Jeanne Goldberg - Academia.edu (original) (raw)
Papers by Jeanne Goldberg
Journal of Hunger & Environmental Nutrition, Nov 5, 2020
This study evaluated the nutritional, economic, and environmental impacts of a Meatless Monday (M... more This study evaluated the nutritional, economic, and environmental impacts of a Meatless Monday (MM) National School Lunch Program (NSLP) in a large urban US school district. After averaging the nutrient content of entrees across the week and comparing changes relative to recommendations, there were no pre-post differences >15%. Monday entrees offered post-MM required considerably less water to produce (-51%) and were associated with fewer greenhouse gas emissions (-74%). The MM program had little impact on entrée cost (-2.5%). Further research is needed to determine how MM program goals can be achieved within the NSLP context.
Journal of Nutrition Education, 1990
Nutrition Reviews, 2004
The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguis... more The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Bruce M. Alberts is president of the National Academy of Sciences. The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Wm. A. Wulf is president of the National Academy of Engineering. The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute of Medicine. The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy's purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Bruce M. Alberts and Dr. Wm. A. Wulf are chair and vice chair, respectively, of the National Research Council.
Childhood Obesity, 2019
Background: Several studies have found that children in the United States gain weight at a faster... more Background: Several studies have found that children in the United States gain weight at a faster rate in the summer than in the school year, but little is known about the prevalence of this problem, its effect on high-risk subgroups, or its determinants. This study compares school year and summer weight change in a low-income, ethnically diverse sample of school-age children in Massachusetts and explores differences by race/ethnicity, weight status, and exposure to school year physical activity (PA) programming. Diet and PA are examined as potential mediators of summer weight gain. Methods: Children participating in a school-based PA program evaluation (in which weight change was not a primary outcome) had their height and weight measured three times between October 2015 and September 2016 to capture a school year and summer interval. Diet and PA patterns were assessed mid-school year and midsummer in a subsample of children. Mixed linear models were used to estimate the effect of season (school year vs. summer) on change in BMI and to examine the influence of race/ethnicity, weight status, and program (walk/run, classroom activity breaks, or control) on any observed effects. Structural equation models were used to explore diet and PA as mediators of seasonal weight change in a subsample of participants. Results: Of 769 participants, 53% were non-Caucasian, 40% were overweight or obese, and 58% were eligible for free or reducedprice school meals. BMI increased in both the school year and summer but increased more rapidly in the summer (0.046 kg/m 2 more per month, p = 0.007). Of the three tested interactions, statistical significance was only observed between season and program (v 2 = 14.90, p < 0.001); on average, children exposed to a school year walk/run program did not gain weight more rapidly during the summer, whereas children in the control group and a classroom activity breaks program did. Poorer diet and PA patterns were observed in the summer, but neither diet nor PA was statistically significant mediators of BMI change. Conclusions: Children in this high-risk sample gained weight at a faster rate during the summer than during the school year, with no discernable demographic differences. However, this phenomenon was not observed in the subgroup exposed to a school year walk/run program. More research is needed to clarify the determinants of summer weight gain and understand how school year programming and its effects can be transferred to the summer months.
Preventing Chronic Disease, Nov 1, 2011
To build on a growing interest in community-based obesity prevention programs, methods are needed... more To build on a growing interest in community-based obesity prevention programs, methods are needed for matching intervention strategies to local needs and assets. We used the Community Readiness Model (CRM), a structured interview guide and scoring system, to assess community readiness to act on childhood obesity prevention, furthering a replication study of a successful intervention.Using the CRM protocol, we conducted interviews with 4 stakeholders in each of 10 communities of similar size, socioeconomic status, and perceived readiness to implement a community-wide obesity prevention intervention. Communities were in California, Florida, Illinois, Massachusetts, New York, North Carolina, Pennsylvania, and Tennessee. The 4 stakeholders were the mayor or city manager, the school superintendent, the school food service director, and a community coalition representative. Interviews were recorded and professionally transcribed. Pairs of trained reviewers scored the transcriptions according to CRM protocol. The CRM assesses 9 stages of readiness for 6 dimensions: existing community efforts to prevent childhood obesity, community knowledge about the efforts, leadership, community climate, knowledge about the issue, and resources. We calculated an overall readiness score for each community from the dimension scores.Overall readiness scores ranged from 2.97 to 5.36 on the 9-point scale. The mean readiness score, 4.28 (SD, 0.68), corresponds with a "preplanning" level of readiness. Of the 6 dimensions, community climate varied the least (mean score, 3.11; SD, 0.64); leadership varied the most (mean score, 4.79; SD, 1.13).The CRM quantified a subjective concept, allowing for comparison among 10 communities. Dimension scores and qualitative data from interviews helped in the selection of 6 communities for a replication