Development and implementation of FRESH--a post-secondary nutrition education program incorporating population strategies, experiential learning and intersectoral partnerships

Qualitative Evaluation of University Students' Experience Delivering an Obesity Prevention Programme in Elementary Schools

The Coordinated Approach to Child Health (CATCH) programme is an accredited obesity prevention programme in the United States, teaching children about nutrition, physical activity, and screen time limits. This study aimed to evaluate the perceptions of undergraduate and graduate student leaders' about their experience delivering the CATCH programme in elementary schools in Northern Illinois school districts during the 2019-2020 school year and its impact on their personal and professional skills and on programme participants. An email questionnaire was sent to eligible students. Grounded theory was used to analyze the students' responses. Two researchers assigned codes to the data and identified themes. Twenty-one students responded (50% response rate). Six identified themes include "purpose of CATCH programme," "school facilities and resources," "university students experience with CATCH lessons and activities," "benefits to university student," "benefits to children and teachers," and "identified weaknesses and suggested improvements to CATCH." University students delivering the CATCH programme appreciated the opportunity to practice in a real-world setting, gained transferable professional skills, increased programme content knowledge, identified CATCH programme benefits/strengths, and planned to apply lessons learned to future practice.

Post-Secondary Food Service Manager Perspectives on Fruit and Vegetable Nudging Strategies: Qualitative Study

BACKGROUND

Changing the choice architecture in post-secondary food service contexts to "nudge" customers to choose more fruits and vegetables (FV) shows promise in intervention studies to date. If such approaches are to become more widely adopted, they must be feasible and acceptable to food service managers. Among possible early adopters, managers of food services in post-secondary education institutions may have unique insights on implementation of such approaches, as they have dual mandates to support student health and maintain profitability.

OBJECTIVE

The goal of this exploratory study was to examine current knowledge, practice, facilitators, and barriers to uptake of nudge strategies promoting FV in a sample of post-secondary food service managers.

METHODS

A qualitative telephone interview study was undertaken with food service managers across Canada (n = 10 institutions), recruited from a national professional organization. One or more representatives from each institution completed the interview. Interviews were audio-recorded, transcribed, and underwent framework descriptive and interpretative content analysis in NVivo (QSR International). Münscher's Taxonomy of Choice Architecture and the Ottawa Model for Research Use guided development and analysis.

RESULTS

Managers from 9 universities and 1 technical college participated. Local context, governance, and resources varied widely. Eight of 10 institutions used some form of FV nudging as part of their marketing and health promotion, most commonly to reduce the effort associated with choosing FV. Nudging strategies aimed at increasing the range and composition of FV offerings, providing a social reference (opinion leaders) for choosing FV, and changing consequences with loyalty cards were also common. Other nudging strategies were used infrequently. Cost, operational ease of implementation, and students' privacy and choices were critical issues in adoption.

CONCLUSIONS

The results can inform development and testing of locally adapted nudge interventions. It is critical that managers be involved from the outset of any planned academic implementation study.

"My Roommates Would Laugh at me": Young Males Reveal Embarrassment over Lack of Food Skills

Purpose: This descriptive qualitative study explored young males' perceptions of food skills in 3 domains: food selection and planning, food preparation, and food safety and storage.Methods: Semi-structured interviews were audio-recorded and transcribed verbatim. Data were analyzed using the constant comparative method.Results: Forty-four young men (aged 17-35) reported varying levels of food skills, from little/no confidence to very confident and skilled. Most participants learned food skills from their mothers. Greater involvement in food selection and planning at a young age appeared to be related to parental influence and encouragement, exposure to food skills at school, and interest in food-related activities, which, in turn, provided a solid foundation for being confident cooks as young adults. Most notable was the lack of knowledge about, or confidence in, food safety and storage. Young men with low self-perceived food skills were deeply embarrassed about this deficiency in front of peers who had higher levels of confidence and skills.Conclusions: Future interventions or curricula should emphasize food safety and storage. This research also illustrates the importance of the home environment in teaching food skills to youth and ensuring that food skills are taught well before young adults begin living independently.

