The Medicine Wheel Nutrition Intervention: a Diabetes Education Study with the Cheyenne River Sioux Tribe

OBJECTIVE: The Northern Plains Indians of the Cheyenne River Sioux Tribe have experienced significant lifestyle and dietary changes over the past seven generations that have resulted in increased rates of diabetes and obesity. The objective of this study was to determine if Northern Plains Indians with type 2 diabetes mellitus who are randomized to receive culturally adapted educational lessons based on the Medicine Wheel Model for Nutrition in addition to their usual dietary education will have better control of their type 2 diabetes than a nonintervention, usual care group who received only the usual dietary education from their personal providers.DESIGN: A 6-month, randomized, controlled trial was conducted January 2005 through December 2005, with participants randomized to the education intervention or usual care control group. The education group received six nutrition lessons based on the Medicine Wheel Model for Nutrition. The usual care group received the usual dietary education from their personal providers.PARTICIPANTS: One hundred fourteen Northern Plains Indians from Cheyenne River Sioux Tribe aged 18 to 65 years, with type 2 diabetes.METHODS: Weight, body mass index (BMI), hemoglobin A1c, fasting serum glucose and lipid parameters, circulating insulin, and blood pressure were measured at the beginning and completion. Diet histories, physical activity, and dietary satiety surveys were measured at baseline and monthly through completion. Differences were determined using Student t tests, chi(2) tests, and analysis of variance.RESULTS: The ED group had a significant weight loss ( 1.4 ± 0.4 kg, mean ± standard error {SE}, P ≤ .05) and decrease in BMI (1.0 ± 0.1 means ± SE, P ≤ .05) from baseline to completion. The UC group had no change in weight (0.5 ± 0.5 kg, mean ± SE) or BMI (0.5 ± 0.2, mean ± SE). There were no between group differences due to intervention in calorie, carbohydrate, protein, and fat intake and physical activity.CONCLUSIONS: The culturally based nutrition intervention promoted small but positive changes in weight. Greater frequency and longer duration of educational support may be needed to influence blood glucose and lipid parameters

The Effectiveness of Telemedicine for Weight Management in the MOVE! Program

PURPOSE: To examine the effectiveness of videoconferencing technology for delivering comprehensive weight management treatment.METHODS: This retrospective cohort study was conducted by extraction of data from medical records for the years 2008-2010. The treatment included a series of 12 weekly MOVE!® classes delivered using videoconferencing. Data were extracted from the time of baseline weight to 1 year after baseline weight for the MOVE! participants (n = 60) and from a concurrent control group (n = 60) that did not participate in MOVE! treatment.FINDINGS: Results indicated that the MOVE! group lost weight while the control group gained weight, resulting in a mean difference between the groups of -5.5 ± 2.7 kg (95% CI = -8.0 to -3.0; P \u3c .0001).CONCLUSIONS: These results indicate that videoconferencing is an effective method to provide the MOVE! Weight Management Program to veterans. Weight loss was maintained for one year after baseline in the MOVE! group. This is very promising as weight re-gain is a common issue and these results support using videoconferencing for a long-term weight management treatment option

Effects of Lean Beef Supplementation on Iron Status, Body Composition and Performance of Collegiate Distance Runners

