Childhood obesity has tripled over the past three decades and poses a serious public health problem. The Smarter Lunchrooms Movement aims to increase healthy eating by incorporating low-cost to no-cost alterations to the school lunchroom in an effort to increase consumption of healthier foods, such as fruits and vegetables, by making them more attractive and convenient. Our study implemented Smarter Lunchrooms interventions at two primarily Hispanic elementary schools in Paso Robles, CA. The interventions focused on increasing the appeal of the salad bars, including installation of age-appropriate signage highlighting fruits and vegetables, as well as branding of fruits and vegetables with fun age-appropriate characters. Fruits were also placed into decorative bowls to increase their attractiveness. To determine whether these changes had an influence on fruit and vegetable choice and consumption, we tracked student’s choice and intake prior to and following the intervention. Consumption was analyzed using a visual tray waste measurement to determine how much fruit, vegetable, and entrée the students ate during lunch. Following the intervention, the proportion of children who selected fruits and vegetables increased at one school, but not at the other. Of the children that selected fruits and/or vegetables, the proportion eating the entire fruit or vegetable increased at both schools, while the proportion of students who did not eat any of their vegetables decreased at one school. There were few significant differences by grade level (1-3 and 4-5). If easy-to-implement strategies such as Smarter Lunchrooms interventions are effective mitigators of obesity risk, larger scale efforts across populations may help stem the ever-increasing impact of obesity. Therefore, future research should identify targeted methods by which to approach younger vs. older children among diverse socio-demographic and geographic groups.

The epidemic of adolescent obesity has become one of the greatest public health concerns in the United States. Approximately 20.5% of adolescents of both sexes aged 12-19 years are considered obese. Higher rates of obesity are evident in ethnic minority and lower income status children with the highest prevalence among Hispanic/Latino and Black populations. The causes for obesity are multifactorial in nature and highlight disparities nationwide. These factors include socioeconomic status, education, environment, availability and access to fresh fruits and vegetables, and behavior patterns. Successful intervention methods that have reduced the impact of adolescent obesity have incorporated nutrition knowledge and culinary skill building into afterschool programs. Pink and Dude Chefs, a 12-lesson nutrition education and culinary skills afterschool program targeted toward middle school students, aims to improve nutrition knowledge and dietary behavior in low income and minority populations. Based off of evidence-based curriculum, the program focuses on culinary fundamentals while incorporating nutrition lessons about macronutrients, micronutrients, label reading, kitchen safety, and USDA guidelines. Research assistants from California Polytechnic State University, San Luis Obispo and Vanderbilt University in Tennessee, were trained to implement each lesson. The program took place at Mesa Middle School in Arroyo Grande, CA; Shandon, CA; and two sites in Nashville, TN from Spring 2014 to Fall 2014. Thirty-two middle school students participated in the study aged 11-14 years. Questionnaires were used to measure fruit and vegetables preferences, nutrition knowledge, and fruit and vegetable intake. Results indicate that participants’ fruit and vegetable preferences, nutrition knowledge and fruit and vegetable intake all increased. However, statistical significance was only achieved with nutrition knowledge, likely due to small sample size. If programs such as Pink and Dude Chefs show promise for decreasing risk for obesity, the public health impact could improve long-term health outcomes for adolescents and mitigate obesity related consequences.

In the U.S., obesity has hit alarming rates and affects Hispanic children disproportionately. Acculturation, the shift from one culture’s values, beliefs and practices to those of a new culture, may have both negative and positive health effects on immigrants. The objectives of this study were to determine the association between the level of acculturation (low acculturation or high acculturation) of low-income Latina mothers and the foods consumed by their children (0 to 36 months old). The association between acculturation and maternal perceptions of infant and toddler body size, maternal perceptions of her own body size and maternal parenting stress were also investigated. This was accomplished in 3 stages. First, data was collected cross-sectionally from 68 participants of WIC. Mothers answered many questionnaires including Food Frequency Questionnaires for their children, body size perception scale questionnaires and a parenting stress test. General linear regression models were performed to investigate an association between acculturation and food frequency, maternal perceptions of body size and parenting stress. Each model controlled for child’s age, maternal age, BMI (m/kg2) and education level. Second, key informant interviews were conducted with nine public health professionals to help gain a better understanding of some of our findings and to develop questions for the third stage: focus groups. Third, a total of 32 mothers participated in focus groups to discuss their perceptions on acculturation and child-feeding habits, and children’s body size. In addition, three mothers completed one-on-one interviews. From the cross-sectional analysis of the first study stage, the level of acculturation did not have a significant effect on any of the factors measured. For all mothers, however an increase in child’s age was associated with an increase in both the amount of healthy foods and less healthy foods consumed; an increase in mother’s BMI was associated with an increase in the children’s consumption of less healthy foods (beta coefficient of -0.042; p = 0.035). An increase in child’s age was associated with an increased likelihood of a mother to correctly estimate her own body size (beta coefficient of 0.041; p = 0.043). An increase in maternal BMI was associated with an increased likelihood to underestimate her own weight as well as that of her child. During the second stage, a theme emerged from the focus groups that the mothers try to feed the children the way they were fed growing up but they encounter difficulties when they can’t find the same ingredients and when their children start to prefer American foods. For all groups health was the number one factor they considered when choosing what to feed their children. The low acculturated mothers stated they wanted more education on how to assess if their child is at a healthy weight and admitted to not thinking about weight very much. In both groups, the mothers reported getting information about their child’s weight from health care professionals but many mothers from the bi acculturated group mentioned not believing the doctor when they told them their child was overweight. Overall, the findings suggest that children’s diets are not different by mother’s acculturation level and that the children start to prefer American foods from a young age. Parental education for several areas were identified: 1) for mothers to learn how to continue with the healthful aspects of a traditional diet 2) teach parents about appropriate stages of growth for their children; 3) when trying to teach about food focus on other areas of health rather than weight since weight does not seem to resonate as a concern.

