OREGON STATE UNIVERSITY

college of public health and human sciences

Photos show promise as dietary assessment tool, but more training needed

CORVALLIS, Ore. – Research at Oregon State University suggests that photographs of your food are good for a lot more than just entertaining your friends on social media – those pictures might help improve your health and also national nutrition policy.

But before that can happen, universities that educate the dietitians who review the photos need to provide more consistent, formal training, particularly hands-on work in food measurement and preparation and the use of computerized nutrient database systems.

A shortage of formalized, standardized training in these skills is problematic, the study shows. Results were recently published in the journal Nutrients.

The research tested the ability of 114 nutrition and dietetics students in the U.S. and Australia to identify foods and determine serving sizes by looking at photos of food on plates. They chose their food identification answers from entries in the U.S. Department of Agriculture’s Food and Nutrient Database for Dietary Studies.

The students correctly identified the nine different foods nearly 80 percent of the time but struggled with serving size; only 38 percent of the estimates were within 10 percent of the actual weight of the food, with foods of amorphous shape or higher energy density, such as ice cream, proving the hardest to assess.

Image-based dietary assessment, or IBDA, aims to reduce or eliminate the inaccuracies that commonly accompany traditional methods such as written dietary records, 24-hour dietary recalls and food frequency questionnaires.

Dietary intake information is important both to individuals using nutrition-based therapy for conditions such as diabetes and heart disease, and to entire populations for identifying nutrition and disease risk.

The U.S. Centers for Disease Control and Prevention uses information from its National Health and Nutrition Examination Survey to set policy for everything from school lunch programs to nutrition education for food-stamp recipients. The survey gathers data about dietary patterns and potential food intake inadequacies.

“We need to know where there are inadequacies in these surveys to identify nutrition and food policy and research needs,” said the study’s corresponding author, Mary Cluskey, an associate professor in OSU’s College of Public Health and Human Sciences and a registered dietitian.

With the prevalence of smartphones, photography is emerging as a means of augmenting food-intake information gathering. A pre-diabetes patient, for example, could take a picture of everything he ate for three days, and a dietitian could then analyze those photos to make recommendations for dietary improvements.

“If you’re providing me with your dietary intake information, you may not be trying to falsify the information, because you’re sincerely interested in improving your diet,” Cluskey said. “But I’m depending on your ability to recall what you ate and your ability to correctly tell me what portions and specific ingredients you had – there are all kinds of things that can make it go wrong.

“Images can facilitate your recall,” Cluskey added, “and they also prompt important questions from a dietitian: ‘Was that low-fat dressing or high-fat?’ Plus, images make dietary assessments more entertaining because people do like to take pictures of food.”

Students with a food preparation background that included cooking from recipes and frequently measuring portions performed better than those without that type of background, suggesting that future training of dietetics students should incorporate more of those types of experiences.

“We also need to work with people on their ability to take photos,” Cluskey said. “Shoot at a 45-degree angle to the food, preferably while you’re standing, and make sure you have adequate light. We want to make it as easy as possible for people to provide information that’s as accurate as possible.”

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Vitamin E deficiency linked to embryo damage, death

CORVALLIS, Ore. – Researchers for the first time have explained how deficient levels of vitamin E can cause neurologic damage to an embryo, failure to normally develop and ultimately death – a process that in women can be one cause of miscarriage.

The research was published by scientists from Oregon State University in Free Radical Biology and Medicine. It answers some questions about the biologic activities of vitamin E that have been debated since 1922, when this essential micronutrient was first discovered, in part for its role in preventing embryonic mortality.

The research also made clear the importance of vitamin E status for any woman who is planning to, or might become pregnant, scientists said.

The study, done with zebrafish embryos, showed that severe vitamin E deficiency causes the depletion of essential fatty acids, especially the omega-3 fatty acid DHA, which has been shown to be of critical importance to health in multiple studies in recent years.

When this happens, cells use glucose to prevent or reduce damage. Lacking glucose for energy, many physical and neurologic features, especially the brain, simply don’t get built, and death can be the result. Restoration of glucose can repair some of the damage, but some physical deformities remain.

In the growing embryo of a zebrafish – which goes from a cell to a swimming fish in about five days – a severe vitamin E deficiency causes 70-80 percent mortality, the study showed.

