Maryann Mason

Measuring Food Availability and Access in African-American Communities: Implications for Intervention and Policy

Obesity is a major public health concern in the U.S. As compared to whites, minority populations are disproportionately at risk, with the highest prevalence rates of overweight and obesity occurring among African American women. Although researchers and policymakers argue that environmental approaches have the greatest potential to reverse the rising prevalence of obesity, critical gaps remain in our understanding of the complex mechanisms that underlie the associations between neighborhood food environments and weight status. A major challenge has been the need for reliable and valid measures to assess aspects of the neighborhood food environment that encourage or inhibit healthful eating behaviors and weight management. Investigators have made considerable gains in the development of tools and approaches to measure neighborhood food environments overall, but few studies focus on the specific challenges and issues associated with characterizing neighborhood food environments in communities of color. This paper highlights important considerations for measuring food environments in African-American neighborhoods and their implications for developing programmatic and policy solutions to reduce racial disparities in overweight.

Identification of contrastive and comparable school neighborhoods for childhood obesity and physical activity research

The neighborhood social and physical environments are considered significant factors contributing to childrens inactive lifestyles, poor eating habits, and high levels of childhood obesity. Understanding of neighborhood environmental profiles is needed to facilitate community-based research and the development and implementation of community prevention and intervention programs. We sought to identify contrastive and comparable districts for childhood obesity and physical activity research studies.We have applied GIS technology to manipulate multiple data sources to generate objective and quantitative measures of school neighborhood-level characteristics for school-based studies. GIS technology integrated data from multiple sources (land use, traffic, crime, and census tract) and available social and built environment indicators theorized to be associated with childhood obesity and physical activity. We used network analysis and geoprocessing tools within a GIS environment to integrate these data and to generate objective social and physical environment measures for school districts. We applied hierarchical cluster analysis to categorize school district groups according to their neighborhood characteristics. We tested the utility of the area characterizations by using them to select comparable and contrastive schools for two specific studies.ResultsWe generated school neighborhood-level social and built environment indicators for all 412 Chicago public elementary school districts. The combination of GIS and cluster analysis allowed us to identify eight school neighborhoods that were contrastive and comparable on parameters of interest (land use and safety) for a childhood obesity and physical activity study.ConclusionThe combination of GIS and cluster analysis makes it possible to objectively characterize urban neighborhoods and to select comparable and/or contrasting neighborhoods for community-based health studies.

Working With Community Partners to Implement and Evaluate the Chicago Park District's 100% Healthier Snack Vending Initiative

BACKGROUND The objective of this case study was to evaluate the acceptability, sales impact, and implementation barriers for the Chicago Park Districts 100% Healthier Snack Vending Initiative to strengthen and support future healthful vending efforts. COMMUNITY CONTEXT The Chicago Park District is the largest municipal park system in the United States, serving almost 200,000 children annually through after-school and summer programs. Chicago is one of the first US cities to improve park food environments through more healthful snack vending. METHODS A community-based participatory evaluation engaged community and academic partners, who shared in all aspects of the research. From spring 2011 to fall 2012, we collected data through observation, surveys, and interviews on staff and patron acceptance of snack vending items, purchasing behaviors, and machine operations at a sample of 10 Chicago parks. A new snack vending contract included nutrition standards for serving sizes, calories, sugar, fat, and sodium for all items. Fifteen months of snack vending sales data were collected from all 98 snack vending machines in park field houses. OUTCOMES Staff (100%) and patrons (88%) reacted positively to the initiative. Average monthly per-machine sales increased during 15 months (

South Asian American Perspectives on Overweight, Obesity, and the Relationship Between Weight and Health

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Learning From State Surveillance Of Childhood Obesity

371). Vendor compliance issues included stocking noncompliant items and delayed restocking. INTERPRETATION The initiative resulted in improved park food environments. Diverse partner engagement, participatory evaluation, and early attention to compliance can be important supports for healthful vending initiatives. Consumer acceptance and increasing revenues can help to counter fears of revenue loss that can pose barriers to adoption.

Role Sharing between Evaluators and Stakeholders in Practice.

