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Orta-Aleman D, Zuercher MD, Bacon KA, Chelius C, Hecht CE, Hecht K, Ritchie LD, Cohen JFW, Gosliner W. Students' Perspectives on the Benefits and Challenges of Universal School Meals Related to Food Accessibility, Stigma, Participation, and Waste. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2024; 56:599-610. [PMID: 38888536 DOI: 10.1016/j.jneb.2024.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 04/30/2024] [Accepted: 04/30/2024] [Indexed: 06/20/2024]
Abstract
OBJECTIVE To reveal students' experiences and perspectives related to Universal School Meals (USM) under the federal coronavirus disease 2019 waivers during school years 2021-22. DESIGN Qualitative; 17 focus groups in June-July 2022. SETTING Virtual; students from 9 California regions in public and charter schools. PARTICIPANTS 67 students (n = 31 in high school, n = 36 in middle school) from a racially and economically diverse sample. PHENOMENON OF INTEREST Students' perceived benefits and drawbacks of USM. ANALYSIS Thematic analysis using an immersion-crystallization approach. RESULTS Students appreciated USM for increasing school meals' accessibility, promoting food security by financially supporting families, reducing the stigma associated with school meals, simplifying the payment system, and enhancing school meals convenience. An increase in school meal participation was observed. However, concerns emerged regarding a perceived decline in food quality and quantity and increased food waste. CONCLUSIONS AND IMPLICATIONS Universal School Meals showed promise in increasing access to meals, reducing food insecurity, stigma, and increasing participation. Addressing food quality, quantity, and waste concerns is critical for its sustained success. Policymakers need to advocate for the expansion and continuous refinement of USM, prioritizing stakeholder feedback. Ensuring adequate funding to balance meal quality and quantity while minimizing waste is essential for an adequate school meal policy.
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Affiliation(s)
- Dania Orta-Aleman
- Nutrition Policy Institute, University of California Agriculture and Natural Resources, Oakland, CA.
| | - Monica D Zuercher
- Nutrition Policy Institute, University of California Agriculture and Natural Resources, Oakland, CA
| | - Kassandra A Bacon
- Nutrition Policy Institute, University of California Agriculture and Natural Resources, Oakland, CA
| | - Carolyn Chelius
- Nutrition Policy Institute, University of California Agriculture and Natural Resources, Oakland, CA
| | - Christina E Hecht
- Nutrition Policy Institute, University of California Agriculture and Natural Resources, Oakland, CA
| | - Kenneth Hecht
- Nutrition Policy Institute, University of California Agriculture and Natural Resources, Oakland, CA
| | - Lorrene D Ritchie
- Nutrition Policy Institute, University of California Agriculture and Natural Resources, Oakland, CA
| | - Juliana F W Cohen
- School of Nursing and Health Science, Merrimack College, North Andover, MA; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Wendi Gosliner
- Nutrition Policy Institute, University of California Agriculture and Natural Resources, Oakland, CA
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Lingiardi N, Arribas A, Arriola I, Godoy E, Reinheimer MA. Reformulation of snacks offered to children and adolescents at school kiosks: is this strategy enough or just the tip of the iceberg? Int J Food Sci Nutr 2024:1-14. [PMID: 39206473 DOI: 10.1080/09637486.2024.2396481] [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: 01/13/2024] [Revised: 07/10/2024] [Accepted: 08/19/2024] [Indexed: 09/04/2024]
Abstract
Several studies have reported high overweight and obesity incidence among schoolchildren and adolescents, who mostly consume packaged snacks with critical nutrients exceeding the criteria of international profiling systems during school breaks. Then, the objectives of this work were to reformulate a snack consumed by Argentinian schoolchildren and adolescents (aged 6-13 years) to decrease its critical nutrient contents and to determine if this product would still be accepted. Chocolate chip vanilla cookies were selected for reformulation considering each recommended cut-off point for critical nutrients, since a prohibition of products with warning octagons being offered at schools would come into effect in Argentina. These cookies received good acceptability scores (above 3 of 5 points) and would be consumed by 8 of 10 schoolchildren in a sample of 200 participants. These findings underscore the importance of legislation promoting awareness of healthier eating habits and increasing the availability of healthier food options in schools.
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Affiliation(s)
- Nadia Lingiardi
- Facultad de Química, Universidad del Centro Educativo Latinoamericano (UCEL), Rosario, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Rosario, Argentina
| | - Alberto Arribas
- Facultad de Química, Universidad del Centro Educativo Latinoamericano (UCEL), Rosario, Argentina
- Asociación Supersaludable, Rosario, Argentina
| | - Ileana Arriola
- Facultad de Química, Universidad del Centro Educativo Latinoamericano (UCEL), Rosario, Argentina
- Asociación Supersaludable, Rosario, Argentina
| | - Ezequiel Godoy
- Facultad Regional Rosario (UTN), Universidad Tecnológica Nacional, Rosario, Argentina
| | - María Agustina Reinheimer
- Facultad de Química, Universidad del Centro Educativo Latinoamericano (UCEL), Rosario, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Rosario, Argentina
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A Noor R, Paulo HA, Shinde S, Tadesse AW, Tinkasimile A, Hussen Y, Ngeba J, Sherfi H, Drysdale R, Mwanyika-Sando M, Codjia P, Chitekwe S, Bärnighausen T, Sharma D, Fawzi WW. School health and nutrition environments: A multicountry survey in five countries of sub-Saharan Africa region-Burkina Faso, Ethiopia, South Africa, Sudan, and Tanzania. MATERNAL & CHILD NUTRITION 2024:e13614. [PMID: 39090832 DOI: 10.1111/mcn.13614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 11/04/2023] [Accepted: 12/04/2023] [Indexed: 08/04/2024]
Abstract
Schools are increasingly regarded as a key setting for promoting the health, well-being, and development of children and adolescents. In this multicountry cross-sectional survey, we describe the health, nutrition, and food environments of public primary schools in five urban settings in Africa region: Ouagadougou, Burkina Faso; Addis Ababa, Ethiopia; Durban; South Africa, Khartoum, Sudan; and, Dar es Salaam, Tanzania. We evaluated the school health and nutrition (SHN) environments in three main areas: (1) the availability of health-related policies, guidelines, and school curricula, (2) the provision of health, nutrition, and water, sanitation, and hygiene (WASH) services in schools, and (3) the school food environments and eating habits of adolescents. We used stratified random sampling to recruit 79 schools from five countries. Trained fieldworkers collected standardized questionnaire data from 79 school administrators, 765 food vendors, and 4999 in-school adolescents aged 10-15 years. In our study, 24 out of 79 school administrators were aware of their school's health-related policies and guidelines while 30 schools had a specific SHN curriculum. In general, health, nutrition, and WASH services were inadequate. Possibly due to a lack of school kitchens, 14.4% of students bought snacks and unhealthy foods from food vendors. Our study indicates that schools' food and nutrition environments are insufficient to improve adolescent health and nutrition in the African region, including limited coverage of SHN policies, suboptimal facilities and nutrition services, and unregulated food environments. Schools in sub-Saharan Africa need to improve their health and nutrition environments.
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Affiliation(s)
| | - Heavenlight A Paulo
- Department of Biostatistics and Epidemiology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- Department of Biostatistics, School of Public Health, Boston University, Boston, Massachusetts, USA
| | - Sachin Shinde
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Amare W Tadesse
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
- Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
| | | | | | - Joyce Ngeba
- United Nations Children's Funds, Dar es Salaam, Tanzania
| | - Huda Sherfi
- Public Health Training and Research Unit, Ahfad University for Women, Omdurman, Sudan
| | | | | | - Patrick Codjia
- United Nations Children's Funds, Dar es Salaam, Tanzania
| | | | - Till Bärnighausen
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
- Heidelberg Institute of Global Health, Heidelberg, Germany
| | - Deepika Sharma
- United Nations Children's Funds, New York, New York, USA
| | - Wafaie W Fawzi
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
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Hendrie GA, Anastasiou K, Brindal E, Wiggins B, Baird DL, Johnson BJ, Bell LK, Gardner C, Arguelles JC, Kelaart A, Cox DN, Golley RK. Increasing Children's Vegetable Consumption: Translating a Review of the Evidence Base to Develop Best Practice Guidelines. AJPM FOCUS 2024; 3:100229. [PMID: 38770236 PMCID: PMC11103422 DOI: 10.1016/j.focus.2024.100229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
Introduction Dietary guidelines worldwide emphasize the importance of consuming vegetables as part of a healthy diet. Despite this, translating this information into messages for consumers that change behavior has been difficult. There have been population-level social marketing campaigns as well as several smaller campaigns directed specifically toward children, which have demonstrated small increases in consumption. However, achieving meaningful and sustained increases in children's vegetable consumption remains a challenge. This article describes the process of synthesizing the published literature and translating these findings to inform the development of 7 best practice guidelines to increase children's vegetable intake. Methods The first step in this process was a systematic review of scientific literature to identify the components of interventions that were associated with successfully increasing vegetable intake. The synthesis of effective intervention components was guided by the Behavior Change Wheel. These scientific findings were translated to guidelines for best practice. This process involved a team of nutrition and behavioral researchers and nutrition practitioners translating the science into actionable advice that could be adopted by a range of stakeholders. The 6 selected stakeholders included long daycare centers, after-hours school care providers, primary schools, industry groups and growers, researchers, and government policy makers. Stakeholders were involved in the development process through surveys and interviews to understand their requirements for resources to support adoption of the best practice guidelines within each setting and within the context of existing practice. Results The guidelines center on coordination of effort, with a focus on components such as planning, environmental restructuring, barrier reduction, feedback, and monitoring. In consultation with key stakeholders, a range of resources were developed for each setting to support the implementation of best practice, with the aim of achieving meaningful increases in intake. The resources and tools have been made available at http://www.vegkit.com.au. Conclusions The translation of knowledge into practice is not traditionally included as part of the research process. Therefore, combining the process of reviewing the science and translating the evidence to stakeholder resources to influence practice in 1 research study is novel, and the study could be used to guide future research translation activities within and beyond the field of public health nutrition.
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Affiliation(s)
- Gilly A. Hendrie
- Human Health Program, CSIRO Health and Biosecurity, Adelaide, Australia
| | - Kim Anastasiou
- Human Health Program, CSIRO Health and Biosecurity, Adelaide, Australia
| | - Emily Brindal
- Human Health Program, CSIRO Health and Biosecurity, Adelaide, Australia
| | - Bonnie Wiggins
- Human Health Program, CSIRO Health and Biosecurity, Adelaide, Australia
| | - Danielle L. Baird
- Human Health Program, CSIRO Health and Biosecurity, Adelaide, Australia
| | - Brittany J. Johnson
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Lucinda K. Bell
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Claire Gardner
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | | | - Amber Kelaart
- Nutrition Australia Victoria Branch, Carlton, Australia
| | - David N. Cox
- Human Health Program, CSIRO Health and Biosecurity, Adelaide, Australia
| | - Rebecca K. Golley
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
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Perry M, Mardin K, Chamberlin G, Busey EA, Taillie LS, Dillman Carpentier FR, Popkin BM. National Policies to Limit Food Marketing and Competitive Food Sales in Schools: A Global Scoping Review. Adv Nutr 2024; 15:100254. [PMID: 38876396 PMCID: PMC11295572 DOI: 10.1016/j.advnut.2024.100254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Revised: 05/20/2024] [Accepted: 06/07/2024] [Indexed: 06/16/2024] Open
Abstract
School food environments contribute to children's nutritional intake and overall health. As such, the World Health Organization and other public health organizations encourage policies that restrict children's access and exposure to foods and beverages that do not build health in and around schools. This global scoping review explores the presence and characteristics of policies that restrict competitive food sales and marketing for unhealthy foods across 193 countries using evidence from policy databases, gray literature, peer-reviewed literature, and primary policy documents. Policies were included if they were nationally mandated and regulated marketing and/or competitive foods in the school environments. Worldwide, only 28% of countries were found to have any national-level policy restricting food marketing or competitive food sales in schools: 16% of countries restrict marketing, 25% restrict competitive foods, and 12% restrict both. Over half of policies were found in high-income countries. No low-income countries had either policy type. Eight marketing policies (27%) and 14 competitive foods policies (29%) lacked explicit guidelines for either policy monitoring or enforcement. Future research is needed to assess the prevalence of policies aimed at improving other key aspects of the school food environment, such as dietary quality of school meals or food procurement, as well as assess the implementation and efficacy of existing policies.
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Affiliation(s)
- Michelle Perry
- Global Food Research Program, Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Kayla Mardin
- Global Food Research Program, Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States; Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Grace Chamberlin
- Global Food Research Program, Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States; Department of Health Policy, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Emily A Busey
- Global Food Research Program, Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Lindsey Smith Taillie
- Global Food Research Program, Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States; Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Francesca R Dillman Carpentier
- Global Food Research Program, Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States; Hussman School of Journalism and Media, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Barry M Popkin
- Global Food Research Program, Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States; Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.
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Murphy M, Coffey A, Pallan M, Oyebode O. Changing the food environment in secondary school canteens to promote healthy dietary choices: a qualitative study with school caterers. BMC Public Health 2024; 24:1970. [PMID: 39044155 PMCID: PMC11267781 DOI: 10.1186/s12889-024-19513-7] [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: 01/18/2024] [Accepted: 07/17/2024] [Indexed: 07/25/2024] Open
Abstract
BACKGROUND Typical adolescent diets do not meet current dietary recommendations. There is a need to address these dietary patterns to reduce the risk of obesity and other diet-related diseases. Schools provide an opportune setting to do so, as students consume a substantial proportion of their daily dietary intake whilst at school. There is a developing evidence base on the use of choice architecture (food choice cues) to promote healthy eating in school contexts. It is necessary to understand the acceptability and feasibility of implementing such interventions. We aimed to explore these factors from the perspectives of secondary school caterers. METHODS We conducted qualitative interviews with caterers from secondary schools across the West Midlands, UK and national/regional catering representatives. A semi-structured topic guide and visual aid were used to guide interviews. Interviews were recorded and transcribed. Framework analysis was conducted in NVivo v12. RESULTS Twelve participants took part. Seven themes were identified and grouped into three categories: Acceptability (Suitability; Salient cues; Student engagement), Barriers (Catering decision drivers; Limits of influence), and Enablers (Perceived role; Opportunities). Caterers considered healthy food cues to be suited to adolescents as they require minimal reflective motivation. Salient cues included enhancing the placement, presentation and portability of healthy items, improving the dining environment and focusing pricing/incentive strategies on increased quantity. Student engagement was considered important. Some catering decision drivers conflicted with healthy food cues, and many felt that their role in healthy eating was limited due to the overwhelming influence of external food environments, adolescent resistance, and features of the secondary school canteen setting e.g. short duration of lunchtime, lack of space. However, caterers appeared motivated to implement healthy food cues and identified key opportunities for implementation, including integration into whole-school approaches to healthy eating. CONCLUSIONS Interventions using healthy food cues appeared acceptable to secondary school caterers, key potential implementers of these strategies. Future interventions could incorporate strategies relating to placement, presentation and pricing to prompt healthy selections, and actions to engage the student body and improve the dining environment. Evaluations should consider potential impacts upon food purchasing, consumption and waste to address caterers' concerns about these issues.
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Affiliation(s)
- Marie Murphy
- Institute of Applied Health Research, University Birmingham, Birmingham, UK.
| | - Alice Coffey
- Institute of Global Sustainable Development, University of Warwick, Coventry, UK
| | - Miranda Pallan
- Institute of Applied Health Research, University Birmingham, Birmingham, UK
| | - Oyinlola Oyebode
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
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Alonge O, Homsi M, Rizvi MS, Malykh R, Geffert K, Kasymova N, Tilenbaeva N, Isakova L, Kushubakova M, Mavlyanova D, Mamyrbaeva T, Duishenkulova M, Pinedo A, Andreeva O, Wickramasinghe K. Implementation of School Nutrition Policies to Address Noncommunicable Diseases in Uzbekistan and Kyrgyzstan. GLOBAL HEALTH, SCIENCE AND PRACTICE 2024; 12:GHSP-D-23-00442. [PMID: 38986582 PMCID: PMC11349503 DOI: 10.9745/ghsp-d-23-00442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 06/04/2024] [Indexed: 07/12/2024]
Abstract
Noncommunicable diseases (NCDs), including cardiovascular diseases, cancer, and diabetes, account for over 80% of mortality in Uzbekistan and Kyrgyzstan in 2019, and unhealthy dietary behaviors are a major risk factor for NCDs in both countries. In 2021, national stakeholders, in consultation with the World Health Organization, identified school nutrition policies (SNPs) as a major approach to reducing the burden of NCDs in both countries. The SNPs included interventions implemented through a multistakeholder and multisectoral arrangement that aimed to improve the health and nutrition status of children and young people by providing healthy food/beverages and restricting unhealthy foods or beverages in schools. We used a multimethod approach of document review, participatory workshops, and key informant interviews to generate theories of change for the large-scale implementation of SNPs and describe the implementation processes to date, including key implementation and health system challenges, salient implementation strategies, and implementation outcomes in both countries. Multiple pathways for enacting and implementing SNPs successfully were identified. However, significant health system challenges, such as the lack of accountability for contracting and tender processes and coordination among different sectors, continue to hamper the large-scale implementation of these policies in both countries. The pathways, theories, and implementation outcomes identified will facilitate the development of implementation strategies and systematic learning and evaluation around SNPs for NCD prevention and control programs in the Central Asian region and other low- and middle-income countries more broadly.
