Claudia Probart

Work site-based cancer prevention: primary results from the Working Well Trial.

OBJECTIVES This paper presents the behavioral results of the Working Well Trial, the largest US work site cancer prevention and control trial to date. METHODS The Working Well Trial used a randomized, matched-pair evaluation design, with the work site as the unit of assignment and analysis. The study was conducted in 111 work sites (n = 28,000 workers). The effects of the intervention were evaluated by comparing changes in intervention and control work sites, as measured in cross-sectional surveys at baseline and follow-up. The 2-year intervention targeted both individuals and the work-site environment. RESULTS There occurred a net reduction in the percentage of energy obtained from fat consumption of 0.37 percentage points (P = .033), a net increase in fiber densities of 0.13 g/1000 kcal (P = .056), and an average increase in fruit and vegetable intake of 0.18 servings per day (P = .0001). Changes in tobacco use were in the desired direction but were not significant. CONCLUSIONS Significant but small differences were observed for nutrition. Positive trends, but no significant results, were observed in trial-wide smoking outcomes. The observed net differences were small owing to the substantial secular changes in target behaviors.

A Comprehensive Coding System to Measure the Quality of School Wellness Policies

In 2006, all local education agencies in the United States participating in the National School Lunch Program were required to establish school wellness policies that covered nutrition education, nutrition standards for school foods, and physical activity. The purpose of this psychometric study was to develop and evaluate the properties of a comprehensive and quantitative coding system to evaluate the quality of these policies. A 96-item coding tool was developed to evaluate seven goal areas: nutrition education, standards for US Department of Agriculture child nutrition programs and school meals, nutrition standards for competitive and other foods and beverages, physical education, physical activity, communication and promotion, and evaluation. Each goal area subscale and the total scale were scored on two dimensions: comprehensiveness and strength. Reliability was assessed by having pairs of researchers from four different states code a sample of 60 polices between July 2007 and July 2008. Goal area subscales were internally reliable (Cronbachs alpha=.60 to .93). Adequate interrater reliability scores were obtained at each level of scoring: total comprehensiveness and strength scores (intraclass correlation coefficient 0.82), subscale scores (intraclass correlation coefficient 0.70), and individual items (intraclass correlation coefficient 0.72). This coding system provided a reliable method for analyzing and comparing school district wellness policies in single or multistate studies.

School feeding programs in developing countries: impacts on children's health and educational outcomes.

School feeding programs (SFPs) are intended to alleviate short-term hunger, improve nutrition and cognition of children, and transfer income to families. The present review explores the impact of SFPs on nutritional, health, and educational outcomes of school-aged children in developing countries. Peer-reviewed journal articles and reviews published in the past 20 years were identified and screened for inclusion. Analysis of the articles revealed relatively consistent positive effects of school feeding in its different modalities on energy intake, micronutrient status, school enrollment, and attendance of the children participating in SFPs compared to non-participants. However, the positive impact of school feeding on growth, cognition, and academic achievement of school-aged children receiving SFPs compared to non-school-fed children was less conclusive. This review identifies research gaps and challenges that need to be addressed in the design and implementation of SFPs and calls for theory-based impact evaluations to strengthen the scientific evidence behind designing, funding, and implementing SFPs.

Statewide Assessment of Local Wellness Policies in Pennsylvania Public School Districts

With the passage of the Child Nutrition and Women, Infants, and Children Reauthorization Act of 2004, schools that sponsor school meals programs are required to establish local wellness policies to address childhood obesity. Little is known about how school districts will respond to this mandate, the nature of local wellness policies, and their compliance with this mandate. The objectives of this cross-sectional descriptive study, conducted in early 2007, were to assess local wellness policies established by Pennsylvania public school districts, compare these policies to local wellness policy mandate requirements, and provide information about local wellness policy development and implementation. Local wellness policies were collected from all Pennsylvania public school districts that sponsor school meals programs (N=499). School district representatives also completed and submitted a local wellness policy checklist, providing information about local wellness policy development and implementation. Policy goal data were abstracted and entered into a Microsoft Access database along with local wellness policy data. Frequencies were calculated. All required public school districts (N=499) submitted local wellness policies. Most school district local wellness policies (85.6%-100%) met each mandate requirement (eg, included goals for nutrition education, physical activity, etc.). The most common policy goals were general and may be difficult to measure, suggesting school staff may need assistance developing action plans and measuring policy implementation. Most respondents identified the superintendent (n=377; 75.6%) and school foodservice director (n=301; 60.3%) as responsible for ensuring local wellness policy implementation. Questions remain about feasibility of these district-level personnel to ensure policy implementation at the school level. The ability of local wellness policies to impact childhood obesity will depend on efforts at both the school and district levels to implement and enforce local wellness policies.

Knowledge and Misconceptions About the Food Label Among Women With Non-Insulin-Dependent Diabetes Mellitus

Women on restricted diets are reportedly among the most frequent readers of nutrition information on food labels. However, the specific label information that women with non- insulin-dependent diabetes mellitus (NIDDM) comprehend and use has not been determined. The purpose of this study was to explore the attitude toward, use, and knowledge of information on the food label among rural women with NIDDM age 40 to 60 years. Focus groups and in-depth interviews were conducted. Participants reported that they referred to the nutrition information on the label when grocery shopping and preferred the newly revised format. Yet, comprehension of the terms and percentages on the label was poor (eg, the majority of participants could not explain the difference between total carbohydrate and sugars). Misconceptions also were noted about nutrients listed on the label and the percent daily value. Further education is needed to help people with NIDDM understand and apply the nutrition information on food labels to meet their individual needs.

