Identifying Sources of Children’s Consumption of Junk Food in Boston After-School Programs, April–May 2011

Introduction: Little is known about how the nutrition environment in after-school settings may affect children’s dietary intake. We measured the nutritional quality of after-school snacks provided by programs participating in the National School Lunch Program or the Child and Adult Care Food Program and compared them with snacks brought from home or purchased elsewhere (nonprogram snacks). We quantified the effect of nonprogram snacks on the dietary intake of children who also received program-provided snacks during after-school time. Our study objective was to determine how different sources of snacks affect children’s snack consumption in after-school settings. Methods: We recorded snacks served to and brought in by 298 children in 18 after-school programs in Boston, Massachusetts, on 5 program days in April and May 2011. We measured children’s snack consumption on 2 program days using a validated observation protocol. We then calculated within-child change-in-change models to estimate the effect of nonprogram snacks on children’s dietary intake after school. Results: Nonprogram snacks contained more sugary beverages and candy than program-provided snacks. Having a nonprogram snack was associated with significantly higher consumption of total calories (+114.7 kcal, P < .001), sugar-sweetened beverages (+0.5 oz, P = .01), desserts (+0.3 servings, P < .001), and foods with added sugars (+0.5 servings; P < .001) during the snack period. Conclusion: On days when children brought their own after-school snack, they consumed more salty and sugary foods and nearly twice as many calories than on days when they consumed only program-provided snacks. Policy strategies limiting nonprogram snacks or setting nutritional standards for them in after-school settings should be explored further as a way to promote child health

Validity of a practitioner-administered observational tool to measure physical activity, nutrition, and screen time in school-age programs

Background: Nutrition and physical activity interventions have been effective in creating environmental changes in afterschool programs. However, accurate assessment can be time-consuming and expensive as initiatives are scaled up for optimal population impact. This study aims to determine the criterion validity of a simple, low-cost, practitioner-administered observational measure of afterschool physical activity, nutrition, and screen time practices and child behaviors. Methods: Directors from 35 programs in three cities completed the Out-of-School Nutrition and Physical Activity Observational Practice Assessment Tool (OSNAP-OPAT) on five days. Trained observers recorded snacks served and obtained accelerometer data each day during the same week. Observations of physical activity participation and snack consumption were conducted on two days. Correlations were calculated to validate weekly average estimates from OSNAP-OPAT compared to criterion measures. Weekly criterion averages are based on 175 meals served, snack consumption of 528 children, and physical activity levels of 356 children. Results: OSNAP-OPAT validly assessed serving water (r = 0.73), fruits and vegetables (r = 0.84), juice >4oz (r = 0.56), and grains (r = 0.60) at snack; sugary drinks (r = 0.70) and foods (r = 0.68) from outside the program; and children’s water consumption (r = 0.56) (all p <0.05). Reports of physical activity time offered were correlated with accelerometer estimates (minutes of moderate and vigorous physical activity r = 0.59, p = 0.02; vigorous physical activity r = 0.63, p = 0.01). The reported proportion of children participating in moderate and vigorous physical activity was correlated with observations (r = 0.48, p = 0.03), as were reports of computer (r = 0.85) and TV/movie (r = 0.68) time compared to direct observations (both p < 0.01). Conclusions: OSNAP-OPAT can assist researchers and practitioners in validly assessing nutrition and physical activity environments and behaviors in afterschool settings. Trial registration Phase 1 of this measure validation was conducted during a study registered at clinicaltrials.gov NCT01396473. Electronic supplementary material The online version of this article (doi:10.1186/s12966-014-0145-5) contains supplementary material, which is available to authorized users

Food insecurity and the role of food assistance programs in supporting diet quality during the COVID-19 pandemic in Massachusetts

