Kathy Hosig

Web-Based Nutrition Education Intervention Improves Self-Efficacy and Self-Regulation Related to Increased Dairy Intake in College Students

Dairy consumption declines substantially during young adulthood. Interventions that incorporate theory-based nutrition education can provide insight into factors associated with dietary choices. The aim of this experimental study was to improve outcome expectations, self-efficacy, self-regulation, and behavior related to dairy intake in college students using social cognitive theory. Students (n=294) enrolled in a personal health class were randomized to intervention (n=148) or comparison group (n=146). The 5-week intervention (March 2006 to April 2006) was conducted using an online course system; components included e-mail messages, posted information, and behavior checklists with tailored feedback. Multivariate analysis of covariance with age and sex as covariates (P<0.05) was conducted to measure change related to dairy intake and social cognitive theory variables. Ninety-two percent of participants (n=135 intervention, n=136 control) completed the study. Dairy intake from food records did not differ between groups at baseline; baseline intake for all participants (mean ± standard error) was 0.45 ± 0.05 servings/day for low-fat dairy products and 1.44 ± 0.06 servings/day for total dairy products. Participants in the intervention group made greater increases in use of self-regulatory strategies (P=0.038) and self-efficacy for consuming three servings/day of dairy products (P=0.049), but not in outcome expectations or consumption of dairy products. A Web-based intervention designed to change dairy intake in college students was effective in modifying some social cognitive theory constructs; strategies that positively impact outcome expectations and social support through online interventions require further development.

Dairy Intake and Related Self-Regulation Improved in College Students Using Online Nutrition Education

BACKGROUND Dairy intake by college students is markedly lower than recommendations. Interventions to improve dairy intake based on Social Cognitive Theory (SCT) have potential to successfully change behavior by improving mediators that influence dietary choices. OBJECTIVE We aimed to use SCT to improve social support, self-efficacy, outcome expectations, self-regulation, and behavior related to dairy intake in college students. DESIGN We conducted a randomized nutrition education intervention. PARTICIPANTS/SETTING Participants included 211 college students (mean age 20.2 ± 0.1 years; 63% women and 37% men) recruited from a university campus. Participants in the intervention group (n=107) and comparison group (n=104) received an 8-week dairy intake or stress management intervention, respectively, via electronic mail. Data collection included dairy intake from 7-day food records and SCT variables from questionnaires administered during January 2008 and April 2008. MAIN OUTCOME MEASURES Changes in dairy intake and SCT variables (ie, social support, self-efficacy, outcome expectations, and self-regulation). STATISTICAL ANALYSES PERFORMED Multivariate analysis of covariance, with age and sex as covariates (P<0.05). RESULTS Ninety-one percent of participants (n=97 intervention, n=94 comparison) provided data; complete data were analyzed for 85% of participants (n=90 intervention, n=89 comparison). Participants in the intervention group reported higher intake of total dairy foods (P=0.012) and improved use of self-regulation strategies for consuming three servings per day of total dairy (P=0.000) and low-fat dairy foods (P=0.002) following the intervention. CONCLUSIONS Nutrition education via electronic mail based on an SCT model improved total dairy intake and self-regulation. Participants reported increased dairy intake and better use of self-regulation strategies. Future interventions should focus on benefits of consuming low-fat vs higher-fat dairy foods.

Implementation of Policies and Strategies for Control of Noncommunicable Diseases in Malawi Challenges and Opportunities

Malawi is a Sub-Saharan African country experiencing the epidemiological transition from predominantly infectious to noncommunicable diseases (NCDs) with dramatically increasing prevalence of lifestyle-related diseases such as obesity, hypertension, and diabetes. Malawi’s 2011-2016 Health Sector Strategic Plan included NCDs, and an NCD Control Program was established with subsequent development of a National Action Plan for prevention and management of NCDs launched in 2013. The current study was designed to identify gaps in implementation of NCD control program policies and action plan strategies by describing current efforts toward prevention and management of NCDs in Malawi with emphasis on challenges and opportunities. Semistructured questionnaires were used to collect quantitative and qualitative data from Malawi Ministry of Health personnel (senior officers, service providers, health education officers, and nutritionists) in 10 health districts and 3 central hospitals. Frequencies were generated for quantitative data. Qualitative data were used to generate themes and most common responses. Results showed that current services focus on facility-based NCD screening and clinical services rather than active screening, prevention, and community awareness and outreach, although respondents emphasized the importance of prevention, lifestyle education, and community outreach. Respondents indicated inadequate resources for NCD services including financial capital, human resources, equipment and supplies, and transportation. While Malawi has begun to address NCDs, policy and practice implications include (a) better integration of services within the existing infrastructure with emphasis on capacity building; (b) greater implementation of planned NCD activities; (c) a stronger, more comprehensive data management system; and (d) innovative funding solutions.

Cost-Effectiveness Model for Youth EFNEP Programs: What Do We Measure and How Do We Do It?

The Youth Expanded Food and Nutrition Education Program (EFNEP) is one of the United States Department of Agricultures hallmark nutrition education programs for limited-resource youth. The objective of this study was to gather opinions from experts in EFNEP and related content areas to identify costs, effects (impacts), and related instruments to develop a cost-effectiveness model (instrument) for youth EFNEP, which does not exist. A cost-effectiveness model determines the economic or financial cost of producing an impact. The findings highlight several challenges in identifying inputs through consensus and provide a roadmap for the creation of a model that can be adopted by state EFNEP coordinators.

