Journal of Nutrition Education and Behavior

Good Outcomes with WIC Continue

Karen Chapman-Novakofski — 2012-05-01

The May, 2010 JNEB supplement was focused on research within the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) program. With 5 Research Articles, 1 Research Brief, 2 Reports, and 2 GEMs, the issue provides compelling reasons that the WIC program is successful and moving forward to be even better.

Few Associations between Income and Fruit and Vegetable Consumption

Amanda L. Middaugh, Paul S. Fisk, Ardith Brunt, Yeong S. Rhee — 2012-03-26

Abstract: Objective: To examine the association between income and the consumption of fruits and vegetables using the poverty income ratio (PIR).Design: Association between PIR and intake of fruits and vegetables combined. The PIR was divided into 5 groups ranging from < poverty threshold (PT) to ≥ 400% PT.Participants: Adults aged 18 years and older (N = 16,232) who participated in the 1999-2006 National Health and Nutrition Examination Survey and fit the qualifiers.Main Outcome Measures: The amount of combined fruit and vegetable intake based on income level.Analyses: Using ANCOVA, a base model with increasing number of covariates was analyzed.Results: Mean daily intake ranged from 253-324 g for those who consumed both fruits and vegetables (N = 16,213). In the base model, significant differences in intake occurred between those who were at ≥ 400% PT and PIR groups < 400. When age, sex, race/ethnicity, and calorie intake were added to the base model, these differences remained. Adding educational level to the model removed these differences.Conclusions and Implications: Dietary intake of fruits and vegetables is directly related to income when income reaches levels of ≥ 400% PT. These differences are mediated by education. Providing nutrition education may help individuals to reach the recommended level of consumption of fruits and vegetables.

Revised WIC Food Package Improves Diets of WIC Families

Shannon E. Whaley, Lorrene D. Ritchie, Phil Spector, Judy Gomez — 2012-03-14

Abstract: Objective: To explore the impact of the new Special Supplemental Nutrition Program for Women, Infants and Children (WIC) food package on WIC participant consumption of fruit, vegetables, whole-grain food, and lower-fat milk.Design: Telephone surveys of cross-sectional samples of California WIC families before and after the changes to the food package.Participants: Random samples of pregnant or postpartum women and/or caregivers of children enrolled in WIC: 3,004 in September, 2009; 2,996 in March, 2010.Main Outcome Measures: Consumption of fruit, vegetables, whole-grain food, and lower-fat milk.Analysis: Comparisons of outcome variables were made by examining the differences by time point, adjusted for sociodemographic variables, using ANOVA (for means) or logistic regression (for percentages).Results: Following the changes to the WIC food package, consumption of whole-grain food increased by 17.3 percentage points, a 51% increase over baseline. Caregivers and children who usually consumed whole milk decreased by 15.7 and 19.7 percentage points, respectively, a 60%-63% reduction over baseline. Accompanying increases in lower-fat milk consumption were demonstrated. Small but significant increases in consumption of fruits and vegetables were also observed.Conclusions and Implications: Federal policy changes to the WIC program had the intended effect of increasing consumption of the prescribed food items.

The Impact of WIC Food Package Changes on Access to Healthful Food in 2 Low-Income Urban Neighborhoods

2012-03-09

Abstract: Objective: To evaluate the impact of the 2009 food package changes for the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) on the availability of healthful food.Design: Survey of all food stores in the study area before and after the changes were implemented.Setting: Two low-income neighborhoods in Philadelphia, 1 predominantly African-American, the other predominantly Hispanic.Participants: One hundred forty one supermarkets, grocery stores, and non-chain corner stores identified through field enumeration.Main Outcome Measures: Nutrition Environment Measure Survey for Stores (NEMS-S) to determine availability, price, and quality of fruit, vegetables, milk, cereal, beans, canned fish, meat, whole grains, and juice.Analysis: Comparison of NEMS-S scores before and after food package changes using t tests and ordinary least squares regression to understand the role of supermarket status, WIC participation, and racial and income composition in predicting NEMS-S scores; geographic information systems to calculate proximity of residents to food stores.Results: The availability of healthful food increased significantly in stores, overall, with more substantial increases in WIC-authorized stores. Supermarket status, WIC retail status, and NEMS-S scores at baseline were significant predictors of NEMS-S scores after the food package changes.Conclusions and Implications: Changes in the WIC food package were associated with increased availability of healthful food in 2 low-income neighborhoods.

