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Zaremba SMM, Cook WB, Anderson AS. ' It was called a grab bag and nobody wanted to grab them': Teachers' perceptions of school lunches during the COVID-19 pandemic - a regional case study. J Public Health Res 2023; 12:22799036231193071. [PMID: 37622100 PMCID: PMC10446468 DOI: 10.1177/22799036231193071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 07/16/2023] [Indexed: 08/26/2023] Open
Abstract
Background The COVID-19 pandemic brought changes to primary school lunches leading to concerns over nutritional quality and uptake of lunches by vulnerable children. Regional data from Tayside, Scotland, showed that only 55% of children who were eligible for free school meals took these (normal uptake pre-pandemic was 66%). The current work aimed to identify teachers' perceptions of meal provisioning in primary schools during the first year of the COVID-19 pandemic. Design and methods A cross-sectional online survey was carried out among primary school teachers across Tayside, Scotland. Using an online survey (21 questions combining multiple choice formats and open text) and interviews, primary school teachers shared their views on food quality, quantity, meal choices and factors influencing uptake of primary school lunches. Interviews were recorded, transcribed and thematically analysed with respect to factors influencing consumption. Results The survey was completed by 41 teachers and 8 participated in a follow up interview. Around one-third (29%) of primary school teachers believed the quality of lunches had decreased and cited poor appearance of food, use of takeaway containers and food wastage. The lunch format was viewed negatively principally relating to the substitution of hot lunches with cold sandwiches, portion sizes, choice and perceived value for money. Concerns were expressed about acceptability and how far the meals contributed to food security. Conclusions Further work on food provisioning is needed in order to identify ways to provide a nutritional safety net for vulnerable children.
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Affiliation(s)
- SMM Zaremba
- Division of Population Health & Genomics, Ninewells Hospital & Medical School, University of Dundee, Dundee, UK
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Spence S, Matthews JNS, McSweeney L, Adamson AJ, Bradley J. The Effect of a Product Placement Intervention on Pupil's Food and Drink Purchases in Two Secondary Schools: An Exploratory Study. Nutrients 2022; 14:nu14132626. [PMID: 35807804 PMCID: PMC9268040 DOI: 10.3390/nu14132626] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 06/21/2022] [Accepted: 06/22/2022] [Indexed: 02/05/2023] Open
Abstract
Limited research exists on the effectiveness of product placement in secondary schools. We explored the impact of re-positioning sweet-baked goods, fruit, sugar-sweetened beverages (SSBs) and water on pupil's lunchtime purchases in two secondary schools in North-East England. We employed a stepped-wedge design with two clusters and four time periods. The intervention(s) involved re-positioning selected food and drinks to increase and decrease accessibility of 'healthier' and 'less healthy' items, respectively. Unidentifiable smartcard data measured the change in number of pupil's purchasing the above items. McNemar tests were undertaken on paired nominal data in Stata(v15). In School A, pupils purchasing fruit pots from control to intervention increased (n = 0 cf. n = 81; OR 0, 95% CI 0 to 0.04); post-intervention, this was not maintained. In School B, from control to intervention pupil's purchasing sweet-baked goods decreased (n = 183 cf. n = 147; OR 1.2, 95% CI 1 to 1.6). This continued post-intervention (n = 161 cf. n = 122; OR 1.3, 95% CI 1.0 to 1.7) and was similar for SSBs (n = 180 cf. n = 79; OR 2.3, 95% CI 1.7 to 3.0). We found no evidence of other changes. There is some evidence that product placement may positively affect pupil's food and drink purchases. However, there are additional aspects to consider, such as, product availability, engaging canteen staff and the individual school context.
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Affiliation(s)
- Suzanne Spence
- Human Nutrition Research Centre, Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne NE2 4HH, UK; (L.M.); (A.J.A.); (J.B.)
- Fuse, The Centre for Translational Research in Public Health, Newcastle University, Newcastle upon Tyne NE2 4HH, UK
- Correspondence: ; Tel.: +44-0191-2085276
| | - John N. S. Matthews
- School of Mathematics, Statistics and Physics, Newcastle University, Newcastle upon Tyne NE1 7RU, UK;
| | - Lorraine McSweeney
- Human Nutrition Research Centre, Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne NE2 4HH, UK; (L.M.); (A.J.A.); (J.B.)
| | - Ashley J. Adamson
- Human Nutrition Research Centre, Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne NE2 4HH, UK; (L.M.); (A.J.A.); (J.B.)
- Fuse, The Centre for Translational Research in Public Health, Newcastle University, Newcastle upon Tyne NE2 4HH, UK
| | - Jennifer Bradley
- Human Nutrition Research Centre, Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne NE2 4HH, UK; (L.M.); (A.J.A.); (J.B.)
