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Hodder RK, O'Brien KM, Wyse RJ, Tzelepis F, Yoong S, Stacey FG, Wolfenden L. Interventions for increasing fruit and vegetable consumption in children aged five years and under. Cochrane Database Syst Rev 2024; 9:CD008552. [PMID: 39312396 PMCID: PMC11418976 DOI: 10.1002/14651858.cd008552.pub8] [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] [Indexed: 09/25/2024]
Abstract
BACKGROUND Insufficient consumption of fruits and vegetables in childhood increases the risk of future non-communicable diseases, including cardiovascular disease. Testing the effects of interventions designed to increase children's consumption of fruit and vegetables, including those focused on specific child-feeding strategies or broader multicomponent interventions targeting the home or childcare environment, is required to assess the potential to reduce this disease burden. OBJECTIVES To assess the benefits and harms of interventions designed to increase the consumption of fruit, vegetables or both amongst children aged five years and under. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase and two clinical trials registries to identify eligible trials on 25 March 2023. We searched Proquest Dissertations and Theses in December 2022. We reviewed reference lists of included trials and contacted authors of the included trials to identify further potentially relevant trials. SELECTION CRITERIA We included randomised controlled trials (RCTs), including cluster-randomised controlled trials (C-RCTs) and cross-over trials, of any intervention primarily targeting consumption of fruit, vegetables or both amongst children aged five years and under compared to no-intervention control, and incorporating a dietary or biochemical assessment of fruit or vegetable consumption. Two review authors independently screened titles and abstracts of identified papers; a third review author resolved disagreements. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data and assessed the risks of bias of included trials; a third review author resolved disagreements. We used random-effects models in meta-analyses for the primary review outcomes where we identified sufficient trials. We calculated standardised mean differences (SMDs) to account for the heterogeneity of fruit and vegetable consumption measures. We conducted assessments of risks of bias and evaluated the certainty of evidence (GRADE approach) using Cochrane procedures. MAIN RESULTS We included 53 trials with 120 trial arms and 12,350 participants. Sixteen trials examined the impact of child-feeding practice interventions only (e.g. repeated food exposure) in increasing child vegetable intake. Twenty trials examined the impact of multicomponent interventions primarily conducted in the childcare setting (e.g. parent nutrition education and preschool policy changes) in increasing child fruit and vegetable intake. Seventeen trials examined the impact of parent nutrition education only in increasing child fruit and vegetable intake. Two trials examined the effect of a nutrition education intervention delivered to children only in increasing child fruit and vegetable intake and one each examined a child-focused mindfulness intervention or providing families with fruit and vegetable interventions. We judged nine of the 53 included trials as free from high risks of bias across all domains. Performance, detection and attrition bias were the most common domains judged at high risk of bias for the remaining trials. There is moderate-certainty evidence that child-feeding practice interventions versus no-intervention control probably have a small positive effect on child vegetable consumption, equivalent to an increase of 15.5 grams as-desired consumption of vegetables (SMD 0.44, 95% confidence interval (CI) 0.24 to 0.65; 15 trials, 1976 participants; mean post-intervention follow-up = 12.3 weeks). No trials in this comparison reported information about intervention costs. One trial reported no harms or serious unintended adverse consequences (low-certainty evidence). Multicomponent interventions versus no-intervention control probably have a small effect on child consumption of fruit and vegetables (SMD 0.27, 95% CI 0.11 to 0.43; 14 trials, 4318 participants; moderate-certainty evidence; mean post-intervention follow-up = 4.0 weeks), equivalent to an increase of 0.34 cups of fruit and vegetables a day. One trial, which tested a multicomponent garden-based intervention, reported the installation of the garden as part of the intervention to be USD 1500 per childcare centre (low-certainty evidence). No trials in this comparison reported information about unintended adverse consequences of interventions. Parent nutrition education interventions may have little to no short-term impact on child consumption of fruit and vegetables versus no-intervention control (SMD 0.10, 95% CI -0.02 to 0.22; 14 trials, 4122 participants; low-certainty evidence; mean post-intervention follow-up = 6.4 weeks). One trial reported the total estimated cost of delivering a parent nutrition education intervention for infant feeding, physical activity and sedentary behaviours delivered by a dietitian as approximately AUD 500 per family (low-certainty evidence). One trial reported no unintended adverse consequences on family food expenditure following implementation of an intervention delivered over the telephone to improve parental knowledge and skills about the home food environment (low-certainty evidence). Trials reported receiving governmental or charitable funds, except for one trial reporting industry funding. AUTHORS' CONCLUSIONS There was moderate-certainty evidence that child-feeding practice interventions and multicomponent interventions probably lead to only small increases in fruit and vegetable consumption in children aged five years and under. Parent nutrition education interventions may have little or no effect on increasing fruit and vegetable consumption in children aged five years and under. Future research should be prioritised on assessment and reporting of both intervention cost and adverse effects, and development and evaluation of interventions in research gaps, including in a broader range of settings and in low- and middle-income countries. This review continues to be maintained as a living systematic review with monthly searches for new evidence and incorporation of relevant new evidence as it becomes available. Please refer to the Cochrane Database of Systematic Reviews for the current status of this review.
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Affiliation(s)
- Rebecca K Hodder
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia
- School of Medicine and Public Health, The University of Newcastle, Callaghan, Australia
- Population Health Research Program, Hunter Medical Research Institute, New Lambton, Australia
- National Centre of Implementation Science, The University of Newcastle, Callaghan, Australia
| | - Kate M O'Brien
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia
- School of Medicine and Public Health, The University of Newcastle, Callaghan, Australia
- Population Health Research Program, Hunter Medical Research Institute, New Lambton, Australia
- National Centre of Implementation Science, The University of Newcastle, Callaghan, Australia
| | - Rebecca J Wyse
- School of Medicine and Public Health, The University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton, Australia
| | - Flora Tzelepis
- School of Medicine and Public Health, The University of Newcastle, Callaghan, Australia
- Population Health Research Program, Hunter Medical Research Institute, New Lambton, Australia
| | - Serene Yoong
- National Centre of Implementation Science, The University of Newcastle, Callaghan, Australia
- Centre for Preventive Health and Nutrition (GLOBE), Institute for Health Transformation, Deakin University, Melbourne, Australia
| | - Fiona G Stacey
- School of Medicine and Public Health, The University of Newcastle, Callaghan, Australia
| | - Luke Wolfenden
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia
- School of Medicine and Public Health, The University of Newcastle, Callaghan, Australia
- Population Health Research Program, Hunter Medical Research Institute, New Lambton, Australia
- National Centre of Implementation Science, The University of Newcastle, Callaghan, Australia
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Wopereis TM, Dijkstra C, Wierda JJ, Rongen FC, Poelman MP. Systems thinking for local food environments: a participatory approach identifying leverage points and actions for healthy and sustainable transformations. Health Res Policy Syst 2024; 22:101. [PMID: 39135050 PMCID: PMC11318250 DOI: 10.1186/s12961-024-01199-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 07/29/2024] [Indexed: 08/16/2024] Open
Abstract
BACKGROUND Current local food environments encourage poor diets, posing a significant threat to public and planetary health. Acknowledging and addressing its inherent complexity is vital to making meaningful improvements to the food environment. Using a participatory approach with local stakeholders, this study aims to gain insight into the factors and mechanisms underlying the local food environment and to identify leverage points and system-based actions to foster healthy and sustainable local food environments. METHODS A systems-thinking approach was used in a Dutch municipality in 2022. Two group model building (GMB) workshops were held with community stakeholders (e.g. local policymakers, retailers and residents). During the first workshop (June 2022), factors and mechanisms influencing the local food environment were identified and visualized through a causal loop diagram (CLD). During the second workshop, leverage points and system-based actions to improve food environments were identified by the stakeholders. Four months after (October 2022), an action-implementation meeting was organized to stimulate the implementation of selected actions. Progress was monitored through brief telephone interviews 6 and 12 months after the second workshop. RESULTS The CLD visualises the factors and mechanisms influencing the local food environment from the point of view of the community stakeholders. The CLD consists of 46 factors shaping the local food environment, which were categorized into four identified subsystems: societal factors, individual, socio-economic factors, commercial factors and political factors. Eight leverage points were identified within the CLD, for example, 'lobby from food industry', 'governmental food policies' and 'e-commerce and platform economy'. Stakeholders formulated 20 actions targeting the identified leverage points. During the action-implementation meeting, long-term plans were created for five actions. After 1 year, only one participant (policy advisory role) remained actively engaged in three of these actions. CONCLUSIONS This study yields insight into the numerous factors and mechanisms underlying the local food environment and identified system-based actions as perceived by local stakeholders to improve this food environment locally. The CLD offers stakeholders valuable insights on employing a systems approach when enhancing food environments. More research is necessary, especially into the long-term processes and effects of implementing system-oriented actions to improve local food environments.
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Affiliation(s)
- Tamika M Wopereis
- Chair Group Consumption and Healthy Lifestyles, Department of Social Sciences, Wageningen University, Wageningen, 6706 KN, The Netherlands
| | - Coosje Dijkstra
- Department of Health Sciences, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Joline J Wierda
- Chair Group Consumption and Healthy Lifestyles, Department of Social Sciences, Wageningen University, Wageningen, 6706 KN, The Netherlands
| | - Frédérique C Rongen
- Chair Group Consumption and Healthy Lifestyles, Department of Social Sciences, Wageningen University, Wageningen, 6706 KN, The Netherlands
| | - Maartje P Poelman
- Chair Group Consumption and Healthy Lifestyles, Department of Social Sciences, Wageningen University, Wageningen, 6706 KN, The Netherlands.
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Liu M, Guan X, Guo X, He Y, Liu Z, Ni S, Wu Y. Impact of Serious Games on Body Composition, Physical Activity, and Dietary Change in Children and Adolescents: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Nutrients 2024; 16:1290. [PMID: 38732536 PMCID: PMC11085665 DOI: 10.3390/nu16091290] [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: 03/11/2024] [Revised: 04/15/2024] [Accepted: 04/19/2024] [Indexed: 05/13/2024] Open
Abstract
Over the past four decades, obesity in children of all ages has increased worldwide, which has intensified the search for innovative intervention strategies. Serious games, a youth-friendly form of intervention designed with educational or behavioral goals, are emerging as a potential solution to this health challenge. To analyze the effectiveness of serious games in improving body composition, physical activity, and dietary change, we performed a systematic review and meta-analysis of randomized controlled trials (RCTs) from PubMed, Web of Science, EMBASE, and Scopus databases. Pooled standardized mean differences (SMD) were calculated for 20 studies (n = 2238 the intervention group; n = 1983 in the control group) using random-effect models. The intervention group demonstrated a slightly better, although non-significant, body composition score, with a pooled SMD of -0.26 (95% CI: -0.61 to 0.09). The pooled effect tends to be stronger with longer duration of intervention (-0.40 [95% CI: -0.96, 0.16] for >3 months vs. -0.02 [95% CI: -0.33, 0.30] for ≤3 months), although the difference was not statistically significant (p-difference = 0.24). As for the specific pathways leading to better weight control, improvements in dietary habits due to serious game interventions were not significant, while a direct positive effect of serious games on increasing physical activity was observed (pooled SMD = 0.61 [95% CI: 0.04 to 1.19]). While the impact of serious game interventions on body composition and dietary changes is limited, their effectiveness in increasing physical activity is notable. Serious games show potential as tools for overweight/obesity control among children and adolescents but may require longer intervention to sustain its effect.
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Affiliation(s)
- Mingchang Liu
- Institute for Hospital Management, School of Medicine, Tsinghua University, Beijing 100084, China; (M.L.); (X.G.); (Z.L.)
| | - Xinyue Guan
- Institute for Hospital Management, School of Medicine, Tsinghua University, Beijing 100084, China; (M.L.); (X.G.); (Z.L.)
| | - Xueqing Guo
- Sargent College of Health & Rehabilitation Sciences, Boston University, Boston, MA 02215, USA;
| | - Yixuan He
- Department of Bioengineering, East China University of Science and Technology, Shanghai 200237, China;
| | - Zeqi Liu
- Institute for Hospital Management, School of Medicine, Tsinghua University, Beijing 100084, China; (M.L.); (X.G.); (Z.L.)
| | - Shiguang Ni
- Shenzhen International Graduate School, Tsinghua University, Shenzhen 518055, China;
| | - You Wu
- Institute for Hospital Management, School of Medicine, Tsinghua University, Beijing 100084, China; (M.L.); (X.G.); (Z.L.)
- Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA
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Blokhuis C, Hofstede GJ, Ocké M, de Vet E. Transitioning towards more plant-based diets: sharing expert knowledge through a system lens. Appetite 2024; 195:107193. [PMID: 38154575 DOI: 10.1016/j.appet.2023.107193] [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: 08/25/2023] [Revised: 12/22/2023] [Accepted: 12/22/2023] [Indexed: 12/30/2023]
Abstract
Transitioning towards more plant-based protein diets is essential for public and planetary health. Current research about consumption practices of protein sources provides limited insight in the multidisciplinary nature and interconnectivity of the food environment. This study aimed to collect mental models of review authors by synthesizing both their implicit and explicit system views into an overarching system view. Published reviews were used to select participants and identify variables that explain the protein transition in relation to the food environment. To overcome differences in disciplines and scale levels (e.g. individual, interpersonal, environmental), variables were organized according to the Determinants of Nutrition and Eating Framework. Eight review authors shared their mental models in an interview. Participants were asked to construct a causal loop diagram (CLD), a tool proven valuable in making one's ontology explicit to others. Implicit system views in narrative were converted into CLDs using a coding framework. The overarching system view suggests that a multitude of feedback loops sustain current consumption patterns of protein sources, for example by reinforcement through habit, availability and peer support. Several aspects require further research, such as variable relationships that were subject to disagreement and the lack of reciprocity between the physical and social elements of the food environment. In addition, knowledge gaps were exposed, including long-term behaviour and interaction of multiple variables. As a boundary object, the overarching system view can facilitate the direction of future research. The findings underscore the interconnected nature of many disparate elements within the food environment, stressing the need for holistic methods like systems thinking. These are essential in developing a systemic understanding and facilitating the transition towards more plant-based diets.
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Affiliation(s)
- Christa Blokhuis
- Consumption and Healthy Lifestyles group, Hollandseweg 1, 6706 KN, Wageningen, the Netherlands; Information Technology group, Wageningen University & Research, Hollandseweg 1, 6706 KN, Wageningen, the Netherlands.
| | - Gert Jan Hofstede
- Information Technology group, Wageningen University & Research, Hollandseweg 1, 6706 KN, Wageningen, the Netherlands; Centre for Applied Risk Management (UARM), North-West University, The Office of the Registrar, Building F1, 11 Hoffman Street, Potchefstroom, 2531, Potchefstroom, South Africa.
| | - Marga Ocké
- National Institute for Public Health and the Environment, Antonie van Leeuwenhoeklaan 9, 3721, MA, Bilthoven, the Netherlands; Human Nutrition and Health, Wageningen University and Research, Stippeneng 4, 6708 WE Wageningen, the Netherlands.
| | - Emely de Vet
- Consumption and Healthy Lifestyles group, Hollandseweg 1, 6706 KN, Wageningen, the Netherlands.
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Luna Pinzon A, Waterlander W, de Pooter N, Altenburg T, Dijkstra C, Emke H, van den Eynde E, Overman ML, Busch V, Renders CM, Halberstadt J, Nusselder W, den Hertog K, Chinapaw M, Verhoeff A, Stronks K. Development of an action programme tackling obesity-related behaviours in adolescents: a participatory system dynamics approach. Health Res Policy Syst 2024; 22:30. [PMID: 38429775 PMCID: PMC10908105 DOI: 10.1186/s12961-024-01116-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 02/02/2024] [Indexed: 03/03/2024] Open
Abstract
System dynamics approaches are increasingly addressing the complexity of public health problems such as childhood overweight and obesity. These approaches often use system mapping methods, such as the construction of causal loop diagrams, to gain an understanding of the system of interest. However, there is limited practical guidance on how such a system understanding can inform the development of an action programme that can facilitate systems changes. The Lifestyle Innovations Based on Youth Knowledge and Experience (LIKE) programme combines system dynamics and participatory action research to improve obesity-related behaviours, including diet, physical activity, sleep and sedentary behaviour, in 10-14-year-old adolescents in Amsterdam, the Netherlands. This paper illustrates how we used a previously obtained understanding of the system of obesity-related behaviours in adolescents to develop an action programme to facilitate systems changes. A team of evaluation researchers guided interdisciplinary action-groups throughout the process of identifying mechanisms, applying the Intervention Level Framework to identify leverage points and arriving at action ideas with aligning theories of change. The LIKE action programme consisted of 8 mechanisms, 9 leverage points and 14 action ideas which targeted the system's structure and function within multiple subsystems. This illustrates the feasibility of developing actions targeting higher system levels within the confines of a research project timeframe when sufficient and dedicated effort in this process is invested. Furthermore, the system dynamics action programme presented in this study contributes towards the development and implementation of public health programmes that aim to facilitate systems changes in practice.
