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The United States Department of Agriculture (USDA) National School Lunch and Breakfast Programs are critical for the health and food security of U.S. schoolchildren, but access to these programs was disrupted by COVID-19 pandemic-related school closures in spring 2020. While temporary policy changes to the programs enabled school food authorities (SFAs) to pivot towards distributing meals throughout their communities instead of within school buildings, SFAs faced complex challenges during COVID-19 with minimal external support. This mixed methods study investigates the implementation and financial challenges experienced by twelve of the largest urban SFAs in the U.S. during COVID-19. We conducted semi-structured interviews with SFA leaders and analyzed alongside quantitative financial data. We found that SFAs reconfigured their usual operations with nearly no preparation time while simultaneously trying to keep staff from contracting COVID-19, accommodate stakeholders with sometimes competing priorities, and remain financially solvent. Because student participation was much lower than during regular times, and revenue is tied to the number of meals served, SFAs saw drastic decreases in revenue even as they carried regular operating costs. For future crises, disaster preparedness plans that help SFAs better navigate the switch to financially viable community distribution methods are needed.
Erica Kenney; Caroline Dunn; Rebecca Mozaffarian; Jane Dai; Katie Wilson; Jeremy West; Ye Shen; Sheila Fleischhacker; Sara Bleich. Feeding Children and Maintaining Food Service Operations during COVID-19: A Mixed Methods Investigation of Implementation and Financial Challenges. Nutrients 2021, 13, 2691 .
AMA StyleErica Kenney, Caroline Dunn, Rebecca Mozaffarian, Jane Dai, Katie Wilson, Jeremy West, Ye Shen, Sheila Fleischhacker, Sara Bleich. Feeding Children and Maintaining Food Service Operations during COVID-19: A Mixed Methods Investigation of Implementation and Financial Challenges. Nutrients. 2021; 13 (8):2691.
Chicago/Turabian StyleErica Kenney; Caroline Dunn; Rebecca Mozaffarian; Jane Dai; Katie Wilson; Jeremy West; Ye Shen; Sheila Fleischhacker; Sara Bleich. 2021. "Feeding Children and Maintaining Food Service Operations during COVID-19: A Mixed Methods Investigation of Implementation and Financial Challenges." Nutrients 13, no. 8: 2691.
Objective: To quantify the potential population-wide costs, number of individuals reached, and impact on obesity of five effective interventions to reduce children's television viewing if implemented nationally.Study Design: Utilizing evidence from systematic reviews, the Childhood Obesity Intervention Cost Effectiveness Study (CHOICES) microsimulation model estimated the cost, population reach, and impact on childhood obesity from 2020 to 2030 of five hypothetical policy strategies to reduce the negative impact of children's TV exposure: (1) eliminating the tax deductibility of food and beverage advertising; (2) targeting TV reduction during home visiting programs; (3) motivational interviewing to reduce home television time at Women, Infants, and Children (WIC) clinic visits; (4) adoption of a television-reduction curriculum in child care; and (5) limiting noneducational television in licensed child care settings.Results: Eliminating the tax deductibility of food advertising could reach the most children [106 million, 95% uncertainty interval (UI): 105–107 million], prevent the most cases of obesity (78,700, 95% UI: 30,200–130,000), and save more in health care costs than it costs to implement. Strategies targeting young children in child care and WIC also cost little to implement (between $0.19 and $32.73 per child reached), and, although reaching fewer children because of the restricted age range, were estimated to prevent between 25,500 (95% UI: 4600–59,300) and 35,400 (95% UI: 13,200–62,100) cases of obesity. Home visiting to reduce television viewing had high costs and a low reach.Conclusions: Interventions to reduce television exposure across a range of settings, if implemented widely, could help prevent childhood obesity in the population at relatively low cost.
Erica L. Kenney; Rebecca S. Mozaffarian; Michael W. Long; Jessica L. Barrett; Angie L. Cradock; Catherine M. Giles; Zachary J. Ward; Steven L. Gortmaker. Limiting Television to Reduce Childhood Obesity: Cost-Effectiveness of Five Population Strategies. Childhood Obesity 2021, 1 .
