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Sobek C, Ober P, Abel S, Spielau U, Kiess W, Meigen C, Poulain T, Igel U, Vogel M, Lipek T. Purchasing Behavior, Setting, Pricing, Family: Determinants of School Lunch Participation. Nutrients 2021; 13:4209. [PMID: 34959761 PMCID: PMC8706800 DOI: 10.3390/nu13124209] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 11/16/2021] [Accepted: 11/22/2021] [Indexed: 11/16/2022] Open
Abstract
Despite growing school lunch availability in Germany, its utilization is still low, and students resort to unhealthy alternatives. We investigated predictors of school lunch participation and reasons for nonparticipation in 1215 schoolchildren. Children reported meal habits, parents provided family-related information (like socioeconomic status), and anthropometry was conducted on-site in schools. Associations between school lunch participation and family-related predictors were estimated using logistic regression controlling for age and gender if necessary. School was added as a random effect. School lunch participation was primarily associated with family factors. While having breakfast on schooldays was positively associated with school lunch participation (ORadj = 2.20, p = 0.002), lower secondary schools (ORadj = 0.52, p < 0.001) and low SES (ORadj = 0.25, p < 0.001) were negatively associated. The main reasons for nonparticipation were school- and lunch-related factors (taste, time constraints, pricing). Parents reported pricing as crucial a reason as an unpleasant taste for nonparticipation. Nonparticipants bought sandwiches and energy drinks significantly more often on school days, whereas participants were less often affected by overweight (OR = 0.66, p = 0.043). Our data stress school- and lunch-related factors as an important opportunity to foster school lunch utilization.
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Affiliation(s)
- Carolin Sobek
- LIFE Child, Hospital for Children and Adolescents, Medical Faculty, Leipzig University, 04103 Leipzig, Germany; (P.O.); (S.A.); (W.K.); (C.M.); (T.P.); (U.I.); (M.V.); (T.L.)
- Center for Pediatric Research (CPL), Hospital for Children and Adolescents, Medical Faculty, Leipzig University, 04103 Leipzig, Germany;
| | - Peggy Ober
- LIFE Child, Hospital for Children and Adolescents, Medical Faculty, Leipzig University, 04103 Leipzig, Germany; (P.O.); (S.A.); (W.K.); (C.M.); (T.P.); (U.I.); (M.V.); (T.L.)
- Center for Pediatric Research (CPL), Hospital for Children and Adolescents, Medical Faculty, Leipzig University, 04103 Leipzig, Germany;
- Integrated Research and Treatment Center Adiposity Diseases, Medical Faculty, Leipzig University, 04103 Leipzig, Germany
| | - Sarah Abel
- LIFE Child, Hospital for Children and Adolescents, Medical Faculty, Leipzig University, 04103 Leipzig, Germany; (P.O.); (S.A.); (W.K.); (C.M.); (T.P.); (U.I.); (M.V.); (T.L.)
- Center for Pediatric Research (CPL), Hospital for Children and Adolescents, Medical Faculty, Leipzig University, 04103 Leipzig, Germany;
- Integrated Research and Treatment Center Adiposity Diseases, Medical Faculty, Leipzig University, 04103 Leipzig, Germany
| | - Ulrike Spielau
- Center for Pediatric Research (CPL), Hospital for Children and Adolescents, Medical Faculty, Leipzig University, 04103 Leipzig, Germany;
- Integrated Research and Treatment Center Adiposity Diseases, Medical Faculty, Leipzig University, 04103 Leipzig, Germany
| | - Wieland Kiess
- LIFE Child, Hospital for Children and Adolescents, Medical Faculty, Leipzig University, 04103 Leipzig, Germany; (P.O.); (S.A.); (W.K.); (C.M.); (T.P.); (U.I.); (M.V.); (T.L.)
- Center for Pediatric Research (CPL), Hospital for Children and Adolescents, Medical Faculty, Leipzig University, 04103 Leipzig, Germany;
| | - Christof Meigen
- LIFE Child, Hospital for Children and Adolescents, Medical Faculty, Leipzig University, 04103 Leipzig, Germany; (P.O.); (S.A.); (W.K.); (C.M.); (T.P.); (U.I.); (M.V.); (T.L.)