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Hock K, Barquera S, Corvalán C, Goodman S, Sacks G, Vanderlee L, White CM, White M, Hammond D. Awareness of and Participation in School Food Programs in Youth from Six Countries. J Nutr 2022; 152:85S-97S. [PMID: 35274730 PMCID: PMC9188863 DOI: 10.1093/jn/nxac052] [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: 01/07/2022] [Revised: 02/25/2022] [Accepted: 03/03/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND School-based meal programs can promote healthy dietary intake in youth. However, limited data exist regarding the impact of income-targeted school meal programs across countries, particularly among food-insecure youth. OBJECTIVES We examined self-reported awareness of and participation in free school meal programs, and associations with dietary intake in youth from 6 countries with differing national school meal policies. METHODS Data were collected through the 2019 International Food Policy Study Youth Survey, a cross-sectional survey of 10,565 youth aged 10-17 y from Australia, Canada, Chile, Mexico, the United Kingdom, and the United States. Regression models examined: 1) country differences in awareness of and participation in breakfast and lunch programs; and 2) associations between lunch program participation and intake of fruit and vegetables, and "less healthy" foods during the previous school lunch day. RESULTS Awareness of and participation in free breakfast and lunch programs varied across countries. Approximately half of USA and Chilean students participated in school lunch programs-the countries with the most comprehensive national policies-compared with one-fifth of students in the United Kingdom, and ∼5% in Australia, Canada, and Mexico (P < 0.001 for all contrasts). In the United States and Chile, more than two-thirds of youth with the highest level of food insecurity participated in lunch programs, compared with 45% in the United Kingdom, 27% in Canada, and ≤20% in Australia and Mexico. In all countries, youth reporting school lunch program participation were more likely to report fruit and vegetable intake during their previous school lunch (P < 0.001), and higher intake of "less healthy" food in all countries except the United States and Chile. CONCLUSIONS More comprehensive national policies were associated with greater participation in school meal programs, particularly among youth at greatest risk of food insecurity, as well as healthier dietary intake from school lunches.
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Affiliation(s)
- Karen Hock
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Simón Barquera
- Center for Nutrition and Health Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Camila Corvalán
- Institute of Nutrition and Food Technology (INTA), University of Chile, Santiago, Chile
| | - Samantha Goodman
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Gary Sacks
- Global Obesity Centre, Deakin University, Melbourne Burwood Campus, Burwood, Victoria, Australia
| | - Lana Vanderlee
- École de Nutrition, Centre Nutrition, santé et société (Centre NUTRISS), and Institut sur la nutrition et les aliments fonctionnels (INAF), Université Laval, Québec, Canada
| | - Christine M White
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Martin White
- MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
| | - David Hammond
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
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4
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McIntyre RL, Adamson AJ, Nelson M, Woodside J, Beattie S, Spence S. Changes and differences in school food standards (2010-2021) and free school meal provision during COVID-19 across the UK: Potential implications for children's diets. NUTR BULL 2022; 47:230-245. [PMID: 35942240 PMCID: PMC9348458 DOI: 10.1111/nbu.12556] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 04/08/2022] [Accepted: 04/12/2022] [Indexed: 11/30/2022]
Abstract
This paper explores changes to school food standards from 2010, free school meal provision during the COVID-19 pandemic across the UK and potential implications for children's diets. To obtain information on UK school food policies and free school meal provision methods we reviewed several sources including news articles, policy documents and journal articles. School food is an important part of the UK's health agenda and commitment to improving children's diets. Each UK nation has food-based standards implemented, however, only Scotland and Wales also have nutrient-based standards. School food standards in each nation have been updated in the last decade. Universal free school meals are available for children in the first 3 years of primary school in England and the first 5 years of primary school in Scotland, with plans announced for implementation of free school meals for all primary schoolchildren in Scotland and Wales. There is a lack of consistent monitoring of school food across the UK nations, and a lack of reporting compliance to the standards. Each nation differed in its response and management of free school meals during COVID-related school closures. Further, there are issues surrounding the monitoring of the methods to provide free school meal support during school closures. The role of school food has been highlighted during COVID-19, and with this, there have been calls for a review of free school meal eligibility criteria. The need for improved and consistent monitoring of school food across the UK remains, as does the need to evaluate the impact of school food on children's diets.
