Betsy Haughton

Model for multicultural nutrition counseling competencies

A model for multicultural nutrition counseling competencies for registered dietitians was developed and tested. Six hundred four registered dietitians who were members of The American Dietetic Association Public Health Nutrition Practice Group or directors of dietetic internships and didactic programs in dietetics were selected by a stratified random sample method and were mailed a survey. Respondents rated each of 46 competencies using a Likert scale to delineate how essential each competency will be for entry-level dietitians in the next 10 years. Of the 60% who responded (n=363), 94.4% met the study selection criteria. Most were white (85.7%), spoke English as their primary language (96.8%), and had a masters degree (64.4%). Many (37.9%) worked in community/public health facilities or organizations, and 50.4% provided nutrition counseling or education to clients culturally different from themselves. Exploratory principal components analysis extracted 3 factors with 28 competencies loading on them: multicultural nutrition counseling skills, multicultural awareness, and multicultural food and nutrition knowledge. Subjects responded similarly whether or not they provided nutrition counseling to culturally different clients. Secondary analysis revealed no significant interaction or differences between how bilingual dietitians and those of color scored items in the 3 factors. The resulting model is a guideline that can be used by educators to enhance dietetics education and training and by public health nutritionists as a basis for self-evaluation and selection of continuing education opportunities to enhance their multicultural nutrition counseling competence.

Profile of Public Health Nutrition Personnel: Challenges for Population/System-Focused Roles and State-Level Monitoring

OBJECTIVE Our 3 objectives were to document the current public health nutrition workforce in the United States, identify top public health nutrition priorities for the next 5 years, and assess the capacity of public health nutrition personnel to address these priorities and the nutrition-related objectives of Healthy People 2000. DESIGN A census survey was distributed to public health nutrition personnel in all state and local health agencies and nonprofit and for-profit agencies funded by official health agencies throughout the United States and US territories. Also, state and territorial nutrition directors were sent a different questionnaire. SUBJECTS Data were collected from 49 states, the District of Columbia, and 2 territories; 7,550 public health nutrition personnel were represented. STATISTICAL ANALYSIS Data were analyzed using EpiInfo software. Descriptive statistics are presented. RESULTS Almost half of the respondents worked in local or county health agencies and about two thirds were involved in direct care services. Only about 40% were registered dietitians and about one fourth had a masters degree. Almost 90% of all full-time equivalent positions were funded through federal dollars; 78% of all funding was from the Special Supplemental Nutrition Program for Women, Infants, and Children. Top health concerns identified were diet/nutrition to prevent chronic disease, low breast-feeding rates, low birth weight, iron deficiency anemia, and obesity/overweight. Public health nutrition personnel will be challenged to assume population/system-focused roles and state-level monitoring of Healthy People 2000 objectives. Only 2 of the 17 nutrition objectives of Healthy People 2000 were monitored by more than 50% of the states. APPLICATIONS If official health agencies are to shift to public health core functions, as recommended by an Institute of Medicine report, then a substantial proportion of the public health nutrition workforce must not only change how they practice but also obtain the knowledge and skills to do so. Strategies to improve workforce capacity are discussed, including continuing education interventions through professional organizations, distance and on-campus educational opportunities through approved public health nutrition programs, and advocacy for new funding streams focused on public health core functions.

The Public Health Nutrition workforce and its future challenges: the US experience

