evaluate local initiatives which promote healthy eating

Evaluating healthy food access interventions The primary objective of the Project was to generate public policy changes supported by a traditional health education program. Childhood socioeconomic status and adult health. There were also other organizational impacts within both the schools subprogram (changes in school canteen policy) and the GP subprogram (GPs initiating discussions about dietary fat and cholesterol reduction as well as weight loss). Can Healthy Cities be made really healthy? - The Lancet However, the modest net differences in risk factors (including cholesterol) suggested the need for new designs and interventions that will accelerate positive risk factor change (Winkleby et al., 1996). Finally, we are grateful to large numbers of individuals in both GS and SUN without whose co-operation the study would have been impossible. Core activities were devised to meet these objectives. . McGill, R., Anwar, E., Orton, L. et al. This study categorisation framework could mask the potential differential effectiveness of multicomponent interventions which have substantial elements of two or more P categories. Article *studies sum to 37 because one study examined several different types of interventions which were included in two separate categories. volume15, Articlenumber:457 (2015) We only included interventions where quantitative results by SEP were presented by the author. Twenty-seven (out of 65) eating places in GS and 24 (out of 46) in SUN formed the study population. Place interventions showed mixed results, although none appeared likely to widen inequalities. 2012;27:106. Ethnicity was only included as a measure of SEP if the authors explicitly stated this was their SEP measurement proxy within the text. Lifestyle factors of a five-year community-intervention program: the Hartslag Limburg intervention. Cite this article, An Erratum to this article was published on 15 September 2015. Downstream interventions (which rely solely on individuals making and sustaining behaviour change) may therefore be more likely to be taken up by those who are of higher SEP and are more likely to widen the health gap between rich and poor. 2007;61:4738. Thomas S, Fayter D, Misso K, Ogilvie D, Petticrew M, Sowden A, et al. 2012;107:183344. For example, a home-based practitioner nutrition-initiated program aimed at hypercholesterolaemic children has been developed. What a healthy, balanced diet is The Eatwell Guide Government advice on a healthy, balanced diet is encapsulated in the UK's national food model, the Eatwell Guide. These are summarised in Table3. One reviewer (RMcG) screened titles, removed duplicates and selected potentially relevant abstracts. Healthy Eating, Active Living: An action plan to improve diet, increase physical activity and tackle obesity (2008-2011) . (Age limits imposed on samples are 1875 years.). In 1991, the population of GS was 50 483. World Health Statistics 2012. In order to assess changes in patterns of food purchases across the Project period, a supermarket food purchases study was conducted. 1999;2:25362. In a number of studies, significance levels were not presented by the study authors (and could not be calculated) and therefore the magnitude of the results was used to determine differential effects. However, the vast majority of full text articles which were assessed for eligibility did not explore differential effects by SEP. Community opinion as well as dietary behaviour and cognition about healthy diet were assessed using a panel mail questionnaire survey of 1137 residents in the two communities. Influence of socioeconomic status on the effectiveness of dietary counselling in healthy volunteers. Sampling frames of all eating places in both GS (116) and SUN (76) were compiled from several sources (e.g. Rothman, J. Briss PA, Zaza S, Pappaioanou M, Fielding J, Wright-De Agero L, Truman BI, et al. Cardiovascular risk factors in multi-ethnic middle school students: the HEALTHY primary prevention trial. Policy, systems, and environmental approaches are recommended for preventing childhood obesity. Participation in community-originated interventions is associated with positive changes in weight status and health behaviors in youth. In addition, there were some impacts on organizational practice (public policy initiatives). Pros and cons of proposed interventions to promote healthy eating Choosing indicators to evaluate Healthy Cities projects: a political These proportions in GS and SUN were then compared. Reinaerts E, Nooijer J, Candel M, de Vries N. Increasing childrens fruit and vegetable consumption: distribution or a multicomponent programme? Several of the included studies were modelling studies. However the studies identified were heterogeneous, addressing different research questions, with diverse theoretical underpinnings study designs and study outcomes. School Health Guidelines to Promote Healthy Eating and Physical Activity 1 There has been an increase in consumption of foods prepared outside the home (eg, fast food) and many of these foods have increased in portion size, which . 4 The Action Plan - Healthy Eating, Active Living: An action plan to Interventions aimed at improving population health should be routinely evaluated for differential socioeconomic impact. Are interventions to promote healthy eating equally effective for all? 2010;34:111624. 