A lifestyle modification intervention for the treatment of osteoporosis

PURPOSE: The purpose of this evaluation was to evaluate the effectiveness of a multidisciplinary educational and exercise program for individuals at risk for osteoporosis-related fractures. METHODS: The Highmark Osteoporosis Prevention and Education (HOPE) program is an ongoing, 8-week program with two postintervention follow-up assessments at 6 months and 2 years. Adults (n = 375) with osteoporosis or significant risk factors, most already engaged in healthy behaviors, self-selected for participation. Baseline measures included bone mineral density scans; fitness assessments; and surveys of depression, exercise, and nutrition behaviors. At course end and 6-month follow-up, assessments were repeated for fitness measures, depression, and exercise and nutrition adherence. Two-year postprogram assessments included bone mineral density scans and adherence measures. RESULTS: Paired t-tests showed significant improvements at course end in all measures (p < .0001) for the 87% completing the course. A repeated measure analysis of variance after 2 years with 79% retention indicated that adherence to nutrition recommendations was maintained at 2-year follow-up (p < .0001), whereas exercise adherence decreased but continued to exceed baseline measures (p < .0001). At 2 years, participants averaged two strength training sessions and 131 minutes aerobic exercise per week and consumed an average of 97% and 99% of the recommended calcium and vitamin D. CONCLUSIONS: Although findings of this nonexperimental study are limited because of lack of a control group, the HOPE program suggests that a comprehensive community-based education and behavior change program can significantly reduce risk factors for osteoporosis and related fractures. Participants maintained lifestyle modifications for a minimum of 2 years despite advancing age.     

Grandparents raising grandchildren: a response to a nutrition and physical activity intervention

This pilot study explored the impact of an educational program on nutrition and physical activity knowledge of urban African-American grandparents raising their grandchildren. The program was integrated into a community-based intervention, Project Healthy Grandparents, and was implemented during the first 15 minutes of 10 grandparent support groups and parenting classes. Subjects included 22 grandparents who attended at least six sessions and completed pre- and posttests of nutrition and physical activity knowledge. Participants' posttest scores were significantly higher than their pretest scores (P<0.05), indicating an increase in knowledge. Eighteen grandparents provided insights about diet and physical activity and barriers to lifestyle changes during an audiotaped focus group. Based on analysis of the focus group's discussion, three major influences on healthful eating and physical activity emerged, including financial considerations, presence of grandchildren in the home, and preference for traditional cultural foods. Themes from the focus group were consistent with responses on the nutrition and physical activity knowledge test. Satisfaction with the program was very high and no specific recommendations for improvements were made. Results can guide future nutrition interventions for this target group and potentially contribute to grandparents' improved health and ability to care for their grandchildren.     

Long-term effects of the strong African American families program on youths' conduct problems

PURPOSE: The Strong African American Families program, a universal intervention to deter alcohol use among rural African American preadolescents, was evaluated to determine whether it also prevented conduct problems across the 29 months separating the pretest and long-term follow-up assessments. The program is based on a contextual model in which intervention effects on parental behavior and youth protective factors are hypothesized to lead to behavior changes. METHODS: African American 11-year-olds (N = 667) and their primary caregivers were randomly selected from public school lists of fifth-grade students and randomly assigned to an intervention (n = 369) or control (n = 298) condition. Intervention families participated in a 7-week family skills training program designed to deter alcohol use. Each meeting included separate, concurrent sessions for parents and children, followed by a joint parent-child session during which the families practiced the skills they learned in their separate sessions. Control families were mailed leaflets regarding early adolescent development, stress management, and exercise. All families completed in-home pretest, posttest, and long-term follow-up interviews during which parent-report and self-report data regarding conduct problems, low self-control, deviance-prone peer affiliations, parenting, and youth protective processes were gathered. RESULTS: Intent-to-treat analyses indicated that prevention-group youth were less involved than control-group youth in conduct problems across time. As hypothesized, prevention effects were stronger for youth at greater risk of developing conduct problems. Intervention targeted parenting and youth factors partially accounted for intervention effects among high risk youth. CONCLUSIONS: Although the Strong African American Families program was designed to deter underage drinking, it is also effective in preventing the development of conduct problems.     

Enhancing didactic education through participation in a clinical research project.

