Abstract
Food Preparation Policies Result in Healthier Lunch Sides in Public Elementary School Cafeterias
Hannah Peterson1, Angeleeta Greyeyes1, Timothy K Behrens, Ph.D,1, Mina Liebert, MS, MCHES2, Jay Sutliffe, PhD, RD1, Aubrey Day, MPH3, Jennifer Howard Smith, PhD4 and Jodi L. Mack4
(1)Northern Arizona University, Flagstaff, AZ, (2)El Paso County Public Health Department, Colorado Springs, CO, (3)YMCA of the Pikes Peak Region, Colorado Springs, CO, (4)Applied Research Solutions, Inc., Colorado Springs, CO
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
Purpose: To examine the impact of a district-wide food policy and preparation change in elementary schools.
Methods: This longitudinal observation examined changes in school lunch preparation methods following policy changes at elementary schools in a high need school district. Specifically, this study examined changes in side items (fruits, vegetables, potatoes, breads, and desserts). In Phase 1 (January 2009-May 2010) baseline data were collected. During Phase 2, (August 2010- May 2011), breaded and processed foods were removed and chefs were trained on scratch cooking methods. Phase 3 (August 2011-December 2012) saw an increase in fresh/frozen fruits and vegetables. During Phase 4 (January 2013 to present) chef consulting and training took place. The frequency of side offerings were tracked across phases. Because of limited sample sizes, data from phases 2-4 (intervention phases) were combined for potatoes and desserts. Descriptive statistics were calculated. After adjusting for length of time for each phase, Pearson chi-square tests were conducted to examine changes in offerings of side items by phase.
Results: Fresh fruit offerings increased and canned fruit decreased in Phases 1-4 (p=.001). A significant difference was observed for vegetables (p=.001), with raw and steamed vegetables increasing and canned vegetables decreasing from Phase 1-4. Fresh potatoes (low in sodium) increased and fried potatoes (high in sodium) decreased from Phase 1 to Phases 2-4 (p=.001). Breads were eliminated entirely in Phase 2 and dessert changes were not significant (p=.927).
Conclusion: This approach to promoting healthier lunch sides is a promising paradigm for improving elementary cafeteria food.
Conduct evaluation related to programs, research, and other areas of practice Implementation of health education strategies, interventions and programs Planning of health education strategies, interventions, and programs Public health or related public policy
Abstract
Evaluation of Comprehensive and Coordinated Health Education in a Large Urban School District
Rachael Dombrowski, MPH1 and Julia Goetten, M.Ed.2
(1)Wayne State University, Detroit, MI, (2)Chicago Public Schools, Chicago, IL
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
Background:
Socioeconomic disparities are abundant among the nearly 400,000 Chicago Public Schools (CPS) students, as 87% are from low-income families and 47% are overweight or obese. The CPS Office of Student Health and Wellness is working to address these disparities through provision of Comprehensive and Coordinated Health Education (CCHE) that is aligned with national standards, supports current efforts in physical education, nutrition and sexual health, and includes a connection to school-based health services.
Methods:
The CCHE pilot project was evaluated over the 2015-16 school year in 25 participating schools. Schools were charged with providing health education instruction (for at least 60 minutes per week) centered around the Whole School, Whole Community, Whole Child model and also provided health services to all students (PreK-12). The evaluation used a mixed methods approach to garner lessons learned from program implementation and effectiveness of CCHE delivery. The primary data sources for implementation outcomes included pre and post measurements of: a survey conducted with school staff; classroom observations of health education lesson delivery; and interviews with school administrators and health education teachers/leaders.
Results:
Findings on outcomes as related to effective program implementation, increased knowledge and awareness in implementing CCHE among school staff and lessons learned for expanding the pilot district-wide (to all 668 schools) will be shared.
Conclusions:
Conclusions will articulate successes and barriers in implementing CCHE throughout a large, urban school district. Lessons learned from partner and teacher training and health service coordination will provide a national model for other schools to implement CCHE.
Administer health education strategies, interventions and programs Conduct evaluation related to programs, research, and other areas of practice Implementation of health education strategies, interventions and programs Other professions or practice related to public health Planning of health education strategies, interventions, and programs Provision of health care to the public
Abstract
Altering the school breakfast environment reduces barriers to school breakfast participation among diverse rural youth: BreakFAST study
Mary Hearst, MPH, PhD1, Qi Wang, MS2, Amy Shanafelt, MPH2, Marilyn S. Nanney, PhD, MPH, RD2 and Robert Leduc, PhD2
(1)St. Catherine University, St. Paul, MN, (2)University of Minnesota, Minneapolis, MN
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
Background: The purpose is to determine if altering school breakfast policies and the school breakfast environment will positively impact adolescent beliefs of the barriers and benefits of eating breakfast.