1.2 Evaluate national and local initiatives which promote healthy eating There have been many national and local initiatives to promote healthy eating in recent years. The principal goal of this phase was to promote public policy initiatives that promoted healthy diet, supported by changes in community opinion and interest in healthy diet. Non communicable diseases (NCDs e.g. GS did, however, perform significantly better than SUN in terms of decreased consumption of take-away food. This study provides support for community-based approaches to healthy diet-based public policy initiatives supported by social marketing in the future. Ann N Y Acad Sci. In Social inequality and public health. It cannot be inferred that these effects were or were not statistically significant. With regard to the items assessed at post-intervention only, 58% of GS residents believed that there had been a recent increase in the number of eating places offering healthy food, compared with 48% of SUN residents. 1984;108:83949. Lowe CF, Horne PJ, Tapper K, Bowdery M, Egerton C. Effects of a peer modelling and rewards-based intervention to increase fruit and vegetable consumption in children. Magne et al. Community here has a different meaning, that of an ecosystem with capacity to work towards solutions to its own community identified problems' (Hawe, 1994). have described the points in the implementation of an intervention which may impact upon differential effectiveness by SEP [18]. Our review supports both White and Frieden [18,79]. https://doi.org/10.1186/s12889-015-1781-7, DOI: https://doi.org/10.1186/s12889-015-1781-7. Havas S, Anliker J, Greenberg D, Block G, Block T, Blik C, et al. Full-cream milk and butter, and saturated (regular) margarine, as proportions of all milk and table spread sales, respectively, were calculated monthly for each individual supermarket and combined within each community. 2003;37:40616. Computer printouts of sales figures for all relevant items were obtained for the period immediately preceding Towards a Healthy Diet till the end of the Project (rather than the end of Towards a Healthy Diet). The frequency of eating takeaway foods (fish and chips, etc., not bread rolls and sandwiches) was also assessed. Ways to make physical activity safe and accessible for all; make healthy food choices easier everywhere; make breastfeeding easier to start and sustain; strengthen obesity prevention standards for early care and education settings; and increase number of and access to family healthy weight programs. However, increased production of processed foods, rapid urbanization and changing lifestyles have led to a shift in dietary patterns. Cummins S, Macintyre S. Food desertsevidence and assumption in health policy making. PRISMA-equity 2012 extension: reporting guidelines for systematic reviews with a focus on health equity. Conversely, the top of the pyramid depicts health education and counselling which depend on higher levels of individual effort; hence resulting in the lowest potential population impact. 1998;88:168590. Nilunger L, Diderichsen F, Burstrm B, Ostlin P. Using risk analysis in Health Impact Assessment: the impact of different relative risks for men and women in different socio-economic groups. All authors listed contributed to the interpretation of the results and to the drafting and finalisation of the manuscript. Assessing equity in systematic reviews: realising the recommendations of the Commission on Social Determinants of Health. WHO urges governments to promote healthy food in public facilities 2009;33:107583. Background Interventions to promote healthy eating make a potentially powerful contribution to the primary prevention of non communicable diseases. 2013;44:e6170. We did not look at age and sex differences in detail as this was not the focus of this particular paper. An annual Fruit Salad Day as well as poster displays and cookbooks for sale in fruit and vegetable retailers were organized. We undertook a systematic review of interventions to promote . Evaluate national and local initiatives which promote children's Interventions in the Price category appeared most likely to reduce inequalities while Person interventions were the most likely to widen inequalities (Figure1). Canteen policies were more frequently implemented in Shepparton schools. Evidence from health surveys have identified that Mori, the indigenous people of Aotearoa New Zealand, experience a high incidence of obesity with physical and social implications. Lim SS, Vos T, Flaxman AD, Danaei G, Shibuya K, Adair-Rohani H, et al. A substantial amount of the NCD burden is attributable to four behavioural risk factors (notably poor diet, also smoking, alcohol and physical inactivity). 1.2 Evaluate national and local initiatives which promote healthy eating Qualification : Level 3 Diploma for the Early Years Educator Unit : 1.1 Support healthy lifestyles for children through the provision of food and nutrition Learning outcome: 1. They comprised a series of checklists (in this case, Likert-style opinion statements) which have been reported to be an efficient, rapid and valid way to inform public health nutrition programs (Kristal et al., 1990). suggest that how an intervention is delivered is crucial. The Towards a Healthy Diet phase of the Shepparton Healthy Heart Project was evaluated. They also included participation in diet classes' over the past month, dietary intentions (using the Transtheoretical Model and the concept of self-efficacy) and knowledge of the effects of diet on heart health (Prochaska et al., 1982; Bandura, 1982). Health Educ Res. We conducted a sensitivity analysis to determine if the key results would change if we had been more or less selective in our study screening process. 