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Carducci B, Dominguez G, Kidd E, Oh C, Jain R, Khan A, Bhutta ZA. Promoting healthy school food environments and nutrition in Canada: a systematic review of interventions, policies, and programs. Nutr Rev 2024:nuae030. [PMID: 38767979 DOI: 10.1093/nutrit/nuae030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2024] Open
Abstract
CONTEXT The school food environment is a critical interface for child and adolescent nutrition, and there is a need to understand existing literature on Canadian school food environments to identify equity gaps and opportunities, and empower decision-makers to plan for future action. OBJECTIVE Literature on Canadian school food and nutrition interventions, policies, programs, and their effects on diets and nutritional status are synthesized and appraised in this systematic review. DATA SOURCES A search strategy was developed for each database used (Medline, Embase, PsycINFO, ERIC, Cochrane Collaboration, Canadian Electronic Library, BiblioMap), with a combination of free text and controlled vocabulary, for articles published from 1990 to 2021. Unpublished data and grey literature were also searched. DATA EXTRACTION Quantitative and qualitative studies with an observational or intervention study design, reviews, or program evaluations conducted in Canadian schools with participants aged 5-19.9 years were included. Key study characteristics and risk of bias were extracted independently by 2 investigators using a standardized tool. DATA ANALYSIS A total of 298 articles were included (n = 192 peer reviewed and 106 from the grey literature), which were mostly conducted in Ontario (n = 52), British Columbia (n = 43), and Nova Scotia (n = 28). Twenty-four interventions, 5 nonevaluated programs, and 1 policy involved Indigenous populations. Overall, 86 articles measured and reported on effectiveness outcomes, including dietary intake; anthropometry; knowledge, attitudes, and practices; and physical activity. The literature remains largely heterogenous and primarily focused on nutrition education programs that use subjective assessments to infer changes in nutrition. A key facilitator to implementation and sustainability was community engagement, whereas key barriers were staff capacity, access to resources and funding, and consistent leadership. CONCLUSIONS This review provides insight into Canadian school food and nutrition interventions, programs, and policies and uncovers important evidence gaps that require careful examination for future evaluations. Governments must create supportive environments that optimize nutrition for children and adolescents through equitable policies and programs. SYSTEMATIC REVIEW REGISTRATION PROSPERO registration no. CRD42022303255.
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Affiliation(s)
- Bianca Carducci
- Centre for Global Child Health, Hospital for Sick Children, Peter Gilgan Centre for Research, and Learning, Toronto, ON, Canada
- Department of Nutritional Sciences, University of Toronto, Faculty of Medicine, University of Toronto, Medical Sciences Building, Toronto, ON, Canada
| | - Georgia Dominguez
- Centre for Global Child Health, Hospital for Sick Children, Peter Gilgan Centre for Research, and Learning, Toronto, ON, Canada
| | - Emily Kidd
- Centre for Global Child Health, Hospital for Sick Children, Peter Gilgan Centre for Research, and Learning, Toronto, ON, Canada
| | - Christina Oh
- Western University, Schulich School of Medicine and Dentistry, London, ON, Canada
| | - Reena Jain
- Centre for Global Child Health, Hospital for Sick Children, Peter Gilgan Centre for Research, and Learning, Toronto, ON, Canada
| | - Amira Khan
- Centre for Global Child Health, Hospital for Sick Children, Peter Gilgan Centre for Research, and Learning, Toronto, ON, Canada
- Department of Nutritional Sciences, University of Toronto, Faculty of Medicine, University of Toronto, Medical Sciences Building, Toronto, ON, Canada
| | - Zulfiqar A Bhutta
- Centre for Global Child Health, Hospital for Sick Children, Peter Gilgan Centre for Research, and Learning, Toronto, ON, Canada
- Department of Nutritional Sciences, University of Toronto, Faculty of Medicine, University of Toronto, Medical Sciences Building, Toronto, ON, Canada
- Centre of Excellence in Women, and Child Health, Aga Khan University, Karachi, Pakistan
- Dalla Lana School of Public, Health University of Toronto Health Sciences Building, Toronto, ON, Canada
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Lavelle MA, Knopp M, Gunther CW, Hopkins LC. Youth and Peer Mentor Led Interventions to Improve Biometric-, Nutrition, Physical Activity, and Psychosocial-Related Outcomes in Children and Adolescents: A Systematic Review. Nutrients 2023; 15:2658. [PMID: 37375562 DOI: 10.3390/nu15122658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 05/25/2023] [Accepted: 06/02/2023] [Indexed: 06/29/2023] Open
Abstract
The utilization of youth (older) and peer (same age) mentor-led interventions to improve nutrition and physical activity has been an emerging trend in recent years. This systematic review is intended to synthesize the effectiveness of these intervention programs on participants and mentors based on biometric, nutrition, physical activity, and psychosocial outcomes of youth and peer mentor-led interventions among children and adolescents. Online databases, including PubMed, ScienceDirect, EBSCOhost and Google Scholar, were searched, and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. A three-step screening process was used to meet the proposed eligibility criteria, and the risk-of-bias tool for randomized trials (RoB 2) was used to assess bias for the included studies. Nineteen unique intervention programs and twenty-five total studies were deemed eligible when considering the criteria required for review. Multiple studies demonstrated positive evidence of the biometric and physical activity outcomes that were considered significant. The findings regarding the nutritional outcomes across the included studies were mixed, as some studies reported significant changes in eating habits while others did not find a significant change. Overall, the utilization of youth and peer mentor-led models in nutrition- and physical-activity-related interventions may be successful in overweight and obesity prevention efforts for those children and adolescents receiving the intervention and the youths and peers leading the interventions. More research is needed to explore the impact on the youths and peers leading the interventions and disseminating more detailed implementation strategies, e.g., training mentors would allow for advancements in the field and the replicability of approaches. Terminology: In the current youth- and peer-led nutrition and physical activity intervention literature, a varying age differential exists between the targeted sample and the peers, and varying terminology with regards to how to name or refer to the youth. In some instances, the youth mentors were individuals of the same grade as the target sample who either volunteered to serve in the peer role or were selected by their fellow students or school staff. In other cases, the youth mentors were slightly older individuals, either in high school or college, who were selected based upon their experience, leadership skills, passion for the project, or demonstration of healthy lifestyle behaviors.
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Affiliation(s)
- Margaret A Lavelle
- Department of Communication Sciences and Disorders, College of Education and Health Sciences, Baldwin Wallace University, Berea, OH 44017, USA
| | - Miriam Knopp
- Department of Health Sciences, College of Education and Human Ecology, The Ohio State University, Columbus, OH 43210, USA
| | - Carolyn W Gunther
- College of Nursing, The Ohio State University, Columbus, OH 43210, USA
| | - Laura C Hopkins
- Department of Public Health and Prevention Science, College of Education and Health Sciences, Baldwin Wallace University, Berea, OH 44017, USA
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Nikniaz Z, Tabrizi JS, Abbasalizad Farhangi M, Hosseini M, Tahmasebi S, Nikniaz L. Community‐based interventions to reduce sugar intake in healthy populations: A systematic review. WORLD MEDICAL & HEALTH POLICY 2022. [DOI: 10.1002/wmh3.524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Affiliation(s)
- Zeinab Nikniaz
- Liver and Gastrointestinal Diseases Research Center, Medicine Faculty Tabriz University of Medical Sciences Tabriz Iran
| | - Jafar S. Tabrizi
- Tabriz Health Services Management Research Center, Faculty of Management and Medical Informatics Tabriz University of Medical Sciences Tabriz Iran
| | | | | | - Sanaz Tahmasebi
- Student Research Committee Tabriz University of Medical Sciences Tabriz Iran
| | - Leila Nikniaz
- Tabriz Health Services Management Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences Faculty of Management and Medical Informatics Tabriz Iran
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Dietary Intake and Sources of Added Sugars in Various Food Environments in Costa Rican Adolescents. Nutrients 2022; 14:nu14050959. [PMID: 35267934 PMCID: PMC8912352 DOI: 10.3390/nu14050959] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 02/17/2022] [Accepted: 02/21/2022] [Indexed: 02/01/2023] Open
Abstract
Consumption of added sugars, especially from sugar-sweetened beverages (SSBs), has been associated with several negative health outcomes during adolescence. This study aimed to identify dietary intake and food sources of added sugars in the home, school, and neighborhood environments of Costa Rican adolescents. Dietary intake of added sugars was determined using 3-day food records in a cross-sectional study of 818 adolescents aged 12 to 19 and enrolled in rural and urban schools in the province of San José. On average, 90% of adolescents consumed more than 10% of their total energy intake from added sugars. Furthermore, 74.0% of added sugars were provided at home, 17.4% at school, and 8.6% in the neighborhood. Added sugars were primarily provided by frescos (29.4%), fruit-flavored still drinks (22.9%), and sugar-sweetened carbonated beverages (12.3%), for a total contribution of 64.6%. Our findings suggest that Costa Rican adolescents have a plethora of added sugar sources in all food environments where they socialize. However, it is relevant for public health to consider the home and school environments as fundamental units of interventions aimed at reducing added sugars in the adolescent diet. Frescos prepared at home and school and fruit-flavored still drinks must be the focus of these interventions.
