Advancing Public Health Policy in Louisiana Through Evidence-Based Strategies: Successes and Opportunities.

In 2013, a team of public health professionals at Tulane University launched a project to explore strategies for shaping a healthier Louisiana. The team investigated methods for improving diet and physical activity behaviors in early childhood, school, and community settings that could be translated into specific policies. Through key informant interviews and scans of academic journals and reports issued by public health agencies, the team generated a set of actionable steps that could increase healthful behaviors. Previous efforts to address similar topics in Louisiana and other states, and their reception from policy makers, were also considered during analysis. Subsequently, a state legislator used the team's work to introduce public health legislation in 2014. The legislation led to a number of incremental changes in state policy and resolutions for additional policy-relevant studies. This case study summarizes the promising physical activity and nutrition strategies that were considered by the Tulane team, how the team's work product was integrated into state legislation, the outcomes of the legislation, and a set of recommendations for how Louisiana can expand on this work. This article demonstrates how the work of public health professionals can have a positive influence on the policy-making process through research and education.

Perceptions of School-Based Kitchen Garden Programs in Low-Income, African American Communities.

Introduction. While school-based kitchen garden programs are shown to improve fruit and vegetable consumption and knowledge among children, there has been little research on participant perceptions of these programs, specifically among minority populations that are disproportionately affected by and at high risk for overweight and obesity. This qualitative study examined the perceptions of and values associated with participation in school-based kitchen garden programs implemented through Edible Schoolyard New Orleans in low-income, predominantly African American schools in New Orleans, Louisiana. Method. Qualitative data were collected through semistructured focus group discussions with key stakeholder groups at schools offering Edible Schoolyard New Orleans. Results. A total of 10 focus groups were conducted across 4 middle schools with students (n = 27), parents (n = 17), and teachers (n = 17). Four primary themes emerged during data analysis: development of life skills, food and health, family and community, and experiential and participatory learning. Conclusions. To strengthen the sustainability and potential impact of school-based kitchen garden programs, future intervention strategies should place specific emphasis on the themes that emerged from this study. School-based kitchen garden programs may be a promising strategy to positively influence the individual, social, and physical environmental factors that contribute to overweight and obesity in low-income, African American communities.

10 Years Later: Changes in Food Access Disparities in New Orleans since Hurricane Katrina.

Inadequate access to healthy food is a problem in many urban neighborhoods, particularly for racial-ethnic minorities and low-income groups who are more likely to reside in food deserts. Although substantial research throughout the country has documented the existence of these disparities, few studies have focused on how this access changes over time or is affected by environmental shocks. This study examined citywide supermarket access in New Orleans as well as racial-ethnic disparities in this access, prior to Hurricane Katrina and at three times afterwards. On-the-ground verification of supermarket locations was conducted in 2004-2005, 2007, 2009, and 2014 and was mapped with secondary demographic data. Census tracts were defined as predominantly African-American neighborhoods if 80 % or more of the population identified as such. HLM Poisson regression analyses were conducted in 2014 to identify the difference in likelihood of finding supermarkets in a neighborhood by race-ethnicity and across all years of interest. Racial-ethnic disparities existed before the storm and worsened after it (IRR = 0.35; 95 % CI = 0.21, 0.60). Improvements in disparities to pre-storm levels were not seen until 2009, 4 years after the storm. By 2014, supermarket access, on average, was not significantly different in African-American neighborhoods than in others (IRR = 0.90; 95 % CI = 0.65, 1.26). The slow recovery of New Orleans' retail food infrastructure after Hurricane Katrina highlights the need for an increased focus on long-term planning to address disparities, especially those that may be exaggerated by shocks.

Application of the Nutrition Functional Diversity indicator to assess food system contributions to dietary diversity and sustainable diets of Malawian households.

OBJECTIVE: Dietary diversity is associated with nutrient adequacy and positive health outcomes but indicators to measure diversity have focused primarily on consumption, rather than sustainable provisioning of food. The Nutritional Functional Diversity score was developed by ecologists to describe the contribution of biodiversity to sustainable diets. We have employed this tool to estimate the relative contribution of home production and market purchases in providing nutritional diversity to agricultural households in Malawi and examine how food system provisioning varies by time, space and socio-economic conditions. DESIGN: A secondary analysis of nationally representative household consumption data to test the applicability of the Nutritional Functional Diversity score. SETTING: The data were collected between 2010 and 2011 across the country of Malawi. SUBJECTS: Households (n 11 814) from predominantly rural areas of Malawi. RESULTS: Nutritional Functional Diversity varied demographically, geographically and temporally. Nationally, purchased foods contributed more to household nutritional diversity than home produced foods (mean score=17·5 and 7·8, respectively). Households further from roads and population centres had lower overall diversity (P<0·01) and accessed relatively more of their diversity from home production than households closer to market centres (P<0·01). Nutritional diversity was lowest during the growing season when farmers plant and tend crops (P<0·01). CONCLUSIONS: The present analysis demonstrates that the Nutritional Functional Diversity score is an effective indicator for identifying populations with low nutritional diversity and the relative roles that markets, agricultural extension and home production play in achieving nutritional diversity. This information may be used by policy makers to plan agricultural and market-based interventions that support sustainable diets and local food systems.