AMA StyleErica L. Kenney, Rebecca S. Mozaffarian, Michael W. Long, Jessica L. Barrett, Angie L. Cradock, Catherine M. Giles, Zachary J. Ward, Steven L. Gortmaker. Limiting Television to Reduce Childhood Obesity: Cost-Effectiveness of Five Population Strategies. Childhood Obesity. 2021; ():1.
Chicago/Turabian StyleErica L. Kenney; Rebecca S. Mozaffarian; Michael W. Long; Jessica L. Barrett; Angie L. Cradock; Catherine M. Giles; Zachary J. Ward; Steven L. Gortmaker. 2021. "Limiting Television to Reduce Childhood Obesity: Cost-Effectiveness of Five Population Strategies." Childhood Obesity , no. : 1.
This study aimed to determine the impact of 2017 revisions to the Child and Adult Care Food Program (CACFP) nutrition standards on foods and beverages served and meal costs in family child care homes (FCCHs). Our pre–post study utilized four weeks of menus and food receipts from 13 FCCH providers in Boston, MA prior to CACFP nutrition standards changes in 2017 and again one year later, resulting in n = 476 menu observation days. We compared daily servings of food and beverage items to the updated standards. Generalized estimating equation models tested for changes in adherence to the standards and meal costs. FCCHs offered more whole grains and less juice and refined grains from baseline to follow-up. FCCHs were more likely to meet the revised whole grain standard at follow-up (OR = 2.7, 95% CI: 1.4, 5.2, p = 0.002), but rarely met all selected standards together. Inflation-adjusted meal costs increased for lunch (+$0.27, p = 0.001) and afternoon snack (+$0.25, p = 0.048). FCCH providers may need assistance with meeting CACFP standards while ensuring that meal costs do not exceed reimbursement rates.
Mary Kathryn Poole; Angie L. Cradock; Erica L. Kenney. Changes in Foods Served and Meal Costs in Boston Family Child Care Homes after One Year of Implementing the New Child and Adult Care Food Program Nutrition Standards. Nutrients 2020, 12, 2817 .
AMA StyleMary Kathryn Poole, Angie L. Cradock, Erica L. Kenney. Changes in Foods Served and Meal Costs in Boston Family Child Care Homes after One Year of Implementing the New Child and Adult Care Food Program Nutrition Standards. Nutrients. 2020; 12 (9):2817.
Chicago/Turabian StyleMary Kathryn Poole; Angie L. Cradock; Erica L. Kenney. 2020. "Changes in Foods Served and Meal Costs in Boston Family Child Care Homes after One Year of Implementing the New Child and Adult Care Food Program Nutrition Standards." Nutrients 12, no. 9: 2817.
The Healthy, Hunger-Free Kids Act of 2010 strengthened nutrition standards for meals and beverages provided through the National School Lunch, Breakfast, and Smart Snacks Programs, affecting fifty million children daily at 99,000 schools. The legislation’s impact on childhood obesity is unknown. We tested whether the legislation was associated with reductions in child obesity risk over time using an interrupted time series design for 2003–18 among 173,013 youth in the National Survey of Children’s Health. We found no significant association between the legislation and childhood obesity trends overall. For children in poverty, however, the risk of obesity declined substantially each year after the act’s implementation, such that obesity prevalence would have been 47 percent higher in 2018 if there had been no legislation. These results suggest that the Healthy, Hunger-Free Kids Act’s science-based nutritional standards should be maintained to support healthy growth, especially among children living in poverty.
Erica L. Kenney; Jessica L. Barrett; Sara N. Bleich; Zachary J. Ward; Angie L. Cradock; Steven L. Gortmaker. Impact Of The Healthy, Hunger-Free Kids Act On Obesity Trends. Health Affairs 2020, 39, 1122 -1129.
AMA StyleErica L. Kenney, Jessica L. Barrett, Sara N. Bleich, Zachary J. Ward, Angie L. Cradock, Steven L. Gortmaker. Impact Of The Healthy, Hunger-Free Kids Act On Obesity Trends. Health Affairs. 2020; 39 (7):1122-1129.