study. Community Efforts and Community Knowledge of Efforts Using a scale from 1 to 10, how much of a concern is childhood obesity in your community (with 1 being "not at all" and 10 being "a very great concern")? Please explain.Describe current efforts in your community to address childhood obesity.For how long have these efforts been going on in your community?Using a scale from 1 to 10, describe how aware people in your community are of these efforts (with 1 being "no awareness" and 10 being "very aware"). Please explain.What does the community know about these efforts or activities (eg, logistics, goals, participants)?What are the strengths of these efforts?What are the weaknesses of these efforts? What formal or informal policies, practices, and laws related to childhood obesity are in place in your community, and for how long? Prompt: A "formal" policy would be an established policy in schools. An informal policy would be an "unsaid rule" or pattern of behavior. Leadership Who are leaders/community champions specific to the childhood obesity issue in your community? Using a scale from 1 to 10, how much of a concern is childhood obesity to the leadership in your community (with 1 being "not at all" and 10 being "of great concern")? Please explain.How are leaders getting involved in this issue? Prompt: Are they involved in a committee, a task force? How often do they meet?Would leadership support additional efforts and services? Please explain. Community Climateb What are community perceptions of childhood overweight? What are the primary obstacles to efforts addressing this issue in your community (eg, language, competing interests, structure of the school district)? Knowledge About the Issue How knowledgeable are community members about childhood obesity? Prompt: Are they familiar with signs, symptoms, effect on family?What type of information is available in your community regarding childhood obesity?What local data are available on this issue in your community?How do people obtain this information in your community? Resources for Prevention Efforts To whom would an individual affected by childhood obesity turn to first for help in your community? Why?What is the community's and/or local business's attitude about supporting efforts to address this issue, with people volunteering time, making financial donations, and/or providing space?Are you aware of any proposals or action plans that have been submitted for funding that address childhood obesity in your community? If yes, please explain.Do you know if there is any evaluation of efforts that are in place to address this issue? If yes, on a scale of 1 to 10, how sophisticated is the evaluation effort (with 1 being "not at all" and 10 being "very sophisticated")?How are the evaluation results being used (ie, to make changes in programs)?Open in a separate windowa Nonanchored questions are presented in italics. The Community Readiness Model interview protocol (29) includes anchored questions (required) and nonanchored questions (optional).b The Tri-Ethnic Center for Prevention Research, which developed the interview protocol for the Community Readiness Model, recommends the inclusion of 21 anchored questions (29). The protocol used for this project included 20 anchored questions. In the category Community Climate, a nonanchored question (What are community perceptions of childhood overweight?) was used to replace an anchored question (How does the community support the efforts to address this issue?).
Childhood obesity, Jun 1, 2019
Background: Several studies have found that children in the United States gain weight at a faster... more Background: Several studies have found that children in the United States gain weight at a faster rate in the summer than in the school year, but little is known about the prevalence of this problem, its effect on high-risk subgroups, or its determinants. This study compares school year and summer weight change in a low-income, ethnically diverse sample of school-age children in Massachusetts and explores differences by race/ethnicity, weight status, and exposure to school year physical activity (PA) programming. Diet and PA are examined as potential mediators of summer weight gain. Methods: Children participating in a school-based PA program evaluation (in which weight change was not a primary outcome) had their height and weight measured three times between October 2015 and September 2016 to capture a school year and summer interval. Diet and PA patterns were assessed mid-school year and midsummer in a subsample of children. Mixed linear models were used to estimate the effect of season (school year vs. summer) on change in BMI and to examine the influence of race/ethnicity, weight status, and program (walk/run, classroom activity breaks, or control) on any observed effects. Structural equation models were used to explore diet and PA as mediators of seasonal weight change in a subsample of participants. Results: Of 769 participants, 53% were non-Caucasian, 40% were overweight or obese, and 58% were eligible for free or reducedprice school meals. BMI increased in both the school year and summer but increased more rapidly in the summer (0.046 kg/m 2 more per month, p = 0.007). Of the three tested interactions, statistical significance was only observed between season and program (v 2 = 14.90, p < 0.001); on average, children exposed to a school year walk/run program did not gain weight more rapidly during the summer, whereas children in the control group and a classroom activity breaks program did. Poorer diet and PA patterns were observed in the summer, but neither diet nor PA was statistically significant mediators of BMI change. Conclusions: Children in this high-risk sample gained weight at a faster rate during the summer than during the school year, with no discernable demographic differences. However, this phenomenon was not observed in the subgroup exposed to a school year walk/run program. More research is needed to clarify the determinants of summer weight gain and understand how school year programming and its effects can be transferred to the summer months.
