Environmental Change Interventions Research Articles

Physical Activity and Healthful Eating in Middle Schools

Greaney et al. describe the problems of overweight and obesity, the efforts made to address this problem in school systems, and a rapid assessment procedure to determine the feasibility of implementing an interdisciplinary curriculum in a school setting. Regarding the last item, they discuss the need for researchers and practitioners to work together to develop multiple interventions that are collaborative, flexible, and effective. The current epidemic of inactivity and poor diet, along with the associated epidemic of obesity, is driven by multiple factors (societal, technological, industrial, commercial, financial), and each of these factors must be considered when dealing with the obesity problem. The Healthy Choices Collaborative Intervention used by Greaney et al. is designed to address these factors. It includes before- and after-school activities to expand school physical education, messages to dissuade youths from pursuing sedentary activities, including television viewing, and nutrition education to increase fruit and vegetable consumption. Community program implementation is more likely to be successful when community leaders are involved. Greaney et al. present the perceptions of key leaders who were previously involved in a school-based nutrition and physical activity program and who shared their perceptions regarding what is needed to facilitate the implementation and sustainability of the Healthy Choices Collaborative Intervention. Many ideas were presented by participants regarding critical elements needed for this program to be successful, including possessing resources, having a visible leader, and achieving buy-in from teachers, administrators, students, food-service personnel, parents, and the community at large. Greaney et al. discuss valuable information for program planners. When designing obesity interventions for youths, program planners are advised to consider characteristics of the priority population. The authors demonstrate that middle school youths as a group require specific attention and intervention. Nutrient needs, eating patterns, and physical activity patterns change markedly during the middle school years. For example, most children maintain adequate milk intake until about 9 years of age. After age 9, milk intake should generally be increased to meet nutrient needs, but most children do not do so. This problem is especially pronounced in preteen girls. As children age and begin to have more influence over their food intake decisions, the nutritional quality of their diets declines. Age transitions in food consumption patterns need to be addressed in the development of school-based obesity prevention programs so that appropriate behavioral targets for nutrition education can be written into the curriculum. Thus, nutrition education between middle and elementary school should vary based on higher nutrient needs and changes in behavioral mediators such as greater freedom of choice. The Teens Eating for Energy and Nutrition at School (TEENS) study revealed that positive intervention results were limited with middle school students. Investigators suggested that future research consider the use of more controlled efficacy studies in working with this age group. They also suggested that efforts to reach this group include use of peer leaders, more intensive teacher training, ongoing formative assessment, and the testing of more powerful environmental change intervention strategies. (1) In examining the target group issue, planners also need to consider that adolescent girls tend to be less active and less responsive to specific treatments than their male counterparts. (2) To reach middle school girls, interventions that provide desirable role models for diet and activity are suggested. One study demonstrated positive body mass index changes among middle school girls who received computer-based feedback combined with parental support. (3) Tailored interventions are suggested for specific age and sex. …

A Community Intervention Reduces BMI z‐score in Children: Shape Up Somerville First Year Results

The objective was to test the hypothesis that a community-based environmental change intervention could prevent weight gain in young children (7.6 +/- 1.0 years). A non-randomized controlled trial was conducted in three culturally diverse urban cities in Massachusetts. Somerville was the intervention community; two socio-demographically-matched cities were control communities. Children (n = 1178) in grades 1 to 3 attending public elementary schools participated in an intervention designed to bring the energy equation into balance by increasing physical activity options and availability of healthful foods within the before-, during-, after-school, home, and community environments. Many groups and individuals within the community (including children, parents, teachers, school food service providers, city departments, policy makers, healthcare providers, before- and after-school programs, restaurants, and the media) were engaged in the intervention. The main outcome measure was change in BMI z-score. At baseline, 44% (n = 385), 36% (n = 561), and 43% (n = 232) of children were above the 85th percentile for BMI z-score in the intervention and the two control communities, respectively. In the intervention community, BMI z-score decreased by -0.1005 (p = 0.001, 95% confidence interval, -0.1151 to -0.0859) compared with children in the control communities after controlling for baseline covariates. A community-based environmental change intervention decreased BMI z-score in children at high risk for obesity. These results are significant given the obesigenic environmental backdrop against which the intervention occurred. This model demonstrates promise for communities throughout the country confronted with escalating childhood obesity rates.

Effect of 3 years of SAFE (surgery, antibiotics, facial cleanliness, and environmental change) strategy for trachoma control in southern Sudan: a cross-sectional study

