1
|
Gance-Cleveland B, Frenn M, Browne N, Greenberg CS, Snethen JA, Hodges EA, Fial AV, Small L, Irving SY. A scoping review of the role of policy in mitigating childhood obesity in underserved populations using the RE-AIM framework. Worldviews Evid Based Nurs 2024. [PMID: 38584314 DOI: 10.1111/wvn.12725] [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: 10/10/2023] [Revised: 03/06/2024] [Accepted: 03/07/2024] [Indexed: 04/09/2024]
Abstract
BACKGROUND Childhood obesity is an escalating crisis in the United States. Health policy may impact this epidemic which disproportionally affects underserved populations. AIM The aim was to use the reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) framework to assess health policy impact on preventing or treating school-aged children (5 > 18 years) with obesity in underserved populations. METHODS A scoping review of 842 articles was conducted. Twenty-four articles met the inclusion criteria and underwent data extraction. RESULTS Twelve studies included subgroup analysis, with four suggesting an impact of policy on at-risk groups. None of the 24 studies fully applied the RE-AIM framework. Policies positively impacted childhood obesity in 12 studies across the sample. LINKING EVIDENCE TO ACTION Our review revealed inconsistent evidence for the effectiveness of policy on childhood obesity, perhaps due to the lack of focus on the social determinants of health. In addition, many studies did not evaluate the outcomes for underserved populations. Therefore, we propose more attention to social determinants in future legislation and evaluation of policy effectiveness on underserved populations. Findings identify an urgent need for the design, implementation, and evaluation of policies specifically directed to address the inequities of racism, social injustices, and social determinants of health that impact childhood obesity in the United States. Future work needs to identify who was reached by the policy, who benefitted from the policy, and how policies were implemented to address obesity-related health disparities. Nurses should advocate for the evaluation of childhood obesity policies, particularly in underserved populations, to determine effectiveness. Nurses, particularly those trained in population and community health and research, should advocate for policy research that considers inequities rather than controls for these variables. Multi-layered interventions can then be tailored to sub-populations and evaluated more effectively.
Collapse
Affiliation(s)
- Bonnie Gance-Cleveland
- University of Colorado, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Marilyn Frenn
- Marquette University College of Nursing, Milwaukee, Wisconsin, USA
| | | | | | - Julia A Snethen
- University of Wisconsin-Milwaukee, School of Nursing, Milwaukee, Wisconsin, USA
| | - Eric A Hodges
- The University of North Carolina at Chapel Hill School of Nursing, Chapel Hill, North Carolina, USA
| | - Alissa V Fial
- Marquette University, Raynor Memorial Libraries, Milwaukee, Wisconsin, USA
| | - Leigh Small
- Michigan State University College of Nursing, East Lansing, Michigan, USA
| | - Sharon Y Irving
- University of Pennsylvania, School of Nursing, Philadelphia, Pennsylvania, USA
| |
Collapse
|
2
|
Sanchez-Vaznaugh EV, Matsuzaki M, Acosta ME, Vasanth S, Dugay ER, Sánchez BN. "Competitive" food and beverage policies and weight status: A systematic review of the evidence among sociodemographic subgroups. Obes Rev 2024; 25:e13678. [PMID: 38151337 PMCID: PMC10947922 DOI: 10.1111/obr.13678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 09/30/2023] [Accepted: 11/13/2023] [Indexed: 12/29/2023]
Abstract
Prior studies identified variable associations between competitive food and beverage policies (CF&B) and youth obesity, potentially due to differences across population subgroups. This review summarizes the evidence on associations between CF&B policies and childhood obesity within gender, grade level/ age, race/ethnicity, and/or socioeconomic levels. PubMed, EMBASE, CINAHL, and ERIC database searches identified studies published in English in Canada and the United States between January 1, 2000, and February 28, 2022. Of the 18 selected studies, six were cross-sectional, two correlational, nine were before/after designs, and one study utilized both a cross-sectional and pre-post design. Twelve studies reported findings stratified by a single sociodemographic factor, with grade level/age as the most frequently reported. Although the evidence varied, greater consistency in direction of associations and strengths of evidence were seen among middle school students. Six studies reported findings jointly by multiple sociodemographic subgroups with evidence suggesting CF&B associations with slower rate of increase or plateaus or declines in obesity among multiple subgroups, though the strengths of evidence varied. Over the past two decades, there have been relatively limited subgroup analyses on studies about CF&B policies and childhood obesity. Studies are needed with stronger designs and analyses disaggregated, particularly by race/ethnicities and socioeconomic factors, across places and time.
Collapse
Affiliation(s)
- Emma V Sanchez-Vaznaugh
- Department of Public Health, Health Equity Institute, San Francisco State University and Center for Health Equity, University of California, San Francisco, California, USA
| | - Mika Matsuzaki
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Maria Elena Acosta
- Department of Public Health, San Francisco State University, San Francisco, California, USA
| | - Sahana Vasanth
- Department of Public Health, San Francisco State University, San Francisco, California, USA
| | - Erika Rachelle Dugay
- Department of Public Health, San Francisco State University, San Francisco, California, USA
| | - Brisa N Sánchez
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
| |
Collapse
|
3
|
Schillinger D, Bullock A, Powell C, Fukagawa NK, Greenlee MC, Towne J, Gonzalvo JD, Lopata AM, Cook JW, Herman WH. The National Clinical Care Commission Report to Congress: Leveraging Federal Policies and Programs for Population-Level Diabetes Prevention and Control: Recommendations From the National Clinical Care Commission. Diabetes Care 2023; 46:e24-e38. [PMID: 36701595 PMCID: PMC9887620 DOI: 10.2337/dc22-0619] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 10/04/2022] [Indexed: 01/27/2023]
Abstract
The etiology of type 2 diabetes is rooted in a myriad of factors and exposures at individual, community, and societal levels, many of which also affect the control of type 1 and type 2 diabetes. Not only do such factors impact risk and treatment at the time of diagnosis but they also can accumulate biologically from preconception, in utero, and across the life course. These factors include inadequate nutritional quality, poor access to physical activity resources, chronic stress (e.g., adverse childhood experiences, racism, and poverty), and exposures to environmental toxins. The National Clinical Care Commission (NCCC) concluded that the diabetes epidemic cannot be treated solely as a biomedical problem but must also be treated as a societal problem that requires an all-of-government approach. The NCCC determined that it is critical to design, leverage, and coordinate federal policies and programs to foster social and environmental conditions that facilitate the prevention and treatment of diabetes. This article reviews the rationale, scientific evidence base, and content of the NCCC's population-wide recommendations that address food systems; consumption of water over sugar-sweetened beverages; food and beverage labeling; marketing and advertising; workplace, ambient, and built environments; and research. Recommendations relate to specific federal policies, programs, agencies, and departments, including the U.S. Department of Agriculture, the Food and Drug Administration, the Federal Trade Commission, the Department of Housing and Urban Development, the Environmental Protection Agency, and others. These population-level recommendations are transformative. By recommending health-in-all-policies and an equity-based approach to governance, the NCCC Report to Congress has the potential to contribute to meaningful change across the diabetes continuum and beyond. Adopting these recommendations could significantly reduce diabetes incidence, complications, costs, and inequities. Substantial political resolve will be needed to translate recommendations into policy. Engagement by diverse members of the diabetes stakeholder community will be critical to such efforts.
Collapse
Affiliation(s)
- Dean Schillinger
- Division of General Internal Medicine, Center for Vulnerable Populations, San Francisco General Hospital, University of California San Francisco School of Medicine, San Francisco, CA
| | - Ann Bullock
- Division of Diabetes Treatment and Prevention, Indian Health Service, Rockville, MD
| | - Clydette Powell
- Division of Neurology, Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Naomi K. Fukagawa
- Beltsville Human Nutrition Research Center, U.S. Department of Agriculture Agricultural Research Service, Beltsville, MD
| | | | - Jana Towne
- Division of Diabetes Treatment and Prevention, Indian Health Service, Rockville, MD
| | - Jasmine D. Gonzalvo
- Center for Health Equity and Innovation, Purdue University/Eskenazi Health, Indianapolis, IN
| | - Aaron M. Lopata
- Maternal and Child Health Bureau, Health Resources and Services Administration, Rockville, MD
| | | | - William H. Herman
- Division of Metabolism, Endocrinology, and Diabetes, Departments of Internal Medicine and Epidemiology, University of Michigan, Ann Arbor, MI
| |
Collapse
|
4
|
Cleveland LP, Grummon AH, Konieczynski E, Mancini S, Rao A, Simon D, Block JP. Obesity prevention across the US: A review of state‐level policies from 2009 to 2019. Obes Sci Pract 2022; 9:95-102. [PMID: 37034562 PMCID: PMC10073818 DOI: 10.1002/osp4.621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 05/13/2022] [Accepted: 05/23/2022] [Indexed: 11/11/2022] Open
Abstract
Objective Uniquely, state legislators may enact obesity prevention policies tailored to each state's needs and take diverse policy approaches to address obesity prevalence. The objective of this study was to identify and describe state-level obesity-related policies between 2009 and 2019. Methods Using a database of legislation covering 2009-2019, researchers categorized obesity-related legislation by status (proposed/enacted), topic, and environment impacted. Researchers determined the number of policies proposed; enacted, by political party control; obesity prevalence, by states over time. Results 3256 obesity-related policies were proposed among 50 states and Washington DC between 2009 and 2019. Collectively, 18% (593) of policies were enacted; California (96), New and Jersey (57) enacted the most. Across environment and topics, the most enacted policies categorized in school environment (226) and school nutrition (150) topic area. Most policies were proposed (496) and enacted (77) in 2011. On average, Democrat-controlled states had higher enactment rates than Republican-controlled states, as did states with lower (vs. higher) obesity prevalence. Conclusions States have actively pursued obesity-related legislation across multiple topics and environments from 2009 to 2019, with mixed enactment rates. Evaluating the impact of these policies, alone and in combination, will be important to determine whether these state-level efforts reduce obesity.
