Healthy Schoolhouse 2.0 Strides toward Equity in Obesity Prevention.

Background: Over the past two decades, childhood obesity has been recognized as an increasing health problem with stark disparities by race, ethnicity, and zip code. A single-level intervention that focuses on individual choices has limited success especially in under-resourced communities. Methods: The "Getting to Equity" model provides a framework for building interventions that incorporate multilevel strategies. We applied this model to an elementary school-based obesity prevention program. Results: By applying the "Getting to Equity" framework, we demonstrate how a school-based program aligns with the quadrants within the framework to holistically address childhood obesity. Conclusion: By applying this model to an elementary school-based obesity prevention program, we demonstrate how program leaders can address childhood obesity while advancing health equity.

Engaging Faith-Based Organizations to Promote Health Through Health Ministries in Washington, DC.

This article describes capacity building and formative assessments completed at five faith-based organizations (FBOs) in Washington, DC to inform sustainable health promotion programming led by certified health ministers. Five FBO partners were recruited with two congregation members from each FBO completing a health minister certificate program. A series of health assessments were conducted to assess each FBO's capacity to implement evidence-based lifestyle change programs that are responsive to congregation members' health needs. Results indicated a need for programming to support older adults in managing high blood pressure and arthritis. Health ministers represent a significant opportunity for building capacity within FBOs to deliver programming that can improve health outcomes.

Campus-based programmes to address food insecurity vary in leadership, funding and evaluation strategies.

College food insecurity is a known detriment to student success, but little is known about the implementation of campus-based programmes to help address this issue on campus in the United States. The objective of this research study was to determine the types of food insecurity initiatives implemented and assess how such programmes are managed, funded, and evaluated. A cross-sectional, 23-item online survey was administered among individuals involved with campus food insecurity initiatives identified through professional networks. Food pantries were the most common (97.1%) and mobile food sharing applications were the least common (14.7%) food security initiatives. A majority of respondents (69.7%) stated that at least one programme on their campus was evaluated, although the methods varied and uncertainty about the methods used was common. An allocated budget was provided at some institutions (38.9%), but funding mechanisms varied. Student Life Offices were most commonly reported as being responsible for programme management. Most respondents (75.3%) reported there had been programme changes due to COVID-19. This research confirmed that food insecurity programmes are widely available, although the type, funding, and leadership of these programmes vary. A coordinated approach on campus to align programming efforts is needed.

In Their Own Words: Parents and Key Informants' Views on Nutrition Education and Family Health Behaviors.

Parents, health professionals, and communities are integral in the development of nutrition behaviors that reduce children's risk for high body mass index (BMI) and chronic disease. The aim of this study was to conduct formative evaluations with key health informants and parents to understand the specific strategies that families use at mealtimes to promote their family's health, along with the barriers they face in attending current nutrition education programming. Focus groups (in English and Spanish) were conducted with parents (n = 22; 63.64% Black/African American, 13.64% Black but not African American, 18.18% Hispanic/Latinx) whose household was located in a community where 50% of residents' gross income was ≤185% of the federal poverty level. Semi-structured interviews were conducted with six key informants with expertise in family health and nutrition. Inductive thematic analysis was used to identify themes across interviews. Six general themes emerged from the interviews including perceptions of health, relationships, health behaviors, facilitators, barriers, and desired changes. Across the six themes, participants responded with suggestions for community-based health promotion programs such as incorporating a broader definition of health to better address the individual and systemic barriers that perpetuate health inequities and make healthy eating difficult. Participants identified stress reduction, health literacy, and cooking knowledge as areas of interest for future programming.

Incentivizing Supplemental Nutrition Assistance Program Purchases with Fresh Produce in Corner Stores to Reduce Food Inequity in Underserved Areas of Washington DC.

