JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION

AN EXAMINATION OF AT-HOME FOOD PREPARATION ACTIVITY AMONG LOW-INCOME, FOOD-INSECURE WOMEN

MCLAUGHLIN CARRY; TARASUK VALERIE; KREIGER NANCY

A secondary analysis of data from a study of nutritional vulnerability among 153 women in families seeking charitable food assistance was undertaken to estimate the extent and nutritional significance of at-home food preparation activity for these women. At-home food preparation was estimated from women's reported food intakes from three 24-hour recalls. The relationships between food preparation and energy and nutrient intake, food intake, and 30-day household food security status were characterized, Almost all participants (97%) consumed foods prepared from scratch at least once during the three days of observation; 57% did so each day. Both the frequency and complexity of at-home food preparation were positively related to women's energy and nutrient intakes and their consumption of fruits and vegetables, grain products, and meat and alternates. The intakes by women in households with food insecurity with hunger reflected less complex food preparation but no less preparation from scratch than women in households where hunger was not evident, raising questions about the extent to which food skills can protect very poor families from food insecurity and hunger. Our findings indicate the need for nutrition professionals to become effective advocates for policy reforms to lessen economic constraints on poor households. J Am Diet Assoc. 2003; 103:1506-1512. FOOD, DIET, SELF IMAGE, WOMEN, LOW INCOME GROUPS

A VIDEO LESSON SERIES IS EFFECTIVE IN CHANGING THE DIETARY INTAKES AND FOOD-RELATED BEHAVIORS OF LOW-INCOME HOMEMAKEERS

COX RUBY H; WHITE ALICIE H; GAYLORD CLARK K

Objective To examine the relative cost-effectiveness of a self-administered video series in delivering nutrition education to low-income homemakers. Design A quasi-experimental design was used, with subjects randomly assigned to traditional lessons (Traditional Group) or video lessons (Video Group). Subjects/setting 108 subjects were recruited, with 93 nonpregnant, low-income, female homemakers completing the study (response rate = 86%). Subjects had recently enrolled in the Expanded Food and Nutrition Education Program, or the Food Stamp Nutrition Education Program, and had a videocassette recorder and telephone. Intervention Both groups received 12 lessons from the Eating Right Is Basic Series, 3rd edition, with the Traditional Group being taught in face-to-face sessions and the Video Group receiving self-administered, video-lesson packets. Outcome measures Dietary intake and food behaviors were assessed at pre and post intervention with 24-hour recalls and a 14-item checklist. Statistical analysis chi!sup 2! and t tests were used to compare the groups on demographics and pre-intervention dietary factors. Multiple analysis of variance was used for comparisons of change from pre to post intervention. Results Significant improvements were observed in both groups for fruits, calcium, and vitamins A and C. The Video Group improved on fiber intake (P<=.005). The groups did not differ on dietary or behavior change (P=.2357). Duplication and implementation costs of the video series totaled $4,820, or 36% of the traditional lesson cost of $13,463. Applications Both methods achieved similar improvements in diet and behaviors, but the video method was less expensive. The video series seems to be a cost-effective method for delivering nutrition education to low-income homemakers. DIET, FOOD, BEHAVIOR, LOW INCOME GROUPS

CELIAC DIET: ITS IMPACT ON QUALITY OF LIFE

LEE ANNE; NEWMAN JACQUELINE M

The objective of this study was to determine the effects of a gluten-free diet, examining food consumption and limitations on quality of life for those with celiac disease. Twenty-nine items on self-administered questionnaires queried demographics, lifestyle, and food use. Some items were from the Rand Survey (Rand Corporation, Santa Monica, CA). Most responses used three- or five-point Likert scales. They were mailed to members of the Westchester Celiac Sprue Support Group. Of the 274 responses, 253 were usable and were the basis of the compiled results. Seventy-four percent of the respondents were female; 42% were between the ages of 36 and 55 years of age, and 46% were more than 55 years of age. Frequencies and cross-tabulations indicated several areas of negative impact in maintaining a gluten-free diet. They included the difficulties of dining out (86%), travel (82%), and impact on family (67%) and less of a negative impact on career or work (41%). The gluten-free diet impacted various lifestyle aspects of the quality of life for individuals with celiac disease.JAm Diet Assoc. 2003; 103:1533-1535. DIET, QUALITY OF LIFE, SOCIAL IMPACT