2008;24:299305. Public Health Nutr. Parental influence on childrens early eating environments and obesity risk: implications for prevention. Springer Nature. Smoking and healthy eating interventions have been assessed for differential effects by SEP. EVALUATING HEALTHY CITIES: STILL AN ISSUE AFTER 20 YEARS. Conducting a sensitivity analysis confirmed the general trends seen in the main Harvest plot (Figure1), with Price interventions appearing likely to reduce inequalities. The six intervention categories used in the analysis are thus: Price fiscal measures such as taxes, subsidies, or economic incentives, Place environmental measures in specific settings such as schools, work places (e.g. The majority were conducted in Europe [34-39], with five in North America [40,41] and one in Australia [42]. BMJ. All four of the dietary counselling interventions appear likely to widen inequalities. Upon fulfilling these criteria, studies were assessed utilising a PICOS (Participants, Interventions, Comparators, Outcomes and Study design) [23]. Nelson M, Erens B, Bates B, Church S, Boshier T. The Low Income Diet and Nutrition Survey. Part of Lorenc T, Petticrew M, Welch V, Tugwell P. What types of interventions generate inequalities? Ann Behav Med. Eat at least 5 fruits and vegetables a day. 2012;380:222460. The purpose of this study is to help researchers and restaurant owners gain an understanding of healthy sustainable initiatives within restaurant businesses. A self-completion mail questionnaire was also administered at the end of Towards a Healthy Diet in Greater Shepparton only. PubMed Socioeconomic inequalities in diet are influenced by factors including cost, access and knowledge. Population tobacco control interventions and their effects on social inequalities in smoking: systematic review. Am J Health Promot. Promoting healthy body weight Preventing or managing diabetes and other diet-related health conditions Healthy food access initiatives can also have valuable co-benefits: Supporting local food systems Promoting local economic development, vocational skills, and job creation in vulnerable communities. Am J Prev Med. Developing an evidence-based guide to community preventive servicesmethods. We categorised interventions based on the underlying theories about how the interventions might have worked to bring about change in healthy eating outcomes. WHO. All four examined the effectiveness of national Five a day health information campaigns. Wendel-Vos GCW, Dutman AE, Verschuren WMM, Ronckers ET, Ament A, van Assema P, et al. As such, many countries have implemented various initiatives to encourage children and adolescents to stay physically active. Frieden TR. Anderson, E. J., Richardson, M., Castle, G., Cercone, S., Delahanty, L., Lyon, R., Mueller, D. and Snetselaar, L. (. 58% of GS residents believed that there had been an increase in the numbers of local residents eating healthy food, compared with 51% of their SUN counterparts. Thomas and colleagues demonstrated differential impact of tobacco control policy interventions. BMC Public Health 15, 457 (2015). This, rather than a particular health-related behaviour, may be the immediate focus of these programs. 2012;102:516. Nor was there any difference between the two communities in terms of the type of cooking oil used. Change in relevant parameters across the Project period towards practices supporting Heart Health was compared for GPs in GS and SUN. The very high rates of coronary heart disease morbidity and mortality existing in all industrialized societies have generated considerable interest in both its primary and secondary prevention. 2011;343:d4995. Am J Public Health. Study of these products also had other methodological advantagesstandard packaging, easy to identify as Heart Healthy or not, amenable to numerical analysis and not subject to widely fluctuating seasonal variations in price or demand. This included frequency of eating fresh fruit, vegetables or green salads, food fried in oil or fat, high- or low-fat milk products, fat on meat and table spreads. They too reported that downstream interventions targeting individuals might increase inequalities but their findings were limited by a lack of studies examining socioeconomic differential effects. Their purpose, however, will be to generate sufficient community support for the initiatives to be taken up and succeed, rather than as in the past, to achieve short-term individual behaviour change. Health Policy (Amsterdam, Netherlands). Ninety-five per cent confidence intervals for these age differences are 2.8, 1.6 years for males and 3.5, 0.7 for females. Significant differences in nutritional knowledge have been shown between differing socioeconomic groups, with knowledge declining with lower socioeconomic status [10]. Sorensen G, Stoddard A, Hunt MK, Hebert JR, Ockene JK, Avrunin JS, et al. Food Policy. Because