Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 54
Filtrar
Mais filtros










Base de dados
Intervalo de ano de publicação
1.
N Engl J Med ; 381(25): 2440-2450, 2019 12 19.
Artigo em Inglês | MEDLINE | ID: mdl-31851800

RESUMO

BACKGROUND: Although the national obesity epidemic has been well documented, less is known about obesity at the U.S. state level. Current estimates are based on body measures reported by persons themselves that underestimate the prevalence of obesity, especially severe obesity. METHODS: We developed methods to correct for self-reporting bias and to estimate state-specific and demographic subgroup-specific trends and projections of the prevalence of categories of body-mass index (BMI). BMI data reported by 6,264,226 adults (18 years of age or older) who participated in the Behavioral Risk Factor Surveillance System Survey (1993-1994 and 1999-2016) were obtained and corrected for quantile-specific self-reporting bias with the use of measured data from 57,131 adults who participated in the National Health and Nutrition Examination Survey. We fitted multinomial regressions for each state and subgroup to estimate the prevalence of four BMI categories from 1990 through 2030: underweight or normal weight (BMI [the weight in kilograms divided by the square of the height in meters], <25), overweight (25 to <30), moderate obesity (30 to <35), and severe obesity (≥35). We evaluated the accuracy of our approach using data from 1990 through 2010 to predict 2016 outcomes. RESULTS: The findings from our approach suggest with high predictive accuracy that by 2030 nearly 1 in 2 adults will have obesity (48.9%; 95% confidence interval [CI], 47.7 to 50.1), and the prevalence will be higher than 50% in 29 states and not below 35% in any state. Nearly 1 in 4 adults is projected to have severe obesity by 2030 (24.2%; 95% CI, 22.9 to 25.5), and the prevalence will be higher than 25% in 25 states. We predict that, nationally, severe obesity is likely to become the most common BMI category among women (27.6%; 95% CI, 26.1 to 29.2), non-Hispanic black adults (31.7%; 95% CI, 29.9 to 33.4), and low-income adults (31.7%; 95% CI, 30.2 to 33.2). CONCLUSIONS: Our analysis indicates that the prevalence of adult obesity and severe obesity will continue to increase nationwide, with large disparities across states and demographic subgroups. (Funded by the JPB Foundation.).


Assuntos
Obesidade Mórbida/epidemiologia , Obesidade/epidemiologia , Adulto , Índice de Massa Corporal , Feminino , Previsões , Humanos , Renda , Masculino , Obesidade/etnologia , Obesidade Mórbida/etnologia , Prevalência , Autorrelato , Distribuição por Sexo , Estados Unidos/epidemiologia
2.
BMC Public Health ; 19(1): 1587, 2019 Nov 28.
Artigo em Inglês | MEDLINE | ID: mdl-31779603

RESUMO

BACKGROUND: There is a great need to identify implementation strategies to successfully scale-up public health interventions in order to achieve their intended population impact. The Out-of-school Nutrition and Physical Activity group-randomized trial previously demonstrated improvements in children's vigorous physical activity and the healthfulness of foods and beverages consumed. This implementation study aimed to assess the effects and costs of two training models to scale-up this evidence-based intervention. METHODS: A 3-arm group-randomized trial was conducted to compare effectiveness of in-person and online training models for scaling up the intervention compared to controls. One-third of sites were randomized to the in-person train-the-trainer model: local YMCA facilitators attended a training session and then conducted three learning collaborative meetings and technical assistance. One-third were assigned to the online model, consisting of self-paced monthly learning modules, videos, quizzes, and facilitated discussion boards. Remaining sites served as controls. Fifty-three afterschool sites from three YMCA Associations in different regions of the country completed baseline and follow-up observations using a validated tool of afterschool nutrition and physical activity practices. We used multivariable regression models, accounting for clustering of observations, to assess intervention effects on an aggregate afterschool practice primary outcome, and conducted secondary analyses of nine intervention goals (e.g. serving water). Cost data were collected to determine the resources to implement each training model. RESULTS: Changes in the primary outcome indicate that, on average, sites in the in-person arm achieved 0.44 additional goals compared to controls (95%CI 0.02, 0.86, p = 0.04). Increases in the number of additional goals achieved in sites in the online arm were not significantly greater than control sites (+ 0.28, 95% CI -0.18, 0.73, p = 0.24). Goal-specific improvements were observed for increasing water offered in the in-person arm and fruits and vegetables offered in the online arm. The cost per person trained was $678 for the in-person training model and $336 for the on-line training model. CONCLUSIONS: This pilot trial presents promising findings on implementation strategies for scale-up. It validated the in-person training model as an effective approach. The less expensive online training may be a useful option for geographically disbursed sites where in-person training is challenging. TRIAL REGISTRATION: Although this study does not report the results of a health care intervention on human subjects, it is a randomized trial and was therefore retrospectively registered in ClinicalTrials.gov on July 4, 2019 in accordance with the BMC guidelines to ensure the complete publication of all results (NCT04009304).

