1
|
Packed School Lunch Food Consumption: A Childhood Plate Waste Nutrient Analysis. Nutrients 2023; 15:nu15051116. [PMID: 36904116 PMCID: PMC10004809 DOI: 10.3390/nu15051116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 02/21/2023] [Accepted: 02/21/2023] [Indexed: 02/25/2023] Open
Abstract
Packed school lunch consumption remains a sparsely studied aspect of childhood nutrition. Most American research focuses on in-school meals provided through the National School Lunch Program (NSLP). The wide variety of available in-home packed lunches are usually nutritionally inferior compared to the highly regulated in-school meals. The purpose of this study was to examine the consumption of home-packed lunches in a sample of elementary-grade children. Through weighing packed school lunches in a 3rd grade class, mean caloric intake was recorded at 67.3% (32.7% plate waste) of solid foods, while sugar-sweetened beverage intake reported a 94.6% intake. This study reported no significant consumption change in the macronutrient ratio. Intake showed significantly reduced levels of calories, sodium, cholesterol, and fiber from the home-packed lunches (p < 0.05). The packed school lunch consumption rates for this class were similar to those reported for the regulated in-school (hot) lunches. Calories, sodium, and cholesterol intake are within childhood meal recommendations. What is encouraging is that the children were not "filling up" on more processed foods at the expense of nutrient dense foods. Of concern is that these meals still fall short on several parameters, especially low fruit/vegetable intake and high simple sugar consumption. Overall, intake moved in a healthier direction compared to the meals packed from home.
Collapse
|
2
|
Abstract
Context Policy-specific actions to improve food environments will support healthy population diets. Objective To identify cited barriers and facilitators to food environment policy (FEP) processes reported in the literature, exploring these according to the nature of the policy (voluntary or mandatory) and country development status. Data sources A systematic search was conducted of 10 academic and 7 grey-literature databases, national websites, and manual searches of publication references. Data extraction Data on government-led FEPs, barriers, and facilitators from key informants were collected. Data synthesis The constant-comparison approach generated core themes for barriers and facilitators. The appraisal tool developed by Hawker et al. was adopted to determine the quality of qualitative and quantitative studies. Results A total of 142 eligible studies were identified. Industry resistance or disincentive was the most cited barrier in policy development. Technical challenges were most frequently a barrier for policy implementation. Frequently cited facilitators included resource availability or maximization, strategies in policy process, and stakeholder partnership or support. Conclusions The findings from this study will strategically inform health-reform stakeholders about key elements of public health policy processes. More evidence is required from countries with human development indices ranging from low to high and on voluntary policies. Systematic Review Registration PROSPERO registration no. CRD42018115034.
Collapse
Affiliation(s)
- SeeHoe Ng
- Early Start, School of Health and Society, University of Wollongong, Wollongong, New South Wales, Australia
- School of Biosciences, Faculty of Health and Medical Sciences, Taylor's University, Subang Jaya, Selangor, Malaysia
| | - Heather Yeatman
- Early Start, School of Health and Society, University of Wollongong, Wollongong, New South Wales, Australia
| | - Bridget Kelly
- Early Start, School of Health and Society, University of Wollongong, Wollongong, New South Wales, Australia
| | - Sreelakshmi Sankaranarayanan
- School of Biosciences, Faculty of Health and Medical Sciences, Taylor's University, Subang Jaya, Selangor, Malaysia
| | - Tilakavati Karupaiah
- T. Karupaiah, School of Biosciences, Faculty of Health and Medical Sciences, Taylor's University, 47500 Subang Jaya, Selangor, Malaysia. E-mail:
| |
Collapse
|
3
|
Machado SS, Brewster AL, Shapiro VB, Ritchie LD, Magee KS, Madsen KA. Implementation Leadership in School Nutrition: A Qualitative Study. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2022; 54:56-64. [PMID: 34728165 DOI: 10.1016/j.jneb.2021.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 08/16/2021] [Accepted: 08/18/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE This paper identifies implementation leadership characteristics in the school nutrition setting and places findings in the context of implementation leadership literature. METHODS Fourteen interviews were conducted with school district leadership/staff in an urban school district. Modified grounded theory was employed. RESULTS Four themes emerged: (1) understanding of technical/operational intervention details; (2) ability to proactively develop and communicate plans; (3) supervisory oversight; and (4) intervention framing. Themes were consistent with 4 of the 5 dimensions comprising the Implementation Leadership Scale: knowledgeable, proactive, perseverant, and distributed leadership. The supportive domain was not a major finding. An additional domain, how leaders message the intervention to staff, was identified. CONCLUSIONS AND IMPLICATIONS Implementation leadership in school nutrition appears similar, but not identical, to leader behaviors present in the Implementation Leadership Scale. School nutrition leaders might consider involving staff early in implementation planning, incorporating technical expertise, and clearly communicating the intervention purpose to support successful implementation. Future research might explore the interplay between leadership and implementation outcomes.
Collapse
Affiliation(s)
- Stephanie S Machado
- Department of Public Health and Health Services Administration, California State University, Chico, CA; Stephanie Machado was at UC Berkeley in the School of Public Health during the study..
| | - Amanda L Brewster
- School of Public Health, University of California, Berkeley, Berkeley, CA
| | - Valerie B Shapiro
- School of Social Welfare, University of California Berkeley, Berkeley, CA
| | - Lorrene D Ritchie
- Nutrition Policy Institute, Division of Agriculture and Natural Resources, University of California, Oakland, CA
| | - Kiran S Magee
- School of Public Health, University of California, Berkeley, Berkeley, CA
| | - Kristine A Madsen
- School of Public Health, University of California, Berkeley, Berkeley, CA
| |
Collapse
|
4
|
Zagorski J, Reyes GA, Stasiewicz MJ, Prescott MP. Using Qualitative Interviews to Better Understand Differences in How Local Health Departments Inspect School Share Tables. J Food Prot 2021; 84:1664-1672. [PMID: 34047784 DOI: 10.4315/jfp-21-054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 05/24/2021] [Indexed: 11/11/2022]
Abstract
ABSTRACT Environmental and health advocates are increasingly promoting food donations to reduce landfilled food waste and feed hungry people. Share tables are locations where students can put unwanted school food or beverage items, allowing their uneaten food items to be "shared" with other students and providing food donation opportunities for the 4.9 billion lunches served annually in the U.S. National School Lunch Program. The purpose of this qualitative study was to identify differences in health inspector interpretations of the Food Code as it relates to share table operations and risk mitigation techniques preferred by inspectors for preventing foodborne illness from recovered food. A snowball sampling technique was used to identify Illinois health inspectors (n = 13) engaged in share table inspections. Telephone interviews were audio recorded and transcribed verbatim. The transcripts were coded using a hybrid process of deductive and inductive content analysis. Participants considered contamination, rather than temperature abuse, to be the primary risk factor for foodborne illness. Those participants with permissive Food Code interpretations considered contamination risk in the context of the overall school environment. Participants had the lowest degree of consensus on whether to allow whole apple recovery via a share table. Participants also lacked consensus on reuse of unclaimed share table items in future meal programs (reservice). This lack of consensus indicates that further research is needed to develop data-driven strategies to assess and manage the microbial risks associated with share tables and ultimately to facilitate increased food recovery. HIGHLIGHTS
Collapse
Affiliation(s)
- Jessica Zagorski
- Department of Food Science and Human Nutrition, University of Illinois at Urbana-Champaign, 905 South Goodwin Avenue, Urbana, Illinois 61801, USA
| | - Gustavo A Reyes
- Department of Food Science and Human Nutrition, University of Illinois at Urbana-Champaign, 905 South Goodwin Avenue, Urbana, Illinois 61801, USA
| | - Matthew J Stasiewicz
- Department of Food Science and Human Nutrition, University of Illinois at Urbana-Champaign, 905 South Goodwin Avenue, Urbana, Illinois 61801, USA
| | - Melissa Pflugh Prescott
- Department of Food Science and Human Nutrition, University of Illinois at Urbana-Champaign, 905 South Goodwin Avenue, Urbana, Illinois 61801, USA
| |
Collapse
|
5
|
Johnston R, Norman J, Furber S, Parkinson J. The barriers and enablers to implementing the NSW Healthy School Canteen Strategy in secondary schools in the Illawarra and Shoalhaven region - A qualitative study. Health Promot J Austr 2021; 33:686-695. [PMID: 34382275 DOI: 10.1002/hpja.528] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 07/20/2021] [Accepted: 08/08/2021] [Indexed: 11/11/2022] Open
Abstract
ISSUE ADDRESSED In 2017, the New South Wales Healthy School Canteen Strategy (Strategy) was introduced into primary and secondary schools. Studies have reported that secondary schools have a lower level of compliance with healthy canteen policies compared with primary schools. This study aims to identify and describe the barriers and enablers to implementing the Strategy in Department of Education (DoE) secondary schools in the Illawarra and Shoalhaven regions. METHODS The framework underpinning the study was the systems theory. Canteen managers (CM) and principals from the 21 DoE secondary schools in the Illawarra and Shoalhaven regions were invited to participate in semi-structured interviews. The interviews were structured around the five focus areas of the Strategy, including questions on school nutrition policies and the role of the canteen. Data were collated using the interview guides as a framework and qualitative content analysis, using manual coding, was undertaken. RESULTS Eight (38%) schools participated with seven CMs and six principals interviewed. Barriers to implementing the Strategy included the changing role of the canteen, the increased demands placed on CMs and inconsistencies between the school food environment and the Strategy. Enablers included monitoring implementation, and internal and external support. This study also recognised that previously identified barriers to healthy canteen strategy implementation are ongoing. CONCLUSIONS The school canteen is an integral part of the school environment and therefore needs whole-of-school support if successful implementation of the Strategy is to occur. SO WHAT Addressing the barriers and promoting the enablers identified in this study will support better nutrition policy implementation in secondary schools.