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Affiliation(s)
- Rebecca Louise McIntyre
- Human Nutrition Research Centre, Population Health Sciences Institute Newcastle University Newcastle upon Tyne UK
| | - Ashley J Adamson
- Human Nutrition Research Centre, Population Health Sciences Institute Newcastle University Newcastle upon Tyne UK.,Fuse, the Centre for Translational Research in Public Health Newcastle University Newcastle upon Tyne UK
| | - Michael Nelson
- Public Health Nutrition Research Ltd London UK.,Department of Nutrition and Dietetics King's College London London UK
| | - Jayne Woodside
- Centre for Public Health, Institute of Clinical Science A Queen's University Belfast Belfast UK
| | | | - Suzanne Spence
- Human Nutrition Research Centre, Population Health Sciences Institute Newcastle University Newcastle upon Tyne UK.,Fuse, the Centre for Translational Research in Public Health Newcastle University Newcastle upon Tyne UK
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5
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Bradley J, Rowland MK, Matthews JNS, Adamson AJ, Spence S. A comparison of food portion size estimation methods among 11-12 year olds: 3D food models vs an online tool using food portion photos (Intake24). BMC Nutr 2021; 7:10. [PMID: 33952349 PMCID: PMC8101205 DOI: 10.1186/s40795-021-00415-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 02/08/2021] [Indexed: 11/10/2022] Open
Abstract
Background Technology has advanced bringing new cost-effective methods to measure food intake. The aim of the study was to compare food and drink portion estimates from a traditional portion estimation method using 3D food models with portion estimates using an online dietary recall tool, Intake24. Methods 11-12 year old children were recruited from secondary schools in Newcastle upon Tyne. Each pupil completed a two-day food diary followed by an interview during which pupils estimated food portion sizes using a range of 3D food models. They also completed Intake24 for the same 2 days. Bland Altman analyses were used to compare mean intake for each method. Results Seventy pupils completed both portion estimation methods. There was good agreement in food weight estimations between the two methods (geometric mean ratio 1.00), with limits of agreement ranging from minus 35% to plus 53%. Intake24 provided estimates of energy intake that were 1% lower on average than estimates of energy intake using the food models. Mean intakes of all macro and micronutrients using Intake24 were within 6% of the food model estimates. Conclusions The findings suggest that there was little difference in portion estimations from the two methods, allowing comparisons to be made between Intake24 data and food diary data collected from same age pupils using 3D food models in previous years.
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Affiliation(s)
- Jennifer Bradley
- Human Nutrition Research Centre, Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK.
| | - Maisie K Rowland
- Human Nutrition Research Centre, Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK
| | - John N S Matthews
- School of Mathematics, Statistics and Physics, Newcastle University, Newcastle upon Tyne, NE1 7RU, UK
| | - Ashley J Adamson
- Human Nutrition Research Centre, Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK
| | - Suzanne Spence
- Human Nutrition Research Centre, Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK
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Rose K, O'Malley C, Eskandari F, Lake AA, Brown L, Ells LJ. The impact of, and views on, school food intervention and policy in young people aged 11-18 years in Europe: A mixed methods systematic review. Obes Rev 2021; 22:e13186. [PMID: 33442954 DOI: 10.1111/obr.13186] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 11/25/2020] [Accepted: 11/25/2020] [Indexed: 01/10/2023]
Abstract
Understanding the social and environmental influencers of eating behaviours has the potential to improve health outcomes for young people. This review aims to explore the effectiveness of school nutrition interventions and the perceptions of young people experiencing a nutrition focused intervention or change in school food policy. A comprehensive systematic search identified studies published between 1 December 2007 to 20 February 2020. Twenty-seven studies were included: 22 quantitative studies of nutrition related outcomes and five qualitative studies reporting views and perceptions of young people (combined sample of 22,138 participants, mean ages 12-18 years). The primary outcome was nutrition knowledge/dietary behaviours, with secondary outcomes exploring body mass index (BMI) and wellbeing. Due to the heterogeneity of studies, a narrative results description is presented. The findings demonstrate that school nutrition programmes can be effective in reducing sugar, sugar sweetened beverages (SSB) and saturated fat and increasing fruit and vegetable (FV) intake. The lived experiences of young people in a school context provide valuable insights that should be considered in the development of effective school food policy and interventions. This review affirms the significant role that schools can play in supporting good nutrition in all young people and provides opportunities to inform the school food agenda.
