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Song S, Chen L, Yu R, Zhu J. Neutrophil-to-lymphocyte ratio as a predictor of all-cause and cardiovascular mortality in coronary heart disease and hypertensive patients: a retrospective cohort study. Front Endocrinol (Lausanne) 2024; 15:1442165. [PMID: 39234507 PMCID: PMC11371692 DOI: 10.3389/fendo.2024.1442165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2024] [Accepted: 07/31/2024] [Indexed: 09/06/2024] Open
Abstract
Background To date, no studies have investigated the correlation between the neutrophil-to-lymphocyte ratio (NLR) and the long-term risk of mortality in individuals with both coronary heart disease (CHD) and hypertension. This study aims to evaluate the association between NLR and all-cause and cardiovascular mortality among this patient population. Methods National Death Index (NDI) and National Health and Nutrition Examination Survey (NHANES 2001-2018) were the data sources. A nonlinear association between the NLR and mortality risk was shown by restricted cubic spline (RCS) analysis. Using a weighted Cox proportional hazards model, we quantitatively evaluated the effect of NLR on mortality risk.The capacity of NLR to forecast survival was assessed by evaluating time-dependent receiver operating characteristic (ROC) curves. A mediating influence analysis was conducted to assess the influence of NLR on mortality through eGFR as a mediator. Results The study involved a total of 2136 individuals. During the median follow-up interval of 76.0 months, 801 deaths were recorded. The RCS analysis showed NLR and mortality risk to have a nonlinear relationship. Two groups were established based on the participants' NLR levels: a group with high NLR (NLR > 2.65) and a group with low NLR (NLR < 2.65). After adjusting for potential confounding factors, the Cox proportional hazards model revealed that participants with an increased NLR faced a significantly higher risk of cardiovascular mortality. (HR 1.58, 95% CI 1.33-1.82, p < 0.0001) and all-cause mortality (HR 1.46, 95% CI 1.30-1.62, p < 0.0001). An analysis of interactions and data stratification corroborated the validity of our findings. eGFR was identified as a partial mediator in the association between NLR and mortality rates, contributing 12.17% and 9.66% of the variance in all-cause and cardiovascular mortality, respectively. The predictive performance for cardiovascular mortality was quantified using ROC curves, with respective AUC values of 0.67, 0.65, and 0.64 for predictions over 3, 5, and 10 years. The AUC values for all-cause mortality were 0.66, 0.64, and 0.63 for the same time frames. Conclusion For patients with CHD and hypertension, an elevated NLR serves as an independent prognostic indicator for both all-cause and cardiovascular mortality.
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Affiliation(s)
- Songhong Song
- Department of Preventive Medicine, Shantou University Medical College, Shantou, China
- Institute of Clinical Electrocardiology, First Affiliated Hospital of Shantou University Medical College, Shantou, China
- Longgang Maternity and Child Institute of Shantou University Medical College (Longgang District Maternity & Child Healthcare Hospital of Shenzhen City), Shenzhen, China
| | - Liwen Chen
- Institute of Clinical Electrocardiology, First Affiliated Hospital of Shantou University Medical College, Shantou, China
- Longgang Maternity and Child Institute of Shantou University Medical College (Longgang District Maternity & Child Healthcare Hospital of Shenzhen City), Shenzhen, China
| | - Rong Yu
- Institute of Clinical Electrocardiology, First Affiliated Hospital of Shantou University Medical College, Shantou, China
- Longgang Maternity and Child Institute of Shantou University Medical College (Longgang District Maternity & Child Healthcare Hospital of Shenzhen City), Shenzhen, China
| | - Jinxiu Zhu
- Institute of Clinical Electrocardiology, First Affiliated Hospital of Shantou University Medical College, Shantou, China
- Longgang Maternity and Child Institute of Shantou University Medical College (Longgang District Maternity & Child Healthcare Hospital of Shenzhen City), Shenzhen, China
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Song S, Tabares E, Ishdorj A, Crews M, Dave J. The Quality of Lunches Brought from Home to School: A Systematic Review and Meta-Analysis. Adv Nutr 2024; 15:100255. [PMID: 38876395 PMCID: PMC11324822 DOI: 10.1016/j.advnut.2024.100255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 05/13/2024] [Accepted: 06/07/2024] [Indexed: 06/16/2024] Open
Abstract
This systematic review and meta-analysis, spanning studies published between 1995 and 2021, investigates various aspects of lunches brought from home (LBFH) to school by children. These meals, in contrast to those provided by the National School Lunch Program (NSLP), lack strict nutritional standards. Despite the availability of NSLP lunches, ∼40% of US children opt for LBFH. This review aims to assess the food content and nutritional quality of LBFH, their adherence to NSLP standards in terms of nutrition and cost, effectiveness of intervention programs designed to enhance their nutritional quality and parental and student perceptions of LBFH. The comprehensive literature search yielded 28 eligible papers, with 16 included in meta-analysis. LBFH commonly include fruits (50%), yet vegetables (17%) and dairy (25%) are less prevalent. They frequently contain snacks (50%), sweets (48%), and sugar-sweetened beverages (31%). Compared with school lunches, LBFH exhibit lower levels of calcium, protein, iron, fiber, and vitamin A, and higher levels of carbohydrates and saturated fat. Intervention programs had no effect on quality of LBFH. On average, LBFH ($1.81) cost slightly less than lunches served at school ($1.98), without accounting for free/reduced-price meals in the calculation. The cost of school lunch for pre-k and kindergarten children became $11.32, nearly 4 times higher than that of LBFH ($2.92), after replicating the meal at home and accounting for meal preparation time. Parents preferred LBFH over school lunches because of concerns related to the quality of school meals served. This study concludes that LBFH are generally less nutritious compared with lunches provided by NSLP. Future research needs to further explore ways to improve parent perception of NSLP. Especially with many states making free meals available to all children, identifying effective ways in promoting and increasing NSLP participation can ensure more children have access to nutritionally balanced and affordable lunches.
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Affiliation(s)
- Siwan Song
- Department of Agricultural and Applied Economics, University of Wisconsin-Madison, Madison, WI, United States
| | - Elizabeth Tabares
- Norman Borlaug Institute for International Agriculture and Development, Texas A&M University, College Station, TX, United States
| | - Ariun Ishdorj
- Norman Borlaug Institute for International Agriculture and Development, Texas A&M University, College Station, TX, United States; Department of Agricultural Economics, Texas A&M University, College Station, TX, United States.
| | - Molly Crews
- School of Veterinary Medicine & Biomedical Sciences, Texas A&M University, College Station, TX, United States
| | - Jayna Dave
- USDA/Agricultural Research Service Children's Nutrition Research Center, Baylor College of Medicine, Houston, TX, United States
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Smith TA, Lin BH, Guthrie J. School Meal Nutrition Standards Reduce Disparities Across Income and Race/Ethnicity. Am J Prev Med 2024; 67:249-257. [PMID: 38521131 DOI: 10.1016/j.amepre.2024.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 03/13/2024] [Accepted: 03/13/2024] [Indexed: 03/25/2024]
Abstract
INTRODUCTION Children's diets in the U.S. typically fail to meet dietary recommendations, contributing to associated adverse health outcomes. The Healthy, Hunger-Free Kids Act (HHFKA) of 2010 required the U.S. government to update nutrition standards for school meals to align with the Dietary Guidelines for Americans (DGAs). This study estimates the evolving impact of substituting school-prepared food for home-prepared food on overall daily diet quality and by subcomponents of diet quality. Subgroup analyses are performed by race/ethnicity and income. METHODS Two, nonconsecutive days of dietary recall data from the National Health and Nutrition Examination Survey (2005-March 2020) are used to calculate schoolchildren's Healthy Eating Index (HEI)-2020 scores. The study includes children with complete two-day dietary intakes who attend kindergarten through twelfth grade in a school offering lunch. An individual-level fixed effects regression is employed to examine the relationship of school food consumption on HEI-2020 scores before and after HHFKA-mandated changes in nutrition standards. Analyses were conducted on September 23, 2023. RESULTS Prior to changes in standards (2005-2008), school food did not impact diet quality within the overall group of children. In 2009-2012, positive associations between school food and diet quality emerged for low-income students and for non-Hispanic Black students. By 2013-2020, improvements were seen across all groups. The association between school food and diet quality was most attributable to more favorable consumption of dairy, fruit, whole grains, refined grains, added sugars and saturated fats. CONCLUSIONS HHFKA-based nutrition standards were associated with beneficial dietary changes and reduced dietary disparities for children across diverse backgrounds.
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Affiliation(s)
- Travis A Smith
- Department of Agricultural and Applied Economics, University of Georgia, Athens, GA.
| | - Biing-Hwan Lin
- Economic Research Service, U.S. Department of Agriculture, Washington DC
| | - Joanne Guthrie
- Economic Research Service, U.S. Department of Agriculture, Washington DC
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Spill MK, Trivedi R, Thoerig RC, Balalian AA, Schwartz MB, Gundersen C, Odoms-Young A, Racine EF, Foster MJ, Davis JS, MacFarlane AJ. Universal Free School Meals and School and Student Outcomes: A Systematic Review. JAMA Netw Open 2024; 7:e2424082. [PMID: 39120904 PMCID: PMC11316229 DOI: 10.1001/jamanetworkopen.2024.24082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Accepted: 05/21/2024] [Indexed: 08/10/2024] Open
Abstract
Importance The White House National Strategy on Hunger, Nutrition, and Health included expanding free school meals to all students, regardless of income, which has sparked debate in the United States. Objective To assess the association between universal free school meals (UFSMs) and school and student outcomes in the United States. Evidence Review An expert panel-informed protocol was developed to evaluate intervention or cohort studies comparing UFSM programs, such as the Community Eligibility Provision (CEP), with non-UFSM programs in US schools from August 2012 (excluding 2020-2021 due to the COVID-19 pandemic) in peer-reviewed publications or government reports. Outcomes included meal participation rates, attendance, dietary intake and quality, food waste, economic impact, food insecurity, anthropometrics, disciplinary actions, stigma, and shaming. A search of Medline, Econlit, Business Source Ultimate, ERIC, Agricola, Cab Abstracts, and CINAHL was performed in April 2024. Two researchers screened articles for inclusion, extracted data, and assessed risk of bias, using the Risk of Bias in Nonrandomized Studies of Interventions tool, for each included study. Grading of Recommendations, Assessment, Development, and Evaluations was used to assess the certainty of evidence for each outcome. Findings The search identified 2784 records, with 6 studies included, representing more than 11 000 elementary, middle, and high schools. Nonrandomized intervention studies performed difference-in-difference or rate ratio analysis to investigate CEP participation rates, attendance, anthropometrics, and/or suspensions. CEP was associated with increased lunch (3 studies; moderate certainty) and breakfast (1 study; very low certainty) participation. School attendance was unchanged or improved in schools with CEP compared with schools without UFSM (2 studies; low certainty). CEP was associated with lower obesity prevalence (1 study; very low certainty) and fewer suspensions (1 study; very low certainty). Reasons for downgrading the certainty ratings included indirectness (data not fully representative of the United States) and inconsistency (small number of studies limiting ability to assess consistency). Despite the limitations, the evidence reflected well-designed longitudinal intervention studies appropriate for decision-making. Conclusions and Relevance In this systematic review, UFSMs were associated with increased meal participation, no or slight improvements in attendance, and decreased obesity prevalence and suspension rates; certainty of evidence was moderate for lunch participation and low or very low for other outcomes. Studies did not report several important outcomes, such as diet quality and food security, suggesting the need for more high-quality research encompassing policy-relevant indicators.
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Affiliation(s)
- Maureen K Spill
- Texas A&M Agriculture, Food & Nutrition Evidence Center, Fort Worth
| | - Rupal Trivedi
- Texas A&M Agriculture, Food & Nutrition Evidence Center, Fort Worth
| | - Rachel C Thoerig
- Texas A&M Agriculture, Food & Nutrition Evidence Center, Fort Worth
| | - Arin A Balalian
- Texas A&M Agriculture, Food & Nutrition Evidence Center, Fort Worth
| | - Marlene B Schwartz
- Department of Human Development and Family Science, College of Liberal Arts and Science, University of Connecticut, Storrs
| | - Craig Gundersen
- Department of Economics, Hankamer School of Business, Baylor University, Waco, Texas
| | - Angela Odoms-Young
- Division of Nutritional Sciences, College of Human Ecology, Cornell University, Ithaca, New York
| | - Elizabeth F Racine
- Department of Nutrition, College of Agriculture and Life Sciences, Texas A&M University, College Station
| | - Margaret J Foster
- Center for Systematic Reviews and Research Syntheses, University Libraries, Texas A&M University, College Station
| | - Julie S Davis
- Texas A&M Agriculture, Food & Nutrition Evidence Center, Fort Worth
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Poole MK, Tucker K, Adams K, Rimm EB, Emmons KM, Gortmaker SL, Norris J, Kenney EL. Prevalence and Implementation Characteristics of Weekend Food Assistance Programs in U.S. Schools. Am J Prev Med 2024:S0749-3797(24)00191-0. [PMID: 38880305 DOI: 10.1016/j.amepre.2024.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 05/31/2024] [Accepted: 06/02/2024] [Indexed: 06/18/2024]
Abstract
INTRODUCTION Amid national efforts to align priorities for nutrition and food assistance programs, little is known about the implementation of community-led efforts for children. This study aimed to estimate U.S. public school participation in weekend backpack programs (WBPs), to document program structure, and to consider characteristics of programs with more nutritious food offerings. METHODS The prevalence of WBP participation in 2022 was estimated using a state-stratified, random sample of n=413 public schools. Administrators from WBPs at 49 schools completed measures of implementation characteristics and nutritional quality of foods offered. In 2022-2023, using a multivariable-adjusted linear regression model, the authors explored the association between hypothesized implementation characteristics and Healthy Eating Index-2015 scores of foods provided. RESULTS Half of public schools (53.7%, 95% CI: 46.8%, 60.7%) in the national sample reported participating in WBPs. Many WBPs in the subsample were affiliated with anti-hunger organizations (41%), led by school counselors and volunteers (55%), and funded by grants (51%). WBPs spent an average of $0.56 (sd=$0.36) per item. Foods provided averaged a Healthy Eating Index-2015 score of 58.4 (sd=12.3), similar to children's average diets. About half of WBPs (41%) reported accessing nutrition resources. CONCLUSIONS Despite the decentralized structure and absence of dedicated funding mechanisms, WBPs were common in our national sample of schools, suggesting widespread perceptions of unmet food needs and extensive efforts from community members to mitigate weekend hunger. Further research on food procurement methods and program impacts on child nutrition outcomes is needed to advance national priorities for nutrition and food security.