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Affiliation(s)
| | - Maysam Homsi
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Regina Malykh
- World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - Karin Geffert
- World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | | | | | - Lola Isakova
- Research Institute of Sanitation, Hygiene and Occupational Diseases, Ministry of Health of the Republic of Uzbekistan, Tashkent, Uzbekistan
| | - Maria Kushubakova
- Department of Disease Prevention and State Epidemiological Surveillance, Ministry of Health of Kyrgyzstan, Bishkek, Kyrgyzstan
| | | | | | - Marina Duishenkulova
- Republican Center of Health Promotion and Mass Communication under Ministry of Health, Bishkek, Kyrgyzstan
| | - Adriana Pinedo
- World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - Olga Andreeva
- World Health Organization Regional Office for Europe, Copenhagen, Denmark
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Choy CC, Simi S, Soti-Ulberg C, Naseri T, Salinas YD, Hawley NL. Noncommunicable disease risk behaviors and protective factors among children in Samoa: Retrospective trend analysis of global school-based health surveys in 2011 and 2017. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003315. [PMID: 38861507 PMCID: PMC11166286 DOI: 10.1371/journal.pgph.0003315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 05/16/2024] [Indexed: 06/13/2024]
Abstract
Pacific Island countries experience a high prevalence of noncommunicable diseases (NCDs), which may be prevented by reducing risk behaviors and strengthening protective factors in childhood and adolescence. To better inform preventative interventions, our objective was to use publicly available data from the Global School-based Student Health Survey (GSHS), to provide cross-sectional and trend estimates for the prevalence of NCD risk and protective factors among school-aged children in 2011 and 2017 in Samoa. Two waves of cross-sectional data included 4,373 children (51.98% female), with a median age of 15 years, who were mainly in school years 9-10 in Samoa. Retrospective analyses were adjusted for the GSHS multistage stratified cluster sample design. Weighted prevalences of overweight/obesity, dietary behaviors, physical activity, and sedentary behavior, oral and hand hygiene, emotional and mental health, and community protective factors were reported by study year. Logistic regressions were fitted to assess differences in the prevalence of risk and protective factors, adjusted for age group, sex, and school year. In 2011 and 2017, the prevalence of overweight/obesity remained consistently high in females (59.12% and 64.29%, p = 0.428) and increased from 44.21% to 53.65% in males (p = 0.039). Time spent sitting for long periods, smoking cigarettes, using other tobacco products, and drinking alcohol were lower in 2017 compared to 2011 (all p<0.05). Many children reported experiencing bullying (33.27% for females and 59.30% for males in 2017), while physical fighting was common among males (73.72% in 2011 and 57.28% in 2017). The high prevalence of obesity and related NCD risk factors require urgent public health action in Samoa. Alongside the continued reduction of tobacco and alcohol use, emotional and mental wellness should be prioritized in interventions and programs to promote healthy behaviors and lifestyle changes starting in childhood.
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Affiliation(s)
- Courtney C. Choy
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut, United States of America
| | | | | | - Take Naseri
- Ministry of Health, Motootua, Apia, Samoa
- Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island, United States of America
| | - Yasmmyn D. Salinas
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut, United States of America
| | - Nicola L. Hawley
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut, United States of America
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Sandri E, Piredda M, De Maria M, Mancin S, Sguanci M, Cabo A, Cerdá Olmedo G. Development and psychometric testing of the nutritional and social health habits scale (NutSo-HH): A methodological review of existing tools. MethodsX 2024; 12:102768. [PMID: 38883583 PMCID: PMC11177200 DOI: 10.1016/j.mex.2024.102768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 05/16/2024] [Indexed: 06/18/2024] Open
Abstract
Habits represent repeated patterns of behavior over time that exert a significant influence on individual health. While specific tools exist to measure individual habits, the number of instruments capable of simultaneously exploring multiple dimensions of health is limited. This research had two main objectives: 1) to examine the literature to find existing tools for evaluating health habits, especially in the Spanish population; 2) through a methodological review, to develop and validate a tool capable of measuring multiple dimensions of health habits. The Nutritional and Social Health Habits Scale (NutSo-HH) was conceived, tested, and refined through pilot testing with cognitive interviews and expert content validation. Construct validity was explored through confirmatory factor analysis and known-group validity, while criterion validity was verified in comparison with the ``Healthy Nutrition Index for the Spanish Population.'' Reliability was assessed using omega coefficients. Confirmatory factor analysis yielded satisfactory fit indices. The final model included two second-order factors (nutritional habits and health habits) and two first-order factors (Mediterranean diet and alcohol consumption). Omega coefficients ranged from 0.521 to 0.815. The NutSo-HH Scale emerges as a valid and reliable tool to assess nutritional and social habits among Spanish young adults. This novel instrument fills a gap in the field, allowing exploration of various health determinants through a single scale and providing support for decision-making in the realm of public health nutrition.
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Affiliation(s)
- Elena Sandri
- Faculty of Medicine and Health Sciences, Catholic University of Valencia San Vicente Mártir, c/Quevedo, 2, Valencia 46001, Spain
- Doctoral School, Catholic University of Valencia San Vicente Mártir, c/Quevedo, 2, Valencia 46001, Spain
| | - Michela Piredda
- Research Unit Nursing Science, Campus Bio-Medico di Roma University, Via Alvaro del Portillo 21, 00128 Rome, Italy
| | - Maddalena De Maria
- Department of Life Health Sciences and Health Professions, Link Campus University, Via del Casale di San Pio V, 44, 00165 Rome, Italy
| | - Stefano Mancin
- IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano - Milan, Italy
| | - Marco Sguanci
- Research Unit Nursing Science, Campus Bio-Medico di Roma University, Via Alvaro del Portillo 21, 00128 Rome, Italy
| | - Asensi Cabo
- Clinical Psychologist, Onda Town Council, Career Civil Servant, c/El Pla 1, Onda-Castellón, 12200, Spain
| | - Germán Cerdá Olmedo
- Faculty of Medicine and Health Sciences, Catholic University of Valencia San Vicente Mártir, c/Quevedo, 2, Valencia 46001, Spain
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10
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Carducci B, Dominguez G, Kidd E, Oh C, Jain R, Khan A, Bhutta ZA. Promoting healthy school food environments and nutrition in Canada: a systematic review of interventions, policies, and programs. Nutr Rev 2024:nuae030. [PMID: 38767979 DOI: 10.1093/nutrit/nuae030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2024] Open
Abstract
CONTEXT The school food environment is a critical interface for child and adolescent nutrition, and there is a need to understand existing literature on Canadian school food environments to identify equity gaps and opportunities, and empower decision-makers to plan for future action. OBJECTIVE Literature on Canadian school food and nutrition interventions, policies, programs, and their effects on diets and nutritional status are synthesized and appraised in this systematic review. DATA SOURCES A search strategy was developed for each database used (Medline, Embase, PsycINFO, ERIC, Cochrane Collaboration, Canadian Electronic Library, BiblioMap), with a combination of free text and controlled vocabulary, for articles published from 1990 to 2021. Unpublished data and grey literature were also searched. DATA EXTRACTION Quantitative and qualitative studies with an observational or intervention study design, reviews, or program evaluations conducted in Canadian schools with participants aged 5-19.9 years were included. Key study characteristics and risk of bias were extracted independently by 2 investigators using a standardized tool. DATA ANALYSIS A total of 298 articles were included (n = 192 peer reviewed and 106 from the grey literature), which were mostly conducted in Ontario (n = 52), British Columbia (n = 43), and Nova Scotia (n = 28). Twenty-four interventions, 5 nonevaluated programs, and 1 policy involved Indigenous populations. Overall, 86 articles measured and reported on effectiveness outcomes, including dietary intake; anthropometry; knowledge, attitudes, and practices; and physical activity. The literature remains largely heterogenous and primarily focused on nutrition education programs that use subjective assessments to infer changes in nutrition. A key facilitator to implementation and sustainability was community engagement, whereas key barriers were staff capacity, access to resources and funding, and consistent leadership. CONCLUSIONS This review provides insight into Canadian school food and nutrition interventions, programs, and policies and uncovers important evidence gaps that require careful examination for future evaluations. Governments must create supportive environments that optimize nutrition for children and adolescents through equitable policies and programs. SYSTEMATIC REVIEW REGISTRATION PROSPERO registration no. CRD42022303255.
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Affiliation(s)
- Bianca Carducci
- Centre for Global Child Health, Hospital for Sick Children, Peter Gilgan Centre for Research, and Learning, Toronto, ON, Canada
- Department of Nutritional Sciences, University of Toronto, Faculty of Medicine, University of Toronto, Medical Sciences Building, Toronto, ON, Canada
| | - Georgia Dominguez
- Centre for Global Child Health, Hospital for Sick Children, Peter Gilgan Centre for Research, and Learning, Toronto, ON, Canada
| | - Emily Kidd
- Centre for Global Child Health, Hospital for Sick Children, Peter Gilgan Centre for Research, and Learning, Toronto, ON, Canada
| | - Christina Oh
- Western University, Schulich School of Medicine and Dentistry, London, ON, Canada
| | - Reena Jain
- Centre for Global Child Health, Hospital for Sick Children, Peter Gilgan Centre for Research, and Learning, Toronto, ON, Canada
| | - Amira Khan
- Centre for Global Child Health, Hospital for Sick Children, Peter Gilgan Centre for Research, and Learning, Toronto, ON, Canada
- Department of Nutritional Sciences, University of Toronto, Faculty of Medicine, University of Toronto, Medical Sciences Building, Toronto, ON, Canada
| | - Zulfiqar A Bhutta
- Centre for Global Child Health, Hospital for Sick Children, Peter Gilgan Centre for Research, and Learning, Toronto, ON, Canada
- Department of Nutritional Sciences, University of Toronto, Faculty of Medicine, University of Toronto, Medical Sciences Building, Toronto, ON, Canada
- Centre of Excellence in Women, and Child Health, Aga Khan University, Karachi, Pakistan
- Dalla Lana School of Public, Health University of Toronto Health Sciences Building, Toronto, ON, Canada
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11
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Braune T, Adams J, Winpenny EM. Exploring the changing association between parental and adolescent fruit and vegetable intakes, from age 10 to 30 years. Int J Behav Nutr Phys Act 2024; 21:56. [PMID: 38730502 PMCID: PMC11083755 DOI: 10.1186/s12966-024-01604-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 04/30/2024] [Indexed: 05/13/2024] Open
Abstract
BACKGROUND Adolescence is a pivotal developmental stage, where escalating rates of overweight and obesity have raised concerns about diet quality and its association with adverse health outcomes. Parents are known to have considerable influence on childhood diet, but how this influence changes as adolescents mature is unknown. This study investigates the association between parental fruit and vegetable (FV) intake and adolescent FV consumption, exploring how this changes across adolescence and when adolescents leave home. METHODS Adolescents aged 10-30 years (n = 12,805) from the UK Household Longitudinal Study (UKHLS), and their parents, reported FV intakes every 2 years. Multilevel linear regression models were fitted to assess associations between parental and adolescent FV intakes, investigating interactions with age and living arrangement, and adjusting for sociodemographic covariates. RESULTS Parental FV intake was positively associated with adolescent FV intake (β = 0.20 [95%CI:0.19,0.22] portions/day), with the strength of this association lowest during early adolescence (10-14 years) and peaking at 17-18 years (β = 0.30 [95%CI: 0.27,0.33] portions/day). When adolescents no longer lived in the parental home, the association of parental FV intake with adolescent FV consumption decreased, but a positive association was maintained up to age 30 years. CONCLUSIONS Our findings emphasise the enduring effect of parental FV consumption on adolescent FV consumption, highlighting the potential for interventions to promote increased FV intake, acknowledging the lasting influence of parental diet, even beyond the confines of the parental home.
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Affiliation(s)
- Tanya Braune
- MRC Epidemiology Unit, University of Cambridge Level 3 Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Cambridge, CB2 0SL, UK.
| | - Jean Adams
- MRC Epidemiology Unit, University of Cambridge Level 3 Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Cambridge, CB2 0SL, UK
| | - Eleanor M Winpenny
- MRC Epidemiology Unit, University of Cambridge Level 3 Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Cambridge, CB2 0SL, UK
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12
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Bonnet C, Coinon M. Environmental co-benefits of health policies to reduce meat consumption: A narrative review. Health Policy 2024; 143:105017. [PMID: 38503172 DOI: 10.1016/j.healthpol.2024.105017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 02/06/2024] [Accepted: 02/09/2024] [Indexed: 03/21/2024]
Abstract
Global meat consumption has risen steadily in recent decades, with heterogeneous growth rates across regions. While meat plays a critical role in providing essential nutrients for human health, excessive consumption of meat, particularly red and processed meat, has also been associated with a higher risk of certain chronic diseases. This has led public authorities, including the World Health Organization, to call for a reduction in meat consumption. How governments can effectively reduce the health costs of meat consumption remains a challenge as implementing effective policy instruments is complex. This paper examines health-related policy instruments and potential economic mechanisms that could reduce meat consumption. Health-related taxation could be the most effective instrument. Other policy instruments, such as informational and behavioral instruments, along with regulations, could discourage meat consumption depending on the policy design. We also provide evidence on the link between meat consumption and the environment, including climate, biodiversity, water use, and pollution. Promoting healthy behaviors by reducing meat consumption can then have environmental co-benefits and promote broader sustainable development goals. We also discuss the policy-related challenges that need to be addressed to meet environmental co-benefits.
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Affiliation(s)
- Céline Bonnet
- Toulouse School of Economics, INRAE, University of Toulouse Capitole, Toulouse, France.
| | - Marine Coinon
- Toulouse School of Economics, INRAE, University of Toulouse Capitole, Toulouse, France
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13
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Basto-Abreu A, Carnalla M, Reyes-Sánchez F, Reyes-García A, Haby MM, Junquera-Badilla I, Sartoris-Ayala L, Rivera JA, Popkin BM, Barrientos-Gutiérrez T. Predicted impact of banning nonessential, energy-dense food and beverages in schools in Mexico: A microsimulation study. PLoS Med 2024; 21:e1004394. [PMID: 38728236 PMCID: PMC11086919 DOI: 10.1371/journal.pmed.1004394] [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: 11/09/2023] [Accepted: 04/02/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Childhood obesity is a growing concern worldwide. School-based interventions have been proposed as effective means to improve nutritional knowledge and prevent obesity. In 2023, Mexico approved a reform to the General Education Law to strengthen the ban of sales and advertising of nonessential energy-dense food and beverages (NEDFBs) in schools and surroundings. We aimed to predict the expected one-year change in total caloric intake and obesity prevalence by introducing the ban of NEDFBs sales in schools, among school-aged children and adolescents (6 to 17 years old) in Mexico. METHODS AND FINDINGS We used age-specific equations to predict baseline fat-free mass (FFM) and fat mass (FM) and then estimated total energy intake (TEI) per day. The TEI after the intervention was estimated under 4 scenarios: (1) using national data to inform the intervention effect; (2) varying law compliance; (3) using meta-analytic data to inform the intervention effect size on calories; and (4) using national data to inform the intervention effect by sex and socioeconomic status (SES). We used Hall's microsimulation model to estimate the potential impact on body weight and obesity prevalence of children and adolescents 1 year after implementing the intervention in Mexican schools. We found that children could reduce their daily energy intake by 33 kcal/day/person (uncertainty interval, UI, [25, 42] kcal/day/person), reducing on average 0.8 kg/person (UI [0.6, 1.0] kg/person) and 1.5 percentage points (pp) in obesity (UI [1.1, 1.9] pp) 1 year after implementing the law. We showed that compliance will be key to the success of this intervention: considering a 50% compliance the intervention effect could reduce 0.4 kg/person (UI [0.3, 0.5] kg/person). Our sensitivity analysis showed that the ban could reduce body weight by 1.3 kg/person (UI [0.8, 1.8] kg/person) and up to 5.4 kg/person (UI [3.4, 7.5] kg/person) in the best-case scenario. Study limitations include assuming that obesity and the contribution of NEDFBs consumed at school remain constant over time, assuming full compliance, and not considering the potential effect of banning NEDFBs in stores near schools. CONCLUSIONS Even in the most conservative scenario, banning sales of NEDFBs in schools is expected to significantly reduce obesity, but achieving high compliance will be key to its success. WHY WAS THIS STUDY DONE? - School-based interventions have been recognized as effective means to improve nutritional knowledge and prevent obesity-related diseases.- In December 2023, the Chamber of Representatives of Mexico approved an amendment that strengthens and updates the General Education Law (Article 75) and nutritional guidelines to ban the sales and advertising of nonessential energy-dense food and beverages (NEDFBs) in schools. WHAT DID THE RESEARCHERS DO AND FIND? - We used age-specific equations to predict baseline fat-free mass (FFM) and fat mass (FM) and total energy intake (TEI) per day.- We used microsimulation modeling to predict body weight and obesity prevalence of children and adolescents 1 year after implementing the intervention in Mexican schools.- Our modeling study suggests that an important impact on obesity prevalence can be expected if the law is implemented and enforced as intended. WHAT DO THESE FINDINGS MEAN? - If successful, this law could serve as an example beyond Mexico on how to achieve changes in body weight through school food regulation.- An important limitation of our main scenario is that we assumed full compliance of schools with the law, yet lower compliance will reduce its impact. We also did not consider historical trends on obesity or NEDFBs consumed in schools during our 1 year simulation, and we considered only the ban impact inside schools, excluding effects near and outside schools.
