Native Hawaiians and Pacific Islanders (NHPI) suffer from disproportionate rates of obesity and other related chronic diseases. Pacific Islander Community Health (PIC Health) is a project in San Diego County that is actively investigating how to improve the health of NHPI, using a mixed methods Community Based Participatory Research (CBPR) approach. This project provided a culturally tailored nutrition curriculum for 12 weeks to participants of the PIC Health program, followed by investigating how this influenced their eating behaviors. After the analysis of the focus group, three main themes were determined to inform future work. These themes were: (1) Intervention Strategies for NHPI Health (2) Impact of Curriculum and (3) Cultural Relevance. The survey data revealed a significant difference from week 0 to week 12 for both fruit consumption per month and vegetable consumption per month (p

The childhood obesity epidemic and related health consequences are urgent public health problems. Approximately one-third of America's young people are overweight or obese. Health problems once seen overwhelmingly in adults, such as type 2 diabetes, cardiovascular disease, and hypertension, are increasingly appearing in youth. Though the health of Americans has improved in many broad areas for decades, increases in obesity could erode these and future improvements. The IOM report Accelerating Progress in Obesity Prevention: Solving the Weight of the Nation recognized the importance of the school environment in addressing the epidemic and recommended making schools a focal point for obesity prevention. The development and implementation of K-12 nutrition benchmarks, guides, or standards (for a discussion of these terms, see the next section of this chapter) would constitute a critical step in achieving this recommendation. National nutrition education curriculum standards could have a variety of benefits, including the following: Improving the consistency and effectiveness of nutrition education in schools; Preparing and training teachers and other education staff to help them provide effective nutrition education; Assisting colleges and universities in the development of courses in nutrition as part of teacher certification and in updating methods courses on how to integrate nutrition education in subject-matter areas in the classroom and in materials; and Establishing a framework for future collaborative efforts and partnerships to improve nutrition education. Nutrition Education in the K-12 Curriculum: The Role of National Standards is a summary of the workshop's presentations and discussions prepared from the workshop transcript and slides. This summary presents recommendations made by individual speakers.

Proper nutrition is a key component that can significantly improve children's overall health. Many elementary schools do not include adequate nutrition education in their curricula. This Doctor of Nursing Practice (DNP) project implemented a nutritional curriculum for fifth graders to develop foundational knowledge and gain experience in choosing essential nutrition options to promote healthy eating behaviors and improve well-being. Fourteen nutrition lessons focusing on nutrition core standards from the Utah Education Network were delivered to 93 5th-grade elementary school students. Lessons taught the importance of consuming fruits and vegetables, avoiding sugar-sweetened beverages, avoiding nutrient-poor energy-dense foods, and applying practical healthy eating strategies. Project assessment included student attendance and participation in each lesson, pre-and post-test questionnaires, weekly interactive quizzes, and comments gathered from students and educators. Lessons had a 94% attendance rate, with an average post-lesson completion rate of 97%. Pre- and post-assessment quiz mean scores improved by 27%. 89% of students liked the nutrition lessons and 91% answered they would improve their food choices because of the lessons. Students’ comments on what they learned included statements about choosing healthier food options, MyPlate, and Utah agriculture. A nutritional curriculum specific to elementary-aged school children leads to increased knowledge and gained experience in choosing essential nutrition to promote well-being and the prevention of diseases. A DNP-FNP is crucial at promoting health and wellness and can serve as a resource for nutrition education that may improve community health outcomes.

