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Poppitt SD. Beverage Consumption: Are Alcoholic and Sugary Drinks Tipping the Balance towards Overweight and Obesity? Nutrients 2015; 7:6700-18. [PMID: 26270675 PMCID: PMC4555143 DOI: 10.3390/nu7085304] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Revised: 07/21/2015] [Accepted: 07/21/2015] [Indexed: 01/03/2023] Open
Abstract
The role that energy-containing beverages may play in the development of overweight and obesity remains highly controversial, in particular the alcoholic and sugar-sweetened beverages (SSB). Both of these beverage formats have been increasing as a percentage of the westernized diet over the past 20 years, and both have contributed significantly to an increase in energy consumed in liquid form. Data from epidemiology and intervention studies however have long been contradictory, despite mechanistic evidence pointing towards poor compensation for addition of "liquid" energy from these two sources into the diet providing a strong rational for the balance to be tipped towards weight gain. Regulatory and government intervention has been increasing globally, particularly with respect to intake of SSBs in children. This narrative review presents evidence which both supports and refutes the link between alcohol and carbohydrate-containing liquids and the regulation of body weight, and investigates mechanisms which may underpin any relationship between increased beverage consumption and increased energy intake, body weight and adiposity.
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Affiliation(s)
- Sally D Poppitt
- Human Nutrition Unit, School of Biological Sciences, Department of Medicine, University of Auckland, Auckland 1024, New Zealand.
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Hoffman JA, Rosenfeld L, Schmidt N, Cohen JFW, Gorski M, Chaffee R, Smith L, Rimm EB. Implementation of Competitive Food and Beverage Standards in a Sample of Massachusetts Schools: The NOURISH Study (Nutrition Opportunities to Understand Reforms Involving Student Health). J Acad Nutr Diet 2015; 115:1299-307.e2. [PMID: 26210085 PMCID: PMC4545612 DOI: 10.1016/j.jand.2015.04.019] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Accepted: 04/21/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND During 2012, Massachusetts adopted comprehensive school competitive food and beverage standards that closely align with Institute of Medicine recommendations and Smart Snacks in School national standards. OBJECTIVE We examined the extent to which a sample of Massachusetts middle schools and high schools sold foods and beverages that were compliant with the state competitive food and beverage standards after the first year of implementation, and complied with four additional aspects of the regulations. DESIGN Observational cohort study with data collected before implementation (Spring 2012) and 1 year after implementation (Spring 2013). PARTICIPANTS/SETTING School districts (N=37) with at least one middle school and one high school participated. MAIN OUTCOME MEASURES Percent of competitive foods and beverages that were compliant with Massachusetts standards and compliance with four additional aspects of the regulations. Data were collected via school site visits and a foodservice director questionnaire. STATISTICAL ANALYSES PERFORMED Multilevel models were used to examine change in food and beverage compliance over time. RESULTS More products were available in high schools than middle schools at both time points. The number of competitive beverages and several categories of competitive food products sold in the sample of Massachusetts schools decreased following the implementation of the standards. Multilevel models demonstrated a 47-percentage-point increase in food and 46-percentage-point increase in beverage compliance in Massachusetts schools from 2012 to 2013. Overall, total compliance was higher for beverages than foods. CONCLUSIONS This study of a group of Massachusetts schools demonstrated the feasibility of schools making substantial changes in response to requirements for healthier competitive foods, even in the first year of implementation.
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Taber DR, Chriqui JF, Vuillaume R, Kelder SH, Chaloupka FJ. The association between state bans on soda only and adolescent substitution with other sugar-sweetened beverages: a cross-sectional study. Int J Behav Nutr Phys Act 2015; 12 Suppl 1:S7. [PMID: 26221969 PMCID: PMC4658713 DOI: 10.1186/1479-5868-12-s1-s7] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND Across the United States, many states have actively banned the sale of soda in high schools, and evidence suggests that students' in-school access to soda has declined as a result. However, schools may be substituting soda with other sugar-sweetened beverages (SSBs), and national trends indicate that adolescents are consuming more sports drinks and energy drinks. This study examined whether students consumed more non-soda SSBs in states that banned the sale of soda in school. METHODS Student data on consumption of various SSBs and in-school access to vending machines that sold SSBs were obtained from the National Youth Physical Activity and Nutrition Study (NYPANS), conducted in 2010. Student data were linked to state laws regarding the sale of soda in school in 2010. Students were cross-classified based on their access to vending machines and whether their state banned soda in school, creating 4 comparison groups. Zero-inflated negative binomial models were used to compare these 4 groups with respect to students’ self-reported consumption of diet soda, sports drinks, energy drinks, coffee/tea, or other SSBs. Students who had access to vending machines in a state that did not ban soda were the reference group. Models were adjusted for race/ethnicity, sex, grade, home food access, state median income, and U.S. Census region. RESULTS Students consumed more servings of sports drinks, energy drinks, coffee/tea, and other SSBs if they resided in a state that banned soda in school but attended a school with vending machines that sold other SSBs. Similar results were observed where schools did not have vending machines but the state allowed soda to be sold in school. Intake was generally not elevated where both states and schools limited SSB availability – i.e., states banned soda and schools did not have SSB vending machines. CONCLUSION State laws that ban soda but allow other SSBs may lead students to substitute other non-soda SSBs. Additional longitudinal research is needed to confirm this. Elevated SSB intake was not observed when both states and schools took steps to remove SSBs from school.
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Affiliation(s)
- Daniel R Taber
- Institute for Health Research and Policy, University of Illinois at Chicago,1747 West Roosevelt Road, Chicago, IL 60608 Chicago, IL, USA
- Michael & Susan Dell Center for Healthy Living, The University of Texas School of Public Health Austin Regional Campus, 1616 Guadalupe St. Austin, TX 78701, USA
| | - Jamie F Chriqui
- Institute for Health Research and Policy, University of Illinois at Chicago,1747 West Roosevelt Road, Chicago, IL 60608 Chicago, IL, USA
- Department of Health Policy and Administration, University of Illinois at Chicago, Chicago, IL, USA
| | - Renee Vuillaume
- Harvard University John F. Kennedy School of Government, 79 John F. Kennedy Street, Cambridge, MA 02138, USA
| | - Steven H Kelder
- Michael & Susan Dell Center for Healthy Living, The University of Texas School of Public Health Austin Regional Campus, 1616 Guadalupe St. Austin, TX 78701, USA
| | - Frank J Chaloupka
- Institute for Health Research and Policy, University of Illinois at Chicago,1747 West Roosevelt Road, Chicago, IL 60608 Chicago, IL, USA
- Department of Economics, University of Illinois at Chicago, Chicago, IL, 601 South Morgan UH725 M/C144, Chicago, IL 60607, USA
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Studdert DM, Flanders J, Mello MM. Searching for Public Health Law's Sweet Spot: The Regulation of Sugar-Sweetened Beverages. PLoS Med 2015; 12:e1001848. [PMID: 26151360 PMCID: PMC4494810 DOI: 10.1371/journal.pmed.1001848] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
David Studdert and colleagues explore how to balance public health, individual freedom, and good government when it comes to sugar-sweetened drinks.
