"That's His Choice Not Mine!" Parents' Perspectives on Providing a Packed Lunch for Their Children in Primary School

Evaluating the impact of the universal infant free school meal policy on the ultra-processed food content of children's lunches in England and Scotland: a natural experiment

BACKGROUND

The Universal Infant Free School Meal (UIFSM) policy was introduced in 2014/15 in England and Scotland for schoolchildren aged 4-7 years, leading to an increase in school meal uptake. UK school meals are known to be healthier and less industrially processed than food brought from home (packed lunches). However, the impact of the UIFSM policy on the quantity of ultra-processed food (UPF) consumed at school during lunchtime is unknown. This study aimed to evaluate the impact of the UIFSM policy on lunchtime intakes of UPF in English and Scottish schoolchildren.

METHODS

Data from the UK National Diet and Nutrition Survey (2008-2019) were used to conduct a difference-in-difference (DID) natural experiment. Outcomes included school meal uptake and the average intake of UPF (% of total lunch in grams (%g) and % total lunch in Kcal (%Kcal)) during school lunchtime. The change in the outcomes before and after the introduction of UIFSM (September 2014 in England, January 2015 in Scotland) in the intervention group (4-7 years, n = 835) was compared to the change in an unexposed control group (8-11 years, n = 783), using linear regression. Inverse probability weights were used to balance characteristics between intervention and control groups.

RESULTS

Before UIFSM, school meal uptake and consumption of UPFs were similar in the intervention and control groups. The DID model showed that after UIFSM, school meal uptake rose by 25%-points (pp) (95% CI 14.2, 35.9) and consumption of UPFs (%g) decreased by 6.8pp (95% CI -12.5,-1.0). Analyses indicated this was driven by increases in minimally processed dairy and eggs, and starchy foods, and decreases in ultra-processed salty snacks, bread and drinks. The differences were larger in the lowest-income children (-19.3 UPF(%g); 95% CI -30.4,-8.2) compared to middle- and high-income children. Analyses using UPF %Kcal had similar conclusions.

CONCLUSIONS

This study builds on previous evidence suggesting that UIFSM had a positive impact on dietary patterns, showing that it reduced consumption of UPFs at school lunchtime, with the greatest impact for children from the lowest-income households. Universal free school meals could be an important policy for long term equitable improvements in children's diet.

Parents face several barriers in providing a healthy school lunch for their primary school children: A survey of Victorian (Australian) parents

ISSUE ADDRESSED

This paper aims to explore Victoria parents' perceptions of their current practices and barriers in providing school lunches for their primary school children.

METHODS

Respondents were asked via an online survey about their lunch provision practices, perceptions of the healthiness of school lunches, and barriers to providing healthy school lunches. Data were analysed using different statistical techniques: Chi-square test, Spearman correlation analysis, Mann-Whitney U test, and Kruskal-Wallis test.

RESULTS

In total, 359 respondents completed the survey. Most respondents (84%) reported their child takes a home-packed lunch to school every day. Most respondents provided fruits (94%), vegetables (57%), and sandwiches (54%) every day for school lunches, whilst other core food items such as milk, meats, and legumes were provided less frequently. A substantial proportion of respondents provided some discretionary food items frequently (e.g., the proportion of respondents providing selected discretionary food items daily or 3-4 times/week: salty crackers-50%, sweet cookies/biscuits-40%, chips-20%). Respondents strongly agreed or agreed with several barriers; examples include not packing certain foods due to food spoilage concerns (50%) (school-related), the allocated time at their child's school is not enough to eat and enjoy school lunch (48%) (school-related), need more meal ideas (61%) (parent-related), healthy foods take more time to prepare (51%) (parent-related), and children request easy-to-eat food for school lunches (50%) (child-related). Core food score (an indicator of frequency of preparing/packing core food) was negatively correlated with parent-related and child-related barrier scores, whilst discretionary food score (an indicator of frequency of preparing/packing discretionary food) was positively correlated with these barrier scores.

CONCLUSIONS

Overall, home-packed lunches remain the main option in primary schools in Victoria, and parents face several challenges in providing healthy lunches for their primary school children. SO WHAT?: The findings suggest the need for strategies from school leaders, education authorities, and policymakers to improve the quality of lunch content and address the barriers faced by parents.

Parental support for free school lunches in Australian primary schools: associated factors and perceived barriers

OBJECTIVE

(1) To explore the feasibility of such programmes in Australia, this study examined parents' views on free school lunch provision. (2) To examine the associations between parents' demographic and personal characteristics and their support for free universal school lunches.

DESIGN

An online cross-sectional survey of parents.

SETTING

Australia, April 2021.

PARTICIPANTS

Seven hundred and eighty-seven parents took the survey. They had a mean age of 40. The respondents were predominantly female (95 %) and had a university degree (72 %).

