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Chriqui JF, Leider J, Temkin D, Piekarz-Porter E, Schermbeck RM, Stuart-Cassel V. State Laws Matter When It Comes to District Policymaking Relative to the Whole School, Whole Community, Whole Child Framework. THE JOURNAL OF SCHOOL HEALTH 2020; 90:907-917. [PMID: 33184878 PMCID: PMC7702124 DOI: 10.1111/josh.12959] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 08/17/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND The Whole School, Whole Community, Whole Child (WSCC) framework supports the "whole child" across 10 domains. This study assessed state law and district policy WSCC coverage. METHODS Primary legal research was used to compile relevant district policies and state laws for a stratified random sample of 368 public school districts across 20 states for school year 2017-18. Policies/laws were evaluated on 79 items across the WSCC domains (range: 3-14 items/domain). Multivariable regressions examined the relationship between state laws and district policies, controlling for district characteristics, and weighted to account for the sample design and non-response. RESULTS On average, district policies and state laws addressed 53% and 60% of the 79 items, respectively. State law predicted district policy WSCC attention across items (coeff. = 0.26, 95% CI = 0.14, 0.38) and 4 domains: physical activity (coeff. = 0.57, 95% CI = 0.29, 0.86); health services (coeff. = 0.50, 95% CI = 0.39, 0.62); social and emotional climate (coeff. = 0.34, 95% CI = 0.23, 0.45); and family engagement (coeff. = 0.41, 95% CI = 0.28, 0.54). State law was associated with lower district-level coverage in 3 domains (health education; counseling, psychological, and social services; and community involvement). CONCLUSIONS Although WSCC implementation is locally-driven, states have an active role to play in setting a policy "floor" for guiding district WSCC attention.
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Affiliation(s)
- Jamie F Chriqui
- Professor, , Division of Health Policy and Administration and Institute for Health Research and Policy, School of Public Health, University of Illinois Chicago, 1603 W. Taylor Street, M/C 923, Chicago, IL 60612
| | - Julien Leider
- Senior Research Specialist, , Institute for Health Research and Policy, University of Illinois Chicago, 1747 W. Roosevelt Road, M/C 275, Chicago, IL 60608
| | - Deborah Temkin
- Vice-President for Youth Development and Education Research, , Child Trends, 7315 Wisconsin Avenue, Suite 1200W, Bethesda, MD 20814
| | - Elizabeth Piekarz-Porter
- Clinical Assistant Professor, , Division of Health Policy and Administration, School of Public Health, University of Illinois Chicago, 1603 W. Taylor Street, M/C 923, Chicago, IL 60612
| | - Rebecca M Schermbeck
- Research Specialist, , Institute for Health Research and Policy, University of Illinois Chicago, Chicago, IL 60608
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Chriqui JF, Lin W, Leider J, Shang C, Perna FM. The harmonizing effect of Smart Snacks on the association between state snack laws and high school students' fruit and vegetable consumption, United States-2005-2017. Prev Med 2020; 139:106093. [PMID: 32305581 PMCID: PMC9437874 DOI: 10.1016/j.ypmed.2020.106093] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 02/08/2020] [Accepted: 04/11/2020] [Indexed: 01/06/2023]
Abstract
Despite national guidelines recommending daily fruit and vegetable (FV) consumption, intake of FV among adolescents is low. Over the past 10-15 years, state and federal laws have reduced the availability of junk foods in schools. This study examined the association between state snack laws and high school (HS) student FV consumption. The overall sample included 99,785 HS students (outcome samples ranged from 96,209-97,328) included in the Youth Risk Behavior Survey (YRBS). National Cancer Institute Classification of Laws Associated with School Students' data for 2004-2016 were lagged on to 2005-2017 YRBS data. Separate analyses examined the state law-youth FV consumption relationship pre- and post-federal Smart Snacks standards (effective school year 2014-2015). Analyses were conducted between 2018 and 2020. Overall, state laws were associated with any vegetable, salad, and other vegetable consumption. The relationship between state laws and vegetable consumption primarily occurred pre-Smart Snacks. Pre-Smart Snacks, state laws were associated with higher odds of youth consumption of any vegetable, salad, carrots, and other vegetables (all compared to students in states without snack laws). The only association post-Smart Snacks was between strong state laws and salads. This study illustrates the important role that standards restricting the availability of junk foods in schools can have on increasing student vegetable consumption. Given current efforts to roll-back federal school meal standards, findings from this study illustrate how federal standards harmonized the patchwork of state laws that existed prior to Smart Snacks and the important role that consistent national standards can play in supporting student consumption of vegetables.
