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Tsai MM, Olarte DA, Hager ER, Cohen JFW, Turner L. Prevalence of Recess and Supportive Practices at a Nationwide Sample of Public Elementary Schools in the United States. J Sch Health 2024; 94:366-373. [PMID: 37395014 DOI: 10.1111/josh.13368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 06/05/2023] [Accepted: 06/22/2023] [Indexed: 07/04/2023]
Abstract
BACKGROUND Recess provides an important opportunity for children to be physically active during weekdays. Updated, nationally representative, prevalence estimates of elementary school recess practices in the United States are needed. METHODS Surveys were sent to a nationally representative sample of 1010 public elementary schools in the 2019-2020 school year. Results were compared by region (Northeast, Midwest, South, West), urbanicity, size, racial and ethnic composition, and socioeconomic status (percent eligible for free/reduced-priced meals). RESULTS A total of 559 responses were obtained. About 87.9% of schools provided at least 20 minutes of daily recess and 26.6% had trained recess supervisors. Most schools did not allow students to voluntarily stay inside during recess (71.6%) and around half prohibited withholding recess for poor behavior (45.6%) or to complete schoolwork (49.5%). Several practices varied by region, and withholding recess was more prevalent among schools with lower student socioeconomic makeup. IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY Regular national surveillance of recess practices can inform policy needs and efforts to advance equitable access to recess. Quality and access should be considered when developing recess policies. CONCLUSIONS Most United States elementary schools provide recess. However, regional and economic disparities exist. Promoting supportive practices for recess, particularly for schools serving lower-income communities, is necessary.
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Affiliation(s)
- Marisa M Tsai
- University of California Berkeley, School of Public Health, Division of Epidemiology, Berkeley Way West, Berkeley, CA
| | - Deborah A Olarte
- Center for Health Inclusion, Research and Practice, Department of Public Health and Nutrition, School of Health Sciences, Merrimack College, North Andover, MA
| | - Erin R Hager
- Johns Hopkins Bloomberg School of Public Health, Department of Population, Family and Reproductive Health, Baltimore, MD
| | - Juliana F W Cohen
- Center for Health Inclusion, Research and Practice, Department of Public Health and Nutrition, School of Nursing and Health Sciences, Merrimack College, North Andover, MA; Adjunt Professor, Department of Nutrition, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA
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Zuercher MD, Cohen JFW, Hecht CA, Hecht K, Orta-Aleman D, Patel A, Olarte DA, Chapman LE, Read M, Schwartz MB, Ritchie LD, Gosliner W. Parent Perceptions of School Meals Influence Student Participation in School Meal Programs. J Nutr Educ Behav 2024; 56:230-241. [PMID: 38583880 DOI: 10.1016/j.jneb.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 01/05/2024] [Accepted: 01/10/2024] [Indexed: 04/09/2024]
Abstract
OBJECTIVE To evaluate if parent perceptions of school meals influence student participation. DESIGN In May 2022, an online survey was used to evaluate parents' perceptions of school meals and their children's participation. PARTICIPANTS A total of 1,110 California parents of kindergarten through 12th-grade students. MAIN OUTCOME MEASURES Student participation in school lunch and breakfast. ANALYSIS Principal component analysis and Poisson regression models. RESULTS Three groups of parental perceptions were identified: (1) positive perceptions (eg, liking school meals and thinking that they are tasty and healthy), (2) perceived benefits to families (eg, school meals save families money, time, and stress), and (3) negative (eg, concerns about the amount of sugar in school meals and stigma). More positive parental perceptions about school meals and their benefits to families were associated with greater student meal participation. In contrast, more negative parental perceptions were associated with reduced student participation in school meals (P < 0.05). CONCLUSION AND IMPLICATIONS Parent perceptions of school meals may affect student participation in school meal programs. Working to ensure parents are familiar with the healthfulness and quality of school meals and the efforts schools are making to provide high-quality, appealing meals may be critical for increasing school meal participation rates.
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Affiliation(s)
- Monica D Zuercher
- Nutrition Policy Institute, Division of Agriculture and Natural Resources, University of California, Berkeley, CA.
| | - Juliana F W Cohen
- Center for Health Inclusion, Research, and Practice, Department of Public Health and Nutrition, Merrimack College, North Andover, MA; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Christina A Hecht
- Nutrition Policy Institute, Division of Agriculture and Natural Resources, University of California, Berkeley, CA
| | - Kenneth Hecht
- Nutrition Policy Institute, Division of Agriculture and Natural Resources, University of California, Berkeley, CA
| | - Dania Orta-Aleman
- Nutrition Policy Institute, Division of Agriculture and Natural Resources, University of California, Berkeley, CA
| | - Anisha Patel
- Stanford Pediatrics, Stanford University, Palo Alto, CA
| | - Deborah A Olarte
- Center for Health Inclusion, Research, and Practice, Department of Public Health and Nutrition, Merrimack College, North Andover, MA
| | - Leah E Chapman
- Center for Health Inclusion, Research, and Practice, Department of Public Health and Nutrition, Merrimack College, North Andover, MA
| | - Margaret Read
- Partnership for a Healthier America, Prince Frederick, MD
| | - Marlene B Schwartz
- Rudd Center for Food Policy & Health University of Connecticut, Hartford, CT
| | - Lorrene D Ritchie
- Nutrition Policy Institute, Division of Agriculture and Natural Resources, University of California, Berkeley, CA
| | - Wendi Gosliner
- Nutrition Policy Institute, Division of Agriculture and Natural Resources, University of California, Berkeley, CA
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3
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Chapman LE, Richardson SA, Rimm EB, Gortmaker SL, Lee MM, Cohen JFW. Daily Saturated Fat and Sodium Content of Elementary School Meals in a Large Sample of 128 Geographically Diverse School Systems in the United States. J Acad Nutr Diet 2024; 124:346-357.e2. [PMID: 37858673 PMCID: PMC10922125 DOI: 10.1016/j.jand.2023.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 10/06/2023] [Accepted: 10/12/2023] [Indexed: 10/21/2023]
Abstract
BACKGROUND Despite federal regulations limiting saturated fat and sodium levels on a weekly average basis, daily nutrient content of school meals in the United States is not regulated, leading to potential large fluctuations and intake well in excess of dietary recommendations. OBJECTIVE To assess the daily prevalence of potential public elementary school meal combinations that were high in saturated fat and sodium (using cutoffs based on the US Department of Agriculture weekly average reimbursable meal thresholds), and to identify saturated fat and sodium thresholds for entrées to limit full meals exceeding those cutoffs. DESIGN Cross-sectional. PARTICIPANTS AND SETTING Four weeks of publicly available public elementary school (kindergarten through grade five) breakfast and lunch menus with associated nutrition data were collected from a national stratified random sample of 128 school districts during fall 2019. MAIN OUTCOME MEASURES Percent of meal combinations exceeding the saturated fat and Target 1 sodium thresholds were calculated, as well as thresholds for saturated fat and sodium levels in breakfast and lunch entrées. STATISTICAL ANALYSES Descriptive statistics and logistic regression were used to examine the odds of alignment with sodium and saturated fat US Department of Agriculture thresholds. RESULTS The prevalence of elementary breakfast and lunch meal combinations that were high in sodium was on average 11% and 12.4%, respectively, and for saturated fat was 10.6% and 34%, respectively. Entrées above certain thresholds (≥400 and ≥1,000 mg sodium and ≥4.5 and ≥6 g saturated fat for breakfast and lunch, respectively) had a higher odds of producing a reimbursable meal that was high in sodium and saturated fat. CONCLUSIONS There is widespread availability of high-saturated fat and sodium elementary school meal combinations on a daily basis. Daily thresholds, in addition to weekly nutrient thresholds, as well as limits on sodium and saturated fat for entrées, may therefore be needed to prevent daily excess intake of saturated fat and sodium among elementary students.
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Affiliation(s)
- Leah Elizabeth Chapman
- Department of Nutrition and Public Health, Merrimack College, North Andover, Massachusetts; Center for Health Inclusion, Research, and Practice, Merrimack College, North Andover, Massachusetts.
| | - Scott A Richardson
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Eric B Rimm
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Department of Nutrition, 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; Harvard Prevention Research Center, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Matthew M Lee
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Juliana F W Cohen
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Department of Nutrition and Public Health, Merrimack College, North Andover, Massachusetts; Center for Health Inclusion, Research, and Practice, Merrimack College, North Andover, Massachusetts
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4
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Burkholder K, Bennett BL, McKee SL, Cohen JFW, Xu R, Schwartz MB. Participation in the US Department of Agriculture's Summer Meal Programs: 2019-2021. J Sch Health 2024. [PMID: 38258650 DOI: 10.1111/josh.13438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 12/21/2023] [Accepted: 01/03/2024] [Indexed: 01/24/2024]
Abstract
BACKGROUND The US Department of Agriculture's (USDA) summer meal programs are designed to provide meals at no cost while school is out of session. In response to the COVID-19 pandemic, several regulatory waivers were enacted to facilitate meal distribution. The aim of this study was to assess the rates of meal distribution before and after these waivers were in effect. METHODS Meal distribution patterns for 2019, 2020, and 2021 were examined through (1) a descriptive comparison of the number of participating districts, sponsors, meal sites, and meals distributed statewide, and (2) repeated measures ANOVAs to examine changes among districts in operation all years. RESULTS The waivers were associated with an increase in the total number of participating districts, sponsors, and meal sites; an increase in the total number of meals distributed to children during the summer months; and an increase in meal distribution among sponsors that had been in place since 2019. CONCLUSION Expanding the area eligibility criteria and enabling flexibility in meal distribution methods increased the number of meals provided. This study provides important preliminary evidence to suggest that the USDA should consider permanent regulatory changes to this program to maximize its reach.
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Affiliation(s)
- Kara Burkholder
- Rudd Center for Food Policy & Health, University of Connecticut, Hartford, CT; Department of Public Health Sciences, University of Connecticut, Storrs, CT
| | - Brooke L Bennett
- Rudd Center for Food Policy & Health, University of Connecticut, Hartford, CT; Department of Psychology, Clemson University, Clemson, SC
| | - Sarah L McKee
- Rudd Center for Food Policy & Health, University of Connecticut, Hartford, CT; Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT
| | - Juliana F W Cohen
- School of Nursing and Health Sciences, Merrimack College, North Andover, MA: Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA
| | - Ran Xu
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT
| | - Marlene B Schwartz
- Rudd Center for Food Policy & Health, University of Connecticut, Hartford, CT; Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT, USA
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Cohen JFW, Kesack A, Daly TP, Elnakib SA, Hager E, Hahn S, Hamlin D, Hill A, Lehmann A, Lurie P, Maroney M, Means J, Mueller MP, Olarte DA, Polacsek M, Schwartz MB, Sonneville KR, Spruance LA, Woodward AR, Chapman LE. Competitive Foods' Nutritional Quality and Compliance with Smart Snacks Standards: An Analysis of a National Sample of U.S. Middle and High Schools. Nutrients 2024; 16:275. [PMID: 38257169 PMCID: PMC10818474 DOI: 10.3390/nu16020275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 01/08/2024] [Accepted: 01/10/2024] [Indexed: 01/24/2024] Open
Abstract
Snacks and beverages are often sold in addition to meals in U.S. schools ("competitive foods"), but their current nutritional quality and compliance with national Smart Snacks standards are unknown. This study assessed competitive foods in a national sample of 90 middle and high schools. Differences in compliance by school characteristics were measured using mixed methods analysis of variance. Overall, 80% of the schools in the sample sold competitive foods; but they were less commonly available in schools with universal free school meal (UFSM) policies. A total of 840 unique products were documented and, on average, 75% were compliant with Smart Snacks standards. A total of 56% aligned with recommended added sugar limits (<10% of calories); and 340 unique products (40%) aligned with both sugar and Smart Snacks standards. Approximately one-fifth of competitive foods contained synthetic dyes, and 31% of beverages contained artificial sweeteners. Smart Snacks standards compliance was greater when competitive foods were overseen by food service departments, in comparison with others (e.g., principals, student organizations, or outside vendors [77% vs. 59% compliance; p = 0.003]). Therefore, district wellness policies should consider requiring food service departments to oversee competitive foods. Federal and state policies should limit added sugars, artificial sweeteners, and synthetic dyes. This appears to be highly feasible, given the substantial number of products that meet these criteria. UFSM policies should also be considered to support healthier school meal environments more broadly.
