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Pillay D, Ali A, Wham CA. Examining the New Zealand school food environment: what needs to change? Nutr Res Rev 2023; 36:406-419. [PMID: 35968693 DOI: 10.1017/s0954422422000154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Habitual dietary intakes and nutrition behaviours developed during childhood and adolescence pave the way for similar behaviours to manifest in adulthood. Childhood obesity rates have now reached a point where one in six children globally are classified as overweight or obese. Schools have the unique ability to reach almost all children during key developmental stages, making them an ideal setting for influencing children's nutrition behaviours. Evidence suggests the school food environment is not always conducive to healthy food choices and may be obesogenic. The aim of this narrative review is to explore factors that influence the healthy food and drink environment in and around schools in New Zealand. The review focused on evidence from New Zealand and Australia given the close resemblance in education systems and school food guidance. Using the Analysis Grid for Environments Linked to Obesity (ANGELO) framework, the school food environment was categorised into the following domains: economic, political, physical and socio-cultural factors. Findings suggest that food policies are not utilised within schools, and guidelines to improve the school food environment are not well implemented. Canteen profit models, lack of staff support and resources, and higher availability of low-cost unhealthy foods are among barriers that hinder implementation. This review highlights recommendations from existing evidence, including canteen pricing strategies, restriction of unhealthy foods and using peer modelling in a time-scarce curriculum to improve the school food environment. Key areas for improvement, opportunities to enhance policy implementation and untapped avenues to improve the food and nutrition behaviours of children are highlighted.
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Affiliation(s)
- Danika Pillay
- School of Sport, Exercise and Nutrition, Massey University, Auckland, New Zealand
| | - Ajmol Ali
- School of Sport, Exercise and Nutrition, Massey University, Auckland, New Zealand
| | - Carol A Wham
- School of Sport, Exercise and Nutrition, Massey University, Auckland, New Zealand
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Wolfenden L, McCrabb S, Barnes C, O'Brien KM, Ng KW, Nathan NK, Sutherland R, Hodder RK, Tzelepis F, Nolan E, Williams CM, Yoong SL. Strategies for enhancing the implementation of school-based policies or practices targeting diet, physical activity, obesity, tobacco or alcohol use. Cochrane Database Syst Rev 2022; 8:CD011677. [PMID: 36036664 PMCID: PMC9422950 DOI: 10.1002/14651858.cd011677.pub3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Several school-based interventions are effective in improving child diet and physical activity, and preventing excessive weight gain, and tobacco or harmful alcohol use. However, schools are frequently unsuccessful in implementing such evidence-based interventions. OBJECTIVES 1. To evaluate the benefits and harms of strategies aiming to improve school implementation of interventions to address student diet, physical activity, tobacco or alcohol use, and obesity. 2. To evaluate the benefits and harms of strategies to improve intervention implementation on measures of student diet, physical activity, obesity, tobacco use or alcohol use; describe their cost or cost-effectiveness; and any harms of strategies on schools, school staff or students. SEARCH METHODS We used standard, extensive Cochrane search methods. The latest search was between 1 September 2016 and 30 April 2021 to identify any relevant trials published since the last published review. SELECTION CRITERIA We defined 'Implementation' as the use of strategies to adopt and integrate evidence-based health interventions and to change practice patterns within specific settings. We included any trial (randomised controlled trial (RCT) or non-randomised controlled trial (non-RCT)) conducted at any scale, with a parallel control group that compared a strategy to implement policies or practices to address diet, physical activity, overweight or obesity, tobacco or alcohol use by students to 'no intervention', 'usual' practice or a different implementation strategy. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. Given the large number of outcomes reported, we selected and included the effects of a single outcome measure for each trial for the primary (implementation) and secondary (student health behaviour and obesity) outcomes using a decision hierarchy. Where possible, we calculated standardised mean differences (SMDs) to account for variable outcome measures with 95% confidence intervals (CI). For RCTs, we conducted meta-analyses of primary and secondary outcomes using a random-effects model, or in instances where there were between two and five studies, a fixed-effect model. The synthesis of the effects for non-randomised studies followed the 'Synthesis without meta-analysis' (SWiM) guidelines. MAIN RESULTS We included an additional 11 trials in this update bringing the total number of included studies in the review to 38. Of these, 22 were conducted in the USA. Twenty-six studies used RCT designs. Seventeen