Search

Beginning with the school year 2006-2007, U.S. school districts participating in the federal Child Nutrition Programs were required to adopt and implement a local wellness policy (LWP) that included goals and/or standards for nutrition education, school meals, other foods sold or served in schools, and physical activity. A primary challenge with LWPs has been inconsistent implementation. This study examined whether state wellness policy requirement laws and district LWP comprehensiveness influence district level implementation, using law/policy data from the National Wellness Policy Study and school food authority (SFA)-reported district LWP implementation from the School Nutrition and Meal Cost Study. Generalized linear and structural equation models were used, controlling for SFA and district characteristics. SFAs in states with wellness policy requirement laws (vs. those in states without) reported implementing significantly more practices (59.56% vs. 44.57%, p < 0.01). State wellness policy requirement laws were associated with district LWP comprehensiveness (coeff.: 0.463; 95% CI: 0.123, 0.803) and district-level implementation (coeff.: 1.392; 95% CI: 0.299, 2.485). District LWP comprehensiveness was associated with district implementation (coeff.: 0.562; 95% CI: 0.072, 1.053), but did not mediate the state law-district implementation relationship. This study highlights the important role that state laws and district LWPs can play in facilitating wellness policy implementation.

Navajo (Diné) and other American Indian children are more affected by overweight and obesity than their U.S. counterparts. In this descriptive study, the authors combined a socioecological and Navajo cultural framework to analyze the various factors that influence food choices available to children in schools. The Healthy Hunger-Free Kids Act of 2010 updated nutrition standards for school meals and all other foods and beverages sold in schools. Some studies have shown that improved nutrition standards were not favorably received by students and school food programs. To better understand these broader trends in a Navajo context, the researcher administered in-person surveys to 6 principals and 14 food service workers from a sample of 6 schools and performed on-site observations of two schools. Data were analyzed using a combination of descriptive statistics, matrix analysis, and thematic analysis techniques. Results showed that schools were offering more healthy food options in school lunches and that some schools were still serving unhealthy foods, such as pizza, tater tots, and French fries. Classroom and fundraising events provided other sources for low-nutrient foods and beverages. Participants had mixed responses about the updated nutrition standards, and food waste of healthy foods was a major concern. This study proposes opportunities for nurses to engage in research and advance stronger policies that increase healthy food options and limit access to less healthy foods.

Issue Addressed: Improving implementation of school healthy canteen policies requires a comprehensive understanding of implementation barriers. Therefore, the aim of this study was to assess a range of barriers, as reported by canteen managers, using a quantitative survey instrument developed based on a theoretical framework., Methods: A cross sectional survey of primary school canteen managers from the Hunter New England region of New South Wales was conducted of eligible schools in the study region identified as having an operational canteen. Survey items assessed canteen manager employment status, canteen characteristics and potential barriers to healthy canteen policy implementation, aligned to the 14 domains of the theoretical domains framework via a 5-point Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree). The mean domain scores of canteen managers were calculated, less than four indicating the canteen manager considered the domain was a barrier. Canteen managers were also asked to provide the current canteen menu for audit by a dietitian., Results: Of the 184 participants, 20% (n = 36) were assessed as having menus compliant with the state policy. The five most common domains identified as potential barriers to policy implementation were behavioural regulation (n = 117, 65%), skills (n = 105, 57%), beliefs about capabilities (n = 100, 55%), reinforcement (n = 95, 52%) and goals (n = 95, 52%). Canteen managers who reported optimism as a barrier had significantly lower odds of having a menu compliant with the state policy (OR = 0.39; 95% CI 0.16-0.95, P = 0.038)., Conclusions: This study provides further evidence of perceived and actual barriers that canteen managers face when attempting to implement a healthy canteen policy, and highlights the need to address differences in canteen characteristics when planning implementation support. SO WHAT?: For public health benefits of nutrition policies within schools to be realised, the barriers to implementation need to be identified and used to help guide implementation support strategies., (© 2018 Australian Health Promotion Association.)