Collapse
Affiliation(s)
- Rosi Johnston
- Health Promotion Service, Illawarra Shoalhaven Local Health District, Warrawong, NSW, 2502, Australia
| | - Jennifer Norman
- Health Promotion Service, Illawarra Shoalhaven Local Health District, Warrawong, NSW, 2502, Australia.,Illawarra Health and Medical Research Institute, Wollongong, NSW, 2522, Australia.,Early Start, University of Wollongong, NSW, 2522, Australia
| | - Susan Furber
- Health Promotion Service, Illawarra Shoalhaven Local Health District, Warrawong, NSW, 2502, Australia.,Illawarra Health and Medical Research Institute, Wollongong, NSW, 2522, Australia.,Early Start, University of Wollongong, NSW, 2522, Australia
| | - Julie Parkinson
- Health Promotion Service, Illawarra Shoalhaven Local Health District, Warrawong, NSW, 2502, Australia
| |
Collapse
|
6
|
Holmes SR, Thompson AM, Herman KC, Reinke WM. Designing Interventions for Implementation in Schools: A Multimethod Investigation of Fidelity of a Self-Monitoring Intervention. SCHOOL PSYCHOLOGY REVIEW 2021. [DOI: 10.1080/2372966x.2020.1870868] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
| | | | - Keith C. Herman
- Missouri Prevention Science Institute, University of Missouri
| | - Wendy M. Reinke
- Missouri Prevention Science Institute, University of Missouri
| |
Collapse
|
7
|
Askelson N, Ryan G, Brady P, Meier CL, Delger P, Scheidel C. Middle School Students' Perceptions of the Lunchroom: Implications for Future Interventions. J Sch Nurs 2020; 38:233-240. [PMID: 32458718 DOI: 10.1177/1059840520928504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The National School Lunch Program provides nutritious and inexpensive lunches, but low participation and food waste are challenges in many schools. Interventions aim to improve participation in the program, but little is known about how students' perceptions affect their participation. This study explored how middle school students in a rural state perceive school food service staff, food served, and lunchroom atmosphere. An online survey was administered to middle school students at six schools participating in a larger lunchroom intervention. Mean perception scores were calculated for all measures. Multilevel logistic regression was used to examine the relationship between perceptions and consumption. Overall perceptions of staff, food, and atmosphere were positive, and students classified as school lunch eaters had more positive perceptions in all three areas than noneaters. Interventions to increase participation in school lunch programs and promote consumption of healthy food items should address multiple factors that contribute to school lunch participation.
Collapse
Affiliation(s)
- Natoshia Askelson
- Public Policy Center, College of Public Health, University of Iowa, IA, USA
| | - Grace Ryan
- Public Policy Center, College of Public Health, University of Iowa, IA, USA
| | - Patrick Brady
- Public Policy Center, College of Public Health, University of Iowa, IA, USA
| | | | - Patti Delger
- Iowa Department of Education, Des Moines, IA, USA
| | | |
Collapse
|
8
|
Lee KE. Students' dietary habits, food service satisfaction, and attitude toward school meals enhance meal consumption in school food service. Nutr Res Pract 2019; 13:555-563. [PMID: 31814931 PMCID: PMC6883234 DOI: 10.4162/nrp.2019.13.6.555] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 09/19/2019] [Accepted: 10/13/2019] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND/OBJECTIVES This study aimed to compare student consumption of school meals by school level, to identify the influencing factors of school meal consumption, and to assess improvement needs of school food service among students. SUBJECTS/METHODS A total of 1,441 elementary, middle, and high school students attending 58 schools in Gyeonggi-do, South Korea participated in the survey in 2015. A questionnaire and informed consent forms for students and legal guardians were sent home and completed responses were returned to the researcher. RESULTS Approximately 58% of the students perceived the portion sizes of school meals as appropriate and 76.1% consumed almost all or all of the meals served. More elementary and middle school students than high school students consumed almost all or all of the meals (P < 0.001). A regression analysis revealed that the students with a higher dietary behavior score (P < 0.001), higher satisfaction with food service (P < 0.001), a higher environmental protection practice score (P < 0.05), and more positive attitudes toward school meals (P < 0.01) consumed significantly more meals. The provision of foods that taste good and reflecting student opinions on menus were the most important factors for increasing school meal consumption. CONCLUSIONS To increase consumption of school meals, food service staff should provide students with quality meals and engage students in school food service. Nutrition education that emphasizes healthy eating behaviors and cafeteria environment modification that applies strategies based on behavioral economics can encourage students to consume more school meals.
Collapse
Affiliation(s)
- Kyung-Eun Lee
- Major of Food & Nutrition, Seoul Women's University, 621 Hwarangro, Nowon-gu, Seoul 01797, Korea
| |
Collapse
|
9
|
Dunn CG, Burgermaster M, Adams A, Koch P, Adintori PA, Stage VC. A Systematic Review and Content Analysis of Classroom Teacher Professional Development in Nutrition Education Programs. Adv Nutr 2019; 10:351-359. [PMID: 30668616 PMCID: PMC6416037 DOI: 10.1093/advances/nmy075] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 03/23/2018] [Accepted: 10/03/2018] [Indexed: 11/14/2022] Open
Abstract
Many nutrition programs include classroom-based education. Schoolteachers are relied upon to deliver these programs despite gaps in nutrition education motivation, knowledge, and self-efficacy. Teacher professional development (PD) for these nutrition education programs has been identified as a strategy for improving program effectiveness, yet many interventions do not include a PD component and still fewer describe it. A literature search was conducted between January and February 2017; articles were collected from PubMed, ERIC, and EBSCOhost. Article inclusion criteria were as follows: 1) published in an English-language peer-reviewed or scholarly journal, 2) published after 2000, 3) empirical research, 4) research conducted in a K-12 classroom, 5) research included nutrition education component, and 6) program delivered by a classroom teacher. Twenty-seven interventions were identified. A team of 2 researchers performed content analysis based on an evidence-based set of 7 PD components to assess if and how these components were incorporated before, during, or after program implementation. Little information was provided that described the role of teacher PD in the course of delivering nutrition education in classroom-based programs. The most common elements of PD described in the literature were the time spent in PD and follow-up with instructors during or after program implementation. There was a notable lack of methodologic description of teacher PD, and this limited reporting may decrease researchers' ability to work with teachers in a consistent and effective manner.
Collapse
Affiliation(s)
- Caroline G Dunn
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC
- Department of Health Policy and Management, Harvard TH Chan School of Public Health, Boston, MA
| | - Marissa Burgermaster
- Nutritional Sciences, College of Natural Sciences, and
- Population Health, Dell Medical School, University of Texas at Austin, Austin, TX
| | - Alyson Adams
- School of Teaching and Learning, College of Education, University of Florida, Gainesville, FL
| | - Pamela Koch
- Department of Health and Behavior Studies, Teachers College, Columbia University, New York, NY
| | - Peter A Adintori
- Department of Health and Behavior Studies, Teachers College, Columbia University, New York, NY
| | - Virginia C Stage
- Department of Nutrition Science, College of Allied Health Sciences, East Carolina University, Gainesville, NC
| |
Collapse
|
10
|
McIsaac JLD, Spencer R, Chiasson K, Kontak J, Kirk SFL. Factors Influencing the Implementation of Nutrition Policies in Schools: A Scoping Review. HEALTH EDUCATION & BEHAVIOR 2018; 46:224-250. [PMID: 30173576 DOI: 10.1177/1090198118796891] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Although school nutrition policies (SNPs) have been highlighted as an important intervention to support childhood nutrition, their implementation and maintenance within real-word settings is complex. There is a need to understand the factors that influence implementation by consolidating existing research and identifying commonalities and differences. AIMS The purpose of this review is to determine what is known about the influence of broad and local system factors on the implementation of SNPs internationally. METHOD This scoping review involved identifying and selecting relevant literature that related SNP implementation in primary and secondary schools. Following the search process, 2,368 articles were screened and 59 articles were synthesized and charted and emerging themes were identified. RESULTS Across the final studies identified, factors emerged as barriers and facilitators to the implementation of SNPs, with system implications that related to five areas to support policy action: providing macro-level support may encourage policy implementation; addressing the financial implications of healthy food access; aligning nutrition and core school priorities; developing a common purpose and responsibility among stakeholders; recognition of school and community characteristics. DISCUSSION While SNPs can help to support childhood nutrition, strategies to address issues related to policy implementation need to be taken to help schools overcome persistent challenges. CONCLUSION The results of this review provide opportunities for action across multiple system levels to ensure synergy and coordinated action toward SNP goals to foster the creation supportive nutrition environments for children.
