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Background: Epidemic increases in childhood obesity and associated health risks are resulting in efforts to implement school policies related to nutrition and physical activity (NPA). With multicomponent policy efforts, challenges exist in characterizing the extent of policy change across the breadth of NPA policies. Methods: Aggregated policy indices were created to characterize NPA policy implementation in Arkansas public schools from 2004 through 2009. Index scores are presented by year, domain, and school level. Results: Both mean and median index scores increased over time, with greater changes seen in nutrition than in physical activity policy scores. The composite index score was heavily dependent on the nutrition index score and, thus, is relatively less useful for the purposes of our evaluation. Policy index scores varied by school level, rurality, enrollment size, and percentage of students eligible for federal meal programs. Conclusions: The policy index approach facilitates the consideration of the effect of school policy change in a holistic, aggregated way. School characteristics influence policy adoption, and thus, should be taken into consideration in the promotion of policy change. (Contains 4 tables and 1 figure.)

Background: Foods provided in schools represent a substantial portion of US children's dietary intake; however, the school food environment has proven difficult to describe due to the lack of comprehensive, standardized, and validated measures. Methods: As part of the Arkansas Act 1220 evaluation project, we developed the School Cafeteria Nutrition Assessment (SCNA) measures to assess food availability in public school cafeterias (n = 113). The SCNA provides a measure to evaluate monthly school lunch menus and to observe foods offered in school cafeterias during the lunch period. These measures provide information on the availability of fruit, vegetables, grains (whole or white), chips (reduced fat or regular), side dishes, main dishes, beverages, a la carte selections, and desserts, as well as information on healthier preparation of these items. Using independent raters, the inter-rater reliability of the measure was determined among a subsample of these schools (n = 32). Results: All food categories assessed, with the exception of the side dish and chip categories, had inter-rater reliability rates of 0.79 or greater, regardless of school type. The SCNA scores encompassed the majority of the possible scores, indicating the ability for the measures to differentiate between school cafeterias in the availability of healthier options. Conclusion: These measures allow comprehensive, rapid measurement of school cafeteria food availability with high inter-rater reliability for public health and school health professionals, communities, and school personnel. These measures have the potential to contribute to school health efforts to evaluate cafeteria offerings and/or the impact of policy changes regarding school foods. (Contains 5 tables.)

Describes multilevel recruitment strategies for High 5 Alabama, a school-based study designed to change fourth graders' fruit and vegetable intake. The paper discusses district-, school-, teacher-, and individual-level recruitment; compares participants to nonparticipants; and presents results from teacher perception surveys. Recruitment success varied, though it was 100% effective at the district and school level. (SM)

An evaluation is presented on a collaboration between health care providers and university researchers to treat homeless persons for substance abuse. Components include abstinent-contingent housing and work therapy and links between community and project services.

Objectives. This study examined health care-seeking behaviors to elucidate factors that contribute to differences in patterns of coronary heart disease between African Americans and Whites. The prevalence of diagnosed coronary heart disease, patients' perceptions of symptoms and attribution of symptoms, and predictors of painful symptoms and attribution of cardiac symptoms were examined. Methods. The study involved 7416 patients admitted with diagnoses of coronary artery disease, ischemic heart disease, or myocardial infarction or to rule out myocardial infarction. Structured interview questions were used to obtain demographic information, symptoms precipitating admission, and patients' attribution of their symptoms. Discharge diagnoses were obtained from hospital records. Results. Acute myocardial infarction, unstable angina, nonacute ischemic heart disease, and atherosclerosis were more frequent in White patients. For Blacks, the odds of reporting painful symptoms were only 64% of the odds found for Whites when other factors were controlled, and the odds of attributing symptoms to cardiac origins were almost 50% lower for Blacks than for Whites. Conclusions. The tendency of Blacks to report fewer painful symptoms and to attribute their symptoms to noncardiac origins may contribute to differences in care-seeking and in medical management of heart disease in Blacks. (Am J Public Health. 1994;84:951-956), Heart attacks and heart disease may be perceived differently according to race. When people admitted to the hospital with diagnoses of heart disease or in order to rule out heart attack were compared, blacks were 64% less likely than whites to report painful symptoms and 50% less likely to attribute symptoms to heart problems. Between 1989 and 1990, 692 black and 1714 white hospital patients, both men and women, were interviewed in five Alabama hospitals. Patients with discharge diagnoses of heart disease were more likely to report painful symptoms. Differences in the reporting of symptoms may have significance in care-seeking on the part of the patient and diagnosis and management on the part of the doctor.

The Physical Activity for Risk Reduction project promotes physical activity to help reduce the risk of chronic disease. This involves relatively minor levels of activity compared with a sedentary life-style. To study levels of physical activity, two cross-sectional studies were carried out one year apart in public housing projects in Birmingham, Alabama. Six hundred eighty-seven interviews were conducted in the first survey and 599 in the second. The respondents in both studies were primarily young Afro-American women who were usually poor and either unemployed or working in a service job. Thirty percent reported they had taken part in none of 13 physical activities in the previous year, and half reported only minimal physical activity. A sedentary life-style is common among individuals in this low-income minority group, and efforts are needed to promote exercise in these communities.