Chicago/Turabian StyleErica L. Kenney; Jessica L. Barrett; Sara N. Bleich; Zachary J. Ward; Angie L. Cradock; Steven L. Gortmaker. 2020. "Impact Of The Healthy, Hunger-Free Kids Act On Obesity Trends." Health Affairs 39, no. 7: 1122-1129.
Objective:To estimate the impact of recent changes to the Child and Adult Care Food Program (CACFP) meal pattern on young children’s diets in family child care homes (FCCHs) serving racially/ethnically diverse children.Design:In a natural experimental study of thirteen CACFP-participating FCCHs, we used digital photographs taken of children’s plates before and after meals matched with menus to measure children’s dietary intake both prior to implementation of the new meal patterns (summer/fall of 2017) and again 1 year later (summer/fall of 2018). Generalised estimating equations tested for change in intake of fruits, vegetables, whole grains, 100 % juice, grain-based desserts, meat/meat alternates and milk, adjusting for clustering of observations within providers.Setting:FCCHs in Boston, MA, USA.Participants:Three- to 5-year-old children attending FCCHs.Results:We observed 107 meals consumed by twenty-eight children at the thirteen FCCHs across an average of 2·5 (sd 1·3) d before the CACFP policy change, and 239 meals consumed by thirty-nine children across 3·8 d (sd 1·4) 1 year later. During lunch, fruit intake increased by about a third of a serving (+0·38 serving, 95 % CI 0·04, 0·73, P = 0·03), and whole grain intake increased by a half serving (+0·50 serving, 95 % CI 0·19, 0·82, P = 0·002). No changes were seen in other meal components.Conclusion:Young children’s dietary intake in CACFP-participating FCCHs improved following the CACFP meal pattern change, particularly for fruits and whole grains, which were targets of the new policy. Additional research should examine impacts of the changes in other child care settings, age groups and locales.
Erica L Kenney; Mary Kathryn Poole; Hannah Cory; Angie L Cradock. Impact of changes to the Child and Adult Care Food Program on children’s dietary intake in family child care homes. Public Health Nutrition 2020, 23, 2016 -2023.
AMA StyleErica L Kenney, Mary Kathryn Poole, Hannah Cory, Angie L Cradock. Impact of changes to the Child and Adult Care Food Program on children’s dietary intake in family child care homes. Public Health Nutrition. 2020; 23 (11):2016-2023.
Chicago/Turabian StyleErica L Kenney; Mary Kathryn Poole; Hannah Cory; Angie L Cradock. 2020. "Impact of changes to the Child and Adult Care Food Program on children’s dietary intake in family child care homes." Public Health Nutrition 23, no. 11: 2016-2023.
Ensuring students’ access to safe drinking water at school is essential. However, many schools struggle with aging infrastructure and subsequent water safety problems and have turned to bottled water delivery systems. Little is known about whether such systems are feasible and effective in providing adequate student water access. This study was a mixed-methods investigation among six schools in an urban district in the U.S. with two types of water delivery systems: (1) tap water infrastructure, with updated water fountains and bottle fillers, and (2) bottled water coolers. We measured students’ water consumption and collected qualitative data from students and teachers about their perceptions of school drinking water. Student water consumption was low—between 2.0 (SD: 1.4) ounces per student and 2.4 (SD: 1.1) ounces per student during lunch. Students and teachers reported substantial operational hurdles for relying on bottled water as a school’s primary source of drinking water, including difficulties in stocking, cleaning, and maintaining the units. While students and teachers perceived newer bottle filler units positively, they also reported a distrust of tap water. Bottled water delivery systems may not be effective long-term solutions for providing adequate school drinking water access and robust efforts are needed to restore trust in tap water.
Erica L. Kenney; James G. Daly; Rebekka M. Lee; Rebecca S. Mozaffarian; Katherine Walsh; Jill Carter; Steven L. Gortmaker. Providing Students with Adequate School Drinking Water Access in an Era of Aging Infrastructure: A Mixed Methods Investigation. International Journal of Environmental Research and Public Health 2019, 17, 62 .
