1
|
Williams BD, Pitts SJ, Onufrak SJ, Sirois E, Utech A, Wood M, Silverman J, Ajenikoko F, Murphy M, Lowry Warnock A. A qualitative exploration of barriers, facilitators and best practices for implementing environmental sustainability standards and reducing food waste in veterans affairs hospitals. J Hum Nutr Diet 2024. [PMID: 39099188 DOI: 10.1111/jhn.13357] [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: 02/28/2024] [Accepted: 07/15/2024] [Indexed: 08/06/2024]
Abstract
BACKGROUND To improve the healthfulness of foods offered while accelerating the use of environmental sustainability practices, it is important to engage hospital food service operators in the adoption of such practices. The purpose of this study was to explore barriers, facilitators and best practices for implementing environmental sustainability standards in food service among veterans affairs (VA) hospitals in the United States. METHODS We conducted an online survey with 14 VA hospital food service directors and then 11 qualitative interviews. The survey assessed motivations for initiating sustainability standards and included a self-rating of implementation for each of five standards: increasing plant-forward dishes, procuring and serving sustainable foods that meet organic/fair trade and other certifications, procuring and serving locally produced foods, reducing food waste and reducing energy consumption. Interviews were transcribed verbatim. Qualitative analysis, including coding of themes and subthemes, was conducted by two coders to determine barriers, facilitators and best practices for each of these five standards. Quantitative methods (counts and frequencies) were used to analyse the survey data. RESULTS Participants had an average of 5 years of experience implementing sustainability standards. The top three motivators cited were reducing food waste, serving healthier foods and increasing efficiency or cost savings. Barriers revolved around patient preferences, contractual difficulties and costs related to reducing waste. Facilitators included taste testing new recipes that include more sustainable food options and easy access to sustainable products from the prime vendor. Best practices included making familiar dishes plant-forward and plate waste studies to prevent overproduction. CONCLUSIONS Although there were many barriers to implementation, food service directors had solutions for overcoming challenges and implementing food service sustainability standards, which can be tested in future sustainability initiatives.
Collapse
Affiliation(s)
- Bethany D Williams
- Department of Nutrition and Exercise Physiology, Washington State University Health Sciences Spokane, Spokane, Washington, USA
- Center for Science in the Public Interest, Washington, District of Columbia, USA
| | | | - Stephen J Onufrak
- Division of Nutrition, Physical Activity, and Obesity, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Emma Sirois
- Healthy Food in Health Care Program, Health Care Without Harm and Practice Greenhealth, Reston, Virginia, USA
| | - Anne Utech
- Nutrition and Food Services, US Department of Veteran Affairs, Washington, District of Columbia, USA
- Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Michelle Wood
- Division of Chronic Disease and Injury Prevention, Los Angeles County Department of Public Health, Los Angeles, California, USA
| | - Jessi Silverman
- Center for Science in the Public Interest, Washington, District of Columbia, USA
| | - Funke Ajenikoko
- American Heart Association, Washington, District of Columbia, USA
| | - Meghan Murphy
- Chronic Disease and Health Equity Unit, County of San Diego Health and Human Services Agency, San Diego, California, USA
| | - Amy Lowry Warnock
- Division of Nutrition, Physical Activity, and Obesity, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| |
Collapse
|
2
|
Wood M, Robles B, Beltran J, Kuo T. Integrating Healthy Nutrition Standards and Practices Into Food Service Contracting in a Large US County Government. Prev Chronic Dis 2024; 21:E15. [PMID: 38452193 PMCID: PMC10944636 DOI: 10.5888/pcd21.230220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2024] Open
Abstract
Purpose and Objectives Although considered a promising model of practice, integrating healthy nutrition standards and practices into a large county government's contracting process with food vendors has not been widely described in empirical literature. We conducted an implementation evaluation project to address this gap. Intervention Approach County of Los Angeles food vendors provide food or meals annually to more than 100,000 employees and millions of clients and visitors. In 2011, the County of Los Angeles Board of Supervisors adopted a policy to integrate healthy nutrition standards and practices into its requests for proposals (RFPs) and contracting process with food vendors. The policy required all contracts awarded to adhere to these new standards. Evaluation Methods In 2011, the Los Angeles County Department of Public Health (DPH) began reviewing RFPs for food services for county departments that procured, served, or sold food. From 2011 through 2021, DPH applied a 4-pronged formative-evaluative approach to help county departments implement the Board of Supervisors policy and ensure that nutritional requirements were appropriately integrated into all RFPs for new and renewing contracts with food vendors. We focused our evaluation on understanding the process and tracking the progress of this policy intervention. Our evaluation included 13 key informant interviews, a 2-part survey, reviews of contract data, and synthesis of lessons learned. Results Based on reviews and subsequent actions taken on more than 20 RFPs, DPH successfully assisted 7 county departments to incorporate healthy nutrition standards and practices into their food vendor contracts. Implementation of the food policy encountered several challenges, including staffing and training constraints and a limited infrastructure. An iterative approach to program improvement facilitated the process. Implications for Public Health Although the model for integrating healthy nutrition standards and practices into a government contracting process is promising, more work is needed to make it less resource-intensive and to increase user buy-in.
Collapse
Affiliation(s)
- Michelle Wood
- Division of Chronic Disease and Injury Prevention, Los Angeles County Department of Public Health, 3530 Wilshire Blvd, 8th floor, Los Angeles, California 90010
| | - Brenda Robles
- Research Group on Statistics, Econometrics and Health, University of Girona, Girona, Spain
| | - Jacqueline Beltran
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles
| | - Tony Kuo
- Department of Family Medicine, David Geffen School of Medicine, University of California, Los Angeles
- Population Health Program, Clinical and Translational Science Institute, University of California, Los Angeles
| |
Collapse
|
3
|
Lowry-Warnock A, Strombom N, Mugavero K, Harris D, Blanck HM, Onufrak S. Advancing Healthy Food Service in the United States: State Food Service Guidelines Policy Adoption and Implementation Supports, 2015-2019. Am J Health Promot 2023; 37:300-312. [PMID: 36178159 PMCID: PMC11107261 DOI: 10.1177/08901171221123311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE Food service guidelines (FSG) policies can impact the nutritional quality of millions of meals sold or served to government employees, citizens in public places, or institutionalized persons. This study examines state FSG policies adopted January 1, 2015 to April 1, 2019, and uses a FSG Classification Tool (FSG Tool) to quantify alignment with nutrition recommendations for public health impact. DESIGN Quantitative Content Analysis. SETTING State Government Worksites and Facilities. PARTICIPANTS 50 states and District of Columbia (D.C.) in the United States. MEASURES Frequency of policies and percent alignment to FSG tool. ANALYSIS FSG policies were identified using legal databases to assess state statutes, regulations, and executive orders. Content analysis and coding determined attributes of policies across 4 FSG Tool domains, (1) nutrition standards referenced; (2) behavioral design strategies encouraging selection of healthier offerings; (3) facility efficiency and environmental sustainability; and (4) FSG implementation supports. RESULTS From 2015-2019, 5 FSG policies met study inclusion criteria. Four out of 5 policies earned a perfect nutrition score (100%) by referencing nutrition standards that align with the Dietary Guidelines for Americans (DGA) and are operationalized for use in food service venues. Four out of 5 policies included at least 1 implementation supports provision, such as naming an implementing agency, and 2 included provisions that encourage local food sourcing. CONCLUSION From 2015-2019, overall FSG policy comprehensiveness scores ranged from 24% to 73%, with most policies referencing food and nutrition standards that align to national nutrition recommendations. Public health practitioners can educate decision makers on the potential impact of FSG policies on diet-related health outcomes and associated cost savings, as well as other important co-benefits that support locally grown products and environmental sustainability practices.
