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Nutrition and overweight concerns in rural areas: A literature review
... For example, although youth of low (versus high) socioeconomic status (SES) typically report lower physical activity levels, they have higher levels of active commuting to school [10][11][12], and report more inschool physical activity [13]. Additionally, rural youth are less likely than urban youth to meet physical activity guidelines, [14] likely due to the cultural and structural limitations specific to rural areas (e.g., limited resources and fewer outlets for physical activity) [15]. Thus, the transition to remote learning during the pandemic may have disproportionately impacted children of lower SES and rural youth that have fewer physical activity opportunities outside of school [15,16]. ...
... Additionally, rural youth are less likely than urban youth to meet physical activity guidelines, [14] likely due to the cultural and structural limitations specific to rural areas (e.g., limited resources and fewer outlets for physical activity) [15]. Thus, the transition to remote learning during the pandemic may have disproportionately impacted children of lower SES and rural youth that have fewer physical activity opportunities outside of school [15,16]. It is therefore important to examine how to best support families, schools, and communities in efforts to mitigate the secondary impact of large-scale disruptions to in-person learning, such as those presented by the COVID-19 pandemic, on children's activity levels. ...
... Child Physical Activity Information Needs by Child and Parent Characteristics among Children ages[11][12][13][14][15][16][17] ...
Background:
The COVID-19 pandemic presented novel barriers to youth physical activity engagement. Identifying what resources parents and children are interested in receiving can support efforts to mitigate the negative impact of the pandemic on youth physical activity behavior. This study aimed to identify physical activity-related information needs during the COVID-19 pandemic among a nationally representative sample of American parents of children 6-10 years-old and parent-child dyads of children 11-17 years-old.
Methods:
A cross-sectional survey was conducted by a market research company in October-November 2020. Parents and children were asked about their interest in specific types of information about helping their family and themselves, respectively, be active (Yes/No). Weighted percentages were calculated for reported information needs and compared using two-sample test of proportions.
Results:
Final analytic sample was 1000 parents (55.4% female; 74.7% White; 74.0% non-Hispanic); 500 children 11-17 years-old (52.1% male; 77.6% White). Over 40% of participants were interested in information about being active during COVID-19. Parents were more likely to be interested in information if they always (versus never) worked from home [53.3% (95% CI: 43.3-63.0%) versus 22.0% (95% CI: 14.9-31.3%), p < 0.001]; had children attending school remotely versus in-person [47.3% (95% CI:40.2-54.5%) versus 27.5% (95% CI: 19.6-37.1%), p < 0.001]; and lived in a big city versus a rural area [66.5% (95% CI:54.5-76.7%) versus 34.1% (95% CI: 22.8-47.6%), p < 0.001]. Children most interested were those who did not have resources for online activity engagement and those worried about their safety or getting infected with COVID-19. Children were also more likely to be interested if their parents worked full-time versus not working [48.6% (95% CI:41.7-55.6%) versus 31.5% (95% CI: 24.1-39.9%), p < 0.001], and lived in a big city versus a rural area [57.2% (95% CI:45.3-68.3%) versus 27.8% (95% CI:17.8-40.7%), p < 0.001].
Conclusions:
Families are interested in physical activity resources, particularly those whose daily routines and opportunities for physical activity may have been most significantly impacted by the pandemic. This includes parents who always worked from home or whose children attended school remotely. Identifying felt needs is an important step in developing tailored interventions that aim to effectively and sustainably support families in promoting physical activity.
... Socioeconomic status modified the strength of these relationships found between rural and urban residents [13]. Additional studies showed associations between rurality and risk factors for disease, disease prevalence, and mortality [14][15][16]. These studies show the importance of investigating potential differences between low and high SES, and rural and urban school districts with regard to the DQ of school lunches in order to determine the potential disparities that may indicate a need for intervention. ...
... This is the first known study to investigate associations between school nutrition and rurality. There have been other, more general population studies that have found significant differences in nutrition, disease prevalence, weight status, and other health behaviors by locale [12][13][14][15][16]. With these studies indicating the possibility for variation in nutrition by rurality [12][13][14][15][16], in conjunction with previous research by our lab group indicating the possibility for significant variation in DQ of school lunches meeting NSLP nutrition standards [4], it was important to investigate the differences in school nutrition that are associated with rurality, especially as federal food assistance programs, including the NSLP, seek to eliminate disparities in nutrition [1]. ...
... There have been other, more general population studies that have found significant differences in nutrition, disease prevalence, weight status, and other health behaviors by locale [12][13][14][15][16]. With these studies indicating the possibility for variation in nutrition by rurality [12][13][14][15][16], in conjunction with previous research by our lab group indicating the possibility for significant variation in DQ of school lunches meeting NSLP nutrition standards [4], it was important to investigate the differences in school nutrition that are associated with rurality, especially as federal food assistance programs, including the NSLP, seek to eliminate disparities in nutrition [1]. Again, the lack of significant differences in DQ by rurality in the current study is likely due to the fact that the NSLP regulates the nutrition that is provided by participating schools' lunches. ...
Research suggests that the dietary quality (DQ) of school lunches meeting the National School Lunch Program (NSLP) requirements may vary significantly. Possible drivers of variation include factors, such as socioeconomic status (SES) and rurality. The purpose of this cross-sectional study was to determine whether there was variation in nutrient content and DQ by SES and rurality, when analyzing middle school lunch menus meeting NSLP requirements. A random sample of 45 Kansas middle school lunch menus each were obtained from websites of randomly selected districts from low-and high-SES strata. Thirty-day menus were analyzed for nutrient content. Healthy Eating Index (HEI) 2015 scores were calculated for DQ. Rurality was determined for schools by National Center for Education Statistics (NCES) locale. There were significant differences in added sugar (p < 0.001) and calcium (p = 0.001) favoring high-SES menus, and in sodium (p = 0.001) favoring low-SES menus. There were no nutrient differences by rurality. The HEI scores were not different by SES or rurality, with a mean score (SD) 61.9 (2.6) across all schools. Middle school lunch DQ in Kansas does not vary by SES or rurality. Efforts to improve DQ should focus on all foodservice operations, not specifically low-SES or rural schools.
... But on what basis is Brazil's institutional response to obesity important in the US context? It is important because like Brazil, in the US obesity is highly prevalent in urban and hard to reach, distant rural areas, especially among low-income groups [33][34][35]. As in Brazil, moreover, the rate of obesity in the US is growing faster in these poor rural versus wealthier urban areas [33][34][35]. ...
... It is important because like Brazil, in the US obesity is highly prevalent in urban and hard to reach, distant rural areas, especially among low-income groups [33][34][35]. As in Brazil, moreover, the rate of obesity in the US is growing faster in these poor rural versus wealthier urban areas [33][34][35]. Similar again to Brazil, the poor in the US, especially in distant rural areas, often cannot seek medical attention due to distance, funding for travel, and time away from work [8,36]. ...
... While community health centers do exist in the US, its staff do not make homes visits, while these centers are also hard to reach [8]. In this context, obese rural residents often lack adequate obesity prevention services, due to limited infrastructure and medical attention ( [8,33,35,37]); because of this, US health officials may stand to gain from adopting a federal assistance program similar to Brazil's FHP. ...
In the United States (US) and Brazil, obesity has emerged as a health epidemic. This article is driven by the following research questions: how did the US and Brazil's federal institutions respond to obesity? And how did these responses affect policy implementation? The aim of this article is therefore to conduct a comparative case study analysis of how these nations' institutions responded in order to determine the key lessons learned.
This study uses primary and secondary qualitative data to substantiate causal arguments and factual claims.
Brazil shows that converting preexisting federal agencies working in primary healthcare to emphasize the provision of obesity prevention services can facilitate policy implementation, especially in rural areas. Brazil also reveals the importance of targeting federal grant support to the highest obesity prevalence areas and imposing grant conditionalities, while illustrating how the incorporation of social health movements into the bureaucracy facilitates the early adoption of nutrition and obesity policies. None of these reforms were pursued in the US.
Brazil's government has engaged in innovative institutional conversion processes aiding its ability to sustain its centralized influence when implementing obesity policy. The US government's adoption of Brazil's institutional innovations may help to strengthen its policy response.
... The American Cancer Society estimates that there will be about 580,350 cancer deaths in the United States (US) for 2013, and among these, about one-quarter to onethird will be attributed to being overweight or obese, physical inactivity, and poor nutrition [1]. According to a review by Tai-Seale and Chandler (2003), obesity seems to be most severe in rural areas [2]. People in rural areas may face greater cancer risk because of the higher prevalence of undesirable diet and physical activity behaviors that contribute to obesity [3]. ...
... However, very little research has been conducted to understand the risk profile of those residing in rural communities to identify factors that may lead to cancer risk, and to identify intervention strategies to reduce these risks. The reasons why there may be a higher prevalence of obesity in rural areas is unclear, but challenges such as fewer prevention and treatment facilities, the distances needed to travel to reach them, limited access to grocery stores and healthier food alternatives, limited access to physical activity options, and cultural challenges may put people living in these areas at higher risks [2,4]. ...
... Prevalences in our study were considerably higher than those of state and national data: in 2010, the combined prevalence of overweight and obesity in Texas adults was 66.5% and nationally, this prevalence was 63.7% [19]. Thus, the prevalence of overweight and obesity in the rural areas in our study are a "call to action" for more population-based strategies to improve social and physical environmental contexts for healthful eating and physical activity [2]. ...
Cancer risks in the
United States are linked to undesirable dietary and physical activity habits
that may be more common in rural communities. This study assessed the cancer
risk in two rural West Texas communities through anthropometrics, diet, and
physical activity measures (n = 374). No significant relationships were found
between body mass index (BMI) and waist circumference (WC) with consumption
of fruits, vegetables, whole grains, and sugar-sweetened beverages; however,
data showed significant negative associations between BMI and WC and physical
activity. Over 58% of the sample was unaware of the link between obesity and
cancer risk. Further evaluation of cancer risk in rural communities is needed
to develop effective interventions and reduce health disparities.
... Notably, the southern states in the U.S. have higher burdens of obesity than northern states. Nation-wide, rural populations exhibit higher prevalence of obesity and obesity-related outcomes such as type 2 diabetes [10][11][12]. Rates of mortality and morbidity from chronic health conditions are higher among rural populations when compared to their urban or suburban counterparts [10,11,13]. ...
... Nation-wide, rural populations exhibit higher prevalence of obesity and obesity-related outcomes such as type 2 diabetes [10][11][12]. Rates of mortality and morbidity from chronic health conditions are higher among rural populations when compared to their urban or suburban counterparts [10,11,13]. ...
... From social determinants of health framework, increased prevalence of obesity in rural populations stems in part, from 'downstream' behavioral factors such as physical inactivity and poor diet among rural populations [11,12,14]. However, these behavioral patterns are influenced by 'upstream' determinants such as lower educational attainment and lower SES also characterizing many rural areas [15]. ...
Background:
The burden of obesity and obesity-related conditions is not borne equally and disparities in prevalence are well documented for low-income, minority and rural adults in the United States. The current literature on rural versus urban disparities is largely derived from national surveillance data which may not reflect regional nuances. There is little practical research that supports the reality of local service providers such as county health departments that may serve both urban and rural residents in a given area. Conducted through a community-academic partnership, the primary aim of this study is to quantify the current levels of obesity (BMI), fruit and vegetable (FV) intake and physical activity (PA) in a predominately rural health disparate region. Secondary aims are to determine if a gradient exists within the region in which rural residents have poorer outcomes on these indicators compared to urban residents.
Methods:
Conducted as part of a larger ongoing community-based participatory research (CBPR) initiative, data were gathered through a random digit dial telephone survey using previously validated measures (n = 784). Linear, logistic and quantile regression models are used to determine if residency (i.e. rural, urban) predicts outcomes of FV intake, PA and BMI.
Results:
The majority (72%) of respondents were overweight (BMI = 29 ± 6 kg/m2), with 29% being obese. Only 9% of residents met recommendations for FV intake and 38% met recommendations for PA. Statistically significant gradients between urban and rural and race exist at the upper end of the BMI distribution. In other words, the severity of obesity is worse among black compared to white and for urban residents compared to rural residents.
Conclusions:
These results will be used by the community-academic partnership to guide the development of culturally relevant and sustainable interventions to increase PA, increase FV intake and reduce obesity within this health disparate region. In particular, local stakeholders may wish to address disparities in BMI by allocating resources to the vulnerable groups identified.
... The problem is particularly severe among lower income and rural populations (Montgomery-Reagan et al., 2010) who also have elevated rates of diseases related to diet and physical activity, such as type 2 diabetes, hypertension, and cardiovascular disease (Daniels, 2009). This is a major concern in rural Appalachian populations that have relatively poor health and health-related self-care behaviors compared to other populations (Behringer & Friedell, 2006;Tai-Seale & Chandler, 2003). ...
... Rural life presents special challenges to maintaining a healthy weight, including structural and cultural factors that prevail in Appalachian areas (Bellamy, Bolin & Gamm, 2011;Tai-Seale & Chandler, 2003). Cultural factors include higher fat and caloric consumption, less exercise, preference for sedentary activities, reliance on nonprofessional health advice, preference for informal communication channels, and less confidence in the recommendations of teachers or health professionals (Bellamy, Bolin & Gamm, 2011;Janicki et al., 2011;Tai-Seale & Chandler, 2003). ...
... Rural life presents special challenges to maintaining a healthy weight, including structural and cultural factors that prevail in Appalachian areas (Bellamy, Bolin & Gamm, 2011;Tai-Seale & Chandler, 2003). Cultural factors include higher fat and caloric consumption, less exercise, preference for sedentary activities, reliance on nonprofessional health advice, preference for informal communication channels, and less confidence in the recommendations of teachers or health professionals (Bellamy, Bolin & Gamm, 2011;Janicki et al., 2011;Tai-Seale & Chandler, 2003). Finally, rural Appalachian residents lack nutritional education and adequate resources for either healthful eating or exercise (Janicki et al., 2009). ...
