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BACKGROUND: More than one-third of children and adolescents consume foods from quick-service restaurants (QSRs) daily, which is associated with an increased risk of diet-related adverse health conditions. OBJECTIVE: To examine trends in the proximity of top-selling QSR chains to all public schools across the United States between 2006 and 2018 by community-, school-, and student-level characteristics. DESIGN: This longitudinal study examined changes in the number QSRs between the 2006-2007 and 2017-2018 school years using data from National Center for Education Statistics, Infogroup US Historical Business Data, and the US Department of Agricultures Economic Research Service. STATISTICAL ANALYSIS: A mixed-model analysis of variance using census tract as a random effect and accounting for repeated measures by school was used to examine the proximity of QSRs near schools. Models adjusted for demographic characteristics and census tract population density. Data were analyzed in 2021. RESULTS: During 2006, 9% of schools had QSRs within 400 m, and 25% of schools in the most populated areas had at least one QSR within 400 m. There were more QSRs near schools with a high percentage of poverty (12%), and near schools with high school students with the highest population of Black or African American (16%) and Hispanic or Latino (18%) students. By 2018, the percent of all public schools within 400 m of QSRs increased to 12%. The increase over time was greater near schools with a high percentage of poverty (16%) and near schools with high school students with the highest population of Black or African American students (22%) and Hispanic or Latino (23%) students. CONCLUSIONS: This is the first nationwide study to examine trends in QSR proximity to all public schools. QSRs were most likely to be located near schools with high school students, near schools with a high percentage of poverty, and near schools with a higher proportion of racial and ethnic minority students. Over time, there were greater increases in QSRs near these schools which may have important implications for childrens health and diet-related disparities.

Background: Whole-of-community interventions have been recommended and show promise for preventing obesity; however, research to understand the mechanisms underlying their success or failure is lacking. Complex systems approaches may be useful to address this gap. Purpose: To describe the evolution and utilization of qualitative and quantitative complex systems methods to understand and model whole-of-community obesity prevention interventions. Approach: We illustrate the retrospective qualitative development of a systems map representing community change dynamic within the Shape Up Somerville (SUS) intervention. We then describe how this systems map, and complementary work of other successful obesity prevention interventions (Romp & Chomp intervention), informed the COMPACT (childhood obesity modeling for prevention and community transformation) study. COMPACT's design aligns complex systems science principles and community-engaged research to better understand stakeholders' leadership roles in whole-of-community interventions. We provide an overview of the complex systems tools used in COMPACT: agent-based modeling, group model building, and social network analysis and describe how whole-of-community intervention stakeholders ("agents") use their social networks to diffuse knowledge about and engagement with childhood obesity prevention efforts, laying the groundwork for community readiness for sustainable change. Conclusion: Complex systems approaches appear feasible and useful to study whole-of-community obesity prevention interventions and provide novel insights that expand on those gained from traditional approaches. Use of multiple methods, both qualitative and quantitative, from the complex systems toolkit working together can be important to success. [This article was written on behalf of the SUS Systems Map Team and the COMPACT Team.]

Background: Employee health promotion in the elementary school setting can support students' health and academic success. School employees can serve as role models, yet evidence suggests poor health in this population. We identified factors that influence school employee health behaviors to inform subsequent development of employee wellness programs. Methods: Focus groups (10 groups, total N = 62) and interviews (N = 5) were conducted with school employees. Participants were recruited from schools in socioeconomically disadvantaged, racially diverse districts in Massachusetts. We used a socioecological framework to identify multi-level factors that influence employee health behaviors. Factors were characterized as supports (+) or barriers (-) to health-promoting behaviors. Results: Eight themes highlighted the importance of an organizational culture that sustains successful employee wellness programming. Intrapersonal themes included: High Stress (+/-), Desire to Adopt Healthy Behaviors (+), and Sufficient Health Knowledge (+). Interpersonal themes included: Strong Social Network (+) and a Desire to Role Model (+). Organizational themes included: Demanding Job (-), Lack of Wellness Culture (-), and Unhealthy Food (-). Conclusions: Our findings suggest that this population would be receptive to wellness programming. Promising strategies include supporting a dedicated wellness champion and creating recognizable top down wellness support for employees.

No one-size-fits-all strategy works to increase physical activity (PA) at schools. To realize success, practitioners need flexible PA programs to support the multi-component comprehensive school physical activity program (CSPAP) approach. Walk/run programs have the potential to provide this flexibility, and some have demonstrated increased physical activity at school. Walk/run clubs may be particularly amenable to widespread adoption given that they require limited equipment, facilities or training among adult leaders; their implementation can occur at diverse times before, during or after school; and they demonstrate high levels of acceptability among children, parents and administrators. This article shares both the challenges and best practices of 85 schools participating in a district-level walk/run club initiative. These actionable findings can inform practice at the thousands of schools nationwide already providing walking and running programs or other schools looking to implement such a program. Incorporating the suggested tactics, such as setting moderate goals, using incentives judiciously, emphasizing fun, and fostering a supportive PA environment, may help other practitioners lead effective walk/run programs.