“Vitamin E has many biologic roles, only one of which is to serve as an antioxidant,” said Maret Traber, a professor in the OSU College of Public Health and Human Sciences, and Ava Helen Pauling Professor in the Linus Pauling Institute.

“In the growing embryo, vitamin E plays a major role in protecting essential fats such as DHA. Loss and oxidation of these fats can begin a chain reaction that involves glucose, depletes the cell of other antioxidants such as vitamin C, robs the cell of energy, and ultimately has a lethal outcome.”

When vitamin E is deficient, the embryonic brain is literally starved of necessary energy and nutrients, particularly DHA and choline, the researchers concluded in their study.

The neurological development of zebrafish is very similar to that of humans, Traber said, which make them a good model for this research.

“The importance of vitamin E in embryonic development, the very earliest days of vertebrate life, is part of what actually led to its discovery,” Traber said. “Since then we’ve learned much more about the need for this micronutrient in women. One study done in Bangladesh, for instance, showed that pregnant women with lower levels of vitamin E had double the risk of miscarriages as another group with adequate nutrition.”

Nutrition surveys suggest that about 96 percent of women in the U.S. have inadequate intakes of vitamin E in their diet, Traber said. The problem may be of even greater concern in young adult women who avoid high-fat foods and may not have a diet rich in oils, nuts and seeds, some of the foods with the highest levels of this micronutrient. The human body can create DHA from some foods, but not vitamin E.

In a human fetus, some of the most critical periods for neurologic and brain development are in the first few weeks of pregnancy. Given the difficulty of obtaining vitamin E in the diet, this would suggest that any woman who is planning to or may become pregnant should take a multivitamin with the recommended daily allowance of vitamin E and some other micronutrients, Traber said.

Collaborators on this research were from the Catholic University of Korea and the University of Southern California. The study was supported by the National Institutes of Health, the National Science Foundation and the Helen P. Rumbel endowment to the Linus Pauling Institute.

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Maret Traber, 541-737-7977

maret.traber@oregonstate.edu

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‘Navigators’ help indigenous cancer patients overcome barriers to diagnosis, treatment

CORVALLIS, Ore. – New research shows that patient “navigators” are a valuable resource for American Indians and Alaskan Natives with cancer as they try to overcome barriers to diagnosis and care, and may offer a path to improved treatment outcomes.

The findings, recently published in the Journal of Primary Prevention, are important because American Indians and Alaskan Natives are stricken with cancer at the same rate as non-Hispanic white people but have lower five-year survivorship rates, and are more likely to die of cancer in general.

Indigenous patients in the Pacific Northwest working with a navigator were almost four times more likely to have a definitive diagnosis within a year of an abnormal screening result than patients without a navigator, the research indicated.

In addition, patients in the study praised their navigators’ ability to provide emotional and logistical support throughout the complicated and often-confusing treatment process. A navigator coordinated patients’ care between multiple providers and agencies and helped connect patients to support groups and other resources.

Megan Cahn, a postdoctoral research associate in Oregon State University’s College of Public Health and Human Sciences, was a co-author of the study along with scientists from the Northwest Tribal Epidemiology Center. The center, one of 12 in the nation, collaborates with the region’s tribes on health-related research, surveillance, training and technical assistance.

The patients in the study all received care through tribal community health clinics, which receive funding from the Indian Health Service. The project was part of a larger program by the National Cancer Institute examining the effectiveness of the patient navigator model in populations with sub-optimal cancer outcomes.

“One of the big concerns for tribal populations is that they have lower screening rates,” Cahn said. “If you don’t screen, then you don’t detect cancer until someone is showing symptoms. A big part of the program was to see if there was a way to get individuals with an abnormal screening result to get a definitive diagnosis, to shorten that window and get treatment in a timely fashion.

“We found that patients enrolled in a navigator program were 3.6 times more likely to have a definitive diagnosis within a year.”

The researchers also learned that not only was the navigator program measurably effective, the patients liked it – an important indicator of the program’s long-term success potential.

“If the patients don’t find it acceptable, the program won’t continue to work,” Cahn said.

A patient navigator was hired by the tribe at each of three tribal clinics in Idaho and Oregon, and researchers interviewed 40 patients for their perceptions of the program. The average age of the participants was 54.4, and 65 percent were female. Thirty-four of the 40 rated the navigator program as “good” or “excellent,” and one added she felt the navigator had saved her life.

