Child Nutrition Programs Research Articles

A 2-Year Integrated Agriculture and Nutrition Program Targeted to Mothers of Young Children in Burkina Faso Reduces Underweight among Mothers and Increases Their Empowerment: A Cluster-Randomized Controlled Trial

Background: Recent evidence demonstrates the benefits of integrated agriculture and nutrition programs for children’s health and nutrition outcomes. These programs may also improve mothers’ nutrition and empowerment outcomes. However, evidence from rigorous evaluations is scarce.Objective: We examined impacts of Helen Keller International’s 2-y enhanced-homestead food production (E-HFP) program in Burkina Faso on the secondary impact measures of mothers’ nutrition and empowerment.Methods: We used a cluster-randomized controlled trial whereby 55 villages with 1767 mothers of young children were randomly assigned to 3 groups: 1) control, 2) E-HFP with the behavior change communication (BCC) strategy implemented by older women leaders, or 3) E-HFP with BCC implemented by health committee members. Data for the treatment groups were pooled for this analysis because no differences were found between the 2 groups in key mothers’ outcomes. We used difference-in-differences (DID) estimates to assess impacts on mothers’ dietary intake, diversity, body mass index (BMI; in kg/m2), prevalence of underweight (BMI <18.5), and empowerment.Results: The E-HFP program significantly increased mothers’ intake of fruit (DID = 15.8 percentage points; P = 0.02) and marginally increased their intake of meat/poultry (DID = 7.5 percentage points; P = 0.08) and dietary diversity (DID = 0.3 points; P = 0.08). The prevalence of underweight was significantly reduced among mothers in treatment compared with control villages by 8.7 percentage points (P < 0.01). Although the changes in BMI did not differ between mothers in treatment and control villages, there was a marginally significant interaction (baseline underweight × change in BMI; P-interaction = 0.07), indicating that underweight mothers had a greater increase in BMI than did mothers who were not underweight. The E-HFP program also positively affected mothers’ overall empowerment score (DID = 3.13 points out of 37 possible points; P < 0.01) and 3 components of empowerment: meeting with women (DID = 1.21 points out of 5 possible points; P < 0.01), purchasing decisions (DID = 0.86 points out of 8 possible points; P = 0.01), and health care decisions (DID = 0.24 points out of 2 possible points; P = 0.05).Conclusions: Helen Keller International’s E-HFP program in Burkina Faso substantially improved mothers’ nutrition and empowerment outcomes. These positive impacts benefit the mothers themselves and may also improve their ability to care for their children. This trial was registered at clinicaltrials.gov as NCT01825226.

Innovation and Changes in Child Nutrition Programs: National and State of Louisiana

The Healthy, Hunger Free Kids Act (HHFKA) of 2010, a reauthorization of the Child Nutrition Act sets new nutrition standards for meal patterns, food sold and served in schools, and requires training and professional standards development for all school nutrition personnel. Major improvements are being made across the country and in Louisiana to incorporate these standards, increase access to healthy food and promote student wellness. The National School Lunch and National School Breakfast Programs improve diet, reduce food insecurity and improve overall health. In April 2015, LSU's Pennington Biomedical Research Center partnered with the Louisiana Department of Education's Division of Nutrition Support to launch the Louisiana Fit Kids project, which aims to strengthen child nutrition programs through a variety of key initiatives. An interactive website was launched to include meal planning, assist with implementation of professional standards requirements for child nutrition personnel, house the approved Smart Snacks listing for Louisiana, and other child nutrition topics. High on the priority list is the completion of a statewide needs assessment to determine training needs, technical assistance requirements, and other priorities which will help allocate resources for future action plans. The needs assessment survey was launched in September 2015 with plans to publish results by January 2016. The data collected will be analyzed to categorize the five regions of the state in terms of trainings needed, technology available and other aspects of their child nutrition program. Portions of the survey include questions about barriers to successful implementation of the child nutrition program, along with training needs related to meal planning and meal pattern requirements. Preliminary data suggest barriers to meal participation vary between 33–83%, trainings related to meal planning vary between 29–63% or meal pattern requirements vary between 40–57%. Complete survey results will point to differences in the five regions of the state and will allow comparisons to other states and national child nutrition data. Louisiana has set some standards differently from USDA, primarily restricting calorie content in the Smart Snacks listing and with several products excluded that have been exempted by USDA. Results of the needs assessment survey and differences between Louisiana and USDA will be the focus of this presentation, along with a discussion of future directions for this project which has Louisiana on the forefront of high achievements in the realm of child nutrition within the school system.Support or Funding InformationSupported by the Louisiana Department of Education, Division of Nutrition Support

