Effect of a Technology-Integrated Curriculum on Sugary Drink and Snack Intake of Elementary-Aged Youth Experiencing Low Income.

OBJECTIVE: To describe the results of a technology-integrated intervention on sugar-sweetened beverage (SSB) and energy-dense snack intake with third graders experiencing low income. DESIGN: A 2 × 2 quasi-randomized cluster-block, parallel-group experimental research design. SETTING: Low-income schools in Rhode Island. PARTICIPANTS: Two-hundred seventeen intervention and 242 control third-grade students in low-income (89.6% and 88.2% free/reduced meals, respectively), ethnically and racially diverse (63% Hispanic/20% Black and 62% Hispanic/18% Black, respectively) schools. INTERVENTION(S): A 13-week in-school program held once per week for 1 hour. The hands-on, technology-integrated program used a modified version of the Body Quest: Food of the Warrior curriculum. MAIN OUTCOME MEASURE(S): Intake of SSB and energy-dense snacks, both salty and sweet snacks, using baseline (week 1) and postassessment (week 13) previous day self-recall. ANALYSIS: Generalized mixed modeling with nesting. RESULTS: Intervention students significantly reduced their SSB intake by 38% (0.5 times/d; F[1, 540] = 4.26; P = 0.04) and salty snack intake by 58% (0.8 times/d; F[1, 534] = 6.58, P < 0.01) from baseline to postassessment as compared with the control students. CONCLUSIONS AND IMPLICATIONS: Findings suggest a technology-integrated curriculum is effective in decreasing SSB and salty snacks in elementary-aged students of low-income, minoritized populations. Improved dietary habits can potentially influence other facets of students' lives.

Perceptions of Low-Income Students Completing a Nutrition Education Program.

OBJECTIVE: To capture students' perceptions of participating in a nutrition education program. DESIGN: Focus groups (n = 16). SETTING: Low-income schools in Rhode Island. PARTICIPANTS: A total of 64 low-income, ethnically and racially diverse third-grade students, 93.5% of whom were eligible for free or reduced-price meals, 62% of whom were Hispanic, and 16% of whom were black. MAIN OUTCOME MEASURE(S): Perceptions about the program's impact on food and beverage consumption, the value of the program, potential changes for improvement, and barriers to change. ANALYSIS: Focus groups were recorded, transcribed, and coded using a hybrid approach of inductive and deductive thematic analysis. Interrater agreement was calculated. RESULTS: Students perceived that the program positively influenced their attitudes toward making healthy choices and what they and their families were eating. Students reported increased empowerment, bravery to try new foods, and knowledge. Students enjoyed the program but suggested increasing the duration and frequency of lessons and including peer-to-peer education. Students felt that the tastiness of unhealthy food was a barrier to choosing healthier food. CONCLUSIONS AND IMPLICATIONS: Findings suggest that the program may have improved students' knowledge, empowerment, and bravery, and that this had a positive influence on healthy food consumption for students and their families. Input from students will help inform future modifications to the curriculum.

Process Evaluation of a Policy, Systems, and Environmental Change Intervention in an Urban School District.

OBJECTIVE: To conduct a comprehensive process evaluation of a policy, systems, and environmental (PSE) change intervention. DESIGN: Quasi-experimental, mixed methods. SETTING: Low-income urban school district. PARTICIPANTS: Fifth-grade students in 4 schools assigned to 2 intervention and 2 comparison schools (intervention, n = 142; comparison, n = 170). INTERVENTION: Both groups received a nutrition curriculum delivered by classroom teachers. Intervention schools also received 10 PSE lessons taught by paraprofessional educators. MAIN OUTCOME MEASURES: Quantitative data were obtained from fidelity and observation checklists, grading rubrics and self-reported student surveys. Focus group and interviews provided qualitative data. Quantitative measures included assessments of PSE and fruit and vegetable knowledge, as well as assessment of times fruits and vegetables (FV) were consumed yesterday. ANALYSES: Qualitative data were analyzed using inductive content analysis. Quantitative data were analyzed using repeated measures analysis of variance and analysis of co-variance. RESULTS: Fidelity, dose, reach, and acceptance of PSE intervention were high; students felt more empowered, although PSE lessons were considered lengthy and complicated. Intervention PSE and FV knowledge scores were significantly higher than comparison scores (F37.56, P < .001; and F3.94, P < .05, respectively). However, issues in communication were identified between school staff and researchers. CONCLUSIONS AND IMPLICATIONS: Policy, systems, and environmental classroom interventions commented on the differences between quantitative and qualitative assessments, and this suggests the need for more sensitive quantitative assessments. Future research should look at long-term outcomes as this study only looked at short-term outcomes.

Increasing breastfeeding in WIC participants: cost of formula as a motivator.

OBJECTIVE: To assess the cost of infant formula, explore mothers' perceptions of formula cost, and assess whether cost influences the decision to breastfeed. METHODS: A mixed-methodological descriptive study with survey (phase 1) and interviews (phase 2) was completed in Rhode Island Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) offices. Thirty non-breastfeeding mothers participated in phase 1 and 14 pregnant women participated in phase 2. Means and frequencies were calculated for phase 1. For phase 2, data were organized into matrices and thematic analysis identified key themes. RESULTS: Non-breastfeeding mothers were spending an extra $46 a month on average in their child's fourth month on formula beyond the formula supplied by WIC. This was perceived as high, but formula cost did not influence their decision to breastfeed. For mothers intending to breastfeed, cost information was perceived as an additional motivation. CONCLUSIONS AND IMPLICATIONS: Information on supplemental formula cost could be provided as a motivator for women intending to breastfeed. Future research should investigate how cost information could be used to support breastfeeding initiation and duration among WIC mothers.

Using focus groups to identify factors affecting healthful weight maintenance in Latino immigrants.

OBJECTIVE: To explore (1) how migration influenced physical activity and dietary behaviors among Latino immigrants and (2) participants' perception of concepts related to a Health at Every Size (HAES) approach to weight maintenance (mindful eating, taking care of oneself). METHODS: Four focus groups (n = 35), homogenous by sex, were conducted in Spanish. RESULTS: Male and female participants spoke of being less physically active and eating less healthful diets since immigrating. Noted barriers to being physically active and eating a healthful diet included time and financial constraints. Participants were interested in the HAES concepts but thought these ideas conflicted with their cultural upbringing. For women, putting family first was identified as a barrier to taking care of oneself. CONCLUSIONS AND IMPLICATIONS: An HAES approach may be a useful in promoting weight maintenance in this population, as participants were interested in key concepts, but it would be important that HAES interventions incorporate cultural traditions.