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Affiliation(s)
- Mary Kathryn Poole
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
| | - Kyla Tucker
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Office of Student Wellbeing, Massachusetts Institute of Technology, Cambridge, Massachusetts
| | - Kate Adams
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; The Greater Boston Food Bank, Boston, Massachusetts
| | - Eric B Rimm
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Karen M Emmons
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Steven L Gortmaker
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Jasmine Norris
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Erica L Kenney
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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Zuercher MD, Cohen JFW, Hecht CA, Hecht K, Orta-Aleman D, Patel A, Olarte DA, Chapman LE, Read M, Schwartz MB, Ritchie LD, Gosliner W. Parent Perceptions of School Meals Influence Student Participation in School Meal Programs. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2024; 56:230-241. [PMID: 38583880 DOI: 10.1016/j.jneb.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 01/05/2024] [Accepted: 01/10/2024] [Indexed: 04/09/2024]
Abstract
OBJECTIVE To evaluate if parent perceptions of school meals influence student participation. DESIGN In May 2022, an online survey was used to evaluate parents' perceptions of school meals and their children's participation. PARTICIPANTS A total of 1,110 California parents of kindergarten through 12th-grade students. MAIN OUTCOME MEASURES Student participation in school lunch and breakfast. ANALYSIS Principal component analysis and Poisson regression models. RESULTS Three groups of parental perceptions were identified: (1) positive perceptions (eg, liking school meals and thinking that they are tasty and healthy), (2) perceived benefits to families (eg, school meals save families money, time, and stress), and (3) negative (eg, concerns about the amount of sugar in school meals and stigma). More positive parental perceptions about school meals and their benefits to families were associated with greater student meal participation. In contrast, more negative parental perceptions were associated with reduced student participation in school meals (P < 0.05). CONCLUSION AND IMPLICATIONS Parent perceptions of school meals may affect student participation in school meal programs. Working to ensure parents are familiar with the healthfulness and quality of school meals and the efforts schools are making to provide high-quality, appealing meals may be critical for increasing school meal participation rates.
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Affiliation(s)
- Monica D Zuercher
- Nutrition Policy Institute, Division of Agriculture and Natural Resources, University of California, Berkeley, CA.
| | - Juliana F W Cohen
- Center for Health Inclusion, Research, and Practice, Department of Public Health and Nutrition, Merrimack College, North Andover, MA; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Christina A Hecht
- Nutrition Policy Institute, Division of Agriculture and Natural Resources, University of California, Berkeley, CA
| | - Kenneth Hecht
- Nutrition Policy Institute, Division of Agriculture and Natural Resources, University of California, Berkeley, CA
| | - Dania Orta-Aleman
- Nutrition Policy Institute, Division of Agriculture and Natural Resources, University of California, Berkeley, CA
| | - Anisha Patel
- Stanford Pediatrics, Stanford University, Palo Alto, CA
| | - Deborah A Olarte
- Center for Health Inclusion, Research, and Practice, Department of Public Health and Nutrition, Merrimack College, North Andover, MA
| | - Leah E Chapman
- Center for Health Inclusion, Research, and Practice, Department of Public Health and Nutrition, Merrimack College, North Andover, MA
| | - Margaret Read
- Partnership for a Healthier America, Prince Frederick, MD
| | - Marlene B Schwartz
- Rudd Center for Food Policy & Health University of Connecticut, Hartford, CT
| | - Lorrene D Ritchie
- Nutrition Policy Institute, Division of Agriculture and Natural Resources, University of California, Berkeley, CA
| | - Wendi Gosliner
- Nutrition Policy Institute, Division of Agriculture and Natural Resources, University of California, Berkeley, CA
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Localio AM, Knox MA, Basu A, Lindman T, Walkinshaw LP, Jones-Smith JC. Universal Free School Meals Policy and Childhood Obesity. Pediatrics 2024; 153:e2023063749. [PMID: 38495019 PMCID: PMC10979297 DOI: 10.1542/peds.2023-063749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/23/2024] [Indexed: 03/19/2024] Open
Abstract
BACKGROUND AND OBJECTIVES The Community Eligibility Provision (CEP), a universal free school meals policy, increases school meal participation by allowing schools in low-income areas to provide free breakfast and lunch to all students; however, its impact on obesity remains uncertain. The objective of this study is to estimate the association of CEP with child obesity. METHODS School obesity prevalence was calculated using BMI measurements collected annually between 2013 and 2019 from students in California public schools in grades 5, 7, and 9. To estimate the association of CEP with obesity, we used a difference-in-differences approach for staggered policy adoption with an outcome regression model conditional on covariates, weighted by student population size. RESULTS The analysis included 3531 CEP-eligible schools using school-level obesity prevalence calculated from 3 546 803 BMI measurements. At baseline, on average, 72% of students identified as Hispanic, 11% identified as white, 7% identified as Black, and 80% were eligible for free or reduced-price meals. Baseline obesity prevalence was 25%. Schools that participated in CEP were associated with a 0.60-percentage-point net decrease in obesity prevalence after policy adoption (95% confidence interval: -1.07 to -0.14 percentage points, P = .01) compared with eligible, nonparticipating schools, corresponding with a 2.4% relative reduction, given baseline prevalence. Meals served increased during this period in CEP-participating schools only. CONCLUSIONS In a balanced sample of California schools, CEP participation was associated with a modest net decrease in obesity prevalence compared with eligible, nonparticipating schools. These findings add to the growing literature revealing potential benefits of universal free school meals for children's well-being.
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Affiliation(s)
| | | | - Anirban Basu
- Departments of Health Systems and Population Health
- Pharmacy
| | - Tom Lindman
- Evans School of Public Policy and Governance, University of Washington, Seattle, Washington
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Heerman WJ, Kenney E, Block JP, Fiechtner L, McMahon E, Kruse L, Sharifi M, Edmondson EK, Virudachalam S. A Narrative Review of Public Health Interventions for Childhood Obesity. Curr Obes Rep 2024; 13:87-97. [PMID: 38172483 DOI: 10.1007/s13679-023-00550-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/05/2023] [Indexed: 01/05/2024]
Abstract
PURPOSE OF REVIEW Public health interventions that intervene on macrolevel systems hold the promise of reducing childhood obesity at the population level through prevention. The purpose of this review is to highlight some of the recent and best scientific evidence related to public health interventions for the prevention of childhood obesity. We provide a narrative review of scientific evidence for six categories of public health interventions and their impact on childhood obesity: federal nutrition assistance programs, programs implemented in early care and education centers, interventions to support healthy nutrition and physical activity in schools, community-based programs and policies, labeling policies and marketing to children, and taxes on sugar sweetened beverages (SSB). RECENT FINDINGS Federal nutrition assistance programs have the strongest evidence to support reduction in childhood obesity and serve populations with the highest prevalence of childhood obesity. Other interventions including SSB taxes, community-wide interventions, and interventions at schools and early care and education centers also show significant improvements in child weight status. Overall public health interventions have strong evidence to support widespread implementation in service of reducing childhood obesity rates at the population level. To effectively address the recalcitrant childhood obesity epidemic, multi-pronged solutions are needed. The current evidence for public health obesity interventions is consistent with the paradigm that recognizes the importance of macrolevel systems influences on childhood obesity: interventions that are most effective intervene at macrolevels.
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Affiliation(s)
- William J Heerman
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, USA.
| | - Erica Kenney
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, USA
| | - Jason P Block
- Department of Population Medicine, Harvard Pilgrim Health Care Institute, Harvard Medical School, Boston, USA
| | - Lauren Fiechtner
- Division of Pediatric Gastroenterology and Nutrition, Mass General for Children, The Greater Boston Food Bank, Boston, USA
| | - Ellen McMahon
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, USA
| | - Lauren Kruse
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, USA
| | - Mona Sharifi
- Department of Pediatrics, Yale School of Medicine, New Haven, USA
| | - Emma K Edmondson
- Department of Pediatrics and Leonard Davis Institute of Health Economics at University of Pennsylvania Perelman School of Medicine, Division of General Pediatrics, PolicyLab, and Clinical Futures at Children's Hospital of Philadelphia, Philadelphia, USA
| | - Senbagam Virudachalam
- Department of Pediatrics and Leonard Davis Institute of Health Economics at University of Pennsylvania Perelman School of Medicine, Division of General Pediatrics, PolicyLab, and Clinical Futures at Children's Hospital of Philadelphia, Philadelphia, USA
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Hou XZ, Lv YF, Li YS, Wu Q, Lv QY, Yang YT, Li LL, Ye XJ, Yang CY, Wang MS, Cao LL, Wang SH. Association between different insulin resistance surrogates and all-cause mortality in patients with coronary heart disease and hypertension: NHANES longitudinal cohort study. Cardiovasc Diabetol 2024; 23:86. [PMID: 38419039 PMCID: PMC10903030 DOI: 10.1186/s12933-024-02173-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 02/19/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Studies on the relationship between insulin resistance (IR) surrogates and long-term all-cause mortality in patients with coronary heart disease (CHD) and hypertension are lacking. This study aimed to explore the relationship between different IR surrogates and all-cause mortality and identify valuable predictors of survival status in this population. METHODS The data came from the National Health and Nutrition Examination Survey (NHANES 2001-2018) and National Death Index (NDI). Multivariate Cox regression and restricted cubic splines (RCS) were performed to evaluate the relationship between homeostatic model assessment of IR (HOMA-IR), triglyceride glucose index (TyG index), triglyceride glucose-body mass index (TyG-BMI index) and all-cause mortality. The recursive algorithm was conducted to calculate inflection points when segmenting effects were found. Then, segmented Kaplan-Meier analysis, LogRank tests, and multivariable Cox regression were carried out. Receiver operating characteristic (ROC) and calibration curves were drawn to evaluate the differentiation and accuracy of IR surrogates in predicting the all-cause mortality. Stratified analysis and interaction tests were conducted according to age, gender, diabetes, cancer, hypoglycemic and lipid-lowering drug use. RESULTS 1126 participants were included in the study. During the median follow-up of 76 months, 455 participants died. RCS showed that HOMA-IR had a segmented effect on all-cause mortality. 3.59 was a statistically significant inflection point. When the HOMA-IR was less than 3.59, it was negatively associated with all-cause mortality [HR = 0.87,95%CI (0.78, 0.97)]. Conversely, when the HOMA-IR was greater than 3.59, it was positively associated with all-cause mortality [HR = 1.03,95%CI (1.00, 1.05)]. ROC and calibration curves indicated that HOMA-IR was a reliable predictor of survival status (area under curve = 0,812). No interactions between HOMA-IR and stratified variables were found. CONCLUSION The relationship between HOMA-IR and all-cause mortality was U-shaped in patients with CHD and hypertension. HOMA-IR was a reliable predictor of all-cause mortality in this population.
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Affiliation(s)
- Xin-Zheng Hou
- Department of Cardiovascular Diseases, Guang 'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yan-Fei Lv
- College of Management, Fudan University, Shanghai, China
| | - Yu-Shan Li
- College of Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Qian Wu
- Department of Cardiovascular Diseases, Guang 'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Qian-Yu Lv
- Department of Cardiovascular Diseases, Guang 'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Ying-Tian Yang
- Department of Cardiovascular Diseases, Guang 'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Lan-Lan Li
- Department of Cardiovascular Diseases, Guang 'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Xue-Jiao Ye
- Department of Cardiovascular Diseases, Guang 'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Chen-Yan Yang
- Department of Cardiovascular Diseases, Guang 'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Man-Shi Wang
- Department of Cardiovascular Diseases, Guangwai Hospital, Beijing, China
| | - Lin-Lin Cao
- Department of Cardiovascular Diseases, Guang 'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Shi-Han Wang
- Department of Cardiovascular Diseases, Guang 'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China.
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Acosta ME, Sanchez-Vaznaugh EV, Matsuzaki M, Barba N, Sánchez BN. Temporal Patterns in Fruit and Vegetable Intake Among Racially and Ethnically Diverse Children and Adolescents in California. Prev Chronic Dis 2024; 21:E09. [PMID: 38329921 PMCID: PMC10870998 DOI: 10.5888/pcd21.230162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024] Open
Abstract
Introduction Childhood dietary behaviors, including fruit and vegetable intake, are associated with adult health. Most children do not meet daily recommended servings of fruits and vegetables. Less is known about temporal patterns in fruit and vegetable consumption or if they vary by race and ethnicity. We investigated temporal patterns in fruit and vegetable intake among California school-age children and adolescents overall and by race and ethnicity. Methods We used 2-year cross-sectional datasets from the child and adolescent samples in the California Health Interview Surveys from 2011-2012 through 2019-2020 and modified Poisson regression models to estimate the likelihood of consuming 5 or more servings of fruits and vegetables in 2013-2016 and 2017-2020 compared with 2011-2012. Models controlled for age, race and ethnicity, gender, citizenship status, family income, and adult education and tested for differences by race and ethnicity. The samples included 16,125 children aged 5 to 11 years and 9,672 adolescents aged 12 to 17 years. Results Overall, 29.3% of children and 25.9% of adolescents reported intake of 5 or more fruits and vegetables per day. Among children, adjusted prevalence ratios (PR) of fruit and vegetable intake were higher in 2013-2016 (PR,1.25; 95% CI, 1.11-1.42) and 2017-2020 (PR,1.13; 95% CI, 0.99-1.30) compared with 2011-2012. Among adolescents, the adjusted prevalence did not differ significantly over time. We found no evidence of differential associations by race and ethnicity for children and adolescents. Conclusion We found favorable temporal changes in fruit and vegetable consumption among children, but not among adolescents. Monitoring temporal patterns in fruit and vegetable intake remains critical for planning population-level interventions to increase consumption.
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Affiliation(s)
- Maria Elena Acosta
- Department of Public Health, San Francisco State University, San Francisco, California
| | - Emma V Sanchez-Vaznaugh
- Department of Public Health, San Francisco State University, San Francisco, California
- College of Health & Social Sciences, Department of Public Health, 1600 Holloway Ave, San Francisco CA 94132
| | - Mika Matsuzaki
- Department of International Health, Bloomberg School of Public Health, John Hopkins University, Baltimore, Maryland
| | - Nancy Barba
- Department of Public Health, San Francisco State University, San Francisco, California
| | - Brisa N Sánchez
- Department of Epidemiology and Biostatistics, Drexel University School of Public Health, Philadelphia, Pennsylvania
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11
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Hou XZ, Li YS, Wu Q, Lv QY, Yang YT, Li LL, Ye XJ, Yang CY, Wang MS, Lv YF, Cao LL, Wang SH. Association of sleep characteristics with cardiovascular disease risk in adults over 40 years of age: a cross-sectional survey. Front Cardiovasc Med 2024; 11:1308592. [PMID: 38327493 PMCID: PMC10847268 DOI: 10.3389/fcvm.2024.1308592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 01/15/2024] [Indexed: 02/09/2024] Open
Abstract
Background The relationship between sleep characteristics and cardiovascular disease (CVD) risk has yet to reach a consistent conclusion, and more research needs to be carried out. This study aimed to explore the relationship between snoring, daytime sleepiness, bedtime, sleep duration, and high-risk sleep patterns with CVD risk. Methods Data from the National Health and Nutrition Examination Survey (NHANES) 2015-2018 were collected and analyzed. Multivariable logistic regression was used to evaluate the relationship between snoring, daytime sleepiness, bedtime, sleep duration, high-risk sleep patterns, and CVD risk. Stratified analysis and interaction tests were carried out according to hypertension, diabetes and age. Results The final analysis contained 6,830 participants, including 1,001 with CVD. Multivariable logistic regression suggested that the relationship between snoring [OR = 7.37,95%CI = (6.06,8.96)], daytime sleepiness [OR = 11.21,95%CI = (9.60,13.08)], sleep duration shorter than 7 h [OR = 9.50,95%CI = (7.65,11.79)] or longer than 8 h [OR = 6.61,95%CI = (5.33,8.19)], bedtime after 0:00 [OR = 13.20,95%CI = (9.78,17.80)] compared to 22:00-22:59, high-risk sleep patterns [OR = 47.73,95%CI = (36.73,62.04)] and CVD risk were statistically significant. Hypertension and diabetes interacted with high-risk sleep patterns, but age did not. Conclusions Snoring, daytime sleepiness, excessive or short sleep duration, inappropriate bedtime, and high-risk sleep patterns composed of these factors are associated with the CVD risk. High-risk sleep patterns have a more significant impact on patients with hypertension and diabetes.
