Month: June 2017

Health Geographer Debarchana Ghosh and Student Mengyao Zhang Use GIS Mapping to Explore the Impact of Supermarket “Redlining” on Healthy Food Access in Hartford

By Loretta Waldman

Spatial Distribution of Supermarket Redlining Model (SuRIM)

“Redlining” is the illegal discriminatory practice of denying services to residents of certain areas based on the racial or ethnic composition of those areas, and it is most commonly associated with the banking, insurance, and real estate industries. In a less common use of the concept, InCHIP Principal Investigator Debarchana Ghosh, PhD (Geography) and her graduate student Mengyao Zhang, examined how “supermarket redlining” has limited the access that residents of Hartford’s low-income neighborhoods have to fresh nutritious foods.

“Supermarket redlining” is a term used to describe a phenomenon where major chain supermarkets are disinclined to locate their stores in inner cities or low-income neighborhoods and move their existing stores out of those locations and relocate them to suburbs. The reasons for supermarket redlining are many and varied including lower demand; the higher cost of urban land, labor, and utilities; lower profit margins associated with perishable foods; the risk of theft in inner cities; the challenge of finding locations big enough to accommodate a new building of 50,000 square feet or more; and competition from other investments, such as the plan for a new $60 million baseball stadium that the city of Hartford chose to pursue instead of a new grocery store at the same location.

Ghosh and Zhang used a combination of quantitative data analysis and Geographic Information System (GIS) mapping technology to study the relationship between geography or “location” and healthy food access in Hartford. They chose to study this practice because there is limited empirical data on the health impact of supermarket redlining. The findings from this study were published in 2016 in Transactions in GIS, and according to Dr. Ghosh, it is the first study to use potential spatial supermarket “redlining” as an indicator of risk for food insecurity and “food deserts” (locations where affordable and healthy food is difficult to access).

Rather than focus on a particular racial or ethnic group, Ghosh and Zhang examined all low-income people with limited access to affordable healthy food in Hartford. The primary focus of their research was on the spatial segregation or discrimination caused by chain supermarkets either closing or relocating to the suburbs. Ghosh and Zhang first calculated a “Supermarket Redlining Index” (SuRI) from five indicators to rank supermarkets in order of importance. These indicators included sales volume, employee count, acceptance of food coupons from the SNAP and WIC government assistance programs, and the size and population density of the service area. To understand the effects of supermarket closures, they next built a Supermarket Redlining Impact Model (SuRIM) using 11 indicators describing both socioeconomic and food access vulnerabilities, the interaction of which identified neighborhoods maximally impacted by spatial supermarket redlining.

The results of the study mapped critical areas of inner city Hartford where, if a nearby supermarket were to close down or relocate to the suburbs, large numbers of minority poor and disadvantaged residents would have difficulty accessing food, leading to food insecurity and perhaps a food desert. “These are the areas in the northwest of the city, basically upper downtown and north of downtown,” Dr. Ghosh explained, “…that are really critical in terms of becoming food deserts. We found out there will be a real problem in terms of accessing nutritious food and that efforts will be needed to reduce the impact of larger supermarket closures.” According to a Federal Government survey, there has been a steady rise in the percentage of households in Connecticut with food insecurity, from 7.6% in 2000-2002 to 13.4% in 2010-2012. Of those households, 36.6 percent were considered at a critical level of food insecurity. In Harford, 11 of the city’s 13 supermarkets – 85% – left the city between 1968 and 1984, and few supermarkets have opened to replace them.

Residents that live in neighborhoods where there is a cluster of large supermarkets in close proximity are less vulnerable to food insecurity when a supermarket closes or relocates, but these neighborhoods tend to be more affluent suburban neighborhoods (e.g., northwest of West Hartford, Newington, south of Wethersfield). In low-income neighborhoods, there are few supermarket options, so when a supermarket closes, only those residents who have the resources to travel the extra miles to an alternate supermarket are less vulnerable to food insecurity. Given that supermarket chains are unlikely to invest in opening new stores in these areas, mitigation efforts to minimize food insecurity and relative negative health outcomes are critical.  Ghosh and Zhang’s recommendations for improving access in these neighborhoods include investing more in fresh food stocks at the existing local medium- to small-sized grocery stores and corner stores, and encouraging more urban farms and community gardens to increase options for healthy foods for at least a few months of the year.

