Experiences and Lessons Learned From the RADx-UP Consortium Community Engagement Projects.

In this study, we used emerging community engagement frameworks to describe the structure and outcomes of a large-scale, community-engaged, research-to-practice initiative, RADx-UP. Qualitative methods were used to analyze survey and meeting data from 2022 for RADx-UP projects. Most projects had diverse partners, achieved moderate levels of community engagement, and experienced positive outcomes. Challenges related to engagement readiness and partnership functioning. These findings demonstrate that community engagement is measurable and valuable. However, additional support is needed to achieve the highest engagement. (Am J Public Health. 2024;114(S5):S405-S409. https://doi.org/10.2105/AJPH.2024.307615).

Ageing well with diabetes: A workshop to co-design research recommendations for improving the diabetes care of older people.

AIMS: To identify key research questions where answers could improve care for older people living with diabetes (PLWD), and provide detailed recommendations for researchers and research funders on how best to address them. METHODS: A series of online research workshops were conducted, bringing together a range of PLWD and an acknowledged group of academic and clinical experts in their diabetes care to identify areas for future research. Throughout the pre-workshop phase, during each workshop, and in manuscript preparation and editing, PLWD played an active and dynamic role in discussions as part of both an iterative and narrative process. RESULTS: The following key questions in this field were identified, and research recommendations for each were developed: How can we improve our understanding of the characteristics of older people living with diabetes (PLWD) and their outcomes, and can this deliver better person-centred care? How are services to care for older PLWD currently delivered, both for their diabetes and other conditions? How can we optimise and streamline the process and ensure everyone gets the best care, tailored to their individual needs? What tools might be used to evaluate the level of understanding of diabetes in the older population amongst non-specialist Healthcare Professionals (HCPs)? How can virtual experts or centres most effectively provide access to specialist multi-disciplinary team (MDT) expertise for older PLWD and the HCPs caring for them? Is a combination of exercise and a nutrition-dense, high protein diet effective in the prevention of the adverse effects of type 2 diabetes and deterioration in frailty, and how might this be delivered in a way which is acceptable to people with type 2 diabetes? How might we best use continuous glucose monitoring (CGM) in older people and, for those who require support, how should the data be shared? How can older PLWD be better empowered to manage their diabetes in their own home, particularly when living with additional long-term conditions? What are the benefits of models of peer support for older PLWD, both when living independently and when in care? CONCLUSIONS: This paper outlines recommendations supported by PLWD through which new research could improve their diabetes care and calls on the research community and funders to address them in future research programmes and strategies.

Comparing Current Practice to Recommendations for the Child and Adult Care Food Program.

BACKGROUND: The federal Child and Adult Care Food Program (CACFP) assists child care centers serving low-income preschoolers and regulates the quality and quantity of food served. The aim of this study was to assess the nutritional quality of lunches served at 38 child care centers and examine how current practices compare to proposed meal pattern recommendations. METHODS: Preschool-aged children (n = 204) were observed eating lunch in 38 CACFP-participating preschools. All foods served and consumed were measured and compared to the 2011 Institute of Medicine (IOM) recommendations to improve CACFP and the 2015 Proposed Rule issued by the USDA. RESULTS: All centers provided access to all required lunch components, but not all components were served (i.e., placed on the child's plate). Vegetables were significantly less likely to be served than meat or grains. Compared with CACFP recommended portion sizes, servings of meat and grain were high, whereas milk was low. Compared with IOM recommendations, average calorie consumption was appropriate, but saturated fat, protein, and sodium intake were high and dietary fiber was low. Meals that offered children both a fruit and a vegetable led to significantly higher produce consumption than meals that offered only one fruit or one vegetable. CONCLUSIONS: Child care centers generally comply with current CACFP regulations, but do not provide lunches consistent with the 2011 IOM recommendations for saturated fat, protein, fiber, and sodium. Decreased use of beef and cheese and increased provision of whole grains, fruits, and vegetables are recommended.

Testing Variations on Family-Style Feeding To Increase Whole Fruit and Vegetable Consumption among Preschoolers in Child Care.