Collapse
Affiliation(s)
- Lauren P. Cleveland
- Department of Population Medicine Harvard Pilgrim Health Care Institute & Harvard Medical School Boston Massachusetts USA
| | - Anna H. Grummon
- Department of Population Medicine Harvard Pilgrim Health Care Institute & Harvard Medical School Boston Massachusetts USA
- Department of Nutrition Harvard TH Chan School of Public Health Boston Massachusetts USA
| | - Elsa Konieczynski
- Department of Population Medicine Harvard Pilgrim Health Care Institute & Harvard Medical School Boston Massachusetts USA
| | - Sally Mancini
- Rudd Center for Food Policy and Health University of Connecticut Hartford Connecticut USA
| | - Anjali Rao
- Department of Population Medicine Harvard Pilgrim Health Care Institute & Harvard Medical School Boston Massachusetts USA
| | - Denise Simon
- Department of Population Medicine Harvard Pilgrim Health Care Institute & Harvard Medical School Boston Massachusetts USA
| | - Jason P. Block
- Department of Population Medicine Harvard Pilgrim Health Care Institute & Harvard Medical School Boston Massachusetts USA
| |
Collapse
|
5
|
Impact of the external school food environment on the associations of internal school food environment with high schoolers’ diet and body mass index. Public Health Nutr 2022; 25:3086-3095. [DOI: 10.1017/s1368980022000994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
Objective:
To examine associations of school food availability with student intake frequency and BMI, and whether the number of neighborhood food outlets modifies these associations.
Design:
Baseline assessment of a nationally representative cohort study of U.S. 10th graders. Students reported intake frequency of fruits and vegetables (FV), snacks, and soda. BMI was calculated from measured height and weight. Administrators of 72 high schools reported the frequency of school availability of FV, snacks, and soda. The number of food outlets within 1 km and 5 km were linked with geocoded school addresses. Data were analyzed using adjusted linear and logistic mixed models with multiple imputation for missing data.
Setting:
U.S. 2009-2010.
Participants:
2,263 U.S. 10th graders from the Next Generation Health Study (NEXT).
Results:
Greater school FV availability was positively associated with student FV intake. Food outlets within 5 km of schools (but not 1 km) attenuated the association of school FV availability with student intake; this was no longer significant at schools with >58 food outlets within 5 km. School food availability was not associated with student BMI or student snack or soda intake.
Conclusions:
School food availability was associated with student intake of FV, but not with snacks, soda, or BMI. Attenuation of the observed associations by the school neighborhood food environment indicates a need to find ways to support healthy student eating behaviors in neighborhoods with higher food outlet density.
Collapse
|
6
|
Pineda E, Bascunan J, Sassi F. Improving the school food environment for the prevention of childhood obesity: What works and what doesn't. Obes Rev 2021; 22:e13176. [PMID: 33462933 DOI: 10.1111/obr.13176] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 10/30/2020] [Indexed: 12/18/2022]
Abstract
The food environment has a significant influence on dietary choices, and interventions designed to modify the food environment could contribute to the prevention of childhood obesity. Many interventions have been implemented at the school level, but effectiveness in addressing childhood obesity remains unclear. We undertook a systematic review, a meta-analysis, and meta-regression analyses to assess the effectiveness of interventions on the food environment within and around schools to improve dietary intake and prevent childhood obesity. Estimates were pooled in a random-effects meta-analysis with stratification by anthropometric or dietary intake outcome. Risk of bias was formally assessed. One hundred papers were included. Interventions had a significant and meaningful effect on adiposity (body mass index [BMI] z score, standard mean difference: -0.12, 95% confidence interval: 0.15, 0.10) and fruit consumption (portions per day, standard mean difference: +0.19, 95% confidence interval: 0.16, 0.22) but not on vegetable intake. Risk of bias assessment indicated that n = 43 (81%) of non-randomized controlled studies presented a high risk of bias in the study design by not accounting for a control. Attrition bias (n = 34, 79%) and low protection of potential contamination (n = 41, 95%) presented the highest risk of bias for randomized controlled trials. Changes in the school food environment could improve children's dietary behavior and BMI, but policy actions are needed to improve surrounding school food environments to sustain healthy dietary intake and BMI.
Collapse
Affiliation(s)
- Elisa Pineda
- Centre for Health Economics & Policy Innovation (CHEPI), Imperial College Business School, London, UK.,School of Public Health, Imperial College London, London, UK
| | - Josefina Bascunan
- Centre for Health Economics & Policy Innovation (CHEPI), Imperial College Business School, London, UK
| | - Franco Sassi
- Centre for Health Economics & Policy Innovation (CHEPI), Imperial College Business School, London, UK
| |
Collapse
|
7
|
Chriqui JF, Leider J, Turner L, Piekarz-Porter E, Schwartz MB. State Wellness Policy Requirement Laws Matter for District Wellness Policy Comprehensiveness and Wellness Policy Implementation in the United States. Nutrients 2021; 13:E188. [PMID: 33435387 PMCID: PMC7827171 DOI: 10.3390/nu13010188] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 01/07/2021] [Accepted: 01/07/2021] [Indexed: 11/24/2022] Open
Abstract
Beginning with the school year 2006-2007, U.S. school districts participating in the federal Child Nutrition Programs were required to adopt and implement a local wellness policy (LWP) that included goals and/or standards for nutrition education, school meals, other foods sold or served in schools, and physical activity. A primary challenge with LWPs has been inconsistent implementation. This study examined whether state wellness policy requirement laws and district LWP comprehensiveness influence district level implementation, using law/policy data from the National Wellness Policy Study and school food authority (SFA)-reported district LWP implementation from the School Nutrition and Meal Cost Study. Generalized linear and structural equation models were used, controlling for SFA and district characteristics. SFAs in states with wellness policy requirement laws (vs. those in states without) reported implementing significantly more practices (59.56% vs. 44.57%, p < 0.01). State wellness policy requirement laws were associated with district LWP comprehensiveness (coeff.: 0.463; 95% CI: 0.123, 0.803) and district-level implementation (coeff.: 1.392; 95% CI: 0.299, 2.485). District LWP comprehensiveness was associated with district implementation (coeff.: 0.562; 95% CI: 0.072, 1.053), but did not mediate the state law-district implementation relationship. This study highlights the important role that state laws and district LWPs can play in facilitating wellness policy implementation.
Collapse
Affiliation(s)
- Jamie F. Chriqui
- Division of Health Policy and Administration, School of Public Health, University of Illinois Chicago, Chicago, IL 60612, USA;
- Institute for Health Research and Policy, University of Illinois Chicago, Chicago, IL 60608, USA;
| | - Julien Leider
- Institute for Health Research and Policy, University of Illinois Chicago, Chicago, IL 60608, USA;
| | - Lindsey Turner
- College of Education, Boise State University, 1910 University Drive, Boise, ID 83725, USA;
| | - Elizabeth Piekarz-Porter
- Division of Health Policy and Administration, School of Public Health, University of Illinois Chicago, Chicago, IL 60612, USA;
- Institute for Health Research and Policy, University of Illinois Chicago, Chicago, IL 60608, USA;
| | - Marlene B. Schwartz
- Rudd Center for Food Policy and Obesity, Department of Human Development and Family Sciences, University of Connecticut, 1 Constitution Plaza, Hartford, CT 06103, USA;
| |
Collapse
|
8
|
School nutrition laws in the US: do they influence obesity among youth in a racially/ethnically diverse state? Int J Obes (Lond) 2021; 45:2358-2368. [PMID: 34285361 PMCID: PMC8528713 DOI: 10.1038/s41366-021-00900-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 06/05/2021] [Accepted: 06/30/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND/OBJECTIVES Little is known about the separate or combined effects of state and national nutrition policies regulating food and beverages in schools on child overweight/obesity (OV/OB) and related racial/ethnic disparities. We investigated the influence of school nutrition policies enacted in California, independently and in combination with the United States' national policy "Healthy Hunger Free Kids Act" (HHFKA) on childhood OV/OB and racial/ethnic disparities. SUBJECTS/METHODS An interrupted time series design was used with data from 12,363,089 child-level records on 5th- and 7th-graders in California public schools to estimate sex- and racial/ethnic-specific time trends in OV/OB prevalence during three periods: before the California nutrition policies (2002-2004); when only California policies were in effect (2005-2012); and when they were in effect simultaneously with HHFKA (2013-2016). RESULTS Before the state's policies, OV/OB prevalence increased annually among children in most subgroups. Improvements in OV/OB trends were observed for almost all groups after the California policies were in effect, with further improvements after the addition of HFFKA. The total change in annual log-odds of OV/OB, comparing the periods with both state and federal policies versus no policies, ranged from -0.08 to -0.01 and varied by grade, sex, and race/ethnicity. Within each sex and grade, the greatest changes were among African-American (-0.08 to -0.02, all p < 0.05) followed by Latino children (-0.06 to -0.01, all p < 0.05). Although disparities narrowed among these groups versus White children after the dual policy period, disparities remained large. CONCLUSIONS State and national nutrition policies for schools may have contributed to containing the upward trend in childhood OV/OB and racial/ethnic OV/OB disparities within California. However, sizable OV/OB prevalence and disparities persist. To end the epidemic, promote healthy weight and increase health equity, future efforts should strengthen state and national policies to improve food quality in schools, particularly those serving populations with the highest OV/OB prevalence.
