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Katz D.L.,Yale Griffin Prevention Research Center | Njike V.Y.,Yale Griffin Prevention Research Center | Lauren Q R.,Yale Griffin Prevention Research Center | Reingold A.,Topco Associates | Ayoob K.T.,Yeshiva University
American Journal of Clinical Nutrition | Year: 2010

Background: Improving diets has considerable potential to improve health, but progress in this area has been limited, and advice to increase fruit and vegetable intake has largely gone unheeded. Objectives: Our objective was to test the performance characteristics of the Overall Nutritional Quality Index (ONQI), a tool designed to help improve dietary patterns one well-informed choice at a time. Design: The ONQI was developed by a multidisciplinary group of nutrition and public health scientists independent of food industry interests and is the basis for the NuVal Nutritional Guidance System. Dietary guidelines, existing nutritional scoring systems, and other pertinent scientific literature were reviewed. An algorithm incorporating >30 entries that represent both micro- and macronutrient properties of foods, as well as weighting coefficients representing epidemiologic associations between nutrients and health outcomes, was developed and subjected to consumer research and testing of performance characteristics. Results: ONQI and expert panel rankings correlated highly (R = 0.92, P < 0.001). In consumer testing, ≈80% of >800 study participants indicated that the ONQI would influence their purchase intent. ONQI scoring distinguished the more-healthful DASH (Dietary Approaches to Stop Hypertension) diet (mean score: 46) from the typical American diet according to the National Health and Nutrition Examination Survey (NHANES) 2003-2006 (mean score: 26.5; P < 0.01). In linear regression analysis of the NHANES 2003-2006 populations (n = 15,900), the NuVal system was significantly associated with the Healthy Eating Index 2005 (P < 0.0001). Recently generated data from ongoing studies indicate favorable effects on purchase patterns and significant correlation with health outcomes in large cohorts of men and women followed for decades. Conclusion: NuVal offers universally applicable nutrition guidance that is independent of food industry interests and is supported by consumer research and scientific evaluation of its performance characteristics. © 2010 American Society for Nutrition.


Kaufman J.S.,Yale University | Vaughan E.L.,Indiana University | Reynolds J.S.,Yale Griffin Prevention Research Center | Di Donato J.,Bridgeport Board of Education | Bernard S.N.,Southern Connecticut State University
Journal of Positive Behavior Interventions | Year: 2010

Research supports that office referral data is useful in informing programmatic decisions and planning interventions such as Positive Behavior Supports (PBS). Knowledge of patterns of office referrals may facilitate development of interventions that target specific groups. This study examines patterns in office referrals within an urban district by gender, race/ ethnicity and grade. Findings reveal that there are differences by grade that appear to be related to developmental level, with more referrals for aggression in younger students (grades K-6), disrespectful behavior in middle school students (grades 7-8), and attendance problems in high school students. Gender differences in the rate and type of referrals were found, with significantly more referrals for boys' delinquent/aggressive behavior, which may relate to how schools define unacceptable behavior and the data collection method. Finally, there were significantly more referrals for African American/black students than Hispanic students, suggesting that schools consider racial differences when developing behavioral expectations. © 2010 Hammill Institute on Disabilities.


Crusto C.A.,Yale University | Whitson M.L.,University of New Haven | Walling S.M.,Pacific University in Oregon | Feinn R.,University of Connecticut | And 4 more authors.
Journal of Traumatic Stress | Year: 2010

This study examines the relationship between the number of types of traumatic events experienced by children 3 to 6 years old, parenting stress, and children's posttraumatic stress (PTS). Parents and caregivers provided data for 154 urban children admitted into community-based mental health or developmental services. By parent and caregiver report, children experienced an average of 4.9 different types of potentially traumatic events. Nearly one quarter of the children evidenced clinically significant PTS. Posttraumatic stress was positively and significantly related to family violence and other family-related trauma exposure, nonfamily violence and trauma exposure, and parenting stress. Additionally, parenting stress partially mediated the relationship between family violence and trauma exposure and PTS. This study highlights the need for early violence and trauma exposure screening in help-seeking populations so that appropriate interventions are initiated. © 2010 International Society for Traumatic Stress Studies.


Reynolds J.S.,Yale Griffin Prevention Research Center | Treu J.A.,Yale Griffin Prevention Research Center | Njike V.,Yale Griffin Prevention Research Center | Walker J.,Independence School District | And 3 more authors.
Journal of Nutrition Education and Behavior | Year: 2012

Objective: To determine the reliability and validity of a 10-item questionnaire, the Food Label Literacy for Applied Nutrition Knowledge questionnaire. Methods: Participants were elementary school children exposed to a 90-minute school-based nutrition program. Reliability was assessed via Cronbach α and intraclass correlation coefficient (ICC). Validity was assessed comparing the questionnaire's food choices using an objective metric of nutrition quality, the Overall Nutritional Quality Index (ONQI), via t test. Statistical significance was set at05. Results: Four hundred ninety-nine children participated, 51% were female, and the average age was 8.6 (± 0.9) years. Cronbach α = .77 and ICC = 0.68 (between administrations) were observed. ONQI scores of correct responses were significantly higher when compared to the ONQI scores of incorrect responses (27.4 ± 9.4 vs 16.2 ± 9.4; P = .01). Conclusions and Implications: The Food Label Literacy for Applied Nutrition Knowledge questionnaire was found to be both reliable and a valid measure of food label literacy in children taught the Nutrition Detectives program. © 2012 Society for Nutrition Education and Behavior.


