RESUMO
Importance: The White House National Strategy on Hunger, Nutrition, and Health included expanding free school meals to all students, regardless of income, which has sparked debate in the United States. Objective: To assess the association between universal free school meals (UFSMs) and school and student outcomes in the United States. Evidence Review: An expert panel-informed protocol was developed to evaluate intervention or cohort studies comparing UFSM programs, such as the Community Eligibility Provision (CEP), with non-UFSM programs in US schools from August 2012 (excluding 2020-2021 due to the COVID-19 pandemic) in peer-reviewed publications or government reports. Outcomes included meal participation rates, attendance, dietary intake and quality, food waste, economic impact, food insecurity, anthropometrics, disciplinary actions, stigma, and shaming. A search of Medline, Econlit, Business Source Ultimate, ERIC, Agricola, Cab Abstracts, and CINAHL was performed in April 2024. Two researchers screened articles for inclusion, extracted data, and assessed risk of bias, using the Risk of Bias in Nonrandomized Studies of Interventions tool, for each included study. Grading of Recommendations, Assessment, Development, and Evaluations was used to assess the certainty of evidence for each outcome. Findings: The search identified 2784 records, with 6 studies included, representing more than 11â¯000 elementary, middle, and high schools. Nonrandomized intervention studies performed difference-in-difference or rate ratio analysis to investigate CEP participation rates, attendance, anthropometrics, and/or suspensions. CEP was associated with increased lunch (3 studies; moderate certainty) and breakfast (1 study; very low certainty) participation. School attendance was unchanged or improved in schools with CEP compared with schools without UFSM (2 studies; low certainty). CEP was associated with lower obesity prevalence (1 study; very low certainty) and fewer suspensions (1 study; very low certainty). Reasons for downgrading the certainty ratings included indirectness (data not fully representative of the United States) and inconsistency (small number of studies limiting ability to assess consistency). Despite the limitations, the evidence reflected well-designed longitudinal intervention studies appropriate for decision-making. Conclusions and Relevance: In this systematic review, UFSMs were associated with increased meal participation, no or slight improvements in attendance, and decreased obesity prevalence and suspension rates; certainty of evidence was moderate for lunch participation and low or very low for other outcomes. Studies did not report several important outcomes, such as diet quality and food security, suggesting the need for more high-quality research encompassing policy-relevant indicators.
Assuntos
Serviços de Alimentação , Instituições Acadêmicas , Estudantes , Humanos , Serviços de Alimentação/estatística & dados numéricos , Estados Unidos , Estudantes/estatística & dados numéricos , Criança , Assistência Alimentar/estatística & dados numéricos , COVID-19/prevenção & controle , COVID-19/epidemiologia , Adolescente , Insegurança Alimentar , RefeiçõesRESUMO
BACKGROUND: In response to the COVID-19 pandemic, the US Congress authorized the US Department of Agriculture to waive a variety of school meal regulations and funded school meals daily for all students at no charge regardless of family income. Because federal Universal Free School Meals (UFSM) ended with the 2021-2022 school year, several states, including California and Maine, adopted state-level UFSM policies. OBJECTIVE: This study aimed to understand parent perceptions of school meals and the federal and new state UFSM policies in California and Maine, including potential challenges and benefits to students and households. DESIGN: A mixed methods study design was used. A quantitative cross-sectional survey was administered, and semi-structured interviews were conducted in English and Spanish during the 2021-2022 school year. PARTICIPANTS/SETTING: The quantitative survey was administered to parents of students in elementary, middle, and high schools in rural, suburban, and urban communities in California (n = 1110) and Maine (n = 80). Qualitative interviews were then conducted with a subset of these parents in California (n = 46) and Maine (n = 20) using Zoom (Zoom Video Communications). Most survey participants (708 of 1190 [59.5%]) and interviewees (40 of 66 [60.6%]) were parents of students who were eligible for free or reduced-price meals. MAIN OUTCOME MEASURES: Parents' perceptions of UFSM, school meal quality, and experiences applying for free or reduced-price meals were examined. ANALYSES PERFORMED: Tests of proportions were used to analyze survey data. Using grounded theory, interview transcripts were analyzed qualitatively by 2 trained research assistants, applying principles of content analysis to identify themes and domains. Inter-rater reliability was conducted. RESULTS: Parents perceived that school meals and UFSM saved families money and time, as parents had fewer meals to purchase and prepare for their children. In addition, UFSM reduced parents' stress and reduced stigma for children and for parents, who described feelings of embarrassment when they previously filled out paperwork for free or reduced-price meals. Although parent perceptions of school meal quality and healthfulness were mixed, most parents reported feeling grateful for school meals. CONCLUSIONS: Parents had mixed opinions on the quality and healthfulness of school meals, but believed UFSM saved them money and time and reduced their stress. Parents also felt UFSM reduced stigma for families.