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Steeves EA, Trude ACB, Ruggiero CF, Ruiz MJM, Jones-Smith JC, Porter KP, Cheskin L, Hurley K, Hopkins L, Gittelsohn J. Perceptions and Impact of a Youth-led Childhood Obesity Prevention Intervention among Youth-leaders. JOURNAL OF HUNGER & ENVIRONMENTAL NUTRITION 2021; 16:213-234. [PMID: 34539947 DOI: 10.1080/19320248.2019.1649777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objective To evaluate the impact of a youth-led nutrition intervention on youth-leaders themselves. Design Mixed methods, including: in-depth interviews and a quasi-experimental quantitative study comparing youth-leaders and nonparticipant comparison youth. Analysis Qualitative analysis using direct content analysis. Difference-in-differences analyses assessing quantitative program impact. Results Youth-leaders perceived that the intervention impacted themselves, the youth-participants, and their respective social networks. Youth-leaders experienced greater increases in intentions to eat healthfully (p=0.04), and greater decreases in support for healthy eating from their friends (p=0.01), than the comparison group. Conclusions/Implications Youth-leaders reported multiple levels of intervention impact, and increased intentions for healthy eating; however, additional research is needed to enhance impact on behavioral outcomes.
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Affiliation(s)
| | - Angela Cristina Bizzotto Trude
- Center for Human Nutrition and the Global Obesity Prevention Center at the Johns Hopkins Bloomberg School of Public Health
| | | | | | | | - Keshia Pollack Porter
- Department of Health Policy and Management and the Global Obesity Prevention Center at the Johns Hopkins Bloomberg School of Public Health
| | - Lawrence Cheskin
- Department of Health Behavior and Society and the Global Obesity Prevention Center at the Johns Hopkins Bloomberg School of Public Health
| | - Kristen Hurley
- Center for Human Nutrition and the Global Obesity Prevention Center at the Johns Hopkins Bloomberg School of Public Health
| | | | - Joel Gittelsohn
- Center for Human Nutrition and the Global Obesity Prevention Center at the Johns Hopkins Bloomberg School of Public Health
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St. Pierre C, Guan W, Barry L, Dease G, Gottlieb S, Morris A, Merrill J, Sacheck JM. Themes in Train-the-Trainer Nutrition Education Interventions Targeting Middle School Students: A Systematic Review. Nutrients 2021; 13:2749. [PMID: 34444910 PMCID: PMC8398099 DOI: 10.3390/nu13082749] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 08/04/2021] [Accepted: 08/05/2021] [Indexed: 11/24/2022] Open
Abstract
Context-appropriate nutrition education interventions targeting middle school students have the potential to promote healthy dietary patters that may help prevent unnecessary weight gain at a point in childhood development when youth experience increasing agency over their food choices. The aim of this review was to identify and synthesize themes in train-the-trainer approaches, intervention content and delivery, and youth receptivity across teacher, mentor, and peer-led nutrition education interventions that targeted middle school-age youth in urban, primarily low-income settings. A systematic, electronic literature search was conducted in seven electronic databases, PubMed/Medline, CINAHL, ERIC, PsycINFO, Scopus, SPORTDiscus, and Cochrane CENTRAL, using fixed inclusion and exclusion criteria. A total of 53 papers representing 39 unique interventions were selected for data extraction and quality assessment. A framework synthesis approach was used to organize the interventions into six categories and identify themes according to whether the intervention was classroom-based or out-of-school-based and whether adults, cross-age peers or same-age peers delivered the intervention. Ten of the interventions contained multiple components such that they were included in two of the categories. The review findings indicated that trainings should be interactive, include opportunities to role-play intervention scenarios and provide follow-up support throughout intervention delivery. Interventions targeting middle school youth should include positive messaging and empower youth to make healthy choices within their specific food environment context.
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Affiliation(s)
- Christine St. Pierre
- Milken Institute School of Public Health, The George Washington University, Washington, DC 20052, USA; (G.D.); (J.M.S.)
| | - Win Guan
- Up2Us Sports, New York, NY 10018, USA; (W.G.); (J.M.)
| | - Leah Barry
- Department of Sociology, Tulane University, New Orleans, LA 70118, USA; (L.B.); (S.G.)
| | - Grace Dease
- Milken Institute School of Public Health, The George Washington University, Washington, DC 20052, USA; (G.D.); (J.M.S.)
| | - Sydney Gottlieb
- Department of Sociology, Tulane University, New Orleans, LA 70118, USA; (L.B.); (S.G.)
| | - Arielle Morris
- School of Science & Engineering, Tulane University, New Orleans, LA 70118, USA;
| | | | - Jennifer M. Sacheck
- Milken Institute School of Public Health, The George Washington University, Washington, DC 20052, USA; (G.D.); (J.M.S.)
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Sundborn G, Thornley S, Grey C, Gentles D, Jackson RT, Swinburn B, Veatupu L, Lang B. Gamification and Sugar: A School-Based Pilot Study of Social Marketing and Gamification Approaches to Reduce Sugary Drink Intake in Pasifika School Students. Asia Pac J Public Health 2021; 33:727-733. [PMID: 34218679 DOI: 10.1177/10105395211030133] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The aim of this study was to investigate a social marketing-gamification intervention to reduce sugary drink intake drawing on popular culture of Pasifika secondary school students in Auckland, New Zealand. Students aged 11 to 14 years from one coeducational high school participated in the 11-week pilot study. The 9-week intervention was undertaken in assemblies and classrooms. Baseline and follow-up measures were completed by 227 and 220 students, respectively, of 298 enrolled students. Retention of the "3-6-9" teaching related to maximum daily sugar intake increased from 9% at baseline to 97% at follow-up (P < .0001). Significant increases were observed of students who correctly answered sugar content of drinks. Overall consumption of sugary drink decreased at follow-up by 0.46 glasses per day. The main conclusion from this study was that this school-based gamification educational package to convey messages about sugar content of drinks using popular modes of engagement is a promising intervention that was acceptable and well supported by school staff and students.
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Affiliation(s)
| | | | - Corina Grey
- Auckland District Health Board, Auckland, New Zealand
| | | | | | | | | | - Bodo Lang
- University of Auckland, Auckland, New Zealand
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Vangeepuram N, Angeles J, Lopez-Belin P, Arniella G, Horowitz CR. Youth Peer Led Lifestyle Modification Interventions: A Narrative Literature Review. EVALUATION AND PROGRAM PLANNING 2020; 83:101871. [PMID: 33032025 DOI: 10.1016/j.evalprogplan.2020.101871] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 06/16/2020] [Accepted: 08/20/2020] [Indexed: 06/11/2023]
Abstract
The prevalence of obesity remains high among school age children and continues to rise among adolescents in the United States. One strategy to address this challenge is to use peer rather than professional leaders to run weight management programs. Youth peer-led lifestyle interventions have become increasingly common over the last few decades, but there is a lack of review and synthesis of these programs. The purpose of this manuscript was to critically review and synthesize results and lessons learned from evaluated youth peer-led lifestyle modification and weight management programs. We searched the PubMed/MEDLINE database to identify articles published between March 2002 and December 2015. We identified 29 interventions including children from kindergarten to 12th grade from different settings and racial/ethnic and economic backgrounds. We first summarized descriptive information about the interventions and then compared outcomes based on intervention type, peer leader characteristics and training, and other related factors. Our review indicated that youth peer-led interventions of varying structure and content can result in positive changes in behavioral influences, diet, physical activity, body measures and other clinical outcomes. We used information from our analysis to formulate recommendations for design of future youth peer-led lifestyle interventions.
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Affiliation(s)
- Nita Vangeepuram
- Departments of Pediatrics and Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place Box 1202A, New York, NY, 10029, United States.
| | - Jesenia Angeles
- Departments of Pediatrics and Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place Box 1077, New York, NY 10029, United States.
| | - Patricia Lopez-Belin
- TEEN HEED Community Action Board, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, 1 Gustave Levy Place Box 1077, New York, NY 10029, United States.
| | - Guedy Arniella
- Institute for Family Health, 1824 Madison Ave, New York, NY, 10035, United States.
| | - Carol R Horowitz
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place Box 1077, New York, NY, 10029, United States.
