The Dietetics Profession Privilege Scale: development, validation, and application among a diverse cohort of dietetic professionals.

BACKGROUND: Privilege (defined as the unearned advantage or disadvantage experienced by social groups resulting from structural power differences), impacts efforts to create a diverse and inclusive dietetics profession. Yet, no current measures exist to assess and observe privilege and the relative privilege among dietetic professionals is unknown. OBJECTIVE: The purpose of this study was to develop and validate a scale to measure dietetics profession privilege and to use that scale to assess privilege among a sample of dietetic professionals in the United States. DESIGN: The initial scale was developed by the research team and the psychometrics were assessed using a three-phase cross-sectional study exploring construct, content and face validity and test-retest reliability. PARTICIPANTS: /setting: A survey with content experts (n=18), interviews with cognitive interviewees (n=12), and a survey of dietetic professionals (n=900) were conducted online and over Zoom during 2021. STATISTICAL ANALYSES: Exploratory factor analysis, one-way Analysis of Variance, Cronbach's alpha, and descriptive statistics were used to assess the final instrument and identify correlates of privilege. RESULTS: Findings indicate that the 40-item Dietetic Profession Privilege Scale has good validity and reliability across six domains (treatment in training, identity alignment, resource access, cultural access, financial access, and physical access). The average privilege score among the current sample of dietetic professionals was 45 out of 58 points (SE=10.2), with the greatest gaps between racial/ethnic groups, where white dietetic professionals (DPs) (n=540) had a mean score of 49.7 (SE=0.33), followed by a mean of 41.0 among Middle Eastern/North African DPs (n=9), score of 40.0 for the Native Hawaiian/Pacific Islander-identifying DP, 39.8 (SE=0.93) among DPs with two or more racial/ethnic identities including white (n=68), 35.7 among DPs with two or more marginalized racial/ethnic identities (n=6), 35.3 (SE=1.07) among Black/African American DPs (n=51), 34.3 (SE=0.93) among Asian DPs (n=67), 33.4 (SE=0.91) among Latino, Hispanic, and Chicano DPs (n=71), and 29.4 (SE=3.42) among American Indian/Alaskan Native DPs (p<0.001 for all racial/ethnic groups in which n>10; SE not indicated for groups where n<10). Dietetic professionals with dominant group identities were found to have statistically higher privilege scores than their peers with marginalized identities in several areas including race, gender, sexual orientation, income, socioeconomic status, neurodivergence, ableness) scored higher on the privilege scale than their peers with marginalized identities. CONCLUSION: The Dietetics Profession Privilege Scale is a valid and reliable scale that demonstrates the ability to distinguish differences in privilege between dietetic professionals in the interest of reducing bias and achieving inclusion, diversity, equity, and access with the profession.

Practitioner perspectives on the use of selected fear of childbirth screening tools within a clinical context.

Fear of childbirth (FOC), or tokophobia, can influence several medical and obstetric variables, and is a significant predictor of maternal and mental health outcomes and birth experiences. Current practice in the UK does not include initial screening for tokophobia, rather, assessment and support occur under extreme circumstances e.g. maternal requests for caesarean sections or pregnancy termination requests in order to avoid childbirth. Moreover, while there are several candidate outcome measures for FOC, none have been evaluated in terms of their perceived suitability by specialist practitioners within perinatal healthcare pathways. The present study explores the perceived barriers and facilitators reported by health professionals working within the maternity and mental health services for the use of FOC candidate outcome measures. Evaluated measures included the Fear of Birth Scale, the Oxford Worries about Labour Scale, The Wijma Delivery Expectancy Scale, the Slade-Pais Expectations of Childbirth Scale the Tokophobia Severity Scale. The Tokophobia Severity Scale, followed by the Slade-Pais Expectations of Childbirth Scales were the most favourable scales selected for use according to clinicians. The identification of preferred scales and how they can be used in the local maternity system is a step towards the application of these consistently in clinical practice, to aid in the identification and assessment of FOC. The use of the correct tool at each stage of contact with the local maternity system will improve clinician confidence in the identification of FOC and facilitate the efficient implementation of treatment and support through the development of pathways of care.

