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Focusing on the obese and overweight individual alone and is not helping us address the broader social and economic issues that influence people’s lives. This paper discusses strategies to remove us from a focus on the O word and from blaming the individual for their condition.

In recent years, newspapers, magazines, and the electronic media have covered obesity and overweight extensively. The “O” word – obesity – seems to be everywhere. Indeed, media coverage of obesity almost quadrupled from January 1999 to April 2005 in the U.S. (International Food Information Council (IFIC) Foundation, 2005). This intense coverage even led the Center for Consumer Freedom (2005), a restaurant and food industry supported group, to label the obesity coverage as “hype” and an “obesity-mortality myth”. Regardless of the controversy over the exact number of deaths associated with overweight and obesity (Kaisernetwork.org, 2005), clearly, the National Center for Health Statistics data shows the doubling of obese adults and the tripling of overweight young people (ages 6-19) over the last 30 years (National Center for Health Statistics, 2004).

Hidden in this confusing rhetoric is an important message that many will find startling: while there are real concerns related to 60 million obese adults and 9 million overweight youth, the single-minded focus on weight results in prejudice towards the obese and overweight and negatively impacts community health overall.

The truth is that despite the recent controversies surrounding the number of deaths attributable to obesity, it is a deadly serious health condition. It’s also true that many people are eating too much and exercising too little. Furthermore, people can and do die from obesity-related chronic diseases, and obesity can be a significant contributor to decreased quality of life. However, the persistent drumbeat of “obesity” oversimplifies a complex issue. It places blame squarely on the shoulders of the individual, without taking into account the social and economic influence of where people live, work, and play. In this sense, the O word discourages all of us from focusing on social ecological changes that could make significant lasting improvements to people’s nutrition and fitness.

While this focus on “obesity” and the implied individual behaviors (e.g., overeating, lack of exercise, etc.) distracts us from seeing the larger community picture, it also fails, often miserably, to improve the health of individuals. In fact, it may lead to mental health problems and, of course, the sequela of chronic disease. In addressing this, we need to acknowledge that while the word had a specific clinical definition; it does not have the same meaning within clinical practice — any more than in broader society. Instead, even in the clinical setting, “obesity” is often imbued with value judgments and biases that associate overweight not only with poorer health but also poorer character and lack of education.

Participant access to hospital information led to obtaining most of the tests except mammograms. If respondents reported that it was easy to read/understand information booklets in a physician’s office, they were more likely to get a physical exam, Pap test, and mammogram. Those that reported difficulty speaking with a physician were at 2.2 times at greater risk of never getting a physical exam and 4.3 times at greater risk of never getting a prostate exam.

Discussion
This study found that Asians used the internet as a source of health information more than non-Asians, which may indicate that the internet is a useful source to influence health behaviors among this population, especially if the information can be tailored to Asians. Asians were less likely to consult with a health care provider or a pharmacist than non-Asians which may indicate tendency to seek out information prior to approaching a health care provider, or they find difficulty approaching health care providers (Saha, Arbelaez, & Cooper, 2003).

Asians found it more difficult to read or understand information on prescription bottles and in booklets in physician offices than other racial/ethnic groups (National Health Care Disparities Report, 2003), which helps to explain why Asians are less likely to seek health information from health care providers and pharmacists than non-Asians.

Asians preferred to be treated by a racially concordant health care provider which may help reduce communication difficulties. Among those who had difficulty speaking with a physician, Asians were less likely to indicate need for an interpreter, and relied more on family and friends as interpreters, whereas non-Asians relied more on staff persons at the health care facility. Interpreters were less available for Asians than non-Asians. Use of friends and family members is problematic because untrained interpreters often lead to less quality of patient-provider communication (Baker et al., 1996). This study shows that since family members are most often used as interpreters and if these tend to be less available and less accurate than trained interpreters, health care providers should be cautious about using just any available bilingual person, especially children (Ngo-Metzger et al., 2003).

