1
|
Jacob V, Reynolds JA, Chattopadhyay SK, Hopkins DP, Brown DR, Devlin HM, Barrett A, Berrigan D, Crespo CJ, Heath GW, Brownson RC, Cuellar AE, Clymer JM, Chriqui JF. Parks, Trails, and Greenways for Physical Activity: A Community Guide Systematic Economic Review. Am J Prev Med 2024:S0749-3797(24)00040-0. [PMID: 38331114 DOI: 10.1016/j.amepre.2024.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 01/30/2024] [Accepted: 01/30/2024] [Indexed: 02/10/2024]
Abstract
INTRODUCTION This systematic economic review examined the cost-benefit and cost-effectiveness of park, trail, and greenway infrastructure interventions to increase physical activity or infrastructure use. METHODS The search period covered the date of inception of publications databases through February 2022. Inclusion was limited to studies that reported cost-benefit or cost-effectiveness outcomes and were based in the U.S. and other high-income countries. Analyses were conducted from March 2022 through December 2022. All monetary values reported are in 2021 U.S. dollars. RESULTS The search yielded 1 study based in the U.S. and 7 based in other high-income countries, with 1 reporting cost-effectiveness and 7 reporting cost-benefit outcomes. The cost-effectiveness study based in the United Kingdom reported $23,254 per disability-adjusted life year averted. The median benefit-to-cost ratio was 3.1 (interquartile interval=2.9-3.9) on the basis of 7 studies. DISCUSSION The evidence shows that economic benefits exceed the intervention cost of park, trail, and greenway infrastructure. Given large differences in the size of infrastructure, intervention costs and economic benefits varied substantially across studies. There was insufficient number of studies to determine the cost-effectiveness of these interventions.
Collapse
Affiliation(s)
- Verughese Jacob
- Community Guide Program, Office of Scientific Evidence and Recommendations, Office of Science, Centers for Disease Control and Prevention, Atlanta, Georgia.
| | - Jeffrey A Reynolds
- Community Guide Program, Office of Scientific Evidence and Recommendations, Office of Science, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Sajal K Chattopadhyay
- Community Guide Program, Office of Scientific Evidence and Recommendations, Office of Science, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - David P Hopkins
- Community Guide Program, Office of Scientific Evidence and Recommendations, Office of Science, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - David R Brown
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Heather M Devlin
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Austin Barrett
- National Recreation and Park Association, Ashburn, Virginia
| | - David Berrigan
- Behavior Research Program, National Cancer Institute, Bethesda, Maryland
| | - Carlos J Crespo
- College of Applied Health Sciences, University of Illinois, Chicago, Illinois
| | - Gregory W Heath
- Department of Health and Human Performance, The University of Tennessee at Chattanooga, Chattanooga, Tennessee
| | - Ross C Brownson
- Brown School, Washington University in St. Louis, Saint Louis, Missouri; Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Alison E Cuellar
- Department of Health Administration and Policy, George Mason University, Fairfax, Virginia
| | - John M Clymer
- National Forum for Heart Disease & Stroke Prevention, Washington, District of Columbia
| | - Jamie F Chriqui
- Institute for Health Research and Policy, University of Illinois Chicago, Chicago, Illinois
| |
Collapse
|
2
|
Greenberg JD, van der Mars H, McKenzie TL, Battista RA, Chriqui JF, Cornett K, Graber KC, Kern BD, Russell JA, Ward DS, Wilson WJ. The Role of Physical Education Within the National Physical Activity Plan. J Phys Educ Recreat Dance 2024; 95:7-16. [PMID: 38463632 PMCID: PMC10922003 DOI: 10.1080/07303084.2023.2291641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Affiliation(s)
- Jayne D Greenberg
- Jayne D. Greenberg is the Education Sector Committee chair, NPAP and North America chair at the International Sport and Culture Association in Weston, FL. Hans van der Mars is a professor emeritus at Arizona State University in Tempe, AZ. Thomas L. McKenzie is a professor emeritus in the School of Exercise and Nutritional Sciences at San Diego State University in San Diego, CA. Rebecca A. Battista is a professor in the Department of Public Health and Exercise Science at Appalachian State University in Boone, NC. Jamie F. Chriqui is a senior associate dean in the School of Public Health; a Professor in the Health Policy and Administration; and a director in Health Policy Research at the Institute for Health Research and Policy at the University of Illinois-Chicago in Chicago, IL. Kelly Cornett is a health scientist in the Research Application and Evaluation Team, Healthy Schools Branch, Division of Population Health at the Centers for Disease Control and Prevention in Atlanta, GA. Kim C. Graber is a professor and department head in the Department of Kinesiology and Community Health, at the University of Illinois-Urbana/Champaign in Urbana, IL. Ben D. Kern is an assistant professor and PETE program coordinator in the Division of Kinesiology and Health at the University of Wyoming in Laramie, WY. Jared A. Russell is an associate dean for Academic and Faculty Affairs and professor in the School of Kinesiology at Auburn University in Auburn, AL. Dianne S. Ward is a professor and director of the Intervention and Policy Division in the Department of Nutrition at the University of North Carolina-Chapel Hill in Chapel Hill, NC. Wesley J. Wilson is an assistant professor in the Department of Kinesiology and Community Health at the University of Illinois-Urbana/Champaign in Urbana, IL
| | - Hans van der Mars
- Jayne D. Greenberg is the Education Sector Committee chair, NPAP and North America chair at the International Sport and Culture Association in Weston, FL. Hans van der Mars is a professor emeritus at Arizona State University in Tempe, AZ. Thomas L. McKenzie is a professor emeritus in the School of Exercise and Nutritional Sciences at San Diego State University in San Diego, CA. Rebecca A. Battista is a professor in the Department of Public Health and Exercise Science at Appalachian State University in Boone, NC. Jamie F. Chriqui is a senior associate dean in the School of Public Health; a Professor in the Health Policy and Administration; and a director in Health Policy Research at the Institute for Health Research and Policy at the University of Illinois-Chicago in Chicago, IL. Kelly Cornett is a health scientist in the Research Application and Evaluation Team, Healthy Schools Branch, Division of Population Health at the Centers for Disease Control and Prevention in Atlanta, GA. Kim C. Graber is a professor and department head in the Department of Kinesiology and Community Health, at the University of Illinois-Urbana/Champaign in Urbana, IL. Ben D. Kern is an assistant professor and PETE program coordinator in the Division of Kinesiology and Health at the University of Wyoming in Laramie, WY. Jared A. Russell is an associate dean for Academic and Faculty Affairs and professor in the School of Kinesiology at Auburn University in Auburn, AL. Dianne S. Ward is a professor and director of the Intervention and Policy Division in the Department of Nutrition at the University of North Carolina-Chapel Hill in Chapel Hill, NC. Wesley J. Wilson is an assistant professor in the Department of Kinesiology and Community Health at the University of Illinois-Urbana/Champaign in Urbana, IL
| | - Thomas L McKenzie
- Jayne D. Greenberg is the Education Sector Committee chair, NPAP and North America chair at the International Sport and Culture Association in Weston, FL. Hans van der Mars is a professor emeritus at Arizona State University in Tempe, AZ. Thomas L. McKenzie is a professor emeritus in the School of Exercise and Nutritional Sciences at San Diego State University in San Diego, CA. Rebecca A. Battista is a professor in the Department of Public Health and Exercise Science at Appalachian State University in Boone, NC. Jamie F. Chriqui is a senior associate dean in the School of Public Health; a Professor in the Health Policy and Administration; and a director in Health Policy Research at the Institute for Health Research and Policy at the University of Illinois-Chicago in Chicago, IL. Kelly Cornett is a health scientist in the Research Application and Evaluation Team, Healthy Schools Branch, Division of Population Health at the Centers for Disease Control and Prevention in Atlanta, GA. Kim C. Graber is a professor and department head in the Department of Kinesiology and Community Health, at the University of Illinois-Urbana/Champaign in Urbana, IL. Ben D. Kern is an assistant professor and PETE program coordinator in the Division of Kinesiology and Health at the University of Wyoming in Laramie, WY. Jared A. Russell is an associate dean for Academic and Faculty Affairs and professor in the School of Kinesiology at Auburn University in Auburn, AL. Dianne S. Ward is a professor and director of the Intervention and Policy Division in the Department of Nutrition at the University of North Carolina-Chapel Hill in Chapel Hill, NC. Wesley J. Wilson is an assistant professor in the Department of Kinesiology and Community Health at the University of Illinois-Urbana/Champaign in Urbana, IL
| | - Rebecca A Battista
- Jayne D. Greenberg is the Education Sector Committee chair, NPAP and North America chair at the International Sport and Culture Association in Weston, FL. Hans van der Mars is a professor emeritus at Arizona State University in Tempe, AZ. Thomas L. McKenzie is a professor emeritus in the School of Exercise and Nutritional Sciences at San Diego State University in San Diego, CA. Rebecca A. Battista is a professor in the Department of Public Health and Exercise Science at Appalachian State University in Boone, NC. Jamie F. Chriqui is a senior associate dean in the School of Public Health; a Professor in the Health Policy and Administration; and a director in Health Policy Research at the Institute for Health Research and Policy at the University of Illinois-Chicago in Chicago, IL. Kelly Cornett is a health scientist in the Research Application and Evaluation Team, Healthy Schools Branch, Division of Population Health at the Centers for Disease Control and Prevention in Atlanta, GA. Kim C. Graber is a professor and department head in the Department of Kinesiology and Community Health, at the University of Illinois-Urbana/Champaign in Urbana, IL. Ben D. Kern is an assistant professor and PETE program coordinator in the Division of Kinesiology and Health at the University of Wyoming in Laramie, WY. Jared A. Russell is an associate dean for Academic and Faculty Affairs and professor in the School of Kinesiology at Auburn University in Auburn, AL. Dianne S. Ward is a professor and director of the Intervention and Policy Division in the Department of Nutrition at the University of North Carolina-Chapel Hill in Chapel Hill, NC. Wesley J. Wilson is an assistant professor in the Department of Kinesiology and Community Health at the University of Illinois-Urbana/Champaign in Urbana, IL
| | - Jamie F Chriqui
- Jayne D. Greenberg is the Education Sector Committee chair, NPAP and North America chair at the International Sport and Culture Association in Weston, FL. Hans van der Mars is a professor emeritus at Arizona State University in Tempe, AZ. Thomas L. McKenzie is a professor emeritus in the School of Exercise and Nutritional Sciences at San Diego State University in San Diego, CA. Rebecca A. Battista is a professor in the Department of Public Health and Exercise Science at Appalachian State University in Boone, NC. Jamie F. Chriqui is a senior associate dean in the School of Public Health; a Professor in the Health Policy and Administration; and a director in Health Policy Research at the Institute for Health Research and Policy at the University of Illinois-Chicago in Chicago, IL. Kelly Cornett is a health scientist in the Research Application and Evaluation Team, Healthy Schools Branch, Division of Population Health at the Centers for Disease Control and Prevention in Atlanta, GA. Kim C. Graber is a professor and department head in the Department of Kinesiology and Community Health, at the University of Illinois-Urbana/Champaign in Urbana, IL. Ben D. Kern is an assistant professor and PETE program coordinator in the Division of Kinesiology and Health at the University of Wyoming in Laramie, WY. Jared A. Russell is an associate dean for Academic and Faculty Affairs and professor in the School of Kinesiology at Auburn University in Auburn, AL. Dianne S. Ward is a professor and director of the Intervention and Policy Division in the Department of Nutrition at the University of North Carolina-Chapel Hill in Chapel Hill, NC. Wesley J. Wilson is an assistant professor in the Department of Kinesiology and Community Health at the University of Illinois-Urbana/Champaign in Urbana, IL
| | - Kelly Cornett
- Jayne D. Greenberg is the Education Sector Committee chair, NPAP and North America chair at the International Sport and Culture Association in Weston, FL. Hans van der Mars is a professor emeritus at Arizona State University in Tempe, AZ. Thomas L. McKenzie is a professor emeritus in the School of Exercise and Nutritional Sciences at San Diego State University in San Diego, CA. Rebecca A. Battista is a professor in the Department of Public Health and Exercise Science at Appalachian State University in Boone, NC. Jamie F. Chriqui is a senior associate dean in the School of Public Health; a Professor in the Health Policy and Administration; and a director in Health Policy Research at the Institute for Health Research and Policy at the University of Illinois-Chicago in Chicago, IL. Kelly Cornett is a health scientist in the Research Application and Evaluation Team, Healthy Schools Branch, Division of Population Health at the Centers for Disease Control and Prevention in Atlanta, GA. Kim C. Graber is a professor and department head in the Department of Kinesiology and Community Health, at the University of Illinois-Urbana/Champaign in Urbana, IL. Ben D. Kern is an assistant professor and PETE program coordinator in the Division of Kinesiology and Health at the University of Wyoming in Laramie, WY. Jared A. Russell is an associate dean for Academic and Faculty Affairs and professor in the School of Kinesiology at Auburn University in Auburn, AL. Dianne S. Ward is a professor and director of the Intervention and Policy Division in the Department of Nutrition at the University of North Carolina-Chapel Hill in Chapel Hill, NC. Wesley J. Wilson is an assistant professor in the Department of Kinesiology and Community Health at the University of Illinois-Urbana/Champaign in Urbana, IL
| | - Kim C Graber
- Jayne D. Greenberg is the Education Sector Committee chair, NPAP and North America chair at the International Sport and Culture Association in Weston, FL. Hans van der Mars is a professor emeritus at Arizona State University in Tempe, AZ. Thomas L. McKenzie is a professor emeritus in the School of Exercise and Nutritional Sciences at San Diego State University in San Diego, CA. Rebecca A. Battista is a professor in the Department of Public Health and Exercise Science at Appalachian State University in Boone, NC. Jamie F. Chriqui is a senior associate dean in the School of Public Health; a Professor in the Health Policy and Administration; and a director in Health Policy Research at the Institute for Health Research and Policy at the University of Illinois-Chicago in Chicago, IL. Kelly Cornett is a health scientist in the Research Application and Evaluation Team, Healthy Schools Branch, Division of Population Health at the Centers for Disease Control and Prevention in Atlanta, GA. Kim C. Graber is a professor and department head in the Department of Kinesiology and Community Health, at the University of Illinois-Urbana/Champaign in Urbana, IL. Ben D. Kern is an assistant professor and PETE program coordinator in the Division of Kinesiology and Health at the University of Wyoming in Laramie, WY. Jared A. Russell is an associate dean for Academic and Faculty Affairs and professor in the School of Kinesiology at Auburn University in Auburn, AL. Dianne S. Ward is a professor and director of the Intervention and Policy Division in the Department of Nutrition at the University of North Carolina-Chapel Hill in Chapel Hill, NC. Wesley J. Wilson is an assistant professor in the Department of Kinesiology and Community Health at the University of Illinois-Urbana/Champaign in Urbana, IL
| | - Ben D Kern
- Jayne D. Greenberg is the Education Sector Committee chair, NPAP and North America chair at the International Sport and Culture Association in Weston, FL. Hans van der Mars is a professor emeritus at Arizona State University in Tempe, AZ. Thomas L. McKenzie is a professor emeritus in the School of Exercise and Nutritional Sciences at San Diego State University in San Diego, CA. Rebecca A. Battista is a professor in the Department of Public Health and Exercise Science at Appalachian State University in Boone, NC. Jamie F. Chriqui is a senior associate dean in the School of Public Health; a Professor in the Health Policy and Administration; and a director in Health Policy Research at the Institute for Health Research and Policy at the University of Illinois-Chicago in Chicago, IL. Kelly Cornett is a health scientist in the Research Application and Evaluation Team, Healthy Schools Branch, Division of Population Health at the Centers for Disease Control and Prevention in Atlanta, GA. Kim C. Graber is a professor and department head in the Department of Kinesiology and Community Health, at the University of Illinois-Urbana/Champaign in Urbana, IL. Ben D. Kern is an assistant professor and PETE program coordinator in the Division of Kinesiology and Health at the University of Wyoming in Laramie, WY. Jared A. Russell is an associate dean for Academic and Faculty Affairs and professor in the School of Kinesiology at Auburn University in Auburn, AL. Dianne S. Ward is a professor and director of the Intervention and Policy Division in the Department of Nutrition at the University of North Carolina-Chapel Hill in Chapel Hill, NC. Wesley J. Wilson is an assistant professor in the Department of Kinesiology and Community Health at the University of Illinois-Urbana/Champaign in Urbana, IL
| | - Jared A Russell
