Table 4 Effectiveness of policies on dietary behaviors
From: Impact of school policies on non-communicable disease risk factors – a systematic review
Study | Design | Policy | Outcomes | Specific outcome | Impact (+) Favorable and significant change (=) No change | Strength of Association |
|---|---|---|---|---|---|---|
Blum et al., 2008 [28] | Quasi-experimental | Elimination from SSB (Diet) and other junk food in schools food policy | Sugar-sweetened beverages consumption | SSB | = | Consumption of SSB decreased in both intervention and control boys (F = 53.69, P < .05) and girls (F = 22.87, P < .05). Intervention girls decreased diet soda consumption as compared to control girls (F = 6.57, P < .05) |
Diet soda | = | |||||
Juice | = | |||||
Johnson et al., 2009 [29] | Cross-sectional | School district SSB policies | Sugar-sweetened beverages consumption | SSBs | + | β = − 9.50, p < .0002 |
Schwartz et al., 2009 [30] | Quasi- Experimental | Removal of snacks of low nutritional value | Consumption of beverages, salty snack, and sweet snack | Beverages | + | β = −.23, p < .05 |
Salty snack | + | β = −.30, p < .05 | ||||
Sweet snack | = | Not reported | ||||
French et al., 2004 [31] | RCT | School nutrition policy initiative: Food availability in à la carte areas; Peer promotions | Lower-fat food choices, Added fats score, Fruit and vegetable score | Lower-fat food choices | = | % Yes: Intervention (Baseline 0.29 First year 0.28 Second year 0.28) Control (Baseline 0.23 First year 0.26 Second year 0.24; p = 0.62) |
Added fats score | = | % Yes: Intervention (Baseline 2.5 First year 2.6 Second year 2.4) Control (Baseline 2.6 First year 2.7 Second year 2.5; p = 0.97) | ||||
Fruit and vegetable score | = | % Yes: Intervention (Baseline 2.7 First year 2.9 Second year 2.9) Control (Baseline 2.8 First year 3.1 Second year 3.1; p = 0.95) | ||||
Foster et al., 2008 [14] | RCT | School self-assessment; nutrition education; nutrition policy; social marketing; and parent outreach. | Total energy consumed (kilo- joules), fat consumption (grams), and the number of fruit and vegetable servings | Energy | = | Adjusted difference: −104.27 (−234.28, 25.73) p = 0.12 |
Fat consumption | = | Adjusted difference: −3.78 (−8.59, 1.02) p = 0.12 | ||||
Fruit and vegetable servings | = | Adjusted difference: −0.04 (−0.37, 0.3) p = 0.82 | ||||
Fung et al., 2013 [21] | Cross-sectional | School food and nutrition policy (Children’s Lifestyle and School Performance Study-CLASS) | Fruit/vegetable, grain products, milk products, meat and alternatives, soda intake, SSBs, | Fruit/vegetable | = | β = −0.08 (−0.27, 0.19) |
Grain products | + | β = 0.26 (0.17, 0.34) | ||||
Milk products | + | β = 0.24 (0.18, 0.31) | ||||
Meat and alternatives | + | β = 0.06 (0.03, 0.09) | ||||
Soda intake | + | β = −0.09 (−0.11, −0.06) | ||||
SSBs | + | β = −0.20 (−0.27, −0.12) | ||||
Moore and Tapper, 2008 [32] | RCT | Fruit Truck Shops | Consumption of fruit and sweet and savoury snacks | Fruits | = | β = 0.06 (−0.1, −0.21) |
Sweets, Chocolates, Biscuits | = | β = −0.1 (−0.3, 0.01) | ||||
Crisps | = | β = −0.05 (−0.2, 0.06) | ||||
Jaenke et al., 2012 [33] | Quasi- Experimental | Nutrition education, gardening program | Fruit and vegetable intake | Fruits | = | P = 0.93 |
Vegetables | + | P = 0.67 | ||||
Knox et al., 2012 [22] | RCT | Brisk Walking Lessons | Consumption of total fat, saturated fat, carbohydrates, proteins, fiber, and total calories | Consumption of total fat, saturated fat, carbohydrates, proteins, fiber, and total calories | = | Non-significant changes, effect, estimates not reported |
Covelli, 2008 [27] | Quasi-experimental - Repeated Measures | Integration of health promotion in existing curriculum (Provision of cognitive behavioral components of health knowledge, health promotion concepts, nutrition, and exercise). | Fruits/vegetables per day | Fruits/vegetables per day | + | Fruits/vegetables per week: Intervention (Baseline 2.6 Follow up 4.9) Control (Baseline 2.7 Follow up 2.5; p = 0.0001) |
Llargues et al., 2011 [23] | RCT | Teacher Training, Develop activities related to food habits and/or physical activity | Fruits, vegetables, SSBs, Sweets, Fizzy drinks | Fruits | = | No changes: Intervention 84.2% (p = 0.36) Control 80.0% (0.18) |
Vegetables | = | No changes: Intervention 73.1% (p = 0.58) Control 81.4% (0.84) | ||||
Sweets | = | No changes: Intervention 93.7% (p = 1.0) Control 94.3% (0.7) | ||||
Fizzy drinks | = | No changes: Intervention 87.9% (p = 1.0) Control 89.2% (0.12) | ||||
Vandongen et al., 1995 [26] | Cross-Sectional | Guidance around fitness and nutrition (Fitness, Fitness + School Nutrition, School Nutrition, School and home nutrition, home nutrition, All groups together | Fat, sugar and protein | Fat | Boys =Girls + | Fat % energy (Intervention Baseline: 33.1 (32.7, 33.7) Follow up: 33.7 (33.1, 34.3) Control Baseline: 33.2 (32.7, 33.7) Follow up: 33.2 (31.5, 34.9) |
Sugar | Boys + Girls = | Sugar % energy (Intervention Baseline: 22.8 (22.1, 23.5) Follow up: 21.9 (21.2, 22.7) Control Baseline: 21.7 (20.0, 23.3) Follow up: 23.3 (21.4, 25.3) | ||||
Protein | Boys + Girls + | Protein (% energy) Intervention Baseline: 15.5 (15.3, 15.8) Follow up: 15.6 (15.2, 15.9) Control Baseline: 15.8 (15.1, 16.4) Follow up: 14.7 (13.9, 15.4) | ||||
Harris et al., 1997 [34] | Quasi- Experimental | Modified school lunches, Enhanced nutrition education and increased opportunities for physical activities | Knowledge and awareness regarding nutrition | Awareness levels | + | (t [33] = −6.64, p < .0001) |
O’Brien et al., 2010 [35] | Cross-Sectional | Comprehensive school health education, physical education and physical activity, school nutrition and food services, health promotion and wellness, school counselling physical and behavioral health services, school climate, physical environment, youth, parent, family and community involvement | SSB consumption | Two or more sodas/week | + | OR: 0.83 (p = .023) |
Spence et al., 2013 [36] | Natural Experiment | Nutrient-based standards | Non-milk extrinsic sugar | % energy NMES | = | Mean difference: −2.6 (−3.2, −1.9) (p < 0.001) |