In addition to the screening and diagnosis issue, the research found that the main barriers to cancer treatment cited by tribal members were physical and emotional obstacles - symptoms of the cancer itself or side effects from treatment, and “also the emotional response to the diagnosis.”

“There’s a lot of fear and anxiety and shock, and those fears often lead patients to be reluctant to continue with treatment,” Cahn said. “Some of them felt like they had received mistreatment or had been misdiagnosed, plus there were financial barriers: the cost of care and a lack of coordination regarding payment for the services.

“Other barriers were concerns around transportation – some people would have to travel several hours to get treatment, and the availability and cost of public transportation were problems. Navigators could help come up with strategies that were effective for addressing these logistical barriers.”

Sometimes a navigator would accompany a patient to an appointment and help the patient understand what the doctor was saying. Navigators also provided direct emotional support as well as referring patients to support groups.

“Patients said they valued that navigators were part of their communities and respected their culture,” Cahn said. “It made them feel like the navigators were invested in the community and the patients and their families.”

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Millions of people with metabolic syndrome may need more vitamin E

CORVALLIS, Ore. – New research has shown that people with metabolic syndrome need significantly more vitamin E – which could be a serious public health concern, in light of the millions of people who have this condition that’s often related to obesity.

A study just published in the American Journal of Clinical Nutrition also made it clear that conventional tests to measure vitamin E levels in the blood may have limited accuracy compared to tests made in research laboratories, to the point that conventional tests can actually mask an underlying problem.

Vitamin E – one of the more difficult micronutrients to obtain by dietary means – is an antioxidant important for cell protection. It also affects gene expression, immune function, aids in repair of wounds and the damage of atherosclerosis, is important for vision and neurologic function, and largely prevents fat from going rancid.

Nutrition surveys have estimated that 92 percent of men and 96 percent of women in the United States fail to get an adequate daily intake of vitamin E in their diet. It is found at high levels in almonds, wheat germ, various seeds and oils, and at much lower levels in some vegetables and salad greens, such as spinach and kale.

This study was done by researchers in the Linus Pauling Institute at Oregon State University and the Human Nutrition Program at The Ohio State University, as a double-blind, crossover clinical trial focusing on vitamin E levels in people with metabolic syndrome. It was supported by the National Institutes of Health, the National Dairy Council and DSM Nutrition.

“The research showed that people with metabolic syndrome need about 30-50 percent more vitamin E than those who are generally healthy,” said Maret Traber, a professor in the OSU College of Public Health and Human Sciences, and Ava Helen Pauling Professor in the Linus Pauling Institute.

“In previous work we showed that people with metabolic syndrome had lower bioavailability of vitamin E. Our current work uses a novel approach to measure how much vitamin E the body needs. This study clearly demonstrates that people with metabolic syndrome need a higher intake of this vitamin.”

More than 30 percent of the American public are obese, and more than 25 percent of the adults in the United States meet the criteria for metabolic syndrome, putting them at significantly increased risk for cardiovascular disease and type-2 diabetes – primary causes of death in the developed world.

That syndrome is defined by diagnosis of three or more of several conditions, including abdominal obesity, elevated lipids, high blood pressure, pro-inflammatory state, a pro-thrombotic state and insulin resistance or impaired glucose tolerance.

This research, for the first time, also clearly outlined a flaw with conventional approaches to measuring vitamin E.

By “labeling” vitamin E with deuterium, a stable isotope of hydrogen, scientists were able to measure the amount of the micronutrient that was eliminated by the body, compared to the intake. The advanced research laboratory tests, which are not available to the general public, showed that people with metabolic syndrome retained 30-50 percent more vitamin E than healthy people – showing that they needed it. When the body doesn’t need vitamin E, the excess is excreted.

But in the group with metabolic syndrome, even as their tissues were taking up and retaining the needed vitamin E, their blood levels by conventional measurement appeared about the same as those of a normal, healthy person.

“We’ve discovered that vitamin E levels often look normal in the blood, because this micronutrient is attracted to high cholesterol and fat,” Traber said. “So vitamin E can stay at higher levels in the circulatory system and give the illusion of adequate levels, even as tissues are deficient.

“This basically means that conventional vitamin E blood tests as they are now being done are useless.”