3.
Obesity (Silver Spring) ; 27(12): 2037-2045, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31746555

RESUMO

OBJECTIVE: This study aimed to estimate the cost-effectiveness and impact on childhood obesity of installation of chilled water dispensers ("water jets") on school lunch lines and to compare water jets' cost, reach, and impact on water consumption with three additional strategies. METHODS: The Childhood Obesity Intervention Cost Effectiveness Study(CHOICES) microsimulation model estimated the cost-effectiveness of water jets on US childhood obesity cases prevented in 2025. Also estimated were the cost, number of children reached, and impact on water consumption of the installation of water jets and three other strategies. RESULTS: Installing water jets on school lunch lines was projected to reach 29.6 million children (95% uncertainty interval [UI]: 29.4 million-29.8 million), cost $4.25 (95% UI: $2.74-$5.69) per child, prevent 179,550 cases of childhood obesity in 2025 (95% UI: 101,970-257,870), and save $0.31 in health care costs per dollar invested (95% UI: $0.15-$0.55). In the secondary analysis, installing cup dispensers next to existing water fountains was the least costly but also had the lowest population reach. CONCLUSIONS: Installating water jet dispensers on school lunch lines could also save almost half of the dollars needed for implementation via a reduction in obesity-related health care costs. School-based interventions to promote drinking water may be relatively inexpensive strategies for improving child health.

4.
J Nutr Educ Behav ; 51(10): 1177-1187, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31402290

RESUMO

OBJECTIVE: To evaluate the potential cost-effectiveness of and stakeholder perspectives on a sugar-sweetened beverage (SSB) excise tax and a Supplemental Nutrition Assistance Program (SNAP) policy that would not allow SSB purchases in Maine, US. DESIGN: A cost-effectiveness simulation model combined with stakeholder interviews. SETTING: Maine, US. PARTICIPANTS: Microsimulation of the Maine population in 2015 and interviews with stakeholders (n = 14). Study conducted from 2013 to 2017. MAIN OUTCOME MEASURES: Health care cost savings, net costs, and quality-adjusted life-years (QALYs) from 2017 to 2027. Stakeholder positions on policies. Retail SSB cost and implementation cost data were collected. ANALYSIS: Childhood Obesity Intervention Cost-Effectiveness Study project microsimulation model with uncertainty analysis to estimate cost-effectiveness. Thematic stakeholder interview coding. RESULTS: Over 10 years, the SSB and SNAP policies were projected to reduce health care costs by $78.3 million (95% uncertainty interval [UI], $31.7 million-$185 million) and $15.3 million (95% UI, $8.32 million-$23.9 million), respectively. The SSB and SNAP policies were projected to save 3,560 QALYs (95% UI, 1,447-8,361) and 749 QALYs (95% UI, 415-1,168), respectively. Stakeholders were more supportive of SSB taxes than the SNAP policy because of equity concerns associated with the SNAP policy. CONCLUSIONS AND IMPLICATIONS: Cost-effectiveness analysis provided evidence of potential health improvement and cost savings to state-level stakeholders weighing broader implementation considerations.

5.
Prev Med Rep ; 15: 100940, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31367511

RESUMO

Many children are not sufficiently physically active. This study uses a quasi-experimental design to evaluate whether participation in a before-school physical activity program called Build Our Kids' Success (BOKS) increases physical activity. Participants (n = 426) were students in Fall, 2016 enrolled in BOKS programming and matched non-BOKS control students from the same grades (Kindergarten-6) and schools in Massachusetts and Rhode Island. Analyses conducted in 2017 examined differences between children in BOKS versus controls in total daily steps, minutes of moderate-to-vigorous (MVPA), vigorous (VPA), and total physical activity (TPA) assessed via Fitbit Charge HR™ monitors. Additional analyses compared physical activity on program days and non-program days. Students (mean age = 8.6 y; 47% female, 58% White, Non-Hispanic) wore monitors an average of 21.7 h/day on 3.2 days during the school week. Compared with controls, on BOKS days, BOKS participants accumulated more steps (1147, 95% confidence interval (CI): 583-1712, P < 0.001), MVPA minutes (13.4, 95% CI: 6.6-20.3, P < 0.001), and VPA minutes (4.0, 95% CI: 1.2-6.7, P = 0.005). Across all school days, BOKS participants accumulated more total steps than controls (716, 95% CI: 228-1204, P = 0.004). Compared to days without BOKS programming, on BOKS days, BOKS participants accumulated more steps (1153; 95% CI: 841-1464, P < 0.001) and daily minutes of MVPA (8.8, 95% CI: 5.3-12.2, P < 0.001), VPA (3.0, 95% CI: 1.6-4.5, P < 0.001), and TPA (20.8, 95% CI: 13.6-28.1, P < 0.001). BOKS programming promotes engagement in additional accumulated steps during the school week and physical activity on days that students participate. Clinical Trial Registration: www.ClinicalTrials.gov, NCT03403816, available at: https://clinicaltrials.gov/ct2/show/NCT03403816?term=NCT03403816&rank=1.

