Healthy Default Beverages in Kids’ Meals: Evaluating Policy Adherence and Impact in California

Abstract Objectives Healthy default beverage policies for restaurant kids’ meals have been identified as a top strategy to improve beverage intake in young children and reduce obesity and diabetes risk. California passed a statewide policy (SB1192), effective January 2019, specifying kids’ meal default beverages as water, unflavored milk, or a nondairy alternative. Although other localities have adopted similar policies, there have been no studies on their effectiveness. The aim of this study was to assess changes in beverages offered with kids’ meals before and after a healthy default beverage policy took effect and to quantify policy adherence in menus and cashier orders in quick service restaurants (QSR). Methods The study employed a pre-post policy design. Baseline data on beverages offered as part of kids’ meals were collected from 111 QSR in low-income areas in California in late 2018, prior to policy implementation. Follow-up data were collected from the same restaurants one year later. Data were collected by menu observation and purchase of kids’ meals. Both walk-in and drive-through settings were assessed where available. Full policy adherence was defined as offering only SB1192-compliant beverages, and was assessed 3 ways: menu board, cashier order, and a combined metric. Results At baseline, prior to any legislative requirement, 6 (6.3%) restaurant menu boards, 5 (4.5%) cashier orders, and 0 restaurants overall were already fully adherent. At follow-up, 64 (66.0%) restaurant menu boards, 1 (0.9%) cashier order, and 0 restaurants overall were fully adherent. Generalized estimating equations, clustered by restaurant chain, were used to test pre-post policy changes. Adherence in menu boards increased (59.7%, p = < .0001). There were no changes in adherence in cashier orders or overall adherence. Conclusions California's healthy default beverage policy for restaurant kids’ meals was effective in changing QSR menu board offerings but did not impact cashier order processes. Additional staff training may improve policy implementation. Studies are underway to assess the impact of staff training and customer behavior change. Funding Sources University of California Division of Agriculture and Natural Resources, Robert Wood Johnson Foundation Healthy Eating Research, CA Department of Public Health/USDA.

Download Full-text

Restaurant kids’ meal beverage offerings before and after implementation of healthy default beverage policy statewide in California compared to citywide in Wilmington, Delaware

Public Health Nutrition ◽

10.1017/s1368980021001245 ◽

2021 ◽

pp. 1-23

Author(s):

Lorrene D. Ritchie ◽

Laura Lessard ◽

Phoebe Harpainter ◽

Marisa M. Tsai ◽

Gail Woodward-Lopez ◽

...

Keyword(s):

Logistic Regression ◽

Policy Implementation ◽

Low Income ◽

Multilevel Logistic Regression ◽

Sugar Sweetened Beverages ◽

Additional Information ◽

Sweetened Beverages ◽

Before And After ◽

Manager Perceptions ◽

Quick Service

Abstract Objective: In 2019, California and Wilmington, Delaware implemented policies requiring healthier default beverages with restaurant kids’ meals. This study assessed restaurant beverage offerings and manager perceptions. Design: Pre-post menu observations were conducted in California and Wilmington. Observations of cashiers/servers during orders were conducted pre-post implementation in California and post-implementation in Wilmington. Changes in California were compared using multilevel logistic regression and paired t-tests. Post-implementation, managers were interviewed. Setting: Inside and drive-through ordering venues in a sample of quick-service restaurants in low-income California communities and all restaurants in Wilmington subject to the policy, the month before and 7-12 months after policy implementation. Participants: Restaurant observations (California n=110; Wilmington n=14); managers (California n=75; Wilmington n=15). Results: Pre-implementation, the most common kids’ meal beverages on California menus were unflavored milk and water (78.8%, 52.0%); in Wilmington, juice, milk, and sugar-sweetened beverages were most common (81.8%, 66.7%, 46.2%). Post-implementation, menus including only policy-consistent beverages significantly increased in California (9.7% to 66.1%, p<0.0001), but remained constant in Wilmington (30.8%). During orders, cashiers/servers offering only policy-consistent beverages significantly decreased post-implementation in California (5.0% to 1.0%, p=0.002). Few managers (California 29.3%; Wilmington 0%) reported policy knowledge, although most expressed support. Most managers wanted additional information for customers and staff. Conclusions: While the proportion of menus offering only policy-consistent kids’ meal default beverages increased in California, offerings did not change in Wilmington. In both jurisdictions managers lacked policy knowledge and few cashiers/servers offered only policy-consistent beverages. Additional efforts are needed to strengthen implementation of kids’ meal beverage policies.

