Objectives Multilevel, multicomponent (MLMC) interventions are a promising strategy to address ob... more Objectives Multilevel, multicomponent (MLMC) interventions are a promising strategy to address obesity, yet they are complex to implement with sufficient intensity. We report on the process evaluation of a MLMC to prevent/reduce obesity in Native American (NA) adults. Methods OPREVENT2 is a recently completed MLMC intervention in six NA communities (3 intervention, 3 comparison). OPREVENT2 worked with food stores to increase access to and promote healthy food choices, worksites to provide nutrition education and to improve physical activity (PA) opportunities, schools to educate children (grades 2–6) to act as change agents, media to reinforce key messages, and through a policy-oriented community action committee (CAC). OPREVENT2 was implemented in six phases targeting various foods, PA strategies and related behaviors. Implementation standards were set for each component and assessed reach, dose delivered, and fidelity. Data were collected using a combination of REDCap-programmed t...
The American journal of clinical nutrition, Apr 1, 1999
Training in portion-size estimation is known to improve the accuracy of dietary self-reporting in... more Training in portion-size estimation is known to improve the accuracy of dietary self-reporting in adults, but there is no comparable evidence for children. To obtain this information, we studied 110 second- and third-grade American Indian schoolchildren (34 control subjects were not trained), testing the hypotheses that a 45-min portion-size estimation training session would reduce children's food quantity estimation error, and that the improvement would be dependent on food type, measurement type, or both. Training was a hands-on, 4-step estimation and measurement skill-building process. Mixed linear models (using logarithmic-transformed data) were used to evaluate within- and between-group differences from pre- to posttest. Test scores were calculated as percentage estimation errors by difference and absolute value methods. Mean within-group estimation error decreased significantly (P<0.05) from pre- to posttest for 7 of 12 foods (trained group) by both calculation methods,...
The food environment has a great impact on the nutritional health of the population. Food environ... more The food environment has a great impact on the nutritional health of the population. Food environment interventions have become a popular strategy to address the obesity epidemic. However, there are still significant gaps in our understanding of the most effective strategies to modify the food environment to improve health. In this review, we examine key gaps in the food environment intervention literature, including the need for: developing appropriate formative research plans when addressing the food environment; methods for selecting intervention domains and components; incorporating food producers and distributors in intervention strategies; strengthening evaluation of environmental interventions; building the evidence base for food environment interventions in diverse settings; engaging policy makers in the process of modifying the food environment; and creating systems science models to examine the costs and benefits of a potential program or policy on the food environment pri...
Disparities in healthy food access commonly exist in urban low-income neighborhoods, where small ... more Disparities in healthy food access commonly exist in urban low-income neighborhoods, where small food stores predominate. What is not commonly understood is the supply network of these small food s...
OPREVENT2 was a multilevel, multicomponent (MLMC) adult obesity prevention that sought to improve... more OPREVENT2 was a multilevel, multicomponent (MLMC) adult obesity prevention that sought to improve access and demand for healthier food and physical activity opportunities in six Native American communities in the Southwest and Midwest. OPREVENT2 worked with worksites, food stores, schools (grades 2–6), through social media and mailings, and with a local community action committee (CAC), in each of the three intervention communities, and was implemented in six phases. We conducted a process evaluation to assess implementation of each intervention component in terms of reach, dose delivered and fidelity. Implementation of each component was classified as high, medium or low according to set standards, and reported back at the end of each phase, allowing for improvements. The school and worksite components were implemented with high reach, dose delivered and fidelity, with improvement over time. The school program had only moderate reach and dose delivered, as did the social media comp...
This case–control study compares the home garden and animal husbandry practices of households wit... more This case–control study compares the home garden and animal husbandry practices of households with and without xerophthalmic children in south-central Nepal, focusing on the relationship between these practices and household intake of vitamin A–rich foods. Eighty-one households with a child between the ages of one and six years diagnosed with xerophthalmia (cases) and 81 households with an age-matched, non-xerophthalmic child (controls) were studied. There was little difference between case and control households in the size of their gardens. However, case households were significantly less likely to plant carotenoid-rich vegetables from October to March than were control households (odds ratio, 0.39; 95% confidence interval, 0.16 to 0.96). The mean consumption of non-carotenoid-rich vegetables, but not of carotenoid-rich vegetables, increased linearly with garden size. Case households were significantly more likely than control households to rent domesticated animals from others (χ...
