Abstract

Efforts are needed to improve U.S. children's poor diet quality. Our purpose was to examine whether a policy that restricts the availability of snack foods in the schools is associated with greater fruit and vegetable consumption in a nationally representative sample of 5th grade children. Children in schools with restricted snack availability had significantly higher frequency of fruit and vegetable consumption than children in schools without restricted snack availability. Our findings suggest that a restrictive snack policy should be part of a multi-faceted approach to improve children's diet quality.

No abstract

Background The Integrated Strategy for Attention to Nutrition (EsIAN in Spanish) is a national strategy within Mexico's conditional cash transfer program (initially Progresa, then Oportunidades, then Prospera, CCT-POP) designed to strengthen the health and nutrition component, address the nutrition transition, and improve the health and nutritional status of its beneficiaries, through 3 main components: 1) procurement of functioning equipment to primary health care (PHC) units; 2) providing free micronutrient supplements to beneficiary women and children; 3) implementing a behavior change communication (BCC) strategy and a training system for PHC providers (PHCPs). Objective We aim to describe the iterative process and evidence-based approach used to design and roll-out the EsIAN at scale, by focusing on the BCC component. Methods The BCC strategy was developed by following an iterative process through the following phases: situational analysis, formative research and design of the BCC strategy (using the socioecological framework and the social marketing approach), large-scale feasibility study, redesign, and national scale-up. Results The review and formative research revealed several barriers and issues that limited program coverage, utilization, and acceptance. These included misconceptions about pregnancy and infant feeding, nonalignment of practices with international recommendations, and lack of knowledge on nutrition and related topics, among others. These results were used to identify priority behaviors and elaborate key messages for mothers/caregivers and providers to develop the BCC strategy. The feasibility study resulted in significant improvements in PHCPs’ knowledge, counseling (breastfeeding, and supplement use and consumption), and caregivers’ complementary feeding behaviors, and highlighted several design and delivery aspects that needed strengthening. Based on these findings, the BCC strategy was adapted prior to a national scale-up. Conclusions The theory-based iterative approach resulted in the identification of specific actions to target, and approaches to do so, as part of the design and roll-out of the BCC strategy at scale.

Interest in household food insecurity (FI) within scientific and policy groups has motivated efforts to develop methods for measuring it. Questionnaires asking about FI experiences have been shown to be valid in the contexts in which they were created. The issue has arisen as to whether such questionnaires need be developed from the ground up or if a generic questionnaire can be adapted to a particular context. This study aimed to gain an in-depth understanding of household FI in urban Costa Rica, develop and validate a questionnaire for its measurement, and inform the choice between the 2 methods of development. The study was conducting using qualitative and quantitative methods provided in the Food and Nutrition Technical Assistance (FANTA) guidelines. In-depth interviews were conducted with 49 low-middle-income urban women using a semistructured interview guide. A 14-item FI questionnaire was developed based on results from these interviews. A field study was conducted in 213 households. The results show that the developed questionnaire provides valid measurement of household FI in urban Costa Rica and is simple and quick to apply in the household setting. FANTA developed a guide during the period that this research was completed that provides a generic questionnaire that can be adapted for use in various countries, rather than building the questionnaire from the ground up. This study provides evidence that careful attention to the procedures in this guide will likely yield a questionnaire suitable for assessing household FI in middle-income countries.

As part of a formative evaluation of a micronutrient powder (MNP) trial in Ethiopia that was organized according to a programme impact pathway model, we conducted in‐depth focused ethnographic interviews with caregivers of children between 6 and 23 months who had accepted to try “Desta,” a locally branded MNP. After stratification into two subgroups by child age, respondents were randomly selected from lists of caregivers who had received MNP from government health workers between 1 and 3 months prior to the interview date. Thirty women who were either currently giving Desta to their child (“continuing users,” n = 14) or had stopped feeding Desta (“noncontinuing users,” n = 16) were purposefully recruited from both urban and rural areas in the two different regions where the trial was conducted. Interviews were recorded, transcribed and translated, and coded for both emerging and prespecified themes. On the basis of identifiable components in the caregiver adherence process, this paper focuses exclusively on factors that facilitated and inhibited “appropriate use” and “continued use.” For “appropriate use,” defined as the caregiver preparing and child consuming MNP as directed, we identified four common themes in caregiver narratives. With respect to “continued use,” the caregiver providing and child consuming the minimum number of MNP sachets over a recommended time period, our interviews spontaneously elicited five themes. We also examined caregivers' perceptions related to problems in obtaining refills. Attention to caregivers' perspectives reflected in their narratives offers opportunities to improve MNP utilization in Ethiopia, with potential application in other social and cultural settings.

We aimed to identify positive parenting practices that set children on differential weight-trajectories. Parenting practices studied were cognitively stimulating activities, limit-setting, disciplinary practices, and parent warmth. Data from two U.S. national longitudinal data sets and linear and logistic regression were used to examine association of initial parenting practices with subsequent change in body mass index (BMI) Z-score and being overweight, stratified by income and gender. Lower change in BMI Z-score and lower likelihood of being or becoming overweight occurred among girls if parents engaged in cognitively stimulating activities or set bedtime; among low-income girls if parents helped with art and set bedtime; among high-income girls if they participated in dance or music, parents talked about nature or visited a museum or library, or parents had rules about number of hours for watching television; among low-income boys if they participated in dance or parents built something with them or set bedtime; and among high-income boys if they participated in dance or music. Greater expression of warmth was associated with lower change in BMI Z-score. Parenting practices facilitating cognitive stimulation, setting limits, and expressing warmth are associated with lower likelihood of being or becoming overweight and can be promoted by healthcare professionals.

Objective: We investigated whether having a policy regarding the availability of sweetened beverages in school was associated with children's purchase and total weekly and daily consumption of sweetened beverages. Design: Data were obtained from 10 719 children aged 9-13 years and 2065 elementary schools in the Early Childhood Longitudinal Study-Kindergarten cohort. Multilevel logistic regression was used to determine the magnitude and significance of relationships between the availability of different beverages and purchase of sweetened beverages at school and overall consumption of beverages. Results: The purchase of sweetened beverages by children in school was strongly associated with the administrative policy of sweetened beverage availability. Compared with children in schools without an administrative policy that allowed sweetened beverages, children in schools with the policy were three times more likely to be either occasional or frequent consumers of sweetened beverages. Conclusions: A policy of availability of sweetened beverages makes an independent contribution to children's purchase and consumption of sweetened beverages in the 5th grade year.