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Affiliation(s)
- Jamie F Chriqui
- Institute for Health Research and Policy, University of Illinois at Chicago, 1747 W. Roosevelt Road, M/C 275, Chicago, IL 60608, USA; Division of Health Policy and Administration, School of Public Health, University of Illinois at Chicago, 1603 W. Taylor Street, M/C 923, Chicago, IL 60612, USA.
| | - Wanting Lin
- Institute for Health Research and Policy, University of Illinois at Chicago, 1747 W. Roosevelt Road, M/C 275, Chicago, IL 60608, USA.
| | - Julien Leider
- Institute for Health Research and Policy, University of Illinois at Chicago, 1747 W. Roosevelt Road, M/C 275, Chicago, IL 60608, USA.
| | - Ce Shang
- Department of Internal Medicine, The Ohio State University, USA.
| | - Frank M Perna
- Health Behaviors Research Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, USA.
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Healthier Food and Beverage Interventions in Schools: Four Community Guide Systematic Reviews. Am J Prev Med 2020; 59:e15-e26. [PMID: 32564807 PMCID: PMC9366443 DOI: 10.1016/j.amepre.2020.01.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 01/12/2020] [Accepted: 01/13/2020] [Indexed: 11/23/2022]
Abstract
CONTEXT Healthy eating during childhood is important for optimal growth and helps reduce the risk of obesity, which has potentially serious health consequences. Changing the school food environment may offer one way to improve students' dietary intake. This manuscript reports 4 Community Guide systematic reviews examining the effectiveness of interventions in schools promoting healthy eating and weight. EVIDENCE ACQUISITION School obesity prevention programs aiming to improve diet were identified from a 2013 Agency for Health Care Research and Quality systematic review and an updated search (August 2012-January 4, 2017). In 2017-2018, Community Guide systematic review methods were used to assess effectiveness as determined by dietary behavior and weight changes. EVIDENCE SYNTHESIS Interventions improving school meals or offering fruits and vegetables (n=27 studies) are considered effective. Evidence is insufficient to determine the effectiveness of interventions supporting healthier snack foods and beverages outside of school meal programs given inconsistent findings (n=13 studies). Multicomponent interventions to increase availability of healthier foods and beverages are considered effective. These interventions must include 1 component from school meals or fruit and vegetable programs and interventions supporting healthier snack foods and beverages (n=12 studies). There is insufficient evidence to determine the effectiveness of interventions to increase water access because only 2 studies met inclusion criteria. CONCLUSIONS A total of 2 school-based dietary interventions have favorable effects for improving dietary habits and modest effects for improving or maintaining weight. More evidence is needed regarding interventions with insufficient findings. These reviews may inform researchers and school administrators about healthy eating and obesity prevention interventions.
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Sanjeevi N, Lipsky LM, Nansel TR, Haynie D, Liu A, Simons-Morton B. Stronger State School Nutrition Laws Are Associated With Healthier Eating Behaviors and Optimal Weight Status in US Adolescents. Am J Health Promot 2020; 34:857-866. [PMID: 32036683 DOI: 10.1177/0890117120902346] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
PURPOSE To investigate relationships of farm-to-school, school meal, and competitive food state laws with eating behaviors and weight status and to examine interaction between different types of state laws. DESIGN Observational cohort study. SETTINGS US adolescents. PARTICIPANTS The NEXT study is a nationally representative sample of adolescents assessed annually for 7 years. Data (N = 2751) from students attending public schools from the first (W1) and third (W3) assessment waves (2010 and 2012), occurring during grades 10 and 12, respectively, of the NEXT study were included. MEASURES Eating behaviors and weight status of adolescents were linked with Classification of Laws Associated with School Students scoring for state laws. ANALYSIS Regression analyses examined associations of laws with intake and weight status, accounting for complex survey design and school-level clustering. RESULTS Adolescents in states with strong farm-to-school laws had greater W1 whole fruit, lower soda, and snack intakes versus those in states with no laws. Strong school meal laws were associated with lower W1 soda intake. Adolescents in states with strong competitive food laws had lower soda intake and overweight/obesity odds than those in states with no laws in W3. Strong farm-to-school laws were inversely associated with W3 overweight/obesity odds only in states with strong competitive food laws. CONCLUSIONS Stronger laws governing school nutrition were related to healthier eating behaviors and optimal weight status in this nationally representative sample of adolescents. Further, farm-to-school laws may be more effective in reducing obesity when combined with strong competitive food legislation.