Collapse
Affiliation(s)
- Amy Lowry-Warnock
- Division of Nutrition, Physical Activity, and Obesity, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Nicole Strombom
- Public Health Law Program Host-Site Intern, Applied Research and Translation, Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kristy Mugavero
- Division of Nutrition, Physical Activity, and Obesity, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Diane Harris
- Division of Nutrition, Physical Activity, and Obesity, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Heidi M. Blanck
- Division of Nutrition, Physical Activity, and Obesity, Centers for Disease Control and Prevention, Atlanta, GA, USA
- United States Public Health Service, Rockville, MD, USA
| | - Stephen Onufrak
- Division of Nutrition, Physical Activity, and Obesity, Centers for Disease Control and Prevention, Atlanta, GA, USA
| |
Collapse
|
4
|
Lasala C, Durán A, Lledó D, Soriano JM. Assessment of Nutritional Quality of Products Sold in University Vending Machines According to the Front-of-Pack (FoP) Guide. Nutrients 2022; 14:5010. [PMID: 36501038 PMCID: PMC9736989 DOI: 10.3390/nu14235010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 11/18/2022] [Accepted: 11/21/2022] [Indexed: 11/27/2022] Open
Abstract
The aim of this research was to assess the nutritional composition of 654 foods and beverages from vending machines on a University Campus. The guide called “Creating a front of pack nutrition label for pre-packed products sold through retail outlets” from the Department of Health (UK) was used to assess the nutritional composition and to compare values from food and beverage categories. A high proportion of food items had high−moderate content of nutrients related to chronic disease (93, 88, 74 and 49% had high−moderate content of fat, saturated fat, salt and sugar, respectively). On the other hand, a few beverages had high−moderate content of these nutrients, except for sugar (2% high to moderate in fat, 2% in saturated fat, 0% in salt and 39% in sugar). The most frequent food categories were chocolates and bars (10.6%) and breadsticks (8.4%), whereas the most available beverages were water (27.7%) and soft drinks (23.4%). There were no statistically significant differences in the proportion of categories between the health science and humanities faculties, except for energy drinks (p < 0.05) and soft drinks (p < 0.05). Vending machines contribute to an obesogenic environment and do not support healthy snacking. Recommendations in this article should be considered to develop official guidelines to ensure the wider availability of healthy dietary choices in vending machines in university settings.
Collapse
Affiliation(s)
- Carmen Lasala
- Area of Nutrition, University Clinic of Nutrition, Physical Activity and Physiotherapy (CUNAFF), Lluís Alcanyís Foundation-University of Valencia, 46020 Valencia, Spain
- Food & Health Lab, Institute of Materials Science, University of Valencia, 46980 Paterna, Spain
| | - Antonio Durán
- Area of Nutrition, University Clinic of Nutrition, Physical Activity and Physiotherapy (CUNAFF), Lluís Alcanyís Foundation-University of Valencia, 46020 Valencia, Spain
- Food & Health Lab, Institute of Materials Science, University of Valencia, 46980 Paterna, Spain
| | - Daniel Lledó
- Area of Nutrition, University Clinic of Nutrition, Physical Activity and Physiotherapy (CUNAFF), Lluís Alcanyís Foundation-University of Valencia, 46020 Valencia, Spain
- Food & Health Lab, Institute of Materials Science, University of Valencia, 46980 Paterna, Spain
| | - Jose M. Soriano
- Food & Health Lab, Institute of Materials Science, University of Valencia, 46980 Paterna, Spain
- Joint Research Unit on Endocrinology, Nutrition and Clinical Dietetics, Research Institute La Fe, University of Valencia-Health, 46026 Valencia, Spain
| |
Collapse
|
5
|
Ng S, Yeatman H, Kelly B, Sankaranarayanan S, Karupaiah T. Identifying barriers and facilitators in the development and implementation of government-led food environment policies: a systematic review. Nutr Rev 2022; 80:1896-1918. [PMID: 35388428 PMCID: PMC9263881 DOI: 10.1093/nutrit/nuac016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
CONTEXT Policy-specific actions to improve food environments will support healthy population diets. OBJECTIVE To identify cited barriers and facilitators to food environment policy (FEP) processes reported in the literature, exploring these according to the nature of the policy (voluntary or mandatory) and country development status. DATA SOURCES A systematic search was conducted of 10 academic and 7 grey-literature databases, national websites, and manual searches of publication references. DATA EXTRACTION Data on government-led FEPs, barriers, and facilitators from key informants were collected. DATA SYNTHESIS The constant-comparison approach generated core themes for barriers and facilitators. The appraisal tool developed by Hawker et al. was adopted to determine the quality of qualitative and quantitative studies. RESULTS A total of 142 eligible studies were identified. Industry resistance or disincentive was the most cited barrier in policy development. Technical challenges were most frequently a barrier for policy implementation. Frequently cited facilitators included resource availability or maximization, strategies in policy process, and stakeholder partnership or support. CONCLUSIONS The findings from this study will strategically inform health-reform stakeholders about key elements of public health policy processes. More evidence is required from countries with human development indices ranging from low to high and on voluntary policies. SYSTEMATIC REVIEW REGISTRATION PROSPERO registration no. CRD42018115034.
Collapse
Affiliation(s)
- SeeHoe Ng
- Early Start, School of Health and Society, University of Wollongong, Wollongong, New South Wales, Australia
- School of Biosciences, Faculty of Health and Medical Sciences, Taylor's University, Subang Jaya, Selangor, Malaysia
| | - Heather Yeatman
- Early Start, School of Health and Society, University of Wollongong, Wollongong, New South Wales, Australia
| | - Bridget Kelly
- Early Start, School of Health and Society, University of Wollongong, Wollongong, New South Wales, Australia
| | - Sreelakshmi Sankaranarayanan
- School of Biosciences, Faculty of Health and Medical Sciences, Taylor's University, Subang Jaya, Selangor, Malaysia
| | - Tilakavati Karupaiah
- School of Biosciences, Faculty of Health and Medical Sciences, Taylor's University, Subang Jaya, Selangor, Malaysia
| |
Collapse
|
6
|
Addressing Sustainability within Public Procurement of Food: A Systematic Literature Review. SUSTAINABILITY 2021. [DOI: 10.3390/su132313395] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Public procurement has been recognized as a tool to promote more sustainable production and consumption practices. As such, an increasing body of literature has become available in recent years focusing on the sustainable public procurement of food. This article reviews the literature on the sustainable public procurement of food with the aim to analyze how sustainability is framed. This is done by analyzing what aspects of sustainability are emphasized and what practices are identified as sustainable. A systematic literature review was conducted between the years 2000 and 2020, identifying 103 articles. Results from the literature review indicate that the focus has primarily been on studies to evaluate and explore policy and good practices for procuring sustainable foods. A dominant focus on specific foods types and origins, e.g., those locally sourced and organic foods, is highlighted by a large share of the literature to address all three sustainability pillars. We observed that most articles focus on all three pillars of sustainability (environmental, social, and economic), addressing different aspects and types of foods, although the focus varied depending upon geographic location. Despite many studies identifying opportunities and potential, few articles assess the sustainability or outcomes of procurement processes through quantitative or qualitative methods or how actors in the procurement process can improve procurement toward more sustainable foods. This indicates a need for further case studies and guidelines to measure the development, progress, and performance of public food procurement.
Collapse
|
7
|
What Are the Relationships between Psychosocial Community Characteristics and Dietary Behaviors in a Racially/Ethnically Diverse Urban Population in Los Angeles County? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18189868. [PMID: 34574791 PMCID: PMC8468734 DOI: 10.3390/ijerph18189868] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 08/22/2021] [Accepted: 09/14/2021] [Indexed: 11/17/2022]
Abstract
To address existing gaps in public health practice, we used data from a 2014 internet panel survey of 954 Los Angeles County adults to investigate the relationships between psychosocial community characteristics (PCCs) and two key chronic disease-related dietary behaviors: fruit and vegetable (F+V) and soda consumption. Negative binomial regression models estimated the associations between 'neighborhood risks and resources' and 'sense of community' factors for each dietary outcome of interest. While high perceived neighborhood violence (p < 0.001) and perceived community-level collective efficacy (p < 0.001) were associated with higher F+V consumption, no PCCs were directly associated with soda consumption overall. However, moderation analyses by race/ethnicity showed a more varied pattern. High perceived violence was associated with lower F+V consumption among White and Asian/Native Hawaiian/Other Pacific Islander (ANHOPI) groups (p < 0.01). Inadequate park access and walking as the primary mode of transportation to the grocery store were associated with higher soda consumption among the ANHOPI group only (p < 0.05). Study findings suggest that current and future chronic disease prevention efforts should consider how social and psychological dynamics of communities influence dietary behaviors, especially among racially/ethnically diverse groups in urban settings. Intervention design and implementation planning could benefit from and be optimized based on these considerations.
