Trading nutrition for education: nutritional status and the sale of snack foods in an eastern Kentucky school

Ecocultural or Biocultural? Towards Appropriate Terminologies in Biocultural Diversity

Biocultural diversity has made notable contributions that have furthered our understanding of the human culture-nature interrelationship. However, the usage of the term 'biocultural' is not unique to biocultural diversity. It was first used in biocultural studies within anthropology decades ahead of biocultural diversity. The existing literature on biocultural diversity does not acknowledge the prior existence of biocultural studies, or provide a clear demarcation between usages of the two terms. In this article, I discuss the varying contexts in usage of the term 'biocultural' between biocultural diversity and biocultural anthropology. While biocultural diversity deals with the linkages between biological, cultural, and linguistic diversity, biocultural studies in anthropology deal with the deterministic influence of physical and social environment on human biology and wellbeing. In biocultural studies, 'biocultural' refers to the integration of methodically collated cultural data with biological and environmental data. 'Bio' in biocultural anthropology therefore denotes biology, unlike biocultural diversity where it refers to biodiversity. Both biocultural studies and biocultural diversity apply 'biocultural' as descriptor to generate overlapping terminologies such as 'biocultural approach'. Such a confusing scenario is not in the interest of biocultural diversity, as it would impede theoretical advancements. I propose that advocates of biocultural diversity explore its harmonies with ecoculturalism and the possibilities of suitably adapting the term 'ecoculture' in lieu of 'bioculture'. Using 'ecocultural' instead of 'biocultural' as a descriptor to coin terminologies could solve confusions arising from the expanding usage of the term 'bioculture'.

"What do you think of when I say the word 'snack'?" Towards a cohesive definition among low-income caregivers of preschool-age children

Despite agreement that snacks contribute significant energy to children's diets, evidence of the effects of snacks on health, especially in children, is weak. Some of the lack of consistent evidence may be due to a non-standardized definition of snacks. Understanding how caregivers of preschool-aged children conceptualize and define child snacks could provide valuable insights on epidemiological findings, targets for anticipatory guidance, and prevention efforts. Participants were 59 ethnically-diverse (White, Hispanic, and African American), low-income urban caregivers of children age 3-5 years. Each caregiver completed a 60-90 min semi-structured in-depth interview to elicit their definitions of child snacks. Data were coded by two trained coders using theoretically-guided emergent coding techniques to derive key dimensions of caregivers' child snack definitions. Five interrelated dimensions of a child snack definition were identified: (1) types of food, (2) portion size, (3) time, (4) location, and (5) purpose. Based on these dimensions, an empirically-derived definition of caregivers' perceptions of child snacks is offered: A small portion of food that is given in-between meals, frequently with an intention of reducing or preventing hunger until the next mealtime. These findings suggest interrelated dimensions that capture the types of foods and eating episodes that are defined as snacks. Child nutrition studies and interventions that include a focus on child snacks should consider using an a priori multi-dimensional definition of child snacks.

Spaces between home and school: The effect of eating location on adolescent nutrition

Using interview and self-administered survey data, this article examines how homes, schools, and the community spaces between these two locations affect adolescent nutrition in a low-income, urban setting. Results from this research show that eating location can play a significant role in the foods that adolescents consume. Food acquisition data provided by adolescents reveal that homes and schools provide spaces for the consumption of healthy foods while shops, restaurants, takeouts, and community centers contribute unhealthy snack foods to adolescent diets in a traditionally low-income, urban neighborhood in Northern Ireland. The results of this research show that eating location can provide a starting point for designing healthy eating interventions in low-income places to avoid overlap with spaces that already provide healthy foods to young people.

Disparities persist in nutrition policies and practices in Minnesota secondary schools