Collapse
Affiliation(s)
- Jessie-Lee D McIsaac
- 1 Dalhousie University, Halifax, Nova Scotia, Canada.,2 Mount Saint Vincent University, Halifax, Nova Scotia, Canada
| | | | | | - Julia Kontak
- 1 Dalhousie University, Halifax, Nova Scotia, Canada
| | - Sara F L Kirk
- 1 Dalhousie University, Halifax, Nova Scotia, Canada
| |
Collapse
|
11
|
Ooi JY, Sutherland R, Nathan N, Yoong SL, Janssen L, Wrigley J, Wolfenden L. A cluster randomised controlled trial of a sugar-sweetened beverage intervention in secondary schools: Pilot study protocol. Nutr Health 2018; 24:260106018791856. [PMID: 30070164 DOI: 10.1177/0260106018791856] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Due to the rising prevalence of overweight and obesity in children and adolescents, reducing childhood overweight and obesity rates is a public-health priority. A significant source of excess sugar and energy in children's diets comes from sugar-sweetened beverages (SSB), with adolescents having the highest intake of all age groups. However, existing interventions targeting SSB intake in adolescents have multiple limitations. Schools have proven to be an appropriate setting for improving student health. AIM To assess the effectiveness of a school-based SSB intervention in reducing daily SSB consumption and daily percentage energy from SSBs of secondary-school students. METHODS A pilot study ( switchURsip) was designed based on the Health Promoting Schools framework components. A convenience sample of schools in New South Wales, Australia will be used to recruit six schools (three intervention; three control). The study incorporates strategies that focus on factors associated with SSB intake in adolescents. These strategies include: lesson plans on SSB; communication with students and parents; school challenge to build peer support; and school nutrition environment modifications. Support strategies to facilitate implementation are executive leadership and school committees, auditing and feedback, providing resources, staff professional learning and communication and marketing. CONCLUSION The high intake of SSB in adolescents has been consistently linked to having overweight and obesity, hence, interventions in this area should be prioritised. This pilot study intends to address identified evidence gaps by piloting the first intervention in Australia of its kind to reduce SSB intake in adolescents.
Collapse
Affiliation(s)
- Jia Ying Ooi
- 1 Hunter New England Population Health, Wallsend, Australia
- 2 School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- 3 Hunter Medical Research Institute, Newcastle, Australia
| | - Rachel Sutherland
- 1 Hunter New England Population Health, Wallsend, Australia
- 2 School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- 3 Hunter Medical Research Institute, Newcastle, Australia
| | - Nicole Nathan
- 1 Hunter New England Population Health, Wallsend, Australia
- 2 School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- 3 Hunter Medical Research Institute, Newcastle, Australia
| | - Sze Lin Yoong
- 1 Hunter New England Population Health, Wallsend, Australia
- 2 School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- 3 Hunter Medical Research Institute, Newcastle, Australia
| | - Lisa Janssen
- 1 Hunter New England Population Health, Wallsend, Australia
| | | | - Luke Wolfenden
- 1 Hunter New England Population Health, Wallsend, Australia
- 2 School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- 3 Hunter Medical Research Institute, Newcastle, Australia
| |
Collapse
|
12
|
Stokes N, Arendt SW. Identifying Farm to School Barriers and Keys to Success: Perceptions of Hourly Employees. JOURNAL OF HUNGER & ENVIRONMENTAL NUTRITION 2017. [DOI: 10.1080/19320248.2016.1157544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Nathan Stokes
- Eastern Kentucky University, Richmond, Kentucky, USA
| | | |
Collapse
|
13
|
Expressed Needs of Students for Prevention of Internet Addiction: A Content Analysis Study. HEALTH SCOPE 2017. [DOI: 10.5812/jhealthscope.15104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
14
|
Perspective of Health Care Providers about Barriers of Instructional Programs: A Qualitative Study. HEALTH SCOPE 2017. [DOI: 10.5812/jhealthscope.15116] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
15
|
Lessa K, Cortes C, Frigola A, Esteve M. Food healthy knowledge, attitudes and practices: Survey of the general public and food handlers. Int J Gastron Food Sci 2017. [DOI: 10.1016/j.ijgfs.2016.11.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
16
|
Harvey-Golding L, Donkin LM, Defeyter MA. Universal Free School Breakfast: A Qualitative Process Evaluation According to the Perspectives of Senior Stakeholders. Front Public Health 2016; 4:161. [PMID: 27532035 PMCID: PMC4970542 DOI: 10.3389/fpubh.2016.00161] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 07/21/2016] [Indexed: 11/13/2022] Open
Abstract
In the last decade, the provision of school breakfast has increased significantly in the UK. However, there is an absence of knowledge regarding senior stakeholder views on the processes and potential outcomes on different groups, within the communities served by school breakfast programs. The purpose of this study was to examine the views and experiences of senior level stakeholders and thereby provide an original qualitative contribution to the research. A sample of senior level stakeholders was recruited, including senior officers, directors, and elected members, from within a Local Authority (LA) involved in the leadership, implementation and delivery of a council-wide universal free school breakfast (UFSB) program, and from the senior staff body of mainstream primary and special schools, participating in the program. A grounded theory analysis of the data collected identified issues encountered in the implementation and delivery, and views on the funding and future of a USFB program, in addition to perceived outcomes for children, parents, families, schools, and the wider community. The results refer to both positive and negative issues and implications associated with the program, according to the perspectives of senior level stakeholders. Perceived positive outcomes included benefits to children, families, schools, and the community. For instance, alleviating hunger, improving health outcomes, and conferring financial benefits, with the potential to cumulate in overall improvements in educational, social, and behavioral outcomes. Reported negative implications included the absence of an effective communication strategy in implementing the USFB program; in addition to concerns about the impacts of "double-breakfasting" on obesity levels among children, particularly in less deprived communities. Findings were validated using theoretical sampling and saturation, triangulation methods, member checks, and inter-rater reliability measures. In presenting these findings, this paper provides a unique qualitative insight into the processes, issues and outcomes of a council-wide UFSB program within a socioeconomically deprived community, according to the perceptions of senior level stakeholders.
Collapse
Affiliation(s)
- Louise Harvey-Golding
- Department of Psychology, Faculty of Health and Life Sciences, Northumbria University, Newcastle Upon Tyne, UK
| | | | - Margaret Anne Defeyter
- Department of Psychology, Faculty of Health and Life Sciences, Northumbria University, Newcastle Upon Tyne, UK
| |
Collapse
|
17
|
Long ACJ, Hagermoser Sanetti LM, Collier-Meek MA, Gallucci J, Altschaefl M, Kratochwill TR. An exploratory investigation of teachers' intervention planning and perceived implementation barriers. J Sch Psychol 2016; 55:1-26. [PMID: 26931064 DOI: 10.1016/j.jsp.2015.12.002] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2013] [Revised: 11/09/2015] [Accepted: 12/09/2015] [Indexed: 11/26/2022]
Abstract
Increasingly teachers are the primary implementer responsible for providing evidence-based interventions to students. However, there is little knowledge regarding the extent to which teachers plan for intervention implementation, receive implementation support, or identify and address implementation barriers. This study explores survey data from over 1200 preschool through grade 12 teachers from 46 public school districts in a Northeastern state. Results indicate that teachers spend significant time engaging in intervention-related behavior and may be a primary source responsible for selecting student interventions. However, the current extent to which they plan for implementation and present levels of implementation support are inadequate to produce high levels of sustained intervention implementation. In addition, almost 60% of implementation barriers reported related to aspects of the intervention itself. Findings from this study provide guidance for future research and preliminary recommendations for ameliorating implementation barriers and proactively supporting treatment integrity in schools.
Collapse
|
18
|
Frerichs L, Brittin J, Intolubbe-Chmil L, Trowbridge M, Sorensen D, Huang TTK. The Role of School Design in Shaping Healthy Eating-Related Attitudes, Practices, and Behaviors Among School Staff. THE JOURNAL OF SCHOOL HEALTH 2016; 86:11-22. [PMID: 26645416 DOI: 10.1111/josh.12347] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Revised: 04/13/2015] [Accepted: 05/08/2015] [Indexed: 06/05/2023]
Abstract
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.