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Affiliation(s)
- David M. Studdert
- Stanford Law School, Stanford, California, United States of America
- Center for Health Policy/PCOR, Department of Medicine, Stanford University School of Medicine, Stanford, California, United States of America
- * E-mail:
| | - Jordan Flanders
- Stanford Law School, Stanford, California, United States of America
| | - Michelle M. Mello
- Stanford Law School, Stanford, California, United States of America
- Department of Health Research and Policy, Stanford University School of Medicine, Stanford, California, United States of America
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Abstract
Prevention of obesity requires policies that work. In this Series paper, we propose a new way to understand how food policies could be made to work more effectively for obesity prevention. Our approach draws on evidence from a range of disciplines (psychology, economics, and public health nutrition) to develop a theory of change to understand how food policies work. We focus on one of the key determinants of obesity: diet. The evidence we review suggests that the interaction between human food preferences and the environment in which those preferences are learned, expressed, and reassessed has a central role. We identify four mechanisms through which food policies can affect diet: providing an enabling environment for learning of healthy preferences, overcoming barriers to the expression of healthy preferences, encouraging people to reassess existing unhealthy preferences at the point-of-purchase, and stimulating a food-systems response. We explore how actions in three specific policy areas (school settings, economic instruments, and nutrition labelling) work through these mechanisms, and draw implications for more effective policy design. We find that effective food-policy actions are those that lead to positive changes to food, social, and information environments and the systems that underpin them. Effective food-policy actions are tailored to the preference, behavioural, socioeconomic, and demographic characteristics of the people they seek to support, are designed to work through the mechanisms through which they have greatest effect, and are implemented as part of a combination of mutually reinforcing actions. Moving forward, priorities should include comprehensive policy actions that create an enabling environment for infants and children to learn healthy food preferences and targeted actions that enable disadvantaged populations to overcome barriers to meeting healthy preferences. Policy assessments should be carefully designed on the basis of a theory of change, using indicators of progress along the various pathways towards the long-term goal of reducing obesity rates.
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Affiliation(s)
| | - Trenton G Smith
- Department of Economics, University of Otago, Dunedin, New Zealand
| | - Jo Jewell
- World Cancer Research Fund International, London, UK
| | - Jane Wardle
- Health Behaviour Research Centre, Department of Epidemiology & Public Health, University College London, London, UK
| | - Ross A Hammond
- Center on Social Dynamics and Policy, The Brookings Institution, Washington, DC, USA
| | - Sharon Friel
- Regulatory Institutions Network, The Australian National University, Canberra, ACT, Australia
| | - Anne Marie Thow
- Menzies Centre for Health Policy, University of Sydney, Sydney, NSW, Australia
| | - Juliana Kain
- Institute of Nutrition and Food Technology, University of Chile, Santiago, Chile
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Ritchie LD, Sharma S, Gildengorin G, Yoshida S, Braff-Guajardo E, Crawford P. Policy Improves What Beverages Are Served to Young Children in Child Care. J Acad Nutr Diet 2015; 115:724-730. [DOI: 10.1016/j.jand.2014.07.019] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Accepted: 07/16/2014] [Indexed: 11/25/2022]
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Regular soda policies, school availability, and high school student consumption. Am J Prev Med 2015; 48:436-44. [PMID: 25576493 PMCID: PMC4380673 DOI: 10.1016/j.amepre.2014.10.022] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Revised: 10/15/2014] [Accepted: 10/31/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Beginning in the 2014-2015 school year, all U.S. schools participating in federally reimbursable meal programs are required to implement new nutrition standards for items sold in competitive venues. Multilevel mediation modeling examining direct, mediated, and indirect pathways between policy, availability, and student consumption might provide insight into possible outcomes of implementing aspects of the new standards. PURPOSE To employ multilevel mediation modeling using state- and school district-level policies mandating school soda bans, school soda availability, and student soda consumption. METHODS The 2010-2012 Monitoring the Future surveys obtained nationally representative data on high school student soda consumption; school administrators provided school soda availability data. State laws and district policies were compiled and coded. Analyses conducted in 2014 controlled for state-, school-, and student-level characteristics. RESULTS State-district-school models found that state bans were associated with significantly lower school soda availability (c, p<0.05) but district bans showed no significant associations. No significant direct, mediated, or indirect associations between state policy and student consumption were observed for the overall sample. Among African American high school students, state policy was associated directly with significantly lower school soda availability (a, p<0.01), and-indirectly through lower school availability-with significantly lower soda consumption (a*b, p<0.05). CONCLUSIONS These analyses indicate state policy focused on regular soda strongly affected school soda availability, and worked through changes in school availability to decrease soda consumption among African American students, but not the overall population.
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Abstract
After nearly a decade of concern over the role of food and beverage marketing to youth in the childhood obesity epidemic, American children and adolescents - especially those from communities of color - are still immersed in advertising and marketing environments that primarily promote unhealthy foods and beverages. Despite some positive steps, the evidence shows that the food and beverage industry self-regulation alone is not likely to significantly reduce marketing of unhealthy foods and beverages to youth. A variety of research is needed to monitor industry marketing of unhealthy products to young people, and identify the most promising approaches to improve children's food marketing environments. The continued presence of unhealthy marketing toward children despite years of industry self-regulation suggests it is time for stronger action by policymakers to protect young people from harmful marketing practices.
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Affiliation(s)
- Andrew Cheyne
- Berkeley Media Studies Group, a project of the Public Health Institute, 2130 Center St. #302, Berkeley, CA, 94704, USA.
- California Association of Food Banks, 1624 Franklin St #722, Oakland, CA, 94612, USA.
| | - Pamela Mejia
- Berkeley Media Studies Group, a project of the Public Health Institute, 2130 Center St. #302, Berkeley, CA, 94704, USA.
| | - Laura Nixon
- Berkeley Media Studies Group, a project of the Public Health Institute, 2130 Center St. #302, Berkeley, CA, 94704, USA.
| | - Lori Dorfman
- Berkeley Media Studies Group, a project of the Public Health Institute, 2130 Center St. #302, Berkeley, CA, 94704, USA.