Child nutrition professionals’ feedback on implementing the Healthy, Hunger-Free Kids Act of 2010

ABSTRACTThis article discusses the first two years of implementation of the Healthy, Hunger-Free Kids Act of 2010 in the United States Department of Agriculture’s (USDA) core child nutrition programs—the National School Lunch Program and the School Breakfast Program. As child nutrition professionals work toward compliance with these new guidelines, they are engaging in ongoing discussions on the USDA’s Mealtalk listserv. The purpose of this study was to identify critical themes emerging from these discussions. This study takes a stakeholder perspective and evaluates Mealtalk discussions from the points-of-view of the organization (schools), foodservice unit, and customers (students). Study results show the most frequently cited themes and child nutrition professionals’ efforts to overcome initial challenges and obstacles in implementing the new guidelines.

Maternal mental health symptoms are positively related to emotional and restrained eating attitudes in a statewide sample of mothers participating in a supplemental nutrition program for women, infants and young children.

Postpartum, low-income mothers are at risk for mental health symptoms and obesity, and disordered eating attitudes may be associated with both mental health and obesity in this vulnerable population. The study objective is to determine whether higher levels of mental health symptoms are associated with increased odds of emotional and restrained eating attitudes in this sample of Special Supplemental Nutrition Program for Women, Infants and Children (WIC) participants. Data on 711 mothers of infants <13 months from a statewide sample of Maryland WIC participants were collected via telephone survey. Maternal mental health symptoms were measured on continuous scales for depression (PRIME-MD), stress (Perceived Stress Scale) and anxiety (Spielberger State-Trait Anxiety Inventory). Emotional and restrained eating attitudes were measured with questions adapted from the Dutch Eating Behavior Questionnaire. Multivariate logistic regression analysis was used. Obesity [body mass index (BMI) ≥ 30] was explored as a moderating variable. Mothers reporting higher levels of depression symptoms [odds ratio (OR) = 3.93, 95%CI: 2.71-5.69], anxiety symptoms (OR = 1.96, 95%CI: 1.47-2.65), stress symptoms (OR = 2.09, 95%CI: 1.67-2.61) and high overall mental health symptomatology (OR = 3.51, 95%CI: 2.43-5.3) had increased odds of emotional eating attitudes. There were significant associations between symptoms of depression (OR = 1.59, 95% CI: 1.12-2.25) and increased odds of restrained eating attitudes. Obesity did not moderate the association. Mothers with mental health symptoms are at risk for disordered eating attitudes, which may increase risk of poor diet. These findings underscore the need for greater focus on addressing maternal mental health status and eating attitudes in the postpartum period.

Parental Involvement in a School-Based Child Physical Activity and Nutrition Program in Southeastern United States: A Qualitative Analysis of Parenting Capacities.

Parent involvement varies widely in school-based programs designed to promote physical activity and healthy nutrition, yet the underlying factors that may limit parent's participation and support of learned behaviors at home are not well understood. We conducted a qualitative study that consisted of one focus group (n = 5) and 52 in-depth interviews among parents whose children participated in a school-based physical activity and nutrition (PAN) promotion program in Williamsburg, Virginia, United States. We sought to identify factors that enabled or constrained parent's support of and involvement in children's programs and to understand the underlying factors that contribute to family success in making dietary and physical activity changes at home. Parents identified their physical and mental health, self-confidence, time, and decision making as underlying "capacities" in the family health pattern. When strengthened, these capacities encourage healthful family behavior and support of school-based PAN programs. Families that succeeded in adopting lessons learned from school-based PAN programs identified four primary strategies for success: shared goals, meal planning, modeling of good behaviors, and collective activities. Interventions that aim to improve child nutrition and physical activity and the broader family health environment should consider underlying capacities of parents and the importance of joint goals and activities.