Collapse
Affiliation(s)
- Leah Frerichs
- University of North Carolina at Chapel Hill, Center for Health Equity Research, 323 MacNider Hall, CB 7240, Chapel Hill, NC 27599-7240.
| | - Jeri Brittin
- University of Nebraska Medical Center, College of Public Health, Department of Health Promotion, Social and Behavioral Health, 984365 Nebraska Medical Center, Omaha, NE 68918-4365.
| | | | - Matthew Trowbridge
- School of Medicine, University of Virginia, PO Box 800699, Charlottesville, VA 22908.
| | - Dina Sorensen
- VMDO Architects, 200 East Market Street, Charlottesville, VA 22902.
| | - Terry T-K Huang
- CUNY School of Public Health, 55 W. 125 Street, Room 803, New York, NY 10027.
| |
Collapse
|
19
|
Jørgensen TS, Rasmussen M, Aarestrup AK, Ersbøll AK, Jørgensen SE, Goodman E, Pedersen TP, Due P, Krølner R. The role of curriculum dose for the promotion of fruit and vegetable intake among adolescents: results from the Boost intervention. BMC Public Health 2015; 15:536. [PMID: 26044311 PMCID: PMC4456704 DOI: 10.1186/s12889-015-1840-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Accepted: 05/13/2015] [Indexed: 11/23/2022] Open
Abstract
Background Multi-component interventions combining educational and environmental strategies have proved effective in increasing children and adolescents’ fruit and vegetable intake. However such interventions are complex and difficult to implement and several studies report poor implementation. There is a need for knowledge on the role of dose for behaviour change and for assessment of intervention dose to avoid conclusions that intervention components which are not implemented are ineffective. This study aimed to examine 1) the association between dose of a class curriculum and adolescents’ fruit and vegetable intake in a school-based multi-component intervention, 2) if gender and socioeconomic position modify this association. Methods We carried out secondary analysis of data from intervention schools in the cluster-randomized Boost study targeting 13-year-olds’ fruit and vegetable intake. Teacher- and student data on curriculum dose delivered and received were aggregated to the school-level and class-level (only possible for student data). We analysed the association between curriculum dose and students’ (n 995) self-reported fruit and vegetable intake (24-h recall questionnaire) after finalization of the intervention using multi-level analyses. Potential moderation was examined by analyses stratified by gender and socioeconomic position. Results Average dose received at class-level was significantly associated with students’ fruit and vegetable intake (10 g (CI: 0.06, 20.33) per curricular activity received). In stratified analyses the association remained significant among boys only (14 g (CI: 2.84, 26.76) per curricular activity received). The average dose delivered and received at the school-level was not significantly associated with students’ intake. Conclusions We found a dose—response relationship between number of curricular activities received and adolescents’ fruit and vegetable intake. The results indicate that curriculum dose received only mattered for promotion of fruit and vegetable intake among boys. Future studies should explore this gender difference in larger samples to guide the planning of school-based curricular interventions with regards to the optimal number of curricular activities required to promote behavioural change in subgroups with low fruit and vegetable intake at baseline. Trial registration Current Controlled Trials ISRCTN11666034.
Collapse
Affiliation(s)
- Thea Suldrup Jørgensen
- Centre for Intervention Research in Health Promotion and Disease Prevention, National Institute of Public Health, University of Southern Denmark, Øster Farimagsgade 5A, 2nd floor, Copenhagen, K, 1353, Denmark.
| | - Mette Rasmussen
- Centre for Intervention Research in Health Promotion and Disease Prevention, National Institute of Public Health, University of Southern Denmark, Øster Farimagsgade 5A, 2nd floor, Copenhagen, K, 1353, Denmark.
| | - Anne Kristine Aarestrup
- Centre for Intervention Research in Health Promotion and Disease Prevention, National Institute of Public Health, University of Southern Denmark, Øster Farimagsgade 5A, 2nd floor, Copenhagen, K, 1353, Denmark.
| | - Annette Kjær Ersbøll
- National Institute of Public Health, University of Southern Denmark, Øster Farimagsgade 5A, 2nd floor, Copenhagen, K, 1353, Denmark.
| | - Sanne Ellegaard Jørgensen
- Centre for Intervention Research in Health Promotion and Disease Prevention, National Institute of Public Health, University of Southern Denmark, Øster Farimagsgade 5A, 2nd floor, Copenhagen, K, 1353, Denmark.
| | - Elizabeth Goodman
- Division of General Academic Pediatrics, Massachusetts General Hospital for Children, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA.
| | - Trine Pagh Pedersen
- National Institute of Public Health, University of Southern Denmark, Øster Farimagsgade 5A, 2nd floor, Copenhagen, K, 1353, Denmark.
| | - Pernille Due
- Centre for Intervention Research in Health Promotion and Disease Prevention, National Institute of Public Health, University of Southern Denmark, Øster Farimagsgade 5A, 2nd floor, Copenhagen, K, 1353, Denmark.
| | - Rikke Krølner
- Centre for Intervention Research in Health Promotion and Disease Prevention, National Institute of Public Health, University of Southern Denmark, Øster Farimagsgade 5A, 2nd floor, Copenhagen, K, 1353, Denmark.
| |
Collapse
|
20
|
Totura CMW, Figueroa HL, Wharton C, Marsiglia FF. Assessing implementation of evidence-based childhood obesity prevention strategies in schools. Prev Med Rep 2015; 2:347-54. [PMID: 26844091 PMCID: PMC4721446 DOI: 10.1016/j.pmedr.2015.04.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Objective Research suggests that schools can play a key role in obesity prevention by implementing evidence-based strategies promoting student health. This study explores school climate factors underlying implementation of evidence-based health and wellness policies and practices in Kindergarten–8th grade programs in the Southwestern United States. Method Utilizing a participatory research survey approach conducted in December 2011 with school health professionals (N = 62) and a multiple regression design, a moderated predictive model of implementation climate (i.e., attitudes and beliefs about prevention, school commitment to prevention, barriers, and stakeholder collaboration) was tested. Results Barriers to obesity prevention efforts, such as lack of resources, support, or strategy clarity, hinder implementation of healthy food policies despite strong school commitment to prevention. Along with the commitment to prevention, stakeholder collaboration predicts physical education strategies, specifically reducing restricted access to physical education as a punishment for student misconduct. Conclusion Obesity prevention strategy implementation relies on the supportiveness and structure of school climates. Barriers to prevention can impede efforts despite school commitment toward prevention, while stakeholder collaboration can enhance the likelihood that practices are in place. This study explored school implementation climate for obesity prevention. Barriers are associated with lower implementation of healthy food policies. Commitment and collaboration predict less restricted access to physical education. School prevention beliefs predict lower student access to physical education. Obesity prevention implementation depends on the supportiveness of school climates.
Collapse
Affiliation(s)
- Christine M W Totura
- Department of Psychology, Auburn University, 226 Thach Hall, Auburn, AL 36849, USA
| | - Holly Lewis Figueroa
- Southwest Interdisciplinary Research Center, Arizona State University, 411 North Central Avenue, Suite 720, Phoenix, AZ 85004, USA
| | - Christopher Wharton
- School of Nutrition and Health Promotion, Arizona State University, 500 N. Third Street, Phoenix, AZ 85004, USA
| | - Flavio F Marsiglia
- Southwest Interdisciplinary Research Center, Arizona State University, 411 North Central Avenue, Suite 720, Phoenix, AZ 85004, USA
| |
Collapse
|
21
|
Frerichs L, Brittin J, Sorensen D, Trowbridge MJ, Yaroch AL, Siahpush M, Tibbits M, Huang TTK. Influence of school architecture and design on healthy eating: a review of the evidence. Am J Public Health 2015; 105:e46-57. [PMID: 25713964 PMCID: PMC4358206 DOI: 10.2105/ajph.2014.302453] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2014] [Indexed: 11/04/2022]
Abstract
We examined evidence regarding the influence of school physical environment on healthy-eating outcomes. We applied a systems perspective to examine multiple disciplines' theoretical frameworks and used a mixed-methods systematic narrative review method, considering both qualitative and quantitative sources (published through March 2014) for inclusion. We developed a causal loop diagram from 102 sources identified. We found evidence of the influence of many aspects of a school's physical environment on healthy-eating outcomes. The causal loop diagram highlights multilevel and interrelated factors and elucidates the specific roles of design and architecture in encouraging healthy eating within schools. Our review highlighted the gaps in current evidence and identified areas of research needed to refine and expand school architecture and design strategies for addressing healthy eating.