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Affiliation(s)
- Juliana F. W. Cohen
- Center for Health Inclusion, Research and Practice (CHIRP), Department of Nutrition and Public Health, Merrimack College, 315 Turnpike Street, North Andover, MA 01845, USA; (A.K.); (T.P.D.); (D.A.O.); (L.E.C.)
- Department of Nutrition, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA 02115, USA
| | - Ashley Kesack
- Center for Health Inclusion, Research and Practice (CHIRP), Department of Nutrition and Public Health, Merrimack College, 315 Turnpike Street, North Andover, MA 01845, USA; (A.K.); (T.P.D.); (D.A.O.); (L.E.C.)
| | - Tara P. Daly
- Center for Health Inclusion, Research and Practice (CHIRP), Department of Nutrition and Public Health, Merrimack College, 315 Turnpike Street, North Andover, MA 01845, USA; (A.K.); (T.P.D.); (D.A.O.); (L.E.C.)
| | - Sara A. Elnakib
- Department of Family and Community Health Sciences, Rutgers University, New Brunswick, NJ 08901, USA;
| | - Erin Hager
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA;
| | - Samuel Hahn
- Center for Science in the Public Interest, Washington, DC 20005, USA (A.H.); (P.L.); (M.M.)
| | - Daniel Hamlin
- Department of Educational Leadership and Policy Studies, University of Oklahoma, Tulsa, OK 74135, USA; (D.H.); (J.M.)
| | - Alla Hill
- Center for Science in the Public Interest, Washington, DC 20005, USA (A.H.); (P.L.); (M.M.)
| | - Annie Lehmann
- School of Allied Health, University of Alaska Anchorage, Anchorage, AK 99508, USA;
| | - Peter Lurie
- Center for Science in the Public Interest, Washington, DC 20005, USA (A.H.); (P.L.); (M.M.)
| | - Meghan Maroney
- Center for Science in the Public Interest, Washington, DC 20005, USA (A.H.); (P.L.); (M.M.)
| | - Jaydn Means
- Department of Educational Leadership and Policy Studies, University of Oklahoma, Tulsa, OK 74135, USA; (D.H.); (J.M.)
| | - Megan P. Mueller
- Department of Food Science and Human Nutrition, Colorado State University, 1571 Campus Dr, Fort Collins, CO 80523, USA;
| | - Deborah A. Olarte
- Center for Health Inclusion, Research and Practice (CHIRP), Department of Nutrition and Public Health, Merrimack College, 315 Turnpike Street, North Andover, MA 01845, USA; (A.K.); (T.P.D.); (D.A.O.); (L.E.C.)
| | - Michele Polacsek
- Center for Excellence in Public Health, University of New England, 716 Stevens Ave, Portland, ME 04103, USA;
| | - Marlene B. Schwartz
- Rudd Center for Food Policy and Health, Department of Human Development and Family Sciences, University of Connecticut, 1 Constitution Plaza, Suite 600, Hartford, CT 06103, USA;
| | - Kendrin R. Sonneville
- Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, MI 48109, USA;
| | - Lori A. Spruance
- Department of Public Health, Brigham Young University, Provo, UT 84602, USA;
| | | | - Leah E. Chapman
- Center for Health Inclusion, Research and Practice (CHIRP), Department of Nutrition and Public Health, Merrimack College, 315 Turnpike Street, North Andover, MA 01845, USA; (A.K.); (T.P.D.); (D.A.O.); (L.E.C.)
- Department of Nutrition, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA 02115, USA
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Zuercher MD, Cohen JFW, Ohri-Vachaspati P, Hecht CA, Hecht K, Polacsek M, Olarte DA, Read M, Patel AI, Schwartz MB, Chapman LE, Orta-Aleman D, Ritchie LD, Gosliner W. Parent perceptions of school meals and how perceptions differ by race and ethnicity. Health Aff Sch 2024; 2:qxad092. [PMID: 38756406 PMCID: PMC10986222 DOI: 10.1093/haschl/qxad092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 12/07/2023] [Accepted: 01/03/2024] [Indexed: 05/18/2024]
Abstract
Parental perceptions of school meals can affect student participation and overall support for school meal policies. Little is known about parental school meal perceptions under universal free school meals (UFSM) policies. We assessed California parents' perceptions of school meals during the COVID-19 emergency response with federally funded UFSM and whether perceptions differed by race/ethnicity. Among 1110 California parents of K-12 students, most reported school meals benefit their families, saving them money (81.6%), time (79.2%), and stress (75.0%). Few reported that their child would be embarrassed to eat school meals (11.7%), but more parents of White students than Hispanic students reported this. Many parents reported that their child likes to eat lunch to be with friends (64.7%); about half felt their child has enough time to eat (54.2%). Fewer parents perceived school lunches to be of good quality (36.9%), tasty (39.6%), or healthy (44.0%). Parents of Hispanic and Asian students had less favorable perceptions of school meal quality, taste, and healthfulness than parents of White students. Parents report that school meals benefit their families, but policy efforts are needed to ensure schools have the resources needed to address cultural appropriateness. Schools should address parental perceptions of meals to optimize participation, nutrition security, and health.
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Affiliation(s)
- Monica D Zuercher
- Division of Agriculture and Natural Resources, Nutrition Policy Institute, University of California, Oakland, CA 94607, United States
| | - Juliana F W Cohen
- Department of Public Health and Nutrition, Center for Health Inclusion, Research, and Practice (CHIRP), Merrimack College, North Andover, MA 01845, United States
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA 02115, United States
| | - Punam Ohri-Vachaspati
- College of Health Solutions, Arizona State University, Phoenix, AZ 85004, United States
| | - Christina A Hecht
- Division of Agriculture and Natural Resources, Nutrition Policy Institute, University of California, Oakland, CA 94607, United States
| | - Kenneth Hecht
- Division of Agriculture and Natural Resources, Nutrition Policy Institute, University of California, Oakland, CA 94607, United States
| | - Michele Polacsek
- Center for Excellence in Public Health, University of New England, Portland, ME 04103, United States
| | - Deborah A Olarte
- Department of Public Health and Nutrition, Center for Health Inclusion, Research, and Practice (CHIRP), Merrimack College, North Andover, MA 01845, United States
| | - Margaret Read
- Share Our Strength, Washington, DC 20005, United States
| | - Anisha I Patel
- Stanford Pediatrics, Stanford University, Palo Alto, CA 94304, United States
| | - Marlene B Schwartz
- Rudd Center for Food Policy and Health & Department of Human Development and Family Sciences, University of Connecticut, Hartford, CT 06013, United States
| | - Leah E Chapman
- Department of Public Health and Nutrition, Center for Health Inclusion, Research, and Practice (CHIRP), Merrimack College, North Andover, MA 01845, United States
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA 02115, United States
| | - Dania Orta-Aleman
- Division of Agriculture and Natural Resources, Nutrition Policy Institute, University of California, Oakland, CA 94607, United States
| | - Lorrene D Ritchie
- Division of Agriculture and Natural Resources, Nutrition Policy Institute, University of California, Oakland, CA 94607, United States
| | - Wendi Gosliner
- Division of Agriculture and Natural Resources, Nutrition Policy Institute, University of California, Oakland, CA 94607, United States
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Cohen JFW, Verguet S, Giyose BB, Bundy D. Universal free school meals: the future of school meal programmes? Lancet 2023; 402:831-833. [PMID: 37562420 DOI: 10.1016/s0140-6736(23)01516-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 07/18/2023] [Indexed: 08/12/2023]
Affiliation(s)
- Juliana F W Cohen
- Department of Nutrition, Harvard T H Chan School of Public Health, Harvard University, Boston, MA 02115, USA; NOURISH Lab, Center for Health Inclusion, Research and Practice, Merrimack College, North Andover, MA, USA.
| | - Stéphane Verguet
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Harvard University, Boston, MA 02115, USA
| | - Boitshepo Bibi Giyose
- The African Union Development Agency-New Partnership for African Development, Johannesburg, South Africa; Nutrition and Food Systems Division, Food and Agriculture Organization of the UN, Rome, Italy
| | - Donald Bundy
- London School of Hygiene & Tropical Medicine, London, UK
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Olarte DA, Tsai MM, Chapman L, Hager ER, Cohen JFW. Alternative School Breakfast Service Models and Associations with Breakfast Participation, Diet Quality, Body Mass Index, Attendance, Behavior, and Academic Performance: A Systematic Review. Nutrients 2023; 15:2951. [PMID: 37447277 DOI: 10.3390/nu15132951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 06/17/2023] [Accepted: 06/19/2023] [Indexed: 07/15/2023] Open
Abstract
The United States (US) School Breakfast Program provides Breakfast After The Bell (BATB) to alleviate hunger, provide nutrition, and ensure students have a healthy start to the day. This study aims to review the evidence regarding the impact of BATB on students' diet and academic outcomes, including participation, diet quality and consumption, body mass index (BMI) and weight status, attendance, classroom behavior, and academic performance. The articles were extracted from three electronic databases and published since the start of the literature through December 2022. Studies were peer-reviewed; quantitative research articles or government reports; and conducted in public or private elementary, middle, and high schools. Quality was assessed using the Newcastle-Ottawa Scale. Thirty-seven studies were included in this review. This review found BATB increased school breakfast participation, improved diet quality, and improved classroom behavior particularly among students from racial and ethnic minority backgrounds and students eligible for free or reduced-price meals. The impact of BATB on BMI and weight status, academic achievement and attendance was mixed. This review is particularly timely given free school meals and updated school nutrition standards are being prioritized over the next decade in the US. Thus, it is important to evaluate the nutritional and educational outcomes of BATB. (PROSPERO registration: CRD42021289719).
