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

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

Exploring the Provider-Level Socio-Demographic Determinants of Diet Quality of Preschool-Aged Children Attending Family Childcare Homes

Since food preferences develop during early childhood and contribute to dietary patterns that can track into adulthood, it is critical to support healthy food environments in places where children spend significant amounts of time in, such as childcare. It is important to understand what factors influence the diet quality of children cared for in family childcare homes (FCCH). Methods: This study used baseline data from a cluster-randomized trial in FCCH, Healthy Start/Comienzos Sanos. Surveys capturing providers’ socio-demographic characteristics were completed. Food and beverage consumptions were estimated using the Dietary Observation in Childcare protocol, and diet quality was calculated using the Healthy Eating Index (HEI)-2015. Comparison of mean HEI scores by provider socio-demographic variables were completed using ANOVAs, followed by multiple linear regression models for significant variables. Post-hoc ANOVA models compared mean HEI-2015 sub-components by income and ethnicity. Results: Significant differences in mean HEI-2015 scores were found for provider income level (less than $25,000, HEI: 64.8 vs.$25,001–$50,000: 62.9 vs.$75,001 or more: 56.2; p = 0.03), ethnicity (Non-Latinx: 56.6 vs. Latinx: 64.4; p = 0.002), language spoken outside of childcare (English: 58.6 vs. Spanish: 64.3, p = 0.005), and language spoken in childcare (English: 59.6 vs. Spanish: 64.4; p = 0.02). In linear regression models, a higher provider income ($75,001 or more) was negatively and significantly associated with the total HEI-2015 scores (β = −9.8, SE = 3.7; p = 0.009) vs. lower income (less than$25,000). When entering provider income and ethnicity to the same model, adjusting for Child and Adult Food Program (CACFP), only ethnicity was significant, with Latinx being positively associated with total HEI-2015 scores vs. non-Latinx (β = 6.5, SE = 2.4; p = 0.007). Statistically significant differences were found by ethnicity and language for greens/beans, total protein, and seafood and plant protein HEI-2015 component scores. Discussion: Lower income, and Latinx providers cared-for children had higher diet quality in FCCH compared to the other providers. Future studies should better understand what specific foods contribute to each of the HEI-2015 components in order to better tailor trainings and interventions

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

Communication With Family Child Care Providers and Feeding Preschool-Aged Children: Parental Perspectives

ABSTRACT Objective To describe parent communication about child nutrition–related topics with family child care providers (FCCPs). Design Five focus groups conducted from December, 2016 to July, 2017. Participants Parents (n = 25) of 2- to 5-year-old children attending family child care homes in Rhode Island. Phenomenon of Interest How and what parents communicate about with FCCPs related to feeding young children. Analysis Recordings were transcribed verbatim. Two independent coders employed content analysis to analyze transcripts. Reflections, emerging themes, and final themes were discussed. Results Participants were recruited through FCCPs and were mostly Hispanic and female. Parents mainly communicated with FCCPs in person. Communication with FCCPs related to how and what children were fed did not occur frequently, and parents usually inquired about how much children ate. Conclusions and Implications Parents did not engage in frequent child nutrition–related communication with their FCCP. However, parents trusted FCCPs to provide healthy and sufficient food to children. More research is needed to identify effective strategies that facilitate child nutrition communication between parents and FCCPs

Weight gain and weight management concerns for patients on β-blockers

β-blocking medications are first-line therapy for young patients with uncomplicated hypertension. They are also prescribed to 55% to 80% of those discharged from the hospital with a diagnosis of myocardial infarction. These drugs are known to decrease cardiovascular morbidity and mortality, but they also have metabolic adverse effects. One that is not widely known is that these drugs cause a decrease in resting metabolic rate, and taking these medications may result in a small weight gain. With continued use, there is an additional difficulty with weight loss, should that be a goal in managing high blood pressure. This article reviews the available research and offers a pragmatic approach to this clinical issue. Copyright © 2010 Lippincott Williams & Wilkins

