(An item from the ISHN Member information service)  Public health nutritionists were asked to describe the elements of system and organizational capacity in an article in Issue #10, 2015 of Public Health Nutrition. " A Delphi study involving three iterations of email-delivered questionnaires testing a range of capacity determinants derived from the literature. Consensus was set at >50 % of panellists ranking items as ‘very important’ on a five-point Likert scale across three survey rounds. A total of thirty expert panellists (68 % of an initial panel of forty-four participants) completed all three rounds of Delphi questionnaires. Consensus identified determinants of capacity building in practice including partnerships, resourcing, community development, leadership, workforce development, intelligence and quality of project management." Note: This article reflects the definition of capacity and capacity building developed and used by ISHN as part of its Wikipedia style web site. Read more>>

(From the ISHN Member information service)  An article in the February 2015 Issue of the International Journal of Obesity questions recent reports and reviewws that claim progress is being made in reducing childhood obesity rates. The authors report that "before concluding that the obesity epidemic is not increasing anymore, the validity of the presented data should be discussed more thoroughly. We had a closer look into the literature presented in recent reviews to address the major potential biases and distortions, and to develop insights about how to interpret the presented suggestions for a potential break in the obesity epidemic. Decreasing participation rates, the use of reported rather than measured data and small sample sizes, or lack of representativeness, did not seem to explain presented breaks in the obesity epidemic. Further, available evidence does not suggest that stabilization of obesity rates is seen in higher socioeconomic groups only, or that urbanization could explain a potential break in the obesity epidemic. However, follow-ups of short duration may, in part, explain the apparent break or decrease in the obesity epidemic. On the other hand, a single focus on body mass index (BMI) greater than or equal to25 or greater than or equal to30 kg m−2 is likely to mask a real increase in the obesity epidemic. And, in both children and adults, trends in waist circumferences were generally suggesting an increase, and were stronger than those reported for trends in BMI." Read more>>

(From the ISHN Member information service) Three articles in the August 2014 issue of the American Journal of Clinical Nutrition question the value of eating breakfast. The first, an RCT, suggests that eating or skipping breakfast had no effect on weight loss. The second, an RCT, reported no difference in resting metabolism rates. The third, a systematic review, found only equivocal evidence that eating breakfast had a positive impact on student academic performance. Another systematic review reported that consuming fruits and vegetables without cutting back on total caloric intake will not result in weight loss and another RCT study found little impact from switching to whole grains. Read more>>

(From the ISHN Member information service)  In our extensive monitoring of the research, we find that the now-popular "ecological approach" is more often actually applied in the "analysis" stage, identifying the complex, multiple and multi-level influences on behaviour and practice, rather than being actually used in the "action" stage, where the approach is used to organize and deliver a planned variety of interventions to affect the multiple influences. We are pleased to read the article in the August 2014 issue of International Journal of Behavioral Nutrition & Physical Activity, which reports on a superb application of the ecological approach in 15 elementary schools in Mexico. The authors report that "Thirty-two distinct intervention strategies were implemented in one setting (i.e., school) to engage four different target-groups (students, parents, school representatives, government) across two domains (Nutrition and Physical Activity). Overall, 47.5% of the strategies targeted the school infrastructure and/or personnel; 37.5% of strategies targeted a key political actor, the Public Education Secretariat while fewer strategies targeted parents (12.5%) and children (3%). More strategies were implemented in the Nutrition domain (69%) than Physical Activity (31%). The most frequently used SCT construct within both intervention domains was Reciprocal Determinism (e.g., where changes to the environment influence changes in behavior and these behavioral changes influence further changes to the environment); no significant differences were observed in the use of SCT constructs across domains. Findings provide insight into a promising combination of strategies and theoretical constructs that can be used to implement a school-based obesity prevention program. Strategies emphasized school-level infrastructure/personnel change and strong political engagement." The complete text of the article is available. A full report on the project is also available here.  

A detailed description of the impact of intervention during its two year implementation is provided here. (Note: the results after two years are modest, with small changes in eating habits and some types of physical activity reported. In our view, this reflects the reality that complex, multi-intervention programs need several years in order to be embedded in the school culture as well as to interact with the local neighbourhood and parents/families. Larger, community, media and societal influences are also important. The study did not report any changes to obesity levels. This is consistent with other studies, not only of school programs, that obesity is a problem that is far more challenging than what can be affected by a single setting within the community.  For schools, we should adjust our expectations of the impact of even well-delivered multiple interventions such that students are truly supported by healthy factors while in school and that they graduate with the knowledge, skills, selected attitudes, beliefs and intentions that can be reasonably expected. If an entire society is obsengenic, then we should recognize the limits of the school's influence.  

