Student receptivity to new school meal offerings: assessing fruit and vegetable waste among middle school students in the Los Angeles Unified School District

A Systematic Review of Economic Evaluations of Health-Promoting Food Retail-Based Interventions

BACKGROUND

While the number of retail interventions with impacts on diet- and/or health-related outcomes is increasing, the economic evaluation literature is limited. This review investigated (i) the cost-effectiveness of health-promoting food retail interventions and (ii) key assumptions adopted in these evaluations.

METHODS

A systematic review of published academic studies was undertaken (CRD42020153763). Fourteen databases were searched. Eligible studies were identified, analysed, and reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines.

RESULTS

Eight studies that evaluated 30 retail interventions were included in the review. Common outcomes reported were cost per healthy food item purchased/served or cost per disability-adjusted life year (DALY) averted. Four studies undertook cost-utility analyses and half of these studies concluded that retail interventions were cost-effective in improving health outcomes. Most studies did not state any assumptions regarding compensatory behaviour (i.e., purchases/consumption of non-intervention foods or food purchases/consumption from non-intervention settings) and presumed that sales data were indicative of consumption.

CONCLUSION

The cost-effectiveness of retail-based health-promoting interventions is inconclusive. Future health-promoting retail interventions should regularly include an economic evaluation which addresses key assumptions related to compensatory behaviour and the use of sales data as a proxy for consumption.

Acceptability and Feasibility of Best Practice School Lunches by Elementary School-Aged Children in a Serve Setting: A Randomized Crossover Trial

Background: National School Lunch Program (NSLP) standards have improved school lunch dietary quality (DQ), however, further improvements could be made. Acceptability and feasibility of higher DQ are potential barriers. Thus, the purpose is to compare acceptability and feasibility of best practice (BPSL, optimizing DQ) with typical school lunches (TSL, meeting minimum NSLP standards) served separately and concurrently. Methods: Forty elementary school-aged participants were recruited for a randomized crossover trial. Participants attended three meal conditions (MC) choosing one of two meal types—MC1) BPSL1/BPSL2, MC2) TSL1/TSL2, MC3) BPSL/TSL. Acceptability included taste test surveys, weighted plate waste assessments, and hunger scales. Feasibility included meal cost, time, and skill and equipment requirements. Results: There were no significant differences in total taste test score, average total plate waste, or change in hunger (ps > 0.017) before or after adjusting for covariates. TSL was selected significantly more often in MC3 (TSL = 83.3%, BPSL = 16.7%, p = 0.001). Meal cost (p = 0.783) and skill and equipment requirements were not significantly different between meal types. BPSL required significantly longer preparation time (TSL = 60 ± 25 min, BPSL = 267 ± 101 min, p = 0.026). Conclusions: Results indicate few differences in acceptability and feasibility between BPSL and TSL. This study could inform decision and policy-makers seeking to improve school lunch DQ and acceptance of higher DQ meals.

Investing in Public School Kitchens and Equipment as a Pathway to Healthy Eating and Equitable Access to Healthy Food

BACKGROUND

We gathered baseline data about student need of healthy, free school food, and if current school meal programming serves students in need of healthy free school food, in anticipation of the completion of a district-wide kitchen infrastructure and educational farm project in a high-poverty urban school district.

METHODS

We used mixed methods to assess student hunger, whether the school meal program met student needs, and to determine associations between presence of a cooking kitchen and perceptions of healthy food. Participants included 72 staff, 143 parents, and 6437 K-5 students in the qualitative component, and 9078 parents and 1693 staff in the quantitative component.

RESULTS

Staff participants stated packaging and reheating food influenced student consumption. During observations, students at seven of nine high poverty sites with packaged reheated food did not eat school meals, but this was not true at four out of four high-poverty sites with unpackaged fresh food. Parents (OR = 1.17, 95% CI 1.00-1.39) and staff (OR = 1.58, 95% CI 1.15-2.17) from schools with a cooking kitchen were more likely to perceive school lunch as healthy in adjusted models.

CONCLUSIONS

Food preparation and presentation appears to influence student consumption of school food and adult perception of school meal quality.

Impact of a Pilot School-Based Nutrition Intervention on Fruit and Vegetable Waste at School Lunches

OBJECTIVE

To determine the preliminary impact of the Brighter Bites nutrition intervention on decreasing fruit and vegetable (F&V) waste at school lunches among fourth- and fifth-grade children.

