Dataset Information

A systematic review of school meal nudge interventions to improve youth food behaviors.

ABSTRACT:

Background

School meal programs have a large reach and thus are ideal environments in which to implement interventions targeting improved youth eating behaviors and reduced food waste. This systematic review summarizes the evidence on the effectiveness of school meal nudge interventions on influencing children's eating and waste behaviors.

Methods

Inclusion criteria required studies have participants in primary or secondary school (grades K-12) with interventions that occurred during school lunch or breakfast in the cafeteria and included at least one of the following outcomes: selection, consumption, waste, or school meal participation. Analyses of intervention outcomes were restricted to studies of strong and moderate quality.

Results

Twenty-nine studies were included in the quality assessment. Included interventions fell into three categories: 1) placement/convenience, 2) marketing/promotion, or 3) variety/portions. The 20 strong and moderate quality studies included in outcome analyses generally used strong data collection methods and study designs, but were limited by an overall lack of intervention fidelity checks. Multi-component interventions often did not use methods that allowed for separate analyses of outcomes for different intervention components.

Conclusions

School meal nudge interventions were positively associated with food selection, and had an inconsistent relationship with food consumption. There were few studies evaluating the impact of nudge interventions on meal participation or food waste. The limited evidence available links nudges to improved meal participation, as well as undesirable increases in food waste. Future research in this area should use methods that incorporate implementation metrics, attend to systems factors, and allow the outcomes of individual intervention components to be isolated.

SUBMITTER: Metcalfe JJ

PROVIDER: S-EPMC7304192 | biostudies-literature | 2020 Jun

REPOSITORIES: biostudies-literature

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Publications

A systematic review of school meal nudge interventions to improve youth food behaviors.

Metcalfe Jessica Jarick JJ Ellison Brenna B Hamdi Nader N Richardson Rachel R Prescott Melissa Pflugh MP

The international journal of behavioral nutrition and physical activity 20200619 1

<h4>Background</h4>School meal programs have a large reach and thus are ideal environments in which to implement interventions targeting improved youth eating behaviors and reduced food waste. This systematic review summarizes the evidence on the effectiveness of school meal nudge interventions on influencing children's eating and waste behaviors.<h4>Methods</h4>Inclusion criteria required studies have participants in primary or secondary school (grades K-12) with interventions that occurred dur ...[more]

PMID: 32560731

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Project description:BackgroundFood and nutrition literacy is a newly emerged concept to connect food-related knowledge and skills to healthy diets. Its promotion is important to protect children as they eat too many low-nutrient, high-energy foods. Food and nutrition literacy promotion needs multi-dimensional interventions. In the process of developing an intervention to promote food and nutrition literacy, the present review protocol aims to critically examine the evidence in the area of school-based interventions for promoting food and nutrition literacy (FNLIT) in elementary school children.MethodsWe will search PubMed/MEDLINE, EMBASE, Web of Science, CENTRAL, and ProQuest (from inception onwards). Additional studies will be identified through manual searching of reference lists. Quantitative studies (e.g., randomized controlled trial, quasi-randomized trials, and cluster randomized trials) evaluating the effect of interventions to promote food and nutrition literacy in elementary school children (5-12?years old) will be included. Main outcomes will be food and nutrition literacy at functional, interactive, and critical levels. Secondary outcomes will be dietary intake indicators (e.g., healthy eating index, DDS) and health outcome measures (e.g., reduction in BMI and less weight gain). Two reviewers will independently screen all citations, full-text articles, and abstract data. Potential conflicts will be resolved through discussion. The study methodological quality (or bias) will be appraised using appropriate tools. If feasible, we will conduct random effects meta-analysis. The quality of the included studies will separately evaluate using the validated Quality Assessment Tool for Quantitative Studies, developed by the Effective Public Health Practice Project (EPHPP). Data will be extracted by two reviewers from the identified relevant literature. Standard data synthesis and analysis will be used for the review.DiscussionThis systematic review will summarize the evidence regarding the components, implementation methods, and effectiveness of the interventions of food and nutrition literacy promotion in elementary school children. The results of this review will provide a useful reference for policymakers and curriculum developers to assess education curricula and develop practical learning and teaching strategies to improve students' food and nutrition literacy.Systematic review registrationPROSPERO (CRD42019135118).

