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Patel AI, Schmidt LA, McCulloch CE, Blacker LS, Cabana MD, Brindis CD, Ritchie LD. Effectiveness of a School Drinking Water Promotion and Access Program for Overweight Prevention. Pediatrics 2023; 152:e2022060021. [PMID: 37545466 PMCID: PMC10471511 DOI: 10.1542/peds.2022-060021] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/05/2023] [Indexed: 08/08/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Drinking water promotion and access shows promise for preventing weight gain. This study evaluated the impact of Water First, a school-based water promotion and access intervention on changes in overweight. METHODS Low-income, ethnically diverse elementary schools in California's Bay Area were cluster-randomized to intervention and control groups. Water First includes classroom lessons, water stations, and schoolwide water promotion over 1 school year. The primary outcome was overweight prevalence (BMI-for-age-and-sex ≥85th percentile). Students (n = 1249) in 56 fourth-grade classes in 18 schools (9 intervention, 9 control) from 2016 to 2019 participated in evaluation at baseline, 7, and 15 months. Data collection was interrupted in 8 additional recruited schools because of coronavirus disease 2019. RESULTS Of 1262 students from 18 schools, 1249 (47.4% girls; mean [SD] age, 9.6 [0.4] years; 63.4% Hispanic) were recruited. From baseline to 7 months, there was no significant difference in changes in overweight prevalence in intervention schools (-0.2%) compared to control schools (-0.4%) (adjusted ratio of odds ratios [ORs]: 0.7 [confidence interval (CI): 0.2-2.9] P = 0.68). From baseline to 15-months, increases in overweight prevalence were significantly greater in control schools (3.7%) compared to intervention schools (0.5%). At 15 months, intervention students had a significantly lower change in overweight prevalence (adjusted ratio of ORs: 0.1 [CI: 0.03-0.7] P = .017) compared to control students. There were no intervention effects for obesity prevalence. CONCLUSIONS Water First prevented increases in the prevalence of overweight, but not obesity, in elementary school students.
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Affiliation(s)
- Anisha I. Patel
- Department of Pediatrics, Stanford University, Palo Alto, California
| | - Laura A. Schmidt
- Philip R. Lee Institute for Health Policy Studies
- Department of Humanities and Social Sciences
| | | | - Lauren S. Blacker
- Department of Pediatrics, Stanford University, Palo Alto, California
| | - Michael D. Cabana
- Department of Pediatrics, Division of General Pediatrics, Albert Einstein College of Medicine, Children’s Hospital at Montefiore, Bronx, New York
| | - Claire D. Brindis
- Philip R. Lee Institute for Health Policy Studies
- Division of Adolescent and Young Adult Health, Department of Pediatrics, University of California, San Francisco, California
| | - Lorrene D. Ritchie
- Nutrition Policy Institute, University of California Division of Agriculture and Natural Resources, Davis, California
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Espinosa PR, Verney SP. The Underutilization of Community-based Participatory Research in Psychology: A Systematic Review. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2021; 67:312-326. [PMID: 33165973 PMCID: PMC8106689 DOI: 10.1002/ajcp.12469] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
Traditional non-participatory research methodologies have struggled to address the needs of multicultural populations in the United States (U.S.). Community-based participatory research (CBPR) is a research paradigm offering a unique opportunity for culturally appropriate research and improving health equity. CBPR is an equitable, strength-based approach involving all stakeholders throughout the research process. We investigate the field of psychology's utilization of CBPR as an approach for working with multicultural populations to collaboratively address relevant and impactful research questions. A total of 1912 CBPR-related articles, from 2004 to 2014, were identified using PsycINFO, PubMed, and CINAHL Complete databases. Of these, approximately 16% (n = 311) met our criteria for psychology-related CBPR articles accounting for a negligible amount (<1%) of peer-reviewed publications in mainstream psychological journals during the same time period. Among U.S. psychology-related CBPR articles, 86% focused on multicultural and marginalized populations. Prominent topics of investigation included physical health, mental and behavioral health, and theoretical or methodological articles. Features of publications, including authors' training, types of journals, study populations, and topics under investigation, were explored for all 1912 publications. Findings highlight an opportunity for further utilization of CBPR within psychology, with key implications for health equity. Recommendations for increasing CBPR uptake within the discipline are also offered.
