Abstract
BACKGROUND: To reverse the epidemic of unhealthy eating and related chronic disease in the United States, intervening early in life is essential. OBJECTIVE: Identify features of community- and school-based programmes, policies and environments related to child intake of fruits and vegetables (FV) and sugar-sweetened beverages (SSB). METHODS: Dietary intake of children 4-15 years old (n = 5138) from elementary and middle schools in 130 US communities was collected by survey (of parent and/or child) in 2013-2015. Features of community programs and policies (CPPs) and school environments were collected by staff surveys, direct observation, key informant interviews, and/or document review. Community characteristics included socioeconomic status and predominant race/ethnicity. Classification and regression trees identified CPP and school environment features related to child dietary intake. RESULTS: Community sociodemographic characteristics were the first-selected variables related to child intakes. Children in communities with lower socioeconomic status and larger proportions of African Americans tended to have lower FV and higher SSB intakes. Associations of dietary intake with race/ethnicity varied with SES. CPPs that addressed certain social determinants of health were related to higher FV intake among community race/ethnicity-SES sub-groups. Few other CPPs and no school environment characteristics were related to child FV or SSB intake. CONCLUSION: Findings suggest the importance of addressing social determinants of health such as education, poverty and transportation to reduce disparities in dietary intake, and the need to tailor interventions to community characteristics. More research is needed to explore the interaction of race/ethnicity and SES on dietary intake and intervention effectiveness.