METHOD

This was a nonrandomized pre-post-controlled study in Houston and Dallas, TX. Two schools received the Brighter Bites intervention (n = 76), and 1 comparison school (n = 39), during the 2017-2018 school year. Brighter Bites is a 16-week school-based nutrition intervention providing weekly distribution of fresh F&V plus nutrition education. Main outcome measures were direct observation and weights to measure the number of F&V dishes selected at school lunches, amount of F&V wasted (gm), and related nutrient waste (4 time points/child). Mixed-effects linear regression analysis was used to determine change in F&V selection and waste over time.

RESULTS

There was a significant decrease over time in proportion of F&V selected among those in the comparison school, but not the intervention schools (P < .001). Compared with children in the comparison group, those receiving Brighter Bites showed a significant decrease in the amount of F&V wasted at each meal (P < .001) and per item (P < .05) at the end of both 8 and 16 weeks of intervention. There were significant decreases in waste of energy (kcal); dietary fiber (gm); vitamins B₁, B₃, and B₆ (mg); total folate (µg); and B₁₂ (µg) among those receiving Brighter Bites (P < .05).

CONCLUSIONS AND IMPLICATIONS

Although absolute food or nutrient changes were small even when significant, programs such as Brighter Bites may contribute to a healthy intake. Future studies are warranted that include a larger sample size with a stringent, cluster-randomized control trial design and consideration for other covariates.

Impact of Breakfast in the Classroom on Participation and Food Waste

OBJECTIVE

To investigate differences in school breakfast participation and food waste in 1 school district before and after the adoption of Breakfast in the Classroom.

METHODS

Using a pretest-posttest design, participation and food waste were measured from 7 elementary schools in a rural area of southwest Virginia during the 2014-2015 school year. Participation and waste were measured on 4 days in each school (twice before and twice after Breakfast in the Classroom implementation) using the quarter-waste method.

RESULTS

Across all schools, food waste decreased from 43.0% to 38.5% with Breakfast in the Classroom, with significant decreases for entrée items, juice, and savory snack foods (P < .01). Fruit and cheese items generated the greatest amount of food waste at 58.2% and 49.0%, respectively.

CONCLUSIONS AND IMPLICATIONS

Breakfast in the Classroom may be an effective tool to decrease food waste while improving dietary intake. Future research is needed among more diverse populations.

Getting shops to voluntarily stop selling cheap, strong beers and ciders: a time-series analysis evaluating impacts on alcohol availability and purchasing

BACKGROUND

'Reducing the Strength' (RtS) is a public health initiative encouraging retailers to voluntarily stop selling cheap, strong beers/ciders (≥6.5% alcohol by volume). This study evaluates the impact of RtS initiatives on alcohol availability and purchasing in three English counties with a combined population of 3.62 million people.

METHODS

We used a multiple baseline time-series design to examine retail data over 29 months from a supermarket chain that experienced a two-wave, area-based role out of RtS: initially 54 stores (W1), then another 77 stores (W2). We measured impacts on units of alcohol sold (primary outcome: beers/ciders; secondary outcome: all alcoholic products), economic impacts on alcohol sales and substitution effects.

RESULTS

We observed a non-significant W1 increase (+3.7%, 95% CI: -11.2, 21.0) and W2 decrease (-6.8%, 95% CI: -20.5, 9.4) in the primary outcome. We observed a significant W2 decrease in units sold across all alcohol products (-10.5%, 95% CI: -19.2, -0.9). The direction of effect between waves was inconsistent for all outcomes, including alcohol sales, with no evidence of substitution effects.

CONCLUSIONS

In the UK, voluntary RtS initiatives appear to have little or no impact on reducing alcohol availability and purchase from the broader population of supermarket customers.

Effects of a Behavioral Economics Intervention on Food Choice and Food Consumption in Middle-School and High-School Cafeterias

Introduction

Changing food choice architecture in school cafeterias through behavioral economics may increase student selection and consumption of healthy foods. However, most research assesses the effects of short-term interventions. We evaluated a year-long choice architecture intervention implemented by school food service staff.

Methods

Food service staff from 6 secondary schools in one school district received training and support to implement behavioral economics strategies in their cafeterias to promote student selection of fruit, vegetables, and low-fat white milk. We compared student selection and consumption of these foods in the intervention schools to 5 comparison schools in the same district on the basis of visual assessment of plate waste. We applied a difference-in-differences approach to estimate intervention effect.