Childhood obesity prevalence rates in the United States are the highest in the rural Appalachian areas. Teens mentoring younger children to reverse obesity health risks are an understudied approach. This randomized-controlled trial compared the effects of two curriculum delivery methods and assessed the mediating effects of the number of sessions attended on the outcomes. The control group received the 8-week Just for Kids! curriculum via an adult teacher in a classroom and the experimental group received the same curriculum via individual teen mentoring. Data collected at baseline and postintervention were analyzed using multilevel linear models. Each of the outcomes (e.g., body mass index, blood pressure, current lifestyle behaviors) were modeled separately. Only the mentored children demonstrated improved current lifestyle behaviors (e.g., physical activity and dietary patterns) and health outcomes. Teen mentoring was an effective and efficacious approach to impact the lifestyle patterns and health outcomes of children in a school setting.
... 6 Children residing in rural areas consume even less F&Vs. 7,8 Some studies show that eating habits established in childhood will persist into adulthood. 9 Because parents are the chief influencers of a child's eating behaviors, it is imperative that parents understand the food they offer their children, as well as, the foods their children desire. ...
... Despite efforts and interventions geared towards increasing children's F&V consumption, studies still show children, especially those residing in rural areas, are not consuming the recommended daily serving of F&V. 8,33,43 In this study, we sought to examine the influence of parent-child decision-making patterns on children's F&V con-sumption in a sample consisting of mainly rural low-income residents. Overall, our results indicate that when parents involve children in F&V consumption decision-making, children are likely to increase their F&V consumption. ...
... By interacting neighborhood characteristics with the child's demographics, the present study is able to examine the relationship between childhood obesity, race and income, and obesogenic environments (unhealthy settings). Urban areas are found to be less obesogenic than rural areas, because they are found to have more outlets for exercising (Tai-Seale & Chandler, 2010). National studies of adults (rather than children) have consistently shown that obesity and low physical activity are more common among rural adults than urban adults (Jackson, Doescher, Jerant, & Hart, 2005;Martin et al., 2005;Patterson, Moore, Probst, & Shinogle, 2004). ...
... Unexpectedly, urban areas are reported to have fewer detractions (litter, dilapidated buildings, etc.; Nolan & Whelan, 2000;Pearce et al., 2007;Salmon et al., 2013). The correlation matrix also indicates that urban areas are more associated with higher income, more amenities (sidewalks, parks, etc.), and less cohesion than rural areas, as was expected (e.g., Davis et al., 2011;Putnam, 2000;Tai-Seale & Chandler, 2010). As such, it is no surprise that low income is more associated with having fewer amenities and with being Black and Hispanic (Larsen et al., 2006). ...
Scholars suggest that children’s built and social environments play key roles in their physical activity (PA) levels and subsequent propensity toward obesity. This study examines the associations between neighborhood constructs and the race and income disparities in PA and health among children ages 10–17 years in the United States. Using the 2011–2012 National Survey of Children’s Health and a series of logistic and ordinary least squares regressions, this study compares obesity and PA levels of Black, Hispanic, and low-income children with their White and more affluent counterparts, interacting demographic and neighborhood characteristics with one another. Findings reveal that non-White respondents report having more amenities and more detractions; low-income respondents report having fewer amenities and more detractions; and non-White and low-income respondents report having less social cohesion. Additionally, though amenities and cohesion improve PA and health and detractions have the reverse effect, these effects are opposite for Black, Hispanic, and low-income children. Black children with more cohesion and Hispanic children with more amenities and fewer detractions have greater odds of being obese. Findings underscore the need for improved physical and social environments in non-White and low-income communities, as well as targeted initiatives to educate parents and children on obesity and healthful activities.
... The high consumption rate found in this investigation could be a function of our NNS consumer definition (equivalent of 1 fl oz of diet soda) as compared to the traditional diet soda definition. Additionally, the higher intake could reflect a shift in beverage patterns among rural populations in order to cope with high obesity and chronic health disease risk [54][55][56][57]. When asked about NNS beverages, participants from rural southwest Virginia reported in a qualitative study (n = 54) that NNS beverages had mostly positive attributes, including taste and health outcomes, acknowledging that NNS beverages contained less calories and sugar [51]. ...
... This investigation is the first to characterize NNS intake (consumer characteristics and frequency, type, and source) in a large (n = 301) rural population. NNS intake patterns in rural populations are particularly relevant as these groups are at a higher risk for obesity and a variety of chronic health conditions [54][55][56][57]. This investigation is unique in that it explores the most commonly consumed types of NNS in both beverages and foods [1,34]. ...
Few data assessing non-nutritive sweetener (NNS) intake are available, especially within rural, health-disparate populations, where obesity and related co-morbidities are prevalent. The objective of this study is to characterize NNS intake for this population and examine the variance in demographics, cardio-metabolic outcomes, and dietary intake between NNS consumers and non-consumers. A cross-sectional sample (n = 301) of Virginian adults from a randomized controlled trial (data collected from 2012 to 2014) targeting sugar-sweetened beverage (SSB) intake completed three 24-h dietary recalls, and demographics and cardio-metabolic measures were assessed. The frequency, types, and sources of NNS consumption were identified. Thirty-three percent of participants reported consuming NNS (n = 100). Sucralose was the largest contributor of mean daily NNS intake by weight (mg), followed by aspartame, acesulfame potassium, and saccharin. NNS in tabletop sweeteners, diet tea, and diet soda were the top contributors to absolute NNS intake. The most frequently consumed NNS sources were diet sodas, juice drinks, and tabletop sweeteners. Although mean body mass index (BMI) was greater for NNS consumers, they demonstrated significantly lower food, beverage, and SSB caloric intake and energy density, and higher overall dietary quality. It remains unclear whether NNS use plays a role in exacerbating weight gain. NNS consumers in this sample may have switched from drinking predominantly SSB to drinking some NNS beverages in an effort to cope with weight gain. Future studies should explore motivations for NNS use across a variety of weight and health categories.
... 1,4 These environments, commonly referred to as obesogenic environments, are areas that promote overweight and obesity on a population level by offering community attributes such as physical inactivity and unhealthy food choices. 5,6 Contribution of Demographics Interestingly, one of the factors related to the increase in obesity in rural areas may include four specific demographic features. First, older individuals tend to have higher obesity rates, and the population in rural America is older than in the rest of the country. ...
... Traditionally, rural areas have experienced a lower incidence of overweight and obesity due to the increased physical demands that are characteristic of an agrarian lifestyle. 6,11 However, this is no longer the case, and as a result, rural residents are experiencing an increased prevalence of obesity and overweight compared to their urban counterparts. 1 Public health research has indicated that modification of the underlying environment influences may be necessary to affect population-level changes in health behaviors. ...
Obesity rates in the United States have drastically increased over the past 20 years. According to the Center for Disease Control and Prevention, the obesity rate for adults has nearly doubled since 1990, reaching as high as 32.2% among adult men and 35.5% among adult women. One rural community, Smith Island, Maryland, has special challenges in obtaining a healthy lifestyle due to their insolated environment. Although there have been small measures to reduce obesity on Smith Island, the need for further education is essential. The purpose of this program evaluation was to determine if a culturally sensitive educational program increases the knowledge of healthy eating practices and benefits of physical activity among residents of Smith Island. A convenience sample of 25 residents living on Smith Island was used. Residents were recruited to participate in an educational program that focused on healthier eating and benefits of physical activity. Overall, participants scored higher on the posttest compared to the pretest (t=-6.28, p<0.001). Additionally, the participants felt more confident in making changes in food choices (t=-4.64, p<0.001) and making nutritious meals for their families (t=-4.54, p<0.001). There was an increase in knowledge of healthy eating practices and benefits of physical activity in a rural community through the use of culturally sensitive educational tools. This demonstrates the need for culturally appropriate educational tools that focus on improving healthier eating habits and benefits of physical activity as a plausible strategy to reduce risk for obesity.
... African Americans are disproportionately affected by obesity in rural areas [15,16]. Prior obesity studies noted families residing in rural areas are limited in prevention efforts because they do not account for rural challenges [13,17,18]. When rural caregivers attempt to model and maintain a healthy lifestyle for children recreational parks and facilities, grocery stores with fresh produce, and health care resources are unavailable or inaccessible [13,[17][18][19]. ...
... Prior obesity studies noted families residing in rural areas are limited in prevention efforts because they do not account for rural challenges [13,17,18]. When rural caregivers attempt to model and maintain a healthy lifestyle for children recreational parks and facilities, grocery stores with fresh produce, and health care resources are unavailable or inaccessible [13,[17][18][19]. African American communities experience more barriers in their environment resulting in higher obesity rates [20][21][22]. ...
Given the pivotal role of African American caregiver's perceptions of childhood obesity in rural areas, the inclusion of caregiver's perceptions could potentially reduce childhood obesity rates. The objective of the current study was to explore childhood obesity perceptions among African Americans in a rural Georgia community. This concurrent mixed methods study utilized two theoretical frameworks: Social Cognitive Theory and Social Ecological Model. Using a convenience sample, caregivers ages 22-65 years completed a paper-based survey (n = 135) and a face-to-face interview (n = 12) to explore perceptions of obesity risk factors, health complications, weight status, built environment features, and obesity prevention approaches. Descriptive statistics were generated and a six-step process was used for qualitative analysis. Participants commonly cited behavioral risk factors; yet, social aspects and appearance of the community were not considered contributing factors. Chronic diseases were reported as obesity health complications. Caregivers had a distorted view of their child's weight status. In addition, analysis revealed that caregivers assessed child's weight and height measurements by the child's appearance or a recent doctor visit. Environmental barriers reported by caregivers included safety concerns and insufficient physical activity venues and programs. Also, caregivers conveyed parents are an imperative component of preventing obesity. Although this study found caregivers were aware of obesity risk factors, health complications, built environment features, and prevention approaches their obesity perceptions were not incorporated into school or community prevention efforts. Findings suggest that children residing in rural areas are in need of tailored efforts that address caregiver perceptions of obesity.
... Although the factors contributing to obesity are complex, it is understood that children are consuming too many calories and not enough nutrients [3]. Studies find that rural children are more likely to be overweight or obese than children living in metropolitan areas [4,5]. Developing approaches to tailor interventions to the unique needs of rural school settings may be critical for shaping policy to reduce child and adolescent obesity nationally as rural communities are often isolated and therefore have unique needs. ...
... Too few students met 100% of guideline to model this probability, so a lower cut-off was used. 2 Excludes Day 3 because no students met guideline for Vitamin C on Day 3 (maximum intake = 2.96 mg). 3 Too few students met guideline of 10% to model this probability, so a higher cut-off was used. 4 Too variable by day to combine days into a single model. *p < 0.05. ...
School recess before lunch (e.g., reverse recess) has been suggested as a means to improve dietary intake and classroom behavior but limited research explores this school-based policy. This pilot study tests the impact of recess scheduling on dietary intake at school lunch.
A mixed methods approach included assessment of dietary intake assessed by measured plate waste on five non-consecutive days at Madras Elementary School, Madras, Oregon, United States (n = 104 intervention; 157 controls). Subjects included primary school children in grades kindergarten, first and second. Logistic regression was used to test associations between recess timing and dietary intake. Four focus groups involving teachers and staff explored reactions to the intervention. Qualitative data was transcribed verbatim and assessed for key themes.
Milk consumption was 1.3 oz greater in the intervention group (5.7 oz vs. 4.4 oz); and 20 % more of the intervention participants drank the entire carton of milk (42 % vs. 25 %, p < 0.0001). Intervention participants were 1.5 times more likely to meet the nutritional guidelines for calcium (>=267 mg, p = 0.01) and fat (<=30 % of total energy, p = 0.02). Consumption of entrees, vegetables, and fruits did not differ between groups. Teachers perceived recess before lunch beneficial to classroom behavior and readiness to concentrate following lunch.
The recess before lunch intervention yielded increased milk consumption; the nutritional and social benefits observed warrant policy change consideration. Future research should assess the impact of recess before lunch in larger districts.
... Previously, people living in rural areas had a lower incidence of overweight and obesity largely because of the heavy physical demands of farming or other rural occupations (Tai-Seale & Chandler, 2003). However, agrarian jobs have become increasingly mechanized and today the highest prevalence of obesity is found in rural areas. ...
... However, agrarian jobs have become increasingly mechanized and today the highest prevalence of obesity is found in rural areas. Rural women are more likely to be overweight and/or obese than women from suburban or mid-sized metropolitan areas, especially if Caucasian (Tai-Seale & Chandler, 2003). Overweight and/or obesity in rural communities may be precipitated by a number of complex social and environmental factors. ...
To identify key behavioral factors that contribute to physical activity and weight management in overweight, rural women and determine the degree to which social support, stage of behavior change, and self-efficacy for physical activity and depressive symptoms are linked to physical activity, body weight, and body mass index (BMI).
Twenty-five overweight or obese rural women completed self-report scales and height and weight measurements; BMI was calculated. Self-report scales included the International Physical Activity Questionnaire (physical activity level), Social Support for Exercise and Social Support Questionnaire (social support), Stage of Exercise Adoption (stage of behavior change), Self-efficacy for Exercise (self-efficacy), and the Patient Health Questionnaire (depressive symptoms).
Higher levels of physical activity were associated with greater self-efficacy and the self-esteem domain of social support. Rural women reported more depressive symptoms over the year. Women did not significantly increase physical activity and gained weight during the 1-year study.
Rural women have limited resources available to increase physical activity to facilitate weight loss. Routine screening and treatment for depression in rural women may need to be initiated concurrently with interventions to promote health behavior changes.
... 23,28 Likewise, other researchers have found that exercise equipment in rural areas tends to be poorly maintained. 29 Other researchers note that rural communities may be averse to health education on physical activity from healthcare providers. Tai-Seale and Coleman 28 suggest that cultural patterns prefer advice from friends and referent others as opposed to provider recommendations for engaging in both diet and physical activity. ...
