From Tobacco to Obesity Prevention Policies: A Framework for Implementing Community-Driven Policy Change.

Efforts to reverse the obesity epidemic require policy, systems, and environmental (PSE) change strategies. Despite the availability of evidence-based and other promising PSE interventions, limited evidence exists on the "how-to" of transitioning them into practice. For the past 13 years, the Los Angeles County Department of Public Health has been building capacity among community residents and other stakeholders to create effective community coalitions and to implement well-designed policy strategy campaigns using an evidence-based approach to policy change, the policy adoption model (PAM). Implementing a phase-based approach to policy change, the PAM was initially used to support the passage of over 140 tobacco control and prevention policies in Los Angeles County. Following these successes, Los Angeles County Department of Public Health applied the PAM to obesity prevention, operationalizing the policy process by training community residents and other stakeholders on the use of the model. The PAM has shown to be helpful in promoting PSE change in tobacco control and obesity prevention, suggesting a local-level model potentially applicable to other fields of public health seeking sustainable, community-driven policy change.

A Trial of the Efficacy and Cost of Water Delivery Systems in San Francisco Bay Area Middle Schools, 2013.

INTRODUCTION: US legislation requires that schools offer free drinking water where meals are served. However, little information is available about what types of water delivery systems schools should install to meet such requirements. The study objective was to examine the efficacy and cost of 2 water delivery systems (water dispensers and bottleless water coolers) in increasing students' lunchtime intake of water in low-income middle schools. METHODS: In 2013, twelve middle schools in the San Francisco Bay Area participated in a cluster randomized controlled trial in which they received 6 weeks of promotional activities, received provision of cups, and were assigned to 1 of 2 cafeteria water delivery systems: water dispensers or bottleless water coolers (or schools served as a control). Student surveys (n = 595) and observations examined the interventions' effect on students' beverage intake and staff surveys and public data assessed intervention cost. RESULTS: Analysis occurred from 2013 through 2015. Mixed-effects logistic regression, accounting for clustering and adjustment for student sociodemographic characteristics, demonstrated a significant increase in the odds of students drinking water in schools with promotion plus water dispensers and cups (adjusted odds ratio = 3.1; 95% confidence interval, 1.4-6.7; P = .004) compared with schools with traditional drinking fountains and no cups or promotion. The cost of dispenser and bottleless water cooler programs was similar ($0.04 per student per day). CONCLUSION: Instead of relying on traditional drinking fountains, schools should consider installing water sources, such as plastic dispensers with cups, as a low-cost, effective means for increasing students' water intake.

Association Between Student Purchases of Beverages During the School Commute and In-School Consumption of Sugar-Sweetened Beverages, San Francisco Bay Area, 2013.

INTRODUCTION: Consumption of sugar-sweetened beverages (SSBs) such as sodas, fruit-flavored drinks, and sports drinks is a major contributor to childhood obesity. One strategy to reduce children's SSB consumption has been to restrict the sale of SSBs in schools. However, such policies may not sufficiently curb students' SSB intake, because students can obtain SSBs elsewhere, including from stores located on their school commute. Little is known about students' purchases of beverages during the school commute or about whether this purchasing behavior is related to in-school SSB consumption. The objective of this study was to describe where students from low-income, ethnically diverse communities obtain the SSBs they drink during school lunchtime and to examine whether students who purchase beverages while traveling to and from school are more likely to drink SSBs during school lunchtime. METHODS: We analyzed survey data from a random sample of low-income, ethnically diverse middle school students (N = 597) who participated in a randomized controlled trial of a water promotion intervention. We used logistic regression analysis to examine the association between students' purchase of beverages during the school commute and their SSB consumption during school lunchtime. RESULTS: One-fifth (20.4%) of students drank an SSB during lunch. Approximately 23% of SSBs were obtained during the school commute. Students who reported buying beverages during their school commute (50.1% of all students) were more likely to report drinking SSBs during lunch than students who reported that they do not buy beverages during the school commute (adjusted odds ratio 3.32, 95% confidence interval, 2.19-5.05, P < .001). CONCLUSION: Students' purchase of beverages during the school commute was strongly associated with SSB consumption during school lunchtime. Interventions could benefit from focusing on retail environments (e.g., encouraging retailers to promote healthy beverages, posting beverage calorie information).

