• Implementation of an education program to improve Smith Island, Maryland residents' knowledge and attributes of healthier eating practices and benefits of physical activity

      Windemuth, Brenda (2011)
      Introduction: Obesity rates in the United States have drastically increased over the past twenty 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 percent among adult men and 35.5 percent among adult women (Flegal, 2010). Obesity is associated with increased health risks for many health related conditions which include diabetes, cardiovascular disease, stroke, cancer, sleep apnea, and a modestly elevated risk for all cause mortality. Educating the community on healthy eating and exercise practices is one strategy to develop skills which can then be used to facilitate behavioral changes. One rural community with increased obesity rates is Smith Island, Maryland. This community has special challenges to obtain a healthy lifestyle including a unique aspect of cultural sensitivity and need to be given the opportunity for obesity prevention in an isolated environment. Although there have been small measures to reduce obesity. These have isolated events, but a program has been established for this community. Purpose: The objective of this capstone project was to determine if a cultural sensitive educational program increases the knowledge of healthy eating practices and benefits of physical activity among residents of Smith Island. Design: A one-group, pre-test post-test, pre-experimental design was used to compare knowledge scores of Smith Island residents before and after an educational program on healthier eating and benefits of physical activity. Sample: A convenience sample of 25 residents living on Smith Island was recruited to participate in the program. Data Sources: The subjects completed a pretest prior to participating in a culturally modified educational program based on Dietary Guidelines for Adult Americans. Participants completed a post-test after the program had been given. Results: A dependent t-test was used to determine if there is a difference between pre-test and post-test attitudes and scores following the educational intervention. Overall, participants scored higher on the post-test as compared to the pre-test (t=.28, p<0.001). Additionally, the participants felt more confident in making changes in their food choices (t = -4.64, p<0.001) and making a nutritious meal for their families (t= - 4.54, p< 0.001). Conclusions/Implications: 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. Thus, the implications of the study demonstrate 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.
    • Individual, Caregiver, and Family Characteristics Associated with Obesity in Preschool-age Children

      Rahmaty, Zahra; Johantgen, Mary E.; 0000-0001-6165-0881 (2021)
      Background and Objectives: Eating habits start from early childhood and may contribute to the development of obesity. Food neophobia (FN) occurs among 50% of preschoolers and has shown inconsistent associations with obesity. Caregiver feeding practices (FPs) influence eating habits but have limited evidence about how they employ together and how they associate with childhood obesity. The first paper examines the relationship between FN and preschooler's obesity/overweight. The second paper assesses patterns of FPs and their associated factors. The third paper examines how the patterns of FP relate to preschoolers' Body Mass Index (BMIz), an objective measure of obesity. Method: Data from the Creating Healthy Habits Among Maryland Preschoolers (CHAMP) study including preschoolers (N=500) and caregivers from 50 Maryland childcare centers were examined. Children's weight and height were measured, and BMI percentile and z-score were calculated. Caregivers reported demographics, weight and height, FN, FPs, child temperament via an online survey. Mixed models, factor analysis, latent profile analysis, and structural equation models were used. Results: A quarter of children were obese/overweight; caregiver-reported FN was not associated with preschoolers' obesity/overweight, although children were more likely to be obese/overweight if their caregiver was overweight (aOR=2.6) or obese (aOR=3.9). Three patterns of FP were found. Controlling class had high coercive control and low autonomy practices (69%), Regulating class had high coercive control, but moderate structural and autonomy practices (16%), and Balancing class were moderate in all practices (15%). Caregivers who desired their child to be heavier (aOR=0.40, 95%CI=0.22-0.72), had higher poverty levels (aOR=0.80, 95%CI=0.65-0.98), were single (aOR=0.38, 95% CI=0.18-0.80), and were less likely to be in the Balanced versus Controlling class. Children’s difficult temperament (b=0.09, p=0.008), caregiver’s BMI (b= 0.26, p<0.001), desire for the child to be thinner (b=0.23, p<0.001), desire for child to be heavier (b=-0.37, p<0.001), and Regulating versus Controlling FP (b=-0.09, p=0.03) were associated with child BMIz. Conclusion: Childhood obesity is a multifactorial phenomenon, with interactive effects among the child, family, and environment. FP are associated with preschooler’s weight and should be assessed comprehensively. Caregivers’ perceptions of child size and temperament may also provide insight into FP and obesity.
    • Nurses' Working Conditions and Obesity

