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Schmidt JM, Epel ES, Jacobs LM, Mason AE, Parrett B, Pickett AM, Mousli LM, Schmidt LA. Controlled trial of a workplace sales ban on sugar-sweetened beverages. Public Health Nutr 2023; 26:2130-2138. [PMID: 37465952 PMCID: PMC10564602 DOI: 10.1017/s1368980023001386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 05/16/2023] [Accepted: 06/26/2023] [Indexed: 07/20/2023]
Abstract
OBJECTIVE To examine the effectiveness of a workplace sugar-sweetened beverage (SSB) sales ban on reducing SSB consumption in employees, including those with cardiometabolic disease risk factors. DESIGN A controlled trial of ethnically diverse, full-time employees who consumed SSB heavily (sales ban n 315; control n 342). Outcomes included standardised measures of change in SSB consumption in the workplace (primary) and at home between baseline and 6 months post-sales ban. SETTING Sutter Health, a large non-profit healthcare delivery system in Northern California. PARTICIPANTS Full-time employees at Sutter Health screened for heavy SSB consumption. RESULTS Participants were 66·1 % non-White. On average, participants consumed 34·7 ounces (about 1 litre) of SSB per d, and the majority had an elevated baseline BMI (mean = 29·5). In adjusted regression analyses, those exposed to a workplace SSB sales ban for 6 months consumed 2·7 (95 % CI -4·9, -0·5) fewer ounces of SSB per d while at work, and 4·3 (95 % CI -8·4, -0·2) fewer total ounces per d, compared to controls. Sales ban participants with an elevated BMI or waist circumference had greater post-intervention reductions in workplace SSB consumption. CONCLUSIONS Workplace sales bans can reduce SSB consumption in ethnically diverse employee populations, including those at higher risk for cardiometabolic disease.
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Affiliation(s)
- Jamey M Schmidt
- Sutter Health California Pacific Medical Center Research Institute, San Francisco, CA, USA
| | - Elissa S Epel
- Department of Psychiatry, University of California at San Francisco, San Francisco, CA, USA
| | - Laurie M Jacobs
- Philip R Lee Institute for Health Policy Studies, University of California at San Francisco, San Francisco, CA, USA
| | - Ashley E Mason
- Department of Psychiatry, University of California at San Francisco, San Francisco, CA, USA
| | - Bethany Parrett
- Sutter Health California Pacific Medical Center Research Institute, San Francisco, CA, USA
| | - Amanda M Pickett
- Sutter Health California Pacific Medical Center Research Institute, San Francisco, CA, USA
| | - Leyla M Mousli
- Philip R Lee Institute for Health Policy Studies, University of California at San Francisco, San Francisco, CA, USA
| | - Laura A Schmidt
- Philip R Lee Institute for Health Policy Studies, University of California at San Francisco, San Francisco, CA, USA
- Department of Humanities and Social Sciences, University of California at San Francisco, San Francisco, CA94143, USA
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Christian D, Maharjan M, Kotov A, Cotter T, Mullin S, Nurse V, McGaw B, Chen D, Puri P, Wang S, Negi NS, Murukutla N. How the "Are We Drinking Ourselves Sick?" Communication Campaign Built Support for Policy Action on Sugary Drinks in Jamaica. Nutrients 2022; 14:nu14142866. [PMID: 35889823 PMCID: PMC9318558 DOI: 10.3390/nu14142866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 07/08/2022] [Accepted: 07/08/2022] [Indexed: 02/01/2023] Open
Abstract
Background: This study assesses the effectiveness of a campaign “Are We Drinking Ourselves Sick?” that ran nationally in Jamaica in four phases from 2017 to 2019 to increase knowledge about the harms of sugary drinks, shift attitudes, and build support for policy actions to address sugary drink consumption, including a tax and a ban in schools. Methods: Campaign impact was measured in representative cross-sectional household surveys of adults ages 18 to 55. A baseline survey was conducted before the launch of the campaign (n = 1430). Evaluation surveys were conducted mid-campaign (n = 1571) and post-campaign (n = 1500). Campaign impact was assessed by comparing changes across survey periods on key knowledge, attitudinal and policy support outcome indicators. The independent association between campaign awareness and outcomes was analyzed using logistic regression analyses. Results: The campaign was recalled by more than 80% of respondents and was well-received with 90% or more respondents describing it as believable and relevant. There was a decline in knowledge on the harms of sugary drinks from the baseline to post-campaign period, notably on risks of diabetes (adjusted odds ratio or AOR = 0.62, p < 0.001), overweight and obesity (AOR = 0.58, p < 0.001), and heart disease (AOR = 0.79, p < 0.003). However, post-campaign awareness was independently associated in logistic regression analysis with improved knowledge of the harms of sugary drinks, including risks of diabetes (AOR = 1.45, p = 0.019), overweight or obesity (AOR = 1.65, p = 0.001), and heart disease (AOR = 1.44, p = 0.011). Support for government action remained high across survey waves (≥90%), and campaign awareness was independently associated with increased policy support for sugary drinks taxes (Mid-campaign: AOR = 1.43, p = 0.019; post-campaign: AOR = 1.46, p = 0.01) and restrictions on sugary drinks in schools (AOR = 1.55, p = 0.01). Conclusion: This study demonstrates the role that media campaigns can play in maintaining knowledge and concern about the health harms of sugary drinks and increasing support for policy passage.
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Affiliation(s)
- Donnelle Christian
- Policy Advocacy and Communication Division, Vital Strategies, New York, NY 10005, USA; (D.C.); (A.K.); (T.C.); (S.M.); (P.P.); (S.W.); (N.S.N.); (N.M.)
| | - Meena Maharjan
- Policy Advocacy and Communication Division, Vital Strategies, New York, NY 10005, USA; (D.C.); (A.K.); (T.C.); (S.M.); (P.P.); (S.W.); (N.S.N.); (N.M.)
- Correspondence:
| | - Alexey Kotov
- Policy Advocacy and Communication Division, Vital Strategies, New York, NY 10005, USA; (D.C.); (A.K.); (T.C.); (S.M.); (P.P.); (S.W.); (N.S.N.); (N.M.)
| | - Trish Cotter
- Policy Advocacy and Communication Division, Vital Strategies, New York, NY 10005, USA; (D.C.); (A.K.); (T.C.); (S.M.); (P.P.); (S.W.); (N.S.N.); (N.M.)
| | - Sandra Mullin
- Policy Advocacy and Communication Division, Vital Strategies, New York, NY 10005, USA; (D.C.); (A.K.); (T.C.); (S.M.); (P.P.); (S.W.); (N.S.N.); (N.M.)
| | - Vonetta Nurse
- Global Health Advocacy Project, The Heart Foundation of Jamaica, 28 Beechwood Avenue P.O. Box 338, Kingston 5, Jamaica; (V.N.); (B.M.); (D.C.)
| | - Barbara McGaw
- Global Health Advocacy Project, The Heart Foundation of Jamaica, 28 Beechwood Avenue P.O. Box 338, Kingston 5, Jamaica; (V.N.); (B.M.); (D.C.)
| | - Deborah Chen
- Global Health Advocacy Project, The Heart Foundation of Jamaica, 28 Beechwood Avenue P.O. Box 338, Kingston 5, Jamaica; (V.N.); (B.M.); (D.C.)
| | - Pallavi Puri
- Policy Advocacy and Communication Division, Vital Strategies, New York, NY 10005, USA; (D.C.); (A.K.); (T.C.); (S.M.); (P.P.); (S.W.); (N.S.N.); (N.M.)
| | - Shuo Wang
- Policy Advocacy and Communication Division, Vital Strategies, New York, NY 10005, USA; (D.C.); (A.K.); (T.C.); (S.M.); (P.P.); (S.W.); (N.S.N.); (N.M.)
| | - Nalin Singh Negi
- Policy Advocacy and Communication Division, Vital Strategies, New York, NY 10005, USA; (D.C.); (A.K.); (T.C.); (S.M.); (P.P.); (S.W.); (N.S.N.); (N.M.)
| | - Nandita Murukutla
- Policy Advocacy and Communication Division, Vital Strategies, New York, NY 10005, USA; (D.C.); (A.K.); (T.C.); (S.M.); (P.P.); (S.W.); (N.S.N.); (N.M.)
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Cuy Castellanos D, Miller B, Zoellner J. Contributing Factors of Sugar-Sweetened Beverage Intake in the Latinx Population: A Narrative Review Using the Social-Ecological Model. HEALTH EDUCATION & BEHAVIOR 2022; 49:10901981221097053. [PMID: 35677964 DOI: 10.1177/10901981221097053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Sugar-sweetened beverage (SSB) consumption in the Latinx population has been a topic of increasing interest due to higher rates of consumption in this population, as well as higher prevalence of chronic health conditions, such as diabetes and obesity. SSB behaviors are influenced by multiple factors across the socio-ecological model. Understanding these factors can inform future intervention development and improve SSB consumption and overall health. Therefore, this narrative review identifies factors contributing to SSB consumption, as well as interventions conducted to address SSB consumption in the Latinx population residing in the United States. Contributing factors that are not currently addressed in published interventions are highlighted with the intent to inform the development of future comprehensive interventions.
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Affiliation(s)
| | | | - Jamie Zoellner
- University of Virginia, Charlottesville, VA, USA
- UVA Cancer Center, Charlottesville, VA, USA
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Impact of the external school food environment on the associations of internal school food environment with high schoolers’ diet and body mass index. Public Health Nutr 2022; 25:3086-3095. [DOI: 10.1017/s1368980022000994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
Objective:
To examine associations of school food availability with student intake frequency and BMI, and whether the number of neighborhood food outlets modifies these associations.
Design:
Baseline assessment of a nationally representative cohort study of U.S. 10th graders. Students reported intake frequency of fruits and vegetables (FV), snacks, and soda. BMI was calculated from measured height and weight. Administrators of 72 high schools reported the frequency of school availability of FV, snacks, and soda. The number of food outlets within 1 km and 5 km were linked with geocoded school addresses. Data were analyzed using adjusted linear and logistic mixed models with multiple imputation for missing data.
Setting:
U.S. 2009-2010.
Participants:
2,263 U.S. 10th graders from the Next Generation Health Study (NEXT).
Results:
Greater school FV availability was positively associated with student FV intake. Food outlets within 5 km of schools (but not 1 km) attenuated the association of school FV availability with student intake; this was no longer significant at schools with >58 food outlets within 5 km. School food availability was not associated with student BMI or student snack or soda intake.
Conclusions:
School food availability was associated with student intake of FV, but not with snacks, soda, or BMI. Attenuation of the observed associations by the school neighborhood food environment indicates a need to find ways to support healthy student eating behaviors in neighborhoods with higher food outlet density.
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Dietary Intake and Sources of Added Sugars in Various Food Environments in Costa Rican Adolescents. Nutrients 2022; 14:nu14050959. [PMID: 35267934 PMCID: PMC8912352 DOI: 10.3390/nu14050959] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 02/17/2022] [Accepted: 02/21/2022] [Indexed: 02/01/2023] Open
Abstract
Consumption of added sugars, especially from sugar-sweetened beverages (SSBs), has been associated with several negative health outcomes during adolescence. This study aimed to identify dietary intake and food sources of added sugars in the home, school, and neighborhood environments of Costa Rican adolescents. Dietary intake of added sugars was determined using 3-day food records in a cross-sectional study of 818 adolescents aged 12 to 19 and enrolled in rural and urban schools in the province of San José. On average, 90% of adolescents consumed more than 10% of their total energy intake from added sugars. Furthermore, 74.0% of added sugars were provided at home, 17.4% at school, and 8.6% in the neighborhood. Added sugars were primarily provided by frescos (29.4%), fruit-flavored still drinks (22.9%), and sugar-sweetened carbonated beverages (12.3%), for a total contribution of 64.6%. Our findings suggest that Costa Rican adolescents have a plethora of added sugar sources in all food environments where they socialize. However, it is relevant for public health to consider the home and school environments as fundamental units of interventions aimed at reducing added sugars in the adolescent diet. Frescos prepared at home and school and fruit-flavored still drinks must be the focus of these interventions.
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Tinney M, Rittinger R, Tomlinson K, Borg D, Warzel A, O'Sullivan M, Nyanhanda T. Removal of sugar sweetened beverages from sale in a hospital setting-Consumer opinion and influence on purchasing behavior. Health Promot J Austr 2021; 33:677-685. [PMID: 34767662 DOI: 10.1002/hpja.557] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 09/29/2021] [Accepted: 11/10/2021] [Indexed: 11/05/2022] Open
Abstract
ISSUE ADDRESSED This study investigated the impact of removing sugar sweetened beverages (SSBs) from sale in a regional health service. Drink purchasing patterns were measured by product ordering data. Consumer opinion regarding the intervention, self-reported packaged drink purchase and consumption were also explored. METHODS Packaged drinks were classified into two categories, SSB or non-SSB and drink types. Drink sales were determined by the collection of product ordering data for all packaged drink types sold, six months prior to and twelve months after the removal of SSBs. A consumer survey was undertaken six months after SSB removal to assess consumer opinion regarding SSB removal, self-reported SSB consumption and purchase. Descriptive and Wilcoxon rank-sum tests analyses assessed differences in packaged drinks purchase, self-reported SSB consumption and purchase. Open-ended survey responses were thematically analysed. RESULTS The median monthly number of juices, and diet drinks ordered increased significantly (P = .05). 59% of the survey respondents regularly consumed SSBs and 58% agreed or strongly agreed with removing SSBs from sale. However, some consumers felt it was a removal of their freedom of choice. CONCLUSIONS Removing SSBs from sale can result in consumers making healthier purchases. There was support for the initiative as it is seen as the responsibility of the health service to role model healthy eating behaviours. SO WHAT?: This study indicates removal of SSBs from sale is a promising health promotion intervention that can contribute to positive behaviour change, and potentially influence longer-term health and wellbeing.
