Fruits, vegetables and whole grains are important sources of nutrients for healthy growth and development of young children. Recent evidence suggests that sack lunches packed by parents for children to consume at childcare centers do not regularly meet the goal of one serving of fruit, vegetables and whole grains. Lunch is in the Bag is a childcare center-based nutrition education program targeted to parents of preschool-age children to increase the number of servings of fruits, vegetables and whole grains in sack lunches sent from home that was pilot tested in fall of 2008. In a quasi-experimental design, six childcare centers were paired by size before being randomly assigned to intervention (n=3) and comparison (n=3) groups. The parents of caregivers with primary responsibility for preparing the sack lunches of the three to five year old children attending the centers were enrolled as parent-child dyads. The intervention included parent handouts, classroom activities, educational stations and teacher training. The contents of the lunch sacks for both the intervention group and comparison group were recorded for three non-consecutive days before and immediately after the intervention period to measure the number of servings of fruits, vegetables and whole grains. A total of 132 parent-child dyads completed the study, 81 in the intervention group and 51 in the comparison group. Direct observation of children’s lunches from the intervention group showed an increase in predicted mean number of servings of vegetables, from 0.41 to 0.65 (P < 0.001) and whole grains, from 0.54 to 1.06 (P < 0.001). No significant difference was observed in the mean number of servings of fruit. Lunch is in the Bag which is designed to fit in the childcare environment and targets parents of three to five year old children is a feasible intervention for improving the nutritional quality of sack lunches.

The diversity of homeless people and the complexity of their problems challenge our understanding of how best to serve them. This article argues that disaffiliation and reaffiliation processes are keys to understanding entrenchment in homelessness and developing remediation strategies. Survey data collected from 166 homeless persons in Austin, Texas, identified four clusters: (1) the Recently Dislocated have small social networks and mild mental health problems; (2) the Vulnerable have been homeless longer, have fewer people in their social networks, and border on severe dysfunction; (3) the Outsiders have been homeless about as long as the Vulnerable but have much larger social networks and function as well as the Recently Dislocated; (4) the Prolonged have been homeless for more than five years, have few people in their networks, and appear moderately dysfunctional. Comparison of life experiences of these four groups provided information on the social processes leading toward entrenchment in homelessness.

Properly implemented school programs to prevent tobacco use and addiction can lower smoking prevalence up to 60%. However, numerous programs are not successful due to poor implementation. A system for estimating likelihood of future implementation fidelity of school-based prevention programs was tested using data collected at baseline and two year follow-up in 47 middle schools and high schools participating in the Texas Tobacco Prevention Initiative. The Bridge-It system includes an eight-factor, 36-item survey to analyze capacity for program implementation and a companion Bayesian model which provides estimations of likelihood of implementation fidelity several years after program initiation. The survey also asks about amount of implementing activity for each of the multiple components recommended in federal guidelines for school programs to prevent tobacco use. Criterion referenced cross-tabulations showed the system's forecast of implementation fidelity was correct in 74% of cases (p < .01). Model reliability was confirmed in regression analyses. Implementation fidelity at follow-up was predicted by the combination of the model's eight capacity factors at baseline. It includes program, implementation support, and non-program factors. Integration of the Bridge-It system, or comparable tools, into the dissemination and evaluation of school-based prevention programs can help to increase understanding of factors that influence implementation and provide guidance for capacity building. If administrators can identify at baseline schools likely to fall short of implementation goals, plans for resource allocation and provision of guidance, training, and technical assistance can be specifically tailored to identified needs.

The first author recruited parent-adolescent dyads (N = 192) into after-school prevention education groups at middle schools in southeast Texas. This author placed participants in either (1) an Interactive Program (IP) in which they role-played, practiced resistance skills, and held parent-child discussions or (2) an Attention Control Program (ACP) that used the same curriculum but was delivered in a traditional, didactic format. Questionnaires administered at the beginning and end of the 4-session program and again after booster sessions in 3 subsequent semesters provided measures of social controls (eg, communication with parents) and self controls (eg, protection against risk) on the youths' sexual health behaviors. Linear mixed models adjusted for gender, age, and ethnicity showed that the IP, in comparison with the ACP, achieved significant gains in social control by increasing parental rules about having sex and other risky behaviors and also enhanced students' selfcontrol by increasing their knowledge about prevention and enhancing resistance responses when pressured to have sex. Index Termsadolescent pregnancy prevention; HIV/STD prevention; parent involvement In a recent nationwide survey, nearly half (47%) of US youths aged 12 to 14 years said their parents influence their decisions about sex more than anyone else. 1 Nearly all (87%) said it would be much easier to postpone sexual activity and avoid teen pregnancy if they were able to have more open, honest conversations with their parents about sex, contraception, and pregnancy.A key strategy for leveraging the power of parents and increasing positive family interactions to reduce risks for teen pregnancy and sexually transmitted diseases (STDs), including HIV/ AIDS, is to involve parents and children in prevention education programs. Researchers 2-4 have found that parent-child interventions can have positive effects on children's knowledge and attitudes about sexual health, as well as improve parent-child communication. The research literature indicates less certainty regarding the longer-term effects of parent-child education programs. Recent reviews of the literature 5,6 revealed only 2 experimental studies of joint For comments and further information, address correspondence to Dr Regina P. Lederman, University of Texas Medical Branch, 301 University Blvd,

BackgroundLunches that parents pack for their young children to eat at school or the Early Care and Education (ECE) center fall short of recommended standards. Lunch is in the Bag is a multi-level behavioral nutrition intervention to increase parents’ packing of fruit, vegetables, and whole grains in their children’s lunches. Designed for implementation in ECE centers, the five-week long intervention is followed three months later with a one-week booster.MethodsEfficacy of Lunch is in the Bag was tested in cluster randomized trial. Participants were 633 families from 30 ECE centers (15 intervention, 15 control) across Austin, San Antonio, and Houston, Texas, USA. Primary outcomes were servings of fruit, vegetables, and whole grains observed in the children’s parent-packed bag lunches. Servings of refined grains, meats/beans/eggs/nuts, dairy, chips, and sweets also were observed. Data were collected at baseline, post-intervention (6-week follow-up), pre-booster (22-weeks follow-up), and post-booster (28-week follow-up). Time-by-treatment interactions were analyzed separately for each of the food groups using multi-level models to compare changes from baseline. Analyses were adjusted for relevant demographic variables and clustering within centers and parents.ResultsThe intervention effected increases from baseline to 6-week follow-up in vegetables (0.17 servings, SE = 0.04, P < 0.001) and whole grains (0.30 servings, SE = 0.13, P = 0.018). The increase in whole grains was maintained through the 28-week follow-up (0.34 servings, SE = 0.13, P = 0.009). Fruit averaged more than 1.40 servings with no differences between groups or across time. The intervention prevented increase in sweets (-0.43 servings, SE = 0.11, P < .001, at the 22-week follow-up). Parents persisted, however, in packing small amounts of vegetables (averages of 0.41 to 0.52 servings) and large amounts of sweets and chips (averages of 1.75 to 1.99 servings).ConclusionsThe need for and positive effects of the Lunch is in the Bag intervention at ECE centers where parents send bag lunch for their preschool-aged children was confirmed. An important direction for future research is discovery of more options for leveraging the partnership of ECE centers and families to help young children learn to eat and enjoy vegetables and other healthy foods in preference to less healthy choices such as chips and sweets.Trial registrationThe Clinical Trials Number is NCT01292434.