HIV knowledge and stigma among dietetic students in Indonesia: implications for the nutrition education system.

BACKGROUND: Studies have demonstrated that health care students and practitioners are not immune to stigma towards people living with HIV (PLHIV). This attitude could lead to poor quality of care if it remains uncorrected. However, little is known about dietetic students' acceptance of PLHIV despite their substantial role in treatment. This study aimed to measure the extent of knowledge and stigma towards PLHIV among dietetic students and to determine the associated factors using the attribution theory. METHODS: Students from three dietetics schools in Indonesia (n = 516) were recruited to participate in this cross-sectional study. Survey questions covered demographic information, interaction with PLHIV, access to information sources, cultural values, and beliefs as predictor variables. The outcome variables were comprehensive knowledge of HIV, HIV and nutrition-specific knowledge, and attitudes. Analyses with linear regression and the stepwise selection were performed to determine factors related to the outcome. RESULTS: The levels of HIV comprehensive knowledge and HIV-nutrition specific knowledge among dietetic students were low, as indicated by the average score of 19.9 ± 0.19 (maximum score = 35) and 8.0 ± 0.11 (maximum score = 15), respectively. The level of negative attitudes towards PLHIV was high, with 99.6% of participants reported having a high stigma score. Types of university affiliation (public or private), beliefs and values, exposure to HIV discourse, access to printed media, and years of study were significantly related to HIV comprehensive knowledge (p < 0.05). Nutrition-specific knowledge was also correlated with university affiliation, beliefs and values, participation in HIV discussion, and years of study (p < 0.05). HIV comprehensive knowledge, university affiliation, discussion participation, and ethnicities were associated with attitudes (p < 0.05). CONCLUSIONS: Awareness and acceptance of PLHIV must be further improved throughout dietetic training to ensure patients' quality of care since students represent future dietary care providers. Considering the consistent findings that affiliation to education institution correlates with HIV knowledge and attitude, some examinations concerning the curriculum and teaching conduct might be necessary.

Ripple Effects of the Communities Preventing Childhood Obesity Project.

This research examines the practice of community coaching within coalitions in the Communities Preventing Childhood Obesity project. A quasi-experimental design was used in seven Midwestern states. Each state selected two rural, low-income communities with functioning health coalitions. Coalitions were randomly assigned to be intervention or comparison communities. After 4 years of the coaching intervention, ripple effect mapping served as one method for examining the coalitions' work that may affect children's weight status. A research team from each state conducted ripple effect mapping with their two coalitions, resulting in 14 ripple maps. Community capitals framework and the social-ecological model were used for coding the items identified within the ripple maps. A quantitative scoring analysis determined if differences existed between the intervention and comparison coalitions in terms of the activities, programs, funding, and partnerships for social-ecological model score (e.g., individual, community, policy levels), community capitals score, and ripples score (e.g., number of branches formed within the maps). All scores were higher in intervention communities; however, the differences were not statistically significant (p > .05). Assessing community assets, such as availability of a community coach, is necessary in order to decide whether to deploy certain resources when designing health promotion strategies.

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.

The Expanded Food and Nutrition Education Program's Impact on Graduates' Quality of Life.

OBJECTIVE: To determine how the Expanded Food and Nutrition Education Program (EFNEP) affects the quality of life (QoL) of its low-income adult participants. METHODS: A cross-sectional exploratory study using focus groups (n = 15) in 8 states with EFNEP participants (n = 111) 2-4 months after graduation. Focus groups were conducted with non-Hispanic white (4 groups), black (4), English-speaking Hispanic (4), and Spanish-speaking Hispanic (3) respondents. A priori template analysis based on constructs from the University of Toronto's Quality of Life Profile for Adults and constant comparative procedures were used to generate results. RESULTS: Participants reported following healthier dietary and physical activity behaviors and having increased motivation to improve themselves and greater satisfaction with life. All groups noted being a more positive influence on their families and a having willingness to learn and try new things. CONCLUSIONS AND IMPLICATIONS: The EFNEP enhances the QoL of its participants, which suggests that the program's benefits go beyond participants' documented nutrition and health-related behavior changes. In the future, EFNEP might examine whether improved QoL is also a predictor of sustained behavior change and a means for differentiating program impacts owing to variations in dose (number of contacts) or delivery methods (face-to-face vs online).

