November 2021

New NCCOR Report Examines the Impact of COVID-19 among Young Children

This month, NCCOR published a new report, titled Key Informant Interviews to Inform Nutrition and Physical Activity Efforts in Child Care Settings During the COVID-19 Pandemic, which highlights research needs and the impact of the COVID-19 pandemic and related legislation on the early care and education (ECE) system from the perspective of researchers, practitioners, and federal representatives. NCCOR worked with the Gretchen Swanson Center for Nutrition (GSCN) to conduct key informant interviews to explore how the Coronavirus Aid, Relief, and Economic Security Act (CARES) and American Rescue Plan (ARP) investments may affect the ECE landscape and ECE facilities, including how it will impact children aged 0-13 years, the ages designated in the legislation. The report is also accompanied by a one-pager that highlights key themes and considerations for strategic use of recovery funds

Key informants identified the following among impacts of the COVID-19 pandemic on ECE settings: high levels of stress for program staff; increased food insecurity among children, families, and ECE staff; greater attention to existing structural inequality within ECE workforce; reduced physical activity and decreased nutritional quality of foods served.

Adjustments and modifications made during the pandemic, often through temporary flexibilities and waivers from federal regulations, likely have both positive and negative impacts. In some cases, flexibilities may have granted leniency that contributed to programs providing less nutritious and more processed foods; however, these same flexibilities have also allowed new promising practices to emerge, such as virtual monitoring of Child and Adult Care Food Program (CACFP) organizations. Key informants noted that the upcoming Child Nutrition Reauthorization presents an opportunity to sustain beneficial flexibilities through longer-term policy change. Evaluations of the impacts of CACFP flexibilities and waivers on food security, diet quality, participation, and program cost could help inform policy. The report also identified 1) opportunities for recovery funding to strengthen child care systems, including actions to support staff recruitment and retention, and their ability to support children’s health and 2) related research and evaluation needs.

NCCOR intends for this report to reach researchers, federal agencies, and policy makers at state levels and early childhood administrators who can use this information to inform their recovery efforts and programs. For more information, check out NCCOR’s project webpage, Impact of COVID-19 on Child Care Programs, Potential Solutions & Emerging Opportunities, which shares potential solutions and considerations for recovery funds for each of these four groups.

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NCCOR Toolbox: Active Travel to School White Paper

NCCOR has just released a new white paper titled “Improving Surveillance of Youth Active Travel to School.” These recommendations stem from two recent NCCOR activities 1) a systematic review that found few youth active travel to school (ATS) surveillance systems exist in North America, and that concurrent monitoring of other ATS-related features in these systems is limited or absent, and 2) a virtual workshop in October 2020 to explore key challenges related to surveillance and measurement of youth ATS. The new white paper will help advance ATS research and surveillance as a priority topic area within overall physical activity surveillance by establishing baseline data where needed and track implementation and evaluation of interventions, programs, and policies that aim to increase physical activity through ATS.

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New Social Media Toolkit Spotlights the Risks of Sugary Fruit Drinks

A new toolkit seeks to reduce the consumption of fruit drinks, which are the most consumed sugary beverage in young children, especially among Latinx children. A “fruit drink” is a fruit flavored beverage containing added sugar that is not 100% juice. The new toolkit contains evidence-based social media messages, in English and Spanish, to highlight the health risks of consuming fruit drinks and promote water as the better alternative. This campaign has been sponsored by Healthy Eating Research, the Arcora Foundation, and the Foundation of Delta Dental of Washington.

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New Toolkit Promotes Youth Sports Programs

The National Recreation and Park Association has developed a new communications toolkit, in partnership with the Walt Disney Company, to help park and recreation professionals make connections and encourage participation in park and recreation youth sports programs. This toolkit provides data-backed messaging, sample social media posts, template graphics, and more.

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Social Inequities Perpetuate Breastfeeding Disparities for Black Women

November 8, EuerkAlert!