6.
Obes Rev ; 20(9): 1262-1286, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31250960

RESUMO

The objective of this study is to identify promising strategies for improving drinking-water access and consumption among children aged 0 to 5 years. MEDLINE/PubMed, Embase, ERIC, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science, and Cochrane Central Register of Controlled Trials (CENTRAL) databases were searched in this review. Studies included peer-reviewed, full-text studies from high-income countries, published in English between January 1, 2000, and January 12, 2018, that evaluated interventions to increase water access or consumption in children aged 0 to 5 years. Twenty-five studies met inclusion criteria; 19 used an effective intervention strategy to increase water access or water consumption. Three studies addressed both water access and consumption. Frequently used strategies included policy and practice changes, increasing water access and convenience, and education, training, or social support for caregivers. Studies were of fair methodological quality (average score: 18.8 of 26) for randomized studies and of moderate quality (5.1 of 9) for non-randomized studies. To date, few high-quality studies with objectively measured outcomes have clearly demonstrated strategies that may influence water intake and consumption among young children aged 0 to 5 years.

7.
Prev Med Rep ; 14: 100823, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30847271

RESUMO

Ensuring safe, accessible drinking water in schools is a national health priority. The objective of this study was to identify whether there are differences in water quality, availability, and education- related practices in schools by demographic characteristics. In 2017-2018, we analyzed data from the 2014 School Health Policies and Practices Study (SHPPS), a nationally representative, cross-sectional survey of US schools. Analyses examined differences in water-related practices by school characteristics. Response rates for the 3 questionnaires used in this analysis ranged from 69%-94% (Ns ranged from 495 to 577). We found that less than half of schools flush drinking water outlets after periods of non-use (46.4%), conduct periodic inspections that test drinking water outlets for lead (45.8%), and require staff training on drinking water quality (25.6%). Most schools teach the importance of water consumption (81.1%) and offer free drinking water in the cafeteria (88.3%). Some water-related school practices differed by school demographic characteristics though no consistent patterns of associations by school characteristics emerged. In US schools, some water quality-related practices are limited, but water availability and education-related practices are more common. SHPPS data suggest many schools would benefit from support to implement best practices related to school-drinking water.

8.
BMC Public Health ; 19(1): 170, 2019 Feb 11.
Artigo em Inglês | MEDLINE | ID: mdl-30760243

RESUMO

BACKGROUND: In an attempt to improve children's physical activity levels governments have introduced policies specifying the minimum time schools are to schedule physical activity each week. Despite this, the majority of schools in many jurisdictions fail to implement these policies. This study will assess the effectiveness of a multi-component implementation strategy on increasing the minutes of planned physical activity scheduled by primary school teachers each week. METHODS: A cluster randomised controlled trial will be conducted in 62 primary schools in the Hunter New England region of New South Wales, Australia. Schools will be randomly allocated to receive either a multi-component implementation strategy that includes; obtaining executive support, training in-school champions, provision of tools and resources, implementation prompts, reminders and feedback; or usual practice. The study will employ an effectiveness-implementation hybrid design, assessing both policy implementation and individual (student) behavioural outcomes. The primary trial outcome of mean minutes of physical activity scheduled by classroom teachers across the school week will be measured via teacher log-book at baseline and approximately 12 and 18 months post baseline. A nested evaluation of the impact of policy implementation on child physical activity will be undertaken of students in Grades 2 and 3. Analyses will be performed using an intention to treat framework. Linear mixed effects regression models will be used to assess intervention effects on the primary outcome at both follow-up periods. DISCUSSION: This study will be the one of the first well powered randomised trials internationally to examine the impact of an implementation strategy for a physical activity policy in primary schools and will address a fundamental research translation gap. Given the dearth of research, the findings will be important in informing future implementation efforts in this setting. TRIAL REGISTRATION: ANZCTR ACTRN12617001265369 version 1 registered 1st September 2017.