AMA StyleErica L. Kenney, James G. Daly, Rebekka M. Lee, Rebecca S. Mozaffarian, Katherine Walsh, Jill Carter, Steven L. Gortmaker. Providing Students with Adequate School Drinking Water Access in an Era of Aging Infrastructure: A Mixed Methods Investigation. International Journal of Environmental Research and Public Health. 2019; 17 (1):62.
Chicago/Turabian StyleErica L. Kenney; James G. Daly; Rebekka M. Lee; Rebecca S. Mozaffarian; Katherine Walsh; Jill Carter; Steven L. Gortmaker. 2019. "Providing Students with Adequate School Drinking Water Access in an Era of Aging Infrastructure: A Mixed Methods Investigation." International Journal of Environmental Research and Public Health 17, no. 1: 62.
This study aimed to estimate the cost-effectiveness and impact on childhood obesity of installation of chilled water dispensers ("water jets") on school lunch lines and to compare water jets' cost, reach, and impact on water consumption with three additional strategies. The Childhood Obesity Intervention Cost Effectiveness Study(CHOICES) microsimulation model estimated the cost-effectiveness of water jets on US childhood obesity cases prevented in 2025. Also estimated were the cost, number of children reached, and impact on water consumption of the installation of water jets and three other strategies. Installing water jets on school lunch lines was projected to reach 29.6 million children (95% uncertainty interval [UI]: 29.4 million-29.8 million), cost $4.25 (95% UI: $2.74-$5.69) per child, prevent 179,550 cases of childhood obesity in 2025 (95% UI: 101,970-257,870), and save $0.31 in health care costs per dollar invested (95% UI: $0.15-$0.55). In the secondary analysis, installing cup dispensers next to existing water fountains was the least costly but also had the lowest population reach. Installating water jet dispensers on school lunch lines could also save almost half of the dollars needed for implementation via a reduction in obesity-related health care costs. School-based interventions to promote drinking water may be relatively inexpensive strategies for improving child health.
Erica L. Kenney; Angie L. Cradock; Michael W. Long; Jessica L. Barrett; Catherine M. Giles; Zachary Ward; Steven L. Gortmaker. Cost‐Effectiveness of Water Promotion Strategies in Schools for Preventing Childhood Obesity and Increasing Water Intake. Obesity 2019, 27, 2037 -2045.
AMA StyleErica L. Kenney, Angie L. Cradock, Michael W. Long, Jessica L. Barrett, Catherine M. Giles, Zachary Ward, Steven L. Gortmaker. Cost‐Effectiveness of Water Promotion Strategies in Schools for Preventing Childhood Obesity and Increasing Water Intake. Obesity. 2019; 27 (12):2037-2045.
Chicago/Turabian StyleErica L. Kenney; Angie L. Cradock; Michael W. Long; Jessica L. Barrett; Catherine M. Giles; Zachary Ward; Steven L. Gortmaker. 2019. "Cost‐Effectiveness of Water Promotion Strategies in Schools for Preventing Childhood Obesity and Increasing Water Intake." Obesity 27, no. 12: 2037-2045.
Afterschool interventions have been found to improve the nutritional quality of snacks served. However, there is limited evidence on how these interventions affect children’s snacking behaviors. Our aim was to determine the impact of an afterschool intervention focused at the school district, site, family, and child levels on dietary consumption of foods and beverages served at snack. This was a secondary analysis of a group-randomized controlled trial. Data were collected from 400 children at 20 afterschool sites in Boston, MA before (fall 2010) and after (spring 2011) intervention implementation. The Out-of-School Nutrition and Physical Activity intervention aimed to promote fruits, vegetables, whole grains, and water, while limiting sugary drinks and trans fats. Researchers worked with district foodservice staff to change snack foods and beverages. Teams of afterschool staff participated in three 3-hour learning collaborative sessions to build skills and created action plans for changing site practices. The intervention included family and child nutrition education. Research assistants observed dietary snack consumption using a validated measure on 2 days per site at baseline and follow-up. This study used multivariable regression models, accounting for clustering of observations, to assess the intervention effect, and conducted post-hoc stratified analyses by foodservice type. Children in intervention sites had greater decreases in consumption of juice (–0.61 oz/snack, 95% CI –1.11 to –0.12), beverage calories (–29.1 kcal/snack, 95% CI –40.2 to 18.0), foods with trans fats (–0.12 servings/snack, 95% CI –0.19 to –0.04), total calories (–47.7 kcal/snack, 95% CI –68.2 to –27.2), and increases in consumption of whole grains (0.10 servings/snack, 95% CI 0.02 to 0.18) compared to controls. In post-hoc analyses, sites with on-site foodservice had significant improvements for all outcomes (P<0.001), with no effect for sites with satellite foodservice. Results demonstrate that an afterschool intervention can improve children’s dietary snack consumption, particularly at sites with on-site foodservice.
