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Boyle NB, Adolphus K, Caton SJ, Croden FC, Dye L, Glass A, Halliwell K, Hansen GL, Holm L, Jackson P, Makinwa F, Stærk B, Wilkinson N. Increasing fibre intake in the UK: lessons from the Danish Whole Grain Partnership. Br J Nutr 2024; 131:672-685. [PMID: 37737071 PMCID: PMC10803819 DOI: 10.1017/s0007114523002106] [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] [Received: 05/23/2023] [Revised: 08/16/2023] [Accepted: 09/18/2023] [Indexed: 09/23/2023]
Abstract
Diets deficient in fibre are reported globally. The associated health risks of insufficient dietary fibre are sufficiently grave to necessitate large-scale interventions to increase population intake levels. The Danish Whole Grain Partnership (DWP) is a public-private enterprise model that successfully augmented whole-grain intake in the Danish population. The potential transferability of the DWP model to Slovenia, Romania and Bosnia-Herzegovina has recently been explored. Here, we outline the feasibility of adopting the approach in the UK. Drawing on the collaborative experience of DWP partners, academics from the Healthy Soil, Healthy Food, Healthy People (H3) project and food industry representatives (Food and Drink Federation), this article examines the transferability of the DWP approach to increase whole grain and/or fibre intake in the UK. Specific consideration is given to the UK's political, regulatory and socio-economic context. We note key political, regulatory, social and cultural challenges to transferring the success of DWP to the UK, highlighting the particular challenge of increasing fibre consumption among low socio-economic status groups - which were also most resistant to interventions in Denmark. Wholesale transfer of the DWP model to the UK is considered unlikely given the absence of the key 'success factors' present in Denmark. However, the DWP provides a template against which a UK-centric approach can be developed. In the absence of a clear regulatory context for whole grain in the UK, fibre should be prioritised and public-private partnerships supported to increase the availability and acceptability of fibre-rich foods.
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Affiliation(s)
- Neil Bernard Boyle
- School of Psychology/School of Food Science & Nutrition, University of Leeds, Woodhouse Lane, Leeds, LS2 9JT, UK
| | - Katie Adolphus
- School of Psychology/School of Food Science & Nutrition, University of Leeds, Woodhouse Lane, Leeds, LS2 9JT, UK
| | - Samantha J. Caton
- School of Health and Related Research, Public Health, University of Sheffield, Sheffield, UK
| | - Fiona C. Croden
- School of Psychology/School of Food Science & Nutrition, University of Leeds, Woodhouse Lane, Leeds, LS2 9JT, UK
| | - Louise Dye
- School of Psychology/School of Food Science & Nutrition, University of Leeds, Woodhouse Lane, Leeds, LS2 9JT, UK
| | - Amy Glass
- Food and Drink Federation, London, UK
| | | | - Gitte L. Hansen
- Danish Cancer Society, Strandboulevarden 49, DK-2100 Copenhagen, Denmark
| | - Lotte Holm
- Department of Food and Resource Economics, University of Copenhagen, Frederiksberg C, Denmark
| | - Peter Jackson
- Department of Geography, University of Sheffield, Sheffield, UK
| | | | - Bente Stærk
- Danish Veterinary and Food Administration, Stationsparken 31-33, DK-2600 Copenhagen, Denmark
| | - Nicholas Wilkinson
- School of Psychology/School of Food Science & Nutrition, University of Leeds, Woodhouse Lane, Leeds, LS2 9JT, UK
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Mandracchia F, Tarro L, Llauradó E, Valls RM, Solà R. Interventions to Promote Healthy Meals in Full-Service Restaurants and Canteens: A Systematic Review and Meta-Analysis. Nutrients 2021; 13:1350. [PMID: 33919552 PMCID: PMC8073122 DOI: 10.3390/nu13041350] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 04/13/2021] [Accepted: 04/16/2021] [Indexed: 11/16/2022] Open
Abstract
Out-of-home eating is increasing, but evidence about its healthiness is limited. The present systematic review and meta-analysis aimed to elucidate the effectiveness of full-service restaurant and canteen-based interventions in increasing the dietary intake, food availability, and food purchase of healthy meals. Studies from 2000-2020 were searched in Medline, Scopus, and Cochrane Library using the PRISMA checklist. A total of 35 randomized controlled trials (RCTs) and 6 non-RCTs were included in the systematic review and analyzed by outcome, intervention strategies, and settings (school, community, workplace). The meta-analysis included 16 RCTs (excluding non-RCTs for higher quality). For dietary intake, the included RCTs increased healthy foods (+0.20 servings/day; 0.12 to 0.29; p < 0.001) and decreased fat intake (-9.90 g/day; -12.61 to -7.19; p < 0.001), favoring the intervention group. For food availability, intervention schools reduced the risk of offering unhealthy menu items by 47% (RR 0.53; 0.34 to 0.85; p = 0.008). For food purchases, a systematic review showed that interventions could be partially effective in improving healthy foods. Lastly, restaurant- and canteen-based interventions improved the dietary intake of healthy foods, reduced fat intake, and increased the availability of healthy menus, mainly in schools. Higher-quality RCTs are needed to strengthen the results. Moreover, from our results, intervention strategy recommendations are provided.