- Center for Pediatric Research (CPL), Hospital for Children and Adolescents, Medical Faculty, Leipzig University, 04103 Leipzig, Germany;
| | - Tanja Poulain
- LIFE Child, Hospital for Children and Adolescents, Medical Faculty, Leipzig University, 04103 Leipzig, Germany; (P.O.); (S.A.); (W.K.); (C.M.); (T.P.); (U.I.); (M.V.); (T.L.)
- Center for Pediatric Research (CPL), Hospital for Children and Adolescents, Medical Faculty, Leipzig University, 04103 Leipzig, Germany;
| | - Ulrike Igel
- LIFE Child, Hospital for Children and Adolescents, Medical Faculty, Leipzig University, 04103 Leipzig, Germany; (P.O.); (S.A.); (W.K.); (C.M.); (T.P.); (U.I.); (M.V.); (T.L.)
- Center for Pediatric Research (CPL), Hospital for Children and Adolescents, Medical Faculty, Leipzig University, 04103 Leipzig, Germany;
- Department of Social Work, University of Applied Science, 99085 Erfurt, Germany
| | - Mandy Vogel
- LIFE Child, Hospital for Children and Adolescents, Medical Faculty, Leipzig University, 04103 Leipzig, Germany; (P.O.); (S.A.); (W.K.); (C.M.); (T.P.); (U.I.); (M.V.); (T.L.)
- Center for Pediatric Research (CPL), Hospital for Children and Adolescents, Medical Faculty, Leipzig University, 04103 Leipzig, Germany;
| | - Tobias Lipek
- LIFE Child, Hospital for Children and Adolescents, Medical Faculty, Leipzig University, 04103 Leipzig, Germany; (P.O.); (S.A.); (W.K.); (C.M.); (T.P.); (U.I.); (M.V.); (T.L.)
- Center for Pediatric Research (CPL), Hospital for Children and Adolescents, Medical Faculty, Leipzig University, 04103 Leipzig, Germany;
- Integrated Research and Treatment Center Adiposity Diseases, Medical Faculty, Leipzig University, 04103 Leipzig, Germany
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Schroeder DG, Pachón H, Dearden KA, Ha TT, Lang TT, Marsh DR. An Integrated Child Nutrition Intervention Improved Growth of Younger, more Malnourished Children in Northern Viet Nam. Food Nutr Bull 2018. [DOI: 10.1177/15648265020234s108] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Dirk G. Schroeder
- Rollins School of Public Health at Emory University in Atlanta, Ga., USA
| | - Helena Pachón
- Rollins School of Public Health in Atlanta, is now affiliated with Cornell University in Ithaca, NewYork
| | - Kirk A. Dearden
- LINKAGES project, Academy for Educational Development in Washington D. C
| | - Tran Thu Ha
- Research and Training Center for Community Development in Hanoi
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Marsh DR, Pachón H, Schroeder DG, Ha TT, Dearden K, Lang TT, Hien ND, Tuan DA, Thach TD, Claussenius D. Design of a Prospective, Randomized Evaluation of an Integrated Nutrition Program in Rural Viet Nam. Food Nutr Bull 2018. [DOI: 10.1177/15648265020234s106] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | - Helena Pachón
- Rollins School of Public Health, Emory University in Atlanta, Ga., USA, is now affiliated with the Division of Nutritional Sciences at Cornell University in Ithaca, New York
| | - Dirk G. Schroeder
- Rollins School of Public Health at Emory University in Atlanta, Ga., USA
| | - Tran Thu Ha
- Save the Children Federation/US in Westport, Conn., USA
| | - Kirk Dearden
- LINKAGES Project, Academy for Educational Development in Washington, D.C., USA, is now at the Department of Health Science, Brigham Young University in Provo, Utah, USA
| | | | | | | | - Tran Duc Thach
- Hanoi Research and Training Centre for Community Development in Hanoi, Viet Nam
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Marsh DR, Pachón H, Schroeder DG, Ha TT, Dearden K, Lang TT, Hien ND, Tuan DA, Thach TD, Claussenius D. Design of a Prospective, Randomized Evaluation of an Integrated Nutrition Program in Rural Viet Nam. Food Nutr Bull 2016. [DOI: 10.1177/15648265020234s206] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Few prospective studies of child growth and its determinants take place in programmatic contexts. We evaluated the effect of Save the Children's (SC) community empowerment and nutrition program (CENP) on child growth, care, morbidity, empowerment, and behavioral determinants. This paper describes the research methods of this community-based study. We used a longitudinal, prospective, randomized design. We selected 12 impoverished communes with documented child malnutrition, three comparison, and three intervention communes in each of two districts in Phu Tho Province, west of Hanoi. SC taught district trainers in November 1999 to train local health volunteers to implement the 10-month CENP, including situation analysis, positive deviance (PD) inquiry, growth monitoring and promotion, nutrition education and