In Briefs

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Paul E. Terry	1329	Editorial Nutrition Research Special Issue and an Interview with Marion Nestle As much as the field of health promotion has benefited mightily in the past decades from internet abetted access to unlimited health content, our field is also experiencing the best of times and the worst of times. When it comes to our core work of supporting healthy decision making for individuals, organizations and communities, the unfettered, voluminous material available has, unimaginably, made facts seem fickle. This special issue of the American Journal of Health Promotion is dedicated to nutrition research where new discoveries provide the light needed to grow fresh knowledge. I am delighted to have Dr. Marion Nestle’s insights as a preamble to this special issue of the Journal. Educating about nutrition and food choices, in particular, has become as much a contest between competing interests and commercial forces as it has been a discipline guided by credible professionals. Exposing both academics and the public to well done studies about how food choices are influenced is ever more crucial in an era of alternative facts about what constitutes healthy eating.
the Science of lifestyle change
Interventions
Jungwon Min Zhengqi Tan Laurie Abadie Scott Townsend Hong Xue Youfa Wang	1333	Physical Activity/Youth An evaluation of the effectiveness of the National Aeronautics and Space Administration (NASA) Mission-X child health promotion program in the United States This article describes the effects of the NASA Mission-X: Train Like an Astronaut program (MX) on children’s health-related knowledge and behaviors. To examine the impact of a 6-week web- and school-based intervention pilot intervention in 5 cities in the United States, the authors employed a nonexperimental design with a pre–post comparison of 409 children’s health-related knowledge and behaviors. Participants had a mean age of 10.1 years. Results indicated that participants significantly improved their health behaviors in the areas of physical activity and diet, as well as their health knowledge regarding nutrition and physical fitness. Program impact did not significantly vary by sex or age. The authors argue that the intervention demonstrates that such approaches can be effective in improving health behaviors and health knowledge among young children, which may serve as a model for sustainable global child health promotion program.
Hatidza Zaganjor Katherine Bishop Kendrick Amy Lowry Warnock Stephen Onufrak Laurie P. Whitsel Julie Ralston Aoki Joel Kimmons	1340	Population Health Food Service Guideline Policies on State Government Controlled Properties State-level Food Service Guidelines bills, statutes, regulations and executive orders were analyzed to identify and assess FSG policy attributes and describe key components of policies that can inform stakeholders interested in pursuing the use of FSG. Two reviewers analyzed the text of each policy to assess its content based on the presence or absence of key FSG policy attributes. Agreement among the two reviewers was assessed using Cohen’s kappa statistic. Of the 1,381 policies identified, 31 met the inclusion criteria. Only 10 of 31 policies met a majority of variables within the classification tool and only two policies were actually adopted. The authors concluded that the study offers baseline data on FSG policies and provides information that can help inform the development of future FSG policies. Since state regulations are continuously updated data sources may not have captured the latest version of a regulation so some important policies might not have been included.
Strategies
Staci Young Melissa DeNomie JoAnne Sabir Eric Gass Jessie Tobin	1353	Health Promoting Community Design Around the Corner to Better Health: A Milwaukee Corner Store Initiative This article sought to explore the successes and challenges of a collaborative pilot project to increase healthy food availability in corner stores in Milwaukee, Wisconsin. The Healthy Corner Store Initiative intervention (1) supported businesses in purchasing equipment to stock fresh produce, (2) connected stores with produce sources, and (3) engaged in community outreach and marketing. Results revealed that storeowners reported more sold produce items per week and increased noticeable fresh produce upon entrance into the store. There was increased or improved store redesign, fresh produce signage, in-store cooking demonstrations, and small business development resources. The authors conclude that youth learned about new vegetables, kitchen skills and proper food storage, and the effects of obesity on health. They argue that similar interventions must address infrastructure costs, cooperation with property owners, and local policies and regulations affecting business practices.