- Jayne D. Greenberg is the Education Sector Committee chair, NPAP and North America chair at the International Sport and Culture Association in Weston, FL. Hans van der Mars is a professor emeritus at Arizona State University in Tempe, AZ. Thomas L. McKenzie is a professor emeritus in the School of Exercise and Nutritional Sciences at San Diego State University in San Diego, CA. Rebecca A. Battista is a professor in the Department of Public Health and Exercise Science at Appalachian State University in Boone, NC. Jamie F. Chriqui is a senior associate dean in the School of Public Health; a Professor in the Health Policy and Administration; and a director in Health Policy Research at the Institute for Health Research and Policy at the University of Illinois-Chicago in Chicago, IL. Kelly Cornett is a health scientist in the Research Application and Evaluation Team, Healthy Schools Branch, Division of Population Health at the Centers for Disease Control and Prevention in Atlanta, GA. Kim C. Graber is a professor and department head in the Department of Kinesiology and Community Health, at the University of Illinois-Urbana/Champaign in Urbana, IL. Ben D. Kern is an assistant professor and PETE program coordinator in the Division of Kinesiology and Health at the University of Wyoming in Laramie, WY. Jared A. Russell is an associate dean for Academic and Faculty Affairs and professor in the School of Kinesiology at Auburn University in Auburn, AL. Dianne S. Ward is a professor and director of the Intervention and Policy Division in the Department of Nutrition at the University of North Carolina-Chapel Hill in Chapel Hill, NC. Wesley J. Wilson is an assistant professor in the Department of Kinesiology and Community Health at the University of Illinois-Urbana/Champaign in Urbana, IL
| | - Dianne S Ward
- Jayne D. Greenberg is the Education Sector Committee chair, NPAP and North America chair at the International Sport and Culture Association in Weston, FL. Hans van der Mars is a professor emeritus at Arizona State University in Tempe, AZ. Thomas L. McKenzie is a professor emeritus in the School of Exercise and Nutritional Sciences at San Diego State University in San Diego, CA. Rebecca A. Battista is a professor in the Department of Public Health and Exercise Science at Appalachian State University in Boone, NC. Jamie F. Chriqui is a senior associate dean in the School of Public Health; a Professor in the Health Policy and Administration; and a director in Health Policy Research at the Institute for Health Research and Policy at the University of Illinois-Chicago in Chicago, IL. Kelly Cornett is a health scientist in the Research Application and Evaluation Team, Healthy Schools Branch, Division of Population Health at the Centers for Disease Control and Prevention in Atlanta, GA. Kim C. Graber is a professor and department head in the Department of Kinesiology and Community Health, at the University of Illinois-Urbana/Champaign in Urbana, IL. Ben D. Kern is an assistant professor and PETE program coordinator in the Division of Kinesiology and Health at the University of Wyoming in Laramie, WY. Jared A. Russell is an associate dean for Academic and Faculty Affairs and professor in the School of Kinesiology at Auburn University in Auburn, AL. Dianne S. Ward is a professor and director of the Intervention and Policy Division in the Department of Nutrition at the University of North Carolina-Chapel Hill in Chapel Hill, NC. Wesley J. Wilson is an assistant professor in the Department of Kinesiology and Community Health at the University of Illinois-Urbana/Champaign in Urbana, IL
| | - Wesley J Wilson
- Jayne D. Greenberg is the Education Sector Committee chair, NPAP and North America chair at the International Sport and Culture Association in Weston, FL. Hans van der Mars is a professor emeritus at Arizona State University in Tempe, AZ. Thomas L. McKenzie is a professor emeritus in the School of Exercise and Nutritional Sciences at San Diego State University in San Diego, CA. Rebecca A. Battista is a professor in the Department of Public Health and Exercise Science at Appalachian State University in Boone, NC. Jamie F. Chriqui is a senior associate dean in the School of Public Health; a Professor in the Health Policy and Administration; and a director in Health Policy Research at the Institute for Health Research and Policy at the University of Illinois-Chicago in Chicago, IL. Kelly Cornett is a health scientist in the Research Application and Evaluation Team, Healthy Schools Branch, Division of Population Health at the Centers for Disease Control and Prevention in Atlanta, GA. Kim C. Graber is a professor and department head in the Department of Kinesiology and Community Health, at the University of Illinois-Urbana/Champaign in Urbana, IL. Ben D. Kern is an assistant professor and PETE program coordinator in the Division of Kinesiology and Health at the University of Wyoming in Laramie, WY. Jared A. Russell is an associate dean for Academic and Faculty Affairs and professor in the School of Kinesiology at Auburn University in Auburn, AL. Dianne S. Ward is a professor and director of the Intervention and Policy Division in the Department of Nutrition at the University of North Carolina-Chapel Hill in Chapel Hill, NC. Wesley J. Wilson is an assistant professor in the Department of Kinesiology and Community Health at the University of Illinois-Urbana/Champaign in Urbana, IL
| |
Collapse
|
3
|
Asada Y, Schermbeck R, Thiede K, Chriqui JF. Opportunities to Improve Access to and Retention in the Child and Adult Care Food Program: Key Recommendations From Early Childcare Providers in Illinois, December 2020-July 2021. Am J Public Health 2023; 113:S231-S239. [PMID: 38118081 PMCID: PMC10733880 DOI: 10.2105/ajph.2023.307433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2023] [Indexed: 12/22/2023]
Abstract
Objectives. To identify recommendations to improve access to and retention in the Child and Adult Care Food Program (CACFP) as critical strategies to address health equity for low-income children. Methods. We conducted a qualitative key informant study of early childcare center and home providers (n = 35) in low-income urban and rural census tracts in Illinois between December 2020 and July 2021. Interviews with providers were organized and analyzed by the study team in MAXQDA Qualitative Data Analysis software. Themes were refined and finalized via member checking with an expert panel of providers and advocates. Results. Overall, providers spoke positively of the benefits of CACFP participation. Themes that centered around strategies to improve awareness of and access to CACFP included (1) conducting systematic statewide outreach, (2) improving technical assistance for enrollment, and (3) supporting positive sponsor-provider relationships. Themes related to retention included (1) alleviating procurement burdens, (2) extending reimbursement rates, and (3) expanding flexibilities. Conclusions. Policymakers looking to increase access to and retention in CACFP could consider state-level strategies such as systematic outreach and more targeted technical assistance. (Am J Public Health. 2024;113(S3):S231-S239. https://doi.org/10.2105/AJPH.2023.307433).
Collapse
Affiliation(s)
- Yuka Asada
- Yuka Asada is with the School of Public Health, University of Illinois, Chicago. Rebecca Schermbeck and Kendall Thiede are with the Institute for Health Research and Policy, University of Illinois, Chicago. Jamie F. Chriqui is with the Division of Health Policy Research, Institute for Health Research and Policy, and Department of Health Policy and Administration, School of Public Health, University of Illinois, Chicago. Yuka Asada is also a Guest Editor for this supplement issue
| | - Rebecca Schermbeck
- Yuka Asada is with the School of Public Health, University of Illinois, Chicago. Rebecca Schermbeck and Kendall Thiede are with the Institute for Health Research and Policy, University of Illinois, Chicago. Jamie F. Chriqui is with the Division of Health Policy Research, Institute for Health Research and Policy, and Department of Health Policy and Administration, School of Public Health, University of Illinois, Chicago. Yuka Asada is also a Guest Editor for this supplement issue
| | - Kendall Thiede
- Yuka Asada is with the School of Public Health, University of Illinois, Chicago. Rebecca Schermbeck and Kendall Thiede are with the Institute for Health Research and Policy, University of Illinois, Chicago. Jamie F. Chriqui is with the Division of Health Policy Research, Institute for Health Research and Policy, and Department of Health Policy and Administration, School of Public Health, University of Illinois, Chicago. Yuka Asada is also a Guest Editor for this supplement issue
| | - Jamie F Chriqui
- Yuka Asada is with the School of Public Health, University of Illinois, Chicago. Rebecca Schermbeck and Kendall Thiede are with the Institute for Health Research and Policy, University of Illinois, Chicago. Jamie F. Chriqui is with the Division of Health Policy Research, Institute for Health Research and Policy, and Department of Health Policy and Administration, School of Public Health, University of Illinois, Chicago. Yuka Asada is also a Guest Editor for this supplement issue
| |
Collapse
|
4
|
Asada Y, Bleiweiss-Sande R, Barnes C, Lane H, Chriqui JF. In Pursuit of Equitable Access in Federal Food and Nutrition Assistance Programs. Am J Public Health 2023; 113:S175-S179. [PMID: 38118097 PMCID: PMC10733889 DOI: 10.2105/ajph.2023.307496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2023] [Indexed: 12/22/2023]
Affiliation(s)
- Yuka Asada
- Yuka Asada is with the School of Public Health, University of Illinois, Chicago. Rachel Bleiweiss-Sande is with Mathematica in Princeton, NJ. Carolyn Barnes is with the Crown Family School of Social Work, Policy, and Practice, The University of Chicago. Hannah Lane is with the Department of Population Health Sciences, School of Medicine, Duke University, Durham, NC. Jamie F. Chriqui is with the Division of Health Policy Research, Institute for Health Research and Policy, and Department of Health Policy and Administration, School of Public Health, University of Illinois, Chicago. Yuka Asada and Rachel Bleiweiss-Sande are also Guest Editors for this supplement issue
| | - Rachel Bleiweiss-Sande
- Yuka Asada is with the School of Public Health, University of Illinois, Chicago. Rachel Bleiweiss-Sande is with Mathematica in Princeton, NJ. Carolyn Barnes is with the Crown Family School of Social Work, Policy, and Practice, The University of Chicago. Hannah Lane is with the Department of Population Health Sciences, School of Medicine, Duke University, Durham, NC. Jamie F. Chriqui is with the Division of Health Policy Research, Institute for Health Research and Policy, and Department of Health Policy and Administration, School of Public Health, University of Illinois, Chicago. Yuka Asada and Rachel Bleiweiss-Sande are also Guest Editors for this supplement issue
| | - Carolyn Barnes
- Yuka Asada is with the School of Public Health, University of Illinois, Chicago. Rachel Bleiweiss-Sande is with Mathematica in Princeton, NJ. Carolyn Barnes is with the Crown Family School of Social Work, Policy, and Practice, The University of Chicago. Hannah Lane is with the Department of Population Health Sciences, School of Medicine, Duke University, Durham, NC. Jamie F. Chriqui is with the Division of Health Policy Research, Institute for Health Research and Policy, and Department of Health Policy and Administration, School of Public Health, University of Illinois, Chicago. Yuka Asada and Rachel Bleiweiss-Sande are also Guest Editors for this supplement issue
| | - Hannah Lane
- Yuka Asada is with the School of Public Health, University of Illinois, Chicago. Rachel Bleiweiss-Sande is with Mathematica in Princeton, NJ. Carolyn Barnes is with the Crown Family School of Social Work, Policy, and Practice, The University of Chicago. Hannah Lane is with the Department of Population Health Sciences, School of Medicine, Duke University, Durham, NC. Jamie F. Chriqui is with the Division of Health Policy Research, Institute for Health Research and Policy, and Department of Health Policy and Administration, School of Public Health, University of Illinois, Chicago. Yuka Asada and Rachel Bleiweiss-Sande are also Guest Editors for this supplement issue
| | - Jamie F Chriqui
- Yuka Asada is with the School of Public Health, University of Illinois, Chicago. Rachel Bleiweiss-Sande is with Mathematica in Princeton, NJ. Carolyn Barnes is with the Crown Family School of Social Work, Policy, and Practice, The University of Chicago. Hannah Lane is with the Department of Population Health Sciences, School of Medicine, Duke University, Durham, NC. Jamie F. Chriqui is with the Division of Health Policy Research, Institute for Health Research and Policy, and Department of Health Policy and Administration, School of Public Health, University of Illinois, Chicago. Yuka Asada and Rachel Bleiweiss-Sande are also Guest Editors for this supplement issue
| |
Collapse
|
5
|
Chriqui JF, Asada Y. The Child and Adult Care Food Program: A Critical Component of the Nutrition Safety Net for More Than 50 Years. Am J Public Health 2023; 113:S171-S174. [PMID: 38118098 PMCID: PMC10733887 DOI: 10.2105/ajph.2023.307474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2023] [Indexed: 12/22/2023]
Affiliation(s)
- Jamie F Chriqui
- Jamie F. Chriqui is with the Division of Health Policy and Administration and the Institute for Health Research and Policy, School of Public Health, University of Illinois, Chicago. Yuka Asada is with the Division of Community Health Sciences and the Institute for Health Research and Policy, School of Public Health, University of Illinois, Chicago. Yuka Asada is also a Guest Editor for this supplement issue
| | - Yuka Asada
- Jamie F. Chriqui is with the Division of Health Policy and Administration and the Institute for Health Research and Policy, School of Public Health, University of Illinois, Chicago. Yuka Asada is with the Division of Community Health Sciences and the Institute for Health Research and Policy, School of Public Health, University of Illinois, Chicago. Yuka Asada is also a Guest Editor for this supplement issue
| |
Collapse
|
6
|
Serrano N, Leider J, Chriqui JF. Pedestrian-oriented zoning moderates the relationship between racialized economic segregation and active travel to work, United States. Prev Med 2023; 177:107788. [PMID: 38013054 PMCID: PMC10872437 DOI: 10.1016/j.ypmed.2023.107788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 11/20/2023] [Accepted: 11/22/2023] [Indexed: 11/29/2023]
Abstract
OBJECTIVE Pedestrian-oriented zoning, including zoning code reforms (ZCR), may be especially beneficial to racially and economically segregated communities, which may lack built environment features that support physical activity. This study examined associations between racialized economic segregation, measured by quintiles of the Index of Concentration at the Extremes, and public transit (PTW) and active travel (ATW) to work, and whether associations were moderated by pedestrian-oriented zoning provisions and ZCR, respectively. METHODS Zoning codes effective as of 2010 representing 3914 US municipalities (45.45% of US population) were evaluated for the presence of ZCR and eight pedestrian-oriented zoning provisions. These data were linked with American Community Survey 2013-2017 and NAVTEQ 2013 data on the outcomes and relevant covariates. Fractional logit regressions were computed with standard errors clustered on county. RESULTS Workers from more deprived quintiles were less likely to engage in PTW and ATW (OR = 0.22-0.55, p < 0.01), and tests revealed moderation by zoning (p < 0.05). ZCR was positively associated with PTW for the three most deprived quintiles (OR = 1.53-2.38, p < 0.01), and with ATW for the two most deprived quintiles (OR = 1.42-1.69, p < 0.01) and the second most privileged quintile (OR = 1.26, p < 0.05). In the most privileged quintile, the zoning scale score was negatively associated with PTW (OR = 0.91, p < 0.001) and ATW (OR = 0.94, p < 0.01). However, in the most deprived quintiles, the zoning scale score was positively associated with PTW (Q2: OR = 1.13, p < 0.01) and ATW (Q1-Q2: OR = 1.07-1.09, p < 0.05). CONCLUSIONS Pedestrian-oriented zoning can provide opportunities for ATW in the most deprived communities. Work is needed to explore zoning policy implementation in those communities.
Collapse
Affiliation(s)
- Natalicio Serrano
- Department of Health Behavior Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Dr. 302 Rosenau Hall, Chapel Hill, NC 27599, USA.
| | - Julien Leider
- Institute for Health Research and Policy, University of Illinois Chicago, Chicago, IL 60608, USA.
| | - Jamie F Chriqui
- Institute for Health Research and Policy, University of Illinois Chicago, Chicago, IL 60608, USA; Division of Health Policy and Administration, School of Public Health, University of Illinois Chicago 60612, USA.
| |
Collapse
|
7
|
Chriqui JF, Asada Y, Smith NR, Kroll-Desrosiers A, Lemon SC. Advancing the science of policy implementation: a call to action for the implementation science field. Transl Behav Med 2023; 13:820-825. [PMID: 37354558 PMCID: PMC10631873 DOI: 10.1093/tbm/ibad034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/26/2023] Open
Abstract
Public policies have been essential in addressing many of the most pressing public health problems in the USA and around the world. A large and convincing body of multidisciplinary research has established the impacts or effectiveness of public policies, such as smoke-free air laws and nutrition standards, on improving health outcomes and behaviors. Most of this research assumes that because an evidence-based policy is adopted or takes effect, it is implemented as intended. This assumption, however, is often incorrect. Like with clinical guidelines and other interventions, implementation science has an important role to play in promoting the uptake and implementation of evidence-based public policies that promote public health. To realize this potential, there remains a critical need to first establish a common understanding of what public policy is, the role of specific policies in the context of implementation (i.e., is it the evidence-based intervention or the implementation strategy?), and to establish an appropriate methodological foundation for the field of policy implementation science. We recommend that the field must evolve to (i) include policy experts and actors on policy implementation science study teams; (ii) identify theories, models, and frameworks that are suitable for policy implementation science; (iii) identify policy implementation strategies; (iv) adapt and/or identify study designs best suited for policy implementation science research; and (v) identify appropriate policy implementation outcome measures.
