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Cohen JFW, Kesack A, Daly TP, Elnakib SA, Hager E, Hahn S, Hamlin D, Hill A, Lehmann A, Lurie P, Maroney M, Means J, Mueller MP, Olarte DA, Polacsek M, Schwartz MB, Sonneville KR, Spruance LA, Woodward AR, Chapman LE. Competitive Foods' Nutritional Quality and Compliance with Smart Snacks Standards: An Analysis of a National Sample of U.S. Middle and High Schools. Nutrients 2024; 16:275. [PMID: 38257169 PMCID: PMC10818474 DOI: 10.3390/nu16020275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 01/08/2024] [Accepted: 01/10/2024] [Indexed: 01/24/2024] Open
Abstract
Snacks and beverages are often sold in addition to meals in U.S. schools ("competitive foods"), but their current nutritional quality and compliance with national Smart Snacks standards are unknown. This study assessed competitive foods in a national sample of 90 middle and high schools. Differences in compliance by school characteristics were measured using mixed methods analysis of variance. Overall, 80% of the schools in the sample sold competitive foods; but they were less commonly available in schools with universal free school meal (UFSM) policies. A total of 840 unique products were documented and, on average, 75% were compliant with Smart Snacks standards. A total of 56% aligned with recommended added sugar limits (<10% of calories); and 340 unique products (40%) aligned with both sugar and Smart Snacks standards. Approximately one-fifth of competitive foods contained synthetic dyes, and 31% of beverages contained artificial sweeteners. Smart Snacks standards compliance was greater when competitive foods were overseen by food service departments, in comparison with others (e.g., principals, student organizations, or outside vendors [77% vs. 59% compliance; p = 0.003]). Therefore, district wellness policies should consider requiring food service departments to oversee competitive foods. Federal and state policies should limit added sugars, artificial sweeteners, and synthetic dyes. This appears to be highly feasible, given the substantial number of products that meet these criteria. UFSM policies should also be considered to support healthier school meal environments more broadly.
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Affiliation(s)
- Juliana F. W. Cohen
- Center for Health Inclusion, Research and Practice (CHIRP), Department of Nutrition and Public Health, Merrimack College, 315 Turnpike Street, North Andover, MA 01845, USA; (A.K.); (T.P.D.); (D.A.O.); (L.E.C.)
- Department of Nutrition, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA 02115, USA
| | - Ashley Kesack
- Center for Health Inclusion, Research and Practice (CHIRP), Department of Nutrition and Public Health, Merrimack College, 315 Turnpike Street, North Andover, MA 01845, USA; (A.K.); (T.P.D.); (D.A.O.); (L.E.C.)
| | - Tara P. Daly
- Center for Health Inclusion, Research and Practice (CHIRP), Department of Nutrition and Public Health, Merrimack College, 315 Turnpike Street, North Andover, MA 01845, USA; (A.K.); (T.P.D.); (D.A.O.); (L.E.C.)
| | - Sara A. Elnakib
- Department of Family and Community Health Sciences, Rutgers University, New Brunswick, NJ 08901, USA;
| | - Erin Hager
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA;
| | - Samuel Hahn
- Center for Science in the Public Interest, Washington, DC 20005, USA (A.H.); (P.L.); (M.M.)
| | - Daniel Hamlin
- Department of Educational Leadership and Policy Studies, University of Oklahoma, Tulsa, OK 74135, USA; (D.H.); (J.M.)
| | - Alla Hill
- Center for Science in the Public Interest, Washington, DC 20005, USA (A.H.); (P.L.); (M.M.)
| | - Annie Lehmann
- School of Allied Health, University of Alaska Anchorage, Anchorage, AK 99508, USA;
| | - Peter Lurie
- Center for Science in the Public Interest, Washington, DC 20005, USA (A.H.); (P.L.); (M.M.)
| | - Meghan Maroney
- Center for Science in the Public Interest, Washington, DC 20005, USA (A.H.); (P.L.); (M.M.)
| | - Jaydn Means
- Department of Educational Leadership and Policy Studies, University of Oklahoma, Tulsa, OK 74135, USA; (D.H.); (J.M.)
| | - Megan P. Mueller
- Department of Food Science and Human Nutrition, Colorado State University, 1571 Campus Dr, Fort Collins, CO 80523, USA;
| | - Deborah A. Olarte
- Center for Health Inclusion, Research and Practice (CHIRP), Department of Nutrition and Public Health, Merrimack College, 315 Turnpike Street, North Andover, MA 01845, USA; (A.K.); (T.P.D.); (D.A.O.); (L.E.C.)
| | - Michele Polacsek
- Center for Excellence in Public Health, University of New England, 716 Stevens Ave, Portland, ME 04103, USA;
| | - Marlene B. Schwartz
- Rudd Center for Food Policy and Health, Department of Human Development and Family Sciences, University of Connecticut, 1 Constitution Plaza, Suite 600, Hartford, CT 06103, USA;
| | - Kendrin R. Sonneville
- Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, MI 48109, USA;
| | - Lori A. Spruance
- Department of Public Health, Brigham Young University, Provo, UT 84602, USA;
| | | | - Leah E. Chapman
- Center for Health Inclusion, Research and Practice (CHIRP), Department of Nutrition and Public Health, Merrimack College, 315 Turnpike Street, North Andover, MA 01845, USA; (A.K.); (T.P.D.); (D.A.O.); (L.E.C.)
- Department of Nutrition, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA 02115, USA
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Abstract
This research was conducted within the framework of a research project aimed at detecting patterns of plate waste and developing recommendations for improving catering in seven schools in Rezekne city (Latvia) by a combination of observation, physical weighing, semi-structured interview approaches and statistical analysis of variance (ANOVA). We identified plate waste (including wasted beverages), which remains after the lunch of schoolchildren in grades 1–7, examining a total of 7064 lunch samples. The originality of the research is due to the fact that a unified menu was designed for the field study, which ensured the same field study conditions in all the schools. The results of the research revealed that the average weight of plate waste per schoolchild reached 178 g, and the total weight of plate waste accounted for 28.75% of the total weight of food served. No significant differences in plate waste weight between various age groups and grades of schoolchildren were found, which was also confirmed by a one-way ANOVA test. An analysis of plate waste by food category showed that beverages accounted for the largest share of total plate waste (42.24%), followed by staple food (28.38%) and meat (11.77%). An analysis of plate waste shares of food served (%) by food category revealed a similar situation: the largest share of food served was made up of beverages (37.56%), followed by staple food (36.48%) and meat (28.77%). An analysis of the monetary value of food waste showed that the average cost of plate waste (excluding beverage) per schoolchild was EUR 0.236, which represented 16.6% of the national and municipal funding of EUR 1.42 per portion. Given the research results, the authors have concluded that in order to reduce the amount of plate waste generated by Rezekne city schools, school menus should be based not only on the requirements prescribed by relevant legal acts but also on cooking processes that meet the requirements of modern consumers (learners), e.g., by following trends in cooking practices in society to make the learners interested in consuming school food.
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Matsuzaki M, Sánchez BN, Rebanal RD, Gittelsohn J, Sanchez-Vaznaugh EV. California and federal school nutrition policies and obesity among children of Pacific Islander, American Indian/Alaska Native, and Filipino origins: Interrupted time series analysis. PLoS Med 2021; 18:e1003596. [PMID: 34029318 PMCID: PMC8143391 DOI: 10.1371/journal.pmed.1003596] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 03/25/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Obesity prevalence remains high among children of Pacific Islander (PI) origin, Filipino (FI), and American Indian/Alaska Native (AIAN) origins in the United States. While school nutrition policies may help prevent and reduce childhood obesity, their influences specifically among PI, FI, and AIAN children remain understudied. We evaluated the association of the California (CA) state school nutrition policies for competitive food and beverages and the federal policy for school meals (Healthy, Hunger-Free Kids Act of 2010 (HHFKA 2010)) with overweight/obesity among PI, FI, and AIAN students. METHODS AND FINDINGS We used an interrupted time series (ITS) design with FitnessGram data from 2002 to 2016 for PI (78,841), FI (328,667), AIAN (97,129), and White (3,309,982) students in fifth and seventh grades who attended CA public schools. Multilevel logistic regression models estimated the associations of the CA school nutrition policies (in effect beginning in academic year 2004 to 2005) and HHFKA 2010 (from academic year 2012 to 2013) with overweight/obesity prevalence (above the 85 percentile of the age- and sex-specific body mass index (BMI) distribution). The models were constructed separately for each grade and sex combination and adjusted for school district-, school-, and student-level characteristics such as percentage of students eligible for free and reduced price meals, neighborhood income and education levels, and age. Across the study period, the crude prevalence of overweight/obesity was higher among PI (39.5% to 52.5%), FI (32.9% to 36.7%), and AIAN (37.7% to 45.6%) children, compared to White (26.8% to 30.2%) students. The results generally showed favorable association of the CA nutrition policies with overweight/obesity prevalence trends, although the magnitudes of associations and strengths of evidence varied among racial/ethnic subgroups. Before the CA policies went into effect (2002 to 2004), overweight/obesity prevalence increased for White, PI, and AIAN students in both grades and sex groups as well as FI girls in seventh grade. After the CA policies took place (2005 to 2012), the overweight/obesity rates decreased for almost all subgroups who experienced increasing trends before the policies, with the largest decrease seen among PI girls in fifth grade (before: log odds ratio = 0.149 (95% CI 0.108 to 0.189; p < 0.001); after: 0.010 (-0.005 to 0.025; 0.178)). When both the CA nutrition policies and HHFKA 2010 were in effect (2013 to 2016), declines in the overweight/obesity prevalence were seen among White girls and FI boys in fifth grade. Despite the evidence of the favorable association of the school nutrition policies with overweight/obesity prevalence trends, disparities between PI and AIAN students and their White peers remained large after the policies took place. As these policies went into effect for all public schools in CA, without a clear comparison group, we cannot conclude that the changes in prevalence trends were solely attributable to these policies. CONCLUSIONS The current study found evidence of favorable associations of the state and federal school nutrition policies with overweight/obesity prevalence trends. However, the prevalence of overweight/obesity continued to be high among PI and AIAN students and FI boys. There remain wide racial/ethnic disparities between these racial/ethnic minority subgroups and their White peers. Additional strategies are needed to reduce childhood obesity and related disparities among these understudied racial/ethnic populations.
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Affiliation(s)
- Mika Matsuzaki
- Johns Hopkins Bloomberg School of Public Health, Department of International Health, Center for Human Nutrition, Baltimore, Maryland, United States of America
| | - Brisa N. Sánchez
- Drexel University Dornsife School of Public Health, Department of Biostatistics, Philadelphia, Pennsylvania, United States of America
| | - R. David Rebanal
- San Francisco State University, Health Equity Institute, San Francisco, California, United States of America
- San Francisco State University, Department of Public Health, San Francisco, California, United States of America
| | - Joel Gittelsohn
- Johns Hopkins Bloomberg School of Public Health, Department of International Health, Center for Human Nutrition, Baltimore, Maryland, United States of America
| | - Emma V. Sanchez-Vaznaugh
- San Francisco State University, Health Equity Institute, San Francisco, California, United States of America
- San Francisco State University, Department of Public Health, San Francisco, California, United States of America
- University of California San Francisco, Center for Health Equity, San Francisco, California, United States of America
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Fox MK, Gearan EC, Schwartz C. Added Sugars in School Meals and the Diets of School-Age Children. Nutrients 2021; 13:471. [PMID: 33573299 PMCID: PMC7911531 DOI: 10.3390/nu13020471] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 01/18/2021] [Accepted: 01/20/2021] [Indexed: 01/06/2023] Open
Abstract
Research is limited on added sugars in school meals and children's dietary intakes after the 2015-2020 Dietary Guidelines for Americans (DGA) recommended that added sugars be limited to less than 10% of total calories. This analysis uses data from the School Nutrition and Meal Cost Study (SNMCS) to examine levels of added sugars in: (1) school meals and (2) children's dietary intakes at breakfast, lunch, and over 24 h on school days. SNMCS data were collected in the 2014-2015 school year after updated nutrition standards for school meals were implemented. Most schools exceeded the DGA limit for added sugars at breakfast (92%), while 69% exceeded the limit at lunch. The leading source of added sugars in school meals (both breakfasts and lunches) was flavored skim milk. More than 62% of children consumed breakfasts that exceeded the DGA limit, and almost half (47%) consumed lunches that exceeded the limit. Leading sources of added sugars in the breakfasts consumed by children were sweetened cold cereals and condiments and toppings; leading sources of added sugars in children's lunches were flavored skim milk and cake. Over 24 h, 63% of children exceeded the DGA limit. These findings show that school meals and children's dietary intakes are high in added sugars relative to the DGA limit and provide insights into the types of foods that should be targeted in order to decrease levels of added sugars.