Associations of Built Food Environment with Dietary Intake among Youth with Diabetes

2012-01-12

Abstract: Objective: To evaluate the associations of supermarket and fast-food outlet accessibility and availability with dietary intake among youth with diabetes.Design: Subjects’ residential location and dietary intake was obtained from the SEARCH for Diabetes in Youth study. Food outlet data obtained from the South Carolina Department of Health and Environmental Control and InfoUSA were merged based on names and addresses of the outlets. The comprehensive data were then used to construct accessibility and availability measures for each participant.Setting: State of South Carolina.Participants: Three hundred fifty-nine youths with diabetes (10 years old and older) from the SEARCH for Diabetes in Youth study.Phenomena of Interest: Supermarket and fast-food outlet accessibility and availability; dietary intake represented by Dietary Approaches to Stop Hypertension (DASH) score.Analysis: Generalized estimating equations analyses.Results: Increased availability and accessibility of supermarkets were significantly associated with higher DASH score, even after adjusting for individual-level correlates, urbanicity, and fast-food outlet accessibility or availability. Fast-food accessibility, however, was associated only with specific food groups (meat, sweets, and low-fat dairy intake), not with the DASH score.Conclusions and Implications: Efforts to promote environments conducive to healthful eating may significantly improve the overall dietary intake and reduce diet-related health complications among youth with diabetes.

A Point-of-Purchase Intervention Featuring In-Person Supermarket Education Affects Healthful Food Purchases

Brandy-Joe Milliron, Kathleen Woolf, Bradley M. Appelhans — 2011-11-21

Abstract: Objective: This study tested the efficacy of a multicomponent supermarket point-of-purchase intervention featuring in-person nutrition education on the nutrient composition of food purchases.Design: The design was a randomized trial comparing the intervention with usual care (no treatment).Setting and Participants: A supermarket in a socioeconomically diverse region of Phoenix, AZ. One hundred fifty-three adult shoppers were recruited onsite.Intervention: The intervention consisted of brief shopping education by a nutrition educator and an explanation and promotion of a supermarket point-of-purchase healthful shopping program that included posted shelf signs identifying healthful foods, sample shopping lists, tips, and signage.Main Outcome Measures: Outcomes included purchases of total, saturated, and trans fat (grams/1,000 kcal), and fruits, vegetables, and dark-green/yellow vegetables (servings/1,000 kcal) derived through nutritional analysis of participant shopping baskets.Analysis: Analysis of covariance compared the intervention and control groups on food purchasing patterns while adjusting for household income.Results: The intervention resulted in greater purchasing of fruit and dark-green/yellow vegetables. No other group differences were observed.Conclusions and Implications: Long-term evaluations of supermarket interventions should be conducted to improve the evidence base and to determine the potential for influence on food choices associated with decreased chronic disease incidence.

Food Consumption Patterns in Mediterranean Adolescents: Are There Differences between Overweight and Normal-Weight Adolescents?

2011-02-08

Abstract: Objective: To quantify food consumption (based on food group classification) during several time periods in a sample of adolescents and to identify potential differences in food patterns between normal-weight and overweight participants.Design: Cross-sectional study. Participants were classified as normal weight and overweight/obese. Dietary intake was assessed by 3-day food records and analyzed at the food group level for 7 different time periods. To exploit the time dimension of the data and to further control for the influence of other covariates, the authors estimated a random effects regression model for panel data.Participants: One hundred twenty students.Setting: Two high schools.Results: In multivariate analysis, no statistically significant differences were found between normal-weight and overweight adolescents with regard to their consumption patterns throughout the day. However, compared to females, male participants had higher intake of all food groups with the exception of fruit, and adolescents engaging in vigorous exercise tended to consume more servings from all food groups during any given time period.Conclusions and Implications: No preferential use of some food or food groups in specific day periods was found among overweight compared to normal-weight high school students.

