Publications by authors named "Anisha I Patel"

41 Publications

The Importance of Body Mass Index Assessment and Surveillance in Schools.

JAMA Pediatr 2021 Feb 22. Epub 2021 Feb 22.

Nutrition Policy Institute, University of California Division of Agriculture and Natural Resources.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1001/jamapediatrics.2021.0016DOI Listing
February 2021

Temperature Measurement at Well-Child Visits in the United States.

J Pediatr 2021 Jan 25. Epub 2021 Jan 25.

Department of Pediatrics, Stanford University School of Medicine, Stanford, CA.

Objective: To determine the frequency and predictors of temperature measurement at well-child visits in the US and report rates of interventions associated with visits at which temperature is measured and fever is detected.

Study Design: In this cross-sectional study, we analyzed 22 518 sampled well-child visits from the National Ambulatory Medical Care Survey between 2003 and 2015. We estimated the frequency of temperature measurement and performed multivariable regression to identify patient, provider/clinic, and seasonal factors associated with the practice. We described rates of interventions (complete blood count, radiograph, urinalysis, antibiotic prescription, and emergency department/hospital referral) by measurement and fever (temperature ≥100.4 °F, ≥38.0 °C) status.

Results: Temperature was measured in 48.5% (95% CI 45.6-51.4) of well-child visits. Measurement was more common during visits by nonpediatric providers (aOR 2.0, 95% CI 1.6-2.5; reference: pediatricians), in Hispanic (aOR 1.9, 95% CI 1.6-2.3) and Black (aOR 1.5, 95% CI 1.2-1.9; reference: non-Hispanic White) patients, and in patients with government (aOR 2.0, 95% CI 1.7-2.4; reference: private) insurance. Interventions were more commonly pursued when temperature was measured (aOR 1.3, 95% CI 1.1-1.6) and fever was detected (aOR 3.8, 95% CI 1.5-9.4).

Conclusions: Temperature was measured in nearly one-half of all well-child visits. Interventions were more common when temperature was measured and fever was detected. The value of routine temperature measurement during well-child visits warrants further evaluation.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jpeds.2021.01.045DOI Listing
January 2021

Water Safety in California Public Schools Following Implementation of School Drinking Water Policies.

Prev Chronic Dis 2020 12 31;17:E166. Epub 2020 Dec 31.

Stanford University. Medical School Office Building, 1265 Welch Rd, Ext 240, Stanford, CA 94305. Email:

Introduction: Recent legislation requires public and charter schools in California to test drinking water for lead. Our objective was to describe 1) results from this testing program in the context of other available water safety data and 2) factors related to schools and water utilities associated with access to safe drinking water in schools.

Methods: Our study focused on a random sample of 240 California public and charter schools. We used multivariable logistic regression, accounting for clustering of tested water sources in schools, to examine school-level factors associated with failure to meet lead-testing deadlines and any history of water utility noncompliance.

Results: Of the 240 schools, the majority (n = 174) tested drinking water for lead. Of the schools tested, 3% (n = 6) had at least 1 sample that exceeded 15 parts per billion (ppb) (California action level) and 16% (n = 28) exceeded 5 ppb (bottled water standard). Suburban schools had lower odds of being served by noncompliant water systems (OR = 0.17; CI, 0.05-0.64; P = .009) than city schools. Compared with city schools, rural schools had the highest odds of not participating in the water testing program for lead (OR = 3.43; CI, 1.46-8.05; P = .005). Hallways and common spaces and food services areas were the most frequent school locations tested; one-third of all locations sampled could not be identified.

Conclusion: In our study, geography influenced access to safe drinking water in schools, including both water utility safety standards and school lead-testing practices. Considerations for improving the implementation of state lead-testing programs include establishing priority locations for sampling, precisely labeling samples, and developing well-defined testing and reporting protocols.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5888/pcd17.200366DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7784553PMC
December 2020

A cluster-randomized controlled trial of an elementary school drinking water access and promotion intervention: Rationale, study design, and protocol.

Contemp Clin Trials 2020 Dec 25;101:106255. Epub 2020 Dec 25.

Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, USA; Department of Pediatrics, School of Medicine, Stanford University, USA. Electronic address:

Introduction: Promoting water consumption among children in schools is a promising intervention to reduce sugar-sweetened beverage (SSB) intake and achieve healthful weight. To date, no studies in the United States have examined how a school-based water access and promotion intervention affects students' beverage and food intake both in and out of school and weight gain over time. The Water First trial is intended to evaluate these interventions.

Methods: Informed by the PRECEDE-PROCEED model and Social Cognitive Theory, the Water First intervention includes: 1) installation of lead-free water stations in cafeterias, physical activity spaces, and high-traffic common areas in lower-income public elementary schools, 2) provision of cups/reusable water bottles for students, and 3) a 6-month healthy beverage education campaign. A five year-long cluster randomized controlled trial of 26 low-income public elementary schools in the San Francisco Bay Area is examining how Water First impacts students' consumption of water, caloric intake from foods and beverages, and BMI z-score and overweight/obesity prevalence, from baseline to 7 months and 15 months after the start of the study. Intervention impact on outcomes will be examined using a difference-in-differences approach with mixed-effects regression accounting for the clustering of students in schools and classrooms.

