Cornell NutritionWorks: Addressing obesity at the community level

Approximately one-third of all adults in the United States are obese and nearly 17 percent of youth are obese.  This national epidemic leads to an increased risk of diabetes, high cholesterol, high blood pressure, sleep disorders, joint problems, as well as social and psychological problems for millions of Americans.  

While there is an urgent need to address obesity with a focus on prevention, it can be difficult – even for a professional – to sort through all of the information about diet and health in the media, on the Internet, and even at grocery stores.

Enter Cornell NutritionWorks, an online professional development program for nutrition, health, and youth professionals such as registered dietitians, extension nutrition and 4-H educators, public health nutritionists, health education specialists, and school food service directors.   

Cornell NutritionWorks uses distance-learning technology to provide cutting edge nutrition information, interaction with Cornell experts, discussion forums for practitioners and continuing education credit for nutrition professionals. The program is lead by Cornell Senior Extension Associate Christina Stark, who’s spent nearly 30 years interpreting and communicating research-based information on food and nutrition issues to extension educators, other professionals, consumers and the media.

“To prevent childhood obesity, professionals need to look beyond focusing just on individual behavior change,” Stark says “We need to work collaboratively with community partners to change local environments so they support healthy eating and active living. For many professionals, this is a new way of thinking and working. Cornell NutritionWorks provides training in using this new evidence-based approach.”

Current offerings on the website include:

  • Preventing Childhood Obesity: An Ecological Approach, an in-depth six-week online course, offered three times a year, that helps participants use an ecological approach to identify local factors that contribute to childhood obesity and develop an action plan for their communities.  The next session will be offered fall 2010. There is a fee for this course.
  • Has the Food Revolution Reached Washington?, a cyber-presentation by Marion Nestle, professor of nutrition, food studies and public health at New York University and a visiting professor at Cornell. The talk examines how the U.S. food system contributes to our obesity epidemic, describes current food industry trends that affect consumers’ ability to choose healthy foods, and outlines the evidence for a food revolution in the United States.
  • The Built Environment, Food, and Physical Activity, a cyber- presentation by Ann Forsyth, professor in Cornell’s Department of City and Regional Planning, that discusses ways to think about the built environment, food, and physical activity measures to improve community health.

To get the latest, research-based information on nutrition and health, Cornell NutritionWorks is the place to go.  All of the content, with the exception of the in-depth course, is available to members at no charge. And membership is free.

Evidence-based cheese!

It’s summer-time in the Finger Lakes – a great time of year to sample regional wines along one of the three local wine trails.  On your tour this year, you can pair that wine with some delicious, local cheese.

Cornell Cooperative Extension has teamed up with regional cheese-makers to create the Finger Lakes Cheese Trail – a driving tour of local creameries where you can learn about the craft of cheese-making and sample local varieties including sheep’s milk cheese, goudas, goat cheese, cheddars, jacks, Colby and even cheese curds.

They’re absolutely delicious!  But are they good for our diets?

The evidence says yes. In fact, cheese provides a myriad of health benefits. A single serving of cheese provides about 300 mg of calcium – nearly one-third of the daily recommended amount.  And a study published in the American Journal of Clinical Nutrition demonstrated that getting calcium from cheese rather than supplements leads to improvements in bone density. Cheese packs in other key nutrients, too, including like protein, magnesium, folate, B1, B2, B6, B12, and vitamins A, D, and E.

Unfortunately, there’s a downside to cheese. Many cheeses are also high in cholesterol, sodium and saturated fat, which can contribute to obesity, high blood pressure, heart disease and cancer. But that doesn’t mean you should eliminate cheese from your diet.

Nutritionists at Yale-New Haven Hospital have published some guidelines on incorporating cheese in a healthy diet. Among their recommendations are:

  • If you like to eat hard cheeses , look for “fat free,” “reduced fat” or “low fat” versions.
  • When looking for soft cheeses, low fat , part-skim or light products are available.
  • If you do use full-fat cheese in a recipe, cut the amount in half to reduce your fat and sodium intake.

So, go ahead. Melt some cheddar on that burger, sprinkle a bit of gorgonzola in your salad or visit a Finger Lakes creamery. As long as you indulge in moderation, you’ll reap all of the health benefits from cheese.

