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BACKGROUND: This article seeks to inform state and local school food policies by evaluating the impact of Connecticut's Healthy Food Certification (HFC), a program which provides monetary incentives to school districts that choose to implement state nutrition standards for all foods sold to students outside reimbursable school meals. METHODS: Food service directors from all school districts participating in the National School Lunch Program (NSLP) (N = 151) in Connecticut were surveyed about the availability of competitive foods before and after the 2006-2007 implementation of HFC. Food categories were coded as healthy or unhealthy based on whether they met the Connecticut Nutrition Standards. Data on NSLP participation were provided by the State Department of Education. Changes in NSLP participation and availability of unhealthy competitive foods in elementary, middle, and high schools were compared pre- and post-HFC across districts participating (n = 74) versus not participating (n = 77) in HFC. RESULTS: On average, all districts in Connecticut reduced the availability of unhealthy competitive foods, with a significantly greater reduction among HFC districts. Average NSLP participation also increased across the state. Participating in HFC was associated with significantly greater NSLP participation for paid meals in middle school; however, implementing HFC did not increase overall NSLP participation beyond the statewide upward trend. CONCLUSION: The 2006-2007 school year was marked by a significant decrease in unhealthy competitive foods and an increase in NSLP participation across the state. Participation in Connecticut's voluntary HFC further reduced the availability of unhealthy competitive foods in local school districts, and had either a positive or neutral effect on NSLP participation. [ABSTRACT FROM AUTHOR]

Objective: To analyse cross-promotions targeted to children and adolescents on packaging in the supermarket. Design: On three occasions from 2006 to 2008, researchers purchased all foods in a large supermarket that included a cross-promotion on the package. A total of 397 products were categorized by promotional partner, food category, targeted age group, promotion type, product nutrition, and company policies on marketing to children. Results: The number of products with youth-oriented cross-promotions increased by 78% during the period examined. Overall, 71% of cross-promotions involved third-party licensed characters and 57% appealed primarily to children under 12 years of age; however, the use of other forms of promotions increased from 5% of the total in 2006 to 53% in 2008, and promotions targeting pre-school and general audiences increased from 23% to 54% of the total. Only 18% of products met accepted nutrition standards for foods sold to youth, and nutritional quality declined during the period examined. Food manufacturers with policies limiting marketing to children represented 65% of all youth-oriented cross-promotions, their use of cross-promotions increased significantly, and the nutritional quality of their products did not improve. Some media companies did reduce the use of their properties on food promotions. Conclusions: Overall, the supermarket environment worsened due to an increase in cross-promotions targeted to children and adolescents and a decline in the nutritional quality of these products. This analysis failed to find improvements in food marketing to youth and highlights the need to expand current industry self-regulatory pledges. [ABSTRACT FROM AUTHOR]

In 2007, the Council of Better Business Bureaus created the Children's Food and Beverage Advertising Initiative to improve the nutritional profile of products marketed to children in the United States. We provide quantitative baseline data describing (a) the amount of child-directed breakfast cereal advertising in 2007; (b) an assessment of the nutritional value for all cereals advertised on television; and (c) the relationship between nutrition quality and child exposure to television advertising for major cereal brands. In 2007, the average American child viewed 757 cereal ads, and 98 per cent of these ads promoted unhealthy cereals that would be prohibited from advertising to children in the United Kingdom. Healthy cereals were advertised in 2007 in the United States, but adults, not children, were predominantly exposed to these ads. These quantitative methods can be used in the future to evaluate the impact of industry self-regulation efforts to improve the marketing landscape. [ABSTRACT FROM AUTHOR]

Removing low nutrition snacks from schools is controversial. Although the objective is to decrease the consumption of these foods at school, some critics argue that children will compensate by eating more of these foods at home. Others worry that school-based obesity prevention programs will increase student preoccupation with weight. The present study examines these concerns. Three middle schools replaced snacks and beverages that did not meet nutrition guidelines, whereas three comparison schools made no systematic changes. Students were surveyed about dietary intake and weight concerns before and after implementation of the intervention. Findings indicate that removing low nutrition items from schools decreased students' consumption with no compensatory increase at home. Furthermore, there were no differences in students' reported weight concerns. These results support the value of strengthening school nutrition standards to improve student nutrition and provide evidence dispelling concerns that such efforts will have unintended negative consequences. [ABSTRACT FROM AUTHOR]

Abstract: In 2006, all local education agencies in the United States participating in the National School Lunch Program were required to establish school wellness policies that covered nutrition education, nutrition standards for school foods, and physical activity. The purpose of this psychometric study was to develop and evaluate the properties of a comprehensive and quantitative coding system to evaluate the quality of these policies. A 96-item coding tool was developed to evaluate seven goal areas: nutrition education, standards for US Department of Agriculture child nutrition programs and school meals, nutrition standards for competitive and other foods and beverages, physical education, physical activity, communication and promotion, and evaluation. Each goal area subscale and the total scale were scored on two dimensions: comprehensiveness and strength. Reliability was assessed by having pairs of researchers from four different states code a sample of 60 polices between July 2007 and July 2008. Goal area subscales were internally reliable (Cronbach''s α=.60 to .93). Adequate interrater reliability scores were obtained at each level of scoring: total comprehensiveness and strength scores (intraclass correlation coefficient 0.82), subscale scores (intraclass correlation coefficient 0.70), and individual items (intraclass correlation coefficient 0.72). This coding system provided a reliable method for analyzing and comparing school district wellness policies in single or multistate studies. [Copyright &y& Elsevier]

Context: Research consistently shows that the majority of American children do not consume diets that meet the recommendations of the Dietary Guidelines for Americans, nor do they achieve adequate levels of daily physical activity. As a result, more children are overweight today than at any other time in U.S. history. Schools offer many opportunities to develop strategies to prevent obesity by creating environments in which children eat healthfully and engage regularly in physical activity. Methods: This article discusses the role of schools in obesity prevention efforts. Current issues in schools' food and physical activity environments are examined, as well as federal, state, and local policies related to food and physical activity standards in schools. The article is organized around four key areas: (1) school food environments and policies, (2) school physical activity environments and policies, (3) school body mass index measurements, and (4) school wellness policies. Recommendations for accelerating change also are addressed. Findings: The article found that (1) competitive foods (foods sold outside of federally reimbursed school meals) are widely available in schools, especially secondary schools. Studies have related the availability of snacks and drinks sold in schools to students' high intake of total calories, soft drinks, total fat and saturated fat, and lower intake of fruits and vegetables; (2) physical activity can be added to the school curriculum without academic consequences and also can offer physical, emotional, and social benefits. Policy leadership has come predominantly from the districts, then the states, and, to a much lesser extent, the federal government; (3) few studies have examined the effectiveness or impact of school-based BMI measurement programs; and (4) early comparative analyses of local school wellness policies suggest that the strongest policies are found in larger school districts and districts with a greater number of students eligible for a free or reduced-price lunch. Conclusions: Studies show that schools have been making some progress in improving the school food and physical activity environments but that much more work is needed. Stronger policies are needed to provide healthier meals to students at schools; limit their access to low-nutrient, energy-dense foods during the school day; and increase the frequency, intensity, and duration of physical activity at school. [ABSTRACT FROM AUTHOR]