Discussion: This paper describes the rationale, study design, and protocol for the Water First study. If the intervention is effective, findings will inform best practices for implementing school water policies, as well as the development of more expansive policies and programs to promote and improve access to drinking water in schools.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.cct.2020.106255DOI Listing
December 2020

Trends in sugar-sweetened beverage consumption among California children - CORRIGENDUM.

Public Health Nutr 2021 Feb 17;24(2):376. Epub 2020 Nov 17.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1017/S1368980020004486DOI Listing
February 2021

Healthy beverage initiatives in higher education: an untapped strategy for health promotion.

Public Health Nutr 2021 Jan 22;24(1):136-138. Epub 2020 Oct 22.

Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA, USA.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1017/S1368980020003766DOI Listing
January 2021

Drinking Water in the United States: Implications of Water Safety, Access, and Consumption.

Annu Rev Nutr 2020 09;40:345-373

Nutrition Policy Institute, Division of Agriculture and Natural Resources, University of California, Berkeley, California 94704, USA; email:

Recent water quality crises in the United States, and recognition of the health importance of drinking water in lieu of sugar-sweetened beverages, have raised interest in water safety, access, and consumption. This review uses a socioecological lens to examine these topics across the life course. We review water intakes in the United States relative to requirements, including variation by age and race/ethnicity. We describe US regulations that seek to ensure that drinking water is safe to consume for most Americans and discuss strategies to reduce drinking water exposure to lead, a high-profile regulated drinking water contaminant. We discuss programs, policies, and environmental interventions that foster effective drinking water access, a concept that encompasses key elements needed to improve water intake. We conclude with recommendations for research, policies, regulations, and practices needed to ensure optimal water intake by all in the United States and elsewhere.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1146/annurev-nutr-122319-035707DOI Listing
September 2020

Trends in sugar-sweetened beverage consumption among California children.

Public Health Nutr 2020 11 29;23(16):2864-2869. Epub 2020 Jun 29.

Department of Medicine, University of California San Francisco, San Francisco, CA, USA.

Objective: To assess trends in consumption of soda, sweetened fruit drinks/sports drinks and any sugar-sweetened beverage (SSB) from 2013 to 2016 among all children in California aged 2-5 and 6-11 years and by racial-ethnic group.

Design: Serial cross-sectional study using the California Health Interview Survey (CHIS).

Setting: CHIS is a telephone survey of households in California designed to assess population-level estimates of key health behaviours. Previous research using CHIS documented a decrease in SSB consumption among children in California from 2003 to 2009 coinciding with state-level policy efforts targeting child SSB consumption.

Participants: Parents of children in California aged 2-11 years (n 4901 in 2013-2014; n 3606 in 2015-2016) were surveyed about the child's consumption of soda and sweetened fruit drinks/sports drinks on the day prior.

Results: Among 2-5-year-olds, consumption of soda, sweetened fruit drinks/sports drinks and any SSB remained stable. Sweetened fruit drink/sports drink consumption was higher than soda consumption in this age group. Latino 2-5- year-olds were more likely to consume any SSB in both 2013-2014 and 2015-2016 compared with Whites. Among 6-11-year-olds, consumption of soda, sweetened fruit drinks/sports drinks and any SSB also remained stable over time. Latino and African-American 6-11-year-olds were more likely to consume an SSB in 2013-2014 compared with White children.

Conclusions: SSB consumption among children in California was unchanged from 2013 to 2016 and racial-ethnic disparities were evident. Increased policy efforts are needed to further reduce SSB consumption, particularly among children of Latino and African-American backgrounds.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1017/S1368980020001147DOI Listing
November 2020

Drinking water access in California schools: Room for improvement following implementation of school water policies.

Prev Med Rep 2020 Sep 8;19:101143. Epub 2020 Jun 8.

School of Medicine, Stanford University, Stanford, CA, USA.

This study aims to investigate how access to free drinking water in California public schools changed after implementation of 2010 federal and state school water policies. Repeated cross-sectional surveys were conducted with administrators in a random sample of California public schools, stratified by school type and urban-centric geography, from 2010 to 2011 (n = 240) and from 2016 to 2018 (n = 240). Surveys assessed excellence in drinking water access, defined as 1) providing water in 4 of 5 key school locations, 2) having a high density of free water available, 3) providing water via a non-fountain source, 4) providing water that is perceived as safe, and 5) offering water sources that are reported as clean and functioning. Multivariate logistic regression was used to examine changes in excellence in drinking water access after implementation of school drinking water policies. Analysis was completed in 2019. In 2010-2011, 5% of schools met all water excellence criteria; in 2016-2018, 18% of schools met all excellence criteria. In adjusted models, post-legislation schools had 4 times the odds of meeting all drinking water excellence criteria compared to pre-legislation schools (OR: 4.34; 95% confidence interval = 2.07, 9.10). There were significant increases in public schools meeting the criteria for excellence in free drinking water access after school water policies were implemented; however, a majority of schools still lacked excellent water access. Findings suggest that policies mandating free water access in schools may help to improve excellence in access, and more work is needed to help all schools excel in this area.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.pmedr.2020.101143DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7305375PMC
September 2020

Stories of success: a qualitative examination of contributors to excellence in school drinking water access.