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Affiliation(s)
- Angie Luna Pinzon
- Department of Public and Occupational Health, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands.
- Health Behaviors and Chronic Diseases, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.
| | - Wilma Waterlander
- Department of Public and Occupational Health, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
- Health Behaviors and Chronic Diseases, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Naomi de Pooter
- Department of Public and Occupational Health, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
- Health Behaviors and Chronic Diseases, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Teatske Altenburg
- Health Behaviors and Chronic Diseases, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Department of Public and Occupational Health, Amsterdam UMC Location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Coosje Dijkstra
- Health Behaviors and Chronic Diseases, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, 1081HV, Amsterdam, The Netherlands
| | - Helga Emke
- Health Behaviors and Chronic Diseases, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Department of Public and Occupational Health, Amsterdam UMC Location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, 1081HV, Amsterdam, The Netherlands
| | - Emma van den Eynde
- Division of Endocrinology, Department of Pediatrics, Erasmus MC-Sophia Children's Hospital, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Meredith L Overman
- Department of Health Promotion, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, 6229ER, Maastricht, The Netherlands
| | - Vincent Busch
- Sarphati Amsterdam, Public Health Service (GGD), City of Amsterdam, Nieuwe Achtergracht 100, 1018WT, Amsterdam, The Netherlands
| | - Carry M Renders
- Health Behaviors and Chronic Diseases, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, 1081HV, Amsterdam, The Netherlands
| | - Jutka Halberstadt
- Health Behaviors and Chronic Diseases, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, 1081HV, Amsterdam, The Netherlands
| | - Wilma Nusselder
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, 3015CN, Rotterdam, The Netherlands
| | - Karen den Hertog
- Amsterdam Healthy Weight Approach, Public Health Service (GGD), City of Amsterdam, Nieuwe Achtergracht 100, 1018WT, Amsterdam, The Netherlands
| | - Mai Chinapaw
- Health Behaviors and Chronic Diseases, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Department of Public and Occupational Health, Amsterdam UMC Location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Arnoud Verhoeff
- Sarphati Amsterdam, Public Health Service (GGD), City of Amsterdam, Nieuwe Achtergracht 100, 1018WT, Amsterdam, The Netherlands
- Department of Sociology, University of Amsterdam, 1018WV, Amsterdam, The Netherlands
| | - Karien Stronks
- Department of Public and Occupational Health, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
- Health Behaviors and Chronic Diseases, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
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Karpouzis F, Lindberg R, Walsh A, Shah S, Abbott G, Ball K. Impact and process evaluation of a primary-school Food Education and Sustainability Training (FEAST) program in 10-12-year-old children in Australia: pragmatic cluster non-randomized controlled trial. BMC Public Health 2024; 24:657. [PMID: 38429629 PMCID: PMC10905805 DOI: 10.1186/s12889-024-18079-8] [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: 07/11/2023] [Accepted: 02/12/2024] [Indexed: 03/03/2024] Open
Abstract
BACKGROUND Environmentally sustainable food initiatives accompanying nutrition education, such as the Food Education and Sustainability Training (FEAST) program, have gained traction in school settings. The aim of this trial was to conduct an impact and process evaluation of FEAST, to evaluate its effect on children's fruit and vegetable (F&V) intakes, and secondary outcomes: F&V variety consumed, nutrition knowledge, food preparation/cooking skills, self-efficacy and behaviours, food waste knowledge and behaviours, and food production knowledge. METHODS FEAST was a 10-week curriculum-aligned program, designed to educate children about healthy eating, food waste, and sustainability, while teaching cooking skills. It was implemented by classroom teachers, face-to-face and online, during COVID-19 school closures, in Australia in 2021. A custom designed survey was used to collect baseline and post-intervention data from students. Generalised linear mixed models (GLMM) estimated group differences in pre-post changes for primary and secondary outcomes. Surveys were also administered to students and teachers to evaluate intervention implementation. RESULTS Twenty schools participated and self-selected to be either intervention schools (n = 10) or wait-list control (WLC) schools (n = 10). A total of 977, 5th and 6th grade children participated in the trial with a mean age of 11.1 years (SD ± 0.7). The FEAST intervention, compared to WLC, did not result in significant increases in primary outcomes nor secondary outcomes. The process evaluation revealed FEAST was well-received by students and teachers, but COVID-19 school closures hindered implementation fidelity with a less intense program delivered under the constraints of pandemic lockdowns. CONCLUSIONS This is the first cluster non-randomized controlled trial designed to independently evaluate FEAST in the primary-school setting. No evidence was found for improved F&V intakes in children, nor secondary outcomes. However, the positive process evaluation results suggest that further trials of the program are warranted. If implemented as originally designed (pre-pandemic), with increased duration and complemented by supporting school policies, such programs have the potential to improve children's daily F&V intakes, cooking skills and food waste behaviours. This would support the Australian curriculum and contribute to: health promotion within schools and sustainable schools initiatives, the national agenda to reduce food waste and sustainable development goals. AUSTRALIAN AND NEW ZEALAND CLINICAL TRIALS REGISTRY: [ACTRN12620001347954]- Registered prospectively on 14/12/2020.
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Affiliation(s)
- F Karpouzis
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Melbourne, VIC, Australia.
- , Rose Bay Nth, Australia, PO Box 2108, NSW, 2030.
| | - R Lindberg
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Melbourne, VIC, Australia
| | - A Walsh
- School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, VIC, Australia
| | - S Shah
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - G Abbott
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Melbourne, VIC, Australia
| | - K Ball
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Melbourne, VIC, Australia
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Raudeniece J, Vanags E, Justamente I, Skara D, Fredriksen PM, Brownlee I, Reihmane D. Relations between the levels of moderate to vigorous physical activity, BMI, dietary habits, cognitive functions and attention problems in 8 to 9 years old pupils: network analysis (PACH Study). BMC Public Health 2024; 24:544. [PMID: 38383413 PMCID: PMC10882845 DOI: 10.1186/s12889-024-18055-2] [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: 08/21/2023] [Accepted: 02/09/2024] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND Physical activity (PA) and dietary habits (DH) play a crucial role on quality of life and health outcomes from various aspects. METHODS This study aims to investigate the relations between recommended daily levels of moderate to vigorous physical activity (MVPA) in 8 to 9 year old pupils, and their body mass index (BMI), DH, cognitive functions and attention problem scores by network analysis. Study participants were split into two groups based on their MVPA levels on weekdays. RESULTS Our findings suggest that children who reach recommended MVPA levels consume more vegetables and fruits, eat breakfast more frequently, have better motor speed and lower impulsivity score. CONCLUSIONS The number of interlinkages between various parameters in network structure for children who do not reach recommended MVPA levels is greater and more intense, highlighting the differences between the groups and suggesting that different interventions and approaches to improve/change lifestyle habits might be used.
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Affiliation(s)
- Jelena Raudeniece
- Department of Human and Animal Physiology, Faculty of Biology, University of Latvia, Jelgavas Street 1, Riga, LV-1004, Latvia
- Department of Human Physiology and Biochemistry, Riga Stradiņš University, Dzirciema Street 16, Riga, LV-1007, Latvia
| | - Edmunds Vanags
- Department of Psychology, Faculty of Education, Psychology and Art, University of Latvia, Jelgavas Street 1, Riga, LV-1004, Latvia
| | - Ilze Justamente
- Department of Human and Animal Physiology, Faculty of Biology, University of Latvia, Jelgavas Street 1, Riga, LV-1004, Latvia
- Department of Human Physiology and Biochemistry, Riga Stradiņš University, Dzirciema Street 16, Riga, LV-1007, Latvia
| | - Dana Skara
- Department of Psychology, Faculty of Education, Psychology and Art, University of Latvia, Jelgavas Street 1, Riga, LV-1004, Latvia
| | - Per Morten Fredriksen
- Department of Biotechology, Faculty of Applied Ecology, Agricultural Sciences and Biotechnology, Inland Norway University of Applied Sciences, 2318, Hamar, Norway
| | - Iain Brownlee
- Department of Applied Sciences, Northumbria University, Newcastle upon Tyne, NE1 8ST, UK
| | - Dace Reihmane
- Department of Human and Animal Physiology, Faculty of Biology, University of Latvia, Jelgavas Street 1, Riga, LV-1004, Latvia.
- Department of Human Physiology and Biochemistry, Riga Stradiņš University, Dzirciema Street 16, Riga, LV-1007, Latvia.
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Karapici A, Cummins S. A participatory approach to model the neighbourhood food environment. PLoS One 2024; 19:e0292700. [PMID: 38266019 PMCID: PMC10807759 DOI: 10.1371/journal.pone.0292700] [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: 05/12/2023] [Accepted: 09/26/2023] [Indexed: 01/26/2024] Open
Abstract
Inequalities in exposure to a health-promoting local food environment have been implicated in the generation of inequalities in diet-related behaviours and outcomes, including obesity and diabetes. Increasingly, poor diet and diet-related disease have been characterised as an emergent property of a complex system and, as such, the drivers of poor diet may be better understood by using a complex system perspective. In this study, we describe a participatory approach for understanding the system drivers of unhealthy food consumption. System dynamics (SD) was used to identify, understand, and visualise the elements of the neighbourhood food retail system that influence individuals' eating behaviour. Group Model Building (GMB), undertaken online with stakeholders (n = 11), was used to funnel existing knowledge and evidence on urban food environments and to build a conceptual system map of the local food retail environment inclusive of the drivers that influence the decision to purchase and consume meals that are high in fat, salt, and sugar (HFSS), and calories. The GMB was organised as a knowledge elicitation process involving a questionnaire, a workbook, and a structured workshop. The GMB generated a comprehensive causal loop diagram (CLD) of the retail environment inclusive of the drivers that influence the decision to purchase and consume unhealthy meals. The CLD was designed around two main variables (i) exposure to food outlets and (ii) food consumption. The system map built during the Group Model Building session linked exposure to food outlets with the possibility to purchase and consume unhealthy meals. The effectiveness of this link will be tested in an Agent-Based model. The conceptual model illustrates the complexity of the factors responsible for inequalities in unhealthy eating. The GMB approach provides a basis for building an agent-based model for local authorities to characterise their food retail environment, uncover potential leverage points for interventions and test them 'in silico' in a virtual environment.
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Affiliation(s)
- Amanda Karapici
- Department of Public Health, Environments & Society, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Steven Cummins
- Professor of Population Health & NIHR Senior Investigator, Department of Public Health, Environments & Society, London School of Hygiene & Tropical Medicine, London, United Kingdom
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9
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Decker H, Wendel M. Applications of Participatory System Dynamics Methods to Public Health: A Systematic Review. FAMILY & COMMUNITY HEALTH 2023; 46:S6-S21. [PMID: 37696012 DOI: 10.1097/fch.0000000000000369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/13/2023]
Abstract
System dynamics, and specifically qualitative participatory applications of system dynamics, have potential to benefit public health research, scholarship, and practice. A systematic review was conducted to examine the existing applications of participatory system dynamics (PSD) to public health research. Three databases were searched using unique search terms related to PSD and methodological applications in public health research. A total of 57 unique articles met inclusion criteria and were included for review. The studies included for review were conducted globally and represent a wide breadth of public health issues. The review identified several advantages to adopting PSD methods in public health scholarship and practice. The PSD methods provide innovative frameworks for conceptualizing complex and nuanced public health problems. The participatory nature of PSD allows for increased community engagement and empowerment to address public health problems, as well as to mitigate existing power dynamics between research institutions and marginalized communities that are disproportionately impacted by social and health inequities. Finally, causal loop diagrams developed using PSD methods have unique potential to convey complex concepts to policy makers and interventionists. This systematic review reports evidence for PSD's potential to advance equity in public health research and practice.
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Affiliation(s)
- Hallie Decker
- Health Equity Innovation Hub, University of Louisville, Louisville, Kentucky (Ms Decker); and Health Promotion & Behavioral Sciences, School of Public Health and Information Sciences, and Health Equity Innovation Hub, University of Louisville, Louisville, Kentucky (Dr Wendel)
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10
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Felmingham T, O'Halloran S, Poorter J, Rhook E, Needham C, Hayward J, Fraser P, Kilpatrick S, Leahy D, Allender S. Systems thinking in local government: intervention design and adaptation in a community-based study. Health Res Policy Syst 2023; 21:90. [PMID: 37667377 PMCID: PMC10478182 DOI: 10.1186/s12961-023-01034-1] [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: 06/05/2023] [Accepted: 08/11/2023] [Indexed: 09/06/2023] Open
Abstract
BACKGROUND Systems thinking approaches are increasingly being used by communities to address complex chronic disease. This paper reports on the VicHealth Local Government Partnership (VLGP) which sought to co-create improvements in the health and well-being of children and young people by working with local government in Victoria, Australia. METHODS The VLGP included a series of health promotion modules, aimed at creating policy, programme and practice changes across local government. One of these modules, Connecting the Dots - creating solutions for lasting change, aimed to build capacity for systems thinking in municipal public health and well-being planning across 13 councils. The approach was adapted and data were collected on the stimuli for, and results of, adaptation. RESULTS The council adapted the systems thinking approach to meet geographic characteristics, priority health issue/s and participant target group needs. Adaptions applied to workshop materials, training delivery, existing and new resources, and to align with other community-based approaches. Stimuli for adaptation included the COVID-19 pandemic, needs of children and young people, capacity of council to deliver the workshop series, and time available within the project or for the participant group. CONCLUSIONS Systems thinking was used and adapted by councils to improve the health and well-being of children and young people and increase the voices of children and young people in decision-making. Flexible delivery is critical to ensure communities can adapt the approach to meet local needs.
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Affiliation(s)
- Tiana Felmingham
- Global Centre for Preventive Health and Nutrition (GLOBE), Institute for Health Transformation, Deakin University, 1 Geringhap Street, Geelong, VIC, 3220, Australia.
| | - Siobhan O'Halloran
- Global Centre for Preventive Health and Nutrition (GLOBE), Institute for Health Transformation, Deakin University, 1 Geringhap Street, Geelong, VIC, 3220, Australia
| | - Jaimie Poorter
- Global Centre for Preventive Health and Nutrition (GLOBE), Institute for Health Transformation, Deakin University, 1 Geringhap Street, Geelong, VIC, 3220, Australia
| | - Ebony Rhook
- Global Centre for Preventive Health and Nutrition (GLOBE), Institute for Health Transformation, Deakin University, 1 Geringhap Street, Geelong, VIC, 3220, Australia
- Barwon South West Public Health Unit, Geelong, Australia
| | - Cindy Needham
- Global Centre for Preventive Health and Nutrition (GLOBE), Institute for Health Transformation, Deakin University, 1 Geringhap Street, Geelong, VIC, 3220, Australia
| | - Joshua Hayward
- Global Centre for Preventive Health and Nutrition (GLOBE), Institute for Health Transformation, Deakin University, 1 Geringhap Street, Geelong, VIC, 3220, Australia
| | - Penny Fraser
- Global Centre for Preventive Health and Nutrition (GLOBE), Institute for Health Transformation, Deakin University, 1 Geringhap Street, Geelong, VIC, 3220, Australia
| | | | | | - Steven Allender
- Global Centre for Preventive Health and Nutrition (GLOBE), Institute for Health Transformation, Deakin University, 1 Geringhap Street, Geelong, VIC, 3220, Australia
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11
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Whelan J, Fraser P, Bolton KA, Love P, Strugnell C, Boelsen-Robinson T, Blake MR, Martin E, Allender S, Bell C. Combining systems thinking approaches and implementation science constructs within community-based prevention: a systematic review. Health Res Policy Syst 2023; 21:85. [PMID: 37641151 PMCID: PMC10463953 DOI: 10.1186/s12961-023-01023-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 06/22/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND Systems science offers methods for designing population health interventions while implementation science provides specific guidance for successful implementation. Integrating systems and implementation science may strengthen implementation and enhance and sustain systemic change to achieve system-level outcomes. Little is known about the extent to which these two approaches have been integrated to date. This review aimed to identify and synthesise the peer-reviewed literature that has reported the combined use of systems thinking approaches and implementation science constructs (within the same study), to deliver population health interventions. METHODS A systematic literature search of peer-reviewed original research was conducted across six databases from 2009 to 2021. Journal manuscripts were included if they: (1) reported on a population health study conducted in a community, (2) reported the use of a systems method in the design of the intervention, and (3) used an implementation science theory, framework or model in the delivery of the intervention. Data extracted related to the specific systems methods and definitions and implementation science constructs used. The Mixed Methods Appraisal Tool (MMAT) was used to assess study quality. RESULTS Of the 9086 manuscripts returned, 320 manuscripts were included for full-text review. Of these, 17 manuscripts that reported on 14 studies were included in the final extraction. The most frequently reported systems methods were a 'whole of community systems approach' (n = 4/14) and 'community-based system dynamics' (n = 2/14). Nineteen different implementation science theories, frameworks and models were used for intervention delivery, with RE-AIM being the only framework used in more than one study. CONCLUSION There are few published peer-reviewed studies using systems thinking and implementation science for designing and delivering population health interventions. An exploration of synergies is worthwhile to operationalise alignment and improve implementation of systems thinking approaches. Review protocol registration PROSPERO CRD42021250419.