Katz D.L.,Yale Griffin Prevention Research Center | Katz D.L.,Yale University | Katz C.S.,Yale Griffin Prevention Research Center | Treu J.A.,Yale Griffin Prevention Research Center | And 5 more authors.
Journal of School Health | Year: 2011

BACKGROUND: The purpose of this study was to evaluate the effects of a nutrition education program designed to teach elementary school students and their parents, and to distinguish between more healthful and less healthful choices in diverse food categories. METHODS: Three schools were assigned to receive the Nutrition Detectives™ program and 2 comparable schools served as controls. A total of 1180 second, third, and fourth grade elementary school students were included, with 628 students in the intervention and 552 in the control group. The program, delivered by physical education instructors over several sessions totaling less than 2 hours, taught the children how to read food labels and detect marketing deceptions, while learning to identify and choose healthful foods. Parents were introduced to the program through written materials sent home and at school functions. Assessments included a food label quiz, dietary pattern, and body mass index (BMI). RESULTS: Students in intervention schools showed a significant increase in nutrition label literacy (p < .01). Third grade students showed the most improvement, 23% (p < .01). The parents of intervention group students also showed a significant increase in nutrition label literacy by 8% (p < .01). Total caloric, sodium, and total sugar intake decreased nonsignificantly among students in the intervention group (p > .05). BMI did not change over the short duration of the study. CONCLUSIONS: Nutrition Detectives effectively enhances the ability of students and their parents to identify more nutritious food choices. Further evaluation of the program and its potential to influence dietary pattern, BMI, and health outcomes in students and their families is warranted. © 2011, American School Health Association.


Mandawat A.,Yale University | Curtis J.P.,Yale University | Mandawat A.,Harvard University | Njike V.Y.,Yale Griffin Prevention Research Center | Lampert R.,Yale University
Circulation | Year: 2013

Background.Data are scarce on outcomes of pacemaker implantation in nonagenarians (age.90 years). Methods and Results.We identified patients >70 years of age (n=115 683) who underwent initial pacemaker implantation in the 2004 to 2008 Healthcare Cost and Utilization Project.Nationwide Inpatient Sample. Outcomes included in-hospital mortality, complications, length of stay, and charges. Unadjusted outcomes were compared using χ2 and Mantel-Haenszel tests. Multivariate hierarchical logistic models and stepwise linear regression models adjusted for case-mix variation and clustering. Eleven percent (12 917) were >90 years of age. Relative to patients aged 70 to 79 years, patients >90 years of age were more likely to have moderate/severe comorbidity (Charlson score >1; 43.2% versus 40.1%) and less likely to be admitted electively (17.5% versus 29.9%), all P<0.001. The unadjusted mortality and complication rates in patients aged 70 to 79 years were 0.60% (confidence interval [CI], 0.53.0.67%) and 5.61% (CI, 5.40.5.82%), respectively, and in patients aged >90 years were 1.87% (CI, 1.63.2.11%) and 6.31% (CI, 5.89.6.72%). Length of stay and charges in patients aged 70 to 79 years were 3.22 days (CI, 3.20.3.24 days) and $38 871 (CI, $38 700.$39 043), and in patients aged >90 years, 4.27 days (CI, 4.25.4.30 days) and $41 373 (CI, $41 190.$41 556). Multivariable analysis revealed severe comorbidity (odds ratio, 5.00; 95% CI, 4.05.6.17) was a greater predictor of mortality than increasing age (odds ratio, 2.81 per decade; CI, 2.35.3.35), all P<0.001. Similarly, severe comorbidity (Charlson score >5) was more strongly associated with complications, length of stay, and charges than age. Conclusions.Although increasing age predicts worsening outcomes in the elderly, the absolute rates are modest, even in nonagenarians, and comorbidity is a stronger predictor. © 2013 American Heart Association, Inc.


Malik A.H.,Griffin Hospital | Malik A.H.,Yale Griffin Prevention Research Center | Akram Y.,Griffin Hospital | Shetty S.,Griffin Hospital | And 2 more authors.
American Journal of Cardiology | Year: 2014

The impact of sugar-sweetened beverages (SSBs) on blood pressure (BP) has been debated, with some evidence suggesting that their increased intake is related to higher risk of developing hypertension. We conducted a systematic review exploring the relation between consumption of SSB and BP. A comprehensive search in 5 electronic databases along with a bibliography search was performed. The keywords "sugar sweetened beverages," "sugary drinks," "added sugars," "blood pressure," and "hypertension" were indexed in all combinations. Studies were included that reported the effects of intake of SSBs on BP. We excluded studies with <100 subjects and those involving subjects aged <12 years. Of 605 potentially relevant studies, a total of 12 studies (409,707 participants) met our inclusion criteria; 6 were cross sectional studies, whereas the rest were prospective cohort studies. All 12 studies showed positive relation between increased SSB intake and hypertension; however, statistical significance was reported in 10 of these studies. Of the 12 studies, 5 reported an increase in mean BP whereas 7 reported an increase in the incidence of high BP. In conclusion, our systematic review shows that the consumption of SSBs is associated with higher BP, leading to increased incidence of hypertension. Restriction on SSB consumption should be incorporated in the recommendations of lifestyle modifications for the treatment of hypertension. Interventions to reduce intake of SSBs should be an integral part of public health strategy to reduce the incidence of hypertension. © 2014 Elsevier Inc. All rights reserved.