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Affiliation(s)
- Kelly Rose
- Centre for Public Health Research, School of Health and Life Sciences, Teesside University, Middlesbrough, UK
- Fuse - Centre for Translational Research in Public Health, Newcastle upon Tyne, UK
| | - Claire O'Malley
- Centre for Public Health Research, School of Health and Life Sciences, Teesside University, Middlesbrough, UK
- Fuse - Centre for Translational Research in Public Health, Newcastle upon Tyne, UK
| | - Fatemeh Eskandari
- Centre for Public Health Research, School of Health and Life Sciences, Teesside University, Middlesbrough, UK
- Fuse - Centre for Translational Research in Public Health, Newcastle upon Tyne, UK
| | - Amelia A Lake
- Centre for Public Health Research, School of Health and Life Sciences, Teesside University, Middlesbrough, UK
- Fuse - Centre for Translational Research in Public Health, Newcastle upon Tyne, UK
| | - Laura Brown
- Centre for Public Health Research, School of Health and Life Sciences, Teesside University, Middlesbrough, UK
| | - Louisa Jane Ells
- School of Clinical and Applied Sciences, Leeds Beckett University, Leeds, UK
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Abstract
We have recently been funded by the UK Prevention Research Partnership (UKPRP) to develop a UK school food network. The overarching aim is to build a community working towards a more health-promoting food and nutrition system in UK schools (primary and secondary). Here we describe the current status of school food research, including a review of the literature supporting the health-promoting schools approach and outline the opportunities for intervention and innovation establishment of the network present. Key potential school food research themes are described, and their prioritisation within the network, as well as network activities that have been planned, with the ultimate ambition of reducing socio-economic diet-related inequalities, and, consequently, non-communicable disease risk.
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Healthier Food and Beverage Interventions in Schools: Four Community Guide Systematic Reviews. Am J Prev Med 2020; 59:e15-e26. [PMID: 32564807 PMCID: PMC9366443 DOI: 10.1016/j.amepre.2020.01.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 01/12/2020] [Accepted: 01/13/2020] [Indexed: 11/23/2022]
Abstract
CONTEXT Healthy eating during childhood is important for optimal growth and helps reduce the risk of obesity, which has potentially serious health consequences. Changing the school food environment may offer one way to improve students' dietary intake. This manuscript reports 4 Community Guide systematic reviews examining the effectiveness of interventions in schools promoting healthy eating and weight. EVIDENCE ACQUISITION School obesity prevention programs aiming to improve diet were identified from a 2013 Agency for Health Care Research and Quality systematic review and an updated search (August 2012-January 4, 2017). In 2017-2018, Community Guide systematic review methods were used to assess effectiveness as determined by dietary behavior and weight changes. EVIDENCE SYNTHESIS Interventions improving school meals or offering fruits and vegetables (n=27 studies) are considered effective. Evidence is insufficient to determine the effectiveness of interventions supporting healthier snack foods and beverages outside of school meal programs given inconsistent findings (n=13 studies). Multicomponent interventions to increase availability of healthier foods and beverages are considered effective. These interventions must include 1 component from school meals or fruit and vegetable programs and interventions supporting healthier snack foods and beverages (n=12 studies). There is insufficient evidence to determine the effectiveness of interventions to increase water access because only 2 studies met inclusion criteria. CONCLUSIONS A total of 2 school-based dietary interventions have favorable effects for improving dietary habits and modest effects for improving or maintaining weight. More evidence is needed regarding interventions with insufficient findings. These reviews may inform researchers and school administrators about healthy eating and obesity prevention interventions.
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Abstract
OBJECTIVE School food policies are an important component of comprehensive strategies to address child obesity and improve children's health. Evaluations have demonstrated that these policies can be initially well accepted and appropriately implemented, however little is known about how acceptance levels may change over time. The present study aimed to re-evaluate a school food policy 10 years after its introduction to assess key stakeholders' support for various policy extensions that would strengthen the scope of the policy. DESIGN Online surveys administered 1 year after policy introduction (n 607, 2008) and 10 years after policy introduction (n 307, 2016). SETTING Western Australia.ParticipantsSchool principals, teachers, canteen managers and presidents of parents & citizens associations from Western Australian Government primary schools. RESULTS At both time points, and especially at time 2 (10 years post policy implementation), high levels of support were reported for the policy and possible policy extensions. Support was strongest for an additional requirement to integrate the canteen menu with the classroom health curriculum. CONCLUSIONS The results suggest that once a policy has become embedded into school practices, stakeholders may be receptive to modifications that strengthen the policy to enhance its potential effects on children's diets.
