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Naughton SS, Al Subhi M, Boelsen-Robinson T, Blake MR, Ananthapavan J, Peeters A. The change in food service costs associated with increasing the healthiness of ready-to-eat food provision: A systematic scoping review. Obes Rev 2024:e13830. [PMID: 39256927 DOI: 10.1111/obr.13830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 08/15/2024] [Accepted: 08/26/2024] [Indexed: 09/12/2024]
Abstract
Increasing the healthiness of food retail environments is an identified mechanism to help halt rising rates of diet-related non-communicable diseases. Previous studies on healthy food environment adoption report that retailers' perceptions of loss of profitability and higher food costs are often barriers to change. Despite this, actual changes to profitability and food costs have not been fully explored. This study aimed to systematically scope the evidence relating to changes to food costs or profitability when changes are made to increase the healthiness of food and drinks sold by food service retailers. Nine databases were searched, with studies included from settings that sold ready-to-consume items, with interventions to increase the healthiness of menus, and reporting food environment/nutrition outcomes, and cost/profit outcomes. Of the 12 studies included, the majority were conducted in the United States and in school settings. Most studies indicated that increasing the healthiness of food service retail environments resulted in neutral or favorable financial outcomes. Food costs and/or profit changes were most often monitored via simple accounting measures. While further research is needed to strengthen the evidence on financial outcomes of healthier food provision, this review indicates that some perceived barriers to change may not be warranted.
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Affiliation(s)
- Shaan S Naughton
- Institute for Health Transformation, Global Centre for Preventive Health and Nutrition, School of Health and Social Development, Faculty of Health, Deakin University, Geelong, Australia
| | - Moosa Al Subhi
- Institute for Health Transformation, Global Centre for Preventive Health and Nutrition, School of Health and Social Development, Faculty of Health, Deakin University, Geelong, Australia
- Institute for Health Transformation, Deakin Health Economics, School of Health and Social Development, Faculty of Health, Deakin University, Geelong, Australia
| | - Tara Boelsen-Robinson
- Institute for Health Transformation, Global Centre for Preventive Health and Nutrition, School of Health and Social Development, Faculty of Health, Deakin University, Geelong, Australia
| | - Miranda R Blake
- Institute for Health Transformation, Global Centre for Preventive Health and Nutrition, School of Health and Social Development, Faculty of Health, Deakin University, Geelong, Australia
| | - Jaithri Ananthapavan
- Institute for Health Transformation, Global Centre for Preventive Health and Nutrition, School of Health and Social Development, Faculty of Health, Deakin University, Geelong, Australia
- Institute for Health Transformation, Deakin Health Economics, School of Health and Social Development, Faculty of Health, Deakin University, Geelong, Australia
| | - Anna Peeters
- Institute for Health Transformation, Global Centre for Preventive Health and Nutrition, School of Health and Social Development, Faculty of Health, Deakin University, Geelong, Australia
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Michael SL, Barnes SP, Wilkins NJ. Scoping Review of Family and Community Engagement Strategies Used in School-Based Interventions to Promote Healthy Behaviors. THE JOURNAL OF SCHOOL HEALTH 2023; 93:828-841. [PMID: 37670597 PMCID: PMC11181466 DOI: 10.1111/josh.13367] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 06/02/2023] [Accepted: 06/22/2023] [Indexed: 09/07/2023]
Abstract
BACKGROUND School efforts to promote health among students are more successful when families and community members are involved. METHODS We conducted a scoping review to summarize and categorize family and community engagement strategies used in US school and out-of-school time (OST) interventions to address physical activity (PA) and nutrition in kindergarten through 12th grade students. RESULTS The National Network of Partnership Schools' Six Keys to Success framework was useful in organizing the types of family and community engagement strategies used in included interventions. Many interventions used multiple family and community engagement strategies, with the most common being communicating with families and community members; providing support or education to families; and collaborations among school/OST program and community to support students and their families. CONCLUSIONS This review identified six common family and community engagement strategies used in school and OST interventions for PA and nutrition. Including family and community engagement strategies in school and OST interventions could play an important role in maximizing support, resources, and expertise to promote healthy behaviors among all students.
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Affiliation(s)
- Shannon L. Michael
- Senior Health Scientist, Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Seraphine Pitt Barnes
- Senior Health Scientist, Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Natalie J. Wilkins
- Health Scientist, TeamLead, Division of Adolescent and School Health, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA
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Sliwa SA, Chang Chusan YA, Dahlstrom C. Opportunities in the Extended Day: Approaches for Promoting Physical Activity and Healthy Eating During Out-of-School Time. THE JOURNAL OF SCHOOL HEALTH 2023; 93:813-827. [PMID: 37670603 PMCID: PMC11181343 DOI: 10.1111/josh.13370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 05/26/2023] [Accepted: 05/31/2023] [Indexed: 09/07/2023]
Abstract
BACKGROUND This systematic review aims to identify out-of-school time (OST) interventions (eg, programming, policies) that increased opportunities for physical activity (PA) and healthy eating and/or improved youth PA and dietary behaviors. METHODS We searched for articles within systematic reviews that met our criteria (2010-2018) and for individual articles (2010-2020). Reviewer pairs screened articles, double-extracted data, assessed risk of bias (RoB), and achieved consensus. We included 71 articles (55 studies, 60 intervention arms). RESULTS Health (n = 3) and nutrition education (n = 7) interventions showed promising results, but most used weak designs and had high RoB. PA-focused interventions (n = 23) were largely consistent in improving fitness and moderate to vigorous PA during programming. Programmatic interventions that improved both PA and nutrition outcomes engaged family or community members (n = 4/13). Most organizational policy interventions improved the nutrition environment and student PA during OST. CONCLUSIONS Organization-level policy and programmatic interventions can improve environmental supports and youth behaviors during OST programming, complementing school-day efforts to address student PA and dietary intake. To maximize their potential impact, OST programs need to be accessible to families. Administrators can consider actions to reduce participation barriers.