Supporting the implementation of school food and nutrition policies is an international priority to encourage healthier eating among children and youth. Schools are an important intervention setting to promote childhood nutrition, and many jurisdictions have adopted policies, guidelines, and programs to modify the school nutrition environment and promote healthier eating. The purpose of this study was to explore the association between perceived adequacy of facilities or equipment and capacity of staff to support policy implementation with food availability and policy adherence in the province of Nova Scotia (NS), Canada, one of the first regions in Canada to launch a comprehensive school food and nutrition policy (SFNP). A cross-sectional online survey was conducted in 2014-2015 to provide a current-state assessment of policy implementation and adherence. Adequacy and capacity for food policy implementation was used to assess policy adherence through the availability of prohibited 'minimum' nutrition foods. An exploratory factor analysis was conducted on a selection of available foods, and 'slow'- and 'quick'-service food composition measures were dichotomized for food availability. Schools with above-average perceived adequacy and capacity for policy implementation had greater odds (OR = 3.62, CI = 1.56, 8.40) of adhering to a lunch policy, while schools that adhered to a snack and lunch policy had lower odds (OR = 0.48, CI = 0.23, 1.01 and OR = 0.18, CI = 0.08, 0.41) of serving quick-service foods. This study identified the need for appropriate adequacy of facilities or equipment and capacity of staff for policy implementation to ensure policy adherence and improve the school food environment. These findings highlight the relationship between school food and nutrition policies, suggesting that better supporting their implementation could increase the likelihood of their success.

Objective: The Healthy Food and Drink Policy was implemented in Western Australian government schools in 2007. The aim of the present study was to assess the compliance of Western Australian school canteen menus with the policy a decade after its introduction., Design: The traffic-light system that underpins the Healthy Food and Drink Policy categorises foods and drinks into three groups: 'green' healthy items, 'amber' items that should be selected carefully and 'red' items that lack nutritional value. Canteen menus were collected online and each menu item was coded as a green, amber or red choice., Setting: Western Australia.ParticipantsOnline canteen menus from 136 primary and secondary government schools., Results: The majority of audited school menus met policy requirements to include ≥60 % green items (84 %) and ≤40 % amber items (90 %), but only 52 % completely excluded red items. Overall, approximately half (48 %) of school canteen menus met all three traffic-light targets. On average, 70 % of the menu items were green, 28 % were amber and 2 % were red. Primary-school canteen menus were more likely than those from secondary schools to meet the requirements of the policy., Conclusions: While the sampled Western Australian government school canteen menus were highly compliant with most of the requirements of the Healthy Food and Drink Policy, many offered red foods and/or drinks. Providing all schools with further education about identifying red items and offering additional services to secondary schools may help improve compliance rates.

Background: In the United States, the National School Lunch Program (NSLP) is the healthiest lunch option for students, yet participation is suboptimal and fruit and vegetable waste remains high. Improving school meal convenience, engaging teachers in the school-lunch program, and enhancing the cafeteria environment are promising strategies to improve participation and dietary intake, yet little evidence is available on their impact., Methods/design: The Multi-Pronged Intervention to Increase Secondary Student Participation in School Lunch (MPI) is a 3-year quasi-experimental study in a large urban school district in California. A total of 24 middle and high schools participated in the study: half received the intervention and half served as controls. The intervention consisted of additional school lunch points of sale (vending machines and mobile carts), a school meal outreach program for teachers, and cafeteria redesigns. School meal participation, student-reported fruit and vegetable consumption, and school lunch plate waste were assessed at baseline and in years 1 and 2 of the intervention. Change in meal participation and fruit and vegetable consumption were compared between intervention and control arms to determine the impact of the intervention on school meal participation and dietary intake., Discussion: This study is positioned to provide evidence on the feasibility and efficacy of a multi-level intervention to increase school meal participation and consumption of fruits and vegetables., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Background: Mexico approved mandatory nutrient-based standards for foods sold in schools in 2011. The aim of this study was to analyse the association between compliance with nutrition standards for foods sold in schools and children's school snacks., Methods: Data came from three surveys representative of Mexican elementary schools in 13 states and their students (2012, 2013 and 2015); n = 645 children from N = 99 different schools. Information on foods sold in schools and snacks consumed by children was collected through direct observation. Compliance with the standards was defined as the proportion of foods sold in school which met nutrition criteria established by the standards. Snacks were classified as healthy if they contained at least one fruit or vegetable and had no sugar-sweetened beverages. Robust logistic regression models for cross-sectional and repeated surveys aggregated at the school-level were fitted to quantify the association between school compliance with standards and healthy snacks., Results: On average across waves 27% of foods sold complied with nutrition standards; 18% of children consumed a healthy snack. For snacks purchased in school, a 10% increase in school compliance with the standards was associated with a 32% increase in the odds of a healthy snack (OR = 1.32; 95%CI 1.09,1.61); no association was observed for snacks brought from home. The odds of a healthy snack increased over time in schools where compliance with the standards improved (OR = 3.89; 95%CI 1.47,10.31) but not in those where compliance remained constant or decreased., Conclusions: Only a small proportion of children are eating healthy snacks in school. School compliance with standards increases the likelihood of a healthy snack if it is bought at school. Our findings support better implementation of the standards and additional strategies to enhance the policy to achieve its aim of reducing childhood obesity.

