Promoting sustainable responses to the US opioid epidemic with community-academic partnerships: qualitative outcomes from a statewide program.

BACKGROUND: Drug overdose deaths in the United States have continued to increase at an alarming rate. The Substance Abuse and Mental Health Services Administration (SAMHSA) distributed more than $7 billion between January 2016 and June 2020 to address the drug overdose crisis. The funds support evidence-based responses, including medications for opioid use disorder, and other prevention, treatment and recovery activities. Although the State Opioid Response (SOR) grants finance much-needed community level interventions, many of the services they support may not be sustainable, without ongoing assessment, evaluation and planning for continuation. METHODS: This paper describes a statewide effort to support local entities through SAMHSA's SOR grants in Virginia. Community agencies across the state participated in detailed needs assessment exercises with VHEOC investigators, and developed requests for proposals (RFPs) to sustain their SOR programs. The RFPs were then distributed to prospective academic partners at the five VHEOC universities, based on the required subject matter expertise identified in the RFP. All responsive proposals were then provided to the local agencies who selected the proposal most likely to meet their needs. VHEOC investigators also conducted an inductive, three-phase content analysis approach to examine the RFPs submitted to the VHEOC to identify nominal categories of support requested of the VHEOC investigators. RESULTS: VHEOC Investigators received and coded 27 RFPs from ten community agencies representing four of five regions of the state. We identified six nominal categories of academic assistance with high inter-coder agreement. The six categories of support requested of the academic partners were program development and support, literature review and best practices, outreach and education, data analysis and interpretation, program evaluation, and grant writing assistance. Several RFPs requested up to three categories of support in a single project. CONCLUSIONS: Our analysis of the requests received by the consortium identified several categories of academic support for SOR-grantees addressing the drug overdose crisis. The most common requests related to development and maintenance of supportive collaborations, which existing research has demonstrated is necessary for the long-term sustainability of SOR-funded services. In this way, the academic partners reinforced sustainable SOR-funded programs. As the state opioid response program is implemented nationally, we hope that other states will consider similar models in response to the opioid crisis.

Implementation and outcomes of the Balanced Living with Diabetes program conducted by Cooperative Extension in rural communities in Virginia.

INTRODUCTION: Adult onset diabetes is a significant health issue in rural communities that are disproportionately suffering from the health, social and financial costs of the disease. Despite this, over half of rural counties in the USA lack access to diabetes self-management programs, which are effective at improving diabetes management. The Cooperative Extension System (CES) is a nationwide education network that provides research-based information and programs in nearly 3000 counties in the USA to improve the health and wellbeing of rural and urban communities. This study evaluated the implementation and outcomes of a lifestyle management program, Balanced Living with Diabetes (BLD) conducted by community-based educators who are part of the CES in rural Virginia, to address the gap in diabetes education in these communities. BLD is grounded in social cognitive theory and has shown efficacy to modify dietary and physical activity behaviors resulting in improved glycemic control in people with type 2 diabetes. METHODS: The study evaluated the implementation and effectiveness of BLD programs conducted by the CES in 16 rural counties over 2 years. Program adoption, reach, context, and barriers and facilitators to implementation were evaluated through program outcome data and extension educator interviews. Program outcomes included change in weight, glycosylated hemoglobin (A1C), diabetes knowledge, self-management practices, diet and physical activity behaviors, and self-efficacy from baseline to 12-week assessment. RESULTS: Extension educators conducted 30 programs, reaching 290 residents, with a 58% mean retention rate. The program resulted in a significant increase in diabetes and food knowledge, fruit, vegetable, and whole grain intake, use of the plate method, exercise, and diabetes management self-efficacy. A1C decreased significantly in participants with diabetes (mean reduction=0.345±1.013; p=0.001). The program was conducted twice in 11 counties, and once in five counties. Barriers to program adoption in the five counties included limited community interest, competing program priorities of the extension educator, and loss of extension personnel to conduct the program. Participant communication materials and systems to enhance program sustainability were developed in response to educator feedback. Process evaluation indicated that the program was highly acceptable to extension educators and program participants. CONCLUSION: The CES is an effective network for implementation of diabetes lifestyle-management programs in underserved communities, and the BLD program is effective at increasing lifestyle behaviors and self-efficacy that improve glycemic control in people with type 2 diabetes. Collaboration by Virginia's CES with a variety of community partners, including healthcare and social service providers, increases the reach and sustainability of extension diabetes programs. The CES in the USA is well positioned to fill the gap in diabetes education in rural communities as part of a chronic care model.