The purpose of this study was to assess self-evaluation of knowledge and skills (e.g., counseling, education, interviewing, and assessment skills) of students participating as research assistants. Fifteen students enrolled in the Dietetics Program (n = 10) or the Graduate Program in Nutrition (n = 5) were recruited as research assistants via flyers and announcements in nutrition courses. These students assisted faculty researchers with their clinical study called "Weight Loss Effects on Bone Mass in Adolescent Females." The clinical study included a comprehensive 6-month weight-loss program. Surveys asking students to evaluate their experience as research assistants were mailed with a self-addressed, stamped envelope to all 15 student research assistants, followed by a reminder telephone call. Thirteen surveys (87%) were returned. On a Likert scale (1 = poor, 5 = excellent) student research assistants scored 63% of the knowledge-based and skill-based requirements of their research participation as "good" (mean score > or = 4.0) and 27% as "adequate" (4.0 > or = mean > or = 3.5). Open-ended questions reported the research experience to be beneficial in developing knowledge and skills and in identifying knowledge deficits (e.g., behavior modification). According to our findings, it seems that participation in clinical research enhances students' knowledge and skills and, thus, is valuable in preparing dietetics students for future practice.     

An Interdisciplinary Health Team Training Program for School Staff in Minnesota

ABSTRACT: This paper describes an interdisciplinary health team training program for school-based clinic staff in Minnesota. The project sought to improve team functioning, level of practice, and health care services at the school sites. Participants were interdisciplinary staff members from clinics in senior high, middle, and elementary schools. The program consisted of further development in team training knowledge and skills and educational sessions on issues identified by participants. Evaluations indicated participants reported greater knowledge and improved team functioning experiences from the team training. Gains also were shown in knowledge and skills in specific school topic areas such as violence, resiliency, working with resistant families, and self-care. The program could serve as a model for other interdisciplinary school health team training.     

Evaluation of a theory-based nutrition intervention for older adults with diabetes mellitus

OBJECTIVE: To evaluate an intervention to improve food label knowledge and skills in diabetes management among older adults with diabetes mellitus. DESIGN: A randomized pretest-posttest control group design was used. SUBJECTS/SETTING: Participants (48 experimental, 50 control) were aged 65 years and older with type 2 diabetes for 1 year or longer; 93 participants (95%) completed the study, conducted in an outpatient setting. INTERVENTION: The intervention included 10 weekly group sessions led by a dietitian. Information processing, learning theory, and Social Cognitive Theory principles were used in program development and evaluation. MAIN OUTCOME MEASURES: Participants' knowledge, outcome expectations (expected results of behavior), self-efficacy, and decision-making skills were assessed. Instrument validity and reliability were established before program evaluation. STATISTICAL ANALYSES PERFORMED: Factor analysis identified underlying factor structures. Analysis of covariance with pretest score as covariate was used to compare groups at posttest. Paired t tests compared results within groups. RESULTS: Two factors were identified for outcome expectations (positive and negative) and for self-efficacy (promoters of and barriers to diabetes management). The experimental group had greater improvement in total knowledge scores (mean +/- standard error of the mean: 7.8+/-0.7) than the control group (0.2+/-0.7) (P < .0001), positive outcome expectations (0.59+/-0.15 vs 0.06+/-0.15, P = .01), promoters of diabetes management (0.83+/-0.12 vs -0.09+/-0.18, P < or = .001) and decision-making skills (5.1+/-0.5 vs 0.3+/-0.5, P < .0001) and greater reduction in barriers to diabetes management (1.1+/-0.16 vs 0.34+/-0.16, P < .01). No significant difference in negative outcome expectations occurred between groups at posttest. APPLICATIONS/CONCLUSIONS: Older adults with diabetes can benefit from nutrition education designed to improve knowledge and skills necessary for diabetes management.     

The effects of a practical diabetes prevention training course for public health care providers in Aichi Prefecture

PURPOSE: Lifestyle intervention for high-risk people is one of the most important issues for reduction of diabetic patients. Public health care providers should update their knowledge and enhance their educational skills. The purpose of this study was to evaluate the effects of a diabetes prevention training course for public health care providers in Aichi Prefecture. METHODS: This course included not only lectures about up-to-date knowledge about diabetes but also many practical aspects such as lifestyle assessment and coaching methods. The participants were made aware of an adequate diet by choosing foods in nutrition sessions, and they experienced walking and aerobic exercise with heart-rate monitors and pedometers in an exercise program. They also learned how to interview and provide health guidance to impaired glucose tolerance (IGT) people through role play. There were 373 participants from 90% of municipal health care centers in Aichi Prefecture. We made inquiries about the effectiveness of this practical training course immediately after the training period and 6-months later for all participants. In follow-up inquiries, we asked if the knowledge obtained in this training course had been useful and had improved their services. RESULTS: The aim and methods were well-accepted by more than 90% of participants. The follow-up examination (6 month later) showed improvement with reference to teaching methods (60%), evaluation of the diabetes prevention service (53%), cooperation with other facilities (48%) and survey on municipal health problems related to diabetes (48%). New methods, which they experienced in this course, were adopted in their own services in many municipalities. Many municipal health care centers started the diabetes individual health promotion program, because the health care providers got aware of importance of diabetes prevention by attending this training course. DISCUSSION: In order to make effective interventions, public health care providers should obtain up-to-date knowledge about diabetics and educational skills. Administrative organ can play important roles in diabetes prevention by training public health care providers and setting up a network between related facilities.     