Collapse
|
8
|
Mann G, Lambert LG, Gupta K, Partacz M. Smart snacks in universities: possibilities for university vending. Health Promot Perspect 2020; 10:393-400. [PMID: 33312935 PMCID: PMC7722994 DOI: 10.34172/hpp.2020.58] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 09/20/2020] [Indexed: 11/15/2022] Open
Abstract
Background: The study goal was to evaluate the nutritional impact of a healthy snack intervention on a southern university campus. Methods: This quasi-experimental study was conducted during the fall 2017 semester weekly for 14 weeks in a large southern U.S. university. For the intervention, half of vending snacks in four campus residential halls (housing from 216 to 361 students) were substituted with snacks complying with federal Smart Snacks in School nutrition standards for K-12 schools. For analysis, data from the Nutrition Facts labels of 14 vending machines or from manufacturer’s websites was collected by trained graduate and undergraduate researchers. Results: On average, for each Smart Snack sold, there was a statistically significant reduction of 99.38 calories (CI=42.32, 156.43), 4 g saturated fat (CI = 2.23, 5.75), and 10.06 g of sugar(CI=2.92, 17.20). An average reduction of 41.88 mg in sodium and an increase of 0.81g in fiber was also found, but was not statistically significant. There was a significant difference (t(16)=3.02, P < 0.025, 95% CI = 10.77, 55.79) between the Quality Score of Smart Snacks (M=59.13,SD= ± 36.50) and that of non-compliant snacks (M=25.85, SD= ± 24.72). Conclusion: The nutritional impact with even a 50% Smart Snack replacement is promising. Many available comparable snacks mimic the mouthfeel, taste, and appearance of their original full-fat, full-sodium, and full-sugar counterparts. Including healthier snack choices in vending machines may be a viable option for universities to transform the campus eating environment.
Collapse
Affiliation(s)
- Georgianna Mann
- Department Nutrition and Hospitality Management, 220 Lenoir Hall, P.O. Box 1848, University of Mississippi, University, MS 38677, United States
| | - Laurel Greenway Lambert
- Department Nutrition and Hospitality Management, 220 Lenoir Hall, P.O. Box 1848, University of Mississippi, University, MS 38677, United States
| | - Kritika Gupta
- Department Nutrition and Hospitality Management, 220 Lenoir Hall, P.O. Box 1848, University of Mississippi, University, MS 38677, United States
| | - Megan Partacz
- University of Memphis Dining, University of Memphis, TN, 38152, United States
| |
Collapse
|
9
|
Riordan M, Zeitz A, Fulton B, Holliday D, Bartoli C, Aquilante J, Spratt O, Miller L, Wilson A, Deutsch J. Culinary Scientists Collaborating with City Health Department and Manufacturers to Improve Public Heath: A Case from Philadelphia’s Sodium Reduction in Communities Program. JOURNAL OF CULINARY SCIENCE & TECHNOLOGY 2020. [DOI: 10.1080/15428052.2019.1671292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Molly Riordan
- Department of Public Health, City of Philadelphia, Philadelphia, USA
| | - Alexandra Zeitz
- Department of Food and Hospitality Management, Drexel University, Philadelphia, USA
| | - Benjamin Fulton
- Department of Food and Hospitality Management, Drexel University, Philadelphia, USA
| | - Darryl Holliday
- Department of Biological and Physical Sciences, University of the Holy Cross, New Orleans, USA
| | - Catherine Bartoli
- Department of Public Health, City of Philadelphia, Philadelphia, USA
| | | | - Olivia Spratt
- Department of Food and Hospitality Management, Drexel University, Philadelphia, USA
| | - Lauren Miller
- Department of Food and Hospitality Management, Drexel University, Philadelphia, USA
| | - Anna Wilson
- Department of Food and Hospitality Management, Drexel University, Philadelphia, USA
| | - Jonathan Deutsch
- Department of Food and Hospitality Management, Drexel University, Philadelphia, USA
| |
Collapse
|
10
|
Robles B, Jewell MP, Thomas Tobin CS, Smith LV, Kuo T. Varying levels of depressive symptoms and lifestyle health behaviors in a low income, urban population. J Behav Med 2020; 44:212-221. [PMID: 32936373 DOI: 10.1007/s10865-020-00179-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 09/02/2020] [Indexed: 01/02/2023]
Abstract
This study examined the relationships between varying levels of depressive symptoms and key dietary indicators of chronic disease risk, sugar-sweetened beverage (SSB) and fruit and vegetable (F + V) consumption, among a racially/ethnically diverse urban population in Los Angeles County (LAC). Analyses were carried out using data from a 2012 cross-sectional health survey of 1401 low-income public health center clients. Participants with a high level of depressive symptoms consumed 30% more SSBs (IRR = 1.30, 95% CI = 1.08, 1.55) than participants with a lower level of these symptoms. Other predictors of higher SSB consumption included being African American/Black (IRR = 1.65, 95% CI = 1.32, 2.05), male (IRR = 1.20, 95% CI = 1.06, 1.35), U.S. born (IRR = 1.32, 95% CI = 1.11, 1.57), and using tobacco (IRR = 1.26, 95% CI = 1.11, 1.43). Similar associations with F + V consumption were not found. Findings suggest that depressive symptoms may influence certain health behaviors in certain groups under certain situations. Policy and practice implications are discussed within this context.
Collapse
Affiliation(s)
- Brenda Robles
- Division of Chronic Disease and Injury Prevention, Los Angeles County Department of Public Health, 3530 Wilshire Blvd., 8th Floor, Los Angeles, CA, 90010, USA. .,Department of Community Health Sciences, UCLA Fielding School of Public Health, P.O. Box 951772, Los Angeles, CA, 90095, USA.
| | - Mirna Ponce Jewell
- Division of Chronic Disease and Injury Prevention, Los Angeles County Department of Public Health, 3530 Wilshire Blvd., 8th Floor, Los Angeles, CA, 90010, USA
| | - Courtney S Thomas Tobin
- Department of Community Health Sciences, UCLA Fielding School of Public Health, P.O. Box 951772, Los Angeles, CA, 90095, USA
| | - Lisa V Smith
- Office of Health Assessment and Epidemiology, Los Angeles County Department of Public Health, 313 N. Figueroa St., Suite 127, Los Angeles, CA, 90012, USA.,Department of Epidemiology, UCLA Fielding School of Public Health, P.O. Box 951772, Los Angeles, CA, 90095, USA
| | - Tony Kuo
- Division of Chronic Disease and Injury Prevention, Los Angeles County Department of Public Health, 3530 Wilshire Blvd., 8th Floor, Los Angeles, CA, 90010, USA.,Department of Epidemiology, UCLA Fielding School of Public Health, P.O. Box 951772, Los Angeles, CA, 90095, USA.,Department of Family Medicine, David Geffen School of Medicine at UCLA, 10880 Wilshire Blvd, Suite 1800, Los Angeles, CA, 90024, USA.,Population Health Program, UCLA Clinical and Translational Science Institute, BE-144 Center of Health Sciences, Los Angeles, CA, 90095, USA
| |
Collapse
|
11
|
Evaluating the Potential Health and Revenue Outcomes of a 100% Healthy Vending Machine Nutrition Policy at a Large Agency in Los Angeles County, 2013-2015. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2019; 24:215-224. [PMID: 29227423 DOI: 10.1097/phh.0000000000000702] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
CONTEXT Healthy vending machine policies are viewed as a promising strategy for combating the growing obesity epidemic in the United States. Few studies have evaluated the short- and intermediate-term outcomes of healthy vending policies, especially for interventions that require 100% healthy products to be stocked. OBJECTIVE To evaluate the potential impact of a 100% healthy vending machine nutrition policy. DESIGN The vendor's quarterly revenue, product sales records, and nutritional information data from 359 unique vending machines were used to conduct a baseline and follow-up policy analysis. SETTING County of Los Angeles facilities, 2013-2015. PARTICIPANTS Vending machines in facilities located across Los Angeles County. INTERVENTION A healthy vending machine policy executed in 2013 that required 100% of all products sold in contracted machines meet specified nutrition standards. OUTCOME MEASURES Policy adherence; average number of calories, sugar, and sodium in food products sold; revenue change. RESULTS Policy adherence increased for snacks and beverages sold by the vending machines by 89% and 98%, respectively. Average snack and beverage revenues decreased by 37% and 34%, respectively, during the sampled period. CONCLUSIONS Although a 100% healthy vending policy represents a promising strategy for encouraging purchases of healthier foods, steps should be taken to counteract potential revenue changes when planning its implementation.