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10
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Micha R, Karageorgou D, Bakogianni I, Trichia E, Whitsel LP, Story M, Peñalvo JL, Mozaffarian D. Effectiveness of school food environment policies on children's dietary behaviors: A systematic review and meta-analysis. PLoS One 2018; 13:e0194555. [PMID: 29596440 PMCID: PMC5875768 DOI: 10.1371/journal.pone.0194555] [Citation(s) in RCA: 232] [Impact Index Per Article: 38.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 03/06/2018] [Indexed: 01/10/2023] Open
Abstract
Background School food environment policies may be a critical tool to promote healthy diets in children, yet their effectiveness remains unclear. Objective To systematically review and quantify the impact of school food environment policies on dietary habits, adiposity, and metabolic risk in children. Methods We systematically searched online databases for randomized or quasi-experimental interventions assessing effects of school food environment policies on children’s dietary habits, adiposity, or metabolic risk factors. Data were extracted independently and in duplicate, and pooled using inverse-variance random-effects meta-analysis. Habitual (within+outside school) dietary intakes were the primary outcome. Heterogeneity was explored using meta-regression and subgroup analysis. Funnel plots, Begg’s and Egger’s test evaluated potential publication bias. Results From 6,636 abstracts, 91 interventions (55 in US/Canada, 36 in Europe/New Zealand) were included, on direct provision of healthful foods/beverages (N = 39 studies), competitive food/beverage standards (N = 29), and school meal standards (N = 39) (some interventions assessed multiple policies). Direct provision policies, which largely targeted fruits and vegetables, increased consumption of fruits by 0.27 servings/d (n = 15 estimates (95%CI: 0.17, 0.36)) and combined fruits and vegetables by 0.28 servings/d (n = 16 (0.17, 0.40)); with a slight impact on vegetables (n = 11; 0.04 (0.01, 0.08)), and no effects on total calories (n = 6; -56 kcal/d (-174, 62)). In interventions targeting water, habitual intake was unchanged (n = 3; 0.33 glasses/d (-0.27, 0.93)). Competitive food/beverage standards reduced sugar-sweetened beverage intake by 0.18 servings/d (n = 3 (-0.31, -0.05)); and unhealthy snacks by 0.17 servings/d (n = 2 (-0.22, -0.13)), without effects on total calories (n = 5; -79 kcal/d (-179, 21)). School meal standards (mainly lunch) increased fruit intake (n = 2; 0.76 servings/d (0.37, 1.16)) and reduced total fat (-1.49%energy; n = 6 (-2.42, -0.57)), saturated fat (n = 4; -0.93%energy (-1.15, -0.70)) and sodium (n = 4; -170 mg/d (-242, -98)); but not total calories (n = 8; -38 kcal/d (-137, 62)). In 17 studies evaluating adiposity, significant decreases were generally not identified; few studies assessed metabolic factors (blood lipids/glucose/pressure), with mixed findings. Significant sources of heterogeneity or publication bias were not identified. Conclusions Specific school food environment policies can improve targeted dietary behaviors; effects on adiposity and metabolic risk require further investigation. These findings inform ongoing policy discussions and debates on best practices to improve childhood dietary habits and health.
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Affiliation(s)
- Renata Micha
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, United States of America
- * E-mail:
| | - Dimitra Karageorgou
- Department of Food Science and Human Nutrition, Agricultural University of Athens, Athens, Greece
| | - Ioanna Bakogianni
- Department of Food Science and Human Nutrition, Agricultural University of Athens, Athens, Greece
| | - Eirini Trichia
- Department of Food Science and Human Nutrition, Agricultural University of Athens, Athens, Greece
| | - Laurie P. Whitsel
- Policy Research, American Heart Association, Dallas, TX, United States of America
| | - Mary Story
- Global Health Institute and Community and Family Medicine, Duke University, Durham, NC, United States of America
| | - Jose L. Peñalvo
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, United States of America
| | - Dariush Mozaffarian
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, United States of America
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11
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Abstract
AbstractObjectiveTo assess (i) the extent to which stakeholders have accepted and implemented a Healthy Food and Drink Policy for schools a decade after its introduction and (ii) any resulting implications for canteen profitability.DesignOnline survey distributed via electronic newsletter to school principals.SettingWestern Australian public schools.SubjectsPrincipals, teachers, canteen managers, and parents and citizens committee presidents (n307).ResultsLarge majorities of respondents reported that the policy has made the foods and drinks provided in schools healthier (85 %) and that the policy constitutes a good opportunity to teach children about healthy eating (90 %). Only small proportions of respondents felt it had been difficult to implement the policy in their schools (13 %) or that the policy fails to accommodate parents’ rights to choose the foods consumed by their children (16 %). Most of the policy outcomes assessed in both the initial post-implementation evaluation (2008) and the 10-year follow-up evaluation (2016) demonstrated significant improvement over time.ConclusionsThe study results indicate that comprehensive school food policies can favourably influence the foods and drinks provided on school premises and can be highly acceptable to key stakeholders, without adversely affecting profitability. The results are encouraging for policy makers in other jurisdictions considering the implementation of similar policies.