Parental Information, Motivation, and Behavioral Skills Correlate with Child Sweetened Beverage Consumption

L. Suzanne Goodell, Michelle B. Pierce, K. Rivet Amico, Ann M. Ferris — 2011-06-02

Abstract: Objective: To evaluate fit of the Information-Motivation-Behavioral Skills (IMB) model applied to sweetened beverage (SB) consumption in children.Design: Cross-sectional. Parents completed a home beverage inventory and IMB survey regarding SB consumption.Setting: Health fairs, Special Supplemental Nutrition Program for Women, Infants, and Children clinics.Participants: Convenience sample of 198 parents of low socioeconomic status.Main Outcome Measures: Independent variables included scores from 3 indices calculated from the IMB survey, information, motivation, and behavioral skills. The dependent variable was average child daily caloric consumption from SB consumption calculated from the home beverage inventory.Analysis: Structural equation modeling.Results: Parental information had direct and indirect negative relationships with SB consumption. Parental motivation was only indirectly associated with SB consumption mediated through behavioral skills. Parental behavioral skills had a negative correlation with SB consumption.Conclusions and Implications: In applying the IMB model to SB consumption, the authors found preliminary support for relationships between parental information, motivation, behavioral skills, and child SB consumption. Application of this model shows promise in identifying the complex interactions between factors influencing consumption behaviors. As nutrition educators frequently desire to alter behaviors, use of the IMB model may help with both targeting and assessment efforts.

An Examination of Sex Differences in Relation to the Eating Habits and Nutrient Intakes of University Students

2011-07-18

Abstract: Objectives: To examine sex differences in eating habits and nutrient intakes and explore whether eating habits mediate the effects of sex on nutrient intakes and whether sex moderates the effects of eating habits on nutrient intakes.Methods: Cross-sectional survey of eating habits and food-intake frequency in a convenience sample of college students.Results: Male students (n = 172) consumed a higher energy content from fat, a larger amount of fiber, and more fruits and vegetables, and engaged less often in various healthful eating habits (eg, reading food labels, having breakfast) than female students (n = 316). Sex predicted the 3 dietary nutrient intakes partially through eating habits. Interactions between sex and eating habits were nonsignificant.Conclusions and Implications: Results reinforce that university students’ nutrient intakes are less than ideal. Women and men may have different needs for nutritional improvement. However, the effects of health promotion concerning eating habits may be similarly effective between the sexes.

“Split Them!” Smaller Item Sizes of Cookies Lead to a Decrease in Energy Intake in Children

David Marchiori, Laurent Waroquier, Olivier Klein — 2012-03-05

Abstract: Objective: Examine the influence of altering the size of snack food (ie, small vs large cookies) on short-term energy intake.Methods: First- and sixth-graders (n = 77) participated in a between-subjects experimental design. All participants were offered the same gram weight of cookies during an afternoon tea at their school. For half of the participants, food was cut in 2 to make the small item size. Food intake (number of cookies, gram weight, and energy intake) was examined using ANOVA.Results: Decreasing the item size of food led to a decrease of 25% in gram weight intake, corresponding to 68 kcal. Appetitive ratings and subject and food characteristics had no moderating effect.Conclusions and Implications: Reducing the item size of food could prove a useful dietary prevention strategy based on decreased consumption, aimed at countering obesity-promoting eating behaviors favored by the easy availability of large food portions.

A Digital Program Informs Low-Income Caregivers of Preschool-age Children about Family Meals

Barbara Lohse, Robin Rifkin, Kristen Arnold, Christine Least — 2012-03-05

Abstract: Objective: To evaluate the digital program, Mealtime is Family Time, as a means of educating caregivers of preschoolers on the importance of family meals within the division of feeding responsibility framework.Methods: Descriptive design using 2 approaches: focus group program review and discussion or self-report survey after independent program review in low-income venues. All participants completed an inventory of child feeding practices.Results: About 75% of feedback survey respondents (n = 147) found the program understandable, easy to read, and helpful and expressed interest in child cues of hunger and satiety. Focus group findings corroborated program utility and were congruent with need for division of feeding responsibility implementation. For example, 39% of respondents reported that children must always or often taste mealtime food.Conclusions and Implications: Education about family meals and child feeding is critical; Mealtime is Family Time was well received by this low-income audience. Further development to measure practice of the division of feeding responsibility is warranted.

