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Tripicchio GL, Croce CM, Coffman DL, Pettinato C, Fisher JO. Age-related differences in eating location, food source location, and timing of snack intake among U.S. children 1-19 years. Int J Behav Nutr Phys Act 2023; 20:90. [PMID: 37495996 PMCID: PMC10369691 DOI: 10.1186/s12966-023-01489-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 06/30/2023] [Indexed: 07/28/2023] Open
Abstract
BACKGROUND Snacking is nearly universal and contributes significant energy to U.S. children's diets. Little is known, however, about where and when snacking intake occurs and if such patterns change with age. This research evaluated age-related differences in eating location, food source location, and timing of snacking among U.S. children aged 1-19 years (y). METHODS A cross-sectional analysis of snacking among 14,666 children in the 2007-2018 U.S. National Health and Nutrition Examination Survey was conducted using a single 24-hour dietary recall. Snacking was participant-defined and included all eating occasions outside of meals. Linear regression and analysis of covariance were used to examine the effects of age (toddler 1-2 y, preschooler 3-5 y, school-age 6-11 y, adolescent 12-19 y) on the percentage of daily snack energy consumed by eating location (at home vs. away from home), food source location (grocery store, convenience store, school/childcare, restaurant, from someone else (i.e. "socially"), and other), and time of day (morning, 6am-12pm; early afternoon, 12pm-3pm; late afternoon/afterschool 3pm-6pm; evening 6pm-9pm, late-night 9pm-12am, and overnight 12am-6am). RESULTS On average, U.S. children consumed most of their daily snacking energy at home (71%), from foods and beverages obtained from grocery stores (75%), and in the late afternoon/afterschool (31%). Toddlers and preschoolers consumed a greater percentage of their daily snack energy during the morning hours compared to school-age children and adolescents (both p < 0.001); school-age children consumed the most in the evening (27%, p < 0.001), and adolescents consumed the most in the late-night period (22%, p < 0.001). Age-related increases were seen in the percentage of daily snacking energy eaten outside the home (p < 0.001), and obtained socially (p < 0.001), from restaurants (p < 0.001), and convenience stores (p < 0.001). CONCLUSION Findings reveal age-related differences in eating location, food source location, and timing of snack intake among U.S. children aged 1-19 y. Younger children consume a greater percentage of snacking calories in the morning and at home relative to older children. School-age children and adolescents show greater snacking in the evening and at night and from foods obtained and eaten outside the home. Efforts to promote healthy snacking behaviors among children should consider developmental differences in snacking patterns.
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Affiliation(s)
- Gina L Tripicchio
- Department of Social and Behavioral Sciences, Center for Obesity Research and Education, College of Public Health, Temple University, 3223 N. Broad Street, Suite 175, Philadelphia, PA, 19140, USA.
| | - Christina M Croce
- Department of Social and Behavioral Sciences, Center for Obesity Research and Education, College of Public Health, Temple University, 3223 N. Broad Street, Suite 175, Philadelphia, PA, 19140, USA
| | - Donna L Coffman
- Department of Psychology, College of Arts and Sciences, University of South Carolina, Columbia, SC, USA
| | - Cameron Pettinato
- Department of Social and Behavioral Sciences, Center for Obesity Research and Education, College of Public Health, Temple University, 3223 N. Broad Street, Suite 175, Philadelphia, PA, 19140, USA
| | - Jennifer O Fisher
- Department of Social and Behavioral Sciences, Center for Obesity Research and Education, College of Public Health, Temple University, 3223 N. Broad Street, Suite 175, Philadelphia, PA, 19140, USA
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Elford A, Gwee C, Veal M, Jani R, Sambell R, Kashef S, Love P. Identification and Evaluation of Tools Utilised for Measuring Food Provision in Childcare Centres and Primary Schools: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:4096. [PMID: 35409781 PMCID: PMC8998327 DOI: 10.3390/ijerph19074096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 03/23/2022] [Accepted: 03/24/2022] [Indexed: 12/04/2022]
Abstract
BACKGROUND Children aged 2-11 years spend significant hours per week in early childhood education and care (ECEC) and primary schools. Whilst considered important environments to influence children's food intake, there is heterogeneity in the tools utilised to assess food provision in these settings. This systematic review aimed to identify and evaluate tools used to measure food provision in ECEC and primary schools. METHODS The Preferred Reporting Items for Systematic Reviews (PRISMA) was followed. Publications (2003-2020) that implemented, validated, or developed measurement tools to assess food provision within ECEC or primary schools were included. Two reviewers extracted and evaluated studies, cross checked by a third reviewer and verified by all authors. The Academy of Nutrition and Dietetics Quality Criteria Checklist (QCC) was used to critically appraise each study. RESULTS Eighty-two studies were included in the review. Seven measurement tools were identified, namely, Menu review; Observation; Weighed food protocol; Questionnaire/survey; Digital photography; Quick menu audit; and Web-based menu assessment. An evidence-based evaluation was conducted for each tool. CONCLUSIONS The weighed food protocol was found to be the most popular and accurate measurement tool to assess individual-level intake. Future research is recommended to develop and validate a tool to assess service-level food provision.
