Suchergebnisse

Over the past forty years various changes in the U.S. "built environment" have promoted sedentary lifestyles and less healthful diets. James Sallis and Karen Glanz investigate whether these changes have had a direct effect on childhood obesity and whether improvements to encourage more physical activity and more healthful diets are likely to lower rates of childhood obesity. Researchers, say Sallis and Glanz, have found many links between the built environment and children's physical activity, but they have yet to find conclusive evidence that aspects of the built environment promote obesity. For example, certain development patterns, such as a lack of sidewalks, long distances to schools, and the need to cross busy streets, discourage walking and biking to school. Eliminating such barriers can increase rates of active commuting. But researchers cannot yet prove that more active commuting would reduce rates of obesity. Sallis and Glanz note that recent changes in the nutrition environment, including greater reliance on convenience foods and fast foods, a lack of access to fruits and vegetables, and expanding portion sizes, are also widely believed to contribute to the epidemic of childhood obesity. But again, conclusive evidence that changes in the nutrition environment will reduce rates of obesity does not yet exist. Research into the link between the built environment and childhood obesity is still in its infancy. Analysts do not know whether changes in the built environment have increased rates of obesity or whether improvements to the built environment will decrease them. Nevertheless, say Sallis and Glanz, the policy implications are clear. People who have access to safe places to be active, neighborhoods that are walkable, and local markets that offer healthful food are likely to be more active and to eat more healthful food—two types of behavior that can lead to good health and may help avoid obesity.

Purpose. This study examined whether eating practices and psychosocial factors differed across stages of change for fruit and vegetables. Design. Data were collected using a self-administered written survey among a convenience sample of 739 Dutch adults. Response rate was 92%. Setting. Data were collected as part of the baseline assessment for a nutrition intervention study. Measures. Fruit and vegetable intake was measured as self-reported consumption with a validated eight-item food frequency questionnaire. Psychosocial variables were measured with six items on bipolar seven-point scales and stage-of-change classifications were based on separate four-item algorithms for fruits and vegetables. Differences in psychosocial factors and consumption were analyzed using one-way analysis of variance with Scheffé's multiple-comparison test. Results. Significant differences were found between stages of change in dietary intake, attitudes, self-efficacy, and judgment of one's own intake compared to others. Attitudes were most positive in preparation and action and least positive in precontemplation. Intake and self-efficacy were more positive in action/maintenance than in pre-action stages. Conclusions. The findings suggest that nutrition education aimed at encouraging higher intake of fruits and vegetables might be most effective if it is stage-tailored. Messages to influence attitudes about fruits and vegetables are likely to affect people in precontemplation, and self-efficacy information to increase confidence in overcoming barriers to consumption is likely to be effective with persons in contemplation and preparation stages.

Purpose. To summarize and provide a critical review of worksite health promotion program evaluations published between 1980 and 1995 that address nutrition and hypercholesterolemia. The article discusses and critiques both intervention methods and research methodologies to identify the most effective strategies. Methods. Core articles are 26 original, data-based studies that report on measures of health status, behavior, attitudes, and knowledge as outcomes of worksite nutrition and cholesterol interventions. Only work published since 1980 that clearly describes nutrition or cholesterol interventions and that includes identifiable nutrition-related outcomes is reviewed. The main search method was the same one used for this special issue; supplementary sources included those found in earlier reviews or identified through backward searches or expert contact. Summary of Important Findings. Ten worksite nutrition education programs were reviewed and were categorized as group education, group education plus individual counseling/instruction, cafeteria-based programs, and group education plus cafeteria-based programs. Four of these were randomized studies, and one used the worksite as the unit of randomization and analysis. Sixteen worksite cholesterol programs were reviewed, in five categories: monitoring; individual counseling; group sessions or classes; mediated methods using print, audiovisual, telephone, and self-help kits; and combination approaches. Of these, eight were randomized controlled trials; most tested interventions for persons with elevated cholesterol levels, although four studies reported cholesterol education programs for the general employee population. Six large controlled trials of worksite nutrition and cholesterol interventions in progress are also described. Major Conclusions. The conclusions that can be drawn from this review are limited by the study designs used, which often lacked control groups, used nonrandomized designs, or relied on self-selected high-risk or volunteer participants. Our rating for the quality of the evidence in the literature as a whole lies between suggestive and indicative. It is clear that worksite nutrition and cholesterol programs are feasible and that participants benefit in the short-term. Conclusive evidence about a causal relationship between worksite nutrition and cholesterol programs and improved behavior or health is not yet available, although studies currently underway hold promise for providing more solid evidence about the potential efficacy of these interventions.

