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The US Dietary Guidelines for Americans is an enormously influential policy that has guided US nutrition programs since 1980. During these last 40 years, some researchers have expressed concern that the guidelines are based on an insufficiently rigorous assessment of the scientific evidence, a view that was largely substantiated by a Congressionally mandated 2017 report by the National Academies of Sciences, Engineering, and Medicine, which identified a need for enhanced transparency, greater scientific rigor, and updates to the scientific methodology for the DGA process. This paper traces the history of these ideas and contextualizes the DGA within the law and regulations that govern its process. The paper also discusses how recent iterations of the Dietary Guidelines have not fully adhered to these guiding documents, which has resulted in diminished independence of the expert committee in charge of evaluating the science for the DGA and a continued lack of a fully rigorous scientific process for producing consistent and trustworthy guidelines for the public.

Creating opportunities for international education, both at home and abroad as well as through virtual means, is an important challenge in higher education today. This article presents some strategies for expanding students' options for learning abroad. A new model for learning abroad that aids in promoting a global perspective is discussed. (BF)

Data from 1,548 Women, Infants, Children clients showed that 93% found nutrition education valuable. A process-oriented evaluation of 494 clients using a skills inventory, and 513 using self-efficacy measures, identified topics they knew most and least about. Clients in facilitated discussion groups scored highest in self-efficacy compared with those attending lectures or reading brochures. (SK)

Food selection is a key factor in the nutritional management of diabetes. Criteria that influence point-of-purchase decision making in women with non-insulin-dependent diabetes mellitus were identified. Four types of shoppers were distinguished from interviews; cluster analysis was used to confirm the analysis. Usefulness in patient education is discussed. (EMK)

Examines label use behavior among high school-aged adolescents (N=90) to uncover gender differences related to these behaviors. Results show that students were five times more likely to rely on front label/nutrition claims than nutrient labels. Females were more likely than males to use front label/nutrition claims. (RJM)

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.jada.2005.10.038 Byline: Sheila Fleischhacker, Katherine L. Cason, Cheryl Achterberg Abstract: This study explored the types of food served at a Head Start child-care center compared with that center's monthly menus. The study design was direct observation of the food provided by a Head Start center throughout the school day (Monday through Friday; 8:45 am to 2:30 pm) from January 4 to June 20, 2002, and analysis of this center's monthly menus. The numbers of meals directly observed for each type of meal service were: breakfast (n=96), lunch (n=95), and afternoon snack (n=78). These meals were compared with six monthly menus. Of the 269 meals and snacks compared, only three breakfast meals and an "ethnic day" matched the meals described on the provided menu. These findings illustrate that this center's menu was not consistently followed and therefore could not be used as an estimate of the preschoolers' intake or used as an educational or informational tool for parents/caregivers. Future research should verify how common these findings are among other Child and Adult Care Food Program child-care centers. Results may provide direction for development of the US Department of Agriculture's Child and Adult Care Food Program training for foodservice workers and educational materials focusing on menu development, appropriate substitutions, and the importance of using menus as a nutrition education tool.

Valid and reliable measures of nutrition knowledge are needed for program evaluation to develop predictive models of learning, food intake, and health behavior. The food label is an essential component of diabetes education. This study describes how an instrument designed to assess knowledge of food labels was pretested for reliability and validity. Five people assessed the test for face validity and rated the test at least 4 on a 5-point scale. The index of content validity was 0.76 based on a review of the test by five dietitians. The test was used to evaluate a nutrition intervention for women with diabetes using a pretest/post-test control-group design (n = 43). The coefficient of stability was 0.86 using the test-retest method among participants in the control group. The reliability estimate for internal consistency was 0.81 based on Kuder-Richardson formula 20. Item analysis found individual questions to be within acceptable limits. Participants in the experimental group showed significant gains in knowledge at post-test (p < .01), supporting the instructional sensitivity of the test. The approach used to assess the reliability and validity of an instrument was feasible and effective and is recommended prior to implementing a test for outcome evaluation.