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Community-based interventions to increase dairy intake in healthy populations: a systematic review. Public Health Rev 2020; 41:18. [PMID: 32774990 PMCID: PMC7401205 DOI: 10.1186/s40985-020-00135-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 06/18/2020] [Indexed: 12/03/2022] Open
Abstract
Background Considering the low frequency of dairy intake in the population, interventions aiming to increase its consumption can be a priority for any health system. Objective This study aims to summarize community-based interventions for improving dairy consumption and their effectiveness to help policy-makers in designing coherent public health strategies. Methods This study was conducted in 2019, using PubMed/MEDLINE, Scopus, EMBASE, Cochrane Library, Web of Science, ProQuest, and Google Scholar. Two independent reviewers selected the eligible studies, and the outcomes of interest were extracted. The quality of eligible studies was assessed using the Joanna Briggs Institute Critical Appraisal Checklist for randomized controlled trials and quasi-experimental studies. Results Out of 521 initially identified articles, 25 studies were included. Interventions reported in 19 studies were effective in increasing dairy consumption. Interventions in high-income countries were more effective than those in middle- and low-income countries. Interventions in health centers and supermarkets were more effective than the community and school-level interventions. Interventions in supermarkets and adolescents as target groups were more effective than children, middle-aged people, and the elderly. Also, educational interventions and changing buying/selling pattern were more effective than multiple interventions. Interventions longer than 24 and 48 weeks were more effective than shorter interventions. Conclusion Three policy options including educational interventions, multiple interventions, and changing the purchase pattern are suggested. It seems that applying all of the interventions together can be more effective. Also, long-term and well-designed future studies in different settings are recommended to confirm these results.
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von Philipsborn P, Stratil JM, Burns J, Busert LK, Pfadenhauer LM, Polus S, Holzapfel C, Hauner H, Rehfuess E. Environmental interventions to reduce the consumption of sugar-sweetened beverages and their effects on health. Cochrane Database Syst Rev 2019; 6:CD012292. [PMID: 31194900 PMCID: PMC6564085 DOI: 10.1002/14651858.cd012292.pub2] [Citation(s) in RCA: 93] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Frequent consumption of excess amounts of sugar-sweetened beverages (SSB) is a risk factor for obesity, type 2 diabetes, cardiovascular disease and dental caries. Environmental interventions, i.e. interventions that alter the physical or social environment in which individuals make beverage choices, have been advocated as a means to reduce the consumption of SSB. OBJECTIVES To assess the effects of environmental interventions (excluding taxation) on the consumption of sugar-sweetened beverages and sugar-sweetened milk, diet-related anthropometric measures and health outcomes, and on any reported unintended consequences or adverse outcomes. SEARCH METHODS We searched 11 general, specialist and regional databases from inception to 24 January 2018. We also searched trial registers, reference lists and citations, scanned websites of relevant organisations, and contacted study authors. SELECTION CRITERIA We included studies on interventions implemented at an environmental level, reporting effects on direct or indirect measures of SSB intake, diet-related anthropometric measures and health outcomes, or any reported adverse outcome. We included randomised controlled trials (RCTs), non-randomised controlled trials (NRCTs), controlled before-after (CBA) and interrupted-time-series (ITS) studies, implemented in real-world settings with a combined length of intervention and follow-up of at least 12 weeks and at least 20 individuals in each of the intervention and control groups. We excluded studies in which participants were administered SSB as part of clinical trials, and multicomponent interventions which did not report SSB-specific outcome data. We excluded studies on the taxation of SSB, as these are the subject of a separate Cochrane Review. DATA COLLECTION AND ANALYSIS Two review authors independently screened studies for inclusion, extracted data and assessed the risks of bias of included studies. We classified interventions according to the NOURISHING framework, and synthesised results narratively and conducted meta-analyses for two outcomes relating to two intervention types. We assessed our confidence in the certainty of effect estimates with the GRADE framework as very low, low, moderate or high, and presented 'Summary of findings' tables. MAIN RESULTS We identified 14,488 unique records, and assessed 1030 in full text for eligibility. We found 58 studies meeting our inclusion criteria, including 22 RCTs, 3 NRCTs, 14 CBA studies, and 19 ITS studies, with a total of 1,180,096 participants. The median length of follow-up was 10 months. The studies included children, teenagers and adults, and were implemented in a variety of settings, including schools, retailing and food service establishments. We judged most studies to be at high or unclear risk of bias in at least one domain, and most studies used non-randomised designs. The studies examine a broad range of interventions, and we present results for these separately.Labelling interventions (8 studies): We found moderate-certainty evidence that traffic-light labelling is associated with decreasing sales of SSBs, and low-certainty evidence that nutritional rating score labelling is associated with decreasing sales of SSBs. For menu-board calorie labelling reported effects on SSB sales varied.Nutrition standards in public institutions (16 studies): We found low-certainty evidence that reduced availability of SSBs in schools is associated with decreased SSB consumption. We found very low-certainty evidence that improved availability of drinking water in schools and school fruit programmes are associated with decreased SSB consumption. Reported associations between improved availability of drinking water in schools and student body weight varied.Economic tools (7 studies): We found moderate-certainty evidence that price increases on SSBs are associated with decreasing SSB sales. For price discounts on low-calorie beverages reported effects on SSB sales varied.Whole food supply interventions (3 studies): Reported associations between voluntary industry initiatives to improve the whole food supply and SSB sales varied.Retail and food service interventions (7 studies): We found low-certainty evidence that healthier default beverages in children's menus in chain restaurants are associated with decreasing SSB sales, and moderate-certainty evidence that in-store promotion of healthier beverages in supermarkets is associated with decreasing SSB sales. We found very low-certainty evidence that urban planning restrictions on new fast-food restaurants and restrictions on the number of stores selling SSBs in remote communities are associated with decreasing SSB sales. Reported associations between promotion of healthier beverages in vending machines and SSB intake or sales varied.Intersectoral approaches (8 studies): We found moderate-certainty evidence that government food benefit programmes with restrictions on purchasing SSBs are associated with decreased SSB intake. For unrestricted food benefit programmes reported effects varied. We found moderate-certainty evidence that multicomponent community campaigns focused on SSBs are associated with decreasing SSB sales. Reported associations between trade and investment liberalisation and SSB sales varied.Home-based interventions (7 studies): We found moderate-certainty evidence that improved availability of low-calorie beverages in the home environment is associated with decreased SSB intake, and high-certainty evidence that it is associated with decreased body weight among adolescents with overweight or obesity and a high baseline consumption of SSBs.Adverse outcomes reported by studies, which may occur in some circumstances, included negative effects on revenue, compensatory SSB consumption outside school when the availability of SSBs in schools is reduced, reduced milk intake, stakeholder discontent, and increased total energy content of grocery purchases with price discounts on low-calorie beverages, among others. The certainty of evidence on adverse outcomes was low to very low for most outcomes.We analysed interventions targeting sugar-sweetened milk separately, and found low- to moderate-certainty evidence that emoticon labelling and small prizes for the selection of healthier beverages in elementary school cafeterias are associated with decreased consumption of sugar-sweetened milk. We found low-certainty evidence that improved placement of plain milk in school cafeterias is not associated with decreasing sugar-sweetened milk consumption. AUTHORS' CONCLUSIONS The evidence included in this review indicates that effective, scalable interventions addressing SSB consumption at a population level exist. Implementation should be accompanied by high-quality evaluations using appropriate study designs, with a particular focus on the long-term effects of approaches suitable for large-scale implementation.
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Affiliation(s)
- Peter von Philipsborn
- Ludwig‐Maximilians‐University MunichInstitute for Medical Informatics, Biometry and Epidemiology, Pettenkofer School of Public HealthMarchioninistr. 15MunichBavariaGermany81377
| | - Jan M Stratil
- Ludwig‐Maximilians‐University MunichInstitute for Medical Informatics, Biometry and Epidemiology, Pettenkofer School of Public HealthMarchioninistr. 15MunichBavariaGermany81377
| | - Jacob Burns
- Ludwig‐Maximilians‐University MunichInstitute for Medical Informatics, Biometry and Epidemiology, Pettenkofer School of Public HealthMarchioninistr. 15MunichBavariaGermany81377
| | - Laura K Busert
- University College LondonGreat Ormond Street Institute of Child HealthLondonUK
| | - Lisa M Pfadenhauer
- Ludwig‐Maximilians‐University MunichInstitute for Medical Informatics, Biometry and Epidemiology, Pettenkofer School of Public HealthMarchioninistr. 15MunichBavariaGermany81377
| | - Stephanie Polus
- Ludwig‐Maximilians‐University MunichInstitute for Medical Informatics, Biometry and Epidemiology, Pettenkofer School of Public HealthMarchioninistr. 15MunichBavariaGermany81377
| | - Christina Holzapfel
- School of Medicine, Technical University of MunichInstitute of Nutritional Medicine, Else Kroener‐Fresenius Centre for Nutritional MedicineMunichGermany
| | - Hans Hauner
- School of Medicine, Technical University of MunichInstitute of Nutritional Medicine, Else Kroener‐Fresenius Centre for Nutritional MedicineMunichGermany
| | - Eva Rehfuess
- Ludwig‐Maximilians‐University MunichInstitute for Medical Informatics, Biometry and Epidemiology, Pettenkofer School of Public HealthMarchioninistr. 15MunichBavariaGermany81377
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Calvert S, Dempsey RC, Povey R. Delivering in-school interventions to improve dietary behaviours amongst 11- to 16-year-olds: A systematic review. Obes Rev 2019; 20:543-553. [PMID: 30550629 DOI: 10.1111/obr.12797] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 09/27/2018] [Accepted: 09/27/2018] [Indexed: 11/29/2022]
Abstract
Childhood obesity is a global health concern, which has both short- and long-term health consequences for the individual, and is a potential burden on health care services and the wider economy. The school environment is a setting where changes can be applied to dietary behaviours, as schools have direct and intensive contact with children. This systematic review evaluated school-based interventions designed to improve dietary behaviours among adolescents (11- to 16-year-olds). The aims were to review types of interventions delivered, dietary behaviours targeted, and interventions' effectiveness in improving dietary behaviour and associated intervention components. Twenty-nine school-based interventional studies with this population were identified for review. The data were synthesized by identifying and comparing individual studies' results, intervention components, and characteristics. Interventions appeared more effective when they involved peers, used educational media to deliver health messages, increased availability of healthy foods in school, and incorporated computer-based individualized feedback with normative information on eating behaviours. A limitation of the review was the lack of description in certain reviewed studies and the nonfeasibility of conducting a meta-analysis owing to study heterogeneity. Future interventions with this population could consider including the aforementioned components, gender-specific feedback, and both short- and long-term follow-ups as change may not be apparent immediately and to determine if changes are sustained.
