Field Goods (R) is a subscription-based, weekly delivery service of fresh produce that operates year-round. To determine the impact of program subscription on diet quality, new customers were asked to complete a survey that included a fruit and vegetable semi-quantitative food frequency questionnaire at baseline and again at 3-5 months after their first purchase. Grocery shopping habits, satisfaction with their own diet and their family's diet were also assessed. Findings revealed a significant increase in satisfaction with program subscribers' diet quality and their family's diet quality (P < 0.001) at follow-up. Subscribers who ordered bags weekly (n = 105) reported consuming five more servings of vegetables per week compared to baseline (P = 0.05) and saving approximately $20 per month. A weekly subscription to a fresh produce delivery program may be an effective intervention to improve vegetable intake and variety in adults without adding undue costs to participants.

BACKGROUND:The shortage of supervised practice sites in dietetics is associated with fewer numbers of preceptors available to supervise interns, especially in the clinical setting.OBJECTIVE:To identify clinical dietitians' perceived benefits and challenges of training dietetic interns and to determine key motivators that would entice nonpreceptors to volunteer for the role.DESIGN:Registered dietitian nutritionists working in clinical settings completed a semi-structured, audiotaped interview followed by a brief questionnaire.PARTICIPANTS:Clinical dietitians working in hospitals, long-term care facilities, and outpatient clinics (n=100) participated: 54 preceptors and 46 nonpreceptors.STATISTICAL ANALYSIS:Qualitative analysis was conducted using an iterative process to identify and code common themes. T tests were used to compare mean differences between the opinions of preceptors and nonpreceptors.RESULTS:Preceptors had approximately 5 more years of experience (mean=14.27±12.09 years) than nonpreceptors (mean=8.83±9.72 years) (P< 0.01). Furthermore, preceptors reported twice as many benefits to mentoring interns (mean=6.7 mentions/participant) as nonpreceptors (mean=3.4 mentions/participant), including knowledge gains and staying current. Lack of time was consistently noted as a barrier in interviews and rated as the greatest barrier in the survey. Both groups rated receiving continuing professional education units (CPEUs) for precepting as the greatest potential motivator for taking on interns.CONCLUSIONS:Incentive programs should be developed to entice nonpreceptors to take on interns. These programs should include extensive training on the preceptor role and how to alleviate the burden of time spent supervising interns and should provide a significant number of CPEUs to make the added workload worthwhile.

In small departments, lack of resources especially faculty time, is a primary hindrance to providing students with individualized research experiences. Nevertheless, familiarity with research ensures that nutrition and dietetic graduates will be capable of applying evidence-based guidelines in their practice. Five years after the inception of our research-focused Master's in Nutrition, only two students were able to complete their research thesis requirement resulting in an abysmal graduation rate of less than 5%. A thesis course was therefore developed that allowed each student to practice and experience every facet of the investigative process without overtly taxing the single faculty available for supervision. The year-long course shepherds students from the beginning of a research project to its end with step-by-step mentoring during scheduled group meetings. Students work individually to develop each piece of the research project (e.g., survey, data collection) then they meet as a group to finalize the piece. The course culminates in a research manuscript and poster, with the poster presentation and defense taking place during the graduate symposium. The research course substantially improved the outcomes of the master's program. Since its introduction in 2009, a total of 53 students completed the program with a 93% graduation rate. All graduates who responded to the alumni survey indicated being comfortable conducting research and half stated that they have since participated in research activities as students or as practitioners. The year-long research course is testimony that with commitment, some creativity and a great deal of tenacity, small departments can find the means to help immerse their students in practical research activities.

Attendees will list three benefits of a regular subscription to a fresh produce program.

Nutrition and dietetics program directors were surveyed to quantify the amount of time they spend meeting accreditation-related requirements, and to determine the type of compensation they receive for their director workload. The survey was sent electronically in August 2011 to all nutrition and dietetics directors (N=572). A total of 312 usable surveys were received for a 54.5% response rate. The distribution of respondents almost mirrored the general distribution of nutrition and dietetics programs: 138 (44%) from Dietetic Internship (DI) programs, 122 (39%) from Didactic Programs in Dietetics (DPD), 29 (9%) from Coordinated Programs (CP) and 23 (7%) from Dietetic Technician (DT) programs. The majority of respondents (83%) were faculty based at a college or university, of whom, 49% had annual teaching loads between 18 and 24 credits. The average number of hours spent on director-type activities was approximately 22 hours/week with 15.6 of these hours dedicated to meeting accreditation specific requirements. Of the 248 directors who responded to the compensation questions, the majority (n=198, 80%) reported receiving some form of time relief or compensation for their responsibilities as program directors, commonly a 3-credit or 6-credit annual load reduction. On the other hand, 55 directors (22%) received no time relief or compensation for any of their work as program directors. Overall, the reported compensation did not match the level of effort stated by directors. Future evaluations should examine the possible association between the amount of time program directors spend on accreditation-related activities and the quality of their programs, and whether these accreditation activities are affecting the quality of the work for the directors’ other job responsibilities.

