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Carducci B, Dominguez G, Kidd E, Oh C, Jain R, Khan A, Bhutta ZA. Promoting healthy school food environments and nutrition in Canada: a systematic review of interventions, policies, and programs. Nutr Rev 2024:nuae030. [PMID: 38767979 DOI: 10.1093/nutrit/nuae030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2024] Open
Abstract
CONTEXT The school food environment is a critical interface for child and adolescent nutrition, and there is a need to understand existing literature on Canadian school food environments to identify equity gaps and opportunities, and empower decision-makers to plan for future action. OBJECTIVE Literature on Canadian school food and nutrition interventions, policies, programs, and their effects on diets and nutritional status are synthesized and appraised in this systematic review. DATA SOURCES A search strategy was developed for each database used (Medline, Embase, PsycINFO, ERIC, Cochrane Collaboration, Canadian Electronic Library, BiblioMap), with a combination of free text and controlled vocabulary, for articles published from 1990 to 2021. Unpublished data and grey literature were also searched. DATA EXTRACTION Quantitative and qualitative studies with an observational or intervention study design, reviews, or program evaluations conducted in Canadian schools with participants aged 5-19.9 years were included. Key study characteristics and risk of bias were extracted independently by 2 investigators using a standardized tool. DATA ANALYSIS A total of 298 articles were included (n = 192 peer reviewed and 106 from the grey literature), which were mostly conducted in Ontario (n = 52), British Columbia (n = 43), and Nova Scotia (n = 28). Twenty-four interventions, 5 nonevaluated programs, and 1 policy involved Indigenous populations. Overall, 86 articles measured and reported on effectiveness outcomes, including dietary intake; anthropometry; knowledge, attitudes, and practices; and physical activity. The literature remains largely heterogenous and primarily focused on nutrition education programs that use subjective assessments to infer changes in nutrition. A key facilitator to implementation and sustainability was community engagement, whereas key barriers were staff capacity, access to resources and funding, and consistent leadership. CONCLUSIONS This review provides insight into Canadian school food and nutrition interventions, programs, and policies and uncovers important evidence gaps that require careful examination for future evaluations. Governments must create supportive environments that optimize nutrition for children and adolescents through equitable policies and programs. SYSTEMATIC REVIEW REGISTRATION PROSPERO registration no. CRD42022303255.
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Affiliation(s)
- Bianca Carducci
- Centre for Global Child Health, Hospital for Sick Children, Peter Gilgan Centre for Research, and Learning, Toronto, ON, Canada
- Department of Nutritional Sciences, University of Toronto, Faculty of Medicine, University of Toronto, Medical Sciences Building, Toronto, ON, Canada
| | - Georgia Dominguez
- Centre for Global Child Health, Hospital for Sick Children, Peter Gilgan Centre for Research, and Learning, Toronto, ON, Canada
| | - Emily Kidd
- Centre for Global Child Health, Hospital for Sick Children, Peter Gilgan Centre for Research, and Learning, Toronto, ON, Canada
| | - Christina Oh
- Western University, Schulich School of Medicine and Dentistry, London, ON, Canada
| | - Reena Jain
- Centre for Global Child Health, Hospital for Sick Children, Peter Gilgan Centre for Research, and Learning, Toronto, ON, Canada
| | - Amira Khan
- Centre for Global Child Health, Hospital for Sick Children, Peter Gilgan Centre for Research, and Learning, Toronto, ON, Canada
- Department of Nutritional Sciences, University of Toronto, Faculty of Medicine, University of Toronto, Medical Sciences Building, Toronto, ON, Canada
| | - Zulfiqar A Bhutta
- Centre for Global Child Health, Hospital for Sick Children, Peter Gilgan Centre for Research, and Learning, Toronto, ON, Canada
- Department of Nutritional Sciences, University of Toronto, Faculty of Medicine, University of Toronto, Medical Sciences Building, Toronto, ON, Canada
- Centre of Excellence in Women, and Child Health, Aga Khan University, Karachi, Pakistan
- Dalla Lana School of Public, Health University of Toronto Health Sciences Building, Toronto, ON, Canada
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Banerjee AT, Islam S, Khan A, Hussain N, Ascencio E, Hafleen N. Beyond the Body: Using Photovoice to Explore Social Determinants of Diabetes With South Asian Adolescents in the Peel Region of Ontario, Canada. Can J Diabetes 2024; 48:97-104.e3. [PMID: 37952645 DOI: 10.1016/j.jcjd.2023.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 10/11/2023] [Accepted: 11/03/2023] [Indexed: 11/14/2023]
Abstract
OBJECTIVES The higher prevalence of diabetes in the South Asian (SA) population living in Canada spans across generations and is often associated with individual risk factors while undermining the social determinants of health (SDOH). There is a scarcity of studies on the perspectives of SA adolescents with a family history of type 2 diabetes mellitus (T2DM). Learning directly from these adolescents can fill a major gap by providing insight on how the SDOH contribute to disproportionate rates of T2DM in SA immigrant communities. METHODS In this study, we used Photovoice, which is a community-based participatory research (CBPR) method that involves the use of photography to visually capture the challenges of diabetes prevention from the perspective of those with lived experiences. A group of 15 SA youth were recruited from an adolescent diabetes education program in the Peel Region of Ontario. The youth discussed their images and accompanied written narratives during focus groups. RESULTS Four themes emerged from the thematic analysis of the photographs and participant narratives that influence the manifestation of T2DM in SA communities: 1) immigration and resettlement stressors; 2) food insecurity; 3) unhealthy school environments; and 4) academic pressures. CONCLUSIONS Findings suggest the need to address T2DM as a response to unjust conditions and environments rather than as an epidemic entrenched in genetic predisposition, culture, and poor lifestyle choices.
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Affiliation(s)
- Ananya Tina Banerjee
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montréal, Québec, Canada.
| | - Shudipta Islam
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Amina Khan
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Nousin Hussain
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Evelyn Ascencio
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Nuzha Hafleen
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Vaillancourt C, Ahmed M, Kirk S, Labonté MÈ, Laar A, Mah CL, Minaker L, Olstad DL, Potvin Kent M, Provencher V, Prowse R, Raine KD, Schram A, Zavala-Mora D, Rancourt-Bouchard M, Vanderlee L. Food environment research in Canada: a rapid review of methodologies and measures deployed between 2010 and 2021. Int J Behav Nutr Phys Act 2024; 21:18. [PMID: 38373957 PMCID: PMC10875887 DOI: 10.1186/s12966-024-01558-x] [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: 01/24/2023] [Accepted: 01/03/2024] [Indexed: 02/21/2024] Open
Abstract
Numerous research methodologies have been used to examine food environments. Existing reviews synthesizing food environment measures have examined a limited number of domains or settings and none have specifically targeted Canada. This rapid review aimed to 1) map research methodologies and measures that have been used to assess food environments; 2) examine what food environment dimensions and equity related-factors have been assessed; and 3) identify research gaps and priorities to guide future research. A systematic search of primary articles evaluating the Canadian food environment in a real-world setting was conducted. Publications in English or French published in peer-reviewed journals between January 1 2010 and June 17 2021 and indexed in Web of Science, CAB Abstracts and Ovid MEDLINE were considered. The search strategy adapted an internationally-adopted food environment monitoring framework covering 7 domains (Food Marketing; Labelling; Prices; Provision; Composition; Retail; and Trade and Investment). The final sample included 220 articles. Overall, Trade and Investment (1%, n = 2), Labelling (7%, n = 15) and, to a lesser extent, Prices (14%, n = 30) were the least studied domains in Canada. Among Provision articles, healthcare (2%, n = 1) settings were underrepresented compared to school (67%, n = 28) and recreation and sport (24%, n = 10) settings, as was the food service industry (14%, n = 6) compared to grocery stores (86%, n = 36) in the Composition domain. The study identified a vast selection of measures employed in Canada overall and within single domains. Equity-related factors were only examined in half of articles (n = 108), mostly related to Retail (n = 81). A number of gaps remain that prevent a holistic and systems-level analysis of food environments in Canada. As Canada continues to implement policies to improve the quality of food environments in order to improve dietary patterns, targeted research to address identified gaps and harmonize methods across studies will help evaluate policy impact over time.
