The Academic,Behavioral, and Health Influence of Summer Child Nutrition Programs: A Narrative Review and Proposed Research and Policy Agenda

Since 1975, the US Department of Agriculture has sponsored the Summer Food Service Program as a nationwide strategy for providing nutritious meals to children and youth (aged 18 years or younger) in low-income communities during the summer months. Many programs are sponsored by community organizations as well as school districts that may offer the program through the Summer Food Service Program or a seamless waiver, allowing them to extend school meals programs into the summer. These summer nutrition programs are designed to decrease food insecurity and improve health outcomes among at-risk populations. However, the characteristics of these programs, including the types of participants reached, and the programs’ influence on outcomes such as academics, behavior, and physical and mental health, have not been summarized. The aims of this narrative review are to present existing knowledge about the characteristics of summer nutrition programs and their influence on students, to identify knowledge gaps, and to identify future research needs. An extensive search identified eight peer-reviewed articles and 10 reports, briefs, or other documents reporting research on the Summer Food Service Program. A variety of additional literature was reviewed to provide relevant information about summer nutrition programs. The review revealed a dearth of research regarding current Summer Food Service Program implementation. Summer nutrition programs alleviated food insecurity among at-risk populations; however, little research was found about the influence of summer programs on students’ dietary intake or weight outcomes. More rigorous and mixed-methods studies examining the characteristics and influence of summer nutrition programs are needed.     

Designing and Implementing Ethnic Congregate Nutrition Programs for Older Americans

ABSTRACT

Montgomery County in Maryland is one of the most ethnically diverse regions in the United States. Since the 1970s, traditional American and Kosher meals have been offered at congregate sites in this County, but few seniors of varied ethnicity participated. This article describes creative approaches used in the County Senior Nutrition Program within the Older Americans Act from 1990 to 2007 to develop nutrition sites targeted to seniors in Korean, Vietnamese, and Chinese communities. The services provided are culturally sensitive, and the meals meet both nutritional and food safety standards. With secure funding, programs can be made available to other ethnic groups.     

The Shaping Healthy Choices Program: Design and Implementation Methodologies for a Multicomponent,School-Based Nutrition Education Intervention

ObjectiveTo provide a framework for implementation of multicomponent, school-based nutrition interventions. This article describes the research methods for the Shaping Healthy Choices Program, a model to improve nutrition and health-related knowledge and behaviors among school-aged children.DesignLongitudinal, pretest/posttest, randomized, controlled intervention.SettingFour elementary schools in California.ParticipantsFourth-grade students at intervention (n = 252) and control (n = 238) schools and their parents and teachers. Power analyses demonstrate that a minimum of 159 students per group will be needed to achieve sufficient power. The sample size was determined using the variables of nutrition knowledge, vegetable preference score, and body mass index percentile.InterventionA multicomponent school-based nutrition education intervention over 1 academic year, followed by activities to support sustainability of the program.Main Outcome MeasuresDietary and nutrition knowledge and behavior, critical thinking skills, healthy food preferences and consumption, and physical activity will be measured using a nutrition knowledge questionnaire, a food frequency questionnaire, a vegetable preferences assessment tool, the Test of Basic Science Process Skills, digital photography of plate waste, PolarActive accelerometers, anthropometrics, a parent questionnaire, and the School and Community Actions for Nutrition survey.AnalysisEvaluation will include quantitative and qualitative measures. Quantitative data will use paired t, chi-square, and Mann-Whitney U tests and regression modeling using P = .05 to determine statistical significance.     

Implementation of Minimum Nutrition Standards and Best Practices in Childcare Centers