Impact evaluation of positive deviance hearth in Migori county, Kenya

A Positive Deviance (PD) Hearth intervention is a home and neighborhood-based nutrition program for children who are at risk for protein-energy malnutrition in a low resource community. The intervention uses the ‘Positive Deviance’ approach to identify those behaviors practiced by the mothers or caretakers of well-nourished children from poor families and transfers such positive practices to other mothers who are equally disadvantaged economically. Positive Deviance Hearth intervention is designed to treat malnourished children, enable the families to sustain their rehabilitation at home on their own and to prevent malnutrition in younger siblings. However, PD Hearth intervention monitoring system in Migori only assesses a program’s ability to treat, one of the three PD Hearth objectives. Thus, there was need for impact evaluation to measure outcomes of the PD Hearth intervention to sustain rehabilitation and prevent malnutrition in younger siblings. The objectives of the study were to determine the level to which PD Hearth enables families to sustain rehabilitation at home on their own and to identify the practices which influence PD Hearth outcomes. The study was designed as a pipeline quasi-experimental and mixed method was used to collect data and perform statistical analyses. Single stage cluster sampling was used to identify 53 and 54 children on the intervention and comparison group in five communities. Weight measurements of the children on the intervention aged 6 to 59 months at the entry, exit and graduation stages were retrieved from Kenya Medical Research Institute Family AIDS Care and Education Services programme activities reports. Anthropometry (height measurements) for the children on the intervention and comparison children was taken. Caregivers filled in a questionnaire, assisted by the researchers as necessary. At entry, 18.9% children on the intervention had moderate underweight while 43.4% had mild underweight. At current status though, 3.8% and 34.0% had moderate and mild underweight respectively. The regression model predicted that Weight-for-Height (WAZ) of the children on the intervention at current status lied on 51.5 percentile, thus, normal for underweight. Increased feeding frequency made the largest contribution to weight gain than other caregiver practices. Therefore, the Migori County government in collaboration with the Ministry of Health needs to scale up PD Hearth intervention to reverse cases of Moderate Acute Malnutrition (MAM) and prevent Severe Acute Malnutrition (SAM) in the County.

Effect of Home-Based Complementary Food Fortification on Prevalence of Anemia Among Infants and Young Children Aged 6 to 23 Months in Poor Rural Regions of China.

Following the 2008 Wenchuan earthquake, the Chinese government instituted an infant and young and child nutrition program that included promotion of in-home fortification of complementary food with ying yang bao (YYB), a soy-based powder containing iron, 2.5 mg as iron-EDTA and 5 mg as ferrous fumarate, and other micronutrients. Ying yang bao was provided to participating families in 8 poor rural counties in Sichuan, Shaanxi, and Gansu provinces by the Ministry of Health. We assessed hemoglobin levels among infants and young children (IYC) aged 6 to 23 months at baseline in May 2010 (n = 1290) and during follow-up in November 2010 (n = 1142), May 2011 (n = 1118), and November 2011 (n = 1040), using the Hemocue method. Interviewers collected basic demographic information and child feeding practices from the children's caretakers. Altitude-adjusted hemoglobin level averaged 10.8 g/dL, and total anemia prevalence was 49.5% at baseline. Average hemoglobin was 11.3 g/dL at 6 months, 11.6 g/dL at 12 months, and 11.7 g/dL at 18 months after introduction of YYB. Moderate anemia (hemoglobin: 70-99 g/dL) decreased from 20.3% at baseline to 7.5%, 5.8%, and 7.3% after 6, 12, and 18 months of home fortification, respectively (P < .001), whereas mild anemia (hemoglobin: 100-110 g/dL) decreased from 29.0% to 16.7%, 18.1%, and 15.4%, respectively (P < .001). Among infants aged 6 to 23 months, 95% had regularly been fed YYB during the observation period. Regression analysis showed that the duration of YYB consumption and number of sachets consumed per week correlated positively with hemoglobin levels and negatively with anemia rates. Home food fortification with YYB is feasible and effective for nutrition promotion among IYC in high-risk regions of China.