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Affiliation(s)
- Jillian Whelan
- School of Medicine, Deakin University, Geelong, Australia.
- Institute for Health Transformation, Geelong, Australia.
- Global Centre for Preventive Health and Nutrition, Geelong, Australia.
| | - Penny Fraser
- School of Health and Social Development, Deakin University, Geelong, Australia
- Institute for Health Transformation, Geelong, Australia
- Global Centre for Preventive Health and Nutrition, Geelong, Australia
| | - Kristy A Bolton
- School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
- Institute for Health Transformation, Geelong, Australia
- Institute for Physical Activity and Nutrition, Geelong, Australia
| | - Penelope Love
- School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
- Institute for Physical Activity and Nutrition, Geelong, Australia
| | - Claudia Strugnell
- School of Health and Social Development, Deakin University, Geelong, Australia
- Global Centre for Preventive Health and Nutrition, Geelong, Australia
- Institute for Physical Activity and Nutrition, Geelong, Australia
| | - Tara Boelsen-Robinson
- School of Health and Social Development, Deakin University, Geelong, Australia
- Institute for Health Transformation, Geelong, Australia
- Global Centre for Preventive Health and Nutrition, Geelong, Australia
| | - Miranda R Blake
- School of Health and Social Development, Deakin University, Geelong, Australia
- Institute for Health Transformation, Geelong, Australia
- Global Centre for Preventive Health and Nutrition, Geelong, Australia
| | - Erik Martin
- School of Medicine, Deakin University, Geelong, Australia
| | - Steven Allender
- School of Health and Social Development, Deakin University, Geelong, Australia
- Institute for Health Transformation, Geelong, Australia
- Global Centre for Preventive Health and Nutrition, Geelong, Australia
| | - Colin Bell
- School of Medicine, Deakin University, Geelong, Australia
- Institute for Health Transformation, Geelong, Australia
- Global Centre for Preventive Health and Nutrition, Geelong, Australia
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12
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Estrada-Magbanua WM, Huang TTK, Lounsbury DW, Zito P, Iftikhar P, El-Bassel N, Gilbert L, Wu E, Lee BY, Mateu-Gelabert P, S. Sabounchi N. Application of group model building in implementation research: A systematic review of the public health and healthcare literature. PLoS One 2023; 18:e0284765. [PMID: 37590193 PMCID: PMC10434911 DOI: 10.1371/journal.pone.0284765] [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: 06/15/2021] [Accepted: 04/09/2023] [Indexed: 08/19/2023] Open
Abstract
BACKGROUND Group model building is a process of engaging stakeholders in a participatory modeling process to elicit their perceptions of a problem and explore concepts regarding the origin, contributing factors, and potential solutions or interventions to a complex issue. Recently, it has emerged as a novel method for tackling complex, long-standing public health issues that traditional intervention models and frameworks cannot fully address. However, the extent to which group model building has resulted in the adoption of evidence-based practices, interventions, and policies for public health remains largely unstudied. The goal of this systematic review was to examine the public health and healthcare applications of GMB in the literature and outline how it has been used to foster implementation and dissemination of evidence-based interventions. METHODS We searched PubMed, Web of Science, and other databases through August 2022 for studies related to public health or health care where GMB was cited as a main methodology. We did not eliminate studies based on language, location, or date of publication. Three reviewers independently extracted data on GMB session characteristics, model attributes, and dissemination formats and content. RESULTS Seventy-two studies were included in the final review. Majority of GMB activities were in the fields of nutrition (n = 19, 26.4%), health care administration (n = 15, 20.8%), and environmental health (n = 12, 16.7%), and were conducted in the United States (n = 29, 40.3%) and Australia (n = 7, 9.7%). Twenty-three (31.9%) studies reported that GMB influenced implementation through policy change, intervention development, and community action plans; less than a third reported dissemination of the model outside journal publication. GMB was reported to have increased insight, facilitated consensus, and fostered communication among stakeholders. CONCLUSIONS GMB is associated with tangible benefits to participants, including increased community engagement and development of systems solutions. Transdisciplinary stakeholder involvement and more rigorous evaluation and dissemination of GMB activities are recommended.
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Affiliation(s)
- Weanne Myrrh Estrada-Magbanua
- Center for Systems and Community Design and NYU-CUNY Prevention Research Center, CUNY Graduate School of Public Health and Health Policy, New York, NY, United States of America
| | - Terry T.-K. Huang
- Center for Systems and Community Design and NYU-CUNY Prevention Research Center, CUNY Graduate School of Public Health and Health Policy, New York, NY, United States of America
| | - David W. Lounsbury
- Division of Health Behavior Research and Implementation Science, Albert Einstein College of Medicine, New York, NY, United States of America
| | - Priscila Zito
- Center for Systems and Community Design and NYU-CUNY Prevention Research Center, CUNY Graduate School of Public Health and Health Policy, New York, NY, United States of America
| | - Pulwasha Iftikhar
- Center for Systems and Community Design and NYU-CUNY Prevention Research Center, CUNY Graduate School of Public Health and Health Policy, New York, NY, United States of America
| | - Nabila El-Bassel
- Social Intervention Group, School of Social Work, Columbia University, New York, NY, United States of America
| | - Louisa Gilbert
- Social Intervention Group, School of Social Work, Columbia University, New York, NY, United States of America
| | - Elwin Wu
- Social Intervention Group, School of Social Work, Columbia University, New York, NY, United States of America
| | - Bruce Y. Lee
- Center for Systems and Community Design and NYU-CUNY Prevention Research Center, CUNY Graduate School of Public Health and Health Policy, New York, NY, United States of America
| | - Pedro Mateu-Gelabert
- Center for Systems and Community Design and NYU-CUNY Prevention Research Center, CUNY Graduate School of Public Health and Health Policy, New York, NY, United States of America
| | - Nasim S. Sabounchi
- Center for Systems and Community Design and NYU-CUNY Prevention Research Center, CUNY Graduate School of Public Health and Health Policy, New York, NY, United States of America
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13
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van den Akker A, Fabbri A, Alardah DI, Gilmore AB, Rutter H. The use of participatory systems mapping as a research method in the context of non-communicable diseases and risk factors: a scoping review. Health Res Policy Syst 2023; 21:69. [PMID: 37415182 DOI: 10.1186/s12961-023-01020-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 06/15/2023] [Indexed: 07/08/2023] Open
Abstract
CONTEXT Participatory systems mapping is increasingly used to gain insight into the complex systems surrounding non-communicable diseases (NCDs) and their risk factors. OBJECTIVES To identify and synthesize studies that used participatory systems mapping in the context of non-communicable diseases. DESIGN Scoping review. ELIGIBILITY CRITERIA Peer-reviewed studies published between 2000 and 2022. STUDY SELECTION Studies that focused on NCDs and/or related risk factors, and included participants at any stage of their system's mapping process, were included. CATEGORIES FOR ANALYSIS The main categories for analysis were: (1) problem definition and goal-setting, (2) participant involvement, (3) structure of the mapping process, (4) validation of the systems map, and (5) evaluation of the mapping process. RESULTS We identified 57 studies that used participatory systems mapping for a variety of purposes, including to inform or evaluate policies or interventions and to identify potential leverage points within a system. The number of participants ranged from 6 to 590. While policymakers and professionals were the stakeholder groups most often included, some studies described significant added value from including marginalized communities. There was a general lack of formal evaluation in most studies. However, reported benefits related mostly to individual and group learning, whereas limitations described included a lack of concrete actions following from systems mapping exercises. CONCLUSIONS Based on the findings of this review, we argue that research using participatory systems mapping would benefit from considering three different but intertwined actions: explicitly considering how different participants and the power imbalances between them may influence the participatory process, considering how the results from a systems mapping exercise may effectively inform policy or translate into action, and including and reporting on evaluation and outcomes of the process, wherever possible.
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14
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Luna Pinzon A, Stronks K, Emke H, van den Eynde E, Altenburg T, Dijkstra SC, Renders CM, Hermans R, Busch V, Chinapaw MJM, Kremers SPJ, Waterlander W. Understanding the system dynamics of obesity-related behaviours in 10- to 14-year-old adolescents in Amsterdam from a multi-actor perspective. Front Public Health 2023; 11:1128316. [PMID: 37304107 PMCID: PMC10248031 DOI: 10.3389/fpubh.2023.1128316] [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: 01/17/2023] [Accepted: 04/28/2023] [Indexed: 06/13/2023] Open
Abstract
Introduction and Methods To develop an understanding of the dynamics driving obesity-related behaviours in adolescents, we conducted systems-based analysis on a causal loop diagram (CLD) created from a multi-actor perspective, including academic researchers, adolescents and local stakeholders. Results The CLD contained 121 factors and 31 feedback loops. We identified six subsystems with their goals: (1) interaction between adolescents and the food environment, with profit maximisation as goal, (2) interaction between adolescents and the physical activity environment, with utility maximisation of outdoor spaces as goal, (3) interaction between adolescents and the online environment, with profit maximisation from technology use as goal, (4) interaction between adolescents, parenting and the wider socioeconomic environment, with a goal focused on individual parental responsibility, (5) interaction between healthcare professionals and families, with the goal resulting in treating obesity as an isolated problem, and (6) transition from childhood to adolescence, with the goal centring around adolescents' susceptibility to an environment that stimulates obesity-related behaviours. Discussion Analysis showed that inclusion of the researchers' and stakeholders' perspectives contributed to an understanding of how the system structure of an environment works. Integration of the adolescents' perspective enriched insights on how adolescents interact with that environment. The analysis further showed that the dynamics driving obesity-related behaviours are geared towards further reinforcing such behaviours.
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Affiliation(s)
- Angie Luna Pinzon
- Amsterdam UMC location University of Amsterdam, Department of Public and Occupational Health, Amsterdam, Netherlands
- Amsterdam Public Health Research Institute, Health Behaviors and Chronic Diseases, Amsterdam, Netherlands
| | - Karien Stronks
- Amsterdam UMC location University of Amsterdam, Department of Public and Occupational Health, Amsterdam, Netherlands
- Amsterdam Public Health Research Institute, Health Behaviors and Chronic Diseases, Amsterdam, Netherlands
| | - Helga Emke
- Amsterdam Public Health Research Institute, Health Behaviors and Chronic Diseases, Amsterdam, Netherlands
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam, Netherlands
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Emma van den Eynde
- Obesity Center CGG, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Teatske Altenburg
- Amsterdam Public Health Research Institute, Health Behaviors and Chronic Diseases, Amsterdam, Netherlands
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam, Netherlands
| | - S. Coosje Dijkstra
- Amsterdam Public Health Research Institute, Health Behaviors and Chronic Diseases, Amsterdam, Netherlands
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Carry M. Renders
- Amsterdam Public Health Research Institute, Health Behaviors and Chronic Diseases, Amsterdam, Netherlands
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Roel Hermans
- Department of Health Promotion, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, Netherlands
| | - Vincent Busch
- Sarphati Amsterdam, Public Health Service (GGD), Amsterdam, Netherlands
| | - Mai J. M. Chinapaw
- Amsterdam Public Health Research Institute, Health Behaviors and Chronic Diseases, Amsterdam, Netherlands
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam, Netherlands
| | - Stef P. J. Kremers
- Department of Health Promotion, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, Netherlands
| | - Wilma Waterlander
- Amsterdam UMC location University of Amsterdam, Department of Public and Occupational Health, Amsterdam, Netherlands
- Amsterdam Public Health Research Institute, Health Behaviors and Chronic Diseases, Amsterdam, Netherlands
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15
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Han YJ, Baek JH, Jung SK, Yang JS, Shin NR, Park MY. Association between the Dietary Phytochemical Index and Lower Prevalence of Obesity in Korean Preschoolers. Nutrients 2023; 15:2439. [PMID: 37299402 PMCID: PMC10255342 DOI: 10.3390/nu15112439] [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] [Received: 04/11/2023] [Revised: 05/18/2023] [Accepted: 05/22/2023] [Indexed: 06/12/2023] Open
Abstract
Little is known regarding Korean preschooler dietary phytochemical index (DPIs). We used the 24 h recall data of 1196 participants aged 3-5 years from the Korea National Health and Nutrition Examination Survey to study the association between dietary food intake and obesity prevalence. The amount of dietary intake by food group was compared according to sex and DPI quartile. Multivariable-adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using logistic regression models. The average total DPI and energy from phytochemical food groups were not significantly different according to sex, although boys had a higher total daily food intake. Different inclinations between DPI quartiles and amount of intake were observed in the food groups; specifically, beans showed a higher intake difference between Q1 and Q4 for boys than in the other food groups. The highest DPI quartile had a significantly lower obesity prevalence than the lowest DPI quartile in all models for boys only when obesity prevalence by weight percentile was analyzed (Model 3, OR: 0.287, 95% CI: 0.095-0.868, p for trend < 0.05). Our results suggest a high DPI could help prevent obesity in preschoolers.
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Affiliation(s)
- Ye-Ji Han
- Department of Food and Nutrition, Sungshin Women’s University, Seoul 01133, Republic of Korea;
| | - Jung-Hyun Baek
- Department of Pediatrics, Woori Children’s Hospital, Seoul 08291, Republic of Korea; (J.-H.B.); (S.-K.J.)
| | - Seong-Kwan Jung
- Department of Pediatrics, Woori Children’s Hospital, Seoul 08291, Republic of Korea; (J.-H.B.); (S.-K.J.)
| | - Joshua SungWoo Yang
- Healthcare Development Head, R&D Center, NGeneBio Inc., Seoul 08390, Republic of Korea; (J.S.Y.); (N.-R.S.)
| | - Na-Rae Shin
- Healthcare Development Head, R&D Center, NGeneBio Inc., Seoul 08390, Republic of Korea; (J.S.Y.); (N.-R.S.)
| | - Mi-Young Park
- Institute of Health and Environment, Graduate School of Public Health, Seoul National University, Seoul 08826, Republic of Korea
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16
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Morales-Garzón S, Parker LA, Hernández-Aguado I, González-Moro Tolosana M, Pastor-Valero M, Chilet-Rosell E. Addressing Health Disparities through Community Participation: A Scoping Review of Co-Creation in Public Health. Healthcare (Basel) 2023; 11:healthcare11071034. [PMID: 37046961 PMCID: PMC10094395 DOI: 10.3390/healthcare11071034] [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: 02/02/2023] [Revised: 03/08/2023] [Accepted: 03/14/2023] [Indexed: 04/14/2023] Open
Abstract
BACKGROUND There is general agreement regarding the relevance of community involvement in public health policy, practice, and research to reduce health inequities. OBJECTIVE This review aims to analyse the experiences of community engagement in public health actions, with particular attention to methodologies used and how community participation is articulated. METHOD AND ANALYSIS We searched the Web of Science, EBSCO, and ProQuest for scientific articles published in peer-reviewed journals. We recorded methodological aspects, the approach to equity, actors that participated in the actions, and participation of the community in different phases (agenda setting, design, implementation, and evaluation). RESULTS Of 4331 records, we finally included 31 studies published between 1995 and 2021. Twelve studies referred to Community-Based Participatory Research as the framework used. The actions addressed equity, mainly by tackling economic vulnerability (n = 20, 64%) and racial discrimination (n = 18, 58%). Workshops were the most used method. Participation was frequently observed in the design and implementation phases of the action, but it was reduced to community feedback in the evaluation. CONCLUSIONS Co-created public health actions offer the opportunity to reduce health inequity and promote social change; yet, further effort is needed to involve communities in the entire cycle of decision making.