Collapse
|
9
|
Chriqui JF, Leider J, Temkin D, Piekarz-Porter E, Schermbeck RM, Stuart-Cassel V. State Laws Matter When It Comes to District Policymaking Relative to the Whole School, Whole Community, Whole Child Framework. THE JOURNAL OF SCHOOL HEALTH 2020; 90:907-917. [PMID: 33184878 PMCID: PMC7702124 DOI: 10.1111/josh.12959] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 08/17/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND The Whole School, Whole Community, Whole Child (WSCC) framework supports the "whole child" across 10 domains. This study assessed state law and district policy WSCC coverage. METHODS Primary legal research was used to compile relevant district policies and state laws for a stratified random sample of 368 public school districts across 20 states for school year 2017-18. Policies/laws were evaluated on 79 items across the WSCC domains (range: 3-14 items/domain). Multivariable regressions examined the relationship between state laws and district policies, controlling for district characteristics, and weighted to account for the sample design and non-response. RESULTS On average, district policies and state laws addressed 53% and 60% of the 79 items, respectively. State law predicted district policy WSCC attention across items (coeff. = 0.26, 95% CI = 0.14, 0.38) and 4 domains: physical activity (coeff. = 0.57, 95% CI = 0.29, 0.86); health services (coeff. = 0.50, 95% CI = 0.39, 0.62); social and emotional climate (coeff. = 0.34, 95% CI = 0.23, 0.45); and family engagement (coeff. = 0.41, 95% CI = 0.28, 0.54). State law was associated with lower district-level coverage in 3 domains (health education; counseling, psychological, and social services; and community involvement). CONCLUSIONS Although WSCC implementation is locally-driven, states have an active role to play in setting a policy "floor" for guiding district WSCC attention.
Collapse
Affiliation(s)
- Jamie F Chriqui
- Professor, , Division of Health Policy and Administration and Institute for Health Research and Policy, School of Public Health, University of Illinois Chicago, 1603 W. Taylor Street, M/C 923, Chicago, IL 60612
| | - Julien Leider
- Senior Research Specialist, , Institute for Health Research and Policy, University of Illinois Chicago, 1747 W. Roosevelt Road, M/C 275, Chicago, IL 60608
| | - Deborah Temkin
- Vice-President for Youth Development and Education Research, , Child Trends, 7315 Wisconsin Avenue, Suite 1200W, Bethesda, MD 20814
| | - Elizabeth Piekarz-Porter
- Clinical Assistant Professor, , Division of Health Policy and Administration, School of Public Health, University of Illinois Chicago, 1603 W. Taylor Street, M/C 923, Chicago, IL 60612
| | - Rebecca M Schermbeck
- Research Specialist, , Institute for Health Research and Policy, University of Illinois Chicago, Chicago, IL 60608
| | | |
Collapse
|
10
|
Chriqui JF, Lin W, Leider J, Shang C, Perna FM. The harmonizing effect of Smart Snacks on the association between state snack laws and high school students' fruit and vegetable consumption, United States-2005-2017. Prev Med 2020; 139:106093. [PMID: 32305581 PMCID: PMC9437874 DOI: 10.1016/j.ypmed.2020.106093] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 02/08/2020] [Accepted: 04/11/2020] [Indexed: 01/06/2023]
Abstract
Despite national guidelines recommending daily fruit and vegetable (FV) consumption, intake of FV among adolescents is low. Over the past 10-15 years, state and federal laws have reduced the availability of junk foods in schools. This study examined the association between state snack laws and high school (HS) student FV consumption. The overall sample included 99,785 HS students (outcome samples ranged from 96,209-97,328) included in the Youth Risk Behavior Survey (YRBS). National Cancer Institute Classification of Laws Associated with School Students' data for 2004-2016 were lagged on to 2005-2017 YRBS data. Separate analyses examined the state law-youth FV consumption relationship pre- and post-federal Smart Snacks standards (effective school year 2014-2015). Analyses were conducted between 2018 and 2020. Overall, state laws were associated with any vegetable, salad, and other vegetable consumption. The relationship between state laws and vegetable consumption primarily occurred pre-Smart Snacks. Pre-Smart Snacks, state laws were associated with higher odds of youth consumption of any vegetable, salad, carrots, and other vegetables (all compared to students in states without snack laws). The only association post-Smart Snacks was between strong state laws and salads. This study illustrates the important role that standards restricting the availability of junk foods in schools can have on increasing student vegetable consumption. Given current efforts to roll-back federal school meal standards, findings from this study illustrate how federal standards harmonized the patchwork of state laws that existed prior to Smart Snacks and the important role that consistent national standards can play in supporting student consumption of vegetables.
Collapse
Affiliation(s)
- Jamie F Chriqui
- Institute for Health Research and Policy, University of Illinois at Chicago, 1747 W. Roosevelt Road, M/C 275, Chicago, IL 60608, USA; Division of Health Policy and Administration, School of Public Health, University of Illinois at Chicago, 1603 W. Taylor Street, M/C 923, Chicago, IL 60612, USA.
| | - Wanting Lin
- Institute for Health Research and Policy, University of Illinois at Chicago, 1747 W. Roosevelt Road, M/C 275, Chicago, IL 60608, USA.
| | - Julien Leider
- Institute for Health Research and Policy, University of Illinois at Chicago, 1747 W. Roosevelt Road, M/C 275, Chicago, IL 60608, USA.
| | - Ce Shang
- Department of Internal Medicine, The Ohio State University, USA.
| | - Frank M Perna
- Health Behaviors Research Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, USA.
| |
Collapse
|
11
|
Healthier Food and Beverage Interventions in Schools: Four Community Guide Systematic Reviews. Am J Prev Med 2020; 59:e15-e26. [PMID: 32564807 PMCID: PMC9366443 DOI: 10.1016/j.amepre.2020.01.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 01/12/2020] [Accepted: 01/13/2020] [Indexed: 11/23/2022]
Abstract
CONTEXT Healthy eating during childhood is important for optimal growth and helps reduce the risk of obesity, which has potentially serious health consequences. Changing the school food environment may offer one way to improve students' dietary intake. This manuscript reports 4 Community Guide systematic reviews examining the effectiveness of interventions in schools promoting healthy eating and weight. EVIDENCE ACQUISITION School obesity prevention programs aiming to improve diet were identified from a 2013 Agency for Health Care Research and Quality systematic review and an updated search (August 2012-January 4, 2017). In 2017-2018, Community Guide systematic review methods were used to assess effectiveness as determined by dietary behavior and weight changes. EVIDENCE SYNTHESIS Interventions improving school meals or offering fruits and vegetables (n=27 studies) are considered effective. Evidence is insufficient to determine the effectiveness of interventions supporting healthier snack foods and beverages outside of school meal programs given inconsistent findings (n=13 studies). Multicomponent interventions to increase availability of healthier foods and beverages are considered effective. These interventions must include 1 component from school meals or fruit and vegetable programs and interventions supporting healthier snack foods and beverages (n=12 studies). There is insufficient evidence to determine the effectiveness of interventions to increase water access because only 2 studies met inclusion criteria. CONCLUSIONS A total of 2 school-based dietary interventions have favorable effects for improving dietary habits and modest effects for improving or maintaining weight. More evidence is needed regarding interventions with insufficient findings. These reviews may inform researchers and school administrators about healthy eating and obesity prevention interventions.
Collapse
|
12
|
Sanjeevi N, Lipsky LM, Nansel TR, Haynie D, Liu A, Simons-Morton B. Stronger State School Nutrition Laws Are Associated With Healthier Eating Behaviors and Optimal Weight Status in US Adolescents. Am J Health Promot 2020; 34:857-866. [PMID: 32036683 DOI: 10.1177/0890117120902346] [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: 01/29/2023]
Abstract
PURPOSE To investigate relationships of farm-to-school, school meal, and competitive food state laws with eating behaviors and weight status and to examine interaction between different types of state laws. DESIGN Observational cohort study. SETTINGS US adolescents. PARTICIPANTS The NEXT study is a nationally representative sample of adolescents assessed annually for 7 years. Data (N = 2751) from students attending public schools from the first (W1) and third (W3) assessment waves (2010 and 2012), occurring during grades 10 and 12, respectively, of the NEXT study were included. MEASURES Eating behaviors and weight status of adolescents were linked with Classification of Laws Associated with School Students scoring for state laws. ANALYSIS Regression analyses examined associations of laws with intake and weight status, accounting for complex survey design and school-level clustering. RESULTS Adolescents in states with strong farm-to-school laws had greater W1 whole fruit, lower soda, and snack intakes versus those in states with no laws. Strong school meal laws were associated with lower W1 soda intake. Adolescents in states with strong competitive food laws had lower soda intake and overweight/obesity odds than those in states with no laws in W3. Strong farm-to-school laws were inversely associated with W3 overweight/obesity odds only in states with strong competitive food laws. CONCLUSIONS Stronger laws governing school nutrition were related to healthier eating behaviors and optimal weight status in this nationally representative sample of adolescents. Further, farm-to-school laws may be more effective in reducing obesity when combined with strong competitive food legislation.
Collapse
Affiliation(s)
- Namrata Sanjeevi
- Social and Behavioral Sciences Branch, Eunice Kennedy Shriver2511National Institute of Child Health and Human Development, Bethesda, MD, USA
| | - Leah M Lipsky
- Social and Behavioral Sciences Branch, Eunice Kennedy Shriver2511National Institute of Child Health and Human Development, Bethesda, MD, USA
| | - Tonja R Nansel
- Social and Behavioral Sciences Branch, Eunice Kennedy Shriver2511National Institute of Child Health and Human Development, Bethesda, MD, USA
| | - Denise Haynie
- Social and Behavioral Sciences Branch, Eunice Kennedy Shriver2511National Institute of Child Health and Human Development, Bethesda, MD, USA
| | - Aiyi Liu
- Biostatistics & Bioinformatics Branch, Eunice Kennedy Shriver2511National Institute of Child Health and Human Development, Bethesda, MD, USA
| | - Bruce Simons-Morton
- Social and Behavioral Sciences Branch, Eunice Kennedy Shriver2511National Institute of Child Health and Human Development, Bethesda, MD, USA
| |
Collapse
|
13
|
Removing competitive foods v. nudging and marketing school meals: a pilot study in high-school cafeterias. Public Health Nutr 2019; 23:366-373. [DOI: 10.1017/s136898001900329x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractObjective:To compare federally reimbursable school meals served when competitive foods are removed and when marketing and nudging strategies are used in school cafeterias operating the National School Lunch Program (NSLP). The second objective was to determine how marketing and nudging strategies influence competitive food sales.Design:In the Healthy Choices School, all competitive foods were removed; the Healthy Nudging School retained competitive foods and promoted the school meal programme using marketing and nudging strategies; a third school made no changes. Cafeteria register data were collected from the beginning of the 2013–2014 school year through the four-week intervention. Outcome measures included daily entrées served; share of entrées served with vegetables, fruit and milk; and total competitive food sales. Difference-in-difference models were used to examine outcome measure changes.Setting:Three high schools in a diverse, Northeast US urban district with universally free meals.Participants:High-school students participating in the NSLP.Results:During the intervention weeks, the average number of entrées served daily was significantly higher in the Healthy Choices School (82·1 (se 33·9)) and the Healthy Nudging School (107·4 (se 28·2)) compared with the control school. The only significant change in meal component selection was a 6 % (se 0·02) higher rate of vegetable servings in the Healthy Choices School compared with the control school. Healthy Nudging School competitive food sales did not change.Conclusions:Both strategies – removing competitive foods and marketing and nudging – may increase school meal participation. There was no evidence that promoting school meals decreased competitive food sales.
