Stronger State School Nutrition Laws Are Associated With Healthier Eating Behaviors and Optimal Weight Status in US Adolescents

State Legislation Related to School Nutrition: Predictors of Bill Passage From 2010-2019

OBJECTIVE

This study aimed to discover the prevalence of school nutrition state legislation and to identify the correlates of enactment.

DESIGN, SETTING, AND PARTICIPANTS

An online legislative database, Legiscan, was used to collect bills related to school nutrition from the US from 2010 to 2019. Bills were coded and compiled into a study database with state-level dietary variables (obesity prevalence, fruit, and vegetable intake, sugar-sweetened beverage consumption), community variables (percent White, poverty), and bill-characteristic variables (party affiliation in legislature, strength of language, party of governor, school gardens, vegetable intake, and other salient variables). Multivariable models were built to examine predictors of bill enactment.

RESULTS

Of the 462 bills introduced, 38.7% (n = 156) were enacted. In a multivariable model, the strength of bill language, political party affiliation, implementation of school gardens, and vegetable intake were the variables associated with bill passage. Bills with strong language were less likely to be enacted (P <0.001). Bills introduced by Democrats were more likely to be enacted (P = 0.01).

CONCLUSION AND IMPLICATION

This study showed a better understanding of legislative support for child nutrition via policy surveillance of bills and their correlates of enactment. This information can be used to prioritize advocacy efforts and identify ways research can better inform policy.

Food insecurity and use of electronic vapor products among high school students

Background: Studies have shown that food insecurity is associated with electronic vapor products (EVP) use in adults; however, an understanding of this relationship in adolescents is needed to inform prevention efforts in this age group. Aim: Examine the relationship of food insecurity with EVP use patterns, frequency and source of acquisition in high school students. Methods: This cross-sectional study used Youth Risk Behavior Survey (YRBS) 2019 data from states that incorporated the YRBS' optional food insecurity question. The data included 42,154 high school students with complete information on food insecurity and two EVP-related questions. Responses to EVP-related questions identified "ever users," "current users," "former users," "current dual EVP-cigarette users," and assessed "frequency of EVP use among current users" and "source of EVP acquisition." Logistic regression examined associations of food insecurity with EVP-related outcomes. Results: The proportion of high school students who ever used EVP was 48.3% and the proportion of food-insecure students was about 12%. Food security status significantly differed by race/ethnicity of students, such that the proportion of food insecure students classified as "non-Hispanic White" was lower than the proportion of food secure students classified as "non-Hispanic White." Food insecurity was significantly associated with greater odds of ever EVP use (odds ratio (OR) = 1.75; 95% confidence interval (CI) = (1.55, 1.96)), current EVP use (OR = 2.07; 95% CI = (1.80, 2.37); using never users as reference category) and current dual use of EVP and cigarettes (OR = 2.91; 95% CI = (2.38, 3.55)). Food insecurity also was associated with greater odds of current EVP use (OR = 1.54; 95% CI = (1.28, 1.84)) when former users were used as reference category. In current users, food insecurity was related to greater odds of daily EVP use (OR = 1.40; 95% CI = (1.14, 1.70)) compared to occasional use. Conclusions: Study findings imply that efforts targeting prevention/cessation of EVP use should consider reducing food insecurity in high school students.

"Competitive" food and beverage policies and weight status: A systematic review of the evidence among sociodemographic subgroups

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.

The food environment in schools and their immediate vicinities associated with excess weight in adolescence: A systematic review and meta-analysis

AIM

The present study systematically reviewed the characteristics of the food environment in schools and their immediate vicinities associated with excess weight in adolescents.

METHODS

We searched for relevant articles in seven databases. No restrictions were applied on language, publication date, and status of publication. The study selection process and data extraction were conducted by two authors independently. For meta-analyses, the random-effects model and the maximum-likelihood method were applied.

RESULTS

A total of 9327 publications were identified from the initial search. Of these, 20 studies met the inclusion criteria and were included in the systematic review. The sale of food in school or immediate vicinity was associated with high BMI [Odds ratio (OR)= 1.14, 95% confidence interval (CI) 1.01, 2.06]. The availability of healthy food provided by school significantly decreased the odds of obesity [OR= 0.89, 95%CI 0.82, 0.96]. However, the presence of nutrition policies or programs at school was not associated with obesity (OR= 0.81, 95%CI 0.57, 1.16).

CONCLUSIONS

This study highlights the need for improvement in school food environment, including restricting students' exposure to unhealthy foods. The quality of food (healthy vs unhealthy) provided or made available to adolescents in the school food environment influences their weight status. Therefore, promotion of healthy food programs and availability of healthy food at school would limit the prevalence of excess weight in adolescents.

The "Best of 2020 List" of Health Promotion Researchers

Each year, the editorial team of the American Journal of Health Promotion selects our "Best of the Year List" of health promotion studies from the prior year. This editorial features the Editor's picks, the Editor in Chief's favorites and other award categories for the research and writing published in 2020 in this journal. Our criteria for selection includes: whether the study addresses a topic of timely importance in health promotion, the research question is clearly stated and the methodologies used are well executed; whether the paper is often cited and downloaded; if the study findings offer a unique contribution to the literature; and if the paper is well-written and enjoyable to read. Awardees in 2020 offered new insights into confronting systemic racism, the impact of state health policies on eating behaviors, the role of leaders in influencing employee health practices and the role of physicians in influencing patient health practices. You will see how researchers are studying psychological and emotional resiliency in ever more specific populations.