Knowledge, Skills, and Behavior Improvements on Peer Educators and Low-Income Hispanic Participants After a Stage of Change-Based Bilingual Nutrition Education Program

A nutrition education program, entitled La Cocina Saludable, was designed according to the Stage of Change Model and implemented in ten southern Colorado counties. The objectives were to improve the nutrition related knowledge, skills, and behaviors that lead to healthy lifestyles in a low-income Hispanic population. The content of the program included nutrition information designed to help mothers of preschool children provide for their children's nutritional needs. Previous studies suggest that low-income Hispanics often demonstrate low intakes of vitamins A and C, calcium, iron, and protein, and high rates of diabetes, obesity, and infections. Additionally, this population presents many obstacles for nutrition educators including limited resources, child care, transportation, time, language, culture, literacy, health beliefs, and, in some cases, the transient nature of the population. The program attempted to overcome these barriers by incorporating a flexible program format carried out by abuela (Hispanic grandmother) educators using the processes described in the Stage of Change Model. The program was evaluated using a knowledge, skills and behavior pre-test, post-test, and six-month follow-up survey on both the abuela educators as well as the actual class participants. Results of the peer education training sessions suggest that this type of training program can be effective in increasing the knowledge, skills, and behavior of peer educators as well as reduce need for retraining for educators who continuously teach classes. Additionally, the results suggest that this type of program can be effective in changing selected nutrition related knowledge, skills, and behaviors leading to healthy lifestyles for low-income Hispanic mothers of preschool children.     

Ecologic study of children's use of a computer nutrition education program

The purpose of this research was to describe the context created by students as they worked in groups on a nutrition computer-assisted instruction (CAI) program. Students worked on the program in groups of three. Observational methods were used to collect data from students in two sixth-grade classrooms that were part of an experimental program designed to restructure the educational process. Thirty-two students, from 12 groups, were observed as they completed the program. The groups were assigned by the teachers according to standard principles of cooperative learning. Students completed "Ship to Shore," a program designed specifically for this research. The program required three to five 50-minute classroom periods to complete. The objectives of the program were to change children's knowledge structure of basic nutrition concepts and to increase children's critical thinking skills related to nutrition concepts. We collected observational data focused on three domains: (1) student-computer interaction, (2) student-student interaction, and (3) students' thinking and learning skills. Grounded theory methods were used to analyze the data. Specifically, the constant-comparative method was used to develop open coding categories, defined by properties and described by dimensions. The open coding categories were in turn used in axial coding to differentiate students' learning styles. Five styles of student interaction were defined. These included (1) dominant directors (n = 6; 19%), (2) passive actors (n = 5; 16%), (3) action-oriented students (n = 7; 22%), (4) content-oriented students (n = 8; 25%), and (5) problem solvers (n = 5; 16%). The "student style" groups were somewhat gender specific. The dominant directors and passive actors were girls and the action-oriented and content-oriented students were boys. The problem solvers group was mixed gender. Children's responses to computer-based nutrition education are highly variable. Based on the results of this research, nutrition educators may recommend that nutrition CAI programs be implemented in mixed gender groups.     