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Affiliation(s)
- Sarah A Sliwa
- Division of Population Health, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Atlanta, GA
| | - Yuilyn A Chang Chusan
- Tufts University Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Boston, MA
| | - Christina Dahlstrom
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
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Crowe RK, Probst Y, Weaver RG, Beets MW, Kemp B, Stanley RM, Okely AD. Systematic observation of healthy eating environments in after-school services: a cross-sectional study. Public Health Nutr 2021; 24:6067-6074. [PMID: 34348825 PMCID: PMC11148606 DOI: 10.1017/s1368980021003220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES Few studies have examined the healthy eating environments within the Australian out of school hours care (OSHC) setting. This study aims to describe healthy eating environments, consisting of: (a) the alignment of provided food and beverages to Australian Dietary Guidelines; (b) healthy eating promotion practices; (c) nutrition education through cooking experiences; (d) staff role modelling healthy eating and (e) regular water availability. DESIGN A cross-sectional study was conducted using direct observations and the validated System for Observing Staff Promotion of Activity and Nutrition (SOSPAN) tool. SETTING OSHC located in urban and semi-rural regions of NSW, Australia. PARTICIPANTS Staff (151) and children (1549) attending twelve OSHC services operating in the hours after school. RESULTS Fifty per cent (50 %) of services offered fruits and 100 % offered water as a part of the afternoon snack on all four observation days. Discretionary foods were offered on more days compared to vegetables (+1·9/d, P = 0·009), lean meats (+2·7/d, P =·0 004) and wholegrains (+2·8/d, P = 0 002). Staff promoted healthy eating on 15 % of days, sat and ate with children 52 %, consumed high sugar drinks 15 % and ate discretionary foods in front of children 8 % of days, respectively. No opportunities for cooking or nutrition education were observed. CONCLUSION Afternoon snacks regularly contained fruits and water. Opportunities exist to improve the frequency by which vegetables, wholegrains and lean meats are offered in addition to staff healthy eating promotion behaviours. Future research is warranted to further explore healthy eating behaviours, practices and policies within the after-school sector.
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Affiliation(s)
- Ruth K Crowe
- School of Medicine, Faculty of Science Medicine and Health, University of Wollongong, Wollongong, NSW2522, Australia
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW, Australia
| | - Yasmine Probst
- School of Medicine, Faculty of Science Medicine and Health, University of Wollongong, Wollongong, NSW2522, Australia
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW, Australia
| | - R Glenn Weaver
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Michael W Beets
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Byron Kemp
- School of Health and Society, University of Wollongong, Wollongong, NSW, Australia
| | - Rebecca M Stanley
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW, Australia
- Early Start, School of Health and Society, Faculty of the Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, NSW, Australia
| | - Anthony D Okely
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW, Australia
- Early Start, School of Health and Society, Faculty of the Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, NSW, Australia
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Incentivizing Healthy Snacks During Out-of-School Time Through Grocery Store Partnerships. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2020; 26:E33-E41. [DOI: 10.1097/phh.0000000000000853] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Helmick M, Esmond AC, Hedrick V, Zoellner J, You W, Hill JL. The Adoption of the Healthy Eating Standards in Local Afterschool Programs Does Not Improve Quality of Snacks. THE JOURNAL OF SCHOOL HEALTH 2019; 89:809-817. [PMID: 31397496 DOI: 10.1111/josh.12822] [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: 08/20/2017] [Revised: 01/23/2018] [Accepted: 04/22/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES In 2011, the National Afterschool Association adopted the Healthy Eating and Physical Activity (HEPA) standards to address snack quality and physical activity in afterschool programs. Although research has indicated promise in the adoption of these policies by national organizations, less is known about local adoption, implementation, and effectiveness. In this study, we aimed to compare the quality of snacks served at program sites pre- and post-adoption and to determine the quality of non-program snacks compared to program snacks. METHODS An interrupted time series design was used to measure snack quality and consumption at 3 policy adopting sites and 2 non-policy adopting sites that served as a comparison control. Trained research staff collected snack type, brand, and amount consumed using a modified quarter-waste method. Analysis on nutrient content of snacks was completed using Nutrition Data System for Research software. RESULTS Adoption of the HEPA standards among policy adopting sites did not result in significantly better snack quality. Across all sites, program snacks were healthier than non-program snacks. CONCLUSION Pursuing additional components of the HEPA standards related to implementation may be necessary to significantly improve snack quality. Environmental supports such as limiting the amount of non-program snacks available onsite may improve snack quality.