Introduction: Rural Americans consistently fall short of diet and exercise guidelines. Meeting RDA's and physical activity guidelines can improve health and increase longevity. The purpose of this study was to determine barriers to healthy eating and physical activity in a rural community. Methods: A cross-sectional survey was administered to a rural community in Spring of 2021. Quantitative data were analyzed using Kendall's tau. Qualitative data were analyzed using thematic analysis. Results: Quantitative results revealed a negative association between age and healthy eating (Tb=-.22, p=.001), income and healthy eating (Tb=-.17, p=.001), and a positive association between age and consumption of nuts and seeds (Tb=.20, p=.001). Barriers to healthy eating included limited access, diet preferences or restrictions, inconvenience, and safety concerns associated with grocery shopping. Physical activity barriers included lack of time and motivation. Conclusions: While some variables related to healthy eating and physical activity are non-modifiable (e.g., income, age, sex), others are. Health practitioners have an ethical obligation to mitigate many of these barriers to ensure healthier communities, especially in rural settings. Education, advocacy, policy, and systems changes should target all demographics, irrespective of age, gender, or socioeconomic status.
... Differences in physical activity levels by urbanicity have also been shown, (Davis et al., 2008;Eime et al., 2015;Liu et al., 2008;Moore et al., 2013) with rural youth being 35% less likely than urban youth to meet guidelines (Lutfiyya et al., 2007). These disparities are likely due to cultural and structural limitations specific to rural areas including limited resources and fewer outlets for physical activity (Tai-Seale & Chandler, 2003). ...
... Differences in physical activity levels by urbanicity have also been shown, (Davis et al., 2008;Eime et al., 2015;Liu et al., 2008;Moore et al., 2013) with rural youth being 35% less likely than urban youth to meet guidelines (Lutfiyya et al., 2007). These disparities are likely due to cultural and structural limitations specific to rural areas including limited resources and fewer outlets for physical activity (Tai-Seale & Chandler, 2003). ...
Purpose: This cross-sectional study used data from the 2018-2019 National Survey of Children's Health to examine the association between metropolitan statistical area (MSA) status and sports participation among American youth ages 6-17. Methods: Weighted prevalence statistics were computed for sports participation by MSA status (non-MSA, MSA), overall and by child sex and age. Modified Poisson regression was used to estimate prevalence ratios (PR) for non-MSA versus MSA youth, before and after adjusting for special health-care needs, race/ethnicity, household income, parent education, and family structure. Results: The final sample included 30,029 youth [Mage = 11.6 years (SD = 0.4), 51.4% female, 49.0% White]. About 56% participated in sports in the past year. Sports participation was significantly higher among females versus males [59.1% (95% CI: 57.4%-60.7%) versus 52.1% (95% CI: 50.4%-53.8%), p < .001]. Among ages 6-11, those in non-MSAs (versus MSAs) were less likely to participate in sports [PR 0.92 (95% CI: 0.86-0.99), p = .033], which was non-significant after adjustment. In adjusted models, youth ages 12-17 in non-MSAs (versus in MSAs) were more likely to participate in sports overall [aPR 1.07 (95% CI: 1.00-1.15), p = .042] and among males [aPR 1.12 (95% CI: 1.01-1.23), p = .026]. Conclusion: The relationship between MSA status and sports participation may be largely driven by factors that affect youth's ability to participate in sports. Sports participation was higher among females versus males overall. In the models adjusted for demographics, non-MSA youth ages 12-17 were more likely to participate, particularly males. Efforts promoting youth sports should consider differences in socio-demographic factors between MSA versus non-MSA areas to help increase participation.
... The most recent U.S. Census reported that adults living in rural areas are older than those living in urban areas, with median ages being 51 and 45 years, respectively (U.S. Census Bureau, 2016). Unfortunately, rural older adults have a higher prevalence of chronic health issues such as obesity, cardiovascular disease, and neurodegeneration, which can diminish quality of life (Gamm, Hutchison, Bellamy, & Dabney, 2002;Casey, Thiede Call, & Klingner, 2001;Tai-Seale & Chandler, 2003;Baernholdt, Yan, Hinton, Rose, & Mattos, 2012). Evidence suggests maintaining good nutritional status plays an important role in preventing or delaying chronic health issues (Slawson, Fitzgerland, & Morgan, 2013;Arjuna et al., 2017). ...
... Adolescent obesity needs to be greatly considered because 80% of obese adolescents potentially continue until they are in adulthood [3]. Obesity is a dominant factor of metabolic syndrome [4] and an elevated risk of mortality and premature death [5]. ...
Robust evidence has shown that sugar is a major contributor to obesity and Non-Communicable Diseases (NCDs). However, there have not been sufficient tools to estimate sugar intakes. Therefore, developing a new and valid tool to assess sugar intake, based on cultural eating habits, is crucial. The study was done in two phases; the first focused on the development of Semi-quantitative Food Frequency Questionnaire (SFFQ), and the second focused on researching the validity of the questionnaire. Food items in the SFFQ were selected from the latest national survey review, exploratory survey, and food market observation. Forty-nine food items were included in the final SFFQ with five open-ended questions for fruit groups. One hundred and six adolescents aged 15-17 years participated in the study. The total sugar intake among the adolescents was 58.80 g/day (52.7 g sucrose; 1.47 g fructose; 1.49 glucose) which contributed to 11.6% of the total energy intake per day. The reliability analysis showed a good agreement between the two administered SFFQs in a one-month interval. The relative validity results, using 6-days food diaries as a reference method, demonstrated a superior ability to rank individuals into the same and adjacent classification and only < 10% gross misclassification in all sugar intakes. The developed SFFQ in turn has been proven to have moderate to good validity and be applicable for a larger epidemiological study.
... More detailed analysis and research into strategies suited to specific cultures and subpopulations would be beneficial. It is quite possible that specific priority populations as well as rural populations have unique barriers [109]. One such barrier may include accessibility. ...
Effective treatment interventions for childhood obesity involve parents, are multicomponent and use behavior change strategies, but more information is needed on the mechanisms influencing behavioral outcomes and the type of parental involvement that is efficacious in behavioral treatment interventions with school-age children. This review aimed to understand key characteristics of programs that contribute to dietary and physical activity behavioral outcomes, and through which key mechanisms. This was a systematic review with narrative synthesis following PRISMA guidelines and realist analysis using RAMESES guidelines to explain outcome patterns and influence of parental involvement. Overall, the findings contribute to understanding the complex relationship between family barriers to behavior change, strategies employed in treatment interventions and behavioral outcomes. Implications for enhancing future policy and practice include involving parents in goal setting, motivational counselling, role modeling, and restructuring the physical environment to promote mutual empowerment of both parents and children, shared value and whole-family ownership in which intrinsic motivation and self-efficacy are implicit. These characteristics were associated with positive dietary and physical activity behavior change in children and may be useful considerations for the design and implementation of future theory-based treatment interventions to encourage habitual healthy diet and physical activity to reduce childhood obesity.
... Currently, (Tai-Seale and Chandler, 2010) and (Shafique et al., 2007)and systematic reviews have reported an alarming increase in prevalence of obesity and overweight among rural women than their urban counterparts, and the results have confirmed. However a study done by (Bridevauxab, Faehcd and Eggimanna, 2007) found no differences in the prevalence of overweight and obesity between rural and urban areas. ...
Women nutrition status plays a key role in preventing adverse maternal and child health outcomes yet there is little existing information on the nutrition status of women of reproductive age (WRA). Therefore this study was carried out to assess the nutrition status of reproductive age women (15 to 49 years) and estimate associated risk factors. Analytical cross-sectional study designs involving 302 WRA was conducted in Dedza district of Malawi from August to September 2017. A pretested questionnaire was used to collect data which was analysed using SPSS software. The results showed that 3%, 19.9% and 6% were underweight, overweight and obese respectively using BM1 cut-off points. Underweight and obesity were more frequent in older women (33 to 49 years) while overweight was common in younger women (15 to 32 years). WRA from all Traditional Authorities were vulnerable to overweight. The odds indicate that young women were less likely to be underweight than older women though not statistically significant (OR= 0.8). Bivariate correlation and logistic regression results have shown that morbidity status, wealth index, level of knowledge and assets ownership were significant risk factors associated with nutrition status of the study population. In conclusion, there is high prevalence of overweight than underweight among WRA. Morbidity status, wealth index, level of knowledge and assets ownership are contributing factors of nutrition status of Dedza district. Hence, there is need for government to develop interventions that can control an alarming increase of overweight and the identified risk factors must be taken into consideration.
... The majority of participants (51.5 %) resided in their community for choices for target populations residing in those locations [12][13][14]. Distinct consequences in nutrition-related health behaviors, including lower fruit and vegetable consumption [15], are correlated with health outcomes, including higher obesity and chronic disease rates [16,17], in rural areas. ...
Nutrition is an essential component in promoting health and quality of life into the older adults years. The purpose of this qualitative research is to explore how the rural food environment influences food choices of older adults. Four focus groups were conducted with 33 older adults (50 years of age and older) residing in rural Montana communities. Four major themes related to factors influencing food choices among rural older adults emerged from this study: perception of the rural community environment, support as a means of increasing food access, personal access to food sources, and dietary factors. The findings from this current study warrant further research and promotion of specifically tailored approaches that influence the food choices of older adults in the rural western USA, including the developing and expanding public transportation systems, increasing availability of local grocers with quality and affordable food options, increasing awareness and decreasing stigma surrounding community food programs, and increasing nutrition education targeting senior health issues.
... Despite the increased prevalence of cardiovascular disease (CVD) and related risks in rural communities [1,2], studies report that rural residents with CVD and related risks are underrepresented in clinical trials [3,4]. Also, as members of the rural population age, the percentage of rural residents with CVD and related risks is expected to increase [5][6][7]. Behavioral modifications, including engagement in healthy lifestyles, can help slow the progression of CVD and reduce risks [8]. However, the impact of behavioral interventions on rural participants' CVD progression and risk reduction is uncertain due to the low participation rate of rural residents in clinical trials designed to promote behavioral modification [9]. ...
Rural residents diagnosed with cardiovascular disease (CVD) or with CVD-related risks are underrepresented in behavioral intervention trials based on an extensive review of published studies. The low participation rate of rural residents weakens both the internal and external validity of published studies. Moreover, compared to urban residents, limited research exists to describe the unique barriers that limit the participation of rural residents in behavioral intervention trials.
Objective: The purpose of this review is to identify a conceptual framework (CF) underpinning common barriers faced by rural CVD patients to enroll in behavioral intervention trials.
Methods: We conducted a literature review using several electronic databases to obtain a representative sample of research articles, synthesized the evidence, and developed a CF to explain the barriers that may affect the research participation rate of rural residents with CVD or related risks.
Results: We found our evidence-based CF well explained the barriers for rural CVD patients to take part in behavioral intervention trials. Besides contextual factors (i.e. patient, community and research levels), other common factors impacting rural patients’ intent to enroll are lack of awareness and understanding about behavioral trials, limited support from their healthcare providers and social circles, unfavorable attitudes, and the lack of opportunity to participating research.
Conclusion and Implication of result: the findings demonstrate the evidence-based model consisting of interlinked multi-level factors may help our understanding of the barriers encountered by rural CVD patients participating interventions to promote behavioral change. The implication for researchers is that identifying and developing strategies to overcome the barriers precedes conducting studies in rural communities.
... Obesity and related chronic diseases are major public health concerns [1,2], with higher rates in rural versus urban areas [3][4][5]. Encouraging consumption of fruits and vegetables, as a substitute for higher-calorie, processed foods, is thought to lower obesity and related chronic disease risk and disparities [6][7][8][9], yet United States residents [10], particularly rural residents [11], do not consume recommended amounts. Improving access to healthy food outlets, such as placing farmers' markets in communities, is one strategy to increase consumption of healthy foods [12]. ...
Context and purpose of the study. To examine (1) associations between county-level zoning to support farmers' market placement and county-level farmers' market availability, rural/urban designation, percent African American residents, and percent of residents living below poverty and (2) individual-level associations between zoning to support farmers' markets; fruit and vegetable consumption and body mass index (BMI) among a random sample of residents of six North Carolina (NC) counties.
Zoning ordinances were scored to indicate supportiveness for healthy food outlets. Number of farmers' markets (per capita) was obtained from the NC-Community Transformation Grant Project Fruit and Vegetable Outlet Inventory (2013). County-level census data on rural/urban status, percent African American, and percent poverty were obtained. For data on farmers' market shopping, fruit and vegetable consumption, and BMI, trained interviewers conducted a random digit dial telephone survey of residents of six NC counties (3 urban and 3 rural). Pearson correlation coefficients and multilevel linear regression models were used to examine county-level and individual-level associations between zoning supportiveness, farmers' market availability, and fruit and vegetable consumption and BMI.
At the county-level, healthier food zoning was greater in more urban areas and areas with less poverty. At the individual-level, self-reported fruit and vegetable consumption was associated with healthier food zoning.
Disparities in zoning to promote healthy eating should be further examined, and future studies should assess whether amending zoning ordinances will lead to greater availability of healthy foods and changes in dietary behavior and health outcomes.
... Multiple studies show that rural populations may have higher rates of overweight and obesity than urban and suburban populations [1][2][3][4] . The local food environment, as defined by the presence or absence of different types of food sources, can influence diet and the risk of developing obesity-related health outcomes [5][6][7][8] . ...
The Maryland Healthy Stores pilot-study tested the feasibility of a small food store intervention in rural Maryland. Eight small stores were randomized to receive a 4-month intervention to increase healthy food availability (n = 4) or serve as comparison stores (n = 4). Changes in stocking of 12 healthier items promoted in the intervention were measured pre-intervention, postintervention, and 6 months postintervention. Storeowner’s acceptability of the changes were measured pre- and postintervention. Results demonstrated the following: (1) trends toward increased healthier food availability in this rural setting through observable increases in intervention stores stocking the promoted foods and (2) in intervention storeowners’ perceived ability to sell healthier items.
... The main reason for the increasing prevalence of overweight and obesity in adolescents is the consequence of increased energetic input (high caloric density products) and decreased adherence to physical activity. [10] The purpose of the study is to identify and compare the overweight and obesity prevalence among high-school students in Constanta County in rural and urban areas schools, and to compare the way they deal and perceive their situation. ...