Measures of Food Choice Behavior Related to Intervention Messages in Worksite Health Promotion

Abstract Worksite nutrition educators and researchers need not only nutrient composition data but also information on employees’ food choices to create intervention messages that are food-focused and tailored to specific target audiences. This paper describes a method of calculating measures of food choice behavior related to intervention messages and reports relationships between workers’ food choices and demographic characteristics. This work was conducted as part of the Working Well Trial, a 5-year worksite cancer prevention randomized, controlled prospective field experiment funded by the National Cancer Institute. It was implemented in 114 worksites employing 37,291 workers who were engaged in a variety of businesses. In the fall of 1990, 20,801 respondents completed and returned a self-administered baseline survey. A modified Block 88-item food frequency questionnaire (FFQ) with portion sizes was used for the quantitative assessment both of nutrient intake and workers’ food choices. The worksite mean response rate was 71.6%. Responses to behavioral items regarding meat were used to measure meat preparation behaviors not captured on the FFQ. We found that higher education, greater age, and female gender were associated with food choices closest to the recommendations to increase fiber, fruits, and vegetables and to reduce fat. An exception to this pattern was the recommendation to increase the consumption of beans and lentils, which was associated with lower education, greater age, and male gender. The relationship of job status to the food choice variables was inconsistent across foods and study centers and there were differences between study centers in the magnitude of associations between food choices and demographic characteristics.

Lessons From Pennsylvania’s Mixed Response To Federal School Wellness Law

Federal legislation aimed at tackling the nations soaring childhood obesity rate through changes to school meals and nutrition and wellness programs has met with mixed results. An examination of Pennsylvanias response to the Child Nutrition and Women, Infants, and Children (WIC) Reauthorization Act of 2004, one of the most comprehensive state responses, found improvements to the nutritional quality of foods offered à la carte in conjunction with school meal programs. However, multiple weaknesses remain. Consistent wellness policy implementation steps were not followed, and there was inadequate statewide enforcement. Despite this, Pennsylvania can offer lessons for other states in moving forward with programs to promote good nutrition and wellness.

Evaluation of Implementation of an Interdisciplinary Nutrition Curriculum in Middle Schools

Abstract This paper provides an evaluation of teachers’ implementation and perceptions of Mid-LINC, an interdisciplinary nutrition curriculum for middle school students. Evaluation methodology included both quantitative and qualitative procedures. Quantitative evaluation included distribution of a survey instrument to measure teacher attitudes toward the curriculum, their implementation of the curriculum, and factors related to attitude and implementation. Qualitative evaluation included classroom observation, depth interviews with teachers, and focus group interviews. On average, elementary and home economics teachers taught the highest number of lessons, and language arts teachers taught the fewest. The number of college nutrition courses taken by the teacher was the best predictor of implementation of the curriculum. Overall, the response to the curriculum was very favorable, with teachers rating it easy to use, flexible, and complete. The perceived importance of team teaching, the extent to which the teacher felt informed about nutrition, and the felt importance of nutrition in the middle school curriculum were significant predictors of comfort with the curriculum. Important facilitators to successful implementation are a project manager, teacher interest, and common planning times. Barriers to implementation include scheduling constraints, teacher resistance, personnel changes, and lack of administrative support.

Diet and athletic performance

Inadequate diet inhibits optimal performance in otherwise well-trained athletes. Controversy exists regarding specific dietary requirements, particularly in the areas of protein and vitamin/mineral supplementation. This article reviews energy substrate utilization, provides an overview of nutrient requirements during exercise, discusses ergogenic aids, and where possible, makes specific dietary recommendations for athletes.

Student Involvement in Wellness Policies: A Study of Pennsylvania Local Education Agencies

OBJECTIVE Explore student-involvement goals in local wellness policies (LWPs) of local education agencies (LEAs) in Pennsylvania (PA) and investigate associations with LEA characteristics. DESIGN An observational study that helped examine student-involvement goals. SETTING Public PA LEAs. PARTICIPANTS LWPs submitted by 539 PA public LEAs. MAIN OUTCOME MEASURES Six student-involvement goals analyzed as dependent variables. Correlations between demographic and policy characteristics of LEAs and student-involvement goals were measured. ANALYSIS Policies developed by LEAs were abstracted and analyzed. Logistic regression models were developed to analyze relationships between student-involvement goals and the demographic and policy characteristics of LEAs. RESULTS Majority of LEAs included policy goals that address student involvement in an array of activities related to wellness policy, food service, and role modeling. Regression models showed that LEAs with comprehensive and strong policies were most likely to include student-involvement goals regardless of LEA location, enrollment, or socioeconomic status of students. CONCLUSIONS AND IMPLICATIONS Student engagement in school nutrition policies has been shown to increase student acceptance in an array of health-related areas and is therefore promising in the area of obesity prevention. Comprehensiveness and rigor of LWPs were strongly correlated with the inclusion of student-involvement goals on LWPs. The upcoming reauthorization of the Child Nutrition programs in 2010 creates a good opportunity to address student involvement in LWPs.