OBJECTIVES To describe the US public health nutrition workforce and its future social, biological and fiscal challenges. DESIGN Literature review primarily for the four workforce surveys conducted since 1985 by the Association of State and Territorial Public Health Nutrition Directors. SETTING The United States. SUBJECTS Nutrition personnel working in governmental health agencies. The 1985 and 1987 subjects were personnel in full-time budgeted positions employed in governmental health agencies providing predominantly population-based services. In 1994 and 1999 subjects were both full-time and part-time, employed in or funded by governmental health agencies, and provided both direct-care and population-based services. RESULTS The workforce primarily focuses on direct-care services for pregnant and breast-feeding women, infants and children. The US Department of Agriculture funds 81.7 % of full-time equivalent positions, primarily through the WIC Program (Special Supplemental Nutrition Program for Women, Infants, and Children). Of those personnel working in WIC, 45 % have at least 10 years of experience compared to over 65 % of the non-WIC workforce. Continuing education needs of the WIC and non-WIC workforces differ. The workforce is increasingly more racially/ethnically diverse and with 18.2 % speaking Spanish as a second language. CONCLUSIONS The future workforce will need to focus on increasing its diversity and cultural competence, and likely will need to address retirement within leadership positions. Little is known about the workforces capacity to address the needs of the elderly, emergency preparedness and behavioural interventions. Fiscal challenges will require evidence-based practice demonstrating both costs and impact. Little is known about the broader public health nutrition workforce beyond governmental health agencies.

An historical study of the underlying assumptions for United States food guides from 1917 through the Basic Four Food Group Guide

Abstract Using an historical approach, we studied United States food guides with the intention of identifying the assumptions underlying their construction. In analyzing food guides up to and including the Basic Four Group Guide, we identified five categories of assumptions; these related to food and nutrient needs, economics, food habits and taste, the food supply, and nutrition education.

Biscuits, Sausage, Gravy, Milk, and Orange Juice: School Breakfast Environment in 4 Rural Appalachian Schools

BACKGROUND The purpose of this study was to assess the school breakfast environment in rural Appalachian schools to inform school environment intervention and policy change. METHODS A total of 4 rural schools with fourth- and fifth-grade students in East Tennessee were assessed. A cross-sectional descriptive examination of the school food environment where food service managers submitted school menus, production sheets, and vendor bid sheets as part of the dietary data collection protocol for a school-based nutrition intervention study. The school breakfast environment was characterized in terms of calories, fat, saturated fat, and fiber from foods served on a per person basis using menus entered into Nutrient Data Systems for Research and production sheets for amounts of each food item served. Food items were grouped by the meal components of the School Breakfast Program (SBP) and ranked according to the items served most frequently. RESULTS Total fat provided slightly less than half the calories (43%); 15% of calories were from saturated fat. The top-ranked foods for each meal component were biscuits, sausage, 2% milk, orange juice, and gravy. CONCLUSIONS Results suggest that clearer policies or regulations for the SBP are warranted to support policy efforts to promote childhood health. These should include technical assistance and provision of resources for school food service managers to provide low-fat meal options. Further research is needed to determine whether what is offered at school breakfast is actually consumed and how that might affect childrens weight because of the high fat content.

The Future of MCH Nutrition Services: A Commentary on the Importance of Supporting Leadership Training to Strengthen the Nutrition Workforce

With roots dating back to the early 20th century, nutrition services and training in the US developed alongside MCH services and training [1]. Federal responsibility for both, especially since the passage of the Title V legislation in 1935, has been that of the MCHB, currently part of the Health Resources and Services Administration of the US Department of Health and Human Services (DHHS) and its predecessors. This commentary will briefly recap the milestones of this history, and focus on the importance of the investment of the MCHB in promoting and supporting the development of MCH nutrition services as well as leadership training for public health nutrition professionals. The authors also address recent challenges to maintaining Title V nutrition services, the need to increase MCH nutrition leadership due to changes in the health care system as the Affordable Care Act (ACA) is implemented, as well as the need to address nutrition conditions such as pediatric obesity and those associated with children with special health care needs. It is expected that these challenges, coupled with the MCHB paradigm shift to strategic implementation of the life course perspective, will lead to a concomitant shift toward an emphasis on upstream disease prevention and health promotion where nutrition will play a significant role.

Incorporating the life course model into MCH nutrition leadership education and training programs.

