Are school employees role models of healthful eating? Dietary intake results from the ACTION worksite wellness trial

Addressing schoolteacher food and nutrition-related health and wellbeing: a scoping review of the food and nutrition constructs used across current research

BACKGROUND

Teachers form a large and essential workforce globally. Their wellbeing impacts personal health-related outcomes with flow on effects for the health, and wellbeing of their students. However, food and nutrition (FN) interventions that include teachers, typically neglect the impact of personal FN factors on a teachers' ability to achieve optimal nutrition-related health and wellbeing, and successfully fulfil their professional FN roles as health promoters, gate keepers, educators', and role models. The aim of this review was to scope FN constructs that have been studied internationally regarding teacher FN-related health and wellbeing.

METHODS

Six databases were searched, and papers extracted in June/July 2021. Eligibility criteria guided by the population, concept, context mnemonic included studies published after 2000, in English language, with an aspect of personal FN-related health and wellbeing, among in-service (practising) and pre-service (training), primary, and secondary teachers. Screening studies for inclusion was completed by two independent researchers with data extraction piloted with the same reviewers and completed by lead author, along with complete descriptive and thematic analysis.

RESULTS

Ten thousand six hundred seventy-seven unique articles were identified with 368 eligible for full text review and 105 included in final extraction and analysis. Sixty-nine descriptive studies were included, followed by 35 intervention studies, with the main data collection method used to assess both personal and professional FN constructs being questionnaires (n = 99 papers), with nutrition knowledge and dietary assessment among the most commonly assessed.

CONCLUSION

FN constructs are used within interventions and studies that include teachers, with diversity in constructs included and how these terms are defined. The evidence from this scoping review can be used to inform data collection and evaluation in future epidemiological and interventional research that addresses teacher FN-related health and wellbeing.

Associations between dietary intake, physical activity, and obesity among public school teachers in Jeddah, Saudi Arabia

Objective

We aimed to assess the dietary intake of certain food groups in a representative sample of public-school teachers living in Jeddah city. We also, examined the association of dietary intake with physical activity and obesity among schoolteachers.

Methods

The study was a cross-sectional online survey, conducted among 640 (177 male, 463 female) schoolteachers aged between 20 and 62 years old and working in public primary, intermediate, and high schools in Jeddah. Measurements included gender, weight, height, body mass index (BMI), health problems, and lifestyle behaviours, including physical activity levels, smoking status, and dietary intake.

Results

Based on gender, number of non-smoking women (94%) was higher than number of non-smoking men (57.1%) (P < 0.001). However, men were more active than women (P = 0.03). Regarding BMI, there were more overweight men than women, while obese women numbered more than men (P = 0.003). There was no significant difference in dietary intake between men and women except that men consumed more soft drinks than women (P = 0.002). Lower physically active schoolteachers were less likely to consume salad (OR = 0.6, 95% CI 0.4-0.9; P = 0.02), vegetables (OR = 0.6, 95% CI 0.3-0.9; P = 0.01), beans and legumes (OR = 0.4, 95% CI 0.2-0.7; P = 0.005), wholegrain bread (OR = 0.6, 95% CI 0.4-0.9; P = 0.03), dairy products (OR = 0.6, 95% CI 0.4-0.9; P = 0.01), snacks (OR = 0.5, 95% CI 0.2-0.8; P = 0.01), and fish (OR = 0.4, 95% CI 0.2-0.9; P = 0.04) compared to those with high levels of physical activity. Only fruit intake was considered statistically significant (OR = 0.4, 95% CI 0.3-0.7; P = 0.003). The study found a relationship between the BMI of schoolteachers and food intake. Obese schoolteachers had lower consumption of fruits (OR = 0.3, 95% CI 0.2-0.7; P = 0.007) and white meat (OR = 0.5, 95%CI 0.3-0.9; P = 0.03) than schoolteachers in the normal weight group.

Conclusion

The high prevalence of physical activity, dietary intake and body weight among Saudi teachers is a major public health concern. The present study identified several lifestyle factors associated with body weight that may represent valid targets for the prevention and management of obesity among Saudi school teachers. Promoting active lifestyles and healthy diets would be primary targets for obesity prevention.

