Impact of Training on Employees' Handwashing Behaviors in School Nutrition Programs.

BACKGROUND: School nutrition employee behavior plays an important role in preventing foodborne outbreaks and protecting the almost 30 million children who partake in daily school lunch. OBJECTIVE: The study aim was to compare the impact of using a food safety training program with or without using a realistic-event video on handwashing behavior modification for school nutrition employees. DESIGN: A 2-group (control and experimental) pretest with 2 post-tests design was used. The control group received training without the video and the experimental group received the food safety training with a realistic-event video. Measurements used to address the purpose and objectives of this study included questionnaires and direct observations. PARTICIPANTS/SETTING: The sample consisted of 443 school nutrition employees responsible for food preparation and service affiliated with 21 school districts in 18 states. Approximately half of the sample attended the original unmodified training and the other half attended the modified training. Data were collected in the United States during 2017. A total of 338 employees participated in the observations and 443 participants completed the questionnaires during the 3 phases; 935 questionnaires were used for the analysis. INTERVENTION: The intervention involved a food safety training program embedded with a realistic-event video related to handwashing. The video used previous research to target antecedents to handwashing behavior among participants. MAIN OUTCOME MEASURES: Actual behavior was observed across 3 phases-pretraining, post training, and final-for both the control and experimental groups. In addition, indirect and direct measures of behavioral intentions for handwashing were measured. STATISTICAL ANALYSIS PERFORMED: For the observation data, a 2-way, fixed-effects, mixed-model procedure was used to analyze the data. Simple and multiple linear regression and contingency table analyses looking for differences among phases and treatments were used for questionnaire data analysis. RESULTS: Most practices were reported as in compliance (51.3% to 80.6%) for both the control and experimental groups during all phases. The experimental group had a higher behavioral intention of properly washing their hands than participants in the control group. CONCLUSIONS: The results showed that handwashing practices were in compliance most of the time for both the control and experimental groups during all 3 observation periods. Differences among the data collection periods on the theory of planned behavior constructs indicated no statistical effect of the treatment (exposure to the video) between the control and intervention groups.

The Nutritional Adequacy and Diet Quality of Vegetarian Menu Substitutions in Urban Kansas Childcare Centers.

While plant-based eating has become increasingly popular, little is known of how this trend has impacted childcare center meals. The purpose of this study was to measure the nutrient content and diet quality of vegetarian alternative lunches and compare these measures to those of standard childcare lunches and nutrient benchmarks representing one-third of the Dietary Reference Intake for 3-year-olds and 4-5-year-olds. Menu data were obtained from seven urban Kansas childcare centers participating in the Child and Adult Care Food Program and regularly providing a vegetarian alternative lunch. The centers provided detailed menu information for 27 days' worth of meals. The most common vegetarian substitution was cheese, which was used to fulfill all or part of the meat/meat alternative requirement in over three-quarters of the vegetarian alternative meals (n = 22). Compared to the standard meals, the vegetarian alternative meals were higher in calories, fat, saturated fat, calcium, and sodium and lower in protein, choline, and diet quality (p = 0.05). Both lunch options met the benchmarks for vitamin A, vitamin D, vitamin B12, calcium, and protein. Iron content for both (95% CI: standard 1.61-2.17 mg; vegetarian 1.37-2.7 mg) was below the benchmark. Although additional research is needed to better understand how vegetarianism has impacted childcare meals in the U.S., important differences in the nutrient contents were observed between the standard and vegetarian alternative meals. In addition, the results suggest vegetarian alternative meals that rely heavily on cheese may be of lower diet quality.

Revising the Academy's Research Priorities: Methods of the Research Priorities and Strategies Development Task Force, 2017-2019.