Using the Food Skills Questionnaire (FSQ) to Evaluate a Cooking Intervention for University Students: A Pilot Study

Purpose: To pilot test the Food Skills Questionnaire (FSQ) to evaluate a cooking intervention.Methods: Students attending Western University were invited to participate in 3 cooking classes over a 3-month period. All participants were asked to complete the FSQ pre- and post-intervention. The FSQ evaluated food skills in 3 domains-Food Selection and Planning, Food Preparation, and Food Safety and Storage-with a maximum score of 100 per domain. Domain scores were then computed as a weighted average for the Total Food Skills Score out of 100. Open-ended questions assessed participants' perceptions of the classes.Results: Forty-four students participated. There was a significant increase in food planning (70.6 ± 13.5-77.6 ± 14.3, P < 0.01), food preparation (67.5 ± 14.0-74.9 ± 12.9, P < 0.01), food safety (78.0 ± 9.9-80.8 ± 13.0, P = 0.04), and total food skills (71.9 ± 8.9-77.8 ± 10.6, P < 0.01) post-intervention. Content analysis of open-ended questions indicated that participants enjoyed healthy recipes, supportive Peer Educators, discussions, the cooking experience, socializing, and the safe environment.Conclusions: The FSQ shows strong potential for evaluating basic (e.g., peeling, chopping, slicing) to intermediate (e.g., meal planning) food skills in an effective and feasible manner. It can also capture changes in specific domains, allowing the development of more focused nutrition education and skills-based interventions.

Experiential learning for children's dental anxiety: a cluster randomized trial

BACKGROUND

Dental anxiety (DA) has an impact on the quality of dental treatment and may have long-lasting implications for children. A recent study introducing experiential learning (EL) into children's oral health promotion resulted in better oral hygiene. The purpose of the study is to evaluate whether EL can reduce children's DA.

METHODS

In September 2018, we recruited 988 children aged 7-8 years from 24 classes to participate in a cluster-randomized trial. Classes were randomly assigned to EL (in which children received a lively presentation on oral health and participated in a role play in a simulated dental clinic in the classroom) or the Tell-Show-Do (TSD) group (in which children received a conventional TSD behavior management). The primary outcome was the prevalence of high DA after the procedure of pit and fissure sealant (PFS), assessed by a modified Children's Fear Survey Schedule-Dental Subscale. Secondary outcomes were changes in blood pressures (BP) and pulse rates (PR) before and after the PFS procedure. The intervention effects were estimated by means of mixed effect models, which included covariates of gender and school (and baseline value for BP and PR only), and a random cluster effect.

RESULTS

In 396 children of the EL group who received the PFS treatment, the prevalence of high DA (score ≥ 38) was 18.5%, compared with 24.3% in 391 children of the TSD group (OR = 0.65; 95% confidence interval, 0.46-0.93; P = 0.019). The increases in BP and PR after the PFS were also significantly less in the EL group.

CONCLUSION

School-based experiential learning intervention before a dental visit is feasible and effective in reducing children's dental anxiety during PFS.

TRIAL REGISTRATION

The trial was registered in Chinese Clinical Trial Registry on 5 January 2020 (No.: ChiCTR2000028878 , retrospectively registered).

Point-of-Purchase Labels and Reward Cards Improve Sales of Healthy Foods in University Dining Halls

Purpose: To compare sales of Food Resources and Education for Student Health (FRESH) Approved versus non-FRESH Approved menu cycle items pre- and postimplementation of the FRESH program.

Methods: Sales data from 2011–2015 of FRESH Approved versus non-FRESH Approved menu items were analyzed. Fruit and milk items sold, net sales, and the cost of free fruit and milk redeemed through the FRESH Reward Card (FRC) program, were also analyzed.

Results: FRESH Approved items sold more often than non-FRESH Approved items in the latter 2 years (P = 0.01). Prices of FRESH Approved menu items were significantly lower than non-FRESH Approved items for all years (e.g., $1.52 ± $0.94 vs $2.21 ± $1.02 per serving in 2014–2015; P < 0.001). Across all FRESH implementation years, FRESH Approved menu items were found more often on the 6-week menu (P < 0.05). The number of fruit items sold increased from a baseline of 143 052 to 170 954, and net sales increased from $135 450 to $154 248 after 3 years of the FRC implementation.