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Affiliation(s)
- Floriana Mandracchia
- Functional Nutrition, Oxidation, and Cardiovascular Diseases Group (NFOC-Salut), Healthy Environment Chair, Facultat de Medicina i Ciències de la Salut, Universitat Rovira i Virgili, 43201 Reus, Spain; (F.M.); (L.T.); (R.M.V.); (R.S.)
| | - Lucia Tarro
- Functional Nutrition, Oxidation, and Cardiovascular Diseases Group (NFOC-Salut), Healthy Environment Chair, Facultat de Medicina i Ciències de la Salut, Universitat Rovira i Virgili, 43201 Reus, Spain; (F.M.); (L.T.); (R.M.V.); (R.S.)
- Institut d’Investigació Sanitaria Pere Virgili, 43204 Reus, Spain
| | - Elisabet Llauradó
- Functional Nutrition, Oxidation, and Cardiovascular Diseases Group (NFOC-Salut), Healthy Environment Chair, Facultat de Medicina i Ciències de la Salut, Universitat Rovira i Virgili, 43201 Reus, Spain; (F.M.); (L.T.); (R.M.V.); (R.S.)
| | - Rosa Maria Valls
- Functional Nutrition, Oxidation, and Cardiovascular Diseases Group (NFOC-Salut), Healthy Environment Chair, Facultat de Medicina i Ciències de la Salut, Universitat Rovira i Virgili, 43201 Reus, Spain; (F.M.); (L.T.); (R.M.V.); (R.S.)
| | - Rosa Solà
- Functional Nutrition, Oxidation, and Cardiovascular Diseases Group (NFOC-Salut), Healthy Environment Chair, Facultat de Medicina i Ciències de la Salut, Universitat Rovira i Virgili, 43201 Reus, Spain; (F.M.); (L.T.); (R.M.V.); (R.S.)
- Institut d’Investigació Sanitaria Pere Virgili, 43204 Reus, Spain
- Hospital Universitari Sant Joan de Reus, 43204 Reus, Spain
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Flure L, Pflugh Prescott M, Ajie W, Allison T, McCaffrey J. Training Preferences of School Food Service Staff Vary by Role in the School Nutrition Program. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 18:E50. [PMID: 33374767 PMCID: PMC7795387 DOI: 10.3390/ijerph18010050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 12/19/2020] [Accepted: 12/21/2020] [Indexed: 06/12/2023]
Abstract
Professional development has been identified as a critical component for school nutrition professionals (SNPs) to successfully implement school meal standards in the United States. However, training needs may vary based on different factors. This study examined (1) the topics of highest priority for SNPs; (2) preferred learning methods; (3) where and when trainings should be conducted; and (4) whether responses differ according to important factors including position type, school locale (urban vs. rural), or job experience. Participants completed surveys that included questions on demographics and preferences for learning methods and training topics (n = 492). Descriptive statistics characterized survey responses. Chi square tests assessed differences in learning method and training topic preferences by participant role, locale, and job experience; Cramer's V assessed the strength of association for each chi square result. Qualitative responses to open-ended questions were analyzed using an inductive thematic analysis method. Nearly all training topic preferences were significantly different (p < 0.001 using Bonferroni method) when stratified by role. Significant differences were also observed for school locale and years of experience, but to a lesser degree. There was less variation in learning method preferences across staff role. Qualitative results (n = 93) identified three key themes related to training needs: role-specific trainings, innovative learning methods, and geographic access. The combination of quantitative and qualitative analysis indicate that professional development for SNPs should mostly be conducted in-person, be easily accessible, and include hands-on activities. Further, training should be tailored by job role and address situational barriers unique to the geographic area.