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Affiliation(s)
- Audrey Elford
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition, Deakin University, Geelong, VIC 3216, Australia;
| | - Cherice Gwee
- Faculty of Health, University of Canberra, Bruce, ACT 2617, Australia; (C.G.); (M.V.)
| | - Maliney Veal
- Faculty of Health, University of Canberra, Bruce, ACT 2617, Australia; (C.G.); (M.V.)
| | - Rati Jani
- School of Health Sciences and Social Work, Griffith University, Gold Coast, QLD 4222, Australia;
| | - Ros Sambell
- School of Medical and Health Sciences, Nutrition and Health Innovation Research Institute, Edith Cowan University, Perth, WA 6027, Australia;
| | - Shabnam Kashef
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA 5042, Australia;
| | - Penelope Love
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition, Deakin University, Geelong, VIC 3216, Australia;
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Crowe RK, Probst YC, Norman JA, Furber SE, Stanley RM, Ryan ST, Vuong C, Hammersley ML, Wardle K, Franco L, Beets MW, Weaver RG, Davis M, Innes-Hughes C, Okely AD. Foods and beverages provided in out of school hours care services: an observational study. BMC Public Health 2022; 22:277. [PMID: 35144567 PMCID: PMC8832650 DOI: 10.1186/s12889-022-12652-9] [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: 09/01/2021] [Accepted: 01/25/2022] [Indexed: 11/10/2022] Open
Abstract
Introduction Out of school hours care (OSHC) is a fast-growing childcare setting in Australia, however the types of foods and beverages offered are relatively unknown. This study describes the food and beverages offered and investigates sector-level and setting-level factors which may impact OSHC in meeting the Australian Dietary Guidelines (ADG). Methods This cross-sectional, observational study was conducted in 89 OSHC services (between 2018 and 2019). Food and beverages offered, kitchen facilities and menus were captured via direct observation. Foods were categorised into five food groups or discretionary foods, based on the ADG, and frequencies determined. Short interviews with OSHC directors ascertained healthy eating policies, staff training, food quality assessment methods and food budgets. Fisher’s exact test explored the influence of sector-level and setting-level factors on food provision behaviours. Results Discretionary foods (1.5 ± 0.68) were offered more frequently than vegetables (0.82 ± 0.80) (p < .001), dairy (0.97 ± 0.81) (p = .013) and lean meats (0.22 ± 0.54) (p < .001). OSHC associated with long day care and reported using valid food quality assessment methods offered more lean meats (p= .002, and p= .004). Larger organisations offered more vegetables (p = .015) and discretionary foods (p= .007). Menus with clearly worded instructions to provide fruits and vegetables daily offered more fruit (p= .009), vegetables (p < .001) and whole grains (p= .003). No other sector or setting-level factors were associated with services aligning with the ADG. Conclusion Future interventions could benefit from trialling menu planning training and tools to assist OSHC services in NSW meet the ADG requirements.
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Affiliation(s)
- Ruth K Crowe
- School of Medicine, Science Medicine and Health, University of Wollongong, Wollongong, NSW, Australia. .,Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW, Australia.
| | - Yasmine C Probst
- School of Medicine, Science Medicine and Health, University of Wollongong, Wollongong, NSW, Australia.,Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW, Australia
| | - Jennifer A Norman
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW, Australia.,Health Promotion Service, Illawarra Shoalhaven Local Health District, Warrawong, NSW, Australia.,Early Start, School of Health and Society, University of Wollongong, Wollongong, NSW, Australia
| | - Susan E Furber
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW, Australia.,Health Promotion Service, Illawarra Shoalhaven Local Health District, Warrawong, NSW, Australia
| | - Rebecca M Stanley
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW, Australia.,Early Start, School of Health and Society, University of Wollongong, Wollongong, NSW, Australia
| | - Sarah T Ryan
- Early Start, School of Health and Society, University of Wollongong, Wollongong, NSW, Australia
| | - Cecilia Vuong
- Health Promotion Service, South Western Sydney Local Health District, Liverpool, NSW, Australia
| | - Megan L Hammersley
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW, Australia.,Early Start, School of Health and Society, University of Wollongong, Wollongong, NSW, Australia
| | - Karen Wardle
- Health Promotion Service, South Western Sydney Local Health District, Liverpool, NSW, Australia
| | - Lisa Franco
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW, Australia.,Health Promotion Service, Illawarra Shoalhaven Local Health District, Warrawong, NSW, Australia
| | - Michael W Beets
- Exercise Science, Arnold School of Public Health University of South Carolina, Columbia, SC, USA
| | - R Glenn Weaver
- Exercise Science, Arnold School of Public Health University of South Carolina, Columbia, SC, USA
| | - Marc Davis
- Centre for Population Health, St Leonards, NSW, Australia
| | | | - Anthony D Okely
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW, Australia.,Early Start, School of Health and Society, University of Wollongong, Wollongong, NSW, Australia
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Systematic observation of healthy eating environments in after-school services: a cross-sectional study. Public Health Nutr 2021; 24:6067-6074. [PMID: 34348825 DOI: 10.1017/s1368980021003220] [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: 11/07/2022]
Abstract
OBJECTIVES Few studies have examined the healthy eating environments within the Australian out of school hours care (OSHC) setting. This study aims to describe healthy eating environments, consisting of: (a) the alignment of provided food and beverages to Australian Dietary Guidelines; (b) healthy eating promotion practices; (c) nutrition education through cooking experiences; (d) staff role modelling healthy eating and (e) regular water availability. DESIGN A cross-sectional study was conducted using direct observations and the validated System for Observing Staff Promotion of Activity and Nutrition (SOSPAN) tool. SETTING OSHC located in urban and semi-rural regions of NSW, Australia. PARTICIPANTS Staff (151) and children (1549) attending twelve OSHC services operating in the hours after school. RESULTS Fifty per cent (50 %) of services offered fruits and 100 % offered water as a part of the afternoon snack on all four observation days. Discretionary foods were offered on more days compared to vegetables (+1·9/d, P = 0·009), lean meats (+2·7/d, P =·0 004) and wholegrains (+2·8/d, P = 0 002). Staff promoted healthy eating on 15 % of days, sat and ate with children 52 %, consumed high sugar drinks 15 % and ate discretionary foods in front of children 8 % of days, respectively. No opportunities for cooking or nutrition education were observed. CONCLUSION Afternoon snacks regularly contained fruits and water. Opportunities exist to improve the frequency by which vegetables, wholegrains and lean meats are offered in addition to staff healthy eating promotion behaviours. Future research is warranted to further explore healthy eating behaviours, practices and policies within the after-school sector.