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Affiliation(s)
- Meagan Helmick
- Radford University Carilion, 101 Elm Ave SE, Roanoke, VA 24013
| | | | - Valisa Hedrick
- 295 West Campus Drive, 338 Wallace Hall, Blacksburg, VA 24061
| | | | - Wen You
- 250 Drillfield Drive, 304 Hutcheson Hall, Blacksburg, VA 24061
| | - Jennie L Hill
- University of Nebraska Medical Center, 984395 Nebraska Medical Center, Omaha, NE 68198
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Impact of the Out-of-School Nutrition and Physical Activity (OSNAP) Group Randomized Controlled Trial on Children's Food, Beverage, and Calorie Consumption among Snacks Served. J Acad Nutr Diet 2019; 118:1425-1437. [PMID: 30055710 DOI: 10.1016/j.jand.2018.04.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 04/15/2018] [Indexed: 11/21/2022]
Abstract
BACKGROUND Afterschool interventions have been found to improve the nutritional quality of snacks served. However, there is limited evidence on how these interventions affect children's snacking behaviors. OBJECTIVE Our aim was to determine the impact of an afterschool intervention focused at the school district, site, family, and child levels on dietary consumption of foods and beverages served at snack. DESIGN This was a secondary analysis of a group-randomized controlled trial. PARTICIPANTS/SETTING Data were collected from 400 children at 20 afterschool sites in Boston, MA before (fall 2010) and after (spring 2011) intervention implementation. INTERVENTION The Out-of-School Nutrition and Physical Activity intervention aimed to promote fruits, vegetables, whole grains, and water, while limiting sugary drinks and trans fats. Researchers worked with district foodservice staff to change snack foods and beverages. Teams of afterschool staff participated in three 3-hour learning collaborative sessions to build skills and created action plans for changing site practices. The intervention included family and child nutrition education. MAIN OUTCOME MEASURES Research assistants observed dietary snack consumption using a validated measure on 2 days per site at baseline and follow-up. STATISTICAL ANALYSES PERFORMED This study used multivariable regression models, accounting for clustering of observations, to assess the intervention effect, and conducted post-hoc stratified analyses by foodservice type. RESULTS Children in intervention sites had greater decreases in consumption of juice (-0.61 oz/snack, 95% CI -1.11 to -0.12), beverage calories (-29.1 kcal/snack, 95% CI -40.2 to 18.0), foods with trans fats (-0.12 servings/snack, 95% CI -0.19 to -0.04), total calories (-47.7 kcal/snack, 95% CI -68.2 to -27.2), and increases in consumption of whole grains (0.10 servings/snack, 95% CI 0.02 to 0.18) compared to controls. In post-hoc analyses, sites with on-site foodservice had significant improvements for all outcomes (P<0.001), with no effect for sites with satellite foodservice. CONCLUSIONS Results demonstrate that an afterschool intervention can improve children's dietary snack consumption, particularly at sites with on-site foodservice.
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Kemper KA, Pate SP, Powers AR, Fair M. Promoting Healthy Environments In Afterschool Settings: The LiveWell Greenville Afterschool Initiative. Prev Chronic Dis 2018; 15:E144. [PMID: 30468420 PMCID: PMC6266516 DOI: 10.5888/pcd15.180164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION LiveWell Greenville, a multi-organization community coalition, launched an initiative in 2011 to help afterschool programs promote environments that decrease the risk of obesity among children and adolescents. The objective of this study was to describe changes in nutrition and physical activity environments, policies, and practices among 37 afterschool programs after their participation in the LiveWell Greenville Afterschool Initiative. METHODS The study used a nonexperimental, pre- and postsurvey design. The survey was based on the Nutrition and Physical Activity Self-Assessment for Child Care questionnaire and modified for afterschool settings. Items addressed sedentary time, physical activity time, availability of sugar-sweetened beverages, sweet and salty snack consumption, fruit consumption, staff behaviors, and policies that support nutrition and physical activity practices. The self-assessment survey was completed by an afterschool program supervisor at each site. The 9-month intervention consisted of program staff members' completing the pre-assessment and goal-setting worksheet, receiving technical support and training from LiveWell Greenville staff, attending networking meetings about nutrition and physical activity promotion strategies, and completing a postassessment. RESULTS We found significant positive changes in afterschool environments in the type and frequency of snacks offered, duration of children's sedentary time, staff behaviors that supported healthy nutrition and physical activity practices, and education provided to staff, children, and parents. CONCLUSION We found the LiveWell Greenville Afterschool Initiative, which involved self-assessment, goal setting and technical support, to be a successful strategy to change nutrition and physical activity environments in afterschool settings.
