McDonald Christine M, Karamlou Tara, Wengle James G, Gibson Jennifer, McCrindle Brian W
Division of Cardiology, Department of Pediatrics, University of Toronto, The Hospital for Sick Children, Toronto, Ontario, Canada.
Arch Pediatr Adolesc Med. 2006 Sep;160(9):900-5. doi: 10.1001/archpedi.160.9.900.
Children's hospitals should advocate for children's health by modeling optimum health environments.
To determine whether children's hospitals provide optimum health environments and to identify associated factors.
Telephone survey.
Canadian and US hospitals with accredited pediatric residency programs.
Food services directors or administrative dietitians.
Health environment grades as determined for 4 domains quantifying (1) the amount of less nutritious food sold at cafeterias (cafeteria grade), (2) the presence of fast food outlets (outlet grade), (3) the amount of nutritious food alternatives available (healthful alternative grade), and (4) the presence of patient obesity or employee exercise programs (program grade).
The overall response rate was 87%. Compared with Canadian hospitals, US hospitals had more food outlets (89% vs 50%) and more snack/beverage vending machines (median, 16 vs 12) (P = .001 for both), despite equivalent consumer numbers. External companies managed more outlets at US vs Canadian hospitals (65% vs 14%; P = .01), and, generally, US hospitals recuperated more revenue from their outlets. Worst cafeteria grade was associated with US hospital location (odds ratio [OR], 8.9; 95% confidence interval [CI], 1.6-50; P = .01) and lower healthful alternative grade (OR, 0.016; 95% CI, 0.002-0.15; P<.001). Lower grade in any domain was related to whether hospitals received more revenue from noncafeteria food outlets (OR, 1.7; 95% CI, 1.06-2.72; P = .03) and the presence of more internally operated cafeterias (OR, 2.3 per cafeteria; 95% CI, 1.53-3.36; P<.001).
Children's hospitals provide suboptimal health environments. Reliance on revenue may be an important motivating factor encouraging the adoption of outlets that serve less nutritious food.
儿童医院应通过塑造最佳健康环境来倡导儿童健康。
确定儿童医院是否提供最佳健康环境，并识别相关因素。
电话调查。
设有经认可的儿科住院医师培训项目的加拿大和美国医院。
食品服务主管或行政营养师。
对4个领域确定的健康环境等级进行量化，包括（1）自助餐厅出售的营养较差食品的数量（自助餐厅等级），（2）快餐店的存在情况（店铺等级），（3）可获得的营养食品替代品的数量（健康替代品等级），以及（4）患者肥胖或员工锻炼项目的存在情况（项目等级）。
总体回复率为87%。与加拿大医院相比，美国医院有更多的食品店铺（89%对50%）和更多的零食/饮料自动售货机（中位数分别为16台和12台）（两者P值均为0.001），尽管消费者数量相当。与加拿大医院相比，美国医院有更多的店铺由外部公司管理（65%对14%；P = 0.01），而且一般来说，美国医院从其店铺获得的收入更多。最差的自助餐厅等级与美国医院的位置相关（优势比[OR]，8.9；95%置信区间[CI]，1.6 - 50；P = 0.01）以及较低的健康替代品等级相关（OR，0.016；95% CI，0.002 - 0.15；P < 0.001）。任何领域的较低等级都与医院从非自助餐厅食品店铺获得更多收入有关（OR，1.7；95% CI，1.06 - 2.72；P = 0.03）以及存在更多内部经营的自助餐厅有关（每个自助餐厅OR，2.3；95% CI，1.53 - 3.36；P < 0.001）。
儿童医院提供的健康环境不理想。对收入的依赖可能是鼓励采用提供营养较差食品的店铺的一个重要推动因素。
