Media Competition Implementation for the Massachusetts Childhood Obesity Research Demonstration Study (MA-CORD): Adoption and Reach.

The Massachusetts Childhood Obesity Research Demonstration Study (MA-CORD) was a multi-level, multi-sector community intervention with a media competition component to provide an overarching synergy and promote awareness of target behaviors to reduce childhood obesity. Students participating in the media competition were tasked with developing videos, song/rap lyrics, and artwork that reflected the goals. The aim of this study is to document the process used to develop and implement the media competition along with its reach and adoption. An adapted version of Neta and colleagues' 2015 framework on dissemination and implementation was used to summarize the process by which the media competition was developed and implemented. Adoption was defined by whether eligible schools or afterschool programs decided to implement the media competition. Reach was defined by student participation rates within schools/programs and the number of votes cast for the finalists on the coalition website and students' paper ballots. A total of 595 students participated in the media competition from 18 school and afterschool programs in two communities. Adoption of the media competitions ranged from 22% to 100% in programs and reach ranged from 3% to 33% of the student population. The documentation of the implementation should contribute to the replication of the media competition.

Strategies to improve the dietary quality of Supplemental Nutrition Assistance Program (SNAP) beneficiaries: an assessment of stakeholder opinions.

OBJECTIVE: To examine the opinions of stakeholders on strategies to improve dietary quality of Supplemental Nutrition Assistance Program (SNAP) participants. DESIGN: Participants answered a thirty-eight-item web-based survey assessing opinions and perceptions of SNAP and programme policy changes. SETTING USA SUBJECTS: Survey of 522 individuals with stakeholder interest in SNAP, conducted in October through December 2011. RESULTS: The top three barriers to improving dietary quality identified were: (i) unhealthy foods marketed in low-income communities; (ii) the high cost of healthy foods; and (iii) lifestyle challenges faced by low-income individuals. Many respondents (70 %) also disagreed that current SNAP benefit levels were adequate to maintain a healthy diet. Stakeholders believed that vouchers, coupons or monetary incentives for purchasing healthful foods might have the greatest potential for improving the diets of SNAP participants. Many respondents (78 %) agreed that sodas should not be eligible for purchases with SNAP benefits. More than half (55 %) believed retailers could easily implement such restrictions. A majority of respondents (58 %) agreed that stores should stock a minimum quantity of healthful foods in order to be certified as a SNAP retailer, and most respondents (83 %) believed that the US Department of Agriculture should collect data on the foods purchased with SNAP benefits. CONCLUSIONS: Results suggest that there is broad stakeholder support for policies that align SNAP purchase eligibility with national public health goals of reducing food insecurity, improving nutrition and preventing obesity.

Public support for policies to improve the nutritional impact of the Supplemental Nutrition Assistance Program (SNAP).

OBJECTIVE: To determine public attitudes towards federal spending on nutrition assistance programmes and support for policies to improve the nutritional impact of the Supplemental Nutrition Assistance Program (SNAP). DESIGN: Participants answered survey questions by telephone assessing support for SNAP spending and proposed programme policy changes. SETTING USA SUBJECTS: Survey of 3024 adults selected by random digit dialling conducted in April 2012, including 418 SNAP participants. RESULTS: A majority (77%; 95% CI 75, 79%) of all respondents supported maintaining or increasing SNAP benefits, with higher support among Democrats (88%; 95% CI 86, 90%) than Republicans (61%; 95% CI 58, 65%). The public supported policies to improve the nutritional impact of SNAP. Eighty-two per cent (95% CI 80, 84%) of respondents supported providing additional benefits to programme participants that can only be used on healthful foods. Sixty-nine per cent (95% CI 67, 71%) of respondents supported removing SNAP benefits for sugary drinks. A majority of SNAP participants (54%; 95% CI 48, 60%) supported removing SNAP benefits for sugary drinks. Of the 46% (95% CI 40, 52%) of SNAP participants who initially opposed removing sugary drinks, 45 % (95% CI 36, 54%) supported removing SNAP benefits for sugary drinks if the policy also included additional benefits to purchase healthful foods. CONCLUSIONS: The US public broadly supports increasing or maintaining spending on SNAP. The majority of respondents, including SNAP participants, supported policies to improve the nutritional impact of SNAP by restricting the purchase of sugary drinks and incentivizing purchase of healthful foods with SNAP benefits.