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Affiliation(s)
- Melissa Tinney
- Healthy Communities Unit, Kitchener House, Barwon Health, Geelong, Australia
| | - Rowena Rittinger
- Healthy Communities Unit, Kitchener House, Barwon Health, Geelong, Australia
| | - Kate Tomlinson
- King's College Hospital, King's College Hospital NHS Foundation Trust, London, UK
| | - Dan Borg
- Healthy Communities Unit, Kitchener House, Barwon Health, Geelong, Australia
| | - Aleksandra Warzel
- Healthy Communities Unit, Kitchener House, Barwon Health, Geelong, Australia
| | - Mairead O'Sullivan
- Healthy Communities Unit, Kitchener House, Barwon Health, Geelong, Australia
| | - Tafadzwa Nyanhanda
- Melbourne Clinical School, School of Medicine, The University of Notre Dame Australia, Werribee, Vic, Australia
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Rocha LL, Pessoa MC, Gratão LHA, do Carmo AS, Cordeiro NG, Cunha CDF, de Oliveira TRPR, Mendes LL. Characteristics of the School Food Environment Affect the Consumption of Sugar-Sweetened Beverages Among Adolescents. Front Nutr 2021; 8:742744. [PMID: 34692751 PMCID: PMC8531082 DOI: 10.3389/fnut.2021.742744] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 09/13/2021] [Indexed: 01/12/2023] Open
Abstract
Sugar-sweetened beverages are widely available and accessible in school environment, and their presence and characteristics of this environment can influence their consumption. This study examines the association of drinking fountains per 100 students, soft drink sales, soft drink advertising, and the presence of street vendors and sugar-sweetened beverages consumption among adolescents in Brazil. This cross-sectional study was carried out using data from the Study of Cardiovascular Risk in Adolescents that was conducted between March 2013 and December 2014. The sample comprised 71,475 adolescents aged 12–17 years from 1,247 public and private schools in Brazilian cities. Sugar-sweetened beverages consumption was the dependent variable. The main effect was the school food environment, which was evaluated based on drinking fountains per 100 students, soft drink sales, soft drink advertising, and the presence of street vendors. Public and private schools that sold soft drinks were associated with higher average sugar-sweetened beverages consumption among adolescents. Our study highlights the importance of creating healthy school food environments by banning sugar-sweetened beverages in schools accordingly.
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Affiliation(s)
- Luana Lara Rocha
- Preventive and Social Medicine Department, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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Boelsen-Robinson T, Jerebine A, Kurzeme A, Gilham B, Huse OT, Blake MR, Backholer K, Chung A, Peeters A. Evaluating the implementation and customer acceptability of a sugar-sweetened beverage reduction initiative in thirty Australian aquatic and recreation centres. Public Health Nutr 2021; 24:5166-5175. [PMID: 34085621 PMCID: PMC11082803 DOI: 10.1017/s1368980021002421] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 05/05/2021] [Accepted: 05/21/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To assess the feasibility of implementation and customer perspectives of a sugar-sweetened beverage (SSB) reduction initiative across YMCA Victoria aquatic and recreation centres. DESIGN Two data sources were used to assess implementation and customer acceptability. Photo audits were used to assess the type of drinks available for purchase 6 months prior to initiative implementation and 6 months after, in thirty centres. Change in the range of SSB targeted for removal, non-targeted SSB, as well as drinks classified as 'red' (limit), 'amber' (choose carefully) and 'green' (best choice), was reported. Customer surveys were conducted in three centres to assess acceptability and awareness of the initiative. Inductive and deductive thematic analysis was used to analyse customers' perspectives of the initiative. SETTING 30 aquatic and recreation centres in Victoria, Australia. PARTICIPANTS 806 customers. RESULTS At post-implementation, 87 % of centres had removed targeted SSB. 'Red' drinks reduced by an average of 4·4 drink varieties compared to pre-implementation (11·9 varieties) and 'green' drinks increased by 1·4 varieties (3·2 varieties pre-implementation). Customers were largely unaware of the SSB-reduction initiative (90 %) but supported YMCA Victoria in continuing the initiative (89 %), with many believing it would support children in making healthier choices. CONCLUSIONS Implementation of an initiative that limited SSB availability across a large number of aquatic and recreation centres was feasible and considered acceptable by customers. Customers frequently mentioned the importance of protecting children from consuming SSB.
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Affiliation(s)
- Tara Boelsen-Robinson
- School of Public Health and Preventive Medicine,
Monash University, Melbourne,
Australia
- Deakin University, Geelong, Global Obesity Centre, Institute for
Health Transformation, Geelong, VIC3220, Australia
| | | | | | - Beth Gilham
- Deakin University, Geelong, Global Obesity Centre, Institute for
Health Transformation, Geelong, VIC3220, Australia
| | - Oliver T Huse
- Deakin University, Geelong, Global Obesity Centre, Institute for
Health Transformation, Geelong, VIC3220, Australia
| | - Miranda R Blake
- Deakin University, Geelong, Global Obesity Centre, Institute for
Health Transformation, Geelong, VIC3220, Australia
| | - Kathryn Backholer
- Deakin University, Geelong, Global Obesity Centre, Institute for
Health Transformation, Geelong, VIC3220, Australia
| | - Alexandra Chung
- School of Public Health and Preventive Medicine,
Monash University, Melbourne,
Australia
- Deakin University, Geelong, Global Obesity Centre, Institute for
Health Transformation, Geelong, VIC3220, Australia
| | - Anna Peeters
- Deakin University, Geelong, Global Obesity Centre, Institute for
Health Transformation, Geelong, VIC3220, Australia
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Brown JA, Ferdinands AR, Prowse R, Reynard D, Raine KD, Nykiforuk CI. Seeing the food swamp for the weeds: Moving beyond food retail mix in evaluating young people's food environments. SSM Popul Health 2021; 14:100803. [PMID: 34041350 PMCID: PMC8142271 DOI: 10.1016/j.ssmph.2021.100803] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 04/16/2021] [Accepted: 04/18/2021] [Indexed: 12/12/2022] Open
Abstract
Nutritional health of children and youth is an increasing cause for concern in Canada. Through food and beverage messaging in multiple environments, young people develop eating behaviours with ramifications throughout their life course. Unhealthy food retailers near schools, recreation facilities, and childcare centres-key activity settings for healthy eating promotion-present repeated, compounding exposures to commercial geomarketing. Geomarketing impacts nutritional health by promoting highly processed, calorie-dense, and nutrient-poor foods and beverages across urban landscapes. While food retail mix (as a ratio of healthy to unhealthy food retailers) can be used to assess food environments at multiple scales, such measures may misrepresent young people's unique experience of these geographic phenomena. Moving beyond uniform conceptualization of food environments, new research methods and tools are needed for children and youth. We investigated young people's food environments in the major Canadian cities of Calgary and Edmonton. Using government-initiated nutrition guidelines, we categorized 55.8% of all food retailers in Calgary, and 59.9% in Edmonton as 'unhealthy'. A Bernoulli trial at the 0.05 alpha level indicated few differences in prevalence proximal to activity settings versus elsewhere in both cities, demonstrating the limited applicability of food retail mix for characterizing young people's food environments. To model unhealthy food retailers geomarketing to children and youth, we considered their proximity to multiple activity settings, using overlapping radial buffers at the 250 m, 500 m, 1000 m, and 1500 m scales. Examining young people's food environments relative to the spaces where they learn and play, we determined that as many as 895 out of 2663 unhealthy food retailers fell within 1500 m of 21+ activity settings. By conceptualizing, measuring, and problematizing these "super-proximal" unhealthy food retailers, urban planners and public health researchers can use these techniques to pinpoint unhealthy food retailers, or "weeds in the food swamp," as a critical site for healthy eating promotion in municipalities.
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Affiliation(s)
- Jennifer Ann Brown
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | | | - Rachel Prowse
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Darcy Reynard
- Department of Earth and Atmospheric Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Kim D. Raine
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
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Basu S, Jacobs LM, Epel E, Schillinger D, Schmidt L. Cost-Effectiveness Of A Workplace Ban On Sugar-Sweetened Beverage Sales: A Microsimulation Model. Health Aff (Millwood) 2021; 39:1140-1148. [PMID: 32634357 PMCID: PMC7968436 DOI: 10.1377/hlthaff.2019.01483] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Sugar-sweetened beverages (SSBs) increase chronic disease risk. We estimated the impact on employee health and health care spending of banning SSB sales in California-based health care organizations. We used survey data from a large, multisite health care organization in California, sampling 2,276 employees three months before and twelve months after a workplace SSB sales ban was imposed. We incorporated the survey data into a simulation model to estimate chronic disease incidence and costs. We estimated that an SSB ban as effective as the one observed would save about $300,000 per 10,000 people over ten years among similar employers, as a result of averted health care and productivity spending—after both SSB sales losses and non-SSB beverage sales gains were accounted for. Sales bans would typically need to reduce SSB consumption by 2.2 ounces per person per day for lost revenue to be fully offset if there were no increase in non-SSB beverage sales.
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Affiliation(s)
- Sanjay Basu
- Sanjay Basu is director of research and population health at Collective Health, in San Francisco, California, and a faculty member at the Center for Primary Care, Harvard Medical School, in Boston, Massachusetts
| | - Laurie M Jacobs
- Laurie M. Jacobs is a researcher at the Institute for Health Policy, University of California San Francisco (UCSF), in San Francisco, California
| | - Elissa Epel
- Elissa Epel is a professor of psychiatry at UCSF
| | - Dean Schillinger
- Dean Schillinger is a professor of general internal medicine at UCSF
| | - Laura Schmidt
- Laura Schmidt is a professor of health policy in the School of Medicine and holds a joint appointment in the Philip R. Lee Institute for Health Policy Studies and the Department of Anthropology, History, and Social Medicine, all at UCSF
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Rocha LL, Pessoa MC, Gratão LHA, do Carmo AS, Cunha CDF, de Oliveira TRPR, Mendes LL. Health behavior patterns of sugar-sweetened beverage consumption among Brazilian adolescents in a nationally representative school-based study. PLoS One 2021; 16:e0245203. [PMID: 33411845 PMCID: PMC7790385 DOI: 10.1371/journal.pone.0245203] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 12/24/2020] [Indexed: 12/22/2022] Open
Abstract
Studies on sugar-sweetened beverage consumption patterns can help in the individual and population level management of chronic non-communicable diseases and other conditions. This study aimed to identify the association between health behavior patterns and the consumption of sugar-sweetened beverages among Brazilian adolescents from a nationally representative school-based study. A cross-sectional study analyzed data from 71,553 adolescents aged 12–17 years who attended public and private schools in Brazilian cities, from the Study of Cardiovascular Risk in Adolescents. Principal component analysis was performed to identify health behavior patterns, and ordered logistic regression was performed to identify the association between health behavior patterns and sugar-sweetened beverage consumption. Sugar-sweetened beverage consumption (mL/day) was used as the dependent variable. The analyses were performed using Stata software version 14.0 with a significance level of 0.05. Patterns 2 (alcoholic beverage and smoking habit) and 3 (ultra-processed food and screen time) of health behaviors and regularly purchasing snacks in the school cafeteria increased the odds of sugar-sweetened beverage consumption, while pattern 1 (water, unprocessed and minimally processed food and physical activity) decreased these odds. The adoption of healthy habits can indirectly stimulate the adoption of other habits beneficial to health. These results indicate the importance of adopting a set of regulatory measures to reduce sugar-sweetened beverage consumption.
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Affiliation(s)
- Luana Lara Rocha
- Pediatrics Department, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Milene Cristine Pessoa
- Nutrition Department, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | | | | | | | | | - Larissa Loures Mendes
- Nutrition Department, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
- * E-mail:
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School nutrition laws in the US: do they influence obesity among youth in a racially/ethnically diverse state? Int J Obes (Lond) 2021; 45:2358-2368. [PMID: 34285361 PMCID: PMC8528713 DOI: 10.1038/s41366-021-00900-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 06/05/2021] [Accepted: 06/30/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND/OBJECTIVES Little is known about the separate or combined effects of state and national nutrition policies regulating food and beverages in schools on child overweight/obesity (OV/OB) and related racial/ethnic disparities. We investigated the influence of school nutrition policies enacted in California, independently and in combination with the United States' national policy "Healthy Hunger Free Kids Act" (HHFKA) on childhood OV/OB and racial/ethnic disparities. SUBJECTS/METHODS An interrupted time series design was used with data from 12,363,089 child-level records on 5th- and 7th-graders in California public schools to estimate sex- and racial/ethnic-specific time trends in OV/OB prevalence during three periods: before the California nutrition policies (2002-2004); when only California policies were in effect (2005-2012); and when they were in effect simultaneously with HHFKA (2013-2016). RESULTS Before the state's policies, OV/OB prevalence increased annually among children in most subgroups. Improvements in OV/OB trends were observed for almost all groups after the California policies were in effect, with further improvements after the addition of HFFKA. The total change in annual log-odds of OV/OB, comparing the periods with both state and federal policies versus no policies, ranged from -0.08 to -0.01 and varied by grade, sex, and race/ethnicity. Within each sex and grade, the greatest changes were among African-American (-0.08 to -0.02, all p < 0.05) followed by Latino children (-0.06 to -0.01, all p < 0.05). Although disparities narrowed among these groups versus White children after the dual policy period, disparities remained large. CONCLUSIONS State and national nutrition policies for schools may have contributed to containing the upward trend in childhood OV/OB and racial/ethnic OV/OB disparities within California. However, sizable OV/OB prevalence and disparities persist. To end the epidemic, promote healthy weight and increase health equity, future efforts should strengthen state and national policies to improve food quality in schools, particularly those serving populations with the highest OV/OB prevalence.