Sheri Hall

Behave! Using the science of behavior change

There are some problems we can’t do much about — hurricaines and earthquakes, for example. But a vast amount of things that make life tough — and sometimes miserable — relate to the choices human beings make and the way we behave. For this reason, a whole science of behavior change has grown up, focusing both on theoretical models and empirical studies of how to change damaging human behaviors, ranging from smoking, to crime, to overeating, to taking excessive risks.

A very helpful new article reviews models to promote positive behavior change that are highly relevant to people designing or implementing interventions. The authors note that getting individuals to make lasting changes in problem behaviors is no easy matter. They synthesize various models of behavior change “to provide a more comprehensive understanding of how educators can promote behavior change among their clientele.”

The authors apply their framework to the issue of financial management. Very interesting reading, available here.

(While you’re at it, take a look at other issues of this free on-line journal, called the The Forum for Family and Consumer Issues, published by North Carolina State University Extension — many interesting articles related to program development and evaluation.)

Research re-imagined at USDA: New “Roadmap” published

The venerable U. S. Department of Agriculture (USDA) has pioneered agricultural research for more than a century (see related post). Over the past several years,  the USDA has been reshaping its research priorities and funding programs, in part through the creation of the new National Institute of Food and Agriculture. NIFA has the mission to “advance knowledge for agriculture, the environment, human health and well-being” through funding research, education, and extension projects.

 USDA has just published a “Roadmap for USDA Science,” that is worthwhile reading. It calls for new approaches to foster robust food, agricultural, and natural resource science.

 The report begins in an interesting way. It asks us to:    

 Imagine a world in which…    

  …Radically improved children’s diets and nutrition slash long-term health care costs in the United States;

  …Farmers, ranchers, and forest landowners are recognized as significant contributors to large and sustainable reductions in global greenhouse gases;  

  …Farmers in sub-Saharan Africa have easy, affordable access to new seeds and animal breeds so well adapted to local conditions and so resilient to changing conditions that they feed five times as many people domestically and eliminate persistent hunger;  

  …Trends in availability of high-quality water and new options for watershed management outpace increasing demand for water even as climate change alters the geography of water resources; and

  …Technologically advanced production, processing, and foodborne pathogen detection methods make food product recalls nonexistent.  

 Farfetched, ask the authors of the Roadmap? Not at all, according to them — They believe that these goals are achievable through the kind of science the USDA will now promote. 

Among other things, the Roadmap calls for a focus on a limted number of “outcome-driven priorities,” cooperation with other agencies and institutions, concentration on both fundamental science and extension, and a “rejuvenation” of the USDA competitive grant system.

All in all, a very interesting read.

Drugs, Medicare, and the older consumer: Economics to the rescue

Okay, let’s have a show of hands. First, how many of you have a relative or someone you care about who is age 65 or older? Thanks.

Now, how many of you tried to help one of these beloved relatives or friends understand and choose a plan under Medicare Part D, the prescription drug benefit for older Americans? Thanks again.

My final question: How many of you who tried to help someone understand their options under Medicare Part D sighed, wept, and eventually wanted to pound your head against the wall in an attempt to lose consciousness? I thought so.

I had this experience myself, trying to help my 80-year old mother-in-law decide which program was best for her. I’m a gerontologist, for heaven’s sake, and I tore out what little hair I have left trying to figure out what her best option was.

 To the rescue comes a highly innovative and effective translational research project, led by Cornell Professor Kosali Simon (Department of Policy Analysis and Management). An economist, Prof. Simon’s desire to apply her expertise to this real-world problem has helped people in New York and across the country make this complex and important decision.

 Medicare Part D was passed in 2003 and is the federal program that subsidizes the costs of prescription drugs for people on Medicare (the federal health insurance program for Americans 65 and over). Some people were basically going broke paying for prescription drugs, and the federal government stepped in.

It sounds good, but here’s the problem: It is extraordinarly difficult to understand the coverage. A beneficiary has to choose among dozens of plans, which include dizzying combinations of deductibles and co-payments, and use different terminology for what they cover.

