Matthew M. Graziose

Educating and Training a Workforce for Nutrition in a Post-2015 World

Nearly all countries in the world today are burdened with malnutrition, manifesting as undernutrition, micronutrient deficiencies, and/or overweight and obesity. Despite some progress, efforts to alleviate malnutrition are hampered by a shortage in number, skills, and geographic coverage, of a workforce for nutrition. Here, we report the findings of the Castel Gandolfo workshop, a convening of experts from diverse fields in March 2014 to consider how to develop the capacity of a global cadre of nutrition professionals for the post-2015 development era. Workshop participants identified several requirements for developing a workforce for nutrition, including an ability to work as part of a multisectoral team; communication, advocacy, and leadership skills to engage decision makers; and a set of technical skills to address future challenges for nutrition. Other opportunities were highlighted that could immediately contribute to capacity development, including the creation of a consortium to link global North and South universities, online training modules for middle managers, and practical, hands-on experiences for frontline nutrition workers. Institutional and organizational support is needed to enable workshop recommendations on education and training to be effectively implemented and sustained. The findings from the Castel Gandolfo workshop can contribute to the delivery of successful nutrition-relevant actions in the face of mounting external pressures and informing and attaining the forthcoming Sustainable Development Goals.

Cost-effectiveness of a Nutrition Education Curriculum Intervention in Elementary Schools

Objective To estimate the long‐term cost‐effectiveness of an obesity prevention nutrition education curriculum (Food, Health, & Choices) as delivered to all New York City fifth‐grade public school students over 1 year. Methods This study is a standard cost‐effectiveness analysis from a societal perspective, with a 3% discount rate and a no‐intervention comparator, as recommended by the US Panel on Cost‐effectiveness in Health and Medicine. Costs of implementation, administration, and future obesity‐related medical costs were included. Effectiveness was based on a cluster‐randomized, controlled trial in 20 public schools during the 2012–2013 school year and linked to published estimates of childhood‐to‐adulthood body mass index trajectories using a decision analytic model. Results The Food, Health, & Choices intervention was estimated to cost

Factors Related to Fruit and Vegetable Consumption at Lunch Among Elementary Students: A Scoping Review

8,537,900 and result in 289 fewer males and 350 fewer females becoming obese (0.8% of New York City fifth‐grade public school students), saving 1,599 quality‐adjusted life‐years (QALYs) and

Association Between the Built Environment in School Neighborhoods With Physical Activity Among New York City Children, 2012

8,098,600 in direct medical costs. Food, Health, & Choices is predicted to be cost‐effective at

Developing Capacity in Nutrition

275/QALY (95% confidence interval, –

Why Do We Choose Certain Foods

2,576/QALY to

Food, Health & Choices (FHC): School Demographics and Neighborhood Food Environment Explains Variations in BMI Across Schools

2,084/QALY) with estimates up to

Systematic review of the design, implementation and effectiveness of mass media and nutrition education interventions for infant and young child feeding

6,029/QALY in sensitivity analyses. Conclusions and Implications This cost‐effectiveness model suggests that a nutrition education curriculum in public schools is effective and cost‐effective in reducing childhood obesity, consistent with the authors’ hypothesis and previous literature. Future research should assess the feasibility and sustainability of scale‐up.

On the Accuracy of Self-Report Instruments for Measuring Food Consumption in the School Setting.

Introduction Few children consume the recommended amount of fruits and vegetables, and schools are a valuable setting for interventions, including programs such as the National School Lunch Program, to increase consumption. Previous research explored factors in this program that influence fruit and vegetable consumption. The objective of this scoping review was to identify, describe, and categorize studies that quantitatively measured the consumption of fruits and vegetables during the school lunch meal among US elementary school students. Methods We conducted a scoping review to identify, describe, and categorize studies examining factors influencing fruit and vegetable consumption during lunch among children in the United States. Eligibility criteria included studies that reported fruit and vegetable consumption at the lunch meal among children in kindergarten through grade 5. We included all types of study designs and categorized factors according to a socioecological framework. Results We identified 49 studies that examined the influence of one or more factors on elementary students’ consumption of fruits and vegetables. Factors (n = 21) were categorized according to a socioecological framework: individual (3 factors), social environment (3 factors), physical environment (9 factors), policy (2 factors), and a combined approach (4 factors). Several factors had consistent positive associations with fruit and vegetable consumption at lunch across 2 or more studies: increasing age, serving sliced fruits, serving vegetables first, allowing more time for eating, using incentives, using social marketing and/or nutrition education curricula, and using the updated nutrition standards. Only 10 studies used a randomized design. Conclusion Although we found consistent evidence for some factors, we found conflicting or limited evidence for most, which points to the need for replication in future studies. The lack of randomized designs is a challenge, because it precludes the ability to draw conclusions about cause and effect. Our review may aid in framing practical aspects of the design of future research and in identifying an approach for a systematic review.

Assessing the Retail Food Environment Surrounding Elementary Schools Across New York City (NYC) Neighborhoods Varying in Their Level of Gentrification

Introduction The benefits of physical activity for health and well-being are well established, yet built environment characteristics in the school neighborhood may constrain students’ ability to engage in physical activity and contribute to the considerable variation in physical activity among students at different schools. Methods Baseline data from the Food, Health and Choices obesity prevention trial were used to create multilevel linear models of the relationship between fifth-grade students’ (n = 952) physical activity and related psychosocial factors and characteristics of the built environment of the school’s neighborhood (park access, public transportation density, total crime, and walkability), controlling for age and body mass index z scores. Results Total crime was inversely associated with boys’ light physical activity duration (β = −0.189; P = .02) and behavioral intention for physical activity (β = −0.178; P = .03). Boys’ habit strength for physical activity was positively associated with public transportation density (β = 0.375; P = .02) and negatively associated with total crime (β = −0.216; P = .01), explaining 67% of between-school variation. Girls’ frequency of light physical activity was positively associated with park access (β = 0.188; P = .04). Built environment characteristics explained 97% of the between-school variation in girls’ self-efficacy in walking for exercise. Conclusions Characteristics of the built environment surrounding schools were associated with and explain between-school variation in students’ physical activity and several theory-based psychosocial factors. Partnerships between public health practitioners, policy makers, and school administrators may be warranted to shape the school neighborhood, specifically to decrease crime rates and increase park access, to encourage physical activity in youth.