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Trends in blood lead levels among children enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children from 1996 to 2000.

We analyzed data from the Wisconsin Childhood Lead Poisoning Prevention Program to examine the distribution of and trends in elevated blood lead levels among WIC-enrolled children from 1996 until 2000. Higher blood lead levels were seen among WIC-enrolled children, and although not statistically significant, the rate of blood lead level decline among WIC-enrolled children was greater than among non-WIC-enrolled children.

Child↗

Productivity in nutrition programs for the elderly that utilize an assembly-serve production system.

Observations of labor activities of workers performing foodservice functions were made in eight senior centers at 5-minute intervals for 3 consecutive days. On-site preparation was limited to rethermalization of frozen entrees and portioning of bulk-delivered items. Time spent was assigned or allocated to either congregate or home-delivered meal service on the basis of number of meals served. Time in each component of direct work, indirect work, and delay was divided by meals served to provide the productivity ratio, labor minutes per meal. Comparisons were also made on the basis of number of meals served. An average of 12.78 minutes per meal was used to serve congregate meals and 21.05 minutes per meal for home-delivered meals. Two of the eight centers differed significantly in time used for direct work and total work to serve congregate-meal participants. There was no difference between centers in time used to serve homebound clients. The number of meals served did not influence productivity for either meal service site. These findings establish baseline data for the amount of time needed in one production system to serve meals to center participants and homebound clients. Managers of senior centers can use information about this food production and delivery system to make decisions about the most cost-effective method to provide meals.

Aged↗

Assistance programs in nutrition management for dairy farms.

Successful veterinary nutrition programs have evolved over the years from little more than the use of a specific product to a ration formulation service to today's total nutritional management assistance program. A dedication to providing this total service, merged with technical help from outside consultants and sealed with experience, yields a package that is indeed valuable to the dairyman. A common thread among successful herd management assistance veterinarians is their willingness to spend time with their clients in discussing all of these areas as well as others not covered. Clients are quite willing to pay for this total service. They are not willing to pay for fragments of the total package. The dilemma of many practitioners is the fact that they do not seen to have enough time to devote to this type of program, even thought they realize they should be providing it. The poultry (and, to some extent, swine)industry faced this dilemma in past years. The unfortunate results were that very few veterinarians are now intimately involved. Dairymen are going to purchase a total service from someone in the future. No one is in a better position to offer this than the local practitioner.

Animal Feed↗

A multicomponent program for nutrition and physical activity change in primary care: PACE+ for adolescents.

BACKGROUND: Most adolescents do not meet national recommendations for nutrition and physical activity. However, no studies of physical activity and nutrition interventions for adolescents conducted in health care settings have been published. The present study was an initial evaluation of the PACE+ (Patient-centered Assessment and Counseling for Exercise plus Nutrition) program, delivered in primary care settings. PARTICIPANTS: Adolescents aged 11 to 18 years (N = 117) were recruited from 4 pediatric and adolescent medicine outpatient clinics. Participants' mean (SD) age was 14.1 (2.0) years, 37% were girls, and 43% were ethnic minorities. INTERVENTION: Behavioral targets were moderate physical activity, vigorous physical activity, fat intake, and fruit and vegetable intake. All patients completed a computerized assessment, created tailored action plans to change behavior, and discussed the plans with their health care provider. Patients were then randomly assigned to receive no further contact or 1 of 3 extended interventions: mail only, infrequent telephone and mail, or frequent telephone and mail. MEASURES: Brief, validated, self-report measures of target behaviors were collected at baseline and 4 months later. RESULTS: All outcomes except vigorous physical activity improved over time, but adolescents who received the extended interventions did not have better 4-month outcomes than those who received only the computer and provider counseling components. Adolescents who targeted a behavior tended to improve more than those who did not target the behavior, except for those who targeted vigorous physical activity. CONCLUSIONS: A primary care-based interactive health communication intervention to improve physical activity and dietary behaviors among adolescents is feasible. Controlled experimental research is needed to determine whether this intervention is efficacious in changing behaviors in the short- and long-term.

Adolescent↗

Nutritional needs assessment of rural agricultural migrants of southern Brazil: designing, implementing and evaluating a nutrition education program.

