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Mozaffarian RS, Carter S, Bovenzi MC, Kenney EL. Comparison of foods and beverages served and consumed in Child and Adult Care Food Program-participating childcare centres to national guidelines. Public Health Nutr 2023; 26:1862-1870. [PMID: 37288521 PMCID: PMC10478045 DOI: 10.1017/s136898002300109x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 02/02/2023] [Accepted: 05/22/2023] [Indexed: 06/09/2023]
Abstract
OBJECTIVE The federal Child and Adult Care Food Program (CACFP) sets minimum nutrition and portion size standards for meals served in participating childcare programs. CACFP has been associated with more nutritious meals served. It is unclear, however, whether CACFP results in children's dietary intake being aligned with national recommendations. We assess whether children's dietary intake in CACFP-participating childcare centres meets benchmarks set by the Dietary Guidelines for Americans (DGA). DESIGN This is a cross-sectional study. We used direct observation to estimate quantities of foods/beverages served and consumed per child. Mean amounts served per child per day were compared with CACFP portion size requirements for each component (fruits, vegetables, milk and meat/meat alternate). Mean amounts of foods/beverages consumed were compared with DGA recommendations (energy content, fruits, vegetables, whole/refined grains, dairy, protein and added sugars). One sample t-tests evaluated if quantities served and consumed were different from CACFP and DGA standards, respectively. SETTING Six CACFP-participating childcare centres. PARTICIPANTS 2-5 year-old children attending childcare. RESULTS We observed forty-six children across 166 child meals. Most meals served met CACFP nutrition standards. Compared with CACFP portion size standards, children were served more grains at breakfast and lunch; more fruits/vegetables at lunch but less at breakfast and snack and less dairy at all eating occasions. Compared with DGA recommendations, children under-consumed every food/beverage category except grains during at least one eating occasion. CONCLUSIONS Children were served quantities of foods/beverages mostly consistent with CACFP portion size requirements, but had sub-optimal intake relative to DGA. More research is needed to help children consume healthy diets in childcare.
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Affiliation(s)
- Rebecca S Mozaffarian
- Department of Nutrition, Harvard TH Chan School of Public Health, 665 Huntington Ave, Boston, MA02115, USA
| | - Sonia Carter
- Boston Public Health Commission, Boston, MA02118, USA
| | | | - Erica L Kenney
- Department of Nutrition, Harvard TH Chan School of Public Health, 665 Huntington Ave, Boston, MA02115, USA
- Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, Boston, MA02115, USA
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Woods AJ, Probst YC, Norman J, Wardle K, Ryan ST, Patel L, Crowe RK, Okely AD. Correlates of physical activity and sedentary behaviour in children attending before and after school care: a systematic review. BMC Public Health 2022; 22:2364. [PMID: 36527045 PMCID: PMC9758811 DOI: 10.1186/s12889-022-14675-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 11/18/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Out of School Hours Care (OSHC) offers structured care to elementary/primary-aged children before and after school, and during school holidays. The promotion of physical activity in OSHC is important for childhood obesity prevention. The aim of this systematic review was to identify correlates of objectively measured physical activity and sedentary behaviour in before and after school care. METHODS A systematic search was conducted in Scopus, ERIC, MEDLINE (EBSCO), PsycINFO and Web of Science databases up to December 2021. Study inclusion criteria were: written in English; from a peer-reviewed journal; data from a centre-based before and/or after school care service; children with a mean age < 13 years; an objective measure of physical activity or sedentary behaviour; reported correlations and significance levels; and if an intervention study design these correlates were reported at baseline. Study quality was assessed using the Office of Health Assessment and Translation Risk of Bias Rating Tool for Human and Animal Studies. The PRISMA guidelines informed the reporting, and data were synthesised according to shared correlations and a social ecological framework. RESULTS Database searches identified 4559 papers, with 18 cross-sectional studies meeting the inclusion criteria.There were a total of 116 physical activity correlates and 64 sedentary behaviour correlates identified. The most frequently reported correlates of physical activity were child sex (males more active), staff engaging in physical activity, an absence of elimination games, and scheduling physical activity in daily programming (all more positively associated). The most frequently reported correlates of sedentary behaviour were child sex (females more sedentary) and age (older children more sedentary). CONCLUSIONS Encouraging physical activity engagement of female children, promoting positive staff behaviours, removing elimination elements from games, and scheduling more time for physical activity should be priorities for service providers. Additional research is needed in before school care services.