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Affiliation(s)
- Caroline Vaillancourt
- École de Nutrition, Centre de Nutrition, Santé et Société (NUTRISS), Université Laval, 2425 Rue de L'Agriculture, Québec, QC, G1V 0A6, Canada
| | - Mavra Ahmed
- Department of Nutritional Sciences, University of Toronto, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada
| | - Sara Kirk
- School of Health and Human Performance, Dalhousie University, 6230 South Street, Kjipuktuk (Halifax), NS, B3H 4R2, Canada
| | - Marie-Ève Labonté
- École de Nutrition, Centre de Nutrition, Santé et Société (NUTRISS), Université Laval, 2425 Rue de L'Agriculture, Québec, QC, G1V 0A6, Canada
| | - Amos Laar
- Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana, P. O. Box LG 13, Legon, Accra, Ghana
| | - Catherine L Mah
- School of Health Administration, Dalhousie University, 5850 College Street, Halifax, NS, B3H 4R2, Canada
| | - Leia Minaker
- School of Planning, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3T1, Canada
| | - Dana Lee Olstad
- Department of Community Health Sciences, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada
| | - Monique Potvin Kent
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON, K1G 5Z3, Canada
| | - Véronique Provencher
- École de Nutrition, Centre de Nutrition, Santé et Société (NUTRISS), Université Laval, 2425 Rue de L'Agriculture, Québec, QC, G1V 0A6, Canada
| | - Rachel Prowse
- Division of Community Health and Humanities, Faculty of Medicine, Memorial University of Newfoundland, 300 Prince Philip Drive, St. John's, NL, A1B 3V6, Canada
| | - Kim D Raine
- School of Public Health, University of Alberta, 11405 87 Ave Northwest, Edmonton, AB, T6G 1C9, Canada
| | - Ashley Schram
- School of Regulation and Global Governance (RegNet), ANU College of Asia & the Pacific, The Australian National University, 8 Fellows Road, Canberra, Australian Capital Territory, 2600, Australia
| | - Daniela Zavala-Mora
- Science Library, Université Laval, 1045 Avenue de La Médecine, Québec, QC, G1V 0A6, Canada
| | - Maryka Rancourt-Bouchard
- École de Nutrition, Centre de Nutrition, Santé et Société (NUTRISS), Université Laval, 2425 Rue de L'Agriculture, Québec, QC, G1V 0A6, Canada
| | - Lana Vanderlee
- École de Nutrition, Centre de Nutrition, Santé et Société (NUTRISS), Université Laval, 2425 Rue de L'Agriculture, Québec, QC, G1V 0A6, Canada.
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Bird M, Barnett TA, Fuller D, Chinerman D, Mathieu MÈ, Datta GD. Multidimensional school features associated with physical activity among youth at risk of obesity: an exploratory principal component and generalized estimating equation analysis. BMC Public Health 2023; 23:2010. [PMID: 37845705 PMCID: PMC10577956 DOI: 10.1186/s12889-023-16889-w] [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: 02/11/2021] [Accepted: 03/24/2022] [Indexed: 10/18/2023] Open
Abstract
BACKGROUND Schools may be high-leverage points for the promotion of physical activity (PA), yet little is known about school built and social environments among youth at high risk of obesity. PURPOSE To characterise school built and social environments that may be salient for PA and to examine associations between school PA environments and PA in youth at risk of obesity. METHODS Data from youth attending 206 schools (314 youth in 2005-2008, and 129 youth in 2008-2010) within the QUALITY cohort study, a longitudinal investigation of youth at high risk of obesity were used. Features of schools, based on built, policy/programming and social environments were identified using principal components (PC) analysis. Gender-stratified generalized estimating equation (GEE) models were used to explore associations between school features and accelerometer measured mean counts per minute (MCPM), mean daily moderate-to-vigorous physical activity (MVPA) and the odds of meeting MVPA guidelines cross-sectionally and prospectively using 90% confidence intervals. RESULTS Nine PCs were identified. Associations were observed between PA and 7 of the 9 PCs. The social environment seemed to be particularly important. Social Norms to Promote PA was associated with an increase in girls' baseline MCPM and MVPA. High Willingness to Promote PA was associated with boys' MCPM, MVPA, and odds of meeting MVPA guidelines, at both baseline and follow-up. CONCLUSION School built and social contexts may be associated with PA cross-sectionally and over time. Further studies are necessary to confirm the direction and magnitude of effects and to establish their relevance to school-based health promotion efforts.
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Affiliation(s)
- Madeleine Bird
- Public Health Agency of Canada, Office of International Affairs for the Health Portfolio, Ottawa, ON, Canada
| | - Tracie A Barnett
- Department of Family Medicine, McGill University, 5858 Côte-Des-Neiges Rd, Montreal, QC, H3S 1Z1, Canada
| | - Daniel Fuller
- Department of Community Health & Epidemiology, College of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Deanna Chinerman
- Department of Family Medicine, McGill University, 5858 Côte-Des-Neiges Rd, Montreal, QC, H3S 1Z1, Canada
- Department of Kinesiology, CHU Sainte-Justine, University of Montreal, 3175 Chemin de La Côte-Sainte-Catherine, Montréal, QC, H3T 1C5, Canada
| | - Marie-Ève Mathieu
- Department of Kinesiology, CHU Sainte-Justine, University of Montreal, 3175 Chemin de La Côte-Sainte-Catherine, Montréal, QC, H3T 1C5, Canada
- School of Kinesiology and Physical Activity Sciences, Faculty of Medicine, Université de Montréal, Montreal, Canada
| | - Geetanjali D Datta
- Department of Social and Preventive Medicine, School of Public Health, University of Montreal, 7101 Avenue du Parc, 3E Étage, Montréal, QC, H3N 1X9, Canada.
- Department of Medicine, Cedars-Sinai Medical Center, PDC Green, 700 N San Vicente Blvd5Th Fl, West Hollywood, CA, 90069, USA.
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Gardone DS, Novaes JF, de Albuquerque FM, Filgueiras MDS, Novaes TG, Mendes LL, Pessoa MC. Community food environment and childhood obesity in a medium-sized Brazilian city: An approach to school and neighborhood environments. Am J Hum Biol 2023; 35:e23935. [PMID: 37318148 DOI: 10.1002/ajhb.23935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 04/12/2023] [Accepted: 05/28/2023] [Indexed: 06/16/2023] Open
Abstract
OBJECTIVE We aimed to analyze the relationship of community food environments with childhood obesity in a medium-sized Brazilian city. METHODS This is a cross-sectional study with 366 schoolchildren aged 8 and 9 years. Children's body mass index (BMI), waist circumference and concentrations of total cholesterol (TC), high cholesterol density lipoprotein (HDL-c), low cholesterol density lipoprotein (LDL-c) and triglycerides (TG) were measured. The parent's nutritional status was assessed by calculating the BMI. All food stores within a 200- and 400-m radius buffers of schools and households were evaluated. The food stores were classified as healthy, unhealthy, and mixed according to the predominance of foods commercialized. Binary logistic regression models were proposed for each category. RESULTS Over seventy percent (70.2%) of the food stores were categorized as "unhealthy". The prevalence of obesity was 15.6%. In the 200-m buffer around schools, there was an inverse and direct association between obesity and the presence of healthy food stores and unhealthy food stores, respectively. Around the households, there was an inverse association between the presence of healthy food stores and obesity in both buffers. CONCLUSION The community food environment may be protective or potentiating childhood obesity, depending on the access and types of food sold.
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Affiliation(s)
- Danielle Soares Gardone
- Departamento de Nutrição, Programa de Pós Graduação em Nutrição e Saúde, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Juliana Farias Novaes
- Departamento de Nutrição e Saúde, Programa de Pós Graduação em Ciência da Nutrição, Universidade Federal de Viçosa (UFV), Viçosa, Brazil
| | - Fernanda Martins de Albuquerque
- Departamento de Nutrição e Saúde, Programa de Pós Graduação em Ciência da Nutrição, Universidade Federal de Viçosa (UFV), Viçosa, Brazil
| | - Mariana De Santis Filgueiras
- Departamento de Nutrição e Saúde, Programa de Pós Graduação em Ciência da Nutrição, Universidade Federal de Viçosa (UFV), Viçosa, Brazil
| | | | - Larissa Loures Mendes
- Departamento de Nutrição, Programa de Pós Graduação em Nutrição e Saúde, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Milene Cristine Pessoa
- Departamento de Nutrição, Programa de Pós Graduação em Nutrição e Saúde, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
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Gell S, Pejkovic E, Heiss R. How (Un-)Healthy are Austrian school food environments? Evidence from focus groups and citizen science. Appetite 2023:106636. [PMID: 37390919 DOI: 10.1016/j.appet.2023.106636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 04/14/2023] [Accepted: 06/14/2023] [Indexed: 07/02/2023]
Abstract
BACKGROUND Adolescents face high-choice school food environments that offer plenty of highly processed foods. Processed food producers target young people in their marketing, but there is limited data on the actual food supply inside and in the vicinity of Austrian schools and its impact on adolescent food choices. This study employs an innovative mixed-methods approach to explore adolescents' food choices. METHODS In Study 1, we conducted a citizen science study, with students as volunteer scientists. The students examined the food supply in and around their schools according to the Austrian food pyramid and categorized 953 food items in 144 food suppliers using photographs and descriptions. In Study 2, we explored students' food preferences in focus groups. We conducted four focus groups at four different schools in Tyrol, with 25 students (11 male, 14 female) between the ages of 12 and 15. We then linked the findings on individual preferences with the documented supply. RESULTS Study 1 found that the food supply in the investigated schools was predominantly categorized as unhealthy. The students categorized 46% as "unhealthy", 32% as "intermediate", and only 22% as "healthy". Study 2 identified three influential factors in students' food choices: 1) individual factors (such as taste and preferences), 2) social factors (such as mingling with peers), and 3) structural factors (such as physical environment and accessibility). CONCLUSION The study shows that unhealthy products cater to unhealthy preferences among adolescents and dominate current school food environments. Policies need to address unhealthy school food environments to address this issue. For instance, food supplies should be presented in an attractive ways, in fun places where students can mingle and express their identities.
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Affiliation(s)
- Sascha Gell
- MCI | The Entrepreneurial School©, Center for Social & Health Innovation Universitätsstraße 15, 6020 Innsbruck, Austria.
| | - Emina Pejkovic
- MCI | The Entrepreneurial School©, Center for Social & Health Innovation Universitätsstraße 15, 6020 Innsbruck, Austria.
| | - Raffael Heiss
- MCI | The Entrepreneurial School©, Center for Social & Health Innovation Universitätsstraße 15, 6020 Innsbruck, Austria.