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Affiliation(s)
- Sergio Morales-Garzón
- Public Health, History of Science and Gynaecology Department, Miguel Hernández University, 03550 Alicante, Spain
| | - Lucy Anne Parker
- Public Health, History of Science and Gynaecology Department, Miguel Hernández University, 03550 Alicante, Spain
- CIBER in Epidemiology and Public Health, 28029 Madrid, Spain
| | - Ildefonso Hernández-Aguado
- Public Health, History of Science and Gynaecology Department, Miguel Hernández University, 03550 Alicante, Spain
- CIBER in Epidemiology and Public Health, 28029 Madrid, Spain
| | | | - María Pastor-Valero
- Public Health, History of Science and Gynaecology Department, Miguel Hernández University, 03550 Alicante, Spain
- CIBER in Epidemiology and Public Health, 28029 Madrid, Spain
- Programa de Pós-Graduação em Saúde Coletiva, Departamento de Medicina Preventiva, Faculdade de Medicina FMUSP, Universidade de São Paulo, Sao Paulo 05508-220, Brazil
| | - Elisa Chilet-Rosell
- Public Health, History of Science and Gynaecology Department, Miguel Hernández University, 03550 Alicante, Spain
- CIBER in Epidemiology and Public Health, 28029 Madrid, Spain
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17
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Bel-Serrat S, Klingenstein P, Marques-Previ M, Hennessy E, Murrin C. Perceived barriers to vegetable intake among urban adolescents from socioeconomically disadvantaged backgrounds: A qualitative study from the perspective of youth workers and teachers. Physiol Behav 2023; 262:114074. [PMID: 36623744 DOI: 10.1016/j.physbeh.2023.114074] [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: 11/08/2022] [Revised: 01/04/2023] [Accepted: 01/05/2023] [Indexed: 01/09/2023]
Abstract
Eating habits established during adolescence have been shown to track into adulthood. Adolescents from lower socioeconomic status groups tend to have lower intakes of vegetables as compared with their more affluent peers. However, there is limited evidence about the determinants of vegetable intake in this population group. Therefore, this study aimed to explore the barriers to vegetable intake in adolescents living in socioeconomically disadvantaged areas through the perspective of school teachers and youth workers. A total of 20 semi-structured interviews were conducted with post-primary school teachers and youth workers from disadvantaged areas in Dublin, Ireland. Thematic analysis was applied to analyze the data. Eleven themes were identified and fitted within the Socioecological Model of Health: adolescent's food preferences, lack of early exposure and familiarity with vegetables, lack of interest, knowledge and skills at the individual and family level, parenting practices around nutrition, living difficulties, peers' influence and social norms around nutrition, dual role of social media, lack of resources and support to promote healthy eating, competition between unhealthy food vs. vegetables, lack of adequate approaches & initiatives at the community and at the public policy levels, and lack of State support to promote healthy eating. Although several actions could be taken at the personal and interpersonal levels, more efforts are needed at the organizational, community and public policy levels to improve dietary choices and vegetable intake among adolescents in socioeconomically deprived areas. These findings will inform the development of tailored intervention strategies and policies for these vulnerable youths.
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Affiliation(s)
- Silvia Bel-Serrat
- National Nutrition Surveillance Centre, School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland.
| | - Pauline Klingenstein
- Department of Health Promotion, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Maria Marques-Previ
- National Nutrition Surveillance Centre, School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Eilis Hennessy
- School of Psychology, University College Dublin, Dublin, Ireland
| | - Celine Murrin
- National Nutrition Surveillance Centre, School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
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18
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Stankov I, Henson RM, Headen I, Purtle J, Langellier BA. Use of qualitative systems mapping and causal loop diagrams to understand food environments, diet and obesity: a scoping review protocol. BMJ Open 2023; 13:e066875. [PMID: 36931683 PMCID: PMC10030560 DOI: 10.1136/bmjopen-2022-066875] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 02/20/2023] [Indexed: 03/19/2023] Open
Abstract
INTRODUCTION Food systems can shape dietary behaviour and obesity outcomes in complex ways. Qualitative systems mapping using causal loop diagrams (CLDs) can depict how people understand the complex dynamics, inter-relationships and feedback characteristic of food systems in ways that can support policy planning and action. To date, there has been no attempt to review this literature. The objectives of this review are to scope the extent and nature of studies using qualitative systems mapping to facilitate the development of CLDs by stakeholders to understand food environments, including settings and populations represented, key findings and the methodological processes employed. It also seeks to identify gaps in knowledge and implications for policy and practice. METHODS AND ANALYSIS This protocol describes a scoping review guided by the Joanna Briggs Institute manual, the framework by Khalil and colleagues and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist reporting guidelines. A search strategy was iteratively developed with two academic librarians and the research team. This strategy will be used to search six databases, including Ovid MEDLINE, Embase, EmCare, Web of Science, Scopus and ProQuest Central. Identified citations will be screened by two independent reviewers; first, by title and abstract, and then full-text articles to identify papers eligible for inclusion. The reference lists of included studies and relevant systematic reviews will be searched to identify other papers eligible for inclusion. Two reviewers will extract information from all included studies and summarise the findings descriptively and numerically. ETHICS AND DISSEMINATION The scoping review will provide an overview of how CLDs developed by stakeholders have been elicited to understand food environments, diet and obesity, the insights gained and how the CLDs have been used. It will also highlight gaps in knowledge and implications for policy and practice. The review will be disseminated through publication in an academic journal and conference presentations.
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Affiliation(s)
- Ivana Stankov
- Urban Health Collaborative, Drexel University, Philadelphia, Pennsylvania, USA
- UniSA Allied Health & Human Performance, University of South Australia, Adelaide, South Australia, Australia
| | - Rosie Mae Henson
- Department of Health Management and Policy, Drexel University, Philadelphia, Pennsylvania, USA
| | - Irene Headen
- Department of Community Health and Prevention, Drexel University, Philadelphia, Pennsylvania, USA
| | - Jonathan Purtle
- Department of Public Health Policy and Management, New York University, New York, New York, USA
| | - Brent A Langellier
- Department of Health Management and Policy, Drexel University, Philadelphia, Pennsylvania, USA
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Hasnin S, Dev DA, Swindle T, Sisson SB, Pitts SJ, Purkait T, Clifton SC, Dixon J, Stage VC. Systematic Review of Reflection Spectroscopy-Based Skin Carotenoid Assessment in Children. Nutrients 2023; 15:nu15061315. [PMID: 36986046 PMCID: PMC10055935 DOI: 10.3390/nu15061315] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 02/28/2023] [Accepted: 03/02/2023] [Indexed: 03/30/2023] Open
Abstract
Assessing children's skin carotenoid score (SCS) using reflection spectroscopy (RS) is a non-invasive, widely used method to approximate fruit and vegetable consumption (FVC). The aims for the current review were to (1) identify distributions of SCS across demographic groups, (2) identify potential non-dietary correlates for RS-based SCS, (3) summarize the validity and reliability of RS-based SCS assessment, and (4) conduct meta-analyses of studies examining the correlation between RS-based SCS with FVC. A literature search in eight databases in June 2021 resulted in 4880 citations and peer-reviewed publications written in English that investigated children's (2-10 years old) SCS using RS. We included 11 studies (intervention = 3, observational = 8). Potential covariates included weight status, ethnicity, seasonal variation, age, sex, and income. Studies reported criterion validity with children's FVC but not with plasma carotenoid. Additionally, no studies reported the reliability of RS-based SCS in children. Among the 726 children included in the meta-analysis, the correlation between RS-based SCS and FVC was r = 0.2 (p < 0.0001). RS-based SCS is a valid method to quantify skin carotenoids for children's FVC estimation with the potential for evaluating nutrition policies and interventions. However, future research should use standardized protocol for using RS and establish how RS-based SCS can translate to the amount of daily FVC in children.
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Affiliation(s)
- Saima Hasnin
- Department of Child, Youth and Family Studies, University of Nebraska-Lincoln, Lincoln, NE 68588, USA
| | - Dipti A Dev
- Department of Child, Youth and Family Studies, University of Nebraska-Lincoln, Lincoln, NE 68588, USA
| | - Taren Swindle
- Department of Family and Preventive Medicine, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
| | - Susan B Sisson
- Department of Allied Health Sciences, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73126, USA
| | - Stephanie Jilcott Pitts
- Department of Public Health at the Brody School of Medicine, East Carolina University, Greenville, NC 27834, USA
| | - Tirna Purkait
- Department of Nutrition and Health Sciences, University of Nebraska-Lincoln, Lincoln, NE 68588, USA
| | - Shari C Clifton
- Robert M. Bird Health Sciences Library, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73126, USA
| | - Jocelyn Dixon
- Department of Human Development and Family Science, East Carolina University, Greenville, NC 27834, USA
| | - Virginia C Stage
- Department of Agricultural and Human Sciences, North Carolina State University, Raleigh, NC 27695, USA
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Savona N, Brown A, Macauley T, Aguiar A, Hayward J, Ayuandini S, Habron J, Grewal NK, Luszczynska A, Mendes S, Klepp KI, Rutter H, Allender S, Knai C. System mapping with adolescents: Using group model building to map the complexity of obesity. Obes Rev 2023; 24 Suppl 1:e13506. [PMID: 36825369 DOI: 10.1111/obr.13506] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 07/18/2022] [Accepted: 09/11/2022] [Indexed: 11/23/2022]
Abstract
Public health research and practice is increasingly employing systems thinking to help grapple with complex issues, from obesity to HIV treatment. At the same time, there is growing recognition that to address a given problem it is essential collaborate with those most at risk of or affected by it. Group model building (GMB), a process grounded in system dynamics, combines systems thinking and participatory methods to structure and address complex issues. As part of the CO-CREATE project we conducted GMB sessions with young people in six countries to create causal loop diagrams showing the factors that they believe drive obesity. This paper describes the background to GMB and the process we used to construct causal loop diagrams; it discusses how GMB contributed to generating noteworthy and useful findings, and the strengths and limitations of the method. Using GMB, we identified areas of concern to adolescents in relation to obesity that have so far had little attention in obesity research and policy: mental health and online activity. In using GMB, we also helped answer calls for a more participatory approach to youth involvement in research and policy development.
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Affiliation(s)
- Natalie Savona
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Andrew Brown
- Global Obesity Centre, Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
| | - Talia Macauley
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Anaely Aguiar
- Department of Geography, System Dynamics Group, University of Bergen, Bergen, Norway
| | - Josh Hayward
- Global Obesity Centre, Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
| | - Sherria Ayuandini
- Department of Sociology, University of Amsterdam, Amsterdam, The Netherlands
| | - Janetta Habron
- Division of Human Nutrition, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | | | - Aleksandra Luszczynska
- CARE-BEH Center for Applied Research on Health Behavior and Health, SWPS University of Social Sciences and Humanities, Wroclaw, Poland
| | - Sofia Mendes
- Centre for Studies and Research on Social Dynamics and Health-CEIDSS, Lisbon, Portugal
| | - Knut-Inge Klepp
- Department of Nutrition, University of Oslo, Oslo, Norway.,Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Harry Rutter
- Department of Social and Policy Sciences, University of Bath, Bath, UK
| | - Steven Allender
- Global Obesity Centre, Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
| | - Cécile Knai
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
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21
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Felmingham T, Backholer K, Hoban E, Brown AD, Nagorcka-Smith P, Allender S. Success of community-based system dynamics in prevention interventions: A systematic review of the literature. Front Public Health 2023; 11:1103834. [PMID: 37033017 PMCID: PMC10080052 DOI: 10.3389/fpubh.2023.1103834] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 03/07/2023] [Indexed: 04/11/2023] Open
Abstract
Systems thinking approaches are increasingly being used to help communities understand and develop responses to preventing complex health problems. Less is known about how success is characterized and what influences success in these approaches. We present a systematic review of how concepts of success are understood and evaluated in the peer reviewed literature of studies using systems thinking in community prevention. We searched five databases for peer-reviewed literature published between 2000 and 2022, with search terms related to systems thinking, prevention and community. Studies were included if they; reported using community-based systems thinking to prevent a public health problem; described the engagement and empowerment of community members to address a public health issue; and, were published in English. Thirty-four articles were identified from 10 countries. Twenty-one aimed to prevent a chronic disease (e.g., obesity) and 16 measured success using specific tools, 10 of which used semi-structured interviews or surveys. Measures of success included implementation processes, cultural appropriateness, the number or type of actions implemented, effectiveness of community action, and changes in individual thinking or mental models, population health outcomes, data collected, or systems level measures. Implementation factors influencing success included the capacity to engage participants, composition and experience of facilitators, strength of coordination teams, allocation of resources, adaptation to participant feedback, use of multiple systems approaches, workshop process providing time and methods to allow new insights, flexible delivery, and diversity of perspectives. Findings from each of the articles indicated that approaches increased a range of outcomes including community action, strategic thinking, future planning and evaluation, community buy-in, community voice, contribution and leadership, in addition to developing shared visions and goals and creating new, ongoing collaborations, among many others. Measures of success varied, suggesting more empirical reporting of proposed outcomes of system science in communities would be valuable. While the measurement of success in the use of systems thinking in community-based prevention efforts is limited, there are helpful examples we can look to for future measurement of success.
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Affiliation(s)
- Tiana Felmingham
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, Deakin University, Geelong, VIC, Australia
- School of Health and Social Development, Faculty of Health, Deakin University, Geelong, VIC, Australia
- *Correspondence: Tiana Felmingham,
| | - Kathryn Backholer
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, Deakin University, Geelong, VIC, Australia
- School of Health and Social Development, Faculty of Health, Deakin University, Geelong, VIC, Australia
| | - Elizabeth Hoban
- School of Health and Social Development, Faculty of Health, Deakin University, Geelong, VIC, Australia
| | - Andrew D. Brown
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, Deakin University, Geelong, VIC, Australia
- School of Health and Social Development, Faculty of Health, Deakin University, Geelong, VIC, Australia
| | - Phoebe Nagorcka-Smith
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, Deakin University, Geelong, VIC, Australia
- School of Health and Social Development, Faculty of Health, Deakin University, Geelong, VIC, Australia
| | - Steven Allender
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, Deakin University, Geelong, VIC, Australia
- School of Health and Social Development, Faculty of Health, Deakin University, Geelong, VIC, Australia
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Bel-Serrat S, von der Schulenburg A, Marques-Previ M, Mullee A, Murrin CM. What are the determinants of vegetable intake among adolescents from socioeconomically disadvantaged urban areas? A systematic review of qualitative studies. Int J Behav Nutr Phys Act 2022; 19:158. [PMID: 36572889 PMCID: PMC9793665 DOI: 10.1186/s12966-022-01396-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 12/01/2022] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Evidence available on the determinants of vegetable intake in young populations is inconsistent. Vegetable intake is particularly low in adolescents from less-affluent backgrounds, yet no systematic review of qualitative studies investigating determinants for vegetable intake specifically has been conducted to date in this group. This systematic review aimed to identify determinants of vegetable intake in adolescents from socioeconomically disadvantaged urban areas located in very high-income countries reported in qualitative studies. METHODS Five electronic databases (PubMed, Web of Science, CINAHL, PsycINFO and ERIC) were searched until August 2022. The search strategy used combinations of synonyms for vegetable intake, adolescents, and qualitative methodologies. Main inclusion criteria were studies exploring views and experiences of motivators and barriers to vegetable intake in a sample of adolescents aged 12-18 years from socioeconomically disadvantaged urban areas in very high income countries. Study quality assessment was conducted using criteria established in a previous review. RESULTS Sixteen studies were included out of the 984 screened citations and 63 full texts. The synthesis of findings identified the following determinants of vegetable intake: sensory attributes of vegetables; psychosocial factors (nutrition knowledge, preferences/liking, self-efficacy, motivation); lifestyle factors (cost/price, time, convenience); fast food properties (taste, cost, satiety); home environment and parental influence; friends' influence; school food environment, nutrition education and teachers' support; and availability and accessibility of vegetables in the community and community nutrition practices. Studies attained between 18 and 49 out of 61 quality points, with eleven of 16 studies reaching ≥ 40 points. One main reason for lower scores was lack of data validation. CONCLUSION Multiple determinants of vegetable intake were identified complementing those investigated in quantitative studies. Future large scale quantitative studies should attempt to examine the relative importance of these determinants in order to guide the development of successful interventions in adolescents from socioeconomically disadvantaged backgrounds.
