Nutrient intake and the effectiveness of a community-based nutrition education program in reducing dietary cancer risk in adult Lumbee Indian women in Robeson County, North Carolina

The purposes of this study were to document: 1) nutrient intakes and eating patterns of adult Lumbee Indian women in Robeson County, North Carolina, and 2) the effectiveness of a community-based, nutrition education program in altering the dietary risk of cancer in these women. In a pilot study, information about eating patterns and the intake of 41 dietary constituents was obtained from 120 Lumbee women in two age categories (21- 40 years, 41-60 years). Nutrient intakes were estimated using a 3-day food record, a 24-hour recall and a food frequency questionnaire, while demographic and health and eating habits were determined using an investigator-designed questionnaire. Nutrient intakes were compared to age- and gender-matched data from national surveys (NHANES II and NFCS), and from surveys of other Native American tribes. In an experimental study, a community-based, nutrition education program designed to modify the intake of dietary components associated with increased cancer risk (fat, fiber, and some antioxidant nutrients) was administered to 29 Lumbee women in six weekly sessions. A subset of 20 women from the pilot study served as controls for the experimental study

Rural-Urban Differences in Dental Service Utilization and Dental Service Procedures Received Among US Adults: Results from the 2016 Medical Expenditure Panel Survey

PURPOSE: To assess rural-urban differences in dental service use and procedures and to explore the interaction effects of individual and county-level factors on having dental service use and procedures. METHODS: Data were from the 2016 Medical Expenditure Panel Survey (MEPS). We assessed rural-urban differences in three outcome variables: number of dental visits (1, 2, or 3+ visits), preventive care procedures (Yes/No), treatment procedures (Yes/No). The study sample included 8,334 adults ≥ 18 years of age who reported at least one dental visit in the past year. Sampling weights embedded in MEPS were incorporated into all the analyses. FINDINGS: A significant interaction between residential location and race/ethnicity (p=0.030) suggested limited access to dental visits for minority groups especially for blacks in the more rural areas. Adults from a more rural area were less likely to have received a preventive procedure (AOR=0.55, 95% CI: 0.35-0.87) than those from an urban area. Adults of racial/ethnic minority groups, with lower SES, and without dental insurance were less likely to have received a preventive procedure (all p<0.01), but were more likely to have received a treatment procedure (all p<0.05). CONCLUSIONS: The study showed rural adults were less likely to have received preventive dental procedures than their urban counterparts. Racial/ethnic minority groups living in a more rural area had even more limited access to dental services. Innovative service delivery models that integrate tele-health and community-based case management may contribute to addressing these gaps in rural communities

Comparing Two Waist-to-Height Ratio Measurements with Cardiometabolic Risk Factors among Youth with Diabetes

Background: Waist circumference (WC) is commonly measured by either the World Health Organization (WHO) or National Health and Nutrition Examination Survey (NHANES) protocol. Objective: Compare the associations of WHO vs. NHANES WC-to-height ratio (WHtR) protocols with cardiometabolic risk factors (CMRFs) in a sample of youth with diabetes. Methods: For youth (10–19 years old with type 1 [N=3082] or type 2 [N=533] diabetes) in the SEARCH for Diabetes in Youth Study, measurements were obtained of WC (by two protocols), weight, height, fasting lipids (total cholesterol, triglycerides, HDL cholesterol, Non-HDL cholesterol) and blood pressures. Associations of CMRFs with WHO and NHANES WHtR were modeled stratified by body mass index (BMI) percentiles for age/sex: lower BMI (&lt;85th BMI percentile; N=2071) vs. higher BMI (≥85th percentile; N=1594). Results: Among lower-BMI participants, both NHANES and WHO WHtR were associated (p&lt;0.005) with all CMRFs except blood pressure. Among higher-BMI participants, both NHANES and WHO WHtR were associated (p&lt;0.05) with all CMRFs. WHO WHtR was more strongly associated (p&lt;0.05) than NHANES WHtR with triglycerides, non-HDL cholesterol, and systolic blood pressure in lower-BMI participants. Among high-BMI participants, WHO WHtR was more strongly associated (p&lt;0.05) than NHANES WHtR with triglycerides and systolic blood pressure. Conclusion: Among youth with diabetes, WHtR calculated from either WC protocol captures cardiometabolic risk. The WHO WC protocol may be preferable to NHANES WC

Tools for Healthy Tribes

There is growing recognition that policymakers can promote access to healthy, affordable foods within neighborhoods, schools, childcare centers, and workplaces. Despite the disproportionate risk of obesity and type 2 diabetes among American Indian children and adults, comparatively little attention has been focused on the opportunities tribal policymakers have to implement policies or resolutions to promote access to healthy, affordable foods. This paper presents an approach for integrating formative research into an action-oriented strategy of developing and disseminating tribally led environmental and policy strategies to promote access to and consumption of healthy, affordable foods. This paper explains how the American Indian Healthy Eating Project evolved through five phases and discusses each phase’s essential steps involved, outcomes derived, and lessons learned

Primary and Specialty Medical Care Among Ethnically Diverse, Older Rural Adults With Type 2 Diabetes: The ELDER Diabetes Study

Residents in rural communities in the United States, especially ethnic minority group members, have limited access to primary and specialty health care that is critical for diabetes management. This study examines primary and specialty medical care utilization among a rural, ethnically diverse, older adult population with diabetes

Self-monitoring of Blood Glucose in a Multiethnic Population of Rural Older Adults With Diabetes

The purpose of the study was to describe self-monitoring of blood glucose (SMBG) practices of 698 older adults with type 2 diabetes in the rural Southeast, to identify characteristics differentiating testers from nontesters, and to identify personal and support-related predictors of monitoring frequency

A Non-Invasive Assessment of Skin Carotenoid Status Through Reflection Spectroscopy is a Feasible, Reliable and Potentially Valid Measure of Fruit and Vegetable Consumption in a Diverse Community Sample

Objective To assess the feasibility, reliability and validity of reflection spectroscopy (RS) to assess skin carotenoids in a racially diverse sample. Design Study 1 was a cross-sectional study of corner store customers (n 479) who completed the National Cancer Institute Fruit and Vegetable Screener as well as RS measures. Feasibility was assessed by examining the time it took to complete three RS measures, reliability was assessed by examining the variation between three RS measures, and validity was examined by correlation with self-reported fruit and vegetable consumption. In Study 2, validity was assessed in a smaller sample (n 30) by examining associations between RS measures and dietary carotenoids, fruits and vegetables as calculated from a validated FFQ and plasma carotenoids. Setting Eastern North Carolina, USA. Results It took on average 94·0 s to complete three RS readings per person. The average variation between three readings for each participant was 6·8 %. In Study 2, in models adjusted for age, race and sex, there were statistically significant associations between RS measures and (i) FFQ-estimated carotenoid intake (P<0·0001); (ii) FFQ-estimated fruit and vegetable consumption (P<0·010); and (iii) plasma carotenoids (P<0·0001).Conclusions RS is a potentially improved method to approximate fruit and vegetable consumption among diverse participants. RS is portable and easy to use in field-based public health nutrition settings. More research is needed to investigate validity and sensitivity in diverse populations