COMPLEMENTARY AND ALTERNATIVE MEDICINE: COMPETENCIES FOR DIETETICS PROFESSIONALS

TOUGER-DECKER RIVA; THOMSON CYNTHIA A

Are dietetics professionals in clinical practice, education, business/industry and research addressing complementary and alternative medicine (CAM) in their professional roles? According to the 2000 Practice Audit conducted by the Commission on Dietetic Registration (1), 18% of entry level (22% of beyond entry level) practitioners reported that they are 'currently performing' CAM in their practice. An additional 46% of entry-level (42% of beyond entry level) practitioners anticipate adding CAM to their practice in the future (1). The incidence and prevalence of CAM use by consumers and health professionals (2-4) have continued to grow over the past several decades. This rapid expansion in both the marketplace and consumer use of CAM therapies has increased the need for health care practitioners to have a solid foundation in CAM (5-7). Although a majority of the literature has focused on physicians, dietetics professionals also need to be educated about CAM to promote comprehensive patient care. In 2002, the ADA appointed a joint Board of Directors/House of Delegates Complementary and Alternative Medicine Taskforce to develop CAM competencies for dietetics practitioners as recommendations and strategies to achieve core competencies among ADA members. The task force included practitioners, educators, and the chair of the Nutrition in Complementary Care (NCC) dietetic practice group (DPG), Roslyn Kulik, along with representatives from the House of Delegates and ADA staff. The purpose of this Commentary is to update the membership on the activities of the Association's Complementary and Alternative Medicine Taskforce. ALTERNATIVE MEDICINE, DIET

DEVELOPMENT AND IMPLEMENTATION OF A VISUAL CARD-SORTING TECHNIQUE FOR ASSESSING FOOD AND ACTIVITY PREFERENCES AND PATTERNS IN AFRICAN AMERICAN GIRLS

SHERWOOD NANCY E; STORY MARY; NEUMARK-SZTAINER DIANE; ADKINS SARAH; DAVIS MARSHA

Objective Card-sorting tasks for assessing food and activity preferences and patterns among African American girls were developed. Associations among food preference and intake frequency, activity preference and frequency, and body mass index were examined. Design Participants completed newly developed card-sorting tasks assessing food and activity preferences and patterns. Height and weight were measured. Subjects/setting Ninety-six 8- to 10-year-old African American girls from schools and community centers in Minneapolis-St. Paul. Main outcome measures Preference and frequency data for 64 foods/beverages and 34 activities. Statistical analyses Frequencies for food and activity preference and frequency categories were computed. Pearson correlations among food and activity preference, frequency, and body mass index were computed. Results High-sugar (eg, fruit drinks, soda) and/or high-fat (eg, ice cream, cookies) foods were among the most popular and frequently consumed. Ninety-six percent of girls liked fruit drinks, with 35% consuming them 'almost every day.' Less-structured activities such as biking, games, jump rope, and dance were most popular. Biking was preferred by 85% of girls, with 48% biking 'almost every day.' Food preference and frequency categories were moderately correlated (r=0.30 to 0.58), as were activity preference and frequency (r=0.37 to 0.49). Applications The card-sorting tasks are useful tools for assessing food and activity preferences and patterns in girls. Obesity prevention programs for African American girls should include preferred activities such as dance, jump rope, and active play. Programs may also benefit from a focus on replacing high fat/ high sugar snacks and sweetened beverages with low-fat, lower- calorie snacks and beverages (eg, fruit, vegetables, water). FOOD, DIET, AFRICAN AMERICANS, GIRLS