Preliminary testing of a program to prevent type 2 diabetes among high-risk youth

Type 2 diabetes is increasing among youth, with minority youth at highest risk. This preliminary study tested the feasibility of a school-based program to prevent type 2 diabetes in youth at risk. Forty-one participants (age 12.6 +/- 1.1 years; 63% female, 51% African American, 44% Hispanic, and 5% Caucasian) were randomly assigned to one of two groups. Both the experimental and control groups received nutrition education and exercise training. The experimental group also received coping skills training. Data collected included body mass index (BMI), insulin resistance, dietary intake (24-Hour Food Recall), self-efficacy (Health Behavior Questionnaire), activity (Revised Godin-Shepard Activity Survey), and parents' health promoting behaviors (Health Promoting Lifestyle Profile III). At baseline BMI ranged from 27 to 53 (M = 36.2 +/- 6.0), and 95% (n = 39) demonstrated insulin resistance or pre-diabetes on an oral glucose tolerance test. After 12 months, the experimental group showed trends in improved usual food choices (p = .1) and increased dietary knowledge (p = .3). They also demonstrated lower glucose (p = .07) and insulin levels (p = .2). Experimental group parents demonstrated improved health responsibility (p = .03), healthier nutrition choices (p = .05), improved stress management skills (p = .05), increased activity (p = .2), and increased spirituality (p = .2). Data suggest a school-based program tailored to multiethnic youth may prove successful in helping these youth increase activity, improve nutrition status, and stabilize glucose and insulin metabolism, and also may be effective in changing parent health behavior.     

Diabetes care management participation in a primary care setting and subsequent hospitalization risk.

Scant evidence exists that examines the impact of participation in primary care diabetes management programs and their educational components on the risk of subsequent significant patient morbidity. This study examined the association between participation in a diabetes management program in a primary care setting and the risk of subsequent hospitalization. Ten thousand nine hundred eighty patients with diabetes mellitus receiving some type of treatment in a large primary care clinic network in Houston, TX were examined for incidence of hospitalization in the year 2002. Information from the year preceding the hospitalization was obtained on several demographic, clinical, and diabetes care management participation related variables. Multivariate logistic regressions were used to examine the relationship between primary care diabetes management participation as well as individual educational components and the likelihood of subsequent-year hospitalization. Patients participating in some type of primary care diabetes management were 16% less likely to have an incidence of hospitalization (p = 0.05). When individual educational components of the diabetes care management program were examined, diabetes education sessions were more beneficial than certified diabetes educator visits in reducing the incidence of hospitalization. Patients with controlled blood glucose levels and a diabetes education session seemed to have the most significant reduction in hospitalization risk (odds ratio [OR] = 0.62; 95% CI: 0.40, 0.95). There seem to be beneficial effects associated with participation in primary care diabetes management programs in terms of reduced hospitalization risk. Attendance at diabetes educational sessions in primary care settings coupled with maintenance of blood glucose control seem to be associated with greatest risk reduction.     

Reaching low-income families: Focus group results provide direction for a behavioral approach to WIC services

Supplemental Nutrition Program for Women, Infants, and Children (WIC) families were asked to identify motivators and barriers to health behavior change and preferred approaches to nutrition education in WIC. Six focus groups involved a total of 41 English-speaking WIC participants and addressed parenting, family meals, food preparation, and physical activity. The discussions were audiotaped, transcribed, and analyzed using NUD*IST software (Non-Numerical Unstructured Data Indexing, Searching, and Theorizing, version 4.0. Thousand Oaks, CA: Sage Publications Software, 1997). Key barriers to behavior change included inadequate parenting skills, lack of knowledge, unhealthy social environments, lack of time, and lack of social or financial support. Key motivators included feelings of responsibility, concern for child health and development, and positive social support. Participants identified facilitated discussions, support groups, cooking classes, and a WIC Web site as preferred methods of nutrition education. Results provided the foundation for the Healthy Habits nutrition education modules implemented in the Washington State WIC program and can be used to improve future nutrition education in WIC.     

Contextually Appropriate Tools and Solutions to Facilitate Healthy Eating Identified by People with Type 2 Diabetes

Type 2 diabetes (T2D) is a complex, multifaceted disease and its treatment involves lifestyle intervention (LI) programs that participants may find difficult to adopt and maintain. The objective of this study is to understand the lived experiences of participants with T2D regarding healthy eating behavior change, in order to identify and incorporate relevant information, skills, and educational approaches into LI programs. An explorative qualitative study was undertaken. Purposeful sampling was used to recruit 15 participants. One-on-one, semi-structured, open-ended, and in-depth interviews were conducted. An essentialist paradigm was adopted to accurately report the experiences, meaning, and reality of participants. An inductive approach was used to analyze the data. Participants reported that being diagnosed and living with T2D could be overwhelming, and their ability to manage was influenced by health care providers (HCP), family, and individual context. Many experienced a loop of “good–bad” eating behaviors. Participants expressed desires for future diabetes management that would include program content (nutrition, physical activity, mental health, foot care, and consequences of T2D), program features (understand context, explicit information, individualized, hands-on learning, applicable, realistic, incremental, and practical), program components (access to multidisciplinary team, set goals, track progress and be held accountable, one-on-one sessions, group support, maintenance/follow-up), and policy change. In conclusion, the results of this study indicate that T2D management requires more extensive, comprehensive, and ongoing support, guided by the individual participant.     