RESUMO
Parental perceptions of school meals can affect student participation and overall support for school meal policies. Little is known about parental school meal perceptions under universal free school meals (UFSM) policies. We assessed California parents' perceptions of school meals during the COVID-19 emergency response with federally funded UFSM and whether perceptions differed by race/ethnicity. Among 1110 California parents of K-12 students, most reported school meals benefit their families, saving them money (81.6%), time (79.2%), and stress (75.0%). Few reported that their child would be embarrassed to eat school meals (11.7%), but more parents of White students than Hispanic students reported this. Many parents reported that their child likes to eat lunch to be with friends (64.7%); about half felt their child has enough time to eat (54.2%). Fewer parents perceived school lunches to be of good quality (36.9%), tasty (39.6%), or healthy (44.0%). Parents of Hispanic and Asian students had less favorable perceptions of school meal quality, taste, and healthfulness than parents of White students. Parents report that school meals benefit their families, but policy efforts are needed to ensure schools have the resources needed to address cultural appropriateness. Schools should address parental perceptions of meals to optimize participation, nutrition security, and health.
RESUMO
OBJECTIVE: To evaluate if parent perceptions of school meals influence student participation. DESIGN: In May 2022, an online survey was used to evaluate parents' perceptions of school meals and their children's participation. PARTICIPANTS: A total of 1,110 California parents of kindergarten through 12th-grade students. MAIN OUTCOME MEASURES: Student participation in school lunch and breakfast. ANALYSIS: Principal component analysis and Poisson regression models. RESULTS: Three groups of parental perceptions were identified: (1) positive perceptions (eg, liking school meals and thinking that they are tasty and healthy), (2) perceived benefits to families (eg, school meals save families money, time, and stress), and (3) negative (eg, concerns about the amount of sugar in school meals and stigma). More positive parental perceptions about school meals and their benefits to families were associated with greater student meal participation. In contrast, more negative parental perceptions were associated with reduced student participation in school meals (P < 0.05). CONCLUSION AND IMPLICATIONS: Parent perceptions of school meals may affect student participation in school meal programs. Working to ensure parents are familiar with the healthfulness and quality of school meals and the efforts schools are making to provide high-quality, appealing meals may be critical for increasing school meal participation rates.
Assuntos
Serviços de Alimentação , Criança , Humanos , Refeições , Desjejum , Almoço , Estudantes , PaisRESUMO
Snacks and beverages are often sold in addition to meals in U.S. schools ("competitive foods"), but their current nutritional quality and compliance with national Smart Snacks standards are unknown. This study assessed competitive foods in a national sample of 90 middle and high schools. Differences in compliance by school characteristics were measured using mixed methods analysis of variance. Overall, 80% of the schools in the sample sold competitive foods; but they were less commonly available in schools with universal free school meal (UFSM) policies. A total of 840 unique products were documented and, on average, 75% were compliant with Smart Snacks standards. A total of 56% aligned with recommended added sugar limits (<10% of calories); and 340 unique products (40%) aligned with both sugar and Smart Snacks standards. Approximately one-fifth of competitive foods contained synthetic dyes, and 31% of beverages contained artificial sweeteners. Smart Snacks standards compliance was greater when competitive foods were overseen by food service departments, in comparison with others (e.g., principals, student organizations, or outside vendors [77% vs. 59% compliance; p = 0.003]). Therefore, district wellness policies should consider requiring food service departments to oversee competitive foods. Federal and state policies should limit added sugars, artificial sweeteners, and synthetic dyes. This appears to be highly feasible, given the substantial number of products that meet these criteria. UFSM policies should also be considered to support healthier school meal environments more broadly.