trials tested strategies to implement healthy eating, 12 physical activity and six a combination of risk factors. Just one trial sought to increase the implementation of interventions to delay initiation or reduce the consumption of alcohol. All trials used multiple implementation strategies, the most common being educational materials, educational outreach and educational meetings. The overall certainty of evidence was low and ranged from very low to moderate for secondary review outcomes. Pooled analyses of RCTs found, relative to a control, the use of implementation strategies may result in a large increase in the implementation of interventions in schools (SMD 1.04, 95% CI 0.74 to 1.34; 22 RCTs, 1917 participants; low-certainty evidence). For secondary outcomes we found, relative to control, the use of implementation strategies to support intervention implementation may result in a slight improvement on measures of student diet (SMD 0.08, 95% CI 0.02 to 0.15; 11 RCTs, 16,649 participants; low-certainty evidence) and physical activity (SMD 0.09, 95% CI -0.02 to 0.19; 9 RCTs, 16,389 participants; low-certainty evidence). The effects on obesity probably suggest little to no difference (SMD -0.02, 95% CI -0.05 to 0.02; 8 RCTs, 18,618 participants; moderate-certainty evidence). The effects on tobacco use are very uncertain (SMD -0.03, 95% CIs -0.23 to 0.18; 3 RCTs, 3635 participants; very low-certainty evidence). One RCT assessed measures of student alcohol use and found strategies to support implementation may result in a slight increase in use (odds ratio 1.10, 95% CI 0.77 to 1.56; P = 0.60; 2105 participants). Few trials reported the economic evaluations of implementation strategies, the methods of which were heterogeneous and evidence graded as very uncertain. A lack of consistent terminology describing implementation strategies was an important limitation of the review. AUTHORS' CONCLUSIONS The use of implementation strategies may result in large increases in implementation of interventions, and slight improvements in measures of student diet, and physical activity. Further research is required to assess the impact of implementation strategies on such behavioural- and obesity-related outcomes, including on measures of alcohol use, where the findings of one trial suggest it may slightly increase student risk. Given the low certainty of the available evidence for most measures further research is required to guide efforts to facilitate the translation of evidence into practice in this setting.
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Affiliation(s)
- Luke Wolfenden
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, NSW, Australia
| | - Sam McCrabb
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
| | - Courtney Barnes
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
| | - Kate M O'Brien
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
| | - Kwok W Ng
- Physical Activity for Health Research Cluster, Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland
- School of Educational Sciences and Psychology, University of Eastern Finland, Joensu, Finland
| | - Nicole K Nathan
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, NSW, Australia
| | - Rachel Sutherland
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, NSW, Australia
| | - Rebecca K Hodder
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, NSW, Australia
| | - Flora Tzelepis
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Erin Nolan
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Christopher M Williams
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, NSW, Australia
- Musculoskeletal Division, The George Institute for Global Health, Sydney, NSW, Australia
| | - Sze Lin Yoong
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, NSW, Australia
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Abstract
Context Policy-specific actions to improve food environments will support healthy population diets. Objective To identify cited barriers and facilitators to food environment policy (FEP) processes reported in the literature, exploring these according to the nature of the policy (voluntary or mandatory) and country development status. Data sources A systematic search was conducted of 10 academic and 7 grey-literature databases, national websites, and manual searches of publication references. Data extraction Data on government-led FEPs, barriers, and facilitators from key informants were collected. Data synthesis The constant-comparison approach generated core themes for barriers and facilitators. The appraisal tool developed by Hawker et al. was adopted to determine the quality of qualitative and quantitative studies. Results A total of 142 eligible studies were identified. Industry resistance or disincentive was the most cited barrier in policy development. Technical challenges were most frequently a barrier for policy implementation. Frequently cited facilitators included resource availability or maximization, strategies in policy process, and stakeholder partnership or support. Conclusions The findings from this study will strategically inform health-reform stakeholders about key elements of public health policy processes. More evidence is required from countries with human development indices ranging from low to high and on voluntary policies. Systematic Review Registration PROSPERO registration no. CRD42018115034.