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Affiliation(s)
- Sian Calvert
- The Staffordshire Centre for Psychological Research and Centre for Health Psychology, Staffordshire University, Stoke-on-Trent, UK
| | - Robert C Dempsey
- The Staffordshire Centre for Psychological Research and Centre for Health Psychology, Staffordshire University, Stoke-on-Trent, UK
| | - Rachel Povey
- The Staffordshire Centre for Psychological Research and Centre for Health Psychology, Staffordshire University, Stoke-on-Trent, UK
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Godin KM, Hammond D, Chaurasia A, Leatherdale ST. Examining changes in school vending machine beverage availability and sugar-sweetened beverage intake among Canadian adolescents participating in the COMPASS study: a longitudinal assessment of provincial school nutrition policy compliance and effectiveness. Int J Behav Nutr Phys Act 2018; 15:121. [PMID: 30482211 PMCID: PMC6257956 DOI: 10.1186/s12966-018-0754-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 11/19/2018] [Indexed: 02/06/2023] Open
Abstract
Background School nutrition policies can encourage restrictions in sugar-sweetened beverage (SSB) availability in school food outlets in order to discourage students’ SSB intake. The main objective was to examine how beverage availability in school vending machines changes over three school years across schools in distinct school nutrition policy contexts. Secondary objectives were to examine how students’ weekday SSB intake varies with time and identify longitudinal associations between beverage availability and SSB intake. Methods This longitudinal study used data from the COMPASS study (2013/14–2015/16), representing 7679 students from 78 Canadian secondary schools and three provincial school nutrition policy contexts (Alberta – voluntary guidelines, Ontario public – mandatory guidelines, and Ontario private schools – no guidelines). We assessed availability of 10 beverage categories in schools’ vending machines via the COMPASS School Environment Application and participants’ intake of three SSB varieties (soft drinks, sweetened coffees/teas, and energy drinks) via a questionnaire. Hierarchical regression models were used to examine whether: i) progression of time and policy group were associated with beverage availability; and, ii) beverage availability was associated with students’ SSB intake. Results Ontario public schools were significantly less likely than the other policy groups to serve SSBs in their vending machines, with the exception of flavoured milks. Vending machine beverage availability was consistent over time. Participants’ overall SSB intake remained relatively stable; reductions in soft drink intake were partially offset by increased sweetened coffee/tea consumption. Relative to Ontario public schools, attending school in Alberta was associated with more frequent energy drink intake and overall SSB intake whereas attending an Ontario private school was associated with less frequent soft drink intake, with no differences in overall SSB intake. Few beverage availability variables were significantly associated with participants’ SSB intake. Conclusions Mandatory provincial school nutrition policies were predictive of more limited SSB availability in school vending machines. SSB intake was significantly lower in Ontario public and private schools, although we did not detect a direct association between SSB consumption and availability. The findings provide support for mandatory school nutrition policies, as well as the need for comprehensive school- and broader population-level efforts to reduce SSB intake. Electronic supplementary material The online version of this article (10.1186/s12966-018-0754-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Katelyn M Godin
- School of Public Health and Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada.
| | - David Hammond
- School of Public Health and Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada
| | - Ashok Chaurasia
- School of Public Health and Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada
| | - Scott T Leatherdale
- School of Public Health and Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada
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Tackling the Consumption of High Sugar Products among Children and Adolescents in the Pacific Islands: Implications for Future Research. Healthcare (Basel) 2018; 6:healthcare6030081. [PMID: 30002327 PMCID: PMC6163880 DOI: 10.3390/healthcare6030081] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2018] [Revised: 07/04/2018] [Accepted: 07/11/2018] [Indexed: 12/17/2022] Open
Abstract
The Pacific Islands are experiencing an obesity epidemic with a rate of overweight and obesity as high as 80% among adults in some Pacific Island nations. Children and adolescents in the region are also affected by overweight and obesity, which is alarming due to the increased likelihood of remaining overweight as an adult. Research supports an association between poor diet and an increased risk of obesity and development of non-communicable diseases (NCDs). Excess consumption of free sugars is associated with poorer overall diet quality and increased risk of weight gain, chronic inflammation and dental caries. Traditional diets in the Pacific Islands are being supplemented with processed, high-sugar foods and beverages; thus, there is a clear need for effective interventions promoting positive dietary behaviors in the region. School and community based interventions offer an opportunity to promote positive behavior change among children and adolescents. This review aims to evaluate interventions targeting the consumption of high-sugar products in this population in the Pacific Islands.
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Examining associations between school food environment characteristics and sugar-sweetened beverage consumption among Canadian secondary-school students in the COMPASS study. Public Health Nutr 2018; 22:1928-1940. [DOI: 10.1017/s1368980018001246] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractObjectiveTo examine associations between Canadian adolescents’ sugar-sweetened beverage (SSB) consumption and several school food environment characteristics, and to investigate differences in these characteristics between schools in provinces with voluntary (Alberta) v. mandatory (Ontario) provincial school nutrition policies.DesignWe used a questionnaire to assess the number of weekdays participants consumed three SSB categories (soft drinks, sweetened coffees/teas, energy drinks) and various sociodemographic and behavioural characteristics. We examined the in-school water fountain accessibility, vending machines’ contents and presence of various food outlets within schools’ 1 km buffer. We developed hierarchical Poisson regression models to identify associations between student- and school-level characteristics and students’ SSB outcomes.SettingAlberta and Ontario, Canada.SubjectsAdolescents (n 41 829) from eighty-nine secondary schools.ResultsCompared with their Ontarian counterparts, Albertan participants had a significantly higher rate of SSB intake across all drink categories and SSB availability was significantly greater in Albertan schools’ vending machines. Availability of sweetened coffees/teas in school vending machines and access to restaurants within the school’s 1 km buffer were associated with increased SSB intake in three of the final models. Overall, the school food environment-level characteristics examined had a modest to negligible impact on student days of SSB intake.ConclusionsWe identified that the school food environment characteristics examined here had little impact on adolescents’ days of SSB consumption. While schools should adopt or maintain a comprehensive policy approach to discourage students’ SSB intake, population-level interventions focusing on other contexts (e.g. home and community) are needed to complement existing school-based interventions.
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Yoshida Y, Simoes EJ. Sugar-Sweetened Beverage, Obesity, and Type 2 Diabetes in Children and Adolescents: Policies, Taxation, and Programs. Curr Diab Rep 2018; 18:31. [PMID: 29671076 PMCID: PMC6025796 DOI: 10.1007/s11892-018-1004-6] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
PURPOSE OF REVIEW Obesity has grown at an alarming rate in children and adolescents. Concurrently, consumption on sugar-sweetened beverages (SSBs) also rose significantly. This review provides an overview of obesity and type 2 diabetes mellitus (T2DM) related to SSBs and current policies restricting SSBs in schools, school-based interventions, and taxation on reducing SSB intake and obesity. We also discuss challenges of and future steps for these initiatives. RECENT FINDINGS Clinical and epidemiological studies suggest a strong association between SSB intake and obesity and T2DM. School food policies have been initiated at federal, state, and local levels. School-based interventions have shown positive effects on SSB intake and obesity reduction. Taxation on SSBs is promising in combating obesity and in generating revenue. Challenges towards compliance and implementation of the policies and programs exist. The relationship between SSB and obesity and T2DM is a complex problem which requires comprehensive solutions. Continued efforts in restricting SSBs in schools are needed. Intervention programs should be tailored to age, gender, language, and culture and involve participation from families and local communities. Taxation can reduce SSB consumption by direct economic incentive, earmarking revenues to support healthy foods, and sending negative message. However, a higher tax rate may be necessary to have a measurable effect on weight.