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Affiliation(s)
- Namrata Sanjeevi
- Social and Behavioral Sciences Branch, Eunice Kennedy Shriver2511National Institute of Child Health and Human Development, Bethesda, MD, USA
| | - Leah M Lipsky
- Social and Behavioral Sciences Branch, Eunice Kennedy Shriver2511National Institute of Child Health and Human Development, Bethesda, MD, USA
| | - Tonja R Nansel
- Social and Behavioral Sciences Branch, Eunice Kennedy Shriver2511National Institute of Child Health and Human Development, Bethesda, MD, USA
| | - Denise Haynie
- Social and Behavioral Sciences Branch, Eunice Kennedy Shriver2511National Institute of Child Health and Human Development, Bethesda, MD, USA
| | - Aiyi Liu
- Biostatistics & Bioinformatics Branch, Eunice Kennedy Shriver2511National Institute of Child Health and Human Development, Bethesda, MD, USA
| | - Bruce Simons-Morton
- Social and Behavioral Sciences Branch, Eunice Kennedy Shriver2511National Institute of Child Health and Human Development, Bethesda, MD, USA
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Allison KR, Philipneri AN, Vu-Nguyen K, Manson HE, Dwyer JJM, Hobin E, Ng B, Li Y. School and classroom effects on Daily Physical Activity (DPA) policy implementation fidelity in Ontario classrooms: a multi-level analysis. BMC Public Health 2018; 18:802. [PMID: 29945575 PMCID: PMC6020426 DOI: 10.1186/s12889-018-5720-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 06/18/2018] [Indexed: 11/13/2022] Open
Abstract
Background This paper examines school and classroom effects on Daily Physical Activity (DPA) policy implementation in classrooms in Ontario, Canada. In 2005 the Ontario Ministry of Education mandated a policy requiring school boards to “ensure that all elementary students, including students with special needs, have a minimum of twenty minutes of sustained MVPA each school day during instructional time”. Based on an adaptation of Chaudoir’s conceptual framework, this paper contributes to understanding the extent to which school factors (as reported by administrators) and classroom factors (as reported by teachers) are associated with policy implementation fidelity at the classroom level. Methods Cross-sectional online surveys were conducted in 2014 with elementary school administrators and teachers, based on representative random samples of schools and classrooms. A measure assessing implementation fidelity was developed from the six required components of the policy and for this paper fidelity at the classroom level is treated as the outcome variable. Several school- and classroom-level measures were also included in the surveys and a number of these were selected for inclusion here. Data from the two surveys were merged and selected variables were included in the multi-level analysis. Two-level logistic regression models were conducted to account for nesting of classrooms within schools and a series of models were conducted to identify factors associated with implementation fidelity. Results The analytic sample for this study included 170 school administrators and 307 classroom teachers from corresponding schools. Findings from the multi-level logistic regression analyses indicated that only classroom/teacher-level factors were significantly associated with implementation fidelity at the classroom level. None of the school/administrator predictors were significantly related to fidelity. The most parsimonious model included five significant classroom/teacher predictors: teachers’ perception of DPA as realistic and achievable; confidence (self-efficacy); scheduling DPA in timetables; lack of space; and lack of time. Conclusions Findings from the study indicate the theoretical and practical importance of addressing classroom and teacher factors since they are most proximal to implementation fidelity to the policy. Several of these factors also reflect complex structural and organizational contexts, indicating that a systems approach to understanding and supporting DPA implementation fidelity is warranted.
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Affiliation(s)
- Kenneth R Allison
- KR Allison Research Consulting, 575 Windermere Avenue, Toronto, ON, M6S 3L9, Canada.
