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Chronic food insecurity in childhood impacts health and academic achievement across the life course. We describe the development of a brief self-report nutrition literacy survey to assess knowledge...

The COVID-19 pandemic exacerbates the complexities of food inequity. As one of the social determinants of health, food insecurity significantly impacts overall health across the life course. Guided by the Getting to Equity Framework, this qualitative community-engaged participatory project examines the impact of the pandemic on food security among adults in Washington, D.C. Semi-structured interviews (n = 79) were conducted by trained community health workers between November 2020 and December 2021 at corner stores. Data analysis was performed using thematic network analysis in NVivo. Results are grouped into four key themes: (1) impact of the pandemic on food access, including expanded services and innovative solutions to meet needs; (2) coping and asset-based strategies at the individual and community level; (3) sources of information and support, and (4) impact of the pandemic on health and well-being. The importance of lived experience research in public health is increasingly recognized as an innovative approach that offers benefits through community engagement and empowerment.

Purpose: Maintaining a healthy eating pattern plays a key role in ensuring optimal health outcomes, yet, in areas considered “food deserts” and lower-income neighborhoods where the accessibility of healthy foods and beverages is limited, the pursuit of adequate nutrient intake is rendered cumbersome. This pilot program aims to improve access to healthful foods by supporting corner stores in stocking and promoting the purchase of produce. Methods: DC Central Kitchen's Healthy Corners program in Washington, DC piloted a nutrition incentive model in 17 corner stores that were upgraded to stock an increased variety and quantity of fresh produce. This program, entitled “5-for-5,” provided a $5 coupon toward the purchase of fresh produce to Supplemental Nutrition Assistance Program (SNAP) shoppers making a qualifying purchase of $5 or more with SNAP benefits. Results: Evaluation based on store owner buy-in and customer intercept surveys indicated overall satisfaction in program offerings with 77% of SNAP shoppers polled indicating an increase in produce consumption as a direct result of the program. Coupon distribution data indicated that in the 5-for-5 program's first year, 76.5% of all 57,989 distributed coupons were redeemed, amounting to $221,770 worth of incentivized fresh produce sales. Conclusion: The results of the incentive program were promising with increases in the amount of produce purchased as a result of the program. Lessons learned concerning the use of a financial incentive to encourage the purchase of produce at corner stores is explored, as well as the feasibility of the corner store as a sustainable venue to increase produce consumption in underserved communities.

Objective To describe the research methods of a multicomponent nutrition education program empowering teachers to improve nutrition literacy and prevent obesity among elementary school students. Design Prospective 5-year study following a pre-post intervention design. Setting Four elementary schools in a high-needs area in Washington, DC: 2 intervention and 2 comparison schools. Participants Approximately 100 teachers (25/school) and 800 students (200/school) enrolled over the study period. Intervention Healthy Schoolhouse 2.0 will engage teachers as agents of change by designing, implementing, and evaluating a structured professional development program to support the integration of nutrition concepts in the classroom. Main Outcome Measures Change in pre-post survey assessment of students’ nutrition literacy, attitudes, and intent; change in teachers’ self-efficacy toward teaching nutrition; fruit and vegetable consumption data collected 6 times/y in the cafeteria. Analysis Process evaluation throughout the study to document implementation and challenges. Multilevel mixed modeling will be used to determine the impact of the intervention.

Childhood obesity prevalence trends involve complex societal and environmental factors as well as individual behaviors. The Healthy Schoolhouse 2.0 program seeks to improve nutrition literacy among elementary school students through an equity-focused intervention that supports the health of students, teachers, and the community. This five-year quasi-experimental study follows a baseline–post-test design. Research activities examine the feasibility and effectiveness of a professional development series in the first program year to improve teachers’ self-efficacy and students’ nutrition literacy. Four elementary schools in Washington, DC (two intervention, two comparison) enrolled in the program (N = 1302 students). Demographic and baseline assessments were similar between schools. Teacher participation in professional development sessions was positively correlated with implementing nutrition lessons (r = 0.6, p &lt, 0.001, n = 55). Post-test student nutrition knowledge scores (W = 39985, p &lt, 0.010, n = 659) and knowledge score changes (W = 17064, p &lt, 0.010, n = 448) were higher among students in the intervention schools. Students who received three nutrition lessons had higher post knowledge scores than students who received fewer lessons (H(2) =22.75, p &lt, 0.001, n = 659). Engaging teachers to implement nutrition curricula may support sustainable obesity prevention efforts in the elementary school environment.