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Affiliation(s)
- Karen A Kemper
- Department of Public Health Sciences, Clemson University, 533 Edwards Hall, Clemson, SC 29634. .,LiveWell Greenville, Greenville, South Carolina
| | | | - Alicia R Powers
- LiveWell Greenville, Greenville, South Carolina.,Supplemental Nutrition Assistance Program-Education, Alabama Cooperative Extension, Auburn University, Alabama
| | - Melissa Fair
- Institute for the Advancement of Community Health, Furman University, Greenville, South Carolina
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Bohnert A, Zarrett N, Beets MW, Hall G, Buscemi J, Heard A, Pate R. Society of Behavioral Medicine (SBM) position statement: SBM supports curbing summertime weight gain among America's youth. Transl Behav Med 2017; 7:912-914. [PMID: 28660591 PMCID: PMC5684082 DOI: 10.1007/s13142-017-0512-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
The Society of Behavioral Medicine recommends adoption of policies at the district, state, and federal levels that minimize weight gain among youth over the summertime, particularly among low-income, minority school-age youth who appear to be at greater risk. Policies that facilitate (1) partnerships between school districts and community organizations to provide affordable summertime programming, (2) strategic efforts by schools and communities to encourage families to enroll and attend summertime programming via the creation of community-wide summertime offerings offices, (3) adoption of joint-use/shared use agreements in communities to promote use of indoor and outdoor school facilities to provide affordable programming during the summer months, and (4) implementation of strategies that help summer programs achieve the Healthy Eating and Physical Activity (HEPA) standards which have been endorsed by the Healthy Out-of-School Time (HOST) coalition. Research is needed to elucidate key mechanisms by which involvement in structured programming may reduce weight gain over the summer months.
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Affiliation(s)
- Amy Bohnert
- Department of Psychology, Loyola University Chicago, Chicago, IL, USA.
| | - Nicole Zarrett
- Department of Psychology, University of South Carolina, Columbia, SC, USA
| | - Michael W Beets
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Georgia Hall
- Wellesley Centers for Women, National Institute on Out-of-School Time, Wellesley, MA, USA
| | - Joanna Buscemi
- Department of Psychology, DePaul University, Chicago, IL, USA
| | - Amy Heard
- Department of Psychology, Loyola University Chicago, Chicago, IL, USA
| | - Russell Pate
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
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Intervention leads to improvements in the nutrient profile of snacks served in afterschool programs: a group randomized controlled trial. Transl Behav Med 2017; 6:329-38. [PMID: 27528522 DOI: 10.1007/s13142-015-0342-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Widely adopted nutrition policies for afterschool programs (ASPs) focus on serving a fruit/vegetable daily and eliminating sugar-sweetened foods/beverages. The impact of these policies on the nutrient profile of snacks served is unclear. Evaluate changes in macro/micronutrient content of snacks served in ASPs. A 1-year group randomized controlled trial was conducted in 20 ASPs serving over 1700 elementary-age children. Intervention ASPs received a multistep adaptive framework intervention. Direct observation of snack served was collected and nutrient information determined using the USDA Nutrient Database, standardized to nutrients/100 kcal. By post-assessment, intervention ASPs reduced total kcal/snack served by 66 kcal (95CI -114 to -19 kcal) compared to control ASPs. Total fiber (+1.7 g/100 kcal), protein (+1.4 g/100 kcal), polyunsaturated fat (+1.2 g/100 kcal), phosphorous (+49.0 mg/100 kcal), potassium (+201.8 mg/100 kcal), and vitamin K (+21.5 μg/100 kcal) increased in intervention ASPs, while added sugars decreased (-5.0 g/100 kcal). Nutrition policies can lead to modest daily caloric reductions and improve select macro/micronutrients in snacks served. Long-term, these nutritional changes may contribute to healthy dietary habits.
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Beets MW, Weaver RG, Turner-McGrievy G, Huberty J, Moore JB, Ward DS, Freedman DA, Beighle A. Two-Year Healthy Eating Outcomes: An RCT in Afterschool Programs. Am J Prev Med 2017; 53:316-326. [PMID: 28532659 PMCID: PMC5562516 DOI: 10.1016/j.amepre.2017.03.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 02/10/2017] [Accepted: 03/08/2017] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Across the U.S., afterschool programs (ASPs, 3:00pm-6:00pm) are trying to achieve nationally endorsed nutrition standards (Healthy Eating Standards) calling for fruits/vegetables and water to be served every day, while eliminating sugar-sweetened beverages and foods. The purpose of this study was to evaluate the 2-year changes in the types of foods and beverages served during a community-based intervention designed to achieve the Healthy Eating Standards. STUDY DESIGN Randomized delayed treatment trial with an immediate (1-year baseline and 2-year intervention) or delayed (2-year baseline and 1-year intervention) group. SETTING/PARTICIPANTS Twenty ASPs serving 1,700 children (aged 5-12 years) were recruited, with baseline occurring spring 2013, and outcome assessment occurring spring 2014 and 2015. INTERVENTION The multistep intervention, Strategies To Enhance Practice for Healthy Eating, assisted ASP leaders/staff to serve foods/beverages that meet the nutrition standards. MAIN OUTCOME MEASURES The foods and beverages served for snack were observed directly. RESULTS Compared with non-intervention years, both the immediate and delayed groups increased the number of days/week that fruits/vegetables (0.6 vs 1.7 days/week and 0.6 vs 4.4 days/week, OR=3.80, 95% CI=1.45, 9.95) and water (2.3 vs 3.7 days/week and 2.7 vs 4.8 days/week, OR=4.65, 95% CI=1.69, 12.79) were served. Sugar-sweetened beverages were almost eliminated by post-assessment (1.2 vs 0.2 days/week and 3.2 vs 0.0 days/week, OR=0.05, 95% CI=0.02, 0.13). Only the immediate group decreased the number of days/week desserts were served (2.9 vs 0.6 days/week, OR=0.10, 95% CI=0.03, 0.33). Implementation barriers for the delayed group included once/month delivery schedules for fruits/vegetables and limited storage space for foods meeting the Healthy Eating Standards. CONCLUSIONS Improvements in the foods/beverages served in ASPs can be made, yet were hindered by structural barriers related to procurement and storage of perishable foods. Additional efforts are needed to support ASPs as they work toward fully achieving the Healthy Eating Standards.