| | - Anne N Philipneri
- Public Health Ontario, 480 University Avenue, Suite 300, Toronto, ON, M5G 1V2, Canada
| | - Karen Vu-Nguyen
- The Regional Municipality of York, 50 High Tech Road, Richmond Hill, ON, L4B 4N7, Canada
| | - Heather E Manson
- Public Health Ontario, 480 University Avenue, Suite 300, Toronto, ON, M5G 1V2, Canada
| | - John J M Dwyer
- Department of Family Relations and Applied Nutrition, University of Guelph, Macdonald Institute Building, 50 Stone Road East, Guelph, ON, N1G 2W1, Canada
| | - Erin Hobin
- Public Health Ontario, 480 University Avenue, Suite 300, Toronto, ON, M5G 1V2, Canada
| | - Bessie Ng
- Peel Public Health, 7120 Hurontario Street, Mississauga, ON, L5W 1N4, Canada
| | - Ye Li
- Public Health Ontario, 480 University Avenue, Suite 300, Toronto, ON, M5G 1V2, Canada
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Collese TS, Nascimento-Ferreira MV, de Moraes ACF, Rendo-Urteaga T, Bel-Serrat S, Moreno LA, Carvalho HB. Role of fruits and vegetables in adolescent cardiovascular health: a systematic review. Nutr Rev 2017; 75:339-349. [PMID: 28475799 DOI: 10.1093/nutrit/nux002] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Context Levels of fruit and vegetable consumption are low among adolescents, and the possible effect of this on cardiovascular health in this age group is undefined. Objective The aim of this systematic review was to investigate the potential role of fruit and vegetable consumption in adolescent cardiovascular health. Data Sources Six electronic databases (BioMed Central, MEDLINE, Web of Science, CINAHL, Scopus, PsycINFO) were searched from database inception to December 2015. Study Selection The search strategy used the following sets of descriptors: adolescents; fruits and vegetables; cardiovascular risk indicators; cross-sectional and cohort studies. Data Extraction Potentially eligible articles were selected independently by 2 reviewers. Results Eleven articles meeting the inclusion criteria were included (10 cross-sectional, 1 cohort). The main reasons for study exclusion (n = 71) were misclassification of individuals as adolescents, an unspecified outcome that was incongruent with the definitions provided, and assessment of fruits and vegetables as part of a food pattern. Articles evaluated fruit and vegetable intake (separately, together, only vegetables, or with fruit juice) in diverse units, using food frequency questionnaires, 24-hour dietary recalls, and food records. One-third of the studies showed significant inverse associations of fruit and vegetable intake with systolic blood pressure, abdominal obesity, triglycerides, high-density lipoprotein cholesterol, and metabolic syndrome. Conclusions The associations between fruit and vegetable consumption and indicators of cardiovascular risk in adolescents are inconsistent, likely because of heterogeneity in the methods used to assess and classify consumption and to define cardiovascular risk in adolescents.
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Affiliation(s)
- Tatiana Sadalla Collese
- T.S. Collese, M.V. Nascimento-Ferreira, A.C. Ferreira de Moraes, T. Rendo-Urteaga, and H.B. Carvalho are with the YCARE (Youth/Child cArdiovascular Risk and Environmental) Research Group, Department of Preventive Medicine, School of Medicine, University of São Paulo, São Paulo, Brazil. T.S. Collese, A.C. Ferreira de Moraes, T. Rendo-Urteaga, S. Bel-Serrat, and L.A. Moreno are with the GENUD (Growth, Exercise, NUtrition and Development) Research Group, Faculty of Health Sciences, University of Zaragoza, Instituto Agroalimentario de Aragón (IA2), Zaragoza, Spain. S. Bel-Serrat is with the School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland. L.A. Moreno is with the Department of Preventive Medicine, School of Medicine, University of São Paulo, São Paulo, Brazil. A.C. Ferreira de Moraes is with the Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Marcus Vinicius Nascimento-Ferreira
- T.S. Collese, M.V. Nascimento-Ferreira, A.C. Ferreira de Moraes, T. Rendo-Urteaga, and H.B. Carvalho are with the YCARE (Youth/Child cArdiovascular Risk and Environmental) Research Group, Department of Preventive Medicine, School of Medicine, University of São Paulo, São Paulo, Brazil. T.S. Collese, A.C. Ferreira de Moraes, T. Rendo-Urteaga, S. Bel-Serrat, and L.A. Moreno are with the GENUD (Growth, Exercise, NUtrition and Development) Research Group, Faculty of Health Sciences, University of Zaragoza, Instituto Agroalimentario de Aragón (IA2), Zaragoza, Spain. S. Bel-Serrat is with the School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland. L.A. Moreno is with the Department of Preventive Medicine, School of Medicine, University of São Paulo, São Paulo, Brazil. A.C. Ferreira de Moraes is with the Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Augusto César Ferreira de Moraes