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Affiliation(s)
- Silvia Bel-Serrat
- grid.7886.10000 0001 0768 2743National Nutrition Surveillance Centre, School of Public Health, Physiotherapy and Sports Science, University College Dublin, Woodview House, Belfield, Dublin, Ireland
| | - Antje von der Schulenburg
- grid.7886.10000 0001 0768 2743National Nutrition Surveillance Centre, School of Public Health, Physiotherapy and Sports Science, University College Dublin, Woodview House, Belfield, Dublin, Ireland
| | - Maria Marques-Previ
- grid.7886.10000 0001 0768 2743National Nutrition Surveillance Centre, School of Public Health, Physiotherapy and Sports Science, University College Dublin, Woodview House, Belfield, Dublin, Ireland
| | - Amy Mullee
- grid.516689.50000 0005 0713 0550Department of Health and Nutritional Sciences, Atlantic Technological University, Sligo, Ireland
| | - Celine M Murrin
- grid.7886.10000 0001 0768 2743National Nutrition Surveillance Centre, School of Public Health, Physiotherapy and Sports Science, University College Dublin, Woodview House, Belfield, Dublin, Ireland
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23
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Zolfaghari M, Meshkovska B, Banik A, Kamphuis CBM, Kopainsky B, Luszczynska A, Murrin C, Lien N. Applying a systems perspective to understand the mechanisms of the European School Fruit and Vegetable Scheme. Eur J Public Health 2022; 32:iv107-iv113. [PMID: 36444113 PMCID: PMC9706111 DOI: 10.1093/eurpub/ckac054] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND For the past two decades, the percentage of European children who consume fruit daily has remained at around 40%, despite numerous school-based policy efforts and interventions. This study aimed to apply a systems approach to provide an integrated perspective of the mechanisms of the European School Fruit and Vegetable Scheme (the Scheme) to understand better how to increase its long-term impact on children's fruit and vegetable consumption. METHODS We developed a causal loop diagram by synthesizing peer-reviewed articles and national government documents related to the Scheme, following the conceptualization steps of system dynamics. The initial causal loop diagrams were then validated in three stages by consulting with experts (two individuals and a group) in school-based fruit and vegetable programmes, children's fruit and vegetable consumption and the Scheme, using disconfirmatory interview guidelines. RESULTS The findings suggest that a central self-reinforcing mechanism through which children socialize during fruit and vegetable consumption is critical in the habituation process. Additionally, the initial increase in children's fruit and vegetable consumption following the Scheme implementation is due to growth in three self-reinforcing loops related to motivation and capability mechanisms; however, this trend gradually slows and stops due to four balancing feedback loops with alternative goals related to opportunity mechanisms that reach their limits. CONCLUSIONS The scheme's design should incorporate activities that align the objectives of the implementers and recipients of the Scheme at all levels. This alignment should provide children with ongoing opportunities to consume fruits and vegetables and strengthen the motivation and capability mechanisms.
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Affiliation(s)
- Mahshid Zolfaghari
- Correspondence: Mahshid Zolfaghari, Department of Nutrition, University of Oslo, P.O. Box 1046 Blindern, 0317 Oslo, Norway, Tel: +47 45 91 70 38, e-mail:
| | | | - Anna Banik
- Wroclaw Faculty of Psychology, SWPS University of Social Sciences and Humanities, Wroclaw, Poland
| | - Carlijn B M Kamphuis
- Department of Interdisciplinary Social Science, Utrecht University, Utrecht, The Netherlands
| | - Birgit Kopainsky
- Department of Geography, System Dynamics Group, University of Bergen, Bergen, Norway
| | - Aleksandra Luszczynska
- Wroclaw Faculty of Psychology, SWPS University of Social Sciences and Humanities, Wroclaw, Poland
| | - Celine Murrin
- School of Public Health, Physiotherapy and Sport Science, University College Dublin, Dublin, Ireland
| | - Nanna Lien
- Department of Nutrition, University of Oslo, Oslo, Norway
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24
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Systems Mapping of the New Zealand Free and Healthy School Lunch Programme: Perspectives from Lunch Providers. Nutrients 2022; 14:nu14204336. [DOI: 10.3390/nu14204336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 10/13/2022] [Accepted: 10/13/2022] [Indexed: 11/16/2022] Open
Abstract
As part of the COVID-19 economic recovery package, the Aotearoa New Zealand Government rolled out a universal free and healthy lunch programme to the 25% least advantaged schools nationwide. This study explored experiences of school lunch providers in the Hawke’s Bay region. The aim was to create a systems map identifying points of intervention through which the lunch programme could be improved to meet the goal of reducing child food insecurity. Twelve lunch providers were interviewed to generate casual loop diagrams which were examined and integrated to form a single systems map. Seven themes arose during analysis: teacher support, principal support, nutrition guidelines and government support, supply chain, ingredient suppliers, student feedback and food waste. Teacher support was important for getting students to try new foods and eat the nutritious lunches. Principal support was a strong theme impacting opportunities for broader student engagement. This study employed systems science to highlight the importance of support from different stakeholders within the lunch programme to achieve the goal of reduced child food insecurity. Further work is needed to ensure the programme meets the wider goals of the government and community, and to determine the potential broader benefits of the programme.
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25
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Mahmood L, Moreno LA, Flores-Barrantes P, Mavrogianni C, Schwarz P, Makrilakis K, Liatis S, Cardon G, Willems R, Rurik I, Radó S, Tankova T, Iotova V, Usheva N, Manios Y, Gonzalez-Gil EM. Parental food consumption and diet quality and its association with children's food consumption in families at high risk of type 2 diabetes: the Feel4Diabetes-study. Public Health Nutr 2022; 25:1-12. [PMID: 36217747 PMCID: PMC9991723 DOI: 10.1017/s1368980022002245] [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: 12/03/2021] [Revised: 08/19/2022] [Accepted: 09/29/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To examine the parental food consumption and diet quality and its associations with children's consumption in families at high risk for developing type 2 diabetes mellitus across Europe. Also, to compare food frequency consumption among parents and children from high-risk families to the European Dietary guidelines/recommendations. DESIGN Cross-sectional study using Feel4diabetes FFQ. SETTING Families completed FFQ and anthropometric measures were obtained. Linear regression analyses were applied to investigate the relations between parental food consumption and diet quality and their children's food consumption after consideration of potential confounders. PARTICIPANTS 2095 European families (74·6 % mothers, 50·9 % girls). The participants included parent and one child, aged 6-8 years. RESULTS Parental food consumption was significantly associated with children's intake from the same food groups among boys and girls. Most parents and children showed under-consumption of healthy foods according to the European Dietary Guidelines. Parental diet quality was positively associated with children's intake of 'fruit' (boys: β = 0·233, P < 0·001; girls: β = 0·134, P < 0·05) and 'vegetables' (boys: β = 0·177, P < 0·01; girls: β = 0·234, P < 0·001) and inversely associated with their 'snacks' consumption (boys: β = -0·143, P < 0·05; girls: β = -0·186, P < 0·01). CONCLUSION The present study suggests an association between parental food consumption and diet quality and children's food intake. More in-depth studies and lifestyle interventions that include both parents and children are therefore recommended for future research.
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Affiliation(s)
- Lubna Mahmood
- Growth, Exercise, Nutrition and Development (GENUD) Research Group, University of Zaragoza, Zaragoza50009, Spain
| | - Luis A Moreno
- Growth, Exercise, Nutrition and Development (GENUD) Research Group, University of Zaragoza, Zaragoza50009, Spain
- Instituto Agroalimentario de Aragón (IA2), Zaragoza, Spain
- Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Spain
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, Madrid, Spain
| | - Paloma Flores-Barrantes
- Growth, Exercise, Nutrition and Development (GENUD) Research Group, University of Zaragoza, Zaragoza50009, Spain
| | - Christina Mavrogianni
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | - Peter Schwarz
- Department of Medicine III, Technical University of Dresden, Dresden, Germany
| | - Konstantinos Makrilakis
- Department of Propaedeutic Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Stavros Liatis
- Department of Propaedeutic Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Greet Cardon
- Department of Movement and Sports Sciences, Ghent University, Gent, Belgium
| | - Ruben Willems
- Department of Public Health and Primary Care, Ghent University, Gent, Belgium
| | - Imre Rurik
- Faculty of Health Sciences, University of Debrecen, Debrecen, Hungary
| | - Sándorné Radó
- Faculty of Health Sciences, University of Debrecen, Debrecen, Hungary
| | - Tsvetalina Tankova
- Department of Diabetology, Clinical Center of Endocrinology, Medical University of Sofia, Sofia, Bulgaria
| | - Violeta Iotova
- Department of Diabetology, Clinical Center of Endocrinology, Medical University of Sofia, Sofia, Bulgaria
| | - Natalya Usheva
- Department of Social Medicine and Health Care Organization, Medical University of Varna, Varna, Bulgaria
| | - Yannis Manios
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
- Institute of Agri-food and Life Sciences, Hellenic Mediterranean University Research Centre, Heraklion, Greece
| | - Esther M Gonzalez-Gil
- Growth, Exercise, Nutrition and Development (GENUD) Research Group, University of Zaragoza, Zaragoza50009, Spain
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, Madrid, Spain
- Department of Biochemistry and Molecular Biology II, Instituto de Nutrición y Tecnología de los Alimentos, Center of Biomedical Research (CIBM), Universidad de Granada, Granada, Spain
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26
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D’Hooghe S, Inaç Y, De Clercq E, Deforche B, Dury S, Vandevijvere S, Van de Weghe N, Van Dyck D, De Ridder K. The CIVISANO protocol: a mixed-method study about the role of objective and perceived environmental factors on physical activity and eating behavior among socioeconomically disadvantaged adults. Arch Public Health 2022; 80:219. [PMID: 36199109 PMCID: PMC9533259 DOI: 10.1186/s13690-022-00956-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 08/19/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Overweight and obesity have a strong socioeconomic profile. Unhealthy behaviors like insufficient physical activity and an unbalanced diet, which are causal factors of overweight and obesity, tend to be more pronounced in socioeconomically disadvantaged groups in high income countries. The CIVISANO project aims to identify objective and perceived environmental factors among different socioeconomic population groups that impede or facilitate physical activity and healthy eating behavior in the local context of two peri-urban Flemish municipalities in Belgium. We also aim to identify and discuss possible local interventions and evaluate the participatory processes of the project. METHODS This study (2020-2023) will use community-based participatory tools, involving collaborative partnerships with civic and stakeholder members of the community and regular exchanges among all partners to bridge knowledge development and health promotion for socioeconomically disadvantaged citizens. Furthermore, a mixed-methods approach will be used. A population survey and geographic analysis will explore potential associations between the physical activity and eating behaviors of socioeconomically disadvantaged adults (25-65 years old) and both their perceived and objective physical, food and social environments. Profound perceptive context information will be gathered from socioeconomically disadvantaged adults by using participatory methods like photovoice, walk-along, individual map creation and group model building. An evaluation of the participatory process will be conducted simultaneously. DISCUSSION The CIVISANO project will identify factors in the local environment that might provoke inequities in adopting a healthy lifestyle. The combination of perceived and objective measures using validated strategies will provide a robust assessment of the municipality environment. Through this analysis, the project will investigate to what extent community engagement can be a useful strategy to reduce health inequities. The strong knowledge exchange and capacity-building in a local setting is expected to contribute to our understanding of how to maximize research impact in this field and generate evidence about potential linkages between a health enhancing lifestyle among socioeconomically disadvantaged groups and their physical, food and social environments.
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Affiliation(s)
- Suzannah D’Hooghe
- grid.508031.fSciensano, Department of Epidemiology and Public Health, Brussels, Belgium ,grid.5342.00000 0001 2069 7798Ghent University, Faculty of Medicine and Health Sciences, Department of Public Health and Primary Care, Ghent, Belgium ,grid.8767.e0000 0001 2290 8069Vrije Universiteit Brussel (VUB), Faculty of Psychology and Educational Sciences, Adult Educational Sciences, Brussels, Belgium
| | - Yasemin Inaç
- grid.508031.fSciensano, Department of Epidemiology and Public Health, Brussels, Belgium ,grid.8767.e0000 0001 2290 8069Vrije Universiteit Brussel (VUB), Faculty of Psychology and Educational Sciences, Adult Educational Sciences, Brussels, Belgium ,grid.5342.00000 0001 2069 7798Ghent University, Faculty of Sciences, Department of Geography, Ghent, Belgium
| | - Eva De Clercq
- grid.508031.fSciensano, Department of Chemical and Physical Health Risks, Brussels, Belgium
| | - Benedicte Deforche
- grid.5342.00000 0001 2069 7798Ghent University, Faculty of Medicine and Health Sciences, Department of Public Health and Primary Care, Ghent, Belgium ,grid.8767.e0000 0001 2290 8069Vrije Universiteit Brussel (VUB), Faculty of Physical Education and Physiotherapy, Department of Movement and Sport Sciences, Brussels, Belgium
| | - Sarah Dury
- grid.8767.e0000 0001 2290 8069Vrije Universiteit Brussel (VUB), Faculty of Psychology and Educational Sciences, Adult Educational Sciences, Brussels, Belgium
| | - Stefanie Vandevijvere
- grid.508031.fSciensano, Department of Epidemiology and Public Health, Brussels, Belgium
| | - Nico Van de Weghe
- grid.5342.00000 0001 2069 7798Ghent University, Faculty of Sciences, Department of Geography, Ghent, Belgium
| | - Delfien Van Dyck
- grid.5342.00000 0001 2069 7798Ghent University, Faculty of Medicine and Health Sciences, Department of Movement and Sports Sciences, Brussels, Belgium
| | - Karin De Ridder
- grid.508031.fSciensano, Department of Epidemiology and Public Health, Brussels, Belgium
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Misra S, Lyngdoh T, Mulchandani R. Guidelines for dyslipidemia management in India: A review of the current scenario and gaps in research. Indian Heart J 2022; 74:341-350. [PMID: 35940234 PMCID: PMC9647649 DOI: 10.1016/j.ihj.2022.07.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 05/31/2022] [Accepted: 07/27/2022] [Indexed: 12/02/2022] Open
Abstract
Cardiovascular Diseases (CVD) have a high disease burden in India. Dyslipidemia, a major CVD risk factor, requires effective management. Our review describes the appropriateness of the international dyslipidemia guidelines in the Indian context. A systematic search was performed in PubMed, Google Scholar, Cochrane Library and Science Direct to obtain relevant articles. Dyslipidemia management guidelines by western medical associations are based on their studies, with ethnic minorities underrepresented and biological features of other racial groups inadequately incorporated. The Lipid Association of India (LAI) came up with a consensus statement guided by an expert panel to adapt the western guidelines to Indians. However, absence of Indian guidelines has led to physicians basing treatment on individual preference, contributing to heterogeneity. Our review underscores the need for formulating Indian dyslipidemia management guidelines and CV risk estimation algorithms, highlighting the scope for further research. This could supplement the clinical expertise of LAI and enhance patient experience.
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Affiliation(s)
- Sanjana Misra
- Indian Institute of Public Health-Delhi, Public Health Foundation of India, Gurgaon, India.
| | - Tanica Lyngdoh
- Indian Institute of Public Health-Delhi, Public Health Foundation of India, Gurgaon, India; Epidemiology and Communicable Diseases Division, Indian Council of Medical Research, New Delhi, India.
| | - Rubina Mulchandani
- Indian Institute of Public Health-Delhi, Public Health Foundation of India, Gurgaon, India.
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Whelan J, Hayward J, Nichols M, Brown AD, Orellana L, Brown V, Becker D, Bell C, Swinburn B, Peeters A, Moodie M, Geddes SA, Chadwick C, Allender S, Strugnell C. Reflexive Evidence and Systems interventions to Prevention Obesity and Non-communicable Disease (RESPOND): protocol and baseline outcomes for a stepped-wedge cluster-randomised prevention trial. BMJ Open 2022; 12:e057187. [PMID: 36581987 PMCID: PMC9438198 DOI: 10.1136/bmjopen-2021-057187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION Systems science methodologies have been used in attempts to address the complex and dynamic causes of childhood obesity with varied results. This paper presents a protocol for the Reflexive Evidence and Systems interventions to Prevention Obesity and Non-communicable Disease (RESPOND) trial. RESPOND represents a significant advance on previous approaches by identifying and operationalising a clear systems methodology and building skills and knowledge in the design and implementation of this approach among community stakeholders. METHODS AND ANALYSIS RESPOND is a 4-year cluster-randomised stepped-wedge trial in 10 local government areas in Victoria, Australia. The intervention comprises four stages: catalyse and set up, monitoring, community engagement and implementation. The trial will be evaluated for individuals, community settings and context, cost-effectiveness, and systems and implementation processes. Individual-level data including weight status, diet and activity behaviours will be collected every 2 years from school children in grades 2, 4 and 6 using an opt-out consent process. Community-level data will include knowledge and engagement, collaboration networks, economic costs and shifts in mental models aligned with systems training. Baseline prevalence data were collected between March and June 2019 among >3700 children from 91 primary schools. ETHICS AND DISSEMINATION Ethics approval: Deakin University Human Research Ethics Committee (HREC 2018-381) or Deakin University's Faculty of Health Ethics Advisory Committee (HEAG-H_2019-1; HEAG-H 37_2019; HEAG-H 173_2018; HEAG-H 12_2019); Victorian Government Department of Education and Training (2019_003943); Catholic Archdiocese of Melbourne (Catholic Education Melbourne, 2019-0872) and Diocese of Sandhurst (24 May 2019). The results of RESPOND, including primary and secondary outcomes, and emerging studies developed throughout the intervention, will be published in the academic literature, presented at national and international conferences, community newsletters, newspapers, infographics and relevant social media. TRIAL REGISTRATION NUMBER ACTRN12618001986268p.