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Affiliation(s)
- Xin-Zheng Hou
- Department of Cardiovascular Diseases, Guang anmen Hospital Affiliated to China Academy of Chinese Medical Sciences, Beijing, China
| | - Yu-Shan Li
- College of Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Qian Wu
- Department of Cardiovascular Diseases, Guang anmen Hospital Affiliated to China Academy of Chinese Medical Sciences, Beijing, China
| | - Qian-Yu Lv
- Department of Cardiovascular Diseases, Guang anmen Hospital Affiliated to China Academy of Chinese Medical Sciences, Beijing, China
| | - Ying-Tian Yang
- Department of Cardiovascular Diseases, Guang anmen Hospital Affiliated to China Academy of Chinese Medical Sciences, Beijing, China
| | - Lan-Lan Li
- Department of Cardiovascular Diseases, Guang anmen Hospital Affiliated to China Academy of Chinese Medical Sciences, Beijing, China
| | - Xue-Jiao Ye
- Department of Cardiovascular Diseases, Guang anmen Hospital Affiliated to China Academy of Chinese Medical Sciences, Beijing, China
| | - Chen-Yan Yang
- Department of Cardiovascular Diseases, Guang anmen Hospital Affiliated to China Academy of Chinese Medical Sciences, Beijing, China
| | - Man-Shi Wang
- Department of Cardiovascular Diseases, Guangwai Hospital, Beijing, China
| | - Yan-Fei Lv
- Shanghai Qianhe Technology Co., Ltd., Shanghai, China
| | - Lin-Lin Cao
- Department of Cardiovascular Diseases, Guang anmen Hospital Affiliated to China Academy of Chinese Medical Sciences, Beijing, China
| | - Shi-Han Wang
- Department of Cardiovascular Diseases, Guang anmen Hospital Affiliated to China Academy of Chinese Medical Sciences, Beijing, China
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12
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Zuercher MD, Cohen JFW, Ohri-Vachaspati P, Hecht CA, Hecht K, Polacsek M, Olarte DA, Read M, Patel AI, Schwartz MB, Chapman LE, Orta-Aleman D, Ritchie LD, Gosliner W. Parent perceptions of school meals and how perceptions differ by race and ethnicity. HEALTH AFFAIRS SCHOLAR 2024; 2:qxad092. [PMID: 38756406 PMCID: PMC10986222 DOI: 10.1093/haschl/qxad092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 12/07/2023] [Accepted: 01/03/2024] [Indexed: 05/18/2024]
Abstract
Parental perceptions of school meals can affect student participation and overall support for school meal policies. Little is known about parental school meal perceptions under universal free school meals (UFSM) policies. We assessed California parents' perceptions of school meals during the COVID-19 emergency response with federally funded UFSM and whether perceptions differed by race/ethnicity. Among 1110 California parents of K-12 students, most reported school meals benefit their families, saving them money (81.6%), time (79.2%), and stress (75.0%). Few reported that their child would be embarrassed to eat school meals (11.7%), but more parents of White students than Hispanic students reported this. Many parents reported that their child likes to eat lunch to be with friends (64.7%); about half felt their child has enough time to eat (54.2%). Fewer parents perceived school lunches to be of good quality (36.9%), tasty (39.6%), or healthy (44.0%). Parents of Hispanic and Asian students had less favorable perceptions of school meal quality, taste, and healthfulness than parents of White students. Parents report that school meals benefit their families, but policy efforts are needed to ensure schools have the resources needed to address cultural appropriateness. Schools should address parental perceptions of meals to optimize participation, nutrition security, and health.
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Affiliation(s)
- Monica D Zuercher
- Division of Agriculture and Natural Resources, Nutrition Policy Institute, University of California, Oakland, CA 94607, United States
| | - Juliana F W Cohen
- Department of Public Health and Nutrition, Center for Health Inclusion, Research, and Practice (CHIRP), Merrimack College, North Andover, MA 01845, United States
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA 02115, United States
| | - Punam Ohri-Vachaspati
- College of Health Solutions, Arizona State University, Phoenix, AZ 85004, United States
| | - Christina A Hecht
- Division of Agriculture and Natural Resources, Nutrition Policy Institute, University of California, Oakland, CA 94607, United States
| | - Kenneth Hecht
- Division of Agriculture and Natural Resources, Nutrition Policy Institute, University of California, Oakland, CA 94607, United States
| | - Michele Polacsek
- Center for Excellence in Public Health, University of New England, Portland, ME 04103, United States
| | - Deborah A Olarte
- Department of Public Health and Nutrition, Center for Health Inclusion, Research, and Practice (CHIRP), Merrimack College, North Andover, MA 01845, United States
| | - Margaret Read
- Share Our Strength, Washington, DC 20005, United States
| | - Anisha I Patel
- Stanford Pediatrics, Stanford University, Palo Alto, CA 94304, United States
| | - Marlene B Schwartz
- Rudd Center for Food Policy and Health & Department of Human Development and Family Sciences, University of Connecticut, Hartford, CT 06013, United States
| | - Leah E Chapman
- Department of Public Health and Nutrition, Center for Health Inclusion, Research, and Practice (CHIRP), Merrimack College, North Andover, MA 01845, United States
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA 02115, United States
| | - Dania Orta-Aleman
- Division of Agriculture and Natural Resources, Nutrition Policy Institute, University of California, Oakland, CA 94607, United States
| | - Lorrene D Ritchie
- Division of Agriculture and Natural Resources, Nutrition Policy Institute, University of California, Oakland, CA 94607, United States
| | - Wendi Gosliner
- Division of Agriculture and Natural Resources, Nutrition Policy Institute, University of California, Oakland, CA 94607, United States
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13
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Haakenstad MK, Butcher MB, Noonan CJ, Fyfe-Johnson AL. Outdoor Time in Childhood: A Mixed Methods Approach to Identify Barriers and Opportunities for Intervention in a Racially and Ethnically Mixed Population. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:7149. [PMID: 38131701 PMCID: PMC10743276 DOI: 10.3390/ijerph20247149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 10/25/2023] [Accepted: 11/20/2023] [Indexed: 12/23/2023]
Abstract
A growing body of literature suggests that outdoor time is beneficial for physical and mental health in childhood. Profound disparities exist in access to outdoor spaces (and the health benefits thereof) for children in communities of color. The objectives of this research were to: (1) identify challenges and solutions to outdoor time for children; (2) assess the importance of outdoor time for children; and (3) evaluate results stratified by race/ethnicity. Using a convergent mixed methods approach, we conducted a thematic analysis from 14 focus groups (n = 50) with outdoor educators, parents with children attending outdoor preschools, and community members with children. In addition, 49 participants completed a survey to identify challenges and solutions, perceived importance, and culturally relevant perspectives of outdoor time. The main challenges identified for outdoor time were safety concerns, inclement weather, lack of access to outdoor spaces, and parent work schedules. The primary proposed solution was integrating outdoor time into the school day. Nearly all participants, independent of racial identity, reported that outdoor time improved physical and mental health. Overall outdoor time was lower in participants from communities of color (~8 h/week) compared to their White counterparts (~10 h/week). While 50% of people of color (POC) reported that outdoor time was an important cultural value, only 18% reported that people in their respective culture spent time outside. This work contributes to accumulating knowledge that unique barriers to outdoor time exist for communities of color, and the children that live, learn, and play in these communities. Increasing outdoor time in school settings offers a potential solution to reduce identified barriers and to promote health equity in childhood.
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Affiliation(s)
- Magdalena K. Haakenstad
- Institute for Research and Education to Advance Community Health, Elson S. Floyd College of Medicine, Washington State University, Seattle, WA 98101, USA; (M.K.H.); (C.J.N.)
| | - Maria B. Butcher
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA 99202, USA;
| | - Carolyn J. Noonan
- Institute for Research and Education to Advance Community Health, Elson S. Floyd College of Medicine, Washington State University, Seattle, WA 98101, USA; (M.K.H.); (C.J.N.)
| | - Amber L. Fyfe-Johnson
- Institute for Research and Education to Advance Community Health, Elson S. Floyd College of Medicine, Washington State University, Seattle, WA 98101, USA; (M.K.H.); (C.J.N.)
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14
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Kenney EL, Poole MK, Frost N, Kinderknecht K, Mozaffarian RS, Andreyeva T. How policy implementation shapes the impact of U.S. food assistance policies: the case study of the Child and Adult Care Food Program. FRONTIERS IN HEALTH SERVICES 2023; 3:1286050. [PMID: 38028947 PMCID: PMC10653325 DOI: 10.3389/frhs.2023.1286050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 10/18/2023] [Indexed: 12/01/2023]
Abstract
Much of the chronic disease burden in the U.S. population can be traced to poor diet. There has been a sustained focus on influencing children's diets and encouraging healthier eating habits by changing policies for what foods and beverages can be served to children through large federally-funded nutrition assistance programs. Yet without attention to how nutrition policies are implemented, and the surrounding context for these policies, these policy changes may not have the intended results. In this perspective, we used Bullock et al.'s (2021) Process Model of Implementation from a Policy Perspective to analyze how the complexities of the implementation process of large-scale nutrition policies can dilute potential health outcomes. We examine the Child and Adult Care Food Program (CACFP), a federal program focused on supporting the provision of nutritious meals to over 4 million children attending childcare, as a case study. We examine how the larger societal contexts of food insecurity, attitudes towards the social safety net, and a fragmented childcare system interact with CACFP. We review the "policy package" of CACFP itself, in terms of its regulatory requirements, and the various federal, state, and local implementation agencies that shape CACFP's on-the-ground implementation. We then review the evidence for how each component of the CACFP policy implementation process impacts uptake, costs, feasibility, equity, and effectiveness at improving children's nutrition. Our case study demonstrates how public health researchers and practitioners must consider the complexities of policy implementation processes to ensure effective implementation of nutrition policies intended to improve population health.
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Affiliation(s)
- Erica L. Kenney
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Mary Kathryn Poole
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | | | - Kelsey Kinderknecht
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Rebecca S. Mozaffarian
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Tatiana Andreyeva
- Department of Agricultural and Resource Economics, Rudd Center for Food Policy and Health, University of Connecticut, Storrs, CT, United States
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15
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Kenney EL, Tucker K, Plummer RS, Mita C, Andreyeva T. The Child and Adult Care Food Program and young children's health: a systematic review. Nutr Rev 2023; 81:1402-1413. [PMID: 36882043 PMCID: PMC10563858 DOI: 10.1093/nutrit/nuad016] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023] Open
Abstract
CONTEXT The Child and Adult Care Food Program (CACFP) is a federal nutrition program that supports young children's nutrition. Its potential impacts on child well-being have not been summarized. OBJECTIVE The objective of this review was to summarize the evidence for the impact of CACFP on children's diet quality, weight status, food insecurity, and cognitive development. DATA SOURCES Databases searched included MEDLINE, CAB Abstracts, Web of Science Core Collection, ERIC, PsycInfo, Dissertations & Theses Global (Proquest), EconLit, NBER, and the USDA's Economic Research Service (ERS), from database inception to November 12, 2021. Studies were included if the sample drew from child care programs serving children between the ages of 2 years and 18 years and if a comparison group of nonparticipating programs was included. DATA EXTRACTION Two reviewers independently extracted data on study design, year(s) of data collection, region, sample size, participant demographics, outcomes, and risk of bias. DATA ANALYSIS Due to the heterogeneity of the studies, a narrative synthesis was used. RESULTS Nineteen articles were reviewed, most of which had been published since 2012. Seventeen used cross-sectional designs. Twelve evaluated foods and beverages served; 4 evaluated dietary intake; 4 evaluated the child care nutrition environment; 2 evaluated food insecurity, 1 evaluated weight status; none evaluated cognitive outcomes. Studies typically found either a small beneficial association with CACFP or no significant association. CONCLUSION Currently, evidence for an association between CACFP and children's health is inconclusive, though it is slightly suggestive of a benefit for some dietary quality outcomes. More research, with stronger study designs, is needed. SYSTEMATIC REVIEW REGISTRATION A protocol for this systematic review was registered with the PROSPERO systematic review protocol registry (PROSPERO 2021 CRD42021254423).
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Affiliation(s)
- Erica L Kenney
- are with the Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- are with the Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Kyla Tucker
- are with the Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Rachel S Plummer
- are with the Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Carol Mita
- is with the Countway Library, Harvard Medical School, Boston, Massachusetts, USA
| | - Tatiana Andreyeva
- is with the Department of Agricultural and Resource Economics, University of Connecticut, Storrs, Connecticut, USA
- is with the Rudd Center for Food Policy and Health, University of Connecticut, Hartford, Connecticut, USA
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16
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Rauzon S, Hewawitharana SC, Esaryk EE, Thompson HR, Whetstone L, Cordon I, Woodward-Lopez GM. Parent perceptions of changes in eating behavior during COVID-19 of school-aged children from Supplemental Assistance Program Education (SNAP-Ed) eligible households in California. Prev Med Rep 2023; 35:102365. [PMID: 37601827 PMCID: PMC10432783 DOI: 10.1016/j.pmedr.2023.102365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 08/03/2023] [Accepted: 08/04/2023] [Indexed: 08/22/2023] Open
Abstract
This cross-sectional study examined the associations between parent-reported, perceptions of changes in school-aged children's (ages 5-18) school meal participation, household cooking, fast food consumption, dietary intake, and weight during the COVID-19 pandemic. Respondents with low-income and school-aged children (n = 1040) were enrolled using quota sampling to approximate the distribution of low-income households and race/ethnicity among California residents who completed an on-line questionnaire developed by the authors. Adjusted multinomial models examined associations between parent-reported changes in school meal participation and time spent cooking, with parent-reported changes in child diet and body weight during COVID-19 (from before March 2020 to January-March 2021). During the pandemic, decreased school meal participation was associated with decreased child's fast food intake (OR[95 %CI] = 1.47[1.04-2.07]); conversely, increased school meal participation was associated with increased child's fast food intake (OR[95 %CI] = 1.71[1.09-2.68]). Decreased cooking at home was associated with decreased fruit and vegetable intake (OR[95 %CI] = 2.71[1.62-4.53]), increased sugar-sweetened beverage intake (OR[95 %CI] = 3.83[2.16-6.81]), and increased fast food intake (OR[95 %CI] = 4.09[2.45-6.84]); while increased cooking at home was associated with increased fruit and vegetable (OR[95 %CI] = 2.26[1.59-3.20]), sugar-sweetened beverage (OR[95 %CI] = 1.88[1.20-2.94]), sweets (OR[95 %CI] = 1.46[1.02-2.10]), and salty snack food intake (OR[95 %CI] = 1.87[1.29-2.71]). These parent-reported perceived changes in meal sources during the pandemic for children from low-income California households, and the mixed results in their associations with changes in parent-reported child dietary intake, suggest the need for strengthening policies and programs to support both access to, and healthfulness of, meals from school and home during prolonged school closures.