- T.S. Collese, M.V. Nascimento-Ferreira, A.C. Ferreira de Moraes, T. Rendo-Urteaga, and H.B. Carvalho are with the YCARE (Youth/Child cArdiovascular Risk and Environmental) Research Group, Department of Preventive Medicine, School of Medicine, University of São Paulo, São Paulo, Brazil. T.S. Collese, A.C. Ferreira de Moraes, T. Rendo-Urteaga, S. Bel-Serrat, and L.A. Moreno are with the GENUD (Growth, Exercise, NUtrition and Development) Research Group, Faculty of Health Sciences, University of Zaragoza, Instituto Agroalimentario de Aragón (IA2), Zaragoza, Spain. S. Bel-Serrat is with the School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland. L.A. Moreno is with the Department of Preventive Medicine, School of Medicine, University of São Paulo, São Paulo, Brazil. A.C. Ferreira de Moraes is with the Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Tara Rendo-Urteaga
- T.S. Collese, M.V. Nascimento-Ferreira, A.C. Ferreira de Moraes, T. Rendo-Urteaga, and H.B. Carvalho are with the YCARE (Youth/Child cArdiovascular Risk and Environmental) Research Group, Department of Preventive Medicine, School of Medicine, University of São Paulo, São Paulo, Brazil. T.S. Collese, A.C. Ferreira de Moraes, T. Rendo-Urteaga, S. Bel-Serrat, and L.A. Moreno are with the GENUD (Growth, Exercise, NUtrition and Development) Research Group, Faculty of Health Sciences, University of Zaragoza, Instituto Agroalimentario de Aragón (IA2), Zaragoza, Spain. S. Bel-Serrat is with the School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland. L.A. Moreno is with the Department of Preventive Medicine, School of Medicine, University of São Paulo, São Paulo, Brazil. A.C. Ferreira de Moraes is with the Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Silvia Bel-Serrat
- T.S. Collese, M.V. Nascimento-Ferreira, A.C. Ferreira de Moraes, T. Rendo-Urteaga, and H.B. Carvalho are with the YCARE (Youth/Child cArdiovascular Risk and Environmental) Research Group, Department of Preventive Medicine, School of Medicine, University of São Paulo, São Paulo, Brazil. T.S. Collese, A.C. Ferreira de Moraes, T. Rendo-Urteaga, S. Bel-Serrat, and L.A. Moreno are with the GENUD (Growth, Exercise, NUtrition and Development) Research Group, Faculty of Health Sciences, University of Zaragoza, Instituto Agroalimentario de Aragón (IA2), Zaragoza, Spain. S. Bel-Serrat is with the School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland. L.A. Moreno is with the Department of Preventive Medicine, School of Medicine, University of São Paulo, São Paulo, Brazil. A.C. Ferreira de Moraes is with the Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Luis A Moreno
- T.S. Collese, M.V. Nascimento-Ferreira, A.C. Ferreira de Moraes, T. Rendo-Urteaga, and H.B. Carvalho are with the YCARE (Youth/Child cArdiovascular Risk and Environmental) Research Group, Department of Preventive Medicine, School of Medicine, University of São Paulo, São Paulo, Brazil. T.S. Collese, A.C. Ferreira de Moraes, T. Rendo-Urteaga, S. Bel-Serrat, and L.A. Moreno are with the GENUD (Growth, Exercise, NUtrition and Development) Research Group, Faculty of Health Sciences, University of Zaragoza, Instituto Agroalimentario de Aragón (IA2), Zaragoza, Spain. S. Bel-Serrat is with the School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland. L.A. Moreno is with the Department of Preventive Medicine, School of Medicine, University of São Paulo, São Paulo, Brazil. A.C. Ferreira de Moraes is with the Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Heráclito Barbosa Carvalho
- T.S. Collese, M.V. Nascimento-Ferreira, A.C. Ferreira de Moraes, T. Rendo-Urteaga, and H.B. Carvalho are with the YCARE (Youth/Child cArdiovascular Risk and Environmental) Research Group, Department of Preventive Medicine, School of Medicine, University of São Paulo, São Paulo, Brazil. T.S. Collese, A.C. Ferreira de Moraes, T. Rendo-Urteaga, S. Bel-Serrat, and L.A. Moreno are with the GENUD (Growth, Exercise, NUtrition and Development) Research Group, Faculty of Health Sciences, University of Zaragoza, Instituto Agroalimentario de Aragón (IA2), Zaragoza, Spain. S. Bel-Serrat is with the School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland. L.A. Moreno is with the Department of Preventive Medicine, School of Medicine, University of São Paulo, São Paulo, Brazil. A.C. Ferreira de Moraes is with the Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
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Winpenny EM, Corder KL, Jones A, Ambrosini GL, White M, van Sluijs EMF. Changes in diet from age 10 to 14 years and prospective associations with school lunch choice. Appetite 2017; 116:259-267. [PMID: 28483584 PMCID: PMC5504772 DOI: 10.1016/j.appet.2017.05.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 05/04/2017] [Accepted: 05/04/2017] [Indexed: 01/05/2023]
Abstract
