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Poole MK, Emmons KM, Gortmaker SL, Rimm EB, Kenney EL. Exploring the Cross-Sectional Relationship Between Implementation Supports for Adopting Nutrition Standards and the Nutritional Quality of School Lunches Served. J Acad Nutr Diet 2024:S2212-2672(24)00839-6. [PMID: 39278348 DOI: 10.1016/j.jand.2024.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 06/28/2024] [Accepted: 09/11/2024] [Indexed: 09/18/2024]
Abstract
BACKGROUND The evidence-based nutrition standards of the Healthy, Hunger-Free Kids Act of 2010 significantly improved school meal nutrition, yet little is known about how school food authorities (SFAs) were supported to translate the standards into practice in schools. OBJECTIVE This study tested whether or not 2 implementation supports, SFA receipt of training/technical assistance (TA) and purchase of new equipment, for implementing the nutrition standards were associated with the nutritional quality of school lunches. DESIGN This study used a cross-sectional design. PARTICIPANTS/SETTING The study sample included 365 SFAs derived from the US Department of Agriculture's School Nutrition and Meal Cost Study (2014 to 2015 school year), the only national data of school nutrition environments since the Healthy, Hunger-Free Kids Act of 2010. MAIN OUTCOME MEASURES Implementation supports included reported participation in training/TA and the purchase of new equipment between the 2012 to 2013 (year of policy adoption) and 2014 to 2015 school years. The primary outcome, nutritional quality of school lunches served, was defined as low/high Healthy Eating Index 2010 scores during the 2014 to 2015 school year. Secondary implementation supports included the number of areas covered by training/TA, the adequacy of training/TA, and the degree of implementation challenges. STATISTICAL ANALYSES Multivariable-adjusted logistic regression models assessed if receipt of implementation supports was associated with lunch Healthy Eating Index 2010 scores. RESULTS The median lunch Healthy Eating Index 2010 score was 81.7 (95% CI 80.4 to 82.9). Most SFAs (78.4%, 95% CI 72.0% to 85.0%) reported having participated in training/TA and one-third (33.8%, 95% CI 24.4% to 43.2%) reported having purchased new equipment-neither were associated with the odds of having higher Healthy Eating Index 2010 scores for lunches served at the time of data collection. CONCLUSIONS Many SFAs accessed implementation supports to adopt the nutrition standards. Information on dose, quality, and nutrition-related impact of implementation supports using measures of change are needed to determine how best to support SFAs with implementation of new nutrition standards.
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Affiliation(s)
- Mary Kathryn Poole
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
| | - Karen M Emmons
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Steven L Gortmaker
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Eric B Rimm
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Erica L Kenney
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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Langner J, Langston K, Mrachek A, Faitak B, Martin P, Cueto A, Clampitt JL, Long CR, Bartow A, Bodey S, McElfish PA. Creating Healthy Environments for Schools: A Comprehensive Approach to Improving Nutrition in Arkansas Public Schools. THE JOURNAL OF SCHOOL HEALTH 2024; 94:653-660. [PMID: 38267004 DOI: 10.1111/josh.13437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 12/12/2023] [Accepted: 01/04/2024] [Indexed: 01/26/2024]
Abstract
BACKGROUND Nutrition plays a vital role in children's physical and emotional health. More than half of school age children's calories are provided in the school food environment, making school interventions an opportunity to address child nutrition. METHODS The Creating Health Environments for Schools (CHEFS) program is designed to leverage local resources to create customized solutions that improve the nutritional content of school food and encourage children to choose healthier food. There are 8 components: (1) customizing nutrition plans, (2) modifying/replacing menu items, (3) helping procure healthier food, (4) providing equipment grants, (5) training cafeteria staff, (6) implementing environmental changes and nudges, (7) engaging students and parents, and (8) supporting sustainability. Supporting child nutrition directors is key to facilitating cooperation with schools. IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY Menu modifications and procurement are interrelated and depend on successfully collaborating with corporate, independent, and local food services organizations. Limited school budgets require low or no-cost solutions and staff training. Student and parent engagement are critical to facilitate culturally-appropriate solutions that increase awareness of healthy food. CONCLUSIONS Every school district has particular resources and constraints. CHEFs engaged stakeholders to design customized solutions and encourage healthier nutrition for school children.
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Affiliation(s)
- Jonathan Langner
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Springdale, AR, 72762
| | - Krista Langston
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Springdale, AR, 72762
| | - Ally Mrachek
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Springdale, AR, 72762
| | - Bonnie Faitak
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Springdale, AR, 72762
| | - Pamela Martin
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Springdale, AR, 72762
| | - Alexa Cueto
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Springdale, AR, 72762
| | - Jennifer L Clampitt
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Springdale, AR, 72762
| | | | | | | | - Pearl A McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Springdale, AR, 72762
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Huang TTK, Callahan EA, Haines ER, Hooley C, Sorensen DM, Lounsbury DW, Sabounchi NS, Hovmand PS. Leveraging systems science and design thinking to advance implementation science: moving toward a solution-oriented paradigm. Front Public Health 2024; 12:1368050. [PMID: 38813425 PMCID: PMC11135204 DOI: 10.3389/fpubh.2024.1368050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 04/23/2024] [Indexed: 05/31/2024] Open
Abstract
Many public health challenges are characterized by complexity that reflects the dynamic systems in which they occur. Such systems involve multiple interdependent factors, actors, and sectors that influence health, and are a primary driver of challenges of insufficient implementation, sustainment, and scale of evidence-based public health interventions. Implementation science frameworks have been developed to help embed evidence-based interventions in diverse settings and identify key factors that facilitate or hinder implementation. These frameworks are largely static in that they do not explain the nature and dynamics of interrelationships among the identified determinants, nor how those determinants might change over time. Furthermore, most implementation science frameworks are top-down, deterministic, and linear, leaving critical gaps in understanding of both how to intervene on determinants of successful implementation and how to scale evidence-based solutions. Design thinking and systems science offer methods for transforming this problem-oriented paradigm into one that is solution-oriented. This article describes these two approaches and how they can be integrated into implementation science strategies to promote implementation, sustainment, and scaling of public health innovation, ultimately resulting in transformative systems changes that improve population health.
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Affiliation(s)
- Terry T.-K. Huang
- Center for Systems and Community Design and NYU-CUNY Prevention Research Center, Graduate School of Public Health & Health Policy, City University of New York, New York, NY, United States
| | | | - Emily R. Haines
- School of Medicine, Wake Forest University, Winston-Salem, NC, United States
| | - Cole Hooley
- School of Social Work, Brigham Young University, Provo, UT, United States
| | | | - David W. Lounsbury
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Nasim S. Sabounchi
- Center for Systems and Community Design, Graduate School of Public Health & Health Policy, City University of New York, New York, NY, United States
| | - Peter S. Hovmand
- Center for Community Health Integration, School of Medicine, Case Western Reserve University, Cleveland, OH, United States
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Vaughan KL, Cade JE, Hetherington MM, Webster J, Evans CEL. The impact of school-based cooking classes on vegetable intake, cooking skills and food literacy of children aged 4-12 years: A systematic review of the evidence 2001-2021. Appetite 2024; 195:107238. [PMID: 38331100 DOI: 10.1016/j.appet.2024.107238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 01/24/2024] [Accepted: 01/24/2024] [Indexed: 02/10/2024]
Abstract
BACKGROUND Many children consume a poor quality diet with only a third of children aged 6-9 years eating vegetables daily. A high quality diet is important for good health in childhood; however, the prevalence of children living with obesity has doubled from 10% to 23% during primary school in the UK. Cooking lessons have the potential to improve diet quality and reduce obesity prevalence in childhood, both of which are associated with improved cardiometabolic outcomes in adulthood. The aim of this systematic review is to investigate the impact of school-based cooking classes on cooking skills, food literacy and vegetable intake of children aged 4-12 years. METHODS We conducted a systematic review of OVID Medline, OVID Embase, EBSCO CINHAL and EBSCO ERIC for comparative studies that evaluated outcomes of children receiving cooking classes compared to a control group. Interventions included contained food preparation or a cooking activities and took place on school premises. Risk of bias was assessed using ROB2 and Robins-I. Outcomes were pooled in a meta-analysis using a random-effects model using standardised mean differences or reviewed using narrative synthesis. Certainty of evidence was assessed using GRADE. RESULTS We included 21 studies, (6 randomised). Meta-analysis showed a small positive effect on cooking self-efficacy of 0.39 units (95% CI 0.05 to 0.54), and a small positive effect on vegetable intake of 0.25 units (95% CI 0.05 to 0.45). Programmes with more than 6 h of cooking showed the greatest effects. CONCLUSIONS Children's cooking programmes result in small improvements in cooking efficacy and vegetable intake, particularly those with more than 6 h of classes. It is recommended that future interventions use consistent measurement for children's food literacy and cooking confidence.
