risk of long-term overweight and obesity and associated comorbidities. Healthy eating and physical activity are important lifestyle behaviors for achieving and maintaining a healthy weight. However, these habits may be hard for women to adopt or maintain during the postpartum period.ObjectiveTo identify and describe barriers and facilitators to healthy eating and physical activity among postpartum women in the United States.MethodsA qualitative systematic review was conducted. Qualitative studies on women’s experiences with weight loss, healthy eating, and physical activity in the postpartum period were identified using a comprehensive search strategy. The quality of included studies was assessed using the Critical Appraisal Skills Programme checklist. Data were qualitatively analyzed using thematic synthesis. Resulting themes were mapped onto components of the Social-Ecological Model for Food and Physical Activity Decisions.ResultsThirteen qualitative studies were included in the review. Barriers and facilitators to healthy eating and physical activity during the postpartum period included individual factors (emotional and mindless eating, physical limitations, and social support), settings and sectors (food environments, childcare needs, and structured information and support), and social and cultural norms (time constraints, and prioritization of maternal responsibilities).ConclusionsResearchers and practitioners should consider how factors within various levels of the Social-Ecological Model may influence healthy eating and physical activity in the postpartum period.     

Eating Behavior,Physical Activity and Exercise Training: A Randomized Controlled Trial in Young Healthy Adults

Regular physical activity (PA) is an important part of the treatment of several medical conditions, including overweight and obesity, in which there may be a weakened appetite control. Eating behaviour traits influence weight control and may be different in active and sedentary subjects. This paper reports the relationships between the time spent in sedentary behaviour and physical activity (PA) of different intensity, and eating behaviour traits in young, healthy adults. Additionally, it reports the results of a six-month-long, randomized, controlled trial to examine the effect of an exercise intervention on eating behaviour traits. A total of 139 young (22.06 ± 2.26 years) healthy adults (68.35% women) with a Body Mass Index (BMI) of 24.95 ± 4.57 kg/m² were enrolled. Baseline assessments of habitual PA were made using wrist-worn triaxial accelerometers; eating behaviour traits were examined via the self-reported questionnaires: Binge Eating, Three-Factor Eating Questionnaire-R18 and Control of Eating Questionnaire. The subjects were then randomly assigned to one of three groups: control (usual lifestyle), moderate-intensity exercise (aerobic and resistance training 3¨C4 days/week at a heart rate equivalent to 60% of the heart rate reserve (HRres) for the aerobic component, and at 50% of the 1 repetition maximum (RM) for the resistance component), or vigorous-intensity exercise (the same training but at 80% HRres for half of the aerobic training, and 70% RM for the resistance training). At baseline, sedentary behaviour was inversely associated with binge eating (r = −0.181, p < 0.05) and with uncontrolled eating (r = −0.286, p = 0.001). Moderate PA (MPA) was inversely associated with craving control (r = −0.188, p < 0.05). Moderate-to-vigorous PA (MVPA) was directly associated with binge eating (r = 0.302, p < 0.001) and uncontrolled eating (r = 0.346, p < 0.001), and inversely associated with craving control (r = −0.170, p < 0.015). Overall, PA was directly associated with binge eating (r = 0.275, p = 0.001), uncontrolled eating (r = 0.321, p < 0.001) and emotional eating (r = 0.204, p < 0.05). Additionally, only emotional eating was modified by the intervention, increasing in the vigorous-intensity exercise group (p < 0.05). In summary, we observed that time spent in sedentary behaviour/PA of different intensity is associated with eating behaviour traits, especially binge eating in young adults. In contrast, the six-month exercise intervention did not lead to appreciable changes in eating behaviour traits.     

武汉市居民保健食品服用行为及影响因素分析

目的：分析消费者保健食品服用行为和影响因素,为居民理性消费保健食品提供参考依据。方法在武汉市6个区抽取1530名保健食品消费者进行保健食品服用状况的调查。结果在调查对象中,每天服用保健食品者占3.6%;服用不到3个月的占62.5%,能坚持1年及以上的仅占8.19%;仅服用1种保健食品的比例为53.9%;服用保健食品最主要的原因是为了“提高自身免疫力”(39.7%),其次是“补充营养元素”(38.2%)。影响保健食品服用的因素主要有年龄、是否相信保健食品的疗效、是否有必要了解保健食品知识、购买意愿和服用意愿。结论武汉市居民服用保健食品行为相对较为理性,保健食品消费要考虑居民的消费认知和消费意愿。     

Knowledge is (Not) Power: Healthy Eating and Physical Activity for African-American Women

African-American women are more likely to be overweight or obese as compared to other ethnic groups. The purpose of this Qualitative Interpretive Meta-Synthesis (QIMS) was to explore the experiences that African-American women encounter when trying to eat healthily and maintain physical activity to inform practice and research. The QIMS included studies from various disciplines to understand the experiences of African-American women with eating healthily and being physically active. Five themes were identified: family; structured support; translating knowledge into behavior modifications; barriers to physical activity; and God is my healer. These themes enhance understanding of what African-American women know, their support system(s), and how cultural barriers impact nutrition and physical activity.     