Study Suggests Weight Loss Outcomes Improve when Participants Increase Breakfast Eating but Not Eating Frequency

By Loretta Waldman

The interplay between breakfast eating, eating frequency, and long-term weight loss was the focus of a recent study by Associate Professor of Allied Health Sciences and InCHIP Principal Investigator Tricia Leahey, PhD. In a paper published in January 2017 in the Journal of Behavioral Medicine, Dr. Leahey and her co-authors shared the results of a two-year study suggesting that increasing breakfast eating while simultaneously reducing or maintaining eating frequency, may influence weight management outcomes.

Their findings built on previous research that looked at breakfast eating alone in connection with weight loss. What makes this study novel is that it simultaneously examines breakfast eating and  frequency of food consumption.  “These two areas haven’t spoken to each other much,” explained Dr. Leahey, Principal Investigator of the study. “Breakfast eating has been one body of work, and eating frequency has been another. This is the first study that looks at both in concert to see if they interact with one another.”

Dr. Leahey specializes in obesity research with a focus on lifestyle interventions, including behavioral strategies to promote healthy eating, reduce caloric intake, and increase physical activity. Her collaborators on this study were Rena Wing, PhD, Professor of Psychiatry and Human Behavior at Brown University, and Maureen Megson, an UConn undergraduate Honors student who graduated in 2016 and is first author on this paper.

This study was part of a larger trial, on which Dr. Leahey is the Principal Investigator, examining the effects of adding behavioral weight loss strategies to Shape Up Rhode Island (SURI). SURI is a statewide exercise and weight loss program founded in 2005 by Rajiv Kumar, MD that uses teamwork and peer support to increase healthy behavior. A total of 230 study participants were recruited for the trial through local employers and mass media; eligibility was based on age, body mass index and other criteria. Participants were randomly assigned to one of three invention conditions for a period of three months: (1) SURI alone, (2) SURI and an Internet behavioral weight loss program, or (3) SURI, an Internet behavioral weight loss program, and optional group meetings.

This study examined the effects of breakfast eating and total eating frequency on baseline Body Mass Index (BMI) and weight loss outcomes in adults with overweight or obesity who were seeking weight loss treatment. The results revealed that breakfast eating during treatment was significantly associated with better weight loss outcomes. More specifically, those who achieved the 5 percent NIH benchmark for a clinically meaningful weight loss during treatment had greater increases in breakfast eating compared to those who did not achieve this benchmark. Additionally, among participants who increased breakfast eating, those who had either no change or a decrease in total daily eating frequency (meals plus snacks) were more likely to achieve a 5 percent weight loss compared to those who had an increase in total daily eating frequency.

The findings are consistent with previous trials showing breakfast eating improves weight loss outcomes and with findings of the National Weight Control Registry demonstrating that breakfast eating is an important behavior for successful long-term weight control. They are also consistent with other studies that found no evidence that frequency of food consumption alone has an effect on overall weight loss outcomes.

This study opens up some novel areas for future research, according to Dr. Leahey, and underscores the importance of taking eating frequency variables into consideration when prescribing breakfast eating.  “The research on the effects of breakfast eating on weight loss outcomes has been somewhat mixed. This study suggests that we may get more consistent results that are more conclusive, if we take into consideration frequency of eating when it comes to breakfast eating. Instead of only suggesting people eat breakfast more often, it’s also important to tell them to keep an eye on overall intake, so it doesn’t increase as well. So add in the breakfast, take out a snack or just make sure you’re not adding in extra meal times.”

The findings from this study are very relevant to research that Dr. Leahey is now doing with young adults, aged 18 to 25. Young adults tend to engage in several negative health behaviors, such as drinking, regularly eating fast food, and skipping breakfast, all of which contribute to weight gain and may adversely affect weight management efforts. The results from Dr. Leahey’s adult breakfast eating study could inform weight management strategies that are suggested to young adults.


InCHIP Researcher Valerie Duffy Instrumental in Getting Taste and Smell Measures into Major National U.S. Health Survey

By Loretta Waldman

The importance of smell and taste is underappreciated, according to Valerie Duffy, Professor of Allied Health Sciences and InCHIP Principal Investigator. These senses enable us to detect pleasurable and unpleasant aromas as well as warning odors, such as the smell of natural gas. They also trigger specific memories and emotions, and drive what we like and choose to eat. These “forgotten” senses play significant roles in our lives, which is why Dr. Duffy was so excited about the addition of a chemosensory component to the National Health and Nutrition Examination Survey (NHANES) protocol.