The authors capture our above assessment of current efforts to implement ecological approaches as follows: " The premise underlying ecological programming is that a multilevel program is likely to be more effective than an individually focused program because it affords the opportunity to encounter the same behavioral prompts (e.g., to be more physically active) from a variety of sources (parents, teachers, coaches) in a variety of settings (home, school, community) [13]-[16]. Therefore, an intervention program that contains diverse strategies to engage several different stakeholders across a range of settings might address the health behavior in a more comprehensive way and thus yield better results than a simpler program (i.e., fewer targets, less settings). Despite its intuitive appeal and an increase in the use of ecological principles for programming to prevent childhood obesity in developed countries [17], optimal (i.e., effective, easy to implement at low cost) combinations of intervention activities to promote healthy lifestyles have yet to be identified. In addition to determining optimal combinations of intervention activities, health promotion practitioners striving to integrate ecological principles into their programs must also strive to develop programs that are theoretically informed. Challenges to theoretical integration include practitioner difficulties in operationalizing and assessing theoretical constructs [18]. The purpose of this study was to assess the integration of ecological principles and theoretical constructs in a school-based obesity prevention program that was successful in creating a supportive environment for healthy behaviors." 

The conclusion to the paper notes that "The aim of this paper was to assess the integration of ecological principles and theoretical constructs involved in a successful school-based obesity prevention program in Mexico City. We sought to unpack the intervention program along intervention domains in order to develop a map of the successful intervention program. If we compare our ecological map with recommendations in the literature [15],[17],[20], we can ascertain that this intervention program was a genuine ecological effort within a single setting since it delivered a diversity of intervention strategies involving multiple targets (POL, ORG, INT, IND), across both intervention domains. The ecological mapping showed that several different targets (PE teachers, school teachers, food vendors, parents, children and the school environment) were engaged, and that these efforts are consistent with those recommended to promote behavior change and to prevent obesity in children [7],[9],[23],[37]-[39]. Overall, our findings are consistent with existing evidence that policy intervention strategies can impact different ecological levels of influence [42]. This may be especially the case for hierarchical institutions such as school systems, where decisions are made at more than one level."


The reflections offered by the researchers are also interesting. "To our knowledge, this is the first research to document the integration of ecological principles and theoretical constructs in a school-based obesity prevention program in Mexico. The deconstruction of a successful intervention program that has documented environmental and student behavior improvements provides novel information for the implementation of multifactorial interventions in school-based health promotion programs. Although there may be a variety of successful combinations of ecological strategies and theoretical constructs, our findings provide one version that can be used as a starting point to develop even more effective combinations. Within the school setting, this ecological combination of strategies emphasizes school and political targets. Moreover, the strategies in both the Nutrition and Physical Activity domains are most commonly underpinned by the theoretical construct of Reciprocal Determinism. In a context where the school environment is considered “obesogenic” and there is compelling evidence that this environment can shape children's eating and PA patterns, the current findings provide valuable insight about the types of strategies that can be leveraged to optimal effects. It is expected that these findings will be especially meaningful to inform obesity prevention programs in Mexico and in low-middle income countries where childhood obesity is an emerging problem."  Read more>>  

(From the ISHN Member information service)  A study reported in Volume 107, 2014 of Social Science & Medicine examined whether "Mothers' work hours are likely to affect their time allocation towards activities related to children's diet, activity and well-being. The researchers examined the suggestion that mothers who work more may be more reliant on processed foods, foods prepared away from home and school meal programs for their children's meals. A greater number of work hours may also lead to more unsupervised time for children that may, in turn, allow for an increase in unhealthy behaviors among their children such as snacking and sedentary activities such as TV watching. the study confirmed that hypothesis, even more so for higher income families. "Using data on a national cohort of children, we examine the relationship between mothers' average weekly work hours during their children's school years on children's dietary and activity behaviors, BMI and obesity in 5th and 8th grade. Our results are consistent with findings from the literature that maternal work hours are positively associated with children's BMI and obesity especially among children with higher socioeconomic status. Unlike previous papers, our detailed data on children's behaviors allow us to speak directly to affected behaviors that may contribute to the increased BMI. We show that children whose mothers work more consume more unhealthy foods (e.g. soda, fast food) and less healthy foods (e.g. fruits, vegetables, milk) and watch more television. Although they report being slightly more physically active, likely due to organized physical activities, the BMI and obesity results suggest that the deterioration in diet and increase in sedentary behaviors dominate." Read more>>