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de Albuquerque FM, Pessoa MC, Filgueiras MDS, do Carmo AS, Vegi ASF, Ribeiro AQ, de Novaes JF. Obesogenic environment around schools is associated with atherogenic risk in Brazilian children. Am J Hum Biol 2023; 35:e23844. [PMID: 36469550 DOI: 10.1002/ajhb.23844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 11/18/2022] [Accepted: 11/23/2022] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Cardiometabolic risk factors often emerge in childhood, increasing the risk of cardiovascular diseases in adulthood. The school environments represent an important active space in a child's routine and may influence their health status. METHODS In this cross-sectional study, we aimed to evaluate the clustering of cardiometabolic risk factors and its association with the obesogenic and leptogenic environment around schools. A total of 378 children (181 boys; 197 girls) aged 8 and 9 years, enrolled in all urban schools of Viçosa, Minas Gerais, Brazil, were evaluated. Concentrations of high-density lipoprotein-cholesterol (HDL-c) and triglycerides (TG), and the insulin resistance (HOMA-IR), waist circumference (WC), and mean arterial pressure (MAP) were measured. The neighborhood income, walkability index, predominantly ultra-processed food stores, public spaces for leisure and/or physical activities, traffic accidents, crime and green spaces densities were assessed in 400 road network buffers around schools. To test association of the obesogenic and leptogenic environment around schools with cardiometabolic risk clustering, binary logistic regression models were performed with generalized estimating equations. RESULTS "Obesogenic school environments" had greater densities of ultra-processed food stores, crime and traffic accidents, and higher walkability. The "↓ Atherogenic risk" cluster consisted of higher HDL-c values. There was an inverse association between the obesogenic environment around schools and a child's "↓ atherogenic risk" clustering (OR = 0.63; p < 0.001). CONCLUSION We concluded that public policies aimed at modifying the environment around schools, by providing healthier food options and safe conditions for active mobility, are essential to prevent child's atherogenic risk.
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Affiliation(s)
- Fernanda Martins de Albuquerque
- Programa de Pós Graduação em Ciência da Nutrição, Departamento de Nutrição e Saúde, Universidade Federal de Viçosa (UFV), Viçosa, Brazil
| | - Milene Cristine Pessoa
- Programa de Pós Graduação em Nutrição e Saúde, Departamento de Nutrição, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Mariana De Santis Filgueiras
- Programa de Pós Graduação em Ciência da Nutrição, Departamento de Nutrição e Saúde, Universidade Federal de Viçosa (UFV), Viçosa, Brazil
| | - Ariene Silva do Carmo
- Programa de Pós Graduação em Ciências da Saúde, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Aline Siqueira Fogal Vegi
- Programa de Pós Graduação em Ciência da Nutrição, Departamento de Nutrição e Saúde, Universidade Federal de Viçosa (UFV), Viçosa, Brazil
| | - Andréia Queiroz Ribeiro
- Programa de Pós Graduação em Ciência da Nutrição, Departamento de Nutrição e Saúde, Universidade Federal de Viçosa (UFV), Viçosa, Brazil
| | - Juliana Farias de Novaes
- Programa de Pós Graduação em Ciência da Nutrição, Departamento de Nutrição e Saúde, Universidade Federal de Viçosa (UFV), Viçosa, Brazil
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de França FCO, Andrade IDS, Zandonadi RP, Sávio KE, Akutsu RDCCDA. Food Environment around Schools: A Systematic Scope Review. Nutrients 2022; 14:nu14235090. [PMID: 36501120 PMCID: PMC9739807 DOI: 10.3390/nu14235090] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 11/22/2022] [Accepted: 11/26/2022] [Indexed: 12/02/2022] Open
Abstract
The present systematic scope review intended to compile state-of-the-art information about the food environment around schools, exploring the main methods used to describe the food environment around schools as well as the possible effects that this environment can promote on the health of children and adolescents. The preferred reporting items for systematic reviews and meta-analyses-extension for scoping reviews (PRISMA-ScR) checklist and guidelines were followed to ensure a robust and repeatable methodological process. A systematic search was performed in the following electronic databases: MEDLINE, Embase, Science Direct, Web of Science, LILACS, and Scopus, as well as in related articles, a manual search of reference lists and gray literature. Forty-six studies were selected. There was no standardization regarding distances from food establishments to schools, methods of analysis, and software used. The food environment around the schools was characterized by the wide availability of food establishments, especially fast food, convenience stores, supermarkets, and grocery stores known for offering a wide variety of unhealthy foods. Regarding the correlations with the health of children and adolescents, the evidence points to possible interferences of the food environment known as obesogenic, but it cannot be related only to the school environment since most of the acquisition and consumption of food usually happens around family homes. Conducting standardized and comprehensive studies evaluating food choices in the school environment and their interrelationships is very important to ensure children's food and nutrition security and minimize negative health outcomes in the medium and long term.
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Affiliation(s)
| | - Iziane da Silva Andrade
- Health Sciences Center, Federal University of Reconcavo da Bahia-Rua Rui Barbosa, 710-Centro, Cruz das Almas 44574-490, BA, Brazil
| | | | | | - Rita de Cassia Coelho de Almeida Akutsu
- Nutrition School, Federal University of Bahia-Augusto Viana, s/n-Palácio da Reitoria, Canela, Salvador 40110-907, BA, Brazil
- Department of Nutrition, University of Brasilia, Brasilia 70910-900, DF, Brazil
- Correspondence:
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Smets V, Vandevijvere S. Changes in retail food environments around schools over 12 years and associations with overweight and obesity among children and adolescents in Flanders, Belgium. BMC Public Health 2022; 22:1570. [PMID: 35982440 PMCID: PMC9387020 DOI: 10.1186/s12889-022-13970-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 08/08/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Children are susceptible to the food environment. This research assessed changes in retail food environments near schools in Flanders between 2008 and 2020 and associations with children's and adolescents' weight status. METHODS The food environment within a 500 m and 1000 m road network distance to all primary and secondary schools was mapped using spatial indicators. The commercial Locatus database, including addresses of all food retailers in Flanders, was used to calculate the density of different types of food retailers near the school perimeter, the percentage of schools with at least one food retailer of a certain type near the school perimeter and the shortest distance from the school entrance to the nearest food retailer of a certain type. A generalized linear model was used to explore associations between these indicators and the percentage of children and adolescents with overweight at the school level. RESULTS Food environments near schools in Flanders were found to be unhealthy in 2020, with a significant increase in fast food restaurants and convenience stores between 2008 and 2020. The density of fast food restaurants within a 1000 m walking distance from primary and secondary schools increased from 5.3 ±0.3 to 6.3 ±0.4 and from 10.2 ±0.7 to 12.7 ±0.9 respectively between 2008 and 2020, while the density of convenience stores increased from 3.2 ±0.3 to 3.8 ±0.4 and from 6.2 ±0.6 to 7.6 ±0.8 respectively. Food environments near schools with a higher proportion of children from a poor socio-economic background were found unhealthier, regardless of the urbanization level. A significant positive association was found between the density of fast food restaurants as well as the density of convenience stores around primary schools and the percentage of children aged < 6 years and 6-12 years with overweight. A positive, not significant association was found between the density of fast food restaurants as well as the density of convenience stores around secondary schools and the percentage of adolescents, aged 13-14 and 15-18 years with overweight. CONCLUSION Food environments around schools in Flanders became unhealthier over time and were associated with children's weight status.
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Affiliation(s)
- Vincent Smets
- Department of Public Health and Epidemiology, Sciensano (Scientific Institute of Public Health), J.Wytsmanstraat 14, 1050, Brussels, Belgium
| | - Stefanie Vandevijvere
- Department of Public Health and Epidemiology, Sciensano (Scientific Institute of Public Health), J.Wytsmanstraat 14, 1050, Brussels, Belgium.
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Novaes TG, Mendes LL, Almeida LFF, Ribeiro AQ, Costa BVDL, Claro RM, Pessoa MC. Availability of food stores around Brazilian schools. CIENCIA & SAUDE COLETIVA 2022; 27:2373-2383. [PMID: 35649024 DOI: 10.1590/1413-81232022276.19372021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 11/30/2021] [Indexed: 11/22/2022] Open
Abstract
The aim of this study was to analyze the availability of food stores in the territory of schools. Ecological study conducted in Viçosa, Minas Gerais, Brazil, with all schools (N=42) and food stores (N=656). Data were collected through the objective evaluation of the environment, and the stores were categorized into healthy, unhealthy, mixed and supermarkets. Bivariate Ripley´s K function assessed the existence of clustering of categories of stores in the territory of schools. All the schools had at least one food store in their territory. Unhealthy stores were the most common and closest to the schools. There were more stores around private schools, offering high school education, located in the central region and in the highest per capita income tercile. The bivariate Ripley´s K function showed evidence of clustering of stores at all analyzed distances (400 to 1.5 km) with up to 3 times more establishments than would be expected if they were randomly distributed. Therefore, schoolchildren were likely exposed to unhealthy food environments, regardless of neighborhood income and location, which may contribute to inadequate food choices.
