Search

COVID-19 disrupted food access, potentially increasing nutritional risk and health inequities. This study aimed to describe and assess associations between changes in food/meal acquisition behaviors and relative changes in dietary intake and bodyweight from before to during the pandemic. Low-income parents (n = 1090) reported these changes by online survey in April-August 2021. Associations were assessed by multinomial logistic regression. Compared to those with no change, those who decreased supermarket shopping had greater odds of decreased fruit and vegetable (FV; OR[95%CI] = 2.4[1.4-4.1]) and increased salty snack intakes (OR[95%CI] = 1.7[1.0-2.8]). Those who decreased farmers market shopping had greater odds of decreased FV intake (OR[95%CI] = 1.8[1.0-3.1]), increased bodyweight (OR[95%CI] = 1.7[1.1-2.6]), and increased SSB (OR[95%CI] = 1.9[1.1-3.2]) and sweets intakes (OR[95%CI] = 1.8[1.1-2.9]). Those who increased online food ordering had greater odds of increased sweets (OR[95%CI] = 1.7[1.1-2.8]), salty snacks (OR[95%CI] = 1.9[1.2-3.2]), and fast food (OR[95%CI] = 2.0[1.2-3.5]) intakes and bodyweight (OR[95%CI] = 1.8[1.1-2.9]). Those who increased healthy meal preparation had greater odds of increased FV intake (OR[95%CI] = 4.0[2.5-6.5]), decreased SSB (OR[95%CI] = 3.7[2.3-6.0]), sweets (OR[95%CI] = 2.7[1.6-4.4]), salty snacks (OR[95%CI] = 3.0[1.8-5]) and fast food intakes (OR[95%CI] = 2.8[1.7-4.6]) and bodyweight (OR[95%CI] = 2.2[1.2-4.0]). Interventions to address the potentially negative impacts of online food/meal shopping and support healthy home cooking may be needed to improve nutrition-related outcomes and reduce health disparities in the aftermath of the current pandemic and during future emergencies requiring similar restrictions.

This cross-sectional study examined the associations between parent-reported, perceptions of changes in school-aged childrens (ages 5-18) school meal participation, household cooking, fast food consumption, dietary intake, and weight during the COVID-19 pandemic. Respondents with low-income and school-aged children (n = 1040) were enrolled using quota sampling to approximate the distribution of low-income households and race/ethnicity among California residents who completed an on-line questionnaire developed by the authors. Adjusted multinomial models examined associations between parent-reported changes in school meal participation and time spent cooking, with parent-reported changes in child diet and body weight during COVID-19 (from before March 2020 to January-March 2021). During the pandemic, decreased school meal participation was associated with decreased childs fast food intake (OR[95 %CI] = 1.47[1.04-2.07]); conversely, increased school meal participation was associated with increased childs fast food intake (OR[95 %CI] = 1.71[1.09-2.68]). Decreased cooking at home was associated with decreased fruit and vegetable intake (OR[95 %CI] = 2.71[1.62-4.53]), increased sugar-sweetened beverage intake (OR[95 %CI] = 3.83[2.16-6.81]), and increased fast food intake (OR[95 %CI] = 4.09[2.45-6.84]); while increased cooking at home was associated with increased fruit and vegetable (OR[95 %CI] = 2.26[1.59-3.20]), sugar-sweetened beverage (OR[95 %CI] = 1.88[1.20-2.94]), sweets (OR[95 %CI] = 1.46[1.02-2.10]), and salty snack food intake (OR[95 %CI] = 1.87[1.29-2.71]). These parent-reported perceived changes in meal sources during the pandemic for children from low-income California households, and the mixed results in their associations with changes in parent-reported child dietary intake, suggest the need for strengthening policies and programs to support both access to, and healthfulness of, meals from school and home during prolonged school closures.

To determine the effectiveness of Supplemental Nutrition Assistance Program--Education (SNAP-Ed) nutrition and physical activity programming in elementary schools, it is necessary to recruit socioeconomically similar comparison schools not receiving SNAP-Ed programming. We developed a flexible recruitment strategy to tailor our approach to each individual school district and site. Here we discuss the lessons learned during the 10-month recruitment period, including early outreach, emphasizing participation benefits, leveraging and building relationships, and visiting sites.

