Healthier Schools & Latino Kids Research: Introduction and Methods

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This is part of our Healthier Schools & Latino Kids: A Research Review »

Introduction

Obesity is a nationwide problem in the United States, and Latino children and adolescents are especially at risk.

Nearly 40 percent of U.S. Latino youths ages 2-19 are overweight or obese, compared to 28.5 percent of non-Latino white youths, according to a recent estimate.1Among children ages 2-5, 29.8 percent of Latino children are overweight or obese; this compares to about 21 percent of non-Latino white children of the same age.

The prevalence of obesity among Latino children and adolescents is of great concern given the multiple adverse physical and mental health issues related to obesity, including cardiovascular disease, asthma, type 2 diabetes, liver disease, sleep apnea, and psychological stress, among others.2 As children who are obese are more likely to be obese as adults,2 childhood represents an important developmental stage for preventing and/or reducing obesity.

From 2001 through 2011, the number of Latino students enrolled in U.S. public schools increased from 8.2 million students (17% of all students) to 11.8 million (24%).3 In contrast, the number of white students enrolled during this period decreased from 28.7 million students (60% of all students) to 25.6 million (52%).

The percentage of Latino students enrolled in public schools is expected to continue to rise, reaching an estimated 30 percent in 2023.

Because many U.S. students, including Latino children and adolescents, consume up to half their daily calories at school,4 foods and beverages available in schools have the potential to influence students’ diets and weight.

Competitive foods, sold through à la carte lines in the cafeteria, vending machines, school stores, snack bars, and other venues,5,6 are often high in fat, calories, sugar and/or salt, and offer little nutritional value.4

Key findings from a 2012 health impact assessment (HIA) indicated that a national competitive foods policy may support a healthy weight and reduced risk of overweight or obesity among Latino students. Based on a review of available evidence, the authors concluded that implementation of strong nutrition standards would benefit vulnerable populations, including Latino students, who are often more likely to have weight-related health issues.4

As required by the Healthy, Hunger-Free Kids Act of 2010, the U.S. Department of Agriculture updated nutrition standards for the National School Lunch Program and School Breakfast Program at the beginning of the 2012-13 school year.

In January 2013, USDA proposed updated nutrition standards for competitive foods and beverages—the first in more than 30 years.7 All schools participating in the federal school meal programs were required to implement updated competitive food nutrition standards (often referred to as the Smart Snacks in School program) beginning in the 2014-2015 school year.

In January 2015, the USDA proposed a rule (based on the Dietary Guidelines for Americans and recommendations from the Institute of Medicine and mandated by the Healthy, Hunger-Free Kids Act) to improve nutrition standards for meals provided through its Child and Adult Care Food Program (CACFP).8

The proposal introduces science-based nutrition standards for meals dispensed through the program, which provides meals for child, adolescent, and adult attendees of daycare centers, Head Start programs, emergency shelters, and after-school programs throughout the United States.

When finalized, the proposed rule would mark the first significant change to the CACFP since 1968.8,9

Physical activity is also an important factor in obesity prevention, and has been found to provide other benefits associated with physical and cognitive growth and development, including improved overall health and academic performance.10–15 According to current guidelines from the United States Department of Health and Human Services, children should participate in at least 60 minutes of moderate-intensity physical activity per day.16

Studies suggest that Latino children are less likely to meet the recommendations for daily physical activity and are more likely to engage in sedentary behaviors than White children.17–19

Current literature suggests that many factors may be associated with lower levels of physical activity among Latino children, and addressing these factors may lead to higher levels of physical activity.11

This review assesses current evidence (2008-present) on access to competitive foods in schools and its impact on childhood obesity among Latino students and summarizes the current evidence on barriers to and supports for physical activity among Latino children, as well as potential strategies for increasing their physical activity levels during school.