Collapse
|
12
|
Lazarus MA, Tandon PS, Otten JJ. Examining Relationships between Food Procurement Characteristics and Nutritional Quality in Washington State Child Care Settings. Child Obes 2019; 14:429-439. [PMID: 30199298 DOI: 10.1089/chi.2018.0090] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Sixty percent of US children 5 years old and under receive up to two-thirds of their daily nutrition in early care and education (ECE) settings. Although participation in the federal Child and Adult Care Food Program (CACFP) is shown to improve nutrition, little is known about the relationship between procurement practices (where and how child care programs purchase food) and nutrition in ECE settings or whether these practices differ depending on participation in CACFP. METHODS We assessed self-reported nutrition practices and procurement practices by CACFP participation using a 2013 cross-sectional survey of 690 Washington ECE centers ("Centers") and 1260 family homes (family home child care [FHCCs]) serving children aged 2-5 years old using validated survey tools. We examined the relationship between procurement variables (i.e., main store and main mode) and nutrition scores using multinomial logistic regression models that adjusted for sociodemographic and program characteristics. RESULTS In-person shopping was the primary mode of shopping for all programs, regardless of CACFP participation. Some Centers but very few FHCCs reported online shopping as their primary mode. Centers and non-CACFP FHCCs shopped primarily at megastores (Costco, Target, etc.). CACFP FHCCs used both megastores and grocery stores (Albertsons, QFC, etc.) at similar rates. Adjusted multinomial models found that shopping online or at two or more stores was associated with higher nutritional quality of foods served by programs. CONCLUSIONS Understanding the procurement behaviors of ECE programs helps to illuminate and prioritize potential interventions that would support healthy food purchases.
Collapse
Affiliation(s)
- Monica A Lazarus
- 1 University of Washington School of Public Health, Nutritional Sciences Program , Center for Public Health Nutrition, Seattle, Seattle, WA
| | - Pooja S Tandon
- 2 Seattle Children's Research Institute, Center for Child Health, Behavior, and Development, University of Washington General Pediatrics, School of Medicine, Seattle, Seattle, WA
| | - Jennifer J Otten
- 1 University of Washington School of Public Health, Nutritional Sciences Program , Center for Public Health Nutrition, Seattle, Seattle, WA
| |
Collapse
|
13
|
Atkey K, Elliott-Moyer P, Freimanis M, Raine KD. Stories of policy change: City of Hamilton's healthy food and beverage policy. Canadian Journal of Public Health 2018; 108:e625-e629. [PMID: 29356673 DOI: 10.17269/cjph.108.6074] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 10/06/2017] [Accepted: 09/10/2017] [Indexed: 11/17/2022]
Abstract
SETTING Municipal buildings and corporate events in the City of Hamilton, Ontario. INTERVENTION In 2011, the City of Hamilton adopted a healthy food and beverage policy. The intent of the policy is to demonstrate the City's commitment to healthy eating by providing food and beverages that are healthy, safe, and free of industrially produced trans fats, and promoting a sustainable, local food system. The corporate policy applies to all City facilities, meetings and events. In this article, we explore adoption and implementation of the policy, as well as key lessons for healthy public policy change. OUTCOMES Integrating the policy into corporate culture and practice through the provision of ongoing supports and resources helped the City of Hamilton overcome barriers and achieve implementation success. IMPLICATIONS Through exploration of the City of Hamilton's healthy food and beverage policy, we identified a number of lessons for policy change and implementation. When viewed in context, these lessons may help to support policy work in other Canadian jurisdictions.
Collapse
Affiliation(s)
- Kayla Atkey
- Policy Analyst, School of Public Health, University of Alberta, Edmonton, AB.
| | | | | | | |
Collapse
|
14
|
Raine KD, Atkey K, Olstad DL, Ferdinands AR, Beaulieu D, Buhler S, Campbell N, Cook B, L'Abbé M, Lederer A, Mowat D, Maharaj J, Nykiforuk C, Shelley J, Street J. Healthy food procurement and nutrition standards in public facilities: evidence synthesis and consensus policy recommendations. Health Promot Chronic Dis Prev Can 2018; 38:6-17. [PMID: 29323862 PMCID: PMC5809107 DOI: 10.24095/hpcdp.38.1.03] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Unhealthy foods are widely available in public settings across Canada, contributing to diet-related chronic diseases, such as obesity. This is a concern given that public facilities often provide a significant amount of food for consumption by vulnerable groups, including children and seniors. Healthy food procurement policies, which support procuring, distributing, selling, and/or serving healthier foods, have recently emerged as a promising strategy to counter this public health issue by increasing access to healthier foods. Although numerous Canadian health and scientific organizations have recommended such policies, they have not yet been broadly implemented in Canada. METHODS To inform further policy action on healthy food procurement in a Canadian context, we: (1) conducted an evidence synthesis to assess the impact of healthy food procurement policies on health outcomes and sales, intake, and availability of healthier food, and (2) hosted a consensus conference in September 2014. The consensus conference invited experts with public health/nutrition policy research expertise, as well as health services and food services practitioner experience, to review evidence, share experiences, and develop a consensus statement/recommendations on healthy food procurement in Canada. RESULTS Findings from the evidence synthesis and consensus recommendations for healthy food procurement in Canada are described. Specifically, we outline recommendations for governments, publicly funded institutions, decision-makers and professionals, citizens, and researchers. CONCLUSION Implementation of healthy food procurement policies can increase Canadians' access to healthier foods as part of a broader vision for food policy in Canada.
Collapse
Affiliation(s)
- Kim D Raine
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Kayla Atkey
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Dana Lee Olstad
- Institute of Physical Activity and Nutrition, Deakin University, Geelong, Australia
| | - Alexa R Ferdinands
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Dominique Beaulieu
- Department of Nursing Sciences, Université du Québec à Rimouski (UQAR), Lévis, Quebec, Canada
| | - Susan Buhler
- Nutrition Services, Alberta Health Services, Edmonton, Alberta, Canada
| | - Norm Campbell
- Physiology and Pharmacology, Community Health Sciences, and Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
| | - Brian Cook
- Toronto Public Health, Toronto, Ontario, Canada
| | - Mary L'Abbé
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Ashley Lederer
- Thoughtful Food Nutrition (formerly NYC Health Department), New York, New York, United States
| | - David Mowat
- Canadian Partnership Against Cancer, Toronto, Ontario, Canada
| | | | - Candace Nykiforuk
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Jacob Shelley
- Faculty of Law & School of Health Studies, Western University, London, Ontario, Canada
| | - Jacqueline Street
- School of Public Health, University of Adelaide, Adelaide, Australia
| |
Collapse
|
15
|
Viana J, Leonard SA, Kitay B, Ansel D, Angelis P, Slusser W. Healthier vending machines in a university setting: Effective and financially sustainable. Appetite 2017; 121:263-267. [PMID: 29137969 DOI: 10.1016/j.appet.2017.11.094] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 11/03/2017] [Accepted: 11/10/2017] [Indexed: 11/17/2022]
Affiliation(s)
- Joseph Viana
- UCLA Fielding School of Public Health, Department of Health Policy and Management, 650 Charles Young Dr. S., 31-269 CHS, Box 951772, Los Angeles, CA 90095, USA.
| | - Stephanie A Leonard
- UCLA Fielding School of Public Health, Department of Epidemiology, 650 Charles Young Dr. S., 71-254 CHS, Box 951772, Los Angeles, CA 90095, USA.