Impact d’une intervention sur l’offre alimentaire et sur les comportements alimentaires des adolescents (hors restauration scolaire)

Within the Nutrition, Prevention, and Health Program for children and teenagers in Aquitaine, an experimental intervention was implemented in 2007-2008 in the middle and high schools in Aquitaine (southwest France). This intervention aimed to improve the eating habits of adolescents, combining actions to improve the food supply sold during recreational times (remove/limit fat and sugar products sold and promote the sale of fruits and bread) and health education actions to make adolescents aware of the concept of nutritional balance and steer their choice towards recommended products. The aim of this paper was to evaluate the impact of the intervention on the eating behavior of adolescents and the food supply sold during recreational times in middle and high schools in Aquitaine. A survey was conducted before and after the implementation of the intervention in seven middle and high schools that have implemented actions (intervention group) and eight middle and high schools that have not implemented actions (control group). In these schools, 1602 adolescents answered the survey before and 1050 after the intervention (samples were independent because of the anonymity of responses). The impact of the intervention on the dietary behavior of teenagers was modeled using logistic regression adjusted on potential confounding variables (sex, age, and educational status). In multivariate analyses, the intervention was associated with more frequent daily intake of breakfast (OR=2.63; 95% CI [1.89; 3.66]) and lower intake of morning snacks (OR=0.66; 95% CI [0.48; 0.90]), higher consumption of starchy foods (OR=1.77; 95% CI [1.30; 2.42]), bread at breakfast, morning snacks, and a light afternoon meal (OR=1.43; 95% CI [1.07; 1.90]), and the food supply sold at recreational times (OR=1.34 95% CI [1.01; 1.78]). These results show that the "Improving food supply in middle and high schools associated with educational support actions" project led to the sales of recommended foods during recreational times and improved students' eating behavior. These results encourage partners to pursue these actions in all volunteer middle and high schools.

Factors associated with early growth in Egyptian infants: implications for addressing the dual burden of malnutrition.

Optimal nutrition is critical to the attainment of healthy growth, human capital and sustainable development. In Egypt, infants and young children face overlapping forms of malnutrition, including micronutrient deficiencies, stunting and overweight. Yet, in this setting, little is known about the factors associated with growth during the first year of life. A rise in stunting in Lower Egypt from 2005 to 2008 prompted this implementation research study, which followed a longitudinal cohort of infants from birth to 1 year of age within the context of a USAID‐funded maternal and child health integrated programme. We sought to determine if growth patterns and factors related to early growth differed in Lower and Upper Egypt, and examined the relationship between weight loss and subsequent stunting at 12 months of age. Growth patterns revealed that length‐for‐age z‐score (LAZ) decreased and weight‐for‐length z‐score (WLZ) increased from 6 to 12 months of age in both regions. One‐quarter of infants were stunted and nearly one‐third were overweight by 12 months of age in lower Egypt. Minimum dietary diversity was significantly associated with WLZ in Lower Egypt (β = 0.22, P < 0.05), but not in Upper Egypt. Diarrhoea, fever and programme exposure were not associated with any growth outcome. Weight loss during any period was associated with a twofold likelihood of stunting at 12 months in Lower Egypt, but not Upper Egypt. In countries, like Egypt, facing the nutrition transition, infant and young child nutrition programmes need to address both stunting and overweight through improving dietary quality and reducing reliance on energy‐dense foods.