Asians were less likely to have a physical exam and examinations for specific diseases such as cervical cancer, breast cancer, and colon cancer. While cancer is the leading cause of death for Asians, they have the lowest screening rates (American Cancer Society, 2004; Chen & Koh, 1997). This may reflect Asian attitudes about fatalism toward health. Ill health is associated with misfortune or external forces over which they have no control (Chin & Bigby, 2003; Rasbridge, 2003). Demographic factors such as a higher education level, having medical insurance, and those who live in the US 10+ years increase the likelihood for screening (American Cancer Society, 2004), however, this was not the case for Asian American women. It is presumed other cultural factors attribute to this disparity. This study found that having access to health information sources such as the World Wide Web, books, a health care provider, and being able to ask a pharmacist increased the odds of getting all the screening tests. Asking family and friends as a source of health information increased the odds of getting an exam for a general physical, breast, and prostate cancer. If participants had access to a health fair, the odds increased for screening for cervical, breast, and prostate cancer.

The odds of never getting a physical exam (OR = 2.2) and a prostate exam (OR=4.3) were increased if participants had difficulty speaking with a physician. While studies (Gandhi et al., 2000) indicate that language is an important barrier to health care access, language is not the only barrier that Asians face. This study found that Asians find it difficult to access other sources of information, prior to meeting with a health care provider.

The study had two limitations. First, it was a cross-sectional study and therefore it is not possible to determine causality. For example, having access to certain sources of health information may be associated with increased probability of screening, but it is difficult to ascertain whether access to health sources will lead to improved screening rates. Second, using the category of Asian to include Asian subgroups of Chinese, Vietnamese, and Koreans may mask the disparity within these subgroups. Future studies may explore the differences between racial and ethnic subgroups in the availability and accessibility of various health sources of information among these groups.

The findings in this study indicate differences in sources of health information between Asians and non-Asians, that Asians used family and friends as interpreters for health care services, and that the sources of health information increased the odds that Asians would go for screening. These findings suggest that as a prelude to accessing health care services, consideration should be given to developing sources of health information relevant to Asians so as to enhance their decision making prior to and in conjunction with receiving medical care services. Informed decisions as health care consumers will more likely reduce the health disparity that exists between ethnic/racial groups.

There was a significant difference between Asians and non-Asians in age, employment, spouse employment, education, income, US as country of origin, and length of time in the US (Table 1). Asian Americans were significantly younger, had full time employment, had higher education, a higher income, be foreign born, and be in the US less than 5 years, compared to non-Asians. While approximately 90% of Asians spoke English at home, they were significantly less likely to speak English at home than non-Asians. Among Asians who did not speak English as their primary language at home, Mandarin or Chinese (48.8%), Korean (21.4%), and Vietnamese (20.2%) were spoken.

Sources of Health Information
Asians were significantly more likely to use the internet as a source of health information than non-Asians, t(66) = -3.06, p<.01. Asians were significantly less likely to call a doctor or health care provider, t(66) = 2.59, p <.01 and pharmacist, t(785) = 5.77, p <.001, to think it was easy to get information about the quality of physicians, t(5865) = 5.93, p <.001, health insurance plans, t(689) = 5.92,

p <.001 and hospitals in the community, t(5633) = 7.95, p <.001, and found significantly greater difficulty in reading or understanding information on the prescription bottles, t(710) = 6.17, p <.001 and information booklets in physician offices, t(6658) = 5.32, p <.001, than non-Asians.

Use of an Interpreter for Understanding a Physician
Asians (15.2%) preferred to be treated by a racially concordant physician, χ2(3) = 17.9, p <.001, than non-Asians (10.0%)(Table 2). Among participants who had difficulty speaking with a physician, ASIANS (31.4%) were significantly less likely to need an interpreter than Non-Asians (61.7%), χ2(1) = 11.6, p <.001. Non-Asians indicated that staff persons (57.8%) and friends or relatives (36.7%) served as interpreters, whereas, Asians used friends or relatives (66.7%) and staff persons (33.3%) as interpreters, but not significantly (p >.05). Non-Asians were significantly more likely to report that the interpreter was always available, χ2(1) = 4.34, p <.05, than Asians.

Cancer Screening
Asians were less likely to have had a complete physical exam, pap tests, mammograms, and screening for colon cancer, within the last two years, than non-Asian Americans (Table 3). Access to health information sources such as the World Wide Web, books, a health care provider and being able to ask a pharmacist significantly (p<.05) increased the likelihood of getting all the screening tests (Table 4). Having friends or family as a source of health information significantly (p<.05) increased the likelihood of getting a physical exam, mammogram, and prostate exam. Having access to a community health fair significantly (p<.05) increased the likelihood of getting a Pap test, mammogram, and prostate exam. Having access to information about quality of physicians in the community significantly increased the likelihood of getting a physical exam, Pap test, and colon cancer test. If it was easy to get information about health insurance plans it was more likely that participants would get a physical exam, and a colon exam.