Collapse
Affiliation(s)
- Leah Frerichs
- At the time of the study, Leah Frerichs, Jeri Brittin, Amy L. Yaroch, Mohammad Siahpush, Melissa Tibbits, and Terry T.-K. Huang were with the College of Public Health, University of Nebraska Medical Center, Omaha. Dina Sorensen is with VMDO Architects, Charlottesville, VA. Matthew J. Trowbridge is with the School of Medicine, University of Virginia, Charlottesville
| | | | | | | | | | | | | | | |
Collapse
|
22
|
Aarestrup AK, Suldrup Jørgensen T, Jørgensen SE, Hoelscher DM, Due P, Krølner R. Implementation of strategies to increase adolescents' access to fruit and vegetables at school: process evaluation findings from the Boost study. BMC Public Health 2015; 15:86. [PMID: 25881262 PMCID: PMC4334355 DOI: 10.1186/s12889-015-1399-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Accepted: 01/12/2015] [Indexed: 11/26/2022] Open
Abstract
Background Access to fruit and vegetables (FV) is associated with adolescents’ FV consumption. However, little is known about implementation of strategies to increase access to FV at schools. We examined the implementation of two environmental components designed to increase access to FV at Danish schools. Methods We used data from 20 intervention schools involved in the school-based multicomponent Boost trial targeting 13-year-olds’ FV consumption. The environmental components at school included daily provision of free FV and promotion of a pleasant eating environment. Questionnaire data was collected by the end of the nine-month intervention period among 1,121 pupils (95%), from all school principals (n = 20) and half way through the intervention period and by the end of the intervention among 114 teachers (44%). The implementation of the components was examined descriptively using the following process evaluation measures; fidelity, dose delivered, dose received and reach. Schools with stable high implementation levels over time were characterised by context, intervention appreciation and implementation of other components. Results For all process evaluation measures, the level of implementation varied by schools, classes and over time. Dose received: 45% of pupils (school range: 13-72%, class range: 7-77%) ate the provided FV daily; 68% of pupils (school range: 40-93%, class range: 24-100%) reported that time was allocated to eating FV in class. Reach: The intake of FV provided did not differ by SEP nor gender, but more girls and low SEP pupils enjoyed eating FV together. Dose delivered: The proportion of teachers offering FV at a daily basis decreased over time, while the proportion of teachers cutting up FV increased over time. Schools in which high proportions of teachers offered FV daily throughout the intervention period were characterized by being: small; having a low proportion of low SEP pupils; having a school food policy; high teacher- and pupil intervention appreciation; having fewer teachers who cut up FV; and having high implementation of educational components. Conclusions The appliance of different approaches and levels of analyses to describe data provided comprehension and knowledge of the implementation process. This knowledge is crucial for the interpretation of intervention effect. Trial registration Current Controlled Trials ISRCTN11666034
Collapse
Affiliation(s)
- Anne Kristine Aarestrup
- Centre for Intervention Research in Health Promotion and Disease Prevention, National Institute of Public Health, University of Southern Denmark, Øster Farimagsgade 5A 2nd floor, 1353, Copenhagen K, Denmark.
| | - Thea Suldrup Jørgensen
- Centre for Intervention Research in Health Promotion and Disease Prevention, National Institute of Public Health, University of Southern Denmark, Øster Farimagsgade 5A 2nd floor, 1353, Copenhagen K, Denmark.
| | - Sanne Ellegaard Jørgensen
- Centre for Intervention Research in Health Promotion and Disease Prevention, National Institute of Public Health, University of Southern Denmark, Øster Farimagsgade 5A 2nd floor, 1353, Copenhagen K, Denmark.
| | - Deanna M Hoelscher
- Michael & Susan Dell Center for Healthy Living, The University of Texas School of Public Health, Austin Regional Campus, 1616 Guadalupe, Suite 6.300, Austin, Texas, 78701, USA.
| | - Pernille Due
- Centre for Intervention Research in Health Promotion and Disease Prevention, National Institute of Public Health, University of Southern Denmark, Øster Farimagsgade 5A 2nd floor, 1353, Copenhagen K, Denmark.
| | - Rikke Krølner
- Centre for Intervention Research in Health Promotion and Disease Prevention, National Institute of Public Health, University of Southern Denmark, Øster Farimagsgade 5A 2nd floor, 1353, Copenhagen K, Denmark.
| |
Collapse
|
23
|
Jørgensen TS, Krølner R, Aarestrup AK, Tjørnhøj-Thomsen T, Due P, Rasmussen M. Barriers and facilitators for teachers' implementation of the curricular component of the boost intervention targeting adolescents' fruit and vegetable intake. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2014; 46:e1-e8. [PMID: 25052937 DOI: 10.1016/j.jneb.2014.06.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2013] [Revised: 06/06/2014] [Accepted: 06/08/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To examine barriers and facilitators to teachers' implementation of the curricular component of the school-based, multicomponent Boost intervention to promote fruit and vegetable intake among 13-year-olds guided by concepts of Diffusion of Innovations Theory and findings of previous implementation studies. DESIGN Five focus group and 2 individual interviews. SETTING Denmark. PARTICIPANTS Twenty-two seventh-grade teachers from 7 of 20 intervention schools. Four schools (15 teachers) with a high implementation level and 3 (7 teachers) with a low implementation level were selected to obtain maximum variation in teachers' view. PHENOMENON OF INTEREST Teacher perceptions of implementation of a curricular component. ANALYSIS Situational Analysis including an introductory phase of systematic coding. RESULTS Teachers' commitment to the Boost curriculum was hindered by intervention duration and extra workload and motivated by a pre-intervention workshop and the thoroughness of the project. Detailed implementation manuals were helpful for some teachers but a barrier to others because they limited opportunities for adaptation. CONCLUSIONS AND IMPLICATIONS Implementation of curricular activities in school-based interventions may be supported by a predefined teaching schedule, detailed teacher manuals, clear learning objectives, and a pre-intervention workshop to enhance motivation. Situational Analysis may contribute to future implementation studies by highlighting the importance of contextual factors.
Collapse
Affiliation(s)
- Thea Suldrup Jørgensen
- Centre for Intervention Research in Health Promotion and Disease Prevention, National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark.
| | - Rikke Krølner
- Centre for Intervention Research in Health Promotion and Disease Prevention, National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Anne Kristine Aarestrup
- Centre for Intervention Research in Health Promotion and Disease Prevention, National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Tine Tjørnhøj-Thomsen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Pernille Due
- Centre for Intervention Research in Health Promotion and Disease Prevention, National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Mette Rasmussen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| |
Collapse
|
24
|
Aarestrup AK, Krølner R, Jørgensen TS, Evans A, Due P, Tjørnhøj-Thomsen T. Implementing a free school-based fruit and vegetable programme: barriers and facilitators experienced by pupils, teachers and produce suppliers in the Boost study. BMC Public Health 2014; 14:146. [PMID: 24512278 PMCID: PMC3946026 DOI: 10.1186/1471-2458-14-146] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2013] [Accepted: 01/29/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Multi-component interventions which combine educational and environmental strategies appear to be most effective in increasing fruit and vegetable (FV) intake in adolescents. However, multi-component interventions are complex to implement and often poorly implemented. Identification of barriers and facilitators for implementation is warranted to improve future interventions.This study aimed to explore implementation of two intervention components which addressed availability and accessibility of FV in the multi-component, school-based Boost study which targeted FV intake among Danish 13-year-olds and to identify barriers and facilitators for implementation among pupils, teachers and FV suppliers. METHODS We conducted focus group interviews with 111 13-year-olds and 13 teachers, completed class observations at six schools, and conducted telephone interviews with all involved FV suppliers. Interviews were transcribed, coded and analysed using qualitative analytical procedures. RESULTS FV suppliers affected the implementation of the FV programme at schools and thereby pupils' intake through their timing of delivery and through the quality, quantity and variety of the delivered FV. Teachers influenced the accessibility and appearance of FV by deciding if and when the pupils could eat FV and whether FV were cut up. Different aspects of time acted as barriers for teachers' implementation of the FV programme: time spent on having a FV break during lessons, time needed to prepare FV and time spent on pupils' misbehaviour and not being able to handle getting FV. Teacher timing of cutting up and serving FV could turn into a barrier for pupils FV intake due to enzymatic browning. The appearance of FV was important for pupils' intake, especially for girls. FV that did not appeal to the pupils e.g. had turned brown after being cut up were thrown around as a part of a game by the pupils, especially boys. Girls appreciated the social dimension of eating FV together to a larger extent than boys. CONCLUSIONS Limited time and pupils' misbehaviour were barriers for teachers' implementation. Establishing FV delivery to schools as a new routine challenged FV suppliers' implementation. Food aesthetics were important for most pupils' FV intake while the social dimension of eating FV together seemed more important to girls than boys. TRIAL REGISTRATION Current Controlled Trials ISRCTN11666034.
