Use of environmental change strategies to facilitate sodium reduction: a case study in a rural California school district

CDC's Sodium Reduction in Communities Program: Evaluating Differential Effects in Food Service Settings, 2013-2016

High sodium intake can lead to hypertension and increase the risk for heart disease and stroke; however, research is lacking on the effectiveness of community-based sodium reduction programs. From 2013 through 2016, the Centers for Disease Control and Prevention (CDC) funded 10 state and local health departments to implement sodium reduction strategies across diverse institutional food settings. Strategies of the Sodium Reduction in Communities Program (SRCP) are implementing food service guidelines, making menu modifications, enabling purchase of reduced-sodium foods, and providing consumer information. CDC aggregated awardee-reported performance measures to evaluate progress in increasing the access, availability, and purchase of reduced sodium foods. Evaluation results of the SRCP show the potential differential effects of sodium reduction strategies in a community setting and support the need for additional community-level efforts in this emerging area of public health.

Evaluation of a Healthy Chinese Take-Out Sodium-Reduction Initiative in Philadelphia Low-Income Communities and Neighborhoods

OBJECTIVES

Sodium reduction in restaurant foods is important because 77% of sodium in the United States is consumed by eating prepared and restaurant foods. We evaluated a sodium-reduction intervention, Healthy Chinese Take-Out Initiative, among Chinese take-out restaurants in low-income neighborhoods in Philadelphia, Pennsylvania. Our objectives were to (1) analyze changes in the sodium content of food samples and (2) collect data on changes in chefs' and owners' knowledge about the health risks of sodium overconsumption, perceptions of the need for sodium reduction, self-efficacy for lowering sodium use, and perceptions of training needs for sodium-reduction strategies.

METHODS

The initiative trained chefs from 206 Chinese take-out restaurants on strategies to reduce sodium in prepared dishes. We analyzed changes in the sodium content of the 3 most frequently ordered dishes-shrimp and broccoli, chicken lo mein, and General Tso's chicken-from baseline (July-September 2012) to 36 months after baseline (July-September 2015) among 40 restaurants. We conducted a survey to examine the changes in chefs' and owners' knowledge, perceptions, and self-efficacy of sodium reduction. We used multilevel analysis and repeated-measures analysis of variance to examine effects of the intervention on various outcomes.

RESULTS

We found significant reductions in the sodium content of all 3 dishes 36 months after a low-sodium cooking training intervention (coefficients range, -1.06 to -1.69, P < .001 for all). Mean knowledge (range, 9.2-11.1), perceptions (range, 4.6-6.0), and self-efficacy (range, 4.2-5.9) ( P < .001 for all) of sodium reduction improved significantly from baseline (August 2012) to posttraining (also August 2012), but perceptions of the need for sodium reduction and self-efficacy for lowering sodium use returned to baseline levels 36 months later (August 2015).

CONCLUSIONS

The intervention was a useful population health approach that led to engaging restaurants in sodium-reduction practices. Local public health agencies and professionals could partner with independent restaurants to introduce environmental changes that can affect population health on a broad scale, particularly for vulnerable populations.

Evaluating Structural Change Approaches to Health Promotion: An Exploratory Scoping Review of a Decade of U.S. Progress

Structural change approaches—also known as policy and environmental changes—are becoming increasingly common in health promotion, yet our understanding of how to evaluate them is still limited. An exploratory scoping review of the literature was conducted to understand approaches and methods used to evaluate structural change interventions in health promotion and public health literature. Two analysts—along with health sciences librarian consultation—searched PubMed, Web of Science, and EMBASE for peer-reviewed U.S.-based, English language studies published between 2005 and 2016. Data were extracted on the use of evaluation frameworks, study designs, duration of evaluations, measurement levels, and measurement types. Forty-five articles were included for the review. Notably, the majority (73%) of studies did not report application of a specific evaluation framework. Studies used a wide range of designs, including process evaluations, quasi- or nonexperimental designs, and purely descriptive approaches. In addition, 15.6% of studies only measured outcomes at the individual level. Last, 60% of studies combined more than one measurement type (e.g., site observation + focus groups) to evaluate interventions. Future directions for evaluating structural change approaches to health promotion include more widespread use and reporting of evaluation frameworks, developing validated tools that measure structural change, and shifting the focus to health-directed approaches, including an expanded consideration for evaluation designs that address health inequities.

Evaluation of the LiveWell@School Food Initiative Shows Increases in Scratch Cooking and Improvement in Nutritional Content

BACKGROUND

The purpose of this evaluation was to examine the effects of the LiveWell@School Food Initiative (LW@SFI), a Colorado-based childhood obesity prevention program that partners with school districts to enable them to serve more scratch cooked foods through culinary training, action planning, and equipment grants.

METHODS

This evaluation used a quasi-experimental design that examined menu cycles prior to entering the LW@SFI and approximately 1 year later. A review of school menus with food service directors from 9 Colorado school districts was conducted.

RESULTS

Data show that districts changed an average of 17.4 entrées and 19.7 side dishes over the course of the year. Changes to serving scratch cooked foods were highest for sauces (an increase of 40.5%). No districts were cooking beans/legumes from scratch during baseline or at follow-up. Across the 9 districts, 7 observed statistically significant pre-post reductions in sodium, 4 in fat, 5 in saturated fat, and 3 in calories.

CONCLUSIONS

Within a year of implementing the LW@SFI, school districts increased the proportion of fresh, scratch cooked foods they offered and this was associated with some decreases in calories, fat, saturated fat, and sodium, contributing to healthier school food environments.

K-12 School Food Service Staff Training Interventions: A Review of the Literature

BACKGROUND

School food service professionals are vital to implementing national nutrition standards in school meal programs. Appropriate and effective training for these professionals may be one key to producing healthful meals that students are excited to eat and also meet United States Department of Agriculture (USDA) nutrient guidelines. A systematic literature review was conducted to understand the scope of interventions conducted with food service staff.

METHODS

PubMed, Web of Knowledge, and Science Direct databases were searched for articles detailing school food service training interventions in K-12 school settings within the United States.

RESULTS

Of 2341 articles retrieved, 17 articles describing 14 food service training interventions met the inclusion criteria. While food service staff training was an important component of many comprehensive school health and school meal interventions, there were few studies that specifically addressed school food service staff trainings. Although some best practices can be concluded from the current literature, major gaps in knowledge about effective school food service training interventions and validated research tools remain.

CONCLUSIONS

As new professional standards are mandated by the USDA, a more thorough evaluation and understanding of best practices is vital to maximize the effectiveness of food service staff training.