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Affiliation(s)
- Ana Basto-Abreu
- National Institute of Public Health, Center for Population Health Research, Mexico
| | - Martha Carnalla
- National Institute of Public Health, Center for Population Health Research, Mexico
| | | | - Alan Reyes-García
- National Institute of Public Health, Center for Population Health Research, Mexico
| | - Michelle M. Haby
- Division of Biological and Health Sciences, Department of Chemical and Biological Sciences, University of Sonora, Hermosillo, Mexico
| | | | | | - Juan A. Rivera
- National Institute of Public Health, Center for Population Health Research, Mexico
| | - Barry M. Popkin
- Department of Nutrition, Gillings School of Global Public Health, and the Carolina Population Center, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
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14
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Carreño Enciso L, de Mateo Silleras B, de la Cruz Marcos S, Redondo del Río P. Social Media for Nutrition Education-A Randomized Controlled Trial to Promote Fruit and Vegetable Intake in a University Setting: "The University of Valladolid Community Eats Healthy" Study. Nutrients 2024; 16:1308. [PMID: 38732555 PMCID: PMC11085167 DOI: 10.3390/nu16091308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 04/16/2024] [Accepted: 04/25/2024] [Indexed: 05/13/2024] Open
Abstract
Social media- and internet-based interventions are nowadays widely used tools in health interventions. Although evidence of their effectiveness is still low, their applications could be very promising due to their affordability and wide reach. The current paper aims to evaluate the effectiveness of an intervention program, "The University of Valladolid Community Eats Healthy" (UVEH), to increase fruit and vegetable (FV) intake in adults from the University of Valladolid (U. Valladolid) employing three online methodologies. A sample of 211 volunteers was randomly assigned into four groups: virtual campus (VC), Facebook (FB), Instagram (IG), and control. An intervention based on the Theory of Planned Behavior was implemented for seven weeks. Data were collected at the beginning (T0) and the end of the program (T1). The Predimed questionnaire was employed to assess FV intake. Vegetable intake was statistically significantly higher in the VC group (17.4% pre vs. 72.7% post). In the rest of the groups, there was also an increase in intake. Fruit consumption increased slightly only in the VC group (23.9% pre vs. 45.5% post). Participation decreased through the weeks: FB (week 2), IG (week 3), and VC (week 4). Retention was higher in the VC (48%) and control (60%) groups. Internet-based interventions employing interactive platforms such as virtual campus can be effective in enhancing participants' dietary habits in a clinically relevant manner.
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Affiliation(s)
- Laura Carreño Enciso
- Department of Nutrition and Food Science, Faculty of Medicine, University of Valladolid, 47005 Valladolid, Spain; (B.d.M.S.); (S.d.l.C.M.); (P.R.d.R.)
| | - Beatriz de Mateo Silleras
- Department of Nutrition and Food Science, Faculty of Medicine, University of Valladolid, 47005 Valladolid, Spain; (B.d.M.S.); (S.d.l.C.M.); (P.R.d.R.)
- Spanish Society of Community Nutrition (SENC), 08029 Barcelona, Spain
| | - Sandra de la Cruz Marcos
- Department of Nutrition and Food Science, Faculty of Medicine, University of Valladolid, 47005 Valladolid, Spain; (B.d.M.S.); (S.d.l.C.M.); (P.R.d.R.)
| | - Paz Redondo del Río
- Department of Nutrition and Food Science, Faculty of Medicine, University of Valladolid, 47005 Valladolid, Spain; (B.d.M.S.); (S.d.l.C.M.); (P.R.d.R.)
- Spanish Society of Community Nutrition (SENC), 08029 Barcelona, Spain
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15
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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.
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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
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16
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Raghoebar S, Mesch A, Gulikers J, Winkens LHH, Wesselink R, Haveman-Nies A. Experts' perceptions on motivators and barriers of healthy and sustainable dietary behaviors among adolescents: The SWITCH project. Appetite 2024; 194:107196. [PMID: 38154577 DOI: 10.1016/j.appet.2023.107196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 12/15/2023] [Accepted: 12/24/2023] [Indexed: 12/30/2023]
Abstract
The interplay of influences shaping dietary behaviors of adolescents needs to be well-understood to develop effective strategies stimulating healthy and sustainable behaviors. This study aimed to identify the most relevant, urgent, changeable and effective motivators and barriers of healthy and sustainable dietary behaviors among adolescents (10-19 years), as perceived by an inter- and transdisciplinary expert panel. Experts working in practice (N = 19) and academia (N = 13) - in the field of sustainability, health, nutrition and/or education - participated in this exploratory mixed-methods study. Five online semi-structured focus groups were conducted (6-7 participants). Data was thematically analyzed by two coders independently, using the socioecological framework. Subsequently, the same experts individually selected the five most relevant determinants and rated those on their urgency, changeability and effectiveness through an online questionnaire (N = 21). Participants revealed a wide system of 31 main determinants including 173 sub-determinants that motivate or hinder healthy and sustainable eating among adolescents. This system of determinants was mapped on the different layers of the socioecological model: individual factors (25 motivators; 30 barriers), social environments (15 motivators; 13 barriers), physical environments (18 motivators; 15 barriers), macro-level environments (19 motivators; 38 barriers). 'Role of peers' (social environment) was selected most as a determinant to be targeted in interventions (N = 13; urgency (M = 6.38) changeability (M = 3.85), effectiveness (M = 5.62)), followed by 'food environment around school' (N = 9; urgency (M = 5.78) changeability (M = 3.44), effectiveness (M = 5.44)), 'social influences' (N = 7; urgency (M = 5.43) changeability (M = 4.00), effectiveness (M = 5.71)), 'autonomy in development' (N = 7; urgency (M = 6.00) changeability (M = 4.29), effectiveness (M = 5.86)) and 'food availability' (N = 7; urgency (M = 6.29) changeability (M = 3.29), effectiveness (M = 6.29)). The prioritized determinants indicate that adolescents should be provided more supportive social and physical environments that promote healthy and sustainable dietary behaviors, taking into account their growing autonomy.
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Affiliation(s)
- Sanne Raghoebar
- Wageningen University & Research, Education & Learning Sciences Group, Wageningen, the Netherlands; Wageningen University & Research, Consumption & Healthy Lifestyles Group, Wageningen, the Netherlands.
| | - Anouk Mesch
- Wageningen University & Research, Education & Learning Sciences Group, Wageningen, the Netherlands; Wageningen University & Research, Consumption & Healthy Lifestyles Group, Wageningen, the Netherlands.
| | - Judith Gulikers
- Wageningen University & Research, Education & Learning Sciences Group, Wageningen, the Netherlands
| | - Laura H H Winkens
- Wageningen University & Research, Consumption & Healthy Lifestyles Group, Wageningen, the Netherlands
| | - Renate Wesselink
- Wageningen University & Research, Education & Learning Sciences Group, Wageningen, the Netherlands
| | - Annemien Haveman-Nies
- Wageningen University & Research, Consumption & Healthy Lifestyles Group, Wageningen, the Netherlands; GGD Noord- en Oost-Gelderland, Academic Collaborative Center AGORA, Zutphen, the Netherlands
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17
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Peñalvo JL. The impact of taxing sugar-sweetened beverages on diabetes: a critical review. Diabetologia 2024; 67:420-429. [PMID: 38177563 DOI: 10.1007/s00125-023-06064-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 10/18/2023] [Indexed: 01/06/2024]
Abstract
The global burden of type 2 diabetes is increasing at an alarming rate, fuelled by the obesity epidemic, with significant associated health and economic consequences and apparent inequalities. Sugar-sweetened beverages (SSBs) are a major source of added sugars in diets worldwide and have been linked to an increased risk of type 2 diabetes through a variety of mechanisms, including excess weight. Taxing SSBs has become a promising public health strategy to reduce consumption and mitigate the burden of type 2 diabetes. A substantial body of evidence suggests that SSB taxes lead to increased prices and subsequent reduced consumption, with a potentially greater effect among lower socioeconomic groups. This highlights the potential for tax policies to have an impact on type 2 diabetes and address health inequalities. Evidence from several ongoing SSB tax schemes, including sales and excise taxes, indicates positive effects on improving consumption patterns, and modelling studies point to health gains by averting type 2 diabetes and other cardiometabolic diseases. In contrast, evidence from empirical evaluation of the impact of SSB tax is scarce. Continued monitoring and the strengthening of evaluation research to develop context-tailored policies are required. In addition, there is a need to implement complementary efforts to amplify the impact of SSB taxation and effectively address the global burden of type 2 diabetes.
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Affiliation(s)
- José L Peñalvo
- Global Health Institute, University of Antwerp, Wilrijk, Belgium.
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18
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Raut S, Kc D, Singh DR, Dhungana RR, Pradhan PMS, Sunuwar DR. Effect of nutrition education intervention on nutrition knowledge, attitude, and diet quality among school-going adolescents: a quasi-experimental study. BMC Nutr 2024; 10:35. [PMID: 38414069 PMCID: PMC10900745 DOI: 10.1186/s40795-024-00850-0] [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: 02/10/2023] [Accepted: 02/19/2024] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND Nutrition education is being used to encourage school adolescents to adopt healthy eating habits. To the best of our knowledge, very little study has been undertaken in Nepal to examine the effectiveness of nutrition education programs. This study aimed to assess the effect of nutrition education on nutritional knowledge, attitude, and diet quality among school-going adolescents in selected private schools in Nepal. METHODS A quasi-experimental study was conducted among 226 students aged 12 - 19 years of two selected private schools in Banepa municipality of Nepal. Students (n = 113) from the first school were assigned to intervention and the same number of students from the second school were enrolled in the study as the control. Over 12 weeks, students in the intervention group received one hour of nutrition education in the form of mini-lectures and interactive discussions, whilst students in the control group received no education. The student's two-sample t-test was used to compare two groups and to assess the effectiveness of the nutrition education program. RESULTS Between the intervention and control group, the magnitude of difference in knowledge score was 1.80 (95% CI: 1.11 - 2.49), emotional eating was 0.98 (95% CI: 0.42 - 1.54), uncontrolled eating was 3.60 (95% CI: 2.10 - 5.09), and cognitive restraint of eating was 2.26 (95% CI: 1.51 - 3.01). CONCLUSIONS A tailored health education intervention was found to be effective in increase nutritional knowledge and attitude among school-going adolescents. Adopting nutrition education interventions as part of public health school intervention builds positive knowledge, attitudes, and healthy eating habits in school-going adolescents.
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Affiliation(s)
- Sagar Raut
- Department of Nutrition and Dietetics, College of Applied Food and Dairy Technology, Purbanchal University, Lalitpur, Nepal
| | - Dirghayu Kc
- Public Health Promotion and Development Organization, Kathmandu, Nepal
| | - Devendra Raj Singh
- School of Human and Health Sciences, University of Huddersfield, Huddersfield, UK
| | - Raja Ram Dhungana
- Faculty of Medicine Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Pranil Man Singh Pradhan
- Department of Community Medicine, Maharajgunj Medical Campus, Institute of Medicine, Kathmandu, Nepal
| | - Dev Ram Sunuwar
- Department of Nutrition and Dietetics, Nepal Armed Police Force Hospital, Kathmandu, Nepal.
- Department of Nutritional Science, University of Michigan School of Public Health, Ann Arbor, USA.
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19
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Durão S, Wilkinson M, Davids EL, Gerritsen A, Kredo T. Effects of policies or interventions that influence the school food environment on children's health and nonhealth outcomes: a systematic review. Nutr Rev 2024; 82:332-360. [PMID: 37253393 PMCID: PMC10859694 DOI: 10.1093/nutrit/nuad059] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
Abstract
CONTEXT Globally, 1 in 3 children under 5 years is undernourished or overweight, and 1 in 2 suffers from hidden hunger due to nutrient deficiencies. As children spend a considerable time at school, school-based policies that aim to improve children's dietary intake may help address this double burden of malnutrition. OBJECTIVE This systematic review aimed to assess the effects of implementing policies or interventions that influence the school food environment on children's health and nonhealth outcomes. DATA SOURCES, EXTRACTION, AND ANALYSIS Eleven databases were searched up to April 2020 and the World Health Organization (WHO) released a call for data due in June 2020. Records were screened against the eligibility criteria, and data extraction and risk-of-bias assessment were conducted by 1 reviewer and checked by another. The synthesis was based on effect direction, and certainty of evidence was assessed using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach. CONCLUSIONS Seventy-four studies reporting 10 different comparisons were included. The body of evidence indicates that interventions addressing the school food environment may have modest beneficial effects on certain key outcomes. Nutrition standards for healthy foods and beverages at schools, interventions that change how food is presented and positioned, and fruit and vegetable provision may have a beneficial effect on the consumption of healthy foods and beverages. Regarding effects on the consumption of discretionary foods and beverages, nutrition standards may have beneficial effects. Nutrition standards for foods and beverages, changes to portion size served, and the implementation of multiple nudging strategies may have beneficial effects on energy intake. Regarding effects of purchasing or selecting healthier foods, changes to how food is presented and positioned may be beneficial. This review was commissioned and supported by the WHO (registration 2020/1001698-0). WHO reviewed and approved the protocol for the systematic review and reviewed the initial report of the completed systematic review. SYSTEMATIC REVIEW REGISTRATION PROSPERO registration no: CRD42020186265.
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Affiliation(s)
- Solange Durão
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | - Maryke Wilkinson
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
- Better Health Programme South Africa, Mott MacDonald, Cape Town, South Africa
| | - Eugene L Davids
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
- Division of Child and Adolescent Psychiatry, Faculty of Health Science, University of Cape Town, Cape Town, South Africa
| | - Annette Gerritsen
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | - Tamara Kredo
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
- Division of Clinical Pharmacology, Department of Medicine and Division of Epidemiology and Biostatistics, and Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
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20
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Acosta ME, Sanchez-Vaznaugh EV, Matsuzaki M, Barba N, Sánchez BN. Temporal Patterns in Fruit and Vegetable Intake Among Racially and Ethnically Diverse Children and Adolescents in California. Prev Chronic Dis 2024; 21:E09. [PMID: 38329921 PMCID: PMC10870998 DOI: 10.5888/pcd21.230162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024] Open
Abstract
Introduction Childhood dietary behaviors, including fruit and vegetable intake, are associated with adult health. Most children do not meet daily recommended servings of fruits and vegetables. Less is known about temporal patterns in fruit and vegetable consumption or if they vary by race and ethnicity. We investigated temporal patterns in fruit and vegetable intake among California school-age children and adolescents overall and by race and ethnicity. Methods We used 2-year cross-sectional datasets from the child and adolescent samples in the California Health Interview Surveys from 2011-2012 through 2019-2020 and modified Poisson regression models to estimate the likelihood of consuming 5 or more servings of fruits and vegetables in 2013-2016 and 2017-2020 compared with 2011-2012. Models controlled for age, race and ethnicity, gender, citizenship status, family income, and adult education and tested for differences by race and ethnicity. The samples included 16,125 children aged 5 to 11 years and 9,672 adolescents aged 12 to 17 years. Results Overall, 29.3% of children and 25.9% of adolescents reported intake of 5 or more fruits and vegetables per day. Among children, adjusted prevalence ratios (PR) of fruit and vegetable intake were higher in 2013-2016 (PR,1.25; 95% CI, 1.11-1.42) and 2017-2020 (PR,1.13; 95% CI, 0.99-1.30) compared with 2011-2012. Among adolescents, the adjusted prevalence did not differ significantly over time. We found no evidence of differential associations by race and ethnicity for children and adolescents. Conclusion We found favorable temporal changes in fruit and vegetable consumption among children, but not among adolescents. Monitoring temporal patterns in fruit and vegetable intake remains critical for planning population-level interventions to increase consumption.