 

That’s the problem Prof. Simon took on. She had spent her career studying things like the economics of state regulation of private health insurance markets for small employers. But then she did an exercise for one of her classes, and students looked at Medicare Part D. Their work led her to become interested in the topic, and she began to do research on it.

Then she got in touch with psychologist Joe Mikels (Cornell Department of Human Development), who looks at how older people make decisions. Together, they used psychological theory and experimental methods to study older persons’ perceived difficulties of choosing a plan when the number of options available under Medicare Part D is increased in a lab setting. She also studied how seniors may actually benefit from increased breadth of choice in plan offerings using econometric methods and data on plan enrollment.

But here’s where it gets really interesting. Prof. Simon saw that there was practical value in learning how to help older people to understand the differences in medication coverage between plans. She used her data to create guides that can form the basis for choosing the right plans based on examining the coverage of medications, rather than simply going by general marketing materials that were mailed to older people.

Working with Project Manager Robert Harris, an experienced pharmacist, she has expanded the reach of the program in many different ways. Based on the research evidence, they have created a variety of materials such as pocket guides to Medicare Part D, posters, counter cards for pharmacies, customized mailings to residents of nursing homes, and an email newsletter and website with thousands of hits per month. 

All of this is very nicely summarized on her project web site CURxED, which I recommend you visit not just for the information, but as a great example of how complex information can be disseminated on the web.

Prof. Simon summed up the translational research approach very well when she told me: “It is very rewarding to be able to use the same data I collect for my research in ways that are practically useful to actual human beings being served by the program I study.”

Master Gardener Volunteers: Good new blog, great benefits

We were recently alerted to a new blog about all things Master Gardener, which got us thinking about the program. For those of you who don’t know, the Master Gardner Volunteer (MGV) program is an extension effort based on volunteers who promote public education in horticulture. The volunteers provide educational assistance about trees, lawns, vegetables, ornamentals and a host of other topics. Volunteers go through extensive training, pass an exam, and make a minimum time commitment to the program.

My Cornell colleague Lori Bushway has done a great job of educating me about the MGV program. And I think it’s hard to find a better example of how to harness the power of volunteering. There are over 90,000 Master Gardener Volunteers nationwide, and it’s estimated that they create an annual service value of over $100 million. The benefit to communities is huge and well-documented.

But after our visit from volunteering researcher Mark Snyder, we wondered: What about the benefits to participants? We’d expect MGV participation to be good for the volunteers, but true to our name, on this blog we obsessively look for research evidence.

Well, from the preliminary research available, it’s not just local gardeners who benefit from MGV, but also the volunteers. First, they get new knowledge. Emilie Swackhammer and Nancy Ellen Kiernan found that MGVs made clear knowledge gains over time in areas like botany, soils, plant disease, integrated pest management, and other areas. In addition, their confidence increased in their ability to answer questions from community members in these areas (here’s the article).

What about areas beyond horticultural knowledge? T.M. Waliczek and Roxanne Boyer’s article looked at more personal outcomes. They found that MGV training and participation led to increased physical activity, social activity, self-esteem, and other positive effects among Master Gardener volunteers.

Talk about a win-win situation: Volunteers work to improve their communities through promoting citizen involvement in horticulture, and along the way increase the knowledge and quality of life of the volunteers themselves. Go Master Gardener Volunteers!

Building extension’s public value: We can be more convincing

Those of us who work in the Cooperative Extension system tend to love it. Over the past weeks, I’ve been involved in an interview project with older people who have been involved in extension most of their lives, either as volunteers or as paid employees. Their devotion to extension’s mission shines through every interview. From the inside, the value of what we do seems self-evident.

Then we come up against the harsh reality: Extension is heavily dependent on public funding. Many other constituencies, and in particular elected officials and the general public, need to see the value of what we do. How can we convince those who hold the purse-strings that the work of extension has public value, worth spending government funds on?

I recently came across the work of Laura Kalambokidis, a faculty member in the Department of Applied Economics at the University of Minnesota. One of the pleasures of writing a blog is that you start reading other people’s, and Laura’s brings a fascinating perspective to extension.

