Carolyn Sutter

The Shaping Healthy Choices Program: Design and Implementation Methodologies for a Multicomponent, School-Based Nutrition Education Intervention

OBJECTIVE To provide a framework for implementation of multicomponent, school-based nutrition interventions. This article describes the research methods for the Shaping Healthy Choices Program, a model to improve nutrition and health-related knowledge and behaviors among school-aged children. DESIGN Longitudinal, pretest/posttest, randomized, controlled intervention. SETTING Four elementary schools in California. PARTICIPANTS Fourth-grade students at intervention (n = 252) and control (n = 238) schools and their parents and teachers. Power analyses demonstrate that a minimum of 159 students per group will be needed to achieve sufficient power. The sample size was determined using the variables of nutrition knowledge, vegetable preference score, and body mass index percentile. INTERVENTION A multicomponent school-based nutrition education intervention over 1 academic year, followed by activities to support sustainability of the program. MAIN OUTCOME MEASURES Dietary and nutrition knowledge and behavior, critical thinking skills, healthy food preferences and consumption, and physical activity will be measured using a nutrition knowledge questionnaire, a food frequency questionnaire, a vegetable preferences assessment tool, the Test of Basic Science Process Skills, digital photography of plate waste, PolarActive accelerometers, anthropometrics, a parent questionnaire, and the School and Community Actions for Nutrition survey. ANALYSIS Evaluation will include quantitative and qualitative measures. Quantitative data will use paired t, chi-square, and Mann-Whitney U tests and regression modeling using P = .05 to determine statistical significance.

How you look versus how you feel: Associations between BMI z-score, body dissatisfaction, peer victimization, and self-worth for African American and white adolescents

Being overweight and having negative self-perceptions (body dissatisfaction) can have problematic consequences for adolescents physically, socially, and psychologically. Understanding associations between weight, self-perceptions, and peer experiences across ethnicities is particularly important given recent increases in obesity among ethnic minorities. The current study aimed to address these issues by examining Body Mass Index (BMI) z-scores and body dissatisfaction predicting change in general self-worth over time via peer victimization experiences in a diverse sample of 236 youth (ages 10-16 years). Body dissatisfaction predicted decreases in self-worth over time even after controlling for BMI z-score. BMI z-scores predicted decreases in self-worth over time only for white adolescents, whereas body dissatisfaction directly predicted decreases in self-worth for African American youth and indirectly via peer victimization for white youth. Associations were also considered by gender. Implications for intervention efforts for both white and African American adolescents are discussed.

A Multicomponent, School-Based Intervention, the Shaping Healthy Choices Program, Improves Nutrition-Related Outcomes

Objective: To evaluate the effectiveness of the Shaping Healthy Choices Program (SHCP). Design: A clustered, randomized, controlled intervention lasting 1 school year. Setting: Schools in northern and central California. Participants: Fourth‐graders (aged 9–10 years) at 2 control schools (n = 179) and 2 intervention schools (n = 230). Intervention: Garden‐enhanced education, family, and community partnerships; increased regionally procured produce in the lunchroom; and school‐site wellness committees. Main Outcome Measures: Changes in body mass index (BMI) percentiles/Z‐scores; nutrition knowledge, science process skills, and vegetable identification and preferences; and reported fruit and vegetable intake. Analysis: Student t test, chi‐square, ANOVA of change, and multilevel regression mixed model to evaluate change in outcomes with school as a random effect to account for cluster design effects. Statistical significance was set at P < .05. Results: There was a greater improvement in BMI percentile (−6.08; P < 0.01), BMI Z‐score (−0.28; P < .001), and waist‐to‐height ratio (−0.02; P < .001) in the intervention compared with the control schools. Conclusions and Implications: The SHCP resulted in improvements in nutrition knowledge, vegetable identification, and a significant decrease in BMI percentiles. This supports the concept that the SHCP can be used to improve the health of upper elementary school students.

Utilizing the desired results developmental profile as a measure of school readiness: evaluating factor structure and predictors of school readiness

ABSTRACT A disconnect exists between definitions of school readiness used in research and early childhood education (ECE). While researchers often discuss school readiness as a single, multidimensional construct, the majority of studies operationalize it using multiple measures rather than as one outcome. In comparison, in ECE settings a single measurement tool including multiple dimensions is used. The current study attempted to bridge this gap by examining the factor structure of the Desired Results Developmental Profile (DRDP), a measure of school readiness used in Head Start. We considered often-cited predictors of school readiness (parenting, effortful control) to replicate previous research findings. Analyses indicated a single factor was most appropriate for the DRDP. Measures of parenting and children’s effortful control were significant predictors of DRDP scores. Findings from the current study suggest an existing single factor, ECE-based measure of school readiness, such as the DRDP, can also be used as a research tool.

Sharing, Trading, Stealing Exploring the Role of Peers in Shaping Foods Available at Lunchtime

Childhood obesity continues to be a major concern in the United States, warranting a comprehensive approach. However, the majority of research studies continue to neglect the influence of peers on dietary behaviors. The present descriptive study aimed to provide information about the ways peers directly shape dietary choices via food exchanges (i.e., sharing, trading, and stealing). Peer food exchanges were examined through daily observations in a sample of 76 fifth-graders. Peer food exchanges occurred among students, in particular, those who brought packed lunch engaged in more sharing exchanges. Obese students engaged in an increased amount of interactions in which they gained food from peers. Findings suggest that students are not always eating what their parents packed for them or the school lunch provides. Future intervention efforts should consider the role that peers play in shaping youth’s dietary behavior through a peer food market economy.