Purpose: To assess the prevalence of school salad bars in Arizona and to describe common practices of salad bar use among school nutrition managers across grade level., Design: Cross-sectional web-based surveys., Participants: School nutrition managers from elementary, middle, high, and K-12 schools (N = 648)., Measures: Prevalence of salad bars; implementation practices such as years with salad bar, salad bar type, location, monitor, and reimbursement practices; and food-related components of salad bars including frequency of items, popular items, and sources of food., Analysis: Descriptive analyses were conducted including Fisher exact test, analysis of variance, and the Kruskal-Wallis test comparing practices across grade level (elementary, middle, high, and K-12 schools)., Results: Overall, 61.1% of respondents had a salad bar; there were significant differences in the prevalence across grade level: elementary, middle, high, and K-12 schools had prevalence of 67.3%, 75.0%, 45.5%, and 51.1%, respectively ( P < .001). We observed significant differences in the implementation and food-related components of salad bars across grade levels including type, salad bar location, sources of food, and frequency of serving cut vegetables., Conclusion: This study provides insights on the prevalence of salad bars and is the first to report on implementation practices of school salad bars. These results may also guide the development of interventions for nutrition educators to use for the promotion fruit and vegetable consumption via school salad bars.

Background: The Healthy, Huger-Free Kids Act (HHFKA) presents challenges for foodservice directors (FSDs) in sourcing and preparing foods that meet nutrition standards. Concurrently, community health coalition members (CHCs) are engaging schools through community and school nutrition initiatives. We hypothesized significant differences in perceptions between FSDs and CHCs related to implementation of HHFKA such that FSDs would perceive greater foodservice challenges, while CHCs would be more supportive of community nutrition initiatives., Methods: A perceptions survey was administered by email to 528 FSDs and 334 CHCs during summer 2016. Experience, education level, urban/rural differences, school demographics, and involvement between FSDs and CHCs were compared., Results: Overall, 132 FSDs and 80 CHCs responded (29.5% FSDs, 24.7% CHCs). Overall perception of HHFKA foodservice challenge ranged between neutral (eg, neither challenging nor unchallenging) to somewhat challenging, and did not differ between groups. CHCs were significantly more supportive of community nutrition initiatives, while FSDs responded neutrally., Conclusions: FSDs awareness of CHCs desire for collaboration may increase FSDs support for broader school nutrition initiatives such as school gardens, farm to school, and student/community engagement. There is great potential for integrating student and community health programs through partnerships., (© 2018, American School Health Association.)

Day-care centers are the ideal place for conducting nutrition intervention to improve children&rsquo;s nutrition. The aim of this study is to evaluate the effectiveness of a multi-strategy childcare-base intervention in improving compliance with nutrition guidelines regarding beverages supply in preschools. The intervention included the staff training, audit, feedback, and ongoing support provided by trained educators. The emphasis was put on adequate nutrition, including recommended beverages, reducing sugar-sweetened beverages and increasing water availability. Enrolled were 478 full-board preschools from Poland (4.2% of all preschools in the country). The assortment of beverages served to children within ten consecutive days was assessed based on menus and inventory reports at the baseline, and three months after the intervention. Education increased significantly the percentage of preschools serving water to meals and between meals (67% vs. 83% and 93% vs. 99%, respectively), fruit/herbal tea (75% vs. 81%), and natural fruit juices (46% vs. 56%). The percentage of preschools offering fruit/soft drinks decreased from 23% to 15%. This study shows that education has a great potential in improving the assortment of beverages served in preschools. Future research is needed to determine barriers in better optimizing the assortment of beverages in preschool settings., Competing Interests: The authors declare no conflict of interest. The founding sponsors had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, and in the decision to publish the results.