The Mortality (Pathway) Survey Manual describes a methodology for capturing quantitative and qual... more The Mortality (Pathway) Survey Manual describes a methodology for capturing quantitative and qualitative data on care giving and care seeking during a catastrophic illness (death). The methodology is based on a conceptual model for care seeking called the Pathway to Survival. The Pathway delineates all the steps that may occur during a child’s illness—the decisions made the different actors involved the care provided at home and in facilities and whether providers and care takers complied with recommendations and standards. By evaluating each of the steps in the Pathway the methodology can clarify the public health importance of different interventions and health sector investments. The Manual contains guidelines and all of the materials a survey planner will need for implementing a mortality (pathway) survey. From questionnaires to how to do the sampling or set up a mortality surveillance the manual contains materials and step by step instructions for doing the survey at national and district levels. (authors)
Objectives Multilevel, multicomponent (MLMC) interventions are a promising strategy to address ob... more Objectives Multilevel, multicomponent (MLMC) interventions are a promising strategy to address obesity, yet they are complex to implement with sufficient intensity. We report on the process evaluation of a MLMC to prevent/reduce obesity in Native American (NA) adults. Methods OPREVENT2 is a recently completed MLMC intervention in six NA communities (3 intervention, 3 comparison). OPREVENT2 worked with food stores to increase access to and promote healthy food choices, worksites to provide nutrition education and to improve physical activity (PA) opportunities, schools to educate children (grades 2–6) to act as change agents, media to reinforce key messages, and through a policy-oriented community action committee (CAC). OPREVENT2 was implemented in six phases targeting various foods, PA strategies and related behaviors. Implementation standards were set for each component and assessed reach, dose delivered, and fidelity. Data were collected using a combination of REDCap-programmed t...
The American journal of clinical nutrition, Apr 1, 1999
Training in portion-size estimation is known to improve the accuracy of dietary self-reporting in... more Training in portion-size estimation is known to improve the accuracy of dietary self-reporting in adults, but there is no comparable evidence for children. To obtain this information, we studied 110 second- and third-grade American Indian schoolchildren (34 control subjects were not trained), testing the hypotheses that a 45-min portion-size estimation training session would reduce children's food quantity estimation error, and that the improvement would be dependent on food type, measurement type, or both. Training was a hands-on, 4-step estimation and measurement skill-building process. Mixed linear models (using logarithmic-transformed data) were used to evaluate within- and between-group differences from pre- to posttest. Test scores were calculated as percentage estimation errors by difference and absolute value methods. Mean within-group estimation error decreased significantly (P<0.05) from pre- to posttest for 7 of 12 foods (trained group) by both calculation methods,...
The food environment has a great impact on the nutritional health of the population. Food environ... more The food environment has a great impact on the nutritional health of the population. Food environment interventions have become a popular strategy to address the obesity epidemic. However, there are still significant gaps in our understanding of the most effective strategies to modify the food environment to improve health. In this review, we examine key gaps in the food environment intervention literature, including the need for: developing appropriate formative research plans when addressing the food environment; methods for selecting intervention domains and components; incorporating food producers and distributors in intervention strategies; strengthening evaluation of environmental interventions; building the evidence base for food environment interventions in diverse settings; engaging policy makers in the process of modifying the food environment; and creating systems science models to examine the costs and benefits of a potential program or policy on the food environment pri...
Disparities in healthy food access commonly exist in urban low-income neighborhoods, where small ... more Disparities in healthy food access commonly exist in urban low-income neighborhoods, where small food stores predominate. What is not commonly understood is the supply network of these small food s...
OPREVENT2 was a multilevel, multicomponent (MLMC) adult obesity prevention that sought to improve... more OPREVENT2 was a multilevel, multicomponent (MLMC) adult obesity prevention that sought to improve access and demand for healthier food and physical activity opportunities in six Native American communities in the Southwest and Midwest. OPREVENT2 worked with worksites, food stores, schools (grades 2–6), through social media and mailings, and with a local community action committee (CAC), in each of the three intervention communities, and was implemented in six phases. We conducted a process evaluation to assess implementation of each intervention component in terms of reach, dose delivered and fidelity. Implementation of each component was classified as high, medium or low according to set standards, and reported back at the end of each phase, allowing for improvements. The school and worksite components were implemented with high reach, dose delivered and fidelity, with improvement over time. The school program had only moderate reach and dose delivered, as did the social media comp...
This case–control study compares the home garden and animal husbandry practices of households wit... more This case–control study compares the home garden and animal husbandry practices of households with and without xerophthalmic children in south-central Nepal, focusing on the relationship between these practices and household intake of vitamin A–rich foods. Eighty-one households with a child between the ages of one and six years diagnosed with xerophthalmia (cases) and 81 households with an age-matched, non-xerophthalmic child (controls) were studied. There was little difference between case and control households in the size of their gardens. However, case households were significantly less likely to plant carotenoid-rich vegetables from October to March than were control households (odds ratio, 0.39; 95% confidence interval, 0.16 to 0.96). The mean consumption of non-carotenoid-rich vegetables, but not of carotenoid-rich vegetables, increased linearly with garden size. Case households were significantly more likely than control households to rent domesticated animals from others (χ...
The Mortality (Pathway) Survey Manual describes a methodology for capturing quantitative and qual... more The Mortality (Pathway) Survey Manual describes a methodology for capturing quantitative and qualitative data on care giving and care seeking during a catastrophic illness (death). The methodology is based on a conceptual model for care seeking called the Pathway to Survival. The Pathway delineates all the steps that may occur during a child’s illness—the decisions made the different actors involved the care provided at home and in facilities and whether providers and care takers complied with recommendations and standards. By evaluating each of the steps in the Pathway the methodology can clarify the public health importance of different interventions and health sector investments. The Manual contains guidelines and all of the materials a survey planner will need for implementing a mortality (pathway) survey. From questionnaires to how to do the sampling or set up a mortality surveillance the manual contains materials and step by step instructions for doing the survey at national and district levels. (authors)
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Papers by J. Gittelsohn