Janice M. Dodds

Fruit and vegetable consumption and prevention of cancer: the Black Churches United for Better Health project.

OBJECTIVES This study assessed the effects of the Black Churches United for Better Health project on increasing fruit and vegetable consumption among rural African American church members in North Carolina. METHODS Ten counties comprising 50 churches were pair matched and randomly assigned to either intervention or delayed intervention (no program until after the follow-up survey) conditions. A multicomponent intervention was conducted over approximately 20 months. A total of 2519 adults (77.3% response rate) completed both the baseline and 2-year follow-up interviews. RESULTS The 2 study groups consumed similar amounts of fruits and vegetables at baseline. AT the 2-year follow-up, the intervention group consumed 0.85 (SE = 0.12) servings more than the delayed intervention group (P < .0001). The largest increases were observed among people 66 years or older (1 serving), those with education beyond high school (0.92 servings), those widowed or divorced (0.96 servings), and those attending church frequently (1.3 servings). The last improvement occurred among those aged 18 to 37 years and those who were single. CONCLUSIONS The project was a successful model for achieving dietary change among rural African Americans.

The North Carolina Black Churches United for Better Health Project: Intervention and Process Evaluation

The North Carolina Black Churches United for Better Health project was a 4-year intervention trial that successfully increased fruit and vegetable (F&V) consumption among rural African American adults, for cancer and chronic disease prevention. The multicomponent intervention was based on an ecological model of change. A process evaluation that included participant surveys, church reports, and qualitative interviews was conducted to assess exposure to, and relative impact of, interventions. Participants were 1,198 members of 24 intervention churches who responded to the 2-year follow-up survey. In addition, reports and interviews were obtained from 23 and 22 churches, respectively. Serving more F&V at church functions was the most frequently reported activity and had the highest perceived impact, followed by the personalized tailored bulletins, pastor sermons, and printed materials. Women, older individuals, and members of smaller churches reported higher impact of certain activities. Exposure to interventions was associated with greater F&V intake. A major limitation was reliance on church volunteers to collect process data.

Social Support and Coping Behaviors of Low-Income Families Experiencing Food Insufficiency in North Carolina

The Food Research and Action Center estimates that approximately 12% of all families with children younger than 12 years old experience food insufficiency in the United States. The authors conducted 16 focus groups with 141 participants, who were either at risk or experienced food insufficiency, to learn about coping strategies. Individual and network-level coping mechanisms were used to manage insufficient food supply. Social networks included family, friends, and neighbors. The assistance provided included food aid, information, and emotional support. Not all networks were relied on or accessed by everyone. Most participants reported that they relied on family members first, followed by friends, and then neighbors. Parents found reliance on anyone as stressful and often threatening. In conclusion, as the social welfare system becomes constrained, more and more households may experience food insufficiency. Responsive policies are therefore needed to assist low-income families.

Coalition building for prevention: lessons learned from the North Carolina Community-Based Public Health Initiative.

This article examines the four-year development of the North Carolina Community-Based Public Health Initiative consortium (NC CBPHI). The NC CBPHI consisted of four separate county coalitions and differed in both its agenda and membership from the many examples of coalitions described in the literature. This article presents and describes evaluation findings that identify six factors as important in coalition functioning and success in the CBPHI coalitions. These factors are: participation, communication, governance and rules for operation, staff/coalition member relationships, technical assistance and skills training, and conflict recognition and containment. Selected CBPHI coalition activities are also described and implications for public health practitioners are presented.

Educating Students for Community-Based Partnerships

ABSTRACT Many courses for students in professional schools may expect or require a learning experience “in the community.” Simple placement in a community does not assure, however, that students will develop competencies from a community-based perspective, that is, competencies that enable professionals to: (1) enhance the capacity of community members to serve in partnership endeavors; (2) appreciate the role of participation by under-represented or under-served populations; and (3) develop skills for mobilizing community resources to address community-defined priorities. This article describes six domains-course goals, partners, exposure, product, classroom activities, disciplines-to characterize courses and other learning experiences, in order to assess the extent to which they promote community-based competencies.

The UNC-CH MCH Leadership Training Consortium: Building the Capacity to Develop Interdisciplinary MCH Leaders

This article describes the UNC-CH MCH Leadership Consortium, a collaboration among five MCHB-funded training programs, and delineates the evolution of the leadership curriculum developed by the Consortium to cultivate interdisciplinary MCH leaders. In response to a suggestion by the MCHB, five MCHB-funded training programs—nutrition, pediatric dentistry, social work, LEND, and public health—created a consortium with four goals shared by these diverse MCH disciplines: (1) train MCH professionals for field leadership; (2) address the special health and social needs of women, infants, children and adolescents, with emphasis on a public health population-based approach; (3) foster interdisciplinary practice; and (4) assure competencies, such as family-centered and culturally competent practice, needed to serve effectively the MCH population. The consortium meets monthly. Its primary task to date has been to create a leadership curriculum for 20–30 master’s, doctoral, and post-doctoral trainees to understand how to leverage personal leadership styles to make groups more effective, develop conflict/facilitation skills, and identify and enhance family-centered and culturally competent organizations. What began as an effort merely to understand shared interests around leadership development has evolved into an elaborate curriculum to address many MCH leadership competencies. The collaboration has also stimulated creative interdisciplinary research and practice opportunities for MCH trainees and faculty. MCHB-funded training programs should make a commitment to collaborate around developing leadership competencies that are shared across disciplines in order to enhance interdisciplinary leadership.

Self-perceived competence of advanced public health nutritionists in the United States

OBJECTIVE To describe the development and use of a self-assessment tool designed to evaluate competencies in skill areas, including management and leadership, among advanced public health nutritionists. DESIGN Subjects were identified by state and territorial nutrition directors who provided lists of nutrition personnel in official, state, public health agencies. The 519 nutritionists identified were mailed a 137-item self-assessment tool developed for advanced public health nutritionists. SUBJECTS A self-selected sample of 281 state public health nutritionists responded. STATISTICAL ANALYSES PERFORMED Means and standard deviations were calculated for descriptive variables. Factor analysis was conducted to examine associations of items within the assessment tool measured by Spearman correlation. The Cronbach alpha coefficient statistic was used to examine reliability. RESULTS Factor analysis produced a 48-item, 3-factor tool comprising items with a correlation of 0.6 or greater; the 3 factors were management, public health nutrition, and communication. Mean scores on the assessment tool indicated that respondents scored competent in 50% of items and adequate in 50% of items. CONCLUSIONS Ongoing self-assessment by public health nutrition professionals can guide the selection of continuing education and higher education degree programs. Although this self-assessment tool was tested in the public health arena, it can be applied to all nutritionists and dietitians with management responsibilities.

Correlates of dietary intake among men involved in the MAN for Health study.

The clustering of diet and other lifestyle behaviors and their psychosocial correlates were examined among 455 Latino and African American men in the U.S. Southeast. Men were recruited by male community health workers and surveys were self-administered in a group format. Latino men were younger, less educated, and more likely to be employed than African American men and reported a lower household income and larger household size. Fruit and vegetable consumption was associated with physical activity (p ≤ .001). A more positive attitude toward health was associated with meeting vegetable dietary guidelines (p ≤ .05) and consuming fast food less frequently (p ≤ .01). Active coping was associated with meeting fruit and vegetable dietary guidelines (p ≤ .01 and p ≤ .001, respectively), and avoidant coping was associated with greater fast-food consumption (p ≤ .001). Latino fast-food consumption was associated with binge drinking (p ≤ .001). This research provides evidence for tailoring dietary intervention for men of color.

Can distance education prepare future public health nutritionists? A case study.

OBJECTIVE To assess student retention, readiness, support and outcomes among students completing the Professional Practice Program in Nutrition (PPPN). DESIGN Qualitative evaluation using semistructured, in-depth interviews conducted with PPPN graduates. Course grades, grade point averages, and comprehensive exam results compared 10 PPPN students from 2 cohorts and 72 residential students from 3 cohorts. SETTING The Professional Practice Program in Nutrition was a 3-year, pilot public health nutrition masters (MPH) degree curriculum using distance education (DE) strategies. ANALYSIS Ethnograph was used to assist with qualitative data analysis. Fisher exact test was used to compare quantitative outcomes. RESULTS Qualitative findings revealed that PPPN students were highly motivated, sought out the DE MPH and initially had great support from family and employers; however, support from employers waned over time. Although several challenges to continued enrollment confronted PPPN students, those who completed the MPH all advanced in the workplace. Course grades and grade point averages were similar between the 2 groups. Students in the PPPN were more likely than residential students to retake the comprehensive exam. CONCLUSIONS AND IMPLICATIONS The findings indicate that DE strategies were suitable to deliver an MPH curriculum in nutrition. The majority of PPPN graduates experienced job advancement and demonstrated leadership development.

Analysis of interest group influence on federal school meals regulations 1992 to 1996

Regulatory changes proposed by the US Department of Agriculture in 1994 promised to bring progressive changes to school meals. However, lobbying by interest groups resulted in substantial changes to the final rule. This analysis retrospectively examines the federal school meals policy-making process during 1992 to 1996. Key questions address why the policy changed and what the role of interest groups was in affecting the shape, pace, and direction of the policy. The study provides suggestions for using the experiences of 1992 to 1996 to guide future advocacy efforts and for adapting the approach for application to other food and nutrition policies.