MCH Nutrition Trainee Hub

ASU TRANSCEND Trainee Spotlight: Sydney Pisano

Sydney is currently a first year Master’s student in Nutrition and a MCH trainee at Arizona State University’s College of Health Solutions. She received her Bachelor’s in Nutrition (Dietetics) in 2018, also from Arizona State University. In the past, she was a Nutrition Instructor for the City of Tempe, where she taught Nutrition classes to people of all ages, from preschool to retirement age. Currently, she is a research assistant for the School Lunch Study at ASU, where salad bars and marketing materials are put in schools to see if fruit and vegetable consumption are affected. In this blog post, she will describe her thesis research on nutrition marketing and how marketing affects children.

In the US today, 70-90% of students are exposed to some form of food marketing in schools.¹ Under the Healthy-Hunger Free Kids Act of 2010 and the “Smart Snacks in School” policy of 2014, participating schools were limited in what they could serve and market to children.^2,3 This combined with local district nutrition policies, helped decrease the exposure of high sugar and high calorie foods at schools.^2,3 However, current research shows that there has not been a large increase in the consumption of fruits and vegetables even with these new policies enacted.⁴

While schools are having trouble trying to get children to eat their meals, fast food companies are putting billions of dollars a year into marketing their products.⁵ When fast food companies market specifically to children, they increase their sales.⁵ They use bright colors, fun characters and prizes to influence children to want their product.⁵ One way that fast food companies develop their marketing materials is through interviews and focus groups with their target population.⁵ By doing this, they can determine exactly what appeals to children and then have their company develop products based on that. Although many successful companies utilize focus groups to help increase their sales, there is currently very little research on how children perceive school nutrition marketing materials

For her thesis, Sydney will be conducting interviews with children in grades 3-12 and determining their opinions on different nutrition marketing materials. The primary goal of her thesis is to determine what children like or dislike about the various marketing materials and if they motivate them to increase their consumption of fruits and vegetables.

References

1. Hales CM, Carroll MD, Fryar CD, Ogden CL. Prevalence of Obesity Among Adults and Youth: United States, 2015-2016 Key Findings Data from the National Health and Nutrition Examination Survey.; 2015.
2. Johnson DB, Podrabsky M, Rocha A, Otten JJ. Effect of the Healthy Hunger-Free Kids Act on the Nutritional Quality of Meals Selected by Students and School Lunch Participation Rates. JAMA Pediatr. 2016;170(1):e153918.
3. Smart Snacks in School USDA’s "All Foods Sold in Schools" Standards. https://fns-prod.azureedge.net/sites/default/files/cn/allfoods-flyer.pdf.
4. Bourke M, Whittaker PJ, Verma A. Are dietary interventions effective at increasing fruit and vegetable consumption among overweight children? A systematic review. J Epidemiol Community Heal. 2014;68(5):485-490. doi:10.1136/JECH-2013-203238
5. Harris JL, Marlene Schwartz MB, Munsell CR, et al. Measuring Progress in Nutrition and Marketing to Children and Teens Fast Food FACTS 2013: Measuring Progress in Nutrition and Marketing to Children and Teens.; 2013.

UTK Trainee Spotlight: Veronica Rubio

Veronica is a first-year graduate student in the Nutrition program at the University of Tennessee, Knoxville (UTK). Veronica also received her Bachelor of Science in Nutrition at UTK in 2014. She then went on to complete her dietetic internship at Vanderbilt University Medical Center. Veronica worked as a registered dietitian in the Women, Infants and Children (WIC) program in South Carolina, and served as a clinical dietitian in the island of American Samoa. Veronica has been a MCH Nutrition trainee since August 2018.

My earliest experience working with the MCH population dates back to my volunteer work as an undergraduate. I worked as a research assistant with Dr. Marsha Spence (UTK) for the Cardiac Club Program, which is an afterschool nutrition and physical activity intervention program for elementary school-age children in fourth and fifth grades. Additionally, I worked as a nutrition educator for the Healthy Kid’s Club program ran by East Tennessee Children’s Hospital. For this program, I helped plan and teach weekly nutrition lessons and games that focused on movement and physical activity. My interest in working with this population grew throughout my dietetic internship, both in my community and clinical rotations, where I chose a concentration in pediatrics/pediatric oncology. My experience in public health nutrition further developed with my work as an RD for the WIC program.