An Evaluation of an eHealth Tool Designed to Improve College Students’ Label-Reading Skills and Feelings of Empowerment to Choose Healthful Foods

Objective College students are at risk for poor dietary choices. New skills can empower individuals to adopt healthful behaviors, yet eHealth tools designed to develop food-choice skills, such as label-reading skills, are uncommon. We investigated the effects of web-based label-reading training on college students’ perceptions of healthful food-choice empowerment. Methods Students completed label-reading training in which they practiced selecting the more healthful food using nutrition labels. We examined improvements in label-reading accuracy (correct healthfulness decisions) and perceptions of empowerment, using a 6-item scale. Repeated measures ANOVAs and paired-samples t-tests were used to examine changes in accuracy and empowerment across the training session. Results In addition to increases in label-reading accuracy with training, we found increases in healthful food-choice empowerment scores. Specifically, the proportion of correct (i.e., more healthful) food choices increased across the three blocks of practice (p = 0.04) and food-choice empowerment scores were about 7.5% higher on average after training (p < 0.001). Conclusion and implications Label-reading training was associated with increased feelings of empowerment associated with making healthful food choices. Skill focused eHealth tools may offer an important avenue for motivating behavior change through skill development.

Feasibility of Visual Estimation Using Digital Template Photos to Assess Children's Dietary Intake in Childcare Settings

intervention and noted its potential for designing precision interventions. For this purpose, psychosocial phenotyping must be scalable and identify mediators that can serve as intervention targets along with related moderators and behaviors. Mixed membership models, including Latent Dirichlet Allocation (LDA) and UPhenome, are machine-learning methods used for clinical phenotyping. Whereas LDA treats mediators, moderators, and behaviors as a single data type, UPhenome handles them separately, learning phenotypes that represent each equally. These data-driven models have not yet been applied in behavioral nutrition. Objective: We assessed the utility of LDA and UPhenome for automatic learning of psychosocial phenotypes from survey data. Study Design, Setting, Participants, Intervention: We extracted individual’s (n = 5,883) psychosocial characteristics from surveys collected during a cohort study of a predominantly Latino New York City community affected by high levels of chronic disease and health disparity. We conducted a secondary analysis of these data using UPhenome and LDA. Outcome Measures and Analysis: Participant responses were tokenized (n = 4,604) and used as input to LDA and UPhenome to identify phenotypes (k = 10). Domain experts (n = 4) assessed internal consistency among phenotypes resulting from LDA; a heatmap (n = 3,233) depicted dietary patterns for each phenotype. Results: Experts found within-phenotype consistency and between-phenotype discrimination. Differences in dietary patterns were visually detected. UPhenome identified more specific intervention targets than LDA. Conclusions and Implications: LDA and UPhenome can identify psychosocial phenotypes in a large cohort of Latino New Yorkers and could advance Precision Behavioral Nutrition. Future research will assess generalizability of psychosocial phenotypes and integrate psychosocial phenotyping into behavioral nutrition interventions. Funding: NIH Sackler Institute for Nutrition Science at the New York Academy of Sciences.

Assessment of an e-training tool for college students to improve accuracy and reduce effort associated with reading nutrition labels

Abstract Objective: Nutrition labels are often underutilized due to the time and effort required to read them. We investigated the impact of label-reading training on effort, as well as accuracy and motivation. Participants: Eighty college students (21 men and 59 women). Methods: The training consisted of a background tutorial on nutrition followed by three blocks of practice reading labels to decide which of two foods was the relatively better choice. Label-reading effort was assessed using an eye tracker and motivation was assessed using a 6-item scale of healthy food-choice empowerment. Results: Students showed increases in label-reading accuracy, decreases in label-reading effort, and increases in empowerment. Conclusions: The nutrition label e-training tool presented here, whether used alone or as part of other wellness and health programs, may be an effective way to boost students’ label-reading skills and healthy food choices, before they settle into grocery shopping habits.

Sources of Information and Support for Breastfeeding: Alignment with Centers for Disease Control and Prevention Strategies

BACKGROUND AND OBJECTIVES Research consistently supports health benefits of breastfeeding; however, rates in the United States remain below Healthy People 2020 goals. To increase breastfeeding, information and support are needed from multiple sources. Given differences in breastfeeding rates by demographic characteristics, sources of information and support may also differ. In addition, recent research suggests potential differences in health outcomes related to feeding method (direct breastfeeding only, feeding expressed human milk, combination-feeding with formula). This study examined (1) information and support received within Centers for Disease Control and Prevention (CDC)-defined strategies for supporting breastfeeding mothers, (2) differences in rates of information and support received by demographics, and (3) associations with feeding method at 6 weeks postpartum. MATERIALS AND METHODS A sample of 447 women participating in the Synergistic Theory Research Obesity and Nutrition Group (STRONG) Kids 2 study completed surveys with questions from the CDC Survey on Infant Feeding Practices II related to sources of information and support for breastfeeding and breast pump use, and about demographics and feeding method at 6 weeks postpartum. RESULTS Frequencies of supports received within each category indicate that professional supports were the most pervasive, followed by support from friends and relatives. However, women at greater risk for breastfeeding cessation (lower education, Women, Infants, and Children participants, single mothers) received information and support at lower rates. Education and information support was the only source significantly associated with feeding method. CONCLUSION New approaches are needed to increase efficacy of information delivery, especially for at-risk populations, to better meet CDC recommendations.