PROMOTING SCHOOL BREAKFAST AT THE COUNTY AND STATE LEVEL: AN EVALUATION OF ALTERNATIVE SERVICE MODELS

Eating breakfast has been associated with improved weight status, nutrient intake, and academic achievement among children. The National School Breakfast Program (SBP) was created by the US Congress to ensure that school-aged children have access to a meal to start the school day. However, SBP participation rates have been consistently low nationwide even among students eligible for free or reduced-price (FRP) meals. Policy makers and practitioners have implemented a variety of initiatives to improve breakfast participation, including alternative breakfast service models, such as universal free school breakfast, breakfast in the classroom, second chance breakfast, and grab and go breakfast. To determine whether alternative breakfast service models are associated with improvements in SBP participation, academic, and health outcomes, we first completed a literature review to examine the associations between these models and SBP participation, student attendance, academic achievement, dietary intake, and weight status. Results indicate that some models may result in an increase in participation, but additional studies are needed. Using district- and school-level longitudinal data on breakfast participation rates and student demographics for schools across North Carolina, we examined whether changes in statewide policies and practices promoting alternative breakfast are associated with improved SBP participation. Findings indicate that most of the initiatives implemented in North Carolina were associated with an increase in either school- or district-level SBP participation. Longitudinal data on students and SBP participation for a large urban school district in the Southeast United States (LUSD) were used to determine whether a district-wide universal free breakfast (UFB) policy implemented in 2013-2014 was associated with changes in school-level SBP participation, attendance, academic achievement, and student weight status. On average across schools there was an increase in participation of 4.1% (SE=0.7, p<0.001) immediately following the implementation of the policy. Changes in participation differed among schools by grade level, FRP percent and race/ethnicity. Results provide no evidence of weight gain immediately following the UFB policy or associations between the policy and attendance or test scores. This evaluation of alternative breakfast service models addresses some of the gaps in knowledge about these initiatives and helps build the evidence base to better inform future policy approaches.Doctor of Philosoph

Disparities in Healthy Food Zoning, Farmers\u27 Market Availability, and Fruit and Vegetable Consumption Among North Carolina Residents

Background: Context and purpose of the study. To examine (1) associations between county-level zoning to support farmers\u27 market placement and county-level farmers\u27 market availability, rural/urban designation, percent African American residents, and percent of residents living below poverty and (2) individual-level associations between zoning to support farmers\u27 markets; fruit and vegetable consumption and body mass index (BMI) among a random sample of residents of six North Carolina (NC) counties. Methods: Zoning ordinances were scored to indicate supportiveness for healthy food outlets. Number of farmers\u27 markets (per capita) was obtained from the NC-Community Transformation Grant Project Fruit and Vegetable Outlet Inventory (2013). County-level census data on rural/urban status, percent African American, and percent poverty were obtained. For data on farmers\u27 market shopping, fruit and vegetable consumption, and BMI, trained interviewers conducted a random digit dial telephone survey of residents of six NC counties (3 urban and 3 rural). Pearson correlation coefficients and multilevel linear regression models were used to examine county-level and individual-level associations between zoning supportiveness, farmers\u27 market availability, and fruit and vegetable consumption and BMI. Results: At the county-level, healthier food zoning was greater in more urban areas and areas with less poverty. At the individual-level, self-reported fruit and vegetable consumption was associated with healthier food zoning. Conclusions: Disparities in zoning to promote healthy eating should be further examined, and future studies should assess whether amending zoning ordinances will lead to greater availability of healthy foods and changes in dietary behavior and health outcomes

Associations between a Universal Free Breakfast Policy and School Breakfast Program Participation, School Attendance, and Weight Status: A District-Wide Analysis

Breakfast consumption among youth is associated with improved diet quality, weight, cognition, and behavior. However, not all youth in the United States consume breakfast. Participation in the School Breakfast Program (SBP) is also low relative to the lunch program. Universal free breakfast (UFB) policies have been implemented to increase breakfast participation by reducing cost and stigma associated with the SBP. This study examined whether a UFB policy implemented in a school district in the Southeast US was associated with changes in breakfast participation, school attendance, and student weight. A longitudinal study of secondary data was conducted, and a mixed modeling approach was used to assess patterns of change in SBP participation. General linear models were used to assess attendance and student weight change. On average, across schools in the district, there was an increase in breakfast participation of 4.1 percentage points following the implementation of the policy. The change in breakfast participation in schools differed by the percent of students in the school who received school meals for free or at a reduced price, the percent of students of color, and the grade level of the school. Increases in SBP participation were not associated with significant changes in attendance or weight. UFB policies may be effective in increasing participation in the SBP

