A Plate Waste Evaluation of the Farm to School Program

Local Food System Approaches to Address Food and Nutrition Security among Low-Income Populations: A Systematic Review

Food and nutrition insecurity disproportionately impact low-income households in the United States, contributing to higher rates of chronic diseases among this population. Addressing this challenge is complex because of various factors affecting the availability and accessibility of nutritious food. Short value chain (SVC) models, informally known as local food systems, offer a systemic approach that aims to optimize resources and align values throughout and beyond the food supply chain. Although specific SVC interventions, such as farmers markets, have been studied individually, a comprehensive review of SVC models was pursued to evaluate their relative impact on food security, fruit and vegetable intake, diet quality, health-related markers, and barriers and facilitators to participation among low-income households. Our systematic literature search identified 37 articles representing 34 studies from 2000-2020. Quantitative, qualitative, and mixed-method studies revealed that farmers market interventions had been evaluated more extensively than other SVC models (i.e., produce prescription programs, community-supported agriculture, mobile markets, food hubs, farm stands, and farm-to-school). Fruit and vegetable intake was the most measured outcome; other outcomes were less explored or not measured at all. Qualitative insights highlighted common barriers to SVC use, such as lack of program awareness, limited accessibility, and cultural incongruence, whereas facilitators included health-promoting environments, community cohesion, financial incentives, and high-quality produce. Social marketing and dynamic nutrition education appeared to yield positive program outcomes. Financial incentives were used in many studies, warranting further investigation into optimal amounts across varying environmental contexts. SVC models are increasingly germane to national goals across the agriculture, social, and health care sectors. This review advances the understanding of key knowledge gaps related to their implementation and impact; it emphasizes the need for research to analyze SVC potential comprehensively across the rural-urban continuum and among diverse communities through long-term studies of measurable health impact and mixed-method studies investigating implementation best practices. This trial was registered at PROSPERO as CRD42020206532.

Policy, Systems, and Environmental Changes in Child Nutrition Programs: A Systematic Literature Review

The National School Lunch Program (NSLP) provides healthy food to millions of children annually. To promote increased lunch consumption, policy, systems, and environmental (PSE) change strategies are being implemented in child nutrition programs. An evaluation of the current evidence supporting PSE interventions in school nutrition programs is needed to facilitate evidence-based practices across the nation for programs. This systematic review aims to determine the quality and breadth of available evidence of the effectiveness of PSE strategies on the consumption and waste of fruits, vegetables, milk, and water in the NSLP. The inclusion criteria required studies to occur in a United States K-12 school setting, data collection after 2012, report consumption and waste findings for fruit, vegetable, milk, or water, and be an original research article. Articles included in the review are restricted to positive or neutral quality. Thirty studies are included, policy level (n = 4), systems level (n = 8), environmental level (n = 10), and multi-category (n = 8). Results from positively rated policy-level studies suggest that recess before lunch may increase milk consumption, whereas removing flavored milk may decrease consumption. System-level studies of offering vegetables first in isolation of other meal components and offering spiced vegetables compared with traditional preparations may increase vegetable consumption, and locally procuring produce may increase fruit and vegetable consumption. Environmental-level studies such as water promotion strategies such as placing cups near drinking fountains may increase water consumption. Improving the convenience, attractiveness, and palatability of fruits and vegetables may increase consumption. Future PSE research in child nutrition programs should incorporate implementation aides and metrics into their study designs to allow a better understanding of how to sustain interventions from the perspective of school nutrition professionals.

Procurement from local producers for food service in primary and secondary school settings: a scoping review

ISSUE ADDRESSED

Australian school canteen guidelines do not broadly incentivise procuring food from local producers, despite evidence of this occurring abroad. This scoping review aims to investigate what is known about local food procurement for school foodservice.

METHODS

A scoping review of peer-reviewed articles published since 2000 was undertaken using MEDLINE, CINAHL and Scopus.