The Validation of a Food Label Literacy Questionnaire for Elementary School Children

2012-03-14

Abstract: Objective: To determine the reliability and validity of a 10-item questionnaire, the Food Label Literacy for Applied Nutrition Knowledge questionnaire.Methods: Participants were elementary school children exposed to a 90-minute school-based nutrition program. Reliability was assessed via Cronbach α and intraclass correlation coefficient (ICC). Validity was assessed comparing the questionnaire’s food choices using an objective metric of nutrition quality, the Overall Nutritional Quality Index (ONQI), via t test. Statistical significance was set at .05.Results: Four hundred ninety-nine children participated, 51% were female, and the average age was 8.6 (± 0.9) years. Cronbach α = .77 and ICC = 0.68 (between administrations) were observed. ONQI scores of correct responses were significantly higher when compared to the ONQI scores of incorrect responses (27.4 ± 9.4 vs 16.2 ± 9.4; P = .01).Conclusions and Implications: The Food Label Literacy for Applied Nutrition Knowledge questionnaire was found to be both reliable and a valid measure of food label literacy in children taught the Nutrition Detectives program.

Exploring the Feasibility of an Academic Course That Provides Nutrition Education to Collegiate Student-Athletes

Christine Karpinski — 2012-03-26

Abstract: The purpose of this article is to explore the delivery of nutrition education to collegiate student-athletes through an academic course. Existing literature has established the need for nutrition education among collegiate athletes. This article considers the collaboration of the university and the athletic department to better serve this population. Academic wellness courses for student-athletes can be used as models. Finally, benefits, barriers, and proposed course objectives are considered. This report proposes a potential solution to provide consistent, sustainable nutrition education to collegiate student-athletes.

Managing Clustered Data Using Hierarchical Linear Modeling

2012-01-12

Abstract: Researchers in nutrition research often use cluster or multistage sampling to gather participants for their studies. These sampling methods often produce violations of the assumption of data independence that most traditional statistics share. Hierarchical linear modeling is a statistical method that can overcome violations of the independence assumption and lead to correct analysis of data, yet it is rarely used in nutrition research. The purpose of this viewpoint is to illustrate the benefits of hierarchical linear modeling within a nutrition research context.

Farm Field Trips Provide Sensory-based Experiences with Fresh, Local Produce

Stacy Bevan, Tamara Vitale, Heidi Wengreen — 2012-05-01

Despite the health benefits of eating fruits and vegetables (FVs), less than 20% of children 9-13 years old are consuming the recommended 5 or more daily servings of FVs. Research has shown that vegetable intake is more difficult to change than fruit intake. Unlike many school-based FV programs, programs incorporating school gardens have shown significant increases in children’s vegetable consumption.

A Pocket Guide to Eating Disorders

Jo Britt-Rankin — 2012-05-01

Whether you specialize in eating disorders or see the occasional patient with an eating disorder, this pocket guide provides information ready to put into practice. This guide follows the Nutrition Care Process; applies language from International Dietetics and Nutrition Terminology; includes American Psychiatric Association criteria; provides insights on counseling and working with eating disorder patients; and offers sample nutrition diagnoses.

Making Nutrition Your Business, Private Practice and Beyond

Kendra K. Kattelmann — 2012-05-01

This book is a resource for the registered dietitian who is starting private practice and other nutrition-based businesses. The book covers the basics of getting started to exploring alternate ways for registered dietitians to capitalize on their unique qualifications.

2011 State of the World: Innovations that Nourish the Planet

Christine McCullum-Gomez — 2012-05-01

This resource contains a plethora of references spread throughout 15 chapters that cover a broad range of topics from how to chart a new path to end hunger through how to create a better road map for nourishing the planet in the future. A welcome feature is that the text includes a range of statistics and current trends, which are included throughout the book.

Veggiecation

Marissa Burgermaster — 2012-05-01

This innovative nutrition education program introduces young children to vegetables while incorporating healthful food and nutrition as a part of class time, lunchtime, and family time. By replacing food fears and resistance with ownership and positive peer pressure, children are empowered to expand their horizons while improving their nutrition knowledge.

2012-05-01

Editorial Board/Board of Directors