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Affiliation(s)
- Maria Elena Acosta
- Department of Public Health, San Francisco State University, San Francisco, California
| | - Emma V Sanchez-Vaznaugh
- Department of Public Health, San Francisco State University, San Francisco, California
- College of Health & Social Sciences, Department of Public Health, 1600 Holloway Ave, San Francisco CA 94132
| | - Mika Matsuzaki
- Department of International Health, Bloomberg School of Public Health, John Hopkins University, Baltimore, Maryland
| | - Nancy Barba
- Department of Public Health, San Francisco State University, San Francisco, California
| | - Brisa N Sánchez
- Department of Epidemiology and Biostatistics, Drexel University School of Public Health, Philadelphia, Pennsylvania
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21
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Craig DW, Walker TJ, Sharma SV, Cuccaro P, Heredia NI, Pavlovic A, DeFina LF, Kohl HW, Fernandez ME. Examining associations between school-level determinants and the implementation of physical activity opportunities. Transl Behav Med 2024; 14:89-97. [PMID: 37713255 PMCID: PMC10849171 DOI: 10.1093/tbm/ibad055] [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] [Indexed: 09/16/2023] Open
Abstract
School-based physical activity (PA) opportunities can help students engage in greater amounts of daily PA, meet PA guidelines, and lead to improved health and educational outcomes. However, we do not completely understand the organizational challenges to implementing these opportunities successfully. This exploratory study examined associations between school-level determinants and the implementation of school-based PA opportunities. We analyzed cross-sectional survey data from schools (n = 46) participating in the Healthy Zone School Program (HZSP) (Dallas, Texas, USA) during 2019-2020. Respondents completed an electronic survey that included measures of school-level determinants (e.g. culture, leadership, priority) and the implementation of school-based PA opportunities. We used linear regression models to examine associations between determinants and implementation outcomes (number of PA opportunities delivered, perceived overall success of each PA program/activity used). After adjusting for campus type (i.e. elementary, middle, high, K-12), student race/ethnicity, and percentage of economically disadvantaged students, no constructs were associated with the number of PA opportunities implemented. Linear regression models suggest access to knowledge and information (β = 0.39, P = .012, 95% CI = 0.24-1.44) and implementation climate (β = 0.34, P = .045, 95% CI = 0.02-1.59) were positively associated with the success of school-based PA opportunities. Our findings provide suggestive evidence that access to knowledge and information and a supportive school climate may improve the overall success of PA opportunities provided to students. Future research should examine additional school-level determinants to understand their importance to implementation and inform the development of strategies to improve schools' capacity for implementing PA opportunities successfully.
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Affiliation(s)
- Derek W Craig
- Department of Health Promotion and Behavioral Sciences, The University of Texas Health Science Center at Houston School of Public Health, 7000 Fannin Street, Houston, TX 77030,USA
| | - Timothy J Walker
- Department of Health Promotion and Behavioral Sciences, The University of Texas Health Science Center at Houston School of Public Health, 7000 Fannin Street, Houston, TX 77030,USA
| | - Shreela V Sharma
- Department of Epidemiology, Human Genetics, and Environmental Sciences, The University of Texas Health Science Center at Houston School of Public Health, 1200 Pressler Street, Houston, TX 77030, USA
| | - Paula Cuccaro
- Department of Health Promotion and Behavioral Sciences, The University of Texas Health Science Center at Houston School of Public Health, 7000 Fannin Street, Houston, TX 77030,USA
| | - Natalia I Heredia
- Department of Health Promotion and Behavioral Sciences, The University of Texas Health Science Center at Houston School of Public Health, 7000 Fannin Street, Houston, TX 77030,USA
| | - Andjelka Pavlovic
- Division of Youth Education, The Cooper Institute, 12330 Preston Road, Dallas, TX 75230, USA
| | - Laura F DeFina
- Division of Youth Education, The Cooper Institute, 12330 Preston Road, Dallas, TX 75230, USA
| | - Harold W Kohl
- Department of Kinesiology and Health Education, The University of Texas at Austin, 2109 San Jacinto Boulevard, Austin, TX 78712, USA
- Department of Epidemiology, Human Genetics, and Environmental Sciences, The University of Texas Health Science Center at Houston School of Public Health, 1616 Guadalupe Street, Austin, TX 78701USA
| | - Maria E Fernandez
- Department of Health Promotion and Behavioral Sciences, The University of Texas Health Science Center at Houston School of Public Health, 7000 Fannin Street, Houston, TX 77030,USA
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22
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Lewis KH, Moore JB, Ard JD. Game changers: do new medications make lifestyle-based treatment of obesity obsolete? Obesity (Silver Spring) 2024; 32:237-239. [PMID: 38044481 DOI: 10.1002/oby.23962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 10/10/2023] [Accepted: 11/05/2023] [Indexed: 12/05/2023]
Abstract
Historically, obesity was viewed as a lifestyle disease, with an associated lifestyle solution, and approaches that embody the "eat less, move more" idea have dominated obesity treatment recommendations for over half a century. Meanwhile, the prevalence and severity of obesity continue to increase globally. Enter the so-called "game changers": glucagon-like peptide-1 receptor agonists. In the media frenzy around these and other new antiobesity medications in the pipeline, lifestyle-based treatment researchers and practitioners may find themselves wondering whether behavioral approaches to obesity will become obsolete in this new therapeutic era. In this Perspective, the authors contend that medical approaches impact physiologic pathways to support the success of behavioral approaches. Similarly, behavioral approaches can improve weight loss-adjacent outcomes that are not addressed by medication. Thus, the two approaches are complementary and must coexist if we are to make a significant, population-level impact on the obesity epidemic.
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Affiliation(s)
- Kristina H Lewis
- Department of Epidemiology & Prevention, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
- Department of Implementation Science, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Justin B Moore
- Department of Epidemiology & Prevention, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
- Department of Implementation Science, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Jamy D Ard
- Department of Epidemiology & Prevention, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
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23
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Ahmed M, Richardson A, Riad J, McPherson C, Sellen DW, Malik VS. Impact of the COVID-19 pandemic on the adaptability and resiliency of school food programs across Canada. Front Public Health 2024; 11:1296620. [PMID: 38235159 PMCID: PMC10791823 DOI: 10.3389/fpubh.2023.1296620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 12/06/2023] [Indexed: 01/19/2024] Open
Abstract
Introduction Following the sudden closure of schools due to the pandemic in 2020, many school food program (SFP) operators lost their operating venues and had to innovate to continue distributing meals to children. Our objective was to assess the impact of the COVID-19 pandemic on the delivery, adaptability, and resiliency of school food programs across Canada by conducting a systematic rapid review. Materials and methods Systematic literature searches identified newspaper articles and social media sources related to the adaptations and challenges faced by school food programs across Canada in response to the COVID-19 pandemic. Included sources were assessed and thematically categorized according to the dimensions of the Analysis Grid for Environments Linked to Obesity (ANGELO) and Getting To Equity (GTE) frameworks to identify factors impacting the delivery, adaptability, and resiliency of school food programs in Canada. Results School food programs in Canada made various efforts to meet existing and new challenges associated with the delivery of these programs to keep feeding school children, particularly those most vulnerable, during the pandemic. Distribution of food kits, prepared meals and gift cards/coupons were successful pathways in ensuring support for food accessibility to students and their families. Increased collaborations between community members and organizations/stakeholders to help maintain food delivery or collectively offer new modes to deliver foods were most frequently cited as key to facilitating school food programming. However, maintenance and sustainability related to operating costs and funding were identified as key challenges to successful school food programming. Conclusion Our study highlights the swift and substantial transformation school food programs,, underwent in response to the pandemic, driven by the urgent need to ensure that students still had access to nutritious meals and the importance of policy and resource support to bolster the adaptability and resiliency of these programs. Findings on facilitators and challenges to school food programs during the early months of the COVID-19 pandemic can inform development of guidelines to design a robust national Canadian school food program and help make existing programs more sustainable, adaptable, and resilient.
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Affiliation(s)
- Mavra Ahmed
- Joannah and Brian Lawson Centre for Child Nutrition, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Alana Richardson
- Joannah and Brian Lawson Centre for Child Nutrition, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Jessica Riad
- Joannah and Brian Lawson Centre for Child Nutrition, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Chelsea McPherson
- Joannah and Brian Lawson Centre for Child Nutrition, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Daniel W. Sellen
- Joannah and Brian Lawson Centre for Child Nutrition, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Vasanti S. Malik
- Joannah and Brian Lawson Centre for Child Nutrition, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States
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24
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Randby JS, Ogden T, Lien N. Implementation and effectiveness of a school-based intervention to increase adherence to national school meal guidelines: a non-randomised controlled trial. Public Health Nutr 2024; 27:e25. [PMID: 38164650 PMCID: PMC10830359 DOI: 10.1017/s1368980023002938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 11/26/2023] [Accepted: 12/17/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVE Implementation of school meal guidelines is often inadequate, and evidence for effective implementation strategies for school-based nutrition interventions is limited. The aim of the present study was to examine the implementation and effectiveness of a multi-strategy implementation intervention to increase adherence to the Norwegian national school meal guideline. DESIGN The study was a school-based hybrid implementation effectiveness trial with a pre-post non-equivalent control group design, testing three implementation strategies: internal facilitation, training and an educational meeting. SETTING Primary schools and after-school services in two counties in south-east Norway. PARTICIPANTS School principals, after-school leaders and class teachers from thirty-three schools in the intervention county and principals and after-school leaders from thirty-four schools in a comparison county. RESULTS There was a significant difference of 4 percentage points in change scores between the intervention and the comparison groups at follow-up, after adjusting for baseline adherence (B = 0·04, seB = 0·01, t = 3·10, P = 0·003). The intervention effect was not associated with the school's socio-economic profile. School-level fidelity was the implementation dimension that was most strongly correlated (r s = 0·48) with the change scores in the intervention group, indicating that principals' support is important for gaining the largest intervention effects. CONCLUSIONS A school-based intervention with low intensity, based on trained teachers as internal facilitators, can increase adherence to the national school meal guideline among Norwegian primary schools, irrespective of local socio-economic conditions. Implementation fidelity, at an organisational level, may be a useful predictor for intervention outcomes in schools.
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Affiliation(s)
- Jorunn Sofie Randby
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Pb. 1046 Blindern, 0317Oslo, Norway
- Department of Child and Adolescent Health, Norwegian Directorate of Health, Pb. 220 Skøyen, 0213Oslo, Norway
| | - Terje Ogden
- Norwegian Center for Child Behavioral Development, P.b. 7053 Majorstuen, 0306Oslo, Norway
| | - Nanna Lien
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Pb. 1046 Blindern, 0317Oslo, Norway
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25
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Pillay D, Ali A, Wham CA. Examining the New Zealand school food environment: what needs to change? Nutr Res Rev 2023; 36:406-419. [PMID: 35968693 DOI: 10.1017/s0954422422000154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Habitual dietary intakes and nutrition behaviours developed during childhood and adolescence pave the way for similar behaviours to manifest in adulthood. Childhood obesity rates have now reached a point where one in six children globally are classified as overweight or obese. Schools have the unique ability to reach almost all children during key developmental stages, making them an ideal setting for influencing children's nutrition behaviours. Evidence suggests the school food environment is not always conducive to healthy food choices and may be obesogenic. The aim of this narrative review is to explore factors that influence the healthy food and drink environment in and around schools in New Zealand. The review focused on evidence from New Zealand and Australia given the close resemblance in education systems and school food guidance. Using the Analysis Grid for Environments Linked to Obesity (ANGELO) framework, the school food environment was categorised into the following domains: economic, political, physical and socio-cultural factors. Findings suggest that food policies are not utilised within schools, and guidelines to improve the school food environment are not well implemented. Canteen profit models, lack of staff support and resources, and higher availability of low-cost unhealthy foods are among barriers that hinder implementation. This review highlights recommendations from existing evidence, including canteen pricing strategies, restriction of unhealthy foods and using peer modelling in a time-scarce curriculum to improve the school food environment. Key areas for improvement, opportunities to enhance policy implementation and untapped avenues to improve the food and nutrition behaviours of children are highlighted.
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Affiliation(s)
- Danika Pillay
- School of Sport, Exercise and Nutrition, Massey University, Auckland, New Zealand
| | - Ajmol Ali
- School of Sport, Exercise and Nutrition, Massey University, Auckland, New Zealand
| | - Carol A Wham
- School of Sport, Exercise and Nutrition, Massey University, Auckland, New Zealand
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26
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Chan L, Freeman B, Hughes C, Richmond K, Dibbs J, O’Hara BJ. Exploring motivations for engagement with the Healthy Lunch Box campaign on social media. Health Promot Int 2023; 38:daad151. [PMID: 37966161 PMCID: PMC10647017 DOI: 10.1093/heapro/daad151] [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] [Indexed: 11/16/2023] Open
Abstract
Many health organisations seek social media engagement through their online health promotion campaigns, but there is little understanding of what engagement means in relation to the uptake of health messages. To understand the relevance of social media engagement, we need to look at the reasons why people engage with health content via social media. This exploratory study examined people's motivations for engaging with health content through a case study of the Healthy Lunch Box campaign. Data was collected via online focus groups (n = 7), with participants being a convenience sample of people who had seen or engaged with the Healthy Lunch Box resources (n = 24). The discussions covered reasons for engaging with the Healthy Lunch Box campaign, and more broadly with health content on social media in general. The data was analysed using a reflexive approach to thematic analysis, with themes developed inductively. The study found that some of the reasons for engagement aligned with the paradigm of social media engagement being an intermediary step in the process towards health behaviour change. However, people also described other reasons, such as alignment with their personal values, consideration of their online presentation, or as a way of curating the content they wanted to be shown on social media. These results demonstrate that people's decision to engage with health-related social media content involves more than consideration about the usefulness of the content, suggesting the need for a deeper examination of the assumptions made about the value of social media engagement in health campaign evaluations.
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Affiliation(s)
- Lilian Chan
- Prevention Research Collaboration, Sydney School of Public Health and Charles Perkins Centre, University of Sydney, John Hopkins Drive, Camperdown, 2050, Australia
| | - Becky Freeman
- Prevention Research Collaboration, Sydney School of Public Health and Charles Perkins Centre, University of Sydney, John Hopkins Drive, Camperdown, 2050, Australia
| | - Clare Hughes
- Cancer Council NSW, 153 Dowling Street, Woolloomooloo, NSW, 2011, Australia
| | - Korina Richmond
- Cancer Council NSW, 153 Dowling Street, Woolloomooloo, NSW, 2011, Australia
| | - Jane Dibbs
- Cancer Council NSW, 153 Dowling Street, Woolloomooloo, NSW, 2011, Australia
| | - Blythe J O’Hara
- Prevention Research Collaboration, Sydney School of Public Health and Charles Perkins Centre, University of Sydney, John Hopkins Drive, Camperdown, 2050, Australia
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27
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Al-Jawaldeh A, Matbouli D, Diab S, Taktouk M, Hojeij L, Naalbandian S, Nasreddine L. School-Based Nutrition Programs in the Eastern Mediterranean Region: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:7047. [PMID: 37998278 PMCID: PMC10671197 DOI: 10.3390/ijerph20227047] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 10/27/2023] [Accepted: 11/08/2023] [Indexed: 11/25/2023]
Abstract
This systematic review aims at documenting government-led school nutrition programs/interventions in countries of the Eastern Mediterranean Region (EMR). A systematic review of the available literature on this topic was conducted between 25 October 2022 and 15 November 2022 using 15 electronic databases as well as grey literature. The search was limited to materials published post 2000 in English, Arabic, or French. Articles/Reports were included in the review if they provided information on school-based nutrition programs/interventions developed, adopted or implemented by a governmental entity in the EMR countries, irrespective of study design. In total, 158 documents were retained until 16 May 2023. School-based programs/interventions were categorized into 13 types. In total, 298 school-based nutrition programs/interventions were identified. The most common were school meals and school feeding programs (all EMR countries) followed by nutrition education within the curriculum (77% of countries), extracurricular nutrition education (64%), standards for school canteens or foods/beverages available in schools (64%), and training of school staff (59%). Approximately half reported the inclusion of fruit and vegetable schemes (54%) or the establishment of hygienic cooking facilities (50%), while less than half reported standards for the marketing of food/beverages (45%), bans/standards for vending machines, milk feeding schemes, or micronutrient supplementation programs (41%). The least common interventions were school gardens (32%) and take-home rations (14%). Countries with the lowest gross domestic product and lowest government effectiveness score had the lowest number of programs/interventions. Many of the programs have tackled both school-aged children as well as preschoolers. We were able to identify monitoring and process evaluation for 21 programs in 14 countries. Few programs have undergone impact assessment.