The findings support the conclusion that people with metabolic syndrome have higher levels of oxidative and inflammatory stress, scientists said in their conclusion, and require more antioxidants such as vitamins E as a result.

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Maret Traber, 541-737-7977

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Air pollution and lack of physical activity pose competing threats to children in China

CORVALLIS, Ore. – Children and adolescents in mainland China are facing two serious and conflicting public health threats: ongoing exposure to air pollution and an increasingly sedentary lifestyle with little regular physical activity outside school.

Health workers and policymakers need to find ways to address both of these issues so that

children can be more physically active without suffering the health risks caused by exposure to air pollution, an Oregon State University researcher suggests in a new commentary published this month in The Journal of Pediatrics

“The question is how do we balance the virtues of physical activity with the hazards of air pollution?” said Brad Cardinal, a kinesiology professor in the College of Public Health and Human Sciences at Oregon State University and a national expert on the benefits of physical activity. “Ultimately, we have to find ways for people to stay active despite the air pollution.”

Many cities and countries around the world grapple with air pollution issues, but there is particular concern for children growing up in China in part because they tend to commute more on foot or bike and their playgrounds and sports fields are often found near busy streets or highways, Cardinal said. The impacts of air pollution contributed to 1.2 million deaths in 2010. 

At the same time, very few Chinese children today are participating in moderate or vigorous physical activity outside of school, and the number of overweight and obese children in China has more than doubled in the last 25 years.

Children are particularly susceptible to adverse health impacts from both short- and long-term exposure to air pollution, in part because they have higher rates of respiration and tend to take shallower breaths. Air pollution has been associated with increases in asthma, chronic cough and other respiratory problems in children that are likely to be exacerbated by heavy breathing from vigorous exercise, Cardinal said. 

So how do public health officials approach these competing challenges? Cardinal and his co-author, Qi Si of Zhejiang University in China and a former visiting scholar at OSU, suggest the two problems should be addressed together.

They recommend four urgent steps for health officials and policymakers who are grappling with these issues: 

  • Increase awareness among parents, children, health workers, educators, and policymakers on the causes and impacts of air pollution on children and adolescents, as well as the potential harm when coupled with outdoor physical activity
  • Add air quality systems at school sites, so pollution can be measured when and where children are engaging in physical activity
  • Adjust the intensity of outdoor physical activity during the school day on the basis of air pollution monitoring results
  • Educate children about exercising in polluted environments, including instruction to stop activity when they notice problems such as coughing, chest tightness or wheezing

Since schools are the base for much of the physical activity of today’s children, they are a critical piece in addressing both issues, Cardinal said. Monitoring the micro-climate at a school would provide better, more localized information for school officials making decisions about whether children should be outside exercising or at what level of intensity. 

“Doing some kind of physical activity, even if it is not as vigorous, is still better than having no physical activity for the children,” he said.

Clothing accessories or fitness equipment could also be designed to help protect children from pollution during outdoor play activities on days when air quality levels were low, he said.

“The goal is to get people thinking about these complex problems and real-world solutions,” Cardinal said. “The hope is that someone will innovate appropriate solutions for addressing both of these problems.” 

The National Health and Fitness Technology Research Key Laboratory of Zhejiang Province provided support for this project.

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Brad Cardinal, 541-737-2506, brad.cardinal@oregonstate.edu

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Improving child-teacher interactions can reduce preschoolers’ stress levels

CORVALLIS, Ore. – A school-based intervention that promotes warm and caring interactions between a teacher and child can reduce the child’s stress in the classroom, a new study has found.

The intervention was designed for teachers of preschool-aged children and focused on fostering close teacher-child relationships through one-on-one play. Children who participated in the intervention showed reduced levels of the hormone cortisol, an indicator of stress, said Bridget Hatfield, an assistant professor in Oregon State University’s College of Public Health and Human Sciences and lead author of the study.

Researchers believe it is the first time a study has examined the relationship between a teacher-child intervention and a child’s cortisol levels in an early childhood education setting.

The findings highlight the importance of the relationship between child and teacher, and underscore the value of warm and caring interactions, including one-on-one play time between a child and his or her teacher, Hatfield said.

“The big message here is that positive relationships between teachers and students matter,” she said. “What a teacher does in the classroom, the way they behave, their positivity and supportiveness, has an enormous impact on the children and their health.”