Rebekka M. Lee; Catherine M. Giles; Angie L. Cradock; Karen M. Emmons; Cassandra Okechukwu; Erica L. Kenney; J. Thayer; Steven L. Gortmaker. Impact of the Out-of-School Nutrition and Physical Activity (OSNAP) Group Randomized Controlled Trial on Children’s Food, Beverage, and Calorie Consumption among Snacks Served. Journal of the Academy of Nutrition and Dietetics 2018, 118, 1425 -1437.
AMA StyleRebekka M. Lee, Catherine M. Giles, Angie L. Cradock, Karen M. Emmons, Cassandra Okechukwu, Erica L. Kenney, J. Thayer, Steven L. Gortmaker. Impact of the Out-of-School Nutrition and Physical Activity (OSNAP) Group Randomized Controlled Trial on Children’s Food, Beverage, and Calorie Consumption among Snacks Served. Journal of the Academy of Nutrition and Dietetics. 2018; 118 (8):1425-1437.
Chicago/Turabian StyleRebekka M. Lee; Catherine M. Giles; Angie L. Cradock; Karen M. Emmons; Cassandra Okechukwu; Erica L. Kenney; J. Thayer; Steven L. Gortmaker. 2018. "Impact of the Out-of-School Nutrition and Physical Activity (OSNAP) Group Randomized Controlled Trial on Children’s Food, Beverage, and Calorie Consumption among Snacks Served." Journal of the Academy of Nutrition and Dietetics 118, no. 8: 1425-1437.
Preventing Chronic Disease (PCD) is a peer-reviewed electronic journal established by the National Center for Chronic Disease Prevention and Health Promotion. PCD provides an open exchange of information and knowledge among researchers, practitioners, policy makers, and others who strive to improve the health of the public through chronic disease prevention.
Erica L. Kenney; Suzanne Wintner; Rebekka M. Lee; S. Bryn Austin. Obesity Prevention Interventions in US Public Schools: Are Schools Using Programs That Promote Weight Stigma? Preventing Chronic Disease 2017, 14, E142 .
AMA StyleErica L. Kenney, Suzanne Wintner, Rebekka M. Lee, S. Bryn Austin. Obesity Prevention Interventions in US Public Schools: Are Schools Using Programs That Promote Weight Stigma? Preventing Chronic Disease. 2017; 14 ():E142.
Chicago/Turabian StyleErica L. Kenney; Suzanne Wintner; Rebekka M. Lee; S. Bryn Austin. 2017. "Obesity Prevention Interventions in US Public Schools: Are Schools Using Programs That Promote Weight Stigma?" Preventing Chronic Disease 14, no. : E142.
