Many quick-service restaurants (QSRs) instituted voluntary kids’ meal default beverage standards (standards) between 2013 to 2017. Little is known about impacts of standards on QSR drive-through practices and on customer choices. This study assessed differences in restaurant practices including kids’ meal beverages shown on menu boards, offered by cashiers, and selected by customers in QSRs with and without voluntary standards. Observations (n = 111) and customer surveys (n = 84) were conducted in 2018 at QSRs with standards (n = 70) and without (n = 41) in low-income California, U.S. neighborhoods. Kids’ meal beverages on menu boards (n = 149) and offered by cashiers (n = 185) at QSRs with and without standards were analyzed using multilevel logistic regression. Significantly more menu boards at QSRs with standards (n = 103) vs. without (n = 46) featured only milk, water or unsweetened juice (65.1% vs. 4.4%; p < 0.001). Most cashiers at QSRs with standards and QSRs without (53.1%, 62.5%) asked what drink the data collector wanted rather than first offering default beverages. A small sample of customer interviews found that customers at QSRs with standards most commonly ordered juice (37.0%); at QSRs without standards, soda (45.5%). Although menu boards showed healthier kids’ meal beverages at QSRs with standards than without, cashier behavior was inconsistent. Results suggest additional measures (legislation, implementation support, enforcement) may be needed to ensure optimal implementation.
Introduction California’s Department of Public Health (CDPH) distributes Supplemental Nutrition Assistance Program-Education (SNAP-Ed) funding, known as CalFresh Healthy Living (CFHL) in California, to local health departments to implement school-based physical activity/nutrition interventions. We determined the association between intervention presence/dose and student cardiorespiratory fitness and BMI. Methods This cross-sectional, observational study included 5th and 7th grade students with 2016–17 FitnessGram® results who attended SNAP-Ed eligible California schools. Intervention group students attended schools with CDPH-CFHL interventions during October 2015-September 2016 (n = 904 schools; 97,504 students, 49% female); comparison group students attended schools without CDPH-CFHL interventions (n = 3,506 schools; 372,298 students, 49% female). Adjusted multilevel models determined the association between school-level intervention presence/dose and students’ cardiorespiratory fitness (estimated VO 2 max) and BMI z-score, and tested for effect modification by student grade and sex. Results Students attending intervention schools demonstrated greater VO 2 max (males: 0.18 mL/kg per min, 95% CI: 0.03, 0.34; females = 0.26 mL/kg per min, 95% CI: 0.13, 0.39) and lower BMI z-scores (males: −0.03, 95% CI: −0.05, −0.02; females = -0.02, 95% CI: −0.04, −0.01) than students in comparison schools. Students in schools with the highest intervention levels demonstrated higher VO 2 max (0.37 (95% CI: 0.06, 0.16) and 0.22 (95% CI: 0.02, 0.42), respectively), than comparison students, with the strongest associations seen for females and 7th graders. Conclusion On average, students in schools with CDPH-CFHL physical activity interventions demonstrated better cardiorespiratory fitness and slightly lower BMI z-scores than students in comparable schools without such programing. Investment in these interventions may positively impact students’ cardiorespiratory health, though further causal investigation is warranted.
BackgroundA dietary screener questionnaire (DSQ) was used to assess dietary outcomes among children in the Healthy Communities Study (HCS), a study of the relationships between programs and policies to prevent child obesity and child diet, physical activity and weight outcomes.MethodsTo compare dietary intake estimates derived from the DSQ against those from the Automated Self-Administered 24-Hour Recalls for Children (ASA24-Kids) among children, a measurement error model, using structural equation modelling, was utilized to estimate slopes, deattenuated correlation coefficients, and attenuation factors by age and sex, ethnicity, and BMI status.Participants/settingA randomly selected sub-sample of HCS participants aged 4–15 years in 130 communities throughout the U.S. who completed the DSQ and up to two ASA24-Kids recalls (n = 656;13% of HCS participants).ResultsFor most nutrient/foods examined, the DSQ yielded larger mean intake estimates than the ASA24-Kids, and agreement between the two measures varied by food/nutrient, age and sex, ethnicity, and BMI category. Deattenuated correlation coefficients of 0.4 or greater were observed for added sugars from SSBs (0.54), fruits and vegetables (0.40), and dairy foods (0.50). Lower deattenuated correlation coefficients were seen for total added sugars (0.37), whole grains (0.34), and fiber (0.34). Attenuation factors were most severe for total added sugars intake among overweight children, and for several other dietary outcomes among children aged 9–11 years.ConclusionsThe DSQ was found to be a tool with acceptable agreement with the ASA24-Kids for measuring multiple dietary outcomes of interest in the HCS, although there may be potential due to measurement error to underestimate results (bias towards the null). In future studies, measurement error modelling and regression calibration may be possible solutions to correct for bias due to measurement error in most food/nutrient intake estimates from the DSQ when used among children.Electronic supplementary materialThe online version of this article (10.1186/s12937-018-0415-1) contains supplementary material, which is available to authorized users.
Objective: School-based CalFresh Healthy Living (CFHL) (California’s SNAP-Ed) interventions adapted to new learning environments necessitated by COVID-19. We examined the impact of these interventions on student diet and physical activity (PA) outcomes. Design: Quasi-experimental, two-group, pre-post. Setting: California public schools with ≥50% of students Free and Reduced Price Meal-eligible (nintervention=47; ncomparison=17). Participants: Fourth and fifth grade students who completed the online Eating and Activity Tool for Students at pre and post (nintervention=1,087; ncomparison=846 students). Results: Intervention students reported a significantly greater increase in consumption frequency of total fruit (by 0.16 times/day; p=0.032), driven primarily by a greater increase in 100% fruit juice (by 0.11 times/day; p=0.007). Intervention students reported a significantly greater increase in total vegetable consumption frequency (by 0.45 times/day; p<0.001) than comparison students. Specifically, intervention students reported increased, whereas comparison students reported decreased, consumption frequencies for starchy vegetables (0.05 vs. -0.10 times/day, p<0.001), salad/green vegetables (0.01 vs. -0.11 times/day, p=0.005), and beans (0.04 vs. -0.03 times/day, p=0.025). Consumption frequency of other vegetables decreased in both groups (-0.01 vs. -0.09 times/day) but decreased more among comparison students (p=0.048). No differences in pre-post change in PA outcomes were detected. Conclusions: Findings suggest that despite COVID-19-related challenges necessitating program modifications, CFHL interventions played a role in protecting student consumption of fruit and vegetables during the 2020-21 school year. Therefore, it appears that school-based CFHL interventions can be a viable means of safeguarding student nutrition at a time when access to nutritious food and PA opportunities are hindered.
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