Background: Although great focus has been placed on nutritional and other consequences of changes in food-related policies within schools, few reports exist describing the impact of such changes on school revenue. This review provides an overview of the few revenue-related studies published recently, as well as information from a sampling of state reports on the subject. Methods: A systematic review of the literature was conducted. Four peer-reviewed papers and 3 state-based reports were identified that assessed the impact on revenues of either targeted policy changes or overarching, district-wide changes in food-related policies. Results: Thus far, few data exist to substantiate the concern that changes in nutrition standards in schools lead to a loss in total revenue. An interesting phenomenon of increased participation in the National School Lunch Program was noted in a number of reports and might play a role in buffering financial losses. Conclusions: A renewed focus on school policies related to health provides the opportunity for researchers to investigate how nutrition-related policy change can affect, if at all, food service and overall school revenues. [ABSTRACT FROM AUTHOR]

This study employed qualitative methods with a sample of overweight and obese adults to identify and describe their subjective experiences of weight bias. Participants (274 females and 44 males) completed an online battery of self- report questionnaires, including several open- ended questions about weight stigmatization. These questions asked them to describe their worst experiences of weight stigmatization, their perceptions of common weight-based stereotypes, their feelings about being overweight and their suggestions for strategies to reduce weight stigma in our culture. Participants reported experiencing weight stigma across a range of contexts and involving a variety of interpersonal sources. Close relationship partners (such as friends, parents and spouses) were the most common source of their worst stigmatizing encounters. Participants challenged common weight-based stereotypes (notably, that obese individuals are `lazy') and reported that they would like the public to gain a better understanding of the difficulties of weight loss, the causes of obesity and the emotional consequences of being stigmatized. Education was reported as the most promising avenue for future stigma- reduction efforts. The experiences and opinions expressed were not significantly different for men versus women or overweight versus obese individuals. A minority of participants ex- pressed beliefs suggestive of self-blame and internalization of weight-based stereotypes. These results indicate that while obese individuals experience weight bias across many domains, more stigma-reduction efforts should target stigmatizing encounters in close relationships, including parents, spouses and friends of obese persons. [ABSTRACT FROM AUTHOR]

One in eight people in the U.S. experience food insecurity (FI). To date, the food banking sector has been at the forefront of efforts to address FI, but the healthcare sector is becoming increasingly involved in such efforts. The extent of collaboration between the two sectors remains unclear. We explored food banking stakeholders' views on the current state of partnerships between the two sectors. We used purposive sampling to recruit ten key informants for semi-structured interviews. We also conducted a national online survey to gather data from food bank directors (n = 137). Thematic analysis generated two major themes: (1) Healthcare and food banking stakeholders are coordinating to achieve collective impact, and (2) Food banking-healthcare partnerships are leveraging various resources and vested interests within the medical community. We found evidence of ongoing partnerships between the two sectors and opportunities to strengthen these partnerships through the support of backbone organizations. [ABSTRACT FROM AUTHOR]

School meals can play an integral role in improving children's diets and addressing health disparities. Initiatives and policies to increase consumption have the potential to ensure students benefit from the healthy school foods available. This systematic review evaluates studies examining initiatives, interventions, and policies to increase school meal consumption. Following PRISMA guidelines, this review was conducted using four databases and resulted in a total of 96 studies. The research evidence supports the following strategies to increase school meal consumption: (1) offering students more menu choices; (2) adapting recipes to improve the palatability and/or cultural appropriateness of foods; (3) providing pre-sliced fruits; (4) rewarding students who try fruits and vegetables; (5) enabling students to have sufficient time to eat with longer (~30 min) lunch periods; (6) having recess before lunch; and (7) limiting students' access to competitive foods during the school day. Research findings were mixed when examining the impact of nutrition education and/or offering taste tests to students, although multiple benefits for nutrition education outside the cafeteria were documented. There is some evidence that choice architecture (i.e., "Smarter Lunchroom") techniques increase the proportion of students who select targeted meal components; however, there is not evidence that these techniques alone increase consumption. There were limited studies of the impact of increasing portion sizes; serving vegetables before other meal components; and strengthening local district and/or school wellness policies, suggesting that further research is necessary. Additionally, longer-term studies are needed to understand the impact of policies that limit students' access to flavored milk. Several studies found increases in students' meal consumption following the Healthy Hunger-Free Kids Act (HHFKA) and concerns regarding an increase in food waste following the HHFKA were not supported. Overall, there are a range of effective strategies to increase school meal consumption that can be implemented by schools, districts, and policymakers at the local, state, and federal levels (PROSPERO registration: CRD42021244688). [ABSTRACT FROM AUTHOR]

In response to the COVID-19 pandemic, the US Congress authorized the US Department of Agriculture to waive a variety of school meal regulations and funded school meals daily for all students at no charge regardless of family income. Because federal Universal Free School Meals (UFSM) ended with the 2021-2022 school year, several states, including California and Maine, adopted state-level UFSM policies. This study aimed to understand parent perceptions of school meals and the federal and new state UFSM policies in California and Maine, including potential challenges and benefits to students and households. A mixed methods study design was used. A quantitative cross-sectional survey was administered, and semi-structured interviews were conducted in English and Spanish during the 2021-2022 school year. The quantitative survey was administered to parents of students in elementary, middle, and high schools in rural, suburban, and urban communities in California (n = 1110) and Maine (n = 80). Qualitative interviews were then conducted with a subset of these parents in California (n = 46) and Maine (n = 20) using Zoom (Zoom Video Communications). Most survey participants (708 of 1190 [59.5%]) and interviewees (40 of 66 [60.6%]) were parents of students who were eligible for free or reduced-price meals. Parents' perceptions of UFSM, school meal quality, and experiences applying for free or reduced-price meals were examined. Tests of proportions were used to analyze survey data. Using grounded theory, interview transcripts were analyzed qualitatively by 2 trained research assistants, applying principles of content analysis to identify themes and domains. Inter-rater reliability was conducted. Parents perceived that school meals and UFSM saved families money and time, as parents had fewer meals to purchase and prepare for their children. In addition, UFSM reduced parents' stress and reduced stigma for children and for parents, who described feelings of embarrassment when they previously filled out paperwork for free or reduced-price meals. Although parent perceptions of school meal quality and healthfulness were mixed, most parents reported feeling grateful for school meals. Parents had mixed opinions on the quality and healthfulness of school meals, but believed UFSM saved them money and time and reduced their stress. Parents also felt UFSM reduced stigma for families. [ABSTRACT FROM AUTHOR]