As Black women continue to have the lowest breastfeeding initiation and duration rates in the United States, researchers examined factors associated with breastfeeding disparities and inequities through the lens of critical race theory and the social-ecological model in a new Perspective in the Journal of Nutrition Education and Behavior, published by Elsevier.

In the United States, there has been a heightened recognition of the health and social disparities that continuously impact Black, Indigenous, and People of Color (BIPOC) communities. Among these health disparities is the low rate of breastfeeding among Black mothers, despite the association between positive health outcomes and breastfeeding. A general lack of acceptance about breastfeeding within the Black American culture and American culture; lack of neighborhood resources like primary care, social cohesion, and safety; and experiences of racism and implicit bias by health care providers have been identified as contributing factors to the low breastfeeding rates among Black women.

“The reality is that right now the breastfeeding rates in the United States are not improving, and [Black women] have the lowest rates of breastfeeding for any race or ethnicity in the US. Unfortunately, the breastfeeding rates between Black infants and White infants are widening, so what we’re doing right now is not working,” said Melissa Petit, MN PH, BA, RN, IBCLC, College of Nursing, Washington State University, Spokane, WA, USA.

This Perspective encourages healthcare providers and nurses to address breastfeeding disparities among Black women in the US from the individual level to the societal level.

“In clinical practice, we need to examine the roadblocks or barriers to fostering inclusion and equity in health care for all women. We need to identify our own assumptions about race, understand and acknowledge our own biases and perceptions, and challenge our own thoughts to identify our own microaggressions by reading about microinequities and microaggressions. We need to be active practitioners of trauma informed care. We need to realize trauma impacts patients and recognize the signs and symptoms of trauma whether it be historical or structural or personal, and we need to respond by implementing care structures for all women by acknowledging our shared humanity and challenges in that shared humanity,” commented coauthor Denise Smart, DrPH, MPH, BSN, RN, College of Nursing, Washington State University, Spokane, WA, USA.

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Diet and Exercise Can Improve Teens’ Mental Health

November 2, University of Colorado Boulder

Depression and anxiety have been increasing among teenagers worldwide for many years, and the COVID-19 global pandemic only exacerbated the problem.

In October 2019, before anyone had heard of the SARS-CoV-2 virus, though, Peter Templeton, founder of the William Templeton Foundation for Young People’s Mental Health and executive director at Institute for Manufacturing’s Engage program in the Cambridge University Engineering Department, launched a wide-ranging, international, multi-disciplinary project intended to “innovate early interventions for depression in young people.”

The project brought together stakeholders and specialists from students to educators, physicians, nutritionists, researchers and even insurance-company representatives to focus on “key aspects of the causal pathways of depression in young people,” including genes and epigenetics, the microbiota-gut-brain axis, the hypothalamic-pituitary-adrenal (HPA) “stress” axis, diet and nutrition, exercise and sleep.

Among those invited to participate was Christopher Lowry, associate professor of integrative physiology at the University of Colorado Boulder.

Christopher Lowry, a professor of integrative physiology, is one of the researchers on the program aimed at innovating early interventions for teenagers with depression.

“I was attracted to the project because my research is focused on stress-related psychiatric disorders,” Lowry says. “My work on the microbiome-gut-brain axis was particularly why I was invited.”

After collating ideas and information from a series of online workshops from November 2019 to January 2020, the project issued its 120-page final report, “Changing Hearts, Changing Minds: Evidence-based approaches to the prevention, diagnosis and treatment of depression in young people,” in September.

One key finding is that diet, nutrition and exercise are among the most accessible and effective interventions to reduce depression in young people.

Most people intuit that diet and exercise improve the physical health of the human body. But Lowry and other researchers have been steadily building a body of evidence confirming that they also have a profound impact on mental health, through mechanisms as varied as the “gut-brain axis,” epigenetics, the impact of hormones on stress, and sleep.

“Diet and nutrition is one of the main factors that influences mental-health outcomes,” Lowry says. “But I don’t think people have really processed how fundamentally important it is.”

