Rebecca Mozaffarian

Harvard University, Cambridge, Massachusetts, United States

Are you Rebecca Mozaffarian?

Claim your profile

Publications (11)18.91 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Introduction: Increasing attention is being paid to the types of beverages sold in schools as a way to reduce childhood obesity. In 2004, the Boston School Committee passed district-wide nutrition guidelines for competitive beverages sold outside of the National School Lunch Program in Boston Public Schools (BPS); guidelines were updated in 2010. We evaluated the extent to which schools were compliant with the guidelines nine years later to determine adherence and sustainability of the policy change. Approach: From March-June 2013, trained personnel documented the types/brands and sizes of competitive beverages sold in 115 schools. Nutrient data were gathered from manufacturer websites to determine compliance with BPS guidelines: in elementary schools no competitive beverages except water; in middle/high schools limited size of non-water beverages, limited calories in 100% juices, allowing low-/non-fat unflavored milk and non-fat flavored milks with sugar limits, and prohibiting sugar-sweetened beverages (SSBs), artificial sweeteners, and caffeine. Results: 90% of all schools were compliant with BPS beverage guidelines; 75% did not sell competitive beverages. 6% of elementary, 15% of middle, and 21% of high schools were not compliant with the guidelines. Most frequently observed non-compliant beverages were 100% juice in elementary schools (N=4 schools); low-fat flavored milk and SSBs in middle and high schools (N=2 schools each). SSBs were sold in 3 of the 115 buildings surveyed. Discussion:90% of BPS schools were compliant with competitive beverage guidelines nine years after implementation of the policy; SSBs were rarely available. Comprehensive district-wide competitive beverage policy can translate into sustained healthier environments.
    142nd APHA Annual Meeting and Exposition 2014; 11/2014
  • [Show abstract] [Hide abstract]
    ABSTRACT: Introduction: Physical activity and healthy eating are important components of worksite wellness policies. Hospitals are an important setting for worksite wellness initiatives because they are major employers of diverse employees. Hospital-based wellness initiatives also have potential to reach many community member visitors and patients. Methods: A multi-state study was designed to examine how hospitals promote physical activity and healthy eating among employees and visitors. In-depth, semi-structured interviews with human resources and wellness staff in over a dozen hospitals across the U.S. in both urban and rural settings are being conducted. The questionnaire and protocol was developed based on a previous study focused on examining physical education policies. The interview addressed the wellness policy environment, physical activity and nutrition components of existing wellness policies and challenges to policy creation, implementation and evaluation within hospital settings. Data analysis includes thematic evaluation. This study is conducted by the Physical Activity Policy Research Network (PAPRN) and the Nutrition and Obesity Policy Research Evaluation Network (NOPREN), two thematic research networks established by the Centers for Disease Control and Prevention (CDC). Results: Our analysis will explore key themes that emerge regarding the extent to which wellness policies focused on physical activity and nutrition guidelines are being promoted in hospital environments. Commonalities and differences across urban and rural hospitals will also be explored. Conclusion: Encouraging worksite wellness in hospital environments may encourage physical activity and healthy eating for employees, patients and visitors.
    142nd APHA Annual Meeting and Exposition 2014; 11/2014
  • [Show abstract] [Hide abstract]
    ABSTRACT: Introduction. Intake of sugar-sweetened beverages (SSB) is associated with negative health impacts. Access to healthier beverage alternatives may be promoted by policies such as the Healthy Beverages Executive Order (HBEO) established by Boston’s Mayor Menino, which directed city departments to eliminate the sale of SSB on city property. This study evaluates the impact of the HBEO, implemented in October 2011 with “traffic light signage” and educational materials at point-of-purchase. Methods. Researchers collected data on the number of beverages for sale before (n=977) and two years after (n=841) HBEO implementation as well as price, brand, and size using an environmental audit tool at all access points (n=30) at multiple city agency locations (n=71) in Boston. Nutrient data, including calories and sugar content, were obtained from manufacturer websites and used to determine HBEO beverage traffic light classification category. Change in calories, sugar and the proportion of beverages by traffic light classification at access points before and after HBEO implementation were examined using regression methods. Results. Average per beverage sugar grams (-14; p<.0001) and calories (-53; p<.0001) decreased following the implementation of the HBEO. The average proportion of high sugar (“red”) beverages available per access point declined dramatically (-31%; p<0.0001) while healthier options increased significantly (+29%; p<0.0001). City agencies were significantly more likely to offer only healthier beverages for sale after HBEO implementation (OR 8.5; 95% CI 2.4 to 30.5. Discussion. Policies such as the HBEO can promote changes that make healthy beverage options more accessible on city-owned properties at low cost.