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Affiliation(s)
- Deborah A Olarte
- Center for Health Inclusion, Research and Practice (CHIRP), Merrimack College, 315 Turnpike Street, North Andover, MA 01845, USA
| | - Marisa M Tsai
- Division of Epidemiology, School of Public Health, University of California Berkeley, 2121 Berkeley Way, Berkeley, CA 94704, USA
| | - Leah Chapman
- Center for Health Inclusion, Research and Practice (CHIRP), Merrimack College, 315 Turnpike Street, North Andover, MA 01845, USA
| | - Erin R Hager
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA
| | - Juliana F W Cohen
- Center for Health Inclusion, Research and Practice (CHIRP), Merrimack College, 315 Turnpike Street, North Andover, MA 01845, USA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Harvard University, 677 Huntington Avenue, Boston, MA 02115, USA
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Zafari Z, Cohen JFW, Sessom-Parks L, Lessard D, Cooper M, Hager E. Impacts of Covid-19 School Closures on School Food Service Revenue: Analysis of Public Local Education Agencies in Maryland. J Sch Health 2023; 93:386-394. [PMID: 36825481 DOI: 10.1111/josh.13299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 12/08/2022] [Accepted: 02/05/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND The public health policies and school closures in response to the Covid-19 pandemic have created disruptions in school meal programs. Research is needed to understand the changes in school food service revenue before and during the initial Covid-19-related school shutdowns. METHODS A longitudinal cohort study examining federal and state reimbursements as well as sales revenues for all public local education agencies (LEAs) in Maryland from school years (SY) 2018-2019 and 2019-2020 was conducted. Monthly changes in federal and state reimbursements for Child Nutrition Programs, including the National School Lunch Program (NSLP), School Breakfast Program (SBP), Summer Food Service Program (SFSP), and Child and Adult Care Food Program (CACFP) were examined. RESULTS In the SY 2018-2019, the total revenues from federal and state reimbursements for SBP, NSLP, SFSP, and at-risk CACFP were $272.9 million; in comparison, for the SY 2019-2020, the total revenues were $241.8 million (11.4% reduction from SY 2018-2019). On average, the school shutdown (during March to June 2020) was associated with a $450,385 (p-value < .01) reduction in federal and state reimbursements per LEA-month (41% reduction). CONCLUSIONS The school shutdown during the Covid-19 pandemic was associated with a statistically significant reduction in school food service revenues across Maryland's public LEAs.
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Affiliation(s)
- Zafar Zafari
- Pharmaceutical Health Services Research, Baltimore, MD
| | - Juliana F W Cohen
- Department of Public Health and Nutrition, School of Health Sciences, Merrimack College, Andover, MA
| | - Leslie Sessom-Parks
- Office of School and Community Nutrition Programs, Maryland State Department of Education, Baltimore, MD
| | | | - Michele Cooper
- Office of School and Community Nutrition Programs, Maryland State Department of Education, Baltimore, MD
| | - Erin Hager
- Department of Population, Family, and Reproductive Health, Johns Hopkins University, Baltimore, MD
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Slotnick MJ, Falbe J, Cohen JFW, Gearhardt AN, Wolfson JA, Leung CW. Environmental and Climate Impact Perceptions in University Students: Sustainability Motivations and Perceptions Correspond With Lower Red Meat Intake. J Acad Nutr Diet 2023; 123:740-750. [PMID: 36150669 PMCID: PMC10764093 DOI: 10.1016/j.jand.2022.09.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 08/11/2022] [Accepted: 09/15/2022] [Indexed: 01/14/2023]
Abstract
BACKGROUND Red meat production is a leading contributor to food-related greenhouse gas emissions. Decreasing red meat intake can mitigate climate change and lower risk of diet-related diseases. OBJECTIVE The goal of this study is to evaluate university students' perceptions of climate-friendly behaviors and to assess how these perceptions are associated with the frequency of red meat intake. DESIGN Cross-sectional survey SETTING: A large, public California university and a large, public Michigan university PARTICIPANTS: Undergraduate students from a California university (n = 721) and a Michigan university (n = 568) MAIN OUTCOME MEASURES: Perceptions of climate-friendly behaviors and frequency of red meat intake STATISTICAL ANALYSIS: Differences in perceptions by student characteristics were compared using t-tests and one-way analysis of variance. Associations between perceptions of climate-friendly behaviors and red meat intake frequency were examined using generalized linear models, adjusted for sociodemographic covariates. RESULTS Across both universities, students rated reducing meat intake as less effective than other climate change mitigation behaviors such as recycling and using less plastic. However, students who reported (1) making food and beverage choices that "are good for the environment," (2) making food and beverage choices that "reduce climate change impact," or (3) agreeing that "eating less meat is an effective way to combat climate change" reported 10% to 25% lower frequency of red meat intake for each point higher on the agreement scale. In contrast, making food and beverage choices motivated by health was not associated with frequency of red meat intake. CONCLUSIONS Sustainability motivations and perceptions of meat's climate impact were associated with lower frequency of red meat intake, despite the overall moderate rating of eating less meat as an effective climate change mitigator. This research lends support to behavioral interventions, public education campaigns, and policies aiming to reinforce sustainable dietary patterns in young adults.
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Yan Z, Peacock J, Cohen JFW, Kurdziel L, Benes S, Oh S, Bowling A. An 8-Week Peer Health Coaching Intervention among College Students: A Pilot Randomized Study. Nutrients 2023; 15:nu15051284. [PMID: 36904282 PMCID: PMC10005245 DOI: 10.3390/nu15051284] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 02/28/2023] [Accepted: 03/03/2023] [Indexed: 03/08/2023] Open
Abstract
This study explored the effects of an 8-week peer coaching program on physical activity (PA), diet, sleep, social isolation, and mental health among college students in the United States. A total of 52 college students were recruited and randomized to the coaching (n = 28) or the control group (n = 24). The coaching group met with a trained peer health coach once a week for 8 weeks focusing on self-selected wellness domains. Coaching techniques included reflective listening, motivational interviews, and goal setting. The control group received a wellness handbook. PA, self-efficacy for eating healthy foods, quality of sleep, social isolation, positive affect and well-being, anxiety, and cognitive function were measured. No interaction effects between time and group were significant for the overall intervention group (all p > 0.05), while the main effects of group difference on moderate PA and total PA were significant (p < 0.05). Goal-specific analysis showed that, compared to the control group, those who had a PA goal significantly increased vigorous PA Metabolic Equivalent of Task (METs) (p < 0.05). The vigorous METs for the PA goal group increased from 1013.33 (SD = 1055.12) to 1578.67 (SD = 1354.09); the control group decreased from 1012.94 (SD = 1322.943) to 682.11 (SD = 754.89); having a stress goal significantly predicted a higher post-coaching positive affect and well-being, controlling the pre-score and other demographic factors: B = 0.37 and p < 0.05. Peer coaching showed a promising effect on improving PA and positive affect and well-being among college students.
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Affiliation(s)
- Zi Yan
- Department of Public Health and Nutrition, School of Nursing and Health Sciences, Merrimack College, North Andover, MA 01845, USA
- Correspondence: ; Tel.: +1-(978)-837-5435
| | - Jessica Peacock
- Department of Exercise Sciences and Rehabilitation, School of Nursing and Health Sciences, Merrimack College, North Andover, MA 01845, USA
| | - Juliana F. W. Cohen
- Department of Public Health and Nutrition, School of Nursing and Health Sciences, Merrimack College, North Andover, MA 01845, USA
| | - Laura Kurdziel
- Department of Psychology and Neuroscience, Merrimack College, North Andover, MA 01845, USA
| | - Sarah Benes
- Department of Health and Movement Science, Southern Connecticut State University, New Haven, CT 06515, USA
| | - Seungbin Oh
- Mental Health Counseling & Behavioral Medicine Program, Department of Psychiatry and Graduate Medical Sciences, Boston University School of Medicine, Boston, MA 02118, USA
| | - April Bowling
- Department of Public Health and Nutrition, School of Nursing and Health Sciences, Merrimack College, North Andover, MA 01845, USA
- Department of Psychiatry, University of Massachusetts TH Chan Medical School, 55 N Lake Ave., Worcester, MA 01655, USA
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Cohen JFW, Polacsek M, Hecht CE, Hecht K, Read M, Olarte DA, Patel AI, Schwartz MB, Turner L, Zuercher M, Gosliner W, Ritchie LD. Implementation of Universal School Meals during COVID-19 and beyond: Challenges and Benefits for School Meals Programs in Maine. Nutrients 2022; 14:nu14194031. [PMID: 36235683 PMCID: PMC9571988 DOI: 10.3390/nu14194031] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 09/24/2022] [Indexed: 11/30/2022] Open
Abstract
School meals play a major role in supporting children’s diets and food security, and policies for universal school meals (USM) have the potential to contribute to positive child health outcomes. During the COVID-19 pandemic, schools provided free school meals to all students in the United States, but this national USM policy ended in school year (SY) 2022–2023; however, a few states have adopted policies to continue USM statewide for SY 2022–2023. Research examining the challenges and strategies for successful continuation of USM is essential, along with studying pandemic-related challenges that are likely to persist in schools. Therefore, we conducted a study in Maine (with a USM policy) to evaluate the impact of COVID-19 and the concurrent implementation of USM, as well as examine differences in implementation by school characteristics, throughout the state. A total of n = 43 school food authorities (SFAs) throughout Maine completed surveys. SFAs reported multiple benefits of USM including increased school meal participation; reductions in the perceived stigma for students from lower-income households and their families; and no longer experiencing unpaid meal charges and debt. SFAs also experienced challenges due to the COVID-19 pandemic, particularly regarding costs. When considering future challenges, most respondents were concerned with obtaining income information from families, product and ingredient availability, and the costs/financial sustainability of the school meal programs. Overall, USM may have multiple important benefits for students and schools, and other states should consider implementation of a USM policy.
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Affiliation(s)
- Juliana F. W. Cohen
- Center for Health Inclusion, Research and Practice (CHIRP), Merrimack College, 315 Turnpike Street, North Andover, MA 01845, USA
- Department of Public Health and Nutrition, Merrimack College, 315 Turnpike Street, North Andover, MA 01845, USA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA 02115, USA
- Correspondence: ; Tel.: +1-978-837-5456
| | - Michele Polacsek
- Center for Excellence in Public Health, University of New England, 716 Stevens Ave, Portland, ME 04103, USA
| | - Christina E. Hecht
- Nutrition Policy Institute, Division of Agriculture and Natural Resources, University of California, Oakland, CA 94607, USA
| | - Ken Hecht
- Nutrition Policy Institute, Division of Agriculture and Natural Resources, University of California, Oakland, CA 94607, USA
| | - Margaret Read
- Share Our Strength, No Kid Hungry, Washington, DC 20005, USA
| | - Deborah A. Olarte
- Center for Health Inclusion, Research and Practice (CHIRP), Merrimack College, 315 Turnpike Street, North Andover, MA 01845, USA
| | - Anisha I. Patel
- Division of General Pediatrics, Stanford University, Palo Alto, CA 94304, USA
| | - Marlene B. Schwartz
- Rudd Center for Food Policy and Obesity, Department of Human Development and Family Sciences, University of Connecticut, 1 Constitution Plaza, Suite 600, Hartford, CT 06103, USA
| | - Lindsey Turner
- College of Education, Boise State University, 1910 University Drive, Boise, ID 83725, USA
| | - Monica Zuercher
- Nutrition Policy Institute, Division of Agriculture and Natural Resources, University of California, Oakland, CA 94607, USA
| | - Wendi Gosliner
- Nutrition Policy Institute, Division of Agriculture and Natural Resources, University of California, Oakland, CA 94607, USA
| | - Lorrene D. Ritchie
- Nutrition Policy Institute, Division of Agriculture and Natural Resources, University of California, Oakland, CA 94607, USA
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Cohen JFW, Posluszny H, Falbe J, Mueller MP, Gearhardt AN, Leung CW, Wolfson JA. Restaurant dining during the COVID-19 pandemic among adults with low-income in the United States. Appetite 2022; 173:105976. [PMID: 35245643 PMCID: PMC8885442 DOI: 10.1016/j.appet.2022.105976] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 02/18/2022] [Accepted: 02/20/2022] [Indexed: 11/23/2022]
Abstract
The COVID-19 pandemic caused widespread non-essential business closures in the U.S., which may have disproportionately impacted food consumption in lower-income communities, in part due to reduced access to healthy and affordable foods, as well as occupations that may have required working outside the home. The aims of this study were to examine restaurant dining behaviors (including drive-through, takeout, and delivery) at fast-food and non-fast-food (i.e., fast casual and full-service ['other']) restaurants and the impact on diet quality among racially/ethnically diverse low-income adults during the early months of the pandemic. Participants completed an online survey using CloudResearch regarding restaurant dining behaviors in the past week (during June 2020) and during a typical week prior to the pandemic. Diet quality was measured using the Prime Diet Quality Score (PDQS). Surveys from 1,756 low-income adults (incomes <250% of the Federal Poverty Level) were analyzed using chi-squared tests to examine differences in demographic characteristics among those dining at restaurants during the pandemic, as well as to examine differences in dining frequency compared with prior to COVID-19. Negative binomial regressions were used to examine the mean frequency of eating food from fast-food and other restaurants, adjusted for socio-demographic characteristics. This study found reductions in fast-food and other restaurant dining compared with prior to COVID-19, although overall restaurant consumption remained high with over half of participants reporting fast-food consumption in the week prior (average consumption of twice per week). Greater fast-food consumption was associated with poorer diet quality. In conclusion, while fast-food consumption was slightly lower during the pandemic, the overall high levels observed among socioeconomically disadvantaged adults remains concerning, highlighting the continued need for initiatives and policies to encourage greater access to and consumption of affordable and healthier foods.