The Academy of Nutrition and Dietetics, as the largest member-based nutrition organization in the world, is dedicated to advancing the world of nutrition and dietetics through research. It is essential for the Academy to identify both current and future research priorities for nutrition and dietetics professionals. To address this, the Academy convened a task force charged with developing research priorities relevant for its members. Specifically, it would define key issues of the nutrition and dietetics profession going into the second century and identify relevant research topics and questions related to the defined issues. The task force leveraged multiple data sources to develop the research priorities. These data sources included existing interviews from a previous Academy event (Nutrition Impact Summit) held in 2016 and answers from an Academy Member Engagement Zone survey. This led to the development of draft research priorities that were included in a more extensive survey e-mailed to all Academy members. Results of this member-wide survey, in addition to multiple stakeholder checks, informed the final Academy research priorities. Thirteen final priorities were established across 4 domains: nutrition-related discovery, clinical nutrition research, implementation science, and public health. These priorities have relevance for all nutrition and dietetics professionals across diverse areas of practice and will be used internally to prioritize research efforts, inform the allocation of resources across Academy units, and guide Academy advocacy for national nutrition research agendas and initiatives. This article will summarize the task force's updated research priorities and detail the 9-step process used to generate them.

Leveraging Online Learning to Promote Systems Thinking for Sustainable Food Systems Training in Dietetics Education.

Educating and training a multisectoral food systems workforce is a critical part of developing sustainable, resilient, and healthy food and water systems. This paper shares perspectives from a working group of educators, learners, and food systems subject matter experts that collaborated over the course of a year to develop, pilot test, and evaluate two interactive webinar series with a multi-site cohort of dietetics interns and graduate students. The three-part webinar series format included a training webinar, a practice activity, and a synthesis webinar. In reflecting on the effectiveness of this format, we provide direct assessments of student learning from subject matter experts alongside indirect assessments from pre- and post-surveys fielded with learners. Learners who participated in an interactive webinar series demonstrated skills in several dimensions of systems thinking and gained confidence in food systems learning outcomes. Learners also shared valuable feedback on the opportunities and challenges of using online platforms for this experience. As online learning opportunities become more common, it will become increasingly important for educators to prioritize strategies that effectively equip students with the higher-order thinking skills, such as systems thinking, needed to address the complexities of sustainable food systems. The interactive webinar series format described here provides an opportunity to leverage didactic webinars in combination with interactive experiences that enable learners to deepen their knowledge through practice with peers and subject matter experts. Though this format was piloted within dietetics education programs, many of the lessons learned are transferable to other food systems educational contexts.

Probabilistic risk model of norovirus transmission during handling and preparation of fresh produce in school foodservice operations.

Human noroviruses (NoV) are recognized worldwide as important pathogens and the primary cause of foodborne disease outbreaks from contaminated food in the U.S. They are often transmitted by infected food handlers manipulating foods during preparation, such as fresh fruits and vegetables. This paper provides a study to model the transfer of NoV between food handlers and vegetables during salad preparation in school food services based on direct observation data. Three transfer pathways were modeled by considering different initial contamination sources (environment, handlers and contaminated produce). The probability of infection by NoV was also estimated based on the NoV levels at consumption obtained from each simulated transfer pathway. A scenario analysis ranging a wide concentration from 102 to 107 NoV infective particles was performed to represent different levels of NoV in the initial contamination sources. In addition, a sensitivity analysis was applied to identify the most important model inputs and determine the safest handling practices to be implemented in school food service operations. The pathway describing transfer from contaminated surfaces or handlers to foods indicated that initial levels of ≤104 NoV particles/fomite resulted in <0.5% cases per serving of NoV infection. When initial levels were higher, % cases of NoV infection was estimated to be ca. 3%. This rise in % cases of infection was linked to higher doses (5% serving with ≥15 NoV particles/serving) and prevalence levels at consumption (>0.2). In the pathway modeling cross contamination from contaminated vegetables to non-contaminated vegetables, all scenarios could lead to infected individuals, although number of cases of infection were lower (<1.3%), despite concentration levels were higher. On the contrary, for this pathway, prevalence was 2-fold lower than that observed in the pathways describing transfer from contaminated surfaces and hands. Based on the sensitivity analysis, NoV transfers to fresh produce may be minimized by improving hand washing, and therefore effective training programs need to be carried out specifically addressing hand washing. Moreover, the produce's washing step showed to be an effective control measure, depending on the desinfectant efficacy, by reducing % cases of NoV infection from 6 to 1%. The model in this study might be used, in the future, to evaluate the impact on the risk associated with NoV transmission of specific and effective training programs, aimed at food chain operators.