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Michael SL, Barnes SP, Wilkins NJ. Scoping Review of Family and Community Engagement Strategies Used in School-Based Interventions to Promote Healthy Behaviors. THE JOURNAL OF SCHOOL HEALTH 2023; 93:828-841. [PMID: 37670597 PMCID: PMC11181466 DOI: 10.1111/josh.13367] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 06/02/2023] [Accepted: 06/22/2023] [Indexed: 09/07/2023]
Abstract
BACKGROUND School efforts to promote health among students are more successful when families and community members are involved. METHODS We conducted a scoping review to summarize and categorize family and community engagement strategies used in US school and out-of-school time (OST) interventions to address physical activity (PA) and nutrition in kindergarten through 12th grade students. RESULTS The National Network of Partnership Schools' Six Keys to Success framework was useful in organizing the types of family and community engagement strategies used in included interventions. Many interventions used multiple family and community engagement strategies, with the most common being communicating with families and community members; providing support or education to families; and collaborations among school/OST program and community to support students and their families. CONCLUSIONS This review identified six common family and community engagement strategies used in school and OST interventions for PA and nutrition. Including family and community engagement strategies in school and OST interventions could play an important role in maximizing support, resources, and expertise to promote healthy behaviors among all students.
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Affiliation(s)
- Shannon L. Michael
- Senior Health Scientist, Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Seraphine Pitt Barnes
- Senior Health Scientist, Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Natalie J. Wilkins
- Health Scientist, TeamLead, Division of Adolescent and School Health, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA
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Sliwa SA, Chang Chusan YA, Dahlstrom C. Opportunities in the Extended Day: Approaches for Promoting Physical Activity and Healthy Eating During Out-of-School Time. THE JOURNAL OF SCHOOL HEALTH 2023; 93:813-827. [PMID: 37670603 PMCID: PMC11181343 DOI: 10.1111/josh.13370] [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: 03/01/2023] [Revised: 05/26/2023] [Accepted: 05/31/2023] [Indexed: 09/07/2023]
Abstract
BACKGROUND This systematic review aims to identify out-of-school time (OST) interventions (eg, programming, policies) that increased opportunities for physical activity (PA) and healthy eating and/or improved youth PA and dietary behaviors. METHODS We searched for articles within systematic reviews that met our criteria (2010-2018) and for individual articles (2010-2020). Reviewer pairs screened articles, double-extracted data, assessed risk of bias (RoB), and achieved consensus. We included 71 articles (55 studies, 60 intervention arms). RESULTS Health (n = 3) and nutrition education (n = 7) interventions showed promising results, but most used weak designs and had high RoB. PA-focused interventions (n = 23) were largely consistent in improving fitness and moderate to vigorous PA during programming. Programmatic interventions that improved both PA and nutrition outcomes engaged family or community members (n = 4/13). Most organizational policy interventions improved the nutrition environment and student PA during OST. CONCLUSIONS Organization-level policy and programmatic interventions can improve environmental supports and youth behaviors during OST programming, complementing school-day efforts to address student PA and dietary intake. To maximize their potential impact, OST programs need to be accessible to families. Administrators can consider actions to reduce participation barriers.
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Affiliation(s)
- Sarah A Sliwa
- Division of Population Health, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Atlanta, GA
| | - Yuilyn A Chang Chusan
- Tufts University Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Boston, MA
| | - Christina Dahlstrom
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
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Polman MAA, Beckers D, Burk WJ, Smit CR, Buijzen M, Vink JM, van den Broek N, Larsen JK. The effect of a multi-component school-based social network intervention on children's body mass index: a four-arm intervention study. Psychol Health 2023:1-18. [PMID: 36803013 DOI: 10.1080/08870446.2023.2179084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 01/31/2023] [Accepted: 02/06/2023] [Indexed: 02/22/2023]
Abstract
Objective: Schools are considered an important setting for stimulating healthy weight. The current study is unique in examining effects of a multi-component school-based social network intervention on children's body mass index z-scores (zBMI).Methods: Four schools were randomly allocated to one of four conditions: a social network intervention using influence agents focusing on water consumption, physical activity, a combination of the two, or a passive control condition. Participants included a total of 201 6- to-11-year-old children (53.7% girls; Mage = 8.51, SDage = 0.93). At baseline, 149 (76.0%) participants had a healthy weight, 29 (14.8%) had overweight and 18 (9.2%) had obesity.Results: Linear mixed effect models indicated that a multi-component school-based social network intervention targeting both water consumption and physical activity was most effective in decreasing children's zBMI.Conclusion: This study suggests that schools can contribute to the intervention of childhood obesity-even without involving the parents-by targeting both children's water consumption and physical activity through influential peers, but more research is needed to identify mechanisms of change.
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Affiliation(s)
- Marloes A A Polman
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
| | - Desi Beckers
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
| | - William J Burk
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
| | - Crystal R Smit
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
- Erasmus School of Social and Behavioural Sciences, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Moniek Buijzen
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
- Erasmus School of Social and Behavioural Sciences, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Jacqueline M Vink
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
| | - Nina van den Broek
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
| | - Junilla K Larsen
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
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Ezennia J, Schmidt LA, Ritchie LD, Blacker L, McCulloch CE, Patel AI. Water Security Experiences and Water Intake Among Elementary Students at Low-Income Schools: A Cross-Sectional Study. Acad Pediatr 2023; 23:68-75. [PMID: 35537674 PMCID: PMC9676021 DOI: 10.1016/j.acap.2022.04.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 04/21/2022] [Accepted: 04/30/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To examine students' experiences of water security at school and how experiences relate to intake of water from different sources of water at school. DESIGN/METHODS In this cross-sectional study, 651 students in grades 3 to 5 in 12 low-income public elementary schools in the San Francisco area completed surveys about their daily intake of water from different sources of water at school, experiences of water security including safety, cleanliness, and taste of water at school, and their demographics. Multivariable linear regressions examined associations between students' water security experiences at school and reported intake from different sources of water at school. RESULTS Approximately half of students were Latino (56.1%) and had overweight/obesity (50.4%). Most (74.5%) had some negative water security experience at school. Students drank from the school fountain or water bottle filling station a mean of 1.2 times/day (standard deviation [SD] = 1.4), sinks 0.2 times/day (SD = 0.7), tap water dispensers 0.2 times/day (SD = 0.6), and bottled water 0.5 times/day (SD = 1.0). In multivariable linear regression, students with more negative experiences of school water security drank less frequently from fountains (-0.5 times/day, P value < .001), but more frequently from tap water dispensers (0.1 times/day, P value = .040) and sinks (0.1 times/day, P value = .043), compared to students with no negative perceptions. CONCLUSIONS On average, students had negative school water security experiences, which decreased their consumption of water from tap water sources. However, relationships between negative water security experiences and reported water intake appeared to be mitigated by water source. Schools should consider installing more appealing water sources to promote water intake.
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Affiliation(s)
- Jeffery Ezennia
- School of Medicine, University of California Riverside (J Ezennia); Department of Pediatrics, Stanford University School of Medicine (J Ezennia, L Blacker, and AI Patel), Palo Alto, Calif
| | - Laura A Schmidt
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco (LA Schmidt and AI Patel); Department of Humanities and Social Sciences, University of California San Francisco (LA Schmidt)
| | - Lorrene D Ritchie
- Division of Agriculture and Natural Resources, Nutrition Policy Institute, University of California (L Ritchie), Oakland, Calif
| | - Lauren Blacker
- Department of Pediatrics, Stanford University School of Medicine (J Ezennia, L Blacker, and AI Patel), Palo Alto, Calif
| | - Charles E McCulloch
- Division of Biostatistics, University of California San Francisco (CE McCulloch)
| | - Anisha I Patel
- Department of Pediatrics, Stanford University School of Medicine (J Ezennia, L Blacker, and AI Patel), Palo Alto, Calif; Philip R. Lee Institute for Health Policy Studies, University of California San Francisco (LA Schmidt and AI Patel).
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5
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Cunningham-Sabo L, Tagtow A, Mi S, Engelken J, Johnston K, Herman DR. Partnerships and Community Engagement Key to Policy, Systems, and Environmental Achievements for Healthy Eating and Active Living: a Systematic Mapping Review. Prev Chronic Dis 2022; 19:E54. [PMID: 36007254 PMCID: PMC9480846 DOI: 10.5888/pcd19.210466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Policy, systems, and environmental (PSE) change approaches frequently address healthy eating and active living (HEAL) priorities. However, the health effects of PSE HEAL initiatives are not well known because of their design complexity and short duration. Planning and evaluation frameworks can guide PSE activities to generate collective impact. We applied a systematic mapping review to the Individual plus PSE Conceptual Framework for Action (I+PSE) to describe characteristics, achievements, challenges, and evaluation strategies of PSE HEAL initiatives. METHODS We identified peer-reviewed articles published from January 2009 through January 2021 by using CINAHL, Web of Science, MEDLINE, PsycINFO, and CAB Abstracts databases. Articles describing implementation and results of PSE HEAL initiatives were included. Activities were mapped against I+PSE components to identify gaps in evaluation efforts. RESULTS Independent reviewers examined 437 titles and abstracts; 52 peer-reviewed articles met all inclusion criteria. Twenty-four focused on healthy eating, 5 on active living, and 23 on HEAL. Descriptive analyses identified federal funding of initiatives (typically 1-3 years), multisector settings, and mixed-methods evaluation strategies as dominant characteristics. Only 11 articles reported on initiatives that used a formal planning and evaluation framework. Achievements focused on partnership development, individual behavior, environmental or policy changes, and provision of technical assistance. Challenges included lack of local coalition and community engagement in initiatives and evaluation activities and insufficient time and resources to accomplish objectives. The review team noted vague or absent descriptions of evaluation activities, resulting in questionable characterizations of processes and outcomes. Although formation of partnerships was the most commonly reported accomplishment, I+PSE mapping revealed a lack of engagement assessment and its contributions toward initiative impact. CONCLUSION PSE HEAL initiatives reported successes in multiple areas but also challenges related to partnership engagement and community buy-in. These 2 areas are essential for the success of PSE HEAL initiatives and need to be adequately evaluated so improvements can be made.
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Affiliation(s)
- Leslie Cunningham-Sabo
- Colorado State University, Food Science and Human Nutrition, 1571 Campus Delivery, 234 Gifford Building, Fort Collins, CO 80523. .,Colorado School of Public Health, Community and Behavioral Health, Aurora, Colorado
| | | | - Sirui Mi
- Colorado State University, Food Science and Human Nutrition, Fort Collins, Colorado
| | - Jessa Engelken
- University of Washington, School of Public Health, Nutritional Sciences Program, Seattle, Washington
| | - Kiaya Johnston
- Colorado State University, Food Science and Human Nutrition, Fort Collins, Colorado
| | - Dena R Herman
- University of California Los Angeles, Fielding School of Public Health, Los Angeles, California.,California State University Northridge, Nutrition, Dietetics, and Food Science, Northridge, California
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Water Wins, Communication Matters: School-Based Intervention to Reduce Intake of Sugar-Sweetened Beverages and Increase Intake of Water. Nutrients 2022; 14:nu14071346. [PMID: 35405959 PMCID: PMC9002784 DOI: 10.3390/nu14071346] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 03/08/2022] [Accepted: 03/19/2022] [Indexed: 02/04/2023] Open
Abstract
We compared three interventions designed for reducing the consumption of sugar-sweetened beverages (SSBs) aimed at decreasing the risk of overweight and obesity among children. We included three experimental (n = 508) and one control school (n = 164) in Slovenia (672 children; 10–16 years) to evaluate interventions that influence behaviour change via environmental (E), communication (C), or combined (i.e., double) environmental and communication approaches (EC) compared to no intervention (NOI). Data of children from the ‘intervention’ and ‘non-intervention’ schools were compared before and after the interventions. The quantity of water consumed (average, mL/day) by children increased in the C and EC schools, while it decreased in the E and NOI schools. Children in the C and EC schools consumed less beverages with sugar (SSBs + fruit juices), and sweet beverages (beverages with: sugar, low-calorie and/or noncaloric sweeteners) but consumed more juices. The awareness about the health risks of SSB consumption improved among children of the ‘combined intervention’ EC school and was significantly different from the awareness among children of other schools (p = 0.03). A communication intervention in the school environment has more potential to reduce the intake of SSBs than a sole environmental intervention, but optimum results can be obtained when combined with environmental changes.
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Mandracchia F, Tarro L, Llauradó E, Valls RM, Solà R. Interventions to Promote Healthy Meals in Full-Service Restaurants and Canteens: A Systematic Review and Meta-Analysis. Nutrients 2021; 13:1350. [PMID: 33919552 PMCID: PMC8073122 DOI: 10.3390/nu13041350] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 04/13/2021] [Accepted: 04/16/2021] [Indexed: 11/16/2022] Open
Abstract
Out-of-home eating is increasing, but evidence about its healthiness is limited. The present systematic review and meta-analysis aimed to elucidate the effectiveness of full-service restaurant and canteen-based interventions in increasing the dietary intake, food availability, and food purchase of healthy meals. Studies from 2000-2020 were searched in Medline, Scopus, and Cochrane Library using the PRISMA checklist. A total of 35 randomized controlled trials (RCTs) and 6 non-RCTs were included in the systematic review and analyzed by outcome, intervention strategies, and settings (school, community, workplace). The meta-analysis included 16 RCTs (excluding non-RCTs for higher quality). For dietary intake, the included RCTs increased healthy foods (+0.20 servings/day; 0.12 to 0.29; p < 0.001) and decreased fat intake (-9.90 g/day; -12.61 to -7.19; p < 0.001), favoring the intervention group. For food availability, intervention schools reduced the risk of offering unhealthy menu items by 47% (RR 0.53; 0.34 to 0.85; p = 0.008). For food purchases, a systematic review showed that interventions could be partially effective in improving healthy foods. Lastly, restaurant- and canteen-based interventions improved the dietary intake of healthy foods, reduced fat intake, and increased the availability of healthy menus, mainly in schools. Higher-quality RCTs are needed to strengthen the results. Moreover, from our results, intervention strategy recommendations are provided.
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Affiliation(s)
- Floriana Mandracchia
- Functional Nutrition, Oxidation, and Cardiovascular Diseases Group (NFOC-Salut), Healthy Environment Chair, Facultat de Medicina i Ciències de la Salut, Universitat Rovira i Virgili, 43201 Reus, Spain; (F.M.); (L.T.); (R.M.V.); (R.S.)
| | - Lucia Tarro
- Functional Nutrition, Oxidation, and Cardiovascular Diseases Group (NFOC-Salut), Healthy Environment Chair, Facultat de Medicina i Ciències de la Salut, Universitat Rovira i Virgili, 43201 Reus, Spain; (F.M.); (L.T.); (R.M.V.); (R.S.)
- Institut d’Investigació Sanitaria Pere Virgili, 43204 Reus, Spain
| | - Elisabet Llauradó
- Functional Nutrition, Oxidation, and Cardiovascular Diseases Group (NFOC-Salut), Healthy Environment Chair, Facultat de Medicina i Ciències de la Salut, Universitat Rovira i Virgili, 43201 Reus, Spain; (F.M.); (L.T.); (R.M.V.); (R.S.)
| | - Rosa Maria Valls
- Functional Nutrition, Oxidation, and Cardiovascular Diseases Group (NFOC-Salut), Healthy Environment Chair, Facultat de Medicina i Ciències de la Salut, Universitat Rovira i Virgili, 43201 Reus, Spain; (F.M.); (L.T.); (R.M.V.); (R.S.)
| | - Rosa Solà
- Functional Nutrition, Oxidation, and Cardiovascular Diseases Group (NFOC-Salut), Healthy Environment Chair, Facultat de Medicina i Ciències de la Salut, Universitat Rovira i Virgili, 43201 Reus, Spain; (F.M.); (L.T.); (R.M.V.); (R.S.)