The Slow Down Program: A mixed methods pilot study of a mindfulness-based stress management and nutrition education program for mothers.

OBJECTIVE: Stress levels have been associated with a broad range of adverse health outcomes, particularly for mothers and subsequently, their children. Mindfulness-based stress management is a tool that has effectively been utilized in several disciplines and has potential applications to eating behaviors. This paper describes the effects of an exploratory mindfulness-based stress management and nutrition education program, the Slow Down Program, on mothers' perceived stress, eating behavior, and self-efficacy. DESIGN & SETTING: This study used a mixed methods quasi-experimental design. Nineteen mothers with young children (five or younger) participated in the study. The SDP consisted of four consecutive weekly 1.5 h sessions focused on experiential learning and facilitated discussion. MAIN OUTCOME MEASURES: Quantitative data were collected pre- and post-intervention and included: the Perceived Stress Scale; Mindfulness Self-Efficacy Scale; and the Three-Factor Eating Questionnaire Revised-18. Qualitative data included a focus group post-intervention and an individual interview 4-6 weeks post-intervention. RESULTS: The SDP showed significant improvements in participants' perceived stress (p = .04), uncontrolled eating (p < 0.01), cognitive restraint (p < 0.01), and mindfulness self-efficacy (p < 0.01). Qualitatively, participants also reported changes in self-efficacy and eating behaviors - specifically improvements in mindful eating, and sensory and satiety awareness. CONCLUSIONS: The results of this pilot study demonstrate that nutrition programs incorporated with mindfulness strategies may offer positive, short-term impacts on stress reduction and eating behaviors. Additional studies are warranted across a variety of populations with more rigorous study designs to assess long-term effects.

Dog Ownership, Physical Activity, and Health-Related Quality of Life in Veterinary Students: A Cross-Sectional Study.

The primary objective of this cross-sectional study was to examine the relationship between dog ownership and physical activity in veterinary students. The secondary objective was to gain an understanding of veterinary students' health-related quality of life (HRQOL), and whether dog ownership and/or physical activity were associated with HRQOL measures. Veterinary students were invited to complete surveys between September and November 2015. The primary outcome for multivariate analyses was self-reported physical activity. Bivariate analyses and descriptive statistics were performed to assess student HRQOL. The survey response rate was 33% (152/460). Self-efficacy to exercise (p<.001, OR 2.24, 95% CI 1.46-3.44) and dog ownership (p=.01, OR 3.38, 95% CI 1.31-8.71) independently predicted meeting physical activity guidelines when controlling for other variables. About two thirds of respondents met physical activity guidelines. Veterinary students had significantly worse self-reported mental health scores when compared to both national and state averages. Neither dog ownership nor meeting physical activity guidelines were significantly associated with measures of HRQOL. The poor mental health status of veterinary students remains a significant issue for the profession to address. Longitudinal studies are needed that examine the relationship between physical activity and mental health outcomes in this population.

Smart Snacks in School Legislation Does Not Change Self-Reported Snack Food and Beverage Intake of Middle School Students in Rural Appalachian Region.

OBJECTIVE: To assess the effects of the national Smart Snacks in School standards, which include nutrient and ingredient limitations for school competitive foods and beverages effective July, 2014, on student intake in low-income rural Appalachian middle schools. METHODS: Food-frequency questionnaires were administered to students before and after implementation. Multiple ordinal logistic regression models were conducted to examine effects from year of data collection, grade, and free or reduced price lunch participation rates. RESULTS: No significant changes were observed after implementation except a decrease in consumption of 1% or nonfat flavored milk at school. CONCLUSIONS AND IMPLICATIONS: Smart Snacks in School standards did not result in significant dietary changes in this study. Longitudinal studies could evaluate long-term impacts of nutrition standards.

Implementation of Policies and Strategies for Control of Noncommunicable Diseases in Malawi: Challenges and Opportunities.

Malawi is a Sub-Saharan African country experiencing the epidemiological transition from predominantly infectious to noncommunicable diseases (NCDs) with dramatically increasing prevalence of lifestyle-related diseases such as obesity, hypertension, and diabetes. Malawi's 2011-2016 Health Sector Strategic Plan included NCDs, and an NCD Control Program was established with subsequent development of a National Action Plan for prevention and management of NCDs launched in 2013. The current study was designed to identify gaps in implementation of NCD control program policies and action plan strategies by describing current efforts toward prevention and management of NCDs in Malawi with emphasis on challenges and opportunities. Semistructured questionnaires were used to collect quantitative and qualitative data from Malawi Ministry of Health personnel (senior officers, service providers, health education officers, and nutritionists) in 10 health districts and 3 central hospitals. Frequencies were generated for quantitative data. Qualitative data were used to generate themes and most common responses. Results showed that current services focus on facility-based NCD screening and clinical services rather than active screening, prevention, and community awareness and outreach, although respondents emphasized the importance of prevention, lifestyle education, and community outreach. Respondents indicated inadequate resources for NCD services including financial capital, human resources, equipment and supplies, and transportation. While Malawi has begun to address NCDs, policy and practice implications include (a) better integration of services within the existing infrastructure with emphasis on capacity building; (b) greater implementation of planned NCD activities; (c) a stronger, more comprehensive data management system; and (d) innovative funding solutions.

