Public Health Nutrition Programs Research Articles

Development of a checklist (I-SEAVD) for public health nutrition programmes related to cardiovascular disease in Southeast Asia

• Nutrition and health surveys in Southeast Asia allow surveillance of the diet and health status of their populations.

Higher Adherence to the Australian Dietary Guidelines Is Associated with Better Mental Health Status among Australian Adult First-Time Mothers

BackgroundMental health disorders are a leading cause of disability worldwide, including in first-time mothers. Understanding the associations between diet and depressive symptoms could assist in improving mental health status in this group. ObjectiveOur aim was to determine the association between diet quality, fruit, vegetable, and fish consumption and depressive symptoms in first-time mothers aged 19 to 45 years. DesignWe analyzed cross-sectional, baseline data (3 months postpartum) from the Melbourne InFANT (Infant Feeding, Activity, and Nutrition Trial) Extend Program. Participants/settingParticipants were first-time Australian mothers aged 19 to 45 years from the Geelong and Melbourne regions of Victoria, Australia (n=457). Main outcome measuresA self-administered, 137-item food frequency questionnaire assessed dietary intake over the past year. Adherence to the 2013 Australian Dietary Guidelines was assessed using the Dietary Guideline Index as a measure of diet quality. Depressive symptoms were determined using the Center for Epidemiologic Studies Depression Scale. Statistical analysis performedRelationships between diet quality, fruit, vegetable, and fish intake and depressive symptoms were investigated using linear regression adjusted for relevant covariates (age, smoking status, sleep quality, education, physical activity status, and body mass index). ResultsBetter diet quality, as indicated by a higher score on the Dietary Guideline Index, was associated with lower depressive symptoms after adjusting for relevant covariates (β=−.034; 95% CI −.056 to −0.012). There were no other associations between dietary intake and depressive symptoms. ConclusionsAdherence to the Australian Dietary Guidelines was associated with better mental health status among first-time mothers. Further research, including longitudinal and intervention studies, are required to determine causality between dietary intake and depressive symptoms, which might help inform future public health nutrition programs for this target group.

A Cross-sectional Study of the Pattern of Body Image Perception among Female Students of BBM College in Vijayapur, North Karnataka.

Body image is an essential aspect of young girls' self-definition and individual identity which is influenced by various biological, psychological and social factors. Excessive concern about body image, body image misconception are leading to dissatisfaction, disturbed eating patterns, affecting the nutritional status and also leading to depression and anxiety disorders. This concept of body image has been less explored in Indian context, especially among young girls. The objectives of the study were to assess the body image perception among young college going girls, using a visual analog scale and to compare body image perception and satisfaction with their BMI levels and weight changing methods adopted. An exploratory cross-sectional study was conducted among 63 female students studying BBM course at a private commerce institution in Vijayapur city. Data was collected using a self administered questionnaire containing details of basic socio-demographic information and a validated visual analogue scale. Height was measured by Seca Stadiometer, weight was measured using Digital weighing machine and Body Mass Index levels were calculated. Percentages were calculated for descriptive variables. Chi-square test was applied for analysing categorical variables. Spearman Rank correlation test was applied for analysing ordinal data. A 39.7% of participants were underweight and 15.9% were overweight/obese. Majority of underweight and overweight girls (72% and 89%, respectively) perceived themselves as normal weight. Body image satisfaction of participants was found to be significantly associated with their body image perception, mothers' educational status and also with relatives' and peer group's opinions about their body weight. Unhealthy weight changing patterns like skipping meals (13%), increasing quantity and frequency of meals (17%) were reported among study participants. This exploratory study highlights the gap between young girls' body image perception and their BMI levels, indicating body image misconception. Lower literacy level of mothers and opinions of relatives and friends significantly influenced body image satisfaction among study participants. Higher percentage of underweight (39.7%) coupled with unhealthy weight changing patterns reportedly adopted by participants (30%) indicates need for further research on this issue, to help inform public health nutrition programmes.

Magnitude of Anemia and Hematological Predictors among Children under 12 Years in Odisha, India.