Tobacco-related morbidity and mortality disproportionately affect people with substance use disorders (SUD). Encouraging overall wellness may support tobacco use cessation. We investigated relationships between wellness (health status, physical activity, sugar-sweetened beverage (SSB) consumption), cigarette smoking, and smoking cessation among SUD treatment patients to inform clinical care. Cross-sectional surveys were conducted with 395 patients in 20 California residential SUD programs. Using multivariate regression, we examined associations between smoking status and wellness. Among smokers, we examined associations between lifetime smoking exposure, cessation behaviors and attitudes, and wellness. Compared to nonsmokers (n = 121), smokers (n = 274) reported more SSB consumption, poorer physical health, and more respiratory symptoms. Among smokers, SSB consumption and respiratory symptoms increased per ten pack-years of smoking. Smokers with respiratory symptoms reported higher motivation to quit and more use of nicotine replacement therapy (NRT). Smokers with more days of poor mental health reported lower motivation to quit. Overall, cigarette smoking was associated with other health-risk behaviors among SUD treatment patients. Respiratory symptoms may increase, and poor mental health may decrease, SUD patients' intent to quit smoking. To reduce chronic disease risk among SUD patients, treatment programs should consider promoting overall wellness concurrently with smoking cessation.

COVID-related school closures had a big impact on millions of children nationwide, many of whom rely on schools for healthy meals. An online survey of 3,297 fourth- and fifth-grade students in 67 California school sstudied the dietary habits of schoolchildren during the pandemic. The results showed that students who ate one or two school meals a day had significantly higher intakes of vegetables, whole fruits, and 100% fruit juice, compared to students who did not eat school meals. Specifically, students who ate one school meal a day ate more beans and orange vegetables, while those who ate two school meals a day consumed a wider variety of vegetables, including beans and orange vegetables. However, children who ate one school meal a day drank more fruit drinks and flavored milks than those who did not eat school meals. Further, students who ate two school meals consumed more fruit drinks, flavored milks, and sports and energy drinks than those who did not eat school meals. Our findings suggest that, while school meals were an important source of fruits and vegetables during the pandemic, more needs to be done to reduce consumption of sugary drinks.

ObjectiveIn 2019, California and Wilmington, Delaware' implemented policies requiring healthier default beverages with restaurant kids' meals. The current study assessed restaurant beverage offerings and manager perceptions.DesignPre-post menu observations were conducted in California and Wilmington. Observations of cashiers/servers during orders were conducted pre-post implementation in California and post-implementation in Wilmington. Changes in California were compared using multilevel logistic regression and paired t tests. Post-implementation, managers were interviewed.SettingInside and drive-through ordering venues in a sample of quick-service restaurants in low-income California communities and all restaurants in Wilmington subject to the policy, the month before and 7-12 months after policy implementation.ParticipantsRestaurant observations (California n 110; Wilmington n 14); managers (California n 75; Wilmington n 15).ResultsPre-implementation, the most common kids' meal beverages on California menus were unflavoured milk and water (78·8 %, 52·0 %); in Wilmington, juice, milk and sugar-sweetened beverages were most common (81·8 %, 66·7 % and 46·2 %). Post-implementation, menus including only policy-consistent beverages significantly increased in California (9·7 % to 66·1 %, P < 0·0001), but remained constant in Wilmington (30·8 %). During orders, cashiers/servers offering only policy-consistent beverages significantly decreased post-implementation in California (5·0 % to 1·0 %, P = 0·002). Few managers (California 29·3 %; Wilmington 0 %) reported policy knowledge, although most expressed support. Most managers wanted additional information for customers and staff.ConclusionsWhile the proportion of menus offering only policy-consistent kids' meal default beverages increased in California, offerings did not change in Wilmington. In both jurisdictions, managers lacked policy knowledge, and few cashiers/servers offered only policy-consistent beverages. Additional efforts are needed to strengthen implementation of kids' meal beverage policies.