RESULTS

Fifty-three percentage of the respondents agreed that all students should have access to healthy and well-balanced, free school lunches. Parents were concerned about healthiness, catering, allergies and cost of school-provided school lunches. Ethnic background, universalism values and education levels were significantly associated with support for free school lunch provision. Non-native English-speaking parents were almost three times more likely to support free universal lunches in primary schools than their native English-speaking counterparts. Parents with higher universalism-concern values were more likely to endorse free lunches in primary school. However, the level of education was negatively associated with parents' support for free school lunches.

CONCLUSIONS

The survey results highlight the complexity of parental views on free school lunch provision. Parents' concerns regarding lunches should be considered in developing school lunch programmes that meet the needs and preferences of diverse communities. These findings can be used to guide future primary school lunch provision initiatives.

Impact of COVID-19 School-Related Policies in Ontario on Parents' School Lunch Packing Habits

Purpose: COVID-19 has disrupted the daily routines of many Canadian families. In Ontario, provincially mandated public health measures have resulted in significant changes to school policies, including those related to food. The impact of COVID-19 related school food policies on parental lunch packing habits is unknown; therefore, this study investigated how school-related COVID-19 policies have impacted parental school lunch packing habits.Methods: Parents (N = 287) of school-aged children were recruited from parent-specific Facebook groups across Ontario, Canada, to complete an online survey regarding lunch packing habits. This survey was developed based on findings from a previously conducted scoping review. Open-ended survey responses were inductively analyzed.Results: Three over-arching themes were constructed: (1) Food Programs and COVID-19; (2) Schedule Changes; and (3) School Policy Changes. Parents explained that the cancellation or modification of food programs at schools, changes to the length of time children are given to eat at school, and removal of access to microwaves, garbage cans, and teacher assistance during lunch have forced parents to change their lunch packing habits.Conclusion: Findings from this study demonstrate a need for better support to help ease the burden parents experience when packing their child's school lunch, during an already extremely stressful time.

School lunchboxes as an opportunity for health and environmental considerations: a scoping review

Very little research has focussed on children's school lunchboxes from both a health and environment standpoint. This scoping review explores studies that considered children's lunchbox food consumption trends at school and the environmental impacts of lunchbox contents. We conducted a scoping review of peer-reviewed literature with a focus on lunchboxes of children in preschool or primary school settings that contained food packed from home, through the lens of food and nutrition in combination with environmental outcomes-particularly food and/or packaging waste. The review included 10 studies, with articles from Australia, USA, Spain, New Zealand and the UK. Half of them were intervention studies aiming to shift knowledge levels and attitudes of teachers, parents and children with regard to reducing packaged food choices and food waste, and improving dietary habits. Acknowledging the complexity of lunchbox packing and consumption practices, this review recommends the consideration of socio-ecological influences on children's health and sustainability behaviour, and mobilizing their pro-environmental agency.

COVID-19 and the National Lockdown: How Food Choice and Dietary Habits Changed for Families in the United Kingdom

COVID-19 changed the way families in the UK live, with as yet uncertain impacts to food choice and dietary habits. This study sought to explore food-related experiences and changes to behavior of families with children, during the pandemic. Semi-structured one-to-one interviews with parents (n = 20) and, separately, their children (n = 22; aged 8-10 years) were conducted. An inductive thematic approach was adopted for the data analysis, and four main themes emerged: commensality; elevated place of food in the home; snacking; and food shopping. Study findings highlighted several changes: some related to increased snacking and more takeaway food; others were more favorable, including spending more time together, increased home cooking, more efficient shopping practices and reduced food waste. Overall, an elevation of the place of food within the home was apparent, alongside enhanced food literacy, and some evidence of the relocalisation of food. This study contributes to the international literature on the impact of COVID-19 and national lockdowns on family lifestyle behaviors, specifically food choice and dietary habits; further research into the longer-term effects of COVID-19 on family food practices is required.

Online Pre-Order Systems for School Lunches: Insights from a Cross-Sectional Study in Primary Schools

Schools are increasingly using online pre-order systems for children to select school meals in advance. This study aimed to explore how children use and interact with these systems. Using a combination of direct observation and an online questionnaire, the operation of these systems in four UK primary schools was examined. This included how the menu options were displayed, how these were selected by children (4–11 years), and the interactions between children and others when making food selections. Where possible, most children pre-ordered their school lunch in the classroom, and differences in the food choice process among children were observed. These apparently related to children’s ages; older children (8–11 years) showed more independence when making food selections, whereas younger children were often supported by others. Most parents reported that their child was the decision maker when pre-ordering the school lunch, and the role of children in the selection of school lunches was evident. This may be accentuated by the online pre-order systems, and given the likely expansion of these systems in schools, there is an opportunity to implement interventions to influence children towards specific or different meal options from the school menu.

