Implications of supermarket access, neighbourhood walkability and poverty rates for diabetes risk in an employee population.

OBJECTIVE: Diabetes is a growing public health problem, and the environment in which people live and work may affect diabetes risk. The goal of the present study was to examine the association between multiple aspects of environment and diabetes risk in an employee population. DESIGN: This was a retrospective cross-sectional analysis. Home environment variables were derived using employees' zip code. Descriptive statistics were run on all individual- and zip-code-level variables, stratified by diabetes risk and worksite. A multivariable logistic regression analysis was then conducted to determine the strongest associations with diabetes risk. SETTING: Data were collected from employee health fairs in a Midwestern health system, 2009-2012. SUBJECTS: The data set contains 25 227 unique individuals across four years of data. From this group, using an individual's first entry into the database, 15 522 individuals had complete data for analysis. RESULTS: The prevalence of high diabetes risk in this population was 2·3 %. There was significant variability in individual- and zip-code-level variables across worksites. From the multivariable analysis, living in a zip code with higher percentage of poverty and higher walk score was positively associated with high diabetes risk, while living in a zip code with higher supermarket density was associated with a reduction in high diabetes risk. CONCLUSIONS: Our study underscores the important relationship between poverty, home neighbourhood environment and diabetes risk, even in a relatively healthy employed population, and suggests a role for the employer in promoting health.

Factors influencing the implementation of school wellness policies in the United States, 2009.

INTRODUCTION: The quality of school wellness policy implementation varies among schools in the United States. The objective of this study was to characterize the school wellness policy environment nationally and identify factors influencing the quality and effectiveness of policy implementation. METHODS: We invited school administrators from 300 high schools to complete a questionnaire; 112 administrators responded. We performed a 2-step cluster analysis to help identify factors influencing the implementation of school wellness policies. RESULTS: Eighty-two percent of schools reported making staff aware of policy requirements; 77% established a wellness committee or task force, 73% developed administrative procedures, and 56% trained staff for policy implementation. Most commonly reported challenges to implementation were lack of time or coordination of policy team (37% of respondents) and lack of monetary resources (33%). The core domains least likely to be implemented were communication and promotion (63% of respondents) and evaluation (54%). Cluster 1, represented mostly by schools that have taken action toward implementing policies, had higher implementation and effectiveness ratings than Cluster 2, which was defined by taking fewer actions toward policy implementation. In Cluster 1, accountability was also associated with high ratings of implementation quality and effectiveness. CONCLUSION: The development of organizational capacity may be critical to ensuring an environment that promotes high-quality policy implementation. Assessing, preventing, and addressing challenges; establishing clear definitions and goals; and requiring accountability for enacting policy across all core domains are critical to ensuring high-quality implementation.

The quality of school wellness policies and energy-balance behaviors of adolescent mothers.

INTRODUCTION: In this study, we 1) compared the quality of school wellness policies among schools participating in Moms for a Healthy Balance (BALANCE), a school- and home-based weight loss study conducted with postpartum adolescents in 27 states; and 2) assessed the relationship between policy quality with energy-balance behaviors and body mass index z scores of postpartum adolescents. METHODS: As a part of BALANCE, we collected data on high-calorie food and beverage consumption, minutes spent walking, and height and weight for 647 participants. The School Wellness Policy Coding Tool was used to assess the strength and comprehensiveness of school district wellness policies from 251 schools attended by participating adolescent mothers. RESULTS: Schools averaged low scores for wellness policy comprehensiveness and strength. When compared with participants in schools with the lowest policy comprehensiveness scores, adolescent mothers in schools with the highest scores reported consuming significantly fewer daily calories from sweetened beverages while reporting higher consumption of water (P = .04 and P = .01, respectively). School wellness policy strength was associated with lower BMI z scores among adolescent mothers (P = .01). CONCLUSION: School wellness policies associated with BALANCE may be limited in their ability to promote a healthy school environment. Future studies are needed to evaluate the effect of the strength and comprehensiveness of policy language on energy balance in high-risk postpartum adolescents. Evidence from this work can provide additional guidance to federal or state government in mandating not only policy content, but also systematic evaluation.

Postpartum teens' breakfast consumption is associated with snack and beverage intake and body mass index.

Addressing high-risk dietary patterns among postpartum teens may help reduce weight retention and prevent intergenerational obesity. The objective of this study was to describe the relationship between breakfast consumption and outcomes of snack and beverage intake and body mass index (BMI) among postpartum teens. During 2007-2009, 1,330 postpartum teens across 27 states participated in a cross-sectional, baseline assessment of a group-randomized, nested cohort study. Participants were enrolled in the Parents as Teachers Teen Program and completed a 7-day recall of breakfast, snack, and beverage consumption. BMI was calculated from heights and weights obtained by on-site staff. Sample descriptives were compared across breakfast consumption frequency groupings by one-way analysis of variance tests or χ² tests. General linear models assessed relationships between breakfast consumption and measures of snack and sweetened beverage intake, water consumption, and BMI-for-age percentile. Almost half (42%) of the sample consumed breakfast fewer than 2 days per week. Those who ate breakfast 6 to 7 days/week consumed 1,197 fewer kilocalories per week from sweet and salty snacks, 1,337 fewer kilocalories per week from sweetened drinks, and had a lower BMI compared to those who ate breakfast fewer than 2 days per week (P < 0.05). Consumption of fruit, vegetables, milk, water, and cereal as a snack were higher among regular breakfast consumers (P < 0.05). Although breakfast consumption among postpartum teens is low, those who regularly consume breakfast had healthier snacking behaviors and weight. Interventions are needed to encourage breakfast consumption among teen mothers.

