Healthy Eating Policy Strategies in Community Health Improvement Plans: A Cross-Sectional Survey of US Local Health Departments

Changes in Local Government Priorities and Stakeholder Satisfaction Following a Healthy Drinks Capacity-Building Intervention in Sports and Recreation Facilities in Victoria, Australia

ISSUE ADDRESSED

Local government (LG) facilities such as libraries, clubs and sport and recreation centres generally offer and promote nutritionally poor foods that may contribute to excess energy intake. It is unclear what effect exposure to a healthy food retail initiative may have on customer and staff support for such changes. This study investigated the association of a healthy drink intervention in LG-owned sporting facilities on changes in (i) intervention LG attitudes and facility healthy food and drink provision, compared to control LGs; and (ii) intervention LG customer and staff support for the intervention.

METHODS

Eight Victorian LGs implemented a two-year intervention to limit sugary drink availability in LG-owned sporting facilities. At baseline (2018) and follow-up (2020), attitudinal surveys were sent to intervention LG staff (baseline: n = 162; follow-up: n = 183) and customers (baseline: n = 1079; follow-up: n = 1188), and policy surveys were sent to all state LGs. Baseline and follow-up responses, and policy survey responses between 8 intervention and 24 control LGs were compared using logistic regression.

RESULTS

Intervention LGs' baseline priorities for promoting healthy eating were higher than control LGs, with no change in priorities at follow-up. Intervention LG staff and customers' belief that sporting facilities should promote healthy eating remained high between baseline (customers 79%; staff 76%) and follow-up (customers 75%; staff: 73%).

CONCLUSIONS

Facility staff and customers support interventions to align sporting facilities' healthy lifestyle message with healthier food environments. SO WHAT?: LG prioritisation of healthy eating appears to be a prerequisite for LG healthy drink policies.

What is in a food store name? Leveraging large language models to enhance food environment data

Introduction

It is not uncommon to repurpose administrative food data to create food environment datasets in the health department and research settings; however, the available administrative data are rarely categorized in a way that supports meaningful insight or action, and ground-truthing or manually reviewing an entire city or neighborhood is rate-limiting to essential operations and analysis. We show that such categorizations should be viewed as a classification problem well addressed by recent advances in natural language processing and deep learning-with the advent of large language models (LLMs).

Methods

To demonstrate how to automate the process of categorizing food stores, we use the foundation model BERT to give a first approximation to such categorizations: a best guess by store name. First, 10 food retail classes were developed to comprehensively categorize food store types from a public health perspective.

Results

Based on this rubric, the model was tuned and evaluated (F1micro = 0.710, F1macro = 0.709) on an extensive storefront directory of New York City. Second, the model was applied to infer insights from a large, unlabeled dataset using store names alone, aiming to replicate known temporospatial patterns. Finally, a complimentary application of the model as a data quality enhancement tool was demonstrated on a secondary, pre-labeled restaurant dataset.

Discussion

This novel application of an LLM to the enumeration of the food environment allowed for marked gains in efficiency compared to manual, in-person methods, addressing a known challenge to research and operations in a local health department.

Clustering of Dietary Patterns Associated with Health-Related Quality of Life in Spanish Children and Adolescents

PURPOSE

The aim of the current study was to examine the association between dietary patterns and health-related quality of life (HRQoL) among Spanish children and adolescents.

METHODS

A modified version of the parental version of 10 items of the Screening for and Promotion of Health-Related Quality of Life in Children and Adolescents-a European Public Health perspective (KIDSCREEN-10) was used to assess children's HRQoL in three areas: subjective physical, mental, and social status. To evaluate dietary habits, a food frequency questionnaire was employed. To identify different feeding patterns in the sample of children and adolescents examined, cluster analyses were carried out. In addition, a generalized linear model with a Gaussian distribution was applied to test the associations between the determined clusters and HRQoL.

RESULTS

The lowest HRQoL was identified in participants located in the unhealthiest cluster (Cluster 1) (mean [M] = 85.2; 95% confidence interval [CI] 83.7 to 86.7). In comparison with the unhealthiest cluster (Cluster 1), a greater estimated marginal mean of HRQoL was identified for participants in the moderately healthy cluster (Cluster 1) (p = 0.020) and in the healthiest cluster (Cluster 2) (p = 0.044).