Assuntos
Corantes , Lanches , Humanos , Valor Nutritivo , Política de Saúde , Açúcares , EdulcorantesRESUMO
BACKGROUND: The US Department of Agriculture's (USDA) summer meal programs are designed to provide meals at no cost while school is out of session. In response to the COVID-19 pandemic, several regulatory waivers were enacted to facilitate meal distribution. The aim of this study was to assess the rates of meal distribution before and after these waivers were in effect. METHODS: Meal distribution patterns for 2019, 2020, and 2021 were examined through (1) a descriptive comparison of the number of participating districts, sponsors, meal sites, and meals distributed statewide, and (2) repeated measures ANOVAs to examine changes among districts in operation all years. RESULTS: The waivers were associated with an increase in the total number of participating districts, sponsors, and meal sites; an increase in the total number of meals distributed to children during the summer months; and an increase in meal distribution among sponsors that had been in place since 2019. CONCLUSION: Expanding the area eligibility criteria and enabling flexibility in meal distribution methods increased the number of meals provided. This study provides important preliminary evidence to suggest that the USDA should consider permanent regulatory changes to this program to maximize its reach.
Assuntos
COVID-19 , Serviços de Alimentação , United States Department of Agriculture , Humanos , Estados Unidos , Serviços de Alimentação/estatística & dados numéricos , Serviços de Alimentação/legislação & jurisprudência , COVID-19/epidemiologia , COVID-19/prevenção & controle , Instituições Acadêmicas , Criança , Estações do Ano , SARS-CoV-2 , RefeiçõesRESUMO
BACKGROUND: The US Department of Agriculture's school meal programs have wide reach during the school year, but food insufficiency among households with children increases during summer months. The US Department of Agriculture summer meal programs are designed to fill this gap, yet participation has historically been low. OBJECTIVE: To examine the facilitators and barriers to participation in a 2021 summer meal program while the COVID-19 pandemic regulation waivers were in place. DESIGN: Cross-sectional mixed-methods survey research. PARTICIPANTS/SETTING: All parents/guardians of children enrolled in a school district in Connecticut were invited to participate in an online survey in December 2021. The respondents included summer meal participants (n = 622) and nonparticipants (n = 294). MAIN OUTCOME MEASURES: Survey respondents reported demographic variables, current food sufficiency, communication preferences, satisfaction with the program, reasons for using or not using the program, and whether they found the program helpful financially. The survey included three open-ended questions about barriers to participation. RESULTS: Respondents who used the summer meal program indicated that the pandemic-related regulatory waivers were key to their decision to participate. Reported barriers included lack of awareness of the program, inability to travel to sites during the times they were open, lack of transportation, concerns about dietary restrictions, and lack of variety in the menu, and concerns about wasting food. Parents/guardians expressed strong preferences for receiving communication about summer meals directly from their child's school and being able to access meals outside of typical work hours. CONCLUSIONS: The pandemic waivers allowed sponsors to test different models of distribution. Parents/guardians responded positively to the opportunity to access grab-and-go meals, multiple meals at once, and meals without a child present. These findings can be used to inform potential policy changes to reduce barriers and increase participation.
Assuntos
COVID-19 , Serviços de Alimentação , Criança , Estados Unidos/epidemiologia , Humanos , Pandemias , United States Department of Agriculture , Estudos Transversais , Pobreza , COVID-19/epidemiologia , RefeiçõesRESUMO
BACKGROUND: Adoption of the Whole School, Whole Community, Whole Child (WSCC) model has been slowed by a lack of available tools to support implementation. The Wellness School Assessment Tool (WellSAT) WSCC is an online assessment tool that allows schools to evaluate the alignment of their policies with the WSCC model. This study assesses the usability of the WellSAT WSCC. METHODS: Using a convergent mixed methods design, we collected qualitative and quantitative data from 5 school-based participants with roles in development and evaluation of policy. Participants explored the platform while engaging in a think-aloud procedure and scored a sample policy using the platform. They also completed the System Usability Scale and responded to open-ended questions about the usability of the platform. RESULTS: Participants rated the WellSAT WSCC as an above-average user experience, but data suggested several areas for improvement, including improved instructions, enhanced visual design of the platform, and guidance for subsequent policy changes. CONCLUSION: The WellSAT WSCC provides an above-average user experience but can be improved to increase user experience. These improvements increase the potential for greater use to facilitate integration of the WSCC model into school policy.
