In this four-week, family-focused pilot intervention study, researchers studied the impact of culturally relevant nutrition and activity sessions on eleven children from eight Native Hawaiian and Pacific Islander (NHPI) families. Mixed methods were used in analysis. In their favorite meal drawings, children included more fruits and vegetables at week four than week one, which was consistent with their self-reported intake of healthy foods that were new to them. From week one to four, mean total scores increased on the nutrition and exercise knowledge exercise questionnaire and the physical activity self-efficacy tool; however, the mean total score decreased on healthy diet self-efficacy tool, and two children moved to less healthy BMI categories. This is the first study on the impact of a family intervention on nutrition and healthy activity for NHPI children. Further studies are needed with larger samples and longer duration to determine the most helpful intervention for NHPI families.

Approximately one-third of children in the United States are overweight or obese with increased risks for numerous physical and psychosocial comorbidities. Schools are ideal environments to address this serious health crisis and school nurses are uniquely positioned qualified healthcare providers to actively participate in childhood obesity prevention (COP). A review of the literature provided findings to identify a gap in the knowledge regarding the association between school nurse COP perceptions and practices. A modified theoretical framework based on Bandura’s health promotion by social cognitive theory guided this study. The purpose of this study was to identify the key perceptions (self-efficacy, perceived benefits and perceived barriers) influencing school nurse participation in COP practices and determine associations between school nurse characteristics and COP perceptions and practices. Preliminary research was conducted to determine content validity for modified perception scales, clarity of instructions and questions, data collection and retrieval procedures, and refinement of recruitment strategies. Adequate reliability and validity was determined for modified scales measuring school nurse self-efficacy, perceived benefits, perceived barriers, and COP practices targeting individual children (child-level) and the entire school population (school-level). Florida RN school nurses (n = 171) completed self-administered anonymous questionnaires from an emailed weblink or a paper version offered at two Florida Association of School Nurses conferences. School nurses with characteristics reflecting more education engaged in more COP practices (p < .05) than those without education-related characteristics. School nurses with > 8 hours of COP education reported higher COP self-efficacy than those with none (p < .01). Linear regressions showed that a model comprised of self-efficacy, perceived benefits, and perceived barriers significantly explained 12.0% of the variance in child-level practices (p < iv .001) and 9.1% of school-level practices (p < .001). Self-efficacy explained the most variance of school nurse child-level and school-level practices (p < .001), and perceived barriers were inversely associated with child-level practices (p < .05). Four series of regressions showed that only perceived barriers partially mediated the influence of self-efficacy on child-level practices. Data analyses indicated self-efficacy and perceived barriers were key determinants of school nurse COP practices. Therefore, policy changes and educational interventions to increase selfefficacy and reduce perceived barriers may be effective in mobilizing school nurses to actively engage in COP practices

The prevalence rate of childhood obesity has increased rapidly worldwide. The childhood obesity epidemic is associated with many adverse health consequences in children as well as a financial burden for a nation’s economy. A meta-analysis was conducted to investigate the effectiveness of school-based childhood obesity prevention programs in preventing childhood obesity. The objectives of this study were to 1) identify the most effective childhood obesity prevention programs through effect size comparison, and 2) identify important program components that affect the effectiveness of the intervention through subgroup analysis. The Comprehensive Meta-Analysis (CMA) program was used for all statistical analyses. Results of the meta-analysis demonstrated that the summary effect size was small (d = 0.039, 95% confidence interval). The school-based program identified in the meta-analysis as the most effective had a d value of 0.368. Subgroup analyses were performed because this meta-analysis study was heterogeneous (Q = 167.774, p = 0.001) with an I2 value of 68.410%. The subgroup moderators were length of program duration, age of participants, nutrition, physical activity, parental involvement, specialist involvement, and theory based versus non-theory based intervention programs. Subgroup analyses demonstrated that significant differences (p < 0.05) occurred among the moderator components. Programs that targeted younger children less than ten years old and programs that were theory based were more effective. The meta-analysis study contained publication bias because the funnel plot was skewed and smaller studies were missing. To further explore the publication bias problem, Classic fail-safe N and Duval and Tweedie’s trim and fill analyses were performed. Classic fail-safe N indicated that two programs were missing from the present study to achieve a non-biased result. The Duval and Tweedie’s trim and fill analysis demonstrated that a small mean effect size difference was detected between the present observed studies and the unbiased effect size. The small mean effect size difference indicated that the results and the reported effect sizes in this meta-analysis study were valid.