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Affiliation(s)
- Juliana F W Cohen
- Department of Nutrition and Public Health, Merrimack College, 315 Turnpike Street, North Andover, MA, 01845, USA; Department of Nutrition, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA.
| | - Hannah Posluszny
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA.
| | - Jennifer Falbe
- Department of Human Ecology, University of California Davis, 1 Shields Ave, Davis, CA, 95616, USA.
| | - Megan P Mueller
- Department of Food Science and Human Nutrition, Colorado State University, 1571 Campus Dr, Fort Collins, CO, 80523, USA.
| | - Ashley N Gearhardt
- Department of Psychology, University of Michigan, 530 Church Street, Ann Arbor, MI, 48109, USA.
| | - Cindy W Leung
- Department of Nutritional Sciences, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, 48109, USA.
| | - Julia A Wolfson
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA; Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA.
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Olarte DA, Stock M, Sutton M, Scott M, Koch PA, Gustus S, Cohen JFW. Teachers' Experiences Implementing a School Wellness Initiative in Anchorage, Alaska: A Qualitative Study. J Acad Nutr Diet 2021; 122:1174-1181.e1. [PMID: 34896301 DOI: 10.1016/j.jand.2021.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 10/18/2021] [Accepted: 12/06/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Teachers are uniquely poised to support students' healthy eating habits and physical activity. However, research is needed to examine the successes and challenges teachers face when implementing a school wellness initiative. OBJECTIVE The purpose of this study was to examine teachers' experiences implementing and managing a pilot school wellness initiative where students had longer lunch and recess, and more physical activity throughout the day. DESIGN Focus groups were conducted to understand the challenging and successful experiences of teachers as they implemented and managed a school wellness initiative. PARTICIPANTS/SETTING The participants were teachers (n=39) from six purposively selected elementary schools participating in a school wellness initiative. Focus groups were conducted in-person at participating schools. ANALYSIS Using a grounded theory approach, transcripts were analyzed qualitatively using principles of content analysis to identify themes and domains. Application of the codes and inter-rater reliability were conducted with a trained research assistant. RESULTS Teachers observed calmer students who ate more lunch with longer lunch periods. Additionally, teachers observed improved focus in the classroom and fewer behavioral issues with more physical activity opportunities. Successful strategies included reversing lunch and recess and implementing physical activity into daily lessons. However, some teachers had difficulty managing the extra time in the cafeteria and scheduling physical activity throughout the day, particularly in schools where administrators were not as supportive of the initiative. In the schools with greater administrative buy-in and support, teachers had easier, more positive experiences implementing the wellness initiative. CONCLUSIONS School wellness initiatives in which teachers play a large role have the potential to support teachers and students. This study found that teachers value student health and understand students need to be nourished to learn, but teachers' experiences suggest they need support and buy-in from their administrators to be successful.
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Affiliation(s)
- Deborah A Olarte
- Post-Doctoral Research Fellow, Merrimack College, School of Health Sciences, 315 Turnpike Street, North Andover, MA 01845, USA, Doctoral Student, Program in Nutrition, Teachers College, Columbia University, 525 W. 120(th) Street, Box 137, New York, NY 10027, USA.
| | - Mark Stock
- Deputy Superintendent, Anchorage School District, 5530 E. Northern Lights Blvd. Anchorage, Alaska 99504, USA
| | - Melanie Sutton
- Teaching and Learning Coordinator, Institute of Social and Economic Research, Anchorage School District, 5530 E. Northern Lights Blvd. Anchorage, Alaska 99504, USA
| | - Michael Scott
- Assistant Principal, Anchorage School District, 5530 E. Northern Lights Blvd. Anchorage, Alaska 99504, USA
| | - Pamela A Koch
- Mary Swartz Rose Associate Professor of Nutrition Education, Program in Nutrition, Teachers College, Columbia University, 525 W. 120(th) Street, Box 137, New York, NY 10027, USA
| | - Sarah Gustus
- Clinical Research Coordinator, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA; Graduate Student Research Fellow, Department of Public Health and Nutrition, School of Health Sciences, Merrimack College, 315 Turnpike Street, North Andover, MA, 01845, USA
| | - Juliana F W Cohen
- Associate Professor, Department of Public Health and Nutrition, School of Health Sciences, Merrimack College, 315 Turnpike Street, North Andover, MA, 01845, USA, Adjunct Associate Professor, Department of Nutrition, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
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Cohen JFW, Hecht AA, Hager ER, Turner L, Burkholder K, Schwartz MB. Strategies to Improve School Meal Consumption: A Systematic Review. Nutrients 2021; 13:3520. [PMID: 34684521 PMCID: PMC8538164 DOI: 10.3390/nu13103520] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 09/26/2021] [Accepted: 09/28/2021] [Indexed: 01/15/2023] Open
Abstract
School meals can play an integral role in improving children's diets and addressing health disparities. Initiatives and policies to increase consumption have the potential to ensure students benefit from the healthy school foods available. This systematic review evaluates studies examining initiatives, interventions, and policies to increase school meal consumption. Following PRISMA guidelines, this review was conducted using four databases and resulted in a total of 96 studies. The research evidence supports the following strategies to increase school meal consumption: (1) offering students more menu choices; (2) adapting recipes to improve the palatability and/or cultural appropriateness of foods; (3) providing pre-sliced fruits; (4) rewarding students who try fruits and vegetables; (5) enabling students to have sufficient time to eat with longer (~30 min) lunch periods; (6) having recess before lunch; and (7) limiting students' access to competitive foods during the school day. Research findings were mixed when examining the impact of nutrition education and/or offering taste tests to students, although multiple benefits for nutrition education outside the cafeteria were documented. There is some evidence that choice architecture (i.e., "Smarter Lunchroom") techniques increase the proportion of students who select targeted meal components; however, there is not evidence that these techniques alone increase consumption. There were limited studies of the impact of increasing portion sizes; serving vegetables before other meal components; and strengthening local district and/or school wellness policies, suggesting that further research is necessary. Additionally, longer-term studies are needed to understand the impact of policies that limit students' access to flavored milk. Several studies found increases in students' meal consumption following the Healthy Hunger-Free Kids Act (HHFKA) and concerns regarding an increase in food waste following the HHFKA were not supported. Overall, there are a range of effective strategies to increase school meal consumption that can be implemented by schools, districts, and policymakers at the local, state, and federal levels (PROSPERO registration: CRD42021244688).
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Affiliation(s)
- Juliana F. W. Cohen
- Department of Public Health and Nutrition, Merrimack College, 315 Turnpike Street, North Andover, MA 01845, USA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, 677 Huntington Ave., Boston, MA 02115, USA
| | - Amelie A. Hecht
- Institute for Research on Poverty, University of Wisconsin-Madison, 1180 Observatory Drive, Madison, WI 53706, USA;
| | - Erin R. Hager
- Departments of Pediatrics and Epidemiology & Public Health, University of Maryland School of Medicine, Baltimore, MD 21201, USA;
| | - Lindsey Turner
- College of Education, Boise State University, 1910 University Drive, Boise, ID 83725, USA;
| | - Kara Burkholder
- College of Liberal Arts and Science, University of Connecticut, Storrs, CT 06269, USA;
| | - Marlene B. Schwartz
- Rudd Center for Food Policy and Obesity, Department of Human Development and Family Sciences, University of Connecticut, 1 Constitution Plaza, Suite 600, Hartford, CT 06103, USA;
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16
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Cohen JFW, Scott M, Sutton M, Cueva K, Shonkoff ET, Goldman RE, Margolis DN, Potempa AE, Fink K, Gustus S, Stock M. A Mixed-Methods Evaluation of a School Wellness Initiative: An Examination of Longer Lunch Periods and More Physical Activity Opportunities. J Acad Nutr Diet 2021; 121:1961-1974. [PMID: 33888437 DOI: 10.1016/j.jand.2021.03.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 02/22/2021] [Accepted: 03/15/2021] [Indexed: 01/04/2023]
Abstract
BACKGROUND There are currently no national standards for lunch period lengths or physical activity in schools. Research is needed to better understand the impact of school initiatives that improve policies related to lunch and movement opportunities on student outcomes. Additionally, best practices are necessary to support schools that are considering initiatives that address these factors. OBJECTIVE This study examined the impact of implementing longer lunch periods, recess, and other movement opportunities on student outcomes and best practices for implementation. DESIGN A mixed-methods study including surveys and semistructured interviews and focus groups conducted during the 2019-2020 school year. PARTICIPANTS/SETTING Surveys (n = 5107) from students in grades 3 and 4 attending 19 pilot and 11 matched control elementary schools and interviews/focus groups among principals, cafeteria managers, teachers, and parents in a representative subsample (n = 6) of pilot schools in Anchorage Alaska. MAIN OUTCOME MEASURES Students' self-reported hunger levels and mood and perceptions and supportive strategies from school principals, cafeteria staff, teachers, and parents were examined. STATISTICAL ANALYSES PERFORMED Mixed-model analysis of variance accounting for student demographics with students as a random effect (students nested within schools) were used to examine differences in hunger and mood. For interviews/focus groups, responses were analyzed qualitatively using principles of content analysis. RESULTS Longer lunch periods were associated with significantly reduced hunger at the end of lunch period and significantly increased self-reported happiness in the cafeteria. Based on interviews/focus groups with school staff and parents, the initiative was generally perceived positively with reported benefits including reductions in disciplinary issues and improvements in student focus, social and emotional learning, and overall student happiness and well-being. Several supportive strategies were identified. CONCLUSIONS Initiatives that increase lunch period lengths and physical activity opportunities have the potential to reduce students' hunger levels and improve focus and behaviors in the classroom. Schools should consider similar initiatives that incorporate the suggested strategies to potentially improve outcomes among students.