Iron deficiency is prevalent among endurance athletes, particularly females. Low iron may compromise oxygen delivery and physical performance. Vegetarianism, desire for convenience, and perceived health risks associated with red meat contribute to low bioavailable iron intakes. The purpose of this study was to examine if lean beef supplementation would maintain iron status, improve body composition and increase performance of distance runners after 8 weeks. Twenty-eight (14 female) Division-I cross-country runners were stratified by iron status, use of iron supplements, and gender, and randomized into a control (n = 14) and intervention group. All participants maintained their typical diet and consumed a daily multivitamin, while the intervention group consumed 9 ounces of lean beef weekly. Dietary intake (total iron, heme-iron, protein, zinc), body composition, VO2max, and iron status (hemoglobin, hematocrit, serum iron, serum ferritin, total iron binding capacity [TIBC]) were measured at baseline and post-intervention. The intervention group had greater intakes of total and heme-iron. There were no group differences in amino acids, protein, or calories. Both groups had a significant body fat increase and lean mass decease over time. There was a significant VO2max in- crease over time in both groups. There were no group differences due to the intervention in serum ferritin, hemoglobin, serum iron, and TIBC. There was a significant difference in hematocrit between groups as a result of the intervention. In conclusion, increasing bioavailable iron from red meat may have effects on body composition and maintenance of blood iron markers; however, its direct impact on performance among endurance athletes is unclear

Cooking Frequency Associated With Dietary Quality in iCook-4H Youth Participants at Baseline

Background: Increased intakes of ready-made and fast foods paralleled with decreased homemade food consumption have been associated with increased rates of obesity. Researchers have shown associations between cooking self-efficacy (SE) and cooking frequency (CF) with dietary quality and weight status. Some cooking interventions have shown positive associations with dietary outcomes, such as increased fruit and vegetable intake and decreased fast food consumption. There is still much unknown about SE and CF, especially among youth. Objective: Determine baseline SE and CF and the associations with dietary quality and body mass index (BMI) of youth enrolled in iCook 4H. Methods: Youth (n=228, ages 9-10 years) completed online surveys assessing SE, CF, dietary quality, and demographics. Anthropometrics were collected to calculate BMI-for-age percentiles and weight categories. Descriptive statistics were completed for CF, SE, BMI categories, and demographics. Differences in CF and SE by sex, race, and participation in government assistance programs were determined through independent-sample t tests. Pearson correlations were used to assess the association between dietary quality and CF and SE. Associations between CF and dietary quality were assessed further through 2-way analyses of variance (ANOVAs) that included CF and sex and CF and race as independent variables. Associations between SE and CF and BMI were assessed through ANOVAs. Results: Thirty-seven percent of youth were overweight or obese. Females reported significantly higher CF than males (P=.042). Cooking frequency was positively associated with dietary quality (P \u3c .001), but BMI was not associated with dietary quality. SE was not associated with dietary quality or BMI. Conclusion: Based on results, CF was positively associated with dietary quality among youth. More research is needed to assess how different types of cooking relate to diet and BMI. Interventions are needed to determine whether increasing CF leads to better diet outcomes

Cooking Frequency Associated With Dietary Quality in iCook-4H Youth Participants at Baseline

Background: Increased intakes of ready-made and fast foods paralleled with decreased homemade food consumption have been associated with increased rates of obesity. Researchers have shown associations between cooking self-efficacy (SE) and cooking frequency (CF) with dietary quality and weight status. Some cooking interventions have shown positive associations with dietary outcomes, such as increased fruit and vegetable intake and decreased fast food consumption. There is still much unknown about SE and CF, especially among youth. Objective: Determine baseline SE and CF and the associations with dietary quality and body mass index (BMI) of youth enrolled in iCook 4H. Methods: Youth (n = 228, ages 9-10 years) completed online surveys assessing SE, CF, dietary quality, and demographics. Anthropometrics were collected to calculate BMI-for-age percentiles and weight categories. Descriptive statistics were completed for CF, SE, BMI categories, and demographics. Differences in CF and SE by sex, race, and participation in government assistance programs were determined through independent-sample t tests. Pearson correlations were used to assess the association between dietary quality and CF and SE. Associations between CF and dietary quality were assessed further through 2-way analyses of variance (ANOVAs) that included CF and sex and CF and race as independent variables. Associations between SE and CF and BMI were assessed through ANOVAs. Results : Thirty-seven percent of youth were overweight or obese. Females reported significantly higher CF than males (P = .042). Cooking frequency was positively associated with dietary quality (P \u3c .001), but BMI was not associated with dietary quality. SE was not associated with dietary quality or BMI. Conclusion: Based on results, CF was positively associated with dietary quality among youth. More research is needed to assess how different types of cooking relate to diet and BMI. Interventions are needed to determine whether increasing CF leads to better diet outcomes

