Hypothesis: "By an environmental change in high school vending machines, making water available, students will choose water over the sugar sweetened sodas." This document highlights a case study analysis of vendor-provided refill data for forty-five beverage vending machines at two campus sites in one high school district in 2003 and 2004. The innovative study and publicized negotiated soda contract of a 50:50 (healthy to unhealthy) beverage ratio stipulation became the “Win-Win-WEAN” compromise, in which exposure to healthier beverage options for students might prove to provide the same income opportunity for the school district. An overview of the political climate in California leading to this local advocacy for reduced availability of sodas on school campuses, which began in 1999 before the passage of Senate Bill 19- Pupil Nutrition, Health Achievement Act of October 2001 (SB-19) is also addressed. The quagmire to generate and implement this unique pilot of a 5-year contract stipulating a 50:50 ratio, with strategic placement of qualified healthy beverages in the top slots of the 45 machines, is discussed to give context of the beverage industry practices. The ratio stipulation was intended to target one significant area of empty calories in students’ daily environments in attempt to help reverse the unprecedented obesity epidemic among adolescents. The agreement voted upon by the Santa Maria Joint Union School District’s Board of Trustees in a public meeting, as noted in the minutes of August 14, 2002, was not implemented as originally approved and thus a series of negotiation meetings began, prompting this data analysis. The 50:50 ratio, per SB-19, was not achieved during the performance life of the contract between the school district and the beverage vendor. School district administration fiscal year-end data in March 2005 confirmed that the hypothesis of a net profit sales quota of $60,000 was rejected, as there was a $7,300 shortfall. The data analyzed did determine that the highest selling, single beverage productwas un-flavored (plain) water with a 65% share. This information was contrary to the beverage vendor and school district business superintendents’ pre-conceived ideas that water in the machines would cause them to lose money. In reality water was the highest revenue generator beverage. The $60,000 minimum guaranteed annual commission, which was in actuality a sales quota projection, was still acknowledged as a contractual commitment by the vendor so no actual deficiency in fund payments was experienced by the school district. The profit margin for both water and other products was 40 cents per can. The data analysis showed that water was indeed the highest selling beverage regardless of equipment malfunction, restocking failures, and misrepresentation of drinks as healthy by vending machine placement and clever advertising with label changes for the same beverage. When water was included in the vending machines, students responded with immediate purchasing of water, demonstrating the 4th of five distinct stages of readiness for behavior change as “Action” following the principles of Drs’ Prochaska and Di Clemete’s Trans-Theoretical model. This model outlines different levels toward sustained behavior change and typical timelines of each relative stage of change. Keywords: beverage consumption, sodas, obesity, empty calories.

Iron deficiency anemia is the most common nutritional deficiency disease worldwide (Mahan & Escott-Stump, 2004). Iron deficiency anemia is of major concern especially in women of child bearing age and those who follow a vegetarian diet. The objective of this study was to compare the nutrient and hematological values related to iron status in female university students following a vegetarian versus following a nonvegetarian diet. This study took a cross sectional analysis of 39 female students at California Polytechnic State University (Cal Poly State University) in San Luis Obispo, CA. Of the participants 19 were following a vegetarian diet and 20 were following a nonvegetarian diet. To participate, individuals had to be female, current Cal Poly students, and between the ages of 18 and 22 years old. Those taking vitamin or mineral supplements, medications (including oral contraceptives), smokers, and pregnant women were excluded. Characteristic, demographic, and anthropometric data were collected through interview, nutrient intake was accessed by averaging three day food records, and hematological parameters were measured. Statistical analysis used nonparametric techniques including the Mann-Whitney Wilcoxon statistical test for demographics and baseline characteristics, the Spearman Rank Correlation analysis and Fisher’s Exact statistical test for associations between vegetarians and nonvegetarians. Results found no significant difference in iron intake between vegetarians and nonvegetarians, however nonvegetarians had higher mean intakes of iron at 16.82 (SD 6.36) mg/day compared to vegetarians at 14.84 (SD 7.10) mg/day (p=0.482). A similar percentage of vegetarians at 66.7% (n=8) compared to nonvegetarians at 65% (n=13) were under the Recommended Daily Allowance (18 mg per day for females 19 to 30 years of age) for mean iron consumption. There were slightly more nonvegetarians at 10% (n=2) compared to vegetarians at 8.3% (n=1) under the Estimated Average Requirement (8.1 mg/day for females 19 to 30 years of age) for mean iron intake. No significant difference was found for serum iron, serum ferritin, transferrin saturation, and total iron binding capacity between vegetarians and nonvegetarians. Finding revealed serum ferritin, the most common iron status indicator, was lower for vegetarians at 23.16 (SD15.54) ng/mL compared to nonvegetarians at 27.75 (SD 18.01) ng/mL (p=0.47). When looking at the stages of iron balance, there was greater percentage of vegetarians with hematological results (serum iron <40 µg/dL, total iron binging capacity of >410 µg/dL, transferrin saturation <15%, and serum ferritin <10 ng/mL) indicating iron deficiency anemia or stage IV negative iron balance compared to nonvegetarians. There was no significant correlation between iron intake and serum ferritin, however results showed a positive association (r=0.28, p=0.09). In conclusion, vegetarian participants are believed to be at higher risk of developing negative iron balance compared to nonvegetarians due to lower iron consumption and lower serum ferritin concentrations. Female university students following a vegetarian diet should be educated on iron deficiency anemia and prevention of iron depletion.