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Affiliation(s)
- Yilin Yoshida
- Department of Health Management and Informatics, School of Medicine, University of Missouri-Columbia, CE707 CS&E Bldg., One Hospital Drive, Columbia, MO 65212, USA
- Missouri Cancer Registry and Research Center, University of Missouri-Columbia, Columbia, MO, USA
| | - Eduardo J. Simoes
- Department of Health Management and Informatics, School of Medicine, University of Missouri-Columbia, CE707 CS&E Bldg., One Hospital Drive, Columbia, MO 65212, USA
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Vangeepuram N, Williams N, Constable J, Waldman L, Lopez-Belin P, Phelps-Waldropt L, Horowitz CR. TEEN HEED: Design of a clinical-community youth diabetes prevention intervention. Contemp Clin Trials 2017; 57:23-28. [PMID: 28344183 DOI: 10.1016/j.cct.2017.03.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 03/01/2017] [Accepted: 03/13/2017] [Indexed: 01/19/2023]
Affiliation(s)
- Nita Vangeepuram
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, Box 1202A, New York, NY 10029, United States; Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, Box 1077, New York, NY 10029, United States; TEEN HEED Community Action Board, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, 1 Gustave Levy Place, Box 1077, New York, NY 10029, United States.
| | - Narissa Williams
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, Box 1077, New York, NY 10029, United States; Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, Box 1077, New York, NY 10029, United States; TEEN HEED Community Action Board, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, 1 Gustave Levy Place, Box 1077, New York, NY 10029, United States
| | - Jeremy Constable
- TEEN HEED Community Action Board, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, 1 Gustave Levy Place, Box 1077, New York, NY 10029, United States
| | - Lindsey Waldman
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, Box 1202A, New York, NY 10029, United States; TEEN HEED Community Action Board, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, 1 Gustave Levy Place, Box 1077, New York, NY 10029, United States
| | - Patricia Lopez-Belin
- TEEN HEED Community Action Board, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, 1 Gustave Levy Place, Box 1077, New York, NY 10029, United States
| | - LaTanya Phelps-Waldropt
- TEEN HEED Community Action Board, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, 1 Gustave Levy Place, Box 1077, New York, NY 10029, United States
| | - Carol R Horowitz
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, Box 1077, New York, NY 10029, United States
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Efficacy of school-based interventions aimed at decreasing sugar-sweetened beverage consumption among adolescents: a systematic review. Public Health Nutr 2017; 20:2416-2431. [DOI: 10.1017/s1368980017000076] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
AbstractObjectiveTo verify the efficacy of school-based interventions aimed at reducing sugar-sweetened beverage (SSB) consumption among adolescents in order to develop or improve public health interventions.DesignSystematic review of interventions targeting adolescents and/or the school environment.SettingThe following databases were investigated: MEDLINE/PubMed, PsycINFO, CINAHL and EMBASE. Proquest Dissertations and Theses was also investigated for unpublished trials.SubjectsAdolescents were defined as individuals between the ages of 12 and 17 years.ResultsA total of thirty-six studies detailing thirty-six different interventions tested among independent samples (n152 001) were included in the review. Twenty interventions were classified as educational/behavioural and ten were classified as legislative/environmental interventions. Only six interventions targeted both individuals and their environment. Over 70 % of all interventions, regardless of whether they targeted individuals, their environment or both, were effective in decreasing SSB consumption. Legislative/environmental studies had the highest success rate (90·0 %). Educational/behavioural interventions only and interventions that combined educational/behavioural and legislative/environmental approaches were almost equally effective in reducing SSB consumption with success rates of 65·0 and 66·7 %, respectively. Among the interventions that had an educational/behavioural component, 61·5 % were theory-based. The behaviour change techniques most frequently used in interventions were providing information about the health consequences of performing the behaviour (72·2 %), restructuring the physical environment (47·2 %), behavioural goal setting (36·1 %), self-monitoring of behaviour (33·3 %), threat to health (30·6 %) and providing general social support (30·6 %).ConclusionsSchool-based interventions show promising results to reduce SSB consumption among adolescents. A number of recommendations are made to improve future studies.
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Hopkins LC, Fristad M, Goodway JD, Eneli I, Holloman C, Kennel JA, Melnyk B, Gunther C. Camp NERF: methods of a theory-based nutrition education recreation and fitness program aimed at preventing unhealthy weight gain in underserved elementary children during summer months. BMC Public Health 2016; 16:1122. [PMID: 27784290 PMCID: PMC5080748 DOI: 10.1186/s12889-016-3765-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 10/12/2016] [Indexed: 01/12/2023] Open
Abstract
Background The number of obese children in the US remains high, which is problematic due to the mental, physical, and academic effects of obesity on child health. Data indicate that school-age children, particularly underserved children, experience unhealthy gains in BMI at a rate nearly twice as fast during the summer months. Few efforts have been directed at implementing evidence-based programming to prevent excess weight gain during the summer recess. Methods Camp NERF is an 8-week, multi-component (nutrition, physical activity, and mental health), theory-based program for underserved school-age children in grades Kindergarten - 5th coupled with the USDA Summer Food Service Program. Twelve eligible elementary school sites will be randomized to one of the three programming groups: 1) Active Control (non-nutrition, physical activity, or mental health); 2) Standard Care (nutrition and physical activity); or 3) Enhanced Care (nutrition, physical activity, and mental health) programming. Anthropometric, behavioral, and psychosocial data will be collected from child-caregiver dyads pre- and post-intervention. Site-specific characteristics and process evaluation measures will also be collected. Discussion This is the first, evidence-based intervention to address the issue of weight gain during the summer months among underserved, school-aged children. Results from this study will provide researchers, practitioners, and public health professionals with insight on evidence-based programming to aid in childhood obesity prevention during this particular window of risk. Trial Registration NCT02908230/09-19-2016
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Affiliation(s)
- Laura C Hopkins
- Department of Human Sciences, Human Nutrition Program, The Ohio State University, 262B Campbell Hall, 1787 Neil Avenue, Columbus, OH, 43210, USA
| | - Mary Fristad
- Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, 1670 Upham Drive Suite 460G, Columbus, OH, 43210-1250, USA
| | - Jacqueline D Goodway
- Department of Human Sciences, Kinesiology Program, College of Education & Human Ecology, The Ohio State University, A244 305 Annie & John Glenn Ave, Columbus, OH, 43210, USA
| | - Ihuoma Eneli
- Nationwide Children's Hospital; The Ohio State University, 700 Children's Drive, Columbus, OH, 43205, USA
| | - Chris Holloman
- Department of Statistics, The Ohio State University, 404 Cockins Hall, 1958 Neil Ave, Columbus, OH, 43210, USA
| | - Julie A Kennel
- Department of Human Sciences, Human, The Ohio State University, 315 Campbell Hall, 1787 Neil Avenue, Columbus, OH, 43210, USA
| | - Bernadette Melnyk
- College of Nursing, The Ohio State University, 1585 Neil Avenue, Rm. 145, Columbus, OH, 43210, USA
| | - Carolyn Gunther
- Department of Human Sciences, Human Nutrition Program, The Ohio State University, 313 Campbell Hall, 1787 Neil Avenue, Columbus, OH, 43210, USA.
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Lane H, Porter K, Estabrooks P, Zoellner J. A Systematic Review to Assess Sugar-Sweetened Beverage Interventions for Children and Adolescents across the Socioecological Model. J Acad Nutr Diet 2016; 116:1295-1307.e6. [PMID: 27262383 PMCID: PMC4967019 DOI: 10.1016/j.jand.2016.04.015] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Accepted: 04/21/2016] [Indexed: 01/06/2023]
Abstract
Sugar-sweetened beverage (SSB) consumption among children and adolescents is a determinant of childhood obesity. Many programs to reduce consumption across the socioecological model report significant positive results; however, the generalizability of the results, including whether reporting differences exist among socioecological strategy levels, is unknown. This systematic review aimed to examine the extent to which studies reported internal and external validity indicators defined by the reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) model and assess reporting differences by socioecological level: Intrapersonal/interpersonal (Level 1), environmental/policy (Level 2), and multilevel (Combined Level). A systematic literature review was conducted in six major databases (PubMed, Web of Science, Cinahl, CAB Abstracts, Education Research Information Center, and Arcola) to identify studies from 2004-2015 meeting inclusion criteria (children aged 3 to 12 years, adolescents aged 13 to 17 years, and young adults aged 18 years, experimental or quasiexperimental, and substantial SSB component). Interventions were categorized by socioecological level, and data were extracted using a validated RE-AIM protocol. One-way analysis of variance assessed differences between levels. There were 55 eligible studies accepted, including 21 Level 1, 18 Level 2, and 16 Combined Level studies. Thirty-six studies (65%) were conducted in the United States, 19 studies (35%) were conducted internationally, and 39 studies (71%) were implemented in schools. Across levels, reporting averages were low for all RE-AIM dimensions (reach=29%, efficacy or effectiveness=45%, adoption=26%, implementation=27%, and maintenance=14%). Level 2 studies had significantly lower reporting on reach and effectiveness (10% and 26%, respectively) compared with Level 1 (44% and 57%, respectively) or Combined Level studies (31% and 52%, respectively) (P<0.001). Adoption, implementation, and maintenance reporting did not vary among levels. Interventions to reduce SSB consumption in children and adolescents across the socioecological spectrum do not provide the necessary information for dissemination and implementation in community nutrition settings. Future interventions should address both internal and external validity to maximize population influence.