Journal of Hunger & Environmental Nutrition, May 1, 2019
Limited research has examined the rapid growth of farm to school (FTS) programs in the US. Qualit... more Limited research has examined the rapid growth of farm to school (FTS) programs in the US. Qualitative interviews (n = 24) framed by Diffusion of Innovations theory were used to explore FTS program adoption and expansion in Massachusetts. Program compatibility and relative advantages related to academics, school meal participation, and child health motivated initial engagement. Active classroom integration, implementation simplification, and strong support networks aided program expansion. Leadership and sustainability plans, garden maintenance partnerships, and Community Eligibility Provision participation hold promise to help further program diffusion. Future research should focus on providing additional evidence for FTS aspects salient to adoption and expansion.
Journal of the Academy of Nutrition and Dietetics, 2020
To improve cultural competency. Target Audience: Graduate students participating in nutrition cou... more To improve cultural competency. Target Audience: Graduate students participating in nutrition counseling courses. Theory, Prior Research, Rationale: The Campinha-Bacote Model of Cultural Competence in the Delivery of Health Care Services was used to design, implement, and evaluate two graduate nutrition counseling classes. Five interdependent constructs of this model include cultural awareness, cultural knowledge, cultural skill, cultural encounter, and cultural desire. Cultural competence is influenced by working on any of these areas and strengthens the impact of the others. Description of Course and Curriculum: Each assignment and activity addressed one or more of the constructs of the model. Examples included participation in a simulation to stimulate self-awareness, using respondent driven interview questions to develop skills, and conducting a nutrition and cultural assessment of an individual addressed encounter. Evaluation: A repeated measure ANOVA evaluated pre-and post-test cultural competence scores (n¼34). Content analysis assessed impressions of course effectiveness. The overall cultural competence score significantly improved (p<0.001) from ''culturally aware'' (68.7 at pre-) to ''culturally competent'' (78.7 at post-). Students significantly improved (p<0.001) four constructs of the model including awareness, knowledge, skill, and encounter. Factor analysis indicated course activities accounted for 83.2% and course assignments accounted for 74.6% of the total variance of cultural competence. Conclusion and Implications: An activity-based counseling course encouraging self-evaluation and reflection and addressing awareness, knowledge, skill, and encounters significantly improved cultural competence. Because factor analysis showed that activities and assignments aligned with the model constructs, the findings of this study can help guide health educators to design effective cultural competence training programs.
Journal of the Academy of Nutrition and Dietetics, Jan 6, 2016
Appetite, Nov 1, 2021
Snacks contribute nearly one-quarter of children's daily energy intake in the USA. Snack time... more Snacks contribute nearly one-quarter of children's daily energy intake in the USA. Snack time therefore represents an opportunity for parents to provide foods with key nutrients. Instead, the most common snack foods are major contributors to children's consumption of added sugars and sodium. Parents face major barriers to providing healthier snacks, including perceptions of high cost and lack of child acceptance. We obtained both economic and qualitative data to inform and optimize interventions for parents to promote vegetable snacks for children. We conducted a survey with parents (n = 368) to estimate how much of a discount would influence vegetable snack purchases by estimating willingness-to-pay using the contingent valuation method, using baby-cut carrots as a sample product. We conducted three focus groups (n = 19) and 1 group interview (n = 2) with children to help understand how to increase the appeal of vegetable snacks. Most (70%) parents accepted the reference price for the vegetable snack. Among those who did not, contingent valuation analysis revealed that a mean discount of approximately 30% would shift consumers to purchasing the snack. Focus group results revealed that the appeal of vegetable snacks to children was influenced by how they were prepared and presented, and the child's familiarity with the vegetables and ability to choose among them. This study lays the groundwork for effective interventions to promote the provision of vegetable snacks by parents.
Journal of the American Dietetic Association, 1999
The first objective of this research was to define a target population of African-American women ... more The first objective of this research was to define a target population of African-American women more clearly. The second was to provide specific information about the needs and preferences of that population in order to design an effective, culturally relevant, community-based communications campaign to promote more healthful lifestyles. Data collection and analysis included the following: interviews with 10 community nutritionists and the director of the State Office of Nutrition, 6 focus groups with a total of 47 members of the target population, and direct observation and documentation of key community resources. This approach, called "triangulation," permits more in-depth understanding of issues, provides different perspectives on the problem, and helps ensure accuracy of conclusions. Interviews with nutritionists identified young African-American women as the appropriate target population for the campaign. These interviews and the focus-group discussions confirmed the acceptability of higher weight and better body-esteem among African-American women than among white women. Both the nutritionists and the focus-group members identified the need and desire for information and skills related to food preparation and provided specific direction for program content. Community observation confirmed the need for food markets with merchandise of consistently high quality, especially in the fresh and frozen produce sections. Observation also helped identify community services and programs. The 3 sets of data, which augmented a comprehensive literature review, provided a firm foundation for the campaign's design and development. Dietitians and nutritionists working in community settings can use triangulation to gain a better understanding of their populations in order to develop more effective interventions.