A nutritional needs assessment was conducted among rural agricultural migrant women (target group) and children (less than 5 years). The study was conducted in Vila Diogo, a slum located on the periphery of Nuporanga, a village in Sao Paulo state, Brazil. A nutrition education program was designed on the basis of evidence obtained from demographic/socioeconomic information of the study population and a nutritional needs assessment of women (target group) and children less than 5 years of age. The nutritional needs assessment consisted of anthropometry, dietary assessment, and nutrition knowledge, attitudes, and beliefs questionnaires. Formative and summative evaluation of the nutrition education program, using appropriately selected criteria and comparisons of nutrition knowledge scores before and after the program, were used to determine program effectiveness. Major findings of the study were: Diets of Vila Diogo residents were generally simplistic, consisting primarily of rice, beans, and coffee with sugar. Vila Diogo women appeared to be at a relatively high risk for vitamin A, iron, calcium, ascorbic, and riboflavin deficiencies, based on comparisons of 24-hour dietary intake data with FAO recommendations. Children (2-5 years) appeared at high risk for vitamin A, iron, and ascorbic acid deficiencies, based on comparisons of 24-hour dietary intake data with FAO recommendations. All children less than 5 years of age had been breast-fed at birth, but more than one half of children had been weaned by the third month. Infant feeding practices during fever and diarrhea were nutritionally detrimental. Women generally recognized a relationship between dietary intake during pregnancy and fetal nourishment. Using weight-for-height index, a significant number of women were probably undernourished; a small percentage of women, however, were overweight or obese. Although children less than 5 years of age did not generally appear malnourished, a relatively large number were stunted in growth. Although Vila Diogo women reported many food taboos during various physiological states (menstruation, pregnancy, immediately post partum, lactation), relatively few food taboos had potentially negative nutritional consequences. For women who participated in the nutrition education program, nutrition knowledge scores after the program showed improvement which was statistically significant at alpha = 0.05, using Wilcoxon signed rank test.

Brazil↗

Knowledge, skills, and behavior improvements on peer educators and low-income Hispanic participants after a stage of change-based bilingual nutrition education program.

A nutrition education program, entitled La Cocina Saludable, was designed according to the Stage of Change Model and implemented in ten southern Colorado counties. The objectives were to improve the nutrition related knowledge, skills, and behaviors that lead to healthy lifestyles in a low-income Hispanic population. The content of the program included nutrition information designed to help mothers of preschool children provide for their children's nutritional needs. Previous studies suggest that low-income Hispanics often demonstrate low intakes of vitamins A and C, calcium, iron, and protein, and high rates of diabetes, obesity, and infections. Additionally, this population presents many obstacles for nutrition educators including limited resources, child care, transportation, time, language, culture, literacy, health beliefs, and, in some cases, the transient nature of the population. The program attempted to overcome these barriers by incorporating a flexible program format carried out by abuela (Hispanic grandmother) educators using the processes described in the Stage of Change Model. The program was evaluated using a knowledge, skills and behavior pre-test, post-test, and six-month follow-up survey on both the abuela educators as well as the actual class participants. Results of the peer education training sessions suggest that this type of training program can be effective in increasing the knowledge, skills, and behavior of peer educators as well as reduce need for retraining for educators who continuously teach classes. Additionally, the results suggest that this type of program can be effective in changing selected nutrition related knowledge, skills, and behaviors leading to healthy lifestyles for low-income Hispanic mothers of preschool children.

Adult↗

Results of a community-based low-literacy nutrition education program.

A nutrition intervention focused on low-fat eating pattern changes was conducted among low-literacy participants in a Twin Cities Metropolitan area Expanded Food and Nutrition Education Program (EFNEP). A total of 134 EFNEP participants who participated in the intervention were compared to 70 comparison participants who received EFNEP nutrition education materials. Associations between changes in outcome variables specific to the intervention were evaluated using mixed-model regression analyses. The principal effects seen for this program were related to changes in eating pattern scales. More modest effects were seen in scales related to attitudes of low-fat eating, and although changes in dietary fat intake as measured by 24-hour dietary interviews suggested a positive intervention effect, this did not approach statistical significance.

Adult↗

Influence of a nutrition education program (EFNEP) on infant nutrition in East Harlem.

An assessment of the effectiveness of aides working in the Expanded Food and Nutrition Education Program (EFNEP) to improve the nutritional status of infants was conducted with a group of 118 infants attending a well-baby clinic in a low-income area of New York City. In addition to clinic care, the fifty-seven study infants received home visits from a nutrition aide whose role was to reinforce nutritional advice received at the clinic. The sixty-one control infants received only regular clinic care. The benefits of having an aide were suggested by three observations: Reduction in the practice of introducing whole cow's milk to young infants, familiarizing older infants with a variety of foods, and reducing the prevalence of iron-deficiency anemia. Few of the differences between study and control infants achieved statistical significance, although trends consistently indicated that the presence of aides was beneficial. The problems of assessing the effectiveness of nutrition education programs with healthy infants are discussed.

Black or African American↗

[Impact of of school children's nutrition education program on the knowledge and nutritional behavior of their parents].

The aim of the work was to present the analysis of the influence of school children's nutrition education program on the knowledge and nutritional behavior of their parents (110 persons). The program was realized during 10 lessons. The interview with the parents concerning their knowledge and nutritional behavior was carried before and after realization of educational program at school. One can state that changes of parents nutritional behavior was connected with the educational materials getting by children, for example higher consumption of vegetables, fruits, milk and its products were observed. An increased level of knowledge especially on sources of selected nutrients: calcium, dietary fiber was found. Education of children and youth can be seen as one of the effective educational method of their parents.