A comparison of fruits, vegetables, sugar-sweetened beverages, and desserts in the packed lunches of elementary school children.

BACKGROUND: An estimated 40% of children bring a packed lunch to school. These lunches are not required to meet nutrition standards. The aim of this study was to compare differences in the nutritional quality of elementary packed lunches by the presence or absence of sugar-sweetened beverages (SSB), desserts, and fruits and vegetables (FVs). METHODS: Observational data for prekindergarten and kindergarten packed lunches were collected from three schools in rural Virginia for 5 consecutive school days and analyzed for macro- and micronutrients and by the presence or absence of food and beverage items. RESULTS: Of the 561 packed lunch observations collected, 41.7% contained no FV, 41.2% contained an SSB, and 61.1% contained a dessert. The nutrient profile of packed lunches with at least one fruit or vegetable had significantly higher levels of carbohydrate, fiber, sugar, vitamin A, and vitamin C. Packed lunches containing an SSB had significantly higher levels of sugar and vitamin C and significantly lower levels of protein, fiber, vitamin A, calcium, and iron. Packed lunches containing a dessert had significantly higher levels of energy, carbohydrate, fat, saturated fat, sodium, sugar, vitamin C, and iron and significantly lower levels of vitamin A. CONCLUSIONS: Additional research is needed to fully understand parent and child motivations for packing lunches and the decision processes that influence the inclusion of food items. The development of packed lunch interventions, encouragement of National School Lunch Program participation, or enactment of school policies to increase the nutritional value of packed lunches is warranted.

Making a Difference in Malawi and Zambia Through Health Education and Public Health Best Practices.

A 2-year U.S. Department of State-funded project* was conducted with the purpose of engaging health professionals from Malawi and Zambia who are actively involved in health care and health education for marginalized populations to develop, implement, and evaluate health education and public health interventions/programs. Twenty-six health professionals from Malawi and Zambia, referred to as Global Health Fellows, participated in the 2-year program, of which the main training component was conducted in the United States. Fellows were exposed to health education and public health best practices and developed an action plan to address a health problem of concern in their respective communities/countries. After completion of the program, Fellows received $300 to implement their action plans. Teams of Americans involved in the training program participated in follow-up visits to Malawi and Zambia to observe real-time progress on Fellows' respective action plans. The project was successful in creating an educational experience focused on health education best practices as well as implementation of action plans to address selected health problems in Malawi and Zambia.

Nutritional comparison of packed and school lunches in pre-kindergarten and kindergarten children following the implementation of the 2012-2013 National School Lunch Program standards.

OBJECTIVE: Approximately 40% of children bring a packed lunch to school. Little is known about the quality of these lunches. This study examined the nutritional quality of packed lunches compared with school lunches for pre-kindergarten and kindergarten children after the implementation of 2012-2013 National School Lunch Program standards. METHODS: The researchers collected observational data for packed and school lunches from 3 schools in rural Virginia for 5 consecutive school days and analyzed them for macro and micro nutrients. RESULTS: Of the 1,314 observations collected; 42.8% were packed lunches (n = 562) and 57.2% were school lunches (n = 752). Energy, fat, saturated fat, sugar, vitamin C, and iron were significantly higher whereas protein, sodium, fiber, vitamin A, and calcium were significantly lower for packed lunches than school lunches. CONCLUSIONS AND IMPLICATIONS: Packed lunches were of less nutritional quality than school lunches. Additional research is needed to explore factors related to choosing packed over school lunches.

Dairy intake and related self-regulation improved in college students using online nutrition education.

