California and federal school nutrition policies and obesity among children of Pacific Islander, American Indian/Alaska Native, and Filipino origins: Interrupted time series analysis
Obesity prevalence remains high among children of Pacific Islander (PI) origin, Filipino (FI), and American Indian/Alaska Native (AIAN) origins in the United States. While school nutrition policies may help prevent and reduce childhood obesity, their influences specifically among PI, FI, and AIAN ch...
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| description | Obesity prevalence remains high among children of Pacific Islander (PI) origin, Filipino (FI), and American Indian/Alaska Native (AIAN) origins in the United States. While school nutrition policies may help prevent and reduce childhood obesity, their influences specifically among PI, FI, and AIAN children remain understudied. We evaluated the association of the California (CA) state school nutrition policies for competitive food and beverages and the federal policy for school meals (Healthy, Hunger-Free Kids Act of 2010 (HHFKA 2010)) with overweight/obesity among PI, FI, and AIAN students.
We used an interrupted time series (ITS) design with FitnessGram data from 2002 to 2016 for PI (78,841), FI (328,667), AIAN (97,129), and White (3,309,982) students in fifth and seventh grades who attended CA public schools. Multilevel logistic regression models estimated the associations of the CA school nutrition policies (in effect beginning in academic year 2004 to 2005) and HHFKA 2010 (from academic year 2012 to 2013) with overweight/obesity prevalence (above the 85 percentile of the age- and sex-specific body mass index (BMI) distribution). The models were constructed separately for each grade and sex combination and adjusted for school district-, school-, and student-level characteristics such as percentage of students eligible for free and reduced price meals, neighborhood income and education levels, and age. Across the study period, the crude prevalence of overweight/obesity was higher among PI (39.5% to 52.5%), FI (32.9% to 36.7%), and AIAN (37.7% to 45.6%) children, compared to White (26.8% to 30.2%) students. The results generally showed favorable association of the CA nutrition policies with overweight/obesity prevalence trends, although the magnitudes of associations and strengths of evidence varied among racial/ethnic subgroups. Before the CA policies went into effect (2002 to 2004), overweight/obesity prevalence increased for White, PI, and AIAN students in both grades and sex groups as well as FI girls in seventh grade. After the CA policies took place (2005 to 2012), the overweight/obesity rates decreased for almost all subgroups who experienced increasing trends before the policies, with the largest decrease seen among PI girls in fifth grade (before: log odds ratio = 0.149 (95% CI 0.108 to 0.189; p < 0.001); after: 0.010 (-0.005 to 0.025; 0.178)). When both the CA nutrition policies and HHFKA 2010 were in effect (2013 to 2016), declines in the overwe |
| doi_str_mv | 10.1371/journal.pmed.1003596 |
| format | Article |
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We used an interrupted time series (ITS) design with FitnessGram data from 2002 to 2016 for PI (78,841), FI (328,667), AIAN (97,129), and White (3,309,982) students in fifth and seventh grades who attended CA public schools. Multilevel logistic regression models estimated the associations of the CA school nutrition policies (in effect beginning in academic year 2004 to 2005) and HHFKA 2010 (from academic year 2012 to 2013) with overweight/obesity prevalence (above the 85 percentile of the age- and sex-specific body mass index (BMI) distribution). The models were constructed separately for each grade and sex combination and adjusted for school district-, school-, and student-level characteristics such as percentage of students eligible for free and reduced price meals, neighborhood income and education levels, and age. Across the study period, the crude prevalence of overweight/obesity was higher among PI (39.5% to 52.5%), FI (32.9% to 36.7%), and AIAN (37.7% to 45.6%) children, compared to White (26.8% to 30.2%) students. The results generally showed favorable association of the CA nutrition policies with overweight/obesity prevalence trends, although the magnitudes of associations and strengths of evidence varied among racial/ethnic subgroups. Before the CA policies went into effect (2002 to 2004), overweight/obesity prevalence increased for White, PI, and AIAN students in both grades and sex groups as well as FI girls in seventh grade. After the CA policies took place (2005 to 2012), the overweight/obesity rates decreased for almost all subgroups who experienced increasing trends before the policies, with the largest decrease seen among PI girls in fifth grade (before: log odds ratio = 0.149 (95% CI 0.108 to 0.189; p < 0.001); after: 0.010 (-0.005 to 0.025; 0.178)). When both the CA nutrition policies and HHFKA 2010 were in effect (2013 to 2016), declines in the overweight/obesity prevalence were seen among White girls and FI boys in fifth grade. Despite the evidence of the favorable association of the school nutrition policies with overweight/obesity prevalence trends, disparities between PI and AIAN students and their White peers remained large after the policies took place. As these policies went into effect for all public schools in CA, without a clear comparison group, we cannot conclude that the changes in prevalence trends were solely attributable to these policies.