DIETETIC TECHNICIANS REPORT LOW TO MODERATE LEVELS OF BURNOUT

FALL MONICA L; WOLF KAY N; SCHILLER M ROSITA; WILSON STEPHEN L

This study identified and described the status of burnout experienced by dietetic technicians (DTRs) in various settings. A questionnaire was sent to a random sample of 300 members from the American Dietetic Association's (ADA's) Dietetic Technician in Practice practice group. The Maslach Burnout Inventory-Human Services Survey was used to measure burnout. On the emotional exhaustion subscale, the respondents reported a mean score of 20.6 (high level of burnout >27), 5.3 on the depersonalization subscale (high level of burnout > 14), and 38.6 on the personal accomplishment subscale (high level of burnout <30). These results suggest that the DTRs as a group perceive themselves to be moderately emotionally exhausted, to have a low level of depersonalization, and to have a high level of personal accomplishment. Further analysis also suggests that DTRs in nontraditional settings experience more personal accomplishment than those in traditional healthcare and foodservice settings. JAm Diet Assoc. 2003; 103:1520-1522. DIET, STUDIES

ENVIRONMENTAL AND BEHAVIORAL FACTORS ARE ASSOCIATED WITH THE CALCIUM INTAKE OF LOW-INCOME ADOLESCENT GIRLS

LEE SEUNGMIN; REICKS MARLA

Based on social cognitive theory, the purpose of this study was to determine whether selected environmental and behavioral factors were associated with the calcium intake of low-income adolescent girls. Teachers in three public middle schools administered a written survey resulting in data from 105 girls (the majority were Asian American). Calcium intake was lower than recommended and was associated with eating breakfast, number of children in the household, availability of some high-calcium foods, and seeing important others drink milk or being encouraged to drink milk. Educational interventions should be targeted to parents in relation to making affordable sources of calcium available and modeling adequate intake to adolescents. JAm Diet Assoc. 2003; 103:1526-1529. BEHAVIOR, CALCIUM, LOW INCOME GROUPS, GIRLS, TEENAGERS

INTERIM REPORT OF THE STATE ISSUES TASK FORCE

OCHS MICHAEL; MCKNIGHT PAT

State laws govern many of the day-to- day activities of dietetics professionals, such as nursing home regulation, Medicaid programs, school health and nutrition education programs, licensure and scope of practice questions, and insurance program regulation. Professional recognition laws for dietetics professionals have now been passed in 44 of the 50 states, as well as in Puerto Rico, Guam, and the District of Columbia. STUDIES, DIET

NONVITAMIN, NONMINERAL SUPPLEMENT USE OVER A 12-MONTH PERIOD BY ADULT MEMBERS OF A LARGE HEALTH MAINTENANCE ORGANIZATION

SCHAFFER DONNA M; GORDON NANCY P; JENSEN CHRISTOPHER D; AVINS ANDREW L

Objective National survey data show an increase in the prevalence of nonvitamin, nonmineral (NVNM) supplement use among adults over the past 10 years. Concern over this trend is based in part on reports of potential drug-supplement interactions. The type and prevalence of supplement use by demographic and behavior characteristics were examined among members of a large group model health plan, including those with selected health conditions. Design Data on the use of herbal medicines and dietary supplements among survey respondents were analyzed. Questions employed a checklist for six specific NVNM supplements with optional write-ins. [Headnote] Subjects/setting A stratified random sample of 15,985 adult members of a large group model health maintenance organization in northern California, who were respondents to a 1999 general health survey. [Headnote] Statistical analyses performed Analyses were conducted with poststratification weighted data to reflect the actual age, gender, and geographic distribution of the adult membership from which the sample was drawn. Results An estimated 32.7% of adult health plan members used at least one NVNM supplement. The most frequently used herbs were Echinacea (14.7%) and Gingko biloba (10.9%). Use of all NVNM supplements was highest among females, 45 to 64 years of age, whites, college graduates, and among those with selected health conditions. Applications Dietetics professionals need to uniformly screen clients for dietary supplement use and provide accurate information and appropriate referrals to users. VITAMINS, DIETARY SUPPLEMENTS, ADULTS