Impact of an Exercise Intervention on Physical Activity During Pregnancy: The Behaviors Affecting Baby and You Study

Objectives. We examined the impact of a prenatal exercise intervention on physical activity in 260 women at risk for gestational diabetes mellitus.Methods. We randomized participants in the Behaviors Affecting Baby and You (BABY) Study, which took place from 2007 to 2012, to either a 12-week individually tailored, motivationally matched exercise intervention (n = 132) or to a comparison health and wellness intervention (n = 128). We assessed physical activity with the Pregnancy Physical Activity Questionnaire. We used linear mixed models to evaluate the impact of the interventions on change in physical activity according to intensity and type, total walking, and sedentary behavior.Results. Compared with the health and wellness arm, the exercise arm had significantly greater increases in sports or exercise activity (0.3 vs 5.3 metabolic equivalent of task [MET] hours/week; P < .001), and smaller declines in total activity (–42.7 vs –2.1 MET hours/week; P = .02) and activities of moderate to vigorous intensity (–30.6 vs −10.6 MET hours/week; P = .05), and was more likely to achieve recommended guidelines for physical activity (odds ratio = 2.12; 95% confidence interval = 1.45, 3.10).Conclusions. These findings extend the previous literature by demonstrating the benefits of a clinically feasible exercise intervention in an ethnically and socio-economically diverse population. Given the increased risk of adverse maternal health outcomes in ethnic minority groups, these findings may have important implications for reducing health disparities.The American College of Obstetricians and Gynecologists (ACOG) recommends that all women who are free from medical or obstetric complications engage in 30 minutes or more of moderate intensity physical activity on most days of the week.1 Physical activity during pregnancy is associated with reduced risk for excess gestational weight gain,2–4 and a reduced risk of gestational diabetes mellitus (GDM)5 and preeclampsia.6 Despite the benefits of physical activity, pregnant women are less likely to meet physical activity recommendations than nonpregnant women of childbearing age.7,8 Furthermore, physical activity levels decline throughout pregnancy, even in women who were active before pregnancy.9,10 Physical activity levels are even lower in Hispanic women; Hispanic women are 40% less likely to meet recommended levels of physical activity than are non-Hispanic White women.11 These numbers are concerning because of the excess risk of adverse maternal outcomes, such as GDM, in Hispanic women.12 Thus, it is important to develop culturally adapted interventions that can engage pregnant women in more active lifestyles.The impact of exercise interventions during pregnancy has been conflicting. Several interventions have been successful at attenuating the decrease in physical activity levels over the course of pregnancy13–15; however, most studies have observed no impact.16–20 In addition, the majority of the successful interventions to date have been conducted in predominantly White non-Hispanic study populations or have used intensive interventions that may not be feasible in clinical practice.21Individually tailored, motivationally matched interventions have been shown to be cost-effective approaches to increasing physical activity in nonpregnant women in community settings.22,23 These interventions are also readily translatable to clinical practice. However, whether these programs are effective at increasing physical activity during pregnancy is unknown. Therefore, we assessed the effectiveness of an individually tailored, motivationally matched exercise intervention on physical activity levels in an ethnically diverse sample of pregnant women at high risk for GDM.     

Cognitive Interviews of Vietnamese Americans on Healthy Eating and Physical Activity Health Educational Materials

The purpose of this study was to better understand if a health educational presentation using culturally adapted materials was understandable and culturally appropriate, and that the content was retained, in an older Vietnamese American population. This study used cognitive interviewing. A convenient sampling was used to recruit eight participants by staff of a community-based organization from its client base. This is the first study to document that family eating style poses a challenge for estimating food intake among Vietnamese Americans. Participants who ate in a family eating style were not able to recall or estimate the number of servings of protein and vegetables. Some older Vietnamese Americans used food for healing and self-adjusted portion sizes from dietary recommendations. Cognitive interviewing is a useful method to improve comprehension, retention, and cultural appropriateness of health educational materials. Further nutrition research concerning intake measurement in ethnic groups that practice a family eating style is warranted.     