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Affiliation(s)
- Suzanne Rauzon
- Nutrition Policy Institute, University of California, Division of Agriculture and Natural Resources, 1111 Franklin Street, Eleventh floor, Oakland, CA 94607, USA
| | - Sridharshi C. Hewawitharana
- Nutrition Policy Institute, University of California, Division of Agriculture and Natural Resources, 1111 Franklin Street, Eleventh floor, Oakland, CA 94607, USA
| | - Erin E. Esaryk
- Nutrition Policy Institute, University of California, Division of Agriculture and Natural Resources, 1111 Franklin Street, Eleventh floor, Oakland, CA 94607, USA
| | - Hannah R. Thompson
- Nutrition Policy Institute, University of California, Division of Agriculture and Natural Resources, 1111 Franklin Street, Eleventh floor, Oakland, CA 94607, USA
- School of Public Health, University of California, Berkeley, CA, 2121 Berkeley Way, Berkeley, CA 94704, USA
| | - Lauren Whetstone
- Research, Evaluation, and Strategic Alignment Section of the Nutrition Education and Obesity Prevention Branch 12(NEOPB), Center for Healthy Communities, California Department of Public Health, 1616 Capitol Avenue, Sacramento, CA 95814, USA
| | - Ingrid Cordon
- Research, Evaluation, and Strategic Alignment Section of the Nutrition Education and Obesity Prevention Branch 12(NEOPB), Center for Healthy Communities, California Department of Public Health, 1616 Capitol Avenue, Sacramento, CA 95814, USA
| | - Gail M. Woodward-Lopez
- Nutrition Policy Institute, University of California, Division of Agriculture and Natural Resources, 1111 Franklin Street, Eleventh floor, Oakland, CA 94607, USA
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17
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Wang L, Cohen JF, Maroney M, Cudhea F, Hill A, Schwartz C, Lurie P, Mozaffarian D. Evaluation of health and economic effects of United States school meal standards consistent with the 2020-2025 dietary guidelines for Americans. Am J Clin Nutr 2023; 118:605-613. [PMID: 37527964 PMCID: PMC10550836 DOI: 10.1016/j.ajcnut.2023.05.031] [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: 02/02/2023] [Revised: 04/10/2023] [Accepted: 05/25/2023] [Indexed: 08/03/2023] Open
Abstract
BACKGROUND The current school meal nutrition standards, established in 2010, are not fully aligned with the 2020-2025 Dietary Guideline for Americans (DGA). This study evaluates the potential short-term and long-term health and economic benefits of strengthening the school meal standards on added sugars, sodium, and whole grains to be aligned with current guidelines. METHODS We used comparative risk assessment frameworks based on nationally representative data incorporating current demographics, dietary habits, and risk factors of United States children aged 5-18 y from 3 cycles of the National Health and Nutrition Examination Survey (2013-2018). To estimate short-term impact, the model incorporated estimated dietary changes owing to potential new DGA-aligned school meal nutrition standards and the effect of these changes on childhood body mass index (in kg/m2) and blood pressure. To estimate long-term impact, the model further incorporated data on the sustainability of childhood dietary changes into adulthood, and on demographics and risk factors of United States adults, diet-disease associations, and disease-specific national mortality. RESULTS In a best-case scenario assuming full school compliance, implementing new DGA-aligned nutritional standards would lower elementary children's BMI by an average 0.14 (95% UI: 0.08-0.20) kg/m2 and systolic blood pressure by 0.13 (95% UI: 0.06-0.19) (95% mm Hg. Later in life, the new standards were estimated to prevent 10,600 [95% uncertainty interval (UI): 4820-16,800) annual deaths from cardiovascular disease (CVD), diabetes, and cancer in adulthood; and save 355,000 (95% UI: 175,000-538,000) disability-adjusted life years and $19.3 (95% UI: 9.35-30.3) B in direct and indirect medical costs each year. Accounting for plausible (incomplete) school compliance, implementation would save an estimated 9110 (95% UI: 2740-15,100) deaths, 302,000 (95% UI: 120,000-479,000) disability-adjusted life years, and $15.9 (95% UI: 4.54-27.2) B in healthcare-related costs per year in later adulthood. CONCLUSIONS Stronger school meal nutrition standards on added sugars, sodium, and whole grains aligned with the 2020-2025 DGA recommendations may improve diet, childhood health, and future adult burdens of CVD, diabetes, cancer, and associated economic costs.
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Affiliation(s)
- Lu Wang
- Friedman School of Nutrition Science and Policy, Boston, MA, United States
| | - Juliana Fw Cohen
- Department of Health Sciences, Merrimack College, North Andover, MA, United States; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Meghan Maroney
- Center for Science in the Public Interest, Washington, DC, United States
| | - Fredrick Cudhea
- Friedman School of Nutrition Science and Policy, Boston, MA, United States
| | - Alla Hill
- Center for Science in the Public Interest, Washington, DC, United States
| | - Colin Schwartz
- Center for Science in the Public Interest, Washington, DC, United States
| | - Peter Lurie
- Center for Science in the Public Interest, Washington, DC, United States
| | - Dariush Mozaffarian
- Friedman School of Nutrition Science and Policy, Boston, MA, United States; Division of Cardiology, Tufts Medical Center, Boston, MA, United States.
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18
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Olarte DA, Tsai MM, Chapman L, Hager ER, Cohen JFW. Alternative School Breakfast Service Models and Associations with Breakfast Participation, Diet Quality, Body Mass Index, Attendance, Behavior, and Academic Performance: A Systematic Review. Nutrients 2023; 15:2951. [PMID: 37447277 DOI: 10.3390/nu15132951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 06/17/2023] [Accepted: 06/19/2023] [Indexed: 07/15/2023] Open
Abstract
The United States (US) School Breakfast Program provides Breakfast After The Bell (BATB) to alleviate hunger, provide nutrition, and ensure students have a healthy start to the day. This study aims to review the evidence regarding the impact of BATB on students' diet and academic outcomes, including participation, diet quality and consumption, body mass index (BMI) and weight status, attendance, classroom behavior, and academic performance. The articles were extracted from three electronic databases and published since the start of the literature through December 2022. Studies were peer-reviewed; quantitative research articles or government reports; and conducted in public or private elementary, middle, and high schools. Quality was assessed using the Newcastle-Ottawa Scale. Thirty-seven studies were included in this review. This review found BATB increased school breakfast participation, improved diet quality, and improved classroom behavior particularly among students from racial and ethnic minority backgrounds and students eligible for free or reduced-price meals. The impact of BATB on BMI and weight status, academic achievement and attendance was mixed. This review is particularly timely given free school meals and updated school nutrition standards are being prioritized over the next decade in the US. Thus, it is important to evaluate the nutritional and educational outcomes of BATB. (PROSPERO registration: CRD42021289719).
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Affiliation(s)
- Deborah A Olarte
- Center for Health Inclusion, Research and Practice (CHIRP), Merrimack College, 315 Turnpike Street, North Andover, MA 01845, USA
| | - Marisa M Tsai
- Division of Epidemiology, School of Public Health, University of California Berkeley, 2121 Berkeley Way, Berkeley, CA 94704, USA
| | - Leah Chapman
- Center for Health Inclusion, Research and Practice (CHIRP), Merrimack College, 315 Turnpike Street, North Andover, MA 01845, USA
| | - Erin R Hager
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA
| | - Juliana F W Cohen
- Center for Health Inclusion, Research and Practice (CHIRP), Merrimack College, 315 Turnpike Street, North Andover, MA 01845, USA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Harvard University, 677 Huntington Avenue, Boston, MA 02115, USA
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19
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Schwartz MB, Chafouleas SM, Koslouski JB. Expanding school wellness policies to encompass the Whole School, Whole Community, Whole Child model. Front Public Health 2023; 11:1143474. [PMID: 37064709 PMCID: PMC10100499 DOI: 10.3389/fpubh.2023.1143474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 03/08/2023] [Indexed: 04/03/2023] Open
Abstract
Schools influence children’s developmental outcomes across multiple domains, including academic, social, emotional, behavioral, and physical. School district wellness policies are powerful mechanisms that set clear expectations for health-related practices in school buildings and the surrounding community. A current challenge is that many health-related school policies are narrow, siloed, and reactive instead of proactive. In this paper, we: (a) describe how written food, nutrition, and physical activity district and state policies were strengthened in the United States in response to specific concerns about childhood obesity; (b) present how schools have historically addressed policies concerning children’s social, emotional, and behavioral health; and (c) propose using the Whole School, Whole Community, Whole Child (WSCC) model to strengthen the coordination and integration of school wellness policies. We conclude by describing recently developed tools to assist school districts in implementing the WSCC model. The Wellness School Assessment Tool (WellSAT) WSCC is a quantitative measure that districts can use to code their current written policies for alignment with the WSCC model. The WSCC Policy and Practice Blueprints are action planning tools that lead school and district leaders through a series of activities to strengthen the implementation of coordinated and integrated policies and practices. By using the WSCC model and accompanying implementation tools, schools can support the development of the whole child.
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Affiliation(s)
- Marlene B. Schwartz
- Rudd Center for Food Policy and Health, Department of Human Development and Family Sciences, University of Connecticut, Hartford, CT, United States
- *Correspondence: Marlene B. Schwartz,
| | - Sandra M. Chafouleas
- Collaboratory on School and Child Health, Neag School of Education, University of Connecticut, Storrs, CT, United States
| | - Jessica B. Koslouski
- Collaboratory on School and Child Health, Neag School of Education, University of Connecticut, Storrs, CT, United States
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Providing School Meals to All Students Free of Charge during the COVID-19 Pandemic and Beyond: Challenges and Benefits Reported by School Foodservice Professionals in California. Nutrients 2022; 14:nu14183855. [PMID: 36145229 PMCID: PMC9500887 DOI: 10.3390/nu14183855] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 09/10/2022] [Accepted: 09/13/2022] [Indexed: 11/20/2022] Open
Abstract
Universal school meals (USM) have the potential to increase access to healthy food for millions of U.S. students. This study evaluated school food authorities’ (SFA) perspectives of federal USM in response to COVID-19 (school year (SY) 2021−22) and California’s upcoming USM policy in the SY 2022−23. In February 2022, all SFAs in California (n = 1116) were invited to complete an online survey. Descriptive statistics and logistic regression examining differences by school demographic characteristics were used. Five hundred and eighty-one SFAs completed the survey; 63% of them first implemented USM during the COVID-19 pandemic. Reported benefits included increased student meal participation (79.2%) and reduced stigma (39.7%). Top challenges included staffing (76.9%) and meal packaging/solid waste (67.4%). Nearly all SFAs reported pandemic-related challenges procuring the necessary types (88.9%) and amounts of foods (85.9%), and non-food supplies/equipment (82.6%). Over 40% reported that federal reimbursements were insufficient to cover costs. SFAs with <40% FRPM-eligible students and/or higher student enrollment reported more current challenges and future concerns than those with ≥40% FRPMs and lower student enrollment. The top resources requested to implement CA’s USM included additional facilities/equipment (83.8%), communications/marketing (76.1%), increasing meal participation (71.5%), and financial management (61.5%). Most California SFAs reported that implementing federal USM had the intended effect of feeding more children. This study’s findings may be useful to the several other U.S. states implementing universal school meals in the SY 2022−23, and to other states or countries considering adopting a USM policy in the future.
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21
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Andreyeva T, Mozaffarian RS, Kenney EL. Updated Meal Patterns in the Child and Adult Care Food Program and Changes in Quality of Food and Beverages Served: A Natural Experimental Study. Nutrients 2022; 14:3786. [PMID: 36145161 PMCID: PMC9505753 DOI: 10.3390/nu14183786] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 09/07/2022] [Accepted: 09/08/2022] [Indexed: 11/17/2022] Open
Abstract
With diet-related chronic diseases being the largest contributors to U.S. morbidity and mortality, identifying population-level strategies to promote healthier diets is essential. Intervention during early childhood may be particularly important. The Child and Adult Care Food Program (CACFP), a federal nutrition assistance program in the U.S. that supports serving meals and snacks in child care settings, reaches millions of U.S. children. Recent 2017 updates to CACFP's meal patterns were meant to improve the nutritional quality of food served through CACFP by providing more whole grains, fruit, and vegetables. In this study, we used a natural experimental, longitudinal study of child care centers participating in CACFP compared to nonparticipating centers to assess whether the quality of food and beverages served (per menu analysis) improved following the CACFP meal pattern changes. While we found that CACFP centers were more likely to meet several key nutrition standards in comparison to non-CACFP centers overall, there were no differences in menu quality from before to after the 2017 standards change between CACFP and non-CACFP centers. Nutrition standards for CACFP may need to be further strengthened with adequate financial and technical support given to child care programs for effective implementation.
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Affiliation(s)
- Tatiana Andreyeva
- Department of Agricultural and Resource Economics, Rudd Center for Food Policy and Health, University of Connecticut, One Constitution Plaza, Hartford, CT 06103, USA
| | - Rebecca S. Mozaffarian
- Department of Nutrition, Harvard T.H. Chan School of Public Health, 655 Huntington Ave, Boston, MA 02115, USA
| | - Erica L. Kenney
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 655 Huntington Ave, Boston, MA 02115, USA
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22
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Petimar J, Grummon AH, Zhang F, Gortmaker SL, Moran AJ, Polacsek M, Rimm EB, Roberto CA, Rao A, Cleveland LP, Simon D, Franckle RL, Till S, Greene J, Block JP. Assessment of Calories Purchased After Calorie Labeling of Prepared Foods in a Large Supermarket Chain. JAMA Intern Med 2022; 182:965-973. [PMID: 35913728 PMCID: PMC9344388 DOI: 10.1001/jamainternmed.2022.3065] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 05/28/2022] [Indexed: 11/14/2022]
Abstract
Importance Calorie labels for prepared (ie, ready-to-eat) foods are required in large chain food establishments in the US. Large evaluations in restaurants suggest small declines in purchases of prepared foods after labeling, but to the authors' knowledge, no studies have examined how this policy influences supermarket purchases. Objective To estimate changes in calories purchased from prepared foods and potential packaged substitutes compared with control foods after calorie labeling of prepared foods in supermarkets. Design, Setting, and Participants This controlled interrupted time series compared sales 2 years before labeling implementation (April 2015-April 2017) with sales 7 months after labeling implementation (May 2017-December 2017). Data from 173 supermarkets from a supermarket chain with locations in Maine, Massachusetts, New Hampshire, New York, and Vermont were analyzed from March 2020 to May 2022. Intervention Implementation of calorie labeling of prepared foods in April 2017. Main Outcomes and Measures Purchased items were classified as prepared foods, potential packaged substitutes for prepared foods, or all other (ie, control) foods. The primary outcome was mean weekly calories per transaction purchased from prepared foods, and the secondary outcome was mean weekly calories per transaction purchased from similar packaged items (for substitution analyses). Analyses of prepared and packaged foods were stratified by food category (bakery, entrées and sides, or deli meats and cheeses). Results Among the included 173 supermarkets, calorie labeling was associated with a mean 5.1% decrease (95% CI, -5.8% to -4.4%) in calories per transaction purchased from prepared bakery items and an 11.0% decrease (95% CI, -11.9% to -10.1%) from prepared deli items, adjusted for changes in control foods; no changes were observed for prepared entrées and sides (change = 0.3%; 95% CI, -2.5% to 3.0%). Labeling was also associated with decreased calories per transaction purchased from packaged bakery items (change = -3.9%; 95% CI, -4.3% to -3.6%), packaged entrées and sides (change = -1.2%; 95% CI, -1.4% to -0.9%), and packaged deli items (change = -2.1%; 95% CI, -2.4% to -1.7%). Conclusions and Relevance In this longitudinal study of supermarkets, calorie labeling of prepared foods was associated with small to moderate decreases in calories purchased from prepared bakery and deli items without evidence of substitution to similar packaged foods.
