Point-of-sale machines in school cafeterias and parental influence on child food choices

The prevalence of obesity has reached epidemic proportions in the United States. Twenty-five percent of school aged students are overweight. Schools have the opportunity to help slow this epidemic. School cafeterias in the United States feed millions of students every day through the National School Lunch Program.^ Point-of-sale machines are used in most school cafeterias to help streamline the process of purchasing school lunches. The point-of-sale software allows school personnel to place special notes on student's accounts to provide alerts about parental requests. This study investigated what the alerts are used for, who uses the alerts, and if there are any patterns by demographic characteristics. ^ Counts and percentages were used to determine what the alerts were used for and who used them. This study found that students who were white non-Hispanic, paid status, or in elementary school were most likely to have alerts placed on their accounts. Also, the majority of point-of-sale alerts were used as allowances (i.e., allowed to purchase snacks from the balance on the school lunch account), rather than restrictions (i.e., restricted from purchasing high calorie foods or specific food items). Using chi-square analysis, a total of 688 alerts were analyzed. There were significant differences in alert frequencies for intent category by grade level (p=0.000), snack access (p=0.000), and gender (p=0.002). Therefore, the results are significant, and one can conclude there is a significant relationship between gender, grade level, and snack access, and the presence of an alert on the school lunch account.^ Also, school administrators may want to take into consideration possible changes to their program, such as requiring more time to run the software. The results of this study can assist school administrators to better understand that a point-of-sale alert program may help their school lunch programs run more efficiently, while also providing parental influence on students’ food choices at the point-of-sale.^ School food service authorities should consider implementing a structured point-of-sale alert policy to encourage parental input on their children's food choices. When implementing the point-of-sale policy, schools should publicize this policy online, through school lunch menus, and parent communications increase participation throughout the school district.^

Systematic review of worksite-based behavior change programs that target metabolic syndrome risk factors

Approximately one-third of US adults have metabolic syndrome, the clustering of cardiovascular risk factors that include hypertension, abdominal adiposity, elevated fasting glucose, low high-density lipoprotein (HDL)-cholesterol and elevated triglyceride levels. While the definition of metabolic syndrome continues to be much debated among leading health research organizations, the fact is that individuals with metabolic syndrome have an increased risk of developing cardiovascular disease and/or type 2 diabetes. A recent report by the Henry J. Kaiser Family Foundation found that the US spent $2.2 trillion (16.2% of the Gross Domestic Product) on healthcare in 2007 and cited that among other factors, chronic diseases, including type 2 diabetes and cardiovascular disease, are large contributors to this growing national expenditure. Bearing a substantial portion of this cost are employers, the leading providers of health insurance. In lieu of this, many employers have begun implementing health promotion efforts to counteract these rising costs. However, evidence-based practices, uniform guidelines and policy do not exist for this setting in regard to the prevention of metabolic syndrome risk factors as defined by the National Cholesterol Education Program (NCEP) Adult Treatment Panel III (ATP III). Therefore, the aim of this review was to determine the effects of worksite-based behavior change programs on reducing the risk factors for metabolic syndrome in adults. Using relevant search terms, OVID MEDLINE was used to search the peer-reviewed literature published since 1998, resulting in 23 articles meeting the inclusion criteria for the review. The American Dietetic Association's Evidence Analysis Process was used to abstract data from selected articles, assess the quality of each study, compile the evidence, develop a summarized conclusion, and assign a grade based upon the strength of supporting evidence. The results revealed that participating in a worksite-based behavior change program may be associated in one or more improved metabolic syndrome risk factors. Programs that delivered a higher dose (>22 hours), in a shorter duration (<2 years) using two or more behavior-change strategies were associated with more metabolic risk factors being positively impacted. A Conclusion Grade of III was obtained for the evidence, indicating that studies were of weak design or results were inconclusive due to inadequate sample sizes, bias and lack of generalizability. These results provide some support for the continued use of worksite-based health promotion and further research is needed to determine if multi-strategy, intense behavior change programs targeting multiple risk factors are able to sustain health improvements in the long-term.^

