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The purpose of this study was to determine the extent to which the selected school districts in the Commonwealth of Virginia were following the Virginia school mandates and fulfilling the requirements identified by NASPE and AHA, as critical elements required in a quality physical education program and the NASPE national recommendations. The population for this study was 116 physical education teachers in the Virginia counties of Carroll, Floyd, Giles, Pulaski, Roanoke, Wythe, and the City of Radford. The evaluation criteria used for the study was influenced by the 2006 Shape of the Nation Report. The instrument used was a web-based survey that consisted of 21 questions in the areas of demographics, time requirements, class size, standards and curriculum, student assessment and program accountability, and school accountability. The following conclusions were drawn: (1) The school districts followed the Virginia school mandates and overall are implementing the national recommendations; (2) The school districts varied in following the Virginia school mandates and implementing the national recommendations; (3) Even though the schools varied at different grade levels in the same school district, the degree of disparity was slight; (4) The originally introduced Senate Bill 1130 needs to be signed into law as opposed to the less stringent Senate Bill 1130 that was passed; (5) The Virginia school mandates need to include time requirements for daily physical education for all students K-12; (6) The school districts need to focus on promoting quality physical education programs at all grades and in all areas that were evaluated in the study. The following recommendations were suggested: (1) Further studies on schools that offer quality physical education programs and the affects these "quality" physical education programs have on reducing the percentage of overweight or obese children; (2) Studies of other school districts in the Commonwealth of Virginia and how they compare in following state mandates, and implementing the national recommendations; (3) School districts performing their own audits of their present physical education programs to determine the quality of their programs. / Ph. D.

Nearly one-third of children in the United States (U.S.) are classified as overweight or obese. Weight status in childhood and adolescence has been tied to adult obesity, which also affects more than one-third of adults in the U.S. Availability of foods and beverages can affect dietary habits, particularly in schools. Students spend most of their waking hours and consume almost half of their daily energy intake in schools. In July of 2014, competitive foods and beverages were required to meet the U.S. Department of Agriculture's Smart Snacks in School nutrition standards. Competitive foods and beverages are items sold outside of the National School Lunch Program and School Breakfast Program. Competitive foods include items offered à la carte, in vending machines, in school stores, and as fundraisers. The goals of this study were to: 1) examine the nutritional quality of competitive foods and beverages in vending machines and as à la carte available to students and 2) assess snack food and beverage intake by students before and after the implementation of the new standards in a sample of middle schools in rural Appalachian Virginia. Eight middle schools with higher than 50% of student eligibility for free or reduced priced lunches were included in the sample. Audits of food and beverage products sold in vending machines and à la carte were completed in the spring of 2014 and 2015. Food frequency questionnaires were completed by students in participating schools. Results showed improvements in school food offerings, though no schools were completely compliant with the new standards. The components of students' diets did not change significantly during the study period, suggesting that improved compliance may not be enough to create a dietary shift. Foods were often replaced with reformulated versions of the same products sold before the implementation of the standards. Incentives for schools to sell more nutrient-dense options such as fruits and vegetables may be helpful to create changes in student's diets. Schools may also require additional training and assistance to fully implement nutrition standards and reach full compliance. Further research is needed to understand barriers to and possible solutions for offering healthier foods and beverages to students in middle schools. / Ph. D.