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Affiliation(s)
- Joshua Petimar
- Department of Population Medicine, Harvard Medical School & Harvard Pilgrim Health Care Institute, Boston, Massachusetts
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Anna H. Grummon
- Department of Population Medicine, Harvard Medical School & Harvard Pilgrim Health Care Institute, Boston, Massachusetts
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Fang Zhang
- Department of Population Medicine, Harvard Medical School & Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Steven L. Gortmaker
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Alyssa J. Moran
- Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Michele Polacsek
- Center for Excellence in Public Health, University of New England, Portland, Maine
| | - Eric B. Rimm
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Christina A. Roberto
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Anjali Rao
- Department of Population Medicine, Harvard Medical School & Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Lauren P. Cleveland
- Department of Population Medicine, Harvard Medical School & Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Denise Simon
- Department of Population Medicine, Harvard Medical School & Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | | | - Sue Till
- Hannaford Supermarkets, Scarborough, Maine
| | - Julie Greene
- Guiding Stars Licensing Company LLC, Ahold Delhaize USA, Scarborough, Maine
| | - Jason P. Block
- Department of Population Medicine, Harvard Medical School & Harvard Pilgrim Health Care Institute, Boston, Massachusetts
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23
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Abstract
Population-based solutions are needed to stabilize and then reverse the continued upward trends in obesity prevalence in the US population and worldwide. This review focuses on the related, urgent issue of disparities in obesity prevalence affecting US racial/ethnic minority and other socially marginalized populations. The review provides background on these disparities from a health equity perspective and highlights evidence of progress in equity-focused obesity efforts. Five recommendations for advancing equity efforts are offered as potential approaches to build on progress to date: (a) give equity issues higher priority, (b) adopt a health equity lens, (c) strengthen approaches by using health equity frameworks, (d) broaden the types of policies considered, and (e) emphasize implementation science concepts and tools. Potential challenges and opportunities are identified, including the prospect of longer-term, transformative solutions that integrate global and national initiatives to address obesity, undernutrition, and climate change.
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Affiliation(s)
- Shiriki K Kumanyika
- Dornsife School of Public Health, Drexel University, and Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA;
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24
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Kenney EL, Walkinshaw LP, Shen Y, Fleischhacker SE, Jones-Smith J, Bleich SN, Krieger JW. Costs, Reach, and Benefits of COVID-19 Pandemic Electronic Benefit Transfer and Grab-and-Go School Meals for Ensuring Youths' Access to Food During School Closures. JAMA Netw Open 2022; 5:e2229514. [PMID: 36044212 PMCID: PMC9434357 DOI: 10.1001/jamanetworkopen.2022.29514] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE School meals are associated with improved nutrition and health for millions of US children, but school closures due to the COVID-19 pandemic disrupted children's access to school meals. Two policy approaches, the Pandemic Electronic Benefit Transfer (P-EBT) program, which provided the cash value of missed meals directly to families on debit-like cards to use for making food purchases, and the grab-and-go meals program, which offered prepared meals from school kitchens at community distribution points, were activated to replace missed meals for children from low-income families; however, the extent to which these programs reached those who needed them and the programs' costs were unknown. OBJECTIVE To assess the proportion of eligible youths who were reached by P-EBT and grab-and-go meals, the amount of meals or benefits received, and the cost to implement each program. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study was conducted from March to June 2020. The study population was all US youths younger than 19 years, including US youths aged 6 to 18 years who were eligible to receive free or reduced-price meals (primary analysis sample). EXPOSURES Receipt of P-EBT or grab-and-go school meals. MAIN OUTCOMES AND MEASURES The main outcomes were the percentage of youths reached by P-EBT and grab-and-go school meals, mean benefit received per recipient, and mean cost, including implementation costs and time costs to families per meal distributed. RESULTS Among 30 million youths eligible for free or reduced-price meals, grab-and-go meals reached an estimated 8.0 million (27%) and P-EBT reached 26.9 million (89%). The grab-and-go school meals program distributed 429 million meals per month in spring 2020, and the P-EBT program distributed $3.2 billion in monthly cash benefits, equivalent to 1.1 billion meals. Among those receiving benefits, the mean monthly benefit was larger for grab-and-go school meals ($148; range across states, $44-$176) compared with P-EBT ($110; range across states, $55-$114). Costs per meal delivered were lower for P-EBT ($6.46; range across states, $6.41-$6.79) compared with grab-and-go school meals ($8.07; range across states, $2.97-$15.27). The P-EBT program had lower public sector implementation costs but higher uncompensated time costs to families (eg, preparation time for meals) compared with grab-and-go school meals. CONCLUSIONS AND RELEVANCE In this economic evaluation, both the P-EBT and grab-and-go school meal programs supported youths' access to food in complementary ways when US schools were closed during the COVID-19 pandemic from March to June 2020.
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Affiliation(s)
- Erica L. Kenney
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | | | - Ye Shen
- Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | | | - Jessica Jones-Smith
- Department of Health Systems and Population Health, University of Washington, Seattle
- Department of Epidemiology, University of Washington, Seattle
| | - Sara N. Bleich
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - James W. Krieger
- Department of Health Systems and Population Health, University of Washington, Seattle
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25
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Yang Z, Pu F, Cao X, Li X, Sun S, Zhang J, Chen C, Han L, Yang Y, Wang W, Zhang Y, Liu Z. Does healthy lifestyle attenuate the detrimental effects of urinary polycyclic aromatic hydrocarbons on phenotypic aging? An analysis from NHANES 2001-2010. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2022; 237:113542. [PMID: 35468442 DOI: 10.1016/j.ecoenv.2022.113542] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 04/08/2022] [Accepted: 04/17/2022] [Indexed: 06/14/2023]
Abstract
Existing evidence has showed that exposure to polycyclic aromatic hydrocarbons (PAHs) increases the risk of many chronic diseases. Given the close connection between aging (a major risk factor) and chronic diseases, however, very few studies have evaluated the association between PAHs and aging. Furthermore, whether modifiable healthy lifestyle could attenuate the detrimental effect of PAHs on aging remains unknown. Therefore, we conducted this study, aiming to: (1) examine the associations of urinary monohydroxy polycyclic aromatic hydrocarbons (OH-PAHs) and lifestyle with Phenotypic Age Acceleration (PhenoAge.Accel), a novel aging measure that captures morbidity and mortality risk; and (2) evaluate the potential interaction effects of OH-PAHs and lifestyle on PhenoAge.Accel. Cross-sectional data of 2,579 participants (aged 20-84 years, n = 1,292 females) from the National Health and Nutrition Examination Survey for years 2001-2010 were analyzed. A lifestyle index was constructed based on five components (drinking, smoking, body mass index, physical activity, and diet), ranging from 0 to 5. We calculated PhenoAge.Accel using algorithms developed previously. General linear regression models were used to examine the associations. We observed strong associations of OH-PAHs and lifestyle with PhenoAge.Accel. For instance, one unit increase in ∑NAP (sum of 1- and 2-hydroxynaphthalene) was associated with 0.37 year (95% confidence interval [CI]: 0.26, 0.48) increase in PhenoAge.Accel. We did not observe statistically significant interaction effects between OH-PAHs and lifestyle on PhenoAge.Accel. After stratified by sex, we observed strong associations as well as statistically significant interactions of OH-PAHs and lifestyle with PhenoAge.Accel among females. In conclusion, both OH-PAHs and lifestyle were independently associated with phenotypic aging and there were statistically significant interactions between OH-PAHs and lifestyle on phenotypic aging among females. The findings highlight the importance of adherence to a healthy lifestyle to attenuate the detrimental effects of exposures to PAHs on phenotypic aging among females.
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Affiliation(s)
- Zhenqing Yang
- Department of Big Data in Health Science School of Public Health and Center for Clinical Big Data and Analytics of the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310058, Zhejiang, China
| | - Fan Pu
- Department of Big Data in Health Science School of Public Health and Center for Clinical Big Data and Analytics of the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310058, Zhejiang, China
| | - Xingqi Cao
- Department of Big Data in Health Science School of Public Health and Center for Clinical Big Data and Analytics of the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310058, Zhejiang, China
| | - Xueqin Li
- Department of Big Data in Health Science School of Public Health and Center for Clinical Big Data and Analytics of the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310058, Zhejiang, China
| | - Sudan Sun
- Department of Big Data in Health Science School of Public Health and Center for Clinical Big Data and Analytics of the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310058, Zhejiang, China
| | - Jingyun Zhang
- Department of Big Data in Health Science School of Public Health and Center for Clinical Big Data and Analytics of the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310058, Zhejiang, China
| | - Chen Chen
- National Institute of Environmental and Health, Chinese Center for Disease Control and Prevention, Beijing 100021, China; National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China
| | - Liyuan Han
- Department of Global Health, Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, Ningbo 315200, Zhejiang, China; Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo 315200, Zhejiang, China
| | - Yongli Yang
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou 450001, Henan, China
| | - Wei Wang
- Department of Occupational Health and Occupational Disease, College of Public Health, Zhengzhou University, Zhengzhou 450001, Henan, China
| | - Yawei Zhang
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Zuyun Liu
- Department of Big Data in Health Science School of Public Health and Center for Clinical Big Data and Analytics of the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310058, Zhejiang, China.
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26
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Maintaining School Foodservice Operations in Ohio during COVID-19: “This [Was] Not the Time to Sit Back and Watch”. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19105991. [PMID: 35627527 PMCID: PMC9141818 DOI: 10.3390/ijerph19105991] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 05/04/2022] [Accepted: 05/12/2022] [Indexed: 02/01/2023]
Abstract
The COVID-19-related lockdowns led to school closures across the United States, cutting off critical resources for nutritious food. Foodservice employees emerged as frontline workers; understanding their experiences is critical to generate innovations for program operations and viability. The purpose of this cross-sectional study was to characterize COVID-19-related foodservice adaptations for summer and school year meal provision. Public school district foodservice administrators across Ohio were surveyed in December 2020. Questions related to meal provision before, during, and after COVID-19-related school closures. Results indicate the majority of districts continued providing meals upon their closure in Spring 2020 (n = 182, 87.1%); fewer did so in Summer (n = 88, 42.1%) and Fall (n = 32, 15.3%). In Spring and Summer, most districts that offered meals functioned as ‘open sites’ (67.0% and 87.5%, respectively), not limiting food receipt to district-affiliated students. Most districts employed a pick-up system for food distribution (76–84% across seasons), though some used a combination of approaches or changed their approach within-season. Qualitatively, districts reported both “successes” (e.g., supporting students) and “challenges” (e.g., supply chain). Despite being ill-prepared, districts responded quickly and flexibly to demands of the pandemic. This analysis provides insight for future practice (e.g., establishing community partnerships) and policy (e.g., bolstering local food systems).
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27
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Comparison of Missing School Meals among Public Schools: How Did New York State Do during COVID-19? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19105838. [PMID: 35627375 PMCID: PMC9141843 DOI: 10.3390/ijerph19105838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 04/29/2022] [Accepted: 05/09/2022] [Indexed: 11/17/2022]
Abstract
Background: The COVID-19 pandemic created barriers to participation in school meals. As a result, many students may have missed out on school meals. The objectives of this study are (1) to compare the number of school meals served by New York State public schools during the first spring and summer of the COVID-19 pandemic to the number served before the COVID-19 pandemic, and (2) to determine relationships between the number of meals served and the levels of school district need and urbanicity. Methods: This study is a secondary analysis of administrative data. The percentage change in the number of school breakfasts and lunches served was calculated for each month and by school district need level and urbanicity level. Results: The number of school meals served decreased during the first spring of the pandemic compared to the spring of the previous school year (−43% in April, −51% in May), while the number of school meals served increased during the first summer of the pandemic compared to the summer of the previous school year (+92% in July, +288% in August). Conclusions: Waivers may provide flexibility to increase participation in school meals, especially during the summer.
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28
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Thorndike AN, Gardner CD, Kendrick KB, Seligman HK, Yaroch AL, Gomes AV, Ivy KN, Scarmo S, Cotwright CJ, Schwartz MB. Strengthening US Food Policies and Programs to Promote Equity in Nutrition Security: A Policy Statement From the American Heart Association. Circulation 2022; 145:e1077-e1093. [PMID: 35535604 DOI: 10.1161/cir.0000000000001072] [Citation(s) in RCA: 51] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Nutritionally inadequate dietary intake is a leading contributor to chronic cardiometabolic diseases. Differences in dietary quality contribute to socioeconomic and racial and ethnic health disparities. Food insecurity, a household-level social or economic condition of limited access to sufficient food, is a common cause of inadequate dietary intake. Although US food assistance policies and programs are designed to improve food security, there is growing consensus that they should have a broader focus on nutrition security. In this policy statement, we define nutrition security as an individual or household condition of having equitable and stable availability, access, affordability, and utilization of foods and beverages that promote well-being and prevent and treat disease. Despite existing policies and programs, significant gaps remain for achieving equity in nutrition security across the life span. We provide recommendations for expanding and improving current food assistance policies and programs to achieve nutrition security. These recommendations are guided by several overarching principles: emphasizing nutritional quality, improving reach, ensuring optimal utilization, improving coordination across programs, ensuring stability of access to programs across the life course, and ensuring equity and dignity for access and utilization. We suggest a critical next step will be to develop and implement national measures of nutrition security that can be added to the current US food security measures. Achieving equity in nutrition security will require coordinated and sustained efforts at the federal, state, and local levels. Future advocacy, innovation, and research will be needed to expand existing food assistance policies and programs and to develop and implement new policies and programs that will improve cardiovascular health and reduce disparities in chronic disease.
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29
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Strieter L, Besana T, Arena R, Hall G. Where are we now? The intersection of healthy living medicine and social justice within our school systems. Prog Cardiovasc Dis 2022; 71:43-50. [PMID: 35523310 DOI: 10.1016/j.pcad.2022.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 04/26/2022] [Indexed: 11/27/2022]
Abstract
Alongside the tensions brought forth by the pandemic, such as health and safety concerns from transmission and economic insecurity, there was also a rise in racial and social tension, bringing issues of equity and justice to the forefront. Consequently, there has been a call for reform and an urgency for change in legal, political, economic, and healthcare spheres. Change only occurs through change, with a pivotal point to target the beginning stages in life which will have a greater likelihood to subsist throughout the lifecourse. The crossroads of healthy living medicine (HLM) and education are an appropriate context for necessary change. If healthy living medicine is to embody the ideals of social justice, then people need equal access to resources of well-being - physical, social, and emotional - in their school systems. This paper examines the current intersection of health and social justice within the school systems in the United States. It is both a critique of how school systems have not yet provided such an intersection and highlight those efforts that have proven valuable and successful in providing HLM resources to populations that are historically under-resourced and under-served. Ultimately, this paper looks to provide a path forward, providing ideas for sustainable, feasible, actionable change in school systems K-12 and in higher education.