The findings were published recently in the journal Prevention Science. The co-author of the paper is Amanda Williford of the University of Virginia. The research was supported in part by grants from the U.S. Department of Education’s Institute of Education Sciences and the American Psychological Association.

About 61 percent of children under the age of five spend time in formal childcare and education settings such as preschool. Past research has shown that this setting may increase children’s stress, which in turn can lead to disruptive classroom behavior.

Children who have frustrating or difficult relationships with their teachers also have shown decreased academic success in kindergarten and their challenging behaviors may increase in intensity as they get older.

“If a child can’t develop a healthy stress response system in early childhood, it limits their ability to develop strong school-readiness skills,” Hatfield said. “That’s why these early teacher-child relationships are so important.”

Hatfield and Williford wanted to see if an intervention designed to improve child-teacher interactions could reduce stress levels in children with challenging behaviors.

In all, 70 teachers and 113 children participated in the study. They were divided into three groups: one group was designated as “business as usual” and the children did not participate in any special activities; one group participated in a “child time” intervention; and one group participated in an intervention called “Banking Time.”

In the child time intervention, the child and teacher spent time playing one-on-one but the teacher was not given any specific guidance or instructions from a consultant for the play period.

Banking Time is a much more formal intervention, designed to foster sensitive, responsive interactions between a teacher and a child, creating a relationship the child and teacher can use as a resource during times of challenge in the classroom.

“When you ‘bank time’ with a child and that relationship, you’re building equity,” Hatfield said. “Then if a conflict arises, you can make a withdrawal.”

To build that relationship, the teachers and children participating in the study had one-on-one play sessions. Consultants directed the teachers in key elements of the program: allowing the child to lead the play sessions, carefully observing and narrating the child’s behavior, describing the child’s positive and negative emotions, and being available as an emotional resource.

Using saliva samples that were assayed for cortisol, researchers found that children whose teachers participated in the Banking Time intervention showed declines in cortisol levels during the school day compared to those in the business as usual group.

Children in the child time intervention also showed some benefits from the one-on-one time, but they were not as significant. Hatfield said additional research is needed to better understand the effects of the Banking Time intervention and what, in particular, is having the positive impact on the teacher-child relationship.

“Is it one thing, or a combination?” she asked. “We know there is something meaningful about that one-on-one time within Banking Time and we want to know more about how we may be able to incorporate that into classrooms every day.”

It may difficult for preschool teachers and early childhood educators to spend 15 minutes a week in one-on-one play with each child in their class, Hatfield said, but even small, positive, one-on-one interactions could have a valuable impact over time.

“Spending even five minutes, once a week in a one-on-one with a child can help you get to know them, what they think and what they might be interested in,” she said. “That investment could pay off during a challenging time later on. It’s the quality of the time that matters.”

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Bridget Hatfield, 541-737-6438, Bridget.hatfield@oregonstate.edu

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Parenting classes benefit all, especially lower-income families

CORVALLIS, Ore. – Parenting education can improve the skills of every mom and dad and the behavior of all children, and it particularly benefits families from low-income or otherwise underserved populations, a new study from Oregon State University suggests.

Researchers examined a sample of more than 2,300 mothers and fathers who participated in parenting education series in the Pacific Northwest between 2010 and 2012. The series, designed to support parents of children up to 6 years old, typically lasted nine to 12 weeks and consisted of one one-hour session per week led by a parent education facilitator. There was no fee for participants. 

The study, part of a growing partnership between the OSU College of Public Health and Human Sciences and the Oregon Parenting Education Collaborative to increase access to parenting education for all families, may remove some of the stigma attached to parenting education, which has historically been associated with court orders for parents who’ve run afoul of child-protective laws.

“Parenting education works across the board,” said John Geldhof, an OSU assistant professor of behavioral and health sciences. “All parents can benefit. The way people typically learn parenting is from their parents and from books, and often times what they’ve learned is out of date and not the best practices for today. All parents – high income, low income, mandated, not mandated – can benefit from evidence-based parenting education.”

Neglectful or otherwise ineffective parenting strategies, which can be heightened by economic strain, can put children in jeopardy. While many parenting practices can lead to favorable outcomes in children, research indicates that the optimal combination usually features high levels of support and monitoring and the avoidance of harsh punishment. Those positive outcomes include higher grades, fewer behavior problems, less substance use, better mental health and greater social competence.

