Sonya J. Jones

Improving Patrons' Meal Selections Through the Use of Point-of-Selection Nutrition Labels

OBJECTIVES We examined changes in meal selection by patrons of university food-service operations when nutrition labels were provided at the point of selection. METHODS We used a quasi-experimental, single-group, interrupted time-series design to examine daily sales before, during, and after provision of point-of-selection nutrition labels. Piecewise linear regression was employed to examine changes in the average energy content of entrées and a paired t test was used to detect differences in sales across the periods. RESULTS The average energy content of entrées purchased by patrons dropped immediately when nutrition labels were made available at point of selection and increased gradually when nutrition information was removed. There was no significant change in number of entrées sold or in revenues between the 2 periods. CONCLUSIONS Use of nutrition labels reduced the average energy content of entrées purchased without reducing overall sales. These results provide support for strengthening the nutrition labeling policy in food-service operations.

Food insecurity and subsequent weight gain in women.

OBJECTIVE Cross-sectional data indicate that a relationship between household food insecurity and overweight exists among women in the USA. Cross-sectional data cannot determine if food insecurity leads to overweight as some have hypothesised. The purpose of the present study was to examine the relationship of food insecurity with subsequent weight gain in women using data from the Panel Study of Income Dynamics (PSID). DESIGN, SETTING AND SUBJECTS Panel data from the 1999 and 2001 PSID, a nationally representative sample of households, were analysed using multivariate regression procedures. RESULTS Average weight gain among all women (n = 5595) was 1.1 kg on average over the two years. There were no significant differences in the percentages of women who gained a clinically significant amount (2.3 kg) by food insecurity status. Overweight women who were on a weight-gain trajectory during the 2-year period gained less if they were food-insecure. This relationship was not observed among healthy-weight or obese women. CONCLUSIONS Overall, food insecurity does not appear to be strongly associated with subsequent weight gain in women.

Restricting Snacks in U.S. Elementary Schools Is Associated with Higher Frequency of Fruit and Vegetable Consumption

Efforts are needed to improve U.S. childrens poor diet quality. Our purpose was to examine whether a policy that restricts the availability of snack foods in the schools is associated with greater fruit and vegetable consumption in a nationally representative sample of 5th grade children. Children in schools with restricted snack availability had significantly higher frequency of fruit and vegetable consumption than children in schools without restricted snack availability. Our findings suggest that a restrictive snack policy should be part of a multi-faceted approach to improve childrens diet quality.

Policies that restrict sweetened beverage availability may reduce consumption in elementary-school children

OBJECTIVE We investigated whether having a policy regarding the availability of sweetened beverages in school was associated with childrens purchase and total weekly and daily consumption of sweetened beverages. DESIGN Data were obtained from 10 719 children aged 9-13 years and 2065 elementary schools in the Early Childhood Longitudinal Study-Kindergarten cohort. Multilevel logistic regression was used to determine the magnitude and significance of relationships between the availability of different beverages and purchase of sweetened beverages at school and overall consumption of beverages. RESULTS The purchase of sweetened beverages by children in school was strongly associated with the administrative policy of sweetened beverage availability. Compared with children in schools without an administrative policy that allowed sweetened beverages, children in schools with the policy were three times more likely to be either occasional or frequent consumers of sweetened beverages. CONCLUSIONS A policy of availability of sweetened beverages makes an independent contribution to childrens purchase and consumption of sweetened beverages in the 5th grade year.

Policy instruments used by States seeking to improve school food environments.

US legislatures and program administrators have sought to control the sale of foods offered outside of federally funded meal programs in schools, but little is known about which policies, if any, will prevent obesity in children. We used a theoretical policy science typology to understand the types of policy instruments used by US state governments from 2001 to 2006. We coded 126 enacted bills and observed several types of instruments prescribed by state legislatures to influence the foods sold in schools and improve the school food environment. Our study helps to better understand the various instruments used by policymakers and sets the stage to examine the effectiveness of the policy instruments used to prevent obesity.

