Reducing the Intake of Sodium in Community Settings: Evaluation of Year One Activities in the Sodium Reduction in Communities Program, Arkansas, 2016-2017

Creating Healthy Environments for Schools: A Comprehensive Approach to Improving Nutrition in Arkansas Public Schools

BACKGROUND

Nutrition plays a vital role in children's physical and emotional health. More than half of school age children's calories are provided in the school food environment, making school interventions an opportunity to address child nutrition.

METHODS

The Creating Health Environments for Schools (CHEFS) program is designed to leverage local resources to create customized solutions that improve the nutritional content of school food and encourage children to choose healthier food. There are 8 components: (1) customizing nutrition plans, (2) modifying/replacing menu items, (3) helping procure healthier food, (4) providing equipment grants, (5) training cafeteria staff, (6) implementing environmental changes and nudges, (7) engaging students and parents, and (8) supporting sustainability. Supporting child nutrition directors is key to facilitating cooperation with schools.

IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY

Menu modifications and procurement are interrelated and depend on successfully collaborating with corporate, independent, and local food services organizations. Limited school budgets require low or no-cost solutions and staff training. Student and parent engagement are critical to facilitate culturally-appropriate solutions that increase awareness of healthy food.

CONCLUSIONS

Every school district has particular resources and constraints. CHEFs engaged stakeholders to design customized solutions and encourage healthier nutrition for school children.

Reducing Sodium Content of Foods Served in Arkansas's Largest School District: Evaluation of the Sodium Reduction in Communities Program

Purpose and Objectives

The Centers for Disease Control and Prevention’s Sodium Reduction in Communities Program aims to reduce dietary sodium intake through policy, systems, and environmental approaches. The objective of our study was to evaluate changes in sodium levels over 5 years (2016–2021) in food served in school lunches as an outcome of a Sodium Reduction in Communities program in Arkansas’s largest school district.

Intervention Approach

We collaborated with Springdale Public Schools (SPS) to reduce dietary sodium intake in school lunches through increased implementation of 1) food service guidelines, 2) procurement practices, 3) food preparation practices, and 4) environmental strategies. These activities were maintained from year 1 through year 5. Implementation priorities were informed each year by evaluation findings from the preceding year.

Evaluation Methods

We collected lunch service records and information on nutritional content of menu items for the 30 schools under the direction of SPS’s Child Nutrition Department. We used a pretest–posttest quantitative evaluation design to analyze annual changes in the sodium content of meals, from baseline through year 5.

Results

From baseline through year 1, SPS reduced sodium served per diner, per entrée offered, and per entrée served. These reductions were maintained from baseline through 5 years of follow-up. Mean sodium per 1,000 kcal per diner served was 1,740 mg at baseline and was lower in each of the 5 follow-up years: 1,488 mg (14% decrease) in year 1; 1,495 mg (14% decrease) in year 2; 1,612 mg (7% decrease) in year 3; 1,560 mg (10% decrease) in year 4; and 1,532 mg (12% decrease) in year 5. Energy served per diner remained stable.

Implications for Public Health

Our study provides evidence for sustained sodium reduction strategies in a large ethnically and socioeconomically diverse school district, pointing to the potential benefit of implementing similar strategies in other school districts. The study also shows how program evaluation can be used to support sustainability.

Partnerships and Community Engagement Key to Policy, Systems, and Environmental Achievements for Healthy Eating and Active Living: a Systematic Mapping Review

INTRODUCTION

Policy, systems, and environmental (PSE) change approaches frequently address healthy eating and active living (HEAL) priorities. However, the health effects of PSE HEAL initiatives are not well known because of their design complexity and short duration. Planning and evaluation frameworks can guide PSE activities to generate collective impact. We applied a systematic mapping review to the Individual plus PSE Conceptual Framework for Action (I+PSE) to describe characteristics, achievements, challenges, and evaluation strategies of PSE HEAL initiatives.

METHODS

We identified peer-reviewed articles published from January 2009 through January 2021 by using CINAHL, Web of Science, MEDLINE, PsycINFO, and CAB Abstracts databases. Articles describing implementation and results of PSE HEAL initiatives were included. Activities were mapped against I+PSE components to identify gaps in evaluation efforts.

RESULTS

Independent reviewers examined 437 titles and abstracts; 52 peer-reviewed articles met all inclusion criteria. Twenty-four focused on healthy eating, 5 on active living, and 23 on HEAL. Descriptive analyses identified federal funding of initiatives (typically 1-3 years), multisector settings, and mixed-methods evaluation strategies as dominant characteristics. Only 11 articles reported on initiatives that used a formal planning and evaluation framework. Achievements focused on partnership development, individual behavior, environmental or policy changes, and provision of technical assistance. Challenges included lack of local coalition and community engagement in initiatives and evaluation activities and insufficient time and resources to accomplish objectives. The review team noted vague or absent descriptions of evaluation activities, resulting in questionable characterizations of processes and outcomes. Although formation of partnerships was the most commonly reported accomplishment, I+PSE mapping revealed a lack of engagement assessment and its contributions toward initiative impact.

CONCLUSION

PSE HEAL initiatives reported successes in multiple areas but also challenges related to partnership engagement and community buy-in. These 2 areas are essential for the success of PSE HEAL initiatives and need to be adequately evaluated so improvements can be made.

