HIV risk among low-income African American mothers of elementary school children

Data from 119 African American low-income mothers of school aged children in Oakland, California show that 38% engaged in behavior that might place them at risk of exposure to the human immunodeficiency virus (HIV). Risk behaviors that were investigated included having multiple partners and having a partner with an incarceration history. Of women studied, 23% were at risk because of multiple partners, while 15% were at risk as a result of having had an incarcerated partner. Women who were < or = 35 years of age were three times more likely to report having had an incarcerated partner compared to women > or = 36 years of age (22% vs. 6%) mean 2 = 5.59, P < or = .01). Single women were also more likely to report having had a partner who had been incarcerated, 21% compared to 9% of married women (mean 2 = 3.73, P < or = .05). Although no significant relationships were found with respect to condom use, a larger proportion of women with an incarcerated partner reported never using condoms (71%) compared to women without an incarcerated partner (63%); whereas, fewer women with multiple partners reported never using condoms (56%) compared to women without multiple partners (67%). Findings suggest that low-income African American women outside of traditional high-risk groups (i.e., generally studied in high-risk settings such as drug treatment centers, sexually transmitted disease [STD] clinics, hospitals or from the sex industry) may be at risk and should be targeted in HIV risk prevention programs. These women may not consider themselves to be at risk and are not generally targeted in HIV risk prevention programs because they are mothers, housewives, and working women.     

Portion size of common foods predicts energy intake among preschool-aged children

This study evaluated the relationship of food intake behaviors to total energy intake among children aged 2 to 5 years old (N=5447) who participated in the Continuing Survey of Food Intakes by Individuals, 1994-1996, 1998 (CSFII 94-96, 98). Food intake behaviors examined were portion size for 10 commonly eaten foods, number of eating occasions per day, and number of foods consumed per day. Using regression models, we examined these eating behaviors as predictors of energy intakes with adjustment for body weight. Eating behaviors and body weight were positively related to energy intake, together explaining 38% to 39% of the variability. Portion size alone accounted for 17% to 19% of the variance in energy intake, whereas body weight predicted only 4%. Feeding recommendations should highlight the importance of age-appropriate portion sizes and provide guidance on the frequency of eating and number of foods consumed.     

Portion size of food affects energy intake in normal-weight and overweight men and women

BACKGROUND: Large portions of food may contribute to excess energy intake and greater obesity. However, data on the effects of portion size on food intake in adults are limited. OBJECTIVES: We examined the effect of portion size on intake during a single meal. We also investigated whether the response to portion size depended on which person, the subject or the experimenter, determined the amount of food on the plate. DESIGN: Fifty-one men and women were served lunch 1 d/wk for 4 wk. Lunch included an entrée of macaroni and cheese consumed ad libitum. At each meal, subjects were presented with 1 of 4 portions of the entrée: 500, 625, 750, or 1000 g. One group of subjects received the portion on a plate, and a second group received it in a serving dish and took the amount they desired on their plates. RESULTS: Portion size significantly influenced energy intake at lunch (P < 0.0001). Subjects consumed 30% more energy (676 kJ) when offered the largest portion than when offered the smallest portion. The response to the variations in portion size was not influenced by who determined the amount of food on the plate or by subject characteristics such as sex, body mass index, or scores for dietary restraint or disinhibition. CONCLUSIONS: Larger portions led to greater energy intake regardless of serving method and subject characteristics. Portion size is a modifiable determinant of energy intake that should be addressed in connection with the prevention and treatment of obesity.     

Social gradients in dental health among low-income mothers and their young children

For low-income mothers of children aged 3-6 years, we estimate whether social gradients exist between mothers' income, education, and employment status and mothers' perceptions of self and child dental and general health, and whether these relationships differ by racial/ethnic group. Disproportionate stratified sampling by racial/ethnic group selected 10,909 eligible children aged 3 to 6 in Medicaid in Washington State. Mothers (n=4,373) completed a mixed-mode (web, mail, telephone) survey. Mothers' education had a strong, gradient relationship with mother ratings of self and child dental health that was not explained by other measures. Similar gradients were found for mothers' employment status and income, but some associations were no longer significant (p>.05) after adjusting for oral health beliefs and behaviors, dental insurance, and regular dental care. Associations did not differ significantly by racial/ethnic group.     