Results

Data for 902 students were assessed at baseline, and data for 1,407 were assessed at follow-up. In fully adjusted analyses for all students, there were significantly greater absolute increases in the proportions of intervention school students selecting any fruit, including (0.09) and excluding (0.16) juice, and students selected more fruit items including (0.21) and excluding (0.17) juice. The absolute increase in proportion of intervention students consuming fruit excluding juice (0.14) was significantly greater. However, in some analyses, fewer intervention students who selected fruits or vegetables ate them, or they ate fewer of them. There were no intervention effects for vegetables or low-fat white milk.

Conclusion

Our results indicate that behavioral economics–based choice architecture can promote student selection of healthy foods, but they raise questions about whether it increases their consumption.

Alimentação Escolar no Brasil e Estados Unidos: uma revisão integrativa

Resumo Trata-se de uma revisão integrativa da literatura que teve como objetivo identificar os fatores que influenciam a adesão e a aceitação da alimentação escolar entre estudantes brasileiros e americanos, e apontar as principais diferenças entre os programas desses dois países. A busca dos trabalhos científicos foi realizada nas bases de dados da Literatura Latino-Americana e do Caribe em Ciências da Saúde (Lilacs), Pubmed, Scientific Eletronic Library Online (SciELO) e Science Direct. Os dados foram coletados no período de julho a agosto de 2015, utilizando os seguintes descritores em português e inglês: “adesão à alimentação escolar” (adherence of school feeding), “aceitação à alimentação escolar” (accepting of school feeding), “Programa Nacional de Alimentação Escolar” e “National School Lunch Program”. A busca resultou em 07 artigos brasileiros e 07 artigos americanos, publicados entre os períodos de 2004 a 2014, além das legislações vigentes de cada programa, selecionadas nos sites eletrônicos dos órgãos responsáveis pelo gerenciamento dos mesmos. Após análise descritiva e comparativa, os resultados demonstraram que a adesão e a aceitação foram baixas em ambos os programas, e que são influenciadas por fatores socioeconômicos, alimentos competitivos presentes no ambiente escolar e pelas preferências alimentares dos alunos.

School Lunch Consumption Among 3 Food Service Providers in New Orleans

BACKGROUND

Louisiana has one of the highest rates of overweight and obese children in the United States. The Healthy School Food Collaborative (HSFC) was created to allow New Orleans's schools to select their own healthy school Food Service Provider (FSP) with requirements for higher nutritional standards than traditional options. The goal of this cross-sectional study was to examine whether HSFC membership was associated with lunch consumption rates in elementary school children.

METHODS

An 8-week plate waste study examining 18,070 trays of food among fourth and fifth graders was conducted. Participants included 7 schools and the 3 FSPs (2 HSFC and 1 non-HSFC member) that serviced them. Mixed models analysis examined whether consumption rates of food items differed among FSPs.

RESULTS

On average, students consumed 307 cal during lunch. Analyses showed significant differences in consumption rates of entrée, vegetables, fruit, and milk between the 3 FSPs (p < .01). The highest consumption rate was among entrées at 65%. One HSFC provider had consumption levels consistent with the non-HSFC FSP.

CONCLUSIONS

Overall, students consumed less than 60% of the US Department of Agriculture recommended calories for school lunch. While overall caloric consumption was higher among the non-HSFC schools, interventions to increase lunch consumption across all schools are needed.

Food Waste in the National School Lunch Program 1978-2015: A Systematic Review

BACKGROUND

Food waste studies have been used for more than 40 years to assess nutrient intake, dietary quality, menu performance, food acceptability, cost, and effectiveness of nutrition education in the National School Lunch Program (NSLP).

OBJECTIVE

Describe methods used to measure food waste and respective results in the NSLP across time.

METHODS

A systematic review using PubMed, Science Direct, Informaworld, and Institute of Scientific Information Web of Knowledge was conducted using the following search terms: waste, school lunch, plate waste, food waste, kitchen, half method, quarter method, weight, and photography. Studies published through June 2015 were included. The systematic review followed preferred reporting items for systematic reviews and meta-analyses recommendations.

RESULTS

The final review included 53 articles. Food waste methodologies included in-person visual estimation (n=11), digital photography (n=11), direct weighing (n=23), and a combination of in-person visual estimation, digital photography, and/or direct weighing (n=8). A majority of studies used a pre-post intervention or cross-sectional design. Fruits and vegetables were the most researched dietary component on the lunch tray and yielded the greatest amount of waste across studies.