In response to concerns about childhood obesity, many US states have implemented policies to limit the sale of unhealthy foods and beverages (e.g., snacks, desserts, and sugary drinks) sold in competition with school meal programs (i.e., competitive foods) in order to improve the nutritional environment of schools and support student health. This study measured state-level competitive food and beverage policies that require foods and beverages sold in à la carte lines, vending machines, and school stores to meet strong nutrition standards and tested the hypothesis that students living in states with stronger laws would have lower body mass index (BMI)-for-age percentiles. BMI data from a national sample of 1625 students attending 284 schools from the School Nutrition and Meal Cost Study were linked to state laws coded as part of the National Wellness Policy Study. A survey-adjusted linear regression model accounting for student and school-level characteristics showed that stronger state nutrition policies were associated with lower student BMI scores (coefficient: −0.06, 95% CI: −0.12, −0.00). Additional models indicated that stronger state policies were significantly associated with fewer unhealthy foods and beverages available in schools. These findings suggest that strong regulations on competitive foods and beverages may lead to improvements in the nutritional quality of the school environment and student BMI. Thus, current federal standards regulating snacks in US schools (i.e., Smart Snacks) are an important element of a comprehensive strategy to improve the school nutrition environment and reduce rates of childhood obesity. [ABSTRACT FROM AUTHOR]

BACKGROUND: The US Department of Agriculture's (USDA) summer meal programs are designed to provide meals at no cost while school is out of session. In response to the COVID‐19 pandemic, several regulatory waivers were enacted to facilitate meal distribution. The aim of this study was to assess the rates of meal distribution before and after these waivers were in effect. METHODS: Meal distribution patterns for 2019, 2020, and 2021 were examined through (1) a descriptive comparison of the number of participating districts, sponsors, meal sites, and meals distributed statewide, and (2) repeated measures ANOVAs to examine changes among districts in operation all years. RESULTS: The waivers were associated with an increase in the total number of participating districts, sponsors, and meal sites; an increase in the total number of meals distributed to children during the summer months; and an increase in meal distribution among sponsors that had been in place since 2019. Conclusion: Expanding the area eligibility criteria and enabling flexibility in meal distribution methods increased the number of meals provided. This study provides important preliminary evidence to suggest that the USDA should consider permanent regulatory changes to this program to maximize its reach. [ABSTRACT FROM AUTHOR]

Food insecurity, or limited or uncertain availability of nutritionally adequate and safe foods or limited or uncertain ability to acquire acceptable foods in socially acceptable ways, affects more than 10% of Americans. The U.S. Department of Agriculture's 18‐item Household Food Security Survey Module (HFSSM) is the most common measure used in the United States to assess food insecurity. This measure is to be completed by one adult who reports on the severity of disruptions in the quality and quantity of the household food supply. Recent work suggests that men and women might respond differently to some of the items in this measure. Therefore, the aim of the current study was to further explore how men and women interpret each of the items and specific concepts in this measure. Pairs (n = 25) of low‐income and food‐insecure mothers and fathers of children aged 2.5–10 years participated in one‐on‐one interviews to answer the HFSSM questions using the think‐aloud method. The data were analyzed using basic inductive qualitative methods, and the findings suggest that gender is related to interpretation of key concepts relevant to food insecurity including "household," "balanced meal," and "worry." These findings have policy implications for the use of this measure as a national benchmark of food insecurity such as the potential need for an additional, complementary instrument to include several male reference questions with different terminology. [ABSTRACT FROM AUTHOR]

BACKGROUND: Adoption of the Whole School, Whole Community, Whole Child (WSCC) model has been slowed by a lack of available tools to support implementation. The Wellness School Assessment Tool (WellSAT) WSCC is an online assessment tool that allows schools to evaluate the alignment of their policies with the WSCC model. This study assesses the usability of the WellSAT WSCC. METHODS: Using a convergent mixed methods design, we collected qualitative and quantitative data from 5 school‐based participants with roles in development and evaluation of policy. Participants explored the platform while engaging in a think‐aloud procedure and scored a sample policy using the platform. They also completed the System Usability Scale and responded to open‐ended questions about the usability of the platform. RESULTS: Participants rated the WellSAT WSCC as an above‐average user experience, but data suggested several areas for improvement, including improved instructions, enhanced visual design of the platform, and guidance for subsequent policy changes. CONCLUSION: The WellSAT WSCC provides an above‐average user experience but can be improved to increase user experience. These improvements increase the potential for greater use to facilitate integration of the WSCC model into school policy. [ABSTRACT FROM AUTHOR]

To evaluate if parent perceptions of school meals influence student participation. In May 2022, an online survey was used to evaluate parents' perceptions of school meals and their children's participation. A total of 1,110 California parents of kindergarten through 12th-grade students. Student participation in school lunch and breakfast. Principal component analysis and Poisson regression models. Three groups of parental perceptions were identified: (1) positive perceptions (eg, liking school meals and thinking that they are tasty and healthy), (2) perceived benefits to families (eg, school meals save families money, time, and stress), and (3) negative (eg, concerns about the amount of sugar in school meals and stigma). More positive parental perceptions about school meals and their benefits to families were associated with greater student meal participation. In contrast, more negative parental perceptions were associated with reduced student participation in school meals (P < 0.05). Parent perceptions of school meals may affect student participation in school meal programs. Working to ensure parents are familiar with the healthfulness and quality of school meals and the efforts schools are making to provide high-quality, appealing meals may be critical for increasing school meal participation rates. [ABSTRACT FROM AUTHOR]