Questionnaire items included demographic variables, health status, cancer screening, health care experiences, health information sources, and use of an interpreter in the patient-provider interaction. Demographic variables included age, gender, English use as primary language spoken at home, employment of participant and spouse (full time, part time, unemployed), education level(5years).

Sources of Health Information and Interaction with Healthcare Provider
To determine source of health information, participants reported how often they acquire information from the World Wide Web, books or printed material, health care provider, friends or family, the pharmacist, or a community health fair. The ease (very easy, somewhat easy, not too easy, not at all easy, don’t look for quality) of acquiring information about quality of physicians in the community, health insurance plans, and hospitals in the community was assessed. Difficulty reading instructions on prescription bottles, and information in booklets were measured (very easy, somewhat easy, not too easy, not at all easy, don’t get any information from physician). Perceptions of health status after going to the hospital or health care provider, difficulty communicating with healthcare provider (always, usually, sometimes, never) and need for an interpreter, preference for a healthcare provider from one’s own ethnic/racial group, who serves as the interpreter (health care provider, staff person, friend or relative, trained medical interpreter, or someone else), and the interpreter’s usual availability were included.

Cancer Screening
Participants reported previous cancer screening (pap test, mammogram, colon, prostate) for relevant cancers (

Descriptive statistics were reported for the variables that characterized Asian and non-Asians (SPSS 10.0). Chi-square analysis was conducted to examine the bivariate relationship between the dependent variable of being Asian or non-Asian and the independent variables. The independent variables were sex, age, language spoken at home, participant and spouse employment, education level, income, US as country of origin, length of time in the US, illness due to visits to healthcare provider, need for an interpreter with healthcare provider, availability of interpreter, and preference for having physicians from own race/ethnicity.

An independent t-test was used to determine differences in means for age, health information source, information for quality of doctors, insurance plans, and hospitals in the community, difficulty reading/understanding prescription labels and booklets, frequency of interpreters, understanding a physician with interpreter, and screening for cancers. Odds ratios (95% CI) were calculated for each health information source, how easy it was to find information about quality physicians, insurance plans, and hospitals, difficulty reading information or booklets in physicians’ offices, difficulty in speaking with a physician, and the need to use an interpreter for a physician.

Screening
There is disparity in screening rates between ethnic/racial groups. While cancer is the number one cause of death among Asian women (Chen & Koh, 1997), they have the lowest screening rates of all ethnic groups in the US (American Cancer Society, 2004; Miller et al., 1996). Asian women are less likely to go for a Pap test (68.2%) compared to White women (83.9%) (American Cancer Society, 2004), and Asian women are more likely to have never had a Pap test (21%) than White women (5%) of the White women (Kagawa-Singer & Pourat, 2000). This disparity exists for other cancers as well. Asian women (57%) are less likely to have a mammograms than White women (72.1%) (American Cancer Society, 2004), and 30% of Asian women have never had a mammogram compared with 21% of White women (Chen, Diamant, Kagawa-Singer, Pourat, & Wold, 2004; Collins et al., 2002; Sanghavi, 2003). For colon cancer, 14.5% of the Asians ≥ 50 years have had Fecal Occult Blood Test (FOBT), whereas among Whites it is 18.3% and the Endoscopy utilization rates within the past five years is 19.2% and 31.3%, respectively (American Cancer Society, 2004).
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The purpose of this study was to examine differences between Asian and non-Asian Americans in sources of health information and cancer screening.

Methods
A 96-item interview questionnaire, developed by the Commonwealth Fund in collaboration with Princeton Survey Research Association, was used. A nationally representative sample of 6,722 adults age 18 and older living in the continental United States who spoke English, Spanish, Mandarin or Cantonese, Vietnamese or Korean was selected. The survey was administered from April to November 2001, and took about 25 minutes to complete. The sample consisted of White, African-American, Hispanic and Asian households (Collins, Hughes, Doty, Ives, Edwards & Tenney, 2002).

