J. Gittelsohn - Academia.edu (original) (raw)

Papers by J. Gittelsohn

Current Developments in Nutrition, 2019

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...

Health Education Research, 2013

Soaring obesity rates in the United States demand comprehensive health intervention strategies th... more Soaring obesity rates in the United States demand comprehensive health intervention strategies that simultaneously address dietary patterns, physical activity, psychosocial factors and the food environment. Healthy Bodies, Healthy Souls (HBHS) is a church-based, communityparticipatory, cluster-randomized health intervention trial conducted in Baltimore City to reduce diabetes risk among urban African Americans by promoting healthy dietary intake, increased physical activity and improvement to the church food environment. HBHS was organized into five 3-8-week phases: Healthy Beverages, Healthy Desserts, Healthy Cooking, Healthy Snacking and Eating Out and Physical Activity. A three-part process evaluation was adopted to evaluate implementation success: an in-church instrument to assess the reach, dose delivered and fidelity of interactive sessions; a post-intervention exposure survey to assess individual-level dose received in a sample of congregants and an evaluation form to assess the church food environment. Print materials were implemented with moderate to high fidelity and high dose. Program reach was low, which may reflect inaccuracies in church attendance rather than study implementation issues. Intervention components with the greatest dose received were giveaways (42.0-61.7%), followed by taste tests (48.7-53.7%) and posters (34.3-65.0%). The dose received of general program information was moderate to high. The results indicate successful implementation of the HBHS program.

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,...

Current obesity reports, 2014

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...

BMC Public Health, 2014

Background: Childhood obesity rates in the U.S. have reached epidemic proportions, and an urgent ... more Background: Childhood obesity rates in the U.S. have reached epidemic proportions, and an urgent need remains to identify evidence-based strategies for prevention and treatment. Multi-level, multi-component interventions are needed due to the multi-factorial nature of obesity, and its proven links to both the social and built environment. However, there are huge gaps in the literature related to doing these kinds of interventions among low-income, urban, minority groups. Methods: The B'More Healthy Communities for Kids (BHCK) intervention is a multi-level, multi-component intervention, targeting low-income African American youth ages 10-14 and their families in Baltimore, Maryland. This intervention prevents childhood obesity by working at multiple levels of the food and social environments to increase access to, demand for, and consumption of healthier foods. BHCK works to create systems-level change by partnering with city policy-makers, multiple levels of the food environment (wholesalers, corner stores, carryout restaurants), and the social environment (peers and families). In addition, extensive evaluation will be conducted at each level of the intervention to assess intervention effectiveness via both process and impact measures. Discussion: This project is novel in multiple ways, including: the inclusion of stakeholders at multiple levels (policy, institutional, and at multiple levels of the food system); that it uses novel computational modeling methodologies to engage policy makers and guide informed decisions of intervention effectiveness; it emphasizes both the built environment (intervening with food sources) and the social environment (intervening with families and peers). The design of the intervention and the evaluation plan of the BHCK project are documented here. Trial registration: NCT02181010 (July 2, 2014).

The FASEB Journal, 2014

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...

Health Education Research, 2020

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...

Indiana Health Law Review, 2010

Doctoral Fellow. Her current research interests include the role of the built environment in chil... more Doctoral Fellow. Her current research interests include the role of the built environment in childhood obesity and health disparities. Specifically, she is working with Alice Ammerman. Kelly Evenson, and Daniel Rodriguez on developing a methodology examining the emergence, employment, effectiveness, and encouragement for policy implication in obesity research articles focused on school-level factors (e.g., walk-toschool options, school food availability within the lunchroom, school campus, and immediate school neighborhood, and school health policies). Sheila is also working with this team, Amy Ries, and the NC Commission on Indian Affairs. to investigate access to healthy eating in NC American Indian communities. In addition, she works with the Society for Nutrition Education, two alliances, and Congressional members on 2009 Child Nutrition Reauthorization. This includes various reports, position statements, and bill language. Sheila received a B.S. and J.D. with a Certificate in Health Law from Loyola University Chicago and Ph.D. in Integrative Biosciences/Nutritional Sciences from The Pennsylvania State University. She has written an array of scientific publications, policy briefs, and law reviews on a range of topics including childhood obesity, health disparities, research ethics, and food safety. Her professional experiences include: The Government Accountability Project, Ob