- Institut d’Investigació Sanitaria Pere Virgili, 43204 Reus, Spain
- Hospital Universitari Sant Joan de Reus, 43204 Reus, Spain
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Patel AI, Hecht CE, Cradock A, Edwards MA, Ritchie LD. Drinking Water in the United States: Implications of Water Safety, Access, and Consumption. Annu Rev Nutr 2020; 40:345-373. [PMID: 32966189 DOI: 10.1146/annurev-nutr-122319-035707] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Recent water quality crises in the United States, and recognition of the health importance of drinking water in lieu of sugar-sweetened beverages, have raised interest in water safety, access, and consumption. This review uses a socioecological lens to examine these topics across the life course. We review water intakes in the United States relative to requirements, including variation by age and race/ethnicity. We describe US regulations that seek to ensure that drinking water is safe to consume for most Americans and discuss strategies to reduce drinking water exposure to lead, a high-profile regulated drinking water contaminant. We discuss programs, policies, and environmental interventions that foster effective drinking water access, a concept that encompasses key elements needed to improve water intake. We conclude with recommendations for research, policies, regulations, and practices needed to ensure optimal water intake by all in the United States and elsewhere.
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Affiliation(s)
- Anisha I Patel
- Division of General Pediatrics, Stanford University, Palo Alto, California 94305, USA
| | - Christina E Hecht
- Nutrition Policy Institute, Division of Agriculture and Natural Resources, University of California, Berkeley, California 94704, USA;
| | - Angie Cradock
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts 02115, USA
| | - Marc A Edwards
- Department of Civil and Environmental Engineering, Virginia Polytechnic Institute and State University, Blacksburg, Virginia 24061, USA
| | - Lorrene D Ritchie
- Nutrition Policy Institute, Division of Agriculture and Natural Resources, University of California, Berkeley, California 94704, USA;
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Promoting Physical Activity and Executive Functions Among Children: A Cluster Randomized Controlled Trial of an After-School Program in Australia. J Phys Act Health 2020; 17:940-946. [PMID: 32858523 DOI: 10.1123/jpah.2019-0381] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 07/09/2020] [Accepted: 07/16/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND The aim of this study was to examine the efficacy of an embedded after-school intervention, on promoting physical activity and academic achievement in primary-school-aged children. METHODS This 6-month, 2-arm cluster randomized controlled trial involved 4 after-school centers. Two centers were randomly assigned to the intervention, which involved training the center staff on and implementing structured physical activity (team sports and physical activity sessions for 75 min) and academic enrichment activities (45 min). The activities were implemented 3 afternoons per week for 2.5 hours. The control centers continued their usual after-school care practice. After-school physical activity (accelerometry) and executive functions (working memory, inhibition, and cognitive flexibility) were assessed pre- and postintervention. RESULTS A total of 60 children were assessed (7.7 [1.8] y; 50% girls) preintervention and postintervention (77% retention rate). Children in the intervention centers spent significantly more time in moderate to vigorous physical activity (adjusted difference = 2.4%; 95% confidence interval, 0.6 to 4.2; P = .026) and scored higher on cognitive flexibility (adjusted difference = 1.9 units; 95% confidence interval, 0.9 to 3.0; P = .009). About 92% of the intervention sessions were implemented. The participation rates varied between 51% and 94%. CONCLUSION This after-school intervention was successful at increasing moderate to vigorous physical activity and enhancing cognitive flexibility in children. As the intervention was implemented by the center staff and local university students, further testing for effectiveness and scalability in a larger trial is required.
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10
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Franse CB, Boelens M, Fries LR, Constant F, van Grieken A, Raat H. Interventions to increase the consumption of water among children: A systematic review and meta-analysis. Obes Rev 2020; 21:e13015. [PMID: 32167233 PMCID: PMC7317453 DOI: 10.1111/obr.13015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 02/21/2020] [Indexed: 12/17/2022]
Abstract
The aim of this study was to conduct a systematic review and meta-analysis on the effectiveness of interventions to increase children's water consumption. A systematic literature search was conducted in seven electronic databases. Studies published in English before 18 February 2019 that evaluated any type of intervention that measured change in water consumption among children aged 2 to 12 years by applying any type of design were included. Of the 47 interventions included in the systematic review, 24 reported a statistically significant increase in water consumption. Twenty-four interventions (17 randomized controlled trials and seven studies with other controlled designs) were included in the meta-analysis. On average, children in intervention groups consumed 29 mL/d (confidence interval [CI] = 13-46 mL/d) more water than did children in control groups. This effect was larger in eight interventions focused specifically on diet (MD = 73 mL/d, CI = 20-126 mL/d) than in 16 interventions focused also on other lifestyle factors (MD = 15 mL/d, CI = 1-29 mL/d). Significant subgroup differences were also found by study setting and socioecological level targeted but not by children's age group, intervention strategy, or study design. In conclusion, there is evidence that, on average, lifestyle interventions can lead to small increases in children's daily water consumption. More research is needed to further understand the specific intervention elements that have the greatest effect.
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Affiliation(s)
- Carmen B. Franse
- Department of Public HealthErasmus University Medical CenterRotterdamThe Netherlands
| | - Mirte Boelens
- Department of Public HealthErasmus University Medical CenterRotterdamThe Netherlands
| | | | | | - Amy van Grieken
- Department of Public HealthErasmus University Medical CenterRotterdamThe Netherlands
| | - Hein Raat
- Department of Public HealthErasmus University Medical CenterRotterdamThe Netherlands
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11
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Lawman HG, Grossman S, Lofton X, Tasian G, Patel AI. Hydrate Philly: An Intervention to Increase Water Access and Appeal in Recreation Centers. Prev Chronic Dis 2020; 17:E15. [PMID: 32078503 PMCID: PMC7085906 DOI: 10.5888/pcd17.190277] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Introduction Previous interventions to increase water access and consumption have focused on school settings, have shown mixed results on sugar-sweetened beverage (SSB) consumption, and have rarely addressed tap water safety. Our randomized controlled trial examined how improving access and appeal of water in recreation centers in low-income neighborhoods affected counts of SSBs carried by youth attending summer camp. Methods Recreation centers (N = 28) matched on their characteristics were randomly assigned to control or intervention groups. Intervention centers received a new water fountain with a bottle filler (hydration station), water testing services, reusable water bottles, and water promotion and education training and materials. Primary outcomes were 1-year changes in center-level average daily gallons of water from fountains and hydration stations (flowmeter readings). Secondary outcomes were counts of SSBs observed, use of bottled water and reusable water bottles, staff SSB consumption, and hydration station maintenance. Results Results showed increased water use (b = 8.6, 95% CI, 4.2–13.0) and reusable bottle counts (b = 10.2, 95% CI, 4.2–16.1) in intervention centers compared with control centers. No change occurred in youth carrying SSBs at camp, but center staff’s past 30-day SSB consumption frequency decreased (b = −34.8, 95% CI, −67.7 to −1.9). Intervention sites had marginally lower odds of maintenance problems (OR = 0.09; 95% CI, 0.004–0.76, P = .06) than control sites. Conclusion Although providing hydration stations along with water testing, reusable water bottles, education, and promotion increased water consumption among youth at recreation centers, it had no effect on the number of SSBs observed during camp. Future strategies to increase water consumption should also address reducing SSB intake.
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Affiliation(s)
- Hannah G Lawman
- Division of Chronic Disease and Injury Prevention, Philadelphia Department of Public Health, Philadelphia, Pennsylvania.,Division of Chronic Disease Prevention, Philadelphia Department of Public Health, 1101 Market St, 9th Flr, Philadelphia, PA 19107.
| | - Sara Grossman
- Division of Chronic Disease and Injury Prevention, Philadelphia Department of Public Health, Philadelphia, Pennsylvania
| | - Xavier Lofton
- Division of Chronic Disease and Injury Prevention, Philadelphia Department of Public Health, Philadelphia, Pennsylvania
| | - Gregory Tasian
- Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.,Department of Surgery, Division of Urology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.,Department of Surgery, Division of Urology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Anisha I Patel
- School of Medicine, Stanford University, Stanford, California.,Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California
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12
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Kenney EL, Daly JG, Lee RM, Mozaffarian RS, Walsh K, Carter J, Gortmaker SL. Providing Students with Adequate School Drinking Water Access in an Era of Aging Infrastructure: A Mixed Methods Investigation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 17:ijerph17010062. [PMID: 31861778 PMCID: PMC6981468 DOI: 10.3390/ijerph17010062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 12/12/2019] [Accepted: 12/14/2019] [Indexed: 11/29/2022]
Abstract
Ensuring students’ access to safe drinking water at school is essential. However, many schools struggle with aging infrastructure and subsequent water safety problems and have turned to bottled water delivery systems. Little is known about whether such systems are feasible and effective in providing adequate student water access. This study was a mixed-methods investigation among six schools in an urban district in the U.S. with two types of water delivery systems: (1) tap water infrastructure, with updated water fountains and bottle fillers, and (2) bottled water coolers. We measured students’ water consumption and collected qualitative data from students and teachers about their perceptions of school drinking water. Student water consumption was low—between 2.0 (SD: 1.4) ounces per student and 2.4 (SD: 1.1) ounces per student during lunch. Students and teachers reported substantial operational hurdles for relying on bottled water as a school’s primary source of drinking water, including difficulties in stocking, cleaning, and maintaining the units. While students and teachers perceived newer bottle filler units positively, they also reported a distrust of tap water. Bottled water delivery systems may not be effective long-term solutions for providing adequate school drinking water access and robust efforts are needed to restore trust in tap water.
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Affiliation(s)
- Erica L. Kenney
- Department of Nutrition, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Boston, MA 02115, USA
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA; (J.G.D.); (R.M.L.); (R.S.M.); (S.L.G.)
- Correspondence: ; Tel.: +1-617-384-8722
| | - James G. Daly
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA; (J.G.D.); (R.M.L.); (R.S.M.); (S.L.G.)
| | - Rebekka M. Lee
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA; (J.G.D.); (R.M.L.); (R.S.M.); (S.L.G.)
| | - Rebecca S. Mozaffarian
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA; (J.G.D.); (R.M.L.); (R.S.M.); (S.L.G.)
| | - Katherine Walsh
- Department of Facilities Management, Boston Public Schools, 1216 Dorchester Ave, Dorchester, MA 02125, USA;
| | - Jill Carter
- Office of Social Emotional Learning and Wellness Instruction & Policy, Boston Public Schools, 2300 Washington Street, Roxbury, MA 02119, USA;
| | - Steven L. Gortmaker
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA; (J.G.D.); (R.M.L.); (R.S.M.); (S.L.G.)
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Lee RM, Barrett JL, Daly JG, Mozaffarian RS, Giles CM, Cradock AL, Gortmaker SL. Assessing the effectiveness of training models for national scale-up of an evidence-based nutrition and physical activity intervention: a group randomized trial. BMC Public Health 2019; 19:1587. [PMID: 31779603 PMCID: PMC6883557 DOI: 10.1186/s12889-019-7902-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 11/05/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is a great need to identify implementation strategies to successfully scale-up public health interventions in order to achieve their intended population impact. The Out-of-school Nutrition and Physical Activity group-randomized trial previously demonstrated improvements in children's vigorous physical activity and the healthfulness of foods and beverages consumed. This implementation study aimed to assess the effects and costs of two training models to scale-up this evidence-based intervention. METHODS A 3-arm group-randomized trial was conducted to compare effectiveness of in-person and online training models for scaling up the intervention compared to controls. One-third of sites were randomized to the in-person train-the-trainer model: local YMCA facilitators attended a training session and then conducted three learning collaborative meetings and technical assistance. One-third were assigned to the online model, consisting of self-paced monthly learning modules, videos, quizzes, and facilitated discussion boards. Remaining sites served as controls. Fifty-three afterschool sites from three YMCA Associations in different regions of the country completed baseline and follow-up observations using a validated tool of afterschool nutrition and physical activity practices. We used multivariable regression models, accounting for clustering of observations, to assess intervention effects on an aggregate afterschool practice primary outcome, and conducted secondary analyses of nine intervention goals (e.g. serving water). Cost data were collected to determine the resources to implement each training model. RESULTS Changes in the primary outcome indicate that, on average, sites in the in-person arm achieved 0.44 additional goals compared to controls (95%CI 0.02, 0.86, p = 0.04). Increases in the number of additional goals achieved in sites in the online arm were not significantly greater than control sites (+ 0.28, 95% CI -0.18, 0.73, p = 0.24). Goal-specific improvements were observed for increasing water offered in the in-person arm and fruits and vegetables offered in the online arm. The cost per person trained was $678 for the in-person training model and $336 for the on-line training model. CONCLUSIONS This pilot trial presents promising findings on implementation strategies for scale-up. It validated the in-person training model as an effective approach. The less expensive online training may be a useful option for geographically disbursed sites where in-person training is challenging. TRIAL REGISTRATION Although this study does not report the results of a health care intervention on human subjects, it is a randomized trial and was therefore retrospectively registered in ClinicalTrials.gov on July 4, 2019 in accordance with the BMC guidelines to ensure the complete publication of all results (NCT04009304).