BackgroundEconomic and supply chain shocks resulting from the COVID-19 pandemic in 2020 led to substantial increases in the numbers of individuals experiencing food-related hardship in the US, with programs aimed at addressing food insecurity like the Supplemental Nutrition Assistance Program (SNAP) and food pantries seeing significant upticks in utilization. While these programs have improved food access overall, the extent to which diet quality changed, and whether they helped mitigate diet quality disruptions, is not well understood.ObjectiveTo evaluate food insecurity, food pantry and/or SNAP participation associations with both diet quality as well as perceived disruptions in diet during the COVID-19 pandemic among Massachusetts adults with lower incomes.MethodsWe analyzed complete-case data from 1,256 individuals with complete data from a cross-sectional online survey of adults (ages 18 years and above) living in Massachusetts who responded to “The MA Statewide Food Access Survey” between October 2020 through January 2021. Study recruitment and survey administration were performed by The Greater Boston Food Bank. We excluded respondents who reported participation in assistance programs but were ineligible (n = 168), those who provided straightlined responses to the food frequency questionnaire component of the survey (n = 34), those with incomes above 300% of the federal poverty level (n = 1,427), those who completed the survey in 2021 (n = 8), and those who reported improved food insecurity (n = 55). Current dietary intake was assessed via food frequency questionnaire. Using Bayesian regression models, we examined associations between pandemic food insecurity, perceived disruption in diet, diet quality, and intakes of individual foods among those who completed a survey in 2020. We assessed interactions by pantry and SNAP participation to determine whether participation moderated these relationships.ResultsIndividuals experiencing food insecurity reported greater disruption in diet during the pandemic and reduced consumption of healthy/unhealthy foods. Pantry participation attenuated significant associations between food insecurity and lower consumption of unhealthy (b = −1.13 [95% CI −1.97 to −0.31]) and healthy foods (b = −1.07 [−1.82 to −0.34]) to null (unhealthy foods: −0.70 [−2.24 to 0.84]; healthy foods: 0.30 [−1.17 to 1.74]), whereas SNAP participation attenuated associations for healthy foods alone (from −1.07 [−1.82 to −0.34] to −0.75 [−1.83 to 0.32]). Results were robust to choice of prior as well as to alternative modeling specifications.ConclusionAmong adults with lower incomes, those experiencing food insecurity consumed less food, regardless of healthfulness, compared to individuals not experiencing food insecurity. Participation in safety-net programs, including SNAP and pantry participation, buffered this phenomenon. Continued support of SNAP and the food bank network and a focus on access to affordable healthy foods may simultaneously alleviate hunger while improving nutrition security

Comparison of foods and beverages served and consumed in CACFP- participating childcare centers to national guidelines

Abstract Objective: The federal Child and Adult Care Food Program (CACFP) sets minimum nutrition and portion size standards for meals served in participating childcare programs. CACFP has been associated with more nutritious meals served. It is unclear, however, whether CACFP results in childrens dietary intake being aligned with national recommendations. We assess whether childrens dietary intake in CACFP-participating childcare centers meets benchmarks set by the Dietary Guidelines for Americans (DGA). Design: This is a cross-sectional study. We used direct observation to estimate quantities of foods/beverages served and consumed per child. Mean amounts served per child per day were compared to CACFP portion size requirements for each component (fruits, vegetables, milk, meat/meat alternate). Mean amounts of foods/beverages consumed were compared to DGA recommendations (calories, fruits, vegetables, whole/refined grains, dairy, protein, added sugars). One sample t-tests evaluated if quantities served and consumed were different from CACFP and DGA standards, respectively. Setting: Six CACFP-participating childcare centers. Participants: 2-5 year-old children attending childcare. Results: We observed 46 children across 166 child-meals. Most meals served met CACFP nutrition standards. Compared to CACFP portion size standards, children were served more grains at breakfast and lunch; more fruits/vegetables at lunch but less at breakfast and snack; and less dairy at all eating occasions. Compared to DGA recommendations, children under-consumed every food/beverage category except grains during at least one eating occasion. Conclusions: Children were served quantities of foods/beverages mostly consistent with CACFP portion size requirements, but had sub-optimal intake relative to DGAs. More research is needed to help children consume healthy diets in childcare

How policy implementation shapes the impact of U.S. food assistance policies: the case study of the Child and Adult Care Food Program

Much of the chronic disease burden in the U.S. population can be traced to poor diet. There has been a sustained focus on influencing children's diets and encouraging healthier eating habits by changing policies for what foods and beverages can be served to children through large federally-funded nutrition assistance programs. Yet without attention to how nutrition policies are implemented, and the surrounding context for these policies, these policy changes may not have the intended results. In this perspective, we used Bullock et al.'s (2021) Process Model of Implementation from a Policy Perspective to analyze how the complexities of the implementation process of large-scale nutrition policies can dilute potential health outcomes. We examine the Child and Adult Care Food Program (CACFP), a federal program focused on supporting the provision of nutritious meals to over 4 million children attending childcare, as a case study. We examine how the larger societal contexts of food insecurity, attitudes towards the social safety net, and a fragmented childcare system interact with CACFP. We review the “policy package” of CACFP itself, in terms of its regulatory requirements, and the various federal, state, and local implementation agencies that shape CACFP's on-the-ground implementation. We then review the evidence for how each component of the CACFP policy implementation process impacts uptake, costs, feasibility, equity, and effectiveness at improving children's nutrition. Our case study demonstrates how public health researchers and practitioners must consider the complexities of policy implementation processes to ensure effective implementation of nutrition policies intended to improve population health