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Affiliation(s)
- SeeHoe Ng
- Early Start, School of Health and Society, University of Wollongong, Wollongong, New South Wales, Australia
- School of Biosciences, Faculty of Health and Medical Sciences, Taylor's University, Subang Jaya, Selangor, Malaysia
| | - Heather Yeatman
- Early Start, School of Health and Society, University of Wollongong, Wollongong, New South Wales, Australia
| | - Bridget Kelly
- Early Start, School of Health and Society, University of Wollongong, Wollongong, New South Wales, Australia
| | - Sreelakshmi Sankaranarayanan
- School of Biosciences, Faculty of Health and Medical Sciences, Taylor's University, Subang Jaya, Selangor, Malaysia
| | - Tilakavati Karupaiah
- T. Karupaiah, School of Biosciences, Faculty of Health and Medical Sciences, Taylor's University, 47500 Subang Jaya, Selangor, Malaysia. E-mail:
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Trapp GSA, Hooper P, Thornton L, Kennington K, Sartori A, Hurworth M, Billingham W. Association between food-outlet availability near secondary schools and junk-food purchasing among Australian adolescents. Nutrition 2021; 91-92:111488. [PMID: 34626957 DOI: 10.1016/j.nut.2021.111488] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 08/07/2021] [Accepted: 09/03/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES We sought to investigate the association between food-outlet availability near Australian secondary schools and frequency of Australian students' discretionary food purchases. METHODS Secondary-school students in Perth (Western Australia) reported the frequency of their discretionary food purchases from food outlets near their school (17 schools, n = 2389 students grades 7-12, ages 12-17 y). Food-outlet availability was sourced from local governments, then geocoded. A mixed-effects model was used in analyses. RESULTS Almost half of students (45%) purchased discretionary foods from food outlets near their secondary school at least weekly. Only the density of top-ranking fast-food chain outlets near secondary schools was associated with a significant increase in the frequency of discretionary food purchases. CONCLUSIONS Availability of major fast-food chains near Australian secondary schools appears to be a key driver of Australian students' discretionary food purchasing. Restricting these outlets near schools may help reduce adolescents' discretionary food intake.
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Affiliation(s)
- Gina S A Trapp
- Telethon Kids Institute, Perth Children's Hospital, Nedlands, Western Australia, Australia; School of Population and Global Health, The University of Western Australia, Nedlands, Western Australia, Australia.
| | - Paula Hooper
- The Australian Urban Design Research Centre, School of Design, The University of Western Australia, Nedlands, Western Australia, Australia
| | - Lukar Thornton
- School of Exercise & Nutrition Science, Faculty of Health, Deakin University, Burwood, Victoria, Australia
| | - Kelly Kennington
- Cancer Council Western Australia, Subiaco, Western Australia, Australia
| | - Ainslie Sartori
- Cancer Council Western Australia, Subiaco, Western Australia, Australia
| | - Miriam Hurworth
- Telethon Kids Institute, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Wesley Billingham
- Telethon Kids Institute, Perth Children's Hospital, Nedlands, Western Australia, Australia
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Healthy snacking in the school environment: Exploring children and mothers' perspective using projective techniques. Food Qual Prefer 2021. [DOI: 10.1016/j.foodqual.2020.104173] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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McPherson M, Lai CC, Leahy D, Wessell A, Srinivasan S, Hanley B, Peeters A, Palermo C. Facilitators to healthy canteen policy implementation: A qualitative approach. Health Promot J Austr 2021; 33:216-223. [PMID: 33561895 DOI: 10.1002/hpja.465] [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: 05/13/2020] [Accepted: 02/06/2021] [Indexed: 11/10/2022] Open
Abstract
ISSUE ADDRESSED Governments across the world use guidelines and policy to support improving the quality and nutrition in school canteens, yet little is known about what makes for success in supporting school canteens. This study aimed to investigate the factors influencing the implementation of a healthy school canteen policy. METHODS A qualitative descriptive approach using interviews with a purposive sample of Victorian schools that had successfully implemented a healthy school canteen was conducted. Twelve interviews were conducted with principals (n = 4), assistant principal (n = 1), canteen managers (n = 5), food services manager (n = 1) and canteen staff members (n = 3) across six Victorian schools. Data were analysed using a content analysis approach. RESULTS Three key themes explained the adoption of policy: Values - emphasising service over profit; Knowledge - understanding of nutrition and the policy; and Support - from within and external to the school. CONCLUSIONS Implementation of school canteen policy is more likely to be achieved when a school can focus on the service and educative component of the policy and where there is a shared priority for healthy eating across the entire school community. SO WHAT?: Creating a culture of service and community engagement with a healthy school canteen may increase policy implementation and should be the focus of future health promotion efforts.