Public Health Nutr 2020 07 26;23(10):1800-1809. Epub 2020 Feb 26.

Pediatrics, Stanford University School of Medicine, Stanford, CA, USA.

Objective: Drinking water instead of beverages with added sugar can help prevent obesity and cavities and promote overall health. Children spend much of their day in school, where they have variable access to drinking water. In 2010, federal and state law required California public schools to provide free potable water to students in areas where meals are served and/or eaten. The current study aims to identify factors associated with an excellent drinking water culture in schools.

Design: A qualitative assessment of barriers and facilitators to providing excellent water quality and access in a purposive sample of California schools. In-depth interviews with key informants were conducted using a snowball sampling approach, after which data were analysed using both inductive and deductive methods.

Setting: California public elementary, middle/junior and high schools.

Participants: Knowledgeable individuals involved in initiatives related to school drinking water accessibility, quality or education at each selected school.

Results: Thirty-four interviewees participated across fifteen schools. Six themes emerged as prominent facilitators to a school's success in providing excellent water access to students: active and engaged champions, school culture and policy, coordination between groups, community influences, available resources and environmentalism.

Conclusions: While policy is an important step for achieving minimum standards, resources and interest in promoting excellence in drinking water access and quality can vary among schools. Ensuring that schools have dedicated staff committed to advancing student health and promoting the benefits of water programs that are more salient to schools could help reduce disparities in drinking water excellence across schools.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1017/S1368980019003975DOI Listing
July 2020

Hydrate Philly: An Intervention to Increase Water Access and Appeal in Recreation Centers.

Prev Chronic Dis 2020 02 20;17:E15. Epub 2020 Feb 20.

School of Medicine, Stanford University, Stanford, California.

Introduction: Previous interventions to increase water access and consumption have focused on school settings, have shown mixed results on sugar-sweetened beverage (SSB) consumption, and have rarely addressed tap water safety. Our randomized controlled trial examined how improving access and appeal of water in recreation centers in low-income neighborhoods affected counts of SSBs carried by youth attending summer camp.

Methods: Recreation centers (N = 28) matched on their characteristics were randomly assigned to control or intervention groups. Intervention centers received a new water fountain with a bottle filler (hydration station), water testing services, reusable water bottles, and water promotion and education training and materials. Primary outcomes were 1-year changes in center-level average daily gallons of water from fountains and hydration stations (flowmeter readings). Secondary outcomes were counts of SSBs observed, use of bottled water and reusable water bottles, staff SSB consumption, and hydration station maintenance.

Results: Results showed increased water use (b = 8.6, 95% CI, 4.2-13.0) and reusable bottle counts (b = 10.2, 95% CI, 4.2-16.1) in intervention centers compared with control centers. No change occurred in youth carrying SSBs at camp, but center staff's past 30-day SSB consumption frequency decreased (b = -34.8, 95% CI, -67.7 to -1.9). Intervention sites had marginally lower odds of maintenance problems (OR = 0.09; 95% CI, 0.004-0.76, P = .06) than control sites.

Conclusion: Although providing hydration stations along with water testing, reusable water bottles, education, and promotion increased water consumption among youth at recreation centers, it had no effect on the number of SSBs observed during camp. Future strategies to increase water consumption should also address reducing SSB intake.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5888/pcd17.190277DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7085906PMC
February 2020

Development and Validation of a Photo-Evidence Tool to Examine Characteristics of Effective Drinking Water Access in Schools.

J Sch Health 2020 04 28;90(4):271-277. Epub 2020 Jan 28.

Nutrition Policy Institute, University of California Division of Agriculture and Natural Resources, Berkeley, CA, 94704.

Background: Federal law requires water access in schools where meals are served. Schools report high rates of water accessibility in cafeterias, but observations indicate lower adherence. Although observation is costly, it permits a more detailed assessment of a water source to determine whether it provides effective access that encourages water consumption and thus, healthy hydration for students.

Methods: To offer a less costly alternative to observations, researchers developed and validated a photo-evidence tool to examine characteristics of effective school drinking water access. Two observers recorded characteristics of 200 water sources in 30 schools, including type, wear, cleanliness, and water flow, and examined obstructions and beverage promotion near sources, as well as, drinking vessel availability. Observers photographed sources which were coded by a separate research team. Agreement between observation audits and photograph coding was assessed through percent agreement, and kappa statistics and correlation coefficients.

Results: Kappas indicated substantial (K > 0.60) or near perfect agreement (K > 0.80) for all characteristics of effective drinking water access with exception of wear. There was moderate agreement (r = 0.66) for water source cleanliness.

Conclusions: Development and validation of a photo-evidence tool to examine characteristics of effective drinking water access in schools.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/josh.12873DOI Listing
April 2020

Agua4All: Providing Safe Drinking Water in Rural California Communities.

Prev Chronic Dis 2019 11 14;16:E151. Epub 2019 Nov 14.