Modeling Parental Influence on Food Consumption among Chinese Adolescents through Self-Efficacy: A Path Analysis

This study aimed to investigate the associations between perceived parental control, perceived parental modeling and parent–teen co-decision making, and fruit and vegetable (F&V) and sugar-sweetened beverage and junk food (S&J) consumption among Chinese adolescents, and examine whether self-efficacy mediates the associations. Data were collected in a cross-sectional survey of Chinese adolescents carried out in the fall of 2019. The questionnaires were adapted from the Family Life, Activity, Sun, Health, and Eating (FLASHE) Study. Ordinary least-squares regressions and a path analysis were performed to evaluate the hypothesized associations. The final sample included 3595 Chinese adolescents (mean (SD) age, 14.67 (1.73) years; 52.82% (n = 1899) males). Perceived parental control was positively associated with adolescents’ F&V consumption, and was negatively associated with adolescents’ S&J consumption. Perceived parental modeling and parent–teen co-decision making were both positively associated with adolescents’ F&V consumption and negatively associated with their S&J consumption. Adolescents’ self-efficacy was positively associated with F&V consumption and negatively associated with S&J consumption. These results suggest that serving as a positive role model, having adolescents participate in the decision-making process, and increasing adolescents’ self-efficacy can be feasible and efficacious strategies to improve the nutritional quality of Chinese adolescents’ diets.

Perspectives on Fruit and Vegetable Consumption and Government Dietary Guidelines: Content Analysis of Comments on News Websites

BACKGROUND

News websites are an essential source of medical news for the public. Many websites offer users the opportunity to leave comments, which may provide rich insights into public perspectives on health issues. With an established role in public health, fruit and vegetable (FV) consumption is central to the government's dietary guidelines. However, FV intake continues to fall short of government recommendations.

OBJECTIVE

Using comments from news websites, this study aims to explore public perspectives on FV intake and related government dietary guidelines.

METHODS

Data comprised 2696 web user comments generated in response to substantial media coverage for a meta-analysis examining FV consumption and the risk of all-cause mortality, cardiovascular disease, and total cancer. Using an inductive thematic approach, the data were analyzed and coded in an iterative process.

RESULTS

Four overarching themes emerged: personal factors, rejection, lack of knowledge, and food landscape, each with component subthemes. The lack of clarity around government dietary health guidelines was apparent, and this, along with emergent personal factors, may hinder better consumption. Rejection was also evident, as was a quality versus quantity of life debate.

CONCLUSIONS

There are gaps in the public's understanding of government guidelines, which may act as a constraint to better compliance. Further work should examine this issue and rejection and the possibility of public fatigue related to dietary health information and news. Similarly, future work should also explore targeted interventions with a specific emphasis on health literacy.

Picky Eating Is Associated with Lower Nutrient Intakes from Children's Home-Packed School Lunches

The objective was to assess the relationship between children’s picky eating (PE) status and nutrient intake from home-packed school lunches. The lunches of 321 students, aged 7–10 years, were quantified via cross-sectional direct observation. Children were classified as having PE (n = 155) or not (non-PE; n = 166) based on food neophobia scores and parental perceptions of PE. The PE group consumed significantly less protein, folate, magnesium, potassium, zinc, and vitamins B1, B2, B3, B6, D, and E than the non-PE group; however, both groups consumed amounts exceeding Dietary Reference Intakes (DRIs) for protein, carbohydrates, sugar, sodium, iron, and vitamins B1, B2, B3, B6, B12, and C. Conversely, both groups consumed amounts significantly lower than DRIs for calcium, fibre, folate, magnesium, potassium, zinc, and vitamins A, D, E, and K. The PE group ate significantly less meat and alternatives, vegetables and fruit, and fruit than the non-PE group, and did not meet any of Canada’s Food Guide (2007) recommendations. The non-PE group met recommendations for meat and alternatives only. PE impacts the dietary intake of children’s home-packed lunches; however, many packed lunches were of low nutritional quality. Focus should be placed on provision of nutritionally complete school lunches for all children.

Food Photography as a Tool to Assess Type, Quantity, and Quality of Foods in Parent-Packed Lunches for Preschoolers

OBJECTIVE

Explore using food photography to assess packed lunches in a university-based Early Childhood Center and contextualize these photographs through parent interviews.

METHODS

An explanatory sequential design was used. Packed lunches were photographed to assess the type and quantity of foods offered and consumed by Child and Adult Food Care Program components (fruit, vegetable, grain, and protein) and quality of foods offered using the Healthy Meal Index. Parent interviews aimed to understand motivations and behaviors related to packing lunch.

RESULTS

Data were collected on 401 lunches. Only 16.2% of lunches met all Child and Adult Food Care Program requirements. Most lunches included fruit (84%) and grains (82%), whereas fewer included vegetables (44%). Portion sizes were large, especially for grains (2.7 ± 1.5 servings). In interviews (n = 24), parents expressed tension between offering healthful items and foods they knew their child would eat, as well as concern about children going hungry.