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Affiliation(s)
- Melinda McPherson
- Department of Nutrition, Dietetics and Food, Monash University, Clayton, Australia
| | - Cheuk Chi Lai
- Department of Nutrition, Dietetics and Food, Monash University, Clayton, Australia
| | - Deana Leahy
- Faculty of Education, Monash University, Clayton, Australia
| | - Adele Wessell
- Faculty of Business, Law and Arts,, Southern Cross University, Lismore, Australia
| | - Saranya Srinivasan
- Department of Nutrition, Dietetics and Food, Monash University, Clayton, Australia
| | - Bridget Hanley
- Department of Nutrition, Dietetics and Food, Monash University, Clayton, Australia
| | - Anna Peeters
- Institute for Health Transformation, Deakin University, Burwood, Australia
| | - Claire Palermo
- Department of Nutrition, Dietetics and Food, Monash University, Clayton, Australia
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Enablers and barriers to implementation of and compliance with school-based healthy food and beverage policies: a systematic literature review and meta-synthesis. Public Health Nutr 2020; 23:2840-2855. [PMID: 32317047 DOI: 10.1017/s1368980019004865] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Schools have been recognised as a potential setting for improving young peoples' food and beverage choices; however, many schools fail to adhere to healthy food and beverage policy standards. The current study aimed to explore the enablers and barriers to effective implementation of and compliance with school-based food and beverage policies. DESIGN Systematic review and meta-synthesis. Eight electronic databases were searched for articles in June 2019. Studies were eligible for inclusion if they reported on implementation and/or compliance of school-based food and/or beverage policies with outcomes relating to enablers and/or barriers. This review had no restrictions on study design, year of publication or language. Seventy-two full-text articles were assessed for eligibility, of which twenty-eight were included in this review. SETTING Studies conducted globally that focused on schools. PARTICIPANTS School-based healthy food and beverage policies. RESULTS Financial (cost of policy-compliant foods, decreased profit and revenue), physical (availability of policy-compliant foods, close geographical proximity to unhealthy food outlets) and social (poor knowledge, understanding, and negative stakeholders' attitudes towards policy) factors were the most frequently reported barriers for policy implementation. Sufficient funding, effective policy communication and management, and positive stakeholders' attitudes were the most frequently reported enablers for policy implementation. CONCLUSIONS There is a need for better communication strategies, financial and social support prior to school-based food policy implementation. Findings of this review contribute to a thorough understanding of factors that underpin best practice recommendations for the implementation of school-based food policy, and inform those responsible for improving public health nutrition.
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Examining school-level implementation of British Columbia, Canada's school food and beverage sales policy: a realist evaluation. Public Health Nutr 2020; 23:1460-1471. [PMID: 32157974 DOI: 10.1017/s1368980019003987] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To identify key school-level contexts and mechanisms associated with implementing a provincial school food and beverage policy. DESIGN Realist evaluation. Data collection included semi-structured interviews (n 23), structured questionnaires (n 62), participant observation at public events (n 3) and scans of school, school district and health authority websites (n 67). The realist heuristic, context + mechanism → outcome configuration was used to conduct the analysis. SETTING Public schools in five British Columbia (BC), Canada school districts. PARTICIPANTS Provincial and regional health and education staff, private food vendors and school-level stakeholders. RESULTS We identified four mechanisms influencing the implementation of BC's school food and beverage sales policy. First, the mandatory nature of the policy triggered some actors' implementation efforts, influenced by their normative acceptance of the educational governance system. Second, some expected implementers had an opposite response to the mandate where they ignored or 'skirted' the policy, influenced by values and beliefs about the role of government and school food. A third mechanism related to economics demonstrated ways vendors' responses to school demand for compliance with nutritional Guidelines were mediated by beliefs about food preferences of children, health and food. The last mechanism demonstrated how resource constraints and lack of capacity led otherwise motivated stakeholders to not implement the mandatory policy. CONCLUSION Implementation of the food and beverage sales policy at the school level is shaped by interactions between administrators, staff, parent volunteers and vendors with contextual factors such as varied motivations, responsibilities and capacities.
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Yii V, Palermo C, Kleve S. Population-based interventions addressing food insecurity in Australia: A systematic scoping review. Nutr Diet 2019; 77:6-18. [PMID: 31593624 DOI: 10.1111/1747-0080.12580] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 07/09/2019] [Accepted: 07/19/2019] [Indexed: 01/07/2023]
Abstract
AIM Food insecurity (FI) is a critical public health issue in Australia. Population-based interventions aiming to address the socio-ecological determinants of FI are critical for relieving and preventing it. This review aimed to map and summarise the characteristics of population-based interventions addressing household and/or community FI in Australia. METHODS A systematic scoping review was undertaken. Five databases, selected for range and relevance to FI in Australia ("CINAHL plus", "Ovid MEDLINE", "Sociological Abstracts", "Australian Public Affairs Information Service", and "Rural and Remote Health") were searched in May 2018 using the terms and relevant synonyms "FI" and "interventions". In addition a systematic grey literature search using multiple Google searches was undertaken. Data synthesis included categorisation and counting intervention type. Interventions were defined and charted by influence of at least one dimension of food security and impact on the socioeconomic, cultural and environmental conditions. RESULTS A total of 3565 published and grey literature records were identified, with the final 60 records describing 98 interventions. Few national interventions were identified, with approaches predominantly in Victoria, Northern Territory and Tasmania. Determinants related to living and working environments, food availability and food utilisation were most frequently addressed. Interventions addressing the key determinant of FI economic access were limited. A number of interventions did not appear to be associated with rigorous evaluation. CONCLUSIONS While there is evidence of population responses to FI in Australia, the effectiveness of these remains limited. Importantly there is a lack of coordinated and coherent national responses that address the range of FI determinants.