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Affiliation(s)
- Rebekka M Lee
- Department of Social and Behavioral Sciences, Prevention Research Center on Nutrition and Physical Activity, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, 7th Floor, Boston, MA, 02115, USA.
| | - Jessica L Barrett
- Department of Social and Behavioral Sciences, Prevention Research Center on Nutrition and Physical Activity, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, 7th Floor, Boston, MA, 02115, USA
| | - James G Daly
- Department of Social and Behavioral Sciences, Prevention Research Center on Nutrition and Physical Activity, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, 7th Floor, Boston, MA, 02115, USA
| | - Rebecca S Mozaffarian
- Department of Social and Behavioral Sciences, Prevention Research Center on Nutrition and Physical Activity, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, 7th Floor, Boston, MA, 02115, USA
| | - Catherine M Giles
- Department of Social and Behavioral Sciences, Prevention Research Center on Nutrition and Physical Activity, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, 7th Floor, Boston, MA, 02115, USA
| | - Angie L Cradock
- Department of Social and Behavioral Sciences, Prevention Research Center on Nutrition and Physical Activity, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, 7th Floor, Boston, MA, 02115, USA
| | - Steven L Gortmaker
- Department of Social and Behavioral Sciences, Prevention Research Center on Nutrition and Physical Activity, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, 7th Floor, Boston, MA, 02115, USA
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Hollands GJ, Carter P, Anwer S, King SE, Jebb SA, Ogilvie D, Shemilt I, Higgins JPT, Marteau TM. Altering the availability or proximity of food, alcohol, and tobacco products to change their selection and consumption. Cochrane Database Syst Rev 2019; 9:CD012573. [PMID: 31482606 PMCID: PMC6953356 DOI: 10.1002/14651858.cd012573.pub3] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Overconsumption of food, alcohol, and tobacco products increases the risk of non-communicable diseases. Interventions to change characteristics of physical micro-environments where people may select or consume these products - including shops, restaurants, workplaces, and schools - are of considerable public health policy and research interest. This review addresses two types of intervention within such environments: altering the availability (the range and/or amount of options) of these products, or their proximity (the distance at which they are positioned) to potential consumers. OBJECTIVES 1. To assess the impact on selection and consumption of altering the availability or proximity of (a) food (including non-alcoholic beverages), (b) alcohol, and (c) tobacco products.2. To assess the extent to which the impact of these interventions is modified by characteristics of: i. studies, ii. interventions, and iii. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, PsycINFO, and seven other published or grey literature databases, as well as trial registries and key websites, up to 23 July 2018, followed by citation searches. SELECTION CRITERIA We included randomised controlled trials with between-participants (parallel group) or within-participants (cross-over) designs. Eligible studies compared effects of exposure to at least two different levels of availability of a product or its proximity, and included a measure of selection or consumption of the manipulated product. DATA COLLECTION AND ANALYSIS We used a novel semi-automated screening workflow and applied standard Cochrane methods to select eligible studies, collect data, and assess risk of bias. In separate analyses for availability interventions and proximity interventions, we combined results using random-effects meta-analysis and meta-regression models to estimate summary effect sizes (as standardised mean differences (SMDs)) and to investigate associations between summary effect sizes and selected study, intervention, or participant characteristics. We rated the certainty of evidence for each outcome using GRADE. MAIN RESULTS We included 24 studies, with the majority (20/24) giving concerns about risk of bias. All of the included studies investigated food products; none investigated alcohol or tobacco. The majority were conducted in laboratory settings (14/24), with adult participants (17/24), and used between-participants designs (19/24). All studies were conducted in high-income countries, predominantly in the USA (14/24).Six studies investigated availability interventions, of which two changed the absolute number of different options available, and four altered the relative proportion of less-healthy (to healthier) options. Most studies (4/6) manipulated snack foods or drinks. For selection outcomes, meta-analysis of three comparisons from three studies (n = 154) found that exposure to fewer options resulted in a large reduction in selection of the targeted food(s): SMD -1.13 (95% confidence interval (CI) -1.90 to -0.37) (low certainty evidence). For consumption outcomes, meta-analysis of three comparisons from two studies (n = 150) found that exposure to fewer options resulted in a moderate reduction in consumption of those foods, but with considerable uncertainty: SMD -0.55 (95% CI -1.27 to 0.18) (low certainty evidence).Eighteen studies investigated proximity interventions. Most (14/18) changed the distance at which a snack food or drink was placed from the participants, whilst four studies changed the order of meal components encountered along a line. For selection outcomes, only one study with one comparison (n = 41) was identified, which found that food placed farther away resulted in a moderate reduction in its selection: SMD -0.65 (95% CI -1.29 to -0.01) (very low certainty evidence). For consumption outcomes, meta-analysis of 15 comparisons from 12 studies (n = 1098) found that exposure to food placed farther away resulted in a moderate reduction in its consumption: SMD -0.60 (95% CI -0.84 to -0.36) (low certainty evidence). Meta-regression analyses indicated that this effect was greater: the farther away the product was placed; when only the targeted product(s) was available; when participants were of low deprivation status; and when the study was at high risk of bias. AUTHORS' CONCLUSIONS The current evidence suggests that changing the number of available food options or altering the positioning of foods could contribute to meaningful changes in behaviour, justifying policy actions to promote such changes within food environments. However, the certainty of this evidence as assessed by GRADE is low or very low. To enable more certain and generalisable conclusions about these potentially important effects, further research is warranted in real-world settings, intervening across a wider range of foods - as well as alcohol and tobacco products - and over sustained time periods.
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Affiliation(s)
- Gareth J Hollands
- University of CambridgeBehaviour and Health Research UnitForvie SiteRobinson WayCambridgeUKCB2 0SR
| | - Patrice Carter
- University College LondonCentre for Outcomes Research and Effectiveness1‐19 Torrington PlaceLondonUKWC1E 7HB
| | - Sumayya Anwer
- University of BristolPopulation Health Sciences, Bristol Medical SchoolCanynge Hall, 39 Whatley RoadBristolUKBS8 2PS
| | - Sarah E King
- University of CambridgeBehaviour and Health Research UnitForvie SiteRobinson WayCambridgeUKCB2 0SR
| | - Susan A Jebb
- University of OxfordNuffield Department of Primary Care Health SciencesRadcliffe Observatory QuarterWoodstock RoadOxfordOxfordshireUKOX2 6GG
| | - David Ogilvie
- University of CambridgeMRC Epidemiology UnitBox 285Cambridge Biomedical CampusCambridgeUKCB2 0QQ
| | - Ian Shemilt
- University College LondonEPPI‐Centre10 Woburn SquareLondonUKWC1H 0NR
| | - Julian P T Higgins
- University of BristolPopulation Health Sciences, Bristol Medical SchoolCanynge Hall, 39 Whatley RoadBristolUKBS8 2PS
| | - Theresa M Marteau
- University of CambridgeBehaviour and Health Research UnitForvie SiteRobinson WayCambridgeUKCB2 0SR
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Cradock AL, Poole MK, Agnew KE, Flax C, Plank K, Capdarest-Arest N, Patel AI. A systematic review of strategies to increase drinking-water access and consumption among 0- to 5-year-olds. Obes Rev 2019; 20:1262-1286. [PMID: 31250960 DOI: 10.1111/obr.12833] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 12/10/2018] [Accepted: 12/27/2018] [Indexed: 12/12/2022]
Abstract
The objective of this study is to identify promising strategies for improving drinking-water access and consumption among children aged 0 to 5 years. MEDLINE/PubMed, Embase, ERIC, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science, and Cochrane Central Register of Controlled Trials (CENTRAL) databases were searched in this review. Studies included peer-reviewed, full-text studies from high-income countries, published in English between January 1, 2000, and January 12, 2018, that evaluated interventions to increase water access or consumption in children aged 0 to 5 years. Twenty-five studies met inclusion criteria; 19 used an effective intervention strategy to increase water access or water consumption. Three studies addressed both water access and consumption. Frequently used strategies included policy and practice changes, increasing water access and convenience, and education, training, or social support for caregivers. Studies were of fair methodological quality (average score: 18.8 of 26) for randomized studies and of moderate quality (5.1 of 9) for non-randomized studies. To date, few high-quality studies with objectively measured outcomes have clearly demonstrated strategies that may influence water intake and consumption among young children aged 0 to 5 years.
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Affiliation(s)
- Angie L Cradock
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Mary Kathryn Poole
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Kaylan E Agnew
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA, USA
| | - Chasmine Flax
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Kaela Plank
- Nutrition Policy Institute, Division of Agriculture and Natural Resources, University of California, Berkeley, CA, USA
| | | | - Anisha I Patel
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA, USA.,Department of Pediatrics, Stanford University, Stanford, CA, USA
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16
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Hollands GJ, Carter P, Anwer S, King SE, Jebb SA, Ogilvie D, Shemilt I, Higgins JPT, Marteau TM. Altering the availability or proximity of food, alcohol, and tobacco products to change their selection and consumption. Cochrane Database Syst Rev 2019; 8:CD012573. [PMID: 31452193 PMCID: PMC6710643 DOI: 10.1002/14651858.cd012573.pub2] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Overconsumption of food, alcohol, and tobacco products increases the risk of non-communicable diseases. Interventions to change characteristics of physical micro-environments where people may select or consume these products - including shops, restaurants, workplaces, and schools - are of considerable public health policy and research interest. This review addresses two types of intervention within such environments: altering the availability (the range and/or amount of options) of these products, or their proximity (the distance at which they are positioned) to potential consumers. OBJECTIVES 1. To assess the impact on selection and consumption of altering the availability or proximity of (a) food (including non-alcoholic beverages), (b) alcohol, and (c) tobacco products.2. To assess the extent to which the impact of these interventions is modified by characteristics of: i. studies, ii. interventions, and iii. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, PsycINFO, and seven other published or grey literature databases, as well as trial registries and key websites, up to 23 July 2018, followed by citation searches. SELECTION CRITERIA We included randomised controlled trials with between-participants (parallel group) or within-participants (cross-over) designs. Eligible studies compared effects of exposure to at least two different levels of availability of a product or its proximity, and included a measure of selection or consumption of the manipulated product. DATA COLLECTION AND ANALYSIS We used a novel semi-automated screening workflow and applied standard Cochrane methods to select eligible studies, collect data, and assess risk of bias. In separate analyses for availability interventions and proximity interventions, we combined results using random-effects meta-analysis and meta-regression models to estimate summary effect sizes (as standardised mean differences (SMDs)) and to investigate associations between summary effect sizes and selected study, intervention, or participant characteristics. We rated the certainty of evidence for each outcome using GRADE. MAIN RESULTS We included 24 studies, with the majority (20/24) giving concerns about risk of bias. All of the included studies investigated food products; none investigated alcohol or tobacco. The majority were conducted in laboratory settings (14/24), with adult participants (17/24), and used between-participants designs (19/24). All studies were conducted in high-income countries, predominantly in the USA (14/24).Six studies investigated availability interventions, of which two changed the absolute number of different options available, and four altered the relative proportion of less-healthy (to healthier) options. Most studies (4/6) manipulated snack foods or drinks. For selection outcomes, meta-analysis of three comparisons from three studies (n = 154) found that exposure to fewer options resulted in a large reduction in selection of the targeted food(s): SMD -1.13 (95% confidence interval (CI) -1.90 to -0.37) (low certainty evidence). For consumption outcomes, meta-analysis of three comparisons from two studies (n = 150) found that exposure to fewer options resulted in a moderate reduction in consumption of those foods, but with considerable uncertainty: SMD -0.55 (95% CI -1.27 to 0.18) (low certainty evidence).Eighteen studies investigated proximity interventions. Most (14/18) changed the distance at which a snack food or drink was placed from the participants, whilst four studies changed the order of meal components encountered along a line. For selection outcomes, only one study with one comparison (n = 41) was identified, which found that food placed farther away resulted in a moderate reduction in its selection: SMD -0.65 (95% CI -1.29 to -0.01) (very low certainty evidence). For consumption outcomes, meta-analysis of 15 comparisons from 12 studies (n = 1098) found that exposure to food placed farther away resulted in a moderate reduction in its consumption: SMD -0.60 (95% CI -0.84 to -0.36) (low certainty evidence). Meta-regression analyses indicated that this effect was greater: the farther away the product was placed; when only the targeted product(s) was available; when participants were of low deprivation status; and when the study was at high risk of bias. AUTHORS' CONCLUSIONS The current evidence suggests that changing the number of available food options or altering the positioning of foods could contribute to meaningful changes in behaviour, justifying policy actions to promote such changes within food environments. However, the certainty of this evidence as assessed by GRADE is low or very low. To enable more certain and generalisable conclusions about these potentially important effects, further research is warranted in real-world settings, intervening across a wider range of foods - as well as alcohol and tobacco products - and over sustained time periods.
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Affiliation(s)
- Gareth J Hollands
- University of CambridgeBehaviour and Health Research UnitForvie SiteRobinson WayCambridgeUKCB2 0SR
| | - Patrice Carter
- University College LondonCentre for Outcomes Research and Effectiveness1‐19 Torrington PlaceLondonUKWC1E 7HB
| | - Sumayya Anwer
- University of BristolPopulation Health Sciences, Bristol Medical SchoolCanynge Hall, 39 Whatley RoadBristolUKBS8 2PS
| | - Sarah E King
- University of CambridgeBehaviour and Health Research UnitForvie SiteRobinson WayCambridgeUKCB2 0SR
| | - Susan A Jebb
- University of OxfordNuffield Department of Primary Care Health SciencesRadcliffe Observatory QuarterWoodstock RoadOxfordUKOX2 6GG
| | - David Ogilvie
- University of CambridgeMRC Epidemiology UnitBox 285Cambridge Biomedical CampusCambridgeUKCB2 0QQ
| | - Ian Shemilt
- University College LondonEPPI‐Centre10 Woburn SquareLondonUKWC1H 0NR
| | - Julian P T Higgins
- University of BristolPopulation Health Sciences, Bristol Medical SchoolCanynge Hall, 39 Whatley RoadBristolUKBS8 2PS
| | - Theresa M Marteau
- University of CambridgeBehaviour and Health Research UnitForvie SiteRobinson WayCambridgeUKCB2 0SR
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von Philipsborn P, Stratil JM, Burns J, Busert LK, Pfadenhauer LM, Polus S, Holzapfel C, Hauner H, Rehfuess E. Environmental interventions to reduce the consumption of sugar-sweetened beverages and their effects on health. Cochrane Database Syst Rev 2019; 6:CD012292. [PMID: 31194900 PMCID: PMC6564085 DOI: 10.1002/14651858.cd012292.pub2] [Citation(s) in RCA: 93] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Frequent consumption of excess amounts of sugar-sweetened beverages (SSB) is a risk factor for obesity, type 2 diabetes, cardiovascular disease and dental caries. Environmental interventions, i.e. interventions that alter the physical or social environment in which individuals make beverage choices, have been advocated as a means to reduce the consumption of SSB. OBJECTIVES To assess the effects of environmental interventions (excluding taxation) on the consumption of sugar-sweetened beverages and sugar-sweetened milk, diet-related anthropometric measures and health outcomes, and on any reported unintended consequences or adverse outcomes. SEARCH METHODS We searched 11 general, specialist and regional databases from inception to 24 January 2018. We also searched trial registers, reference lists and citations, scanned websites of relevant organisations, and contacted study authors. SELECTION CRITERIA We included studies on interventions implemented at an environmental level, reporting effects on direct or indirect measures of SSB intake, diet-related anthropometric measures and health outcomes, or any reported adverse outcome. We included randomised controlled trials (RCTs), non-randomised controlled trials (NRCTs), controlled before-after (CBA) and interrupted-time-series (ITS) studies, implemented in real-world settings with a combined length of intervention and follow-up of at least 12 weeks and at least 20 individuals in each of the intervention and control groups. We excluded studies in which participants were administered SSB as part of clinical trials, and multicomponent interventions which did not report SSB-specific outcome data. We excluded studies on the taxation of SSB, as these are the subject of a separate Cochrane Review. DATA COLLECTION AND ANALYSIS Two review authors independently screened studies for inclusion, extracted data and assessed the risks of bias of included studies. We classified interventions according to the NOURISHING framework, and synthesised results narratively and conducted meta-analyses for two outcomes relating to two intervention types. We assessed our confidence in the certainty of effect estimates with the GRADE framework as very low, low, moderate or high, and presented 'Summary of findings' tables. MAIN RESULTS We identified 14,488 unique records, and assessed 1030 in full text for eligibility. We found 58 studies meeting our inclusion criteria, including 22 RCTs, 3 NRCTs, 14 CBA studies, and 19 ITS studies, with a total of 1,180,096 participants. The median length of follow-up was 10 months. The studies included children, teenagers and adults, and were implemented in a variety of settings, including schools, retailing and food service establishments. We judged most studies to be at high or unclear risk of bias in at least one domain, and most studies used non-randomised designs. The studies examine a broad range of interventions, and we present results for these separately.Labelling interventions (8 studies): We found moderate-certainty evidence that traffic-light labelling is associated with decreasing sales of SSBs, and low-certainty evidence that nutritional rating score labelling is associated with decreasing sales of SSBs. For menu-board calorie labelling reported effects on SSB sales varied.Nutrition standards in public institutions (16 studies): We found low-certainty evidence that reduced availability of SSBs in schools is associated with decreased SSB consumption. We found very low-certainty evidence that improved availability of drinking water in schools and school fruit programmes are associated with decreased SSB consumption. Reported associations between improved availability of drinking water in schools and student body weight varied.Economic tools (7 studies): We found moderate-certainty evidence that price increases on SSBs are associated with decreasing SSB sales. For price discounts on low-calorie beverages reported effects on SSB sales varied.Whole food supply interventions (3 studies): Reported associations between voluntary industry initiatives to improve the whole food supply and SSB sales varied.Retail and food service interventions (7 studies): We found low-certainty evidence that healthier default beverages in children's menus in chain restaurants are associated with decreasing SSB sales, and moderate-certainty evidence that in-store promotion of healthier beverages in supermarkets is associated with decreasing SSB sales. We found very low-certainty evidence that urban planning restrictions on new fast-food restaurants and restrictions on the number of stores selling SSBs in remote communities are associated with decreasing SSB sales. Reported associations between promotion of healthier beverages in vending machines and SSB intake or sales varied.Intersectoral approaches (8 studies): We found moderate-certainty evidence that government food benefit programmes with restrictions on purchasing SSBs are associated with decreased SSB intake. For unrestricted food benefit programmes reported effects varied. We found moderate-certainty evidence that multicomponent community campaigns focused on SSBs are associated with decreasing SSB sales. Reported associations between trade and investment liberalisation and SSB sales varied.Home-based interventions (7 studies): We found moderate-certainty evidence that improved availability of low-calorie beverages in the home environment is associated with decreased SSB intake, and high-certainty evidence that it is associated with decreased body weight among adolescents with overweight or obesity and a high baseline consumption of SSBs.Adverse outcomes reported by studies, which may occur in some circumstances, included negative effects on revenue, compensatory SSB consumption outside school when the availability of SSBs in schools is reduced, reduced milk intake, stakeholder discontent, and increased total energy content of grocery purchases with price discounts on low-calorie beverages, among others. The certainty of evidence on adverse outcomes was low to very low for most outcomes.We analysed interventions targeting sugar-sweetened milk separately, and found low- to moderate-certainty evidence that emoticon labelling and small prizes for the selection of healthier beverages in elementary school cafeterias are associated with decreased consumption of sugar-sweetened milk. We found low-certainty evidence that improved placement of plain milk in school cafeterias is not associated with decreasing sugar-sweetened milk consumption. AUTHORS' CONCLUSIONS The evidence included in this review indicates that effective, scalable interventions addressing SSB consumption at a population level exist. Implementation should be accompanied by high-quality evaluations using appropriate study designs, with a particular focus on the long-term effects of approaches suitable for large-scale implementation.