Food insecurity of low-income lone mothers and their children in Atlantic Canada

OBJECTIVE: To examine the occurrence and predictors of hunger and food insecurity over the past year and month among low-income mother-led households in Atlantic Canada. METHOD: The Cornell-Radimer Questionnaire to Estimate the Prevalence of Hunger and Food Insecurity was administered weekly for a month, with modifications, to a community sample of 141 lone mothers who took part in a larger dietary intake study. Eligible women included those living alone with at least two children under the age of 14 years in the four Atlantic Provinces and having an annual income less than or equal to Statistics Canada's low-income cut-off. RESULTS: Food insecurity over the past year occurred in 96.5% of households. Child hunger was similar to maternal hunger over the one-month study period (23%), however, it was lower than maternal hunger over the past year. On multiple logistic regression analysis, maternal hunger over the past year was predicted by maternal age over 35 years (p < 0.0005), and Nova Scotia residence (p = 0.03). Child hunger over the past year was also predicted by maternal age over 35 years (p = 0.009). Families from New Brunswick experienced less food insecurity over the past month at both the household (p = 0.01) and maternal levels (p < 0.0005). DISCUSSION: Provincial policies that might contribute to the regular occurrence of food insecurity in these families should be investigated.     

Combined effects of energy density and portion size on energy intake in women

BACKGROUND: Increases in both the portion size and energy density of food have both been shown to increase energy intake, but the combined effects of such increases have not been investigated. OBJECTIVE: The objective was to determine the combined effects of energy density and portion size on energy intake in women. DESIGN: This study used a within-subjects design. Once a week for 6 wk, 39 women were served breakfast, lunch, and dinner ad libitum. The main entrée at lunch was formulated in 2 versions that varied in energy density (5.23 or 7.32 kJ/g), each of which was served in 3 different portion sizes (500, 700, or 900 g). The 2 versions were matched for macronutrient composition and palatability. Breakfast and dinner were standard meals. RESULTS: Increases in portion size and energy density led to independent and additive increases in energy intake (P <0.0001). Subjects consumed 56% more energy (925 kJ) when served the largest portion of the higher energy-dense entrée than when served the smallest portion of the lower energy-dense entrée. Subjects did not compensate for the additional intake by eating less at the subsequent meal. Despite substantial differences in energy intake, no systematic differences in ratings of hunger and fullness across conditions were observed. CONCLUSIONS: The energy density and the portion size of a food act independently to affect energy intake. The findings indicate that large portions of foods with a high energy density may facilitate the overconsumption of energy.     

Lead poisoning and asthma among low-income and African American children in Saginaw, Michigan

Objective

We sought to ascertain whether asthmatic children are more likely to have elevated blood lead levels (EBLLs), BLLs≥10 μg/dL, than non-asthmatic children. Household risk factors associated with both lead and asthma were examined.

Method

We undertook a cross-sectional study involving children residing in mainly low-income and minority households in Michigan which were identified by the Statewide Systemic Tracking of Elevated Lead Levels and Remediation database (STELLAR) (n=356 children).

Results

Of the 356 index children, 19% had EBLLs and 15% were doctor-diagnosed asthmatic. After adjusting for confounders known to be related to lead poisoning and/or asthma, association remained between asthmatic children and EBLL children (AOR: 5.17; 95% CI (1.25–21.37)).

Conclusions

The results of our study show that asthmatic children are over 5 times more likely to have EBLLs than non-asthmatics (AOR: 5.17; 95% CI (1.25–21.37)). Intervention strategies designed to address lead poisoning prevention may be effective in reducing incidence of asthma. Further study is required.     

Nutritive intake of black and Hispanic mothers in a Brooklyn ghetto

The nutritional status of black and Hispanic mothers living in the Bedford-Stuyvesant section of Brooklyn, New York, was evaluated, using three-day dietary recall, a questionnaire on food buying and preparation techniques, and anthropometric measurements. Mean nutrient intake of both groups was considerably lower than the 1974 Recommended Dietary Allowances for all nutrients studied except protein, ascorbic acid, and phosphorus. Body weight and triceps skinfold values for both groups were higher than standard, suggesting obesity. Reasons for these findings are discussed with emphasis on the importance of nutrition education.     

Reducing disparities in dental care for low-income Hispanic children

Using a social ecological model, this study examined the influences of socio-demographic factors, mother's attitudes, financial barriers, and the health care delivery system on the use of dental services for 4-8 year-old Hispanic children. Initiating dental care during the preschool years was significantly related to the mothers' beliefs and her social network's beliefs in the value of preventive dental care. The mother was almost four times more likely to continue the care if she believed that dentist visits would keep the child's teeth healthy. Extended clinic hours in the evenings also increased the likelihood of the mother's return to the dentist to continue child's care. It was not the mother's attitudes but provider availability, dental insurance (including Medicaid) and family income that were related to frequency of planned visits. The study findings can be used in improving access to care and reducing barriers for low-income, urban Hispanic children.     