A Community Based Participatory Approach to Training Young Adults to Design and Implement a Social Marketing Framed Lifestyle Intervention on Their College Campus

Background: Using a Community-Based Participatory Research (CBPR) approach may increase the likelihood of relevance and acceptability of the designed intervention, especially on a college campus. Furthermore, recruiting and training college students to design a social marketing framed healthy lifestyle intervention for their peers will allow the intervention to be tailored to the needs of the campus. Objectives: To describe the process of online-course training college students to develop a campus-based, social marketing health promotion intervention. Methods: Four universities recruited current college students (18+ y.o.) to develop a social marketing and environmental intervention (SMEI), which was completed during a 16-week, online/in-person hybrid semester course. Researchers and Extension professionals trained students to design 24 weeks of intervention events that would be implemented the upcoming year. Results: Seventy-eight students enrolled in the study and social marketing and environmental intervention course among the four intervention states (Florida = 30, South Dakota = 8, Tennessee = 13, West Virginia = 27); students were predominately Caucasian (65.8%), females (84.0%), and sophomore status in college (64.9%). Throughout the semester, students assessed their campus environments, set priorities, and developed weekly events and resources needed to implement the intervention on their campuses. By the end of the semester, with researcher support, students had designed 24 weeks of intervention events (marketing, recruiting, and implementation) focusing on nutrition/food/diet, physical activity, stress management, sleep, and time management. These events and resources were catalogued into a digital toolkit of instructions and activities for each week of intervention events. Conclusion: Using a Community-Based Participatory Research approach with college students interested in health allows for the development of an intervention that stems from grass roots efforts and is tailored to the acceptability and needs of their peers

A Community Based Participatory Approach to Training Young Adults to Design and Implement a Social Marketing Framed Lifestyle Intervention on Their College Campus

Background: Using a Community-Based Participatory Research (CBPR) approach may increase the likelihood of relevance and acceptability of the designed intervention, especially on a college campus. Furthermore, recruiting and training college students to design a social marketing framed healthy lifestyle intervention for their peers will allow the intervention to be tailored to the needs of the campus. Objectives: To describe the process of online-course training college students to develop a campus-based, social marketing health promotion intervention. Methods: Four universities recruited current college students (18+ y.o.) to develop a social marketing and environmental intervention (SMEI), which was completed during a 16-week, online/in-person hybrid semester course. Researchers and Extension professionals trained students to design 24 weeks of intervention events that would be implemented the upcoming year. Results: Seventy-eight students enrolled in the study and social marketing and environmental intervention course among the four intervention states (Florida = 30, South Dakota = 8, Tennessee = 13, West Virginia = 27); students were predominately Caucasian (65.8%), females (84.0%), and sophomore status in college (64.9%). Throughout the semester, students assessed their campus environments, set priorities, and developed weekly events and resources needed to implement the intervention on their campuses. By the end of the semester, with researcher support, students had designed 24 weeks of intervention events (marketing, recruiting, and implementation) focusing on nutrition/food/diet, physical activity, stress management, sleep, and time management. These events and resources were catalogued into a digital toolkit of instructions and activities for each week of intervention events. Conclusion: Using a Community-Based Participatory Research approach with college students interested in health allows for the development of an intervention that stems from grass roots efforts and is tailored to the acceptability and needs of their peer

Development and Testing of Program Evaluation Instruments for the iCook 4-H Curriculum