More than 14 million children in the United States attend summer camp annually, yet little is known about the food environment in day camps. Our aim was to describe the nutritional quality of meals served to, brought by, and consumed by children attending summer day camps serving meals and snacks, and to describe camp water access. We conducted a cross-sectional study. Participants were 149 children attending five summer camps in Boston, MA, in 2013. Foods and beverages served were observed for 5 consecutive days. For 2 days, children's dietary intake was directly observed using a validated protocol. Outcome measures included total energy (kilocalories) and servings of different types of foods and beverages served and consumed during breakfast, lunch, and snack. Mean total energy, trans fats, sodium, sugar, and fiber served per meal were calculated across the camps, as were mean weekly frequencies of serving fruits, vegetables, meat/meat alternates, grains, milk, 100% juice, sugar-sweetened beverages, whole grains, red/highly processed meats, grain-based desserts, and salty snacks. Mean consumption was calculated per camper per day. Camps served a mean (standard deviation) of 647.7 (134.3) kcal for lunch, 401.8 (149.6) kcal for breakfast, and 266.4 (150.8) kcal for snack. Most camps served red/highly processed meats, salty snacks, and grain-based desserts frequently, and rarely served vegetables or water. Children consumed little (eg, at lunch, 36.5% of fruit portions, 35.0% of meat/meat alternative portions, and 37.6% of milk portions served) except for salty snacks (66.9% of portions) and grain-based desserts (64.1% of portions). Sugar-sweetened beverages and salty snacks were frequently brought to camp. One-quarter of campers drank nothing throughout the entire camp day. The nutritional quality of foods and beverages served at summer day camps could be improved. Future studies should assess barriers to consumption of healthy foods and beverages in these settings.
Erica L. Kenney; Rebekka M. Lee; Carolyn J. Brooks; Angie L. Cradock; Steven L. Gortmaker. What Do Children Eat in the Summer? A Direct Observation of Summer Day Camps That Serve Meals. Journal of the Academy of Nutrition and Dietetics 2017, 117, 1097 -1103.
AMA StyleErica L. Kenney, Rebekka M. Lee, Carolyn J. Brooks, Angie L. Cradock, Steven L. Gortmaker. What Do Children Eat in the Summer? A Direct Observation of Summer Day Camps That Serve Meals. Journal of the Academy of Nutrition and Dietetics. 2017; 117 (7):1097-1103.
Chicago/Turabian StyleErica L. Kenney; Rebekka M. Lee; Carolyn J. Brooks; Angie L. Cradock; Steven L. Gortmaker. 2017. "What Do Children Eat in the Summer? A Direct Observation of Summer Day Camps That Serve Meals." Journal of the Academy of Nutrition and Dietetics 117, no. 7: 1097-1103.
Providing children and youth with safe, adequate drinking water access during school is essential for health. This study used objectively measured data to investigate the extent to which schools provide drinking water access that meets state and federal policies. We visited 59 middle and high schools in Massachusetts during spring 2012. Trained research assistants documented the type, location, and working condition of all water access points throughout each school building using a standard protocol. School food service directors (FSDs) completed surveys reporting water access in cafeterias. We evaluated school compliance with state plumbing codes and federal regulations and compared FSD self-reports of water access with direct observation; data were analyzed in 2014. On average, each school had 1.5 (standard deviation: .6) water sources per 75 students; 82% (standard deviation: 20) were functioning and fewer (70%) were both clean and functioning. Less than half of the schools met the federal Healthy Hunger-Free Kids Act requirement for free water access during lunch; 18 schools (31%) provided bottled water for purchase but no free water. Slightly over half (59%) met the Massachusetts state plumbing code. FSDs overestimated free drinking water access compared to direct observation (96% FSD reported vs. 48% observed, kappa = .07, p = .17). School drinking water access may be limited. In this study, many schools did not meet state or federal policies for minimum student drinking water access. School administrative staff may not accurately report water access. Public health action is needed to increase school drinking water access.
Erica L. Kenney; Steven L. Gortmaker; Juliana F.W. Cohen; Eric B. Rimm; Angie L. Cradock. Limited School Drinking Water Access for Youth. Journal of Adolescent Health 2016, 59, 24 -29.
AMA StyleErica L. Kenney, Steven L. Gortmaker, Juliana F.W. Cohen, Eric B. Rimm, Angie L. Cradock. Limited School Drinking Water Access for Youth. Journal of Adolescent Health. 2016; 59 (1):24-29.
Chicago/Turabian StyleErica L. Kenney; Steven L. Gortmaker; Juliana F.W. Cohen; Eric B. Rimm; Angie L. Cradock. 2016. "Limited School Drinking Water Access for Youth." Journal of Adolescent Health 59, no. 1: 24-29.