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Affiliation(s)
- Patricia Rodriguez Espinosa
- Office of Community Engagement, Stanford University School of Medicine, Palo Alto, CA, USA
- Psychology Department, University of New Mexico, Albuquerque, NM, USA
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Steven P. Verney
- Psychology Department, University of New Mexico, Albuquerque, NM, USA
- Psychology Clinical Neuroscience Center, University of New Mexico, Albuquerque, NM, USA
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Tatum KL, Valenzuela JM, Amirniroumand RA, Brochu PM. Parents' Perceptions of and Responses to School-Based Body Mass Index Screening Programs-A Systematic Review. THE JOURNAL OF SCHOOL HEALTH 2021; 91:331-344. [PMID: 33655546 DOI: 10.1111/josh.13003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 11/11/2020] [Accepted: 11/24/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND Evidence for the effectiveness of state-mandated body mass index (BMI) screening programs in the United States has been inconclusive, and potential unintended consequences of the programs have been debated. The present review aims to understand parents' perceptions of and responses to school-based BMI screening, and to highlight racial/ethnic differences. METHODS We systematically identified studies published January 2003-May 2019 examining parent and/or youth perceptions of and/or responses to US school-based BMI screening. RESULTS A total of 16 studies were included in the review. Studies suggested that while parents largely found BMI screening helpful, they held concerns regarding stigma, lack of privacy, and unhealthy behaviors and attitudes resulting from school-based screening. Furthermore, parents did not frequently follow-up with health care providers, although they reported some healthy behavior changes. CONCLUSIONS Our review highlights existing parent perceptions of school-based BMI screening including the potential for healthy behavior change and important concerns regarding weight-stigma and disturbed eating attitudes/behaviors. Additionally, racial/ethnic differences in screening preferences and experiences were found. Limitations of existing literature included a need to understand youths' experiences and a lack of standardized, reliable outcomes research. Implications for future research and the role of parents, schools, and providers are discussed.
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Affiliation(s)
- Kristina L Tatum
- Doctoral Student, , Nova Southeastern University, 3301 College Avenue, Fort Lauderdale, Florida, 33314., USA
| | - Jessica M Valenzuela
- Associate Professor, , Nova Southeastern University, 3301 College Avenue, Fort Lauderdale, Florida, 33314., USA
| | - Roya A Amirniroumand
- Doctoral Student, , Nova Southeastern University, 3301 College Avenue, Fort Lauderdale, Florida, 33314., USA
| | - Paula M Brochu
- Assistant Professor, , Nova Southeastern University, 3301 College Avenue, Fort Lauderdale, Florida, 33314., USA
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4
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A systematic review of existing observational tools to measure the food and physical activity environment in schools. Health Place 2020; 66:102388. [DOI: 10.1016/j.healthplace.2020.102388] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 05/17/2020] [Accepted: 06/23/2020] [Indexed: 01/18/2023]
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Ulijaszek SJ, Pentecost M, Marcus C, Karpe F, Frühbeck G, Nowicka P. Inequality and childhood overweight and obesity: a commentary. Pediatr Obes 2017; 12:195-202. [PMID: 26990034 DOI: 10.1111/ijpo.12128] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Accepted: 02/17/2016] [Indexed: 02/02/2023]
Abstract
Statements on childhood overweight and obesity (COO) have focused on different avenues for prevention and treatment, critical stages of the life cycle, including pregnancy and lactation, individual, family, school and community-based interventions, multidisciplinary family programmes and multicomponent interventions. This commentary is concerned with the less-addressed relationship between COO and inequality. It describes current global patterns of inequality and COO and the ways in which those inequalities are linked to COO at micro-level, meso-level and macro-level. It then describes current programmatic approaches for COO inequality, preventive and medical, and considers important pitfalls in the framing of the problem of COO and inequality. It ends with describing how childhood and adolescent overweight and obesity prevention and treatment programmes might be formulated within broader socio-political frameworks to influence outcomes.