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Affiliation(s)
- Michael W Beets
- Arnold School of Public Health, University of South Carolina, Columbia, South Carolina.
| | - R Glenn Weaver
- Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | | | - Jennifer Huberty
- School of Nutrition and Health Promotion, Arizona State University, Phoenix, Arizona
| | - Justin B Moore
- Family and Community Medicine, Wake Forest School of Medicine, Wake Forest University, Winston-Salem, North Carolina
| | - Dianne S Ward
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, Chapel Hill, North Carolina
| | - Darcy A Freedman
- Department of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, Ohio
| | - Aaron Beighle
- College of Education, University of Kentucky, Lexington, Kentucky
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Economos CD, Anzman-Frasca S, Koomas AH, Chan G, Folta SC, Heck J, Newman M, Sacheck JM. Snacks, beverages, and physical activity during volunteer-led out-of-school-time programs: a cross-sectional analysis. BMC Public Health 2017; 17:125. [PMID: 28129761 PMCID: PMC5270327 DOI: 10.1186/s12889-017-4040-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 01/14/2017] [Indexed: 11/10/2022] Open
Abstract
Background Tens of millions of children regularly participate in out-of-school-time (OST) programs, providing an opportunity for child health promotion. Most research on OST has focused on structured, staff-led after-school programs, as opposed to volunteer-led programs such as enrichment programs and youth sports. The aim of this study was to describe snacks, beverages, and physical activity (PA) practices in volunteer-led OST programs across five organizations in three states. Methods An online survey including the Out-of-School-Time Snacks, Beverages, and Physical Activity Questionnaire was distributed to 1,695 adult leaders of enrichment and youth sports programs serving 5–12 year-old children in Maine, Massachusetts, and New Hampshire, USA. The response rate was 57.8%, with 980 leaders participating and 698 (136 youth sports, 562 enrichment) remaining after data cleaning procedures. Frequencies were calculated to describe snack, beverage, and PA offerings during typical meetings and whether healthy snack, beverage, and PA criteria were met. Criteria were developed a priori with the intent to capture co-occurring practices that together indicate healthy snack (fruits and vegetables or no snack over salty/sweet snacks); beverage (water over sugar-sweetened beverages); and PA environments (regular opportunities for >15 or 45 min of PA in enrichment and sports programs, respectively). Results About half of enrichment leaders reported that snacks and beverages were provided during typical meetings vs. one-fifth of sports leaders. In 28.4% of enrichment programs, PA was offered at every meeting vs. 98.5% of sports programs. Among enrichment programs, 50.4 and 25.8% met healthy snack and beverage criteria, respectively, and 29.4% met PA criteria, with 27.6% meeting criteria in two or more areas, and 5.0% in all three. Among sports programs, 72.8 and 78.7% met healthy snack and beverage criteria, respectively, and 71.3% met PA criteria. Eighty-two percent met criteria in two or more areas, and 46.3% met criteria in all three. Conclusions Most programs did not meet criteria for healthier snacks and beverages and opportunities for PA during typical meetings, indicating room for improvement in encouraging widespread adoption of these practices. Efforts to improve the healthfulness of snacks and beverages and increase opportunities for PA during volunteer-led OST programs are warranted. Electronic supplementary material The online version of this article (doi:10.1186/s12889-017-4040-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Christina D Economos
- ChildObesity180, Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Avenue, Boston, 02111, MA, USA. .,Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Avenue, Boston, MA, 02111, USA.