The increasing prevalence of obesity among high-school students is a public health problem, as more and more children are facing it.[5] Education has a great impact on the way young people deal with this problem. A significant effect on the behaviour of the pupils is the background they have, differences between children from rural areas compared to children from urban areas in terms of BMI being documented. A number of 185 high-school students from two schools in Constanta, from urban and rural areas were interviewed and data about height and weight was collected.
The results show that there is no statistically significant difference of the height between teenagers from urban and rural area, but there is a statistically significant association between area and BMI-z score distribution. Also, a higher number of teenagers from urban area underestimate their weight status compared to teenagers from rural areas.
... [2][3][4]6 Disparities in obesity extend to geography as well, with children in rural areas more likely to be obese or overweight than urban children. 7,8 Obesity also clusters according to school characteristics. Secondary schools with high minority enrollment or low mean parental education have students with disproportionately higher body mass index (BMI), and schools located in non-metropolitan areas have a high proportion of students who are obese. ...
Access to healthy foods among secondary school students is patterned by individual-level socioeconomic status, but few studies have examined how school nutrition policies and practices are patterned by school-level characteristics. The objective of our study was to examine school nutrition policies and practices by school characteristics (eg, location, racial/ethnic composition, and free/reduced priced lunch eligibility) in Minnesota secondary schools between 2008 and 2012. Data from the 2008 to 2012 Minnesota School Health Profiles survey were used to assess school nutrition policies and practices, and National Center for Educational Statistics data were used for school characteristics (n=505 secondary schools). Nutrition policies and practices included the availability of low-nutrient, energy dense (LNED) items, strategies to engage students in healthy eating, and restrictions on advertisements of LNED products in areas around the school. Among school-level characteristics, school location was most strongly related to school nutrition policies. Across all years, city schools were less likely than town/rural schools to have vending machines/school stores (prevalence difference [PD] −13.7, 95% CI −25.0 to −2.3), and less likely to sell sport drinks (PD −36.3, 95% CI −51.8 to −20.7). City schools were also more likely to prohibit advertisements for LNED products in school buildings (PD 17.7, 95% CI 5.5 to 29.9) and on school grounds (PD 15.6, 95% CI 1.7 to 29.5). Between 2008 and 2012, the prevalence of some healthy eating policies/practices (eg, limiting salty snacks, offering taste testing, and banning unhealthy food advertisements in school publications) declined in city schools only, where these policies/practices had previously been more common. Monitoring of these trends is needed to understand the influence of these policies on student outcomes across school settings.
... Although rural areas vary widely across the United States [8][9][10], rural residents generally consume fewer health-promoting foods like fruits and vegetables compared to urban or suburban residents [11]. Rural communities also face disproportionately higher risk for nutrition-related chronic diseases such as obesity when compared to urban residents [12][13][14][15][16]. Indeed, obesity prevalence is 39.6% among rural adults compared to 33.4% among urban adults, and remains significantly higher after controlling for demographics, diet, and physical activity [12]. ...
Introduction: Rural communities have high rates of nutrition-related disease and obesity. Rural residents often face unique barriers to accessing healthy, affordable foods. Many food access studies focus on urban communities and measures have often not been validated in rural settings. Policy and environmental change approaches would benefit from additional research that examines rural contexts. In 2011, participants of the CDC-funded Nutrition and Obesity Policy Research and Evaluation Network Rural Food Access Working Group (RFAWG) formed to conduct collaborative transdisciplinary policy research to address these concerns. Methods: Using concept mapping methodology, RFAWG researchers collected data from approximately 200 rural food access experts throughout the United States. Participants identified issues perceived as important to the topic and then prioritized those ideas for research and policy development. A subset of participants sorted the ideas, and researchers used aggregate results to create concept maps. Results: Concept maps included five high-level domains (Food and Nutrition Assistance; Food Retail and Availability; Food Production; Consumer Knowledge, Attitudes and Behaviors; and Data and Policy) and 17 lower-level domains (e.g., Agricultural Pathways, Healthy Food in Institutions, Price and Financial Resources). Policy research priorities included: 1) Food and nutrition support adaptations; 2) Retail availability and shopping patterns; 3) Food production and distribution capacity; and 4) Economic development and viability and consumer purchasing power. Discussion: Lessons learned from this transdisciplinary approach can inform others interested in developing policy research agendas. The domains and priorities identified can inform future policy research and actions to address access to healthy foods in rural communities.
... Finally, there are several cultural, structural, and demographic limitations in rural areas that may hamper having a healthy diet and engaging in regular exercise, such as a lack of health and nutrition education, and less access to health care and exercise facilities (Tai-Seale & Chandler, 2003). This intervention addressed some of those barriers to a healthy lifestyle by providing free health assessments in an accessible community location and training mentors to facilitate the exercise sessions and teach culturally appropriate nutrition education; other studies should examine if this intervention is effective in other rural areas. ...
Approximately 8.3% of the U.S. population (25.8 million people) is affected by type 2 diabetes. The burden of diabetes is disproportionately greater in the African American community. Compared with non-Hispanic Caucasian adults, the risk of diagnosed type 2 diabetes was 77% higher among non-Hispanic Blacks, who are 27% more likely to die of diabetes complications than either Caucasians or Hispanics. The purpose of this longitudinal community intervention was to promote healthy lifestyles among African American participants through multiple channels, including individualized point-of-testing counseling, and weekly exercise and nutrition classes led by trained community health mentors. Data collection procedures were guided by the World Health Organization's STEPS approach, which includes gathering demographic and health information, collecting anthropometric measurements, and analyzing biochemical blood work. Changes in body mass index were assessed from in-person measurements and changes in blood lipids and glucose were examined by biochemical analyses. A total of 157 individuals participated in this study. Results showed that weight gain during the intervention was prevented, glucose levels decreased (-10.88 mg/dL), and low-density lipoprotein cholesterol decreased (-8.8 mg/dL), while high-density lipoprotein increased (+3.2 mg/dL). Lifestyle interventions and point-of-testing counseling can be successful in reducing risk factors for type 2 diabetes among the African American population. The results of this intervention indicate that the use of community health mentors and point-of-testing counseling may be effective in fostering healthy lifestyle changes, which can halt the progression of type 2 diabetes among non-Hispanic Black populations.
... Although rural areas vary widely across the United States [8][9][10], rural residents generally consume fewer health-promoting foods like fruits and vegetables compared to urban or suburban residents [11]. Rural communities also face disproportionately higher risk for nutrition-related chronic diseases such as obesity when compared to urban residents [12][13][14][15][16]. Indeed, obesity prevalence is 39.6% among rural adults compared to 33.4% among urban adults, and remains significantly higher after controlling for demographics, diet, and physical activity [12]. ...
Background
Policies that improve access to healthy, affordable foods may improve population health and reduce health disparities. In the United States most food access policy research focuses on urban communities even though residents of rural communities face disproportionately higher risk for nutrition-related chronic diseases compared to residents of urban communities. The purpose of this study was to (1) identify the factors associated with access to healthy, affordable food in rural communities in the United States; and (2) prioritize a meaningful and feasible rural food policy research agenda.
Methods
This study was conducted by the Rural Food Access Workgroup (RFAWG), a workgroup facilitated by the Nutrition and Obesity Policy Research and Evaluation Network. A national sample of academic and non-academic researchers, public health and cooperative extension practitioners, and other experts who focus on rural food access and economic development was invited to complete a concept mapping process that included brainstorming the factors that are associated with rural food access, sorting and organizing the factors into similar domains, and rating the importance of policies and research to address these factors. As a last step, RFAWG members convened to interpret the data and establish research recommendations.
Results
Seventy-five participants in the brainstorming exercise represented the following sectors: non-extension research (n = 27), non-extension program administration (n = 18), “other” (n = 14), policy advocacy (n = 10), and cooperative extension service (n = 6). The brainstorming exercise generated 90 distinct statements about factors associated with rural food access in the United States; these were sorted into 5 clusters. Go Zones were established for the factors that were rated highly as both a priority policy target and a priority for research. The highest ranked policy and research priorities include strategies designed to build economic viability in rural communities, improve access to federal food and nutrition assistance programs, improve food retail systems, and increase the personal food production capacity of rural residents. Respondents also prioritized the development of valid and reliable research methodologies to measure variables associated with rural food access.
Conclusions
This collaborative, trans-disciplinary, participatory process, created a map to guide and prioritize research about polices to improve healthy, affordable food access in rural communities.
... 13 Various characteristics of rural regions may promote RMT adoption. Rural populations tend to be older and in poorer health than their urban counterparts, 14 characteristics that may warrant RMT tracking and monitoring. Additionally, rural patients have access to fewer health care providers, frequently receive care in facilities with a limited scope of service, have longer distances to travel and higher costs associated with accessing health care, and experience disparities in the receipt of medical services. ...
Remote monitoring technologies (RMTs) may improve the quality of care, reduce access barriers, and help control medical costs. Despite the role of primary care clinicians as potential key users of RMTs, few studies explore their views. This study explores rural primary care clinician interest and the resources necessary to incorporate RMTs into routine practice.
We conducted 15 in-depth interviews with rural primary care clinician members of the Oregon Rural Practice-based Research Network (ORPRN) from November 2011 to April 2012. Our multidisciplinary team used thematic analysis to identify emergent themes and a cross-case comparative analysis to explore variation by participant and practice characteristics.
Clinicians expressed interest in RMTs most relevant to their clinical practice, such as supporting chronic disease management, noting benefits to patients of all ages. They expressed concern about the quantity of data, patient motivation to utilize equipment, and potential changes to the patient-clinician encounter. Direct data transfer into the clinic's electronic health record (EHR), availability in multiple formats, and review by ancillary staff could facilitate implementation. Although participants acknowledged the potential system-level benefits of using RMTs, adoption would be difficult without payment reform.
Adoption of RMTs by rural primary care clinicians may be influenced by equipment purpose and functionality, implementation resources, and payment. Clinician and staff engagement will be critical to actualize RMT use in routine primary care.
... Additionally, as in urban areas, rural food deserts often appear to be positively associated with socioeconomic disadvantage, including increased poverty rates and diminished educational attainment (Blanchard and Matthews 2007; see also Morton and Blanchard 2007; Morton et al. 2005). These findings are especially compelling given that, although the underlying causes are not fully understood, a number of regional studies completed in the United States strongly suggest that obesity rates are higher in rural places (Lewis et al. 2006; Patterson et al. 2004; Tai-Seale and Chandler 2003). This finding is true for both adults (Satcher 2001; Sobal, Troiana, and Frongillo 1996) and children (Larson and Terry 1992; Lacar, Soto, and Riley 2000; Neal et al. 2001). ...
Abstract The concept of the food desert, an area with limited access to retail food stores, has increasingly been used within social scientific and public health research to explore the dimensions of spatial inequality and community well-being. While research has demonstrated that food deserts are frequently characterized by higher levels of poverty and food insecurity, there has been relatively little research examining the relationship between food deserts and obesity, particularly in rural areas. In this article we use Geographic Information System (GIS) techniques to identify food desert areas in rural Pennsylvania. We then analyze student body mass index (BMI) data along with census and school district-level data to determine the extent to which the percentage of a school district's population residing within a food desert is positively associated with increased incidence of child overweight among students within the district. We find that school districts with higher percentages of populations located within food deserts are more likely to be structurally and economically disadvantaged. Net of these district-level structural and economic characteristics, we additionally find a positive relationship between increased rates of child overweight and the percentage of the district population residing in a food desert.
Este estudo teve como objetivo comparar hábitos alimentares de adolescentes de uma escola pública em Glória de Goitá, município do estado de Pernambuco, que residiam em área urbana e rural. Participaram do estudo 232 adolescentes, com idade entre 11 e 15 anos. Foi aplicado questionário semiquantitativo de hábitos e frequência alimentar. Em relação aos hábitos, observou-se que adolescentes da área urbana consumiam maior quantidade de sal adicionado. Em relação ao número de refeições realizadas por dia o resultado encontrado foi similar entre as duas áreas. Os adolescentes que residiam na zona rural realizaram mais exercícios por semana quando comparado aos residentes na zona urbana. Quanto à frequência de consumo alimentar, observou-se valores bem próximos em relação ao consumo dos produtos proteicos, com maior frequência para proteína de origem vegetal como o feijão. Tanto as frutas como as hortaliças eram pouco consumidas pelos adolescentes de ambas as áreas de moradia. Os dados encontrados mostraram que os hábitos alimentares em áreas urbanas e rurais estavam similares.
There has been a steady increase in childhood obesity, comparable to that seen in adults, over the past decade with the incidence almost tripling. As seen in adults, there are trends in discrepancy among gender, ethnicity, race, and underserved populations in the incidence of childhood obesity. Effective interventions for childhood obesity need to be broad including both diet and exercise, but there is little evidence on the most effective approach. The use of telehealth interventions to treat childhood obesity in ethnic, low‐income, and underserved populations could be an effective platform. The pharmacist is a health care professional that is easily accessible to these populations and can assist with lifestyle modification counseling for weight loss. The purpose of this review is to summarize and evaluate the effectiveness of telehealth modalities on weight loss in overweight/obese children identified as minority, low‐income, or underserved populations. The review found there were many different forms of telehealth interventions utilized which may have influenced the success of evaluated outcomes. The majority of modalities did not improve BMI or BMI z‐score when not accompanied by a form of real‐time intervention. Studies, where telehealth was accompanied by motivational coaching, did show a significant decrease in BMI and/or BMI z‐score.
Background
The North Carolina Healthy Food Small Retailer Program (NC HFSRP) was established through a policy passed by the state legislature to provide funding for small food retailers located in food deserts with the goal of increasing access to and sales of healthy foods and beverages among local residents. The purpose of this study was to qualitatively examine perceptions of the NC HFSRP among store customers.
Methods
Qualitative interviews were conducted with 29 customers from five NC HFSRP stores in food deserts across eastern NC. Interview questions were related to shoppers’ food and beverage purchases at NC HFSRP stores, whether they had noticed any in-store efforts to promote healthier foods and beverages, their suggestions for promoting healthier foods and beverages, their familiarity with and support of the NC HFSRP, and how their shopping and consumption habits had changed since implementation of the NC HFSRP. A codebook was developed based on deductive (from the interview guide questions) and inductive (emerged from the data) codes and operational definitions. Verbatim transcripts were double-coded and a thematic analysis was conducted based on code frequency, and depth of participant responses for each code.