Association between intimate partner violence and child morbidity in South Asia.

BackgroundThis study investigates the association between intimate partner violence (IPV) against women and its impact on child morbidity in the south Asian region.MethodsThe analysis uses logistic regression models with cross sectional nationally representative data from three countries - Bangladesh, India and Nepal. The data have been pooled from ‘Demographic and Health Surveys’ (DHS) of Bangladesh, Nepal and ‘National Family and Health Survey’ (NFHS) of India.ResultsThe study revealed that after controlling for potential confounders, children of mothers experiencing physical violence, sexual violence or both were more likely to have Acute Respiratory Infection (ARI) (ORadj 1.57; 95 % CI 1.48–1.67), fever (ORadj 1.44; 95 % CI 1.35–1.54) and diarrhea (ORadj 1.56; 95 % CI 1.44–1.69).ConclusionsThe results highlight that IPV can influence childhood morbidity and support the need to address IPV with a greater focus within current child nutrition and health programs and policies.

A televideo exercise and nutrition program for children with acute lymphoblastic leukemia in maintenance therapy: design and methods

A televideo exercise and nutrition program for children with acute lymphoblastic leukemia in maintenance therapy: design and methods

Use of the Community Readiness Model to Develop and Evaluate a Chef-Based Training Program for School Nutrition Professionals

ObjectiveDevelop and implement a culinary training program for school nutrition professionals that has the potential to change the paradigm of school nutrition in Oklahoma.Target AudienceKitchen staff in six pilot Oklahoma school sites that participate in the USDA Child Nutrition Programs. Sites were diverse in geographic location, meal preparation system, and grade level.Theory, Prior Research, RationaleMeeting the USDA school nutrition meal patterns and standards includes using less processed foods. The Academy of Nutrition and Dietetics recommends the use of chef-based training model to help meet the requirements. Based on six dimensions, Community Readiness describes the extent to which a group of people are ready to engage in change. When program planners do not match strategies to readiness sustained success is unlikely.DescriptionPrior to developing the chef-based pilot training focus groups were conducted in each school to assess readiness to use less processed food. Findings were used to address the lowest scoring dimensions (i.e., knowledge of efforts and resources). The two-day training sessions focused on 1) increasing awareness and misconceptions of why changes are needed and 2) increasing skills and knowledge.EvaluationPost-training assessments measured change in staffs’ readiness. Across schools, readiness moved from vague awareness to preparation. Knowledge of efforts increased 4 units; resources did not change.Conclusions and ImplicationsStage-matched training improved staffs’ readiness to use less processed foods. Future efforts should include 1) specific application of knowledge and skills to school nutrition, including on-site chef consultations and 2) addressing school stakeholders’ attitudes toward school nutrition to move readiness to initiation and expansion stages.FundingCenters for Disease Control and Prevention, Expanded Food and Nutrition Education Program, National Heart, Lung, and Blood Institute, NIH, NIFA, Robert Wood Johnson Foundation, Supplemental Nutrition Assistance Program, Oklahoma State Department of Education Child Nutrition Programs. ObjectiveDevelop and implement a culinary training program for school nutrition professionals that has the potential to change the paradigm of school nutrition in Oklahoma. Develop and implement a culinary training program for school nutrition professionals that has the potential to change the paradigm of school nutrition in Oklahoma. Target AudienceKitchen staff in six pilot Oklahoma school sites that participate in the USDA Child Nutrition Programs. Sites were diverse in geographic location, meal preparation system, and grade level. Kitchen staff in six pilot Oklahoma school sites that participate in the USDA Child Nutrition Programs. Sites were diverse in geographic location, meal preparation system, and grade level. Theory, Prior Research, RationaleMeeting the USDA school nutrition meal patterns and standards includes using less processed foods. The Academy of Nutrition and Dietetics recommends the use of chef-based training model to help meet the requirements. Based on six dimensions, Community Readiness describes the extent to which a group of people are ready to engage in change. When program planners do not match strategies to readiness sustained success is unlikely. Meeting the USDA school nutrition meal patterns and standards includes using less processed foods. The Academy of Nutrition and Dietetics recommends the use of chef-based training model to help meet the requirements. Based on six dimensions, Community Readiness describes the extent to which a group of people are ready to engage in change. When program planners do not match strategies to readiness sustained success is unlikely. DescriptionPrior to developing the chef-based pilot training focus groups were conducted in each school to assess readiness to use less processed food. Findings were used to address the lowest scoring dimensions (i.e., knowledge of efforts and resources). The two-day training sessions focused on 1) increasing awareness and misconceptions of why changes are needed and 2) increasing skills and knowledge. Prior to developing the chef-based pilot training focus groups were conducted in each school to assess readiness to use less processed food. Findings were used to address the lowest scoring dimensions (i.e., knowledge of efforts and resources). The two-day training sessions focused on 1) increasing awareness and misconceptions of why changes are needed and 2) increasing skills and knowledge. EvaluationPost-training assessments measured change in staffs’ readiness. Across schools, readiness moved from vague awareness to preparation. Knowledge of efforts increased 4 units; resources did not change. Post-training assessments measured change in staffs’ readiness. Across schools, readiness moved from vague awareness to preparation. Knowledge of efforts increased 4 units; resources did not change. Conclusions and ImplicationsStage-matched training improved staffs’ readiness to use less processed foods. Future efforts should include 1) specific application of knowledge and skills to school nutrition, including on-site chef consultations and 2) addressing school stakeholders’ attitudes toward school nutrition to move readiness to initiation and expansion stages. Stage-matched training improved staffs’ readiness to use less processed foods. Future efforts should include 1) specific application of knowledge and skills to school nutrition, including on-site chef consultations and 2) addressing school stakeholders’ attitudes toward school nutrition to move readiness to initiation and expansion stages.

