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Kasman M, Hammond RA, Reader L, Purcell R, Guyer S, Ganiban JM, Mitchell DC, Dabelea DM, Bellatorre A, Bekelman TA, Cohen CC, Perng W, Grummon AH, Wu AJ, Oken E, Kleinman K. Childhood Sugar-Sweetened Beverage Consumption: an Agent-Based Model of Context-Specific Reduction Efforts. Am J Prev Med 2023; 65:1003-1014. [PMID: 37451323 PMCID: PMC10787028 DOI: 10.1016/j.amepre.2023.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 07/07/2023] [Accepted: 07/09/2023] [Indexed: 07/18/2023]
Abstract
INTRODUCTION Despite widespread recognition among public health experts that childhood sugar-sweetened beverage consumption should be reduced, doing so has proven to be a challenge. An agent-based model of early childhood sugar-sweetened beverage consumption was applied to data from three high-quality, longitudinal cohort studies to gain insight into potentially effective intervention strategies across contexts. METHODS From 2021 to 2023, a single agent-based model design was applied to data sets derived from three separate cohorts of children followed from infancy to childhood, with very different populations and environments (participants recruited in 1999-2002; 2003-2010; and 2009-2014). After assessing its ability to reproduce observed consumption patterns across cohorts, it was used to simulate potential impacts of multiple intervention strategies across contexts. RESULTS Interventions reducing home availability of sugar-sweetened beverages consistently had the largest potential effects. Impact differed between cohort settings: a complete decrease in availability resulted in an estimated 87% decrease in overall early childhood consumption for one of the cohorts, compared with 61% and 54% in the others. Reducing availability in center-based child care resulted in substantially greater reduction in one cohort relative to the other two. CONCLUSIONS There is untapped potential for strategies targeting children's sugar-sweetened beverage consumption in the home, but in some instances, other approaches might also yield meaningful effects. Tailoring approach to setting may be important, and agent-based models can be informative for doing so. This agent-based model has broad generalizability and potential to serve as a tool for designing effective, context-specific strategies to reduce childhood sugar-sweetened beverage consumption.
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Affiliation(s)
- Matt Kasman
- Center on Social Dynamics and Policy, Brookings Institution, Washington, District of Columbia.
| | - Ross A Hammond
- Center on Social Dynamics and Policy, Brookings Institution, Washington, District of Columbia; Center for Public Health Systems Science, Brown School at Washington University, St Louis, Missouri; The Santa Fe Institute, Santa Fe, New Mexico
| | - Lydia Reader
- Center for Public Health Systems Science, Brown School at Washington University, St Louis, Missouri
| | - Rob Purcell
- Center on Social Dynamics and Policy, Brookings Institution, Washington, District of Columbia
| | - Sally Guyer
- Leve Lab, University of Oregon, Eugene, Oregon
| | - Jody M Ganiban
- Department of Psychology, The George Washington University, Washington, District of Columbia
| | - Diane C Mitchell
- Department of Nutritional Sciences, Pennsylvania State University, University Park, Pennsylvania
| | - Dana M Dabelea
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Anna Bellatorre
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Traci A Bekelman
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Catherine C Cohen
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Wei Perng
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Anna H Grummon
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California
| | - Allison J Wu
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Emily Oken
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts; Department of Nutrition, Harvard TH Chan School of Public Health, Boston, Massachusetts
| | - Ken Kleinman
- Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts-Amherst, Amherst, Massachusetts
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Kasman M, Hammond RA, Purcell R, Heuberger B, Moore TR, Grummon AH, Wu AJ, Block JP, Hivert MF, Oken E, Kleinman K. An agent-based model of child sugar-sweetened beverage consumption: implications for policies and practices. Am J Clin Nutr 2022; 116:1019-1029. [PMID: 36041179 PMCID: PMC9535525 DOI: 10.1093/ajcn/nqac194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 07/08/2022] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND A strong body of evidence links young children's intake of sugar-sweetened beverages (SSBs) with myriad negative outcomes. OBJECTIVES Our research provides insight into whether and to what extent potential intervention strategies can reduce young children's consumption of