Methodology

This research review summarizes scientific literature (as well as the gray literature) regarding the influence of access to competitive foods in daycare centers, preschools, and K-12 schools on nutrition, overweight, and obesity among Latino children and adolescents ages 2-19; and identifies literature relevant to increasing physical activity among Latino children (defined as individuals younger than 18) in school and school-based before- or after-school programs.

Keyword searches were conducted in PubMed and Google Scholar. Databases were searched with key terms such as: “competitive food AND Latino childhood obesity,” “competitive food in school AND obesity AND Hispanic,” “competitive food AND childhood obesity,” “competitive food in school AND BMI, overweight preschool AND Hispanic,” “competitive food in school AND access,” “child care AND obesity and Hispanic,” “child care AND food policy AND Hispanic”, “USDA ‘smart snacks in school’ AND Hispanic,” “preschool AND food policy AND Hispanic,” “school sports AND Hispanic,” “school physical activity AND Hispanic,” “school recess AND Hispanic,” “health policy AND schools AND Hispanic,” and “local wellness policy AND Hispanic.”

We also searched combinations of the following keywords and Medical Subject Headings (MeSH) terms: community, neighborhood, physical activity, youth, Latino, “Hispanic Americans”[MeSH], “Mexican Americans”[MeSH], “Child”[MeSH], “Adolescent”[MeSH], “Overweight”[MeSH] “Obesity”[MeSH], “Pediatric Obesity”[MeSH], “Obesity, Morbid”[MeSH], “Motor Activity”[MeSH], “Play and Playthings”[MeSH], “Recreation””[MeSH], “Schools”[MeSH], “Community-Based Participatory Research”[MeSH], “Community Networks”[MeSH], “Community Health Planning”[MeSH], “Policy”[MeSH], “Public Policy”[MeSH], “Policy Making”[MeSH], “Health Policy”[MeSH].

Article titles and abstracts were examined, and relevant articles were retrieved, including those that were contradictory. Additional articles were identified through searches of the references of the initial set of publications found through keyword searches, and additional sources of evidence include reports from governmental agencies and other relevant stakeholders and peer-reviewed, published studies and review articles.

The literature identified for this review is comprised primarily of survey-based research (interviews and questionnaires) and non-comparative studies. To be included, the studies must have stated in the study abstract and/or methods that ethnicity was considered in the analysis or must have included a high proportion (greater than 30%) of Latino students in the study population. Search limits were confined to the English language.

More from our Healthier Schools & Latino Kids: A Research Review »

References for this section »

(1) Ogden, C. L.; Carroll, M. D.; Kit, B. K.; Flegal, K. M. Prevalence of Childhood and Adult Obesity in the United States, 2011-2012. JAMA 2014, 311 (8), 806–814.

(2) Centers for Disease Control and Prevention. Obesity and Overweight for Professionals: Childhood Basics. Available at: http://www.cdc.gov/obesity/childhood/basics.html (accessed Nov 16, 2012).

(3) National Center for Education Statistics. The Condition of Education: Racial/Ethnic Enrollment in Public Schools. Available at: http://nces.ed.gov/programs/coe/indicator_cge.asp (accessed Mar 13, 2015).

(4) Robert Wood Johnson Foundation. Health Impact Assessment: National Nutrition Standards for Snack and a La Carte Foods and Beverages Sold in Schools; 2012.

(5) Johnston, L. D.; O’Malley, P. M.; Terry-McElrath, Y.; Colabianchi, N.; Foundation, R. W. J. School Policies and Practices to Improve Health and Prevent Obesity: National Secondary School Survey Results. Volume 2; Ann Arbor, 2012.

(6) Turner, L.; Chaloupka, F.; Sandoval, A. School Policies and Practices for Improving Children’s Health: National Elementary School Survey Results: School Years 2006–07 through 2009–10; 2012.

(7) USDA Food and Nutrition Service. National School Lunch Program and School Breakfast Program: Nutrition Standards for All Foods Sold in School as Required by the Healthy, Hunger-Free Kids Act of 2010; Federal Register, 2013; p p. 54.