BackgroundThe federal Child and Adult Care Food Program (CACFP) provides reimbursable meals to 4.6 million children annually and sets nutrition standards for foods served. Licensing regulations in many states extend these rules to nonparticipating programs.ObjectiveTo evaluate the quality of meals and snacks served in Connecticut licensed childcare centers in 2019 and assess implementation of a state licensing requirement to adhere to CACFP minimum nutrition standards in all centers.DesignCross-sectional survey.Participants/settingTwo hundred licensed childcare centers in Connecticut in 2019.Main outcome measuresMeal/snack quality was assessed based on menus. Foods/beverages listed were compared to the minimum CACFP nutrition standards and optional best practices. Surveys completed by center directors measured center characteristics.Statistical analysisLogistic and linear multivariable regression models tested differences in centers’ adherence to nutrition standards and best practices by CACFP participation status.ResultsCACFP centers complied with more required nutrition standards than non-CACFP centers (an adjusted mean of 4.7 vs 3.4 standards among programs serving meals, P < 0.001), with particularly large mean differences for whole grains and low-fat milk. Implementation of optional best practices, except for beverages, was relatively low among all centers, especially for snacks. Compliance (adjusted mean number of minimum nutrition standards met) was greater among centers accredited by the National Association for the Education of Young Children and those using a registered dietitian or a sponsoring agency to prepare menus and receiving food from a vendor. Recent completion of nutrition training was associated with greater mean implementation of best practices.Conclusions and implicationsBetter adherence to minimum nutrition standards and best practices among CACFP-participating childcare centers contributed to higher nutritional quality of meals and snacks offered. Snack quality would benefit most from greater compliance with nutrition standards. Providers outside of CACFP need additional supports in the implementation of licensing regulations to improve the food environment for young children.     

Cooking Camp Provides Hands-On Nutrition Education Opportunity

Abstract

Making healthy food choices requires far more than nutrition knowledge. Food preparation skills are essential in order to prepare healthful, palatable meals that meet dietary recommendations for children and for young adults. Children who cook are more likely to taste the foods they've prepared than those who are simply served meals. College-age individuals are likely to try new foods but they often lack the basic skills to plan menus, purchase appropriate ingredients and balance meals. They many want to cook but don't know how, or don't think they have the time. Children participated in a five day culinary program which covered eight different regions, each with a particularly distinctive culinary style and heritage. A nutritionist provided nutrition education and lab support and a kinesiology instructor planned games and activities that engaged the participants in outdoor physical activities for an hour each day. A validated evaluation tool, Eating Right is Fun: Food and Me for assessment indicated a positive change in knowledge and behavior of participants. Cooking Campand similar programs present unique opportunities for professional chefs to engage people of all ages in cooking activities that build confidence in home food preparation.     

Design and Implementation of a Nutrition and Breastfeeding Education Program for Black Expecting Mothers and Fathers

ObjectiveTo describe the intervention and research methods of Project Dads in Nutrition Education, an intervention that adds nutrition and breastfeeding education to the existing Healthy Start program in Georgia for Black expecting mothers and fathers to improve nutrition literacy, health outcomes, and breastfeeding rates.DesignThis 2-year community-based participatory research study employs a cluster randomization factorial design.SettingSix Healthy Start program sites (3 intervention and 3 control sites) in Georgia counties with high infant and maternal mortality rates.ParticipantsApproximately 480 Black, expecting, Healthy Start program participants (20 couples [mother and father] and 40 single mothers from each site) will be enrolled over the study period.Intervention(s)Project Dads in Nutrition Education will strengthen the capacity of the Georgia Healthy Start program to integrate an evidence-based nutrition education program, breastfeeding education, and father engagement into its routine services.Main Outcome Measure(s)Changes in prepost survey assessment of participants’ nutrition literacy and eating behaviors; changes in prepost survey assessment of participants’ breastfeeding knowledge, attitudes, intent, initiation, and duration; and health and food diary collected 3 times (ie, at baseline, 3 months, and 6 months after enrollment).AnalysisProcess evaluation throughout the study to document implementation. Generalized linear mixed modeling will be used to determine the impact of the intervention.     

A Formative Evaluation in Maternal and Child Health Practice: The Partners for Life Nutrition Education Program for Pregnant Women

