Michelle Zive

Environmental Interventions for Eating and Physical Activity A Randomized Controlled Trial in Middle Schools

BACKGROUND Our objective was to evaluate the effects of environmental, policy, and social marketing interventions on physical activity and fat intake of middle school students on campus. DESIGN Twenty-four middle schools were randomly assigned to intervention or control conditions. Baseline measures were collected in spring 1997, and interventions were conducted during the 1997-1998 and 1998-1999 school years SETTING/PARTICIPATION: The schools had mean enrollments of 1109, with 44.5% nonwhite students. Over 2 years, physical activity interventions were designed to increase physical activity in physical education classes and throughout the school day. Nutrition interventions were designed to provide and market low-fat foods at all school food sources, including cafeteria breakfasts and lunches, a la carte sources, school stores, and bag lunches. School staff and students were engaged in policy change efforts, but there was no classroom health education. MAIN OUTCOMES MEASURES Primary outcomes were measured by direct observation and existing records. RESULTS Randomized regression models (N =24 schools) revealed a significant intervention effect for physical activity for the total group (p <0.009) and boys (p <0.001), but not girls (p <0.40). The intervention was not effective for total fat (p <0.91) or saturated fat (p <0.79). Survey data indicated that the interventions reduced reported body mass index for boys (p <0.05). CONCLUSIONS Environmental and policy interventions were effective in increasing physical activity at school among boys but not girls. The interventions were not effective in reducing fat intake at school. School environmental and policy interventions have the potential to improve health behavior of the student population, but barriers to full implementation need to be better understood and overcome.

Childhood movement skills: predictors of physical activity in Anglo American and Mexican American adolescents?

Abstract We assessed the relationship between young childrens movement skills and their physical activity in early adolescence. Balance, agility, eye-hand coordination, and skinfold thicknesses in 207 Mexican American and Anglo American children (104 boys, 103 girls) were measured at ages 4, 5, and 6 years. Habitual physical activity was assessed at the age of 12 years by two interviewer-administered 7-day recalls. Ethnic differences in movement skills were not found. Young girls were better at jumping and balancing, and young boys were better at catching. Tracking of skills was low, and childrens early childhood skills were not related to their physical activity 6 years later. Further studies involving additional movement skills and other populations are recommended to determine if enhanced movement skills in children promote subsequent physical activity.

Fat and sugar levels are high in snacks purchased from student stores in middle schools.

OBJECTIVE Children consume about one third of their daily energy at school, mostly from cafeteria food and bag lunches. Students also shop at student-run stores that generate revenue for extracurricular activities; yet the nutritional value of snacks sold at student stores has not been documented to our knowledge. DESIGN Cross-sectional study of foods sold at student stores in middle schools. SUBJECTS/SETTING Twenty-four San Diego County (Calif) public middle schools, grades 6 through 8 (age 11 to 13), from 9 school districts. The schools represent a diversity of ethnic groups and socioeconomic levels. STATISTICAL ANALYSES PERFORMED Descriptive statistics, Pearson product moment correlations, analysis of variance. RESULTS Snacks averaged 8.7 g fat and 23.0 g sugar. Overall, 88.5% of store inventory was high in fat and/or high in sugar. Sugar candy accounted for one third of store sales. Chocolate candy was highest in fat content: 15.7 g. Fourteen of the 24 schools had stores that sold food and were run by student organizations. Stores were open daily for about 90 minutes; half sold food during lunch. CONCLUSIONS Adolescents need opportunities to supplement main meals; however, student stores in middle schools sell primarily high-fat, high-sugar snacks. Key intervention possibilities include limiting sales of chocolate candy and substituting low-fat varieties of cakes, cookies, chips, and crackers. Competition with cafeterias for sales at lunchtime should be addressed.

Effects of the Child and Adolescent Trial for Cardiovascular Health (CATCH) on Fruit and Vegetable Intake

Abstract The purpose of this article is to report the impact of the Child and Adolescent Trial for Cardiovascular Health (CATCH) on fruit and vegetable consumption of third-through fifth-grade children.The primary messages delivered in the CATCH interventions concerned dietary fat, dietary sodium, physical activity, and smoking. However, a significant portion of the classroom curricula, parental involvement programs, and food service changes were directed at promoting a generally healthful diet, including increasing fruit and vegetable intake. Therefore, it is of interest whether the general nutrition intervention was sufficient to effect an increase in intake of fruits and vegetables. Intakes were assessed using single, food-record-assisted 24-hour recalls at baseline and follow-up.The final sample size for paired baseline and follow-up recalls was 1186.The mean unadjusted daily intake of fruits and vegetables for the entire cohort at follow-up was 4.04 servings; for fruit it was 2.13 servings, and for vegetables it was 1.91 servings.The analyses of variance revealed no differences in fruit and vegetable consumption at follow-up due to site, sex, race, sex by race, condition by sex, condition by race, or condition by race by sex. Only the baseline servings of fruits and vegetables (F = 14.89; p

Do Adolescent Vitamin-Mineral Supplement Users Have Better Nutrient Intakes Than Nonusers? Observations from the CATCH Tracking Study

OBJECTIVE Describe whether users of vitamin-mineral supplements differed from nonusers in micronutrient intakes or in nutrition awareness. DESIGN Cross-sectional, observational study. SUBJECTS One thousand five hundred thirty-two students now in grade 8, who participated in the Third Child and Adolescent Trial for Cardiovascular Health tracking study and who also provided a single 24-hour dietary recall. STATISTICAL ANALYSES PERFORMED Mixed-model analysis of covariance was used to ascertain if supplement users had higher vitamin and mineral intakes from food sources, and to examine if supplement users had better nutrition awareness than nonusers. RESULTS The 24-hour recall showed that 17.6% of the students reported using vitamin-mineral supplements. Users reported a mean of 1.4 supplements, of which 47% were multivitamin or multimineral preparations, 37% were single nutrients, and 16% were combinations. White persons and residents of Minnesota and California were more likely to be supplement users. Users had higher micronutrient intakes from food sources for 16 of the 20 nutrients studied after adjusting for gender, race/ethnicity, site, treatment condition, and within-school variability. Users had higher scores on a health behavior survey for food choice and slightly but not significantly higher nutrition knowledge scores. CONCLUSIONS Vitamin-mineral supplement use is prevalent among eighth-grade students. Users have higher nutrient intakes from foods, higher total intakes for several micronutrients, higher nutrition awareness, and differ in their demographic characteristics from nonusers.

