CPH student helps connect neighborhood to fresh produce

A plant most people try to rid from their driveways and sidewalks, purslane, is the best-selling item at the new Pheasant Ridge produce stand. The plant is popular with the large Sudanese population living in the Pheasant Ridge apartment complex.

Julia Friberg (MPH ’16), a recent grad from the College of Public Health, conducted a need assessment last semester that helped Local Foods Connection “identify the needs and desires of the community,” said program Executive Director Cassidy Bell.

Read more in the Daily Iowan


Healthier Workforce Center for Excellence produces nutrition training video

healthierworkforcecenterlogoResearchers at the University of Iowa’s Healthier Workforce Center for Excellence (HWCE) have produced a new installment in a series of in-depth training videos focused on Total Worker Health®.

“Nutrition in the Workplace” features nutrition experts and employers discussing good food choices as well as programs, policies, practices, strategies, and interventions to promote healthy eating among employees.

According to Linda Snetselaar, professor of epidemiology and director of the UI’s Nutrition Center, nutrition is an often overlooked aspect of worker health that can also have a big impact on job performance.

“Employees who eat a healthy, well-balanced diet tend to be more productive, more attentive, and safer at work,” Snetselaar says. “The bottom line is that both the employee and the company benefit when a workplace offers healthy food options and emphasizes good nutrition and wellness.”

Other videos in the “In-Depth” series feature segments about ergonomics, transportations safety, and managing stress, along with tips and best practices from experts, employers, and business leaders around the Midwest.

HWCE has also produced a series of Total Worker Health® Essentials videos; 8 short segments where business industry leaders share their experiences with designing, implementing, and evaluating Total Worker Health® programs, practices, and policies. The series is designed to help small businesses utilize innovative techniques to incorporate programs, practices, and policies that can be tailored to their workplace.

To view Total Worker Health and other related videos, visit the Healthier Workforce Center for Excellence web site.

Giving kids a taste for healthy foods

CPH researchers are helping to unpack what works in a program that introduces kids to new foods.

Second-grade students are give cherry tomatoes and cheese cubes to taste-test.Most parents have been pestered for sugary cereal or fat-laden chips during a visit to the grocery store. But what about kids asking for red bell peppers? Or mango?

For many parents, such a request would be nothing short of miraculous. But an Iowa-grown nutrition education program that is now in its second decade has spurred many kids to ask for healthier foods.

Pick a better snack™ was developed by the Iowa Nutrition Network in the Iowa Department of Public Health. With a proven track record, it is becoming a model for other states. Since all states receive funds from the Supplemental Nutrition Assistance Program (SNAP) to provide nutrition education for low-income children, it makes sense to replicate the most effective programs.

When the USDA did a large scale evaluation of the Iowa Pick a better snack™ (PABS) program in 2013, the results were clear: The program works.

“What was less clear,” says Doris Montgomery, state coordinator for the Iowa Nutrition Network, “was why it worked.”

Montgomery enlisted the help of Natoshia Askelson, CPH assistant professor of community and behavioral health. Along with a team of graduate students and recent alumni, Askelson is working to unpack which aspects of the PABS program are effective. And that’s not as easy as it might sound.

The program has a lot of moving parts. Understanding which ones are vital to producing positive results will help Montgomery and her peers across the nation to know where to put their funds.

Nutrition Rock Stars

Nutrition educators who visit schools once a month are the hallmark of the program. In addition to in-class time, kids take home bingo cards that encourage them to try different foods and physical activity throughout the month. Children who complete a bingo receive prizes like hacky sacks and Frisbees. Parents receive a newsletter with cooking and shopping tips. The program also has signage in local grocery stores and advertising on billboards.

It’s that class time that the kids remember. Montgomery calls the nutrition educators “rock stars” and says that kids will try things for them that they won’t for their parents or regular teachers.

One of those stars is Judith Dittmar, who leads the program in the seven Council Bluffs elementary schools that are eligible. The curriculum is focused on younger grades, so each month Dittmar visits kindergarten through third-grade classrooms, bringing with her a healthy snack that features a different fruit or vegetable. Recent offerings have included jicama, cranberries, and cauliflower.