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Affiliation(s)
- Hannah Lane
- Virginia Tech, Department of Human Nutrition, Foods and Exercise, 1981 Kraft Drive, Blacksburg, VA 24061, 540-797-3465,
| | - Kathleen Porter
- Virginia Tech, Department of Human Nutrition, Foods and Exercise, 1981 Kraft Drive, Blacksburg, VA 24061, 540-231-1267,
| | - Paul Estabrooks
- University of Nebraska Medical Center, Department of Health Promotion, Social & Behavioral Health, Omaha, NE 68198, 402-559-4325,
| | - Jamie Zoellner
- Virginia Tech, Department of Human Nutrition, Foods and Exercise, 1981 Kraft Drive, Blacksburg, VA 24061, 540-231-3670,
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Racey M, O'Brien C, Douglas S, Marquez O, Hendrie G, Newton G. Systematic Review of School-Based Interventions to Modify Dietary Behavior: Does Intervention Intensity Impact Effectiveness? THE JOURNAL OF SCHOOL HEALTH 2016; 86:452-63. [PMID: 27122145 DOI: 10.1111/josh.12396] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2015] [Revised: 11/03/2015] [Accepted: 01/09/2016] [Indexed: 05/21/2023]
Abstract
BACKGROUND Owing to the associations between diet and health, it is important that effective health promotion strategies establish healthful eating behaviors from an early age. We reviewed the intensity of school-based interventions aimed to modify dietary behavior in preadolescent and adolescents and related intervention characteristics to effectiveness. METHODS Our systematic literature search of 8 databases sought to identify interventions measuring dietary intake in school settings to students aged 9 to 18. We evaluated these studies for effectiveness, intensity, intervention category, and follow-up measures. RESULTS Of the 105 interventions 81 were found to be effective immediately postintervention, irrespective of intensity. Studies that were 6 weeks to 5 months in duration, targeted students' environment or group (alone or in combination), and reached students only in schools were more effective. Only one-fifth of interventions conducted a follow-up measure, and a majority showed a loss of effectiveness from postintervention to follow-up. CONCLUSIONS We identified characteristics of effective interventions. These findings may inform the development of future interventions targeting dietary behavior in preadolescents and adolescents in the school-based setting.
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Affiliation(s)
- Megan Racey
- University of Guelph, Department of Human Health & Nutritional Science, Guelph, ON N1G 2W1, Canada.
| | - Charlene O'Brien
- University of Guelph, Department of Human Health & Nutritional Science, Guelph, ON N1G 2W1, Canada.
| | - Sabrina Douglas
- University of Guelph, Department of Human Health & Nutritional Science, Guelph, ON N1G 2W1, Canada.
| | - Olivia Marquez
- University of Guelph, Department of Human Health & Nutritional Science, Guelph, ON N1G 2W1, Canada.
| | - Gilly Hendrie
- CSIRO Food and Nutritional Sciences, PO BOX 10041, Adelaide 5000, South Australia.
| | - Genevieve Newton
- University of Guelph, Department of Human Health & Nutritional Science, Guelph, ON N1G 2W1, Canada.
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Yip C, Gates M, Gates A, Hanning RM. Peer-led nutrition education programs for school-aged youth: a systematic review of the literature. HEALTH EDUCATION RESEARCH 2016; 31:82-97. [PMID: 26661724 PMCID: PMC4883032 DOI: 10.1093/her/cyv063] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Accepted: 11/06/2015] [Indexed: 06/05/2023]
Abstract
To date, the impacts of school-based, peer-led nutrition education initiatives have not been summarized or assessed collectively. This review presents the current evidence, identifies knowledge gaps, and provides recommendations for future research. PubMed, Scopus, ERIC and Google Scholar were searched for refereed Canadian and American primary studies published between January 2000 and November 2013, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Seventeen articles (11 programs) from Canada (24%) and the United States (76%) were identified. The results were summarized in terms of the study population, program design and main outcomes. Common outcome measures included healthy eating knowledge (n = 5), self-efficacy or attitudes towards healthy eating (n = 13), dietary measures (n = 9) and body mass index (n = 4), all of which tended to improve as a result of the programs. More research is needed to ascertain the effect of improvements in knowledge, self-efficacy and attitudes towards healthy eating on food behaviors. When evaluated, programs were generally well received, while the long-term maintenance of positive impacts was a challenge. Studies of sustainability and feasibility to promote long-term impact are a logical next step.
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Affiliation(s)
- Calvin Yip
- Department of Epidemiology and Biostatistics, Western University, 1151 Richmond Street, London, Ontario, N6A 3K1, Canada and
| | - Michelle Gates
- School of Public Health and Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, Ontario, N2L 3G1, Canada
| | - Allison Gates
- School of Public Health and Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, Ontario, N2L 3G1, Canada
| | - Rhona M Hanning
- School of Public Health and Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, Ontario, N2L 3G1, Canada
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Marquez O, Racey M, Preyde M, Hendrie GA, Newton G. Interventions to Increase Dairy Consumption in Adolescents. ACTA ACUST UNITED AC 2015. [DOI: 10.1177/1941406415600752] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective. Effective interventions are needed to address the reported inadequacies of dairy product and calcium (Ca) intakes among adolescents. The present review investigated interventions aimed at increasing adolescent dairy and/or Ca intakes and determined the characteristics associated with successful interventions. Design. A PRISMA systematic review search identified 17 interventions, described in 16 publications, between 1993 and 2015 (February). Studies were evaluated for population, delivery, dietary targets and outcomes measures, measure of intervention intensity, use of behavior change techniques, intervention effectiveness, and effect size and quality. Setting. Interventions targeting an increase in dairy food or Ca intake, either exclusively or in combination with other dietary modifications. Subjects. Adolescents, aged 12 to 18 years. Results. Twelve of the 17 interventions were found to be effective. Effective interventions tended to be higher in overall intensity (mean intensity: negative interventions 12.2, positive interventions 14.25), with the most notable difference in the duration category, such that effective interventions tended to be longer in duration. The number of behavior change techniques applied did not differentiate effective and ineffective interventions, but prompting the review of behavioral goals and including interviews or brief counseling appeared to be important for effective interventions. Effective interventions tended to have higher methodological quality, while the majority of ineffective interventions were qualitatively assessed as weak. Conclusions. The current review has identified characteristics of effective interventions that offer insight into promising strategies likely to increase dairy consumption and Ca intakes in countries where adolescent intake is insufficient. These findings may have important implications for future intervention design.
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Affiliation(s)
- Olivia Marquez
- Department of Human Health & Nutritional Science (OM, MR, GN), University of Guelph, Guelph, Ontario, Canada
- Department of Family Relations & Applied Nutrition (MP), University of Guelph, Guelph, Ontario, Canada
- CSIRO Food and Health Flagship, Adelaide, Australia (GAH)
| | - Megan Racey
- Department of Human Health & Nutritional Science (OM, MR, GN), University of Guelph, Guelph, Ontario, Canada
- Department of Family Relations & Applied Nutrition (MP), University of Guelph, Guelph, Ontario, Canada
- CSIRO Food and Health Flagship, Adelaide, Australia (GAH)
| | - Michèle Preyde
- Department of Human Health & Nutritional Science (OM, MR, GN), University of Guelph, Guelph, Ontario, Canada
- Department of Family Relations & Applied Nutrition (MP), University of Guelph, Guelph, Ontario, Canada
- CSIRO Food and Health Flagship, Adelaide, Australia (GAH)
| | - Gilly A. Hendrie
- Department of Human Health & Nutritional Science (OM, MR, GN), University of Guelph, Guelph, Ontario, Canada
- Department of Family Relations & Applied Nutrition (MP), University of Guelph, Guelph, Ontario, Canada
- CSIRO Food and Health Flagship, Adelaide, Australia (GAH)
| | - Genevieve Newton
- Department of Human Health & Nutritional Science (OM, MR, GN), University of Guelph, Guelph, Ontario, Canada
- Department of Family Relations & Applied Nutrition (MP), University of Guelph, Guelph, Ontario, Canada
- CSIRO Food and Health Flagship, Adelaide, Australia (GAH)
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Tipton JA. Reducing Sugar-Sweetened Beverage Intake Among Students: School-Based Programs and Policies That Work. NASN Sch Nurse 2015; 31:102-10. [PMID: 25816431 DOI: 10.1177/1942602x15578456] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The amount of sugar-sweetened beverages (SSBs) consumed by U.S. youth has nearly doubled since the 1970s. The majority of children between 2 and 19 years drink SSBs on any given day. Many serious health problems such as childhood overweight and obesity, type 2 diabetes, kidney disease, and cardiovascular problems have been linked to SSBs. This article provides an overview of school-based interventions and policies that have successfully contributed to a reduction in sugar-sweetened intake among children. School nurses and nurses in other community-based settings are well positioned to promote intake of more healthful beverages among children using strategies recommended in this article.