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Cohen JFW, Hecht AA, McLoughlin GM, Turner L, Schwartz MB. Universal School Meals and Associations with Student Participation, Attendance, Academic Performance, Diet Quality, Food Security, and Body Mass Index: A Systematic Review. Nutrients 2021; 13:911. [PMID: 33799780 PMCID: PMC8000006 DOI: 10.3390/nu13030911] [Citation(s) in RCA: 81] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 03/03/2021] [Accepted: 03/08/2021] [Indexed: 12/20/2022] Open
Abstract
The school environment plays an important role in children's diets and overall health, and policies for universal free school meals have the potential to contribute to positive child health outcomes. This systematic review evaluates studies examining the association between universal free school meals and students' school meal participation rates, diets, attendance, academic performance, and Body Mass Index (BMI), as well as school finances. The search was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA). A search for studies published in economically developed countries published through December 2020 was performed in PubMed, Education Resources Information Center (ERIC), Thomson Reuters' Web of Science, and Academic Search Ultimate, followed by examining the references in the resultant literature. A total of 47 studies were identified and the Newcastle-Ottawa Scale (NOS) was applied to assess bias. Nearly all studies examining universal free school meals found positive associations with school meal participation. Most studies examining universal free school meals that included free lunch found positive associations with diet quality, food security, and academic performance; however, the findings of studies examining only universal free breakfast were mixed. Research findings were similarly mixed when examining attendance as an outcome. Concerns about adverse outcomes on student BMI were not supported by the literature; in fact, several studies detected a potentially protective effect of universal free school meals on BMI. Research examining the impact of universal free meals on school finances was limited, but suggest that lower-income school districts in the U.S. may have positive financial outcomes from participation in universal free school meal provisions. Additionally, providing free meals to students may be associated with improved household incomes, particularly among lower-income families with children. Further research is needed to examine the financial implications of universal free meals for both school districts and families. Overall, universal free school meals may have multiple benefits for students and countries should consider universal free school meal provisions with strong nutrition guidelines. (PROSPERO registration: CRD42020221782).
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Affiliation(s)
- Juliana F. W. Cohen
- Department of Nutrition and Public Health, Merrimack College, 315 Turnpike Street, North Andover, MA 01845, USA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA 02115, USA
| | - Amelie A. Hecht
- Institute for Research on Poverty, University of Wisconsin-Madison, 1180 Observatory Drive, Madison, WI 53706, USA;
| | - Gabriella M. McLoughlin
- Implementation Science Center for Cancer Control and Prevention Research Center, Brown School, Washington University in St. Louis, St. Louis, MO 63130, USA;
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO 63130, USA
| | - Lindsey Turner
- College of Education, Boise State University, 1910 University Drive, Boise, ID 83725-1742, USA;
| | - Marlene B. Schwartz
- Rudd Center for Food Policy and Obesity, Department of Human Development and Family Sciences, University of Connecticut, 1 Constitution Plaza, Suite 600, Hartford, CT 06103, USA;
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Chriqui JF, Leider J, Cohen JFW, Schwartz M, Turner L. Are Nutrition Standards for Beverages in Schools Associated with Healthier Beverage Intakes among Adolescents in the US? Nutrients 2020; 13:E75. [PMID: 33383659 PMCID: PMC7824136 DOI: 10.3390/nu13010075] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 12/22/2020] [Accepted: 12/22/2020] [Indexed: 12/01/2022] Open
Abstract
Under the U.S. Department of Agriculture's Smart Snacks in School standards, beverages sold in schools are restricted to water, flavored or unflavored non-fat milk or unflavored low-fat milk (and milk alternatives), and 100% fruit and vegetable juices; and, at the high school level, diet (≤10 kcal), low-calorie (≤60 kcal), and caffeinated beverages may also be sold. Using data from the School Nutrition and Meal Cost Study, this study examined whether secondary school student beverage consumption was associated with school-level à la carte and vending machine beverage availability, controlling for district, school, and student characteristics. On average, most beverages sold in middle schools (84.54%) and high schools (74.11%) were Smart Snacks compliant; while 24.06 percent of middle school students and 14.64 percent of high school students reported consuming non-compliant beverages, including non-compliant milk, fruit drinks, and sports or energy drinks. School beverage availability was not related to consumption among middle school students; however, high school students were less likely to consume non-compliant beverages when enrolled in schools that sold a higher proportion of compliant beverages (Range: OR = 0.97-0.98, 95% CI = 0.95, 1.00). Findings from this study build upon prior research illustrating the role that schools can play in influencing student dietary intake.
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Affiliation(s)
- Jamie F. Chriqui
- Division of Health Policy and Administration, School of Public Health, University of Illinois Chicago, Chicago, IL 60612, USA
- Institute for Health Research and Policy, University of Illinois Chicago, Chicago, IL 60608, USA;
| | - Julien Leider
- Institute for Health Research and Policy, University of Illinois Chicago, Chicago, IL 60608, USA;
| | - Juliana F. W. Cohen
- Department of Public Health and Nutrition, Merrimack College, 315 Turnpike Street, North Andover, MA 01845, USA;
- Department of Nutrition, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA 02115, USA
| | - Marlene Schwartz
- Rudd Center for Food Policy and Obesity, Department of Human Development and Family Sciences, University of Connecticut, 1 Constitution Plaza, Hartford, CT 06103, USA;
| | - Lindsey Turner
- College of Education, Boise State University, 1910 University Drive, Boise, ID 83725, USA;
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Schwartz MB, Leider J, Cohen JFW, Turner L, Chriqui JF. Association between Nutrition Policies and Student Body Mass Index. Nutrients 2020; 13:E13. [PMID: 33374504 PMCID: PMC7822196 DOI: 10.3390/nu13010013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 12/14/2020] [Accepted: 12/18/2020] [Indexed: 12/29/2022] Open
Abstract
In response to concerns about childhood obesity, many US states have implemented policies to limit the sale of unhealthy foods and beverages (e.g., snacks, desserts, and sugary drinks) sold in competition with school meal programs (i.e., competitive foods) in order to improve the nutritional environment of schools and support student health. This study measured state-level competitive food and beverage policies that require foods and beverages sold in à la carte lines, vending machines, and school stores to meet strong nutrition standards and tested the hypothesis that students living in states with stronger laws would have lower body mass index (BMI)-for-age percentiles. BMI data from a national sample of 1625 students attending 284 schools from the School Nutrition and Meal Cost Study were linked to state laws coded as part of the National Wellness Policy Study. A survey-adjusted linear regression model accounting for student and school-level characteristics showed that stronger state nutrition policies were associated with lower student BMI scores (coefficient: -0.06, 95% CI: -0.12, -0.00). Additional models indicated that stronger state policies were significantly associated with fewer unhealthy foods and beverages available in schools. These findings suggest that strong regulations on competitive foods and beverages may lead to improvements in the nutritional quality of the school environment and student BMI. Thus, current federal standards regulating snacks in US schools (i.e., Smart Snacks) are an important element of a comprehensive strategy to improve the school nutrition environment and reduce rates of childhood obesity.
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Affiliation(s)
- Marlene B. Schwartz
- Rudd Center for Food Policy and Obesity, Department of Human Development and Family Sciences, University of Connecticut, 1 Constitution Plaza, Hartford, CT 06103, USA
| | - Julien Leider
- Institute for Health Research and Policy, University of Illinois Chicago, Chicago, IL 60608, USA; (J.L.); (J.F.C.)
| | - Juliana F. W. Cohen
- Department of Public Health and Nutrition, Merrimack College, 315 Turnpike Street, North Andover, MA 01845, USA;
- Department of Nutrition, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA 02115, USA
| | - Lindsey Turner
- College of Education, Boise State University, 1910 University Drive, Boise, ID 83725, USA;
| | - Jamie F. Chriqui
- Institute for Health Research and Policy, University of Illinois Chicago, Chicago, IL 60608, USA; (J.L.); (J.F.C.)
- Division of Health Policy and Administration, School of Public Health, University of Illinois Chicago, 1603 W. Taylor St, Chicago, IL 60612, USA
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Cohen JFW, Richardson S, Roberto CA, Rimm EB. Availability of Lower-Sodium School Lunches and the Association with Selection and Consumption among Elementary and Middle School Students. J Acad Nutr Diet 2020; 121:105-111.e2. [PMID: 33350941 DOI: 10.1016/j.jand.2020.07.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 07/15/2020] [Accepted: 07/21/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND During 2010, the US Department of Agriculture updated the school meals standards, including three progressively decreasing sodium targets. The Target 1 standards went into effect in 2014, but during 2018, the US Department of Agriculture delayed the Target 2 standards until 2024 and eliminated the Target 3 standards citing concerns regarding the availability and acceptability of lower-sodium foods. In addition, there are currently no sugar standards, and it is unknown whether sugar is substituted for salt in lower-sodium school foods. OBJECTIVE To examine the availability, selection, and consumption of school lunches already in alignment with the Target 2 and 3 sodium levels and the association between sodium and sugar. DESIGN An observational cafeteria-based study conducted during fall 2018. PARTICIPANTS AND SETTING Students (n = 1985) in grades three through eight attending 13 elementary/kindergarten through eighth-grade schools in a large, urban school district in New England. MAIN OUTCOME MEASURES Availability, selection, and consumption were examined using plate waste methodology. STATISTICAL ANALYSES PERFORMED Mixed-model analysis of variance accounting for student demographic characteristics with schools/students as a random effect (students nested within schools) were used to examine differences in availability, selection, and consumption. Linear regression was used to examine the association between sodium and sugar in the school foods. RESULTS The majority of meals selected (87%) and consumed (98%) were already in alignment with the Target 2 standards. There were significant inverse associations between sodium levels and consumption; each 100-mg increase in sodium was associated with a decrease in consumption by 2% for entrées (P = 0.002) and 5% for vegetables (P = 0.01). When examining the association between sodium and sugar, each 10-mg reduction in sodium was associated with 1-g increase in sugar among entrées (P < 0.0001), whereas there was a significant positive association between sodium and sugar with vegetables and condiments. CONCLUSIONS This study provides some evidence that schools may already have the ability to provide lower-sodium meals that are acceptable to students, and therefore the recent rollbacks to the sodium standards may be unwarranted. Study findings suggest that the US Department of Agriculture should take under consideration policies that would limit added sugar for school meals as sugar may be substituted for salt.
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Affiliation(s)
- Juliana F W Cohen
- (1)Department of Health Sciences, Merrimack College, North Andover, MA; (2)Department of Nutrition, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA.
| | - Scott Richardson
- (2)Department of Nutrition, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA
| | - Christina A Roberto
- (3)Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Eric B Rimm
- (4)Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
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Cohen JFW, Richardson S, Rimm EB. Impact of the Updated USDA School Meal Standards, Chef-Enhanced Meals, and the Removal of Flavored Milk on School Meal Selection and Consumption. J Acad Nutr Diet 2019; 119:1511-1515. [PMID: 31153957 PMCID: PMC6710101 DOI: 10.1016/j.jand.2019.04.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 04/02/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND In Fall 2012, updated US Department of Agriculture school meal standards went into effect and did not result in increased food waste overall. However, consumption of school foods, especially fruits and vegetables, remains low. Therefore, strategies to improve school meal consumption are necessary. OBJECTIVE This study evaluated the combined impact of the updated school meal standards and chef-enhanced, healthier meals, and the removal of flavored milk on students' school food selection and consumption compared with students in control schools. DESIGN The Project MEALS (Modifying Eating and Lifestyles at School) study was a cafeteria-based quasi-experimental intervention conducted during the 2012 to 2013 school year. PARTICIPANTS/SETTING Participants were students (n=1,309) in grades 3 through 8 attending four intervention and four control schools in two low-income, urban school districts. INTERVENTION Chef-enhanced school meals and the removal of flavored milk combined with the updated US Department of Agriculture school meal standards. MAIN OUTCOME MEASURES Changes in school meal selection and consumption were examined using plate waste methodology. STATISTICAL ANALYSES PERFORMED Logistic regression and mixed-model analysis of variance adjusting for student demographics and schools/students as a random effect (students nested within schools) were used to examine differences in selection and consumption before (Fall 2012) and after (Spring 2013) a chef-based intervention with the updated school meal standards. RESULTS After the chef-based intervention was implemented, there were no significant differences in entrée, vegetable, or fruit selection. Significantly fewer students selected milk compared with students in control schools (56.8% vs 94.0%; P<0.0001) and milk consumption was significantly lower (54.8% vs 63.7%; P=0.004). However, consumption was significantly greater for vegetables (62.2% vs 38.2%; P=0.005) and fruits (75.2 vs 59.2%; P=0.04) in the intervention schools compared with control schools. There were no significant differences in entrée consumption. CONCLUSIONS Schools collaborating with chefs can be an effective method to improve the consumption of fruits and vegetables with the updated US Department of Agriculture school meal standards. Further research should examine the longer-term impact of the removal of flavored milk from schools to determine whether the lower selection and consumption rates persist.