| | - Bob Kitay
- UCLA Housing & Hospitality Services, 360 De Neve Drive, Suite 182, Los Angeles, CA 90095, USA.
| | - Daryl Ansel
- UCLA Housing & Hospitality Services, 360 De Neve Drive, Suite 182, Los Angeles, CA 90095, USA.
| | - Peter Angelis
- UCLA Housing & Hospitality Services, 360 De Neve Drive, Suite 182, Los Angeles, CA 90095, USA.
| | - Wendelin Slusser
- UCLA Fielding School of Public Health, Department of Health Policy and Management, 650 Charles Young Dr. S., 31-269 CHS, Box 951772, Los Angeles, CA 90095, USA; UCLA School of Medicine, 10833 Le Conte Avenue, Los Angeles, CA 90095, USA.
| |
Collapse
|
16
|
Visual attention to food cues is differentially modulated by gustatory-hedonic and post-ingestive attributes. Food Res Int 2017; 97:199-208. [DOI: 10.1016/j.foodres.2017.04.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 04/08/2017] [Accepted: 04/10/2017] [Indexed: 11/21/2022]
|
17
|
Kamali A, Hameed H, Shih M, Simon P. Turning the Curve on Obesity Prevalence Among Fifth Graders in the Los Angeles Unified School District, 2001-2013. Prev Chronic Dis 2017; 14:E16. [PMID: 28207380 PMCID: PMC5313126 DOI: 10.5888/pcd14.160377] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Introduction After multiple decades of increasing childhood obesity prevalence in the United States, findings from recent studies suggest that prevalence has leveled or is decreasing in some populations. However, demographic and socioeconomic disparities in prevalence remain and may be increasing. Methods To assess recent trends and disparities in childhood obesity prevalence in Los Angeles County, we analyzed data from 2001 through 2013 in fifth graders in the Los Angeles Unified School District (LAUSD). Obesity was defined as a body mass index at or above the 95th percentile for children of the same age and sex as compared with Centers for Disease Control and Prevention growth charts, on the basis of measured height and weight. Trends were examined by sex, race/ethnicity, and socioeconomic status (SES). SES was determined by using school-level data on the percentage of students participating in a free and reduced-price meal program. Results Obesity prevalence increased from 27.5% in 2001 to 31.6% in 2005, was stable from 2005 through 2010, and decreased from 31.6% in 2010 to 28.5% in 2013. Similar trajectories in prevalence were observed for all demographic and SES subgroups, although the decline in prevalence began earlier among whites and students attending schools in the highest SES group. Disparities in prevalence by race/ethnicity and SES were observed during the entire study period but narrowed slightly from 2010 through 2013. Conclusion Although obesity prevalence among fifth graders in LAUSD declined from 2010 through 2013, prevalence remains higher than in 2001, and demographic and socioeconomic disparities in prevalence persist. Future interventions in the county should prioritize Latinos and students attending low SES schools.
Collapse
Affiliation(s)
- Amanda Kamali
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Los Angeles County Department of Public Health, Acute Communicable Disease Control, Los Angeles, California
| | - Heena Hameed
- Los Angeles County Department of Public Health, Office of Health Assessment and Epidemiology, Los Angeles, California
| | - Margaret Shih
- Los Angeles County Department of Public Health, Office of Health Assessment and Epidemiology, Los Angeles, California
| | - Paul Simon
- Los Angeles County Department of Public Health, Division of Chronic Disease and Injury Prevention, Los Angeles, California
| |
Collapse
|
18
|
Otten JJ, Hirsch T, Lim C. Factors Influencing the Food Purchases of Early Care and Education Providers. J Acad Nutr Diet 2017; 117:725-734. [PMID: 28139425 DOI: 10.1016/j.jand.2016.10.029] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2016] [Accepted: 10/26/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND With the majority of US children enrolled in some form of early care and education, the settings for early care and education represent a valuable opportunity to positively impact young children's diets and their interactions with food. Little evidence exists on how early care and education providers make food purchasing and service decisions for this population of young children. OBJECTIVE Our aim was to explore the factors that influence early care and education providers' food purchasing and service decisions. DESIGN A qualitative design consisting of individual, in-person, and semi-structured interviews with providers and on-site observations was used. PARTICIPANTS/SETTING Sixteen early care and education providers-selected across a variety of characteristics that might affect food selection (eg, size of site, participation in reimbursement programs, presence of staff assigned to foodservice) using maximum variation purposive sampling-based in the Puget Sound region, Washington, were interviewed from June to September 2014. MAIN OUTCOME MEASURE Provider perspectives on food purchasing and service decisions. STATISTICAL ANALYSES PERFORMED Inductive analysis of transcribed interviews using TAMS Analyzer software (GPL version 2, 2012) to identify themes. RESULTS Ten main influencers emerged from the data. These were grouped into four categories based on an ecological framework: macro-level environments (ie, regulations; suppliers and vendors, including stores); physical environment and settings (ie, organizational mission, budget, and structure; the facility itself); social environments (ie, professional networks; peers; the site-specific parent and child community); and individual factors at both a provider and child-level (ie, providers' skills, behaviors, motivations, attitudes, knowledge, and values; child food preferences; and, child allergies). A model was then developed to identify potential pathways of intervention and underscore the need for a comprehensive approach to improve early care and education nutrition. CONCLUSIONS This study suggests that a more system-based understanding and approach-one that accounts for an array of influencers and their interactions-is necessary to take advantage of opportunities and address barriers to improving early care and education-based nutrition.
Collapse
|
19
|
Soares P, Davó-Blanes MC, Martinelli SS, Melgarejo L, Cavalli SB. The effect of new purchase criteria on food procurement for the Brazilian school feeding program. Appetite 2016; 108:288-294. [PMID: 27756636 DOI: 10.1016/j.appet.2016.10.016] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Revised: 10/10/2016] [Accepted: 10/13/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To explore the effect of the school feeding program purchase criteria on the quantity, variety and origin of food products acquired for school meals in a municipality in Brazil. METHOD Analysis of purchase lists for two years prior and two years after implementation of the purchase criteria (2010). The origin (family farms (FF)/other providers (OP)) and nutritional characteristics (recommended/controlled) of food products were studied, registering annual varieties (n) and daily quantities (kg/day); contrast of proportions was applied. RESULTS The acquisition of recommended products increased, and the quantity of controlled products decreased (p = 0.005). Purchase of legumes and vegetables (p < 0.05) increased and high sugar foods decreased (p = 0.02). The majority of food products in 2010 and 2011 were acquired from OP (64% and 61%), although FF provided the greatest proportion of legumes and vegetables. Ten new varieties of recommended products were incorporated, 9 of which were acquired from FF. CONCLUSION The criteria of direct purchase from family farms resulted in an increase in the variety and quantity of healthy foods in the schools in the municipality.
Collapse
Affiliation(s)
- Panmela Soares
- Public Health Research Group, University of Alicante (Universidad de Alicante), Edificio de Ciencias Sociales, Campus San Vicente del Raspeig, Ap. 99, C.P. 03080, Alicante, Spain; Nutrition in Foodservice Research Centre, Federal University of Santa Catarina, Brazil.
| | - M Carmen Davó-Blanes
- Public Health Research Group, University of Alicante (Universidad de Alicante), Edificio de Ciencias Sociales, Campus San Vicente del Raspeig, Ap. 99, C.P. 03080, Alicante, Spain; Department of Community Nursing, Preventive Medicine and Public Health and History of Science, University of Alicante, Campus San Vicente del Raspeig, Ap. 99, C.P. 03080, Alicante, Spain.
| | - Suellen Secchi Martinelli
- Nutrition in Foodservice Research Centre, Federal University of Santa Catarina, Brazil; Nutrition Post-Graduate Program, Federal University of Santa Catarina, Campus Universitário Trindade, Centro de Ciências da Saúde, Departamento de Nutrição, Florianópolis, SC, 88040-900, Brazil.
| | - Leonardo Melgarejo
- Gaúcha Association for the Protection of the Natural Environment (AGAPAN), Av Osvaldo Aranha, 440 sala, 304 - Bairro Bom Fim, Porto Alegre, RS, 90, 035-190, Brazil.