Assuntos
Exercício , Promoção da Saúde/organização & administração , Políticas , Serviços de Saúde Escolar/organização & administração , Professores Escolares/organização & administração , Criança , Feminino , Humanos , Capacitação em Serviço , Masculino , New South Wales , Educação Física e Treinamento , Projetos de Pesquisa , Capacitação de Professores , Fatores de Tempo
9.
J Acad Nutr Diet ; 118(8): 1425-1437, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-30055710

RESUMO

BACKGROUND: Afterschool interventions have been found to improve the nutritional quality of snacks served. However, there is limited evidence on how these interventions affect children's snacking behaviors. OBJECTIVE: Our aim was to determine the impact of an afterschool intervention focused at the school district, site, family, and child levels on dietary consumption of foods and beverages served at snack. DESIGN: This was a secondary analysis of a group-randomized controlled trial. PARTICIPANTS/SETTING: Data were collected from 400 children at 20 afterschool sites in Boston, MA before (fall 2010) and after (spring 2011) intervention implementation. INTERVENTION: The Out-of-School Nutrition and Physical Activity intervention aimed to promote fruits, vegetables, whole grains, and water, while limiting sugary drinks and trans fats. Researchers worked with district foodservice staff to change snack foods and beverages. Teams of afterschool staff participated in three 3-hour learning collaborative sessions to build skills and created action plans for changing site practices. The intervention included family and child nutrition education. MAIN OUTCOME MEASURES: Research assistants observed dietary snack consumption using a validated measure on 2 days per site at baseline and follow-up. STATISTICAL ANALYSES PERFORMED: This study used multivariable regression models, accounting for clustering of observations, to assess the intervention effect, and conducted post-hoc stratified analyses by foodservice type. RESULTS: Children in intervention sites had greater decreases in consumption of juice (-0.61 oz/snack, 95% CI -1.11 to -0.12), beverage calories (-29.1 kcal/snack, 95% CI -40.2 to 18.0), foods with trans fats (-0.12 servings/snack, 95% CI -0.19 to -0.04), total calories (-47.7 kcal/snack, 95% CI -68.2 to -27.2), and increases in consumption of whole grains (0.10 servings/snack, 95% CI 0.02 to 0.18) compared to controls. In post-hoc analyses, sites with on-site foodservice had significant improvements for all outcomes (P<0.001), with no effect for sites with satellite foodservice. CONCLUSIONS: Results demonstrate that an afterschool intervention can improve children's dietary snack consumption, particularly at sites with on-site foodservice.


Assuntos
/métodos , Serviços de Alimentação , Promoção da Saúde/métodos , Lanches , Bebidas , Boston , Criança , Ingestão de Alimentos/psicologia , Ingestão de Energia , Exercício , Comportamento Alimentar/psicologia , Feminino , Frutas , Humanos , Masculino , Valor Nutritivo , Avaliação de Programas e Projetos de Saúde , Verduras
10.
Am J Health Promot ; 32(3): 657-666, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-29108441

RESUMO

PURPOSE: To assess predictors of stated support for policies promoting physically active transportation. DESIGN: Cross-sectional. SETTING: US counties selected on county-level physical activity and obesity health status. PARTICIPANTS: Participants completing random-digit dialed telephone survey (n = 906). MEASURES: Survey measures assessed stated support for 5 policies to promote physically active transportation, access to active transportation facilities, and time spent in a car. County-level estimates included household car dependence and funding for bicycle-pedestrian projects. ANALYSIS: Multivariable generalized linear mixed models using binary distribution and logit link, accounting for clustering within county. RESULTS: Respondents supported policies for accommodating bicyclists and pedestrians through street improvements (89%), school active transportation programs (75%), employer-funded active commuting incentives (67%), and allocation of public funding (68%) and tax support (56%) for building and maintaining public transit. Residents spending >2 h/d (vs <0.7 hours) in cars were more likely to support street (odds ratio [OR]: 1.87; confidence interval [CI]: 1.09-3.22) and public transit (OR: 1.85; CI: 1.24-2.77) improvements. Residents in counties investing >$1.6 million in bicycle and pedestrian improvements expressed greater support for funding (OR: 1.71; CI: 1.04-2.83) and tax increases (OR: 1.73; CI: 1.08-2.75) for transit improvements compared to those with lower prior investments (<$276 100). CONCLUSION: Support for policies to enable active transportation is higher where relevant investments in active transportation infrastructure are large (>$1.6 M), public transit is nearby, and respondents drive >2 h/d.