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Lucan SC. Concerning limitations of food-environment research: a narrative review and commentary framed around obesity and diet-related diseases in youth. J Acad Nutr Diet 2014; 115:205-212. [PMID: 25443565 DOI: 10.1016/j.jand.2014.08.019] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Accepted: 08/15/2014] [Indexed: 10/24/2022]
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Greathouse KL, Chriqui J, Moser RP, Agurs-Collins T, Perna FM. The association of soda sales tax and school nutrition laws: a concordance of policies. Public Health Nutr 2014; 17:2201-6. [PMID: 24477116 PMCID: PMC10282621 DOI: 10.1017/s1368980013003029] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Revised: 09/13/2013] [Accepted: 09/25/2013] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The current research examined the association between state disfavoured tax on soda (i.e. the difference between soda sales tax and the tax on food products generally) and a summary score representing the strength of state laws governing competitive beverages (beverages that compete with the beverages in the federally funded school lunch programme) in US schools. DESIGN The Classification of Laws Associated with School Students (CLASS) summary score reflected the strength of a state's laws restricting competitive beverages sold in school stores, vending machines, school fundraisers and à la carte cafeteria items. Bridging the Gap (BTG) is a nationally recognized research initiative that provided state-level soda tax data. The main study outcome was the states' competitive beverage summary scores for elementary, middle and high school grade levels, as predicted by the states' disfavoured soda tax. Univariate and multivariate analyses were conducted, adjusting for year and state. SETTING Data from BTG and CLASS were used. SUBJECTS BTG and CLASS data from all fifty states and the District of Columbia from 2003 to 2010 were used. RESULTS A higher disfavoured soda sales tax was generally associated with an increased likelihood of having strong school beverage laws across grade levels, and especially when disfavoured soda sales tax was >5 %. CONCLUSIONS These data suggest a concordance between states' soda taxes and laws governing beverages sold in schools. States with high disfavoured sales tax on soda had stronger competitive beverage laws, indicating that the state sales tax environment may be associated with laws governing beverage policy in schools.
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Affiliation(s)
- K Leigh Greathouse
- Health Behaviors Research Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, 6130 Executive Blvd, Bethesda, MD 20892-7326, USA
- Cancer Prevention Fellowship Program, National Cancer Institute, Rockville, MD, USA
| | - Jamie Chriqui
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, IL, USA
| | - Richard P Moser
- Health Behaviors Research Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, 6130 Executive Blvd, Bethesda, MD 20892-7326, USA
| | - Tanya Agurs-Collins
- Health Behaviors Research Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, 6130 Executive Blvd, Bethesda, MD 20892-7326, USA
| | - Frank M Perna
- Health Behaviors Research Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, 6130 Executive Blvd, Bethesda, MD 20892-7326, USA
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61
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Hennessy E, Oh A, Agurs-Collins T, Chriqui JF, Mâsse LC, Moser RP, Perna F. State-level school competitive food and beverage laws are associated with children's weight status. THE JOURNAL OF SCHOOL HEALTH 2014; 84:609-16. [PMID: 25117896 PMCID: PMC4176686 DOI: 10.1111/josh.12181] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2012] [Revised: 12/11/2013] [Accepted: 12/15/2013] [Indexed: 05/11/2023]
Abstract
BACKGROUND This study attempted to determine whether state laws regulating low nutrient, high energy-dense foods and beverages sold outside of the reimbursable school meals program (referred to as "competitive foods") are associated with children's weight status. METHODS We use the Classification of Laws Associated with School Students (CLASS) database of state codified law(s) relevant to school nutrition. States were classified as having strong, weak, or no competitive food laws in 2005 based on strength and comprehensiveness. Parent-reported height and weight along with demographic, behavioral, family, and household characteristics were obtained from the 2007 National Survey of Children's Health. Bivariate and logistic regression analyses estimated the association between states' competitive food laws and children's overweight and obesity status (body mass index [BMI]-for-age ≥85th percentile). Children (N = 16,271) between the ages of 11-14 years with a BMI for age ≥5th percentile who attended public school were included. RESULTS Children living in states with weak competitive food laws for middle schools had over a 20% higher odds of being overweight or obese than children living in states with either no or strong school competitive food laws. CONCLUSION State-level school competitive food and beverage laws merit attention with efforts to address the childhood obesity epidemic. Attention to the specificity and requirements of these laws should also be considered.
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Affiliation(s)
- Erin Hennessy
- Cancer Prevention Fellow, Health Behaviors Research Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, 6130 Executive Boulevard, EPN 4087C, Bethesda, MD 20892-7236, Tel: 301-594-6542, Fax: 301-480-2087
| | - April Oh
- Senior Behavioral Scientist, Contractor, Clinical Research Program Directorate/CMRP, SAIC-Frederick, Inc., National Cancer Institute-Frederick, 6130 Executive Blvd, EPN 4039, Bethesda, MD 20892-7236, Tel: 301-496-8136
| | - Tanya Agurs-Collins
- Program Director, Health Behaviors Research Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, 6130 Executive Boulevard, EPN 4074, Bethesda, MD 20892-7236, Tel: 301-594-6637
| | - Jamie F. Chriqui
- Senior Research Scientist, Institute for Health Research and Policy, University of Illinois at Chicago (MC 275), 453 Westside Research Office Bldg, 1747 West Roosevelt Road Chicago, IL 60608, Tel: 312-996-6410
| | - Louise C. Mâsse
- Associate Professor, School of Population and Public Health, University of British Columbia, BC Children’s Hospital and BC Women’s Hospital & Health Centre, Room L408, 4480 Oak Street, Vancouver, BC, CANADA V6H 3V4, Tel: 604-875-2000 ext. 5563
| | - Richard P. Moser
- Research Psychologist, Science of Research and Technology Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, 6130 Executive Boulevard, EPN 4052, Bethesda, MD 20892-7236, Tel: 301-496-0273
| | - Frank Perna
- Program Director, Health Behaviors Research Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, 6130 Executive Boulevard, EPN 4070, Bethesda, MD 20892-7236, Tel: 301-451-9477
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Cross-regional analysis of multiple factors associated with childhood obesity in India: a national or local challenge? Indian J Pediatr 2014; 81 Suppl 1:5-16. [PMID: 25139390 DOI: 10.1007/s12098-014-1550-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Accepted: 07/22/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To investigate obesogenic co-causing factors, promoting rise of weight in children, associated to local differences in India. METHODS Overall 1,680 children, aged 3-11 and balanced by gender, were recruited in school contexts distributed in seven major Indian cities. All children were weighted and measured in order to calculate their BMI. A validated cultural specific questionnaire was administered to children's parents for assessing socio-demographic data, eating habits, physical activity, etc. Furthermore children's brand awareness scores were computed in order to analyze their affiliation towards food-based advertisement. Descriptive statistics of frequencies, duration and intensity of the various factors were performed. Chi-square tests or Wilcoxon signed rank test were used for evaluating significance of differences in factors distribution across Indian cities. RESULTS Four factors, promoting rise of children's weight, were individuated as associated to urban differences, namely meal times consumed in the family, parents' BMI, brand awareness and physical activity. These aspects exercised a significant impact on children's body size in Kolkata and Chennai. Hyderabad and Mumbai, instead, were the cities where religion played some role in influencing children's weight gain. CONCLUSIONS Such findings underline the need to frame obesity as a situated phenomenon rather than a national problem. Health policies, implemented in treating and preventing obesity, should be therefore specifically focused on locally situated peculiarities.