      Han, Kihye; Trinkoff, Alison M. (2011)
      Background: Job stress and shift work are known risk factors for obesity, yet comprehensive measures of job stress/work schedules (JS/WS) in relation to nurse obesity have been little investigated. Moreover, the effect of JS on obesity can vary with WS characteristics because WS comprehensively influence workers' lives. Nonetheless, there are knowledge gaps about differences in factors which are associated with nurse obesity by WS status. Purpose: This study aimed to 1) examine the proportion of overweight/obesity (OW/OB) among nurses, 2) investigate the relationship between JS/WS and nurse obesity, and 3) compare the relationship between JS and nurse obesity by WS status. Methods: The conceptual framework was based on the Demand-Control-Support model which assumes workers' health is affected by stress-producing factors in employment settings. This study was a cross-sectional secondary data analysis of 2,103 female nurses. Obesity was measured using body mass index estimates. To examine associations of JS/WS with nurse obesity, binomial logistic regression models for OW/OB incorporated independent components of JS/WS. To compare associations between JS and nurse obesity by WS status, binomial regression models were stratified by WS status (favorable WS and unfavorable WS). All models included demographics, depressive symptoms, and health and family related covariates. Results: The prevalence of OW/OB was 55%. In the overall nurse sample, longer work hours (OR=1.22, 95% CI=1.08-1.39) and jobs with lower physical exertion (OR=0.83, 95% CI=0.73-0.95) and more limited movement (OR=1.14, 95% CI=1.02-1.28) were significantly associated with OW/OB. When comparing associations between JS and nurse obesity by WS status, among nurses with favorable WS, OW/OB nurses reported significantly less supervisory support (OR=0.83, 95% CI=0.68-1.00). On the other hand, among those with unfavorable WS, no job stress components were significantly related to OW/OB. Only healthy behaviors (i.e., exercise and sleep) were significantly associated with decreased odds of OW/OB (OR=0.79, 95% CI=0.66-0.95). Conclusion: Organizational supports to limit adverse WS are needed. In particular, for nurses with unfavorable WS, educational interventions about sleep hygiene and other lifestyle modifications for adaptation to their WS may help improve health. For nurses with favorable WS, organizational supports for alleviating nurses' home/family responsibilities and stress are needed.
    • Participation and Effectiveness of Worksite Health Promotion Program

      Han, Myeunghee; Doran, Kelly; Storr, Carla L. (2019)
      Background: Worksite Health Promotion Programs (WHPPs) are limited by low participation and engagement. However, little is known about what factors influence participation and the relationship between participation and changes in body weight and composition. Mobile health technology (mHealth) may facilitate participation and engagement in WHPPs as mhealth is not limited by time or location, which are known barriers to participation and engagement. Yet, few studies have examined the use and effectiveness of WHPPs using mHealth interventions that aimed to change body weight and composition. Purpose: To explore the features and effectiveness of WHPPs in previous studies that used mHealth interventions. To identify factors influencing participation and engagement in a WHPP and the relationship between participation and changes in body weight and composition. Methods: A systematic literature review was conducted to explore features of WHPPs using mHealth that aimed to change body weight and composition. A secondary data analysis was conducted using data obtained from participants in the intervention group of a WHPP to identify: 1) factors that influence participation and engagement and 2) the relationship between participation and body weight and composition changes. Results: From the systematic review, 10 out of 12 WHPP studies using mHealth significantly improved body weight and composition. The most commonly used mHealth interventions were providing information, goal setting, and data entry. Based on the secondary data analysis, low levels of stress, anxiety, or high job satisfaction were significantly related to high participation in a WHPP. Significant relationships between participation and body weight and composition changes were not found due to a small sample size. However, this study found that those who reduced five pounds of body weight at six months among overweight or obese participants showed high participation in physical activity and/or diet components of a WHPP. Conclusions: WHPPs using mHealth can significantly improve body weight and composition. Employees’ psychological factors should be considered to increase participation in WHPPs. Further studies with larger sample size are needed to identify the relationship between participation and changes in body weight or body composition.