Sample
The sample was designed to generalize to the U.S. adult population (Collins et al., 2002). A stratified minority sample design was conducted, utilizing a random-digit dialing method. Telephone numbers were drawn disproportionately from area code exchange combinations with higher than average densities of minority households. Non-Asians consisted of Whites, African-Americans, Hispanics, Native Americans, and others not self-reported to be Asians. Asians consisted of Chinese, Vietnamese, and Koreans.
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Design
The questionnaire was pre-tested based on a random digit phone sample of respondents. The final questionnaire was translated into multiple languages: Spanish, Mandarin, Cantonese, Vietnamese and Korean. Up to 20 attempts were made to contact a person at every sampled telephone number. Telephone calls took place at various times of the day and days of the week to maximize the chance of making contact with potential participants. Interviewers randomly selected household members.
Five stages of statistical weighting were employed to assure a racial/ethnic distribution of a disproportionately large sample of African Americans, Latinos, and Asian Americans of the matching the distribution of the U.S. general adult population (Collins et al., 2002). The overall response rate was 54.3% which was based on the contact, cooperation (initial consent obtained), and completion (initially cooperating and eligible participants) rates.

This study examined differences between Asian and non-Asian Americans in sources of health information and cancer screening. A nationally representative sample of 6,722 adults in the US, including those who speak, Spanish, Chinese, Vietnamese and Korean was selected. Questionnaire items included demographic variables, health status, cancer screening, health care experiences, health information sources, and use of an interpreter in the patient-provider interaction. Asians used the internet more for health information, preferred a physician from their own race, had friends or relatives and staff persons serve as interpreters, and less likely to call a health care provider and pharmacist, to need an interpreter, have had a complete physical exam, pap test, mammogram, and colorectal exam, within the last two years, than non-Asian Americans. Difficulty speaking with a physician led to 2.2 times greater risk of never getting a physical exam and 4.3 times greater risk of never getting a prostate exam. Development of sources of health information relevant to Asian Americans may enhance their decision making prior to and in conjunction with receiving medical care services.

Healthcare access may be a significant barrier to reducing health disparities among racial/ethnic groups (IOM, 2003). Accessing health care involves access to health information, access to healthcare providers, facilities, to follow treatment regimens, and to engage in more mutual decision making by consumers. In general, Asians (58%) have a harder time understanding physician provided health information than Whites (41%) which may in part explain why Asians are less satisfied with health care (Saha, Arbelaez, & Cooper, 2003; Saha & Hickam, 2003;), and health insurance coverage (Haviland, Morales, Reise, & Hays, 2003), as compared to other ethnic/racial groups. Access to health information from the World Wide Web, printed materials, or obtaining it from physicians show no racial/ethnic differences (National Health Care Disparities Report, 2003; Williams et al., 1995). Language and underinsurance are barriers to health care access which often cause complications (Burstin, Lipsitz, & Brennan, 1992; Gandhi, Burstin, Cook, Puopolo, Haas, Brennan, Bates, 2000).

Language
Asians who speak little or no English may encounter barriers to health care. Often research in healthcare excludes non-English speakers (Burstin et al., 1992). Approximately 27% of Asians reported poor communication with their health care providers compared to 17% of Whites (National Health Care Disparities Report, 2003), and language concordant patients appear to have better health related quality of life (Seijo, 1991). Nearly 14% of the US population speaks a language in their homes other than English (1990 Census). Lack of an interpreter is a challenge to health care delivery (Erzinger, 1991; Perez-Stable, Napoles-Springer, & Miramontes, 1997; Seijo, 1991) and often leads to physicians to use interpreters who are untrained and limited in English language skills such as family members or staff from nearby ethnic restaurants (Baker, Parker, Williams, Coates, & Pitkin, 1996; Ginsberg, Martin, Andrulis, Shaw-Taylor, & McGregor, 1995). Some Asians prefer trained interpreters to use of family members for privacy, and for sensitive issues prefer same sex interpreters (Ngo-Metzger et al., 2003. Research is necessary on utilization rates of types of interpreters.

