COVID-19 disrupted food access, potentially increasing nutritional risk and health inequities. This study aimed to describe and assess associations between changes in food/meal acquisition behaviors ...and relative changes in dietary intake and bodyweight from before to during the pandemic. Low-income parents (n = 1090) reported these changes by online survey in April–August 2021. Associations were assessed by multinomial logistic regression. Compared to those with no change, those who decreased supermarket shopping had greater odds of decreased fruit and vegetable (FV; OR95%CI = 2.41.4–4.1) and increased salty snack intakes (OR95%CI = 1.71.0–2.8). Those who decreased farmer’s market shopping had greater odds of decreased FV intake (OR95%CI = 1.81.0–3.1), increased bodyweight (OR95%CI = 1.71.1–2.6), and increased SSB (OR95%CI = 1.91.1–3.2) and sweets intakes (OR95%CI = 1.81.1–2.9). Those who increased online food ordering had greater odds of increased sweets (OR95%CI = 1.71.1–2.8), salty snacks (OR95%CI = 1.91.2–3.2), and fast food (OR95%CI = 2.01.2–3.5) intakes and bodyweight (OR95%CI = 1.81.1–2.9). Those who increased healthy meal preparation had greater odds of increased FV intake (OR95%CI = 4.02.5–6.5), decreased SSB (OR95%CI = 3.72.3–6.0), sweets (OR95%CI = 2.71.6–4.4), salty snacks (OR95%CI = 3.01.8–5) and fast food intakes (OR95%CI = 2.81.7–4.6) and bodyweight (OR95%CI = 2.21.2–4.0). Interventions to address the potentially negative impacts of online food/meal shopping and support healthy home cooking may be needed to improve nutrition-related outcomes and reduce health disparities in the aftermath of the current pandemic and during future emergencies requiring similar restrictions.
•School meal participation dropped 46% during COVID-19 school closures in California.•Districts had valuable but partial meal access information during school closures.•Number of school meal sites ...dropped 32% during COVID-19 school closures.•School meal sites tended to be placed in priority population areas.•Density of school meal sites was disproportional to density of populations in need.
The National School Lunch and School Breakfast programs are a nutrition safety net for millions of children in the United States, particularly children in households with lower incomes. During Spring 2020 COVID-19 school closures, schools served school meals through the Summer Meal Programs. Despite efforts to increase access, meal participation declined and food insecurity increased. We aimed to (1) describe meal program features as communicated in low-income California school districts’ on-line resources (2) examine associations between meal program features and change in meal participation between May 2019 and May 2020 and (3) evaluate equity by describing meal site coverage and placement relative to the size of priority populations. Data from district online resources and meal reimbursement claims were collected for a stratified, random sample of 190 CalFresh Healthy Living-eligible districts. Linear regression was used to examine associations between district meal program features and percent change in meal participation. Meal site location and density were examined in relation to the size of priority populations. In May 2020, compared to May 2019, total meals served decreased by a median 46%. There were gaps in the information provided in district online resources and low variation in measured district meal program features. These features explained little of the variation in the percent change in meal participation. A greater proportion of meal sites were placed in areas with larger priority populations, yet the density of sites was not proportionate to the priority populations’ sizes. Findings show actionable areas for improving meal access during school closures.
•During COVID, parents reported more home cooking and less child school meal and fast food intake.•Decreased school meal participation was associated with decreased fast food consumption.•More home ...cooking was associated with increased fruit and vegetable and some unhealthy food intake.
This cross-sectional study examined the associations between parent-reported, perceptions of changes in school-aged children’s (ages 5–18) school meal participation, household cooking, fast food consumption, dietary intake, and weight during the COVID-19 pandemic. Respondents with low-income and school-aged children (n = 1040) were enrolled using quota sampling to approximate the distribution of low-income households and race/ethnicity among California residents who completed an on-line questionnaire developed by the authors. Adjusted multinomial models examined associations between parent-reported changes in school meal participation and time spent cooking, with parent-reported changes in child diet and body weight during COVID-19 (from before March 2020 to January-March 2021). During the pandemic, decreased school meal participation was associated with decreased child’s fast food intake (OR95 %CI = 1.471.04–2.07); conversely, increased school meal participation was associated with increased child’s fast food intake (OR95 %CI = 1.711.09–2.68). Decreased cooking at home was associated with decreased fruit and vegetable intake (OR95 %CI = 2.711.62–4.53), increased sugar-sweetened beverage intake (OR95 %CI = 3.832.16–6.81), and increased fast food intake (OR95 %CI = 4.092.45–6.84); while increased cooking at home was associated with increased fruit and vegetable (OR95 %CI = 2.261.59–3.20), sugar-sweetened beverage (OR95 %CI = 1.881.20–2.94), sweets (OR95 %CI = 1.461.02–2.10), and salty snack food intake (OR95 %CI = 1.871.29–2.71). These parent-reported perceived changes in meal sources during the pandemic for children from low-income California households, and the mixed results in their associations with changes in parent-reported child dietary intake, suggest the need for strengthening policies and programs to support both access to, and healthfulness of, meals from school and home during prolonged school closures.