Collapse
|
14
|
Development and Validation of the Policies, Opportunities, Initiatives and Notable Topics (POINTS) Audit for Campuses and Worksites. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16050778. [PMID: 30836633 PMCID: PMC6427413 DOI: 10.3390/ijerph16050778] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 02/19/2019] [Accepted: 02/26/2019] [Indexed: 12/22/2022]
Abstract
Background: Workplace or campus wellness/obesity-prevention policies and initiatives can improve health. Research tools to assess worksite or campus policies/initiatives are scarce. Thus, the aim of this research is to develop and validate the policies, opportunities, initiatives, and notable topics (POINTS) audit. Methods: POINTS was developed and refined via expert review, pilot-testing, and field testing. Trained researchers completed a web-based review from a student-focus or employee-focus regarding 34 health-promoting topics for colleges. Each topic was evaluated on a 0⁻2 scale: 0 = no policy/initiative, 1 = initiatives, 2 = written policy. When a written policy was detected, additional policy support questions (administered, monitored, reviewed) were completed. Results: Cronbach's Alpha for the student-focused POINTS audit was α = 0.787 (34 items, possible points = 65), and for the employee-focused POINTS audit was α = 0.807 (26 items, possible points = 50). A total of 115 student-focused and 33 employee-focused audits were completed. Although there was little evidence of policy presence beyond stimulant standards (smoking and alcohol), there were extensive examples of health initiatives. The student-focused POINTS audit was validated using the Healthier Campus Initiative's survey. Conclusions: POINTS is a web-based audit tool that is valid and useful for pre-assessment, advocacy, benchmarking, and tracking policies for health and well-being for students (campus) and employees (worksite).
Collapse
|
15
|
Bramante CT, Thornton RLJ, Bennett WL, Zhang A, Wilson RF, Bass EB, Tseng E. Systematic Review of Natural Experiments for Childhood Obesity Prevention and Control. Am J Prev Med 2019; 56:147-158. [PMID: 30573143 PMCID: PMC7397557 DOI: 10.1016/j.amepre.2018.08.023] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 08/06/2018] [Accepted: 08/07/2018] [Indexed: 12/16/2022]
Abstract
CONTEXT The National Academy of Medicine recommends childhood obesity prevention efforts making healthier options the passive choice. This review evaluated the effectiveness of population-level policies and programs from natural experiments for childhood obesity prevention. EVIDENCE ACQUISTION The search included PubMed, CINAHL, PsycINFO, and EconLit from 2000 to 2017 for policies evaluated by natural experiments reporting childhood BMI outcomes. The studies were analyzed in 2017-2018. Interventions were classified by environmental focus (food/beverage, physical activity, or both) and stratified by setting (school, community, both). Risk of bias was evaluated for each study. EVIDENCE SYNTHESIS Of 33 natural experiments, most (73%) took place in the school setting only. The most common environmental focus in any setting was food/beverage (48%). All four studies that focused on both food/beverage and physical activity in schools demonstrated decreased prevalence of overweight/obesity or BMI z-score by 0.04-0.17. BMI decreased in all four studies in both school and community settings. The largest effect size was a decrease in BMI z-score of 0.5, but most were <0.25. The risk of bias was high for most (76%) studies. Most (63%) of the eight studies with low/medium risk of bias took place in the school setting focused on the food/beverage environment; effects on BMI were mixed. CONCLUSIONS Natural experiments evaluating school-based policies focusing on both the food/beverage and physical activity environments (versus targeting only one) consistently showed improvement in BMI. However, most studies had high risk of bias, highlighting the need for improved methods for evaluation of natural experiments for childhood obesity prevention.
Collapse
Affiliation(s)
- Carolyn T Bramante
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
| | - Rachel L J Thornton
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland; Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Wendy L Bennett
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Allen Zhang
- Johns Hopkins Evidence-Based Practice Center, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Renee F Wilson
- Johns Hopkins Evidence-Based Practice Center, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Eric B Bass
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Johns Hopkins Evidence-Based Practice Center, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Eva Tseng
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland
| |
Collapse
|
16
|
Sildén KE. Impact of competitive foods in public schools on child nutrition: effects on adolescent obesity in the United States an integrative systematic literature review. Glob Health Action 2018; 11:1477492. [PMID: 29893188 PMCID: PMC5998782 DOI: 10.1080/16549716.2018.1477492] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background: The United States (US) is currently facing a public health crisis due to the percentage of obesity in adolescents. The Center for Disease Control (CDC) stated the risks for children due to obesity are many. Adolescents obtain a large portion of their daily caloric intake at school; therefore, what foods/drinks they are consuming is so serious. Objective: To identify and analyze literature on the effects of competitive foods in public schools on adolescent weight, or Body Mass Index (BMI), and possible impacts they may have on adolescent obesity in the United States. Methods: An integrative systematic review of literature was conducted. The literature was collected in CINAHL, MEDLINE and EMBASE databases. Refined keyword search is further detailed in the report. Year restrictions were 2006–2017 from peer-reviewed journals and published in English, including adolescents 13–18 years old in the US. Criteria for inclusion targeted at least one of (1) sugar-sweetened beverages (SSB), (2) competitive foods, (3) commercial foods, (4) vending machines, (5) al a carte venues, and (6) school stores, examining their associations with weight measurements, using either weight or BMI, or caloric intake analysis. Results: A total of 164 articles were detected and assessed, for a final analysis of 34 full text articles. Twenty-six articles met the inclusion criteria. Common aspects of interest involved BMI/Obesity/Weight (73%), (58%) examined Calorie density or consumption, (77%) discussed the Availability of competitive foods in schools, (54%) included Analysis of competitive food, beverage and nutrition policies, and (69%) addressed Other effects. Conclusion: This review discovered substantial evidence that competitive foods are highly available in schools, however, lacking in robust evidence proving causality in increasing BMI or weight. There is strong corroboration in the research revealing that Other effects are factors worthy of studying further. Additional longitudinal and higher-quality research needs to be performed.
Collapse
Affiliation(s)
- Kirsten E Sildén
- a Department of Public Health , Lund University , Ängelholm , Sweden
| |
Collapse
|
17
|
Au LE, Crawford PB, Woodward-Lopez GM, Gurzo K, Kao J, Webb KL, Ritchie LD. School Wellness Committees Are Associated With Lower Body Mass Index Z-Scores and Improved Dietary Intakes in US Children: The Healthy Communities Study. THE JOURNAL OF SCHOOL HEALTH 2018; 88:627-635. [PMID: 30133773 PMCID: PMC6108443 DOI: 10.1111/josh.12664] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 10/16/2017] [Accepted: 12/27/2017] [Indexed: 06/08/2023]
Abstract
BACKGROUND Our objective was to examine the association between school wellness committees and implementation of nutrition wellness policies and children's weight status and obesity-related dietary outcomes. METHODS A cross-sectional study was conducted of 4790 children aged 4-15 years recruited from 130 communities in the Healthy Communities Study. Multilevel statistical models assessed associations between school wellness policies and anthropometric (body mass index z-score [BMIz]) and nutrition measures, adjusting for child and community-level covariates. RESULTS Children had lower BMI z-scores (-0.11, 95% confidence interval [CI]: -0.19, -0.03) and ate breakfast more frequently (0.14 days/week, 95% CI: 0.02-0.25) if attending a school with a wellness committee that met once or more in the past year compared to attending a school with a wellness committee that did not meet/did not exist. Children had lower added sugar (p < .0001), lower energy-dense foods (p = .0004), lower sugar intake from sugar-sweetened beverages (p = .0002), and lower dairy consumption (p = .001) if attending a school with similar or stronger implementation of the nutrition components of the school wellness policies compared to other schools in the district. CONCLUSIONS A more active wellness committee was associated with lower BMI z-scores in US schoolchildren. Active school engagement in wellness policy implementation appears to play a positive role in efforts to reduce childhood obesity.