Communities Partnering With Researchers: An Evaluation of Coalition Function in a Community-Engaged Research Approach.

BACKGROUND: Community coalitions are frequently used as partners for community-engaged research. However, limited research shows how these partnerships affect the coalitions. OBJECTIVE: To evaluate the effects of researcher-coalition collaboration on coalition function in the pilot year of a 4-year intervention program targeting childhood obesity in rural, low-income communities. METHODS: A quasi-experimental study using a quantitative survey (Coalition Self-Assessment Survey [CSAS]) evaluated factors related to coalition function and efficacy. Twelve community coalitions from seven states completed survey evaluations at baseline (n = 133), and at the 1-year follow-up (n = 113). Pearson's χ2 and Mann-Whitney U tests were computed; significance was set at p < .05. RESULTS: Survey results revealed significant changes for coalitions engaged in research partnership. Institutional engagement with community health coalitions in the first year of partnership was related to enhanced coalition function. CONCLUSIONS: Coalitions with a greater degree of researcher collaboration may be more successful in addressing community health problems.

Breastfeeding duration and childhood overweight among low-income children in Kansas, 1998-2002.

OBJECTIVES: We sought to determine whether increased duration of breast-feeding was associated with decreased risk of overweight among 4-year-old children in Kansas families with limited means. METHODS: We linked data on Kansas families from the Pediatric Nutrition Surveillance System and Pregnancy Nutrition Surveillance System, 1998 to 2002, to determine breastfeeding duration and weight status at age 4 years. Overweight among 4-year-old children was defined as body mass index-for-age at the 95th percentile and above. Linked analysis included 3692 children. Logistic regression was applied to determine odds of being overweight at each duration of breastfeeding. RESULTS: Breastfeeding duration considered independently showed a significant protective association with childhood overweight at age 4 years for all non-Hispanics (odds ratio [OR]=0.72; 95% confidence interval [CI]=0.55, 0.94) and for Whites only (OR=0.68; CI=0.50, 0.92). When we controlled for other significant risk factors for childhood overweight, the association diminished and was not statistically significant. CONCLUSIONS: Although breastfeeding for longer duration appeared to be protective against overweight among 4-year-old non-Hispanic children, cultural and environmental factors may override this protective benefit.

The MFFAPP Tanzania Efficacy Study Protocol: Newly Formulated, Extruded, Fortified Blended Foods for Food Aid.

Fortified blended foods (FBFs) are micronutrient-fortified blends of milled cereals and pulses that represent the most commonly distributed micronutrient-fortified food aid. FBFs have been criticized due to lack of efficacy in treating undernutrition, and it has also been suggested that alternative commodities, such as sorghum and cowpea, be investigated instead of corn and soybean. The Micronutrient Fortified Food Aid Pilot Project (MFFAPP) Tanzania efficacy study was the culmination of economic, processing, sensory, and nutrition FBF research and development. MFFAPP Tanzania was a 20-wk, partially randomized cluster design conducted between February and July 2016 that enrolled children aged 6-53 mo in the Mara region of Tanzania with weight-for-height z scores >-3 and hemoglobin concentrations <10.3 mg/dL. The intervention was complementary feeding of newly formulated, extruded FBFs (white sorghum cowpea variety 1, white sorghum-cowpea variety 2, red sorghum-cowpea, white sorghum-soy blend, and corn-soy blend 14) compared with Corn Soy Blend Plus (CSB+), a current US Agency for International Development-distributed corn-soy blend, and a no-FBF-receiving control. Screened participants (n = 2050) were stratified by age group (6-23 and 24-53 mo) and allocated to 1 of 7 FBF clusters provided biweekly. Biochemical and anthropometric data were measured every 10 wk at weeks 0, 10, and 20. The primary objectives of this study were to determine whether newly formulated, extruded corn-, soy-, sorghum-, and cowpea-based FBFs result in equivalent vitamin A or iron outcomes compared with CSB+. Changes in anthropometric outcomes were also examined. Results from the MFFAPP Tanzania Efficacy Study will inform food aid producers and distributers about whether extruded sorghum- and cowpea-based FBFs are viable options for improving the health of the undernourished. This trial was registered at clinicaltrials.gov as NCT02847962.