RCAP Inc., Washington, District of Columbia.

Introduction: Drinking water instead of sugar-sweetened beverages may reduce obesity and dental caries. Tap water is more affordable and sustainable than bottled water and more likely to contain fluoride, which prevents caries. To address inequities in access to safe tap water, cross-sector partners established the Agua4All safe drinking-water program in 2 rural San Joaquin Valley, California, communities. The program's objective was to examine Agua4All's feasibility, acceptability, and effect on water intake.

Methods: We provided bottle-filling stations dispensing safe water at 12 sites in 2 communities and provided limited promotional support. To compare the effect of different levels of promotion, sites in 1 community also received a promotions toolkit, a stipend, and assistance in developing and conducting their own promotional activities (site-led promotion). Beverage intake at sites was observed at baseline (pre-installation), at time 1 (post-installation), and at times 2 and 3 (post-promotion). Flowmeters tracked water dispensings. Staff interviews examined implementation barriers and facilitators.

Results: From baseline to time 3, a nonsignificant increase (21.16%) occurred in the proportion of people drinking water at sites with water stations and site-led promotion compared with sites with water stations and limited promotion (5.13%) (P = .14). Mean daily gallons of water taken from stations per site was 3.61 (standard deviation, 3.84). Most staff members (77%) at the sites preferred water stations to traditional drinking fountains.

Conclusion: Bottle-filling stations with safe water and site-led promotion are a promising strategy for increasing water intake in communities without safe tap water. Larger studies should examine the effects of such stations on intake of sugar-sweetened beverages and on overall health.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5888/pcd16.190165DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6880921PMC
November 2019

Teachers as Healthy Beverage Role Models: Relationship of Student and Teacher Beverage Choices in Elementary Schools.

J Community Health 2020 02 12;45(1):121-127. Epub 2019 Aug 12.

Division of General Pediatrics, Stanford University, Stanford, USA.

Schools are a key setting for curbing student intake of sugar-sweetened beverages (SSBs). While studies suggest that restrictions on SSBs, increased access to healthier beverages, and education about the importance of drinking water instead of SSBs can promote healthier beverage patterns among students, there is little known about the impact that teachers' own beverage choices can have on those of their students. Data were drawn from cross-sectional surveys administered as part of a larger evaluation of a drinking water access and promotion intervention in public elementary schools in the San Francisco Bay Area region of California. Descriptive statistics were used to examine teacher (n = 56) and student (n = 1176) self-reported beverage consumption at school. Mixed-effects logistic regression was used to examine associations between teacher and student beverage intake adjusting for clustering of students by teacher. Teachers were also surveyed via open-ended questions about strategies to increase student water consumption at school. Nearly all teachers reported drinking water during the school day (95%), often in front of students. Teacher SSB intake was rare (9%). Students whose teachers drank water in front of their classes were significantly more likely to report drinking water during the school day. Teachers tend to select healthy beverages at work and may serve as role models to encourage student consumption of water instead of SSBs.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s10900-019-00717-7DOI Listing
February 2020

Effects of a multipronged beverage intervention on young children's beverage intake and weight: a cluster-randomized pilot study.

Public Health Nutr 2019 10 15;22(15):2856-2867. Epub 2019 Jul 15.

Department of Pediatrics, Stanford University, 1265 Welch Road MSOB X240, Mailcode 5459, Stanford, CA 94305, USA.

Objective: To evaluate whether a multipronged pilot intervention promoting healthier beverage consumption improved at-home beverage consumption and weight status among young children.

Design: In this exploratory pilot study, we randomly assigned four childcare centres to a control (delayed-intervention) condition or a 12-week intervention that promoted consumption of healthier beverages (water, unsweetened low- or non-fat milk) and discouraged consumption of less-healthy beverages (juice, sugar-sweetened beverages, high-fat or sweetened milk). The multipronged intervention was delivered via childcare centres; simultaneously targeted children, parents and childcare staff; and included environmental changes, policies and education. Outcomes were measured at baseline and immediately post-intervention and included children's (n 154) at-home beverage consumption (assessed via parental report) and overweight/obese status (assessed via objectively measured height and weight). We estimated intervention impact using difference-in-differences models controlling for children's demographics and classroom.

Setting: Two northern California cities, USA, 2013-2014.

Participants: Children aged 2-5 years and their parents.

Results: Relative to control group children, intervention group children reduced their consumption of less-healthy beverages from baseline to follow-up by 5·9 ounces/d (95 % CI -11·2, -0·6) (-174·5 ml/d; 95 % CI -331·2, -17·7) and increased their consumption of healthier beverages by 3·5 ounces/d (95 % CI -2·6, 9·5) (103·5 ml/d; 95 % CI -76·9, 280·9). Children's likelihood of being overweight decreased by 3 percentage points (pp) in the intervention group and increased by 3 pp in the control group (difference-in-differences: -6 pp; 95 % CI -15, 3).

Conclusions: Our exploratory pilot study suggests that interventions focused comprehensively on encouraging healthier beverage consumption could improve children's beverage intake and weight. Findings should be confirmed in longer, larger studies.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1017/S1368980019001629DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6750979PMC
October 2019

A systematic review of strategies to increase drinking-water access and consumption among 0- to 5-year-olds.