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Affiliation(s)
- Julia A Tipton
- Instructor, Louisiana State University Health Sciences Center, New Orleans, LA
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24
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Henry C, Whiting SJ, Phillips T, Finch SL, Zello GA, Vatanparast H. Impact of the removal of chocolate milk from school milk programs for children in Saskatoon, Canada. Appl Physiol Nutr Metab 2015; 40:245-50. [DOI: 10.1139/apnm-2014-0242] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Studies in the United States report inclusion of flavoured milk in the diets of children and youth improves nutrient intakes. No research has investigated the contribution of flavoured milk to overall milk intake or the milk preferences of Canadian children. The objective of the study was to measure milk consumption (plain milk and flavoured milk) by children in an elementary school environment and investigate factors contributing to milk choice. A mixed-method research design was applied across 6 schools for 12 weeks. Milk waste was measured in grades 1–8 for 12 weeks. Weeks 1–4 (phase 1) and 9–12 (phase 3) provided both plain milk and flavoured milk as chocolate milk while weeks 5–8 (phase 2) provided plain milk only. Beverage Frequency Questionnaires were used in each phase (in grades 5–8 only) to assess usual beverage consumption. Statistical nutrient modelling was conducted to determine the effects of removing chocolate milk during phase 2 as a milk choice. Later, focus groups were conducted with students in grades 5–8 to determine what influences them to choose/not choose to drink milk. Total milk intake decreased by 12.3% when chocolate milk was removed from the schools (26.6% ± 5.2% to 14.31% ± 1.6%, p < 0.001). Milk choice was influenced by environmental factors as well as taste, cost, convenience, and variety. Total milk intake was associated with location (p = 0.035) and cost (p < 0.001), with rural students and/or those students receiving free milk drinking the greatest amount of milk. Nutrient modelling revealed chocolate milk is more cost-efficient and convenient at providing nutrients than alternative food/drink combinations.
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Affiliation(s)
- Carol Henry
- College of Pharmacy and Nutrition, University of Saskatchewan, 110 Science Place, Thorvaldson Building, Saskatoon SK S7N 5C9, Canada
| | - Susan J. Whiting
- College of Pharmacy and Nutrition, University of Saskatchewan, 110 Science Place, Thorvaldson Building, Saskatoon SK S7N 5C9, Canada
| | - Theodosia Phillips
- College of Pharmacy and Nutrition, University of Saskatchewan, 110 Science Place, Thorvaldson Building, Saskatoon SK S7N 5C9, Canada
| | - Sarah L. Finch
- College of Pharmacy and Nutrition, University of Saskatchewan, 110 Science Place, Thorvaldson Building, Saskatoon SK S7N 5C9, Canada
| | - Gordon A. Zello
- College of Pharmacy and Nutrition, University of Saskatchewan, 110 Science Place, Thorvaldson Building, Saskatoon SK S7N 5C9, Canada
| | - Hassan Vatanparast
- College of Pharmacy and Nutrition, University of Saskatchewan, 110 Science Place, Thorvaldson Building, Saskatoon SK S7N 5C9, Canada
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Kebaili R, Harrabi I, Maatoug J, Ghammam R, Slim S, Ghannem H. School-based intervention to promote healthy nutrition in Sousse, Tunisia. Int J Adolesc Med Health 2014; 26:253-8. [PMID: 24096439 DOI: 10.1515/ijamh-2013-0306] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Accepted: 07/04/2013] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Obesity among children is a major risk factor for chronic diseases. School interventions programs can represent a mean to implement healthy nutrition attitudes at early ages. Our objective was to evaluate the effects of a school intervention program to promote healthy nutrition among adolescents, in terms of knowledge, behaviors and intention. METHODS Quasi experimental study among urban students in Sousse, Tunisia with 2 groups, intervention and control. The intervention group had an interactive program integrated with school courses that promoted healthy nutrition habits. Both groups had a pre post evaluation. RESULTS 2200 students aged from 12 to 16 participated to the pre post evaluation. In the intervention group, there were significant changes form pre to post test in knowledge, intentions, and behaviors. In the control group, almost no significant changes were observed. CONCLUSION School intervention programs can represent an interesting approach to promote healthy nutrition habits among adolescents.
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Avery A, Bostock L, McCullough F. A systematic review investigating interventions that can help reduce consumption of sugar-sweetened beverages in children leading to changes in body fatness. J Hum Nutr Diet 2014; 28 Suppl 1:52-64. [PMID: 25233843 PMCID: PMC4309175 DOI: 10.1111/jhn.12267] [Citation(s) in RCA: 97] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Both the prevalence of childhood obesity and the consumption of sugar-sweetened beverages (SSBs) have increased globally. The present review describes interventions that reduce the consumption of SSBs in children and determines whether this leads to subsequent changes in body fatness. METHODS Three databases were searched from 2000 to August 2013. Only intervention control trials, ≥6 months in duration, which aimed to reduce the consumption of SSBs in >100 children aged 2-18 years, and reporting changes in body fatness, were included. The quality of selected papers was assessed. RESULTS Eight studies met inclusion criteria. Six interventions achieved significant (P < 0.05) reductions in SSB intake, although this was not always sustained. In the two interventions providing replacement drinks, significant differences in body mass index (12- or 18-month follow-up) were reported (P = 0.001 and 0.045). The risk of being overweight/obesity was reduced (P < 0.05) in three of the five education programmes but in one programme only for girls who were overweight at baseline and in one programme only for pupils perceived to be at greater risk at baseline. In the one study that included both provision of water and education, the risk of being overweight was reduced by 31% (P = 0.04) in the intervention group. CONCLUSIONS The evidence suggests that school-based education programmes focusing on reducing SSB consumption, but including follow-up modules, offer opportunities for implementing effective, sustainable interventions. Peer support and changing the school environment (e.g. providing water or replacement drinks) to support educational programmes could improve their effectiveness. Home delivery of more suitable drinks has a big impact on reducing SSB consumption, with associated reductions in body weight.
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Affiliation(s)
- A Avery
- Division of Nutritional Sciences, University of Nottingham, Leics, UK
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Levy DT, Friend KB. Simulation modeling of policies directed at youth sugar-sweetened beverage consumption. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2013; 51:299-313. [PMID: 22810953 DOI: 10.1007/s10464-012-9535-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Childhood obesity is a significant public health problem requiring innovative solutions. While recent reviews indicate that some policies show promise, there is a lack of information regarding which policies, and policy combinations, work best. Low-nutrition, energy-dense foods and beverages such as sugar-sweetened beverages (SSBs) have been identified as a major contributor to the problem. The purpose of this paper is to use simulation modeling to show how changes in three categories of SSB policies-school nutrition, school-based education, and taxes-impact SSB and other food consumption. The model shows that policies directed at SSBs, particularly tax hikes, could lead to substantial reductions in the number of calories consumed by youth. The estimates, however, are subject to a high degree of uncertainty. Estimates from school-based nutrition and school-based education policies, while also helping to reduce caloric intake, generally show smaller effects than tax policies and considerable variation around parameter estimates for individual and combined policies. We conclude with a discussion of the limits of the model, and suggest where additional information is needed. Limitations notwithstanding, simulation modeling is a promising methodology that can help advance our understanding of policy effects, thereby helping policymakers to better formulate effective policies to reduce obesity prevalence and the associated social harms.
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Affiliation(s)
- David T Levy
- Cancer Control, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA.
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Rhee H, McQuillan BE, Belyea MJ. Evaluation of a peer-led asthma self-management program and benefits of the program for adolescent peer leaders. Respir Care 2013; 57:2082-9. [PMID: 22710616 DOI: 10.4187/respcare.01488] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Asthma is the leading chronic condition in adolescents. Nonetheless, research efforts to address adolescent asthma morbidity by applying a developmentally appropriate self-management intervention have been limited. Recently a peer-led asthma self-management program has been developed and implemented for adolescents. The purpose of the study was to assess the acceptability of a peer-led asthma program for adolescents based on participant feedback and to examine the program's impact on asthma outcomes in peer leaders. METHODS Adolescents with persistent asthma (n = 91, 13-17 years) participated in a camp-based asthma program led by peer leaders (the intervention group) or healthcare professionals (the control group), and completed a set of program evaluation forms. Peer leaders (n = 14, 16-20 years) completed study questionnaires measuring asthma knowledge, self-efficacy, asthma control, and quality of life at baseline, immediately after camp, and 3, 6, and 9 months post-camp. RESULTS The peer-led group reported more positive experience with the program than the adult-led group (P = .01, Cohen's d = 0.53), particularly in its usefulness in dealing with asthma. Peer leaders were rated by participants highly on knowledge (98%), attitudes (93-96%), personal skills (91%), and perceived similarities (80-86%). Significant improvements were found in peer leaders' knowledge (P < .001, η(2) = 0.87), self-efficacy (P < .001, η(2) = 0.74), asthma control (P = .01, η(2) = 0.66), and quality of life in emotional functioning (P = .002, η(2) = 0.82) and activity (P = .003, η(2) = 0.62). CONCLUSIONS A peer-led asthma self-management program was successfully implemented and well received by adolescent learners. Asthma outcomes in peer leaders appear to have improved as a result of the program, although caution should be exercised in determining clinical meaningfulness, given the modest changes in mean scores. ClinicalTrials.gov registration NCT01161225.