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Erfani K, Grabowski A, Parker G, Garrity A, Peterson KE, Lee JM, Nanda U. Point of Decision Design to Address Adolescent Overweight and Obesity. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2023; 16:182-194. [PMID: 36946329 PMCID: PMC11042780 DOI: 10.1177/19375867231153365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
OBJECTIVES This study aims to utilize the point of decision design framework to understand how, where, and why adolescents and families make decisions about diet and physical activity and to explore how modifications to the environment can help to promote healthier choices and reduce obesity. BACKGROUND Child and adolescent obesity is a critical public health problem. As environmental factors are a primary contributor, understanding the role of design in our surrounding environment highlights an important area of interdisciplinary study. Design strategies have been used successfully to increase stair use and reduce sedentary behavior and can be used to further promote healthier diet and activity choices among adolescents and families. METHODS We leveraged the human-centered design-thinking process through (1) qualitative interviews and survey instruments, (2) persona and prompt development, and (3) a design workshop with multidisciplinary stakeholders. RESULTS Five personas were developed from the qualitative data and used in a design-thinking workshop. During the workshop, participants generated 12 influential factors and nine points of decision which were used to generate 33 solutions spanning the design continuum (from information and policy design to the design of urban, architectural, and interior environments) aimed at improving nutrition and physical activity among adolescents. Additionally, a tool kit was prototyped, which includes interview guides, a persona framework, and a workshop facilitation guide. CONCLUSIONS Our novel process led to the generation of design solutions that can be implemented to expand and improve upon existing interventions for childhood obesity and create environments that encourage positive health outcomes.
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Affiliation(s)
- Kimia Erfani
- A. Alfred Taubman College of Architecture and Urban Planning, University of Michigan, Ann Arbor, MI, USA
| | - Aria Grabowski
- Susan B. Meister Child Health Evaluation and Research Center, University of Michigan, Ann Arbor, MI, USA
- Department of Nutritional Sciences, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Grant Parker
- A. Alfred Taubman College of Architecture and Urban Planning, University of Michigan, Ann Arbor, MI, USA
| | - Ashley Garrity
- Susan B. Meister Child Health Evaluation and Research Center, University of Michigan, Ann Arbor, MI, USA
- Division of Pediatric Endocrinology, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Karen E. Peterson
- Department of Nutritional Sciences, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Joyce M. Lee
- Susan B. Meister Child Health Evaluation and Research Center, University of Michigan, Ann Arbor, MI, USA
- Division of Pediatric Endocrinology, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Upali Nanda
- A. Alfred Taubman College of Architecture and Urban Planning, University of Michigan, Ann Arbor, MI, USA
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Isbanner S, Carins J, Rundle-Thiele S. Healthy Eats-Evaluation of a Social Marketing Program Delivered in Primary School Settings in Queensland. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14415. [PMID: 36361286 PMCID: PMC9655208 DOI: 10.3390/ijerph192114415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 10/28/2022] [Accepted: 11/02/2022] [Indexed: 06/16/2023]
Abstract
One in four school children in Australia are overweight or obese. In response, the Healthy Eats program was developed, piloted, and delivered using a whole-of-school approach underpinned by the socio-ecological model to increase fruit and vegetable consumption among children aged 8-10 years in regional Queensland, Australia. This research presents an outcome evaluation of the Healthy Eats program using pre-post data collected throughout 2021 (cross-sectional for knowledge and longitudinal for behaviour) from 19 schools to assess whether changes occurred in students' nutritional knowledge (n = 1868 (pre = 933, post = 935)) and fruit and vegetable consumption (n = 1042 (pre = 521, post = 521)). Knowledge data was collected via self-reports two weeks prior and immediately after the Nutrition Module. Behavioural data on daily fruit and vegetable consumption was gathered via student passports (i.e., surveys) one week before and for four consecutive weeks after the Nutrition Module. Chi-Square Difference tests and t-Tests were conducted with a significance level set at p < 0.05. Across all 19 schools, knowledge of the daily recommended serves of fruit and vegetables improved significantly following participation in the program, aligning knowledge closer to the Australian dietary guidelines. Behavioural results for fruit consumption were favourable, with clear improvements reported. Increases in vegetable consumption were demonstrated in two of the eight schools. A discussion on the knowledge-action gap is provided, including recommendations for future iterations of the Healthy Eats program.
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Hong QN, Bangpan M, Stansfield C, Kneale D, O'Mara-Eves A, van Grootel L, Thomas J. Using systems perspectives in evidence synthesis: A methodological mapping review. Res Synth Methods 2022; 13:667-680. [PMID: 35932206 DOI: 10.1002/jrsm.1595] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 07/15/2022] [Accepted: 08/01/2022] [Indexed: 01/07/2023]
Abstract
Reviewing complex interventions is challenging because they include many elements that can interact dynamically in a nonlinear manner. A systems perspective offers a way of thinking to help understand complex issues, but its application in evidence synthesis is not established. The aim of this project was to understand how and why systems perspectives have been applied in evidence synthesis. A methodological mapping review was conducted to identify papers using a systems perspective in evidence synthesis. A search was conducted in seven bibliographic databases and three search engines. A total of 101 papers (representing 98 reviews) met the eligibility criteria. Two categories of reviews were identified: (1) reviews using a "systems lens" to frame the topic, generate hypotheses, select studies, and guide the analysis and interpretation of findings (n = 76) and (2) reviews using systems methods to develop a systems model (n = 22). Several methods (e.g., systems dynamic modeling, soft systems approach) were identified, and they were used to identify, rank and select elements, analyze interactions, develop models, and forecast needs. The main reasons for using a systems perspective were to address complexity, view the problem as a whole, and understand the interrelationships between the elements. Several challenges for capturing the true nature and complexity of a problem were raised when performing these methods. This review is a useful starting point when designing evidence synthesis of complex interventions. It identifies different opportunities for applying a systems perspective in evidence synthesis, and highlights both commonplace and less familiar methods.