Obes Rev 2019 09 28;20(9):1262-1286. Epub 2019 Jun 28.

Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA, USA.

The objective of this study is to identify promising strategies for improving drinking-water access and consumption among children aged 0 to 5 years. MEDLINE/PubMed, Embase, ERIC, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science, and Cochrane Central Register of Controlled Trials (CENTRAL) databases were searched in this review. Studies included peer-reviewed, full-text studies from high-income countries, published in English between January 1, 2000, and January 12, 2018, that evaluated interventions to increase water access or consumption in children aged 0 to 5 years. Twenty-five studies met inclusion criteria; 19 used an effective intervention strategy to increase water access or water consumption. Three studies addressed both water access and consumption. Frequently used strategies included policy and practice changes, increasing water access and convenience, and education, training, or social support for caregivers. Studies were of fair methodological quality (average score: 18.8 of 26) for randomized studies and of moderate quality (5.1 of 9) for non-randomized studies. To date, few high-quality studies with objectively measured outcomes have clearly demonstrated strategies that may influence water intake and consumption among young children aged 0 to 5 years.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/obr.12833DOI Listing
September 2019

The association of flavored milk consumption with milk and energy intake, and obesity: A systematic review.

Prev Med 2018 06 6;111:151-162. Epub 2018 Mar 6.

Department of Epidemiology, University of California, San Francisco, San Francisco, CA, United States.

Taxes on sugary drinks are being implemented to prevent chronic diseases. Sugar-sweetened milk has been exempt from such policies because of its nutritional value. This systematic review sought to examine whether flavored milk consumption was associated with milk and energy intake, and obesity among children. A search of PubMed, EMBASE, Cochrane, CINAHL, Web of Science, Cochrane Central Register of Controlled Trials and the grey literature was conducted for peer-reviewed publications published before June 6, 2016 that met the following criteria: 1) English-language publications 2) studies of children ages 1 to 18 years, 3) controlled experimental, cohort, case-control, systematic reviews, or meta-analysis studies 4) dependent variable: flavored milk consumption 5) independent variable: weight, weight gain, weight change, body mass index, metabolic syndrome, waist circumference, cholesterol, triglycerides, blood pressure, serum glucose, calories, sugar, or milk consumed. Of 3978 studies identified, 13 met inclusion criteria. Ten studies were experimental and three were longitudinal cohort studies. Eleven studies found that flavored milk increased overall milk intake, five of seven studies that examined energy intake showed that flavored milk increased energy intake, and one of three studies that assessed obesity outcomes demonstrated an increase in weight gain with flavored milk consumption. Only one study was a randomized controlled trial, most studies had high bias, and over half were industry-funded or did not disclose funding. Although flavoring milk may increase milk intake, added sugars may promote increased energy intake. More data regarding flavored milk's impact on health is needed to inform its role in sugary drink policies.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ypmed.2018.02.031DOI Listing
June 2018

Validation of a survey to examine drinking-water access, practices and policies in schools.

Public Health Nutr 2017 Dec 12;20(17):3068-3074. Epub 2017 Sep 12.

1Department of Pediatrics,University of California,San Francisco,San Francisco,CA,USA.

Objective: Ensuring ready access to free drinking-water in schools is an important strategy for prevention of obesity and dental caries, and for improving student learning. Yet to date, there are no validated instruments to examine water access in schools. The present study aimed to develop and validate a survey of school administrators to examine school access to beverages, including water and sports drinks, and school and district-level water-related policies and practices.

Design: Survey validity was measured by comparing results of telephone surveys of school administrators with on-site observations of beverage access and reviews of school policy documents for any references to beverages. The semi-structured telephone survey included items about free drinking-water access (sixty-four items), commonly available competitive beverages (twenty-nine items) and water-related policies and practices (twenty-eight items). Agreement between administrator surveys and observation/document review was calculated using kappa statistics for categorical variables, and Pearson correlation coefficients and t tests for continuous variables.

Setting: Public schools in the San Francisco Bay Area, California, USA.

Subjects: School administrators (n 24).

Results: Eighty-one per cent of questions related to school beverage access yielded κ values indicating substantial or almost perfect agreement (κ>0·60). However, only one of twenty-eight questions related to drinking-water practices and policies yielded a κ value representing substantial or almost perfect agreement.

Conclusions: This school administrator survey appears reasonably valid for questions related to beverage access, but less valid for questions on water-related practices and policies. This tool provides policy makers, researchers and advocates with a low-cost, efficient method to gather national data on school-level beverage access.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1017/S1368980017002312DOI Listing
December 2017

Water Access in the United States: Health Disparities Abound and Solutions Are Urgently Needed.

Am J Public Health 2017 09;107(9):1354-1356

Anisha I. Patel is with the Department of Pediatrics and the Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco (UCSF). Laura A. Schmidt is with the Department of Anthropology, History, and Social Medicine and the Philip R. Lee Institute for Health Policy Studies at UCSF.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2105/AJPH.2017.303972DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5551618PMC
September 2017

Validation of a Brief Questionnaire Against Direct Observation to Assess Adolescents' School Lunchtime Beverage Consumption.