Purpose: Maintaining a healthy eating pattern plays a key role in ensuring optimal health outcomes, yet, in areas considered "food deserts" and lower-income neighborhoods where the accessibility of healthy foods and beverages is limited, the pursuit of adequate nutrient intake is rendered cumbersome. This pilot program aims to improve access to healthful foods by supporting corner stores in stocking and promoting the purchase of produce. Methods: DC Central Kitchen's Healthy Corners program in Washington, DC piloted a nutrition incentive model in 17 corner stores that were upgraded to stock an increased variety and quantity of fresh produce. This program, entitled "5-for-5," provided a $5 coupon toward the purchase of fresh produce to Supplemental Nutrition Assistance Program (SNAP) shoppers making a qualifying purchase of $5 or more with SNAP benefits. Results: Evaluation based on store owner buy-in and customer intercept surveys indicated overall satisfaction in program offerings with 77% of SNAP shoppers polled indicating an increase in produce consumption as a direct result of the program. Coupon distribution data indicated that in the 5-for-5 program's first year, 76.5% of all 57,989 distributed coupons were redeemed, amounting to $221,770 worth of incentivized fresh produce sales. Conclusion: The results of the incentive program were promising with increases in the amount of produce purchased as a result of the program. Lessons learned concerning the use of a financial incentive to encourage the purchase of produce at corner stores is explored, as well as the feasibility of the corner store as a sustainable venue to increase produce consumption in underserved communities.

Translating school health research to policy. School outcomes related to the health environment and changes in mathematics achievement.

This paper describes an exploration of the relationship between mathematic achievement and the school health environment relative to policy-driven changes in the school setting, specifically with regard to physical education/physical activity. Using school-level data, the authors seek to understand the relationship between mathematics achievement and the school health environment and physical education minutes. This work provides a description of the aspects of the school health environment, an exploration of the interrelationships between school health and student achievement, and an assessment of the effects of the school health policy and practice on student performance and health status. Based on these findings, we identify additional research necessary to describe the relationship between obesity and learning in children.

Health promotion overview: evidence-based strategies for occupational health nursing practice.

Health promotion practice has evolved over the past four decades in response to the rising rates of chronic disease. The focus of health promotion is attaining wellness by managing modifiable risk factors, such as smoking, diet, or physical activity. Occupational health nurses are often asked to conduct worksite health promotion programs for individuals or groups, yet may be unfamiliar with evidence-based strategies. Occupational health nurses should lead interprofessional groups in designing and implementing worksite health promotion programs. This article introduces occupational health nurses to health promotion concepts and discusses evidence-based theories and planning models that can be easily introduced into practice.

The effect of nutrient-based standards on competitive foods in 3 schools: potential savings in kilocalories and grams of fat.

BACKGROUND: The study investigated how nutrient standards affected the number of kilocalories and grams of fat and saturated fat in competitive foods offered and sold in 3 high schools. METHODS: The study is a quasi-experimental design with 3 schools serving as the units of assignment and analysis. The effect of the nutrient standards was measured by the change in kilocalories and grams of fat and saturated fat in offerings and purchases of competitive foods pre- and postimplementation of the standards. A paired sample t-test was used to compare kilocalories and grams of fat and saturated fat pre- and postimplementation of nutrition standards. RESULTS: After the implementation of the nutrition standards, students in 3 high schools purchased significantly smaller numbers of kilocalories and grams of fat and saturated fat, during the postpolicy school year of 2007-2008 than during the prepolicy school year of 2004-2005. CONCLUSION: Using nutrient standards to guide the selection of competitive foods offered in school cafeterias may positively affect intake of kilocalories, total grams of fat, and total saturated fat of those foods. The quantitative assessment is novel and demonstrates the reduction in kilocalories and fat in both the competitive food offerings and purchases as a result of nutrient standards.

The impact of nutrition standards on competitive food offerings and purchasing behaviors of high school students.

BACKGROUND: With adolescent obesity rates on the rise, the school food environment is receiving closer scrutiny. This study looks at the effects of nutrient standards as part of a wellness policy that was implemented in 3 public high schools in 1 county, by analyzing the nutritional value of competitive food offerings and purchases before and after the development of the standards. METHODS: All food offerings and purchases were labeled based on their nutritional density using a stoplight approach of green, yellow, and red colors for the pre- and post- period. The stoplight approach to ranking foods is on a continuum of nutrient density, with green foods being the healthiest choices and red foods offering minimal nutrient density. RESULTS: Results showed that after the implementation of the standards, red foods made up 30% of offerings, down from 48% of offerings prior to the existence of the guidelines. The proportion of red food purchases also decreased, from 83% to 47%. Additionally, yellow food offerings increased from 18% to 48% and purchases increased from 6% to 34%. CONCLUSION: Results indicate that the nutrient standards as part of the wellness policy contributed to a positive shift in the nutritional value of competitive food purchases and offerings.

The national school lunch and competitive food offerings and purchasing behaviors of high school students.