achieving healthy eating patterns is central to all of the Heart Health Programs described above, it is possible to investigate the feasibility of establishing public policy initiatives in Heart Health by reference to healthy diet. Int J Obes. This was supported by a Project nurse. These public policy initiatives were directed at eating places, schools and the health services. Evaluate national and local initiatives which promote healthy eating. Similarly, 58% of GS residents believed that there had been an increase in the numbers of local residents eating healthy food, compared with 51% of their SUN counterparts. Over the last 40 years global eating patterns have changed in significant ways. Kaplan GA, Keil JE. 2013;67:1903. We followed best practice guidance as detailed by the PRISMA-Equity 2012 Extension for systematic reviews with a focus on health equity. The evaluation of the Pawtucket Program concluded that achieving cardiovascular risk reduction (including cholesterol and body mass index) at the community level was feasible, but maintaining statistically significant differences between cities was not (Carleton et al., 1995). As noted, there were no significant differences in the socio-demographic characteristics of the two cohorts. Samples of 1115 and 1090 residents of all ages in GS and SUN, respectively, were randomly selected from the Electoral Roll. Increasing the fruit and vegetable consumption of fourth-graders: results from the high 5 project. As noted, the majority of identified studies did not explore differential effects by SEP. This paper presents the overall results of the evaluation of the Towards a Healthy Diet phase of the project. Initiatives aimed at schools were assessed by on-site interviews, those at general practitioners by a panel mail questionnaire survey. Net movement in GS compared with SUN was estimated. There were reports of change in customer behaviour (more requests for fruit) as well as proprietor/manager behaviour (more fruit and salad dishes, and less fried food offered). Prev Med. This intervention is summarised in Table3. Full text articles were then screened independently by the two reviewers (RMcG & EA). 2007;107:102832. While many intervention components proved effective in targeted groups, against a background of strong secular trends of increasing health promotion and declining risk factors, the overall program effects (including cholesterol and body mass index) were modest in size and duration, and generally within chance limits. School Health Guidelines At a Glance. The potential differential effectiveness of mass media (five a day) campaigns within the Promotion category was unclear, as only four studies were found and these showed mixed results. Two interventions (one subsidy on fruit and vegetables [40] and one tax on high energy density foods [42]) had a greater impact on higher SEP, and there was no differential effect demonstrated in the remaining six studies in the Price category [35,37,41]. The results were therefore synthesised using a combination of graphical and narrative methods, including the use of the Harvest plot, which is a useful graphical method for synthesising and displaying evidence about the differential effects of population-level interventions [32]. Of these, nine were taxes on high energy density foods [34,36,37,41,42], three were subsidies on fruit and vegetables [35,40] and six were combinations of taxes and subsidies [37-39]. Brownson RC, Smith CA, Pratt M, Mack NE, Jackson-Thompson J, Dean CG, et al. Healthy eating: applying All Our Health - GOV.UK Since these studies could not be assessed using the same quality assessment tool as the empirical studies, two modelling experts assessed the quality of these independently. There were no significant differences between the two communities in terms of reported requests for vegetables, low-fat foods or grilled foods. 2012;9:001333. J Health Econ. This evaluation will allow policymakers to make more informed decisions concerning the relative merits of these strategies in combating the obesity epidemic. When the results were stratified by age, gender or intervention site, the results referring to the largest subsample were used. Unit 1.1: Support healthy lifestyles for children through the provision Havas S, Anliker J, Damron D, Langenberg P, Ballesteros M, Feldman R. Final results of the Maryland WIC 5-A-Day Promotion Program. Twenty (77%) of the 26 identified in GS completed the questionnaire at both pre- and post-intervention, as did 15 (79%) of the 19 identified in SUN. Public Health Nutr. For this proper education on giving the right kind of nutrition to children is required. There was no evidence of any downward trend in the consumption of Heart Unhealthy products in GS during the Project period. Thus, eating a healthy diet demonstrates a social gradient with diet among people in lower SEPs being poorer in quality when compared to more advantaged groups. A disadvantage of two-community evaluation studies is that it is difficult to determine the extent to which change would have occurred in the absence of the Project, i.e. Haerens L, Deforche B, Maes L, Brug J, Vandelanotte C, De Bourdeaudhuij I. An experiment Appetite. 2010;1186:3755. Prevention of overweight in preschool children: results of kindergarten-based interventions. This is because there have been relatively few such programs that have also been subject to rigorous evaluation. 