Years of observations of nutrition counselors conducting open discussions with clients reveal that asking effective open-ended questions is a limiting factor during these exchanges. 1 Nestor B. McKenzie J. Hasan N. et al. Client satisfaction with the nutrition education component of the California WIC program. J Nutr Educ. 2001; 33: 83-94 Abstract Full Text PDF PubMed Google Scholar , 2 AbuSabha R. Client-Centered Nutrition Education Intervention Fit WIC Final USDA Report. Evaluation and Analysis Unit, Division of Nutrition, NYS Department of Health, Latham, NY2010 Google Scholar Educators and counselors are aware of the nature of open-ended questions, which usually begin with who, what, when, where, why, and how. They avoid simple, limited “yes” or “no” responses and are often used to initiate conversation. By providing the opportunity to reflect and engage in conversation, such questions elicit opinions and rich descriptions of experiences. Open-ended questions are often used by psychotherapists to encourage patients to share relevant information. 3 Yalom I.D. Leszcz M. The Theory and Practice of Group Psychotherapy. 5th ed. Basic Books, New York, NY2005 Google Scholar Use of effective open-ended questions is the cornerstone of motivational interviewing technique, which uses discussion to help guide clients to overcome ambivalence and move toward behavior change. 4 Rollnick S. Miller W.R. Butler C.C. Motivational Interviewing in Health Care: Helping Patients Change Behavior. The Guilford Press, New York, NY2008 Google Scholar Motivational interviewing and open discussion techniques are increasingly being used by nutrition educators and registered dietitians to effect behavior change in their clients. 5 Constance A. Sauter C. Inspiring and Supporting Behavior Change: A Food and Nutrition Professional's Counseling Guide. American Dietetic Association, Chicago, IL2011 Google Scholar , 6 Mahan K. Escott-Stump S. Raymond J.L. Krause's Food & Nutrition Care Process. 13th ed. Saunders, Elsevier, Philadelphia, PA2011 Google Scholar , 7 Flattum C. Friend S. Story M. Neumark-Sztainer D. Evaluation of an individualized counseling approach as part of a multicomponent school-based program to prevent weight-related problems among adolescent girls. J Am Diet Assoc. 2011; 111: 1218-1223 Abstract Full Text Full Text PDF PubMed Scopus (18) Google Scholar , 8 Spahn J.M. Reeves R.S. Keim K.S. et al. State of the evidence regarding behavior change theories and strategies in nutrition counseling to facilitate health and food behavior change. J Am Diet Assoc. 2010; 110: 879-891 Abstract Full Text Full Text PDF PubMed Scopus (222) Google Scholar In outpatient settings, facilitating support groups with open discussion to manage conditions, such as overweight and diabetes, is common, 9 Nonas C.A. Foster G.D. Managing Obesity A Clinical Guide. 2nd ed. The Academy of Nutrition and Dietetics, Chicago, IL2009 Google Scholar , 10 Livhits M. Mercado C. Yermilov I. et al. Is social support associated with greater weight loss after bariatric surgery?. Obes Rev. 2011; 12: 142-148 Crossref PubMed Scopus (120) Google Scholar , 11 Ramadas A. Quek K.F. Chan C.K. Oldenburg B. Web-based interventions for the management of type 2 diabetes mellitus: A systematic review of recent evidence. Int J Med Inform. 2011; 80: 389-405 Crossref PubMed Scopus (131) Google Scholar whereas in inpatient and community settings, more targeted participant-centered interviewing techniques are often recommended. 6 Mahan K. Escott-Stump S. Raymond J.L. Krause's Food & Nutrition Care Process. 13th ed. Saunders, Elsevier, Philadelphia, PA2011 Google Scholar , 12 Sigman-Grant M. Facilitated Dialogue Basics: A Self-Study Guide for Nutrition Educators. http://www.unce.unr.edu/publications/files/hn/2004/sp0421.pdf Google Scholar , 13 Smith R.C. Dwamena F.C. Grover M. et al. Behaviorally defined patient-centered communication—A narrative review of the literature. J Gen Intern Med. 2011; 26: 185-191 Crossref PubMed Scopus (47) Google Scholar The success of these approaches to counseling is largely dependent on using the correct type of open-ended questions. •Example of a poor question: “What foods that you normally eat are high in calcium?” •Example of a better question: “How do you make sure that you are getting enough calcium in your diet?”