RESULTS

Twenty-one studies met the inclusion criteria. Local food was generally perceived as fresher and more nutritious. Small, positive impacts on fruit and vegetable intake have been demonstrated when food is procured locally. Challenges identified included concerns around food safety, varied availability, time spent coordinating food supply, lack of incentive from regional or national guidelines, inadequate kitchen facilities and budget constraints.

CONCLUSIONS

There is no universal definition or standard for procuring 'local food'. The main motivation for local food procurement was a sense of social responsibility, however there are barriers, including cost, facilities and food safety. Purchasing food locally holds potential to benefit the local economy but government funding and policy supporting local and small-scale producers is an important enabler. So what? Government support to build stakeholder capacity is important in establishing and maintaining these programs and would be crucial in achieving change in Australian schools. Investigating feasibility of a national school lunch service would be beneficial, as these programs may have merit not just in feeding children but also in supporting the local economy. Further research is warranted in this area.

Do Behavioral Interventions Increase the Intake of Biofortified Foods in School Lunch Meals? Evidence from a Field Experiment with Elementary School Children in Ethiopia

BACKGROUND

Many African countries are seeking to improve nutrition by introducing biofortified foods in school feeding programs. These programs are generally designed to create demand for biofortified foods both in and outside of school. Finding ways to encourage child acceptance of novel biofortified foods is key to the success of this strategy.

OBJECTIVES

The aim was to assess effects of 2 behavioral interventions in promoting the consumption of biofortified foods as part of school lunch meals.

METHODS

The study is based on a field experiment involving 360 school-going children of in the third, fourth, and sixth grades. We tested if structured provision of information about the nutritional benefits of a biofortified food and its association with an aspirational figure influence its consumption when served alongside a favorite local food as part of school lunch meal. Six schools in Tigray, Ethiopia, were randomly selected to participate, with 4 participating in the Orange-Fleshed Sweetpotato (OFSP) Program. Of the 4 participating in the program, 2 were assigned to provide educational information about sweetpotato, whereas 2 presented the same information plus depictions of an aspirational figure (a famous local athlete) associated with the sweetpotato.

RESULTS

Provision of information on the nutritional benefits of biofortified food combined with an aspirational figure resulted in increased consumption of biofortified food by children. However, provision of the information alone did not detectably increase consumption. An analysis of trends over the course of the study revealed no discernable decay effect.

CONCLUSIONS

Our results highlight the potential for relatively inexpensive behavioral interventions to increase acceptance of novel biofortified foods among children in a developing-country context. Larger studies with more varied interventions and larger numbers of participating schools could address several of the weaknesses in this study and establish more robust findings.

Impact of introducing a farm to school program on the number of school lunches served

Farm to school (FTS) programs are becoming more prevalent throughout the United States. Yet, their impacts on students' behaviors are still not well understood. This study analyzes the impacts of introducing the local procurement aspect of a FTS program in a Florida school district on the number of National School Lunch Program (NSLP) meals served and the selection of salad meals prepared with FTS products using daily school-level point of sale (POS) data, product procurement records, NSLP menu data and linear panel regression analyses. The study district implemented the FTS program in 15 of its 22 elementary schools between mid-October of 2015 and mid-January of 2016. Weighted difference in differences regressions that account for the non-random assignment of the district's elementary schools into the FTS program and variation in the timing of implementation across schools indicate that the introduction of the FTS program did not affect the number of NSLP meals served or type of meals served at schools with FTS programs. We find some evidence that students selected more NSLP salad offerings on days when these meals were prepared with FTS products; however, these findings were no longer significant when school-level fixed effects were included in the model.

Evaluation of a Farm-to-School Intervention to Improve Locally Grown Vegetable Choices of Low-Income, Primary School Students

BACKGROUND

The study objective was to determine impact of a Farm-to-School intervention on low-income, diverse elementary school students' nutrition-related attitudes, self-efficacy, behaviors, and locally grown vegetable choices.