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Affiliation(s)
- Quan Nha Hong
- EPPI-Centre, UCL Social Research Institute, University College London, London, UK
| | - Mukdarut Bangpan
- EPPI-Centre, UCL Social Research Institute, University College London, London, UK
| | - Claire Stansfield
- EPPI-Centre, UCL Social Research Institute, University College London, London, UK
| | - Dylan Kneale
- EPPI-Centre, UCL Social Research Institute, University College London, London, UK
| | - Alison O'Mara-Eves
- EPPI-Centre, UCL Social Research Institute, University College London, London, UK
| | | | - James Thomas
- EPPI-Centre, UCL Social Research Institute, University College London, London, UK
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Tools for Supporting the MCH Workforce in Addressing Complex Challenges: A Scoping Review of System Dynamics Modeling in Maternal and Child Health. Matern Child Health J 2022; 26:176-203. [PMID: 35188621 PMCID: PMC9482604 DOI: 10.1007/s10995-022-03376-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2022] [Indexed: 11/17/2022]
Abstract
Objectives System Dynamics (SD) is a promising decision support modeling approach for growing shared understanding of complex maternal and child health (MCH) trends. We sought to inventory published applications of SD to MCH topics and introduce the MCH workforce to these approaches through examples to support further iteration and use. Methods We conducted a systematic search (1958–2018) for applications of SD to MCH topics and characterized identified articles, following PRISMA guidelines. Pairs of experts abstracted information on SD approach and MCH relevance. Results We identified 101 articles describing applications of SD to MCH topics. Approach: 27 articles present qualitative diagrams, 10 introduce concept models that begin to quantify dynamics, and 67 present more fully tested/analyzed models. Purpose: The most common purposes described were to increase understanding (n = 55) and support strategic planning (n = 26). While the majority of studies (n = 53) did not involve stakeholders, 40 included what we considered to be a high level of stakeholder engagement – a strength of SD for MCH. Topics: The two Healthy People 2020 topics addressed most frequently were early and middle childhood (n = 30) and access to health services (n = 26). The most commonly addressed SDG goals were “End disease epidemics” (n = 26) and “End preventable deaths” (n = 26). Conclusions for Practice While several excellent examples of the application of SD in MCH were found, SD is still underutilized in MCH. Because SD is particularly well-suited to studying and addressing complex challenges with stakeholders, its expanded use by the MCH workforce could inform an understanding of contemporary MCH challenges. Supplementary Information The online version contains supplementary material available at 10.1007/s10995-022-03376-8.
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Herke M, Moor I, Winter K, Hack M, Hoffmann S, Spallek J, Hilger-Kolb J, Herr R, Pischke C, Dragano N, Novelli A, Richter M. Role of contextual and compositional characteristics of schools for health inequalities in childhood and adolescence: a scoping review. BMJ Open 2022; 12:e052925. [PMID: 35105578 PMCID: PMC8808395 DOI: 10.1136/bmjopen-2021-052925] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVES To synthesise the evidence on the role of compositional or contextual characteristics of schools in the association between students' socioeconomic position and their health in primary and secondary education in developed economies. DESIGN Scoping review. We included studies examining the role of at least one school or class characteristic on students' health inequalities and was published since 1 January 2000, in English or German. We searched PubMed/Medline, Web of Science and Education Resources Information Center. We provided a narrative synthesis and an overview of findings. School characteristics were grouped into five broad categories: school composition, school climate, school policies and organisation, food environment and facilities. RESULTS Of 8520 records identified, 26 studies were included. Twelve studies found a moderating and 3 a mediating effect. The strongest evidence came from studies examining the moderating effect of school composition, that is, the negative impact of a low individual socioeconomic position on mental health and well-being was aggravated by a low average socioeconomic position of schools. Evidence concerning the role of school climate, school stratification (eg, performance base tracking) and sponsorship, food environment and sport facilities and equipment was generally weak or very weak and mostly based on singular findings. Overall, favourable meso-level characteristics mitigated the negative impact of low individual socioeconomic position on health outcomes. CONCLUSIONS School characteristics affect health inequalities in children and adolescents to some degree, but future research is necessary to strengthen the existing evidence and address under-represented aspects in school characteristics and health outcomes.
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Affiliation(s)
- Max Herke
- Institute of Medical Sociology, Medical Faculty, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Irene Moor
- Institute of Medical Sociology, Medical Faculty, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Kristina Winter
- Institute of Medical Sociology, Medical Faculty, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Miriam Hack
- Institute of Medical Sociology, Medical Faculty, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Stephanie Hoffmann
- Department of Public Health, Brandenburg University of Technology, Senftenberg, Germany
| | - Jacob Spallek
- Department of Public Health, Brandenburg University of Technology, Senftenberg, Germany
| | - Jennifer Hilger-Kolb
- Mannheim Institute of Public Health, Social and Preventive Medicine, Heidelberg University, Mannheim, Germany
| | - Raphael Herr
- Mannheim Institute of Public Health, Social and Preventive Medicine, Heidelberg University, Mannheim, Germany
| | - Claudia Pischke
- Institute of Medical Sociology, Centre for Health and Society, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Nico Dragano
- Institute of Medical Sociology, Centre for Health and Society, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Anna Novelli
- Chair of Health Economics, Technical University of Munich, München, Germany
| | - Matthias Richter
- Institute of Medical Sociology, Medical Faculty, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
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Fudla H, Pratiwi AA, Tarmizi NAA, Meiyetriani E, Wangge G, Pramesthi IL, Ananda AJN, Anggraini R, Iswarawanti DN, Ermayani E. A Mixed-Methods Exploration of Implementation of a Healthy School Canteen Program after a Year Intervention. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.9483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background: Previous studies have shown that adolescents prefer less healthy food and their eating habits will affect their nutritional status in adulthood and old age. School canteen is a part of food retailing and provisioning that influence the diet quality of the adolescents. Healthy school canteen intervention is recommended as one of the public health strategies in supporting the development of healthy diet behavior.
Objectives: To evaluate the effects of a healthy school canteen intervention program among middle school children.
Methods: A mixed-methods research design including focus group interviews for teachers and principal, observation on school canteen, a survey for food handlers and food testing for hazardous chemicals. Thematic analysis of focus group data and descriptive analyses of survey data were conducted. Four schools were selected as intervention groups and four schools as positive control groups. Data collection phase took place between April 22 and May 2, 2019.
Results: Only one school out of eight schools that had written commitment and a food safety team. In intervention school 50% of food handlers use personal protective equipment and 25% of food handlers received training. In the positive control group, none of the food handlers used personal protective equipment and they had not received any training. Food handlers in the positive control group have a higher rate of correct answers. Only 2 out of 4 schools in the intervention group had nutritious foods available in the canteen and 3 out of 4 schools in the positive control group. None of the school canteens were found positive for metanil yellow. Higher positive findings for Rhodamin B, Formaldehyde and Borax (33.3%, 60.0%, 33.3%, respectively) in the control group compared to the control group (28.6%, 27.3%, and 28.6%, respectively).
Conclusions: Intervention groups have been slightly more successful in creating healthy school canteens, as they had a slightly better total score in the observation sheet compared to the schools from the positive control group. Collaboration with another stakeholder such as Primary Health Center (PHC) can be thought of as a solution to train food handlers about healthy practice while handling the food.
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Johnston R, Norman J, Furber S, Parkinson J. The barriers and enablers to implementing the NSW Healthy School Canteen Strategy in secondary schools in the Illawarra and Shoalhaven region - A qualitative study. Health Promot J Austr 2021; 33:686-695. [PMID: 34382275 DOI: 10.1002/hpja.528] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 07/20/2021] [Accepted: 08/08/2021] [Indexed: 11/11/2022] Open
Abstract
ISSUE ADDRESSED In 2017, the New South Wales Healthy School Canteen Strategy (Strategy) was introduced into primary and secondary schools. Studies have reported that secondary schools have a lower level of compliance with healthy canteen policies compared with primary schools. This study aims to identify and describe the barriers and enablers to implementing the Strategy in Department of Education (DoE) secondary schools in the Illawarra and Shoalhaven regions. METHODS The framework underpinning the study was the systems theory. Canteen managers (CM) and principals from the 21 DoE secondary schools in the Illawarra and Shoalhaven regions were invited to participate in semi-structured interviews. The interviews were structured around the five focus areas of the Strategy, including questions on school nutrition policies and the role of the canteen. Data were collated using the interview guides as a framework and qualitative content analysis, using manual coding, was undertaken. RESULTS Eight (38%) schools participated with seven CMs and six principals interviewed. Barriers to implementing the Strategy included the changing role of the canteen, the increased demands placed on CMs and inconsistencies between the school food environment and the Strategy. Enablers included monitoring implementation, and internal and external support. This study also recognised that previously identified barriers to healthy canteen strategy implementation are ongoing. CONCLUSIONS The school canteen is an integral part of the school environment and therefore needs whole-of-school support if successful implementation of the Strategy is to occur. SO WHAT Addressing the barriers and promoting the enablers identified in this study will support better nutrition policy implementation in secondary schools.
