The Administration and Practice of Public Health Nutrition in the Arkansas State Department of Health

This report provides an analysis of the student\u27s experiences during eight weeks of field training with the Nutrition Service of the Arkansas State Department of Health. The purpose of this field experience was to supplement the student\u27s academic training in Public Health Nutrition. The experience was designed to help the student strengthen her philosophy and understanding of public health by introducing her to the following aspects of an official health agency: (1) the practice of public health at the state and local level, (2) the administrative organization of public health nutrition, and (3) the practice of public health nutrition. The Arkansas State Department of Public Health was chosen as the training agency as it has an established nutrition program which offers opportunities to observe the functioning of nutrition in the total health program. Experience in dealing with other professional personnel within the agency as well as in other agencies was also offered. In addition, the student was given the opportunity to develop her abilities in carrying out applied nutrition programs with both professional and nonprofessional groups and individuals. The experience provided the author with the following: (1) an overview of the total state health program and the role of nutrition in this program, (2) an understanding of the overall functioning of a local health department, (3) observation of some of the administrative responsibilities involved in a state nutrition program, and (4) an opportunity to observe and participate in direct and indirect services in conjunction with nutrition staff members and other paramedical personnel. Through academic training and the field experience, the student has developed knowledge, techniques, and skills which will be most helpful in her future practice of public health nutrition

The Role of Community Health Advisors in Community-Based Participatory Research

Mistrust and fear of research often exist in minority communities because of assumptions, preconceived ideas, and historical abuse and racism that continue to influence research participation. The research establishment is full of well-meaning \u27outsider\u27 investigators who recognize discrimination, health disparities, and insufficient health care providers in minority communities, but struggle in breaking through this history of mistrust. This article provides ethical insights from one such \u27insider-outsider\u27, community-based participatory research project implemented via community health advisors in the Mississippi Delta. Both community-based participatory research and community health advisors provide opportunities to address the ethical issues of trust, non-maleficence, and justice in minority communities. Implications for ethics-driven nursing research are discussed

Predictors of Breastfeeding Intention Among Low-Income Women

Objective: Breastfeeding rates are below the Healthy People 2010 goals despite recognized benefits of breastfeeding. This study determined factors that predict breastfeeding initiation among low-income pregnant women. Methods: A self-administered closed-ended questionnaire was introduced to 694 pregnant women who were certified for WIC in Mississippi. The questionnaire collected data about demographics, breastfeeding intention, breastfeeding knowledge, self-efficacy, and three recognized barriers to breastfeeding: embarrassment, time and social constraints, and lack of social support. Results: In bivariate analysis, women who intended to breastfeed were more often white and had at least some college education, higher income, a smaller family size, fewer children, and previous breastfeeding experience than women who did not intend to breastfeed. Intenders had higher levels of breastfeeding knowledge and self-efficacy and reported fewer barriers to breastfeeding than nonintenders. In multivariate logistic regression, fewer children, past breastfeeding experience, breastfeeding knowledge, self-efficacy, and perceived social support were independent predictors of breastfeeding intention. Conclusions: Women at high risk for not wanting to breastfeed can be identified for additional support. Interventions should focus on improving breastfeeding knowledge, enhancing confidence in one\u27s ability to breastfeed, and overcoming barriers to breastfeeding, especially lack of social support, among low-income women

Improving breastfeeding knowledge, attitudes, and practices of WIC clinic staff.

OBJECTIVE: This study was conducted to assess the impact of a breastfeeding promotion clinic environment project implemented by the state of Mississippi on breastfeeding knowledge, attitudes, and practices of WIC clinic staff. METHODS: Thirteen pairs of matched intervention and comparison WIC clinics participated in the study. Clinical and administrative staff completed pre-test and post-test self-administered questionnaires in 1998 and 1999. RESULTS: A total of 397 staff members provided pre-test data, and 277 staff members provided post-test data. Before project implementation, the intervention and comparison groups were similar overall. The majority of staff had positive attitudes/beliefs about breastfeeding, but gaps in knowledge and practices were noted. Post-test data showed that the project improved knowledge, attitudes/beliefs, and confidence/practice of intervention clinic staff. CONCLUSIONS: Clinic environment projects, which combine physical improvements and staff training, are effective in promoting support for breastfeeding among public health clinic staff. Similar interventions may contribute to the overall effectiveness of breastfeeding promotion programs