Access to healthy foods among secondary school students is patterned by individual-level socioeconomic status, but few studies have examined how school nutrition policies and practices are patterned by school-level characteristics. The objective of our study was to examine school nutrition policies and practices by school characteristics (eg, location, racial/ethnic composition, and free/reduced priced lunch eligibility) in Minnesota secondary schools between 2008 and 2012. Data from the 2008 to 2012 Minnesota School Health Profiles survey were used to assess school nutrition policies and practices, and National Center for Educational Statistics data were used for school characteristics (n=505 secondary schools). Nutrition policies and practices included the availability of low-nutrient, energy dense (LNED) items, strategies to engage students in healthy eating, and restrictions on advertisements of LNED products in areas around the school. Among school-level characteristics, school location was most strongly related to school nutrition policies. Across all years, city schools were less likely than town/rural schools to have vending machines/school stores (prevalence difference [PD] -13.7, 95% CI -25.0 to -2.3), and less likely to sell sport drinks (PD -36.3, 95% CI -51.8 to -20.7). City schools were also more likely to prohibit advertisements for LNED products in school buildings (PD 17.7, 95% CI 5.5 to 29.9) and on school grounds (PD 15.6, 95% CI 1.7 to 29.5). Between 2008 and 2012, the prevalence of some healthy eating policies/practices (eg, limiting salty snacks, offering taste testing, and banning unhealthy food advertisements in school publications) declined in city schools only, where these policies/practices had previously been more common. Monitoring of these trends is needed to understand the influence of these policies on student outcomes across school settings.

Instant noodles as an antifriction device: making the BOP with PPP in PNG

Focusing primarily, but not exclusively, on urban and periurban Papua New Guinea (PNG), we discuss the significance of instant ramen noodles to those now known as the “bottom of the pyramid” (BOP). Although instant noodles are remarkable in that they are eaten by virtually everyone in the world, albeit in different amounts and for different reasons, they are marketed in PNG specifically as a “popularly positioned product” (PPP) for the BOP. Cheap, convenient, tasty, filling, and shelf stable, they are a modern addition to Sidney Mintz's classic “proletarian hunger killers” of sugar, tea, and coffee. But, we argue, instant noodles have a distinctive contemporary role: they do more than sustain the poor; they transform them into the aspiring consumers of the BOP. As such, instant noodles can be viewed as an antifriction device, greasing the skids of capitalism as it extends its reach.

Campus sustainable food projects: critique and engagement

Campus sustainable food projects recently have expanded rapidly. A review of four components - purchasing goals, academic programs, direct marketing, and experiential learning - shows both intent and capacity to contribute to transformational change toward an alternative food system. The published rationales for campus projects and specific purchasing guidelines join curricular and cocurricular activities to evaluate, disseminate, and legitimize environmental, economic, social justice, and health concerns about conventional food. Emerging new metrics of food service practices mark a potential shift from rhetoric to market clout, and experiential learning builds new coalitions and can reshape relations with food and place. Campus projects are relatively new and their resilience is not assured, but leading projects have had regional, state, and national impact. The emergence of sustainability rankings in higher education and contract-based compliance around purchasing goals suggests that if support continues, higher education's leadership can extend to the broader agrifood system.

The "childhood obesity epidemic": health crisis or social construction?

There has been a meteoric rise over the past two decades in the medical research and media coverage of the so-called global childhood obesity epidemic. Recently, in response to this phenomenon, there has been a spate of books and articles in the fields of critical sociology and cultural studies that have argued that this "epidemic" is socially constructed, what Natalie Boero (2007) dubs a "postmodern epidemic." As an anthropologist who has studied child nutrition and obesity in relation to poverty and the school environment, I am concerned about both the lack of reflexivity among medical researchers as well as critical scholars' treatment of the problem as entirely socially constructed. In this article I present both sides of this debate and then discuss how wee can attempt to navigate a middle course that recognizes this health issue but also offers alternative approaches to those set by the biomedical agenda.

Obesity and gastroesophageal reflux disease and gastroesophageal reflux symptoms in children

BACKGROUND

The association between body mass index (BMI) and gastroesophageal reflux disease (GERD) has been extensively studied among adults but few studies have examined such association in children.

AIMS

1) to determine the relationship between BMI in children and GERD, and 2) to use the National Center for Health Statistics (NCHS) values for BMI as a valid source for comparison.

METHODS

We identified two cohorts of children aged between two and 17 years who were seen at Texas Children's Hospital (TCH). The first cohort consisted of children diagnosed with GERD based on upper gastrointestinal endoscopic and histologic evaluation, which was recorded in the Pediatric Endoscopic Database System-Clinical Outcomes Research Initiative (PEDS-CORI) at TCH. A diagnosis of GERD was based on the presence of erosive esophagitis or esophageal ulcers. Endoscopic reports that were incomplete or did not include demographic features, indications for endoscopy, or endoscopic findings were excluded. The second cohort consisted of all children with symptoms due to gastroesophageal reflux (GER) who received outpatient gastrointestinal (GI) consultation at TCH for any 9th revision of the International Statistical Classification of Diseases (ICD-9) code suggestive of GER. There was no overlap between the two cohorts as each child was indexed only once. Children with any comorbid illnesses were excluded.