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Affiliation(s)
- S J Ulijaszek
- School of Anthropology, University of Oxford, Oxford, UK
| | - M Pentecost
- School of Anthropology, University of Oxford, Oxford, UK
| | - C Marcus
- Karolinska Institutet, Stockholm, Sweden
| | - F Karpe
- Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford, UK
| | - G Frühbeck
- Department of Endocrinology and Nutrition, Clinica Universidad de Navarra, CIBEROBN, IdiSNA, Pamplona, Spain
| | - P Nowicka
- Karolinska Institutet, Stockholm, Sweden.,Department of Food, Nutrition and Dietetics, Uppsala University, Uppsala, Sweden
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Bogart LM, Elliott MN, Cowgill BO, Klein DJ, Hawes-Dawson J, Uyeda K, Schuster MA. Two-Year BMI Outcomes From a School-Based Intervention for Nutrition and Exercise: A Randomized Trial. Pediatrics 2016; 137:peds.2015-2493. [PMID: 27244788 PMCID: PMC4845865 DOI: 10.1542/peds.2015-2493] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/03/2016] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES This study examined the long-term effects on BMI of a randomized controlled trial of Students for Nutrition and Exercise, a 5-week, middle school-based obesity prevention intervention combining school-wide environmental changes, encouragement to eat healthy school cafeteria foods, and peer-led education and marketing. METHODS We randomly selected schools from the Los Angeles Unified School District and assigned 5 to the intervention group and 5 to a wait-list control group. Of the 4022 seventh-graders across schools, a total of 1368 students had their height and weight assessed at baseline and 2 years' postintervention. RESULTS A multivariable linear regression was used to predict BMI percentile at ninth grade by using BMI percentile at seventh grade, school indicators, and sociodemographic characteristics (child gender, age, Latino race/ethnicity, US-born status, and National School Lunch Program eligibility [as a proxy for low-income status]). Although the Students for Nutrition and Exercise intervention did not exhibit significant effects on BMI percentile overall, intervention students who were classified as obese at baseline (in seventh grade) showed significant reductions in BMI percentile in ninth grade (b = -2.33 percentiles; SE, 0.83; P = .005) compared with control students. This outcome translated into ∼9 pounds (∼4.1 kg) lower expected body weight after 2 years for an obese student in the intervention school at the mean height and age of the sample at baseline. CONCLUSIONS Multilevel school-based interventions can have long-term effects on BMI among students who are obese. Future research should examine the mechanisms by which school-based obesity interventions can affect BMI over time.
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Affiliation(s)
- Laura M. Bogart
- Division of General Pediatrics, Department of Medicine, Boston Children’s Hospital, Boston, Massachusetts;,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts;,RAND Corporation, Santa Monica, California
| | | | - Burton O. Cowgill
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, California; and
| | - David J. Klein
- Division of General Pediatrics, Department of Medicine, Boston Children’s Hospital, Boston, Massachusetts;,RAND Corporation, Santa Monica, California
| | | | - Kimberly Uyeda
- Community Partners and Medi-Cal Programs, Student Health and Human Services, Los Angeles Unified School District, Los Angeles, California
| | - Mark A. Schuster
- Division of General Pediatrics, Department of Medicine, Boston Children’s Hospital, Boston, Massachusetts;,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
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Dinour LM. Conflict and compromise in public health policy: analysis of changes made to five competitive food legislative proposals prior to adoption. HEALTH EDUCATION & BEHAVIOR 2016; 42:76S-86S. [PMID: 25829121 DOI: 10.1177/1090198114568303] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Competitive foods in schools have historically been scrutinized for their ubiquity and poor nutritional quality, leading many states to enact legislation limiting the availability and accessibility of these items. Evaluations of these policy approaches show their promise in improving the healthfulness of school food environments, considered an important strategy for reducing childhood obesity. Yet little is known about the decision-making processes by which such legislation is formed and adopted. Using a comparative case study design, this study describes and analyzes the policy formation processes surrounding five state-level competitive food bills introduced in 2009-2010. Data for each case were drawn from multiple key informant interviews and document reviews. Case studies were conducted, analyzed, and written independently using a standard protocol and were subsequently compared for recurring and unique themes. Abbreviated case studies and summary tables are provided. Results indicate that bill cost is a major barrier to achieving strong, health-promoting policy change. Additionally, findings reveal that supporters of stronger competitive food policies often concede to changes that weaken a bill in order to neutralize opposition and achieve stakeholder buy-in. These challenges suggest that continued research on the development, implementation, and evaluation of public health policies can contribute to the advancement of new strategies for effective health promotion.