That may sound simple, Lowry says, but those interventions “are also potentially the hardest to implement because they involve lifestyle changes.” In both the United States and United Kingdom, there are considerable obstacles to improving diet and nutrition among young people, as well as to getting them to exercise more.

For example, U.S. schools in the 1970s and ‘80s often provided homemade “hot lunches” and families sent children to school with a brown bag, but today’s school cafeterias typically peddle food high in calories, salt, sugar and fat, and students may go off campus to eat fast food.

The answer, Lowry says, “is to reduce takeout foods, trans fats, high-sugar and ultra-processed foods and replace them with vegetables, fruits, nuts, seeds, healthy oils and fish … Basically a Mediterranean diet.”

Easier said than done, for a host of reasons.

First, it’s no surprise that kids gravitate toward high-fat, high-sugar, high-salt food: The human body is evolutionarily primed to seek out such once-difficult-to-obtain nutrients.

But politics also has made it difficult to even offer healthy options in schools, Lowry says. In Britain, celebrity chef Jamie Oliver’s effort to improve school nutrition met considerable resistance, while former First Lady Michelle Obama’s campaign to reduce childhood obesity was criticized as an attack on liberty.

Additional challenges include poverty and families living in “food deserts” with limited access to affordable, nutritional food.

“If their only source of food is a Dollar Store, they have very little access to fresh fruit and vegetables,” Lowry notes.

Meanwhile, Lowry’s research suggests a radically altered approach to nutrition and diet. Since a healthy gut microbiome can reduce inflammatory disease and improve mental health, the best thing humans can do is increase the variety of organisms living in their bodies, he says.

“It’s like a self-sustaining Amazon rainforest vs. a monoculture of wheat, where you have to input fertilizer and pesticide and fungicide, just to keep it alive,” Lowry says. “Turns out the microbiome is like that: The more diversity you have, the consensus is, the healthier you are.”

Eating a wide variety of plant-based food—up to 30 different kinds of plant, with up to 1,000 species of bacteria per plant, per week, Lowry says—can mean the ingestion of up to 30,000 species of bacteria that survive in specialized ecosystems on and in different plants.

Diet and nutrition is one of the main factors that influences mental-health outcomes. … But I don’t think people have really processed how fundamentally important it is.”

“That understanding has completely changed the way I think about feeding my own children. I’ll give them one or two small carrots, one or two blueberries, and so on, very small proportions, very high diversity of foods. It would be great if you could buy a pack of 30 different vegetables at the grocery store, take it home and graze on all those different plants. … We need a little ‘hunter-gatherer’ pack, but no one’s done that yet.”

Getting kids to exercise more to improve their mental health faces implementation challenges, as well. Just 24% of children 6 to 17 years of age participate in the recommended 60 minutes of physical activity every day, according to the U.S. Centers for Disease Control (CDC), and levels of activity decline continually as they age.

In decades past, American schools placed greater emphasis on challenging physical education, requiring all students to do everything from run a timed mile once a month to clambering up a two-story rope and do calisthenics. But where 41% of high-school students participated in physical education activities in 1991, only 25% did as of 2015, and just 3.7% of K–12 schools require daily physical education, according to the CDC.

And increasing obesity in children—almost one out of five children is considered clinically obese, the CDC reports—“further impairs their ability to engage in meaningful exercise,” creating a downward spiral.

Despite the challenges moving forward, Lowry applauds the innovative process that led to the report. Based on engineering principles and tested management techniques, it brought together participants from widely varying fields, disciplines and backgrounds to collaborate on identifying the problem and potential interventions.

“As scientists, one of the criticisms we often hear is that we work in siloes—a narrow focus, without really interacting with other scientists,” he says. “But this particular project was good at breaking down those siloes. … It’s rare to be able to engage with a process that has such a broad spectrum of participants.”

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New Study Reveals Marketing Disproportionately Affects Purchases of Sweetened Children’s Drinks by Households with Low Incomes

October 26, Rudd Center for Food Policy & Health

Continued extensive advertising that targets children and families, as well as lower prices of sweetened children’s fruit drinks, influence purchasing behaviors of U.S. households with young children, according to a new study from researchers at the Rudd Center for Food Policy and Health at the University of Connecticut.