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Affiliation(s)
- Vivien Yii
- Department of Nutrition, Dietetics and Food, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Notting Hill, Victoria, Australia
| | - Claire Palermo
- Department of Nutrition, Dietetics and Food, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Notting Hill, Victoria, Australia
| | - Sue Kleve
- Department of Nutrition, Dietetics and Food, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Notting Hill, Victoria, Australia
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Factors underlying compliance with a healthy snacking initiative in the school environment: accounts of school principals in Montevideo (Uruguay). Public Health Nutr 2018; 22:726-737. [PMID: 30587269 DOI: 10.1017/s1368980018003488] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To evaluate the implementation of the Uruguayan healthy snacking initiative in primary and secondary schools in the capital, and to explore the factors underlying compliance from the perspective of school principals. DESIGN A mixed-method approach was used, which included semi-structured interviews with school principals and a survey of the foods and beverages sold and advertised in the schools. SETTING Primary and secondary schools in Montevideo (the capital city of Uruguay). PARTICIPANTS School principals. RESULTS The great majority of the schools did not comply with the initiative. Exhibition of non-recommended products was the main cause for non-compliance, followed by advertising of non-recommended products through promotional activities of food and beverage companies. Although school principals were aware of the healthy snack initiative and showed a positive attitude towards it, the majority lacked knowledge about its specific content. Factors underlying compliance with the healthy snacking initiative were related to its characteristics, characteristics of the schools, and external factors such as family habits and advertising. CONCLUSIONS Results showed that the rationale underlying the selling of products at schools favours the availability of ultra-processed products and constitutes the main barrier for the promotion of healthy dietary habits among children and adolescents. Strategies aimed at facilitating the identification of unhealthy foods and beverages and provision of incentives to canteen managers to modify their offer are recommended.
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Abstract
AbstractObjectiveTo assess (i) the extent to which stakeholders have accepted and implemented a Healthy Food and Drink Policy for schools a decade after its introduction and (ii) any resulting implications for canteen profitability.DesignOnline survey distributed via electronic newsletter to school principals.SettingWestern Australian public schools.SubjectsPrincipals, teachers, canteen managers, and parents and citizens committee presidents (n307).ResultsLarge majorities of respondents reported that the policy has made the foods and drinks provided in schools healthier (85 %) and that the policy constitutes a good opportunity to teach children about healthy eating (90 %). Only small proportions of respondents felt it had been difficult to implement the policy in their schools (13 %) or that the policy fails to accommodate parents’ rights to choose the foods consumed by their children (16 %). Most of the policy outcomes assessed in both the initial post-implementation evaluation (2008) and the 10-year follow-up evaluation (2016) demonstrated significant improvement over time.ConclusionsThe study results indicate that comprehensive school food policies can favourably influence the foods and drinks provided on school premises and can be highly acceptable to key stakeholders, without adversely affecting profitability. The results are encouraging for policy makers in other jurisdictions considering the implementation of similar policies.