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Crowe R, Probst Y, Norman J, Furber S, Franco L, Stanley RM, Vuong C, Wardle K, Davies M, Ryan S, Okely AD. Healthy eating and physical activity environments in out-of-school hours care: an observational study protocol. BMJ Open 2020; 10:e036397. [PMID: 32988940 PMCID: PMC7523195 DOI: 10.1136/bmjopen-2019-036397] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Childcare settings have been widely identified as important venues for promoting healthy lifestyles to children. Out-of-school hours care (OSHC) is a rapidly growing childcare service, yet there has been limited research reported on healthy eating and physical activity (HEPA) environments within the Australian OSHC setting. This research aims to describe the HEPA environments related to foods and beverages served, staff behaviours and child physical activity levels across two local health districts within New South Wales, Australia. This study will provide evidence to support future interventions and policies in Australian OSHC settings. METHODS AND ANALYSIS A cross-sectional study design will be used to describe the food and beverages provided and child activity levels, and report on environmental correlates. OSHC programmes will be visited on non-consecutive weekdays between 2018 and 2020. The frequency of foods and beverages offered will be observed and categorised into food groups aligned to the Australian Dietary Guidelines. Children's physical activity will be measured using ActiGraph wGT3X-BT accelerometers. Staff behaviour will be captured via direct observation and the System for Observing Staff Promotion of Activity and Nutrition. Short interviews with programme directors will gather contextual information about OSHC practices and policies. ETHICS AND DISSEMINATION Findings will be disseminated through peer-reviewed scientific journals, conference presentations and individualised feedback to each participating service. Ethical approval was granted by the University of Wollongong Human Research Ethics Committee (HE17/490).
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Affiliation(s)
- Ruth Crowe
- School of Medicine, Science Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, New South Wales, Australia
| | - Yasmine Probst
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, New South Wales, Australia
| | - Jennifer Norman
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, New South Wales, Australia
- Health Promotion Service, Illawarra Shoalhaven Local Health District, Wollongong, New South Wales, Australia
| | - Susan Furber
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, New South Wales, Australia
- Health Promotion Service, Illawarra Shoalhaven Local Health District, Wollongong, New South Wales, Australia
| | - Lisa Franco
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, New South Wales, Australia
- Health Promotion Service, Illawarra Shoalhaven Local Health District, Wollongong, New South Wales, Australia
| | - Rebecca M Stanley
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, New South Wales, Australia
- Early Start, School of Education, University of Wollongong, Wollongong, New South Wales, Australia
| | - Cecilia Vuong
- Health Promotion Service, South Western Sydney Local Health District, Liverpool, New South Wales, Australia
| | - Karen Wardle
- Health Promotion Service, South Western Sydney Local Health District, Liverpool, New South Wales, Australia
| | - Marc Davies
- NSW Healthy Children Initiative, NSW Office of Preventive Health, Liverpool, New South Wales, Australia
| | - Sarah Ryan
- Early Start, School of Education, University of Wollongong, Wollongong, New South Wales, Australia
| | - Anthony D Okely
- Early Start, School of Education, University of Wollongong, Wollongong, New South Wales, Australia
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Banna J, Richards R, Jones B, Anderson AK, Reicks M, Cluskey M, Gunther C, Hongu NK, Lora K, Misner S, Monroe-Lord L, Topham G, Wong SS, Lim E. Describing Independent Eating Occasions among Low-Income Adolescents. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17030981. [PMID: 32033251 PMCID: PMC7037151 DOI: 10.3390/ijerph17030981] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Revised: 01/31/2020] [Accepted: 02/02/2020] [Indexed: 12/26/2022]
Abstract
The purpose of this formative, cross-sectional study was to describe independent eating occasions (iEOs) among a convenience sample of low-income early adolescents (10–13 years, n = 46) in 10 U.S. states, including environmental context, foods selected and reasons for selection, and parental rules about foods consumed. Participants took pictures of all foods consumed over 24 h and participated in semi-structured interviews to describe the context of each eating occasion using the pictures as a guide. Responses based on a total of 304 eating occasions were coded to classify foods based on United States Department of Agriculture (USDA) MyPlate food groups and to characterize parental rules and reasons for food selection. Average age was 10.9 ± 1.1 years and 60% were female. Approximately 58% of eating occasions were classified as iEOs with approximately 65% as snacks. Most iEOs took place at home. Foods frequently consumed during iEOs were from the sweets, total fruit, dairy, and whole fruit food categories. Primary parental rules for iEOs focused on avoiding certain foods and not eating too much. Early adolescents selected foods for convenience, taste preferences, and availability. Foods selected during iEOs were based on parent, household and early adolescent factors, which could be addressed to influence overall diet quality.
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Affiliation(s)
- Jinan Banna
- Department of Human Nutrition, Food and Animal Sciences, University of Hawaii-Manoa, Honolulu, HI 96822, USA
- Correspondence: ; Tel.: +1-808-956-7857
| | - Rickelle Richards
- Department of Nutrition, Dietetics & Food Science, Brigham Young University, Provo, UT 84602, USA;
| | - Blake Jones
- Department of Psychology, Brigham Young University, Provo, UT 84602, USA;
| | - Alex Kojo Anderson
- Department of Foods and Nutrition, University of Georgia, Athens, GA 30602, USA;
| | - Marla Reicks
- Department of Food Science and Nutrition, University of Minnesota, St. Paul, MN 55108, USA;
| | - Mary Cluskey
- School of Biological and Population Health Sciences, Nutrition, Oregon State University, Corvallis, OR 97331, USA; (M.C.); (S.S.W.)
| | - Carolyn Gunther
- Department of Human Sciences, Ohio State University, Human Nutrition Program, Columbus, OH 43210, USA;
| | - Nobuko Kay Hongu
- Department of Nutritional Sciences, University of Arizona, Tucson, AZ 85721, USA; (N.K.H.); (S.M.)