Parents, health professionals, and communities are integral in the development of nutrition behaviors that reduce children’s risk for high body mass index (BMI) and chronic disease. The aim of this study was to conduct formative evaluations with key health informants and parents to understand the specific strategies that families use at mealtimes to promote their family’s health, along with the barriers they face in attending current nutrition education programming. Focus groups (in English and Spanish) were conducted with parents (n = 22, 63.64% Black/African American, 13.64% Black but not African American, 18.18% Hispanic/Latinx) whose household was located in a community where 50% of residents’ gross income was ≤185% of the federal poverty level. Semi-structured interviews were conducted with six key informants with expertise in family health and nutrition. Inductive thematic analysis was used to identify themes across interviews. Six general themes emerged from the interviews including perceptions of health, relationships, health behaviors, facilitators, barriers, and desired changes. Across the six themes, participants responded with suggestions for community-based health promotion programs such as incorporating a broader definition of health to better address the individual and systemic barriers that perpetuate health inequities and make healthy eating difficult. Participants identified stress reduction, health literacy, and cooking knowledge as areas of interest for future programming.

Previous research indicates that youth with obesity exhibit deficits in executive functioning (EF), which often take the form of impaired response inhibition. One aspect of EF not previously studied in obesity is the adaptive process known as retrieval-induced forgetting (RIF), the suppression/inhibition of intrusive or non-target items by the retrieval of specific items from memory. The present study investigated if child or adolescent obesity disrupts the ability to inhibit retrieval of intrusive memories.We compared the manifestation of RIF in children (ages 8-12) and adolescents (ages 13-18) as a function of their weight status and sex. We also evaluated the effects of these variables on simple recall of items from episodic memory under conditions where competition from intrusive items was reduced.Children with obesity did not demonstrate significant RIF, whereas RIF was exhibited by preteens without obesity and by teenage participants with- and without obesity (Weight Status × Age Group interaction p = 0.028). This pattern of results did not differ as a function of sex for either age group. No differences in episodic memory were found. Additional analyses using Age as continuous covariate (and not as a nominal group) comparing participants who exhibited RIF with those who did not, found that the no RIF group consumed fast-food meals more frequently (p = 0.024) and had higher percentages of total body adiposity and android fat compared to the RIF group (p's 0.05).The findings expand what is known about the effects of childhood obesity on cognitive functioning, identify impaired RIF with specific behavioral and dietary factors and increased adiposity, and suggest the possibility that impairments in the ability to inhibit intrusive memories of food and eating may contribute to poor early-life weight control.

INTRODUCTION: Effective communication approaches are necessary to reach food-security program participants. Accessing food-security programs has been especially challenging during the COVID-19 pandemic. Social media can play an important role in reducing some communication barriers. We examined interest in receiving nutrition information via social media among adults participating in food-security programs in Washington, DC. METHODS: We developed and administered a 22-item survey to adults participating in food-security programs (N = 375). Participants were recruited at Martha's Table, in Washington, DC, from January through March 2020. We performed bivariate analyses and multinomial logistic regressions to examine predictors of interest in receiving nutrition information via social media. RESULTS: Sixty-nine percent of participants reported using social media, and 49% expressed interest in receiving nutrition information via social media. Higher levels of self-efficacy and belief in the value of digital technology were associated with greater likelihood of interest in receiving nutrition information via social media (χ2 6 = 139.0; Nagelkerke R2 = 0.35; P < .001). We found no differences by sex or digital technology access in interest in receiving nutrition information via social media. CONCLUSION: Social media is a widely used and a feasible method to reach food-security program participants. Understanding program participants' interest in receiving health information via social media may help food-security programs plan effective communication strategies to improve food security, especially when in-person participation is limited, such as during the COVID-19 pandemic.