Introduction: Calorie labeling is now required on all large U.S. chain restaurant menus, but its influence on consumer behavior is mixed. This study examines whether different parent-targeted messages encourage parents to order lower-calorie meals for their children in a hypothetical online setting.Methods: An online RCT was conducted with sociodemographically diverse primary caregivers of children aged 6-12 years (data collected and analyzed in 2017-2019). Participants (N=2,373) were randomized to see 1 of 4 messages: (1) nonfood control, (2) kids' meals are the right size for children, (3) doctors recommend a 600 kcal per meal limit for kids, or (4) 600 kcal per meal is a generally recommended limit for kids. Participants ordered hypothetical meals for their children and themselves and rated meal and message perceptions.Results: There were no significant differences between conditions in calories ordered for children at either restaurant, although all 3 food message conditions ordered fewer calories for their children than the control (full service: 27-68 fewer kcal, fast food: 18-64 fewer kcal). The general 600 kcal/meal limit message consistently performed best across outcomes, encouraging parents to order the fewest calories for their children at both restaurants (5%-7% fewer) and significantly increasing their understanding of calorie recommendations for kids' meals. It also significantly reduced fast-food calories parents ordered for themselves compared with the control (-106 kcal, p=0.042).Conclusions: Although no statistically significant differences were detected, messages with specific calorie recommendations for kids led parents to order lower-calorie restaurant meals for their children, suggesting that additional real-world studies with larger sample sizes are warranted. [ABSTRACT FROM AUTHOR]

BACKGROUND: Stakeholders increasingly recognize the role of policy in implementing Whole School, Whole Community, Whole Child (WSCC) frameworks in schools; however, few tools are currently available to assess alignment between district policies and WSCC concepts. The purpose of this study was to expand the Wellness School Assessment Tool (WellSAT) for evaluation of policies related to all 10 domains of the WSCC model. METHODS: Developing the WellSAT WSCC was an iterative process that involved (1) identifying items for each domain based on key concepts and best practice recommendations; (2) expert review of the draft measure; (3) cognitive pre‐testing; (4) developing scoring criteria; and (5) pilot‐testing the measure. RESULTS: Ratings from expert reviewers indicated that the tool included items that were both relevant and important to each of the 10 WSCC domains. Results of cognitive pre‐testing indicated that the items were understood as intended. Feedback from expert reviews, cognitive pre‐testing, and pilot‐testing was used to further revise and refine the measure and develop a final version of the tool. Acceptable interrater reliability was established for the final selection of items. CONCLUSIONS: The WellSAT WSCC provides a reliable means for assessing integration and alignment between WSCC model concepts and district policies. [ABSTRACT FROM AUTHOR]

Abstract Objective To compare beverages and foods selected by high school students on days when juice was offered (juice days) and not offered (non-juice days) with the reimbursable school meal. Methods Lunch register data from 386 days across 3 low-income Northeast high schools were used to compare juice and non-juice days for average daily selections of meal components and à la carte water and 100% juice sales. Results On juice days, 9.9% fewer milks (P <.01) and 7.4% fewer fruits (P <.01) were selected with lunches. In addition, on juice days, 8.2% fewer bottles of water and 24.4% fewer bottles of 100% juice were sold à la carte (P <.05). Conclusions and Implications Reducing juice availability in the reimbursable school lunch may increase selection of milk and fruit. Future research is warranted to assess how juice availability influences selection of milk, fruit, and water across a range of student populations. [ABSTRACT FROM AUTHOR]

Background: The food and beverages served in family childcare homes (FCCHs) may play an important role in the development of childhood overweight and obesity. This analysis examines whether children's diet quality mediates the relationship between foods and beverages served in FCCHs and preschool-aged children's weight status. Methods: Trained and certified staff conducted observations for two days in each FCCH, using the Environment and Policy Assessment and Observation (EPAO) measure to determine the foods and beverages served to children (N = 370) in FCCHs (N = 120). They also used the Dietary Observation in Child Care (DOCC) protocol to assess children's food and beverage intake during childcare, from which we calculated the Healthy Eating Index-2015 (HEI), a measure of diet quality. Height and weight were measured for each child with parent consent from which the child's body mass index (BMI) z-scores were calculated. A multilevel mediation analysis was conducted to indicate whether children's diet quality mediates the relations between food and beverage served in FCCHs and preschool-aged children's weight status. Results: Children's total HEI scores significantly mediated the relationship between the EPAO subscale Food Provided and children's BMI z-scores (B=-0.01, p <.05, 95% CI = [-0.03, − 0.002]). Further, the EPAO subscale Food Provided was positively associated with the total HEI score (B = 0.75, p <.01, 95% CI = [0.32, 1.18]). Total HEI scores were negatively associated with BMI z-score (B=-0.01, p <.05, 95% CI = [-0.02, − 0.001]). Conclusion: Children's diet quality did significantly mediate the relationship between the food served in FCCHs and children's weight status. More longitudinal studies with longer follow-up periods need to be conducted to confirm these relationships. Further, future studies need to examine the relationships between a broader spectrum of FCCH environmental characteristics and home environment with children's weight status, as well as other mediators including physical activity. [ABSTRACT FROM AUTHOR]

To examine the relationship between the diet quality of children aged 2–5 years cared for in family child care homes (FCCHs) with provider adherence to nutrition best practices. Cross-sectional analysis. Family child care home providers (n = 120, 100% female, 67.5% Latinx) and children (n = 370, 51% female, 58% Latinx) enrolled in a cluster-randomized trial. Data were collected over 2 days at each FCCH. The Environment and Policy Assessment and Observation tool was used to document whether providers exhibited nutrition practices on the basis of the Nutrition and Physical Activity Self-Assessment for Child Care. Each practice was scored as either present or absent. Children's food intake was observed using Diet Observation at Child Care and analyzed with the Healthy Eating Index–2015. Multilevel linear regression models assessed the association between providers exhibiting best practices regarding nutrition and children's diet quality. The model accounted for clustering by FCCH and controlled for provider ethnicity, income level, and multiple comparisons. Children in FCCHs in which more of the best practices were implemented had higher diet quality (B = 1.05; 95% confidence interval [CI], 0.12–1.99; P = 0.03). Specifically, children whose providers promoted autonomous feeding (B = 27.52; 95% CI, 21.02–34.02; P < 0.001) and provided nutrition education (B = 7.76; 95% CI, 3.29–12.23; P = 0.001) had higher total Healthy Eating Index scores. Future interventions and policies could support FCCH providers in implementing important practices such as autonomy feeding practices, talking informally to children about nutrition, and providing healthful foods and beverages. [ABSTRACT FROM AUTHOR]