An Innovative Video Succeeds in Addressing Barriers to Breastfeeding Among Low-Income Women

This study evaluates the effectiveness of an innovative breastfeeding promotion video intervention in addressing barriers to breastfeeding among low-income women in the state of Mississippi. The 15-minute video features a diverse group of women and their families. Survey data were collected from Special Supplemental Nutrition Program for Women, Infants and Children clients in the intervention group (n = 310) before and after watching the video, and from a comparison group (n = 204) that did not watch the video. The 2 groups were comparable at baseline. The intervention significantly improved women\u27s perceptions with regard to the “embarrassment” and “time and social constraints” barriers to breastfeeding. In terms of the “lack of social support” barrier, the video positively affected participants’ feelings that the baby\u27s father encouraged breastfeeding but did not change their perceptions of support from female relatives and friends. The authors conclude that the video is an effective method of breastfeeding promotion among low-income women. © 2002, Sage Publications. All rights reserved

Social Cognitive Model of Fruit and Vegetable Consumption in Elementary School Children

Fruit and vegetable consumption is related to reduced risk for certain forms of cancer. Health organizations recommend the increased consumption of fruit and vegetables. Despite these recommendations, few U.S. children eat the recommended number of at least five servings of fruit and vegetables per day. Understanding the determinants of consumption might improve our ability to increase consumption. Few theory-based models have been developed to explain and predict the consumption of various foods by children. This study proposed a model to explain fruit and vegetable consumption in children based on Social Cognitive Theory and on the literature in nutrition education. The model was tested using structural equation modeling techniques. Data from 414 third-graders were gathered on five predictors including availability, modeling, nutrition education, motivation (i.e., self-efficacy, outcome expectancies, food preferences), and knowledge. The proposed model was tested with two random splits of the data and also separately for males and females. Results indicate adequate fit of the models for each of the four data sets (split 1, split 2, males, females). The pattern of significant paths was similar across the data sets. Availability and motivation (i.e., self-efficacy, outcome expectancies, food preference) were most consistently related to consumption and to other constructs in the model

The Community Health Advisor Program and the Deep South Network for Cancer Control - Health Promotion Programs for Volunteer Community Health Advisors

The Community Health Advisor program is a proven, community-driven health promotion program that identifies and trains natural helpers who then seek to improve the health of individuals and their communities. This article details the basis of the Community Health Advisor model and describes early pilot programs in the Mississippi Delta. Also described is the formation of the Community Health Advisor Network, which provides technical assistance to Community Health Advisor programs and the proliferation of Community Health Advisor programs nationally. Specifically, details are presented of the modification of the model for the Deep South Network for Cancer Control and of early findings showing a decrease in health disparities in Alabama

Breast-Feeding Initiation In Low-Income Women: Role of Attitudes, Support, and Perceived Control

Despite the documented health and emotional benefits of breast-feeding to women and children, breast-feeding rates are low among subgroups of women. In this study, we examine factors associated with breast-feeding initiation in low-income women, including Theory of Planned Behavior measures of attitude, support, and perceived control, as well as sociodemographic characteristics. A mail survey, with telephone follow-up, Of 733 postpartum Medicaid beneficiaries in Mississippi was conducted in 2000. The breast-feeding initiation rate in this population was 38%. Women who were older, white, non-Hispanic, college-educated, married, not certified for the Supplemental Nutrition Program for Women, Infants, and Children, and not working full-time were more likely to breast-feed than formula-feed at hospital discharge. Attitudes regarding benefits and barriers to breast-feeding, as well as health care system and social support, were associated with breast-feeding initiation at the multivariate level. Adding the health care system support variables to the regression model, and specifically support from lactation specialists and hospital nurses, explained the association between breast-feeding initiation and women\u27s perceived control over the time and social constraints barriers to breast-feeding. The findings support the need for health care system interventions, family interventions, and public health education campaigns to promote breast-feeding in low-income women