Download Full-text

A prospective, observational clinical trial on the impact of COVID-19-related national lockdown on thyroid hormone in young males

Scientific Reports ◽

10.1038/s41598-021-86670-9 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Giulia Brigante ◽

Giorgia Spaggiari ◽

Barbara Rossi ◽

Antonio Granata ◽

Manuela Simoni ◽

...

Keyword(s):

Clinical Trial ◽

Serum Levels ◽

Stressful Event ◽

Italian Population ◽

Reference Ranges ◽

Endocrine Regulation ◽

Before And After ◽

Hpt Axis ◽

The Impact

AbstractTrying to manage the dramatic coronavirus disease 2019 (COVID-19) infection spread, many countries imposed national lockdown, radically changing the routinely life of humans worldwide. We hypothesized that both the pandemic per se and the consequent socio-psychological sequelae could constitute stressors for Italian population, potentially affecting the endocrine system. This study was designed to describe the effect of lockdown-related stress on the hypothalamic-pituitary-thyroid (HPT) axis in a cohort of young men. A prospective, observational clinical trial was carried out, including patients attending the male infertility outpatient clinic before and after the national lockdown for COVID-19 pandemic. The study provided a baseline visit performed before and a follow-up visit after the lockdown in 2020. During the follow-up visit, hormonal measurements, lifestyle habits and work management were recorded. Thirty-one male subjects were enrolled (mean age: 31.6 ± 6.0 years). TSH significantly decreased after lockdown (p = 0.015), whereas no significant changes were observed in the testosterone, luteinising hormone, follicle-stimulating hormone, estradiol and prolactin serum levels. No patient showed TSH serum levels above or below reference ranges, neither before nor after lockdown. Interestingly, TSH variation after lockdown was dependent on the working habit change during lockdown (p = 0.042). We described for the first time a TSH reduction after a stressful event in a prospective way, evaluating the HPT axis in the same population, before and after the national lockdown. This result reinforces the possible interconnection between psychological consequences of a stressful event and the endocrine regulation.

Download Full-text

Aortic endograft and bridging stent-graft remodeling after branched endovascular aortic repair

Vascular ◽

10.1177/1708538120983698 ◽

2020 ◽

pp. 170853812098369

Author(s):

Stefano Fazzini ◽

Giovanni Torsello ◽

Martin Austermann ◽

Efthymios Beropoulis ◽

Roberta Munaò ◽

...

Keyword(s):