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Affiliation(s)
- Rosi Johnston
- Health Promotion Service, Illawarra Shoalhaven Local Health District, Warrawong, NSW, 2502, Australia
| | - Jennifer Norman
- Health Promotion Service, Illawarra Shoalhaven Local Health District, Warrawong, NSW, 2502, Australia.,Illawarra Health and Medical Research Institute, Wollongong, NSW, 2522, Australia.,Early Start, University of Wollongong, NSW, 2522, Australia
| | - Susan Furber
- Health Promotion Service, Illawarra Shoalhaven Local Health District, Warrawong, NSW, 2502, Australia.,Illawarra Health and Medical Research Institute, Wollongong, NSW, 2522, Australia.,Early Start, University of Wollongong, NSW, 2522, Australia
| | - Julie Parkinson
- Health Promotion Service, Illawarra Shoalhaven Local Health District, Warrawong, NSW, 2502, Australia
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O'Mahony B, Kerins C, Murrin C, Kelly C. Barriers and facilitators to the implementation of nutrition standards for school food: a mixed-methods systematic review protocol. HRB Open Res 2021; 3:20. [PMID: 32743340 PMCID: PMC7372527 DOI: 10.12688/hrbopenres.13041.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2021] [Indexed: 06/30/2024] Open
Abstract
Background: The importance of nutrition during childhood and the high prevalence of child and adolescent obesity has resulted in several countries implementing nutritional standards for school food as a way of providing healthy school food environments. Yet, there has been less focus on the barriers and facilitators influencing the process of implementing school food standards. This mixed-methods systematic review aims to address this evidence gap by synthesising the empirical evidence on the factors that may influence the implementation of school food standards. Methods: This mixed-methods systematic review will use qualitative, quantitative and mixed-methods evidence from peer-reviewed publications retrieved from the following databases; PubMed, CINAHL, Scopus, EMBASE, Medline, PsycINFO and Web of Science. Grey literature will be accessed through Google Scholar, Open Access Theses and Dissertations, OpenGrey, RIAN, EThOS, ProQuest, WorldCat, Networked Digital Library of Theses and Dissertations, and public health organisation websites will also be accessed. Screening reference lists and citation chaining of all included studies will also be undertaken. No restrictions on publication date or language will be applied, however, only primary research studies relevant to supply-side stakeholders will be eligible for inclusion. Study quality will be assessed using the Mixed Methods Appraisal Tool. Study titles and abstracts will be screened to decide whether the full-text manuscript should be retrieved. For screening reliability, a second review author will assess a random sample of 20%. Kappa statistics will be used to assess inter-rater reliability, with values of 0.75 and higher representing high agreement. Two authors will independently extract data and factors reported to influence implementation. This will be synthesized using the Theoretical Domains Framework. Discussion: A comprehensive understanding of these factors can provide guidance to relevant stakeholders to enhance the adoption, implementation and sustainability of nutrition standards for school meals. Systematic review registration: PROSPERO CRD42019117904.
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Affiliation(s)
- Breda O'Mahony
- Home Economics Department, St. Angela's College, Sligo, Ireland
- Discipline of Health Promotion, National University of Ireland Galway, Galway, Ireland
| | - Claire Kerins
- Discipline of Health Promotion, National University of Ireland Galway, Galway, Ireland
| | - Celine Murrin
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Colette Kelly
- Health Promotion Research Centre, School of Health Sciences, National University of Ireland Galway, Galway, Ireland
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O'Mahony B, Kerins C, Murrin C, Kelly C. Barriers and facilitators to the implementation of nutrition standards for school food: a mixed-methods systematic review protocol. HRB Open Res 2021; 3:20. [PMID: 32743340 PMCID: PMC7372527 DOI: 10.12688/hrbopenres.13041.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2021] [Indexed: 11/20/2022] Open
Abstract
Background: The importance of nutrition during childhood and the high prevalence of child and adolescent obesity has resulted in several countries implementing nutritional standards for school food as a way of providing healthy school food environments. Yet, there has been less focus on the barriers and facilitators influencing the process of implementing school food standards. This mixed-methods systematic review aims to address this evidence gap by synthesising the empirical evidence on the factors that may influence the implementation of school food standards. Methods: This mixed-methods systematic review will use qualitative, quantitative and mixed-methods evidence from peer-reviewed publications retrieved from the following databases; PubMed, CINAHL, Scopus, EMBASE, Medline, PsycINFO and Web of Science. Grey literature will be accessed through Google Scholar, Open Access Theses and Dissertations, OpenGrey, RIAN, EThOS, ProQuest, WorldCat, Networked Digital Library of Theses and Dissertations, and public health organisation websites will also be accessed. Screening reference lists and citation chaining of all included studies will also be undertaken. No restrictions on publication date or language will be applied, however, only primary research studies relevant to supply-side stakeholders will be eligible for inclusion. Study quality will be assessed using the Mixed Methods Appraisal Tool. Study titles and abstracts will be screened to decide whether the full-text manuscript should be retrieved. For screening reliability, a second review author will assess a random sample of 20%. Kappa statistics will be used to assess inter-rater reliability, with values of 0.75 and higher representing high agreement. Two authors will independently extract data and factors reported to influence implementation. This will be synthesized using the Theoretical Domains Framework. Discussion: A comprehensive understanding of these factors can provide guidance to relevant stakeholders to enhance the adoption, implementation and sustainability of nutrition standards for school meals. Systematic review registration: PROSPERO
CRD42019117904
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Affiliation(s)
- Breda O'Mahony
- Home Economics Department, St. Angela's College, Sligo, Ireland.,Discipline of Health Promotion, National University of Ireland Galway, Galway, Ireland
| | - Claire Kerins
- Discipline of Health Promotion, National University of Ireland Galway, Galway, Ireland
| | - Celine Murrin
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Colette Kelly
- Health Promotion Research Centre, School of Health Sciences, National University of Ireland Galway, Galway, Ireland
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O'Mahony B, Kerins C, Murrin C, Kelly C. Barriers and facilitators to the implementation of nutrition standards for school food: a mixed methods systematic review protocol. HRB Open Res 2020; 3:20. [DOI: 10.12688/hrbopenres.13041.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2020] [Indexed: 11/20/2022] Open
Abstract
Background: The importance of nutrition during childhood and the high prevalence of child and adolescence obesity has resulted in several countries implementing nutritional standards for school food as a way of providing healthy school food environments. Yet there has been less focus on the barriers and facilitators influencing the process of implementing school food standards. This mixed methods systematic review aims to address this evidence gap by synthesising the empirical evidence on the factors that may influence implementation of school food standards. Methods: This mixed methods systematic review will use qualitative, quantitative and mixed methods evidence from peer reviewed publications retrieved from the following databases; PubMed, CINAHL, Scopus, EMBASE, Medline, PsycINFO and Web of Science. Grey literature will be accessed through Google Scholar, Open Access Theses and Dissertations, OpenGrey, RIAN, EThOS, ProQuest, WorldCat, Networked Digital Library of Theses and Dissertations, and public health organisation websites will also be accessed. Screening reference lists and citation chaining of all included studies will also be undertaken. No restrictions on publication date or language will be applied, however, only primary research studies relevant to supply-side stakeholders will be eligible for inclusion. Study quality will be assessed using the Mixed Methods Appraisal Tool. Study titles and abstracts will be screened to decide whether the full text manuscript should be retrieved. For screening reliability, a second review author will assess a random sample of 20%. Kappa statistics will be used to assess inter-rater reliability, with values of 0.75 and higher representing high agreement. Two authors will independently extract data and factors reported to influence implementation. This will be synthesized using the Theoretical Domains Framework. Discussion: A comprehensive understanding of these factors can provide guidance to relevant stakeholders to enhance the adaption, implementation and sustainability of nutrition standards for school meals. Systematic review registration: PROSPERO CRD42019117904
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O'Neill M, Mujahid M, Hutson M, Fukutome A, Robichaud R, Lopez J. Investing in Public School Kitchens and Equipment as a Pathway to Healthy Eating and Equitable Access to Healthy Food. THE JOURNAL OF SCHOOL HEALTH 2020; 90:492-503. [PMID: 32232865 DOI: 10.1111/josh.12894] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 12/23/2019] [Accepted: 12/30/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND We gathered baseline data about student need of healthy, free school food, and if current school meal programming serves students in need of healthy free school food, in anticipation of the completion of a district-wide kitchen infrastructure and educational farm project in a high-poverty urban school district. METHODS We used mixed methods to assess student hunger, whether the school meal program met student needs, and to determine associations between presence of a cooking kitchen and perceptions of healthy food. Participants included 72 staff, 143 parents, and 6437 K-5 students in the qualitative component, and 9078 parents and 1693 staff in the quantitative component. RESULTS Staff participants stated packaging and reheating food influenced student consumption. During observations, students at seven of nine high poverty sites with packaged reheated food did not eat school meals, but this was not true at four out of four high-poverty sites with unpackaged fresh food. Parents (OR = 1.17, 95% CI 1.00-1.39) and staff (OR = 1.58, 95% CI 1.15-2.17) from schools with a cooking kitchen were more likely to perceive school lunch as healthy in adjusted models. CONCLUSIONS Food preparation and presentation appears to influence student consumption of school food and adult perception of school meal quality.