Background: Recent efforts supporting children's dietary behaviors suggest the importance of food literacy (FL), which is a multidimensional concept that encompasses food-related knowledge, skills, and behaviors. To date, FL has been largely informed by adult and adolescent research. Aims: To assess the FL experiences, perceived skills, and knowledge of school-age children to inform FL educational opportunities. Method: Six focus groups were conducted with children (age 9-12 years) from three Massachusetts elementary schools. Two team members independently reviewed and coded a portion of the transcripts to assess interrater reliability. Predominant themes connected to children's perceived FL skills and knowledge were identified using an inductive and deductive content analysis approach. Results: There were five central FL themes identified during the focus groups (n = 31 children), including (1) food systems concepts; (2) food safety and food freshness; (3) gardening environment, perceived skills, and knowledge; (4) cooking environment, perceived skills, and safety; and (5) autonomy of meal preparation. Discussion: The themes that emerged in these focus groups with children provided new information surrounding children's perceived FL skills and knowledge as well as important context regarding the food environment (school vs. home). These findings captured important concepts across the "farm to plate" spectrum and highlight potential school-based opportunities where FL topics could be expanded upon most successfully. Conclusion: This formative research informed educational opportunities for a FL curriculum, which holds promise for improving food-based education and programs, designing more effective interventions, and developing measurement tools.

Objective: To evaluate implementation of nutrition/physical activity-related policies/practices at colleges participating in a healthy campus initiative and campus health leaders' perceptions of policies/practices' support for student health and ease of/barriers to implementation. Participants: Health leaders at colleges participating in the Healthier Campus Initiative (HCI), with completed or ongoing three-year HCI commitments. Methods: Surveys asked which of 41 guidelines were implemented and perceptions around support for student health and ease of/barriers to implementation. Qualitative interviews explored similar domains. Results: Campuses with completed HCI commitments (n = 17) averaged 27.6 guidelines implemented, versus 21.1 on campuses with commitments ongoing (n = 13; p = 0.003). Perceived support for student health and implementation ease varied by guideline. Common implementation barriers included financial costs and time. Interviews largely reinforced these findings. Conclusions: Completion of a campus environmental change initiative may be associated with more health-supporting practices. Campuses may benefit from implementing coordinated policy/practice changes supporting healthy eating and physical activity. [ABSTRACT FROM AUTHOR]

BackgroundExcess energy intake from meals consumed away from home is implicated as a major contributor to obesity, and ∼50% of US restaurants are individual or small-chain (non-chain) establishments that do not provide nutrition information.ObjectiveTo measure the energy content of frequently ordered meals in non-chain restaurants in three US locations, and compare with the energy content of meals from large-chain restaurants, energy requirements, and food database information.DesignA multisite random-sampling protocol was used to measure the energy contents of the most frequently ordered meals from the most popular cuisines in non-chain restaurants, together with equivalent meals from large-chain restaurants.SettingMeals were obtained from restaurants in San Francisco, CA; Boston, MA; and Little Rock, AR, between 2011 and 2014.Main outcome measuresMeal energy content determined by bomb calorimetry.Statistical analysis performedRegional and cuisine differences were assessed using a mixed model with restaurant nested within region×cuisine as the random factor. Paired t tests were used to evaluate differences between non-chain and chain meals, human energy requirements, and food database values.ResultsMeals from non-chain restaurants contained 1,205±465 kcal/meal, amounts that were not significantly different from equivalent meals from large-chain restaurants (+5.1%; P=0.41). There was a significant effect of cuisine on non-chain meal energy, and three of the four most popular cuisines (American, Italian, and Chinese) had the highest mean energy (1,495 kcal/meal). Ninety-two percent of meals exceeded typical energy requirements for a single eating occasion.ConclusionsNon-chain restaurants lacking nutrition information serve amounts of energy that are typically far in excess of human energy requirements for single eating occasions, and are equivalent to amounts served by the large-chain restaurants that have previously been criticized for providing excess energy. Restaurants in general, rather than specific categories of restaurant, expose patrons to excessive portions that induce overeating through established biological mechanisms.

Background: A supportive school-based physical activity environment (PAE) is integral to children's physical activity behaviors, but less understood is its association with academic achievement. We aimed to assess the association between PAE and academic performance and whether a stronger relationship exists in lower-income schools (LIS) compared to middle-income schools (MIS). Methods: Schoolchildren (grades 3rd to 5th) were recruited from 17 Massachusetts public schools. Schools were classified based on geographic characteristics and free/reduced-price lunch (FRPL) eligibility (LIS = 7, Median FRPL = 86%; MIS = 10, Median FRPL = 20%). PAE was measured using a 10-item survey. Mixed-effects logistic regression models were used to examine associations between PAE and scoring Advanced/Proficient on standardized Math and English Language Arts (ELA) tests. Results: Demographic characteristics differed between LIS (N = 278, 5% non-Hispanic white) and MIS (N = 297, 73% non-Hispanic white). In LIS, PAE was associated with Math (odds ratio = 5.40, 95% CI = 2.52-11.54 p < 0.001), but not ELA test scores (p > 0.05). There was no relationship between PAE and MIS test scores (p > 0.05). Schooltime moderate-to-vigorous physical activity was not associated with test scores (p > 0.05). Conclusions: A beneficial relationship exists between a high-PAE and test scores among LIS children, suggesting that the PAE may be associated with a more supportive environment and may be more fundamentally important for lower-income students.