Parks promoting physical activity: synthesis of findings from interventions in seven national parks.

BACKGROUND: We synthesized the results of 7 National Park Service pilot interventions designed to increase awareness of the health benefits from participation in recreation at national parks and to increase physical activity by park visitors. METHODS: A content analysis was conducted of the final evaluation reports of the 7 participating parks. Pooled data were also analyzed from a standardized trail-intercept survey administered in 3 parks. RESULTS: The theme of new and diverse partnerships was the most common benefit reported across the 7 sites. The 2 parks that focused on youth showed evidence of an increase in awareness of the benefits of physical activity. Many of the other sites found high levels of awareness at baseline (approaching 90%), suggesting little room for improvement. Five of the 7 projects showed evidence of an increase in physical activity that was associated with the intervention activities. Multivariate analyses suggested that the media exposure contributed to a small but significant increase in awareness of the importance of physical activity (6%) and number of active visits (7%). CONCLUSIONS: Enhancements and replication of these programs represents a promising opportunity for improving partnerships between public health and recreation to increase physical activity.

The reliability of a questionnaire-based metabolic syndrome surveillance tool.

BACKGROUND: The objectives of this study were to report measures of internal consistency and test-retest reliability for a proxy method of detecting the metabolic syndrome with a questionnaire-based Metabolic Syndrome Surveillance tool (Met-X StL). METHODS: The Met-X StL was constructed to obtain information concerning metabolic syndrome risk factors, and added to a population-based survey targeting rural, mid-western communities in three states with above average risk for chronic disease. Two to four weeks following individual completion of the survey, we re-administered the Met-X StL to a group of one-hundred randomly selected participants and assessed the tool for internal consistency and test-retest reliability. RESULTS: Study participants were mostly females (70%), and of Caucasian ethnicity (97%), with an average age of 60.7 yrs. and some college education (65%). Our proxy method of detecting the metabolic syndrome revealed a prevalence of 31% in a population with mixed awareness concerning their current health status. The measures of internal consistency were acceptable (test = 0.75 | retest = 0.73). The retest reliability for each risk factor of the metabolic syndrome ranged from moderate (0.50-Physical Activity) to almost perfect agreement (0.97-BMI), while the reliability of the proxy metabolic syndrome diagnosis was substantial (0.77). CONCLUSIONS: The Met-X StL is reliable in a rural population with an above average risk profile. This method may have application in population-based surveillance or intervention projects that wish to consider the metabolic syndrome, but are lacking the resources for clinical testing.

Consumption of whole-grain cereals during weight loss: effects on dietary quality, dietary fiber, magnesium, vitamin B-6, and obesity.

OBJECTIVE: While various weight-management approaches produce weight loss, they may differ in dietary quality. We monitored changes in nutrient intakes in overweight and obese subjects on three different weight-management programs. DESIGN: Randomized clinical trial (pilot study) with two 12-week phases: phase 1, weekly counseling; phase 2, monitoring only. SUBJECTS/SETTING: One hundred eighty nonsmoking, sedentary overweight and obese adults began this outpatient study; 134 (body mass index [calculated as kg/m(2)]=30.9+/-2.4; age=42.3+/-1.2 years) were used in analyses. INTERVENTION: Twenty-four weeks of exercise only (control group), hypocaloric diet plus exercise, or hypocaloric diet with fiber-rich whole-grain cereals plus exercise. MAIN OUTCOME MEASURES: At weeks 0, 12, and 24, diet quality was assessed by 3-day food records and body weight was measured. STATISTICAL ANALYSES PERFORMED: Three-way analysis of variance with repeated measures. RESULTS: The hypocaloric diet with fiber-rich whole-grain cereals plus exercise decreased energy intake more than exercise only (P=0.032). By week 12, the hypocaloric diet with fiber-rich whole-grain cereals plus exercise and the hypocaloric diet plus exercise decreased total fat more than exercise only, which was sustained in the hypocaloric diet with fiber-rich whole-grain cereals plus exercise at 24 weeks (P<0.001). At weeks 12 and 24, the hypocaloric diet with fiber-rich whole-grain cereals plus exercise reduced saturated fat intake more than exercise only. The hypocaloric diet with fiber-rich whole-grain cereals plus exercise increased total fiber, insoluble fiber (both P<0.001), magnesium (P=0.004), and vitamin B-6 (P=0.002) intakes more than the hypocaloric diet plus exercise and exercise only. Calcium and vitamin E intakes were inadequate in all groups. Weight loss was similar in the hypocaloric diet with fiber-rich whole-grain cereals plus exercise and the hypocaloric diet plus exercise. CONCLUSIONS: Weight-reduction strategies may be associated with reduced intake of micronutrients, such as calcium and vitamin E. However, a hypocaloric diet with fiber-rich whole-grain cereal is effective for improving or maintaining other aspects of dietary quality during weight loss.