The current study found evidence of favorable associations of the state and federal school nutrition policies with overweight/obesity prevalence trends. However, the prevalence of overweight/obesity continued to be high among PI and AIAN students and FI boys. There remain wide racial/ethnic disparities between these racial/ethnic minority subgroups and their White peers. Additional strategies are needed to reduce childhood obesity and related disparities among these understudied racial/ethnic populations.</description><identifier>ISSN: 1549-1676</identifier><identifier>ISSN: 1549-1277</identifier><identifier>EISSN: 1549-1676</identifier><identifier>DOI: 10.1371/journal.pmed.1003596</identifier><identifier>PMID: 34029318</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject><![CDATA[Adolescent ; Age ; Alaska Natives - statistics & numerical data ; American Indian or Alaska Native - statistics & numerical data ; Asian - statistics & numerical data ; Bans ; Beverages ; Biology and Life Sciences ; Body composition ; Body mass index ; California - epidemiology ; Child ; Children & youth ; Design specifications ; Elementary schools ; Evaluation ; Family income ; Federal policy ; Female ; Filipino Americans ; Food ; Food and nutrition ; Health aspects ; Humans ; Interrupted Time Series Analysis ; Laws, regulations and rules ; Male ; Meals ; Medicine and Health Sciences ; Middle schools ; Minority teenagers ; Minority youth ; Native Americans ; Native Hawaiian or Other Pacific Islander - statistics & numerical data ; Nutrition ; Nutrition Policy ; Obesity ; Obesity in children ; Oceanians ; Overweight ; Overweight - epidemiology ; Overweight - prevention & control ; Pacific Islander people ; Pediatric Obesity - epidemiology ; Pediatric Obesity - prevention & control ; Pediatric research ; People and Places ; Physical fitness ; Prevalence ; Prevention ; Public schools ; Risk factors ; School lunches ; School lunchrooms, cafeterias, etc ; Social Sciences ; Statistics ; Students ; Time series ; United States ; Variables]]></subject><ispartof>PLoS medicine, 2021-05, Vol.18 (5), p.e1003596</ispartof><rights>COPYRIGHT 2021 Public Library of Science</rights><rights>2021 Matsuzaki et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2021 Matsuzaki et al 2021 Matsuzaki et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c764t-f8349b41200e2041bdf56e95c3e7aeb7b6818b2356158e53f4a68514fb6b412b3</citedby><cites>FETCH-LOGICAL-c764t-f8349b41200e2041bdf56e95c3e7aeb7b6818b2356158e53f4a68514fb6b412b3</cites><orcidid>0000-0002-7020-3757 ; 0000-0002-6121-5510</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC8143391/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC8143391/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,860,881,2096,2915,23845,27901,27902,53766,53768,79342,79343</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34029318$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Matsuzaki, Mika</creatorcontrib><creatorcontrib>Sánchez, Brisa N</creatorcontrib><creatorcontrib>Rebanal, R David</creatorcontrib><creatorcontrib>Gittelsohn, Joel</creatorcontrib><creatorcontrib>Sanchez-Vaznaugh, Emma V</creatorcontrib><title>California and federal school nutrition policies and obesity among children of Pacific Islander, American Indian/Alaska Native, and Filipino origins: Interrupted time series analysis</title><title>PLoS medicine</title><addtitle>PLoS Med</addtitle><description>Obesity prevalence remains high among children of Pacific Islander (PI) origin, Filipino (FI), and American Indian/Alaska Native (AIAN) origins in the United States. While school nutrition policies may help prevent and reduce childhood obesity, their influences specifically among PI, FI, and AIAN children remain understudied. We evaluated the association of the California (CA) state school nutrition policies for competitive food and beverages and the federal policy for school meals (Healthy, Hunger-Free Kids Act of 2010 (HHFKA 2010)) with overweight/obesity among PI, FI, and AIAN students.