1997;29:2735. This review suggests interventions aimed at the individual may be less cost-effective, especially among poorer groups, since greater effort and resources may be needed to achieve effectiveness similar to more affluent groups. In GS the proportion of table spread sales accounted for by butter exceeded 20% in all but 4 months, whereas in SUN it never reached 20% and was below 15% for 11 months during the period. Four Promotion interventions were identified. Our 6P adaptation highlights the effectiveness of the Harvest plot in displaying heterogeneous results. Guideline 1: Healthy Eating and Physical Activity. 2013;9:72349. Evaluating the effectiveness of these initiatives is difficult, as many factors influence dietary habits. New Jersey: John Wiley & Sons, Ltd; 1996. Anyone you share the following link with will be able to read this content: Sorry, a shareable link is not currently available for this article. Welch V, Petticrew M, Tugwell P, Moher D, ONeill J, Waters E, et al. J Am Diet Assoc. Carcaise-Edinboro P, McClish D, Kracen AC, Bowen D, Fries E. Fruit and vegetable dietary behavior in response to a low-intensity dietary intervention: the rural physician cancer prevention project. Its use of health service practitioners was small as it relied for its implementation on a parentchild autotutorial group (Tershakovec et al., 1998). Bandura, A. The response of the eating place across Project start to end was classified as being Heart Healthy, Heart Unhealthy or No Change. Changing individual behaviour was a secondary goal only. Caution needs nevertheless to be exercised in interpreting the study's results. Explain the impact on health and development of food . The pre-intervention and post-intervention questionnaires were mailed to respondents for self-completion prior to the commencement of the Project and 2 years later at the completion of the Project, respectively (note not at the end of Towards a Healthy Diet). Furthermore, the settings in which these interventions are introduced may affect their impact. *Each matrix within the Harvest plot supermatrix illustrates our findings for each P. 2000;30:30919. You need to evaluate the strengths and weaknesses. Do effects of price discounts and nutrition education on food purchases vary by ethnicity, income and education? 1.2 Evaluate national and local initiatives which promote healthy eating The Harvest plot shows each intervention illustrated as an individual bar. RCTs. When the screening process was made more selective, the general trends seen in the main Harvest plot were essentially unchanged. There were no differences observed related to the other P categories. Extracted data were compared for accuracy and completeness. Evaluation of the Healthy Lifestyles Initiative for Improving Community LO, MMW and SC contributed to the search strategy. Cecchini M, Sassi F, Lauer JA, Lee YY, Guajardo-Barron V, Chisholm D. Tackling of unhealthy diets, physical inactivity, and obesity: health effects and cost-effectiveness. Learning outcome: 1. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Sixteen of the 41 schools in GS and 13 of the 41 in SUN provided interview data. 2008;108:202130. 2010;92:22845. Nederkoorn C, Havermans RC, Giesen JCAH, Jansen A. Br J Nutr. Cohen S, Janicki-Deverts D, Chen E, Matthews KA. 2007;34:25362. Each bar represents one intervention. Systematic review of socioeconomic inequalities in impact. 2004;67:21524. Otherwise there was no consistent increase in strategies in GS than SUN GPs relating to the other seven dietary fat and cholesterol change strategies or the other seven weight reduction strategies. CAS 1999;149:110412. Given the considerable heterogeneity of the studies, undertaking a meta-analysis was not deemed appropriate. Cookies policy. Five supermarkets in GS and four in SUN had suitable scanning equipment, and all of these agreed to participate. The new action framework serves as a tool for governments to develop, implement, monitor and evaluate public food procurement and service policies that align with the core principles of healthy diets as outlined in existing WHO recommendations: limit sodium consumption and ensure that salt is iodized; limit the intake of free sugars; Where necessary, mail and telephone follow-up was conducted to maximize the response rate. Drink 0 sugar-sweetened drinks. Promotion interventions showed mixed results. These include intervention efficacy, service provision or access, uptake, and compliance [15]. This involved semi-structured interviews of canteen managers, teachers or volunteers. State and Local Programs | DNPAO | CDC BMC Public Health Five of the 16 GS schools had changed their policy during the Project period, four as a result of Project input. Systematic review of socioeconomic inequalities in impact, https://doi.org/10.1186/s12889-015-1781-7, http://www.who.int/dietphysicalactivity/diet/en/(2014, http://tna.europarchive.org/20110116113217/, http://www.food.gov.uk/science/dietarysurveys/lidnsbranch/, http://dx.doi.org/10.1186/s12889-015-2162-y, http://creativecommons.org/licenses/by/4.0, http://creativecommons.org/publicdomain/zero/1.0/. 1985;14:27992. Are interventions to promote healthy eating equally effective for all
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