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Schliemann D, Spence S, O'Kane N, Chiang CC, Olgacher D, McKinley MC, Woodside JV. Identifying the top 10 research priorities for the school food system in the UK: a priority setting exercise. BMJ Open 2024; 14:e081400. [PMID: 38485482 PMCID: PMC10941135 DOI: 10.1136/bmjopen-2023-081400] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 02/28/2024] [Indexed: 03/17/2024] Open
Abstract
INTRODUCTION The school food system varies widely between schools and across the UK. There is a need to understand evidence gaps in school food research to allow the development, implementation and evaluation of policies and interventions to support children's healthy eating at school. This study aimed to conduct a priority setting exercise to co-produce research priorities in relation to the UK school food system. METHODS The James Lind Alliance process informed this priority setting exercise; all key steps engaged a wide range of UK school food stakeholders (including teachers, parents, principals, school governors, policymakers, caterers). An initial online stakeholder survey identified perceived research priorities. In a second survey, stakeholders were asked to rank these priorities. Lastly, an online priority setting workshop with stakeholders elicited the most important research priorities. RESULTS In 2021, school food stakeholders (n=1280) completed the first survey, from which 136 research priorities were identified. In the second survey, participants (n=107) ranked these research priorities regarding their importance. Lastly, 30 workshop participants discussed and reached consensus on the research priorities. After final refinement by the research team, 18 priorities resulted, with the top 10 being related to the provision of free school meals (effectiveness of cost-effectiveness of different levels of eligibility, including universal provision), implementation of policy (including improving uptake) and food standards, issues around procurement, leadership, inequalities, social norms, the eating environment, food culture throughout the school setting and healthy eating. CONCLUSION The top 10 research priorities were elicited through a rigorous approach, including a wide range of stakeholders across the UK. These should be considered by policymakers, researchers and others to inform research, evidence-based policy development and, ultimately, improve the UK school food system.
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Affiliation(s)
| | - Suzanne Spence
- Human Nutrition & Exercise Research Centre, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Niamh O'Kane
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | | | - Dilara Olgacher
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | | | - Jayne V Woodside
- Centre for Public Health, Queen's University Belfast, Belfast, UK
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O'Kane N, Watson S, Kehoe L, O'Sullivan E, Muldoon A, Woodside J, Walton J, Nugent A. The patterns and position of snacking in children in aged 2-12 years: A scoping review. Appetite 2023:106974. [PMID: 37421978 DOI: 10.1016/j.appet.2023.106974] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 06/12/2023] [Accepted: 07/05/2023] [Indexed: 07/10/2023]
Abstract
BACKGROUND Childhood obesity is associated with serious comorbidities during childhood and into adulthood. One potential risk factor for childhood obesity is consumption of unhealthy, energy-dense foods. This scoping review examines evidence on snacking in children aged 2-12years of age and presents the patterns and position of snacking in children's diets. METHODS A search of electronic databases (MEDLINE, Web of Science, PubMed, Embase) for articles published from March 2011 to November 2022 was conducted. Articles providing insight into the position of snacking (e.g., energy contribution), or patterns (e.g., location, timing), in children aged 2-12years were included. A quality assessment was conducted and data was synthesised according to data source (nationally representative or other). RESULTS Twenty-one articles were included, most (n = 13) reporting nationally representative data. The average number of daily snacks was 3, with 92.9-100.0% of children consuming snacks. Most were consumed in the afternoon (75.2-84.0%) and at home (46.5-67.3%). Snacks frequently consumed were 'fruits and vegetables', 'baked desserts', 'sweets, candy and confectionery', and 'dairy products'. Snacks contributed 231-565 kcal daily, up to a third of daily carbohydrate intake, a quarter of fat intake, and a fifth of protein intake. Snacks provided up to one third of vitamin C intake, one quarter of vitamin E, potassium and magnesium intake, and a fifth of calcium, folic acid, vitamins D and B12, iron and sodium intake. DISCUSSION This scoping review provides insight into patterns and position of snacking within children's diets. Snacking plays a significant role in children's diets with multiple snacking occasions occurring throughout a child's day, the overconsumption of which has the potential to increase risk of childhood obesity. Further research is required into the role of snacking, particularly specific foods playing a role in micronutrient intake, and clear guidance for snacking intake in children.
