OBJECTIVE. To evaluate the effect of a pediatric primary care-based intervention, on improved clinical decision support and family management of risk behaviors for childhood overweight.METHODS. An experimental field trial was conducted with 12 intervention sites in urban and rural areas of Maine and nonrandomized control sites. Change was assessed by using clinical and parent measures from 9 intervention and 10 control sites before and during the Maine Youth Overweight Collaborative intervention. Longitudinal information was collected from chart audits of patients aged 5-18 years (n ϭ 600), systematic samples of parents collected before (n ϭ 346) and during (n ϭ 386) the intervention in 12 sites, and systematic samples of parents in 9 intervention (n ϭ 235) and 10 control (n ϭ 304) sites collected during the intervention. Surveys of health care providers (n ϭ 14 and 17) before and during the intervention were also collected. Teams worked over 18 months to implement improvements in clinical decision support, including tracking BMI percentiles, identification of overweight patients, appropriate laboratory tests, counseling of families and patients use of a behavioral screening tool, and other improvements following the chronic-care model targeting patients aged 5 to 18 and their families.RESULTS. Large changes occurred in clinical practice from before to during the Maine Youth Overweight Collaborative: increases in assessment of BMI (38%-94%), BMI percentile for age and gender (25%-89%), use of the 5-2-1-0 behavioral screening tool (0%-82%), and weight classification (19%-75%). Parent surveys indicated improvements in providers' behavior and rates of counseling. Intervention providers reported improvements in knowledge, attitudes, self-efficacy, and practice.CONCLUSIONS. The Maine Youth Overweight Collaborative intervention improved clinical decision support and family management of risk behaviors, indicating a promising primary care-based approach to address overweight risk among children and youth. Pediatrics 2009;123:S258-S266 T HE PREVALENCE OF childhood overweight* is increasing rapidly in the United States and now affects at least 16% of children and adolescents, 1 with even higher rates among subpopulations of minority, economically disadvantaged 2,3 and rural children. 4 Overweight is associated with significant health problems in this age group and is an important early risk factor for much of adult morbidity and mortality. The rapid increase in the prevalence of childhood and adolescent overweight portends an increase in associated chronic disease. An estimated 60% of overweight 5-to 10-year-olds already have 1 associated cardiovascular disease risk factor, or hyperinsulinemia, and more than 20% have 2 or more associated cardiovascular disease risk factors. 5 The incidence of type 2 diabetes, until recently thought to have an almost exclusively adult onset, has increased dramatically among youth. 6 Overweight and sedentary children and adolescents are also more likely than their peers to have adv...

Objective: To carry out a pilot study to determine if a supermarket double-dollar fruit and vegetable (F&V) incentive increases F&V purchases among low-income families Design: Randomized controlled design. Purchases were tracked using a loyalty card that provided participants with a 5% discount on all purchases during a 3-month baseline period followed by the 4-month intervention. Setting: A supermarket in a low-income rural Maine community Participants: 401 low-income and SNAP supermarket customers Intervention: Same day coupon at checkout for half-off eligible fresh, frozen or canned F&V over 4 months Main Outcome Measure: Weekly spending in dollars on eligible F&V Analysis: A linear model with random intercepts accounted for repeated transactions by individuals to estimate change in F&V spending per week from baseline to intervention. Secondary analyses examined changes among SNAP-eligible participants. Results: Coupons were redeemed among 53% of eligible baskets. Total weekly F&V spending increased in the intervention arm compared to control ($1.83, 95% CI=$0.29, 3.88). The largest increase was for fresh F&V ($1.97, 95% CI=$0.49, 3.44). Secondary analyses revealed greater increases in F&V spending among SNAP-eligible participants who redeemed coupons ($5.14, 95% CI =$1.93, 8.34) than among non-SNAP-eligible participants who redeemed coupons ($3.88, 95% CI =$1.67, 6.08). Conclusions and Implications: A double-dollar pricing incentive increased F&V spending in a low-income community despite the moderate uptake of the coupon redemption. SNAP-eligible customers saw the greatest F&V spending increases. Financial incentives for F&V are an effective strategy for food assistance programs to increase healthy purchases and improve dietary intake in low income families.

ObjectiveTo evaluate whether calorie labeling of menus in large restaurant chains was associated with a change in mean calories purchased per transaction.DesignQuasi-experimental longitudinal study.SettingLarge franchise of a national fast food company with three different restaurant chains located in the southern United States (Louisiana, Texas, and Mississippi) from April 2015 until April 2018.Participants104 restaurants with calorie information added to in-store and drive-thru menus in April 2017 and with weekly aggregated sales data during the pre-labeling (April 2015 to April 2017) and post-labeling (April 2017 to April 2018) implementation period.Main outcome measuresPrimary outcome was the overall level and trend changes in mean purchased calories per transaction after implementation of calorie labeling compared with the counterfactual (ie, assumption that the pre-intervention trend would have persisted had the intervention not occurred) using interrupted time series analyses with linear mixed models. Secondary outcomes were by item category (entrees, sides, and sugar sweetened beverages). Subgroup analyses estimated the effect of calorie labeling in stratums defined by the sociodemographic characteristics of restaurant census tracts (defined region for taking census).ResultsThe analytic sample comprised 14 352 restaurant weeks. Over three years and among 104 restaurants, 49 062 440 transactions took place and 242 726 953 items were purchased. After labeling implementation, a level decrease was observed of 60 calories/transaction (95% confidence interval 48 to 72; about 4%), followed by an increasing trend of 0.71 calories/transaction/week (95% confidence interval 0.51 to 0.92) independent of the baseline trend over the year after implementation. These results were generally robust to different analytic assumptions in sensitivity analyses. The level decrease and post-implementation trend change were stronger for sides than for entrees or sugar sweetened beverages. The level decrease was similar between census tracts with higher and lower median income, but the post-implementation trend in calories per transaction was higher in low income (change in calories/transaction/week 0.94, 95% confidence interval 0.67 to 1.21) than in high income census tracts (0.50, 0.19 to 0.81).ConclusionsA small decrease in mean calories purchased per transaction was observed after implementation of calorie labeling in a large franchise of fast food restaurants. This reduction diminished over one year of follow-up.