SSBs. METHODS We built an agent-based model (ABM) of SSB consumption representing participants in the Project Viva longitudinal study between ages 2 and 7 y. In addition to extensive data from Project Viva, our model used nationally representative data as well as recent, high-quality literature. We tested the explanatory power of the model through comparison to consumption patterns observed in the Project Viva cohort. Then, we applied the model to simulate the potential impact of interventions that would reduce SSB availability in 1 or more settings or affect how families receive and respond to pediatrician advice. RESULTS Our model produced age-stratified trends in beverage consumption that closely match those observed in Project Viva cohort data. Among the potential interventions we simulated, reducing availability in the home-where young children spend the greatest amount of time-resulted in the largest consumption decrease. Removing access to all SSBs in the home resulted in them consuming 1.23 (95% CI: 1.21, 1.24) fewer servings of SSBs per week on average between the ages of 2 and 7 y, a reduction of ∼60%. By comparison, removing all SSB availability outside of the home (i.e., in schools and childcare) had a smaller impact (0.77; CI: 0.75, 0.78), a reduction of ∼40%. CONCLUSIONS These results suggest that interventions reducing SSB availability in the home would have the strongest effects on SSB consumption.
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Affiliation(s)
- Matt Kasman
- Center on Social Dynamics and Policy, Brookings Institution, Washington, DC, USA
| | - Ross A Hammond
- Center on Social Dynamics and Policy, Brookings Institution, Washington, DC, USA
- Brown School at Washington University in St. Louis, St. Louis, MO, USA
- The Santa Fe Institute, Santa Fe, NM, USA
| | - Rob Purcell
- Center on Social Dynamics and Policy, Brookings Institution, Washington, DC, USA
| | - Benjamin Heuberger
- Center on Social Dynamics and Policy, Brookings Institution, Washington, DC, USA
| | - Travis R Moore
- ChildObesity180, Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
- Department of Community Health, School of Arts and Sciences, Tufts University, Medford, MA, USA
| | - Anna H Grummon
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Allison J Wu
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
- Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, MA, USA
| | - Jason P Block
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Marie-France Hivert
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
- Diabetes Unit, Massachusetts General Hospital, Boston, MA, USA
| | - Emily Oken
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Ken Kleinman
- Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts–Amherst, Amherst, MA, USA
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Lee DL, Gurzo K, Nhan LA, Vitale EH, Yoshida S, Hecht K, Ritchie LD. Status of Beverages Served to Young Children in Child Care After Implementation of California Policy, 2012-2016. Prev Chronic Dis 2020; 17:E30. [PMID: 32271702 PMCID: PMC7207061 DOI: 10.5888/pcd17.190296] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Since 2012, licensed California child care centers and homes, per state policy, are required to serve only unflavored low-fat or nonfat milk to children aged 2 years or older, no more than one serving of 100% juice daily, and no beverages with added sweeteners, and they are required to ensure that drinking water is readily accessible throughout the day. We evaluated adherence to the policy after 4 years in comparison to the adherence evaluation conducted shortly after the policy went into effect. METHODS Licensed California child care sites were randomly selected in 2012 and 2016 and surveyed about beverage practices and provisions to children aged 1-5 years. We used logistic regression to analyze between-year differences for all sites combined and within-year differences by site type and participation in the federal Child and Adult Care Food Program (CACFP) in self-reported policy adherence and beverage provisions. RESULTS Respondents in 2016 (n = 680), compared with those in 2012 (n = 435), were more adherent to California's 2010 Healthy Beverages in Child Care Act overall (45.1% vs 27.2%, P < .001) and with individual provisions for milk (65.0% vs 41.4%, P < .001), 100% juice (91.2% vs 81.5%, P < .001), and sugar-sweetened beverages (97.4% vs 93.4%, P = .006). In 2016, centers compared with homes (48.5% vs 28.0%, P = .001) and CACFP sites compared with non-CACFP sites (51.6% vs 27.9%, P < .001) were more adherent to AB2084 overall. DISCUSSION Beverage policy adherence in California child care has improved since 2012 and is higher in CACFP sites and centers. Additional policy promotion and implementation support is encouraged for non-CACFP sites and homes. Other states should consider adopting such policies.