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Affiliation(s)
- Niamh O'Kane
- Institute for Global Food Security, School of Biological Sciences, Queen's University Belfast, Ireland; Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Ireland.
| | - Sinead Watson
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Ireland
| | - Laura Kehoe
- Department of Biological Sciences, Munster Technological University, Cork, Ireland; School of Food & Nutritional Sciences, University College Cork, Cork, Ireland
| | - Emma O'Sullivan
- Department of Biological Sciences, Munster Technological University, Cork, Ireland
| | - Aine Muldoon
- Department of Biological Sciences, Munster Technological University, Cork, Ireland
| | - Jayne Woodside
- Institute for Global Food Security, School of Biological Sciences, Queen's University Belfast, Ireland; Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Ireland
| | - Janette Walton
- Department of Biological Sciences, Munster Technological University, Cork, Ireland
| | - Anne Nugent
- Institute for Global Food Security, School of Biological Sciences, Queen's University Belfast, Ireland; Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Ireland
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Bryant M, Burton W, O'Kane N, Woodside JV, Ahern S, Garnett P, Spence S, Sharif A, Rutter H, Baker T, Evans CEL. Understanding school food systems to support the development and implementation of food based policies and interventions. Int J Behav Nutr Phys Act 2023; 20:29. [PMID: 36907879 PMCID: PMC10009978 DOI: 10.1186/s12966-023-01432-2] [Citation(s) in RCA: 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: 12/21/2022] [Accepted: 03/02/2023] [Indexed: 03/14/2023] Open
Abstract
BACKGROUND Schools provide opportunities to improve the quality of children's diet, whilst reducing inequalities in childhood diet and health. Evidence supports whole school approaches, including consistency in food quality, eating culture and food education. However, such approaches are often poorly implemented due to the highly complex environments in which schools operate. We aimed to develop a school food systems map using a systems thinking approach to help identify the key factors influencing primary school children's dietary choice. METHODS Eight workshops were conducted with 80 children (from schools from varying locations (region of England/UK; urban/rural), deprivation levels and prioritisation of school food policies)) and 11 workshops were held with 82 adult stakeholders across the UK (principals, teachers, caterers, school governors, parents, and local and voluntary sector organisations) to identify factors that influence food choice in children across a school day and their inter-relationships. Initial exploratory workshops started with a 'blank canvas' using a group model building approach. Later workshops consolidated findings and supported a wider discussion of factors, relationships and influences within the systems map. Strengths of the relationship between factors/nodes were agreed by stakeholders and individually depicted on the map. We facilitated an additional eight interactive, in-person workshops with children to map their activities across a whole school day to enable the production of a journey map which was shared with stakeholders in workshops to facilitate discussion. RESULTS The final 'CONNECTS-Food' systems map included 202 factors that were grouped into 27 nodes. Thematic analysis identified four key themes: leadership and curriculum; child food preference; home environment; and school food environment. Network analysis highlighted key factors that influence child diet across a school day, which were largely in keeping with the thematic analysis; including: 'available funds/resources', 'awareness of initiatives and resources', 'child food preference and intake', 'eligibility of free school meals', 'family circumstances and eating behaviours', 'peer/social norms', 'priorities of head teachers and senior leaders'. CONCLUSIONS Our systems map demonstrates the need to consider factors external to schools and their food environments. The map supports the identification of potential actions, interventions and policies to facilitate a systems-wide positive impact on children's diets.
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Affiliation(s)
- Maria Bryant
- Department of Health Sciences, University of York, York, YO150DD, UK
- Hull York Medical School, University of York, York, YO150DD, UK
| | - Wendy Burton
- Department of Health Sciences, University of York, York, YO150DD, UK
| | - Niamh O'Kane
- Centre for Public Health, Queen's University Belfast, Belfast, BT12 6BJ, UK
| | - Jayne V Woodside
- Centre for Public Health, Queen's University Belfast, Belfast, BT12 6BJ, UK.