Collapse
Affiliation(s)
- Lauren E. Au
- Nutrition Policy Institute, Division of Agriculture and Natural Resources, University of California, 2115 Milvia Street, Suite 301, Berkeley, CA, 94704; (P) 510-642-1584; (F) 510-643-8197;
| | - Patricia B. Crawford
- School of Public Health, University of California, Berkeley, Nutrition Policy Institute, Division of Agriculture and Natural Resources, University of California, 2115 Milvia Street, Suite 301, Berkeley, CA, 94704; (P) 510 642-3589; (F) 510-643-8197;
| | - Gail M. Woodward-Lopez
- Nutrition Policy Institute, Division of Agriculture and Natural Resources, University of California, 2115 Milvia Street, Suite 301, Berkeley, CA, 94704; (P) 510-888-9762; (F) 510-643-8197;
| | - Klara Gurzo
- Nutrition Policy Institute, Division of Agriculture and Natural Resources, University of California, 2115 Milvia Street, Suite 301, Berkeley, CA, 94704; (P) 510-643-6945; (F) 510-643-8197;
| | - Janice Kao
- Nutrition Policy Institute, Division of Agriculture and Natural Resources, University of California, 2115 Milvia Street, Suite 301, Berkeley, CA, 94704; (P) 510.642.0278; (F) 510-643-8197;
| | - Karen L. Webb
- Nutrition Policy Institute, Division of Agriculture and Natural Resources, University of California, 2115 Milvia Street, Suite 301, Berkeley, CA, 94704, (P) 510 642-3589; (F) 510-643-8197;
| | - Lorrene D. Ritchie
- Nutrition Policy Institute, Division of Agriculture and Natural Resources, University of California, 2115 Milvia Street, Suite 301, Berkeley, CA, 94704, (P) 510 642-3589; (F) 510-643-8197;
| |
Collapse
|
18
|
Grannon KY, Larson N, Pelletier J, O'Connell MJ, Nanney MS. State Agency Support of Weight-Related School Policy Implementation. THE JOURNAL OF SCHOOL HEALTH 2018; 88:685-692. [PMID: 30133777 DOI: 10.1111/josh.12673] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 11/01/2017] [Accepted: 02/25/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND In this study, we describe state agency strategies to support weight-related policy implementation in schools, and examine the association among state support, obesity prevalence, and strength of state policies governing school nutrition and physical education. METHODS The 2012 School Health Policies and Practices Study describes prevalence of implementation support state agencies provided to schools/districts. Implementation support items were analyzed by weight-related policy area (eg, advertising, wellness policy) and by type of support (eg, technical assistance). Results were summed to create a total weight-related policy support score. Linear regression was used to examine associations between policy support and state youth obesity prevalence (2011-2012 National Survey for Children's Health), overall and stratified by state policy strength (2012 Classification of Laws Associated with School Students). RESULTS States provided support most commonly for school meals and wellness policies (89% and 81%, respectively) and least often for after-school PE (26%). Most states (80%) provided technical assistance. The total weight-related policy support score had a significant positive association with state-level youth overweight/obesity prevalence (p = .03). CONCLUSION State agencies appear to be responding to their youth obesity prevalence with technical support. Schools and state agencies should work in collaboration to provide a healthy school environment for all students.
Collapse
Affiliation(s)
- Katherine Y Grannon
- Medical School, Department of Family Medicine and Community Health, University of Minnesota, 717 Delaware Street SE, Minneapolis, MN 55414
| | - Nicole Larson
- School of Public Health, Division of Epidemiology and Community Health, University of Minnesota, 1300 South Second Street, Suite 300, Minneapolis, MN 55454
| | - Jennifer Pelletier
- Minnesota Department of Health, Office of Statewide Health Improvement Initiatives, 85 East 7th Place, Suite 220, St. Paul, MN 55164-0882
| | - Michael J O'Connell
- University of Minnesota, Biostatistical Design and Analysis Center, 717 Delaware Street SE, Minneapolis, Minnesota 55414
| | - Marilyn S Nanney
- School of Medicine, Department of Family Medicine and Community Health, University of Minnesota, 717 Delaware Street SE, Minneapolis, Minnesota 55414
| |
Collapse
|
19
|
The fight against overweight and obesity in school children: Public policy in Mexico. J Public Health Policy 2018; 38:407-428. [PMID: 28860550 DOI: 10.1057/s41271-017-0090-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Excess weight in schoolchildren is a serious health problem in Mexico. In 2010, the government established General Guidelines for Dispensing or Distribution of Foods and Beverages at School Food Establishments (SFEs) in Elementary Schools with the objective of stopping the epidemic of overweight and obesity. This study aimed to evaluate compliance with the Guidelines during two academic years. With a sample of 39 schools already randomly selected, we carried out a follow-up study. The research team recorded foods and beverages available at schools in two academic years, and compared their nutritional characteristics to those established in the Guidelines. At the schools in both stages of the study, we found broad availability of energy-dense foods not allowed in the SFEs. Vegetables, fruits, and plain water accounted for less than 7 per cent of the foods and drinks. We observed no changes between stages in the compliance the Guidelines.
Collapse
|
20
|
Bennett WL, Wilson RF, Zhang A, Tseng E, Knapp EA, Kharrazi H, Stuart EA, Shogbesan O, Bass EB, Cheskin LJ. Methods for Evaluating Natural Experiments in Obesity: A Systematic Review. Ann Intern Med 2018; 168:791-800. [PMID: 29710087 DOI: 10.7326/m18-0309] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Given the obesity pandemic, rigorous methodological approaches, including natural experiments, are needed. PURPOSE To identify studies that report effects of programs, policies, or built environment changes on obesity prevention and control and to describe their methods. DATA SOURCES PubMed, CINAHL, PsycINFO, and EconLit (January 2000 to August 2017). STUDY SELECTION Natural experiments and experimental studies evaluating a program, policy, or built environment change in U.S. or non-U.S. populations by using measures of obesity or obesity-related health behaviors. DATA EXTRACTION 2 reviewers serially extracted data on study design, population characteristics, data sources and linkages, measures, and analytic methods and independently evaluated risk of bias. DATA SYNTHESIS 294 studies (188 U.S., 106 non-U.S.) were identified, including 156 natural experiments (53%), 118 experimental studies (40%), and 20 (7%) with unclear study design. Studies used 106 (71 U.S., 35 non-U.S.) data systems; 37% of the U.S. data systems were linked to another data source. For outcomes, 112 studies reported childhood weight and 32 adult weight; 152 had physical activity and 148 had dietary measures. For analysis, natural experiments most commonly used cross-sectional comparisons of exposed and unexposed groups (n = 55 [35%]). Most natural experiments had a high risk of bias, and 63% had weak handling of withdrawals and dropouts. LIMITATION Outcomes restricted to obesity measures and health behaviors; inconsistent or unclear descriptions of natural experiment designs; and imperfect methods for assessing risk of bias in natural experiments. CONCLUSION Many methodologically diverse natural experiments and experimental studies were identified that reported effects of U.S. and non-U.S. programs, policies, or built environment changes on obesity prevention and control. The findings reinforce the need for methodological and analytic advances that would strengthen evaluations of obesity prevention and control initiatives. PRIMARY FUNDING SOURCE National Institutes of Health, Office of Disease Prevention, and Agency for Healthcare Research and Quality. (PROSPERO: CRD42017055750).
Collapse
Affiliation(s)
- Wendy L Bennett
- Johns Hopkins University School of Medicine and Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (W.L.B., R.F.W., A.Z., E.T., E.A.K., H.K., E.A.S., O.S., E.B.B., L.J.C.)
| | - Renee F Wilson
- Johns Hopkins University School of Medicine and Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (W.L.B., R.F.W., A.Z., E.T., E.A.K., H.K., E.A.S., O.S., E.B.B., L.J.C.)
| | - Allen Zhang
- Johns Hopkins University School of Medicine and Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (W.L.B., R.F.W., A.Z., E.T., E.A.K., H.K., E.A.S., O.S., E.B.B., L.J.C.)
| | - Eva Tseng
- Johns Hopkins University School of Medicine and Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (W.L.B., R.F.W., A.Z., E.T., E.A.K., H.K., E.A.S., O.S., E.B.B., L.J.C.)
| | - Emily A Knapp
- Johns Hopkins University School of Medicine and Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (W.L.B., R.F.W., A.Z., E.T., E.A.K., H.K., E.A.S., O.S., E.B.B., L.J.C.)
| | - Hadi Kharrazi
- Johns Hopkins University School of Medicine and Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (W.L.B., R.F.W., A.Z., E.T., E.A.K., H.K., E.A.S., O.S., E.B.B., L.J.C.)
| | - Elizabeth A Stuart
- Johns Hopkins University School of Medicine and Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (W.L.B., R.F.W., A.Z., E.T., E.A.K., H.K., E.A.S., O.S., E.B.B., L.J.C.)
| | - Oluwaseun Shogbesan
- Johns Hopkins University School of Medicine and Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (W.L.B., R.F.W., A.Z., E.T., E.A.K., H.K., E.A.S., O.S., E.B.B., L.J.C.)
| | - Eric B Bass
- Johns Hopkins University School of Medicine and Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (W.L.B., R.F.W., A.Z., E.T., E.A.K., H.K., E.A.S., O.S., E.B.B., L.J.C.)
| | - Lawrence J Cheskin
- Johns Hopkins University School of Medicine and Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (W.L.B., R.F.W., A.Z., E.T., E.A.K., H.K., E.A.S., O.S., E.B.B., L.J.C.)
| |
Collapse
|
21
|
Frongillo EA, Fawcett SB, Ritchie LD, Sonia Arteaga S, Loria CM, Pate RR, John LV, Strauss WJ, Gregoriou M, Collie-Akers VL, Schultz JA, Landgraf AJ, Nagaraja J. Community Policies and Programs to Prevent Obesity and Child Adiposity. Am J Prev Med 2017; 53:576-583. [PMID: 28688728 PMCID: PMC5650930 DOI: 10.1016/j.amepre.2017.05.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 04/21/2017] [Accepted: 05/08/2017] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Evidence regarding impact of community policies and programs (CPPs) to prevent child obesity is limited, and which combinations of strategies and components are most important is not understood. The Healthy Communities Study was an observational study to assess relationships of characteristics and intensity of CPPs with adiposity, diet, and physical activity in children, taking advantage of variation across the U.S. in community actions to prevent child obesity. The study examined the association of CPPs to prevent child obesity with measured BMI and waist circumference, hypothesizing that communities with more-comprehensive CPPs would have children with lower adiposity. METHODS The study included 130 communities selected by probability-based sampling or because of known CPPs targeting child obesity. Data were collected at home visits on 5,138 children during 2013-2015. CPPs were scored for multiple attributes to create a CPP intensity score. A CPP target behavior score reflected the number of distinct target behaviors addressed. Scores were standardized with the smallest observed score across communities being 0 and the largest 1. Multilevel regression analysis in 2016 adjusted for community, household, and individual characteristics. RESULTS Higher CPP target behavior score was significantly associated with lower BMI and waist circumference in a dose-response relationship, with magnitude for the past 3 years of CPPs of 0.843 (p=0.013) for BMI and 1.783 cm (p=0.020) for waist circumference. CONCLUSIONS This study provides plausible evidence that comprehensive CPPs targeting a greater number of distinct physical activity and nutrition behaviors were associated with lower child adiposity.