BACKGROUND: Preschoolers do not consume whole fruit and vegetables (FVs) in recommended quantities. Two strategies to increase FV intake were tested. METHODS: One Head Start preschool participated. Two variations of family-style feeding were compared to usual practice: (1) Fruits, vegetables, and milk were served before the main meal (first course); and (2) fruits, vegetables, and milk were served before the main meal and meats and grains were removed from the table after the first serving (combination). A within-subject crossover design was used to test each condition for three meals. The amount of food served and consumed was weighed and converted to Child and Adult Care Feeding Program (CACFP) standard serving sizes for analysis. RESULTS: Eighty-five children ages 3-5 participated. The sample was 81% Hispanic with diverse racial backgrounds. Thirty percent of the children were overweight. FV consumption was at CACFP recommended levels at baseline and remained consistent across conditions. The average amount served for each meal component was at or above CACFP recommendations for all foods except milk, which was consistently served in small portions. Meat and grains servings were frequently 2-3 times larger than CACFP recommendations. Milk consumption was significantly higher in the Combined intervention for two meals. Children ate significantly less meat during the Combined intervention for one meal. CONCLUSIONS: The intervention led to significant increases in milk consumption, which was the only underconsumed meal component. These strategies should be tested with children who have lower baseline intake of FVs.

Prevalence of partially hydrogenated oils in US packaged foods, 2012.

Although there is evidence that consumption of trans fat has declined in the United States, limited documentation exists on current levels of industrial trans fat in foods. We estimated the prevalence of partially hydrogenated oils in 4,340 top-selling US packaged foods. Nine percent of products in the sample contained partially hydrogenated oils; 84% of these products listed "0 grams" of trans fat per serving, potentially leading consumers to underestimate their trans fat consumption. Government efforts to eliminate partially hydrogenated oils from packaged foods will substantially reduce exposure to this known cardiovascular disease risk factor.

From policy to practice: implementation of water policies in child care centers in Connecticut.

OBJECTIVE: Child care policies may contribute to healthy beverage consumption patterns. This study documented availability and accessibility of water and correspondence with state and federal policy and accreditation standards in child care centers. DESIGN: One-day observations were conducted in a random sample of 40 Child and Adult Care Food Program-participating preschool classrooms in Connecticut. SETTING AND PARTICIPANTS: Child care centers, center directors, and preschool teachers. MAIN OUTCOME MEASURES: Raters observed water availability and teacher behaviors during lunch, physical activity, and in the classroom. National, state, and childcare center water regulations and policies were reviewed. ANALYSIS: Descriptive statistics present data on water availability, promotion, and modeling. Bivariate relationships between water availability and accreditation status, center water policy, location of physical activity, and verbal promotion were assessed using the Fisher exact test (P < .05). RESULTS: Many centers were in violation of water-promoting policies. Water was available in most classrooms (84%) but was only adult accessible in over half of those classrooms. Water was available during one third of physical activity periods observed. Verbal prompts for children to drink water were few. CONCLUSIONS AND IMPLICATIONS: Support is needed to help centers meet existing water policies and new water requirements included in the 2010 Child Nutrition Reauthorization Act.

Positive influence of the revised Special Supplemental Nutrition Program for Women, Infants, and Children food packages on access to healthy foods.

BACKGROUND: The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) has important potential for preventing diet-related disease in low-income children. WIC food packages were recently revised to offer foods that better reflect dietary recommendations for Americans. OBJECTIVE: This article reports on how implementation of the new healthier WIC food packages affected access of low-income populations to healthy foods (eg, whole grains, fruit and vegetables, and lower-fat milk). DESIGN: A pre-post store inventory was completed using a standardized instrument to assess availability, variety, quality and prices of WIC-approved foods (65 food items). Stores were assessed before (spring 2009) and shortly after the new WIC package implementation (spring 2010). PARTICIPANTS/SETTING: All convenience stores and nonchain grocery stores located in five towns of Connecticut (N=252), including 33 WIC-authorized stores and 219 non-WIC stores. STATISTICAL ANALYSES PERFORMED: The healthy food supply score was constructed to summarize postrevision changes in availability, variety, prices of healthy foods, and produce quality. The effect of the WIC food package revisions was measured by differential changes in the scores for stores authorized to accept WIC benefits and stores not participating in WIC, including differences by neighborhood income. Multivariate multilevel regression models were estimated. RESULTS: The 2009 introduction of the revised WIC food packages has significantly improved availability and variety of healthy foods in WIC-authorized and (to a smaller degree) non-WIC convenience and grocery stores. The increase in the composite score of healthy food supply varied from 16% in WIC convenience and grocery stores in higher-income neighborhoods to 39% in lower-income areas. Improved availability and variety of whole-grain products were responsible for most of the increase in the composite score of healthy food supply. CONCLUSIONS: Designed as cost-neutral changes, the WIC food package revisions have improved access to healthy foods for WIC participants and society at large.

Validity of a measure to assess the child-care nutrition and physical activity environment.