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Affiliation(s)
- Mary Kay Fox
- Mathematica, 955 Massachusetts Avenue, Suite 801, Cambridge, MA 02139, USA;
| | | | - Colin Schwartz
- Center for Science in the Public Interest, 1220 L Street NW, Suite 300, Washington, DC 20005, USA;
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Schwartz MB, Leider J, Cohen JFW, Turner L, Chriqui JF. Association between Nutrition Policies and Student Body Mass Index. Nutrients 2020; 13:E13. [PMID: 33374504 PMCID: PMC7822196 DOI: 10.3390/nu13010013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 12/14/2020] [Accepted: 12/18/2020] [Indexed: 12/29/2022] Open
Abstract
In response to concerns about childhood obesity, many US states have implemented policies to limit the sale of unhealthy foods and beverages (e.g., snacks, desserts, and sugary drinks) sold in competition with school meal programs (i.e., competitive foods) in order to improve the nutritional environment of schools and support student health. This study measured state-level competitive food and beverage policies that require foods and beverages sold in à la carte lines, vending machines, and school stores to meet strong nutrition standards and tested the hypothesis that students living in states with stronger laws would have lower body mass index (BMI)-for-age percentiles. BMI data from a national sample of 1625 students attending 284 schools from the School Nutrition and Meal Cost Study were linked to state laws coded as part of the National Wellness Policy Study. A survey-adjusted linear regression model accounting for student and school-level characteristics showed that stronger state nutrition policies were associated with lower student BMI scores (coefficient: -0.06, 95% CI: -0.12, -0.00). Additional models indicated that stronger state policies were significantly associated with fewer unhealthy foods and beverages available in schools. These findings suggest that strong regulations on competitive foods and beverages may lead to improvements in the nutritional quality of the school environment and student BMI. Thus, current federal standards regulating snacks in US schools (i.e., Smart Snacks) are an important element of a comprehensive strategy to improve the school nutrition environment and reduce rates of childhood obesity.
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Affiliation(s)
- Marlene B. Schwartz
- Rudd Center for Food Policy and Obesity, Department of Human Development and Family Sciences, University of Connecticut, 1 Constitution Plaza, Hartford, CT 06103, USA
| | - Julien Leider
- Institute for Health Research and Policy, University of Illinois Chicago, Chicago, IL 60608, USA; (J.L.); (J.F.C.)
| | - Juliana F. W. Cohen
- Department of Public Health and Nutrition, Merrimack College, 315 Turnpike Street, North Andover, MA 01845, USA;
- Department of Nutrition, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA 02115, USA
| | - Lindsey Turner
- College of Education, Boise State University, 1910 University Drive, Boise, ID 83725, USA;
| | - Jamie F. Chriqui
- Institute for Health Research and Policy, University of Illinois Chicago, Chicago, IL 60608, USA; (J.L.); (J.F.C.)
- Division of Health Policy and Administration, School of Public Health, University of Illinois Chicago, 1603 W. Taylor St, Chicago, IL 60612, USA
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Richardson AS, Nicosia N, Ghosh-Dastidar MB, Datar A. School Food and Beverage Availability and Children's Diet, Purchasing, and Obesity: Evidence From a Natural Experiment. J Adolesc Health 2020; 67:804-813. [PMID: 32331931 PMCID: PMC7575612 DOI: 10.1016/j.jadohealth.2020.03.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 02/27/2020] [Accepted: 03/01/2020] [Indexed: 12/31/2022]
Abstract
PURPOSE Existing evidence on relationships between school food environments and children's in-school purchases, dietary behaviors, and body composition is based on observational studies that are vulnerable to residential selection bias. METHODS This study leveraged exogenous variation in school environments generated by the natural experiment due to military parents' assignment to installations. We analyzed 1,010 child-wave observations from the Military Teenagers Environments, Exercise, and Nutrition Study collected during 2013-2015. Using multiple linear and logistic regression, we examined whether the number of competitive food and beverage (CF&B) items available for purchase in school, overall and by type (unhealthy, healthy, neutral), was associated with in-school food purchases, dietary behaviors, and body mass index (BMI) outcomes. Covariates included child and family characteristics and the healthiness of the home food environment. RESULTS Unhealthy item availability was positively associated with purchasing any sweets (adjusted odds ratio [AOR], 1.30; p < .01), snacks (AOR, 1.23; p < .01), and sugar-sweetened beverages (AOR, 1.19; p = .01). However, there were no significant associations with overall food and beverage intake (e.g., sweets, soda) nor BMI outcomes. The home food environment was significantly associated with all outcomes. CONCLUSIONS Access to unhealthy CF&B items may influence in-school purchases but does not appear to influence overall dietary behaviors and BMI outcomes. Substitution of caloric intake across locations within versus outside of school may play a role in explaining why purchases were associated with unhealthy CF&B availability but overall diet and downstream BMI were not.
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Affiliation(s)
| | - Nancy Nicosia
- Economics, Sociology & Statistics, RAND Corporation, Boston, Massachusetts
| | | | - Ashlesha Datar
- Center for Economic and Social Research, University of Southern California, Los Angeles, California
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A systematic review of existing observational tools to measure the food and physical activity environment in schools. Health Place 2020; 66:102388. [DOI: 10.1016/j.healthplace.2020.102388] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 05/17/2020] [Accepted: 06/23/2020] [Indexed: 01/18/2023]
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Mohammadi S, Su TT, Jalaludin MY, Dahlui M, Azmi Mohamed MN, Papadaki A, Jago R, Toumpakari Z, Majid HA. School-Based Intervention to Improve Healthy Eating Practices Among Malaysian Adolescents: A Feasibility Study Protocol. Front Public Health 2020; 8:549637. [PMID: 33072694 PMCID: PMC7536333 DOI: 10.3389/fpubh.2020.549637] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 08/19/2020] [Indexed: 01/15/2023] Open
Abstract
Introduction: School environments can influence students' dietary habits. Hence, implementing a healthy canteen intervention programme in schools is a recommended strategy to improve students' dietary intake. This study will evaluate the feasibility of providing healthier food and beverage options in selected secondary schools in Malaysia by working with canteen vendors. It also will assess the changes in food choices before and after the intervention. Methods: A feasibility cluster randomised controlled study will be conducted in six secondary schools (intervention, n = 4; control, n = 2) comprising of rural and urban schools located in Selangor and Perak states in Malaysia. Four weeks of intervention will be conducted among Malaysian adolescents aged 15 years old. Two interventions are proposed that will focus on providing healthier food options in the canteen and convenience shops in the selected schools. Interventions 1 and 2 will entail training the canteen and school convenience shop operators. Intervention 2 will be applied to subsidise the cost of low energy-dense kuih (traditional cake), vegetables, and fruits. The control group will continue to sell the usual food. Trained dietitians will audit the canteen menu and food items sold by the school canteen and convenience shops in all schools. Anthropometric measurements, blood pressure and dietary assessment will be collected at baseline and at the end of 4-week intervention. Focus group discussions with students and in-depth interviews with headmasters, teachers, and school canteen operators will be conducted post-intervention to explore intervention acceptability. Under this Healthy School Canteen programme, school canteens will be prohibited from selling “red flag” foods. This refers to foods which are energy-dense and not nutritious, such as confectionery and deep-fried foods. They will also be prohibited from selling soft drinks, which are sugar-rich. Instead, the canteens will be encouraged to sell “green flag” food and drinks, such as fruits and vegetables. Conclusion: It is anticipated that this feasibility study can provide a framework for the conception and implementation of nutritional interventions in a future definitive trial at the school canteens in Malaysia.
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Affiliation(s)
- Shooka Mohammadi
- Department of Social and Preventive Medicine, Faculty of Medicine, Centre of Population Health, University of Malaya, Kuala Lumpur, Malaysia
| | - Tin Tin Su
- Department of Social and Preventive Medicine, Faculty of Medicine, Centre of Population Health, University of Malaya, Kuala Lumpur, Malaysia.,South East Asia Community Observatory (SEACO), Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Subang Jaya, Malaysia
| | | | - Maznah Dahlui
- Department of Social and Preventive Medicine, Faculty of Medicine, Centre of Population Health, University of Malaya, Kuala Lumpur, Malaysia
| | - Mohd Nahar Azmi Mohamed
- Department of Sports Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Angeliki Papadaki
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Bristol, United Kingdom
| | - Russell Jago
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Bristol, United Kingdom
| | - Zoi Toumpakari
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Bristol, United Kingdom
| | - Hazreen A Majid
- Department of Social and Preventive Medicine, Faculty of Medicine, Centre of Population Health, University of Malaya, Kuala Lumpur, Malaysia.,Department of Nutrition, Faculty of Public Health, Universitas Airlangga, Surabaya, Indonesia
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Bardin S, Washburn L, Gearan E. Disparities in the Healthfulness of School Food Environments and the Nutritional Quality of School Lunches. Nutrients 2020; 12:E2375. [PMID: 32784416 PMCID: PMC7468741 DOI: 10.3390/nu12082375] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 07/31/2020] [Accepted: 08/05/2020] [Indexed: 01/18/2023] Open
Abstract
The Healthy, Hunger-Free Kids Act (HHFKA), a public law in the United States passed in 2010, sought to improve the healthfulness of the school food environment by requiring updated nutrition standards for school meals and competitive foods. Studies conducted since the passage of the HHFKA indicate improvements in the food environment overall, but few studies have examined whether these improvements varied by the socioeconomic and racial/ethnic composition of students in schools. To better understand the extent of disparities in the school food environment after HHFKA, this paper examined differences in the healthfulness of school food environments and the nutritional quality of school lunches by the school poverty level and racial/ethnic composition of students using data from the School Nutrition and Meal Cost Study. Results from chi-square analyses showed lower proportions of high poverty, majority black, and majority Hispanic schools had access to competitive foods, while higher proportions of these schools had a school wellness policy in addition to a district wellness policy. The overall nutritional quality of school lunches, as measured by total Healthy Eating Index (HEI)-2010 scores, did not vary significantly across school types, although some HEI component scores did. From these findings, we concluded that there were disparities in the school food environment based on the socioeconomic and racial/ethnic composition of students in schools, but no significant disparities in the overall nutritional quality of school lunches were found.
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Affiliation(s)
- Sarah Bardin
- Mathematica, 955 Massachusetts Avenue, Suite 801, Cambridge, MA 02139, USA;
| | - Liana Washburn
- Mathematica, 1100 First Street, NE, 12th Floor, Washington, DC 20002, USA;
| | - Elizabeth Gearan
- Mathematica, 955 Massachusetts Avenue, Suite 801, Cambridge, MA 02139, USA;
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Liz Martins M, Rodrigues SSP, Cunha LM, Rocha A. Factors influencing food waste during lunch of fourth-grade school children. WASTE MANAGEMENT (NEW YORK, N.Y.) 2020; 113:439-446. [PMID: 32599349 DOI: 10.1016/j.wasman.2020.06.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 06/03/2020] [Accepted: 06/17/2020] [Indexed: 06/11/2023]
Abstract
This study aims to explore the factors that influence plate waste at lunches served in primary schools. Data was collected for all fourth-grade children attending 21 primary schools from the city of Porto (Portugal) (n = 463). Plate waste was evaluated by the weighing method and factors influencing plate waste were collected by observation of menu and canteen characteristics and through the application of a questionnaire to children aiming to evaluate factors related to preferences and dietary patterns. Logistic regression was performed to identify predictors of plate waste. It was observed that fish menus and composed dishes showed a higher tendency for increased plate waste. However, this effect was not observed when adjusted for other variables. Soups without pulses and blended soups were less likely to be discarded by children. The presence of the teacher during meals and the possibility for children to leave the canteen whenever they wish, protected both the main dish and the soup from being wasted. A higher number of children in the canteen was associated with increased soup waste. As expected, children more pleased with the sensory characteristics of the main dish and soup were less likely to waste food. Children who consumed high-saturated fat content mid-morning snacks were more likely to waste soup. The main factors associated with plate waste were related to the presence of teachers during the mealtime, school meal policies and the meals' sensory characteristics. Additionally, soup waste was determined by its composition, mid-morning snacks and the number of children in the canteen.
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Affiliation(s)
- Margarida Liz Martins
- Faculty of Food Sciences and Nutrition, University of Porto, Rua Dr. Roberto Frias, 4200-465 Porto, Portugal; University of Trás-Os-Montes e Alto Douro, Quinta de Prados, 5000-801 Vila Real, Portugal; Universidade Católica Portuguesa, CBQF - Centro de Biotecnologia e Química Fina - Laboratório Associado, Escola Superior de Biotecnologia, Rua Diogo Botelho 1327, 4169-005 Porto, Portugal; GreenUPorto - Sustainable Agrifood Production Research Centre, Campus de Vairão - Edifício de Ciências Agrárias (FCV2), Rua da Agrária, 747, 4485-646 Vairão, Portugal.
| | - Sara S P Rodrigues
- Faculty of Food Sciences and Nutrition, University of Porto, Rua Dr. Roberto Frias, 4200-465 Porto, Portugal; Epidemiology Research Unit, Institute of Public Health, University of Porto (EPIUnit), Portugal.
| | - Luís M Cunha
- DGAOT, Faculty of Sciences, University of Porto, Rua do Campo Alegre, s/n, 4169-007 Porto, Portugal; GreenUPorto - Sustainable Agrifood Production Research Centre, Campus de Vairão - Edifício de Ciências Agrárias (FCV2), Rua da Agrária, 747, 4485-646 Vairão, Portugal.
| | - Ada Rocha
- Faculty of Food Sciences and Nutrition, University of Porto, Rua Dr. Roberto Frias, 4200-465 Porto, Portugal; GreenUPorto - Sustainable Agrifood Production Research Centre, Campus de Vairão - Edifício de Ciências Agrárias (FCV2), Rua da Agrária, 747, 4485-646 Vairão, Portugal; LAQV-Requimte - University of Porto, 4051-401 Porto, Portugal.
