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Background: Consumption levels of fruits and vegetables (F/V) among children/adolescents are low. Programs like school-based salad bars (SB) provide children/adolescents increased F/V access. Aims: The purpose of this study was to examine the relationship between SB use and individual and school-level factors among elementary and secondary school students in New Orleans public schools. Method: Twelve schools receiving SB units from the "Let's Move Salad Bars to Schools Campaign" participated in this study. Self-reported data were collected from students (n = 1,012), administrators (n = 12), and food service staff (n = 37). School environmental data were obtained through direct observation. Generalized estimating equation regression methods were used to develop a multilevel model including both school-level (e.g., length of lunchtime, SB marketing, vending machines) and individual-level (e.g., sex, food preferences, nutrition knowledge) effects. Results: Female students had higher odds of using the SB compared to males. Students with healthier food preferences had higher odds of using the SB than those who reported less healthy food preferences. Within the multilevel model for all students, only sex and healthy food preferences remained significant. In a multilevel model assessing secondary students only, student encouragement toward others for healthy eating and school-based SB marketing were significantly related to SB use. Conclusions: Little research has examined factors related to school-based SB use. These findings suggest recommendations that may help improve student use of SBs. For example, increasing the promotion of SB, particularly in secondary schools, might encourage their use among students.

Purpose/Objectives: Evaluation of school-based activities is a high priority for school personnel. Nutrition activities, such as salad bars (SBs) incorporated into school lunchrooms, may increase children's consumption of low-energy, high fiber diets. The purpose of this paper is to describe a problem-solving/ decision-making model and demonstrate its application in the evaluation of a school-based SB program. Methods: The proposed model includes five steps: 1) problem definition; 2) goal setting; 3) method options; 4) action plans; and 5) ongoing assessment. The Tulane Prevention Research Center (PRC) conducted an SB evaluation with 19 schools in Orleans Parish. The evaluation, developed with the 5-step model, led to multi-level school data collection: administrative, nutrition service, students, and cafeteria environmental scans. Results: Important practical data about lunchroom SBs was obtained. The evaluation, using the model, successfully demonstrated that all methods were achievable, participation reached expected levels, and identified goals were attained. Application to Child Nutrition Professionals: Previously identified problems (safety, extra labor, cost, storage) with SB use make SB evaluation a high priority for school food management. This proposed easy-to-use model can be applied by professionals and non-professionals in evaluating any school-based activities. The demonstration of this SB evaluation showed that the model can provide efficient guidance that yields practical data for school decisions about SBs in school lunchrooms. School personnel will find this model easy to use; the steps of the model are transferable, and the model could potentially be applied to other evaluation issues.

Background: Childhood obesity continues to be a public health problem in the United States. Increasing consumption of fruits and vegetables (F/V) is one strategy for decreasing high consumption of energy-dense, high-fat foods, thereby improving weight status. Many Orleans Parish public schools were provided with salad bars (SBs) to augment school lunch with increased access to F/V. This study identified factors associated with student use of SBs. Methods: Surveys examining SB use, demographics, food preference, nutrition knowledge, and social support were administered to students in the 7th to 12th grades (N?=?702) in Orleans Parish (New Orleans, Louisiana). Generalized estimating equations, which incorporate clustering at the school level, helped to determine associations between independent variables and SB use. Results: Sixty percent of participants were SB users. Non-African-American students were more likely to be SB users than African-American students (odds ratio [OR]?=?2.35, confidence interval [CI]: 1.35-4.07) and students who had high preference for healthy food were more likely to use the SB than those who had low preference (OR?=?2.41, CI: 1.44-4.01). Students who encouraged others to consume F/V were more likely to use the SB than those who did not (p?=?0.015). Conclusions: Individual and interpersonal factors related to SB use can provide guidance in the development of school-based interventions to increase SB use and F/V consumption.

Background: Although the prevalence of obesity is increasing during adulthood, there have been few assessments of obesity, cardiovascular risk factors, and levels of physical activity among adult elementary school staff. Methods: Data were collected from 745 African-American and White female school personnel in a suburban school district in southeastern Louisiana as part of the baseline assessment before implementation of a program to improve eating and physical activity behaviors. Anthropometry, blood pressure, serum lipids and lipoproteins, and glucose were measured using established protocols. Physical activity was assessed by accelerometry. Results: For both White and Black females, 30% were overweight (body mass index [BMI]) greater than or equal to 25 kg/m[superscript 2] but less than 30 kg/m[superscript 2]). Whereas 37% of White females were obese (BMI greater than or equal to 30 kg/m[superscript 2]), 61% of the Black females were obese. There was a positive association between BMI and other cardiovascular risk factors except for high-density lipoprotein cholesterol, where the association was negative. The mean number of minutes of daily moderate-to-vigorous physical activity was less than 1 minute per day and was lower for overweight and obese women than for normal weight women. Conclusions: School personnel in the study have adverse cardiovascular risk factors, including high rates of obesity and very low levels of physical activity. Because these individuals are often called upon to promote health for children, they are an important target population for wellness interventions. (Contains 4 tables and 1 figure.)