Collapse
Affiliation(s)
- Anne Kristine Aarestrup
- Centre for Intervention Research in Health Promotion and Disease Prevention, National Institute of Public Health, University of Southern Denmark, Øster Farimagsgade 5A 2nd floor, 1353 Copenhagen K, Denmark.
| | | | | | | | | | | |
Collapse
|
25
|
Lucarelli JF, Alaimo K, Mang E, Martin C, Miles R, Bailey D, Kelleher DK, Drzal NB, Liu H. Facilitators to promoting health in schools: is school health climate the key? THE JOURNAL OF SCHOOL HEALTH 2014; 84:133-140. [PMID: 25099428 PMCID: PMC5598759 DOI: 10.1111/josh.12123] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2011] [Revised: 12/24/2012] [Accepted: 01/19/2013] [Indexed: 05/30/2023]
Abstract
BACKGROUND Schools can promote healthy eating in adolescents. This study used a qualitative approach to examine barriers and facilitators to healthy eating in schools. METHODS Case studies were conducted with 8 low-income Michigan middle schools. Interviews were conducted with 1 administrator, the food service director, and 1 member of the coordinated school health team at each school. RESULTS Barriers included budgetary constraints leading to low prioritization of health initiatives; availability of unhealthy competitive foods; and perceptions that students would not eat healthy foods. Schools had made improvements to foods and increased nutrition education. Support from administrators, teamwork among staff, and acknowledging student preferences facilitated positive changes. Schools with a key set of characteristics, (presence of a coordinated school health team, nutrition policies, and a school health champion) made more improvements. CONCLUSIONS The set of key characteristics identified in successful schools may represent a school's health climate. While models of school climate have been utilized in the educational field in relation to academic outcomes, a health-specific model of school climate would be useful in guiding school health practitioners and researchers and may improve the effectiveness of interventions aimed at improving student dietary intake and other health behaviors.
Collapse
Affiliation(s)
- Jennifer F Lucarelli
- Assistant Professor, , School of Health Sciences, Oakland University, 2200 N. Squirrel Road, Rochester, MI 48309
| | | | | | | | | | | | | | | | | |
Collapse
|
26
|
Bisset S, Potvin L, Daniel M. The adaptive nature of implementation practice: case study of a school-based nutrition education intervention. EVALUATION AND PROGRAM PLANNING 2013; 39:10-18. [PMID: 23501242 DOI: 10.1016/j.evalprogplan.2012.12.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2012] [Revised: 12/18/2012] [Accepted: 12/21/2012] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To describe how and why nutritionists implement and strategize particular program operations across school contexts. DESIGN Instrumental case study with empirical propositions from Actor-Network Theory (ANT). Data derived from interviews with interventionists and observations of their practices. SETTING Seven primary schools from disadvantaged Montreal neighborhoods. PARTICIPANTS Six nutritionists implementing the nutrition intervention in grades 4 and 5. From 133 nutrition workshops held in 2005/06, 31 workshops were observed with audio-recordings. INTERVENTION(S) Little Cooks--Parental Networks aims to promote healthy eating behaviors through engagement in food preparation and promotion of nutrition knowledge. PHENOMENON OF INTEREST The program-context interface where interventionists' practices form interactively within a given social context. ANALYSIS Coding inspired by ANT. Interview analysis involved construction of collective implementation strategies. Observations and audio-recordings were used to qualify and quantify nutritionists' practices against variations in implementation. RESULTS Nutritionists privileged intervention strategies according to particularities of the setting. Some such variation was accounted for by school-level social conditions, individual preferences and nutritionists' past experiences. CONCLUSIONS AND IMPLICATIONS Implementation practices are strategic and aim to engage educational actors to achieve intervention goals. These results challenge implementation frameworks centered on purely technical considerations that exclude the social and interpretive nature of practice.
Collapse
Affiliation(s)
- Sherri Bisset
- Department of Social and Preventive Medicine, Centre de recherche Léa-Roback sur les inégalités sociales de santé de Montréal & IRSPUM, Université de Montréal Public Health Research Institute, Québec, Canada.
| | | | | |
Collapse
|
27
|
Slawson DL, Southerland J, Lowe EF, Dalton WT, Pfortmiller DT, Schetzina K. Go Slow Whoa meal patterns: cafeteria staff and teacher perceptions of effectiveness in winning with wellness schools. THE JOURNAL OF SCHOOL HEALTH 2013; 83:485-492. [PMID: 23782091 DOI: 10.1111/josh.12056] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2011] [Revised: 06/04/2012] [Accepted: 07/08/2012] [Indexed: 06/02/2023]
Abstract
BACKGROUND School-based interventions hold promise for child obesity prevention. Implemented as a part of the Winning With Wellness obesity prevention project, the "Go Slow Whoa" meal pattern (GSW) was designed to promote healthier foods in school cafeterias. This investigation determined perceived program effectiveness and impact on student's food purchases. METHODS A mixed method design was used, including focus groups with cafeteria staff (CS), quantitative analysis of CS and teacher surveys, and pre-post analysis of cafeteria sales. A total of 37 CS and 131 teachers from 7 schools in northeast Tennessee participated. RESULTS CS recognized the important role of school nutrition services in influencing student choices, yet perceived lack of administrative support for cafeteria-based interventions and minimal interaction with teachers were barriers. CS also believed that students choose less nutritious options due to family influence. Cafeteria sales indicated that changes were made in menu planning and production, yet students' choices improved minimally. Teachers expressed moderate levels of confidence in GSW as influential in children's dietary habits. CONCLUSIONS Successful implementation of school-based nutrition programs requires supportive policies, administrators, and teachers. CS should be included in program implementation efforts and the role of school nutrition services should be maximized.
Collapse
Affiliation(s)
- Deborah L Slawson
- Department of Community and Behavioral Health, College of Public Health, East Tennessee State University, P.O. Box 70674, Johnson City, TN 37614, USA.
| | | | | | | | | | | |
Collapse
|
28
|
Jain A, Langwith C. Collaborative school-based obesity interventions: lessons learned from 6 southern districts. THE JOURNAL OF SCHOOL HEALTH 2013; 83:213-222. [PMID: 23343322 DOI: 10.1111/josh.12017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Revised: 09/17/2012] [Accepted: 09/28/2012] [Indexed: 06/01/2023]
Abstract
BACKGROUND Although studies have shown that school-based obesity interventions can be effective, little is known about how to translate and implement programs into real-world school settings. METHODS Semistructured interviews were conducted in spring 2012 with 19 key informants who participated in a multifaceted childhood obesity intervention involving school nurses and wellness coordinators in 6 school districts and over 100 schools. RESULTS The intervention changed form according to the needs and interests of the school districts. Despite funding support, schools and nurses had little capacity to address childhood obesity without the help of the coordinator. Initiating programs at the beginning of the school year was particularly difficult for schools. Applying for grants from internal and external sources and assisting with planning and logistics for wellness activities were significant activities of the coordinator. Although some school personnel and families preferred a focus on wellness rather than obesity, those working with individual at-risk children and families found the experience especially gratifying. CONCLUSIONS In contrast to controlled studies, real-world implementation of obesity interventions in schools that are intended to create sustained change requires flexibility in intervention design, timing, and personnel. A single change agent focused on obesity-related activities was essential to success.
Collapse
Affiliation(s)
- Anjali Jain
- The Lewin Group, Fairview Park Drive, Suite 500, Falls Church, VA 22042, USA.
| | | |
Collapse
|
29
|
Pelletier DL, Porter CM, Aarons GA, Wuehler SE, Neufeld LM. Expanding the frontiers of population nutrition research: new questions, new methods, and new approaches. Adv Nutr 2013; 4:92-114. [PMID: 23319128 PMCID: PMC3648745 DOI: 10.3945/an.112.003160] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Nutrition research, ranging from molecular to population levels and all points along this spectrum, is exploring new frontiers as new technologies and societal changes create new possibilities and demands. This paper defines a set of frontiers at the population level that are being created by the increased societal recognition of the importance of nutrition; its connection to urgent health, social, and environmental problems; and the need for effective and sustainable solutions at the population level. The frontiers are defined in terms of why, what, who, and how we study at the population level and the disciplinary foundations for that research. The paper provides illustrations of research along some of these frontiers, an overarching framework for population nutrition research, and access to some of the literature from outside of nutrition that can enhance the intellectual coherence, practical utility, and societal benefit of population nutrition research. The frontiers defined in this paper build on earlier forward-looking efforts by the American Society for Nutrition and extend these efforts in significant ways. The American Society for Nutrition and its members can play pivotal roles in advancing these frontiers by addressing a number of well-recognized challenges associated with transdisciplinary and engaged research.