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Mrug S, Jones LC, Elliott MN, Tortolero SR, Peskin MF, Schuster MA. Soft Drink Consumption and Mental Health in Adolescents: A Longitudinal Examination. J Adolesc Health 2021; 68:155-160. [PMID: 32636141 DOI: 10.1016/j.jadohealth.2020.05.034] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 04/28/2020] [Accepted: 05/13/2020] [Indexed: 12/11/2022]
Abstract
PURPOSE Previous studies showed associations between soft drink consumption and mental health problems in adolescents, but the direction of these effects is unknown. This study examines the hypotheses that soft drink consumption predicts aggression and depressive symptoms over time and that these mental health problems predict soft drink consumption. METHODS Interviews were conducted with 5,147 children and their caregivers from three sites at child ages 11, 13, and 16. At each time point, youth reported on their frequency of consuming soft drinks, aggressive behavior, and depressive symptoms. An autoregressive cross-lagged path model tested reciprocal relationships between soft drink consumption, aggressive behavior, and depressive symptoms over time. RESULTS More frequent consumption of soft drinks was associated with more aggressive behavior at each time point and depressive symptoms at ages 11 and 13 (r = .04 to .18, p ≤ .002). After adjusting for covariates and stability of each behavior over time, soft drink consumption at ages 11 and 13 predicted more aggressive behavior at the next time point (β = .08 and .06, p < .001). Aggressive behavior at age 13 also predicted more soft drink consumption at age 16 (β = .06, p = .002). Soft drink consumption at age 13 predicted fewer depressive symptoms (β = -.04, p = .007), but depressive symptoms did not predict soft drink consumption. CONCLUSIONS More frequent consumption of soft drinks may contribute to aggressive behavior in adolescents over time; there is some support for reciprocal relationships. There is no evidence for soft drink consumption contributing to adolescents' depression. Future research should examine longitudinal effects over shorter intervals.
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Affiliation(s)
- Sylvie Mrug
- Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama.
| | - LaRita C Jones
- Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama
| | | | - Susan R Tortolero
- Texas Prevention Research Center, University of Texas Health Science Center, Houston, Texas
| | - Melissa F Peskin
- Texas Prevention Research Center, University of Texas Health Science Center, Houston, Texas
| | - Mark A Schuster
- Office of the Dean, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California
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14
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Chriqui JF, Leider J, Cohen JFW, Schwartz M, Turner L. Are Nutrition Standards for Beverages in Schools Associated with Healthier Beverage Intakes among Adolescents in the US? Nutrients 2020; 13:E75. [PMID: 33383659 PMCID: PMC7824136 DOI: 10.3390/nu13010075] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 12/22/2020] [Accepted: 12/22/2020] [Indexed: 12/01/2022] Open
Abstract
Under the U.S. Department of Agriculture's Smart Snacks in School standards, beverages sold in schools are restricted to water, flavored or unflavored non-fat milk or unflavored low-fat milk (and milk alternatives), and 100% fruit and vegetable juices; and, at the high school level, diet (≤10 kcal), low-calorie (≤60 kcal), and caffeinated beverages may also be sold. Using data from the School Nutrition and Meal Cost Study, this study examined whether secondary school student beverage consumption was associated with school-level à la carte and vending machine beverage availability, controlling for district, school, and student characteristics. On average, most beverages sold in middle schools (84.54%) and high schools (74.11%) were Smart Snacks compliant; while 24.06 percent of middle school students and 14.64 percent of high school students reported consuming non-compliant beverages, including non-compliant milk, fruit drinks, and sports or energy drinks. School beverage availability was not related to consumption among middle school students; however, high school students were less likely to consume non-compliant beverages when enrolled in schools that sold a higher proportion of compliant beverages (Range: OR = 0.97-0.98, 95% CI = 0.95, 1.00). Findings from this study build upon prior research illustrating the role that schools can play in influencing student dietary intake.
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Affiliation(s)
- Jamie F. Chriqui
- Division of Health Policy and Administration, School of Public Health, University of Illinois Chicago, Chicago, IL 60612, USA
- Institute for Health Research and Policy, University of Illinois Chicago, Chicago, IL 60608, USA;
| | - Julien Leider
- Institute for Health Research and Policy, University of Illinois Chicago, Chicago, IL 60608, USA;
| | - Juliana F. W. Cohen
- Department of Public Health and Nutrition, Merrimack College, 315 Turnpike Street, North Andover, MA 01845, USA;
- Department of Nutrition, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA 02115, USA
| | - Marlene Schwartz
- Rudd Center for Food Policy and Obesity, Department of Human Development and Family Sciences, University of Connecticut, 1 Constitution Plaza, Hartford, CT 06103, USA;
| | - Lindsey Turner
- College of Education, Boise State University, 1910 University Drive, Boise, ID 83725, USA;
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15
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Richardson AS, Nicosia N, Ghosh-Dastidar MB, Datar A. School Food and Beverage Availability and Children's Diet, Purchasing, and Obesity: Evidence From a Natural Experiment. J Adolesc Health 2020; 67:804-813. [PMID: 32331931 PMCID: PMC7575612 DOI: 10.1016/j.jadohealth.2020.03.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 02/27/2020] [Accepted: 03/01/2020] [Indexed: 12/31/2022]
Abstract
PURPOSE Existing evidence on relationships between school food environments and children's in-school purchases, dietary behaviors, and body composition is based on observational studies that are vulnerable to residential selection bias. METHODS This study leveraged exogenous variation in school environments generated by the natural experiment due to military parents' assignment to installations. We analyzed 1,010 child-wave observations from the Military Teenagers Environments, Exercise, and Nutrition Study collected during 2013-2015. Using multiple linear and logistic regression, we examined whether the number of competitive food and beverage (CF&B) items available for purchase in school, overall and by type (unhealthy, healthy, neutral), was associated with in-school food purchases, dietary behaviors, and body mass index (BMI) outcomes. Covariates included child and family characteristics and the healthiness of the home food environment. RESULTS Unhealthy item availability was positively associated with purchasing any sweets (adjusted odds ratio [AOR], 1.30; p < .01), snacks (AOR, 1.23; p < .01), and sugar-sweetened beverages (AOR, 1.19; p = .01). However, there were no significant associations with overall food and beverage intake (e.g., sweets, soda) nor BMI outcomes. The home food environment was significantly associated with all outcomes. CONCLUSIONS Access to unhealthy CF&B items may influence in-school purchases but does not appear to influence overall dietary behaviors and BMI outcomes. Substitution of caloric intake across locations within versus outside of school may play a role in explaining why purchases were associated with unhealthy CF&B availability but overall diet and downstream BMI were not.
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Affiliation(s)
| | - Nancy Nicosia
- Economics, Sociology & Statistics, RAND Corporation, Boston, Massachusetts
| | | | - Ashlesha Datar
- Center for Economic and Social Research, University of Southern California, Los Angeles, California
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The drivers, trends and dietary impacts of non-nutritive sweeteners in the food supply: a narrative review. Nutr Res Rev 2020; 34:185-208. [PMID: 33148371 DOI: 10.1017/s0954422420000268] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Poor diets, including excess added sugar consumption, contribute to the global burden of disease. Subsequently, many nutrition policies have been implemented to reduce added sugar intake and improve population health, including taxes, education, labelling and environmental interventions. A potential consequence of these policy actions is the substitution of added sugars with non-nutritive sweeteners (NNS) in a variety of foods and beverages. NNS are used to reduce the energy and sugar content of foods and beverages while maintaining their palatability. Evidence of the toxicological risks of NNS is inconsistent, though concerns have been raised over the potential substitution effects of ultra-processed foods containing NNS for whole foods. This review aimed to provide an overview of current NNS food supply and consumption patterns, assess added sugar-reduction policies and their impact on NNS, and determine the impact of NNS on food choice, energy intake and diet quality. NNS are widely available in a variety of products, though most commonly in carbonated beverages, dairy products, confectionery, table-top sweeteners and fruit drinks. However, the longitudinal trends of different product categories, and differences between geographies and economy-income levels, require further study. Few studies have examined NNS consumption trends globally, though an increase in NNS consumption in beverages has been observed in some regions. Research examining how the increased availability of low-sugar, NNS-containing products affects global dietary patterns is limited, particularly in terms of their potential substitution effects.
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Healthier Food and Beverage Interventions in Schools: Four Community Guide Systematic Reviews. Am J Prev Med 2020; 59:e15-e26. [PMID: 32564807 PMCID: PMC9366443 DOI: 10.1016/j.amepre.2020.01.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 01/12/2020] [Accepted: 01/13/2020] [Indexed: 11/23/2022]
Abstract
CONTEXT Healthy eating during childhood is important for optimal growth and helps reduce the risk of obesity, which has potentially serious health consequences. Changing the school food environment may offer one way to improve students' dietary intake. This manuscript reports 4 Community Guide systematic reviews examining the effectiveness of interventions in schools promoting healthy eating and weight. EVIDENCE ACQUISITION School obesity prevention programs aiming to improve diet were identified from a 2013 Agency for Health Care Research and Quality systematic review and an updated search (August 2012-January 4, 2017). In 2017-2018, Community Guide systematic review methods were used to assess effectiveness as determined by dietary behavior and weight changes. EVIDENCE SYNTHESIS Interventions improving school meals or offering fruits and vegetables (n=27 studies) are considered effective. Evidence is insufficient to determine the effectiveness of interventions supporting healthier snack foods and beverages outside of school meal programs given inconsistent findings (n=13 studies). Multicomponent interventions to increase availability of healthier foods and beverages are considered effective. These interventions must include 1 component from school meals or fruit and vegetable programs and interventions supporting healthier snack foods and beverages (n=12 studies). There is insufficient evidence to determine the effectiveness of interventions to increase water access because only 2 studies met inclusion criteria. CONCLUSIONS A total of 2 school-based dietary interventions have favorable effects for improving dietary habits and modest effects for improving or maintaining weight. More evidence is needed regarding interventions with insufficient findings. These reviews may inform researchers and school administrators about healthy eating and obesity prevention interventions.
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Correlation of Sugar-Sweetened Beverage Consumption and School Free and Reduced Lunch Eligibility as a Measure of Socioeconomic Status. J Community Health 2020; 44:307-312. [PMID: 30386974 DOI: 10.1007/s10900-018-0588-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
To determine whether a correlation exists between sugar-sweetened beverage consumption (SSB) and school free and reduced lunch (FRL) eligibility as a measure of socioeconomic status (SES). In January 2016, a modified version of the Bev 15 survey was anonymously administered to 5th and 6th grade students in 14 Chicago suburban public elementary schools. Students were asked to recall and record their beverage intake over the last 24 h for five predefined beverage groups [SSB, real fruit juice (RFJ), diet or sugar free beverages, milk, and water]. Concurrently, data regarding FRL eligibility for each of the 14 schools was obtained from the Illinois State Board of Education website. Mean student consumption of the five beverage categories in each school was correlated with the school's respective FRL status. A total of 1389 student surveys were used for analysis. FRL eligibility ranged from 16 to 64% in the 14 schools. There was a significant correlation between school FRL eligibility and consumption of SSB (p = 0.001), RFJ (p = 0.004) and diet or sugar-free beverage (p = 0.04). There was no significant correlation between FRL eligibility and consumption of water (p = 0.5), and milk (p = 0.2). This study shows that consumption of SSB highly correlates with school FRL eligibility, which can be a measure of SES. These findings reinforce the idea that there is a link between lower SES and unhealthy behaviors pertaining to dietary choices. Knowing this relationship between SSB consumption and FRL eligibility, specific schools can be targeted to reduce SSB consumption and its negative health consequences.