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Affiliation(s)
- Ayoub Al-Jawaldeh
- Regional Office for the Eastern Mediterranean (EMRO), World Health Organization (WHO), Cairo 11371, Egypt;
| | - Dana Matbouli
- Nutrition and Food Sciences Department, Faculty of Agriculture and Food Sciences, American University of Beirut, Beirut 1107 2020, Lebanon; (D.M.); (S.D.); (M.T.); (L.H.)
| | - Sarah Diab
- Nutrition and Food Sciences Department, Faculty of Agriculture and Food Sciences, American University of Beirut, Beirut 1107 2020, Lebanon; (D.M.); (S.D.); (M.T.); (L.H.)
| | - Mandy Taktouk
- Nutrition and Food Sciences Department, Faculty of Agriculture and Food Sciences, American University of Beirut, Beirut 1107 2020, Lebanon; (D.M.); (S.D.); (M.T.); (L.H.)
| | - Leila Hojeij
- Nutrition and Food Sciences Department, Faculty of Agriculture and Food Sciences, American University of Beirut, Beirut 1107 2020, Lebanon; (D.M.); (S.D.); (M.T.); (L.H.)
| | - Sally Naalbandian
- Science and Agriculture Library, American University of Beirut, Beirut 1107 2020, Lebanon;
| | - Lara Nasreddine
- Nutrition and Food Sciences Department, Faculty of Agriculture and Food Sciences, American University of Beirut, Beirut 1107 2020, Lebanon; (D.M.); (S.D.); (M.T.); (L.H.)
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28
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Rocha LL, Cordeiro NG, Jardim MZ, Kurihayashi AY, Gentil PC, Russo GC, Mendes LL. Do Brazilian regulatory measures promote sustainable and healthy eating in the school food environment? BMC Public Health 2023; 23:2166. [PMID: 37932690 PMCID: PMC10626708 DOI: 10.1186/s12889-023-17111-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 10/30/2023] [Indexed: 11/08/2023] Open
Abstract
BACKGROUND Regulatory measures regarding food in the school environment aim to promote a healthier food environment in public and private schools. In Brazil, implementing regulations in the school food environment does not occur the same way across states and cities, and no national regulation covers public and private schools. The present study aims to analyze regulatory measures for school food environments in Brazilian states and cities and develop a score to evaluate them. METHODS A systematic search of the regulatory measures in force and implemented until 2021 was conducted. The score was developed based on the Model Law Project prepared by the Brazilian Institute for Consumer Protection. It considered food and nutrition education actions, restrictions on the sale and distribution of food, a ban or restriction on food advertising and marketing, and points of excellence. These points included regulations that addressed the importance of supervision and social control, laws regulated by decree, the mention of a ban on ultra-processed foods, and whether the regulatory measures covered public and private schools. RESULTS Sixty-five cities and states regulatory measures in force were found to be evaluated jointly by a federal entity (n = 43). Among the federal entities evaluated, only 13.95% fulfilled the function of promoting sustainable and healthy eating (8-12 points). CONCLUSIONS Brazilian children and adolescents are exposed to a school food environment with regulations that partially fulfill the function of promoting an adequate, healthy, and sustainable diet. In this sense, it is necessary to improve regulatory measures or to encourage states and cities to develop effective legal provisions that are in line with the food guide for the Brazilian population and with the perspective of a healthy school food environment for the effective promotion of adequate, healthy and sustainable and healthy food in schools.
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Affiliation(s)
- Luana Lara Rocha
- Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | | | | | | | | | | | - Larissa Loures Mendes
- Departamento de Nutrição, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.
- , Av. Alfredo Balena 190 Santa Efigênia, Belo Horizonte, 30130-100, Brazil.
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29
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Lee YTH, Zhang Q, Elmontser M, Stevenson E, Gazmararian JA. Association between early care and education centres policies and practices and children's healthy behaviours. Int J Health Plann Manage 2023; 38:1743-1756. [PMID: 37556382 DOI: 10.1002/hpm.3698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 04/17/2023] [Accepted: 07/07/2023] [Indexed: 08/11/2023] Open
Abstract
OBJECTIVE To examine the impact of nutritional and physical activity (PA) policies and practices at early care and education centres on behavioural changes among children ages 2-5. METHODS The study population included 586 children from 25 education centres throughout the state of Georgia. Policies and practices were measured using the Georgia Nutrition and PA Assessment at the start of school year in Fall 2017. Survey data were collected at the beginning of school year September/October 2017 and at the end of school year April/May 2018 to measure changes in children's nutritional and PA behaviour over the school year. We used generalised estimating equations to estimate odds ratios and 95% confidence intervals. RESULTS Children at centres with a high nutrition assessment score had higher odds of increasing vegetable consumption (OR = 2.1; 95% CI: 1.1, 4.0) while the odds of increasing fruit (OR = 1.4; 95% CI: 0.8, 2.4) and water (OR = 1.2; 95% CI: 0.5, 2.7) consumption increased non-significantly. The odds of improving PA were similar between children at centres with a high versus a low PA assessment score. CONCLUSION The results, though insignificant, indicate that policies and practices could influence children's health behaviours. Further research is warranted to examine whether improvements in policies and practices could explain changes in children's health behaviours, the impact of educator's knowledge on children's health behaviours and the implementation of and adherence to policy and practice improvement plans.
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Affiliation(s)
- Yi-Ting Hana Lee
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Qi Zhang
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Mohnd Elmontser
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
- Saint Louis University School of Medicine, St. Louis, Missouri, USA
| | | | - Julie A Gazmararian
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
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30
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Tobias DK, Papatheodorou S, Yamamoto JM, Hu FB. A Primer on Systematic Review and Meta-analysis in Diabetes Research. Diabetes Care 2023; 46:1882-1893. [PMID: 37890100 PMCID: PMC10620547 DOI: 10.2337/dci23-0031] [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: 04/27/2023] [Accepted: 07/22/2023] [Indexed: 10/29/2023]
Abstract
A systematic review is a rigorous process that involves identifying, selecting, and synthesizing available evidence pertaining to an a priori-defined research question. The resulting evidence base may be summarized qualitatively or through a quantitative analytic approach known as meta-analysis. Systematic review and meta-analysis (SRMAs) have risen in popularity across the scientific realm including diabetes research. Although well-conducted SRMAs are an indispensable tool in informing evidence-based medicine, the proliferation of SRMAs has led to many reviews of questionable quality and misleading conclusions. The objective of this article is to provide up-to-date knowledge and a comprehensive understanding of strengths and limitations of SRMAs. We first provide an overview of the SRMA process and offer ways to identify common pitfalls at key steps. We then describe best practices as well as evolving approaches to mitigate biases, improve transparency, and enhance rigor. We discuss several recent developments in SRMAs including individual-level meta-analyses, network meta-analyses, umbrella reviews, and prospective meta-analyses. Additionally, we outline several strategies that can be used to enhance quality of SRMAs and present key questions that authors, editors, and readers should consider in preparing or critically reviewing SRMAs.
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Affiliation(s)
- Deirdre K. Tobias
- Division of Preventive Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
- Nutrition Department, Harvard T.H. Chan School of Public Health, Boston, MA
| | | | - Jennifer M. Yamamoto
- Department of Internal Medicine, Faculty of Health Sciences, University of Manitoba, and Children’s Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Frank B. Hu
- Nutrition Department, Harvard T.H. Chan School of Public Health, Boston, MA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
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31
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Špečkauskienė V, Trišauskė J, Grincaitė M, Kriaučionienė V, Petrauskienė A. Changes of anthropometric indicators of lithuanian first-graders in 2008-2019 according to International Obesity Task Force (IOTF) and World Health Organization (WHO) definitions. BMC Public Health 2023; 23:2097. [PMID: 37880648 PMCID: PMC10601166 DOI: 10.1186/s12889-023-17031-6] [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: 06/06/2023] [Accepted: 10/20/2023] [Indexed: 10/27/2023] Open
Abstract
INTRODUCTION The monitoring of children's growth plays a crucial role in assessing their growth patterns and indicating their weight status. Overweight and obesity, determined by cut-offs of body mass index (BMI), are most commonly associated with unhealthy nutrition, non-communicable diseases, and other health disorders. The World Health Organization (WHO) initiated the WHO European Childhood Obesity Surveillance Initiative (COSI) to measure routinely trends in children's anthropometric changes, which allow intercountry comparisons within the European Region. Lithuania joined the COSI initiative. Our study aims to evaluate and compare underweight, normal and elevated weight (overweight and obesity) changes of Lithuanian first-graders during eleven years period. METHODS This study was composed according to the COSI study protocol, and it compares the five rounds of anthropometric measurements of Lithuanian first-graders (7-8-year-old) from 2008 to 2019. The main analysed variables were weight and height; calculated BMI, weight-for-age (W/A), height-for-age (H/A) and body mass index-for-age (BMI/A) z-scores. Changes of the indicators were evaluated according to the International Obesity Task Force (IOTF) cut-offs and WHO child growth standards, grouped by 4 estimates: underweight (thinness), normal weight, overweight and obesity. All comparisons were performed between age groups, gender and COSI round year. RESULTS The mean values for weight, height, W/A and H/A Z-scores were significantly higher for both age and gender groups when comparing later COSI round years (2016 or 2019) to earlier years (2008-2013, in some cases 2016 is included in this range). Time trends of the WHO growth standards and IOTF cut-offs indicate significant decrease among 7-year-old overweight group for boys and girls. Also, a significant decrease was indicated among boys aged 8 years in the overweight group according to the WHO definitions. The only significant increase in trend were expressed in girl's group with obesity aged 8 years according to IOTF cut-offs. CONCLUSION The prevalence of overweight and obesity of first-grade children in Lithuania indicates positive changes, that is the proportion of children with elevated body weight decreased, during eleven-year period. However, it is important to continue the monitoring of children's growth tendencies.
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Affiliation(s)
- Vita Špečkauskienė
- Health Research Institute, Faculty of Public Health, Lithuanian University of Health Sciences, Kaunas, LT47181, Lithuania.
- Department of Physics, Mathematics, and Biophysics, Faculty of Medicine, Lithuanian University of Health Sciences, Kaunas, LT, 50162, Lithuania.
| | - Justina Trišauskė
- Health Research Institute, Faculty of Public Health, Lithuanian University of Health Sciences, Kaunas, LT47181, Lithuania
| | - Monika Grincaitė
- Health Research Institute, Faculty of Public Health, Lithuanian University of Health Sciences, Kaunas, LT47181, Lithuania
| | - Vilma Kriaučionienė
- Health Research Institute, Faculty of Public Health, Lithuanian University of Health Sciences, Kaunas, LT47181, Lithuania
- Department of Preventive Medicine, Faculty of Public Health, Lithuanian University of Health Sciences, Kaunas, LT47181, Lithuania
| | - Aušra Petrauskienė
- Health Research Institute, Faculty of Public Health, Lithuanian University of Health Sciences, Kaunas, LT47181, Lithuania
- Department of Preventive Medicine, Faculty of Public Health, Lithuanian University of Health Sciences, Kaunas, LT47181, Lithuania
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Sierra-Velez D, Gundewar A, Persaud A, Simione M, Castro I, Perkins M, Lindros J, Salmon J, Smith JD, Taveras EM, Fiechtner L. Stakeholders' perception of factors influencing adoption of a pediatric weight management intervention: a qualitative study. Front Public Health 2023; 11:1045618. [PMID: 37900042 PMCID: PMC10613059 DOI: 10.3389/fpubh.2023.1045618] [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: 10/17/2022] [Accepted: 09/19/2023] [Indexed: 10/31/2023] Open
Abstract
Background Childhood obesity is highly prevalent in the United States and disproportionately impacts communities of color and low-income populations; these disparities have worsened during the COVID-19 pandemic. Adoption of effective pediatric weight management interventions (PWMIs) that have been evaluated among low-income diverse populations is needed. The Healthy Weight Clinic PWMI, a package co-developed by the American Academy of Pediatrics and Massachusetts General Hospital, helps health centers establish multidisciplinary Healthy Weight Clinics based on previous randomized controlled trials which demonstrated effectiveness. We sought to identify the factors influencing successful adoption of this PWMI and understand adaptations needed prior to implementation in new sites. Methods We interviewed 20 stakeholders, 10 from two health centers in Mississippi where the Healthy Weight Clinic PWMI will be piloted (pre-implementation sites) and 10 from health centers that have previously implemented it (sites in maintenance stages). Separate interview guides informed by the Consolidated Framework for Implementation Research (CFIR) were developed for the pre-implementation sites and those in maintenance stages, including questions related to adaptations of the PWMI in response to the COVID-19 pandemic. Qualitative data analysis was conducted using directed content analysis based on CFIR constructs. Adaptations in response to the pandemic were categorized using Framework for Reporting Adaptations and Modifications-Expanded (FRAME). Results In pre-implementation sites, an inner setting facilitator mentioned was a positive learning climate. Characteristics of individuals that can facilitate adoption include staff willingness to learn, valuing evidence-based care for childhood obesity, and culturally and weight-sensitive staff. In terms of patient needs and resources (outer setting), social drivers of health are barriers to adoption, but creative solutions were suggested to mitigate these. Other facilitators related to the intervention included its multidisciplinary model and adaptability. Similar themes were elicited from sites in maintenance stages; adaptations brought on by the pandemic, such as telehealth visits and content modification to align with distancing guidelines and the effects of social isolation were also described. Conclusion Understanding the factors influencing adoption of an evidence-based PWMI informs necessary adaptations and implementation strategies required to facilitate nationwide dissemination of PWMIs, with the goal of reaching the populations most at-risk.
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Affiliation(s)
- Desiree Sierra-Velez
- Division of Pediatric Gastroenterology and Nutrition, MassGeneral Hospital for Children, Boston, MA, United States
| | - Anisha Gundewar
- Department of Pediatrics, MassGeneral Hospital for Children, Boston, MA, United States
| | - Alicia Persaud
- Division of General Academic Pediatrics, Department of Pediatrics, MassGeneral Hospital for Children, Boston, MA, United States
| | - Meg Simione
- Division of General Academic Pediatrics, Department of Pediatrics, MassGeneral Hospital for Children, Boston, MA, United States
| | - Ines Castro
- Division of General Academic Pediatrics, Department of Pediatrics, MassGeneral Hospital for Children, Boston, MA, United States
| | - Meghan Perkins
- Division of General Academic Pediatrics, Department of Pediatrics, MassGeneral Hospital for Children, Boston, MA, United States
| | - Jeanne Lindros
- Institute for Healthy Childhood Weight, American Academy of Pediatrics, Itasca, IL, United States
| | - Jeremiah Salmon
- Institute for Healthy Childhood Weight, American Academy of Pediatrics, Itasca, IL, United States
| | - Justin D. Smith
- Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Elsie M. Taveras
- Division of General Academic Pediatrics, Department of Pediatrics, MassGeneral Hospital for Children, Boston, MA, United States
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Lauren Fiechtner
- Division of Pediatric Gastroenterology and Nutrition, MassGeneral Hospital for Children, Boston, MA, United States
- Division of General Academic Pediatrics, Department of Pediatrics, MassGeneral Hospital for Children, Boston, MA, United States
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Drouka A, Brikou D, Causeret C, Al Ali Al Malla N, Sibalo S, Ávila C, Alcat G, Kapetanakou AE, Gurviez P, Fellah-Dehiri N, Masson M, Kontogianni MD, Yannakoulia M. Effectiveness of School-Based Interventions in Europe for Promoting Healthy Lifestyle Behaviors in Children. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1676. [PMID: 37892339 PMCID: PMC10605522 DOI: 10.3390/children10101676 10.3390/儿童10101676] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 10/06/2023] [Accepted: 10/10/2023] [Indexed: 06/30/2024]
Abstract
The objective of this narrative review was to summarize existing literature on the effectiveness of school-based interventions, implemented in Europe, under the aim of promoting healthy lifestyle behaviors in children (6-10 years old). A search of PubMed, Scopus, EFSA and Google Scholar databases was performed for studies published from January 2016 to June 2022. Specific search terms and exclusion criteria were used. Based on the results, diet and physical activity interventions had favorable effects on a series of health outcomes, including anthropometric parameters, biomarkers, eating behavior and self-efficacy. Diet-only interventions had a positive impact specifically on eating habits, mostly on water consumption. Most successful interventions lasted for 1 school year, and they were characterized by parental involvement and teachers' training.