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Affiliation(s)
- Lindsey Strieter
- Department of Physical Therapy, College of Applied Science, University of Illinois, Chicago, IL, United States of America; Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, IL, United States of America.
| | - Tiffany Besana
- Department of Physical Therapy, College of Applied Science, University of Illinois, Chicago, IL, United States of America
| | - Ross Arena
- Department of Physical Therapy, College of Applied Science, University of Illinois, Chicago, IL, United States of America; Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, IL, United States of America
| | - Grenita Hall
- Department of Physical Therapy, College of Applied Science, University of Illinois, Chicago, IL, United States of America; Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, IL, United States of America
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30
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Richardson AS, Weden MM, Cabreros I, Datar A. Association of the Healthy, Hunger-Free Kids Act of 2010 With Body Mass Trajectories of Children in Low-Income Families. JAMA Netw Open 2022; 5:e2210480. [PMID: 35511177 PMCID: PMC9073566 DOI: 10.1001/jamanetworkopen.2022.10480] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 03/18/2022] [Indexed: 01/13/2023] Open
Abstract
Importance Implemented in 2012, the Healthy, Hunger-Free Kids Act of 2010 (HHFKA) increased nutritional requirements of the National School Lunch Program (NSLP) to reverse the potential role of the NSLP in childhood obesity. Objective To evaluate whether associations between the free or reduced-price NSLP and body mass growth differed after implementation of the HHFKA. Design, Setting, and Participants This cohort study used data from 2 nationally representative cohorts of US kindergarteners sampled in 1998 to 1999 and 2010 to 2011 and followed up for 6 years, through grade 5, in the Early Childhood Longitudinal Study Kindergarten Class of 1998-1999 (ECLS-K:1999, in 2003-2004) and Kindergarten Class of 2010-2011 (ECLS-K:2011, in 2015-2016). In total, 5958 children were selected for analysis from low-income families eligible for the free or reduced-price NSLP (household income <185% of the federal poverty level) who attended public schools and had no missing data on free or reduced-price NSLP participation or on body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) at kindergarten or grades 1 and 5. Data were analyzed from January 1 to September 7, 2021. Exposures Cross-cohort comparison of before vs after implementation of the HHFKA for free or reduced-price NSLP participation at kindergarten and grades 1 and 5. Main Outcomes and Measures Body mass index difference (BMID) from obesity threshold was the difference in BMI units from the age- and sex-specific obesity thresholds (95th percentile) and is sensitive to change at high BMI. Multigroup models by cohort included weights to balance the distribution of the 2 cohorts across a wide range of covariates. A Wald test was used to assess whether associations differed between the cohorts. Results In the final analysis, 3388 children in ECLS-K:1999 (1696 girls [50.1%]; mean [SD] age at baseline, 74.6 [4.3] months) and 2570 children in ECLS-K:2011 (1348 males [52.5%]; mean [SD] age at baseline, 73.6 [4.2] months) were included. The best fitting model for BMID change by free or reduced-price NSLP participation across the cohorts included fixed and time-varying associations. Before HHFKA implementation, grade 5 free or reduced-price NSLP participants had higher BMID, adjusted for their prior BMID trajectory, than nonparticipants (β = 0.54; 95% CI, 0.27-0.81). After HHFKA implementation, this association was attenuated (β = -0.07; 95% CI, -0.58 to 0.45), and grade 5 associations were different across cohorts (χ21 = 4.29, P = .04). Conclusions and Relevance In this cohort study using cross-cohort comparisons, children from low-income families who participated in the free or reduced-price NSLP had a higher likelihood of progression to high BMI that was no longer observed after HHFKA implementation. This finding suggests that the HHFKA may have attenuated the previous association of the NSLP with child obesity disparities.
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Affiliation(s)
- Andrea S. Richardson
- Department of Behavioral and Policy Sciences, RAND Corporation, Pittsburgh, Pennsylvania
| | - Margaret M. Weden
- Department of Economics, Sociology, and Statistics, RAND Corporation, Santa Monica, California
| | - Irineo Cabreros
- Department of Economics, Sociology, and Statistics, RAND Corporation, Boston, Massachusetts
| | - Ashlesha Datar
- Center for Economic and Social Research, University of Southern California, Los Angeles
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Whitsel LP, Johnson J. Addressing social and racial justice in public policy for healthy living. Prog Cardiovasc Dis 2022; 71:37-42. [PMID: 35490866 DOI: 10.1016/j.pcad.2022.04.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 04/24/2022] [Indexed: 10/18/2022]
Abstract
Long-standing health disparities stemming from the historical, inequitable distribution of wealth, power, and privilege in the United States exist across almost every health indicator and outcome. There is a need for equitable policy, systems, and environment changes that are rooted in an understanding of the historical arc of structural racism across obesity prevention and treatment, ending tobacco and nicotine addiction and increasing access to healthy, affordable foods and physical activity opportunities and infrastructure. This paper explores the influence of structural inequities on the proliferation of health-compromising social conditions, and opportunities to leverage the policymaking process at the local, state, and federal levels to cultivate environments that support healthy living. Policy makers, community change leaders and advocacy organizations, with powerful grassroots voices can catalyze movements, advocacy campaigns and equitable policy change that address race and social justice and support healthy living for all.
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Affiliation(s)
- Laurie P Whitsel
- American Heart Association, Washington, DC, United States of America.
| | - Janay Johnson
- American Heart Association, Washington, DC, United States of America
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Gans KM, Tovar A, Kang A, Ward DS, Stowers KC, von Ash T, Dionne L, Papandonatos GD, Mena N, Jiang Q, Risica PM. A multi-component tailored intervention in family childcare homes improves diet quality and sedentary behavior of preschool children compared to an attention control: results from the Healthy Start-Comienzos Sanos cluster randomized trial. Int J Behav Nutr Phys Act 2022; 19:45. [PMID: 35428298 PMCID: PMC9013065 DOI: 10.1186/s12966-022-01272-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 03/09/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Childcare settings are important environments for influencing child eating and physical activity (PA). Family childcare homes (FCCH) care for many children of low-income and diverse racial/ethnic backgrounds who are at greater risk for poor diet quality, low PA, and obesity, but few interventions have targeted this setting. The aim of this study was to assess the efficacy of a multicomponent intervention conducted in FCCH on the diet quality and PA of 2-5 year old children in their care. TRIAL DESIGN Cluster randomized trial. METHODS The cluster-randomized trial, Healthy Start/Comienzos Sanos (2015-2019) evaluated an 8-month nutrition and PA intervention that included four components: (1) monthly telephone calls from a support coach using brief motivational interviewing, (2) tailored reports, newsletters and videos, (3) group support meetings, and (4) active play toys. After completing baseline measurement, FCCH were randomized into intervention or comparison groups in matched pairs. Both groups received the same intervention components but on different topics (intervention: nutrition/PA vs. comparison: reading readiness/literacy). Evaluation staff were blinded to group assignment. Child primary outcome measures collected at baseline and 8-months included: 1) Healthy Eating Index (HEI-2015) scores calculated from diet observation, and 2) accelerometer measurement of PA. Process measures were collected from field data and provider surveys. Generalized Estimating Equation Models assessed changes in HEI-2015 scores and PA over time by experimental condition. RESULTS Ethnically diverse FCCH providers (n = 119) and 2-to-5-year-old children in their care (n = 377) were included in the final analysis. Process evaluation showed high participation in all intervention components except for group meetings. Compared to children in comparison group FCCH, children in intervention FCCH increased total HEI-2015 scores by 7.2 points (p < .001) including improvement in component scores for vegetables (0.84 points, p = .025) and added sugar (0.94 points, p = .025). For PA, compared to children in the comparison group, children in intervention FCCH decreased sedentary time by 5.7% (p = .021). CONCLUSIONS The multicomponent Healthy Start intervention was effective in improving diet quality and sedentary behavior of children in FCCH, which demonstrates the promise of obesity prevention interventions in this setting. Future research could include enhancing the Healthy Start intervention to strengthen the PA component, considering virtual peer support, and determining how to best translate and disseminate the intervention into FCCH nationally. TRIAL REGISTRATION National Institutes of Health, NCT02452645 . Registered 5 May 2015.
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Affiliation(s)
- Kim M. Gans
- Department of Human Development and Family Sciences, University of Connecticut, 348 Mansfield Road, Storrs, CT 06269 USA
- Brown University School of Public Health, Box G-121-5, 121 S. Main St, Providence, 02912 USA
| | - Alison Tovar
- Brown University School of Public Health, Box G-121-5, 121 S. Main St, Providence, 02912 USA
- Center for Health Promotion and Health Equity, Brown School of Public Health, Box G-121 8, Providence, RI 02912 USA
| | | | - Dianne Stanton Ward
- Department of Nutrition, Gillings School of Global Public Health, 135 Dauer Drive 245 Rosenau Hall, CB #7461, Chapel Hill, NC 27599 USA
| | - Kristen Cooksey Stowers
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT 06269 USA
- Rudd Center for Food Policy and Obesity, University of Connecticut, Hartford, CT 06103 USA
| | - Tayla von Ash
- Brown University School of Public Health, Box G-121-5, 121 S. Main St, Providence, 02912 USA
- Center for Health Promotion and Health Equity, Brown School of Public Health, Box G-121 8, Providence, RI 02912 USA
| | - Laura Dionne
- Center for Health Promotion and Health Equity, Brown School of Public Health, Box G-121 8, Providence, RI 02912 USA
| | | | - Noereem Mena
- Division of Nutritional Sciences, Cornell University, Ithaca, NY USA
| | - Qianxia Jiang
- Department of Human Development and Family Sciences, University of Connecticut, 348 Mansfield Road, Storrs, CT 06269 USA
| | - Patricia Markham Risica
- Brown University School of Public Health, Box G-121-5, 121 S. Main St, Providence, 02912 USA
- Center for Health Promotion and Health Equity, Brown School of Public Health, Box G-121 8, Providence, RI 02912 USA
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Azarieva J, Berry EM, Troen AM. Child food insecurity in the wake of the COVID-19 pandemic: urgent need for policy evaluation and reform in Israel's school feeding programs. Isr J Health Policy Res 2022; 11:13. [PMID: 35168666 PMCID: PMC8845395 DOI: 10.1186/s13584-022-00523-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 02/04/2022] [Indexed: 11/16/2022] Open
Abstract
Even in high-income countries like Israel, children have been particularly vulnerable to the surge in food insecurity driven by quarantines, unemployment, and economic hardships of the COVID-19 pandemic. Under normal circumstances, School Feeding Programs (SFPs) can help to ensure child food security. In the wake of the pandemic, policy makers worldwide have been challenged to adapt national SFPs to provide nutritional support to children (and indirectly to their families) during extended school closures. Most national SFPs implemented contingency plans to ensure continued nutritional support for children. In Israel, where SFPs were largely suspended during long periods of mandated school closing, there was a loss of 30–50% of feeding days for the ~ 454,000 children enrolled in the program. The lack of emergency contingency planning and failure to maintain Israeli SFPs during school closures reveals longstanding structural policy flaws that hindered coordination between relevant ministries and authorities and impeded the mobilization of funds and existing programs to meet the emergent need. The school feeding law does not identify child food security as an explicit aim, there are no benchmarks for monitoring and evaluating the program to ensure that the food aid reaches the children most in need, even routinely, and the Ministry of Education had no obligation to maintain the program and to marshal data on the participants that could be acted upon in the emergency. Moreover, because Israeli SFPs are “selective”, in other words, implemented according to community risk (low-income, high poverty rate) and geographical factors, attendant stigma and financial burdens can make participation in the program less attractive to families and communities that need them the most. We argue that Israel should make urgent, long-term improvements to the SFPs as follows: First, eliminating childhood food insecurity should be made an explicit goal of legislation in the broader context of national social, health, and nutritional goals, and this includes ensuring SFPs are maintained during emergencies. Second, the government should assume responsibility for the routine assessment and data collection on food insecurity among Israeli children. Third, SFPs should be subjected to rigorous independent program evaluation. Finally, a “universal” SFP providing nutritious diets would likely improve the health of all Israeli children, across all socioeconomic backgrounds. These steps to guarantee that Israeli children have food to realize their full physical and cognitive potential would emphasize Israel’s firm commitment to support multiple dimensions of health, educational achievement, and societal values, to combat the complex and long-term consequences of the pandemic, and to prepare for the next one.
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Affiliation(s)
- Janetta Azarieva
- The Nutrition and Brain Health Laboratory, The Institute of Biochemistry Food Science and Nutrition, The Robert H. Smith Faculty of Agriculture Food and Environment, The Hebrew University of Jerusalem, 76100, Rehovot, Israel
| | - Elliot M Berry
- The Hebrew University-Hadassah Braun School of Public Health and Community Medicine, The Faculty of Medicine, The Hebrew University of Jerusalem, 9112102, Jerusalem, Israel
| | - Aron M Troen
- The Nutrition and Brain Health Laboratory, The Institute of Biochemistry Food Science and Nutrition, The Robert H. Smith Faculty of Agriculture Food and Environment, The Hebrew University of Jerusalem, 76100, Rehovot, Israel.
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Effect of school feeding program on the anthropometric and haemoglobin status of school children in Sidama region, Southern Ethiopia: a prospective study. J Nutr Sci 2022; 11:e69. [PMID: 36106090 PMCID: PMC9428659 DOI: 10.1017/jns.2022.73] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 07/29/2022] [Accepted: 08/02/2022] [Indexed: 12/03/2022] Open
Abstract
Ethiopia recently scaled up the implementation of a school feeding program (SFP) as a targeted intervention for protecting disadvantaged school children from hunger and food insecurity. However, the contribution of the program to advancing the nutritional status of children has not been adequately explored. We assessed the effect of SFP on the anthropometric and haemoglobin status of school children in Sidama Region, Southern Ethiopia. Our prospective cohort study compared the height-for-age z-score (HAZ), BMI-for-age z-score (BAZ) and haemoglobin concentration of SFP beneficiary (n 240) and non-beneficiary (n 240) children, 10–14 years of age. The children were recruited from 8 SFP implementing and 8 control schools using a multistage sampling procedure and were followed for an academic year. The SFP intervention and control schools were matched one-to-one based on agro ecological features and geographical proximity. Exposure, outcome and pertinent extraneous variables were collected through baseline and end-line surveys. Multilevel difference-in-differences (DID) analysis was used to measure the net effect on the outcomes of interest. In the multivariable DID model adjusted for potential confounders including maternal and paternal literacy, household monthly income, wealth index and household food insecurity, the SFP did not show significant effects on the haemoglobin concentration (β = 0⋅251, 95 % confidence interval (CI): −0⋅238, 0⋅739), BAZ (β = 0⋅121, 95 % CI: −0⋅163, 0⋅405) and HAZ (β = −0⋅291, 95 % CI: −0⋅640, 0⋅588) of children.