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Affiliation(s)
- Andrew J. Woods
- grid.1007.60000 0004 0486 528XSchool of Health and Society, Faculty of the Arts Social Sciences and Humanities, University of Wollongong, Wollongong, NSW Australia ,grid.1007.60000 0004 0486 528XEarly Start, Faculty of the Arts Social Sciences and Humanities, University of Wollongong, Wollongong, NSW Australia
| | - Yasmine C. Probst
- grid.1007.60000 0004 0486 528XSchool of Medical Indigenous and Health Sciences, Faculty of Science Medicine and Health, University of Wollongong, Wollongong, NSW Australia ,grid.1007.60000 0004 0486 528XIllawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW Australia
| | - Jennifer Norman
- grid.1007.60000 0004 0486 528XSchool of Health and Society, Faculty of the Arts Social Sciences and Humanities, University of Wollongong, Wollongong, NSW Australia ,grid.1007.60000 0004 0486 528XIllawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW Australia ,grid.508553.e0000 0004 0587 927XHealth Promotion Service, Illawarra Shoalhaven Local Health District, Warrawong, NSW 2502 Australia
| | - Karen Wardle
- grid.410692.80000 0001 2105 7653Health Promotion Service, South Western Sydney Local Health District, Liverpool, NSW 2170 Australia
| | - Sarah T. Ryan
- grid.1007.60000 0004 0486 528XSchool of Health and Society, Faculty of the Arts Social Sciences and Humanities, University of Wollongong, Wollongong, NSW Australia ,grid.1007.60000 0004 0486 528XEarly Start, Faculty of the Arts Social Sciences and Humanities, University of Wollongong, Wollongong, NSW Australia
| | - Linda Patel
- grid.1007.60000 0004 0486 528XSchool of Health and Society, Faculty of the Arts Social Sciences and Humanities, University of Wollongong, Wollongong, NSW Australia ,grid.1007.60000 0004 0486 528XEarly Start, Faculty of the Arts Social Sciences and Humanities, University of Wollongong, Wollongong, NSW Australia
| | - Ruth K. Crowe
- grid.1007.60000 0004 0486 528XEarly Start, Faculty of the Arts Social Sciences and Humanities, University of Wollongong, Wollongong, NSW Australia ,grid.1007.60000 0004 0486 528XSchool of Medical Indigenous and Health Sciences, Faculty of Science Medicine and Health, University of Wollongong, Wollongong, NSW Australia
| | - Anthony D. Okely
- grid.1007.60000 0004 0486 528XSchool of Health and Society, Faculty of the Arts Social Sciences and Humanities, University of Wollongong, Wollongong, NSW Australia ,grid.1007.60000 0004 0486 528XEarly Start, Faculty of the Arts Social Sciences and Humanities, University of Wollongong, Wollongong, NSW Australia ,grid.1007.60000 0004 0486 528XIllawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW Australia
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Healthy snacking in the school environment: Exploring children and mothers' perspective using projective techniques. Food Qual Prefer 2021. [DOI: 10.1016/j.foodqual.2020.104173] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Hartline-Grafton H, Hassink SG. Food Insecurity and Health: Practices and Policies to Address Food Insecurity among Children. Acad Pediatr 2021; 21:205-210. [PMID: 32653691 PMCID: PMC7347342 DOI: 10.1016/j.acap.2020.07.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 07/01/2020] [Accepted: 07/05/2020] [Indexed: 11/23/2022]
Affiliation(s)
| | - Sandra G Hassink
- AAP Institute for Healthy Childhood Weight (SG Hassink), Itasca, Ill
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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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Kemper KA, Pate SP, Powers AR, Fair M. Promoting Healthy Environments In Afterschool Settings: The LiveWell Greenville Afterschool Initiative. Prev Chronic Dis 2018; 15:E144. [PMID: 30468420 PMCID: PMC6266516 DOI: 10.5888/pcd15.180164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION LiveWell Greenville, a multi-organization community coalition, launched an initiative in 2011 to help afterschool programs promote environments that decrease the risk of obesity among children and adolescents. The objective of this study was to describe changes in nutrition and physical activity environments, policies, and practices among 37 afterschool programs after their participation in the LiveWell Greenville Afterschool Initiative. METHODS The study used a nonexperimental, pre- and postsurvey design. The survey was based on the Nutrition and Physical Activity Self-Assessment for Child Care questionnaire and modified for afterschool settings. Items addressed sedentary time, physical activity time, availability of sugar-sweetened beverages, sweet and salty snack consumption, fruit consumption, staff behaviors, and policies that support nutrition and physical activity practices. The self-assessment survey was completed by an afterschool program supervisor at each site. The 9-month intervention consisted of program staff members' completing the pre-assessment and goal-setting worksheet, receiving technical support and training from LiveWell Greenville staff, attending networking meetings about nutrition and physical activity promotion strategies, and completing a postassessment. RESULTS We found significant positive changes in afterschool environments in the type and frequency of snacks offered, duration of children's sedentary time, staff behaviors that supported healthy nutrition and physical activity practices, and education provided to staff, children, and parents. CONCLUSION We found the LiveWell Greenville Afterschool Initiative, which involved self-assessment, goal setting and technical support, to be a successful strategy to change nutrition and physical activity environments in afterschool settings.
