The UNC-CH MCH Leadership Training Consortium: building the capacity to develop interdisciplinary MCH leaders.

This article describes the UNC-CH MCH Leadership Consortium, a collaboration among five MCHB-funded training programs, and delineates the evolution of the leadership curriculum developed by the Consortium to cultivate interdisciplinary MCH leaders. In response to a suggestion by the MCHB, five MCHB-funded training programs--nutrition, pediatric dentistry, social work, LEND, and public health--created a consortium with four goals shared by these diverse MCH disciplines: (1) train MCH professionals for field leadership; (2) address the special health and social needs of women, infants, children and adolescents, with emphasis on a public health population-based approach; (3) foster interdisciplinary practice; and (4) assure competencies, such as family-centered and culturally competent practice, needed to serve effectively the MCH population. The consortium meets monthly. Its primary task to date has been to create a leadership curriculum for 20-30 master's, doctoral, and post-doctoral trainees to understand how to leverage personal leadership styles to make groups more effective, develop conflict/facilitation skills, and identify and enhance family-centered and culturally competent organizations. What began as an effort merely to understand shared interests around leadership development has evolved into an elaborate curriculum to address many MCH leadership competencies. The collaboration has also stimulated creative interdisciplinary research and practice opportunities for MCH trainees and faculty. MCHB-funded training programs should make a commitment to collaborate around developing leadership competencies that are shared across disciplines in order to enhance interdisciplinary leadership.

Can distance education prepare future public health nutritionists? A case study.

OBJECTIVE: To assess student retention, readiness, support and outcomes among students completing the Professional Practice Program in Nutrition (PPPN). DESIGN: Qualitative evaluation using semistructured, in-depth interviews conducted with PPPN graduates. Course grades, grade point averages, and comprehensive exam results compared 10 PPPN students from 2 cohorts and 72 residential students from 3 cohorts. SETTING: The Professional Practice Program in Nutrition was a 3-year, pilot public health nutrition master's (MPH) degree curriculum using distance education (DE) strategies. ANALYSIS: Ethnograph was used to assist with qualitative data analysis. Fisher exact test was used to compare quantitative outcomes. RESULTS: Qualitative findings revealed that PPPN students were highly motivated, sought out the DE MPH and initially had great support from family and employers; however, support from employers waned over time. Although several challenges to continued enrollment confronted PPPN students, those who completed the MPH all advanced in the workplace. Course grades and grade point averages were similar between the 2 groups. Students in the PPPN were more likely than residential students to retake the comprehensive exam. CONCLUSIONS AND IMPLICATIONS: The findings indicate that DE strategies were suitable to deliver an MPH curriculum in nutrition. The majority of PPPN graduates experienced job advancement and demonstrated leadership development.

An intervention to promote healthy weight: Nutrition and Physical Activity Self-Assessment for Child Care (NAP SACC) theory and design.

Health professionals are faced with the growing challenge of addressing childhood overweight. Few overweight prevention efforts have targeted young children, particularly children in child care settings. We describe the theory and development of a novel nutrition and physical activity environmental intervention. On the basis of findings from interviews and focus groups, a review of national recommendations and standards, and a review of the literature, we developed a nutrition and physical activity environmental self-assessment instrument to assess physical activity and nutrition policies and practices in child care settings. An intervention model was built around existing public health infrastructure to support use of the self-assessment instrument and encourage environmental changes at the child care level, and this intervention model became the Nutrition and Physical Activity Self-Assessment for Child Care (NAP SACC) program. The NAP SACC program was designed for dissemination and has potential for implementation in many settings. Broad interest in NAP SACC has been expressed by a number of states and institutions, and many groups are using NAP SACC intervention and materials. The NAP SACC program shows promise as a useful approach to promoting healthy weight behaviors in child care settings.

Nutrition and physical activity self-assessment for child care (NAP SACC): results from a pilot intervention.

OBJECTIVE: To determine the feasibility, acceptability, and reported impact of a nutrition and physical activity environmental intervention in child care. DESIGN: Self-assessment instrument completed pre- and post-intervention by randomly assigned intervention and comparison child care centers. SETTING: Child care centers in 8 counties across North Carolina. PARTICIPANTS: A convenience sample of 19 child care centers (15 intervention and 4 comparison). INTERVENTION: Intervention centers completed the self-assessment instrument at baseline and then selected 3 environmental improvements to make over the 6-month intervention period with assistance from a trained NAP SACC Consultant. MAIN OUTCOME MEASURE: Changes in pre- and post-intervention self-assesment of the nutrition and physical activity child care environment with additional process measures to evaluate project implementation, feasibility and acceptability. ANALYSIS: Comparison of pre- and post-test scores for the intervention group using a Wilcoxon signed-rank test and descriptions of environmental changes. RESULTS: Intervention centers rated themselves higher at follow-up than at baseline, and relative to comparison centers, reported a variety of environmental nutrition and physical activity improvements confirmed by research staff. CONCLUSIONS AND IMPLICATIONS: The NAP SACC pilot intervention shows promise as an approach to promote healthy weight environments in preschool settings. Additional evaluation of the project is needed using a greater number of centers and a more objective outcome measure.

Development of a master's in public health nutrition degree program using distance education.