A mixed-model approach has been used to help 1,805 nutrition practitioners to update their skills, and the project has been evaulated using a questionnaire. Participants were found to have benefited by increasing their knowledge, and they were positive about this method of learning, with 77% of the total keen to continue using the method. Professionals in this field seek continued training, and this is a practical way of allowing them to update their skills.

Computers have been promoted as a tool to facilitate learning. Subsequently, health education software programs have been developed, but few of these programs have been evaluated. Little is known about how students use or learn from computer-assisted instruction (CAI). Qualitative research methods are needed to reveal the critical issues related to CAI in nutrition education and establish the direction for future research. The purpose of this paper is to describe a process evaluation model that was used to test a nutrition education CAI program for middle school students. The specific outcome that was measured was learning. Learning was assessed by changes in students' cognitive structures of basic nutrition concepts included in the program. Concept maps were used to represent students' cognitive structure and were constructed from data collected by semistructured interviews with children before and after they completed the program. Context was defined by students' interaction with the computer and with other students. These data were collected by observation and analyzed by grounded theory methods. The value of the model is in the integration of measurements of change and context. Together, change and context provide a dynamic, continuous, and inductive evaluation of the learning process and the effectiveness of a nutrition education program.

Objective To evaluate an educational intervention about the food label designed specifically for women with type 2 diabetes mellitus. Design A pretest-posttest control group design. Participants received random group assignment. Subjects/setting Forty-three women aged 40 to 60 years with type 2 diabetes living in a rural community in Pennsylvania participated. Forty participants (93%) completed the program. Intervention Nine weekly group sessions were developed on the basis of findings from previous research among this sample. Principles from Ausubel's learning theory were also incorporated into program design and evaluation. Main outcome measures The effectiveness of the food label education program on participants' knowledge was determined using a multiple-choice test designed to measure declarative and procedural knowledge. A skills inventory assessed participants' perceived confidence in using the food label. The validity and reliability of the instruments had been established previously. Statistical analyses Analysis of variance was performed to compare groups. Paired t tests compared pretest and posttest results. Results The experimental group showed a greater gain than the control group in total knowledge (P, Nutrition therapy is an essential component of successful diabetes management. Food selection affects the nutrient and energy content of the diet and the metabolic control of levels of glycated hemoglobin, [...]

Facilitated group discussions provide an alternative method to lecture and one-on-one approaches for conducting educational interventions at clinic sites. They are an interactive form of education wherein learners generate the specific topics to be addressed and share their knowledge and experience with other group members through discussion. In brief, the educator becomes a facilitator who, rather than lecturing, encourages clients to discuss freely among themselves their own approach to the nutrition problems posed during the session. As a facilitator, the nutritionist strives to create a comfortable atmosphere for discussion, encourages participation, and interjects only to correct misinformation and manage group dynamics. Facilitated group discussions allow nutrition practitioners to deliver meaningful nutrition education in a manner that helps empower their clients to improve their dietary habits; at the same time such discussions meet the increased public administrative demands for efficiency. Possible benefits to clients include more confidence, better communication skills, improved thinking skills, and increased motivation and commitment to improving nutrition behavior. We recommend that nutrition educators try facilitated group discussions in their clinics., Facilitated group discussions are an innovative educational technique developed through grassroots input of personnel in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in the State of [...]