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Taber DR, Chriqui JF, Vuillaume R, Chaloupka FJ. How state taxes and policies targeting soda consumption modify the association between school vending machines and student dietary behaviors: a cross-sectional analysis. PLoS One 2014; 9:e98249. [PMID: 25083906 PMCID: PMC4118851 DOI: 10.1371/journal.pone.0098249] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Accepted: 04/30/2014] [Indexed: 01/28/2023] Open
Abstract
Background Sodas are widely sold in vending machines and other school venues in the United States, particularly in high school. Research suggests that policy changes have reduced soda access, but the impact of reduced access on consumption is unclear. This study was designed to identify student, environmental, or policy characteristics that modify the associations between school vending machines and student dietary behaviors. Methods Data on school vending machine access and student diet were obtained as part of the National Youth Physical Activity and Nutrition Study (NYPANS) and linked to state-level data on soda taxes, restaurant taxes, and state laws governing the sale of soda in schools. Regression models were used to: 1) estimate associations between vending machine access and soda consumption, fast food consumption, and lunch source, and 2) determine if associations were modified by state soda taxes, restaurant taxes, laws banning in-school soda sales, or student characteristics (race/ethnicity, sex, home food access, weight loss behaviors.) Results Contrary to the hypothesis, students tended to consume 0.53 fewer servings of soda/week (95% CI: -1.17, 0.11) and consume fast food on 0.24 fewer days/week (95% CI: -0.44, -0.05) if they had in-school access to vending machines. They were also less likely to consume soda daily (23.9% vs. 27.9%, average difference = -4.02, 95% CI: -7.28, -0.76). However, these inverse associations were observed primarily among states with lower soda and restaurant tax rates (relative to general food tax rates) and states that did not ban in-school soda sales. Associations did not vary by any student characteristics except for weight loss behaviors. Conclusion Isolated changes to the school food environment may have unintended consequences unless policymakers incorporate other initiatives designed to discourage overall soda consumption.
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Affiliation(s)
- Daniel R. Taber
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, Illinois, United States of America
- * E-mail:
| | - Jamie F. Chriqui
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, Illinois, United States of America
| | - Renee Vuillaume
- John F. Kennedy School of Government, Harvard University, Cambridge, Massachusetts, United States of America
| | - Frank J. Chaloupka
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, Illinois, United States of America
- Department of Economics, University of Illinois at Chicago, Chicago, Illinois, United States of America
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64
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Affiliation(s)
- Joanne Slavin
- From the Department of Food Science and Nutrition, University of Minnesota, St Paul, MN.
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65
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Folayan MO, Chukwumah NM, Onyejaka N, Adeniyi AA, Olatosi OO. Appraisal of the national response to the caries epidemic in children in Nigeria. BMC Oral Health 2014; 14:76. [PMID: 24957148 PMCID: PMC4091672 DOI: 10.1186/1472-6831-14-76] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Accepted: 06/16/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This article reviews the caries profile for children in Nigeria and proposes an appropriate framework for addressing the silent caries epidemic. DISCUSSION We reviewed the caries prevalence among children in Nigeria, assessed the existing responses to the caries epidemic including the national oral healthcare delivery situation in the country and discussed the current caries management in children. We then proposed a response framework for Nigeria. We argue that successful interventions will require the adoption of a socio-ecological model. This would ensure that the micro-, meso-, exo- and macrosystems required to support the behavioural, structural and biological interventions for promoting caries prevention are addressed. National oral health surveys are required to help understand the epidemiology, social determinants of and factors that undermine the ability of children to access oral health care. A global caries prevention agenda for children would help get the government's support for a national response agenda. Currently, there is no global call for action on the caries epidemic in children. This lack of an agenda needs to be urgently addressed. SUMMARY A combination of approaches for the prevention of caries in children in Nigeria is needed. A national survey is needed to generate the needed evidence for the planning of community relevant responses to the national caries epidemic in children. The design of a global health agenda for children is an important first step that can facilitate the development of a national oral health programme for children in Nigeria.
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Affiliation(s)
- Morenike O Folayan
- Department of Child Dental Health, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Nneka M Chukwumah
- Department of Child Dental Health, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
| | - Nneka Onyejaka
- Department of Child Dental Health, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
| | - Abiola A Adeniyi
- Department of Preventive Dentistry, Lagos State University College of Medicine, Ikeja, Lagos State, Nigeria
| | - Olubukola O Olatosi
- Department of Child Dental Health, College of Medicine, University of Lagos, Idi-Araba, Lagos, Nigeria
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Cluss PA, Fee L, Culyba RJ, Bhat KB, Owen K. Effect of food service nutrition improvements on elementary school cafeteria lunch purchase patterns. THE JOURNAL OF SCHOOL HEALTH 2014; 84:355-362. [PMID: 24749917 DOI: 10.1111/josh.12157] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2012] [Revised: 08/08/2013] [Accepted: 10/06/2013] [Indexed: 06/03/2023]
Abstract
BACKGROUND Schools can play a major role in prevention and intervention for childhood obesity. We describe changes in elementary school cafeteria lunch sales patterns resulting from nutritional improvements in menu offerings that were part of a community-wide focus on health. METHODS Elementary school lunch sales data were collected for 1 week in each of 7 years in a district serving a predominantly poor, rural, and Caucasian student population, with high rates of obesity. Post hoc data analyses described lunch sales patterns and related food service costs over the project years. RESULTS The percentage of high calorie/low nutrition foods sold decreased from 22% of all sales in 2005 to 0% in 2011. High-calorie snack purchases decreased from 535 items to 0 items. The sale of fresh fruits increased by 12%. There was only a slight decline in the percentage of children who purchased cafeteria lunches over the years and a 15.2% cost increase for purchasing healthier food supplies. CONCLUSIONS Elementary school children purchased healthier lunches when healthier menu items were offered and when less healthy foods were eliminated from the menu. There was no significant decline in the number of students who purchased lunches as nutritional improvements were made.