ObjectiveTo reduce children's sugar-sweetened beverage intake, California's Healthy-By-Default Beverage law (SB1192) mandates only unflavoured dairy/non-dairy milk or water be the default drinks with restaurant children's meals. The objective of this study is to examine consistency with this law for meals sold through online platforms from restaurants in low-income California neighbourhoods.DesignThis observational, cross-sectional study examines beverage availability, upcharges (additional cost) and presentation of beverage options consistent with SB1192 (using four increasingly restrictive criteria) within a random sample of quick-service restaurants (QSR) in Supplemental Nutrition Assistance Program Education eligible census tracts selling children's meals online from November 2020 to April 2021.SettingLow-income California neighbourhoods (n 226 census tracts).ParticipantsQSR that sold children's meals online via a restaurant-specific platform, DoorDash, GrubHub and/or UberEats (n 631 observations from 254 QSR).ResultsSeventy percent of observations offered water; 63 % offered unflavoured milk. Among all beverages, water was most likely to have an upcharge; among observations offering water (n 445), 41 % had an upcharge (average $0·51). Among observations offering unflavoured milk (n 396), 11 % had an upcharge (average $0·38). No observations upcharged for soda (regular or diet). Implementation consistency with SB1192 ranged from 40·5 % (using the least restrictive criteria) to 5·6 % (most restrictive) of observations.ConclusionsBased on observations from restaurant websites and three of the most popular online ordering platforms, most California QSR located in low-income neighbourhoods are not offering children's meal beverages consistent with the state's Healthy-By-Default Beverage law. As the popularity of online ordering increases, further work to ensure restaurants offering healthy default beverages with children's meals sold online is necessary.

Schools are a critical setting for improving child nutrition and food security and preventing obesity in the United States. The U.S. Department of Agriculture mandates that the Supplemental Nutrition Assistance Program--Education, known as CalFresh Healthy Living (CFHL) in California, implements obesity prevention efforts that utilize multicomponent policy, systems, and environmental change interventions supplemented with direct and indirect education. However, evaluation of these complex interventions has proven challenging due to a lack of established evaluation methods, particularly for comprehensively measuring the dose of multicomponent interventions. This article proposes and demonstrates a method to score the dose of multicomponent California Department of Public Health-funded CFHL school interventions received by children attending public schools, using administrative data collected by CFHL in California.

Objective: To promote healthy beverage consumption among 9-12 grade students (ages 14-18) by means of a 4-week curriculum promoting increased awareness of drinks containing added sugar and the association between sugar-sweetened beverage consumption and health risks. Design: Quasi-experimental pre-post design. Setting: High schools in Northern California with at least 50% of students eligible for free or reduced-price meals. Method: A 4-lesson version of the Rethink Your Drink high school curriculum was piloted in three high schools in two northern California counties. Two high schools in the same area served as comparison sites. A survey of beverage-related knowledge, behaviours, perceptions and self-efficacy was administered to intervention and comparison students before and after the intervention. Focus groups with students and an online survey and semi-structured interviews with teachers were conducted following the intervention. Results: Intervention students reported significantly greater frequency of reading Nutrition Facts labels and understanding of beverage choice influences and decreased consumption of diet soda than comparison students. A decrease of 0.26 times per day in consumption of sugar-sweetened beverages relative to the comparison group was not significant. Conclusion: The intervention resulted in some positive outcomes, but improvements in targeted beverage consumption were not significant. Students and teachers want shorter, more engaging and experiential curricula that build on previous learning. Findings point to actionable recommendations for improvement of high school healthy beverage curricula and suggest the need for reinforcement using a multi-level approach.