Results
Although very few participants were aware of the NC HFSRP legislation, they recognized changes within the store. Customers noted that the provision of healthier foods and beverages in the store had encouraged them to make healthier purchase and consumption choices. When a description of the NC HFSRP was provided to them, all participants were supportive of the state-funded program. Participants discussed program benefits including improving food access in low-income and/or rural areas and making healthy choices easier for youth and for those most at risk of diet-related chronic diseases.
Conclusions
Findings can inform future healthy corner store initiatives in terms of framing a rationale for funding or policies by focusing on increased food access among vulnerable populations.
Background
Poor diet quality among children can lead to poor health, development, and academic achievement. Child nutrition assistance programs aim to improve diet quality among children.
Objective
This study tested the impact of the Packed Promise intervention on diet quality among low-income children in Chickasaw Nation territory.
Design
This study was a cluster randomized controlled trial of 40 school districts and 4,750 eligible, consented households within treatment and control districts.
Participants/setting
Household data were collected at baseline (n = 2,859) and follow-up (n = 2,852) in 12 rural Oklahoma counties.
Intervention
Packed Promise treatment households chose from 5 types of home-delivered food boxes that contained nutritious foods ($38 food value) and a $15 check for purchasing fruits and vegetables.
Main outcome measures
Key outcomes included children’s daily consumed amounts of fruits and vegetables, whole grains, and added sugars collected by a dietary screener questionnaire. Other outcomes included food shopping frequency, type of grocery store used, distance traveled from home to grocery stores, and the number of weekly family dinners. All outcomes in this article are secondary to the study’s primary outcome—food insecurity among children.
Statistical analyses performed
Differences between the treatment and control groups were estimated by a regression model controlling for baseline characteristics and population-based average portion sizes.
Results
Children’s mean daily consumption of fruits and vegetables combined was about 2.35-cup equivalents in the treatment group and 2.25-cup equivalents in the control group (P < 0.001). Mean consumption of whole grains was 0.73-ounce equivalents in the treatment group compared with 0.67-ounce equivalents in the control group (P < 0.001). Other outcomes were not statistically significant.
Conclusion
Packed Promise led to significant but small improvements in children’s daily consumption of fruits and vegetables and whole grains. Several factors, including household participation levels in Packed Promise, may have moderated the size of impacts.
Funding/Support
This article is published as part of a supplement supported by the US Department of Agriculture, Food and Nutrition Service.
RESUMO Objetivo: comparar as características nutricionais do estilo de vida de escolares residentes em zona rural e urbana, associando com o excesso de peso. Método: Foi utilizado o as questões do componente Nutrição do questionário Pentáculo do Bem-estar de Barros e Nahas (2003) e avaliado o IMC. Participaram do estudo 257 crianças e adolescentes, com idades entre 7 a 17 anos, estudantes de escolas localizadas na zona rural e urba-na de Santa Cruz do Sul. Resultados: A prevalência de excesso de peso foi maior na zona urbana (30,1%), em comparação com a zona rural (25,8%). Com relação aos hábitos alimentares, escolares da zona rural apresentaram maior consumo de frutas e hortaliças do que escolares da zona urbana (p=0,001), em que apenas 4,0% dos que re-sidem na zona rural afirmaram nunca consumir, enquanto na zona urbana este percentual foi de 18,8%. Já no que se refere a preocupação em evitar ingerir alimentos gorduro-sos ou doces, se observa maior percentual de escolares da zona urbana (30,8%) que quase sempre ou sempre evitam ingerir este tipo de alimento, enquanto entre os escolares da zona rural, este percentual é de 13,7% (p=0,002). O hábito de realizar de 4 a 5 refeições diárias, incluindo café da manhã, não apresentou diferença entre as zonas, bem como não se observou diferença, em ambas as zonas, para a associação entre as faixas de IMC e os hábitos alimentares. Conclusão: Em geral, não se observou, na amostra estudada, associação entre os hábitos alimenta-res e o excesso de peso. Ocorreu maior prevalência de so-brepeso e obesidade na zona urbana, um maior consumo de frutas e hortaliças por escolares da zona rural e uma maior preocupação de escolares da zona urbana em evitar o consumo de alimentos gordurosos e doces. ABSTRACT Objective: Objective: To compare the nutritional characteristics of the lifestyle of children living in rural and urban areas, associating with excess weight. Method: the issues of Nutrition component of the questionnaire Pen-tacle Welfare de Barros and Nahas (2003) was used and analyzed BMI. The study included 257 children and adolescents aged 7 to 17 years, students from schools located in rural and urban area of Santa Cruz do Sul. Results: The prevalence of overweight was higher in the urban (30.1%), compared to the rural areas (25.8%). Regarding eating habits, students from rural areas had higher consumption of fruits and vegetables than students from urban areas (p=0.001), in which only 4.0% of those living in rural areas reported never consuming, while the urban area this percentage was 18.8%. In what refers the concern to avoid eating fatty foods or sweets, a higher percentage of students from urban areas (30.8%) almost always or always avoid eating this kind of food, while among school children in rural this percentage is 13.7% (p=0.002). The habit of 4-5 meals a day, including breakfast, did not differ between areas and no difference was observed in both areas for the association between BMI ranges and eating habits. Conclusion: In general, not observed in the studied sample, the association between eating habits and excess Diferenças entre os hábitos alimentares associados ao excesso de peso de crianças e adolescentes da zona rural e urbana do município de Santa Cruz do Sul-RS Differences between the eating habits associated with overweight of children and adolescents of urban and rural area in the city of Santa Cruz do Sul-RS
Introduction: While for adults in Pennsylvania, obesity rates tripled from less than 10% in 1990 to 30% in 2015, the combined rates of overweight, obese, and severely obese children and adolescents in Pennsylvania are projected to approach 37.11% by the end of 2018.
Method: Pediatric obesity rates in rural areas tend to be even higher than those in urban areas. Pediatric obesity needs to be addressed, since it is strongly correlated with several chronic diseases. Given the scarcity of resources to manage this trend, innovative population-based approaches are needed. Web-based telehealth, telemedicine, mobile health (mHealth), and telephone conferences have been proposed as solutions to treat and prevent childhood obesity in rural areas; the most suitable solution is through a family-based telemedicine intervention. The purpose of this study is to explore the feasibility of such a telehealth application especially for rural Pennsylvania.
Results: Telehealth use in healthcare organizations in Pennsylvania is scarce; however, 92% of Pennsylvania’s school districts meet the minimum internet connectivity standards.
Discussions: This article, while acknowledging barriers to the adoption of the internet-based telemedicine resources, discusses solutions for increasing their availability and dissemination in rural Pennsylvania. Current internet connectivity standards in Pennsylvania schools reflect ability to participate in telehealth programs in terms of technological background, but schools are not engaged in such programs. An appraisal of the real-life challenges to implement this modality is critical and will pave the way for advocacy and implementation of useful telehealth services in low-resource areas.
With over one-third of U.S. adults considered obese, there is growing concern over the social implications pertaining to the health and welfare of U.S. citizens. This study examines the impact of local food systems (i.e., access to healthy foods and unhealthy foods) and other control variables on adult obesity rates, general health conditions, and mortality rates in counties across the United States. The findings suggest that adult obesity disproportionately impacts people with less access to healthy food, fewer resources to make healthy food choices, and often lacking the health care needed to provide intervention and care for obesity related health concerns. Policies that seek to reduce obesity will require addressing the underlying socioeconomic and environmental conditions that prevent individuals from making healthier food choices.
Background: the food environment, including access to retail food outlets and the presence of healthy food in the home, has been shown to be associated with eating behavior and obesity, but this relationship is not well understood in rural locations. Methods: A statewide Maine household survey in 2009 of parents of children enrolled in Medicaid (n = 1421) oversampled in 6 rural communities, resulting in n = 272 for 6 target communities. the food environment was measured using modified Nutrition environment Measures survey in stores (NeMs-s) for 46 retail food outlets. Multivariate analysis assessed factors affecting home food environment, child's eating behavior, and bMi. Results: Home food behaviors (how often the family eats together, child eats breakfast, vegetables served) and parent food consumption were significantly associated with children's healthy eating behaviors. the only significant predictor of childhood obesity was parent eating behavior. We observed several alternative strategies such as hunting, gardening, and buying from local farmers. Parents who drove over 20 miles to shop were found to shop at stores with higher NeMs scores as compared to parents who drove shorter distances. Conclusions: Current approaches to defining the food environment spatially may not be appropriate for measuring the rural food environment due to long-distance trips, careful price shopping, and local alternative strategies. strategies to place healthier food in the home should be combined with interventions directed at parents' and families' eating behaviors.
Rates of obesity are higher for children and adults living in rural areas relative to non-rural settings. As a result, there is an immense need for pediatric weight management programs focused on children and families living in rural areas. However, clinicians and families in rural communities experience numerous barriers when participating in these programs. This article reviews challenges faced during the course of providing family-based weight management interventions as part of the Extension Family Lifestyle Intervention Project (E-FLIP) for kids. Effective and innovative suggestions for future programs are provided for consideration when designing weight management programs for rural pediatric populations. A selected review of the pediatric and adult rural service delivery literature and clinicians' experiences are discussed. Challenges to providing pediatric weight management interventions in rural communities include the lower socioeconomic status of many rural families, unique aspects of rural culture, transportation difficulties, limited access and availability of healthy foods, lack of safe places devoted to physical activity, and time constraints. Strategies to overcome barriers related to providing pediatric weight management services and recommendations for future programs targeting children and families from rural areas are provided.
Those living in rural areas face particular risks to health and well-being as they are more likely to be poor, have no health insurance, and have less access to health care. Many obstacles exist in achieving optimal rural health outcomes. Many of the health related issues experienced by adolescents are preventable and are often related to risky behavior such as substance use and abuse, smoking, and unprotected sex. The purpose of this review is to define the current primary health concerns of rural dwelling adolescents worldwide. Based on current research, the primary health related problems of rural adolescents were identified as risky sexual behaviors, mental health issues, violence and bullying, substance and alcohol use, and overweight and obesity. These problems are exacerbated by diminished access to care, peer influences, and parental influences. This integrative review also illustrates many dimensions of health disparities exist in rural areas. When addressing diversity in care models, it is important to consider the rural setting as well as race or ethnicity, sex, and socioeconomic status in designing curriculum and interventions. Globally, evidence based findings are needed to inform curriculum and respond to the health needs of rural adolescents.
The purpose of this study was to refine and psychometrically test an instrument measuring the home food and activity environment of geographically and economically diverse families of preschool aged children. Caregivers of preschool aged children (n = 83) completed a modified self-report questionnaire. Reliably trained researchers conducted independent observations on 25 randomly selected homes. Agreement statistics were conducted at the item level (159 total items) to determine reliability. Frequency counts were calculated to identify item availability. Results showed Kappa statistics were high (0.67-1.00) between independent researchers but varied between researchers and parents resulting in 85 items achieving criterion validity (Kappa > 0.60). Analyses of reliable items revealed the presence in the home of a high frequency of unhealthy snack foods, high fat milk and low frequency of availability of fruits/vegetables and low fat milk. Fifty-two percent of the homes were arranged with a television in the preschool child's bedroom. Physical Activity devices also were found to have high frequency availability. Families reporting lower education reported higher levels of sugar sweetened beverages and less low-fat dairy (p < 0.05) compared to higher education families. Low-income families (<$27K/year) reported significantly fewer Physical Activity devices (p < 0.001) compared to higher income families. Hispanic families reported significantly higher numbers of Sedentary Devices (p < 0.05) compared to non-Hispanic families. There were no significant differences between demographic comparisons on available fruits/vegetables, meats, whole grains, and regular fat dairy. A modified home food and activity instrument was found to reliably identify foods and activity devices with geographically and economically diverse families.
The Community Health Improvement Partnership (CHIP) model has supported community health development in more than 100 communities nationally. In 2011, four rural Oregon CHIPs collaborated with investigators from the Oregon Rural Practice-based Research Network (ORPRN), a component of the Oregon Clinical and Translational Research Institute (OCTRI), to obtain training on research methods, develop and implement pilot research studies on childhood obesity, and explore matches with academic partners. This article summarizes the experiences of the Lincoln County CHIP, established in 2003, as it transitioned from CHIP to Community Health Improvement and Research Partnership (CHIRP). Our story and lessons learned may inform rural community-based health coalitions and academicians who are engaged in or considering Community-based participatory research (CBPR) partnerships. Utilizing existing infrastructure and relationships in community and academic settings provides an ideal starting point for rural, bidirectional research partnerships.
In this article, we examine the socioecological determinants—the biological, geographic, and built environment factors—that influence risk for prediabetes and type 2 diabetes. A socioecological perspective looks beyond the individual to evaluate a multitude of influences, from the surrounding home, work, school, and community environments to social determinants and the influence of public policy on individual behavior (1). Figure 1, adapted from the Institute of Medicine socioecological model of childhood obesity, provides a good framework for understanding potential socioecological determinants of risk for type 2 diabetes.
Figure 1
Levels and sectors of influence on obesity and diabetes risk (progress in preventing childhood obesity) (© 2007 the National Academies Press). SES, socioeconomic status.
In November 2012, the American Diabetes Association Prevention Committee convened a writing group to review the evidence on socioecological factors contributing to recent increases in prediabetes and type 2 diabetes. Drawing from the work of the committee, in this article we review the overarching evidence-based contributions of socioecological factors to risk for type 2 diabetes. Rather than incorporate the entire universe of relational observations, this scientific statement is intended to evaluate the extent to which data indicate a contributing role of social and environmental factors to the current epidemic of type 2 diabetes.
The world is in the midst of parallel and rapidly advancing epidemics—obesity and type 2 diabetes—that began in the latter half of the 20th century and continue to grow, unchecked. Current prevalence rates are staggering and are expected to continue to climb over the ensuing decades.