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Affiliation(s)
- Jillian Whelan
- School of Medicine, Deakin University, Geelong, Victoria, Australia
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
| | - Joshua Hayward
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
| | - Melanie Nichols
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
| | - Andrew D Brown
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
| | - Liliana Orellana
- Biostatistics Unit, Institute for Health Transformation, Deakin University, Burwood, Victoria, Australia
| | - Victoria Brown
- Deakin Health Economics, Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, Deakin University, Burwood, Victoria, Australia
| | - Denise Becker
- Biostatistics Unit, Institute for Health Transformation, Deakin University, Burwood, Victoria, Australia
| | - Colin Bell
- School of Medicine, Deakin University, Geelong, Victoria, Australia
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
| | - Boyd Swinburn
- School of Population Health, The University of Auckland, Auckland, New Zealand
| | - Anna Peeters
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
| | - Marj Moodie
- Deakin Health Economics, Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, Deakin University, Burwood, Victoria, Australia
| | - Sandy A Geddes
- Department of Health and Human Services, State Government of Victoria, Melbourne, Victoria, Australia
| | - Craig Chadwick
- Goulburn Valley Primary Care Partnership, Shepparton, Victoria, Australia
| | - Steven Allender
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
| | - Claudia Strugnell
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
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Determinants of vegetable intake among urban socio-economically disadvantaged adolescents: a systematic review of quantitative studies. Public Health Nutr 2022; 25:1447-1460. [PMID: 34814970 PMCID: PMC9991624 DOI: 10.1017/s136898002100464x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To investigate the determinants of vegetable intake in urban socio-economically disadvantaged adolescents to inform the development of an intervention programme. DESIGN A narrative systematic review was carried out by searching five electronic databases from 2013 to 2020. The descriptors used for the search strategy were vegetable intake, adolescents, determinants and correlates. Inclusion criteria were including a sample of socio-economically disadvantaged adolescents aged 12-18 years, evaluation of the association between vegetable intake and determinants of intake, and conducted in urban settings of high-income countries. Thirteen studies met the inclusion criteria. Identified determinants of vegetable intake were reported according to the five levels of the socio-ecological model of health. SETTING Studies included in the review were conducted in four countries: USA (n 8), Australia (n 3), Ireland (n 1) and New Zealand (n 1). PARTICIPANTS Adolescents aged 12-18 years from socio-economically disadvantaged backgrounds living in urban settings. RESULTS Thirty-nine determinants were identified. Nutrition knowledge was the only determinant consistently investigated in several independent samples which was not associated with vegetable intake in socio-economically disadvantaged adolescents. For the remaining potential determinants, it was not possible to examine the consistency of evidence as there were not enough studies investigating the same determinants. Most of the studies followed a cross-sectional design and were carried out in school settings. CONCLUSIONS There is a need for further studies on the determinants of vegetable intake in this population preferably with longitudinal designs and beyond the school setting in different countries to guide the development of successful interventions.
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Bolton KA, Fraser P, Lowe J, Moodie M, Bell C, Strugnell C, Hayward J, McGlashan J, Millar L, Whelan J, Brown A, Allender S. Generating change through collective impact and systems science for childhood obesity prevention: The GenR8 Change case study. PLoS One 2022; 17:e0266654. [PMID: 35544522 PMCID: PMC9094504 DOI: 10.1371/journal.pone.0266654] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 03/14/2022] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Community-based interventions have shown promise in reducing childhood overweight and obesity. However, they have been critiqued for using linear logic models. Participatory community-based systems approaches are posited as addressing the complexity of non-linear relationships in a local context. Community members are empowered to understand and describe obesity causation, identify and prioritise possible solutions. The application of such approaches to childhood obesity is in its infancy. AIM To describe the first 12 months of a participatory whole-of-community systems approach to creating collective action to tackle childhood obesity, called GenR8 Change, in a local government area of Victoria, Australia. METHODS Three group model building (GMB) sessions focused on the development of a causal loop diagram (CLD), prioritised evidence-informed actions, and developed implementation strategies. The collective impact framework underpinned the approach, with a local backbone group supporting community members to implement prioritised actions. RESULTS The first two GMB sessions included 20 key community leaders where a CLD examining the factors contributing to childhood obesity in the community was constructed and refined (22 variables GMB1, 53 variables GMB2). In the third session, 171 members of the wider community further refined the CLD, identified priorities for childhood obesity prevention (72 variables in final CLD). One-hundred and thirteen individuals signed up across 13 working groups to plan and implement 53 prioritised actions. Agreed community actions included creating sugar free zones; developing healthy policies; increasing breastfeeding rates; improving drinking water access; and increasing physical activity options. Twelve months post-GMB3, 115 actions had been implemented. CONCLUSION GenR8 Change is one of the first communities to apply systems thinking to childhood obesity prevention. Knowledge on how to collectively identify relevant leverage points to tackle childhood obesity can now be shared with other communities.
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Affiliation(s)
- Kristy A. Bolton
- Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
- * E-mail:
| | - Penny Fraser
- Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
| | - Janette Lowe
- Southern Grampians Glenelg Primary Care Partnership, Hamilton, Victoria, Australia
| | - Marj Moodie
- Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
- Deakin Health Economics, Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
| | - Colin Bell
- Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
| | - Claudia Strugnell
- Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
| | - Josh Hayward
- Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
| | - Jaimie McGlashan
- Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
| | - Lynne Millar
- School of Population Health, Curtin University, Bentley, Western Australia, Australia
- Institute for Health Research, University of Notre Dame, Fremantle, Western Australia, Australia
| | - Jillian Whelan
- Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
| | - Andrew Brown
- Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
| | - Steven Allender
- Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
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Drapkina OM, Kontsevaya AV, Kalinina AM, Avdeev SM, Agaltsov MV, Alexandrova LM, Antsiferova AA, Aronov DM, Akhmedzhanov NM, Balanova YA, Balakhonova TV, Berns SA, Bochkarev MV, Bochkareva EV, Bubnova MV, Budnevsky AV, Gambaryan MG, Gorbunov VM, Gorny BE, Gorshkov AY, Gumanova NG, Dadaeva VA, Drozdova LY, Egorov VA, Eliashevich SO, Ershova AI, Ivanova ES, Imaeva AE, Ipatov PV, Kaprin AD, Karamnova NS, Kobalava ZD, Konradi AO, Kopylova OV, Korostovtseva LS, Kotova MB, Kulikova MS, Lavrenova EA, Lischenko OV, Lopatina MV, Lukina YV, Lukyanov MM, Mayev IV, Mamedov MN, Markelova SV, Martsevich SY, Metelskaya VA, Meshkov AN, Milushkina OY, Mukaneeva DK, Myrzamatova AO, Nebieridze DV, Orlov DO, Poddubskaya EA, Popovich MV, Popovkina OE, Potievskaya VI, Prozorova GG, Rakovskaya YS, Rotar OP, Rybakov IA, Sviryaev YV, Skripnikova IA, Skoblina NA, Smirnova MI, Starinsky VV, Tolpygina SN, Usova EV, Khailova ZV, Shalnova SA, Shepel RN, Shishkova VN, Yavelov IS. 2022 Prevention of chronic non-communicable diseases in Of the Russian Federation. National guidelines. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2022. [DOI: 10.15829/1728-8800-2022-3235] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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McKelvie-Sebileau P, Rees D, Tipene-Leach D, D’Souza E, Swinburn B, Gerritsen S. Community Co-Design of Regional Actions for Children's Nutritional Health Combining Indigenous Knowledge and Systems Thinking. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:4936. [PMID: 35564331 PMCID: PMC9106006 DOI: 10.3390/ijerph19094936] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 04/01/2022] [Accepted: 04/15/2022] [Indexed: 02/01/2023]
Abstract
Children's nutrition is highly influenced by community-level deprivation and socioeconomic inequalities and the health outcomes associated, such as childhood obesity, continue to widen. Systems Thinking using community-based system dynamics (CBSD) approaches can build community capacity, develop new knowledge and increase commitments to health improvement at the community level. We applied the formal structure and resources of a Group Model Building (GMB) approach, embedded within an Indigenous worldview to engage a high deprivation, high Indigenous population regional community in New Zealand to improve children's nutrition. Three GMB workshops were held and the youth and adult participants created two systems map of the drivers and feedback loops of poor nutrition in the community. Māori Indigenous knowledge (mātauranga) and approaches (tikanga) were prioritized to ensure cultural safety of participants and to encourage identification of interventions that take into account social and cultural environmental factors. While the adult-constructed map focused more on the influence of societal factors such as cost of housing, financial literacy in communities, and social security, the youth-constructed map placed more emphasis on individual-environment factors such as the influence of marketing by the fast-food industry and mental wellbeing. Ten prioritized community-proposed interventions such as increasing cultural connections in schools, are presented with the feasibility and likely impact for change of each intervention rated by community leaders. The combination of community-based system dynamics methods of group model building and a mātauranga Māori worldview is a novel Indigenous systems approach that engages participants and highlights cultural and family issues in the systems maps, acknowledging the ongoing impact of historical colonization in our communities.
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Affiliation(s)
- Pippa McKelvie-Sebileau
- School of Population Health, University of Auckland, Auckland 1023, New Zealand; (B.S.); (S.G.)
- Research and Innovation Centre, Eastern Institute of Technology, Napier 4112, New Zealand;
| | - David Rees
- Synergia Consulting Ltd., Auckland 1011, New Zealand;
| | - David Tipene-Leach
- Research and Innovation Centre, Eastern Institute of Technology, Napier 4112, New Zealand;
| | - Erica D’Souza
- School of Future Environments, AUT University, Auckland 1141, New Zealand;
| | - Boyd Swinburn
- School of Population Health, University of Auckland, Auckland 1023, New Zealand; (B.S.); (S.G.)
| | - Sarah Gerritsen
- School of Population Health, University of Auckland, Auckland 1023, New Zealand; (B.S.); (S.G.)
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Design and Implementation of a Workshop for Evaluation of the Role of Power in Shaping and Solving Challenges in a Smart Foodshed. SUSTAINABILITY 2022. [DOI: 10.3390/su14052642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Current studies on data sharing via data commons or shared vocabularies using ontologies mainly focus on developing the infrastructure for data sharing yet little attention has been paid to the role of power in data sharing among food system stakeholders. Stakeholders within food systems have different interpretations of the types and magnitudes of their own and other’s level of power to solve food system challenges. Politically neutral, yet scientifically/socioeconomically accurate power classification systems are yet to be developed, and must be capable of enumerating and characterizing what power means to each stakeholder, existing power dynamics within the food system, as well as alternative forms of power not currently utilized to their full capacity. This study describes the design and implementation of a workshop, which used methods from community-based participatory modeling, to examine the role of power relative to data sharing and equitable health outcomes. Workshop participants co-created several boundary objects that described the power relationships among food system stakeholders and the changes needed to current power relationships. Our results highlight current imbalances in power relationships among food system stakeholders. The information we collected on specific relationships among broad categories of stakeholders highlighted needs for initiatives and activities to increase the types and varieties of power especially across consumers, farmers, and labor stakeholder groups. Furthermore, by utilizing this workshop methodology, food system stakeholders may be able to envision new power relationships and bring about a fundamental re-orienting of current power relationships capable of valorizing food system sustainability/resiliency, especially the health of its workers and consumers.
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Calancie L, Fullerton K, Appel JM, Korn AR, Hennessy E, Hovmand P, Economos CD. Implementing Group Model Building With the Shape Up Under 5 Community Committee Working to Prevent Early Childhood Obesity in Somerville, Massachusetts. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2022; 28:E43-E55. [PMID: 32810067 DOI: 10.1097/phh.0000000000001213] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To describe our process of using group model building (GMB) with the Shape Up Under 5 Committee; measure the effects on Committee members; and describe the community-wide health messaging campaign that resulted from the process. DESIGN Pilot study. SETTING Somerville, Massachusetts. PARTICIPANTS Members of the Shape Up Under 5 Committee, a multisector group of professionals. INTERVENTION Research team convened the Committee and facilitated GMB from October 2015 to June 2017. MAIN OUTCOME MEASURES Boundary objects produced during GMB activities; committee members' perspectives on early childhood obesity in their community; and Committee members' knowledge, engagement, and trust at the conclusion of each meeting. RESULTS Working together using GMB activities and with support from the research team, the Committee created a community-wide campaign that provided evidence-based messages to reach an entire city that emphasized diversity and reaching immigrants and community members who spoke languages other than English. More than 80% of Committee members reported changes in their perspectives related to early childhood obesity at the conclusion of the pilot test. Six perspective shift themes emerged from interviews and open-ended survey items: exposure to new perspectives about challenges community members face; increased awareness of others working on similar issues; increased knowledge about early childhood obesity; seeing value in creating a space to work across sectors; appreciating complexity and linkages between early childhood obesity prevention and other community issues; and how participation in committee influences members' priorities in their own work. Knowledge of and engagement with early childhood obesity prevention varied at the conclusion of each meeting, as did increases in trust among Committee members. CONCLUSION Group model building is a promising approach to support multisector groups working to address early childhood obesity in their community. Meeting activities may have had differential impacts on members' knowledge of and engagement with early childhood obesity.
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Affiliation(s)
- Larissa Calancie
- ChildObesity180, Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts (Drs Calancie, Korn, Hennessy, and Economos and Mss Fullerton and Appel); and Social System Design Lab, Brown School, Washington University in St Louis, St Louis, Missouri (Dr Hovmand)
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Moyo G, Montenegro-Montenegro E, Stickley Z, Egal A, Oldewage-Theron W. A Structural Equation Modelling Approach to Examine the Relationship between Socioeconomic Status, Diet Quality and Dyslipidaemia in South African Children and Adolescents, 6-18 Years. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312825. [PMID: 34886551 PMCID: PMC8657719 DOI: 10.3390/ijerph182312825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 11/19/2021] [Accepted: 11/26/2021] [Indexed: 11/16/2022]
Abstract
This study utilised a structural equation model to examine the relationship between diet quality, socioeconomic status, and cardiovascular disease (CVD) risk in South African learners. Confirmatory factor analysis was used to test the indirect effects model for diet, socioeconomic status, diet quality and cardiovascular risk using pre-existing cross-sectional data. The structural equation model was fit using Lavaan version 0.6-5 in R version 3.6.1. Data were analysed from 178 children and adolescents, aged 6-18 years, from five rural schools in Cofimvaba, South Africa. Latent variables were created for dietary quality, dyslipidaemia and the socioeconomic status of participants. A negative association was observed between socioeconomic status and dyslipidaemia in school-aged children (p = 0.029).
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Affiliation(s)
- Gugulethu Moyo
- Department of Nutritional Sciences, College of Human Sciences, Texas Tech University, 1301 Akron Ave, Lubbock, TX 79409, USA;
- Correspondence:
| | | | - Zachary Stickley
- Institute for Measurement, Methodology, Analysis & Policy, Texas Tech University, Lubbock, TX 79409, USA;
| | - Abdulkadir Egal
- Centre of Food and Nutrition Security, Somali National University, Mogadishu, Somalia;
| | - Wilna Oldewage-Theron
- Department of Nutritional Sciences, College of Human Sciences, Texas Tech University, 1301 Akron Ave, Lubbock, TX 79409, USA;
- Department of Sustainable Food Systems and Development, University of the Free State, Bloemfontein 9300, South Africa
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Body Composition Assessment and Mediterranean Diet Adherence in U12 Spanish Male Professional Soccer Players: Cross-Sectional Study. Nutrients 2021; 13:nu13114045. [PMID: 34836297 PMCID: PMC8623059 DOI: 10.3390/nu13114045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 11/08/2021] [Accepted: 11/10/2021] [Indexed: 01/10/2023] Open
Abstract
Soccer is the most practiced team sport in the world. Due to the importance of nutrition in soccer performance, controlling the body composition and dietary guidelines of players takes place starting from lower categories. The objective of this study was to evaluate body composition and adherence to the Mediterranean diet of U12 players from a professional soccer team and to identify their dietary weak points. Seventy-one U12 male soccer players participated in the study. Weight, height, percentiles, skinfolds, and body fat were measured by a certified anthropometrist following the procedures recommended by the International Society for the Advancement of Kinanthropometry. The Mediterranean diet adherence test (KIDMED) was the questionnaire used to evaluate eating habits. In addition, a comparison was made among field positions. The results showed percentiles and body fat percentages appropriate for their age. Furthermore, the average score on the KIDMED test showed that the players generally adhered well to the Mediterranean diet, although they should improve their consumption of fruits and vegetables, as well as avoid skipping breakfast. Moreover, goalkeepers and defenders had a higher percentile BMI and percentage of fat than midfielders and forwards. In addition, these players had lower KIDMED values than midfielders and forwards. Although U12 soccer players have an appropriate body composition and adherence to the Mediterranean diet, there are differences between the different field positions that should be assessed by coaches, doctors, and nutritionists/dietitians.
