Environmental Interventions to Promote Healthy Eating: A Review of Models, Programs, and Evidence

Home-based interventions to improve indoor air quality have demonstrated benefits for asthma morbidity, yet little is known about the effect of environmental interventions in the school setting. We piloted the feasibility and effectiveness of a classroom-based air cleaner intervention to reduce particulate pollutants in classrooms of children with asthma. In this pilot randomized controlled trial, we assessed the effect of air cleaners on indoor air particulate pollutant concentrations in 18 classrooms (9 control, 9 intervention) in 3 urban elementary schools. We enrolled 25 children with asthma (13 control, 12 intervention) aged 6 to 10 years. Classroom air pollutant measurements and spirometry were completed once before and twice after randomization. Asthma symptoms were surveyed every 3 months. Baseline classroom levels of fine particulate matter (particulate matter with diameter of <2.5 μm [PM2.5]) and black carbon (BC) were 6.3 and 0.41 μg/m3, respectively. When comparing the intervention to the control group, classroom PM2.5 levels were reduced by 49% and 42% and BC levels were reduced by 58% and 55% in the first and second follow-up periods, respectively (P < .05 for all comparisons). When comparing the children randomized to intervention and control classrooms, there was a modest improvement in peak flow, but no significant changes in forced expiratory volume in 1 second (FEV1) and asthma symptoms. In this pilot study, a classroom-based air cleaner intervention led to significant reductions in PM2.5 and BC. Future large-scale studies should comprehensively evaluate the effect of school-based environmental interventions on pediatric asthma morbidity.

Evidence based practice guidelines for the nutritional management of malnutrition in adult patients across the continuum of care

Next-Generation Solutions to Address Adaptive Challenges in Dietetics Practice: The I+PSE Conceptual Framework for Action.

Rural residents are at greater risk of obesity than urban and suburban residents. Failure to meet physical activity and healthy eating recommendations play a role. Emerging evidence shows the effectiveness of environmental and policy interventions to promote physical activity and healthy eating. Yet most of the evidence comes from urban and suburban communities. The objectives of this study were to (1) identify types of environmental and policy interventions being implemented in rural communities to promote physical activity or healthy eating, (2) identify barriers to the implementation of environmental or policy interventions, and (3) identify strategies rural communities have employed to overcome these barriers. Key informant interviews with public health professionals working in rural areas in the United States were conducted in 2010. A purposive sample included 15 practitioners engaged in planning, implementing, or evaluating environmental or policy interventions to promote physical activity or healthy eating. Our findings reveal that barriers in rural communities include cultural differences, population size, limited human capital, and difficulty demonstrating the connection between social and economic policy and health outcomes. Key informants identified a number of strategies to overcome these barriers such as developing broad-based partnerships and building on the existing infrastructure. Recent evidence suggests that environmental and policy interventions have potential to promote physical activity and healthy eating at the population level. To realize positive outcomes, it is important to provide opportunities to implement these types of interventions and document their effectiveness in rural communities.

Diarrhoeal diseases kill an estimated 2.5 million people each year, the majority being children under 5 years (Kosek et al. 2003). An estimated 4 billion cases annually account for 5.7% of the global burden of disease and place diarrhoeal disease as the third highest cause of morbidity and sixth highest cause of mortality (Pruess et al. 2002). Among children under 5 years in developing countries, diarrhoeal disease accounts for 21% of all deaths (Parashar et al. 2003). By inhibiting normal consumption of foods and adsorption of nutrients, diarrhoeal diseases are also an important cause of malnutrition, leading to impaired physical growth and cognitive development (Guerrant et al. 1999), reduced resistance to infection (Baqui et al. 1993) and potentially long-term gastrointestinal disorders (Schneider et al. 1978). Infectious agents associated with diarrhoeal disease are transmitted chiefly through the faecal-oral route (Byers et al. 2001). A wide variety of bacterial, viral and protozoan pathogens excreted in the faeces of humans and animals are known to cause diarrhoea. Many of these are potentially waterborne – transmitted through the ingestion of contaminated water (Leclerc et al. 2002). Accordingly, a number of interventions have been developed to treat water. These include (i) physical removal of pathogens (e.g. filtration, adsorption and sedimentation); (ii) chemical treatment (e.g. assisted sedimentation, chemical disinfection and ion exchange); or (iii) heat and ultra violet (UV) radiation. Because of the risk of recontamination (Clasen & Bastable 2003), interventions to improve water quality also include steps to maintain the microbiological quality of safe drinking water, such as piped distribution, residual disinfection and improved storage. These efforts are expected to receive additional priority as a result of the United Nation’s commitment to reduce by one-half of the 1.5 billion people without sustainable access to improved water, one of the United Nation’s Millennium Development Goals (United Nations 2000), and by the World Health Organization’s steps to accelerate the health gains of safe water to the remaining population by improved treatment and storage of water at the household level (Sobsey 2002). Health authorities generally accept that safe water plays an important role in preventing outbreaks of diarrhoeal disease (Hunter 1997). Accordingly, the most widely accepted standard for water quality allows no detectable level of harmful pathogens at the point of distribution (WHO 1993). However, in those settings in which diarrhoeal disease is endemic, much of the epidemiological evidence for increased health benefits following improvements in the quality of drinking water has been equivocal (Esrey & Habicht 1986; Lindskog et al. 1987; Cairncross 1989). As many of these same waterborne pathogens are also transmitted via ingestion of contaminated food and other beverages, by person-to-person contact, and by direct or indirect contact with infected faeces, improvements in water quality alone may not necessarily interrupt transmission (Briscoe 1984). As a result of this variety of risk factors, interventions for the prevention of diarrhoeal disease not only include enhanced water quality but also steps to (i) improve the proper disposal of human faeces (sanitation), (ii) increase the quantity and improve access to water (water supply), and (iii) promote hand washing and other hygiene practices within domestic and community settings (hygiene). As in the case of studies of water quality, there is a wide range in the reported measure of effect on diarrhoea morbidity of each of these other environmental interventions (Esrey et al. 1985). Even more fundamentally, there are also questions about the methods and validity of studies designed to assess the health impact of such interventions (Briscoe et al. 1986; Imo State Evaluation Team 1989). As part of a larger evaluation of interventions for the control of diarrhoeal disease (Feachem et al. 1983), Esrey et al. (1985) reviewed 67 studies to determine the health impact from improvements in water supplies and excreta disposal facilities (Esrey et al. 1985). The median reduction in diarrhoeal morbidity from improved water quality was 16% (range 0–90%). This compared with 22% for Tropical Medicine and International Health