Assuntos
Ciclismo , Políticas , Transportes/métodos , Transportes/estatística & dados numéricos , Caminhada , Adolescente , Adulto , Idoso , Estudos Transversais , Planejamento Ambiental/economia , Planejamento Ambiental/estatística & dados numéricos , Exercício , Feminino , Financiamento Governamental/economia , Financiamento Governamental/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/epidemiologia , Fatores Socioeconômicos , Impostos/estatística & dados numéricos , Transportes/economia , Estados Unidos/epidemiologia , Adulto Jovem
11.
Am J Health Promot ; 32(1): 72-74, 2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-27698227

RESUMO

PURPOSE: We assessed public support for required water access in schools and parks and perceived safety and taste of water in these settings to inform efforts to increase access to and consumption of tap water. DESIGN: Cross-sectional survey of the US public collected from August to November 2011. SETTING: Random digit-dialed telephone survey. PARTICIPANTS: Participants (n = 1218) aged 17 and older from 1055 US counties in 46 states. MEASURES: Perceived safety and taste of water in schools and parks as well as support for required access to water in these settings. ANALYSIS: Survey-adjusted perceived safety and taste as well as support for required access were estimated. RESULTS: There was broad support for required access to water throughout the day in schools (96%) and parks (89%). Few participants believed water was unsafe in schools (10%) or parks (18%). CONCLUSION: This study provides evidence of public support for efforts to increase access to drinking water in schools and parks and documents overall high levels of perceived taste and safety of water provided in these settings.


Assuntos
Água Potável/normas , Parques Recreativos/normas , Opinião Pública , Instituições Acadêmicas/normas , Abastecimento de Água/normas , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Estados Unidos , Adulto Jovem
12.
N Engl J Med ; 377(22): 2145-2153, 2017 11 30.
Artigo em Inglês | MEDLINE | ID: mdl-29171811

RESUMO

BACKGROUND: Although the current obesity epidemic has been well documented in children and adults, less is known about long-term risks of adult obesity for a given child at his or her present age and weight. We developed a simulation model to estimate the risk of adult obesity at the age of 35 years for the current population of children in the United States. METHODS: We pooled height and weight data from five nationally representative longitudinal studies totaling 176,720 observations from 41,567 children and adults. We simulated growth trajectories across the life course and adjusted for secular trends. We created 1000 virtual populations of 1 million children through the age of 19 years that were representative of the 2016 population of the United States and projected their trajectories in height and weight up to the age of 35 years. Severe obesity was defined as a body-mass index (BMI, the weight in kilograms divided by the square of the height in meters) of 35 or higher in adults and 120% or more of the 95th percentile in children. RESULTS: Given the current level of childhood obesity, the models predicted that a majority of today's children (57.3%; 95% uncertainly interval [UI], 55.2 to 60.0) will be obese at the age of 35 years, and roughly half of the projected prevalence will occur during childhood. Our simulations indicated that the relative risk of adult obesity increased with age and BMI, from 1.17 (95% UI, 1.09 to 1.29) for overweight 2-year-olds to 3.10 (95% UI, 2.43 to 3.65) for 19-year-olds with severe obesity. For children with severe obesity, the chance they will no longer be obese at the age of 35 years fell from 21.0% (95% UI, 7.3 to 47.3) at the age of 2 years to 6.1% (95% UI, 2.1 to 9.9) at the age of 19 years. CONCLUSIONS: On the basis of our simulation models, childhood obesity and overweight will continue to be a major health problem in the United States. Early development of obesity predicted obesity in adulthood, especially for children who were severely obese. (Funded by the JPB Foundation and others.).


Assuntos
Estatura , Peso Corporal , Crescimento , Obesidade/epidemiologia , Obesidade Pediátrica/epidemiologia , Adolescente , Adulto , Índice de Massa Corporal , Criança , Pré-Escolar , Feminino , Humanos , Estudos Longitudinais , Masculino , Modelos Teóricos , Prevalência , Valores de Referência , Risco , Estados Unidos/epidemiologia , Adulto Jovem
13.
Am J Public Health ; 107(9): 1387-1394, 2017 09.
Artigo em Inglês | MEDLINE | ID: mdl-28727528

RESUMO

OBJECTIVES: To evaluate whether differences in tap water and other beverage intake explain differences in inadequate hydration among US adults by race/ethnicity and income. METHODS: We estimated the prevalence of inadequate hydration (urine osmolality ≥ 800 mOsm/kg) by race/ethnicity and income of 8258 participants aged 20 to 74 years in the 2009 to 2012 National Health and Nutrition Examination Survey. Using multivariable regression models, we estimated associations between demographic variables, tap water intake, and inadequate hydration. RESULTS: The prevalence of inadequate hydration among US adults was 29.5%. Non-Hispanic Blacks (adjusted odds ratio [AOR] = 1.44; 95% confidence interval [CI] = 1.17, 1.76) and Hispanics (AOR = 1.42; 95% CI = 1.21, 1.67) had a higher risk of inadequate hydration than did non-Hispanic Whites. Lower-income adults had a higher risk of inadequate hydration than did higher-income adults (AOR = 1.23; 95% CI = 1.04, 1.45). Differences in tap water intake partially attenuated racial/ethnic differences in hydration status. Differences in total beverage and other fluid intake further attenuated sociodemographic disparities. CONCLUSIONS: Racial/ethnic and socioeconomic disparities in inadequate hydration among US adults are related to differences in tap water and other beverage intake. Policy action is needed to ensure equitable access to healthy beverages.