Weight bias can negatively impact health, and schools may be risky environments for students with obesity. We aimed to explore teachers' perceptions of the school experiences and academic challenges of students with obesity.
Erica L. Kenney; Morgan T. Redman; Shaniece Criss; Kendrin R. Sonneville; S. Bryn Austin. Are K-12 school environments harming students with obesity? A qualitative study of classroom teachers. Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity 2016, 22, 141 -152.
AMA StyleErica L. Kenney, Morgan T. Redman, Shaniece Criss, Kendrin R. Sonneville, S. Bryn Austin. Are K-12 school environments harming students with obesity? A qualitative study of classroom teachers. Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity. 2016; 22 (1):141-152.
Chicago/Turabian StyleErica L. Kenney; Morgan T. Redman; Shaniece Criss; Kendrin R. Sonneville; S. Bryn Austin. 2016. "Are K-12 school environments harming students with obesity? A qualitative study of classroom teachers." Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity 22, no. 1: 141-152.
We appreciate the letter from Hew-Butler and the EAH (Exercise-Associated Hyponatremia) Panel regarding our recent study on inadequate hydration among children in the United States. We agree with the author that our data do not support the conclusion that, “a majority of the world’s children are dehydrated.” We made no such claim. Instead, using the 800 milliosmoles per kilogram urine osmololality (Uosm) threshold for inadequate hydration from previous research, 1 which Hew-Butler and the EAH Panel note is associated with thirst stimulation, we found that more than half (54.5%) of the children in the United States may be inadequately hydrated—or thirsty—at any given time. We specifically used the term “inadequate hydration” rather than “dehydration” because the threshold of 800 Uosm does not serve as a clinical indicator of urgent dehydration. ( Am J Public Health . Published online ahead of print August 13, 2015: e1. doi:10.2105/AJPH.2015.302846)
Erica L. Kenney; Michael W. Long; Angie L. Cradock; Steven L. Gortmaker. Kenney et al. Respond. American Journal of Public Health 2015, 105, e6 -7.
AMA StyleErica L. Kenney, Michael W. Long, Angie L. Cradock, Steven L. Gortmaker. Kenney et al. Respond. American Journal of Public Health. 2015; 105 (10):e6-7.
Chicago/Turabian StyleErica L. Kenney; Michael W. Long; Angie L. Cradock; Steven L. Gortmaker. 2015. "Kenney et al. Respond." American Journal of Public Health 105, no. 10: e6-7.
Objectives. We evaluated a low-cost strategy for schools to improve the convenience and appeal of drinking water.
Erica L. Kenney; Steven L. Gortmaker; Jill E. Carter; M. Caitlin W. Howe; Jennifer F. Reiner; Angie L. Cradock. Grab a Cup, Fill It Up! An Intervention to Promote the Convenience of Drinking Water and Increase Student Water Consumption During School Lunch. American Journal of Public Health 2015, 105, 1777 -1783.
AMA StyleErica L. Kenney, Steven L. Gortmaker, Jill E. Carter, M. Caitlin W. Howe, Jennifer F. Reiner, Angie L. Cradock. Grab a Cup, Fill It Up! An Intervention to Promote the Convenience of Drinking Water and Increase Student Water Consumption During School Lunch. American Journal of Public Health. 2015; 105 (9):1777-1783.
Chicago/Turabian StyleErica L. Kenney; Steven L. Gortmaker; Jill E. Carter; M. Caitlin W. Howe; Jennifer F. Reiner; Angie L. Cradock. 2015. "Grab a Cup, Fill It Up! An Intervention to Promote the Convenience of Drinking Water and Increase Student Water Consumption During School Lunch." American Journal of Public Health 105, no. 9: 1777-1783.