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Turner L, Leider J, Piekarz-Porter E, Chriqui JF. Association of State Laws Regarding Snacks in US Schools With Students' Consumption of Solid Fats and Added Sugars. JAMA Netw Open 2020; 3:e1918436. [PMID: 31940035 PMCID: PMC6991240 DOI: 10.1001/jamanetworkopen.2019.18436] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE The Smart Snacks in School standards (hereafter, Smart Snacks) were issued in 2013 with the aim of improving students' dietary intake behaviors. Goals of Smart Snacks included reducing total energy intake, consumption of solid fats and added sugars, and sodium intake. Smart Snacks standards were required to be implemented by the start of the 2014 to 2015 school year at all US schools participating in federal child nutrition programs. OBJECTIVE To examine the association of state laws that specifically direct schools to implement Smart Snacks with student dietary consumption outcomes. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study used nationally representative data collected in the 2014 to 2015 school year as part of the School Nutrition and Meal Cost Study. Students in grades 1 through 12 (ages approximately 6-18 years) were randomly selected from 310 public schools in 30 US states and the District of Columbia. Analytic weights were applied and all percentages reported are weighted. Analyses were conducted from March 1, 2018, to December 12, 2019. EXPOSURES State laws requiring schools to implement Smart Snacks. MAIN OUTCOMES AND MEASURES A 24-hour recall was used to assess student dietary intake as daily kilocalories consumed as (a) total energy, (b) solid fats and added sugars combined, (c) solid fats, or (d) added sugars. Milligrams of daily sodium consumption were also computed. RESULTS Among 1959 students (mean [SD] age, 11.9 [3.5] years; 1014 [50.9%] boys), 420 students (22.5%) attended school in a state with Smart Snacks laws, and 528 students (26.1%) consumed snacks obtained at school. In covariate-adjusted models, total energy intake did not vary based on state law. Adjusted mean daily kilocalories from solid fats and added sugars was significantly lower among students in states with laws (508.7 [95% CI, 463.0 to 554.4] kcal) than among students in states without laws (562.5 [95% CI, 534.3 to 590.8] kcal; difference, -53.9 [95% CI, -104.5 to -3.2] kcal; P = .04). Consumption of sodium did not differ by state law. Kilocalories from solid fats contributed more to the difference than kilocalories from added sugars (-37.7 [95% CI -62.8 to -12.6] kcal vs -16.2 [95% CI, -51.3 to 19.0] kcal). CONCLUSIONS AND RELEVANCE These findings suggest that students in states with laws requiring schools to implement Smart Snacks had better dietary intake than students in states without laws, consuming a mean of 53.9 fewer kilocalories from solid fats and added sugars per day, after adjusting for covariates. State-level policy mechanisms may support schools' implementation of federal standards in ways that are associated with healthier diets among children and adolescents.
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Affiliation(s)
- Lindsey Turner
- College of Education, Boise State University, Boise, Idaho
| | - Julien Leider
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago
| | | | - Jamie F Chriqui
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago
- Division of Health Policy and Administration, School of Public Health, University of Illinois at Chicago, Chicago
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Motta V. The Impact of Local Food Expenditure on School Foodservice Revenues. THE JOURNAL OF SCHOOL HEALTH 2019; 89:722-729. [PMID: 31264235 DOI: 10.1111/josh.12809] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 10/19/2017] [Accepted: 04/22/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Locally grown foods, through farm-to-school (FTS) activities, may be a key component to balancing foodservice budgets and alleviating financial constraints in school districts. Therefore, the purpose of this study is to examine the impact of local food expenditures on school foodservice revenues and earnings. We anticipated a positive impact of local food expenditures on foodservice revenues and earnings. METHODS Ordinary Least Squares (OLS) regression analysis was conducted using data from the 2013 US Department of Agriculture Farm to School Census. The questionnaire primarily asked all US public school districts about their FTS operations during 2011-2012 school year. RESULTS Although our results initially showed a negative impact of local milk and nonmilk expenditures on foodservice revenues from food sales, when combined with revenues from the federal government, the impact is positive. The positive effect seems to hold when adding foodservice revenues from both food sales and federal funds. Our study found a similar pattern for foodservice earnings. CONCLUSIONS This may indicate that competitive foods are still widely preferred in school districts. Revenue from the federal government is critical to maintain FTS activities viable to students and community members although federal funds and food sales may not cover total foodservice expenditures.
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Affiliation(s)
- Victor Motta
- Business Administration School of São Paulo, Getulio Vargas Foundation, Av. 9 de Julho, 2029, São Paulo CEP 01313-902, SP, Brazil
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Rossi CE, Costa LDCF, Machado MDS, Andrade DFD, Vasconcelos FDAGD. Fatores associados ao consumo alimentar na escola e ao sobrepeso/obesidade de escolares de 7-10 anos de Santa Catarina, Brasil. CIENCIA & SAUDE COLETIVA 2019; 24:443-454. [DOI: 10.1590/1413-81232018242.34942016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 04/21/2017] [Indexed: 11/21/2022] Open
Abstract
Resumo O objetivo deste artigo é investigar associação entre a proveniência de lanches consumidos na escola, seu valor nutricional e o sobrepeso/obesidade. Estudo transversal com 3.930 escolares de 7-10 anos de idade, de Santa Catarina. O consumo alimentar na escola foi avaliado com R-24 horas ilustrado, e a origem dos lanches por entrevista estruturada. Refrigerantes e sucos artificiais, frituras, salgadinhos industrializados, lanches prontos, doces, guloseimas e biscoitos recheados foram classificados como “lanches de baixo valor nutricional”, enquanto frutas, sucos naturais, legumes, verduras e sopa de verduras foram os “lanches de alto valor nutricional”. Realizou-se regressão logística univariada e múltipla. O sobrepeso/obesidade se associou significativamente ao consumo de alimentos provenientes da cantina (OR = 1,34; IC = 1,07-1,68), na rede particular. Trazer alimentos de casa foi significativamente associado ao maior consumo de lanches de baixo valor nutricional, nas escolas públicas (OR = 1,56; IC = 1,32-1,83) e nas particulares (OR = 2,64; IC = 1,76-3,97). Os resultados apontam a necessidade de expansão de normativas que minimizem a disponibilidade de alimentos de baixo valor nutricional nas cantinas e que promovam educação nutricional envolvendo a comunidade escolar.
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Factors underlying compliance with a healthy snacking initiative in the school environment: accounts of school principals in Montevideo (Uruguay). Public Health Nutr 2018; 22:726-737. [PMID: 30587269 DOI: 10.1017/s1368980018003488] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To evaluate the implementation of the Uruguayan healthy snacking initiative in primary and secondary schools in the capital, and to explore the factors underlying compliance from the perspective of school principals. DESIGN A mixed-method approach was used, which included semi-structured interviews with school principals and a survey of the foods and beverages sold and advertised in the schools. SETTING Primary and secondary schools in Montevideo (the capital city of Uruguay). PARTICIPANTS School principals. RESULTS The great majority of the schools did not comply with the initiative. Exhibition of non-recommended products was the main cause for non-compliance, followed by advertising of non-recommended products through promotional activities of food and beverage companies. Although school principals were aware of the healthy snack initiative and showed a positive attitude towards it, the majority lacked knowledge about its specific content. Factors underlying compliance with the healthy snacking initiative were related to its characteristics, characteristics of the schools, and external factors such as family habits and advertising. CONCLUSIONS Results showed that the rationale underlying the selling of products at schools favours the availability of ultra-processed products and constitutes the main barrier for the promotion of healthy dietary habits among children and adolescents. Strategies aimed at facilitating the identification of unhealthy foods and beverages and provision of incentives to canteen managers to modify their offer are recommended.
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Kranjac AW. School-Level Body Mass Index Shapes Children's Weight Trajectories. THE JOURNAL OF SCHOOL HEALTH 2018; 88:917-927. [PMID: 30392191 DOI: 10.1111/josh.12701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Revised: 01/08/2018] [Accepted: 05/03/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Embedded within children's weight trajectories are complex environmental contexts that influence obesity risk. As such, the normative environment of body mass index (BMI) within schools may influence children's weight trajectories as they age from kindergarten to fifth grade. METHODS I use 5 waves of the ECLS-K-Kindergarten Class 1998-1999 data and a series of multilevel growth models to examine whether attending schools with higher overall BMI influences children's weight status over time. RESULTS Results show that, net of child, family, and school sociodemographic characteristics, children who attend schools with higher rates of obesity have increased weight compared to children who attend schools with lower rates of obesity, and this effect increases annually. CONCLUSIONS Findings indicate that the overall weight status of schools influence child obesity, and further speak to the importance of school-based intervention programs.
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Sildén KE. Impact of competitive foods in public schools on child nutrition: effects on adolescent obesity in the United States an integrative systematic literature review. Glob Health Action 2018; 11:1477492. [PMID: 29893188 PMCID: PMC5998782 DOI: 10.1080/16549716.2018.1477492] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background: The United States (US) is currently facing a public health crisis due to the percentage of obesity in adolescents. The Center for Disease Control (CDC) stated the risks for children due to obesity are many. Adolescents obtain a large portion of their daily caloric intake at school; therefore, what foods/drinks they are consuming is so serious. Objective: To identify and analyze literature on the effects of competitive foods in public schools on adolescent weight, or Body Mass Index (BMI), and possible impacts they may have on adolescent obesity in the United States. Methods: An integrative systematic review of literature was conducted. The literature was collected in CINAHL, MEDLINE and EMBASE databases. Refined keyword search is further detailed in the report. Year restrictions were 2006–2017 from peer-reviewed journals and published in English, including adolescents 13–18 years old in the US. Criteria for inclusion targeted at least one of (1) sugar-sweetened beverages (SSB), (2) competitive foods, (3) commercial foods, (4) vending machines, (5) al a carte venues, and (6) school stores, examining their associations with weight measurements, using either weight or BMI, or caloric intake analysis. Results: A total of 164 articles were detected and assessed, for a final analysis of 34 full text articles. Twenty-six articles met the inclusion criteria. Common aspects of interest involved BMI/Obesity/Weight (73%), (58%) examined Calorie density or consumption, (77%) discussed the Availability of competitive foods in schools, (54%) included Analysis of competitive food, beverage and nutrition policies, and (69%) addressed Other effects. Conclusion: This review discovered substantial evidence that competitive foods are highly available in schools, however, lacking in robust evidence proving causality in increasing BMI or weight. There is strong corroboration in the research revealing that Other effects are factors worthy of studying further. Additional longitudinal and higher-quality research needs to be performed.
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Affiliation(s)
- Kirsten E Sildén
- a Department of Public Health , Lund University , Ängelholm , Sweden
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Cohen JFW, Gorski Findling MT, Rosenfeld L, Smith L, Rimm EB, Hoffman JA. The Impact of 1 Year of Healthier School Food Policies on Students' Diets During and Outside of the School Day. J Acad Nutr Diet 2018; 118:2296-2301. [PMID: 30213618 DOI: 10.1016/j.jand.2018.07.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 07/09/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND In 2012, Massachusetts implemented both the updated national school meal standards and comprehensive competitive food/beverage standards that closely align with current national requirements for school snacks. OBJECTIVES This study examines the impact of these combined standards on school meal and snack food selections, as well as food choices outside of school. In addition, this study examines the impact of these standards on nutrients consumed. DESIGN The NOURISH (Nutrition Opportunities to Understand Reforms Involving Student Health) Study was an observational cohort study conducted among students from spring 2012 to spring 2013. PARTICIPANTS/SETTING One hundred sixty students in 12 middle schools and high schools in Massachusetts completed two 24-hour recalls before (spring 2012) and after implementation (spring 2013) of the updated standards. MAIN OUTCOME MEASURES Changes in school meals, competitive food, and after-school snack selection, as well as nutrients consumed outside of school were examined. STATISTICAL ANALYSES PERFORMED Logistic regression and mixed-model analysis of variance were used to examine food selection and consumption. RESULTS After implementation, 13.6% more students chose a school meal (70.1% vs 56.5%; P=0.02). There were no differences in competitive food purchases but a significant decrease in the number of after-school unhealthy snacks consumed (0.69 [standard error=0.08] vs 1.02 [standard error=0.10]; P=0.009). During the entire day, students consumed, on average, 22 fewer grams of sugar daily after implementation compared with before implementation (86 g vs 108 g; P=0.002). CONCLUSIONS With the reduction in the number of unhealthy school snacks, significantly more students selected school meals. Students did not compensate for lack of unhealthy snacks in school by increased consumption of unhealthy snacks outside of school. This provides important new evidence that both national school meal and snack policies may improve daily diet quality and should remain strong.