Background. Anemia is a wide spread public health problem in India which affects children. The present study evaluates the prevalence of anemia and status of various hematological parameters among children of Khurda district, Odisha. Method. A total of 313 children aged 0–12 years were enrolled for the study which included preschool (0–5 years) and school aged (6–12 years) groups. Hematological indicators were measured by standard procedures, which include red blood cell (RBC) indicators, white blood cell (WBC) indicators, and plasma ferritin. Results. Mean hemoglobin (Hb) of the study population was 10.43 ± 3.33 g/dL and prevalence of anemia was 62%. In this population, boys had a lower mean Hb value than that of the girls. All grades of anemia were higher among school age children than preschool children. Mean plasma ferritin was found to be higher in school age boys than their counterpart girls. The mean level of WBC count was found to be higher among preschool age boys than among the school age boys (p = 0.025). Conclusion. The prevalence of anemia was higher with concomitant acute infection among study population, which is a matter of concern. Since the hematological parameters are interrelated with each other as well as with the age and gender, relevant intervention strategy and constant monitoring are needed while providing public health nutrition programs to eradicate anemia.

Preventative lipid-based nutrient supplements (LNS) and young child feeding practices: findings from qualitative research in Haiti.

To prevent undernutrition in an urban slum in Haiti, a lipid-based nutrient supplement (LNS) was introduced through a randomised control trial. Food supplementation for young child nutrition has a long history in Haiti, but there is little empirical information regarding the effects of supplementation on young child feeding practices. One of the concerns raised by supplementation is that it may disrupt other positive feeding practices such as breastfeeding and use of other complementary foods, with negative consequences for child nutrition. We conducted 29 in-depth interviews with mother-baby pairs from the three comparison groups: control, 3-month LNS supplementation and 6-month LNS supplementation. Findings from those in the LNS groups indicated high acceptance and satisfaction with LNS and perceptions that it positively affects child health and development. LNS was integrated into and enhanced ongoing complementary feeding practices. The effects of LNS use on duration and perceived quantity of breastfeeding were variable, but generally, breastfeeding was maintained during and after the intervention. Interviews generated insights into beliefs regarding infant and young child feeding practices such as introduction and use of complementary foods, and breastfeeding duration, exclusivity and cessation. Implications for the use of LNS in public health nutrition programmes are discussed.

Postsecondary Public Health Nutrition Programs in Egypt

Background. Escalating obesity rates have become a major public health problem in Egypt. To address this concern, the education and training of a competent and culturally relevant public health nutrition (PHN) workforce is necessary. The aim of this study is to list and identify current PHN education and training programs offered in Egyptian colleges and universities. Method. An electronic review of websites, departmental homepages, and academic program web links of selected colleges and universities in Egypt ( N = 63) was conducted to identify available training and education in PHN and nutrition-affiliated academic programs. Results. Of the 63 identified Egyptian colleges and universities, two universities, both located in Alexandria, offered education and training degrees in PHN, and 16 were identified as offering non-PHN degree programs, predominantly in home economics. Conclusions. The relative scarcity of PHN training programs in colleges and universities in Egypt coupled with the lack of nationally recognized professional nutrition associations as well as a regulatory standard by which to define the nutrition profession appears to be a gap within the allied health profession in Egypt. Greater cooperation between colleges and universities in Egypt and international collaboration with other colleges and universities outside Egypt may help facilitate the development of academic PHN programs in Egyptian higher education. This would serve the dual purpose of addressing the obesity prevalence and developing a sustainable congruent allied health workforce capacity that includes culturally relevant and competent public health dietitians/nutritionists for effective PHN action operating in Egypt.

Alcohol consumption and breast cancer risk subtypes in the E3N-EPIC cohort.