Objectives: This paper describes the formative evaluation of the Partners For Life Program that was developed to change dietary behavior of low income pregnant women in the Mississippi Delta region. Methods: A diverse group of nutrition/health professionals, adapted the Expanded Food and Nutrition Education Program's (EFNEP) methodology for pregnant patients in the local Women, Infants, and Children program who were receiving maternity care at the county health department. Formative evaluation activities included gathering data to determine 1) whether a new nutrition curriculum, modeled after EFNEP could be created, 2) whether peer educators could be recruited and trained to deliver the intervention, 3) whether pregnant women could be recruited to participate in the new program, 4) whether a pilot test of the new intervention would produce short-term impact in nutrition knowledge and dietary behavior, and 5) reactions of pregnant women on the usability of the new program. Data were gathered through use of the Program Implementation Index, focus groups, and a retrospective record review. Pilot test assessments included tests of nutrition knowledge and self-reported changes in dietary behavior. Results: The formative evaluation demonstrated both positive and negative outcomes. Positive data included 1) successful recruitment and training of the peer educators to deliver the intervention; 2) successful recruitment of the targeted population for the pilot study; 3) complete information on project questionnaires and measuring forms; and 4) among those who completed the program, a statistically significant improvement in nutrition knowledge and dietary behavior. Two negative aspects in this formative study were 1) the Program Implementation Index quantitatively showed that the program experienced problems retaining participants it recruited and 2) deviation of the timeframe for intervention delivery. Program length was identified as the primary reason for participant attrition. Conclusions: It is important for program developers to use results from formative evaluations to make changes in problem areas prior to implementation of a full-scale impact evaluation.     

Context Considerations for Developing the In Defense of Food Nutrition Education Curriculum

Objective

To examine perceptions of teachers and afterschool program staff related to the positive aspects and challenges of afterschool education for youth to guide the development of the “In Defense of Food” nutrition education curriculum.

Position of the American Dietetic Association: Local Support for Nutrition Integrity in Schools

It is the position of the American Dietetic Association (ADA) that schools and communities have a shared responsibility to provide students with access to high-quality, affordable, nutritious foods and beverages. School-based nutrition services, including the provision of meals through the National School Lunch Program and the School Breakfast Program, are an integral part of the total education program. Strong wellness policies promote environments that enhance nutrition integrity and help students to develop lifelong healthy behaviors. ADA actively supported the 2004 and proposed 2010 Child Nutrition reauthorization which determines school nutrition policy. ADA believes that the Dietary Guidelines for Americans should serve as the foundation for all food and nutrition assistance programs and should apply to all foods and beverages sold or served to students during the school day. Local wellness policies are mandated by federal legislation for all school districts participating in the National School Lunch Program. These policies support nutrition integrity, including a healthy school environment. Nutrition integrity also requires coordinating nutrition education and promotion and funding research on program outcomes. Registered dietitians and dietetic technicians, registered, and other credentialed staff, are essential for nutrition integrity in schools to perform in policy-making, management, education, and community-building roles. A healthy school environment can be achieved through adequate funding of school meals programs and through implementation and evaluation of strong local wellness policies.     

Identification of a Framework for Best Practices in Nutrition Education for Low-Income Audiences

To promote effective low-income nutrition education programs, an expert panel of nutrition education and public health researchers built consensus around 28 best practices grouped into 5 domains (Program Design, Program Delivery, Educator Characteristics, Educator Training, and Evaluation) targeting direct delivery of nutrition education. These best practices can be used to assess program strengths, promote fidelity in delivery and evaluation, and design research to strengthen programs’ evidence base. A survey of Supplemental Nutrition Assistance Program–Education nutrition education leaders helped identify staff development needs and interest relative to specific best practices. Best practices can be used to identify staff development needs among frontline educators, supervisors, and program leaders in Supplemental Nutrition Assistance Program–Education, Expanded Food and Nutrition Education Program, and other programs targeting low-income audiences.     

2019年“农村义务教育学生营养改善计划”覆盖地区学生餐剩饭状况及影响因素分析

目的:分析我国“农村义务教育学生营养改善计划”覆盖地区中小学学生餐剩饭情况及影响因素。方法:2019年在“农村义务教育学生营养改善计划”覆盖地区699个县中,分片选取1~3个国家试点县,共选取50个重点监测县。按照不同供餐模式,随机各抽取2所小学和2所初中作为重点监测学校。从小学三年级到初中三年级,每个年级抽取1~2个...     