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Affiliation(s)
- Karen A Kemper
- Department of Public Health Sciences, Clemson University, 533 Edwards Hall, Clemson, SC 29634. .,LiveWell Greenville, Greenville, South Carolina
| | | | - Alicia R Powers
- LiveWell Greenville, Greenville, South Carolina.,Supplemental Nutrition Assistance Program-Education, Alabama Cooperative Extension, Auburn University, Alabama
| | - Melissa Fair
- Institute for the Advancement of Community Health, Furman University, Greenville, South Carolina
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Kenney EL, Lee RM, Brooks CJ, Cradock AL, Gortmaker SL. What Do Children Eat in the Summer? A Direct Observation of Summer Day Camps That Serve Meals. J Acad Nutr Diet 2017; 117:1097-1103. [PMID: 28330733 DOI: 10.1016/j.jand.2017.01.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 01/24/2017] [Indexed: 01/01/2023]
Abstract
BACKGROUND More than 14 million children in the United States attend summer camp annually, yet little is known about the food environment in day camps. OBJECTIVE Our aim was to describe the nutritional quality of meals served to, brought by, and consumed by children attending summer day camps serving meals and snacks, and to describe camp water access. DESIGN We conducted a cross-sectional study. PARTICIPANTS/SETTINGS Participants were 149 children attending five summer camps in Boston, MA, in 2013. MAIN OUTCOME MEASURES Foods and beverages served were observed for 5 consecutive days. For 2 days, children's dietary intake was directly observed using a validated protocol. Outcome measures included total energy (kilocalories) and servings of different types of foods and beverages served and consumed during breakfast, lunch, and snack. STATISTICAL ANALYSES PERFORMED Mean total energy, trans fats, sodium, sugar, and fiber served per meal were calculated across the camps, as were mean weekly frequencies of serving fruits, vegetables, meat/meat alternates, grains, milk, 100% juice, sugar-sweetened beverages, whole grains, red/highly processed meats, grain-based desserts, and salty snacks. Mean consumption was calculated per camper per day. RESULTS Camps served a mean (standard deviation) of 647.7 (134.3) kcal for lunch, 401.8 (149.6) kcal for breakfast, and 266.4 (150.8) kcal for snack. Most camps served red/highly processed meats, salty snacks, and grain-based desserts frequently, and rarely served vegetables or water. Children consumed little (eg, at lunch, 36.5% of fruit portions, 35.0% of meat/meat alternative portions, and 37.6% of milk portions served) except for salty snacks (66.9% of portions) and grain-based desserts (64.1% of portions). Sugar-sweetened beverages and salty snacks were frequently brought to camp. One-quarter of campers drank nothing throughout the entire camp day. CONCLUSIONS The nutritional quality of foods and beverages served at summer day camps could be improved. Future studies should assess barriers to consumption of healthy foods and beverages in these settings.
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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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Moaadeli Z, Hossainnejad Neyrizi A, Sharifikia I, Abbasi Marandi K. The Study of Knowledge, Attitude and Nutritional Practice of Secondary School Students in Darab City, Fars Province, Iran in 2011-2012. INTERNATIONAL JOURNAL OF SCHOOL HEALTH 2015. [DOI: 10.17795/intjsh-25702] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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