Assuntos
Serviços de Saúde Escolar , Instituições Acadêmicas , Criança , Humanos , Política de Saúde , Promoção da SaúdeRESUMO
Parental communication about body weight can influence children's emotional well-being and eating behaviors. However, little is known about the role of parental self-stigma concerning weight and social position variables (ie, race/ethnicity, income, and gender) in weight communication. This study examined how parents' self-stigmatization for their own weight (ie, weight bias internalization) and self-stigmatization for their child's weight (ie, affiliate stigma) relates to weight talk frequency with their children, and whether these associations vary across parental race/ethnicity, income, and gender. Parents (n = 408) completed a cross-sectional, online survey about their weight communication and self-stigmatization. Linear regression was used to examine the relationships among these variables, including interactions between the stigma variables and social position variables in predicting weight talk. Higher levels of weight bias internalization and affiliate stigma were strongly associated with increased parental weight talk frequency; parents who endorsed higher levels of internalized bias about their own weight expressed greater affiliate stigma for their child's weight, regardless of demographic characteristics or weight status. Associations between the stigma variables and weight talk outcomes were stronger among fathers and parents of higher income. Findings highlight the importance of considering weight stigma variables in parental weight communication research.
Assuntos
Preconceito de Peso , Criança , Humanos , Estudos Transversais , Inquéritos e Questionários , Pais/psicologia , Estigma SocialRESUMO
Background: Food pantries are an important source of food for those facing food insecurity. The Charitable Food Nutrition Index (CFNI) was developed for research and practice to measure the nutritional quality of assortments of foods in this setting. Objective: The study assessed the construct validity of the CFNI using secondary data from a group-randomized food pantry intervention in Minnesota. Methods: The CFNI was calculated for each client cart post-intervention (n = 187; 85 intervention, 102 control). CFNI scores were based on the proportion of items in each client cart ranked "green," "yellow," or "red" using the Healthy Eating Research Nutrition Guidelines for the Charitable Food System. An implementation score assessing intervention fidelity was measured for each pantry (n = 11; 5 intervention, 6 control) based on the four intervention subcomponents: aesthetics/use of space; healthy food prominence and appeal; unhealthy food de-emphasis; and stocking standards. Mixed linear models were used to test whether: (a) client carts from pantries in the intervention condition had higher CFNI scores than those in the control condition, and (b) higher implementation scores were associated with higher CFNI scores. Results: In adjusted models, clients from intervention group pantries had higher CFNI scores, reflecting a healthier assortment of foods compared with clients from control group pantries (p = 0.022). CFNI scores were positively associated with greater fidelity to the intervention (p = 0.020). Conclusions: The CFNI was sensitive enough to detect the effects of the intervention in the expected directions. These findings support its construct validity and utility as a measure in the charitable food system.
RESUMO
BACKGROUND: The food and beverages served in family childcare homes (FCCHs) may play an important role in the development of childhood overweight and obesity. This analysis examines whether children's diet quality mediates the relationship between foods and beverages served in FCCHs and preschool-aged children's weight status. METHODS: Trained and certified staff conducted observations for two days in each FCCH, using the Environment and Policy Assessment and Observation (EPAO) measure to determine the foods and beverages served to children (N = 370) in FCCHs (N = 120). They also used the Dietary Observation in Child Care (DOCC) protocol to assess children's food and beverage intake during childcare, from which we calculated the Healthy Eating Index-2015 (HEI), a measure of diet quality. Height and weight were measured for each child with parent consent from which the child's body mass index (BMI) z-scores were calculated. A multilevel mediation analysis was conducted to indicate whether children's diet quality mediates the relations between food and beverage served in FCCHs and preschool-aged children's weight status. RESULTS: Children's total HEI scores significantly mediated the relationship between the EPAO subscale Food Provided and children's BMI z-scores (B=-0.01, p < .05, 95% CI = [-0.03, - 0.002]). Further, the EPAO subscale Food Provided was positively associated with the total HEI score (B = 0.75, p < .01, 95% CI = [0.32, 1.18]). Total HEI scores were negatively associated with BMI z-score (B=-0.01, p < .05, 95% CI = [-0.02, - 0.001]). CONCLUSION: Children's diet quality did significantly mediate the relationship between the food served in FCCHs and children's weight status. More longitudinal studies with longer follow-up periods need to be conducted to confirm these relationships. Further, future studies need to examine the relationships between a broader spectrum of FCCH environmental characteristics and home environment with children's weight status, as well as other mediators including physical activity.