The aim of this study was to obtain an overview of the associations between alcohol consumption and breast cancer risk at adulthood, by type of alcohol and subtype of breast cancer. Between 1993 and 2008, 66,481 women from the French E3N-EPIC cohort were followed up and asked to report their alcohol consumption, by type of alcohol, through a 208-item diet-history questionnaire. A total of 2812 breast cancer cases were validated during the follow-up session. No association was found between high alcohol consumption, whatever its type, and increase in breast cancer risk in the premenopausal period. During the postmenopausal period, a linear association between total alcohol consumption and breast cancer risk was found (P<0.0001), mainly driven by the associations with wine and beer [hazard ratio=1.33 (1.11-1.58) and 1.85 (1.19-2.89)] for more than two glasses per day of wine and beer, respectively, compared with nondrinkers] and with ER+/PR+ breast cancer subtypes. In the postmenopausal period, we observed interactions between total alcohol and folate intake levels (P=0.1192) and BMI (P=0.0367), with higher increased risks observed for high alcohol intake among women with low folate intake or who were overweight or obese. Our results make precise the current body of knowledge on the relationship between alcohol and breast cancer subtypes. Interactions between alcohol and other factors should further be taken into account in public health nutrition programs.

Association of Prenatal Participation in a Public Health Nutrition Program With Healthy Infant Weight Gain

We tested the hypothesis that early enrollment in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) is associated with a reduced risk of rapid infant weight gain (RIWG). We used a longitudinal cohort of mother-infant pairs (n = 157,590) enrolled in WIC in New York State from 2008 to 2009 and estimated the odds of RIWG, defined as a 12-month change in weight-for-age z score of more than .67, comparing infants of mothers enrolled during the first, second, or third trimester of pregnancy with those who delayed enrollment until the postpartum period. After adjusting for potential confounders, the odds of RIWG (odds ratio [OR] = 0.76; 95% confidence interval [CI] = 0.74, 0.79) were significantly lower for infants of women enrolling during the first trimester versus postpartum. Birth weight-for-gestational-age z score (OR = 0.33; 95% CI = 0.32, 0.33) attenuated the estimate of prenatal versus postpartum enrollment (OR = 0.92; 95% CI = 0.88, 0.95; first-trimester enrollees). The results demonstrate that prenatal WIC participation is associated with reduced risk of RIWG between birth and age 1 year. Improved birth weight for gestational age may be the mechanism through which early prenatal WIC enrollment protects against RIWG.

Employers’ Perspectives of Students: In a Master of Public Health (Nutrition) Program

Efforts to support workforce development led to the launch of a new master of public health program aimed at improving access to graduate studies for practising nutrition professionals. The first cohort of students identified employer support as a key determinant of their success. In order to identify ways of addressing both student and employer needs, we explored the perspectives of students' employers. Seventeen in-depth, semi-structured, open-ended interviews were conducted with employers. Interviews were audiotaped and transcribed. Transcripts were organized using NVivo software and coded thematically. All employers indicated support for employee education and development in principle, but most faced practical challenges related to limited staffing during education leaves. Organizational policies varied considerably across employer groups. Collective agreements that guided education policy were seen to ensure consistent support for employees, but also to limit creative approaches to education support in some situations. Employers highly valued graduate student projects that were directly related to the workplace; these projects presented opportunities for collaboration among the university, students, and employers. Universities need to work with employers and other stakeholders to identify ways of overcoming barriers to public health nutrition graduate education and workforce development.

Pancreatic Cancer Prevention and the 2010 Dietary Guidelines for Americans

Pancreatic Cancer Prevention and the 2010 Dietary Guidelines for Americans

Enhancing the Intrinsic Work Motivation of Community Nutrition Educators

Mixed-methods research investigated the work motivation of paraprofessional community nutrition educators (CNEs) delivering a long-running public health nutrition program. In interviews, CNEs (n = 9) emphasized "freedom," supportive supervision, and "making a difference" as key sources of motivation. Community nutrition educator surveys (n = 115) confirmed high levels of autonomy, which was associated with supervisors' delegation and support, CNE decision-making on scheduling and curricula, and job satisfaction. Supervisors (n = 32) rated CNEs' job design as having inherently motivating characteristics comparable to professional jobs. Supervisory strategies can complement job design to create structured, supportive contexts that maintain fidelity, while granting autonomy to paraprofessionals to enhance intrinsic work motivation.