(8) USDA Food and Nutrition Service. Child and Adult Care Food Program: Meal Pattern Revisions Related to the Healthy, Hunger-Free Kids Act of 2010; Federal Register, 2015; p p. 24.

(9) Kong, A.; Odoms-Young, A. M.; Schiffer, L. A.; Kim, Y.; Berbaum, M. L.; Porter, S. J.; Blumstein, L. B.; Bess, S. L.; Fitzgibbon, M. L. The 18-Month Impact of Special Supplemental Nutrition Program for Women, Infants, and Children Food Package Revisions on Diets of Recipient Families. Am. J. Prev. Med. 2014, 46 (6), 543–551.

(10) Hohensee, C. W.; Nies, M. A. Physical Activity and BMI: Evidence from the Panel Study of Income Dynamics Child Development Supplement. J. Sch. Health 2012, 82 (12), 553–559.

(11) Centers for Disease Control and Prevention. School Health Guidelines to Promote Healthy Eating and Physical Activity. Morb. Mortal. Wkly. report. 2011, 60 (5), 1–76.

(12) Johnston, C. a; Tyler, C.; Fullerton, G.; McFarlin, B. K.; Poston, W. S. C.; Haddock, C. K.; Reeves, R. S.; Foreyt, J. P. Effects of a School-Based Weight Maintenance Program for Mexican-American Children: Results at 2 Years. Obesity (Silver Spring). 2010, 18 (3), 542–547.

(13) McFarlin, B. K.; Johnston, C. J.; Carpenter, K. C.; Davidson, T.; Moreno, J. L.; Strohacker, K.; Breslin, W. L.; Foreyt, J. P. A One-Year School-Based Diet/exercise Intervention Improves Non-Traditional Disease Biomarkers in Mexican-American Children. Matern. Child Nutr. 2013, 9 (4), 524–532.

(14) Gyllenhammer, L. E.; Vanni, A. K.; Byrd-Williams, C. E.; Kalan, M.; Bernstein, L.; Davis, J. N. Objective Habitual Physical Activity and Estradiol Levels in Obese Latina Adolescents. J. Phys. Act. Health 2013, 10 (5), 727–733.

(15) Many, G.; Hurtado, M. E.; Tanner, C.; Houmard, J.; Gordish-Dressman, H.; Park, J. J.; Uwaifo, G.; Kraus, W.; Hagberg, J.; Hoffman, E. Moderate-Intensity Aerobic Training Program Improves Insulin Sensitivity and Inflammatory Markers in a Pilot Study of Morbidly Obese Minority Teens. Pediatr Exerc Sci 2013, 25 (1), 12–26.

(16) U.S. Department of Health and Human Services. 2008 Physical Activity Guidelines for Americans: Contents. Available at: http://www.health.gov/PAGuidelines/guidelines/default.aspx (accessed Dec 21, 2012).

(17) Kann, L.; Kinchen, S.; Shanklin, S. L.; Flint, K. H.; Kawkins, J.; Harris, W. a; Lowry, R.; Olsen, E. O.; McManus, T.; Chyen, D.; et al. Youth Risk Behavior Surveillance–United States, 2013. MMWR. Surveill. Summ. 2014, 63 Suppl 4 (4), 1–169.

(18) Trost, S. G.; Mccoy, T. a.; Vander Veur, S. S.; Mallya, G.; Duffy, M. L.; Foster, G. D. Physical Activity Patterns of Inner-City Elementary Schoolchildren. Med. Sci. Sports Exerc. 2013, 45 (3), 470–474.

(19) Fakhouri, T. H.; Hughes, J. P.; Brody, D. J.; Kit, B. K.; Ogden, C. L. Physical Activity and Screen-Time Viewing among Elementary School-Aged Children in the United States from 2009 to 2010. JAMA Pediatr 2013, 167 (3), 223–229.

By The Numbers By The Numbers

84

percent

of Latino parents support public funding for afterschool programs.

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