Journal of the American Dietetic Association, 2004
Since its release in 1992, the Food Guide Pyramid has become one of the most recognized nutrition... more Since its release in 1992, the Food Guide Pyramid has become one of the most recognized nutrition education tools in US history. As such, it has been subject to criticism, particularly in several recent media reports that implicate it as the culprit in America's current obesity epidemic. What these reports often overlook, however, is that the diets of many Americans do not adhere to the dietary guidelines illustrated by the Pyramid, refuting the notion that the Pyramid is the cause of the nation's obesity problem. Data indicate that the more likely causes of escalating obesity rates are increased per capita caloric consumption and larger portion sizes, along with a lack of adequate physical activity. Although the Pyramid graphic was designed more than a decade ago, it still communicates three key concepts that continue to be the cornerstone of federal dietary guidance: variety, proportionality, and moderation. As such, it remains a viable and relevant nutrition education tool, especially when used by dietetics professionals as a component of individualized , comprehensive nutrition education and behavior modification interventions. As the United States Department of Agriculture begins to investigate whether the food intake patterns illustrated by the Pyramid are in need of updating, research is urgently needed to determine how nutrition education tools, including the Pyramid, can be most effectively implemented to help consumers adopt healthful eating behaviors and to improve the public health of America.
Journal of the American Dietetic Association, 2003
Journal of the American Dietetic Association, 1998
Objective To examine the self-reported importance of taste, nutrition, cost, convenience, and wei... more Objective To examine the self-reported importance of taste, nutrition, cost, convenience, and weight control on personal dietary choices and whether these factors vary across demographic groups, are associated with lifestyle choices related to health (termed health lifestyle), and actually predict eating behavior.Design Data are based on responses to 2 self-administered cross-sectional surveys. The main outcomes measured were consumption of fruits
Journal of Nutrition Education, 1990
A self-administered questionnaire was used in a cross-sectional survey of 459 individuals, betwee... more A self-administered questionnaire was used in a cross-sectional survey of 459 individuals, between 55 and 89 years old, to identify topics in food and nutrition of greatest interest and concern to generally healthy, older individuals, and to estimate the extent to which relevant behaviors were related to those concerns. In this study, 84.9% of the married men engaged in food shopping and 83.4% in cooking at least some of the time. There were no gender-related differences in either health concerns or behaviors associated with those concerns. This suggests that nutrition education interventions for the elderly should be designed to appeal to both men and women. Food safety in the home and of the food supply were of great concern to more individuals than any diet and health topic explored, and were associated with several health purchasing and food handling behaviors. Among diet-related topics, con• cern about salt intake ranked first, followed by weight control, sugar intake, serum cholesterol, and nutritional adequacy of the diet. Concern about these topics and either diagnosis-related information or specific advice from the doctor were associated with reported dietary modifications. Print and audiovisual media were important sources of information about certain topics. This survey was conducted for the immediate purpose of guiding the content of a nutrition education video program for the elderly. However, the information obtained can also be used for the development of other types of programs.
Journal of Nutrition Education, 1989
Journal of Nutrition Education, 1970
Journal of Nutrition Education, 2000
The purpose of this study was to test an ecological model designed to identi@ social and environm... more The purpose of this study was to test an ecological model designed to identi@ social and environmental factors that encourage local produce buying. Pre-and postintervention surveys in June and September 1997 measured local produce purchasing and factors identified by the model.At three mid-sized worksites in a rural Maine community, the response rate was 68% (135 employees) preintervention and 61% (124) postintervention. For 6 weeks, workers were given the opportunity to order local produce at work; to see, taste, and read about the produce; and to see coworkers sample and buy it. Associations were examined between increased purchases of locally grown produce outside the workplace and ordering at work, proportion of friends who ordered, degree of satisfaction with orders ascribed to coworkers, and degree of satisfaction with the project ascribed to management. McNemar's test and chi-square analyses were the statistical analyses performed. Purchasing locally grown produce at work apparently motivated consumers to purchase local produce outside the workplace. Workers' observations of coworker and management participation in and satisfaction with the project were associated with increased purchasing outside the workplace. Sales at worksites offer a potentially important way to increase purchases oflocally grown produce.
Journal of Health Communication, 1999
The Sisters Together, Move More Eat Better pilot communication program focuses on young Black wom... more The Sisters Together, Move More Eat Better pilot communication program focuses on young Black women in three inner-city communities to encourage improved nutrition and increased physical activity. The design for Sisters Together is based on an expansion of a public health campaign that combines social marketing with community building efforts. The pilot program design comprises five phases: design, promotion, demonstration, transfer, and sustained activity. The proposed five-stage model holds potential for increasing the life span of a campaign and contributing to community building. Partnerships and coalition development promise to maintain the campaign beyond the limited budget period. This descriptive article illustrates the elements of a hybrid model for the design of a communication program with examples from Sisters Together, Move More Eat Better, a pilot program currently in the last year of implementation.