A cluster-randomized controlled trial to assess the impact of a nutrition intervention on dietary behaviors among early care and education providers: The Create Healthy Futures study

Create Healthy Futures is a self-paced, web-based intervention on improving healthy eating behaviors among Early Care and Education (ECE) providers. We examined the impact of web-based Create Healthy Futures on diet quality measured by the Alternative Healthy Eating Index (AHEI) 2010, dietary behaviors, and related psychosocial and environmental factors among ECE providers. A cluster randomized controlled trial (CRCT) was implemented with baseline surveys administered from October 2019-January 2020, intervention implementation from April-May 2020, and post-intervention from May 2020-August 2020. Centered-based ECE programs under the Pennsylvania Head Start Association (n = 12) were recruited and randomized to intervention (n = 5) or comparison (n = 7) groups. A total of 186 ECE providers completed the post-intervention surveys (retention rate: 86.1%). At baseline, 31.5% of ECE providers were food insecure. Pre-to-post intervention demonstrated no significant within-or-between-group changes in the AHEI-2010 diet quality scores. ECE providers in the intervention group reported a significant decrease from baseline to post-intervention in the number of days eating out (aMD = -0.8, CI:-1.6, -0.1, P = 0.03). Process evaluation showed that 89.9% of the intervention group completed all online module, and 82.9% attended all of wellness session groups. Although the Create Healthy Futures intervention did not improve ECE providers' diet quality and dietary behaviors, it confirmed critical needs to provide health support to ECE providers. Future studies should employ strategies that improve access to healthy foods and nutrition education, and address social determinants of health such as food insecurity to improve diet quality and health in ECE provider population.

Systematic review of the effectiveness of health promotion interventions targeting obesity prevention in school-based staff

School-based employee interventions can benefit the health of staff and have the potential to influence the health of school students through role-modelling. However, interventions within schools typically focus on students, with very few studies addressing obesity and related health behaviours among school staff. A systematic review of the peer-reviewed literature published between January 2000 and May 2020 was undertaken to synthesize the evidence on the impact that school-based obesity prevention programmes have on the staff they employ. Search terms were derived from four major topics: (i) school; (ii) staff; (iii) health promotion and (iv) obesity. Terms were adapted for six databases and three independent researchers screened results. Studies were included if they reported on the outcomes of body weight, dietary behaviours and/or physical activity. Of 3483 papers identified in the search, 13 studies met the inclusion criteria. All 13 studies included an intervention that focussed on improving nutrition, physical activity or both. All included studies demonstrated a positive outcome for either dietary intake, weight or body mass index or physical activity outcomes, however not all results were statistically significant. The included studies showed promising, although limited, impacts on employee health outcomes. This review demonstrated a lack of global focus and investment in interventions targeting school staff, particularly in contrast to the large amount of research on school-based health promotion initiatives focussed on students. There is a need for further research to understand effective interventions to promote health and prevent obesity in this large, diverse and influential workforce.

Barriers, Enablers, and Possible Solutions for Student Wellness: A Qualitative Analysis of Student, Administrators, and Staff Perspectives

BACKGROUND

Child well-being, which includes physical, mental, and social health, has a critical effect on academic performance. Schools face many challenges in meeting needs for child well-being. Schools in low-resource areas, including the Mississippi Delta, face greater challenges when meeting student needs.

METHODS

Eleven focus groups with middle school students and 12 interviews with teachers, staff, and administration in one Mississippi Delta middle school were completed in 2019. The Social Ecological Model and Theory of Organizational Readiness for Change were used as a framework for the study.

RESULTS

Focus group data with middle school students and interviews with teachers, staff, and administrators show that academic stressors play a major role in student well-being; yet, teachers, staff, and administrators face immense pressure to achieve high test scores. However, students seem to be encouraged by a positive school environment, which could help minimize some stressors.

CONCLUSIONS

It seems that small improvements to the school environment could have a significant effect on student well-being, especially when school infrastructure and limited resources do not support comprehensive changes.

Parents' and teachers' views of the promotion of healthy eating in Australian primary schools

BACKGROUND

Primary schools have long been identified as appropriate settings for improving the healthy eating behaviours of children and helping them develop food skills. This qualitative study explored the views of Australian primary school parents and teachers about schools' strengths and weaknesses in promoting healthy eating and equipping children with food skills.

METHODS

Nineteen parents and 17 teachers from Victoria participated in semi-structured interviews. Audio recordings were transcribed and underwent thematic analysis using Nvivo.

RESULTS

This study demonstrated that parents and teachers believed that several facilitators helped promote children's healthy eating. These included food and nutrition education (FNE) programs, the community-based nature of schools, and teacher role modelling and the authority schools possess over children. Time scarcity, lack of teacher expertise, lack of leadership and funding were reported as barriers. School food environments such as canteens, lunch orders, fundraising events and school fairs were identified as both weaknesses and strengths by parents and teachers, which indicated inconsistent implementation of school nutrition policies across schools.

