Wendelin Slusser

A school salad bar increases frequency of fruit and vegetable consumption among children living in low-income households

OBJECTIVE To measure change in fruit and vegetable (F&V) consumption among elementary-school children after the introduction of a salad bar programme as a lunch menu option in the US Department of Agricultures (USDA) reimbursable lunch programme in Los Angeles Unified School District (LAUSD). DESIGN A cross-sectional sample of children was interviewed before and after a salad bar intervention (1998 and 2000, respectively) utilising a 24-hour food recall questionnaire. Frequencies of F&V consumption were calculated. SETTING The evaluation took place in three LAUSD elementary schools participating in the salad bar programme and the USDA reimbursable lunch programme. SUBJECTS Three hundred and thirty-seven children in 2nd-5th grade (7-11 years old). RESULTS After the salad bar was introduced, there was a significant increase in frequency (2.97 to 4.09, P < 0.001) of F&V consumed among the children studied. The increase in frequency of F&V consumed was almost all due to an increase during lunch (84%). Mean energy, cholesterol, saturated fat and total fat intakes were significantly lower in the children after the salad bar was introduced in the schools compared with the intakes in the children before the salad bar was introduced. CONCLUSION A salad bar as a lunch menu option in the USDA reimbursable lunch programme can significantly increase the frequency of F&V consumption by elementary-school children living in low-income households.

Breast milk expression in the workplace: A look at frequency and time

The objective of this article is to study a barrier for breastfeeding women working full-time outside the home: breast milk expression in the workplace. Data are from a large corporation that provides employee benefits. Mothers express breast milk about twice a day when infants are 4 months old (x = 2.2 ± 0.8) and 6 months old (x = 1.9 ± 0.6), with a significant decline in frequency (P < .05) comparing the 2 age groups. Most mothers spend 1 hour or less expressing breast milk when infants are 3 (82%) or 6 months old (96%), with a significant difference (P < .05) between the 2 age groups. Mothers of younger infants were no more likely to work fewer days per week than were mothers of older infants. Most women can express breast milk for 3- and 6-month-old infants in less than an hour, distributed in about 2 separate portions, in an employment environment supportive of breastfeeding.

Overweight in urban, low-income, African American and Hispanic children attending Los Angeles elementary schools: research stimulating action

OBJECTIVE This study was undertaken to establish the prevalence and severity of nutritional problems among low-income children of elementary school age in the Los Angeles Unified School District (LAUSD) in order to collect baseline data to inform policy-makers. DESIGN AND METHODS A cross-sectional survey of children in 14 elementary schools was conducted from January to June, 1998. Nine hundred and nineteen children were measured and interviewed. The planning, design and data analysis were carried out in collaboration with key LAUSD policy-makers. RESULTS More than 35% of the sample was classified as being at risk for overweight or overweight according to body mass index. CONCLUSION There is a high prevalence of children who are at risk for overweight or who are overweight in Los Angeles. This finding has triggered the development of multiple school-based intervention programmes.

A public health approach to pediatric residency education: responding to social determinants of health.

OBJECTIVE To evaluate the impact of a public health approach to pediatric residency education on learner knowledge, skills, attitudes, beliefs, and career choice. BACKGROUND Incorporating public health principles into traditional residency education can give pediatricians the population-oriented perspective to address social determinants of health. METHODS The Community Health and Advocacy Training (CHAT) program is an educational intervention with a public health framework. From 2001-2007, 215 categorical pediatric residents and 37 residents in the CHAT program were evaluated by using an annual survey of community pediatrics exposure, knowledge, attitudes, and beliefs. American Board of Pediatrics (ABP) examination passage rates for both groups were also examined, as was career choice after graduation. RESULTS While interns in both the categorical and CHAT programs scored similarly on attitudes, beliefs, skills, and knowledge of community pediatrics, the postgraduate level-3 (PL-3) year CHAT residents scored higher in attitudes (P < .001) and skills (P < .05). Exposure to both didactic (P < .05) and practical (P < .001) community pediatrics curricular experiences were higher for CHAT residents than for categorical residents. No significant differences between ABP examination scores were found for the 2 groups, although 100% of CHAT graduates passed on the first try compared to 91% of categorical graduates during this time period. A greater percentage of CHAT graduates (82%) than categorical graduates (53%) reported pursuing careers in primary care. CONCLUSION With a public health approach to residency education, residents gain the knowledge, attitudes, and skills to address child health problems from a population perspective. Participation in such a curriculum still resulted in high passage rates on the ABP examination.

Participatory prevention research model promotes environmental change for healthier schools.