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Affiliation(s)
- Patricia A Cluss
- Associate Professor of Psychiatry, Retired , University of Pittsburgh, School of Medicine, Pittsburgh, PA 15261; Consultant, UPMC Health Plan, 5889 Forbes Avenue, Suite 320, Pittsburgh, PA 15217
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Merlo CL, Olsen EO, Galic M, Brener ND. The relationship between state policies for competitive foods and school nutrition practices in the United States. Prev Chronic Dis 2014; 11:E66. [PMID: 24762530 PMCID: PMC4008945 DOI: 10.5888/pcd11.130216] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Most students in grades kindergarten through 12 have access to foods and beverages during the school day outside the federal school meal programs, which are called competitive foods. At the time of this study, competitive foods were subject to minimal federal nutrition standards, but states could implement additional standards. Our analysis examined the association between school nutrition practices and alignment of state policies with Institute of Medicine recommendations (IOM Standards). METHODS For this analysis we used data from the Centers for Disease Control and Prevention's (CDC's) report, Competitive Foods and Beverages in US Schools: A State Policy Analysis and CDC's 2010 School Health Profiles (Profiles) survey to examine descriptive associations between state policies for competitive foods and school nutrition practices. RESULTS Access to chocolate candy, soda pop, sports drinks, and caffeinated foods or beverages was lower in schools in states with policies more closely aligned with IOM Standards. No association was found for access to fruits or nonfried vegetables. CONCLUSION Schools in states with policies more closely aligned with the IOM Standards reported reduced access to less healthful competitive foods. Encouraging more schools to follow these standards will help create healthier school environments and may help promote healthy eating among US children.
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Affiliation(s)
- Caitlin L Merlo
- Centers for Disease Control and Prevention, 4770 Buford Highway, NE, Mailstop F-78, Atlanta, GA 30341. E-mail:
| | | | | | - Nancy D Brener
- Centers for Disease Control and Prevention, Atlanta, Georgia
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Mâsse LC, de Niet-Fitzgerald JE, Watts AW, Naylor PJ, Saewyc EM. Associations between the school food environment, student consumption and body mass index of Canadian adolescents. Int J Behav Nutr Phys Act 2014; 11:29. [PMID: 24666770 PMCID: PMC3987130 DOI: 10.1186/1479-5868-11-29] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Accepted: 02/13/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Increasing attention has been paid to the school food environment as a strategy to reduce childhood obesity. The purpose of this study was to examine associations between the school food environment, students' dietary intake, and obesity in British Columbia (BC), Canada. METHODS In 2007/08, principal responses about the school environment (N=174) were linked to grades 7-12 students (N=11,385) from corresponding schools, who participated in the BC Adolescent Health Survey. Hierarchical mixed-effect regression analyses examined the association between the school food environment and student's intake of sugar-sweetened beverages (SSBs), food consumption, and body mass index. Analyses controlled for school setting, neighborhood education level and student's age and sex. RESULTS School availability of SSBs was positively associated with moderate (Odds Ratio (OR)=1.15, 95% Confidence Interval (CI)=1.02-1.30) and high (OR=1.43, 95% CI=1.13-1.80) SSB intake as were less healthful school nutrition guidelines for moderate SSB consumers only (OR=0.65, 95% CI=0.48-0.88). Availability of SSBs at school and its consumption were positively associated with student obesity (OR=1.50, 95% CI=1.12-2.01 and OR=1.66, 95% CI=1.19-2.34, respectively) but not with overweight. In contrast, consumption of less healthful food was positively associated with overweight (OR=1.03, 95% CI=1.01-1.06). CONCLUSIONS The results of this study provide further evidence to support the important role of schools in shaping adolescents' dietary habits. Availability and consumption of SSBs, but not less healthful foods, at school were associated with higher adolescent obesity highlighting that other environments also contribute to adolescent obesity.
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Affiliation(s)
- Louise C Mâsse
- School of Population and Public Health, University of British Columbia, F508-4480 Oak Street, Vancouver, British Columbia V6H 3V4, Canada.
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Yon BA, Johnson RK. Dietary Patterns and Sugar-Sweetened Beverage Consumption among Adolescents and Adults. Curr Nutr Rep 2014. [DOI: 10.1007/s13668-013-0071-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Abstract
In a linked Perspective, Tony Blakely and colleagues discuss the real-world implications of this type of modeling study. Please see later in the article for the Editors' Summary
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Affiliation(s)
- Tony Blakely
- Department of Public Health, University of Otago, Wellington, New Zealand
- * E-mail:
| | - Nick Wilson
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Bill Kaye-Blake
- New Zealand Institute of Economic Research, Wellington, New Zealand
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Hodge JG, Barraza L, Russo S, Nelson K, Measer G. A Proposed Ban on the Sale to and Possession of Caloric Sweetened Beverages by Minors in Public. THE JOURNAL OF LAW, MEDICINE & ETHICS : A JOURNAL OF THE AMERICAN SOCIETY OF LAW, MEDICINE & ETHICS 2014; 42:110-114. [PMID: 26767482 DOI: 10.1111/jlme.12124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Obesity is the definitive epidemic of the modern era in the United States. Its well-documented public health impacts, especially related to children and adolescents, are horrific. Nearly one-third of American minors are overweight; over 50% of them are obese. Already, these kids suffer from multiple adverse physical and mental health conditions. Sadly, absent serious communal and individual interventions, their lives may be cut short compared to their own parents’ life expectancy. While recent surveillance suggests childhood obesity may be trending down slightly in some populations, public health experts remain concerned about the threat obesity poses to the health of America's youth.The concurrent travesty underlying childhood obesity is the relative societal failure to slow and reverse its spread.
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Affiliation(s)
- James G Hodge
- Lincoln Professor of Health Law and Ethics and the Director of the Public Health Law and Policy Program at the Sandra Day O'Connor College of Law at Arizona State University (ASU)
| | - Leila Barraza
- Assistant Professor at the Mel and Enid Zuckerman College of Public Health at the University of Arizona
| | - Susan Russo
- Senior Legal Researchers in the Public Health Law and Policy Program at the Sandra Day O'Connor College of Law at ASU
| | - Kellie Nelson
- Senior Legal Researchers in the Public Health Law and Policy Program at the Sandra Day O'Connor College of Law at ASU
| | - Greg Measer
- Member of the Public Health Law and Policy Cluster Group at the Sandra Day O'Connor College of Law at ASU
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Alaimo K, Oleksyk SC, Drzal NB, Golzynski DL, Lucarelli JF, Wen Y, Velie EM. Effects of changes in lunch-time competitive foods, nutrition practices, and nutrition policies on low-income middle-school children's diets. Child Obes 2013; 9:509-23. [PMID: 24215386 DOI: 10.1089/chi.2013.0052] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The School Nutrition Advances Kids project tested the effectiveness of school-initiated and state-recommended school nutrition practice and policy changes on student dietary intake in low-income middle schools. METHODS Schools recruited by an application for grant funding were randomly assigned to (1) complete an assessment of nutrition education, policies, and environments using the Healthy School Action Tools (HSAT) and implement an action plan, (2) complete the HSAT, implement an action plan, and convene a student nutrition action team, (3) complete the HSAT and implement an action plan and a Michigan State Board of Education nutrition policy in their cafeteria à la carte, or (4) a control group. All intervention schools were provided with funding and assistance to make self-selected nutrition practice, policy, or education changes. Block Youth Food Frequency Questionnaires were completed by 1176 seventh-grade students from 55 schools at baseline and during eighth-grade follow-up. Nutrient density and food group changes for the intervention groups were compared to the control group, controlling for baseline dietary intake values, gender, race/ethnicity, school kitchen type, urbanization, and percent of students eligible for free or reduced-price meals. Analyses were conducted by randomization and based on changes the schools self-selected. RESULTS Improvements in students' nutrient density and food group intake were found when schools implemented at least three new nutrition practice changes and established at least three new nutrition policies. Students in schools that introduced mostly healthful foods in competitive venues at lunch demonstrated the most dietary improvements. CONCLUSIONS New USDA nutrition standards for à la carte and vending will likely increase the healthfulness of middle school children's diets.