So far, as a trainee, one of the projects I am leading is the diversity recruitment and retention committee. The committee is comprised of faculty members from both the Departments of Nutrition and Public Health at UTK. Currently, the committee is planning strategies to increase recruitment efforts of racially/ethnically diverse students into the dietetics profession. One of these strategies includes visiting historically black colleges and universities (HBCUs) in the surrounding states. Another strategy is to create an infographic to disseminate to Hispanic-serving institutions and tribal colleges/universities that are further away. I am excited about the many opportunities the traineeship offers, and am looking forward to increasing my knowledge, refining my leadership skills, and better serving the MCH population.

UMN Trainee Spotlight: Somadee Cheam

Somadee is a first year MPH Nutrition student in coordinated masters program at the University of Minnesota Twin Cities where she also received her undergraduate degree in nutrition and dietetics in 2018. She began her MCH traineeship in September 2018 and has been working on the development of the University of Minnesota’s Public Health Nutrition newsletter. Somadee is passionate about increasing healthy food access through transformation of the agricultural system to prioritize investments in healthy foods and farms and through the creation of a more transparent supply chain.

For the first semester of my program, I had the privilege of interning at St. Paul Ramsey County Public Health in the Healthy Communities division. During my time spent there, I primarily worked with the Food and Nutrition Commission which is funded and supported by the Statewide Healthy Initiative Partnership grant. I was introduced to the Good Food Purchasing Program and have been working on expanding the partnership between the Twin Cities coalition and the Commission. The Good Food Purchasing Program is a national program with local coalitions working to build relationships with institutions and encouraging them to direct their buying power to source their foods with the consideration of their five core values of nutrition, animal welfare, local economies, valued workforce, and sustainable agriculture.

Public institutions across the country spend billions of dollars on food purchases and have the opportunity to lead the movement for food system change and influence supply chains. Local food procurement through large institutions has been shown to positively impact the food system as it increases transparency throughout the supply chain. Currently the Twin Cities coalition is working with Minneapolis Public Schools and just finished a full assessment of food procurement of the district. With nutrition being one of the core values of the program, it is emphasized within procurement practices. With strategic planning, schools can leverage their purchasing power to provide nutritious food to their students without exceeding their limited budgets. It is very exciting to get involved in this program just as it is starting to gain national momentum. I look forward to continuing to strengthen local and regional food systems through fostering these relationships between producers and consumers and ultimately increasing access to healthy food to communities who need it most.

ASU TRANSCEND Trainees Attend Obesity Week Conference

By: Armando Pena and Kiley Vander Wyst

Nestled between businesses and bars around every corner, The Obesity Society’s Annual Meeting took place right in the heart of downtown Nashville, TN. The conference was four-days long with scientists and clinicians from all over the world in attendance. The lecture topics ranged from bariatric surgery and pharmacokinetics to basic science and community- or school-based research. With such diverse experts gathered in one place, it was easy to feel like you didn’t belong. However, the common theme, treatment and prevention of obesity, that brought all of these unique individuals together was apparent. The conference demonstrated that innovations and breakthroughs in obesity science is only the tip of the iceberg if we do not share our ideas and collaborate on projects.

There was a whole section devoted to perinatal and infant obesity research where three speakers presented on early life influences of the infant gut microbiome, the utility of a novel measure of body composition in infants, and behavioral aspects of food preferences impact on child growth. These presentations really stood out to two ASU TRANSCEND trainees who attended the conference. As the trainees continue to learn about maternal child health outcomes, it is critical for them to understand where the field is currently and, perhaps, where the field is going in order to become experts. These trainees also had the opportunity to attend the meeting this year. Here is a little bit about the posters they both presented.

