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Results of a community-based low-literacy nutrition education program.

A nutrition intervention focused on low-fat eating pattern changes was conducted among low-literacy participants in a Twin Cities Metropolitan area Expanded Food and Nutrition Education Program (EFNEP). A total of 134 EFNEP participants who participated in the intervention were compared to 70 comparison participants who received EFNEP nutrition education materials. Associations between changes in outcome variables specific to the intervention were evaluated using mixed-model regression analyses. The principal effects seen for this program were related to changes in eating pattern scales. More modest effects were seen in scales related to attitudes of low-fat eating, and although changes in dietary fat intake as measured by 24-hour dietary interviews suggested a positive intervention effect, this did not approach statistical significance.

Adult↗

Influence of a nutrition education program (EFNEP) on infant nutrition in East Harlem.

An assessment of the effectiveness of aides working in the Expanded Food and Nutrition Education Program (EFNEP) to improve the nutritional status of infants was conducted with a group of 118 infants attending a well-baby clinic in a low-income area of New York City. In addition to clinic care, the fifty-seven study infants received home visits from a nutrition aide whose role was to reinforce nutritional advice received at the clinic. The sixty-one control infants received only regular clinic care. The benefits of having an aide were suggested by three observations: Reduction in the practice of introducing whole cow's milk to young infants, familiarizing older infants with a variety of foods, and reducing the prevalence of iron-deficiency anemia. Few of the differences between study and control infants achieved statistical significance, although trends consistently indicated that the presence of aides was beneficial. The problems of assessing the effectiveness of nutrition education programs with healthy infants are discussed.

Black or African American↗

[Impact of of school children's nutrition education program on the knowledge and nutritional behavior of their parents].

The aim of the work was to present the analysis of the influence of school children's nutrition education program on the knowledge and nutritional behavior of their parents (110 persons). The program was realized during 10 lessons. The interview with the parents concerning their knowledge and nutritional behavior was carried before and after realization of educational program at school. One can state that changes of parents nutritional behavior was connected with the educational materials getting by children, for example higher consumption of vegetables, fruits, milk and its products were observed. An increased level of knowledge especially on sources of selected nutrients: calcium, dietary fiber was found. Education of children and youth can be seen as one of the effective educational method of their parents.

Adolescent↗

Effects of a nutrition education program on the dietary behavior and nutrition knowledge of second-grade and third-grade students.

This research investigated the effects of a nutrition education program on dietary behavior and nutrition knowledge among elementary school-aged children participating in a Social Cognitive Theory-based nutrition education program. Participants included 1100 second-grade and third-grade students selected by convenience-type sampling from public schools in Alabama. A preassessment and postassessment control group design assessed dietary behavior and nutrition knowledge using Pizza Please, a specially designed interactive evaluation tool. A 2 x 2 mixed analysis of variance was used to analyze data. Children in the treatment group exhibited significantly (p < .001) greater improvement in overall dietary behaviors such as consumption of dairy products, fruits, and vegetables, than children in the control group. Children in the treatment group exhibited significantly (p < .001) greater improvement in nutrition knowledge, including Food Guide Pyramid understanding, nutrient-food association, and nutrient-job association, than children in the control group. Results suggest that nutrition education programs that teach positive dietary messages potentially can improve dietary behavior and increase nutrition knowledge in children.

Alabama↗

Survey of clinical nutrition training programs for physicians.

Clinical nutrition training programs for physicians were surveyed to determine their number, demographic characteristics, primary teaching focuses, number of available trainee positions, funding bases, trainee numbers, backgrounds, and career positions taken. Twenty-two active programs were identified, compared with 38 programs in 1993. Thirteen of the programs were primarily focused on adult nutrition and 7 were focused on pediatric nutrition. Twelve programs appeared to have nutrition as their sole subspecialty focus, 8 were housed within gastroenterology fellowships, and 2 were within endocrinology fellowships. Most programs included training in research, which is conducted during a second or third year, or both. The decrease in numbers of programs appears to have resulted not only from relocation, retirement of key faculty members, and loss of training grants, but also because of the clearer definition of clinical nutrition training programs in this survey. The changes also reflect a national trend toward decreasing subspecialization. Within this climate, it is apparent that a new model for the training and career activities of physician nutrition specialists is needed that will attract more physicians into the discipline of nutrition. Intersociety efforts are underway to address this need and to develop a unified voice that can guide clinical nutrition training for physicians into the 21st century.