In the U.S., one-third of adults and 16–18% of youth are obese (2), up from 5 to 6% three decades ago (Fig. 2). Increases in rates of type 2 diabetes have closely followed the increases in obesity. In the U.S., diabetes affects 8.3% of the population, including 18.8 million with diagnosed …
Objective:
The objective of the current study was to examine the effectiveness of a multidisciplinary weekly family-based behavioral group delivered via telemedicine to rural areas, compared with a standard physician visit intervention.
Methods:
A randomized controlled trial was conducted with 58 rural children and their families comparing a family-based behavioral intervention delivered via telemedicine to a structured physician visit condition. Outcome measures included child body mass index z-score (BMIz), 24-hr dietary recalls, accelerometer data, Child Behavior Checklist, Behavioral Pediatrics Feeding Assessment Scale, and feasibility and fidelity.
Results:
Child BMIz outcomes were not statistically different between the 2 groups (F = 0.023, p = .881). Improvements in BMIz, nutrition, and physical activity were seen for both groups.
Conclusions:
Both telemedicine and structured physician visit may be feasible and acceptable methods of delivering pediatric obesity treatment to rural children.
Parents play an important role in shaping children's eating habits. Few studies have evaluated the influence of both parenting style and parenting practices on child outcomes such as dietary intake. During spring 2007, 99 parent-child dyads from four rural US areas participated in this cross-sectional study. Child food intake was reported during two interviewer-administered, parent-assisted 24-hour recalls. Diet quality was defined as the average number of low-nutrient-dense (LND) foods consumed. Validated questionnaires were used to assess parental feeding practices and feeding style. Pearson correlations identified relationships among child food intake, parental feeding style typologies, and covariates. Regression analyses were used to predict child diet quality. Sixty percent of children and 76% of parents were overweight or obese. A permissive feeding style, which is highly responsive to a child's requests and sets few demands on him or her, was the most common (n=37) parental feeding style. This feeding style was associated with child intake of LND foods (r=0.3; P<0.001) and moderated the relationship between parental feeding practices and child intake of LND foods. In the presence of a permissive feeding style, higher levels of monitoring were associated with child intake of LND foods (β=.69; P<0.05). Parental feeding style may alter the effectiveness of parental feeding practices on children's food intake. More research is needed to understand the parent-child feeding relationship in the context of parental feeding styles and practices.
In this chapter authors discuss how health issues impact the ability to maintain employment. Poverty is associated with a
wide variety of increased health risks contributing to lower economic status. Health care services are more limited in rural
areas, decreasing the likelihood that families will get preventative or timely care. Rural Families Speak (RFS) findings highlight
the health challenges of family members, which interfere with the ability of low-income mothers to seek, obtain, and maintain
employment. The core findings of RFS research focusing on physical health and food insecurity of rural low-income families
are presented.
KeywordsFamily health and illness cycle-Food security-Health care-Health insurance-Rural Families Speak-Rural health-Welfare reform
This study developed, implemented, and evaluated a healthful school lunch program that provided tasty food choices that were lower in fat and sodium. The LUNCHPOWER! Intervention Program was implemented in 34 elementary schools in four school districts that represented diverse geographic areas of Minnesota. A team of registered dietitians, foodservice directors, and cook managers reduced the fat and sodium content of school lunches by modifying recipes and food preparation methods and by identifying and selecting vendor products (prepared food products) that were lower in fat and sodium. Nutrition education messages for students and parents were developed for the 5-month intervention. Monthly menus were analyzed for fat, sodium, and energy content before and after the intervention. There was a significant decrease in both total grams of fat and percent of energy from fat between baseline and follow-up. At all 34 schools, mean daily amount of total fat in the lunch menu decreased 39% (from 32 g to 20 g) and percent of energy from fat decreased 29% (from 40% to 28%). We found that schools could serve lower-sodium and lower-fat meals and retain student participation in the school lunch program.
The persistence of obesity and overweight over eight years was assessed in a biracial (Black-White) cohort of 1,490 two-to 14-year-olds. Initial levels of triceps skinfold thickness (TRSF) and Rohrer index (weight/height3) were moderately predictive of subsequent levels: r = 0.54 and 0.67, respectively. However, TRSF and Rohrer index tended to track most strongly in Black females (r = 0.64 and 0.72) and less well in both White females (r = 0.45 and 0.57) and preschool children (r = 0.45 and 0.54). Based on elevated levels of TRSF or Rohrer index, children were classified as obese or overweight, respectively. Of the 222 children who were initially above the 85th percentile for TRSF, 43 per cent remained obese after eight years. Persistence of overweight was slightly greater at follow-up, with 50 per cent of initially overweight children staying above the 85th percentile for Rohrer index. Severe, initial obesity/overweight (greater than 95th percentile) and consecutively elevated levels increased the probability of remaining obese/overweight. Results indicate that moderate, juvenile-onset obesity is malleable, but that the child who is extremely obese over consecutive examinations is likely to become an obese adult.
Obesity and low levels of physical and metabolic fitness are risk factors for cardiovascular disease and diabetes. The purpose of this investigation was to attenuate obesity and improve physical and metabolic fitness in elementary school children. Schools have the opportunity, mechanisms, and personnel in place to deliver nutrition education, fitness activities, and a school food service that is nutritious and healthy. Cohorts from grades 3 to 5 in two school districts in rural Nebraska (Intervention/Control) participated in a 2-year study of physical activity and modified school lunch program. Data collection for aerobic capacity, body composition, blood chemistry, nutrition knowledge, energy intake, and physical activity was at the beginning and end of each year. Int received enhanced physical activity, grade specific nutrition education, and a lower fat and sodium school lunch program. Con continued with a regular school lunch and team sports activity program. At year 2, Int lunches had significantly less energy (9%), fat (25%), sodium (21%), and more fiber (17%). However, measures of 24-hour energy intake for Int and Con showed significant differences for sodium only. Physical activity in the classroom was 6% greater for Int compared to Con (p < 0.05) but physical activity outside of school was approximately 16% less for Int compared to Con (p < 0.05). Body weight and body fat were not different between schools for normal weight or obese children. No differences were found for cholesterol, insulin, and glucose; however, HDL cholesterol was significantly greater and cholesterol/HDL was significantly less for Int compared to Con (p < 0.05). It appears that compensation in both energy intake and physical activity outside of school may be responsible for the lack of differences between Int and Con.
For at least 50 years, stroke death rates have been higher in the southeast region of the United States than in other US regions. To test the hypotheses that stroke incidence is higher in the Southeast than in other regions and that higher levels of known stroke risk factors in the Southeast explain the difference in incidence, data were analyzed from a nationally representative, longitudinal cohort study of a sample drawn from the US population, the First National Health and Nutrition Examination Survey (NHANES I) Epidemiologic Followup Study (1971-1987). In white men and women aged 45-74 years, the risk of stroke was significantly higher in the Southeast than the Northeast or the West in men and the Midwest in women. In white men, this excess risk could not be explained by regional differences in multiple stroke risk factors (Northeast vs. Southeast risk-adjusted relative risk = 0.71, 95% confidence interval 0.52-0.98). In white women, some of the excess risk associated with residence in the Southeast compared with the Midwest could be explained by the regional differences in risk factors measured in NHANES I (Midwest vs. Southeast risk-adjusted relative risk = 0.73, 95% confidence interval 0.53-1.00). In blacks, regional differences that were statistically significant could not be demonstrated. However, a strong association of increased stroke risk with nonmetropolitan residence in blacks was demonstrated that was independent of region or other stroke risk factors. Higher stroke incidence rates in the Southeast contribute to the higher stroke mortality rates in that US region.
To examine how long-term patterns of weight change affect the risk for diabetes, especially non-insulin-dependent diabetes mellitus, the authors examined the relation of weight change over a period of about 10 years (from the baseline examination in 1971-1975 until the first follow-up examination in 1982-1984) to the 9-year incidence of diabetes mellitus (1984-1992) in a national cohort of 8,545 US adults from the National Health and Nutrition Examination Survey Epidemiologic Followup Study. Diabetes incidence was identified from death certificates, hospitalization and nursing home records, and self-report. In this cohort, 487 participants developed diabetes. The hazard ratios were 2.11 (95% confidence interval (CI) 1.40-3.18) for participants who gained 5- < 8 kg, 1.19 (95% CI 0.75-1.89) for participants who gained 8- < 11 kg, 2.57 (95% CI 1.84-3.85) for participants who gained 11- < 20 kg, and 3.85 (95% CI 2.04-7.22) for participants who gained 20 kg or more compared with participants whose weights remained relatively stable. The authors found no evidence that the results differed by age, sex, or race. They estimated that the population attributable risk was 27% for weight increases of 5 kg or more. Results from this study and other recent studies suggest that the increase in body mass index in the United States that occurred during the 1980s may portend an increase in the incidence of non-insulin-dependent diabetes mellitus with important public health consequences in future years.
The increasing prevalence of overweight and obesity is a major public health concern in many developed countries.
We aimed to describe socioeconomic differences in change in body mass index (BMI; in kg/m2) from age 25 y, assess possible factors behind these differences, and study whether socioeconomic differences in a variety of coronary risk factors can be accounted for by change in BMI.
The data come from a cohort study of London-based civil servants (Whitehall II), who participated in the first (1985-1988) and third (1991-1993) phases of the study and were 35-55-y old at phase 1: altogether there were 5507 men and 2466 women. Both study phases included a questionnaire and a screening examination.
In men and women, employment grade--the measure of socioeconomic status used in this cohort--was strongly related to BMI gain from age 25 y to phase 3 (25 y apart on average). The lower the grade the larger the gain in BMI. Adjustment for health behaviors reduced the grade differences in BMI gain by approximately 20%. A substantial part of the grade differences in diastolic and systolic blood pressure and plasma triacylglycerol concentrations could be accounted for by BMI change from age 25 y.
Grade differences in BMI change are evident, but many of the determinants of these differences remain unknown. If lower-status persons continue to gain weight more rapidly than higher-status persons, overweight is likely to be of growing importance as a pathway to social inequalities in ill health.
Studied the effects of a behavior modification diet that was presented 3 times a week for a month on the Louisville, Kentucky, NBC affiliate WAVE-TV Morning Show. The 1st 500 people who initially responded received a packet by mail that included a weight chart and 4 diet progress sheets with postage-paid mail-back envelopes. Ss who sent in weekly progress sheets were eligible for weekly prizes. Of these 500 Ss, 50% returned at least 1 progress sheet and 38% returned all their progress sheets. 189 Ss completing the entire program reported a mean weight loss of 5.6 pounds and 87% of these Ss reported at least some weight loss. A 2nd group of 1,000 Ss, who requested participation in writing after the 1st group, received only diet instructions and a weight chart and were not eligible for weekly prizes. Less that 1% of this group returned data. It is concluded that TV appears to be a cost-effective medium for helping people to change their eating habits and lose weight. (4 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Background:
Results are reported from a large randomized trial designed to increase fruit and vegetable consumption among callers to the National Cancer Institute's Cancer Information Service (CIS) (n = 1,717).
Methods:
CIS callers assigned to the intervention group (n = 861) received a brief proactive educational intervention over the telephone at the end of usual service, with two follow-up mailouts. Key educational messages and print material derived from the NCI 5 A Day for Better Health program were provided to intervention participants. Participants were interviewed by telephone at 4 weeks (n = 1,307), 4 months (n = 1,180), and 12 months for follow-up (n = 1,016).
Results:
Results obtained from a single-item measure of fruit and vegetable consumption indicate a significant intervention effect of 0.88 servings per day at 4 weeks follow-up (P < 0.001), 0.63 servings per day at 4 months follow-up (P < 0.001), and 0.43 servings per day at 12 months follow-up (P < 0.001). Using a 7-item food frequency measure, an intervention effect of 0.63 servings per day was obtained at 4 weeks follow-up (P < 0.001), compared with 0.39 servings per day at 4 months follow-up (P = 0.002) and 0.44 servings per day at 12 months follow-up (P = 0.002). A 24-h recall assessment included in the 4-month interviews also yielded a significant intervention effect of 0.67 servings per day (P = 0.015). The vast majority of callers (90%) endorsed the strategy of providing 5 A Day information proactively within the CIS.
Conclusions:
This brief educational intervention was associated with higher levels of self-reported fruit and vegetable intake at both short- and long-term follow-up. Additional research is recommended to test this or a similar intervention in diverse populations.
Nutrition educators have been vocal in their criticism of the food and nutrition messages in children's programming and associated advertising. At the same time, they have been reluctant to test their impact on food behavior or to capitalize on the potential of television as an educational tool. The authors provide a comprehensive review of our knowledge on the topic and challenge educators to expand our knowledge base through relevant research.
(C) Williams & Wilkins 1995. All Rights Reserved.
Objectives:
The North Carolina WISEWOMAN project was initiated to evaluate the feasibility of expanding an existing cancer screening program to include a cardiovascular disease (CVD) screening and intervention program among low-income women.
Methods:
Seventeen North Carolina county health departments were designated as minimum intervention (MI), and 14 as enhanced intervention (EI). The EI included three specially constructed counseling sessions spanning 6 months using a structured assessment and intervention program tailored to lower income women.
Results:
Of the 2,148 women screened, 40% had elevated total cholesterol (> or = 240 mg/dL), 39% had low high-density lipoprotein cholesterol (HDL-C) levels (< 45 mg/dL), and 63% were hypertensive (systolic blood pressure 140 and/or diastolic blood pressure > or = 90 mm Hg or on hypertensive medication). The majority of women (86%) had at least one of these three risk factors. Seventy-six percent were either overweight or obese. After 6 months of follow-up in the EI health departments, changes in total cholesterol levels, HDL-C levels, diastolic blood pressure, and BMI were observed (-5.8 mg/dL, -0.9 mg/dL, -1.7 mm Hg, and -0.3 kg/m(2), respectively), but were not significantly different from MI health departments. A dietary score that summarized fat and cholesterol intake improved by 2.1 units in the EI group, compared with essentially no change in the MI group.
Conclusions:
Expanding existing cancer screening programs to include CVD intervention was feasible and may be an effective means for promoting healthful dietary practices among low-income women.