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.

Objective: Standard menu compliance requires disposing of the sample evaluated due to the high degree of manipulation to which it is subjected. A new methodology is proposed to preserve the sample used during the evaluation process of the standard serving size, compared with the conventional methodology that disposes of it, and to validate its use in a group of school canteens in the city of Bogotá., Materials and Methods: A pilot test was carried out in nine canteens to select the most feasible implementation methodology, considering aspects such as weight and volume measurement, execution times, temperatures and microbiological risk for solid and liquid items. Regarding liquid items, a formula was developed to establish the relationship between weight and volume of the beverages offered., Results: The results show that there are no statistically significant differences between the weight and volume measurements obtained with the proposed methodology "Measurement by item in tared plate" compared to the usual "Measurement by complete plate and sample disposal"., Conclusion: It is necessary to implement a new methodology for verifying standard menu compliance in food services that does not imply disposing of samples and encourages waste reduction and savings for schools.

Introduction: The Healthy, Hunger-Free Kids Act of 2010 gave the U.S. Department of Agriculture authority to regulate school wellness policies, which include nutritional standards for foods advertised in schools. Brand marketing programs, which encourage students to purchase a company's products in exchange for money or rewards, were not explicitly prohibited. This study assesses the nutritional quality of products participating in "Box Tops for Education" ("Box Tops"), one of the largest national brand marketing programs in schools., Methods: Participating foods and beverages were obtained from the Box Tops product list and matched to nutrient information and ingredients from manufacturer websites in 2016 (N=949). Products were categorized as beverages (n=13); entrees (n=171); snacks (n=677); or fruits and vegetables exempt from the Smart Snacks in School Standards ("Smart Snacks" standards) (n=88) to assess the percentage that met the Smart Snacks standards., Results: Of the foods participating in the Box Tops program, 69% of beverages, 26% of entrees, and 23% of snacks met the Smart Snacks standards. Most foods met the standards for trans fats (98%); calories (90%); and sugar (89%); but fewer met the requirements for sodium (60%). Noncompliant snacks contained more than twice the recommended sodium (mean=420 mg, SD=191 mg) and percent calories from saturated fat (mean=22%, SD=13%)., Conclusions: Fewer than one third of Box Tops foods met the Smart Snacks standards. Schools should consider whether the benefit of participation outweighs the harm of exposing kids to unhealthful marketing. Alternatively, schools could opt not to participate unless companies limit redeemable products to household items or healthful options meeting the Smart Snacks standards., (Copyright © 2017 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.)

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., Competing Interests: The authors declare no conflict of interest.

Objective: Appetite regulation is influenced by the environment, and the environment is shaped by food-related policies. This review summarizes the environment and policy research portion of an NIH Workshop (Bethesda, MD, 2015) titled "Self-Regulation of Appetite-It's Complicated.", Methods: In this paper, we begin by making the case for why policy is an important tool in efforts to improve nutrition, and we introduce an ecological framework that illustrates the multiple layers that influence what people eat. We describe the state of the science on how policies influence behavior in several key areas: the federal food programs, schools, child care, food and beverage pricing, marketing to youth, behavioral economics, and changing defaults. Next, we propose novel approaches for multidisciplinary prevention and intervention strategies to promote breastfeeding, and examine interactions between psychology and the environment., Results: Policy and environmental change are the most distal influences on individual-level appetite regulation, yet these strategies can reach many people at once by changing the environment in which food choices are made. We note the need for more research to understand compensatory behavior, reactance, and how to effectively change social norms., Conclusions: To move forward, we need a more sophisticated understanding of how individual psychological and biological factors interact with the environment and policy influences., (© 2017 The Obesity Society.)

