文章基本信息

标题：Development of the Policy Indicator Checklist: A Tool to Identify and Measure Policies for Calorie-Dense Foods and Sugar-Sweetened Beverages Across Multiple Settings
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作者：Rebecca E. Lee ; Allen M. Hallett ; Nathan Parker 等
期刊名称：American journal of public health
印刷版ISSN：0090-0036
出版年度：2015
卷号：105
期号：5
页码：1036-1043
DOI：10.2105/AJPH.2015.302559
语种：English
出版社：American Public Health Association
摘要：Objectives. We developed the policy indicator checklist (PIC) to identify and measure policies for calorie-dense foods and sugar-sweetened beverages to determine how policies are clustered across multiple settings. Methods. In 2012 and 2013 we used existing literature, policy documents, government recommendations, and instruments to identify key policies. We then developed the PIC to examine the policy environments across 3 settings (communities, schools, and early care and education centers) in 8 communities participating in the Childhood Obesity Research Demonstration Project. Results. Principal components analysis revealed 5 components related to calorie-dense food policies and 4 components related to sugar-sweetened beverage policies. Communities with higher youth and racial/ethnic minority populations tended to have fewer and weaker policy environments concerning calorie-dense foods and healthy foods and beverages. Conclusions. The PIC was a helpful tool to identify policies that promote healthy food environments across multiple settings and to measure and compare the overall policy environments across communities. There is need for improved coordination across settings, particularly in areas with greater concentration of youths and racial/ethnic minority populations. Policies to support healthy eating are not equally distributed across communities, and disparities continue to exist in nutrition policies. There has been increasing attention on policy-focused approaches to reduce the prevalence of childhood obesity 1–6 at the federal (e.g., Public Law 111–296), 7–9 state, 10–17 and local 6,16,18 levels of government. Policies are a promising strategy at all levels for sustainable improvements in health, because an effective policy can change contextual cues and, in turn, affect many individual behavioral choices with very little individual effort. 1,19,20 Despite the promise of these approaches, there is a lack of comprehensive, systematic, and valid measurement protocols that may be applied across multiple settings. Settings are places where policies can improve child behavior or the behavior of adults that affects children; these settings include communities, schools, and early care and education centers (ECECs), among others. Policies have the potential to change community food environments, 21,22 to improve food access and availability in schools and ECECs, 23–31 and to affect the pricing and marketing of food (e.g., vending machines), all of which could have an important impact on dietary habits. 32,33 Taken together, most studies are descriptive in nature, do not actually investigate the policy itself, are often regionally specific, and do not account for the broad range of policies that may make up the child nutrition policy portfolio across multiple settings. These limitations make research that combines the effects of policies across settings impossible, so it is unknown how policies in different settings may complement or confound each other. There is little understanding of how, when, or why policies may work at one level together with policies at another level to produce sustainable systems changes. This hampers the ability of policymakers within and across settings to partner together and to enact policies at multiple levels that might yield the greatest impact for improving health. Policy enactment often outpaces available evidence. Policies originate from a broad range of places, including the immediate concerns of constituent or advocacy groups, best practices or models, or knee-jerk responses to current events or political pressures. 34 As a consequence, policymakers may produce policies that fall short of efficacy evidence and understanding of what is needed for implementation. To date, research has been limited by the lack of standardized measures and protocols that are widely applicable across municipal, state, and federal levels, as well as across settings, such as community, school, and ECEC settings. There is need for development of instruments that incorporate multiple levels of analysis and settings to measure policies that may influence these behaviors. 35 This is vital to enhance monitoring and evaluation of policies that might create supportive nutrition environments and improve the readiness of communities to deliver childhood obesity prevention programs. The Childhood Obesity Research Demonstration (CORD) project, which was funded by the Centers for Disease Control and Prevention, tested whether integrating primary care interventions and public health interventions within multiple settings (community, schools, and ECEC settings) that targeted obesity-related behaviors and health outcomes among participants could provide lasting impact to reduce childhood obesity. 36 The demonstration sites spanned 8 communities in 3 states, which allowed the CORD evaluation center to assess policies to provide comprehensive recommendations on how future programs should be designed nationwide. The project targeted children 2 to 12 years old who were eligible for services provided by Medicare and the Children’s Health Insurance Program. 37 As part of the evaluation, we developed the policy indicator checklist (PIC) to measure the policy environments of the 8 CORD communities with special attention to community, school, and ECEC settings. We described the development and testing of 2 PIC subscales that focused on calorie-dense foods and sugar-sweetened beverages. We used factor analysis to determine common policy components or dimensions that represented a community’s overall policy environment. Last, we aimed to compare the CORD communities on these policies by sociodemographic dimensions of educational attainment, youth population, and racial/ethnic composition.