| | - Suzi Barletto Cavalli
- Nutrition in Foodservice Research Centre, Federal University of Santa Catarina, Brazil; Nutrition Department, Nutrition Post-Graduate Program, Federal University of Santa Catarina, Campus Universitário Trindade, Centro de Ciências da Saúde, Departamento de Nutrição, Florianópolis, SC, 88040-900, Brazil.
| |
Collapse
|
20
|
Framing the Local Context and Estimating the Health Impact of CPPW Obesity Prevention Strategies in Los Angeles County, 2010-2012. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2016; 22:360-9. [DOI: 10.1097/phh.0000000000000334] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
|
21
|
Nianogo RA, Kuo T, Smith LV, Arah OA. Associations between self-perception of weight, food choice intentions, and consumer response to calorie information: a retrospective investigation of public health center clients in Los Angeles County before the implementation of menu-labeling regulation. BMC Public Health 2016; 16:60. [PMID: 26801241 PMCID: PMC4722675 DOI: 10.1186/s12889-016-2714-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Accepted: 01/08/2016] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Although obesity continues to rise and remains a great public health concern in the U.S., a number of important levers such as self-perception of weight and calorie postings at point-of-purchase in restaurants are still not well-characterized in the literature, especially for low-income and minority groups in Los Angeles County (LAC). To study this gap, we examined the associations of self-perception of weight (as measured by body weight discrepancy) with food choice intentions and consumer response to calorie information among low-income adults residing in LAC during the pre-menu labeling regulation era. METHODS Descriptive and multivariable logistic regression analyses were performed to examine the aforementioned associations utilizing data from the 2007-2008 Calorie and Nutrition Information Survey (CNIS). The CNIS was a local health department study of 639 low-income adults recruited from five large, multi-purpose public health centers in LAC. RESULTS Survey participants who reported that their desired weight was less than their current weight (versus desired weight the same as current weight) had (i) higher odds of intending to select lower-calorie foods under the scenario that calorie information was available at point-of-purchase (aOR = 2.0; 95 % CI: 1.0-3.9); and (ii) had higher odds of reporting that it is "very important" to have these calorie postings on food items in grocery stores (aOR = 3.1; 95 % CI: 0.90-10.7) and in fast-food restaurants (aOR = 3.4; 95 % CI: 1.0-11.4). CONCLUSIONS Self-perception of weight was found to be associated with the intention to select lower-calorie foods under the scenario that calorie information was available at point-of-purchase. Future public health efforts to support menu labeling implementation should consider these and other findings to inform consumer education and communications strategies that can be tailored to assist restaurant patrons with this forthcoming federal law.
Collapse
Affiliation(s)
- Roch A Nianogo
- Department of Epidemiology, UCLA Fielding School of Public Health, 650 Charles E. Young Drive South, Los Angeles, 90095-1772, CA, USA. .,UCLA Center for Health Policy Research, Los Angeles, CA, USA.
| | - Tony Kuo
- Department of Epidemiology, UCLA Fielding School of Public Health, 650 Charles E. Young Drive South, Los Angeles, 90095-1772, CA, USA.,Division of Chronic Disease and Injury Prevention, Los Angeles County Department of Public Health, Los Angeles, CA, USA.,Department of Family Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Lisa V Smith
- Department of Epidemiology, UCLA Fielding School of Public Health, 650 Charles E. Young Drive South, Los Angeles, 90095-1772, CA, USA.,Office of Health Assessment and Epidemiology, Los Angeles County Department of Public Health, Los Angeles, CA, USA
| | - Onyebuchi A Arah
- Department of Epidemiology, UCLA Fielding School of Public Health, 650 Charles E. Young Drive South, Los Angeles, 90095-1772, CA, USA.,UCLA Center for Health Policy Research, Los Angeles, CA, USA.,California Center for Population Research, UCLA, Los Angeles, CA, USA
| |
Collapse
|
22
|
Kuo T, Gase LN, Inkelas M. Dissemination, Implementation, and Improvement Science Research in Population Health: Opportunities for Public Health and CTSAs. Clin Transl Sci 2015; 8:807-13. [PMID: 26243323 PMCID: PMC4703442 DOI: 10.1111/cts.12313] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
IMPORTANCE The complex, dynamic nature of health systems requires dissemination, implementation, and improvement (DII) sciences to effectively translate emerging knowledge into practice. Although they hold great promise for informing multisector policies and system-level changes, these methods are often not strategically used by public health. OBJECTIVES AND METHODS More than 120 stakeholders from Southern California, including the community, federal and local government, university, and health services were convened to identify key priorities and opportunities for public health departments and Clinical and Translational Science Awards programs (CTSAs) to advance DII sciences in population health. MAIN OUTCOMES Participants identified challenges (mismatch of practice realities with narrowly focused research questions; lack of iterative learning) and solutions (using methods that fit the dynamic nature of the real world; aligning theories of change across sectors) for applying DII science research to public health problems. Pragmatic steps that public health and CTSAs can take to facilitate DII science research include: employing appropriate study designs; training scientists and practicing professionals in these methods; securing resources to advance this work; and supporting team science to solve complex-systems issues. CONCLUSIONS Public health and CTSAs represent a unique model of practice for advancing DII research in population health. The partnership can inform policy and program development in local communities.
Collapse
Affiliation(s)
- Tony Kuo
- Division of Chronic Disease and Injury PreventionLos Angeles County Department of Public HealthLos AngelesCaliforniaUSA
- Department of EpidemiologyUCLA Fielding School of Public HealthLos AngelesCaliforniaUSA
- Department of Family MedicineDavid Geffen School of Medicine at UCLALos AngelesCaliforniaUSA
| | - Lauren N. Gase
- Division of Chronic Disease and Injury PreventionLos Angeles County Department of Public HealthLos AngelesCaliforniaUSA
- Department of Health Policy and ManagementUCLA Fielding School of Public HealthLos AngelesCaliforniaUSA
| | - Moira Inkelas
- Department of Health Policy and ManagementUCLA Fielding School of Public HealthLos AngelesCaliforniaUSA
| | | |
Collapse
|
23
|
Schwartz MB, Gilstad-Hayden K, Henderson KE, Luedicke J, Carroll-Scott A, Peters SM, McCaslin C, Ickovics JR. The Relationship between Parental Behaviors and Children's Sugary Drink Consumption Is Moderated by a Television in the Child's Bedroom. Child Obes 2015; 11:560-8. [PMID: 26317365 PMCID: PMC4808288 DOI: 10.1089/chi.2014.0041] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND The aim of this longitudinal study was to examine the link between perceived authoritative parenting behaviors and sugary drink consumption among children from low-income families who do or do not have televisions (TVs) in their bedrooms. METHODS Middle school students (N = 480) completed a baseline survey in sixth grade and a follow-up survey in seventh grade. The students were recruited from 12 schools in a low-income, predominantly black (33%) and Latino (48%), urban school district. The survey assessed the children's perception of their parents' controlling and nurturing behaviors, the presence of a TV in their bedrooms, and their level of sugary drink consumption on the previous school day. Children's report of specific controlling and nurturing parental behaviors were used to create an "authoritative parenting" score. Regression analyses were used to test the main and interactive effects of authoritative parenting behaviors and having a TV in the bedroom with sugary drink consumption in seventh grade, controlling for age, race/ethnicity, gender, BMI, and sugary drink consumption in sixth grade. RESULTS A significant interaction emerged: The authoritative parenting score predicted lower levels of sugary drink consumption in seventh grade, but this relationship was moderated by whether or not there was a TV in the child's bedroom. CONCLUSION A TV in the child's bedroom may weaken the positive influence of authoritative parenting behaviors on limiting sugary drink consumption among middle school children from low-income families. Stronger initiatives are recommended to educate parents and help them refrain from placing TVs in their children's bedrooms.