RUBY P. PUCKETT, MA, RD, FCSI, CFE RECEIVES 2003 COPHER MEMORIAL AWARD

The Marjorie Hulsizer Gopher Award is the highest award bestowed upon a member of the American Dietetic Association. The 2003 award is presented to Ruby P. Puckett, MA, RD, FCSI, CFE in recognition of her contributions to the Association and to the profession of dietetics. AWARDS & HONORS, RESEARCHERS, DIET

PCS OR PAPER AND PENCIL: ONLINE SURVEYS FOR DATA COLLECTION

WHARTON CHRISTOPHER M; HAMPL JEFFREY S; HALL RICK; WINHAM DONNA M

Over the last few decades, industrialized countries have come to rely on computers for immediate data processing. As the rate of information gathering and sharing continues at a feverish rate, new technologies have emerged to keep pace with society's demands. For example, the Internet has become widely used for information handling and global communication. As a massive network of networks, the Internet connects millions of computers together globally; within this infrastructure, any computer can communicate with any other as long as they both are connected to the Internet. ONLINE INFORMATION SERVICES, POLLS & SURVEYS, DATA COLLECTION, DIET

JAMES O. HILL, PHD, AND BARBARA J. ROLLS, PHD AWARDED HONORARY MEMBERSHIPS

In October 2003, at the 86th Annual Meeting and Exhibition in San Antonio TX, the American Dietetic Association awarded honorary memberships to James 0. Hill, PhD, and Barbara J. Rolls, PhD. RESEARCHERS, AWARDS & HONORS

MEMBERS HONORED WITH EXCELLENCE ON PRACTICE AWARDS

At the 86th Annual Meeting and Expo, the American Dietetic Association and its Foundation honored 4 dietitians for their excellence in practice. The awards recognize an outstanding dietitian who has demonstrated excellence in a specific area of practice. RESEARCHERS, DIET, AWARDS & HONORS

MEMBERS HONORED AS MEDALLION AWARD WINNERS

Recipients of the American Dietetic Association's (ADA) Medallion award are listed. AWARDS & HONORS, DIET

MEASURING FRUIT AND VEGETABLE CONSUMPTION: PROVIDING SERVING SIZE INFORMATION DOUBLES ESTIMATED PERCENT EATING FIVE PER DAY

BENSLEY LILLIAN; VAN EENWYK JULIET; BRUEMMER BARBARA A

Measuring the extent to which individuals meet the 5 A Day dietary recommendation for fruits and vegetables can provide information on the effectiveness of public health efforts to increase consumption of these foods. However, dietary measurement is complicated by the issue of serving size. We compared two methods of measuring fruit and vegetable consumption using a random-digit-dialed telephone survey of 917 Washington state adults. The survey included two sets of questions about fruit and vegetable consumption, one providing and the other not providing standard definitions of serving size. The specific wording of questions had a large effect on the conclusions about levels of fruit and vegetable consumption. Although only 26% of respondents met the 5 A Day recommendations without serving size information, 50% met these recommendations when using a measure that included a definition of serving size. J Am Diet Assoc. 2003; 103:1530-1532. FRUITS, VEGETABLES, DIET

DECISION-MAKING PATTERNS FOR DIETARY SUPPLEMENT PURCHASES AMONG WOMEN AGED 25 TO 45 YEARS

MILLER CARLA K; RUSSELL TERI; KISSLING GRACE

Women frequently consume dietary supplements but the criteria used to select supplements have received little investigation. This research identified the decision-making criteria used for dietary supplements among women aged 25 to 45 years who consumed a supplement at least four times per week. Participants (N=51) completed an in-store shopping interview that was audiotaped, transcribed, and analyzed qualitatively for the criteria used to make supplement selections. Qualitative analysis revealed 10 key criteria and the number of times each person used each criterion was quantified. Cluster analysis identified five homogeneous subgroups of participants based on the criteria used. These included brand shopper, bargain shopper, quality shopper, convenience shopper, and information gatherer. Supplement users vary in the criteria used to make point-of-purchase supplement selections. Dietetics professionals can classify supplement users according to the criteria used to tailor their nutrition counseling and better meet the educational needs of consumers. JAm Diet Assoc. 2003; 103:1523-1526. DECISION MAKING, DIETARY SUPPLEMENTS, WOMEN