Current Status of Nutrition Training in Graduate Medical Education From a Survey of Residency Program Directors

Introduction: Nutrition leaders surmised graduate medical nutrition education was not well addressed because most medical and surgical specialties have insufficient resources to teach current nutrition practice. A needs assessment survey was constructed to determine resources and commitment for nutrition education from U.S. graduate medical educators to address this problem. Methods: An online survey of 36 questions was sent to 495 Accreditation Council for Graduate Medical Education (ACGME) Program Directors in anesthesia, family medicine, internal medicine, pediatrics, obstetrics/gynecology, and general surgery. Demographics, resources, and open‐ended questions were included. There was a 14% response rate (72 programs), consistent with similar studies on the topic. Results: Most (80%) of the program directors responding were from primary care programs, the rest surgical (17%) or anesthesia (3%). Program directors themselves lacked knowledge of nutrition. While some form of nutrition education was provided at 78% of programs, only 26% had a formal curriculum and physicians served as faculty at only 53%. Sixteen programs had no identifiable expert in nutrition and 10 programs stated that no nutrition training was provided. Training was variable, ranging from an hour of lecture to a month‐long rotation. Seventy‐seven percent of program directors stated that the required educational goals in nutrition were not met. The majority felt an advanced course in clinical nutrition should be required of residents now or in the future. Conclusions: Nutrition education in current graduate medical education is poor. Most programs lack the expertise or time commitment to teach a formal course but recognize the need to meet educational requirements. A broad‐based, diverse universal program is needed for training in nutrition during residency.     

Development and Validation of a Technology-Based System for Tracking and Reporting Dietary Intake at School Meals

Objective

This report describes the development and validation of a technology-based system that integrates data on food choice, nutrition, and plate waste to generate feedback reports summarizing students' dietary intake at school meals.

Position of the American Dietetic Association: local support for nutrition integrity in schools

It is the position of The American Dietetic Association that the school and community have a shared responsibility to provide all students with access to high-quality foods and nutrition services as an integral part of the total education program. Educational goals, including the nutrition goals of the National School Lunch Program and the School Breakfast Program, should be supported and extended through school district policies that create an overall school environment with learning experiences that enable students to develop lifelong, healthful eating habits. Local school policy, developed through a collaborative process that responds to community needs and priorities, should include the integration of the school nutrition program with education. Nutrition integrity policy provides a framework for the integration and coordination of all aspects of the school nutrition program. Nutrition integrity is defined as “a guaranteed level of performance that ensures that all foods available and consumed by children in schools are consistent with the Recommended Dietary Allowances and the Dietary Guidelines for Americans, and contribute to the development of lifelong, healthy eating habits.” Achieving nutrition integrity means taking a comprehensive approach to program planning, management, operations, and integration of nutrition into the total education program of the school. The community is a valuable resource for this effort. Collaboration between key school- and community-based constituents, including children and other stakeholders, will result in the most effective and relevant plans for local school nutrition programs. However, competing and profit-making food and beverage sales may create a conflicting environment and can contradict lessons taught in health and nutrition education. This position provides direction for the dietetics profession for addressing this issue along with providing a suggested action plan for local schools and their communities. J Am Diet Assoc. 2000;100:108-111.     

Position of the American Dietetic Association,Society for Nutrition Education,and American School Food Service Association: Nutrition services: an essential component of comprehensive school health programs

It is the position of the American Dietetic Association (ADA), the Society for Nutrition Education (SNE), and the American School Food Service Association (ASFSA) that comprehensive nutrition services must be provided to all of the nation's preschool through grade 12 students. These nutrition services shall be integrated with a coordinated, comprehensive school health program and implemented through a school nutrition policy. The policy should link comprehensive, sequential nutrition education; access to and promotion of child nutrition programs providing nutritious meals and snacks in the school environment; and family, community, and health services' partnerships supporting positive health outcomes for all children. Childhood obesity has reached epidemic proportions and is directly attributed to physical inactivity and diet. Schools can play a key role in reversing this trend through coordinated nutrition services that promote policies linking comprehensive, sequential nutrition education programs, access to and marketing of child nutrition programs, a school environment that models healthful food choices, and community partnerships. This position statement provides information and resources for nutrition professionals to use in developing and supporting comprehensive school health programs.     