High cost and limited access to food have been associated with lower intake of fruits and vegetables in limited-income individuals. The Veggie Mobile is a van that carries fresh produce and travels in low-income neighborhoods, selling fruits and vegetables at a fraction of regular supermarket prices. The purpose of this study was to determine whether participation in the Veggie Mobile increases fruit and vegetable intake in a group of seniors. The intervention, buying fruits and vegetables from the Veggie Mobile, was implemented between April and October 2008 in two senior housing sites that had not previously received Veggie Mobile services. Participants were asked about fruit and vegetable intake using a modified six-item questionnaire based on the Behavioral Risk Factor Surveillance System at preintervention and again at 3 to 5 months. The post-survey also included questions about perceived benefits and barriers to using the Veggie Mobile. The two cross-sections of seniors were matched using date of birth. Wilcoxon signed rank test and paired samples t tests examined change in pre- and post-intervention variables. Seventy-nine older adults completed the baseline survey and 63 completed the post-survey. Of these, 43 participants completed both surveys (70% white [n=30], mean age 69 ± 9 years). Mean intake of fruits and vegetables after using the Veggie Mobile increased by 0.37 servings/day. Vegetable intake alone increased from 1.98 ± 1.71 servings/day to 2.58 ± 1.4 servings/day (P=0.027), half of which was potatoes. Change in fruit intake was not significant (P=0.358). At post-intervention, seniors visited the supermarket less often (P=0.001) and spent an average of $14.92 less during their last visit. The majority of participants who completed the post-survey (62 of 63) indicated being satisfied with the program. The Veggie Mobile provides an example of a simple community intervention that has potential to lead to positive behavior change among low-income seniors.

The Commodity Supplemental Food Program (CSFP) provides supplemental food for pregnant and postpartum women, children under age 6, and seniors 60 years and older. This is the first formal evaluation of CSFP and examines whether participation in the program helps alleviate food insecurity among low-income seniors. A questionnaire was administered to seniors who live in housing that receives CSFP services and those living in housing that does not receive CSFP services. A total of 193 seniors completed the survey: 144 in CSFP sites and 49 in non-CSFP sites. The majority of respondents had no (n = 87; 45.1%) or little (n =49; 25.4%) food insecurity, whereas a small number (n = 18; 9.3%) indicated severe food insecurity. Seniors at CSFP sites had the same food security level as did seniors at non-CSFP sites. CSFP may substitute for other programs in helping seniors cope with food insecurity.

Meeting participants will list three factors that may lead to picky eating in childhood.

The objective of this study is to describe overweight trends in a large, multiethnic, low-income population of preschool children by race/ethnicity and examine cohort changes in body mass index (BMI) distribution. Cross-sectional data were collected January 1 through March 31, every year, from 1989 to 2003. Subjects were children aged 2 to 4 years participating in the Special Supplemental Nutrition Program for Women, Infants, and Children in New York State. The prevalence of overweight (BMI ≥95th age- and sex-specific percentile of the 2000 Centers for Disease Control and Prevention growth charts) was calculated for each year. Least squares regression compared trends in prevalence by race/ethnicity. Changes in BMI distribution were assessed graphically. Overweight prevalence increased 33% (12% to 16%). Prevalence was highest for Hispanics and lowest for non-Hispanic whites. Rates of increase (0.28 percentage points per year) were the same for Hispanic, non-Hispanic black, and non-Hispanic white children. The BMI distribution shifted toward higher values for all children studied; for 3- and 4-year-old children, the difference increased as BMI increased, indicating that, in 2003, the heaviest children were considerably heavier than the heaviest children were in 1989.