Introduction Compared with other racial groups, South Asian adults develop type 2 diabetes and cardiovascular disease at a lower body mass index (BMI). Perceptions of weight and the effect of weight on health can influence weight-loss attempts but are not well described in this population. The objective of this study was to examine perceptions of weight appropriateness and the effect of weight on health among South Asian Americans. Methods We recruited 75 South Asian American adults from a single metropolitan area in the Midwestern United States. During individual, face-to-face interviews, we asked participants what they think about their weight and how weight affects their health. We measured their weight and height and calculated BMI. Each interview was audiotaped, transcribed verbatim, and translated into English. We conducted analyses using NVivo software. A second investigator coded 20% of interviews to verify coding consensus. Results Sixty-seven percent of participants were overweight or obese; 40% of overweight participants and 12% of obese participants perceived themselves to be normal weight or underweight. Forty-eight percent of overweight and 82% of obese participants believed their weight affected their health. Participants commonly cited physical problems as being associated with their weight, but few connected their weight with risk for chronic diseases. Conclusion South Asian Americans may underestimate their weight status and the effect of their weight on their risk for chronic diseases. Interventions to promote weight loss among South Asian Americans should focus on modifying perceptions of normal weight and personalizing the relationship between overweight and chronic diseases.

Nutrient content of school meals before and after implementation of nutrition recommendations in five school districts across two U.S. counties

Data on childhood obesity collected by the Centers for Disease Control and Prevention helped reveal the nations epidemic of overweight and obese children. But more information is needed. Collecting body mass index (BMI)-the widely accepted measurement of childhood weight status-at the state and local levels can be instrumental in identifying and tracking obesity trends, designing interventions to help overweight children, and guiding broader policy solutions. Approximately thirty states have enacted or proposed BMI surveillance laws and regulations. Arkansas stands out as the state with the highest-quality surveillance data. Innovative strategies being pursued in a number of other states should be explored for broader dissemination.

Policy, Systems, and Environmentally Oriented School-Based Obesity Prevention: Opportunities and Challenges

In the past three decades, program evaluation has sought to more fully engage stakeholders in the evaluative process. But little information has been gathered from stakeholders about how they share in evaluation tasks and whether role sharing leads to confusion or tensions between the evaluator and the stakeholders. This article reports findings from surveys and interviews with 20 evaluator—project director (lead stakeholder) pairs to explore how they share each others roles in practice. In this study, sharing roles between evaluators and project directors generally was the norm among study participants but varied by the orientation of the evaluator (academic, program, or client). For some, there was tension and confusion in the role sharing of evaluators and stakeholders, but it was typically resolved early on in the cases where evaluators bring strong communication skills to the project. Where these skills were not present, the tensions did not resolve consistently.

Parental attitudes toward research participation in pediatric sickle cell disease.

OBJECTIVE To compare changes in nutrient levels of school meals before and after implementation of nutrition interventions at five school districts in two, large U.S. counties. School menu changes were compared against national school meal recommendations. METHODS A large urban school district in Los Angeles County (LAC), California and four school districts in suburban Cook County (SCC), Illinois implemented school meal nutrition interventions. Nutrition analyses were conducted for school breakfast and lunch before and after changes were made to the meal programs. Means, % change, and net calories (kilocalories or kcal) offered as a result of the nutrition interventions were calculated. RESULTS School districts in both counties made district-wide changes in their school breakfast and lunch menus. Menu changes resulted in a net reduction of calories, sugar, and sodium content offered in the meals. Net fewer calories offered as a result of the nutrition interventions were estimated to be about 64,075kcal per student per year for LAC and 22,887kcal per student per year for SCC. CONCLUSIONS Nutrition interventions can have broad reach through changes in menu offerings to school-aged children and adolescents. However, further research is needed to examine how these changes affect student food selection and consumption.

Partnering with community institutions to increase access to healthful foods across municipalities.

Public health is increasingly emphasizing policy, systems, and environmental (PSE) change as a key strategy for population-level health promotion and disease prevention. When applied to childhood obesity, this strategy typically involves school systems, since children spend large portions of their days in school and are heavily influenced by this environment. While most school systems have implemented nutrition education and physical activity programs for some time, their understanding and use of PSE approaches to obesity prevention is accelerating based on several large federally funded initiatives. As part of one initiatives evaluation, key informant interviews reveal the specific obesity prevention PSE strategies schools are attempting and the corresponding barriers and facilitators to their implementation. These evaluation findings raise several fundamental issues regarding school-based obesity prevention, including the potential role of school personnel, the influence of grant funding on school health initiatives, and the fit between public health and educational priorities.