Assessment of a Districtwide Policy on Availability of Competitive Beverages in Boston Public Schools, Massachusetts, 2013

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

Copy Number Variation in the Horse Genome

We constructed a 400K WG tiling oligoarray for the horse and applied it for the discovery of copy number variations (CNVs) in 38 normal horses of 16 diverse breeds, and the Przewalski horse. Probes on the array represented 18,763 autosomal and X-linked genes, and intergenic, sub-telomeric and chrY sequences. We identified 258 CNV regions (CNVRs) across all autosomes, chrX and chrUn, but not in chrY. CNVs comprised 1.3% of the horse genome with chr12 being most enriched. American Miniature horses had the highest and American Quarter Horses the lowest number of CNVs in relation to Thoroughbred reference. The Przewalski horse was similar to native ponies and draft breeds. The majority of CNVRs involved genes, while 20% were located in intergenic regions. Similar to previous studies in horses and other mammals, molecular functions of CNV-associated genes were predominantly in sensory perception, immunity and reproduction. The findings were integrated with previous studies to generate a composite genome-wide dataset of 1476 CNVRs. Of these, 301 CNVRs were shared between studies, while 1174 were novel and require further validation. Integrated data revealed that to date, 41 out of over 400 breeds of the domestic horse have been analyzed for CNVs, of which 11 new breeds were added in this study. Finally, the composite CNV dataset was applied in a pilot study for the discovery of CNVs in 6 horses with XY disorders of sexual development. A homozygous deletion involving AKR1C gene cluster in chr29 in two affected horses was considered possibly causative because of the known role of AKR1C genes in testicular androgen synthesis and sexual development. While the findings improve and integrate the knowledge of CNVs in horses, they also show that for effective discovery of variants of biomedical importance, more breeds and individuals need to be analyzed using comparable methodological approaches.Sharmila Ghosh, Zhipeng Qu, Pranab J. Das, Erica Fang, Rytis Juras, E. Gus Cothran, Sue McDonell, Daniel G. Kenney, Teri L. Lear, David L. Adelson, Bhanu P. Chowdhary, Terje Raudsep

Updated Meal Patterns in the Child and Adult Care Food Program and Changes in Quality of Food and Beverages Served: A Natural Experimental Study

With diet-related chronic diseases being the largest contributors to U.S. morbidity and mortality, identifying population-level strategies to promote healthier diets is essential. Intervention during early childhood may be particularly important. The Child and Adult Care Food Program (CACFP), a federal nutrition assistance program in the U.S. that supports serving meals and snacks in child care settings, reaches millions of U.S. children. Recent 2017 updates to CACFP’s meal patterns were meant to improve the nutritional quality of food served through CACFP by providing more whole grains, fruit, and vegetables. In this study, we used a natural experimental, longitudinal study of child care centers participating in CACFP compared to nonparticipating centers to assess whether the quality of food and beverages served (per menu analysis) improved following the CACFP meal pattern changes. While we found that CACFP centers were more likely to meet several key nutrition standards in comparison to non-CACFP centers overall, there were no differences in menu quality from before to after the 2017 standards change between CACFP and non-CACFP centers. Nutrition standards for CACFP may need to be further strengthened with adequate financial and technical support given to child care programs for effective implementation

De-implementing public health policies: a qualitative study of the process of implementing and then removing body mass index (BMI) report cards in Massachusetts public schools

Abstract Background This study explored reasons for the adoption of a policy to distribute report cards to parents about children’s weight status (“BMI report cards”) in Massachusetts (MA) public schools in 2009 and the contextual factors influencing the policy removal in 2013. Methods We conducted semi-structured, qualitative interviews with 15 key decision-makers and practitioners involved with implementing and de-implementing the MA BMI report card policy. We analyzed interview data using a thematic analytic approach guided by the Consolidated Framework for Implementation Research (CFIR) 2.0. Results Primary themes were that (1) factors other than scientific evidence mattered more for policy adoption, (2) societal pressure spurred policy adoption, (3) problems with the policy design contributed to inconsistent implementation and dissatisfaction, and (4) media coverage, societal pressure, and organizational politics and pressure largely prompted de-implementation. Conclusions Numerous factors contributed to the de-implementation of the policy. An orderly process for the de-implementation of a policy in public health practice that manages drivers of de-implementation may not yet exist. Public health research should further focus on how to de-implement policy interventions when evidence is lacking or there is potential for harm