Marginal Vitamin and Mineral Intakes of Young Adults: The Bogalusa Heart Study

PURPOSE To determine reported vitamin and mineral intakes, vitamin supplement use, and food consumption patterns of young adults. METHODS Twenty-four-hour dietary recalls were collected from 1988-1991 on a cross-sectional sample of 504 young adults in Bogalusa, Louisiana, between the ages of 19 and 28 years (58% female; 70% white). Reported vitamin and mineral intake data were analyzed for race and gender differences. Descriptive and inferential statistics were calculated where appropriate. Food sources of selected vitamins and minerals were also examined. RESULTS Reported intakes of vitamins A, B6, E, D, and C, folacin, magnesium, iron, zinc, and calcium were most likely to be inadequate compared with the Recommended dietary Allowances (RDA); with more females than males reported nutrient intakes less than two thirds of the RDA. Approximately 10% of the population reported taking a vitamin/mineral supplement over the 24-h survey period. Food source data indicated that breads and grains, milk, vegetables and soups, fruits, and beef were the primary contributors of the selected vitamins and minerals. CONCLUSIONS Public health organizations and dietitians need to educate young adults on practical strategies for making wise food choices rich in nutrient content relative to energy value to ensure intakes that approach the RDAs.

CATCH: food service program process evaluation in a multicenter trial

Process evaluation is an essential element of a multicenter trial in order to explain study outcomes and monitor intervention progress. This paper presents the process evaluation model for the Eat Smart School Nutrition Program, the food service intervention component of the Child and Adolescent Trial for Cardiovascular Health (CATCH), and describes the process evaluation strategies developed to assess this program. The paper details (1) measures of program implementation including training, support visits, and program promotion, (2) food service staff characteristics, and (3) measures of mediating variables including secular trends and school meal participation.

Meeting the Dietary Goals for School Meals by the Year 2000: The CATCH Eat Smart School Nutrition Program

Abstract During the past decade health promotion for our nations school children has received considerable attention. The Child and Adolescent Trial for Cardiovascular Health (CATCH) was the largest multicenter school-based health promotion program ever funded by the National Heart, Lung, and Blood Institute, involving 96 public elementary schools in four states and over 5,000 students in the baseline measurement cohort. The Eat Smart School Nutrition Program, the environmental component of CATCH, was tested for effectiveness in reducing fat, saturated fat, and sodium in school meals. This article provides an overview of the CATCH Eat Smart kitchen visits and intervention materials including the School Meal Program Guide, Fat and Sodium Criteria for recipes, ingredients, and vendor products, Recipe File Box, Vendor Product Handbook, Newsline, and intervention posters, training models, and process and outcome evaluation measures. All these components were essential in implementing a well tested model that...

Parent Support and Parent-Mediated Behaviors Are Associated with Children's Sugary Beverage Consumption

Consumption of sugary beverages has been identified as a contributor to childhood obesity. Studies have established the importance of specific parenting practices to childrens beverage consumption; however, no study has examined multiple operationalizations of parenting to better understand where to focus future interventions. The present study examined the relationship between childrens sugary beverage consumption and a parenting model that included household food rules, parent modeling of food rules, parent-mediated behaviors, and parent support. Baseline data from Project MOVE/me Muevo were used. Participants included 541 children, aged 5 to 8 years old, and their parents. Parents completed a 45-minute self-administered survey in Spanish or English, providing information about their childs dietary intake, as well as their parenting practices. Childrens sugary beverage consumption included nondiet soda, noncarbonated sugary drinks, and sport drinks. Household food rules and parent modeling of food rules were assessed with seven items each. Parent-mediated behaviors consisted of four behaviors. Parent support was assessed with five items. Parent support and parent-mediated behaviors, including total screen time and eating at fast-food restaurants at least weekly, were associated with greater consumption of sugary beverages in children. No other parenting variables were significant. Encouraging caregivers to promote healthy dietary behaviors and provide healthy choices, limiting childrens television and computer use, and reducing fast-food consumption can contribute to reductions in sugary beverage consumption among children.

Ethnic and Gender Trends for Cardiovascular Risk Behaviors in Anglo and Mexican American Children, Ages Four to Seven

Abstract Gender and ethnic trends were examined in 351 Mexican American and Anglo American children between the ages of four and seven. Four physiologic variables, seven observed and reported variables related to diet, and eight observed and reported variables related to physical activity were periodically assessed. Children were observed at home at meal times and at school (or a day care center) at lunch and recess. A linear regression model was used. Of the four physiologic variables, two variables (height and total skinfolds) showed significant ethnic differences, with Mexican American children showing greater skinfolds over time and the tendency to be shorter than Anglo American children. Of the variables related to diet, five of the seven variables showed gender or ethnic differences; percent of calories from fat and food preparation behaviors tended to place Mexican American children at greater risk. When examining physical activity, four of the eight variables showed gender and/or ethnic difference...