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Affiliation(s)
- Peter von Philipsborn
- Ludwig‐Maximilians‐University MunichInstitute for Medical Informatics, Biometry and Epidemiology, Pettenkofer School of Public HealthMarchioninistr. 15MunichBavariaGermany81377
| | - Jan M Stratil
- Ludwig‐Maximilians‐University MunichInstitute for Medical Informatics, Biometry and Epidemiology, Pettenkofer School of Public HealthMarchioninistr. 15MunichBavariaGermany81377
| | - Jacob Burns
- Ludwig‐Maximilians‐University MunichInstitute for Medical Informatics, Biometry and Epidemiology, Pettenkofer School of Public HealthMarchioninistr. 15MunichBavariaGermany81377
| | - Laura K Busert
- University College LondonGreat Ormond Street Institute of Child HealthLondonUK
| | - Lisa M Pfadenhauer
- Ludwig‐Maximilians‐University MunichInstitute for Medical Informatics, Biometry and Epidemiology, Pettenkofer School of Public HealthMarchioninistr. 15MunichBavariaGermany81377
| | - Stephanie Polus
- Ludwig‐Maximilians‐University MunichInstitute for Medical Informatics, Biometry and Epidemiology, Pettenkofer School of Public HealthMarchioninistr. 15MunichBavariaGermany81377
| | - Christina Holzapfel
- School of Medicine, Technical University of MunichInstitute of Nutritional Medicine, Else Kroener‐Fresenius Centre for Nutritional MedicineMunichGermany
| | - Hans Hauner
- School of Medicine, Technical University of MunichInstitute of Nutritional Medicine, Else Kroener‐Fresenius Centre for Nutritional MedicineMunichGermany
| | - Eva Rehfuess
- Ludwig‐Maximilians‐University MunichInstitute for Medical Informatics, Biometry and Epidemiology, Pettenkofer School of Public HealthMarchioninistr. 15MunichBavariaGermany81377
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Lawman HG, Lofton X, Grossman S, Root M, Perez M, Tasian G, Patel A. A randomized trial of a multi-level intervention to increase water access and appeal in community recreation centers. Contemp Clin Trials 2019; 79:14-20. [PMID: 30771559 PMCID: PMC6499604 DOI: 10.1016/j.cct.2019.02.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Revised: 02/04/2019] [Accepted: 02/11/2019] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Improving children's tap water intake and reducing sugar-sweetened beverage (SSB) consumption is beneficial for health and health equity, particularly in low-income communities and communities of color. Existing community level interventions to improve the intake of tap water have predominantly occurred in schools and have focused on promoting water consumption in cafeterias during lunch or snack periods. METHODS The "Hydrate Philly" intervention was developed to target multiple environmental and social factors to improve tap water consumption in community recreation centers in low-income communities: replacing old and unappealing water fountains with appealing water-bottle-filling "hydration stations", conducting water safety testing and publicizing results, disseminating reusable water bottles, promoting tap water, and discouraging SSB consumption. Efficacy of the intervention will be tested through a group-randomized controlled trial (n = 28 centers) of the intervention's impact on center-level water fountain/station use as measured by flow meters during a youth summer camp program primarily for children aged 6-12 years. Intervention impact on the primary outcome (use of drinking water sources) will be examined with a difference-in-differences approach using an ordinary least squares regression model for analysis at the center level. Secondary outcomes include SSBs brought to summer camp, reusable and single-use bottled water use, program trash, and recreation center staff SSB consumption. DISCUSSION Multilevel approaches are needed to increase tap water intake and decrease SSB consumption among low-income and minority youth beyond school and meal settings. The current study describes the Hydrate Philly intervention, the study design, and baseline characteristics of recreation centers participating in the study. ClinicalTrials.gov Registration: #NCT03637465.
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Affiliation(s)
- Hannah G Lawman
- Philadelphia Department of Public Health, Philadelphia, PA, USA.
| | - Xavier Lofton
- Philadelphia Department of Public Health, Philadelphia, PA, USA
| | - Sara Grossman
- Philadelphia Department of Public Health, Philadelphia, PA, USA
| | - Mica Root
- Philadelphia Department of Public Health, Philadelphia, PA, USA
| | - Meka Perez
- Philadelphia Department of Public Health, Philadelphia, PA, USA; Philadelphia Parks and Recreation Department, Philadelphia, PA, USA
| | - Gregory Tasian
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Anisha Patel
- School of Medicine, Stanford University, Stanford, CA, USA; Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA, USA
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Cradock AL, Everett Jones S, Merlo C. Examining differences in the implementation of school water-quality practices and water-access policies by school demographic characteristics. Prev Med Rep 2019; 14:100823. [PMID: 30847271 PMCID: PMC6389728 DOI: 10.1016/j.pmedr.2019.100823] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 01/04/2019] [Accepted: 02/06/2019] [Indexed: 11/28/2022] Open
Abstract
Ensuring safe, accessible drinking water in schools is a national health priority. The objective of this study was to identify whether there are differences in water quality, availability, and education- related practices in schools by demographic characteristics. In 2017-2018, we analyzed data from the 2014 School Health Policies and Practices Study (SHPPS), a nationally representative, cross-sectional survey of US schools. Analyses examined differences in water-related practices by school characteristics. Response rates for the 3 questionnaires used in this analysis ranged from 69%-94% (Ns ranged from 495 to 577). We found that less than half of schools flush drinking water outlets after periods of non-use (46.4%), conduct periodic inspections that test drinking water outlets for lead (45.8%), and require staff training on drinking water quality (25.6%). Most schools teach the importance of water consumption (81.1%) and offer free drinking water in the cafeteria (88.3%). Some water-related school practices differed by school demographic characteristics though no consistent patterns of associations by school characteristics emerged. In US schools, some water quality-related practices are limited, but water availability and education-related practices are more common. SHPPS data suggest many schools would benefit from support to implement best practices related to school-drinking water.
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Affiliation(s)
- Angie L Cradock
- Prevention Research Center on Nutrition and Physical Activity, Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, 7th Floor, Boston, MA, USA
| | - Sherry Everett Jones
- Division of Adolescent and School Health, Centers for Disease Control and Prevention, 1600 Clifton Rd, NE, MS E75, Atlanta, GA, 30329, USA
| | - Caitlin Merlo
- Division of Population Health, Centers for Disease Control and Prevention, 4770 Buford Highway, NE, MS S107-6, Atlanta, GA 30341, USA
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Sliwa SA, Calvert HG, Williams HP, Turner L. Prevalence and Types of School-Based Out-of-School Time Programs at Elementary Schools and Implications for Student Nutrition and Physical Activity. THE JOURNAL OF SCHOOL HEALTH 2019; 89:48-58. [PMID: 30506694 PMCID: PMC6743323 DOI: 10.1111/josh.12710] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 01/30/2018] [Accepted: 02/23/2018] [Indexed: 05/03/2023]
Abstract
BACKGROUND Out-of-school time (OST) programs are an important setting for supporting student health and academic achievement. This study describes the prevalence and characteristics of school-based OST programs, which can inform efforts to promote healthy behaviors in this setting. METHODS A nationally representative sample of public elementary schools (N = 640) completed surveys in 2013-2014. Administrators reported on OST programs and policies at their school. Multivariable logistic regression models estimated the prevalence of school-based OST programs, adjusting for school characteristics. Among schools with OST programs (N = 475), chi-square tests identified school characteristics associated with having an OST policy about physical activity or nutrition. RESULTS Three fourths of elementary schools (75.6%) had a full- or partial-year school-based OST program, with 30.8% having both. Full- and partial-year programs were significantly less prevalent in rural and township areas versus urban settings. Only 27.5% of schools with OST programs reported having physical activity and/or nutrition policies. CONCLUSIONS Most US elementary schools have an on-site OST program, but disparities in access exist, and most lack policies or awareness of existing policies regarding physical activity and nutrition. To maximize OST programs' potential benefits, strategies are needed to increase access to programs and physical activity and/or nutrition policy adoption.
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Affiliation(s)
- Sarah A. Sliwa
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Highway, GA 30341
| | - Hannah G. Calvert
- College of Education, Boise State University, 1910 University Drive, #1740, Boise, ID 83725-1740
| | - Heather P. Williams
- College of Education, Boise State University, 1910 University Drive, #1740, Boise, ID 83725-1740
| | - Lindsey Turner
- College of Education, Boise State University, 1910 University Drive, #1740, Boise, ID 83725-1740
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Intervention leads to improvements in the nutrient profile of snacks served in afterschool programs: a group randomized controlled trial. Transl Behav Med 2017; 6:329-38. [PMID: 27528522 DOI: 10.1007/s13142-015-0342-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Widely adopted nutrition policies for afterschool programs (ASPs) focus on serving a fruit/vegetable daily and eliminating sugar-sweetened foods/beverages. The impact of these policies on the nutrient profile of snacks served is unclear. Evaluate changes in macro/micronutrient content of snacks served in ASPs. A 1-year group randomized controlled trial was conducted in 20 ASPs serving over 1700 elementary-age children. Intervention ASPs received a multistep adaptive framework intervention. Direct observation of snack served was collected and nutrient information determined using the USDA Nutrient Database, standardized to nutrients/100 kcal. By post-assessment, intervention ASPs reduced total kcal/snack served by 66 kcal (95CI -114 to -19 kcal) compared to control ASPs. Total fiber (+1.7 g/100 kcal), protein (+1.4 g/100 kcal), polyunsaturated fat (+1.2 g/100 kcal), phosphorous (+49.0 mg/100 kcal), potassium (+201.8 mg/100 kcal), and vitamin K (+21.5 μg/100 kcal) increased in intervention ASPs, while added sugars decreased (-5.0 g/100 kcal). Nutrition policies can lead to modest daily caloric reductions and improve select macro/micronutrients in snacks served. Long-term, these nutritional changes may contribute to healthy dietary habits.
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Beets MW, Weaver RG, Turner-McGrievy G, Huberty J, Moore JB, Ward DS, Freedman DA, Beighle A. Two-Year Healthy Eating Outcomes: An RCT in Afterschool Programs. Am J Prev Med 2017; 53:316-326. [PMID: 28532659 PMCID: PMC5562516 DOI: 10.1016/j.amepre.2017.03.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 02/10/2017] [Accepted: 03/08/2017] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Across the U.S., afterschool programs (ASPs, 3:00pm-6:00pm) are trying to achieve nationally endorsed nutrition standards (Healthy Eating Standards) calling for fruits/vegetables and water to be served every day, while eliminating sugar-sweetened beverages and foods. The purpose of this study was to evaluate the 2-year changes in the types of foods and beverages served during a community-based intervention designed to achieve the Healthy Eating Standards. STUDY DESIGN Randomized delayed treatment trial with an immediate (1-year baseline and 2-year intervention) or delayed (2-year baseline and 1-year intervention) group. SETTING/PARTICIPANTS Twenty ASPs serving 1,700 children (aged 5-12 years) were recruited, with baseline occurring spring 2013, and outcome assessment occurring spring 2014 and 2015. INTERVENTION The multistep intervention, Strategies To Enhance Practice for Healthy Eating, assisted ASP leaders/staff to serve foods/beverages that meet the nutrition standards. MAIN OUTCOME MEASURES The foods and beverages served for snack were observed directly. RESULTS Compared with non-intervention years, both the immediate and delayed groups increased the number of days/week that fruits/vegetables (0.6 vs 1.7 days/week and 0.6 vs 4.4 days/week, OR=3.80, 95% CI=1.45, 9.95) and water (2.3 vs 3.7 days/week and 2.7 vs 4.8 days/week, OR=4.65, 95% CI=1.69, 12.79) were served. Sugar-sweetened beverages were almost eliminated by post-assessment (1.2 vs 0.2 days/week and 3.2 vs 0.0 days/week, OR=0.05, 95% CI=0.02, 0.13). Only the immediate group decreased the number of days/week desserts were served (2.9 vs 0.6 days/week, OR=0.10, 95% CI=0.03, 0.33). Implementation barriers for the delayed group included once/month delivery schedules for fruits/vegetables and limited storage space for foods meeting the Healthy Eating Standards. CONCLUSIONS Improvements in the foods/beverages served in ASPs can be made, yet were hindered by structural barriers related to procurement and storage of perishable foods. Additional efforts are needed to support ASPs as they work toward fully achieving the Healthy Eating Standards.
