Invited review: Maintaining and growing fluid milk consumption by children in school lunch programs in the United States

Fluid milk consumption among children has declined for decades. Adequate consumption of milk and dairy products, especially during childhood, has beneficial health outcomes for growth, development, and reduced risk of osteoporosis, hypertension, obesity, and cancer during adulthood. Satisfaction with milk flavor, perceived health benefits derived from milk, and habit are primary drivers of lifelong milk consumption. Child preferences and attitudes for milk may differ from those of adults, and as such, understanding and fulfilling the needs of children is crucial to reverse the decline in milk consumption. School meal programs make fluid milk accessible to millions of children each day; however, regulations and school lunch procurement systems in the United States sometimes make it difficult to provide novel or value-added milk products in these programs. Total consumption of all milk types in US schools declined by 14.2% from 2008 to 2017, and the percentage of children participating in the school lunch program has also declined. This decline has also been driven by declining average daily participation in the school meal program and may also reflect children's dissatisfaction with the sensory characteristics and the form of milk offered in schools. The change in form of milk offered in schools to lower fat and lower added sugar content in the United States has been driven by government-mandated school lunch calorie and fat requirements. This review describes the current milk consumption trends among children; the structure and basic requirements of the school lunch program in total and for milk; and the intrinsic, extrinsic, and environmental factors that influence child perception, preference, and consumption of fluid milk in the US school system.

A qualitative study exploring pupil and school staff perceptions of school meal provision in England

Despite recent attempts to improve the quality of school meals in England through the introduction of school meal standards, uptake remains low. Since the introduction of the universal infant free school meal (UIFSM) scheme in September 2014 all pupils in Reception, Year 1 and Year 2 in English state-funded primary schools are eligible to receive a free lunch. This study aimed to explore the perceptions of pupils, catering managers and head teachers concerning school meal provision in eight primary schools in North England and provides a unique insight into each school’s preparation for implementation of UIFSM. A total of thirty-two focus groups were conducted with sixty-four pupils aged 7–8 years (Year 3) and sixty-four pupils aged 9–10 years (Year 5) in June–July 2014, to explore perceptions of school meals. Interviews were carried out with six catering managers and five head teachers concerning catering and the impending implementation of UIFSM. Increasing acceptance of school meals could lead to improved uptake. Pupils desired increased choice and menu variety, including greater variety of vegetables and fruit. Caterers can influence the quantity and types of foods offered to pupils, and there are opportunities for them to promote healthy eating behaviours in the dining room. The important roles of school meal providers, caterers, pupils and parents need to be recognised to improve delivery and acceptability of school meals and ultimately school meal uptake. There were practical challenges to implementation of UIFSM, with some concerns expressed over its feasibility. Head teachers were mainly positive about the potential beneficial impacts of the scheme.

Perceptions and reasons for choice of fat- and fibre-containing foods by Swedish schoolchildren

This study investigated schoolchildren's breakfast choices focusing on their reported usual intake and perceptions of fat-reduced or fibre-enriched alternatives. A total of 184 eleven- to fifteen-year-old were asked to participate, and 181 completed the study. Using pictures of food items, the children were instructed to reproduce their usual breakfast, and then breakfasts that would be: healthy, tasty, consumed by their parents, or approved by their parents. Participants' usual breakfast included breads and breakfast cereals containing a higher fibre content than that of the breakfast reported as most palatable. Their usual breakfast also contained products with less fibre than was the case for their healthy or perceived parental norm breakfasts. This may be interpreted as evidence that high-fibre bread and breakfast cereals are perceived as healthy but that consumption of these products is limited by palatability. In contrast to the ambivalence towards cereal products, corresponding disagreements between breakfasts were not observed for milk, and only a small systematic disagreement was observed for spread. Thus, the majority consumed the kind of milk and spread perceived as being healthy, tasty and parentally sanctioned despite the fact that full-fat products were frequently consumed. In conclusion, the results suggest that taste may be a barrier to consumption of high-fibre products, while consumption of low-fat products appears to be impeded by health beliefs.

Understanding choice of milk and bread for breakfast among Swedish children aged 11-15 years: an application of the Theory of Planned Behaviour

The present study examined the influences of attitudes, social norms, perceived control and underlying beliefs on 11 to 15-year-olds' breakfast choices of milk with different fat content and high-fibre bread. All pupils in the 5th, 7th and 9th grades in Mölndal community (N=1730), Sweden, were asked to complete a questionnaire based on the Theory of Planned Behaviour. Two weeks later, they were asked to fill in a 7-day record of food consumed for breakfast. Consumption of milk and high-fibre bread was predicted from intentions, and for milk also by perceived behavioural control. Intentions were influenced by attitudes, perceptions of significant others' preferences, and perceived control. In addition, perception of the parents' consumption (descriptive norm) of the specific food played an important role. Attitudes, norms and perceived control predicted intentions to a similar extent in each age group. Attitudes to the consumption of milk and high fibre bread were influenced by beliefs about their sensory and health aspects. Females and the oldest children had greater knowledge about the healthier alternatives and the oldest children had a tendency to choose healthier options.

Assessing food choice in school children: reliability and construct validity of a method stacking food photographs

A method utilizing pictures was used to assess food choice with 44 school boys in three different age groups (10, 13 and 16 years old). The aim of the study was to test reliability and construct validity (i.e. inter-instrument agreement) of food choice assessed when the boys were asked to compose breakfasts. The focus was on choices of milk, margarine, bread and breakfast cereals, as in these food groups it is possible to choose between low-fat/high-fat and low-fibre/high-fibre products. Subjects were asked to repeat their composing of breakfasts after eight weeks, and to complete a four-day food record on breakfasts after the second interview occasion. For comparisons between food choices a new non-parametric statistical method was used. Both reliability and construct validity were good for choices of milk and margarine. The unreliability could be explained as random in nature or in terms of healthier choices in the second interview.