Conclusions: FRESH Approved items were less expensive, available more often, and had higher sales. The FRC increased net fruit sales despite the cost of free fruit. Highlighting and reducing the cost of healthy foods are promising practices to improve campus food environments.

Strategies Used for Making Healthy Eating Choices among Veterinary Medical Students

Healthy eating is a challenge for most college students, and students in the field of veterinary medicine are no exception. Health experts have recommended that universities emphasize the importance of healthy eating and promote healthy eating habits among students. However, before we can begin offering targeted interventions to promote healthy eating strategies and behaviors, we must first understand students' current strategies used for making healthy eating choices, self-reported eating habits, and perceptions of diet quality. Thus, the purpose of this study was to understand veterinary medical students' perceptions of current diet quality and to characterize their strategies for making healthy eating choices. Results indicate veterinary medical students employ a wide range of strategies and behaviors for healthy eating, yet few students reported eating a diet of poor quality. We conclude that while most students report eating a relatively healthy diet, variation in strategies used suggests room for improvement for many. This article discusses potential intervention strategies to promote healthy eating among veterinary students.

Experiential learning in oral health education

Experiential learning is an innovative learning method that knowledge is gained through experience. The aim of this paper was to review the application of experiential learning in health education and suggest an oral health education program using experiential learning. Experiential learning has been used in the past successfully in health education mostly in university curricula. In oral health education, its use is limited and without following a comprehensive structure. An experiential learning oral health education program, implemented in the classroom by a trained teacher, is proposed to be integrated in the school's curriculum. Initially, using brainstorming students express their opinions and feelings toward oral health. Then, students are allocated to working groups to develop oral health projects. The outcome of these projects is presented in the classroom to their peers through role playing, posters, songs, games, etc., Finally, a discussion is stimulated by the teacher to encourage children to express their feelings about oral health issues and thus experientially recognize the importance of oral health. Experiential learning has been effectively used in health education and can be a successful method for oral health education. For optimal results, a predetermined experiential method structure has to be followed.

Determining attitudinal and behavioral factors concerning milk and dairy intake and their association with calcium intake in college students

BACKGROUND/OBJECTIVES

Average intake of calcium among college students is below the recommended intake, and knowledge surrounding the attitudinal and behavioral factors that influence milk and dairy intake, a primary food source of calcium, is limited. The purpose of this study was to evaluate college students' attitudes and behaviors concerning milk and dairy consumption and their association with calcium intake.

SUBJECTS/METHODS

Participants were 1,730 undergraduate students who completed an online survey (SurveyMonkey) as part of baseline data collection for a social marketing dairy campaign. The online survey assessed attitudes and behaviors concerning milk and dairy intake, and calcium intake. Questions about milk- and dairy-related attitudes and behaviors were grouped into 14 factors using factor analysis. Predictors of calcium intake were then evaluated.

RESULTS

Median calcium intake across all participants was 928.6 mg/day, with males consuming higher calcium intakes than females (P < 0.001). Adjusted for gender, calcium intakes were most strongly (and positively) correlated with associating milk with specific eating occasions and availability (i.e., storing calcium-rich foods in one's dorm or apartment) (both P < 0.001). Other correlates of calcium intake included: positive-viewing milk as healthy (P = 0.039), having family members who drink milk) (P = 0.039), and taking calcium supplements (P = 0.056); and negative-parent rules concerning milk (P = 0.031) and viewing milk in dining halls negatively (P = 0.05).

CONCLUSIONS

Calcium intakes among college students enrolled in the current study was below the recommended dietary allowance of 1,000 mg/day, reinforcing the need for dietary interventions in this target population, especially females. Practitioners and researchers should consider the factors found here to impact calcium intake, particularly associating milk with specific eating occasions (e.g., milk with breakfast) and having calcium-rich foods available in the dorm room or apartment, as intervention strategies in future efforts aimed at promoting milk and dairy foods and beverages for improved calcium intake in college students.

