The unintended consequences of school-based health and nutrition policies: a systematic review.

Background: Significant funding and attention are directed toward school-based health and nutrition interventions. Less attention is given to the potential unintended consequences of these policies, especially those that target children and adolescents. This systematic review aimed to elucidate the unintended consequences of school-based health and nutrition policies in the United States. Methods: We conducted a systematic review, adhering to PRISMA guidelines, to analyze quantitative, qualitative, and mixed methods research conducted between January 2013 and September 2023. The search strategy encompassed three databases, identifying 11 articles that met the inclusion criteria. Results: Unintended consequences were organized into four themes: disordered weight control behaviors, parental discomfort or encouragement of disordered weight control behaviors, eating disorder triggers, and financial losses. The analysis of disordered weight control behaviors indicates limited impact on youth, and we noted limited consensus in the assessment of these behaviors. We observed parent concerns about BMI screening and reporting as well as apprehensions about privacy and efficacy. There were fewer articles addressing eating disorder antecedents, although there was evidence that some youths with eating disorders considered school health class a trigger of their disorder. One study was identified that found an increase in food waste following replacement of sugar-sweetened beverages. Implications: Findings underscore the importance of comprehensive evaluation and consideration of unintended consequences in the development and implementation of school-based health policies. Recommendations include further longitudinal research, integrating obesity prevention with eating disorder prevention, and de-implementation when unintended consequences potentially outweigh benefits, such as in BMI screening and surveillance.Systematic Review Registration: Identifier CRD42023467355. https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=467355.

Nurses' use of 'wellness' supplements during the COVID-19 pandemic in the United States.

AIM: Quantify disparities and identify correlates and predictors of 'wellness' supplement use among nurses during the first year of the pandemic. DESIGN: Longitudinal secondary analysis of Nurses' Health Studies 2 and 3 and Growing Up Today Study data. METHODS: Sample included 36,518 total participants, 12,044 of which were nurses, who completed surveys during the first year of the COVID-19 pandemic (April 2020 to April 2021). Analyses were conducted in March 2023. Modified Poisson models were used to estimate disparities in 'wellness' supplement use between nurses and non-healthcare workers and, among nurses only, to quantify associations with workplace-related predictors (occupational discrimination, PPE access, workplace setting) and psychosocial predictors (depression/anxiety, county-level COVID-19 mortality). Models included race/ethnicity, gender identity, age and cohort as covariates. RESULTS: Nurses were significantly more likely to use all types of supplements than non-healthcare workers. Lacking personal protective equipment and experiencing occupational discrimination were significantly associated with new immune supplement use. Depression increased the risk of using weight loss, energy and immune supplements. CONCLUSION: Nurses' disproportionate use of 'wellness' supplements during the COVID-19 pandemic may be related to workplace and psychosocial stressors. Given well-documented risks of harm from the use of 'wellness' supplements, the use of these products by nurses is of concern. IMPACT: 'Wellness' supplements promoting weight loss, increased energy, boosted immunity and cleansing of organs are omnipresent in today's health-focused culture, though their use has been associated with harm. This is of added concern among nurses given their risk of COVID-19 infection at work. Our study highlighted the risk factors associated with use of these products (lacking PPE and experiencing occupational discrimination). Findings support prior research suggesting a need for greater public health policy and education around the use of 'wellness' supplements. REPORTING METHOD: STROBE guidelines were followed throughout manuscript. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution was involved.

Pediatric healthcare professionals' attitudes and beliefs about weight stigma: A descriptive study.