    142nd APHA Annual Meeting and Exposition 2014; 11/2014
  • [Show abstract] [Hide abstract]
    ABSTRACT: OBJECTIVE: Eating whole grains (WG) is recommended for health, but multiple conflicting definitions exist for identifying whole grain (WG) products, limiting the ability of consumers and organizations to select such products. We investigated how five recommended WG criteria relate to healthfulness and price of grain products. DESIGN: We categorized grain products by different WG criteria including: the industry-sponsored Whole Grain stamp (WG-Stamp); WG as the first ingredient (WG-first); WG as the first ingredient without added sugars (WG-first-no-added-sugars); the word 'whole' before any grain in the ingredients ('whole'-anywhere); and a content of total carbohydrate to fibre of ≤10:1 (10:1-ratio). We investigated associations of each criterion with health-related characteristics including fibre, sugars, sodium, energy, trans-fats and price. SETTING: Two major grocery store chains. SUBJECTS: Five hundred and forty-five grain products. RESULTS: Each WG criterion identified products with higher fibre than products considered non-WG; the 10:1-ratio exhibited the largest differences (+3·15 g/serving, P < 0·0001). Products achieving the 10:1-ratio also contained lower sugar (-1·28 g/serving, P = 0·01), sodium (-15·4 mg/serving, P = 0·04) and likelihood of trans-fats (OR = 0·14, P < 0·0001), without energy differences. WG-first-no-added-sugars performed similarly, but identified many fewer products as WG and also not a lower likelihood of containing trans-fats. The WG-Stamp, WG-first and 'whole'-anywhere criteria identified products with a lower likelihood of trans-fats, but also significantly more sugars and energy (P < 0·05 each). Products meeting the WG-Stamp or 10:1-ratio criterion were more expensive than products that did not (+$US 0·04/serving, P = 0·009 and +$US 0·05/serving, P = 0·003, respectively). CONCLUSIONS: Among proposed WG criteria, the 10:1-ratio identified the most healthful WG products. Other criteria performed less well, including the industry-supported WG-Stamp which identified products with higher fibre and lower trans-fats, but also higher sugars and energy. These findings inform efforts by consumers, organizations and policy makers to identify healthful WG products.
    Public Health Nutrition 01/2013; 16(12):1-10. DOI:10.1017/S1368980012005447 · 2.48 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background:As childhood obesity has rapidly increased over the past two decades, researchers and practitioners have sought innovative strategies to promote healthy eating and physical activity early in life. Many impactful interventions have aimed at creating environmental changes in schools and afterschool programs. While situating interventions in these settings has proven effective, the development of user-friendly tools that capitalize on new technology is limited. Methods:We developed two websites, foodandfun.org and osnap.org, with complementary mobile apps to help promote healthy environments in out-of-school time settings. The sites' mobile applications use the iUI Web Framework and have been accessed by mobile devices such as the iPhone, iPad, and Android Smartphones. With the Food and Fun app, staff can browse over 70 activities that encourage fruits and vegetables, whole grains, water, and physical activity, while discouraging trans fats, sugary drinks, and screen time. The Out-of-School Time Nutrition and Physical Activity(OSNAP) app, offers two interactive self-assessments and tools that help staff overcome barriers to creating healthy afterschool environments. Results:During a 6-month pilot launch, the sites were access by 932 unique visitors in 66 countries. The program observation tool is a particularly useful feature, as analyses show this staff self-report measure can validly assess children's consumption of water(r=0.56,p=0.01), snacks and sugary drinks brought in from outside the program(r=0.68,p<0.01;r=0.71,p<0.01), and computer and TV/movie time(r=0.85,p<0.01;r=0.68,p<0.01) compared to direct observations. Conclusions:This technology brings evidence-based materials and measures to staff quickly and easily and has the promise of assisting organizations as they disseminate obesity prevention broadly for larger population impact.
    140st APHA Annual Meeting and Exposition 2012; 10/2012
  • [Show abstract] [Hide abstract]
