Seizing the Moment: Policy Advocacy to End Mass Incarceration in the Time of COVID-19.

The mass human and economic casualties wrought by the COVID-19 pandemic laid bare the deep inequities at the base of the disproportionate losses and suffering experienced by diverse U.S. populations. But the urgency and enormity of unmet needs requiring bold policy action also provided a unique opportunity to learn from and partner with community-based organizations that often are at the frontlines of such work. Following a review of Kingdon's model of the policy-making process, we illustrate how a partnership in a large California county navigated the streams in the policy-making process and used the window of opportunity provided by the pandemic to address a major public health problem: the incarceration of over 2 million people, disproportionately African American and Latinx, in overcrowded, unsafe jails, prisons, and detention centers. We highlight tactics and strategies used, challenges faced, and implications for health educators as policy advocates during and beyond the pandemic.

Healthy Retail as a Strategy for Improving Food Security and the Built Environment in San Francisco.

In low-income neighborhoods without supermarkets, lack of healthy food access often is exacerbated by the saturation of small corner stores with tobacco and unhealthy foods and beverages. We describe a municipal healthy retail program in San Francisco, California, focusing on the role of a local coalition in program implementation and outcomes in the city's low income Tenderloin neighborhood. By incentivizing selected corner stores to become healthy retailers, and through community engagement and cross-sector partnerships, the program is seeing promising outcomes, including a "ripple effect" of improvement across nonparticipating neighborhood stores.

Bringing Healthy Retail to Urban "Food Swamps": a Case Study of CBPR-Informed Policy and Neighborhood Change in San Francisco.

In urban "food swamps" like San Francisco's Tenderloin, the absence of full-service grocery stores and plethora of corner stores saturated with tobacco, alcohol, and processed food contribute to high rates of chronic disease. We explore the genesis of the Tenderloin Healthy Corner Store Coalition, its relationship with health department and academic partners, and its contributions to the passage and implementation of a healthy retail ordinance through community-based participatory research (CBPR), capacity building, and advocacy. The healthy retail ordinance incentivizes small stores to increase space for healthy foods and decrease tobacco and alcohol availability. Through Yin's multi-method case study analysis, we examined the partnership's processes and contributions to the ordinance within the framework of Kingdon's three-stage policymaking model. We also assessed preliminary outcomes of the ordinance, including a 35% increase in produce sales and moderate declines in tobacco sales in the first four stores participating in the Tenderloin, as well as a "ripple effect," through which non-participating stores also improved their retail environments. Despite challenges, CBPR partnerships led by a strong community coalition concerned with bedrock issues like food justice and neighborhood inequities in tobacco exposure may represent an important avenue for health equity-focused research and its translation into practice.

Impact of California Children's Power Play! Campaign on Fruit and Vegetable Intake and Physical Activity among Fourth- and Fifth-Grade Students.

PURPOSE: Examine the impact of the Children's Power Play! Campaign on fruit and vegetable (FV) intake and physical activity (PA). DESIGN: Study design was a cluster randomized, controlled trial. SETTING: Forty-four low-resource public schools in San Diego County, California, were included in the study. SUBJECTS: Study subjects comprised a total of 3463 fourth/fifth-graders (1571 intervention, 1892 control), with an 86.9% completion rate. INTERVENTION: Throughout 10 weeks, activities were conducted during/after school, including weekly FV/PA lessons and PA breaks; biweekly classroom promotions/taste tests; posters displayed in/around schools; and weekly nutrition materials for parents. MEASURES: Self-reported FV intake (cups/d) and PA (min/d) were collected at baseline and follow-up using a diary-assisted, 24-hour dietary recall and Self-Administered Physical Activity Checklist. ANALYSIS: Multivariate regression models adjusted for demographics and cluster design effects were used, with change as the dependent variable. RESULTS: Intervention children, compared with controls, showed gains in daily FV intake (.26 cups, p < .001) and PA time at recess/lunch (5.1 minutes, p = .003), but not total daily PA minutes. CONCLUSION: Power Play! can help schools and community organizations improve low-income children's FV intake and PA during recess/lunch.

The Healthy Communities Study Nutrition Assessments: Child Diet and the School Nutrition Environment.