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35
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Wyse R, Delaney T, Stacey F, Lecathelinais C, Ball K, Zoetemeyer R, Lamont H, Sutherland R, Nathan N, Wiggers JH, Wolfenden L. Long-term Effectiveness of a Multistrategy Behavioral Intervention to Increase the Nutritional Quality of Primary School Students' Online Lunch Orders: 18-Month Follow-up of the Click & Crunch Cluster Randomized Controlled Trial. J Med Internet Res 2021; 23:e31734. [PMID: 34847063 PMCID: PMC8669584 DOI: 10.2196/31734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 09/08/2021] [Accepted: 09/26/2021] [Indexed: 11/13/2022] Open
Abstract
Background School food services, including cafeterias and canteens, are an ideal setting in which to improve child nutrition. Online canteen ordering systems are increasingly common and provide unique opportunities to deliver choice architecture strategies to nudge users to select healthier items. Despite evidence of short-term effectiveness, there is little evidence regarding the long-term effectiveness of choice architecture interventions, particularly those delivered online. Objective This study determined the long-term effectiveness of a multistrategy behavioral intervention (Click & Crunch) embedded within an existing online school lunch-ordering system on the energy, saturated fat, sugar, and sodium content of primary school students’ lunch orders 18 months after baseline. Methods This cluster randomized controlled trial (RCT) involved a cohort of 2207 students (aged 5-12 years) from 17 schools in New South Wales, Australia. Schools were randomized to receive either a multistrategy behavioral intervention or the control (usual online ordering only). The intervention strategies ran continuously for 14-16.5 months until the end of follow-up data collection. Trial primary outcomes (ie, mean total energy, saturated fat, sugar and sodium content of student online lunch orders) and secondary outcomes (ie, the proportion of online lunch order items that were categorized as everyday, occasional, and caution) were assessed over an 8-week period at baseline and 18-month follow-up. Results In all, 16 schools (94%) participated in the 18-month follow-up. Over time, from baseline to follow-up, relative to control orders, intervention orders had significantly lower energy (–74.1 kJ; 95% CI [–124.7, –23.4]; P=.006) and saturated fat (–0.4 g; 95% CI [–0.7, –0.1]; P=.003) but no significant differences in sugar or sodium content. Relative to control schools, the odds of purchasing everyday items increased significantly (odds ratio [OR] 1.2; 95% CI [1.1, 1.4]; P=.009, corresponding to a +3.8% change) and the odds of purchasing caution items significantly decreased among intervention schools (OR 0.7, 95% CI [0.6, 0.9]; P=.002, corresponding to a –2.6% change). There was no between-group difference over time in canteen revenue. Conclusions This is the first study to investigate the sustained effect of a choice architecture intervention delivered via an online canteen ordering systems in schools. The findings suggest that there are intervention effects up to 18-months postbaseline in terms of decreased energy and saturated fat content and changes in the relative proportions of healthy and unhealthy food purchased for student lunches. As such, this intervention approach may hold promise as a population health behavior change strategy within schools and may have implications for the use of online food-ordering systems more generally; however, more research is required. Trial Registration Australian New Zealand Clinical Trials Registry ACTRN12618000855224; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=375075
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Affiliation(s)
- Rebecca Wyse
- Hunter New England Population Health, Wallsend, Australia.,School of Medicine and Public Health, University of Newcastle, Callaghan, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, Australia.,Hunter Medical Research Institute, New Lambton, Australia
| | - Tessa Delaney
- Hunter New England Population Health, Wallsend, Australia.,School of Medicine and Public Health, University of Newcastle, Callaghan, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, Australia.,Hunter Medical Research Institute, New Lambton, Australia
| | - Fiona Stacey
- Hunter New England Population Health, Wallsend, Australia.,School of Medicine and Public Health, University of Newcastle, Callaghan, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, Australia.,Hunter Medical Research Institute, New Lambton, Australia
| | - Christophe Lecathelinais
- Hunter New England Population Health, Wallsend, Australia.,School of Medicine and Public Health, University of Newcastle, Callaghan, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, Australia.,Hunter Medical Research Institute, New Lambton, Australia
| | - Kylie Ball
- Institute for Physical Activity and Nutrition, Deakin University, Melbourne, Australia
| | - Rachel Zoetemeyer
- Hunter New England Population Health, Wallsend, Australia.,School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
| | - Hannah Lamont
- Hunter New England Population Health, Wallsend, Australia.,School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
| | - Rachel Sutherland
- Hunter New England Population Health, Wallsend, Australia.,School of Medicine and Public Health, University of Newcastle, Callaghan, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, Australia.,Hunter Medical Research Institute, New Lambton, Australia
| | - Nicole Nathan
- Hunter New England Population Health, Wallsend, Australia.,School of Medicine and Public Health, University of Newcastle, Callaghan, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, Australia.,Hunter Medical Research Institute, New Lambton, Australia
| | - John H Wiggers
- Hunter New England Population Health, Wallsend, Australia.,School of Medicine and Public Health, University of Newcastle, Callaghan, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, Australia.,Hunter Medical Research Institute, New Lambton, Australia
| | - Luke Wolfenden
- Hunter New England Population Health, Wallsend, Australia.,School of Medicine and Public Health, University of Newcastle, Callaghan, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, Australia.,Hunter Medical Research Institute, New Lambton, Australia
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Watts A, Araiza AL, Fernández CR, Rosenthal L, Vargas-Rodriguez I, Duroseau N, Accles L, Rieder J. The Campaign for Universal Free Lunch in New York City: Lessons Learned. Pediatrics 2021; 148:peds.2020-049734. [PMID: 34526351 DOI: 10.1542/peds.2020-049734] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/14/2021] [Indexed: 11/24/2022] Open
Abstract
The New York City (NYC) Department of Education is the largest public school system in the United States, with an enrollment of >1.1 million students. Students who participate in school meal programs can have higher dietary quality than nonparticipating students. Historically, family income documentation qualifying students in the NYC Department of Education for free or reduced-price meals reimbursed by the National School Lunch Program perpetuated poverty stigma. Additionally, National School Lunch Program qualification paperwork was a deterrent to many vulnerable families to participate and impeded all eligible children's access to nutritious meals, potentially magnifying food insecurity. The Healthy, Hunger-Free Kids Act of 2010 provided a viable option for schools to serve free meals to all students, regardless of income status, as a universal free lunch (UFL) through a Community Eligibility Provision if ≥40% of students already participated in another means-based program, such as the Supplemental Nutrition Assistance Program. In this case study, we describe the processes of (1) strategic coalition building of the Lunch 4 Learning campaign (a coalition of students, parents, school-based unions, teachers, pediatricians, community leaders, and children's advocacy organizations) to bring UFL to all NYC public schools, (2) building political support, (3) developing a media strategy, and (4) using an evidence-based strategy to overcome political, administrative, and procedural challenges. The Lunch 4 Learning campaign successfully brought UFL to all NYC public schools in 2017. This case study informs further advocacy efforts to expand UFL in other school districts across the country and national UFL advocacy.
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Affiliation(s)
| | | | - Cristina R Fernández
- Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Irving Medical Center, New York, New York
| | - Leslie Rosenthal
- Division of Adolescent Medicine, Department of Pediatrics, Children's Hospital at Montefiore and Albert Einstein College of Medicine, Bronx, New York
| | - Ileana Vargas-Rodriguez
- Division of Pediatric Endocrinology, Diabetes, and Metabolism, Department of Pediatrics, Children's Hospital at Montefiore and Albert Einstein College of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Nathalie Duroseau
- Division of Adolescent Medicine, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Liz Accles
- Community Food Advocates, New York, New York
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Thayer EK, Farquhar SA, Walkinshaw LP, Wool JL, Jones-Smith JC. Youth Perceptions of the Food Environment in One Seattle, WA Neighborhood: A Qualitative Study. JOURNAL OF HUNGER & ENVIRONMENTAL NUTRITION 2021. [DOI: 10.1080/19320248.2021.1971136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- Erin K Thayer
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, Washington, United States
| | - Stephanie A Farquhar
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, Washington, United States
| | - Lina P Walkinshaw
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, Washington, United States
| | - Jenny L. Wool
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, Washington, United States
| | - Jessica C. Jones-Smith
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, Washington, United States
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Koch PA, Wolf RL, Trent RJ, Ang IYH, Dallefeld M, Tipton E, Gray HL, Guerra L, Di Noia J. Wellness in the Schools: A Lunch Intervention Increases Fruit and Vegetable Consumption. Nutrients 2021; 13:nu13093085. [PMID: 34578962 PMCID: PMC8466064 DOI: 10.3390/nu13093085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 08/30/2021] [Accepted: 08/30/2021] [Indexed: 11/18/2022] Open
Abstract
Wellness in the Schools (WITS) is a national non-profit organization partnering with public schools to provide healthy, scratch cooked, less processed meals (called an Alternative Menu), and active recess. This study examined the effects of WITS programming on school lunch consumption, including fruit and vegetable intake, in second and third grade students in New York City public schools serving a high proportion of students from low-income households. The intervention was evaluated with a quasi-experimental, controlled design with 14 elementary schools (7 that had initiated WITS programming in fall 2015 and were designated as intervention schools, and 7 matched Control schools). School lunch consumption was assessed by anonymous observation using the System of Observational Cafeteria Assessment of Foods Eaten (SOCAFE) tool in the fall of 2015 (Time 0, early intervention) and the spring of 2016 (Time 1) and 2017 (Time 2). There were no baseline data. Data were also collected on the types of entrées served in the months of October, January, and April during the two school years of the study. Across time points, and relative to students in the Control schools, students in WITS schools ate more fruits and vegetables (units = cups): Time 0: Control 0.18 vs. WITS 0.28; Time 1: Control 0.25 vs. WITS 0.31; and Time 2: Control 0.19 vs. WITS 0.27; p < 0.001. They also had more fruits and vegetables (cups) on their trays, which included more vegetables from the salad bar. However, students in the WITS schools ate fewer entrées (grain and protein) and drank less milk than students in the Control schools. Compared to the Control schools, WITS schools offered more homestyle entrées and fewer finger foods and sandwich entrees, i.e., less processed food. Students in WITS schools who received the Alternative menu and all of the WITS programming at all data collection time points selected and consumed more fruits and vegetables. Replication studies with randomized designs and true baseline data are needed to confirm these findings and to identify avenues for strengthening the effects of the program on other school lunch components.
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Affiliation(s)
- Pamela A. Koch
- Department of Health and Behavior Studies, Teachers College, Columbia University, New York, NY 10027, USA; (R.L.W.); (R.J.T.); (M.D.); (L.G.)
- Correspondence: ; Tel.: +1-(212)-678-3001
| | - Randi L. Wolf
- Department of Health and Behavior Studies, Teachers College, Columbia University, New York, NY 10027, USA; (R.L.W.); (R.J.T.); (M.D.); (L.G.)
| | - Raynika J. Trent
- Department of Health and Behavior Studies, Teachers College, Columbia University, New York, NY 10027, USA; (R.L.W.); (R.J.T.); (M.D.); (L.G.)
| | - Ian Yi Han Ang
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore 117549, Singapore;
| | - Matthew Dallefeld
- Department of Health and Behavior Studies, Teachers College, Columbia University, New York, NY 10027, USA; (R.L.W.); (R.J.T.); (M.D.); (L.G.)
| | - Elizabeth Tipton
- Department of Statistics, Weinberg College of Arts and Sciences, Northwestern University, Evanston, IL 60208, USA;
| | - Heewon L. Gray
- College of Public Health, University of South Florida, Tampa, FL 33612, USA;
| | - Laura Guerra
- Department of Health and Behavior Studies, Teachers College, Columbia University, New York, NY 10027, USA; (R.L.W.); (R.J.T.); (M.D.); (L.G.)
| | - Jennifer Di Noia
- Department of Sociology, William Paterson University, Wayne, NJ 07470, USA;
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Calvert HG, Ohri-Vachaspati P, McQuilkin M, Boedeker P, Turner L. Prevalence of Evidence-Based School Meal Practices and Associations with Reported Food Waste across a National Sample of U.S. Elementary Schools. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:8558. [PMID: 34444303 PMCID: PMC8393708 DOI: 10.3390/ijerph18168558] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 08/06/2021] [Accepted: 08/09/2021] [Indexed: 11/29/2022]
Abstract
Providing meals at school is an important part of the hunger safety net for children in the United States and worldwide; however, many children do not receive school meals even when they qualify for federally-subsidized free or reduced-priced meals. This study investigates the prevalence of several evidence-based practices that have previously been shown to increase the reach and impact of school meals. A survey was sent to a national sample of US elementary schools, with items examining practices regarding school breakfast, school lunch, recess, the promotion of meals, nutrition standards, and food waste, during the 2019-20 school year. Almost all schools that offered lunch also offered breakfast. More than 50% used a breakfast service strategy other than cafeteria service, such as grab-and-go breakfast meals. Providing at least 30 min for lunch periods and providing recess before lunch were reported by less than half of schools. About 50% of schools reported using only one or fewer meal promotional strategies (such as taste tests) throughout the school year. Use of more promotional strategies was associated with less reported food waste in a multivariable regression model accounting for school demographic characteristics. Findings show that some evidence-based practices for school meals are being implemented, but many recommendations are not being widely adopted.
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Affiliation(s)
- Hannah G. Calvert
- Center for School and Community Partnerships, College of Education, Boise State University, 1910 University Drive, Boise, ID 83725, USA; (H.G.C.); (M.M.)
| | | | - Michaela McQuilkin
- Center for School and Community Partnerships, College of Education, Boise State University, 1910 University Drive, Boise, ID 83725, USA; (H.G.C.); (M.M.)
| | - Peter Boedeker
- Department of Curriculum, Instruction and Foundational Studies, College of Education, Boise State University, 1910 University Drive, Boise, ID 83725, USA;
| | - Lindsey Turner
- Center for School and Community Partnerships, College of Education, Boise State University, 1910 University Drive, Boise, ID 83725, USA; (H.G.C.); (M.M.)
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Kenney EL, Dunn CG, Mozaffarian RS, Dai J, Wilson K, West J, Shen Y, Fleischhacker S, Bleich SN. Feeding Children and Maintaining Food Service Operations during COVID-19: A Mixed Methods Investigation of Implementation and Financial Challenges. Nutrients 2021; 13:nu13082691. [PMID: 34444851 PMCID: PMC8401539 DOI: 10.3390/nu13082691] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 07/28/2021] [Accepted: 07/29/2021] [Indexed: 11/16/2022] Open
Abstract
The United States Department of Agriculture (USDA) National School Lunch and Breakfast Programs are critical for the health and food security of U.S. schoolchildren, but access to these programs was disrupted by COVID-19 pandemic-related school closures in spring 2020. While temporary policy changes to the programs enabled school food authorities (SFAs) to pivot towards distributing meals throughout their communities instead of within school buildings, SFAs faced complex challenges during COVID-19 with minimal external support. This mixed methods study investigates the implementation and financial challenges experienced by twelve of the largest urban SFAs in the U.S. during COVID-19. We conducted semi-structured interviews with SFA leaders and analyzed alongside quantitative financial data. We found that SFAs reconfigured their usual operations with nearly no preparation time while simultaneously trying to keep staff from contracting COVID-19, accommodate stakeholders with sometimes competing priorities, and remain financially solvent. Because student participation was much lower than during regular times, and revenue is tied to the number of meals served, SFAs saw drastic decreases in revenue even as they carried regular operating costs. For future crises, disaster preparedness plans that help SFAs better navigate the switch to financially viable community distribution methods are needed.
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Affiliation(s)
- Erica L. Kenney
- Department of Nutrition, Harvard TH Chan School of Public Health, 665 Huntington Ave, Boston, MA 02115, USA;
- Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, 677 Huntington Ave, Boston, MA 02115, USA
- Correspondence: ; Tel.: +1-617-384-8722
| | - Caroline G. Dunn
- Department of Health Policy and Management, Harvard TH Chan School of Public Health, 677 Huntington Ave, Boston, MA 02115, USA; (C.G.D.); (J.D.); (Y.S.); (S.N.B.)