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Iyer SP, Jones A, Talamantes E, Barnert ES, Kanzaria HK, Detz A, Daskivich TJ, Jones L, Ryan GW, Mahajan AP. Improving Health Care for the Future Uninsured in Los Angeles County: A Community-Partnered Dialogue. Ethn Dis 2015; 25:487-94. [PMID: 26675541 DOI: 10.18865/ed.25.4.487] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To understand the health care access issues faced by Los Angeles (LA) County's uninsured and residually uninsured after implementation of the Affordable Care Act (ACA) and to identify potential solutions using a community-partnered dialogue. DESIGN Qualitative study using a community-partnered participatory research framework. SETTING Community forum breakout discussion. DISCUSSANTS Representatives from LA County health care agencies, community health care provider organizations, local community advocacy and service organizations including uninsured individuals, and the county school district. MAIN OUTCOME MEASURES Key structural and overarching value themes identified through community-partnered pile sort, c-coefficients measuring overlap between themes. RESULTS Five overarching value themes were identified - knowledge, trust, quality, partnership, and solutions. Lack of knowledge and misinformation were identified as barriers to successful enrollment of the eligible uninsured and providing health care to undocumented individuals. Discussants noted dissatisfaction with the quality of traditional sources of health care and a broken cycle of trust and disengagement. They also described inherent trust by the uninsured in "outsider" community-based providers not related to quality. CONCLUSIONS Improving health care for the residually uninsured after ACA implementation will require addressing dissatisfaction in safety-net providers, disseminating knowledge and providing health care through trusted nontraditional sources, and using effective and trusted partnerships between community and health care agencies with mutual respect. Community-academic partnerships can be a trusted conduit to discuss issues related to the health care of vulnerable populations.
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Affiliation(s)
- Sharat P Iyer
- 1. Robert Wood Johnson Foundation Clinical Scholars® at the University of California, Los Angeles ; 2. VISN3 Mental Illness Research, Education, and Clinical Center, James J. Peters VA Medical Center, Bronx, NY ; 3. Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York
| | - Andrea Jones
- 4. Charles R. Drew University of Medicine and Science, Los Angeles ; 5. Healthy African American Families, Los Angeles
| | - Efrain Talamantes
- 1. Robert Wood Johnson Foundation Clinical Scholars® at the University of California, Los Angeles ; 6. National Research Service Award GIM Fellowship in Primary Care & Health Services Research, University of California, Los Angeles
| | - Elizabeth S Barnert
- 1. Robert Wood Johnson Foundation Clinical Scholars® at the University of California, Los Angeles
| | - Hemal K Kanzaria
- 1. Robert Wood Johnson Foundation Clinical Scholars® at the University of California, Los Angeles ; 7. Department of Pediatrics, David Geffen School of Medicine at the University of California, Los Angeles ; 8. VA Greater Los Angeles Healthcare System
| | - Alissa Detz
- 6. National Research Service Award GIM Fellowship in Primary Care & Health Services Research, University of California, Los Angeles
| | - Timothy J Daskivich
- 1. Robert Wood Johnson Foundation Clinical Scholars® at the University of California, Los Angeles
| | - Loretta Jones
- 4. Charles R. Drew University of Medicine and Science, Los Angeles ; 5. Healthy African American Families, Los Angeles
| | - Gery W Ryan
- 10. Los Angeles County Department of Health Services
| | - Anish P Mahajan
- 10. Los Angeles County Department of Health Services ; 11. Division of General Internal Medicine and Health Service Research, University of California, Los Angeles
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Bogart LM, Cowgill BO, Elliott MN, Klein DJ, Hawes-Dawson J, Uyeda K, Elijah J, Binkle DG, Schuster MA. A randomized controlled trial of students for nutrition and eXercise: a community-based participatory research study. J Adolesc Health 2014; 55:415-22. [PMID: 24784545 PMCID: PMC4143532 DOI: 10.1016/j.jadohealth.2014.03.003] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2013] [Revised: 03/04/2014] [Accepted: 03/06/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE To conduct a randomized controlled trial of Students for Nutrition and eXercise, a 5-week middle school-based obesity-prevention intervention combining school-wide environmental changes, multimedia, encouragement to eat healthy school cafeteria foods, and peer-led education. METHODS We randomly selected schools (five intervention, five waitlist control) from the Los Angeles Unified School District. School records were obtained for number of fruits and vegetables served, students served lunch, and snacks sold per attending student, representing an average of 1,515 students (SD = 323) per intervention school and 1,524 students (SD = 266) per control school. A total of 2,997 seventh-graders (75% of seventh-graders across schools) completed pre- and postintervention surveys assessing psychosocial variables. Consistent with community-based participatory research principles, the school district was an equal partner, and a community advisory board provided critical input. RESULTS Relative to control schools, intervention schools showed significant increases in the proportion of students served fruit and lunch and a significant decrease in the proportion of students buying snacks at school. Specifically, the intervention was associated with relative increases of 15.3% more fruits served (p = .006), 10.4% more lunches served (p < .001), and 11.9% fewer snacks sold (p < .001) than would have been expected in its absence. Pre-to-post intervention, intervention school students reported more positive attitudes about cafeteria food (p = .02) and tap water (p = .03), greater obesity-prevention knowledge (p = .006), increased intentions to drink water from the tap (p = .04) or a refillable bottle (p = .02), and greater tap water consumption (p = .04) compared with control school students. CONCLUSIONS Multilevel school-based interventions may promote healthy adolescent dietary behaviors.