Sodium Reduction in Distributive Meals Through Speed-Scratch Cooking

Purpose and Objectives

Through the Centers for Disease Control and Prevention’s Sodium Reduction in Communities Program, the Marion County Public Health Department and partners implemented sodium reduction strategies in distributive meal programs (ie, low- or no-cost meals available to under-resourced populations) to meet the long-term goal of reducing the burden of sodium-related chronic disease among adults aged 60 or older. The purpose of our study was to evaluate results from the first 2 years of the program, which modified recipes to reduce overall sodium levels through speed–scratch cooking (combining prepared food products with those made from scratch).

Intervention Approach

We modified recipes to reduce sodium content in 2 potato products served frequently as side dishes in distributive programs for older adults for congregate meals — those provided to groups in a community setting — and home-delivered meals.

Evaluation Methods

We compared average sodium content of a 3-month menu cycle between 2 program years, the costs and consumer acceptance of recipe modifications, and consumer perceptions of product changes. Primary data included a nutrient analysis and key informant interviews.

Results

Approximately 2,000 distributive meal clients of CICOA Aging and In-Home Solutions were served reduced-sodium potato dishes over the 2 years of the intervention. From year 1 to year 2, the sodium content of scalloped potatoes was reduced by 65%, and the sodium content of mashed potatoes was reduced by 87%. Client acceptance of the modified recipes met the target threshold of a mean Likert-scale score of 3.75 out of 5.0, and the combined cost savings for both potato dishes was 45 cents per serving. Key informants noted the themes of economics of cost and labor, knowledge of how to identify reduced sodium options, and quality of the replacement food as essential factors for recipe modification.

Implications for Public Health

Using speed–scratch recipe modification for 2 potato dishes significantly reduced the sodium content of distributive meals for older adults. Speed–scratch recipe modification can be used as a tool to improve the nutritional value of meals and reduce the chronic disease burden of high-risk populations.

Reducing Sodium Intake in Community Meals Programs: Evaluation of the Sodium Reduction in Communities Program, Arkansas, 2016-2019

The Sodium Reduction in Communities Program (SRCP) aims to reduce dietary sodium intake through policy, systems, and environmental approaches. We evaluated progress of 3 years of SRCP activities in 3 community meals programs in northwest Arkansas. These activities sought to reduce dietary sodium intake through implementation of 1) food service guidelines, 2) procurement practices, 3) food preparation practices, and 4) environmental strategies. Mean reductions of 579 mg (−40%) in sodium served per diner and 525 mg (−22%) in sodium per 1,000 kcal served per diner were found from baseline to Year 1. Mean reductions of 499 mg (−35%) in sodium served per diner and 372 mg (−16%) in sodium per 1,000 kcal served per diner were sustained from baseline to Year 3. These results highlight the effectiveness and sustainability of sodium reduction interventions in community meals programs, whose diners experience food insecurity, have low incomes, and are at high risk for hypertension.

Sodium menu labelling: priorities for research and policy

OBJECTIVE

To understand the different Na menu labelling approaches that have been considered by state and local policymakers in the USA and to summarise the evidence on the relationship between Na menu labelling and Na content of menu items offered by restaurants or purchased by consumers.

DESIGN

Proposed and enacted Na menu labelling laws at the state and local levels were reviewed using legal databases and an online search, and a narrative review of peer-reviewed literature was conducted on the relationship between Na menu labelling and Na content of menu items offered by restaurants or purchased by consumers.

SETTING

Local and state jurisdictions in the USA.

PARTICIPANTS

Not applicable.

RESULTS

Between 2000 and 2020, thirty-eight laws - eleven at the local level and twenty-seven at the state level - were proposed to require Na labelling of restaurant menu items. By 2020, eight laws were enacted requiring chain restaurants to label the Na content of menu items. Five studies were identified that evaluated the impact of Na menu labelling on Na content of menu items offered by restaurants or purchased by consumers in the USA. The studies had mixed results: two studies showed a statistically significant association between Na menu labelling and reduced Na content of menu items; three showed no effects.

CONCLUSION

Data suggest that Na menu labelling may reduce Na in restaurant menu items, but further rigorous research evaluating Na menu labelling effects on Na content of menu items, as well as on the Na content in menu items purchased by consumers, is needed.

A Community-Based Participatory Approach to Promote Healthy Eating Among Marshallese

This article describes changes made to the menu served during the 2015 Marshallese May Day celebration in Northwest Arkansas, an annual Marshallese community event. The menu changes were part of a community-based participatory collaborative to improve nutrition and health in the Marshallese community. The 2015 May Day menu significantly reduced the 2014 May Day menu amount of calories, fat, carbohydrates, sodium, and cholesterol of foods offered by incorporating healthier ingredients and reducing portion sizes. Compared to the 2014 May Day menu, the total caloric value of the revised menu was reduced by more than 63%, declining from 1369 calories to 499 calories. The menu change affected an estimated 1,800 Marshallese in attendance for the 2015 May Day celebration. The successful implementation of the menu changes, which resulted in reductions in calories, fat, carbohydrates, sodium, and cholesterol offered to participants demonstrates the effectiveness of community-based participatory approaches in the implementation of policy, systems, and environmental strategies to promote health.