Assuntos
Bebidas/estatística & dados numéricos , Grupos de Populações Continentais/estatística & dados numéricos , Ingestão de Líquidos , Grupos Étnicos/estatística & dados numéricos , Fatores Socioeconômicos , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos Nutricionais
14.
J Acad Nutr Diet ; 117(7): 1097-1103, 2017 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-28330733

RESUMO

BACKGROUND: More than 14 million children in the United States attend summer camp annually, yet little is known about the food environment in day camps. OBJECTIVE: Our aim was to describe the nutritional quality of meals served to, brought by, and consumed by children attending summer day camps serving meals and snacks, and to describe camp water access. DESIGN: We conducted a cross-sectional study. PARTICIPANTS/SETTINGS: Participants were 149 children attending five summer camps in Boston, MA, in 2013. MAIN OUTCOME MEASURES: Foods and beverages served were observed for 5 consecutive days. For 2 days, children's dietary intake was directly observed using a validated protocol. Outcome measures included total energy (kilocalories) and servings of different types of foods and beverages served and consumed during breakfast, lunch, and snack. STATISTICAL ANALYSES PERFORMED: Mean total energy, trans fats, sodium, sugar, and fiber served per meal were calculated across the camps, as were mean weekly frequencies of serving fruits, vegetables, meat/meat alternates, grains, milk, 100% juice, sugar-sweetened beverages, whole grains, red/highly processed meats, grain-based desserts, and salty snacks. Mean consumption was calculated per camper per day. RESULTS: Camps served a mean (standard deviation) of 647.7 (134.3) kcal for lunch, 401.8 (149.6) kcal for breakfast, and 266.4 (150.8) kcal for snack. Most camps served red/highly processed meats, salty snacks, and grain-based desserts frequently, and rarely served vegetables or water. Children consumed little (eg, at lunch, 36.5% of fruit portions, 35.0% of meat/meat alternative portions, and 37.6% of milk portions served) except for salty snacks (66.9% of portions) and grain-based desserts (64.1% of portions). Sugar-sweetened beverages and salty snacks were frequently brought to camp. One-quarter of campers drank nothing throughout the entire camp day. CONCLUSIONS: The nutritional quality of foods and beverages served at summer day camps could be improved. Future studies should assess barriers to consumption of healthy foods and beverages in these settings.


Assuntos
Creches , Refeições , Valor Nutritivo , Estações do Ano , Bebidas , Boston , Criança , Fenômenos Fisiológicos da Nutrição Infantil , Estudos Transversais , Gorduras na Dieta/administração & dosagem , Fibras na Dieta/administração & dosagem , Sacarose na Dieta/administração & dosagem , Grão Comestível , Ingestão de Energia , Serviços de Alimentação , Frutas , Humanos , Carne , Sódio na Dieta/administração & dosagem , Estados Unidos , Verduras
15.
Prev Med ; 95 Suppl: S17-S27, 2017 02.
Artigo em Inglês | MEDLINE | ID: mdl-27773710

RESUMO

Participation in recommended levels of physical activity promotes a healthy body weight and reduced chronic disease risk. To inform investment in prevention initiatives, we simulate the national implementation, impact on physical activity and childhood obesity and associated cost-effectiveness (versus the status quo) of six recommended strategies that can be applied throughout childhood to increase physical activity in US school, afterschool and childcare settings. In 2016, the Childhood Obesity Intervention Cost Effectiveness Study (CHOICES) systematic review process identified six interventions for study. A microsimulation model estimated intervention outcomes 2015-2025 including changes in mean MET-hours/day, intervention reach and cost per person, cost per MET-hour change, ten-year net costs to society and cases of childhood obesity prevented. First year reach of the interventions ranged from 90,000 youth attending a Healthy Afterschool Program to 31.3 million youth reached by Active School Day policies. Mean MET-hour/day/person increases ranged from 0.05 MET-hour/day/person for Active PE and Healthy Afterschool to 1.29 MET-hour/day/person for the implementation of New Afterschool Programs. Cost per MET-hour change ranged from cost saving to $3.14. Approximately 2500 to 110,000 cases of children with obesity could be prevented depending on the intervention implemented. All of the six interventions are estimated to increase physical activity levels among children and adolescents in the US population and prevent cases of childhood obesity. Results do not include other impacts of increased physical activity, including cognitive and behavioral effects. Decision-makers can use these methods to inform prioritization of physical activity promotion and obesity prevention on policy agendas.