NHANES is a survey research program conducted by CDC’s National Center for Health Statistics (NCHS), which assesses the health and nutritional status of adults and children in the United States and tracks changes over time. The very first NHANES protocol was conducted in 1971, and it has been administered annually since 1999. It is the primary way that researchers monitor the health of the U.S. population, including the prevalence of major diseases and risk factors for diseases.

The 2011-2014 NHANES was the first battery of assessments in which taste and smell assessments were included, and this change is due in large part to the efforts of Dr. Duffy and her team: former UConn graduate student Shristi Rawal, PhD at National Institute of Child Health and Human Development (NICHD), and Howard Hoffman, MA at National Institute on Deafness and other Communication Disorders (NIDCD). The addition of chemosensory assessments to the NHANES has created new opportunities for data collection and analysis, such as estimating the prevalence and risks of smell and taste alterations, and the associations between smell and taste perception and a wide range of measures of health and well-being.

Over the last year, Dr. Duffy and her team have published articles using the data from the NHANES survey, including a paper published in Reviews of Endocrine and Metabolic Disorders that provides an overview of the NHANES taste and smell protocol and reports on the first results from the 2012 NHANES olfactory exam findings, including the prevalence of olfactory dysfunction. The 2012 NHANES involved the collection of questionnaire and clinical measures from a nationally-representative sample of the non-institutionalized, civilian U.S. population. The sample for Duffy’s olfactory study consisted of 1281 adults, aged 40 years and over, who completed the 8-item odor identification test (Pocket Smell Test or PST) along with the Chemosensory Questionnaire (CSQ), which assesses perceived smell and taste problems. Olfactory dysfunction was found in 12.4% (55% males/45% females) of participants, including 4.2% of 40- to 49-year-olds, 12.7% of 60- to 69-year-olds, and 39.4% of those 80 years and older. Among adults aged 70 years and older, misidentification rates for warning odors were 20.3% for smoke and 31.3% for natural gas. “For the first time, we have evidence of smell impairment that is equal to vision and hearing,” stated Dr. Duffy. “When we have over 30% of people over 70 who can’t smell a natural gas warning odor, it’s a problem. This new knowledge supports the need for advances in public health, clinical care, and research to address smell impairment in health promotion and disease prevention efforts.”

The taste measure used in the NHANES survey was developed by Dr. Duffy after many years of collecting data in her lab at UConn. She recently published a paper in the journal Obesity, where she used that measure, among others, to model associations between taste and obesity among women with self-reported histories of risks factors for altered taste functioning: tonsillectomy, multiple ear infections, and head trauma. There is evidence from other studies that certain health conditions may lead to taste damage which in turn may alter food preferences and increase the risk for obesity. Dr. Duffy wanted to try to better understand this relationship, so she studied a sample of 407 women, 24% of whom had elevated waist circumferences, and 39% had overweight or obesity. Dr. Duffy and her colleagues, Dr. Rawal, Mr. Hoffman, and InCHIP researcher Tania Huedo-Medina, PhD (Allied Health Sciences) found that abdominal obesity was directly linked with a history of tonsillectomy and multiple ear infections and also directly linked with lower taste functioning. In addition, risk factors for taste alterations were significantly associated with lower taste functioning, with taste mediating the association between head trauma and reduced body fat. Dr. Duffy intends to confirm these findings with other population-based studies, including the National Health and Nutrition Examination Survey 2013-2014 taste data.

Study Led by Crystal Park Compares Stress Management Strategies for Female College Freshman

By Loretta Waldman

Across the United States, the rates of college students experiencing psychological difficulties such as anxiety, panic attacks, and severe stress have greatly increased. Students juggle a myriad of demands, including financial responsibilities, school-work-life balance, parental expectations, and the pressure of career decisions, all while undergoing the challenging transition into independence and self-sufficiency.

Professor of Psychological Sciences and InCHIP Principal Investigator Crystal Park, PhD has long been interested in the broad mental health and well-being of college students and the variety of strategies that can be undertaken when coping with stress. In recent years, she has also been investigating mind-body relationships, particularly the science of yoga and its impact on physical and mental health.