Effect of environmental intervention on mouse allergen levels in homes of inner-city Boston children with asthma

Among several vector control methods commonly used, environmental management is one of the control measures to mitigate dengue in such vulnerable communities. Since there is no curative treatment for dengue yet, targeted environmental and ecosystem management is increasingly relevant. Hence, this review was conducted to identify the effectiveness of environmental management intervention strategy to reduce dengue cases. We searched PUBMED, CENTRAL, SCOPUS, Web of Science, CIJE, WHO ICTRP, and ClinicalTrials.gov up to January 2021. A total of 521 articles were screened. Only 16 studies were included in this review. There were 6 studies that applied all three types of environmental management interventions (manipulation, modification and behavior), 8 studies applied two types of interventions (manipulation and behavior) and 2 studies applied one type of intervention (manipulation or behavior). All included studies reported reduction of Aedes entomological indices. The studies showed reduction in dengue cases and density of Aedes population through environmental interventions. It is recommended for the health authority to incorporate environmental management intervention in dengue control activities and enhanced the community involvement to ensure sustainability with high impact on dengue reduction.

From neighborhood design and food options to residents’ weight status

Long-Haul Truck Drivers Want Healthful Meal Options at Truck-Stop Restaurants

Commentary and translation: 1994 nutrition recommendations for diabetes

Among Young Adults, College Students and Graduates Practiced more Healthful Habits and made more Healthful Food Choices than did Nonstudents

College students are at risk for poor dietary choices. New skills can empower individuals to adopt healthful behaviors, yet eHealth tools designed to develop food-choice skills, such as label-reading skills, are uncommon. We investigated the effects of web-based label-reading training on college students' perceptions of healthful food-choice empowerment. Students completed label-reading training in which they practiced selecting the more healthful food using nutrition labels. We examined improvements in label-reading accuracy (correct healthfulness decisions) and perceptions of empowerment, using a 6-item scale. Repeated measures ANOVAs and paired-samples t-tests were used to examine changes in accuracy and empowerment across the training session. In addition to increases in label-reading accuracy with training, we found increases in healthful food-choice empowerment scores. Specifically, the proportion of correct (i.e., more healthful) food choices increased across the three blocks of practice (p = 0.04) and food-choice empowerment scores were about 7.5% higher on average after training (p < 0.001). Label-reading training was associated with increased feelings of empowerment associated with making healthful food choices. Skill focused eHealth tools may offer an important avenue for motivating behavior change through skill development.

Exposure to indoor air pollutants such as tobacco smoke and dust mites may exacerbate childhood asthma. Environmental interventions to reduce exposures to these pollutants can help prevent exacerbations of the disease. Among the most important interventions is the elimination of environmental tobacco smoke from the environments of children with asthma. However, the effectiveness of reducing asthmatic children's exposure to environmental tobacco smoke on the severity of their symptoms has not yet been systematically evaluated. Dust mite reduction is another helpful environmental intervention. This can be achieved by enclosing the child's mattresses, blankets, and pillows in zippered polyurethane-coated casings. Primary prevention of asthma is not as well understood. It is anticipated that efforts to reduce smoking during pregnancy could reduce the incidence of asthma in children. European studies have suggested that reducing exposure to food and house dust mite antigens during lactation and for the first 12 months of life diminishes the development of allergic disorders in infants with high total IgE in the cord blood and a family history of atopy. Many children with asthma and their families are not receiving adequate counseling about environmental interventions from health care providers or other sources.

Environmental intervention reduces mouse allergen levels in homes of boston inner-city children with asthma

Obesity has been characterized as a disease. Strategies to change the incidence and prevalence of this disease include a focus on changing physical and social environments, over and above individual-level strategies, using a multilevel or systems approach. We focus our attention on evidence published between 2008 and 2013 on the effectiveness of interventions in nutrition environments, i.e., environmental interventions designed to influence the intake of healthful foods and amount of energy consumed. An overarching socioecological framework that has guided much of this research was used to characterize different types of environmental strategies. Intervention examples in each area of the framework are provided with a discussion of key findings and related conceptual and methodological issues. The emphasis in this review is on adults, but clearly this literature is only one part of the picture. Much research has been focused on child-specific interventions, including environmental interventions. Some evidence suggests effectiveness of policy-based or other types of interventions that aim to regulate or restructure environments to promote healthy dietary choices, and these strategies would apply to both children and adults. Opportunities to evaluate these policy changes in adults' social and physical environments are rare. Much of the existing research has been with children. As conceptual and methodological issues continue to be identified and resolved, we hope that future research in this domain will identify environmental strategies that can be included in intervention toolboxes to build healthy nutrition environments for both adults and children.