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12
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Winpenny EM, Corder KL, Jones A, Ambrosini GL, White M, van Sluijs EMF. Changes in diet from age 10 to 14 years and prospective associations with school lunch choice. Appetite 2017; 116:259-267. [PMID: 28483584 PMCID: PMC5504772 DOI: 10.1016/j.appet.2017.05.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 05/04/2017] [Accepted: 05/04/2017] [Indexed: 01/05/2023]
Abstract
BACKGROUND There is limited evidence on how diet changes over the transition from primary to secondary school. In this study we investigated changes in diet from age 10 (2007) to age 14 years (2011) and the contribution of school-time consumption and school lunch choice to such changes. METHODS The 351 participants with dietary data (4 day food record) available at baseline (age 10 years) and follow-up (age 14 years) were included. Multi-level regression models were fitted for absolute or change in food and nutrient intake, cross-classified by primary and secondary school attended as appropriate, with adjustment for covariates and mis-reporting. RESULTS From age 10 to age 14 years, children decreased energy intake from sugars (-2.6% energy (%E)) (standard error (SE) 0.44) and from saturated fats (-0.54%E (SE 0.18)), decreased fruit (-3.13 g/MJ (SE 1.04)) and vegetables (-1.55 g/MJ (SE 0.46)) consumption and increased sugar sweetened beverage (SSB) (4.66 g/MJ (SE 1.87)) and fries (1.31 g/MJ (SE 0.39)) consumption. Intake of snack foods, SSBs, and fries, but also fruits and vegetables was higher outside school hours. Prospective change from non-school lunch to school lunch, compared to maintaining non-school lunch consumption, was associated with decreased consumption of savoury snacks (-8.32 g/day (SE 2.03)), increased consumption of fries (12.8 g/day (SE 4.01)) and decreased consumption of fruit (-25.16 g/day (SE 11.02)) during school hours. CONCLUSIONS Changes in diet from age 10 to age 14 years differed within and outside of school hours. Consumption of a school lunch, compared to lunch obtained elsewhere, was associated with negative as well as positive changes in diet, suggesting that any efforts to encourage school lunch take-up need to be accompanied by further efforts to improve school lunch provision to meet nutritional guidelines.
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Affiliation(s)
- Eleanor M Winpenny
- MRC Epidemiology Unit & Centre for Diet and Activity Research (CEDAR), University of Cambridge School of Clinical Medicine, Box 285, Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge CB2 0QQ, UK.
| | - Kirsten L Corder
- MRC Epidemiology Unit & Centre for Diet and Activity Research (CEDAR), University of Cambridge School of Clinical Medicine, Box 285, Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge CB2 0QQ, UK.
| | - Andy Jones
- Norwich Medical School, University of East Anglia, Norwich, Norfolk NR4 7TJ, UK.
| | - Gina L Ambrosini
- MRC Human Nutrition Research, Elsie Widdowson Laboratory, 120 Fulbourn Road, Cambridge CB1 9NL, UK; School of Population Health, University of Western Australia, 35 Stirling Highway, Crawley, Perth, Western Australia 6009, Australia.
| | - Martin White
- MRC Epidemiology Unit & Centre for Diet and Activity Research (CEDAR), University of Cambridge School of Clinical Medicine, Box 285, Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge CB2 0QQ, UK.
| | - Esther M F van Sluijs
- MRC Epidemiology Unit & Centre for Diet and Activity Research (CEDAR), University of Cambridge School of Clinical Medicine, Box 285, Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge CB2 0QQ, UK.
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13
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Preschool and School Meal Policies: An Overview of What We Know about Regulation, Implementation, and Impact on Diet in the UK, Sweden, and Australia. Nutrients 2017; 9:nu9070736. [PMID: 28696403 PMCID: PMC5537850 DOI: 10.3390/nu9070736] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2017] [Revised: 06/29/2017] [Accepted: 07/03/2017] [Indexed: 01/08/2023] Open
Abstract
School meals make significant contributions to healthy dietary behaviour, at a time when eating habits and food preferences are being formed. We provide an overview of the approaches to the provision, regulation, and improvement of preschool and primary school meals in the UK, Sweden, and Australia, three countries which vary in their degree of centralisation and regulation of school meals. Sweden has a centralised approach; all children receive free meals, and a pedagogical approach to meals is encouraged. Legislation demands that meals are nutritious. The UK system is varied and decentralised. Meals in most primary schools are regulated by food-based standards, but preschool-specific meal standards only exist in Scotland. The UK uses food groups (starchy foods, fruit and vegetables, proteins and dairy) in a healthy plate approach. Australian States and Territories all employ guidelines for school canteen food, predominantly using a "traffic light" approach outlining recommended and discouraged foods; however, most children bring food from home and are not covered by this guidance. The preschool standards state that food provided should be nutritious. We find that action is often lacking in the preschool years, and suggest that consistent policies, strong incentives for compliance, systematic monitoring, and an acknowledgement of the broader school eating environment (including home provided food) would be beneficial.