Validation of a Brief Questionnaire Against Direct Observation to Assess Adolescents' School Lunchtime Beverage Consumption.

OBJECTIVE: Beverage consumption is an important determinant of youth health outcomes. Beverage interventions often occur in schools, yet no brief validated questionnaires exist to assess whether these efforts improve in-school beverage consumption. This study validated a brief questionnaire to assess beverage consumption during school lunch. METHODS: Researchers observed middle school students' (n = 25) beverage consumption during school lunchtime using a standardized tool. After lunch, students completed questionnaires regarding their lunchtime beverage consumption. Kappa statistics compared self-reported with observed beverage consumption across 15 beverage categories. RESULTS: Eight beverages showed at least fair agreement (kappa [κ] > 0.20) for both type and amount consumed, with most showing substantial agreement (κ > 0.60). One beverage had high raw agreement but κ < 0.20. Six beverages had too few ratings to compute κ's. CONCLUSIONS AND IMPLICATIONS: This brief questionnaire was useful for assessing school lunchtime consumption of many beverages and provides a low-cost tool for evaluating school-based beverage interventions.

Autopercepción de capacidades de autocuidado en estudiantes universitarios sobre enfermedades crónicas, sexualidad y adicciones / Self-perception of self-care skills in university students concerning chronic diseases, sexuality and addictions

Introducción: en el mundo hay aproximadamente 1800 millones de jóvenes entre los 10 y 24 años de edad, los cuales constituyen 25% del total de la población mundial. Esto genera un potencial de avance económico y social y, en consecuencia, un incremento en la incidencia de enfermedades crónicas no transmisibles (ECNT), infecciones de transmisión sexual (ITS) y adicciones. Objetivo: analizar en estudiantes universitarios de nuevo ingreso el nivel de autopercepción de capacidades de autocuidado (CAc) ante las ECNT, la salud sexual y reproductiva (SSyR) y prevención de adicciones con base en la teoría del déficit de autocuidado. Métodos: estudio analítico correlacional en una muestra por conveniencia de 2342 estudiantes de nuevo ingreso. Se utilizó un instrumento diseñado y validado en el año 2015 para identificar las CAc en ECNT, SSyR, y prevención de adicciones, con un alfa de Cronbach de 0.88. Asimismo, se hizo un análisis bivariado, con las pruebas no paramétricas U de Mann-Whitney, H de Kruskal-Wallis y ANOVA de Kruskal-Wallis. También se empleó la prueba de correlación Rho de Spearman (p < 0.05). Resultados: el nivel de autopercepción de los estudiantes en cuanto a sus CAc fue bueno (61%) ante las ECNT, la SSyR y la prevención de adicciones. Se encontró que el nivel de autopercepción de CAc es diferente entre los estudiantes de las tres divisiones académicas (p = 0.000). Conclusiones: aunque la autopercepción de las CAc en los estudiantes tiene un nivel bueno, es necesario que durante la trayectoria académica se promuevan hábitos de vida saludables.

Introduction: In the world there are approximately 1800 million young people between 10 and 24 years, which constitute 25% of total world population. This creates a potential for economic and social advance and, consequently, an increase in the incidence of chronic non- communicable diseases (CNCDs), sexually transmitted infections (STIs) and addictions. Objective: To analyze the level of self-perception of self-care skills (SCS) in new university students in the presence of CNCDs, sexual and reproductive health (SRH) and addiction prevention. Methods: Correlational analytical study in a convenience sample of 2342 new students. An instrument designed and validated in 2015 was used to identify SCSs in CNCDs, SRH, and addiction prevention, with a Cronbach's alpha of 0.88. It was performed a bivariate analysis, with non-parametric tests Mann-Whitney U, Kruskal-Wallis H, and Kruskal-Wallis ANOVA. It was used Rho Spearman's correlation test (p < 0.05) as well. Results: The level of self-perception of the students in terms of their SCSs was good (61%) in the face of CNCDs, SRH and addiction prevention. It was found that the level of self-perception of SCSs is different among the students of the three academic divisions (p = 0.000). Conclusions: Although self-perception of SCS in the students is at a good level, it is necessary the promotion of healthy habits of living during the academic career.