Effect of a Wii Fit® intervention on balance, muscular fitness, and bone health in middle-aged women
This work aims to understand how the community layer, represented by the food environment, moderates the association of two other layers and dietary behaviors: the interpersonal layer, represented by receiving health care provider’s (HCP) advice to lose weight, and the policy layer, represented by participation in the Supplemental Nutrition Assistance Program (SNAP), and a policy change within the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC).
Participant data were obtained from a household telephone survey of 2,211 adults in four cities in New Jersey from two cross-sectional panels in 2009-10 and 2014. Community food data were purchased and classified according to previously established protocol. Interaction and stratified analyses determined the differences in the association between HCP advice, SNAP participation, and time (for WIC participants) and eating behaviors by the food environment.
Interaction and stratified analyses revealed that HCP advice was associated with a decrease in SSB consumption when participants lived near a small grocery store, or far from a supermarket, limited service restaurant (LSR), or convenience store. SNAP participation was associated with a higher SSB consumption when respondents lived close to a small grocery store, supermarket, and LSR. There were no differences in fruit and vegetable consumption between two time points among WIC participants, or by food outlet.
The food environment, part of the community layer of SEM, moderated the relationship between the interpersonal layer and dietary behaviors and the policy layer and dietary behaviors. The association between HCP advice and dietary behaviors and SNAP participation and dietary behaviors were both influenced by the food environment in which participants lived.
Methods: Study participants (n=1469) were elementary and middle school students who ate school lunch on the day of data collection. Photographs and weights (to nearest 2 g) were taken of fruits and vegetables on students’ trays before and after lunch. Trained research assistants viewed photographs and sorted trays into variable categories: color of main tray, presence/absence of secondary fruit/vegetable container, and color of secondary fruit/vegetable container. Fruit and vegetable selection, consumption, and waste were calculated using tray weights. Negative binomial regression models adjusted for gender, grade level, race/ethnicity, free/reduced price lunch status, and within-school similarities were used to examine relationships between tray color and fruit and vegetable selection, consumption, and waste.
Results: Findings indicated that students with a light tray selected (IRR= 0.44), consumed (IRR=0.73) and wasted (IRR=0.81) less fruit and vegetables. Students without a secondary fruit/vegetable container selected (IRR=0.66) and consumed (IRR=0.49) less fruit and vegetables compared to those with a secondary container. Light or clear secondary fruit and vegetable containers were related to increased selection (IRR=2.06 light, 2.30 clear) and consumption (IRR=1.95 light, 2.78 clear) compared to dark secondary containers, while light secondary containers were related to decreased waste (IRR= 0.57).
Conclusion: Tray color may influence fruit and vegetable selection, consumption, and waste among students eating school lunch. Further research is needed to determine if there is a cause and effect relationship. If so, adjusting container colors may be a practical intervention for schools hoping to increase fruit and vegetable intake among students.
Purpose: The purpose of this study was to understand how implementing EIM influenced provider behaviors in a university-based healthcare system, using a process evaluation.
Methods: A multiple baseline, time series design was used. Providers were allocated to three groups. Group 1 (n=11) was exposed to an electronic medical record (EMR) systems change, EIM-related resources, and EIM training session. Group 2 (n=5) received the EMR change and resources but no training. Group 3 (n=6) was only exposed to the systems change. The study was conducted across three phases. Outcomes included asking about patient physical activity (PA) as a vital sign (PAVS), prescribing PA (ExRx), and providing PA resources or referrals. Patient surveys and EMR data were examined. Time series analysis, chi-square, and logistic regression were used.
Results: Patient survey data revealed the systems change increased patient reports of being asked about PA, χ2(4) = 95.47, p < .001 for all groups. There was a significant effect of training and resource dissemination on patients receiving PA advice, χ2(4) = 36.25, p < .001. Patients receiving PA advice was greater during phase 2 (OR = 4.7, 95% CI = 2.0-11.0) and phase 3 (OR = 2.9, 95% CI = 1.2-7.4). Increases were also observed in EMR data for PAVS, χ2(2) = 29.27, p <. 001 during implementation for all groups. Increases in PA advice χ2(2) = 140.90, p < .001 occurred among trained providers only. No statistically significant change was observed for ExRx, PA resources or PA referrals. However, visual analysis showed an upwards trend among trained providers.
Conclusions: An EMR systems change is effective for increasing the collection of the PAVS. Training and resources may influence provider behavior but training alone increased provider documentation. The low levels of documented outcomes for PA advice, ExRx, resources, or referrals may be due to the limitations of the EMR system. This approach was effective for examining the EIM Solution and scaled-up, longer trials may yield more robust results.
The context in which many self-governed commons systems operate will likely be significantly altered as globalization processes play out over the next few decades. Such dramatic changes will induce some systems to fail and subsequently to be transformed, rather than merely adapt. Despite this possibility, research on globalization-induced transformations of social-ecological systems (SESs) is still underdeveloped. We seek to help fill this gap by exploring some patterns of transformation in SESs and the question of what factors help explain the persistence of cooperation in the use of common-pool resources through transformative change. Through the analysis of 89 forest commons in South Korea that experienced such transformations, we found that there are two broad types of transformation, cooperative and noncooperative. We also found that two system-level properties, transaction costs associated group size and network diversity, may affect the direction of transformation. SESs with smaller group sizes and higher network diversity may better organize cooperative transformations when the existing system becomes untenable.
The insights in Governing the Commons have provided foundational ideas for commons research in the past 23 years. However, the cases that Elinor Ostrom analyzed have been exposed to new social, economic, and ecological disturbances. What has happened to these cases since the 1980s? We reevaluated one of Ostrom’s case studies, the lobster and groundfishery of Port Lameron, Southwest Nova Scotia (SWNS). Ostrom suggested that the self-governance of this fishery was fragile because the government did not recognize the rights of resource users to organize their own rules. In the Maine lobster fishery, however, the government formalized customary rules and decentralized power to fishing ports. We applied the concepts of feedback, governance mismatches, and the robustness of social-ecological systems to understand the pathway of institutional change in Port Lameron. We revisited the case of Port Lameron using marine harvesters’ accounts collected from participant observation, informal interviews and surveys, and literature on fisheries policy and ecology in SWNS and Maine. We found that the government’s failure to recognize the customary rights of harvesters to organize has weakened feedback between the operational level, where resource users interact with the resource, and the collective-choice level, where agents develop rules to influence the behavior of resource users. This has precipitated governance mismatches, which have led harvesters to believe that the decision-making process is detrimental to their livelihoods. Thus, harvesters rarely participate in decision making and resist regulatory change. In Maine, harvesters can influence decisions through participation, but there is a trade-off. With higher influence in decisions, captains have co-opted the decision-making process. Nevertheless, we suggest that the fisheries of SWNS are more vulnerable to social-ecological change because of weaker feedbacks than in Maine. Finally, we have discussed the potential benefits of polycentricity to both fisheries.