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19
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Epel ES, Hartman A, Jacobs LM, Leung C, Cohn MA, Jensen L, Ishkanian L, Wojcicki J, Mason AE, Lustig RH, Stanhope KL, Schmidt LA. Association of a Workplace Sales Ban on Sugar-Sweetened Beverages With Employee Consumption of Sugar-Sweetened Beverages and Health. JAMA Intern Med 2020; 180:9-16. [PMID: 31657840 PMCID: PMC6820289 DOI: 10.1001/jamainternmed.2019.4434] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
IMPORTANCE Reductions in sugar-sweetened beverage (SSB) intake can improve health, but are difficult for individuals to achieve on their own. OBJECTIVES To evaluate whether a workplace SSB sales ban was associated with SSB intake and cardiometabolic health among employees and whether a brief motivational intervention provides added benefits to the sales ban. DESIGN, SETTING, AND PARTICIPANTS This before-after study and additional randomized trial conducted from July 28, 2015, to October 16, 2016, at a Northern California university and hospital assessed SSB intake, anthropometrics, and cardiometabolic biomarkers among 214 full-time English-speaking employees who were frequent SSB consumers (≥360 mL [≥12 fl oz] per day) before and 10 months after implementation of an SSB sales ban in a large workplace, with half the employees randomized to receive a brief motivational intervention targeting SSB reduction. INTERVENTIONS The employer stopped selling SSBs in all workplace venues, and half the sample was randomized to receive a brief motivational intervention and the other half was a control group that did not receive the intervention. This intervention was modeled on standard brief motivational interventions for alcohol used in the workplace that promote health knowledge and goal setting. MAIN OUTCOMES AND MEASURES Outcomes included changes in SSB intake, Homeostatic Model Assessment of Insulin Resistance (HOMA-IR), and measures of abdominal adiposity. The primary associations tested were the correlation between changes in SSB intake and changes in HOMA-IR. RESULTS Among the 214 study participants, 124 (57.9%) were women, with a mean (SD) age of 41.2 (11.0) years and a baseline mean (SD) body mass index of 29.4 (6.5). They reported a mean daily intake of 1050 mL (35 fl oz) of SSBs at baseline and 540 mL (18 fl oz) at follow-up-a 510-mL (17-fl oz) (48.6%) decrease (P < .001). Reductions in SSB intake correlated with improvements in HOMA-IR (r = 0.16; P = .03). Those not randomized to receive the brief intervention reduced their SSB intake by a mean (SD) of 246.0 (84.0) mL (8.2 [2.8] fl oz), while those also receiving the brief intervention reduced SSB intake by 762.0 (84.0) mL (25.4 [2.8] fl oz). From baseline to follow-up, there were significant reductions in mean (SE) waist circumference (2.1 [2.8] cm; P < .001). CONCLUSIONS AND RELEVANCE This study's findings suggest that the workplace sales ban was associated with a reduction in SSB intake and a significant reduction in waist circumference among employees within 10 months. The randomized clinical trial portion of this study found that targeting those at high risk with a brief motivational intervention led to additional improvements. Workplace sales bans may offer a promising new private-sector strategy for reducing the health harms of SSB intake. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT02585336.
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Affiliation(s)
- Elissa S Epel
- Department of Psychiatry, University of California, San Francisco.,Center for Health and Community, University of California, San Francisco
| | - Alison Hartman
- Center for Health and Community, University of California, San Francisco
| | - Laurie M Jacobs
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco
| | - Cindy Leung
- Department of Nutritional Sciences, School of Public Health, University of Michigan, Ann Arbor
| | - Michael A Cohn
- Osher Center for Integrative Medicine, University of California, San Francisco
| | - Leeane Jensen
- Campus Life Services, UCSF Wellness Program, University of California, San Francisco
| | - Laura Ishkanian
- Campus Life Services, UCSF Wellness Program, University of California, San Francisco
| | - Janet Wojcicki
- Center for Health and Community, University of California, San Francisco.,Department of Pediatrics, University of California, San Francisco
| | - Ashley E Mason
- Department of Psychiatry, University of California, San Francisco.,Osher Center for Integrative Medicine, University of California, San Francisco
| | - Robert H Lustig
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco.,Department of Pediatrics, University of California, San Francisco
| | - Kimber L Stanhope
- Department of Molecular Biosciences, University of California, Davis
| | - Laura A Schmidt
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco.,Department of Anthropology, History and Social Medicine, University of California, San Francisco
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Abdel Rahman A, Jomaa L, Kahale LA, Adair P, Pine C. Effectiveness of behavioral interventions to reduce the intake of sugar-sweetened beverages in children and adolescents: a systematic review and meta-analysis. Nutr Rev 2019; 76:88-107. [PMID: 29281069 PMCID: PMC5939855 DOI: 10.1093/nutrit/nux061] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Context Consumption of sugar-sweetened beverages (SSBs) among children has been associated with adverse health outcomes. Numerous behavioral interventions aimed at reducing the intake of SSBs among children have been reported, yet evidence of their effectiveness is lacking. Objective This systematic review explored the effectiveness of educational and behavioral interventions to reduce SSB intake and to influence health outcomes among children aged 4 to 16 years. Data Sources Seven databases were searched for randomized controlled trials published prior to September 2016. Studies identified were screened for eligibility. Study Selection Trials were included in the review if they met the PICOS (Population, Intervention, Comparison, Outcome, and Study design) criteria for inclusion of studies. Data Extraction Data were extracted by 2 reviewers following Cochrane guidelines and using Review Manager software. Results Of the 16 trials included, 12 were school based and 4 were community or home based. Only 3 trials provided data that could be pooled into a meta-analysis for evaluating change in SSB intake. Subgroup analyses showed a trend toward a significant reduction in SSB intake in participants in school-based interventions compared with control groups. Change in body mass index z scores was not statistically significant between groups. Conclusions The quality of evidence from included trials was considered moderate, and the effectiveness of educational and behavioral interventions in reducing SSB intake was modest. Systematic Review Registration PROSPERO registration number CRD42014004432.
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Affiliation(s)
- Abir Abdel Rahman
- Department of Medical Laboratory Sciences, Faculty of Health Sciences, University of Balamand, Ashrafieh, Beirut, Lebanon
| | - Lamis Jomaa
- Department of Nutrition and Food Sciences, Faculty of Agricultural and Food Sciences, American University of Beirut, Beirut, Lebanon
| | - Lara A Kahale
- Clinical Research Institute, Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Pauline Adair
- School of Psychology, Queens University Belfast, Belfast, United Kingdom
| | - Cynthia Pine
- Institute of Dentistry, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
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21
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Alston L, Crooks N, Strugnell C, Orellana L, Allender S, Rennie C, Nichols M. Associations between School Food Environments, Body Mass Index and Dietary Intakes among Regional School Students in Victoria, Australia: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E2916. [PMID: 31416245 PMCID: PMC6720309 DOI: 10.3390/ijerph16162916] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 08/06/2019] [Accepted: 08/08/2019] [Indexed: 12/17/2022]
Abstract
(1) Background: Childhood overweight and obesity is a significant and preventable problem worldwide. School environments have been suggested to be plausible targets for interventions seeking to improve the quality of children's dietary intake. The objective of this study was to determine the extent to which the current characteristics of the school food environment were associated with primary school students' dietary intake and Body Mass Index (BMI) z scores in a representative sample in regional Victoria. (2) Methods: This study included 53 schools, comprising a sample of 3,496 students in year levels two (aged 7-8 years), four (9-10 years) and six (11-12 years). Year four and six students completed dietary questionnaires. Principals from each school completed a survey on school food environment characteristics. Mixed-effects logistic regression was used to assess the relationship between students' dietary intake and school food environment scores, controlling for confounders such as socio-economic status, school size and sex. Food environment scores were also analysed against the odds of being healthy weight (defined as normal BMI z score). (3) Results: Mixed associations were found for the relationship between students' dietary intake and food environment scores. Meeting the guidelines for vegetable intake was not associated with food environment scores, but students were more likely (OR: 1.68 95% CI 1.26, 2.24) to meet the guidelines if they attended a large school (>300 enrolments) and were female (OR: 1.28 95% CI: 1.02, 1.59). Healthy weight was not associated with school food environment scores, but being a healthy weight was significantly associated with less disadvantage (OR: 1.24 95% CI 1.05, 1.45). Conclusion: In this study, the measured characteristics of school food environments did not have strong associations with dietary intakes or BMI among students.
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Affiliation(s)
- Laura Alston
- Global Obesity Centre (GLOBE), Faculty of Health, Deakin University, Geelong 3217, Victoria, Australia.
| | - Nicholas Crooks
- Global Obesity Centre (GLOBE), Faculty of Health, Deakin University, Geelong 3217, Victoria, Australia
| | - Claudia Strugnell
- Global Obesity Centre (GLOBE), Faculty of Health, Deakin University, Geelong 3217, Victoria, Australia
| | - Liliana Orellana
- Biostatistics Unit, Faculty of Health, Deakin University, Geelong 3217, Victoria, Australia
| | - Steven Allender
- Global Obesity Centre (GLOBE), Faculty of Health, Deakin University, Geelong 3217, Victoria, Australia
| | - Claire Rennie
- Cancer Council Victoria, Melbourne 3004, Victoria, Australia
| | - Melanie Nichols
- Global Obesity Centre (GLOBE), Faculty of Health, Deakin University, Geelong 3217, Victoria, Australia
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Abstract
PURPOSE OF REVIEW Various policies to reduce sugar-sweetened beverages (SSBs) consumption in children have been implemented. Here, we review the evidence on whether these policies are effective in reducing SSB intake and whether a reduction in SSB intake results in a concomitant reduction in child obesity. We also highlight ethical concerns with such efforts. RECENT FINDINGS The evidence supporting relationship between SSB consumption and child body mass index (BMI) is consistently small and lacks causality. The effects of policies are unclear; taxation has no clear relationship to SSB purchasing, innovative marketing outlets make it difficult to examine the effects of restricting marketing on SSB consumption, and there is no evidence that reducing SSB availability in schools decreases consumption. Research studies with rigorous and reproducible study designs are needed to examine whether reducing SSB consumption reduces child obesity, and to identify implementable policies that not only reduce SSB consumption but also child weight.
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Affiliation(s)
- Shabnam R Momin
- USDA/ARS Children's Nutrition Research Center, Baylor College of Medicine, 1100 Bates Street, Houston, TX, 77030, USA.
| | - Alexis C Wood
- USDA/ARS Children's Nutrition Research Center, Baylor College of Medicine, 1100 Bates Street, Houston, TX, 77030, USA
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23
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Massri C, Sutherland S, Källestål C, Peña S. Impact of the Food-Labeling and Advertising Law Banning Competitive Food and Beverages in Chilean Public Schools, 2014-2016. Am J Public Health 2019; 109:1249-1254. [PMID: 31318604 DOI: 10.2105/ajph.2019.305159] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Objectives. To evaluate the impact of a national law banning sales of competitive food and beverages (CF&B) in schools on the availability of CF&B sold at school kiosks.Methods. This study was uncontrolled before and after study. We evaluated public schools in Santiago de Chile (n = 21; 78% response rate) in 2014 and 2016 (6 months after the law came into force). Trained personnel collected data on calories, total sugars, saturated fat, and sodium from food labels. The outcome was the percentage of foods exceeding the cutoff levels defined in the law and the mean difference between 2014 and 2016.Results. Foods exceeding any cutoffs decreased from 90.4% in 2014 to 15.0% in 2016. Solid products had a substantial reduction in calories, sugar, saturated fat, and sodium. Liquid products had a reduction in calories, total sugar, and saturated fat, whereas sodium increased. This was a result of changes in product mix.Conclusions. A ban on sales of CF&B reduced the availability of CF&B at Santiago's school kiosks. Further research should examine the impact of this ban on food intake and health outcomes.
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Affiliation(s)
- Camila Massri
- Camila Massri and Carina Källestål are with the Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden. Sofía Sutherland is with the Faculty of Medicine, Universidad de los Andes, Santiago, Chile. Sofía Sutherland and Sebastián Peña are with the Santiago Sano Program, Municipality of Santiago, Santiago. Sebastián Peña is also with the Department of Public Health Solutions, National Institute for Health and Welfare, Helsinki, Finland
| | - Sofía Sutherland
- Camila Massri and Carina Källestål are with the Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden. Sofía Sutherland is with the Faculty of Medicine, Universidad de los Andes, Santiago, Chile. Sofía Sutherland and Sebastián Peña are with the Santiago Sano Program, Municipality of Santiago, Santiago. Sebastián Peña is also with the Department of Public Health Solutions, National Institute for Health and Welfare, Helsinki, Finland
| | - Carina Källestål
- Camila Massri and Carina Källestål are with the Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden. Sofía Sutherland is with the Faculty of Medicine, Universidad de los Andes, Santiago, Chile. Sofía Sutherland and Sebastián Peña are with the Santiago Sano Program, Municipality of Santiago, Santiago. Sebastián Peña is also with the Department of Public Health Solutions, National Institute for Health and Welfare, Helsinki, Finland
| | - Sebastián Peña
- Camila Massri and Carina Källestål are with the Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden. Sofía Sutherland is with the Faculty of Medicine, Universidad de los Andes, Santiago, Chile. Sofía Sutherland and Sebastián Peña are with the Santiago Sano Program, Municipality of Santiago, Santiago. Sebastián Peña is also with the Department of Public Health Solutions, National Institute for Health and Welfare, Helsinki, Finland
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Lopez T, Arlinghaus KR, Johnston CA. Developing Adaptive Learning Environments to Support Long-Term Health Promotion. Am J Lifestyle Med 2019; 13:30-32. [PMID: 30627073 PMCID: PMC6311601 DOI: 10.1177/1559827618807389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Health promotion strategies typically include changing the environment, providing supervision to decrease the likelihood an unhealthy behavior will occur, and increasing skills to make decisions supporting health in environments in which such choices are challenging to make. The first two strategies are important in improving the environment to promote healthy decision making. However, the creation of restrictive environments has repeatedly shown to not support disease prevention in the long term. Restrictive environments do not support the development of skills to make healthy choices when restrictions are not in place. This is particularly true for children who are learning to navigate their environment and make health decisions. The creation of adaptive learning environments should be prioritized to help individuals develop the skills needed for long-term health promotion.