Family Functioning: Associations With Weight Status,Eating Behaviors,and Physical Activity in Adolescents

PurposeThis article examines the relationship between family functioning (e.g., communication, closeness, problem solving, behavioral control) and adolescent weight status and relevant eating and physical activity behaviors.MethodsData are from EAT 2010 (Eating and Activity in Teens), a population-based study that assessed eating and activity among socioeconomically and racially/ethnically diverse youths (n = 2,793). Adolescents (46.8% boys, 53.2% girls) completed anthropometric assessments and surveys at school between 2009 and 2010. Multiple linear regression was used to test the relationship between family functioning and adolescent weight, dietary intake, family meal patterns, and physical activity. Additional regression models were fit to test for interactions by race/ethnicity.ResultsFor adolescent girls, higher family functioning was associated with lower body mass index z score and percent overweight, less sedentary behavior, higher intake of fruits and vegetables, and more frequent family meals and breakfast consumption. For adolescent boys, higher family functioning was associated with more physical activity, less sedentary behavior, less fast-food consumption, and more frequent family meals and breakfast consumption. There was one significant interaction by race/ethnicity for family meals; the association between higher family functioning and more frequent family meals was stronger for nonwhite boys compared with white boys. Overall, strengths of associations tended to be small, with effect sizes ranging from −.07 to .31 for statistically significant associations.ConclusionsFindings suggest that family functioning may be protective for adolescent weight and weight-related health behaviors across all race/ethnicities, although assumptions regarding family functioning in the homes of overweight children should be avoided, given small effect sizes.     

Schools and Obesity Prevention: Creating School Environments and Policies to Promote Healthy Eating and Physical Activity

Context: Research consistently shows that the majority of American children do not consume diets that meet the recommendations of the Dietary Guidelines for Americans, nor do they achieve adequate levels of daily physical activity. As a result, more children are overweight today than at any other time in U.S. history. Schools offer many opportunities to develop strategies to prevent obesity by creating environments in which children eat healthfully and engage regularly in physical activity. Methods: This article discusses the role of schools in obesity prevention efforts. Current issues in schools' food and physical activity environments are examined, as well as federal, state, and local policies related to food and physical activity standards in schools. The article is organized around four key areas: (1) school food environments and policies, (2) school physical activity environments and policies, (3) school body mass index measurements, and (4) school wellness policies. Recommendations for accelerating change also are addressed. Findings: The article found that (1) competitive foods (foods sold outside of federally reimbursed school meals) are widely available in schools, especially secondary schools. Studies have related the availability of snacks and drinks sold in schools to students' high intake of total calories, soft drinks, total fat and saturated fat, and lower intake of fruits and vegetables; (2) physical activity can be added to the school curriculum without academic consequences and also can offer physical, emotional, and social benefits. Policy leadership has come predominantly from the districts, then the states, and, to a much lesser extent, the federal government; (3) few studies have examined the effectiveness or impact of school‐based BMI measurement programs; and (4) early comparative analyses of local school wellness policies suggest that the strongest policies are found in larger school districts and districts with a greater number of students eligible for a free or reduced‐price lunch. Conclusions: Studies show that schools have been making some progress in improving the school food and physical activity environments but that much more work is needed. Stronger policies are needed to provide healthier meals to students at schools; limit their access to low‐nutrient, energy‐dense foods during the school day; and increase the frequency, intensity, and duration of physical activity at school.     

Factors Influencing Healthy Eating Habits Among College Students: An Application of the Health Belief Model

Poor eating habits are an important public health issue that has large health and economic implications. Many food preferences are established early, but because people make more and more independent eating decisions as they move through adolescence, the transition to independent living during the university days is an important event. To study the phenomenon of food selection, the heath belief model was applied to predict the likelihood of healthy eating among university students. Structural equation modeling was used to investigate the validity of the health belief model (HBM) among 194 students, followed by gender-based analyses. The data strongly supported the HBM. Social change campaign implications are discussed.     

Gastrointestinal Hormones in Healthy Adults: Reliability of Repeated Assessments and Interrelations with Eating Habits and Physical Activity

