Advancing Inclusive Communication: Implementing an Audit to Center Equity in SNAP-Ed Programming.

Public health interventions rely on information exchange to influence health outcomes. Increasingly, practitioners are working to be intentional with public health messaging. The language used to communicate program objectives and health recommendations should reflect the community's lived experience and avoid perpetuating health and social inequities. Words and tone matter, and both should be inclusive and non-stigmatizing. Prioritizing a health equity lens for communication may require a critical review and revision of existing materials. This Practice Note highlights the development and implementation of an audit tool designed to systematically review a cookbook created to support healthy eating for families and individuals experiencing low income and participating in a Supplemental Nutrition Assistance Program-Education (SNAP-Ed) intervention in Maine. The purpose of the audit tool and the collaborative review process was to revise the cookbook content to ensure a weight-neutral, empowering approach to supporting the community's nutritional needs. The audit process resulted in a comprehensive methodology to examine intervention resources for inclusive communication approaches that avoid deficit framing, use person-first language, and do not overemphasize limited resources or appropriate cultures. The instrument and methodology are conceptually replicable and adaptable. In sharing the process and audit results, the authors seek to provide an example for practitioners to draw from for similar critical reviews of public health intervention resources and promotional materials.

Implementation of low-fat, low-sugar, and portion-controlled nutrition guidelines in competitive food venues of Maine public high schools.

BACKGROUND: The prevalence of childhood "overweight" and "at risk for overweight" has become a major public health concern. School food environments can affect key nutritional risk factors, especially in high schools where foods of poor nutrient value are pervasive in à la carte and vending programs. This study examines à la carte and vending programs in Maine public high schools at baseline and following implementation of low-fat (defined as items

The vending and à la carte policy intervention in Maine public high schools.

BACKGROUND: A healthy school nutrition environment may be important for decreasing childhood overweight. This article describes a project to make healthier snacks and beverages available in vending machines and à la carte programs in Maine public high schools. CONTEXT: Seven public high schools in Maine volunteered to participate in this project. Four schools made changes to the nutrition environment, and three schools that served as controls did not. The nutrition guidelines were to offer only low-fat (not more than 30% of total calories from fat) and low-sugar (not more than 35% by weight of sugar) items in vending machines and à la carte programs. METHODS: Strategies to implement the project included early communications with school officials, monetary stipends for participation, identification of a school liaison, and a committee at each school to promote the healthy changes. Baseline nutrient content and sales of all competitive foods and beverages were assessed to develop the guidelines for changes in the four schools. Student volunteers at all seven schools were measured for height, weight, diet quality, and physical activity level to assess the impact of the change to the nutrition environment. Baseline measures were taken in the spring semester of 2004. Nutrition changes were made to the à la carte programs and vending machines in the four intervention schools at the start of the fall semester of 2004. Follow-up nutrition assessment and student data collection occurred in the spring semester of 2005. CONSEQUENCES: Healthy changes in vending machines were more easily achieved than those made in the à la carte programs. Technical assistance and ongoing support were essential for successful implementation of this intervention. INTERPRETATION: It is possible to improve the nutrition environment of Maine public high schools. Stakeholder support is essential to sustain healthy changes.

Development and implementation of the guiding stars nutrition guidance program.

PURPOSE . To describe the collaborative process between a grocery retailer and a panel of nutrition experts used to develop a nutrition guidance system (Guiding Stars) that evaluates the nutrient profile of all edible products in the supermarket, and to report the results of the food and beverage ratings. DESIGN . A collaboration between a private retailer and members of the scientific community that led to the development of a scoring algorithm used to evaluate the nutritional quality of foods and beverages. SETTING/SUBJECTS . Northeast supermarkets (n  =  160). MEASURES . Food and beverage nutrition ratings and distribution of stars across different grocery categories. ANALYSIS . Descriptive statistics for rating distributions were computed. T-tests were conducted to assess differences in mean nutrient values between foods with zero versus three stars or a dichotomized variable representing all foods with one to three stars. RESULTS . All edible grocery items (n  =  27,466) were evaluated, with 23.6% earning at least one star. Items receiving at least one star had lower mean levels of sodium, saturated fat, and sugars and higher amounts of fiber than products not earning stars. CONCLUSION . The Guiding Stars system rates edible products without regard to brand or manufacturer, and provides consumers with a simple tool to quickly identify more nutritious choices while shopping. The low percentage of products qualifying for stars reflects poorly on the food choices available to Americans.

Guiding stars: the effect of a nutrition navigation program on consumer purchases at the supermarket.

BACKGROUND: To improve diet quality and overall population health, the need to develop nutritional rating systems that are comprehensive in scope and easy for the consumer to understand and use at the point-of-purchase has emerged. OBJECTIVE: Our aim was to examine the effect of a comprehensive storewide supermarket point-of-purchase nutrition navigation intervention by using a shelf-label 3-tiered star icon on consumer food and beverage choices and their associated nutritional quality. DESIGN: By using a natural experiment design, purchasing data from 2006 to 2008 were obtained from a Northeast supermarket chain with 168 stores located in northern New England and New York and examined at preimplementation and at 1- and 2-y follow-up periods. RESULTS: The nutrition navigation system studied showed significant changes in food purchasing immediately after implementation, and these changes continued to be significant 1 and 2 y later. When the same 8-mo period (January-August) each year was compared, in 2006, 24.50% of items purchased earned a star rating; this proportion increased to 24.98% (P < 0.001) and 25.89% (P < 0.0001) at the 1- and 2-y follow-up periods, respectively. For a 4-wk period, 1 y after program implementation, consumers purchased significantly more ready-to-eat cereals with stars (eg, less added sugars and more dietary fiber) and fewer no-star, high-sugar, low-fiber cereals. CONCLUSION: Increasing rates of obesity and declining diet quality for Americans strongly support the need for effective supermarket point-of-purchase programs, such as the Guiding Stars nutrition navigation program, that provide clear, concise, and simplified nutrition information to guide consumer food and beverage choices.

Reduced availability of sugar-sweetened beverages and diet soda has a limited impact on beverage consumption patterns in Maine high school youth.

OBJECTIVE: To examine change in high school students' beverage consumption patterns pre- and post-intervention of reduced availability of sugar-sweetened beverages (SSB) and diet soda in school food venues. DESIGN: A prospective, quasi-experimental, nonrandomized study design. SETTING: Public high schools. PARTICIPANTS: A convenience sample from control (n = 221) and intervention (n = 235) high schools. INTERVENTION: Schools aimed to reduce (n = 4) or not change (n = 3) availability of SSB and diet soda in food venues for 1 school year. MAIN OUTCOME MEASURES: Subjects' beverage servings/day was determined from a food frequency questionnaire pre- and post-intervention. ANALYSIS: Two-by-two mixed analysis of variance model compared pre- to post-intervention servings/day between control and intervention subjects, stratified by gender. RESULTS: Consumption of SSB decreased in both intervention and control boys (F = 53.69, P < .05) and girls (F = 22.87, P < .05). Intervention girls decreased diet soda consumption as compared to control girls (F = 6.57, P < .05). CONCLUSION AND IMPLICATIONS: Reducing availability of SSB in schools did not result in a greater decrease in SSB consumption by intervention as compared to control subjects. The impact of reducing availability of SSB at school may be limited. A better understanding of beverage consumption patterns may be needed to determine the efficacy of school food policies on those youth susceptible to obesity.