Impact of portion size and energy density on snack intake in preschool-aged children

The influence of dietary environmental factors on child weight status may be important in the battle against childhood obesity. Portion size and energy density are factors shown to impact entrée energy intake in children. However, the influence of these factors on child snack energy intake has not been studied. Thus, the aim of this study was to investigate the impact of portion size on intake of a lower energy-dense and higher energy-dense snack in preschool-aged children. A 2×2 crossover design (within-subject factors of portion size and energy density) was conducted on Wednesdays in a preschool setting on the University of Tennessee campus from October 2008 to November 2008. Seventeen children had complete data (age 3.8±0.6 years; 10 of 17 were female; 14 of 17 were white). Foods were applesauce (lower energy dense=0.43 kcal/g) and chocolate pudding (higher energy dense=1.19 kcal/g), and portion sizes were 150 g (small) and 300 g (large). Measures included anthropometrics, hunger, liking of foods, and caretakers' child-feeding practices using validated instruments. Mixed factorial analyses of covariance, with order controlled, analyzed gram and energy snack intake across conditions. There was no significant main effect of energy density on snack intake, but the main effect of portion size on snack intake (small portion size 84.2±30.8 kcal, large portion size 99.0±52.5 kcal; P<0.05) was significant. Results indicate increased energy intake when snacks are offered in larger portion size, regardless of energy density. Snack portion size may be an environmental strategy that can reduce excessive energy intake in children.     

Breakfast glycemic index affects subsequent daily energy intake in free-living healthy children

BACKGROUND: Experimental studies have reported that the effect of a meal's glycemic index (GI) on subsequent energy intake depends on the timing of the subsequent meal. OBJECTIVE: We examined whether the timing of the next meal after breakfast modifies the effect of the breakfast GI (GI(br)) on subsequent daytime energy intake of healthy free-living children. DESIGN: Analyses included 381 participants of the DOrtmund Nutritional and Anthropometrical Longitudinally Designed (DONALD) Study who had provided weighed dietary records at ages 2, 4-5, and 7 y. RESULTS: At all ages, among children who consumed their next meal in the early postprandial phase (after 3-4 h), children with a lower GI(br) consumed more calories throughout the remainder of the day than did children with a higher GI(br), independent of major dietary confounders. For the age groups 2, 4-5, and 7 y, energy intakes in tertiles 1 and 3 were 785 kcal (95% CI: 743-830 kcal) and 717 kcal (678-758 kcal), P for trend = 0.2; 993 kcal (941-1047 kcal) and 949 kcal (900-1000 kcal), P for trend = 0.05; 1255 (1171-1344) and 1166 (1090-1247 kcal), P for trend = 0.03, respectively. Conversely, among children consuming their next meal in the late postprandial phase (>3-4 h), subsequent daytime energy intake was not associated with GI(br). CONCLUSION: This study confirms differential early and late postprandial effects of the GI(br) on subsequent daytime energy intake for free-living children at different ages. Interestingly, the apparent short-term satiating effect of a higher GI(br), in particular, persisted throughout the day, if a second breakfast was consumed midmorning.     

Immunomodulatory effects of the intake of fermented milk with Lactobacillus casei DN114001 in lactating mothers and their children

The healthy action of probiotics is not only due to their nutritional properties and their influence on the gastrointestinal environment, but also to their action on the immune system. The aim of the present study was to determine if 6 weeks of probiotic intake would be able to modulate the immune system in women who had recently delivered and were breast-feeding. The design consisted of a randomised, controlled and double-blind nutritional intervention study with parallel groups with a sample size of 104 women. The main variable is the T helper type 1/T helper type 2 (Th1/Th2) profile determined by measuring interferon-gamma (Th1) and IL-4 (Th2) values in peripheral blood by flow cytometry. The modifications of cytokines were evaluated in maternal milk by cytometric bead array in a flow cytometer and ELISA at three stages of breast-feeding: colostrum, early milk (10 d) and mature milk (45 d). Additionally, the anthropometry and infectious and allergic episodes in the newborn were followed up throughout the first 6 months of life. After the consumption of milk fermented with Lactobacillus casei during the puerperium, we observed a nonsignificant increase in T and B lymphocytes and a significant increase in natural killer cells. A decrease in the pro-inflammatory cytokine TNF-alpha in maternal milk and fewer gastrointestinal disturbances were also observed in the breast-fed child of the mothers who consumed L. casei. The intake of milk fermented with L. casei during the lactation period modestly contributes to the modulation of the mother's immunological response after delivery and decreases the incidence of gastrointestinal episodes in the breast-fed child.     