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Affiliation(s)
- Laura M. Bogart
- Division of General Pediatrics, Department of Medicine, Boston Children's Hospital,Department of Pediatrics, Harvard Medical School
| | - Burton O. Cowgill
- UCLA/RAND Prevention Research Center, UCLA Fielding School of Public Health
| | | | - David J. Klein
- Division of General Pediatrics, Department of Medicine, Boston Children's Hospital
| | | | - Kimberly Uyeda
- Student Medical Services, Los Angeles Unified School District
| | - Jacinta Elijah
- UCLA/RAND Prevention Research Center, UCLA Fielding School of Public Health
| | | | - Mark A. Schuster
- Division of General Pediatrics, Department of Medicine, Boston Children's Hospital,Department of Pediatrics, Harvard Medical School
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Patel AI, Hecht K, Hampton KE, Grumbach JM, Braff-Guajardo E, Brindis CD. Tapping into water: key considerations for achieving excellence in school drinking water access. Am J Public Health 2014; 104:1314-9. [PMID: 24832141 PMCID: PMC4056210 DOI: 10.2105/ajph.2013.301797] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2013] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined free drinking water access in schools. METHODS We conducted cross-sectional interviews with administrators from 240 California public schools from May to November 2011 to examine the proportion of schools that met excellent water access criteria (i.e., location, density, type, maintenance, and appeal of water sources), school-level characteristics associated with excellent water access, and barriers to improvements. RESULTS No schools met all criteria for excellent water access. High schools and middle schools had lower fountain:student ratios than elementary schools (odds ratio [OR] = 0.06; 95% confidence interval [CI] = 0.02, 0.20; OR = 0.30, 95% CI = 0.12, 0.70). Rural schools were more likely to offer a nonfountain water source than city schools (OR = 5.0; 95% CI = 1.74, 14.70). Newer schools were more likely to maintain water sources than older schools (OR = 0.98; 95% CI = 0.97, 1.00). Schools that offered free water in food service areas increased from pre- to postimplementation of California's school water policy (72%-83%; P < .048). Barriers to improving school water included cost of programs and other pressing concerns. CONCLUSIONS Awareness of the benefits related to school drinking water provision and funding may help communities achieve excellence in drinking water access.
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Affiliation(s)
- Anisha I Patel
- At the time of the study, Anisha I. Patel, Jacob M. Grumbach, and Claire D. Brindis were with the Division of Pediatrics and Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco. Kenneth Hecht and Ellen Braff-Guajardo were with California Food Policy Advocates, Oakland. Karla E. Hampton was with Changelab Solutions, Oakland
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Patel AI, Bogart LM, Klein DJ, Cowgill B, Uyeda KE, Hawes-Dawson J, Schuster MA. Middle school student attitudes about school drinking fountains and water intake. Acad Pediatr 2014; 14:471-7. [PMID: 25169158 PMCID: PMC4193898 DOI: 10.1016/j.acap.2014.05.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Revised: 05/19/2014] [Accepted: 05/23/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To describe middle school student attitudes about school drinking fountains, investigate whether such attitudes are associated with intentions to drink water at school, and determine how intentions relate to overall water intake. METHODS Students (n = 3211) in 9 California middle schools completed surveys between 2009 and 2011. We used multivariate linear regression, adjusting for school sociodemographic characteristics, to examine how attitudes about fountains (5-point scale; higher scores indicating more positive attitudes) were associated with intentions to drink water at school and how intentions to drink water at school were related to overall water intake. RESULTS Mean age of students was 12.3 (SD = 0.7) years; 75% were Latino, 89% low income, and 39% foreign born. Fifty-two percent reported lower than recommended overall water intake (<3 glasses/day), and 30% reported that they were unlikely or extremely unlikely to drink water at school. Fifty-nine percent reported that school fountains were unclean, 48% that fountain water does not taste good, 33% that fountains could make them sick, 31% that it was not okay to drink from fountains, and 24% that fountain water is contaminated. In adjusted analyses, attitudes about school drinking fountains were related to intentions to drink water at school (β = 0.41; P < .001); intentions to drink water at school were also associated with overall water intake (β = 0.20; P < .001). CONCLUSIONS Students have negative attitudes about school fountains. To increase overall water intake, it may be important to promote and improve drinking water sources not only at school but also at home and in other community environments.