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Affiliation(s)
- Leia Flure
- Office of Extension and Outreach, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA; (T.A.); (J.M.)
| | - Melissa Pflugh Prescott
- Department of Food Science and Human Nutrition, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA;
| | - Whitney Ajie
- Washington State Department of Health, Tumwater, WA 98501, USA;
| | - Trinity Allison
- Office of Extension and Outreach, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA; (T.A.); (J.M.)
| | - Jennifer McCaffrey
- Office of Extension and Outreach, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA; (T.A.); (J.M.)
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Asada Y, Mitric S, Chriqui JF. Addressing Equity in Rural Schools: Opportunities and Challenges for School Meal Standards Implementation. THE JOURNAL OF SCHOOL HEALTH 2020; 90:779-786. [PMID: 32820533 DOI: 10.1111/josh.12943] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 02/06/2020] [Accepted: 05/24/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Few studies examine why rural public schools have weaker policies and practices related to school nutrition environments compared to their urban counterparts. It is important to understand this disparity because federal school meal standards aim for children to access health-promoting nutrition environments. In this study, we identify challenges and opportunities for the implementation of school meal standards in rural high schools. METHODS We interviewed 38 rural school professionals from 22 high schools across 7 states. School professionals included food service directors, principals, school nurses, and teachers. Team coding in Atlas.ti Qualitative Data Analysis software v8 and principles of comparative analysis were employed to generate themes related to challenges and opportunities. RESULTS Overall, school professionals described improvements with implementation experiences and student acceptance over time. Key challenges included the negative influences of home and community food environments and limited staff size and capacity. Key opportunities involved joining co-ops to enhance purchasing power, leveraging state technical assistance, and forming external partnerships. CONCLUSIONS This study offers insights from a broad range of rural school professionals' implementation experiences. The findings can inform governments and technical assistance agencies working with rural schools and school districts to facilitate implementation and sustainability of initiatives.
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Affiliation(s)
- Yuka Asada
- Institute for Health Research and Policy, School of Public Health, University of Illinois Chicago, 1747 W Roosevelt Rd M/C 275, Chicago, IL, 60608
| | - Svetlana Mitric
- College of Education, University of Illinois at Chicago, 1040 W Harrison St, Chicago, IL, 60607
| | - Jamie F Chriqui
- Division of Health Policy & Administration and Institute for Health Research and Policy, School of Public Health, University of Illinois Chicago, 1603 W. Taylor Street, MC 923, Chicago, 60608
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Hollands GJ, Carter P, Anwer S, King SE, Jebb SA, Ogilvie D, Shemilt I, Higgins JPT, Marteau TM. Altering the availability or proximity of food, alcohol, and tobacco products to change their selection and consumption. Cochrane Database Syst Rev 2019; 9:CD012573. [PMID: 31482606 PMCID: PMC6953356 DOI: 10.1002/14651858.cd012573.pub3] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Overconsumption of food, alcohol, and tobacco products increases the risk of non-communicable diseases. Interventions to change characteristics of physical micro-environments where people may select or consume these products - including shops, restaurants, workplaces, and schools - are of considerable public health policy and research interest. This review addresses two types of intervention within such environments: altering the availability (the range and/or amount of options) of these products, or their proximity (the distance at which they are positioned) to potential consumers. OBJECTIVES 1. To assess the impact on selection and consumption of altering the availability or proximity of (a) food (including non-alcoholic beverages), (b) alcohol, and (c) tobacco products.2. To assess the extent to which the impact of these interventions is modified by characteristics of: i. studies, ii. interventions, and iii. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, PsycINFO, and seven other published or grey literature databases, as well as trial registries and key websites, up to 23 July 2018, followed by citation searches. SELECTION CRITERIA We included randomised controlled trials with between-participants (parallel group) or within-participants (cross-over) designs. Eligible studies compared effects of exposure to at least two different levels of availability of a product or its proximity, and included a measure of selection or consumption of the manipulated product. DATA COLLECTION AND ANALYSIS We used a novel semi-automated screening workflow and applied standard Cochrane methods to select eligible studies, collect data, and assess risk of bias. In separate analyses for availability interventions and proximity interventions, we combined results using random-effects meta-analysis and meta-regression models to estimate summary effect sizes (as standardised mean differences (SMDs)) and to investigate associations between summary effect sizes and selected study, intervention, or participant characteristics. We rated the certainty of evidence for each outcome using GRADE. MAIN RESULTS We included 24 studies, with the majority (20/24) giving concerns about risk of bias. All of the included studies investigated food products; none investigated alcohol or tobacco. The majority were conducted in laboratory settings (14/24), with adult participants (17/24), and used between-participants designs (19/24). All studies were conducted in high-income countries, predominantly in the USA (14/24).Six studies investigated availability interventions, of which two changed the absolute number of different options available, and four altered the relative proportion of less-healthy (to healthier) options. Most studies (4/6) manipulated snack foods or drinks. For selection outcomes, meta-analysis of three comparisons from three studies (n = 154) found that exposure to fewer options resulted in a large reduction in selection of the targeted food(s): SMD -1.13 (95% confidence interval (CI) -1.90 to -0.37) (low certainty evidence). For consumption outcomes, meta-analysis of three comparisons from two studies (n = 150) found that exposure to fewer options resulted in a moderate reduction in consumption of those foods, but with considerable uncertainty: SMD -0.55 (95% CI -1.27 to 0.18) (low certainty evidence).Eighteen studies investigated proximity interventions. Most (14/18) changed the distance at which a snack food or drink was placed from the participants, whilst four studies changed the order of meal components encountered along a line. For selection outcomes, only one study with one comparison (n = 41) was identified, which found that food placed farther away resulted in a moderate reduction in its selection: SMD -0.65 (95% CI -1.29 to -0.01) (very low certainty evidence). For consumption outcomes, meta-analysis of 15 comparisons from 12 studies (n = 1098) found that exposure to food placed farther away resulted in a moderate reduction in its consumption: SMD -0.60 (95% CI -0.84 to -0.36) (low certainty evidence). Meta-regression analyses indicated that this effect was greater: the farther away the product was placed; when only the targeted product(s) was available; when participants were of low deprivation status; and when the study was at high risk of bias. AUTHORS' CONCLUSIONS The current evidence suggests that changing the number of available food options or altering the positioning of foods could contribute to meaningful changes in behaviour, justifying policy actions to promote such changes within food environments. However, the certainty of this evidence as assessed by GRADE is low or very low. To enable more certain and generalisable conclusions about these potentially important effects, further research is warranted in real-world settings, intervening across a wider range of foods - as well as alcohol and tobacco products - and over sustained time periods.
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Affiliation(s)
- Gareth J Hollands
- University of CambridgeBehaviour and Health Research UnitForvie SiteRobinson WayCambridgeUKCB2 0SR
| | - Patrice Carter
- University College LondonCentre for Outcomes Research and Effectiveness1‐19 Torrington PlaceLondonUKWC1E 7HB
| | - Sumayya Anwer
- University of BristolPopulation Health Sciences, Bristol Medical SchoolCanynge Hall, 39 Whatley RoadBristolUKBS8 2PS
| | - Sarah E King
- University of CambridgeBehaviour and Health Research UnitForvie SiteRobinson WayCambridgeUKCB2 0SR
| | - Susan A Jebb
- University of OxfordNuffield Department of Primary Care Health SciencesRadcliffe Observatory QuarterWoodstock RoadOxfordOxfordshireUKOX2 6GG
| | - David Ogilvie
- University of CambridgeMRC Epidemiology UnitBox 285Cambridge Biomedical CampusCambridgeUKCB2 0QQ
| | - Ian Shemilt
- University College LondonEPPI‐Centre10 Woburn SquareLondonUKWC1H 0NR
| | - Julian P T Higgins
- University of BristolPopulation Health Sciences, Bristol Medical SchoolCanynge Hall, 39 Whatley RoadBristolUKBS8 2PS
| | - Theresa M Marteau
- University of CambridgeBehaviour and Health Research UnitForvie SiteRobinson WayCambridgeUKCB2 0SR