Multiple U.S. localities have introduced legislation requiring sugar-sweetened beverage (SSB) warnings. This study effects of different warning designs on beverage selections and perceptions. The study was an RCT. An online virtual convenience store and survey were used with a nationally representative sample of primary caregivers of 6–11-year-olds (n =961). Data were collected in January 2020 and analyzed in May–July 2020. Participants were randomized to view SSBs with 1 of 4 front-of-package label designs: (1) no-warning control, (2) health-related text warning, (3) sugar pictorial warning (image of beverage sugar content in cubes/teaspoons/packets with health-related warning text), or (4) health pictorial warning (image of possible health consequences of overconsuming SSBs with health-related warning text). Outcomes included participants' beverage choice for their child and perceptions of beverages, their assigned labels, and warning policies. Proportionally fewer participants chose a SSB in the sugar pictorial warning condition (-13.4 percentage points; 95% CI= -21.6 to -0.1 percentage points; p=0.007) and in the health pictorial warning condition (-14.7 percentage points; 95% CI= -22.8 to -0.1 percentage points; p=0.004) compared to the control. Sugar pictorial warnings led to more accurate added-sugar content estimates than all conditions and greater label trust and support for sugar-sweetened beverage warning policies than health pictorial warnings. SSB warning policies may be most effective if they mandate images of beverages' added sugar content accompanied by warning text. This study is registered at www.clinicaltrials.gov NCT03648138. [ABSTRACT FROM AUTHOR]

Abstract: Record levels of obesity in children and adolescents are predictable in light of powerful conditions that promote high consumption of calorie-dense, nutrient-poor foods and discourage physical activity. Default conditions for youth are dangerous, and include multiple and relentless forms of marketing, poor foods promoted in schools, and a variety of other conditions that undermine personal resources, individual responsibility, and parental authority. This article discusses how optimal defaults can be created using five issues as examples: framing of the obesity issue, treating versus preventing obesity, nutrition in schools, marketing, and addressing weight bias and discrimination. By adopting a public health approach that addresses the conditions causing obesity, there is hope of reversing troubling trends in prevalence. [Copyright &y& Elsevier]

Context: The Supplemental Nutrition Assistance Program (SNAP) is an effective component in reducing food insecurity in the U.S. In the discussion of strategies to also help SNAP participants maximize diet quality, it is important to know their current dietary patterns and food choices. This paper provides a systematic review of recent U.S. studies on dietary quality, food consumption, and spending among SNAP participants as compared to income-eligible and higher-income nonparticipants.Evidence Acquisition: The review, completed in 2014, summarized studies that were peer-reviewed, published between January 2003 and August 2014, and provided data on dietary quality and intake of SNAP participants and nonparticipants.Evidence Synthesis: Twenty-five studies were included in this review. Daily caloric, macronutrient, and micronutrient intake of SNAP participants did not differ systematically from those of income-eligible nonparticipants; however, differences in dietary quality emerged. Adult SNAP participants scored lower on the Healthy Eating Index than either group of nonparticipants. Children's diets were similar among SNAP participants and low-income nonparticipants, but were less nutritious than diets of higher-income children. The evidence regarding sugar-sweetened beverage consumption was mixed, with most studies indicating significantly higher beverage intake among SNAP participants compared with higher-income nonparticipants, but no difference compared to income-eligible nonparticipants.Conclusions: SNAP effectively alleviates food insecurity in terms of caloric, macronutrient, and micronutrient intake. Still, SNAP participants are struggling more than income-eligible and higher-income nonparticipants to meet key dietary guidelines. Future policies should ensure that this vital food assistance program addresses diet quality while reducing food insecurity. [ABSTRACT FROM AUTHOR]

BACKGROUND: The Whole School, Whole Community, Whole Child (WSCC) model offers a comprehensive framework for creating safe, healthy, and supportive school environments. However, few studies to date have examined the degree to which school policies represent a comprehensive and integrated approach to this goal beyond nutrition and physical activity. Therefore, the purpose of this study was to provide a baseline evaluation of the alignment of district‐level policies with the WSCC model within one state. METHODS: Fifty‐four Connecticut public school districts' policies were evaluated using the WellSAT WSCC, a new measure of how well district‐level policies address topic areas within each domain of the WSCC model. The comprehensiveness and strength of each district's policies were calculated and then averaged across districts to assess areas of strength and need. RESULTS: Districts' policies were most comprehensive in the domains of Social and Emotional Climate; Behavioral Supports (Counseling, Psychological, and Social Services); and Family Engagement. Policies were strongest for Safe Environment (Physical Environment); Behavioral Supports; and Health Services. CONCLUSIONS: School district policy coverage of the WSCC model within Connecticut varies by domain and is often fragmented. Comprehensive and coordinated policies modeled from WSCC domains are needed to better support safe, healthy, and supportive school environments. [ABSTRACT FROM AUTHOR]

Background: Food and beverage companies have pledged to reduce unhealthy marketing to children through the Children's Food and Beverage Advertising Initiative (CFBAI). However, public health experts question the initiative's effectiveness because pledges apply to only some types of marketing. For instance, the CFBAI covers only TV advertising that is "child-directed," defined as advertising during programs for which children make up 35% or more of the viewing audience.Purpose: To quantify the proportion of food and beverage TV advertisements (ads) viewed by children that is covered by current CFBAI pledges and examine the potential impact of broader definitions of child-directed advertising.Methods: Nielsen data were used to quantify percentages of children (aged 2-11 years) in the audience (i.e., child-audience share), as well as absolute numbers of child viewers, for all national TV programs in 2009. Nielsen advertising data provided the number of food and beverage ads viewed by preschoolers (aged 2-5 years); older children (aged 6-11 years); and adults (aged 18-49 years) during programs with various child-audience compositions. Data were collected in 2010 and analyzed in 2011.Results: Just 45%-48% of food ads viewed by children met current CFBAI definitions of child-directed advertising. Expanding this definition to include advertising during programs with a child-audience share of 20% or higher and/or 100,000 or more child viewers would cover 70%-71% of food advertising seen by children but just one third of ads seen by adults.Conclusions: Children viewed an estimated 35% fewer food ads during TV programs with a high child-audience share (≥50%) in 2009 compared with 2004. However, ensuring that nutrition standards apply to the majority of food ads viewed by children requires broader definitions of child-directed advertising. [ABSTRACT FROM AUTHOR]