Journal of Hunger & Environmental Nutrition, Nov 5, 2020
This study evaluated the nutritional, economic, and environmental impacts of a Meatless Monday (M... more This study evaluated the nutritional, economic, and environmental impacts of a Meatless Monday (MM) National School Lunch Program (NSLP) in a large urban US school district. After averaging the nutrient content of entrees across the week and comparing changes relative to recommendations, there were no pre-post differences >15%. Monday entrees offered post-MM required considerably less water to produce (-51%) and were associated with fewer greenhouse gas emissions (-74%). The MM program had little impact on entrée cost (-2.5%). Further research is needed to determine how MM program goals can be achieved within the NSLP context.
Journal of Nutrition Education, 1990
Nutrition Reviews, 2004
The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguis... more The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Bruce M. Alberts is president of the National Academy of Sciences. The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Wm. A. Wulf is president of the National Academy of Engineering. The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute of Medicine. The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy's purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Bruce M. Alberts and Dr. Wm. A. Wulf are chair and vice chair, respectively, of the National Research Council.
Childhood Obesity, 2019
Background: Several studies have found that children in the United States gain weight at a faster... more Background: Several studies have found that children in the United States gain weight at a faster rate in the summer than in the school year, but little is known about the prevalence of this problem, its effect on high-risk subgroups, or its determinants. This study compares school year and summer weight change in a low-income, ethnically diverse sample of school-age children in Massachusetts and explores differences by race/ethnicity, weight status, and exposure to school year physical activity (PA) programming. Diet and PA are examined as potential mediators of summer weight gain. Methods: Children participating in a school-based PA program evaluation (in which weight change was not a primary outcome) had their height and weight measured three times between October 2015 and September 2016 to capture a school year and summer interval. Diet and PA patterns were assessed mid-school year and midsummer in a subsample of children. Mixed linear models were used to estimate the effect of season (school year vs. summer) on change in BMI and to examine the influence of race/ethnicity, weight status, and program (walk/run, classroom activity breaks, or control) on any observed effects. Structural equation models were used to explore diet and PA as mediators of seasonal weight change in a subsample of participants. Results: Of 769 participants, 53% were non-Caucasian, 40% were overweight or obese, and 58% were eligible for free or reducedprice school meals. BMI increased in both the school year and summer but increased more rapidly in the summer (0.046 kg/m 2 more per month, p = 0.007). Of the three tested interactions, statistical significance was only observed between season and program (v 2 = 14.90, p < 0.001); on average, children exposed to a school year walk/run program did not gain weight more rapidly during the summer, whereas children in the control group and a classroom activity breaks program did. Poorer diet and PA patterns were observed in the summer, but neither diet nor PA was statistically significant mediators of BMI change. Conclusions: Children in this high-risk sample gained weight at a faster rate during the summer than during the school year, with no discernable demographic differences. However, this phenomenon was not observed in the subgroup exposed to a school year walk/run program. More research is needed to clarify the determinants of summer weight gain and understand how school year programming and its effects can be transferred to the summer months.
Preventing Chronic Disease, Nov 1, 2011
To build on a growing interest in community-based obesity prevention programs, methods are needed... more To build on a growing interest in community-based obesity prevention programs, methods are needed for matching intervention strategies to local needs and assets. We used the Community Readiness Model (CRM), a structured interview guide and scoring system, to assess community readiness to act on childhood obesity prevention, furthering a replication study of a successful intervention.Using the CRM protocol, we conducted interviews with 4 stakeholders in each of 10 communities of similar size, socioeconomic status, and perceived readiness to implement a community-wide obesity prevention intervention. Communities were in California, Florida, Illinois, Massachusetts, New York, North Carolina, Pennsylvania, and Tennessee. The 4 stakeholders were the mayor or city manager, the school superintendent, the school food service director, and a community coalition representative. Interviews were recorded and professionally transcribed. Pairs of trained reviewers scored the transcriptions according to CRM protocol. The CRM assesses 9 stages of readiness for 6 dimensions: existing community efforts to prevent childhood obesity, community knowledge about the efforts, leadership, community climate, knowledge about the issue, and resources. We calculated an overall readiness score for each community from the dimension scores.Overall readiness scores ranged from 2.97 to 5.36 on the 9-point scale. The mean readiness score, 4.28 (SD, 0.68), corresponds with a "preplanning" level of readiness. Of the 6 dimensions, community climate varied the least (mean score, 3.11; SD, 0.64); leadership varied the most (mean score, 4.79; SD, 1.13).The CRM quantified a subjective concept, allowing for comparison among 10 communities. Dimension scores and qualitative data from interviews helped in the selection of 6 communities for a replication study. Community Efforts and Community