Stent Graft ◽

Endovascular Repair ◽

Main Body ◽

Thoracoabdominal Aneurysm ◽

Before And After ◽

Long Term Follow Up ◽

Instability Rate ◽

One Year ◽

The Impact

Objectives The results of branched endovascular repair of thoracoabdominal aneurysms are mainly dependent on durability of the graft used. The purpose of this study was to evaluate postoperative aortic main body and bridging stent-graft remodeling, and their impact on bridging stent-graft instability at one year. Methods Computed tomoangiographies of 43 patients (43 aortic main body mated with 171 bridging stent-grafts) were analyzed before and after branched endovascular repair as well as after a follow-up of 12 months. Primary endpoint was aortic main body remodeling (migration >5 mm, shortening >5 mm, scoliosis >5° or lordosis >5°). Shortening was defined as a reduced length in the long axis, scoliosis as left-right curvature, and lordosis as antero-posterior curvature. Aortic main body remodeling, aneurysm sac changes, and bridging stent-graft tortuosity were evaluated to study their correlations and the impact on the bridging stent-graft instability. Results At 12 months, aortic main body remodeling was observed in 72% of the cases, migration in 39.5% (mean 5.21 mm), shortening in 41.9% (mean 5.79 mm), scoliosis in 58.1%, (mean 10.10°), lordosis in 44.2% (mean 5.78°). Migration, shortening, and scoliosis were more frequent in patients with larger aneurysms ( p = .005), while scoliosis was significantly more frequent in type II thoracoabdominal aneurysm ( p = .019). Aortic main body remodeling was significantly associated to bridging stent-graft remodeling (r: 0.3–0.48). The bridging stent-graft instability rate was 9.3%. Despite a trend toward significance ( p = .07), none of the evaluated aortic main body and bridging stent-graft changes were associated with bridging stent-graft instability at 12 months. Conclusions Aortic main body remodeling is frequent especially in large and extended thoracoabdominal aneurysm aneurysms. Aortic main body and bridging stent-graft remodeling was significantly correlated. While these geometric changes had no significant impact on bridging stent-graft instability at one year, a close long-term follow-up after branched endovascular repair could predict bridging stent-graft failures.

Download Full-text

SP9.1.1 The Impact of Anaesthetic Use on Healing in Sub-cutaneous Abscess Management: A Retrospective Before and After Cohort Study

British Journal of Surgery ◽

10.1093/bjs/znab361.165 ◽

2021 ◽

Vol 108 (Supplement_7) ◽

Author(s):

Hannah Elkadi ◽

Eleanor Dodd ◽

Theodore Poulton ◽

William Bolton ◽

Joshua Burke ◽

...

Keyword(s):

Wound Healing ◽

Local Anaesthetic ◽

Surrogate Endpoints ◽

Incision And Drainage ◽

Number Of Patients ◽

Significant Difference ◽

Patient Reported ◽

Before And After ◽

The Impact

Abstract Aims Despite being the most common surgical procedure, there is wide variation that exists in the management of simple subcutaneous abscesses with no national guideline describing best practice. During the COVID-19 Pandemic national guidelines promoted the use of regional or local anaesthetic (LA) instead of general anaesthesia (GA) to avoid aerosol generating intubation associated with GA. This study aimed to assess the impact of anaesthetic choice in outcomes following incision and drainage of subcutaneous abscesses. Methods Two cohorts of patients undergoing abscess incision and drainage at St. James’ University Hospital Leeds were retrospectively identified over a 14-week period before and after the introduction of the new COVID-19 anaesthetic guidelines. Wound healing surrogate endpoints were used: i) total number of follow up appointments and ii) attendance to healthcare services after 30 days from I&D. Result 133 patients were included. Significantly more procedures were performed under LA after the intervention (84.1% vs 5.7%; p < 0.0001) with a significant reduction in wound packing (68.3% vs 87.1%. p=0.00473). Follow up data found no significant difference in the average number of follow-up appointments (7.46 vs 5.11; p = 0.0731) and the number of patients who required ongoing treatment after 30 days (n = 14 vs n = 14, p = 0.921). Conclusion Drainage of simple subcutaneous abscess under 5 cm is safe under local anaesthetic with no significant difference in surrogate endpoints of wound healing observed in this patient cohort. Recurrent packing may not be required. Future work should explore patient reported measures such as pain management and the health economics of this intervention.