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Hollands GJ, Carter P, Anwer S, King SE, Jebb SA, Ogilvie D, Shemilt I, Higgins JPT, Marteau TM. Altering the availability or proximity of food, alcohol, and tobacco products to change their selection and consumption. Cochrane Database Syst Rev 2019; 8:CD012573. [PMID: 31452193 PMCID: PMC6710643 DOI: 10.1002/14651858.cd012573.pub2] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Overconsumption of food, alcohol, and tobacco products increases the risk of non-communicable diseases. Interventions to change characteristics of physical micro-environments where people may select or consume these products - including shops, restaurants, workplaces, and schools - are of considerable public health policy and research interest. This review addresses two types of intervention within such environments: altering the availability (the range and/or amount of options) of these products, or their proximity (the distance at which they are positioned) to potential consumers. OBJECTIVES 1. To assess the impact on selection and consumption of altering the availability or proximity of (a) food (including non-alcoholic beverages), (b) alcohol, and (c) tobacco products.2. To assess the extent to which the impact of these interventions is modified by characteristics of: i. studies, ii. interventions, and iii. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, PsycINFO, and seven other published or grey literature databases, as well as trial registries and key websites, up to 23 July 2018, followed by citation searches. SELECTION CRITERIA We included randomised controlled trials with between-participants (parallel group) or within-participants (cross-over) designs. Eligible studies compared effects of exposure to at least two different levels of availability of a product or its proximity, and included a measure of selection or consumption of the manipulated product. DATA COLLECTION AND ANALYSIS We used a novel semi-automated screening workflow and applied standard Cochrane methods to select eligible studies, collect data, and assess risk of bias. In separate analyses for availability interventions and proximity interventions, we combined results using random-effects meta-analysis and meta-regression models to estimate summary effect sizes (as standardised mean differences (SMDs)) and to investigate associations between summary effect sizes and selected study, intervention, or participant characteristics. We rated the certainty of evidence for each outcome using GRADE. MAIN RESULTS We included 24 studies, with the majority (20/24) giving concerns about risk of bias. All of the included studies investigated food products; none investigated alcohol or tobacco. The majority were conducted in laboratory settings (14/24), with adult participants (17/24), and used between-participants designs (19/24). All studies were conducted in high-income countries, predominantly in the USA (14/24).Six studies investigated availability interventions, of which two changed the absolute number of different options available, and four altered the relative proportion of less-healthy (to healthier) options. Most studies (4/6) manipulated snack foods or drinks. For selection outcomes, meta-analysis of three comparisons from three studies (n = 154) found that exposure to fewer options resulted in a large reduction in selection of the targeted food(s): SMD -1.13 (95% confidence interval (CI) -1.90 to -0.37) (low certainty evidence). For consumption outcomes, meta-analysis of three comparisons from two studies (n = 150) found that exposure to fewer options resulted in a moderate reduction in consumption of those foods, but with considerable uncertainty: SMD -0.55 (95% CI -1.27 to 0.18) (low certainty evidence).Eighteen studies investigated proximity interventions. Most (14/18) changed the distance at which a snack food or drink was placed from the participants, whilst four studies changed the order of meal components encountered along a line. For selection outcomes, only one study with one comparison (n = 41) was identified, which found that food placed farther away resulted in a moderate reduction in its selection: SMD -0.65 (95% CI -1.29 to -0.01) (very low certainty evidence). For consumption outcomes, meta-analysis of 15 comparisons from 12 studies (n = 1098) found that exposure to food placed farther away resulted in a moderate reduction in its consumption: SMD -0.60 (95% CI -0.84 to -0.36) (low certainty evidence). Meta-regression analyses indicated that this effect was greater: the farther away the product was placed; when only the targeted product(s) was available; when participants were of low deprivation status; and when the study was at high risk of bias. AUTHORS' CONCLUSIONS The current evidence suggests that changing the number of available food options or altering the positioning of foods could contribute to meaningful changes in behaviour, justifying policy actions to promote such changes within food environments. However, the certainty of this evidence as assessed by GRADE is low or very low. To enable more certain and generalisable conclusions about these potentially important effects, further research is warranted in real-world settings, intervening across a wider range of foods - as well as alcohol and tobacco products - and over sustained time periods.