Establishing Community Wellness Teams

Grants Competitive and Non-competitive in 2013 and 2014. Poster will highlight training, nutrition education, and wellness policy work. Evaluation: Kansas State Department of Education has reached over 19,500 students through nutrition education promotion, over 4,200 foodservice professionals in training classes developed through the TNTG, and over 450 school staff through regional Impacting School Wellness Workshops. Conclusions and Implications: Evaluations from programs conducted under the Kansas State Department of Education's Team Nutrition Training Grants have shown positive response to program activities. Funding: USDA Grant #CNTN-14-KS(C).

School and District-Level Characteristics Associated With Participation in the After-School Snack Component of the National School Lunch Program

Providing children with nutritious after-school snacks as part of an after-school enrichment program can promote healthy diets and improve food security of at-risk children. However, in 2010 only 27% of schools that participate in the National School Lunch Program (NSLP) also offered the after-school snack component of the program, making it available to only a minority of American schoolchildren. We investigate school and district-level characteristics associated with the likelihood of a school offering the program. Schools more likely to offer the program serve mainly low-income students and are located in urban, high-poverty districts. Elementary schools are the most likely to offer the program and high schools the least likely. Further investigation of the factors influencing availability of after-school snacks would assist child nutrition program staff, policymakers, and child nutrition advocates to assess needs and target efforts to encourage schools to offer NSLP snacks.

The impact of Tubaramure, a food‐assisted integrated health and nutrition program in Burundi, on maternal and child anemia