A trachoma control programme was started in southern Sudan in 2001. We did a 3-year evaluation to quantify uptake of SAFE (surgery, antibiotics, facial cleanliness, and environmental change) interventions, and to assess the prevalence of active trachoma and unclean faces. Cross-sectional surveys, including clinical assessment of trachoma (WHO simplified system) and structured questionnaires, were done in four intervention areas at baseline and follow-up. Process indicators were uptake of SAFE components; primary outcome indicators included trachomatous inflammation-follicular (TF) and unclean face in children aged 1-9 years. There was heterogeneous uptake of SAFE between intervention areas. Surgical coverage was low in all areas (range 0.5% of 428 individuals in Katigiri to 6% of 5002 in Kiech Kuon), antibiotic uptake ranged from 14% of 1257 individuals in Kiech Kuon to 75% of 954 in Katigiri, health education ranged from 49% of 190 households in Kiech Kuon to 90% of 182 in Padak, and latrine coverage from 3% of households in Tali to 16% in Katigiri. Substantial decreases in prevalence of TF and unclean faces were recorded in Katigiri and Tali, two of three sites where uptake of antibiotics and health education was high: TF decreased by 92% (95% CI 87-96) and 91% (86-95), respectively, and unclean face decreased by 87% (78-94) and 38% (22-52), respectively. Moderate effects were recorded in Padak, an area with high coverage, with a 28% (14-41) decrease in TF and a 16% (7-25) decrease in unclean face. No evidence of decline was seen in Kiech Kuon, where uptake of antibiotics and health education was low, with a 2% (-10 to 12) decrease in TF and a 10% (-3 to 23) decrease in unclean face. Our results show that substantial falls in active trachoma can occur where SAFE is implemented, and that good results could be achieved with the SAFE strategy in other trachoma-endemic areas.

Facilitating Resident Information Seeking Regarding Meals in a Special Care Unit: AN ENVIRONMENTAL DESIGN INTERVENTION

Repetitive questions and requests for information are common in older adults with dementia. The purpose of this environmental design intervention was to provide residents continuous access to information about common mealtime questions with the intent of decreasing agitation around mealtimes and facilitating more pleasant patient-staff and patient-patient interactions. A special care unit for residents with dementia of the Alzheimer's type was the setting. During the intervention conditions, a large clock and a sign with large lettering that identified mealtimes were hung in the dining area. Direct observations of 35 residents were conducted at mealtimes for a 5-month period. Results showed reductions from baseline to the intervention phase in food-related questions or requests. These results suggest a simple, inexpensive environmental change intervention can reduce repetitive questions commonly exhibited by individuals with dementia.

Mount Mitchell and the Black Mountains: An Environmental History of the Highest Peaks in Eastern America

Each year, thousands of tourists visit Mount Mitchell, the most prominent feature of North Carolina's Black Mountain range and the highest peak in the eastern United States. From Native Americans and early explorers to land speculators and conservationists, people have long been drawn to this rugged region. Timothy Silver explores the long and complicated history of the Black Mountains, drawing on both the historical record and his experience as a backpacker and fly fisherman. He chronicles the geological and environmental forces that created this intriguing landscape, then traces its history of environmental change and human intervention from the days of Indian-European contact to today. Among the many tales Silver recounts is that of Elisha Mitchell, the renowned geologist and University of North Carolina professor for whom Mount Mitchell is named, who fell to his death there in 1857. But nature's stories - of forest fires, chestnut blight, competition among plants and animals, insect invasions, and, most recently, airborne toxins and acid rain - are also part of Silver's narrative, making it the first history of the Appalachians in which the natural world gets equal time with human history. It is only by understanding the dynamic between these two forces, Silver says, that we can begin to protect the Black Mountains for future generations.

The Los Angeles Lift Off: a sociocultural environmental change intervention to integrate physical activity into the workplace

Purpose. To present the development and feasibility testing of a sociocultural environmental change intervention strategy aimed at integrating physical activity into workplace routine. Design. Randomized, controlled, post-test only, intervention trial. Setting. Los Angeles County Department of Health Services' worksites. Participants. Four hundred forty-nine employees, predominantly sedentary, overweight, middle-aged women of color, distributed across 26 meetings. Intervention. A single 10-min exercise break during work time involving moderate intensity, low-impact aerobic dance and calisthenic movements to music. Measures. Primary—level of participation, particularly among sedentary staff; secondary—self-perceived health status, satisfaction with current fitness level, and mood/affective state. Results. More than 90% of meeting attendees participated in the exercises. Among completely sedentary individuals, intervention participants' self-perceived health status ratings were significantly lower than controls' (OR = 0.17; 95% CI = 0.05, 0.60; P = 0.0003). Among all respondents not regularly physically active, intervention participants' levels of satisfaction with fitness were more highly correlated with self-ranked physical activity stage of change ( r = 0.588) than the control participants' ( r = 0.376, z = −2.32, p = 0.02). Among the completely sedentary, control participants reported significantly higher levels of energy than did intervention participants ( P < 0.01). Conclusions. Captive audiences may be engaged in brief bouts of exercise as a part of the workday, regardless of physical activity level or stage of change. This experience may also appropriately erode sedentary individuals' self-perception of good health and fitness, providing motivation for adoption of more active lifestyles.

Environmental interventions to promote vegetable and fruit consumption among youth in school settings

Background This paper reviews the available literature on the school food environment with a focus on identifying effective strategies to promote vegetable and fruit (VF) consumption among youth in school settings. Methods Studies were identified through a search of electronic databases as well as references cited within published articles. Seven studies were identified that evaluated changes in VF intake and included a control group. Four additional school-based interventions were reviewed that focused on changes in VF intake as part of a multibehavior intervention. Results Multicomponent school interventions have been effective in increasing F intake, with reported increases ranging from 0.2 to 0.6 servings per day. Impact on V intake has been less effective, with increases ranging from 0 to 0.3 servings per day. Total VF increases ranged from 0 to 0.6 servings per day. Results of environmental-only, school-based interventions have shown positive effects on students' choice of targeted foods. Conclusions Environmental change interventions in schools show potential for positively affecting VF consumption among youth.