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Affiliation(s)
- Gareth J Hollands
- University of CambridgeBehaviour and Health Research UnitForvie SiteRobinson WayCambridgeUKCB2 0SR
| | - Patrice Carter
- University College LondonCentre for Outcomes Research and Effectiveness1‐19 Torrington PlaceLondonUKWC1E 7HB
| | - Sumayya Anwer
- University of BristolPopulation Health Sciences, Bristol Medical SchoolCanynge Hall, 39 Whatley RoadBristolUKBS8 2PS
| | - Sarah E King
- University of CambridgeBehaviour and Health Research UnitForvie SiteRobinson WayCambridgeUKCB2 0SR
| | - Susan A Jebb
- University of OxfordNuffield Department of Primary Care Health SciencesRadcliffe Observatory QuarterWoodstock RoadOxfordUKOX2 6GG
| | - David Ogilvie
- University of CambridgeMRC Epidemiology UnitBox 285Cambridge Biomedical CampusCambridgeUKCB2 0QQ
| | - Ian Shemilt
- University College LondonEPPI‐Centre10 Woburn SquareLondonUKWC1H 0NR
| | - Julian P T Higgins
- University of BristolPopulation Health Sciences, Bristol Medical SchoolCanynge Hall, 39 Whatley RoadBristolUKBS8 2PS
| | - Theresa M Marteau
- University of CambridgeBehaviour and Health Research UnitForvie SiteRobinson WayCambridgeUKCB2 0SR
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Suthers R, Broom M, Beck E. Key Characteristics of Public Health Interventions Aimed at Increasing Whole Grain Intake: A Systematic Review. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2018; 50:813-823. [PMID: 30076022 DOI: 10.1016/j.jneb.2018.05.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 05/13/2018] [Accepted: 05/16/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To identify characteristics of successful public health interventions aimed at increasing whole grain consumption. METHODS The Preferred Reporting Items for Systematic Reviews and Meta-analyses framework, guided by higher-quality interventions with greatest effect size, was adopted to conduct a systematic literature review. RESULTS Of 8,500 initial records, only 8 interventions with demonstrated reach (up to national populations) and effectiveness (increasing consumption 8-27 g/d) were eligible for synthesis. Their characteristics included multiple stakeholder involvement, specified target intakes in dietary guidelines, manufacturer codes of practice, product reformulation, evidence-based educational resources, social media, and community events with tasting and preparation opportunities. Empowerment of food service providers was also linked to success. CONCLUSIONS AND IMPLICATIONS Successful interventions require multifaceted strategies across multiple aspects of the food system, underpinned by multiple stakeholder partnerships. Uniform capture of interventions using an online, searchable, public domain resource may provide a strategy to enable health professionals globally to plan local interventions across cultural settings, drawing on best practice guidelines developed from interventions with demonstrated reach and effectiveness.
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Affiliation(s)
- Ronel Suthers
- School of Medicine, Faculty of Science, Medicine, and Health, University of Wollongong, Australia.
| | | | - Eleanor Beck
- School of Medicine, Faculty of Science, Medicine, and Health, University of Wollongong, Australia
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Au LE, Gurzo K, Gosliner W, Webb KL, Crawford PB, Ritchie LD. Eating School Meals Daily Is Associated with Healthier Dietary Intakes: The Healthy Communities Study. J Acad Nutr Diet 2018; 118:1474-1481.e1. [PMID: 29555435 PMCID: PMC6064655 DOI: 10.1016/j.jand.2018.01.010] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 01/11/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Research on the association between school meal consumption and overall dietary intake post-Healthy Hunger-Free Kids Act implementation is limited. OBJECTIVE This study examines the association between frequency of participating in the National School Lunch and School Breakfast Programs and children's dietary intakes. DESIGN The Healthy Communities Study was a cross-sectional observational study conducted between 2013 and 2015. PARTICIPANTS AND SETTING US children aged 4 to 15 years (n=5,106) were included. MAIN OUTCOME MEASURES Dietary measures were assessed using the National Health and Nutrition Examination Survey Dietary Screener Questionnaire. Dietary intake included fruit and vegetables, fiber, whole grains, dairy, calcium, total added sugar, sugar-sweetened beverages, and energy-dense foods of minimal nutritional value. STATISTICAL ANALYSIS Multivariate statistical models assessed associations between frequency of eating school breakfast or lunch (every day vs not every day) and dietary intake, adjusting for child- and community-level covariates. RESULTS Children who ate school breakfast every day compared with children who ate 0 to 4 days/wk, reported consuming more fruits and vegetables (0.1 cup/day, 95% CI: 0.01, 0.1), dietary fiber (0.4 g/day, 95% CI: 0.2, 0.7), whole grains (0.1 oz/day, 95% CI: 0.05, 0.1), dairy (0.1 cup/day, 95% CI: 0.05, 0.1), and calcium (34.5 mg/day, 95% CI: 19.1, 49.9). Children who ate school lunch every day, compared with those who ate less frequently, consumed more dairy (0.1 cup/day, 95% CI: 0.1, 0.2) and calcium (32.4 mg/day, 95% CI: 18.1, 46.6). No significant associations were observed between school meal consumption and energy-dense nutrient-poor foods or added sugars. CONCLUSIONS Eating school breakfast and school lunch every day by US schoolchildren was associated with modestly healthier dietary intakes. These findings suggest potential nutritional benefits of regularly consuming school meals.