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Affiliation(s)
- Tabbetha Lopez
- Department of Health and Human Performance, University of Houston, Houston, Texas (TL, KRA, CAJ)
| | - Katherine R. Arlinghaus
- Department of Health and Human Performance, University of Houston, Houston, Texas (TL, KRA, CAJ)
| | - Craig A. Johnston
- Department of Health and Human Performance, University of Houston, Houston, Texas (TL, KRA, CAJ)
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Pérez-Ferrer C, Barrientos-Gutierrez T, Rivera-Dommarco JA, Prado-Galbarro FJ, Jiménez-Aguilar A, Morales-Ruán C, Shamah-Levy T. Compliance with nutrition standards in Mexican schools and their effectiveness: a repeated cross-sectional study. BMC Public Health 2018; 18:1411. [PMID: 30591040 PMCID: PMC6307217 DOI: 10.1186/s12889-018-6330-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 12/17/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Mexico approved mandatory nutrient-based standards for foods sold in schools in 2011. The aim of this study was to analyse the association between compliance with nutrition standards for foods sold in schools and children's school snacks. METHODS Data came from three surveys representative of Mexican elementary schools in 13 states and their students (2012, 2013 and 2015); n = 645 children from N = 99 different schools. Information on foods sold in schools and snacks consumed by children was collected through direct observation. Compliance with the standards was defined as the proportion of foods sold in school which met nutrition criteria established by the standards. Snacks were classified as healthy if they contained at least one fruit or vegetable and had no sugar-sweetened beverages. Robust logistic regression models for cross-sectional and repeated surveys aggregated at the school-level were fitted to quantify the association between school compliance with standards and healthy snacks. RESULTS On average across waves 27% of foods sold complied with nutrition standards; 18% of children consumed a healthy snack. For snacks purchased in school, a 10% increase in school compliance with the standards was associated with a 32% increase in the odds of a healthy snack (OR = 1.32; 95%CI 1.09,1.61); no association was observed for snacks brought from home. The odds of a healthy snack increased over time in schools where compliance with the standards improved (OR = 3.89; 95%CI 1.47,10.31) but not in those where compliance remained constant or decreased. CONCLUSIONS Only a small proportion of children are eating healthy snacks in school. School compliance with standards increases the likelihood of a healthy snack if it is bought at school. Our findings support better implementation of the standards and additional strategies to enhance the policy to achieve its aim of reducing childhood obesity.
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Affiliation(s)
- Carolina Pérez-Ferrer
- Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Avenida Universidad 655, Santa María Ahuacatitlán, 62100, Cuernavaca, Morelos, Mexico
| | - Tonatiuh Barrientos-Gutierrez
- Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Avenida Universidad 655, Santa María Ahuacatitlán, 62100, Cuernavaca, Morelos, Mexico
| | - Juan A Rivera-Dommarco
- Dirección General, Instituto Nacional de Salud Pública, Avenida Universidad 655, Santa María Ahuacatitlán, 62100, Cuernavaca, Morelos, Mexico
| | - Francisco Javier Prado-Galbarro
- Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Avenida Universidad 655, Santa María Ahuacatitlán, 62100, Cuernavaca, Morelos, Mexico
| | - Alejandra Jiménez-Aguilar
- Centro de Investigación en Evaluación y Encuestas, Instituto Nacional de Salud Pública, Avenida Universidad 655, Santa María Ahuacatitlán, 62100, Cuernavaca, Morelos, Mexico
| | - Carmen Morales-Ruán
- Centro de Investigación en Evaluación y Encuestas, Instituto Nacional de Salud Pública, Avenida Universidad 655, Santa María Ahuacatitlán, 62100, Cuernavaca, Morelos, Mexico
| | - Teresa Shamah-Levy
- Centro de Investigación en Evaluación y Encuestas, Instituto Nacional de Salud Pública, Avenida Universidad 655, Santa María Ahuacatitlán, 62100, Cuernavaca, Morelos, Mexico.
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Godin KM, Hammond D, Chaurasia A, Leatherdale ST. Examining changes in school vending machine beverage availability and sugar-sweetened beverage intake among Canadian adolescents participating in the COMPASS study: a longitudinal assessment of provincial school nutrition policy compliance and effectiveness. Int J Behav Nutr Phys Act 2018; 15:121. [PMID: 30482211 PMCID: PMC6257956 DOI: 10.1186/s12966-018-0754-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 11/19/2018] [Indexed: 02/06/2023] Open
Abstract
Background School nutrition policies can encourage restrictions in sugar-sweetened beverage (SSB) availability in school food outlets in order to discourage students’ SSB intake. The main objective was to examine how beverage availability in school vending machines changes over three school years across schools in distinct school nutrition policy contexts. Secondary objectives were to examine how students’ weekday SSB intake varies with time and identify longitudinal associations between beverage availability and SSB intake. Methods This longitudinal study used data from the COMPASS study (2013/14–2015/16), representing 7679 students from 78 Canadian secondary schools and three provincial school nutrition policy contexts (Alberta – voluntary guidelines, Ontario public – mandatory guidelines, and Ontario private schools – no guidelines). We assessed availability of 10 beverage categories in schools’ vending machines via the COMPASS School Environment Application and participants’ intake of three SSB varieties (soft drinks, sweetened coffees/teas, and energy drinks) via a questionnaire. Hierarchical regression models were used to examine whether: i) progression of time and policy group were associated with beverage availability; and, ii) beverage availability was associated with students’ SSB intake. Results Ontario public schools were significantly less likely than the other policy groups to serve SSBs in their vending machines, with the exception of flavoured milks. Vending machine beverage availability was consistent over time. Participants’ overall SSB intake remained relatively stable; reductions in soft drink intake were partially offset by increased sweetened coffee/tea consumption. Relative to Ontario public schools, attending school in Alberta was associated with more frequent energy drink intake and overall SSB intake whereas attending an Ontario private school was associated with less frequent soft drink intake, with no differences in overall SSB intake. Few beverage availability variables were significantly associated with participants’ SSB intake. Conclusions Mandatory provincial school nutrition policies were predictive of more limited SSB availability in school vending machines. SSB intake was significantly lower in Ontario public and private schools, although we did not detect a direct association between SSB consumption and availability. The findings provide support for mandatory school nutrition policies, as well as the need for comprehensive school- and broader population-level efforts to reduce SSB intake. Electronic supplementary material The online version of this article (10.1186/s12966-018-0754-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Katelyn M Godin
- School of Public Health and Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada.
| | - David Hammond
- School of Public Health and Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada
| | - Ashok Chaurasia
- School of Public Health and Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada
| | - Scott T Leatherdale
- School of Public Health and Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada
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Tseng E, Zhang A, Shogbesan O, Gudzune KA, Wilson RF, Kharrazi H, Cheskin LJ, Bass EB, Bennett WL. Effectiveness of Policies and Programs to Combat Adult Obesity: a Systematic Review. J Gen Intern Med 2018; 33:1990-2001. [PMID: 30206789 PMCID: PMC6206360 DOI: 10.1007/s11606-018-4619-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 06/30/2018] [Accepted: 07/31/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND This systematic review identifies programs, policies, and built-environment changes targeting prevention and control of adult obesity and evaluates their effectiveness. METHODS We searched PubMed, CINAHL, PsycINFO, and EconLit from January 2000 to March 2018. We included natural experiment studies evaluating a program, policy, or built-environment change targeting adult obesity and reporting weight/body mass index (BMI). Studies were categorized by primary intervention target: physical activity/built environment, food/beverage, messaging, or multiple. Two reviewers independently assessed the risk of bias for each study using the Effective Public Health Practice Project tool. RESULTS Of 158 natural experiments targeting obesity, 17 reported adult weight/BMI outcomes. Four of 9 studies reporting on physical activity/built environment demonstrated reduced weight/BMI, although effect sizes were small with low strength of evidence and high risk of bias. None of the 5 studies targeting the food/beverage environment decreased weight/BMI; strength of evidence was low, and 2 studies were rated high risk of bias. DISCUSSION We identified few natural experiments reporting on the effectiveness of programs, policies, and built-environment changes on adult obesity. Overall, we found no evidence that policies intending to promote physical activity and healthy eating had beneficial effects on weight/BMI and most studies had a high risk of bias. Limitations include few studies met our inclusion criteria; excluded studies in children and those not reporting on weight/BMI outcomes; weight/BMI reporting was very heterogeneous. More high-quality research, including natural experiments studies, is critical for informing the population-level effectiveness of obesity prevention and control initiatives in adults.
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Affiliation(s)
- Eva Tseng
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA. .,Welch Center for Prevention, Epidemiology, & Clinical Research, The Johns Hopkins University, Baltimore, MD, USA.
| | - Allen Zhang
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Johns Hopkins University Evidence-based Practice Center, Johns Hopkins Bloomberg School of Public Health, The Johns Hopkins University, Baltimore, MD, USA
| | | | - Kimberly A Gudzune
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Welch Center for Prevention, Epidemiology, & Clinical Research, The Johns Hopkins University, Baltimore, MD, USA
| | - Renee F Wilson
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Johns Hopkins University Evidence-based Practice Center, Johns Hopkins Bloomberg School of Public Health, The Johns Hopkins University, Baltimore, MD, USA
| | - Hadi Kharrazi
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Lawrence J Cheskin
- Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Eric B Bass
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Johns Hopkins University Evidence-based Practice Center, Johns Hopkins Bloomberg School of Public Health, The Johns Hopkins University, Baltimore, MD, USA
| | - Wendy L Bennett
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Welch Center for Prevention, Epidemiology, & Clinical Research, The Johns Hopkins University, Baltimore, MD, USA
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Sildén KE. Impact of competitive foods in public schools on child nutrition: effects on adolescent obesity in the United States an integrative systematic literature review. Glob Health Action 2018; 11:1477492. [PMID: 29893188 PMCID: PMC5998782 DOI: 10.1080/16549716.2018.1477492] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background: The United States (US) is currently facing a public health crisis due to the percentage of obesity in adolescents. The Center for Disease Control (CDC) stated the risks for children due to obesity are many. Adolescents obtain a large portion of their daily caloric intake at school; therefore, what foods/drinks they are consuming is so serious. Objective: To identify and analyze literature on the effects of competitive foods in public schools on adolescent weight, or Body Mass Index (BMI), and possible impacts they may have on adolescent obesity in the United States. Methods: An integrative systematic review of literature was conducted. The literature was collected in CINAHL, MEDLINE and EMBASE databases. Refined keyword search is further detailed in the report. Year restrictions were 2006–2017 from peer-reviewed journals and published in English, including adolescents 13–18 years old in the US. Criteria for inclusion targeted at least one of (1) sugar-sweetened beverages (SSB), (2) competitive foods, (3) commercial foods, (4) vending machines, (5) al a carte venues, and (6) school stores, examining their associations with weight measurements, using either weight or BMI, or caloric intake analysis. Results: A total of 164 articles were detected and assessed, for a final analysis of 34 full text articles. Twenty-six articles met the inclusion criteria. Common aspects of interest involved BMI/Obesity/Weight (73%), (58%) examined Calorie density or consumption, (77%) discussed the Availability of competitive foods in schools, (54%) included Analysis of competitive food, beverage and nutrition policies, and (69%) addressed Other effects. Conclusion: This review discovered substantial evidence that competitive foods are highly available in schools, however, lacking in robust evidence proving causality in increasing BMI or weight. There is strong corroboration in the research revealing that Other effects are factors worthy of studying further. Additional longitudinal and higher-quality research needs to be performed.
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Affiliation(s)
- Kirsten E Sildén
- a Department of Public Health , Lund University , Ängelholm , Sweden
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Availability of food and beverage items on school canteen menus and association with items purchased by children of primary-school age. Public Health Nutr 2018; 21:2907-2914. [DOI: 10.1017/s1368980018001726] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractObjectiveTo (i) describe the proportion of foods and beverages available on school canteen menus classified as having high (‘green’), moderate (‘amber’) or low (‘red’) nutritional value; (ii) describe the proportion of these items purchased by students; and (iii) examine the association between food and beverage availability on school canteen menus and food and beverage purchasing by students.DesignA cross-sectional study was conducted as part of a larger randomised controlled trial (RCT).SettingA nested sample of fifty randomly selected government schools from the Hunter New England region of New South Wales, Australia, who had participated in an RCT of an intervention to improve the availability of healthy foods sold from school canteens, was approached to participate.SubjectsSchool principals, canteen managers and students.ResultsThe average proportion of green, amber and red items available on menus was 47·9, 47·4 and 4·7 %, respectively. The average proportion of green, amber and red items purchased by students was 30·1, 61·8 and 8·1 %, respectively. There was a significant positive relationship between the availability and purchasing of green (R2=0·66), amber (R2=0·57) and red menu items (R2=0·61). In each case, a 1 % increase in the availability of items in these categories was associated with a 1·21, 1·35 and 1·67 % increase in purchasing of items of high, moderate and low nutritional value, respectively.ConclusionsThe findings provide support for school-based policies to improve the relative availability of healthy foods for sale in these settings.