Collapse
Affiliation(s)
- Edward A Frongillo
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, South Carolina.
| | - Stephen B Fawcett
- Work Group for Community Development, University of Kansas, Lawrence, Kansas
| | - Lorrene D Ritchie
- Nutrition Policy Institute, Division of Agriculture and Natural Resources, University of California, Oakland, California
| | - S Sonia Arteaga
- National Heart, Lung, and Blood Institute, Bethesda, Maryland
| | | | - Russell R Pate
- Department of Exercise Science, University of South Carolina, Columbia, South Carolina
| | - Lisa V John
- Battelle Health and Analytics, St. Louis, Missouri
| | | | | | | | - Jerry A Schultz
- Work Group for Community Development, University of Kansas, Lawrence, Kansas
| | | | | |
Collapse
|
22
|
Evidence-based policies on school nutrition and physical education: Associations with state-level collaboration, obesity, and socio-economic indicators. Prev Med 2017; 99:87-93. [PMID: 28209518 PMCID: PMC5432375 DOI: 10.1016/j.ypmed.2017.02.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 01/17/2017] [Accepted: 02/08/2017] [Indexed: 01/05/2023]
Abstract
Despite calls for more cross-sector collaboration on obesity prevention, little is known about the role of collaborative partnerships, or groups of organizations from different sectors working together toward a shared goal, in state policy activities. This study examined associations between competitive food/beverage and physical education policies and state-level collaboration and state characteristics (obesity, socioeconomic indicators, public health funding levels) for all 50 states and the District of Columbia, USA, in 2012. We examined cross-sectional associations between evidence-based competitive food/beverage and physical education policies from the Classification of Laws Associated with School Students and state characteristics from the School Health Policies and Practices Study and other national data sources using prevalence ratios and generalized linear models. Analyses were conducted in 2016. Cross-sector collaboration (i.e., state staff reports of working together on school nutrition or physical education activities) between state-level nutrition and physical education staff and ten types of organizations was not significantly associated with having state policies. Childhood obesity (RR=1.78, 95% CI[1.11,2.85]), high-school non-completion (RR=2.35, 95% CI[1.36,4.06]), poverty (RR=1.89, 95% CI[1.16,3.09]) and proportion non-white or Hispanic residents (RR=1.75, 95% CI[1.07, 2.85]) were positively associated with the presence of elementary school competitive food/beverage policies. Fewer indicators were associated with policies for middle and high schools. The large investment of time and resources required for cross-sector collaboration demands greater research evidence on how to structure and manage collaborative partnerships for the greatest impact.
Collapse
|
23
|
Social media indicators of the food environment and state health outcomes. Public Health 2017; 148:120-128. [PMID: 28478354 DOI: 10.1016/j.puhe.2017.03.013] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 03/24/2017] [Accepted: 03/28/2017] [Indexed: 01/10/2023]
Abstract
OBJECTIVES Contextual factors can influence health through exposures to health-promoting and risk-inducing factors. The aim of this study was to (1) build, from geotagged Twitter and Yelp data, a national food environment database and (2) to test associations between state food environment indicators and health outcomes. STUDY DESIGN This is a cross-sectional study based upon secondary analyses of publicly available data. METHODS Using Twitter's Streaming Application Programming Interface (API), we collected and processed 4,041,521 food-related, geotagged tweets between April 2015 and March 2016. Using Yelp's Search API, we collected data on 505,554 unique food-related businesses. In linear regression models, we examined associations between food environment characteristics and state-level health outcomes, controlling for state-level differences in age, percent non-Hispanic white, and median household income. RESULTS A one standard deviation increase in caloric density of food tweets was related to higher all-cause mortality (+46.50 per 100,000), diabetes (+0.75%), obesity (+1.78%), high cholesterol (+1.40%), and fair/poor self-rated health (2.01%). More burger Yelp listings were related to higher prevalence of diabetes (+0.55%), obesity (1.35%), and fair/poor self-rated health (1.12%). More alcohol tweets and Yelp bars and pub listings were related to higher state-level binge drinking and heavy drinking, but lower mortality and lower percent reporting fair/poor self-rated health. Supplemental analyses with county-level social media indicators and county health outcomes resulted in finding similar but slightly attenuated associations compared to those found at the state level. CONCLUSIONS Social media can be utilized to create indicators of the food environment that are associated with area-level mortality, health behaviors, and chronic conditions.
Collapse
|
24
|
Datar A, Nicosia N. The Effect of State Competitive Food and Beverage Regulations on Childhood Overweight and Obesity. J Adolesc Health 2017; 60:520-527. [PMID: 27836530 PMCID: PMC5401783 DOI: 10.1016/j.jadohealth.2016.09.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 08/31/2016] [Accepted: 09/01/2016] [Indexed: 11/28/2022]
Abstract
PURPOSE Policy efforts for combating childhood obesity have sought stronger state policies for regulating competitive foods and beverages (CF&Bs) available in schools. However, the evidence linking state policies to children's overall diet and body weight outcomes is limited and mixed, and experts have called for more rigorous studies that are able to address concerns about selection bias. The present study leverages a rare natural experiment where children in military families are "assigned" to different state policies, due to their military parent's periodic relocation, to examine whether state CF&B policies were associated with children's body mass index (BMI) and overweight or obesity. METHODS We analyzed data from 894 children (12-13 years old) in army families attending public schools located near 25 installations across 23 states in 2013. State CF&B policy measures from the Bridging the Gap project were linked to the child data. Primary outcomes included BMI z-scores and indicator for overweight or obesity. For a subsample of children with self-reported food frequency measures, we also examined the link between state CF&B policies and overall diet. All regression analyses adjusted for a rich set of child and family covariates. RESULTS Having strong or weak policies was significantly associated with lower BMI z-scores, lower odds of overweight or obesity, and better dietary outcomes, relative to no policy. CONCLUSIONS A portfolio of policies that includes multiple strong policies is likely needed to observe any meaningful changes in BMI and obesity.
Collapse
Affiliation(s)
- Ashlesha Datar
- Center for Economic and Social Research, University of Southern California, Los Angeles, California.
| | - Nancy Nicosia
- RAND Corporation, 20 Park Plaza, 9 Floor, Suite 920, Boston, MA 02116
| |
Collapse
|
25
|
Wang YC, Hsiao A, Chamberlin P, Largay M, Archibald A, Malone A, Stevelos J. Nutrition Quality of US School Snack Foods: A First Look at 2011-2014 Bid Records in 8 School Districts. THE JOURNAL OF SCHOOL HEALTH 2017; 87:29-35. [PMID: 27917489 DOI: 10.1111/josh.12465] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Revised: 04/07/2016] [Accepted: 05/16/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND As part of the Healthy, Hunger-Free Kids Act, snacks, and desserts sold in K-12 schools as of the 2014-2015 school year are required to meet the "Smart Snacks" nutritional guidelines. Although studies exist in tracking progress in local and national efforts, the proportion of snack food procured by school districts compliant with the Smart Snacks standard prior to its full implementation is unknown. METHODS We repurposed a previously untapped database, Interflex, of public bid records to examine the nutritional quality of snacks and desserts procured by school districts. We selected 8 school districts with at least 90% complete data each year during 2011-2012, 2012-2013, and 2013-2014 school years and at locations across different regions of the United States. We quantified the amount of calories and sugar of each product contained in the won bids based on available online sources and determined whether the produce complied with Smart Snack guidelines. RESULTS In all 8 districts (snack expenditure analyzed ranging from $152,000 to $4.4 million), at least 50% of snack bids were compliant with the US Department of Agriculture Smart Snacks standard during the 2013-2014 school year. Across sampled districts, we observed a general trend in lower caloric density (kcal per product) and sugar density (grams of sugar per product) over a 3-year period. CONCLUSIONS Many districts across the country have made headway in complying with the Smart Snack guidelines, though gaps remain.
Collapse
Affiliation(s)
- Y Claire Wang
- Mailman School of Public Health, Columbia University, 722 West 168th Street, New York, NY 10032
| | - Amber Hsiao
- Mailman School of Public Health, Columbia University, 722 West 168th Street, New York, NY 10032
| | - Peter Chamberlin
- Mailman School of Public Health, Columbia University, 722 West 168th Street, New York, NY 10032
| | - McKenzie Largay
- Mailman School of Public Health, Columbia University, 722 West 168th Street, New York, NY 10032
| | - Abbie Archibald
- Alliance for Healthier Generation, 722 West 168th Street, New York, NY 10020
| | - Andrew Malone
- Alliance for Healthier Generation, 722 West 168th Street, New York, NY 10020
| | - JoAnn Stevelos
- Alliance for Healthier Generation, 722 West 168th Street, New York, NY 10020
| |
Collapse
|
26
|
Palakshappa D, Fiks AG, Faerber JA, Feudtner C. Association between state school nutrition laws and subsequent child obesity. Prev Med 2016; 90:107-13. [PMID: 27370166 DOI: 10.1016/j.ypmed.2016.06.039] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 06/03/2016] [Accepted: 06/27/2016] [Indexed: 11/19/2022]
Abstract
Many states have enacted laws to improve school nutrition. We tested whether stronger state nutrition laws are associated with subsequently decreased obesity. We conducted a retrospective national multi-year panel data study (analyzed 2014-2016 at the Children's Hospital of Philadelphia). The predictors were 2010 laws regarding 9 nutrition categories from the Classification of Laws Associated with School Students, which grades the strength of state laws (none, weak, or strong). The outcome was weight status (healthy weight, overweight, or obese) in elementary, middle, and high school from the 2011/2012 National Survey of Children's Health. We tested the association between the strength of laws and weight using multinomial logistic regression. To further evaluate our main results, we conducted state-level longitudinal analyses testing the association between competitive food and beverage laws on the change in obesity from 2003-2011. In main analyses of 40,177 children ages 10-17years, we found strong state laws restricting the sale of competitive food and beverages in elementary school (OR: 0.68; 95% CI: 0.48, 0.96) and strong advertising laws across all grades (OR: 0.63; 95% CI: 0.46, 0.86) were associated with reduced odds of obesity. In longitudinal analyses, states with strong competitive food and beverage laws from 2003-2010 had small but significant decreases in obesity, compared to states with no laws. Although further research is needed to determine the causal effect of these laws, this study suggests that strong state laws limiting the sale and advertising of unhealthy foods and beverages in schools are associated with decreased obesity rates.