CONCLUSIONS

Food waste is commonly assessed in the NSLP, but the methods are diverse and reporting metrics are variable. Future research should focus on establishing more uniform metrics to measure and report on food waste in the NSLP. Consistent food waste measurement methods will allow for better comparisons between studies. Such measures may facilitate better decision making about NSLP practices, programs, and policies that influence student consumption patterns across settings and interventions.

Factors Associated with School Lunch Consumption: Reverse Recess and School "Brunch"

BACKGROUND

While school foods have become healthier under the Healthy, Hunger Free Kids Act, research suggests there is still substantial food waste in cafeterias. It is therefore necessary to study factors that can impact food consumption, including holding recess before lunch ("reverse recess") and starting lunch periods very early or very late.

OBJECTIVE

This study examined the association between the timing of recess (pre-lunch vs post-lunch recess), the timing of the lunch period, and food consumed by students at lunch.

DESIGN

We conducted a secondary data analysis from a repeated cross-sectional design.

PARTICIPANTS/SETTING

An 8-week plate waste study examining 20,183 trays of food was conducted in New Orleans, LA, in 2014. The study involved 1,036 fourth- and fifth-grade students from eight public schools.

MAIN OUTCOME MEASURES

We measured percent of entrées, fruit, vegetables, and milk consumed by students at lunch.

STATISTICAL ANALYSES PERFORMED

We used mixed-model analyses, controlling for student sex, grade, and the timing of the lunch period, and examined the association between reverse recess and student lunch consumption. Mixed-model analyses controlling for student sex, grade, and recess status examined whether the timing of the lunch period was associated with student lunch consumption.

RESULTS

On average, students with reverse recess consumed 5.1% more of their fruit than students with post-lunch recess (P=0.009), but there were no significant differences in entrées, vegetables, or milk intake. Compared to students with "midday" lunch periods, on average students with "early" lunch periods consumed 5.8% less of their entrées (P<0.001) and 4.5% less of their milk (P=0.047). Students with "late" lunch periods consumed 13.8% less of their entrées (P<0.001) and 15.9% less of their fruit (P<0.001).

CONCLUSIONS

Reverse recess was associated with increased fruit consumption. "Early" lunch periods were associated with decreased entrée and milk consumption, and "late" lunch periods were associated with decreased entrée and fruit consumption. Additional research is recommended to determine whether these associations are causal.

Patterns in Vegetable Consumption: Implications for Tailored School Meal Interventions

BACKGROUND

Vegetable consumption is a challenging behavioral target; consumption rates are below recommended levels and when interventions produce improvements, increases in vegetable consumption are typically a fraction of the change in fruit consumption. We describe vegetable consumption within Ohio school meals and examine how fruit selection, the more popular item, impacts vegetable consumption.

METHODS

Fruit and vegetable waste was collected on 11,250 trays from 17 elementary and 16 middle/high schools, using the quarter-waste visualization method.

RESULTS

One in 4 students ate at least a one-fourth of a cup of vegetables with their school lunch. Consumption was the highest (30.8%) in elementary school buildings with a majority of regular priced meals. Fruit selection was associated with vegetable consumption (p < .001). Middle/high school students who consumed a fruit were 88% more likely to consume a vegetable as oppose to waste it (95% CI: 1.45-2.42). Fruit selection was also associated with not selecting a vegetable, but the association was of a lower magnitude (odds ratio 1.32; 95% CI: 1.06-1.64). Trends were similar in elementary schools.

CONCLUSIONS

Fruit and vegetable consumption should be approached as 2 distinct behaviors with particular attention given to vegetables. Fruit items can be leveraged, though, as a means to encourage vegetable selection.

Trends in Nutrient Content of Children's Menu Items in U.S. Chain Restaurants

INTRODUCTION

Restaurant food is widely consumed by children and is associated with poor diet quality. Although many restaurants have made voluntary commitments to improve the nutritional quality of children's menus, it is unclear whether this has led to meaningful changes.

METHODS

Nutrients in children's menu items (n=4,016) from 45 chain restaurants were extracted from the nutrition information database MenuStat. Bootstrapped mixed linear models estimated changes in mean calories, saturated fat, and sodium in children's menu items between 2012 and 2013, 2014, and 2015. Changes in nutrient content of these items over time were compared among restaurants participating in the Kids LiveWell initiative and non-participating restaurants. Types of available children's beverages were also examined. Data were analyzed in 2016.