Tubaramure is a food‐assisted, preventive maternal and child health and nutrition (MCHN) program targeted to pregnant women and their child 0‐2 y of age (first 1000 days) in two highly food insecure provinces in Burundi. Monthly food rations include corn‐soy‐blend (CSB) and vit A‐ and D‐fortified oil. We evaluated the program's impact using a cluster randomized controlled study, where 60 villages were assigned to: T24: benefits during pregnancy up to 24 m; T18: pregnancy up to 18 m; TNFP: same as T24, but without food rations during pregnancy; and Control. We estimated the program's impact on Hb and anemia in children 0‐24 m and their mothers using double difference estimates with repeated cross‐sectional data at baseline (BL) and 2 y later (EL). We used mixed methods to document pathways of impact.Mean Hb was significantly lower at EL compared to BL in children (0.8 g/dL) and their mothers (0.7 g/dL), but the program had a significant protective effect. Compared to control, Hb in beneficiary children dropped 0.3‐0.5 g/dL less; in mothers 0‐3 m post‐partum, anemia increased 24‐39 pp less. Impact pathway analyses suggest that impacts were achieved through positive changes among children in dietary diversity, intake of Fe‐rich foods, bednet use, and lower morbidity; among mothers, bednet use appears to be part of the pathway. Differences between treatment groups will be discussed. This theory‐based impact evaluation demonstrated the effectiveness of a preventive food assisted MCHN program on children's HB and maternal anemia and highlighted the contribution of different program inputs in achieving this impact.Funded by USAID's Food and Nutrition Technical Assistance Project &amp; CGIAR Research Program on Agriculture for Nutrition and Health (A4NH), led by IFPRI.

Choice Architecture for Promoting Healthy Eating Environments: Cafe NudgeSAT Project

To assess the cafeteria environment in three Appalachian high schools assessing flow of students through the lunch-line to determine enhancements or changes to encourage healthy food choices. Observation study of thee Appalachian high schools in West Virginia. An assessment tool was created by adapting research from the Behavioral Economics and Child Nutrition Program (BEN Center) Smarter Lunchrooms. NudgeSAT (Nudge Student Assessment Tool) was composed of 6 different scoring categories that according to BEN make up a smarter lunchroom. Also, flow of the cafeteria was videotaped to observe how students move through the serving areas. Eight components: exterior, hot serving area, cold serving area, salad bar, beverage area, payment station, dining area and grab-n-go (only 2 sites had this option) were each identified with a score (higher score equals more healthier components offered). HS#1 earned 73/128 points (57%), HS#2 earned 59/128 points (46%) and HS#3 earned 53/101 (52%). Each school had a recommendation report based on areas identified for improvement to score higher. Some of these recommendations focused on increasing fresh fruit and vegetable consumption, low-fat white milk, and decreasing consumption of high-fat and high-calorie foods. The NudgeSAT evaluation tool to understand choice architecture is one more novel way to assess the lunchroom environment to encourage smarter lunchroom choices.

Cognitive development among preschoolers improves in relation to endline ferritin and vitamin D levels only among recipients randomized to a fortified poultry‐based spread (Spammy™) intervention group (250.6)

Background: Dietary improvements during early childhood have potential to both reduce nutritional deficiencies and improve cognitive outcomes.Objective: To assess the efficacy to improve cognitive function of a poultry‐based spread that provides between 20% to 333% of the RDA of 12 selected micronutrients, including vitamin D and iron.Methods: Sixty preschoolers, aged 4‐7 years, were randomized in a triple‐blinded format to receive 43 g of fortified (FS) or unfortified (US) SpammyTM during weekdays over a 20 week period as part of the institutional breakfast on the outskirts of Guatemala City. The Spanish language Bracken Basic Concept Scale‐ Receptive (BBCS‐R) was administered and circulating nutrient status indicators (25(OH)vit D and ferritin) were measured at both ends of the trial.Results: Reliability analyses for both the BBCS‐R School Readiness Component (SRC) and total test (TT) were high (.96 and .95, respectively). Both FS and US groups had larger than expected gains on the age‐standardized SRC scores (p=.068 and 0.03, respectively) with no difference between groups (p=.84). In the FS only, a significant, positive relationship was found between TT cognitive gain score and both endline vitamin D (Pearson r = .37) and ferritin (Pearson r = .42).Conclusion: Regular consumption of a fortified poultry spread to breakfasts, combined with educational programming, set the stage for improved cognitive functioning.Grant Funding Source: Supported by McGovern‐Dole Food for Education and Child Nutrition Program and Hormel Foods