CONCLUSIONS

Australian primary schools demonstrate some useful efforts to promote healthy eating among children. However, there are numerous facilitators and barriers which impact on the promotion of healthy eating. These factors need to be addressed in order to develop healthy eating habits further among elementary students. These results provide directions for policymakers and school managers, as they point to the areas that need to be improved to assist the design of schools that better promote healthy eating among children.

Impact of physical activity, diet quality and stress on cardiometabolic health in school employees

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School employee health and well-being directly impact student learning and success.

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Higher physical activity levels were associated with better cardiometabolic health.

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High stress had a negative impact on the relationship between PA and BMI.

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Stress may affect heart health, potentially through an impact on health behaviors.

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Enhancing school employee well-being may improve student academic achievement.

Among school employees, it has been reported that poor physical and mental health, as well as high stress and large workloads, have resulted in high absenteeism and low retention. The consequences of unhealthy behaviors and stress can extend to students, impacting academic achievement and school costs. Our objective was to examine the impact of school employees’ physical activity (PA), diet quality and perceived occupational stress on cardiometabolic health, and explore how stress may influence the impact of PA and diet on health.

In this cross-sectional study, employees from lower-income Massachusetts schools participated in Wellness Assessments (2015–2016), including measured height, weight, and lipids [total (TC), high-density lipoprotein (HDL-C), low-density lipoprotein (LDL-C)]. Self-administered surveys were used to collect demographic, stress, PA and 24-hour food intake data. Linear regression models were used to examine the relationship among health behaviors (PA and diet), stress and cardiometabolic health. An interaction between stress and health behaviors was also explored.

Seventy-four employees (66% teachers) participated. Overweight/obesity (mean BMI: 25.6 kg/m²), high TC and LDL-C were observed in 47%, 4%, and 34%, respectively, and moderate-to-vigorous PA (MVPA) was low (median: 17 min/day). Positive associations were identified between MVPA and cardiometabolic health, but not diet. The effect of MVPA on BMI was modified by stress (p-for-interaction = 0.001), with higher levels of stress associated with a diminished protective association between MVPA and BMI.

Higher levels of PA were associated with more favorable cardiometabolic health, with increasing levels of stress minimizing the beneficial effect of PA on BMI.

A Pilot Randomized Controlled Trial of a Nutrition and Dietary Intervention for Early Care and Education Providers

BACKGROUND

The aim of this study is to evaluate the feasibility and preliminary impact of the Create Healthy Futures program, a self-paced, 6-lesson, web-based intervention on promoting healthy eating for Early Care and Education (ECE) providers, using a group-randomized controlled trial design with 3 repeated measurements.

METHODS

Nine ECE facilities in Ohio were recruited and randomly assigned to intervention (N = 4) and comparison (N = 5). The 111 participants are mostly female (97.3%), college graduated (59.5%), and overweight or obese (75.2%). Nutrition-related psychosocial and environmental factors and individual behaviors were assessed at baseline, post-test, and 3-month follow-up. We used mixed model analyses to compare changes between time points, controlling for ethnicity, age, and center effect, and calculated effect size to assess the magnitude of change.

RESULTS

We observed significant between-group changes in improving nutrition knowledge (p = .003), increasing perceived support for staff wellness (p = .038), and reducing perceived barriers to eating fruits and vegetables (p = .004) and promoting nutrition in classrooms (p = .038), with small to medium effect sizes. The study demonstrated high feasibility with 94.1% enrollment rate, 87.5% intervention completion rate, and 83.8% retention rate.

CONCLUSIONS

This pilot study demonstrated high feasibility and acceptability of nutrition intervention programs using an online platform among ECE providers.

Diet quality of elementary and middle school teachers is associated with healthier nutrition-related classroom practices

Many schools have implemented policies and programs to address childhood obesity. However, few have evaluated obesity-related health behaviors among teachers, or how these behaviors may be associated with teachers' nutrition-related practices in the classroom setting. This cross-sectional study utilized data from teachers employed in 20 schools representing three public school districts in a mid-Atlantic state from 2017 to 2019 to examine associations between teachers' diet quality and their nutrition-related classroom practices (e.g. rewarding students with food; modeling healthy diet behaviors). Measures included: one 24-h dietary recall summarized via healthy eating index (HEI-2015; higher scores indicate better diet quality; Range: 0-100); demographics, self-reported height/weight (BMI; ≥25 kg/m2 = overweight/obese), and nutrition-related classroom practices (10 item survey; sum score range: 0-40; alpha = 0.65; higher score = more health-promoting practices). Associations between HEI and nutrition-related classroom practices were assessed in multilevel models, adjusting for covariates (gender, race/ethnicity, age, income, BMI, years teaching) and controlling for within-school effects. Of 331 teachers recruited, 116 (35.0%) completed both the optional dietary recall and incentivized survey (analytic sample: 89% female; 45% black; 79% overweight/obese; BMI = 30.5 ± 7.1; aged 41.1 ± 11.8 years). Means and standard deviations were calculated for HEI (52.2 ± 12.2) and nutrition-related classroom practices sum score (25.4 ± 5.9). For every one-unit increase in HEI, there was a 0.20 increase in nutrition-related classroom practices score (SE = 0.05; p < 0.001), which remained significant in the adjusted model. To better inform obesity prevention efforts, future studies should collect data among both students and teachers and explore the mechanisms through which teacher health behaviors may impact student health behaviors.