Collapse
Affiliation(s)
- Jamie F Chriqui
- Division of Health Policy and Administration and Institute for Health Research and Policy, School of Public Health, University of Illinois Chicago, Chicago, IL, USA
| | - Yuka Asada
- Division of Community Health Sciences and Institute for Health Research and Policy, School of Public Health, University of Illinois Chicago, Chicago, IL, USA
| | - Natalie Riva Smith
- Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Aimee Kroll-Desrosiers
- Research & Education, VA Central Western Massachusetts Healthcare System, Leeds, MA, USA
- Division of Health Informatics and Implementation Science, UMass Chan Medical School, Worcester, MA, USA
| | - Stephenie C Lemon
- Division of Preventive and Behavioral Medicine, UMass Chan Medical School, Worcester, MA, USA
| |
Collapse
|
8
|
Lemon SC, Neptune A, Goulding M, Pendharkar JA, Dugger R, Chriqui JF. Integrating Equity Into Bicycle Infrastructure, Planning, and Programming: A Mixed Methods Exploration of Implementation Among Participants in the Bicycle Friendly Community Program. Prev Chronic Dis 2023; 20:E89. [PMID: 37797289 PMCID: PMC10557976 DOI: 10.5888/pcd20.230119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/07/2023] Open
Abstract
INTRODUCTION Integrating equity considerations into bicycle infrastructure, planning, and programming is essential to increase bicycling and reduce physical inactivity-related health disparities. However, little is known about communities' experiences with activities that promote equity considerations in bicycle infrastructure, planning, and programming or about barriers and facilitators to such considerations. The objective of this project was to gain in-depth understanding of the experiences, barriers, and facilitators that communities encounter with integrating equity considerations into bicycle infrastructure, planning, and programming. METHODS We administered a web-based survey in 2022 to assess communities' experiences with 31 equity-focused activities in 3 areas: 1) community engagement, education, events, and programming (community engagement); 2) data collection, evaluation, and goal setting (data); and 3) infrastructure, facilities, and physical amenities (infrastructure). Respondents were people who represented communities in the US that participated in the League of American Bicyclists' Bicycle Friendly Community (BFC) Program. We then conducted 6 focus groups with a subset of survey respondents to explore barriers and facilitators to implementing equity-focused activities. RESULTS Survey respondents (N = 194) had experience with a mean (SD) of 5.9 (5.7) equity-focused activities. Focus group participants (N = 30) identified themes related to community engagement (outreach to and engagement of underrepresented communities, cultural perceptions of bicycling, and funding and support for community rides and programs); data (locally relevant data); and infrastructure (political will, community design, and infrastructure). They described barriers and facilitators for each. CONCLUSION Communities are challenged with integrating equity into bicycle infrastructure, planning, and programming. Multicomponent strategies with support from entities such as the BFC program will be required to make progress.
Collapse
Affiliation(s)
- Stephenie C Lemon
- Division of Preventive and Behavioral Medicine, Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts
- University of Massachusetts Chan Medical School, 55 North Lake Ave, Worcester, MA 01655
| | - Amelia Neptune
- League of American Bicyclists, Washington, District of Columbia
| | - Melissa Goulding
- Morningside Graduate School of Biomedical Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts
| | - Jyothi Ananth Pendharkar
- Division of Preventive and Behavioral Medicine, Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts
| | - Roddrick Dugger
- Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Jamie F Chriqui
- School of Public Health, University of Illinois, Chicago, Illinois
| |
Collapse
|
9
|
Asada Y, Kroll-Desrosiers A, Chriqui JF, Curran GM, Emmons KM, Haire-Joshu D, Brownson RC. Applying hybrid effectiveness-implementation studies in equity-centered policy implementation science. Front Health Serv 2023; 3:1220629. [PMID: 37771411 PMCID: PMC10524255 DOI: 10.3389/frhs.2023.1220629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 08/21/2023] [Indexed: 09/30/2023]
Abstract
Policy implementation science (IS) is complex, dynamic, and fraught with unique study challenges that set it apart from biomedical or clinical research. One important consideration is the ways in which policy interacts with local contexts, such as power and social disadvantage (e.g., based on ability, race, class, sexual identity, geography). The complex nature of policy IS and the need for more intentional integration of equity principles into study approaches calls for creative adaptations to existing implementation science knowledge and guidance. Effectiveness-implementation hybrid studies were developed to enhance translation of clinical research by addressing research questions around the effectiveness of an intervention and its implementation in the same study. The original work on hybrid designs mainly focused on clinical experimental trials; however, over the last decade, researchers have applied it to a wide range of initiatives and contexts, including more widespread application in community-based studies. This perspectives article demonstrates how effectiveness-implementation hybrid studies can be adapted for and applied to equity-centered policy IS research. We draw upon principles of targeted universalism and Equity in Implementation Research frameworks to guide adaptations to hybrid study typologies, and suggest research and engagement activities to enhance equity considerations; for example, in the design and testing of implementing strategies. We also provide examples of equity-centered policy IS studies. As the field of policy IS rapidly evolves, these adapted hybrid type studies are offered to researchers as a starting guide.
Collapse
Affiliation(s)
- Yuka Asada
- Community Health Sciences, School of Public Health, University of Illinois Chicago (UIC), Chicago, IL, United States
| | - Aimee Kroll-Desrosiers
- VA Central Western Massachusetts Health Care System, Leeds, MA, United States
- Department of Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, MA, United States
- Department of Health Policy and Promotion, School of Public Health and Health Sciences, UMass Amherst, Amherst, MA, United States
| | - Jamie F. Chriqui
- Health Policy Research, Institute for Health Research and Policy, School of Public Health, University of Illinois Chicago, Chicago, IL, United States
- Department of Health Policy and Administration, School of Public Health, University of Illinois Chicago, Chicago, IL, United States
| | - Geoffrey M. Curran
- Departments of Pharmacy Practice and Psychiatry, Center for Implementation Research, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Karen M. Emmons
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Debra Haire-Joshu
- Department is Public Health, Brown School at Washington University in St. Louis, St. Louis, MO, United States
| | - Ross C. Brownson
- Prevention Research Center, Brown School at Washington University in St. Louis, St. Louis, MO, United States
- Division of Public Health Sciences, Department of Surgery, Alvin J. Siteman Cancer Center, Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO, United States
| |
Collapse
|
10
|
Jarpe-Ratner E, Cleary M, Chriqui JF. The Role of Wellness Teams in Promoting Health and Wellness Implementation Strategies in Elementary Schools in Chicago. J Sch Health 2023; 93:402-410. [PMID: 36864762 DOI: 10.1111/josh.13309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 11/15/2022] [Accepted: 02/05/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND Strategies used by wellness teams (WTs) to foster local wellness policy (LWP) implementation have been documented, yet there remains a need to better understand how WTs respond to district-level LWP requirements, particularly when bundled with additional health-related policies. This study's goal was to explore how WTs implement Healthy Chicago Public School (CPS), a district-led initiative focused on both LWP and other health policy implementation in the CPS district, one of the most diverse in the nation. METHODS Eleven discussion groups were conducted with WTs in CPS. Discussions were recorded, transcribed, and thematically coded. RESULTS Six overarching strategies used by WTs in working to achieve Healthy CPS include: (1) using district guides and resources to support planning, progress monitoring, and reporting; (2) under the leadership of wellness champions, as required by the district, facilitating engagement among staff, students, and/or families; (3) taking district guidance and adapting and integrating it into their schools' existing structures, curricula, and practices, often taking a holistic approach; (4) fostering linkages in the communities surrounding their schools to supplement internal school capacities; and (5) stewarding resources, time, and staff for sustainability. IMPLICATIONS Strategies for LWP implementation by WTs in urban and diverse schools include planning for staff turnover, integrating health and wellness into existing curricula and structures, and leveraging relationships with the local community. CONCLUSION WTs can play a critical role in supporting schools in diverse, urban districts to implement district-level LWP and the plethora of related policies that schools are subject to at the federal, state, and district levels.
Collapse
Affiliation(s)
| | - Mary Cleary
- School of Public Health, University of Illinois Chicago, Chicago, IL, 60612
| | - Jamie F Chriqui
- School of Public Health, University of Illinois Chicago, Chicago, IL, 60612
| |
Collapse
|
11
|
Zenk SN, Pugach O, Chriqui JF, Wing C, Raymond D, Tarlov E, Sheridan B, Jones KK, Slater SJ. Active living-oriented zoning codes and cardiometabolic conditions across the lifespan. Transl Behav Med 2022; 12:595-600. [PMID: 35192715 PMCID: PMC9132202 DOI: 10.1093/tbm/ibab157] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Environments that make it easier for people to incorporate physical activity into their daily life may help to reduce high rates of cardiometabolic conditions. Local zoning codes are a policy and planning tool to create more walkable and bikeable environments. This study evaluated relationships between active living-oriented zoning code environments and cardiometabolic conditions (body mass index, hyperlipidemia, hypertension). The study used county identifiers to link electronic health record and other administrative data for a sample of patients utilizing primary care services between 2012 and 2016 with county-aggregated zoning code data and built environment data. The analytic sample included 7,441,991 patients living in 292 counties in 44 states. Latent class analysis was used to summarize municipal- and unincorporated county-level data on seven zoning provisions (e.g., sidewalks, trails, street connectivity, mixed land use), resulting in classes that differed in strength of the zoning provisions. Based on the probability of class membership, counties were categorized as one of four classes. Linear and logistic regression models estimated cross-sectional associations with each cardiometabolic condition. Models were fit separately for youth (aged 5-19), adults (aged 20-59), and older adults (aged 60+). Little evidence was found that body mass index in youth, adults, or older adults or the odds of hyperlipidemia or hypertension in adults or older adults differed according to the strength of active living-oriented zoning. More research is needed to identify the health impacts of zoning codes and whether alterations to these codes would improve population health over the long term.
Collapse
Affiliation(s)
- Shannon N Zenk
- National Institute of Nursing Research, Bethesda, MD, USA,Division of Intramural Research, National Institute on Minority Health and Health Disparities, Bethesda, MD, USA,Correspondence to: SN Zenk,
| | - Oksana Pugach
- Methodology Research Core, Institute of Health Research and Policy, University of Illinois Chicago (UIC), Chicago, IL, USA
| | - Jamie F Chriqui
- Methodology Research Core, Institute of Health Research and Policy, University of Illinois Chicago (UIC), Chicago, IL, USA,Health Policy and Administration Division, UIC, Chicago, IL, USA
| | - Coady Wing
- School of Public and Environmental Affairs at Indiana University, Bloomington, IN, USA
| | | | - Elizabeth Tarlov
- Department of Health Population Nursing Science, College of Nursing, UIC, Chicago, IL, USA
| | | | - Kelly K Jones
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, Bethesda, MD, USA
| | - Sandy J Slater
- Department of Pharmaceutical and Administrative Sciences, School of Pharmacy at Concordia University in Mequon, Mequon, WI, USA
| |
Collapse
|
12
|
Slater SJ, Leider J, Chriqui JF. Examining the Implementation of Activity-Friendly Zoning and Land Use Policies Through the Use of Google Street View Measures: A Pilot Study. J Public Health Manag Pract 2022; 28:E127-E136. [PMID: 32487921 DOI: 10.1097/phh.0000000000001176] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Pedestrian-oriented zoning and land use policies are being used by local jurisdictions as tools to implement population-level built environmental changes to create more walkable communities. There is a paucity of evidence examining whether these policies lead to actual changes in the built environment. We used Google Street View (GSV), an established, less expensive, alternative built environment data collection method, to conduct an exploratory pilot study of 19 jurisdictions to examine associations between variations in the presence of these adopted zoning policies and their corresponding specific street-level built environment features. METHODS Samples of 10 large and 9 small jurisdictions (18 municipalities and 1 county) were purposively selected on the basis of the presence of activity-friendly zoning policy provisions (sidewalks, crosswalks, bike-pedestrian connectivity, street connectivity, trails/paths, bike lanes, bike parking, and other items). Corresponding activity-friendly street-level built environment measures were constructed using GSV. Street segments in these jurisdictions were sampled using ArcGIS and stratified by type (residential and arterial) and income (high, medium, and low). RESULTS A total of 4363 street segments were audited across the 19 sampled jurisdictions. Results show significant differences in the presence of activity-friendly street features when the corresponding zoning policy element was addressed in New Urbanist zones/districts in the site's zoning code (eg, crosswalks, 24.48% vs 16.18%; and bike lanes, 12.60% vs 7.14%). Street segments in the middle- and high-income block groups were less likely to have activity-friendly features than low-income segments, except bike lanes. CONCLUSIONS Results show that having activity-friendly policy provisions embedded in a jurisdiction's (municipality/county) zoning codes was associated with a greater presence of the corresponding built environmental street feature on the ground. Results suggest that the methods tested in this article may be a useful policy tool for local governments to identify high need areas that should be prioritized for built environment improvements.
Collapse
Affiliation(s)
- Sandy J Slater
- School of Pharmacy, Concordia University Wisconsin, Mequon, Wisconsin (Dr Slater); Institute for Health Research and Policy (Mr Leider and Dr Chriqui), and Division of Health Policy and Administration, School of Public Health (Dr Chriqui), Institute for Health Research and Policy and School of Public Health, University of Illinois at Chicago, Chicago, Illinois
| | | | | |
Collapse
|
13
|
Lemon SC, Goins KV, Ussery EN, Rose KM, Chriqui JF. Building Evidence, Building Community: The Physical Activity Policy Research and Evaluation Network (PAPREN). J Healthy Eat Act Living 2021; 1:177-180. [PMID: 37771560 PMCID: PMC10522013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 09/30/2023]
Affiliation(s)
- Stephenie C. Lemon
- Division of Preventive and Behavioral Medicine, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts,
U.S.A
- Physical Activity Policy Research and Evaluation Network, Atlanta, Georgia,
U.S.A
| | - Karin Valentine Goins
- Division of Preventive and Behavioral Medicine, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts,
U.S.A
- Physical Activity Policy Research and Evaluation Network, Atlanta, Georgia,
U.S.A
| | - Emily N. Ussery
- Physical Activity Policy Research and Evaluation Network, Atlanta, Georgia,
U.S.A
- Division of Nutrition, Physical Activity and Obesity, Centers for Disease Control and Prevention, Atlanta, Georgia,
U.S.A
| | - Kenneth M. Rose
- Physical Activity Policy Research and Evaluation Network, Atlanta, Georgia,
U.S.A
- Division of Nutrition, Physical Activity and Obesity, Centers for Disease Control and Prevention, Atlanta, Georgia,
U.S.A
| | - Jamie F. Chriqui
- Physical Activity Policy Research and Evaluation Network, Atlanta, Georgia,
U.S.A
- Division of Health Policy and Administration, School of Public Health, University of Illinois Chicago, Chicago, Illinois,
U.S.A
| |
Collapse
|
14
|
Charron LM, Milstein C, Moyers SI, Abildso CG, Chriqui JF. Do State Comprehensive Planning Statutes Address Physical Activity?: Implications for Rural Communities. Int J Environ Res Public Health 2021; 18:12190. [PMID: 34831946 PMCID: PMC8617896 DOI: 10.3390/ijerph182212190] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 11/15/2021] [Accepted: 11/17/2021] [Indexed: 12/30/2022]
Abstract
Less than one-quarter of U.S. adults meet physical activity (PA) recommendations, with rural residents less likely to be active than urban residents. The built environment has been identified as a potential facilitator of PA and local comprehensive plans are a foundational tool for guiding the development of the built environment. The purpose of this study was therefore to understand the current landscape of comprehensive planning state statutes related to PA and rural communities. We used primary legal research methods to identify, compile, and evaluate all 50 state comprehensive planning statutes for items related to PA and conditional mandates based on population size of local jurisdictions. The presence of population-conditional planning mandates and the inclusion of PA-related items was analyzed by state-level rurality using Fisher's exact tests. Our analyses demonstrated that (1) broader PA-related items were addressed in state statutes more often than more specific PA-related items; (2) when PA-related items were addressed, they were most likely to be mandated, subsumed elements; (3) several PA-related items were less likely to be addressed in the most rural states and/or conditionally mandated for jurisdictions meeting minimum population requirements; and (4) only two states addressed PA directly and explicitly in their comprehensive planning statutes.
Collapse
Affiliation(s)
- Lisa M. Charron
- Nelson Institute for Environmental Studies, University of Wisconsin-Madison, Madison, WI 53706, USA
| | - Chloe Milstein
- School of Public Health, University of Illinois at Chicago, Chicago, IL 60612, USA; (C.M.); (J.F.C.)
| | - Samantha I. Moyers
- Department of Social and Behavioral Health Sciences, School of Public Health, West Virginia University, Morgantown, WV 26506, USA; (S.I.M.); (C.G.A.)
| | - Christiaan G. Abildso
- Department of Social and Behavioral Health Sciences, School of Public Health, West Virginia University, Morgantown, WV 26506, USA; (S.I.M.); (C.G.A.)
| | - Jamie F. Chriqui
- School of Public Health, University of Illinois at Chicago, Chicago, IL 60612, USA; (C.M.); (J.F.C.)