Multifaceted community interventions directed at improving food environments are emerging, but their impact on dietary change and obesity prevalence has not been adequately documented. The Healthy Communities Study (HCS) is seeking to identify characteristics and combinations of programs and policies that are associated with children's diets and obesity-related outcomes in various types of communities across the U.S. The purpose of this paper is to describe the methods used in 2013-2015 in the HCS to assess dietary intake, school nutrition environments, and other nutrition-related behaviors. The conceptual framework of the HCS is based on the socioecological model and behaviors shown in previous studies to be related to obesity in children guided selection of domains. Nine domains were identified as essential measures of nutrition in the HCS: (1) intake of selected foods and beverages; (2) food patterns and behaviors; (3) social support; (4) home environment; (5) school environment; (6) community environment; (7) breastfeeding history; (8) household food insecurity; and (9) dieting behaviors and body image. Children's dietary intake was assessed using a dietary screener and up to two automated 24-hour recalls. Dietary-related behaviors were assessed by a survey administered to the parent, child, or both, depending on child age. School nutrition measures were obtained from a combination of school staff surveys and researcher observations. Information from these measures is expected to contribute to a better understanding of "what is working" to improve the dietary behaviors that are likely to prevent obesity and improve health in children.

Increasing Child Fruit and Vegetable Intake: Findings from the US Department of Agriculture Fresh Fruit and Vegetable Program.

BACKGROUND: Fewer than 10% of US children and adolescents consume the recommended amounts of fruits and vegetables (F/V). The US Department of Agriculture's Fresh Fruit and Vegetable Program (FFVP) is intended to increase child F/V consumption by funding low-income schools to distribute free fresh F/V snacks outside of school mealtimes. OBJECTIVE: The evaluation assessed FFVP effects on student F/V consumption and total energy intake in and out of school. DESIGN: The evaluation employed a regression discontinuity design; that is, cross-sectional comparisons of a sample of students in schools just above and just below the FFVP funding cutoff for the program, which depended on the proportion of students eligible for free or reduced-price meals. During the 2010-2011 school year within a randomly selected sample of states, we selected schools in closest proximity to each state-specific FFVP funding cutoff. Interviewers conducted 24-hour diary-assisted recall interviews to assess dietary intake among children in selected schools. PARTICIPANTS/SETTING: Participants were 4,696 students (grades 4 to 6) from 214 elementary schools in 16 randomly selected states. STATISTICAL ANALYSES PERFORMED: Analysis proceeded via multivariate regression, comparing adjusted mean student intake in schools just above and just below the funding cutoff. RESULTS: Adjusted mean daily F/V intake was one-third of a cup per day higher in FFVP-participating schools than in nonparticipating schools (0.32 cups per day; P<0.001), a difference of 15.5%. This included one-quarter cup higher daily F/V intake during school hours (0.26 cups; P<0.001) among students attending FFVP-participating schools. Fresh (but not total) F/V consumption also increased outside of school. CONCLUSIONS: The FFVP increases child fresh and total F/V intake in school, and fresh F/V intake outside of school.

Eat lunch first or play first? Inconsistent associations with fruit and vegetable consumption in elementary school.

Scheduling play before eating lunch has been suggested as a relatively simple environmental strategy to increase fruit and vegetable (FV) intake among elementary school students. However, the few small studies to date have had mixed findings. The primary aim of this observational study was to evaluate the possible relationship between the relative order of play and eating and students' lunch intake of FV. A secondary aim was to examine whether any differences existed in this relationship by student sex, ethnicity, language spoken at home, and school lunch source. A diary-assisted 24-hour recall was collected during the 2011-2012 school year from 2,167 fourth- and fifth-graders attending 31 elementary schools in California. The association of play before eating with FV intake was estimated using Generalized Estimation Equations. Overall, lunch FV intake was not significantly higher for students who had a play-before-eating vs a play-after-eating lunch schedule at school. However, variables included in the model showed significant interaction with play before eating, resulting in the need for separate effect estimates for distinct strata based on sex, ethnicity, language spoken at home, and school lunch source. For 10 of the 16 strata, no significant effect of play before eating was observed on lunch FV intake, while increases in intake were observed in four strata and decreases in two strata. Before rescheduling play before eating for the purpose of improving student FV intake, additional research is recommended.