An Onsite Fitness Facility and Integrative Wellness Program Positively Impacted Health-Related Outcomes Among Teachers and Staff at an Urban Elementary/Middle School

Background

Given the large number of obesity-focused studies conducted in schools, there is a surprising lack of data regarding teacher workplace health behaviors in the United States.

Objective

To determine the feasibility and effectiveness of an onsite fitness facility with a structured integrative wellness program to improve health-related outcomes among teachers and staff at an urban elementary/middle school.

Methods

A 2-year mixed-methods analysis using Patient-Reported Outcomes Measurement Information System (PROMIS) measures and qualitative interviews included 39 teachers and staff employed at an urban elementary/middle school in Baltimore, Maryland. The fitness facility was dedicated exclusively to teachers and staff and the integrative wellness program included group exercise classes, yoga, mindfulness, and nutrition competitions. T tests were used to compare quantitative outcomes at baseline, the end of year 1, and the end of year 2.

Results

Compared to baseline, at year 1, there was a significant improvement in the PROMIS Sleep Disturbance score. From baseline to end of year 2, there were significant increases in the PROMIS Global Physical Health as well as significant decreases in Sleep Disturbances, Fatigue, and Social Isolation. Qualitative interviews conducted at the end of year 1 indicated that teachers who used the facility felt that it improved their mood, increased their energy, motivated them to eat healthily, and gave them opportunities to socialize with their colleagues in new ways. This impact was further enhanced in year 2.

Conclusions

An onsite fitness facility with an integrative wellness program may improve health-related outcomes among urban elementary school teachers and staff, with the greatest benefits seen after 2 years of implementation.

Impact of multiple food environments on body mass index

Background

Although the relationship between residential food environments and health outcomes have been extensively studied, the relationship between body mass index (BMI) and multiple food environments have not been fully explored. We examined the relationship between characteristics of three distinct food environments and BMI among elementary school employees in the metropolitan area of New Orleans, LA. We assessed the food environments around the residential and worksite neighborhoods and the commuting corridors.

Research methodology/principal findings

This study combined data from three different sources: individual and worksite data (ACTION), food retailer database (Dunn and Bradstreet), and the U.S. Census TIGER/Line Files. Spatial and hierarchical analyses were performed to explore the impact of predictors at the individual and environmental levels on BMI. When the three food environments were combined, the number of supermarkets and the number of grocery stores at residential food environment had a significant association with BMI (β = 0.56 and β = 0.24, p < 0.01), whereas the number of full-service restaurants showed an inverse relationship with BMI (β = -0.15, p < 0.001). For the commute corridor food environment, it was found that each additional fast-food restaurant in a vicinity of one kilometer traveled contributed to a higher BMI (β = 0.80, p <0.05), while adjusting for other factors. No statistical associations were found between BMI and worksite food environment.

Conclusions

The current study was the first to examine the relationship between BMI and food environments around residential neighborhoods, work neighborhoods, and the commuting corridor. Significant results were found between BMI and the availability of food stores around residential neighborhoods and the commuting corridor, adjusted for individual-level factors. This study expands the analysis beyond residential neighborhoods, illustrating the importance of multiple environmental factors in relation to BMI.

Multi-pronged intervention to increase secondary student participation in school lunch: Design and rationale

BACKGROUND

In the United States, the National School Lunch Program (NSLP) is the healthiest lunch option for students, yet participation is suboptimal and fruit and vegetable waste remains high. Improving school meal convenience, engaging teachers in the school-lunch program, and enhancing the cafeteria environment are promising strategies to improve participation and dietary intake, yet little evidence is available on their impact.