Formative research is used to inform intervention development, but the processes of transmitting results to intervention planners and incorporating information into intervention designs are not well documented. The authors describe how formative research results from the Trial of Activity for Adolescent Girls (TAAG) were transferred to planners to guide intervention development. Methods included providing oral and written reports, prioritizing recommendations, and cross-checking recommendations with intervention objectives and implementation strategies. Formative work influenced the intervention in many ways. For example, results indicated that middle schools offered only coeducational physical education and health education classes, so the TAAG intervention was designed to be appropriate for both sexes, and intervention strategies were developed to directly address girls' stated preferences (e.g., enjoyable activities, opportunity to socialize) and barriers (e.g., lack of skills, fear of injury) for physical activity. The challenges of using formative research for intervention development are discussed. (Contains 1 figure and 4 tables.)

Formative research uses qualitative and quantitative methods to provide information for researchers to plan intervention programs. Gaps in the formative research literature include how to define goals, implementation plans, and research questions; select methods; analyze data; and develop interventions. The National Heart, Lung, and Blood Institute funded the Trial of Activity for Adolescent Girls (TAAG), a randomized, multicenter field trial, to reduce the decline in physical activity in adolescent girls. The goals of the TAAG formative research are to (a) describe study communities and schools, (b) help design the trial's interventions, (c) develop effective recruitment and retention strategies, and (d) design evaluation instruments. To meet these goals, a variety of methods, including telephone interviews, surveys and checklists, semistructured interviews, and focus group discussions, are employed. The purpose, method of development, and analyses are explained for each method. (Contains 2 tables.)

Abstinence-only programs for preventing teen pregnancy are the only options in some states but are the programs of choice in others. Effectiveness data, however, are lacking. The SOS Adolescent Family Life Program (SOS), an abstinence-only teen pregnancy prevention program, was implemented in south central Louisiana. Peer mentoring with an abstinence and life skills curriculum comprised the major components. SOS was implemented in the same grades in the same schools with new students each year for five years. During the final years of the program, qualitative evaluation was conducted with principals, teachers, peer mentors, and students. Use of peer mentors was reaffirmed as valuable; however, quality of peer mentoring was questioned and was a major issue for improvement. Other issues included: starting sexuality education in earlier grades, updating curricula and materials, offering more interactive classes, improving peer mentor training, and using teacher input to improve educational aspects of the program. Qualitative assessments provided valuable insights for future improvement in abstinence-only programs.

Examined smoking behaviors and predictors from fifth through eighth grades by ethnicity, gender, and geographic location. Overall, Hispanic and white adolescents had a similar 30-day smoking prevalence. Predictor variables were powerful across different geographic regions. There were no differences in predictor variables between blacks, whites, and Hispanics. There was a strong connection between fifth grade intentions and eighth grade behaviors. (SM)

Describes the effectiveness of the Gimme 5 intervention to increase high school students' fruit and vegetable consumption. Intervention included media campaigns, classroom workshops, school meal modification, and parental support. After two years, daily servings increased more in the intervention group. Control students, who received Gimme 5 measurements without interventions, increased their consumption to similar levels by three years. (SM)

This article explores cross-sectional associations between depressive symptoms and body mass index (BMI) in women working in schools in the Greater New Orleans area. Self-efficacy for eating and exercise, eating styles, and exercise are examined as potential pathways. This is a secondary data analysis of 743 women who were participating in a workplace wellness randomized controlled trial to address environmental factors influencing eating and exercise behaviors using baseline data prior to the intervention. BMI was the primary outcome examined. Path analysis suggested that increased depressive symptoms were associated with increased BMI in women. Indirect effects of depressive symptoms on BMI were found for increased healthy eating self-efficacy, increased emotional eating, and decreased exercise self-efficacy. The association between greater healthy eating self efficacy and BMI was unexpected, and may indicate a suppressor effect of eating self-efficacy in the relationship between depressive symptoms and BMI in women. The findings suggest the importance of depressive symptoms to BMI in women. Targets for interventions to reduce BMI include targeting depressive symptoms and related sequelae including self-efficacy for exercise, and emotional eating. Further investigation of eating self-efficacy and BMI are recommended with particular attention to both efficacy for health eating and avoidance of unhealthy foods. Keywords Depressive symptoms * BMI * Self-efficacy * Emotional eating, The health and economic burden associated with both depression and obesity is an important public health issue (Simon et al., 2011). The National Comorbidity Survey suggests that lifetime episodes of [...]