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Affiliation(s)
- Moira O'Neill
- Institute of Urban and Regional Development, University of California, Berkeley, CA, 94720-1870
| | - Mahasin Mujahid
- University of California, Berkeley, School of Public Health, Berkeley, CA
| | - Malo Hutson
- Columbia University, 1172 Amsterdam Avenue, New York, NY, 10027
| | - Amanda Fukutome
- Institute of Urban and Regional Development, University of California, Berkeley, Berkeley, CA, 94720-1870
| | - Raine Robichaud
- Institute of Urban and Regional Development, University of California, Berkeley, Berkeley, CA, 94720-1870
| | - Jaime Lopez
- Sol Price School of Public Policy, University of Southern California, Los Angeles, CA, 90089-0626
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Hermans RC, Smit K, van den Broek N, Evenhuis IJ, Veldhuis L. Adolescents' Food Purchasing Patterns in The School Food Environment: Examining the Role of Perceived Relationship Support and Maternal Monitoring. Nutrients 2020; 12:nu12030733. [PMID: 32168757 PMCID: PMC7146524 DOI: 10.3390/nu12030733] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 03/06/2020] [Accepted: 03/09/2020] [Indexed: 02/07/2023] Open
Abstract
The school food environment plays a role in adolescents’ dietary behaviors. In this study, adolescents’ food purchasing patterns in and around school and its potential relationship with perceived maternal relationship support and maternal monitoring were examined. Data were collected in The Netherlands in 2017. A total of 726 adolescents (45.8% boys; Mage = 13.78 ± 0.49) and 713 mothers (Mage = 45.05 ± 4.45) participated. Adolescents’ frequency of bringing and purchasing foods was assessed via a Food Frequency Questionnaire (FFQ). Relationship support and monitoring were measured via self-report questionnaires. Structural Equation Modelling (SEM) was conducted to examine associations between adolescents’ food purchasing patterns, relationship support, and monitoring. Results indicated that adolescents brought food and drinks mostly from home, and infrequently purchased these products in and around school. Yet, differences exist between subgroups of adolescents. Relationship support was positively associated with bringing fruit, vegetables and salad and negatively associated with purchasing sweet snacks. No associations were found for monitoring. These findings indicate that family-home determinants of healthy and unhealthy eating are important factors to consider when examining the impact of the school food environment on adolescents’ food purchasing patterns. This has implications for policy makers who aim to develop and implement measures to improve adolescents’ eating in and around school.
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Affiliation(s)
- Roel C.J. Hermans
- The Netherlands Nutrition Centre, 2594 AC The Hague, The Netherlands; (I.J.E.); (L.V.)
- Department of Health Promotion, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, 6299 AH Maastricht, The Netherlands
- Correspondence: ; Tel.: +31-43-388-2415
| | - Koen Smit
- Behavioural Science Institute, Radboud University, 6500 HE Nijmegen, The Netherlands; (K.S.); (N.v.d.B.)
- Trimbos Institute, Netherlands Institute of Mental Health and Addiction, 3500 AS Utrecht, The Netherlands
| | - Nina van den Broek
- Behavioural Science Institute, Radboud University, 6500 HE Nijmegen, The Netherlands; (K.S.); (N.v.d.B.)
| | - Irma J. Evenhuis
- The Netherlands Nutrition Centre, 2594 AC The Hague, The Netherlands; (I.J.E.); (L.V.)
| | - Lydian Veldhuis
- The Netherlands Nutrition Centre, 2594 AC The Hague, The Netherlands; (I.J.E.); (L.V.)
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Swierad E, Huang TTK, Ballard E, Flórez K, Li S. Developing a Socioculturally Nuanced Systems Model of Childhood Obesity in Manhattan's Chinese American Community via Group Model Building. J Obes 2020; 2020:4819143. [PMID: 33628493 PMCID: PMC7895604 DOI: 10.1155/2020/4819143] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 05/27/2020] [Indexed: 01/01/2023] Open
Abstract
The purpose of this study was to develop a qualitative and socioculturally tailored systems model of childhood obesity in the Chinese American community in Manhattan's Chinatown. We utilized group model building (GMB) methodology as a form of participatory systems modeling. The study was conducted in Manhattan's Chinatown community. We recruited 16 Chinese American adults from the community. GMB workshops engendered a causal loop diagram (CLD), the visualization of a complex systems model illustrating the structures, feedbacks, and interdependencies among socioculturally specific pathways underlying childhood obesity, in Manhattan's Chinatown community. The analysis of CLD revealed that participants considered the following factors to influence childhood obesity: (1) traditional social norms affecting body image, how children are raised, parental pressure to study, and trust in health of traditional foods; (2) grandparents' responsibility for children; (3) limited time availability of parents at home; and (4) a significant amount of children's time spent indoors. GMB represents a novel method to understand the complexity of childhood obesity in culturally specific populations and contexts. The study identified sociocultural subsystems that may underlie the development and perpetuation of childhood obesity among Chinese American children. Insights from the study can be useful in the design of future empirical studies and interventions.
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Affiliation(s)
- Ewelina Swierad
- Columbia University Irving Medical Center, New York, NY, USA
- Center for Systems and Community Design, Graduate School of Public Health and Health Policy, City University of New York, New York, NY, USA
| | - Terry T.-K. Huang
- Center for Systems and Community Design, Graduate School of Public Health and Health Policy, City University of New York, New York, NY, USA
| | - Ellis Ballard
- Social System Design Lab, Brown School at Washington University in St. Louis, St. Louis, WA, USA
| | - Karen Flórez
- Center for Systems and Community Design, Graduate School of Public Health and Health Policy, City University of New York, New York, NY, USA
| | - Sheng Li
- Center for Systems and Community Design, Graduate School of Public Health and Health Policy, City University of New York, New York, NY, USA
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Travert AS, Sidney Annerstedt K, Daivadanam M. Built Environment and Health Behaviors: Deconstructing the Black Box of Interactions-A Review of Reviews. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E1454. [PMID: 31022911 PMCID: PMC6517917 DOI: 10.3390/ijerph16081454] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Revised: 04/13/2019] [Accepted: 04/15/2019] [Indexed: 01/08/2023]
Abstract
A review of reviews following a scoping review study design was conducted in order to deconstruct the black box of interactions between the built environment and human behaviors pertaining to physical activity and/or diet. In the qualitative analysis 107 records were included, 45 of which were also coded. Most review papers confirmed the influence of the built environment on the behaviors of interest with some noting that a same built environment feature could have different behavioral outcomes. The conceptual model developed sheds light on these mixed results and brings out the role of several personal and behavioral factors in the shift from the measured to the perceived built environment. This shift was found to shape individuals' behaviors critically and to have the power of redefining the strength of every interaction. Apart from its theoretical relevance, this model has high practical relevance especially for the design and implementation of interventions with a behavioral component. Intervention researchers can use the model developed to identify and label the built environment and individual factors that can be measured objectively or perceived as facilitators, concurrent options and barriers, in order to develop comprehensive and multi-component intervention strategies.