Knowledge of Efforts Using a scale from 1 to 10, how much of a concern is childhood obesity in your community (with 1 being "not at all" and 10 being "a very great concern")? Please explain.Describe current efforts in your community to address childhood obesity.For how long have these efforts been going on in your community?Using a scale from 1 to 10, describe how aware people in your community are of these efforts (with 1 being "no awareness" and 10 being "very aware"). Please explain.What does the community know about these efforts or activities (eg, logistics, goals, participants)?What are the strengths of these efforts?What are the weaknesses of these efforts? What formal or informal policies, practices, and laws related to childhood obesity are in place in your community, and for how long? Prompt: A "formal" policy would be an established policy in schools. An informal policy would be an "unsaid rule" or pattern of behavior. Leadership Who are leaders/community champions specific to the childhood obesity issue in your community? Using a scale from 1 to 10, how much of a concern is childhood obesity to the leadership in your community (with 1 being "not at all" and 10 being "of great concern")? Please explain.How are leaders getting involved in this issue? Prompt: Are they involved in a committee, a task force? How often do they meet?Would leadership support additional efforts and services? Please explain. Community Climateb What are community perceptions of childhood overweight? What are the primary obstacles to efforts addressing this issue in your community (eg, language, competing interests, structure of the school district)? Knowledge About the Issue How knowledgeable are community members about childhood obesity? Prompt: Are they familiar with signs, symptoms, effect on family?What type of information is available in your community regarding childhood obesity?What local data are available on this issue in your community?How do people obtain this information in your community? Resources for Prevention Efforts To whom would an individual affected by childhood obesity turn to first for help in your community? Why?What is the community's and/or local business's attitude about supporting efforts to address this issue, with people volunteering time, making financial donations, and/or providing space?Are you aware of any proposals or action plans that have been submitted for funding that address childhood obesity in your community? If yes, please explain.Do you know if there is any evaluation of efforts that are in place to address this issue? If yes, on a scale of 1 to 10, how sophisticated is the evaluation effort (with 1 being "not at all" and 10 being "very sophisticated")?How are the evaluation results being used (ie, to make changes in programs)?Open in a separate windowa Nonanchored questions are presented in italics. The Community Readiness Model interview protocol (29) includes anchored questions (required) and nonanchored questions (optional).b The Tri-Ethnic Center for Prevention Research, which developed the interview protocol for the Community Readiness Model, recommends the inclusion of 21 anchored questions (29). The protocol used for this project included 20 anchored questions. In the category Community Climate, a nonanchored question (What are community perceptions of childhood overweight?) was used to replace an anchored question (How does the community support the efforts to address this issue?).
Childhood obesity, Jun 1, 2019
Background: Several studies have found that children in the United States gain weight at a faster... more Background: Several studies have found that children in the United States gain weight at a faster rate in the summer than in the school year, but little is known about the prevalence of this problem, its effect on high-risk subgroups, or its determinants. This study compares school year and summer weight change in a low-income, ethnically diverse sample of school-age children in Massachusetts and explores differences by race/ethnicity, weight status, and exposure to school year physical activity (PA) programming. Diet and PA are examined as potential mediators of summer weight gain. Methods: Children participating in a school-based PA program evaluation (in which weight change was not a primary outcome) had their height and weight measured three times between October 2015 and September 2016 to capture a school year and summer interval. Diet and PA patterns were assessed mid-school year and midsummer in a subsample of children. Mixed linear models were used to estimate the effect of season (school year vs. summer) on change in BMI and to examine the influence of race/ethnicity, weight status, and program (walk/run, classroom activity breaks, or control) on any observed effects. Structural equation models were used to explore diet and PA as mediators of seasonal weight change in a subsample of participants. Results: Of 769 participants, 53% were non-Caucasian, 40% were overweight or obese, and 58% were eligible for free or reducedprice school meals. BMI increased in both the school year and summer but increased more rapidly in the summer (0.046 kg/m 2 more per month, p = 0.007). Of the three tested interactions, statistical significance was only observed between season and program (v 2 = 14.90, p < 0.001); on average, children exposed to a school year walk/run program did not gain weight more rapidly during the summer, whereas children in the control group and a classroom activity breaks program did. Poorer diet and PA patterns were observed in the summer, but neither diet nor PA was statistically significant mediators of BMI change. Conclusions: Children in this high-risk sample gained weight at a faster rate during the summer than during the school year, with no discernable demographic differences. However, this phenomenon was not observed in the subgroup exposed to a school year walk/run program. More research is needed to clarify the determinants of summer weight gain and understand how school year programming and its effects can be transferred to the summer months.