In an article in the Journal of Extension, Laura raises the issue of identifying the public value of extension. She lays out the problem facing us succinctly:

The current economic climate has placed significant pressure on the budgets of state and county governments. In turn, those governments have compelled state Cooperative Extension Services to defend their continued receipt of state and county funding. Even when policymakers are persuaded of the efficacy of an Extension program, they have questioned whether the program should be supported with scarce public dollars rather than through user charges.

To address this issue, Laura translates economic theory and research from public sector economics to practical issues of extension. What policymakers need to be convinced of is that extension work has public value – that is, why should the public pay for our services rather than being purchased on the private market? The challenge is to show that extension activities are a public good, one that benefits society as a whole (in addition to benefitting specific program participants). In her words: “Extension staff must also be able to explain why citizens and policymakers who are not direct program participants should value the program.”

In the extension programs I’ve created, I confess that I haven’t done this. When I justify my programs, I point to the good outcomes and satisfaction for program participants. But I don’t really look at the public good – how they have benefits  for the larger community, beyond my participants. For example, I’ve created extension programs to train nursing home staff. But someone could ask: “That’s well and good, but why shouldn’t those programs be paid for by nursing homes as a private good? What’s the public value for what you do?”

Laura’s work suggests that the most effective case can be made for public value when there is market failure – we provide something that isn’t effectively offered privately – and when there are issues of fairness and justice not addressed by private markets. Her article gives a detailed process for identifying public value.

To give one example, extension folks typically believe that they address market failure by providing information. But Laura suggests we consider this carefully, asking questions like:

  • Is there a demonstrable information gap?
  • Can you show that other entities are providing wrong or incomplete information to consumers?
  • Does your information direct consumers (and producers) toward activities that have external benefits?
  • Are you providing information to a population that does not have access to private information sources?

Laura has developed a workshop program where she helps extension associations determine public value of their programs and how to present them as such. More information is available on her web site, which includes a blog.

Why do you think kids make risky decisions? Bet you’re wrong…

On a trip to Dallas last week, I stayed in a large hotel that was playing host to a convention of high school student members of a service organization. A group of boys was roughhousing on a balcony where only a low railing served as a barrier against a 3-floor drop to the lobby, and it looked like a shove in the wrong direction would send someone over the edge. Down swept a small phalanx of chaperones exclaiming what a bunch of idiots the kids were. The young fellows sauntered off, muttering about “over-reacting,” and “always ruining it when we’re having fun.”

To adults, the reason for this behavior seems obvious: Kids are illogical and don’t understand the risks of their behavior. We assume that they do risky things – like use drugs, drive drunk, or have unprotected sex – because they are irrational beings. Like my grandmother would say: “Those kids just don’t have any sense.”

Enter Cornell professor Valerie Reyna to show us that we’re wrong about this, and our misconceptions have implications for how we try to help kids make less risky decisions. A faculty member in Human Development, Prof. Reyna conducts groundbreaking work on judgment and decision making. And she has taken the additional step of turning her basic research into practical programs to help young people.

In the laboratory under controlled conditions, she has conducted many studies of children and adolescents. Following a translational research model, she and her colleagues wanted to first understand the causal mechanisms that generated risky behavior. What she learned in the lab about the psychology of adolescent risk-taking and about how risky decision making changes with age, she found could then be used to modify unhealthy behavior.

The findings are fascinating. It turns out that adolescents don’t take risks because they are irrational and feel invulnerable and immortal. In fact, it’s because they are too logical. Adults can access informed intuition to avoid risk, whereas adolescents count up and weigh risks versus immediate benefits, and often the risk comes out on top. As Prof. Reyna puts it, “We found that teenagers quite rationally weigh benefits and risks. But when they do that, the equation delivers the message to go ahead and do that, because to the teen the benefits outweigh the risks.”

Existing prevention curricula that had been developed tended to have effects that faded over time and were not as large as they could be.  Prof. Reyna translated her research findings into a curriculum based on both theory and empirical findings.  She has created interventions to teach adolescents to think categorically—to make sweeping, automatic gist-based decisions about life: “unprotected sex bad,” “illegal drugs bad.”

After more than 800 teenagers participated in a randomized controlled trial, the investigators found that the curriculum was more broadly effective, and its effects lasted in many cases for long periods of time.