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School lunches in Japan: their contribution to healthier nutrient intake among elementary-school and junior high-school children. Public Health Nutr 2017; 20:1523-1533. [PMID: 28294086 DOI: 10.1017/s1368980017000374] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The role of school lunches in diet quality has not been well studied. Here, we aimed to determine the contribution of school lunches to overall nutrient intake in Japanese schoolchildren. DESIGN The study was conducted nationwide under a cross-sectional design. A non-consecutive, three-day diet record was performed on two school days and a non-school day separately. The prevalence of inadequate nutrient intake was estimated for intakes on one of the school days and the non-school day, and for daily habitual intake estimated by the best-power method. The relationship between food intake and nutrient intake adequacy was examined. SETTING Fourteen elementary and thirteen junior high schools in Japan. SUBJECTS Elementary-school children (n 629) and junior high-school children (n 281). RESULTS Intakes between the school and non-school days were significantly different for ≥60 % of nutrients. Almost all inadequacies were more prevalent on the non-school day. Regarding habitual intake, a high prevalence of inadequacy was observed for fat (29·9-47·7 %), dietary fibre (18·1-76·1 %) and salt (97·0-100 %). Inadequate habitual intake of vitamins and minerals (except Na) was infrequent in elementary-school children, but was observed in junior high-school children, particularly boys. CONCLUSIONS School lunches appear to improve total diet quality, particularly intake of most vitamins and minerals in Japanese children. However, excess intakes of fat and salt and insufficient intake of dietary fibre were major problems in this population. The contribution of school lunches to improving the intakes of these three nutrients was considered insufficient.
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Tugault-Lafleur CN, Black JL, Barr SI. A Systematic Review of Methods to Assess Children's Diets in the School Context. Adv Nutr 2017; 8:63-79. [PMID: 28096128 PMCID: PMC5227974 DOI: 10.3945/an.116.013144] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
To evaluate the impact of school-based nutrition interventions, accurate and reliable methods are needed to assess what children eat at school. The primary objective of this study was to systematically review methodological evidence on the relative accuracy and reliability of dietary assessment methods used in the school context. The secondary objective was to assess the frequency of methods and analytical approaches used in studies reporting in-school dietary outcomes. Three health databases were searched for full-text English-language studies. Twenty-two methodological studies were reviewed. For school meal recalls, the majority of studies (n = 8 of 12) reported poor accuracy when accuracy was measured by using frequencies of misreported foods. However, when energy report rates were used as a measure of accuracy, studies suggested that children were able to accurately report energy intake as a group. Results regarding the accuracy of food-frequency questionnaires (FFQs) and food records (FRs) were promising but limited to a single study each. Meal observations offered consistently good interrater reliability across all studies reviewed (n = 11). Studies reporting in-school dietary outcomes (n = 47) used a broad range of methods, but the most frequently used methods included weighed FRs (n = 12), school meal recalls (n = 10), meal observations by trained raters (n = 8), and estimated FRs (n = 7). The range of dietary components was greater among studies relying on school meal recalls and FRs than among studies using FFQs. Overall, few studies have measured the accuracy of dietary assessment methods in the school context. Understanding the methodological characteristics associated with dietary instruments is vital for improving the quality of the evidence used to inform and evaluate the impact of school-based nutrition policies and programs.
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Affiliation(s)
- Claire N Tugault-Lafleur
- Food, Nutrition and Health, Faculty of Land and Food Systems, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jennifer L Black
- Food, Nutrition and Health, Faculty of Land and Food Systems, University of British Columbia, Vancouver, British Columbia, Canada
| | - Susan I Barr
- Food, Nutrition and Health, Faculty of Land and Food Systems, University of British Columbia, Vancouver, British Columbia, Canada
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Pampaloni B, Cianferotti L, Gronchi G, Bartolini E, Fabbri S, Tanini A, Brandi ML. Growing Strong and Healthy with Mister Bone: An Educational Program to Have Strong Bones Later in Life. Nutrients 2015; 7:9985-98. [PMID: 26633485 PMCID: PMC4690062 DOI: 10.3390/nu7125510] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Revised: 11/19/2015] [Accepted: 11/20/2015] [Indexed: 01/03/2023] Open
Abstract
Optimal peak bone mass and bone health later in life are favored by a sufficient calcium intake in infancy, childhood and adolescence. The purpose of this study was to test a new educational program created to monitor and to improve calcium and vitamin D intake in children. Nutritional habits in children were evaluated through a food frequency questionnaire (FFQ) to assess the intake of calcium, vitamin D, dairy products, and total caloric energy at baseline and after seven months of exposure to a unique educational program applied between November 2013 and May 2014 in 176 schoolchildren (48% male, 52% female) attending the fourth and fifth grades of two selected primary schools in Florence, Italy. A significant increase of calcium (from 870 ± 190 to 1100 ± 200 mg/day, p < 0.05), and vitamin D (from 3.6 ± 1.53 to 4.1 ± 2 µg/day) intake in children was documented after the educational program. The amount of specific foods important for bone health consumed, such as milk and vegetables, increased significantly, both in male and female children (p < 0.05). The proposed educational program appears to be effective in modifying calcium intake in children, with a significant increase in the consumption of dairy products and vegetables, but without a significant change in the total caloric intake.