Collapse
Affiliation(s)
- Marlene B. Schwartz
- Rudd Center for Food Policy and Obesity, University of Connecticut, Hartford, CT
| | - Kathryn Gilstad-Hayden
- Community Alliance for Research and Engagement, Yale School of Public Health, New Haven, CT
| | | | | | - Amy Carroll-Scott
- Department of Community Health and Prevention, Drexel School of Public Health, Philadelphia, PA
| | | | | | - Jeannette R. Ickovics
- Community Alliance for Research and Engagement, Yale School of Public Health, New Haven, CT
| |
Collapse
|
24
|
The relationship between amount of soda consumed and intention to reduce soda consumption among adults exposed to the Choose Health LA ‘Sugar Pack’ health marketing campaign. Public Health Nutr 2015; 18:2582-91. [DOI: 10.1017/s1368980014003097] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractObjectiveTo examine behavioural intention to reduce soda consumption after exposure to the Choose Health LA ‘Sugar Pack’ campaign in Los Angeles County, California, USA.DesignA cross-sectional street-intercept survey was conducted to assess knowledge, attitudes, health behaviours and behavioural intentions after exposure to the ‘Sugar Pack’ campaign. A multivariable regression analysis was performed to examine the relationships between the amount of soda consumed and self-reported intention to reduce consumption of non-diet soda among adults who saw the campaign.SettingThree pre-selected Los Angeles County Metro bus shelters and/or rail stops with the highest number of ‘Sugar Pack’ campaign advertisement placements.SubjectsRiders of the region’s Metro buses and railways who were the intended audience of the campaign advertisements.ResultsThe overall survey response rate was 56 % (resulting n 1041). Almost 60 % of respondents were exposed to the advertisements (619/1041). The multivariable logistic regression analysis suggested that the odds of reporting intention to reduce soda consumption among moderate consumers (1–6 sodas/week) were 1·95 times greater than among heavy consumers (≥1 soda/d), after controlling for clustering and covariates. Respondents with less than a high-school education and who perceived sugary beverage consumption as harmful also had higher odds; in contrast, respondents aged ≥65 years had lower odds.ConclusionsResults suggest that future campaigns should be tailored differently for moderate v. heavy consumers of soda. Similar tailoring strategies are likely needed for younger groups, for those with less educational attainment and for those who do not perceive consumption of soda as harmful.
Collapse
|
25
|
Woods J, Bressan A, Langelaan C, Mallon A, Palermo C. Australian school canteens: menu guideline adherence or avoidance? Health Promot J Austr 2014; 25:110-5. [PMID: 25200467 DOI: 10.1071/he14009] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2014] [Accepted: 07/10/2014] [Indexed: 11/23/2022] Open
Abstract
ISSUE ADDRESSED Since 2005, all states and territories across Australia have progressively introduced policy guidelines to promote nutritious food sales in school canteens. This study aimed to assess the compliance of school canteens with their state or territory canteen guidelines. METHODS School canteen menus from a convenience sample of online government school websites were assessed for compliance with guidelines for the inclusion of foods meeting the criteria for 'red' ('not recommended' or 'only occasional - no more than twice per term'), 'amber' ('select carefully') and 'green' ('always on the menu', 'everyday', 'fill the menu' or 'plenty'). The costs of a salad and a regular pie were also collected where present. RESULTS A total of 263 school menus were sourced and assessed (4% of government schools). Western Australia was the most compliant, with 62% of menus adhering to the state guidelines; compliance in other jurisdictions ranged from 5-35%. Compared with primary schools, a higher proportion of secondary schools offered 'red' items on the menu (P<0.05). The mean cost of a regular pie (A$3.17 ± 0.51) was significantly cheaper than the cost of a salad (A$4.2 5 ± 0.82) (P<0.001). A range of discretionary food items were present on a large proportion of menus. CONCLUSION This study found that the majority of school canteens were not complying with relevant state or territory guidelines, particularly those schools in which no monitoring or enforcement of the guidelines was conducted. SO WHAT? Monitoring and enforcement by those responsible for the policy, together with efforts to build the capacity for schools and manufacturers to improve the food supply, may increase compliance.
Collapse
Affiliation(s)
- Julie Woods
- School of Exercise and Nutrition Sciences, Deakin University, Burwood, Vic. 3125, Australia
| | - Alex Bressan
- Department of Nutrition and Dietetics, Monash University, Level 1, 264 Ferntree Gully Road, Notting Hill, Vic. 3168, Australia
| | - Corrina Langelaan
- The Parents' Jury, 570 Elizabeth Street, Melbourne, Vic. 3000, Australia
| | - Angela Mallon
- The Parents' Jury, 570 Elizabeth Street, Melbourne, Vic. 3000, Australia
| | - Claire Palermo
- Department of Nutrition and Dietetics, Monash University, Level 1, 264 Ferntree Gully Road, Notting Hill, Vic. 3168, Australia
| |
Collapse
|
26
|
Cummings PL, Welch SB, Mason M, Burbage L, Kwon S, Kuo T. Nutrient content of school meals before and after implementation of nutrition recommendations in five school districts across two U.S. counties. Prev Med 2014; 67 Suppl 1:S21-7. [PMID: 24631497 DOI: 10.1016/j.ypmed.2014.03.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Revised: 02/28/2014] [Accepted: 03/02/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To compare changes in nutrient levels of school meals before and after implementation of nutrition interventions at five school districts in two, large U.S. counties. School menu changes were compared against national school meal recommendations. METHODS A large urban school district in Los Angeles County (LAC), California and four school districts in suburban Cook County (SCC), Illinois implemented school meal nutrition interventions. Nutrition analyses were conducted for school breakfast and lunch before and after changes were made to the meal programs. Means, % change, and net calories (kilocalories or kcal) offered as a result of the nutrition interventions were calculated. RESULTS School districts in both counties made district-wide changes in their school breakfast and lunch menus. Menu changes resulted in a net reduction of calories, sugar, and sodium content offered in the meals. Net fewer calories offered as a result of the nutrition interventions were estimated to be about 64,075kcal per student per year for LAC and 22,887kcal per student per year for SCC. CONCLUSIONS Nutrition interventions can have broad reach through changes in menu offerings to school-aged children and adolescents. However, further research is needed to examine how these changes affect student food selection and consumption.
Collapse
Affiliation(s)
- Patricia L Cummings
- Department of Epidemiology, Jonathan and Karin Fielding School of Public Health, University of California Los Angeles, 71-254 CHS, Los Angeles, CA 90024-1772, USA; Division of Chronic Disease and Injury Prevention, Los Angeles County Department of Public Health, 3530 Wilshire Blvd., 8th Floor, Los Angeles, CA 90010, USA.
| | - Sarah B Welch
- Mary Ann and J. Milburn Smith Child Health Research Program, Ann and Robert H. Lurie Children's Hospital of Chicago Research Center, Consortium to Lower Obesity in Chicago Children, 225 E. Chicago Avenue, Box 205, Chicago, IL 60611, USA.
| | - Maryann Mason
- Mary Ann and J. Milburn Smith Child Health Research Program, Ann and Robert H. Lurie Children's Hospital of Chicago Research Center, Consortium to Lower Obesity in Chicago Children, 225 E. Chicago Avenue, Box 205, Chicago, IL 60611, USA; Department of Pediatrics and Preventive Medicine, Northwestern University Feinberg School of Medicine, 680 N. Lake Shore Drive, Suite 157, Chicago, IL 60611, USA.
| | - Lindsey Burbage
- Division of Chronic Disease and Injury Prevention, Los Angeles County Department of Public Health, 3530 Wilshire Blvd., 8th Floor, Los Angeles, CA 90010, USA.
| | - Soyang Kwon
- Mary Ann and J. Milburn Smith Child Health Research Program, Ann and Robert H. Lurie Children's Hospital of Chicago Research Center, Consortium to Lower Obesity in Chicago Children, 225 E. Chicago Avenue, Box 205, Chicago, IL 60611, USA.
| | - Tony Kuo
- Division of Chronic Disease and Injury Prevention, Los Angeles County Department of Public Health, 3530 Wilshire Blvd., 8th Floor, Los Angeles, CA 90010, USA; Department of Family Medicine, David Geffen School of Medicine, University of California Los Angeles, 10880 Wilshire Blvd., Suite 1800, Los Angeles, CA 90024-4142, USA.
| |
Collapse
|
27
|
Soler RE, Whitten KL, Ottley PG. Communities putting prevention to work: local evaluation of community-based strategies designed to make healthy living easier. Prev Med 2014; 67 Suppl 1:S1-3. [PMID: 25150384 PMCID: PMC4476513 DOI: 10.1016/j.ypmed.2014.08.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Accepted: 08/11/2014] [Indexed: 10/24/2022]
Abstract
This introduction is an overview of the articles presented in this supplement that describe implementation and evaluation activities conducted as part of the Centers for Disease Control and Prevention's (CDC's) Communities Putting Prevention to Work (CPPW) initiative. CPPW was one of the largest federal investments ever to combat chronic diseases in the United States. CPPW supported high-impact, jurisdiction-wide policy, systems, and environmental changes to improve health by increasing access to physical activity and healthy foods, and by decreasing tobacco use and exposure to secondhand smoke. The articles included in this supplement describe implementation and evaluation efforts of strategies implemented as part of CPPW by local awardees. This supplement is intended to guide the evidence base for public health interventions on the basis of jurisdiction-wide policy and environmental-level improvements and to encourage rigorous evaluation of the public health interventions.
