Association between neighborhood need and spatial access to food stores and fast food restaurants in neighborhoods of Colonias

Objective To determine the extent to which neighborhood needs (socioeconomic deprivation and vehicle availability) are associated with two criteria of food environment access: 1) distance to the nearest food store and fast food restaurant and 2) coverage (number) of food stores and fast food restaurants within a specified network distance of neighborhood areas of colonias, using ground-truthed methods. Methods Data included locational points for 315 food stores and 204 fast food restaurants, and neighborhood characteristics from the 2000 U.S. Census for the 197 census block group (CBG) study area. Neighborhood deprivation and vehicle availability were calculated for each CBG. Minimum distance was determined by calculating network distance from the population-weighted center of each CBG to the nearest supercenter, supermarket, grocery, convenience store, dollar store, mass merchandiser, and fast food restaurant. Coverage was determined by calculating the number of each type of food store and fast food restaurant within a network distance of 1, 3, and 5 miles of each population-weighted CBG center. Neighborhood need and access were examined using Spearman ranked correlations, spatial autocorrelation, and multivariate regression models that adjusted for population density. Results Overall, neighborhoods had best access to convenience stores, fast food restaurants, and dollar stores. After adjusting for population density, residents in neighborhoods with increased deprivation had to travel a significantly greater distance to the nearest supercenter or supermarket, grocery store, mass merchandiser, dollar store, and pharmacy for food items. The results were quite different for association of need with the number of stores within 1 mile. Deprivation was only associated with fast food restaurants; greater deprivation was associated with fewer fast food restaurants within 1 mile. CBG with greater lack of vehicle availability had slightly better access to more supercenters or supermarkets, grocery stores, or fast food restaurants. Increasing deprivation was associated with decreasing numbers of grocery stores, mass merchandisers, dollar stores, and fast food restaurants within 3 miles. Conclusion It is important to understand not only the distance that people must travel to the nearest store to make a purchase, but also how many shopping opportunities they have in order to compare price, quality, and selection. Future research should examine how spatial access to the food environment influences the utilization of food stores and fast food restaurants, and the strategies used by low-income families to obtain food for the household

Nutrition Services for Children with Special Needs in Child Care Programs

Children with special needs are increasingly being served in community-based settings. Guidelines for out-of-home child care programs published by the American Public Health Association and the American Academy of Pediatrics recommend that child care facilities integrate children with disabilities and children without disabilities. The objectives of this study were to determine the nutrition services provided to children with special needs in child care programs and the continuing education needs of child care personnel related to providing these services. Pretested questionnaires were mailed to a random sample of 500 licensed day care homes and child care centers in a southeastern state. Two hundred forty-four programs (49%) serving 21,027 children completed questionnaires. Descriptive statistics were used to summarize data. Thirty-eight percent of programs reported serving children with special needs. A total of 403 children with special needs (an average of 4.3 children/program) were served. Programs reported serving children with special needs with food allergies/intolerances (55% of children served), growth problems (21%), feeding problems (8%), seizure disorders (7%), metabolic problems (3%), and a variety of other conditions including cystic fibrosis, Down syndrome, asthma, and extreme medical fragility requiring tube feeding. Thirty-three percent of programs responding reported making special nutritional provisions for children with special needs. Of 289 children for whom special provisions were made, menu changes were provided for 57%, recipe changes for 12%, texture changes for 9%, assistance with feeding for 9%, food provided by parents was served for 6%, special eating devices provided for 4%, and eating area modified for wheelchair access for 4%. Forty-eight percent of programs responding reported that they measured height and weight of children, and 96% reported that they monitored children\u27s eating. Continuing education needs identified included planning menus with more variety (48% reported moderate or high continuing education need), planning food and nutrition activities for the curriculum (44%), modifying recipes to decrease fat, sugar, and salt (44%), and planning menus that appeal to children (43%). The American Dietetic Association recommends that child care programs obtain consultation and guidance from a registered dietitian (RD) on a regular basis. Forty-five percent of child care programs in this study reported receiving consultation from a dietitian or nutritionist. The variety of nutritional needs of children with disabilities and chronic illnesses served by child care programs included in this study support the need for regular consultation and guidance by the RD. © 1995 American Dietetic Association

Nutrition Service and Education Needs of Children With Disabilities and Chronic Illnesses

National leaders in maternal and child health have recommended that nutrition services for children with special health care needs be culturally sensitive, family centered, and community based, and that families of children served be included in all levels of service development, implementation, and evaluation. The purpose of this research was to identify needs for nutrition services and nutrition education resources, as perceived by parents of children with special health care needs. Needs were assessed using the focus group technique, a qualitative research method that has been used for health promotion and nutrition education needs assessment in a variety of settings with various population groups. Focus groups were conducted with parents in three of four Children\u27s Medical Program (CMP) regions of a southeastern state. Parents were invited to participate in the focus groups through region-specific mailings to families of children receiving services through the CMP or through notification in a parent support group newsletter. Four focus groups ranging in size from four to six parents were conducted. The groups were representative of the racial diversity and the variety of disabilities and chronic illnesses included in the population of children served by the CMP. Conditions represented included phenylketonuria, galactosemia, Down syndrome, cerebral palsy, spina bifida, cleft Up/palate, and others. Focus group sessions were conducted by a social worker and a dietitian trained in the technique, and were recorded on audiotape. Tapes were transcribed following the sessions, and reviewed to identify common themes. Nutrition education needs identified included: need for information on reading food labels to determine if a particular food is appropriate for the child\u27s dietary restrictions and for information on meal planning to address the family\u27s nutritional needs as well as the specific needs of the chfld. Nutrition service needs included: need for more service delivery and follow-up care at the local level; need for assistance in working with school foodservice to meet child\u27s special nutritional needs in the school setting. Parents are an important source of information about nutrition-related needs of children with chronic illnesses and disabilities. The focus group technique can be used to seek their input as a basis for development of programs, services, and educational materials. © 1995 American Dietetic Association

A randomized trial using motivational interviewing for maintenance of blood pressure improvements in a community-engaged lifestyle intervention: HUB city steps

Little is known about the effective dose of motivational interviewing for maintaining intervention-induced health outcome improvements. The purpose of this study was to compare effects of two doses of motivational interviewing for maintaining blood pressure improvements in a community-engaged lifestyle intervention conducted with African-Americans. Participants were tracked through a 12-month maintenance phase following a 6-month intervention targeting physical activity and diet. For the maintenance phase, participants were randomized to receive a low (4) or high (10) dose of motivational interviewing delivered via telephone by trained research staff. Generalized linear models were used to test for group differences in blood pressure. Blood pressure significantly increased during the maintenance phase. No differences were apparent between randomized groups. Results suggest that 10 or fewer motivational interviewing calls over a 12-month period may be insufficient to maintain post-intervention improvements in blood pressure. Further research is needed to determine optimal strategies for maintaining changes