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Affiliation(s)
- Anne-Sophie Travert
- School of Public Affairs, Sciences Po, 75007 Paris, France.
- Department of Public Health Sciences, Karolinska Institutet, 171 77 Stockholm, Sweden.
| | | | - Meena Daivadanam
- Department of Public Health Sciences, Karolinska Institutet, 171 77 Stockholm, Sweden.
- Department of Food Studies, Nutrition and Dietetics, Uppsala University; 751 22 Uppsala, Sweden.
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Broers VJV, Van den Broucke S, Taverne C, Luminet O. Default-name and tasting nudges increase salsify soup choice without increasing overall soup choice. Appetite 2019; 138:204-214. [PMID: 30928516 DOI: 10.1016/j.appet.2019.03.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 03/04/2019] [Accepted: 03/23/2019] [Indexed: 10/27/2022]
Abstract
Nudging is a popular behavior change technique but the conditions for its effectiveness have not been researched extensively. The current study aimed to test whether the effectiveness of nudging is limited to certain characteristics of the nudged product by focusing on a specific product (salsify soup) within a broader category (soups). Two parallel studies were conducted in two sandwich restaurants in a university setting at which a default-name nudge ("suggestion of the chef") and a tasting nudge were implemented aimed at increasing the choice for salsify soup using a non-randomized study design during 10 and 12 measurement days. The beta-regression model showed that the default-name nudge increased the proportion of customers that choose the salsify soup during intervention days compared to non-intervention days, p < .001, OR: 1.70. The tasting nudge also increased the proportion of customers that choose the salsify soup from baseline to intervention, p < .001, OR: 6.17 and from baseline to post-intervention, p < .01, OR: 1.87, and decreased from intervention to post-intervention, p < .001, OR: 0.30. Both nudges did not increase the choice for the overall category of soups. The results show that certain types of nudges are able to increase specific products of a category without increasing overall choice of a category in contrast to previous findings.
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Affiliation(s)
- V J V Broers
- Psychological Sciences Research Institute, Université catholique de Louvain, Belgium.
| | - S Van den Broucke
- Psychological Sciences Research Institute, Université catholique de Louvain, Belgium
| | - C Taverne
- Institute of Statistics, Biostatistics and Actuarial Sciences, Université catholique de Louvain, Belgium
| | - O Luminet
- Psychological Sciences Research Institute, Université catholique de Louvain, Belgium; Fund for Scientific Research (FRS-FNRS), Belgium
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20
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Investigating the conditions for the effectiveness of nudging: Cue-to-action nudging increases familiar vegetable choice. Food Qual Prefer 2019. [DOI: 10.1016/j.foodqual.2018.08.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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21
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Askelson NM, Brady P, Ryan G, Meier C, Ortiz C, Scheidel C, Delger P. Actively Involving Middle School Students in the Implementation of a Pilot of a Behavioral Economics-Based Lunchroom Intervention in Rural Schools. Health Promot Pract 2018; 20:675-683. [PMID: 30326740 DOI: 10.1177/1524839918807717] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
School-based interventions can play an important role in improving childhood and adolescent nutrition and preventing obesity. Schools offer a unique opportunity to implement policy, systems, and environmental interventions targeting healthy eating behaviors. An intervention was piloted in six middle schools featuring behavioral economics-based changes to the lunchroom, communication training, and communicate cues for food service staff. The pilot study employed a multicomponent evaluation with students and food service directors and staff including a lunchroom assessment, online surveys, production records, and interviews. Five schools increased their scores on the lunchroom assessment tool, and four schools increased the number of servings produced of healthy food items. Interviews with food service directors indicated the interventions was feasible and well received. School-based policy, systems, and environmental interventions targeting healthy eating behaviors may play a role in preventing obesity in children and adolescents.
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Affiliation(s)
- Natoshia M Askelson
- 1 University of Iowa, Iowa City, IA, USA.,2 University of Minnesota-Morris, Morris, MN, USA
| | | | - Grace Ryan
- 1 University of Iowa, Iowa City, IA, USA
| | | | | | | | - Patti Delger
- 3 Iowa Department of Education, Des Moines, IA, USA
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22
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Rollings KA, Wells NM. Cafeteria assessment for elementary schools (CAFES): development, reliability testing, and predictive validity analysis. BMC Public Health 2018; 18:1154. [PMID: 30285685 PMCID: PMC6171137 DOI: 10.1186/s12889-018-6032-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Accepted: 09/10/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Strategies to reduce childhood obesity and improve nutrition include creating school food environments that promote healthy eating. Despite well-documented health benefits of fruit and vegetable (FV) consumption, many U.S. school-aged children, especially low-income youth, fail to meet national dietary guidelines for FV intake. The Cafeteria Assessment for Elementary Schools (CAFES) was developed to quantify physical attributes of elementary school cafeteria environments associated with students' selection and consumption of FV. CAFES procedures require observation of the cafeteria environment where preparation, serving, and eating occur; staff interviews; photography; and scoring. METHODS CAFES development included three phases. First, assessment items were identified via a literature review, expert panel review, and pilot testing. Second, reliability testing included calculating inter-item correlations, internal consistency (Kuder-Richardson-21 coefficients), and inter-rater reliability (percent agreement) based on data collected from 50 elementary schools in low-income communities and 3187 National School Lunch Program participants in four U.S. states. At least 43% of each participating school's students qualified for free- or reduced-price meals. Third, FV servings and consumption data, obtained from lunch tray photography, and multi-level modeling were used to assess the predictive validity of CAFES. RESULTS CAFES' 198 items (grouped into 108 questions) capture four environmental scales: room (50 points), table/display (133 points), plate (4 points), and food (11 points). Internal consistency (KR-21) was 0.88 (overall), 0.80 (room), 0.72 (table), 0.83 (plate), and 0.58 (food). Room subscales include ambient environment, appearance, windows, layout/visibility, healthy signage, and kitchen/serving area. Table subscales include furniture, availability, display layout/presentation, serving method, and variety. Inter-rater reliability (percent agreement) of the final CAFES tool was 90%. Predictive validity analyses indicated that the total CAFES and four measurement scale scores were significantly associated with percentage consumed of FV served (p < .05). CONCLUSIONS CAFES offers a practical and low-cost measurement tool for school staff, design and public health practitioners, and researchers to identify critical areas for intervention; suggest low- and no-cost intervention strategies; and contribute to guidelines for cafeteria design, food presentation and layout, and operations aimed at promoting healthy eating among elementary school students.