| | - Sara Ahern
- Bradford Institute of Health Research, Bradford Royal Infirmary, Bradford, BD9 6RJ, UK
| | - Phillip Garnett
- School for Business and Society, University of York, York, YO10 5DD, UK
| | - Suzanne Spence
- Human Nutrition Exercise Research Centre, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK
| | - Amir Sharif
- Faculty of Management, Law and Social Sciences, University of Bradford, Bradford, BD7, 1DP, UK
| | - Harry Rutter
- Department of Social and Policy Sciences, University of Bath, Bath, BA2 7AY, UK
| | - Tim Baker
- Charlton Manor Primary School, Indus Road, Charlton, London, SE7 7EF, UK
| | - Charlotte E L Evans
- School of Food Science and Nutrition, University of Leeds, Leeds, LS2 9JT, UK
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Dean M, O'Kane C, Issartel J, McCloat A, Mooney E, McKernan C, Brooks S, O'Kane N, Crowe W, Murphy B, Lavelle F. Cook Like A Boss: An effective co-created multidisciplinary approach to improving children's cooking competence. Appetite 2021; 168:105727. [PMID: 34606938 DOI: 10.1016/j.appet.2021.105727] [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: 03/02/2021] [Revised: 09/17/2021] [Accepted: 09/29/2021] [Indexed: 01/13/2023]
Abstract
Cooking interventions are emphasised as promising methods for changing children's food-related preferences, attitudes and behaviours. However, criticisms remain, including relatively weak intervention designs; lack of validated tools, and limited underpinning theory. Therefore, this research aimed to assess the effectiveness of a theory-driven co-created children's cooking intervention with underpinning rationale for the content, using a validated measure. 'Cook Like A Boss' was a one week, controlled cooking camp style intervention. Thirty two children aged 10-12 years participated. The intervention was developed using the Cook-Ed model for planning, implementing and evaluating cooking programs and was underpinned by Social Learning theory and Experiential Learning theory. The intervention content was developed in a co-creation process with the research team, a chef and the children. The underlying developmental skills required for the recipes were assessed to ensure they were age-appropriate. Children completed pre and post measurements including perceived cooking competence. Process evaluations were also gathered. There was a significant increase in perceived cooking competence after the intervention (P < 0.05) and a significant difference between the intervention and control group (P < 0.001). Additionally, process evaluations found the intervention to have high fidelity and dose received and that it was received extremely positively. The 'Cook Like A Boss' children's cooking camp was an effective multidisciplinary co-created intervention with a vulnerable group, e.g. children, guided by a model and underpinned by theory. The content was developed to ensure it was age-appropriate and achievable for the children. This approach could act as a template for future children's cooking interventions.
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Affiliation(s)
- Moira Dean
- Institute for Global Food Security, School of Biological Sciences, Queen's University Belfast, UK
| | - Chloe O'Kane
- Institute for Global Food Security, School of Biological Sciences, Queen's University Belfast, UK
| | - Johann Issartel
- Multisensory Motor Learning Lab, Dublin City University, Dublin, Ireland
| | - Amanda McCloat
- School of Home Economics, St. Angela's College, Sligo (National University of Ireland Galway), Ireland
| | - Elaine Mooney
- School of Home Economics, St. Angela's College, Sligo (National University of Ireland Galway), Ireland
| | - Claire McKernan
- Institute for Global Food Security, School of Biological Sciences, Queen's University Belfast, UK
| | - Stephanie Brooks
- Institute for Global Food Security, School of Biological Sciences, Queen's University Belfast, UK
| | - Niamh O'Kane
- Institute for Global Food Security, School of Biological Sciences, Queen's University Belfast, UK
| | - William Crowe
- Institute for Global Food Security, School of Biological Sciences, Queen's University Belfast, UK
| | - Blain Murphy
- Institute for Global Food Security, School of Biological Sciences, Queen's University Belfast, UK
| | - Fiona Lavelle
- Institute for Global Food Security, School of Biological Sciences, Queen's University Belfast, UK.