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Boehm R, Schuknecht TJ, Cash SB. Cool Intentions: Adding Refrigerators to Elementary Classrooms Improves Fruit and Vegetable Access in a Pilot Study. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2018; 50:746-747. [PMID: 29779996 DOI: 10.1016/j.jneb.2018.04.278] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 04/25/2018] [Accepted: 04/25/2018] [Indexed: 06/08/2023]
Affiliation(s)
- Rebecca Boehm
- Rudd Center for Food Policy and Obesity, University of Connecticut, Hartford, CT
| | - Tara J Schuknecht
- Department of Consumer Science, University of Wisconsin, Madison, WI
| | - Sean B Cash
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA.
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Ramirez B, Chen TA, Moore CE, Dave JM, Cullen KW. The costs and calorie content of à la carte food items purchased by students during school lunch. Prev Med Rep 2018; 10:162-166. [PMID: 29868361 PMCID: PMC5984217 DOI: 10.1016/j.pmedr.2018.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 02/01/2018] [Accepted: 03/09/2018] [Indexed: 10/27/2022] Open
Abstract
School environments influence student food choices. À la carte foods and beverages are often low nutrient and energy dense. This study assessed how much money students spent for these foods, and the total kilocalories purchased per student during the 2012-2013 school year. Six elementary and four intermediate schools in the Houston area provided daily food purchase transaction data, and the cost and the calories for each item. Chi-square analysis assessed differences in the number of students purchasing à la carte items by grade level and school free/reduced-price meal (FRP) eligibility. Analysis of covariance assessed grade level differences in cost and calories of weekly purchases, controlling for FRP eligibility. Intermediate grade students spent significantly more on à la carte food purchases and purchased more calories (both p < 0.001) than elementary school students. Lower socioeconomic status (SES) elementary and intermediate school students purchased fewer à la carte foods compared to those in higher SES schools (p < 0.001). Intermediate school students purchased more à la carte foods and calories from à la carte foods than elementary students. Whether the new competitive food rules in schools improve student food selection and purchase, and dietary intake habits across all grade levels remains unknown.
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Affiliation(s)
- Betsey Ramirez
- Baylor CHI St. Luke's Hospital, 6720 Bertner Ave., Houston, TX 77030, United States
| | - Tzu-An Chen
- University of Houston, Health Research Institute, Houston, TX 77204, United States
| | - Carolyn E Moore
- Texas Woman's University, Department of Nutrition and Food Sciences, 6700 Fannin St., Houston, TX 77030, United States
| | - Jayna M Dave
- USDA/ARS Children's Nutrition Research Center, Baylor College of Medicine, Department of Pediatrics, 1100 Bates St., Houston, TX 77030, United States
| | - Karen Weber Cullen
- USDA/ARS Children's Nutrition Research Center, Baylor College of Medicine, Department of Pediatrics, 1100 Bates St., Houston, TX 77030, United States
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Product reformulation and nutritional improvements after new competitive food standards in schools. Public Health Nutr 2017; 21:1011-1018. [PMID: 29262875 DOI: 10.1017/s1368980017003445] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE In 2012, Massachusetts enacted school competitive food and beverage standards similar to national Smart Snacks. These standards aim to improve the nutritional quality of competitive snacks. It was previously demonstrated that a majority of foods and beverages were compliant with the standards, but it was unknown whether food manufacturers reformulated products in response to the standards. The present study assessed whether products were reformulated after standards were implemented; the availability of reformulated products outside schools; and whether compliance with the standards improved the nutrient composition of competitive snacks. DESIGN An observational cohort study documenting all competitive snacks sold before (2012) and after (2013 and 2014) the standards were implemented. SETTING The sample included thirty-six school districts with both a middle and high school. RESULTS After 2012, energy, saturated fat, Na and sugar decreased and fibre increased among all competitive foods. By 2013, 8 % of foods were reformulated, as were an additional 9 % by 2014. Nearly 15 % of reformulated foods were look-alike products that could not be purchased at supermarkets. Energy and Na in beverages decreased after 2012, in part facilitated by smaller package sizes. CONCLUSIONS Massachusetts' law was effective in improving the nutritional content of snacks and product reformulation helped schools adhere to the law. This suggests fully implementing Smart Snacks standards may similarly improve the foods available in schools nationally. However, only some healthier reformulated foods were available outside schools.
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FIUZA RFDP, MURARO AP, RODRIGUES PRM, SENA EDMS, FERREIRA MG. Skipping breakfast and associated factors among Brazilian adolescents. REV NUTR 2017. [DOI: 10.1590/1678-98652017000500007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
ABSTRACT Objective To analyze the prevalence and factors associated with breakfast skipping among adolescents. Methods Cross-sectional study, with adolescents aged 10-17 years, evaluated between 2009 and 2011, belonging to a cohort study in the Central-West region of Brazil. Breakfast skipping was considered as not having breakfast every day. Demographic, socioeconomic, and lifestyle factors were evaluated through a questionnaire. Anthropometric assessment included measurement of weight and height, which were used to classify weight status using body mass index. Poisson regression was used to assess the association of breakfast skipping with demographic and socioeconomic variables, lifestyle factors, and weight status. Results Among 1,716 Brazilian adolescents evaluated, 36.2% reported not consuming breakfast every day, with the highest prevalence among girls (p=0.03). After adjusting for age and economic class, breakfast skipping was associated with not consuming breakfast with parents and morning shift at school, in both genders, and with obesity only in boys. Lifestyle factors such as alcohol consumption, physical activity, diet quality, and smoking were not associated with skipping breakfast. Conclusion The omission of breakfast was observed in more than a third of adolescents, being associated with demographic and lifestyle factors. In the public health perspective, the importance of encouraging the consumption of this meal is highlighted, with actions involving the school environment and the family.
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Vargas CM, Stines EM, Granado HS. Health-equity issues related to childhood obesity: a scoping review. J Public Health Dent 2017; 77 Suppl 1:S32-S42. [DOI: 10.1111/jphd.12233] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 05/30/2017] [Indexed: 12/14/2022]
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Baugh MLA, Opalinski A, Dyess SM, Gropper SS. Snack Provisions by 21st-Century Community Learning Center–Based Afterschool Programs. JOURNAL OF HUNGER & ENVIRONMENTAL NUTRITION 2017. [DOI: 10.1080/19320248.2016.1146197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Martha Lee Anne Baugh
- Department of Nutrition, Dietetics and Hospitality Management, Auburn University, Auburn, Alabama, USA
| | - Andra Opalinski
- Christine E. Lynn College of Nursing, Florida Atlantic University, Boca Raton, Florida, USA
| | - Susan MacLeod Dyess
- Christine E. Lynn College of Nursing, Florida Atlantic University, Boca Raton, Florida, USA
| | - Sareen S. Gropper
- Department of Nutrition, Dietetics and Hospitality Management, Auburn University, Auburn, Alabama, USA
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Allehdan SS, Tayyem RF, Bawadi HA, Al-Awwad NJ, Al-Mannai M, Musaiger AO. Fast foods perception among adolescents by gender and weight status. Nutr Health 2017; 23:39-45. [PMID: 28032519 DOI: 10.1177/0260106016685724] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND Fast food restaurants have become widespread in both developed and developing countries due to nutritional and economic transitions. The frequency of fast food intake is relatively high among adolescents; however, fast food consumption is positively associated with total energy intake and obesity in adolescents. OBJECTIVE This study aimed to examine the perception of Jordanian adolescents towards fast foods relative to gender and obesity. METHODS A cross-sectional survey was conducted on 400 boys and 395 girls, aged 15-18 years. The adolescents completed a validated questionnaire to measure the perception of adolescents towards fast foods during the year 2013-2014. Weight and height were measured. Numbers who were non-overweight, overweight, and obese were calculated for each age and sex using the International Obesity Task Force (IOTF) standard. RESULTS The majority of participants perceived foods which are eaten as sandwiches as fast foods. A significant difference between boy and girl adolescents was reported regarding perception of French fries ( p < 0.012), fried chicken ( p < 0.001), fattayer ( p < 0.001), foul (boiled broad beans) sandwich ( p < 0.001), falafel sandwich ( p < 0.044) and fried eggs sandwich ( p < 0.001) as fast foods. Girls were significantly more enthusiastic than boys to consider cuscusi plate ( p < 0.001), rice dishes ( p < 0.002), Chinese foods ( p < 0.001), Indian foods ( p < 0.010), Mexican foods ( p < 0.011), and Italian foods ( p < 0.004) as non-fast foods. The difference between obese and non-obese regarding the perception of fast foods was only significant among boy participants. Western or non-Arab foods, food prepared fast and eaten fast in self-service outlets, and food rich in calories were significantly perceived as fast food by Jordanian adolescents ( p < 0.05). CONCLUSIONS The perception of foods as fast foods or non-fast foods was significantly different between both genders as well as in obese and non-obese male Jordanian adolescents.
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Affiliation(s)
- Sabika S Allehdan
- 1 Department of Nutrition and Food Technology, Faculty of Agriculture, The University of Jordan, Amman, Jordan
| | - Reema F Tayyem
- 1 Department of Nutrition and Food Technology, Faculty of Agriculture, The University of Jordan, Amman, Jordan
| | - Hiba A Bawadi
- 2 Human Nutrition Department, College of Health Sciences, Qatar University, Doha, Qatar
| | - Narmeen J Al-Awwad
- 3 Department of Clinical Nutrition and Dietetics, Faculty of Allied Health Sciences, Hashemite University, Zarqa, Jordan
| | - Mariam Al-Mannai
- 4 Department of Mathematics, College of Science, University of Bahrain, Manama, Bahrain
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Lytle LA, Sokol RL. Measures of the food environment: A systematic review of the field, 2007-2015. Health Place 2017; 44:18-34. [PMID: 28135633 DOI: 10.1016/j.healthplace.2016.12.007] [Citation(s) in RCA: 158] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 11/21/2016] [Accepted: 12/02/2016] [Indexed: 12/24/2022]
Abstract
BACKGROUND Many studies have examined the relationship between the food environment and health-related outcomes, but fewer consider the integrity of measures used to assess the food environment. The present review builds on and makes comparisons with a previous review examining food environment measures and expands the previous review to include a more in depth examination of reliability and validity of measures and study designs employed. METHODS We conducted a systematic review of studies measuring the food environment published between 2007 and 2015. We identified these articles through: PubMed, Embase, Web of Science, PsycINFO, and Global Health databases; tables of contents of relevant journals; and the National Cancer Institute's Measures of the Food Environment website. This search yielded 11,928 citations. We retained and abstracted data from 432 studies. RESULTS The most common methodology used to study the food environment was geographic analysis (65% of articles) and the domination of this methodology has persisted since the last review. Only 25.9% of studies in this review reported the reliability of measures and 28.2% reported validity, but this was an improvement as compared to the earlier review. Very few of the studies reported construct validity. Studies reporting measures of the school or worksite environment have decreased since the previous review. Only 13.9% of the studies used a longitudinal design. CONCLUSIONS To strengthen research examining the relationship between the food environment and population health, there is a need for robust and psychometrically-sound measures and more sophisticated study designs.
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Affiliation(s)
- Leslie A Lytle
- Department of Health Behavior, Campus Box 7440, UNC Gillings School of Global Public Health, Chapel Hill, NC 27599-7440, United States.
| | - Rebeccah L Sokol
- Department of Health Behavior, Campus Box 7440, UNC Gillings School of Global Public Health, Chapel Hill, NC 27599-7440, United States
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Cohen JFW, Gorski MT, Hoffman JA, Rosenfeld L, Chaffee R, Smith L, Catalano PJ, Rimm EB. Healthier Standards for School Meals and Snacks: Impact on School Food Revenues and Lunch Participation Rates. Am J Prev Med 2016; 51:485-92. [PMID: 27147133 PMCID: PMC7346735 DOI: 10.1016/j.amepre.2016.02.031] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2015] [Revised: 02/15/2016] [Accepted: 02/23/2016] [Indexed: 10/22/2022]
Abstract
INTRODUCTION In 2012, the updated U.S. Department of Agriculture school meals standards and a competitive food law similar to the fully implemented version of the national Smart Snack standards went into effect in Massachusetts. This study evaluated the impact of these updated school meal standards and Massachusetts' comprehensive competitive food standards on school food revenues and school lunch participation. METHODS Revenue and participation data from 11 Massachusetts school districts were collected from 2011 to 2014 and analyzed in 2015 using multilevel modeling. The association between the change in compliance with the competitive food standards and revenues/participation was assessed using linear regression. RESULTS Schools experienced declines in school food revenues of $15.40/student in Year 1 from baseline (p=0.05), due to competitive food revenue losses. In schools with 3 years of data, overall revenues rebounded by the second year post-implementation. Additionally, by Year 2, school lunch participation increased by 15% (p=0.0006) among children eligible for reduced-price meals. Better competitive food compliance was inversely associated with school food revenues in the first year only; an absolute change in compliance by 10% was associated with a $9.78/student decrease in food revenues over the entire school year (p=0.04). No association was seen between the change in compliance and school meal participation. CONCLUSIONS Schools experienced initial revenue losses after implementation of the standards, yet longer-term school food revenues were not impacted and school meal participation increased among children eligible for reduced-price meals. Weakening the school meal or competitive food guidelines based on revenue concerns appears unwarranted.