Methods: Participants were 904 adolescents from 16 rural high schools in Minnesota who reported eating breakfast fewer than 3 times per week at baseline. Schools were randomized to intervention including school policy and environmental change (n=8 schools) or control (delayed intervention) condition. The intervention lasted one school year. Students completed an online survey of breakfast eating behaviors and beliefs of barriers and benefits of eating breakfast at baseline and follow-up. Summative scales were created. Bivariate and multivariate linear regression, accounting for clustering by school, was performed using SAS. Sex interaction was tested. Models tested the effect of the intervention on follow-up scales, with baseline adjustment.
Results: Participants were 54% female, 69.1% white, 36.6% eligible for free or reduced price meals (FRM) and 13.1 % of families received public assistance. The change in reported barriers was significantly different in intervention versus control schools (Net difference = 1.0, p=0.03). There was no intervention effect of perceived benefits.
Conclusions: A school based policy and environmental change intervention can successfully reduce perceived barriers to eating school breakfast. This study has important lessons for schools who aim to improve school breakfast participation.
Implementation of health education strategies, interventions and programs
Abstract
Creative Before & After School Programs for Success (CAPS): Turning a food desert into a gardening experience at the school-site
Magali Cardenas, BS1, Ashley Wang, BS1, Katherine Alberto, BA1, Nina Nguyen, BA2, Frecia Gonzalez, BS, MPH1, Elizabeth Holzhauser, CHES, DrPH3 and Patti Herring, PhD, RN3
(1)Loma Linda University, School of Public Health, Loma Linda, CA, (2)Loma Linda University, Loma Linda, CA, (3)Loma Linda University School of Public Health, Loma Linda, CA
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
People trapped in “food desert” communities have low access to fresh produce, limited transportation, and an overabundance of fast food establishments, resulting in diets high in fat, sugar, and calories. These factors contribute to higher rates of obesity, diabetes, and heart disease. To address this problem, a group of MPH students conducted a needs assessment with staff, parents, and students at Muscoy Elementary School in Muscoy, CA in San Bernardino County. The majority of the residents are Latino, with 1/3 living below the federal poverty line. Data were collected through a windshield survey, site observations, literature reviews, six theory-based key informant interviews, and a focus group. Using Grounded Theory, data were transcribed, analyzed, and coded for emerging themes. Data revealed that barriers to eating healthy included time for preparation, distance to grocery stores, poor quality and expensive produce sold at nearby liquor marts, and not liking the taste of fresh produce. This program includes hydroponic garden towers in which students and their families can grow fruits and vegetables together, and a health curriculum portion. Parental participation is vital for a positive and long-term influence over the children's eating habits since providing meals is parents' chief responsibility. Excess produce from the garden towers would be sold at low prices to community members at the school's farmer's market, increasing the Muscoy community's access to healthy food choices. A pilot program was developed, implemented, and evaluated using process and impact evaluation for program improvement. Results will be discussed in light of program sustainability.
Assessment of individual and community needs for health education Diversity and culture Planning of health education strategies, interventions, and programs Program planning Public health or related education
Abstract
Classroom Plate-waste Findings Demonstrate Impacts from School-based Intervention
Jini Puma, PhD, Max Young, RD, LDN, Julie Atwood, MNM, Heather Owen, BS, BA and Courtney Jacobson, MSW, MNM
University of Colorado Denver, Aurora, CO
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
Background: In the last four decades, the obesity rate for children ages 6-11 has more than quadrupled. School-based nutrition education programs have the opportunity to improve children's health and prevent chronic diseases. Increased consumption of fruits/vegetables can decrease one's risk of obesity and related chronic illnesses.
Description: The Integrated Nutrition Education Program (INEP) addresses the need for healthy, life-long nutrition behaviors by educating children and their families through a school-based intervention. In alignment with the social ecological model, nutrition education is provided to the student and parent, while evidence-based policy and environmental changes are implemented.
Methods: Student fruit/vegetable consumption were assessed using a quasi-experimental study design. Classroom plate-waste data were collected in 13 (7 intervention, 6 control) classrooms in 2013-2014 and 14 classrooms (8 intervention, 6 control) in 2014-2015. Consumption of 3 fruits and vegetables and 2 INEP salad recipes were assessed between intervention and control students each year.
Results: Statistically significant differences were found between intervention vs. control students, in consumption of snap peas (p<.01) and INEP recipes (Chinese Noodle Salad (p < .001) and Couscous Salad (p<.001)) across both years. A statistically significant difference was observed between groups in consumption of mango (p < .05) and jicama (p < .001) for one year only.