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Affiliation(s)
- Danielle L Lee
- University of California, Division of Agriculture and Natural Resources, Nutrition Policy Institute, Berkeley, California
| | - Klara Gurzo
- University of California, Division of Agriculture and Natural Resources, Nutrition Policy Institute, Berkeley, California
- Stockholm University, Department of Public Health Sciences, Stockholm, Sweden
| | - Lilly A Nhan
- University of California, Division of Agriculture and Natural Resources, Nutrition Policy Institute, Berkeley, California
- University of California, Los Angeles, Fielding School of Public Health, Community Health Sciences, Los Angeles, California
| | - Elyse Homel Vitale
- California Food Policy Advocates, Oakland, California
- Child Care Food Program Roundtable, Los Angeles, California
| | - Sallie Yoshida
- The Sarah Samuels Center for Public Health Research and Evaluation, Oakland, California
| | - Ken Hecht
- University of California, Division of Agriculture and Natural Resources, Nutrition Policy Institute, Berkeley, California
| | - Lorrene D Ritchie
- University of California, Division of Agriculture and Natural Resources, Nutrition Policy Institute, 2115 Milvia St, Suite 301, Berkeley, CA, 94704.
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Lee DL, Gurzo K, Yoshida S, Homel Vitale E, Hecht K, Ritchie LD. Compliance with the New 2017 Child and Adult Care Food Program Standards for Infants and Children before Implementation. Child Obes 2018; 14:393-402. [PMID: 30199288 PMCID: PMC6150931 DOI: 10.1089/chi.2018.0092] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Nationally, child care providers serve nutritious food to over 4.5 million children each day as part of the federal Child and Adult Care Food Program (CACFP). As implementation of the first major revisions to the CACFP standards occurs in 2017, understanding how to support compliance is critical. METHODS In 2016, surveys were sent to a randomly selected sample of 2400 licensed California child care centers and homes. Compliance with the new CACFP standards and best practices for infants under 1 year and children 1-5 years of age was assessed. Also, compliance was compared by CACFP participation, and between centers and homes. Interviews were conducted with 16 CACFP stakeholders to further understand barriers to and facilitators of compliance. RESULTS Analysis of 680 survey responses revealed that compliance with most individual CACFP standards and best practices examined was high (>60% of sites). However, compliance with all new standards was low (<23% of sites). Compliance was lowest for timing of introduction of solids to infants, not serving sweet grains, serving yogurt low in sugar, and serving appropriate milk types to children. When different, compliance was higher for sites participating in CACFP versus nonparticipants, and for centers versus homes. Although providers indicated few barriers, stakeholders identified the need for incremental and easily accessible trainings that provide practical tips on implementation. CONCLUSION Training on a number of topics is needed to achieve full implementation of the new CACFP standards to ensure that young children in child care have access to healthier meals and snacks.
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Affiliation(s)
- Danielle L. Lee
- Nutrition Policy Institute, University of California Division of Agriculture and Natural Resources, Berkeley, CA
| | - Klara Gurzo
- Nutrition Policy Institute, University of California Division of Agriculture and Natural Resources, Berkeley, CA
| | - Sallie Yoshida
- The Sarah Samuels Center for Public Health Research and Evaluation, Oakland, CA
| | | | - Ken Hecht
- Nutrition Policy Institute, University of California Division of Agriculture and Natural Resources, Berkeley, CA
| | - Lorrene D. Ritchie
- Nutrition Policy Institute, University of California Division of Agriculture and Natural Resources, Berkeley, CA.,Address correspondence to:Lorrene D. Ritchie, PhD, RDNutrition Policy InstituteUniversity of California Division of Agriculture and Natural Resources2115 Milvia Street, Suite 301Berkeley, CA 94704
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