| | - Stephanie Anzman-Frasca
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, G56 Farber Hall, South Campus, Buffalo, NY, 14214, USA
| | - Alyssa H Koomas
- ChildObesity180, Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Avenue, Boston, 02111, MA, USA
| | - Grace Chan
- ChildObesity180, Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Avenue, Boston, 02111, MA, USA
| | - Sara C Folta
- Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Avenue, Boston, MA, 02111, USA
| | - Julianne Heck
- ChildObesity180, Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Avenue, Boston, 02111, MA, USA
| | - Molly Newman
- ChildObesity180, Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Avenue, Boston, 02111, MA, USA
| | - Jennifer M Sacheck
- Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Avenue, Boston, MA, 02111, USA
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Beets MW, Weaver RG, Turner-McGrievy G, Beighle A, Moore JB, Webster C, Khan M, Saunders R. Compliance With the Healthy Eating Standards in YMCA After-School Programs. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2016; 48:555-562.e1. [PMID: 27372234 PMCID: PMC5018418 DOI: 10.1016/j.jneb.2016.05.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 05/25/2016] [Accepted: 05/26/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE In 2011, the YMCA of the US adopted Healthy Eating standards for all of their after-school programs (ASPs). The extent to which YMCA ASPs comply with the standards is unknown. METHODS Twenty ASPs from all YMCA ASPs across South Carolina (N = 102) were invited to participate. Direct observation of the food and beverages served and staff behaviors were collected on 4 nonconsecutive days per ASP. RESULTS One ASP did not serve a snack. Of the remaining ASPs, a total of 26% served a fruit or vegetable and 32% served water every day; 26% served sugar-sweetened beverages, 47% served sugar-added foods, and only 11% served whole grains when grains were served. Staff members sat with the children (65%) or verbally promoted healthy eating (15%) on at least 1 observation day. Staff drank non-approved drinks (25%) or foods (45%) on at least 1 observation day. No ASPs served snacks family-style every day. CONCLUSIONS AND IMPLICATIONS Additional efforts are required to assist YMCA-operated ASPs in achieving these important nutrition standards.
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Affiliation(s)
- Michael W Beets
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC.
| | - R Glenn Weaver
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC
| | - Gabrielle Turner-McGrievy
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC
| | - Aaron Beighle
- Department of Kinesiology & Health Promotion, College of Education, University of Kentucky, Lexington, KY
| | - Justin B Moore
- Department of Family & Community Medicine, Wake Forest School of Medicine, Winston-Salem, NC
| | - Collin Webster
- Department of Physical Education, College of Education, University of South Carolina, Columbia, SC
| | - Mahmud Khan
- Department of Health Service, Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC
| | - Ruth Saunders
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC
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Lane H, Porter K, Estabrooks P, Zoellner J. A Systematic Review to Assess Sugar-Sweetened Beverage Interventions for Children and Adolescents across the Socioecological Model. J Acad Nutr Diet 2016; 116:1295-1307.e6. [PMID: 27262383 PMCID: PMC4967019 DOI: 10.1016/j.jand.2016.04.015] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Accepted: 04/21/2016] [Indexed: 01/06/2023]
Abstract
Sugar-sweetened beverage (SSB) consumption among children and adolescents is a determinant of childhood obesity. Many programs to reduce consumption across the socioecological model report significant positive results; however, the generalizability of the results, including whether reporting differences exist among socioecological strategy levels, is unknown. This systematic review aimed to examine the extent to which studies reported internal and external validity indicators defined by the reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) model and assess reporting differences by socioecological level: Intrapersonal/interpersonal (Level 1), environmental/policy (Level 2), and multilevel (Combined Level). A systematic literature review was conducted in six major databases (PubMed, Web of Science, Cinahl, CAB Abstracts, Education Research Information Center, and Arcola) to identify studies from 2004-2015 meeting inclusion criteria (children aged 3 to 12 years, adolescents aged 13 to 17 years, and young adults aged 18 years, experimental or quasiexperimental, and substantial SSB component). Interventions were categorized by socioecological level, and data were extracted using a validated RE-AIM protocol. One-way analysis of variance assessed differences between levels. There were 55 eligible studies accepted, including 21 Level 1, 18 Level 2, and 16 Combined Level studies. Thirty-six studies (65%) were conducted in the United States, 19 studies (35%) were conducted internationally, and 39 studies (71%) were implemented in schools. Across levels, reporting averages were low for all RE-AIM dimensions (reach=29%, efficacy or effectiveness=45%, adoption=26%, implementation=27%, and maintenance=14%). Level 2 studies had significantly lower reporting on reach and effectiveness (10% and 26%, respectively) compared with Level 1 (44% and 57%, respectively) or Combined Level studies (31% and 52%, respectively) (P<0.001). Adoption, implementation, and maintenance reporting did not vary among levels. Interventions to reduce SSB consumption in children and adolescents across the socioecological spectrum do not provide the necessary information for dissemination and implementation in community nutrition settings. Future interventions should address both internal and external validity to maximize population influence.