Background: Latinos in the United States are at heightened risk for obesity and health disparities, yet community-based interventions to promote health are limited. Purpose: This research examined the feasibility and efficacy of a culturally relevant obesity prevention program (Vivir Sano), which included stress reduction and behavioral lifestyle intervention components. Methods: In phase 1, focus groups were completed with 21 residents of an affordable housing community to assess program needs and interests. In phase 2, 41 primarily Latino adults living in several neighboring affordable housing communities enrolled in the intervention. Twenty-three (56%) completed both pre- and postassessments (per protocol group). We examined pre–post differences in health-related behaviors, knowledge, and attitudes. Results: Over 96% of participants who completed a posttest satisfaction questionnaire reported that they were likely or very likely to use the skills learned in the program. Approximately 85% report...

Community partnerships provide an invaluable and practical teaching opportunity for undergraduate public health education programs. This is especially true when working with Generation Z students who desire meaningful, effective learning experiences. The continued strong interest of Generation Z undergraduates in public health and health promotion, combined with their skills and learning preferences, provides a strong rationale for utilization of community-based learning strategies. It could be argued, however, that programs must go beyond providing service learning and reflection opportunities. Indeed, experiential learning has come under criticism for lack of engagement with community-based organizations served by students and a lack of evidence on the quality or utility of the “services” provided. In this light, we constructed a transformational model of learning, where students complete tangible, timely projects with community partner organizations. In this model, all parties benefit: The students experience an often-profound learning opportunity through project execution; the community partners benefit from the skills, insight, time, and talents of the students; and the undergraduate program is able to assess a novel marker of student achievement—evaluation of a real-world application of public health skills and knowledge.

Children with disabilities are likely to have unmet health needs, including access to quality health care, and many face significant challenges related to poor housing conditions. Studies find significant negative correlations between neighborhood disadvantage and health and education outcomes for students with disabilities (SWDs). SWDs are overrepresented in public housing communities and represent an especially at-risk and understudied segment of the population. This chapter examined the use of the Whole School, Whole Community, Whole Child (WSCC) framework as a means by which to improve both health and educational outcomes for SWD living in a public housing community. Families reported that 27% of the children in this community have a disability, so attention to providing a holistic set of interventions to support families of SWD in this community is essential.

Objective The goal of Healthy Schoolhouse 2.0 is to improve health literacy and prevent obesity in elementary school students in Washington, DC. The first year of a five-year intervention program involves the design and implementation of research, education, and extension activities in two elementary schools. Data were collected in both the experimental and control school, including the use of assessment instruments to measure students’ nutrition literacy and teachers’ self-efficacy and attitudes toward teaching nutrition and the belief about the intersection of health and education. Plate waste data were also collected on students’ fruit and vegetable consumption at both schools. Description Findings from year one include no significant differences at baseline between teacher or student demographics and knowledge assessment in the experimental and control settings. Pre-program assessments in teacher attitudes at both experimental and control settings are positive. Food consumption was measured during the lunch period at three time periods. Evaluation Fifty one nutrition lessons were taught during the program implementation at the experimental school as a result of the professional development program. A significant difference was observed on student knowledge between the pre-and post-assessment in the experimental school (t (124) = 7.1, P Conclusion and Implications Lessons learned include refinement of the approach to the professional development program for teachers later in mid-fall; administering the teacher surveys online; and engaging the teachers with health programming early into the school year.

This paper describes an exploration of the relationship between mathematic achievement and the school health environment relative to policy-driven changes in the school setting, specifically with regard to physical education/physical activity. Using school-level data, the authors seek to understand the relationship between mathematics achievement and the school health environment and physical education minutes. This work provides a description of the aspects of the school health environment, an exploration of the interrelationships between school health and student achievement, and an assessment of the effects of the school health policy and practice on student performance and health status. Based on these findings, we identify additional research necessary to describe the relationship between obesity and learning in children.