- Health Resources and Services Administration, U.S. Department of Health and Human Services, Washington, DC 20201, USA
| | - Rebecca S. Mozaffarian
- Department of Nutrition, Harvard TH Chan School of Public Health, 665 Huntington Ave, Boston, MA 02115, USA;
| | - Jane Dai
- Department of Health Policy and Management, Harvard TH Chan School of Public Health, 677 Huntington Ave, Boston, MA 02115, USA; (C.G.D.); (J.D.); (Y.S.); (S.N.B.)
| | - Katie Wilson
- Urban School Food Alliance, 1612 K Street NW, Suite 200, Washington, DC 20006, USA; (K.W.); (J.W.)
| | - Jeremy West
- Urban School Food Alliance, 1612 K Street NW, Suite 200, Washington, DC 20006, USA; (K.W.); (J.W.)
| | - Ye Shen
- Department of Health Policy and Management, Harvard TH Chan School of Public Health, 677 Huntington Ave, Boston, MA 02115, USA; (C.G.D.); (J.D.); (Y.S.); (S.N.B.)
| | - Sheila Fleischhacker
- Georgetown University Law Center, 600 New Jersey Ave, NW, Washington, DC 20001, USA;
| | - Sara N. Bleich
- Department of Health Policy and Management, Harvard TH Chan School of Public Health, 677 Huntington Ave, Boston, MA 02115, USA; (C.G.D.); (J.D.); (Y.S.); (S.N.B.)
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Nogueira T, Ferreira RJ, Dias da Silva V, Liñan Pinto M, Damas C, Sousa J. Analytical Assessment and Nutritional Adequacy of School Lunches in Sintra's Public Primary Schools. Nutrients 2021; 13:1946. [PMID: 34198879 PMCID: PMC8228420 DOI: 10.3390/nu13061946] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 05/27/2021] [Accepted: 06/01/2021] [Indexed: 11/19/2022] Open
Abstract
School meals present several cost benefits overtime at the short, medium, and long term for individuals and society. This cross-sectional study aims to analyse the nutritional composition and evaluate the adequacy of school lunches. One hundred and fifty-eight samples were collected and analysed from 10 primary schools in Sintra's municipality, served during one week. On average, energy (27.7% daily energetic requirements) and carbohydrate (48.1%) contents did not reach the reference values, and the content of protein (19.5%) exceeded the reference value (p < 0.05). The mean total fat (28.8%) and saturated fatty acids (5.4%) content complied with the recommendations. The mean salt (1.7 g) and dietary fibre (8.3 g) content exceeded the reference value but did not differ significantly from the recommendations. Addressing school canteens is crucial, not only in a nutritional approach, but also as an opportunity to achieve healthier, sustainable, and accessible food systems, aligned with the Sustainable Development Goals 2030. We highlighted the importance of evaluating evidence-based practices and disseminated practice-based evidence regarding the adequacy of school lunches.
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Affiliation(s)
- Telma Nogueira
- Laboratório de Nutrição, Faculdade de Medicina, Universidade de Lisboa, 1649-028 Lisboa, Portugal; (V.D.d.S.); (M.L.P.); (J.S.)
- Instituto de Saúde Ambiental, Faculdade de Medicina, Universidade de Lisboa, 1649-028 Lisboa, Portugal
| | - Raquel J. Ferreira
- Câmara Municipal de Sintra, 2714-501 Sintra, Portugal;
- Escola Superior de Tecnologia da Saúde de Lisboa, Instituto Politécnico de Lisboa, 1990-096 Lisboa, Portugal;
| | - Vitória Dias da Silva
- Laboratório de Nutrição, Faculdade de Medicina, Universidade de Lisboa, 1649-028 Lisboa, Portugal; (V.D.d.S.); (M.L.P.); (J.S.)
| | - Mariana Liñan Pinto
- Laboratório de Nutrição, Faculdade de Medicina, Universidade de Lisboa, 1649-028 Lisboa, Portugal; (V.D.d.S.); (M.L.P.); (J.S.)
| | - Carlos Damas
- Escola Superior de Tecnologia da Saúde de Lisboa, Instituto Politécnico de Lisboa, 1990-096 Lisboa, Portugal;
- Direção de Qualidade e Ambiente, Indústria e Comércio Alimentar, S.A, 1000-203 Lisboa, Portugal
| | - Joana Sousa
- Laboratório de Nutrição, Faculdade de Medicina, Universidade de Lisboa, 1649-028 Lisboa, Portugal; (V.D.d.S.); (M.L.P.); (J.S.)
- Instituto de Saúde Ambiental, Faculdade de Medicina, Universidade de Lisboa, 1649-028 Lisboa, Portugal
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Adams EL, Raynor HA, Thornton LM, Mazzeo SE, Bean MK. Nutrient Intake During School Lunch in Title I Elementary Schools With Universal Free Meals. HEALTH EDUCATION & BEHAVIOR 2021; 49:118-127. [PMID: 34024168 DOI: 10.1177/10901981211011936] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The National School Lunch Program (NSLP) provides >30 million meals to children daily; however, the specific nutrient composition of NSLP-selected and consumed meals for students from lower income and racial/ethnic minoritized backgrounds is unknown. AIMS To quantify the nutrients in school lunch selection and consumption among students participating in the NSLP and compare these values to nutrient recommendations. METHOD Students (1st-5th graders; 98.6% from racial/ethnic minoritized backgrounds; 92.5% NSLP participation) from six Title I elementary schools serving universal free meals participated. Digital images of students' lunch meal selection and consumption were obtained (n = 1,102 image pairs). Plate waste analyses quantified portions consumed. Nutrient composition of students' lunch selection and consumption were calculated and compared with the 2010 Healthy Hunger-Free Kids Act and 2009 Institute of Medicine recommendations. RESULTS Most lunches selected (59%-97%) met recommendations for all nutrients except for total calories (23%), vitamin C (46%), and dietary fiber (48%). Based on lunch consumption, most students' lunches met recommendations for sodium (98%), protein (55%), calories from fat (82%), and saturated fat (89%); however, few met recommendations for total calories (5%), calcium (8%), iron (11%), vitamin A (18%), vitamin C (16%), and fiber (7%). DISCUSSION Meals selected met most nutrient recommendations for the majority of children; yet overall consumption patterns reflect suboptimal nutrient intake. CONCLUSION Meals served under the NSLP policy mandates align with recommended nutrient patterns, highlighting the importance of maintaining these standards. Strategies to optimize children's intake of nutrient-rich portions of these meals are needed to optimize policy impact.
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Affiliation(s)
| | | | - Laura M Thornton
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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43
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Dietz WH. Better Diet Quality in the Healthy Hunger-Free Kids Act and WIC Package Reduced Childhood Obesity. Pediatrics 2021; 147:peds.2020-032375. [PMID: 33658320 DOI: 10.1542/peds.2020-032375] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/12/2020] [Indexed: 11/24/2022] Open
Affiliation(s)
- William H Dietz
- Sumner M. Redstone Global Center for Prevention and Wellness, Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia
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44
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The Influence of Eating at Home on Dietary Diversity and Airway Inflammation in Portuguese School-Aged Children. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18052646. [PMID: 33808006 PMCID: PMC7967357 DOI: 10.3390/ijerph18052646] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 02/21/2021] [Accepted: 02/26/2021] [Indexed: 11/26/2022]
Abstract
Considering the negative impact of a lack of dietary diversity on children’s nutritional status, we aimed to describe dietary variety according to eating at home frequency and assessed its association with respiratory outcomes in school-aged children. This cross-sectional study included 590 children (49% girls) aged 7 to 12 years from 20 public schools located in city of Porto, Portugal. Daily frequency of eating at home groups were calculated and dietary diversity was calculated using a 10-food group score from a 24 h recall questionnaire. Spirometry and exhaled nitric oxide levels (eNO; <35 and ≥35 ppb) were assessed. The comparison of diet diversity according to the groups was performed by ANOVA and ANCOVA. The association between dietary diversity and respiratory outcomes was examined using regression models. In multivariate analysis, children in the highest group of eating at home episodes (≥4 occasions) obtained the lowest dietary diversity mean score, while the lowest group (<2) had the highest mean score (p-value 0.026). After adjustment for confounders, higher diet diversity (≥5 food groups) significantly decreased the odds of having an eNO ≥35. Diet diversity might decrease the chance of airway inflammation among children. However, having more eating episodes at home could be a barrier to a more diverse diet.
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45
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Fox MK, Gearan EC, Schwartz C. Added Sugars in School Meals and the Diets of School-Age Children. Nutrients 2021; 13:471. [PMID: 33573299 PMCID: PMC7911531 DOI: 10.3390/nu13020471] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 01/18/2021] [Accepted: 01/20/2021] [Indexed: 01/06/2023] Open
Abstract
Research is limited on added sugars in school meals and children's dietary intakes after the 2015-2020 Dietary Guidelines for Americans (DGA) recommended that added sugars be limited to less than 10% of total calories. This analysis uses data from the School Nutrition and Meal Cost Study (SNMCS) to examine levels of added sugars in: (1) school meals and (2) children's dietary intakes at breakfast, lunch, and over 24 h on school days. SNMCS data were collected in the 2014-2015 school year after updated nutrition standards for school meals were implemented. Most schools exceeded the DGA limit for added sugars at breakfast (92%), while 69% exceeded the limit at lunch. The leading source of added sugars in school meals (both breakfasts and lunches) was flavored skim milk. More than 62% of children consumed breakfasts that exceeded the DGA limit, and almost half (47%) consumed lunches that exceeded the limit. Leading sources of added sugars in the breakfasts consumed by children were sweetened cold cereals and condiments and toppings; leading sources of added sugars in children's lunches were flavored skim milk and cake. Over 24 h, 63% of children exceeded the DGA limit. These findings show that school meals and children's dietary intakes are high in added sugars relative to the DGA limit and provide insights into the types of foods that should be targeted in order to decrease levels of added sugars.
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Affiliation(s)
- Mary Kay Fox
- Mathematica, 955 Massachusetts Avenue, Suite 801, Cambridge, MA 02139, USA;
| | | | - Colin Schwartz
- Center for Science in the Public Interest, 1220 L Street NW, Suite 300, Washington, DC 20005, USA;
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46
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Bardin S, Gola AA. Analyzing the Association between Student Weight Status and School Meal Participation: Evidence from the School Nutrition and Meal Cost Study. Nutrients 2020; 13:nu13010017. [PMID: 33374590 PMCID: PMC7822417 DOI: 10.3390/nu13010017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 12/17/2020] [Accepted: 12/20/2020] [Indexed: 11/16/2022] Open
Abstract
Childhood obesity remains a pressing public health concern. Children consume a substantial amount of their caloric intake while in school, making the passage of the Healthy Hunger-Free Kids Act (HHFKA) in 2010 and the subsequent improvements to the school meal standards a key policy change. Using data from the School Nutrition and Meal Cost Study, this paper seeks to re-examine the association between students' (N = 1963) weight status and participation in the National School Lunch Program (NSLP) and School Breakfast Program (SBP) since the implementation of these policy changes to determine whether, and how, this relationship has changed. After controlling for a wide array of student characteristics and school-level fixed effects, findings from the multivariate regression analyses indicate that usual participation in the school meal programs has no clear association with students' weight status, which contradicts findings from earlier studies conducted prior to the passage of the HHFKA. These findings are discussed in relation to changes in the demographic composition of usual NSLP participants over time.
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Affiliation(s)
- Sarah Bardin
- Mathematica, 955 Massachusetts Avenue, Suite 801, Cambridge, MA 02139, USA
- Correspondence:
| | - Alice Ann Gola
- US Department of Agriculture, Food and Nutrition Service (FNS), 1320 Braddock Place, Alexandria, VA 22314, USA;
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Gearan EC, Monzella K, Jennings L, Fox MK. Differences in Diet Quality between School Lunch Participants and Nonparticipants in the United States by Income and Race. Nutrients 2020; 12:E3891. [PMID: 33352695 PMCID: PMC7765856 DOI: 10.3390/nu12123891] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 12/12/2020] [Accepted: 12/15/2020] [Indexed: 12/14/2022] Open
Abstract
Prior research has shown that participation in the United States' National School Lunch Program (NSLP) is associated with consuming higher-quality lunches and diets overall, but little is known about differences by income and race/ethnicity. This analysis used 24 h dietary recall data from the School Nutrition and Meal Cost Study to examine how NSLP participation affects the diet quality of students in different income and racial/ethnic subgroups. Diet quality at lunch and over 24 h was assessed using the Healthy Eating Index (HEI)-2010, where higher scores indicate higher-quality intakes. HEI-2010 scores for NSLP participants and nonparticipants in each subgroup were estimated, and two-tailed t-tests were conducted to determine whether participant-nonparticipant differences in scores within each subgroup were statistically significant. NSLP participants' lunches received significantly higher total HEI-2010 scores than those of nonparticipants for lower-income, higher-income, non-Hispanic White, and non-Hispanic Black students, suggesting that participating in the NSLP helps most students consume healthier lunches. These significantly higher total scores for participants' lunch intakes persisted over 24 h for higher-income students and non-Hispanic White students but not for lower-income students or students of other races/ethnicities. For NSLP participants in all subgroups, the nutritional quality of their 24 h intakes was much lower than at lunch, suggesting that the positive influence of the NSLP on their overall diet quality was negatively influenced by foods consumed the rest of the day (outside of lunch).
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Affiliation(s)
- Elizabeth C. Gearan
- Mathematica Policy Research Inc., 955 Massachusetts Avenue, Suite 801, Cambridge, MA 02139, USA; (K.M.); (L.J.); (M.K.F.)
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Poole MK, Musicus AA, Kenney EL. Alignment Of US School Lunches With The EAT-Lancet Healthy Reference Diet's Standards For Planetary Health. Health Aff (Millwood) 2020; 39:2144-2152. [PMID: 33284707 PMCID: PMC8318070 DOI: 10.1377/hlthaff.2020.01102] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
By feeding more than thirty million schoolchildren daily, the National School Lunch Program's food offerings substantially influence a contributing factor to climate change: US food production methods. Modifying school lunch nutrition standards could be a policy strategy to reduce climate change while promoting human health. To estimate how school lunches could be adjusted to encourage both outcomes, we compared the composition of school lunches with the EAT-Lancet Commission's healthy reference diet science-based benchmarks for reducing food system impacts on climate change. Analyzing more than 5,000 lunches served in the US during school year 2014-15, we found that they exceeded EAT-Lancet targets for dairy, fruit, refined grains, red meat, and starchy vegetables while containing insufficient whole grains, legumes, vegetables, and nuts. In addition, estimated food costs were higher for school lunches than for lunches meeting EAT-Lancet targets. Our findings suggest that redesigning school lunches could provide high-quality nutrition while benefiting the environment and reducing food costs.
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Affiliation(s)
- Mary Kathryn Poole
- Mary Kathryn Poole is a PhD student in population health sciences in the Department of Nutrition, Harvard T. H. Chan School of Public Health, in Boston, Massachusetts
| | - Aviva A Musicus
- Aviva A. Musicus is a postdoctoral research fellow in the Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health
| | - Erica L Kenney
- Erica L. Kenney is an assistant professor of public health nutrition in the Departments of Nutrition and Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health
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