Implications: School-based childhood obesity prevention models that incorporate the social ecological model are more likely to be effective, as shown by INEP. The program model, its results, and implications of taking a public health approach to obesity prevention in school settings will be discussed.
Conduct evaluation related to programs, research, and other areas of practice Implementation of health education strategies, interventions and programs Planning of health education strategies, interventions, and programs
Abstract
Hip Hop H.E.A.L.S. (Healthy Eating And Living in Schools): The feasibility of a school-based integrated nutrition and math curriculum to improve menu board calorie literacy
Ellyn Leighton-Herrmann, PhD1, Vanessa Sawyer, MS RD2, Monique Hedmann, MPH1, Wei-Jen Hsieh, MD MSED3 and Olajide Williams, MD MS4
(1)Columbia University Medical Center, New York, NY, (2)Harlem Hospital, New York, NY, (3)Seattle Children's Hospital, University of Washington, Seattle, WA, (4)Columbia University College of Physicians and Surgeons, New York, NY
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
Fast food consumption and childhood obesity are greater among minority children living in urban environments. Better food choices within fast food restaurants can have a significant impact on weight-gain. However, low literacy and numeracy hinder the effectiveness of menu board calorie postings. “Menu board calorie literacy” (MBCL) requires an understanding of relevant abbreviations, serving sizes, calorie ranges, simple math, and recommended daily caloric intake.
We pilot tested Hip Hop HEALS (HHH), a 20-hour, after-school, integrated nutrition and math curriculum designed to improve MBCL. A class of 5th-grade students participated in the 20 one-hour lessons conducted over 12 weeks. HHH incorporated child-centric Hip Hop music and media (e.g., songs, cartoons, comic books), and math Common Core standards to address healthy MBCL, food choices, and energy balance. Students completed a 9-item MBCL assessment at baseline, immediately following the intervention, and 10-weeks post-intervention. Data were analyzed using descriptives and means comparisons.
Seventeen students completed the pre-test, 13 immediate post-test, and 14 delayed post-test. The average MBCL score increased from 51.6% at baseline to 82.9% at immediate post-test (31.3%, p<.01), and 78.6% at 10-weeks post-intervention (27.0%, p<.01). Students reported positive attitudes toward the inclusion of math problems and real-world math and nutrition applications. Program strengths included the entertainment education framework, instructiveness, and use of chain restaurant menu board photographs. Overall, the program demonstrated high acceptability and engagement with the students.
HHH presents a viable option for teaching nutrition and MBCL to 5th grade students using a math-based approached in the after-school setting.
Implementation of health education strategies, interventions and programs Public health or related education Public health or related research Social and behavioral sciences
Abstract
Pilot Light: A Chicago-Based Multidisciplinary Program Building Food and Nutrition Education into School Classrooms and Cafeterias
Alexandra DeSorbo, MPH and Kendra Julion, MS
Pilot Light, Chicago, IL
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
In Chicago, Illinois, rates of childhood overweight and obesity are nearly double the national estimate. At the same time, teachers and students face high pressure to meet academic performance standards and school hours previously devoted to health are often the first to be dropped in favor of the core curriculum.
In an effort to bring food and nutrition back into school curriculum, Pilot Light was founded in Chicago by a multidisciplinary team of chefs, teachers, and health educators. In the program, chefs partner with teachers to develop and deliver standards-aligned classroom lessons for Kindergarten-6th grade that build food and nutrition education into core subjects, such as math and English. The lessons are augmented by a chef-designed lunch served in the cafeteria, where students make connections between the food on their plates and lessons learned in the classroom. Evaluation of the program was conducted through surveys conducted with parents and students.
Results indicate that the program is effective at facilitating conversation in the home around food. Among a sample 140 3rd, 4th, and 5th grade student participants, 83.5% of students share with their parents what they learned, 86% are confident asking their parents about the source of their food, and 90% report feeling confident asking their parents about how healthy their food is.
This presentation will describe Pilot Light's model and impact, its strengths as a multi-disciplinary approach to program development in health education, and lessons learned as the program moves to expand to reach more schools and communities through Chicago.
Administer health education strategies, interventions and programs Conduct evaluation related to programs, research, and other areas of practice Implementation of health education strategies, interventions and programs Planning of health education strategies, interventions, and programs Program planning
Abstract
Active Kids Campaign: Increasing Physical Activity, Nutrition and PSE Change in Schools
Hannah Laughlin, MPH, Amy Moyer, MPH, RD and Heidi Milby, MPH
Action for Healthy Kids, Chicago, IL
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
Introduction: Schools are great places to get kids active! Through the School Grants for Healthy Kids: Active Kids Campaign, Action for Healthy Kids has worked with almost 800 schools over the past three school years to increase school-based physical activity and improve their policy, environmental and system to support active students, parents and communities.