Beyond Food Access: The Impact of Parent-, Home-, and Neighborhood-Level Factors on Children's Diets.

Despite the growth in empirical research on neighborhood environmental characteristics and their influence on children's diets, physical activity, and obesity, much remains to be learned, as few have examined the relationship between neighborhood food availability on dietary behavior in children, specifically. This analysis utilized data from a community-based, cross-sectional sample of children (n = 199) that was collected in New Orleans, Louisiana, in 2010. This dataset was linked to food environment data to assess the impact of neighborhood food access as well as household and parent factors on children's diets. We observed a negligible impact of the neighborhood food environment on children's diets, except with respect to fast food, with children who had access to fast food within 500 m around their home significantly less likely (OR = 0.35, 95% CI: 0.1, 0.8) to consume vegetables. Key parental and household factors did play a role in diet, including receipt of public assistance and cooking meals at home. Children receiving public assistance were 2.5 times (95% CI: 1.1, 5.4) more likely to consume fruit more than twice per day compared with children not receiving public assistance. Children whose family cooked dinner at home more than 5 times per week had significantly more consumption of fruit (64% vs. 58%) and vegetables (55% vs. 39%), but less soda (27% vs. 43%). Findings highlight the need for future research that focuses on the dynamic and complex relationships between built and social factors in the communities and homes of children that impact their diet in order to develop multilevel prevention approaches that address childhood obesity.

Lunch Salad Bars in New Orleans' Middle and High Schools: Student Intake of Fruit and Vegetables.

The school lunch salad bar (SB) is a recommended food environmental strategy to increase access to, and consumption of fruit and vegetables (F/V). In a study to examine use of school lunch SBs, middle and high school students provided data via the Automated Self-Administered 24-h dietary recall (24HDR) tool for kids (ASA24-Kids-2012), a web-based data collection platform. Kilocalories were computed, food groups were assigned and F/V sources were obtained. Students (n = 718) from 12 schools with SBs and nine schools without SBs were approximately 87% African American, over 64% female and most were 7th and 8th graders. SB school students had higher median energy consumption at lunch but a higher percent of non-SB students reported eating fruit at lunch compared to SB students. Most students reporting eating F/V at lunch obtained F/V from the cafeteria main line; only 19.6% reported eating F/V exclusively from the SB. In SB schools median intake of cups F/V was higher among students using the SB (0.92) compared to those not using the SB (0.53). Results of this study are mixed, but encouraging. Additional factors, e.g., nutrition education, marketing, and kinds of foods offered on the SB need to be examined for potential influence on SB use.

Adolescent Student Use of School-Based Salad Bars.

BACKGROUND: Childhood obesity continues to be a public health problem in the United States. Increasing consumption of fruits and vegetables (F/V) is one strategy for decreasing high consumption of energy-dense, high-fat foods, thereby improving weight status. Many Orleans Parish public schools were provided with salad bars (SBs) to augment school lunch with increased access to F/V. This study identified factors associated with student use of SBs. METHODS: Surveys examining SB use, demographics, food preference, nutrition knowledge, and social support were administered to students in the 7th to 12th grades (N = 702) in Orleans Parish (New Orleans, Louisiana). Generalized estimating equations, which incorporate clustering at the school level, helped to determine associations between independent variables and SB use. RESULTS: Sixty percent of participants were SB users. Non-African-American students were more likely to be SB users than African-American students (odds ratio [OR] = 2.35, confidence interval [CI]: 1.35-4.07) and students who had high preference for healthy food were more likely to use the SB than those who had low preference (OR = 2.41, CI: 1.44-4.01). Students who encouraged others to consume F/V were more likely to use the SB than those who did not (p = .015). CONCLUSIONS: Individual and interpersonal factors related to SB use can provide guidance in the development of school-based interventions to increase SB use and F/V consumption.