J Nutr Educ Behav 2017 Nov - Dec;49(10):847-851.e1. Epub 2017 Jul 22.

Department of Pediatrics, University of California, San Francisco, San Francisco, CA; Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA.

Objective: Beverage consumption is an important determinant of youth health outcomes. Beverage interventions often occur in schools, yet no brief validated questionnaires exist to assess whether these efforts improve in-school beverage consumption. This study validated a brief questionnaire to assess beverage consumption during school lunch.

Methods: Researchers observed middle school students' (n = 25) beverage consumption during school lunchtime using a standardized tool. After lunch, students completed questionnaires regarding their lunchtime beverage consumption. Kappa statistics compared self-reported with observed beverage consumption across 15 beverage categories.

Results: Eight beverages showed at least fair agreement (kappa [κ] > 0.20) for both type and amount consumed, with most showing substantial agreement (κ > 0.60). One beverage had high raw agreement but κ < 0.20. Six beverages had too few ratings to compute κ's.

Conclusions And Implications: This brief questionnaire was useful for assessing school lunchtime consumption of many beverages and provides a low-cost tool for evaluating school-based beverage interventions.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jneb.2017.06.006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5682217PMC
May 2018

Public Perception of Quality and Support for Required Access to Drinking Water in Schools and Parks.

Am J Health Promot 2018 01 3;32(1):72-74. Epub 2016 Oct 3.

2 Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA.

Purpose: We assessed public support for required water access in schools and parks and perceived safety and taste of water in these settings to inform efforts to increase access to and consumption of tap water.

Design: Cross-sectional survey of the US public collected from August to November 2011.

Setting: Random digit-dialed telephone survey.

Participants: Participants (n = 1218) aged 17 and older from 1055 US counties in 46 states.

Measures: Perceived safety and taste of water in schools and parks as well as support for required access to water in these settings.

Analysis: Survey-adjusted perceived safety and taste as well as support for required access were estimated.

Results: There was broad support for required access to water throughout the day in schools (96%) and parks (89%). Few participants believed water was unsafe in schools (10%) or parks (18%).

Conclusion: This study provides evidence of public support for efforts to increase access to drinking water in schools and parks and documents overall high levels of perceived taste and safety of water provided in these settings.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/0890117116671253DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5378665PMC
January 2018

A Trial of the Efficacy and Cost of Water Delivery Systems in San Francisco Bay Area Middle Schools, 2013.

Prev Chronic Dis 2016 07 7;13:E88. Epub 2016 Jul 7.

Division of General Pediatrics, Philip R. Lee Institute for Health Policy Studies, and Adolescent and Young Adult Health National Resource Center, University of California, San Francisco, California.

Introduction: US legislation requires that schools offer free drinking water where meals are served. However, little information is available about what types of water delivery systems schools should install to meet such requirements. The study objective was to examine the efficacy and cost of 2 water delivery systems (water dispensers and bottleless water coolers) in increasing students' lunchtime intake of water in low-income middle schools.

Methods: In 2013, twelve middle schools in the San Francisco Bay Area participated in a cluster randomized controlled trial in which they received 6 weeks of promotional activities, received provision of cups, and were assigned to 1 of 2 cafeteria water delivery systems: water dispensers or bottleless water coolers (or schools served as a control). Student surveys (n = 595) and observations examined the interventions' effect on students' beverage intake and staff surveys and public data assessed intervention cost.

Results: Analysis occurred from 2013 through 2015. Mixed-effects logistic regression, accounting for clustering and adjustment for student sociodemographic characteristics, demonstrated a significant increase in the odds of students drinking water in schools with promotion plus water dispensers and cups (adjusted odds ratio = 3.1; 95% confidence interval, 1.4-6.7; P = .004) compared with schools with traditional drinking fountains and no cups or promotion. The cost of dispenser and bottleless water cooler programs was similar ($0.04 per student per day).

Conclusion: Instead of relying on traditional drinking fountains, schools should consider installing water sources, such as plastic dispensers with cups, as a low-cost, effective means for increasing students' water intake.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5888/pcd13.160108DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4951080PMC
July 2016

Maximizing School Policies to Reduce Youth Consumption of Sugar-Sweetened Beverages.

J Adolesc Health 2016 07;59(1):1-2

Department of Pediatrics, Division of Adolescent and Young Adult Health, National Resource Center, Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, California; Department of Obstetrics, Gynecology and Reproductive Health Sciences, Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, California.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jadohealth.2016.04.015DOI Listing
July 2016

San Francisco childcare centers' preparedness in the prevention and management of asthma among preschool-aged children.

J Asthma 2016 09 10;53(7):691-8. Epub 2016 May 10.

c Department of Pediatrics , University of California , San Francisco, San Francisco , California , USA.

Introduction: Asthma is a common health condition for children in childcare. National recommendations for asthma in childcare exist. However, no studies have investigated the extent to which childcare centers adhere to these recommendations. We aimed to assess childcare center adherence to National Asthma Education and Prevention Program (NAEPP) recommendations for asthma care and preparedness and to identify characteristics associated with increased adherence to national asthma recommendations.