The study’s findings, published in the  American Journal of Preventive Medicine, revealed that households with low incomes purchased more sweetened children’s fruit drinks than households with higher incomes, while households with higher incomes purchased more sugar-sweetened flavored water and unsweetened juices. Non-Hispanic Black and Hispanic households also purchased more fruit drinks than non-Hispanic white households, and Hispanic households purchased more unsweetened juices.

“Companies continue to advertise sweetened children’s drinks, including offering them at lower price points, despite years’ worth of evidence that show such products harm our health. Of particular concern is that advertising is targeted to people in low-income communities and people of color, who are also disproportionately at risk for diet-related diseases, including obesity and type 2 diabetes,” says Yoon Young Choi, the study’s lead author and statistician at the UConn Rudd Center.

The study examined trends over 12 years (2006-2017) in children’s drink purchases (sweetened fruit drinks and flavored water and unsweetened juices) among U.S. households with children ages 1 to 5. The researchers used Nielsen consumer panel data, including demographic information, and Nielsen TV advertising expenditures. They modeled the relationship between marketing (advertising spending, price-per-ounce, and special deals) and household purchases, including differences by household race/ethnicity and income.

Key findings include:

• The amount of money that drink brands spent on TV advertising was directly related to household purchases of the drinks advertised.
• Responsiveness to advertising was disproportionately higher for households with lower incomes.
• Advertising spending on sweetened children’s fruit drinks and flavored water decreased by 68%, whereas unsweetened juice advertising increased by 47%.
• Prices increased for all drink types, but increases were lower (one cent-per-ounce) for sweetened fruit drinks than for unsweetened juice (four cents-per-ounce).

Households with young children (1-5 years old) purchased 27% fewer ounces of children’s fruit drinks (fruit-flavored drinks with added sugar and/or non-nutritive sweeteners) and 12% less unsweetened children’s juices in 2017 than in 2006. However, purchases of sugar-sweetened flavored water (labeled as “water beverage” and containing added sugar and/or non-nutritive sweeteners) increased by 68%. Moreover, households with young children purchased three times as many ounces of fruit drinks than unsweetened juice.

According to a recent study published in the Journal of the American Medical Association, the COVID-19 pandemic is linked to weight gain among children; researchers found a 9% increase in obesity among 5-11-year-olds. Research has also shown that both ultra-processed foods and sugary drinks cause weight gain. In addition, drinking too many sugary drinks can raise the risk of heart disease, high blood pressure, type 2 diabetes, and tooth decay. However, in 2018, companies spent $21 million advertising children’s fruit drinks and flavored water. Young children (2-5 years old) saw twice as many TV ads for sugary children’s drinks than they did for unsweetened juice, and some fruit drink brands disproportionately targeted advertising to Spanish-speaking households and/or Black children.

The authors urge the beverage industry, public health, and policy initiatives to address sugary drink consumption by young children and restrictions on marketing to children. They ask for:

• Greater industry self-regulation through the Children’s Food and Beverage Advertising Initiative (CFBAI), including closing loopholes that still allow for sugary drink marketing to children.
• Industry commitments to address disproportionate targeted marketing of sugary drinks to communities of color.
• Required disclosures of added sugars, non-nutritive sweeteners, and percentage of juice on package fronts, regulated by the U.S. Food and Drug Administration.
• Taxes on sugary drinks.

The study was co-authored by Yoon Young Choi; Tatiana Andreyeva; Frances Fleming-Milici; and Jennifer L. Harris.

This is the first-ever study that has investigated trends in children’s drink availability in households with young children and their associations with marketing and socio-demographic characteristics. It is also the first to show that purchases of sweetened children’s flavored water have increased significantly.

This study was funded by a grant from the Robert Wood Johnson Foundation (RWJF). The views expressed in this report do not necessarily reflect the views of the Foundation.

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