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Bennett WL, Wilson RF, Zhang A, Tseng E, Knapp EA, Kharrazi H, Stuart EA, Shogbesan O, Bass EB, Cheskin LJ. Methods for Evaluating Natural Experiments in Obesity: A Systematic Review. Ann Intern Med 2018; 168:791-800. [PMID: 29710087 DOI: 10.7326/m18-0309] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Given the obesity pandemic, rigorous methodological approaches, including natural experiments, are needed. PURPOSE To identify studies that report effects of programs, policies, or built environment changes on obesity prevention and control and to describe their methods. DATA SOURCES PubMed, CINAHL, PsycINFO, and EconLit (January 2000 to August 2017). STUDY SELECTION Natural experiments and experimental studies evaluating a program, policy, or built environment change in U.S. or non-U.S. populations by using measures of obesity or obesity-related health behaviors. DATA EXTRACTION 2 reviewers serially extracted data on study design, population characteristics, data sources and linkages, measures, and analytic methods and independently evaluated risk of bias. DATA SYNTHESIS 294 studies (188 U.S., 106 non-U.S.) were identified, including 156 natural experiments (53%), 118 experimental studies (40%), and 20 (7%) with unclear study design. Studies used 106 (71 U.S., 35 non-U.S.) data systems; 37% of the U.S. data systems were linked to another data source. For outcomes, 112 studies reported childhood weight and 32 adult weight; 152 had physical activity and 148 had dietary measures. For analysis, natural experiments most commonly used cross-sectional comparisons of exposed and unexposed groups (n = 55 [35%]). Most natural experiments had a high risk of bias, and 63% had weak handling of withdrawals and dropouts. LIMITATION Outcomes restricted to obesity measures and health behaviors; inconsistent or unclear descriptions of natural experiment designs; and imperfect methods for assessing risk of bias in natural experiments. CONCLUSION Many methodologically diverse natural experiments and experimental studies were identified that reported effects of U.S. and non-U.S. programs, policies, or built environment changes on obesity prevention and control. The findings reinforce the need for methodological and analytic advances that would strengthen evaluations of obesity prevention and control initiatives. PRIMARY FUNDING SOURCE National Institutes of Health, Office of Disease Prevention, and Agency for Healthcare Research and Quality. (PROSPERO: CRD42017055750).
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Affiliation(s)
- Wendy L Bennett
- Johns Hopkins University School of Medicine and Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (W.L.B., R.F.W., A.Z., E.T., E.A.K., H.K., E.A.S., O.S., E.B.B., L.J.C.)
| | - Renee F Wilson
- Johns Hopkins University School of Medicine and Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (W.L.B., R.F.W., A.Z., E.T., E.A.K., H.K., E.A.S., O.S., E.B.B., L.J.C.)
| | - Allen Zhang
- Johns Hopkins University School of Medicine and Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (W.L.B., R.F.W., A.Z., E.T., E.A.K., H.K., E.A.S., O.S., E.B.B., L.J.C.)
| | - Eva Tseng
- Johns Hopkins University School of Medicine and Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (W.L.B., R.F.W., A.Z., E.T., E.A.K., H.K., E.A.S., O.S., E.B.B., L.J.C.)
| | - Emily A Knapp
- Johns Hopkins University School of Medicine and Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (W.L.B., R.F.W., A.Z., E.T., E.A.K., H.K., E.A.S., O.S., E.B.B., L.J.C.)
| | - Hadi Kharrazi
- Johns Hopkins University School of Medicine and Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (W.L.B., R.F.W., A.Z., E.T., E.A.K., H.K., E.A.S., O.S., E.B.B., L.J.C.)
| | - Elizabeth A Stuart
- Johns Hopkins University School of Medicine and Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (W.L.B., R.F.W., A.Z., E.T., E.A.K., H.K., E.A.S., O.S., E.B.B., L.J.C.)
| | - Oluwaseun Shogbesan
- Johns Hopkins University School of Medicine and Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (W.L.B., R.F.W., A.Z., E.T., E.A.K., H.K., E.A.S., O.S., E.B.B., L.J.C.)
| | - Eric B Bass
- Johns Hopkins University School of Medicine and Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (W.L.B., R.F.W., A.Z., E.T., E.A.K., H.K., E.A.S., O.S., E.B.B., L.J.C.)
| | - Lawrence J Cheskin
- Johns Hopkins University School of Medicine and Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (W.L.B., R.F.W., A.Z., E.T., E.A.K., H.K., E.A.S., O.S., E.B.B., L.J.C.)
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Yoshida Y, Simoes EJ. Sugar-Sweetened Beverage, Obesity, and Type 2 Diabetes in Children and Adolescents: Policies, Taxation, and Programs. Curr Diab Rep 2018; 18:31. [PMID: 29671076 PMCID: PMC6025796 DOI: 10.1007/s11892-018-1004-6] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
PURPOSE OF REVIEW Obesity has grown at an alarming rate in children and adolescents. Concurrently, consumption on sugar-sweetened beverages (SSBs) also rose significantly. This review provides an overview of obesity and type 2 diabetes mellitus (T2DM) related to SSBs and current policies restricting SSBs in schools, school-based interventions, and taxation on reducing SSB intake and obesity. We also discuss challenges of and future steps for these initiatives. RECENT FINDINGS Clinical and epidemiological studies suggest a strong association between SSB intake and obesity and T2DM. School food policies have been initiated at federal, state, and local levels. School-based interventions have shown positive effects on SSB intake and obesity reduction. Taxation on SSBs is promising in combating obesity and in generating revenue. Challenges towards compliance and implementation of the policies and programs exist. The relationship between SSB and obesity and T2DM is a complex problem which requires comprehensive solutions. Continued efforts in restricting SSBs in schools are needed. Intervention programs should be tailored to age, gender, language, and culture and involve participation from families and local communities. Taxation can reduce SSB consumption by direct economic incentive, earmarking revenues to support healthy foods, and sending negative message. However, a higher tax rate may be necessary to have a measurable effect on weight.
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Affiliation(s)
- Yilin Yoshida
- Department of Health Management and Informatics, School of Medicine, University of Missouri-Columbia, CE707 CS&E Bldg., One Hospital Drive, Columbia, MO 65212, USA
- Missouri Cancer Registry and Research Center, University of Missouri-Columbia, Columbia, MO, USA
| | - Eduardo J. Simoes
- Department of Health Management and Informatics, School of Medicine, University of Missouri-Columbia, CE707 CS&E Bldg., One Hospital Drive, Columbia, MO 65212, USA
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Rosas CE, Gregorio-Pascual P, Driver R, Martinez A, Price SL, Lopez C, Mahler HIM. Effects of Social Norms Information and Self-Affirmation on Sugar-Sweetened Beverage Consumption Intentions and Behaviors. BASIC AND APPLIED SOCIAL PSYCHOLOGY 2018; 39:112-126. [PMID: 29398745 DOI: 10.1080/01973533.2017.1283503] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The separate and combined efficacy of a social norms and a self-affirmation intervention to motivate decreased sugar-sweetened beverage (SSB) consumption was examined in two experiments. College students were randomly assigned to receive information about SSB consumption risks, norms, both, or neither. In addition, participants performed either a self-affirmation or control task. Self-affirmation only weakly affected SSB consumption intentions and behaviors. However, participants in Experiment 2 who received risks information, norms information, or both reported greater SSB reduction intentions than did those who received no information. Two-weeks later, those who received both types of information reported more frequent behavior change preparations, and it appears this effect may have been partially mediated by the changes in intentions to reduce SSB consumption.
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Mata J, Hertwig R. Public Beliefs About Obesity Relative to Other Major Health Risks: Representative Cross-Sectional Surveys in the USA, the UK, and Germany. Ann Behav Med 2018; 52:273-286. [DOI: 10.1093/abm/kax003] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Jutta Mata
- Center for Adaptive Rationality (ARC), Max Planck Institute for Human Development, Berlin, Germany
- Department of Social Sciences, University of Mannheim, Mannheim, Germany
| | - Ralph Hertwig
- Center for Adaptive Rationality (ARC), Max Planck Institute for Human Development, Berlin, Germany
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Capacci S, Mazzocchi M, Shankar B. Breaking Habits: The Effect of the French Vending Machine Ban on School Snacking and Sugar Intakes. JOURNAL OF POLICY ANALYSIS AND MANAGEMENT : [THE JOURNAL OF THE ASSOCIATION FOR PUBLIC POLICY ANALYSIS AND MANAGEMENT] 2018; 37:88-111. [PMID: 29320810 DOI: 10.1002/pam.22032] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
This paper estimates the effect of the 2005 vending machine ban in French secondary schools on nutrient intakes and on the frequency of morning snacking at school. Using data before and after the ban, and exploiting the discontinuity associated with the age-dependent exposure to the ban, we specify a difference-in-differences regression discontinuity design. Since the relationship between age-at-interview and school level is not precise, we introduce fuzziness in the model. We find that the ban has generated a 10-gram reduction in sugar intakes from morning snacks at school, and a significant reduction in the frequency of these morning snacks. However, we find no evidence that the intervention affects total daily intakes, and our results are suggestive of compensation effects.
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Affiliation(s)
- Sara Capacci
- Department of Economics, University of Bologna, Rimini, Italy
| | - Mario Mazzocchi
- Department of Statistical Sciences, University of Bologna, Bologna, Italy
| | - Bhavani Shankar
- Leverhulme Centre for Integrative Research in Agriculture and Health at the University of London, London, UK
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Lindhout P, Reniers G. What about nudges in the process industry? Exploring a new safety management tool. J Loss Prev Process Ind 2017. [DOI: 10.1016/j.jlp.2017.10.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Bogart LM, Elliott MN, Ober AJ, Klein DJ, Hawes-Dawson J, Cowgill BO, Uyeda K, Schuster MA. Home Sweet Home: Parent and Home Environmental Factors in Adolescent Consumption of Sugar-Sweetened Beverages. Acad Pediatr 2017; 17:529-536. [PMID: 28143794 PMCID: PMC5495605 DOI: 10.1016/j.acap.2017.01.015] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 01/18/2017] [Accepted: 01/23/2017] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Sugar-sweetened beverages (SSBs) are key contributors to obesity among youth. We investigated associations among parental and home-related factors (parental attitudes and consumption; home availability) regarding 3 types of SSBs-soda, sports drinks, and fruit-flavored drinks-with consumption of each type of SSB in a general school-based sample of adolescents. METHODS Data were collected across 3 school semesters, from 2009 to 2011. A total of 1313 seventh grade student-parent dyads participated. Students completed in-class surveys across 9 schools in a large Los Angeles school district; their parents completed telephone interviews. Youth were asked about their SSB consumption (soda, sports drinks, and fruit-flavored drinks), and parents were asked about their attitudes, consumption, and home availability of SSBs. RESULTS We estimated expected rates of youth SSB consumption for hypothetical parents at very low (5th) and very high (95th) percentiles for home/parental risk factors (ie, they consumed little, had negative attitudes, and did not keep SSBs in the home; or they consumed a lot, had positive attitudes, and did keep SSBs in the home). Youth of lower-risk parents (at the 5th percentile) were estimated to drink substantially less of each type of beverage than did youth of higher-risk parents (at the 95th percentile). For example, youth with higher-risk parents averaged nearly double the SSB consumption of youth of lower-risk parents (2.77 vs 1.37 glasses on the previous day; overall model significance F22,1312 = 3.91, P < .001). CONCLUSIONS Results suggest a need to focus on parental and home environmental factors when intervening to reduce youths' SSB consumption.
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Affiliation(s)
- Laura M. Bogart
- RAND Corporation, 1776 Main St, P.O. Box 2138, Santa Monica, CA, 90407-2138,Division of General Pediatrics, Department of Medicine, Boston Children’s Hospital, 300 Longwood Ave, Boston, MA, 02115,Department of Pediatrics, Harvard Medical School, 25 Shattuck St, Boston, MA, 02115
| | - Marc N. Elliott
- RAND Corporation, 1776 Main St, P.O. Box 2138, Santa Monica, CA, 90407-2138
| | - Allison J. Ober
- RAND Corporation, 1776 Main St, P.O. Box 2138, Santa Monica, CA, 90407-2138
| | - David J. Klein
- RAND Corporation, 1776 Main St, P.O. Box 2138, Santa Monica, CA, 90407-2138,Division of General Pediatrics, Department of Medicine, Boston Children’s Hospital, 300 Longwood Ave, Boston, MA, 02115
| | | | - Burton O. Cowgill
- Department of Health Policy and Management, UCLA Fielding School of Public Health, 650 Charles Young Drive South, A2-125 CHS, Box 9569000, Los Angeles, CA 90095-6900
| | - Kimberly Uyeda
- Community Partners and Medi-Cal Programs, Student Health and Human Services, Los Angeles Unified School District, 333 South Beaudry Ave, 29th floor, Los Angeles, CA 90017
| | - Mark A. Schuster
- Division of General Pediatrics, Department of Medicine, Boston Children’s Hospital, 300 Longwood Ave, Boston, MA, 02115,Department of Pediatrics, Harvard Medical School, 25 Shattuck St, Boston, MA, 02115
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Choi SK, Frongillo EA, Blake CE, Thrasher JF. Korean Adolescents’ Energy Intake of Selected Foods by Eating Place from 1998 to 2012 During Implementation of Two National School Nutrition Policies. JOURNAL OF HUNGER & ENVIRONMENTAL NUTRITION 2017. [DOI: 10.1080/19320248.2017.1337534] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Seul Ki Choi
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, South Carolina
| | - Edward A. Frongillo
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, South Carolina
| | - Christine E. Blake
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, South Carolina
| | - James F. Thrasher
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, South Carolina
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Chen HJ, Xue H, Kumanyika S, Wang Y. School beverage environment and children's energy expenditure associated with physical education class: an agent-based model simulation. Pediatr Obes 2017; 12:203-212. [PMID: 27098225 DOI: 10.1111/ijpo.12126] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Revised: 11/13/2015] [Accepted: 02/10/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Physical activity contributes to children's energy expenditure and prevents excess weight gain, but fluid replacement with sugar-sweetened beverages (SSBs) may diminish this benefit. OBJECTIVE The aim of this study was to explore the net energy expenditure (EE) after physical education (PE) class given the competition between water and SSB consumption for rehydration and explore environmental factors that may influence the net EE, e.g. PE duration, affordability of SSB and students' SSB preference. METHODS We built an agent-based model that simulates the behaviour of 13-year-old children in a PE class with nearby water fountains and SSB vending machines available. RESULTS A longer PE class contributed to greater prevalence of dehydration and required more time for rehydration. The energy cost of a PE class with activity intensity equivalent to 45 min of jogging is about 300 kcal on average, i.e. 10-15% of average 13-year-old children's total daily EE. Adding an SSB vending machine could offset PE energy expenditure by as much as 90 kcal per child, which was associated with PE duration, students' pocket money and SSB preference. CONCLUSIONS Sugar-sweetened beverage vending machines in school may offset some of the EE in PE classes. This could be avoided if water is the only readily available source for children's fluid replacement after class.