Methods: We developed a standardized instrument. Each childcare center received a score of 0 through 7 based on number of recommendations met. We conducted t-tests, chi square tests and linear regression to identify childcare center factors associated with increased asthma preparedness.

Results: 36 out of 40 eligible childcare centers (90%) participated. These sites served 1570 children primarily between the ages of 2 to 5 years. On average, centers met 3.8 out of 7 (SD  =  1.3) recommendations. Staff familiarity caring for children with asthma (p < 0.001) and the center's asthma prevalence (p  =  0.01) was positively associated with the center's asthma preparedness. The 3 areas most in need of improvement related to asthma medications, asthma action plans and asthma policies. None of the managers reported being familiar with the NAEPP recommendations.

Discussion: There is room for improvement in the asthma care and preparedness of childcare centers. The 3 areas in which centers performed poorly (appropriate asthma medication management, use of asthma action plans, and presence of appropriate asthma policies) suggest that closer collaboration between clinicians and childcare centers may be a key to improving asthma management for young children.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3109/02770903.2015.1135944DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5814296PMC
September 2016

Association Between Student Purchases of Beverages During the School Commute and In-School Consumption of Sugar-Sweetened Beverages, San Francisco Bay Area, 2013.

Prev Chronic Dis 2015 Dec 17;12:E220. Epub 2015 Dec 17.

Department of Pediatrics and the Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, California.

Introduction: Consumption of sugar-sweetened beverages (SSBs) such as sodas, fruit-flavored drinks, and sports drinks is a major contributor to childhood obesity. One strategy to reduce children's SSB consumption has been to restrict the sale of SSBs in schools. However, such policies may not sufficiently curb students' SSB intake, because students can obtain SSBs elsewhere, including from stores located on their school commute. Little is known about students' purchases of beverages during the school commute or about whether this purchasing behavior is related to in-school SSB consumption. The objective of this study was to describe where students from low-income, ethnically diverse communities obtain the SSBs they drink during school lunchtime and to examine whether students who purchase beverages while traveling to and from school are more likely to drink SSBs during school lunchtime.

Methods: We analyzed survey data from a random sample of low-income, ethnically diverse middle school students (N = 597) who participated in a randomized controlled trial of a water promotion intervention. We used logistic regression analysis to examine the association between students' purchase of beverages during the school commute and their SSB consumption during school lunchtime.

Results: One-fifth (20.4%) of students drank an SSB during lunch. Approximately 23% of SSBs were obtained during the school commute. Students who reported buying beverages during their school commute (50.1% of all students) were more likely to report drinking SSBs during lunch than students who reported that they do not buy beverages during the school commute (adjusted odds ratio 3.32, 95% confidence interval, 2.19-5.05, P < .001).

Conclusion: Students' purchase of beverages during the school commute was strongly associated with SSB consumption during school lunchtime. Interventions could benefit from focusing on retail environments (e.g., encouraging retailers to promote healthy beverages, posting beverage calorie information).
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5888/pcd12.150306DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5241631PMC
December 2015

Lunchtime School Water Availability and Water Consumption Among California Adolescents.

J Adolesc Health 2016 Jan 7;58(1):98-103. Epub 2015 Nov 7.

Division of General Pediatrics, Department of Medicine, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts.

Purpose: To examine the potential impact of California SB 1413, which required school districts to provide free, fresh drinking water during mealtimes in food service areas by July 1, 2011, on greater water consumption among California adolescents.

Methods: Data were drawn from the 2012 and 2013 state-representative California Health Interview Survey. A total of 2,665 adolescents aged 12-17 years were interviewed regarding their water consumption and availability of free water during lunchtime at their school.

Results: Three-fourths reported that their school provided free water at lunchtime, mainly via fountains. In a multivariate model that controlled for age, gender, income, race/ethnicity, body mass index, and school type, adolescents in schools that provided free water consumed significantly more water than adolescents who reported that water was not available, bivariate (standard error) = .67 (.28), p = .02. School water access did not significantly vary across the 2 years.

Conclusions: Lunchtime school water availability was related to water consumption, but a quarter of adolescents reported that their school did not provide free water at lunch. Future research should explore what supports and inducements might facilitate provision of drinking water during school mealtimes.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jadohealth.2015.09.007DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4695239PMC
January 2016

Development of a Tool to Evaluate Asthma Preparedness and Management in Child-Care Centers.

Pediatr Allergy Immunol Pulmonol 2015 Jun;28(2):121-128

Department of Pediatrics, University of California , San Francisco, San Francisco, California. ; Philip R. Lee Institute of Health Policy Studies, University of California , San Francisco, San Francisco, California. ; Department of Epidemiology and Biostatistics, University of California , San Francisco, San Francisco, California.