Objectives. This study evaluated retention of the effect of a home-based, practitioner-initiated nutrition education model. Methods. Children with elevated low-density lipoprotein (LDL) cholesterol levels were randomly assigned to one of two nutrition interventions or to an at-risk control group. Intervention effects were evaluated 3, 6, and 12 months postbaseline. Results. The parent-child autotutorial group demonstrated significant increases in knowledge and, along with the counseling group, decreases in total and saturated fat intake. Also, the autotutorial and counseling groups retained a majority of their initial LDL cholesterol decrease. Conclusions: Knowledge of heart-healthful eating and dietary fat intake as well as dietary change can be affected and retained via home-based, practitioner-initiated nutrition interventions with hypercholesterolemic children, although some form of ongoing intervention may be necessary to produce lasting decreases in LDL cholesterol levels. (Am J Public Health. 1998;88: 258-261)

This article reviews several cognitive predictors of health- and diet-related behaviors commonly used in theories and models of nutrition and health behavior change. Constructs such as self-efficacy, self-esteem, outcome expectancies, health value, and locus of control are examined. Self-efficacy has repeatedly been a good predictor of health behavior, sometimes explaining more than 50% of variability. Research on locus of control and other predictive factors has been less conclusive. The take-home message is threefold: (a) task specificity of self-efficacy and domain specificity of locus of control are crucial for unraveling their effects on behavior; (b) careful segmentation of different population groups under study may explain the inconsistencies in previous research; and (c) especially when studying dietary behavior, these predictors of behavior change should not be used alone or in place of one another but should be used simultaneously to explain complex food and diet-related behaviors. We recommend that nutritionists systematically integrate available theories and models and explore new areas for studying human behavior, such as sociology and anthropology, to form a more powerful, comprehensive model for behavior change., In the never-ending search for explanations of health-related behavior, many predictive factors have been identified. Three widespread models, or theories - Social Cognitive Theory, Theory of Reasoned Action, and the [...]

Newsletters are an increasingly popular way of providing nutrition information. However, there has been little evaluation of their effectiveness as a communication vehicle. This study was conducted to evaluate older adults' opinions about a nutrition newsletter designed specifically for them and to determine relationships between characteristics of older adults and their opinions. A nationwide sample of men and women aged 55 years and older was asked to answer an initial telephone survey with demographic, health, and nutrition-related questions. They were then asked to receive an issue of a nutrition newsletter written specifically for older adults. If they agreed, they were sent the newsletter, followed by a telephone call that included questions about their opinion of the newsletter relative to its appearance and content, as well as their interest in future nutrition newsletters. One hundred and seventy-two subjects completed all phases of the study. All three newsletter evaluation variables - appearance, interest in content, and interest in future issues - were rated positively by participants. The appearance of the newsletter received the most positive response. The best-fit models accounted for a relatively small percentage of the variation in appearance and content scores. A larger percentage of the variation in interest in future newsletters could be explained by the multivariate model, which found that women and those who were more interested in nutrition and reading were more likely to be interested in future newsletters. The results of this study suggest that a newsletter designed specifically for older adults is an effective way to gain the attention of its intended audience.

Ninety adolescents (41 males and 49 females) stratified by shopping experience (44 shoppers and 46 nonshoppers) were given a list of 20 foods to select in a supermarket. An interview was conducted to determine reason(s) given for each food selection, use of nutrition information, and other variables. Reasons most often reported for selecting foods were personal preference/taste, custom/habit, and price/cost. Participants were five times more likely to use front label/nutrition claims than nutrient labels. Fat free/low fat, lite/light, and cholesterol free/low cholesterol were the most commonly used claims whereas total fat and calories were the most commonly used nutrient label constituents. Females were more likely than males to use front label/nutrition claims (F (1,82) = 4.78, p < .01). There were no significant differences between males' and females' use of nutrient labels. Education that emphasizes food-shopping and label-reading skills is needed by adolescents., INTRODUCTION Congress passed the Nutrition Labeling and Education Act (NLEA) in 1990, a law requiring that virtually all foods regulated by the Food and Drug Administration (FDA) carry a food [...]

