Department of Human Nutrition, Foods, and Exercise

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Browsing Department of Human Nutrition, Foods, and Exercise by Subject "1117 Public Health and Health Services"

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    Coronary Heart Disease (CHD) Risk Factors and Metabolic Syndrome in HIV-Positive Drug Users in Miami
    Baum, Marianna K.; Rafie, Carlin; Lai, Shenghan; Xue, Lihua; Sales, Sabrina; Page, J. Bryan; Berkman, Ronald; Karas, Linden; Campa, Adriana (Science Publications, 2006-01)
    The frequency of coronary heart disease (CHD) is increasing among HIV seropositive persons. This phenomenon may be related to HIV disease itself, the use of antiretroviral medications and increased length of survival, or the synergism of these factors. In this study we have calculated the 10-year CHD risk estimate and the prevalence of metabolic syndrome in a cohort of 118 HIV seropositive chronic drug users, including those who are on HAART with or without protease inhibitors (PI). The results showed that the 10-year coronary heart disease risk among the HIV seropositive drug users was 4.8 ± 5.7, which is within the range of results published for other HIV infected cohorts. The 10-year CHD risk was significantly higher in men (5.9±6.1, p<0.001) than in women (1.7±2.4), due to their gender and the pre-menopausal mean age of the women (39.4±7.3 years of age), despite a significantly higher rate of abdominal obesity (54.8% in women vs. 8.1% in men, p<0.001) and lower HDL (61.3% in women vs. 40% in men, p=0.042). The rate of metabolic syndrome among our female HIV seropositive drug users was significantly higher (29% vs 10.3%, p=0.013) compared to men (10.3%). Participants with metabolic syndrome had a significantly higher 10-year CHD risk (27.8% vs. 10.2%, p=0.041) and higher mean BMI (28.6 ± 4.1 vs. 24.2±4, p<0.001) than those without the syndrome. The predominant proportion of the cohort had a high viral load, suggesting that their use of illicit drugs has an influence on either adherence or effectiveness of antiretroviral medication. Increased viral load was significantly associated with metabolic syndrome (OR=2.23, 95% CI:1.12, 4.47; p=0.023), high fasting glucose (OR=1.61, 95% CI: 1.02, 2.55; p=0.042) and low HDL levels (OR=1.41, 95% CI: 1.01, 1.98; p=0.046), after controlling for age gender, smoking, PI exposure, BMI and CD4. HAART with or without PI did not significantly impact the 10-year CHD risk estimate or metabolic syndrome in this cohort. The estimated effect of PI, however, was positively and significantly related to triglyceride levels (effect estimate=95.81; 95% CI:39.40, 152.21; p<0.01) after controlling for age, gender, smoking, viral load, CD4 cell count and BMI. Heavy use of cigarettes and crack/cocaine was inversely associated with obesity (OR=0.84, 95% CI:0.67, 0.99; p=0.049; OR=0.43, 95% CI:0.19, 0.98; p=0.044, respectively), while use of marijuana tended to be associated with increased central obesity (p=0.08). Heavy cigarette smoking was significantly associated with low HDL (OR=3.06, 95% CI:1.18; 7.95, p=0.02). The significant association of higher viral load with CHD risk indicates that controlling viral load may be important in reducing CHD risk in HIV infected drug users.
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    Developing a Master Food Volunteer Continuing Education Program: A Model for Volunteer Capacity Building
    Jiles, Kristina A.; Chase, Melissa W.; Hosig, Kathy L.; Wenzel, Sophie; Schlenker, Eleanor; Rafie, Carlin (2019-04-30)
    We developed a master food volunteer (MFV) continuing education program (CEP) for MFVs assisting Extension agents with a diabetes self-management program. Our development process included two phases of pilot testing. First, seasoned MFVs tested and provided formative feedback on the first iteration of the MFV CEP modules. After revising the modules in response to their feedback, we evaluated program effectiveness by comparing pretraining/posttraining score change between MFVs who had completed the training (intervention group) and those who had not (comparison group). All test scores increased for intervention group members, whereas half declined for comparison group members. Our process of developing enhanced education to address program-specific volunteer capacity building has broad applicability.