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Affiliation(s)
- Katherine Alaimo
- 1 Department of Food Science and Human Nutrition, Michigan State University , East Lansing, MI
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73
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Turner L, Chriqui JF, Chaloupka FJ. Classroom parties in US elementary schools: the potential for policies to reduce student exposure to sugary foods and beverages. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2013; 45:611-619. [PMID: 23819904 DOI: 10.1016/j.jneb.2013.04.261] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2012] [Revised: 04/03/2013] [Accepted: 04/22/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To examine associations among school, district, and state policies regarding classroom birthday and holiday parties. DESIGN School-level policies assessed by survey during the 2009-2011 school years, with collection of corresponding district policies and state laws. SETTING United States public elementary schools. PARTICIPANTS Surveys from 1,204 schools (response rate, 60.9%). VARIABLES MEASURED Prevalence of school-wide restrictions on sugary items served during parties. Predictor variables included district policy and state law. ANALYSIS Multivariate logistic regressions to examine associations between school-level restrictions (outcome) and district policies and state laws, controlling for demographics and school year. RESULTS Approximately one half of schools discouraged or prohibited sugary items during parties, or did not allow parties. Schools with a district policy and state law were 2.5 times more likely to restrict sweet items at parties than were schools with no corresponding policy or law. School-level limits were more common where policy and law addressed specific nutritional aspects of foods and beverages served in classroom parties (odds ratios, > 2.0; P < .001). CONCLUSIONS AND IMPLICATIONS Prohibitions on sugary party fare were uncommon at all levels. Even though most policies were framed as recommendations rather than requirements, policy and law were associated with increased school-level restrictions, which demonstrates the value of policy.
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Affiliation(s)
- Lindsey Turner
- Health Policy Center, Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, Illinois.
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Chen HJ, Wang Y. Influence of school beverage environment on the association of beverage consumption with physical education participation among US adolescents. Am J Public Health 2013; 103:e63-70. [PMID: 24028221 DOI: 10.2105/ajph.2013.301555] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined the association of adolescents' beverage consumption with physical activity and studied how their school beverage environment influences the association. METHODS We used nationally representative data from the 2007 Early Childhood Longitudinal Study-Kindergarten Cohort (n = 8850). We examined nonlinear associations of eighth graders' self-report of beverage consumption (milk, 100% juices, soft drinks) with moderate to vigorous physical activity and physical education (PE) participation using piecewise linear regression models. RESULTS We found a nonlinear association of participation in PE class with beverage consumption, especially in schools with vending machines and those selling soft drinks. For students participating in PE less than 3 days per week, beverage consumption was not significantly associated with participation in PE class frequency. For students participating in PE 3 to 5 days per week, 1 more day of participation in PE class was associated with 0.43 (SE = 0.14; P = .002) more times per week of soft drink consumption and 0.41 (SE = 0.17; P = .021) fewer glasses per week of milk consumption. CONCLUSIONS The more soft drink and less milk consumption related to high participation in PE class might be prevented by improving the beverage environment in schools. Systematic environmental interventions are needed to prevent such potential unintended consequences of promoting physical activity.
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Affiliation(s)
- Hsin-Jen Chen
- Hsin-Jen Chen and Youfa Wang are with the Department of International Health, Johns Hopkins Global Center on Childhood Obesity, and the Center for Human Nutrition, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
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Abstract
Obesity is a complex problem requiring large-scale, population-based solutions. Public policy strategies have been identified as critical tools in obesity prevention efforts as they can benefit all who are exposed rather than simply changing individual behaviors one at a time. This paper reviews the peer-reviewed scientific U.S.-based literature published between January 2012 and March 2013 to examine the influence of state laws and local policies on changes to school and other environments, individual activity and nutrition-related behaviors, and obesity and weight outcomes. Virtually all recent studies have focused on policies directed at the school environment and, across-the board, the evidence was mixed. Most studies were cross-sectional, focused on policy implementation in schools and other settings rather than impacts on individual behaviors or obesity. Opportunities exist for impact studies focusing on a broader spectrum of policies as well as for continued policy actions at all levels of government.
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Affiliation(s)
- Jamie F Chriqui
- Institute for Health Research and Policy, University of Illinois at Chicago, 1747 W. Roosevelt Road, M/C 275, Chicago, IL 60608; tel. 312-996-6410; fax 312-355-2801;
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Taber DR, Chriqui JF, Powell L, Chaloupka FJ. Association between state laws governing school meal nutrition content and student weight status: implications for new USDA school meal standards. JAMA Pediatr 2013; 167:513-9. [PMID: 23567869 PMCID: PMC4147666 DOI: 10.1001/jamapediatrics.2013.399] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE This study assessed whether stronger school meal nutrition standards may improve student weight status. Results have immediate implications because of the ongoing implementation of new nutrition standards for the National School Lunch Program. OBJECTIVE To determine if state laws with stricter school meal nutrition standards are inversely associated with adolescent weight status, while controlling for unmeasured state-level confounders. DESIGN Quasi-experiment. SETTING Public schools. PARTICIPANTS Four thousand eight hundred seventy eighth-grade students in 40 states. Students were categorized by type of school lunch they usually obtained (free/reduced price, regular price, or none). INTERVENTIONS State laws governing school meal nutrition standards. States with standards that exceeded US Department of Agriculture (USDA) school meal standards were compared with states that did not exceed USDA standards. The parameter of interest was the interaction between state laws and student lunch participant status, ie, whether disparities in weight status between school lunch participants and nonparticipants were smaller in states with stricter standards. MAIN OUTCOME MEASURES Body mass index percentile and obesity status. RESULTS In states that exceeded USDA standards, the difference in obesity prevalence between students who obtained free/reduced-price lunches and students who did not obtain school lunches was 12.3 percentage points smaller (95% CI, -21.5 to -3.0) compared with states that did not exceed USDA standards. Likewise, differences in mean body mass index percentile between those student populations were 11 units smaller in states that exceeded USDA standards (95% CI, -17.7 to -4.3). There was little evidence that students compensated for school meal laws by purchasing more sweets, salty snacks, or sugar-sweetened beverages from other school venues (eg, vending machines) or other sources (eg, fast food). CONCLUSIONS AND RELEVANCE Stringent school meal standards that reflect the latest nutrition science may improve weight status among school lunch participants, particularly those eligible for free/reduced-price lunches.