Objective The purposes of this study were to identify specific food choice behaviors used to decrease dietary fat intake in a community-dwelling population; assess how people categorize changes to diet; determine whether logical grouping of food intake changes revealed one or more common patterns or strategies used by these participants to decrease fat; and determine which strategies were responsible for the greatest decrease in dietary fat intake in the study population. Design Survey analysis and in-depth interviews were used to quantitatively and qualitatively define dietary change patterns retrospectively in a population who, according to self-report, had decreased their fat intake. Specific food changes made to decrease fat intake, interview statements, and participants' reduction of percentage energy from fat were examined. Setting Interviews were conducted from June 1993 through April 1994. Subjects Included in the study were 145 persons aged 30 to 55 years who reported that they had been decreasing their dietary fat intake for 5 years or more, maintained a healthful diet for at least 5 months, and resided in the United States while changing their diets. Statistical analyses performed Confirmatory factor analysis, reliability analysis, and linear regression analysis were performed. Results Nine fat-reduction strategies were identified. Decrease fat flavorings, decrease 'recreational foods,' decrease cooking fat, replace meat, change breakfast, and use fat-modified foods accounted for significant reduction in fat intake. Conclusions People use a variety of dietary changes to reduce their fat intake. These changes can be categorized into strategies according to the way people change their diets. Knowledge of these strategies and their importance in dietary fat reduction can improve and help nutritionists prioritize the messages they convey. JAm Diet Assoc. 1996; 96:1245-1250,1253., The adoption of a low-fat diet has been associated with decreased risk for chronic disease and excess body weight (especially for women) and associated physiological and psychological issues (1-3). As [...]

The purpose of this article is to give concrete direction to first-time instructors of electronic mail (e-mail) courses. The information is primarily based on personal experience with two courses, but existing literature on the subject is integrated as well. The use of and problems commonly associated with listservs, bulletin boards, computer configurations, varying computer platforms, software, class management, enrollment caps, text materials, and instructor time are described. Recommendations are made throughout. The paper ends with a frank discussion of the pros and cons of an e-mail approach and outlines potential research directions. The major conclusion is that e-mail is suitable for some people in some situations, but not others. Users (both teachers and students) should be well prepared for the amount and kind of effort required to ensure success.

The use of an educational video and accompanying activities appeared to help children with high levels of low density lipoprotein-cholesterol (LDL-C) to reduce serum LDL-C levels, at least for the short term. Children aged 4 to 10 with abnormally high LDL-C levels were randomly assigned to a video autotutorial (88 children), dietary counseling with a dietician (86 children), or a control group receiving no intervention (87 children). Children were mainly white and from middle to upper-class intact families. At the end of three months, three days of data from food diaries were assessed, the child's knowledge was evaluated, and LDL-C levels were remeasured. Autotutorial children had three times the knowledge of counseling and control groups. Average amounts of total and saturated fat declined the same amount in both autotutorial and counseling groups, but the autotutorial group had a 10 mg/dL decline in LDL-C levels versus 4 mg/dl and 3 mg/dL declines among counseling and control groups., Objective. To assess the effects of a home-based, parent-child autotutorial (PCAT) dietary education program on the dietary knowledge, lipid consumption, and plasma low density lipoprotein-cholesterol (LDL-C) of 4- to 10-year-old children with elevated plasma LDL-C. Methods. "At-risk" children (screening total cholesterol, (TC), exceeded 4.55 mmol/L and average LDL-C from two fasting samples was between 2.77 and 4.24 mmol/L for boys or 2.90 and 4.24 mmol/L for girls) were randomized to the PCAT program (N = 88), for dietary counseling with a registered dietitian (N = 86), or to an at-risk control group (N = 87). Dietary knowledge, diet, and LDL-C of these groups were assessed at baseline and after the educational period (3-month follow-up). The knowledge and diet of a not-at-risk (TC below 4.22 and 4.34 mmol/L for boys and girls, respectively) control group (N = 81) was also assessed and compared with that of the at-risk control group. Results. At the 3-month follow-up, the PCAT children&apos;s knowledge scores had increased three times more than those of the counseling and at-risk control groups (P