It has been shown that participation in food and nutrition programs provide a safety net for American children and adolescents at risk for poor nutritional intakes secondary to low socioeconomic status (Stang & Bayerl, 2003). Federally funded food and nutrition programs have been shown to improve the intake of select nutrients and energy; to reduce rates of low birth weight, preterm birth, growth retardation, and iron deficiency anemia (Stang & Bayerl, 2003).

Though additional future longitudinal studies are needed to determine the link between food insecurity to child overweight status; it is suggested that food insufficiency can have long-term effects in children which include the inability to establish life-long eating patterns, which can contribute to patterns of childhood, adolescent, and adult obesity (Mazur et al., 2003). Alarming findings of lack of food and consumption of poor quality foods among our youth requires a community of healthcare provides, schools, community leaders and legislation to come together and make this health crisis a national top priority.

Implications for Research and Practice
Obesity and chronic illness, such as type 2 diabetes among Mexican-American children and youth continue to increase as do the number of households experiencing food insecurity (Holben, 2006; Sigman-Grant, 2003; Trevino et al., 2004). A possible explanation for the relationship between food insecurity and obesity may include periods of both under- and over consumption, in which families may adopt unhealthy eating practices when food is plentiful or scarce which could compromise the nutritional quality of their diets (Sigman-Grant, 2003). In the United States, periods of food insecurity are most often reported towards the end of the food stamp cycle when food supplies are inadequate (Sigman-Grant, 2003). Study conclusions suggest that energy intakes among female and males adolescents do not meet the recommended energy intakes, which may be due to low economic status and food insufficiency. Youth, eating behaviors may be a result of typical erratic and unpredictable eating patterns commonly seen in this population. Reported consumption among this group was mainly provided from the USDA National School Lunch program. Participants receive both breakfast and lunch at no charge. Based on the results of this study, it is recommended that nutrition education programs be culturally sensitive and appropriate as well as age appropriate to meet the needs Mexican- American adolescents. Nutrition programs must provide specific learning skills and knowledge that target behavior, such as how to improve fiber consumption through fruit and vegetables.

The limitations of this study include self-reported data which is subject to inaccurate reporting of dietary behaviors due to the use of recall. Secondly, the study used a convenient sample of participant which may not represent the entire adolescent population. In addition, the participants did not provide information on their socioeconomic status to fully assess whether they were experiencing food insufficiency. Lastly, the 24-hour dietary recall used within this study has not been tested for reliability or validity.

Future research is needed to better understand the relationship between obesity and food insufficiency among Mexican-American adolescents. Research and funding is also needed to improve fruit and vegetable consumption among adolescents of low income families. Collaboration among National School Lunch Programs and Fresh Produce Programs (FPP) would increase the availability of fresh fruit and vegetables for this population. The Fresh Produce Program (FPP), also known as the Volunteer Gleaning Program, provided by the local Food Bank, salvages and distributes fruits and vegetables not are going to be sold, to local agencies free of charge. Schools are in a key position to educate families on nutrition and prevention of chronic illness. Low-income families, need to receive nutrition education services at the locations, they are most likely to receive aid or services, such as the food bank, Women’s Infants and Children (WIC), food stamps office, school district or local shelters.

Schools must provide a healthy environment to reinforce good nutrition behaviors through coordinate school health programs, school health advisory councils, and nutrition and wellness polices. The National School Lunch and Breakfast Programs must continue to provide the best quality meals that meet macronutrients and micronutrients that are necessary for growth and development among adolescents. Parent programs should not only included nutrition education, but should provide critical resources and teach skills on how to obtain food security in the household.

Food consumption in the Mexican-American culture depends on several factors such as income, education, urbanization, geographic region, and family customs and availability (Warrix, 1995). Families experiencing food insecurity have been found to use many coping skills to survive during difficult times. Coping skills include, eating a less varied diet, increased participation in federal food assistance programs or utilizing emergency food assistance from food pantries, emergency kitchens and shelters, adjusting the number of meals consumed and using low-cost energy-dense foods at times during financial hardships (Casey et al., 2006; Holben, 2006).

There are also several other possibilities to explain the inconsistency in eating behaviors among food insufficient households, such as overeating when food is available as well as purchasing cheaper, less nutritious foods that are energy-dense (Casey et al., 2006). Moreover, periods of both under- and over-consumption, episodic food shortages that cause physiologic adaptation of increased body fat, and an increased intake of less expensive foods that are higher in fat are associated with obesity (Centers for Disease Control and Prevention, 2003).