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Hebert JR, Allison DB, Archer E, Lavie CJ, Blair SN. Scientific decision making, policy decisions, and the obesity pandemic. Mayo Clin Proc 2013; 88:593-604. [PMID: 23726399 PMCID: PMC3759398 DOI: 10.1016/j.mayocp.2013.04.005] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2013] [Revised: 03/26/2013] [Accepted: 04/01/2013] [Indexed: 01/02/2023]
Abstract
Rising and epidemic rates of obesity in many parts of the world are leading to increased suffering and economic stress from diverting health care resources to treating a variety of serious, but preventable, chronic diseases etiologically linked to obesity, particularly type 2 diabetes mellitus and cardiovascular diseases. Despite decades of research into the causes of the obesity pandemic, we seem to be no nearer to a solution now than when the rise in body weights was first chronicled decades ago. The case is made that impediments to a clear understanding of the nature of the problem occur at many levels. These obstacles begin with defining obesity and include lax application of scientific standards of review, tenuous assumption making, flawed measurement and other methods, constrained discourse limiting examination of alternative explanations of cause, and policies that determine funding priorities. These issues constrain creativity and stifle expansive thinking that could otherwise advance the field in preventing and treating obesity and its complications. Suggestions are made to create a climate of open exchange of ideas and redirection of policies that can remove the barriers that prevent us from making material progress in solving a pressing major public health problem of the early 21st century.
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Affiliation(s)
- James R Hebert
- South Carolina Statewide Cancer Prevention and Control Program, University of South Carolina, Columbia, SC 29208, USA.
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78
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Abstract
The impact of dietary behaviors and food consumption and their relation to oral health are significant public health issues. Women and men exhibit different dietary behaviors. Understanding the influences of dietary behaviors on oral health from the perspective of gender disparities, however, is limited. This article provides the intersections of dietary factors and oral-systemic health for which women are at greater risk than men. Topics include the effect of dietary choices on oral health disparities seen in female patients. Interventional strategies at the local and community level that are designed to influence the balance between dietary habits and oral-systemic health are discussed.
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Affiliation(s)
- Juhee Kim
- Department of Public Health, Center for Health Disparities, Brody School of Medicine, East Carolina University, Greenville, NC 27834, USA.
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79
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Taber DR, Chriqui JF, Chaloupka FJ. State laws governing school meals and disparities in fruit/vegetable intake. Am J Prev Med 2013; 44:365-372. [PMID: 23498102 PMCID: PMC3664760 DOI: 10.1016/j.amepre.2012.11.038] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2012] [Revised: 10/11/2012] [Accepted: 11/21/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND Home access to fruits/vegetables (FV) is a consistent predictor of adolescent FV intake, but many adolescents face barriers to home access. PURPOSE To determine if state laws that require FV in school meals are positively associated with FV intake, particularly among students with limited home access to FV. METHODS Student data on home food access and FV intake were obtained from the National Youth Physical Activity and Nutrition Study (n=9574) and linked to state laws regarding FV requirements for school meals. All data were collected in 2010. Ordinary least-squares models were utilized in 2012 to estimate differences in intake between states with different FV laws, overall and by whether students had access to various foods at home (FV, unhealthy snacks). Models were weighted to account for the sample design and controlled for race, gender, age, fast-food intake, and school lunches consumed per week. RESULTS The association between FV requirement laws and FV intake was strongest among students without regular home access to FV. Particularly among students who had home access to only unhealthy snacks and who regularly consumed school meals, mean FV intake was 0.45 and 0.61 cups/day higher, respectively (95% CIs=0.07, 0.84 and 0.21, 1.00), in states with FV requirements. Students with access to healthier foods at home tended to consume more FV, but such disparities in intake were smaller in states with FV laws. CONCLUSIONS Laws that require FV in school meals may improve FV intake, particularly among students with limited access to healthy foods at home.
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Affiliation(s)
- Daniel R Taber
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, Illinois.
| | - Jamie F Chriqui
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, Illinois; Department of Political Science, University of Illinois at Chicago, Chicago, Illinois
| | - Frank J Chaloupka
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, Illinois; Department of Economics, University of Illinois at Chicago, Chicago, Illinois
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Pettigrew S, Donovan RJ, Jalleh G, Pescud M. Predictors of positive outcomes of a school food provision policy in Australia. Health Promot Int 2013; 29:317-27. [PMID: 23297338 DOI: 10.1093/heapro/das075] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
This study identified predictors of parents' and school principals' perceptions of the impact of a Western Australian school food policy. An initial qualitative phase involving focus groups with parents and interviews with school principals, teachers, canteen managers and Parents & Citizens Committee members provided general feedback on the policy and identified various factors that appeared to be related to its successful implementation. In the following quantitative phase of the study, 1200 parents responded to a telephone questionnaire and 310 principals responded to an internet-based questionnaire. The primary outcome variables were, respectively, the extent to which parents reported that their children's diets were healthier as a result of the policy, and the extent to which principals reported that their schools complied with the policy. Logistic regression models were generated for the parent and principal samples. Those parents reporting that their children's diets were healthier were more likely to agree that the policy reflected their beliefs and their children's dietary needs and preferences, that their child talked about the traffic light food classification system and that this system influenced their food choices in the supermarket. Those principals reporting full compliance with the policy were more likely to agree that implementing the policy was not overly difficult. Specific factors facilitating school compliance were canteen manager training and conducive kitchen setup. Provision of appropriate information and training prior to implementation may assist schools in implementing new food policies, thereby enhancing their impact beyond the school environment.
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Healthier fundraising in U. S. elementary schools: associations between policies at the state, district, and school levels. PLoS One 2012; 7:e49890. [PMID: 23166788 PMCID: PMC3498188 DOI: 10.1371/journal.pone.0049890] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2012] [Accepted: 10/17/2012] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES We examined whether state laws and district policies pertaining to nutritional restrictions on school fundraisers were associated with school policies as reported by administrators in a nationally-representative sample of United States public elementary schools. METHODS We gathered data on school-level fundraising policies via a mail-back survey during the 2009-10 and 2010-11 school years. Surveys were received from 1,278 public elementary schools (response rate = 60.9%). Data were also gathered on corresponding school district policies and state laws. After removing cases with missing data, the sample size for analysis was 1,215 schools. RESULTS After controlling for school characteristics, school policies were consistently associated with state laws and district policies, both those pertaining to fundraising generally, as well as specific restrictions on the sale of candy and soda in fundraisers (all Odds Ratios >2.0 and Ps<.05). However, even where district policies and state laws required fundraising restrictions, school policies were not uniformly present; school policies were also in place at only 55.8% of these schools, but were more common at schools in the West (77.1%) and at majority-Latino schools (71.4%), indicating uneven school-level implementation of district policy and state law. CONCLUSIONS District policies and state laws were associated with a higher prevalence of elementary school-level fundraising policies, but many schools that were subject to district policies and state laws did not have school-level restrictions in place, suggesting the need for further attention to factors hindering policy implementation in schools.