Download Full-text

Impact of an Online Sleep and Circadian Education Program on University Students’ Sleep Knowledge, Attitudes, and Behaviours

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph181910180 ◽

2021 ◽

Vol 18 (19) ◽

pp. 10180

Author(s):

Caitlin R. Semsarian ◽

Gabrielle Rigney ◽

Peter A. Cistulli ◽

Yu Sun Bin

Keyword(s):

University Students ◽

Undergraduate Students ◽

Stages Of Change ◽

Behavioural Change ◽

Poor Sleep ◽

Course Grades ◽

Before And After ◽

Students Attitudes ◽

The Impact

University students consistently report poor sleep. We conducted a before-and-after study to evaluate the impact of an online 10-week course on undergraduate students’ sleep knowledge, attitudes, and behaviours at 6-month follow-up. Data were collected via baseline course surveys (August–September 2020) and follow-up surveys distributed via email (February–March 2021). n = 212 students completed baseline surveys and n = 75 (35%) completed follow-up. Students retained to follow-up possessed higher baseline sleep knowledge and received higher course grades. At the 6-month follow-up, sleep knowledge had increased (mean score out of 5: 3.0 vs. 4.2, p < 0.001). At baseline, 85% of students aimed to increase their sleep knowledge and 83% aimed to improve their sleep. At follow-up, 91% reported being more knowledgeable and 37% reported improved sleep. A novel Stages of Change item revealed that 53% of students’ attitudes towards their sleep behaviours had changed from baseline. There was a reduction in sleep latency at follow-up (mean 33.3 vs. 25.6 min, p = 0.015), but no change in the total Pittsburgh Sleep Quality Index score. In summary, completion of an online course led to increased sleep and circadian knowledge and changed sleep attitudes, with no meaningful change in sleep behaviours. Future interventions should consider components of behavioural change that go beyond the knowledge–attitudes–behaviour continuum.

Download Full-text

Healthcare hackathons: fostering medical education through innovation in a developing country: a case study from Pakistan

BMJ Innovations ◽

10.1136/bmjinnov-2019-000400 ◽

2020 ◽

Vol 7 (1) ◽

pp. 103-108

Author(s):

Waqaas Akmal Butt ◽

Qurratulain Shahood ◽

Walid Hussain Farooqi ◽

Kulsoom Ghias ◽

Saniya Sabzwari ◽

...

Keyword(s):

Medical Education ◽

Low Income ◽

Teaching And Learning ◽

Postgraduate Medical Education ◽

Learning Potential ◽

Learning Tool ◽

Middle Income ◽

Alternative Teaching ◽

Before And After

BackgroundHackathons aim to develop solutions to preidentified problem domains and catalyse startup cultures. Recently, the teaching and learning potential of hackathons has also been documented. In this study, we make the case for utilisation of hackathons as an alternative teaching and learning tool geared towards entrepreneurship and as an opportunity for interprofessional integration.MethodsThis research study followed up with participants from the third hackathon at the Aga Khan University in Karachi, Pakistan. Hack MedEd was about solutions to problems of undergraduate and postgraduate medical education with an emphasis on low-income to middle-income countries. Participant evaluation data were filled at the end of the hackathon and gathered from three focused group discussions (FGDs): immediately before and after the event, a delayed follow-up after 11 months was recorded.ResultsOf 116 participants, the majority (71%) were under 30 years old, and over half were female. The evaluations provided by hackers were positive overall with a mean score of 4.37 out of 5 on a Likert Scale. During the FGDs, participants spoke positively of the process and felt that, by the end of the hackathon, they had learnt something new. In the delayed follow-up FGD, teams that had undergone incubation expressed that they had gained a critical and simple skillset that they might not have acquired otherwise.ConclusionHackathons business incubation programmes may be considered an alternative teaching and learning tool—especially for individuals studying or working within the healthcare discipline within low-resource settings.