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Affiliation(s)
- Kimberly A. Rollings
- School of Architecture, University of Notre Dame, 110 Bond Hall, Notre Dame, IN 46556 USA
| | - Nancy M. Wells
- Design + Environmental Analysis, College of Human Ecology, Cornell University, 1411 Martha Van Rensselaer Hall, Ithaca, NY 14853 USA
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Broers VJV, De Breucker C, Van den Broucke S, Luminet O. A systematic review and meta-analysis of the effectiveness of nudging to increase fruit and vegetable choice. Eur J Public Health 2018; 27:912-920. [PMID: 28655176 DOI: 10.1093/eurpub/ckx085] [Citation(s) in RCA: 91] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Nudging refers to interventions that organize the choice architecture in order to alter people's behaviour in a predictable way without forbidding any options or significantly changing their economic incentives. As a strategy to encourage healthy behaviour, nudging can serve as a complement to health education. However, the empirical evidence regarding the effectiveness of nudging as a way to influence food choice remains contradictory. To address this issue, a systematic review and meta-analysis was conducted to test the effects of nudging to encourage people to select more fruit and vegetables. Methods A systematic literature search was performed on PubMed, Medline, PsycInfo, Cochrane library, Scopus and Google Scholar. After quality assessment, 20 articles (23 studies) were retained for narrative synthesis. Twelve articles (14 studies) contained enough information to calculate effect-sizes for meta-analysis using Comprehensive Meta-analysis software. Results The meta-analysis shows that nudging interventions that aim to increase fruit and/or vegetable choice/sales/servings have a moderately significant effect (d = 0.30), with the largest effect for altering placement (d = 0.39) and combined nudges (d = 0.28). Conclusion The results of this review provide an indication of the effectiveness of nudging on fruit and vegetable choice in terms of actual effect-sizes, while also highlighting the problems that must be addressed before more definitive conclusions can be drawn.
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Affiliation(s)
- Valérie J V Broers
- Psychological Sciences Research Institute, Université Catholique de Louvain, Louvain-la-Neuve, Belgium
| | - Céline De Breucker
- Psychological Sciences Research Institute, Université Catholique de Louvain, Louvain-la-Neuve, Belgium
| | - Stephan Van den Broucke
- Psychological Sciences Research Institute, Université Catholique de Louvain, Louvain-la-Neuve, Belgium
| | - Olivier Luminet
- Psychological Sciences Research Institute, Université Catholique de Louvain, Louvain-la-Neuve, Belgium.,Fonds de la Recherche Scientifique (FNRS)
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Kontak JCH, McIsaac JLD, Penney TL, Kuhle S, Kirk SFL. The picture of health: examining school-based health environments through photographs. Health Promot Int 2017; 32:322-330. [PMID: 27107022 DOI: 10.1093/heapro/daw027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Health-promoting schools (HPS) is an effective approach to enhance the health and well-being of children and youth, but its measurement remains a challenge considering contextual differences across school environments. The purpose of this study was to qualitatively explore the physical features of the school environment through photographs of schools that had implemented an HPS approach compared with schools that had not. This study used a descriptive approach, wherein physical features of the school environment were distilled through visual images and qualitatively analyzed. School environment data were collected from 18 elementary schools (10 HPS, 8 comparison schools) from a school board in rural Nova Scotia (Canada). Evaluation assistants captured photographs of the physical school environment as part of a broader environment audit. Overarching themes included the promotion, access and availability of opportunities for healthy eating and physical activity, healthy school climate and safety and accessibility of the school. The photographs characterized diverse aspects of the school environment and revealed differences between schools that had implemented an HPS approach compared with schools that had not. There were increased visual cues to support healthy eating, physical activity and mental well-being, and indications of a holistic approach to health among schools that implemented an HPS approach. This research adds to understanding the environmental elements of HPS. The use of photographic data to understand school environments provided an innovative method to explore the physical features of schools that had implemented an HPS approach.
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Affiliation(s)
- Julia C H Kontak
- Applied Research Collaborations for Health, School of Health and Human Performance, Faculty of Health Professions, Dalhousie University, 1318 Robie Street, Halifax, NS, Canada B3H 3E2
| | - Jessie-Lee D McIsaac
- Applied Research Collaborations for Health, School of Health and Human Performance, Faculty of Health Professions, Dalhousie University, 1318 Robie Street, Halifax, NS, Canada B3H 3E2.,Healthy Populations Institute, Dalhousie University, Halifax, NS, Canada
| | - Tarra L Penney
- Applied Research Collaborations for Health, School of Health and Human Performance, Faculty of Health Professions, Dalhousie University, 1318 Robie Street, Halifax, NS, Canada B3H 3E2
| | - Stefan Kuhle
- Perinatal Epidemiology Research Unit, Departments of Pediatrics and Obstetrics and Gynaecology, Dalhousie University, Halifax, NS, Canada
| | - Sara F L Kirk
- Applied Research Collaborations for Health, School of Health and Human Performance, Faculty of Health Professions, Dalhousie University, 1318 Robie Street, Halifax, NS, Canada B3H 3E2.,Healthy Populations Institute, Dalhousie University, Halifax, NS, Canada
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García-Padilla FM, González-Rodríguez A. [Cafeterias service and health promotion in the school context]. Aten Primaria 2017; 49:271-277. [PMID: 28274694 PMCID: PMC6876017 DOI: 10.1016/j.aprim.2016.09.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 08/19/2016] [Accepted: 09/06/2016] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To assess the Secondary Schools (IES) cafeterias of Andalusia as services to promote healthy eating among students as well as to check the adequacy of the food supply to the Law on Food Security and Spanish Nutrition, and the knowledge of this law by the school managers. DESIGN Observational descriptive transversal study. LOCATION IES of Andalusia's eight provinces. PARTICIPANTS Cafeteria services. Stratified random sample with proportional allocation by province and size of habitat of 95 Andalusian IES with+10% error and confidence level (NC) 95.5. MAIN MEASUREMENTS Implementation of the Healthy Food Promotion Guide, validated through a Delphi group, which collects information on: the food supply, the location of the food products and the advertising on healthy eating. Structured interview with a member of the management team. RESULTS In 84.9% of the cafeterias a deficient healthy eating habits promotion is observed. 100% of the cafeterias offer a wide variety of non-recommended products (candy, soda, snack chips, industrial bakery) breaching the provisions of the Law on Food Safety and Nutrition. 33.68% of the interviewees claim to know the existence of this law. CONCLUSIONS Andalusian IES cafeterias do not promote healthy eating. It can be affirmed that the law has had little impact during its first year. It is a priority to introduce measures in conformity with the law and with recent research in order to promote a healthy school environment.
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de Ridder D, Kroese F, Evers C, Adriaanse M, Gillebaart M. Healthy diet: Health impact, prevalence, correlates, and interventions. Psychol Health 2017; 32:907-941. [DOI: 10.1080/08870446.2017.1316849] [Citation(s) in RCA: 90] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Denise de Ridder
- Department of Social Health and Organizational Psychology, Utrecht University, Utrecht, The Netherlands
| | - Floor Kroese
- Department of Social Health and Organizational Psychology, Utrecht University, Utrecht, The Netherlands
| | - Catharine Evers
- Department of Social Health and Organizational Psychology, Utrecht University, Utrecht, The Netherlands
| | - Marieke Adriaanse
- Department of Social Health and Organizational Psychology, Utrecht University, Utrecht, The Netherlands
| | - Marleen Gillebaart
- Department of Social Health and Organizational Psychology, Utrecht University, Utrecht, The Netherlands
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Lee-Kwan SH, Pan L, Kimmons J, Foltz J, Park S. Support for Food and Beverage Worksite Wellness Strategies and Sugar-Sweetened Beverage Intake Among Employed U.S. Adults. Am J Health Promot 2017; 31:128-135. [PMID: 26559714 PMCID: PMC9067258 DOI: 10.4278/ajhp.141113-quan-575] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE Sugar-sweetened beverage (SSB) consumption is high among U.S. adults and is associated with obesity. Given that more than 100 million Americans consume food or beverages at work daily, the worksite may be a venue for interventions to reduce SSB consumption. However, the level of support for these interventions is unknown. We examined associations between workday SSB intake and employees' support for worksite wellness strategies (WWSs). DESIGN We conducted a cross-sectional study using data from Web-based annual surveys that gather information on health-related attitudes and behaviors. SETTING Study setting was the United States. SUBJECTS A total of 1924 employed adults (≥18 years) selected using probability-based sampling. MEASURES The self-reported independent variable was workday SSB intake (0, <1 or ≥1 times per day), and dependent variables were employees' support (yes/no) for the following WWSs: (1) accessible free water, (2) affordable healthy food/drink, (3) available healthy options, and (4) less available SSB. ANALYSIS Multivariable logistic regression was used to control for sociodemographic variables, employee size, and availability of cafeteria/vending machine. RESULTS About half of employees supported accessible free water (54%), affordable healthy food/drink (49%), and available healthy options (46%), but only 28% supported less available SSB. Compared with non-SSB consumers, daily SSB consumers were significantly less supportive of accessible free water (adjusted odds ratio, .67; p < .05) or less available SSB (odds ratio, .49; p < .05). CONCLUSION Almost half of employees supported increasing healthy options within worksites, although daily workday SSB consumers were less supportive of certain strategies. Lack of support could be a potential barrier to the successful implementation of certain worksite interventions.