Background: Gastrointestinal hormones (GIHs) are crucial for the regulation of a variety of physiological functions and have been linked to hunger, satiety, and appetite control. Thus, they might constitute meaningful biomarkers in longitudinal and interventional studies on eating behavior and body weight control. However, little is known about the physiological levels of GIHs, their intra-individual stability over time, and their interaction with other metabolic and lifestyle-related parameters. Therefore, the aim of this pilot study is to investigate the intra-individual stability of GIHs in normal-weight adults over time. Methods: Plasma concentrations of ghrelin, leptin, GLP-1 (glucagon-like-peptide), and PP (pancreatic polypeptide) were assessed by enzyme-linked immunosorbent assay (ELISA) in 17 normal-weight, healthy adults in a longitudinal design at baseline and at follow-up six months later. The reliability of the measurements was estimated using intra-class correlation (ICC). In a second step, we considered the stability of GIH levels after controlling for changes in blood glucose and hemoglobin A1 (HbA1c) as well as self-reported physical activity and dietary habits. Results: We found excellent reliability for ghrelin, good reliability for GLP1 and PP, and moderate reliability for leptin. After considering glucose, HbA1c, physical activity, and dietary habits as co-variates, the reliability of ghrelin, GLP1, and PP did not change significantly; the reliability of leptin changed to poor reliability. Conclusions: The GIHs ghrelin, GLP1, and PP demonstrated good to excellent test–retest reliability in healthy individuals, a finding that was not modified after adjusting for glucose control, physical activity, or dietary habits. Leptin showed only moderate to poor reliability, which might be linked to weight fluctuations, albeit small, between baseline and follow-up assessment in our study sample. Together, these findings support that ghrelin, GLP1, and PP might be further examined as biomarkers in studies on weight control, with GLP1 and PP serving as anorexic markers and ghrelin as an orexigenic marker. Additional reliability studies in obese individuals are necessary to verify or refute our findings for this cohort.     

Characteristics of Eating Habits and Physical Activity in Relation to Body Mass Index Among Adolescents

Objective: To assess eating habits and the level of physical activity in adolescents and develop a predictive model for the body mass index (BMI) based on these variables.

Design: In this cross-sectional study, eating habits and the level of physical activity were assessed using a questionnaire validated in adolescents. Body mass and height collected during the last annual checkup were extracted from personal medical records.

Subjects: The sample included 330 boys and 377 girls (mean age 15.8 ± 0.2 years) who were first-year high school students in the city of Belgrade, Serbia.

Measures: Responses to each of the 14 questions about eating habits and 6 questions about physical activity were scored from the least (0) to the most (3) desired behaviors. These ratings were then averaged to arrive to an aggregate score for each domain. The BMI was calculated according to the standard method. A series of regression analyses was performed to derive the best model for predicting BMI in boys and girls based on individual eating habits and physical activity items, first separately and then combined.

Results: In the sample, 24.5% of boys and 9.5% of girls were overweight or obese. Girls’ eating habits were better than boys (mean aggregate score 2.3 ± 0.3 and 2.1 ± 0.3, respectively, p < 0.001), whereas the level of physical activity was greater in boys than girls (2.1 ± 0.6 vs 1.9 ± 0.6, p < 0.001). The differences between boys and girls in the BMI, eating habits, and physical activity remained significant after controlling for their knowledge about healthy eating and education level of their parents. Eating habits were a better predictor of BMI than physical activity, particularly in boys (R ² = 0.13 vs R ² = 0.02) compared to girls (R ² = 0.04 vs R ² = 0.01). Combining eating habits and physical activity in the multivariate model of BMI resulted in a better predictive accuracy in boys (R ² = 0.17) but not girls (R ² = 0.04).

Conclusions: Eating habits and physical activity differ between adolescent boys and girls and can predict BMI, particularly in boys. The results suggest the need to develop gender-specific programs for promoting healthy lifestyle among adolescents in our country.     

A Study of Predictive Factors Affecting Health: Promoting Behaviors of North Korean Adolescent Refugees

Objectives:

The present study aimed to analyze the factors that could affect the health-promoting behaviors of North Korean adolescent refugees residing in South Korea.

Methods:

Questions about their sociodemographic variables, subjective health status, healthy living habits, and health-promoting behaviors were asked.

Results:

Statistically significant differences were found in religion (t=2.30, p<0.05), having family members in South Korea (t=2.02, p<0.05), and subjective health status (t=4.96, p<0.01). Scores on health-responsible behaviors were higher with higher age (t=2.90, p<0.01) and for subjects without family or friends (t=2.43, p<0.05). Higher physical-activity behaviors were observed in males (t=3.32, p<0.01), in those with better subjective health status (t=3.46, p<0.05) and lower body mas index (t=3.48, p<0.05), and in smokers (t=3.17, p<0.01). Nutritional behaviors were higher in those who followed a religion (t=2.17, p<0.05). Spiritual growth behaviors were higher in those who followed a religion (t=4.21, p<0.001), had no family in South Korea (t=2.04, p<0.05), and had higher subjective health status (t=5.74, p<0.01). Scores on interpersonal relationships and stress-management behaviors were higher for those with higher subjective health status. A multiple regression analysis showed greater effects on health-promoting behaviors when subjective health status was better. Older people and non-smokers exhibited more health-responsible behaviors, while more physical-activity behaviors and spiritual growth activities were observed when subjective health status was better. Interpersonal relationship behaviors had positive effects on those with good subjective heath status and on non-smokers.

Conclusions:

Based on the results of the current study, an alternative was suggested for promoting health in North Korean adolescent refugees.