The purpose of this study was to identify specific nutrients or nutritional biomarkers of dietary intake that are associated with stunting among children ages 2 and older in sub-Saharan Africa. This is a systematic review conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Twelve studies from sub-Saharan Africa met the eligibility criteria, including 11 observational studies and one randomized control trial. Nine of the 12 studies assessed dietary intake of macronutrients. Four studies found a significant association between proteins and stunting. Four found that children with stunting had lower dietary fat intakes or lower blood or serum levels of certain fatty acids. Five assessed dietary intake of micronutrients or looked at serum levels micronutrients. Children with stunting had lower intakes or biomarkers for, calcium, phosphorous, vitamin D, vitamin B12, and choline. Children with stunting tend to consume diets lower in nutrients of high-quality protein foods like essential amino acids, essential fatty acids, and micronutrients such as calcium, phosphorous, vitamin D, vitamin B12, and choline.

A goal of schools is to provide students with practical nutritional information that will foster healthy lifelong behaviors. Unfortunately, students at one school were found to have difficulty grasping basic nutritional information and practical health-related skills. There remains an important gap in current literature regarding strategies to improve students' understanding of nutrition education material. The purpose of this study was to investigate the benefits of a 4-week nutrition intervention unit in the Foods I classes consisting of 82 male and female students in Grades 9-12. Constructivist teaching methods were implemented to provide students with both information and valuable skills, which might positively impact student health and student learning. A pre-experimental quantitative design was used for this study. The repeated-measures t test was used to compute differences in pre- and post-tests scores on the nutrition test, which indicated a 6.207 mean increase in student posttest scores. The 82 students also completed a Likert style survey, which indicated both a positive student result in perceiving a better understanding of nutrition knowledge, and a positive change in dietary choices due to constructivist teaching strategies used in the intervention. These results revealed the benefits of the nutrition intervention unit by the significant increase in students' nutrition knowledge and students' implementation of that knowledge in daily living. The results make an important contribution to the existing literature and can enhance social change initiatives through increasing students' knowledge of nutrition, providing them with life-based skills, and enhancing their quality of life.

In the past 30 years, binge eating and obesity has increased among all age groups due to lifestyle, environment, social, and biological reasons. To change eating habits, individuals may have to collaborate with others beyond the medical professional. Societal impacts of binge eating and obesity include increases in insurance rates, medical costs, and increased early-age mortality. The purposes of this study were to assess how individuals are referred to other professionals if they self-identify as binge eaters or obese and to understand personal awareness individuals had of binge eating and obesity. Cognitive behavioral theory was used as the theoretical foundation. A quantitative, non experimental design was used with a nonrandom convenience sampling of residents in a northern US state aged 18 years and older. 166 participants completed a demographic questionnaire and the Eating Attitudes Test (EAT-26). Chi square analyses indicated a significant relationship between individuals who were obese and the lack of referral to another professional beyond the primary care physician. Individuals over identified with binge eating based on elevated EAT-26 scores, and under identified with obesity based on identifying with lower BMI categories than those set by the American Medical Association. Implications for positive social change include an increased awareness of binge eating and obesity, which can result in reduced medical costs and healthier lifestyles. Prevention and intervention programs can be developed to educate children, parents, and communities about lifestyle choices.