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Affiliation(s)
- H-J Chen
- Institute of Public Health, National Yang-Ming University, Taipei, Taiwan.,Global Obesity Prevention Center at Johns Hopkins, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - H Xue
- Global Obesity Prevention Center at Johns Hopkins, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.,Systems-Oriented Global Childhood Obesity Intervention Program, Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - S Kumanyika
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Y Wang
- Global Obesity Prevention Center at Johns Hopkins, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.,Systems-Oriented Global Childhood Obesity Intervention Program, Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, State University of New York, Buffalo, NY, USA
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Datar A, Nicosia N. The Effect of State Competitive Food and Beverage Regulations on Childhood Overweight and Obesity. J Adolesc Health 2017; 60:520-527. [PMID: 27836530 PMCID: PMC5401783 DOI: 10.1016/j.jadohealth.2016.09.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 08/31/2016] [Accepted: 09/01/2016] [Indexed: 11/28/2022]
Abstract
PURPOSE Policy efforts for combating childhood obesity have sought stronger state policies for regulating competitive foods and beverages (CF&Bs) available in schools. However, the evidence linking state policies to children's overall diet and body weight outcomes is limited and mixed, and experts have called for more rigorous studies that are able to address concerns about selection bias. The present study leverages a rare natural experiment where children in military families are "assigned" to different state policies, due to their military parent's periodic relocation, to examine whether state CF&B policies were associated with children's body mass index (BMI) and overweight or obesity. METHODS We analyzed data from 894 children (12-13 years old) in army families attending public schools located near 25 installations across 23 states in 2013. State CF&B policy measures from the Bridging the Gap project were linked to the child data. Primary outcomes included BMI z-scores and indicator for overweight or obesity. For a subsample of children with self-reported food frequency measures, we also examined the link between state CF&B policies and overall diet. All regression analyses adjusted for a rich set of child and family covariates. RESULTS Having strong or weak policies was significantly associated with lower BMI z-scores, lower odds of overweight or obesity, and better dietary outcomes, relative to no policy. CONCLUSIONS A portfolio of policies that includes multiple strong policies is likely needed to observe any meaningful changes in BMI and obesity.
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Affiliation(s)
- Ashlesha Datar
- Center for Economic and Social Research, University of Southern California, Los Angeles, California.
| | - Nancy Nicosia
- RAND Corporation, 20 Park Plaza, 9 Floor, Suite 920, Boston, MA 02116
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40
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Schwartz MB, Just DR, Chriqui JF, Ammerman AS. Appetite self-regulation: Environmental and policy influences on eating behaviors. Obesity (Silver Spring) 2017; 25 Suppl 1:S26-S38. [PMID: 28229539 DOI: 10.1002/oby.21770] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 12/20/2016] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Appetite regulation is influenced by the environment, and the environment is shaped by food-related policies. This review summarizes the environment and policy research portion of an NIH Workshop (Bethesda, MD, 2015) titled "Self-Regulation of Appetite-It's Complicated." METHODS In this paper, we begin by making the case for why policy is an important tool in efforts to improve nutrition, and we introduce an ecological framework that illustrates the multiple layers that influence what people eat. We describe the state of the science on how policies influence behavior in several key areas: the federal food programs, schools, child care, food and beverage pricing, marketing to youth, behavioral economics, and changing defaults. Next, we propose novel approaches for multidisciplinary prevention and intervention strategies to promote breastfeeding, and examine interactions between psychology and the environment. RESULTS Policy and environmental change are the most distal influences on individual-level appetite regulation, yet these strategies can reach many people at once by changing the environment in which food choices are made. We note the need for more research to understand compensatory behavior, reactance, and how to effectively change social norms. CONCLUSIONS To move forward, we need a more sophisticated understanding of how individual psychological and biological factors interact with the environment and policy influences.
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Affiliation(s)
- Marlene B Schwartz
- Rudd Center for Food Policy and Obesity, University of Connecticut, Hartford, Connecticut, USA
| | - David R Just
- Dyson School of Applied Economics and Management, Cornell University, Ithaca, New York, USA
| | - Jamie F Chriqui
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Alice S Ammerman
- Department of Nutrition, Gillings School of Global Public Health, and Center for Health Promotion and Disease Prevention, UNC-Chapel Hill, Chapel Hill, North Carolina, USA
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Gu X, Tucker KL. Dietary quality of the US child and adolescent population: trends from 1999 to 2012 and associations with the use of federal nutrition assistance programs. Am J Clin Nutr 2017; 105:194-202. [PMID: 27881390 DOI: 10.3945/ajcn.116.135095] [Citation(s) in RCA: 109] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 10/18/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The state of the economy, changes in federal food assistance programs, and policies related to nutrition and the food supply in the United States may influence dietary quality in children and adolescents. OBJECTIVE We investigated dietary quality trends from 1999 to 2012 in the US child and adolescent population and their associations with socioeconomic status and participation in federal food assistance programs. DESIGN In this study, a nationally representative sample of 38,487 children and adolescents, aged 2-18 y, in the NHANES from 1999 to 2012 were included. Dietary information was collected with the use of a 24-h dietary recall. Dietary quality was measured with the use of the Healthy Eating Index 2010 (HEI-2010). RESULTS The mean HEI-2010 increased significantly from 42.5 (95% CI: 41.2, 43.8) to 50.9 (95% CI: 50.0, 51.8) from 1999 to 2012 (P-linear trend < 0.001). The reduction in empty calorie intake contributed to greater than one-third of this improvement in the total HEI-2010. We also observed significant increases in 9 other HEI-2010 component scores. However, the HEI-2010 component score for sodium decreased significantly, which reflected an increase in sodium consumption. We calculated the covariate-adjusted mean HEI-2010 score in subgroups that were defined by sociodemographic status and participation in nutrition assistance program at each NHANES cycle. Non-Hispanic black children and adolescents had a consistently lower HEI-2010 than that of other groups across all NHANES cycles. We observed a trend toward a lower HEI-2010 in Supplemental Nutrition Assistance Program (SNAP) participants than in nonparticipants after the 2003-2004 cycle. We also observed a lower HEI-2010 in participants in the National School Lunch Program (NSLP) and the School Breakfast Program (SBP) than in nonparticipants. In general, participants in the Special Supplemental Nutrition Program for Women, Infants, and Children appeared to have a higher HEI-2010 than that of nonparticipants. CONCLUSIONS Although HEI-2010 scores in children and adolescents improved steadily, the overall dietary quality remained poor. Participants in the SNAP and participants in the National School Lunch Program, School Breakfast Program, or both have lower dietary quality than do nonparticipants. Future policy interventions are needed to continue improvement in dietary quality and to address disparities.
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Affiliation(s)
- Xiao Gu
- Department of Epidemiology, School of Public Health, Brown University; and
| | - Katherine L Tucker
- Clinical Laboratory and Nutritional Sciences, Center for Population Health, University of Massachusetts Lowell, Lowell, MA
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Fred Wen CK, Hsieh S, Huh J, Martinez LC, Davis JN, Weigensberg M, Spruijt-Metz D. The Role of Assimilating to the US Culture and the Relationship Between Neighborhood Ethnic Composition and Dietary Intake Among Hispanic Youth. J Racial Ethn Health Disparities 2016; 4:10.1007/s40615-016-0293-1. [PMID: 27753052 PMCID: PMC5529269 DOI: 10.1007/s40615-016-0293-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 09/26/2016] [Accepted: 09/28/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Dietary fiber and sugar intake have been shown to affect metabolic health in overweight Hispanic youth. Evidence on the influence of culture on fiber and sugar intake in Hispanic youth is limited. METHODS The associations among score for levels of assimilation, neighborhood ethnic characteristics, and daily total and added dietary sugar and dietary fiber intake were assessed using regression analyses. RESULTS One hundred twenty-four Hispanic youth (age = 13.6 ± 3.0, 106 female) were included. The proportion of Hispanic population in the neighborhood was positively associated with fiber intake (standardized β = 0.205, p < 0.01) and inversely associated with added (standardized β = -0.234, p < 0.01) and total sugar intake (standardized β = -0.229, p < 0.01). Youth's self-identified levels of assimilation inversely moderated (standardized β = -0.465, p = 0.036) the association between %HP and dietary fiber intake. CONCLUSIONS Hispanic youth residing in areas of that are predominantly populated with Hispanics may be protected from conforming to unhealthy dietary behaviors. This protective effect is weaker among Hispanic youth with higher level of assimilation.
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Affiliation(s)
- Cheng K Fred Wen
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
| | - Stephanie Hsieh
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Jimi Huh
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Lauren Cook Martinez
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Jamie N Davis
- Department of Nutrition, University of Texas, Austin, Austin, TX, USA
| | - Marc Weigensberg
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Institute for Integrative Health, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Donna Spruijt-Metz
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Center for Social and Economic Research, University of Southern California, Los Angeles, CA, USA
- Department of Psychology, Dana and David Dornsife College of Letters, Arts, and Sciences, University of Southern California, Los Angeles, CA, USA
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Lebel A, Morin P, Robitaille É, Lalonde B, Florina Fratu R, Bisset S. Sugar Sweetened Beverage Consumption among Primary School Students: Influence of the Schools' Vicinity. JOURNAL OF ENVIRONMENTAL AND PUBLIC HEALTH 2016; 2016:1416384. [PMID: 27752265 PMCID: PMC5056269 DOI: 10.1155/2016/1416384] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 08/30/2016] [Indexed: 01/15/2023]
Abstract
The purpose of the research was to explore the associations between the characteristics of schools' vicinity and the risk of sugar sweetened beverage (SSB) consumption in elementary students. Findings exposed an important variation in student's SSB consumption between schools. Schools with a lower socioeconomic status or in a densely built environment tend to have higher proportion of regular SSB drinkers. These characteristics of the school's vicinity partly explained the variation observed between them. We estimated that a student moving to a school with a higher proportion of SSB drinkers may increase his/her chances by 52% of becoming a daily consumer. Important changes in dietary preferences can occur when children are in contact with a new social environment. Findings also support the idea that dietary behaviors among children result from the complex interactions between biological, social, and environmental factors.
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Affiliation(s)
- Alexandre Lebel
- Graduate School of Land Management and Regional Planning, Laval University, 2325 Rue des Bibliothèques, Quebec, QC, Canada G1V 0A6
- Evaluation Platform on Obesity Prevention, 2725 Chemin Sainte-Foy, Quebec, QC, Canada G1V 4G5
| | - Pascale Morin
- University of Sherbrooke, Faculty of Physical Activity Sciences, 2500 Boulevard de l'Université, Sherbrooke, QC, Canada J1K 2R1
| | - Éric Robitaille
- Quebec's National Institute of Public Health, 190 Boulevard Crémazie Est, Montréal, QC, Canada H2P 1E2
| | - Benoit Lalonde
- Evaluation Platform on Obesity Prevention, 2725 Chemin Sainte-Foy, Quebec, QC, Canada G1V 4G5
| | - Ramona Florina Fratu
- Evaluation Platform on Obesity Prevention, 2725 Chemin Sainte-Foy, Quebec, QC, Canada G1V 4G5
- Quebec's National Institute of Public Health, 190 Boulevard Crémazie Est, Montréal, QC, Canada H2P 1E2
| | - Sherri Bisset
- Evaluation Platform on Obesity Prevention, 2725 Chemin Sainte-Foy, Quebec, QC, Canada G1V 4G5
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The effect on drink sales of removal of unhealthy drinks from display in a self-service café. Public Health Nutr 2016; 19:3142-3145. [DOI: 10.1017/s1368980016002482] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractObjectiveThe present study assessed the impact of the retailer-led removal of unhealthy beverages from display at a self-service café within a major health service. While unhealthy beverages remained available from behind the counter upon request, this was not communicated directly to customers.DesignDrinks were categorised based on the state government nutrient profiling system, classifying drinks as ‘green’ (best choices), ‘amber’ (choose carefully) and ‘red’ (limit). Total drink sales (as number of items sold per week) in the café were measured for five weeks. All unhealthy ‘red’ beverages were removed from display (but were still available for purchase) and the sales of all beverages were measured for another six weeks.ResultsWe found that, in response to this strategy, the proportion of ‘red’ drinks sold decreased from 33 % to 10 % of total drink sales. As ‘amber’ and ‘green’ drink sales increased in response to this strategy, total retailer sales remained steady. Most consumers appeared to switch to purchasing ‘amber’ drinks rather than the healthiest option, ‘green’ drinks.ConclusionsThe removal of unhealthy beverages from display can result in consumers making healthier purchases, while not significantly affecting retailers’ sales.