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Abstract
PURPOSE OF REVIEW Obesity is well recognized as a major public health crisis throughout the USA. In recent years, governmental bodies at the federal, state and local levels have enacted policies intended to prevent the transition to obesity. Researchers have had the opportunity to study these policies and evaluate their impact on prevention of obesity. RECENT FINDINGS Most public policies have been directed principally, but not exclusively, to the prevention of obesity in school-age children. Interventions have been directed to encouraging breast-feeding, to changing school lunches, limiting access to sugar-sweetened beverages, encouraging physical activity, changing the composition of competitive foods and affecting food advertising directed at children as well as collecting BMI information. Efforts more directed at adults include encouraging workplace wellness programs and improving the nutrition label on packaged foods with front-of-package labels and caloric information on restaurant menus. SUMMARY For the most part, evaluations of the interventions reveal weak or modest benefits. The actual picture might be less positive due to the poor quality of research and publication bias. Push back by industry and others will require higher quality experimental and real world studies. All interventions fail to accommodate the multifactorial aspects of obesity.
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Affiliation(s)
- Morgan Downey
- Downey Obesity Report, Washington, District of Columbia, USA.
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83
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Abstract
OBJECTIVE To provide an overview of school food and nutrition monitoring from 1980 to the Healthy Hunger-Free Kids Act of 2010 and data on school food availability in the USA. DESIGN A review of the history of school food and nutrition policy, monitoring and evaluation efforts in the USA over the past three decades. SETTING USA. SUBJECTS School food service, school districts and schools nationwide. RESULTS The school food environment in the USA is governed by a patchwork of federal, state and local laws and policies. The federal government has primary authority over the school meal programmes and has recently issued updated regulations governing the food and nutrient requirements for meals sold or served through the National School Lunch and School Breakfast Programs. Competitive foods (i.e. foods and beverages sold/served outside the meal programmes) are governed primarily by state and district laws and policies, although new federal regulations are expected to set minimum standards in this area. The USA has a long history of data monitoring and evaluation funded by government and private foundations which has enabled decision makers to monitor progress and opportunities to improve the foods and beverages made available to students in school. CONCLUSIONS School food-related monitoring and evaluation research has been highly influential in influencing legislation and policy, leading to improvements in the foods and beverages available to children at school as part of planned meals and individual items sold outside the meal programmes. The lessons learned from the US experience provide insights that may be valuable for implementation, monitoring and evaluation of school food programmes in other countries.
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84
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Taber DR, Chriqui JF, Perna FM, Powell LM, Chaloupka FJ. Weight status among adolescents in States that govern competitive food nutrition content. Pediatrics 2012; 130:437-44. [PMID: 22891223 PMCID: PMC3428756 DOI: 10.1542/peds.2011-3353] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVES To determine if state laws regulating nutrition content of foods and beverages sold outside of federal school meal programs ("competitive foods") are associated with lower adolescent weight gain. METHODS The Westlaw legal database identified state competitive food laws that were scored by using the Classification of Laws Associated with School Students criteria. States were classified as having strong, weak, or no competitive food laws in 2003 and 2006 based on law strength and comprehensiveness. Objective height and weight data were obtained from 6300 students in 40 states in fifth and eighth grade (2004 and 2007, respectively) within the Early Childhood Longitudinal Study-Kindergarten Class. General linear models estimated the association between baseline state laws (2003) and within-student changes in BMI, overweight status, and obesity status. Fixed-effect models estimated the association between law changes during follow-up (2003-2006) and within-student changes in BMI and weight status. RESULTS Students exposed to strong laws at baseline gained, on average, 0.25 fewer BMI units (95% confidence interval: -0.54, 0.03) and were less likely to remain overweight or obese over time than students in states with no laws. Students also gained fewer BMI units if exposed to consistently strong laws throughout follow-up (β = -0.44, 95% confidence interval: -0.71, -0.18). Conversely, students exposed to weaker laws in 2006 than 2003 had similar BMI gain as those not exposed in either year. CONCLUSIONS Laws that regulate competitive food nutrition content may reduce adolescent BMI change if they are comprehensive, contain strong language, and are enacted across grade levels.
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Affiliation(s)
- Daniel R. Taber
- Health Policy Center, Institute for Health Research and Policy
| | - Jamie F. Chriqui
- Health Policy Center, Institute for Health Research and Policy,,Departments of Political Science, and
| | - Frank M. Perna
- Health Behaviors Research Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland
| | - Lisa M. Powell
- Health Policy Center, Institute for Health Research and Policy,,Economics, University of Illinois at Chicago, Chicago, Illinois; and
| | - Frank J. Chaloupka
- Health Policy Center, Institute for Health Research and Policy,,Economics, University of Illinois at Chicago, Chicago, Illinois; and
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Joshi PH, Chaudhari S, Blaha MJ, Jones SR, Martin SS, Post WS, Cannon CP, Fonarow GC, Wong ND, Amsterdam E, Hirshfeld JW, Blumenthal RS. A point-by-point response to recent arguments against the use of statins in primary prevention: this statement is endorsed by the American Society for Preventive Cardiology. Clin Cardiol 2012; 35:404-9. [PMID: 22674150 DOI: 10.1002/clc.22016] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2012] [Revised: 04/27/2012] [Indexed: 01/14/2023] Open
Abstract
Recently, a debate over the merits of statin therapy in primary prevention was published in the Wall Street Journal. The statin opponent claimed that statins should only be used in secondary prevention and never in any primary-prevention patients at risk for cardiovascular events. In this evidence-based rebuttal to those claims, we review the evidence supporting the efficacy of statin therapy in primary prevention. Cardiovascular risk is a continuum in which those at an elevated risk of events stand to benefit from early initiation of therapy. Statins should not be reserved until after a patient suffers the catastrophic consequences of atherosclerosis. Contrary to the assertions of the statin opponent, this principle has been demonstrated through reductions in heart attacks, strokes, and mortality in numerous randomized controlled primary-prevention statin trials. Furthermore, data show that once a patient tolerates the initial treatment period, the few side effects that subsequently emerge are largely reversible. Accordingly, every major guidelines committee endorses statin use in secondary prevention and selectively in primary prevention for those with risk factors. The foundation for prevention remains increased physical activity, better dietary habits, and smoking cessation. However, prevention of heart attacks, strokes, and death from cardiovascular disease does not have to be all or none-all statin or all lifestyle. In selected at-risk individuals, the combination of pharmacotherapy and lifestyle changes is more effective than either alone. Future investigation in prevention should focus on improving our ability to identify these at-risk individuals.
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Affiliation(s)
- Parag H Joshi
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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