Exploring behaviors related to positive growth in an urban slum of Mumbai (620.9)

BACKGROUND: Within Mumbai slums 47% of children under five are severely stunted. The aim of this project was to apply the positive deviance approach to assess what contributes to positive child nutrition in the slum of Dharavi. Results will inform programs offered by the Society for Nutrition, Education and Health Action (SNEHA).METHODS: Children with a height‐for‐age z‐score (HAZ)&gt;0 (n=10) or a HAZ&lt;‐2.0 (n=12) were randomly selected from SNEHA’s Child Health and Nutrition program. Eligibility was restricted to households with limited resources and more than one child. Qualitative semi‐structured interviews were conducted with mothers. A 24‐hour dietary recall and anthropometric measurements were taken for the index child. An observation checklist assessed household hygiene. RESULTS: Themes from the mothers of children with HAZ&gt;0 include: having strong social support or having an elder female present to assist with child rearing, borrowing food in times of food insecurity, feeding infant formula as a supplemental food, mothers actively seeking nutrition information, and mothers acknowledging the importance of maternal nutrition. Mothers of children with HAZ&lt;‐2.0 reported lack of social and family support to help with child care and household tasks. CONCLUSIONS: Enhancing social support, complementary feeding practices and maternal nutrition knowledge may have potential as interventions, and should be explored in a larger sample.Grant Funding Source: Wilbur G. Downs Fellowship for International Research

Integrating maternal psychosocial well-being into a child-development intervention: the five-pillars approach.

Maternal psychosocial well-being (MPW) is a wide-ranging concept that encompasses the psychological (e.g., mental health, distress, anxiety, depression, coping, problem solving) and social (e.g., family and community support, empowerment, culture) aspects of motherhood. Evidence-based MPW interventions that can be integrated into large-scale maternal and child health programs have not been developed. Building on several years of research in Pakistan, we developed and integrated a cognitive behavioral therapy-based MPW intervention (the five-pillars approach) into a child nutrition and development program. Following formative research with community health workers (CHWs; n = 40) and families (n = 37), CHWs were trained in (1) empathic listening, (2) family engagement, (3) guided discovery using pictures, (4) behavioral activation, and (5) problem solving. A qualitative feasibility study in one area demonstrated that CHWs were able to apply these skills effectively to their work, and the approach was found to be useful by CHWs, mothers, and their families. The success of the approach can be attributed to (1) mothers being the central focus of the intervention, (2) using local CHWs whom the mothers trust, (3) simplified training and regular supervision, and (4) an approach that facilitates, not adds, to the CHWs' work.

Spatial Analysis of Undernutrition of Children in Léogâne Commune, Haiti

Over a fifth (21.9%) of children under 5 years of age in Haiti suffer from chronic malnutrition, 11.4% are underweight, and 5.1% suffer from acute malnutrition. Léogâne Commune has one of the highest under-five mortality rates in the country. Ordinary least squares regression conducted using data from household surveys to assess the impact of causal factors on child undernutrition may mask important local variations. To characterize the nutrition and health situation of children 6 to 35 months of age in LLogdne Commune, Haiti, using geographically weighted regression. In July 2008, the Children's Nutrition Program of Haiti conducted a representative cross-sectional household survey (N = 150) using a modified 33 x 6 alternative sampling design. Household questionnaires were administered to caregivers of children 6 to 35 months of age and anthropometric measurements were collected. Geographically weighted regression was employed to evaluate how undernutrition (weight-forage) and its household determinants vary across the region. Geographically weighted regression and ordinary least squares regression models were compared. The residuals of the ordinary least squares regression model were spatially autocorrelated (Moran's I = 0.08, z = 1.90, p = .058), indicating that undernutrition occurs in pockets rather than being evenly distributed throughout the population. There was no improvement in performance from the ordinary least squares regression model to the geographically weighted regression model. Despite some limitations, this study illustrates a promising approach for using geospatial data to improve the understanding of how a nutrition situation varies across a region and provide deeper insight into its underlying causes.