Methods: Schools worked to add components of a comprehensive school physical activity plan to their student's day to increase physical activity (PA) minutes and had the opportunity to add a nutrition initiative as well for a holistic school wellness program. In addition, schools engaged family and community members through the nationally recognized Every Kid Healthy Week and other volunteer engagement opportunities.
Results: Schools reported an average increase of 16 minutes of additional of physical activity a day as well as themes related to increased awareness of the importance of PA, increased PA, increase student participation and engagement, improved student focus/behavior and teacher support. In addition, nutrition initiatives showed themes of increased awareness and enthusiasm around nutrition, improved student food choices and the benefits of school gardens. Schools also reported policy, environmental and systems changes as well that positively impact school wellness.
Discussion: Using an innovative model, Action for Healthy Kids is helping schools implement wellness initiatives, improve student physical activity and nutrition behaviors and address school policy, systems and environmental changes.
Conduct evaluation related to programs, research, and other areas of practice Implementation of health education strategies, interventions and programs
Abstract
Fat phobias of undergraduate student school nurses
Michael Young, PhD1, Larry Olsen, MAT, MPH, DrPH, MCHES2, Adriana Pena De La Cruz, BS3 and Anup Amayta, PhD4
(1)Center for Evidence-Based Programming, Hot Springs National Park, AR, (2)A.T. Still University, Kirksville, MO, (3)None, Las Cruces, NM, (4)New Mexico State University, Las Cruces, NM
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
Every day, thousands of students visit school nurse offices. Bullying because students are obese or overweight is one of the most frequent causes of these visits. Data show that obese children are 65% more likely to be bullied, and overweight children are 13% more likely to be bullied than their normal weight peers. The school nurse is often the first person the bullied child contacts, but what might transpire if the school nurse has negative attitudes toward obesity and overweight individuals? The purpose of the present study was to assess the fat phobias of a select group of undergraduate nurses who indicated they wanted to be school nurses. Following IRB approval, an e-mail survey that contained a valid and reliable 14 item “Fat Phobia” instrument (Bacon, Scheltema, & Robinson, 2001) was sent to approximately 2,200 student nurses. A total of 126 of 220 respondents indicated they were interested or very interested in becoming school nurses. There were no significant item differences between those who were interested versus those who were very interested in becoming school nurses. The average item mean score for the 14 items was 3.06, which indicates that in this sample there was a fat bias. The attitudes of aspiring school nurses toward obese and overweight youth could adversely affect their interactions with overweight or obese youth. These types of biases should be addressed in professional preparation or in-service programs for school nurses so they understand that their personal biases and attitudes could affect their interaction with youth.
Provision of health care to the public Public health or related nursing Social and behavioral sciences
Abstract
Role of School Nurses in Early Detection of Eating Disorders: An Application of PAPM and the 5 A's Approach
Jamie Dowling Tawes, MPH, BSW1, Amy Thompson, Ph.D., CHES2, Candace Hendershot, PhD, RN , MS, MA, NCSN, FASHA3, Joseph Dake, PhD2 and Debra Boardley, PhD, RD, LD, FAND2
(1)The University of Toledo, Toledo, OH, (2)University of Toledo, Toledo, OH, (3)University of Findlay, Findlay, OH
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
Background: Eating disorders are serious conditions and have the highest mortality rate of all psychiatric disorders. They most often manifest in adolescence. The severity of the health impact, typical age of onset, and challenges related to treatment, all demonstrate a need to focus on early intervention. School nurses have access and ability to monitor student well-being, and this can include eating disorders. This study is assessing school nurses to measure current perceptions and practices regarding students with eating disorders.
Methods: An email survey was sent to a random sample of 3,001 members of the National Association of School Nurses (NASN). The survey used was created from a comprehensive review of the literature and was based on Precaution Adoption Process Model and 5 “A”s of intervention. The survey was reviewed by experts in the field and was tested for psychometrics using stability, reliability and Cronbach alpha.
Results: Data collection began January 2016 and 40% response rate is anticipated. There is some evidence that school nurses are not engaging in screening and assisting students with eating disorders.
Discussion: Eating disorders are serious health conditions that affect school aged youth. Early diagnosis and treatment are associated with improved treatment outcomes. School nurses monitor and screen school children for a variety of health issues. School nurses could help identify and provide resources for students with these disorders.
Administer health education strategies, interventions and programs Basic medical science applied in public health Other professions or practice related to public health Public health or related education Public health or related nursing