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Affiliation(s)
- Taiane Gonçalves Novaes
- Departamento de Nutrição e Saúde, Universidade Federal de Viçosa. Av. Peter Henry Rolfs s/n, Campus Universitário. 36570-900 Viçosa MG Brasil.
| | - Larissa Loures Mendes
- Departamento de Nutrição, Escola de Enfermagem, Universidade Federal de Minas Gerais (UFMG). Belo Horizonte MG Brasil
| | | | - Andréia Queiroz Ribeiro
- Departamento de Nutrição e Saúde, Universidade Federal de Viçosa. Av. Peter Henry Rolfs s/n, Campus Universitário. 36570-900 Viçosa MG Brasil.
| | - Bruna Vieira de Lima Costa
- Departamento de Nutrição, Escola de Enfermagem, Universidade Federal de Minas Gerais (UFMG). Belo Horizonte MG Brasil
| | - Rafael Moreira Claro
- Departamento de Nutrição, Escola de Enfermagem, Universidade Federal de Minas Gerais (UFMG). Belo Horizonte MG Brasil
| | - Milene Cristine Pessoa
- Departamento de Nutrição, Escola de Enfermagem, Universidade Federal de Minas Gerais (UFMG). Belo Horizonte MG Brasil
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Olstad DL, Beall R, Spackman E, Dunn S, Lipscombe LL, Williams K, Oster R, Scott S, Zimmermann GL, McBrien KA, Steer KJD, Chan CB, Tyminski S, Berkowitz S, Edwards AL, Saunders-Smith T, Tariq S, Popeski N, White L, Williamson T, L'Abbé M, Raine KD, Nejatinamini S, Naser A, Basualdo-Hammond C, Norris C, O'Connell P, Seidel J, Lewanczuk R, Cabaj J, Campbell DJT. Healthy food prescription incentive programme for adults with type 2 diabetes who are experiencing food insecurity: protocol for a randomised controlled trial, modelling and implementation studies. BMJ Open 2022; 12:e050006. [PMID: 35168964 PMCID: PMC8852661 DOI: 10.1136/bmjopen-2021-050006] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION The high cost of many healthy foods poses a challenge to maintaining optimal blood glucose levels for adults with type 2 diabetes mellitus who are experiencing food insecurity, leading to diabetes complications and excess acute care usage and costs. Healthy food prescription programmes may reduce food insecurity and support patients to improve their diet quality, prevent diabetes complications and avoid acute care use. We will use a type 2 hybrid-effectiveness design to examine the reach, effectiveness, adoption, implementation and maintenance (RE-AIM) of a healthy food prescription incentive programme for adults experiencing food insecurity and persistent hyperglycaemia. A randomised controlled trial (RCT) will investigate programme effectiveness via impact on glycosylated haemoglobin (primary outcome), food insecurity, diet quality and other clinical and patient-reported outcomes. A modelling study will estimate longer-term programme effectiveness in reducing diabetes-related complications, resource use and costs. An implementation study will examine all RE-AIM domains to understand determinants of effective implementation and reasons behind programme successes and failures. METHODS AND ANALYSIS 594 adults who are experiencing food insecurity and persistent hyperglycaemia will be randomised to a healthy food prescription incentive (n=297) or a healthy food prescription comparison group (n=297). Both groups will receive a healthy food prescription. The incentive group will additionally receive a weekly incentive (CDN$10.50/household member) to purchase healthy foods in supermarkets for 6 months. Outcomes will be assessed at baseline and follow-up (6 months) in the RCT and analysed using mixed-effects regression. Longer-term outcomes will be modelled using the UK Prospective Diabetes Study outcomes simulation model-2. Implementation processes and outcomes will be continuously measured via quantitative and qualitative data. ETHICS AND DISSEMINATION Ethical approval was obtained from the University of Calgary and the University of Alberta. Findings will be disseminated through reports, lay summaries, policy briefs, academic publications and conference presentations. TRIAL REGISTRATION NUMBER NCT04725630. PROTOCOL VERSION Version 1.1; February 2022.
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Affiliation(s)
- Dana Lee Olstad
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Reed Beall
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Eldon Spackman
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Sharlette Dunn
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Lorraine L Lipscombe
- 2Department of Medicine, Women's College Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Kienan Williams
- Indigenous Wellness Core, Alberta Health Services, Calgary, Alberta, Canada
| | - Richard Oster
- Department of Agricultural, Food & Nutritional Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Sara Scott
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Gabrielle L Zimmermann
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Knowledge Translation Platform, Alberta SPOR SUPPORT Unit, Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Kerry A McBrien
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Family Medicine, G012 Health Sciences Centre, 3330 Hospital Drive NW, Calgary, Alberta, Canada
| | - Kieran J D Steer
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Catherine B Chan
- Department of Agricultural, Food & Nutritional Sciences, University of Alberta, Edmonton, Alberta, Canada
- Department of Physiology, University of Alberta, Edmonton, Alberta, Canada
- Diabetes, Obesity and Nutrition Strategic Clinical Network, Alberta Health Services, Calgary, Alberta, Canada
| | - Sheila Tyminski
- Nutrition Services, Alberta Health Services, Edmonton, Alberta, Canada
| | - Seth Berkowitz
- Division of General Medicine and Clinical Epidemiology, Department of Medicine, University of North Carolina at Chapel Hill School of Medicine, Gatineau, Quebec, Canada
| | - Alun L Edwards
- Department of Medicine, Cumming School of Medicine, University of Calgary Foothills Medical Centre, Calgary, Alberta, Canada
| | - Terry Saunders-Smith
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Saania Tariq
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Naomi Popeski
- Diabetes, Obesity and Nutrition Strategic Clinical Network, Alberta Health Services, Calgary, Alberta, Canada
| | - Laura White
- Alberta Region, First Nations and Inuit Health Branch, Indigenous Services Canada, Edmonton, Alberta, Canada
| | - Tyler Williamson
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Mary L'Abbé
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Kim D Raine
- School of Public Health, University of Alberta, 3-300 Edmonton Clinic Health Academy, Edmonton, Alberta, Canada
| | - Sara Nejatinamini
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Aruba Naser
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | - Colleen Norris
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
- Cardiovascular Health and Stroke Strategic Clinic Network, Alberta Health Services, Calgary, Alberta, Canada
| | - Petra O'Connell
- Diabetes, Obesity and Nutrition Strategic Clinical Network, Alberta Health Services, Calgary, Alberta, Canada
| | - Judy Seidel
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Primary Health Care Integration Network, Primary Health Care, Alberta Health Services, Calgary, Alberta, Canada
| | - Richard Lewanczuk
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Calgary, Alberta, Canada
| | - Jason Cabaj
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - David J T Campbell
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Medicine, Cumming School of Medicine, University of Calgary Foothills Medical Centre, Calgary, Alberta, Canada
- Department of Cardiac Sciences, Cumming School of Medicine, University Drive NW, Calgary, Alberta, Canada
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Sobek C, Ober P, Abel S, Spielau U, Kiess W, Meigen C, Poulain T, Igel U, Vogel M, Lipek T. Purchasing Behavior, Setting, Pricing, Family: Determinants of School Lunch Participation. Nutrients 2021; 13:4209. [PMID: 34959761 PMCID: PMC8706800 DOI: 10.3390/nu13124209] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 11/16/2021] [Accepted: 11/22/2021] [Indexed: 11/16/2022] Open
Abstract
Despite growing school lunch availability in Germany, its utilization is still low, and students resort to unhealthy alternatives. We investigated predictors of school lunch participation and reasons for nonparticipation in 1215 schoolchildren. Children reported meal habits, parents provided family-related information (like socioeconomic status), and anthropometry was conducted on-site in schools. Associations between school lunch participation and family-related predictors were estimated using logistic regression controlling for age and gender if necessary. School was added as a random effect. School lunch participation was primarily associated with family factors. While having breakfast on schooldays was positively associated with school lunch participation (ORadj = 2.20, p = 0.002), lower secondary schools (ORadj = 0.52, p < 0.001) and low SES (ORadj = 0.25, p < 0.001) were negatively associated. The main reasons for nonparticipation were school- and lunch-related factors (taste, time constraints, pricing). Parents reported pricing as crucial a reason as an unpleasant taste for nonparticipation. Nonparticipants bought sandwiches and energy drinks significantly more often on school days, whereas participants were less often affected by overweight (OR = 0.66, p = 0.043). Our data stress school- and lunch-related factors as an important opportunity to foster school lunch utilization.
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Affiliation(s)
- Carolin Sobek
- LIFE Child, Hospital for Children and Adolescents, Medical Faculty, Leipzig University, 04103 Leipzig, Germany; (P.O.); (S.A.); (W.K.); (C.M.); (T.P.); (U.I.); (M.V.); (T.L.)
- Center for Pediatric Research (CPL), Hospital for Children and Adolescents, Medical Faculty, Leipzig University, 04103 Leipzig, Germany;
| | - Peggy Ober
- LIFE Child, Hospital for Children and Adolescents, Medical Faculty, Leipzig University, 04103 Leipzig, Germany; (P.O.); (S.A.); (W.K.); (C.M.); (T.P.); (U.I.); (M.V.); (T.L.)
- Center for Pediatric Research (CPL), Hospital for Children and Adolescents, Medical Faculty, Leipzig University, 04103 Leipzig, Germany;
- Integrated Research and Treatment Center Adiposity Diseases, Medical Faculty, Leipzig University, 04103 Leipzig, Germany
| | - Sarah Abel
- LIFE Child, Hospital for Children and Adolescents, Medical Faculty, Leipzig University, 04103 Leipzig, Germany; (P.O.); (S.A.); (W.K.); (C.M.); (T.P.); (U.I.); (M.V.); (T.L.)