Objective To develop and test the validity of program outcome evaluation instruments for cooking, eating, and playing together for obesity prevention during iCook 4-H. Design Instrument development for both youth and adults through pre-post testing of items newly constructed and compiled to address key curriculum constructs. Testing occurred throughout program intervention and dissemination to determine dimensionality, internal consistency and test-retest reliability, and validity. Setting A 5-state out-of-school program in cooperative extension and other community sites. Participants Youths aged 9–10 years; adults were main food preparers; the first phase involved 214 dyads and the second phase, 74 dyads. Main Outcome Measure(s) Youth measures were cooking skills, culinary self-efficacy, physical activity, and openness to new foods. Adult measures were cooking together, physical activity, and eating together. Analysis Exploratory factor analysis to determine initial scale structure and confirmatory factor analysis to confirm factor structures. Longitudinal invariance tests to see whether the factor structure held over time. Test-retest reliability was determined by Pearson r and internal consistency was determined by coefficient Ω and Cronbach α. Validity testing was determined by Pearson rcorrelations. Results Youth cooking skills, openness to new foods, and adult eating together and cooking together showed strong evidence for dimensionality, reliability, and validity. Youth physical activity and adult physical activity measures showed strong evidence for dimensionality and validity but not reliability. The youth culinary self-efficacy measure showed strong evidence for reliability and validity but weaker evidence for dimensionality. Conclusions and Implications Program outcome evaluation instruments for youths and adults were developed and tested to accompany the iCook 4-Hcurriculum. Program leaders, stakeholders, and administrators may monitor outcomes within and across programs and generate consistent reporting

Teens Implementing a Childhood Obesity Prevention Program in the Community: Feasibility and Perceptions of a Partnership with HSTA and iCook 4-H

High school student researchers and teen leaders from the Health Science Technology Academy (HSTA), under the supervision of HSTA teachers, led a childhood obesity prevention (COP) program (iCook 4-H). The objective was to evaluate the feasibility and perceptions of having teen leaders implement a COP program for dyads of youth (9–10 years old) and their primary adult food preparer. Behavior change and perceptions were assessed through surveys and open-ended interviews. Across eight HSTA organizations, 43 teen leaders participated in teaching the iCook 4-H program to 24 dyads. Increased frequency of culinary skills, physical activity and mealtime behavior were reported by youth. Almost all adults (93%) reported that their youth had learned kitchen skills and that the program provided youth-adult quality time and developed culinary skills. Youth echoed adult perceptions with additional themes of food safety and physical activity. HSTA teen leaders perceived the program to be successful and reported the training they received to implement the program was adequate 98% of the time. HSTA teachers found the program to be beneficial for HSTA students in improving leadership, confidence and responsibility. iCook 4-H was feasible to be disseminated through teen leaders in the HSTA program. This teen-led approach could serve as a model for youth health-related programming

Health Disparities Score Composite of Youth and Parent Dyads from an Obesity Prevention Intervention: iCook 4-H

iCook 4-H is a lifestyle intervention to improve diet, physical activity and mealtime behavior. Control and treatment dyads (adult primary meal preparer and a 9–10-year-old youth) completed surveys at baseline and 4, 12, and 24 months. A Health Disparity (HD) score composite was developed utilizing a series of 12 questions (maximum score = 12 with a higher score indicating a more severe health disparity). Questions came from the USDA short form U.S. Household Food Security Survey (5), participation in food assistance programs (1), food behavior (2), level of adult education completed (1), marital status (1), and race (1 adult and 1 child). There were 228 dyads (control n = 77; treatment n = 151) enrolled in the iCook 4-H study. Baseline HD scores were 3.00 ± 2.56 among control dyads and 2.97 ± 2.91 among treatment dyads, p = 0.6632. There was a significant decline in the HD score of the treatment group from baseline to 12 months (p = 0.0047) and baseline to 24 months (p = 0.0354). A treatment by 12-month time interaction was found (baseline mean 2.97 ± 2.91 vs. 12-month mean 1.78 ± 2.31; p = 0.0406). This study shows that behavioral change interventions for youth and adults can help improve factors that impact health equity; although, further research is needed to validate this HD score as a measure of health disparities across time