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Affiliation(s)
- Juliana F W Cohen
- Department of Health Sciences, Merrimack College, North Andover, Massachusetts; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
| | - Mary T Gorski
- Interfaculty Initiative in Health Policy, Harvard Graduate School of Arts and Sciences, Harvard University, Cambridge, Massachusetts
| | - Jessica A Hoffman
- Department of Applied Psychology, Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts
| | - Lindsay Rosenfeld
- Institute for Child, Youth, and Family Policy, The Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts
| | - Ruth Chaffee
- Department of Applied Psychology, Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts
| | | | - Paul J Catalano
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Eric B Rimm
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
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How do we actually put smarter snacks in schools? NOURISH (Nutrition Opportunities to Understand Reforms Involving Student Health) conversations with food-service directors. Public Health Nutr 2016; 20:556-564. [PMID: 27573806 DOI: 10.1017/s1368980016002044] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE In autumn 2012, Massachusetts schools implemented comprehensive competitive food and beverage standards similar to the US Department of Agriculture's Smart Snacks in School standards. We explored major themes raised by food-service directors (FSD) regarding their school-district-wide implementation of the standards. DESIGN For this qualitative study, part of a larger mixed-methods study, compliance was measured via direct observation of foods and beverages during school site visits in spring 2013 and 2014, calculated to ascertain the percentage of compliant products available to students. Semi-structured interviews with school FSD conducted in each year were analysed for major implementation themes; those raised by more than two-thirds of participating school districts were explored in relationship to compliance. SETTING Massachusetts school districts (2013: n 26; 2014: n 21). SUBJECTS Data collected from FSD. RESULTS Seven major themes were raised by more than two-thirds of participating school districts (range 69-100 %): taking measures for successful transition; communicating with vendors/manufacturers; using tools to identify compliant foods and beverages; receiving support from leadership; grappling with issues not covered by the law; anticipating changes in sales of competitive foods and beverages; and anticipating changes in sales of school meals. Each theme was mentioned by the majority of more-compliant school districts (65-81 %), with themes being raised more frequently after the second year of implementation (range increase 4-14 %). CONCLUSIONS FSD in more-compliant districts were more likely to talk about themes than those in less-compliant districts. Identified themes suggest best-practice recommendations likely useful for school districts implementing the final Smart Snacks in School standards, effective July 2016.
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Abstract
From the age of 2 years, an American child is more likely to consume a sugar-sweetened product than a fruit or vegetable on any given day-a troubling statistic, given that food preferences are established early in childhood, as well as the strong association between this dietary pattern and increased risk of developing a number of chronic diseases. Here, we review the ontogeny and biopsychology of sweet taste, highlighting how a biological drive to prefer sweetness at high concentrations during childhood, which would have conferred an advantage in environments of scarcity, now predisposes children to overconsume all that is sweet in a modern food system replete with added sugars. We review the power of sweet taste to blunt expressions of pain and mask bad tastes in foods as well as factors that predispose some to consume high-sugar diets, including experiential learning and taste preferences driven in part by genetics. Understanding children's unique vulnerability to our current food environment, rich in both nutritive and nonnutritive sweeteners, is highlighted as a priority for future research to develop evidence-based strategies to help establish healthy dietary behaviors early in life.
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Affiliation(s)
- Julie A Mennella
- Monell Chemical Senses Center, Philadelphia, PA, 19104-3308, USA.
| | - Nuala K Bobowski
- Monell Chemical Senses Center, Philadelphia, PA, 19104-3308, USA
| | - Danielle R Reed
- Monell Chemical Senses Center, Philadelphia, PA, 19104-3308, USA
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Abstract
The school food environment-including when and where children obtain food and the types of options available during the school day-plays an important role in children's consumption patterns. Thus, childhood obesity prevention efforts often focus on altering the school food environment as a mechanism for improving student dietary intake. This review examines the role school food programs and policies play in improving children's diet, weight, and health. Overall, research suggests that significant improvements have been made in school nutrition policies and programs. Due to the recent program changes made as a result of the 2010 Healthy, Hunger-Free Kids Act, an emphasis was placed on research conducted over the past decade and especially on the evaluation of foods and beverages served and sold since implementation of this national law. This review also examines remaining gaps in the literature and opportunities for further improvements in school food programs and policies.
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Affiliation(s)
- Emily Welker
- Duke Global Health Institute, Duke University, 310 Trent Drive, Duke Box 90519, Durham, NC, 27708, USA.
| | - Megan Lott
- Duke Global Health Institute, Duke University, 310 Trent Drive, Duke Box 90519, Durham, NC, 27708, USA
| | - Mary Story
- Duke Global Health Institute, Duke University, 310 Trent Drive, Duke Box 90519, Durham, NC, 27708, USA
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Zeng D, Thomsen MR, Nayga RM, Rouse HL. Middle school transition and body weight outcomes: Evidence from Arkansas Public Schoolchildren. ECONOMICS AND HUMAN BIOLOGY 2016; 21:64-74. [PMID: 26794273 DOI: 10.1016/j.ehb.2015.12.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Revised: 11/09/2015] [Accepted: 12/26/2015] [Indexed: 06/05/2023]
Abstract
There is evidence that middle school transition adversely affects educational and psychological outcomes of pre-teen children, but little is known about the impacts of middle school transition on other aspects of health. In this article, we estimate the impact of middle school transition on the body mass index (BMI) of public schoolchildren in Arkansas, United States. Using an instrumental variable approach, we find that middle school transition in grade 6 led to a moderate decrease of 0.04 standard deviations in BMI z-scores for all students. Analysis by subsample indicated that this result was driven by boys (0.06-0.07 standard deviations) and especially by non-minority boys (0.09 standard deviations). We speculate that the changing levels of physical activities associated with middle school transition provide the most reasonable explanation for this result.
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Affiliation(s)
- Di Zeng
- Department of Agricultural Economics and Agribusiness, University of Arkansas, 217 Agricultural Building, Fayetteville, AR 72703, United States.
| | - Michael R Thomsen
- Department of Agricultural Economics and Agribusiness, University of Arkansas, 217 Agricultural Building, Fayetteville, AR 72703, United States
| | - Rodolfo M Nayga
- Department of Agricultural Economics and Agribusiness, University of Arkansas, 217 Agricultural Building, Fayetteville, AR 72703, United States; Norwegian Institute of Bioeconomy Research, Postboks 115, NO-1431 Ås, Norway; Department of Food and Resource Economics, Korea University, Anam-dong 5-ga, Seongbuk-gu, Seoul, Korea
| | - Heather L Rouse
- Department of Human Development and Family Studies, Iowa State University, 2330 Palmer HDFS Building, Ames, IA 50011, United States; Arkansas Center for Health Improvement, University of Arkansas for Medical Sciences, 1401 W Capitol Avenue Suite 300, Victory Building Little Rock, AR 72201, United States
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Gorski MT, Cohen JFW, Hoffman JA, Rosenfeld L, Chaffee R, Smith L, Rimm EB. Impact of Nutrition Standards on Competitive Food Quality in Massachusetts Middle and High Schools. Am J Public Health 2016; 106:1101-8. [PMID: 27077344 DOI: 10.2105/ajph.2016.303139] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To examine changes in competitive foods (items sold in à la carte lines, vending machines, and school stores that "compete" with school meals) in Massachusetts middle and high schools before and after implementation of a statewide nutrition law in 2012. METHODS We photographed n = 10 782 competitive foods and beverages in 36 Massachusetts school districts and 7 control state districts to determine availability and compliance with the law at baseline (2012), 1 year (2013), and 2 years (2014) after the policy (overall enrollment: 71 202 students). We examined availability and compliance trends over time. RESULTS By 2014, 60% of competitive foods and 79% of competitive beverages were compliant. Multilevel models showed an absolute 46.2% increase for foods (95% confidence interval = 36.2, 56.3) and 46.8% increase for beverages (95% confidence interval = 39.2, 54.4) in schools' alignment with updated standards from 2012 to 2014. CONCLUSIONS The law's implementation resulted in major improvements in the availability and nutritional quality of competitive foods and beverages, but schools did not reach 100% compliance. This law closely mirrors US Department of Agriculture Smart Snacks in School standards, suggesting that complying with strict nutrition standards is feasible, and schools may experience challenges and improvements over time.
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Affiliation(s)
- Mary T Gorski
- Mary T. Gorski is with the Interfaculty Initiative in Health Policy, Harvard Graduate School of Arts and Sciences, Harvard University, Cambridge, MA. Juliana F. W. Cohen is with the Department of Health Sciences, Merrimack College, North Andover, MA. Jessica A. Hoffman and Ruth Chaffee are with the Department of Applied Psychology, Bouvé College of Health Sciences, Northeastern University, Boston. Lindsay Rosenfeld is with the Institute for Child, Youth, and Family Policy, The Heller School for Social Policy and Management, Brandeis University, Waltham, MA. At the time of the study Lauren Smith was with the Department of Public Health, Commonwealth of Massachusetts, Boston. Eric B. Rimm is with the departments of Nutrition and Epidemiology, Harvard T. H. Chan School of Public Health, Harvard University, Boston
| | - Juliana F W Cohen
- Mary T. Gorski is with the Interfaculty Initiative in Health Policy, Harvard Graduate School of Arts and Sciences, Harvard University, Cambridge, MA. Juliana F. W. Cohen is with the Department of Health Sciences, Merrimack College, North Andover, MA. Jessica A. Hoffman and Ruth Chaffee are with the Department of Applied Psychology, Bouvé College of Health Sciences, Northeastern University, Boston. Lindsay Rosenfeld is with the Institute for Child, Youth, and Family Policy, The Heller School for Social Policy and Management, Brandeis University, Waltham, MA. At the time of the study Lauren Smith was with the Department of Public Health, Commonwealth of Massachusetts, Boston. Eric B. Rimm is with the departments of Nutrition and Epidemiology, Harvard T. H. Chan School of Public Health, Harvard University, Boston
| | - Jessica A Hoffman
- Mary T. Gorski is with the Interfaculty Initiative in Health Policy, Harvard Graduate School of Arts and Sciences, Harvard University, Cambridge, MA. Juliana F. W. Cohen is with the Department of Health Sciences, Merrimack College, North Andover, MA. Jessica A. Hoffman and Ruth Chaffee are with the Department of Applied Psychology, Bouvé College of Health Sciences, Northeastern University, Boston. Lindsay Rosenfeld is with the Institute for Child, Youth, and Family Policy, The Heller School for Social Policy and Management, Brandeis University, Waltham, MA. At the time of the study Lauren Smith was with the Department of Public Health, Commonwealth of Massachusetts, Boston. Eric B. Rimm is with the departments of Nutrition and Epidemiology, Harvard T. H. Chan School of Public Health, Harvard University, Boston
| | - Lindsay Rosenfeld
- Mary T. Gorski is with the Interfaculty Initiative in Health Policy, Harvard Graduate School of Arts and Sciences, Harvard University, Cambridge, MA. Juliana F. W. Cohen is with the Department of Health Sciences, Merrimack College, North Andover, MA. Jessica A. Hoffman and Ruth Chaffee are with the Department of Applied Psychology, Bouvé College of Health Sciences, Northeastern University, Boston. Lindsay Rosenfeld is with the Institute for Child, Youth, and Family Policy, The Heller School for Social Policy and Management, Brandeis University, Waltham, MA. At the time of the study Lauren Smith was with the Department of Public Health, Commonwealth of Massachusetts, Boston. Eric B. Rimm is with the departments of Nutrition and Epidemiology, Harvard T. H. Chan School of Public Health, Harvard University, Boston
| | - Ruth Chaffee
- Mary T. Gorski is with the Interfaculty Initiative in Health Policy, Harvard Graduate School of Arts and Sciences, Harvard University, Cambridge, MA. Juliana F. W. Cohen is with the Department of Health Sciences, Merrimack College, North Andover, MA. Jessica A. Hoffman and Ruth Chaffee are with the Department of Applied Psychology, Bouvé College of Health Sciences, Northeastern University, Boston. Lindsay Rosenfeld is with the Institute for Child, Youth, and Family Policy, The Heller School for Social Policy and Management, Brandeis University, Waltham, MA. At the time of the study Lauren Smith was with the Department of Public Health, Commonwealth of Massachusetts, Boston. Eric B. Rimm is with the departments of Nutrition and Epidemiology, Harvard T. H. Chan School of Public Health, Harvard University, Boston
| | - Lauren Smith
- Mary T. Gorski is with the Interfaculty Initiative in Health Policy, Harvard Graduate School of Arts and Sciences, Harvard University, Cambridge, MA. Juliana F. W. Cohen is with the Department of Health Sciences, Merrimack College, North Andover, MA. Jessica A. Hoffman and Ruth Chaffee are with the Department of Applied Psychology, Bouvé College of Health Sciences, Northeastern University, Boston. Lindsay Rosenfeld is with the Institute for Child, Youth, and Family Policy, The Heller School for Social Policy and Management, Brandeis University, Waltham, MA. At the time of the study Lauren Smith was with the Department of Public Health, Commonwealth of Massachusetts, Boston. Eric B. Rimm is with the departments of Nutrition and Epidemiology, Harvard T. H. Chan School of Public Health, Harvard University, Boston
| | - Eric B Rimm
- Mary T. Gorski is with the Interfaculty Initiative in Health Policy, Harvard Graduate School of Arts and Sciences, Harvard University, Cambridge, MA. Juliana F. W. Cohen is with the Department of Health Sciences, Merrimack College, North Andover, MA. Jessica A. Hoffman and Ruth Chaffee are with the Department of Applied Psychology, Bouvé College of Health Sciences, Northeastern University, Boston. Lindsay Rosenfeld is with the Institute for Child, Youth, and Family Policy, The Heller School for Social Policy and Management, Brandeis University, Waltham, MA. At the time of the study Lauren Smith was with the Department of Public Health, Commonwealth of Massachusetts, Boston. Eric B. Rimm is with the departments of Nutrition and Epidemiology, Harvard T. H. Chan School of Public Health, Harvard University, Boston
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Cisse-Egbuonye N, Liles S, Schmitz KE, Kassem N, Irvin VL, Hovell MF. Availability of Vending Machines and School Stores in California Schools. THE JOURNAL OF SCHOOL HEALTH 2016; 86:48-53. [PMID: 26645420 PMCID: PMC4825854 DOI: 10.1111/josh.12349] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Revised: 05/05/2015] [Accepted: 05/10/2015] [Indexed: 06/05/2023]
Abstract
BACKGROUND This study examined the availability of foods sold in vending machines and school stores in United States public and private schools, and associations of availability with students' food purchases and consumption. METHODS Descriptive analyses, chi-square tests, and Spearman product-moment correlations were conducted on data collected from 521 students aged 8 to 15 years recruited from orthodontic offices in California. RESULTS Vending machines were more common in private schools than in public schools, whereas school stores were common in both private and public schools. The food items most commonly available in both vending machines and school stores in all schools were predominately foods of minimal nutritional value (FMNV). Participant report of availability of food items in vending machines and/or school stores was significantly correlated with (1) participant purchase of each item from those sources, except for energy drinks, milk, fruits, and vegetables; and (2) participants' friends' consumption of items at lunch, for 2 categories of FMNV (candy, cookies, or cake; soda or sports drinks). CONCLUSIONS Despite the Child Nutrition and Women, Infants, and Children (WIC) Reauthorization Act of 2004, FMNV were still available in schools, and may be contributing to unhealthy dietary choices and ultimately to health risks.