- Center for Pediatric Research (CPL), Hospital for Children and Adolescents, Medical Faculty, Leipzig University, 04103 Leipzig, Germany;
- Integrated Research and Treatment Center Adiposity Diseases, Medical Faculty, Leipzig University, 04103 Leipzig, Germany
| | - Ulrike Spielau
- Center for Pediatric Research (CPL), Hospital for Children and Adolescents, Medical Faculty, Leipzig University, 04103 Leipzig, Germany;
- Integrated Research and Treatment Center Adiposity Diseases, Medical Faculty, Leipzig University, 04103 Leipzig, Germany
| | - Wieland Kiess
- LIFE Child, Hospital for Children and Adolescents, Medical Faculty, Leipzig University, 04103 Leipzig, Germany; (P.O.); (S.A.); (W.K.); (C.M.); (T.P.); (U.I.); (M.V.); (T.L.)
- Center for Pediatric Research (CPL), Hospital for Children and Adolescents, Medical Faculty, Leipzig University, 04103 Leipzig, Germany;
| | - Christof Meigen
- LIFE Child, Hospital for Children and Adolescents, Medical Faculty, Leipzig University, 04103 Leipzig, Germany; (P.O.); (S.A.); (W.K.); (C.M.); (T.P.); (U.I.); (M.V.); (T.L.)
- Center for Pediatric Research (CPL), Hospital for Children and Adolescents, Medical Faculty, Leipzig University, 04103 Leipzig, Germany;
| | - Tanja Poulain
- LIFE Child, Hospital for Children and Adolescents, Medical Faculty, Leipzig University, 04103 Leipzig, Germany; (P.O.); (S.A.); (W.K.); (C.M.); (T.P.); (U.I.); (M.V.); (T.L.)
- Center for Pediatric Research (CPL), Hospital for Children and Adolescents, Medical Faculty, Leipzig University, 04103 Leipzig, Germany;
| | - Ulrike Igel
- LIFE Child, Hospital for Children and Adolescents, Medical Faculty, Leipzig University, 04103 Leipzig, Germany; (P.O.); (S.A.); (W.K.); (C.M.); (T.P.); (U.I.); (M.V.); (T.L.)
- Center for Pediatric Research (CPL), Hospital for Children and Adolescents, Medical Faculty, Leipzig University, 04103 Leipzig, Germany;
- Department of Social Work, University of Applied Science, 99085 Erfurt, Germany
| | - Mandy Vogel
- LIFE Child, Hospital for Children and Adolescents, Medical Faculty, Leipzig University, 04103 Leipzig, Germany; (P.O.); (S.A.); (W.K.); (C.M.); (T.P.); (U.I.); (M.V.); (T.L.)
- Center for Pediatric Research (CPL), Hospital for Children and Adolescents, Medical Faculty, Leipzig University, 04103 Leipzig, Germany;
| | - Tobias Lipek
- LIFE Child, Hospital for Children and Adolescents, Medical Faculty, Leipzig University, 04103 Leipzig, Germany; (P.O.); (S.A.); (W.K.); (C.M.); (T.P.); (U.I.); (M.V.); (T.L.)
- Center for Pediatric Research (CPL), Hospital for Children and Adolescents, Medical Faculty, Leipzig University, 04103 Leipzig, Germany;
- Integrated Research and Treatment Center Adiposity Diseases, Medical Faculty, Leipzig University, 04103 Leipzig, Germany
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13
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Aydin G, Margerison C, Worsley A, Booth A. Essential food and nutrition knowledge and skills for primary school children: Australian parents' opinions. HEALTH EDUCATION 2021. [DOI: 10.1108/he-09-2021-0131] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeThis paper examines the views of Australian primary school parents regarding the food and nutrition education (FNE) curriculum. Associations with personal values (Universalism and Hedonism) and demographic measures were also explored.Design/methodology/approachAn online survey was conducted among 787 parents in March 2021. Parents rated the importance of 17 FNE topics. They were also asked about their support for six curriculum improvements and to state their own improvement suggestions.FindingsParents viewed the “Effect of food on health” and “Food hygiene” as the most important topics. Three FNE components were derived: (1) food safety and preparation, (2) health and nutrition information, (3) food origins and environmental sustainability. The “Food safety and preparation” component score was associated with both universalism-nature and hedonism values but negatively associated with parental education. The “Health and nutrition information” component score was associated with universalism-nature value and main language spoken at home. Lastly, the “Food origins and environmental sustainability” component score was associated with universalism-nature value. The two personal values, universalism-nature and hedonism, were more strongly associated with parents' views of curriculum topics than parental demographic characteristics. Parents had several criticisms of current FNE, including school food environments not resonating with FNE taught in the classroom and that FNE might increase the risk of eating disorders. They also suggested that the FNE curriculum should support both parents and teachers by providing relevant resources and training.Originality/valueAustralian parents' views of the importance of FNE topics and how to improve FNE in primary schools have been under-examined.
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14
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Fornari E, Brusati M, Maffeis C. Nutritional Strategies for Childhood Obesity Prevention. Life (Basel) 2021; 11:532. [PMID: 34201017 PMCID: PMC8227398 DOI: 10.3390/life11060532] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 05/31/2021] [Accepted: 05/31/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Reducing the spread of obesity represents a challenge for clinicians in which obesity prevention plays a key role in achieving this purpose. The aim of this review is to analyze the nutritional interventions that can be implemented to prevent childhood obesity. METHODS Searching PubMed and Cochrane Library between 2019 and 2021. Further searching with no date range for articles selected for their specific relevance in the pediatric area or for their scientific relevance. A total of 871 articles were identified and 90 were included. RESULTS We organized the results of the selected articles into age groups, and according to the subjects targeted for interventions or to the site of interventions, reserving an in-depth analysis on specific nutritional aspects. Promotion of breastfeeding, reduction of protein content of formulated milks, and diet of the first 12-24 months, involving family and schools in interventions that promote physical activity and healthy diet, are promising strategies for reduction of the risk of obesity. To increase the efficacy of interventions, a multidimensional approach is crucial. CONCLUSIONS A multidimensional approach, which takes into consideration different areas of intervention, is pivotal for childhood obesity prevention. Integrated programs involving several components (nutrition and physical activity at first) at different levels (individual, family, school, and institutional) are crucial.
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Affiliation(s)
- Elena Fornari
- Department of Surgery, Dentistry, Pediatrics and Gynecology, Section of Pediatric Diabetes and Metabolism, University and Azienda Ospedaliera Universitaria Integrata of Verona, 37126 Verona, Italy;
| | - Marco Brusati
- Department of Medical and Surgical Sciences, University of Bologna, 40126 Bologna, Italy;
| | - Claudio Maffeis
- Department of Surgery, Dentistry, Pediatrics and Gynecology, Section of Pediatric Diabetes and Metabolism, University and Azienda Ospedaliera Universitaria Integrata of Verona, 37126 Verona, Italy;
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Pitt TM, Aucoin J, HubkaRao T, Goopy S, Cabaj J, Hagel B, McCormack GR. The Relationship of Urban Form on Children and Adolescent Health Outcomes: A Scoping Review of Canadian Evidence. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18084180. [PMID: 33920876 PMCID: PMC8071316 DOI: 10.3390/ijerph18084180] [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] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 04/09/2021] [Accepted: 04/12/2021] [Indexed: 11/16/2022]
Abstract
Urban form can have an impact on health outcomes in children, and the synthesis of findings can identify gaps in the literature and regional reviews may help guide policymakers. This study aims to complete a scoping review of the research relating urban form to health outcomes in children and adolescents from urban Canadian settings. Thirteen online databases were searched to identify studies that had objective measures of urban form and health outcomes. Two research assistants independently reviewed 27,444 titles and abstracts, and 176 full-text articles, returning 32 unique studies with youth-specific data. The majority of the included studies were cross-sectional or ecological (n = 26). Six studies used Canada-wide data and the rest were from Ontario (n = 11), Alberta (n = 6), and Quebec (n = 6). Urban form characteristics included neighbourhood food environment (n = 11), parks/natural space/greenness (n = 10), road or intersection characteristics (n = 7), and aggregated urban form measures (n = 7). Studies examined a variety of health outcomes: the majority considered weight status (n = 16) and injury (n = 10). Although there is over-reliance on mainly cross-sectional study designs, there is evidence suggesting that urban form is associated with health outcomes in Canadian youth, with parks/greenspace, road connectivity, and road characteristics most consistently associated with health outcomes in youth.
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Affiliation(s)
- Tona M. Pitt
- Department of Paediatrics, Cumming School of Medicine, University of Calgary, 28 Oki Drive NW, Calgary, AB T3B 6A8, Canada; (T.H.); (B.H.)
- Correspondence: ; Tel.: +1-403-955-7517
| | - Janet Aucoin
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6, Canada; (J.A.); (J.C.); (G.R.M.)
| | - Tate HubkaRao
- Department of Paediatrics, Cumming School of Medicine, University of Calgary, 28 Oki Drive NW, Calgary, AB T3B 6A8, Canada; (T.H.); (B.H.)