Zinc intake from daily meals in preschool children and its influence on their physical growth

OBJECTIVE: The aims of this study were to investigate the influence of dietary zinc intake on physical growth and to clarify effects of dietary factors in preschool children. METHODS: Food consumption of 30 children aged 5-6 years (15 boys and 15 girls) was surveyed using a weighing dietary method for three consecutive days each in spring and autumn. Daily nutrient intakes were calculated using the Standard Tables of Food Composition in Japan Fifth Revised Edition, 2000. The heights and weights were also measured in each season. They were classified into low, middle and high zinc intake groups, and their physical growth and dietary factors were compared. RESULTS: The average zinc intake was 6.4 +/- 1.1 mg/day in all children, which met the demands of the Japanese RDA (6.0 mg/day). Classification was a low zinc intake group (5.4 +/- 0.5 mg/day), a middle group (6.2 +/- 0.3 mg/day), and a high group (7.7 +/- 0.6 mg/day). The lower zinc intake group showed lower heights and weights, but all children who participated demonstrated increase during the 5 months from spring to autumn. In particular, increase in height in the low zinc intake group was the highest among the three groups. Regarding each food item contribution for the zinc intake, rice (20.53%), meat (16.28%), milk (15.57%), eggs (7.45%), and soybeans (6.87%) were the highest 5 of 19 items, accounting for 66.7% of the total. Zinc intake from vegetable foods (55%) was more than that from animal foods (45%). Intake of total energy, nutrients, and some food groups positively associated with average zinc intake. However, energy intake from confectionery in the lowest zinc intake group was highest among the three groups. CONCLUSION: Estimation of zinc intake of Japanese children using a weighing dietary method has suggested that even a relatively low dietary value might not significantly affect the physical growth of children. Rice is the main source and reduction of zinc intake from regular meals might be related to high consumption of confectionery.     

Predictors of weight loss in low-income mothers of young children

OBJECTIVE: To identify predictors of weight loss in a tri-ethnic population of low-income mothers. DESIGN: An 8-week dietary and physical activity program was tested. Demographic data were collected at baseline; anthropometric, dietary, physical activity, and psychosocial data were measured at baseline and week 8. SUBJECTS/SETTING: A convenience sample of 114 Hispanic, African-American, and white, low-income mothers with a body mass index > or = 25 (calculated as kg/m2) participated in the intervention. INTERVENTION: Weight-loss classes that incorporated nutrition, physical activity, and behavior modification were administered for 8 weeks. MAIN OUTCOME MEASURES: Anthropometry (body weight, weight loss). STATISTICAL ANALYSES PERFORMED: Analysis of variance, chi2 tests, and Spearman and Pearson correlations were used to test for associations between baseline and change data and total weight loss. Hierarchical regression was employed to assess the marginal importance of factors beyond socioeconomic influences. RESULTS: Correlates of weight loss included less satisfaction with appearance (r=0.24), greater percentage of energy from protein (r=-0.22), enhanced nutrition knowledge (r=-0.23), and higher scores for benefits of weight loss (r =-0.20) at baseline; and the change in healthful eating attitudes (r=-0.28) and social support (r=-0.21) at 8 weeks. The predictive models of baseline and change variables represented 11.4% and 13.8% of the variance, respectively. CONCLUSIONS: Weight-management programs serving low-income mothers should provide techniques to enhance social support, attitudes toward healthful eating, benefits of weight loss, and nutrition knowledge.     

Concepts of diabetes self-management in Mexican American and African American low-income patients with diabetes

The goal of the study was to explore low-income minority patients' concepts of diabetes self-management and assess the extent to which patient beliefs correspond to evidence-based recommendations. African American and Mexican American patients with type 2 diabetes were recruited from safety net clinics that serve the uninsured and under-insured in Chicago and San Francisco to participate in focus group discussions. Grounded theory was used to identify themes related to diabetes self-management. Strategies participants mentioned for diabetes self-care were medication use, diet, weight loss and exercise. Eating more fruit and vegetables and consuming smaller portions were the most commonly mentioned dietary behaviors to control diabetes. African Americans expressed skepticism about taking medications. Mexican Americans discussed barriers to acquiring medications and use of herbal remedies. Mexican Americans frequently mentioned intentional exercise of long duration as a management strategy, whereas African Americans more frequently described exercise as regular activities of daily living. Blood glucose self-monitoring and reducing risks of diabetes complications were rarely mentioned as diabetes self-management behaviors. African American and Mexican American patients have different concepts of diabetes self-management, especially with regard to medication use and physical activity. Consideration of these differences may facilitate design of effective self-management interventions for these high-risk populations.     