(From the ISHN Member information service)     An article in Issue #3, 2014 of Health Promotion Practice illustrates the challenges of working in loosely-coupled education and health systems. This Canadian study examined policy documents on school nutrition and education in Canada at the federal, provincial and regional or local authority levels. The researchers note that "Results reveal distinct differences across federal, provincial, and regional levels. The availability of nutritious food in schools and having nutrition education as part of the curriculum were key components of the physical environment across federal and provincial levels. Federal and provincial priorities are guided by a health promotion framework and adopting a partnership approach to policy implementation. Gaps in regional-level policy include incorporating nutrition education in the curriculum and making the link between nutrition and obesity."  Read more>>

(From Politico) First lady Michelle Obama and school lunch ladies used to be on the same team, but now they’re locked in a political war against each other. For the first three years of Obama’s Let’s Move! campaign, the School Nutrition Association, a powerful group that represents 55,000 cafeteria professionals, was a close ally in the White House push to get kids to eat healthier. Fast-forward to today: SNA is standing shoulder to shoulder with House Republicans, pushing to grant schools waivers from the requirements if they are losing money and aiming to relax the standards when the law is reauthorized next year. The story behind the school lunch flip-flop is a complicated web of lobbying change-ups, industry influence and partisan posturing inside the Beltway. It also casts a spotlight on how difficult it is to make the economics of school meals work — and just how much resistance there can be to Washington directing nationwide change. Read more

(From the ISHN Member information service) The nutrition related data from the US School Health Policies & Practices Survey (2012 Results shows that over 80% of school districts requited instruction about nutrition at all grade levels,   80.8% of districts required all schools to offer breakfast to students and 96.6% of districts required all schools to offer lunch to students. The percentage of districts that made information available to students on the nutrition and caloric content of foods available to them increased from 46.0% in 2000 to 68.2% in 2012. 72.5% of states evaluated the implementation of local wellness policies at the district or school level. 35.5% of districts had no single individual responsible for ensuring compliance with the district’s wellness policy. 73.5% of states provided funding for professional development or offered professional development to those who teach health education on nutrition and dietary behavior. The percentage of districts that provided funding for professional development or
offered professional development to those who teach health education on nutrition and dietary behavior increased from 43.3% in 2000 to 62.9% in 2012. Read more>>
 

(An item from the ISHN Member information service) A supplementary issue of Childhood Obesity explores the influence that parents have on their children's physical activity, eating habits and use of media such as TV, games and other screen time. Several articles in the special issue explore different styles of parenting, role modeling and child-parent communications and other aspects. Parenting/family development models are applied to food, activity and screen use. Mini-research agendas are described. The editorial for the issue notes that measurement issues need considerable work in this area. The articles all appear to be excellent and interesting but sometimes i wonder if researchers on one health issue ever read the similar research that has already been done by people working on other health issues. Parenting and parental influences have already been well-described and discussed in respect to sexual health, substance abuse and problem behaviours as well as in regards to youth development and family systems in general. How much of tbhis is really new or noteworthy? Read more >>

(An item from the ISHN Member information service) An article in the September 2013 Issue of Public Health Nutrition documents the value of a low-cost snack provided in a school-feeding programs in Kenyan school children. The study compared three types of snacks and found that "The Meat and Plain Githeri (i.e. githeri + oil) groups showed the greatest declines in the probability of a morbidity outcome (PMO) for total and severe illnesses, malaria, poor appetite, reduced activity, fever and chills. The Meat group showed significantly greater declines in PMO for gastroenteritis (mainly diarrhoea) and typhoid compared with the Control group, for jaundice compared with the Plain Githeri group, and for skin infection compared with the Milk group. The Milk group showed the greatest decline in PMO for upper respiratory infection. For nearly all morbidity outcomes the Control group had the highest PMO and the least decline over time."  Read more>>

(An item from the ISHN Member information service)  Shape Up – a school-community approach to influencing the determinants of a healthy and balanced growing up (www.shapeupeurope.net) was a three-year project aimed at the development, implementation and assessment of an innovative approach to health promotion and health education concerning overweight and obesity in children and young people. The researchers report that ' Shape Up demonstrated that young people can be guided to successfully bring about health-promoting changes at the school and community level. For example, these chnages included healthier food consumption at school, new forms of physical activity, and increased interest, motivation and ability among children and young people to deal with health issues. More specifically, Shape Up has proven to be effective in initiating and bringing about health-promoting changes in the ecology of the school, including improvements at the school, parent, community/municipal and individual student levels. 