BACKGROUND There is limited evidence on how diet changes over the transition from primary to secondary school. In this study we investigated changes in diet from age 10 (2007) to age 14 years (2011) and the contribution of school-time consumption and school lunch choice to such changes. METHODS The 351 participants with dietary data (4 day food record) available at baseline (age 10 years) and follow-up (age 14 years) were included. Multi-level regression models were fitted for absolute or change in food and nutrient intake, cross-classified by primary and secondary school attended as appropriate, with adjustment for covariates and mis-reporting. RESULTS From age 10 to age 14 years, children decreased energy intake from sugars (-2.6% energy (%E)) (standard error (SE) 0.44) and from saturated fats (-0.54%E (SE 0.18)), decreased fruit (-3.13 g/MJ (SE 1.04)) and vegetables (-1.55 g/MJ (SE 0.46)) consumption and increased sugar sweetened beverage (SSB) (4.66 g/MJ (SE 1.87)) and fries (1.31 g/MJ (SE 0.39)) consumption. Intake of snack foods, SSBs, and fries, but also fruits and vegetables was higher outside school hours. Prospective change from non-school lunch to school lunch, compared to maintaining non-school lunch consumption, was associated with decreased consumption of savoury snacks (-8.32 g/day (SE 2.03)), increased consumption of fries (12.8 g/day (SE 4.01)) and decreased consumption of fruit (-25.16 g/day (SE 11.02)) during school hours. CONCLUSIONS Changes in diet from age 10 to age 14 years differed within and outside of school hours. Consumption of a school lunch, compared to lunch obtained elsewhere, was associated with negative as well as positive changes in diet, suggesting that any efforts to encourage school lunch take-up need to be accompanied by further efforts to improve school lunch provision to meet nutritional guidelines.
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Affiliation(s)
- Eleanor M Winpenny
- MRC Epidemiology Unit & Centre for Diet and Activity Research (CEDAR), University of Cambridge School of Clinical Medicine, Box 285, Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge CB2 0QQ, UK.
| | - Kirsten L Corder
- MRC Epidemiology Unit & Centre for Diet and Activity Research (CEDAR), University of Cambridge School of Clinical Medicine, Box 285, Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge CB2 0QQ, UK.
| | - Andy Jones
- Norwich Medical School, University of East Anglia, Norwich, Norfolk NR4 7TJ, UK.
| | - Gina L Ambrosini
- MRC Human Nutrition Research, Elsie Widdowson Laboratory, 120 Fulbourn Road, Cambridge CB1 9NL, UK; School of Population Health, University of Western Australia, 35 Stirling Highway, Crawley, Perth, Western Australia 6009, Australia.
| | - Martin White
- MRC Epidemiology Unit & Centre for Diet and Activity Research (CEDAR), University of Cambridge School of Clinical Medicine, Box 285, Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge CB2 0QQ, UK.
| | - Esther M F van Sluijs
- MRC Epidemiology Unit & Centre for Diet and Activity Research (CEDAR), University of Cambridge School of Clinical Medicine, Box 285, Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge CB2 0QQ, UK.
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Asada Y, Hughes A, Chriqui J. Insights on the Intersection of Health Equity and School Nutrition Policy Implementation: An Exploratory Qualitative Secondary Analysis. HEALTH EDUCATION & BEHAVIOR 2017; 44:685-695. [PMID: 28814162 DOI: 10.1177/1090198117723961] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Recent federal policies aimed to ensure that all children have equitable access to healthy school nutrition environments. However, historically, disparities have persisted in the quality of school nutrition environments across geographic and socioeconomic groups. There is limited literature addressing if and how recent efforts to reform the school nutrition environment have influenced such disparities. The main objective of this study was to explore stakeholders' insights on how school nutrition reform intersected with issues of inequity. METHOD Qualitative secondary analysis (QSA) offers a unique method to examine existing data with a related but distinct inquiry. This QSA analyzed three primary studies, including stakeholder interviews and focus group data with school professionals and students (total 60 transcripts). Two trained analysts iteratively coded all transcripts in Atlas.ti Version 7 and followed principles of constant comparative analysis. Measures to enhance "trustworthiness" were built into the primary studies and the QSA. RESULTS Broadly, stakeholders' complex insights about the school food environments' ability to compensate for healthy dietary options and "whole child" education that were perceived to be lacking in home environments. Despite the majority of respondents' positive perceptions of reforms, they also noted the challenges of addressing disparities due to family home environments and complex socioeconomic conditions. Overall, respondents reported that school food reform and nutrition education had the potential for long-term impacts on students' health, including the potential to improve disparities through enhanced academic achievement for disadvantaged populations. DISCUSSION AND CONCLUSION QSA allowed for inquiry into frontline stakeholders' understandings of how school nutrition reform may affect health inequities. Qualitative methods allowed for the examination of complex motivations and perspectives involved in policy implementation. Understanding frontline stakeholders' perspectives is key to advance school nutrition reform in a sustainable manner, especially in light of the federal local school wellness policy final rule.
