Deposit‐Derived Block‐and‐Ash Flows: The Hazard Posed by Perched Temporary Tephra Accumulations on Volcanoes; 2018 Fuego Disaster, Guatemala

The impact of hazardous pyroclastic density currents (PDCs) increases with runout distance, which is strongly influenced by the mass flux. This article shows that the mass flux of a PDC may derive not only from vent discharge during the eruption, but also from partly hot, temporary stores (accumulations) of aerated pyroclastic material perched high on the volcano. The unforeseen PDC at Fuego volcano (Guatemala) on 3 June 2018 happened c.1.5 hr after the eruption climax. It overran the village of San Miguel Los Lotes causing an estimated 400+ fatalities. Analysis of the facies architecture of the deposit combined with video footage shows that a pulsatory block-and-ash flow flowed down the Las Lajas valley and rapidly waxed, the runout briefly increasing to 12.2 km as it filled and then spilled out of river channels, entered a second valley where it devastated the village and became increasingly erosive, prior to waning. Paleomagnetic analysis shows that the PDC contained only 6% very hot (>590°C) clasts, 39% moderately hot (∼200°C–500°C) clasts, and 51% cool (<200°C) clasts. This reveals that the block-and-ash flow mostly derived from collapse of loose and partly hot pyroclastic deposits, stored high on the volcano, gradually accumulated during the last 2–3 years. Progressive collapse of unstable deposits supplied the block-and-ash flow, causing a bulk-up process, waxing flow, channel overspill and unexpected runout. The study demonstrates that deposit-derived pyroclastic currents from perched temporary tephra stores pose a particular hazard that is easy to overlook and requires a new, different approach to hazard assessment and monitoring

An Assessment of Nutrition Practices and Attitudes in Family Child-Care Homes: Implications for Policy Implementation

Introduction: Family child-care homes (FCCHs) provide care and nutrition for millions of US children, including 28% in Rhode Island. New proposed regulations for FCCHs in Rhode Island require competencies and knowledge in nutrition. We explored nutrition-related practices and attitudes of FCCH providers in Rhode Island and assessed whether these differed by provider ethnicity or socioeconomic status of the enrolled children. Methods: Of 536 licensed FCCHs in Rhode Island, 105 randomly selected FCCH providers completed a survey about provider nutrition attitudes and practices, demographics of providers, and characteristics of the FCCH, including participation in the federal Child and Adult Care Food Program (CACFP). No differences between CACFP and non-CACFP participants were found; responses were compared by provider ethnicity using χ2 tests and multivariate models. Results: Nearly 70% of FCCHs reported receiving nutrition training only 0 to 3 times during the past 3 years; however, more than 60% found these trainings to be very helpful. More Hispanic than non-Hispanic providers strongly agreed to sitting with children during meals, encouraging children to finish their plate, and being involved with parents on the topics of healthy eating and weight. These differences persisted in multivariate models. Discussion: Although some positive practices are in place in Rhode Island FCCHs, there is room for improvement. State licensing requirements provide a foundation for achieving better nutrition environments in FCCHs, but successful implementation is key to translating policies into real changes. FCCH providers need culturally and linguistically appropriate nutrition-related training

Community clinic-based lifestyle change for prevention of metabolic syndrome: Rationale, design and methods of the ‘Vida Sana/healthy life’ program

Purpose and Objectives: The risk of diseases associated with Metabolic Syndrome (MetS) is higher for Hispanics living in the northeastern United States than for other racial and ethnic groups. Higher risk of diabetes, high blood lipids, obesity and limited access to continuity of care are all factors that also contribute to disproportionately poorer chronic disease outcomes for Hispanics. Intervention approach: This article describes the planning and implementation of, and evaluation plans for the Vida Sana Program (VSP), a community-based group intervention created to address the identified MetS risks by encouraging healthier diet and physical activity behaviors among a low-income, largely Spanish speaking, and literacy limited uninsured population. Developed in response to recent calls for culturally-tailored interventions, VSP is conducted by trained bicultural/bilingual Navegantes, who deliver a culturally sensitive, fun and engaging eight-week, in-person educational series through group meetings. The intervention also includes a 40-page colorful, picture and graphic enhanced booklet to be used in the group setting and at home. The intervention focused on screening for MetS-associated disease risk factors, understanding chronic disease management, encouraging medication adherence, increasing physical activity, and healthful dietary changes such as limiting alcohol, sodium, unhealthy fats and excess carbohydrate intake, while emphasizing portion control, whole grains and healthy fats. Conclusions: This creative, community-based approach fills an important gap in the community and in the public health literature, is well liked by health literacy limited patients, and will provide an important model of successfully engaging the Hispanic community on these important health issues

Tailored weight loss intervention in obese adults within primary care practice: rationale, design, and methods of Choose to Lose.