Needs, interests, and attitudes of university faculty for a wellness program

During the 1986-1987 academic year, 484 full-time faculty members at Oklahoma State University responded to a health habits questionnaire. The purpose of this study was to assess the needs, interests, and attitudes of faculty for a wellness program. Behaviors were assessed in the following categories: cigarette smoking, alcohol/drugs, eating habits, exercise/fitness, stress management, and safety. Only 100 (20.6%) of the total indicated that they were currently smokers. Neither the alcohol/drugs nor the safety categories appeared to be problem areas, with no significance noted. Categories indicating a need for improvement were exercise/fitness, eating habits, and stress management. Faculty members were interested in and willing to participate in a wellness program. Preferred areas of interest in rank order were (1) exercise/fitness, (2) stress management, and (3) nutrition. Results of this study indicate that faculty in a major university are interested in wellness and will participate in a wellness program. Need and interest suggest that an exercise/fitness program should be instituted first, with stress management and nutrition components added as funds become available. A successful wellness program in a university setting has implications for happier, more productive employees, reduced absenteeism, and lower health insurance premiums.     

Using Formative Research to Develop a Worksite Health Promotion Program for African American Women

ABSTRACT

Objectives: To describe the development of a culturally appropriate worksite health promotion program (WHPP) designed to promote increased physical activity and improved nutrition in a high risk group of African American women.

Methods: The program was based on EatRight, which is a lifestyle-oriented weight control program that focuses on food volume, rather than calories. Formative research included four nominal group technique (NGT) sessions conducted with 14 African American women from the selected worksite to gather input on job factors that affected their weight and daily life factors that affected their amount of physical activity. Their responses were used to adapt existing EatRight materials to target areas of special need for this unique group.

Results: Themes emerged from the NGT sessions that indicated stress at work and an environment of unhealthy eating, in addition to social eating and lack of social support for healthy eating added to unhealthy eating patterns at work. In response to physical activity, the primary themes included lack of time to exercise, stress of multiple family roles and responsibilities, and perceived physical barriers to physical activity.

Discussion: Based on the NGT themes, EatRight materials were adapted and additional topics (e.g., increasing social support, overcoming limitations, and time management) were included to develop a WHPP that addressed issues that the participants identified as relevant for their work and home lives. Conducting the NGT sessions and EatRight classes in the work environment, we were able to provide a convenient, familiar environment which fostered social support among participants. We believe that a culturally appropriate modification of EatRight holds great promise in addressing health disparities seen among African American women by offering education on lifestyle changes that will decrease weight through nutrition and physical activity.     

Food Resource Management Mediates the Relationship Between Participation in a SNAP-Ed Nutrition Education Program and Diet Quality

ObjectiveTo examine the mediating effects of food resource management skills (FRM) on the relationship between participation in a Supplemental Nutrition Assistance Program Education (SNAP-Ed) nutrition education program and diet quality.DesignSecondary analysis of data from a propensity score-matched sample of participants (n = 396) and nonparticipants (n = 111) in a SNAP-Ed nutrition education program.AnalysisIndependent-samples t tests were used to compare entry, exit, and gain scores in FRM and diet quality between participants and nonparticipants. Structural equation modeling was used to examine direct and mediated relationships among participation, FRM, and diet quality.Main Outcome MeasuresFood resource management was measured as a summated rating scale, and diet quality measured as Healthy Eating Index and program participation.ResultsMediated effect of FRM on the relationship between participation in a SNAP-Ed program and diet quality was statistically significant (P < 0.01). The effect size for the mediation effect indicated that about 70% of program participation on diet quality was transferred by FRM skills. The hypothesized model had acceptable fit indices as model χ² was nonsignificant (P = 0.31), all fit indices were above 0.9, and the root mean square of error approximation was low at 0.02.Conclusions and ImplicationsParticipation in a SNAP-Ed program enhanced participants’ FRM, which in turn enhanced their diet quality.     