    ABSTRACT: The Food & Fun training video is designed to help staff learn how to implement the Food & Fun Afterschool curriculum, which was developed jointly by the Harvard School of Public Health Prevention Research Center and the YMCA of the USA. The curriculum consists of 11 units and aims to promote nutrition and physical activity in out-of-school time environments. The video was created to model activities and enrich the training experience for program staff. Staff and children from afterschool programs are the main stars of the video. Each video guides staff through the curriculum units addressing each topic, behavior goals, key messages, and the relevant environmental health standards for nutrition and physical activity in out-of-school time, which guided intervention development based on current scientific evidence. Each video includes tips for communicating healthy messages to families and strategies for overcoming common barriers to make program changes. There are six video segments that highlight the main topics of Food & Fun with demonstrations of several activities from each Unit : Segment 1- Introduction, Segment 2- Fruits and Vegetables, Segment 3- Physical Activity and Screen Time, Segment 4- Water/Sugar-Sweetened Beverages, Segment 5- Healthy and Unhealthy Fats, and Segment 6- Whole Grains. All curriculum materials and training videos are provided free-of-charge through FoodAndFun.org, YouTube, Vimeo, and DVD. This research was supported by the Donald and Sue Pritzker Nutrition and Fitness Initiative, Centers for Disease Control and Prevention (Prevention Research Centers Grant U48DP001946 and U48DP000064), and the Initiative to Maximize Student Diversity (GM055353-13).
    140st APHA Annual Meeting and Exposition 2012; 10/2012
  • [Show abstract] [Hide abstract]
    ABSTRACT: A common perception is that healthful foods are more expensive than less healthful foods. We assessed the cost of beverages and foods served at YMCA after-school programs, determined whether healthful snacks were more expensive, and identified inexpensive, healthful options. We collected daily snack menus from 32 YMCAs nationwide from 2006 to 2008 and derived prices of beverages and foods from the US Department of Agriculture price database. Multiple linear regression was used to assess associations of healthful snacks and of beverage and food groups with price (n = 1,294 snack-days). We identified repeatedly served healthful snacks consistent with Child and Adult Care Food Program guidelines and reimbursement rate ($0.74/snack). On average, healthful snacks were approximately 50% more expensive than less healthful snacks ($0.26/snack; SE, 0.08; P = .003). Compared to water, 100% juice significantly increased average snack price, after controlling for other variables in the model. Similarly, compared to refined grains with trans fats, refined grains without trans fat significantly increased snack price, as did fruit and canned or frozen vegetables. Fresh vegetables (mostly carrots or celery) or whole grains did not alter price. Twenty-two repeatedly served snacks met nutrition guidelines and the reimbursement rate. In this sample of after-school programs, healthful snacks were typically more expensive than less healthful options; however, we identified many healthful snacks served at or below the price of less healthful options. Substituting tap water for 100% juice yielded price savings that could be used toward purchasing more healthful foods (eg, an apple). Our findings have practical implications for selecting snacks that meet health and reimbursement guidelines.
    Preventing chronic disease 01/2012; 9:E38. DOI:10.5888/pcd9.110097 · 1.96 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Evaluate the effect of an after-school intervention on physical activity program changes and individual behaviors among children. A quasi-experimental evaluation of a YMCA-driven environmental change intervention with 16 intervention and 16 control sites in four metropolitan areas in the United States. Intervention sites participated in learning collaboratives designed to promote physical activity and nutrition through environmental change, educational activities, and parent engagement. Behavioral foci included increasing overall physical activity levels as well as combined moderate and vigorous physical activity and vigorous physical activity. Outcomes were assessed longitudinally using preintervention and follow-up surveys of program implementation and accelerometer measures of physical activity. ActiGraph accelerometer data were collected from a sample of 212 children, ages 5-11 yr, attending the programs. On average, 3 d of data were gathered per child. Reliability of the accelerometer counts averaged 0.78. Multivariate regression models were used to control for potential confounding variables and to account for clustering of observations. Data indicate greater physical activity increases in children in intervention versus control sites after modest intervention implementation. Controlling for baseline covariates, children in intervention sites showed greater increases in average physical activity level than in control sites (76 counts per minute, P = 0.037, 95% confidence interval (CI) = 8.1-144) and more minutes of moderate and vigorous physical activity (10.5 min·d(-1), P = 0.017, 95% CI = 1.5-18.6), minutes of moderate physical activity (5.6 min·d(-1), P = 0.020, 95% CI = 0.99-10.2), and minutes of vigorous physical activity (5.1 min·d(-1), P = 0.051, 95% CI = 0.21-9.93). Results indicate significant increases in daily physical activity among children in intervention versus control sites. This study documents the effectiveness of an environmental change approach in an applied setting.