| | - Karina Lora
- Department of Exercise and Nutrition Sciences, George Washington University, Washington, DC 20052, USA;
| | - Scottie Misner
- Department of Nutritional Sciences, University of Arizona, Tucson, AZ 85721, USA; (N.K.H.); (S.M.)
| | - Lillie Monroe-Lord
- Center for Nutrition, Diet and Health, University of the District of Columbia, Washington, DC 20008, USA;
| | - Glade Topham
- Couple and Family Therapy Program, Kansas State University, Manhattan, KS 66506, USA;
| | - Siew Sun Wong
- School of Biological and Population Health Sciences, Nutrition, Oregon State University, Corvallis, OR 97331, USA; (M.C.); (S.S.W.)
| | - Eunjung Lim
- Department of Quantitative Health Sciences, University of Hawaii-Manoa, Honolulu, HI 96813, USA;
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Opalinski AS, Parra AV, Gropper SS. Foods served at faith community events for children - Is there room for improvements in this unexplored child nutrition site? Public Health Nurs 2019; 37:81-86. [PMID: 31631396 DOI: 10.1111/phn.12675] [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: 06/25/2019] [Revised: 09/30/2019] [Accepted: 10/03/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To describe food and beverage provisions by Faith Communities from one denomination in association with events for children. DESIGN, SAMPLE AND MEASURES Foods and beverages provided at 32 child-focused activities were documented using direct observation methodology and analyzed for contribution to food groups and per serving energy, fat, saturated fat, sugar, and sodium contents. RESULTS Main dishes were mostly (71%) convenience/casserole-type foods, and averaged 962 mg sodium and 436 kcal, with 36% of energy from fat and 14% as saturated fat. Cheese was the main source of dairy products. Grain-based side dishes, provided at 29% of meals, included white rice, pasta, and bread. Non-starchy vegetables were provided at three (29%) meals. Fruits were served at six events. Desserts, served at 75% of events, contained 41% of energy from fat, with 17% as saturated fat, and 22 g of added sugar. Snack chips, provided at 31% of events, contributed 165 kcal mostly from fat and 243 mg of sodium. Sugar-sweetened beverages, served at 71% of events, contributed 28 g of added sugar. CONCLUSIONS This pilot investigation identified areas for improvements in the nutritional quality of foods/beverages served at faith community child-focused events and aligns with expanding public health efforts to improve child nutrition beyond traditional settings.
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Affiliation(s)
- Andra S Opalinski
- Christine E. Lynn College of Nursing, Florida Atlantic University, Boca Raton, FL, USA
| | - Andrea V Parra
- Charles E Schmidt College of Science, Florida Atlantic University, Boca Raton, FL, USA
| | - Sareen S Gropper
- Christine E. Lynn College of Nursing, Florida Atlantic University, Boca Raton, FL, USA
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Helmick M, Esmond AC, Hedrick V, Zoellner J, You W, Hill JL. The Adoption of the Healthy Eating Standards in Local Afterschool Programs Does Not Improve Quality of Snacks. THE JOURNAL OF SCHOOL HEALTH 2019; 89:809-817. [PMID: 31397496 DOI: 10.1111/josh.12822] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2017] [Revised: 01/23/2018] [Accepted: 04/22/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES In 2011, the National Afterschool Association adopted the Healthy Eating and Physical Activity (HEPA) standards to address snack quality and physical activity in afterschool programs. Although research has indicated promise in the adoption of these policies by national organizations, less is known about local adoption, implementation, and effectiveness. In this study, we aimed to compare the quality of snacks served at program sites pre- and post-adoption and to determine the quality of non-program snacks compared to program snacks. METHODS An interrupted time series design was used to measure snack quality and consumption at 3 policy adopting sites and 2 non-policy adopting sites that served as a comparison control. Trained research staff collected snack type, brand, and amount consumed using a modified quarter-waste method. Analysis on nutrient content of snacks was completed using Nutrition Data System for Research software. RESULTS Adoption of the HEPA standards among policy adopting sites did not result in significantly better snack quality. Across all sites, program snacks were healthier than non-program snacks. CONCLUSION Pursuing additional components of the HEPA standards related to implementation may be necessary to significantly improve snack quality. Environmental supports such as limiting the amount of non-program snacks available onsite may improve snack quality.
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Affiliation(s)
- Meagan Helmick
- Radford University Carilion, 101 Elm Ave SE, Roanoke, VA 24013
| | | | - Valisa Hedrick
- 295 West Campus Drive, 338 Wallace Hall, Blacksburg, VA 24061
| | | | - Wen You
- 250 Drillfield Drive, 304 Hutcheson Hall, Blacksburg, VA 24061
| | - Jennie L Hill
- University of Nebraska Medical Center, 984395 Nebraska Medical Center, Omaha, NE 68198
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Impact of the Out-of-School Nutrition and Physical Activity (OSNAP) Group Randomized Controlled Trial on Children's Food, Beverage, and Calorie Consumption among Snacks Served. J Acad Nutr Diet 2019; 118:1425-1437. [PMID: 30055710 DOI: 10.1016/j.jand.2018.04.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 04/15/2018] [Indexed: 11/21/2022]
Abstract
BACKGROUND Afterschool interventions have been found to improve the nutritional quality of snacks served. However, there is limited evidence on how these interventions affect children's snacking behaviors. OBJECTIVE Our aim was to determine the impact of an afterschool intervention focused at the school district, site, family, and child levels on dietary consumption of foods and beverages served at snack. DESIGN This was a secondary analysis of a group-randomized controlled trial. PARTICIPANTS/SETTING Data were collected from 400 children at 20 afterschool sites in Boston, MA before (fall 2010) and after (spring 2011) intervention implementation. INTERVENTION The Out-of-School Nutrition and Physical Activity intervention aimed to promote fruits, vegetables, whole grains, and water, while limiting sugary drinks and trans fats. Researchers worked with district foodservice staff to change snack foods and beverages. Teams of afterschool staff participated in three 3-hour learning collaborative sessions to build skills and created action plans for changing site practices. The intervention included family and child nutrition education. MAIN OUTCOME MEASURES Research assistants observed dietary snack consumption using a validated measure on 2 days per site at baseline and follow-up. STATISTICAL ANALYSES PERFORMED This study used multivariable regression models, accounting for clustering of observations, to assess the intervention effect, and conducted post-hoc stratified analyses by foodservice type. RESULTS Children in intervention sites had greater decreases in consumption of juice (-0.61 oz/snack, 95% CI -1.11 to -0.12), beverage calories (-29.1 kcal/snack, 95% CI -40.2 to 18.0), foods with trans fats (-0.12 servings/snack, 95% CI -0.19 to -0.04), total calories (-47.7 kcal/snack, 95% CI -68.2 to -27.2), and increases in consumption of whole grains (0.10 servings/snack, 95% CI 0.02 to 0.18) compared to controls. In post-hoc analyses, sites with on-site foodservice had significant improvements for all outcomes (P<0.001), with no effect for sites with satellite foodservice. CONCLUSIONS Results demonstrate that an afterschool intervention can improve children's dietary snack consumption, particularly at sites with on-site foodservice.