Research Methods
Katherine A. John Mary E. Cogswell Lixia Zhao Xin Tong Erika C. Odom Carma Ayala Robert Merritt	1357	Quantitative Research Change in US Adult Consumer Knowledge, Attitudes, and Behaviors Related to Sodium Intake and Reduction, SummerStyles 2012 and 2015 HealthStyles surveys are web-based surveys designed to gather information from US consumers regarding health topics. This cross-sectional study involved an analysis of respondent data from the 2012 and 2015 HealthStyles surveys in order to assess their knowledge, attitudes and behaviors related to sodium intake and reduction. Wald Chi-square tests were used to examine differences by year and hypertensive status. Results showed that a higher percentage of respondents in 2015 agreed that most sodium comes from processed or restaurant foods (56.9% vs. 54%, P=0.04). Also, the percentage of respondents who buy or choose low/reduced sodium foods increased from 32.2% in 2012 to 36.5% in 2015 (p=0.016). The authors concluded that positive changes were observed in sodium-related knowledge and behaviors. Since questions related to sodium were only examined at two points over a 3 year period generalizability is limited.
Brenna K. VanFrank Sohyun Park Jennifer L. Foltz Lisa C. McGuire Diane M. Harris	1365	Quantitative Research Physician Characteristics Associated with Sugar-Sweetened Beverage Counseling Practices In this study, the authors used data from a 2014 cross-sectional survey on 1,510 practicing US physicians to explore the sweetened beverage (SSB) related topics that physicians discuss when counseling overweight/obese patients and examined associations between physicians’ SSB-related counseling practices and their personal and medical practice characteristics. Adjusted odds ratios (aOR) were calculated with multivariable logistic regression (adjusting for physician personal and medical practice characteristics). The results indicated that most physicians (98.5%) reported SSB-related counseling. The most reported topic was obesity/weight gain (81.4%); the least reported were added sugars (53.1%) and referral (35.0%). Physicians in adult focused specialties had lower odds than pediatricians of counseling on several topics (aOR range: 0.26–0.64). Outpatient physicians had higher odds than inpatient physicians of counseling on consumption frequency and water substitution (aOR range: 1.60–2.01). Physicians consuming SSBs ≥1 time/day (15.7%) had lower odds than non-consumers of counseling on most topics (aOR range: 0.58–0.68). The authors concluded that most physicians reported SSB-related counseling and obesity/weight gain was discussed most frequently. Opportunities also exist to strengthen SSB counseling practices in adult-focused specialties, inpatient settings, and among physicians who consume SSBs daily.
Meg Bruening Marc A. Adams Punam Ohri-Vachaspati Jane Hurley	1375	Quantitative Research Prevalence and implementation practices of school salad bars across grade levels This study used a cross-sectional web-based survey on school nutrition managers from elementary, middle, high and K-12 schools (N=648) to assess the prevalence of school bars in Arizona and to describe common practices of salad bar use. Descriptive analyses were conducted including Fisher’s exact test, ANOVA, and the Kruskal-Wallis test to compare practices across grade levels. The results indicated that, overall, 61.1% of respondents had a salad bar; there were significant differences in the prevalence across grade level: elementary, middle, high, and K-12 schools had prevalences of 67.3%, 75.0%, 45.5%, and 51.1% respectively (p<0.01). There were significant differences in the implementation and food-related components of salad bars across grade levels including type, salad bar location, sources of food, and frequency of serving cut vegetables. The authors concluded that their study provided insights on the prevalence of salad bars and is the first to report on implementation practices of school salad bars. Additionally, their results may guide the development of interventions for nutrition educators to use for the promotion of fruit and vegetable consumption via school salad bars.
Harvey W. Kaufman Zhen Chen	1383	Quntitative Research Vitamin D Status and Supplementation in Employer-Sponsored Wellness Program The current study explored the responses of participants to information regarding their vitamin D status. The results are based on 50,209 subjects from 12 employeer sponsored wellness programs who participanted in laboratory testing and/or self-reports of the use of vitamin D supplementation. Approximately 66% of participants had deficient or suboptimal levels of vitamin D. Many participants acted counter to their status by starting supplements when vitamin D level was optimal (20%) or discontinuing supplements when it was deficient (36%). For most, being informed of havinG suboptimal vitamin D levels did not influence their behavior. The authors argue that this paper contributes to the knowledge-base in this area by clarifying currrent levels of vitamin D deficiencies in working-age populations and by highlighting the need for more than informational feedback to motivate individuals to correct the situation.