Assuntos
Análise Custo-Benefício , Exercício , Promoção da Saúde/métodos , Obesidade Pediátrica/prevenção & controle , Criança , Cuidado da Criança , Política de Saúde , Humanos , Instituições Acadêmicas
16.
Prev Chronic Dis ; 13: E97, 2016 07 28.
Artigo em Inglês | MEDLINE | ID: mdl-27468156

RESUMO

INTRODUCTION: Routine collection, analysis, and reporting of data on child height, weight, and body mass index (BMI), particularly at the state and local levels, are needed to monitor the childhood obesity epidemic, plan intervention strategies, and evaluate the impact of interventions. Child BMI surveillance systems operated by the US government do not provide state or local data on children across a range of ages. The objective of this study was to describe the extent to which state governments conduct child BMI surveillance. METHODS: From August through December 2014, we conducted a structured telephone survey with state government administrators to learn about state surveillance of child BMI. We also searched websites of state health and education agencies for information about state surveillance. RESULTS: State agency administrators in 48 states and Washington, DC, completed telephone interviews (96% response rate). Based on our interviews and Internet research, we determined that 14 states collect child BMI data in a manner consistent with standard definitions of public health surveillance. CONCLUSION: The absence of child BMI surveillance systems in most states limits the ability of public health practitioners and policymakers to develop and evaluate responses to the childhood obesity epidemic. Greater investment in surveillance is needed to identify the most effective and cost-effective childhood obesity interventions.


Assuntos
Índice de Massa Corporal , Obesidade Pediátrica/epidemiologia , Vigilância em Saúde Pública/métodos , Governo Estadual , Adolescente , Criança , Pré-Escolar , Feminino , Empregados do Governo , Humanos , Masculino , Obesidade Pediátrica/prevenção & controle , Telefone , Estados Unidos/epidemiologia
17.
J Adolesc Health ; 59(1): 24-9, 2016 07.
Artigo em Inglês | MEDLINE | ID: mdl-27235376

RESUMO

PURPOSE: Providing children and youth with safe, adequate drinking water access during school is essential for health. This study used objectively measured data to investigate the extent to which schools provide drinking water access that meets state and federal policies. METHODS: We visited 59 middle and high schools in Massachusetts during spring 2012. Trained research assistants documented the type, location, and working condition of all water access points throughout each school building using a standard protocol. School food service directors (FSDs) completed surveys reporting water access in cafeterias. We evaluated school compliance with state plumbing codes and federal regulations and compared FSD self-reports of water access with direct observation; data were analyzed in 2014. RESULTS: On average, each school had 1.5 (standard deviation: .6) water sources per 75 students; 82% (standard deviation: 20) were functioning and fewer (70%) were both clean and functioning. Less than half of the schools met the federal Healthy Hunger-Free Kids Act requirement for free water access during lunch; 18 schools (31%) provided bottled water for purchase but no free water. Slightly over half (59%) met the Massachusetts state plumbing code. FSDs overestimated free drinking water access compared to direct observation (96% FSD reported vs. 48% observed, kappa = .07, p = .17). CONCLUSIONS: School drinking water access may be limited. In this study, many schools did not meet state or federal policies for minimum student drinking water access. School administrative staff may not accurately report water access. Public health action is needed to increase school drinking water access.


Assuntos
Água Potável/normas , Instituições Acadêmicas/normas , Estudantes/estatística & dados numéricos , Adolescente , Serviços de Alimentação/normas , Humanos , Almoço , Massachusetts , Política Nutricional/legislação & jurisprudência , Saúde Pública , Instituições Acadêmicas/estatística & dados numéricos , Inquéritos e Questionários
18.
PLoS One ; 11(3): e0150735, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26954566

RESUMO

BACKGROUND: State-level estimates from the Centers for Disease Control and Prevention (CDC) underestimate the obesity epidemic because they use self-reported height and weight. We describe a novel bias-correction method and produce corrected state-level estimates of obesity and severe obesity. METHODS: Using non-parametric statistical matching, we adjusted self-reported data from the Behavioral Risk Factor Surveillance System (BRFSS) 2013 (n = 386,795) using measured data from the National Health and Nutrition Examination Survey (NHANES) (n = 16,924). We validated our national estimates against NHANES and estimated bias-corrected state-specific prevalence of obesity (BMI≥30) and severe obesity (BMI≥35). We compared these results with previous adjustment methods. RESULTS: Compared to NHANES, self-reported BRFSS data underestimated national prevalence of obesity by 16% (28.67% vs 34.01%), and severe obesity by 23% (11.03% vs 14.26%). Our method was not significantly different from NHANES for obesity or severe obesity, while previous methods underestimated both. Only four states had a corrected obesity prevalence below 30%, with four exceeding 40%-in contrast, most states were below 30% in CDC maps. CONCLUSIONS: Twelve million adults with obesity (including 6.7 million with severe obesity) were misclassified by CDC state-level estimates. Previous bias-correction methods also resulted in underestimates. Accurate state-level estimates are necessary to plan for resources to address the obesity epidemic.