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, IL 60612, USA
| |
Collapse
|
15
|
Piekarz-Porter E, Lin W, Leider J, Turner L, Perna F, Chriqui JF. State laws matter when it comes to school provisions for structured PE and daily PE participation. Transl Behav Med 2021; 11:597-603. [PMID: 32115650 DOI: 10.1093/tbm/ibaa013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
The physical and mental benefits children receive from physical activity have been well documented, and physical education is a key way to ensure that physical activity opportunities are available during the school day. This study evaluates whether state PE laws are associated with school-level practices of requiring structured PE classes and whether students take PE classes daily. State laws were obtained as part of the National Cancer Institute's Classification of Laws Associated with School Students (CLASS) and were compiled for all 50 states and District of Columbia using Boolean keyword searches in LexisAdvance and WestlawNext. PE time requirements and state daily PE requirements in the laws were subsequently linked to school-required structured PE classes and daily PE in the School Nutrition and Meal Cost Study (SNMCS) Principal Survey. Logistic regression analyses were conducted while controlling for grade level, district child poverty rate, district race/ethnicity, school urbanicity, and school size. The state daily PE analysis also controlled for region. Schools located in a state that required at least 90 min of PE per week at the elementary level or 150 min of PE per week at the middle or high school levels had almost seven times higher odds of requiring structured PE. Schools located in a state that required daily participation of PE had almost five times higher odds of at least some students taking PE daily. State policymakers can utilize these findings to promote laws that require time for PE every week, daily if possible.
Collapse
Affiliation(s)
- Elizabeth Piekarz-Porter
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, IL, USA.,Health Policy and Administration, School of Public Health, University of Illinois at Chicago, Chicago, IL, USA
| | - Wanting Lin
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, IL, USA
| | - Julien Leider
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, IL, USA
| | - Lindsey Turner
- College of Education, Boise State University, Boise, ID, USA
| | - Frank Perna
- Health Behaviors Research Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Jamie F Chriqui
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, IL, USA.,Health Policy and Administration, School of Public Health, University of Illinois at Chicago, Chicago, IL, USA
| |
Collapse
|
16
|
Perna FM, Piekarz-Porter E, Lowry M, Schermbeck R, Chriqui JF. State Laws Governing Adaptive Pe: Making Pe Accessible For All. Med Sci Sports Exerc 2021. [DOI: 10.1249/01.mss.0000764988.55141.bf] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
17
|
Sprow K, Perna FM, Leider J, Turner L, Piekarz-Porter EM, Michael SL, Brener N, Chriqui JF. Standards-based physical education in schools: The role of state laws. Transl J Am Coll Sports Med 2021; 6:e000166. [PMID: 38124718 PMCID: PMC10732540 DOI: 10.1249/tjx.0000000000000166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Purpose Examine the association of state physical education (PE) laws (https://class.cancer.gov) with school policies addressing motor skill development, physical activity (PA) participation, and health-enhancing physical fitness (https://www.cdc.gov/healthyyouth/data/shpps/data.htm). Methods National school-level data on PE standards were obtained from the 2014 School Health Policies and Practices Study (SHPPS) of US schools for analytical samples of 408-410 schools in 43 states. These data were linked to Classification of Laws Associated with School Students (CLASS) data, which reflect the strength of state-PE curriculum laws and the associated state PE curriculum standards. Logistic regressions and generalized linear models with a complementary log-log link examined associations between state law and school-level standards. Results Compared to having no state law, weak law (OR: 5.07, 95% CI: 1.02-25.27) or strong law (OR: 2.96, 95% CI: 1.04-8.37) was associated with higher odds of school PE standards addressing motor skill development, while only strong state law was associated with higher prevalence of addressing achievement and maintenance of physical fitness (coefficient: 0.63, 95% CI: 0.12, 1.14). State laws were not associated with addressing PA participation. Conclusions Schools were more likely to address motor skills and physical fitness development when states had strong PE laws.
Collapse
Affiliation(s)
- Kyle Sprow
- Division of Cancer Control and Populations Sciences, National Cancer Institute, National Institutes of Health, Rockville, MD
| | - Frank M. Perna
- Division of Cancer Control and Populations Sciences, National Cancer Institute, National Institutes of Health, Rockville, MD
| | - Julien Leider
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, Illinois
| | - Lindsey Turner
- College of Education, Boise State University, Boise, Idaho
| | - Elizabeth M. Piekarz-Porter
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, Illinois
- Division of Health Policy and Administration, School of Public Health, University of Illinois at Chicago, Chicago, Illinois
| | - Shannon L. Michael
- Division of Population Health, Centers for Disease Control and Prevention, Atlanta GA
| | - Nancy Brener
- Division of Adolescent and School Health, Centers for Disease Control and Prevention, Atlanta, GA
| | - Jamie F. Chriqui
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, Illinois
- Division of Health Policy and Administration, School of Public Health, University of Illinois at Chicago, Chicago, Illinois
| |
Collapse
|
18
|
Asada Y, Pipito AA, Chriqui JF, Taher S, Powell LM. Oakland's Sugar-Sweetened Beverage Tax: Honoring the "Spirit" of the Ordinance Toward Equitable Implementation. Health Equity 2021; 5:35-41. [PMID: 33681687 PMCID: PMC7929915 DOI: 10.1089/heq.2020.0079] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2020] [Indexed: 11/12/2022] Open
Abstract
Purpose: On November 8, 2016, Oakland, California, voters passed a sugar-sweetened beverage (SSB) tax, which included language to support programs affecting communities and residents most affected by SSB-related health disparities. The purpose of this study was to qualitatively assess the extent to which those communities most affected by SSB-related health disparities were included in implementation decisions and were recipients of funding to support their needs. Methods: A longitudinal case study from 2016 to 2019 in Oakland, CA, explored equity implementation themes through key informant interview transcripts (n=15) triangulated with media (n=90) and archived documents (n=43). Using principals of constant comparative analysis, all documents (n=148) were coded and thematically analyzed in Atlas.ti. Results: SSB taxes—designed to support communities disproportionately impacted by SSB consumption—can be implemented with inclusivity and community representation. The Oakland ordinance established a Community Advisory Board (CAB) that partnered with community organizations throughout implementation to ensure inclusivity and recommend funding for programs to address health inequities, described as the “spirit” of the ordinance. These activities countered the beverage industry's tactics to target lower income communities of color with misinformation campaigns and hinder implementation. Conclusion: A clearly written ordinance provides guidance, which affords an intentional and legal foundation for implementation processes. Establishing a CAB can mitigate inequities as members are invested in the community and initiatives to support residents. Advisory boards are able to liaise between city and local partners, which is a powerful tool for countering opposition campaigns, reaching lower income and communities of color, and ensuring adherence to funding mandates.
Collapse
Affiliation(s)
- Yuka Asada
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Andrea A Pipito
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Jamie F Chriqui
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, Illinois, USA.,Division of Health Policy and Administration, School of Public Health, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Sabira Taher
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Lisa M Powell
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, Illinois, USA.,Division of Health Policy and Administration, School of Public Health, University of Illinois at Chicago, Chicago, Illinois, USA
| |
Collapse
|
19
|
Ngo AP, Wang X, Slater S, Chriqui JF, Chaloupka FJ, Yang L, Smith L, Li Q, Shang C. Alcohol excise taxes as a percentage of retail alcohol prices in 26 OECD countries. Drug Alcohol Depend 2021; 219:108415. [PMID: 33307302 PMCID: PMC7856250 DOI: 10.1016/j.drugalcdep.2020.108415] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 10/30/2020] [Accepted: 11/03/2020] [Indexed: 01/16/2023]
Abstract
BACKGROUND Many countries have implemented alcohol excise taxes. However, measures of excise taxes as a percentage of alcohol prices have not been systematically studied. METHODS Data on the retail prices of alcoholic beverages sold in stores and excise taxes in 26 countries during 2003-2018 was from the Economist Intelligence Unit price city data and the Organization for Economic Co-operation and Development (OECD) tax database. The percentages of excise taxes in off-premise retail prices were derived as the ratio of taxes to prices at different price levels. Changes of excise taxes over time were assessed using negative binominal regressions. RESULTS The percentage of excise taxes in average off-premise alcohol prices was from 5 % in Luxembourg to 59 % in Iceland for beer, and from 0 % in France to 26 % in Iceland for wine. Excise taxes accounted for 5% of discount liquor prices in Czech Republic to 41 % in Sweden for Cognac, for 19 % in the United States (US) to 67 % in Sweden for Gin, for 13 % in the US to 63 % in Australia for Scotch Whisky six years old, and for 6 % in Iceland to 76 % in Sweden for Liqueur Cointreau. There were no significant changes in the percentage of excise taxes in alcohol prices over time in most countries except for Nordic countries. While wine had the lowest excise taxes, liquors had the highest tax burden. CONCLUSION Tax burden on alcoholic beverages is low in OECD countries, indicating ample room for increasing alcohol excise taxes, particularly for beer and wine in those countries.
Collapse
Affiliation(s)
- Anh P Ngo
- Institute for Health Research and Policy, The University of Illinois at Chicago, Chicago, Illinois, USA
| | - Xuening Wang
- University of Illinois at Chicago, Chicago, IL, USA
| | | | - Jamie F Chriqui
- Institute for Health Research and Policy, The University of Illinois at Chicago, Chicago, Illinois, USA
| | - Frank J Chaloupka
- Institute for Health Research and Policy, The University of Illinois at Chicago, Chicago, Illinois, USA
| | - Lin Yang
- Department of Cancer Epidemiology and Prevention Research, Alberta Health Services, Calgary, Canada; Departments of Oncology and Community Health Sciences, University of Calgary, Calgary, Canada
| | - Lee Smith
- The Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University, Cambridge, UK
| | - Qing Li
- Center for Behavioral Epidemiology and Community Health, School of Public Health, San Diego State University, San Diego, CA, USA
| | - Ce Shang
- The Ohio State University Wexner Medical Center, Columbus, OH, USA.
| |
Collapse
|
20
|
Abstract
PURPOSE To describe media coverage and framing of Oakland, California's, sugar-sweetened beverage tax. DESIGN Media content analysis. SAMPLE Media documents (n = 90), published January 1, 2016-August 31, 2019, were retrieved from Oakland news outlets and ProQuest, NexusUni, EBSCO, and Google. ANALYSIS Documents were coded using constant comparative analysis in Atlas.ti v8; with descriptive analyses conducted using Stata/SE v. 15.1. RESULTS Documents were published evenly between pre- and post-ballot periods (n = 45); the majority (n = 47) provided neutral framing. Protax documents (n = 33) highlighted SSB consumption and health associations and countered antitax messaging; antitax documents (n = 10) focused on misinformation and sowing public confusion. CONCLUSION Neutral media educates and raises awareness. Published prior to a vote, the media may help influence public opinion regarding SSB taxes. SSB tax media advocacy campaigns, giving particular attention to timing and perspective-based framing, may help to secure adoption and support implementation.
Collapse
Affiliation(s)
- Yuka Asada
- Institute for Health Research and Policy, 14681University of Illinois Chicago, IL, USA
| | - Sabira Taher
- Institute for Health Research and Policy, 14681University of Illinois Chicago, IL, USA
| | - Andrea Pipito
- Institute for Health Research and Policy, 14681University of Illinois Chicago, IL, USA
| | - Jamie F Chriqui
- Institute for Health Research and Policy, 14681University of Illinois Chicago, IL, USA.,Health Policy and Administration, School of Public Health, 14681University of Illinois at Chicago, IL, USA
| |
Collapse
|
21
|
Chriqui JF, Leider J, Turner L, Piekarz-Porter E, Schwartz MB. State Wellness Policy Requirement Laws Matter for District Wellness Policy Comprehensiveness and Wellness Policy Implementation in the United States. Nutrients 2021; 13:E188. [PMID: 33435387 PMCID: PMC7827171 DOI: 10.3390/nu13010188] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 01/07/2021] [Accepted: 01/07/2021] [Indexed: 11/24/2022] Open
Abstract
Beginning with the school year 2006-2007, U.S. school districts participating in the federal Child Nutrition Programs were required to adopt and implement a local wellness policy (LWP) that included goals and/or standards for nutrition education, school meals, other foods sold or served in schools, and physical activity. A primary challenge with LWPs has been inconsistent implementation. This study examined whether state wellness policy requirement laws and district LWP comprehensiveness influence district level implementation, using law/policy data from the National Wellness Policy Study and school food authority (SFA)-reported district LWP implementation from the School Nutrition and Meal Cost Study. Generalized linear and structural equation models were used, controlling for SFA and district characteristics. SFAs in states with wellness policy requirement laws (vs. those in states without) reported implementing significantly more practices (59.56% vs. 44.57%, p < 0.01). State wellness policy requirement laws were associated with district LWP comprehensiveness (coeff.: 0.463; 95% CI: 0.123, 0.803) and district-level implementation (coeff.: 1.392; 95% CI: 0.299, 2.485). District LWP comprehensiveness was associated with district implementation (coeff.: 0.562; 95% CI: 0.072, 1.053), but did not mediate the state law-district implementation relationship. This study highlights the important role that state laws and district LWPs can play in facilitating wellness policy implementation.
Collapse
Affiliation(s)
- Jamie F. Chriqui
- Division of Health Policy and Administration, School of Public Health, University of Illinois Chicago, Chicago, IL 60612, USA;
- Institute for Health Research and Policy, University of Illinois Chicago, Chicago, IL 60608, USA;
| | - Julien Leider
- Institute for Health Research and Policy, University of Illinois Chicago, Chicago, IL 60608, USA;
| | - Lindsey Turner
- College of Education, Boise State University, 1910 University Drive, Boise, ID 83725, USA;
| | - Elizabeth Piekarz-Porter
- Division of Health Policy and Administration, School of Public Health, University of Illinois Chicago, Chicago, IL 60612, USA;
- Institute for Health Research and Policy, University of Illinois Chicago, Chicago, IL 60608, USA;
| | - Marlene B. Schwartz
- Rudd Center for Food Policy and Obesity, Department of Human Development and Family Sciences, University of Connecticut, 1 Constitution Plaza, Hartford, CT 06103, USA;
| |
Collapse
|
22
|
Chriqui JF, Leider J, Piekarz-Porter E, Lin W, Turner L, Michael SL, Brener N, Perna F. “Waiving” Goodbye to PE: State Law and School Exemption and Substitution Practices in the United States. Transl J ACSM 2021. [DOI: 10.1249/tjx.0000000000000161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
23
|
Bauer KW, Chriqui JF, Andreyeva T, Kenney EL, Stage VC, Dev D, Lessard L, Cotwright CJ, Tovar A. A Safety Net Unraveling: Feeding Young Children During COVID-19. Am J Public Health 2021; 111:116-120. [PMID: 33211589 PMCID: PMC7750580 DOI: 10.2105/ajph.2020.305980] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The emergence of COVID-19 in the United States led most states to close or severely limit the capacity of their early child-care and education (ECE) programs. This loss affected millions of young children, including many of the 4.6 million low-income children who are provided free meals and snacks by their ECE programs through support from the federal Child and Adult Care Food Program (CACFP).Although Congress swiftly authorized waivers that would allow CACFP-participating ECE programs to continue distributing food to children, early evidence suggests that most ECE programs did not have the capacity to do so, leaving a fragmented system of federal, state, and local food programs to fill the gaps created by this loss.Critical steps are needed to repair our nation's fragile ECE system, including greater investment in CACFP, to ensure the nutrition, health, and development of young children during the COVID-19 pandemic and beyond.