PURPOSE: Children face weight-based stigma from their healthcare providers at a disconcerting rate, and efforts to mitigate this have been scant. This study aimed to quantify pediatric healthcare professionals' attitudes and beliefs about weight stigma and to determine stigma reduction interventions that are most supported by pediatric healthcare providers. DESIGN AND METHODS: Participants completed two validated instruments which measured implicit and explicit weight bias, respectively. They then completed a researcher-designed questionnaire to assess their attitudes and beliefs about weight stigma, and demographic questions. ANOVA models were used to examine associations between bias measures and participant characteristics, chi-square analyses were used to examine associations between questionnaire responses and participant characteristics, and Spearman's rank was used to determine correlations between weight bias and questionnaire responses. RESULTS: Participants exhibited moderate-to-high levels of implicit and explicit weight bias (mean Implicit Association Test score = 0.59, mean Crandall Anti-Fat Attitudes Score = 38.95). Associations were noted between implicit bias and years in practice (p < 0.05), and implicit bias and occupation (p < 0.05). There was a significant correlation between explicit bias and multiple questionnaire items, suggesting that healthcare providers with greater weight bias are aware of those biases and are ready to take action to address them. CONCLUSION: Though pediatric healthcare exhibit weight-based biases, they are invested in taking steps to mitigate these biases and their impact on patients. PRACTICE IMPLICATIONS: The results of this study can inform the design of future interventions that aim to reduce healthcare-based weight bias, thus improving the quality of pediatric healthcare.

Population-level policy recommendations for the prevention of disordered weight control behaviors: A scoping review.

OBJECTIVE: The aim of this scoping review was to identify recommendations and gaps in knowledge surrounding the prevention of disordered weight control behaviors (DWCBs) through policy. METHOD: A search was conducted in several databases to identify English language articles that described an active policy, recommendation, guideline, or educational curriculum that could be implemented by governments or regulatory bodies to prevent DWCBs or related constructs (e.g., weight stigma, body dissatisfaction). Two researchers independently screened articles with oversight from a third researcher. Data were extracted from the final sample (n = 65) and analyzed qualitatively across all articles and within the domains of education, public policy, public health, industry regulation, and media. RESULTS: Only a single empirical evaluation of an implemented policy to reduce DWCBs was identified. Over one-third of articles proposed recommendations relating to industry regulation and media (n = 24, 36.9%), followed by education (n = 21, 32.3%), public policy (n = 19, 29.2%), and public health (n = 10, 15.4%). Recommendations included school-based changes to curricula, staff training, and anti-bullying policies; legislation to ban weight discrimination; policies informed by strategic science; collaboration with researchers from other fields; de-emphasizing weight in health communications; diversifying body sizes and limiting modified images in media; and restricting the sale of weight-loss supplements. DISCUSSION: The findings of this review highlight gaps in empirically evaluated policies to reduce DWCBs but also promising policy recommendations across several domains. Although some policy recommendations were supported by empirical evidence, others were primarily based on experts' knowledge, highlighting the need for greater research on population-level DWCBs prevention through policy. PUBLIC SIGNIFICANCE: Our scoping review of the evidence on policies for the prevention of disordered weight control behaviors identified several recommendations across the domains of education, public policy, public health, and industry regulation and media. Although few empirical investigations of implemented policies have been conducted, expert recommendations for policies to prevent disordered weight control behaviors among populations are plentiful and warrant future consideration by researchers and policymakers alike.

OBJETIVO: El objetivo de esta revisión sistemática exploratoria fue identificar recomendaciones y lagunas en el conocimiento sobre la prevención de comportamientos disfuncionales de control de peso (DWCB) a través de políticas. MÉTODO: Se realizó una búsqueda en varias bases de datos para identificar artículos en ingel resumenlés que describieran una política activa, recomendación, directriz o currículo educativo que pudieran implementar los gobiernos u organismos reguladores para prevenir DWCB o constructos relacionados (por ejemplo, estigma de peso, insatisfacción corporal). Dos investigadores examinaron de forma independiente los artículos con la supervisión de un tercer investigador. Los datos se extrajeron de la muestra final (n = 65) y se analizaron cualitativamente en todos los artículos y dentro de los dominios de educación, políticas públicas, salud pública, regulación de la industria y medios de comunicación. RESULTADOS: Solo se identificó una evaluación empírica única de una política implementada para reducir los DWCB. Más de un tercio de los artículos propusieron recomendaciones relacionadas con la regulación de la industria y los medios de comunicación (n = 24, 36.9%), seguido de educación (n = 21, 32.3%), políticas públicas (n = 19, 29.2%) y salud pública (n = 10, 15.4%). Las recomendaciones incluyeron cambios en los planes de estudio, capacitación del personal y políticas contra el acoso (bullying); legislación para prohibir la discriminación por peso; políticas basadas en la ciencia estratégica; colaboración con investigadores de otros campos; restar importancia al peso en las comunicaciones sanitarias; diversificar los tamaños corporales y limitar las imágenes modificadas en los medios; y restringir la venta de suplementos para bajar de peso. DISCUSIÓN: Los hallazgos de esta revisión destacan las brechas en las políticas evaluadas empíricamente para reducir los DWCB, pero también las recomendaciones de políticas prometedoras en varios dominios. Aunque algunas recomendaciones de políticas estaban respaldadas por evidencia empírica, otras se basaban principalmente en el conocimiento de expertos, destacando la necesidad de una mayor investigación sobre la prevención de DWCB a nivel poblacional a través de políticas.