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Affiliation(s)
- Yuka Asada
- 1 University of Illinois at Chicago, Chicago, IL, USA
| | | | - Jamie Chriqui
- 1 University of Illinois at Chicago, Chicago, IL, USA
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Mennella JA, Daniels LM, Reiter AR. Learning to like vegetables during breastfeeding: a randomized clinical trial of lactating mothers and infants. Am J Clin Nutr 2017; 106:67-76. [PMID: 28515063 PMCID: PMC5486194 DOI: 10.3945/ajcn.116.143982] [Citation(s) in RCA: 83] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 04/13/2017] [Indexed: 11/14/2022] Open
Abstract
Background: What lactating mothers eat flavors breast milk and, in turn, modifies their infants' acceptance of similarly flavored foods.Objective: We sought to determine the effects of the timing and duration of eating a variety of vegetables during breastfeeding on the liking of vegetables in both members of the dyad.Design: We conducted a randomized controlled study of 97 mother-infant dyads. Lactating mothers drank vegetable, beet, celery, and carrot juices for 1 mo beginning at 0.5, 1.5, or 2.5 mo postpartum or for 3 mo beginning at 0.5 mo postpartum. The control group drank equal volumes of water and avoided drinking the juices. Mothers rated the tastes of the juices and self-reported dietary intakes at each monthly visit (0.5-4.5 mo). After weaning, when 7.9 mo of age, infants' acceptance of plain, carrot-flavor (exposed flavor), and broccoli-flavor (nonexposed flavor) cereals was assessed on separate days.Results: The timing of exposure affected the acceptance of the carrot flavor that did not generalize to the novel broccoli flavor. A relatively brief experience (1 mo) with vegetable flavors in mothers' milk, starting at 0.5 mo postpartum, was sufficient to shift the hedonic tone, which resulted in a faster rate of eating carrot-flavored cereal than that in infants who were exposed during subsequent months or not at all. One month of exposure had a greater effect than 3 mo of exposure or no exposure. Regardless of when exposure occurred, infants were less likely to display facial expressions of distaste initially when eating the carrot cereal. Over time, mothers liked the tastes of carrot, beet, and celery juices more, but no changes in dietary intake of vegetables were observed.Conclusions: Early life may be an optimum time for both infants and their mothers to learn to like the taste of healthy foods. More research is needed to facilitate the liking and eating of these foods by mothers, which will, in turn, increase the likelihood of their feeding these foods to their children. This trial was registered at clinicaltrials.gov as NCT01667549.
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Schwartz MB, Just DR, Chriqui JF, Ammerman AS. Appetite self-regulation: Environmental and policy influences on eating behaviors. Obesity (Silver Spring) 2017; 25 Suppl 1:S26-S38. [PMID: 28229539 DOI: 10.1002/oby.21770] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 12/20/2016] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Appetite regulation is influenced by the environment, and the environment is shaped by food-related policies. This review summarizes the environment and policy research portion of an NIH Workshop (Bethesda, MD, 2015) titled "Self-Regulation of Appetite-It's Complicated." METHODS In this paper, we begin by making the case for why policy is an important tool in efforts to improve nutrition, and we introduce an ecological framework that illustrates the multiple layers that influence what people eat. We describe the state of the science on how policies influence behavior in several key areas: the federal food programs, schools, child care, food and beverage pricing, marketing to youth, behavioral economics, and changing defaults. Next, we propose novel approaches for multidisciplinary prevention and intervention strategies to promote breastfeeding, and examine interactions between psychology and the environment. RESULTS Policy and environmental change are the most distal influences on individual-level appetite regulation, yet these strategies can reach many people at once by changing the environment in which food choices are made. We note the need for more research to understand compensatory behavior, reactance, and how to effectively change social norms. CONCLUSIONS To move forward, we need a more sophisticated understanding of how individual psychological and biological factors interact with the environment and policy influences.