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6, Canada; (J.A.); (J.C.); (G.R.M.)
| | - Suzanne Goopy
- Faculty of Nursing, University of Calgary, 2500 University Drive NW, Calgary, AB T2N 1N4, Canada;
- Usher Institute, Old Medical School, University of Edinburgh, Teviot Place, Edinburgh EH8 9AG, Scotland, UK
| | - Jason Cabaj
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6, Canada; (J.A.); (J.C.); (G.R.M.)
- Alberta Health Services, 10301 Southport Lane SW, Calgary, AB T2W 1S7, Canada
| | - Brent Hagel
- Department of Paediatrics, Cumming School of Medicine, University of Calgary, 28 Oki Drive NW, Calgary, AB T3B 6A8, Canada; (T.H.); (B.H.)
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6, Canada; (J.A.); (J.C.); (G.R.M.)
- Alberta Children’s Hospital Research Institute, University of Calgary, 28 Oki Drive NW, Calgary, AB T3B 6A8, Canada
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, 2500 University Drive NW, Calgary, AB T2N 1N4, Canada
- O’Brien Institute for Public Health, University of Calgary, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6, Canada
| | - Gavin R. McCormack
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6, Canada; (J.A.); (J.C.); (G.R.M.)
- School of Architecture, Planning and Landscape, University of Calgary, 2500 University Drive NW, Calgary, AB T2N 1N4, Canada
- Faculty of Kinesiology, University of Calgary, 2500 University Drive NW, Calgary, AB T2N 1N4, Canada
- Faculty of Sport Sciences, Waseda University, 1-104 Totsukamachi, Shinjuku-ku, Tokyo 169-8050, Japan
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16
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da Costa Peres CM, Gardone DS, Costa BVDL, Duarte CK, Pessoa MC, Mendes LL. Retail food environment around schools and overweight: a systematic review. Nutr Rev 2021; 78:841-856. [PMID: 31968100 DOI: 10.1093/nutrit/nuz110] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
CONTEXT The presence of retail food establishments around schools can be a potentiating or protective factor for overweight in students, depending on access to these places as well as types of foods available therein. The hypothesis for this study was that a greater density and proximity of retail food establishments around schools influence the weight of students. OBJECTIVE To systematically review the available observational literature on the association between retail food establishments around schools and the occurrence of overweight and obesity in schoolchildren and adolescents. DATA SOURCES Observational studies were searched in the MEDLINE, EMBASE, and SCOPUS databases published until May 2019. DATA EXTRACTION Two independent reviewers extracted relevant data. DATA ANALYSIS Data on the 31 included studies were summarized with narrative synthesis according to meta-analyses of observational studies in epidemiology, exploring the type of food establishments around schools and analyzing qualitatively the impact of proximity or density on overweight and obesity rates. CONCLUSION Of the 31 articles, a direct association between proximity or density of establishments (mainly fast food restaurants, convenience stores, grocery stores) around schools and overweight and obesity in children and adolescents were found in 14 studies. However, authors of 13 papers found no association and inverse association was presented in 4 papers. The studies presented different methods of classification, location, and analysis of retail food establishments, making it difficult to conclude the real influence that the presence of these establishments near schools have on the nutritional status of children and adolescents. Therefore, future studies should consider the use of longitudinal designs and standardized analysis of the food environment around schools to better understand this food environment and its influence on health-related behaviors.
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Affiliation(s)
- Carla Marien da Costa Peres
- Post-Graduate Program in Nutrition and Health, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.,Department of Nutrition, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Danielle Soares Gardone
- Post-Graduate Program in Nutrition and Health, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Bruna Vieira de Lima Costa
- Post-Graduate Program in Nutrition and Health, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.,Department of Nutrition, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Camila Kümmel Duarte
- Department of Nutrition, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Milene Cristine Pessoa
- Department of Nutrition, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Larissa Loures Mendes
- Post-Graduate Program in Nutrition and Health, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.,Department of Nutrition, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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Pineda E, Bascunan J, Sassi F. Improving the school food environment for the prevention of childhood obesity: What works and what doesn't. Obes Rev 2021; 22:e13176. [PMID: 33462933 DOI: 10.1111/obr.13176] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 10/30/2020] [Indexed: 12/18/2022]
Abstract
The food environment has a significant influence on dietary choices, and interventions designed to modify the food environment could contribute to the prevention of childhood obesity. Many interventions have been implemented at the school level, but effectiveness in addressing childhood obesity remains unclear. We undertook a systematic review, a meta-analysis, and meta-regression analyses to assess the effectiveness of interventions on the food environment within and around schools to improve dietary intake and prevent childhood obesity. Estimates were pooled in a random-effects meta-analysis with stratification by anthropometric or dietary intake outcome. Risk of bias was formally assessed. One hundred papers were included. Interventions had a significant and meaningful effect on adiposity (body mass index [BMI] z score, standard mean difference: -0.12, 95% confidence interval: 0.15, 0.10) and fruit consumption (portions per day, standard mean difference: +0.19, 95% confidence interval: 0.16, 0.22) but not on vegetable intake. Risk of bias assessment indicated that n = 43 (81%) of non-randomized controlled studies presented a high risk of bias in the study design by not accounting for a control. Attrition bias (n = 34, 79%) and low protection of potential contamination (n = 41, 95%) presented the highest risk of bias for randomized controlled trials. Changes in the school food environment could improve children's dietary behavior and BMI, but policy actions are needed to improve surrounding school food environments to sustain healthy dietary intake and BMI.
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Affiliation(s)
- Elisa Pineda
- Centre for Health Economics & Policy Innovation (CHEPI), Imperial College Business School, London, UK.,School of Public Health, Imperial College London, London, UK
| | - Josefina Bascunan
- Centre for Health Economics & Policy Innovation (CHEPI), Imperial College Business School, London, UK
| | - Franco Sassi
- Centre for Health Economics & Policy Innovation (CHEPI), Imperial College Business School, London, UK
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Earnshaw VA, Karpyn A. Understanding stigma and food inequity: a conceptual framework to inform research, intervention, and policy. Transl Behav Med 2020; 10:1350-1357. [PMID: 33421077 PMCID: PMC8218858 DOI: 10.1093/tbm/ibaa087] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
There is increasing understanding that stigma associated with poverty, race, nationality, gender, obesity, and other intersecting, socially devalued characteristics is a key social determinant of health that plays a role in food inequities; yet, the processes linking stigma with food inequities are poorly defined. Building on prior conceptual and empirical stigma research in public health, this paper introduces The Stigma and Food Inequity Framework. Supporting empirical evidence for the associations proposed by the framework is reviewed. The framework proposes that stigma is manifested at the structural (e.g., neighborhood infrastructure and targeted marketing) and individual (e.g., internalized stigma and stereotypes) levels. These stigma manifestations are associated with food inequities via a series of mediating mechanisms, including access to resources, the home food environment, and psychosocial and behavioral processes, which ultimately undermine healthy food consumption, contribute to food insecurity, and impact diet quality. The framework further proposes that processes linking stigma with food inequities are situated within contexts of history, culture, and human development. Future directions to address stigma and enhance food equity include the value of addressing the broad range of underlying structural stigma manifestations when creating policy to promote food equity.
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Affiliation(s)
- Valerie A Earnshaw
- Human Development and Family Sciences, University of Delaware, Newark, DE, USA
| | - Allison Karpyn
- Human Development and Family Sciences, University of Delaware, Newark, DE, USA
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Kitunen A, Rundle-Thiele S, Carins J. Segmenting Young Adult University Student's Eating Behaviour: A Theory-Informed Approach. Nutrients 2019; 11:nu11112793. [PMID: 31731796 PMCID: PMC6893594 DOI: 10.3390/nu11112793] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Revised: 09/26/2019] [Accepted: 11/14/2019] [Indexed: 12/20/2022] Open
Abstract
The purpose of this paper is to extend behavioural theory and segmentation application. Specifically, this paper draws on three segmentation bases and behavioural theory that extends focus beyond individual psychological predispositions to form segments within the healthy eating context for young adult university students (20–35 years) in Queensland, Australia. Participants were invited to take part in an online survey via email and through face to face intercept to ensure a diverse cross section was obtained. Structural equation modelling revealed that the Motivation, Opportunity, and Ability (MOA) framework can be utilised to explain healthful eating behaviour and two-step cluster analysis uncovered two distinct segments with education, motivation to eat healthily and Turconi’s eating behaviour scores being the most important variables within the wider multivariate segment formation. This paper contributes to literature in the following ways. First, it confirms the importance of behavioural bases in segment formation and supports inclusion of other bases, namely demographics and psychographics. Next, it provides evidence of the value of including behavioural theory, which extends focus beyond what individuals think to understand how the environment may support them. Finally, this paper demonstrates that the MOA framework together with eating behaviour and demographic factors (education) can produce theoretically informed segments.
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Affiliation(s)
- Anna Kitunen
- Social Marketing @ Griffith, Griffith University, 170 Kessels Road, Nathan, QLD 4111, Australia; (S.R.-T.); (J.C.)
- Correspondence: ; Tel.: +61-737-357-673
| | - Sharyn Rundle-Thiele
- Social Marketing @ Griffith, Griffith University, 170 Kessels Road, Nathan, QLD 4111, Australia; (S.R.-T.); (J.C.)
| | - Julia Carins
- Social Marketing @ Griffith, Griffith University, 170 Kessels Road, Nathan, QLD 4111, Australia; (S.R.-T.); (J.C.)