Collapse
Affiliation(s)
- Deepak Palakshappa
- Department of Pediatrics, Center for Pediatric Clinical Effectiveness and PolicyLab, Children's Hospital of Philadelphia, 34th & Civic Center Blvd, CHOP North, Philadelphia, PA 19104, USA.
| | - Alexander G Fiks
- Department of Pediatrics, Center for Pediatric Clinical Effectiveness and PolicyLab, Children's Hospital of Philadelphia, 34th & Civic Center Blvd, CHOP North, Philadelphia, PA 19104, USA.
| | - Jennifer A Faerber
- Department of Pediatrics, Children's Hospital of Philadelphia, 34th & Civic Center Blvd, Philadelphia, PA 19104, USA.
| | - Chris Feudtner
- Department of Pediatrics, Center for Pediatric Clinical Effectiveness and PolicyLab, Children's Hospital of Philadelphia, 34th & Civic Center Blvd, CHOP North, Philadelphia, PA 19104, USA.
| |
Collapse
|
27
|
Tsai YA, Lin CL, Hou JW, Huang PC, Lee MC, Chen BH, Wu MT, Chen CC, Wang SL, Lee CC, Hsiung CA, Chen ML. Effects of high di(2-ethylhexyl) phthalate (DEHP) exposure due to tainted food intake on pre-pubertal growth characteristics in a Taiwanese population. ENVIRONMENTAL RESEARCH 2016; 149:197-205. [PMID: 27209343 DOI: 10.1016/j.envres.2016.05.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 04/28/2016] [Accepted: 05/02/2016] [Indexed: 06/05/2023]
Abstract
On May 23, 2011, a major scandal involving the illegal use of phthalates as clouding agents in food products was reported. Specifically, di(2-ethylhexyl) phthalate (DEHP) was purposefully added to foods as a substitute emulsifier. The purpose of this study was to examine the effects of DEHP exposure on the growth characteristics of the child victims of this scandal. Eighty-eight victims, originating from northern, central, and southern Taiwan and ranging in age from 6.0 to 10.5 years, were invited to participate in this study during clinic visits. The participants underwent follow-up health examinations from August 2012 to February 2013. We collected information on each participant's history of exposure to tainted food products using a questionnaire, and we analyzed their urinary concentrations of DEHP metabolites using high-performance liquid chromatography/tandem mass spectrometry. These data were then used to estimate their daily DEHP intake (DIAll) during the scandal. We also measured physical development parameters (height, weight, and bone age) and hormone levels (thyroid, sex and growth hormones) to evaluate their overall growth characteristics. The average (SD) duration of DEHP intake from tainted nutrition supplements was 1.39 (1.01) years. The median DIAll values were 19.93 and 20.69μg/kg bw/day for boys and girls, respectively. Among the enrolled children, the DIAll values of 46.9% of boys and 51.3% of girls exceeded the reference dose (RfD) of 20μg/kg bw/day established by the US Environmental Protection Agency. Our results demonstrate that DIAll is negatively associated with the height percentile, weight percentile, bone age/chronological age, and insulin-like growth factor 1 (IGF-1) levels but not with IGF binding protein 3 (IGF-BP3) level, IGF-1/IGF-BP3, sex hormones, or thyroid hormone levels. The DEHP DIAll value exceeded the RfD at high rates among children of both genders. Our results suggest that high levels of DEHP exposure due to the consumption of tainted food products are negatively associated with body weight, height, bone age, and IGF-1 levels in children. The likelihood of delayed puberty among the affected children is therefore a reasonable concern, and further follow-up is required.
Collapse
Affiliation(s)
- Yen-An Tsai
- Institute of Environmental and Occupational Health Sciences, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Ching-Ling Lin
- Department of Endocrinology & Metabolism, Cathay General Hospital, Taipei, Taiwan; School of Medicine, Fu Jen Catholic University, Taipei, Taiwan
| | - Jia-Woei Hou
- School of Medicine, Fu Jen Catholic University, Taipei, Taiwan; Department of Pediatrics, Cathay General Hospital, Taipei, Taiwan
| | - Po-Chin Huang
- National Environmental Health Research Center, National Health Research Institutes, Miaoli, Taiwan
| | - Meng-Chih Lee
- Department of Family Medicine, Taichung Hospital, Ministry of Health and Welfare, Taichung, Taiwan
| | - Bai-Hsiun Chen
- Department of Laboratory Medicine and Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ming-Tsang Wu
- Department of Public Health, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan; Research Center of Environmental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Family Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Center of Environmental and Occupational Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung, Taiwan
| | - Chu-Chih Chen
- Division of Biostatistics and Bioinformatics, Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan
| | - Shu-Li Wang
- Division of Environmental Health and Occupational Medicine, National Health Research Institutes, Miaoli, Taiwan
| | - Ching-Chang Lee
- Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Research Center of Environmental Trace Toxic Substance, National Cheng Kung University, Tainan, Taiwan
| | - Chao Agnes Hsiung
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan.
| | - Mei-Lien Chen
- Institute of Environmental and Occupational Health Sciences, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
| |
Collapse
|
28
|
Asada Y, Chriqui J, Chavez N, Odoms-Young A, Handler A. USDA Snack Policy Implementation: Best Practices From the Front Lines, United States, 2013-2014. Prev Chronic Dis 2016; 13:E79. [PMID: 27309416 PMCID: PMC4927271 DOI: 10.5888/pcd13.160023] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Introduction The Smart Snacks in Schools interim final rule was promulgated by the US Department of Agriculture (USDA) as authorized by the Healthy, Hunger-Free Kids Act of 2010 (PL 111–296) and implementation commenced beginning July 1, 2014; however, in the years leading up to this deadline, national studies suggested that most schools were far from meeting the USDA standards. Evidence to guide successful implementation of the standards is needed. This study examined snack policy implementation in exemplary high schools to learn best practices for implementation. Methods Guided by a multiple case study approach, school professionals (n = 37) from 9 high schools across 8 states were recruited to be interviewed about perceptions of school snack implementation; schools were selected using criterion sampling on the basis of the HealthierUS Schools Challenge: Smarter Lunchrooms (HUSSC: SL) database. Interview transcripts and internal documents were organized and coded in ATLAS.Ti v7; 2 researchers coded and analyzed data using a constant comparative analysis method to identify best practice themes. Results Best practices for snack policy implementation included incorporating the HUSSC: SL award’s comprehensive wellness approach; leveraging state laws or district policies to reinforce snack reform initiatives; creating strong internal and external partnerships; and crafting positive and strategic communications. Conclusion Implementation of snack policies requires evidence of successful experiences from those on the front lines. As federal, state, and local technical assistance entities work to ensure implementation of the Smart Snacks standards, these best practices provide strategies to facilitate the process.
Collapse
Affiliation(s)
- Yuka Asada
- Postdoctoral Research Associate, Institute for Health Research and Policy, University of Illinois at Chicago, 1747 W Roosevelt Rd, Chicago, M/C 275, IL 60608.
| | - Jamie Chriqui
- Institute for Health Research and Policy, School of Public Health, University of Illinois at Chicago, Chicago, Illinois
| | - Noel Chavez
- Community Health Sciences, School of Public Health, University of Illinois at Chicago, Chicago, Illinois
| | - Angela Odoms-Young
- College of Applied Health Sciences, Department of Kinesiology and Nutrition, College of Allied Health, University of Illinois at Chicago, Chicago, Illinois
| | - Arden Handler
- Community Health Sciences, School of Public Health, University of Illinois at Chicago, Chicago, Illinois
| |
Collapse
|
29
|
Gorski MT, Cohen JFW, Hoffman JA, Rosenfeld L, Chaffee R, Smith L, Rimm EB. Impact of Nutrition Standards on Competitive Food Quality in Massachusetts Middle and High Schools. Am J Public Health 2016; 106:1101-8. [PMID: 27077344 DOI: 10.2105/ajph.2016.303139] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To examine changes in competitive foods (items sold in à la carte lines, vending machines, and school stores that "compete" with school meals) in Massachusetts middle and high schools before and after implementation of a statewide nutrition law in 2012. METHODS We photographed n = 10 782 competitive foods and beverages in 36 Massachusetts school districts and 7 control state districts to determine availability and compliance with the law at baseline (2012), 1 year (2013), and 2 years (2014) after the policy (overall enrollment: 71 202 students). We examined availability and compliance trends over time. RESULTS By 2014, 60% of competitive foods and 79% of competitive beverages were compliant. Multilevel models showed an absolute 46.2% increase for foods (95% confidence interval = 36.2, 56.3) and 46.8% increase for beverages (95% confidence interval = 39.2, 54.4) in schools' alignment with updated standards from 2012 to 2014. CONCLUSIONS The law's implementation resulted in major improvements in the availability and nutritional quality of competitive foods and beverages, but schools did not reach 100% compliance. This law closely mirrors US Department of Agriculture Smart Snacks in School standards, suggesting that complying with strict nutrition standards is feasible, and schools may experience challenges and improvements over time.