Drawing from a number of qualitative studies, a set of basic principles is presented for development of sound, effective nutrition education material. First, research is needed each and every time a new intervention or materials development project is initiated. This research should include formative, process, and outcome testing. Second, reality checks are needed. Programs and materials need to be tested in the settings and for the purpose for which they are intended. Third, messages need to be tailored to the audience. Certain concepts, such as the Dietary Guidelines, may be more or less universal, but the actual educational process and materials need to be tailored to specific target groups. Generic messages do not work. Sound scientific methodology is readily available as well as empirical principles to guide in the development and testing of nutrition education programs and materials, but each new intervention must be tested because there is always a creative element involved. Research will be ineffective, however, unless the right questions are asked and the right people (usually requiring a multidisciplinary team) are used to find the answer. J. Nutr. 124: 1808S-1812S, 1994. INDEXING KEY WORDS: * formative research * nutrition education * qualitative research

The Food Guide Pyramid, which was released in 1992, is the official food guide for the United States and the only one recognized by federal agencies or departments. Nutrition and [...]

The purpose of this study was to examine the literature in nutrition education research in order to identify changes in the frequency of theory- or model-driven research in the past ten years, as well as to identify the specific theories and models that authors have used. All papers in the Journal of Nutrition Education and abstracts in Dissertation Abstracts that reported any data collection during the years 1980-1990 (n = 346) were read and coded into categories of theory/model use or no use. Studies that utilized theory and/or models were further divided into five subcategories using Gowin's educative commonplaces. These subcategories included teacher, learner, curriculum, governance, and other. Results indicate that three-fourths of the studies do not explicitly use a theory or model to select variables or methods or to interpret the results. This proportion has stayed constant over the decade, even with an increase in the number of studies reported. Most of the theories used are drawn from the psychological literature. Alternative theories are presented. The need for a set of theories is emphasized to better address the issues pertinent to nutrition education research.

Because health beliefs and concepts develop early in life, Natapoff (1) and several expert groups (2-5) have recommended that health education begin in early childhood. At present, however, few data [...]

Two recent articles have reported the use of focus groups in nutrition education research [1,2]. The purpose of this article is to describe the methods used more fully so that [...]

Dietitians, physicians, the government, and the press have repeatedly told the public that intake of dietary fat and cholesterol is associated with heart disease and should therefore be reduced. The [...]

A dietary education program for hypercholesterolemic children and their parents The National Cholesterol Education Program [1] is directed to adults. Several expert groups [2-5], however, recommend that children, particularly those [...]

According to the theory of meaningful learning, a person tends to act towards things according to the meaning things have for that individual. Therefore, athletes should apply nutrition knowledge to their eating habits to the extent that this knowledge is meaningful to them. The purpose of this exploratory study was to examine the meanings given to training and the role of eating/nutrition as a part of training in a sample of high school distance runners. Using instruments that were pilot tested previously, data were collected for this study from twenty-seven high school distance runners from one high school. Each participant completed both a qualitative interview designed to probe the athlete's concepts of training and eating and a traditional fifty-question multiple choice knowledge test. The previously validated knowledge test was included to cross-check the interview data and to provide some basis for comparing the sample to others reported in the literature. A questionnaire for demographic and training data was also administered. Results showed that the more complex the athletes' concept of training, the more complex was their concept of eating in the context of training. 'Running' and 'practice' were the most meaningful training concepts. 'Coach' was the concept most often linked to eating in the context of training. However, concepts that are common in sports nutrition materials (e.g., 'goal-setting' and 'races/meets') were less meaningful to this group. Nutrition knowledge was poor. These results imply that educators may need to re-examine their approach in order to make their message more applicable to adolescent athletes.

Print material at an advanced reading level was revised for low literate individuals and given to a treatment group randomly chosen from 295 participants. Revisions had an insignificant effect on knowledge. It was recommended that materials for low-literate audiences be developed from scratch and not revised from existing material. (SK)