A student inspects a new food. Kids are encouraged to touch the food, smell it, and then – hopefully – taste it. The idea is that the more curiosity kids can bring to the experience, the more likely they are to take the final step and eat something new.

“We use positive peer pressure,” says Dittmar, noting that sometimes kids will be cheering for each other to try a food that’s either unfamiliar to them or believed to be “bad.” During her ten years in the position, she has watched a lot of kids overcome preconceived notions about different foods. Blueberries may not be such a hard sell, but spinach and asparagus are tougher.

There are eleven participating sites in the state. These are places where more than 60 percent of a school is eligible for free and reduced lunch. In each location, a school district or county extension office receives funding from the Iowa Nutrition Network School Grant Program to provide nutrition education to schools. Montgomery notes that many schools around the state that are not eligible find alternative funding to cover the program’s expenses and maintain participation because they find the program so valuable.

Pester Power

Iowa has an increasing poverty rate and low national ranking in consumption of fruits and vegetables, meaning kids often lack access to fresh food at home.  Which is where Askelson’s research comes into play. The success of PABS lies, she says, in “pester power” – that age-old talent kids have for getting what they want. In this case, it’s being used to ask for healthier food options.

“We want to be sure they are learning how to be better askers,” Askelson says. After the kids learn about a new food, it’s important that they have the skills to help make that food appear on the family dinner table.

Last summer, two College of Public Health graduate students called parents of children who had participated in the program. One of the interviewers, Julia Friberg, a second year Master of Public Health student from Rockford, Ill., explains, “The questions focused on how children ask for food, grocery shopping habits, and strategizing for food budgets.”

Friberg, whose own interests include community-based participatory research and health disparities, said the experience helped her to hone skills while also gaining a better idea of the current landscape of nutrition and food access issues.

Montgomery says that having an independent evaluator provides more credence to the results. She also appreciates that Askelson has added her own experience in health promotion and community-based initiatives to the table.

The results of Askelson’s research from last summer were used to revise the classroom lessons. Following this summer’s research, another round of revisions will be made with the aim of making PABS as effective as possible.

Maine has already adopted PABS, and Montgomery believes other states will follow suit. With child hunger an ever-growing problem – more than twice as many K-12 students are eligible for free and reduced lunch nationwide as compared to 1980 – finding programs that really help to connect children and families with healthy food is essential. PABS is just one small piece to a larger problem, but it provides kids with knowledge and a hunger for better foods.

This story originally appeared in the spring 2015 issue InSight magazine for alumni and friends of the UI College of Public Health.

Photos by Tom Langdon

Snetselaar addresses community, culture of food in Presidential Lecture

Portrait of Epidemiology Professor and Associate Provost Linda Snetselaar of the University of Iowa College of Public Health.
Linda Snetselaar

Linda Snetselaar, CPH professor of epidemiology, delivered the UI’s 32nd annual Presidential Lecture on Feb. 22. During her presentation, “Food, Culture and Community,” she highlighted several nutrition studies and emphasized that healthy eating is a community effort. “When we work with studies, and I’ve been doing this for many, many years, we often are focused on food, but know that when we’re working with food it’s very important to understand and know the culture that we’re working with,” she said.

Iowa Now
Watch a video and view photos of the lecture

UI presidential lecture to offer much food for thought

Healthy eating a community effort, UI lecturer says

The Daily Iowan
Lecture talks Food for Thought

Research helps Iowa families understand school lunch changes

Natoshia Askelson has conducted research on the HPV vaccine, teen pregnancy prevention, and other hot-button topics, but none elicited the response she received from a survey on the new school lunch program.

“I was very surprised to learn how strongly parents felt about school lunches,” says Askelson, who led the study to determine Iowa parents’ knowledge and perceptions of the Healthy Hunger-Free Kids Act of 2010. She cites one open-ended question that generated 270 pages of comments. “I didn’t expect that level of engagement,” she says.