Lessons to Build an Educational Model for Higher Education Institutions Defined as Anchor Institutions to Tackle Public Health Crises: A Pilot Study on COVID-19 Vaccine Hesitancy Among Faculty and Students in Hebert L. College in the Bronx, NY.

Coronavirus disease 2019 exacerbated health inequities in Bronx Communities. This study explored vaccine hesitancy among a random sample of faculty and students from Hebert Lehman College. Findings suggest faculty are largely vaccinated (87%), while 59% of students are unvaccinated. Significant gaps in information were found related to safety and complications. This suggests universities need to adopt an educational model with a multipronged social support strategy to gain students' trust and a greater sense of belonging.

COVID-19 exacerbó las desigualdades de salud en el Bronx. Herbert Lehman College, es uno de los campos del sistema de la ciudad de New York ubicado en el Bronx, con más del 60% de los estudiantes residiendo en el Bronx. En este estudio, se recolectó una muestra aleatoria de estudiantes y profesores de Lehman para entender la predisposición y resistencia a recibir la vacuna contra el COVID-19. Los resultados sugieren que la mayoría de los profesores reportan están vacunados, mientras que solo el 59% de los estudiantes reportan estar vacunados. Se encontraron lagunas significativas de información relacionadas con seguridad y complicaciones. Este estudio sugiere que las universidades necesitan adoptar un modelo educacional con estrategias de apoyo social múltiple para obtener confianza estudiantil y un mayor sentido de pertenencia.

Examining the psychometric properties of a refined perceived stress scale during the COVID-19 pandemic.

The Perceived Stress Scale (PSS) measures general life stress and the Impact of Events Scale (IES) measures retrospective stress from a specific event; both have been validated across various audiences and settings. However, neither measure stress during an evolving public health crisis. The aim was to refine the PSS to measure stress during an event (e.g. COVID-19 pandemic) and examine its psychometric properties within a 4-year Hispanic-Serving Institution in the Bronx, NY. Three items from the IES were added to and one PSS item was removed from the PSS-10, creating a new PSS-12. Cronbach's α for the scale was 0.902 for faculty and 0.903 for students, indicating high internal consistency. Factor analyses also supported calculation of two subtotals similarly across groups. The PSS-12 is a valid instrument to measure perceived stress during a public health crisis, particularly among populations that already experience community health disparities.

The Case for a Health at Every Size Approach for Chronic Disease Risk Reduction in Women of Color.

The conventional approach to chronic disease management in women of color is a dieting-for-weight-loss approach, which has not been proven to be effective. The purpose of this article is to highlight the shortcomings of the dieting-for-weight-loss approach and demonstrate the potential efficacy of the Health at Every Size approach when working with women of color to prevent and address chronic diseases. The article's areas of focus are weight stigma, bias, and size discrimination; the implications of differing weight perceptions and motivations for change; and weight as the primary determinant of health and biological factors affecting weight.

A Nationwide Snapshot of the Predictors of and Barriers to School Garden Success.

OBJECTIVE: To explore the degree and predictors of and barriers to school garden integration (termed success). DESIGN: A 30-item online survey consisting of demographic, garden characteristic, and barrier questions, as well as the School Garden Integration Scale, was conducted in 266 school garden organizations (13 national, 8 regional, and 245 state or local). PARTICIPANTS: A total of 414 school gardeners from 38 states and Puerto Rico. MAIN OUTCOME MEASURES: School garden success using the GREEN Tool. ANALYSIS: Descriptive statistics were used to determine the degree of success of school garden programs and explore barriers. Multiple regression analysis was conducted to determine independent predictors of school garden success. RESULTS: The average score was 37 (range 1-53, of a possible 57 points), indicating moderate success. Operating budget (P < .001), operating time (P < .05), and planting in-ground (P < .01) had a positive significant influence on success score, whereas rural location (P < .01) and lacking community interest (P < .01) had a negative significant influence, controlling for race/ethnicity, region, total garden investment, and Community Need Index score (a proxy for socioeconomic status). CONCLUSIONS AND IMPLICATIONS: Results indicate that success of school garden programs may be more difficult for the schools located in a rural area or in the absence of school or community-at-large interest. This study found that race/ethnicity of students and socioeconomic status are not related to success score, which is promising as other research indicates that successful school gardens may be especially impactful for low-income people of color. Causal research is needed to identify strategies that increase school garden success, with a focus on engaging key stakeholders (administrators, teachers, parents, the community at large, and garden coordinators).