Collapse
Affiliation(s)
- Katherine W Bauer
- Katherine W. Bauer is with the Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor. Jamie F. Chriqui is with the Division of Health Policy and Administration, School of Public Health, University of Illinois, Chicago. Tatiana Andreyeva is with the Department of Agricultural and Resource Economics, Rudd Center for Food Policy & Obesity, University of Connecticut, Hartford. Erica L. Kenney is with the Departments of Nutrition and Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA. Virginia C. Stage is with the Department of Nutrition Science, College of Allied Health Sciences, East Carolina University, Greenville, NC. Dipti Dev is with the Department of Child, Youth and Family Studies, College of Education and Human Sciences, University of Nebraska, Lincoln. Laura Lessard is with the Department of Behavioral Health & Nutrition, University of Delaware, Newark. Caree J. Cotwright is with the Department of Foods and Nutrition, University of Georgia, Athens. Alison Tovar is with the Department of Nutrition and Food Sciences, University of Rhode Island, Kingston
| | - Jamie F Chriqui
- Katherine W. Bauer is with the Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor. Jamie F. Chriqui is with the Division of Health Policy and Administration, School of Public Health, University of Illinois, Chicago. Tatiana Andreyeva is with the Department of Agricultural and Resource Economics, Rudd Center for Food Policy & Obesity, University of Connecticut, Hartford. Erica L. Kenney is with the Departments of Nutrition and Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA. Virginia C. Stage is with the Department of Nutrition Science, College of Allied Health Sciences, East Carolina University, Greenville, NC. Dipti Dev is with the Department of Child, Youth and Family Studies, College of Education and Human Sciences, University of Nebraska, Lincoln. Laura Lessard is with the Department of Behavioral Health & Nutrition, University of Delaware, Newark. Caree J. Cotwright is with the Department of Foods and Nutrition, University of Georgia, Athens. Alison Tovar is with the Department of Nutrition and Food Sciences, University of Rhode Island, Kingston
| | - Tatiana Andreyeva
- Katherine W. Bauer is with the Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor. Jamie F. Chriqui is with the Division of Health Policy and Administration, School of Public Health, University of Illinois, Chicago. Tatiana Andreyeva is with the Department of Agricultural and Resource Economics, Rudd Center for Food Policy & Obesity, University of Connecticut, Hartford. Erica L. Kenney is with the Departments of Nutrition and Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA. Virginia C. Stage is with the Department of Nutrition Science, College of Allied Health Sciences, East Carolina University, Greenville, NC. Dipti Dev is with the Department of Child, Youth and Family Studies, College of Education and Human Sciences, University of Nebraska, Lincoln. Laura Lessard is with the Department of Behavioral Health & Nutrition, University of Delaware, Newark. Caree J. Cotwright is with the Department of Foods and Nutrition, University of Georgia, Athens. Alison Tovar is with the Department of Nutrition and Food Sciences, University of Rhode Island, Kingston
| | - Erica L Kenney
- Katherine W. Bauer is with the Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor. Jamie F. Chriqui is with the Division of Health Policy and Administration, School of Public Health, University of Illinois, Chicago. Tatiana Andreyeva is with the Department of Agricultural and Resource Economics, Rudd Center for Food Policy & Obesity, University of Connecticut, Hartford. Erica L. Kenney is with the Departments of Nutrition and Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA. Virginia C. Stage is with the Department of Nutrition Science, College of Allied Health Sciences, East Carolina University, Greenville, NC. Dipti Dev is with the Department of Child, Youth and Family Studies, College of Education and Human Sciences, University of Nebraska, Lincoln. Laura Lessard is with the Department of Behavioral Health & Nutrition, University of Delaware, Newark. Caree J. Cotwright is with the Department of Foods and Nutrition, University of Georgia, Athens. Alison Tovar is with the Department of Nutrition and Food Sciences, University of Rhode Island, Kingston
| | - Virginia C Stage
- Katherine W. Bauer is with the Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor. Jamie F. Chriqui is with the Division of Health Policy and Administration, School of Public Health, University of Illinois, Chicago. Tatiana Andreyeva is with the Department of Agricultural and Resource Economics, Rudd Center for Food Policy & Obesity, University of Connecticut, Hartford. Erica L. Kenney is with the Departments of Nutrition and Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA. Virginia C. Stage is with the Department of Nutrition Science, College of Allied Health Sciences, East Carolina University, Greenville, NC. Dipti Dev is with the Department of Child, Youth and Family Studies, College of Education and Human Sciences, University of Nebraska, Lincoln. Laura Lessard is with the Department of Behavioral Health & Nutrition, University of Delaware, Newark. Caree J. Cotwright is with the Department of Foods and Nutrition, University of Georgia, Athens. Alison Tovar is with the Department of Nutrition and Food Sciences, University of Rhode Island, Kingston
| | - Dipti Dev
- Katherine W. Bauer is with the Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor. Jamie F. Chriqui is with the Division of Health Policy and Administration, School of Public Health, University of Illinois, Chicago. Tatiana Andreyeva is with the Department of Agricultural and Resource Economics, Rudd Center for Food Policy & Obesity, University of Connecticut, Hartford. Erica L. Kenney is with the Departments of Nutrition and Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA. Virginia C. Stage is with the Department of Nutrition Science, College of Allied Health Sciences, East Carolina University, Greenville, NC. Dipti Dev is with the Department of Child, Youth and Family Studies, College of Education and Human Sciences, University of Nebraska, Lincoln. Laura Lessard is with the Department of Behavioral Health & Nutrition, University of Delaware, Newark. Caree J. Cotwright is with the Department of Foods and Nutrition, University of Georgia, Athens. Alison Tovar is with the Department of Nutrition and Food Sciences, University of Rhode Island, Kingston
| | - Laura Lessard
- Katherine W. Bauer is with the Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor. Jamie F. Chriqui is with the Division of Health Policy and Administration, School of Public Health, University of Illinois, Chicago. Tatiana Andreyeva is with the Department of Agricultural and Resource Economics, Rudd Center for Food Policy & Obesity, University of Connecticut, Hartford. Erica L. Kenney is with the Departments of Nutrition and Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA. Virginia C. Stage is with the Department of Nutrition Science, College of Allied Health Sciences, East Carolina University, Greenville, NC. Dipti Dev is with the Department of Child, Youth and Family Studies, College of Education and Human Sciences, University of Nebraska, Lincoln. Laura Lessard is with the Department of Behavioral Health & Nutrition, University of Delaware, Newark. Caree J. Cotwright is with the Department of Foods and Nutrition, University of Georgia, Athens. Alison Tovar is with the Department of Nutrition and Food Sciences, University of Rhode Island, Kingston
| | - Caree J Cotwright
- Katherine W. Bauer is with the Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor. Jamie F. Chriqui is with the Division of Health Policy and Administration, School of Public Health, University of Illinois, Chicago. Tatiana Andreyeva is with the Department of Agricultural and Resource Economics, Rudd Center for Food Policy & Obesity, University of Connecticut, Hartford. Erica L. Kenney is with the Departments of Nutrition and Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA. Virginia C. Stage is with the Department of Nutrition Science, College of Allied Health Sciences, East Carolina University, Greenville, NC. Dipti Dev is with the Department of Child, Youth and Family Studies, College of Education and Human Sciences, University of Nebraska, Lincoln. Laura Lessard is with the Department of Behavioral Health & Nutrition, University of Delaware, Newark. Caree J. Cotwright is with the Department of Foods and Nutrition, University of Georgia, Athens. Alison Tovar is with the Department of Nutrition and Food Sciences, University of Rhode Island, Kingston
| | - Alison Tovar
- Katherine W. Bauer is with the Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor. Jamie F. Chriqui is with the Division of Health Policy and Administration, School of Public Health, University of Illinois, Chicago. Tatiana Andreyeva is with the Department of Agricultural and Resource Economics, Rudd Center for Food Policy & Obesity, University of Connecticut, Hartford. Erica L. Kenney is with the Departments of Nutrition and Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA. Virginia C. Stage is with the Department of Nutrition Science, College of Allied Health Sciences, East Carolina University, Greenville, NC. Dipti Dev is with the Department of Child, Youth and Family Studies, College of Education and Human Sciences, University of Nebraska, Lincoln. Laura Lessard is with the Department of Behavioral Health & Nutrition, University of Delaware, Newark. Caree J. Cotwright is with the Department of Foods and Nutrition, University of Georgia, Athens. Alison Tovar is with the Department of Nutrition and Food Sciences, University of Rhode Island, Kingston
| |
Collapse
|
24
|
Lemon SC, Goins KV, Ussery EN, Rose KM, Chriqui JF. Building Evidence, Building Community: The Physical Activity Policy Research and Evaluation Network (PAPREN). J Healthy Eat Act Living 2021; 1:165-168. [PMID: 37181829 PMCID: PMC10174214 DOI: 10.51250/jheal.v1i4.26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Affiliation(s)
- Stephenie C. Lemon
- Division of Preventive and Behavioral Medicine, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts,
U.S.A
- Physical Activity Policy Research and Evaluation Network, Atlanta, Georgia,
U.S.A
| | - Karin Valentine Goins
- Division of Preventive and Behavioral Medicine, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts,
U.S.A
- Physical Activity Policy Research and Evaluation Network, Atlanta, Georgia,
U.S.A
| | - Emily N. Ussery
- Physical Activity Policy Research and Evaluation Network, Atlanta, Georgia,
U.S.A
- Division of Nutrition, Physical Activity and Obesity, Centers for Disease Control and Prevention, Atlanta, Georgia,
U.S.A
| | - Kenneth M. Rose
- Physical Activity Policy Research and Evaluation Network, Atlanta, Georgia,
U.S.A
- Division of Nutrition, Physical Activity and Obesity, Centers for Disease Control and Prevention, Atlanta, Georgia,
U.S.A
| | - Jamie F. Chriqui
- Physical Activity Policy Research and Evaluation Network, Atlanta, Georgia,
U.S.A
- Division of Health Policy and Administration, School of Public Health, University of Illinois Chicago, Chicago, Illinois,
U.S.A
| |
Collapse
|
25
|
Chriqui JF, Leider J, Cohen JFW, Schwartz M, Turner L. Are Nutrition Standards for Beverages in Schools Associated with Healthier Beverage Intakes among Adolescents in the US? Nutrients 2020; 13:E75. [PMID: 33383659 PMCID: PMC7824136 DOI: 10.3390/nu13010075] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 12/22/2020] [Accepted: 12/22/2020] [Indexed: 12/01/2022] Open
Abstract
Under the U.S. Department of Agriculture's Smart Snacks in School standards, beverages sold in schools are restricted to water, flavored or unflavored non-fat milk or unflavored low-fat milk (and milk alternatives), and 100% fruit and vegetable juices; and, at the high school level, diet (≤10 kcal), low-calorie (≤60 kcal), and caffeinated beverages may also be sold. Using data from the School Nutrition and Meal Cost Study, this study examined whether secondary school student beverage consumption was associated with school-level à la carte and vending machine beverage availability, controlling for district, school, and student characteristics. On average, most beverages sold in middle schools (84.54%) and high schools (74.11%) were Smart Snacks compliant; while 24.06 percent of middle school students and 14.64 percent of high school students reported consuming non-compliant beverages, including non-compliant milk, fruit drinks, and sports or energy drinks. School beverage availability was not related to consumption among middle school students; however, high school students were less likely to consume non-compliant beverages when enrolled in schools that sold a higher proportion of compliant beverages (Range: OR = 0.97-0.98, 95% CI = 0.95, 1.00). Findings from this study build upon prior research illustrating the role that schools can play in influencing student dietary intake.
Collapse
Affiliation(s)
- Jamie F. Chriqui
- Division of Health Policy and Administration, School of Public Health, University of Illinois Chicago, Chicago, IL 60612, USA
- Institute for Health Research and Policy, University of Illinois Chicago, Chicago, IL 60608, USA;
| | - Julien Leider
- Institute for Health Research and Policy, University of Illinois Chicago, Chicago, IL 60608, USA;
| | - Juliana F. W. Cohen
- Department of Public Health and Nutrition, Merrimack College, 315 Turnpike Street, North Andover, MA 01845, USA;
- Department of Nutrition, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA 02115, USA
| | - Marlene Schwartz
- Rudd Center for Food Policy and Obesity, Department of Human Development and Family Sciences, University of Connecticut, 1 Constitution Plaza, Hartford, CT 06103, USA;
| | - Lindsey Turner
- College of Education, Boise State University, 1910 University Drive, Boise, ID 83725, USA;
| |
Collapse
|
26
|
Schwartz MB, Leider J, Cohen JFW, Turner L, Chriqui JF. Association between Nutrition Policies and Student Body Mass Index. Nutrients 2020; 13:E13. [PMID: 33374504 PMCID: PMC7822196 DOI: 10.3390/nu13010013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 12/14/2020] [Accepted: 12/18/2020] [Indexed: 12/29/2022] Open
Abstract
In response to concerns about childhood obesity, many US states have implemented policies to limit the sale of unhealthy foods and beverages (e.g., snacks, desserts, and sugary drinks) sold in competition with school meal programs (i.e., competitive foods) in order to improve the nutritional environment of schools and support student health. This study measured state-level competitive food and beverage policies that require foods and beverages sold in à la carte lines, vending machines, and school stores to meet strong nutrition standards and tested the hypothesis that students living in states with stronger laws would have lower body mass index (BMI)-for-age percentiles. BMI data from a national sample of 1625 students attending 284 schools from the School Nutrition and Meal Cost Study were linked to state laws coded as part of the National Wellness Policy Study. A survey-adjusted linear regression model accounting for student and school-level characteristics showed that stronger state nutrition policies were associated with lower student BMI scores (coefficient: -0.06, 95% CI: -0.12, -0.00). Additional models indicated that stronger state policies were significantly associated with fewer unhealthy foods and beverages available in schools. These findings suggest that strong regulations on competitive foods and beverages may lead to improvements in the nutritional quality of the school environment and student BMI. Thus, current federal standards regulating snacks in US schools (i.e., Smart Snacks) are an important element of a comprehensive strategy to improve the school nutrition environment and reduce rates of childhood obesity.
Collapse
Affiliation(s)
- Marlene B. Schwartz
- Rudd Center for Food Policy and Obesity, Department of Human Development and Family Sciences, University of Connecticut, 1 Constitution Plaza, Hartford, CT 06103, USA
| | - Julien Leider
- Institute for Health Research and Policy, University of Illinois Chicago, Chicago, IL 60608, USA; (J.L.); (J.F.C.)
| | - Juliana F. W. Cohen
- Department of Public Health and Nutrition, Merrimack College, 315 Turnpike Street, North Andover, MA 01845, USA;
- Department of Nutrition, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA 02115, USA
| | - Lindsey Turner
- College of Education, Boise State University, 1910 University Drive, Boise, ID 83725, USA;
| | - Jamie F. Chriqui
- Institute for Health Research and Policy, University of Illinois Chicago, Chicago, IL 60608, USA; (J.L.); (J.F.C.)
- Division of Health Policy and Administration, School of Public Health, University of Illinois Chicago, 1603 W. Taylor St, Chicago, IL 60612, USA
| |
Collapse
|
27
|
Chriqui JF, Leider J, Temkin D, Piekarz-Porter E, Schermbeck RM, Stuart-Cassel V. State Laws Matter When It Comes to District Policymaking Relative to the Whole School, Whole Community, Whole Child Framework. J Sch Health 2020; 90:907-917. [PMID: 33184878 PMCID: PMC7702124 DOI: 10.1111/josh.12959] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 08/17/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND The Whole School, Whole Community, Whole Child (WSCC) framework supports the "whole child" across 10 domains. This study assessed state law and district policy WSCC coverage. METHODS Primary legal research was used to compile relevant district policies and state laws for a stratified random sample of 368 public school districts across 20 states for school year 2017-18. Policies/laws were evaluated on 79 items across the WSCC domains (range: 3-14 items/domain). Multivariable regressions examined the relationship between state laws and district policies, controlling for district characteristics, and weighted to account for the sample design and non-response. RESULTS On average, district policies and state laws addressed 53% and 60% of the 79 items, respectively. State law predicted district policy WSCC attention across items (coeff. = 0.26, 95% CI = 0.14, 0.38) and 4 domains: physical activity (coeff. = 0.57, 95% CI = 0.29, 0.86); health services (coeff. = 0.50, 95% CI = 0.39, 0.62); social and emotional climate (coeff. = 0.34, 95% CI = 0.23, 0.45); and family engagement (coeff. = 0.41, 95% CI = 0.28, 0.54). State law was associated with lower district-level coverage in 3 domains (health education; counseling, psychological, and social services; and community involvement). CONCLUSIONS Although WSCC implementation is locally-driven, states have an active role to play in setting a policy "floor" for guiding district WSCC attention.