Project description:BackgroundDiet is an important determinant of health, and food purchasing is a key antecedent to consumption.ObjectiveWe set out to evaluate the effectiveness of grocery store interventions to change food purchasing, and to examine whether effectiveness varied based on intervention components, setting, or socioeconomic status.DesignWe conducted a systematic review of randomized controlled trials (search performed June 2017). Studies must have: aimed to change food purchasing; been implemented in grocery stores (real or simulated); reported purchasing; and had a minimal control or compared interventions fulfilling our criteria. Searching, screening, bias assessment, and data extraction followed Cochrane methods. We grouped studies by intervention type (economic, environmental, swaps, and/or education), synthesized results narratively, and conducted an exploratory qualitative comparative analysis.ResultsWe included 35 studies representing 89 interventions, >20,000 participants, and >800 stores. Risk of bias was mixed. Economic interventions showed the most promise, with 8 of the 9 studies in real stores and all 6 in simulated environments detecting an effect on purchasing. Swap interventions appeared promising in the 2 studies based in real stores. Store environment interventions showed mixed effects. Education-only interventions appeared effective in simulated environments but not in real stores. Available data suggested that effects of economic interventions did not differ by socioeconomic status, whereas for other interventions impact was variable. In our qualitative comparative analysis, economic interventions (regardless of setting) and environmental and swap interventions in real stores were associated with statistically significant changes in purchasing in the desired direction for ?1 of the foods targeted by the intervention, whereas education-only interventions in real stores were not.ConclusionsFindings suggest that interventions implemented in grocery stores-particularly ones that manipulate price, suggest swaps, and perhaps manipulate item availability-have an impact on purchasing and could play a role in public health strategies to improve health. Review protocol registered at https://www.crd.york.ac.uk/PROSPERO/ as CRD42017068809.

Project description:BackgroundSchool food environment policies may be a critical tool to promote healthy diets in children, yet their effectiveness remains unclear.ObjectiveTo systematically review and quantify the impact of school food environment policies on dietary habits, adiposity, and metabolic risk in children.MethodsWe systematically searched online databases for randomized or quasi-experimental interventions assessing effects of school food environment policies on children's dietary habits, adiposity, or metabolic risk factors. Data were extracted independently and in duplicate, and pooled using inverse-variance random-effects meta-analysis. Habitual (within+outside school) dietary intakes were the primary outcome. Heterogeneity was explored using meta-regression and subgroup analysis. Funnel plots, Begg's and Egger's test evaluated potential publication bias.ResultsFrom 6,636 abstracts, 91 interventions (55 in US/Canada, 36 in Europe/New Zealand) were included, on direct provision of healthful foods/beverages (N = 39 studies), competitive food/beverage standards (N = 29), and school meal standards (N = 39) (some interventions assessed multiple policies). Direct provision policies, which largely targeted fruits and vegetables, increased consumption of fruits by 0.27 servings/d (n = 15 estimates (95%CI: 0.17, 0.36)) and combined fruits and vegetables by 0.28 servings/d (n = 16 (0.17, 0.40)); with a slight impact on vegetables (n = 11; 0.04 (0.01, 0.08)), and no effects on total calories (n = 6; -56 kcal/d (-174, 62)). In interventions targeting water, habitual intake was unchanged (n = 3; 0.33 glasses/d (-0.27, 0.93)). Competitive food/beverage standards reduced sugar-sweetened beverage intake by 0.18 servings/d (n = 3 (-0.31, -0.05)); and unhealthy snacks by 0.17 servings/d (n = 2 (-0.22, -0.13)), without effects on total calories (n = 5; -79 kcal/d (-179, 21)). School meal standards (mainly lunch) increased fruit intake (n = 2; 0.76 servings/d (0.37, 1.16)) and reduced total fat (-1.49%energy; n = 6 (-2.42, -0.57)), saturated fat (n = 4; -0.93%energy (-1.15, -0.70)) and sodium (n = 4; -170 mg/d (-242, -98)); but not total calories (n = 8; -38 kcal/d (-137, 62)). In 17 studies evaluating adiposity, significant decreases were generally not identified; few studies assessed metabolic factors (blood lipids/glucose/pressure), with mixed findings. Significant sources of heterogeneity or publication bias were not identified.ConclusionsSpecific school food environment policies can improve targeted dietary behaviors; effects on adiposity and metabolic risk require further investigation. These findings inform ongoing policy discussions and debates on best practices to improve childhood dietary habits and health.