Journal of Hunger & Environmental Nutrition, May 1, 2019
Limited research has examined the rapid growth of farm to school (FTS) programs in the US. Qualit... more Limited research has examined the rapid growth of farm to school (FTS) programs in the US. Qualitative interviews (n = 24) framed by Diffusion of Innovations theory were used to explore FTS program adoption and expansion in Massachusetts. Program compatibility and relative advantages related to academics, school meal participation, and child health motivated initial engagement. Active classroom integration, implementation simplification, and strong support networks aided program expansion. Leadership and sustainability plans, garden maintenance partnerships, and Community Eligibility Provision participation hold promise to help further program diffusion. Future research should focus on providing additional evidence for FTS aspects salient to adoption and expansion.
Journal of the Academy of Nutrition and Dietetics, 2020
To improve cultural competency. Target Audience: Graduate students participating in nutrition cou... more To improve cultural competency. Target Audience: Graduate students participating in nutrition counseling courses. Theory, Prior Research, Rationale: The Campinha-Bacote Model of Cultural Competence in the Delivery of Health Care Services was used to design, implement, and evaluate two graduate nutrition counseling classes. Five interdependent constructs of this model include cultural awareness, cultural knowledge, cultural skill, cultural encounter, and cultural desire. Cultural competence is influenced by working on any of these areas and strengthens the impact of the others. Description of Course and Curriculum: Each assignment and activity addressed one or more of the constructs of the model. Examples included participation in a simulation to stimulate self-awareness, using respondent driven interview questions to develop skills, and conducting a nutrition and cultural assessment of an individual addressed encounter. Evaluation: A repeated measure ANOVA evaluated pre-and post-test cultural competence scores (n¼34). Content analysis assessed impressions of course effectiveness. The overall cultural competence score significantly improved (p<0.001) from ''culturally aware'' (68.7 at pre-) to ''culturally competent'' (78.7 at post-). Students significantly improved (p<0.001) four constructs of the model including awareness, knowledge, skill, and encounter. Factor analysis indicated course activities accounted for 83.2% and course assignments accounted for 74.6% of the total variance of cultural competence. Conclusion and Implications: An activity-based counseling course encouraging self-evaluation and reflection and addressing awareness, knowledge, skill, and encounters significantly improved cultural competence. Because factor analysis showed that activities and assignments aligned with the model constructs, the findings of this study can help guide health educators to design effective cultural competence training programs.
Journal of the Academy of Nutrition and Dietetics, Jan 6, 2016
Appetite, Nov 1, 2021
Snacks contribute nearly one-quarter of children's daily energy intake in the USA. Snack time... more Snacks contribute nearly one-quarter of children's daily energy intake in the USA. Snack time therefore represents an opportunity for parents to provide foods with key nutrients. Instead, the most common snack foods are major contributors to children's consumption of added sugars and sodium. Parents face major barriers to providing healthier snacks, including perceptions of high cost and lack of child acceptance. We obtained both economic and qualitative data to inform and optimize interventions for parents to promote vegetable snacks for children. We conducted a survey with parents (n = 368) to estimate how much of a discount would influence vegetable snack purchases by estimating willingness-to-pay using the contingent valuation method, using baby-cut carrots as a sample product. We conducted three focus groups (n = 19) and 1 group interview (n = 2) with children to help understand how to increase the appeal of vegetable snacks. Most (70%) parents accepted the reference price for the vegetable snack. Among those who did not, contingent valuation analysis revealed that a mean discount of approximately 30% would shift consumers to purchasing the snack. Focus group results revealed that the appeal of vegetable snacks to children was influenced by how they were prepared and presented, and the child's familiarity with the vegetables and ability to choose among them. This study lays the groundwork for effective interventions to promote the provision of vegetable snacks by parents.
Journal of the American Dietetic Association, 1999
The first objective of this research was to define a target population of African-American women ... more The first objective of this research was to define a target population of African-American women more clearly. The second was to provide specific information about the needs and preferences of that population in order to design an effective, culturally relevant, community-based communications campaign to promote more healthful lifestyles. Data collection and analysis included the following: interviews with 10 community nutritionists and the director of the State Office of Nutrition, 6 focus groups with a total of 47 members of the target population, and direct observation and documentation of key community resources. This approach, called "triangulation," permits more in-depth understanding of issues, provides different perspectives on the problem, and helps ensure accuracy of conclusions. Interviews with nutritionists identified young African-American women as the appropriate target population for the campaign. These interviews and the focus-group discussions confirmed the acceptability of higher weight and better body-esteem among African-American women than among white women. Both the nutritionists and the focus-group members identified the need and desire for information and skills related to food preparation and provided specific direction for program content. Community observation confirmed the need for food markets with merchandise of consistently high quality, especially in the fresh and frozen produce sections. Observation also helped identify community services and programs. The 3 sets of data, which augmented a comprehensive literature review, provided a firm foundation for the campaign's design and development. Dietitians and nutritionists working in community settings can use triangulation to gain a better understanding of their populations in order to develop more effective interventions.