Collapse
Affiliation(s)
- Robin E Soler
- Division of Community Health, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Kathleen L Whitten
- Public Health and Survey Research Division, ICF International, Atlanta, GA, USA
| | - Phyllis G Ottley
- Public Health and Survey Research Division, ICF International, Atlanta, GA, USA
| |
Collapse
|
28
|
Evaluating Changes to Sodium Content in School Meals at a Large, Urban School District in Los Angeles County, California. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2014; 20:S43-9. [DOI: 10.1097/phh.0b013e31829f2e50] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
29
|
Cummings PL, Kuo T, Gase LN, Mugavero K. Integrating sodium reduction strategies in the procurement process and contracting of food venues in the County of Los Angeles government, 2010-2012. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2014; 20:S16-22. [PMID: 24322811 PMCID: PMC4450096 DOI: 10.1097/phh.0b013e31829d7f63] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Since sodium is ubiquitous in the food supply, recent approaches to sodium reduction have focused on increasing the availability of lower-sodium products through system-level and environmental changes. This article reviews integrated efforts by the Los Angeles County Sodium Reduction Initiative to implement these strategies at food venues in the County of Los Angeles government. The review used mixed methods, including a scan of the literature, key informant interviews, and lessons learned during 2010-2012 to assess program progress. Leveraging technical expertise and shared resources, the initiative strategically incorporated sodium reduction strategies into the overall work plan of a multipartnership food procurement program in Los Angeles County. To date, 3 County departments have incorporated new or updated nutrition requirements that included sodium limits and other strategies. The strategic coupling of sodium reduction to food procurement and general health promotion allowed for simultaneous advancement and acceleration of the County's sodium reduction agenda.
Collapse
Affiliation(s)
- Patricia L Cummings
- Division of Chronic Disease and Injury Prevention, Los Angeles County Department of Public Health and University of California, Los Angeles, California (Mss Cummings and Gase, and Dr Kuo); and Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia (Ms Mugavero)
| | | | | | | |
Collapse
|
30
|
Robles B, Smith LV, Ponce M, Piron J, Kuo T. The influence of gender and self-efficacy on healthy eating in a low-income urban population affected by structural changes to the food environment. J Obes 2014; 2014:908391. [PMID: 24800064 PMCID: PMC3985319 DOI: 10.1155/2014/908391] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Accepted: 01/09/2014] [Indexed: 11/17/2022] Open
Abstract
Although U.S. obesity prevention efforts have begun to implement a variety of system and environmental change strategies to address the underlying socioecological barriers to healthy eating, factors which can impede or facilitate community acceptance of such interventions are often poorly understood. This is due, in part, to the paucity of subpopulation health data that are available to help guide local planning and decision-making. We contribute to this gap in practice by examining area-specific health data for a population targeted by federally funded nutrition interventions in Los Angeles County. Using data from a local health assessment that collected information on sociodemographics, self-reported health behaviors, and objectively measured height, weight, and blood pressure for a subset of low-income adults (n = 720), we compared health risks and predictors of healthy eating across at-risk groups using multivariable modeling analyses. Our main findings indicate being a woman and having high self-efficacy in reading Nutrition Facts labels were strong predictors of healthy eating (P < 0.05). These findings suggest that intervening with women may help increase the reach of these nutrition interventions, and that improving self-efficacy in healthy eating through public education and/or by other means can help prime at-risk groups to accept and take advantage of these food environment changes.
Collapse
Affiliation(s)
- Brenda Robles
- Division of Chronic Disease and Injury Prevention, Los Angeles County Department of Public Health, 3530 Wilshire Boulevard, 8th Floor, Los Angeles, CA 90010, USA
| | - Lisa V. Smith
- Office of Health Assessment and Epidemiology, Los Angeles County Department of Public Health, 313 North Figueroa Street, Room 127, Los Angeles, CA 90012, USA
- Department of Epidemiology, UCLA Jonathan and Karin Fielding School of Public Health, Box 951772, 71-254 CHS, Los Angeles, CA 90095-1772, USA
| | - Mirna Ponce
- Division of Chronic Disease and Injury Prevention, Los Angeles County Department of Public Health, 3530 Wilshire Boulevard, 8th Floor, Los Angeles, CA 90010, USA
| | - Jennifer Piron
- Office of Health Assessment and Epidemiology, Los Angeles County Department of Public Health, 313 North Figueroa Street, Room 127, Los Angeles, CA 90012, USA
| | - Tony Kuo
- Division of Chronic Disease and Injury Prevention, Los Angeles County Department of Public Health, 3530 Wilshire Boulevard, 8th Floor, Los Angeles, CA 90010, USA
- Department of Family Medicine, David Geffen School of Medicine at UCLA, 10880 Wilshire Boulevard, Suite 1800, Los Angeles, CA 90024-4142, USA
- *Tony Kuo:
| |
Collapse
|
31
|
Barragan NC, Noller AJ, Robles B, Gase LN, Leighs MS, Bogert S, Simon PA, Kuo T. The “Sugar Pack” Health Marketing Campaign in Los Angeles County, 2011-2012. Health Promot Pract 2013; 15:208-16. [DOI: 10.1177/1524839913507280] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
As part of a comprehensive approach to combating the obesity epidemic, the Los Angeles County Department of Public Health launched the “Sugar Pack” health marketing campaign in fall 2011. Carried out in three stages, the campaign sought to educate and motivate the public to reduce excess calorie intake from sugar-sweetened beverage consumption. The primary Sugar Pack creative concepts provided consumers with information about the number of sugar packs contained in sugary drinks. Data from formative market research as well as lessons from previous campaigns in other U.S. jurisdictions informed the development of the materials. These materials were disseminated through a multipronged platform that included paid outdoor media on transit and billboards and messaging using social media (i.e., Twitter, Facebook, YouTube, and sendable e-cards). Initial findings from a postcampaign assessment indicate that the Sugar Pack campaign reached broadly into targeted communities, resulting in more than 515 million impressions. Lessons learned from the campaign suggest that employing health marketing to engage the public can lead to increased knowledge, favorable recognition of health messages, and self-reported intention to reduce sugar-sweetened beverage consumption, potentially complementing other obesity prevention strategies in the field.
Collapse
Affiliation(s)
- Noel C. Barragan
- Los Angeles County Department of Public Health, Los Angeles, CA, USA
| | - Ali J. Noller
- Los Angeles County Department of Public Health, Los Angeles, CA, USA
| | - Brenda Robles
- Los Angeles County Department of Public Health, Los Angeles, CA, USA
| | - Lauren N. Gase
- Los Angeles County Department of Public Health, Los Angeles, CA, USA
| | - Michael S. Leighs
- Los Angeles County Department of Public Health, Los Angeles, CA, USA
| | - Suzanne Bogert
- Los Angeles County Department of Public Health, Los Angeles, CA, USA
| | - Paul A. Simon
- Los Angeles County Department of Public Health, Los Angeles, CA, USA
- UCLA Jonathan and Karin Fielding School of Public Health, Los Angeles, CA, USA
| | - Tony Kuo
- Los Angeles County Department of Public Health, Los Angeles, CA, USA
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| |
Collapse
|