Use of tabletop exercises for disaster preparedness training

Background. In public health preparedness, disaster preparedness refers to the strategic planning of responses to all types of disasters. Preparation and training for disaster response can be conducted using different teaching modalities, ranging from discussion-based programs such as seminars, drills and tabletop exercises to more complex operation-based programs such as functional exercises and full-scale exercises. Each method of instruction has its advantages and disadvantages. Tabletop exercises are facilitated discussions designed to evaluate programs, policies, and procedures; they are usually conducted in a classroom, often with tabletop props (e.g. models, maps or diagrams). ^ Objective. The overall goal of this project was to determine whether tabletop exercises are effective teaching modalities for disaster preparedness, with an emphasis on intentional chemical exposure. ^ Method. The target audience for the exercise was the Medical Reserve Brigade of the Texas State Guard, a group of volunteer healthcare providers and first responders who prepare for response to local disasters. A new tabletop exercise was designed to provide information on the complex, interrelated organizations within the national disaster preparedness program that this group would interact with in the event of a local disaster. This educational intervention consisted of a four hour multipart program that included a pretest of knowledge, lecture series, an interactive group discussion using a mock disaster scenario, a posttest of knowledge, and a course evaluation. ^ Results. Approximately 40 volunteers attended the intervention session; roughly half (n=21) had previously participated in a full scale drill. There was an 11% improvement in fund of knowledge between the pre- and post-test scores (p=0.002). Overall, the tabletop exercise was well received by those with and without prior training, with no significant differences found between these two groups in terms of relevance and appropriateness of content. However, the separate components of the tabletop exercise were variably effective, as gauged by written text comments on the questionnaire. ^ Conclusions. Tabletop exercises can be a useful training modality in disaster preparedness, as evidenced by improvement in knowledge and qualitative feedback on its value. Future offerings could incorporate recordings of participant responses during the drill, so that better feedback can be provided to them. Additional research should be conducted, using the same or similar design, in different populations that are stakeholders in disaster preparedness, so that the generalizability of these findings can be determined.^

Can accreditation work as a tool for quality improvement in public health? A critical review

Public health departments play an important role in promoting and preserving the health of communities. The lack of a system to ensure their quality and accountability led to the development of a national voluntary accreditation program by Public Health Accreditation Board (PHAB). The concept that accreditation will lead to quality improvement in public health which will ultimately lead to healthy communities seems intuitive but lacks a robust body of evidence. A critical review of literature was conducted to explore if accreditation can lead to quality improvement in public health. The articles were selected from publically available databases using a specific set of criteria for inclusion, exclusion, and appraisal. To understand the relationship between accreditation and quality improvement, the potential strengths and limitations of accreditation process were evaluated. Recommendations for best practices are suggested so that public health accreditation can yield maximum benefits. A logic model framework to help depict the impact of accreditation on various levels of public health outcomes is also discussed in this thesis. The literature review shows that existing accreditation programs in other industries show limited but encouraging evidence that accreditation will improve quality and strengthen the delivery of public health services. While progress in introducing accreditation in public health can be informed by other accredited industries, the public health field has its own set of challenges. Providing incentives, creating financing strategies, and having a strong leadership will allow greater access to accreditation by all public health departments. The suggested recommendations include that continuous evaluation, public participation, systems approach, clear vision, and dynamic standards should become hallmarks of the accreditation process. Understanding the link between accreditation, quality improvement, and health outcomes will influence the successful adoption and implementation of the public health accreditation program. This review of literature suggests that accreditation is an important step in improving the quality of public health departments and in ultimately improving the health of communities. However, accreditation should be considered in an integrated system of tools and approaches to improve the public health practice. Hence, it is a means to an end - not an end unto itself.^

Alternativas ante el conflicto entre autoridades ambientales y habitantes de áreas protegidas en páramos colombianos

Colombia es uno de los países denominados megadiversos biológica y culturalmente. Presenta a su interior la mayor extensión de páramos del mundo, los cuales son considerados fábricas de agua del planeta y hábitats de rica diversidad biológica. Por otro lado, la ocupación humana de los páramos colombianos ha generado conflictos entre las normativas ambientales vigentes y los usos productivos del suelo. El presente artículo analiza las alternativas aplicadas ante el conflicto entre autoridades ambientales de áreas protegidas y habitantes de los páramos en Colombia. Se encontraron dos tipos de alternativas: la primera plantea la concesión de servicios ecoturísticos en los parques naturales y la compra de tierras por parte de sociedades de economía mixta. La segunda plantea el abandono de las actividades productivas de los agricultores, mediado por procesos educativos o de cumplimiento de las normas ambientales vigentes, so pena de enfrentar acciones punitivas por parte del Estado. Este trabajo presenta una tercera alternativa, que parte de la crítica a las dos anteriores e incluye diferentes estrategias: planes de manejo comunitario con tiempo y financiación institucional pertinente, aplicación de modelos agroecológicos y rescate de la memoria biocultural y cambios en la estructura agraria.