BACKGROUND: Across the nation, schools have become actively involved in developing obesity prevention strategies both in classrooms and in cafeterias. We sought to determine the type of foods being offered during lunch in the cafeteria of 3 public high schools in 1 county and if this reflects the purchasing patterns of students. By labeling foods based on nutrient density using a stoplight approach of green, yellow, and red colors, we were able to categorize all foods including the National School Lunch Program (NSLP) and competitive foods available in the cafeteria. METHODS: Over a 4-week cycle, daily food purchases were gathered and the proportions of green, yellow, and red foods offered and purchased was compared. RESULTS: Findings from this study suggest that students in these 3 high schools purchased foods in relative proportion to what was available in the school cafeteria for the NSLP. Green and yellow foods included in the NSLP comprised 77% of the offerings and 73% of the purchases. In contrast, 61% of the competitive foods were classified as red foods, and the purchasing of red foods made up 83% of competitive food sales. These results indicate that students purchase foods of minimal nutritional value at greater proportions in the school cafeteria. CONCLUSIONS: These results suggest that the nutritional policy for the NSLP promotes the offerings of a wide array of foods. Schools should consider a nutrition policy that regulates the sale of competitive foods.

Health professionals' advice to Iowa adults with hypertension using the 2002 Behavioral Risk Factor Surveillance System.

PURPOSE: We investigated the prevalence of hypertension-lowering lifestyle-modification advice given to adults living in Iowa. We sought to determine if persons with high blood pressure and those who are overweight receive more advice than do persons with normal blood pressure and a desirable body weight. METHODS: By using the 2002 Behavioral Risk Factor Surveillance System, we asked Iowa adults with (N=1050) and without (N=2514) high blood pressure five questions relating to the most recent Joint National Committee guidelines on lowering blood pressure. Respondents with high blood pressure were placed into normal weight and overweight categories. Chi-square analysis revealed group differences in amount of advice received. To reflect the true Iowa population, data were weighted by SPSS software. RESULTS: Compared with persons without high blood pressure, those with high blood pressure received more lifestyle-modification advice (p < .001) for eating less high-fat or high-cholesterol foods (28.3% vs. 12.5%), eating more fruits and vegetables (35.7% vs. 20.0%), exercising more (37.6% vs. 20.8%), losing weight (19.3% vs. 9.3%), and quitting smoking (80.5% vs. 64.6%). CONCLUSIONS: Although persons with multiple chronic-disease risk factors are given more advice, the prevalence of advice given to individuals when lifestyle changes may reduce risk factors is still very low. Methods of translating research on lifestyle modifications into practice are discussed.

Stages of change algorithm for calcium intake by male college students.

Using a sample of college-aged men, we evaluated the validity of a staging algorithm for dairy calcium intake that had been previously validated in a sample of college women. College-aged men enrolled at a private university in the United States were randomly selected to participate. The sample consisted of 180 male participants. Self-reported calcium intake was measured using a 26-item food frequency questionnaire. Stages of change classifications were based on a four-question algorithm for dairy calcium intake and a three-item self-efficacy questionnaire. Significant differences were found between dairy/calcium intake levels between pre-contemplation, contemplation/preparation, and action/maintenance groups. Results also showed that 46% of participants were in the action/maintenance stage. There was a significant difference in self-efficacy between members of the pre-action and action stages. The study suggests that this stage of change algorithm for dairy calcium intake is valid for use in a male college student population.

Development and validation of a stages of change algorithm for calcium intake for college female students.

OBJECTIVES: The purpose of this study was to develop and validate a staging algorithm for calcium intake. METHODS: Three hundred seventy-six college-aged females at a private university were randomly selected to participate. After 8.5% of the data were omitted due to incomplete surveys, the sample consisted of 344 female participants. Calcium intake was measured as self-reported consumption with a 26-item food frequency questionnaire. Stages of change classifications were based on a four-item algorithm for calcium intake, and self-efficacy was measured with three items. RESULTS: Significant differences were found between calcium intake levels between precontemplation, contemplation/preparation and action/maintenance. Results also showed that 40% of the participants were in action/maintenance and were consuming the Dietary Reference Intake level of 1,000 mg of daily calcium. Participants in the action and maintenance stages had significantly higher self-efficacy than the preaction group. CONCLUSION: The study suggests that the stages of change algorithm may be used as an effective tool in assessing daily calcium intake among a college female population.