Prof. Reyna’s web page Resources on Risky Decision-Making in Adolescence is a terrific resource. I recommend starting by watching one of her presentations on the topic, conveniently available on the site. An article in the New York Times provides a quick overview. If you are a professional working with adolescents (or if you have one in your family) you’ll find a whole new way of looking at why kids take risks.

Agricultural Extension: The Model for Health Reform?

Atul Gawande is a rare mix: A practicing surgeon who is also a wonderful writer. In thinking about our health care crisis and reform, he started looking for models in American history that have worked to transform systems. In a recent article in the New Yorker entitled “Testing, Testing,” he found his model in a surprising place: Agricultural Extension. His treatment of early success of the extension system makes for fascinating reading (and for those of us working in the system, a nice pat on the back!).

Gawande notes that our health care system lags behind other countries but costs an astronomical amount. He asks: What have we gained by paying more than twice as much for medical care as we did a decade ago? Not much, because the system is fragmented and disorganized. To control costs, the new health reform bill proposes to address many problems through pilot programs: basically, a number of small-scale experiments.

Lest this approach seem absurdly inadequate, Gawande shows that it has worked before – in agriculture. He takes us back to the beginning of the 20th century, when agriculture looked a lot like the current health care system. About 40% of a family’s income was spent on food. Farming tied up half the U. S. workforce. To become an industrial power, policymakers realized that food costs had to be reduced so consumer spending could move to other economic sectors. And more of the workforce needed to move to other industries to build economic growth.

As Gawande sums it up,

The inefficiency of farms meant low crop yields, high prices, limited choice, and uneven quality. The agricultural system was fragmented and disorganized, and ignored evidence showing how things could be done better. Shallow plowing, no crop rotation, inadequate seedbeds, and other habits sustained by lore and tradition resulted in poor production and soil exhaustion. And lack of coordination led to local shortages of many crops and overproduction of others.

Unlike other countries, the U. S. didn’t pursue a top-down, national solution. But government didn’t stay uninvolved either. Gawande tells the intriguing story of Seaman Knapp, the original agricultural extension pioneer. Sent by USDA to Texas as an “agricultural explorer,” he persuaded farmers one-by-one to try scientific methods, using a set of simple innovations (e.g., deeper plowing, application of fertilizer). As other farmers saw the successes (and in particular, that the farmers using extension principles made more money), they bought into the new practices.

Extension agents began to set up demonstration farms in other states, and the program was off and running. In 1914, Congress passed the Smith-Lever Act, which established the Cooperative Extension Service. By 1930 there were more than 750,000 demonstration farms.

The rest is, as they say, history. Agricultural experiment stations were set up in every state that piloted new methods and disseminated them. Data were provided to farmers so they could make better informed planning decisions.

And it worked. Gawande sums up:

What seemed like a hodgepodge eventually cohered into a whole. The government never took over agriculture, but the government didn’t leave it alone, either. It shaped a feedback loop of experiment and learning and encouragement for farmers across the country. The results were beyond what anyone could have imagined.

Gawande profiles Athens, Ohio agricultural extension educator Rory Lewandowski, showing that the system performs the same vital functions it did a hundred years ago. Gawande suggests that the health care system can’t be fixed by one piece of legislation. It will take efforts at the local level that involve “sidestepping the ideological battles, encouraging local change, and following the results.” Impossible, people say? Not really, since it’s been done before – in agricultural extension.

Reimagining Extension and Outreach at Cornell: Strategic Plan for “Public Engagement”

Have you heard about “Reimagining Cornell?” Universities like to reimagine themselves every once in a while, and Cornell is no exception. In Cornell’s case, this strategic planning process will have profound and long-term effects on the university – and not least for extension and outreach. Cornell’s approach should be of key interest to Cornell Cooperative Extension educators, as well as to others interested in university outreach efforts.

Reimagining Cornell is the name for  a coordinated planning and implementation effort upon which, as the leaders put it “the future health of our great university depends,” There are two main goals:  (1) to position Cornell for excellence in priority areas, and (2) to ensure the ongoing financial health of the university. Over the past year, activities have included gathering ideas from throughout Cornell, launching 20 task forces, and releasing a draft strategic plan. They’ve done a great job of putting all the information together on a user-friendly Reimagining Cornell web site.