No single or simple solution can solve this obesity epidemic, but a possible way to help reverse the obesity epidemic is through the partnership between families and communities. The community can help parents learn to bridge the gap between school and home, the gap caused by the lack of education, economical status, and limited health care resources. The purpose of this graduate project was to help bridge this gap by developing a bilingual (English and Spanish) family and community-based program aimed at educating the entire family on healthy nutrition and physical activity. A second objective of this project was to develop a curriculum that contains detailed instructions for how to lead the structured lessons, thus allowing inexperience instructors to easily implement the program at various community locations and reach a larger population. The Healthy Families for Healthy Communities (HFHC) program was created in four phases: needs assessment; planning and development; implementation; and evaluation. The program's curriculum was designed to include nutrition education lesson plans, physical activity sessions, cooking demonstrations and self-monitoring resources to help change and sustain healthy behaviors. In addition, the lesson plans were written in dialogue to help guide the instructor during teaching process; therefore, enhanced the teaching and learning experienced. The program was implemented as a pilot study integrated into a six week structured program administered once a week that took place at multiple community locations within the West San Fernando Valley. The effectiveness of the program was not evaluated due to the small size of the sample; however, participant's knowledge and feedback was analyzed with the use of quantitative and qualitative date. In addition, the relevance and overall usefulness of the curriculum design was evaluated by a panel of experts using a formative evaluation. Feedback regarding the program was obtained and helped make improvements and modifications to the program and its curriculum. The program was well received among the participants and both participants and experts confirmed that they would recommend the implementation of the curriculum as means to educate families on topics related to healthy lifestyle behaviors. Further research is suggested to evaluate the overall effectiveness of the program and its tools on healthy behavioral changes.

References: 1. Ng M, Fleming T, Robinson M, et al.Global, regional, and national prevalence of overweight and obesity in children and adults during 1980-2013: A systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2014;384(9945):766-781. doi:10.1016/S0140-6736(14)60460-8. 2. Institute for Health Metrics and Evaluation. Overweight and Obesity Data Visualizations. https://vizhub.healthdata.org/obesity/. Published 2017. 3. Verstraeten R, Roberfroid D. Effectiveness of preventive school-based obesity interventions in low-and middle-income countries: a systematic review. Am J. 2012;96(10):415-438. doi:10.3945/ajcn.112.035378.INTRODUCTION. 4. Organization for Economic Co-Operation and Development (OECD). Obesity Update 2017. 2017:1-16. www.oecd.org/health/obesity-update.htm. 5. Hoelscher DM, Kirk S, Ritchie L, Cunningham-Sabo L. Position of the Academy of Nutrition and Dietetics: Interventions for the Prevention and Treatment of Pediatric Overweight and Obesity. J Acad Nutr Diet. 2013;113(10):1375-1394. doi:10.1016/j.jand.2013.08.004.

Abstract: The evaluation contains an overview of the national NET, description of Nebraska's NET curriculum and its evaluation and analysis, the instruments used, follow-up study on a sub-sample of children, and a special food consumption study. Nebraska was selected to provide Congress, OMB, federal oversight agencies, and advocacy groups with a comprehensive assessment of their Nutrition Education and Training (NET) Program's impact because sufficient implementation had occurred to evaluate the effects on students, teachers, and food service workers. Findings indicated that: teacher preparation usually took more time than expected; cooperation between teachers and food service personnel was not as good as anticipated; and the curriculum materials had mixed effects. Nutrition knowledge did increase for grades 1-3 and 4-6; food attitudes were not altered. Food preference for vegetables increased for students in grades 1-3; this was not so for grades 4-6. Food habits, plate waste, and the cost of the curriculum Experience Nutrition are discussed along with bias within the study. (kbc).

School-based health promotion interventions are one approach to reducing population health disparities, but few studies evaluate the implementation process to understand how it produced the outcomes. As part of a larger study to test efficacy, we conducted a qualitative process evaluation of the Yéego! Healthy Eating and Gardening Program, a school-based intervention which aims to promote fresh fruit and vegetable consumption among Navajo elementary school children. We collected data through lesson fidelity checklists completed by program intervention staff delivering the lessons and semi-structured interviews with program intervention staff and classroom teachers. We performed content analysis on the combined qualitative data set to identify themes. We identified several themes related to evidence of fidelity, practices that supported delivery, and lessons learned about delivery. Intervention staff followed similar procedures to prepare for and deliver lessons, but timing, teaching styles, and school-level factors shaped overall implementation fidelity. Teachers and students had positive perceptions of the program, especially lessons that were highly visual, experiential, and connected to Navajo culture and surrounding community. Participants discussed enhancing the curriculum’s usability, narrowing the scope, improving its responsiveness to student experiences, and achieving strong alignment with school curriculum standards. The program was implemented with moderately high fidelity across contexts, and we identified program areas where modifications could improve engagement, acceptability, efficacy, and sustainability of the program. The study contributes to an evidence base for school-based health interventions to promote healthy eating among Navajo children.