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Affiliation(s)
- Archontoula Drouka
- Department of Nutrition & Dietetics, Harokopio University, 17671 Athens, Greece; (A.D.); (D.B.); (M.D.K.)
| | - Dora Brikou
- Department of Nutrition & Dietetics, Harokopio University, 17671 Athens, Greece; (A.D.); (D.B.); (M.D.K.)
| | | | | | | | - Concha Ávila
- Federación Española de Industrias de Alimentación y Bebidas, 28001 Madrid, Spain; (C.Á.); (G.A.)
| | - Gabriela Alcat
- Federación Española de Industrias de Alimentación y Bebidas, 28001 Madrid, Spain; (C.Á.); (G.A.)
| | | | - Patricia Gurviez
- Agroparistech, INRAE, Paris-Saclay University, 91120 Palaiseau, France; (P.G.); (N.F.-D.); (M.M.)
| | - Nawel Fellah-Dehiri
- Agroparistech, INRAE, Paris-Saclay University, 91120 Palaiseau, France; (P.G.); (N.F.-D.); (M.M.)
| | - Marine Masson
- Agroparistech, INRAE, Paris-Saclay University, 91120 Palaiseau, France; (P.G.); (N.F.-D.); (M.M.)
| | - Meropi D. Kontogianni
- Department of Nutrition & Dietetics, Harokopio University, 17671 Athens, Greece; (A.D.); (D.B.); (M.D.K.)
| | - Mary Yannakoulia
- Department of Nutrition & Dietetics, Harokopio University, 17671 Athens, Greece; (A.D.); (D.B.); (M.D.K.)
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Drouka A, Brikou D, Causeret C, Al Ali Al Malla N, Sibalo S, Ávila C, Alcat G, Kapetanakou AE, Gurviez P, Fellah-Dehiri N, Masson M, Kontogianni MD, Yannakoulia M. Effectiveness of School-Based Interventions in Europe for Promoting Healthy Lifestyle Behaviors in Children. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1676. [PMID: 37892339 PMCID: PMC10605522 DOI: 10.3390/children10101676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 10/06/2023] [Accepted: 10/10/2023] [Indexed: 10/29/2023]
Abstract
The objective of this narrative review was to summarize existing literature on the effectiveness of school-based interventions, implemented in Europe, under the aim of promoting healthy lifestyle behaviors in children (6-10 years old). A search of PubMed, Scopus, EFSA and Google Scholar databases was performed for studies published from January 2016 to June 2022. Specific search terms and exclusion criteria were used. Based on the results, diet and physical activity interventions had favorable effects on a series of health outcomes, including anthropometric parameters, biomarkers, eating behavior and self-efficacy. Diet-only interventions had a positive impact specifically on eating habits, mostly on water consumption. Most successful interventions lasted for 1 school year, and they were characterized by parental involvement and teachers' training.
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Affiliation(s)
- Archontoula Drouka
- Department of Nutrition & Dietetics, Harokopio University, 17671 Athens, Greece; (A.D.); (D.B.); (M.D.K.)
| | - Dora Brikou
- Department of Nutrition & Dietetics, Harokopio University, 17671 Athens, Greece; (A.D.); (D.B.); (M.D.K.)
| | | | | | | | - Concha Ávila
- Federación Española de Industrias de Alimentación y Bebidas, 28001 Madrid, Spain; (C.Á.); (G.A.)
| | - Gabriela Alcat
- Federación Española de Industrias de Alimentación y Bebidas, 28001 Madrid, Spain; (C.Á.); (G.A.)
| | | | - Patricia Gurviez
- Agroparistech, INRAE, Paris-Saclay University, 91120 Palaiseau, France; (P.G.); (N.F.-D.); (M.M.)
| | - Nawel Fellah-Dehiri
- Agroparistech, INRAE, Paris-Saclay University, 91120 Palaiseau, France; (P.G.); (N.F.-D.); (M.M.)
| | - Marine Masson
- Agroparistech, INRAE, Paris-Saclay University, 91120 Palaiseau, France; (P.G.); (N.F.-D.); (M.M.)
| | - Meropi D. Kontogianni
- Department of Nutrition & Dietetics, Harokopio University, 17671 Athens, Greece; (A.D.); (D.B.); (M.D.K.)
| | - Mary Yannakoulia
- Department of Nutrition & Dietetics, Harokopio University, 17671 Athens, Greece; (A.D.); (D.B.); (M.D.K.)
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Fathi LI, Walker J, Dix CF, Cartwright JR, Joubert S, Carmichael KA, Huang YS, Littlewood R, Truby H. Applying the Integrated Sustainability Framework to explore the long-term sustainability of nutrition education programmes in schools: a systematic review. Public Health Nutr 2023; 26:2165-2179. [PMID: 37548226 PMCID: PMC10564612 DOI: 10.1017/s1368980023001647] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 04/27/2023] [Accepted: 07/17/2023] [Indexed: 08/08/2023]
Abstract
OBJECTIVE This review aimed to identify and synthesise the enablers and barriers that influence the long-term (≥ 2 years) sustainment of school-based nutrition programmes. DESIGN Four databases (PubMed, Cochrane Library, Embase and Scopus) were searched to identify studies reporting on the international literature relating to food and nutrition programmes aimed at school-age (5-14 years) children that had been running for ≥ 2 years (combined intervention and follow-up period). Eligible studies were analysed using the Integrated Sustainability Framework (ISF), which involved deductive coding of programme enablers and barriers. A quality assessment was completed, using the Mixed-Methods Appraisal Tool and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. SETTING International school-based nutrition programmes. SUBJECTS Individuals involved with the implementation of school-based nutrition programmes. RESULTS From the 7366 articles identified, thirteen studies (seven qualitative, five mixed methods and one quantitative descriptive) were included, from which the enablers and barriers of eleven different nutrition-related programmes were analysed. Thirty-four factors across the five domains of the ISF were identified that influenced the sustained implementation of programmes. The most common barrier was a lack of organisational readiness and resources, whereas the most common enabler was having adequate external partnerships and a supportive environment. CONCLUSIONS These findings have application during the initiation and implementation phases of school-based nutrition programmes. Paying attention to the 'outer contextual factors' of the ISF including the establishment and maintenance of robust relationships across whole of government systems, local institutions and funding bodies are crucial for programme sustainment.
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Affiliation(s)
- Leila Isabella Fathi
- School of Human Movement and Nutrition Sciences, The University of Queensland, St Lucia, QLD4067, Australia
| | - Jacqueline Walker
- School of Human Movement and Nutrition Sciences, The University of Queensland, St Lucia, QLD4067, Australia
- Health and Wellbeing Queensland, Brisbane, Australia
| | - Clare Frances Dix
- School of Human Movement and Nutrition Sciences, The University of Queensland, St Lucia, QLD4067, Australia
| | - Jessica Rose Cartwright
- School of Human Movement and Nutrition Sciences, The University of Queensland, St Lucia, QLD4067, Australia
| | - Suné Joubert
- School of Human Movement and Nutrition Sciences, The University of Queensland, St Lucia, QLD4067, Australia
| | - Kerri Amelia Carmichael
- School of Human Movement and Nutrition Sciences, The University of Queensland, St Lucia, QLD4067, Australia
| | - Yu-Shan Huang
- School of Human Movement and Nutrition Sciences, The University of Queensland, St Lucia, QLD4067, Australia
| | - Robyn Littlewood
- School of Human Movement and Nutrition Sciences, The University of Queensland, St Lucia, QLD4067, Australia
- Health and Wellbeing Queensland, Brisbane, Australia
| | - Helen Truby
- School of Human Movement and Nutrition Sciences, The University of Queensland, St Lucia, QLD4067, Australia
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Tandoh A, Laar A, Pradeilles R, Le Port A, Osei-Kwasi H, Amevinya GS, Aryeetey RNO, Agyemang C, Holdsworth M. Addressing the marketing and availability of unhealthy food and beverages in and around selected schools in Ghana: a community readiness appraisal. BMJ Open 2023; 13:e075166. [PMID: 37770260 PMCID: PMC10546112 DOI: 10.1136/bmjopen-2023-075166] [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: 04/28/2023] [Accepted: 08/21/2023] [Indexed: 09/30/2023] Open
Abstract
OBJECTIVE This study assessed stakeholder readiness to address unhealthy food and beverage marketing and availability in/around Public Basic Schools (for children 4-15 years) in Greater Accra Region, the highly urbanised administrative capital of Ghana. DESIGN The community readiness model was used to conduct in-depth mixed methods interviews with stakeholders. Using predefined anchored rating statements, quantitative readiness scores ranging from 1 to 9 were generated. Thematic qualitative analysis was undertaken to understand barriers and facilitators that could influence the implementation of interventions. SETTING Greater Accra Region, Ghana. PARTICIPANTS 18 key informants from various school/education/citizen sectors, which together represented the 'school community' of Greater Accra Region. RESULTS The mean readiness scores indicated that the 'school community' was at the 'preplanning' stage of readiness (4.44±0.98) to address the marketing and availability of unhealthy food and beverages in and around schools. The mean readiness score for 'leadership' was the highest of all dimensions (5.36±1.60), corresponding to the 'preparation' stage. The lowest scores were found for 'community knowledge of efforts' (3.19±2.45) and 'resources for efforts' (3.64±0.87), both of which were at a 'vague awareness' stage. CONCLUSIONS The 'school community' recognised that the marketing and availability of unhealthy food and beverages was a problem. Additionally, current leadership was actively supportive of continuing/improving efforts that create healthier children's food environments. However, actions that aim to increase the 'school community's' knowledge of existing interventions and securing resources to sustain those interventions are needed before introducing readiness appropriate strategies.
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Affiliation(s)
- Akua Tandoh
- Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana, Legon, Greater Accra, Ghana
- UMR MoISA (Montpellier Interdisciplinary centre on Sustainable Agri-food systems), Univ Montpellier, CIRAD, CIHEAM-IAMM, INRAE, Institut Agro Montpellier, IRD, Montpellier, France
| | - Amos Laar
- Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana, Legon, Greater Accra, Ghana
| | - Rebecca Pradeilles
- UMR MoISA (Montpellier Interdisciplinary centre on Sustainable Agri-food systems), Univ Montpellier, CIRAD, CIHEAM-IAMM, INRAE, Institut Agro Montpellier, IRD, Montpellier, France
| | - Agnes Le Port
- UMR MoISA (Montpellier Interdisciplinary centre on Sustainable Agri-food systems), Univ Montpellier, CIRAD, CIHEAM-IAMM, INRAE, Institut Agro Montpellier, IRD, Montpellier, France
| | - Hibbah Osei-Kwasi
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Gideon Senyo Amevinya
- Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana, Legon, Greater Accra, Ghana
| | - Richmond Nii Okai Aryeetey
- Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana, Legon, Greater Accra, Ghana
| | - Charles Agyemang
- Department of Public & Occupational Health, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
- Department of Medicine, Division of Endocrinology, Diabetes, and Metabolism, Johns Hopkins University, Baltimore, Maryland, USA
| | - Michelle Holdsworth
- UMR MoISA (Montpellier Interdisciplinary centre on Sustainable Agri-food systems), Univ Montpellier, CIRAD, CIHEAM-IAMM, INRAE, Institut Agro Montpellier, IRD, Montpellier, France
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Wang L, Cohen JF, Maroney M, Cudhea F, Hill A, Schwartz C, Lurie P, Mozaffarian D. Evaluation of health and economic effects of United States school meal standards consistent with the 2020-2025 dietary guidelines for Americans. Am J Clin Nutr 2023; 118:605-613. [PMID: 37527964 PMCID: PMC10550836 DOI: 10.1016/j.ajcnut.2023.05.031] [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: 02/02/2023] [Revised: 04/10/2023] [Accepted: 05/25/2023] [Indexed: 08/03/2023] Open
Abstract
BACKGROUND The current school meal nutrition standards, established in 2010, are not fully aligned with the 2020-2025 Dietary Guideline for Americans (DGA). This study evaluates the potential short-term and long-term health and economic benefits of strengthening the school meal standards on added sugars, sodium, and whole grains to be aligned with current guidelines. METHODS We used comparative risk assessment frameworks based on nationally representative data incorporating current demographics, dietary habits, and risk factors of United States children aged 5-18 y from 3 cycles of the National Health and Nutrition Examination Survey (2013-2018). To estimate short-term impact, the model incorporated estimated dietary changes owing to potential new DGA-aligned school meal nutrition standards and the effect of these changes on childhood body mass index (in kg/m2) and blood pressure. To estimate long-term impact, the model further incorporated data on the sustainability of childhood dietary changes into adulthood, and on demographics and risk factors of United States adults, diet-disease associations, and disease-specific national mortality. RESULTS In a best-case scenario assuming full school compliance, implementing new DGA-aligned nutritional standards would lower elementary children's BMI by an average 0.14 (95% UI: 0.08-0.20) kg/m2 and systolic blood pressure by 0.13 (95% UI: 0.06-0.19) (95% mm Hg. Later in life, the new standards were estimated to prevent 10,600 [95% uncertainty interval (UI): 4820-16,800) annual deaths from cardiovascular disease (CVD), diabetes, and cancer in adulthood; and save 355,000 (95% UI: 175,000-538,000) disability-adjusted life years and $19.3 (95% UI: 9.35-30.3) B in direct and indirect medical costs each year. Accounting for plausible (incomplete) school compliance, implementation would save an estimated 9110 (95% UI: 2740-15,100) deaths, 302,000 (95% UI: 120,000-479,000) disability-adjusted life years, and $15.9 (95% UI: 4.54-27.2) B in healthcare-related costs per year in later adulthood. CONCLUSIONS Stronger school meal nutrition standards on added sugars, sodium, and whole grains aligned with the 2020-2025 DGA recommendations may improve diet, childhood health, and future adult burdens of CVD, diabetes, cancer, and associated economic costs.
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Affiliation(s)
- Lu Wang
- Friedman School of Nutrition Science and Policy, Boston, MA, United States
| | - Juliana Fw Cohen
- Department of Health Sciences, Merrimack College, North Andover, MA, United States; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Meghan Maroney
- Center for Science in the Public Interest, Washington, DC, United States
| | - Fredrick Cudhea
- Friedman School of Nutrition Science and Policy, Boston, MA, United States
| | - Alla Hill
- Center for Science in the Public Interest, Washington, DC, United States
| | - Colin Schwartz
- Center for Science in the Public Interest, Washington, DC, United States
| | - Peter Lurie
- Center for Science in the Public Interest, Washington, DC, United States
| | - Dariush Mozaffarian
- Friedman School of Nutrition Science and Policy, Boston, MA, United States; Division of Cardiology, Tufts Medical Center, Boston, MA, United States.
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SALINI CHIARA, MESSINA GABRIELE, MESSINA DANIELE, NANTE NICOLA. Every cockroach is beautiful to his mother's eyes"? A multicentric study on the perception of child's health status according to the parent. JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2023; 64:E311-E315. [PMID: 38125996 PMCID: PMC10730050 DOI: 10.15167/2421-4248/jpmh2023.64.3.2859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 10/20/2023] [Indexed: 12/23/2023]
Abstract
Introduction Childhood obesity is a social health problem in the Western World and an important goal is to analyze and correct risk factors. However, part of the problem could be determined by a different perception of the weight. Material and methods In October 2019, we conducted a cross-sectional study in which a questionnaire was administered to the parents of primary and secondary school children in South-East Tuscany, Italy. The aim was to determine the association between children's Body Mass Index (BMI) and the parent's perception. Results Analysis was carried out on 1,405 complete questionnaires. We found that most parents wrongly perceive the weight of their children. 88.3% of parents with obese children believe that their children are of normal weight or only "a little overweight". 67.6% of parents who have overweight children think that their children are of normal weight (p < 0.001). Conclusions Our results show a misperception of the weight of the children in the parents eyes. The acquisition of healthy behaviour during childhood is extremely important for health in adulthood and for avoiding the onset of associated diseases. Therefore, food education becomes a crucial objective. Children and parents need to increase consciousness of the correct weight and diseases resulting from bad nutrition.