School Gardens in the United States: Current Barriers to Integration and Sustainability.

OBJECTIVES: To elucidate details about the barriers (time, funding, staffing, and space) to integrating and sustaining school gardens. METHODS: A total of 99 school gardeners from 15 states participated in an online survey in June 2017. The 29-item survey contained qualitative and quantitative items that we analyzed using descriptive statistics and inductive content analysis. RESULTS: In order of greatest to least barrier, gardeners ranked time, staff, funding, curriculum, and space. Time for classes to use the garden (66% of respondents) and time for staff training (62%) were the most frequently listed time-related challenges. Respondents also reported low engagement within the school community. An overall lack of funding was the most common funding-related barrier, and gardeners were unaware of how to obtain more funding. CONCLUSIONS: We identified 3 aspects of school gardens as opportunities to address time- and staff-related issues: strengthening of garden committees, professional development, and community outreach. Better channels are needed to disseminate funding opportunities within schools and to communicate with communities at large. Ultimately, doing so will strengthen existing school gardens as a vehicle to promote dietary, physical, and social health within communities.

Predictors of School Garden Integration: Factors Critical to Gardening Success in New York City.

The purpose of this study was to determine the level of integration of school gardens and identify factors that predict integration. 211 New York City schools completed a survey that collected demographic information and utilized the School Garden Integration Scale. A mean garden integration score was calculated, and multiple regression analysis was conducted to determine independent predictors of integration and assess relationships between individual integration characteristics and budget. The average integration score was 34.1 (of 57 points) and ranged from 8 to 53. Operating budget had significant influence on integration score, controlling for all other factors ( p < .0001). Partner organizations, evaluation/feedback, planning the physical space, and characteristics of the physical space were positively and significantly related to budget. The results of this study indicate that any garden can become well integrated, as budget is a modifiable factor. When adequate funding is secured, a well-integrated garden may be established with proper planning and sound implementation.

Development of the GREEN (Garden Resources, Education, and Environment Nexus) Tool: An Evidence-Based Model for School Garden Integration.

BACKGROUND: Researchers have established the benefits of school gardens on students' academic achievement, dietary outcomes, physical activity, and psychosocial skills, yet limited research has been conducted about how school gardens become institutionalized and sustained. OBJECTIVE: Our aim was to develop a tool that captures how gardens are effectively established, integrated, and sustained in schools. DESIGN: We conducted a sequential, exploratory, mixed-methods study. Participants were identified with the help of Grow To Learn, the organization coordinating the New York City school garden initiative, and recruited via e-mail. PARTICIPANTS/SETTING: A stratified, purposeful sample of 21 New York City elementary and middle schools participated in this study throughout the 2013/2014 school year. The sample was stratified in their garden budgets and purposeful in that each of the schools' gardens were determined to be well integrated and sustained. MAIN OUTCOME MEASURES: The processes and strategies used by school gardeners to establish well-integrated school gardens were assessed via data collected from surveys, interviews, observations, and concept mapping. STATISTICAL ANALYSES PERFORMED: Descriptive statistics as well as multidimensional scaling and hierarchical cluster analysis were used to examine the survey and concept mapping data. Qualitative data analysis consisted of thematic coding, pattern matching, explanation building and cross-case synthesis. RESULTS: Nineteen components within four domains of school garden integration were found through the mixed-methods concept mapping analysis. When the analyses of other data were combined, relationships between domains and components emerged. These data resulted in the development of the GREEN (Garden Resources, Education, and Environment Nexus) Tool. CONCLUSIONS: When schools with integrated and sustained gardens were studied, patterns emerged about how gardeners achieve institutionalization through different combinations of critical components. These patterns are best described by the GREEN Tool, the first framework to identify how to operationalize school gardening components and describe an evidence-based strategy of successful school garden integration.