Increasing rates of overweight, obesity, and related metabolic diseases documented among refugee communities across the United States necessitate greater attention to how processes of integration impact refugee health. These nutritional health trends (e.g., increasing rates of obesity) suggest potential disconnects between refugees' past environments and their conditions after re-settlement, which may contribute to adverse changes in energy balance (diet and exercise). While Bhutanese refugees were among the largest refugee groups entering the US during the five years leading up to this research, very few studies have examined how they have responded to integration and the impact of this transition on their health. Grounded in human adaptability and political economic theories, and adopting a biocultural approach, this dissertation investigates how Bhutanese refugees in “Prospect City” (pseudonym) negotiate changing and unfamiliar structural and sociocultural conditions after resettlement and the consequences for energy balance and nutritional status. The results reveal high rates of overweight and obesity compared to US averages. Age and caste related differences in nutritional status were also found. High rates of overweight and obesity corresponded with an energy imbalance due to over consumption of energy dense traditional foods and limited understanding of the importance of regular exercise. Over consumption of energy dense traditional foods stemmed from several interrelated factors: the abundance of foods in the US, prior experiences with food deprivation, a history of political exile that reinforced desires to preserve cultural food preferences, and joint family efforts to accommodate work-related time constraints by increasing food production and availability. Decreases in exercise appeared to stem from more sedentary lifestyles in the US as a result of work environments and available transportation, coupled with a lack of health knowledge regarding health benefits of physical activity. This dissertation’s findings are being reported to Prospect City’s Bhutanese Community Organization to help develop strategies for improving nutritional health in the community.

Rates of adult obesity in the United States continue to rise, especially among the college-age population who typically practice poor dietary choices, contributing to weight gain. College-age students experience a transitional phase called ‘emerging adulthood’ where they learn autonomy in many areas that influence long-term health status. The purpose of the online health promotion program BUCS: Live Well was to promote self-efficacy in ability to incorporate positive dietary changes, assess incidences of positive dietary habits after completing the program, and determine if weight status, residence, and health perceptions influence dietary behaviors. BUCS: Live Well was successful in assessing current dietary intake, facilitating positive dietary changes, and improving self-efficacy about incorporating positive dietary changes, although it did not promote weight loss. Online health promotion programs for college students are effective in initiating lifestyle modification and need to be available in hopes of reducing the obesity rate in this population.

Nutrition labeling research suggests consumers want nutrition information on the label; however, many do not comprehend it. The purpose of Phase I was to determine the effect of: 1. two levels of nutrition label formats; 2. three levels of nutrition information load on consumers' preference for product choice using adaptive conjoint analysis. A computer interactive interview was conducted on 252 consumers in Crossroads Mall, Salt Lake City, Utah. label alternatives were printed on soup cans to realistically portray the information. The conjoint analysis compared the attributes, nutrition information format, and nutrition information load in addition to brand and price and determined how the study participants ranked choices within each of these attributes and against the other attributes. There were significant differences (p < .000) among all three mean utility values± Standard Error of the Mean (SEM) of information load, most (.300 ± .03) , more (.154 ± .02), and some (-.231 ± .03). There was no difference between graphical (.093 ± .027) and traditional (.055 ± .020) formats (p = .298). For the other attributes, there were significant differences (p < .000) among all brands, Campbell's (.590 ± .03), Private label (-.007 ± .02) Generic (-.361 ± .03) and all prices, (p < .000), low (.431 ± .03), medium (.022 ± .02), and high (-.230 ± .03). Market simulations were performed and market share was shifted from the major brand when nutrition information was added to a Private label or Generic brand. The purpose of Phase II was to determine the effect of: 1. three levels of nutrition information content load; 2. two levels of nutrition information order; 3. three levels of nutrition information format; and 4. four levels of nutrition information expression on consumers' perceptions of label usefulness in purchase decisions. The methodology was the same as Phase I. There were significant differences (p < .000) among all three mean utility values ± SEM of information load, most (.327 ± .02), more (.091 ± .02) , and some (-.213 ± .03), and between the two mean utility values ± SEM of information order, rearranged (.157 ± .03) and traditional (-.02 ± .02). Consumers significantly preferred (p < .000) the graphical format (.148 ± .02) over the graphical nutrient density (.038 ± .02) and traditional (.018 ± .03) formats. Consumers significantly preferred (p < .000) nutrition information stated in absolute numbers and percentages (.296 ± .03), versus absolute numbers only (.028 ± .03), traditional (-.026 ± .03), and percentages only (-.025 ± .03) expressions. The most useful nutrition label in a purchase decision was one that contained the most information, in a rearranged order, with a graphical format, and an absolute number and percentages expression.