Objective: In England, standards for school meals included both foods and nutrients until 2015. School policies for packed lunches are generally food based; research is needed to determine whether these are adequate or whether a small number of nutrients would potentially improve their quality., Design: From dietary data obtained using a weighed dietary assessment tool, a diet quality score (DQS) for packed lunches was calculated using the number of standards met out of twenty-one (eight foods and thirteen nutrients). Multilevel regression analysis determined the foods and nutrients contributing to variation in the DQS., Setting: Eighty-nine primary schools across the four regions of the UK (England, Wales, Scotland and Northern Ireland)., Subjects: British schoolchildren (n 1294), aged 8-9 years, taking a packed lunch., Results: The optimal model included all eight foods and seven of the thirteen nutrients, explaining 72 % of the variance in DQS. Folate, Fe and vitamin C, together with the eight food groups, explained 70 % of DQS variation., Conclusions: Ideally, policies for school packed lunches should include food-based standards plus recommendations based on a small number of nutrients.

Background: As part of the Healthy, Hunger-Free Kids Act, snacks, and desserts sold in K-12 schools as of the 2014-2015 school year are required to meet the "Smart Snacks" nutritional guidelines. Although studies exist in tracking progress in local and national efforts, the proportion of snack food procured by school districts compliant with the Smart Snacks standard prior to its full implementation is unknown., Methods: We repurposed a previously untapped database, Interflex, of public bid records to examine the nutritional quality of snacks and desserts procured by school districts. We selected 8 school districts with at least 90% complete data each year during 2011-2012, 2012-2013, and 2013-2014 school years and at locations across different regions of the United States. We quantified the amount of calories and sugar of each product contained in the won bids based on available online sources and determined whether the produce complied with Smart Snack guidelines., Results: In all 8 districts (snack expenditure analyzed ranging from $152,000 to $4.4 million), at least 50% of snack bids were compliant with the US Department of Agriculture Smart Snacks standard during the 2013-2014 school year. Across sampled districts, we observed a general trend in lower caloric density (kcal per product) and sugar density (grams of sugar per product) over a 3-year period., Conclusions: Many districts across the country have made headway in complying with the Smart Snack guidelines, though gaps remain., (© 2016, American School Health Association.)

This final rule requires all local educational agencies that participate in the National School Lunch and School Breakfast Programs to meet expanded local school wellness policy requirements consistent with the requirements set forth in section 204 of the Healthy, Hunger-Free Kids Act of 2010. The final rule requires each local educational agency to establish minimum content requirements for the local school wellness policies, ensure stakeholder participation in the development and updates of such policies, and periodically assess and disclose to the public schools' compliance with the local school wellness policies. These regulations are expected to result in local school wellness policies that strengthen the ability of a local educational agency to create a school nutrition environment that promotes students' health, well-being, and ability to learn. In addition, these regulations will increase transparency for the public with regard to school wellness policies and contribute to integrity in the school nutrition program.

Objectives: To examine changes in competitive foods (items sold in à la carte lines, vending machines, and school stores that "compete" with school meals) in Massachusetts middle and high schools before and after implementation of a statewide nutrition law in 2012., Methods: We photographed n = 10 782 competitive foods and beverages in 36 Massachusetts school districts and 7 control state districts to determine availability and compliance with the law at baseline (2012), 1 year (2013), and 2 years (2014) after the policy (overall enrollment: 71 202 students). We examined availability and compliance trends over time., Results: By 2014, 60% of competitive foods and 79% of competitive beverages were compliant. Multilevel models showed an absolute 46.2% increase for foods (95% confidence interval = 36.2, 56.3) and 46.8% increase for beverages (95% confidence interval = 39.2, 54.4) in schools' alignment with updated standards from 2012 to 2014., Conclusions: The law's implementation resulted in major improvements in the availability and nutritional quality of competitive foods and beverages, but schools did not reach 100% compliance. This law closely mirrors US Department of Agriculture Smart Snacks in School standards, suggesting that complying with strict nutrition standards is feasible, and schools may experience challenges and improvements over time.

Objective: To give an account of provisions in the framework of international human rights and intergovernmental policy agreements in relation to eating at school and discuss how these provisions could be invoked to ensure healthy eating at school., Design: A review of provisions in the international and European human rights frameworks and policy documents was performed in order to identify evidence and examples of provisions implying responsibilities of the school as a public service provider to ensure healthy eating., Results: The review of the human rights and policy texts showed that there are a large number of provisions that can be invoked in support of measures at school which can contribute to ensuring healthier eating as well as better education supporting such measures., Conclusions: The international frameworks of human rights and intergovernmental policy agreements should be invoked and translated into concrete strategies, policies, regulations and accountability mechanisms at national, regional, local and school levels. Ensuring healthy eating should be a top priority among all stakeholders in and around the school environment since it is a good investment in children's short- and long-term health and educational achievements.