Lack of fruit and vegetable (FV) consumption is directly linked to the prevalence of obesity and chronic disease in the United States. The USDA Fresh Fruit and Vegetable Program (FFVP) offers elementary school teachers access to healthy foods as part of the public school classroom experience. The purpose of this study---which was based on self-efficacy theory and the socio-ecological model---was to examine if an association exists between selected factors: (a) daily fruit and vegetable consumption, training status in the USDA Fresh Fruit and Vegetable Program (FFVP), and an established school nutrition policy and (b) nutrition-teaching self-efficacy (NTSE) among elementary school teachers who participated in the FFVP. Using an online survey, 66 teachers out of 114 (58% response rate) completed a 26-question survey adapted from the Nutrition-Teaching Self-Efficacy Scale and the National Cancer Institute's Food Attitude and Behavior Survey. Based on the results of the chi-square test of association (p = 0.031), an association between daily FV intake and NTSE among teachers involved in the USDA FFVP was confirmed. The odds of having high NTSE are 3.45 higher in those who consume more than 3 cups of combined FV each day (p = 0.029). There were no significant associations between NTSE and FFVP training and established school nutrition policy. The social change implication of this study is that healthier, confident teachers build healthier school environments and create the impetus for increasing FV consumption in the community at large, thereby helping to reduce the risk of obesity and chronic diseases.

While caffeine withdrawal has been well-characterized, research on caffeine intake and factors associated with withdrawal has been limited. The present study examined prevalence rates of caffeine use and identified psychosocial factors associated with having caffeine withdrawal headaches (CWH). Participants were N = 1,989 college freshmen who participated in the 2011 Spit for Science project. Caffeine use was reported by 80% of the sample. Females were more likely than males to consume caffeine, and soda was the primary source of caffeine for both genders. As hypothesized, daily caffeine users were more likely to report CWH than non-daily users. When multivariable analyses examined other variables identified through univariable analyses, the most parsimonious model for distinguishing between those with and without CWH included the following set of predictor variables: daily caffeine use; female; non-white minority; peers with alcohol problems; greater neuroticism, and those reporting maternal depression or anxiety.

Purpose of this study was to compare two methods of supplementing diets in order to provide additional protein and calories to increase body weight. The study consisted of two groups from the James H. Quillen Veterans Affair Medical Center Nursing Home Care Unit. Experimental group received foods fortified with increased calories and protein at mealtimes. Control group received nutrition supplements between meals. Fifteen subjects began the study. Analysis of weight change revealed that those in the experimental group had no weight change over the four months. Subjects in the control group gained an average of 4.8 lbs of body weight in the same period. The Mann-Whitney Test was used to determine if the weight changes were significantly different between groups. Analysis indicated that (p-value = 0.2550) there was no significant difference in body weight gain between the groups. A larger sample size would have improved the outcome of the study.

The purpose of this study was to determine the needs and relationships of high-risk community members in Cocke County Tennessee to food sources. Cocke County was chosen as the representative county in this pilot study due its high percentage of residents living at or below the poverty level, which can lead to hunger and food insecurities. A community food assessment was conducted among residents participating in a commodities disbursement program in Cocke County. Two hundred seven individuals participated in this survey. The results of the surveys were posted and analyzed using an online statistical analysis software program. With the needs of the Cocke County community identified, steps will be taken to implement a plan of action and the results from this study will also be used as a model to identify needs in both Greene and Hancock counties as well as other counties in the Northeast Tennessee region.

The purpose of this study was to determine if there was a significant difference in weight loss, body fat, waist circumference, or diet quality among participants taking calcium or placebo supplements in a lifestyle intervention program. Three participants ages 52-55 completed the 14 week program. Two participants took 1,000 milligrams calcium while one participant took a placebo. Changes in diet were analyzed by Nutribase IV and self perception. Anthropometrics were analyzed by analysis of variance, alpha level 0.05. There was significant decrease in weight and waist circumference for the calcium group and decrease in bioelectrical impedance for the placebo group; however, due to small sampling size, results are inconclusive. There was no significant difference between groups in skinfold, diet, or quality of life.