Findings of the OSU research, recently published in Children and Youth Services Review, indicate that parent education series serving predominantly lower-income parents resulted in greater improvements in their skills and their children’s behaviors compared to series serving higher-income parents.

“The results provide preliminary evidence that parenting education may be most effective when it targets underserved populations,” said lead author Jennifer Finders, a graduate student in the College of Public Health and Human Sciences. “Another thing that’s exciting - the Oregon Parenting Education Collaborative classes that are offered are general in content, and we’re seeing evidence that they’re being adapted for diverse families. This suggests that the local parenting educators are implementing the programs with fidelity and also with flexibility.”

Finders called the results “really great preliminary findings.”

“Now we need to better understand the mechanisms that underlie the findings so we can tailor programs to specific families in exciting ways for research and for practice,” she said. “This highlights the need for future research that continues to involve the Oregon Parenting Education Collaborative and other researchers at OSU and elsewhere. We think parents are gaining knowledge of child development, tools for dealing with the stresses of parenting, and social networks.”

The collaborative includes among its leadership Shauna Tominey, assistant professor of practice and parenting education specialist at OSU’s Hallie E. Ford Center for Healthy Children & Families, part of the College of Public Health and Human Sciences. The parenting education series the collaborative offers are delivered at no cost to the parents.

“Given that the gap is widening between the white, middle-class population of children and children belonging to the growing low-income and Latino populations, examining the relative impact of parenting education programs across these diverse populations is essential,” Finders said. “We think parenting education can have the greatest impact by adapting existing curricula to be culturally relevant and sensitive to diverse children and families’ needs.”

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Policy changes needed for promoting physical activity in group home settings

CORVALLIS, Ore. – Increased physical activity for group home residents and the potentially huge health care savings that could come with it hinge on people who run the homes making health-promoting behaviors a priority.

Physical inactivity and high rates of chronic conditions are public health concerns for people with intellectual disabilities, said postdoctoral scholar Alicia Dixon-Ibarra of the Oregon State University College of Public Health and Human Sciences. Few health promotion programs, she added, target residential settings like group homes, where many individuals with intellectual disabilities live.

Obesity is rising steadily among people with intellectual disabilities, with prevalence at least 1.5 times higher than that of the general population. Addressing weight-related health issues through physical activity promotion is the focal point of multiple national initiatives, but despite that only 30 percent of adults with intellectual disabilities meet physical activity guidelines.

Dixon-Ibarra studied 18 residents, 22 staff members and 14 program coordinators from five different group homes in the Pacific Northwest. Each home was given a program designed to help residents and staff work together to set physical activity goals and include time in their schedules for trying to reach them.

The study showed that when a home’s top leadership allowed the program to be an option rather than a requirement, staff did not regularly make the effort to work with residents to create possibilities for physical activity.

Results were recently published in Evaluation and Program Planning.

In Dixon-Ibarra’s research, each group home was provided with a health-promotion program called “Menu-Choice,” designed to assist staff in including physical activity goals in residents’ schedules.

The program included weekly scheduling sheets, plus a calendar on which residents could display images depicting their activities. There was also a binder of resources for staff to learn about physical activity; to get examples of activities for residents with different abilities; to gather information about goal setting; and to gain knowledge about guidelines relating to specific disabilities.

“The overall intent of the program was to intervene at an environmental level,” Dixon-Ibarra said. “It’s evident that policy-level change in the group home setting is needed to promote active lifestyles.”

That’s because the staff members, who play a huge role in how residents spend their time, often looked at working with residents on Menu-Choice as an extra, optional duty. Staff turnover and lack of time were other barriers to Menu-Choice implementation, as was the fact that 79 percent of the program coordinators were themselves overweight or obese and not exercise oriented.

“One of the main goals is that health education can be part of staff orientation training,” Dixon-Ibarra said. “When you apply for the job you know that encouraging physical activity and nutrition is part of the job description, and you have that direction from the agency level and the coordinator level. I would also promote that group home agencies mandate the use of health-promotion programs and allocate resources to help staff and residents pursue physical activity and other health-promoting behaviors.” 

With that direction, staff turnover and/or indifference to physical activity won’t be able to negatively affect health-promotion programs nearly as much.