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    Implementation and outcomes of the Balanced Living with Diabetes program conducted by Cooperative Extension in Rural Communities in Virginia
    Rafie, Carlin; Hosig, Kathy L.; Wenzel, Sophie; Borowski, Shelby; Jiles, Kristina A.; Schlenker, Eleanor (2021-08)
    Introduction: Adult onset diabetes is a significant health issue in rural communities that are disproportionately suffering from the health, social and financial costs of the disease. Despite this, over half of rural counties in the USA lack access to diabetes selfmanagement programs, which are effective at improving diabetes management. The Cooperative Extension System (CES) is a nationwide education network that provides research-based information and programs in nearly 3000 counties in the USA to improve the health and wellbeing of rural and urban communities. This study evaluated the implementation and outcomes of a lifestyle management program, Balanced Living with Diabetes (BLD) conducted by community-based educators who are part of the CES in rural Virginia, to address the gap in diabetes education in these communities. BLD is grounded in social cognitive theory and has shown efficacy to modify dietary and physical activity behaviors resulting in improved glycemic control in people with type 2 diabetes. Methods: The study evaluated the implementation and effectiveness of BLD programs conducted by the CES in 16 rural counties over 2 years. Program adoption, reach, context, and barriers and facilitators to implementation were evaluated through program outcome data and extension educator interviews. Program outcomes included change in weight, glycosylated hemoglobin (A1C), diabetes knowledge, self-management practices, diet and physical activity behaviors, and self-efficacy from baseline to 12-week assessment. Results: Extension educators conducted 30 programs, reaching 290 residents, with a 58% mean retention rate. The program resulted in a significant increase in diabetes and food knowledge, fruit, vegetable, and whole grain intake, use of the plate method, exercise, and diabetes management self-efficacy. A1C decreased significantly in participants with diabetes (mean reduction=0.345±1.013; p=0.001). The program was conducted twice in 11 counties, and once in five counties. Barriers to program adoption in the five counties included limited community interest, competing program priorities of the extension educator, and loss of extension personnel to conduct the program. Participant communication materials and systems to enhance program sustainability were developed in response to educator feedback. Process evaluation indicated that the program was highly acceptable to extension educators and program participants. Conclusion: The CES is an effective network for implementation of diabetes lifestyle-management programs in underserved communities, and the BLD program is effective at increasing lifestyle behaviors and self-efficacy that improve glycemic control in people with type 2 diabetes. Collaboration by Virginia’s CES with a variety of community partners, including healthcare and social service providers, increases the reach and sustainability of extension diabetes programs. The CES in the USA is well positioned to fill the gap in diabetes education in rural communities as part of a chronic care model.
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    One Small Step in the Lecture Hall, One Big Step for Student Motivation: Short Bursts of In-Class Small Group Work
    Anderson, Angela S. (SAGE, 2021-06-01)
    Great teachers are continually introducing strategies to engage students, especially those who teach large-lecture classes, whose format can limit active learning and student motivation to engage in learning. Implementation of active teaching strategies must be assessed for effectiveness. Using the simple MUSIC model postcourse assessment survey, student motivation to engage in learning was statistically quantified. A simple short intervention of in-class group work led to significant areas of improvement, which included the students’ perception of the class’ Usefulness towards their future career (p <.01), their perceived ability for Success in the class (p <.01), their Interest in the material (p <.01), and their perception of the instructor Caring about their success (p <.05). No change was seen in eMpowerment. In addition, students rated the ease of the class (p <.01) and the overall satisfaction with the course (p <.01) significantly higher than the previous semester, prior to the in-class group work implementation. The implementation of this short simple intervention of in-class group work was highly successful in increasing student motivation in a large-lecture, in-major required exercise and health class and can be easily adapted to other large-lecture classes.
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    Opportunities to Reduce Cancer Barriers: Community Town Halls and Provider Focus Groups
    Mosavel, Maghboeba; Rafie, Carlin; Cadet, Debbie L.; Ayers, Antoinette (Springer, 2012-09-01)
    This paper presents the findings from town hall meetings held with community residents and focus groups with health care providers. A total of five town halls (N = 139) were conducted. Four were conducted in English and a fifth was conducted in Spanish to obtain the input of the local Hispanic community. Surveys were provided to town hall participants to assess their perceptions of cancer and screening as well as their cancer screening behaviors. Participants were asked questions designed to determine local gaps and needs in health and cancer care, and their attitudes regarding breast cancer resources, education, treatment, and clinical trials. Additionally, four focus groups (N = 45) were held with a wide range of providers to obtain their perspectives on barriers to breast cancer screening, local cancer prevention and care, and clinical trials. Results indicate gaps in local resources and support services, particularly in terms of education and integrated care. © 2012 Springer Science+Business Media New York.
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    Reaching Hard to Reach Populations with Hard to Communicate Messages: Efficacy of a Breast Health Research Champion Training Program
    Rafie, Carlin; Ayers, Antoinette; Cadet, Debbie; Quillin, John; Hackney, Mary H. (Springer, 2015-09-01)
    A Breast Health Research Champion training program was a developed targeting self-identified community breast health advocates from a predominant African-American community with a significant breast cancer mortality disparity. Twelve individuals completed the program that provided training in breast cancer risk and screening, breast cancer research, biospecimen in cancer research, and human research subject protection. The training emphasized four key messages to be disseminated to the community. Trainees hosted a minimum of two social chats with individuals from their social networks and functioned as community researchers, acquiring consent and gathering follow-up data from attendees. Trainees reached 199 individuals from their social networks, and chats were diverse in the venue selected, mode of message transmission, and the audience reached. Post/pre questionnaire data from attendees at the chats showed significant improvement in knowledge, attitudes, and intended behaviors as it relates to breast cancer screening, clinical research, and biospecimen in research. Forty percent of attendees provided 4-week follow-up information. Of respondents eligible for mammography, 38 % had taken action to be screened, and 86 % of respondents had spoken about the information to someone else in their social network. Trainees expressed feelings of empowerment after completing the project, “feeling like the expert,” and all trainees were surprised at the enthusiastic response from attendees of their chats. Trainees continued to disseminate the information learned from the training program during the 6 months following the training, reaching an additional 786 individuals in the community.