In this study, there are multiple reasons that could have contributed to the low caloric intake among participants, along with the possibility that participants did not have access to enough food, other possibilities include, dieting for weight loss, eating disorders, medical problems, or not hungry on the day of the collection. In this study, participants commonly reported consuming lunch through the National School Lunch Program, but in many cases reported no breakfast consumption through the National School Breakfast Program or dinner consumption.

Schools play an important role in promoting lifelong healthy eating and are considered to be an integral central location for the entire family to learn about good dietary behaviors and habits (Centers for Disease Control and Prevention, 1996). There is a great need to develop nutrition education programs for adolescents and their families that focus on improving dietary behaviors and nutrition knowledge (Hoelscher, Evan, Parcel & Kelder, 2002). Nutrition programs that are behavioral-based are necessary to reduce the rates of obesity in the Mexican-American population. In addition, programs must be sensitive to address issues regarding food insecurity/insufficiency. Resources to local community organizations, shelters and school nutrition programs that assist in hunger efforts should be provided to parents and adolescents in this population. Currently the National School Lunch Program (NSLP) and School Breakfast Program (SBP) are required to provide a third of the Recommended Dietary Allowances (RDAs) for lunch and one fourth for breakfast (USDA Food and Nutrition Services, 2004). In addition, meals should not exceed 30% of energy from fat and 10% or less of saturated to meet Dietary Guidelines recommendations.

The 24-hour dietary recall completed by the participants asked if their consumption was usual, more than unusual or less than usual. Participants were asked to give an explanation based on their response. While only ten out of 532 participants provided qualitative comments regarding their food intake, these comments may suggest the existence of food insecurity and insufficiency as well as dietary inconsistencies.
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The following statements were made by the participants in regard to their consumption:

usual consumption: “I was hungry.”, “I eat various amounts of food during the day.”, “Good food.”, “I ate good.”, “I don’t eat healthy. Well, at least I don’t think so, but I don’t eat a lot either. I take vitamins for extra help for my body.”, “I am poor.”, “I eat less now because they took my tonsils out and now I’m not used to eating a lot. My doctor said my stomach shrinked, cause I lost 20 pounds.” more than usual: “I ate a lot.” less than usual: “[It] varies from day to day, what I eat.”, “I don’t pick my own food at stores, my parents do.” Participants in this study reported low caloric intake and poor dietary behaviors, which may be a result of food insecurity and/or food insufficiency in the household. It has been noted that Mexican-American households experiencethe national average in the United States (Holben, 2006; Kaiser et al., 2002). In the Mexican-American culture, many households survive on a low-income (Mazur et al., 2003). A low socioeconomic status has been consistently associated with poor child nutrition, health and development, along with food insufficiency (Mazur et al., 2003). Education, race, sex, ethnicity and literacy are associated with poverty and health disparities. The lack of being able to obtain appropriate health care and health insurance or the inability to understand the critical role of health behaviors in prevention of disease is commonly noted in this population (Harris, 2003; Mazur et al., 2003). Other contributing factors that affect the health of Mexican-Americans include food influences, food preferences and acculturation (Harris, 2003).

To better understand all the factors that contribute to eating behaviors among low-income, Mexican-Americans, we first must understand the circumstances that may contribute to or compete with their dietary intake. Many possibilities have been associated with lack of food in the household, such as employee related problems, unemployment, low-paying jobs, high housing cost, poverty or lack of income, medical or healthcare costs, substance abuse, high utility costs, mental health issues, homelessness, reduced public benefits, gaining a household member and high child-care costs (Holben, 2006).