“Success definitely depends on staff involvement,” Dixon-Ibarra said. “Staff being motivated to pursue physical activity with residents is so important. Every staff member needs to be trained in how to incorporate activity in residents’ schedules and how to encourage residents. You can’t make someone be physically active, but you can make it a health-promoting environment where residents are encouraged to choose to be active if they want to be.”

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Chronically ill women underusing online self-care resources, study shows

CORVALLIS, Ore. – Barriers to internet use may be preventing chronically ill middle-aged and older women from being as healthy as they otherwise could be, new research from Oregon State University suggests.

The study conducted by researchers from the OSU College of Public Health and Human Sciences and the University of Georgia analyzed data from hundreds of women age 44 and older with at least one chronic condition and found that 35 percent of them didn’t use the internet at all. Among those who did, fewer than half used it to learn from the experiences of other chronic-disease patients; fewer than 20 percent took part in online discussions regarding their conditions.

Self-care, including the use of online resources, is an important component in managing chronic illnesses such as heart disease, cancer, stroke, diabetes, arthritis, asthma, high blood pressure, emphysema, chronic bronchitis, depression and anxiety. Effective management of these types of conditions delays or prevents them from becoming debilitating, maintaining quality of life for the patient and saving health care dollars.

The research showed the potential for improved condition management by getting online resources into the hands of more patients.

“We want people to be able to optimize their health,” said researcher Carolyn Mendez-Luck, an assistant professor in the School of Social and Behavioral Health Sciences at OSU.

Among the 418 women participating in the study, internet use for self-care varied depending on factors that included age, the specific condition or conditions a patient had, education level and ethnic background.

“It really seemed to be the lower-resourced individuals who weren’t using the internet and thus online resources,” Mendez-Luck said. “If you’re older, if you’re a member of a minority group, if you’re less educated, if you’re not working, all of those things work against you and impede your use of the internet; that’s what this research suggests.”

The women in the study all completed, via telephone, the National Council on Aging Chronic Care Survey and all had one or more chronic conditions. Support for the research also came from Atlantic Philanthropies, the California Healthcare Foundation, and the Center for Community Health Development. Results were recently published in the Journal of Women’s Health.

The study featured two parts. The first analyzed data in terms of sociodemographics, disease types and healthcare management associated with internet use, and the second focused on the 251 internet-using women to identify the online self- care resources they use and for what purposes.

About 31 percent of the women in the study were 65 and older; 30 percent had three or more chronic conditions; and 65 percent said they used the internet.

“A significantly larger proportion of older women reported multiple chronic conditions, and a significantly smaller proportion of older women reported using the internet or relying on it for help or support,” Mendez-Luck said. “A significantly larger proportion of non-internet users reported needing help learning what to do to manage their health conditions and needing help learning how to care for their health conditions.”

Mendez-Luck says understanding how women with chronic conditions use the internet, or why they don’t, can inform targeted efforts to increase internet availability, to educate patients about online resources, and to tailor internet-based materials to self-care needs. Women tend to live longer than men and also tend to be particularly affected by chronic diseases.

“The number of people living with chronic conditions for longer durations is growing,” Mendez-Luck said. “Complex patients, especially individuals with multiple chronic conditions, present enormous challenges to healthcare providers and a significant financial burden to the healthcare system. This situation is likely to become more critical as the number of Americans living to advanced ages increases in the next few decades.”

Self-care behaviors are important in managing chronic disease, Mendez-Luck noted. Without effective management, chronic conditions can diminish individuals’ capacity to care for themselves as well as thwart caregivers’ efforts.

“We discovered that a significantly larger proportion of internet-using women with diabetes and depression reported needing help in both learning what to do to manage their health conditions and how to better care for their health, compared with women with other health conditions,” Mendez-Luck said. “This finding highlights the notion that internet resources are not a one size fits all situation; it really does depend on the condition.”

Older women represent the chronic-conditions group with the most potential for gains in using online resources for disease self-management.

“There’s an opportunity for sure,” Mendez-Luck said, noting that one method for improvement might be as simple as a physician, nurse or dietitian taking a moment to talk to patients about using the internet and how it can benefit them.

“The fact that older women in general use the internet at lower rates, I think that’s not surprising,” Mendez-Luck said. “We need to give them a chance to get connected to community resources like libraries and senior centers that try to do education to dispel that fear or discomfort older women might have regarding technology. And more research needs to be done to determine how to tailor that online information in a way that meets their needs.”