MEASUREMENTS

The records for each child namely, age, gender, height, and weight were obtained on the same date as that of the diagnosis. Using the growth curves published by the NCHS, the gender/age specific weight-for-age Z-score (WAZ), and height-for-age Z-score (HAZ) were calculated. BMI was calculated as the weight in kilograms divided by height in meters squared. Children having values greater than the 95th percentile for their age/gender-specific BMI were defined as obese.

RESULTS

In a one-year period (January 2006 to December 2006), a total of 627 children who attended the GI clinic at TCH were identified with GERD symptoms of whom 131 underwent endoscopic examination. The mean age was 9.7 years; 42% were females; 57% were Caucasians; 15% were African Americans, and 28% were Hispanics. Using National Health and Nutrition Examination Survey (NHANES) data obtained from the same period as the the current data as a baseline for comparison, the BMI of children diagnosed with GERD was higher than the BMI reported by NHANES data. The final analysis of test proportion showed an overall proportion of 0.207 for the current study versus NHANES data (0.174). The current study also showed that more boys than girls have BMI greater than 95th percentile (24.7% vs 16.5%, respectively, OR = 1.7, 95% CI = 1.2-2.6, p = 0.04).

CONCLUSIONS

Children diagnosed with GERD or those who presented with symptoms of GERD are more likely to be obese. The findings of this study show a possible association between obesity and GERD in children. Further understanding about the co-morbidity between GERD and obesity in children may have important implications on GERD management and treatment in children.

Unpacking dietary acculturation among new Americans: results from formative research with African refugees

Epidemiological studies focusing on Latino immigrant health have found links between acculturation (time and language competency), weight gain, and disease risk. Since time and language competency are not mechanisms by which diets and activities change, associations between acculturation and weight change offer little to public health professionals who aim to develop nutrition and health interventions. We present a conceptual model and use a mixed-methods biocultural approach to address the fine-grained details of diet and activity choice for new arrivals to the USA. The results of our anthropological work with Liberian and Somali Bantu refugees indicate that, in addition to standard surveys (individual-level characteristics, socioeconomic status, employment, and acculturation), epidemiological research would benefit from the data generated from ethnography and more nuanced behavioral studies. A focus on the lived experiences of new Americans and the explicit examination of institutional support, peer support, and interactions between children and caretakers might offer points of intervention for immigrant health which is a growing public health concern.

The school food environment and adolescent obesity: qualitative insights from high school principals and food service personnel

Objectives

To examine high school personnel's perceptions of the school environment, its impact on obesity, and the potential impact of legislation regulating schools' food/beverage offerings.

Methods

Semi-structured interviews were conducted with the principal (n = 8) and dietitian/food service manager (n = 7) at 8 schools (4 rural, 4 suburban) participating in a larger study examining the relationship between the school environment and adolescent health behavior patterns.

Results

Principal themes included: 1) Obesity is a problem in general, but not at their school, 2) Schools have been unfairly targeted above more salient factors (e.g., community and home environment), 3) Attempts at change should start before high school, 4) Student health is one priority area among multiple competing demands; academic achievement is the top priority, 5) Legislation should be informed by educators and better incorporate the school's perspective. Food service themes included: 1) Obesity is not a problem at their school; school food service is not the cause, 2) Food offerings are based largely on the importance of preparing students for the real world by providing choice and the need to maintain high participation rates; both healthy and unhealthy options are available, 3) A la carte keeps lunch participation high and prices low but should be used as a supplement, not a replacement, to the main meal, 4) Vending provides school's additional revenue; vending is not part of food service and is appropriate if it does not interfere with the lunch program.

Conclusion

Discrepancies exist between government/public health officials and school personnel that may inhibit collaborative efforts to address obesity through modifications to the school environment. Future policy initiatives may be enhanced by seeking the input of school personnel, providing recommendations firmly grounded in evidence-based practice, framing initiatives in terms of their potential impact on the issues of most concern to schools (e.g., academic achievement, finances/revenue), and minimizing barriers by providing schools adequate resources to carry out and evaluate the effectiveness of their efforts.

Recurrent abdominal pain in school children: effect of obesity and diet

AIMS

To study the epidemiology and some of the risk factors of childhood recurrent abdominal pain (RAP) in school age children.