The Use of Social Networking Sites (SNSs) in Health Communication Campaigns: Review and Recommendations

The past decade has witnessed a rapid increase in the use of Social Networking Sites (SNSs) in health communication campaigns seeking to achieve an ambitious range of health-related impacts. This article provides a review of 40 studies and research protocols, with a focus on two key factors that differentiate SNSs from more traditional health communication approaches of the past. The first is the potential dualism between message sender and receiver, in which receivers become receiver-sources who forward and amplify the content and reach of health messages. The second is the potential dualism between message and message impact, in which the act of forwarding and modifying messages by receiver-sources itself becomes a measure of message impact. Each of these dualisms has implications for the design and evaluation of contemporary health communication campaigns. The review concludes with a series of observations and recommendations for future health communication research.

Dietitians' Attitudes and Beliefs Regarding Peer Education in Nutrition

PURPOSE

Peer education (PE) has been used effectively in nutrition; however, research examining dietitians' attitudes regarding PE is lacking.

METHODS

An online survey was sent to a random sample of 1198 Dietitians of Canada members to assess attitudes regarding PE by practice area.

RESULTS

A representative sample of dietitians by practice area and location was obtained (n = 229; 19%). Their total attitude score (TAS) was 226 ± 26 (mean ± SD) out of 295 (maximum). Community/public health dietitians had significantly higher TASs compared with clinical dietitians (234 ± 23 vs. 221 ± 27, respectively; P = 0.03). Dietitians believed PE to be most useful in community settings (P < 0.001), with cultural groups or adolescents (P < 0.001), and for healthy eating program goals (P < 0.001). The barrier most agreed with was limited financial resources, whereas the highest perceived benefits were social support and experience/employment for participants and peer educators, respectively. Overall, 63% agreed PE is an effective model, and 59% agreed that PE should be used more often in nutrition.

CONCLUSIONS

Dietitians have a positive attitude towards PE, with community/public health dietitians having the most positive attitudes. Dietitians believe PE is useful with specific target populations and particular program goals/strategies; however, they could be challenged to consider PE in a greater variety of programs.

University Students Intend to Eat Better but Lack Coping Self-Efficacy and Knowledge of Dietary Recommendations

OBJECTIVE

To assess university students' knowledge, intentions, and coping self-efficacy related to dietary recommendations.

DESIGN

The study used a cross-sectional online survey.

SETTING

Large university campus.

PARTICIPANTS

Students (n = 6,638; 22% response).

VARIABLES MEASURED

Self-efficacy and intentions were measured using 11-point scales. Students' perceived dietary recommendations were evaluated as correct or incorrect.

ANALYSIS

Categorical variables were analyzed using chi-square and continuous variables by t tests or ANOVAs. Significance was set at P ≤ .05 and multiple comparisons at P ≤ .01.

RESULTS

Respondents believed that they need fewer vegetables and fruit and more milk or alternatives servings/d than recommended; eg, males aged ≥ 19 years perceived milk or alternatives recommendations to be 4.3 ± 2.1 servings/d, significantly more than the 2 servings/d recommended (P < .001). Students in health sciences or with a food or nutrition course were significantly more likely to claim that they met recommendations (eg, 56% with vs 47% without a food or nutrition course for vegetables and fruit; P < .001); however, they were no more likely to identify them correctly. Males aged < 19 years had higher coping self-efficacy than females aged < 19 years to consume vegetables (68.3 ± 24.2 vs 64.0 ± 24.7; P < .01) and avoid high-calorie foods and beverages (HCFB) (56.2 ± 27.2 vs 49.0 ± 25.2; P < .01) when under stress; however, they had significantly lower intentions to consume vegetables (72.1 ± 24.5 vs 80.9 ± 20.3; P < .01) and avoid HCFB (60.5 ± 30.3 vs 77.7 ± 22.8; P < .01).

CONCLUSIONS AND IMPLICATIONS

Students do not have adequate knowledge of age- and sex-specific food guide recommendations. Simpler food guide recommendations or age- and sex-targeted campaigns may enhance knowledge. Students intend to consume more vegetables and less HCFB; however, they have low coping self-efficacy, all of which could be targeted in nutrition interventions.