Alternativas ante el conflicto entre autoridades ambientales y habitantes de áreas protegidas en páramos colombianos

Colombia es uno de los países denominados megadiversos biológica y culturalmente. Presenta a su interior la mayor extensión de páramos del mundo, los cuales son considerados fábricas de agua del planeta y hábitats de rica diversidad biológica. Por otro lado, la ocupación humana de los páramos colombianos ha generado conflictos entre las normativas ambientales vigentes y los usos productivos del suelo. El presente artículo analiza las alternativas aplicadas ante el conflicto entre autoridades ambientales de áreas protegidas y habitantes de los páramos en Colombia. Se encontraron dos tipos de alternativas: la primera plantea la concesión de servicios ecoturísticos en los parques naturales y la compra de tierras por parte de sociedades de economía mixta. La segunda plantea el abandono de las actividades productivas de los agricultores, mediado por procesos educativos o de cumplimiento de las normas ambientales vigentes, so pena de enfrentar acciones punitivas por parte del Estado. Este trabajo presenta una tercera alternativa, que parte de la crítica a las dos anteriores e incluye diferentes estrategias: planes de manejo comunitario con tiempo y financiación institucional pertinente, aplicación de modelos agroecológicos y rescate de la memoria biocultural y cambios en la estructura agraria.

Alternativas ante el conflicto entre autoridades ambientales y habitantes de áreas protegidas en páramos colombianos

Colombia es uno de los países denominados megadiversos biológica y culturalmente. Presenta a su interior la mayor extensión de páramos del mundo, los cuales son considerados fábricas de agua del planeta y hábitats de rica diversidad biológica. Por otro lado, la ocupación humana de los páramos colombianos ha generado conflictos entre las normativas ambientales vigentes y los usos productivos del suelo. El presente artículo analiza las alternativas aplicadas ante el conflicto entre autoridades ambientales de áreas protegidas y habitantes de los páramos en Colombia. Se encontraron dos tipos de alternativas: la primera plantea la concesión de servicios ecoturísticos en los parques naturales y la compra de tierras por parte de sociedades de economía mixta. La segunda plantea el abandono de las actividades productivas de los agricultores, mediado por procesos educativos o de cumplimiento de las normas ambientales vigentes, so pena de enfrentar acciones punitivas por parte del Estado. Este trabajo presenta una tercera alternativa, que parte de la crítica a las dos anteriores e incluye diferentes estrategias: planes de manejo comunitario con tiempo y financiación institucional pertinente, aplicación de modelos agroecológicos y rescate de la memoria biocultural y cambios en la estructura agraria.

Alternativas ante el conflicto entre autoridades ambientales y habitantes de áreas protegidas en páramos colombianos

Colombia es uno de los países denominados megadiversos biológica y culturalmente. Presenta a su interior la mayor extensión de páramos del mundo, los cuales son considerados fábricas de agua del planeta y hábitats de rica diversidad biológica. Por otro lado, la ocupación humana de los páramos colombianos ha generado conflictos entre las normativas ambientales vigentes y los usos productivos del suelo. El presente artículo analiza las alternativas aplicadas ante el conflicto entre autoridades ambientales de áreas protegidas y habitantes de los páramos en Colombia. Se encontraron dos tipos de alternativas: la primera plantea la concesión de servicios ecoturísticos en los parques naturales y la compra de tierras por parte de sociedades de economía mixta. La segunda plantea el abandono de las actividades productivas de los agricultores, mediado por procesos educativos o de cumplimiento de las normas ambientales vigentes, so pena de enfrentar acciones punitivas por parte del Estado. Este trabajo presenta una tercera alternativa, que parte de la crítica a las dos anteriores e incluye diferentes estrategias: planes de manejo comunitario con tiempo y financiación institucional pertinente, aplicación de modelos agroecológicos y rescate de la memoria biocultural y cambios en la estructura agraria.

Interview forms for integrating education for conservation in marine protected areas management in Colombia

Environmental Education (EE) is a key component in any marine protected area management. However, its visibility and action plans are still poorly developed and structured as a clear element in management procedures. The objective of this study is to contribute with a methodological route that integrates EE to the existing model of management planning and strategies, taking the Colombian National Natural Parks System as a case study. The creation of the route is proposed as a participatory research with different stakeholders in order to respond to the specific conservation needs and goals for the National Parks System. The EE national diagnosis has shown that its integration within the parks management structure is a first priority need, being a converging result on the two case studies on National Parks from the Pacific Coast of Colombia. The diagnosis also demonstrates that communication, participation, training and evaluation have to be reinforced, linking the community and stakeholders involved in the park management to the whole EE process. The proposed methodology route has been agreed upon by the National Parks staff and incorporates advice and recommendations from different stakeholders, in order to better include the park users. This step will help us to advance toward sustainable management in marine and coastal protected areas elsewhere, taking into account not only the biological but also the social-cultural prism. The main challenges in the management and conservation of coastal and marine ecosystems today are discussed.