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Affiliation(s)
- CHIARA SALINI
- Post Graduate School of Public Health, University of Siena, Italy
| | - GABRIELE MESSINA
- Department of Molecular and Developmental Medicine, University of Siena, Italy
| | | | - NICOLA NANTE
- Post Graduate School of Public Health, University of Siena, Italy
- Department of Molecular and Developmental Medicine, University of Siena, Italy
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Gaudin V, Stranges S, Wilk P, Sarma S. School nutrition policy and diet quality of children and youth: a quasi-experimental study from Canada. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2023; 114:613-628. [PMID: 36976487 PMCID: PMC10351299 DOI: 10.17269/s41997-023-00743-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 01/10/2023] [Indexed: 03/29/2023]
Abstract
OBJECTIVE We investigated the impact of mandatory school nutrition policy on diet quality of Canadian school children using a quasi-experimental study design. METHODS Using 24-h dietary recall data from the 2004 Canadian Community Health Survey (CCHS) Cycle 2.2 and 2015 CCHS - Nutrition, we constructed the Diet Quality Index (DQI). We used multivariable difference-in-differences regressions to quantify the DQI scores associated with school nutrition policy. We conducted stratified analyses by sex, school grade, household income, and food security status to gain additional insights into the impact of nutrition policy. RESULTS We found that mandatory school nutrition policy was associated with an increased DQI score by 3.44 points (95% CI: 1.1, 5.8) during school-hours in intervention provinces relative to control provinces. DQI score was higher among males (3.8 points, 95% CI: 0.6, 7.1) than among females (2.9 points, 95% CI: -0.5, 6.3), and the score among students in elementary schools was higher (5.1 points, 95% CI: 2.3, 8.0) than that among high school students (0.4 points, 95% CI: -3.6, 4.5). We also found that DQI scores were higher for middle-high income and food secure households. CONCLUSION Provincial mandatory school nutrition policy was associated with better diet quality among children and youth in Canada. Our findings suggest that other jurisdictions may consider implementing mandatory school nutrition policy.
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Affiliation(s)
- Victoria Gaudin
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western Centre for Public Health and Family Medicine, University of Western Ontario, Room 313, 11465 Richmond Street, London, ON, N6G 2M1, Canada
| | - Saverio Stranges
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western Centre for Public Health and Family Medicine, University of Western Ontario, Room 313, 11465 Richmond Street, London, ON, N6G 2M1, Canada
- Department of Family Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada
- Department of Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada
- Department of Precision Health, Luxembourg Institute of Health, Strassen, Luxembourg
| | - Piotr Wilk
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western Centre for Public Health and Family Medicine, University of Western Ontario, Room 313, 11465 Richmond Street, London, ON, N6G 2M1, Canada
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Department of Epidemiology, Maastricht University, Maastricht, the Netherlands
| | - Sisira Sarma
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western Centre for Public Health and Family Medicine, University of Western Ontario, Room 313, 11465 Richmond Street, London, ON, N6G 2M1, Canada.
- Institute for Clinical Evaluative Sciences (ICES), Toronto, ON, Canada.
- Lawson Health Research Institute, London, ON, Canada.
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Moore SE, Brennan SF, Lavelle F, Dean M, McKinley MC, Olgacher D, McCole P, Hunter RF, Dunne L, O’Connell NE, Elliott CT, McCarthy D, Woodside JV. Capturing the whole-school food environment in primary schools. Public Health Nutr 2023; 26:1671-1678. [PMID: 37272413 PMCID: PMC10410367 DOI: 10.1017/s1368980023001131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 01/23/2023] [Accepted: 05/23/2023] [Indexed: 06/06/2023]
Abstract
OBJECTIVE The school food environment (SFE) is an ideal setting for encouraging healthy dietary behaviour. We aimed to develop an instrument to assess whole-SFE, test the instrument in the school setting and demonstrate its use to make food environment recommendations. DESIGN SFE literature and UK school food guidance were searched to inform instrument items. The instrument consisted of (i) an observation proforma capturing canteen areas systems, food presentation and monitoring of food intake and (ii) a questionnaire assessing food policies, provision and activities. The instrument was tested in schools and used to develop SFE recommendations. Descriptive analyses enabled narrative discussion. SETTING Primary schools. PARTICIPANTS An observation was undertaken at schools in urban and rural geographical regions of Northern Ireland of varying socio-economic status (n 18). School senior management completed the questionnaire with input from school caterers (n 16). RESULTS The instrument captured desired detail and potential instrument modifications were identified. SFE varied. Differences existed between food policies and how policies were implemented and monitored. At many schools, there was scope to enhance physical eating environments (n 12, 67 %) and food presentation (n 15, 83 %); emphasise healthy eating through food activities (n 7, 78 %) and increase parental engagement in school food (n 9, 56 %). CONCLUSIONS The developed instrument can measure whole-SFE in primary schools and also enabled identification of recommendations to enhance SFE. Further assessment and adaptation of the instrument are required to enable future use as a research tool or for self-assessment use by schools.
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Affiliation(s)
- Sarah E Moore
- Institute for Global Food Security, Queen’s University Belfast, BelfastBT9 5AG, United Kingdom of Great Britain and Northern Ireland
- Centre for Public Health, Queen’s University Belfast, BelfastBT12 6BA, United Kingdom of Great Britain and Northern Ireland
| | - Sarah F Brennan
- Institute for Global Food Security, Queen’s University Belfast, BelfastBT9 5AG, United Kingdom of Great Britain and Northern Ireland
- Centre for Public Health, Queen’s University Belfast, BelfastBT12 6BA, United Kingdom of Great Britain and Northern Ireland
| | - Fiona Lavelle
- Institute for Global Food Security, Queen’s University Belfast, BelfastBT9 5AG, United Kingdom of Great Britain and Northern Ireland
| | - Moira Dean
- Institute for Global Food Security, Queen’s University Belfast, BelfastBT9 5AG, United Kingdom of Great Britain and Northern Ireland
| | - Michelle C McKinley
- Institute for Global Food Security, Queen’s University Belfast, BelfastBT9 5AG, United Kingdom of Great Britain and Northern Ireland
- Centre for Public Health, Queen’s University Belfast, BelfastBT12 6BA, United Kingdom of Great Britain and Northern Ireland
- Centre for Evidence and Social Innovation, Queen’s University Belfast, Belfast, United Kingdom of Great Britain and Northern Ireland
| | - Dilara Olgacher
- Centre for Public Health, Queen’s University Belfast, BelfastBT12 6BA, United Kingdom of Great Britain and Northern Ireland
| | - Patrick McCole
- Queen’s Management School, Queen’s University Belfast, BelfastBT9 5EE, United Kingdom of Great Britain and Northern Ireland
| | - Ruth F Hunter
- Institute for Global Food Security, Queen’s University Belfast, BelfastBT9 5AG, United Kingdom of Great Britain and Northern Ireland
| | - Laura Dunne
- Centre for Evidence and Social Innovation, Queen’s University Belfast, Belfast, United Kingdom of Great Britain and Northern Ireland
| | - Niamh E O’Connell
- Institute for Global Food Security, Queen’s University Belfast, BelfastBT9 5AG, United Kingdom of Great Britain and Northern Ireland
| | - Chris T Elliott
- Institute for Global Food Security, Queen’s University Belfast, BelfastBT9 5AG, United Kingdom of Great Britain and Northern Ireland
| | - Danielle McCarthy
- Institute for Global Food Security, Queen’s University Belfast, BelfastBT9 5AG, United Kingdom of Great Britain and Northern Ireland
| | - Jayne V Woodside
- Institute for Global Food Security, Queen’s University Belfast, BelfastBT9 5AG, United Kingdom of Great Britain and Northern Ireland
- Centre for Public Health, Queen’s University Belfast, BelfastBT12 6BA, United Kingdom of Great Britain and Northern Ireland
- Centre for Evidence and Social Innovation, Queen’s University Belfast, Belfast, United Kingdom of Great Britain and Northern Ireland
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Zaremba SMM, Cook WB, Anderson AS. ' It was called a grab bag and nobody wanted to grab them': Teachers' perceptions of school lunches during the COVID-19 pandemic - a regional case study. J Public Health Res 2023; 12:22799036231193071. [PMID: 37622100 PMCID: PMC10446468 DOI: 10.1177/22799036231193071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 07/16/2023] [Indexed: 08/26/2023] Open
Abstract
Background The COVID-19 pandemic brought changes to primary school lunches leading to concerns over nutritional quality and uptake of lunches by vulnerable children. Regional data from Tayside, Scotland, showed that only 55% of children who were eligible for free school meals took these (normal uptake pre-pandemic was 66%). The current work aimed to identify teachers' perceptions of meal provisioning in primary schools during the first year of the COVID-19 pandemic. Design and methods A cross-sectional online survey was carried out among primary school teachers across Tayside, Scotland. Using an online survey (21 questions combining multiple choice formats and open text) and interviews, primary school teachers shared their views on food quality, quantity, meal choices and factors influencing uptake of primary school lunches. Interviews were recorded, transcribed and thematically analysed with respect to factors influencing consumption. Results The survey was completed by 41 teachers and 8 participated in a follow up interview. Around one-third (29%) of primary school teachers believed the quality of lunches had decreased and cited poor appearance of food, use of takeaway containers and food wastage. The lunch format was viewed negatively principally relating to the substitution of hot lunches with cold sandwiches, portion sizes, choice and perceived value for money. Concerns were expressed about acceptability and how far the meals contributed to food security. Conclusions Further work on food provisioning is needed in order to identify ways to provide a nutritional safety net for vulnerable children.
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Affiliation(s)
- SMM Zaremba
- Division of Population Health & Genomics, Ninewells Hospital & Medical School, University of Dundee, Dundee, UK
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Temple NJ. A Proposed Strategy against Obesity: How Government Policy Can Counter the Obesogenic Environment. Nutrients 2023; 15:2910. [PMID: 37447235 DOI: 10.3390/nu15132910] [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: 05/01/2023] [Revised: 06/25/2023] [Accepted: 06/25/2023] [Indexed: 07/15/2023] Open
Abstract
An epidemic of obesity emerged in the USA in 1976-1980. The epidemic then spread to many other Westernized nations. Many interventions have been carried out with the goal of lowering the prevalence of obesity. These have mostly taken the form of various types of health promotion (i.e., providing people with education, advice, and encouragement). These actions have achieved, at most, only limited success. A strategy with a better chance of success starts with the recognition that the fundamental cause of obesity is that we live in an obesogenic environment. It is therefore necessary to change the environment so that it fosters a generally healthy lifestyle, thereby leading to enhanced health for the population, including improved weight control. A major goal is to increase the intake of healthy foods (especially fruit, vegetables, and whole grains), while decreasing intake of unhealthy foods (especially ultra-processed foods such as sugar). This will require major changes of many government policies. Some of the required policies are as follows. Schools should implement policies that create a healthy environment for children. For example, they should adopt a policy that only foods of high nutritional quality are sold in vending machines or given to students within school meals. Policies need to go well beyond the school setting; a broad strategy is needed that creates a healthy environment for children. Another important policy is the manipulation of food prices in order to shift the diet toward healthy foods. This requires using subsidies to lower the price of healthy foods, while adding a tax to less healthy foods to increase the price. This policy has been implemented in many cities and countries in the form of a tax on sugar-sweetened beverages (SSBs). The advertising of unhealthy foods (including fast-food restaurants) should be banned, especially where children and adolescents are the major target. Such a ban could be extended to a complete ban on all advertising for unhealthy foods, including that directed at adults. The proposed policy measures are likely to be strongly opposed by food corporations.
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Affiliation(s)
- Norman J Temple
- Centre for Science, Athabasca University, Athabasca, AB T9S 3A3, Canada
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Osei AN, Djekic-Ivankovic M, Larson CP, Agbemafle I, Agbozo F. Effect of school-based nutrition interventions among primary school children in sub-Saharan Africa: a systematic review protocol. BMJ Open 2023; 13:e068901. [PMID: 37072365 PMCID: PMC10124275 DOI: 10.1136/bmjopen-2022-068901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/20/2023] Open
Abstract
INTRODUCTION Preadolescents are passing through an intensive growth and development period that will benefit from healthy eating practices. For those attending school, school environments offer several potential benefits and have been demonstrated to influence the quality of dietary intakes and consequentially, nutritional status of school-aged children (SAC). Considering the amount of time children spend in school and the enormous potential of evidence-based interventions, the purpose of this review is to critically appraise peer-reviewed literature addressing the impact of school-based interventions on the nutritional status of SAC aged 6-12 years in sub-Saharan Africa. METHODS AND ANALYSIS A systematic search will be conducted in the following databases and online search records: Medline, CINAHL, Web of Science, Embase, Global health, Global Index Medicus, Cochrane library, Hinari and Google Scholar using search terms and keywords codeveloped with two librarians. An additional search will also be conducted from the reference list of identified literature. Search results of titles and abstracts will be initially screened for eligibility criteria by two independent reviewers and where there is disagreement, a third reviewer will be consulted. Articles meeting these criteria will then undergo a full-text review for the eligibility and exclusion criteria. The Joanna Briggs Institute critical appraisal tool will be used to assess the risk of bias. Data from articles meeting all study criteria will be extracted, analysed and synthesised. A meta-analysis will also be conducted if sufficient data are available. ETHICS AND DISSEMINATION This systematic review is limited to publicly accessible data bases not requiring prior ethical approval to access. The results of the systematic review will be disseminated through publications in peer-reviewed journals as well as conference and stakeholder presentations. PROSPERO REGISTRATION NUMBER CRD42022334829.
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Affiliation(s)
- Angela Nyamekye Osei
- School of Population and Global Health, McGill University, Montreal, Québec, Canada
| | | | - Charles P Larson
- School of Population and Global Health, McGill University, Montreal, Québec, Canada
| | - Isaac Agbemafle
- Fred N Binka School of Public Health, University of Health and Allied Sciences, Ho, Ghana
| | - Faith Agbozo
- Fred N Binka School of Public Health, University of Health and Allied Sciences, Ho, Ghana
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López-Gil JF, García-Hermoso A, Smith L, Gallego A, Victoria-Montesinos D, Ezzatvar Y, Hershey MS, Gutiérrez-Espinoza H, Mesas AE, Jiménez-López E, Sánchez-Miguel PA, López-Benavente A, Moreno-Galarraga L, Chen S, Brazo-Sayavera J, Fernandez-Montero A, Alcaraz PE, Panisello Royo JM, Tárraga-López PJ, Kales SN. A Cluster Randomized Controlled Trial of the Archena Infancia Saludable Project on 24-h Movement Behaviors and Adherence to the Mediterranean Diet among Schoolchildren: A Pilot Study Protocol. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10040738. [PMID: 37189987 DOI: 10.3390/children10040738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 03/14/2023] [Accepted: 03/15/2023] [Indexed: 05/17/2023]
Abstract
Objective: The aim of this paper is to describe the protocol of pilot cluster randomized controlled trial (RCT) that will evaluate the effects of a lifestyle-based intervention. The Archena Infancia Saludable project will have several objectives. The primary objective of this project is to determine the 6-month effects of a lifestyle-based intervention on adherence to 24-h movement behaviors and Mediterranean diet (MedDiet) in schoolchildren. The secondary objective of this project is to test the intervention effects of this lifestyle-based intervention on a relevant set of health-related outcomes (i.e., anthropometric measurements, blood pressure, perceived physical fitness, sleep habits, and academic performance). The tertiary objective is to investigate this intervention's "halo" effect on parents'/guardians' 24-h movement behaviors and adherence to the MedDiet. Methods: The Archena Infancia Saludable trial will be a cluster RCT submitted to the Clinical Trials Registry. The protocol will be developed according to SPIRIT guidelines for RCTs and CONSORT statement extension for cluster RCTs. A total of 153 eligible parents/guardians with schoolchildren aged 6-13 years will be randomized into an intervention group or a control group. This project focuses on two fundamental pillars: 24-h movement behaviors and MedDiet. It will mainly focus on the relationship between parents/guardians and their children. Behavior change strategies for dietary and 24-h movement behaviors in schoolchildren will be based on healthy lifestyle education for parents/guardians through infographics, video recipes, brief video clips, and videos. Conclusions: Most of the current knowledge on 24-h movement behaviors and adherence to the MedDiet is based on cross-sectional or longitudinal cohort studies, warranting a need to design and conduct RCTs to obtain more robust evidence on the effect of a healthy lifestyle program to increase 24-h movement behaviors and to improve adherence to the MedDiet in schoolchildren.