Adolescent↗

Effects of a nutrition education program on the dietary behavior and nutrition knowledge of second-grade and third-grade students.

This research investigated the effects of a nutrition education program on dietary behavior and nutrition knowledge among elementary school-aged children participating in a Social Cognitive Theory-based nutrition education program. Participants included 1100 second-grade and third-grade students selected by convenience-type sampling from public schools in Alabama. A preassessment and postassessment control group design assessed dietary behavior and nutrition knowledge using Pizza Please, a specially designed interactive evaluation tool. A 2 x 2 mixed analysis of variance was used to analyze data. Children in the treatment group exhibited significantly (p < .001) greater improvement in overall dietary behaviors such as consumption of dairy products, fruits, and vegetables, than children in the control group. Children in the treatment group exhibited significantly (p < .001) greater improvement in nutrition knowledge, including Food Guide Pyramid understanding, nutrient-food association, and nutrient-job association, than children in the control group. Results suggest that nutrition education programs that teach positive dietary messages potentially can improve dietary behavior and increase nutrition knowledge in children.

Alabama↗

Survey of clinical nutrition training programs for physicians.

Clinical nutrition training programs for physicians were surveyed to determine their number, demographic characteristics, primary teaching focuses, number of available trainee positions, funding bases, trainee numbers, backgrounds, and career positions taken. Twenty-two active programs were identified, compared with 38 programs in 1993. Thirteen of the programs were primarily focused on adult nutrition and 7 were focused on pediatric nutrition. Twelve programs appeared to have nutrition as their sole subspecialty focus, 8 were housed within gastroenterology fellowships, and 2 were within endocrinology fellowships. Most programs included training in research, which is conducted during a second or third year, or both. The decrease in numbers of programs appears to have resulted not only from relocation, retirement of key faculty members, and loss of training grants, but also because of the clearer definition of clinical nutrition training programs in this survey. The changes also reflect a national trend toward decreasing subspecialization. Within this climate, it is apparent that a new model for the training and career activities of physician nutrition specialists is needed that will attract more physicians into the discipline of nutrition. Intersociety efforts are underway to address this need and to develop a unified voice that can guide clinical nutrition training for physicians into the 21st century.

Curriculum↗

A multidisciplinary QA program for enteral nutrition in high-risk patients.

An increase in elderly patients and severity of illness rates means greater use of nasogastric feeding tubes for both high-risk acutely ill and chronically ill patients. When the QA screening process at Booth Memorial Medical Center revealed a certain percentage of complications with small bore, weight-tipped feeding tubes inserted through the nares, a multidisciplinary peer review committee (MPRC) was formed to review the enteral nutrition program. After a literature review to determine possible complications, the MPRC identified lung perforations due to tube misplacement, tube feeding aspiration into the lungs leading to possible aspiration pneumonia, and an internal tip separation from the tube product failure. Unconscious incubated patients on ventilators were shown as at high risk for feeding tube misplacement in an initial MPRC patient study. A second study evaluated several different feeding tube products in the medical, respiratory and surgical ICU. The MPRC established a credentialing process for physician assistants, interns and residents in feeding tube placement. The MPRC proceedings were presented to the hospital-wide QA committee for review, endorsement and recommendations on all policy and procedure changes. The conclusions were that a more concerted effort must be made to improve medical management and encourage ongoing education in the administration of enteral feedings to high-risk patients.

Cost-Benefit Analysis↗

Pawtucket Heart Health Program point-of-purchase nutrition education program in supermarkets.

Point-of-purchase nutrition education in supermarkets is one intervention strategy of the Pawtucket Heart Health Program, a community cardiovascular disease prevention program in Pawtucket, Rhode Island. Using consumer intercept interviews, awareness of shelf labels and their effect on purchase behavior have been continuously evaluated. Between 1984 and 1988, the percent of shoppers who could identify correct labels increased from 11 percent to 24 percent (95% confidence intervals of difference: 7.17). The percent who reported they were encouraged to purchase the identified foods increased from 36 percent to 54 percent (95% CI of difference: 5.41).

Adult↗

Evaluation of the South Carolina seniors farmers' market nutrition education program.

The Seniors Farmers' Market Nutrition Program (SFMNP) provides vouchers to low-income seniors for use at local farmers' markets. This study was conducted to determine if SFMNP participants increased fruit and vegetable consumption. A total of 15,000 people from 13 counties received vouchers. A random sample of 1,500 received a follow-up survey, of which 658 (44%) were returned. Of the 98% of respondents who used the vouchers, 531 respondents (83%) did not purchase foods that they had never tried before, but 89% reported the intention to eat more fruits and vegetables year round because of the program. Farmers reported benefits from the program, have a positive attitude about it, and are willing to make certain accommodations to participate in it again. The SFMNP is an effective method for increasing consumption of agricultural commodities from farmers' markets by low-income seniors and is worthy of continued funding.

Aged↗