Smoking Cessation in the WIC Program

To the Editor, In their recent paper, Yunzal-Butler et al. [1] report an analysis of the association between the timing of enrollment in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) and cigarette smoking among prenatal WIC participants. Based on the finding that women who enroll in WIC early during pregnancy experience only modestly higher quit rates than women who enroll late, Yunzal-Butler et al. conclude that there ‘‘is ample room to improve WIC’s performance,’’ suggesting the WIC program consider intensifying its role in smoking cessation, perhaps through ‘‘more frequent and more focused’’ counseling. The purpose of this letter is twofold: first, we wanted to clarify the goals and approach of WIC in an effort to better contextualize smoking cessation efforts in the program. Second, we wanted to comment on issues that were not raised or adequately discussed by the authors, namely statistical issues regarding the smoking data and covariates utilized in the analysis. WIC is the only federally sponsored public health nutrition program whose mission is ‘‘to safeguard the health of low-income women, infants, and children up to age 5 who are at nutrition risk by providing nutritious foods to supplement diets, information on healthy eating, and referrals to health care’’ services [2]. Contrary to popular belief, WIC is not an entitlement program. This means that available funds do not cover all eligible applicants. With the funds that are available, and the recognition that the epidemic of obesity leads to numerous poor health outcomes, the primary goal of the WIC program is to provide nutritional education, counseling and nutritious foods to supplement participants’ diets. The WIC program provides grants to states to administer the program. States, in turn, fund contracts to local agencies to deliver WIC nutrition services. The scope of services provided by WIC local agencies is broad and includes nutrition education, nutrition risk assessment, breastfeeding support and promotion, immunization screening, referrals to health care and drug and substance abuse services and programs, and promotion of good nutrition for good health, including promotion of physical activity. Participation in nutrition education is voluntary; referrals to health care and other services are offered but not enforced. The positive results presented by Yunzal-Butler et al. suggest that WIC successfully goes beyond its primary goal of improving participants’ nutritional status and education by encouraging healthier lifestyle changes, in this case impacting smoking quit rates. While the authors are correct that the quit rates are modest compared to targeted smoking cessation programs, we believe this comparison is quite inappropriate, due to the aforementioned primary goal of the WIC program as a public health nutrition and education program. Although the WIC program offers participants referrals to smoking cessation programs, it is unrealistic to expect this public health nutrition program to achieve quit rates as high as a focused tobacco cessation program. In C. F. Davis (&) School of Public Health, Department of Epidemiology and Biostatistics, George Education Center 125, University at Albany SUNY, One University Place, Rensselaer, NY 12144, USA e-mail: cd5341@albany.edu

The politics of developing reference standards for nutrient intakes: the case of Australia and New Zealand

Nutrient Reference Values (NRV) are evidence-based benchmarks for assessing the dietary adequacy of individuals and population groups as well as informing public health nutrition policies and programmes. The present paper presents the findings of an analysis of the views of submitters to a draft document associated with the development of the 2006 NRV for Australia and New Zealand. The aim of the study was to explore how these views were reflected in the policy-making process and final policy document. The information necessary to fulfil this aim required access to stakeholder submissions to the NRV development process and this necessitated exploiting the provisions of the Commonwealth of Australia's Freedom of Information (FOI) Act 1982. We understand that the present research represents the first time that an FOI request seeking information about a National Health and Medical Research Council food and nutrition policy process has been made and therefore is novel in its approach to public health nutrition policy analysis. The analysis of stakeholder submissions identified that stakeholders had particular concerns about the conduct of the review process and the future application of the nutrient values to policy and programmes. There is a lack of evidence that the majority of stakeholder comments were addressed in the final NRV document. Although these findings cannot be interpreted to assess the validity or otherwise of the set nutrient values, they do raise questions about the process for their development and the adequacy of the final document to reflect the views of key stakeholders.

Patients, Caregivers, and Telehome-Based Care Systems

The Personal Health Assistant Project (PHA) is a pilot system implementation sponsored by the Kozani Region Governors’ Association (KRGA) and installed in one of the two major public hospitals of the city of Kozani. PHA is intended to demonstrate how a secure, networked, multipurpose electronic health and food benefits digital signage system can transform common TV sets inside patient homes or hospital rooms into health care media players and facilitate information sharing and improve administrative efficiency among private doctors, public health care providers, informal caregivers, and nutrition program private companies, while placing individual patients firmly in control of the information at hand. This case evaluation of the PHA demonstration is intended to provide critical information to other decision makers considering implementing PHA or related digital signage technology at other institutions and public hospitals around the globe.