Sanders M.J.,Quinnipiac University | Reynolds J.,Yale Center for Analytical science | Bagatell N.,Quinnipiac University | Treu J.A.,Yale Griffin Prevention Research Center | And 2 more authors.
Journal of Public Health Management and Practice | Year: 2015

Objective: The purpose of the study was to examine the efficacy of a multidisciplinary train-the-trainer model for improving fitness and food label literacy in third-grade students. Design: University student trainers taught ABC for Fitness and Nutrition Detectives, established programs to promote physical activity and nutrition knowledge, to 239 third-grade students in 2 communities over a 6-month period. A total of 110 children were in the intervention group and 129 children in the control group (2 schools each). Outcomes included the Food Label Literacy and Nutrition Knowledge test and the fitness measures of curl-ups, push-ups, 0.5-mile run, and sit and reach. Focus groups were conducted as process feedback. Setting: Four public schools in 2 different communities. Participants: A total of 200 third-grade students. Intervention: ABC for Fitness and Nutrition Detectives. Main Outcome Measures: Food Label Literacy and Nutrition Knowledge test and the fitness measures of curl-ups, push-ups, 0.5-mile run, and sit and reach. Results: Nutrition knowledge increased in the intervention group by 25.2% (P <.01). Fitness measures in the intervention schools showed greater improvement than those in the controls for curl-ups (P <.01), push-ups (P <.01), sit and reach left (P =.07), and 0.5-mile run (P =.06). Process feedback from 3 teachers and 60 students indicated satisfaction with the program. Conclusion: Adaptation of the train-the-trainer approach for Nutrition Detectives and ABC for Fitness was effective for delivering these health-related programs. Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.


Nawaz H.,Griffin Hospital | Via C.M.,Griffin Hospital | Ali A.,Yale University | Rosenberger L.D.,Yale Griffin Prevention Research Center
American Journal of Preventive Medicine | Year: 2015

Griffin Hospital, a community hospital affiliated with Yale School of Public Health and Yale School of Medicine, received Health Resources and Services Administration funding to strengthen and improve its combined internal medicine and general preventive medicine residency program by incorporating an integrative medicine curriculum. The purpose of project ASPIRE (Advancing Skills of Preventive medicine residents through Integrative medicine Education, Research and Evaluation) was to create, implement, and evaluate a needs-based, innovative training curriculum in integrative medicine. Through this robust new training, the authors aimed to produce preventive medicine-trained physicians with competencies in integrative medicine to collaboratively work with other integrative medicine practitioners in interdisciplinary teams to provide holistic, patient-centered care. The multifaceted collaborative curriculum was composed of didactics, grand rounds, journal club, objective structured clinical examinations, and two new practicum rotations in integrative medicine. The new practicum rotations included block rotations at the Integrative Medicine Center at Griffin Hospital and the Yale Stress Center. Between 2012 and 2014, three cohorts participated in the curriculum; two of these cohorts included three advanced preventive medicine residents each and the fourth included four residents. Project faculty conducted 14 lectures and journal clubs, and two grand rounds. Six of the ten participating residents (60%) completed integrative medicine clinical rotations. Residents' attitudes toward integrative medicine were evaluated through self-assessment using the Complementary, Alternative, and Integrative Medicine Attitudes Questionnaire; data were analyzed in 2015. This article describes the results of this prospective observational study based on single-institution experience over the course of the 2-year project period. © 2015 American Journal of Preventive Medicine.


INTRODUCTION: Despite well-documented evidence that physical activity is beneficial to children, average fitness levels of US children have declined. Lack of physical activity has been associated with childhood obesity. We evaluated the effects of a physical activity program in the elementary school classroom on health outcomes. METHODS: Three schools in the Independence School District in Independence, Missouri, were assigned to receive the ABC (Activity Bursts in the Classroom) for Fitness program, and 2 comparable schools served as controls. The program, led by classroom teachers, provides multiple, brief, structured physical activity breaks throughout the day. Baseline data for the study were collected in September 2007, and follow-up data were collected in April 2008. RESULTS: Physical fitness measures of upper-body strength, abdominal strength, and trunk extensor improved (P <.001). Medication use for asthma (P = .03), attention-deficit hyperactivity disorder (P = .07), or either medication combined (P = .005) decreased. CONCLUSION: The effects of the program on daily physical activity, fitness, and measures of health are beneficial.

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