Historical data reveal contrasting habitat amount relationships with plant biodiversity

Assessing habitat loss effects on biodiversity is a major focus of ecological research. The relationship between habitat amount and biodiversity, postulated in the habitat amount hypothesis, is usually assessed at one point in time, which does not account for habitat loss as a temporal process. We examined habitat amount effects at two time periods, 1930s and 2010s, using plant data from three semi-natural habitats: calcareous grassland, heathland and broadleaved woodland, across Dorset, southern England. Woodlands, which changed little in area over the time period, showed minimal effects of habitat amount on species occurrence in both time periods. For grassland and heathland, which had undergone severe losses over the study period, we found the expected positive relationship in the 2010s, but the relationship was negative for these habitats in the 1930s. We explored possible reasons for this result. Total perimeter-to-area ratio (TPAR) showed positive effects in the 1930s for grassland and heathland, suggesting effects of habitat configuration, specifically edge. However, TPAR was highly correlated with habitat amount so this finding is speculative. One possible explanation for the relationships with habitat amount, and the change between the two periods could be the quality of the surrounding matrix. In the 1930s, the landscape was less intensified and was dominated by semi-natural habitats, whereas by the 2010s much had been converted to arable and intensive grasslands. We speculate that species could likely utilise the matrix to a greater degree in the 1930s compared with the 2010s when the matrix was more hostile, thereby decreasing the importance of habitat amount in the 1930s compared with the 2010s. These findings have important implications for conservation, as they show the importance of context (i.e. matrix quality) in determining the relationship between habitat amount and biodiversity

Farmers’ market shopping and dietary behaviours among Supplemental Nutrition Assistance Program participants

Abstract Objective Because farmers’ markets include a variety of fruits and vegetables, shopping at farmers’ markets would likely improve diet quality among low-income consumers, as well as promote sustainable direct farm-to-consumer business models. However, not much is known about how to promote farmers’ market shopping among low-income consumers. Therefore, the purpose of the present paper was to examine barriers to and facilitators of shopping at farmers’ markets and associations between shopping at farmers’ markets and self-reported dietary behaviours (fruit and vegetable, sugar-sweetened beverage and fast-food consumption) and BMI. Design Cross-sectional analyses of associations between farmers’ market shopping frequency, awareness of markets, access to markets, dietary behaviours and BMI. Setting Department of Social Services, Pitt County, eastern North Carolina, USA. Subjects Between April and July 2013, Supplemental Nutrition Assistance Program (SNAP) participants ( n 205) completed a quantitative survey. Results Barriers to shopping at farmers’ markets included does not accept SNAP/electronic benefit transfer, out of the way and lack of transportation. Farmers’ market shopping was associated with awareness of farmers’ markets (estimate =0·18 ( se 0·04), P &lt;0·001). Fruit and vegetable consumption was positively associated with farmers’ market shopping (estimate =1·06 ( se 0·32), P =0·001). Conclusions Our study is one of the first to examine SNAP participants’ farmers’ market shopping, distance to farmers’ markets and dietary behaviours. Barriers to shopping at farmers’ markets and increasing awareness of existing markets should be addressed in future interventions to increase SNAP participants’ use of farmers’ markets, ultimately improving diet quality in this high-risk group

Spirituality and end-of-life care in disadvantaged men dying of prostate cancer

Despite the positive influence of spiritual coping on the acceptance of a cancer diagnosis, higher spirituality is associated with receipt of more high intensity care at the end of life. The purpose of our study was to assess the association between spirituality and type of end-of-life care received by disadvantaged men with prostate cancer. We studied low-income, uninsured men in IMPACT, a state-funded public assistance program, who had died since its inception in 2001. Of the 60 men who died, we included the 35 who completed a spirituality questionnaire at program enrollment. We abstracted sociodemographic and clinical information as well as treatment within IMPACT, including zolendroic acid, chemotherapy, hospice use, and palliative radiation therapy. We measured spirituality with the Functional Assessment of Chronic Illness Therapy—Spiritual Well-Being questionnaire (FACIT-Sp) and compared end-of-life care received between subjects with low and high FACIT-Sp scores using chi-squared analyses. A higher proportion of men with high (33%) versus low (13%) spirituality scores enrolled in hospice, although our analysis was not adequately powered to demonstrate statistical significance. Likewise, we saw a trend toward increased receipt of palliative radiation among those with higher spirituality (37% vs. 25%, P = 0.69). The differences in end-of-life care received among those with low and high spirituality varied little by the FACIT-Sp peace and faith subscales. End-of-life care was similar between men with lower and higher spirituality. Men with higher spirituality trended toward greater hospice use, suggesting that they redirected the focus of their care from curative to palliative goals