Objectives. We evaluated the hydration status of US children and adolescents. Methods. The sample included 4134 participants aged 6 to 19 years in the National Health and Nutrition Examination Survey from 2009 to 2012. We calculated mean urine osmolality and the proportion with inadequate hydration (urine osmolality > 800 mOsm/kg). We calculated multivariable regression models to estimate the associations between demographic factors, beverage intake, and hydration status. Results. The prevalence of inadequate hydration was 54.5%. Significantly higher urine osmolality was observed among boys (+92.0 mOsm/kg; 95% confidence interval [CI] = 69.5, 114.6), non-Hispanic Blacks (+67.6 mOsm/kg; 95% CI = 31.5, 103.6), and younger children (+28.5 mOsm/kg; 95% CI = 8.1, 48.9) compared with girls, Whites, and older children, respectively. Boys (OR = 1.76; 95% CI = 1.49, 2.07) and non-Hispanic Blacks (odds ratio [OR] = 1.34; 95% CI = 1.04, 1.74) were also at significantly higher risk for inadequate hydration. An 8-fluid-ounce daily increase in water intake was associated with a significantly lower risk of inadequate hydration (OR = 0.96; 95% CI = 0.93, 0.98). Conclusions. Future research should explore drivers of gender and racial/ethnic disparities and solutions for improving hydration status.
Erica L. Kenney; Michael Long; Angie L. Cradock; Steven L. Gortmaker. Prevalence of Inadequate Hydration Among US Children and Disparities by Gender and Race/Ethnicity: National Health and Nutrition Examination Survey, 2009–2012. American Journal of Public Health 2015, 105, e113 -e118.
AMA StyleErica L. Kenney, Michael Long, Angie L. Cradock, Steven L. Gortmaker. Prevalence of Inadequate Hydration Among US Children and Disparities by Gender and Race/Ethnicity: National Health and Nutrition Examination Survey, 2009–2012. American Journal of Public Health. 2015; 105 (8):e113-e118.
Chicago/Turabian StyleErica L. Kenney; Michael Long; Angie L. Cradock; Steven L. Gortmaker. 2015. "Prevalence of Inadequate Hydration Among US Children and Disparities by Gender and Race/Ethnicity: National Health and Nutrition Examination Survey, 2009–2012." American Journal of Public Health 105, no. 8: e113-e118.
Afterschool programs can be health-promoting environments for children. Written policies positively influence nutrition and physical activity (PA) environments, but effective strategies for building staff capacity to write such policies have not been evaluated. This study measures the comprehensiveness of written nutrition, PA, and screen time policies in afterschool programs and assesses impact of the Out of School Nutrition and Physical Activity (OSNAP) intervention on key policies. Twenty afterschool programs in Boston, MA participated in a group-randomized, controlled trial from September 2010 to June 2011. Intervention program staff attended learning collaboratives focused on practice and policy change. The Out-of-School Time (OST) Policy Assessment Index evaluated written policies. Inter-rater reliability and construct validity of the measure and impact of the intervention on written policies were assessed. The measure demonstrated moderate to excellent inter-rater reliability (Spearman's r = 0.53 to 0.97) and construct validity. OSNAP was associated with significant increases in standards-based policy statements surrounding snacks (+ 2.6, p = 0.003), beverages (+ 2.3, p = 0.008), screen time (+ 0.8, p = 0.046), family communication (+ 2.2, p = 0.002), and a summary index of OSNAP goals (+ 3.3, p = 0.02). OSNAP demonstrated success in building staff capacity to write health-promoting policy statements. Future research should focus on determining policy change impact on practices.
Erica L. Kenney; Catherine M. Giles; Madeleine Deblois; Steven L. Gortmaker; Sherene Chinfatt; Angie L. Cradock. Improving nutrition and physical activity policies in afterschool programs: Results from a group-randomized controlled trial. Preventive Medicine 2014, 66, 159 -166.
AMA StyleErica L. Kenney, Catherine M. Giles, Madeleine Deblois, Steven L. Gortmaker, Sherene Chinfatt, Angie L. Cradock. Improving nutrition and physical activity policies in afterschool programs: Results from a group-randomized controlled trial. Preventive Medicine. 2014; 66 ():159-166.
Chicago/Turabian StyleErica L. Kenney; Catherine M. Giles; Madeleine Deblois; Steven L. Gortmaker; Sherene Chinfatt; Angie L. Cradock. 2014. "Improving nutrition and physical activity policies in afterschool programs: Results from a group-randomized controlled trial." Preventive Medicine 66, no. : 159-166.