Curriculum↗

A multidisciplinary QA program for enteral nutrition in high-risk patients.

An increase in elderly patients and severity of illness rates means greater use of nasogastric feeding tubes for both high-risk acutely ill and chronically ill patients. When the QA screening process at Booth Memorial Medical Center revealed a certain percentage of complications with small bore, weight-tipped feeding tubes inserted through the nares, a multidisciplinary peer review committee (MPRC) was formed to review the enteral nutrition program. After a literature review to determine possible complications, the MPRC identified lung perforations due to tube misplacement, tube feeding aspiration into the lungs leading to possible aspiration pneumonia, and an internal tip separation from the tube product failure. Unconscious incubated patients on ventilators were shown as at high risk for feeding tube misplacement in an initial MPRC patient study. A second study evaluated several different feeding tube products in the medical, respiratory and surgical ICU. The MPRC established a credentialing process for physician assistants, interns and residents in feeding tube placement. The MPRC proceedings were presented to the hospital-wide QA committee for review, endorsement and recommendations on all policy and procedure changes. The conclusions were that a more concerted effort must be made to improve medical management and encourage ongoing education in the administration of enteral feedings to high-risk patients.

Cost-Benefit Analysis↗

Pawtucket Heart Health Program point-of-purchase nutrition education program in supermarkets.

Point-of-purchase nutrition education in supermarkets is one intervention strategy of the Pawtucket Heart Health Program, a community cardiovascular disease prevention program in Pawtucket, Rhode Island. Using consumer intercept interviews, awareness of shelf labels and their effect on purchase behavior have been continuously evaluated. Between 1984 and 1988, the percent of shoppers who could identify correct labels increased from 11 percent to 24 percent (95% confidence intervals of difference: 7.17). The percent who reported they were encouraged to purchase the identified foods increased from 36 percent to 54 percent (95% CI of difference: 5.41).

Adult↗

Evaluation of the South Carolina seniors farmers' market nutrition education program.

The Seniors Farmers' Market Nutrition Program (SFMNP) provides vouchers to low-income seniors for use at local farmers' markets. This study was conducted to determine if SFMNP participants increased fruit and vegetable consumption. A total of 15,000 people from 13 counties received vouchers. A random sample of 1,500 received a follow-up survey, of which 658 (44%) were returned. Of the 98% of respondents who used the vouchers, 531 respondents (83%) did not purchase foods that they had never tried before, but 89% reported the intention to eat more fruits and vegetables year round because of the program. Farmers reported benefits from the program, have a positive attitude about it, and are willing to make certain accommodations to participate in it again. The SFMNP is an effective method for increasing consumption of agricultural commodities from farmers' markets by low-income seniors and is worthy of continued funding.

Aged↗

The Comprehensive Nutrition Action Program in Arizona.

Through the Comprehensive Nutrition Action Program for Arizona (funded by the Nutrition Program, Center for Disease Control, Atlanta), a nutrition care delivery system was developed. Four sub-systems-screening, referral, monitoring, and the development of community nutrition workers--allowed for the identification of problems, intervention, utilization of other agencies, and expansion of manpower with community nutrition/health workers. Improvement in nutritional status was demonstrated by this program. As a result, it has been expanded.

Adult↗

Development of the New York State Nutrition Surveillance Program.

New York State established a Nutrition Surveillance Program (NSP) in 1984. Precedents for the program included the Pediatric Nutrition Surveillance System of the Public Health Service's Centers for Disease Control and Prevention and periodic food and nutrition surveys conducted by the National Center for Health Statistics and the Human Nutrition Information Service, Department of Agriculture. The first phase of NSP was connected to a new program, the Supplemental Nutrition Assistance Program (SNAP), which established support for more than 1,000 emergency food programs across the State. SNAP also expanded the home delivered meal program for the frail elderly and the Special Supplemental Food Program for Women, Infants, and Children. NSP provided information on the extent of unmet nutrition needs that was used to establish funding requests and provided data describing the characteristics of SNAP participants that were used in developing new SNAP program components. The second phase of NSP began in 1988. It identified populations that were thought to be at nutrition risk and compiled information about the extent of unmet need, the characteristics of the population, and the status of current nutrition programs to meet the needs. As a result of this review, NSP added a nutrition component to the Dental Survey of School Children; conducted a dietary survey; developed an inventory of information sources in all State agencies; and established an annual work plan using department of health objectives. The third phase of NSP is the policy and planning phase, monitoring the Year 2000 Objectives and the Five-Year Plan of the New York State Food and Nutrition Policy Council.