Workshop on ‘Developing professionalism in public health practice’ Sustainability in local public health nutrition programmes: beyond nutrition education, towards community collaboration

The present paper presents the approach, results and outcome of an innovative piece of action research amongst professionals (health and non-health) and the public (women and young people from low-income families in one of the deprived areas of Birmingham, UK). A cooperative inquiry approach was used and data were collected on concerns about health of professionals (n 15) and the public (n 19), as well as dietary practices, smoking pattern and access to healthy foods amongst the public (n 49). The methods of data collection were: desk research; observation; semi-structured individual and focus-group interviews; structured individual interviews. The findings highlight diverse views and expectations about health amongst the public and the professionals, and suggest the existence of tensions between the partnership and the ownership of inter-agency collaboration. It argues the importance of having a shared vision amongst health and non-health professionals regarding health strategy and the way forward for working together to promote the public's health. It recommends that by using the tenet of action research, and adapting a cooperative inquiry approach, members of a partnership project could learn through reflection on action and achieve personal development and social action.

Workshop on ‘Developing professionalism in public health practice’ Sustainability in local public health nutrition programmes: beyond nutrition education, towards community collaboration

The present paper presents the approach, results and outcome of an innovative piece of action research amongst professionals (health and non-health) and the public (women and young people from low-income families in one of the deprived areas of Birmingham, UK). A cooperative inquiry approach was used and data were collected on concerns about health of professionals (n 15) and the public (n 19), as well as dietary practices, smoking pattern and access to healthy foods amongst the public (n 49). The methods of data collection were: desk research; observation; semi-structured individual and focus-group interviews; structured individual interviews. The findings highlight diverse views and expectations about health amongst the public and the professionals, and suggest the existence of tensions between the partnership and the ownership of inter-agency collaboration. It argues the importance of having a shared vision amongst health and non-health professionals regarding health strategy and the way forward for working together to promote the public's health. It recommends that by using the tenet of action research, and adapting a cooperative inquiry approach, members of a partnership project could learn through reflection on action and achieve personal development and social action.

Wearable schizophrenia treatment with real-time affective context awareness.

The Personal Health Assistant Project (PHA) is a pilot system implementation sponsored by the Kozani Region Governors’ Association (KRGA) and installed in one of the two major public hospitals of the city of Kozani. PHA is intended to demonstrate how a secure, networked, multipurpose electronic health and food benefits digital signage system can transform common TV sets inside patient homes or hospital rooms into health care media players and facilitate information sharing and improve administrative efficiency among private doctors, public health care providers, informal caregivers, and nutrition program private companies, while placing individual patients firmly in control of the information at hand. This case evaluation of the PHA demonstration is intended to provide critical information to other decision makers considering implementing PHA or related digital signage technology at other institutions and public hospitals around the globe.

The WIC program: A classic example of where individuals do make a difference

The Special Supplemental Nutrition Program for Women, Infants and Children (WIC) is viewed as one of the most successful public health nutrition programs in the United States. Senator George McGovern, at the May 2000, National Nutrition Summit, referred to WIC as the perfect program. Despite the broad, bipartisan support the program has enjoyed, WIC has had an often stormy history. This paper chronicles the events that were instrumental in shaping the progam as we now know it. The influence of key organizations and individuals in the WIC program are discussed.

A framework for food-based dietary guidelines in the European Union.