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Affiliation(s)
- Michael W Beets
- Arnold School of Public Health, University of South Carolina, Columbia, South Carolina.
| | - R Glenn Weaver
- Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | | | - Jennifer Huberty
- School of Nutrition and Health Promotion, Arizona State University, Phoenix, Arizona
| | - Justin B Moore
- Family and Community Medicine, Wake Forest School of Medicine, Wake Forest University, Winston-Salem, North Carolina
| | - Dianne S Ward
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, Chapel Hill, North Carolina
| | - Darcy A Freedman
- Department of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, Ohio
| | - Aaron Beighle
- College of Education, University of Kentucky, Lexington, Kentucky
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Franckle RL, Falbe J, Gortmaker S, Barrett JL, Giles C, Ganter C, Blaine RE, Buszkiewicz J, Taveras EM, Kwass JA, Land T, Davison KK. Student obesity prevalence and behavioral outcomes for the massachusetts childhood obesity research demonstration project. Obesity (Silver Spring) 2017; 25:1175-1182. [PMID: 28653502 PMCID: PMC5488705 DOI: 10.1002/oby.21867] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 03/02/2017] [Accepted: 03/17/2017] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To examine changes in prevalence of obesity and target health behaviors (fruit, vegetable, and beverage consumption; physical activity; screen time; sleep duration) among students from communities that participated in the Massachusetts Childhood Obesity Research Demonstration (MA-CORD) project compared to controls. METHODS MA-CORD was implemented in two low-income communities. School-level prevalence of obesity among students in first, fourth, and seventh grades was calculated for the intervention communities and nine matched control communities pre and post intervention. Fourth- and seventh-grade students' self-reported health behaviors were measured in intervention communities at baseline and post intervention. RESULTS Among seventh-graders (the student group with greatest intervention exposure), a statistically significant decrease in prevalence of obesity from baseline to post intervention in Community 2 (-2.68%, P = 0.049) and a similar but nonsignificant decrease in Community 1 (-2.24%, P = 0.099) was observed. Fourth- and seventh-grade students in both communities were more likely to meet behavioral targets post intervention for sugar-sweetened beverages (both communities: P < 0.0001) and water (Community 1: P < 0.01; Community 2: P = 0.04) and in Community 2 for screen time (P < 0.01). CONCLUSIONS This multisector intervention was associated with a modest reduction in obesity prevalence among seventh-graders in one community compared to controls, along with improvements in behavioral targets.
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Affiliation(s)
- Rebecca L. Franckle
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Jennifer Falbe
- Division of Community Health and Human Development, School of Public Health, University of California, Berkeley, CA
| | - Steven Gortmaker
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Jessica L. Barrett
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Catherine Giles
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Claudia Ganter
- Medical Faculty Mannheim, Heidelberg University, Mannheim Institute of Public Health, Social and Preventive Medicine, Mannheim, Germany
| | - Rachel E. Blaine
- Department of Family and Consumer Sciences, California State University, Long Beach, CA
| | - James Buszkiewicz
- Department of Epidemiology, University of Washington School of Public Health, Seattle, WA
| | - Elsie M. Taveras
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
- Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children, Boston, MA
| | - Jo-Ann Kwass
- Bureau of Community Health and Prevention, Massachusetts Department of Public Health, Boston, MA
| | - Thomas Land
- Office of Data Management and Outcomes Assessment, Massachusetts Department of Public Health, Boston, MA
| | - Kirsten K. Davison
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA
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Barrett N, Colón-Ramos U, Elkins A, Rivera I, Evans WD, Edberg M. Formative Research to Design a Promotional Campaign to Increase Drinking Water among Central American Latino Youth in an Urban Area. JOURNAL OF HEALTH COMMUNICATION 2017; 22:459-468. [PMID: 28426322 DOI: 10.1080/10810730.2017.1303557] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Latinos consume more sugary drinks and less water than other demographic groups. Our objective was to understand beverage choice motivations and test promotional concepts that can encourage Central American Latino urban youth to drink more water. Two rounds of focus group discussions were conducted (n = 10 focus groups, 61 participants, 6-18 years old). Data were transcribed verbatim and analyzed using inductive and deductive coding approaches. Youth motivations for drinking water were shaped by level of thirst, weather, energy, and perceptions of health benefits. Youth were discouraged from drinking water due to its taste and perceptions of the safety and cleanliness of tap water. Youth beverage preference depended on what their friends were drinking. Availability of water versus other beverages at home and other settings influenced their choice. Promotional materials that included mixed language, informative messages about the benefits of drinking water, and celebrities or athletes who were active, energized, and drinking water were preferred. A promotional campaign to increase water consumption among these Latino youth should include bicultural messages to underscore the power of water to quench true thirst, highlight the health benefits of drinking water, and address the safety of tap water.
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Affiliation(s)
- Nicole Barrett
- a Department of Global Health , Milken Institute School of Public Health, George Washington University , Washington , DC , USA
| | - Uriyoán Colón-Ramos
- a Department of Global Health , Milken Institute School of Public Health, George Washington University , Washington , DC , USA
| | - Allison Elkins
- a Department of Global Health , Milken Institute School of Public Health, George Washington University , Washington , DC , USA
| | | | - W Douglas Evans
- a Department of Global Health , Milken Institute School of Public Health, George Washington University , Washington , DC , USA
- c Department of Prevention and Community Health , Milken Institute School of Public Health, George Washington University , Washington , DC , USA
| | - Mark Edberg
- c Department of Prevention and Community Health , Milken Institute School of Public Health, George Washington University , Washington , DC , USA
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Kenney EL, Lee RM, Brooks CJ, Cradock AL, Gortmaker SL. What Do Children Eat in the Summer? A Direct Observation of Summer Day Camps That Serve Meals. J Acad Nutr Diet 2017; 117:1097-1103. [PMID: 28330733 DOI: 10.1016/j.jand.2017.01.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 01/24/2017] [Indexed: 01/01/2023]
Abstract
BACKGROUND More than 14 million children in the United States attend summer camp annually, yet little is known about the food environment in day camps. OBJECTIVE Our aim was to describe the nutritional quality of meals served to, brought by, and consumed by children attending summer day camps serving meals and snacks, and to describe camp water access. DESIGN We conducted a cross-sectional study. PARTICIPANTS/SETTINGS Participants were 149 children attending five summer camps in Boston, MA, in 2013. MAIN OUTCOME MEASURES Foods and beverages served were observed for 5 consecutive days. For 2 days, children's dietary intake was directly observed using a validated protocol. Outcome measures included total energy (kilocalories) and servings of different types of foods and beverages served and consumed during breakfast, lunch, and snack. STATISTICAL ANALYSES PERFORMED Mean total energy, trans fats, sodium, sugar, and fiber served per meal were calculated across the camps, as were mean weekly frequencies of serving fruits, vegetables, meat/meat alternates, grains, milk, 100% juice, sugar-sweetened beverages, whole grains, red/highly processed meats, grain-based desserts, and salty snacks. Mean consumption was calculated per camper per day. RESULTS Camps served a mean (standard deviation) of 647.7 (134.3) kcal for lunch, 401.8 (149.6) kcal for breakfast, and 266.4 (150.8) kcal for snack. Most camps served red/highly processed meats, salty snacks, and grain-based desserts frequently, and rarely served vegetables or water. Children consumed little (eg, at lunch, 36.5% of fruit portions, 35.0% of meat/meat alternative portions, and 37.6% of milk portions served) except for salty snacks (66.9% of portions) and grain-based desserts (64.1% of portions). Sugar-sweetened beverages and salty snacks were frequently brought to camp. One-quarter of campers drank nothing throughout the entire camp day. CONCLUSIONS The nutritional quality of foods and beverages served at summer day camps could be improved. Future studies should assess barriers to consumption of healthy foods and beverages in these settings.
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Economos CD, Anzman-Frasca S, Koomas AH, Chan G, Folta SC, Heck J, Newman M, Sacheck JM. Snacks, beverages, and physical activity during volunteer-led out-of-school-time programs: a cross-sectional analysis. BMC Public Health 2017; 17:125. [PMID: 28129761 PMCID: PMC5270327 DOI: 10.1186/s12889-017-4040-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 01/14/2017] [Indexed: 11/10/2022] Open
Abstract
Background Tens of millions of children regularly participate in out-of-school-time (OST) programs, providing an opportunity for child health promotion. Most research on OST has focused on structured, staff-led after-school programs, as opposed to volunteer-led programs such as enrichment programs and youth sports. The aim of this study was to describe snacks, beverages, and physical activity (PA) practices in volunteer-led OST programs across five organizations in three states. Methods An online survey including the Out-of-School-Time Snacks, Beverages, and Physical Activity Questionnaire was distributed to 1,695 adult leaders of enrichment and youth sports programs serving 5–12 year-old children in Maine, Massachusetts, and New Hampshire, USA. The response rate was 57.8%, with 980 leaders participating and 698 (136 youth sports, 562 enrichment) remaining after data cleaning procedures. Frequencies were calculated to describe snack, beverage, and PA offerings during typical meetings and whether healthy snack, beverage, and PA criteria were met. Criteria were developed a priori with the intent to capture co-occurring practices that together indicate healthy snack (fruits and vegetables or no snack over salty/sweet snacks); beverage (water over sugar-sweetened beverages); and PA environments (regular opportunities for >15 or 45 min of PA in enrichment and sports programs, respectively). Results About half of enrichment leaders reported that snacks and beverages were provided during typical meetings vs. one-fifth of sports leaders. In 28.4% of enrichment programs, PA was offered at every meeting vs. 98.5% of sports programs. Among enrichment programs, 50.4 and 25.8% met healthy snack and beverage criteria, respectively, and 29.4% met PA criteria, with 27.6% meeting criteria in two or more areas, and 5.0% in all three. Among sports programs, 72.8 and 78.7% met healthy snack and beverage criteria, respectively, and 71.3% met PA criteria. Eighty-two percent met criteria in two or more areas, and 46.3% met criteria in all three. Conclusions Most programs did not meet criteria for healthier snacks and beverages and opportunities for PA during typical meetings, indicating room for improvement in encouraging widespread adoption of these practices. Efforts to improve the healthfulness of snacks and beverages and increase opportunities for PA during volunteer-led OST programs are warranted. Electronic supplementary material The online version of this article (doi:10.1186/s12889-017-4040-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Christina D Economos
- ChildObesity180, Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Avenue, Boston, 02111, MA, USA. .,Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Avenue, Boston, MA, 02111, USA.
| | - Stephanie Anzman-Frasca
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, G56 Farber Hall, South Campus, Buffalo, NY, 14214, USA
| | - Alyssa H Koomas
- ChildObesity180, Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Avenue, Boston, 02111, MA, USA
| | - Grace Chan
- ChildObesity180, Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Avenue, Boston, 02111, MA, USA
| | - Sara C Folta
- Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Avenue, Boston, MA, 02111, USA
| | - Julianne Heck
- ChildObesity180, Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Avenue, Boston, 02111, MA, USA
| | - Molly Newman
- ChildObesity180, Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Avenue, Boston, 02111, MA, USA
| | - Jennifer M Sacheck
- Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Avenue, Boston, MA, 02111, USA
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Lee RM, Okechukwu C, Emmons KM, Gortmaker SL. Impact of implementation factors on children's water consumption in the Out-of-School Nutrition and Physical Activity group-randomized trial. ACTA ACUST UNITED AC 2016; 2014:79-101. [PMID: 25530242 DOI: 10.1002/yd.20105] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
National data suggest that children are not consuming enough water. Experimental evidence has linked increased water consumption to obesity prevention, and the National AfterSchool Association has named serving water as ones of its standards for healthy eating and physical activity in out-of-school time settings. From fall 2010 to spring 2011, twenty Boston afterschool program sites participated in the Out-of-School Nutrition and Physical Activity (OSNAP) initiative, a group-randomized trial investigating nutrition and physical activity policies and practices that promote child health. Researchers used data from OSNAP to study the key factors that influence the implementation of practices that promote water intake. Aspects of the organizational capacity of the afterschool programs, characteristics of the providers, and the community context were hypothesized to impact changes in children's water consumption. This chapter demonstrates the effectiveness of an afterschool intervention on increases in children's water consumption. It also outlines the substantial influence that implementation factors can have on the effectiveness of an obesity prevention intervention, highlighting the importance of understanding how interventions are delivered in real-world settings.
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Affiliation(s)
- Rebekka M Lee
- Department of Social and Behavioral Sciences, Harvard School of Public Health
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Beets MW, Weaver RG, Turner-McGrievy G, Beighle A, Moore JB, Webster C, Khan M, Saunders R. Compliance With the Healthy Eating Standards in YMCA After-School Programs. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2016; 48:555-562.e1. [PMID: 27372234 PMCID: PMC5018418 DOI: 10.1016/j.jneb.2016.05.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 05/25/2016] [Accepted: 05/26/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE In 2011, the YMCA of the US adopted Healthy Eating standards for all of their after-school programs (ASPs). The extent to which YMCA ASPs comply with the standards is unknown. METHODS Twenty ASPs from all YMCA ASPs across South Carolina (N = 102) were invited to participate. Direct observation of the food and beverages served and staff behaviors were collected on 4 nonconsecutive days per ASP. RESULTS One ASP did not serve a snack. Of the remaining ASPs, a total of 26% served a fruit or vegetable and 32% served water every day; 26% served sugar-sweetened beverages, 47% served sugar-added foods, and only 11% served whole grains when grains were served. Staff members sat with the children (65%) or verbally promoted healthy eating (15%) on at least 1 observation day. Staff drank non-approved drinks (25%) or foods (45%) on at least 1 observation day. No ASPs served snacks family-style every day. CONCLUSIONS AND IMPLICATIONS Additional efforts are required to assist YMCA-operated ASPs in achieving these important nutrition standards.
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Affiliation(s)
- Michael W Beets
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC.
| | - R Glenn Weaver
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC
| | - Gabrielle Turner-McGrievy
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC
| | - Aaron Beighle
- Department of Kinesiology & Health Promotion, College of Education, University of Kentucky, Lexington, KY
| | - Justin B Moore
- Department of Family & Community Medicine, Wake Forest School of Medicine, Winston-Salem, NC
| | - Collin Webster
- Department of Physical Education, College of Education, University of South Carolina, Columbia, SC
| | - Mahmud Khan
- Department of Health Service, Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC
| | - Ruth Saunders
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC
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Lane H, Porter K, Estabrooks P, Zoellner J. A Systematic Review to Assess Sugar-Sweetened Beverage Interventions for Children and Adolescents across the Socioecological Model. J Acad Nutr Diet 2016; 116:1295-1307.e6. [PMID: 27262383 PMCID: PMC4967019 DOI: 10.1016/j.jand.2016.04.015] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Accepted: 04/21/2016] [Indexed: 01/06/2023]
Abstract
Sugar-sweetened beverage (SSB) consumption among children and adolescents is a determinant of childhood obesity. Many programs to reduce consumption across the socioecological model report significant positive results; however, the generalizability of the results, including whether reporting differences exist among socioecological strategy levels, is unknown. This systematic review aimed to examine the extent to which studies reported internal and external validity indicators defined by the reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) model and assess reporting differences by socioecological level: Intrapersonal/interpersonal (Level 1), environmental/policy (Level 2), and multilevel (Combined Level). A systematic literature review was conducted in six major databases (PubMed, Web of Science, Cinahl, CAB Abstracts, Education Research Information Center, and Arcola) to identify studies from 2004-2015 meeting inclusion criteria (children aged 3 to 12 years, adolescents aged 13 to 17 years, and young adults aged 18 years, experimental or quasiexperimental, and substantial SSB component). Interventions were categorized by socioecological level, and data were extracted using a validated RE-AIM protocol. One-way analysis of variance assessed differences between levels. There were 55 eligible studies accepted, including 21 Level 1, 18 Level 2, and 16 Combined Level studies. Thirty-six studies (65%) were conducted in the United States, 19 studies (35%) were conducted internationally, and 39 studies (71%) were implemented in schools. Across levels, reporting averages were low for all RE-AIM dimensions (reach=29%, efficacy or effectiveness=45%, adoption=26%, implementation=27%, and maintenance=14%). Level 2 studies had significantly lower reporting on reach and effectiveness (10% and 26%, respectively) compared with Level 1 (44% and 57%, respectively) or Combined Level studies (31% and 52%, respectively) (P<0.001). Adoption, implementation, and maintenance reporting did not vary among levels. Interventions to reduce SSB consumption in children and adolescents across the socioecological spectrum do not provide the necessary information for dissemination and implementation in community nutrition settings. Future interventions should address both internal and external validity to maximize population influence.