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Affiliation(s)
- José Francisco López-Gil
- Navarrabiomed, Hospital Universitario de Navarra (HUN), Universidad Pública de Navarra (UPNA), IdiSNA, 31006 Pamplona, Spain
- Department of Environmental Health, Harvard University T.H. Chan School of Public Health, Boston, MA 02138, USA
- One Health Research Group, Universidad de Las Américas, Quito 170124, Ecuador
| | - Antonio García-Hermoso
- Navarrabiomed, Hospital Universitario de Navarra (HUN), Universidad Pública de Navarra (UPNA), IdiSNA, 31006 Pamplona, Spain
| | - Lee Smith
- Centre for Health, Performance and Wellbeing, Anglia Ruskin University, Cambridge CB1 1PT, UK
| | - Alejandra Gallego
- Department of Applied Economics, Faculty of Economics and Business, University of Murcia, 30100 Murcia, Spain
| | | | - Yasmin Ezzatvar
- Department of Nursing, Universitat de València, 46007 Valencia, Spain
| | - Maria S Hershey
- Department of Environmental Health, Harvard University T.H. Chan School of Public Health, Boston, MA 02138, USA
| | | | - Arthur Eumann Mesas
- Health and Social Research Center, Universidad de Castilla-La Mancha (UCLM), 16071 Cuenca, Spain
- Postgraduate Program in Public Health, Universidade Estadual de Londrina, Londrina 86057-970, Brazil
| | - Estela Jiménez-López
- Health and Social Research Center, Universidad de Castilla-La Mancha (UCLM), 16071 Cuenca, Spain
| | - Pedro Antonio Sánchez-Miguel
- Grupo Análisis Comportamental de la Actividad Física y el Deporte (ACAFYDE), Departamento de Didáctica de la Expresión Musical, Plástica y Corporal, Facultad de Formación del Profesorado, Universidad de Extremadura, 10003 Cáceres, Spain
| | - Alba López-Benavente
- Departamento de Expresión Plástica, Musical y Dinámica, Facultad de Educación, Universidad de Murcia, 30100 Espinardo, Spain
| | - Laura Moreno-Galarraga
- IdiSNA (Instituto de Investigación Sanitaria de Navarra), 31008 Pamplona, Spain
- Department of Pediatrics, Complejo Hospitalario de Navarra, Servicio Navarro de Salud, 31008 Pamplona, Spain
| | - Sitong Chen
- Institute for Health and Sport, Victoria University, Melbourne 8001, Australia
| | - Javier Brazo-Sayavera
- PDU EFISAL, Centro Universitario Regional Noreste, Universidad de la República (UdelaR), Rivera 40000, Uruguay
- Department of Sports and Computer Science, Universidad Pablo de Olavide (UPO), 41013 Seville, Spain
| | - Alejandro Fernandez-Montero
- Department of Environmental Health, Harvard University T.H. Chan School of Public Health, Boston, MA 02138, USA
- IdiSNA (Instituto de Investigación Sanitaria de Navarra), 31008 Pamplona, Spain
- Department of Occupational Medicine, University of Navarra, 31008 Pamplona, Spain
| | - Pedro Emilio Alcaraz
- Research Center for High Performance Sport, San Antonio Catholic University of Murcia, 30830 Murcia, Spain
- Faculty of Sport Sciences, San Antonio Catholic University of Murcia, 30107 Murcia, Spain
| | | | - Pedro J Tárraga-López
- Departamento de Ciencias Médicas, Facultad de Medicina, Universidad Castilla-La Mancha (UCLM), 02008 Albacete, Spain
| | - Stefanos N Kales
- Department of Environmental Health, Harvard University T.H. Chan School of Public Health, Boston, MA 02138, USA
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Fretes G, Corvalán C, Reyes M, Taillie LS, Economos CD, Wilson NL, Cash SB. Changes in children's and adolescents' dietary intake after the implementation of Chile's law of food labeling, advertising and sales in schools: a longitudinal study. Int J Behav Nutr Phys Act 2023; 20:40. [PMID: 37016430 PMCID: PMC10074676 DOI: 10.1186/s12966-023-01445-x] [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: 02/25/2022] [Accepted: 03/22/2023] [Indexed: 04/06/2023] Open
Abstract
BACKGROUND In June 2016, a comprehensive food policy was implemented in Chile that included front-of-package warning labels on key nutrients of concern (total sugars, added saturated fats, sodium, and calories), child-directed food advertisement bans, and school regulations. The policy was implemented in 3 phases from 2016 to 2019 and the primary objective was to improve children's food environments. This study's objective was to assess changes in child and adolescent intake of key nutrients of concern (total sugars, saturated fats, and sodium) at school after the initial implementation of Chile's Law of Food Labeling and Advertisement. METHODS Longitudinal study of 349 children from the Food Environment Chilean Cohort (FECHIC) and 294 adolescents from the Growth and Obesity Cohort Study (GOCS). Data were from single 24-hour dietary recalls collected from 2016 to 2019. Fixed-effects models stratified by school, home, and other locations compared nutrient consumption in each year to consumption at the pre-policy 2016 baseline. Nutrient intakes are expressed as percent of total energy. RESULTS Compared to 2016 (pre-policy), total sugars consumed by children at school decreased 4.5 [-8.0, -0.9] percentage points (pp) and 11.8 [-15.4, -8.3] pp in 2018 and 2019 respectively. In 2019, children's saturated fats and sodium intake at school also decreased (1.1 [-1.9, -0.2] pp and 10.3 [-18.1, -2.5] mg/100 kcal respectively). Likewise, in adolescents, total sugars and saturated fats consumed at school decreased in 2018 (5.3 [-8.4, -2.2] pp and 1.5 [-2.7, -0.3] pp respectively). However, consumption of key nutrients of concern at other locations increased after implementation of the policy. CONCLUSIONS After initial implementation of Chile's Labeling Law, intake of most key nutrients of concern significantly declined at school. However, we found evidence of compensatory behavior in out-of-school settings. Further research is needed to evaluate what other actions are needed to impact overall diets in the long term both at schools and out of school.
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Affiliation(s)
- Gabriela Fretes
- International Food Policy Research Institute (IFPRI), 1201 Eye St NW, Washington, DC USA
| | - Camila Corvalán
- Instituto de Nutrición y Tecnología de los Alimentos (INTA), Universidad de Chile, Santiago, Chile
| | - Marcela Reyes
- Instituto de Nutrición y Tecnología de los Alimentos (INTA), Universidad de Chile, Santiago, Chile
| | - Lindsey Smith Taillie
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC USA
- Global Food Research Program, Carolina Population Center, Chapel Hill, NC USA
| | | | - Norbert L.W. Wilson
- Duke Divinity School, Sanford School of Public Policy, and World Food Policy Center, Duke University, Durham, NC USA
| | - Sean B. Cash
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA USA
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Food waste in primary schools: Evidence from peri-urban Viet Nam. Appetite 2023; 183:106485. [PMID: 36746278 DOI: 10.1016/j.appet.2023.106485] [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: 06/16/2022] [Revised: 01/29/2023] [Accepted: 02/02/2023] [Indexed: 02/07/2023]
Abstract
Schools are a major source of food waste and an important setting for achieving dietary improvements. Few studies explore the links between food waste and nutrition. This study measured individual plate waste of about 1700 primary school children in peri-urban Viet Nam, adding to evidence on school food waste in low- and middle-income countries. We used survey data to explore whether food waste is associated with personal characteristics such as sex, knowledge and attitudes about nutritious foods. Qualitative interviews and focus groups with teachers, parents, food providers and children helped identify potential causes of food waste. The average student wasted 23% of the food served (approximately 85 g) during lunch, which roughly equates to 15.3 kg of food in a school year. Vegetables were wasted most: children left almost half of their portion unconsumed. Boys wasted less food than girls. Better knowledge and attitudes about fruits and vegetables are associated with less waste of these foods. A large portion was associated with a higher share of wasted food, suggesting the potential trade-off between efforts to cut food waste and efforts to increase consumption of nutritious foods. Students were dissatisfied with the quality of the dishes, especially vegetables were evaluated as undercooked, served too cold and too oily. To reduce food waste, it is critical for schools to prepare food in line with students' preferences. Food waste reduction could be treated as an intermediate step towards ultimate policy goals such as healthier food consumption.
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Cabrera-Ledesma B, Abril-Ulloa V, Pinos-Vélez V, Carpio-Arias V. A Descriptive Qualitative Study of the Perceptions of Regulatory Authorities, Parents, and School Canteen Owners in the South of Ecuador about the Challenges and Facilities Related to Compliance with the National Regulation for School Canteens. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5313. [PMID: 37047929 PMCID: PMC10094177 DOI: 10.3390/ijerph20075313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Revised: 02/23/2023] [Accepted: 03/13/2023] [Indexed: 06/19/2023]
Abstract
The prevalence of overweight and obesity in the Ecuadorian school population continues to increase. An important factor in children's nutrition is the food offered in school canteens. The objective of this study was to explore the perceptions of the challenges faced by and facilities of school canteens in the provinces of southern Ecuador in terms of complying with national regulations. For this qualitative descriptive study, semi-structured interviews were conducted in 2021 with six school canteen owners, six school directors, five health experts, and seven parents of children attending school from three provinces, Cañar, Azuay, and Morona Santiago, in Ecuador. The data were transcribed and subsequently analyzed in ATLAS ti. The participants indicated several challenges to comply with the regulations of school canteens, such as the expenses generated by them, the lack of control of street food vendors in the surroundings of the schools, and the lack of trained personnel. Regarding the facilities, they highlighted that the regulation for cleaning and hygiene are more easily fulfilled. Standards and control of the food stipend in school canteens are required to ensure a supply of healthy food for the children. Multiple challenges and strategies are proposed to improve the eating habits of the school population and to improve the nutrition of schoolchildren.
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Affiliation(s)
| | - Victoria Abril-Ulloa
- Faculty of Medical Sciences, University of Cuenca, Cuenca 010201, Ecuador
- Research Group: “Public Health, Food and Physical Activity in the Life Cycle” Career of Nutrition and Dietetic, Medical Sciences Faculty, University of Cuenca, Cuenca 010201, Ecuador
| | | | - Valeria Carpio-Arias
- Research Group GIANH, School of Nutrition and Dietetics, Faculty of Public Health, Escuela Superior Politécnica de Chimborazo, Riobamba 060155, Ecuador
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Bryant M, Burton W, O'Kane N, Woodside JV, Ahern S, Garnett P, Spence S, Sharif A, Rutter H, Baker T, Evans CEL. Understanding school food systems to support the development and implementation of food based policies and interventions. Int J Behav Nutr Phys Act 2023; 20:29. [PMID: 36907879 PMCID: PMC10009978 DOI: 10.1186/s12966-023-01432-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 03/02/2023] [Indexed: 03/14/2023] Open
Abstract
BACKGROUND Schools provide opportunities to improve the quality of children's diet, whilst reducing inequalities in childhood diet and health. Evidence supports whole school approaches, including consistency in food quality, eating culture and food education. However, such approaches are often poorly implemented due to the highly complex environments in which schools operate. We aimed to develop a school food systems map using a systems thinking approach to help identify the key factors influencing primary school children's dietary choice. METHODS Eight workshops were conducted with 80 children (from schools from varying locations (region of England/UK; urban/rural), deprivation levels and prioritisation of school food policies)) and 11 workshops were held with 82 adult stakeholders across the UK (principals, teachers, caterers, school governors, parents, and local and voluntary sector organisations) to identify factors that influence food choice in children across a school day and their inter-relationships. Initial exploratory workshops started with a 'blank canvas' using a group model building approach. Later workshops consolidated findings and supported a wider discussion of factors, relationships and influences within the systems map. Strengths of the relationship between factors/nodes were agreed by stakeholders and individually depicted on the map. We facilitated an additional eight interactive, in-person workshops with children to map their activities across a whole school day to enable the production of a journey map which was shared with stakeholders in workshops to facilitate discussion. RESULTS The final 'CONNECTS-Food' systems map included 202 factors that were grouped into 27 nodes. Thematic analysis identified four key themes: leadership and curriculum; child food preference; home environment; and school food environment. Network analysis highlighted key factors that influence child diet across a school day, which were largely in keeping with the thematic analysis; including: 'available funds/resources', 'awareness of initiatives and resources', 'child food preference and intake', 'eligibility of free school meals', 'family circumstances and eating behaviours', 'peer/social norms', 'priorities of head teachers and senior leaders'. CONCLUSIONS Our systems map demonstrates the need to consider factors external to schools and their food environments. The map supports the identification of potential actions, interventions and policies to facilitate a systems-wide positive impact on children's diets.
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Affiliation(s)
- Maria Bryant
- Department of Health Sciences, University of York, York, YO150DD, UK
- Hull York Medical School, University of York, York, YO150DD, UK
| | - Wendy Burton
- Department of Health Sciences, University of York, York, YO150DD, UK
| | - Niamh O'Kane
- Centre for Public Health, Queen's University Belfast, Belfast, BT12 6BJ, UK
| | - Jayne V Woodside
- Centre for Public Health, Queen's University Belfast, Belfast, BT12 6BJ, UK.
| | - Sara Ahern
- Bradford Institute of Health Research, Bradford Royal Infirmary, Bradford, BD9 6RJ, UK
| | - Phillip Garnett
- School for Business and Society, University of York, York, YO10 5DD, UK
| | - Suzanne Spence
- Human Nutrition Exercise Research Centre, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK
| | - Amir Sharif
- Faculty of Management, Law and Social Sciences, University of Bradford, Bradford, BD7, 1DP, UK
| | - Harry Rutter
- Department of Social and Policy Sciences, University of Bath, Bath, BA2 7AY, UK
| | - Tim Baker
- Charlton Manor Primary School, Indus Road, Charlton, London, SE7 7EF, UK
| | - Charlotte E L Evans
- School of Food Science and Nutrition, University of Leeds, Leeds, LS2 9JT, UK
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49
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Guarino M, Matonti L, Chiarelli F, Blasetti A. Primary prevention programs for childhood obesity: are they cost-effective? Ital J Pediatr 2023; 49:28. [PMID: 36864472 PMCID: PMC9983264 DOI: 10.1186/s13052-023-01424-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 02/02/2023] [Indexed: 03/04/2023] Open
Abstract
Childhood obesity is increasing all over the world. It is associated with a reduction in quality of life and a relevant burden on society costs. This systematic review deals with the cost-effectiveness analysis (CEA) of primary prevention programs on childhood overweight/obesity, in order to benefit from cost-effective interventions.We screened and evaluated all the studies with a cost-effectiveness analysis on childhood obesity primary prevention program by PUBMED and Google Scholar, using inclusion and exclusion criteria. The quality of the studies was assessed by Drummond's checklist.Ten studies were included. Two of them examined the cost-effectiveness of community-based prevention programs, four focused only on school-based programs while four more studies examined both community-based and school-based programs. The studies were different in terms of study design, target population, health and economic outcomes. Seventy per cent of the works had positive economic results.The majority of the studies showed effective economic outcomes applying primary prevention programs on childhood obesity. It is important to increase homogeneity and consistency among different studies.
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Affiliation(s)
| | - Lorena Matonti
- grid.4708.b0000 0004 1757 2822University of Study G. d’Annunzio, Chieti-Pescara, Italy
| | - Francesco Chiarelli
- grid.4708.b0000 0004 1757 2822University of Study G. d’Annunzio, Chieti-Pescara, Italy
| | - Annalisa Blasetti
- grid.4708.b0000 0004 1757 2822University of Study G. d’Annunzio, Chieti-Pescara, Italy
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50
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Calabro R, Kemps E, Prichard I, Tiggemann M. Vending machine backgrounds: nudging healthier beverage choices. CURRENT PSYCHOLOGY 2023:1-10. [PMID: 37359624 PMCID: PMC9971671 DOI: 10.1007/s12144-023-04420-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2023] [Indexed: 03/06/2023]
Abstract
Soft drink overconsumption is a growing public health concern. The present research investigated whether priming nudges could decrease soft drink choices from a vending machine. We compared the effect of six vending machine wraps (Mount Franklin ™ logo, Coca-Cola™ logo, picture of water, picture of soft drink, blue, red) on beverage choice against a black (control) computerised vending machine display. In two studies, young adult participants (17 - 25 years) were recruited from [removed for blind review] (Study 1, n = 142, Study 2, n = 232). Participants were randomly allocated to choose a beverage from one of the wrap conditions. They also rated how much the beverage was liked and how often it was consumed (Study 1), or rated the refreshing value, healthiness, taste, and energy of each beverage in the vending machine (Study 2). We predicted that wraps referencing water would produce healthier choices and those referencing soft drink would result in unhealthier choices. Contrary to these predictions, the type of vending machine wrap did not significantly influence beverage choice in Study 1. However, viewing the black vending machine wrap resulted in significantly more caffeine-based selections in Study 2. Other significant predictors of the choice of beverage were how often the beverages were consumed and how much they were liked (Study 1), as well as their perceptions of the taste, healthiness and refreshing value (Study 2). The finding that the black vending machine produced more caffeine-based beverage choices demonstrates, in principle, that color-based priming nudges could influence beverage choices.
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Affiliation(s)
- Ryan Calabro
- Psychology, College of Education, Psychology and Social Work, School of Psychology, Flinders University, GPO Box 2100, SA 5001 Adelaide, Australia
| | - Eva Kemps
- Psychology, College of Education, Psychology and Social Work, School of Psychology, Flinders University, GPO Box 2100, SA 5001 Adelaide, Australia
| | - Ivanka Prichard
- Health & Exercise Sciences, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Marika Tiggemann
- Psychology, College of Education, Psychology and Social Work, School of Psychology, Flinders University, GPO Box 2100, SA 5001 Adelaide, Australia
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