Hannah Lane Kathleen J. Porter Erin Hecht Priscilla Harris Vivica Kraak Jamie Zoellner	1386	Quantitative Research Kids SIPsmartER: a feasibility study to reduce sugar-sweetened beverage consumption among middle school youth in Central Appalachia This study was designed to test the feasibility of implementing Kids SIPsmartER, an intervention to reduce sugar sweetened beverages (SSBs) among middle school students.Seventy-four (n=74) 6th and 7th graders were randomly assigned to KidsSIPsmartER or a matched-contact physical activity program. Measures included psychosocial and literacy constructs, physical activity, demographics, BMI, and SSB intake, Repeated measures ANOVAs were used to analyze data. Results showed at baseline average daily SSB intake was 36.2 ounces. Significant decreases in SSB fluidounces were found (-11.0 ounces (SD=26.5; p=0.010) in the group receiving the program and the differences were maintained overtime. In the comparison group, at two follow-up points, no significant between group differences for SSB fluid ounces were noted. The authors concluded that Kids SIPsmartER is feasible in an under-resourced, rural school setting. The extent to which parents received, listened to and spoke with their children about the content of the calls was not assessed generalizability is limited.
Sohyun Park Elizabeth A. Lundeen Liping Pan Heidi M. Blanck	1402	Quantitative Research Impact of Knowledge of Health Conditions on Sugar-Sweetened Beverage Intake Varies Among U.S. Adults. To examine the associations between knowledge of sugar-sweetened beverage (SSB)-related health conditions and SSB intake among US adults, the authors analyzed 2014 cross-sectional SummerStyles survey data on 4163 US adults (≥18 years). Six logistic regression models were used to estimate adjusted odds ratios (ORs) for consuming SSBs ≥2 times/d. The results indicated that overall 37.8% of adults reported consuming SSBs ≥2 times/d. Although most adults identified that weight gain (80.2%), diabetes (73.6%), and cavities (71.8%) were related to drinking SSBs, fewer adults identified high cholesterol (24.1%), heart disease (31.5%), and hypertension (33.0%) as being related to drinking SSBs. Crude analyses indicated that lower SSB intake was significantly associated with knowledge of the associations between SSBs and weight gain, diabetes, cavities, and heart disease. However, after adjustment for covariates, only lack of knowledge of the association between heart disease and SSBs was significantly associated with consuming SSBs ≥2 times/d (OR = 1.29) than non-SSB consumers. Based on these results, the authors concluded that knowledge on SSB-related health conditions alone may not be sufficient for adult behavior change.
Amy Bleakley Amy Jordan Giridhar Mallya Michael Hennessy Jessica Taylor Piotrowski	1409	Quantitative Research Do you know what your kids are drinking? Evaluation of a Media Campaign to Reduce Consumption of Sugar-Sweetened Beverages This study analyzed rolling cross-sectional survey data, collected before and during the media campaign, with 1,367 parents with children to assess exposure to and effect of televised public service advertisements (PSAs) developed using a reasoned action approach to evaluate a city-wide media campaign that targeted reducing sugar-sweetened beverage (SSB) consumption as a strategy for addressing obesity. A Linear regression analysis showed that exposure to the televised PSA was significantly associated with intention to substitute non-sugary drinks for sugar-sweetened beverages for the parent (p = 0.04) and the child (p=0.02). The effect of exposure on intention to reduce child’s SSB consumption increased the longer the campaign was in the field. Exposure was also significantly associated with the belief that reducing SSB consumption decreases the risk of diabetes (p=0.04) and was significantly negatively related to the belief that reducing SSB consumption would make mealtimes less enjoyable (p=0.04). Based on these results, the authors concluded that their findings suggest that a theory-based mass media campaign can achieve positive changes in intention related to SSB consumption by changing relevant and salient underlying beliefs.