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Carolyn Mendez-Luck

Carolyn Mendez-Luck

Repeatedly thinking about work-family conflict linked to health problems

CORVALLIS, Ore. – Thinking over and over again about conflicts between your job and personal life is likely to damage both your mental and physical health, research from Oregon State University suggests.

The study included more than 200 people, with results showing that “repetitive thought” was a pathway between work-family conflict and negative outcomes in six different health categories.

As the term suggests, repetitive thought regarding work-family conflict refers to thinking repeatedly and attentively about the parts of your job and your personal life that clash with each other: for example, that late-afternoon meeting that prevents you from attending your son’s baseball game. It’s a maladaptive coping strategy that impedes daily recovery from stress.

Kelly D. Davis of OSU’s College of Public Health and Human Sciences was the lead author on the project funded by Pennsylvania State University’s Social Science Research Institute and Penn State’s Center for Healthy Aging.

The journal Stress & Health recently published the results.

Davis, an assistant professor in the CPHHS School of Social and Behavioral Health Sciences, says repetitive thought over work-family conflict keeps the stressor active and thus gets in the way of recovery.

The study involved 203 adults ages 24 to 76. Each was in a romantic relationship, and roughly two-thirds had at least one child at home.

Results showed a link between repetitive thought and negative outcomes in the health categories of life satisfaction, positive affect, negative affect, fatigue, perceived health, and health conditions.

Positive affect is the extent to which a person subjectively experiences positive moods, and negative affect is the extent to which someone experiences negative moods. In this study, health conditions referred to a list of 22 conditions or problems, such as stroke or diabetes. Participants were scored based on how many times they answered yes.

In the category of perceived health, participants were asked to rate their health on a five-point scale. 

“The main objective of this study was to test a conceptual model in which repetitive thought explained the association between work-family conflict and health,” Davis said. “There was support for repetitive thought as a mediator in the association between work-family conflict and all six health outcomes.”

Repetitive thought is related to two other types of cognition that also can have adverse effects on health: rumination and worry. Rumination is persistent, redundant thinking that usually looks backward and is associated with depression; worry is also persistent, redundant thinking but tends to look forward and is typically more associated with anxious apprehension.

“Practitioners can assist individuals facing the dual demands of work and family by reducing repetitive thought, and the related issues of worry and rumination,” Davis said.

One technique that can help is mindfulness: intentionally paying attention to the present-moment experience, such as physical sensations, perceptions, affective states, thoughts and imagery, in a nonjudgmental way.

“You stay in the moment and acknowledge what you are feeling, recognize that those are real feelings, and process them, putting things in perspective,” Davis said. “In the hypothetical baseball game example, the person could acknowledge the disappointment and frustration he was feeling as legitimate, honest feelings, and then also think in terms of ‘these meeting conflicts don’t happen that often, there are lots of games left for me to watch my child play, etc.’”

Davis also points out that the burden for coping with work-family conflict shouldn’t fall solely on the employee.

“There needs to be strategies at the organizational level as well as the individual level,” she said. “For example, a business could implement mindfulness training or other strategies in the workplace that make it a more supportive culture, one that recognizes employees have a life outside of work and that sometimes there’s conflict. There can be a good return on investment for businesses for managing work-family stress, because positive experiences and feelings at home can carry over to work and vice versa.”

Work-family conflict is not just a women’s issue or even just a parent’s issue, Davis notes, given the number of workers who are caring for their own mother and/or father.

“Planning ahead and having a backup plan, having a network to support one another, those things make you better able to reduce work-family conflict,” Davis said. “But it shouldn’t just rest on the shoulders of the individual. We need changes in the ways in which organizations treat their employees. We can’t deny the fact that work and family influence one another, so by improving the lives of employees, you get that return on investment with positive work and family lives spilling over onto one another.”

Policy changes are particularly important to lower-income workers, Davis says.

“Not all of us are so fortunate to have backup plans for our family responsibilities to stop us from repetitively thinking about work-family conflict,” she said. “It’s the organizational support and culture that matter most. Knowing there’s a policy you can use without backlash maybe is almost as beneficial as actually using the policy. It’s also important for managers and executives to be modeling that too, going to family events and scheduling time to fit all of their roles.”

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Kelly Davis

Kelly D. Davis