Understanding and responding to COVID-19 in Wales: protocol for a privacy-protecting data platform for enhanced epidemiology and evaluation of interventions.

INTRODUCTION: The emergence of the novel respiratory SARS-CoV-2 and subsequent COVID-19 pandemic have required rapid assimilation of population-level data to understand and control the spread of infection in the general and vulnerable populations. Rapid analyses are needed to inform policy development and target interventions to at-risk groups to prevent serious health outcomes. We aim to provide an accessible research platform to determine demographic, socioeconomic and clinical risk factors for infection, morbidity and mortality of COVID-19, to measure the impact of COVID-19 on healthcare utilisation and long-term health, and to enable the evaluation of natural experiments of policy interventions. METHODS AND ANALYSIS: Two privacy-protecting population-level cohorts have been created and derived from multisourced demographic and healthcare data. The C20 cohort consists of 3.2 million people in Wales on the 1 January 2020 with follow-up until 31 May 2020. The complete cohort dataset will be updated monthly with some individual datasets available daily. The C16 cohort consists of 3 million people in Wales on the 1 January 2016 with follow-up to 31 December 2019. C16 is designed as a counterfactual cohort to provide contextual comparative population data on disease, health service utilisation and mortality. Study outcomes will: (a) characterise the epidemiology of COVID-19, (b) assess socioeconomic and demographic influences on infection and outcomes, (c) measure the impact of COVID-19 on short -term and longer-term population outcomes and (d) undertake studies on the transmission and spatial spread of infection. ETHICS AND DISSEMINATION: The Secure Anonymised Information Linkage-independent Information Governance Review Panel has approved this study. The study findings will be presented to policy groups, public meetings, national and international conferences, and published in peer-reviewed journals.

Risk factors associated with unintentional house fire incidents, injuries and deaths in high-income countries: a systematic review.

OBJECTIVE: To identify the distinguishing risk factors associated with unintentional house fire incidents, injuries and deaths. STUDY DESIGN: Systematic review. METHODS: A range of bibliographical databases and grey literature were searched from their earliest records to January 2016. To ensure the magnitude of risk could be quantified, only those study types which contained a control group, and undertook appropriate statistical analyses were included. A best evidence synthesis was conducted instead of a meta-analysis due to study heterogeneity. RESULTS: Eleven studies investigating a variety of risk factors and outcomes were identified. Studies ranged from medium to low quality with no high quality studies identified. Characteristics commonly associated with increased risk of house fire incidents, injuries and fatalities included: higher numbers of residents, male, children under the age of 5 years, non-working households, smoking, low income, non-privately owned properties, apartments and buildings in poor condition. Several risk factors were only associated with one outcome (eg, living alone was only associated with increased risk of injurious fires), and households with older residents were at increased risk of injurious fires, but significantly less likely to experience a house fire in the first place. CONCLUSIONS: This best evidence synthesis indicates that several resident and property characteristics are associated with risk of experiencing house fire incidents, injuries or death. These findings should be considered by the Fire and Rescue Services and others with a role in fire prevention. Future research should adopt robust, standardised study designs to permit meta-analyses and enable stronger conclusions to be drawn.