Abstract: Food banks are the foundation of the US emergency food system. Although their primary mission is to alleviate hunger, the rise in obesity and diet-related diseases among food-insecure individuals has led some food bank personnel to actively promote more nutritious products. A qualitative interview approach was used to assess nutrition-related policies and practices among a sample of 20 food banks from the national Feeding America network. Most food bank personnel reported efforts to provide more fresh produce to their communities. Several described nutrition-profiling systems to evaluate the quality of products. Some food banks had implemented nutrition policies to cease distributing low-nutrient products, such as soda and candy; however, these policies were more controversial than other strategies. The obstacles to implementing strong nutrition policies included fear of reducing the total amount of food distributed, discomfort choosing which foods should not be permitted, and concern about jeopardizing relationships with donors and community partners. Empirical research is needed to measure how food bank nutrition policies influence relationships with food donors, the amount of food distributed, the nutritional quality of food distributed, and the contribution of food bank products to the food security and nutritional status of the communities they serve. [Copyright &y& Elsevier]

Objective: Child care policies may contribute to healthy beverage consumption patterns. This study documented availability and accessibility of water and correspondence with state and federal policy and accreditation standards in child care centers. Design: One-day observations were conducted in a random sample of 40 Child and Adult Care Food Program-participating preschool classrooms in Connecticut. Setting and Participants: Child care centers, center directors, and preschool teachers. Main Outcome Measures: Raters observed water availability and teacher behaviors during lunch, physical activity, and in the classroom. National, state, and childcare center water regulations and policies were reviewed. Analysis: Descriptive statistics present data on water availability, promotion, and modeling. Bivariate relationships between water availability and accreditation status, center water policy, location of physical activity, and verbal promotion were assessed using the Fisher exact test (P < .05). Results: Many centers were in violation of water-promoting policies. Water was available in most classrooms (84%) but was only adult accessible in over half of those classrooms. Water was available during one third of physical activity periods observed. Verbal prompts for children to drink water were few. Conclusions and Implications: Support is needed to help centers meet existing water policies and new water requirements included in the 2010 Child Nutrition Reauthorization Act. [ABSTRACT FROM AUTHOR]

Background: The U.S. food and beverage industry recently released a new front-of-package nutrition labeling system called Facts Up Front that will be used on thousands of food products. Purpose: To test consumer understanding of the Facts Up Front system (Facts Up Front) compared to the Multiple Traffic Light system (Traffic Light). Facts Up Front displays grams/milligrams and percentage daily value information for various nutrients; Traffic Light uses an interpretive color-coded scheme to alert consumers to low, medium, and high levels of certain nutrients. Design: Participants in an Internet-based study were randomized to one of five front-of-package label conditions: (1) no label; (2) Traffic Light; (3) Traffic Light plus information about protein and fiber (Traffic Light+); (4) Facts Up Front; or (5) Facts Up Front plus information about “nutrients to encourage” (Facts Up Front+). Setting/participants: A total of 703 adults recruited through an online database in May 2011 participated in this study, and data were analyzed in June 2011. Main outcome measures: Total percentage correct quiz scores were generated reflecting participants'' ability to compare two foods on nutrient levels, based on their labels, and to estimate amounts of saturated fat, sugar, sodium, fiber and protein in the foods. Results: The front-of-package label groups outperformed the control group on nearly all of the nutrient quizzes (p<0.05). The control group did not differ from the Facts Up Front group on the saturated fat quiz, or from the Facts Up Front+ group on the sugars quiz. Those in the Traffic Light+ group had the best overall performance (>80% on all quizzes). Conclusions: Overall, those in the Traffic Light+ condition performed better than those in the Facts Up Front conditions on measures of nutrition knowledge and label perceptions. Trial registration: This study is registered at clinicaltrials.gov NCT01626729. [Copyright &y& Elsevier]

Background: The food industry disproportionately markets to young people through product placements. Children and adolescents may be more susceptible to these disguised persuasive attempts. Purpose: Quantify incidence and youth exposure to food and beverage brand appearances within shows on prime-time TV. Methods: Data on the number of food, beverage, and restaurant brand appearances within shows during prime-time programming in 2008 were purchased from Nielsen and analyzed by product category and company in 2010. Exposure to these brand appearances by children, adolescents, and adults were examined and compared with exposure to prime-time TV advertisements for the same categories and companies using additional Nielsen data. Results: Food, beverage, and restaurant brands appeared a total of 35,000 times within prime-time TV programming examined by Nielsen in 2008. Regular soft drinks, traditional restaurants (i.e., not quickserve), and energy/sports drinks made up 60% of all brand appearances. Young people viewed relatively few of these appearances with one notable exception. Coca-Cola products were seen 198 times by the average child and 269 times by the average adolescent during prime-time shows over the year, accounting for 70% of child exposure and 61% of adolescent exposure to brand appearances. One show, American Idol, accounted for more than 95% of these exposures. Exposure of children to Coca-Cola products through traditional advertisements was much less common. Conclusions: Brand appearances for most food industry companies, except for Coca-Cola, are relatively rare during prime-time programming with large youth audiences. Coca-Cola has pledged to refrain from advertising to children, yet the average child views almost four Coke appearances on prime-time TV every week. This analysis reveals a substantial, potential loophole in current food industry self-regulatory pledges to advertise only better-for-you foods to children. [ABSTRACT FROM AUTHOR]

The US Department of Agriculture's school meal programs have wide reach during the school year, but food insufficiency among households with children increases during summer months. The US Department of Agriculture summer meal programs are designed to fill this gap, yet participation has historically been low. To examine the facilitators and barriers to participation in a 2021 summer meal program while the COVID-19 pandemic regulation waivers were in place. Cross-sectional mixed-methods survey research. All parents/guardians of children enrolled in a school district in Connecticut were invited to participate in an online survey in December 2021. The respondents included summer meal participants (n = 622) and nonparticipants (n = 294). Survey respondents reported demographic variables, current food sufficiency, communication preferences, satisfaction with the program, reasons for using or not using the program, and whether they found the program helpful financially. The survey included three open-ended questions about barriers to participation. Respondents who used the summer meal program indicated that the pandemic-related regulatory waivers were key to their decision to participate. Reported barriers included lack of awareness of the program, inability to travel to sites during the times they were open, lack of transportation, concerns about dietary restrictions, and lack of variety in the menu, and concerns about wasting food. Parents/guardians expressed strong preferences for receiving communication about summer meals directly from their child's school and being able to access meals outside of typical work hours. The pandemic waivers allowed sponsors to test different models of distribution. Parents/guardians responded positively to the opportunity to access grab-and-go meals, multiple meals at once, and meals without a child present. These findings can be used to inform potential policy changes to reduce barriers and increase participation. [ABSTRACT FROM AUTHOR]