Collapse
Affiliation(s)
- David L Pelletier
- Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA.
| | | | | | | | | |
Collapse
|
30
|
Dick M, Lee A, Bright M, Turner K, Edwards R, Dawson J, Miller J. Evaluation of implementation of a healthy food and drink supply strategy throughout the whole school environment in Queensland state schools, Australia. Eur J Clin Nutr 2012; 66:1124-9. [DOI: 10.1038/ejcn.2012.108] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
|
31
|
Long-term impact of a chef on school lunch consumption: findings from a 2-year pilot study in Boston middle schools. J Acad Nutr Diet 2012; 112:927-33. [PMID: 22504283 DOI: 10.1016/j.jand.2012.01.015] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2011] [Accepted: 01/19/2012] [Indexed: 11/20/2022]
Abstract
School cafeterias can play an important role in providing healthy meals. Although schools participating in the National School Lunch Program are required to meet minimum program standards, advocates recommend that innovations be sought to enhance menu dietary quality. This study evaluated the Chef Initiative, a 2-year pilot study in two Boston middle schools, designed to increase the availability and consumption of healthier school foods. Between 2007 and 2009, a professional chef trained cafeteria staff to prepare healthier school lunches (ie, more whole grains, fresh/frozen fruits and vegetables, and less sugar, salt, saturated fats, and trans fats). Meal nutrient compositions were monitored from 2007 to 2009, and a plate waste study conducted in the spring of 2009 compared food selection and consumption patterns among students at Chef Initiative schools, with students receiving standard school lunches at two matched control schools. Paired t tests and descriptive statistics were used to examine differences in menus and mixed-model analysis of variance was used to analyze differences in students' food selection and consumption between Chef Initiative and control schools. Overall, the Chef Initiative schools provided healthier lunches and the percent of foods consumed at Chef Initiative and control schools were similar (61.6% vs 57.3%; P=0.63). Of the areas targeted, there was greater whole-grain selection and vegetable consumption; 51% more students selected whole grains (P=0.02) and students consumed 0.36 more vegetable servings/day (P=0.01) at Chef Initiative schools. The potential of chefs collaborating with cafeteria staff to improve the availability, selection, and consumption of healthier meals is promising.
Collapse
|
32
|
|
33
|
Costa AMAM, Silva KSD, Bonan C. Organizações Não Governamentais na área da Saúde da Criança - revisão da literatura. CIENCIA & SAUDE COLETIVA 2011. [DOI: 10.1590/s1413-81232011000800018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
A segunda metade do século vinte assistiu ao crescimento de entidades que refletiam a mobilização da sociedade civil para uma participação mais efetiva nas questões de interesse público e de cunho social. Desta forma surgiram as organizações não governamentais (ONG) que ganharam espaço como parceiros dos setores públicos e privados para a atuação em diferentes áreas, entre elas a saúde. Baseado em uma revisão da literatura, este trabalho teve como objetivo conhecer o status do conhecimento científico sobre a participação das ONG na saúde da criança e a partir da identificação e classificação de suas atividades, observar se esta atuação tem se compatibilizado com a agenda desse campo. A análise das publicações considerou a procedência dos autores, o periódico, os objetivos, a origem e o local de atuação das ONG e a procedência dos recursos aplicados nos projetos desenvolvidos. A natureza das atividades variou de acordo com o grau de desenvolvimento da região onde as ONG atuavam e os temas, parceria entre órgãos de governo e terceiro setor, sustentabilidade e impacto das ações nas comunidades beneficiárias foram os principais tópicos destacados pelos autores. Concluiu-se que as questões estão apenas se esboçando e que o impacto das intervenções das ONG na área da saúde da criança é um campo de conhecimento a ser explorado.
Collapse
|
34
|
Hammerschmidt P, Tackett W, Golzynski M, Golzynski D. Barriers to and facilitators of healthful eating and physical activity in low-income schools. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2011; 43:63-68. [PMID: 20880753 DOI: 10.1016/j.jneb.2009.11.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2008] [Revised: 10/23/2009] [Accepted: 11/22/2009] [Indexed: 05/29/2023]
Abstract
OBJECTIVE To identify barriers to and facilitators of healthful eating and physical activity in low-income schools as perceived by school-affiliated staff. METHODS Perceptions of barriers and facilitators were measured in low-income schools through two online surveys (Kindergarten-8th grade and high school). Sixty-nine (Kindergarten-8th grade) and 22 (high school) responses were analyzed using descriptive statistics and frequency distributions. RESULTS Respondents felt students received too little nutrition education, physical activity, and physical education. Time within the school day and lack of funds were barriers. Family programs were highest rated for increasing nutrition education yet reported as implemented the least. CONCLUSIONS AND IMPLICATIONS Schools are a logical place to promote healthful eating and physical activity; however, time within the school day and lack of funds are major barriers for low-income schools. Health professionals can respect these barriers by holding programs outside of classroom time and finding ways to involve families (eg, during school events).
Collapse
|
35
|
Thomas M, Rowe F, Harris N. Understanding the factors that characterise school‐community partnerships. HEALTH EDUCATION 2010. [DOI: 10.1108/09654281011087242] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
36
|
The social, physical and temporal characteristics of primary school dining halls and their implications for children's eating behaviours. HEALTH EDUCATION 2010. [DOI: 10.1108/09654281011068540] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
37
|
Holthe A, Larsen T, Samdal O. Understanding barriers to implementing the Norwegian national guidelines for healthy school meals: a case study involving three secondary schools. MATERNAL AND CHILD NUTRITION 2010; 7:315-27. [PMID: 21689274 DOI: 10.1111/j.1740-8709.2009.00239.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The main goal of the present study was to investigate the barriers to implementing the Norwegian national guidelines for healthy school meals as perceived by principals, project leaders, teachers and students. This study employed a multiple-case design using an explorative approach. Data were collected at three secondary schools in Norway participating in the intervention project Physical activity and healthy school meals. Individual interviews were conducted with school principals and project leaders, and focus group interviews were conducted separately with teachers and students. Four categories of barriers were identified: (1) lack of adaptation of the guidelines to the target group; (2) lack of resources and funding; (3) conflicting values and goals; and (4) access to unhealthy food outside school. The research identified differences in perceived barriers between the staff responsible for implementation and the students as the target group of the measures. All staff groups perceived barriers relating to both resources, and conflicting values and goals. The teachers were more concerned about issues of relevance for adaptation to the target groups than were the principals and project leaders. The students were concerned mostly with issues directly affecting their experience with items offered in the canteen.
Collapse
Affiliation(s)
- Asle Holthe
- Faculty of Education, Bergen University College, 5096 Bergen, Norway.
| | | | | |
Collapse
|
38
|
Walton M, Pearce J, Day P. Examining the interaction between food outlets and outdoor food advertisements with primary school food environments. Health Place 2009; 15:811-8. [PMID: 19297234 DOI: 10.1016/j.healthplace.2009.02.003] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2008] [Revised: 01/27/2009] [Accepted: 02/02/2009] [Indexed: 11/18/2022]
Abstract
Schools are commonly seen as a site of intervention to improve children's nutrition, and prevent excess weight gain. Schools may have limited influence over children's diets; however, with home and community environments also exerting an influence within schools. This study considered the environment of food outlets and outdoor food advertisements surrounding four case study primary schools in New Zealand, and the impact of that external environment on within-school food environments. The shortest travel route between school and home addresses, and the number of food outlets and advertisements passed on that route, was calculated for each student. Interviews with school management were conducted. The schools with a higher percentage of students passing food outlets and advertisements considered that their presence impacted on efforts within schools to improve the food environment. Limiting students' exposure to food outlets and outdoor food adverts through travel route planning, reducing advertising, or limiting the location of food outlets surrounding schools could be explored as intervention options to support schools in promoting nutrition.
Collapse
Affiliation(s)
- Mat Walton
- Department of Public Health, University of Otago, Wellington, Wellington 6242, New Zealand.
| | | | | |
Collapse
|
39
|
Abstract
This review discusses school-based health promotion, including evidence-based perspectives on the school's feasibility as a venue for lifestyle risk reduction and disease prevention efforts. Future directions for inquiry and implications for empirically driven public policy initiatives are addressed.
Collapse
Affiliation(s)
- Lisa Terre
- Department of Psychology, University of Missouri-Kansas City,
| |
Collapse
|
40
|
Meals and snacks from the child's perspective: the contribution of qualitative methods to the development of dietary interventions. Public Health Nutr 2008; 12:739-47. [PMID: 18671890 DOI: 10.1017/s1368980008003248] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To explore the everyday consumption of meals and snacks from the child's perspective, among those with healthier v. less healthy dietary habits. DESIGN The sample in this qualitative study comprised two groups of Danish schoolchildren aged 10 to 11 years, one with a healthier diet (n 9) and the other with a less healthy diet (n 8). Both groups were recruited from respondents to a dietary survey. Semi-structured interviews took their starting point in photographs of their meals and snacks taken by the children themselves. RESULTS Both subgroups of children had a meal pattern with three main meals and two to four snacks. We found a connection between the nutritional quality of the diet and the social contexts of consumption, especially with regard to snacks. Among children with healthier eating habits, both snacks and meals tended to be shared social events and items of poor nutritional quality functioned as markers of a special social occasion. This was not the case among children with less healthy eating habits. All children described particular rules governing food consumption within their families. Although only some of them had participated in the development of these rules, and despite the fact that rules were different and were perceived as having been developed for different reasons, children from both subgroups tended to accept them. CONCLUSIONS The results of the study suggest that dietary interventions designed to promote children's health should focus more on the different social contexts of consumption and more on the role of parents.