Community-engaged interventions on diet, activity, and weight outcomes in U.S. schools: a systematic review.

CONTEXT: Community engagement literature suggests that capacity-building approaches and community partnership in health intervention design, delivery, and analysis improve outcomes. School communities influence childhood diet and activity patterns affecting lifelong obesity risk. This systematic review's purpose is to assess whether incorporating community engagement principles in school-based interventions influences weight-related outcomes. EVIDENCE ACQUISITION: Obesity-prevention interventions (published January 2000-2011) in diverse U.S. schools, meeting a minimum threshold of community engagement and targeting weight-, diet- or activity-related outcomes were identified in MEDLINE, PsycINFO, and CINAHL (December 2010-March 2011). Two reviewers scored community engagement performance on 24 metrics of capacity building and partner involvement along four research stages. Outcome performance was calculated as percentage of targeted primary and/or secondary outcomes achieved. EVIDENCE SYNTHESIS: Sixteen studies were included, targeting anthropometric (n = 12); dietary (n = 13); and activity (n = 10) outcomes in schoolchildren (mean age=10.7 years). Studies averaged 46% of targeted outcomes (95% CI = 0.33, 0.60) and met 60% of community engagement metrics. Positive correlations existed between community engagement performance and all-outcome performance (r = 0.66, 95% CI = 0.25, 0.87) and secondary-outcome performance (r = 0.67, 95% CI = 0.22, 0.89), but not primary-outcome performance (r = 0.26, 95% CI = -0.27, 0.67). Number of outcomes met was not correlated with number of outcomes targeted, number of partners, or study size. Specific qualitative and quantitative trends suggested that capacity-building efforts, engagement in needs assessments and results dissemination, and durable partnerships positively influence outcomes. CONCLUSIONS: Results suggest that meaningful partnership of diverse school communities within obesity prevention interventions can improve health outcomes.

Validation of a food frequency questionnaire for Hispanics.

INTRODUCTION: The Hispanic population will grow to comprise one fourth of the U.S. population by 2050. Compared with non-Hispanic whites, Hispanics have disproportionately higher rates of obesity, diabetes, and other diet-related conditions. Valid methods for studying the dietary intake of this group are needed. METHODS: From June through September 2000, we conducted a study of low-income Hispanic men and women (n = 89) who were recruited for a validation study of the Spanish-language food frequency questionnaire used in the Study of Women's Health Across the Nation. The mean age of the participants was 36.8 years, 42% were male, and 92% had been born in Mexico. Three 24-hour dietary recalls provided the reference data. The food frequency questionnaire was administered by interview, with a portion-size graphic to aid in quantitation. The questionnaire asked about diet in the previous 12 months. Mean nutrient values, correlation coefficients, and the sensitivity and specificity for identifying people with intakes of less than the recommended levels were calculated. RESULTS: Mean energy and macronutrient intake estimates were significantly higher by the food frequency questionnaire than by the 24-hour dietary recalls. Cholesterol, saturated fat, dietary fiber, iron, vitamin A, and percentage of energy from fat were not significantly different by the two methods. The median of unadjusted correlations was 0.52 and of deattenuated correlations was 0.61. The median sensitivity was 0.62, and the median specificity was 0.76. CONCLUSION: The Study of Women's Health Across the Nation Spanish food frequency questionnaire appears to be reasonably valid in assessing the dietary intakes of Hispanics. Correlations tended to be higher than those found in other validation studies in Hispanic populations. Interviewer administration of questionnaires may be necessary in this population.

Development and reliability of brief dietary assessment tools for Hispanics.

INTRODUCTION: The Hispanic population is the most rapidly growing ethnic group in the United States. Culturally appropriate and efficient strategies for dietary assessment for this population are currently lacking. To address this issue and promote a healthy diet for disease prevention, we developed screening tools to assess the fruit, vegetable, and fat intake of Mexican Americans. METHODS: Brief screening tools (screeners) were developed based on national data on Mexican Americans' dietary intake and were then modified after interviews and field testing. The screeners take less than 10 minutes to administer. A reliability study was conducted from June through September 2000, during which 93 Mexican Americans (39 men, 54 women) completed the screeners twice, 1 month apart. The mean age of the study participants was 36.5 years (range 18-71 years), and 91.4% had been born in Mexico. RESULTS: Correlations between the first and second administration of the screeners were r = 0.64 for fruits and vegetables and r = 0.85 for dietary fat contributors. In addition, estimates of fruit and vegetable consumption frequency were similar to statewide estimates for Hispanics in California. Reproducibility of reported use of vitamin supplements at least once per week was high; 84% were classified in the same way both times (P < .001). CONCLUSION: The screening tools provide a reliable assessment of selected dietary factors among Mexican Americans. The tools can be scored immediately to provide feedback to respondents. They may be useful in situations requiring easily administered and economical assessment tools, such as in large-scale studies or in community situations.