Collapse
Affiliation(s)
- Jamie F Chriqui
- Professor, , Division of Health Policy and Administration and Institute for Health Research and Policy, School of Public Health, University of Illinois Chicago, 1603 W. Taylor Street, M/C 923, Chicago, IL 60612
| | - Julien Leider
- Senior Research Specialist, , Institute for Health Research and Policy, University of Illinois Chicago, 1747 W. Roosevelt Road, M/C 275, Chicago, IL 60608
| | - Deborah Temkin
- Vice-President for Youth Development and Education Research, , Child Trends, 7315 Wisconsin Avenue, Suite 1200W, Bethesda, MD 20814
| | - Elizabeth Piekarz-Porter
- Clinical Assistant Professor, , Division of Health Policy and Administration, School of Public Health, University of Illinois Chicago, 1603 W. Taylor Street, M/C 923, Chicago, IL 60612
| | - Rebecca M Schermbeck
- Research Specialist, , Institute for Health Research and Policy, University of Illinois Chicago, Chicago, IL 60608
| | | |
Collapse
|
28
|
Piekarz-Porter E, Leider J, Turner L, Chriqui JF. District Wellness Policy Nutrition Standards Are Associated with Healthier District Food Procurement Practices in the United States. Nutrients 2020; 12:E3417. [PMID: 33171701 PMCID: PMC7694957 DOI: 10.3390/nu12113417] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 11/04/2020] [Accepted: 11/05/2020] [Indexed: 11/29/2022] Open
Abstract
Food procurement policies often exist to require that schools purchase foods with specific nutrient standards. Such policies are increasingly being used with the hope of improving access to healthier foods and beverages. Local wellness policies, required in any school district that participates in Federal Child Nutrition Programs, often contain specific nutrition standards that detail what can be sold to students during the school day. This study investigated the extent to which nutrition standards in wellness policies may be associated with healthier nutrition standards in district-level purchasing specifications. Cross-sectional data from the 2014-2015 school year for 490 school food authorities from 46 states and the District of Columbia were collected as part of the School Nutrition and Meal Cost Study and the National Wellness Policy Study. Survey-adjusted multivariable logistic regression models were computed to examine the association between district wellness policy nutrition standards and corresponding district food purchasing specifications. Results show that having a district wellness policy with corresponding nutrition standards and being in a rural area were associated with district food purchasing specifications for specific nutrients. These findings contribute to the literature to suggest that having a wellness policy with detailed nutrition standards may help to increase access to healthier foods and beverages.
Collapse
Affiliation(s)
- Elizabeth Piekarz-Porter
- Institute for Health Research and Policy, University of Illinois Chicago, Chicago, IL 60608, USA; (J.L.); (J.F.C.)
- Division of Health Policy and Administration, School of Public Health, University of Illinois Chicago, Chicago, IL 60612, USA
| | - Julien Leider
- Institute for Health Research and Policy, University of Illinois Chicago, Chicago, IL 60608, USA; (J.L.); (J.F.C.)
| | - Lindsey Turner
- College of Education, Boise State University, Boise, ID 83725, USA;
| | - Jamie F. Chriqui
- Institute for Health Research and Policy, University of Illinois Chicago, Chicago, IL 60608, USA; (J.L.); (J.F.C.)
- Division of Health Policy and Administration, School of Public Health, University of Illinois Chicago, Chicago, IL 60612, USA
| |
Collapse
|
29
|
Asada Y, Mitric S, Chriqui JF. Addressing Equity in Rural Schools: Opportunities and Challenges for School Meal Standards Implementation. J Sch Health 2020; 90:779-786. [PMID: 32820533 DOI: 10.1111/josh.12943] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 02/06/2020] [Accepted: 05/24/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Few studies examine why rural public schools have weaker policies and practices related to school nutrition environments compared to their urban counterparts. It is important to understand this disparity because federal school meal standards aim for children to access health-promoting nutrition environments. In this study, we identify challenges and opportunities for the implementation of school meal standards in rural high schools. METHODS We interviewed 38 rural school professionals from 22 high schools across 7 states. School professionals included food service directors, principals, school nurses, and teachers. Team coding in Atlas.ti Qualitative Data Analysis software v8 and principles of comparative analysis were employed to generate themes related to challenges and opportunities. RESULTS Overall, school professionals described improvements with implementation experiences and student acceptance over time. Key challenges included the negative influences of home and community food environments and limited staff size and capacity. Key opportunities involved joining co-ops to enhance purchasing power, leveraging state technical assistance, and forming external partnerships. CONCLUSIONS This study offers insights from a broad range of rural school professionals' implementation experiences. The findings can inform governments and technical assistance agencies working with rural schools and school districts to facilitate implementation and sustainability of initiatives.
Collapse
Affiliation(s)
- Yuka Asada
- Institute for Health Research and Policy, School of Public Health, University of Illinois Chicago, 1747 W Roosevelt Rd M/C 275, Chicago, IL, 60608
| | - Svetlana Mitric
- College of Education, University of Illinois at Chicago, 1040 W Harrison St, Chicago, IL, 60607
| | - Jamie F Chriqui
- Division of Health Policy & Administration and Institute for Health Research and Policy, School of Public Health, University of Illinois Chicago, 1603 W. Taylor Street, MC 923, Chicago, 60608
| |
Collapse
|
30
|
Chriqui JF, Lin W, Leider J, Shang C, Perna FM. The harmonizing effect of Smart Snacks on the association between state snack laws and high school students' fruit and vegetable consumption, United States-2005-2017. Prev Med 2020; 139:106093. [PMID: 32305581 PMCID: PMC9437874 DOI: 10.1016/j.ypmed.2020.106093] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 02/08/2020] [Accepted: 04/11/2020] [Indexed: 01/06/2023]
Abstract
Despite national guidelines recommending daily fruit and vegetable (FV) consumption, intake of FV among adolescents is low. Over the past 10-15 years, state and federal laws have reduced the availability of junk foods in schools. This study examined the association between state snack laws and high school (HS) student FV consumption. The overall sample included 99,785 HS students (outcome samples ranged from 96,209-97,328) included in the Youth Risk Behavior Survey (YRBS). National Cancer Institute Classification of Laws Associated with School Students' data for 2004-2016 were lagged on to 2005-2017 YRBS data. Separate analyses examined the state law-youth FV consumption relationship pre- and post-federal Smart Snacks standards (effective school year 2014-2015). Analyses were conducted between 2018 and 2020. Overall, state laws were associated with any vegetable, salad, and other vegetable consumption. The relationship between state laws and vegetable consumption primarily occurred pre-Smart Snacks. Pre-Smart Snacks, state laws were associated with higher odds of youth consumption of any vegetable, salad, carrots, and other vegetables (all compared to students in states without snack laws). The only association post-Smart Snacks was between strong state laws and salads. This study illustrates the important role that standards restricting the availability of junk foods in schools can have on increasing student vegetable consumption. Given current efforts to roll-back federal school meal standards, findings from this study illustrate how federal standards harmonized the patchwork of state laws that existed prior to Smart Snacks and the important role that consistent national standards can play in supporting student consumption of vegetables.
Collapse
Affiliation(s)
- Jamie F Chriqui
- Institute for Health Research and Policy, University of Illinois at Chicago, 1747 W. Roosevelt Road, M/C 275, Chicago, IL 60608, USA; Division of Health Policy and Administration, School of Public Health, University of Illinois at Chicago, 1603 W. Taylor Street, M/C 923, Chicago, IL 60612, USA.
| | - Wanting Lin
- Institute for Health Research and Policy, University of Illinois at Chicago, 1747 W. Roosevelt Road, M/C 275, Chicago, IL 60608, USA.
| | - Julien Leider
- Institute for Health Research and Policy, University of Illinois at Chicago, 1747 W. Roosevelt Road, M/C 275, Chicago, IL 60608, USA.
| | - Ce Shang
- Department of Internal Medicine, The Ohio State University, USA.
| | - Frank M Perna
- Health Behaviors Research Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, USA.
| |
Collapse
|
31
|
Chriqui JF, Leider J, Schermbeck RM, Sanghera A, Pugach O. Changes in Child and Adult Care Food Program (CACFP) Practices at Participating Childcare and Education Centers in the United States Following Updated National Standards, 2017-2019. Nutrients 2020; 12:E2818. [PMID: 32942598 PMCID: PMC7551123 DOI: 10.3390/nu12092818] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 09/04/2020] [Accepted: 09/11/2020] [Indexed: 11/22/2022] Open
Abstract
The U.S. Department of Agriculture's (USDA) Child and Adult Care Food Program (CACFP) updated meal pattern standards took effect in October 2017. The aim of this quasi-experimental, pre-post study is to identify changes in food and beverage practices of CACFP-participating centers due to implementation of updated CACFP meal patterns over a 21-month period. Eight hundred and fifty-eight centers located in 47 states and the District of Columbia completed a survey (primarily electronic) at both time points (67.6% follow-up response rate). Multivariable logistic regressions with robust standard errors assessed changes over time, accounting for repeated observations within each site. From baseline to follow-up, centers reported the increased familiarity and implementation, albeit with time, money, and staffing-related challenges. Significant improvements were seen in not serving sugary cereals or flavored milk, in serving 100% whole grains, and serving processed meats less than once a week. While CACFP-participating centers reported making significant progress in meeting the updated meal pattern standards and suggested best practices within 15-19 months of their effective date, reported compliance and adherence to the standards and best practices was not universal. USDA, state agencies, and technical assistance providers should work to provide centers with additional guidance to help them with implementation.
Collapse
Affiliation(s)
- Jamie F. Chriqui
- Division of Health Policy and Administration, School of Public Health, University of Illinois Chicago, Chicago, IL 60608, USA
- Institute for Health Research and Policy, University of Illinois Chicago, Chicago, IL 60608, USA; (J.L.); (R.M.S.); (A.S.); (O.P.)
| | - Julien Leider
- Institute for Health Research and Policy, University of Illinois Chicago, Chicago, IL 60608, USA; (J.L.); (R.M.S.); (A.S.); (O.P.)
| | - Rebecca M. Schermbeck
- Institute for Health Research and Policy, University of Illinois Chicago, Chicago, IL 60608, USA; (J.L.); (R.M.S.); (A.S.); (O.P.)
| | - Anmol Sanghera
- Institute for Health Research and Policy, University of Illinois Chicago, Chicago, IL 60608, USA; (J.L.); (R.M.S.); (A.S.); (O.P.)
| | - Oksana Pugach
- Institute for Health Research and Policy, University of Illinois Chicago, Chicago, IL 60608, USA; (J.L.); (R.M.S.); (A.S.); (O.P.)
| |
Collapse
|
32
|
Schermbeck RM, Kim M, Chriqui JF. Independent Early Childhood Education Centers' Experiences Implementing the Revised Child and Adult Care Food Program Meal Pattern Standards: A Qualitative Exploratory Study. J Acad Nutr Diet 2020; 121:678-687.e1. [PMID: 32855102 DOI: 10.1016/j.jand.2020.06.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 05/15/2020] [Accepted: 06/23/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Nationally, approximately one-third of early childhood education centers participating in the Child and Adult Care Food Program (CACFP) are independently owned and operated (ie, not owned by a corporation, not affiliated with Head Start, and with no food program sponsor). Independent providers are less likely to meet CACFP standards and best practices and would benefit from additional support and technical assistance. OBJECTIVE To explore independent early childhood education center key informants' (KIs) (ie, directors or relevant staff) perspectives on implementing the revised CACFP standards. DESIGN Following qualitative exploratory design, semistructured, in-depth, telephone interviews were conducted with KIs individually. PARTICIPANTS/SETTING In summer 2018, 30 randomly sampled KIs from independent CACFP-participating early childhood education centers serving children ages 2 to 5 years nationwide were interviewed. Participants were sampled from respondents to a previously completed nationwide survey of providers. MAIN OUTCOMES KIs' perspectives on the CACFP program and revised meal pattern standard implementation. ANALYSIS PERFORMED After audio recordings were professionally transcribed and reviewed, constant comparative analysis was conducted using Atlas.ti v8 qualitative software (Atlas.ti. version 8 for Windows, 2018, Scientific Software Development GmbH). RESULTS KIs indicated that program benefits (eg, health and nutrition benefits, reimbursement, guidelines, and training) outweighed challenges experienced. Challenges associated with revised CACFP standards implementation (eg, availability or acceptability of new, creditable foods) were impacted by enhanced CACFP standards status, reported revised standards, and availability or utilization of outside support. KIs desired more contact with their state representative. KIs found the training and technical assistance on the revised standards useful and suggestions to enhance future training and technical assistance (eg, increasing accessibility, training resources, and audience-specific training). CONCLUSIONS Overall, KIs desired additional resources, training, and increased communication from CACFP state representatives specific to CACFP-approved and reimbursable products, menu ideas, recipes, and cooking demonstrations. The present study suggests that a more tailored training and technical assistance approach is necessary as reported benefits, challenges, and program needs varied based on state-enhanced CACFP standards, reported familiarity with the revised meal pattern, and reported outside support.
Collapse
Affiliation(s)
- Rebecca M Schermbeck
- Division of Health Policy and Administration, Institute for Health Research and Policy, School of Public Health, University of Illinois at Chicago, Chicago.
| | - Mhinjine Kim
- Division of Health Policy and Administration, Institute for Health Research and Policy, School of Public Health, University of Illinois at Chicago, Chicago
| | - Jamie F Chriqui
- Division of Health Policy and Administration, Institute for Health Research and Policy, School of Public Health, University of Illinois at Chicago, Chicago
| |
Collapse
|
33
|
Schwartz MB, Piekarz-Porter E, Read MA, Chriqui JF. Wellness School Assessment Tool Version 3.0: An Updated Quantitative Measure of Written School Wellness Policies. Prev Chronic Dis 2020; 17:E52. [PMID: 32614770 PMCID: PMC7367066 DOI: 10.5888/pcd17.190373] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Schools play an important role in promoting student wellness. As directed by the Healthy Hunger-Free Kids Act, the US Department of Agriculture updated the requirements for written school wellness policies in 2016. The WellSAT (Wellness School Assessment Tool) is an online tool that provides a quantitative score for wellness policy comprehensiveness and strength. The WellSAT has been updated 3 times over the past decade to remain current with federal law and best practices. In this article, we describe the process of updating to WellSAT 3.0. The steps included: reviewing the language of each item linked to a federal provision; adding and deleting items based on frequencies from the National Wellness Policy Study and the empirical support for specific policies; gathering feedback from a survey of experts (N = 77) about best practices and measure usability; and establishing intercoder reliability in a national sample (N = 50) of policies. We conclude with recommendations and guidance for the use of WellSAT 3.0.
Collapse
Affiliation(s)
- Marlene B Schwartz
- Rudd Center for Food Policy and Obesity, University of Connecticut, Hartford, Connecticut.,Department of Human Development and Family Sciences, Director, Rudd Center for Food Policy and Obesity, University of Connecticut, 1 Constitution Plaza, Suite 600, Hartford, CT 06103.
| | - Elizabeth Piekarz-Porter
- Institute for Health Research and Policy, School of Public Health, University of Illinois at Chicago, Chicago, Illinois
| | - Margaret A Read
- Rudd Center for Food Policy and Obesity, University of Connecticut, Hartford, Connecticut
| | - Jamie F Chriqui
- Institute for Health Research and Policy, School of Public Health, University of Illinois at Chicago, Chicago, Illinois
| |
Collapse
|
34
|
Chriqui JF, Powell LM. Sugar-Sweetened Beverage Taxes: Increasing Prices to Reduce Beverage Consumption. Am J Public Health 2020. [DOI: 10.2105/ajph.2020.305682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Jamie F. Chriqui
- Jamie F. Chriqui is a professor of Health Policy and Administration in the School of Public Health at the University of Illinois at Chicago (UIC) and codirector of the Health Policy Center in the Institute for Health Research and Policy at UIC. Lisa M. Powell is a distinguished professor and director of the Division of Health Policy and Administration in the School of Public Health at UIC
| | - Lisa M. Powell
- Jamie F. Chriqui is a professor of Health Policy and Administration in the School of Public Health at the University of Illinois at Chicago (UIC) and codirector of the Health Policy Center in the Institute for Health Research and Policy at UIC. Lisa M. Powell is a distinguished professor and director of the Division of Health Policy and Administration in the School of Public Health at UIC
| |
Collapse
|
35
|
Abstract
Objectives. To describe the public health and policy lessons learned from the failure of the Cook County, Illinois, Sweetened Beverage Tax (SBT).Methods. This retrospective, mixed-methods, qualitative study involved key informant (KI) and discussion group interviews and document analysis including news media, court documents, testimony, letters, and press releases. Two coders used Atlas.ti v.8A to analyze 321 documents (from September 2016 through December 2017) and 6 KI and discussion group transcripts (from December 2017 through August 2018).Results. Key lessons were (1) the SBT process needed to be treated as a political campaign, (2) there was inconsistent messaging regarding the tax purpose (i.e., revenue vs public health), (3) it was important to understand the local context and constraints, (4) there was implementation confusion, and (5) the media influenced an antitax backlash.Conclusions. The experience with the implementation and repeal of the Cook County SBT provides important lessons for future beverage tax efforts.Public Health Implications. Beverage taxation efforts need to be treated as political campaigns requiring strong coalitions, clear messaging, substantial resources, and work within the local context.