RESULTS

There was a significant increase in mean beverage calories from 2012 to 2013 (6, 95% CI=0.8, 10.6) and from 2012 to 2014 (11, 95% CI=3.7, 18.3), but no change between 2012 and 2015, and no differences in nutrient content of other items over time. Restaurants participating in Kids LiveWell reduced entrée calories between 2012 and 2013 (-24, 95% CI= -40.4, -7.2) and between 2012 and 2014 (-40, 95% CI= -68.1, -11.4) and increased side dish calories between 2012 and 2015 (49, 95% CI=4.6, 92.7) versus non-participating restaurants. Sugar-sweetened beverages consistently constituted 80% of children's beverages, with soda declining and flavored milks increasing between 2012 and 2015.

CONCLUSIONS

Results suggest little progress toward improving nutrition in children's menu items. Efforts are needed to engage restaurants in offering healthful children's meals.

Food waste generation and potential interventions at Rhodes University, South Africa

Estimation of food waste generation represents the first step when considering efforts to reduce waste generation and monitor food waste reduction against set targets. This study reports on an estimation of food waste generated in university dining halls at Rhodes University, South Africa. Daily food waste generation was estimated at about 555g per student or 2tonnes across all sample dining halls, translating to about 450tonnes per year. The results show that food waste is influenced by an array of contextual factors, including distance to dining hall, gender composition of hall and meal times and meal options. It is estimated that the university could save up to US$ 80000 annually for every 10% reduction in the current rate of food waste generation. Possible educational, technical and administrative interventions for food waste reduction are discussed.

The School Food Environment and Obesity Prevention: Progress Over the Last Decade

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.

Food-related Beliefs of Adolescent Girls Ages 9-13 and Their Mothers on O'ahu, Hawai'i

A number of factors contribute to the development of obesity in adolescents, including various dietary and lifestyle behaviors, and a host of social and environmental factors, such as socioeconomic status, parental education, and culture. Research examining beliefs about behaviors related to weight status in adolescents, such as food intake, can create a better understanding of risk factors for obesity. This study explored beliefs about behaviors related to weight status in 20 early adolescent girls aged 9 to 13 years and their mothers in O'ahu, Hawai'i. Semi-structured individual interviews were conducted to elucidate beliefs through discussion of food purchasing, feeding practices, portion control strategies, eating outside the home, and body size perception. Interviews were transcribed verbatim and examined using directed content analysis. Both mothers and daughters believed that diets should consist of fresh foods and be based on principles of variety, balance, and moderation, and had negative perceptions of school lunch. In describing ideal body size, mothers expressed greater concern for overweight, as well as ethno-cultural beauty standards, than daughters. Mothers believed daughters should have a positive relationship with food but also applied various portion control strategies with them. Findings reveal how mothers' and daughters' beliefs may influence daily food-related practices in adolescent girls. Future studies may seek to investigate the role these factors may play in determining weight status in adolescents in Hawai'i, with findings to be used to inform health promotion programs.

Simple interventions to improve healthy eating behaviors in the school cafeteria

The National School Lunch Program in the United States provides an important opportunity to improve nutrition for the 30 million children who participate every school day. The purpose of this narrative review is to present and evaluate simple, evidence-based strategies to improve healthy eating behaviors at school. Healthy eating behaviors are defined as increased selection/consumption of fruits and/or vegetables, increased selection of nutrient-dense foods, or decreased selection of low-nutrient, energy-dense foods. Data were collected from sales records, 24-hour food recalls, direct observation, and estimation of plate waste. The review is limited to simple, discrete interventions that are easy to implement. Sixteen original, peer-reviewed articles are included. Interventions are divided into 5 categories: modification of choice, behavior modification, marketing strategies, time-efficiency strategies, and fruit slicing. All interventions resulted in improved eating behaviors, but not all interventions are applicable or feasible in all settings. Because these studies were performed prior to the implementation of the new federally mandated school meal standards, it is unknown if these interventions would yield similar results if repeated now.

Evaluación de menús ofertados em comedores escolares: comparación entre colegios públicos, privados y concertados

