The Relationship between School Infrastructure and School Nutrition Program Participation and Policies in New York City.

School nutrition programs (SNP) provide much needed access to fruits, vegetables, and other healthy foods at low or no cost. Yet, the infrastructure of school kitchens and cafeteria vary across schools, potentially contributing to systematic barriers for SNP operation and equity. The purpose of this paper is to examine the association between school infrastructure and outcomes including meal participation, untraditional lunch periods, and having an open campus. Regression analyses were conducted using administrative data for 1804 schools and school nutrition manager survey data (n = 821) in New York City (NYC). Co-location was significantly associated with open campus status (OR = 2.84, CI: 1.11, 7.26) and high school breakfast participation (ß = -0.056, p = 0.003). Overcrowding was associated with breakfast (elementary: ß = -0.046, p = 0.03; middle: ß = 0.051, p = 0.04; high: ß = 0.042, p = 0.04) and lunch participation (elementary: ß = -0.031, p = 0.01) and untraditional lunchtimes (elementary: OR = 2.47, CI: 1.05, 5.83). Higher enrollment to cafeteria capacity ratios was associated with breakfast (elementary: ß = -0.025, p = 0.02) and lunch (elementary: ß = -0.015, p = 0.001; high: ß = 0.014, p = 0.02) participation and untraditional lunchtimes (middle: OR = 1.66, CI: 1.03, 2.68). Infrastructure characteristics are an important source of variation across NYC schools that may hinder the equity of school nutrition programs across the city.

Community Priorities for Healthy Eating in Older Adults.

Community planners such as policymakers and health care and nutrition service providers can create an "age-friendly" environment to support healthy eating in older residents by addressing the highest priorities that enable older adults to improve their dietary intake through different food-related community settings. To identify and prioritize these factors that facilitate behavioral change (enablers) and behavioral settings important for older adult nutrition based on the social ecological model, nutrition and aging professionals (n = 30) from two rural (West Virginia, Iowa) and two urban (Massachusetts, New York) city/county regions (communities) participated in an online or live focus group discussion and completed an analytic hierarchy process survey online. Overall, the most important perceived enablers were accessibility and cost, followed by transportation and social support, but their relative importance varied by community. Participants from all communities considered congregate meal sites and food banks among the most important behavioral settings. Participants from most communities considered food stores to be important and also highlighted other settings unique to the area, such as senior housing, neighborhood, and farmers' markets. By targeting interventions to address the most notable enablers and behavioral settings specific to their community, planning groups can enhance their older residents' ability to achieve optimal nutritional health.

Measures of acculturation are associated with cardiovascular disease risk factors, dietary intakes, and physical activity in older Chinese Americans in New York City.

Cardiovascular disease (CVD) is the leading cause of death in the U.S. and affects Chinese Americans disproportionately compared to other ethnic groups in the American population. Studies of immigrant populations have shown that risk factors for CVD, including diet and physical activity, differ by acculturation. This cross-sectional study evaluated whether two measures of acculturation (region of birthplace, length of residence in the U.S.) were associated with CVD risk factors, dietary intakes, and physical activity of 125 older Chinese Americans who participated in health fairs conducted in NYC. In this study, mean waist circumference differed significantly by birthplace. Mean systolic and diastolic blood pressure differed significantly by length of residence in the U.S. Mean intake of vitamin B6, folate and calcium differed significantly by birthplace: Chinese Americans from Hong Kong had the highest mean vitamin B6 intake whereas older Chinese Americans from Northern China had the highest folate and calcium intakes. Mean intake of riboflavin differed significantly by length of residence in the U.S. with Chinese Americans adults who lived in the U.S. less than 10 years having the highest mean intake. Mean dairy intake of Chinese Americans differed significantly by birthplace, with adults from northern China having the highest mean dairy intake. Vigorous-intensity physical activity differed significantly by birthplace, with adults from Hong Kong reporting the most daily minutes of vigorous-intensity physical activity. This study suggests that acculturation may be associated with the cardiovascular health of older Chinese Americans living in NYC.

Diet, physical activity, and cardiovascular disease risk factors among older Chinese Americans living in New York City.

Cardiovascular disease (CVD) is the leading cause of death in the US and affects Chinese Americans disproportionately compared to other ethnic groups in the American population. However, few studies have examined CVD risk factors, including diet and physical activity, in Chinese Americans. This investigation used a cross-sectional design to evaluate the dietary intake, dietary supplement use, and physical activity of 125 older Chinese Americans aged 50-98 years, and to determine how these behaviors may be related to obesity and other CVD risk factors. Sociodemographic information, CVD risk factors, dietary intake, and physical activity were obtained from all participants recruited from health fairs conducted in New York City (NYC). The findings revealed that older Chinese American adults living in NYC had a high prevalence of overweight and obesity, borderline hypertension, pre-diabetes, and diabetes. Many participants did not meet their daily requirements calcium, potassium, folate, vitamin B6, and vitamin B12, several minerals and vitamins important for cardiovascular health. Although most participants consumed an adequate numbers of servings of foods from the main food groups, most did not meet the recommended number of servings of dairy foods and only one in four adults took a multivitamin supplement daily. After adjusting for potential confounders, daily consumption of oil/sweets and dairy foods was positively associated with waist circumference. Also, daily consumption of oils/sweets, meats, and grains was positively associated with systolic blood pressure. The majority of the participants reported at least 30 min of moderate intensity physical activity per day. Dietary intake or supplement use did not show protective effects but performing vigorous physical activity may reduce risk of CVD in this population.