Download Full-text

Health Outcomes of an Integrated Behaviour-Centred Water, Sanitation, Hygiene and Food Safety Intervention–A Randomised before and after Trial

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17082648 ◽

2020 ◽

Vol 17 (8) ◽

pp. 2648 ◽

Cited By ~ 2

Author(s):

Tracy Morse ◽

Elizabeth Tilley ◽

Kondwani Chidziwisano ◽

Rossanie Malolo ◽

Janelisa Musaya

Keyword(s):

Low Income ◽

Diarrhoeal Disease ◽

Control Group ◽

Food Hygiene ◽

Children Under Five ◽

Under Five ◽

Cluster Group ◽

Point Reduction ◽

Before And After ◽

The Impact

Diarrhoeal disease in children under five in low income settings has been associated with multiple environmental exposure pathways, including complementary foods. Conducted from February to December 2018 in rural Malawi, this before and after trial with a control used diarrhoeal disease as a primary outcome, to measure the impact of a food hygiene intervention (food hygiene + handwashing) relative to a food hygiene and water, sanitation and hygiene (WASH) intervention (food hygiene + handwashing + faeces management + water management). The 31-week intervention was delivered by community-based coordinators through community events (n = 2), cluster group meetings (n = 17) and household visits (n = 14). Diarrhoeal disease was self-reported and measured through an end line survey, and daily diaries completed by caregivers. Difference-in-differences results show a 13-percentage point reduction in self-reported diarrhoea compared to the control group. There were also significant increases in the presence of proxy measures in each of the treatment groups (e.g., the presence of soap). We conclude that food hygiene interventions (including hand washing with soap) can significantly reduce diarrhoeal disease prevalence in children under five years in a low-income setting. Therefore, the promotion of food hygiene practices using a behaviour-centred approach should be embedded in nutrition and WASH policies and programming.

Download Full-text

The Association of Knowledge, Attitudes and Access with Park Use before and after a Park-Prescription Intervention for Low-Income Families in the U.S.

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17030701 ◽

2020 ◽

Vol 17 (3) ◽

pp. 701 ◽

Cited By ~ 2

Author(s):

Nooshin Razani ◽

Nancy K. Hills ◽

Doug Thompson ◽

George W. Rutherford

Keyword(s):

Low Income ◽

Secondary Data ◽

Family Characteristics ◽

Urban Setting ◽

Park Use ◽

Before And After ◽

Unit Increase ◽

Low Income Families ◽

Perceived Access

We conducted secondary data analyses of pooled data from a clinical trial that prescribed park visits to children and their caregivers in a low-income, urban setting. Data were collected at the prescribing visit (baseline) and at one and three months of follow up from 78 families. Family characteristics were identified at baseline; regression models were used to explore changes during follow up in associations of park use with knowledge, attitudes and perceived access to parks. At baseline, park users differed from non-users in demographics, knowledge of park locations, attitudes about the value of park visits, but not affinity for nature. Park users were also more likely than non-users to feel that their neighborhood was safe for children to play in. Changes in knowledge of park locations, nature affinity, and perceived access to parks were each significantly associated with increased park use by families at one and three months after the park prescription. Adjusting for age, gender, race, poverty, and US birth, increases in knowing the location of parks were associated with an increase of 0.27 weekly park visits (95% CI 0.05, 0.49; p = 0.016); increases in feeling a caregiver had money to visit parks were associated with 0.48 more weekly park visits (95% CI 0.28, 0.69; p < 0.001); increases in perceived money for park outings were associated with 0.24 increased park visits per week (95% CI 0.05, 0.42; p = 0.01); each unit increase in nature affinity was associated with 0.34 more weekly park visits (95% CI 0.09, 0.59; p = 0.007). In other words, knowing where to go, valuing nature, and having time, and money contributed to increased likelihood of visiting a park. We discuss in terms of health behavior theory how demographics, knowledge, attitudes and perceived barriers to park use can inform park prescription interventions.

Download Full-text

Evaluation of a national lung cancer symptom awareness campaign in Wales

British Journal of Cancer ◽

10.1038/s41416-019-0676-2 ◽

2019 ◽

Vol 122 (4) ◽

pp. 491-497 ◽

Cited By ~ 2

Author(s):

Grace McCutchan ◽

Stephanie Smits ◽

Lucy Ironmonger ◽

Ciarán Slyne ◽

Amanda Boughey ◽

...