The food and activity environments of childcare centers in Rhode Island: a directors’ survey

BACKGROUND: The food and activity environments of childcare have been identified as promising areas in which to improve nutrition and activity for children. METHODS: Of the 292 centers caring for children 18–60 months of age, 107 randomly selected directors completed a survey. The survey queried nutrition and physical activity practices, attitudes of providers and staff, and demographics of the enrolled children and the center, including participation in the federal Child and Adult Care Food Program (CACFP). Responses were compared for CACFP compared with non-CACFP participating centers. RESULTS: CACFP center directors reported serving more fruit, fried potatoes, beans, 100 % fruit juice, non-fat milk and water compared with non-CACFP directors. Sixty-four percent of CACFP centers and 87 % of non-CACFP centers served no vegetables the previous day (p = .0973). There were no differences in the amount of physical activity time reported by CACFP status. Also, 81 % of directors reported never or rarely allowing screen time in the previous week. Directors of Non-CACFP centers were more likely (93 %) to strongly agree that they were able to identify healthy foods and (87 %) that healthy foods are available where they shop than CACFP center directors (65 %, p = 0.0088, 54 %, p = 0.0354, respectively). DISCUSSION: More nutritious foods (fruit, beans, 100 % fruit juice, non-fat milk and water) were provided in CACFP centers, compared with non-CACFP centers, but no differences in physical activity were identified. However, non-CACFP directors were better able to access and identify healthy foods. CACFP guidelines regarding food served were likely responsible for the more nutritious foods, though CACFP providers may be challenged by fewer skills and lower educational background. CONCLUSIONS: Stronger guidelines supporting both food and activity would bolster policies for childcare centers and improve the nutrition and physical activity environments in this setting

Computer Kiosks to Deliver Medication Information in the Pharmacy

The feasibility of using a computer kiosk to deliver medication information to patients was tested in a community pharmacy environment. Viewers used a computer kiosk to access the National Library of Medicine (NLM) MedlinePlus® website. In four weeks, 198 pharmacy patients viewed the website and completed brief questionnaires about their experiences. The majority of patients (63%) were female and between 46 and 65 years of age (48%). Few (8%) had used the NLM website before. Patient age was associated with access to the Internet, previous use of the NLM website, and other habits regarding medication information sources; however, the differences were not as great as anticipated. © 2011 Copyright Taylor and Francis Group, LLC

Racial/ethnic differences in maternal feeding practices and beliefs at 6 months postpartum

Objective: To examine racial/ethnic differences in maternal feeding practices and beliefs in a sample of low-income smoke-exposed women. Design: Cross-sectional analysis using data collected during a randomised control trial. Maternal feeding practices and beliefs were assessed using the Infant Feeding Questionnaire (IFQ), which was administered at 6 months postpartum. ANOVA was used to examine differences in IFQ items by race/ethnicity, while multivariable linear regression models were used to examine differences in IFQ factor scores by race/ethnicity adjusting for potential confounders. Setting: Participants were recruited from prenatal clinics. Participants: 343 women (39 % non-Hispanic White, 28 % Hispanic/Latina, 13 % Black, and 20 % other). Results: Racial/ethnic minority mothers were more likely than non-Hispanic White mothers to put cereal in their infant's bottle so that the infant would stay full longer (P = 0 center dot 032), state their infant wanted more than just formula or breast milk prior to 4 months (P = 0 center dot 019), allow their infant to eat whenever he/she wanted (P = 0 center dot 023) and only allow their infant to eat at set times (P < 0 center dot 001). Adjusting for potential confounders, racial/ethnic minority mothers had higher scores for factors 1 (concern about infant undereating or becoming underweight), 2 (concern about infant's hunger), 4 (concern about infant overeating or becoming overweight) and 5 (feeding infant on a schedule), and lower scores for factor 7 (social interaction with the infant during feeding) than White mothers. Racial/ethnic differences were not found for the other two factors. Conclusions: Differences in maternal feeding practices and beliefs across race/ethnicity are present at 6 months postpartum