- Food and Nutrition, Land Division, Defence Science and Technology, Scottsdale, TAS 7260, Australia
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Gray HL, Buro AW, Barrera Ikan J, Wang W, Stern M. School-level factors associated with obesity: A systematic review of longitudinal studies. Obes Rev 2019; 20:1016-1032. [PMID: 31013544 DOI: 10.1111/obr.12852] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Revised: 02/16/2019] [Accepted: 02/25/2019] [Indexed: 01/27/2023]
Abstract
Although school has been an important intervention venue for obesity prevention, the role of school-level factors in obesity development or prevention has not been well-documented. This study aimed to systematically examine the current evidence on school-level factors associated with obesity outcomes in longitudinal studies. The literature search was performed in PubMed, EMBASE, CINHAL, and PsycINFO. Peer-reviewed articles using longitudinal study designs and published in English from 1991 to 2018 were eligible. Twelve articles met eligibility criteria for final systematic review. Nine studies reported significant long-term associations between school-level factors and obesity outcomes. Higher parental education, longer minutes of recess, meeting recommended recess and physical education time, higher socio-economic status, suburban compared with rural area, higher parental involvement in school, and healthful school food environment were significantly associated with lower rates of obesity or obesity trajectory. However, due to the small number of studies and heterogeneity of measures and variables used in their analytic models, the overall level of evidence from this review suggests the importance of further, systematic study. Empirically rigorous research is needed to identify additional aspects of the school context and environment that may contribute to the risk of obesity throughout the life course.
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Affiliation(s)
- Heewon L Gray
- College of Public Health, University of South Florida, Tampa, Florida
| | - Acadia W Buro
- College of Public Health, University of South Florida, Tampa, Florida
| | | | - Wei Wang
- College of Public Health, University of South Florida, Tampa, Florida.,Centre for Addiction and Mental Health, Ontario, Canada
| | - Marilyn Stern
- Department of Child & Family Studies, College of Behavioral & Community Sciences, University of South Florida, Tampa, Florida
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Characteristics of the school food environment associated with hypertension and obesity in Brazilian adolescents: a multilevel analysis of the Study of Cardiovascular Risks in Adolescents (ERICA). Public Health Nutr 2019; 22:2625-2634. [DOI: 10.1017/s1368980019001010] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractObjective:To characterize the food environment in schools that participated in the Study of Cardiovascular Risks in Adolescents (ERICA) and to identify individual and contextual factors associated with hypertension and obesity.Design:National school-based survey.Setting:Blood pressure, weight and height were measured, and characteristics of the schools were obtained in interviews with the principals. For each outcome, multilevel models of mixed effects were applied by logistic regression.Participants:School-going adolescents aged 12–17 years.Results:A total of 73 399 adolescents were evaluated. The prevalence of hypertension was 9·6 (95 % CI 9·0, 10·3) % and that of obesity was 8·4 (95 % CI 7·9, 8·9) %. Approximately 50 % of the adolescents were able to purchase food at school and in its immediate vicinity and 82 % had access to no-charge meals through Brazil’s National School Feeding Program. In the adjusted analysis, hypertension was associated (OR; 95 % CI) with the consumption of meals prepared on the school premises (0·79; 0·69, 0·92), the sale of food in the school’s immediate vicinity (0·67; 0·48, 0·95) and the purchase of food in the school cafeteria (1·29; 1·11, 1·49). It was observed that there were lower odds of obesity among students who were offered meals prepared on the school premises (0·68; 0·54, 0·87).Conclusions:High frequency of sales of ultra-processed foods in schools was identified. Contextual and individual characteristics in the school food environment were associated with hypertension and obesity, pointing to the need for regulation and supervision of these spaces.
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Jia P, Xue H, Yin L, Stein A, Wang M, Wang Y. Spatial Technologies in Obesity Research: Current Applications and Future Promise. Trends Endocrinol Metab 2019; 30:211-223. [PMID: 30712979 DOI: 10.1016/j.tem.2018.12.003] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 12/09/2018] [Accepted: 12/16/2018] [Indexed: 11/25/2022]
Abstract
Geographic Information Systems (GIS), Global Positioning Systems (GPS), and remote sensing (RS) are revolutionizing obesity-related research. The primary applications of GIS have included visualizing obesity outcomes and risk factors, constructing obesogenic environmental indicators, and detecting geographical patterns of obesity prevalence and obesogenic environmental features. GPS was mainly used to delineate individual activity space and combined with other devices to measure obesogenic behaviors. RS has been understated for its role as important sources of data about natural and built environments. These spatial technologies, collectively called the 3S technologies, will be useful in measuring more facets of obesogenic environments and individual environmental exposure at finer levels and studying obesity etiology and interventions.
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Affiliation(s)
- Peng Jia
- Department of Earth Observation Science, Faculty of Geo-information Science and Earth Observation (ITC), University of Twente, Enschede, 7500, The Netherlands; International Initiative on Spatial Lifecourse Epidemiology (ISLE), Enschede, 7500, The Netherlands.
| | - Hong Xue
- Department of Health Behavior and Policy, School of Medicine, Virginia Commonwealth University, Richmond, VA 23298, USA
| | - Li Yin
- Department of Urban and Regional Planning, University at Buffalo, The State University of New York, Buffalo, NY 14214, USA
| | - Alfred Stein
- Department of Earth Observation Science, Faculty of Geo-information Science and Earth Observation (ITC), University of Twente, Enschede, 7500, The Netherlands
| | - Minqi Wang
- Department of Behavioral and Community Health, University of Maryland at College Park, College Park, MD 20742, USA
| | - Youfa Wang
- Global Health Institute, Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, 710061, China.
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Abstract
OBJECTIVE School food policies are an important component of comprehensive strategies to address child obesity and improve children's health. Evaluations have demonstrated that these policies can be initially well accepted and appropriately implemented, however little is known about how acceptance levels may change over time. The present study aimed to re-evaluate a school food policy 10 years after its introduction to assess key stakeholders' support for various policy extensions that would strengthen the scope of the policy. DESIGN Online surveys administered 1 year after policy introduction (n 607, 2008) and 10 years after policy introduction (n 307, 2016). SETTING Western Australia.ParticipantsSchool principals, teachers, canteen managers and presidents of parents & citizens associations from Western Australian Government primary schools. RESULTS At both time points, and especially at time 2 (10 years post policy implementation), high levels of support were reported for the policy and possible policy extensions. Support was strongest for an additional requirement to integrate the canteen menu with the classroom health curriculum. CONCLUSIONS The results suggest that once a policy has become embedded into school practices, stakeholders may be receptive to modifications that strengthen the policy to enhance its potential effects on children's diets.
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Kelly C, Callaghan M, Molcho M, Nic Gabhainn S, Alforque Thomas A. Food environments in and around post-primary schools in Ireland: Associations with youth dietary habits. Appetite 2019; 132:182-189. [DOI: 10.1016/j.appet.2018.08.021] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 07/09/2018] [Accepted: 08/13/2018] [Indexed: 12/16/2022]
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Bramante CT, Thornton RLJ, Bennett WL, Zhang A, Wilson RF, Bass EB, Tseng E. Systematic Review of Natural Experiments for Childhood Obesity Prevention and Control. Am J Prev Med 2019; 56:147-158. [PMID: 30573143 PMCID: PMC7397557 DOI: 10.1016/j.amepre.2018.08.023] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 08/06/2018] [Accepted: 08/07/2018] [Indexed: 12/16/2022]
Abstract
CONTEXT The National Academy of Medicine recommends childhood obesity prevention efforts making healthier options the passive choice. This review evaluated the effectiveness of population-level policies and programs from natural experiments for childhood obesity prevention. EVIDENCE ACQUISTION The search included PubMed, CINAHL, PsycINFO, and EconLit from 2000 to 2017 for policies evaluated by natural experiments reporting childhood BMI outcomes. The studies were analyzed in 2017-2018. Interventions were classified by environmental focus (food/beverage, physical activity, or both) and stratified by setting (school, community, both). Risk of bias was evaluated for each study. EVIDENCE SYNTHESIS Of 33 natural experiments, most (73%) took place in the school setting only. The most common environmental focus in any setting was food/beverage (48%). All four studies that focused on both food/beverage and physical activity in schools demonstrated decreased prevalence of overweight/obesity or BMI z-score by 0.04-0.17. BMI decreased in all four studies in both school and community settings. The largest effect size was a decrease in BMI z-score of 0.5, but most were <0.25. The risk of bias was high for most (76%) studies. Most (63%) of the eight studies with low/medium risk of bias took place in the school setting focused on the food/beverage environment; effects on BMI were mixed. CONCLUSIONS Natural experiments evaluating school-based policies focusing on both the food/beverage and physical activity environments (versus targeting only one) consistently showed improvement in BMI. However, most studies had high risk of bias, highlighting the need for improved methods for evaluation of natural experiments for childhood obesity prevention.