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Cohen JFW, Gorski Findling MT, Rosenfeld L, Smith L, Rimm EB, Hoffman JA. The Impact of 1 Year of Healthier School Food Policies on Students' Diets During and Outside of the School Day. J Acad Nutr Diet 2018; 118:2296-2301. [PMID: 30213618 DOI: 10.1016/j.jand.2018.07.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 07/09/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND In 2012, Massachusetts implemented both the updated national school meal standards and comprehensive competitive food/beverage standards that closely align with current national requirements for school snacks. OBJECTIVES This study examines the impact of these combined standards on school meal and snack food selections, as well as food choices outside of school. In addition, this study examines the impact of these standards on nutrients consumed. DESIGN The NOURISH (Nutrition Opportunities to Understand Reforms Involving Student Health) Study was an observational cohort study conducted among students from spring 2012 to spring 2013. PARTICIPANTS/SETTING One hundred sixty students in 12 middle schools and high schools in Massachusetts completed two 24-hour recalls before (spring 2012) and after implementation (spring 2013) of the updated standards. MAIN OUTCOME MEASURES Changes in school meals, competitive food, and after-school snack selection, as well as nutrients consumed outside of school were examined. STATISTICAL ANALYSES PERFORMED Logistic regression and mixed-model analysis of variance were used to examine food selection and consumption. RESULTS After implementation, 13.6% more students chose a school meal (70.1% vs 56.5%; P=0.02). There were no differences in competitive food purchases but a significant decrease in the number of after-school unhealthy snacks consumed (0.69 [standard error=0.08] vs 1.02 [standard error=0.10]; P=0.009). During the entire day, students consumed, on average, 22 fewer grams of sugar daily after implementation compared with before implementation (86 g vs 108 g; P=0.002). CONCLUSIONS With the reduction in the number of unhealthy school snacks, significantly more students selected school meals. Students did not compensate for lack of unhealthy snacks in school by increased consumption of unhealthy snacks outside of school. This provides important new evidence that both national school meal and snack policies may improve daily diet quality and should remain strong.
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Cohen JFW, Rifas-Shiman SL, Young J, Oken E. Associations of Prenatal and Child Sugar Intake With Child Cognition. Am J Prev Med 2018; 54:727-735. [PMID: 29674185 PMCID: PMC5962431 DOI: 10.1016/j.amepre.2018.02.020] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 02/05/2018] [Accepted: 02/26/2018] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Sugar consumption among Americans is above recommended limits, and excess sugar intake may influence cognition. The aim of this study was to examine associations of pregnancy and offspring sugar consumption (sucrose, fructose) with child cognition. Additionally, associations of maternal and child consumption of sugar-sweetened beverages (SSBs), other beverages (diet soda, juice), and fruit with child cognition were examined. METHODS Among 1,234 mother-child pairs enrolled 1999-2002 in Project Viva, a pre-birth cohort, in 2017 diet was assessed during pregnancy and early childhood, and cognitive outcomes in early and mid-childhood (median ages 3.3 and 7.7 years). Analyses used linear regression models adjusted for maternal and child characteristics. RESULTS Maternal sucrose consumption (mean 49.8 grams/day [SD=12.9]) was inversely associated with mid-childhood Kaufman Brief Intelligence Test (KBIT-II) non-verbal scores (-1.5 points per 15 grams/day, 95% CI= -2.8, -0.2). Additionally, maternal SSB consumption was inversely associated with mid-childhood cognition, and diet soda was inversely associated with early and mid-childhood cognition scores. Early childhood consumption of SSBs was inversely associated with mid-childhood KBIT-II verbal scores (-2.4 points per serving/day, 95% CI= -4.3, -0.5) while fruit consumption was associated with higher cognitive scores in early and mid-childhood. Maternal and child fructose and juice consumption were not associated with cognition. After adjusting for multiple comparisons, the association between maternal diet soda consumption and mid-childhood KBIT-II verbal scores remained significant. CONCLUSIONS Sugar consumption, especially from SSBs, during pregnancy and childhood, and maternal diet soda consumption may adversely impact child cognition, while child fruit consumption may lead to improvements. Interventions and policies that promote healthier diets may prevent adverse effects on childhood cognition.
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Affiliation(s)
- Juliana F W Cohen
- Department of Health Sciences, Merrimack College, North Andover, Massachusetts; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
| | - Sheryl L Rifas-Shiman
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Jessica Young
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Emily Oken
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
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Cohen JFW, Richardson S, Rimm EB. Selection Does Not Equate Consumption. JAMA Intern Med 2017; 177:1875. [PMID: 29204635 DOI: 10.1001/jamainternmed.2017.6725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Juliana F W Cohen
- Department of Health Sciences, Merrimack College, North Andover, Massachusetts.,Department of Nutrition, Harvard TH Chan School of Public Health, Boston, Massachusetts
| | - Scott Richardson
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, Massachusetts
| | - Eric B Rimm
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, Massachusetts.,Departments of Epidemiology, Harvard TH Chan School of Public Health, Boston, Massachusetts
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Cohen JFW, Roberts SB, Anzman-Frasca S, Gamache MMG, Lynskey VM, Matthews E, Mueller MP, Sharma S, Economos CD. A pilot and feasibility study to assess children's consumption in quick-service restaurants using plate waste methodology. BMC Public Health 2017; 17:259. [PMID: 28298184 PMCID: PMC5353951 DOI: 10.1186/s12889-017-4171-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Accepted: 03/04/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Children regularly consume foods from quick-service restaurants (QSR), but little is known about the foods that children order, the calories and nutrients consumed, the accuracy of stated calorie information, or the ability to assess food orders and consumption in QSRs. This study evaluated the feasibility of plate waste collection in QSRs and examined children's orders and consumption of meals from the standard and children's menus. Additional aims were to examine if the meals ordered met healthier standards for children's menu items and determine the accuracy of the QSR-stated energy content of foods. METHODS Fifteen QSRs, two malls, and 116 eligible parents were approached to participate in the study in 2015. Among the families recruited, children's meal orders and consumption were analyzed using plate waste methodology, and a subsample of foods was analyzed using bomb calorimetry in 2015. RESULTS Two individual QSRs and one mall food court with two QSRs agreed to participate, and n = 50 participants (parents with children between the ages of 5-10 years) were recruited. Children consumed on average 519 calories, 5.7 g saturated fat, 957 mg sodium, 3.7 g fiber, and 22.7 g sugar. Children ordered and consumed significantly fewer calories and less sodium and sugar with meals ordered exclusively from the children's menu compared with the standard menu. Overall there were no significant differences between the measured and stated energy contents of the QSR foods. CONCLUSIONS Conducting plate waste research in QSRs is feasible and there is concordance with stated calorie information. Consuming foods exclusively from the children's menu may help limit overconsumption in QSRs.
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Affiliation(s)
- Juliana F. W. Cohen
- Department of Health Sciences, Merrimack College, 315 Turnpike Street, North Andover, MA 01845 USA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA USA
| | - Susan B. Roberts
- Human Nutrition Research Center on Aging, Tufts University, Boston, MA USA
| | | | | | - Vanessa M. Lynskey
- ChildObesity180, Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA USA
| | - Emilia Matthews
- ChildObesity180, Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA USA
| | - Megan P. Mueller
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA USA
| | - Shanti Sharma
- ChildObesity180, Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA USA
| | - Christina D. Economos
- ChildObesity180, Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA USA
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Cohen JFW, Gorski MT, Hoffman JA, Rosenfeld L, Chaffee R, Smith L, Catalano PJ, Rimm EB. Healthier Standards for School Meals and Snacks: Impact on School Food Revenues and Lunch Participation Rates. Am J Prev Med 2016; 51:485-92. [PMID: 27147133 PMCID: PMC7346735 DOI: 10.1016/j.amepre.2016.02.031] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2015] [Revised: 02/15/2016] [Accepted: 02/23/2016] [Indexed: 10/22/2022]
Abstract
INTRODUCTION In 2012, the updated U.S. Department of Agriculture school meals standards and a competitive food law similar to the fully implemented version of the national Smart Snack standards went into effect in Massachusetts. This study evaluated the impact of these updated school meal standards and Massachusetts' comprehensive competitive food standards on school food revenues and school lunch participation. METHODS Revenue and participation data from 11 Massachusetts school districts were collected from 2011 to 2014 and analyzed in 2015 using multilevel modeling. The association between the change in compliance with the competitive food standards and revenues/participation was assessed using linear regression. RESULTS Schools experienced declines in school food revenues of $15.40/student in Year 1 from baseline (p=0.05), due to competitive food revenue losses. In schools with 3 years of data, overall revenues rebounded by the second year post-implementation. Additionally, by Year 2, school lunch participation increased by 15% (p=0.0006) among children eligible for reduced-price meals. Better competitive food compliance was inversely associated with school food revenues in the first year only; an absolute change in compliance by 10% was associated with a $9.78/student decrease in food revenues over the entire school year (p=0.04). No association was seen between the change in compliance and school meal participation. CONCLUSIONS Schools experienced initial revenue losses after implementation of the standards, yet longer-term school food revenues were not impacted and school meal participation increased among children eligible for reduced-price meals. Weakening the school meal or competitive food guidelines based on revenue concerns appears unwarranted.
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Affiliation(s)
- Juliana F W Cohen
- Department of Health Sciences, Merrimack College, North Andover, Massachusetts; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
| | - Mary T Gorski
- Interfaculty Initiative in Health Policy, Harvard Graduate School of Arts and Sciences, Harvard University, Cambridge, Massachusetts
| | - Jessica A Hoffman
- Department of Applied Psychology, Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts
| | - Lindsay Rosenfeld
- Institute for Child, Youth, and Family Policy, The Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts
| | - Ruth Chaffee
- Department of Applied Psychology, Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts
| | | | - Paul J Catalano
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, 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; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
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Abstract
PURPOSE Providing children and youth with safe, adequate drinking water access during school is essential for health. This study used objectively measured data to investigate the extent to which schools provide drinking water access that meets state and federal policies. METHODS We visited 59 middle and high schools in Massachusetts during spring 2012. Trained research assistants documented the type, location, and working condition of all water access points throughout each school building using a standard protocol. School food service directors (FSDs) completed surveys reporting water access in cafeterias. We evaluated school compliance with state plumbing codes and federal regulations and compared FSD self-reports of water access with direct observation; data were analyzed in 2014. RESULTS On average, each school had 1.5 (standard deviation: .6) water sources per 75 students; 82% (standard deviation: 20) were functioning and fewer (70%) were both clean and functioning. Less than half of the schools met the federal Healthy Hunger-Free Kids Act requirement for free water access during lunch; 18 schools (31%) provided bottled water for purchase but no free water. Slightly over half (59%) met the Massachusetts state plumbing code. FSDs overestimated free drinking water access compared to direct observation (96% FSD reported vs. 48% observed, kappa = .07, p = .17). CONCLUSIONS School drinking water access may be limited. In this study, many schools did not meet state or federal policies for minimum student drinking water access. School administrative staff may not accurately report water access. Public health action is needed to increase school drinking water access.