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Kołota A, Głąbska D. Analysis of Food Habits during Pandemic in a Polish Population-Based Sample of Primary School Adolescents: Diet and Activity of Youth during COVID-19 (DAY-19) Study. Nutrients 2021; 13:3711. [PMID: 34835967 PMCID: PMC8622037 DOI: 10.3390/nu13113711] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 10/19/2021] [Accepted: 10/19/2021] [Indexed: 02/07/2023] Open
Abstract
The improper dietary behaviors of children and adolescents during the COVID-19 pandemic, which are associated with lockdowns and reduced physical activity, are a complex problem, potentially resulting in increased risk of diet-related diseases, including overweight and obesity and their consequences. The aim of the study was to assess the food habits during the COVID-19 pandemic and to define their association with physical activity and body mass changes in a Polish population of primary school adolescents within the Diet and Activity of Youth During COVID-19 (DAY-19) Study. The DAY-19 Study was conducted in June 2020 in a national cohort of 1334 primary school students aged 10-16 years, recruited based on a stratified random sampling of schools (sampling counties from voivodeships and schools from counties). The Adolescent Food Habits Checklist (AFHC) was used to assess food habits, associated with food purchase, preparation, and consumption, which in the studied group were analyzed separately for the period before (retrospective data) and during the COVID-19 pandemic (prospective data). The recognizable physical activity changes and recognizable body mass changes were also assessed (retrospective data) and respondents were classified as those declaring that their physical activity and body mass decreased, remained stable, or increased during the COVID-19 pandemic. It was observed that during the COVID-19 pandemic the majority of food habits changed in a statistically significant way (p < 0.05). Within food purchase habits, the number of respondents who declared choosing a low-fat lunch away from home decreased, often buying pastries or cakes decreased, and buying a low-fat crisps brand increased (p < 0.05). Within food preparation habits, the number of respondents who declared trying to keep overall fat intake down increased, trying to keep overall sugar intake down increased, eating at least one serving of vegetables or salad with evening meal increased, and usually including some chocolate and/or biscuits in a packed lunch decreased (p < 0.05). Within food consumption habits, the number of respondents who declared making sure that they eat at least one serving of fruit a day increased, eating at least three servings of fruit most days increased, making sure that they eat at least one serving of vegetables or salad a day increased, trying to ensure that they eat plenty of fruit and vegetables increased, often choosing a fruit when they have a snack between meals increased, eating at least three servings of fruit most days increased, and generally trying to have a healthy diet increased (p < 0.05). It was concluded that in the period of the COVID-19 pandemic and resultant remote education, adolescents in Poland presented different food habits than before, while the majority of changes were positive. The positive food purchase, preparation, and consumption habits were observed mainly in sub-groups of adolescents declaring decreased body mass or increased physical activity during the COVID-19 pandemic. It may be suggested that physical activity may support positive changes of dietary behaviors and while combined positive changes of diet and increased physical activity, they may effectively promote body mass reduction in adolescents.
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Affiliation(s)
- Aleksandra Kołota
- Department of Dietetics, Institute of Human Nutrition Sciences, Warsaw University of Life Sciences (SGGW-WULS), 159c Nowoursynowska Street, 02-776 Warsaw, Poland;
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Ren X, Jensen BW, Larsen SC, Rohde JF, Specht IO, Nielsen BM, Husby I, Bugge A, Andersen LB, Trolle E, Heitmann BL. Three-Year Intervention Effects on Food and Beverage Intake-Results from the Quasi-Experimental Copenhagen School Child Intervention Study (CoSCIS). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:10543. [PMID: 34639843 PMCID: PMC8507748 DOI: 10.3390/ijerph181910543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 09/27/2021] [Accepted: 10/04/2021] [Indexed: 11/23/2022]
Abstract
The diet of Danish children is often not in accordance with dietary guidelines. We aimed to evaluate changes in the intake of selected foods and beverages during a multi-component school-based physical activity intervention, and to investigate if changes were modified by socioeconomic status (SES). The study included 307 children (intervention group: 184; comparison group: 123) with information on dietary intake pre- and post-intervention as well as on SES. Linear regression models were conducted to assess the effect of the intervention on changes in dietary factors. Children from the intervention group increased their intake of whole-grain bread during the intervention (group means: 6.1 g/d (95% CI: 2.2 to 10.0) vs. 0.3 g/d (95% CI: -3.1 to 3.7) in the comparison group, p = 0.04). A significant interaction between SES and group allocation was observed to change in fruit intake (p = 0.01). Among children from low SES families, only those from the comparison group decreased their fruit intake (group means: -40.0 g/d (95% CI: -56.0 to -23.9) vs. 9.3 g/d (95% CI: -16.1 to 94) in the intervention group, p = 0.006). The present study found no convincing effect of introducing a multi-component intervention on dietary intake except a small beneficial effect on whole-grain bread consumption. However, beneficial intervention effects in fruit intake were found particularly among children from low SES families.
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Affiliation(s)
- Xuan Ren
- Research Unit for Dietary Studies at The Parker Institute, Bispebjerg and Frederiksberg Hospital, 2000 Frederiksberg, Denmark; (S.C.L.); (J.F.R.); (I.O.S.); (B.L.H.)
| | - Britt Wang Jensen
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, 2000 Frederiksberg, Denmark;
| | - Sofus Christian Larsen
- Research Unit for Dietary Studies at The Parker Institute, Bispebjerg and Frederiksberg Hospital, 2000 Frederiksberg, Denmark; (S.C.L.); (J.F.R.); (I.O.S.); (B.L.H.)
| | - Jeanett Friis Rohde
- Research Unit for Dietary Studies at The Parker Institute, Bispebjerg and Frederiksberg Hospital, 2000 Frederiksberg, Denmark; (S.C.L.); (J.F.R.); (I.O.S.); (B.L.H.)
| | - Ina Olmer Specht
- Research Unit for Dietary Studies at The Parker Institute, Bispebjerg and Frederiksberg Hospital, 2000 Frederiksberg, Denmark; (S.C.L.); (J.F.R.); (I.O.S.); (B.L.H.)
| | - Birgit Marie Nielsen
- Health Research and Innovation, Centre for Regional Development, Capital Region of Denmark, 2000 Copenhagen, Denmark;
| | - Ida Husby
- The Danish Health Authorities, 2300 Copenhagen, Denmark;
| | - Anna Bugge
- Department of Midwifery, Physiotherapy, Occupational Therapy and Psychomotor Therapy, University College Copenhagen, 2200 Copenhagen, Denmark;
| | - Lars Bo Andersen
- Department of Education, Arts and Sport, Western Norway University of Applied Sciences, 6851 Sogndal, Norway;
| | - Ellen Trolle
- Division of Food Technology, National Food Institute, Technical University of Denmark, 2800 Kongens Lyngby, Denmark;
| | - Berit Lilienthal Heitmann
- Research Unit for Dietary Studies at The Parker Institute, Bispebjerg and Frederiksberg Hospital, 2000 Frederiksberg, Denmark; (S.C.L.); (J.F.R.); (I.O.S.); (B.L.H.)
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Sydney Medical School, University of Sydney, Sydney, NSW 2006, Australia
- Department of Public Health, Section for General Practice, University of Copenhagen, 1014 Copenhagen, Denmark
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Browne J, Walker T, Brown A, Sherriff S, Christidis R, Egan M, Versace V, Allender S, Backholer K. Systems thinking for Aboriginal Health: Understanding the value and acceptability of group model building approaches. SSM Popul Health 2021; 15:100874. [PMID: 34355056 PMCID: PMC8325093 DOI: 10.1016/j.ssmph.2021.100874] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 07/08/2021] [Accepted: 07/13/2021] [Indexed: 12/25/2022] Open
Abstract
Systems thinking is increasingly applied to understand and address systemic drivers of complex health problems. In Australia, group model building, a participatory method from systems science, has been applied in various locations to engage communities in systems-based health promotion projects. To date there is limited evidence regarding GMB use with Australian Aboriginal communities. This study aimed to determine the value and acceptability of group model building (GMB) as a methodological approach in research with Aboriginal communities and identify any adaptations required to optimise its utility. Semi-structured interviews were undertaken with 18 Aboriginal health and university staff who had prior experience with a GMB research project. Interview transcripts were inductively analysed using thematic analysis and key themes were organised using an Indigenous research framework. Participants reported that GMB methods generally aligned well with Aboriginal ways of knowing, being, and doing. Participants valued the holistic, visual and collaborative nature of the method and its emphasis on sharing stories and collective decision-making. Group model building was viewed as a useful tool for identifying Aboriginal-led actions to address priority issues and advancing self-determination. Our findings suggest that by bringing together Aboriginal and non-Aboriginal knowledge, GMB is a promising tool, which Aboriginal communities could utilise to explore and address complex problems in a manner that is consistent with their worldviews. In adapting group model building methods, non-Aboriginal researchers should aspire to move beyond co-design processes and enable Aboriginal health research to be entirely led by Aboriginal people. Group model building is a promising method for research with Aboriginal communities that is generally consistent with Aboriginal worldviews. Group Model Building may be a useful tool for identifying actions to address priority issues and advancing Aboriginal self-determination. Capacity building is required so that Group Model Building workshops, and ideally entire research projects, can be led by Aboriginal people.
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Affiliation(s)
- Jennifer Browne
- Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Locked Bag, 20000, Geelong Victoria, Australia
| | - Troy Walker
- Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Locked Bag, 20000, Geelong Victoria, Australia
| | - Andrew Brown
- Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Locked Bag, 20000, Geelong Victoria, Australia
| | - Simone Sherriff
- Sax Institute, Level 3/30C Wentworth St, Glebe, NSW, Australia
| | - Rebecca Christidis
- Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Locked Bag, 20000, Geelong Victoria, Australia
| | - Mikaela Egan
- Victorian Aboriginal Community Controlled Health Organisation, 17-23, Sackville St Collingwood, Victoria, Australia
| | - Vincent Versace
- Deakin Rural Health, School of Medicine, Deakin University, PO Box 423, Warrnambool Victoria, Australia
| | - Steven Allender
- Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Locked Bag, 20000, Geelong Victoria, Australia
| | - Kathryn Backholer
- Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Locked Bag, 20000, Geelong Victoria, Australia
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Jessiman PE, Powell K, Williams P, Fairbrother H, Crowder M, Williams JG, Kipping R. A systems map of the determinants of child health inequalities in England at the local level. PLoS One 2021; 16:e0245577. [PMID: 33577596 PMCID: PMC7880458 DOI: 10.1371/journal.pone.0245577] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 01/05/2021] [Indexed: 12/03/2022] Open
Abstract
Children and young people in the UK have worse health outcomes than in many similar western countries and child health inequalities are persistent and increasing. Systems thinking has emerged as a promising approach to addressing complex public health issues. We report on a systems approach to mapping the determinants of child health inequalities at the local level in England for young people aged 0-25, and describe the resulting map. Qualitative group concept mapping workshops were held in two contrasting English local authorities with a range of stakeholders: professionals (N = 35); children and young people (N = 33) and carers (N = 5). Initial area maps were developed, and augmented using data from qualitative interviews with professionals (N = 16). The resulting local maps were reviewed and validated by expert stakeholders in each area (N = 9; N = 35). Commonalities between two area-specific system maps (and removal of locality-specific factors) were used to develop a map that could be applied in any English local area. Two rounds of online survey (N = 21; N = 8) experts in public health, local governance and systems science refined the final system map displaying the determinants of child health inequalities. The process created a map of over 150 factors influencing inequalities in health outcomes for children aged 0-25 years at the local area level. The system map has six domains; physical environment, governance, economic, social, service, and personal. To our knowledge this is the first study taking a systems approach to addressing inequalities across all aspects of child health. The study shows how group concept mapping can support systems thinking at the local level. The resulting system map illustrates the complexity of factors influencing child health inequalities, and it may be a useful tool in demonstrating to stakeholders the importance of policies that tackle the systemic drivers of child health inequalities beyond those traditionally associated with public health.
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Affiliation(s)
- Patricia E. Jessiman
- Department of Population Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Katie Powell
- School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
| | - Philippa Williams
- Department of Population Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Hannah Fairbrother
- Health Sciences School, University of Sheffield, Sheffield, United Kingdom
| | - Mary Crowder
- School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
| | - Joanna G. Williams
- Department of Population Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Ruth Kipping
- Department of Population Health Sciences, University of Bristol, Bristol, United Kingdom
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Bensberg M, Joyce A, Wilson E. Building a Prevention System: Infrastructure to Strengthen Health Promotion Outcomes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:1618. [PMID: 33567719 PMCID: PMC7914461 DOI: 10.3390/ijerph18041618] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 02/01/2021] [Accepted: 02/04/2021] [Indexed: 12/27/2022]
Abstract
Prevention systems improve the performance of health promotion interventions. This research describes the establishment of the Australian state government initiative, Healthy Together Victoria's (HTV) macro infrastructure for the delivery of large-scale prevention interventions. METHODS This paper reports on findings of 31 semi-structured interviews about participants' understanding of systems thinking and their reflections of the strengths and weaknesses of the HTV prevention system. A chronic disease prevention framework informed the coding that was used to create a causal loop diagram and a core feedback loop to illustrate the results. RESULTS Findings highlighted that HTV created a highly connected prevention system that included a sizeable workforce, significant funding and supportive leadership. Operating guidelines, additional professional development and real-time evaluation were significant gaps, which hindered systems practice. For inexperienced systems thinkers, these limitations encouraged them to implement programs, rather than interact with the seemingly ambiguous systems methods. CONCLUSIONS HTV was an innovative attempt to strengthen health promotion infrastructure, creating a common language and shared understanding of prevention system requirements. However, the model was inadequate for HTV to achieve population-level reductions in chronic disease as system oversight was missing, as was an intervention delivery focus. Clarity was needed to define the systems practice that HTV was seeking to achieve. Importantly, the HTV prevention system needed to be understood as complex and adaptive, and not prioritized as individual parts.
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Affiliation(s)
- Monica Bensberg
- Centre for Social Impact, Faculty of Business and Law, Swinburne University of Technology, P.O. Box 218, Mail H25, Hawthorn, VIC 3122, Australia; (A.J.); (E.W.)
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Athavale P, Khadka N, Roy S, Mukherjee P, Chandra Mohan D, Turton B(B, Sokal-Gutierrez K. Early Childhood Junk Food Consumption, Severe Dental Caries, and Undernutrition: A Mixed-Methods Study from Mumbai, India. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17228629. [PMID: 33233797 PMCID: PMC7699964 DOI: 10.3390/ijerph17228629] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 11/14/2020] [Accepted: 11/15/2020] [Indexed: 12/18/2022]
Abstract
In India, globalization has caused a nutrition transition from home-cooked foods to processed sugary snacks and drinks, contributing to increased early childhood caries (ECC). This mixed-methods study describes risk factors for ECC and associations with undernutrition in low-income communities in Mumbai. Interviews with mothers of 959 children, ages six-months through six-years, addressed maternal-child nutrition and oral health, and children received dental exams and anthropometric assessments. Focus groups with community health workers and mothers explored experiences and perceptions of oral health, nutrition, and ECC. Descriptive and logistic regression analyses of quantitative data, and content analysis of qualitative data were performed. Eighty percent of children lived 5 min from a junk-food store, over 50% consumed junk-food and sugary tea daily, 50% experienced ECC, 19% had severe deep tooth decay, 27% experienced mouth pain, and 56% experienced chronic and/or acute malnutrition. In children ages 3–6, each additional tooth with deep decay was associated with increased odds of undernutrition (Odds Ratio [OR] 1.10, Confidence Interval [CI] 1.02–1.21). Focus groups identified the junk-food environment, busy family life, and limited dental care as contributors to ECC. Policy interventions include limits on junk-food marketing and incorporating oral health services and counseling on junk-food/sugary drinks into maternal–child health programs.
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Affiliation(s)
- Priyanka Athavale
- School of Public Health, University of California, Berkeley, CA 94704, USA; (N.K.); (S.R.); (D.C.M.); (K.S.-G.)
- School of Medicine, University of California, San Francisco, CA 94143, USA
- Correspondence: ; Tel.: +1-(408)-647-0477
| | - Nehaa Khadka
- School of Public Health, University of California, Berkeley, CA 94704, USA; (N.K.); (S.R.); (D.C.M.); (K.S.-G.)
- Fielding School of Public Health, Department of Epidemiology, University of California, Los Angeles, CA 90095, USA
| | - Shampa Roy
- School of Public Health, University of California, Berkeley, CA 94704, USA; (N.K.); (S.R.); (D.C.M.); (K.S.-G.)
| | | | - Deepika Chandra Mohan
- School of Public Health, University of California, Berkeley, CA 94704, USA; (N.K.); (S.R.); (D.C.M.); (K.S.-G.)
| | | | - Karen Sokal-Gutierrez
- School of Public Health, University of California, Berkeley, CA 94704, USA; (N.K.); (S.R.); (D.C.M.); (K.S.-G.)