Project description:ObjectivesWe reviewed the literature on interventions that aimed to improve hospital-to-school reintegration for children and youth with acquired brain injury (ABI). ABI is the leading cause of disability among children and youth. A successful hospital-to-school reintegration process is essential to the rehabilitative process. However, little is known about the effective components of of such interventions.Methods and findingsOur research team conducted a systematic review, completing comprehensive searches of seven databases and selected reference lists for relevant articles published in a peer-reviewed journal between 1989 and June 2014. We selected articles for inclusion that report on studies involving: a clinical population with ABI; sample had an average age of 20 years or younger; an intentional structured intervention affecting hospital-to-school transitions or related components; an experimental design; and a statistically evaluated health outcome. Two independent reviewers applied our inclusion criteria, extracted data, and rated study quality. A meta-analysis was not feasible due to the heterogeneity of the studies reported. Of the 6933 articles identified in our initial search, 17 articles (reporting on 350 preadolescents and adolescents, aged 4-19, (average age 11.5 years, SD: 2.21) met our inclusion criteria. They reported on interventions varying in number of sessions (one to 119) and session length (20 minutes to 4 hours). The majority of interventions involved multiple one-to-one sessions conducted by a trained clinician or educator, homework activities, and parental involvement. The interventions were delivered through different settings and media, including hospitals, schools, and online. Although outcomes varied (with effect sizes ranging from small to large), 14 of the articles reported at least one significant improvement in cognitive, social, psychological, or behavioral functioning or knowledge of ABI.ConclusionsCognitive, behavioral, and problem-solving interventions have the potential to improve school reintegration for youth with ABI. However, more comprehensive interventions are needed to help link rehabilitation clinicians, educators, adolescents, and families.

Project description:BACKGROUND:School health systems are increasingly investing in telemedicine platforms to address acute and chronic illnesses. Asthma, the most common chronic illness in childhood, is of particular interest given its high burden on school absenteeism. OBJECTIVE:Conduct a systematic review evaluating impact of school-based telemedicine programs on improving asthma-related outcomes. DATA SOURCES:PubMed, Cochrane CENTRAL, CINAHL, ERIC, PsycINFO, Embase, and Google Scholar. STUDY ELIGIBILITY CRITERIA:Original research, including quasi-experimental studies, without restriction on the type of telemedicine. PARTICIPANTS:School-aged pediatric patients with asthma and their families. INTERVENTIONS:School-based telemedicine. STUDY APPRAISAL AND SYNTHESIS METHODS:Two authors independently screened each abstract, conducted full-text review, assessed study quality, and extracted information. A third author resolved disagreements. RESULTS:Of 371 articles identified, 7 were included for the review. Outcomes of interest were asthma symptom-free days, asthma symptom frequency, quality of life, health care utilization, school absences, and spirometry. Four of 7 studies reported significant increases in symptom-free days and/or decrease in symptom frequency. Five of 6 reported increases in at least one quality-of-life metric, 2 of 7 reported a decrease in at least 1 health care utilization metric, 1 of 3 showed reductions in school absences, and 1 of 2 reported improvements in spirometry measures. LIMITATIONS:Variability in intervention designs and outcome measures make comparisons and quantitative analyses across studies difficult. Only 2 of 7 studies were randomized controlled trials. CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS:High-quality evidence supporting the use of school-based telemedicine programs to improve patient outcomes is limited. While available evidence suggests benefit, only 2 comparative trials were identified, and the contribution of telemedicine to these studies' results is unclear.

Dataset Information

A systematic review of school meal nudge interventions to improve youth food behaviors.

Background

Methods

Results

Conclusions

Publications

A systematic review of school meal nudge interventions to improve youth food behaviors.

Similar Datasets

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