Low-income and minority youth are disproportionately affected by low food access, low dietary quality, and high levels of obesity. The Expanded Food and Nutrition Education Program (EFNEP) is designed specifically to assist limited resource youth and adult audiences to acquire the knowledge, skills, attitudes, and changed behavior necessary for nutritionally sound diets, and to contribute to their personal development and improvement of the overall family diet and nutritional well-being by using a peer-education model (USDA, 2012). To date, little published research exists on dietary patterns and food access among youth who participated in EFNEP. The specific research goals of this study were to: 1) explore baseline dietary and physical activity self-efficacy and behaviors of youth EFNEP participants and compare to national trends, 2) examine differences in self-efficacy and behaviors based on socio-demographic factors and food availability, and 3) determine the association between food availability and dietary behavior. This study consisted of conducting surveys with 1,864 low-income youth, ages 7 to 14 years old, across Virginia prior to participation in an obesity-prevention program. The survey consisted of a 55-item written pre, post-test instrument that had been previously tested for validity and reliability. Most participants reported availability across all food groups, with the exception of meat and beans (41.4%) and dessert (48.3%). Significantly less than half of participants reported not meeting dietary behavior thresholds for the following food groups: grains (27.0%); whole grain (19.7%); low-fat milk (31.5%); vegetables (18.2%); colored vegetables (15.3%); and baked foods (31.7%). Availability of meats and beans and fruits were higher among Latinos than non-Latinos. Younger participants reported a higher consumption of sugar-sweetened beverages and screen time; however, the children had participated in physical activity. Participants who reported a higher availability of fruits and vegetables at home also participated in physical activities at least once a day. This study provided insight into the availability of food, as well as food consumption among low-income audiences across Virginia, based on youth EFNEP reporting. The results highlighted the importance of strategic interventions to improve the availability of nutritious foods and obesity prevention strategies to enhance self-efficacy and intake of nutritious foods among low-income youth. / Ph. D.

Background: Childhood obesity is a pressing public health concern; the prevalence of childhood obesity is 15.5% in Virginia. About 15% of Virginia's K-12 population participates in after-school programs (ASPs), identified as appropriate venues in which to promote healthy eating. In 2011, the National Afterschool Association (NAA) adopted the evidence-based Healthy Eating and Physical Activity Quality Standards (HEPAQS) to address snack quality and physical activity in ASPs. Although research has indicated promise in implementation of such policies in after-school programs, a need for assessment of effectiveness still exists. Are the quality standards being implemented effective in increasing positive nutritional habits among children in ASPs? In 2014, Danville Parks and Recreation (PandR), a key partner in the Dan River Partnership for a Healthy Community (DRPHC), adopted the HEPAQS policies to improve the nutrition and physical activity of attending students. Objective: The primary purpose of this study was to determine the effectiveness of the adopted HEPAQS Healthy Eating standards by comparing the quality of snacks served at the ASP sites before and after the HEPAQS policies were implemented. A secondary purpose of this study was to describe the quality of snacks among both policy-adoption and comparison sites. The tertiary purpose of this study was to compare the quality of program versus non-program snacks in the ASPs. Methods: To meet the objective, a natural experiment followed a pre-post evaluation design to determine the impact of adoption of the Healthy Eating standards at three policy-adoption ASPs. Applying an interrupted time series design, a total of 531 children's snack observations were performed across all sites during a five-week pre-policy adoption data collection period and 412 total snack observations were performed during a six-week post-policy data collection period. Direct observation methods including a modified quarter-waste method for dietary observations and the HAAND tool were conducted by trained research staff to collect snack quantity, type, brand, and amount consumed. Observational data was entered into statistical software for hypothesis testing. Data were also analyzed using Nutrition Data System for Research (NDSR) software to determine the mean servings, fluid ounces, or grams of each nutrient specified in the adopted Healthy Eating standards. Results: Adoption of the Healthy Eating standards among the three policy-adoption sites did not result in better snack quality based on adherence to the Healthy Eating standards. Policy-adoption sites were only meeting four of the nine adopted Healthy Eating standards post-policy, almost all of which were also being met pre-policy: serving foods without trans-fats, serving no sugar-sweetened beverages (SSBs), limiting fruit juice to one 8 oz. serving, and avoiding artificially sweetened beverages. By post-policy data collection, policy-adoption sites were not meeting five of the nine adopted standards: weekly serving a fruit or vegetable, offering water at all times, serving no candy or sugar-based snacks, emphasizing whole grains, and serving no snack chips. Although no significant changes were expected among comparison sites, they saw a significant increase in 100% fruit juice consumption and a decrease in grams of trans-fat from pre- to post-policy data collection. Across all five sites, program snacks were generally healthier than non-program snacks, as program snacks contained less SSBs, sweets, and snack chips. Conclusion: Adoption of the Healthy Eating standards among the three policy-adoption sites did not result in better snack quality. Pursuing additional HEPAQS regarding implementation, staff training, and social and program support may be necessary to impact snack quality. ASPs may improve non-program snack quality by addressing HEPAQS for vending machines and guidelines provided to parents regarding non-program snacks. The PandR partners of the Dan River Partnership for a Healthy Community should continue to seek support as they implement the Healthy Eating standards in their ASPs. / Master of Science