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Affiliation(s)
- Hannah Lane
- Virginia Tech, Department of Human Nutrition, Foods and Exercise, 1981 Kraft Drive, Blacksburg, VA 24061, 540-797-3465,
| | - Kathleen Porter
- Virginia Tech, Department of Human Nutrition, Foods and Exercise, 1981 Kraft Drive, Blacksburg, VA 24061, 540-231-1267,
| | - Paul Estabrooks
- University of Nebraska Medical Center, Department of Health Promotion, Social & Behavioral Health, Omaha, NE 68198, 402-559-4325,
| | - Jamie Zoellner
- Virginia Tech, Department of Human Nutrition, Foods and Exercise, 1981 Kraft Drive, Blacksburg, VA 24061, 540-231-3670,
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Beets MW, Weaver RG, Turner-McGrievy G, Huberty J, Ward DS, Freedman D, Hutto B, Moore JB, Beighle A. Making Healthy Eating Policy Practice: A Group Randomized Controlled Trial on Changes in Snack Quality, Costs, and Consumption in After-School Programs. Am J Health Promot 2016; 30:521-31. [PMID: 26158679 DOI: 10.4278/ajhp.141001-quan-486] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 01/25/2015] [Indexed: 11/17/2022]
Abstract
PURPOSE The aim of this study was to evaluate an intervention designed to assist after-school programs (ASPs) in meeting snack nutrition policies that specify that a fruit or vegetable be served daily and sugar-sweetened beverages/foods and artificially flavored foods eliminated. DESIGN The study used a 1-year group-randomized controlled trial. SETTING The study took place in ASPs operating in South Carolina, United States. SUBJECTS Twenty ASPs serving over 1700 children were recruited, match-paired postbaseline on enrollment size and days fruits/vegetables were served per week, and randomized to either intervention (n = 10) or control (n = 10) groups. INTERVENTION The study used Strategies To Enhance Practice for Healthy Eating (STEPs-HE), a multistep adaptive intervention framework that assists ASP leaders and staff to serve snacks that meet nutrition policies while maintaining cost. MEASURES Direct observation of snacks served and consumed and monthly snack expenditures as determined by receipts were used. ANALYSIS The study used nonparametric and mixed-model repeated measures. RESULTS By postassessment, intervention ASPs increased serving of fruits/vegetables to 3.9 ± 2.1 vs. 0.7 ± 1.7 d/wk and decreased serving sugar-sweetened beverages to 0.1 ± 0.7 vs. 1.8 ± 2.4 d/wk and sugar-sweetened foods to 0.3 ± 1.1 vs. 2.7 ± 2.5 d/wk compared to controls, respectively. Cost of snacks increased by $0.02/snack in the intervention ASPs ($0.36 to $0.38) compared to a $0.01 per snack decrease in the control group ($0.39 to $0.38). Across both assessments and groups, 80% to 100% of children consumed FVs. CONCLUSIONS The STEPs-HE intervention can assist ASPs in meeting nationally endorsed nutrition policies with marginal increases in cost.
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Affiliation(s)
| | | | | | | | - Dianne S Ward
- University of North Carolina, Chapel Hill, South Carolina
| | | | - Brent Hutto
- University of South Carolina, Columbia, South Carolina
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Weaver RG, Beets MW, Beighle A, Webster C, Huberty J, Moore JB. Strategies to Increase After-School Program Staff Skills to Promote Healthy Eating and Physical Activity. Health Promot Pract 2016; 17:88-97. [PMID: 26055462 PMCID: PMC7244216 DOI: 10.1177/1524839915589732] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Standards targeting children's healthy eating and physical activity (HEPA) in after-school programs call for staff to display or refrain from HEPA-promoting or -discouraging behaviors that are linked to children's HEPA. This study evaluated strategies to align staff behaviors with HEPA Standards. Staff at four after-school programs serving approximately 500 children participated in professional development training from January 2012 to May 2013. Site leaders also attended workshops and received technical support during the same time frame. Changes in staff behaviors were evaluated using the System for Observing Staff Promotion of Activity and Nutrition in a pre- (fall 2011) multiple-post (spring 2012, fall 2012, and spring 2013), no-control group study design. A total of 8,949 scans were completed across the four measurement periods. Of the 19 behaviors measured, 14 changed in the appropriate direction. For example, staff engaging in physical activity with children increased from 27% to 40% of scans and staff eating unhealthy foods decreased from 56% to 14% of days. Ongoing training and technical assistance can have a measureable impact on staff behaviors linked to child-level HEPA outcomes. Future research should explore the feasibility of disseminating ongoing trainings to after-school program staff on a large scale.
