Anita Rocha

Effect of the Healthy Hunger-Free Kids Act on the Nutritional Quality of Meals Selected by Students and School Lunch Participation Rates

IMPORTANCE Effective policies have potential to improve diet and reduce obesity. School food policies reach most children in the United States. OBJECTIVE To assess the nutritional quality of foods chosen by students and meal participation rates before and after the implementation of new school meal standards authorized through the Healthy Hunger-Free Kids Act. DESIGN, SETTING, AND PARTICIPANTS This descriptive, longitudinal study examined changes in the nutritional quality of 1,741,630 school meals at 3 middle schools and 3 high schools in an urban school district in Washington state. Seventy two hundred students are enrolled in the district; 54% are eligible for free and reduced-price meals. Student food selection data were collected daily from January 2011 through January 2014 during the 16 months prior to and the 15 months after implementation of the Healthy Hunger-Free Kids Act. EXPOSURE The Healthy Hunger-Free Kids Act. MAIN OUTCOMES AND MEASURES Nutritional quality was assessed by calculating monthly mean adequacy ratio and energy density of the foods selected by students each day. Six nutrients were included in the mean adequacy ratio calculations: calcium, vitamin C, vitamin A, iron, fiber, and protein. Monthly school meal participation was calculated as the mean number of daily meals served divided by student enrollment. Mean monthly values of mean adequacy ratio, energy density, and participation were compared before and after policy implementation. RESULTS After implementation of the Healthy Hunger-Free Kids Act, change was associated with significant improvement in the nutritional quality of foods chosen by students, as measured by increased mean adequacy ratio from a mean of 58.7 (range, 49.6-63.1) prior to policy implementation to 75.6 (range, 68.7-81.8) after policy implementation and decreased energy density from a mean of 1.65 (range, 1.53-1.82) to 1.44 (range, 1.29-1.61), respectively. There was negligible difference in student meal participation following implementation of the new meal standards with 47% meal participation (range, 40.4%-49.5%) meal participation prior to the implemented policy and 46% participation (range, 39.1%-48.2%) afterward. CONCLUSIONS AND RELEVANCE Food policy in the form of improved nutrition standards was associated with the selection of foods that are higher in nutrients that are of importance in adolescence and lower in energy density. Implementation of the new meal standards was not associated with a negative effect on student meal participation. In this district, meal standards effectively changed the quality of foods selected by children.

Assessment of the relative dose-response test based on serum retinol-binding protein instead of serum retinol in determining low hepatic vitamin A stores

BACKGROUND The relative dose-response (RDR) test, which measures the percentage of change in serum retinol concentration in response to an oral vitamin A (VA) dose, is a functional reference method to assess low hepatic VA stores. However, problems due to the relative instability of retinol, which is measured in the traditional RDR test, could be circumvented if retinol-binding protein (RBP), a more stable marker of VA, could be measured instead of retinol to provide the RDR value. OBJECTIVE The objective was to compare classification of VA status assessed by retinol-RDR with that assessed by using RBP-RDR. DESIGN With the use of serum samples from 57 lactating women in northern Kenya collected in August-September 2006, we assessed the accuracy of RBP-RDR in predicting low hepatic VA stores through receiver operator characteristic (ROC) analysis using retinol-RDR values as the gold standard. By using regression analysis, we explored the effects of 1) body mass index (BMI) on RBP-RDR performance and 2) the oral VA dose on the retinol-RBP molar ratio. RESULTS The classificatory accuracy of RBP-RDR was low to moderate (n = 50; ROC area: 0.56-0.72) depending on the cutoffs used. RBP-RDR systematically overestimated VA deficiency with higher BMI, although it was superior to a single measurement of serum retinol. The discrepancy between RBP-RDR and retinol-RDR appears to originate in a retinol concentration-dependent alteration of the retinol-RBP molar ratio triggered by the oral dose. CONCLUSIONS RBP-RDR has the potential to serve as a moderately accurate surrogate measure of retinol-RDR if the variation associated with BMI is understood and adjusted. Further studies should clarify the dynamics of the retinol-RBP molar ratio and its link to RBP-RDR performance.

Predictors of recovery-oriented competencies among mental health professionals in one community mental health system.

AbstractA survey of 813 mental health professionals serving adults with severe mental illness clustered in 25 community mental health centers assessed the extent to which mental health professionals possess clinical competencies that support recovery and the predictors of these competencies. The results suggest there is room for improvement in recovery-oriented competencies. In-depth professional training in recovery, greater job variety, more years practicing in mental health, participation on an intensive case management team, and perceptions of workplace recovery culture were predictors of recovery-oriented competencies. Prioritization of on-going professional, worker retention, and management strategies that incorporate a team approach to treatment and improvements in workplace recovery culture may potentially increase recovery-oriented clinical practice.

Fruit and vegetable access programs and consumption in low-income communities

ABSTRACT States, cities, and communities are implementing a variety of programs to increase access to fruits and vegetables, but relatively little is known about their impact, especially among low-income populations. To determine factors associated with program utilization and fruit and vegetable consumption, we interviewed 217 participants in three types of programs – farmers market Supplemental Nutrition Assistance Program (SNAP) incentives, subsidized farm stands, and subsidized produce bag distribution – as well as a comparison group of 90 non-participants, all in King County, Washington. Demographics and utilization differed by program. Participation in the farmers market SNAP incentive program was positively associated with fruit and vegetable consumption.

Providers’ Implicit and Explicit Stereotypes About Mental Illnesses and Clinical Competencies in Recovery

We examined community providers’ stereotypes about mental illnesses and their association with clinical competencies among mental health professionals in Washington State’s community mental health system (N = 584). Mental Health Competence and Recovery Implicit Association Tests were developed. The Competency Assessment Instrument (CAI) measured provider competencies in rehabilitation. Bivariate and multivariate analyses were used to examine the associations between stereotypes and clinical competencies. On average, providers did not differentially associate the concepts of competence or recovery with physical illnesses versus mental illnesses. However, providers that implicitly associated recovery more with physical illnesses had lower clinical competency scores (p = .03). Explicit stereotypes were associated with lower competency scores. Providers’ stereotypes about mental illnesses are predictors of clinical competencies.