The Journal of Nutrition, 1996

Community-based studies of body image concepts can be useful for developing health interven tions... more Community-based studies of body image concepts can be useful for developing health interven tions to prevent obesity-related diseases such as dia betes and cardiovascular disease in specific popula tions. First Mations peoples, in particular, face in creased obesity-related health problems as a result of acculturative changes in diet and activity. This study examined body shape perception in an Ojibway-Cree community in Northern Ontario, Canada. A set of fig ure outline drawings ranging from very thin to very obese were used to examine perceived body shape, body shape satisfaction and ideals of healthiness across sex and age groups. Overall, only 16% of the population were satisfied with their current body shape. People with a higher body mass index (BMI) were less satisfied with their bodies and thought they were less healthy than people with a lower BMI. While females had a significantly greater BMI than males, males and females did not differ significantly in percep tion of current body shape. On the other hand, females desired relatively smaller body shapes than males (P< 0.05). Older people chose significantly larger healthy body shapes than did younger people (P < 0.05). Dif ferences between our results and those reported for Anglo populations indicate that while both groups pre fer body shapes smaller than those they have currently, the Ojibway-Cree tend to prefer relatively larger body shapes. Knowledge of age and sex-related patterns of body image concepts in communities can assist in the design of obesity-reducing interventions targeting spe cific groups.

Health Education Research, 2017

Youth obesity is a major public health problem in the United States, especially among urbanbased,... more Youth obesity is a major public health problem in the United States, especially among urbanbased, minority youth. The B'More Healthy Communities for Kids (BHCK) trial worked at multiple levels of the food environment, including carryouts, to increase access to and demand for healthy, affordable foods. The objective of this article is to describe the development and implementation of BHCK's carryout intervention. Process evaluation was conducted to assess intervention reach (number of interactions with youth and adults either in person or on social media), dose delivered (number of food samples and promotional materials distributed, social media posts and meetings with owners) and fidelity (availability of promoted items). Overall, the carryout intervention showed moderate to optimal reach, moderate to optimal dose delivered and moderate to optimal fidelity. These findings demonstrate a successfully implemented carryout intervention in a low-income urban setting. Lessons learned about new methods for engaging the community and increasing demand for healthy food can be used to inform future studies and programs to improve the food environment.

Prevention Science, 2018

This paper describes capacity development as a key aspect of community-based research with indige... more This paper describes capacity development as a key aspect of community-based research with indigenous communities. University research engagement with indigenous communities includes extensive, and often negative, historical antecedents. We discuss strategies for developing effective, egalitarian, and balanced indigenous community-university relationships to build research capacity of these communities, and to create sustainable partnerships to improve health and wellness, and to reduce health disparities. We draw on the experience of eight investigators conducting research with indigenous communities to assess effective strategies for building and enhancing partnerships, including (1) supporting indigenous investigator development; (2) developing university policies and practices sensitive and responsive to Indigenous community settings and resources, and training for research; (3) developing community and scientifically acceptable research designs and practices; (4) aligning indigenous community and university review boards to enhance community as well as individual protection (e.g., new human subjects training for Indigenous research, joint research oversight, adaptation of shorter consent forms, appropriate incentives, etc.); (5) determining appropriate forms of dissemination (i.e., Indian Health Services provider presentation, community reports, digital stories, etc.); (6) best practices for sharing credit; and (7) reducing systematic discrimination in promotion and tenure of indigenous investigators and allies working in indigenous communities.

Food and Nutrition Bulletin, 1998

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)

Frontiers in Endocrinology, 2013

The Sandy Lake Health and Diabetes Project (SLHDP) was initiated in 1991 as a partnership between... more The Sandy Lake Health and Diabetes Project (SLHDP) was initiated in 1991 as a partnership between Sandy Lake First Nation and researchers interested in addressing the high rates of type 2 diabetes mellitus (T2DM) in the community. Following the expressed wishes of the community, the SLHDP has encompassed a variety of community-wide interventions and activities including: community surveys to document T2DM prevalence and risk factors, the Northern Store program aimed at increasing the availability and knowledge of healthy food options, a home visit program for the prevention and management of T2DM, a local diabetes radio show, a school diabetes curriculum for grades 3 and 4, a community-wide walking trail to encourage increased physical activity, youth diabetes summer camps, and a variety of community events focusing on nutrition and physical activity. Over the 22 year existence of the SLHDP, the community has taken ownership of the program and activities have evolved in alignment with community needs and priorities. This paper discusses the history, implementation, evaluation, and outcomes of the SLHDP and describes its sustainability. The SLHDP is a model of culturally appropriate participatory research that is iterative, with reciprocal capacity building for both key community stakeholders and academic partners.