Purposes/Objectives: Fruit and vegetable (F/V) consumption may aid in childhood obesity prevention. F/V consumption in youth is low. School-based salad bars (SBs) may improve F/V access in youth. The purpose of this study was to explore administrative and school nutrition personnel perspectives related to adoption and continued implementation of SBs. Methods: In Orleans Parish schools with SBs (n = 19), self-report questionnaires were administered to school administrators and school nutrition directors (SNDs) and staff. Modified surveys were used in schools not currently operating SBs (n = 7). Results: Administrators of SB schools perceived they had more facilitators for SB operation than administrators from non-SB schools. SNDs from SB schools perceived they had staff capacity, more facilitators, and more barriers for SB operations than SNDs s from non-SB schools. Applications to Child Nutrition Professionals: Findings contribute to understanding factors related to continued use of school-based SBs. Facilitators identified by SNDs and administrators, such as strong support from staff and adequate equipment, may contribute to the successful implementation of SBs.

Objectives. We evaluated the effect of providing a safe play space on the physical activity level of inner-city schoolchildren. Methods. In 1 of 2 matched neighborhoods, we opened a schoolyard and provided attendants to ensure children's safety. Over the next 2 years we directly observed the number of children and their physical activity levels in the schoolyard, as well as in the surrounding intervention and comparison neighborhoods. We also surveyed children in the schools in the intervention and comparison neighborhoods regarding sedentary activities. Results. After the schoolyard was opened, a mean of 71.4 children used it on weekdays and 25.8 used it on weekends during the school year. When observed, 66% of these children were physically active. The number of children who were outdoors and physically active was 84% higher in the intervention neighborhood than the comparison neighborhood. Survey results showed that children in the intervention school reported declines relative to the children in the comparison school in watching television, watching movies and DVDs, and playing video games on weekdays. Conclusion. When children were provided with a safe play space, we observed a relative increase in their physical activity. Provision of safe play spaces holds promise as a simple replicable intervention. (Am J Public Health. 2007;97: 1625-1631. doi:10.2105/AJPH.2006.092692)

Abstinence-only programs for preventing teen pregnancy are the only options in some states but are the programs of choice in others. Effectiveness data, however, are lacking. The SOS Adolescent Family Life Program (SOS), an abstinence-only teen pregnancy prevention program, was implemented in south central Louisiana. Peer mentoring with an abstinence and life skills curriculum comprised the major components. SOS was implemented in the same grades in the same schools with new students each year for five years. During the final years of the program, qualitative evaluation was conducted with principals, teachers, peer mentors, and students. Use of peer mentors was reaffirmed as valuable; however, quality of peer mentoring was questioned and was a major issue for improvement. Other issues included: starting sexuality education in earlier grades, updating curricula and materials, offering more interactive classes, improving peer mentor training, and using teacher input to improve educational aspects of the program. Qualitative assessments provided valuable insights for future improvement in abstinence-only programs. (J Sch Health. 2004;74(8):329-334), Unwanted teen pregnancies create costly and perplexing health, economic, and social problems in the United States. Recent declines in teen pregnancies and births produced a 20-year low in these rates; [...]

CATCH provides multiethnic cohort data from third to eighth grades from four US geographic regions. This study examined smoking behaviors and predictors from fifth and eighth grades by ethnicity, gender, and geographic location through self-report data obtained from the cohort (N = 3,654). Overall, eighth grade prevalence for ever smoked was about 44%, 30-day prevalence was about 20%, 7-day prevalence 13.3%, and daily prevalence 7.4%. Prevalence was similar for Caucasians (21.5%) and Latinos (21.6%) and lowest for African Americans (13.1%). The 30-day prevalence for smokeless tobacco was higher for boys than for girls (9.8% vs 5.1%). Tobacco use by parents, siblings, and friends, and easy accessibility in the home in fifth grade, were significant predictors for smoking in eighth grade. Results did not differ by race, gender, or geographic location. The strongest correlate of smoking in eighth grade was having a best friend who smoked. Intention not to smoke in fifth grade predicted nonsmoking in eighth grade. Predictor strength across ethnic groups in different geographic regions was impressive. The social environment of young people continues to be an important instigator of smoking onset. The connection between intention and behavior over time suggests students' intentions not to smoke reflect decision-making at an early age. (J Sch Health. 2002;72(2):58-64), Tobacco use constitutes the most lethal modifiable behavior persistent in the United States today, and it represents a significant factor in developing heart disease and specific cancers. (1) Tobacco-related illnesses [...]