Associations of food stamp participation with dietary quality and obesity in children.

OBJECTIVE: To determine if obesity and dietary quality in low-income children differed by participation in the Supplemental Nutrition Assistance Program (SNAP), formerly the Food Stamp Program. METHODS: The study population included 5193 children aged 4 to 19 with household incomes ≤130% of the federal poverty level from the 1999-2008 NHANES. Diet was measured by using 24-hour recalls. RESULTS: Among low-income US children, 28% resided in households currently receiving SNAP benefits. After adjusting for sociodemographic differences, SNAP participation was not associated with a higher rate of childhood obesity (odds ratio = 1.11, 95% confidence interval [CI]: 0.71-1.74). Both SNAP participants and low-income nonparticipants were below national recommendations for whole grains, fruits, vegetables, fish, and potassium, while exceeding recommended limits for processed meat, sugar-sweetened beverages, saturated fat, and sodium. Zero percent of low-income children met at least 7 of 10 dietary recommendations. After multivariate adjustment, compared with nonparticipants, SNAP participants consumed 43% more sugar-sweetened beverages (95% CI: 8%-89%), 47% more high-fat dairy (95% CI: 7%, 101%), and 44% more processed meats (95% CI: 9%-91%), but 19% fewer nuts, seeds, and legumes (95% CI: -35% to 0%). In part due to these differences, intakes of calcium, iron, and folate were significantly higher among SNAP participants. Significant differences by SNAP participation were not evident in total energy, macronutrients, Healthy Eating Index 2005 scores, or Alternate Healthy Eating Index scores. CONCLUSIONS: The diets of low-income children are far from meeting national dietary recommendations. Policy changes should be considered to restructure SNAP to improve children's health.

Disparities in overweight and obesity among US college students.

OBJECTIVES: To examine social disparities and behavioral correlates of overweight and obesity over time among college students. METHODS: Multilevel analyses of BMI, physical activity, and television viewing from 2 representative surveys of US college students (n=24,613). RESULTS: Overweight and obesity increased over time and were higher among males, African Americans, and students of lower socioeconomic position and lower among Asians. Television viewing and in activity were associated with obesity, and disparities in these behaviors partially accounted for excess weight among African Americans. CONCLUSIONS: Social disparities in overweight and obesity exist among college students. Promoting physical activity and reducing television viewing may counteract increasing trends.

Facilitating change in school health: a qualitative study of schools' experiences using the School Health Index.

INTRODUCTION: As school-based efforts increase to address the epidemic of childhood obesity, a priority for health professionals and educators will be to identify effective tools appropriate for use in schools to help guide health promotion programs and policies. This article describes the results of a qualitative research study examining school staff and community members' experiences working with the Centers for Disease Control and Prevention's School Health Index, a self-assessment and planning tool that addresses nutrition and physical activity. METHODS: In-depth interviews were carried out with faculty, staff, and community collaborators in nine public schools that were using the School Health Index to develop nutrition and physical activity initiatives for students. Interviews were conducted twice: once after a school had completed the School Health Index and once approximately 1 year later. Transcript data from interviews with 34 participants were analyzed using thematic analysis. RESULTS: Findings indicated that school experiences differed markedly depending on whether they received help from an outside facilitator to work with the School Health Index. Unlike staff in schools working on their own, school staff working with outside facilitators described completing the School Health Index in a collaborative way, creating action plans, and working as a team to implement health promotion initiatives. In addition, the involvement of an outside facilitator supported schools in undertaking more complex tasks with a greater degree of collaboration across the school and local communities in order to achieve goals. CONCLUSION: Outside facilitators may significantly enhance schools' efforts to work with the School Health Index and influence the organizational strategies they use to implement health promotion initiatives.