Objectives To identify barriers that deter parents/caretakers of infants and children enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) from taking full advantage of the services provided by the program.Subjects/Setting A total of 3,167 parents/caretakers at 51 New York State WIC local agency sites completed a barriers survey.Design Sixty-eight potential barriers to WIC were identified through a literature review, five focus groups with parents/caretakers of WIC participants, and an expert review panel. The barriers survey was administered per, son-to-person to parents/caretakers of infants and children on WIC.Statistical Analysis Classification tree analysis was used to identify characteristics that best predict WIC check usage behavior.Results A small set of barriers (n = 11) were identified by more than 20% of respondents. Waiting too long was the most frequently cited barrier (48%). Difficulties in bringing the infant/child to recertify and rescheduling appointments were key variables associated with failure to use (ie, pick up or cash) WIC checks. Further analyses indicated that (a) for each additional reported barrier, there was a 2% increase in failure to use WIC checks (P<.0001); (b) waiting for services was related to an increase in the number of people who failed to use checks; and (c) the longer the reported wait, the greater the number of reported barriers (P<.0001).Conclusions Conducting this barriers research enabled the New York State WIC to improve services provided to participants and their families. A decrease in waiting times should generally reduce exposure to noisy, crowded facilities and lead to fewer reports of nothing for kids to do.

The purpose of this study was to examine consumers’ knowledge and understanding of the 1995 Dietary Guidelines for Americans and the sources from where consumers obtain their health information. A telephone survey was administered to 400 adults in the Twin Cities area in Minnesota. The number of guideline recommendations recalled per person was, on average, less than 2.5 of a total of 13 recommendations. Participants had difficulties interpreting the guidelines. Knowledge of the dietary fat guideline was especially poor. Only 17% of survey participants correctly stated the amount of total fat they should have in their diet. The total number of media sources used to obtain health information was the variable that best explained the variance in knowledge of the Dietary Guidelines recommendations. To effectively change dietary behavior, health educators must work effectively with the media to develop behavior-focused nutrition messages that are meaningful and clear to consumers.

Past evaluation research has documented improved nutritional outcomes resulting from participation in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC). However, these evaluations have not examined the program from the clients' perspective, nor have they examined the independent effect of the nutrition education component. The purpose of this study was to quantitatively and qualitatively examine client satisfaction with the nutrition education component of the California WIC program. The methodology consisted of two phases. During phase I of the study (the quantitative component), participants completed Client Satisfaction Surveys immediately following attendance of one nutrition class. During phase II (the qualitative component), four focus groups were conducted. All subjects were participants in the California WIC program. Client Satisfaction Surveys were completed by 2138 participants, and the focus groups included 29 participants. Results from both phases of the study indicated that client satisfaction with the nutrition education component of the California WIC program was high. Between 80% and 95% of participants responded positively to five satisfaction questions, and focus group participants unanimously agreed that the nutrition education was an essential component of the program. Hispanic participants were more likely than non-Hispanic Caucasians, Asians, or African Americans to respond positively to three of the five satisfaction questions. For two of the questions, the frequency of positive responses increased as age increased and decreased as education level increased. A small segment of clients reported some dissatisfaction by responding negatively to one or more of the satisfaction questions (4% to 20% of respondents). Some suggestions for improvement were made by survey respondents. Identification of some WIC participants who are not completely satisfied with the nutrition education that they have received, paired with differences in satisfaction across demographic variables, suggests the need for a personalized approach to WIC nutrition education.

Objective To investigate the fat-reduction strategies used by a group of older adults who successfully made and maintained positive dietary changes for 5 years or longer.Design Participants completed 2 copies of a self-administered food frequency questionnaire: The first copy assessed diet before they began making changes and the second copy assessed diet after initiation of healthful dietary changes. Positive food changes were identified from the food frequency questionnaires. During in-person interviews, participants placed food changes onto a time line according to the nearest estimated date of initiation of the change.Subjects Participants were 65 free-living older adults (aged > 50 years) who had maintained substantial changes to decrease fat intake in their diet for at, least 5 years.Statistical analyses performed Quantitative and qualitative data were used to identify the fat-reduction strategies acid to confirm and validate the fat-reduction strategy model. Confirmatory factor analysis was performed to confirm the new model. The Kuder-Richardson-20 reliability coefficient (kr) was used to determine internal consistency of the scales developed for the study.Results The majority of participants decreased their fat intake gradually, at different time points in their lives, and over a long period of tune (5 to 43 years). Mean percent energy intake from fat decreased from 44.3 +/- 5.9% before dietary improvement to 25.9 +/- 7.1% at the time of the study. The final model consisted of 5 fat-reduction strategies with 63 food changes. The strategies were: increase summer fruits (4 items; kr=0.66), increase vegetables and grains (14 items; kr=0.79), decrease recreational foods (14 items; kr=0.76), decrease cooking fat (20 items; kr=0.86), and use fat-modified foods (11 items; kr=0.80).Applications/conclusions Dietetics professionals should base their advice on the dietary strategies used by consumers rather than hypothetical premises such as food or nutrient groupings. Nutrition education interventions will have better chances for success if they are based on a set of customized programs that guide appropriate consumer segments through a series of small, comfortable. and sustainable dietary changes over a prolonged period of time.