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Affiliation(s)
- Nafissatou Cisse-Egbuonye
- Department of Health & Kinesiology, Texas A&M University, 311 Blocker Hall, College Station, TX 77843.
| | - Sandy Liles
- Center for Behavioral Epidemiology and Community Health, Graduate School of Public Health, San Diego State University, 9245 Sky Park Court, Suite 230, San Diego, CA 92123.
| | - Katharine E Schmitz
- Center for Behavioral Epidemiology and Community Health, Graduate School of Public Health, San Diego State University, 9245 Sky Park Court, Suite 230, San Diego, CA 92123.
| | - Nada Kassem
- Center for Behavioral Epidemiology and Community Health, Graduate School of Public Health, San Diego State University, 9245 Sky Park Court, Suite 230, San Diego, CA 92123.
| | - Veronica L Irvin
- College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, 97331.
| | - Melbourne F Hovell
- Center for Behavioral Epidemiology and Community Health, Graduate School of Public Health, San Diego State University, San Diego, CA.
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O'Hara JK, Haynes-Maslow L. Examining the Association Between School Vending Machines and Children's Body Mass Index by Socioeconomic Status. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2015; 47:526-531.e1. [PMID: 26371992 DOI: 10.1016/j.jneb.2015.08.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Revised: 07/30/2015] [Accepted: 08/03/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To examine the association between vending machine availability in schools and body mass index (BMI) among subgroups of children based on gender, race/ethnicity, and socioeconomic status classifications. METHODS First-difference multivariate regressions were estimated using longitudinal fifth- and eighth-grade data from the Early Childhood Longitudinal Study. The specifications were disaggregated by gender, race/ethnicity, and family socioeconomic status classifications. RESULTS Vending machine availability had a positive association (P < .10) with BMI among Hispanic male children and low-income Hispanic children. Living in an urban location (P < .05) and hours watching television (P < .05) were also positively associated with BMI for these subgroups. Supplemental Nutrition Assistance Program enrollment was negatively associated with BMI for low-income Hispanic students (P < .05). These findings were not statistically significant when using Bonferroni adjusted critical values. CONCLUSIONS AND IMPLICATIONS The results suggest that the school food environment could reinforce health disparities that exist for Hispanic male children and low-income Hispanic children.
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Affiliation(s)
- Jeffrey K O'Hara
- Food and Environment Program, Union of Concerned Scientists, Washington, DC
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Mann G, Kraak V, Serrano E. The Availability of Competitive Foods and Beverages to Middle School Students in Appalachian Virginia Before Implementation of the 2014 Smart Snacks in School Standards. Prev Chronic Dis 2015; 12:E153. [PMID: 26378899 PMCID: PMC4576436 DOI: 10.5888/pcd12.150051] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The study objective was to examine the nutritional quality of competitive foods and beverages (foods and beverages from vending machines and à la carte foods) available to rural middle school students, before implementation of the US Department of Agriculture’s Smart Snacks in School standards in July 2014. In spring 2014, we audited vending machines and à la carte cafeteria foods and beverages in 8 rural Appalachian middle schools in Virginia. Few schools had vending machines. Few à la carte and vending machine foods met Smart Snacks in School standards (36.6%); however, most beverages did (78.2%). The major challenges to meeting standards were fat and sodium content of foods. Most competitive foods (63.4%) did not meet new standards, and rural schools with limited resources will likely require assistance to fully comply.
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Affiliation(s)
- Georgianna Mann
- Department of Human Nutrition, Foods, and Exercise, Virginia Polytechnic Institute and State University, Blacksburg, VA 24061.
| | - Vivica Kraak
- Department of Human Nutrition, Foods, and Exercise, Virginia Polytechnic Institute and State University, Blacksburg, Virginia
| | - Elena Serrano
- Department of Human Nutrition, Foods, and Exercise, Virginia Polytechnic Institute and State University, Blacksburg, Virginia
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Hoffman JA, Rosenfeld L, Schmidt N, Cohen JFW, Gorski M, Chaffee R, Smith L, Rimm EB. Implementation of Competitive Food and Beverage Standards in a Sample of Massachusetts Schools: The NOURISH Study (Nutrition Opportunities to Understand Reforms Involving Student Health). J Acad Nutr Diet 2015; 115:1299-307.e2. [PMID: 26210085 PMCID: PMC4545612 DOI: 10.1016/j.jand.2015.04.019] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Accepted: 04/21/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND During 2012, Massachusetts adopted comprehensive school competitive food and beverage standards that closely align with Institute of Medicine recommendations and Smart Snacks in School national standards. OBJECTIVE We examined the extent to which a sample of Massachusetts middle schools and high schools sold foods and beverages that were compliant with the state competitive food and beverage standards after the first year of implementation, and complied with four additional aspects of the regulations. DESIGN Observational cohort study with data collected before implementation (Spring 2012) and 1 year after implementation (Spring 2013). PARTICIPANTS/SETTING School districts (N=37) with at least one middle school and one high school participated. MAIN OUTCOME MEASURES Percent of competitive foods and beverages that were compliant with Massachusetts standards and compliance with four additional aspects of the regulations. Data were collected via school site visits and a foodservice director questionnaire. STATISTICAL ANALYSES PERFORMED Multilevel models were used to examine change in food and beverage compliance over time. RESULTS More products were available in high schools than middle schools at both time points. The number of competitive beverages and several categories of competitive food products sold in the sample of Massachusetts schools decreased following the implementation of the standards. Multilevel models demonstrated a 47-percentage-point increase in food and 46-percentage-point increase in beverage compliance in Massachusetts schools from 2012 to 2013. Overall, total compliance was higher for beverages than foods. CONCLUSIONS This study of a group of Massachusetts schools demonstrated the feasibility of schools making substantial changes in response to requirements for healthier competitive foods, even in the first year of implementation.
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Yoong SL, Nathan NK, Wyse RJ, Preece SJ, Williams CM, Sutherland RL, Wiggers JH, Delaney TM, Wolfenden L. Assessment of the School Nutrition Environment: A Study in Australian Primary School Canteens. Am J Prev Med 2015; 49:215-22. [PMID: 26091931 DOI: 10.1016/j.amepre.2015.02.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Revised: 01/10/2015] [Accepted: 02/09/2015] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Schools represent a valuable setting for interventions to improve children's diets, as they offer structured opportunities for ongoing intervention. Modifications to the school food environment can increase purchasing of healthier foods and improve children's diets. This study examines the availability of healthy food and drinks, implementation of pricing and promotion strategies in Australian primary school canteens, and whether these varied by school characteristics. METHODS In 2012 and 2013, canteen managers of primary schools in the Hunter New England region of New South Wales reported via telephone interview the pricing and promotion strategies implemented in their canteens to encourage healthier food and drink purchases. A standardized audit of canteen menus was performed to assess the availability of healthy options. Data were analyzed in 2014. RESULTS Overall, 203 (79%) canteen managers completed the telephone interview and 170 provided menus. Twenty-nine percent of schools had menus that primarily consisted of healthier food and drinks, and 11% did not sell unhealthy foods. Less than half reported including only healthy foods in meal deals (25%), labeling menus (43%), and having a comprehensive canteen policy (22%). A significantly larger proportion of schools in high socioeconomic areas (OR=3.0) and large schools (OR=4.4) had primarily healthy options on their menus. School size and being a Government school were significantly associated with implementation of some pricing and promotion strategies. CONCLUSIONS There is a need to monitor canteen environments to inform policy development and research. Future implementation research to improve the food environments of disadvantaged schools in particular is warranted.
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Affiliation(s)
- Sze Lin Yoong
- Hunter New England Population Health; Faculty of Health, School of Medicine and Public Health, University of Newcastle; Hunter Medical Research Institute, Newcastle.
| | - Nicole K Nathan
- Hunter New England Population Health; Faculty of Health, School of Medicine and Public Health, University of Newcastle; Hunter Medical Research Institute, Newcastle
| | - Rebecca J Wyse
- Faculty of Health, School of Medicine and Public Health, University of Newcastle; Hunter Medical Research Institute, Newcastle
| | | | - Christopher M Williams
- Hunter New England Population Health; Faculty of Health, School of Medicine and Public Health, University of Newcastle; Hunter Medical Research Institute, Newcastle; George Institute for Global Health, Sydney, New South Wales, Australia
| | - Rachel L Sutherland
- Hunter New England Population Health; Faculty of Health, School of Medicine and Public Health, University of Newcastle; Hunter Medical Research Institute, Newcastle
| | - John H Wiggers
- Hunter New England Population Health; Faculty of Health, School of Medicine and Public Health, University of Newcastle; Hunter Medical Research Institute, Newcastle
| | | | - Luke Wolfenden
- Hunter New England Population Health; Faculty of Health, School of Medicine and Public Health, University of Newcastle; Hunter Medical Research Institute, Newcastle
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Demissie Z, Eaton DK, Lowry R, Kim SA, Park S, Grimm KA, Merlo C, Harris DM. The Association of Meal Practices and Other Dietary Correlates With Dietary Intake Among High School Students in the United States, 2010. Am J Health Promot 2015; 29:e203-13. [PMID: 25372239 PMCID: PMC10962471 DOI: 10.4278/ajhp.131211-quan-632] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To examine behavioral and environmental factors that may be related to dietary behaviors among U.S. high school students. DESIGN Data were obtained from the 2010 National Youth Physical Activity and Nutrition Study, a cross-sectional study. SETTING The study was school-based. SUBJECTS Study subjects were a nationally representative sample of students in grades 9 to 12 (n = 11,458). MEASURES Variables of interest included meal practices, in-home snack availability, and intakes of healthful foods/beverages (fruits, vegetables, water, and milk) and less healthful foods/beverages (fried potatoes, pizza, and sugar-sweetened beverages). ANALYSIS Sex-stratified logistic regression models were used to examine associations of meal practices and snack availability with dietary intake. Odds ratios (ORs) were adjusted for race/ethnicity and grade. RESULTS Eating breakfast daily, frequent family dinners, and bringing lunch from home were associated with higher odds of consuming at least three healthful foods or beverages. High fast-food intake was associated with lower odds of healthful dietary intake and higher odds of sugar-sweetened beverage intake (female OR = 3.73, male OR = 4.60). Students who mostly/always had fruits and vegetables available at home had increased odds of fruits (female OR = 3.04, male OR = 2.24), vegetables (female OR = 2.12, male OR = 1.65), water (female OR = 1.82, male OR = 1.85), and milk intake (female OR = 1.45, male OR = 1.64). CONCLUSION Encouraging daily breakfast consumption, frequent family dinners, and fruit and vegetable availability at home may lead to higher intakes of healthful foods among high school students.