    Medicine and science in sports and exercise 08/2011; 44(3):450-7. DOI:10.1249/MSS.0b013e3182300128 · 4.46 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Current cancer care focuses on procuring the most up-to-date therapy to prevent cancer death. However, the majority of cancer survivors will not die from cancer but from cardiovascular disease.A cancer diagnosis presents a 'teachable moment' for lifestyle behavior change.Changes in key behavioral risk factors reduce cardiovascular risk; yet, this potential for primary prevention of cardiovascular disease among cancer survivors is often overlooked.Evidence now exists for both individual clinic-based approaches and complementary community-based strategies to induce successful behavior change.We propose a systematic re-alignment of clinical and research focus to complement cancer surveillance and adjuvant treatments with key patient-and community-based strategies to improve lifestyles in cancer survivors [added].
    Journal of Internal Medicine 01/2011; 269(1):88-93. DOI:10.1111/j.1365-2796.2010.02273.x · 5.79 Impact Factor
  • Rebekka M. Lee, Steve Gortmaker, Rebecca Mozaffarian, Jean Wiecha
    [Show abstract] [Hide abstract]
    ABSTRACT: Background: Sugar-sweetened beverage (SSB) consumption contributes to childhood obesity in the US. The YMCA-Harvard Afterschool Evaluation aims to improve children's nutrition and physical activity through environmental change within afterschool programs. One of six nutrition standards is to serve water as a primary beverage everyday and to eliminate SSB. We assessed water serving practices in 30 afterschool sites in 4 regions of the US and water consumption of children within these programs. Methodology: Data on water were collected at the environmental and individual level. Sites submitted monthly snack menus and site observations were made at over half of the programs. Site directors' interviews documented implementation. Child consumption data were collected through parent/child diaries pre and post and in a validation sub-study. Results: Menu analyses indicate 6 intervention and 6 control sites served water everyday at baseline. An additional 4 intervention and 1 control sites served water daily by follow-up. Site observations validated to menu data (r=0.74, p<0.01). Child observations indicate children took water when it was served to them 57% of the time; of these, 83% drank all or most of what they were served. Further analyses are examining potential barriers to implementation of this environmental change and evidence for change in children's daily water and SSB consumption. Discussion: Our findings indicate the promise of simple environmental and policy changes to promote water consumption in afterschool settings and future obesity prevention efforts.
    137st APHA Annual Meeting and Exposition 2009; 11/2009
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: We evaluated the quality of snacks and beverages served at YMCA after-school programs before and after the programs' participation in a YMCA Learning Collaborative. We collected data on the types and brands of snacks and beverages (including fresh fruits and vegetables, whole grains, foods with trans fats, water, and sugar-sweetened beverages) served daily during 3 different time periods spanning 14 months in total, and the components of the healthy eating standards. We compared snack and beverage quality before and after the intervention. Weekly servings of fresh fruits and vegetables (1.3 vs 3.9; P = .02) and weekly servings of fruits and vegetables as a whole (1.9 vs 5.2; P = .009) increased from baseline to postintervention; weekly servings of desserts (1.3 vs 0.5; P = .049), foods with added sugars (3.9 vs 2.4; P = .03), and foods containing trans fats (2.6 vs 0.7; P = .01) decreased. After the intervention, all YMCAs offered water daily, and none served sugar-sweetened beverages. The percentage of calories from fruits and vegetables significantly increased after the intervention, whereas the percentage of calories from foods containing trans fats and added sugars decreased. A learning collaborative can disseminate healthy eating standards among participating organizations and facilitate improvements in the quality of after-school snacks and beverages.
    American Journal of Public Health 10/2009; 100(5):925-32. DOI:10.2105/AJPH.2008.158907 · 4.23 Impact Factor

Publication Stats

72 Citations
18.91 Total Impact Points

Institutions

  • 2011–2013
    • Harvard University
      • Department of Society, Human Development, and Health
      Cambridge, Massachusetts, United States
  • 2009–2012
    • Harvard Medical School
      • Division of Nutrition
      Boston, Massachusetts, United States