METHODS

Six elementary schools within 1 US school district were equally assigned to 1 of 3 conditions: Local Message, Nutrition Message, or Control. Locally grown vegetables (kale, green beans, zucchini, butternut squash, and beets) were served twice during lunch over 16 weeks. "Local" and "Nutrition" groups also received biweekly nutrition education and a messaging campaign in the cafeteria. Knowledge, attitudes, self-efficacy, and related behaviors were assessed using a validated questionnaire. Vegetable selection was assessed using the food service daily production records. General linear model analysis, analysis of covariance, and t tests were performed.

RESULTS

Students in the "Local" group (N = 81) had significantly improved nutrition-related attitudes (p = .0001), preferences (p = .001), and overall vegetable behavior score (p = .002), compared to control (N = 79). There was no difference in overall locally grown vegetable choices, but local beet choices were higher in the "Local" (p = .005) and "Nutrition" (p = .02) groups compared to control.

CONCLUSIONS

Messages about local foods in school cafeterias may improve students' attitudes, preferences, and selection of certain locally grown vegetables.

Characteristics of successful primary school-based experiential nutrition programmes: a systematic literature review

OBJECTIVE

Diet and nutrition in childhood has been associated with the risk of chronic disease later in life. The aim of this review was to identify key characteristics of successful experiential nutrition interventions aimed to change nutrition-related cognitive and behavioural outcomes in primary schoolchildren.

DESIGN

A systematic literature review was undertaken using search terms ('food security', 'school', 'nutrition' and 'program') applied to five scientific databases (CINAHL, Scopus, Web of Science, Medline and Academic Search complete), with outcomes defined as nutrition-related knowledge, attitudes and/or dietary behaviours.

PARTICIPANTS

Primary school-aged children exposed to interventions conducted, at least partially, on school grounds.

RESULTS

A total of 3800 articles were identified from the initial search and manual searching, of which sixty-seven articles were eligible for inclusion. Forty-two articles met the criteria of being successful, defined as achieving significant differences in outcomes of interest, accompanied by a demonstrated reach. Interventions included school gardens (n 9), food provision (n 5), taste testing (n 8), cooking classes (n 10) and multicomponent programmes (n 10). Nutrition education (when combined with taste testing), cooking-related activities and gardening interventions increased children's willingness to taste unfamiliar foods including new fruits and vegetables, improved their cooking and food preparation skills and increased nutritional knowledge.

CONCLUSIONS

This review provides evidence that nutrition education programmes in primary schoolchildren that are experiential in nature are most likely to be successful if they include multiple strategies, have parental involvement and focus specifically on vegetable intake.

Food Trying and Liking Related to Grade Level and Meal Participation

School-based child nutrition programs provide students with meals and snacks that align with guidelines for a healthy eating pattern. However, participation is not universal, and research on the determinants of food selection is needed to improve school nutrition practices and policies. The purpose of this study was to examine the relationships between grade level (i.e., grade school, middle school, or high school) as well as meal participation category (i.e., only breakfast, only lunch, or both) and food trying and liking in a large urban school district. Outcomes were measured using an online survey completed by students from 2nd through 12th grade (n = 21,540). Breakfast and lunch item liking scores were higher among the grade school and middle school students than among the high school students. Breakfast and lunch liking scores were also higher among those who participated in both breakfast and lunch as opposed to those who only participated in one meal. Food item liking scores were positively correlated with the percentage of students who had tried the particular foods (r = 0.52, p < 0.001), and the number of foods tried was dependent on both grade level and meal participation category (F(4, 21,531) = 10.994, p < 0.001). In this survey of students, both grade level and meal participation category were found to be related to the liking of foods, while foods that were tried more often tended to be liked more. Future studies should consider grade level and meal participation when exploring student preferences. School nutrition programs should also consider these factors when assessing satisfaction.