Two hundred overweight men participating in the Multiple Risk Factor Intervention Trial were recruited for participation in either a group or correspondence program for weight reduction. Choice of program was found to be related to weight history. Interest in group treatment was higher among those who had gained the most weight in the preceding 3 years. Men participating actively in the correspondence program had the best recent weight history. Active participation in either program led to significant weight losses compared to nonparticipation, and these losses were maintained for 1 year.
PURPOSE: To examine community differences in cardiovascular disease (CVD) risk factors among black and white young adults by combining data from two large epidemiologic studies.
METHODS: Data are from participants aged 20-31 years in the Coronary Artery Risk Development In Young Adults (CARDIA) study (1987-1988; N = 4129) and the Bogalusa Heart study (1988-1991; N = 1884), adjusting for data collection differences prior to analysis. CARDIA includes four urban sites: Birmingham, Alabama; Chicago, Illinois; Minneapolis, Minnesota; and Oakland, California. Bogalusa is a semi-rural town in Southeastern Louisiana. CVD risk factors examined were smoking status, body habitus, and blood pressure.
RESULTS: In Birmingham and Bogalusa, more white than black women were current smokers; no ethnic differences were observed among men. In Chicago, Minneapolis, and Oakland, more blacks were current smokers than were whites. For all sites, educational level was strongly inversely related to current smoking status; ethnic differences were more apparent among those with up to a high school education. Among white men and women, prevalence of obesity (body mass index > 31.1 kg/m2 in men and 32.3 kg/m2 in women) was greater in Birmingham and Bogalusa than in Chicago. Minneapolis, and Oakland. Mean systolic blood pressures were highest in Bogalusa, and the proportion of black men with elevated blood pressure (> or = 130/85 mmHg) was higher in Bogalusa and Birmingham.
CONCLUSIONS: Community and ethnic differences in CVD risk factors were observed among young adults in two large epidemiologic studies. Further studies may enhance our understanding of the relationship of geographic differences in CVD risk to subsequent disease.
Using a detailed, 24-hr. recall protocol, the dietary intake of sixty-eight school children ums obtained and compared with the Recommended Dietary Allowances.
This study compared the growth indexes of first-grade, white children living in geographic areas of high poverty (n = 281) and low poverty (n = 442) in the state of Washington. Obesity was the most common growth deviance observed in these children. In the low-poverty area, 18% of children had a weight for height greater than the 90th percentile on the National Center for Health Statistics (NCHS) growth standards, whereas only 12% of children from the high-poverty area were in this category. Neither area had high numbers of children with reduced weight for height (less than the 10th percentile on the NCHS growth standards), but children from the high-poverty area were almost twice as likely to be short for their age; 9% of children from the high-poverty area and 5% of children from the low-poverty area had height-for-age values less than the 10th percentile on the NCHS growth standards. Criteria used to determine students' eligibility for financial support for school lunch did not accurately identify children who were thin or short. The prevalence of obesity in these first-grade children suggests that school-based growth screening as well as weight management and physical fitness programs are needed to identify and avert childhood obesity.
Behaviors and concerns related to weight were measured among 457 fourth-grade children attending 10 rural schools in central Iowa. A questionnaire was used to gather data on the children's concerns about being overweight, concerns that certain types or amounts of food would contribute to their being overweight, alterations in food intake to avoid being overweight, and perceptions that peers and family members were concerned about being overweight. In addition, each child's height and weight were measured. Weight-related behaviors and concerns increased with increasing weight-for-age and body mass index (BMI) and were more prevalent among girls than boys. The frequency of drinking diet soft drinks was positively correlated with weight-for-age and BMI and tended to increase with an increase in weight-related behaviors and concerns. Girls were more likely than boys to report a desire to be thinner (60.3% vs 38.4%), whereas boys were more likely than girls to want to be taller (67.2% vs 49.1%). The desire for less body fat was significantly associated with an increase in the frequency of weight-related behaviors and concerns, the frequency of drinking diet soft drinks, weight-for-age, and BMI. These findings indicate a need for interventions that combat fear of obesity and restrictive eating among growing children.
The relationship of race to preventive health behavior among women is examined using data from the 1985 National Health Interview Survey. We find that black women are less likely to engage in primary prevention behaviors such as exercising, non-smoking and maintaining a favorable weight. However, black women are more likely to engage in secondary prevention behaviors such as receiving a Pap test or a breast exam. These findings are surprising as they indicate a change in secondary prevention behavior among black women. The racial differences in exercising, maintaining a favorable weight and receiving a Pap test or a breast exam cannot fully be explained by the differing levels of socio-economic status, measured by education and income. However, the higher percentage of smoking among black women is due to their lower levels of education. Urban/rural residence modifies the effect of race on smoking and receiving a Pap test. Black women in urban areas are most likely to be smokers. Almost no difference exists between white women in urban and rural areas concerning their likelihood of receiving a Pap test, we find that black women in urban areas are much more likely to be screened for cervical cancer than black women in rural areas.
Although the prevalence of overweight as estimated from nationally representative cross-sectional studies is well documented, much less is known about the incidence of overweight and major weight gain in United States adults. I review results from the First National Health Examination Follow-Up Study involving 9862 people aged 25-74 yr who were first weighed between 1971 and 1975 and reweighed 10 yr later between 1982 and 1984.
This article reviews the existing literature on urban and rural differences for the uninsured population and presents new analyses to supplement earlier research to identify issues for future research. The extent of poverty in urban and rural areas and the scope of insurance coverage for the nonelderly population is discussed in the first section on financing medical care. The second section, which covers obtaining medical care, assesses and contrasts health status and use of health services by the poor and uninsured in urban and rural areas. The final section proposes an agenda for future research.
The increasing prevalence of childhood obesity, its attendant morbidity, and the limited success of therapy mandate increased attention to preventive approaches. Environmental and family variables serve to identify families with children at risk for the development of obesity. Although the behavioral correlates that link these risk factors to childhood obesity remain unclear, inactivity and increased dietary intake of fat appear at this time to be the most logical foci for preventive interventions. Television viewing, which promotes both increased food consumption and reduced activity, represents a major concern at which counseling should be directed.
The snack patterns of 225 adolescents selected from four metropolitan and three rural schools in eastern Tennessee were examined with the use of 24-hour food records kept on a school day. Most (89%) of the respondents ate at least one snack on the day of the survey. Morning snacks, most of which were obtained from school stores or school vending machines, were more likely to include candies and salty snack foods than were afternoon and evening snacks, most of which were eaten at home. Breads and cereals were popular choices for afternoon and evening snacks. Carbonated beverages and desserts were popular during all time periods. Nutrient densities of snacks were low in all time periods but lowest in morning snacks. Nutrients present in lowest amounts were iron, calcium, and vitamin A. Snack patterns of boys and girls were similar, although boys' intakes of energy, calcium, and riboflavin were higher than those of girls.
Anthropometric and dietary data were obtained on 78 rural and 66 urban Black girls age 9 years residing in eastern North Carolina. Direct measures were taken of standing height, sitting height, upper limb length, arm girth, calf girth, and body weight. Body form indices were derived for arm girth in percentage of upper limb length, calf girth in percentage of lower limb length, and lower limb length in percentage of sitting height. Intakes of protein and calories were estimated from 24-hour dietary recall protocols. Rural girls, on average, had shorter upper and lower limbs than urban girls. The Recommended Dietary Allowance (RDA) for protein intake was met by almost all subjects. More than 60% of both rural and urban girls were below the RDA for calorie intake, and about 40% below the RDA for vitamin A intake.
The relationship of obesity to environmental factors such as season, region, and population density was examined in children studied during cycle II of the National Health Examination Survey. This survey selected 7119 children aged 6 to 11 yr old from a representative noninstitutionalized sample of the United States population. The prevalence of obesity (triceps skinfold more than the 85th percentile) was significantly more in the Northeast and Midwest than in the West and significantly more in large metropolitan areas than in areas with lower population densities. The prevalence of obesity was generally lowest in the summer and highest in the fall or winter. Each environmental variable was associated with 2- to 3-fold variations in the prevalence of obesity. The effect of region, population density, and season appeared independent of race and socioeconomic status. Similar relationships were found for superobesity (triceps skinfold more than the 95th percentile). These results emphasize that environmental variables significantly affect the prevalence of obesity and could help account for the wide variations in prevalence that have been previously published. Understanding the mechanisms by which the environment affects childhood obesity may improve the effectiveness of community level interventions.
It is proposed that whether or not a physically deviant person is derogated will depend on the extent to which that individual can be blamed or held responsible for his or her appearance. In line with this proposition, two experiments were conducted to examine how adolescent girls' opinions of an obese peer would be influenced by their beliefs about the cause of her obesity. In both studies, subjects were asked to look at a folder containing a photograph and a statement of introduction that a girl from a previous experiment had supposedly written. It was demonstrated that unless the obese target could offer an 'excuse' for her weight, such as a glandular disorder, or could report recent successful weight loss, she was given a less positive evaluation, and was less liked, than was a normal-weight target.
The purpose of this study was to provide a description of the current dietary intake of a large sample of U.S. adolescents and to identify sociodemographic risk factors for nutrient intakes that did not meet recommended levels.
The 1987-88 USDA Nationwide Food Consumption Survey was used to assess the nutrient intake of 933 adolescents aged 11 to 18 years. Analysis of covariance was used to determine the effect of the following on the nutrient intakes of males and females: household income and size, race, geographic region, degree of urbanization, and head of household status. Subject age was entered as a control variable.
Vitamin A, vitamin E, calcium, magnesium, and zinc were the nutrients most often consumed below recommended levels. In addition the females consumed low levels of phosphorus and iron. Percent calories from total fat and saturated fat and mean sodium intakes were above recommended levels for the majority of the sample. Females were more likely to meet cholesterol recommendations than males. Race and region affected the most nutrient intake variables. For the females, living in the south was a significant predictor for low intakes of several essential vitamins and minerals.
On average, the adolescents consumed diets that were low in several essential vitamins and minerals and high in some nutrients related to increased incidence of chronic disease. There were groups of teens who had dietary patterns that placed them at especially high risk, in particular the black and Southern females.
Estimates of the prevalence of selected chronic conditions are presented by biological system involved, sex, age, race, family income, geographic region, and place of residence. The percent of conditions causing limitation of activity, the percent of conditions for which a physician was consulted, and the number of restricted-activity days and bed-disability days resulting from the conditions are also included.
The estimated prevalence of obesity in North American children and youth (6 to 17 years) in the 1960s through the 1980s is reported. Use of the triceps skinfold and BMI independently and in combination as indicators of obesity provides different estimates of prevalence due to ethnicity. With the triceps skinfold as the indicator, there is an increase in the prevalence of obesity and a reduction in variation between Black and White children and youth from the 1960s to 1980; however, with the BMI as the indicator, there is no change in the prevalence of obesity and negligible ethnic difference in these national data sets. On the other hand, the prevalence of obesity has increased over time in Mexican American and American Indian children and youth. Data for American children and youth of Asiatic ancestry are limited.
To determine whether a moderately reduced fat diet affects the stature or growth of healthy preschool children.
Cohort study with mean of 25 months of follow-up.
Primary care pediatrics practice at a large urban medical center.
A predominantly Hispanic group of 215 children aged 3 to 4 years at baseline.
The children's diet was assessed using four 24-hour recalls and three Willett semiquantitative food-frequency questionnaires administered to the children's mothers over a 1-year baseline period. Stature was defined in terms of height, weight, and body mass index at baseline. Growth was defined in terms of change during follow-up in height, weight, and body mass index. Total fat provided a mean of 27.1% of caloric intake in the lowest quintile of intake compared with 38.4% in the highest quintile. There were no differences in stature or growth across quintiles of children defined by consumption of total fat, saturated fat, or cholesterol. These findings were consistent across the two methods of diet assessment. Children who consumed a smaller percentage of total calories from fat consumed significantly less total calories, saturated fat, cholesterol, calcium, and phosphorus, as well as more carbohydrates, iron, thiamine, niacin, vitamin A, and vitamin C.
These data support the safety of a moderately reduced fat diet in healthy preschool children. Maintenance of calcium and phosphorus intake should be part of any program of dietary fat reduction. Substitution of low-fat milk for whole milk, rather than elimination of whole milk, is one such strategy.
The present study was conducted to determine the effects of applying different fat reduction strategies to the overall nutrient profile of diets for preschool-age children.
Computer modeling techniques were used to modify the diets of children (ages 2 through 3 and 4 through 5 years old) to meet contemporary dietary recommendations (< 30% of calories from total fat, < 10% from saturated fatty acids, and < 300 mg of cholesterol daily). Fat reduction strategies were applied to a 1-week menu that included preschoolers' favorite foods. Strategies applied were replacing high-fat meat exchanges with lean meat exchanges (+/- three high-fat meat exchanges per week), replacing higher fat milks with skim milk, replacing high-fat meat exchanges with medium-fat meat exchanges, using fat-modified products, using low-fat preparation techniques, and added fat. All diets were made isocaloric after modifications were applied.
It is more difficult to meet all recommendations for the 2- and 3-year-old children. Use of skim milk is the simplest strategy to use for the 4- and 5-year-old children, although other single strategies are effective.
When multiple strategies are effected. Some diets are very low in fat (< 20% of calories) and potentially inadequate in energy and nutrients. It is important that caregivers know the appropriate foods to choose when modifying fat in children's diets to ensure meeting energy and nutrient requirements.
Expert panels recommend reduction of dietary fat and cholesterol, because excessive fat intake may lead to known health hazards. However, there are no data demonstrating beneficial effects of such diets starting in childhood for all children, including those with normal serum cholesterol levels. Dietary restrictions in early life may not necessarily induce a long-lasting decrease in blood cholesterol levels in children persisting into adulthood or reduce disease incidence. On the other hand, the result of such diets may be suboptimal growth and development. Furthermore, low fat diets may lower high density lipoprotein cholesterol levels and not specifically low density lipoprotein cholesterol. In addition, low serum cholesterol levels may be associated with increased mortality, including deaths due to accidents, which is most important in children. Recently, increased attention has been drawn to the association between short stature and/or nutritional status and deficiencies in intrauterine and early life with coronary artery disease in adulthood. Also, the problems of associated psychological consequences, family conflicts and cost should not be ignored while implementing a low fat diet. In this review, we discuss the controversies on dietary fat restrictions for children.