We used an interrupted time series (ITS) design with FitnessGram data from 2002 to 2016 for PI (78,841), FI (328,667), AIAN (97,129), and White (3,309,982) students in fifth and seventh grades who attended CA public schools. Multilevel logistic regression models estimated the associations of the CA school nutrition policies (in effect beginning in academic year 2004 to 2005) and HHFKA 2010 (from academic year 2012 to 2013) with overweight/obesity prevalence (above the 85 percentile of the age- and sex-specific body mass index (BMI) distribution). The models were constructed separately for each grade and sex combination and adjusted for school district-, school-, and student-level characteristics such as percentage of students eligible for free and reduced price meals, neighborhood income and education levels, and age. Across the study period, the crude prevalence of overweight/obesity was higher among PI (39.5% to 52.5%), FI (32.9% to 36.7%), and AIAN (37.7% to 45.6%) children, compared to White (26.8% to 30.2%) students. The results generally showed favorable association of the CA nutrition policies with overweight/obesity prevalence trends, although the magnitudes of associations and strengths of evidence varied among racial/ethnic subgroups. Before the CA policies went into effect (2002 to 2004), overweight/obesity prevalence increased for White, PI, and AIAN students in both grades and sex groups as well as FI girls in seventh grade. After the CA policies took place (2005 to 2012), the overweight/obesity rates decreased for almost all subgroups who experienced increasing trends before the policies, with the largest decrease seen among PI girls in fifth grade (before: log odds ratio = 0.149 (95% CI 0.108 to 0.189; p < 0.001); after: 0.010 (-0.005 to 0.025; 0.178)). When both the CA nutrition policies and HHFKA 2010 were in effect (2013 to 2016), declines in the overweight/obesity prevalence were seen among White girls and FI boys in fifth grade. Despite the evidence of the favorable association of the school nutrition policies with overweight/obesity prevalence trends, disparities between PI and AIAN students and their White peers remained large after the policies took place. As these policies went into effect for all public schools in CA, without a clear comparison group, we cannot conclude that the changes in prevalence trends were solely attributable to these policies.
The current study found evidence of favorable associations of the state and federal school nutrition policies with overweight/obesity prevalence trends. However, the prevalence of overweight/obesity continued to be high among PI and AIAN students and FI boys. There remain wide racial/ethnic disparities between these racial/ethnic minority subgroups and their White peers. Additional strategies are needed to reduce childhood obesity and related disparities among these understudied racial/ethnic populations.</description><subject>Adolescent</subject><subject>Age</subject><subject>Alaska Natives - statistics & numerical data</subject><subject>American Indian or Alaska Native - statistics & numerical data</subject><subject>Asian - statistics & numerical data</subject><subject>Bans</subject><subject>Beverages</subject><subject>Biology and Life Sciences</subject><subject>Body composition</subject><subject>Body mass index</subject><subject>California - epidemiology</subject><subject>Child</subject><subject>Children & youth</subject><subject>Design specifications</subject><subject>Elementary schools</subject><subject>Evaluation</subject><subject>Family income</subject><subject>Federal policy</subject><subject>Female</subject><subject>Filipino Americans</subject><subject>Food</subject><subject>Food and nutrition</subject><subject>Health aspects</subject><subject>Humans</subject><subject>Interrupted Time Series Analysis</subject><subject>Laws, regulations and rules</subject><subject>Male</subject><subject>Meals</subject><subject>Medicine and Health Sciences</subject><subject>Middle schools</subject><subject>Minority teenagers</subject><subject>Minority youth</subject><subject>Native Americans</subject><subject>Native Hawaiian or Other Pacific Islander - statistics & numerical data</subject><subject>Nutrition</subject><subject>Nutrition Policy</subject><subject>Obesity</subject><subject>Obesity in