Objective: To compare the strength of district wellness policies with corresponding school-level practices reported by principals and teachers., Design: District-level wellness policy data were collected from school district websites and, if not available online, by requests made to district administrators in the autumn of 2013. The strength of district policies was scored using the Wellness School Assessment Tool. School-level data were drawn from the 2012 Minnesota School Health Profiles principal and teacher surveys and the National Center for Education Statistics Common Core Data. Generalized estimating equations which accounted for school-level demographics and the nesting of up to two schools within some districts were used to examine ten district policy items and fourteen school-level practices of relevance to nutrition standards, nutrition education and wellness promotion, and physical activity promotion., Setting: State-wide sample of 180 districts and 212 public schools in Minnesota, USA., Results: The mean number of energy-dense, nutrient-poor snack foods and beverages available for students to purchase at school was inversely related to the strength of district wellness policies regulating vending machines and school stores (P=0·01). The proportion of schools having a joint use agreement for shared use of physical activity facilities was inversely related to the strength of district policies addressing community use of school facilities (P=0·03). No associations were found between the strength of other district policies and school-level practices., Conclusions: Nutrition educators and other health professionals should assist schools in periodically assessing their wellness practices to ensure compliance with district wellness policies and environments supportive of healthy behaviours.

Milk is a source of shortfall nutrients in children's diets, but most children do not consume recommended amounts. We measured consumption of milk by elementary-schoolchildren (grades 3-5) in a diverse sample of schools before and after implementation of the US Department of Agriculture's updated meal regulations requiring flavored milk to be fat-free. Flavored milk consumption did not change from 2010 to 2013; 52.2% of students in 2010 and 49.7% in 2013 consumed 7 ounces or more of an 8-ounce container. Updated regulations succeeded in lowering the amount of fat, added sugars, and calories in school milk but did not change overall milk consumption, thus improving children's diet quality.

The study objective was to examine the nutritional quality of competitive foods and beverages (foods and beverages from vending machines and à la carte foods) available to rural middle school students, before implementation of the US Department of Agriculture's Smart Snacks in School standards in July 2014. In spring 2014, we audited vending machines and à la carte cafeteria foods and beverages in 8 rural Appalachian middle schools in Virginia. Few schools had vending machines. Few à la carte and vending machine foods met Smart Snacks in School standards (36.5%); however, most beverages did (78.2%). The major challenges to meeting standards were fat and sodium content of foods. Most competitive foods (62.2%) did not meet new standards, and rural schools with limited resources will likely require assistance to fully comply.

Access to healthy foods among secondary school students is patterned by individual-level socioeconomic status, but few studies have examined how school nutrition policies and practices are patterned by school-level characteristics. The objective of our study was to examine school nutrition policies and practices by school characteristics (eg, location, racial/ethnic composition, and free/reduced priced lunch eligibility) in Minnesota secondary schools between 2008 and 2012. Data from the 2008 to 2012 Minnesota School Health Profiles survey were used to assess school nutrition policies and practices, and National Center for Educational Statistics data were used for school characteristics (n=505 secondary schools). Nutrition policies and practices included the availability of low-nutrient, energy dense (LNED) items, strategies to engage students in healthy eating, and restrictions on advertisements of LNED products in areas around the school. Among school-level characteristics, school location was most strongly related to school nutrition policies. Across all years, city schools were less likely than town/rural schools to have vending machines/school stores (prevalence difference [PD] -13.7, 95% CI -25.0 to -2.3), and less likely to sell sport drinks (PD -36.3, 95% CI -51.8 to -20.7). City schools were also more likely to prohibit advertisements for LNED products in school buildings (PD 17.7, 95% CI 5.5 to 29.9) and on school grounds (PD 15.6, 95% CI 1.7 to 29.5). Between 2008 and 2012, the prevalence of some healthy eating policies/practices (eg, limiting salty snacks, offering taste testing, and banning unhealthy food advertisements in school publications) declined in city schools only, where these policies/practices had previously been more common. Monitoring of these trends is needed to understand the influence of these policies on student outcomes across school settings., (Copyright © 2015 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.)