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Gurney JC, Ansari E, Harle D, O'Kane N, Sagar RV, Dunne MCM. Application of Bayes' to the prediction of referral decisions made by specialist optometrists in relation to chronic open angle glaucoma. Eye (Lond) 2018; 32:1074-1078. [PMID: 29422665 DOI: 10.1038/s41433-018-0023-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 11/20/2017] [Accepted: 11/23/2017] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To determine the accuracy of a Bayesian learning scheme (Bayes') applied to the prediction of clinical decisions made by specialist optometrists in relation to the referral refinement of chronic open angle glaucoma. METHODS This cross-sectional observational study involved collection of data from the worst affected or right eyes of a consecutive sample of cases (n = 1,006) referred into the West Kent Clinical Commissioning Group Community Ophthalmology Team (COT) by high street optometrists. Multilevel classification of each case was based on race, sex, age, family history of chronic open angle glaucoma, reason for referral, Goldmann Applanation Tonometry (intraocular pressure and interocular asymmetry), optic nerve head assessment (vertical size, cup disc ratio and interocular asymmetry), central corneal thickness and visual field analysis (Hodapp-Parrish-Anderson classification). Randomised stratified tenfold cross-validation was applied to determine the accuracy of Bayes' by comparing its output to the clinical decisions of three COT specialist optometrists; namely, the decision to discharge, follow-up or refer each case. RESULTS Outcomes of cross-validation, expressed as means and standard deviations, showed that the accuracy of Bayes' was high (95%, 2.0%) but that it falsely discharged (3.4%, 1.6%) or referred (3.1%, 1.5%) some cases. CONCLUSIONS The results indicate that Bayes' has the potential to augment the decisions of specialist optometrists.
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Affiliation(s)
- J C Gurney
- Community Ophthalmology Team, West Kent CCG, Aylesford, UK.,Ophthalmic Research Group, Optometry School, Aston University, Birmingham, UK
| | - E Ansari
- Maidstone and Tunbridge Wells NHS Trust, Maidstone, UK
| | - D Harle
- Community Ophthalmology Team, West Kent CCG, Tunbridge, UK
| | - N O'Kane
- Community Ophthalmology Team, West Kent CCG, Rochester, UK
| | - R V Sagar
- Ophthalmic Research Group, Optometry School, Aston University, Birmingham, UK
| | - M C M Dunne
- Ophthalmic Research Group, Optometry School, Aston University, Birmingham, UK.
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Hunter RF, Gough A, O'Kane N, McKeown G, Fitzpatrick A, Walker T, McKinley M, Lee M, Kee F. Ethical Issues in Social Media Research for Public Health. Am J Public Health 2018; 108:343-348. [PMID: 29346005 DOI: 10.2105/ajph.2017.304249] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [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
Social media (SM) offer huge potential for public health research, serving as a vehicle for surveillance, delivery of health interventions, recruitment to trials, collection of data, and dissemination. However, the networked nature of the data means they are riddled with ethical challenges, and no clear consensus has emerged as to the ethical handling of such data. This article outlines the key ethical concerns for public health researchers using SM and discusses how these concerns might best be addressed. Key issues discussed include privacy; anonymity and confidentiality; authenticity; the rapidly changing SM environment; informed consent; recruitment, voluntary participation, and sampling; minimizing harm; and data security and management. Despite the obvious need, producing a set of prescriptive guidelines for researchers using SM is difficult because the field is evolving quickly. What is clear, however, is that the ethical issues connected to SM-related public health research are also growing. Most importantly, public health researchers must work within the ethical principles set out by the Declaration of Helsinki that protect individual users first and foremost.