METHODS

We used a questionnaire concerning socioeconomic parameters, intensity, frequency, duration, nature of RAP and anthropometric measures. We used several criteria to identify RAP and the Wong-Baker FACES scale for pain intensity and calculated the gender/age-specific body mass index (BMI) Z-score using NCHS standards. Obesity was defined as a BMI>or=95th percentile for age and gender.

RESULTS

A total of 925 children mean age of 9.5 years completed and returned the questionnaires. The prevalence of RAP was 24%; 22% among boys versus 26% among girls (p=0.28) and reached its peak among children aged 7-9 (29%) years. Children with BMI>or=95% percentile reported more RAP compared to those not obese (33.3% vs. 22.5%) (OR=1.8, p=0.01). There was an inverse correlation between fruit consumption and RAP prevalence with 20% among children reporting more than three serving of fruit per week compared to 40% of those who did not consume any fruits (p<0.002). Logistic regression analysis confirmed BMI>or=95th percentile and low consumption of fruits are significant risk factors for RAP.

CONCLUSIONS

There is a significant association between RAP and obesity and both conditions are prevalent among children in this population. Understanding more about the co-morbidity between RAP and obesity could have important implications on RAP management and treatment.

Sponsorship and fund-raising in New Zealand schools: implications for health

OBJECTIVE

To examine school participation in sponsorship, incentive and fundraising initiatives and to describe feedback about potential health implications and possible solutions from key stakeholders in the health and education sectors.

METHODS

All secondary/area schools and 15% of primary/intermediate schools were randomly selected from six geographical regions of New Zealand. School principals completed a self-report questionnaire. Survey findings were summarised in a discussion document and forwarded to 53 key stakeholders for comment.

RESULTS

Most schools reported participation in sponsorship, incentive and fundraising initiatives (83% of primary/intermediate and 85% of secondary/area schools). Some partnerships delivered positive health messages to students, but others were linked with products or activities potentially deleterious to health. Examples of the latter included provision of foods high in fat and sugar to students and funding from organisations whose profits were generated from gambling and alcohol sales. Key stakeholder concerns included the undermining of classroom health education and perceptions that schools were endorsing product consumption. Suggestions to address these concerns included increasing co-ordination and awareness, alternative sources of funding, and policy guidelines or legislation.

CONCLUSIONS

Most schools were involved in some sort of sponsorship, incentive and fundraising initiatives, some of which had the potential to have a negative impact on the health of students.

IMPLICATIONS

There is an urgent need for co-operation between the health and education sectors to ensure that these funding partnerships do not compromise student health.

Biocultural construction of obesogenic ecologies of childhood: Parent-feeding versus child-eating strategies

Human biologists recognize the centrality of parental feeding beliefs and related practices in structuring children's under-nutrition risk in food-insecure settings. By contrast, how they might similarly structure children's nutrition-related health risks in calorically rich ecologies has barely been considered. Using the case of 3- to 6-year-old children in a rural Southeastern U.S. community with very high obesity rates, we use cognitive methods such as consensus analysis to determine how parental cultural models of child eating and feeding are linked to high calorie, obesogenic child diets. We find that parental models are very consistent with biomedical understandings (reduce fat, reduce sugar, portion control, etc.). Regardless, children's diets are extremely high in calories overall as well as in high sugar and fat food items. We suggest three likely and mutually reinforcing contributing factors to persistent and increasing early childhood overweight and obesity: parents' ambivalence about modeling healthy eating, children's active resistance, and the balance of parents' social against nutritive goals at meal times. The active role of children as social architects of their own biology has been little explored in human biological studies, and should provide novel and important understandings of the biocultural construction of childhood over-nutrition.

Stature and adiposity among children in contrasting neighborhoods in the city of Hamilton, Ontario, Canada

It is hypothesized in this study that body size and shape vary by local area within the North American urban environment. This study tests that hypothesis by comparing stature and adiposity among children (of age 6-10 years) attending elementary schools in three neighborhoods that contrast by socioeconomic status and recent immigrant status. While the whole sample of children (n = 266) has 27.4% of children that can be classified as overweight/obese (> or =85th percentile for body mass index), analysis by socioeconomic status (SES) reveals that there are approximately twice as many children in the overweight/obese category in the two low-SES schools compared to the high-SES school. Further analysis by individual school indicates that the school in the poorest neighborhood has a statistically significantly lower mean height-for-age Z score relative to the most affluent school. It is concluded that the influence of socioeconomic, demographic, and environmental factors on stature and adiposity can be investigated through studies such as this one that consider local area variation.