The Professional Practice Program in Nutrition (PPPN) uses distance education to offer a master's degree in public health (MPH) nutrition designed for practitioners who desire to maintain their employment and develop new skills. Public health nutrition leadership faces challenges in recruiting a large enough workforce to (a) carry out the core functions of assessment, policy, and assurance; (b) update current nutritionists in new skill areas to face the demands of dynamic health care and public health climates; and (c) conduct monitoring and surveillance of Healthy People 2010 objectives. In 1996, the University of North Carolina at Chapel Hill designed and implemented this program after a market analysis to identify advanced educational need in a nine state area. PPPN was initiated as a pilot program and enrolled two cohorts of students from 1996 through 1998. This project identified four key steps: (a) conduct a detailed market analysis; (b) establish an infrastructure to deliver the program; (c) tailor the curriculum using the technology; and (d) identify, accommodate, and develop student capabilities. The findings indicate that distance education strategies are appropriate to carry out a full MPH curriculum in nutrition, but sufficient enrollment is necessary to cover the added curriculum expenditures.

A framework for assessing the effectiveness of antihunger advocacy organizations.

Food insufficiency is a major public health problem that has been linked to poor nutritional intake, poor diabetes management, poor cognitive development in children, and other adverse health outcomes. Since the 1960s, antihunger advocacy organizations (AHAOs) have fought to alleviate hunger at the local, state, and federal levels. Few studies have investigated the organizational structure, programs, advocacy activities, and outcomes of these organizations, although many organizations have been instrumental in advocating for state and federal food policy, creating measurements for hunger, and conducting research. Four state-level AHAOs were studied by using multiple case study methodology and grounded theory for analysis to assess organizational effectiveness. The findings highlight a conceptual framework that identified 19 important organizational characteristics that reflect organizational capacity, performance, achievement, and effectiveness. The conceptual framework may be useful in assessing effectiveness of public health organizations and coalitions.

Analysis of interest group influence on federal school meals regulations 1992 to 1996.

Regulatory changes proposed by the US Department of Agriculture in 1994 promised to bring progressive changes to school meals. However, lobbying by interest groups resulted in substantial changes to the final rule. This analysis retrospectively examines the federal school meals policy-making process during 1992 to 1996. Key questions address why the policy changed and what the role of interest groups was in affecting the shape, pace, and direction of the policy. The study provides suggestions for using the experiences of 1992 to 1996 to guide future advocacy efforts and for adapting the approach for application to other food and nutrition policies.

Correlates of dietary intake among men involved in the MAN for Health study.

The clustering of diet and other lifestyle behaviors and their psychosocial correlates were examined among 455 Latino and African American men in the U.S. Southeast. Men were recruited by male community health workers and surveys were self-administered in a group format. Latino men were younger, less educated, and more likely to be employed than African American men and reported a lower household income and larger household size. Fruit and vegetable consumption was associated with physical activity (p < or = .001). A more positive attitude toward health was associated with meeting vegetable dietary guidelines (p < or = .05) and consuming fast food less frequently (p < or = .01). Active coping was associated with meeting fruit and vegetable dietary guidelines (p < or = .01 and p < or = .001, respectively), and avoidant coping was associated with greater fast-food consumption (p < or = .001). Latino fast-food consumption was associated with binge drinking (p < or = .001). This research provides evidence for tailoring dietary intervention for men of color.

Preparing Child Care Health Consultants to address childhood overweight: a randomized controlled trial comparing web to in-person training.

OBJECTIVES: Child care centers have recently become targets for overweight prevention efforts directed at young children. Child Care Health Consultants (CCHCs), who provide consultation to these centers, receive little training on the basic nutrition and physical activity principles important for the promotion of child healthy weight. Traditional approaches, such as in-person training, are limited in their ability to disseminate health information to a geographically diverse population of health professionals. The purpose of this study was to determine if web-based training is as effective as in-person training. METHODS: A randomized controlled trial was conducted between August 2005 and June 2006 with 50 CCHCs. Web-based and in-person trained CCHCs were compared to each other and to controls. The main outcome of this study was performance on a test of nutrition knowledge related to childhood overweight measured by a 28-item multiple choice test administered pre- and post-training. RESULTS: Results from the ANCOVA model suggest that web trained CCHCs performed similarly to in-person trained CCHCs on the knowledge test (P < .0001). Additionally, both training groups improved significantly compared to controls (P < .0001 for each group). CONCLUSIONS: This study found no significant differences in post-training knowledge between in-person and web trained Child Care Health Consultants. Scores on the post-training knowledge test were within 0.5 points for the in-person and web trained groups. These results demonstrate that web-based instruction is as effective as in-person training on improving basic nutrition and physical activity knowledge for promoting healthy weight in preschool children.

Structure and culture of schools of public health to support academic public health practice.

Schools of public health have been cautioned about producing graduates and research that were disconnected from public interest. Although institutions may implement a variety of strategies to rectify the situation, institutional structural and cultural barriers impede progress. Public health practice coordinators in accredited schools of public health were surveyed to describe the presence of structural and cultural barriers to academic public health practice using the Stevens model. Administrative leadership and faculty reward systems are described as critical to advance academic public health practice.