Victoria A. Zigmont Abigail B. Shoben Gail L. Kaye Richard J. Snow Steven K. Clinton Randall E. Harris Susan E. Olivo-Marston	1417	Quantitative Research An Evaluation of Reach for a Worksite Implementation of the National Diabetes Prevention Program Focusing on Diet and Exercise. In this study, the authors employed a cross-sectional study design to evaluate the “reach” component of the Reach Effectiveness Adoption Implementation Maintenance (RE-AIM) framework by comparing prediabetics who were and were not interested in enrolling in a free work site diabetes prevention program (DPP) during the first year of the program. Reach is defined as the proportion of eligible participants who enroll in a health program. The participants included 2158 prediabetic health plan enrollees and their spouses from a large health system in the Midwest. The study population was 63% female, 79% white, and 16% black, and the mean age was 50.2 years (standard deviation [SD] = 10.2). The reach of this program was 10%. Prediabetics were more likely to express interest in the DPP if they were female (adjusted odds ratio [AOR]:2.4; 95% confidence interval [95% CI]: 1.55-3.72; P < .001), black (AOR = 2.23; CI: 1.43-3.47; P < .001), older (AOR: 1.08; CI: 0.99-1.17; P = .05), or had a high-risk waist circumference (AOR = 1.44; CI: 0.98-2.13; P = .07), lower self-efficacy to make healthy changes (AOR = 0.48; C: 0.26-0.91; P = .03), and 5 or more doctor visits in the last year (AOR = 2.13; CI: 0.99-4.57; P = .05), after controlling for other covariates. Based on these results, the authors concluded that current recruitment and implementation strategies are reaching only a small group of individuals who are not representative of the larger prediabetic population. Public health practitioners should evaluate “reach” to ensure that health promotion programs are of high value.
Ravi Grivois-Shah Juan R. Gonzalez Shashank P. Khandekar Amy L. Howerter Patrick A. O'Connor Barbara A. Edwards	1425	Quantitative Research Impact of Healthy Vending Machine Options in a Large Community Health Organization. This study evaluated the impact of altering nutritious options to vending machines throughout the Banner Health organization by comparing vended item sales and nutrition information using data from vending machine purchases in 23 locations including corporate and patient-care centers. The intervention including changing vending machines composition toward more nutritious options. A paired t test was used to compare the 6-month period before implementation to 6-month postimplementation. The results indicated that significant average monthly decreases were seen for calories (16.7%, P = .002), fat (27.4%, P ≤ .0001), sodium (25.9%, P ≤ .0001), and sugar (11.8%, P = .045) vended from 2014 to 2015. The revenue and units vended did not change from 2014 to 2015 (P = .58 and P = .45, respectively). Based on these results, the authors concluded that increasing the proportions of healthier options in vending machines from 20% to 80% significantly lowered the amount of calories, sodium, fat, and sugar vended, while not reducing the utilization of the vending machines or having a negative financial impact.
Elizabeth A. Lundeen Sohyun Park Carrie Dooyema Heidi M. Blanck	1431	Quantitative Research Total sugar-sweetened beverage intake among U.S. adults lower when measured using a one-question versus four-question screener The study sought to determine the efficacy of a 1-item survey screening question versus a 4-item scale to assess total sugar-sweetened beverage (SSB). A web-based survey was employed to examine the frequency of SSB intake on both the 1- and the 4-question screener. The results revealed different findings, at times large, regarding the frequency of SSB intake employing the different measures. There was fair to weak agreement for the 3 SSB intake categories created and poor absolute agreement between the 2continuous measures. The authors conclude that researchers seeking SSB types consider that daily SSB intake is likely underestimated with a 1-question screening measure.
R. McManus D. Miller M. Mottola I. Giroux L. Donovan	1438	Quantitative Research Translating healthy living messages to postpartum women and their partners after gestational diabetes (GDM): body habitus, A1C, lifestyle habits and program engagement results from the FDD (Families Defeating Diabetes) randomized trial. This study designed a randomized controlled trial to evaluate a postpartum healthy living program for women with recent gestational diabetes mellitus (GDM) in tertiary centers in London, Calgary, and Victoria Canada. Participants included women with GDM and partners; 46% of eligible maternal participants agreed to participate. The interventional (INT) participants received a healthy living seminar at 3 months, access to a walking group/Website, and bimonthly e-mails; and the control (CON) participants received a contemporary postpartum diabetes prevention handout. The results indicated that the maternal participants were 170 (89 INT; 81 CON) with 63 partners (30 INT; 33 CON), and 103 (73 maternal; 30 partners) were lost to follow-up; 57% of maternal participants completed 12 months, 33% INT women (n = 50) lost ≥7% weight versus 25% CON women (n = 47), P = .43. Interventional participant results did not correlate with accession of study elements. Maternal completion was significantly associated with partner involvement, breastfeeding, higher income, and education. Paternal weights correlated significantly with maternal and offspring weights. The authors concluded that families defeating diabetes outcomes were not significantly different for INT maternal or paternal participants versus CON. Secondary outcomes of future value included statistically significant positive associations between paternal participation, socioeconomic indicators, and maternal study completion.