Assuntos
Cuidado da Criança , Obesidade Infantil , Humanos , Pré-Escolar , Criança , Cuidado da Criança/métodos , Dieta , Índice de Massa Corporal , Obesidade Infantil/epidemiologia , Análise MultinívelRESUMO
Introduction: Significantly fewer children participate in the U.S. Department of Agriculture-sponsored summer meal programs than in the federal school meal programs during the academic year. During the summer of 2021, several pandemic-related waivers supported more flexible operations for summer meal programs, such as allowing grab-and-go meals and the distribution of meals for multiple days at once. This study assessed how summer meal site characteristics and geographically targeted outreach methods were associated with summer meals served in 2021 in Connecticut. Methods: Weekly meal count data were requested from all sponsors of the Summer Food Service Program and the National School Lunch Program Seamless Summer Option. Data were received from 78 sponsors with 763 sites. Geographically targeted outreach (e.g., billboards, bus ads, and flyers) was tracked by location each week. Mixed methods ANOVA was used to examine the predictive value of outreach efforts, program characteristics, and meal distribution methods on meals served each week. The program characteristics examined included the hours open per week, the number of weeks serving meals, the maximum number of meals distributed at one time, and the number of open and closed sites in a school district. Results: Between June 21 and August 20, 2021, a total of 1,188,669 breakfasts and 1,389,347 lunches were served. Sites that were open more hours per week (mean=7.60 hours per week; range=0.17-35) and gave multiple meals to parents at each visit (mean=4.68 meals; range=1-15) reported greater rates of meal distribution. The outreach efforts assessed were not significantly associated with changes in meal distribution at nearby sites. Conclusions: The U.S. Department of Agriculture's waivers in response to COVID-19 permitted extended operating hours and multiple-meal distribution. These operational flexibilities should be considered for permanent regulation changes owing to their positive association with summer meal participation.
RESUMO
Background: The food and beverages served in family childcare homes (FCCHs) may play an important role in the development of childhood overweight and obesity. This analysis examines whether children's diet quality mediates the relationship between foods and beverages served in FCCHs and preschool-aged children's weight status. Methods: Trained and certified staff conducted observations for two days in each FCCH, using the Environment and Policy Assessment and Observation (EPAO) measure to determine the foods and beverages served to children (N=370) in FCCHs (N=120). They also used the Dietary Observation in Child Care (DOCC) protocol to assess children's food and beverage intake during childcare, from which we calculated the Healthy Eating Index-2015 (HEI), a measure of diet quality. Height and weight were measured for each child with parent consent from which the child's body mass index (BMI) z-scores were calculated from. A multilevel mediation analysis was conducted to indicate whether children's diet quality mediates the relations between food and beverage served in FCCHs and preschool-aged children's weight status. Results: Children's total HEI scores significantly mediated the relationship between the EPAO subscale "Food provided" and children's BMI z-scores (B=-.01, p<.05, 95% CI = [-.03, -.002]). Further, the EPAO subscale "Food provided" was positively associated with the total HEI score (B=.75, p<.01, 95% CI = [.32, 1.18]). Total HEI scores were negatively associated with BMI z-score (B=-.01, p<.05, 95% CI = [-.02, -.001]). Conclusion: Children's diet quality did significantly mediate the relationship between the food served in FCCHs and children's weight status. More longitudinal studies with longer follow-up periods need to be conducted to confirm these relationships. Further, future studies need to examine the relationships between a broader spectrum of FCCH environmental characteristics and home environment with children's weight status, as well as other mediators including physical activity.