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Beets MW, Weaver RG, Tilley F, Turner-McGrievy B, Huberty J, Ward DS, Freedman DA. Salty or sweet? Nutritional quality, consumption, and cost of snacks served in afterschool programs. THE JOURNAL OF SCHOOL HEALTH 2015; 85:118-124. [PMID: 25564980 PMCID: PMC4432474 DOI: 10.1111/josh.12224] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Revised: 07/10/2014] [Accepted: 07/12/2014] [Indexed: 06/04/2023]
Abstract
BACKGROUND Snacks served in afterschool programs (ASPs, 3-6 pm) represent an important opportunity to promote healthy eating. ASP policies suggest a fruit/vegetable is served daily, while sugar-sweetened foods/beverages and artificially flavored snacks are eliminated. Limited information exists on the types of snacks served in ASPs, if snacks meet existing nutrition policies, whether children eat the snacks, and their cost. METHODS Direct observation of snacks served and consumed was collected in 20 ASPs serving over 1700 elementary age children. The number of days that snacks were served/week was evaluated for compliance with nutrition policies. Costs of snacks were collected via receipts. RESULTS Programs served desserts and artificially flavored salty snacks on 2.7 and 2.1 days/week. Fruits and vegetables were served 0.6 and 0.1 days/week, respectively. Sugar-sweetened beverages were served 1.8 days/week. Of the children (N = 383) observed, 75% to 100% consumed the snack served, with 95% and 100% of served fruits/vegetables consumed. No ASP served fruit/vegetables daily, 18 served sugar-sweetened foods, 16 served artificially flavored snacks, and 14 served sugar-sweetened beverages. Desserts and salty snacks cost $0.27-$0.32/snack vs $0.38-$0.40/snack for vegetables/fruits. CONCLUSIONS The quality of snacks failed to meet nutrition policies and consists of predominately high-sugar and artificially flavored options. Strategies to improve snack offerings in ASPs while addressing price barriers are required.
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Beets MW, Tilley F, Kyryliuk R, Weaver RG, Moore JB, Turner-McGrievy G. Children select unhealthy choices when given a choice among snack offerings. J Acad Nutr Diet 2014; 114:1440-6. [PMID: 24935610 DOI: 10.1016/j.jand.2014.04.022] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Accepted: 04/15/2014] [Indexed: 10/25/2022]
Abstract
Out-of-school-time programs serve snacks to millions of children annually. State and national snack policies endorse serving more-healthful options, such as fruits, yet often allow less-healthful options, such as cookies and chips, to be served simultaneously. To date, no studies have examined the choices children make when provided with disparate snack options in out-of-school-time programs. An experimental study with randomized exposures was conducted that exposed children (5 to 10 years old) to the following conditions: whole or sliced fruit; whole/sliced fruit, sugar-sweetened snacks (eg, cookies) and flavored salty (eg, nacho cheese-flavored tortilla chips) snacks; and whole/sliced fruit and less-processed/unflavored grain snacks (eg, pretzels), during a 2-week period representing 18 snack occasions (morning and afternoon) during summer 2013. The percentage of children who selected snacks, snack consumption, and percent of serving wasted were calculated and analyzed using repeated-measures analyses of variance with Bonferroni adjustments. A total of 1,053 observations were made. Sliced fruit was selected more than whole fruit across all conditions. Fruit (sliced or whole) was seldom selected when served simultaneously with sugar-sweetened (6% vs 58%) and flavored salty (6% vs 38%) snacks or unflavored grain snacks (23% vs 64%). More children consumed 100% of the sugar-sweetened (89%) and flavored salty (82%) snacks compared with fruit (71%); 100% consumption was comparable between fruit (59%) and unflavored grain snacks (49%). Approximately 15% to 47% of fruit was wasted, compared with 8% to 38% of sugar-sweetened, flavored salty, and unflavored grain snacks. Snack policies that encourage out-of-school-time programs to serve fruit require clear language that limits offering less-healthful snack options simultaneously.
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Beets MW, Glenn Weaver R, Turner-McGrievy G, Huberty J, Ward DS, Freedman DA, Saunders R, Pate RR, Beighle A, Hutto B, Moore JB. Making healthy eating and physical activity policy practice: the design and overview of a group randomized controlled trial in afterschool programs. Contemp Clin Trials 2014; 38:291-303. [PMID: 24893225 DOI: 10.1016/j.cct.2014.05.013] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Revised: 05/21/2014] [Accepted: 05/26/2014] [Indexed: 11/26/2022]
Abstract
National and state organizations have developed policies calling upon afterschool programs (ASPs, 3-6 pm) to serve a fruit or vegetable (FV) each day for snack, while eliminating foods and beverages high in added-sugars, and to ensure children accumulate a minimum of 30 min/d of moderate-to-vigorous physical activity (MVPA). Few efficacious and cost-effective strategies exist to assist ASP providers in achieving these important public health goals. This paper reports on the design and conceptual framework of Making Healthy Eating and Physical Activity (HEPA) Policy Practice in ASPs, a 3-year group randomized controlled trial testing the effectiveness of strategies designed to improve snacks served and increase MVPA in children attending community-based ASPs. Twenty ASPs, serving over 1800 children (6-12 years) will be enrolled and match-paired based on enrollment size, average daily min/d MVPA, and days/week FV served, with ASPs randomized after baseline data collection to immediate intervention or a 1-year delayed group. The framework employed, STEPs (Strategies To Enhance Practice), focuses on intentional programming of HEPA in each ASPs' daily schedule, and includes a grocery store partnership to reduce price barriers to purchasing FV, professional development training to promote physical activity to develop core physical activity competencies, as well as ongoing technical support/assistance. Primary outcome measures include children's accelerometry-derived MVPA and time spend sedentary while attending an ASP, direct observation of staff HEPA promoting and inhibiting behaviors, types of snacks served, and child consumption of snacks, as well as, cost of snacks via receipts and detailed accounting of intervention delivery costs to estimate cost-effectiveness.
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