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Jones SJ, Childers C, Weaver AT, Ball J. SC Farm-to-School Programs Encourages Children to Consume Vegetables. JOURNAL OF HUNGER & ENVIRONMENTAL NUTRITION 2015. [DOI: 10.1080/19320248.2015.1007259] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Haire-Joshu DL, Schwarz CD, Peskoe SB, Budd EL, Brownson RC, Joshu CE. A group randomized controlled trial integrating obesity prevention and control for postpartum adolescents in a home visiting program. Int J Behav Nutr Phys Act 2015; 12:88. [PMID: 26112041 PMCID: PMC4499890 DOI: 10.1186/s12966-015-0247-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Accepted: 06/15/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Adolescence represents a critical period for the development of overweight that tracks into adulthood. This risk is significantly heightened for adolescents that become pregnant, many of whom experience postpartum weight retention. The aim of this study was to evaluate Balance Adolescent Lifestyle Activities and Nutrition Choices for Energy (BALANCE), a multicomponent obesity prevention intervention targeting postpartum adolescents participating in a national home visiting child development-parent education program. METHODS A group randomized, nested cohort design was used with 1325 adolescents, 694 intervention and 490 control, (mean age = 17.8 years, 52 % underrepresented minorities) located across 30 states. Participatory methods were used to integrate lifestyle behavior change strategies within standard parent education practice. Content targeted replacement of high-risk obesogenic patterns (e.g. sweetened drink and high fat snack consumption, sedentary activity) with positive behaviors (e.g. water intake, fruit and vegetables, increased walking). Parent educators delivered BALANCE through home visits, school based classroom-group meetings, and website activities. Control adolescents received standard child development information. Phase I included baseline to posttest (12 months); Phase II included baseline to follow-up (24 months). RESULTS When compared to the control group, BALANCE adolescents who were ≥12 weeks postpartum were 89 % more likely (p = 0.02) to maintain a normal BMI or improve an overweight/obese BMI by 12 months; this change was not sustained at 24 months. When compared to the control group, BALANCE adolescents significantly improved fruit and vegetable intake (p = .03). In stratified analyses, water intake improved among younger BALANCE teens (p = .001) and overweight/obese BALANCE teens (p = .05) when compared to control counterparts. There were no significant differences between groups in sweetened drink and snack consumption or walking. CONCLUSION Prevention of postpartum weight retention yields immediate health benefits for the adolescent mother and may prevent the early development or progression of maternal obesity, which contributes to the intergenerational transmission of obesity to her offspring. Implementing BALANCE through a national home visiting organization may hold promise for promoting positive lifestyle behaviors associated with interruption of the progression of maternal obesity. TRIAL REGISTRATION Clinical Trials Registry NCT01617486 .
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Affiliation(s)
- Debra L Haire-Joshu
- Washington University in St. Louis, The Brown School of Social Work and Public Health, and The School of Medicine, 1 Brookings Dr, St. Louis, MO, 63130, USA.
| | - Cynthia D Schwarz
- Washington University in St. Louis, The Brown School of Social Work and Public Health, and The School of Medicine, 1 Brookings Dr, St. Louis, MO, 63130, USA.
| | - Sarah B Peskoe
- Harvard School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA.
| | - Elizabeth L Budd
- Washington University in St. Louis, The Brown School of Social Work and Public Health, and The School of Medicine, 1 Brookings Dr, St. Louis, MO, 63130, USA.
| | - Ross C Brownson
- Washington University in St. Louis, The Brown School of Social Work and Public Health, and The School of Medicine, 1 Brookings Dr, St. Louis, MO, 63130, USA.
| | - Corinne E Joshu
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21218, USA.
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Williams CM, Nathan N, Delaney T, Yoong SL, Wiggers J, Preece S, Lubans N, Sutherland R, Pinfold J, Smith K, Small T, Reilly KL, Butler P, Wyse RJ, Wolfenden L. CAFÉ: a multicomponent audit and feedback intervention to improve implementation of healthy food policy in primary school canteens: protocol of a randomised controlled trial. BMJ Open 2015; 5:e006969. [PMID: 26109111 PMCID: PMC4480036 DOI: 10.1136/bmjopen-2014-006969] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Accepted: 10/31/2014] [Indexed: 01/19/2023] Open
Abstract
INTRODUCTION A number of jurisdictions internationally have policies requiring schools to implement healthy canteens. However, many schools have not implemented such policies. One reason for this is that current support interventions cannot feasibly be delivered to large numbers of schools. A promising solution to support population-wide implementation of healthy canteen practices is audit and feedback. The effectiveness of this strategy has, however, not previously been assessed in school canteens. This study aims to assess the effectiveness and cost-effectiveness of an audit and feedback intervention, delivered by telephone and email, in increasing the number of school canteens that have menus complying with a government healthy-canteen policy. METHODS AND ANALYSIS Seventy-two schools, across the Hunter New England Local Health District in New South Wales Australia, will be randomised to receive the multicomponent audit and feedback implementation intervention or usual support. The intervention will consist of between two and four canteen menu audits over 12 months. Each menu audit will be followed by two modes of feedback: a written feedback report and a verbal feedback/support via telephone. Primary outcomes, assessed by dieticians blind to group status and as recommended by the Fresh Tastes @ School policy, are: (1) the proportion of schools with a canteen menu containing foods or beverages restricted for sale, and; (2) the proportion of schools that have a menu which contains more than 50% of foods classified as healthy canteen items. Secondary outcomes are: the proportion of menu items in each category ('red', 'amber' and 'green'), canteen profitability and cost-effectiveness. ETHICS AND DISSEMINATION Ethical approval has been obtained by from the Hunter New England Human Research Ethics Committee and the University of Newcastle Human Research Ethics Committee. The findings will be disseminated in usual forums, including peer-reviewed publication and conference presentations. TRIAL REGISTRATION NUMBER ACTRN12613000543785.
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Affiliation(s)
- Christopher M Williams
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia The George Institute for Global Health, Sydney, New South Wales, Australia
| | - Nicole Nathan
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia Hunter New England Area Health Service, Hunter New England Population Health, Newcastle, New South Wales, Australia
| | - Tessa Delaney
- Hunter New England Area Health Service, Hunter New England Population Health, Newcastle, New South Wales, Australia
| | - Sze Lin Yoong
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia Hunter New England Area Health Service, Hunter New England Population Health, Newcastle, New South Wales, Australia
| | - John Wiggers
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia Hunter New England Area Health Service, Hunter New England Population Health, Newcastle, New South Wales, Australia
| | - Sarah Preece
- Hunter New England Area Health Service, Hunter New England Population Health, Newcastle, New South Wales, Australia
| | - Nicole Lubans
- Hunter New England Area Health Service, Hunter New England Population Health, Newcastle, New South Wales, Australia
| | - Rachel Sutherland
- Hunter New England Area Health Service, Hunter New England Population Health, Newcastle, New South Wales, Australia
| | - Jessica Pinfold
- Hunter New England Area Health Service, Hunter New England Population Health, Newcastle, New South Wales, Australia
| | - Kay Smith
- Hunter New England Area Health Service, Hunter New England Population Health, Newcastle, New South Wales, Australia
| | - Tameka Small
- Hunter New England Area Health Service, Hunter New England Population Health, Newcastle, New South Wales, Australia
| | - Kathryn L Reilly
- Hunter New England Area Health Service, Hunter New England Population Health, Newcastle, New South Wales, Australia
| | - Peter Butler
- Hunter New England Area Health Service, Hunter New England Population Health, Newcastle, New South Wales, Australia
| | - Rebecca J Wyse
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
| | - Luke Wolfenden
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
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Sanchez-Vaznaugh EV, Sánchez BN, Crawford PB, Egerter S. Association between competitive food and beverage policies in elementary schools and childhood overweight/obesity trends: differences by neighborhood socioeconomic resources. JAMA Pediatr 2015; 169:e150781. [PMID: 25938657 PMCID: PMC4449257 DOI: 10.1001/jamapediatrics.2015.0781] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
IMPORTANCE To our knowledge, few published studies have examined the influence of competitive food and beverage (CF&B) policies on student weight outcomes; none have investigated disparities in the influence of CF&B policies on children's body weight by school neighborhood socioeconomic resources. OBJECTIVE To investigate whether the association between CF&B policies and population-level trends in childhood overweight/obesity differed by school neighborhood income and education levels. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study, from July 2013 to October 2014, compared overweight/obesity prevalence trends before (2001-2005) and after (2006-2010) implementation of CF&B policies in public elementary schools in California. The study included 2 700 880 fifth-grade students in 5362 public schools from 2001 to 2010. EXPOSURES California CF&B policies (effective July 1, 2004, and July 1, 2007) and school neighborhood income and education levels. MAIN OUTCOMES AND MEASURES Overweight/obesity defined as a body mass index at or greater than the 85th percentile for age and sex. RESULTS Overall rates of overweight/obesity ranged from 43.5% in 2001 to 45.8% in 2010. Compared with the period before the introduction of CF&B policies, overweight/obesity trends changed in a favorable direction after the policies took effect (2005-2010); these changes occurred for all children across all school neighborhood socioeconomic levels. In the postpolicy period, these trends differed by school neighborhood socioeconomic advantage. From 2005-2010, trends in overweight/obesity prevalence leveled off among students at schools in socioeconomically disadvantaged neighborhoods but declined in socioeconomically advantaged neighborhoods. Students in the lowest-income neighborhoods experienced zero or near zero change in the odds of overweight/obesity over time: the annual percentage change in overweight/obesity odds was 0.1% for females (95% CI, -0.7 to 0.9) and -0.3% for males (95% CI, -1.1 to 0.5). In contrast, in the highest-income neighborhoods, the annual percentage decline in the odds of overweight was 1.2% for females (95% CI, 0.4 to 1.9) and 1.0% for males (95% CI, 0.3 to 1.8). Findings were similar for school neighborhood education. CONCLUSIONS AND RELEVANCE Our study found population-level improvements in the prevalence of childhood overweight/obesity that coincided with the period following implementation of statewide CF&B policies (2005-2010). However, these improvements were greatest at schools in the most advantaged neighborhoods. This suggests that CF&B policies may help prevent child obesity; however, the degree of their effectiveness is likely to depend on socioeconomic and other contextual factors in school neighborhoods. To reduce disparities and prevent obesity, school policies and environmental interventions must address relevant contextual factors in school neighborhoods.
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Affiliation(s)
- Emma V Sanchez-Vaznaugh
- Department of Health Education, San Francisco State University, San Francisco, California4Center on Social Disparities in Health, University of California, San Francisco
| | - Brisa N Sánchez
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor
| | | | - Susan Egerter
- Center on Social Disparities in Health, University of California, San Francisco
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Matthews MA, Horacek TM. Vending machine assessment methodology. A systematic review. Appetite 2015; 90:176-86. [PMID: 25772195 DOI: 10.1016/j.appet.2015.03.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Revised: 02/12/2015] [Accepted: 03/06/2015] [Indexed: 01/28/2023]
Abstract
The nutritional quality of food and beverage products sold in vending machines has been implicated as a contributing factor to the development of an obesogenic food environment. How comprehensive, reliable, and valid are the current assessment tools for vending machines to support or refute these claims? A systematic review was conducted to summarize, compare, and evaluate the current methodologies and available tools for vending machine assessment. A total of 24 relevant research studies published between 1981 and 2013 met inclusion criteria for this review. The methodological variables reviewed in this study include assessment tool type, study location, machine accessibility, product availability, healthfulness criteria, portion size, price, product promotion, and quality of scientific practice. There were wide variations in the depth of the assessment methodologies and product healthfulness criteria utilized among the reviewed studies. Of the reviewed studies, 39% evaluated machine accessibility, 91% evaluated product availability, 96% established healthfulness criteria, 70% evaluated portion size, 48% evaluated price, 52% evaluated product promotion, and 22% evaluated the quality of scientific practice. Of all reviewed articles, 87% reached conclusions that provided insight into the healthfulness of vended products and/or vending environment. Product healthfulness criteria and complexity for snack and beverage products was also found to be variable between the reviewed studies. These findings make it difficult to compare results between studies. A universal, valid, and reliable vending machine assessment tool that is comprehensive yet user-friendly is recommended.