RESUMO
Background: Healthcare-based interventions to address sugary beverage intake could achieve broad reach, but intensive in-person interventions are unsustainable in clinical settings. Technology-based interventions may provide an alternative, scalable approach. Methods: Within an academic health system in the United States that already performs electronic health record-based sugary drink screening, we conducted a pilot randomized trial of a technology-driven family beverage choice intervention. The goal of the intervention was to reduce sugar-sweetened beverage (SSB) and fruit juice (FJ) consumption in 60 parent-child dyads, in which children were 1-8 years old. The pediatrician-initiated intervention consisted of a water promotion toolkit, a video, a mobile phone application, and 14 interactive voice-response phone calls to parents over 6 months. The study was conducted between June 2021 and May 2022. The aim of the pilot study was to assess the potential feasibility and efficacy of the newly developed intervention. Results: Intervention fidelity was excellent, and acceptability was high for all intervention components. Children in both the intervention and the control groups substantially decreased their consumption of SSB and FJ over follow-up (mean combined baseline 2.5 servings/day vs. 1.4/day at 6 months) and increased water consumption, but constrained linear mixed-effects models showed no differences between groups on these measures. Compared to parents in the control group, intervention parents had larger decreases in SSB intake at 3 months (-0.80 (95% CI: -1.54, -0.06, p = 0.03) servings daily), but these differences were not sustained at 6 months. Conclusion: These findings suggest that, though practical to implement in a clinical care setting and acceptable to a diverse participant group, our multicomponent intervention may not be universally necessary to achieve meaningful behavior changes around family beverage choice. A lower-intensity intervention, such as EHR-based clinical screening alone, might be a less resource-intense way for health systems to achieve similar behavioral outcomes. Future studies might therefore explore whether, instead of applying a full intervention to all families whose children overconsume SSB or FJ, a stepped approach, starting with clinical screening and brief counseling, could be a better use of health system resources.
Assuntos
Bebidas , Bebidas Adoçadas com Açúcar , Humanos , Estados Unidos , Lactente , Pré-Escolar , Criança , Projetos Piloto , Sucos de Frutas e Vegetais , Recursos em SaúdeRESUMO
INTRODUCTION: Early childcare has been identified as an influential setting for children's physical activity. Our objective was to determine whether children aged 2 to 5 years had more accelerometer-measured minutes of physical activity when caregivers in their family childcare home (FCCH) adhered to best practices for physical activity and screen time. METHODS: We analyzed baseline 2-day observation data collected by using the Environment and Policy Assessment and Observation measure from a cluster-randomized trial. Multilevel linear regression models assessed the association between caregivers' meeting best practices for physical activity and screen time and children's time spent sedentary or in moderate-to-vigorous physical activity (MVPA). RESULTS: All FCCH caregivers (N = 120) in our study were female, and 67.5% were Hispanic. Participating children (N = 349) were 52.1% female and 57.4% Hispanic. A higher score among caregivers for physical activity best practices was associated with more MVPA (B = 0.79; 95% CI, 0.02 to 1.56; P = .04) for children and less sedentary time (B = -2.07; 95% CI, -3.94 to -0.19; P = .04). A higher caregiver score for screen time best practices was associated with less sedentary time (B = -2.07; 95% CI, -3.94 to -0.19; P = .04) and more MVPA time (B = 0.65; 95% CI, 0.03 to .27; P = .04). Children in homes where caregivers offered them 60 minutes or more of outdoor play and participated in outdoor physical activity had more MVPA and less sedentary time. We found no association between various screen-time best practices and children's sedentary time. DISCUSSION: Children with caregivers who used more best practices for physical activity and screen time had higher activity levels and spent less time sedentary. These findings could help policy makers and people caring for young children modify existing policies and develop programs to help early childhood caregivers implement best practices to promote children's physical activity.
Assuntos
Cuidado da Criança , Tempo de Tela , Pré-Escolar , Feminino , Humanos , Masculino , Acelerometria , Saúde da Criança , Exercício Físico , Comportamento SedentárioRESUMO
OBJECTIVE: Sugary drink consumption is associated with adverse health outcomes in children, highlighting the need for scalable family interventions that address barriers to water consumption. To inform development of a scalable, health-care-system-based intervention targeting family beverage choice, a formative qualitative study was conducted using semi-structured interviews with parents whose children were identified as over-consuming sugar-sweetened beverages (SSB) and/or fruit juice (FJ). The first goal of these interviews was to understand, in a diverse real-world patient population, what parents viewed as the primary drivers of their family's beverage choices, and explore how these drivers might need to be addressed in order to make changes to beverage consumption. A second goal was to explore parental preferences for planned intervention components. An exploratory goal of the interviews was to examine whether knowledge, attitudes, and beliefs around family beverage choice differed across racial and ethnic groups in this sample. DESIGN: Semi-structured phone interviews were conducted and interviews audio-recorded and transcribed. PARTICIPANTS: 39 parents/caregivers of children ages 1-8 who over-consumed sugary drinks as determined by screenings at pediatric visits. PHENOMENON OF INTEREST: Parents were interviewed about family beverage choices and preferences to inform development of a multi-component intervention. ANALYSIS: Thematic analysis was performed, including comparison of themes across racial/ethnic groups. RESULTS: Parents expressed that sugary drinks were unhealthy and water was a better alternative. Most were familiar with the health consequences of excess sugar consumption. They identified many reasons why sugary drinks are chosen over water despite this knowledge. One common reason was concern about tap water safety. Few differences were noted across racial and ethnic groups in our sample. Parents were enthusiastic about a technology-based intervention to be delivered through their child's doctor's office. CONCLUSIONS AND IMPLICATIONS: Knowledge is not enough to change behavior. Beverage interventions need to be easy to access, make water more appealing, and elevate beverage choice above the "white noise" of everyday life. Delivering an intervention in a clinical setting could provide an extra level of care, while technology would reduce the amount of live contact and decrease the burden for clinicians and parents.