CONCLUSIONS AND IMPLICATIONS

Food photography is a feasible methodology to capture parent-packed lunches for preschoolers and may have utility in nutrition education, particularly related to age-appropriate portion sizes.

Using behavioural insights to reduce sugar in primary school children's packed lunches in derby; A cluster randomised controlled trial

Children's packed lunches contain more sugar than school-provided meals. Interventions to improve the provision of healthier packed lunches have modest effects on lunch contents. This cluster randomised controlled trial tested an intervention to encourage healthier provision of packed lunches by parents of primary school children in Derby. Schools were randomised to intervention (n = 8) or control (n = 9) using blocked random allocation. In the intervention group, parents of children who brought packed lunches to school in years 3-6 (age 7-11 years) received three bundles of materials (including packed lunch planner, shopping list, information on sugar content of popular lunchbox items and suggestions for healthier swap alternatives) in bookbags/lunchboxes over a 4-week period. Control parents received no materials. Photos of lunchbox contents were taken at baseline, immediately post-intervention and at three-month follow-up. A parental survey aimed to assess capability, opportunity and motivation for packing a healthier lunchbox. No intervention effects were observed for primary outcomes (presence and number of sugary snacks or chilled sugary desserts). The intervention had a significant impact on one secondary outcome (increased number of healthier "swap" items suggested in intervention materials) immediately post-intervention, but this effect had disappeared at three-month follow-up. No intervention effects were found on survey variables. Parent comments revealed that materials were either received positively (as they reinforced existing behaviours) or negatively (as they were not perceived to be helpful or appropriate). The results of this study suggest that providing educational materials and resources to parents of primary school children in Derby was not sufficient to increase provision of healthier packed lunches. Future research should investigate how behavioural science can support families to improve the nutritional content of primary school children's lunchboxes.

What's for Lunch? Investigating the Experiences, Perceptions, and Habits of Parents and School Lunches: A Scoping Review

BACKGROUND

Research indicates home-packed school lunches are lower in nutritional value compared with school-provided meals. Due to the lack of a school lunch program, most of what Canadian children consume during the school day is determined by parents and caregivers through packed lunches. Despite this, little research has focused on the school lunch packing habits and attitudes of parents. The purpose of this scoping review was to improve understanding of parental perceptions, experiences, and habits with respect to home-packed school lunches.

METHODS

We conducted a scoping review of peer-reviewed and gray literature. We reviewed only studies published from January 2000 to January 2019 with a focus on parents' lunch packing habits for their school-aged children.

RESULTS

The review included 7 studies, with articles from the United Kingdom, Australia, and Canada. The studies identified 6 themes influencing parental decisions regarding what to pack in their child's lunch-school environment, food as fuel, convenience, child's influence, cost, and the lunch experience.

CONCLUSIONS

The decisions that influence what is packed in a school lunch are complex and indicate the need for support. Parents, schools, districts, and government policymakers need to work collaboratively to improve the healthiness of home-packed school lunches.

Modeling Parental Influence on Teenagers' Food Consumption: An Analysis Using the Family Life, Activity, Sun, Health, and Eating (FLASHE) Survey

OBJECTIVE

To investigate (1) how perceived parental control, perceived parental modeling, and parent-teen co-decision making are associated with teenagers' consumption of fruits and vegetables as well as sugary drinks and less healthful food; and (2) whether self-efficacy mediates this relationship.

DESIGN

Cross-sectional survey.

PARTICIPANTS

A total of 1,657 adolescents aged 12-17years.

MAIN OUTCOME MEASURE(S)

Perceived parental control, perceived parental modeling, parent-teen co-decision making, self-efficacy, and consumption of fruits and vegetables as well as sugary drinks and less healthful food.

ANALYSIS

Ordinary least-squares regressions and mediation analyses.

RESULTS

After controlling for teenagers' self-efficacy, perceived parental control was not significantly associated with teenagers' fruit and vegetable consumption but it was negatively related to teenagers' consumption of sugary drinks and less nutrient-dense food. Perceived parental modeling had a positive correlation to teenagers' fruit and vegetable consumption and a negative relationship to their consumption of sugary drinks and less healthful food. Parent-teen co-decision making regarding teenagers' food consumption emerged as a positive predictor for teenagers' fruit and vegetable consumption but not for that of sugary drinks and foods with little nutritional value after controlling for self-efficacy.

CONCLUSIONS AND IMPLICATIONS

Findings from this study demonstrated that perceived parental behaviors were related to teenagers' nutrition intakes. Not exerting too much control and having teenagers participate in the decision-making process could help teenagers eat more healthily. Furthermore, providing a positive role model for teenagers can be an effective strategy to encourage teenagers to eat better.