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Turner L, Leider J, Piekarz-Porter E, Schwartz MB, Merlo C, Brener N, Chriqui JF. State Laws Are Associated with School Lunch Duration and Promotion Practices. J Acad Nutr Diet 2018; 118:455-463. [PMID: 29111088 PMCID: PMC6049821 DOI: 10.1016/j.jand.2017.08.116] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 08/22/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND The changes in school meal programs stemming from the Healthy, Hunger-Free Kids Act of 2010 have expanded interest in strategies that increase student participation in school lunch and reduce plate waste. However, it remains unclear what factors are associated with schools' use of such strategies. OBJECTIVE This study examines whether state laws are associated with two types of school meal-related practices: (a) using promotional strategies (ie, taste tests, using posters or announcements) and (b) duration of lunch periods. DESIGN This cross-sectional study utilized the nationally representative 2014 School Health Policies and Practices Study, combined with corresponding state laws gathered by the National Wellness Policy Study. School data were available from 414 public schools in 43 states. MAIN OUTCOME MEASURES Outcome measures included 16 strategies to promote school meals and the amount of time students had to eat lunch after being seated. STATISTICAL ANALYSES PERFORMED Multivariate logistic regression and Poisson regression were used to examine associations between state laws and school practices, after accounting for school demographic characteristics. RESULTS Compared to schools in states with no law about engaging stakeholders in meal programs, schools in states with a law were more likely to conduct taste tests (64% vs 44%, P=0.016), collect suggestions from students (67% vs 50%, P=0.017), and invite family members to a school meal (71% vs 53%, P=0.015). Schools used more promotion strategies in states with a law than in states without a law (mean=10.4 vs 8.8, P=0.003). Schools were more likely to provide students at least 30 minutes to eat lunch after being seated in states with laws that addressed a minimum amount of time for lunch duration (43% vs 27%, P=0.042). CONCLUSIONS State-level policy provisions are associated with school practices. Policy development in more states may support school practices that promote lunch participation and consumption.
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Blumenschine M, Adams M, Bruening M. Prevalence of and Differences in Salad Bar Implementation in Rural Versus Urban Arizona Schools. J Acad Nutr Diet 2017; 118:448-454. [PMID: 29198842 DOI: 10.1016/j.jand.2017.09.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 09/10/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND Rural children consume more calories per day on average than urban children, and they are less likely to consume fruit. Self-service salad bars have been proposed as an effective approach to better meet the National School Lunch Program's fruit and vegetable recommendations. No studies have examined how rural and urban schools differ in the implementation of school salad bars. OBJECTIVE To compare the prevalence of school-lunch salad bars and differences in implementation between urban and rural Arizona schools. DESIGN Secondary analysis of a cross-sectional web-based survey. PARTICIPANTS/SETTING School nutrition managers (N=596) in the state of Arizona. MAIN OUTCOMES MEASURED National Center for Education Statistics locale codes defined rural and urban classifications. Barriers to salad bar implementation were examined among schools that have never had, once had, and currently have a school salad bar. Promotional practices were examined among schools that once had and currently have a school salad bar. STATISTICAL ANALYSES PERFORMED Generalized estimating equation models were used to compare urban and rural differences in presence and implementation of salad bars, adjusting for school-level demographics and the clustering of schools within districts. RESULTS After adjustment, the prevalence of salad bars did not differ between urban and rural schools (46.9%±4.3% vs 46.8%±8.5%, respectively). Rural schools without salad bars more often reported perceived food waste and cost of produce as barriers to implementing salad bars, and funding was a necessary resource for offering a salad bar in the future, as compared with urban schools (P<0.05). No other geographic differences were observed in reported salad bar promotion, challenges, or resources among schools that currently have or once had a salad bar. CONCLUSIONS After adjustment, salad bar prevalence, implementation practices, and concerns are similar across geographic settings. Future research is needed to investigate methods to address cost and food waste concerns in rural areas.