Life course perspective, social determinants of health, and health equity have been combined into one comprehensive model, the life course model (LCM), for strategic planning by US Health Resources and Services Administration’s Maternal and Child Health Bureau. The purpose of this project was to describe a faculty development process; identify strategies for incorporation of the LCM into nutrition leadership education and training at the graduate and professional levels; and suggest broader implications for training, research, and practice. Nineteen representatives from 6 MCHB-funded nutrition leadership education and training programs and 10 federal partners participated in a one-day session that began with an overview of the models and concluded with guided small group discussions on how to incorporate them into maternal and child health (MCH) leadership training using obesity as an example. Written notes from group discussions were compiled and coded emergently. Content analysis determined the most salient themes about incorporating the models into training. Four major LCM-related themes emerged, three of which were about training: (1) incorporation by training grants through LCM-framed coursework and experiences for trainees, and similarly framed continuing education and skills development for professionals; (2) incorporation through collaboration with other training programs and state and community partners, and through advocacy; and (3) incorporation by others at the federal and local levels through policy, political, and prevention efforts. The fourth theme focused on anticipated challenges of incorporating the model in training. Multiple methods for incorporating the LCM into MCH training and practice are warranted. Challenges to incorporating include the need for research and related policy development.

Leadership Profiles of Public Health Nutritionists

Abstract Public health nutritionists (PHN) practice in dynamic and complex organizations. Providing leadership in these types of organizations requires diverse skills. One leadership theory differentiates transactional from transformational leadership. Transactional leaders achieve results by providing and maintaining structure while transformational leaders raise awareness of others and facilitate goal achievement The purpose of this study was to evaluate transactional and transformational leadership roles of PHN. The Competing Values Leadership Profile was completed by 342 PHN in an 8 state region in the southeastern US. This profile included 32 items that assessed frequency of performance of transactional leadership roles (monitor, coordinator, director, producer) and transformational leadership roles (facilitator, mentor, innovator, broker) using a 7-point hedonic scale (7=high) for each item. Differences between role performance was determined by repeated measures analysis of variance. Median experience of PHN was 12 years in nutrition, 7 of that in public health nutrition. Most (74%) had administrative responsibilities. Mean performance scores for transactional roles were: monitor (4.8 ± 1.4), coordinator (5.3 ± 1.4), director (5.0 ± 1.5), and producer (5.1 ± 1). Mean performance scores for transformational roles were: facilitator (5.3 ± 1.4), mentor (5.7 ± 1.3), innovator (4.9 ± 1.1) and broker (4.5 ± 1.3). PHN performed the innovator and broker roles significantly less often than the other 6 roles (p Results suggest that PHN may benefit from professional continuing education and career development opportunities that foster development of innovator and broker roles.

Evaluation of Interactive Video Conferences as a Medium for Professional Continuing Education

Abstract Distance education techniques are increasingly being used to deliver continuing education (CE) to dietetic professionals. The purpose of this project was to evaluate the acceptability of a one-way video, two way audio interactive video conference for professional CE on leadership development for public health nutritionists. The evaluation instrument addressed technical, production and content issues and obtained demographic information from participants. The instrument contained 29 items and used a 5-point hedonic scale for most items. Face validity of the instrument was established by a panel of 3 registered dietitians and 2 teleconference specialists. Evaluations were received from 327 public health nutritionists from 30 sites in an 8 state region in the southeastern US. Most respondents (64%) had worked in public health over 5 years and 74% had administrative responsibilities. Most (70%) spent at least half of their time working with mothers and children. Most participants strongly agreed or agreed that the down link sites were convenient (85%), facilities were appropriate (81%), audio/video reception was clear (88%), video conference length of 3 hours was appropriate (94%), and the format was enjoyable (91%). Most participants strongly agreed or agreed that they had an opportunity to call in with questions during the interactive video conference (77%) and thought visual aids used were helpful (82%). Most participants rated the video conference as very good to excellent (88%). Most participants strongly agreed or agreed that the video conference met its objectives (87%), increased their knowledge and skills in leadership (88%), and developed confidence in their leadership roles (70%). Results indicate that distance learning technology, such as an interactive video conference, is an acceptable medium for providing professional CE to dietetic professionals in public health settings.