Healthy School Meals for All in Utah

BACKGROUND

The National School Lunch and School Breakfast programs reduce food insecurity and improve dietary intake. During the COVID-19 pandemic, school meals were provided to all children at no cost, regardless of income. This policy is known as Healthy School Meals For All (HSMFA). The purpose of the study was to examine the feasibility of a HSMFA policy in Utah.

METHODS

A mixed-methods approach was used, including qualitative interviews for policymakers, surveys for school foodservice directors, and financial modeling of Utah Child Nutrition Programs data. Analysis included a phenomenological analytic approach for qualitative data, descriptive statistics for surveys, and development of a cost model with 6 scenarios.

RESULTS

Qualitative data revealed themes of (1) awareness; (2) responsibility; (3) perspectives on school meals; and (4) new opportunities. Most (81%) foodservice directors believed HSMFA should continue post-pandemic. HSMFA would cost $51,341,436 to $82,358,375 per year.

IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY

HSMFA would result in the equitable treatment of all children regarding access to healthy school meals.

CONCLUSIONS

Given the support of foodservice directors but the lack of political consensus, considering stepwise implementation and providing cost estimates may increase feasibility of a HSMFA policy in Utah.

Interpersonal communication campaign promoting knowledge, attitude, intention, and consumption of iron folic acid tablets and iron rich foods among pregnant Indonesian women

BACKGROUND AND OBJECTIVES

Indonesia's community health delivery system offers services such as prenatal care and supplementation. Despite accessibility to these services, compliance with supplementation is low, and childhood stunting rates remain high. To address undernutrition, a National Nutrition Communication Campaign (NNCC) - using interpersonal communication (IPC) strategies - was implemented to promote consumption of iron-folic acid (IFA) supplements and iron-rich foods (ATIKA). The purpose of this study was to understand how participation in IPC activities influenced knowledge, attitude/intention, and consumption of IFA supplements and ATIKA among pregnant Indonesian women.

METHODS AND STUDY DESIGN

Cross-sectional data came from 766 pregnant women that participated in a survey that was based on the constructs from the Theory of Planned Behavior and Health Belief Model. Adjusted linear and logistic regression models were conducted to analyze the differences between self-reported IPC participants and non-IPC participants. Approximately 20% of women were exposed to the IFA portion of the IPC campaign, and 18% were exposed to the ATIKA portion.

RESULTS

Women that were exposed to the campaign reported significantly higher knowledge of IFA tablets and ATIKA, and improved attitudes/intentions towards IFA, compared to non-exposed women. Exposure was not associated with actual consumption behaviors.

CONCLUSIONS

These findings suggest that exposure to a low-intensity intervention can increase knowledge but may not be sufficient to impact behavior. As such, future efforts to reduce stunting through improved maternal nutrition should seek to increase exposure, address barriers, understand perceived susceptibility, and improve self-efficacy in order to expand intervention reach in Indonesia.

Tanzanian Women Exposed to Nutrition-Related Media Messages and Interpersonal Counselling Are More Likely Than Unexposed Women to Practice Optimal Nutrition Behaviors

Objectives

We tested the hypothesis that mothers of infants < 2 y of age who were exposed to nutrition- and health-focused radio and TV spots, interpersonal counselling (IPC), or both were more likely than mothers with no exposure to media nor to IPC to practice the following behaviors during their most recent pregnancy: eat more food than usual, eat more frequently than usual, eat more types of food than usual, make at least one antenatal care (ANC) visit, receive or purchase iron tablets, and reduce household workload.

Methods

Between 2016 and 2020, the Addressing Stunting in Tanzania Early (ASTUTE) project conducted a social and behavior change intervention in the Lake zone of Tanzania that reached

8.4 million individuals, including 4.4 million people through radio and TV spots, 6.4 million through community health worker home visits, 411,000 through support groups, and 1.6 million through health facility-based counselling. We administered a cross-sectional survey to 5,000 households with children < 2 y before the intervention and 5,000 households after program activities ended. We used bivariate analyses and logistic regression to test our hypotheses.

Results

After adjusting for maternal age, education, and household wealth, IPC alone was only associated receiving ANC (OR: 1.7, p = 0.008). Exposure to media alone was significantly associated with every behavior except self-reported increased food consumption (OR range for all comparisons: 1.2–1.9; p < 0.001). Exposure to both media and IPC was associated with every behavior (p < 0.001 for all comparisons) and the odds of practicing such behaviors were greater than for media alone (OR range: 1.6–3.8; p < 0.01 for all comparisons).

Conclusions

In this program setting, exposure to IPC alone was not associated with nutrition and health behaviors in pregnancy but media and media + IPC were strongly associated with such practices. Media and IPC have the potential to improve maternal nutrition, an often-neglected public health challenge.

Funding Sources

ASTUTE was funded by UKAid (contract # PO 6803).