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Affiliation(s)
- Marlene B Schwartz
- Rudd Center for Food Policy and Obesity, University of Connecticut, Hartford, Connecticut, USA
| | - David R Just
- Dyson School of Applied Economics and Management, Cornell University, Ithaca, New York, USA
| | - Jamie F Chriqui
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Alice S Ammerman
- Department of Nutrition, Gillings School of Global Public Health, and Center for Health Promotion and Disease Prevention, UNC-Chapel Hill, Chapel Hill, North Carolina, USA
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Longacre MR, Drake KM, Titus LJ, Peterson KE, Beach ML, Langeloh G, Hendricks K, Dalton MA. School food reduces household income disparities in adolescents' frequency of fruit and vegetable intake. Prev Med 2014; 69:202-7. [PMID: 25456807 PMCID: PMC4312181 DOI: 10.1016/j.ypmed.2014.10.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Revised: 09/08/2014] [Accepted: 10/09/2014] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The aim of this study is to examine whether school food attenuates household income-related disparities in adolescents' frequency of fruit and vegetable intake (FVI). METHOD Telephone surveys were conducted between 2007 and 2008 with adolescent-parent dyads from Northern New England; participants were randomly assigned to be surveyed at different times throughout the year. The main analysis comprised 1542 adolescents who typically obtained breakfast/lunch at school at least once/week. FVI was measured using 7-day recall of the number of times adolescents consumed fruits and vegetables. Fully adjusted linear regression was used to compare FVI among adolescents who were surveyed while school was in session (currently exposed to school food) to those who were surveyed when school was not in session (currently unexposed to school food). RESULTS Mean FVI was 8.0 (SD=5.9) times/week. Among adolescents unexposed to school food, household income and FVI were strongly, positively associated. In contrast, among adolescents exposed to school food, FVI was similar across all income categories. We found a significant cross-over interaction between school food and household income in which consuming food at school was associated with higher FVI among adolescents from low-income households versus lower FVI among adolescents from high-income households. CONCLUSION School food may mitigate income disparities in adolescent FVI. The findings suggest that the school food environment positively influences FVI among low-income adolescents.
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Affiliation(s)
- Meghan R Longacre
- Community Health Research Program, The Hood Center for Children and Families, The Geisel School of Medicine at Dartmouth, Lebanon, NH, USA; Department of Pediatrics, The Geisel School of Medicine at Dartmouth, Lebanon, NH, USA.
| | - Keith M Drake
- Community Health Research Program, The Hood Center for Children and Families, The Geisel School of Medicine at Dartmouth, Lebanon, NH, USA; Greylock McKinnon Associates, Cambridge, MA, USA
| | - Linda J Titus
- Community Health Research Program, The Hood Center for Children and Families, The Geisel School of Medicine at Dartmouth, Lebanon, NH, USA; Department of Community and Family Medicine, The Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Karen E Peterson
- Human Nutrition Program, School of Public Health, University of Michigan, Ann Arbor, MI, USA; Department of Nutrition, Harvard School of Public Health, Boston, MA, USA
| | - Michael L Beach
- Community Health Research Program, The Hood Center for Children and Families, The Geisel School of Medicine at Dartmouth, Lebanon, NH, USA; Department of Anesthesiology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Gail Langeloh
- Community Health Research Program, The Hood Center for Children and Families, The Geisel School of Medicine at Dartmouth, Lebanon, NH, USA; Department of Pediatrics, The Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Kristy Hendricks
- Community Health Research Program, The Hood Center for Children and Families, The Geisel School of Medicine at Dartmouth, Lebanon, NH, USA; Department of Pediatrics, The Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Madeline A Dalton
- Community Health Research Program, The Hood Center for Children and Families, The Geisel School of Medicine at Dartmouth, Lebanon, NH, USA; Department of Pediatrics, The Geisel School of Medicine at Dartmouth, Lebanon, NH, USA; Department of Community and Family Medicine, The Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
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Moulton AD, Albright AL, Gregg EW, Goodman RA. Law, public health, and the diabetes epidemic. Am J Prev Med 2013; 45:486-93. [PMID: 24050425 DOI: 10.1016/j.amepre.2013.05.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2012] [Revised: 03/22/2013] [Accepted: 05/22/2013] [Indexed: 01/15/2023]
Abstract
The prevalence of new cases of diabetes continues to increase, and the health burden for those with diabetes remains high. This is attributable, in part, to low adoption of evidence-based interventions for diabetes prevention and control. Law is a critical tool for health improvement, yet assessments reported in this paper indicate that federal, state, and local laws give only partial support to guidelines and evidence-based interventions relevant to diabetes prevention and control. Public health practitioners and policymakers who are concerned with the human, fiscal, and economic costs of the epidemic can explore new ways to translate the evidence base for diabetes prevention and control into effective laws and policies.
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Affiliation(s)
- Anthony D Moulton
- Office of Surveillance, Epidemiology, and Laboratory Services (Moulton), CDC, Atlanta, Georgia.
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Scutchfield FD, Costich JF. Law and the public's health: science and policies. Am J Prev Med 2013; 44:427-428. [PMID: 23498111 DOI: 10.1016/j.amepre.2013.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Revised: 01/07/2013] [Accepted: 01/07/2013] [Indexed: 10/27/2022]
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