children</subject><subject>Oceanians</subject><subject>Overweight</subject><subject>Overweight - epidemiology</subject><subject>Overweight - prevention & control</subject><subject>Pacific Islander people</subject><subject>Pediatric Obesity - epidemiology</subject><subject>Pediatric Obesity - prevention & control</subject><subject>Pediatric research</subject><subject>People and Places</subject><subject>Physical fitness</subject><subject>Prevalence</subject><subject>Prevention</subject><subject>Public schools</subject><subject>Risk factors</subject><subject>School lunches</subject><subject>School lunchrooms, cafeterias, etc</subject><subject>Social Sciences</subject><subject>Statistics</subject><subject>Students</subject><subject>Time series</subject><subject>United States</subject><subject>Variables</subject><issn>1549-1676</issn><issn>1549-1277</issn><issn>1549-1676</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><sourceid>DOA</sourceid><recordid>eNqVk11v0zAUhiMEYmPwDxBYQkIgrZ0dO2nCBVI1Mag0DcTXreU4x6mHYxfbmdgf4_fhtN20ol6AchHLed73fOVk2VOCp4TOyMmlG7wVZrrqoZ0SjGlRl_eyQ1KwekLKWXn_zvkgexTCJcZ5jWv8MDugLB0pqQ6z36fCaOW81QIJ2yIFLXhhUJBL5wyyQ_Q6amfRyhktNYQ15RoIOl4j0TvbIbnUpvVgkVPok5BaaYkWwSQQ_DGa9-C1FBYtbKuFPZkbEX4IdCGivoLjtd2ZNnqlrUPO607b8CaxEbwfVhFaFHUPKCSTdXBhroMOj7MHSpgAT7bvo-zb2buvpx8m5x_fL07n5xM5K1mcqIqyumEkxxhyzEjTqqKEupAUZgKaWVNWpGpyWpSkqKCgiomyKghTTTmqGnqUPd_4rowLfNvywPOCkaooaE0SsdgQrROXfOV1L_w1d0Lz9YXzHRc-ammA57hmGOQMVAWsYUq0Epo8pSQxbYQco73dRhuaNFUJNqZZ7JjufrF6yTt3xSvC6CaZV1sD734OECLvdZBg0izADWPeNM8LkqpO6Iu_0P3VbalOpAK0VS7FlaMpn5clK_HYu0RN9lAd2PFXchaUTtc7_HQPn54Wei33Cl7vCBIT4VfsxBACX3z5_B_sxb-zH7_vsi_vsEsQJi6DM8O4HWEXZBtQeheCB3U7QIL5uLo3nebj6vLt6ibZs7vDvxXd7Cr9A8XUQII</recordid><startdate>20210524</startdate><enddate>20210524</enddate><creator>Matsuzaki, Mika</creator><creator>Sánchez, Brisa N</creator><creator>Rebanal, R David</creator><creator>Gittelsohn, Joel</creator><creator>Sanchez-Vaznaugh, Emma V</creator><general>Public Library of Science</general><general>Public Library of Science (PLoS)</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>IOV</scope><scope>ISN</scope><scope>ISR</scope><scope>3V.</scope><scope>7TK</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope><scope>DOA</scope><scope>CZK</scope><orcidid>https://orcid.org/0000-0002-7020-3757</orcidid><orcidid>https://orcid.org/0000-0002-6121-5510</orcidid></search><sort><creationdate>20210524</creationdate><title>California and federal school nutrition policies and obesity among children of Pacific Islander, American Indian/Alaska Native, and Filipino origins: Interrupted time series analysis</title><author>Matsuzaki, Mika ; Sánchez, Brisa N ; Rebanal, R David ; Gittelsohn, Joel ; Sanchez-Vaznaugh, Emma V</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c764t-f8349b41200e2041bdf56e95c3e7aeb7b6818b2356158e53f4a68514fb6b412b3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Adolescent</topic><topic>Age</topic><topic>Alaska Natives - 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Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><collection>PLoS Medicine</collection><jtitle>PLoS medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Matsuzaki, Mika</au><au>Sánchez, Brisa N</au><au>Rebanal, R David</au><au>Gittelsohn, Joel</au><au>Sanchez-Vaznaugh, Emma V</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>California and federal school nutrition policies and obesity among children of Pacific Islander, American Indian/Alaska Native, and Filipino origins: Interrupted time series analysis</atitle><jtitle>PLoS medicine</jtitle><addtitle>PLoS Med</addtitle><date>2021-05-24</date><risdate>2021</risdate><volume>18</volume><issue>5</issue><spage>e1003596</spage><pages>e1003596-</pages><issn>1549-1676</issn><issn>1549-1277</issn><eissn>1549-1676</eissn><abstract>Obesity prevalence remains high among children of Pacific Islander (PI) origin, Filipino (FI), and American Indian/Alaska Native (AIAN) origins in the United States. While school nutrition policies may help prevent and reduce childhood obesity, their influences specifically among PI, FI, and AIAN children remain understudied. We evaluated the association of the California (CA) state school nutrition policies for competitive food and beverages and the federal policy for school meals (Healthy, Hunger-Free Kids Act of 2010 (HHFKA 2010)) with overweight/obesity among PI, FI, and AIAN students.
We used an interrupted time series (ITS) design with FitnessGram data from 2002 to 2016 for PI (78,841), FI (328,667), AIAN (97,129), and White (3,309,982) students in fifth and seventh grades who attended CA public schools. Multilevel logistic regression models estimated the associations of the CA school nutrition policies (in effect beginning in academic year 2004 to 2005) and HHFKA 2010 (from academic year 2012 to 2013) with overweight/obesity prevalence (above the 85 percentile of the age- and sex-specific body mass index (BMI) distribution). The models were constructed separately for each grade and sex combination and adjusted for school district-, school-, and student-level characteristics such as percentage of students eligible for free and reduced price meals, neighborhood income and education levels, and age. Across the study period, the crude prevalence of overweight/obesity was higher among PI (39.5% to 52.5%), FI (32.9% to 36.7%), and AIAN (37.7% to 45.6%) children, compared to White (26.8% to 30.2%) students. The results generally showed favorable association of the CA nutrition policies with overweight/obesity prevalence trends, although the magnitudes of associations and strengths of evidence varied among racial/ethnic subgroups. Before the CA policies went into effect (2002 to 2004), overweight/obesity prevalence increased for White, PI, and AIAN students in both grades and sex groups as well as FI girls in seventh grade. After the CA policies took place (2005 to 2012), the overweight/obesity rates decreased for almost all subgroups who experienced increasing trends before the policies, with the largest decrease seen among PI girls in fifth grade (before: log odds ratio = 0.149 (95% CI 0.108 to 0.189; p < 0.001); after: 0.010 (-0.005 to 0.025; 0.178)). When both the CA nutrition policies and HHFKA 2010 were in effect (2013 to 2016), declines in the overweight/obesity prevalence were seen among White girls and FI boys in fifth grade. Despite the evidence of the favorable association of the school nutrition policies with overweight/obesity prevalence trends, disparities between PI and AIAN students and their White peers remained large after the policies took place. As these policies went into effect for all public schools in CA, without a clear comparison group, we cannot conclude that the changes in prevalence trends were solely attributable to these policies.
The current study found evidence of favorable associations of the state and federal school nutrition policies with overweight/obesity prevalence trends. However, the prevalence of overweight/obesity continued to be high among PI and AIAN students and FI boys. There remain wide racial/ethnic disparities between these racial/ethnic minority subgroups and their White peers. Additional strategies are needed to reduce childhood obesity and related disparities among these understudied racial/ethnic populations.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>34029318</pmid><doi>10.1371/journal.pmed.1003596</doi><orcidid>https://orcid.org/0000-0002-7020-3757</orcidid><orcidid>https://orcid.org/0000-0002-6121-5510</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1549-1676 |
| ispartof | PLoS medicine, 2021-05, Vol.18 (5), p.e1003596 |
| issn | 1549-1676 1549-1277 1549-1676 |
| language | eng |
| recordid | cdi_plos_journals_2541855391 |
| source | MEDLINE; DOAJ Directory of Open Access Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; PubMed Central; Public Library of Science (PLoS) |
| subjects | Adolescent Age Alaska Natives - statistics & numerical data American Indian or Alaska Native - statistics & numerical data Asian - statistics & numerical data Bans Beverages Biology and Life Sciences Body composition Body mass index California - epidemiology Child Children & youth Design specifications Elementary schools Evaluation Family income Federal policy Female Filipino Americans Food Food and nutrition Health aspects Humans Interrupted Time Series Analysis Laws, regulations and rules Male Meals Medicine and Health Sciences Middle schools Minority teenagers Minority youth Native Americans Native Hawaiian or Other Pacific Islander - statistics & numerical data Nutrition Nutrition Policy Obesity Obesity in children Oceanians Overweight Overweight - epidemiology Overweight - prevention & control Pacific Islander people Pediatric Obesity - epidemiology Pediatric Obesity - prevention & control Pediatric research People and Places Physical fitness Prevalence Prevention Public schools Risk factors School lunches School lunchrooms, cafeterias, etc Social Sciences Statistics Students Time series United States Variables |
| title | California and federal school nutrition policies and obesity among children of Pacific Islander, American Indian/Alaska Native, and Filipino origins: Interrupted time series analysis |
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