Collapse
Affiliation(s)
- Jamie F Chriqui
- Jamie F. Chriqui and Lisa M. Powell are with the Division of Health Policy and Administration, School of Public Health, and the Health Policy Center, Institute for Health Research and Policy (IHRP), University of Illinois at Chicago. At the time of this study, Christina N. Sansone was a visiting research specialist at IHRP
| | - Christina N Sansone
- Jamie F. Chriqui and Lisa M. Powell are with the Division of Health Policy and Administration, School of Public Health, and the Health Policy Center, Institute for Health Research and Policy (IHRP), University of Illinois at Chicago. At the time of this study, Christina N. Sansone was a visiting research specialist at IHRP
| | - Lisa M Powell
- Jamie F. Chriqui and Lisa M. Powell are with the Division of Health Policy and Administration, School of Public Health, and the Health Policy Center, Institute for Health Research and Policy (IHRP), University of Illinois at Chicago. At the time of this study, Christina N. Sansone was a visiting research specialist at IHRP
| |
Collapse
|
36
|
Asada Y, Turner L, Schwartz M, Chriqui JF. "Bridging, brokering, and buffering": a theoretical exploration of school leaders' engagement with local school wellness policy implementation. Implement Sci Commun 2020; 1:44. [PMID: 32885201 PMCID: PMC7427866 DOI: 10.1186/s43058-020-00029-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 03/25/2020] [Indexed: 11/26/2022] Open
Abstract
Background The Healthy, Hunger-Free Kids Act of 2010 (P.L. 111-296) prompted the expansion of federal requirements for local school wellness policies, which aim to improve health promoting practices across school districts in the USA. This qualitative study examined how school district superintendents—as key school leaders who are often listed as the district accountability figure for wellness policies applicable to kindergarten through 12th grade—engaged with wellness policy implementation. The inquiry was guided by evidence-informed implementation and leadership frameworks, including the Consolidated Framework for Implementation Research (CFIR) and “bridging, buffering, and brokering” strategies from education leadership theory. Methods We conducted focus groups and interviews with superintendents (n = 39) from 23 states. Interviews were recorded and professionally transcribed; transcripts were team-coded in Atlas.ti v8 using an iteratively revised coding guide that was informed by CFIR, pilot testing, and during weekly analyst meetings. Principles of constant comparative analysis were employed to develop themes. Results Most superintendents’ reported positive perspectives and personal motivations to engage with wellness policy implementation. Within the CFIR process domain, superintendents demonstrated adaptive leadership traits and employed a combination of “bridging, buffering, and brokering” strategies to lead implementation activities. Rather than focus on personal traits, an emphasis on specific strategies highlights actions that may be applied. Conclusions The findings offer practical strategies to support superintendents with implementation, as well as a formative contribution to the dearth of theoretical frameworks in school wellness literature, particularly by advancing the specific understanding of leadership roles within a broader implementation framework. The application of education theory allowed for a deeper inquiry into the potential ways that leaders’ strategies and engagement influences implementation more broadly.
Collapse
Affiliation(s)
- Y Asada
- Institute for Health Research and Policy, University of Illinois at Chicago, 1747 W Roosevelt Rd, M/C 275, Chicago, IL 60608 USA
| | - L Turner
- College of Education, Boise State University, 1910 University Drive, Boise, Idaho 83725 USA
| | - M Schwartz
- UConn Rudd Center for Food Policy and Obesity University of Connecticut, One Constitution Plaza, Suite 600, Hartford, CT 06103 USA
| | - J F Chriqui
- Institute for Health Research and Policy, School of Public Health, University of Illinois at Chicago, 1747 W Roosevelt Rd, M/C 275, Chicago, IL 60608 USA
| |
Collapse
|
37
|
Eyler AA, Valko CR, Curoe KA, Ramadas R, Chriqui JF. Adherence to Updated Childcare Nutrition Regulations in Colorado, United States. Front Public Health 2020; 8:102. [PMID: 32322568 PMCID: PMC7156549 DOI: 10.3389/fpubh.2020.00102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 03/16/2020] [Indexed: 12/03/2022] Open
Abstract
Background: Preschool years are an important time for shaping healthy eating behaviors. Childcare centers can be a venue for policy change for broad and sustained positive impact on healthy eating environment. The objectives of this study were to assess how self-reported current practices align with updated statewide childcare center licensing regulations in Colorado, US, and to explore correlates of adherence. Methods: Using a post-test only study design, a survey was sent to all full-day, licensed childcare centers in Colorado (N = 1,398) with a valid street or email address. The survey included questions on allowable food and beverages, mealtime practices, and perceptions of the updated regulations. Frequencies were calculated and logistic regression models computed for a composite score of each of these factors. Results: Respondents (N = 344) were mostly center directors, with over 8 years of experience, from urban areas. Compliance was high for most food and beverage criteria (over 90%) and all meal practices. One third participated in the federal Child and Adult Care Food Program (CACFP), and were more likely to comply with the state meal regulations than non-CACFP centers. Conclusion: Although our results show high self-reported compliance, a more thorough study of the policy process would provide comprehensive evidence on effective development, enactment, and implementation of these regulations.
Collapse
Affiliation(s)
- Amy A. Eyler
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, St. Louis, MO, United States
| | - Cheryl R. Valko
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, St. Louis, MO, United States
| | - Katherine A. Curoe
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, St. Louis, MO, United States
| | - Ramya Ramadas
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, St. Louis, MO, United States
| | - Jamie F. Chriqui
- Division of Health Policy and Administration and Institute for Health Research and Policy, School of Public Health, University of Illinois at Chicago, Chicago, IL, United States
| |
Collapse
|
38
|
Lin W, Leider J, Shang C, Hennessy E, Perna FM, Chriqui JF. The Association Between State Physical Education Laws and Student Physical Activity. Am J Prev Med 2020; 58:436-445. [PMID: 31870591 DOI: 10.1016/j.amepre.2019.09.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 09/16/2019] [Accepted: 09/17/2019] [Indexed: 12/28/2022]
Abstract
INTRODUCTION This study examined the association between state physical education time requirements and physical activity and physical education outcomes among high school students. METHODS State physical education time requirement laws for 2004-2016 from the Classification of Laws Associated with School Students database were linked with 2005-2017 national Youth Risk Behavior Survey data using state and year identifiers. Analyses were conducted between 2018 and 2019 to assess associations between physical education time requirement laws and physical activity or physical education outcomes using multinomial logistic regressions, while controlling for sociodemographic characteristics, year-fixed effects, and state confounders. RESULTS State laws requiring ≥90 minutes of physical education per week were associated with 3.1 percentage points lower probability of no days of physical activity ≥60 minutes (95% CI= -5.0, -1.1), 3.7 percentage points lower probability of no days of moderate exercise ≥30 minutes (95% CI= -6.2, -1.3), 4.2 percentage points lower probability of no days of vigorous exercise ≥20 minutes (95% CI= -5.2, -3.3), and 19.3 percentage points lower probability of not attending physical education class (95% CI= -34.4, -4.2). The laws were associated with a 2.4 percentage point higher probability of daily moderate exercise ≥30 minutes in male students (95% CI=0.6, 4.2) and a 3.4 percentage point higher probability in female students (95% CI=1.9, 4.9), with larger associations for female students (p<0.01). CONCLUSIONS Findings from this study help support the role that physical education state requirements can play in enhancing adolescents' ability to meet recommended amounts of daily physical activity and the related public health benefits.
Collapse
Affiliation(s)
- Wanting Lin
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, Illinois
| | - Julien Leider
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, Illinois
| | - Ce Shang
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Erin Hennessy
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts
| | - Frank M Perna
- Health Behaviors Research Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland
| | - Jamie F Chriqui
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, Illinois; Division of Health Policy and Administration, School of Public Health, University of Illinois at Chicago, Chicago, Illinois.
| |
Collapse
|
39
|
Abstract
IMPORTANCE The Smart Snacks in School standards (hereafter, Smart Snacks) were issued in 2013 with the aim of improving students' dietary intake behaviors. Goals of Smart Snacks included reducing total energy intake, consumption of solid fats and added sugars, and sodium intake. Smart Snacks standards were required to be implemented by the start of the 2014 to 2015 school year at all US schools participating in federal child nutrition programs. OBJECTIVE To examine the association of state laws that specifically direct schools to implement Smart Snacks with student dietary consumption outcomes. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study used nationally representative data collected in the 2014 to 2015 school year as part of the School Nutrition and Meal Cost Study. Students in grades 1 through 12 (ages approximately 6-18 years) were randomly selected from 310 public schools in 30 US states and the District of Columbia. Analytic weights were applied and all percentages reported are weighted. Analyses were conducted from March 1, 2018, to December 12, 2019. EXPOSURES State laws requiring schools to implement Smart Snacks. MAIN OUTCOMES AND MEASURES A 24-hour recall was used to assess student dietary intake as daily kilocalories consumed as (a) total energy, (b) solid fats and added sugars combined, (c) solid fats, or (d) added sugars. Milligrams of daily sodium consumption were also computed. RESULTS Among 1959 students (mean [SD] age, 11.9 [3.5] years; 1014 [50.9%] boys), 420 students (22.5%) attended school in a state with Smart Snacks laws, and 528 students (26.1%) consumed snacks obtained at school. In covariate-adjusted models, total energy intake did not vary based on state law. Adjusted mean daily kilocalories from solid fats and added sugars was significantly lower among students in states with laws (508.7 [95% CI, 463.0 to 554.4] kcal) than among students in states without laws (562.5 [95% CI, 534.3 to 590.8] kcal; difference, -53.9 [95% CI, -104.5 to -3.2] kcal; P = .04). Consumption of sodium did not differ by state law. Kilocalories from solid fats contributed more to the difference than kilocalories from added sugars (-37.7 [95% CI -62.8 to -12.6] kcal vs -16.2 [95% CI, -51.3 to 19.0] kcal). CONCLUSIONS AND RELEVANCE These findings suggest that students in states with laws requiring schools to implement Smart Snacks had better dietary intake than students in states without laws, consuming a mean of 53.9 fewer kilocalories from solid fats and added sugars per day, after adjusting for covariates. State-level policy mechanisms may support schools' implementation of federal standards in ways that are associated with healthier diets among children and adolescents.
Collapse
Affiliation(s)
- Lindsey Turner
- College of Education, Boise State University, Boise, Idaho
| | - Julien Leider
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago
| | | | - Jamie F Chriqui
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago
- Division of Health Policy and Administration, School of Public Health, University of Illinois at Chicago, Chicago
| |
Collapse
|
40
|
Chriqui JF, Leider J, Schermbeck RM. Early Childhood Education Centers' Reported Readiness to Implement the Updated Child and Adult Care Food Program Meal Pattern Standards in the United States, 2017. Child Obes 2019; 14:412-420. [PMID: 30199290 PMCID: PMC6909706 DOI: 10.1089/chi.2018.0075] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The Child and Adult Care Food Program (CACFP) serves nutritious meals/snacks to >3.6 million children in early childhood education (ECE) centers. This study provides a nationwide assessment of nonhome-based CACFP-participating ECE centers' awareness of and reported readiness for implementing updated CACFP standards/best practices that took effect October 1, 2017. METHODS A national frame of 38,760 centers serving children ages 0-5 was developed. A web-based survey of 5483 sampled centers, stratified by census division, was conducted between August 22 and September 30, 2017. One thousand three hundred forty-three centers (25%) located in 47 states and the District of Columbia responded. Surveys were primarily completed by center directors/assistant directors (71%). Nonresponse adjusted multivariate regressions were conducted, controlling for center/zip code-level characteristics. RESULTS The majority of centers reported being "very" familiar with the updated standards and met specific standards/best practices. Centers that reported being "somewhat" (vs. "very") familiar with the standards were less prepared and likely to have begun implementation and more likely to need additional time, money, and staff. Centers that reported being "not"/"somewhat" familiar (vs. "very") with the updated standards were also less likely to meet specific standards/best practices. Center preparedness and standards/best practices varied by weekly rates/fees charged. Centers in the West (vs. South) were more likely to report meeting sugary cereal standards and fruits and vegetables as a snack component best practice. CONCLUSIONS While most centers reported familiarity with and were prepared to implement the updated CACFP standards, readiness is not universal. Technical assistance and training should ensure that all centers are trained on the updated standards.
Collapse
Affiliation(s)
- Jamie F. Chriqui
- Division of Health Policy and Administration, School of Public Health, University of Illinois at Chicago, Chicago, IL
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, IL
| | - Julien Leider
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, IL
| | - Rebecca M. Schermbeck
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, IL
| |
Collapse
|
41
|
Chriqui JF, Schermbeck RM, Leider J. Food Purchasing and Preparation at Child Day Care Centers Participating in the Child and Adult Care Food Program in the United States, 2017. Child Obes 2019; 14:375-385. [PMID: 30199293 PMCID: PMC6909716 DOI: 10.1089/chi.2018.0099] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND More than 3.6 million children are served daily by the Child and Adult Care Food Program (CACFP)-participating child day care centers. This study provides a nationwide assessment of center-level responsibilities for menu, meal/snack preparation, meal preparer training, and food and beverage (F&B) purchasing. METHODS A nationally representative survey of 5483 CACFP child day care centers was conducted between August 22, 2017, and September 30, 2017. One thousand three hundred forty-three centers (25% response) in 47 states and the District of Columbia responded. Descriptive statistics describe center-level menu, meal, and purchasing practices and center characteristics. Multivariate logistic regressions examined characteristics associated with F&B purchasing sources. RESULTS Menus were primarily prepared by directors/assistant directors and on-site food manager/cooks, while site staff primarily prepared meals/snacks. Fifty-two percent of meal preparers held a food sanitation license, but only 5% had formal nutrition training (e.g., Registered Dietician). Most centers purchased F&B from food service providers (63%), local grocery stores (59%), warehouse stores (40%), or from 2+ sources (50%). Independent centers were more likely to purchase F&B from local grocery stores or 2+, while free or state-subsidized sites were more likely to purchase from a food service provider and less likely to purchase from other sources than were centers charging between $101 and $201.99 per week. Centers where an on-site cook/food manager prepared the menus were significantly more likely to purchase their F&B from local grocery and/or warehouse stores and/or from 2+ sources. CONCLUSIONS Opportunities exist to target CACFP training to specific roles within and specific types of CACFP-participating child day care centers to facilitate compliance with the updated CACFP standards.
Collapse
Affiliation(s)
- Jamie F. Chriqui
- Division of Health Policy and Administration, School of Public Health, University of Illinois at Chicago, Chicago, IL
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, IL
| | - Rebecca M. Schermbeck
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, IL
| | - Julien Leider
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, IL
| |
Collapse
|
42
|
Piekarz-Porter E, Lin W, Chriqui JF. Smart Snacks Fundraiser Exemption Policies: Are States Supporting the Spirit of Smart Snacks? J Sch Health 2019; 89:692-697. [PMID: 31257602 DOI: 10.1111/josh.12807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 10/03/2017] [Accepted: 04/22/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Under Smart Snacks, state agencies can adopt a policy regulating infrequent school-sponsored fundraisers. Fundraiser exemptions allow noncompliant foods and beverages to be sold during the school day. This article examines fundraiser exemption policies in each state as of September 1, 2017. METHODS Laws were collected for all 50 states and the District of Columbia using Boolean searches of LexisNexis and Westlaw. Informal state-level policies (eg, memos) were collected through searches of state department of education and child nutrition program websites. Policies were analyzed to determine the number of exempt fundraisers allowed in each state. RESULTS By September 1, 2017, 47 states adopted a fundraiser exemption policy; 21 states adopted a zero exemption policy; 19 states regulated the number of exempt fundraisers; five states regulated the number of exempt fundraising days; one state regulated the number of exempt events; and one state approved all requested exemptions. Four states had not adopted a policy and default under the rule to zero exemptions allowed. CONCLUSIONS A patchwork of state policies governs the school food-related fundraiser landscape. However, the overall goal of improving the school food environment should persist as an important factor in determining how many, if any, will be allowed each school year.
Collapse
Affiliation(s)
- Elizabeth Piekarz-Porter
- Institute for Health Research and Policy, University of Illinois at Chicago, 1747 West Roosevelt Road, Chicago, IL 60608
| | - Wanting Lin
- Institute for Health Research and Policy, University of Illinois at Chicago, 1747 West Roosevelt Road, Chicago, IL 60608
| | - Jamie F Chriqui
- Division of Health Policy and Administration Co-Director, Health Policy Center and Fellow, Institute for Health Research and Policy, University of Illinois at Chicago, 1747 West Roosevelt Road, Chicago, IL 60608
| |
Collapse
|
43
|
Abstract
The objective of this study was to describe the provision of sugary cereals by early childhood education (ECE) centers participating in the Child and Adult Care Food Program (CACFP) before required implementation of the updated CACFP meal pattern standards. We distributed a web-based survey, which included a question on breakfast cereals, to a random sample of 5,483 CACFP-participating ECE centers nationwide. Of the 1,343 centers that responded, 30% did not meet the updated requirement for cereal; 38% of independently owned or operated centers did not meet the requirement. Results indicate the need for additional training and technical assistance on the updated CACFP standards for sugar in cereal.