Assuntos
Obesidade/epidemiologia , Adulto , Fatores Etários , Sistema de Vigilância de Fator de Risco Comportamental , Índice de Massa Corporal , Conjuntos de Dados como Assunto , Feminino , Humanos , Masculino , Obesidade Mórbida/epidemiologia , Prevalência , Vigilância em Saúde Pública , Autorrelato , Estados Unidos/epidemiologia
19.
Prev Chronic Dis ; 13: E32, 2016 Mar 03.
Artigo em Inglês | MEDLINE | ID: mdl-26940299

RESUMO

INTRODUCTION: Competitive beverages are drinks sold outside of the federally reimbursable school meals program and include beverages sold in vending machines, a la carte lines, school stores, and snack bars. Competitive beverages include sugar-sweetened beverages, which are associated with overweight and obesity. We described competitive beverage availability 9 years after the introduction in 2004 of district-wide nutrition standards for competitive beverages sold in Boston Public Schools. METHODS: In 2013, we documented types of competitive beverages sold in 115 schools. We collected nutrient data to determine compliance with the standards. We evaluated the extent to which schools met the competitive-beverage standards and calculated the percentage of students who had access to beverages that met or did not meet the standards. RESULTS: Of 115 schools, 89.6% met the competitive beverage nutrition standards; 88.5% of elementary schools and 61.5% of middle schools did not sell competitive beverages. Nutrition standards were met in 79.2% of high schools; 37.5% did not sell any competitive beverages, and 41.7% sold only beverages meeting the standards. Overall, 85.5% of students attended schools meeting the standards. Only 4.0% of students had access to sugar-sweetened beverages. CONCLUSION: A comprehensive, district-wide competitive beverage policy with implementation support can translate into a sustained healthful environment in public schools.


Assuntos
Bebidas/estatística & dados numéricos , Distribuidores Automáticos de Alimentos , Serviços de Alimentação/normas , Política Nutricional , Instituições Acadêmicas , Adolescente , Boston , Bebidas Gaseificadas/estatística & dados numéricos , Criança , Estudos Transversais , Feminino , Humanos , Modelos Logísticos , Masculino , Adoçantes Calóricos/análise , Valor Nutritivo , Estudantes
20.
JAMA Pediatr ; 170(2): 155-62, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-26641557

RESUMO

IMPORTANCE: Millions of children attend after-school programs in the United States. Increasing physical activity levels of program participants could have a broad effect on children's health. OBJECTIVE: To test the effectiveness of the Out of School Nutrition and Physical Activity (OSNAP) Initiative in increasing children's physical activity levels in existing after-school programs. DESIGN, SETTING, AND PARTICIPANTS: Cluster-randomized controlled trial with matched program pairs. Baseline data were collected September 27 through November 12, 2010, with follow-up data collected April 25 through May 27, 2011. The dates of our analysis were March 11, 2014, through August 18, 2015. The setting was 20 after-school programs in Boston, Massachusetts. All children 5 to 12 years old in participating programs were eligible for study inclusion. INTERVENTIONS: Ten programs participated in a series of three 3-hour learning collaborative workshops, with additional optional opportunities for training and technical assistance. MAIN OUTCOMES AND MEASURES: Change in number of minutes and bouts of moderate to vigorous physical activity, vigorous physical activity, and sedentary activity and change in total accelerometer counts between baseline and follow-up. RESULTS: Participants with complete data were 402 racially/ethnically diverse children, with a mean age of 7.7 years. Change in the duration of physical activity opportunities offered to children during program time did not differ between conditions (-1.2 minutes; 95% CI, -14.2 to 12.4 minutes; P = .87). Change in moderate to vigorous physical activity minutes accumulated by children during program time did not differ significantly by intervention status (-1.0; 95% CI, -3.3 to 1.3; P = .40). Total minutes per day of vigorous physical activity (3.2; 95% CI, 1.8-4.7; P < .001), vigorous physical activity minutes in bouts (4.1; 95% CI, 2.7-5.6; P < .001), and total accelerometer counts per day (16,894; 95% CI, 5101-28,686; P = .01) increased significantly during program time among intervention participants compared with control participants. CONCLUSIONS AND RELEVANCE: Although programs participating in the OSNAP Initiative did not allot significantly more time for physical activity, they successfully made existing time more vigorously active for children receiving the intervention. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01396473.


Assuntos
Promoção da Saúde/métodos , Atividade Motora , Serviços de Saúde Escolar , Acelerometria , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Masculino , Massachusetts , Instituições Acadêmicas
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA