Jessica A. Hoffman

Decaying Behavioral Effects in a Randomized, Multi-year Fruit and Vegetable Intake Intervention

OBJECTIVE To examine the effects of a multi-component, theory-based, 2.5-year intervention on childrens fruit and vegetable consumption, preferences, knowledge and body mass index. METHODS Four inner city elementary schools in the Northeastern United States were randomized to an intervention (n=149) or control group (n=148) in 2005. Fruit and vegetable consumption during school lunch (measured by plate waste), preferences, and knowledge, as well as body mass index, were assessed five times across 3.5 years (pre-intervention, spring 2006, 2007, 2008 and 2009). Hierarchical linear modeling was used to analyze program outcomes. RESULTS At the first post-test assessment, children in the experimental group ate 0.28 more servings/lunch of fruit and vegetable relative to children in the control group and changes in fruit and vegetable consumption were found in each year throughout the program. However, this effect declined steadily across time so that by the delayed one-year follow-up period there was no difference between the groups in fruit and vegetable consumption. There were persistent intervention effects on childrens knowledge. There were no effects on fruit and vegetable preferences and body mass index throughout the study. CONCLUSION Although there was initial fruit and vegetable behavior change, annual measurements indicated a gradual decay of behavioral effects. These data have implications for the design of school-based fruit and vegetable interventions.

Spaceship Launch: Designing a Collaborative Exergame for Families

Parents play a critical role in facilitating childrens physical activity, as they are an important source of modeling and support. While Human-Computer Interaction (HCI) researchers have explored exergame design for children or adults separately, an important open area of work is identifying design guidelines for family exergames. One question that researchers have increasingly posed is, how can exergames be designed to avoid potential negative consequences of competition? To address these questions we designed Spaceship Launch, an exergame for parents and kids in lower income neighborhoods, where obesity is most prevalent. We describe our iterative design process: the formative study to identify design opportunities, our resulting system, and our field evaluation of the tool. Our findings highlight the impact of SL on physical activity intentions, and how parental preferences for in-game competition were aligned with the psychological needs of relatedness and competence. We conclude with design recommendations for future family-focused exergames.

Implementation of Competitive Food and Beverage Standards in a Sample of Massachusetts Schools: The NOURISH Study (Nutrition Opportunities to Understand Reforms Involving Student Health)

BACKGROUND During 2012, Massachusetts adopted comprehensive school competitive food and beverage standards that closely align with Institute of Medicine recommendations and Smart Snacks in School national standards. OBJECTIVE We examined the extent to which a sample of Massachusetts middle schools and high schools sold foods and beverages that were compliant with the state competitive food and beverage standards after the first year of implementation, and complied with four additional aspects of the regulations. DESIGN Observational cohort study with data collected before implementation (Spring 2012) and 1 year after implementation (Spring 2013). PARTICIPANTS/SETTING School districts (N=37) with at least one middle school and one high school participated. MAIN OUTCOME MEASURES Percent of competitive foods and beverages that were compliant with Massachusetts standards and compliance with four additional aspects of the regulations. Data were collected via school site visits and a foodservice director questionnaire. STATISTICAL ANALYSES PERFORMED Multilevel models were used to examine change in food and beverage compliance over time. RESULTS More products were available in high schools than middle schools at both time points. The number of competitive beverages and several categories of competitive food products sold in the sample of Massachusetts schools decreased following the implementation of the standards. Multilevel models demonstrated a 47-percentage-point increase in food and 46-percentage-point increase in beverage compliance in Massachusetts schools from 2012 to 2013. Overall, total compliance was higher for beverages than foods. CONCLUSIONS This study of a group of Massachusetts schools demonstrated the feasibility of schools making substantial changes in response to requirements for healthier competitive foods, even in the first year of implementation.

Increasing Culturally Diverse Meals in Head Start Using a Collaborative Approach: Lessons Learned for School Food Service Modifications

Head Starts performance standards require that the nutrition programs “serve a variety of foods which consider cultural and ethnic preferences and which broaden the childs food experience” (Head Start Program Performance Standards and Other Regulations, 2006). In this study, food service modifications were made via a participatory process in 5 Head Start programs to increase culturally diverse meals served while adhering to national nutrition standards. A 2-group quasi-experimental design with 2 data collection periods was used to examine differences in consumption between standardized recipes and culturally diverse meal suggestions from parents and staff. Consumption was measured using weighed plate waste. Culturally diverse foods were eaten at equal or greater levels compared with standardized recipes. Facilitators and barriers associated with initiating and maintaining food service modifications are described.