A randomized trial of the Little by Little CD-ROM: demonstrated effectiveness in increasing fruit and vegetable intake in a low-income population.

INTRODUCTION: Research indicates that low fruit and vegetable intake is a risk factor for many chronic diseases. Despite large-scale education campaigns, the great majority of Americans do not consume recommended levels. We tested the ability of a single brief interactive experience of the Little by Little CD-ROM to increase fruit and vegetable intake in low-income women. METHODS: A randomized placebo-controlled, parallel-group trial included 481 low-income, female participants: mean age 50.1 years, 48.4% African American, 51.6% non-Hispanic white, and 92.5% below 185% of the federally designated poverty level. Participants received one of three conditions: 1) a one-time experience with the Little by Little CD-ROM, 2) the Little by Little CD-ROM plus two reminder telephone calls, or 3) a stress management CD-ROM (control condition). We assessed baseline and follow-up dietary intake with a modified 24-hour recall. RESULTS: Two months after the one-time experience with the CD-ROMs, both intervention groups reported significantly higher intakes of fruits and vegetables than the control group. The Little by Little group with reminder calls increased daily intake by 1.32 fruits/vegetables, an 86% greater increase than the control group (P = .016). The Little by Little group without reminder calls increased daily intake by 1.20 fruits/vegetables, a 69% greater increase than the control group (P = .052). Significantly greater movement in Stage of Readiness for Change also occurred in the Little by Little groups compared with the control group. CONCLUSION: The Little by Little CD-ROM may be useful in public health and clinical situations to increase fruit and vegetable intake.

Demonstration of an E-mailed worksite nutrition intervention program.

INTRODUCTION: Dietary fat and low fruit and vegetable intake are linked to many chronic diseases, and U.S. population intake does not meet recommendations. Interventions are needed that incorporate effective behavior-change principles and that can be delivered inexpensively to large segments of the population. METHODS: Employees at a corporate worksite were invited to participate in a program, delivered entirely by e-mail, to reduce dietary fat and increase fruit and vegetable intake. Behavior-change principles underlying the intervention included tailoring to the participant's dietary lifestyle, baseline assessment and feedback about dietary intake, family participation, and goal setting. Assessment, tailoring, and delivery was fully automated. The program was delivered weekly to participants' e-mail inboxes for 12 weeks. Each e-mail included information on nutrition or on the relationship between diet and health, dietary tips tailored to the individual, and small goals to try for the next week. In this nonrandomized pilot study, we assessed technical feasibility, acceptability to employees, improvement in Stage of Change, increase in fruit and vegetable consumption, and decrease in fat intake. RESULTS: Approximately one third (n = 84) of employees who were offered the 12-week program signed up for it, and satisfaction was high. There was significant improvement in Stage of Change: 74% of those not already at the top had forward movement (P < .001). In addition, results suggest significant increase in fruit and vegetable consumption (0.73 times/day, P < .001) and significant decrease in intake of fat sources (-0.39 times/day, P < .001). CONCLUSION: This inexpensive program is feasible and appears to be effective. A randomized controlled trial is needed.

Are vitamin and mineral deficiencies a major cancer risk?

Diet is estimated to contribute to about one-third of preventable cancers -- about the same amount as smoking. Inadequate intake of essential vitamins and minerals might explain the epidemiological findings that people who eat only small amounts of fruits and vegetables have an increased risk of developing cancer. Recent experimental evidence indicates that vitamin and mineral deficiencies can lead to DNA damage. Optimizing vitamin and mineral intake by encouraging dietary change, multivitamin and mineral supplements, and fortifying foods might therefore prevent cancer and other chronic diseases.