The study, conducted by the College of Public Health and University of Iowa Public Policy Center for the Iowa Department of Education, used an online survey to gauge the opinions of parents of school-aged children regarding the federal school lunch guidelines that were implemented in August 2012. The landmark legislation marked the most extensive changes to school lunches in decades, such as requiring a greater variety of vegetables and substantially increasing whole grain foods.

The survey’s goal was to better understand the knowledge and attitudes surrounding the recent school meal changes, explains Askelson, an associate research scientist in the Public Policy Center and CPH alumna (PhD ’08).

Meal Misgivings

The researchers, which included College of Public Health students Elizabeth Golembiewski and Daniel Elchert, learned that not only is there misinformation about the new guidelinesfor example, some respondents erroneously thought First Lady Michelle Obama developed the rulesbut also that parents have their own ideas about which foods are nutritious. For instance, one mother was disappointed that her child was not receiving meat and potatoes at every meal. Others reported that their children said they were “starving” at school, given the smaller portion sizes under the new guidelines.

In total, 2,189 respondents took the online survey, which was distributed by schools via email, on school web sites, and as information sent home with students. The parents, representing 139 districts and 12 private/parochial schools across the state, answered a series of questions regarding the school lunch program at their oldest child’s school, given that school staff indicated younger children were less concerned about the changes. Just 8 percent reported their children participated in the free- or reduced-cost lunch program. The survey questions were developed based on previous research conducted with school administrators and staff, as well as information gathered from other states.

Askelson says she was surprised by how much parents and students talk about school lunches. According to the survey, 84 percent of parents were aware of the changes to the school lunch program and, of those, 75 percent said their child had talked to them about the changes.

Informing Families

In general, however, parents were uninformed about the basis of the changes, why the guidelines are important, and what it means for students’ health.

“There is a lot of education to be done,” Askelson says.

To help inform families and get them involved in their children’s school nutrition program, the research team used the survey findings to develop the School Meal Parent Campaign. The campaign, created in collaboration with CPH designer Patti O’Neill, includes nutrition information, newsletters, recipes, fact sheets, and other resources under the tagline, “It’s Not Just School Lunch. It’s Bigger Than That.”

Askelson says one of the goals is to have parents encourage their children to try new foods and make healthy choices, which carries over to eating at home. The Iowa Department of Education, which funded the research through a U.S. Department of Agriculture grant, worked with Askelson’s team to make the campaign resources available online.

The study concluded that while a majority of the parents surveyed are aware of changes to school meals and regularly communicate with their child about school lunches, opinions are mixed on whether the changes are effective in providing students what they want and need in terms of taste and nutrition.

“Parents overwhelmingly agree that the school lunch should be composed of fresh, nutritious food, yet do not believe this need is being met,” the report states.

In addition, while almost half of the parents agree that school lunches are “healthy,” a list of common concerns emerged on the survey, including smaller or inadequate portions and their impacts to student performance; off site and pre-packaged meal preparation; wasting of undesirable food; and poor food taste and quality.

Next Steps

One of the team’s next steps is to determine how school districts are implementing the policy, so those that are more successful can provide guidance for other districts, and those that are struggling can indicate where support is needed.

In-depth telephone interviews are being conducted with rural food service directors to better understand the unique challenges they face, such as time, space, and funding, Askelson adds. The study is being conducted in conjunction with CPH alumna Disa Cornish (MS ’05) at the University of Northern Iowa Center for Social and Behavioral Research, with funding from the UI Prevention Research Center for Rural Health.

Also, given that Iowa ranks near the bottom in the school breakfast program participation, the Iowa Department of Education would like to encourage high school and middle school students to eat breakfast at school.

“There’s a lot of national attention on adolescents and breakfast,” says Askelson. “Research is highlighting the importance of breakfast for teens related to health, school performance, and behavior issues.”

The most important message gleaned from the research, Askelson says, is that “parents care deeply about this” and want their children to have healthy meals served at school.

“We’d like to take some of that energy that we discovered and fuel it in a productive way,” she says.