BACKGROUND: Licensed child-care centers represent an opportunity to positively influence children's health behaviors. Valid and easy-to-use measures of the child-care environment are needed to assess the influence of environmental change on health. OBJECTIVE: To develop and validate a self-administered survey to assess the nutrition and physical activity environment of child-care centers, and to identify domains that may be evaluated adequately through self-report. DESIGN: A survey was developed to assess four areas related to nutrition and physical activity: center policies, practices related to the social environment, physical environment, and nutrition quality. Development involved review of the literature, existing measures, and regulations/standards as well as collaboration with a working group. The survey was pilot tested and feedback was sought from expert consultants. It was administered statewide and validated against a menu rating tool, interviews with a center director, and a direct observation tool that was developed for this study. PARTICIPANTS/SETTING: Participating sites were drawn from Child and Adult Care Food Program-participating licensed Connecticut child-care centers serving 13 or more children aged 3 to 5 years. Survey responses from 146 center directors were included, as were 62 center menus, and director interviews and observational data from 33 sites. PRIMARY OUTCOMES/STATISTICAL ANALYSES: Criterion validity of the survey was assessed through percent agreement with mirroring items in the additional measures. Healthy and unhealthy food scores were calculated for menu and survey tools, and Pearson correlations were computed. RESULTS: Percent agreement with criterion outcomes ranged from 39% to 97%, with 61% of items achieving agreement ≥80%. Agreement was highest for nutrition and policy domains, and lowest for physical activity and barriers to promoting health. Correlations between food scores across measures were moderate. CONCLUSIONS: The self-report survey demonstrated adequate criterion validity. We make recommendations for improving validity of low-agreement items and for the use of more labor-intensive evaluation procedures for domains not adequately assessed through self-report.

Food retailer practices, attitudes and beliefs about the supply of healthy foods.

OBJECTIVE: Non-supermarket food retailers can be a promising channel for increasing the availability of healthy foods in underserved communities. The present paper reports on retailer practices, attitudes and beliefs about the supply of healthy foods before and after the introduction of new subsidies for healthy foods by the US Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in October 2009. DESIGN: We designed and conducted in-person standardized interviews with store owners and managers to assess perceptions of demand and profits for different foods, supply networks, barriers to stocking healthy foods and their changes following implementation of the new WIC packages. SETTING: Non-supermarket retailers in five towns of Connecticut, USA (n 68 in 2009 and n 58 in 2010). SUBJECTS: Owners and managers of WIC-authorized and non-WIC convenience stores and non-chain grocery stores. RESULTS: Retailers identified customer demand as the primary factor in stocking decisions. They reported observing a significantly weaker demand for healthy foods compared with unhealthy foods, although it improved for certain foods with the new WIC subsidies. Less healthy foods were also perceived as more profitable. Supplier networks varied by product from convenient manufacturer delivery for salty snacks to self-supply for produce. WIC retailers were able to quickly adapt and supply healthy foods required under the new WIC programme guidelines. CONCLUSIONS: Retailers other than supermarkets currently perceive little demand for healthy foods, but new WIC subsidies have the power to change these perceptions. Supply barriers seem secondary in the limited offerings of healthy foods by stores and could be overcome when policy changes generate new demand for healthy foods.

Stereoelectronic effects in a homologous series of bidentate cyclic phosphines. A clear correlation of hydroformylation catalyst activity with ring size.

The homologous series of diphosphines (CH(2))(n-1)P(CH(2))(3)P(CH(2))(n-1) where n = 5 (L(5)), 6 (L(6)), or 7 (L(7)) have been synthesized from the corresponding PhP(CH(2))(n-1). Treatment of [PtCl(2)(cod)] with L(5-7) gave the 6-membered chelates cis-[PtCl(2)(L(5-7))], the crystal structures for which reveal that L(5-7) have very similar steric bulk and bite angles. Treatment of [Rh(2)Cl(2)(CO)(4)] with L(5-7) gave the binuclear trans-[Rh(2)Cl(2)(CO)(2)(micro-L(5-7))(2)] with syn and anti orientations of the CO and Cl ligands suggested by the (31)P NMR spectra and the crystal structures of syn-trans-[Rh(2)Cl(2)(CO)(2)(micro-L(5))(2)] and anti-trans-[Rh(2)Cl(2)(CO)(2)(micro-L(7))(2)]. The nu(CO) values for trans-[Rh(2)Cl(2)(CO)(2)(micro-L(5-7))(2)] indicate that the donor strength increases in the order L(5) < L(6) < L(7). A study of rhodium-catalysed hydroformylation of 1-octene using diphosphines L(5-7) is described. The catalyst activity decreases with increasing phosphacycle ring size: L(5) > L(6) > L(7).