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Affiliation(s)
- Anisha I. Patel
- Division of General Pediatrics, University of California, San Francisco, CA
| | - Laura M. Bogart
- Division of General Pediatrics, Boston Children’s Hospital Boston, Boston, MA,Harvard School of Public Health, Boston, MA
| | - David J. Klein
- Division of General Pediatrics, Boston Children’s Hospital Boston, Boston, MA
| | - Burt Cowgill
- Department of Health Policy and Management, Fielding School of Public Health University of California, Los Angeles, Los Angeles, CA
| | - Kimberly E. Uyeda
- Student Health and Human Services, Los Angeles Unified School District, Los Angeles, CA
| | | | - Mark A. Schuster
- Division of General Pediatrics, Boston Children’s Hospital Boston, Boston, MA,Harvard School of Public Health, Boston, MA
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Patel AI, Hampton KE. Encouraging consumption of water in school and child care settings: access, challenges, and strategies for improvement. Am J Public Health 2011; 101:1370-9. [PMID: 21680941 DOI: 10.2105/ajph.2011.300142] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Children and adolescents are not consuming enough water, instead opting for sugar-sweetened beverages (sodas, sports and energy drinks, milks, coffees, and fruit-flavored drinks with added sugars), 100% fruit juice, and other beverages. Drinking sufficient amounts of water can lead to improved weight status, reduced dental caries, and improved cognition among children and adolescents. Because children spend most of their day at school and in child care, ensuring that safe, potable drinking water is available in these settings is a fundamental public health measure. We sought to identify challenges that limit access to drinking water; opportunities, including promising practices, to increase drinking water availability and consumption; and future research, policy efforts, and funding needed in this area.
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Affiliation(s)
- Anisha I Patel
- Department of Pediatrics, Institute for Health Policy Studies, University of California, San Francisco San Francisco, CA 94118, USA.
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Patel AI, Bogart LM, Klein DJ, Schuster MA, Elliott MN, Hawes-Dawson J, Lamb S, Uyeda KE. Increasing the availability and consumption of drinking water in middle schools: a pilot study. Prev Chronic Dis 2011; 8:A60. [PMID: 21477500 PMCID: PMC3103565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Although several studies suggest that drinking water may help prevent obesity, no US studies have examined the effect of school drinking water provision and promotion on student beverage intake. We assessed the acceptability, feasibility, and outcomes of a school-based intervention to improve drinking water consumption among adolescents. METHODS The 5-week program, conducted in a Los Angeles middle school in 2008, consisted of providing cold, filtered drinking water in cafeterias; distributing reusable water bottles to students and staff; conducting school promotional activities; and providing education. Self-reported consumption of water, nondiet soda, sports drinks, and 100% fruit juice was assessed by conducting surveys among students (n = 876), preintervention and at 1 week and 2 months postintervention, from the intervention school and the comparison school. Daily water (in gallons) distributed in the cafeteria during the intervention was recorded. RESULTS After adjusting for sociodemographic characteristics and baseline intake of water at school, the odds of drinking water at school were higher for students at the intervention school than students at the comparison school. Students from the intervention school had higher adjusted odds of drinking water from fountains and from reusable water bottles at school than students from the comparison school. Intervention effects for other beverages were not significant. CONCLUSION Provision of filtered, chilled drinking water in school cafeterias coupled with promotion and education is associated with increased consumption of drinking water at school. A randomized controlled trial is necessary to assess the intervention's influence on students' consumption of water and sugar-sweetened beverages, as well as obesity-related outcomes.