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Affiliation(s)
- Hannah Lane
- Virginia Tech, Department of Human Nutrition, Foods and Exercise, 1981 Kraft Drive, Blacksburg, VA 24061, 540-797-3465,
| | - Kathleen Porter
- Virginia Tech, Department of Human Nutrition, Foods and Exercise, 1981 Kraft Drive, Blacksburg, VA 24061, 540-231-1267,
| | - Paul Estabrooks
- University of Nebraska Medical Center, Department of Health Promotion, Social & Behavioral Health, Omaha, NE 68198, 402-559-4325,
| | - Jamie Zoellner
- Virginia Tech, Department of Human Nutrition, Foods and Exercise, 1981 Kraft Drive, Blacksburg, VA 24061, 540-231-3670,
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von Philipsborn P, Stratil JM, Burns J, Busert LK, Pfadenhauer LM, Polus S, Holzapfel C, Hauner H, Rehfuess E. Environmental interventions to reduce the consumption of sugar-sweetened beverages and their effects on health. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2016. [DOI: 10.1002/14651858.cd012292] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Peter von Philipsborn
- Technical University Munich; Faculty of Medicine; Stuntzstrasse 12 81677 Munich Germany
| | - Jan M Stratil
- University of Tuebingen; Faculty of Medicine; Wilhelmstrasse 127 Tuebingen Germany 72076
| | - Jacob Burns
- Ludwig-Maximilians-University Munich; Institute for Medical Informatics, Biometry and Epidemiology; Marchioninistr. 15 Munich Bavaria Germany
| | - Laura K Busert
- Ludwig-Maximilians-University Munich; Institute for Medical Informatics, Biometry and Epidemiology; Marchioninistr. 15 Munich Bavaria Germany
| | - Lisa M Pfadenhauer
- Ludwig-Maximilians-University Munich; Institute for Medical Informatics, Biometry and Epidemiology; Marchioninistr. 15 Munich Bavaria Germany
| | - Stephanie Polus
- Ludwig-Maximilians-University Munich; Institute for Medical Informatics, Biometry and Epidemiology; Marchioninistr. 15 Munich Bavaria Germany
| | - Christina Holzapfel
- Technische Universität München Klinikum rechts der Isar; Institute for Nutritional Medicine; Munich Germany
| | - Hans Hauner
- Technische Universität München Klinikum rechts der Isar; Institute for Nutritional Medicine; Munich Germany
| | - Eva Rehfuess
- Ludwig-Maximilians-University Munich; Institute for Medical Informatics, Biometry and Epidemiology; Marchioninistr. 15 Munich Bavaria Germany
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Schwartz AE, Leardo M, Aneja S, Elbel B. Effect of a School-Based Water Intervention on Child Body Mass Index and Obesity. JAMA Pediatr 2016; 170:220-6. [PMID: 26784336 PMCID: PMC4977575 DOI: 10.1001/jamapediatrics.2015.3778] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Decreasing the amount of caloric beverages consumed and simultaneously increasing water consumption is important to promoting child health and decreasing the prevalence of childhood obesity. OBJECTIVE To estimate the impact of water jets (electrically cooled, large clear jugs with a push lever for fast dispensing) on standardized body mass index, overweight, and obesity in elementary school and middle school students. Milk purchases were explored as a potential mechanism for weight outcomes. DESIGN, SETTING, AND PARTICIPANTS This quasi-experimental study used a school-level database of cafeteria equipment deliveries between the 2008-2009 and 2012-2013 and included a sample of 1227 New York, New York, public elementary schools and middle schools and the 1,065,562 students within those schools. INTERVENTION Installation of water jets in schools. MAIN OUTCOMES AND MEASURES Individual body mass index (BMI) was calculated for all students in the sample using annual student-level height and weight measurements collected as part of New York's FITNESSGRAM initiative. Age- and sex-specific growth charts produced by the Centers for Disease Control and Prevention were used to categorize students as overweight and obese. The hypothesis that water jets would be associated with decreased standardized BMI, overweight, and obesity was tested using a difference-in-difference strategy, comparing outcomes for treated and nontreated students before and after the introduction of a water jet. RESULTS This study included 1 065 562 students within New York City public elementary schools and middle schools. There was a significant effect of water jets on standardized BMI, such that the adoption of water jets was associated with a 0.025 (95% CI, -0.038 to -0.011) reduction of standardized BMI for boys and a 0.022 (95% CI, -0.035 to -0.008) reduction of standardized BMI for girls (P < .01). There was also a significant effect on being overweight. Water jets were associated with a 0.9 percentage point reduction (95% CI, 0.015-0.003) in the likelihood of being overweight for boys and a 0.6 percentage reduction (95% CI, 0.011-0.000) in the likelihood of being overweight for girls (P < .05). We also found a 12.3 decrease (95% CI, -19.371 to -5.204) in the number of all types of milk half-pints purchased per student per year (P < .01). CONCLUSIONS AND RELEVANCE Results from this study show an association between a relatively low-cost water availability intervention and decreased student weight. Milk purchases were explored as a potential mechanism. Additional research is needed to examine potential mechanisms for decreased student weight, including reduced milk taking, as well as assessing impacts on longer-term outcomes.
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Affiliation(s)
| | - Michele Leardo
- New York University Institute for Education and Social Policy, New York
| | - Siddhartha Aneja
- New York University Institute for Education and Social Policy, New York
| | - Brian Elbel
- New York University School of Medicine, New York; New York University Robert F. Wagner Graduate School of Public Service, New York
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Hennessy E, Ornstein JT, Economos CD, Herzog JB, Lynskey V, Coffield E, Hammond RA. Designing an Agent-Based Model for Childhood Obesity Interventions: A Case Study of ChildObesity180. Prev Chronic Dis 2016; 13:E04. [PMID: 26741998 PMCID: PMC4707946 DOI: 10.5888/pcd13.150414] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Complex systems modeling can provide useful insights when designing and anticipating the impact of public health interventions. We developed an agent-based, or individual-based, computation model (ABM) to aid in evaluating and refining implementation of behavior change interventions designed to increase physical activity and healthy eating and reduce unnecessary weight gain among school-aged children. The potential benefits of applying an ABM approach include estimating outcomes despite data gaps, anticipating impact among different populations or scenarios, and exploring how to expand or modify an intervention. The practical challenges inherent in implementing such an approach include data resources, data availability, and the skills and knowledge of ABM among the public health obesity intervention community. The aim of this article was to provide a step-by-step guide on how to develop an ABM to evaluate multifaceted interventions on childhood obesity prevention in multiple settings. We used data from 2 obesity prevention initiatives and public-use resources. The details and goals of the interventions, overview of the model design process, and generalizability of this approach for future interventions is discussed.
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Affiliation(s)
- Erin Hennessy
- National Cancer Institute, National Institutes of Health, 9609 Medical Center Dr, Bethesda, MD 20852.
| | - Joseph T Ornstein
- Department of Political Science, University of Michigan, Ann Arbor, Michigan
| | - Christina D Economos
- ChildObesity180, Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts
| | - Julia Bloom Herzog
- ChildObesity180, Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts
| | - Vanessa Lynskey
- ChildObesity180, Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts
| | - Edward Coffield
- Department of Health Professions, Hofstra University, Hempstead, New York
| | - Ross A Hammond
- Center on Social Dynamics and Policy, The Brookings Institution, Washington, DC
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Kist-van Holthe J, Altenburg T, Chinapaw M. Question 1: What is the best strategy to promote water consumption in children? Arch Dis Child 2016; 101:107-9. [PMID: 26543070 DOI: 10.1136/archdischild-2015-309726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 10/15/2015] [Indexed: 11/04/2022]
Affiliation(s)
- Joana Kist-van Holthe
- Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Teatske Altenburg
- Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Mai Chinapaw
- Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
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Weaver RG, Beets MW, Hutto B, Saunders RP, Moore JB, Turner-McGrievy G, Huberty JL, Ward DS, Pate RR, Beighle A, Freedman D. Making healthy eating and physical activity policy practice: process evaluation of a group randomized controlled intervention in afterschool programs. HEALTH EDUCATION RESEARCH 2015; 30:849-65. [PMID: 26590240 PMCID: PMC4836399 DOI: 10.1093/her/cyv052] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Accepted: 10/16/2015] [Indexed: 05/20/2023]
Abstract
This study describes the link between level of implementation and outcomes from an intervention to increase afterschool programs' (ASPs) achievement of healthy eating and physical activity (HE-PA) Standards. Ten intervention ASPs implemented the Strategies-To-Enhance-Practice (STEPs), a multi-component, adaptive intervention framework identifying factors essential to meeting HE-PA Standards, while 10 control ASPs continued routine practice. All programs, intervention and control, were assigned a STEPs for HE-PA index score based on implementation. Mixed-effects linear regressions showed high implementation ASPs had the greatest percentage of boys and girls achieving 30 min of moderate-to-vigorous physical activity (47.3 and 29.3%), followed by low implementation ASPs (41.3 and 25.0%), and control ASPs (34.8 and 18.5%). For healthy eating, high/low implementation programs served fruits and vegetables an equivalent number of days, but more days than control programs (74.0 and 79.1% of days versus 14.2%). A similar pattern emerged for the percent of days sugar-sweetened foods and beverages were served, with high and low implementation programs serving sugar-sweetened foods (8.0 and 8.4% of days versus 52.2%), and beverages (8.7 and 2.9% of days versus 34.7%) equivalently, but less often than control programs. Differences in characteristics and implementation of STEPs for HE-PA between high/low implementers were also identified.
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Affiliation(s)
| | | | | | | | - Justin B Moore
- Department of Health Promotion, Education, and Behavior, Office of Practice and Community Engagement, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | | | - Jennifer L Huberty
- School of Nutrition and Health Promotion, College of Health Solutions, Arizona State University, Phoenix, AZ, USA
| | - Dianne S Ward
- Department of Nutrition, Schools of Public Health and Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Aaron Beighle
- Department of Kinesiology and Health Promotion, University of Kentucky, Lexington, KY, USA and
| | - Darcy Freedman
- Department of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, OH, USA
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A comprehensive professional development training's effect on afterschool program staff behaviors to promote healthy eating and physical activity. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2015; 20:E6-E14. [PMID: 24858323 DOI: 10.1097/phh.0b013e3182a1fb5d] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Evaluate a comprehensive intervention designed to support staff and program leaders in the implementation of the YMCA of USA healthy eating and physical activity (HEPA) standards for their afterschool programs (3-6 pm). DESIGN Pre- (fall 2011) and postassessment (spring 2012) no-control group. SETTING/PARTICIPANTS Four large-scale YMCA afterschool programs serving approximately 500 children. INTERVENTION Professional development training founded on the 5Ms (ie, Mission, Model, Manage, Monitor, and Maximize) and LET US Play principles (ie, Lines, Elimination, Team size, Uninvolved staff/kids, and Space, equipment, and rules), on-site booster training sessions, workshops, and ongoing technical support for staff and program leaders from January to May 2012. MAIN OUTCOME MEASURES System for Observing Staff Promotion of Activity and Nutrition. ANALYSIS Multilevel mixed-effects linear (ie, staff behaviors expressed as a percentage of the number of scans observed) and logistic regression. RESULTS A total of 5328 System for Observing Staff Promotion of Activity and Nutrition scans were completed over the 2 measurement periods. Of the 20 staff behaviors identified in HEPA standards and measured in this study, 17 increased or decreased in the appropriate direction. For example, the proportion staff engaged in physical activity with children increased from 26.6% to 37% and the proportion of staff eating unhealthy foods decreased from 42.1% to 4.5%. CONCLUSIONS Comprehensive professional development training, founded on the 5Ms and LET US Play principles, and ongoing technical assistance can have a sizable impact on key staff behaviors identified by HEPA standards for afterschool programs.
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Anzman-Frasca S, Boulos R, Hofer T, Folta SC, Koomas A, Nelson ME, Sacheck JM, Economos CD. Validation of the Out-of-School-Time Snacks, Beverages, and Physical Activity Questionnaire. Child Obes 2015; 11:439-48. [PMID: 26176191 PMCID: PMC8104022 DOI: 10.1089/chi.2014.0142] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Recent research has highlighted the potential for out-of-school-time (OST) environments to impact children's energy balance. Expanding upon this evidence requires validated measures to assess nutrition and physical activity (PA) environments across large samples of OST programs. The aim of this study was to assess the criterion validity of the Out-of-School-Time Snacks, Beverages, and Physical Activity Questionnaire (OST-SBPA), an online questionnaire designed to measure OST nutrition and PA environments by program leaders' reports. METHODS The study consisted of two samples of OST programs (total n=65). Objective data across program meetings were compared to program leaders' reports of usual snack, beverage, and PA offerings. All 65 programs provided snack and beverage data; PA data were available from 31 programs. Validity was assessed using percent agreement, Cohen's kappa, and Spearman's correlations. RESULTS All OST-SBPA items demonstrated agreement above 60% when dichotomized (e.g., none/some versus most/all of the time for frequency items). Most OST-SBPA items were significantly correlated with objective data, including how often fresh and processed fruits and vegetables, salty snacks, sweet snacks, protein snacks, milk, juice, and sweetened beverages were offered and four PA measures (r=0.43-0.78; p<0.01), whereas one item, the frequency that water was offered, was not (r=0.13; p=0.37). The water item demonstrated validity once water from water fountains was recoded and not considered a program-provided beverage. CONCLUSIONS These findings fill a gap in the literature through the validation of a brief questionnaire that can be used to assess OST nutrition and PA environments. The current results support the use of the OST-SBPA in studies aiming to assess and impact these environments.