Predictors for research involvement among registered dietitians.

OBJECTIVE: The primary aim of this study was to measure registered dietitians' (RDs') research involvement (by creating a research score) and to determine whether their perceptions, attitudes, and knowledge of evidence-based practice and key antecedent factors (eg, sociodemographic characteristics, education and training, professional experiences, and employment setting) predicted their research involvement. DESIGN: This cross-sectional, descriptive study used the Dietitian Research Involvement Survey and followed the Tailored Design Method. SUBJECTS/SETTING: This study surveyed 258 randomly selected RDs from seven dietetic practice groups of the American Dietetic Association. STATISTICAL ANALYSES PERFORMED: Descriptive statistics, bivariate relationships, and multiple linear regression analyses were conducted to test whether perceptions, attitudes, and knowledge of evidence-based practice score and antecedent factors predicted the research score of dietitians. RESULTS: Perceptions, attitudes, and knowledge of evidence-based practice score (r = 0.59, P < 0.0005), level of education (r = 0.53, P < 0.0005), taking a research course (r = 0.40, P < 0.0005), last time read research (r = 0.35, P < 0.0005), frequency of professional reading (r = 0.32, P < 0.0005), primary area of practice (r = 0.14, P = 0.02), association memberships (r = 0.14, P = 0.02), and dietetic practice group affiliation (r = 0.14, P = 0.02) were significantly correlated with research score. Using multivariate linear regression, the perceptions, attitudes, and knowledge of evidence-based practice score (beta = 0.48, P < 0.0005) and level of education (beta = 0.39, P < 0.0005) were identified as the strongest predictors of research score. CONCLUSIONS: Involvement in research by RDs is largely determined by their perceptions, attitudes, and knowledge of evidence-based practice and their level of education. Additional education and training related to research methodology and design, and evidence-based practice, is essential for greater participation in research activities by RDs.

Evidence-based practice: what are dietitians' perceptions, attitudes, and knowledge?

OBJECTIVE: The objective of this study was to measure dietitians' perceptions, attitudes, and knowledge of evidence-based practice (PAK score), and to determine whether antecedent factors (eg, sociodemographic characteristics, education and training, professional experiences, and employment setting) predicted PAK score. DESIGN: This cross-sectional, descriptive study used the Dietitian Research Involvement Survey following the Tailored Design Method. SUBJECTS/SETTING: This study surveyed 500 randomly selected registered dietitians from seven dietetic practice groups of the American Dietetic Association. STATISTICAL ANALYSES PERFORMED: Bivariate relationships were examined between antecedent factors and PAK score. Multiple linear regression analyses were conducted to test whether these factors predicted PAK score. RESULTS: Higher PAK scores were associated with registered dietitians who completed more years of education (r=0.28, P<.0005), had taken a research course (r=0.28, P<.0005), frequently read research articles (r=0.41, P<.0005), earned an advanced-level board certification (r=0.18, P=.004), worked full-time (r=0.26, P<.0005), or belonged to professional organizations (r=0.18, P=.003). The strongest predictors for PAK score were "last time read research" (beta=.33, P<.0005), work status (beta=.20, P<.0005), level of education (beta=.19, P=.001), and association memberships (beta=.14, P=.01). CONCLUSIONS: Results indicated that dietitians' ability to incorporate an evidence-based approach is largely determined by their education and training, work experience, and professional association involvement. This study identified a need to integrate concepts and principles of evidence-based practice into dietetics curriculums so that practitioners are able to routinely apply research findings to clinical practice.

Nutritional Considerations for the Stroke Patient with Dysphagia.

Dysphagia is a physical disability that negatively affects patients' abilities to meet their nutritional needs. Dysphagia may result in anorexia, weight loss, protein-energy malnutrition, and vitamin and mineral deficiencies. Dehydration is also a major risk. Swallowing abnormalities have been observed in 25% to 50% of patients following a stroke. The dietitian's role in assessingthe nutritional status of dysphagic patients and in working with the interdisciplinary team isessential to comprehensive patient care. A Nutrition Assessment Form is presented for stroke patients, and recommendations are made for dysphagic diets and feeding management for the interdisciplinary team. Increasing food consumption is critical to improving nutritional status and quality of life for those receiving rehabilitation services.