Yes / Allied Health Professionals (AHPs) have the capacity to promote healthy behaviours in young children through routine ‘contact points’, as well as structured weight management programmes. This scoping review aims to evaluate the impact of AHPs in the prevention of obesity in young children. Methods: Databases were searched for relevant evidence between 1st January 2000 and 17th January 2022. Eligibility criteria included primary evidence (including, but not limited to; randomised controlled trials, observational studies, service evaluations) evaluating the impact of AHPs on the primary and secondary prevention of obesity in young children (mean age under five years old). Results: AHP related interventions typically demonstrated improvements in outcomes such as nutritional behaviour (e.g., lower sweetened drink intake), with some reductions in screen time. However, changes in weight outcomes (e.g., Body Mass Index (BMI) z score, BMI) in response to an AHP intervention were inconsistent. There was insufficient data to determine moderating effects, however tentative evidence suggests that those with a lower socioeconomic status or living in an underprivileged area may be more likely to lose weight following an AHP intervention. There was no evidence identified evaluating how AHPs use routine ‘contact points’ in the prevention of obesity in young children. Conclusion: AHP interventions could be effective in optimising weight and nutritional outcomes in young children. However, more research is required to determine how routine AHP contact points, across the range of professional groups may be used in the prevention of obesity in young children.

Study One aimed to provide a current understanding of pupils’ attitudes towards people who are overweight and the prevalence and significance of weight-based unkindness in school. Methods: The study followed a mixed method, sequential qualitative and quantitative research design. Part One of the study used exploratory focus groups to ascertain that weight-based unkindness was a valid concern for children and young people, when compared against unkindness of other content. The focus group also ensured that the vignettes used in the survey (Part Two) were ecologically valid. Part Two included an existing measure of weight-stigma (attitude scale) and three sets of vignette-based questions to measure pupils’ perceptions of the frequency and severity of different incidents of unkindness. Part Two, was administered to 214 participants via a computerised survey. Results: The majority of pupils (61%) judged the overweight characters to be the least accepted. Participants also perceived significantly greater hurt, anger, embarrassment and humour to follow episodes of weight-based unkindness. Study Two aimed to better understand why, how and what is ‘different’ about pupils’ understanding of weight-based unkindness when compared to other types of unkindness. Methods: This study adopted an explorative approach to hear the lived experiences of six teachers and 29 children in two South West Primary Schools. Data was collected via semi-structured interviews, administered through focus groups (pupils) and paired interviews (teachers). Data was analysed using latent thematic analysis (Braun & Clarke, 2006). Results: The study found that pupils used the language of personal choice to attribute personal responsibility to overweight CYP, whilst teachers attributed this blame to their parents. Teachers espoused acceptance for the overweight whilst their behaviours implicitly reinforced the ‘thin-ideal’. Key findings are discussed from a theoretical perspective and their implication for supporting attitude change is highlighted.

Master of Science / Department of Human Nutrition / Koushik Adhikari / Obesity in adolescence is associated with a complex web of ecological, psychosocial, and physiological factors, and many of these factors relate to nutrition and physical activity behaviors. Before interventions are developed, researchers need to know what factors specifically influence an adolescent’s food choices and physical activity within the community context. Cultural norms, school environment, and neighborhood attributes are examples of factors that may vary across different communities, and accounting for this variation can be quite challenging, unless community perspectives are acknowledged. The use of qualitative data from focus groups has shown to be an effective way of gathering community perspectives about the diversity of their views and experiences. The current study used focus groups to reveal facilitators and barriers to healthy eating behavior and physical activity engagement in 6th to 8th grade youth in a low-income community in South-Western Kansas. This methodology enabled community members (adolescents, parents, and teachers) to discuss and articulate their perceptions in relation to 6th to 8th grade youth’s eating habits and physical activity, and assessed available resources, needs, and opportunities for developing effective and sustainable intervention approaches in the community. Using the socio-ecological model, individual influences (e.g., taste preferences), social influences (e.g., parent and peer influences), and larger contextual influences (e.g., school) on early adolescent health were assessed. This information will be used to develop interventions addressing factors at these different levels of influence that are needed to improve eating habits and physical activity of youth in the community.