Collapse
Affiliation(s)
- Mary T Gorski
- Mary T. Gorski is with the Interfaculty Initiative in Health Policy, Harvard Graduate School of Arts and Sciences, Harvard University, Cambridge, MA. Juliana F. W. Cohen is with the Department of Health Sciences, Merrimack College, North Andover, MA. Jessica A. Hoffman and Ruth Chaffee are with the Department of Applied Psychology, Bouvé College of Health Sciences, Northeastern University, Boston. Lindsay Rosenfeld is with the Institute for Child, Youth, and Family Policy, The Heller School for Social Policy and Management, Brandeis University, Waltham, MA. At the time of the study Lauren Smith was with the Department of Public Health, Commonwealth of Massachusetts, Boston. Eric B. Rimm is with the departments of Nutrition and Epidemiology, Harvard T. H. Chan School of Public Health, Harvard University, Boston
| | - Juliana F W Cohen
- Mary T. Gorski is with the Interfaculty Initiative in Health Policy, Harvard Graduate School of Arts and Sciences, Harvard University, Cambridge, MA. Juliana F. W. Cohen is with the Department of Health Sciences, Merrimack College, North Andover, MA. Jessica A. Hoffman and Ruth Chaffee are with the Department of Applied Psychology, Bouvé College of Health Sciences, Northeastern University, Boston. Lindsay Rosenfeld is with the Institute for Child, Youth, and Family Policy, The Heller School for Social Policy and Management, Brandeis University, Waltham, MA. At the time of the study Lauren Smith was with the Department of Public Health, Commonwealth of Massachusetts, Boston. Eric B. Rimm is with the departments of Nutrition and Epidemiology, Harvard T. H. Chan School of Public Health, Harvard University, Boston
| | - Jessica A Hoffman
- Mary T. Gorski is with the Interfaculty Initiative in Health Policy, Harvard Graduate School of Arts and Sciences, Harvard University, Cambridge, MA. Juliana F. W. Cohen is with the Department of Health Sciences, Merrimack College, North Andover, MA. Jessica A. Hoffman and Ruth Chaffee are with the Department of Applied Psychology, Bouvé College of Health Sciences, Northeastern University, Boston. Lindsay Rosenfeld is with the Institute for Child, Youth, and Family Policy, The Heller School for Social Policy and Management, Brandeis University, Waltham, MA. At the time of the study Lauren Smith was with the Department of Public Health, Commonwealth of Massachusetts, Boston. Eric B. Rimm is with the departments of Nutrition and Epidemiology, Harvard T. H. Chan School of Public Health, Harvard University, Boston
| | - Lindsay Rosenfeld
- Mary T. Gorski is with the Interfaculty Initiative in Health Policy, Harvard Graduate School of Arts and Sciences, Harvard University, Cambridge, MA. Juliana F. W. Cohen is with the Department of Health Sciences, Merrimack College, North Andover, MA. Jessica A. Hoffman and Ruth Chaffee are with the Department of Applied Psychology, Bouvé College of Health Sciences, Northeastern University, Boston. Lindsay Rosenfeld is with the Institute for Child, Youth, and Family Policy, The Heller School for Social Policy and Management, Brandeis University, Waltham, MA. At the time of the study Lauren Smith was with the Department of Public Health, Commonwealth of Massachusetts, Boston. Eric B. Rimm is with the departments of Nutrition and Epidemiology, Harvard T. H. Chan School of Public Health, Harvard University, Boston
| | - Ruth Chaffee
- Mary T. Gorski is with the Interfaculty Initiative in Health Policy, Harvard Graduate School of Arts and Sciences, Harvard University, Cambridge, MA. Juliana F. W. Cohen is with the Department of Health Sciences, Merrimack College, North Andover, MA. Jessica A. Hoffman and Ruth Chaffee are with the Department of Applied Psychology, Bouvé College of Health Sciences, Northeastern University, Boston. Lindsay Rosenfeld is with the Institute for Child, Youth, and Family Policy, The Heller School for Social Policy and Management, Brandeis University, Waltham, MA. At the time of the study Lauren Smith was with the Department of Public Health, Commonwealth of Massachusetts, Boston. Eric B. Rimm is with the departments of Nutrition and Epidemiology, Harvard T. H. Chan School of Public Health, Harvard University, Boston
| | - Lauren Smith
- Mary T. Gorski is with the Interfaculty Initiative in Health Policy, Harvard Graduate School of Arts and Sciences, Harvard University, Cambridge, MA. Juliana F. W. Cohen is with the Department of Health Sciences, Merrimack College, North Andover, MA. Jessica A. Hoffman and Ruth Chaffee are with the Department of Applied Psychology, Bouvé College of Health Sciences, Northeastern University, Boston. Lindsay Rosenfeld is with the Institute for Child, Youth, and Family Policy, The Heller School for Social Policy and Management, Brandeis University, Waltham, MA. At the time of the study Lauren Smith was with the Department of Public Health, Commonwealth of Massachusetts, Boston. Eric B. Rimm is with the departments of Nutrition and Epidemiology, Harvard T. H. Chan School of Public Health, Harvard University, Boston
| | - Eric B Rimm
- Mary T. Gorski is with the Interfaculty Initiative in Health Policy, Harvard Graduate School of Arts and Sciences, Harvard University, Cambridge, MA. Juliana F. W. Cohen is with the Department of Health Sciences, Merrimack College, North Andover, MA. Jessica A. Hoffman and Ruth Chaffee are with the Department of Applied Psychology, Bouvé College of Health Sciences, Northeastern University, Boston. Lindsay Rosenfeld is with the Institute for Child, Youth, and Family Policy, The Heller School for Social Policy and Management, Brandeis University, Waltham, MA. At the time of the study Lauren Smith was with the Department of Public Health, Commonwealth of Massachusetts, Boston. Eric B. Rimm is with the departments of Nutrition and Epidemiology, Harvard T. H. Chan School of Public Health, Harvard University, Boston
| |
Collapse
|
30
|
Arteaga SS, Loria CM, Crawford PB, Fawcett SB, Fishbein HA, Gregoriou M, John LV, Kelley M, Pate RR, Ritchie LD, Strauss WJ. The Healthy Communities Study: Its Rationale, Aims, and Approach. Am J Prev Med 2015; 49:615-23. [PMID: 26384931 PMCID: PMC6266875 DOI: 10.1016/j.amepre.2015.06.029] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Revised: 06/03/2015] [Accepted: 06/23/2015] [Indexed: 11/15/2022]
Abstract
Communities across the U.S. are implementing programs and policies designed to address the epidemic of childhood obesity. These programs vary widely in their approaches, including the intensity level, duration, funding, target population, and implementation techniques. However, no previous studies have examined these variations and determined how such aspects of community programs and policies are related to childhood obesity outcomes. The Healthy Communities Study is an observational study that is assessing the associations between characteristics of community programs and policies and BMI, nutrition, and physical activity in children. The Healthy Communities Study was funded in 2010, field data collection and medical record abstraction will be completed in 2015, and data cleaning and analyses will be completed by mid-year 2016. One-hundred and thirty communities (defined as a high school catchment area) and approximately 5,000 children in kindergarten through eighth grade and their parents have been recruited from public elementary and middle schools across the country. The study is examining quantitative and qualitative information obtained from community-based initiatives; measures of community characteristics (e.g., school environment); and child and parent measures, including children's physical activity levels and dietary practices and children's and parents' BMI. The Healthy Communities Study employs a complex study design that includes a diverse sample of communities across the country and combines current/cross-sectional and retrospective data (abstracted from children's medical records). This paper describes the rationale for the Healthy Communities Study, the study aims and logic model, and a brief overview of the study design.
Collapse
Affiliation(s)
- S Sonia Arteaga
- National Heart, Lung, and Blood Institute, Bethesda, Maryland.
| | | | - Patricia B Crawford
- Nutrition Policy Institute, Division of Agriculture and Natural Resources, University of California, Oakland, California
| | - Stephen B Fawcett
- Work Group for Community Development, University of Kansas, Lawrence, Kansas
| | | | | | - Lisa V John
- Battelle Health and Analytics, St. Louis, Missouri
| | | | - Russell R Pate
- Department of Exercise Science, University of South Carolina, Columbia, South Carolina
| | - Lorrene D Ritchie
- Nutrition Policy Institute, Division of Agriculture and Natural Resources, University of California, Oakland, California
| | | |
Collapse
|
31
|
Mann G, Kraak V, Serrano E. The Availability of Competitive Foods and Beverages to Middle School Students in Appalachian Virginia Before Implementation of the 2014 Smart Snacks in School Standards. Prev Chronic Dis 2015; 12:E153. [PMID: 26378899 PMCID: PMC4576436 DOI: 10.5888/pcd12.150051] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The study objective was to examine the nutritional quality of competitive foods and beverages (foods and beverages from vending machines and à la carte foods) available to rural middle school students, before implementation of the US Department of Agriculture’s Smart Snacks in School standards in July 2014. In spring 2014, we audited vending machines and à la carte cafeteria foods and beverages in 8 rural Appalachian middle schools in Virginia. Few schools had vending machines. Few à la carte and vending machine foods met Smart Snacks in School standards (36.6%); however, most beverages did (78.2%). The major challenges to meeting standards were fat and sodium content of foods. Most competitive foods (63.4%) did not meet new standards, and rural schools with limited resources will likely require assistance to fully comply.
Collapse
Affiliation(s)
- Georgianna Mann
- Department of Human Nutrition, Foods, and Exercise, Virginia Polytechnic Institute and State University, Blacksburg, VA 24061.
| | - Vivica Kraak
- Department of Human Nutrition, Foods, and Exercise, Virginia Polytechnic Institute and State University, Blacksburg, Virginia
| | - Elena Serrano
- Department of Human Nutrition, Foods, and Exercise, Virginia Polytechnic Institute and State University, Blacksburg, Virginia
| |
Collapse
|