(An item from ISHN Member information service) An article in the February 2013 issue of the International Journal of Behavioral Nutrition & Physical Activity reported on a correlational assessment of school level capacity and the implementation of school nutrition policies and programs as well as the food offered to students. The authors report that "Our measurement framework integrated constructs from the Theories of Organizational Change and elements from Stillman’s Tobacco Policy Framework adapted for obesity prevention. Our measurement framework included assessment of policy institutionalization of nutritional guidelines at the district and school levels, climate, nutritional capacity and resources (nutritional resources and participation in nutritional programs), nutritional practices, and school community support for enacting stricter nutritional guidelines. We used hierarchical mixed-effects logistic regression analyses to examine associations with the availability of fruit, vegetables, pizza/hamburgers/hot dogs, chocolate candy, sugar-sweetened beverages, and french fried potatoes." They also found that "In elementary schools, fruit and vegetable availability was more likely among schools that have more nutritional resources (OR = 6.74 and 5.23, respectively). In addition, fruit availability in elementary schools was highest in schools that participated in the BC School Fruit and Vegetable Nutritional Program and the BC Milk program (OR = 4.54 and OR = 3.05, respectively). In middle/high schools, having more nutritional resources was associated with vegetable availability only (OR = 5.78). Finally, middle/high schools that have healthier nutritional practices (i.e., which align with upcoming provincial/state guidelines) were less likely to have the following food/beverage items available at school: chocolate candy (OR = .80) and sugar-sweetened beverages (OR = .76).Read More. 

(An item from ISHN Member information service)  Several articles in the January 2013 issue of the International Journal of Behavioral Nutrition & Physical Activity explain the influence that parents and familiy patterns have on childhood weight and eating. Another article notes that walking to school is correlated with better health. All of these artlcles are good science but rarely extend our knowledge beyond our own common sense. The challenge for researchers is to explain how, when and what can be done to support families with low cost, sustainable interventions. Read more. 

(An item from ISHN Member information service) An article from the December 2012 Issue of Public Health Nutrition reports that the quality of lunches brought to school from home were of poorer quality then those provided at school. The authors are reporting on lunches of Grade 5-6 students in Prince Edward Island, Canada. The authors note that " Foods purchased at school were higher in nutrient density for ten micronutrients (Ca, Mg, K, Zn, vitamin A, vitamin D, riboflavin, niacin, vitamin B6 and vitamin B12) compared with packed lunch foods from home, which were higher in three micronutrients (Fe, vitamin C and folate). School lunches provided sufficient protein but were higher in sugar and fat than home lunches. Foods brought from home were higher in carbohydrates, fibre and Na than foods purchased at school. The overall nutritional quality of lunches was poor, regardless of source. A significant proportion of foods consumed by the students came from home sources; these were lower nutritional quality and were higher in Na than foods offered at school. Findings suggest that improving the dietary habits of school-aged children will require a collaborative effort from multiple stakeholders, including parents" Read more. 

(An item from ISHN Member information service) Most of the articles in Issue #9, 2012 (Supplement) of the Canadian Journal of Public Health, a special issue on the research about built environments, focus on children, neighbourhoods, including schools. There are articles that focus on neighbourhood design and how that can influence children`s physical actiivty. One intriguing article suggests that there is no bad weather, just the wrong clothing, as an impediment of walking to school. Other articles repoeat similar studies correlating prevalent food choices in neighbourhoods with pooer diets of children. Another article suggested that if fast food outlets were within walking distance of schools or if public recreation facilities were within 500 metres of the home, that there would be effects on diet or activity levels among children. Read more

(From Research Summary, National Food Service Management Institute, U of Southern Mississippi) Benefits of the School Breakfast Program (SBP) have been documented, however many of America's neediest children are not participating. A national trend to improve school breakfast participation is the integration of breakfast within the school day and in-classroom breakfast. Service models include “grab and go”, distribution of breakfasts to each classroom, and mobile breakfast carts in hallways. These in-classroom breakfast programs dramatically increase student access to school breakfast, while positively influencing the nutrition status of school-age children.  Data analysis revealed that in-classroom breakfast improves school culture and has a positive effect on student behavior. Schools that offer in-classroom breakfast have experienced dramatic increases in participation which leads to increased revenue. SN directors, SN managers, principals, teachers, custodians, and school health staff were supportive of in-classroom breakfast programs and their effect on nutrition intake and readiness to learn.   Read More. 

(From the ASCD Health & Learning News Updates)  A study in the journal Appetite found that students who skipped breakfast performed worse on Internet-based tests of attention, memory, and reaction time than their peers who had eaten breakfast. Researchers in the United Kingdom asked 1,386 students from 32 schools to take several online performance tests and indicate whether or not they had eaten breakfast. The vast majority of students (1,202) reported having eaten breakfast, but 5.6 percent of boys and 7.6 percent of girls said they had skipped a morning meal. In addition, results showed that girls who did not eat breakfast were less able to focus then the boys who had missed breakfast. Read More.