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Palakshappa D, Fiks AG, Faerber JA, Feudtner C. Association between state school nutrition laws and subsequent child obesity. Prev Med 2016; 90:107-13. [PMID: 27370166 DOI: 10.1016/j.ypmed.2016.06.039] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 06/03/2016] [Accepted: 06/27/2016] [Indexed: 11/19/2022]
Abstract
Many states have enacted laws to improve school nutrition. We tested whether stronger state nutrition laws are associated with subsequently decreased obesity. We conducted a retrospective national multi-year panel data study (analyzed 2014-2016 at the Children's Hospital of Philadelphia). The predictors were 2010 laws regarding 9 nutrition categories from the Classification of Laws Associated with School Students, which grades the strength of state laws (none, weak, or strong). The outcome was weight status (healthy weight, overweight, or obese) in elementary, middle, and high school from the 2011/2012 National Survey of Children's Health. We tested the association between the strength of laws and weight using multinomial logistic regression. To further evaluate our main results, we conducted state-level longitudinal analyses testing the association between competitive food and beverage laws on the change in obesity from 2003-2011. In main analyses of 40,177 children ages 10-17years, we found strong state laws restricting the sale of competitive food and beverages in elementary school (OR: 0.68; 95% CI: 0.48, 0.96) and strong advertising laws across all grades (OR: 0.63; 95% CI: 0.46, 0.86) were associated with reduced odds of obesity. In longitudinal analyses, states with strong competitive food and beverage laws from 2003-2010 had small but significant decreases in obesity, compared to states with no laws. Although further research is needed to determine the causal effect of these laws, this study suggests that strong state laws limiting the sale and advertising of unhealthy foods and beverages in schools are associated with decreased obesity rates.
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Affiliation(s)
- Deepak Palakshappa
- Department of Pediatrics, Center for Pediatric Clinical Effectiveness and PolicyLab, Children's Hospital of Philadelphia, 34th & Civic Center Blvd, CHOP North, Philadelphia, PA 19104, USA.
| | - Alexander G Fiks
- Department of Pediatrics, Center for Pediatric Clinical Effectiveness and PolicyLab, Children's Hospital of Philadelphia, 34th & Civic Center Blvd, CHOP North, Philadelphia, PA 19104, USA.
| | - Jennifer A Faerber
- Department of Pediatrics, Children's Hospital of Philadelphia, 34th & Civic Center Blvd, Philadelphia, PA 19104, USA.
| | - Chris Feudtner
- Department of Pediatrics, Center for Pediatric Clinical Effectiveness and PolicyLab, Children's Hospital of Philadelphia, 34th & Civic Center Blvd, CHOP North, Philadelphia, PA 19104, USA.
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Essington M, Hertelendy AJ. Legislating Weight Loss: Are Antiobesity Public Health Policies Making an Impact? JOURNAL OF HEALTH POLITICS, POLICY AND LAW 2016; 41:453-461. [PMID: 26921382 DOI: 10.1215/03616878-3524008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Obesity affects America's children both in childhood and into their adult years. Unfortunately, a long history of public policy has done little to effectively reduce obesity among children. Federal programs including the National School Lunch Program, School Breakfast Program, and the School Meals Initiative for Healthy Children have proven to be less than effective in reducing obesity rates among school-aged children. Studies find that children participating in these programs are more likely to be overweight than their brown-bag peers while nutritional targets are missed. Various iterations of school-based nutrition programs have proven to be ineffective and wasteful, yet policy leaders continue to consume tax dollars with their implementation. Although strict guidelines for evaluating scientific evidence were historically used to ensure rigorous reviews were conducted, recent relaxation of those guidelines jeopardizes the integrity of the scientific platform. Consequently, recommendations that were once rooted in science may be less reliable due to a compromise of the scientific literature review process, and the conclusions drawn by the Dietary Guidelines Advisory Committee may be somewhat questionable. Public policy must be augmented by scientific evidence and any further obesity reduction initiatives must be well-grounded in research that has been rigorously reviewed and evaluated.
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Folayan MO, Kolawole KA, Chukwumah NM, Oyedele T, Agbaje HO, Onyejaka N, Oziegbe EO, Oshomoji OV. Use of caries prevention tools and associated caries risk in a suburban population of children in Nigeria. Eur Arch Paediatr Dent 2016; 17:187-93. [PMID: 27160760 DOI: 10.1007/s40368-016-0227-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Accepted: 02/03/2016] [Indexed: 11/29/2022]
Abstract
AIMS To determine the association between use of recommended oral self-care (ROSC) caries prevention tools and presence of dental caries in children resident in suburban Nigeria. METHODOLOGY Secondary analysis was conducted for a dataset generated for 1-12 years old children recruited through a household survey. Information on use of ROSC caries prevention tools (brushing more than once a day, use of fluoridated toothpaste always, and eating sugary snacks between main meals less than once a day), use of oral health adjuncts (dental floss, mouth rinses, other tooth cleansing agents) and presence of caries were extracted. The odds of having caries when ROSC caries prevention tools were used singly or in combination, were determined using multivariate logistic regression adjusted for age and sex. RESULTS The single or combined use of ROSC caries prevention tools had no statistically significant association with presence of caries. Brushing more than once a day reduced the odds of having caries while consumption of sugar between meals once a day or more increased the odds of having caries after adjusting for age and gender. The use of two ROSC caries prevention tools reduced the risk for caries (AOR 0.28; 95 % CI 0.05-1.53) when adjusted for age. The converse was observed when adjusted for gender (AOR 1.15; 95 % CI 0.38-3.45). The largest effect size was observed when sugary snacks were taken once a day or more between meals after adjusting for age (AOR 5.74; 95 % CI 0.34-96.11). CONCLUSION The use of a combination of fluoridated toothpaste and twice-daily tooth brushing had the largest effect on reducing the chance for caries in children resident in Ile-Ife, Nigeria.
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Affiliation(s)
- M O Folayan
- Department of Child Dental Health, Obafemi Awolowo University, Ile-Ife, Nigeria. .,Oral Habit Study Group, Ile-Ife, Nigeria. .,Department of Child Dental Health, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria.
| | - K A Kolawole
- Department of Child Dental Health, Obafemi Awolowo University, Ile-Ife, Nigeria.,Oral Habit Study Group, Ile-Ife, Nigeria.,Department of Child Dental Health, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
| | - N M Chukwumah
- Oral Habit Study Group, Ile-Ife, Nigeria.,Department of Child Dental Health, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
| | - Titus Oyedele
- Oral Habit Study Group, Ile-Ife, Nigeria.,Department of Child Dental Health, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
| | - H O Agbaje
- Oral Habit Study Group, Ile-Ife, Nigeria.,Department of Child Dental Health, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
| | - N Onyejaka
- Oral Habit Study Group, Ile-Ife, Nigeria.,Department of Child Dental Health, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
| | - E O Oziegbe
- Department of Child Dental Health, Obafemi Awolowo University, Ile-Ife, Nigeria.,Oral Habit Study Group, Ile-Ife, Nigeria.,Department of Child Dental Health, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
| | - O V Oshomoji
- Oral Habit Study Group, Ile-Ife, Nigeria.,Department of Child Dental Health, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
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Chatterjee A, Daftary G, Campbell M, Gatison L, Day L, Ramsey K, Goldman R, Gillman MW. "Can't We Just Have Some Sazón?" Student, Family, and Staff Perspectives on a New School Food Program at a Boston High School. THE JOURNAL OF SCHOOL HEALTH 2016; 86:273-280. [PMID: 26930239 DOI: 10.1111/josh.12377] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Revised: 08/28/2015] [Accepted: 04/01/2015] [Indexed: 06/05/2023]
Abstract
BACKGROUND In September 2013, a Massachusetts high school launched a nutrition program in line with 2013 United States Department of Agriculture requirements. We sought to understand attitudes of stakeholders toward the new program. METHODS We employed community-based participatory research methods in a qualitative evaluation of the food program at the school, where 98% of students are students of color and 86% qualify for free/reduced lunch. We conducted 4 student (N = 32), 2 parent (N = 10), 1 faculty/staff focus group (N = 14), and interviews with school leadership (N = 3). RESULTS A total of 10 themes emerged from focus groups and interviews, in 3 categories--impressions of the food (insufficient portion size, dislike of the taste, appreciation of the freshness, increased unhealthy food consumption outside school), impact on learning (learning what's healthy, the program's innovativeness, control versus choice), and concerns about stakeholder engagement (lack of student/family engagement, culturally incompatible foods). A representative comment was: "You need something to hold them from 9 to 5, because if they are hungry, McDonald's is right there." CONCLUSION Stakeholders appreciated the educational value of the program but stakeholder dissatisfaction may jeopardize its success. Action steps could include incorporating culturally appropriate recipes in the school's menus and working with local restaurants to promote healthier offerings.
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Affiliation(s)
- Avik Chatterjee
- Division of Global Health Equity, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115.
| | - Genevieve Daftary
- Codman Academy Charter Public School, 637 Washington St, Boston, MA 02124.
| | - Meg Campbell
- Codman Academy Charter Public School, 637 Washington St, Boston, MA 02124.
| | - Lenward Gatison
- Codman Academy Charter Public School, 637 Washington St, Boston, MA 02124.
| | - Liam Day
- Peer Health Exchange, 637 Washington St, Boston, MA 02124.
| | - Kibret Ramsey
- Codman Square Health Center, 637 Washington St, Boston, MA 02124.
| | - Roberta Goldman
- Alpert Medical School of Brown University, 222 Richmond St, Providence, RI 02903.
| | - Matthew W Gillman
- Harvard Medical School/Harvard Pilgrim Health Care Institute, 133 Brookline Ave, Boston, MA 02215.
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Dinour LM. Conflict and compromise in public health policy: analysis of changes made to five competitive food legislative proposals prior to adoption. HEALTH EDUCATION & BEHAVIOR 2016; 42:76S-86S. [PMID: 25829121 DOI: 10.1177/1090198114568303] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Competitive foods in schools have historically been scrutinized for their ubiquity and poor nutritional quality, leading many states to enact legislation limiting the availability and accessibility of these items. Evaluations of these policy approaches show their promise in improving the healthfulness of school food environments, considered an important strategy for reducing childhood obesity. Yet little is known about the decision-making processes by which such legislation is formed and adopted. Using a comparative case study design, this study describes and analyzes the policy formation processes surrounding five state-level competitive food bills introduced in 2009-2010. Data for each case were drawn from multiple key informant interviews and document reviews. Case studies were conducted, analyzed, and written independently using a standard protocol and were subsequently compared for recurring and unique themes. Abbreviated case studies and summary tables are provided. Results indicate that bill cost is a major barrier to achieving strong, health-promoting policy change. Additionally, findings reveal that supporters of stronger competitive food policies often concede to changes that weaken a bill in order to neutralize opposition and achieve stakeholder buy-in. These challenges suggest that continued research on the development, implementation, and evaluation of public health policies can contribute to the advancement of new strategies for effective health promotion.
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Grummon AH, Oliva A, Hampton KE, Patel AI. Association Between Student Purchases of Beverages During the School Commute and In-School Consumption of Sugar-Sweetened Beverages, San Francisco Bay Area, 2013. Prev Chronic Dis 2015; 12:E220. [PMID: 26679489 PMCID: PMC5241631 DOI: 10.5888/pcd12.150306] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Consumption of sugar-sweetened beverages (SSBs) such as sodas, fruit-flavored drinks, and sports drinks is a major contributor to childhood obesity. One strategy to reduce children's SSB consumption has been to restrict the sale of SSBs in schools. However, such policies may not sufficiently curb students' SSB intake, because students can obtain SSBs elsewhere, including from stores located on their school commute. Little is known about students' purchases of beverages during the school commute or about whether this purchasing behavior is related to in-school SSB consumption. The objective of this study was to describe where students from low-income, ethnically diverse communities obtain the SSBs they drink during school lunchtime and to examine whether students who purchase beverages while traveling to and from school are more likely to drink SSBs during school lunchtime. METHODS We analyzed survey data from a random sample of low-income, ethnically diverse middle school students (N = 597) who participated in a randomized controlled trial of a water promotion intervention. We used logistic regression analysis to examine the association between students' purchase of beverages during the school commute and their SSB consumption during school lunchtime. RESULTS One-fifth (20.4%) of students drank an SSB during lunch. Approximately 23% of SSBs were obtained during the school commute. Students who reported buying beverages during their school commute (50.1% of all students) were more likely to report drinking SSBs during lunch than students who reported that they do not buy beverages during the school commute (adjusted odds ratio 3.32, 95% confidence interval, 2.19-5.05, P < .001). CONCLUSION Students' purchase of beverages during the school commute was strongly associated with SSB consumption during school lunchtime. Interventions could benefit from focusing on retail environments (e.g., encouraging retailers to promote healthy beverages, posting beverage calorie information).
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Affiliation(s)
- Anna H Grummon
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, 135 Dauer Dr, 302 Rosenau Hall, CB No. 7440, Chapel Hill, NC 27599.
| | - Ariana Oliva
- California Food Policy Advocates, Oakland, California
| | | | - Anisha I Patel
- Department of Pediatrics and the Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, California
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