FOOD MIXTURE OR INGREDIENT SOURCES FOR DIETARY CALCIUM: SHIFTS IN FOOD GROUP CONTRIBUTIONS USING FOUR GROUPING PROTOCOLS

COOK ANNETTA J; FRIDAY JAMES E

Identifying dietary sources of nutrients by assigning survey foods to food groups can under- or overestimate the contribution a group makes to the intake of specific nutrients. Using calcium and food intakes from USDA's 1994-1996, 1998 Continuing Survey of Food Intakes by Individuals, the authors determined the proportion of dietary calcium from the dairy, grains, meats, fruits, and vegetables groups using four grouping protocols. Calcium contributions from milk and cheese were higher as more ingredient sources and fewer survey food items were represented in the dairy group. Milk, cheese, and yogurt reported as separate survey food items contributed 42% of total calcium intake. An additional 21% of dietary calcium came from dairy ingredients in mixed foods such as macaroni and cheese, pizza, sandwiches, and desserts. The remaining dietary calcium sources were single grains (16%); vegetable (7%); meat, poultry, and fish (5%); fruit (3%); and miscellaneous foods (7%). Data quantifying the nutrient contributions from dairy ingredients could affect dietary guidance messages or research using dairy foods as variables. JAm Diet Assoc. 2003; 103:1513-1519. FOOD, DIET, CALCIUM

NUTRITION DIAGNOSING AND ORDER WRITING: VALUE FOR PRACTITIONERS, QUALITY FOR CLIENTS

SILVER HEIDI J; WELLMAN NANCY S

Although the words have changed today from recognition to value, the issue for our profession continues to be one of respect-and indispensability (1). Recent articles in this Journal have addressed the need to increase the value of the profession (1,2). Some have discussed expanding clinical privileges, including nutrition diagnosing and order writing. Similar discussions go back years as part of the general theme of improving professional status and the scope of dietetics practice. In 1988, Koteski and McKinney (3) suggested expanding health-related tasks to increase understanding and respect for the contributions of dietitians. NUTRITION

WAYS DIETITIANS OF DIFFERENT GENERATIONS CAN WORK TOGETHER

BROWN DAMON

Baby Boomers. Traditionalists. Generation Xers and Yers. Never before has there been a time with so many distinct generations in the workplace. As a result communication issues have become crucial, with patience and understanding necessary to get younger generations involved in organizations such as ADA. GENERATIONS, DIET, TRENDS

WHAT KIDS SAY THEY DO AND WHAT PARENTS THINK KIDS ARE DOING: THE ADAF/KNOWLEDGE NETWORKS 2003 FAMILY NUTRITION AND PHYSICAL ACTIVITY STUDY

MOAG-STAHLBERG ALICIA; MILES AIDA; MARCELLO MELISSA

Nearly three years ago the decision was made for the ADA Foundation (ADAF) to focus on childhood overweight as its core public health issue. The initiative began with an Obesity Summit (January 2001) that identified the family as a primary audience and area for focus. Since the December 2001 landmark report by the Surgeon General, Call to Action to Prevent and Decrease Obesity, rarely a day goes by without a media story on the obesity epidemic with special emphasis on children and their environment. Because of this national health crisis, and our professional skill set, the dietetics professional has an unprecedented opportunity to play a critical role in both prevention and treatment efforts for childhood overweight. US culture has experienced profound changes over the last 40 years-the family structure and maternal employment has changed significantly since the 1960s. In 1960, only 9% of children lived in single-parent households, and by 1998 that number rose to 27% (3). There has also been substantial growth in maternal employment, with 74% of mothers with children aged 6-17 being employed outside the household (3). This trend alone has implications on many areas of family life including fewer family meals, less time for meal preparation, and increased demand for convenience and prepared foods. In addition, longer work hours and distances to travel for work coupled with advances in technology can produce overall less physical activity for the entire family. CHILDREN & YOUTH, PARENTS & PARENTING, NUTRITION, STUDIES, DIET