How Do We Actually Put Smarter Snacks in Schools? NOURISH (Nutrition Opportunities to Understand Reforms Involving Student Health) Conversations with Food-Service Directors

OBJECTIVE In autumn 2012, Massachusetts schools implemented comprehensive competitive food and beverage standards similar to the US Department of Agricultures Smart Snacks in School standards. We explored major themes raised by food-service directors (FSD) regarding their school-district-wide implementation of the standards. DESIGN For this qualitative study, part of a larger mixed-methods study, compliance was measured via direct observation of foods and beverages during school site visits in spring 2013 and 2014, calculated to ascertain the percentage of compliant products available to students. Semi-structured interviews with school FSD conducted in each year were analysed for major implementation themes; those raised by more than two-thirds of participating school districts were explored in relationship to compliance. SETTING Massachusetts school districts (2013: n 26; 2014: n 21). SUBJECTS Data collected from FSD. RESULTS Seven major themes were raised by more than two-thirds of participating school districts (range 69-100 %): taking measures for successful transition; communicating with vendors/manufacturers; using tools to identify compliant foods and beverages; receiving support from leadership; grappling with issues not covered by the law; anticipating changes in sales of competitive foods and beverages; and anticipating changes in sales of school meals. Each theme was mentioned by the majority of more-compliant school districts (65-81 %), with themes being raised more frequently after the second year of implementation (range increase 4-14 %). CONCLUSIONS FSD in more-compliant districts were more likely to talk about themes than those in less-compliant districts. Identified themes suggest best-practice recommendations likely useful for school districts implementing the final Smart Snacks in School standards, effective July 2016.

Family Gym: A Model to Promote Physical Activity for Families with Young Children

This report describes Family Gym, a family-centered model that (1) provides free access to physical activity for low-income families in the inner city; (2) targets young children (3–8 years) and their families; (3) engages families together in physical activity; and (4) stimulates social interaction among families.

Farm to Preschool: The State of the Research Literature and a Snapshot of National Practice

ABSTRACT Farm to preschool connects early care and education settings to local food and/or food producers with the objectives of serving locally grown, healthy foods to young children, improving child nutrition, and providing related educational opportunities. This study systematically reviewed the farm to preschool research literature from 1994 to 2015 and described findings from the 2012 National Farm to Preschool Survey. A wide range of activities was represented in the 14 studies reviewed; most employed participatory research collaborations, assessed process outcomes, and used uncontrolled research designs. Survey findings indicated that programs operate in at least 39 states and Puerto Rico, in many types of communities and settings. Respondents identified types of foods and activities, motivations for participation, and parent engagement. There is still much to be learned about farm to preschool programs, and well-controlled research is necessary.

A Community Health Orientation for Wellness Technology Design & Delivery

Abstract Health promotion increasingly occurs outside of the boundaries of traditional care settings such as hospitals and clinics. Interventions that are anchored within community-based organizations, seeking to meet the nuanced needs of local residents, are a vital component of the wellness promotion ecosystem. These programs are particularly critical when addressing health in low socioeconomic communities, as the services may be more accessible, affordable, and relevant to the needs of populations facing significant barriers to wellness. In this chapter, we examine how technology can become embedded within the context of community-based health interventions. We present a case study from our research, in which we employed a user-centered design process to create and evaluate a novel family exergame within a community-based organization. We use this case study to discuss the criticality, challenge, and benefits of integrating wellness technologies within a broader community health promotion infrastructure.

Using Text Messages to Promote Engagement in a Subsidized Community Supported Agriculture Program for Head Start Families

ABSTRACT Farm to Family is a subsidized community supported agriculture model for low-income families. This study evaluated text message reminders on Head Start parents’ farm share pickup rates. Pickup rates were high for both groups within 2 days of delivery, with 96% (SD = 0.04) of parents in the text messaging group picking up their produce vs. 92% (SD = 0.07) of parents in the no text message group, and lower on the day of delivery, with 69% (SD = 0.14) of parents in the text messaging group picking up their produce vs. 62% (SD = 0.13) of parents in the no text messaging group. There were no statistically significant differences between the groups. Program coordinators reported using additional efforts to promote parent participation (e-mails or verbal reminders). Because sites used multiple methods to promote parent participation, this study could not isolate the effects of text messages.

Cultural/Favorite Recipe Day: Strengthening Approaches to Increase Culturally Diverse Foods Served in Head Start Meals

This article summarizes the findings and implications of a study that evaluated food service modifications designed to increase culturally diverse meals served in Head Start programs while adhering to nutrition performance standards in Boston, Massachusetts.