Aged↗

Evaluating a nutrition education program for pregnant teen-agers: cognitive vs. behavioral outcomes.

A manual-based program of nutrition education for pregnancy and lactation was developed. This program was evaluated in a classroom setting using two measures of effectiveness. A pretest and posttest format was used to assess cognitive outcomes and predietary and postdietary records were used to assess behavioral changes. The difference between cognitive test scores was significant. However, actual dietary improvements were slight and were within the range of normal intake variation. This study emphasizes the need to assess behavior in order to more fully evaluate educational effectiveness. Observations of the study also suggest the desirability of environmental support for the successful translation of classroom knowledge into appropriate behaviors.

Adolescent↗

Effects of a nutrition education program for urban, low-income, older adults: a collaborative program among nurses and nursing students.

Nutrition education programs can be effective in reducing risks of cardiovascular disease in older adults. The objective of the Eat and Learn Nutrition Program was to increase knowledge of nutrition and promote healthy eating among the residents of an older adult, low-income, urban housing community. The program was a series of 3 discussions on nutrition topics, based on a community needs assessment, that were presented in the common room of the participants' residence over a heart-healthy lunch. On average, participants were able to increase their nutrition knowledge learning 1 major point per session. In addition, participants discussed alternative methods for healthy eating and shared culturally diverse nutritious recipes with each other. The collaborative nursing effort in designing the program served to facilitate learning about community program implementation for all nursing students involved. Collaboration between nurses and nursing students from a variety of educational backgrounds may enhance learning and program success.

Aged↗

Cholesterol-lowering effect of the Food for Heart Nutrition Education Program.

The objective of this prospective, randomized controlled trial was to assess the effectiveness of the Food For Heart Program patient nutrition tool in hypercholesterolemic outpatients. The setting for this study was an urban academic primary-care practice; 175 hypercholesterolemic adults not taking cholesterol-lowering medications were enrolled as subjects. The study intervention involved four monthly dietary counseling visits, using the Food For Heart Program, conducted by the study research assistant. The main outcome measures were fasting serum lipids (primary); body weight (secondary); and change in Dietary Risk Assessment score (intervention group only), analyzed using Student's t test. Our results showed that total and low-density lipoprotein cholesterol decreased 0.40+/-0.65 mmol/L and 0.32+/-0.58 mmol/L, respectively, in the intervention group (n=91), compared with 0.06+/-0.57 mmol/L and 0.0088+/-0.56 mmol/L in the control group (n=84) ( P <.001). There was no significant change in high-density lipoprotein cholesterol. Intervention subjects lost a small but statistically significant amount of weight, 2.2+/-7.4 pounds ( P <.01), and decreased their Dietary Risk Assessment score 5.9+/-6.5 points ( P <.001). Based on these findings, we concluded that total and low-density lipoprotein cholesterol, weight, and dietary risk for coronary heart disease decreased significantly in hypercholesterolemic patients counseled using the Food For Heart Program.

Adult↗

Development of a master's in public health nutrition degree program using distance education.

The Professional Practice Program in Nutrition (PPPN) uses distance education to offer a master's degree in public health (MPH) nutrition designed for practitioners who desire to maintain their employment and develop new skills. Public health nutrition leadership faces challenges in recruiting a large enough workforce to (a) carry out the core functions of assessment, policy, and assurance; (b) update current nutritionists in new skill areas to face the demands of dynamic health care and public health climates; and (c) conduct monitoring and surveillance of Healthy People 2010 objectives. In 1996, the University of North Carolina at Chapel Hill designed and implemented this program after a market analysis to identify advanced educational need in a nine state area. PPPN was initiated as a pilot program and enrolled two cohorts of students from 1996 through 1998. This project identified four key steps: (a) conduct a detailed market analysis; (b) establish an infrastructure to deliver the program; (c) tailor the curriculum using the technology; and (d) identify, accommodate, and develop student capabilities. The findings indicate that distance education strategies are appropriate to carry out a full MPH curriculum in nutrition, but sufficient enrollment is necessary to cover the added curriculum expenditures.

Curriculum↗