Keyword(s):

Lung Cancer ◽

Early Stage ◽

Routine Data ◽

X Rays ◽

Before And After ◽

Symptom Awareness ◽

Gp Visits ◽

Symptom Recall ◽

The Impact

Abstract Background Lung cancer is the leading cause of cancer mortality in Wales. We conducted a before- and after- study to evaluate the impact of a four-week mass-media campaign on awareness, presentation behaviour and lung cancer outcomes. Methods Population-representative samples were surveyed for cough symptom recall/recognition and worry about wasting doctors’ time pre-campaign (June 2016; n = 1001) and post-campaign (September 2016; n = 1013). GP cough symptom visits, urgent suspected cancer (USC) referrals, GP-ordered radiology, new lung cancer diagnoses and stage at diagnosis were compared using routine data during the campaign (July–August 2016) and corresponding control (July–August 2015) periods. Results Increased cough symptom recall (p < 0.001), recognition (p < 0.001) and decreased worry (p < 0.001) were observed. GP visits for cough increased by 29% in the target 50+ age-group during the campaign (p < 0.001) and GP-ordered chest X-rays increased by 23% (p < 0.001). There was no statistically significant change in USC referrals (p = 0.82), new (p = 0.70) or early stage (p = 0.27) diagnoses, or in routes to diagnosis. Conclusions Symptom awareness, presentation and GP-ordered chest X-rays increased during the campaign but did not translate into increased USC referrals or clinical outcomes changes. Short campaign duration and follow-up, and the small number of new lung cancer cases observed may have hampered detection effects.

Download Full-text

Evaluating tobacco retailer experience and compliance with a flavoured tobacco product restriction in Boston, Massachusetts: impact on product availability, advertisement and consumer demand

Tobacco Control ◽

10.1136/tobaccocontrol-2019-055124 ◽

2019 ◽

pp. tobaccocontrol-2019-055124 ◽

Cited By ~ 3

Author(s):

Lindsay Kephart ◽

Claude Setodji ◽

Joseph Pane ◽

William Shadel ◽

Glory Song ◽

...

Keyword(s):

Policy Implementation ◽

Smokeless Tobacco ◽

Consumer Demand ◽

Tobacco Product ◽

Tobacco Products ◽

Process Measures ◽

Product Availability ◽

The Impact ◽

The City

BackgroundFlavoured tobacco products are widely available in youth-accessible retailers and are associated with increased youth initiation and use. The city of Boston, Massachusetts restricted the sale of flavoured tobacco products, including cigars, smokeless tobacco and e-cigarettes, to adult-only retailers. This paper describes the impact of the restriction on product availability, advertisement and consumer demand.MethodsBetween January and December 2016, data were collected in 488 retailers in Boston at baseline and 469 retailers at 8-month follow-up, measuring the type, brand and flavour of tobacco products being sold. Process measures detailing the educational enforcement process, and retailer experience were also captured. McNemar tests and t-tests were used to assess the impact of the restriction on product availability.ResultsAfter policy implementation, only 14.4% of youth-accessible retailers sold flavoured products compared with 100% of retailers at baseline (p<0.001). Flavoured tobacco product advertisements decreased from being present at 58.9% of retailers to 28.0% at follow-up (p<0.001). Postimplementation, retailers sold fewer total flavoured products, with remaining products often considered as concept flavours (eg, jazz, blue). At follow-up, 64.0% of retailers reported that customers only asked for flavoured products a few times a week or did not ask at all. Retailers reported that educational visits and the flavoured product guidance list aided with compliance.ConclusionTobacco retailers across Boston were largely in compliance with the regulation. Availability of flavoured tobacco products in youth-accessible retailers declined city-wide after policy implementation. Strong educational and enforcement infrastructure may greatly enhance retailer compliance.

Download Full-text