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Affiliation(s)
- Ruth F Hunter
- Ruth F. Hunter, Aisling Gough, Niamh O'Kane, Michelle McKinley, and Frank Kee are with the United Kingdom Clinical Research Collaboration Centre of Excellence for Public Health/Centre for Public Health, Queen's University Belfast, Belfast. Gary McKeown and Aine Fitzpatrick are with the School of Psychology, Queen's University Belfast. Tom Walker is with the School of History, Anthropology, Philosophy and Politics, Queen's University Belfast. Mandy Lee is with the Centre for Health Policy and Management School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Aisling Gough
- Ruth F. Hunter, Aisling Gough, Niamh O'Kane, Michelle McKinley, and Frank Kee are with the United Kingdom Clinical Research Collaboration Centre of Excellence for Public Health/Centre for Public Health, Queen's University Belfast, Belfast. Gary McKeown and Aine Fitzpatrick are with the School of Psychology, Queen's University Belfast. Tom Walker is with the School of History, Anthropology, Philosophy and Politics, Queen's University Belfast. Mandy Lee is with the Centre for Health Policy and Management School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Niamh O'Kane
- Ruth F. Hunter, Aisling Gough, Niamh O'Kane, Michelle McKinley, and Frank Kee are with the United Kingdom Clinical Research Collaboration Centre of Excellence for Public Health/Centre for Public Health, Queen's University Belfast, Belfast. Gary McKeown and Aine Fitzpatrick are with the School of Psychology, Queen's University Belfast. Tom Walker is with the School of History, Anthropology, Philosophy and Politics, Queen's University Belfast. Mandy Lee is with the Centre for Health Policy and Management School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Gary McKeown
- Ruth F. Hunter, Aisling Gough, Niamh O'Kane, Michelle McKinley, and Frank Kee are with the United Kingdom Clinical Research Collaboration Centre of Excellence for Public Health/Centre for Public Health, Queen's University Belfast, Belfast. Gary McKeown and Aine Fitzpatrick are with the School of Psychology, Queen's University Belfast. Tom Walker is with the School of History, Anthropology, Philosophy and Politics, Queen's University Belfast. Mandy Lee is with the Centre for Health Policy and Management School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Aine Fitzpatrick
- Ruth F. Hunter, Aisling Gough, Niamh O'Kane, Michelle McKinley, and Frank Kee are with the United Kingdom Clinical Research Collaboration Centre of Excellence for Public Health/Centre for Public Health, Queen's University Belfast, Belfast. Gary McKeown and Aine Fitzpatrick are with the School of Psychology, Queen's University Belfast. Tom Walker is with the School of History, Anthropology, Philosophy and Politics, Queen's University Belfast. Mandy Lee is with the Centre for Health Policy and Management School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Tom Walker
- Ruth F. Hunter, Aisling Gough, Niamh O'Kane, Michelle McKinley, and Frank Kee are with the United Kingdom Clinical Research Collaboration Centre of Excellence for Public Health/Centre for Public Health, Queen's University Belfast, Belfast. Gary McKeown and Aine Fitzpatrick are with the School of Psychology, Queen's University Belfast. Tom Walker is with the School of History, Anthropology, Philosophy and Politics, Queen's University Belfast. Mandy Lee is with the Centre for Health Policy and Management School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Michelle McKinley
- Ruth F. Hunter, Aisling Gough, Niamh O'Kane, Michelle McKinley, and Frank Kee are with the United Kingdom Clinical Research Collaboration Centre of Excellence for Public Health/Centre for Public Health, Queen's University Belfast, Belfast. Gary McKeown and Aine Fitzpatrick are with the School of Psychology, Queen's University Belfast. Tom Walker is with the School of History, Anthropology, Philosophy and Politics, Queen's University Belfast. Mandy Lee is with the Centre for Health Policy and Management School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Mandy Lee
- Ruth F. Hunter, Aisling Gough, Niamh O'Kane, Michelle McKinley, and Frank Kee are with the United Kingdom Clinical Research Collaboration Centre of Excellence for Public Health/Centre for Public Health, Queen's University Belfast, Belfast. Gary McKeown and Aine Fitzpatrick are with the School of Psychology, Queen's University Belfast. Tom Walker is with the School of History, Anthropology, Philosophy and Politics, Queen's University Belfast. Mandy Lee is with the Centre for Health Policy and Management School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Frank Kee
- Ruth F. Hunter, Aisling Gough, Niamh O'Kane, Michelle McKinley, and Frank Kee are with the United Kingdom Clinical Research Collaboration Centre of Excellence for Public Health/Centre for Public Health, Queen's University Belfast, Belfast. Gary McKeown and Aine Fitzpatrick are with the School of Psychology, Queen's University Belfast. Tom Walker is with the School of History, Anthropology, Philosophy and Politics, Queen's University Belfast. Mandy Lee is with the Centre for Health Policy and Management School of Medicine, Trinity College Dublin, Dublin, Ireland
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