Farmers' Market Shopping and Dietary Behaviours Among Supplemental Nutrition Assistance Program Participants

Abstract Objective Because farmers’ markets include a variety of fruits and vegetables, shopping at farmers’ markets would likely improve diet quality among low-income consumers, as well as promote sustainable direct farm-to-consumer business models. However, not much is known about how to promote farmers’ market shopping among low-income consumers. Therefore, the purpose of the present paper was to examine barriers to and facilitators of shopping at farmers’ markets and associations between shopping at farmers’ markets and self-reported dietary behaviours (fruit and vegetable, sugar-sweetened beverage and fast-food consumption) and BMI. Design Cross-sectional analyses of associations between farmers’ market shopping frequency, awareness of markets, access to markets, dietary behaviours and BMI. Setting Department of Social Services, Pitt County, eastern North Carolina, USA. Subjects Between April and July 2013, Supplemental Nutrition Assistance Program (SNAP) participants ( n 205) completed a quantitative survey. Results Barriers to shopping at farmers’ markets included does not accept SNAP/electronic benefit transfer, out of the way and lack of transportation. Farmers’ market shopping was associated with awareness of farmers’ markets (estimate =0·18 ( se 0·04), P &lt;0·001). Fruit and vegetable consumption was positively associated with farmers’ market shopping (estimate =1·06 ( se 0·32), P =0·001). Conclusions Our study is one of the first to examine SNAP participants’ farmers’ market shopping, distance to farmers’ markets and dietary behaviours. Barriers to shopping at farmers’ markets and increasing awareness of existing markets should be addressed in future interventions to increase SNAP participants’ use of farmers’ markets, ultimately improving diet quality in this high-risk group

The SOS-framework (Systems of Sedentary behaviours): an international transdisciplinary consensus framework for the study of determinants, research priorities and policy on sedentary behaviour across the life course: a DEDIPAC-study.

BACKGROUND: Ecological models are currently the most used approaches to classify and conceptualise determinants of sedentary behaviour, but these approaches are limited in their ability to capture the complexity of and interplay between determinants. The aim of the project described here was to develop a transdisciplinary dynamic framework, grounded in a system-based approach, for research on determinants of sedentary behaviour across the life span and intervention and policy planning and evaluation. METHODS: A comprehensive concept mapping approach was used to develop the Systems Of Sedentary behaviours (SOS) framework, involving four main phases: (1) preparation, (2) generation of statements, (3) structuring (sorting and ranking), and (4) analysis and interpretation. The first two phases were undertaken between December 2013 and February 2015 by the DEDIPAC KH team (DEterminants of DIet and Physical Activity Knowledge Hub). The last two phases were completed during a two-day consensus meeting in June 2015. RESULTS: During the first phase, 550 factors regarding sedentary behaviour were listed across three age groups (i.e., youths, adults and older adults), which were reduced to a final list of 190 life course factors in phase 2 used during the consensus meeting. In total, 69 international delegates, seven invited experts and one concept mapping consultant attended the consensus meeting. The final framework obtained during that meeting consisted of six clusters of determinants: Physical Health and Wellbeing (71% consensus), Social and Cultural Context (59% consensus), Built and Natural Environment (65% consensus), Psychology and Behaviour (80% consensus), Politics and Economics (78% consensus), and Institutional and Home Settings (78% consensus). Conducting studies on Institutional Settings was ranked as the first research priority. The view that this framework captures a system-based map of determinants of sedentary behaviour was expressed by 89% of the participants. CONCLUSION: Through an international transdisciplinary consensus process, the SOS framework was developed for the determinants of sedentary behaviour through the life course. Investigating the influence of Institutional and Home Settings was deemed to be the most important area of research to focus on at present and potentially the most modifiable. The SOS framework can be used as an important tool to prioritise future research and to develop policies to reduce sedentary time

Participation in environmental enhancement and conservation activities for health and well-being in adults: a review of quantitative and qualitative evidence

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