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Waddingham S, Shaw K, Van Dam P, Bettiol S. What motivates their food choice? Children are key informants. Appetite 2018; 120:514-522. [DOI: 10.1016/j.appet.2017.09.029] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 09/01/2017] [Accepted: 09/27/2017] [Indexed: 10/18/2022]
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Wolfenden L, Nathan NK, Sutherland R, Yoong SL, Hodder RK, Wyse RJ, Delaney T, Grady A, Fielding A, Tzelepis F, Clinton‐McHarg T, Parmenter B, Butler P, Wiggers J, Bauman A, Milat A, Booth D, Williams CM. Strategies for enhancing the implementation of school-based policies or practices targeting risk factors for chronic disease. Cochrane Database Syst Rev 2017; 11:CD011677. [PMID: 29185627 PMCID: PMC6486103 DOI: 10.1002/14651858.cd011677.pub2] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND A number of school-based policies or practices have been found to be effective in improving child diet and physical activity, and preventing excessive weight gain, tobacco or harmful alcohol use. Schools, however, frequently fail to implement such evidence-based interventions. OBJECTIVES The primary aims of the review are to examine the effectiveness of strategies aiming to improve the implementation of school-based policies, programs or practices to address child diet, physical activity, obesity, tobacco or alcohol use.Secondary objectives of the review are to: Examine the effectiveness of implementation strategies on health behaviour (e.g. fruit and vegetable consumption) and anthropometric outcomes (e.g. BMI, weight); describe the impact of such strategies on the knowledge, skills or attitudes of school staff involved in implementing health-promoting policies, programs or practices; describe the cost or cost-effectiveness of such strategies; and describe any unintended adverse effects of strategies on schools, school staff or children. SEARCH METHODS All electronic databases were searched on 16 July 2017 for studies published up to 31 August 2016. We searched the following electronic databases: Cochrane Library including the Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE; MEDLINE In-Process & Other Non-Indexed Citations; Embase Classic and Embase; PsycINFO; Education Resource Information Center (ERIC); Cumulative Index to Nursing and Allied Health Literature (CINAHL); Dissertations and Theses; and SCOPUS. We screened reference lists of all included trials for citations of other potentially relevant trials. We handsearched all publications between 2011 and 2016 in two specialty journals (Implementation Science and Journal of Translational Behavioral Medicine) and conducted searches of the WHO International Clinical Trials Registry Platform (ICTRP) (http://apps.who.int/trialsearch/) as well as the US National Institutes of Health registry (https://clinicaltrials.gov). We consulted with experts in the field to identify other relevant research. SELECTION CRITERIA 'Implementation' was defined as the use of strategies to adopt and integrate evidence-based health interventions and to change practice patterns within specific settings. We included any trial (randomised or non-randomised) conducted at any scale, with a parallel control group that compared a strategy to implement policies or practices to address diet, physical activity, overweight or obesity, tobacco or alcohol use by school staff to 'no intervention', 'usual' practice or a different implementation strategy. DATA COLLECTION AND ANALYSIS Citation screening, data extraction and assessment of risk of bias was performed by review authors in pairs. Disagreements between review authors were resolved via consensus, or if required, by a third author. Considerable trial heterogeneity precluded meta-analysis. We narratively synthesised trial findings by describing the effect size of the primary outcome measure for policy or practice implementation (or the median of such measures where a single primary outcome was not stated). MAIN RESULTS We included 27 trials, 18 of which were conducted in the USA. Nineteen studies employed randomised controlled trial (RCT) designs. Fifteen trials tested strategies to implement healthy eating policies, practice or programs; six trials tested strategies targeting physical activity policies or practices; and three trials targeted tobacco policies or practices. Three trials targeted a combination of risk factors. None of the included trials sought to increase the implementation of interventions to delay initiation or reduce the consumption of alcohol. All trials examined multi-strategic implementation strategies and no two trials examined the same combinations of implementation strategies. The most common implementation strategies included educational materials, educational outreach and educational meetings. For all outcomes, the overall quality of evidence was very low and the risk of bias was high for the majority of trials for detection and performance bias.Among 13 trials reporting dichotomous implementation outcomes-the proportion of schools or school staff (e.g. classes) implementing a targeted policy or practice-the median unadjusted (improvement) effect sizes ranged from 8.5% to 66.6%. Of seven trials reporting the percentage of a practice, program or policy that had been implemented, the median unadjusted effect (improvement), relative to the control ranged from -8% to 43%. The effect, relative to control, reported in two trials assessing the impact of implementation strategies on the time per week teachers spent delivering targeted policies or practices ranged from 26.6 to 54.9 minutes per week. Among trials reporting other continuous implementation outcomes, findings were mixed. Four trials were conducted of strategies that sought to achieve implementation 'at scale', that is, across samples of at least 50 schools, of which improvements in implementation were reported in three trials.The impact of interventions on student health behaviour or weight status were mixed. Three of the eight trials with physical activity outcomes reported no significant improvements. Two trials reported reductions in tobacco use among intervention relative to control. Seven of nine trials reported no between-group differences on student overweight, obesity or adiposity. Positive improvements in child dietary intake were generally reported among trials reporting these outcomes. Three trials assessed the impact of implementation strategies on the attitudes of school staff and found mixed effects. Two trials specified in the study methods an assessment of potential unintended adverse effects, of which, they reported none. One trial reported implementation support did not significantly increase school revenue or expenses and another, conducted a formal economic evaluation, reporting the intervention to be cost-effective. Trial heterogeneity, and the lack of consistent terminology describing implementation strategies, were important limitations of the review. AUTHORS' CONCLUSIONS Given the very low quality of the available evidence, it is uncertain whether the strategies tested improve implementation of the targeted school-based policies or practices, student health behaviours, or the knowledge or attitudes of school staff. It is also uncertain if strategies to improve implementation are cost-effective or if they result in unintended adverse consequences. Further research is required to guide efforts to facilitate the translation of evidence into practice in this setting.