Evaluation of a motivational education program for cardiovascular risk reduction: Effects on knowledge and behavior

The purposes of this study were 1) to compare the effectiveness of an interactive/reflective lifestyle education program with an instrumental program in changing nutrition behavior for the reduction of cardiovascular risk, and 2) to evaluate the effects of interactive/reflective nutrition education practice on patients' development of critical/creative thinking and problem-solving skills. Patients were stratified according to risk, and randomly assigned to the experimental (interactive/reflective) or control (instrumental) group. Measures of knowledge and nutrition behavior were administered prior to and immediately following the intervention, six weeks after program completion, and three months later to assess maintenance effects. Of 32 relatively well-educated patients completing the study, participants in interactive/reflective sessions demonstrated improvements in nutrition behavior relative to the control group that could not be attributed to gains in knowledge scores. Qualitative evaluation of the learning process suggested that the development of critical/creative thinking and problem-solving skills among experimental group participants may have contributed to behavior change.     

A Toddler Parenting Intervention in Primary Care for Caregivers With Depression Symptoms

Caregiver depression impacts parenting behaviors and has deleterious effects on child behavior. Evidence-based interventions to address parenting have not been adapted for use with depressed caregivers in pediatric primary care settings. Our study examined the feasibility and explored outcomes of an evidence-based parenting program implemented in primary care and adapted for caregivers with depressive symptoms caring for toddlers. We conducted a randomized controlled trial with a wait-list control. Participants were caregivers who screened positive for depressive symptoms in pediatric settings with a toddler. Our study was implemented from July 2011 to June 2012. We adapted the Incredible Years Parents, Babies and Toddlers program with the addition of depression psychoeducation (12 weekly sessions), and assessed caregivers at baseline and immediately post-intervention. We assessed participation rates, depressive symptoms, parenting discipline practices, social support, and parenting stress. Our results revealed that 32 caregivers participating in the intervention group had significantly greater improvement in self-reported parenting discipline practices compared to the 29 wait-list control group caregivers. We found no differences between groups in depressive symptoms, social support, or parenting stress. Our study demonstrated that the average attendance was poor (mean attendance = 3.7 sessions). We adapted an evidence-based parenting intervention for caregivers with depressive symptoms and toddlers in primary care; however, participation was challenging. Alternative intervention strategies are needed to reach and retain low-income caregivers with depression symptoms as they face multiple barriers to participation in groups within center-based services. Trial Registration Clinical Trials.gov identifier NCT01464619.     

Expanding the understanding of how parenting influences the dietary intake and weight status of children: A cross‐sectional study

Aim: The present study explored whether existing tools measuring parenting could be combined to assess an expanded parenting definition, specifically to include co‐participation in food‐related activities and teaching children about nutrition. The relationships between parenting, child dietary intake and weight outcomes were explored. Methods: The sample included 93 children aged 4–13 years and their parent/caregiver. Child outcomes were dietary intake and body mass index z‐score. Parent measures included demographics, nutrition knowledge and parenting practices. Exploratory factor analysis was used to identify underlying dimensions of parenting. Hierarchical linear regression was used to investigate the independent effects of parenting on child outcomes (body mass index z‐score, fruit and vegetable, fibre, saturated and total fat) after adjustment for covariates. Results: Five factors were extracted, accounting for 44% of the total variance (α= 0.77–0.87). The regression model for kilojoules explained 31% of the variance (P= 0.001), with a significant independent contribution from construct ‘guide and reward’ (β=?0.249, P= 0.027). For child body mass index z‐score, the model explained 25% of variance, and parenting constructs ‘guide and reward’ (β= 0.274, P= 0.015) and ‘concern about intake’ (β=?0.273, P= 0.008) made significant contributions. Conclusions: The present study adds to our understanding of parenting influences on children's dietary intake and weight status. Results support the inclusion of parenting strategies in obesity prevention interventions. Future research should explore the range of ways parenting influences children's diet and risk of obesity, preferably longitudinally.     

Diabetes training for dietitians: needs assessment, program description, and effects on knowledge and problem solving

Recent changes in management and medical nutrition therapy for diabetes mellitus have produced a need to retrain many practicing dietitians. To meet this need, a multidisciplinary group experienced in medical nutrition therapy and educational methods used a formal needs-assessment process to design a new training program. Sugar is Not a Poison (SNAP): The Dietitian's New Role in Diabetes Management is a 2 1/2-day program that uses written text, didactic presentation, and exercises that simulate patient encounters to accomplish 12 learning objectives. Program evaluations show high levels of participant satisfaction. Mean (+/- standard deviation) scores on pre- and postests of knowledge and problem solving were 69 +/- 13% and 86 +/- 9%, respectively (P < 0.01). The SNAP program needs assessment, training methods, and knowledge problem-solving test are relevant to all types of education programs in clinical dietetics.