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Affiliation(s)
- Barbara Pampaloni
- Metabolic Bone Diseases Unit, Department of Surgery and Translational Medicine, University of Florence, Viale Pieraccini 6, Florence 50139, Italy.
| | - Luisella Cianferotti
- Metabolic Bone Diseases Unit, Department of Surgery and Translational Medicine, University of Florence, Viale Pieraccini 6, Florence 50139, Italy.
| | - Giorgio Gronchi
- Metabolic Bone Diseases Unit, Department of Surgery and Translational Medicine, University of Florence, Viale Pieraccini 6, Florence 50139, Italy.
| | - Elisa Bartolini
- Metabolic Bone Diseases Unit, Department of Surgery and Translational Medicine, University of Florence, Viale Pieraccini 6, Florence 50139, Italy.
| | - Sergio Fabbri
- Metabolic Bone Diseases Unit, Department of Surgery and Translational Medicine, University of Florence, Viale Pieraccini 6, Florence 50139, Italy.
| | - Annalisa Tanini
- Metabolic Bone Diseases Unit, Department of Surgery and Translational Medicine, University of Florence, Viale Pieraccini 6, Florence 50139, Italy.
| | - Maria Luisa Brandi
- Metabolic Bone Diseases Unit, Department of Surgery and Translational Medicine, University of Florence, Viale Pieraccini 6, Florence 50139, Italy.
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Evans CEL, Albar SA, Vargas-Garcia EJ, Xu F. School-Based Interventions to Reduce Obesity Risk in Children in High- and Middle-Income Countries. ADVANCES IN FOOD AND NUTRITION RESEARCH 2015; 76:29-77. [PMID: 26602571 DOI: 10.1016/bs.afnr.2015.07.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
School-based interventions are relatively new and were first introduced in the United States in the 1990s. Early programs were mainly education based with many of the findings now embedded in school policy in the form of a healthy eating curriculum. More recent school programs have taken education outside the classroom and attempted to engage parents as well as teachers. Environmental changes such as improving the quality of foods available at lunchtime and at other times during the school day are now common. Reviews of evaluations of school-based programs have demonstrated that they are effective and successfully improve dietary quality such as increasing fruit and vegetable intake and decreasing sweet and savory snacks and sweetened drinks; not just in school but over the whole day and particularly in younger school children. School-based interventions are also effective at reducing obesity if components to increase physical activity and reduce sedentary behaviors are also targeted but not if only dietary behaviors are tackled. Most of the high-quality evaluation studies using randomized controlled trials have been carried out in high-income countries as they are costly to run. However, middle-income countries have benefitted from the information available from these evaluation studies and many are now starting to fund and evaluate school-based programs themselves, resulting in unique problems such as concomitant under- and overnutrition being addressed. Action for the future demands more focus on populations most at risk of poor dietary quality and obesity in order to reduce inequalities in health and on adolescents who have not benefited as much as younger children from school-based interventions. This will involve innovative solutions within schools as well as targeting the food environment outside schools such as reducing the density of fast-food outlets and marketing of sweet and savory snacks and drinks.
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Affiliation(s)
- Charlotte E L Evans
- Lecturer in Public Health Nutrition, Nutritional Epidemiology Group, School of Food Science and Nutrition, University of Leeds, Woodhouse Lane, Leeds, LS2 9JT, UK.
| | - Salwa Ali Albar
- School of Food Science and Nutrition, King Abdul-Aziz University, PO Box 42807, 21551 Jeddah, Saudi Arabia; Nutritional Epidemiology Group, School of Food Science and Nutrition, University of Leeds, Woodhouse Lane, Leeds, LS2 9JT, UK
| | - Elisa J Vargas-Garcia
- Nutritional Epidemiology Group, School of Food Science and Nutrition, University of Leeds, Woodhouse Lane, Leeds, LS2 9JT, UK
| | - Fei Xu
- Nanjing Municipal Center for Disease Control and Prevention 2, Zizhulin, Nanjing 210003, China
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