Achieving and maintaining maximal peak bone mass is critical to the prevention of osteoporosis. Adequate calcium intake during youth is a major aspect of proper bone mass development. Because of the importance of calcium, a food frequency questionnaire (FFQ) that estimates calcium intake of 10- to 18-year-old Asian, Hispanic, and white youth living in the western United States was developed. This new FFQ was shown to accurately and reliably estimate calcium intake of these youth. Accuracy among Hispanics, however, was low and requires further evaluation. A second study examined intake of calcium, milk, and non-milk beverages of Hispanic and non-Hispanic white children aged 10 to 11 years and 15 to 18 years living in Utah. Milk fat percentage and source of beverage procurement were considered. Studies assessing the intake of calcium, calcium-rich foods, and foods that may interfere with calcium intake of youth in the United States were reviewed.

The purpose of this study was to describe the nutrition knowledge and child care feeding practices of Early Childhood Education students in a university setting. Thirty-three Early Childhood Education students from seven geographically diverse universities completed a web-based survey assessing nutrition knowledge and child feeding practices. A nutrition knowledge instrument was developed and validated to measure knowledge of nutrition for preschool-aged children. The Comprehensive Feeding Practices Questionnaire, which has been previously validated in parents, was slightly modified and used to assess child feeding practices. Mean scores for the nutrition knowledge and child feeding practices were determined. Multivariate analyses were conducted to determine differences in mean nutrition knowledge and feeding practices scores across sample characteristics. Early Childhood Education students were found to have more knowledge of MyPyramid food groups and dietary sources of nutrients than dietary intake recommendations for preschool-aged children. Students who had completed a college-level nutrition course scored higher on MyPyramid food groups and food sources of nutrients than those who had not, although these differences were not statistically significant. A nonsignificant trend was observed in knowledge of dietary recommendations according to practicum status. Additionally, students who had not started a practicum reported using food as a reward significantly more than students who had completed a practicum. Results suggest roles for both nutrition coursework and practicum training in optimizing nutrition knowledge and child feeding practices among future leaders in early childhood education. Further research is needed to more clearly identify nutrition knowledge and child feeding practices in this population.

This study examines models of community gardens and urban farms and determined a successful hybrid model for future implementation at the Huerta del Valle Community Garden. This was accomplished through analyzing the unique benefits and drawbacks of community gardens and urban farms as defined by the author, and then determining the components of each model that would maximize Huerta del Valle’s social and economic potential. Community gardens are defined in this thesis as places where community members can grow their own food in individual plots, and these spaces often contribute to community building, hands-on gardening education, and improved food access. Urban farms are defined as business models that produce food to sell to the community both to support the business and to improve community food access. Through research of existing community garden, urban farm, and hybrid models, the author determined that the most effective hybrid model includes intensive crop production, crop sales onsite as well as in farmers’ markets and delivery methods, a large community garden, and education programs for the community. The author then offered Huerta del Valle a potential model that includes these components as well as a store front, cooking lessons, value-added products, a Community Supported Agriculture program, and specific themed gardening classes. This complete model will potentially increase Huerta del Valle’s scope so it is able to improve healthy food access throughout Ontario while creating an enduring economic model.

The Village Market is a nonprofit Healthy Corner Store that has been open since May of 2011 in the mixed-use, mixed-income New Columbia housing development in Portland, Oregon's Portsmouth neighborhood. The venture began as a "community-led" effort in partnership with Janus Youth Programs and Home Forward. The project was conceived after a private enterprise in the small grocery space designed into the development failed, leaving the neighborhood without easy access to healthy foods. This dissertation is a case study of the development process, the operation of the market, and the degree to which it addresses food justice and health equity concerns, among others, of residents. It is a case study of the Healthy Corner Store movement that uses food regime theory and political economy perspectives to critically examine the translation of Healthy Corner Store movement theory into practice, highlighting the perspectives of New Columbia residents on the endeavor. It explores the transition of the store from a community-led project to a management-led social enterprise, and the impacts of that approach on local autonomy, food justice, health equity as well as its successes and shortcomings. The store's situation in a mixed-income community meant that it had a particularly diverse set of expectations to navigate, and the changes to the store over time reflect Village Market's growing understanding of the implications of that situation but also a limited capacity to accommodate residents' differing tastes and the price sensitivity that many of them exhibit in their shopping habits.