Introduction: Healthier school environments can benefit students, and school wellness policies may result in meaningful enhancements. Schools participating in federal child nutrition programs must implement wellness policies as mandated by law. The primary study objective is to assess effectiveness of implementing school-based nutrition and physical activity policies on student BMI trajectories.Study Design: Cluster randomized trial using 2 × 2 factorial design.Setting/participants: Twelve randomly selected schools in an urban district. Students were followed for 3 years through middle school, fifth to eighth grades (2011-2015, n=595 students, 92.3% participation, 85.2% retention).Intervention: Specific to randomized condition, support was provided for implementation of nutrition policies (e.g., alternatives to food-based rewards/celebrations) and physical activity policies (e.g., opportunities for physical activity during/after school).Main Outcome Measures: Sex-/age-adjusted BMI percentile and BMI z-score; behavioral indicators. Data collected via standardized protocols.Results: Analyses followed intention-to-treat principles, with planned secondary analyses (conducted 2016-2018). Students at schools randomized to receive support for nutrition policy implementation had healthier BMI trajectories over time (F=3.20, p=0.02), with a greater magnitude over time and cumulatively significant effects 3 years post-intervention (β=-2.40, p=0.04). Overall, students at schools randomized to receive the nutrition intervention had an increase in BMI percentile of <1%, compared with students in other conditions, whereas BMI percentile increased 3%-4%. There was no difference in student BMI between those in schools with and without physical activity policy implementation. Examining behavioral correlates in eighth grade, students at schools randomized to the nutrition condition consumed fewer unhealthy foods and sugar-sweetened beverages, and ate less frequently at fast-food restaurants (all p<0.03).Conclusions: This cluster randomized trial demonstrated effectiveness of providing support for implementation of school-based nutrition policies, but not physical activity policies, to limit BMI increases among middle school students. Results can guide future school interventions.Trial Registration: This study is registered at www.clinicaltrials.gov NCT02043626. [ABSTRACT FROM AUTHOR]

Objective: To test an obesity prevention strategy derived from behavioural economics (optimal defaults plus delay), focused on changing the college dining hall service method.Design: After a uniform pre-load, participants attended an experimental lunch in groups randomized to one of three conditions: a nutrient-dense, lower-fat/energy lunch as an optimal default (OD); a less-nutrient-dense, higher-fat/energy lunch as a suboptimal default (SD); or a free array (FA) lunch. In the OD condition, students were presented a menu depicting healthier vegetarian and omnivore foods as default, with opt-out alternatives (SD menu) available on request with a 15 min wait. In the SD condition, the same menu format was used with the positioning of food items switched. In the FA condition, all choices were presented in uniform fonts and were available immediately.Setting: Private rooms designed to provide a small version of a college dining hall, on two campuses of a Northeastern US university.Subjects: First-year college students (n 129).Results: There was a significant main effect for condition on percentage of optimal choices selected, with 94 % of food choices in the OD condition optimal, 47 % in the FA condition optimal and none in the SD condition optimal. Similarly, energy intake for those in the SD condition significantly exceeded that in the FA condition, which exceeded that in the OD condition.Conclusions: Presenting menu items as optimal defaults with a delay had a significant impact on choice and consumption, suggesting that further research into its long-term applicability is warranted. [ABSTRACT FROM AUTHOR]

ABSTRACT: BACKGROUND: In this study, we applied behavioral economics to optimize elementary school lunch choices via parent‐driven decisions. Specifically, this experiment tested an optimal defaults paradigm, examining whether strategically manipulating the health value of a default menu could be co‐opted to improve school‐based lunch selections. METHODS: The design was a randomized comparison of optimal versus suboptimal (standard) default lunch menus for all first‐graders in a school district for a period of 1 week. We hypothesized that making the default lunch option healthier, while providing parents the opportunity to access and choose from the standard school menu for their child, would yield more frequent selection of healthier items than when the default option was suboptimal. RESULTS: Overall, 127 (93%) first‐grade children's families participated. Among those families randomized to receive the nutritionally optimized default menu, all but one remained with these options; of those parents randomized to the standard menu (suboptimal default), all parents remained with these options (Χ2 = 123.06, df = 1, p < .001). CONCLUSIONS: The mere positioning of choices, without restricting options, significantly affected which menu items the children received during the test period. Results are proof of concept for a strategy to increase health‐promoting school lunch content, procedures, and policies. [ABSTRACT FROM AUTHOR]

Background The changes in school meal programs stemming from the Healthy, Hunger-Free Kids Act of 2010 have expanded interest in strategies that increase student participation in school lunch and reduce plate waste. However, it remains unclear what factors are associated with schools’ use of such strategies. Objective This study examines whether state laws are associated with two types of school meal-related practices: (a) using promotional strategies (ie, taste tests, using posters or announcements) and (b) duration of lunch periods. Design This cross-sectional study utilized the nationally representative 2014 School Health Policies and Practices Study, combined with corresponding state laws gathered by the National Wellness Policy Study. School data were available from 414 public schools in 43 states. Main outcome measures Outcome measures included 16 strategies to promote school meals and the amount of time students had to eat lunch after being seated. Statistical analyses performed Multivariate logistic regression and Poisson regression were used to examine associations between state laws and school practices, after accounting for school demographic characteristics. Results Compared to schools in states with no law about engaging stakeholders in meal programs, schools in states with a law were more likely to conduct taste tests (64% vs 44%, P =0.016), collect suggestions from students (67% vs 50%, P =0.017), and invite family members to a school meal (71% vs 53%, P =0.015). Schools used more promotion strategies in states with a law than in states without a law (mean=10.4 vs 8.8, P =0.003). Schools were more likely to provide students at least 30 minutes to eat lunch after being seated in states with laws that addressed a minimum amount of time for lunch duration (43% vs 27%, P =0.042). Conclusions State-level policy provisions are associated with school practices. Policy development in more states may support school practices that promote lunch participation and consumption. [ABSTRACT FROM AUTHOR]