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Brazendale K, Beets MW, Weaver RG, Turner-McGrievy B, Brazendale AB, Chandler JL, Moore JB, Huberty JL, Lemley J, Brownson RC. The application of mHealth to monitor implementation of best practices to support healthy eating and physical activity in afterschool programs. Glob Health Promot 2018; 27:33-40. [PMID: 29809105 DOI: 10.1177/1757975918768442] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Childhood obesity continues to be a global epidemic and many child-based settings (e.g. school, afterschool programs) have great potential to make a positive impact on children's health behaviors. Innovative and time-sensitive methods of gathering health behavior information for the purpose of evaluation and strategically deploying support are needed in these settings. PURPOSE The aim is to (1) demonstrate the feasibility of mobile health (mHealth) for monitoring implementation of healthy eating and physical activity (HEPA) standards and, (2) illustrate the utility of mHealth for identifying areas where support is needed, within the afterschool setting. METHODS Site leaders (N = 175) of afterschool programs (ASPs) were invited to complete an online observation checklist via a mobile web app (Healthy Eating and Physical Activity Mobile, HEPAm) once per week during ASP operating hours. Auto-generated weekly text reminders were sent to site leaders' mobile devices during spring and fall 2015 and 2016 and spring 2017 school semesters. Data from HEPAm was separated into HEPA variables, and expressed as a percent of checklists where an item was present. A higher percentage for a given item would indicate an afterschool has higher compliance with current HEPA standards. RESULTS A total of 141 site leaders of ASPs completed 13,960 HEPAm checklists. The average number of checklists completed per ASP was 43 (range 1-220) for healthy eating and 50 (range 1-230) for physical activity. For healthy eating, the most common challenge for ASPs was 'Staff educating children about healthy eating', and for physical activity checklists, 'Girls only physical activity is provided at ASP'. CONCLUSION HEPAm was widely used and provided valuable information that can be used to strategically deploy HEPA support to ASPs. This study gives confidence to the adoption of mHealth strategies as a means for public health practitioners to monitor compliance of an initiative or intervention.
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Beets MW, Brazendale K, Glenn Weaver R, Turner-McGrievy GM, Huberty J, Moore JB, Mahmud Khan M, Ward DS. Economic evaluation of a group randomized controlled trial on healthy eating and physical activity in afterschool programs. Prev Med 2018; 106:60-65. [PMID: 28987341 PMCID: PMC10165537 DOI: 10.1016/j.ypmed.2017.10.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 09/25/2017] [Accepted: 10/02/2017] [Indexed: 10/18/2022]
Abstract
Limited information is available on the cost-effectiveness of interventions to achieve healthy eating and physical activity policies in afterschool programs (ASPs). The objective of this study is to present the costs associated with a comprehensive intervention in ASPs. Intervention delivery inputs (IDIs) associated with a group randomized delayed treatment controlled trial involving 20 ASPs serving >1700 children (5-12yrs) were catalogued prospectively across 2-years (2014-2015). IDIs, analyzed 2015, were expressed as increases in per-child per-week enrollment fees based on a 34-week school year in US$. Total IDIs for year-1 were $15,058 (+$0.58/child/week enrollment fee). In year-2, total costs were $13,828 (+$0.52/child/week) for the delayed group and $7916 (+$0.30/child/week) for the immediate group, respectively. Site leader and staff hourly wages represented 11-17% and 45-46% of initial training costs; travel and trainer wages represented 31-42% and 50-58% of booster costs. Overall, a 1% increase in boys and girls, separately, accumulating 30 mins/d of moderate-to-vigorous physical activity ranged from $0.05 to $0.26/child/week, while a one-day increase in serving a fruit/vegetable or water, or not serving sugar-added foods/beverages ranged from $0.16 to $0.87/child/week. Costs associated with implementing the intervention were minimal. Additional efforts to reduce costs and improve intervention effectiveness are necessary.