Predictors of seat-belt use among school-aged children in two low-income Hispanic communities

OBJECTIVES: To examine the prevalence of seat belt use among school-aged children in low-income Hispanic communities. METHODS: We conducted unobtrusive observations of school-aged children (aged 5 to 12 years) traveling to and from nine elementary schools in two communities. We documented vehicle type, and belted status and seating position of children, driver, and other passengers. Results are presented as percentages with 95% confidence intervals (CIs). RESULTS: We observed 3651 children, of which restraint use could be determined for 2741. Overall, 29% of children were using seat belts. By seating location, 58% were in the front seat with 40% belted, and 42% were in the back seat with 14% belted. Children were most likely to be restrained when traveling in the front seat (40.0%, CI=37.6-42.5); traveling with a belted driver (42.4%, CI=40.0-44.8); or traveling without additional passengers (40.3%, CI=37.0-43.7) CONCLUSIONS: Seat belt use among children from this study population was below the national average and was alarmingly low among children in the back seat. While traveling, being belted in the back seat provides the most protection in a collision. Prevention efforts need to be based on an understanding of the barriers to restraint use for children traveling in the back seat.     

The reproducibility of data from a Food Frequency Questionnaire among low-income Latina mothers and their children.

We examined the 3-month and 1-year reproducibility of mothers' and children's dietary intakes of calories and 11 nutrients derived from oral administrations of a food frequency questionnaire to 166 Latina women. One-year correlations generally ranged from 0.40 to 0.55 for both mothers and children. For most nutrients, roughly half the children in the highest (lowest) quartile of intake at baseline were also in the highest (lowest) quartile 1 year later. The food frequency questionnaire has great potential for measuring typical nutrient intakes in these populations.     

Lead and cadmium levels in daily foods,blood and urine in children and their mothers in Korea

OBJECTIVES: The present study was initiated to examine the dietary intake, blood level and urinary concentration of lead (Pb) and cadmium (Cd) among children in Korea, in comparison with the findings in their mothers. METHODS: Peripheral blood, spot urine and 24-h food duplicate samples were collected in Busan, Korea, from 38 pairs of children (4-10 years of age) and their mothers (28-46 years, non-smoking, mostly housewives), who provided informed consent. Samples were wet-ashed by being heated in the presence of mineral acids, and Pb and Cd in the wet-ashed samples were analyzed by graphite furnace atomic absorption spectrometry. Pb and Cd in food (Pb-F, Cd-F), blood (Pb-B, Cd-B) and urine [observed value (Pb-Uob, Cd-Uob), and values corrected for creatinine (Pb-Ucr, Cd-Ucr) or a specific gravity (1.016; Pb-Usg, Cd-Usg)] were presented in terms of geometric mean (GM) and geometric standard deviation (GSD). RESULTS: Pb-F and Cd-F in the children were 0.337 microg Pb and 0.457 microg Cd/kg body weight per day as GM, respectively. Pb-B and Cd-B were 38.0 microg Pb and 1.51 microg Cd/l, and Pb-U and Cd-Uob were 5.44 microg Pb/l and 1.33 microg Cd/l, respectively. Pb-F and Pb-B for children were not significantly different from the values for their mothers. In contrast, Cd-F and Cd-B were significantly different between children and their mothers. Cd-F for children correlated with Cd-F for mothers, but no significant correlation was observed in Cd-B, Cd-U, Pb-F, Pb-B or Pb-U between children and their mothers. The dietary intake of Pb in total Pb intake (i.e., respiratory and dietary intake) accounted for 51.7 and 64.8% in children and their mothers, respectively, whereas the corresponding proportions were 97.8 and 98.2%, respectively, for Cd. CONCLUSION: Cd intake was exclusively from food, both in children and mothers. Dietary Cd intake of children significantly correlated with that of their mothers. Dietary Pb intake in children, however, did not correlate with that of their mothers. Pb uptake from ambient air tended to be higher in children than in their mothers.