Background: Schools can play a major role in prevention and intervention for childhood obesity. We describe changes in elementary school cafeteria lunch sales patterns resulting from nutritional improvements in menu offerings that were part of a community-wide focus on health., Methods: Elementary school lunch sales data were collected for 1 week in each of 7 years in a district serving a predominantly poor, rural, and Caucasian student population, with high rates of obesity. Post hoc data analyses described lunch sales patterns and related food service costs over the project years., Results: The percentage of high calorie/low nutrition foods sold decreased from 22% of all sales in 2005 to 0% in 2011. High-calorie snack purchases decreased from 535 items to 0 items. The sale of fresh fruits increased by 12%. There was only a slight decline in the percentage of children who purchased cafeteria lunches over the years and a 15.2% cost increase for purchasing healthier food supplies., Conclusions: Elementary school children purchased healthier lunches when healthier menu items were offered and when less healthy foods were eliminated from the menu. There was no significant decline in the number of students who purchased lunches as nutritional improvements were made., (© 2014, American School Health Association.)

Aims: School food in many countries has become the object of change and innovation processes, not only in relation to policies for healthier eating but also in relation to policies for more sustainable food consumption and procurement. The purpose of this study was to examine the possible influence that organic food sourcing policies in Danish school meal systems may have on the development of healthier school food environments., Methods: The study was a cross-sectional analysis undertaken among 179 school food coordinators (SFCs) through a web-based questionnaire (WBQ) in a sample of Danish public primary schools. The 'organic' schools were compared to 'non-organic' schools. The questionnaire explored the attitudes, intentions/policies and actions in relation to organic and healthy foods served in the schools., Results: Data indicates that 20 'organic' schools were associated with the indicators of healthier school environments, including adopting a Food and Nutrition Policy (FNP) in the school (p = .032), recommending children to eat healthily (p = .004)., Conclusions: The study suggests that organic food policies in schools may have potential to support a healthier school food environment.

School nutrition policies aim to eliminate ubiquitous unhealthy foods and beverages from schools to improve adolescent dietary behavior and reduce childhood obesity. This paper evaluates the impact of an early nutrition policy, Los Angeles Unified School District's food-and-beverage standards of 2004, using two large datasets on food intake and physical measures. I implement cohort and cross-section estimators using "synthetic" control groups, combinations of unaffected districts that are reweighted to closely resemble the treatment unit in the pre-intervention period. The results indicate that the policy was mostly ineffective at reducing the prevalence of overweight or obesity 8-15 months after the intervention but significantly decreased consumption of two key targets, soda and fried foods. The policy's impact on physical outcomes appears to be mitigated by substitution toward foods that are still (or newly) available in the schools., (Copyright © 2013 Elsevier B.V. All rights reserved.)

Objective: To assess the impact on food-related cost of meals to fulfill the new compulsory dietary standards for primary schools in France., Design: A descriptive study assessed the relationship between the level of compliance with the standards of observed school meals and their food-related cost. An analytical study assessed the cost of series of meals published in professional journals, and complying or not with new dietary standards. The costs were based on prices actually paid for food used to prepare school meals., Main Outcome Measure: Food-related cost of meals., Analysis: Parametric and nonparametric tests from a total of 42 and 120 series of 20 meals in the analytical and descriptive studies, respectively., Results: The descriptive study indicated that meeting the standards was not related to cost. The analytical study showed that fulfilling the frequency guidelines increased the cost, whereas fulfilling the portion sizes criteria decreased it. Series of meals fully respecting the standards (ie, frequency and portion sizes) cost significantly less (-0.10 €/meal) than series not fulfilling them, because the standards recommend smaller portion sizes., Conclusions and Implications: Introducing portion sizes rules in dietary standards for school catering may help increase dietary quality without increasing the food cost of meals., (Copyright © 2013 Society for Nutrition Education and Behavior. Published by Elsevier Inc. All rights reserved.)