Asthma is a common condition affecting many children in child-care centers. The National Asthma Education and Prevention Program offers recommendations about creating an asthma-friendly child-care setting. However, no studies have investigated the extent to which child-care centers adhere to these recommendations. This study describes the development of a novel instrument to determine the ability of child-care centers to meet national recommendations for asthma. The Preparing for Asthma in Child Care (PACC) Instrument was developed using information from existing recommendations and standards, the peer-reviewed literature, site visits, and expert interviews. The survey questions were pilot-tested at 36 child-care centers throughout San Francisco. The instrument is composed of 43 items across seven domains: smoking exposure, presence of a medical consultant and policies, management of ventilation and triggers, access to medication, presence of asthma action plans, staff training, and encouragement of physical activity. The PACC Instrument is an evidence-based and comprehensive tool designed to identify areas to target to improve asthma care for children in child-care centers.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1089/ped.2014.0471DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4491155PMC
June 2015

Reach Out and Eat: Food and Beverages Depicted in Books for Preschoolers.

Clin Pediatr (Phila) 2015 Nov 24;54(13):1257-64. Epub 2015 Feb 24.

Department of Pediatrics, University of California, San Francisco, San Francisco, CA, USA

Objective: To examine food and beverage depictions in books for preschoolers.

Methods: Books for preschoolers from Reach Out and Read (ROR; n = 42), public library (n = 27), and Publisher's Weekly booklists (n = 31) were examined for nutritive and empty-calorie food and beverage depictions.

Results: It was found that 66% of books depicted at least 1 food or beverage. More books depicted nutritive items than empty-calorie items (87.5% vs 54.7%, P < .001). There was a trend toward fewer empty-calorie depictions in ROR books than in other booklists. Yet nearly half of ROR books depicted at least 1 empty-calorie item. ROR books also accounted for 5 of 10 books with the most empty-calorie item depictions and 3 of 4 books with branding. With regard to messaging, approximately a third of books with the most empty-calorie depictions promoted unhealthy foods.

Conclusions: When selecting books for ROR, it may be important to consider food and beverage depictions and messages.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/0009922815574078DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4547902PMC
November 2015

Middle school student attitudes about school drinking fountains and water intake.

Acad Pediatr 2014 Sep-Oct;14(5):471-7

Division of General Pediatrics, Boston Children's Hospital Boston, Mass; Harvard School of Public Health, Boston, Mass.

Objective: To describe middle school student attitudes about school drinking fountains, investigate whether such attitudes are associated with intentions to drink water at school, and determine how intentions relate to overall water intake.

Methods: Students (n = 3211) in 9 California middle schools completed surveys between 2009 and 2011. We used multivariate linear regression, adjusting for school sociodemographic characteristics, to examine how attitudes about fountains (5-point scale; higher scores indicating more positive attitudes) were associated with intentions to drink water at school and how intentions to drink water at school were related to overall water intake.

Results: Mean age of students was 12.3 (SD = 0.7) years; 75% were Latino, 89% low income, and 39% foreign born. Fifty-two percent reported lower than recommended overall water intake (<3 glasses/day), and 30% reported that they were unlikely or extremely unlikely to drink water at school. Fifty-nine percent reported that school fountains were unclean, 48% that fountain water does not taste good, 33% that fountains could make them sick, 31% that it was not okay to drink from fountains, and 24% that fountain water is contaminated. In adjusted analyses, attitudes about school drinking fountains were related to intentions to drink water at school (β = 0.41; P < .001); intentions to drink water at school were also associated with overall water intake (β = 0.20; P < .001).

Conclusions: Students have negative attitudes about school fountains. To increase overall water intake, it may be important to promote and improve drinking water sources not only at school but also at home and in other community environments.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.acap.2014.05.010DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4193898PMC
October 2015

Tapping into water: key considerations for achieving excellence in school drinking water access.

Am J Public Health 2014 Jul 15;104(7):1314-9. Epub 2014 May 15.

At the time of the study, Anisha I. Patel, Jacob M. Grumbach, and Claire D. Brindis were with the Division of Pediatrics and Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco. Kenneth Hecht and Ellen Braff-Guajardo were with California Food Policy Advocates, Oakland. Karla E. Hampton was with Changelab Solutions, Oakland.

Objectives: We examined free drinking water access in schools.

Methods: We conducted cross-sectional interviews with administrators from 240 California public schools from May to November 2011 to examine the proportion of schools that met excellent water access criteria (i.e., location, density, type, maintenance, and appeal of water sources), school-level characteristics associated with excellent water access, and barriers to improvements.

Results: No schools met all criteria for excellent water access. High schools and middle schools had lower fountain:student ratios than elementary schools (odds ratio [OR] = 0.06; 95% confidence interval [CI] = 0.02, 0.20; OR = 0.30, 95% CI = 0.12, 0.70). Rural schools were more likely to offer a nonfountain water source than city schools (OR = 5.0; 95% CI = 1.74, 14.70). Newer schools were more likely to maintain water sources than older schools (OR = 0.98; 95% CI = 0.97, 1.00). Schools that offered free water in food service areas increased from pre- to postimplementation of California's school water policy (72%-83%; P < .048). Barriers to improving school water included cost of programs and other pressing concerns.

Conclusions: Awareness of the benefits related to school drinking water provision and funding may help communities achieve excellence in drinking water access.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2105/AJPH.2013.301797DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4056210PMC
July 2014