Assuntos
Bebidas , Bebidas Adoçadas com Açúcar , Humanos , Criança , Bebidas Adoçadas com Açúcar/efeitos adversos , Sucos de Frutas e Vegetais , Água , PaisRESUMO
OBJECTIVE: To examine the relationship between the diet quality of children aged 2-5 years cared for in family child care homes (FCCHs) with provider adherence to nutrition best practices. DESIGN: Cross-sectional analysis. PARTICIPANTS: Family child care home providers (n = 120, 100% female, 67.5% Latinx) and children (n = 370, 51% female, 58% Latinx) enrolled in a cluster-randomized trial. MAIN OUTCOME MEASURES: Data were collected over 2 days at each FCCH. The Environment and Policy Assessment and Observation tool was used to document whether providers exhibited nutrition practices on the basis of the Nutrition and Physical Activity Self-Assessment for Child Care. Each practice was scored as either present or absent. Children's food intake was observed using Diet Observation at Child Care and analyzed with the Healthy Eating Index-2015. ANALYSIS: Multilevel linear regression models assessed the association between providers exhibiting best practices regarding nutrition and children's diet quality. The model accounted for clustering by FCCH and controlled for provider ethnicity, income level, and multiple comparisons. RESULTS: Children in FCCHs in which more of the best practices were implemented had higher diet quality (B = 1.05; 95% confidence interval [CI], 0.12-1.99; P = 0.03). Specifically, children whose providers promoted autonomous feeding (B = 27.52; 95% CI, 21.02-34.02; P < 0.001) and provided nutrition education (B = 7.76; 95% CI, 3.29-12.23; P = 0.001) had higher total Healthy Eating Index scores. CONCLUSIONS AND IMPLICATIONS: Future interventions and policies could support FCCH providers in implementing important practices such as autonomy feeding practices, talking informally to children about nutrition, and providing healthful foods and beverages.
Assuntos
Cuidado da Criança , Creches , Humanos , Feminino , Criança , Masculino , Estudos Transversais , Dieta , Estado NutricionalRESUMO
OBJECTIVE: Family-based weight stigma can be expressed as criticism, judgment, teasing, and mistreatment by family members because of an individual's body weight. The current study compared the prevalence and psychosocial correlates of family-based weight stigma among adult members of a weight-management program living in Australia, Canada, France, Germany, the UK, and the US. METHODS: Participants (N = 8100 adults who reported having ever experienced weight stigma; 95% female; 94% White) completed an identical online survey in their country's dominant language that assessed their experiences of weight stigma from 16 different family member sources, as well as internalized weight bias, body image, eating behaviors, perceived stress, and self-rated health. RESULTS: Family-based weight stigma, especially from mothers (49%-62%), spouses/romantic partners (40%-57%), and fathers (35%-48%), was highly prevalent across countries. Weight stigma from one's immediate family members was associated with indices of poorer psychosocial health across the six countries (ß coefficients = |0.08-0.13|). CONCLUSIONS: Findings highlight the need for weight stigma-reduction efforts to help family members distinguish between supportive, encouraging discourse and potentially weight-stigmatizing communication. Future research should examine the prevalence and correlates of family-based weight stigma in more diverse community samples, including among racially/ethnically and gender diverse adults, and in non-Western countries.