Armando Peña, MS

I presented my poster entitled, Evaluating a Novel Measure of Insulin Sensitivity in Latino Youth. The Matsuda Index is a measure of insulin sensitivity that is formulated from insulin and glucose values collected during an OGTT at 0-, 30-, 60-, 90-, and 120-minutes post-glucose stimulus. The originators of this index came out with a later study deeming it appropriate to estimate the Matsuda Index by only using samples collected at 0- and 120-min. However, this measure has not been compared to the Matsuda Index in a sample of obese Latino youth, which was the objective of the study. In brief, the data suggests that it is an acceptable measure for use in obese Latino youth with prediabetes (defined by a 2-hour OGTT glucose ≥ 140 mg/dl) compared to those without prediabetes. In addition, it is approximately one-third the cost of the Matsuda Index, making it a measure of interest for researchers with funding limitations or those looking to generate preliminary data. Overall, I had a good turnout of visitors to my poster session, with about 8-10 visitors. A majority were pediatric physicians that were interested in the measure since it already follows clinical diabetes screening practice guidelines. It was gratifying to know that most of those who stopped by had seen the program ahead of time and found interest in my poster.

Kiley Vander Wyst, MPH

I presented my poster entitled, Comparison of Prenatal Health Parameters & Nutrition Counseling Among Macrosomic Deliveries. The prevalence of obesity in Arizona is 25.7% among women of childbearing age. Although prenatal nutrition counseling has demonstrated a reduction in gestational weight gain, weight retention, and decrease in pregnancy complications it is seldom done by clinicians due to lack of knowledge and insufficient time. The aim of these retrospective chart review was to evaluate the type of nutritional counseling provided to women who delivered a fetal macrosomic (>4000 grams) infant and compare differences in health outcomes by pre-pregnancy BMI category. Of 2,689 deliveries, 225 resulted in fetal macrosomia, of which 188 were included in the study. Regardless of pre-pregnancy BMI, 59% of women received nutritional counseling (NC). Although, 97% of diabetic women received NC of which 80% met with a Registered Dietitian (RD), only 49% of non-diabetic women received NC, with only 3% meeting with a RD. Of the 41% of women that did not receive NC, 20% were normal weight, 33% were overweight, and 48% were obese prior to pregnancy. Nutrition topics discussed during prenatal visits varied based on pre-pregnancy BMI category; however, healthy foods and snacks, general pregnancy diet information, and carbohydrate counting were the three common topics across all BMI categories. There were no differences in weight-related outcomes among women who received NC. The prevalence of c-sections, diabetes, and hypertension were highest among OB pregnant women. However, OB women had the lowest GWG and smallest 3^rd trimester fetal AC but the highest one-hour glucose. Presenting my poster was really fun with several visitors ranging from physician assistants and nurses to physician-scientists and dietitians. It was such a unique experience to talk about my poster to such a diverse group of people!

Despite the weather being wet and cold, the barbecue was delicious and the live music was plentiful. The ASU TRANSCEND trainees had a great time at the Obesity Week conference and plan to attend again next year. Hopefully, we will see the sun at least once in Vegas, unlike in Nashville!

UTK Former Trainee Spotlight: Amber Ford

Amber Ford, an alumnus of the Maternal and Child Health Leadership traineeship, is a registered and licensed dietitian at the Knox County Health Department. At the University of Tennessee, Amber completed a dual Master’s program in Public Health and Public Health Nutrition, and completed the dietetic internship. As a Public Health Educator, Amber has focused on school health for the past three years.  

I completed the dual master’s program in public health and nutrition along with the dietetic internship through the University of Tennessee in December 2015. Serving as an MCH trainee was one of the biggest highlights of my time in the program, and the training and experience I received have been so valuable in my current position. I’ve worked as a Public Health Educator focused on school health at the Knox County Health Department for the past three years.

In my role, I specifically partner with Knox County Community Schools to help improve the health of students and families as it relates to nutrition and physical activity. The Community Schools initiative aims to use public schools as hubs for community resources to improve health and academic success. This involves working alongside teachers, students, and families to identify their specific needs and bringing in partners and resources to address these needs. We currently have 18 Community Schools in Knox County, and most of my work is aimed at creating and enhancing access to places for physical activity, promoting increased physical activity and physical education, creating supportive nutrition environments, and increasing access to healthy foods for students and families.