Purpose – The purpose of this paper is to explore the relationship between television viewing time, physical activity level, food consumption patterns, and academic performance of adolescents in a large urban school district in the USA where health disparities are prevalent, particularly among minority residents. Design/methodology/approach – The 2010 Youth Risk Behavior Survey was used to analyze the relationship between academic grades and physical activity patterns and food consumption in a large urban school district serving over 77,000 students. Findings – Results indicated that students who self-reported grades of As and Bs had higher levels of physical activity and less screen time compared to students who reported grades of Ds and Fs. Further, as grades decreased the consumption of soda and fast food increased. Originality/value – Higher grades track significantly with improved physical activity and lower intake of soda and fast food. These findings provide additional support for the role of regular physical activity and its positive effect on academic performance.

Purpose – The purpose of this paper is to examine the impact of a nutrition-education intervention delivered at low-income middle schools in Washington, DC in the USA, using a mobile farmers’ market to bring hands-on lessons to schools. The program was a partnership between a local farm and university and was funded by the United States Department for Agriculture (USDA) Team Nutrition grant. Design/methodology/approach – Seven low-income middle schools received the intervention, which included 45-minute lessons focussed on nutrition education and sustainable farming concepts. The farmers’ market was delivered via a converted school bus, allowing for full market setup at each school to provide local fruits and vegetables as teaching tools. The nutrition-education lesson focussed on the USDA MyPlate and healthy meal planning. The farm education component focussed on organic farming principles, sustainability of local food systems, and seasonality. A six question pre- and post-survey was administered to 408 participating middle school students to assess changes in knowledge. Findings – Overall, average scores increased from 51 to 58 percent. Nutrition knowledge questions increased from 58 to 74 percent, while agriculture questions remained constant at 43 percent. Both increases significant using a two-sample t-test (p Originality/value – Childhood obesity is a growing epidemic that affects low-income communities disproportionally. Innovative strategies must be implemented to increase healthy food consumption. This case study presents such an approach and its value in increasing student knowledge of healthy behavior.

This study investigated the prevalence of food insecurity among community college students (N = 301) and the relationship between food insecurity and student grade point average (GPA). It employed a cross-sectional intercept survey, utilizing the U.S. Department of Agriculture’s Household Food Security Survey Module, student self-reported GPA, and demographic variables. The research setting was two community colleges in Maryland—one located in a low income urban area and one located in an affluent suburban area. Results demonstrate that 56% of the students in the overall sample were classified as food insecure. Students at higher risk of food insecurity included those who reported living alone and those who reported being single parents. Students identifying themselves as African American or as multiracial were also at increased risk for food insecurity. Food insecure students were more likely than food secure students to report a lower GPA (2.0–2.49) versus a higher GPA (3.5–4.0). Data suggest that food ...

The objective of this qualitative study was to identify what school and food bank personnel report as key factors for a successful school-based food pantry program.In-depth interviews were conducted with food bank employees and school pantry personnel to gain an understanding of school food pantry operations. School pantry success was fostered by healthy relationships between schools and food banks, program marketing, convenience, supportive school staff, and adequate operating budgets. School pantries are perceived as a key component in reducing childhood hunger. An understanding of these programs is important for researchers and practitioners concerned about hunger and academic success.

Background: Across the nation, schools have become actively involved in developing obesity prevention strategies both in classrooms and in cafeterias. We sought to determine the type of foods being offered during lunch in the cafeteria of 3 public high schools in 1 county and if this reflects the purchasing patterns of students. By labeling foods based on nutrient density using a stoplight approach of green, yellow, and red colors, we were able to categorize all foods including the National School Lunch Program (NSLP) and competitive foods available in the cafeteria. Methods: Over a 4-week cycle, daily food purchases were gathered and the proportions of green, yellow, and red foods offered and purchased was compared. Results: Findings from this study suggest that students in these 3 high schools purchased foods in relative proportion to what was available in the school cafeteria for the NSLP. Green and yellow foods included in the NSLP comprised 77% of the offerings and 73% of the purchases. In contrast, 61% of the competitive foods were classified as red foods, and the purchasing of red foods made up 83% of competitive food sales. These results indicate that students purchase foods of minimal nutritional value at greater proportions in the school cafeteria. Conclusions: These results suggest that the nutritional policy for the NSLP promotes the offerings of a wide array of foods. Schools should consider a nutrition policy that regulates the sale of competitive foods.