Applied Research Brief
Meghan K. Edwards Elizabeth A. Crush Paul D. Loprinzi	1447	Dietary Behavior and Predicted 10-Year Risk for a First Atherosclerotic Cardiovascular Disease Event Using the Pooled Cohort Risk Equations Among US Adults The purpose of the present study was to evaluate how predicted 10-year atherosclerotic cardiovascular disease (ASCVD) event risk varies as a function of daily dietary behavior. Participants included 2362 adults aged 40 to 79 years. The pooled cohort equations were developed in 2013 by the American College of Cardiology/American Heart Association Task Force to predict an individual’s 10-year risk for an ASCVD event. The primary predictors in this cross-sectional study are derived from the Healthy Eating Index calculated from self-reported dietary behavior. Findings suggest that adults in the United States consuming a healthy diet (vs those not consuming a healthy diet) had an 88% increased odds of being at low risk for a future ASCVD event within the next 10 years. A limitation of this brief report is the subjective assessment of dietary behavior, which may have some degree of recall bias. The findings of this brief report add to the literature as they are confirmatory and in support of other studies suggesting a protective effect of healthy eating on cardiovascular disease (CVD), which underscores the importance of clinicians promoting healthy eating to their patients who are free of CVD. The results have implications for health promotion practice and underscore the importance of clinicians promoting healthy eating to their patients who are free of CVD.
Critical Issues and Trends
David Katz Elizabeth P. Frates Jonathan P. Bonnet Sanjay K. Gupta Erkki Vartiainen Richard H. Carmona	1452	Lifestyle as medicine: The case for a True Health Initiative The power of lifestyle as medicine was perceived thousands of years ago. There is now compelling science to support the important influence of lifestyle on health. About 80% of chronic disease and premature deaths could be prevented by not smoking, being physically active, and adhering to a healthful dietary pattern. Cardiovascular disease, diabetes, stroke, dementia, and cancer are all influenced by lifestyle choices. Despite evidence about what behaviors promote health, confusion still prevails among the general population, especially with regard to diet. Confusing nutrition messages from scientists, the media, the food industry, and other sources have made it all but impossible for any single authority to convey persuasively the fundamentals of healthful eating. This article argues that a global coalition of diverse experts can help clarify and popularize an understanding of the fundamentals of a health-promoting, sustainable pattern of diet and lifestyle.
Jessica Grossmeier	TAHP-1459	Editor’s Desk: The Built Environment Issue: This issue identifies tools, resources, and case studies that can support professionals and community members seeking to influence policymakers, urban planners, and real estate developers to create spaces that foster health for all.
Andrea Nathan Karen Villanueva Julianna Rozek Melanie Davern Lucy Gunn Gina Trapp Claire Boulangé Hayley Christian	TAHP-1460	The Role of the Built Environment on Health Across the Life Course: A Call for CollaborACTION: This article summarizes the published research on the influence of the built environment on health across the lifespan and across settings, offering specific actions that can be taken to influence the design and development of health-promoting homes, neighborhoods, schools, workplaces, and communities.
Stephanie Timm Whitney Austin Gray Trey Curtis Susan Sung Eun Chung	TAHP-1468	Designing for Health: How the Physical Environment Plays a Role in Workplace Wellness: This article focuses on the influence of the work environment on employee health and well-being and provides an overview of healthy building certification tools and frameworks available to guide the development of a health-promoting physical work space. It also provides a case study to highlight how one organization implemented recommendations for a healthy work environment.
Dan McDonough	TAHP-1474	Kansas City’s Mill Creek Park: A Community Collaboration for Health: This case study shares how multiple stakeholders in Kansas City collaborated to transform a public park into a space intentionally designed to promote the health and well-being of residents, workers, community members, and visitors to this Kansas City landmark.