Although there are efficacious weight loss interventions that can improve health and delay onset of diabetes and hypertension, these interventions have not been translated into clinical practice. The primary objective of this study is to evaluate the effectiveness and cost effectiveness of a tailored lifestyle intervention in primary care patients. Patients were recruited by their primary care physicians and eligible participants were randomized to an enhanced intervention or standard intervention. All participants met with a lifestyle counselor to set calorie and physical activity goals and to discuss behavioral strategies at baseline, 6 and 12 months. During the first year, enhanced intervention participants receive monthly counseling phone calls to assist in attaining and maintaining their goals. Enhanced intervention participants also receive weekly mailings consisting of tailored and non-tailored print materials and videos focusing on weight loss, physical activity promotion and healthy eating. The second year focuses on maintenance with enhanced intervention participants receiving tailored and non-tailored print materials and videos regularly throughout the year. Standard intervention participants receive five informational handouts on weight loss across the two years. This enhanced intervention that consists of multiple modalities of print, telephone, and video with limited face-to-face counseling holds promise for being effective for encouraging weight loss, increasing physical activity and healthy eating, and also for being cost effective and generalizable for wide clinical use. This study will fill an important gap in our knowledge regarding the translation and dissemination of research from efficacy studies to best practices in clinical settings

Feasibility and Acceptability of an Early Childhood Obesity Prevention Intervention: Results from the Healthy Homes, Healthy Families Pilot Study

BACKGROUND: This study examined the feasibility and acceptability of a home-based early childhood obesity prevention intervention designed to empower low-income racially/ethnically diverse parents to modify their children\u27s health behaviors. METHODS: We used a prospective design with pre-/posttest evaluation of 50 parent-child pairs (children aged 2 to 5 years) to examine potential changes in dietary, physical activity, and sedentary behaviors among children at baseline and four-month follow-up. RESULTS: 39 (78%) parent-child pairs completed evaluation data at 4-month follow-up. Vegetable intake among children significantly increased at follow-up (0.54 cups at 4 months compared to 0.28 cups at baseline, P = 0.001) and ounces of fruit juice decreased at follow-up (11.9 ounces at 4 months compared to 16.0 ounces at baseline, P = 0.036). Sedentary behaviors also improved. Children significantly decreased time spent watching TV on weekdays (P \u3c 0.01) and also reduced weekend TV time. In addition, the number of homes with TV sets in the child\u27s bedroom also decreased (P \u3c 0.0013). CONCLUSIONS: The findings indicate that a home-based early childhood obesity prevention intervention is feasible, acceptable and demonstrates short-term effects on dietary and sedentary behaviors of low-income racially/ethnically diverse children

Rationale, design and study protocol of the ‘Strong Families Start at Home’ feasibility trial to improve the diet quality of low-income, ethnically diverse children by helping parents improve their feeding and food preparation practices

There is an urgent need to create effective interventions that help parents establish a healthy diet among their children early in life, especially among low-income and ethnically and racially diverse families. U.S. children eat too few fruits, vegetables and whole grains, and too many energy dense foods, dietary behaviors associated with increased morbidity from chronic diseases. Parents play a key role in shaping children\u27s diets. Best practices suggest that parents should involve children in food preparation, and offer, encourage and model eating a variety of healthy foods. In addition, while parents help to shape food preferences, not all children respond in the same way. Certain child appetitive traits, such as satiety responsiveness (sensitivity to internal satiety signals), food responsiveness (sensitivity to external food cues), and food fussiness may help explain some of these differences. Prior interventions to improve the diet of preschool children have not used a holistic approach that targets the home food environment, by focusing on food quality, food preparation, and positive feeding practices while also acknowledging a child\u27s appetitive traits. This manuscript describes the rationale and design for a 6-month pilot randomized controlled trial, Strong Families Start at Home, that randomizes parents and their 2-to 5-year old children to either a home-based environmental dietary intervention or an attention-control group. The primary aim of the study is to explore the feasibility and acceptability of the intervention and evaluation and to determine the intervention\u27s preliminary efficacy on child diet quality, feeding practices, and availability of healthy foods in the home

Clinical outcomes of a community clinic-based lifestyle change program for prevention and management of metabolic syndrome: Results of the ‘Vida Sana/Healthy Life’ program

Introduction: As US Hispanic populations are at higher risk than non-Hispanics for cardiovascular disease and Type 2 diabetes targeted interventions are clearly needed. This paper presents the four years results of the Vida Sana Program (VSP), which was developed and is implemented by a small clinic serving mostly Spanish-speaking, limited literacy population. Methods: The eight-week course of interactive two-hour sessions taught by Navegantes, bilingual/cultural community health workers, was delivered to participants with hypertension, or high lipids, BMI, waist circumference, glucose or hemoglobin A1C (A1C). Measures, collected by Navegantes and clinic nurses, included blood chemistries, blood pressure, anthropometry, and an assessment of healthy food knowledge. Results: Most participants (67%) were female, Hispanic (95%), and all were 18 to 70 years of age. At baseline, close to half of participants were obese (48%), had high waist circumference (53%), or elevated A1C (52%), or fasting blood glucose (57%). About one third had high blood pressure (29%) or serum cholesterol (35%), and 22% scored low on the knowledge assessment. After the intervention, participants decreased in weight (-1.0 lb), BMI (-0.2 kg/m2), WC (-0.4 inches), and cholesterol (-3.5 mg/dl, all p\u3c0.001). Systolic blood pressure decreased (-1.7 mm Hg, p\u3c0.001), and the knowledge score increased (6.8 percent, p\u3c0.001). Discussion: VSP shows promising improvements in metabolic outcomes, similar to other programs with longer duration or higher intensity interventions. VSP demonstrates an important model for successful community-connected interventions