Barriers exist to healthy eating and physical activity for children in the school environment. Modifiable school environmental factors have led to the development of the Nutrition Friendly Schools and Communities (NFSC) model to prevent the development of overweight in school children and adolescents. The design of the NFSC environmental intervention is to actively engage the school community to prevent overweight in school-aged children. This article presents data measuring the environmental changes achieved by the Los Angeles Unified School District (LAUSD) elementary schools participating in a 3-year participatory research pilot study funded by the Centers for Disease Control and Prevention (CDC). An objective of the pilot study is to determine whether any or all of the 15 steps developed for the NFSC model could be implemented. Further, researchers want to know if any of the study schools could implement the NFSC model as a whole during the allotted time of the pilot study.

Using Participatory Action Research to Develop a School-based Environmental Intervention to Support Healthy Eating and Physical Activity

Abstract Rates of overweight children and adolescents have nearly tripled over the past 30 years. Many barriers exist to healthy eating and physical activity for children and adolescents, including factors in the school and community environment. It is these modifiable school environmental factors that led to the development of the Nutrition Friendly Schools and Communities (NFSC) model to prevent the development of overweight in children and adolescents. Development of the NFSC model built upon the Coordinated School Health Program, the Baby Friendly Hospital Initiative, Participatory Research, and Empowerment Evaluation. The purpose of the NFSC environmental intervention is to actively engage the school community to prevent overweight in students through a multi-level participative intervention that facilitates coordinated changes in the school environment in the following areas: health education, physical education, health services, food services, school policy, staff wellness, psychosocial services, and family/community involvement. The NFSC model is the basis by which school communities develop a plan and evaluation that lead to a healthy school environment and prevent the development of overweight in children. A pilot study of the NFSC model is currently being conducted in eight low—income, minority, urban schools. This paper describes the development of the NFSC model and criteria.

Use of Mind–Body Therapies Among Young Adults Aged 18–24 Years: Findings From the 2012 National Health Interview Survey

PURPOSE To investigate the prevalence, patterns, and satisfaction of use of mind-body therapies (MBTs) in a nationally representative sample of young adults (ages 18-24 years). METHODS Young adults interviewed in the 2012 National Health Interview Survey were analyzed (n = 3,286). Individual types (e.g., mindfulness) and a combined measure of use of any MBT were assessed. Reasons for and satisfaction with use was also investigated. Design-based F tests and logistic regression were used; all analyses were weighted and stratified by gender. RESULTS Overall, 14.6% of young adults used MBT in the past year (9.6% of men and 19.1% of women, p < .001). Among men, higher levels of education, greater numbers of health conditions, and healthy behaviors were associated with greater odds of MBT use. Among women, Latina and black women had lower odds of use (vs. white). Higher education, greater mental distress, and greater numbers of health conditions and healthy behaviors were associated with greater odds of use. While both men and women reported stress reduction and general wellness as top reasons for use, men also reported the use to improve athletic performance. CONCLUSIONS Young adulthood is a critical period in the life course when individuals are establishing lifestyle and health behaviors that can be enduring. Because stress is a persistent problem, and many MBTs can be helpful with management of stress and anxiety, young adult may be underutilizing these modalities. Public health and educational strategies for greater engagement in MBT among young adults are warranted.

Healthier vending machines in a university setting: Effective and financially sustainable

a UCLA Fielding School of Public Health, Department of Health Policy and Management, 650 Charles Young Dr. S., 31-269 CHS, Box 951772, Los Angeles, CA 90095, USA b UCLA Fielding School of Public Health, Department of Epidemiology, 650 Charles Young Dr. S., 71-254 CHS, Box 951772, Los Angeles, CA 90095, USA c UCLA Housing & Hospitality Services, 360 De Neve Drive, Suite 182, Los Angeles, CA 90095, USA d UCLA School of Medicine, 10833 Le Conte Avenue, Los Angeles, CA 90095, USA

Lessons Learned from the Development and Implementation of a Parent Nutrition Education Program with Low-Income Latina Mothers in an Urban School District Setting.

Abstract This article describes the steps involved in the development and implementation of a parent nutrition education workshop series for a low-income, primarily Spanish-speaking population in an urban school district setting. Overall, those parents who participated in the nutrition education workshops showed positive changes in their knowledge, attitudes, self-efficacy, and behaviors with regard to healthy eating when compared to parents who did not participate in the workshops. Lessons learned from working with a variety of different groups and organizations to complete the project are presented, including the value of formative research for program design, tailoring the intervention to the population of interest, and developing relationships among key stakeholder groups. Our project demonstrates the benefits that may result from academic/community collaborations.