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Affiliation(s)
- Erica L Kenney
- 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
| | - Juliana F W Cohen
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Department of Health Sciences, Merrimack College, North Andover, 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; Department of Medicine, Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Angie L Cradock
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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Gorski MT, Cohen JFW, Hoffman JA, Rosenfeld L, Chaffee R, Smith L, Rimm EB. Impact of Nutrition Standards on Competitive Food Quality in Massachusetts Middle and High Schools. Am J Public Health 2016; 106:1101-8. [PMID: 27077344 DOI: 10.2105/ajph.2016.303139] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To examine changes in competitive foods (items sold in à la carte lines, vending machines, and school stores that "compete" with school meals) in Massachusetts middle and high schools before and after implementation of a statewide nutrition law in 2012. METHODS We photographed n = 10 782 competitive foods and beverages in 36 Massachusetts school districts and 7 control state districts to determine availability and compliance with the law at baseline (2012), 1 year (2013), and 2 years (2014) after the policy (overall enrollment: 71 202 students). We examined availability and compliance trends over time. RESULTS By 2014, 60% of competitive foods and 79% of competitive beverages were compliant. Multilevel models showed an absolute 46.2% increase for foods (95% confidence interval = 36.2, 56.3) and 46.8% increase for beverages (95% confidence interval = 39.2, 54.4) in schools' alignment with updated standards from 2012 to 2014. CONCLUSIONS The law's implementation resulted in major improvements in the availability and nutritional quality of competitive foods and beverages, but schools did not reach 100% compliance. This law closely mirrors US Department of Agriculture Smart Snacks in School standards, suggesting that complying with strict nutrition standards is feasible, and schools may experience challenges and improvements over time.
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Affiliation(s)
- Mary T Gorski
- Mary T. Gorski is with the Interfaculty Initiative in Health Policy, Harvard Graduate School of Arts and Sciences, Harvard University, Cambridge, MA. Juliana F. W. Cohen is with the Department of Health Sciences, Merrimack College, North Andover, MA. Jessica A. Hoffman and Ruth Chaffee are with the Department of Applied Psychology, Bouvé College of Health Sciences, Northeastern University, Boston. Lindsay Rosenfeld is with the Institute for Child, Youth, and Family Policy, The Heller School for Social Policy and Management, Brandeis University, Waltham, MA. At the time of the study Lauren Smith was with the Department of Public Health, Commonwealth of Massachusetts, Boston. Eric B. Rimm is with the departments of Nutrition and Epidemiology, Harvard T. H. Chan School of Public Health, Harvard University, Boston
| | - Juliana F W Cohen
- Mary T. Gorski is with the Interfaculty Initiative in Health Policy, Harvard Graduate School of Arts and Sciences, Harvard University, Cambridge, MA. Juliana F. W. Cohen is with the Department of Health Sciences, Merrimack College, North Andover, MA. Jessica A. Hoffman and Ruth Chaffee are with the Department of Applied Psychology, Bouvé College of Health Sciences, Northeastern University, Boston. Lindsay Rosenfeld is with the Institute for Child, Youth, and Family Policy, The Heller School for Social Policy and Management, Brandeis University, Waltham, MA. At the time of the study Lauren Smith was with the Department of Public Health, Commonwealth of Massachusetts, Boston. Eric B. Rimm is with the departments of Nutrition and Epidemiology, Harvard T. H. Chan School of Public Health, Harvard University, Boston
| | - Jessica A Hoffman
- Mary T. Gorski is with the Interfaculty Initiative in Health Policy, Harvard Graduate School of Arts and Sciences, Harvard University, Cambridge, MA. Juliana F. W. Cohen is with the Department of Health Sciences, Merrimack College, North Andover, MA. Jessica A. Hoffman and Ruth Chaffee are with the Department of Applied Psychology, Bouvé College of Health Sciences, Northeastern University, Boston. Lindsay Rosenfeld is with the Institute for Child, Youth, and Family Policy, The Heller School for Social Policy and Management, Brandeis University, Waltham, MA. At the time of the study Lauren Smith was with the Department of Public Health, Commonwealth of Massachusetts, Boston. Eric B. Rimm is with the departments of Nutrition and Epidemiology, Harvard T. H. Chan School of Public Health, Harvard University, Boston
| | - Lindsay Rosenfeld
- Mary T. Gorski is with the Interfaculty Initiative in Health Policy, Harvard Graduate School of Arts and Sciences, Harvard University, Cambridge, MA. Juliana F. W. Cohen is with the Department of Health Sciences, Merrimack College, North Andover, MA. Jessica A. Hoffman and Ruth Chaffee are with the Department of Applied Psychology, Bouvé College of Health Sciences, Northeastern University, Boston. Lindsay Rosenfeld is with the Institute for Child, Youth, and Family Policy, The Heller School for Social Policy and Management, Brandeis University, Waltham, MA. At the time of the study Lauren Smith was with the Department of Public Health, Commonwealth of Massachusetts, Boston. Eric B. Rimm is with the departments of Nutrition and Epidemiology, Harvard T. H. Chan School of Public Health, Harvard University, Boston
| | - Ruth Chaffee
- Mary T. Gorski is with the Interfaculty Initiative in Health Policy, Harvard Graduate School of Arts and Sciences, Harvard University, Cambridge, MA. Juliana F. W. Cohen is with the Department of Health Sciences, Merrimack College, North Andover, MA. Jessica A. Hoffman and Ruth Chaffee are with the Department of Applied Psychology, Bouvé College of Health Sciences, Northeastern University, Boston. Lindsay Rosenfeld is with the Institute for Child, Youth, and Family Policy, The Heller School for Social Policy and Management, Brandeis University, Waltham, MA. At the time of the study Lauren Smith was with the Department of Public Health, Commonwealth of Massachusetts, Boston. Eric B. Rimm is with the departments of Nutrition and Epidemiology, Harvard T. H. Chan School of Public Health, Harvard University, Boston
| | - Lauren Smith
- Mary T. Gorski is with the Interfaculty Initiative in Health Policy, Harvard Graduate School of Arts and Sciences, Harvard University, Cambridge, MA. Juliana F. W. Cohen is with the Department of Health Sciences, Merrimack College, North Andover, MA. Jessica A. Hoffman and Ruth Chaffee are with the Department of Applied Psychology, Bouvé College of Health Sciences, Northeastern University, Boston. Lindsay Rosenfeld is with the Institute for Child, Youth, and Family Policy, The Heller School for Social Policy and Management, Brandeis University, Waltham, MA. At the time of the study Lauren Smith was with the Department of Public Health, Commonwealth of Massachusetts, Boston. Eric B. Rimm is with the departments of Nutrition and Epidemiology, Harvard T. H. Chan School of Public Health, Harvard University, Boston
| | - Eric B Rimm
- Mary T. Gorski is with the Interfaculty Initiative in Health Policy, Harvard Graduate School of Arts and Sciences, Harvard University, Cambridge, MA. Juliana F. W. Cohen is with the Department of Health Sciences, Merrimack College, North Andover, MA. Jessica A. Hoffman and Ruth Chaffee are with the Department of Applied Psychology, Bouvé College of Health Sciences, Northeastern University, Boston. Lindsay Rosenfeld is with the Institute for Child, Youth, and Family Policy, The Heller School for Social Policy and Management, Brandeis University, Waltham, MA. At the time of the study Lauren Smith was with the Department of Public Health, Commonwealth of Massachusetts, Boston. Eric B. Rimm is with the departments of Nutrition and Epidemiology, Harvard T. H. Chan School of Public Health, Harvard University, Boston
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Cohen JFW, Jahn JL, Richardson S, Cluggish SA, Parker E, Rimm EB. Amount of Time to Eat Lunch Is Associated with Children's Selection and Consumption of School Meal Entrée, Fruits, Vegetables, and Milk. J Acad Nutr Diet 2015; 116:123-128. [PMID: 26372337 DOI: 10.1016/j.jand.2015.07.019] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Accepted: 07/24/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND There are currently no national standards for school lunch period length and little is known about the association between the amount of time students have to eat and school food selection and consumption. OBJECTIVE Our aim was to examine plate-waste measurements from students in the control arm of the Modifying Eating and Lifestyles at School study (2011 to 2012 school year) to determine the association between amount of time to eat and school meal selection and consumption. DESIGN We used a prospective study design using up to six repeated measures among students during the school year. PARTICIPANTS/SETTING One thousand and one students in grades 3 to 8 attending six participating elementary and middle schools in an urban, low-income school district where lunch period lengths varied from 20 to 30 minutes were included. MAIN OUTCOME MEASURES School food selection and consumption were collected using plate-waste methodology. STATISTICAL ANALYSES PERFORMED Logistic regression and mixed-model analysis of variance was used to examine food selection and consumption. RESULTS Compared with meal-component selection when students had at least 25 minutes to eat, students were significantly less likely to select a fruit (44% vs 57%; P<0.0001) when they had <20 minutes to eat. There were no significant differences in entrée, milk, or vegetable selections. Among those who selected a meal component, students with <20 minutes to eat consumed 13% less of their entrée (P<0.0001), 10% less of their milk (P<0.0001), and 12% less of their vegetable (P<0.0001) compared with students who had at least 25 minutes to eat. CONCLUSIONS During the school year, a substantial number of students had insufficient time to eat, which was associated with significantly decreased entrée, milk, and vegetable consumption compared with students who had more time to eat. School policies that encourage lunches with at least 25 minutes of seated time might reduce food waste and improve dietary intake.
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Hoffman JA, Rosenfeld L, Schmidt N, Cohen JFW, Gorski M, Chaffee R, Smith L, Rimm EB. Implementation of Competitive Food and Beverage Standards in a Sample of Massachusetts Schools: The NOURISH Study (Nutrition Opportunities to Understand Reforms Involving Student Health). J Acad Nutr Diet 2015; 115:1299-307.e2. [PMID: 26210085 PMCID: PMC4545612 DOI: 10.1016/j.jand.2015.04.019] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Accepted: 04/21/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND During 2012, Massachusetts adopted comprehensive school competitive food and beverage standards that closely align with Institute of Medicine recommendations and Smart Snacks in School national standards. OBJECTIVE We examined the extent to which a sample of Massachusetts middle schools and high schools sold foods and beverages that were compliant with the state competitive food and beverage standards after the first year of implementation, and complied with four additional aspects of the regulations. DESIGN Observational cohort study with data collected before implementation (Spring 2012) and 1 year after implementation (Spring 2013). PARTICIPANTS/SETTING School districts (N=37) with at least one middle school and one high school participated. MAIN OUTCOME MEASURES Percent of competitive foods and beverages that were compliant with Massachusetts standards and compliance with four additional aspects of the regulations. Data were collected via school site visits and a foodservice director questionnaire. STATISTICAL ANALYSES PERFORMED Multilevel models were used to examine change in food and beverage compliance over time. RESULTS More products were available in high schools than middle schools at both time points. The number of competitive beverages and several categories of competitive food products sold in the sample of Massachusetts schools decreased following the implementation of the standards. Multilevel models demonstrated a 47-percentage-point increase in food and 46-percentage-point increase in beverage compliance in Massachusetts schools from 2012 to 2013. Overall, total compliance was higher for beverages than foods. CONCLUSIONS This study of a group of Massachusetts schools demonstrated the feasibility of schools making substantial changes in response to requirements for healthier competitive foods, even in the first year of implementation.