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Affiliation(s)
- Anisha I. Patel
- Assistant Professor, Department of Pediatrics, University of California at San Francisco. Dr Patel is also affiliated with the Philip R. Lee Institute for Health Policy Studies, San Francisco, California
| | - Laura M. Bogart
- Division of General Pediatrics, Children's Hospital Boston, Boston, Massachusetts, Harvard Medical School, Boston, Massachusetts, and RAND Corporation, Santa Monica, California
| | - David J. Klein
- Division of General Pediatrics, Children's Hospital Boston, Boston, Massachusetts, Harvard Medical School, Boston, Massachusetts, and RAND Corporation, Santa Monica, California
| | - Mark A. Schuster
- Division of General Pediatrics, Children's Hospital Boston, Boston, Massachusetts, Harvard Medical School, Boston, Massachusetts, and RAND Corporation, Santa Monica, California
| | | | | | - Sheila Lamb
- Los Angeles Unified School District, Los Angeles, California
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Bogart LM, Elliott MN, Uyeda K, Hawes-Dawson J, Klein DJ, Schuster MA. Preliminary healthy eating outcomes of SNaX, a pilot community-based intervention for adolescents. J Adolesc Health 2011; 48:196-202. [PMID: 21257120 PMCID: PMC3050639 DOI: 10.1016/j.jadohealth.2010.06.004] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2009] [Revised: 06/08/2010] [Accepted: 06/09/2010] [Indexed: 11/18/2022]
Abstract
PURPOSE We used principles of community-based participatory research to develop and pilot test a 5-week intervention for middle school students, Students for Nutrition and eXercise (SNaX). SNaX aimed to translate school obesity-prevention policies into practice with peer advocacy of healthy eating and school cafeteria changes. METHODS A total 425 seventh graders (63% of all seventh graders) in the intervention school were surveyed at baseline regarding cafeteria attitudes and sugar-sweetened beverage consumption; of the 425 students, 399 (94%) were surveyed again at 1-month post-intervention. School cafeteria records were obtained from two schools: the intervention school and a nonrandomized selected comparison school with similar student socio-demographic characteristics. RESULTS A total of 140 students in the intervention school were trained as peer advocates. In the intervention school, cafeteria attitudes among peer advocates significantly improved over time (approximately one-third of a standard deviation), whereas cafeteria attitudes of non-peer advocates remained stable; the improvement among peer advocates was significantly greater than the pre-post-change for non-peer advocates (b = .71, p < .001). Peer advocates significantly reduced their sugar-sweetened beverage intake (sports and fruit drinks), from 33% before intervention to 21% after intervention (p = .03). Cafeteria records indicated that servings of fruit and healthier entrées (salads, sandwiches, and yogurt parfaits) significantly decreased in the comparison school and significantly increased in the intervention school; the magnitude of changes differed significantly between the schools (p < .001). CONCLUSIONS As compared with the non-peer advocates, peer advocates appeared to benefit more from the intervention. Future research should consider engaging parents, students, and other key community stakeholders to determine acceptable and sustainable cafeteria changes.
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Affiliation(s)
- Laura M Bogart
- Division of General Pediatrics, Department of Medicine, Children's Hospital Boston, 21 Autumn Street, Boston, MA 02215, USA.
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Uyeda K, Bogart LM, Hawes-Dawson J, Schuster MA. Development and implementation of a school-based obesity prevention intervention: lessons learned from community-based participatory research. Prog Community Health Partnersh 2011; 3:249-55. [PMID: 20208226 DOI: 10.1353/cpr.0.0085] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND National, state, and local policies aim to change school environments to prevent child obesity. Community-based participatory research (CBPR) can be effective in translating public health policy into practice. OBJECTIVES We describe lessons learned from developing and pilot testing a middle school-based obesity prevention intervention using CBPR in Los Angeles, California. METHODS We formed a community-academic partnership between the Los Angeles Unified School District (LAUSD) and the UCLA/RAND Center for Adolescent Health Promotion to identify community needs and priorities for addressing adolescent obesity and to develop and pilot test a school-based intervention. LESSONS LEARNED Academic partners need to be well-versed in organizational structures and policies. Partnerships should be built on relationships of trust, shared vision, and mutual capacity building, with genuine community engagement at multiple levels. CONCLUSION These lessons are critical, not only for partnering with schools on obesity prevention, but also for working in other community settings and on other health issues.
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Perceptions about availability and adequacy of drinking water in a large California school district. Prev Chronic Dis 2010; 7:A39. [PMID: 20158967 PMCID: PMC2831793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Concerns about the influence of sugar-sweetened beverage consumption on obesity have led experts to recommend that water be freely available in schools. We explored perceptions about the adequacy of drinking water provision in a large California school district to develop policies and programs to encourage student water consumption. METHODS From March to September 2007, we used semistructured interviews to ask 26 California key stakeholders - including school administrators and staff, health and nutrition agency representatives, and families - about school drinking water accessibility; attitudes about, facilitators of, and barriers to drinking water provision; and ideas for increasing water consumption. Interviews were analyzed to determine common themes. RESULTS Although stakeholders said that water was available from school drinking fountains, they expressed concerns about the appeal, taste, appearance, and safety of fountain water and worried about the affordability and environmental effect of bottled water sold in schools. Stakeholders supported efforts to improve free drinking water availability in schools, but perceived barriers (eg, cost) and mistaken beliefs that regulations and beverage contracts prohibit serving free water may prevent schools from doing so. Some schools provide water through cold-filtered water dispensers and self-serve water coolers. CONCLUSION This is the first study to explore stakeholder perceptions about the adequacy of drinking water in US schools. Although limited in scope, our study suggests that water available in at least some schools may be inadequate. Collaborative efforts among schools, communities, and policy makers are needed to improve school drinking water provision.