Carbohydrate, protein, and fat intake were above the recommendations for both genders, while fiber intake was below the recommendation. Despite both genders exceeding the daily gram intake of carbohydrate, protein, fiber and fat, distribution of calories throughout the day was within acceptable ranges. The reported participant food intake was from a weekday 24-hour recall with the exception of one school reporting a weekend 24-hour recall. This weekend sample reported an average weekend dietary intake of 1516 calories verses a weekday consumption of 1845 calories. This finding may additionally support the belief that participants may be experiencing food insecurity and/or insufficiency in their household. In a study using the 12-item Radimer/Cornell scale to detect food insecurity in the household, Kaiser et al. (2002) discusses the complexity of food insecurity as a “managed process” in the household, which is believed to causes a sequence of responses as the food supplies decrease. Kaiser et al. (2002) continues to discuss the occurrences at the first level, which is considered of mild severity; during this time anxiety and concern about the household food supply begins to exist. As a result, the household makes adjustments that may affect the overall quality of the diet. At the adult level, which is considered of moderate severity, adults limit the quantity and quality of food consumed. At the last stage which is considered to be the most severe stage, the child feels the effects of the limited food supplies and experiences hunger.
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Characteristics that seem to appear as food insecurity increases in the household consist of less fruit and vegetable consumption, increased participation in food assistance programs and disordered eating (Kaiser et al., 2002).

In addition, this study found that males exceeded the sodium consumption per day (2664.55 mg per day) while females were within acceptable levels of sodium consumption per day (2105.84 mg day). Males consumed 674.25 mg of calcium per day and females consumed 571.74 mg/day. Males consumed 12.82 mg of iron per day and females consumed 10.37 mg/day. Calcium intake among both genders was below the national recommendations. Males meet the iron recommendations, while females did not. The increase in soft drink consumption has been associated with a decrease in calcium intake among this age group (Spear, 2002). Participants in this study reported a high consumption on soda intake as well as sugary-type beverages which are not considered to be good sources of calcium. Possible conclusions for the increased sodium consumption among males could be attributed to the high intake of processed and snack type-foods reported such as fast food French fries, hamburgers, luncheon meats, snack crackers and chips.

There were significant differences among gender in total fat consumption. In this study, males consumed 34% fat (64.63 grams) and females consumed 32% fat (51.59 grams). National Academy of Sciences, (2004) recommends males and females consume a range of total fat between 25%-35% . Though both genders were within an acceptable percentage of fat intake on the days of the dietary collection, the quality of foods consumed is still in question. For participants reporting lunch consumption through the National School Lunch Program, there is some protection against eating foods that are high in saturated fat. The National School Lunch Program is required to meet the Dietary Guidelines for Americans, which recommends that no more than 30% of an individual’s calories come from fat and less than 10% from saturated fat (USDA Food and Nutrition Services, 2004). Additional foods that are high in fat reported by the participants could also be dependent on what was available in the household during the 24-hour dietary recall collection. Families have reported more access to high fat fast foods when funds are more readily available (Kaiser et al., 2002).

The recommendation for fiber intake for males aged nine to thirteen years is 31 grams per day and for females 26 grams per day; males aged 14-18 years is 38 grams per day and females 26 grams per day ((National Academy of Sciences, 2004). Both males and females in this study reported minimal to no fruit or vegetables intake. One participant did report eating whole grain bread on one occasion; however, other participants commonly reported a high intake of refined carbohydrates. Males, in this study, consumed 14.46 grams of fiber per day and females consumed 12.51 grams of fiber per day. Both males and females were below the national recommendation for fiber. The role of dietary fiber has been linked to childhood weight management and the prevention of type 2 diabetes (Trevino et al., 2004). However, despite its availability through the National School Lunch Program, many participants are not choosing to include fruits and vegetables into their daily diet. The National School Lunch Program is required to provide two or more servings of fruits or vegetables or both during meal service (USDA, 2004). According to the 2005, Youth Risk Behavior Surveillance, national statistics suggest that 20.1% of students had eaten fruits and vegetables greater than five times/day during the seven days preceding the survey. In the same survey, the overall prevalence of having eaten fruits and vegetables greater than five times/day was higher among male (21.4%) than female (18.7%) students and higher among black male (24.3%) than black female (19.9%) students. Lastly, in the same survey the overall prevalence of having eaten fruits and vegetables >5 times/day was higher among black (22.1%) and Hispanic (23.2%) than white (18.6%) students; higher among Hispanic female (21.8%) than white female (17.4%) students; and higher among black male (24.3%) and Hispanic male (24.5%) than white male (19.7%) students (Eaton, Kann, Kinchen, Ross, Hawkins, Harris et al., 2005). In the home environment, the consumption of dark green and other vegetable intake may decrease during times that the family may be experiencing food insecurity (Holben, 2006).