Collapse
Affiliation(s)
- Rebecca M Schermbeck
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, Illinois
| | - Julien Leider
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, Illinois
| | - Jamie F Chriqui
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, Illinois
- Division of Health Policy and Administration, School of Public Health, University of Illinois at Chicago, Chicago, Illinois
- University of Illinois at Chicago, 1747 W Roosevelt Rd, M/C 275, Room 558, Chicago, IL 60608.
| |
Collapse
|
44
|
Turner L, Leider J, Piekarz-Porter E, Schwartz MB, Merlo C, Brener N, Chriqui JF. State Laws Are Associated with School Lunch Duration and Promotion Practices. J Acad Nutr Diet 2018; 118:455-463. [PMID: 29111088 PMCID: PMC6049821 DOI: 10.1016/j.jand.2017.08.116] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 08/22/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND The changes in school meal programs stemming from the Healthy, Hunger-Free Kids Act of 2010 have expanded interest in strategies that increase student participation in school lunch and reduce plate waste. However, it remains unclear what factors are associated with schools' use of such strategies. OBJECTIVE This study examines whether state laws are associated with two types of school meal-related practices: (a) using promotional strategies (ie, taste tests, using posters or announcements) and (b) duration of lunch periods. DESIGN This cross-sectional study utilized the nationally representative 2014 School Health Policies and Practices Study, combined with corresponding state laws gathered by the National Wellness Policy Study. School data were available from 414 public schools in 43 states. MAIN OUTCOME MEASURES Outcome measures included 16 strategies to promote school meals and the amount of time students had to eat lunch after being seated. STATISTICAL ANALYSES PERFORMED Multivariate logistic regression and Poisson regression were used to examine associations between state laws and school practices, after accounting for school demographic characteristics. RESULTS Compared to schools in states with no law about engaging stakeholders in meal programs, schools in states with a law were more likely to conduct taste tests (64% vs 44%, P=0.016), collect suggestions from students (67% vs 50%, P=0.017), and invite family members to a school meal (71% vs 53%, P=0.015). Schools used more promotion strategies in states with a law than in states without a law (mean=10.4 vs 8.8, P=0.003). Schools were more likely to provide students at least 30 minutes to eat lunch after being seated in states with laws that addressed a minimum amount of time for lunch duration (43% vs 27%, P=0.042). CONCLUSIONS State-level policy provisions are associated with school practices. Policy development in more states may support school practices that promote lunch participation and consumption.
Collapse
|
45
|
Huang J, Chriqui JF, DeLong H, Mirza M, Diaz MC, Chaloupka FJ. Do state minimum markup/price laws work? Evidence from retail scanner data and TUS-CPS. Tob Control 2018; 25:i52-i59. [PMID: 27697948 PMCID: PMC5099228 DOI: 10.1136/tobaccocontrol-2016-053093] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 06/23/2016] [Indexed: 11/25/2022]
Abstract
Background Minimum markup/price laws (MPLs) have been proposed as an alternative non-tax pricing strategy to reduce tobacco use and access. However, the empirical evidence on the effectiveness of MPLs in increasing cigarette prices is very limited. This study aims to fill this critical gap by examining the association between MPLs and cigarette prices. Methods State MPLs were compiled from primary legal research databases and were linked to cigarette prices constructed from the Nielsen retail scanner data and the self-reported cigarette prices from the Tobacco Use Supplement to the Current Population Survey. Multivariate regression analyses were conducted to examine the association between MPLs and the major components of MPLs and cigarette prices. Results The presence of MPLs was associated with higher cigarette prices. In addition, cigarette prices were higher, above and beyond the higher prices resulting from MPLs, in states that prohibit below-cost combination sales; do not allow any distributing party to use trade discounts to reduce the base cost of cigarettes; prohibit distributing parties from meeting the price of a competitor, and prohibit distributing below-cost coupons to the consumer. Moreover, states that had total markup rates >24% were associated with significantly higher cigarette prices. Conclusions MPLs are an effective way to increase cigarette prices. The impact of MPLs can be further strengthened by imposing greater markup rates and by prohibiting coupon distribution, competitor price matching, and use of below-cost combination sales and trade discounts.
Collapse
Affiliation(s)
- Jidong Huang
- School of Public Health, Georgia State University, Atlanta, USA
| | - Jamie F Chriqui
- Division of Health Policy and Administration, School of Public Health, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Hillary DeLong
- School of Public Health, Georgia State University, Atlanta, USA
| | - Maryam Mirza
- Department of Economics, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Megan C Diaz
- Department of Economics, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Frank J Chaloupka
- School of Public Health, Georgia State University, Atlanta, USA Department of Economics, University of Illinois at Chicago, Chicago, Illinois, USA
| |
Collapse
|
46
|
Cradock AL, Barrett JL, Chriqui JF, Evenson KR, Goins KV, Gustat J, Heinrich KM, Perry CK, Scanze M, Schmid TL, Tabak RG, Umstattd Meyer MR, Valko C. Driven to Support: Individual- and County-Level Factors Associated With Public Support for Active Transportation Policies. Am J Health Promot 2017; 32:657-666. [PMID: 29108441 DOI: 10.1177/0890117117738758] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To assess predictors of stated support for policies promoting physically active transportation. DESIGN Cross-sectional. SETTING US counties selected on county-level physical activity and obesity health status. PARTICIPANTS Participants completing random-digit dialed telephone survey (n = 906). MEASURES Survey measures assessed stated support for 5 policies to promote physically active transportation, access to active transportation facilities, and time spent in a car. County-level estimates included household car dependence and funding for bicycle-pedestrian projects. ANALYSIS Multivariable generalized linear mixed models using binary distribution and logit link, accounting for clustering within county. RESULTS Respondents supported policies for accommodating bicyclists and pedestrians through street improvements (89%), school active transportation programs (75%), employer-funded active commuting incentives (67%), and allocation of public funding (68%) and tax support (56%) for building and maintaining public transit. Residents spending >2 h/d (vs <0.7 hours) in cars were more likely to support street (odds ratio [OR]: 1.87; confidence interval [CI]: 1.09-3.22) and public transit (OR: 1.85; CI: 1.24-2.77) improvements. Residents in counties investing >$1.6 million in bicycle and pedestrian improvements expressed greater support for funding (OR: 1.71; CI: 1.04-2.83) and tax increases (OR: 1.73; CI: 1.08-2.75) for transit improvements compared to those with lower prior investments (<$276 100). CONCLUSION Support for policies to enable active transportation is higher where relevant investments in active transportation infrastructure are large (>$1.6 M), public transit is nearby, and respondents drive >2 h/d.
Collapse
Affiliation(s)
- Angie L Cradock
- 1 Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Jessica L Barrett
- 1 Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Jamie F Chriqui
- 2 Division of Health Policy and Administration, School of Public Health and the Institute for Health Research & Policy, University of Illinois at Chicago, Chicago, IL, USA
| | - Kelly R Evenson
- 3 Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Karin Valentine Goins
- 4 Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Jeanette Gustat
- 5 Department of Epidemiology; Prevention Research Center, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Katie M Heinrich
- 6 Department of Kinesiology, Kansas State University, Manhattan, KS, USA
| | - Cynthia K Perry
- 7 Oregon Health & Science University School of Nursing, Portland, OR, USA
| | - Michele Scanze
- 8 College of Architecture, Planning and Landscape Architecture, University of Arizona, Tucson, AZ, USA
| | - Thomas L Schmid
- 9 Physical Activity and Health Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Rachel G Tabak
- 10 Prevention Research Center, Brown School at Washington University in St Louis, St Louis, MO, USA
| | - M Renee Umstattd Meyer
- 11 Department of Health, Human Performance, & Recreation, Baylor University, Waco, TX, USA
| | - Cheryl Valko
- 10 Prevention Research Center, Brown School at Washington University in St Louis, St Louis, MO, USA
| |
Collapse
|
47
|
Asada Y, Hughes AG, Read M, Schwartz MB, Chriqui JF. High School Students' Recommendations to Improve School Food Environments: Insights From a Critical Stakeholder Group. J Sch Health 2017; 87:842-849. [PMID: 29023833 DOI: 10.1111/josh.12562] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Revised: 02/01/2017] [Accepted: 04/21/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND The Healthy, Hunger-Free Kids Act of 2010 (HHFKA) directed the US Department of Agriculture (USDA) to revise school meal standards. Students are most affected by efforts to improve the school food environment; yet, few studies directly include students. This study examined high school students' experiences of school meal reform to gain insight into implementation recommendations. METHODS We conducted 5 focus groups with high school students (N = 15) from high schools across 9 states. We also conducted follow-up interviews to further explore personal experiences. Focus groups and interview transcripts were coded and organized in Atlas.ti v7 by analysts, following principles of constant comparative analysis. RESULTS Students reported overall positive perceptions of the revised school meal standards and supported continued efforts to improve the food environment. Recommendations to improve the food environment included engaging students, focusing on the quality and palatability of meal items, moving toward scratch-cooking, and addressing cafeteria infrastructure. CONCLUSIONS Students' recommendations point to opportunities where school districts, as well as local, state, and federal organizations can work to improve the school food environment. Their insights are directly relevant to USDA's recently released Local School Wellness Policy final rule, of which school meal standards are one provision.
Collapse
Affiliation(s)
- Yuka Asada
- Institute for Health Research and Policy, School of Public Health, University of Illinois at Chicago, 1747W Roosevelt Rd M/C 275, Chicago, IL 60608
| | - Alejandro G Hughes
- Institute for Health Research and Policy, School of Public Health, University of Illinois at Chicago, 1747W Roosevelt Rd M/C 275, Chicago, IL 60608
| | - Margaret Read
- UConn Rudd Center for Food Policy and Obesity, University of Connecticut, One Constitution Plaza, Suite 600, Hartford, CT 06103
| | - Marlene B Schwartz
- UConn Rudd Center for Food Policy and Obesity, Department of Human Development and Family Studies, University of Connecticut, One Constitution Plaza, Suite 600, Hartford, CT 06103
| | - Jamie F Chriqui
- Healthy Policy & Administration, School of Public Health and Institute for Health Research and Policy, University of Illinois at Chicago, 1747W Roosevelt Rd, M/C 275, Chicago, IL 60608
| |
Collapse
|
48
|
Turner L, Leider J, Piekarz E, Schermbeck RM, Merlo C, Brener N, Chriqui JF. Facilitating Fresh: State Laws Supporting School Gardens Are Associated With Use of Garden-Grown Produce in School Nutrition Services Programs. J Nutr Educ Behav 2017; 49:481-489.e1. [PMID: 28420546 PMCID: PMC10408657 DOI: 10.1016/j.jneb.2017.03.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 03/03/2017] [Accepted: 03/06/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To examine whether state laws are associated with the presence of school gardens and the use of garden-grown produce in school nutrition services programs. DESIGN Nationally representative data from the School Health Policies and Practices Study 2014 were combined with objectively coded state law data regarding school gardens. MAIN OUTCOME MEASURES Outcomes were: (1) the presence of a school garden at each school (n = 419 schools), and (2) the use of garden-grown items in the school nutrition services program. ANALYSIS Multivariate logistic regression was used to examine each outcome. Contextual covariates included school level, size, locale, US Census region, student race/ethnic composition, and percentage of students eligible for free and reduced-priced meals. RESULTS State law was not significantly associated with whether schools had a garden, but it was associated with whether schools used garden-grown items in nutrition services programs (odds ratio, 4.21; P < .05). Adjusted prevalence of using garden-grown items in nutrition services programs was 15.4% among schools in states with a supportive law, vs 4.4% among schools in states with no law. CONCLUSIONS AND IMPLICATIONS State laws that support school gardens may facilitate the use of garden-grown items in school nutrition service programs. Additional research is needed regarding the types of messaging that might be most effective for motivating school administrators to appreciate the value of school gardens. In addition, another area for further research pertains to scaling garden programs for broader reach.
Collapse
Affiliation(s)
- Lindsey Turner
- College of Education, Boise State University, Boise, ID.
| | - Julien Leider
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, IL
| | - Elizabeth Piekarz
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, IL
| | - Rebecca M Schermbeck
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, IL
| | - Caitlin Merlo
- Division of Population Health, Centers for Disease Control and Prevention, Atlanta, GA
| | - Nancy Brener
- Division of Adolescent and School Health, Centers for Disease Control and Prevention, Atlanta, GA
| | - Jamie F Chriqui
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, IL
| |
Collapse
|
49
|
Nicholson LM, Leider J, Chriqui JF. Exploring the Linkage between Activity-Friendly Zoning, Inactivity, and Cancer Incidence in the United States. Cancer Epidemiol Biomarkers Prev 2017; 26:578-586. [PMID: 28270500 DOI: 10.1158/1055-9965.epi-16-0331] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 08/25/2016] [Accepted: 08/26/2016] [Indexed: 11/16/2022] Open
Abstract
Background: Physical activity (PA) protects against cancer and enhances cancer survivorship. Given high inactivity rates nationwide, population-level physical activity facilitators are needed. Several authoritative bodies have recognized that zoning and planning helps create activity-friendly environments. This study examined the association between activity-friendly zoning, inactivity, and cancer in 478 of the most populous U.S. counties.Methods: County geocodes linked county-level data: cancer incidence and smoking (State Cancer Profiles), inactivity (Behavioral Risk Factor Surveillance System), 11 zoning measures (compiled by the study team), and covariates (from the American Community Survey and NAVTEQ). For each zoning measure, single mediation regression models and Sobel tests examined whether activity-friendly zoning was associated with reduced cancer incidence, and whether inactivity mediated those associations. All models were clustered on state with robust SEs and significance at the P < 0.05 level.Results: Zoning for crosswalks, bike-pedestrian connectivity, and bike-pedestrian trails/paths were associated with reduced cancer incidence (β between -0.71 and -1.27, P < 0.05), about 1 case per 100,000 for each 10 percentage-point increase in county population exposure to zoning. Except for crosswalks, each association was mediated by inactivity. However, county smoking attenuated these results, with only crosswalks remaining significant. Results were similar for males (with zoning for bike-pedestrian connectivity, street connectivity, and bike-pedestrian trails/paths), but not females, alone.Conclusions: Zoning can help to create activity-friendly environments that support decreased inactivity, and possibly reduced cancer incidence.Impact: Given low physical activity levels nationwide, cross-sectoral collaborations with urban planning can inform cancer prevention and public health efforts to decrease inactivity and cancer. Cancer Epidemiol Biomarkers Prev; 26(4); 578-86. ©2017 AACRSee all the articles in this CEBP Focus section, "Geospatial Approaches to Cancer Control and Population Sciences."
Collapse
Affiliation(s)
- Lisa M Nicholson
- Institute for Health Research and Policy, The University of Illinois at Chicago, Chicago, Illinois.
| | - Julien Leider
- Institute for Health Research and Policy, The University of Illinois at Chicago, Chicago, Illinois
| | - Jamie F Chriqui
- Institute for Health Research and Policy, The University of Illinois at Chicago, Chicago, Illinois
| |
Collapse
|
50
|
Schwartz MB, Just DR, Chriqui JF, Ammerman AS. Appetite self-regulation: Environmental and policy influences on eating behaviors. Obesity (Silver Spring) 2017; 25 Suppl 1:S26-S38. [PMID: 28229539 DOI: 10.1002/oby.21770] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 12/20/2016] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Appetite regulation is influenced by the environment, and the environment is shaped by food-related policies. This review summarizes the environment and policy research portion of an NIH Workshop (Bethesda, MD, 2015) titled "Self-Regulation of Appetite-It's Complicated." METHODS In this paper, we begin by making the case for why policy is an important tool in efforts to improve nutrition, and we introduce an ecological framework that illustrates the multiple layers that influence what people eat. We describe the state of the science on how policies influence behavior in several key areas: the federal food programs, schools, child care, food and beverage pricing, marketing to youth, behavioral economics, and changing defaults. Next, we propose novel approaches for multidisciplinary prevention and intervention strategies to promote breastfeeding, and examine interactions between psychology and the environment. RESULTS Policy and environmental change are the most distal influences on individual-level appetite regulation, yet these strategies can reach many people at once by changing the environment in which food choices are made. We note the need for more research to understand compensatory behavior, reactance, and how to effectively change social norms. CONCLUSIONS To move forward, we need a more sophisticated understanding of how individual psychological and biological factors interact with the environment and policy influences.
Collapse
Affiliation(s)
- Marlene B Schwartz
- Rudd Center for Food Policy and Obesity, University of Connecticut, Hartford, Connecticut, USA
| | - David R Just
- Dyson School of Applied Economics and Management, Cornell University, Ithaca, New York, USA
| | - Jamie F Chriqui
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Alice S Ammerman
- Department of Nutrition, Gillings School of Global Public Health, and Center for Health Promotion and Disease Prevention, UNC-Chapel Hill, Chapel Hill, North Carolina, USA
| |
Collapse
|