ABSTRACT BACKGROUND The Healthy, Hunger-Free Kids Act of 2010 ( HHFKA) directed the US Department of Agriculture ( USDA) to revise school meal standards. Students are most affected by efforts to improve the school food environment; yet, few studies directly include students. This study examined high school students' experiences of school meal reform to gain insight into implementation recommendations. METHODS We conducted 5 focus groups with high school students (N = 15) from high schools across 9 states. We also conducted follow-up interviews to further explore personal experiences. Focus groups and interview transcripts were coded and organized in Atlas.ti v7 by analysts, following principles of constant comparative analysis. RESULTS Students reported overall positive perceptions of the revised school meal standards and supported continued efforts to improve the food environment. Recommendations to improve the food environment included engaging students, focusing on the quality and palatability of meal items, moving toward scratch-cooking, and addressing cafeteria infrastructure. CONCLUSIONS Students' recommendations point to opportunities where school districts, as well as local, state, and federal organizations can work to improve the school food environment. Their insights are directly relevant to USDA's recently released Local School Wellness Policy final rule, of which school meal standards are one provision. [ABSTRACT FROM AUTHOR]

Optimal defaults is a compelling model from behavioral economics and the psychology of human decision-making, designed to shape or "nudge" choices in a positive direction without fundamentally restricting options. The current study aimed to test the effectiveness of optimal (less obesogenic) defaults and parent empowerment priming on health-based decisions with parent-child (ages 3-8) dyads in a community-based setting. Two proof-of-concept experiments (one on breakfast food selections and one on activity choice) were conducted comparing the main and interactive effects of optimal versus suboptimal defaults, and parent empowerment priming versus neutral priming, on parents' health-related choices for their children. We hypothesized that in each experiment, making the default option more optimal will lead to more frequent health-oriented choices, and that priming parents to be the ultimate decision-makers on behalf of their child's health will potentiate this effect. Results show that in both studies, default condition, but not priming condition or the interaction between default and priming, significantly predicted choice (healthier vs. less healthy option). There was also a significant main effect for default condition (and no effect for priming condition or the interaction term) on the quantity of healthier food children consumed in the breakfast experiment. These pilot studies demonstrate that optimal defaults can be practicably implemented to improve parents' food and activity choices for young children. Results can inform policies and practices pertaining to obesogenic environmental factors in school, restaurant, and home environments. [ABSTRACT FROM AUTHOR]

Public health interventions must address poor diet among U.S. children, but research is needed to better understand factors influencing children's food choices. Using an online grocery store simulation, this research piloted a novel method to assess children's snack selection in a controlled but naturalistic laboratory setting, evaluate predictors of choice, and experimentally test whether promotions on food packages altered choices. Children (7-12 years, N = 61) were randomly assigned to one of three conditions: promotions on healthy products; promotions on unhealthy products; and no promotions (control). They selected from a variety of healthy and unhealthy foods and beverages and rated all products on healthfulness and taste. Promotions on food packaging did not affect snack selection in this study, but findings supported our other hypothesis that perceived taste would be the strongest predictor of food choice. Children accurately rated product healthfulness, but these ratings did not predict healthy snack choices or taste ratings for healthy or unhealthy snacks. These results suggest that interventions to improve children's food choices should focus on increasing availability of healthy options and identifying opportunities to enhance children's liking of healthy options. However, nutrition education alone is unlikely to improve children's diets. Further testing is required, but the simulated online grocery store method shows potential for measuring children's food choices. [ABSTRACT FROM AUTHOR]

Candy advertising illustrates limitations of the Children's Food and Beverage Advertising Initiative (CFBAI) self-regulatory program to improve food marketing to children. Participating companies pledge to not advertise candy in child-directed media. Yet independent analyses show that children viewed 65% more candy ads on U.S. television in 2011 than in 2007, before CFBAI implementation. The present research corroborates these findings, characterizes the increase, and examines how CFBAI-participating and non-participating companies use child-targeted techniques and media placement to advertise candy on U.S. television. Content analysis identified child-targeted messages and techniques in 2011 television candy ads, and Nielsen data (2008-2011) quantified candy advertising viewed on children's and other types of television programming. Differences between brands according to CFBAI status and use of child-targeted techniques in ads are evaluated. Data were obtained and analyzed in 2013. CFBAI-company non-approved brands represented 65% of candy ads viewed by children in 2011, up from 45% in 2008, and 77% of these ads contained child-targeted techniques. Although CFBAI companies only placed ads for approved brands on children's networks, 31% of ads viewed by children for CFBAI non-approved brands appeared on networks with higher-than-average youth audiences. CFBAI non-participating companies placed child-targeted candy ads primarily on children's networks. Despite CFBAI pledges, companies continue to advertise candy during programming with large youth audiences utilizing techniques that appeal to children. Both increased CFBAI participation and a more effective definition of "child-directed advertising" are required to reduce children's exposure to targeted advertising for foods that can harm their health. [ABSTRACT FROM AUTHOR]

Abstract: In 2009, the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) implemented revisions to the WIC food packages. Milk and cheese allowances were reduced, and whole milk was disallowed for participants older than 23 months. Using a pre-post research design and scanner data from a New England supermarket chain on purchases of WIC households, this article assesses how the new WIC packages affected milk and cheese purchases and saturated fat intake among WIC households in Connecticut and Massachusetts. Milk and cheese volume purchased by 515 WIC households in Connecticut was compared before and after the WIC revisions (2009-2010) using generalized estimating equation models. Analysis for Massachusetts was descriptive. After implementation of the new WIC packages in Connecticut, whole-milk share declined from about 60% to 25% in WIC milk purchases, but remained flat at about 50% for purchases with non-WIC funds. Total milk volume fell by 14.2% (P<0.001), whole milk by half (P<0.001), and WIC-eligible cheese by 37.2% (P<0.001). Restrictions on whole milk shifted WIC purchases to reduced-fat milk in Connecticut and low-fat milk in Massachusetts, where reduced-fat milk is not permitted by WIC. The amounts of saturated fat from purchased milk and cheese declined by 85 g/month per WIC household in Connecticut and 107 g/month in Massachusetts. The 2009 WIC revisions led to a substantial decrease in purchases of whole milk and cheese among WIC families in New England. The related reduction in saturated fat intake could have important public health implications. [Copyright &y& Elsevier]