School-based Nutrition Interventions & Policies: Opportunities to Improve Dietary Intake among Typically Developing Schoolchildren and Youth with Intellectual and Developmental Disabilities.
dietary intake among children, with its strong link to obesity, is a major public health
concern. Policy and environmental changes in schools may be the most effective
strategies to achieve population-level improvements in child dietary intake. Substantial
policy efforts have been initiated to improve school food environments including school
wellness policy mandates and federa... read morel nutrition standards for school meals, competitive
foods, and after school snack programs. Despite the potential for broad-reaching
improvements in dietary intake anticipated by these landmark policy changes, two groups
of children may not fully benefit from these school-based initiatives: children who
bring lunch and snack from home and youth with intellectual and developmental
disabilities (I/DD). Article 1. What's in Children's Backpacks: Foods Brought From Home.
Lunches and snacks brought from home to school by 626 elementary schoolchildren
participating in the GREEN Project Lunch Box Study were evaluated using digital
photography and a supplemental food checklist. Foods and beverages brought from home
were characterized; lunches were compared to National School Lunch Program (NSLP)
standards and snacks compared to Child and Adult Care Food Program (CACFP) requirements.
Only 28% of lunches and 4% of snacks met federal food-based standards. The typical lunch
consisted of a beverage, a sandwich, and a snackfood. The typical snack consisted of a
sugar-sweetened beverage, a snackfood, and dessert. Article 2. The Adaptation of a
School-based Health Promotion Program for Youth with Intellectual and Developmental
Disabilities: A Community-Engaged Research Process. We undertook a community-engaged
process to adapt a Smarter Lunchroom intervention for youth with I/DD aged 9-22 years
attending a specialized private residential school. Focus groups and interviews with
school staff elicited recommendations for adaptation strategies. Qualitative data were
analyzed using NVIVO; themes were reviewed by the Project Advisory Board. Adaptations to
Smarter Lunchroom design elements were developed to address needs in three categories:
food-related challenges among students, adjusting to change and transition, and social
environment factors. Choice and heterogeneity were overarching themes across the
adaptation categories. Article 3. Impact of a Smarter Lunchroom Intervention on Food
Selection and Consumption among Adolescents and Young Adults with Intellectual and
Developmental Disabilities in a Residential School Setting. We assessed whether a
Smarter Lunchroom intervention, adapted for youth with I/DD, would increase the
selection and consumption of fruits, vegetables, and whole grains; and reduce the
selection and consumption of refined grains. The evaluation employed a pre-post
quasi-experimental design in which five days of matched dietary data were compared
between baseline and follow-up to assess changes at the individual level. Selection and
plate waste of foods at lunch were assessed using digital photography. Consumption was
estimated from plate waste. Mixed linear regression models were used to evaluate mean
changes in daily servings of fruits, vegetables, whole grains, and refined grains
selected, wasted, and consumed, with the individual participant as the unit of analysis.
The intervention resulted in shifts in the sources of calories selected and consumed,
with an overall improvement in diet composition, and no decrease in overall energy
intake. We observed the following impacts in mean servings: an increase in whole grain
selection and consumption; a decrease in refined grain selection and consumption; and an
increase in fruit consumption. The percentage of daily fruit and vegetable servings
wasted of those selected decreased. Among typically developing schoolchildren, few
packed lunches and snacks from home met federal food-based standards. Further research
is needed to understand the multiple determinants of food packing behavior, including
constraints faced by families. School wellness policies should consider initiatives that
work collaboratively with parents to improve the quality of foods brought from home to
school. Among youth with I/DD, results from the adapted Smarter Lunchroom suggest
low-cost interventions that create environments in which the healthiest choice is the
easiest choice hold great promise to improve the short-term food choices and dietary
intake of this vulnerable population. Future research should consider community-engaged
approaches for adaptation within school settings so youth with I/DD can participate and
benefit from evidence-based nutrition interventions to their maximum
Thesis (Ph.D.)--Tufts University, 2013.
Submitted to the Dept. of Food Policy & Applied Nutrition.
Advisor: Aviva Must.
Committee: Linda Bandini, Sara Folta, and Brian Wansink.
Keywords: Nutrition, and Public health.read less