The primary goal for pediatric dietary guidelines is to provide nutrients to support optimal growth and development at different ages from infancy through the end of adolescence. Over the past 15 years increasing attention has been directed toward developing nutrition recommendations that may lower the risk of chronic illness later in life. Recent evidence supports earlier studies that demonstrate that atherogenesis begins in childhood, is an evolving process and is influenced by environmental factors. As a result, in part, because of nutritional recommendations to lower the fat content of the diet, total fat and saturated fat as a percentage of total energy intake have declined in the diet of children and adolescents over the past 20 years. At the same time there has been no increase in the prevalence of growth failure; children, in fact, are heavier than their counterparts of 15 years ago. With a decrease in dietary fat, the mean serum cholesterol of the population as a whole has decreased steadily over the past 20 years. Children can safely eat a lower fat diet in which fat contributes 30% of total energy and saturated fat < 10% of total energy.
This research examines the association between parity and body weight and how this relationship is modified by sociodemographic and behavioral factors. Using multiple linear regression analysis, the study assessed the relationship between parity and relative body weight (as Body Mass Index, BMI) and how this relationship interacts with seven sociodemographic and seven behavioral factors in a national sample of 5,707 women from the Second National Health and Nutritional Examination (NHANES II) survey. After adjusting for sociodemographic factors, the amount of weight associated with parity averaged about 0.5 kg per child. However, parity-associated weight differed by sociodemographic and behavioral factors, and was much larger in some subgroups. Among 18-45 year olds, the amount of weight associated with parity was greater in blacks than in whites, less in employed than unemployed white women but greater in employed than unemployed black women, less in smokers than nonsmokers, less in those with a high level of recreational exercise, and differed with the level of nonrecreational physical activity depending on race. Among 46-74 year olds, the amount of weight associated with parity was greater in married than unmarried women, and less in those who were active outside of recreation versus those who were less active. These results suggest that sociodemographic and behavioral variables modify the relationship between parity and body weight, and provide insight for identifying women who are at risk for having greater BMI with higher parity. This information may be applicable to the targeting and design of interventions to prevent postpartum weight retention.
From both societal and payer perspectives, the economic effect of obesity in the United States is substantial, estimated at approximately 6% of our national health expenditure and cost of care in a major health maintenance organization. The number of physician visits related to obesity has increased 88% in a 6-year period. The morbidity cost (lost productivity) and functional capability of the patient with obesity is increasing rapidly (50% increase in lost productivity, 36% increase in restricted activity, and 28% increase in number of bed-days). Cost savings of treating obesity are comparable to those of treating other chronic diseases such as coronary heart disease and diabetes. Most studies indicate that most of the direct health care costs of obesity are from type 2 diabetes, coronary heart disease and hypertension. To date, however, there have been no published reports of the cost effectiveness of the medical management of obesity treatment. In conclusion, the cost of obesity is comparable to that of other chronic diseases, yet it receives disproportionately less attention. Cost effectiveness studies need to be initiated promptly.
Obesity is a risk factor for several chronic diseases and some cancers. We suspected that patients in our primary care practices were, on the average, heavier than state and national norms.
Rates of overweight patients in primary care practices were compared with rates from the Michigan Behavioral Risk Factor Survey (MBRFS) of 1993 and the National Health and Nutrition Evaluation Survey (NHANES) III Phase I (1988-91), the most recent state and national surveys for which summarized data were available. The 19 family practice offices of the rural Upper Peninsula Research Network (UPRNet) and two urban clinics in the Lansing area participated. We measured heights and weights of 5267 consecutive patients 18 years of age and older who visited one of the offices or clinics during the study period in 1996.
Fifty-three percent of the primary care patients were overweight, and 28.5% were severely overweight. The age-adjusted rates were 51.0% and 27.5%, respectively. These rates are much higher than rates reported from the MBRFS (29.1% for overweight), and NHANES III Phase I (33% overweight, 14% severely overweight). The age-adjusted prevalence of overweight and severely overweight was higher in the rural than the urban sample: 52.5% vs 47.2% for overweight and 33.7% vs 25.6% for severely overweight, respectively.
Compared with data from the Michigan Behavioral Risk Factor Survey of 1993 and the National Health and Nutrition Evaluation Survey III Phase I, a much larger proportion of patients visiting our primary care practices are overweight and severely overweight. The prevalence of obesity in primary care practices may be much higher than rates estimated from population-based surveys.
Relationships between body mass index (BMI) and weight gain with perinatal outcome and birthweight were examined. BMI was calculated on 582 consecutive pregnant women who delivered at or >37 weeks gestational age. Statistical analysis was done using Chi-square tests, analysis of variance, and multiple logistic regression. Of those studied, 13% were underweight, 39% normal, 13% overweight, and 35% obese. Obesity was associated with increasing age (P < .01), multiparity (P < .01), previous cesarean delivery (P < .01), previous macrosomia (P = .01), previous fetal death (P = .03), hypertensive disorders (P < .01), gestational diabetes (P = .02), cesarean delivery (P = .03), and neonatal intensive care unit admission (NICU) (P = .01). The underweight group had the most low birthweight (LBW) infants and the lowest mean birthweight. Ideal weight gain occurred in 31%, inadequate weight gain in 34%, and excessive weight gain in 35%. Inadequate weight gain had increased asthma (P < .05), and hyperemesis (P = .03). Women with ideal weight gain had less smokers (P < .01), fetal distress (P < .05), cesarean delivery (P = .02), and preeclampsia (P < .001). The mean birthweight was highest in the excessive weight gain (P < .01). With multivariate analysis, previous LBW, BMI, and tobacco use were significant predictors of LBW. Normal BMI and ideal weight gain in pregnancy is associated with decreased perinatal complications and an optimum birthweight.
The inability to deliver cancer prevention and treatment to the rural population poses a significant barrier in the national effort to reduce cancer mortality. Since 25 percent of the U.S. population lives in rural areas and few rural areas are readily accessible to cancer centers or Community Clinical Oncology Programs (CCOPs), the prospects for accomplishing the National Cancer Institute (NCI) Goals for the Year 2000 are limited unless substantive changes occur in rural cancer care delivery. This article reviews the problem of cancer risk and care in rural areas and describes one effort to deliver state-of-the-art cancer treatment to rural patients in Virginia. It describes the needs and barriers to access in rural Virginia, the structural elements of the Rural Cancer Outreach Program, and the health policy issues that result when subspecialty care is exported to disadvantaged areas.
To determine whether low fat intake is associated with increased risk of nutritional inadequacy in children 2 to 8 years old and to identify eating patterns associated with differences in fat intake.
Using 2 days of recall from the Continuing Survey of Food Intake by Individuals (CSFII), 1994 to 1996, we classified 2802 children into quartiles of energy intake from fat (<29%, 29% to 31.9% [defined as moderate fat], 32% to 34.9%, and > or =35%) and compared nutrient intakes, the proportion of children at risk for inadequate intakes, Food Pyramid servings, and fat content per serving across quartiles.
More children in quartile 2 were at risk for inadequate intakes of vitamin E, calcium, and zinc than children in higher quartiles (P <.0001); more children in quartiles 3 and 4 were at risk for inadequate intakes of vitamins A and C and folate (P <.001). Fruit intake decreased across quartiles (P <.0001); whereas vegetable, meat, and fat-based condiment intakes increased (P <.0001). Fat per serving of grain, vegetables, dairy, and meat increased across quartiles (P <.0001).
Moderate-fat diets were not consistently associated with an increased proportion of children at risk for nutritional inadequacy, and higher-fat diets were not consistently protective against inadequacy. Dietary fat could be reduced by judicious selection of lower-fat foods without compromising nutritional adequacy.
This study was undertaken to determine whether perceptions about body image and size vary by body mass index (BMI) and demographic factors among American Indian children in the Southwestern United States. We surveyed 1,996 American Indian schoolchildren in the fifth grade (mean age 10.5 +/- 0.7 years) at eleven rural elementary schools. Heights and weights were measured using standard protocol. Multiple linear regression models were developed for preferred body shape, desired body shape, and body satisfaction to determine association with demographic and physical factors. Results from multiple linear regression modeling indicated that BMI and gender influence body satisfaction, with heavier children and girls being less satisfied with their bodies (P<.001 and P<.05, respectively). Geographic isolation and lack of amenities in the home did not appear to affect body satisfaction or messages from others about being too fat or thin; however, geographically isolated students were more likely to choose a larger body shape as best looking. Girls of appropriate weight were 2.2 times more likely than boys to have been told they were too fat. Sixty-one percent of all students surveyed had tried to lose weight. These findings, although similar to those for non-Hispanic Whites of the same age, are contrary to prevailing ideas that American Indians value obesity. In fact, we observed a high level of body dissatisfaction among children of appropriate weight, particularly girls, and prevalent dieting across all weight categories and both genders.
The Third National Health and Nutrition Examination Survey, 1988-1994(NHANES III) revealed that 11.5% of adolescents were obese. The NHANES III sample size for Mexican Americans was small.
To determine the prevalence of adolescent obesity in a South Texas population that is preponderantly low-income Mexican Americans.
Cross-sectional prevalence study.
All secondary school campuses of one rural independent school district with a low-income Mexican American population.
Four thousand three hundred seventy-five students, aged between 12 and 17 years, enrolled in 4 secondary school campuses of 1 Rio Grande Valley, South Texas, independent school district for academic year 1998-1999.
Body mass index (BMI) was calculated for all 4375 students using weights and heights measured by school nurses on enrollment. Each student's BMI was then plotted on a sex-specific chart and the percentile range for age was determined. Those within the 85th to the 95th percentile were classified as at risk for obesity and those above the 95th percentile were classified as obese.
Of 2149 adolscent girls and 2226 adolescent boys, 18% were at risk for obesity and 22. 1% were obese. A total of 40.1% had a BMI at the 85th percentile or higher for age and sex. The prevalence of obesity also continues to rise even after puberty more markedly in adolescent girls than adolescent boys. Furthermore, the mean BMI progressively increases with age and is generally at the 85th percentile or higher.
Our data revealed a much higher prevalence rate of obesity in this adolescent Mexican American population than the rate obtained in NHANES III. It is even higher than the rate specific for Mexican American adolescents in NHANES III. The NHANES III significantly underestimates the prevalence of adolescent obesity in preponderantly impoverished Mexican American adolescents. This consequently leads to underestimation of the public health risks as well as the present and future cost of health care associated with obesity in this population. Arch Pediatr Adolesc Med. 2000;154:837-840
The Rural Alabama Health Professional Training Consortium is a rural community health center-based program that began in 1990 to provide interdisciplinary training for medical, nursing, pharmacy, dentistry, and nutrition students. After 6 years, 166 students had participated. This article discusses an evaluation of the impact of this program on these students by means of comparing pre-tests and posttests. Dentists demonstrated attitudes less favorable to locating in rural practices compared to other students. There was a significant increase in clinical competencies relevant to rural practice. Professional perceptions about working in an interdisciplinary environment were significantly lower for medical students compared to pharmacists, but their attitudes improved over time. The team concept was highly rated. Over 90% of the students thought that the program met or exceeded their expectations and would recommend it to other students, except for nurses. Over 80% of the students will consider working in a rural area on graduation, except for dentists.
West Virginia's mortality and morbidity from cardiovascular disease (CVD) is among the highest in the developed world. Appalachia, and West Virginia in particular, could reduce the high prevalence of premature coronary heart disease (CHD) by addressing modifiable independent risk factors such as poor nutrition, sedentary lifestyle, and tobacco use. School-based health promotion programs have been shown to be an effective means of influencing student and parental health behavior. The pilot phase of the Coronary Artery Risk Detection in Appalachian Communities (CARDIAC) project substantiated an alarmingly high incidence of CVD risk factors among 347 fifth grade children from three rural counties, and was also an effective means of identifying parents at risk of developing CHD. Utilization of the innovative Rural Health Education Partnerships (WVRHEP), coupled with a health conscious public school system, offers a unique opportunity to establish the first statewide cardiovascular disease community intervention project in the nation.
The prevalence of selected health indicators were compared among the Catawba Indians, African Americans, and whites in South Carolina, considering the possible role of rural locality and education.
Catawba members were respondents of a 1998 survey (N = 808). Other South Carolina residents were respondents of the 1995-1997 Behavioral Risk Factor Survey (4,150 whites and 1,413 African Americans). Prevalence of cardiovascular disease, diabetes, hypertension, overweight, poor health, smoking, physical inactivity, and poor diet were compared among the racial/ethnic groups. Logistic regression analyses were conducted within strata of urban/rural locality and education to determine whether these factors were associated with the adverse health indicators.
Both Catawba and African Americans had higher prevalence of diabetes, hypertension, overweight, poor health, physical inactivity, and poor diet than whites. In addition, prevalence of diabetes, poor health, smoking, and poor diet were higher among the Catawba than among African Americans. Restricting the analyses to comparisons within urban/rural locality had little effect, whereas restricting the analyses to comparisons by education level eliminated many of the disparities among those with low education.
Prevalence of chronic disease and adverse health behavior are higher among the Catawba than among other residents of South Carolina, especially compared with white residents.
This paper compares the effects of obesity, overweight, smoking, and problem drinking on health care use and health status based on national survey data. Obesity has roughly the same association with chronic health conditions as does twenty years' aging; this greatly exceeds the associations of smoking or problem drinking. Utilization effects mirrors the health effects. Obesity is associated with a 36 percent increase in inpatient and outpatient spending and a 77 percent increase in medications, compared with a 21 percent increase in inpatient and outpatient spending and a 28 percent increase in medications for current smokers and smaller effects for problem drinkers. Nevertheless, the latter two groups have received more consistent attention in recent decades in clinical practice and public health policy.
Impact of body weight, body composition, and adipose tissue distribution on morbidity and mortality
- L Sjostrom
Sjostrom, L. Impact of body weight, body composition, and adipose tissue distribution on morbidity and mortality. Obesity: Theory and Therapy, 2nd ed. New York: Raven Press, 1993, 13- 41