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Background: School districts across the country have adopted breakfast in the classroom (BIC) initiatives as a means of increasing participation in the School Breakfast Program (SBP). Little is known regarding the impact of such programs on children’s weight status. This study sought to evaluate the impact of a BIC initiative on the combined incidence of overweight/obesity among urban school aged children. Design: Cluster-randomized controlled trial with matched school pairs. Intervention schools received the “One Healthy Breakfast” program included BIC, nutrition-education, social marketing, corner store marketing, and parent outreach, while control schools continued to serve breakfast in the cafeteria Baseline data were collected in October-December, 2013, with midpoint and endpoint data collected in May-June 2015 and May-June 2016 respectively. Schools were matched based on school size, food service type, and racial/ethnic composition. Setting/Participants: 1371 4th-6th grade studen / Epidemiology

This dissertation is comprised of three essays that investigate consumer behavior and health outcomes. The first essay uses experimental economic techniques to explore consumers' preferences and willingness to pay (WTP) for nutritionally differentiated grass-fed beef. Our findings suggest that consumers' nutrition knowledge about the functions of Vitamin A, Vitamin E, CLA, and Omega 3 could positively affect their WTP for grass-fed beef while the knowledge about the main food sources of these nutrients negatively affects their WTP for grass-fed beef. Furthermore, a higher sensory evaluation score of grass-fed beef compared to conventional beef will lead to a higher probability for a consumer to choose grass-fed beef and a higher monetary value she/he is willing to pay for grass-fed beef. Using the same experimental data collected in the first study, the second essay investigates the impacts of consumers' nutrition knowledge on their WTP by accommodating the potential endogeneity problem using an instrumental variable approach and a non-instrumental variable approach. Our results suggest the existence of the endogeneity of nutrition knowledge and indicate that ignoring the endogeneity problem in econometric modeling will downwardly bias the estimates of the true effects of nutrition knowledge. The estimates obtained from different estimation strategies in the study indicate the robustness of our findings about the effects of nutrition knowledge on consumers' food purchasing behavior. The third essay investigates the impacts of primary care giver (PCG)'s time allocation patterns and household food expenditure choices on childhood obesity using the national panel study of income dynamics data. Our results do not suggest significant impacts of PCG's labor force participation, involvement in children's outdoor activity, and household food expenditures on children's Body Mass Index (BMI). However, the estimates from iterated seemingly unrelated regression (SUR) and semi-parametric polynomial estimation indicate that parents' BMI significantly influence children's BMI. Interestingly, physical activity appears to have weak correlation with children's BMI. / Ph. D.

According to recent estimates, approximately 423,773 children in the United States are in foster care (US Department of Health and Human Services, 2011). While research has documented that childhood obesity is high in foster children, the relationship between nutrition, physical activity, weight status of foster children and the foster home environment is unclear. Furthermore, there is a gap in the literature on the capacity of the child welfare system to address obesity among this population nor practical intervention strategies. This dissertation consists of three studies, with the following purposes: 1) assess the current foster care landscape related to the promotion of healthy eating and physical activity through questionnaire based and objective data; 2) examine legislature and training programs that focus on nutrition and physical activity as it relates to foster families; and 3) utilize the Delphi method to begin the development of a potential healthy eating and physical activity intervention for foster care through the recommendation of intervention strategies that could be integrated into the foster care system. These purposes are achieved utilizing a systems-based approach. More specifically, research was conducted through collaboration with several local agencies throughout Virginia. The findings from Study 1 suggest that obesity is prevalent among foster children and foster parents in Virginia and that there are some indications that the foster home environment is related to lifestyle behaviors and weight status, though the relationships were small. Study 2 identified face-to-face trainings targeting foster parents and children (depending on the child's age) as an important and practical method to intervene through regular trainings. Study 3 indicated that there are few federal or local policies that explicitly address physical activity, nutrition, and weight status. A number of recommendations are made for the structure, content, and process of integrating obesity prevention and treatment strategies within the foster care system. / Ph. D.