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Affiliation(s)
- Stephanie Anzman-Frasca
- 1 ChildObesity180, Tufts University , Boston, MA
- 2 Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University , Boston, MA
| | - Rebecca Boulos
- 1 ChildObesity180, Tufts University , Boston, MA
- 2 Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University , Boston, MA
| | - Teresa Hofer
- 1 ChildObesity180, Tufts University , Boston, MA
| | - Sara C Folta
- 2 Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University , Boston, MA
- 3 Jonathan M. Tisch College of Citizenship and Public Service, Tufts University , Medford, MA
| | | | - Miriam E Nelson
- 1 ChildObesity180, Tufts University , Boston, MA
- 2 Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University , Boston, MA
- 3 Jonathan M. Tisch College of Citizenship and Public Service, Tufts University , Medford, MA
| | - Jennifer M Sacheck
- 2 Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University , Boston, MA
- 3 Jonathan M. Tisch College of Citizenship and Public Service, Tufts University , Medford, MA
| | - Christina D Economos
- 1 ChildObesity180, Tufts University , Boston, MA
- 2 Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University , Boston, MA
- 3 Jonathan M. Tisch College of Citizenship and Public Service, Tufts University , Medford, MA
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Frerichs L, Brittin J, Sorensen D, Trowbridge MJ, Yaroch AL, Siahpush M, Tibbits M, Huang TTK. Influence of school architecture and design on healthy eating: a review of the evidence. Am J Public Health 2015; 105:e46-57. [PMID: 25713964 PMCID: PMC4358206 DOI: 10.2105/ajph.2014.302453] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2014] [Indexed: 11/04/2022]
Abstract
We examined evidence regarding the influence of school physical environment on healthy-eating outcomes. We applied a systems perspective to examine multiple disciplines' theoretical frameworks and used a mixed-methods systematic narrative review method, considering both qualitative and quantitative sources (published through March 2014) for inclusion. We developed a causal loop diagram from 102 sources identified. We found evidence of the influence of many aspects of a school's physical environment on healthy-eating outcomes. The causal loop diagram highlights multilevel and interrelated factors and elucidates the specific roles of design and architecture in encouraging healthy eating within schools. Our review highlighted the gaps in current evidence and identified areas of research needed to refine and expand school architecture and design strategies for addressing healthy eating.
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Affiliation(s)
- Leah Frerichs
- At the time of the study, Leah Frerichs, Jeri Brittin, Amy L. Yaroch, Mohammad Siahpush, Melissa Tibbits, and Terry T.-K. Huang were with the College of Public Health, University of Nebraska Medical Center, Omaha. Dina Sorensen is with VMDO Architects, Charlottesville, VA. Matthew J. Trowbridge is with the School of Medicine, University of Virginia, Charlottesville
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Kenney EL, Davison KK, Austin SB, Giles CM, Cradock AL, Lee RM, Gortmaker SL. Validity and reliability of a simple, low-cost measure to quantify children's dietary intake in afterschool settings. J Acad Nutr Diet 2015; 115:426-432. [PMID: 25596895 PMCID: PMC5390520 DOI: 10.1016/j.jand.2014.11.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Accepted: 11/14/2014] [Indexed: 11/18/2022]
Abstract
BACKGROUND Interest in evaluating and improving children's diets in afterschool settings has grown, necessitating the development of feasible yet valid measures for capturing children's intake in such settings. OBJECTIVE The purpose of this study was to test the criterion validity and cost of three unobtrusive visual estimation methods compared with a plate-weighing method: direct onsite observation using a 4-category rating scale and offsite rating of digital photographs taken onsite using 4- and 10-category scales. DESIGN Researchers observed and photographed 174 total snack meals consumed across 2 days at each program. PARTICIPANTS/SETTING Participants were 111 children in first through sixth grades attending four afterschool programs in Boston, MA, during December 2011. STATISTICAL ANALYSIS Visual estimates of consumption were compared to weighed estimates (the criterion measure) using intraclass correlations. RESULTS All three methods were highly correlated with the criterion measure, ranging from 0.92 to 0.94 for total calories consumed, 0.86 to 0.94 for consumption of prepackaged beverages, 0.90 to 0.93 for consumption of fruits/vegetables, and 0.92 to 0.96 for consumption of grains. For water, which was not preportioned, coefficients ranged from 0.47 to 0.52. The photographic methods also demonstrated excellent interrater reliability: 0.84 to 0.92 for the 4-point and 0.92 to 0.95 for the 10-point scale. The costs of the methods for estimating intake ranged from $0.62 per observation for the onsite direct visual method to $0.95 per observation for the criterion measure. CONCLUSIONS Feasible, inexpensive methods can validly and reliably measure children's dietary intake in afterschool settings. Improving precision in measures of children's dietary intake can reduce the likelihood of spurious or null findings in future studies.
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Davison KK, Falbe J, Taveras EM, Gortmaker S, Kulldorff M, Perkins M, Blaine RE, Franckle RL, Ganter C, Woo Baidal J, Kwass JA, Buszkiewicz J, Smith L, Land T. Evaluation overview for the Massachusetts Childhood Obesity Research Demonstration (MA-CORD) project. Child Obes 2015; 11:23-36. [PMID: 25575095 PMCID: PMC5915219 DOI: 10.1089/chi.2014.0059] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND The Massachusetts Childhood Obesity Research Demonstration (MA-CORD) project is a 2-year, multilevel, multisector community intervention to prevent and control obesity among children 2-12 years of age from two predominantly low-income communities in Massachusetts. MA-CORD includes evidence-based interventions in multiple sectors, including community health centers, early care and education centers, schools, afterschool programs, the Special Supplemental Nutrition Program for Women, Infants and Children, and the broader community. Currently, implementation of MA-CORD is complete and the final year of data collection is in progress. Here, the MA-CORD evaluation plan is described and baseline data are presented. METHODS/DESIGN The impact of MA-CORD on children's BMI, lifestyle behaviors, obesity-related care, and quality of life will be assessed using sector-specific, pre/post, time-series, and quasi-experimental designs. Change in the primary outcomes will be compared for intervention and comparison communities. Additionally, change in mean BMI and obesity prevalence in intervention school districts will be compared to similar districts throughout the state. RESULTS At baseline in 2012, approximately 16% of preschool-aged and 25% of school-aged children were obese. Moreover, 15-40% of children consumed no vegetables on the previous day, 25-75% drank a sugar-sweetened beverage on the previous day, up to 87% had insufficient physical activity, 50-75% had a television in the room where they slept, and 50-80% obtained insufficient sleep. CONCLUSIONS There is ample room for improvement in BMI and health behaviors in children in MA-CORD communities. If successful, MA-CORD may serve as a model for multilevel, multisector approaches to childhood obesity prevention and control.
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Affiliation(s)
- Kirsten K. Davison
- Department of Nutrition, Harvard School of Public Health, Boston, MA
- Department of Social and Behavioral Science, Harvard School of Public Health, Boston, MA
| | - Jennifer Falbe
- Division of Community Health and Human Development, School of Public Health, University of California, Berkeley, CA
| | - Elsie M. Taveras
- Department of Nutrition, Harvard School of Public Health, Boston, MA
- Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children, Boston, MA
| | - Steve Gortmaker
- Department of Social and Behavioral Science, Harvard School of Public Health, Boston, MA
| | - Martin Kulldorff
- Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, MA
| | - Meghan Perkins
- Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children, Boston, MA
| | - Rachel E. Blaine
- Department of Nutrition, Harvard School of Public Health, Boston, MA
| | - Rebecca L. Franckle
- Department of Nutrition, Harvard School of Public Health, Boston, MA
- Department of Social and Behavioral Science, Harvard School of Public Health, Boston, MA
| | - Claudia Ganter
- Department of Nutrition, Harvard School of Public Health, Boston, MA
| | - Jennifer Woo Baidal
- Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children, Boston, MA
| | - Jo-Ann Kwass
- Bureau of Community Health and Prevention, Massachusetts Department of Public Health, Boston, MA
| | - James Buszkiewicz
- Bureau of Community Health and Prevention, Massachusetts Department of Public Health, Boston, MA
| | - Lauren Smith
- National Initiative for Children's Health Quality, Boston, MA
| | - Thomas Land
- Bureau of Community Health and Prevention, Massachusetts Department of Public Health, Boston, MA
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Taveras EM, Blaine RE, Davison KK, Gortmaker S, Anand S, Falbe J, Kwass JA, Perkins M, Giles C, Criss S, Colchamiro R, Woo Baidal J, Land T, Smith L. Design of the Massachusetts Childhood Obesity Research Demonstration (MA-CORD) study. Child Obes 2015; 11:11-22. [PMID: 25469676 PMCID: PMC4322791 DOI: 10.1089/chi.2014.0031] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Childhood obesity is highly prevalent, is associated with both short- and long-term adverse outcomes, disproportionately affects racial/ethnic minority and economically deprived children, and represents a major threat to public health. Among the most promising approaches for its prevention and management are multilevel, multisector strategies. METHODS/DESIGN The Massachusetts Childhood Obesity Research Demonstration (MA-CORD) Study was a comprehensive, systematic intervention to prevent and reduce childhood obesity among low-income children ages 2-12 years in two selected cities in Massachusetts. Building on the Obesity Chronic Care Model, MA-CORD expanded a state public health department community-level obesity prevention initiative that incorporated evidence-based interventions in primary healthcare, the Women, Infants, and Children program, early care and education, schools/afterschool programs, as well as community-wide programs to improve food, beverage, physical activity (PA), and messaging environments. The study used a combination of pre- and post-time series and quasi-experimental designs to examine the extent to which the intervention resulted in changes in BMI, individual-level lifestyle behaviors, satisfaction with healthcare services, and quality of life among children, as well as changes in health policies, programs, and environments in the two intervention cities, compared to a comparison city. The intervention period was 2 years. CONCLUSIONS MA-CORD will determine the extent to which a multisetting, multilevel intervention that integrates activities in primary care with broader public health interventions in schools, early care and education, and the community at large can improve children's dietary and PA behaviors and ultimately reduce obesity in low-income children.
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Affiliation(s)
- Elsie M. Taveras
- Division of General Academic Pediatrics, Department of Pediatrics, MassGeneral Hospital for Children, Boston, MA
- Department of Nutrition, Harvard School of Public Health, Boston, MA
| | - Rachel E. Blaine
- Department of Nutrition, Harvard School of Public Health, Boston, MA
| | - Kirsten K. Davison
- Department of Nutrition, Harvard School of Public Health, Boston, MA
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA
| | - Steven Gortmaker
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA
| | - Shikha Anand
- National Initiative for Children's Healthcare Quality, Boston, MA
| | - Jennifer Falbe
- Division of Community Health and Human Development, School of Public Health, University of California Berkeley, Berkeley, CA
| | - Jo-Ann Kwass
- Bureau of Community Health and Prevention, Massachusetts Department of Public Health, Boston, MA
| | - Meghan Perkins
- Division of General Academic Pediatrics, Department of Pediatrics, MassGeneral Hospital for Children, Boston, MA
| | - Catherine Giles
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA
| | - Shaniece Criss
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA
| | - Rachel Colchamiro
- Bureau of Community Health and Prevention, Massachusetts Department of Public Health, Boston, MA
| | - Jennifer Woo Baidal
- Division of General Academic Pediatrics, Department of Pediatrics, MassGeneral Hospital for Children, Boston, MA
- Division of Gastroenterology and Nutrition, Children's Hospital Boston, Boston, MA
| | - Thomas Land
- Office of the Commissioner, Massachusetts Department of Public Health, Boston, MA
| | - Lauren Smith
- National Initiative for Children's Healthcare Quality, Boston, MA
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Blanck HM, Collins JL. The Childhood Obesity Research Demonstration project: linking public health initiatives and primary care interventions community-wide to prevent and reduce childhood obesity. Child Obes 2015; 11:1-3. [PMID: 25679058 DOI: 10.1089/chi.2014.0122] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Heidi M Blanck
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion , Centers for Disease Control and Prevention, Atlanta, GA
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Lee RM, Emmons KM, Okechukwu CA, Barrett JL, Kenney EL, Cradock AL, Giles CM, deBlois ME, Gortmaker SL. Validity of a practitioner-administered observational tool to measure physical activity, nutrition, and screen time in school-age programs. Int J Behav Nutr Phys Act 2014; 11:145. [PMID: 25429898 PMCID: PMC4264534 DOI: 10.1186/s12966-014-0145-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Accepted: 11/10/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Nutrition and physical activity interventions have been effective in creating environmental changes in afterschool programs. However, accurate assessment can be time-consuming and expensive as initiatives are scaled up for optimal population impact. This study aims to determine the criterion validity of a simple, low-cost, practitioner-administered observational measure of afterschool physical activity, nutrition, and screen time practices and child behaviors. METHODS Directors from 35 programs in three cities completed the Out-of-School Nutrition and Physical Activity Observational Practice Assessment Tool (OSNAP-OPAT) on five days. Trained observers recorded snacks served and obtained accelerometer data each day during the same week. Observations of physical activity participation and snack consumption were conducted on two days. Correlations were calculated to validate weekly average estimates from OSNAP-OPAT compared to criterion measures. Weekly criterion averages are based on 175 meals served, snack consumption of 528 children, and physical activity levels of 356 children. RESULTS OSNAP-OPAT validly assessed serving water (r = 0.73), fruits and vegetables (r = 0.84), juice >4oz (r = 0.56), and grains (r = 0.60) at snack; sugary drinks (r = 0.70) and foods (r = 0.68) from outside the program; and children's water consumption (r = 0.56) (all p <0.05). Reports of physical activity time offered were correlated with accelerometer estimates (minutes of moderate and vigorous physical activity r = 0.59, p = 0.02; vigorous physical activity r = 0.63, p = 0.01). The reported proportion of children participating in moderate and vigorous physical activity was correlated with observations (r = 0.48, p = 0.03), as were reports of computer (r = 0.85) and TV/movie (r = 0.68) time compared to direct observations (both p < 0.01). CONCLUSIONS OSNAP-OPAT can assist researchers and practitioners in validly assessing nutrition and physical activity environments and behaviors in afterschool settings. TRIAL REGISTRATION Phase 1 of this measure validation was conducted during a study registered at clinicaltrials.gov NCT01396473.
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Affiliation(s)
- Rebekka M Lee
- Harvard School of Public Health, Social and Behavioral Sciences, 677 Huntington Avenue, Boston, MA, 02115, USA.
| | - Karen M Emmons
- Kaiser Foundation Research Institute, Oakland, California.
| | - Cassandra A Okechukwu
- Harvard School of Public Health, Social and Behavioral Sciences, 677 Huntington Avenue, Boston, MA, 02115, USA.
| | - Jessica L Barrett
- Harvard School of Public Health, Social and Behavioral Sciences, 677 Huntington Avenue, Boston, MA, 02115, USA.
| | - Erica L Kenney
- Harvard School of Public Health, Social and Behavioral Sciences, 677 Huntington Avenue, Boston, MA, 02115, USA.
| | - Angie L Cradock
- Harvard School of Public Health, Social and Behavioral Sciences, 677 Huntington Avenue, Boston, MA, 02115, USA.
| | - Catherine M Giles
- Harvard School of Public Health, Social and Behavioral Sciences, 677 Huntington Avenue, Boston, MA, 02115, USA.
| | - Madeleine E deBlois
- Harvard School of Public Health, Social and Behavioral Sciences, 677 Huntington Avenue, Boston, MA, 02115, USA.
| | - Steven L Gortmaker
- Harvard School of Public Health, Social and Behavioral Sciences, 677 Huntington Avenue, Boston, MA, 02115, USA.