Dr. Park’s forthcoming article in the Journal of Applied Behavioral Research combines these two interests in an examination of the use of yoga by college-aged women as an effective coping strategy for stress. She worked collaboratively on this study with a team of researchers that included Co-Investigator Linda Pescatello, PhD, FACSM (Kinesiology); UConn graduate students Kristen Riley, Tosca Braun, Ji Yeon Jung, Hyungyung G. Suh; and University of Miami colleague, Michael Antoni, PhD. Together they examined the feasibility and differential efficacy of yoga and Cognitive Behavioral Stress Management (CBSM) in reducing stress and improving mental and physical health in first-year college students. Yoga is increasingly popular as a health-promoting activity, but little research has examined how it affects college students. CBSM is a short-term therapeutic approach that focuses on how people’s thoughts affect their emotions and behaviors.

Thirty-four incoming first-year female students were assigned to eight weeks of yoga, CBSM, or a wait-list control. Participants were assessed prior to the start of the intervention, at the conclusion of the 8-week intervention, and then four months after it ended. The results indicated that relative to the control group, both CBSM and yoga produced positive changes in psychosocial and behavioral health as well as in health-related measures of physical function and activity. Although yoga was rated as more helpful by the participants than CBSM when assessed immediately after the intervention, both methods were perceived as equally helpful at the four-month follow-up. Most importantly, both interventions appeared to offer benefits to first semester, first-year women in the midst of a major life transition when stress is high and opportunities to establish healthy lifestyle and coping patterns are readily available.

“I think the bottom line is that both interventions relative to control were useful,” said Park. “These kinds of inexpensive, easy-to-implement programs should be more available to incoming college students…. I know the effects of stress on people and the toll that it takes mentally and physically. People have problems sleeping and with academics. There are so many ways that stress negatively impacts people, so the notion that there is something relatively easy to implement and that is readily disseminated, I think that would reach of a lot of people and potentially do a lot of good in terms of preventive mental and physical health. That’s ultimately where I would like to see this go.”

Researchers have been testing campus stress management programs for decades, but most of those programs have been based on Cognitive-Behavioral Therapy principles and designed to help individuals identify and modify dysfunctional beliefs that trigger distress. Yoga is another method of stress-management that is becoming increasingly popular among college students in the U.S., but rarely have its health benefits been studied in that population. This study is one of the first to demonstrate yoga’s potential with college students as a stress management measure.

“We are getting people right when they are coming to campus, so they had not been identified as being at particularly high risk of having other problems,” stated Dr. Park. “I think this suggests that being proactive can be very helpful for people who are facing potentially stressful situations.”

Promoting Healthcare Access for Refugees and the Underserved is a Mission for Tom Buckley

By Loretta Waldman

Tom Buckley, MPH, RPh

Associate Clinical Professor of Pharmacy Practice and InCHIP Principal Investigator (PI) Tom Buckley, MPH, RPh has had a career path that is anything but conventional. Prior to joining the UConn faculty about 10 years ago, Buckley monitored public health outcomes for a major pharmaceutical company. He left that job to return as a volunteer to a refugee camp near the Thailand/Burma border, where he had previously completed a fellowship with the International Refugee Committee – the second of four trips to Southeast Asia to work with refugees.

Dr. Buckley’s prior work with refugees had a profound impact on his research, which focuses predominantly on healthcare equity and health disparities among immigrants/refugees and other underserved populations in the U.S. Approximately half of his research is with Khmer Health Advocates, the only Cambodian-American health organization in the country, and the other half is with community pharmacies in Connecticut, where he has created a community pharmacy practice research network.

At Khmer Health, Buckley is applying what he learned working with Burmese refugees to help the Cambodian immigrant and refugee community in Connecticut and throughout the country, many of whom struggle with the effects of trauma and torture. Located in West Hartford, Khmer Health had never had a pharmacist before Buckley’s arrival, and he quickly saw an opportunity to help clients better manage the many medications they were taking for diabetes, hypertension and other conditions linked to their post-traumatic stress. The prevalence of depression and PTSD (Post-Traumatic Stress Disorder) in the Cambodian-American immigrant/refugee population is more than 10 times the national average, and they experience rates of hypertension, heart disease, diabetes, and stroke and death from diabetic complications at a rate six times greater than the overall population. With the help of grants from the Centers for Disease Control (CDC), National Institutes of Health, Connecticut Department of Public Health (CT DPH), and private foundations, Buckley has expanded his public health work to include a host of initiatives within refugee communities.