The Dietary Guidelines for Americans represent the cornerstone of the US federal nutrition policy and aim to provide sound, current advice to the public about food choices that promote optimal health. The fifth edition of the guidelines and its corresponding bulletin, Nutrition and Your Health: Dietary Guidelines for Americans( (1) Nutrition and your Health. US Depts of Agriculture and Health and Human Services, Washington, DC2000 Google Scholar ) were released at the National Nutrition Summit on May 30, 2000. In this new edition, the guidelines reflect the most radical changes to date. The purpose of this commentary is to briefly examine the complexities associated with the content of the Dietary Guidelines bulletin, highlight the primary changes in the fifth edition of the guidelines, and emphasize those facets of the guidelines that may continue to present challenges for practitioners who use them as the basis for nutrition interventions.

Dietary change is an inherently complex process. Although dietary fat reduction is an important issue in nutrition education, factors facilitating this type of change have not been fully examined. By accumulating information from individuals who have already been successful in initiating and maintaining dietary fat reduction, practical means of assisting others can be learned. This study collected information from 155 participants between the ages of 30 and 55. Participants were included if they reported the initiation of sustained dietary fat reduction strategies beginning at least 5 years prior to recruitment. Data used to examine individual patterns of dietary fat reduction were collected via in-depth, semistructured, retrospective interviews. Qualitative analyses identified 134 factors that played a role in facilitating the adoption of multiple fat reduction strategies. The factors identified were further classified into two categories: unplanned and planned. Unplanned factors were defined as life events or occurrences that are not nor should they be intentionally included in one's life as a means of dietary improvement (e.g., market influence, health issues, disease diagnosis). Planned factors were defined as occurrences often intentionally included in one's life to facilitate dietary change (e.g., going on a weight loss diet, acquiring an appliance, making a resolution).They frequently resulted from mediation by an unplanned factor.These factors can be used to help nutrition educators identify specific times conducive to initiating dietary change, as well as techniques for facilitating dietary fat reduction.

Food frequency questionnaires (FFQs) are widely used to estimate usual intake. A questionnaire without portion sizes may facilitate data collection. We examined the nutrient agreement between three days of food recall (FR) and FFQ in older women when portion information is used or ignored. When mean values were compared to FR, there was no consistent bias when using or ignoring FFQ portions. The correlation between either FFQ calculation and FR was significant for most nutrients, and 53% of the subjects were perfectly classified into categories of dietary intake. Thus, based on the data omitting FFQ portions results in overall small differences in the data obtained when portions are used.

This study examined how altering text and graphics of a nutrition brochure could affect the ability to remember the content of the message. Two theoretical models were used to guide alterations: dual-coding theory and the communications model. Three brochure formats were tested: the original brochure containing abstract text and abstract graphics, a modified brochure with relatively concrete text and abstract graphics, and a relatively concrete text brochure with concrete graphics. Participants (N = 239 women) were divided into four age groups: 20-30, 40-50, 60-70 and over 70 years. Women were randomly assigned into each of the three experimental brochure formats or a control group. Participants completed recalled materials from the assigned brochures (the no treatment control group did not include a brochure) at two different sessions, 30 days apart. Data were content analyzed and results were compared using analysis of covariance to test differences by age and brochure types. Younger women (20-30 and 40-50 years) recalled more information than women over 60 years. More concrete nutrition education print materials enhanced recall of information presented immediately after reading the material; however, this effect was transient and lasted less than 30 days after a one-time reading. The implications of these data for communicating nutrition messages with print materials are discussed.