Factors such as parental/caregiver influences and socioeconomic status have been shown to impact food-related attitudes and behaviors. Consequently, these attitudes and behaviors affect health outcomes. The purpose of this study was to assess, using the Social Cognitive Theory (SCT), attitudes toward milk fat type and milk consumption among Texas WIC participants. Few studies, using this theoretical framework, have examined milk intake specifically among this population. Four hypotheses were proposed according to the theoretical model. The inclusionary criteria used for this study yielded a subset sample of 2,115; all cases included were Texas WIC participants. The results of this study show that caregivers' attitudes toward drinking and offering milk fat type are related. Caregivers' attitudes toward drinking milk fat type and the type of milk they drank were proven to be statistically significant. Similarly, caregivers' attitudes toward offering milk fat type and the milk fat type their children drank were proven to be significant. Caregivers' milk intakes were positively associated with children's milk intakes. It is evident that parental/caregiver modeling influences children's dietary habits. Parental/caregiver behaviors are important influences to consider when implementing nutrition education programs or intervention efforts, especially for participants of WIC. Improving caregivers' attitudes toward low-fat or fat-free milk intake can also contribute to healthier food-related choices.

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The rise of unhealthy beverage consumption, such as soft drinks, in children and youth for the last 25 years has increased the risk of low bone mass density by replacing milk (a major source of calcium intake), compromised dental health, and possibly contributed obesity. A school-based nutrition education intervention was developed to promote a change in this behavior. This study examined the effectiveness of this nutrition education program, called FUEL (Fluids Used Effectively in Living), in promoting healthy beverage consumption among high school students. The FUEL nutrition education manual consisted of six classroom sessions; it was delivered in four classes of grade nine students using different approaches, either multiple or single strategies. The nutrition intervention used multiple teaching methods which included six lessons delivered as visual, group interaction, tactile, individual, and auditory teaching styles. The multiple strategies approach was delivered through peer educators (led by a dietitian) in one class and dietitian-only in another class. In the single strategy approach, also called self-taught, two classes received only the handouts in the FUEL manual. This latter approach was considered the control to the nutrition intervention. The two classes that received either peer education or self-taught approach were in two high schools in Saskatoon. The two classes with either dietitian-taught or self-taught approaches were in a high school in Prince Albert. The beverage intake, knowledge, and attitude of students were assessed by a self-administered questionnaire before the intervention, a week after the intervention, and three months after the intervention. In Saskatoon only, a one year follow-up beverage intake assessment was performed. None of the schools in the FUEL study provided healthy beverage choices for the students. Generally, students in our study consumed an adequate amount of milk, but they drank sugary beverages daily. There was a tendency to replace milk and 100% fruit juices with sugary drinks. After the intervention, students in multiple teaching strategies decreased their sugary beverage intake significantly. The findings indicated that a school-based nutrition education with multiple teaching strategies may lead to positive knowledge, attitude and behavioural change which will have beneficial effect on long-term health.

The rise of unhealthy beverage consumption, such as soft drinks, in children and youth for the last 25 years has increased the risk of low bone mass density by replacing milk (a major source of calcium intake), compromised dental health, and possibly contributed obesity. A school-based nutrition education intervention was developed to promote a change in this behavior. This study examined the effectiveness of this nutrition education program, called FUEL (Fluids Used Effectively in Living), in promoting healthy beverage consumption among high school students. The FUEL nutrition education manual consisted of six classroom sessions; it was delivered in four classes of grade nine students using different approaches, either multiple or single strategies. The nutrition intervention used multiple teaching methods which included six lessons delivered as visual, group interaction, tactile, individual, and auditory teaching styles. The multiple strategies approach was delivered through peer educators (led by a dietitian) in one class and dietitian-only in another class. In the single strategy approach, also called self-taught, two classes received only the handouts in the FUEL manual. This latter approach was considered the control to the nutrition intervention. The two classes that received either peer education or self-taught approach were in two high schools in Saskatoon. The two classes with either dietitian-taught or self-taught approaches were in a high school in Prince Albert. The beverage intake, knowledge, and attitude of students were assessed by a self-administered questionnaire before the intervention, a week after the intervention, and three months after the intervention. In Saskatoon only, a one year follow-up beverage intake assessment was performed. None of the schools in the FUEL study provided healthy beverage choices for the students. Generally, students in our study consumed an adequate amount of milk, but they drank sugary beverages daily. There was a tendency to replace milk and 100% fruit juices with sugary drinks. After the intervention, students in multiple teaching strategies decreased their sugary beverage intake significantly. The findings indicated that a school-based nutrition education with multiple teaching strategies may lead to positive knowledge, attitude and behavioural change which will have beneficial effect on long-term health.

The relationship between milk intake and risk of osteoporotic fractures is uncertain. Associations between milk intake and milk avoidance in relation to osteoporotic hip fracture were examined in the Utah Study of Nutrition and Bone Health (USNBH), a statewide case-control study. Cases were ascertained at Utah hospitals treating 98 percent of hip fractures during 1997-2001 and included 1188 men and women aged 50-89 years. Age- and gender-matched controls were randomly selected from Utah driver's license and Medicare databases (N= 1324). In-person interviews were conducted and participants reported frequency of milk intake per week at age 18 and during pregnancy among women who reported being pregnant. Milk avoidance for a period of more than one year and duration of milk avoidance were also reported. Diet and supplement intake in the one-year period before fracture (cases) or the interview (controls) was assessed using a picture-sort food frequency questionnaire. Milk consumption frequency was categorized into four levels of intake at each life stage. Total calcium intake was categorized into quintiles of distribution of intake. Logistic regression models were used to examine associations between milk intake and milk avoidance and risk of hip fracture while controlling for the potential confounding effects of gender, age, body mass index, alcohol use, smoking, physical activity, estrogen use, and total calorie, protein, calcium, and vitamin D intake. Recent milk intake, milk intake during pregnancy, and milk avoidance duration were not associated with risk of hip fracture. A borderline association was found at age 18 showing a decreased risk of hip fracture among those in the highest quartile (2: 15 cups of milk per week) of milk intake (odds ratio (OR): 0.86, 95 percent confidence interval (Cl): 0.75, 1.00; P = 0.046). Milk avoidance for a year or more was associated with an increased risk of hip fracture compared to those who did not avoid milk (OR: 1.38, 95 percent CI: 1.07, 1.78). A significant interaction was found between milk avoidance and quintile of total calcium intake (P = 0.02). Milk avoidance was associated with a significantly higher risk of hip fracture at the lowest two quintiles of calcium intake (OR: 1.72, 95 percent CI: 1.26, 2.17; P = 0.02 and OR: 1.58, 95 percent CI: 1.01, 2.15; P = 0.01, respectively) but was not associated with elevated risk among those with higher calcium intakes. In conclusion, milk intake during pregnancy for women, and in the year before hip fracture (for cases) or before interview (for controls), was not associated with hip fracture risk. The highest level of milk intake at age 18 was associated with decreased risk of hip fracture. Avoidance of milk for one year or more was associated with hip fracture risk, but only among those with low calcium intake (Q1 and Q2).