The nutrient targets derived from analysis of the relation between nutrient intake and disease prevalence or other scientific evidence, have to be translated into food-based guidelines in order to be understood by the general population. Furthermore, Food-Based Dietary Guidelines (FBGD) have to be realistic, attainable and culturally acceptable and should also give consideration to relevant social, economic, agricultural and environmental factors affecting food availability and eating patterns. This requires a thorough understanding of the relation between foods, food patterns and nutrient intakes in the population. The aims of Working Party 2 were to propose a framework for strategies in the development of FBDG and to examine existing data for nutrient and food intakes in the EU. The over-all strategy given by the joint FAO/WHO consultation 1995 was used as the starting point, i.e. target foods or food patterns for public health nutrition programmes should be identified from an analysis of prevailing food and nutrient intakes. Prevailing data for food and nutrient intakes in 14 EU countries were examined and different principles and options for the derivation of FBDG were explored. Methodological issues and their influence on the interpretation of data for the development of FBDG were also examined. The process from nutrients to foods can be briefly: 1) identification of major food sources of the nutrient of interest, 2) identification of foods contributing substantially to population intakes, 3) identification of foods or food patterns compatible with desirable nutrient intakes or explaining variations in nutrient intakes, 4) formulation of FBDG into foods, portion sizes, frequency of intake, meal composition taking attainability and acceptability as well as compatibility of co-existing guidelines into account. The level of complexity that can be applied in the analytical approaches depends on the characteristics of available intake data. A detailed analysis requires data on an individual level for nutrients, foods, food patterns, eating and meal habits etc. When individual data are available different analytical approaches (examination of distribution of intakes, correlation analysis between foods and nutrients, examination of food intakes in compliers/non-compliers to nutrient goals, discriminant analysis, cluster/factor analysis) can be used to identify key foods or food patterns fulfilling nutrient goals. The examination of prevailing food and nutrient intake data in the EU revealed: a number of methodological differences in approaches to dietary surveys exist in the EU countries e.g., regarding methods used, selection of population, classification of foods, which have to be kept in mind in pan-EU comparisons at present there is a substantial gap between actual intakes and present nutrient goals suggesting that major changes of dietary habits are needed while some food patterns were consistently related to intake of specific nutrients in most EU countries, other patterns showed large variations between countries methodological issues, such as survey duration, survey techniques, under- or over-reporting, could have substantial influence on the identification of target foods or food patterns. A science-based analysis of nutrient and food intakes allows development of FBDG, which, if implemented, are likely to result in mean population intakes closer to nutrient goals. Acknowledging the social and cultural differences within the EU as well as the need to focus on the most relevant public health problem in the population, FBDG should first be developed within member states. Harmonisation of survey methods within the EU would facilitate development of regional and EU FBDG.

Profile of Public Health Nutrition Personnel: Challenges for Population/System-Focused Roles and State-Level Monitoring

Objective Our 3 objectives were to document the current public health nutrition workforce in the United States, identify top public health nutrition priorities for the next 5 years, and assess the capacity of public health nutrition personnel to address these priorities and the nutrition-related objectives of Healthy People 2000. Design A census survey was distributed to public health nutrition personnel in all state and local health agencies and nonprofit and for-profit agencies funded by official health agencies throughout the United States and US territories. Also, state and territorial nutrition directors were sent a different questionnaire. Subjects Data were collected from 49 states, the District of Columbia, and 2 territories; 7,550 public health nutrition personnel were represented. Statistical analysis Data were analyzed using EpiInfo software. Descriptive statistics are presented. Results Almost half of the respondents worked in local or county health agencies and about two thirds were involved in direct care services. Only about 40% were registered dietitians and about one fourth had a master's degree. Almost 90% of all full-time equivalent positions were funded through federal dollars; 78% of all funding was from the Special Supplemental Nutrition Program for Women, Infants, and Children. Top health concerns identified were diet/nutrition to prevent chronic disease, low breast-feeding rates, low birth weight, iron deficiency anemia, and obesity/overweight. Public health nutrition personnel will be challenged to assume population/system-focused roles and state-level monitoring of Healthy People 2000 objectives. Only 2 of the 17 nutrition objectives of Healthy People 2000 were monitored by more than 50% of the states. Applications If official health agencies are to shift to public health core functions, as recommended by an Institute of Medicine report, then a substantial proportion of the public health nutrition workforce must not only change how they practice but also obtain the knowledge and skills to do so. Strategies to improve workforce capacity are discussed, including continuing education interventions through professional organizations, distance and on-campus educational opportunities through approved public health nutrition programs, and advocacy for new funding streams focused on public health core functions. J Am Diet Assoc. 1998;98:664–670.