Throughout my time as a trainee, I had the opportunity to lead the cultural and linguistic competency workshops, Interactions that Make a Difference, for graduate students and frontline staff of health departments in East Tennessee. Countless times, I’ve used the skills I developed in presenting and leading trainings for diverse audiences, but I also use the cultural competency knowledge I gained on a daily basis. Our Community Schools are some of the most diverse and economically disadvantaged in our county, and the knowledge and skills provided by these trainings have improved my interactions with the students and families I serve and have helped me develop more culturally competent interventions.

Further, my time as a trainee equipped me with other skills for which I am consistently grateful. Working with a team to plan and implement the bi-annual Promoting Healthy Weight Colloquium improved my long-range planning skills, efficiency, and ability to delegate and recognize the strengths and weaknesses of others and myself. Assessment and evaluation of community needs and effectiveness of our interventions are important for sustained funding and effective utilization of limited resources, and I’m able to rely on the practices of regular evaluation and responding to evaluation outcomes used throughout my time as a trainee. All and all, I can’t say enough about how much serving as an MCH trainee impacted me and shaped the work I do. Well worth every minute!

 

UMN Trainee Spotlight: Noelle Yeo

Noelle is a second-year MPH Nutrition student in the coordinated masters program and an MCH Nutrition trainee at the University of Minnesota Twin Cities. She completed her bachelors of science at the University of Nebraska- Lincoln in nutrition, exercise, and health sciences in 2017 with minors in Spanish and business administration. After graduation in August 2019, Noelle plans to work in school nutrition. 

This summer I had the opportunity to complete one of my dietetic rotations at the Minnesota Department of Education (MDE) working with the School Nutrition Programs team. Over the course of ten weeks, I…

• assisted with school nutrition program and summer feeding program reviews
• learned about the USDA School Nutrition Program policies
• created training materials for school food service directors and workers
• worked on projects to increase the efficiency and effectiveness of the school nutrition program review process
• and much more!

One of my favorite projects was creating Visual Portion Size Guides for training food service workers on visually identifying portion sizes of fresh fruits and vegetables as students bring their trays through the lunch line. Many schools in Minnesota have begun implementing salad bars in cafeterias which is great for allowing students more choices and access to fresh fruits and vegetables. However, because students are serving themselves, it can be more challenging to determine if they have taken enough of a fruit or vegetable to meet the meal pattern requirements for a reimbursable meal. The nutrition consultants noticed this issue while visiting schools on reviews and wanted to create something to help.

After discussing with the team, we came up with the idea to take photographs of fresh fruits and vegetables on a school lunch tray in different portion sizes and create life-size photo cards. These cards could then be used for training to become more familiar with the various quantities or even be kept at the registers for reference. We selected common fruits and vegetables, purchased them, cleaned and chopped them, set-up the lighting, and took the photos. There was definitely a lot of questions from other MDE staff in the kitchen area and lots of snacks to pass around once we were done! The final product was cards of 9 fruits and 14 vegetables that showed portion sizes of ¼ cup, ½ cup, and ¾ cup of each.

At the end of the summer, I was able to attend the Minnesota School Nutrition Association annual conference in Rochester, Minnesota. We gave out samples of the visual portion size guides at the MDE booth during the expo and it was really exciting to talk to school food service directors. They all seemed really happy that this resource was available to help train their staff and were excited to use it. Now, the cards are available online on MDE’s website so anyone can print and use them.

Here are some examples of the  cards (not to scale):

Full versions can be found at:

Vegetables

https://education.mn.gov/mdeprod/idcplg?IdcService=GET_FILE&dDocName=MDE074461&RevisionSelectionMethod=latestReleased&Rendition=primary

Fruits

https://education.mn.gov/mdeprod/idcplg?IdcService=GET_FILE&dDocName=MDE074442&RevisionSelectionMethod=latestReleased&Rendition=primary