BACKGROUND: Dairy intake by college students is markedly lower than recommendations. Interventions to improve dairy intake based on Social Cognitive Theory (SCT) have potential to successfully change behavior by improving mediators that influence dietary choices. OBJECTIVE: We aimed to use SCT to improve social support, self-efficacy, outcome expectations, self-regulation, and behavior related to dairy intake in college students. DESIGN: We conducted a randomized nutrition education intervention. PARTICIPANTS/SETTING: Participants included 211 college students (mean age 20.2 ± 0.1 years; 63% women and 37% men) recruited from a university campus. Participants in the intervention group (n=107) and comparison group (n=104) received an 8-week dairy intake or stress management intervention, respectively, via electronic mail. Data collection included dairy intake from 7-day food records and SCT variables from questionnaires administered during January 2008 and April 2008. MAIN OUTCOME MEASURES: Changes in dairy intake and SCT variables (ie, social support, self-efficacy, outcome expectations, and self-regulation). STATISTICAL ANALYSES PERFORMED: Multivariate analysis of covariance, with age and sex as covariates (P<0.05). RESULTS: Ninety-one percent of participants (n=97 intervention, n=94 comparison) provided data; complete data were analyzed for 85% of participants (n=90 intervention, n=89 comparison). Participants in the intervention group reported higher intake of total dairy foods (P=0.012) and improved use of self-regulation strategies for consuming three servings per day of total dairy (P=0.000) and low-fat dairy foods (P=0.002) following the intervention. CONCLUSIONS: Nutrition education via electronic mail based on an SCT model improved total dairy intake and self-regulation. Participants reported increased dairy intake and better use of self-regulation strategies. Future interventions should focus on benefits of consuming low-fat vs higher-fat dairy foods.

Cost-effectiveness model for youth EFNEP programs: what do we measure and how do we do it?

The Youth Expanded Food and Nutrition Education Program (EFNEP) is one of the United States Department of Agriculture's hallmark nutrition education programs for limited-resource youth. The objective of this study was to gather opinions from experts in EFNEP and related content areas to identify costs, effects (impacts), and related instruments to develop a cost-effectiveness model (instrument) for youth EFNEP, which does not exist. A cost-effectiveness model determines the economic or financial cost of producing an impact. The findings highlight several challenges in identifying inputs through consensus and provide a roadmap for the creation of a model that can be adopted by state EFNEP coordinators.

Web-based nutrition education intervention improves self-efficacy and self-regulation related to increased dairy intake in college students.

Dairy consumption declines substantially during young adulthood. Interventions that incorporate theory-based nutrition education can provide insight into factors associated with dietary choices. The aim of this experimental study was to improve outcome expectations, self-efficacy, self-regulation, and behavior related to dairy intake in college students using social cognitive theory. Students (n=294) enrolled in a personal health class were randomized to intervention (n=148) or comparison group (n=146). The 5-week intervention (March 2006 to April 2006) was conducted using an online course system; components included e-mail messages, posted information, and behavior checklists with tailored feedback. Multivariate analysis of covariance with age and sex as covariates (P<0.05) was conducted to measure change related to dairy intake and social cognitive theory variables. Ninety-two percent of participants (n=135 intervention, n=136 control) completed the study. Dairy intake from food records did not differ between groups at baseline; baseline intake for all participants (mean ± standard error) was 0.45 ± 0.05 servings/day for low-fat dairy products and 1.44 ± 0.06 servings/day for total dairy products. Participants in the intervention group made greater increases in use of self-regulatory strategies (P=0.038) and self-efficacy for consuming three servings/day of dairy products (P=0.049), but not in outcome expectations or consumption of dairy products. A Web-based intervention designed to change dairy intake in college students was effective in modifying some social cognitive theory constructs; strategies that positively impact outcome expectations and social support through online interventions require further development.

Low-fat dairy intake and body weight and composition changes in college students.

Dairy calcium may help prevent excess weight gain and obesity when consumed in adequate amounts (three or more servings per day) and combined with energy balance. This prospective cohort study was conducted to evaluate dairy intake and examine the association between low-fat dairy intake and body weight and composition changes in college students. Seventy-six college students (65 women and 11 men; mean age+/-standard error [SE]=19.2+/-0.2 years) completed 7-day food records, body height (cm), weight (kg), and waist circumference (cm) measurements twice (September 2004 and April 2005). Percentage of truncal fat and percentage of total body fat were measured by dual-energy x-ray absorptiometry. One-way multivariate analysis of covariance was conducted. Overall (mean+/-SE) total dairy (1.4+/-0.1 servings/day), low-fat dairy (0.5+/-0.1 servings/day), and calcium (815+/-41 mg/day) intakes were low. Subjects who consumed a higher amount of low-fat dairy products (mean+/-SE=0.8+/-0.1 servings/day) had better diet quality, gained less body weight, and had reductions in waist circumference, percentage truncal fat, and percentage total body fat compared to those with lower intake (mean+/-SE=0.1+/-0.0 servings/day). Low-fat dairy intake may be associated with better diet quality and weight management in college students. Nutrition interventions in young adults should promote low-fat dairy intake as part of an overall healthful lifestyle.