RESUMEN Objetivo: Evaluar los menús ofertados en los colegios públicos, privados y concertados de la ciudad de Sevilla (España) para los diferentes grupos de edad escolar. Métodos: Se consideró un total de 86 colegios, incluyendo centros públicos, privados y concertados, representando a todos los distritos de la ciudad. Cuatro colegios disponían de cocina propia, mientras el resto tenían contratado un catering. Los menús iban dirigidos a escolares de entre 3 a 16 años. Se evaluó el grado de cumplimiento de las recomendaciones respecto a la frecuencia mensual de los distintos grupos de alimentos, repetición de recetas, variabilidad de técnicas culinarias y equilibrio nutricional. Para el tratamiento estadístico se utilizó el programa Statistica 7. Resultados: En la mayoría de comedores escolares la oferta de frutas, verduras y legumbres era deficitaria a diferencia de los postres lácteos, carnes y patatas. Se observaron diferencias significativas entre los tres tipos de colegio respecto a la frecuencia mensual de alimentos, siendo los públicos los que más se ajustaban a las recomendaciones. La mayoría de los comedores evaluados no aportaban menús suficientemente detallados así como se observó falta de variedad de técnicas culinarias. La energía no se ajustaba a las necesidades de todos los grupos de edad y la distribución de macronutrientes sólo era adecuada en el 50% de los menús. Conclusión: Aunque se ha observado una evolución favorable de los menús respecto a estudios anteriores hay que seguir trabajando en aumentar la oferta de frutas y verduras, disminuir el aporte de lípidos y proteínas, así como adaptar la energía de los menús a los diferentes grupos de edad.

Removing Potatoes from Children's Diets May Compromise Potassium Intake

White potatoes are a forgotten source of nutrients. The goal of this study was to identify the nutritional implications of replacing a composite of white potatoes with a composite of vegetables commonly consumed by children aged 2-18 y (n = 3460) in a nationally representative sample. The NHANES 2005-2012 24-h dietary recall data were used to determine nutrient intake. Two replacement models were developed: one for potato consumers and another for those consuming vegetables other than potatoes. Analyses focused on 1) mean nutrient contributions per 1 cup equivalent vegetable composite (VC)/potato composite (PC) consumed by participants, and 2) mean daily nutrient intake when the nutrients per 1 cup equivalent PC replaced the nutrients per 1 cup equivalent VC. Covariate adjusted analysis was tested for statistical significance (P < 0.002). When 1 cup equivalent VC replaced 1 cup equivalent PC, significantly lower mean intakes were found for 20 of the 23 nutrients studied and higher mean intakes of total sugars, folate, and calcium. Differences were found including higher total intakes of monounsaturated fatty acids and potassium and lower total intakes of vitamins A and K. The percentage contribution of the PC to total daily nutrient intake was 6% for total energy, 8% for total fat, 5% for saturated fatty acids, 13% for dietary fiber, 4% for sodium, and 11% for potassium. Both composites contributed a variety of nutrients to the total diet; the consumption of white potatoes may be an important strategy to help meet the potassium recommendation.

Dissemination, Implementation, and Improvement Science Research in Population Health: Opportunities for Public Health and CTSAs

IMPORTANCE

The complex, dynamic nature of health systems requires dissemination, implementation, and improvement (DII) sciences to effectively translate emerging knowledge into practice. Although they hold great promise for informing multisector policies and system-level changes, these methods are often not strategically used by public health.

OBJECTIVES AND METHODS

More than 120 stakeholders from Southern California, including the community, federal and local government, university, and health services were convened to identify key priorities and opportunities for public health departments and Clinical and Translational Science Awards programs (CTSAs) to advance DII sciences in population health.

MAIN OUTCOMES

Participants identified challenges (mismatch of practice realities with narrowly focused research questions; lack of iterative learning) and solutions (using methods that fit the dynamic nature of the real world; aligning theories of change across sectors) for applying DII science research to public health problems. Pragmatic steps that public health and CTSAs can take to facilitate DII science research include: employing appropriate study designs; training scientists and practicing professionals in these methods; securing resources to advance this work; and supporting team science to solve complex-systems issues.

CONCLUSIONS

Public health and CTSAs represent a unique model of practice for advancing DII research in population health. The partnership can inform policy and program development in local communities.

Communities putting prevention to work: local evaluation of community-based strategies designed to make healthy living easier

This introduction is an overview of the articles presented in this supplement that describe implementation and evaluation activities conducted as part of the Centers for Disease Control and Prevention's (CDC's) Communities Putting Prevention to Work (CPPW) initiative. CPPW was one of the largest federal investments ever to combat chronic diseases in the United States. CPPW supported high-impact, jurisdiction-wide policy, systems, and environmental changes to improve health by increasing access to physical activity and healthy foods, and by decreasing tobacco use and exposure to secondhand smoke. The articles included in this supplement describe implementation and evaluation efforts of strategies implemented as part of CPPW by local awardees. This supplement is intended to guide the evidence base for public health interventions on the basis of jurisdiction-wide policy and environmental-level improvements and to encourage rigorous evaluation of the public health interventions.