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Affiliation(s)
- Michael W Beets
- University of South Carolina, 921 Assembly Street, Columbia, SC, USA
| | - Keith Brazendale
- University of South Carolina, 921 Assembly Street, Columbia, SC, USA.
| | - R Glenn Weaver
- University of South Carolina, 921 Assembly Street, Columbia, SC, USA
| | | | | | | | - M Mahmud Khan
- University of South Carolina, 921 Assembly Street, Columbia, SC, USA
| | - Dianne S Ward
- University of North Carolina, Chapel Hill, 2202 McGavran-Greenberg Hall, Chapel Hill, NC, USA
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Intervention leads to improvements in the nutrient profile of snacks served in afterschool programs: a group randomized controlled trial. Transl Behav Med 2017; 6:329-38. [PMID: 27528522 DOI: 10.1007/s13142-015-0342-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Widely adopted nutrition policies for afterschool programs (ASPs) focus on serving a fruit/vegetable daily and eliminating sugar-sweetened foods/beverages. The impact of these policies on the nutrient profile of snacks served is unclear. Evaluate changes in macro/micronutrient content of snacks served in ASPs. A 1-year group randomized controlled trial was conducted in 20 ASPs serving over 1700 elementary-age children. Intervention ASPs received a multistep adaptive framework intervention. Direct observation of snack served was collected and nutrient information determined using the USDA Nutrient Database, standardized to nutrients/100 kcal. By post-assessment, intervention ASPs reduced total kcal/snack served by 66 kcal (95CI -114 to -19 kcal) compared to control ASPs. Total fiber (+1.7 g/100 kcal), protein (+1.4 g/100 kcal), polyunsaturated fat (+1.2 g/100 kcal), phosphorous (+49.0 mg/100 kcal), potassium (+201.8 mg/100 kcal), and vitamin K (+21.5 μg/100 kcal) increased in intervention ASPs, while added sugars decreased (-5.0 g/100 kcal). Nutrition policies can lead to modest daily caloric reductions and improve select macro/micronutrients in snacks served. Long-term, these nutritional changes may contribute to healthy dietary habits.
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Beets MW, Weaver RG, Turner-McGrievy G, Huberty J, Moore JB, Ward DS, Freedman DA, Beighle A. Two-Year Healthy Eating Outcomes: An RCT in Afterschool Programs. Am J Prev Med 2017; 53:316-326. [PMID: 28532659 PMCID: PMC5562516 DOI: 10.1016/j.amepre.2017.03.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 02/10/2017] [Accepted: 03/08/2017] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Across the U.S., afterschool programs (ASPs, 3:00pm-6:00pm) are trying to achieve nationally endorsed nutrition standards (Healthy Eating Standards) calling for fruits/vegetables and water to be served every day, while eliminating sugar-sweetened beverages and foods. The purpose of this study was to evaluate the 2-year changes in the types of foods and beverages served during a community-based intervention designed to achieve the Healthy Eating Standards. STUDY DESIGN Randomized delayed treatment trial with an immediate (1-year baseline and 2-year intervention) or delayed (2-year baseline and 1-year intervention) group. SETTING/PARTICIPANTS Twenty ASPs serving 1,700 children (aged 5-12 years) were recruited, with baseline occurring spring 2013, and outcome assessment occurring spring 2014 and 2015. INTERVENTION The multistep intervention, Strategies To Enhance Practice for Healthy Eating, assisted ASP leaders/staff to serve foods/beverages that meet the nutrition standards. MAIN OUTCOME MEASURES The foods and beverages served for snack were observed directly. RESULTS Compared with non-intervention years, both the immediate and delayed groups increased the number of days/week that fruits/vegetables (0.6 vs 1.7 days/week and 0.6 vs 4.4 days/week, OR=3.80, 95% CI=1.45, 9.95) and water (2.3 vs 3.7 days/week and 2.7 vs 4.8 days/week, OR=4.65, 95% CI=1.69, 12.79) were served. Sugar-sweetened beverages were almost eliminated by post-assessment (1.2 vs 0.2 days/week and 3.2 vs 0.0 days/week, OR=0.05, 95% CI=0.02, 0.13). Only the immediate group decreased the number of days/week desserts were served (2.9 vs 0.6 days/week, OR=0.10, 95% CI=0.03, 0.33). Implementation barriers for the delayed group included once/month delivery schedules for fruits/vegetables and limited storage space for foods meeting the Healthy Eating Standards. CONCLUSIONS Improvements in the foods/beverages served in ASPs can be made, yet were hindered by structural barriers related to procurement and storage of perishable foods. Additional efforts are needed to support ASPs as they work toward fully achieving the Healthy Eating Standards.
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Affiliation(s)
- Michael W Beets
- Arnold School of Public Health, University of South Carolina, Columbia, South Carolina.
| | - R Glenn Weaver
- Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | | | - Jennifer Huberty
- School of Nutrition and Health Promotion, Arizona State University, Phoenix, Arizona
| | - Justin B Moore
- Family and Community Medicine, Wake Forest School of Medicine, Wake Forest University, Winston-Salem, North Carolina
| | - Dianne S Ward
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, Chapel Hill, North Carolina
| | - Darcy A Freedman
- Department of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, Ohio
| | - Aaron Beighle
- College of Education, University of Kentucky, Lexington, Kentucky
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Machado AP, Lima BM, Laureano MG, Silva PHB, Tardin GP, Reis PS, Santos JS, Jácomo D, D'Artibale EF. Educational strategies for the prevention of diabetes, hypertension, and obesity. Rev Assoc Med Bras (1992) 2017; 62:800-808. [PMID: 27992023 DOI: 10.1590/1806-9282.62.08.800] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2015] [Accepted: 09/15/2015] [Indexed: 12/19/2022] Open
Abstract
Objective: The main goal of this work was to produce a review of educational strategies to prevent diabetes, hypertension, and obesity. Method: PubMed database was consulted using combined descriptors such as [Prevention], [Educational Activities], [Diabetes], [Hypertension], and [Obesity]. Data from randomized trials published between 2002 and 2014 were included in spreadsheets for analysis in duplicate by the reviewers. Results: A total of 8,908 articles were found, of which 1,539 were selected about diabetes mellitus (DM, n=369), arterial systemic hypertension (ASH, n=200), and obesity (OBES, n=970). The number of free full text articles available was 1,075 (DM = 276, ASH = 118 and OBES = 681). In most of these studies, demographic characteristics such as gender and age were randomized, and the population mainly composed by students, ethnic groups, family members, pregnant, health or education professionals, patients with chronic diseases (DM, ASH, OBES) or other comorbidities. Group dynamics, physical activity practices, nutritional education, questionnaires, interviews, employment of new technologies, people training and workshops were the main intervention strategies used. Conclusion: The most efficient interventions occurred at community level, whenever the intervention was permanent or maintained for long periods, and relied on the continuous education of community health workers that had a constant interference inside the population covered. Many studies focused their actions in children and adolescents, especially on students, because they were more influenced by educational activities of prevention, and the knowledge acquired by them would spread more easily to their family and to society.