EFNEP's Impact on Exemplary Educators' Quality of Life.

OBJECTIVE: To determine how the Expanded Food and Nutrition Education Program (EFNEP) affects the quality of life (QoL) of its exemplary paraprofessional educators. METHODS: Qualitative telephone interviews with EFNEP supervisors (15), educators (28), and agency partners (15). Template analysis based on the University of Toronto's QoL constructs. RESULTS: The EFNEP had a positive impact on 6 of 9 a priori categories: physical being, psychological being, social belonging, community belonging, practical becoming, and growth becoming. CONCLUSIONS AND IMPLICATIONS: The EFNEP enhances the QoL of its exemplary educators, which suggests that the program's benefits go beyond those documented in participants.

Position of the Academy of Nutrition and Dietetics: nutrition and lifestyle for a healthy pregnancy outcome.

It is the position of the Academy of Nutrition and Dietetics that women of childbearing age should adopt a lifestyle optimizing health and reducing risk of birth defects, suboptimal fetal development, and chronic health problems in both mother and child. Components leading to a healthy pregnancy outcome include healthy prepregnancy weight, appropriate weight gain and physical activity during pregnancy, consumption of a wide variety of foods, appropriate vitamin and mineral supplementation, avoidance of alcohol and other harmful substances, and safe food handling. Pregnancy is a critical period during which maternal nutrition and lifestyle choices are major influences on mother and child health. Inadequate levels of key nutrients during crucial periods of fetal development may lead to reprogramming within fetal tissues, predisposing the infant to chronic conditions in later life. Improving the well-being of mothers, infants, and children is key to the health of the next generation. This position paper and the accompanying practice paper (www.eatright.org/members/practicepapers) on the same topic provide registered dietitian nutritionists and dietetic technicians, registered; other professional associations; government agencies; industry; and the public with the Academy's stance on factors determined to influence healthy pregnancy, as well as an overview of best practices in nutrition and healthy lifestyles during pregnancy.

EFNEP's impact on the quality of life of its participants and educators.

OBJECTIVE: Determine whether the Expanded Food and Nutrition Education Program (EFNEP) affects the quality of life (QOL) of its participants and educators. DESIGN: Longitudinal, where QOL was measured 3 times for participants (pre, post, 3-month delayed post) and educators (before and 6 and 12 months after training). SETTING: Participants' and educators' QOL was measured in Colorado, Kansas, Missouri, and Nebraska. Georgia and Texas measured educators; Minnesota and Virginia measured participants. PARTICIPANTS: English speaking EFNEP participants and educators. MAIN OUTCOME MEASURES: The investigators used the QOL Profile to measure QOL in 3 domains: Being (who one is), Belonging (connection with social and physical environment), and Becoming (achieving personal goals). ANALYSIS: Chi-square and t tests compared group demographics; repeated-measures ANOVA detected changes over time; ANCOVA examined the influence of demographic variables. RESULTS: Both groups had QOL Profile scores above 1.5, which is considered acceptable. Participants improved from pre to post in the Being domains including Overall Being (least square means [standard error of the mean], 3.1 [0.2] to 4.1 [0.3]), and in Social Belonging (3.5 [0.3] to 3.8 [0.3]); most improvements were sustained at 3 months. Educators improved in the Belonging domains, and a number of scores continued to improve at 1 year after training, for example, Social Belonging (4.2 [0.5], 5.0 [0.5], and 5.8 [0.6]); and Community Belonging (3.5 [0.5], 3.8 [0.5], and 4.7 [0.5]) at the 3 time points, respectively. CONCLUSIONS AND IMPLICATIONS: EFNEP improved the QOL of participants, primarily in the Being domain, and of educators, primarily in the Belonging domain. The QOL profile has the potential to broaden the assessment of EFNEP impacts.