One of Dr. Buckley’s initiatives involved creating a clinical rotation for fourth-year pharmacy students at KHA that pairs them with Cambodian-American community health workers for client home visits and to a Buddhist Temple in Bristol to visit with monks. He also was the PI on a study funded through the Center for Technology and Aging that tested the effectiveness of teleconferencing and other technologies in connecting older Cambodian-Americans living in Connecticut, Massachusetts, and California with medication therapy management services at Khmer Health Advocates.

Currently, Dr. Buckley is collaborating with Julie Wagner, Associate Professor of Oral Health and Diagnostic Sciences at UConn Health and an InCHIP PI, on a study aimed at preventing the onset of diabetes in Cambodian Americans with pre-diabetes. Along with intensive medication management, participants in two of the three arms of the so-called DREAM study will be offered a culturally-formulated lifestyle intervention called Eat, Walk, Sleep. They are recruiting adult Cambodian-Americans with major depressive disorder and associated functional impairment at high risk for Type 2 diabetes, from a network of community-based organizations in Connecticut, Rhode Island and Massachusetts. The goal of the study, which will offer some participants home visits and visits via teleconferencing, is to determine if combined strategies reduce the risk for diabetes in a population with numerous diabetes risk factors related to depression.

Dr. Buckley is also working with Megan Berthold, Assistant Professor in the School of Social Work and an InCHIP PI, on a grant project with KHA to specifically identify health equity issues and barriers in Southeast Asian Limited English speaking patients. Using surveys, interviews, and focus groups with community members and healthcare professionals, the goal is to develop policy initiatives to directly address health equity issues in these communities.

As for community pharmacies, Dr. Buckley currently has three projects funded through grants from the CDC and CT DPH. One of the grants will provide the funding for pharmacists to provide comprehensive medication management for patients with complex chronic conditions, including diabetes and hypertension. The pharmacist will spend an hour with the patient and then follow up with him/her.

Another study, conducted in partnership with Optimus Health Care and Bridgeport Pharmacy, focuses on screening African American mostly men, for hypertension. Funded with a grant from the CDC, through the Association of State and Territorial Health Organizations (ASTHO), this study sent trained Community Health Workers (CHWs) into barbershops, car washes, churches, and laundromats to conduct screenings. Armed with tablets and blood pressure cuffs, the CHWs took blood pressure measurements and registered participants with previously undiagnosed high blood pressure to see a doctor at Optimus Health Care. For the vast majority of these individuals, it was the first time they had seen a physician. As part of that study, Dr. Buckley worked with Optimus and the pharmacy to identify individuals already diagnosed and previously treated for high blood pressure but whose blood pressure was currently uncontrolled. “The pharmacist brought those people into the pharmacy, and they were able to get 80% of them to blood pressure goal,” he said.

Buckley often tells his students that pharmacists are the most accessible healthcare professionals but are often underutilized for their professional expertise. “You can walk into one of these pharmacies and theoretically get free medication information,” he said. “Data shows that there are more than 300 million visits to pharmacies in the U.S. every week. So if the pharmacist is truly the most accessible healthcare provider,… how do we get underserved people with the least access to appropriate care – whether it’s culturally or linguistically appropriate care, or just care in general for the English-speaking population – how do we get them linked to that resource which is so accessible and valuable but underutilized?”

Making that happen is Tom Buckley’s mission.












Workshop in Havana, Cuba Fosters Development of Collaborative Relationships and Commitment to Pursue Important Research Projects in Health Behavior

By Loretta Waldman

Cuban and UConn Collaborators on final day of Workshop

In March 2017, a delegation of nine UConn faculty members who are InCHIP affiliates traveled to Cuba for a five-day networking workshop designed to develop collaborative relationships between investigators at UConn and their counterparts in Cuba.  A total of 10 researchers from Cuba, representing multiple institutions in Cuba, took part in the five-day workshop, with another ten Cuban researchers taking part for one day.

This workshop represented the culmination of months of effort by InCHIP Affiliate Tania Huedo-Medina, PhD (Allied Health Sciences and Statistics), InCHIP Director Jeffrey Fisher, PhD (Psychological Sciences), UConn Global Affairs, and numerous other UConn faculty and staff, who worked diligently with those in Cuba to lay the groundwork for this very important workshop. Funding for the workshop was generously provided by Global Affairs, Office of the Vice President of Research, and InCHIP.