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Affiliation(s)
- Seung Hee Lee-Kwan
- Epidemic Intelligence Service Officer, CDC
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, CDC
| | - Liping Pan
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, CDC
| | - Joel Kimmons
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, CDC
| | - Jennifer Foltz
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, CDC
| | - Sohyun Park
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, CDC
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An Interpretive Framework for Assessing and Monitoring the Sustainability of School Gardens. SUSTAINABILITY 2016. [DOI: 10.3390/su8080801] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Springer AE, Evans AE. Assessing environmental assets for health promotion program planning: a practical framework for health promotion practitioners. Health Promot Perspect 2016; 6:111-8. [PMID: 27579254 PMCID: PMC5002877 DOI: 10.15171/hpp.2016.19] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 07/24/2016] [Indexed: 11/25/2022] Open
Abstract
Conducting a health needs assessment is an important if not essential first step for health promotion planning. This paper explores how health needs assessments may be further strengthened for health promotion planning via an assessment of environmental assets rooted in the multiple environments (policy, information, social and physical environments) that shape health and behavior. Guided by a behavioral-ecological perspective- one that seeks to identify environmental assets that can influence health behavior, and an implementation science perspective- one that seeks to interweave health promotion strategies into existing environmental assets, we present a basic framework for assessing environmental assets and review examples from the literature to illustrate the incorporation of environmental assets into health program design. Health promotion practitioners and researchers implicitly identify and apply environmental assets in the design and implementation of health promotion interventions;this paper provides foundation for greater intentionality in assessing environmental assets for health promotion planning.
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Affiliation(s)
- Andrew E Springer
- Assistant Professor of Health Promotion and Behavioral Sciences, Michael & Susan Dell Center for Healthy Living, University of Texas Health Science Center at Houston School of Public Health, Austin, TX, USA
| | - Alexandra E Evans
- Associate Professor of Health Promotion and Behavioral Sciences, Michael & Susan Dell Center for Healthy Living, University of Texas Health Science Center at Houston School of Public Health, Austin, TX, USA
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Frerichs L, Brittin J, Intolubbe-Chmil L, Trowbridge M, Sorensen D, Huang TTK. The Role of School Design in Shaping Healthy Eating-Related Attitudes, Practices, and Behaviors Among School Staff. THE JOURNAL OF SCHOOL HEALTH 2016; 86:11-22. [PMID: 26645416 DOI: 10.1111/josh.12347] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Revised: 04/13/2015] [Accepted: 05/08/2015] [Indexed: 06/05/2023]
Abstract
BACKGROUND Schools have increasing responsibility to address healthy eating, but physical barriers influence their ability to adopt and sustain recommended strategies. We took advantage of a natural experiment to investigate the role of the physical environment in shaping healthy eating attitudes and practices among school staff members. METHODS A school district consolidated its elementary schools and incorporated architectural features to support healthy eating into a building renovation. Surveys along with structured, in-depth interviews were administered prior to and at 12 months postoccupancy. Paired t-tests and McNemar's tests were used to analyze changes in survey indices and interview data were coded for themes. RESULTS The school implemented new policies and programs, including staff wellness activities. There was a significant decrease in the percent of teachers with a high-fat diet (from 73.68% to 57.14%, p < .05). Many physical barriers were removed but new challenges emerged, and staff varied in their awareness and comfort with using the new healthy eating features. CONCLUSIONS We found promising evidence that school architecture can support a school to address healthy eating. To enhance influence of the physical environment, more research is merited to test complementary strategies such as improving ownership of space and increasing self-efficacy to manage space.
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Affiliation(s)
- Leah Frerichs
- University of North Carolina at Chapel Hill, Center for Health Equity Research, 323 MacNider Hall, CB 7240, Chapel Hill, NC 27599-7240.
| | - Jeri Brittin
- University of Nebraska Medical Center, College of Public Health, Department of Health Promotion, Social and Behavioral Health, 984365 Nebraska Medical Center, Omaha, NE 68918-4365.
| | | | - Matthew Trowbridge
- School of Medicine, University of Virginia, PO Box 800699, Charlottesville, VA 22908.
| | - Dina Sorensen
- VMDO Architects, 200 East Market Street, Charlottesville, VA 22902.
| | - Terry T-K Huang
- CUNY School of Public Health, 55 W. 125 Street, Room 803, New York, NY 10027.
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Brittin J, Sorensen D, Trowbridge M, Lee KK, Breithecker D, Frerichs L, Huang T. Physical Activity Design Guidelines for School Architecture. PLoS One 2015; 10:e0132597. [PMID: 26230850 PMCID: PMC4521876 DOI: 10.1371/journal.pone.0132597] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Accepted: 06/16/2015] [Indexed: 11/19/2022] Open
Abstract
Increasing children's physical activity at school is a national focus in the U.S. to address childhood obesity. While research has demonstrated associations between aspects of school environments and students' physical activity, the literature currently lacks a synthesis of evidence to serve as a practical, spatially-organized resource for school designers and decision-makers, as well as to point to pertinent research opportunities. This paper describes the development of a new practical tool: Physical Activity Design Guidelines for School Architecture. Its aims are to provide architects and designers, as well as school planners, educators, and public health professionals, with strategies for making K-12 school environments conducive to healthy physical activity, and to engage scientists in transdisciplinary perspectives toward improved knowledge of the school environment's impact. We used a qualitative review process to develop evidence-based and theory-driven school design guidelines that promote increased physical activity among students. The design guidelines include specific strategies in 10 school design domains. Implementation of the guidelines is expected to enable students to adopt healthier physical activity behaviors. The tool bridges a translational gap between research and environmental design practice, and may contribute to setting new industry and education standards.
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Affiliation(s)
- Jeri Brittin
- University of Nebraska Medical Center, College of Public Health, Department of Health Promotion, Social & Behavioral Health, Omaha, NE, United States of America
| | - Dina Sorensen
- VMDO Architects, Charlottesville, VA, United States of America
| | - Matthew Trowbridge
- University of Virginia School of Medicine, Department of Emergency Medicine, Charlottesville, VA, United States of America
| | - Karen K. Lee
- New York City Department of Health and Mental Hygiene, New York, NY, United States of America
| | - Dieter Breithecker
- Federal Institute for Posture and Mobilisation Support, Wiesbaden, Germany
| | - Leah Frerichs
- University of Nebraska Medical Center, College of Public Health, Department of Health Promotion, Social & Behavioral Health, Omaha, NE, United States of America
- University of North Carolina, Chapel Hill, Center for Health Equity, Chapel Hill, NC, United States of America
| | - Terry Huang
- University of Nebraska Medical Center, College of Public Health, Department of Health Promotion, Social & Behavioral Health, Omaha, NE, United States of America
- City University of New York, School of Public Health, New York, NY, United States of America
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