This paper describes an intervention to increase high school students' fruit and vegetable consumption. Twelve schools were randomized to intervention or control conditions. The cohort (2,213 students; 56% females, 84% Caucasian) were followed from 9th to 12th grades. Interventions comprised a media campaign, classroom workshops, school meal modification, and parental support. Usual daily servings of fruit/vegetables increased 14% in the intervention compared to the control group (p [is greater than] 0.001) the first three years. At follow-up, consumption within the control group also increased, resulting in no significant difference between groups. Intervention group knowledge scores and awareness indicators were significantly higher than those of the control group (p [is less than] 0.0001). Gimme 5 provided a first model to show that dietary habits of high school students can be influenced by positive media messages relative to that age group, increased exposure to a variety of tasty products, and minimal classroom activity. (J Sch Health. 1998;68(6):248-253), Nutrition has a major impact on the development of certain cancers.[1-3] According to Willet, 'the inverse relationship between the intake of vegetables and fruits and the risk of cancer represents [...]

Objectives. This study examined cigarette smoking attitudes, peer and parental influence, and first use among children in southeastern Louisiana. Methods. Data from 933 children in grades 3 through 6 in the Bogalusa Heart Study (1993 through 1994) were analyzed. Results. Fifteen percent of the children had tried smoking. Of these, 40% first smoked with a family member, and 46% obtained their first cigarette from a family member or from home. Correlates of ever having smoked were race, sex, having a best friend or family member who smoked, and attitudes that smoking is disgusting and that nonsmokers get better grades. Conclusions. Prevention programs should begin early and focus on family and peer influences as well as attitudes. (Am J Public Health. 1997;87:1345-1348)

Cardiovascular health interventions based on food service and physical education improvements at elementary schools in addition to family participation appears to decrease the fat intake and increase the vigorous physical activity of children. The Child and Adolescent Trial for Cardiovascular Health (CATCH) was implemented at 56 schools in diverse communities in California, Louisiana, Minnesota and Texas. An additional 40 non-intervention schools were used as controls. A total of 5106 students were followed from third through fifth grade. With intervention, the percentage of energy in school lunches derived from fat decreased and the intensity of physical exercise increased significantly compared to non-intervention. Students' reported fat intake decreased and their reported vigorous physical activity increased significantly with intervention. Serum cholesterol, blood pressure and body size were not found to change significantly with intervention.

This report describes the alcohol consumption of adolescents and young adults who participated in the Bogalusa Heart Study, 1981 to 1991. Data were collected in three cross-sectional surveys of school-age children (11 to 19 years) and three surveys of young adults (18 to 32 years). White males had the highest proportion of drinkers and Black females had the lowest. By the end of the decade, adult White and Black male drinkers were about equal. Most individuals drank once or twice a week, but daily drinkers had the highest weekly alcohol intake. An association between alcohol and highdensity lipoprotein cholesterol was found only in the latest survey and probably reflects the aging of the cohort. (Am J Public Health. 1995; 85:979-982), The changes in drinking patterns as a group of teenagers moved into adulthood and the effect on a marker for heart disease are described. Between 1981 and 1991, 3600 Louisiana students in grades 7 through 12 were surveyed. Surveys followed up 2900 of the earlier participants, now between 18 and 32 years old. Among students, whites and males were more likely to drink than blacks or females. Most drinkers drank once or twice weekly. Among young adults, men were more likely to drink than women, and black males drank as frequently as white males. Adults were more likely than teenagers to drink daily. The percentage of male drinkers increased during adolescence, plateauing around age 25. The percentage of white female drinkers peaked around age 19 and then declined whereas black females continued to increase. No correlations with risk factors for heart disease were found. Drinkers had higher levels of high-density-lipid (HDL) cholesterol whether they smoked or not compared with nondrinking smokers but the HDL levels seemed to factor.

Health promotion interventions intended to improve dietary behavior frequently incorporate self-efficacy as a construct to enhance behavior change. This paper presents results from a study to establish psychometric properties of a scale to measure children's self-efficacy for selecting healthful food. As part of a series of pilot studies to develop instrumentation for the Child and Adolescent Trial for Cardiovascular Health (CATCH), data were collected on third and fourth grade students (n = 1,127). Data analyses were conducted to estimate internal consistency, test-retest reliability, factorial validity, and criterion related validity. Results revealed acceptable estimates of internal consistency for the dietary self-efficacy scale (coefficient alpha = .84). Self-efficacy was strong associated with the children's usual food choices, accounting for about 34% of variance (Multiple R =. 58). Findings support using such an instrument for evaluating intervention programs addressing nutrition behavior and for studies to determine the association of self-efficacy to dietary behavior or related constructs. (J Sch Health. 1995;65(1):23-27), Social psychology models that identify environmental, individual, and behavioral characteristics associated with cardiovascular disease (CVD) helped to guide development of chronic disease prevention programs among children and youth.[1-5] Social cognitive [...]