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Lawlis T, Eckley D, Jamieson M, Knox M. Scoping study investigating stakeholder perceptions and use of school canteens in an Australian city. Nutr Diet 2017; 74:502-508. [DOI: 10.1111/1747-0080.12363] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 04/09/2017] [Accepted: 05/22/2017] [Indexed: 11/26/2022]
Affiliation(s)
- Tanya Lawlis
- School of Public Health and Nutrition; University of Canberra; Canberra Australian Capital Territory Australia
- University of Canberra-Health Research Institute (UC-HRI); University of Canberra; Canberra Australian Capital Territory Australia
| | - Dionne Eckley
- School of Public Health and Nutrition; University of Canberra; Canberra Australian Capital Territory Australia
| | - Maggie Jamieson
- School of Public Health and Nutrition; University of Canberra; Canberra Australian Capital Territory Australia
- University of Canberra-Health Research Institute (UC-HRI); University of Canberra; Canberra Australian Capital Territory Australia
| | - Melissa Knox
- School of Public Health and Nutrition; University of Canberra; Canberra Australian Capital Territory Australia
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Abstract
AbstractObjectiveThe Crunch&Sip programme is a school-based nutrition initiative designed to increase the fruit, vegetable and water intakes of primary-school children. In recognition of the notable deficits in children’s vegetable consumption, the present study explored the receptivity of school staff to a realignment of the Crunch&Sip programme to feature a primary focus on vegetable consumption. This involved investigating school staff members’ perceptions of relevant barriers, motivators and facilitators.DesignA multi-method approach was adopted that involved four focus groups and a survey (administered in paper and online formats) containing a mixture of open- and closed-ended items.SettingWestern Australia.SubjectsStaff from Western Australian schools participated in the focus groups (n37) and survey (n620).ResultsSchool staff were strongly supportive of modifying the Crunch&Sip programme to focus primarily on children’s vegetable consumption and this was generally considered to be a feasible change to implement. Possible barriers identified included children’s taste preferences and a perceived lack of parental support. Suggested strategies to overcome these barriers were education sessions for parents and children, teachers modelling vegetable consumption for their students and integrating vegetable-related topics into the school curriculum.ConclusionsSchool staff are likely to support the introduction of school-based nutrition programmes that specifically encourage the consumption of vegetables. Potential barriers may be overcome through strategies to engage parents and children.
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Wolfenden L, Nathan N, Janssen LM, Wiggers J, Reilly K, Delaney T, Williams CM, Bell C, Wyse R, Sutherland R, Campbell L, Lecathelinais C, Oldmeadow C, Freund M, Yoong SL. Multi-strategic intervention to enhance implementation of healthy canteen policy: a randomised controlled trial. Implement Sci 2017; 12:6. [PMID: 28077151 PMCID: PMC5225642 DOI: 10.1186/s13012-016-0537-9] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2016] [Accepted: 12/13/2016] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Internationally, governments have implemented school-based nutrition policies to restrict the availability of unhealthy foods from sale. The aim of the trial was to assess the effectiveness of a multi-strategic intervention to increase implementation of a state-wide healthy canteen policy. The impact of the intervention on the energy, total fat, and sodium of children's canteen purchases and on schools' canteen revenue was also assessed. METHODS Australian primary schools with a canteen were randomised to receive a 12-14-month, multi-strategic intervention or to a no intervention control group. The intervention sought to increase implementation of a state-wide healthy canteen policy which required schools to remove unhealthy items (classified as 'red' or 'banned') from regular sale and encouraged schools to 'fill the menu' with healthy items (classified as 'green'). The intervention strategies included allocation of a support officer to assist with policy implementation, engagement of school principals and parent committees, consensus processes with canteen managers, training, provision of tools and resources, academic detailing, performance feedback, recognition and marketing initiatives. Data were collected at baseline (April to September, 2013) and at completion of the implementation period (November, 2014 to April, 2015). RESULTS Seventy schools participated in the trial. Relative to control, at follow-up, intervention schools were significantly more likely to have menus without 'red' or 'banned' items (RR = 21.11; 95% CI 3.30 to 147.28; p ≤ 0.01) and to have at least 50% of menu items classified as 'green' (RR = 3.06; 95% CI 1.64 to 5.68; p ≤ 0.01). At follow-up, student purchases from intervention school canteens were significantly lower in total fat (difference = -1.51 g; 95% CI -2.84 to -0.18; p = 0.028) compared to controls, but not in energy (difference = -132.32 kJ; 95% CI -280.99 to 16.34; p = 0.080) or sodium (difference = -46.81 mg; 95% CI -96.97 to 3.35; p = 0.067). Canteen revenue did not differ significantly between groups. CONCLUSION Poor implementation of evidence-based school nutrition policies is a problem experienced by governments internationally, and one with significant implications for public health. The study makes an important contribution to the limited experimental evidence regarding strategies to improve implementation of school nutrition policies and suggests that, with multi-strategic support, implementation of healthy canteen policies can be achieved in most schools. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry ( ACTRN12613000311752 ).