There is major attention in the plan to the area of extension and outreach, included under the broad area of “Promoting Excellence in Public Engagement.”

The plan strongly endorses the importance of engaging with the community and extending the work of Cornell to benefit citizens of New York State and beyond. It also points to goals for extension that may imply a shift in focus. The plan proposes to integrate extension activities more closely with the many other public engagement activities at Cornell, including departments not part of the land-grant side of the university. It also calls for better integration of extension activities with the research and teaching efforts at Cornell, and an emphasis on evidence-based programming and evaluation of extension programs.

The five main recommendations are:

  1. Construct a unified concept and coherent organizational model for the University’s outreach and public engagement mission.
  2. Strongly connect extension and outreach to on-campus research and educational strengths.
  3. Develop rigorous, systematic evaluations of all outreach and extension programs.
  4. Promote stronger collaborations and partnerships between the University and stakeholders that can make use of and strengthen Cornell’s research (e.g., industry, K-12 schools, nonprofit organizations, government).
  5. Make public engagement a distinctive feature of education at Cornell.

You can read more detailed discussion of these points on the web page.

What do you think? Feel free to start a dialogue by posting comments here. We are very interested in your reactions and thoughts about these recommendations and their relevance to work in the counties.

What the heck is evidence-based extension?

Evidence-based this and evidence-based that: Every field seems to be talking about practices and programs that are evidence-based. The term is popping up everywhere, from medicine, to social work, to education, to physical therapy, to nursing. Where, you may well ask, does Cooperative Extension fit in? In an article appropriately titled: “Evidence-Based Extension,” in the Journal of Extension, Rachel Dunifon and colleagues explain it for you.

http://www.joe.org/joe/2004april/a2.php

The authors note that an evidence-based approach “entails a thorough scientific review of the research literature, the identification of the most effective interventions or strategies, and a commitment to translating the results into guidelines for practice.” Their point? That “extension can improve its use of research-based practice and also inform and advance the ongoing evidence-based work occurring in the scientific community. “

Translating Science Can Work – If You Have the Energy

In an earlier post, I wrote about the problem of translating scientific information to the public. Somehow, we need compelling ways to help people see the value of research, and even to change their behavior based on scientific evidence.

After I posted that piece I came across a terrific example from Prof. Joe laquatra of exactly how that can be done – how we can engage youth and adults in a topic they might otherwise find boring.

Joe Laquatra and his colleagues from Cornell’s Design and Environmental Analysis Department wanted New York State citizens to change their residential energy use. They developed a set of activities and educational programs county Extension educators used to teach adults and youth about the practical aspects of energy efficiency. See the article here: http://www.joe.org/joe/2009december/a6.php

Partnering with the New York State Energy Research and Development Authority, Laquatra’s team came up with a fascinating array of programs to bring the science home to consumers and their families. Some of the ways they helped people learn about energy conservation were:

Energy Bikes. A stationary bicycle with a generator attached to the rear wheel has a panel with light bulbs, a hair dryer, a fan, and a small television.  Someone gets on the bike, and they can see firsthand how much energy it takes to power everything. Kids especially like it and learn about energy use by taking a ride.

Child riding energy bike

The energy bike in action

Grid-Tied Photovoltaic Display. Okay, I didn’t know what a “grid-tied photovoltaic display” was until I read the article. Now I know it’s basically a solar energy system, like the kinds that are installed in homes. It generates 600 watts of electricity. The educators exhibited this grid-tied solar electric display along with educational posters, handouts, and information for homeowners who install this kind of system. Thousands of people have seen it at county fairs, Earth Day events and the New York State Fair.

Energy Forums. Counties conducted energy forums that addressed residential energy efficiency, renewable energy efficiency, bio-fuels, and other areas. Interested citizens were able to actively engage the presenters.

Web Site. The project Web site <http://housing.cce.cornell.edu/nyserda/> provides a description of the program with links to resources for Extension educators and the general public.

So getting complex scientific information out to the general public not only can be done – it can be fun and exciting. As this article richly details, thousands of people have been reached by county educators with these and other activities, leading to home modificaton and substantial energy savings.

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