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Affiliation(s)
- Alexandre Paulo Machado
- Adjunct Professor, Department of Health Sciences, Faculdade de Medicina da Universidade Federal de Mato Grosso (UFMT), Cuiabá, MT, Brazil
| | - Bruno Muniz Lima
- Medical Student, Faculdade de Medicina da UFMT, Cuiabá, MT, Brazil
| | | | | | | | - Paulo Silva Reis
- Medical Student, Faculdade de Medicina da UFMT, Cuiabá, MT, Brazil
| | | | - Domingos Jácomo
- Medical Student, Faculdade de Medicina da UFMT, Cuiabá, MT, Brazil
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Baugh MLA, Opalinski A, Dyess SM, Gropper SS. Snack Provisions by 21st-Century Community Learning Center–Based Afterschool Programs. JOURNAL OF HUNGER & ENVIRONMENTAL NUTRITION 2017. [DOI: 10.1080/19320248.2016.1146197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Martha Lee Anne Baugh
- Department of Nutrition, Dietetics and Hospitality Management, Auburn University, Auburn, Alabama, USA
| | - Andra Opalinski
- Christine E. Lynn College of Nursing, Florida Atlantic University, Boca Raton, Florida, USA
| | - Susan MacLeod Dyess
- Christine E. Lynn College of Nursing, Florida Atlantic University, Boca Raton, Florida, USA
| | - Sareen S. Gropper
- Department of Nutrition, Dietetics and Hospitality Management, Auburn University, Auburn, Alabama, USA
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Economos CD, Anzman-Frasca S, Koomas AH, Chan G, Folta SC, Heck J, Newman M, Sacheck JM. Snacks, beverages, and physical activity during volunteer-led out-of-school-time programs: a cross-sectional analysis. BMC Public Health 2017; 17:125. [PMID: 28129761 PMCID: PMC5270327 DOI: 10.1186/s12889-017-4040-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 01/14/2017] [Indexed: 11/10/2022] Open
Abstract
Background Tens of millions of children regularly participate in out-of-school-time (OST) programs, providing an opportunity for child health promotion. Most research on OST has focused on structured, staff-led after-school programs, as opposed to volunteer-led programs such as enrichment programs and youth sports. The aim of this study was to describe snacks, beverages, and physical activity (PA) practices in volunteer-led OST programs across five organizations in three states. Methods An online survey including the Out-of-School-Time Snacks, Beverages, and Physical Activity Questionnaire was distributed to 1,695 adult leaders of enrichment and youth sports programs serving 5–12 year-old children in Maine, Massachusetts, and New Hampshire, USA. The response rate was 57.8%, with 980 leaders participating and 698 (136 youth sports, 562 enrichment) remaining after data cleaning procedures. Frequencies were calculated to describe snack, beverage, and PA offerings during typical meetings and whether healthy snack, beverage, and PA criteria were met. Criteria were developed a priori with the intent to capture co-occurring practices that together indicate healthy snack (fruits and vegetables or no snack over salty/sweet snacks); beverage (water over sugar-sweetened beverages); and PA environments (regular opportunities for >15 or 45 min of PA in enrichment and sports programs, respectively). Results About half of enrichment leaders reported that snacks and beverages were provided during typical meetings vs. one-fifth of sports leaders. In 28.4% of enrichment programs, PA was offered at every meeting vs. 98.5% of sports programs. Among enrichment programs, 50.4 and 25.8% met healthy snack and beverage criteria, respectively, and 29.4% met PA criteria, with 27.6% meeting criteria in two or more areas, and 5.0% in all three. Among sports programs, 72.8 and 78.7% met healthy snack and beverage criteria, respectively, and 71.3% met PA criteria. Eighty-two percent met criteria in two or more areas, and 46.3% met criteria in all three. Conclusions Most programs did not meet criteria for healthier snacks and beverages and opportunities for PA during typical meetings, indicating room for improvement in encouraging widespread adoption of these practices. Efforts to improve the healthfulness of snacks and beverages and increase opportunities for PA during volunteer-led OST programs are warranted. Electronic supplementary material The online version of this article (doi:10.1186/s12889-017-4040-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Christina D Economos
- ChildObesity180, Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Avenue, Boston, 02111, MA, USA. .,Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Avenue, Boston, MA, 02111, USA.
| | - Stephanie Anzman-Frasca
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, G56 Farber Hall, South Campus, Buffalo, NY, 14214, USA
| | - Alyssa H Koomas
- ChildObesity180, Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Avenue, Boston, 02111, MA, USA
| | - Grace Chan
- ChildObesity180, Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Avenue, Boston, 02111, MA, USA
| | - Sara C Folta
- Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Avenue, Boston, MA, 02111, USA
| | - Julianne Heck
- ChildObesity180, Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Avenue, Boston, 02111, MA, USA
| | - Molly Newman
- ChildObesity180, Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Avenue, Boston, 02111, MA, USA
| | - Jennifer M Sacheck
- Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Avenue, Boston, MA, 02111, USA
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Beets MW, Weaver RG, Turner-McGrievy G, Beighle A, Moore JB, Webster C, Khan M, Saunders R. Compliance With the Healthy Eating Standards in YMCA After-School Programs. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2016; 48:555-562.e1. [PMID: 27372234 PMCID: PMC5018418 DOI: 10.1016/j.jneb.2016.05.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 05/25/2016] [Accepted: 05/26/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE In 2011, the YMCA of the US adopted Healthy Eating standards for all of their after-school programs (ASPs). The extent to which YMCA ASPs comply with the standards is unknown. METHODS Twenty ASPs from all YMCA ASPs across South Carolina (N = 102) were invited to participate. Direct observation of the food and beverages served and staff behaviors were collected on 4 nonconsecutive days per ASP. RESULTS One ASP did not serve a snack. Of the remaining ASPs, a total of 26% served a fruit or vegetable and 32% served water every day; 26% served sugar-sweetened beverages, 47% served sugar-added foods, and only 11% served whole grains when grains were served. Staff members sat with the children (65%) or verbally promoted healthy eating (15%) on at least 1 observation day. Staff drank non-approved drinks (25%) or foods (45%) on at least 1 observation day. No ASPs served snacks family-style every day. CONCLUSIONS AND IMPLICATIONS Additional efforts are required to assist YMCA-operated ASPs in achieving these important nutrition standards.