Purpose The current epidemic of childhood overweight has launched a variety of school-based efforts to address the issue. This study reports on the first 2 years of a 3-year evaluation of one school ...district's comprehensive intervention to transform school foodservices and dining experiences, offer cooking and gardening programs, and integrate nutrition and food systems concepts into the academic curriculum. Methods This 3-year prospective study enrolled 327 4th and 5th graders in a mid-sized school district in California, and followed them into middle school. Intervention exposure was determined through interviews with school staff and student surveys. Student knowledge and attitudes were assessed annually by questionnaire, and student behavior was assessed annually by 3-day food diary. Household information was gathered by parent questionnaire. Changes in knowledge, attitudes, and behavior were compared by level of intervention exposure using analysis of covariance; pairwise differences were evaluated using Bonferroni's test at a procedure-wise error rate of 5%. Results After controlling for family sociodemographic background, students most exposed to the intervention increased their consumption of fruits and vegetables by nearly 0.5 cups (one standard serving), whereas students least exposed decreased their consumption by 0.3 cups ( p < .05). Students most exposed to the programming also showed a significantly greater increase in preference for fruit and green leafy vegetables, compared to students least exposed to the programming ( p < .05). Conclusions Future research is needed to better understand the relative importance of the different components of such a program, and their cost-benefits as well as health impacts.
Reducing sugar-sweetened beverage (SSB) consumption is a leading strategy to help combat high rates of adult obesity and overweight. Regulating SSB sales in schools has reduced access among youth. ...However, current federal school nutrition standards are focused on student rather than staff environments (i.e. school staff lounges). This study examines the association between the availability of SSBs in school vending machines and school staff SSB consumption.
The study sample included 51 public schools in California, Oregon, Washington, Maryland, and Washington DC participating in an evaluation of Kaiser Permanente’s Thriving Schools initiative in school year 2017–18. Data collection included: 1) observations of school cafeterias, staff lounges, stores and outdoor snack areas for the presence of, and content in, vending machines, and 2) an online survey of school staff about their SSB consumption.
Fifty-nine percent (n = 1586) of staff responded to the survey; 1229 (77% of respondents) reported on SSB consumption. Thirty percent of schools had staff lounges with SSB vending machines and 34% of staff reported drinking ≥1 SSBs/day. On average, the probability of consuming ≥1 SSBs/day was 6.6% greater in staff in schools with SSBs available in staff lounge vending machines (95% CI: 0.11%, 13.12%).
Staff in schools with SSB vending machines in staff lounges were more likely to report consuming ≥1 SSBs per day compared to staff without SSB vending in staff lounges. Examining the impact of extending SSB regulations to the entire school environment on school staff SSB consumption is an important next step.
From 2012 to 2014, a total of 17 family child care homes participated in a multisector, community-wide initiative to prevent obesity. Strategies included staff workshops, materials, site visits, and ...technical assistance regarding development and implementation of nutrition policies. The purpose of the evaluation was to examine the impact of the initiative on family child care home nutrition-related policies and practices and child dietary intake.
Pre- and post-intervention without control group. Measures taken at baseline and follow-up included structured observations and questionnaires regarding nutrition policies, practices, and environments; documentation of lunch foods served on 5 days; and lunch plate waste observations on 2 days. Paired t-tests were used to determine the significance of change over time.
Seventeen family child care homes in a low-income diverse community in Northern California; children aged 2–5 years who attended the family child care homes.
Change in nutrition-related policies and practices, lunch foods served and consumed.
Data was collected at 17 sites for an average of 5.2 children aged 2–5 years per site per day at baseline and 4.6 at follow-up for a total of 333 plate waste observations. There were significant increases in staff training, parental involvement, and several of the targeted nutrition-related practices; prevalence of most other practices either improved or was maintained over time. There were significant increases in the number of sites meeting Child and Adult Care Food Program meal guidelines, variety of fruit and frequency of vegetables offered, and reductions in frequency of juice and high-fat processed meats offered. Adequate portions of all food groups were consumed at both time points with no significant change over time.