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Green LW, Glasgow RE, Atkins D, Stange K. Making evidence from research more relevant, useful, and actionable in policy, program planning, and practice slips "twixt cup and lip". Am J Prev Med 2009; 37:S187-91. [PMID: 19896017 DOI: 10.1016/j.amepre.2009.08.017] [Citation(s) in RCA: 111] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2009] [Revised: 08/15/2009] [Accepted: 08/15/2009] [Indexed: 11/18/2022]
Affiliation(s)
- Lawrence W Green
- Department of Epidemiology and Biostatistics, Schoolof Medicine, University of California at San Francisco, 185 Berry Street, San Francisco, CA 94107-1728, USA.
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Goh YY, Bogart LM, Sipple-Asher BK, Uyeda K, Hawes-Dawson J, Olarita-Dhungana J, Ryan GW, Schuster MA. Using community-based participatory research to identify potential interventions to overcome barriers to adolescents' healthy eating and physical activity. J Behav Med 2009; 32:491-502. [PMID: 19544091 PMCID: PMC2863037 DOI: 10.1007/s10865-009-9220-9] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2008] [Accepted: 05/27/2009] [Indexed: 10/20/2022]
Abstract
Using a community-based participatory research approach, we explored adolescent, parent, and community stakeholder perspectives on barriers to healthy eating and physical activity, and intervention ideas to address adolescent obesity. We conducted 14 adolescent focus groups (n = 119), 8 parent focus groups (n = 63), and 28 interviews with community members (i.e., local experts knowledgeable about youth nutrition and physical activity). Participants described ecological and psychosocial barriers in neighborhoods (e.g., lack of accessible nutritious food), in schools (e.g., poor quality of physical education), at home (e.g., sedentary lifestyle), and at the individual level (e.g., lack of nutrition knowledge). Participants proposed interventions such as nutrition classes for families, addition of healthy school food options that appeal to students, and non-competitive physical education activities. Participants supported health education delivered by students. Findings demonstrate that community-based participatory research is useful for revealing potentially feasible interventions that are acceptable to community members.
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Affiliation(s)
- Ying-Ying Goh
- Robert Wood Johnson Clinical Scholars Program, Department of Pediatrics, UCLA School of Medicine, Los Angeles, CA, USA
| | - Laura M. Bogart
- RAND Corporation, Santa Monica, CA, USA; Division of General Pediatrics, Children’s Hospital Boston, 300 Longwood Ave., Boston, MA 02115, USA; Harvard Medical School, Boston, MA, USA
| | | | - Kimberly Uyeda
- Los Angeles Unified School District, Los Angeles, CA, USA
| | | | | | | | - Mark A. Schuster
- RAND Corporation, Santa Monica, CA, USA; Division of General Pediatrics, Children’s Hospital Boston, 300 Longwood Ave., Boston, MA 02115, USA; Harvard Medical School, Boston, MA, USA
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Bogart LM, Uyeda K. Community-based participatory research: partnering with communities for effective and sustainable behavioral health interventions. Health Psychol 2009; 28:391-3. [PMID: 19594261 PMCID: PMC2854509 DOI: 10.1037/a0016387] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The present issue contains one of the first studies published in Health Psychology-by Resnicow and colleagues-that uses elements of community-based participatory research (CBPR) (Resnicow et al., 2009). The authors engaged community partners (three health maintenance organizations or HMOs) to develop and implement a fruit and vegetable promotion intervention (Tolsma et al., 2009). African American HMO patients (the intervention targets) participated in formative work (i.e., focus groups) on survey items and intervention content and in survey pilot testing. A diverse group of researcher and nonresearcher expert stakeholders (e.g., African American health plan staff; consultants with expertise in Black identity theory, on which the intervention was based) was engaged in major project decisions regarding the measures and intervention design.
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Affiliation(s)
- Laura M Bogart
- Department of Medicine, Children's Hospital Boston, Boston, MA 02115, USA.
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