rehabilitation program (NERP), deworming, and monitoring. PD inquiries aim to discover successful care practices in poor households that likely promote well-nourished children. NERPs are neighborhood-based, facilitated group learning sessions where caregivers of malnourished children learn and practice PD and other healthy behaviors. We dewormed all intervention and comparison children. We weighed all children less than 24 months of age living in the intervention and comparison communes and randomly selected 240 children (120 intervention and 120 comparison). We gathered information on nutritional status, diet, illness, care, behavioral determinants, empowerment, and program quality, monthly for six months with a re-survey at 12 months. We collected most information through maternal interview but also observed hygiene and program quality, and videotaped feedings at home. Some implementation and research limitations will attenuate CENP impact and measurement of its effectiveness.
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Schroeder DG, Pachón H, Dearden KA, Ha TT, Lang TT, Marsh DR. An Integrated Child Nutrition Intervention Improved Growth of Younger, More Malnourished Children in Northern Viet Nam. Food Nutr Bull 2016. [DOI: 10.1177/15648265020234s208] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Integrated nutrition programs are widely used to prevent and/or reverse childhood malnutrition, but rarely rigorously evaluated. The impact of such a program on the physical growth of young rural Vietnamese children was measured. We randomized six communes to receive an integrated nutrition program implemented by Save the Children. We matched six communes to serve as controls. Our sample consisted of 238 children ( n = 119 per group) who were 5 to 30 months old on entry. Between December 1999 and December 2000, we measured weight and height monthly for six months and again at month 12. Principle outcomes were weight-for-age Z score (WAZ), height-for-age Z score (HAZ), and weight-for-height Z score (WHZ), and the changes among these measures. As expected, anthropometric indicators relative to international references worsened as the children aged. Overall, children in the intervention communes who were exposed to the integrated nutrition program did not show statistically significant better growth than comparison children. Intervention children who were younger (15 months or less) and more malnourished (less than −2 Z) at baseline, however, deteriorated significantly less than their comparable counterparts. Between baseline and month four, for example, intervention children who were malnourished and less than 15 months old at entry lost on average 0.05 WAZ while similar comparison children lost 0.25 WAZ ( p = .02). Lack of overall impact on growth may be due to a lower than expected prevalence of malnutrition at baseline and/or deworming of comparison children. Targeting nutrition interventions at very young children will have the maximum impact on growth.
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Abstract
BACKGROUND In clinical settings, it is common to measure weight of clothed patients and estimate a correction for the weight of clothing, but we can find no papers in the medical literature regarding the variability in clothing weight of adults with weather, season and gender. METHODS Fifty adults (35 women) were weighed four times during a 12-month period with and without clothing. Clothing weights were determined and regressed against minimum, maximum and average daily outdoor temperature. RESULTS The average clothing weight (±s.d.) throughout the year was significantly greater in men than in women (1.2±0.3 vs 0.8±0.3 kg, P<0.0001). The average within-person minimum and the average within-person maximum clothing weights across the year were 0.9±0.2 and 1.5±0.4 kg for men, and 0.5±0.2 and 1.1±0.4 kg for women, respectively. The within-person s.d. in clothing weight was 0.3 kg for both men and women. Over the 55 °C range in the lowest to the highest outdoor temperatures, the regressions predicted a maximal change in clothing weight of only 0.4 kg in women and 0.6 kg in men. CONCLUSION The clothing weight of men is significantly greater than that of women, but there is little variability throughout the year. Therefore, a clothing adjustment of approximately 0.8 kg for women and 1.2 kg for men is appropriate regardless of outdoor temperature.
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Affiliation(s)
- L D Whigham
- USDA ARS Grand Forks Human Nutrition Research Center, Grand Forks, ND 58203, USA.
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