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Kenney EL, Austin SB, Cradock AL, Giles CM, Lee RM, Davison KK, Gortmaker SL. Identifying sources of children's consumption of junk food in Boston after-school programs, April-May 2011. Prev Chronic Dis 2014; 11:E205. [PMID: 25412028 PMCID: PMC4241369 DOI: 10.5888/pcd11.140301] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Little is known about how the nutrition environment in after-school settings may affect children's dietary intake. We measured the nutritional quality of after-school snacks provided by programs participating in the National School Lunch Program or the Child and Adult Care Food Program and compared them with snacks brought from home or purchased elsewhere (nonprogram snacks). We quantified the effect of nonprogram snacks on the dietary intake of children who also received program-provided snacks during after-school time. Our study objective was to determine how different sources of snacks affect children's snack consumption in after-school settings. METHODS We recorded snacks served to and brought in by 298 children in 18 after-school programs in Boston, Massachusetts, on 5 program days in April and May 2011. We measured children's snack consumption on 2 program days using a validated observation protocol. We then calculated within-child change-in-change models to estimate the effect of nonprogram snacks on children's dietary intake after school. RESULTS Nonprogram snacks contained more sugary beverages and candy than program-provided snacks. Having a nonprogram snack was associated with significantly higher consumption of total calories (+114.7 kcal, P < .001), sugar-sweetened beverages (+0.5 oz, P = .01), desserts (+0.3 servings, P < .001), and foods with added sugars (+0.5 servings; P < .001) during the snack period. CONCLUSION On days when children brought their own after-school snack, they consumed more salty and sugary foods and nearly twice as many calories than on days when they consumed only program-provided snacks. Policy strategies limiting nonprogram snacks or setting nutritional standards for them in after-school settings should be explored further as a way to promote child health.
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Affiliation(s)
- Erica L Kenney
- Department of Social and Behavioral Sciences, Harvard School of Public Health, 677 Huntington Ave, SPH3, Floor 7, Boston, MA 02115. E-mail:
| | - S Bryn Austin
- Harvard School of Public Health, Boston, Massachusetts
| | | | | | - Rebekka M Lee
- Harvard School of Public Health, Boston, Massachusetts
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Kenney EL, Giles CM, deBlois ME, Gortmaker SL, Chinfatt S, Cradock AL. Improving nutrition and physical activity policies in afterschool programs: results from a group-randomized controlled trial. Prev Med 2014; 66:159-66. [PMID: 24941286 PMCID: PMC5369229 DOI: 10.1016/j.ypmed.2014.06.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2013] [Revised: 05/21/2014] [Accepted: 06/08/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Afterschool programs can be health-promoting environments for children. Written policies positively influence nutrition and physical activity (PA) environments, but effective strategies for building staff capacity to write such policies have not been evaluated. This study measures the comprehensiveness of written nutrition, PA, and screen time policies in afterschool programs and assesses impact of the Out of School Nutrition and Physical Activity (OSNAP) intervention on key policies. METHODS Twenty afterschool programs in Boston, MA participated in a group-randomized, controlled trial from September 2010 to June 2011. Intervention program staff attended learning collaboratives focused on practice and policy change. The Out-of-School Time (OST) Policy Assessment Index evaluated written policies. Inter-rater reliability and construct validity of the measure and impact of the intervention on written policies were assessed. RESULTS The measure demonstrated moderate to excellent inter-rater reliability (Spearman's r=0.53 to 0.97) and construct validity. OSNAP was associated with significant increases in standards-based policy statements surrounding snacks (+2.6, p=0.003), beverages (+2.3, p=0.008), screen time (+0.8, p=0.046), family communication (+2.2, p=0.002), and a summary index of OSNAP goals (+3.3, p=0.02). CONCLUSIONS OSNAP demonstrated success in building staff capacity to write health-promoting policy statements. Future research should focus on determining policy change impact on practices.
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Affiliation(s)
- Erica L Kenney
- Department of Social and Behavioral Sciences, Harvard School of Public Health, 677 Huntington Ave., Boston, MA 02215, USA.
| | - Catherine M Giles
- Department of Social and Behavioral Sciences, Harvard School of Public Health, 677 Huntington Ave., Boston, MA 02215, USA
| | - Madeleine E deBlois
- Department of Social and Behavioral Sciences, Harvard School of Public Health, 677 Huntington Ave., Boston, MA 02215, USA
| | - Steven L Gortmaker
- Department of Social and Behavioral Sciences, Harvard School of Public Health, 677 Huntington Ave., Boston, MA 02215, USA
| | - Sherene Chinfatt
- Department of Social and Behavioral Sciences, Harvard School of Public Health, 677 Huntington Ave., Boston, MA 02215, USA
| | - Angie L Cradock
- Department of Social and Behavioral Sciences, Harvard School of Public Health, 677 Huntington Ave., Boston, MA 02215, USA
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Beets MW, Tilley F, Turner-McGrievy G, Weaver RG, Jones S. Community partnership to address snack quality and cost in after-school programs. THE JOURNAL OF SCHOOL HEALTH 2014; 84:543-8. [PMID: 25040123 PMCID: PMC4109654 DOI: 10.1111/josh.12175] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Revised: 09/05/2013] [Accepted: 10/02/2013] [Indexed: 05/20/2023]
Abstract
BACKGROUND Policies call on after-school programs (ASPs) to serve more nutritious snacks. A major barrier for improving snack quality is cost. This study describes the impact on snack quality and expenditures from a community partnership between ASPs and local grocery stores. METHODS Four large-scale ASPs (serving ˜500 children, aged 6-12 years, each day) and a single local grocery store chain participated in this study. The nutritional quality of snacks served was recorded preintervention (18 weeks spring/fall 2011) and postintervention (7 weeks spring 2012) via direct observation, along with cost/child/snack/day. RESULTS Preintervention snacks were low-nutrient-density salty snacks (eg, chips, 3.0 servings/week), sugar-sweetened beverages (eg, powdered-lemonade, 1.9 servings/week), and desserts (eg, cookies, 2.1 servings/week), with only 0.4 servings/week of fruits and no vegetables. By postintervention, fruits (3.5 servings/week) and vegetables (1.2 servings/week) were increased, whereas sugar-sweetened beverages and desserts were eliminated. Snack expenditures were $0.26 versus $0.24 from preintervention to postintervention. Partnership savings versus purchasing snacks at full retail cost was 24.5% or $0.25/serving versus $0.34/serving. CONCLUSIONS This innovative partnership can serve as a model in communities where ASPs seek to identify low-cost alternatives to providing nutritious snacks.
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Affiliation(s)
- Michael W. Beets
- Arnold School of Public Health, University of South Carolina, 921 Assembly St., 1st Fl. Suite, RM 131, Columbia, SC 29208, PH: 803-777-3003
| | - Falon Tilley
- Arnold School of Public Health, University of South Carolina, 921 Assembly St., 1st Fl. Suite, Columbia, SC 29208
| | - Gabrielle Turner-McGrievy
- Arnold School of Public Health, University of South Carolina, 921 Assembly St., 1st Fl. Suite, Columbia, SC 29208
| | - Robert Glenn Weaver
- Arnold School of Public Health, University of South Carolina, 921 Assembly St., 1st Fl. Suite, Columbia, SC 29208
| | - Sonya Jones
- Arnold School of Public Health, University of South Carolina, 921 Assembly St., 1st Fl. Suite, Columbia, SC 29208
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Anzman-Frasca S, Newman MB, Angstrom HM, Sharma S, Nelson ME, Dolan PR, Economos CD. Parent perspectives on nutrition and physical activity during out-of-school time. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2014; 46:156-163. [PMID: 24220045 DOI: 10.1016/j.jneb.2013.09.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Revised: 09/25/2013] [Accepted: 09/27/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVE Out-of-school time (OST) programs serve a large, diverse population of children, including those at increased obesity risk. In this study, parents' perspectives about nutrition and physical activity (PA) during OST were assessed. DESIGN Survey. SETTING Online. PARTICIPANTS Six hundred parents with a school-aged child participating in programs from selected OST organizations. MAIN OUTCOME MEASURES Parent perspectives about the importance and availability of different foods, beverages, and PA opportunities during OST, and OST program and parent involvement in promoting healthful environments. ANALYSIS Frequencies were used to describe parents' perspectives. Wilcoxon tests and logistic regression analyses were conducted to test for significant differences. RESULTS Most parents reported that it was important that their children have water (96.2%), fresh fruits and vegetables (79.0%), and PA (97.2%) during OST; fewer parents reported that these were regularly available. About two thirds of parents agreed that OST programs should promote healthy environments for children, whereas one third agreed that parents alone should be responsible for children's nutrition and PA. CONCLUSIONS AND IMPLICATIONS Results suggest that many parents would support efforts to improve OST nutrition and PA. Yet, there is a need to further understand the perceptions and motivations of different subgroups to enact successful obesity prevention efforts during OST.
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Affiliation(s)
- Stephanie Anzman-Frasca
- ChildObesity180, Tufts University, Boston, MA; Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA
| | - Molly B Newman
- ChildObesity180, Tufts University, Boston, MA; Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA
| | - Heather M Angstrom
- ChildObesity180, Tufts University, Boston, MA; Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA
| | - Shanti Sharma
- ChildObesity180, Tufts University, Boston, MA; Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA
| | - Miriam E Nelson
- ChildObesity180, Tufts University, Boston, MA; Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA
| | | | - Christina D Economos
- ChildObesity180, Tufts University, Boston, MA; Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA.
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Hood NE, Turner L, Colabianchi N, Chaloupka FJ, Johnston LD. Availability of drinking water in US public school cafeterias. J Acad Nutr Diet 2014; 114:1389-95. [PMID: 24726348 DOI: 10.1016/j.jand.2014.02.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Accepted: 01/28/2014] [Indexed: 11/29/2022]
Abstract
This study examined the availability of free drinking water during lunchtime in US public schools, as required by federal legislation beginning in the 2011-2012 school year. Data were collected by mail-back surveys in nationally representative samples of US public elementary, middle, and high schools from 2009-2010 to 2011-2012. Overall, 86.4%, 87.4%, and 89.4% of students attended elementary, middle, and high schools, respectively, that met the drinking water requirement. Most students attended schools with existing cafeteria drinking fountains and about one fourth attended schools with water dispensers. In middle and high schools, respondents were asked to indicate whether drinking fountains were clean, and whether they were aware of any water-quality problems at the school. The vast majority of middle and high school students (92.6% and 90.4%, respectively) attended schools where the respondent perceived drinking fountains to be clean or very clean. Approximately one in four middle and high school students attended a school where the survey respondent indicated that there were water-quality issues affecting drinking fountains. Although most schools have implemented the requirement to provide free drinking water at lunchtime, additional work is needed to promote implementation at all schools. School nutrition staff at the district and school levels can play an important role in ensuring that schools implement the drinking water requirement, as well as promote education and behavior-change strategies to increase student consumption of water at school.
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Patel AI, Shapiro DJ, Wang YC, Cabana MD. Sociodemographic characteristics and beverage intake of children who drink tap water. Am J Prev Med 2013; 45:75-82. [PMID: 23790991 PMCID: PMC4452285 DOI: 10.1016/j.amepre.2013.04.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2012] [Revised: 12/14/2012] [Accepted: 04/09/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Tap water provides a calorie-free, no-cost, environmentally friendly beverage option, yet only some youth drink it. PURPOSE To examine sociodemographic characteristics, weight status, and beverage intake of those aged 1-19 years who drink tap water. METHODS National Health and Nutrition Examination Survey data (2005-2010) were used to examine factors associated with tap water consumption. A comparison was made of beverage intake among tap water consumers and nonconsumers, by age, race/ethnicity, and income. RESULTS Tap water consumption was more prevalent among school-aged children (OR=1.85, 95% CI=1.47, 2.33, for those aged 6-11 years; OR=1.85, 95% CI=1.32, 2.59, for those aged 12-19 years) as compared to those aged 1-2 years. Tap water intake was less prevalent among girls/women (OR=0.76, 95% CI=0.64, 0.89); Mexican Americans (OR=0.32, 95% CI=0.23, 0.45); non-Hispanic blacks (OR=0.48, 95% CI=0.34, 0.67); and others (OR=0.50, 95% CI=0.36, 0.68) as compared to whites; Spanish speakers (OR=0.72, 95% CI=0.55, 0.95); and among referents with a lower than Grade-9 education (OR=0.52, 95% CI=0.31, 0.88); Grade 9-11 education (OR=0.50, 95% CI=0.32, 0.77); and high school/General Educational Development test completion (OR=0.50, 95% CI=0.33, 0.76), as compared to college graduates. Tap water consumers drank more fluid (52.5 vs 48.0 ounces, p<0.01); more plain water (20.1 vs 15.2 ounces, p<0.01); and less juice (3.6 vs 5.2 ounces, p<0.01) than nonconsumers. CONCLUSIONS One in six children/adolescents does not drink tap water, and this finding is more pronounced among minorities. Sociodemographic disparities in tap water consumption may contribute to disparities in health outcomes. Improvements in drinking water infrastructure and culturally relevant promotion may help to address these issues.
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Affiliation(s)
- Anisha I Patel
- Department of Pediatrics, Columbia Mailman School of Public Health, New York, New York; Philip R. Lee Institute for Health Policy Studies, Columbia Mailman School of Public Health, New York, New York.
| | - Daniel J Shapiro
- Philip R. Lee Institute for Health Policy Studies, Columbia Mailman School of Public Health, New York, New York
| | - Y Claire Wang
- Department of Health Policy and Management, Columbia Mailman School of Public Health, New York, New York
| | - Michael D Cabana
- Department of Pediatrics, Columbia Mailman School of Public Health, New York, New York; Philip R. Lee Institute for Health Policy Studies, Columbia Mailman School of Public Health, New York, New York; Epidemiology and Biostatistics, University of California, San Francisco, California
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Cradock AL, Wilking CL, Olliges SA, Gortmaker SL. Getting back on tap: the policy context and cost of ensuring access to low-cost drinking water in Massachusetts schools. Am J Prev Med 2012; 43:S95-101. [PMID: 22898169 DOI: 10.1016/j.amepre.2012.05.016] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2012] [Revised: 05/17/2012] [Accepted: 05/24/2012] [Indexed: 11/29/2022]
Abstract
BACKGROUND Adequate water intake may have important health benefits for schoolchildren. Layers of federal, state, and local policy are relevant to provision of water within schools. Recently passed state and federal laws require free drinking-water access for students during mealtimes. PURPOSE To review Massachusetts local district wellness policies related to water access, provide estimates of costs for three water-provision strategies, and discuss implications for policy relevant to adequate drinking-water access. METHODS Legal research was conducted using the LexisNexis legal database and government websites. Local wellness policies were double-coded using existing research tools. Costs of three water-delivery options were estimated using a 10-year school-district perspective. RESULTS Prior to 2010, most Massachusetts public school district wellness policies (92%-94%) did not address access to free drinking water. Ten-year costs per school for providing water during mealtimes to students, including dispenser unit, installation, water testing, water, cups, and labor, range between $12,544 and $27,922 (depending on water-delivery option) assuming the average Massachusetts school enrollment. Water-provision strategies relying on tap water are more economical than bottled water in the long term. CONCLUSIONS Policy recommendations and cost considerations deserve attention at the local, state, and federal levels. Recommendations are discussed to ensure access to safe, free drinking water for all students.
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Affiliation(s)
- Angie L Cradock
- Department of Society, Human Development, and Health, Harvard School of Public Health, Boston, Massachusetts 02215,
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Gortmaker SL, Story M. Nutrition policy research that can lead to reduced childhood obesity in the U.S. Am J Prev Med 2012; 43:S149-51. [PMID: 22898165 DOI: 10.1016/j.amepre.2012.06.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2012] [Revised: 05/21/2012] [Accepted: 06/07/2012] [Indexed: 11/19/2022]
Affiliation(s)
- Steven L Gortmaker
- Department of Society, Human Development, and Health, Harvard School of Public Health, Boston, Massachusetts 02215, USA.
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