African-American students' perceptions of their majors, future professions, and the dietetics major and profession: a qualitative analysis.

African-American professionals are underrepresented in the profession of dietetics. This preliminary qualitative study identified African-American students' perceptions of their majors, future professions, and the dietetics major/profession to understand why they did or did not enter dietetics. It was hypothesized that dietetics students chose dietetics primarily for altruistic reasons, whereas students in other fields of study did not choose dietetics due to lack of awareness of dietetics. To learn students' views, African-American college students engaged in elicitation interviews or focus group discussions. Twenty-eight women and 12 men participated. Phenomenologic analysis identified common themes and meanings: African-American students selected their majors for a variety of reasons, including desire to help people, interest in the field, recommendation from an adult, and family influence. African-American students in fields of study other than dietetics believed that the dietetics major was not selected due to lack of awareness about dietetics. Both dietetics students and students in other fields of study perceived versatility, ability to work with/help people, and to have an influence as positive qualities about their future professions. Advanced degree and training requirements, lack of diversity, and low salary were identified as negative qualities about future professions. African-American students in fields of study other than dietetics had not been exposed to the dietetics major, careers, and profession. Recruitment efforts should begin early to increase the number of African-American students in dietetics.

Whole-grain intake is associated with body mass index in college students.

OBJECTIVE: To measure whole-grain intake in college students and determine the association with body mass index (BMI). DESIGN: Cross-sectional convenience sample of college students enrolled in an introductory nutrition course. SETTING: Large state university. PARTICIPANTS: 159 college students, mean age: 19.9. MAIN OUTCOME MEASURES: Intake of whole grains, refined grains, calories, and fiber from food records; BMI determined from height and weight measurements. ANALYSIS: Analysis of variance with linear contrasts; participants grouped by BMI category (P<.05). RESULTS: Average intake of cereal grains was 5.4 servings per day, of which whole-grain intake accounted for an average of 0.7 servings per day. Whole-grain intake was significantly higher in normal weight students than in overweight and obese students (based on BMI). CONCLUSIONS AND IMPLICATIONS: The low intake of whole grains in this population of college students indicates the need for interventions aiming to increase whole-grain intake to the recommended minimum of 3 servings per day. College students who are concerned about their body weight may be motivated to increase their intake of whole-grain foods; however, their intake of whole grains is likely to be influenced by the availability of these food items in campus dining halls and other locations around the college campus.

Status and goals of local school wellness policies in Virginia: a response to the child nutrition and WIC Reauthorization Act of 2004.

By fall 2006 each school division participating in the National School Lunch Program was mandated to establish a local wellness policy. The study objective was to assess schools' plans for the policy, including goals for food, nutrition education, and physical activity and evaluation. Surveys were administered to 132 School Health Advisory Board coordinators in Virginia in early 2006; 92 (69.7%) responded. The findings highlight gaps toward meeting minimum requirements for the policy and give guidance on how nutrition educators and researchers can provide expertise to optimize the policy and document progress and impacts on children's health related to the policy.

Perceived hunger is lower and weight loss is greater in overweight premenopausal women consuming a low-carbohydrate/high-protein vs high-carbohydrate/low-fat diet.

The impact of a low-carbohydrate/high-protein diet compared with a high-carbohydrate/low-fat diet on ratings of hunger and cognitive eating restraint were examined. Overweight premenopausal women consumed a low-carbohydrate/high-protein (n=13) or high-carbohydrate/low-fat diet (n=15) for 6 weeks. Fasting body weight (BW) was measured and the Eating Inventory was completed at baseline, weeks 1 to 4, and week 6. All women experienced a reduction in BW (P<.01), although relative BW loss was greater in the low-carbohydrate/high-protein vs high-carbohydrate/low-fat group at week 6 (P<.05). Based on Eating Inventory scores, self-rated hunger decreased (P<.03) in women in the low-carbohydrate/high-protein but not in the high-carbohydrate/low-fat group from baseline to week 6. In both groups, self-rated cognitive eating restraint increased (P<.01) from baseline to week 1 and remained constant to week 6. Both diet groups reported increased cognitive eating restraint, facilitating short-term weight loss; however, the decrease in hunger perception in the low-carbohydrate/high-protein group may have contributed to a greater percentage of BW loss.