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Affiliation(s)
- Carolyn T Bramante
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
| | - Rachel L J Thornton
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland; Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Wendy L Bennett
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Allen Zhang
- Johns Hopkins Evidence-Based Practice Center, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Renee F Wilson
- Johns Hopkins Evidence-Based Practice Center, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Eric B Bass
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Johns Hopkins Evidence-Based Practice Center, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Eva Tseng
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland
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Pérez-Ferrer C, Barrientos-Gutierrez T, Rivera-Dommarco JA, Prado-Galbarro FJ, Jiménez-Aguilar A, Morales-Ruán C, Shamah-Levy T. Compliance with nutrition standards in Mexican schools and their effectiveness: a repeated cross-sectional study. BMC Public Health 2018; 18:1411. [PMID: 30591040 PMCID: PMC6307217 DOI: 10.1186/s12889-018-6330-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 12/17/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Mexico approved mandatory nutrient-based standards for foods sold in schools in 2011. The aim of this study was to analyse the association between compliance with nutrition standards for foods sold in schools and children's school snacks. METHODS Data came from three surveys representative of Mexican elementary schools in 13 states and their students (2012, 2013 and 2015); n = 645 children from N = 99 different schools. Information on foods sold in schools and snacks consumed by children was collected through direct observation. Compliance with the standards was defined as the proportion of foods sold in school which met nutrition criteria established by the standards. Snacks were classified as healthy if they contained at least one fruit or vegetable and had no sugar-sweetened beverages. Robust logistic regression models for cross-sectional and repeated surveys aggregated at the school-level were fitted to quantify the association between school compliance with standards and healthy snacks. RESULTS On average across waves 27% of foods sold complied with nutrition standards; 18% of children consumed a healthy snack. For snacks purchased in school, a 10% increase in school compliance with the standards was associated with a 32% increase in the odds of a healthy snack (OR = 1.32; 95%CI 1.09,1.61); no association was observed for snacks brought from home. The odds of a healthy snack increased over time in schools where compliance with the standards improved (OR = 3.89; 95%CI 1.47,10.31) but not in those where compliance remained constant or decreased. CONCLUSIONS Only a small proportion of children are eating healthy snacks in school. School compliance with standards increases the likelihood of a healthy snack if it is bought at school. Our findings support better implementation of the standards and additional strategies to enhance the policy to achieve its aim of reducing childhood obesity.
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Affiliation(s)
- Carolina Pérez-Ferrer
- Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Avenida Universidad 655, Santa María Ahuacatitlán, 62100, Cuernavaca, Morelos, Mexico
| | - Tonatiuh Barrientos-Gutierrez
- Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Avenida Universidad 655, Santa María Ahuacatitlán, 62100, Cuernavaca, Morelos, Mexico
| | - Juan A Rivera-Dommarco
- Dirección General, Instituto Nacional de Salud Pública, Avenida Universidad 655, Santa María Ahuacatitlán, 62100, Cuernavaca, Morelos, Mexico
| | - Francisco Javier Prado-Galbarro
- Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Avenida Universidad 655, Santa María Ahuacatitlán, 62100, Cuernavaca, Morelos, Mexico
| | - Alejandra Jiménez-Aguilar
- Centro de Investigación en Evaluación y Encuestas, Instituto Nacional de Salud Pública, Avenida Universidad 655, Santa María Ahuacatitlán, 62100, Cuernavaca, Morelos, Mexico
| | - Carmen Morales-Ruán
- Centro de Investigación en Evaluación y Encuestas, Instituto Nacional de Salud Pública, Avenida Universidad 655, Santa María Ahuacatitlán, 62100, Cuernavaca, Morelos, Mexico
| | - Teresa Shamah-Levy
- Centro de Investigación en Evaluación y Encuestas, Instituto Nacional de Salud Pública, Avenida Universidad 655, Santa María Ahuacatitlán, 62100, Cuernavaca, Morelos, Mexico.
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Associations between home and school neighbourhood food environments and adolescents’ fast-food and sugar-sweetened beverage intakes: findings from the Olympic Regeneration in East London (ORiEL) Study. Public Health Nutr 2018; 21:2842-2851. [DOI: 10.1017/s1368980018001477] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractObjectiveTo examine associations between availability of fast-food restaurants and convenience stores in the home and school neighbourhoods, considered separately and together, and adolescents’ fast-food and sugar-sweetened beverage (SSB) intakes.DesignCross-sectional observational study.SettingEast London, UK.SubjectsAdolescents (n3089; aged 13–15 years) from the Olympic Regeneration in East London (ORiEL) Study self-reported their weekly frequency of fast-food and SSB consumption. We used food business addresses collected from local authority registers to derive absolute (counts) and relative (proportions) exposure measures to fast-food restaurants and convenience stores within 800 m from home, school, and home and school combined. Associations between absolute and relative measures of the food environment and fast-food and SSB intakes were assessed using Poisson regression models with robust standard errors.ResultsAbsolute exposure to fast-food restaurants or convenience stores in the home, school, or combined home and school neighbourhoods was not associated with any of the outcomes. High SSB intake was associated with relative exposure to convenience stores in the residential neighbourhood (risk ratio=1·45; 95 % CI 1·08, 1·96) and in the home and school neighbourhoods combined (risk ratio=1·69; 95 % CI 1·11, 2·57).ConclusionsWe found no evidence of an association between absolute exposure to fast-food restaurants and convenience stores around home and school and adolescents’ fast-food and SSB intakes. Relative exposure, which measures the local diversity of the neighbourhood food environment, was positively associated with SSB intake. Relative measures of the food environment may better capture the environmental risks for poor diet than absolute measures.
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Bennett WL, Wilson RF, Zhang A, Tseng E, Knapp EA, Kharrazi H, Stuart EA, Shogbesan O, Bass EB, Cheskin LJ. Methods for Evaluating Natural Experiments in Obesity: A Systematic Review. Ann Intern Med 2018; 168:791-800. [PMID: 29710087 DOI: 10.7326/m18-0309] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Given the obesity pandemic, rigorous methodological approaches, including natural experiments, are needed. PURPOSE To identify studies that report effects of programs, policies, or built environment changes on obesity prevention and control and to describe their methods. DATA SOURCES PubMed, CINAHL, PsycINFO, and EconLit (January 2000 to August 2017). STUDY SELECTION Natural experiments and experimental studies evaluating a program, policy, or built environment change in U.S. or non-U.S. populations by using measures of obesity or obesity-related health behaviors. DATA EXTRACTION 2 reviewers serially extracted data on study design, population characteristics, data sources and linkages, measures, and analytic methods and independently evaluated risk of bias. DATA SYNTHESIS 294 studies (188 U.S., 106 non-U.S.) were identified, including 156 natural experiments (53%), 118 experimental studies (40%), and 20 (7%) with unclear study design. Studies used 106 (71 U.S., 35 non-U.S.) data systems; 37% of the U.S. data systems were linked to another data source. For outcomes, 112 studies reported childhood weight and 32 adult weight; 152 had physical activity and 148 had dietary measures. For analysis, natural experiments most commonly used cross-sectional comparisons of exposed and unexposed groups (n = 55 [35%]). Most natural experiments had a high risk of bias, and 63% had weak handling of withdrawals and dropouts. LIMITATION Outcomes restricted to obesity measures and health behaviors; inconsistent or unclear descriptions of natural experiment designs; and imperfect methods for assessing risk of bias in natural experiments. CONCLUSION Many methodologically diverse natural experiments and experimental studies were identified that reported effects of U.S. and non-U.S. programs, policies, or built environment changes on obesity prevention and control. The findings reinforce the need for methodological and analytic advances that would strengthen evaluations of obesity prevention and control initiatives. PRIMARY FUNDING SOURCE National Institutes of Health, Office of Disease Prevention, and Agency for Healthcare Research and Quality. (PROSPERO: CRD42017055750).
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Affiliation(s)
- Wendy L Bennett
- Johns Hopkins University School of Medicine and Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (W.L.B., R.F.W., A.Z., E.T., E.A.K., H.K., E.A.S., O.S., E.B.B., L.J.C.)
| | - Renee F Wilson
- Johns Hopkins University School of Medicine and Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (W.L.B., R.F.W., A.Z., E.T., E.A.K., H.K., E.A.S., O.S., E.B.B., L.J.C.)
| | - Allen Zhang
- Johns Hopkins University School of Medicine and Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (W.L.B., R.F.W., A.Z., E.T., E.A.K., H.K., E.A.S., O.S., E.B.B., L.J.C.)
| | - Eva Tseng
- Johns Hopkins University School of Medicine and Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (W.L.B., R.F.W., A.Z., E.T., E.A.K., H.K., E.A.S., O.S., E.B.B., L.J.C.)
| | - Emily A Knapp
- Johns Hopkins University School of Medicine and Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (W.L.B., R.F.W., A.Z., E.T., E.A.K., H.K., E.A.S., O.S., E.B.B., L.J.C.)
| | - Hadi Kharrazi
- Johns Hopkins University School of Medicine and Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (W.L.B., R.F.W., A.Z., E.T., E.A.K., H.K., E.A.S., O.S., E.B.B., L.J.C.)
| | - Elizabeth A Stuart
- Johns Hopkins University School of Medicine and Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (W.L.B., R.F.W., A.Z., E.T., E.A.K., H.K., E.A.S., O.S., E.B.B., L.J.C.)
| | - Oluwaseun Shogbesan
- Johns Hopkins University School of Medicine and Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (W.L.B., R.F.W., A.Z., E.T., E.A.K., H.K., E.A.S., O.S., E.B.B., L.J.C.)
| | - Eric B Bass
- Johns Hopkins University School of Medicine and Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (W.L.B., R.F.W., A.Z., E.T., E.A.K., H.K., E.A.S., O.S., E.B.B., L.J.C.)
| | - Lawrence J Cheskin
- Johns Hopkins University School of Medicine and Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (W.L.B., R.F.W., A.Z., E.T., E.A.K., H.K., E.A.S., O.S., E.B.B., L.J.C.)
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