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Cohen JFW, Richardson SA, Cluggish SA, Parker E, Catalano PJ, Rimm EB. Effects of choice architecture and chef-enhanced meals on the selection and consumption of healthier school foods: a randomized clinical trial. JAMA Pediatr 2015; 169:431-7. [PMID: 25798990 PMCID: PMC4540052 DOI: 10.1001/jamapediatrics.2014.3805] [Citation(s) in RCA: 77] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Little is known about the long-term effect of a chef-enhanced menu on healthier food selection and consumption in school lunchrooms. In addition, it remains unclear if extended exposure to other strategies to promote healthier foods (eg, choice architecture) also improves food selection or consumption. OBJECTIVE To evaluate the short- and long-term effects of chef-enhanced meals and extended exposure to choice architecture on healthier school food selection and consumption. DESIGN, SETTING, AND PARTICIPANTS A school-based randomized clinical trial was conducted during the 2011-2012 school year among 14 elementary and middle schools in 2 urban, low-income school districts (intent-to-treat analysis). Included in the study were 2638 students in grades 3 through 8 attending participating schools (38.4% of eligible participants). INTERVENTIONS Schools were first randomized to receive a professional chef to improve school meal palatability (chef schools) or to a delayed intervention (control group). To assess the effect of choice architecture (smart café), all schools after 3 months were then randomized to the smart café intervention or to the control group. MAIN OUTCOMES AND MEASURES School food selection was recorded, and consumption was measured using plate waste methods. RESULTS After 3 months, vegetable selection increased in chef vs control schools (odds ratio [OR], 1.75; 95% CI, 1.36-2.24), but there was no effect on the selection of other components or on meal consumption. After long-term or extended exposure to the chef or smart café intervention, fruit selection increased in the chef (OR, 3.08; 95% CI, 2.23-4.25), smart café (OR, 1.45; 95% CI, 1.13-1.87), and chef plus smart café (OR, 3.10; 95% CI, 2.26-4.25) schools compared with the control schools, and consumption increased in the chef schools (OR, 0.17; 95% CI, 0.03-0.30 cups/d). Vegetable selection increased in the chef (OR, 2.54; 95% CI, 1.83-3.54), smart café (OR, 1.91; 95% CI, 1.46-2.50), and chef plus smart café schools (OR, 7.38, 95% CI, 5.26-10.35) compared with the control schools, and consumption also increased in the chef (OR, 0.16; 95% CI, 0.09-0.22 cups/d) and chef plus smart café (OR, 0.13; 95% CI, 0.05-0.19 cups/d) schools; however, the smart café intervention alone had no effect on consumption. CONCLUSIONS AND RELEVANCE Schools should consider both collaborating with chefs and using choice architecture to increase fruit and vegetable selection. Efforts to improve the taste of school foods through chef-enhanced meals should remain a priority because this was the only method that also increased consumption. This was observed only after students were repeatedly exposed to the new foods for 7 months. Therefore, schools should not abandon healthier options if they are initially met with resistance. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT02309840.
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Affiliation(s)
- Juliana F W Cohen
- Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts
| | | | | | | | - Paul J Catalano
- Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts4Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Eric B Rimm
- Departments of Epidemiology and Nutrition, Harvard School of Public Health, Boston, Massachusetts6Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
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Cohen JFW, Richardson S, Parker E, Catalano PJ, Rimm EB. Impact of the new U.S. Department of Agriculture school meal standards on food selection, consumption, and waste. Am J Prev Med 2014; 46:388-94. [PMID: 24650841 PMCID: PMC3994463 DOI: 10.1016/j.amepre.2013.11.013] [Citation(s) in RCA: 148] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Revised: 10/31/2013] [Accepted: 11/23/2013] [Indexed: 10/25/2022]
Abstract
BACKGROUND The U.S Department of Agriculture (USDA) recently made substantial changes to the school meal standards. The media and public outcry have suggested that this has led to substantially more food waste. PURPOSE School meal selection, consumption, and waste were assessed before and after implementation of the new school meal standards. METHODS Plate waste data were collected in four schools in an urban, low-income school district. Logistic regression and mixed-model ANOVA were used to estimate the differences in selection and consumption of school meals before (fall 2011) and after implementation (fall 2012) of the new standards among 1030 elementary and middle school children. Analyses were conducted in 2013. RESULTS After the new standards were implemented, fruit selection increased by 23.0% and entrée and vegetable selection remained unchanged. Additionally, post-implementation entrée consumption increased by 15.6%, vegetable consumption increased by 16.2%, and fruit consumption remained the same. Milk selection and consumption decreased owing to an unrelated milk policy change. CONCLUSIONS Although food waste levels were substantial both pre- and post-implementation, the new guidelines have positively affected school meal selection and consumption. Despite the increased vegetable portion size requirement, consumption increased and led to significantly more cups of vegetables consumed. Significantly more students selected a fruit, whereas the overall percentage of fruit consumed remained the same, resulting in more students consuming fruits. Contrary to media reports, these results suggest that the new school meal standards have improved students' overall diet quality. Legislation to weaken the standards is not warranted.
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Affiliation(s)
- Juliana F W Cohen
- Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts.
| | | | | | - Paul J Catalano
- Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts; Department of Biostatistics and Computational Biology, Harvard School of Public Health, Boston, Massachusetts; Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Eric B Rimm
- Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts; Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
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Cohen JFW, Rimm EB, Austin SB, Hyatt RR, Kraak VI, Economos CD. A food service intervention improves whole grain access at lunch in rural elementary schools. J Sch Health 2014; 84:212-219. [PMID: 24443783 PMCID: PMC4540181 DOI: 10.1111/josh.12133] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2012] [Revised: 01/20/2013] [Accepted: 03/03/2013] [Indexed: 06/03/2023]
Abstract
BACKGROUND Whole grain (WG) options are often limited in schools, which may impact rural, low-income students who rely on school meals for a substantial portion of their food intake. This study examined the changes in the availability and quantity of WG and refined grain foods offered in schools participating in the Creating Healthy, Active and Nurturing Growing-up Environments (CHANGE) study, a randomized, controlled intervention among rural communities (4 intervention and 4 control). METHODS Foods were assessed using production records, recipes, and nutrition labels from breakfast and lunch over 1 week during fall 2008 and spring 2009. Key informant interviews were conducted with school food service directors in the spring 2009. RESULTS The CHANGE intervention schools significantly increased the average percent of school days WGs were offered (p = .047) and the amount of WGs offered/food item (ounces) at lunch compared with control schools (p = .02). There was a significant decrease in the percent of students with access to refined grains at lunch compared with control schools (p = .049), although there were no significant differences in WG availability during breakfast. CONCLUSIONS The CHANGE schools improved WG availability, enabling student's WG consumption to be closer to national recommendations.
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Affiliation(s)
- Juliana F. W. Cohen
- Department of Nutrition, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA 02115
| | - Eric B. Rimm
- Department of Nutrition, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA 02115; Department of Epidemiology, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA 02115
| | - S. Bryn Austin
- Division of Adolescent and Young Adult Medicine, Children's Hospital Boston and Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115
| | - Raymond R. Hyatt
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 136 Harrison Avenue, Boston, MA 02111
| | - Vivica I. Kraak
- Deakin Population Health Strategic Research Centre, School of Health and Social Development, Deakin University, Melbourne Burwood Campus, 221 Burwood Highway, Burwood, Victoria 3125, Australia
| | - Christina D. Economos
- John Hancock Research Center on Physical Activity, Nutrition and Obesity Prevention, Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, 50 Harrison Avenue, Boston, MA 02111
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Choumenkovitch SF, McKeown NM, Hyatt RR, Kraak VI, Cohen JFW, Economos CD. Food group consumption and its association with BMI z‐score and socioeconomic characteristics in rural school‐aged children. FASEB J 2013. [DOI: 10.1096/fasebj.27.1_supplement.617.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - Nicola M McKeown
- Nutritional Epidemiology ProgramJean Mayer USDA HNRCA at Tufts UniversityBostonMA
| | - Raymond R Hyatt
- Public Health and Community MedicineTufts University School of MedicineBostonMA
| | - Vivica I Kraak
- School of Health and Social DevelopmentDeakin UniversityBurwoodAustralia
| | | | - Christina D Economos
- John Hancock Research Center on Physical Activity, Nutrition, and Obesity PreventionTufts UniversityBostonMA
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Cohen JFW, Richardson S, Austin SB, Economos CD, Rimm EB. School lunch waste among middle school students: nutrients consumed and costs. Am J Prev Med 2013; 44:114-21. [PMID: 23332326 PMCID: PMC3788640 DOI: 10.1016/j.amepre.2012.09.060] [Citation(s) in RCA: 119] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2012] [Revised: 07/30/2012] [Accepted: 09/27/2012] [Indexed: 11/30/2022]
Abstract
BACKGROUND The National School Lunch Program has been guided by modest nutrient standards, and the palatability of meals, which drives consumption, receives inadequate attention. School food waste can have important nutritional and cost implications for policymakers, students, and their families. PURPOSE Nutrient losses and economic costs associated with school meal waste were examined. The study also assessed if school foods served were valid proxies for foods consumed by students. METHODS Plate waste measurements were collected from middle school students in Boston attending two Chef Initiative schools (n=1609) and two control schools (n=1440) during a 2-year pilot study (2007-2009) in which a professional chef trained cafeteria staff to make healthier school meals. The costs associated with food waste were calculated and the percentage of foods consumed was compared with a gold standard of 85% consumption. Analyses were conducted in 2010-2011. RESULTS Overall, students consumed less than the required/recommended levels of nutrients. An estimated $432,349 of food (26.1% of the total food budget) was discarded by middle school students annually at lunch in these Boston middle schools. For most meal components, substantially less than 85% was consumed. CONCLUSIONS There is substantial food waste among middle school students in Boston. Overall, students' nutrient consumption levels were below school meal standards, and foods served were not valid proxies for foods consumed. The costs associated with discarded foods are high; if translated nationally for school lunches, roughly $1,238,846,400 annually is wasted. Students might benefit if additional focus were given to the quality and palatability of school meals.
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Affiliation(s)
- Juliana F W Cohen
- Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts 02115, USA.
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Abstract
BACKGROUND It is unclear from previous studies whether total or common subtypes of trans fatty acids are associated with fetal growth. OBJECTIVE We examined associations of maternal trans fatty acid intake during pregnancy with fetal growth. DESIGN We studied 1369 mother-child pairs participating in Project Viva-a prospective cohort study of pregnant women and their offspring. We assessed trans fatty acid consumption by using a validated semiquantitative food-frequency questionnaire in each of the first and second trimesters of pregnancy. We estimated fetal growth as the birth-weight-for-gestational-age (BW/GA) z value in infants born at term. RESULTS We observed no associations of first-trimester trans fatty acid consumption with fetal growth. In the second trimester, the estimated mean (±SD) total trans fatty acid intake was 2.35 ± 1.07 g/d, of which 0.11 g was 16:1(n-7t), 1.78 g was 18:1(n-9t), 0.13 g was 18:2(n-6tt), 0.33 g was 18:2(n-6tc), and 0.12 g was 18:2(n-6ct). The mean (±SD) BW/GA was 0.24 ± 0.95 z score units. Total trans fatty acid consumption during the second trimester was positively associated with the fetal growth z score (0.29 units; 95% CI: 0.07, 0.51 units) for each 1% increment in energy from trans fatty acids as a replacement for carbohydrates. The associations were limited to the trans fatty acids 16:1t (0.12 units; 95% CI: 0.02, 0.22 units) and 18:2tc (0.53 units; 95% CI: 0.09, 0.96 units). CONCLUSION A higher maternal intake of trans fatty acids, especially 16:1t and 18:2tc, during the second trimester of pregnancy was associated with greater fetal growth.
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Affiliation(s)
- Juliana F W Cohen
- Department of Nutrition, Harvard School of Public Health, Boston, MA 02115, USA.
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