Collapse
|
41
|
Wagner B, Senauer B, Runge CF. An Empirical Analysis of and Policy Recommendations to Improve the Nutritional Quality of School Meals. ACTA ACUST UNITED AC 2007. [DOI: 10.1111/j.1467-9353.2007.00380.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
42
|
Rogers IS, Ness AR, Hebditch K, Jones LR, Emmett PM. Quality of food eaten in English primary schools: school dinners vs packed lunches. Eur J Clin Nutr 2007; 61:856-64. [PMID: 17213869 DOI: 10.1038/sj.ejcn.1602592] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To compare the food and nutrient intakes of primary school children eating school dinners and packed lunches. SUBJECTS Six-hundred and twenty-one 7-year-old children participating in the Avon Longitudinal Study of Parents and Children in South West England. METHODS Diet was assessed by 3-day unweighed food record. RESULTS The composition of both types of school meals compared unfavourably with dietary guidelines. Intakes of energy, non-starch polysaccharides (NSP), calcium, iron, folate, retinol equivalents, zinc, copper, magnesium, iodine and riboflavin were too low, and intakes of total and saturated fat were too high. However, children who ate school dinners had higher lunchtime intakes of protein, starch, NSP and most vitamins and minerals and lower intakes of sugar (14.2 and 20.9% of energy in school dinners and packed lunches, respectively, P<0.001) and saturated fat (12.0 and 16.2%, P<0.001). Only around half of the recommended amount of fruit and vegetables was eaten by children having either type of school meal. There were also differences in the whole day's nutrient intake according to school meal type. Children eating packed lunches had lower daily intakes of potassium and zinc, and higher intakes of sugar and saturated fat. Differences in nutrient intake were independent of maternal education. CONCLUSIONS The food and nutrient content of both school dinners and packed lunches needed improvement. However, the standard of food brought from home by children was, if anything, worse than that served at school. Recent moves to improve school dinners will need to be complemented by education about what constitutes a healthy packed lunch.
Collapse
Affiliation(s)
- I S Rogers
- Avon Longitudinal Study of Parents and Children, Department of Social Medicine, University of Bristol, Bristol, UK
| | | | | | | | | |
Collapse
|
43
|
McCullum-Gomez C, Barroso CS, Hoelscher DM, Ward JL, Kelder SH. Factors Influencing Implementation of the Coordinated Approach to Child Health (CATCH) Eat Smart School Nutrition Program in Texas. ACTA ACUST UNITED AC 2006; 106:2039-44. [PMID: 17126635 DOI: 10.1016/j.jada.2006.09.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2005] [Indexed: 11/25/2022]
Abstract
The purpose of this research was to evaluate factors influencing the implementation of the Coordinated Approach to Child Health (CATCH) Eat Smart School Nutrition Program in Texas using data from the CATCH dissemination study. A mail survey was sent to school foodservice personnel (N = 213) who attended a CATCH training from August 2000 through January 2002. A response rate of 40% (n = 85) was achieved. The mean score for the percentage of CATCH Eat Smart guidelines implemented was 80.44. Multivariate linear regression analysis revealed that, after adjusting for age and number of years employed in school foodservice, the following factors were significantly associated with the percentage of CATCH Eat Smart guidelines implemented: utility of CATCH and CATCH Eat Smart in meeting requirements for Coordinated School Health Programs (P = 0.006), school foodservice personnel's satisfaction with food made using the CATCH Eat Smart guidelines (P = 0.008), utility of CATCH in facilitating interschool communication about children's health (P = 0.019), and perceived student satisfaction with food made using the CATCH Eat Smart guidelines (P = 0.046). These results suggest that dissemination approaches for Coordinated School Health Programs should focus on ways to enhance program satisfaction, be consistent with legislated mandates, and increase interschool staff communication to increase program implementation by school foodservice personnel.
Collapse
|
44
|
|
45
|
Izumi BT, Rostant OS, Moss MJ, Hamm MW. Results from the 2004 Michigan Farm-to-School Survey. THE JOURNAL OF SCHOOL HEALTH 2006; 76:169-74. [PMID: 16635200 DOI: 10.1111/j.1746-1561.2006.00090.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
The purpose of this study was to investigate Michigan school food service directors' interest in, and opportunities and barriers to, implementing a farm-to-school program. Farm-to-school may be a timely and innovative approach to improving the school food environment and helping food service directors meet their nutrition goals for school meals. Health and agriculture advocates have recognized the importance of farm-to-school in addressing health issues and creating opportunities for farmers and rural communities. Research subjects were 664 food service directors representing school districts across Michigan. Respondents (n = 383) reported a high degree of interest in sourcing food from local producers (73% reported being very interested or interested). Interest was significantly augmented (83%) when respondents were asked to assume that these foods were available through current vendors. Interest was independent of free/reduced lunch participation rate or school district location (rural, suburban, urban location). Food service directors expressed diverse motivations for their interest in farm-to-school, including supporting the local economy and community; accessing fresher, higher-quality food; and potentially increasing students' fruit and vegetable consumption. The most frequently reported barriers and concerns included cost, federal and state procurement regulations, reliable supply, seasonality of fruits and vegetables, and food safety. Michigan school food service directors appear ready to make linkages with local agriculture. However, there is need to address the concerns and barriers through education; inclusion of community partners, such as current vendors; funding; and state and federal policies that support local purchasing.
Collapse
Affiliation(s)
- Betty T Izumi
- Department of Community, Agriculture, Recreation and Resource Studies, Michigan State University, East Lansing 48824-1222, USA.
| | | | | | | |
Collapse
|
46
|
Bartholomew JB, Jowers EM. Increasing frequency of lower-fat entrees offered at school lunch: an environmental change strategy to increase healthful selections. ACTA ACUST UNITED AC 2006; 106:248-52. [PMID: 16442873 DOI: 10.1016/j.jada.2005.10.030] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2004] [Indexed: 11/22/2022]
Abstract
OBJECTIVE A two-phase study was conducted to determine the effect of an environmental intervention aimed to increase the selection of low- and moderate-fat entrees at school. DESIGN An evaluation of a school-wide intervention followed for two semesters. SUBJECTS Two schools of similar size and demographic data were randomly assigned to either intervention or control. Participants were the children in these schools. INTERVENTION In Phase 1, the rotation of existing entrees was modified such that one of three entree choices was low or moderate in fat. In Phase 2, the number of competing high-fat entrees was reduced from two choices to one. MAIN OUTCOME MEASURES Data were: (a) entree fat content (determined by a registered dietitian) and (b) the aggregate entree selections compiled from daily selection reports. STATISTICAL ANALYSES PERFORMED Frequency distributions were used to describe entree availability. Two-way analysis of variance indicated differences in the mean daily selection of low-, moderate-, and high-fat entrees. RESULTS In Phase 1 in the intervention school, the number of days that a low-fat entree was offered increased by 70%, with no increase in the rate of selection of the low- or moderate-fat entrees. In Phase 2, both low- and moderate-fat entrees were selected at a higher rate in the intervention school (32.1% and 26.4%, respectively) than the control school (13.8% and 7.5%, respectively), P<0.01. CONCLUSIONS Increasing the availability of low- and moderate-fat entrees is not sufficient to increase their rate of selection. However, their rate of selection is increased as the availability of high-fat entree choices is reduced.
Collapse
Affiliation(s)
- John B Bartholomew
- Department of Kinesiology and Health Education, University of Texas at Austin, 78712-1204, USA.
| | | |
Collapse
|
47
|
Knai C, Pomerleau J, Lock K, McKee M. Getting children to eat more fruit and vegetables: a systematic review. Prev Med 2006; 42:85-95. [PMID: 16375956 DOI: 10.1016/j.ypmed.2005.11.012] [Citation(s) in RCA: 276] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2005] [Revised: 11/10/2005] [Accepted: 11/11/2005] [Indexed: 11/29/2022]
Abstract
BACKGROUND There is growing recognition of the need to increase consumption of currently suboptimal levels of fruit and vegetables by children, given their known beneficial effects for health. There is, however, a need for a synthesis of the evidence on interventions that might achieve this policy goal. METHODS A systematic review of published and unpublished studies was carried out by searching 14 publication databases and contacting experts in the fields. All papers in eight languages were considered if they described individual- and population-based interventions and promotion programmes that encouraged the consumption of a diet relatively higher in fruit and/or vegetables in free-living, not acutely ill children of both genders, with follow-up periods of at least 3 months, measurement of change in intake and a control group. RESULTS Fifteen studies focusing on children met the criteria for inclusion in the systematic review. None of the studies reviewed had a detrimental effect on fruit and vegetable consumption. Ten studies had a significant effect, ranging from +0.3 to +0.99 servings/day. CONCLUSIONS More research is needed to examine in more depth, for longer follow-up periods, the effectiveness of interventions promoting fruit and vegetable consumption. The evidence is strongest in favor of multi-component interventions to increase fruit and vegetable consumption in children.
Collapse
Affiliation(s)
- Cécile Knai
- European Centre on Health of Societies in Transition, London School of Hygiene and Tropical Medicine, UK.
| | | | | | | |
Collapse
|