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Affiliation(s)
- Luke Wolfenden
- Hunter New England Population Health, Locked Bag 10 Longworth Ave, Wallsend, New South Wales 2289 Australia
- The University of Newcastle, C/O Hunter New England Population Health, Locked Bag 10 Longworth Ave, Wallsend, New South Wales 2289 Australia
| | - Nicole Nathan
- Hunter New England Population Health, Locked Bag 10 Longworth Ave, Wallsend, New South Wales 2289 Australia
| | - Lisa M. Janssen
- Hunter New England Population Health, Locked Bag 10 Longworth Ave, Wallsend, New South Wales 2289 Australia
- The University of Newcastle, C/O Hunter New England Population Health, Locked Bag 10 Longworth Ave, Wallsend, New South Wales 2289 Australia
| | - John Wiggers
- Hunter New England Population Health, Locked Bag 10 Longworth Ave, Wallsend, New South Wales 2289 Australia
- The University of Newcastle, C/O Hunter New England Population Health, Locked Bag 10 Longworth Ave, Wallsend, New South Wales 2289 Australia
| | - Kathryn Reilly
- Hunter New England Population Health, Locked Bag 10 Longworth Ave, Wallsend, New South Wales 2289 Australia
| | - Tessa Delaney
- Hunter New England Population Health, Locked Bag 10 Longworth Ave, Wallsend, New South Wales 2289 Australia
| | - Christopher M. Williams
- Hunter New England Population Health, Locked Bag 10 Longworth Ave, Wallsend, New South Wales 2289 Australia
- The University of Newcastle, C/O Hunter New England Population Health, Locked Bag 10 Longworth Ave, Wallsend, New South Wales 2289 Australia
| | - Colin Bell
- Waurn Ponds Campus, School of Medicine, Deakin University, Geelong, 3220 Australia
| | - Rebecca Wyse
- The University of Newcastle, C/O Hunter New England Population Health, Locked Bag 10 Longworth Ave, Wallsend, New South Wales 2289 Australia
| | - Rachel Sutherland
- Hunter New England Population Health, Locked Bag 10 Longworth Ave, Wallsend, New South Wales 2289 Australia
| | - Libby Campbell
- Hunter New England Population Health, Locked Bag 10 Longworth Ave, Wallsend, New South Wales 2289 Australia
| | - Christophe Lecathelinais
- Hunter New England Population Health, Locked Bag 10 Longworth Ave, Wallsend, New South Wales 2289 Australia
| | - Chris Oldmeadow
- Hunter Medical Research Institute, 1 Kookaburra Circuit, New Lambton Heights, New South Wales 2305 Australia
| | - Megan Freund
- Hunter New England Population Health, Locked Bag 10 Longworth Ave, Wallsend, New South Wales 2289 Australia
| | - Sze Lin Yoong
- Hunter New England Population Health, Locked Bag 10 Longworth Ave, Wallsend, New South Wales 2289 Australia
- The University of Newcastle, C/O Hunter New England Population Health, Locked Bag 10 Longworth Ave, Wallsend, New South Wales 2289 Australia
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Lawlis T, Knox M, Jamieson M. School canteens: A systematic review of the policy, perceptions and use from an Australian perspective. Nutr Diet 2016. [DOI: 10.1111/1747-0080.12279] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Tanya Lawlis
- School of Public Health Nutrition; University of Canberra; Canberra Australian Capital Territory Australia
| | - Melissa Knox
- School of Public Health Nutrition; University of Canberra; Canberra Australian Capital Territory Australia
| | - Maggie Jamieson
- School of Public Health Nutrition; University of Canberra; Canberra Australian Capital Territory Australia
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PESCUD M, PETTIGREW S, DONOVAN RJ, COWIE S, FIELDER L. Australian children's food and drink preferences: Implications for health professionals. Nutr Diet 2012. [DOI: 10.1111/j.1747-0080.2012.01606.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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