Li-Ling Hsu, Suh-Ing Hsieh
Development and psychometric evaluation of the competency inventory for nursing students: a learning outcome perspective
Nurse education today
prevalence obesity among youths 2 19 years age us 2017 2018 193 previous studies suggested school lunch consumption associated increased obesity healthy hungerfree kids act 2010 hhfka strengthened nutritional standards schoolbased meals evaluate association hhfka youth body mass index bmi cohort study conducted using data environmental influences child health outcomes program nationwide consortium child cohort studies january 2005 march 2020 cohorts us youths aged 5 18 years reported height weight measurements included full implementation hhfka main outcome annual bmi zscore bmiz trends january 2005 august 2016 september 2016 march 2020 implementation hhfka adjusted selfreported race ethnicity maternal education cohort group interrupted timeseries analysis design used fit generalized estimating equation regression models total 14 121 schoolaged youths 7237 513 male mean sd age first measurement 88 36 years contributing 26 205 bmi measurements included study overall significant decrease observed annual bmiz period following implementation hhfka compared prior implementation 0041 95 ci 0066 0016 interaction models evaluate subgroup associations similar trends observed among youths 12 18 years age 0045 95 ci 0071 0018 among youths living households lower annual income 0038 95 ci 0063 0013 cohort study hhfka implementation associated significant decrease bmiz among schoolaged youths us findings suggest school meal programs represent key opportunity interventions combat childhood obesity epidemic given high rates program participation proportion total calories consumed schoolbased meals