Journal of the American Dietetic Association, 2004
Since its release in 1992, the Food Guide Pyramid has become one of the most recognized nutrition... more Since its release in 1992, the Food Guide Pyramid has become one of the most recognized nutrition education tools in US history. As such, it has been subject to criticism, particularly in several recent media reports that implicate it as the culprit in America's current obesity epidemic. What these reports often overlook, however, is that the diets of many Americans do not adhere to the dietary guidelines illustrated by the Pyramid, refuting the notion that the Pyramid is the cause of the nation's obesity problem. Data indicate that the more likely causes of escalating obesity rates are increased per capita caloric consumption and larger portion sizes, along with a lack of adequate physical activity. Although the Pyramid graphic was designed more than a decade ago, it still communicates three key concepts that continue to be the cornerstone of federal dietary guidance: variety, proportionality, and moderation. As such, it remains a viable and relevant nutrition education tool, especially when used by dietetics professionals as a component of individualized , comprehensive nutrition education and behavior modification interventions. As the United States Department of Agriculture begins to investigate whether the food intake patterns illustrated by the Pyramid are in need of updating, research is urgently needed to determine how nutrition education tools, including the Pyramid, can be most effectively implemented to help consumers adopt healthful eating behaviors and to improve the public health of America.
Journal of the American Dietetic Association, 2003
Journal of the American Dietetic Association, 1998
Objective To examine the self-reported importance of taste, nutrition, cost, convenience, and wei... more Objective To examine the self-reported importance of taste, nutrition, cost, convenience, and weight control on personal dietary choices and whether these factors vary across demographic groups, are associated with lifestyle choices related to health (termed health lifestyle), and actually predict eating behavior.Design Data are based on responses to 2 self-administered cross-sectional surveys. The main outcomes measured were consumption of fruits
Journal of Nutrition Education, 1990
A self-administered questionnaire was used in a cross-sectional survey of 459 individuals, betwee... more A self-administered questionnaire was used in a cross-sectional survey of 459 individuals, between 55 and 89 years old, to identify topics in food and nutrition of greatest interest and concern to generally healthy, older individuals, and to estimate the extent to which relevant behaviors were related to those concerns. In this study, 84.9% of the married men engaged in food shopping and 83.4% in cooking at least some of the time. There were no gender-related differences in either health concerns or behaviors associated with those concerns. This suggests that nutrition education interventions for the elderly should be designed to appeal to both men and women. Food safety in the home and of the food supply were of great concern to more individuals than any diet and health topic explored, and were associated with several health purchasing and food handling behaviors. Among diet-related topics, con• cern about salt intake ranked first, followed by weight control, sugar intake, serum cholesterol, and nutritional adequacy of the diet. Concern about these topics and either diagnosis-related information or specific advice from the doctor were associated with reported dietary modifications. Print and audiovisual media were important sources of information about certain topics. This survey was conducted for the immediate purpose of guiding the content of a nutrition education video program for the elderly. However, the information obtained can also be used for the development of other types of programs.
Journal of Nutrition Education, 1989
Journal of Nutrition Education, 1970
Journal of Nutrition Education, 2000
The purpose of this study was to test an ecological model designed to identi@ social and environm... more The purpose of this study was to test an ecological model designed to identi@ social and environmental factors that encourage local produce buying. Pre-and postintervention surveys in June and September 1997 measured local produce purchasing and factors identified by the model.At three mid-sized worksites in a rural Maine community, the response rate was 68% (135 employees) preintervention and 61% (124) postintervention. For 6 weeks, workers were given the opportunity to order local produce at work; to see, taste, and read about the produce; and to see coworkers sample and buy it. Associations were examined between increased purchases of locally grown produce outside the workplace and ordering at work, proportion of friends who ordered, degree of satisfaction with orders ascribed to coworkers, and degree of satisfaction with the project ascribed to management. McNemar's test and chi-square analyses were the statistical analyses performed. Purchasing locally grown produce at work apparently motivated consumers to purchase local produce outside the workplace. Workers' observations of coworker and management participation in and satisfaction with the project were associated with increased purchasing outside the workplace. Sales at worksites offer a potentially important way to increase purchases oflocally grown produce.
Journal of Health Communication, 1999
The Sisters Together, Move More Eat Better pilot communication program focuses on young Black wom... more The Sisters Together, Move More Eat Better pilot communication program focuses on young Black women in three inner-city communities to encourage improved nutrition and increased physical activity. The design for Sisters Together is based on an expansion of a public health campaign that combines social marketing with community building efforts. The pilot program design comprises five phases: design, promotion, demonstration, transfer, and sustained activity. The proposed five-stage model holds potential for increasing the life span of a campaign and contributing to community building. Partnerships and coalition development promise to maintain the campaign beyond the limited budget period. This descriptive article illustrates the elements of a hybrid model for the design of a communication program with examples from Sisters Together, Move More Eat Better, a pilot program currently in the last year of implementation.