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Turner L, Ohri-Vachaspati P, Powell L, Chaloupka FJ. Improvements and Disparities in Types of Foods and Milk Beverages Offered in Elementary School Lunches, 2006-2007 to 2013-2014. Prev Chronic Dis 2016; 13:E39. [PMID: 26986542 PMCID: PMC4797477 DOI: 10.5888/pcd13.150395] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Children consume much of their daily energy intake at school. School district policies, state laws, and national policies, such as revisions to the US Department of Agriculture's school meals standards, may affect the types of foods and beverages offered in school lunches over time. METHODS This study evaluated changes and disparities in school lunch characteristics from 2006-2007 to 2013-2014. Data were obtained from annual cross-sectional surveys at 4,630 public elementary schools participating in the National School Lunch Program. Multivariate logistic regressions were conducted to examine lunch characteristics. RESULTS The percentage of schools regularly offering healthful items such as vegetables (other than potatoes), fresh fruit, salad bars, whole grains, and more healthful pizzas increased significantly from 2006-2007 to 2013-2014, and the percentage of schools offering less healthful items such as fried potatoes, regular pizza, and high-fat milks decreased significantly. Nevertheless, disparities were evident in 2013-2014. Schools in the West were significantly more likely to offer salad bars than were schools in the Northeast, Midwest, or South (adjusted prevalence: West, 66.3%; Northeast, 22.3%; Midwest, 20.8%; South, 18.3%). Majority-black or majority-Latino schools were significantly less likely to offer fresh fruit than were predominantly white schools (adjusted prevalence: majority black, 61.3%; majority Latino, 73.0%; predominantly white, 87.8%). Schools with low socioeconomic status were significantly less likely to offer salads regularly than were schools with middle or high socioeconomic status (adjusted prevalence: low, 38.5%; middle, 47.4%; high, 59.3%). CONCLUSION Much progress has been made in improving the quality of school lunches in US public elementary schools, but additional opportunities for improvement remain.
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Affiliation(s)
- Lindsey Turner
- College of Education, Boise State University, 1910 University Dr, #1745, Boise, ID 83716.
| | - Punam Ohri-Vachaspati
- School of Nutrition and Health Promotion, Arizona State University, Phoenix, Arizona
| | - Lisa Powell
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, Illinois
| | - Frank J Chaloupka
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, Illinois
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Abstract
Within most developed countries, rural residents are more likely to be obese and overweight compared to their urban counterparts. Studies of specific rural communities have found that the limited availability of healthy foods in the community and home as well as individual characteristics and preferences contribute to poor diet and overweight. The rural food environment is varied and may be affected by climate, regional and cultural preferences, transportation access, and remoteness among other factors. Given this diversity and the vulnerabilities of rural residents, who are more likely to have low-income, substandard housing or low educational attainment compared to their urban counterparts, policy and programmatic interventions should target specific needs and communities. This review will describe the rural community, home, and individual food environments and what is known about their roles in healthy eating.
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Affiliation(s)
- Jennifer D Lenardson
- Maine Rural Health Research Center, University of Southern Maine, 432B Wishcamper Center, 34 Bedford Street, Portland, ME, 04104, USA.
| | - Anush Y Hansen
- Maine Rural Health Research Center, University of Southern Maine, 404G Wishcamper Center, 34 Bedford Street, Portland, ME, 04104, USA.
| | - David Hartley
- Maine Rural Health Research Center, University of Southern Maine, 418 Wishcamper Center, 34 Bedford Street, Portland, ME, 04104, USA.
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