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Affiliation(s)
- Michael W Beets
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC.
| | - R Glenn Weaver
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC
| | - Gabrielle Turner-McGrievy
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC
| | - Aaron Beighle
- Department of Kinesiology & Health Promotion, College of Education, University of Kentucky, Lexington, KY
| | - Justin B Moore
- Department of Family & Community Medicine, Wake Forest School of Medicine, Winston-Salem, NC
| | - Collin Webster
- Department of Physical Education, College of Education, University of South Carolina, Columbia, SC
| | - Mahmud Khan
- Department of Health Service, Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC
| | - Ruth Saunders
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC
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Beets MW, Weaver RG, Turner-McGrievy G, Huberty J, Ward DS, Freedman D, Hutto B, Moore JB, Beighle A. Making Healthy Eating Policy Practice: A Group Randomized Controlled Trial on Changes in Snack Quality, Costs, and Consumption in After-School Programs. Am J Health Promot 2016; 30:521-31. [PMID: 26158679 DOI: 10.4278/ajhp.141001-quan-486] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 01/25/2015] [Indexed: 11/17/2022]
Abstract
PURPOSE The aim of this study was to evaluate an intervention designed to assist after-school programs (ASPs) in meeting snack nutrition policies that specify that a fruit or vegetable be served daily and sugar-sweetened beverages/foods and artificially flavored foods eliminated. DESIGN The study used a 1-year group-randomized controlled trial. SETTING The study took place in ASPs operating in South Carolina, United States. SUBJECTS Twenty ASPs serving over 1700 children were recruited, match-paired postbaseline on enrollment size and days fruits/vegetables were served per week, and randomized to either intervention (n = 10) or control (n = 10) groups. INTERVENTION The study used Strategies To Enhance Practice for Healthy Eating (STEPs-HE), a multistep adaptive intervention framework that assists ASP leaders and staff to serve snacks that meet nutrition policies while maintaining cost. MEASURES Direct observation of snacks served and consumed and monthly snack expenditures as determined by receipts were used. ANALYSIS The study used nonparametric and mixed-model repeated measures. RESULTS By postassessment, intervention ASPs increased serving of fruits/vegetables to 3.9 ± 2.1 vs. 0.7 ± 1.7 d/wk and decreased serving sugar-sweetened beverages to 0.1 ± 0.7 vs. 1.8 ± 2.4 d/wk and sugar-sweetened foods to 0.3 ± 1.1 vs. 2.7 ± 2.5 d/wk compared to controls, respectively. Cost of snacks increased by $0.02/snack in the intervention ASPs ($0.36 to $0.38) compared to a $0.01 per snack decrease in the control group ($0.39 to $0.38). Across both assessments and groups, 80% to 100% of children consumed FVs. CONCLUSIONS The STEPs-HE intervention can assist ASPs in meeting nationally endorsed nutrition policies with marginal increases in cost.
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Affiliation(s)
| | | | | | | | - Dianne S Ward
- University of North Carolina, Chapel Hill, South Carolina
| | | | - Brent Hutto
- University of South Carolina, Columbia, South Carolina
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Beets MW, Glenn Weaver R, Turner-McGrievy G, Huberty J, Ward DS, Freedman DA, Saunders R, Pate RR, Beighle A, Hutto B, Moore JB. Making healthy eating and physical activity policy practice: the design and overview of a group randomized controlled trial in afterschool programs. Contemp Clin Trials 2014; 38:291-303. [PMID: 24893225 DOI: 10.1016/j.cct.2014.05.013] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Revised: 05/21/2014] [Accepted: 05/26/2014] [Indexed: 11/26/2022]
Abstract
National and state organizations have developed policies calling upon afterschool programs (ASPs, 3-6 pm) to serve a fruit or vegetable (FV) each day for snack, while eliminating foods and beverages high in added-sugars, and to ensure children accumulate a minimum of 30 min/d of moderate-to-vigorous physical activity (MVPA). Few efficacious and cost-effective strategies exist to assist ASP providers in achieving these important public health goals. This paper reports on the design and conceptual framework of Making Healthy Eating and Physical Activity (HEPA) Policy Practice in ASPs, a 3-year group randomized controlled trial testing the effectiveness of strategies designed to improve snacks served and increase MVPA in children attending community-based ASPs. Twenty ASPs, serving over 1800 children (6-12 years) will be enrolled and match-paired based on enrollment size, average daily min/d MVPA, and days/week FV served, with ASPs randomized after baseline data collection to immediate intervention or a 1-year delayed group. The framework employed, STEPs (Strategies To Enhance Practice), focuses on intentional programming of HEPA in each ASPs' daily schedule, and includes a grocery store partnership to reduce price barriers to purchasing FV, professional development training to promote physical activity to develop core physical activity competencies, as well as ongoing technical support/assistance. Primary outcome measures include children's accelerometry-derived MVPA and time spend sedentary while attending an ASP, direct observation of staff HEPA promoting and inhibiting behaviors, types of snacks served, and child consumption of snacks, as well as, cost of snacks via receipts and detailed accounting of intervention delivery costs to estimate cost-effectiveness.
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