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Novel participatory methods for co-building an agent-based model of physical activity with youth. PLoS One 2020; 15:e0241108. [PMID: 33170862 PMCID: PMC7654780 DOI: 10.1371/journal.pone.0241108] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 10/09/2020] [Indexed: 12/15/2022] Open
Abstract
Public health scholarship has increasingly called for the use of system science approaches to understand complex problems, including the use of participatory engagement to inform the modeling process. Some system science traditions, specifically system dynamics modeling, have an established participatory practice tradition. Yet, there remains limited guidance on engagement strategies using other modeling approaches like agent-based models. Our objective is to describe how we engaged adolescent youth in co-building an agent-based model about physical activity. Specifically, we aim to describe how we communicated technical aspects of agent-based models, the participatory activities we developed, and the resulting visual diagrams that were produced. We implemented six sessions with nine adolescent participants. To make technical aspects more accessible, we used an analogy that linked core components of agent-based models to elements of storytelling. We also implemented novel, facilitated activities that engaged youth in the development, annotation, and review of graphs over time, geographical maps, and state charts. The process was well-received by the participants and helped inform the basic structure of an agent-based model. The resulting visual diagrams created space for deeper discussion among participants about patterns of daily activity, important places for physical activity, and interactions between social and built environments. This work lays a foundation to develop and refine engagement strategies, especially for translating qualitative insights into quantitative model specifications such as ‘decision rules’.
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Fruits and fruit by-products as sources of bioactive compounds. Benefits and trends of lactic acid fermentation in the development of novel fruit-based functional beverages. Food Res Int 2020; 140:109854. [PMID: 33648172 DOI: 10.1016/j.foodres.2020.109854] [Citation(s) in RCA: 72] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 10/07/2020] [Accepted: 10/25/2020] [Indexed: 12/11/2022]
Abstract
Current awareness about the benefits of a balanced diet supports ongoing trends in humans towards a healthier diet. This review provides an overview of fruits and fruit-by products as sources of bioactive compounds and their extraction techniques, and the use of lactic acid fermentation of fruit juices to increase their functionality. Fruit matrices emerge as a technological alternative to be fermented by autochthonous or allochthonous lactic acid bacteria (LAB such as Lactiplantibacillus plantarum, Lacticaseibacillus rhamnosus, and other Lactobacillus species), and also as probiotic vehicles. During fermentation, microbial enzymes act on several fruit phytochemicals producing new derived compounds with impact on the aroma and the functionality of the fermented drinks. Moreover, fermentation significantly reduces the sugar content improving their nutritional value and extending the shelf-life of fruit-based beverages. The generation of new probiotic beverages as alternatives to consumers with intolerance to lactose or with vegan or vegetarian diets is promising for the worldwide functional food market. An updated overview on the current knowledge of the use of fruit matrices to be fermented by LAB and the interaction between strains and the fruit phytochemical compounds to generate new functional foods as well as their future perspectives in association with the application of nanotechnology techniques are presented in this review.
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Hodder RK, O'Brien KM, Tzelepis F, Wyse RJ, Wolfenden L. Interventions for increasing fruit and vegetable consumption in children aged five years and under. Cochrane Database Syst Rev 2020; 5:CD008552. [PMID: 32449203 PMCID: PMC7273132 DOI: 10.1002/14651858.cd008552.pub7] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Insufficient consumption of fruits and vegetables in childhood increases the risk of future non-communicable diseases, including cardiovascular disease. Testing the effects of interventions to increase consumption of fruit and vegetables, including those focused on specific child-feeding strategies or broader multicomponent interventions targeting the home or childcare environment is required to assess the potential to reduce this disease burden. OBJECTIVES To assess the effectiveness, cost effectiveness and associated adverse events of interventions designed to increase the consumption of fruit, vegetables or both amongst children aged five years and under. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase and two clinical trials registries to identify eligible trials on 25 January 2020. We searched Proquest Dissertations and Theses in November 2019. We reviewed reference lists of included trials and handsearched three international nutrition journals. We contacted authors of included trials to identify further potentially relevant trials. SELECTION CRITERIA We included randomised controlled trials, including cluster-randomised controlled trials and cross-over trials, of any intervention primarily targeting consumption of fruit, vegetables or both among children aged five years and under, and incorporating a dietary or biochemical assessment of fruit or vegetable consumption. Two review authors independently screened titles and abstracts of identified papers; a third review author resolved disagreements. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data and assessed the risks of bias of included trials; a third review author resolved disagreements. Due to unexplained heterogeneity, we used random-effects models in meta-analyses for the primary review outcomes where we identified sufficient trials. We calculated standardised mean differences (SMDs) to account for the heterogeneity of fruit and vegetable consumption measures. We conducted assessments of risks of bias and evaluated the quality of evidence (GRADE approach) using Cochrane procedures. MAIN RESULTS We included 80 trials with 218 trial arms and 12,965 participants. Fifty trials examined the impact of child-feeding practices (e.g. repeated food exposure) in increasing child vegetable intake. Fifteen trials examined the impact of parent nutrition education only in increasing child fruit and vegetable intake. Fourteen trials examined the impact of multicomponent interventions (e.g. parent nutrition education and preschool policy changes) in increasing child fruit and vegetable intake. Two trials examined the effect of a nutrition education intervention delivered to children in increasing child fruit and vegetable intake. One trial examined the impact of a child-focused mindfulness intervention in increasing vegetable intake. We judged 23 of the 80 included trials as free from high risks of bias across all domains. Performance, detection and attrition bias were the most common domains judged at high risk of bias for the remaining trials. There is low-quality evidence that child-feeding practices versus no intervention may have a small positive effect on child vegetable consumption, equivalent to an increase of 5.30 grams as-desired consumption of vegetables (SMD 0.50, 95% CI 0.29 to 0.71; 19 trials, 2140 participants; mean post-intervention follow-up = 8.3 weeks). Multicomponent interventions versus no intervention has a small effect on child consumption of fruit and vegetables (SMD 0.32, 95% CI 0.09 to 0.55; 9 trials, 2961 participants; moderate-quality evidence; mean post-intervention follow-up = 5.4 weeks), equivalent to an increase of 0.34 cups of fruit and vegetables a day. It is uncertain whether there are any short-term differences in child consumption of fruit and vegetables in meta-analyses of trials examining parent nutrition education versus no intervention (SMD 0.13, 95% CI -0.02 to 0.28; 11 trials, 3050 participants; very low-quality evidence; mean post-intervention follow-up = 13.2 weeks). We were unable to pool child nutrition education interventions in meta-analysis; both trials reported a positive intervention effect on child consumption of fruit and vegetables (low-quality evidence). Very few trials reported long-term effectiveness (6 trials), cost effectiveness (1 trial) or unintended adverse consequences of interventions (2 trials), limiting our ability to assess these outcomes. Trials reported receiving governmental or charitable funds, except for four trials reporting industry funding. AUTHORS' CONCLUSIONS Despite identifying 80 eligible trials of various intervention approaches, the evidence for how to increase children's fruit and vegetable consumption remains limited in terms of quality of evidence and magnitude of effect. Of the types of interventions identified, there was moderate-quality evidence that multicomponent interventions probably lead to, and low-quality evidence that child-feeding practice may lead to, only small increases in fruit and vegetable consumption in children aged five years and under. It is uncertain whether parent nutrition education or child nutrition education interventions alone are effective in increasing fruit and vegetable consumption in children aged five years and under. Our confidence in effect estimates for all intervention approaches, with the exception of multicomponent interventions, is limited on the basis of the very low to low-quality evidence. Long-term follow-up of at least 12 months is required and future research should adopt more rigorous methods to advance the field. This is a living systematic review. Living systematic reviews offer a new approach to review updating, in which the review is continually updated, incorporating relevant new evidence as it becomes available. Please refer to the Cochrane Database of Systematic Reviews for the current status of this review.
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Affiliation(s)
- Rebecca K Hodder
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton, Australia
- Priority Research Centre in Health and Behaviour, University of Newcastle, Callaghan, Australia
| | - Kate M O'Brien
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton, Australia
- Priority Research Centre in Health and Behaviour, University of Newcastle, Callaghan, Australia
| | - Flora Tzelepis
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton, Australia
- Priority Research Centre in Health and Behaviour, University of Newcastle, Callaghan, Australia
| | - Rebecca J Wyse
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton, Australia
- Priority Research Centre in Health and Behaviour, University of Newcastle, Callaghan, Australia
| | - Luke Wolfenden
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton, Australia
- Priority Research Centre in Health and Behaviour, University of Newcastle, Callaghan, Australia
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Community Group Model Building as a Method for Engaging Participants and Mobilising Action in Public Health. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17103457. [PMID: 32429183 PMCID: PMC7277214 DOI: 10.3390/ijerph17103457] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 05/13/2020] [Accepted: 05/13/2020] [Indexed: 11/17/2022]
Abstract
Group model building (GMB) is a qualitative method aimed at engaging stakeholders to collectively consider the causes of complex problems. Tackling inequities in community nutrition is one such complex problem, as the causes are driven by a variety of interactions between individual factors, social structures, local environments and the global food system. This methods paper describes a GMB process that utilises three system mapping tools in a study with members of a multicultural, low-income community to explore declining fruit and vegetable intake in children. The tools were: 1) graphs over time, which captures the community's understanding of an issue; 2) cognitive mapping, which enables participants to think systemically about the causes and consequences of the issue; 3) causal loop diagrams, which describe feedback loops that reinforce the issue and identify potential actions. Cognitive mapping, a tool not usually associated with GMB, was added to the research process to support the gradual development of participants' thinking and develops the skills needed to tackle an issue from a systems perspective. We evaluate the benefits and impact of these three tools, particularly in engaging participants and increasing understanding of systems thinking in order to develop and mobilise action. The tools could be adapted for use in other community-based research projects. Key learnings were the value of genuine partnership with a local organisation for longevity of the project, recruitment of key decisionmakers from the community early in the process, and allowing time to create sustainable change.
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Hodder RK, O'Brien KM, Stacey FG, Tzelepis F, Wyse RJ, Bartlem KM, Sutherland R, James EL, Barnes C, Wolfenden L. Interventions for increasing fruit and vegetable consumption in children aged five years and under. Cochrane Database Syst Rev 2019; 2019:CD008552. [PMID: 31697869 PMCID: PMC6837849 DOI: 10.1002/14651858.cd008552.pub6] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Insufficient consumption of fruits and vegetables in childhood increases the risk of future non-communicable diseases, including cardiovascular disease. Interventions to increase consumption of fruit and vegetables, such as those focused on specific child-feeding strategies and parent nutrition education interventions in early childhood may therefore be an effective strategy in reducing this disease burden. OBJECTIVES To assess the effectiveness, cost effectiveness and associated adverse events of interventions designed to increase the consumption of fruit, vegetables or both amongst children aged five years and under. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase and two clinical trials registries to identify eligible trials on 25 August 2019. We searched Proquest Dissertations and Theses in May 2019. We reviewed reference lists of included trials and handsearched three international nutrition journals. We contacted authors of included trials to identify further potentially relevant trials. SELECTION CRITERIA We included randomised controlled trials, including cluster-randomised controlled trials and cross-over trials, of any intervention primarily targeting consumption of fruit, vegetables or both among children aged five years and under, and incorporating a dietary or biochemical assessment of fruit or vegetable consumption. Two review authors independently screened titles and abstracts of identified papers; a third review author resolved disagreements. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data and assessed the risks of bias of included trials; a third review author resolved disagreements. Due to unexplained heterogeneity, we used random-effects models in meta-analyses for the primary review outcomes where we identified sufficient trials. We calculated standardised mean differences (SMDs) to account for the heterogeneity of fruit and vegetable consumption measures. We conducted assessments of risks of bias and evaluated the quality of evidence (GRADE approach) using Cochrane procedures. MAIN RESULTS We included 78 trials with 214 trial arms and 13,746 participants. Forty-eight trials examined the impact of child-feeding practices (e.g. repeated food exposure) in increasing child vegetable intake. Fifteen trials examined the impact of parent nutrition education in increasing child fruit and vegetable intake. Fourteen trials examined the impact of multicomponent interventions (e.g. parent nutrition education and preschool policy changes) in increasing child fruit and vegetable intake. Two trials examined the effect of a nutrition education intervention delivered to children in increasing child fruit and vegetable intake. One trial examined the impact of a child-focused mindfulness intervention in increasing vegetable intake. We judged 20 of the 78 included trials as free from high risks of bias across all domains. Performance, detection and attrition bias were the most common domains judged at high risk of bias for the remaining trials. There is very low-quality evidence that child-feeding practices versus no intervention may have a small positive effect on child vegetable consumption equivalent to an increase of 4.45 g as-desired consumption of vegetables (SMD 0.42, 95% CI 0.23 to 0.60; 18 trials, 2004 participants; mean post-intervention follow-up = 8.2 weeks). Multicomponent interventions versus no intervention has a small effect on child consumption of fruit and vegetables (SMD 0.34, 95% CI 0.10 to 0.57; 9 trials, 3022 participants; moderate-quality evidence; mean post-intervention follow-up = 5.4 weeks), equivalent to an increase of 0.36 cups of fruit and vegetables per day. It is uncertain whether there are any short-term differences in child consumption of fruit and vegetables in meta-analyses of trials examining parent nutrition education versus no intervention (SMD 0.12, 95% CI -0.03 to 0.28; 11 trials, 3078 participants; very low-quality evidence; mean post-intervention follow-up = 13.2 weeks). We were unable to pool child nutrition education interventions in meta-analysis; both trials reported a positive intervention effect on child consumption of fruit and vegetables (low-quality evidence). Very few trials reported long-term effectiveness (6 trials), cost effectiveness (1 trial) and unintended adverse consequences of interventions (2 trials), limiting their assessment. Trials reported receiving governmental or charitable funds, except for four trials reporting industry funding. AUTHORS' CONCLUSIONS Despite identifying 78 eligible trials of various intervention approaches, the evidence for how to increase children's fruit and vegetable consumption remains limited. There was very low-quality evidence that child-feeding practice may lead to, and moderate-quality evidence that multicomponent interventions probably lead to small increases in fruit and vegetable consumption in children aged five years and younger. It is uncertain whether parent nutrition education interventions are effective in increasing fruit and vegetable consumption in children aged five years and younger. Given that the quality of the evidence is very low or low, future research will likely change estimates and conclusions. Long-term follow-up of at least 12 months is required and future research should adopt more rigorous methods to advance the field. This is a living systematic review. Living systematic reviews offer a new approach to review updating, in which the review is continually updated, incorporating relevant new evidence as it becomes available. Please refer to the Cochrane Database of Systematic Reviews for the current status of this review.
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Affiliation(s)
- Rebecca K Hodder
- Hunter New England Local Health DistrictHunter New England Population HealthLocked Bag 10WallsendAustralia2287
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia
- Hunter Medical Research InstituteNew LambtonAustralia
- University of NewcastlePriority Research Centre in Health and BehaviourCallaghanAustralia
| | - Kate M O'Brien
- Hunter New England Local Health DistrictHunter New England Population HealthLocked Bag 10WallsendAustralia2287
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia
- Hunter Medical Research InstituteNew LambtonAustralia
- University of NewcastlePriority Research Centre in Health and BehaviourCallaghanAustralia
| | - Fiona G Stacey
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia
- Hunter Medical Research InstituteNew LambtonAustralia
- University of NewcastlePriority Research Centre in Health and BehaviourCallaghanAustralia
- University of NewcastlePriority Research Centre in Physical Activity and NutritionCallaghanAustralia
| | - Flora Tzelepis
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia
- Hunter Medical Research InstituteNew LambtonAustralia
- University of NewcastlePriority Research Centre in Health and BehaviourCallaghanAustralia
| | - Rebecca J Wyse
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia
- Hunter Medical Research InstituteNew LambtonAustralia
- University of NewcastlePriority Research Centre in Health and BehaviourCallaghanAustralia
| | - Kate M Bartlem
- University of NewcastleSchool of PsychologyUniversity DriveCallaghanNew South WalesAustralia2308
| | - Rachel Sutherland
- Hunter New England Local Health DistrictHunter New England Population HealthLocked Bag 10WallsendAustralia2287
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia
- Hunter Medical Research InstituteNew LambtonAustralia
- University of NewcastlePriority Research Centre in Health and BehaviourCallaghanAustralia
| | - Erica L James
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia
- Hunter Medical Research InstituteNew LambtonAustralia
| | - Courtney Barnes
- Hunter New England Local Health DistrictHunter New England Population HealthLocked Bag 10WallsendAustralia2287
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia
- Hunter Medical Research InstituteNew LambtonAustralia
- University of NewcastlePriority Research Centre in Health and BehaviourCallaghanAustralia
| | - Luke Wolfenden
- Hunter New England Local Health DistrictHunter New England Population HealthLocked Bag 10WallsendAustralia2287
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia
- Hunter Medical Research InstituteNew LambtonAustralia
- University of NewcastlePriority Research Centre in Health and BehaviourCallaghanAustralia
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