Background: Most children do not eat enough fruits and vegetables (FV). Schools are a critical setting for supporting children to consume FV. To fill a gap in available materials, a classroom curriculum was developed and evaluated to determine impacts on student FV-related knowledge, attitudes, and behaviors. Methods: A pre-/post-intervention survey was administered to 4th-6th grade students in 3 intervention and one comparison schools. Post-intervention student focus groups, parent/guardian surveys, and teacher surveys provided complementary information. Results: Intervention students had a significantly greater increase in total FV intake, fruit intake, and 100% juice consumption, and preference for several types of FV relative to comparison group students. Students, teachers, and parents reported overall high levels of satisfaction with the curriculum. Conclusions: The Harvest of the Month curriculum is effective at increasing fruit intake among a low-income, diverse student population in grades 4-6, is acceptable to students, teachers, and parents, and is feasible to implement. Findings suggest this impact is the result of changes in preferences, skills, and motivation but not self-efficacy or perceived social norms. Some tailoring of the curriculum may be needed to increase its appropriateness for 6th-grade students, increase the impact on vegetable intake, and limit intake of juice.

Schools are a critical setting for improving child nutrition and food security and preventing obesity in the United States. The U.S. Department of Agriculture mandates that the Supplemental Nutrition Assistance Program–Education, known as CalFresh Healthy Living (CFHL) in California, implements obesity prevention efforts that utilize multicomponent policy, systems, and environmental change interventions supplemented with direct and indirect education. However, evaluation of these complex interventions has proven challenging due to a lack of established evaluation methods, particularly for comprehensively measuring the dose of multicomponent interventions. This article proposes and demonstrates a method to score the dose of multicomponent California Department of Public Health–funded CFHL school interventions received by children attending public schools, using administrative data collected by CFHL in California. [ABSTRACT FROM AUTHOR]

Objective: To promote healthy beverage consumption among 9–12 grade students (ages 14–18) by means of a 4-week curriculum promoting increased awareness of drinks containing added sugar and the association between sugar-sweetened beverage consumption and health risks. Design: Quasi-experimental pre–post design. Setting: High schools in Northern California with at least 50% of students eligible for free or reduced-price meals. Method: A 4-lesson version of the Rethink Your Drink high school curriculum was piloted in three high schools in two northern California counties. Two high schools in the same area served as comparison sites. A survey of beverage-related knowledge, behaviours, perceptions and self-efficacy was administered to intervention and comparison students before and after the intervention. Focus groups with students and an online survey and semi-structured interviews with teachers were conducted following the intervention. Results: Intervention students reported significantly greater frequency of reading Nutrition Facts labels and understanding of beverage choice influences and decreased consumption of diet soda than comparison students. A decrease of 0.26 times per day in consumption of sugar-sweetened beverages relative to the comparison group was not significant. Conclusion: The intervention resulted in some positive outcomes, but improvements in targeted beverage consumption were not significant. Students and teachers want shorter, more engaging and experiential curricula that build on previous learning. Findings point to actionable recommendations for improvement of high school healthy beverage curricula and suggest the need for reinforcement using a multi-level approach. [ABSTRACT FROM AUTHOR]

BACKGROUND Most children do not eat enough fruits and vegetables (FV). Schools are a critical setting for supporting children to consume FV. To fill a gap in available materials, a classroom curriculum was developed and evaluated to determine impacts on student FV‐related knowledge, attitudes, and behaviors. METHODS: A pre‐/post‐intervention survey was administered to 4th‐6th grade students in 3 intervention and one comparison schools. Post‐intervention student focus groups, parent/guardian surveys, and teacher surveys provided complementary information. RESULTS: Intervention students had a significantly greater increase in total FV intake, fruit intake, and 100% juice consumption, and preference for several types of FV relative to comparison group students. Students, teachers, and parents reported overall high levels of satisfaction with the curriculum. CONCLUSIONS: The Harvest of the Month curriculum is effective at increasing fruit intake among a low‐income, diverse student population in grades 4‐6, is acceptable to students, teachers, and parents, and is feasible to implement. Findings suggest this impact is the result of changes in preferences, skills, and motivation but not self‐efficacy or perceived social norms. Some tailoring of the curriculum may be needed to increase its appropriateness for 6th‐grade students, increase the impact on vegetable intake, and limit intake of juice. [ABSTRACT FROM AUTHOR]