BACKGROUND With the rise in childhood obesity, school policies related to nutrition and physical activity have been written and implemented. In this paper, we present a model to evaluate the degree to which state legislation for school health policies are implemented at the school level. METHODS Using Washington, DC's Healthy Schools Act (HSA) and a self-report measure of the implementation of the HSA, we illustrate the process of developing a composite score that can be used to measure compliance with the provisions of the law. RESULTS We calculated elementary and middle school composite scores based on the provisions within the HSA. Schools have been successful in implementing nutrition provisions; however, more resources are needed for schools to achieve the minutes of health and physical education. We found statistically significant differences between public charter and traditional public schools on the implementation of the provisions of the HSA. CONCLUSIONS Understanding how schools are complying with school wellness policies is a next step to determining where additional resources or support are needed in order to support school-wide adoption of healthy policies.

Using a sample of college-aged men, we evaluated the validity of a staging algorithm for dairy calcium intake that had been previously validated in a sample of college women. College-aged men enrolled at a private university in the United States were randomly selected to participate. The sample consisted of 180 male participants. Self-reported calcium intake was measured using a 26-item food frequency questionnaire. Stages of change classifications were based on a four-question algorithm for dairy calcium intake and a three-item self-efficacy questionnaire. Significant differences were found between dairy/calcium intake levels between precontemplation, contemplation/preparation, and action/maintenance groups. Results also showed that 46% of participants were in the action/maintenance stage. There was a significant difference in self-efficacy between members of the preaction and action stages. The study suggests that this stage of change algorithm for dairy calcium intake is valid for use in a male college student population.

Health promotion practice has evolved over the past four decades in response to the rising rates of chronic disease. The focus of health promotion is attaining wellness by managing modifiable risk factors, such as smoking, diet, or physical activity. Occupational health nurses are often asked to conduct worksite health promotion programs for individuals or groups, yet may be unfamiliar with evidence-based strategies. Occupational health nurses should lead interprofessional groups in designing and implementing worksite health promotion programs. This article introduces occupational health nurses to health promotion concepts and discusses evidence-based theories and planning models that can be easily introduced into practice.

We wished to study the relationship between modifiable and nonmodifiable factors that were correlated with osteoporosis using a national sample of women aged 50 years and older who have never been on hormone replacement therapy (HRT). We used a cross-sectional study design with a nationally representative sample with a detailed clinical examination and a home interview. Between 1988 and 1994, 1953 postmenopausal women who had never been on HRT, aged 50 years and older, were examined as part of the Third National Health and Nutrition Examination Survey (NHANES III). Mexican Americans and non-Hispanic blacks were oversampled to produce reliable estimates for these groups. Bone density measurements of four proximal femur sites were assessed by using x-ray absorptiometry (DEXA). A DEXA measurement at any single femur site indicated osteoporosis if it was2.5 standard deviations (SD) below the reference mean of 20--29-year-old women. The study demonstrated that numerous factors, both modifiable and nonmodifiable, were significantly related to the prevalence of osteoporosis. The modifiable factors identified were participation in physical activity (three to five times per week) and body mass index (BMI). Nonmodifiable factors included age, race, and mother's history. With the aging population, osteoporosis is a growing concern for the medical community. It is suggested that educational strategies are needed to increase awareness of factors that contribute to maintaining bone health among postmenopausal women. Emphasis may be placed on maintaining regular physical activity.

Rising childhood obesity rates have spurred the government and school districts to legislate school wellness policies. Policy formulation must be paired with policy implementation. This article describes how a school-wide health education program addressed the needs of students, faculty, and parents while advancing academic achievement.