METHODS/DESIGN

The Multi-Pronged Intervention to Increase Secondary Student Participation in School Lunch (MPI) is a 3-year quasi-experimental study in a large urban school district in California. A total of 24 middle and high schools participated in the study: half received the intervention and half served as controls. The intervention consisted of additional school lunch points of sale (vending machines and mobile carts), a school meal outreach program for teachers, and cafeteria redesigns. School meal participation, student-reported fruit and vegetable consumption, and school lunch plate waste were assessed at baseline and in years 1 and 2 of the intervention. Change in meal participation and fruit and vegetable consumption were compared between intervention and control arms to determine the impact of the intervention on school meal participation and dietary intake.

DISCUSSION

This study is positioned to provide evidence on the feasibility and efficacy of a multi-level intervention to increase school meal participation and consumption of fruits and vegetables.

Does high-carbohydrate intake lead to increased risk of obesity? A systematic review and meta-analysis

OBJECTIVES

The present study aimed to test the association between high and low carbohydrate diets and obesity, and second, to test the link between total carbohydrate intake (as a percentage of total energy intake) and obesity.

SETTING, PARTICIPANTS AND OUTCOME MEASURES

We sought MEDLINE, PubMed and Google Scholar for observation studies published between January 1990 and December 2016 assessing an association between obesity and high-carbohydrate intake. Two independent reviewers selected candidate studies, extracted data and assessed study quality.

RESULTS

The study identified 22 articles that fulfilled the inclusion and exclusion criteria and quantified an association between carbohydrate intake and obesity. The first pooled strata (high-carbohydrate versus low-carbohydrate intake) suggested a weak increased risk of obesity. The second pooled strata (increasing percentage of total carbohydrate intake in daily diet) showed a weak decreased risk of obesity. Both these pooled strata estimates were, however, not statistically significant.

CONCLUSIONS

On the basis of the current study, it cannot be concluded that a high-carbohydrate diet or increased percentage of total energy intake in the form of carbohydrates increases the odds of obesity. A central limitation of the study was the non-standard classification of dietary intake across the studies, as well as confounders like total energy intake, activity levels, age and gender. Further studies are needed that specifically classify refined versus unrefined carbohydrate intake, as well as studies that investigate the relationship between high fat, high unrefined carbohydrate-sugar diets.

PROSPERO REGISTRATION NUMBER

CRD42015023257.

The Role of School Design in Shaping Healthy Eating-Related Attitudes, Practices, and Behaviors Among School Staff

BACKGROUND

Schools have increasing responsibility to address healthy eating, but physical barriers influence their ability to adopt and sustain recommended strategies. We took advantage of a natural experiment to investigate the role of the physical environment in shaping healthy eating attitudes and practices among school staff members.

METHODS

A school district consolidated its elementary schools and incorporated architectural features to support healthy eating into a building renovation. Surveys along with structured, in-depth interviews were administered prior to and at 12 months postoccupancy. Paired t-tests and McNemar's tests were used to analyze changes in survey indices and interview data were coded for themes.

RESULTS

The school implemented new policies and programs, including staff wellness activities. There was a significant decrease in the percent of teachers with a high-fat diet (from 73.68% to 57.14%, p < .05). Many physical barriers were removed but new challenges emerged, and staff varied in their awareness and comfort with using the new healthy eating features.

CONCLUSIONS

We found promising evidence that school architecture can support a school to address healthy eating. To enhance influence of the physical environment, more research is merited to test complementary strategies such as improving ownership of space and increasing self-efficacy to manage space.

Cardiovascular risk factors and physical activity behavior among elementary school personnel: baseline results from the ACTION! worksite wellness program

BACKGROUND

Although the prevalence of obesity is increasing during adulthood, there have been few assessments of obesity, cardiovascular risk factors, and levels of physical activity among adult elementary school staff.

METHODS

Data were collected from 745 African-American and White female school personnel in a suburban school district in southeastern Louisiana as part of the baseline assessment before implementation of a program to improve eating and physical activity behaviors. Anthropometry, blood pressure, serum lipids and lipoproteins, and glucose were measured using established protocols. Physical activity was assessed by accelerometry.

RESULTS

For both White and Black females, 30% were overweight (body mass index [BMI]) ≥25 kg/m(2) but <30 kg/m(2) ). Whereas 37% of White females were obese (BMI ≥ 30 kg/m(2) ), 61% of the Black females were obese. There was a positive association between BMI and other cardiovascular risk factors except for high-density lipoprotein cholesterol, where the association was negative. The mean number of minutes of daily moderate-to-vigorous physical activity was <1 minute per day and was lower for overweight and obese women than for normal weight women.

CONCLUSIONS

School personnel in the study have adverse cardiovascular risk factors, including high rates of obesity and very low levels of physical activity. Because these individuals are often called upon to promote health for children, they are an important target population for wellness interventions.