Design and Implementation of a 5-Year School-Based Nutrition Education Intervention

ObjectiveTo describe the research methods of a multicomponent nutrition education program empowering teachers to improve nutrition literacy and prevent obesity among elementary school students.DesignProspective 5-year study following a pre-post intervention design.SettingFour elementary schools in a high-needs area in Washington, DC: 2 intervention and 2 comparison schools.ParticipantsApproximately 100 teachers (25/school) and 800 students (200/school) enrolled over the study period.InterventionHealthy Schoolhouse 2.0 will engage teachers as agents of change by designing, implementing, and evaluating a structured professional development program to support the integration of nutrition concepts in the classroom.Main Outcome MeasuresChange in pre-post survey assessment of students’ nutrition literacy, attitudes, and intent; change in teachers’ self-efficacy toward teaching nutrition; fruit and vegetable consumption data collected 6 times/y in the cafeteria.AnalysisProcess evaluation throughout the study to document implementation and challenges. Multilevel mixed modeling will be used to determine the impact of the intervention.     

Pairing Feeding Content With a Nutrition Education Curriculum: A Comparison of Online and In-Class Delivery

ObjectiveTo develop a childhood obesity prevention program, Food, Feeding and Your Family (FFYF), which encourages eating self-regulation in young children. This article describes the research methods for FFYF. Activities that will be used to guide the development of the program are illustrated in a logic model.DesignA randomized control trial will be conducted with participant groups randomized into 1 of 3 conditions: (1) in-class delivery of feeding content and nutrition education, (2) online delivery of feeding content and in-class delivery of nutrition education, and (3) nutrition education only. Assessments will be collected at baseline, program completion, and 6 and 12 months after completion of the program.SettingStudy will be conducted through the Expanded Food and Nutrition Education Program in Colorado and Washington State.ParticipantsParents with 2- to 8-year-old children will be recruited from affiliated community agencies, 540 participants across both states.InterventionsFFYF derives content from an empirically validated parental feeding program, Strategies for Effective Eating Development, and will be administered with Eating Smart • Being Active, an evidence-based, nutrition education curriculum.Main Outcome MeasuresParents will report on feeding practices, child eating behaviors, feeding styles, and acculturation.AnalysisBecause of the nested nature of the data, multilevel analyses will be used: time points, within parents, and within groups.     

Nutrition behavior change among EFNEP participants is higher at sites that are well managed and whose front-line nutrition educators value the program

Effective programs to promote improved dietary practices among low-income families depend on the motivation and performance of front-line nutrition educators, yet little is known about the work context experienced by nutrition workers or how their perceptions of work context relate to program effectiveness. This research examined the perceived work context of nutrition educators, a multidimensional construct developed through formative research, in the Expanded Food and Nutrition Education Program (EFNEP) in New York State. We proposed that work context, program management, and program and educator characteristics would be related to program effectiveness (reported behavior change among participants). A state-wide survey of paraprofessional Community Nutrition Educators (CNEs) in 30 program sites was conducted and analyzed in relation to program monitoring data. Greater behavior change was reported by participants in sites whose CNEs gave positive ratings to the value of EFNEP (P < 0.02) and to the managerial practices of their supervisors (P < 0.001). To our knowledge, this is the first time that an association was demonstrated between perceived work context at the front lines and effectiveness of a nutrition program. Higher behavior change scores were also reported at sites in which a greater proportion of participants received individual rather than group instruction (P < 0.001). Associations between participants' reported behavior change and CNEs' perceptions of program value and program management suggest that improvements in these areas could enhance nutrition program success.     

Training Needs of Nutrition Educators Engaged in Policy,Systems, and Environmental Approaches

ObjectiveAssess training needs of nutrition educators incorporating policy, systems, and environmental (PSE) approaches into their obesity prevention efforts, to identify content for online training.MethodsConducted a national, online survey of state and local Expanded Food and Nutrition Education Program and Supplemental Nutrition Assistance Program Education professionals engaged in PSE efforts.ResultsRespondents (n = 601) rated the importance of 24 training topics related to planning, implementing, and evaluating PSE approaches. Most (21) topics were rated very important or essential, confirming the need for a comprehensive approach. Paired-sample t tests found significant differences (P <0.001) in some training needs between local and state staff (eg, training in evaluation rated higher for state staff). Training needs did not differ by program, region, or length of employment. The top 5 settings for PSE efforts were schools, farmers’ markets, food banks/pantries, community gardens, and after-school programs.Conclusions and ImplicationsResults informed the development of an online training for program implementers. Future research will be needed to assess and refine training needs further, which will evolve as nutrition educators gain more experience in PSE approaches.