A simple, policy-focused intervention by a child care resource and referral agency was successful at reinforcing and improving upon nutrition-related practices at family child care homes. Children consumed adequate, but not excessive, portions of the balanced meals served to them, suggesting there is no reason to offer unhealthy options.
This article is part of a supplement entitled Building Thriving Communities Through Comprehensive Community Health Initiatives, which is sponsored by Kaiser Permanente, Community Health.
Reaching preschool-aged children to establish healthy lifestyle habits, including physical activity, is an important component of obesity prevention efforts. However, few studies have examined family ...child care homes where nearly 1 million children receive care.
A pre- and post-intervention evaluation without a control group was conducted to evaluate what changes occurred in family child care homes that participated in the Healthy Eating and Active Living project, a multicomponent obesity prevention initiative, focused on community-driven policy and environmental change in neighborhoods within Kaiser Permanente service areas.
From 2012 to 2014, a total of 17 family child care homes in Northern California participated in the intervention.
A physical activity workshop for child care staff and technical assistance to develop a policy to promote physical activity and other healthy behaviors.
Pre and post observations, questionnaires, and physical activity logs were completed to assess change in physical activity resources available in the family child care homes, the amount of child screen time offered, type and amount of physical activity offered to children, and implementation of physical activity best practices.
Between baseline and follow-up, providers significantly increased both the number of structured, adult-led activities (2.6 vs 3.2 activities per day) and the number of structured, adult-led minutes of activity in which children participated (49 vs 83 minutes per day). Providers also improved screen time practices and made improvements to the physical activity environment.
In this study, a community-based organization designed and implemented multicomponent strategies tailored for participating family child care homes. The successful implementation of the intervention likely contributed to implementation of practices that increased opportunities for physical activity for the young children attending these family child care homes.
This article is part of a supplement entitled Building Thriving Communities Through Comprehensive Community Health Initiatives, which is sponsored by Kaiser Permanente, Community Health.
Successful community-level health initiatives require implementing an effective portfolio of strategies and understanding their impact on population health. These factors are complicated by the ...heterogeneity of overlapping multicomponent strategies and availability of population-level data that align with the initiatives. To address these complexities, the population dose methodology was developed for planning and evaluating multicomponent community initiatives. Building on the population dose methodology previously developed, this paper operationalizes dose estimates of one initiative targeting youth physical activity as part of the Kaiser Permanente Community Health Initiative, a multicomponent community-level obesity prevention initiative. The technical details needed to operationalize the population dose method are explained, and the use of population dose as an interim proxy for population-level survey data is introduced. The alignment of the estimated impact from strategy-level data analysis using the dose methodology and the data from the population-level survey suggest that dose is useful for conducting real-time evaluation of multiple heterogeneous strategies, and as a viable proxy for existing population-level surveys when robust strategy-level evaluation data are collected.
This article is part of a supplement entitled Building Thriving Communities Through Comprehensive Community Health Initiatives, which is sponsored by Kaiser Permanente, Community Health.
From 2011 to 2014, small stores in three communities participated in a community-wide obesity prevention initiative. The study aimed to determine how participation in the initiative influenced store ...environments and consumer purchases.
Pre- and post-intervention without control. Structured observations of the store environments and intercept surveys of adult shoppers at all stores, and of children at two stores, conducted at baseline and follow-up. Manager/owner interviews regarding perceived impacts of the intervention conducted at follow-up.
Shoppers at nine small stores in three diverse, low-income communities in Northern California.
The store interventions were determined locally with combinations of strategies such as product displays, healthier options, marketing and promotion, store layout, and facility improvements that were implemented to varying degrees at each site.
Changes in store environments and purchases of select foods and beverages.
Stores experienced consistent, but not always significant, declines in purchases of sweets and chips and increases in purchases of fruits and vegetables at select stores. Decreases in purchases of targeted sugar-sweetened beverages were offset by increases in purchases of other sugar-sweetened beverages. Changes in store environments and promotional activities varied widely from store to store and corresponded to variations in changes in purchasing. The owners/managers perceived benefits to their bottom line and community/customer relations, but challenges were identified that may account for the varied degree of implementation.
Substantive improvements in fruit and vegetable availability and promotion were needed to achieve a measurable impact on purchases but reducing purchases of unhealthy foods, like sweets and chips, required a less consistent intensive effort. These findings suggest it may be challenging to achieve the consistent and targeted implementation of changes and ongoing promotional efforts at a large enough proportion of stores where residents shop that would be required to get measurable impacts at the community level.
This article is part of a supplement entitled Building Thriving Communities Through Comprehensive Community Health Initiatives, which is sponsored by Kaiser Permanente, Community Health.
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