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Chapter 1 School Policies and Children's Obesity. ACTA ACUST UNITED AC 2015. [DOI: 10.1108/s0573-8555(2010)0000290004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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Rosenkoetter E, Loman DG. Self-Efficacy and Self-Reported Dietary Behaviors in Adolescents at an Urban School With No Competitive Foods. J Sch Nurs 2015; 31:345-52. [DOI: 10.1177/1059840515570641] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Over one third of U.S. adolescents are overweight. A descriptive, cross-sectional study examined the relationship between student dietary self-efficacy (SE), sugar-sweetened beverages, and low-nutrient energy-dense food consumption, and exposure to a healthy school food environment without competitive foods. The sample consisted of 292 urban, primarily African American students aged 11 to 16 years. Mantel–Haenszel χ2 analyses revealed a significant but weak linear trend for girls between number of school meals and SE to drink less soda, χ2(1) = 6.882, p = .008, and between semesters attended with SE to eat more fruits and vegetables, χ2(1) = 5.908, p = .015. Obese students had significantly higher scores for two SE items than nonobese students, that is, plan better nutrition, χ2(1) = 3.998, p = .045, and eat healthy at a fast-food restaurant, χ2(1) = 4.078, p = .043. Further study of adolescent SE for healthy eating and school-based, food-focused obesity prevention interventions is needed.
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Affiliation(s)
| | - Deborah G. Loman
- Pediatric Primary Care Nurse Practitioner Graduate Specialty, Saint Louis University, St. Louis, MO, USA
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Abstract
Concern over childhood obesity has generated a decade-long reformation of school nutrition policies. Food is available in school in 3 venues: federally sponsored school meal programs; items sold in competition to school meals, such as a la carte, vending machines, and school stores; and foods available in myriad informal settings, including packed meals and snacks, bake sales, fundraisers, sports booster sales, in-class parties, or other school celebrations. High-energy, low-nutrient beverages, in particular, contribute substantial calories, but little nutrient content, to a student's diet. In 2004, the American Academy of Pediatrics recommended that sweetened drinks be replaced in school by water, white and flavored milks, or 100% fruit and vegetable beverages. Since then, school nutrition has undergone a significant transformation. Federal, state, and local regulations and policies, along with alternative products developed by industry, have helped decrease the availability of nutrient-poor foods and beverages in school. However, regular access to foods of high energy and low quality remains a school issue, much of it attributable to students, parents, and staff. Pediatricians, aligning with experts on child nutrition, are in a position to offer a perspective promoting nutrient-rich foods within calorie guidelines to improve those foods brought into or sold in schools. A positive emphasis on nutritional value, variety, appropriate portion, and encouragement for a steady improvement in quality will be a more effective approach for improving nutrition and health than simply advocating for the elimination of added sugars.
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Porto EBS, Schmitz BAS, Recine E, Rodrigues MDLCF. School canteens in the Federal District, Brazil and the promotion of healthy eating. REV NUTR 2015. [DOI: 10.1590/1415-52732015000100003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objective: To characterize the school cafeterias in the Federal District of Brazil with respect to the promotion of healthy eating in schools. Methods: This is a descriptive, analytical, cross-sectional study, with a representative sample of schools with cafeterias in the Federal District, Brazil (n=202). The data were collected from April to November 2010 by means of on-site interviews and a structured questionnaire. The Pearson's chi-squared and Student's t tests were used. Results: A higher prevalence of outsourcing, and few employees and dieticians were observed. The prevailing foods were baked sausage, cheese, or chicken rolls or pastries. It was also found that 42.2% of the schools influence the menu of the cafeterias, and 58.6% of the representatives believe in the possibility of influencing the students' eating habits. However, 68.0% of the respondents do not believe in the economic feasibility of completely healthful school cafeterias. Approximately 30.0% of the respondents carry out activities to promote healthy eating. Conclusion: Most of the school cafeterias in the Federal District do not encourage healthful eating. The high prevalence of outsourced services with little interference from the school community gives high autonomy to the cafeteria's owner, whose priority is the pursuit of profit at the expense of the students' nutritional education. Improving the nutritional quality of school foods should be a continuous interactive effort of the food suppliers, principals, students, parents, and government authorities.
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Clary CM, Ramos Y, Shareck M, Kestens Y. Should we use absolute or relative measures when assessing foodscape exposure in relation to fruit and vegetable intake? Evidence from a wide-scale Canadian study. Prev Med 2015; 71:83-7. [PMID: 25481095 DOI: 10.1016/j.ypmed.2014.11.023] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2014] [Revised: 10/24/2014] [Accepted: 11/26/2014] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This paper explores which of absolute (i.e. densities of "healthy" and "unhealthy" food outlets taken separately) or relative (i.e. the percentage of "healthy" outlets) measures of foodscape exposure better predicts fruit and vegetable intake (FVI), and whether those associations are modified by gender and city in Canada. METHODS Self-reported FVI from participants of four cycles (2007-2010) of the repeated cross-sectional Canadian Community Health Survey living in the five largest metropolitan areas of Canada (n=49,403) was analyzed. Absolute and relative measures of foodscape exposure were computed at participants' residential postal codes. Linear regression models, both in the whole sample and in gender- and city-stratified samples, were used to explore the associations between exposure measures and FVI. RESULTS The percentage of healthy outlets was strongly associated with FVI among men both in Toronto/Montreal (β=0.012; P<0.001), and in Calgary/Ottawa/Vancouver (β=0.008; P<0.001), but not among women. Observed associations of absolute measures with FVI were either weak or faced multicollinearity issues. Overall, models with the relative measure showed the best fit. CONCLUSIONS Relative measures should be more widely used when assessing foodscape influences on diet. The absence of a single effect of the foodscape on diet positions sub-group analysis as a promising avenue for research.
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Affiliation(s)
- Christelle M Clary
- Université de Montréal, Département de médecine sociale et préventive, 7101 Avenue du Parc, Montréal, QC H3N 1X9, Canada; Centre de recherche du CHUM, 850 St-Denis, Montréal, QC H2X 0A9, Canada.
| | - Yuddy Ramos
- Centre de recherche du CHUM, 850 St-Denis, Montréal, QC H2X 0A9, Canada; Université de Montréal - Département de géographie, 520 ch. de la Côte-Sainte-Catherine, Montréal, QC H3C 3J7, Canada
| | - Martine Shareck
- Université de Montréal, Département de médecine sociale et préventive, 7101 Avenue du Parc, Montréal, QC H3N 1X9, Canada; Centre de recherche du CHUM, 850 St-Denis, Montréal, QC H2X 0A9, Canada; Institut de Recherche en Santé Publique de l'Université de Montréal (IRSPUM), 7101 Avenue du Parc, Montréal, QC H3N 1X9, Canada
| | - Yan Kestens
- Université de Montréal, Département de médecine sociale et préventive, 7101 Avenue du Parc, Montréal, QC H3N 1X9, Canada; Centre de recherche du CHUM, 850 St-Denis, Montréal, QC H2X 0A9, Canada
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Egner R, Oza-Frank R, Cunningham SA. The school breakfast program: a view of the present and preparing for the future-a commentary. THE JOURNAL OF SCHOOL HEALTH 2014; 84:417-20. [PMID: 24889077 PMCID: PMC4888955 DOI: 10.1111/josh.12164] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Revised: 05/16/2013] [Accepted: 06/04/2013] [Indexed: 05/17/2023]
Affiliation(s)
- Rebecca Egner
- Research Assistant, School of Nursing, Duke University, 307 Trent Dr, Durham, NC 27710
| | - Reena Oza-Frank
- Research Assistant Professor, Center for Perinatal Research, Nationwide Children’s Hospital, 700 Children’s Drive, Columbus, OH43205
| | - Solveig Argeseanu Cunningham
- Assistant Professor, Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Road, NE, Room7045, Atlanta, GA 30322
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Terry-McElrath YM, Hood NE, Colabianchi N, O'Malley PM, Johnston LD. Profits, commercial food supplier involvement, and school vending machine snack food availability: implications for implementing the new competitive foods rule. THE JOURNAL OF SCHOOL HEALTH 2014; 84:451-458. [PMID: 24889082 DOI: 10.1111/josh.12165] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Revised: 12/16/2013] [Accepted: 01/14/2014] [Indexed: 06/03/2023]
Abstract
BACKGROUND The 2013-2014 school year involved preparation for implementing the new US Department of Agriculture (USDA) competitive foods nutrition standards. An awareness of associations between commercial supplier involvement, food vending practices, and food vending item availability may assist schools in preparing for the new standards. METHODS Analyses used 2007-2012 questionnaire data from administrators of 814 middle and 801 high schools in the nationally representative Youth, Education, and Society study to examine prevalence of profit from and commercial involvement with vending machine food sales, and associations between such measures and food availability. RESULTS Profits for the school district were associated with decreased low-nutrient, energy-dense (LNED) food availability and increased fruit/vegetable availability. Profits for the school and use of company suppliers were associated with increased LNED availability; company suppliers also were associated with decreased fruit/vegetable availability. Supplier "say" in vending food selection was associated with increased LNED availability and decreased fruit/vegetable availability. CONCLUSIONS Results support (1) increased district involvement with school vending policies and practices, and (2) limited supplier "say" as to what items are made available in student-accessed vending machines. Schools and districts should pay close attention to which food items replace vending machine LNED foods following implementation of the new nutrition standards.
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Affiliation(s)
- Yvonne M Terry-McElrath
- Survey Research Associate, , Institute for Social Research, University of Michigan, PO Box 1248, Ann Arbor, MI 48106-1248
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Caparosa SL, Shordon M, Santos AT, Pomichowski ME, Dzewaltowski DA, Coleman KJ. Fundraising, celebrations and classroom rewards are substantial sources of unhealthy foods and beverages on public school campuses. Public Health Nutr 2014; 17:1205-13. [PMID: 23764087 PMCID: PMC10282267 DOI: 10.1017/s1368980013001493] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2012] [Revised: 04/15/2013] [Accepted: 04/17/2013] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The emphasis in school nutrition policy has been on vending and competitive items. Our study was designed to characterize and quantify the amount and source of other foods and beverages on school campuses. DESIGN A cross-sectional observational study was conducted using a specially designed objective nutrition observation system. SETTING One low-income school district in southern California with six elementary and two middle schools. SUBJECTS Data were not collected from individual children. A total of 4033 students, 42 % of whom were Hispanic/Latino, 26 % African American and 21 % non-Hispanic white, were observed across school settings. RESULTS Data were collected continuously from 9 January 2008 to 16 June 2010. Healthy foods had, per serving, total energy ≤732 kJ (≤175 kcal), total fat content ≤35 %, total saturated fat ≤10 %, sugar less ≤15 g, sodium <200 mg and trans-fat ≤0·5 g. Healthy beverages were only 100 % juice or water, and unflavoured non-fat, 1 %, 2 % milk and soya or rice milk. The system had high inter-rater reliability (r = 0·78 to 0·99), percentage agreement (83 % to 100 %) and test-retest reliability (r = 0·81 to 0·98). Significantly more unhealthy foods and beverages than healthy items were observed on all campuses (P < 0·001). An average of 1·26 (sd 0·46) items per student per week was found with an average of 0·86 (sd 0·34) unhealthy items per child per week. CONCLUSIONS There were substantial amounts of unhealthy foods and beverages brought onto campuses for classroom rewards, celebrations and fundraising that should be targeted for intervention.
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Affiliation(s)
- Susan L Caparosa
- Department of Research and Evaluation, Kaiser Permanente Southern California, Southern California Permanente Medical Group, 100 S. Los Robles, 2nd Floor, Pasadena, CA 91101, USA
| | - Maggie Shordon
- Department of Research and Evaluation, Kaiser Permanente Southern California, Southern California Permanente Medical Group, 100 S. Los Robles, 2nd Floor, Pasadena, CA 91101, USA
| | - Asherlev T Santos
- Graduate School of Public Health Joint Doctoral Program, San Diego State University and University of California at San Diego, San Diego, CA, USA
| | - Magdalena E Pomichowski
- Department of Research and Evaluation, Kaiser Permanente Southern California, Southern California Permanente Medical Group, 100 S. Los Robles, 2nd Floor, Pasadena, CA 91101, USA
| | | | - Karen J Coleman
- Department of Research and Evaluation, Kaiser Permanente Southern California, Southern California Permanente Medical Group, 100 S. Los Robles, 2nd Floor, Pasadena, CA 91101, USA
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