Developing and Implementing Health and Sustainability Guidelines for Institutional Food Service

Health and sustainability guidelines for institutional food service are directed at improving dietary intake and increasing the ecological benefits of the food system. The development and implementation of institutional food service guidelines, such as the Health and Human Services (HHS) and General Services Administration (GSA) Health and Sustainability Guidelines for Federal Concessions and Vending Operations (HHS/GSA Guidelines), have the potential to improve the health and sustainability of the food system. Institutional guidelines assist staff, managers, and vendors in aligning the food environment at food service venues with healthier and more sustainable choices and practices. Guideline specifics and their effective implementation depend on the size, culture, nature, and management structure of an institution and the individuals affected. They may be applied anywhere food is sold, served, or consumed. Changing institutional food service practice requires comprehensive analysis, engagement, and education of all relevant stakeholders including institutional management, members of the food supply chain, and customers. Current examples of food service guidelines presented here are the HHS and GSA Health and Sustainability Guidelines for Federal Concessions and Vending Operations, which translate evidence-based recommendations on health and sustainability into institutional food service practices and are currently being implemented at the federal level. Developing and implementing guidelines has the potential to improve long-term population health outcomes while simultaneously benefitting the food system. Nutritionists, public health practitioners, and researchers should consider working with institutions to develop, implement, and evaluate food service guidelines for health and sustainability.

Youth Can! Results of a Pilot Trial to Improve the School Food Environment

OBJECTIVE This study evaluated the potential of youth partnerships to improve the school environment and child nutrition. METHODS A quasi-experimental trial was conducted with 2 intervention and 3 control schools. Intervention schools selected student leaders to participate in youth-led interventions in their schools. Students (n = 104) were included in the evaluation if they were in the fourth grade at baseline and had complete baseline and follow-up data. The intervention trained student leaders in research, advocacy, and nutrition. Leaders implemented interventions appropriate to their schools. Changes in childrens reported dietary intake were examined. Data were analyzed using multivariable regression. RESULTS Childrens diets changed in response to the interventions offered at the schools, although the dietary changes differed by the types of interventions selected. CONCLUSIONS AND IMPLICATIONS Partnering with youth, even at the elementary school level, is a promising avenue for developing tailored interventions for schools.

Can distance education prepare future public health nutritionists? A case study.

OBJECTIVE To assess student retention, readiness, support and outcomes among students completing the Professional Practice Program in Nutrition (PPPN). DESIGN Qualitative evaluation using semistructured, in-depth interviews conducted with PPPN graduates. Course grades, grade point averages, and comprehensive exam results compared 10 PPPN students from 2 cohorts and 72 residential students from 3 cohorts. SETTING The Professional Practice Program in Nutrition was a 3-year, pilot public health nutrition masters (MPH) degree curriculum using distance education (DE) strategies. ANALYSIS Ethnograph was used to assist with qualitative data analysis. Fisher exact test was used to compare quantitative outcomes. RESULTS Qualitative findings revealed that PPPN students were highly motivated, sought out the DE MPH and initially had great support from family and employers; however, support from employers waned over time. Although several challenges to continued enrollment confronted PPPN students, those who completed the MPH all advanced in the workplace. Course grades and grade point averages were similar between the 2 groups. Students in the PPPN were more likely than residential students to retake the comprehensive exam. CONCLUSIONS AND IMPLICATIONS The findings indicate that DE strategies were suitable to deliver an MPH curriculum in nutrition. The majority of PPPN graduates experienced job advancement and demonstrated leadership development.

U.S. Households With Children Are Exposed to Nonpersistent and Persistent Food Insecurity

The objective of this study was to quantify and describe the extent to which children are exposed to food insecurity across middle childhood in the United States. Specifically, we aimed to longitudinally identify (1) the prevalence of nonpersistent and persistent food insecurity in households with children between kindergarten and eighth grade and (2) possible disparities in the prevalence of nonpersistent and persistent food insecurity in households with children between kindergarten and eighth grade. Data were obtained from the Early Childhood Longitudinal Study-Kindergarten data set. We found that many households with children in the United States experience nonpersistent and persistent food insecurity and considerable disparities exist between population groups.

Positive Parenting Practices Associated with Subsequent Childhood Weight Change

We aimed to identify positive parenting practices that set children on differential weight-trajectories. Parenting practices studied were cognitively stimulating activities, limit-setting, disciplinary practices, and parent warmth. Data from two U.S. national longitudinal data sets and linear and logistic regression were used to examine association of initial parenting practices with subsequent change in body mass index (BMI) Z-score and being overweight, stratified by income and gender. Lower change in BMI Z-score and lower likelihood of being or becoming overweight occurred among girls if parents engaged in cognitively stimulating activities or set bedtime; among low-income girls if parents helped with art and set bedtime; among high-income girls if they participated in dance or music, parents talked about nature or visited a museum or library, or parents had rules about number of hours for watching television; among low-income boys if they participated in dance or parents built something with them or set bedtime; and among high-income boys if they participated in dance or music. Greater expression of warmth was associated with lower change in BMI Z-score. Parenting practices facilitating cognitive stimulation, setting limits, and expressing warmth are associated with lower likelihood of being or becoming overweight and can be promoted by healthcare professionals.