A Comparison of Fruits, Vegetables, Sugar-Sweetened Beverages, and Desserts in the Packed Lunches of Elementary School Children

BACKGROUND An estimated 40% of children bring a packed lunch to school. These lunches are not required to meet nutrition standards. The aim of this study was to compare differences in the nutritional quality of elementary packed lunches by the presence or absence of sugar-sweetened beverages (SSB), desserts, and fruits and vegetables (FVs). METHODS Observational data for prekindergarten and kindergarten packed lunches were collected from three schools in rural Virginia for 5 consecutive school days and analyzed for macro- and micronutrients and by the presence or absence of food and beverage items. RESULTS Of the 561 packed lunch observations collected, 41.7% contained no FV, 41.2% contained an SSB, and 61.1% contained a dessert. The nutrient profile of packed lunches with at least one fruit or vegetable had significantly higher levels of carbohydrate, fiber, sugar, vitamin A, and vitamin C. Packed lunches containing an SSB had significantly higher levels of sugar and vitamin C and significantly lower levels of protein, fiber, vitamin A, calcium, and iron. Packed lunches containing a dessert had significantly higher levels of energy, carbohydrate, fat, saturated fat, sodium, sugar, vitamin C, and iron and significantly lower levels of vitamin A. CONCLUSIONS Additional research is needed to fully understand parent and child motivations for packing lunches and the decision processes that influence the inclusion of food items. The development of packed lunch interventions, encouragement of National School Lunch Program participation, or enactment of school policies to increase the nutritional value of packed lunches is warranted.

Smart Snacks in School Legislation Does Not Change Self-Reported Snack Food and Beverage Intake of Middle School Students in Rural Appalachian Region

Objective: To assess the effects of the national Smart Snacks in School standards, which include nutrient and ingredient limitations for school competitive foods and beverages effective July, 2014, on student intake in low‐income rural Appalachian middle schools. Methods: Food‐frequency questionnaires were administered to students before and after implementation. Multiple ordinal logistic regression models were conducted to examine effects from year of data collection, grade, and free or reduced price lunch participation rates. Results: No significant changes were observed after implementation except a decrease in consumption of 1% or nonfat flavored milk at school. Conclusions and Implications: Smart Snacks in School standards did not result in significant dietary changes in this study. Longitudinal studies could evaluate long‐term impacts of nutrition standards.

Acceptance of Healthier School Lunches by Second Through Fifth Grade Students in the Rural Arkansas Delta

Abstract The United States Department of Agriculture (USDA) proposed guidelines for school lunch menus in 1995, which were consistent with the 1995 Dietary Guidelines for Americans for total fat and saturated fat. Under the proposed regulations, school lunches would provide one-third of the RDA for protein, vitamins A and C, iron, calcium and energy over a weeks menu cycle. This study was part of a school-based community nutrition education project. The purpose of this study was to evaluate student acceptance of four school lunch menus that were consistent with the USDAs 1995 proposed nutrient guidelines. Focus groups were conducted to determine student food preferences, and four lunch menus were developed based on the information provided. Each lunch menu was prepared once per week on a four week rotating cycle for three months. Focus groups were conducted with the students after the lunch changes to assess their satisfaction with the new meals. Parents of the students were invited to lunch, and completed a survey evaluating the new lunches. When asked about favorite new food items in the cafeteria, the children cited low-fat cookies, fresh fruit, lasagna, baked fries, carrots, and barbecue chicken. When asked about what new foods the children did not like, they stated lasagna, barbecue chicken, California vegetables and tuna. When asked to give a grade to certain menu items, more than two-thirds of the students gave an A or B to the following: barbecue chicken, sloppy Joes, tuna fish sandwiches, baked potato, fresh fruit, baked fries and low-fat cookies. They gave poor scores (Ds and Fs) for California vegetables and raw broccoli. The majority of new food items were well received by the students. New food items that were already familiar to the students were more readily accepted. Increased exposure to new foods also improved acceptance. Student feedback is especially helpful in planning successful meals. We learned it is possible to serve healthy meals at school that children enjoy.

Establishing a Nutrition Position Shared Between Student Affairs and Academic Affairs at a Small State University

Abstract Like many smaller colleges and universities, this small state university (approximately 6,600 students) did not employ a registered dietitian to meet nutrition screening, assessment and education needs for students, faculty and staff. Two full time, tenure track faculty members provided these services when possible, but their time was limited due to responsibilities associated with both an ADA-approved AP4 program and an ADA-approved DPD program in addition to a nutrition emphasis in the Masters of Health Sciences degree program. Although sporadic part-time teaching funds were available to cover one to two academic courses per year, these courses were usually service courses for other majors. Thus, there was documented need for both a non-academic registered dietitian and more stable funding for at least a partial academic position. Because funding was not available for either position, a proposal was developed for a shared position between the two areas. The proposal was accepted, and a full-time, 12-month position was created (1/3 academic, 2/3 non-academic). This approach may be successful at other small universities to enhance nutrition services offered to faculty, staff and students while increasing the number, types and frequency of nutrition courses offered.