CONCLUSIONS

Based on our findings, dietary habits based on the low consumption of bread, cereals, and dairy products (mainly), together with low intake of fruits and vegetables, are related to lower HRQoL in children and adolescents. These results underscore the importance of promoting balanced and nutrient-rich diets among young populations. Public health initiatives should focus on educating parents, caregivers, and children about the benefits of a varied diet that includes adequate portions of fruits, vegetables, whole grains, and dairy products.

Use of Evidence-Based Interventions to Promote Healthy Weight, Nutrition, and Physical Activity in Community Health Improvement Plans from Large Local Health Departments

We sought to identify evidence-based healthy weight, nutrition, and physical activity strategies related to obesity prevention in large local health department (LHD) Community Health Improvement Plans (CHIPs). We analyzed the content of the most recent, publicly available plans from 72 accredited LHDs serving a population of at least 500 000 people. We matched CHIP strategies to the County Health Rankings and Roadmaps' What Works for Health (WWFH) database of interventions. We identified 739 strategies across 55 plans, 62.5% of which matched a "WWFH intervention" rated for effectiveness on diet and exercise outcomes. Among the 20 most commonly identified WWFH interventions in CHIPs, 10 had the highest evidence for effectiveness while 4 were rated as likely to decrease health disparities according to WWFH. Future prioritization of strategies by health agencies could focus on strategies with the strongest evidence for promoting healthy weight, nutrition, and physical activity outcomes and reducing health disparities.

Local government policies on healthy food promotion and obesity prevention: results from a national Australian survey

OBJECTIVE

Local governments (LGs) often own or manage sport and recreation facilities and can promote health in these settings by implementing healthy food policies. The primary aim of this study was to assess the policies, attitudes and practices of Australian LGs relating to obesity prevention and the provision of healthy food in this setting.

METHODS

In July 2020, all 539 Australian LGs were invited to complete a survey. We assessed LG priorities to obesity prevention, promoting healthy eating and public health as well as the presence of healthy food policies in sporting facilities.

RESULTS

203 (38%) LGs completed the survey. Improving public health was a high priority, while obesity prevention and promoting healthy eating were a medium priority. 22% of LGs reported that the priority given to promoting healthy food had increased over the previous year and stayed the same at 65%. Ten per cent of LGs had a healthy food and drink policy in sporting facilities, with 32% reporting having made changes without a policy. LGs located in major cities, with larger populations and with more facilities reported having made more healthy changes at their facilities.

CONCLUSION

Promoting health is a priority for LGs across Australia, but very few have policies relating to the food environments in their sporting facilities.

IMPLICATIONS FOR PUBLIC HEALTH

Ongoing monitoring is important to assess changes over time and identify LGs where greater support is required.

Healthy Eating and Physical Activity Policy, Systems, and Environmental Strategies: A Content Analysis of Community Health Improvement Plans

Background: Policy, systems, and environmental (PSE) approaches can sustainably improve healthy eating (HE) and physical activity (PA) but are challenging to implement. Community health improvement plans (CHIPs) represent a strategic opportunity to advance PSEs but have not been adequately researched. The objective of this study was to describe types of HE and PA strategies included in CHIPs and assess strategies designed to facilitate successful PSE-change using an established framework that identifies six key activities to catalyze change. Methods: A content analysis was conducted of 75 CHIP documents containing HE and/or PA PSE strategies, which represented communities that were identified from responses to a national probability sample of US local health departments (<500,000 residents). Each HE/PA PSE strategy was assessed for alignment with six key activities that facilitate PSE-change (identifying and framing the problem, engaging and educating key people, identifying PSE solutions, utilizing available evidence, assessing social and political environment, and building support and political will). Multilevel latent class analyses were conducted to identify classes of CHIPs based on HE/PA PSE strategy alignment with key activities. Analyses were conducted separately for CHIPs containing HE and PA PSE strategies. Results: Two classes of CHIPs with PSE strategies emerged from the HE (n = 40 CHIPs) and PA (n = 43 CHIPs) multilevel latent class analyses. More CHIPs were grouped in Class A (HE: 75%; PA: 79%), which were characterized by PSE strategies that simply identified a PSE solution. Fewer CHIPs were grouped in Class B (HE: 25%; PA: 21%), and these mostly included PSE strategies that comprehensively addressed multiple key activities for PSE-change. Conclusions: Few CHIPs containing PSE strategies addressed multiple key activities for PSE-change. Efforts to enhance collaborations with important decision-makers and community capacity to engage in a range of key activities are warranted.