BACKGROUND: The study investigated how nutrient standards affected the number of kilocalories and grams of fat and saturated fat in competitive foods offered and sold in 3 high schools. METHODS: The study is a quasi-experimental design with 3 schools serving as the units of assignment and analysis. The effect of the nutrient standards was measured by the change in kilocalories and grams of fat and saturated fat in offerings and purchases of competitive foods pre- and postimplementation of the standards. A paired sample t-test was used to compare kilocalories and grams of fat and saturated fat pre- and postimplementation of nutrition standards. RESULTS: After the implementation of the nutrition standards, students in 3 high schools purchased significantly smaller numbers of kilocalories and grams of fat and saturated fat, during the postpolicy school year of 2007-2008 than during the prepolicy school year of 2004-2005. CONCLUSION: Using nutrient standards to guide the selection of competitive foods offered in school cafeterias may positively affect intake of kilocalories, total grams of fat, and total saturated fat of those foods. The quantitative assessment is novel and demonstrates the reduction in kilocalories and fat in both the competitive food offerings and purchases as a result of nutrient standards.

BACKGROUND: With adolescent obesity rates on the rise, the school food environment is receiving closer scrutiny. This study looks at the effects of nutrient standards as part of a wellness policy that was implemented in 3 public high schools in 1 county, by analyzing the nutritional value of competitive food offerings and purchases before and after the development of the standards. METHODS: All food offerings and purchases were labeled based on their nutritional density using a stoplight approach of green, yellow, and red colors for the pre- and post- period. The stoplight approach to ranking foods is on a continuum of nutrient density, with green foods being the healthiest choices and red foods offering minimal nutrient density. RESULTS: Results showed that after the implementation of the standards, red foods made up 30% of offerings, down from 48% of offerings prior to the existence of the guidelines. The proportion of red food purchases also decreased, from 83% to 47%. Additionally, yellow food offerings increased from 18% to 48% and purchases increased from 6% to 34%. CONCLUSION: Results indicate that the nutrient standards as part of the wellness policy contributed to a positive shift in the nutritional value of competitive food purchases and offerings.

A strategic marketing plan was created for an east coast university campus wellness program serving over 12,000 students, faculty, and staff, to include three major program objectives: (1) to increase program awareness and name recognition, (2) to aid in recruitment and enrollment of program participants, and (3) to increase the profit margin by 100 percent. Moreover, a marketing philosophy, marketing goals, demographic analysis, mass segmentation, and marketing strategy analysis were established as components in the strategic plan. In addition to the various media vehicles employed in marketing strategies, several marketing techniques adapted and employed in this strategic plan to accomplish these objectives including: (1) LIFE Enhancement Leaders; specially trained groups of peer educators serving as liaisons to the academic departments and dormitories, (2) a Guest Speaker Series held at various locations on campus, and (3) evening and weekend wellness workshops and screening clinics. As a resu...

With increasing emphasis being placed on identifying the health risks associated with cholesterol levels, there have been positive advancements in increasing public knowledge and controversy surrounding the methods of cholesterol evaluation. Total cholesterol is principally determined by either venous blood drawing with laboratory analysis or finger-stick with tabletop assessment. The results of some studies based on the use of the analyzer in the office have demonstrated a favorable agreement between the tabletop analyzers and laboratory measures; however, some have not reported such a good relationship. Some of the mixed results have been attributed to whether serum or whole blood is being analyzed, j,2 Other studies have specifically examined and compared values obtained by the fingerstick method and analyzed by the Boehringer Mannheim Reflotron analyzer with a venous-drawn serum sample that was analyzed by a commercial laboratory. As with all controversial issues, some of the studies have found that there is a high correlation between the two methods of analysis, ~’5

The purpose of this study was to develop and validate a staging algorithm for calcium intake.Three hundred seventy-six college-aged females at a private university were randomly selected to participate. After 8.5% of the data were omitted due to incomplete surveys, the sample consisted of 344 female participants. Calcium intake was measured as self-reported consumption with a 26-item food frequency questionnaire. Stages of change classifications were based on a four-item algorithm for calcium intake, and self-efficacy was measured with three items.Significant differences were found between calcium intake levels between precontemplation, contemplation/preparation and action/maintenance. Results also showed that 40% of the participants were in action/maintenance and were consuming the Dietary Reference Intake level of 1,000 mg of daily calcium. Participants in the action and maintenance stages had significantly higher self-efficacy than the preaction group.The study suggests that the stages of change algorithm may be used as an effective tool in assessing daily calcium intake among a college female population.