Patricia Snyder

Pathways: a culturally appropriate obesity-prevention program for American Indian schoolchildren

Pathways, a culturally appropriate obesity prevention study for third-, fourth-, and fifth-grade American Indian schoolchildren includes an intervention that promotes increased physical activity and healthful eating behaviors. The Pathways intervention, developed through a collaboration of universities and American Indian nations, schools, and families, focuses on individual, behavioral, and environmental factors and merges constructs from social learning theory with American Indian customs and practices. We describe the Pathways program developed during 3 y of feasibility testing in American Indian schools, with special emphasis on the activities developed for the third grade; review the theoretical and cultural underpinnings of the program; outline the construction process of the intervention; detail the curriculum and physical education components of the intervention; and summarize the formative assessment and the school food service and family components of the intervention.

The Pathways study: a model for lowering the fat in school meals

We describe the development and implementation of the Pathways school food service intervention during the feasibility phase of the Pathways study. The purpose of the intervention was to lower the amount of fat in school meals to 30% of energy to promote obesity prevention in third- through fifth-grade students. The Pathways nutrition staff and the food service intervention staff worked together to develop 5 interrelated components to implement the intervention. These components were nutrient guidelines, 8 skill-building behavioral guidelines, hands-on materials, twice yearly trainings, and monthly visits to the kitchens by the Pathways nutrition staff. The components were developed and implemented over 18 mo in a pilot intervention in 4 schools. The results of an initial process evaluation showed that 3 of the 4 schools had implemented 6 of the 8 behavioral guidelines. In an analysis of 5 d of school menus from 3 control schools, the lunch menus averaged from 34% to 40% of energy from fat; when the menus were analyzed by using the food preparation and serving methods in the behavioral guidelines, they averaged 31% of energy from total fat. This unique approach of 5 interrelated food service intervention components was accepted in the schools and is now being implemented in the full-scale phase of the Pathways study in 40 schools for 5 y.

Process evaluation in a multisite, primary obesity-prevention trial in American Indian schoolchildren

We describe the development, implementation, and use of the process evaluation component of a multisite, primary obesity prevention trial for American Indian schoolchildren. We describe the development and pilot testing of the instruments, provide some examples of the criteria for instrument selection, and provide examples of how process evaluation results were used to document and refine intervention components. The theoretical and applied framework of the process evaluation was based on diffusion theory, social learning theory, and the desire for triangulation of multiple modes of data collection. The primary objectives of the process evaluation were to systematically document the training process, content, and implementation of 4 components of the intervention. The process evaluation was developed and implemented collaboratively so that it met the needs of both the evaluators and those who would be implementing the intervention components. Process evaluation results revealed that observation and structured interviews provided the most informative data; however, these methods were the most expensive and time consuming and required the highest level of skill to undertake. Although the literature is full of idealism regarding the uses of process evaluation for formative and summative purposes, in reality, many persons are sensitive to having their work evaluated in such an in-depth, context-based manner as is described. For this reason, use of structured, quantitative, highly objective tools may be more effective than qualitative methods, which appear to be more dependent on the skills and biases of the researcher and the context in which they are used.

How the Catch Eat Smart Program Helps Implement the USDA Regulations in School Cafeterias

This article describes the implementation of the U.S. Department of Agricultures National School Lunch Program (NSLP) standards in school lunch menus in 56 intervention and 20 control schools from the Child and Adolescent Trial for Cardiovascular Health (CATCH) 5 years after the main trial, compared with 12 schools previously unexposed to CATCH. School food service personnel completed questionnaires to assess CATCH guideline implementation, demographic data, behavioral constructs, training, program material use, and par ticipation in competing programs. Five days of menus and recipes were collected from school cafeteria staff, averaged, and compared to USDA School Meal Initiative (SMI) standards. Significant differences between intervention and unexposed schools were found for training and knowledge of CATCH and in mean percentage energy from fat and carbohydrates. Intervention schools most closely met USDA SMI recommendations for fat. Thus, the CATCH Eat Smart Program assisted school cafeterias in meeting USDA guidelines 5 years postimplementation.

Maintenance of Effects of the Eat Smart School Food Service Program: Results from the Catch-on Study

The Child and Adolescent Trial for Cardiovascular Health (CATCH) Eat Smart Program targeted the food service of the 56 CATCH intervention elementary schools to effect positive changes in the total fat and saturated fat content of school lunch. Maintenance of the food service intervention in former intervention (n = 56) and control (n = 20) schools was evaluated 5 years postintervention. After 5 years of follow-up and no further intervention, the former CATCH intervention schools not only maintained prior levels but also had further decreases in the mean percentage of calories from total and saturated fat to 31% and 10.4%, respectively. Significant decreases in these nutrients were also observed in the former CATCH control schools; however, the former intervention schools more closely approached the Eat Smart goal for total fat. Overall, sodium levels rose in both school conditions and did not differ significantly at follow-up.

Point of choice nutrition information, federal regulations, and consumer health education: a critical view

Efforts to provide simple, available, and useful nutrition information in the marketplace that would help consumers make healthful food choices have generated considerable controversy in recent years. Disagreements have emerged among various interests: the scientific community, public health organizations, government regulatory agencies, food producers and marketers, and consumer groups. Central to these controversies are issues such as the lack of definitive scientific evidence about nutrition and disease prevention, opinions about the need for consensus and standardization of information, the motives of private sector information suppliers, and the effectiveness of nutrition information in improving food choices. TWQ articles which recently appeared in the] ournal of Nutrition Education touch on these issues but fail, in our view, to give adequate attention to these disagreements and controversies. Pennington et al. (1) described the current situation regarding grocery store nutrition information programs, and Pennington and Vanderveen (2) critiqued the lack of use of consistent, standardized descriptive terms for foods with special dietary characteristics. Pennington et al. reported on a survey of 83 major grocery store chains which found that 36% of the stores used in-store nutrition information programs, but that their use of terminology, criteria for identification of foods with special nutritional qualities, and modes of presentation (e.g., color-coding schemes) varied widely (1). Elsewhere in the same journal issue, Pennington and Vanderveen reviewed the history of the Food and Drug Administration (FDA) regulations defining descriptors

Nutrient Intakes of Third Graders: Results from the Child and Adolescent Trial for Cardiovascular Health (CATCH) Baseline Survey

The purpose of this article is to report on baseline intakes of 1874 third-grade children representing a subsample of the Child and Adolescent Trial for Cardiovascular Health (CATCH) cohort. Intakes were assessed using a single, food record-assisted, 24-hour recall. The sample is unique in that it is drawn from four states and includes students from various ethnic backgrounds. Nutrients of interest include total energy, sodium, dietary cholesterol, and percent of energy from total fat and saturated fat. At baseline, third-grade students were consuming above nationally recommended levels of energy from fat, saturated fat, and sodium. The CATCH findings show a mean energy intake of 2031 kcal with significant differences by sex. Significant differences by site were seen for percent of energy from total fat, saturated fat, and dietary cholesterol. Children from Minnesota consumed the lowest proportion of energy from total fat and saturated fat while children from Texas had the highest proportion of energy from total fat and saturated fat. Intake of dietary cholesterol was lowest in Minnesota and highest in Louisiana. Nutrient differences by ethnic group were seen only for energy, with African Americans having the highest energy intake and Hispanics having the lowest energy intake. The number of meals consumed from school food service significantly influenced childrens nutrient, intake; children consuming two meals from school food service had significantly greater intakes of energy, saturated fat, and dietary cholesterol compared to students consuming one or no meals from school food-service. The results are compared to other national nutritional surveys of children.