The workshop, which was co-hosted by InCHIP and the Cuban Society of Psychology, began with a meet-and-greet on the evening of Sunday, March 12 and ran through Friday, March 17. Over the course of the five-day workshop, researchers from both countries made presentations about their research and took part in brainstorming sessions focused on identifying the gaps in the state of science and areas for future fruitful joint investigation. The primary goal of the trip was to foster the development of collaborative research projects between Cuban and UConn investigators in the areas of HIV, obesity, cancer, and substance use. And that goal was achieved, according to Dr. Fisher who attended the workshop: “The trip was extremely successful. We developed some wonderful partnerships with our Cuban colleagues, and we are excited about the work that we are going to do together.”

Rick Gibbons
UConn Professor and InCHIP PI Rick Gibbons presenting at Workshop

Beyond these four studies, UConn faculty have continued working with Cuban investigators to identify common areas of interest and begin other projects. For example, InCHIP Principal Investigator Michael Copenhaver, PhD (Allied Health Sciences) is now collaborating with several Cuban investigators whom he met in Havana, on the development of a culturally-appropriate measure of neurocognitive impairment that can be used to assess the capacity of patients with HIV to fully understand and participate in various care and treatment programs.

The University of Havana, Universidad Central “Marta Abreau” de Las Villas, Universidad de Oriente-Santiago de Cuba, and Hermanos Ameijeiras University Surgical Hospital were among the Cuban institutions represented at the workshop. In addition to Dr. Fisher and Dr. Copenhaver, the following UConn researchers participated in the workshop:  Lisa Butler, Associate Research Professor and InCHIP PI; Deborah Cornman, InCHIP Associate Director and Associate Research Professor; Michael Fendrich, Associate Dean for Research and Professor at School of Social Work and InCHIP affiliate; Kim Gans, Professor of Human Development and Family Studies and InCHIP PI; Meg Gerrard, Research Professor of Psychological Sciences and InCHIP PI; Debarchana Ghosh, Associate Professor of Geography and InCHIP PI; and Rick Gibbons, Professor of Psychological Sciences and InCHIP PI.

The collaborative projects that came out of the workshop not only address important public health issues in Cuba, they provide an opportunity for UConn and Cuban researchers to exchange research expertise, methodological innovations, and insights about the two cultures that, until recently, the Cuban and U.S. research communities had not been able to do. “Cultural, geographic, and language differences do not need to be barriers to researchers working together on common public health issues,” stated Dr. Cornman. “This trip will hopefully mark the beginning of long-lasting research partnerships that will benefit the various investigators and universities involved, and the U.S. and Cuban nations as a whole.”

Announcement of UConn Collaboratory on School and Child Health Grant Awardees

The UConn Collaboratory on School and Child Health (CSCH) is pleased to announce and congratulate the two awardees of our FY17 seed grant competition. These grants provide funds to investigators to support projects that align with the vision of CSCH to promote an integrated approach to health and learning through collaborations across the components within the Whole School, Whole Community, Whole Child (WSCC) model. They are intended for projects that can lead to innovative external grant applications. Eligible applicants were InCHIP members, with CSCH affiliation. Drs. Amy Mobley and Marlene Schwartz are the recipients of the $10,000 grants.

Dr. Amy Mobley, an Assistant Professor in the Department of Nutritional Sciences, and her co-investigators are studying the impact of local foods on elementary school students’ nutrition behaviors. The first phase of the project will determine the salient reasons that may motivate elementary school students’ to choose to eat local foods in their school. The second phase of the project will involve evaluating a local food procurement intervention on students’ nutrition health behaviors in low socioeconomic schools in Connecticut.

Dr. Marlene Schwartz is Director of the UConn Rudd Center for Food Policy and Obesity and Professor in the Department of Human Development and Family Studies. She will be creating a WSCC Policy Assessment Tool that captures and scores all of the school policies relevant to the WSCC model. In creating this WSCC tool, she will follow the framework she used to create the already existing Wellness School Assessment Tool ( that measures and scores the strength of school district wellness policies.

We wish to thank all of the applicants for their excellent proposals and the review committee members for their substantial contributions to the seed grant competitions.