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Affiliation(s)
- Hyekyun Rhee
- School of Nursing, University of Rochester, Rochester, NY, USA.
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Ganann R, Fitzpatrick-Lewis D, Ciliska D, Peirson L. Community-based interventions for enhancing access to or consumption of fruit and vegetables among five to 18-year olds: a scoping review. BMC Public Health 2012; 12:711. [PMID: 22931474 PMCID: PMC3505745 DOI: 10.1186/1471-2458-12-711] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2011] [Accepted: 08/23/2012] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Low fruit and vegetable ( FV) consumption is a key risk factor for morbidity and mortality. Consumption of FV is limited by a lack of access to FV. Enhanced understanding of interventions and their impact on both access to and consumption of FV can provide guidance to public health decision-makers. The purpose of this scoping review is to identify and map literature that has evaluated effects of community-based interventions designed to increase FV access or consumption among five to 18-year olds. METHODS The search included 21 electronic bibliographic databases, grey literature, targeted organization websites, and 15 key journals for relevant studies published up to May 2011. Retrieved citations were screened in duplicate for relevance. Data extracted from included studies covered: year, country, study design, target audience, intervention setting, intervention strategies, interventionists, and reported outcomes. RESULTS The search located 19,607 unique citations. Full text relevance screening was conducted on 1,908 studies. The final 289 unique studies included 30 knowledge syntheses, 27 randomized controlled trials, 55 quasi-experimental studies, 113 cluster controlled studies, 60 before-after studies, one mixed method study, and three controlled time series studies. Of these studies, 46 included access outcomes and 278 included consumption outcomes. In terms of target population, 110 studies focused on five to seven year olds, 175 targeted eight to 10 year olds, 192 targeted 11 to 14 year olds, 73 targeted 15 to 18 year olds, 55 targeted parents, and 30 targeted teachers, other service providers, or the general public. The most common intervention locations included schools, communities or community centres, and homes. Most studies implemented multi-faceted intervention strategies to increase FV access or consumption. CONCLUSIONS While consumption measures were commonly reported, this review identified a small yet important subset of literature examining access to FV. This is a critically important issue since consumption is contingent upon access. Future research should examine the impact of interventions on direct outcome measures of FV access and a focused systematic review that examines these interventions is also needed. In addition, research on interventions in low- and middle-income countries is warranted based on a limited existing knowledge base.
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Affiliation(s)
- Rebecca Ganann
- Effective Public Health Practice Project, McMaster University, Hamilton, ON, Canada
| | | | - Donna Ciliska
- Effective Public Health Practice Project, McMaster University, Hamilton, ON, Canada
| | - Leslea Peirson
- Effective Public Health Practice Project, McMaster University, Hamilton, ON, Canada
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Zoellner J, Estabrooks P, Davy B, Chen Y, You W. Exploring the theory of planned behavior to explain sugar-sweetened beverage consumption. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2012; 44:172-7. [PMID: 22154130 PMCID: PMC3290682 DOI: 10.1016/j.jneb.2011.06.010] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2010] [Revised: 05/27/2011] [Accepted: 06/24/2011] [Indexed: 05/14/2023]
Abstract
OBJECTIVE To describe sugar-sweetened beverage (SSB) consumption and to establish psychometric properties and utility of a Theory of Planned Behavior (TPB) instrument for SSB consumption. METHODS This cross-sectional survey included 119 southwest Virginia participants. Most of the respondents were female (66%), white (89%), and had at least a high school education (79%), and their average age was 41.4 ± 13.5 years. A validated beverage questionnaire was used to measure SSB. Eleven TPB constructs were assessed with a 56-item instrument. Analyses included descriptive statistics, 1-way ANOVA, Cronbach α, and multiple regression. RESULTS Sugar-sweetened beverage intake averaged 457 ± 430 kcal/d. The TPB model provided a moderate explanation of SSB intake (R(2) = 0.38; F = 13.10, P < .01). Behavioral intentions had the strongest relationships with SSB consumption, followed by attitudes, perceived behavioral control, and subjective norms. The 6 belief constructs did not predict significant variance in the models. CONCLUSIONS AND IMPLICATIONS Future efforts to comprehensively develop and implement interventions guided by the TPB hold promise for reducing SSB intake.
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Affiliation(s)
- Jamie Zoellner
- Assistant Professor, Virginia Polytechnic Institute and State University, Department of Human Nutrition, Foods and Exercise, Blacksburg, VA 24061, 540-231-3670
| | - Paul Estabrooks
- Associate Professor, Virginia Polytechnic Institute and State University, Department of Human Nutrition, Foods and Exercise
| | - Brenda Davy
- Associate Professor, Virginia Polytechnic Institute and State University, Department of Human Nutrition, Foods and Exercise
| | - Yvonnes Chen
- Assistant Professor, Virginia Polytechnic Institute and State University, Department of Communication
| | - Wendy You
- Assistant Professor, Virginia Polytechnic Institute and State University, Department of Agricultural and Applied Economics
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Mattes RD, Shikany JM, Kaiser KA, Allison DB. Nutritively sweetened beverage consumption and body weight: a systematic review and meta-analysis of randomized experiments. Obes Rev 2011; 12:346-65. [PMID: 20524996 PMCID: PMC3169649 DOI: 10.1111/j.1467-789x.2010.00755.x] [Citation(s) in RCA: 116] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Nutritively sweetened beverages (NSBs) may play a role in the obesity epidemic. We abstracted data from randomized controlled trials (RCTs) and evidence-based reviews through January 2009 concerning effects of consumption of NSBs on changes in body weight and adiposity. Studies included were those (i) conducted in humans; (ii) lasting at least 3 weeks; (iii) incorporating random assignment of subjects to conditions that differed only in the consumption of NSBs and (iv) including an adiposity indicator as an outcome. Twelve studies met the inclusion criteria. Meta-analysis of six studies that added NSBs to persons' diets showed dose-dependent increases in weight. Contrarily, meta-analysis of studies that attempted to reduce NSB consumption consistently showed no effect on body mass index (BMI) when all subjects were considered. Meta-analysis of studies providing access to results separately for subjects overweight at baseline showed a significant effect of a roughly 0.35 standard deviations lesser BMI change (i.e. more weight loss or less weight gain) relative to controls. The current evidence does not demonstrate conclusively that NSB consumption has uniquely contributed to obesity or that reducing NSB consumption will reduce BMI levels in general. We recommend an adequately powered RCT with overweight persons, for whom there is suggestive evidence of an effect.
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Affiliation(s)
- R D Mattes
- Department of Foods and Nutrition, Purdue University, West Lafayette, IN, USA
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Levy DT, Friend KB, Wang YC. A review of the literature on policies directed at the youth consumption of sugar sweetened beverages. Adv Nutr 2011; 2:182S-200S. [PMID: 22332051 PMCID: PMC3065753 DOI: 10.3945/an.111.000356] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Sugar sweetened beverages (SSB) constitute a large percentage of energy consumed by youth. This paper reviews the literature on school nutrition policies and price interventions directed at youth SSB consumption. In addition to considering the direct effect of policies on SSB consumption, we provide an overview of the literature on how SSB consumption affects total energy intake (TEI) and BMI, as well as on how TEI affects BMI. By considering each of these links, we attempted to gauge the effect of policies directed at SSB consumption, as well as highlight areas that merit future research. We found that school nutrition and price policies reduce SSB consumption and that reduced SSB consumption is associated with a reduction in energy intake that can influence BMI. Policies directed at SSB consumption can play an important role in reducing youth overweight and obesity.
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Affiliation(s)
- David T. Levy
- Pacific Institute, Calverton, MD 20705,Department of Economics, University of Baltimore, Baltimore MD 21201,To whom correspondence should be addressed. E-mail:
| | | | - Y. Claire Wang
- Department of Health Policy and Management, Columbia Mailman School of Public Health, New York, NY 10027
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Wouters EJ, Larsen JK, Kremers SP, Dagnelie PC, Geenen R. Peer influence on snacking behavior in adolescence. Appetite 2010; 55:11-7. [DOI: 10.1016/j.appet.2010.03.002] [Citation(s) in RCA: 95] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2009] [Revised: 01/09/2010] [Accepted: 03/01/2010] [Indexed: 10/19/2022]
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