Purpose: Indoor tanning is associated with an increased risk of developing skin cancer. In the United States, nearly 1 in 5 white women aged 18 to 25 are indoor tanners. This study elicited beliefs about tanning indoors and quitting/cutting back on indoor tanning. Design: Semi-structured interviews. Participants and Setting: Forty 18- to 25-year-old white females who engaged in frequent indoor tanning participated in either in-person or telephone interviews. Most were college students from southeastern Pennsylvania and Delaware. Method: A semi-structured interview was used to elicit beliefs about indoor tanning and quitting or cutting back. Data analyses using NVivo and multiple coders identified key themes about going and quitting/cutting back on indoor tanning. Results: Key themes stated as reasons for indoor tanning included improving physical appearance, social acceptance, increased confidence, and happiness. The main themes identified as advantages of quitting/cutting back on indoor tanning were to decrease skin cancer risk and save money. Perceived disadvantages of quitting/cutting back included themes of concerns about being pale and a decline in self-confidence. The prospect of saving money and warm weather were seen as facilitating quitting/cutting back. Conclusion: Findings suggest the necessity of addressing appearance concerns, psychological benefits associated with feeling more attractive, and short-term gains such as saving money. These findings provide a foundation for developing effective anti-indoor tanning communication.

Research on urban walkability does not always make a clear distinction between design features supporting walkability and those leading to a sense of urban liveliness. Walkability, for this article's purposes, entails the opportunity for continuous movement across some distance and therefore engages both the local and global street networks. Urban liveliness, by contrast, may exist in isolated pockets that provide limited support for physical activity. This case study of a large, urban smart growth development in Atlanta, Georgia, provides an example of a new development with characteristics that suggest a high degree of walkability. However, observational data show pedestrians are clumped on relatively few street segments rather than distributed throughout the site, indicating it is unlikely that the site is hosting much walking between the development and its surrounds. This descriptive case study is intended to contribute to more explicit theory of how environmental design contributes to walking.

Purpose. Nutrition education and labeling may help consumers to eat less fat. The purpose of this study is to assess the effect of nutrition education with and without shelf labeling on reduced fat intake in Dutch supermarkets. Methods. The design consisted of a randomized, pretest-posttest, experimental control group design. In total, 2203 clients of 13 supermarkets were included in the sample. Total fat intake of clients and behavioral determinants of eating less fat were measured by a questionnaire. A mixed-effect regression model was used for the analysis. Results. No significant effects were found for the educational intervention, alone or with the labeling, on total fat intake and the psychosocial determinants of eating less fat. Conclusion. Nutrition education and labeling of low-fat food products in supermarkets did not prove to be effective strategies. The fact that the supermarket is a highly competitive environment may have accounted for this lack of effect.

Purpose. The purposes of this article are to review what is known about participation in mammography programs and to propose several elements that warrant consideration in planning mammography screening programs in occupational settings. Breast cancer is the most common female cancer. Regular screening programs including mammography, clinical breast examination, and monthly breast self-examination can reduce breast cancer deaths by as much as 35%. However, mammography is underutilized. This review examines factors affecting acceptance of mammography and possible worksite-based strategies to increase its appropriate use. Search Methods. We identified the sources cited in this review through a combination of literature searches of computerized data bases, backward searches of reference lists, and contacts with active investigators. The article includes a selected subset of the most recent and relevant references. Summary of Important Findings. A variety of individual factors, environmental influences, health care system factors, and employer factors influence the acceptance of mammography. Workplace mammography programs can be especially important in reducing access barriers. Major Conclusions. Six program elements which are central to planning successful worksite mammography programs are discussed: location and facilities; health professional involvement; the range of services; education and referral; employer policies, and plans for follow-up and repeat screening.

Assessments of access to healthful food frequently use GIS to measure the distance and concentration of food outlets relative to where residents live. These descriptive approaches do not account for food shopping behavior, which may vary based on the attributes of food shoppers and their activity space—places where they live, work, access resources, and socialize. Building on transportation research about accessibility, we reframe the issue of food access and equity from one about 'what is nearby?' to 'where do people shop?'. We use a conditional logit model to analyze disaggregate data from a door-to-door survey of food shopping choice and food store surveys conducted in a predominantly non-Hispanic Black and middle-income and low-income section of Philadelphia. Our results highlight the importance of distance from home to food stores, overall, but they also emphasize the influence on food store choice of the race and sex of food shoppers, travel mode, and where they spend time other than at home, as well as food prices and the availability of healthful foods. This approach to understanding food access holds promise for future research that can link store choice to specific food purchases and health outcomes as well as for refining place-based strategies for improving access to healthful foods.

Purpose. Innovations in information technology offer new opportunities for creative application of personalized, tailored feedback strategies for improving dietary adherence. We developed and tested a real-time diet-monitoring and feedback system using hand-held computers. The goals were to increase diet self-monitoring, reduce the burden of monitoring food intake, and increase adherence to dietary goals within a clinical trial. Methods. Participants were 33 women in the Diet Modification arm of the Women's Health Initiative (WHI). After using focus groups to determine system features, women used the Personal Digital Assistant (PDA)–based system for 1 month and received immediate and weekly tailored feedback. The process and outcomes were evaluated using real-time food records collected through the PDAs; surveys; and self-reported food frequency questionnaires. Results. Participants significantly increased self-monitoring, improved their attitudes toward self-monitoring, and met their dietary goals more often. Reported total fat intake and percent energy from fat decreased significantly. There was a modest decrease in mean caloric intake. Discussion. The pilot study findings support the largely untapped potential of handheld computers for improving diet monitoring and diet adherence, particularly within a clinical trial.