This final rule updates the meal patterns and nutrition standards for the National School Lunch and School Breakfast Programs to align them with the Dietary Guidelines for Americans. This rule requires most schools to increase the availability of fruits, vegetables, whole grains, and fat-free and low-fat fluid milk in school meals; reduce the levels of sodium, saturated fat and trans fat in meals; and meet the nutrition needs of school children within their calorie requirements. These improvements to the school meal programs, largely based on recommendations made by the Institute of Medicine of the National Academies, are expected to enhance the diet and health of school children, and help mitigate the childhood obesity trend.

This article highlights sodium intake and risk for cardiovascular disease among women in the U.S. population and reviews selected interventions to promote sodium reduction conducted by CDC's Division for Heart Disease and Stroke Prevention.

To increase opportunities for healthy eating and physical activity, US school districts participating in the National School Lunch Program were required to create a Local Wellness Policy (LWP) by June 2006. The What's Working project described the initial influence of this mandate on nutrition environments and policies. In 2005 and 2007 (before and after the mandate went into effect), a survey about school features related to nutrition and physical activity was sent to a random sample of 45 low-income, rural elementary foodservice managers and principals. Schools averaged 204 students, 27% Hispanic. Districts' LWPs were coded for strength and comprehensiveness. In addition, key informant interviews were conducted with foodservice managers almost 2 years after the LWP went into effect. Three improvements were observed: increases in the percent of schools with policies stipulating predominantly healthy items be offered in classroom parties (21.4% in 2005 vs 48.7% in 2007), daily fresh fruit offerings in the lunchroom (0.80 choices in 2005 vs 1.15 choices in 2007), and the percent of schools using skinless poultry (27% in 2005 vs 59% in 2007). LWPs were weakly worded and rarely addressed energy content. Nutrition guideline elements most commonly addressed included vending machines, school stores, and à la carte food offerings. Seveny-three percent of foodservice managers were familiar with their district's LWP but did not perceive it changed lunchroom practices. Although LWPs offer a framework to support opportunities for healthy eating, few evidence-based practices were implemented as a direct result of the mandate. Schools need more information about evidence-based practices, as well as technical and financial assistance for implementation., (Copyright © 2010 American Dietetic Association. Published by Elsevier Inc. All rights reserved.)

Objectives: We assessed the impact of legislation that established nutrition standards for foods and beverages that compete with reimbursable school meals in California., Methods: We used documentation of available foods and beverages, sales accounts, and surveys of and interviews with students and food service workers to conduct 3 studies measuring pre- and postlegislation food and beverage availability, sales, and student consumption at 99 schools., Results: Availability of nutrition standard-compliant foods and beverages increased. Availability of noncompliant items decreased, with the biggest reductions in sodas and other sweetened beverages, regular chips, and candy. At-school consumption of some noncompliant foods dropped; at-home consumption of selected noncompliant foods did not increase. Food and beverage sales decreased at most venues, and food service à la carte revenue losses were usually offset by increased meal program participation. Increased food service expenditures outpaced revenue increases., Conclusions: Regulation of competitive foods improved school food environments and student nutritional intake. Improvements were modest, partly because many compliant items are fat- and sugar-modified products of low nutritional value. Additional policies and actions are needed to achieve more substantive improvements in school nutrition environments and student nutrition and health.

States and school districts around the country are developing policies that set nutrition standards for competitive foods and beverages sold outside of the US Department of Agriculture's reimbursable school lunch program. However, few tools exist for monitoring the implementation of these new policies. The objective of this research was to develop a computerized assessment tool, the Food and Beverage Environment Analysis and Monitoring System (FoodBEAMS), to collect data on the competitive school food environment and to test the inter-rater reliability of the tool among research and nonresearch professionals. FoodBEAMS was used to collect data in spring 2007 on the competitive foods and beverages sold in 21 California high schools. Adherence of the foods and beverages to California's competitive food and beverage nutrition policies for schools (Senate Bills 12 and 965) was determined using the data collected by both research and nonresearch professionals. The inter-rater reliability between the data collectors was assessed using the intraclass correlation coefficient. Researcher vs researcher and researcher vs nonresearcher inter-rater reliability was high for both foods and beverages, with intraclass correlation coefficients ranging from .972 to .987. Results of this study provide evidence that FoodBEAMS is a promising tool for assessing and monitoring adherence to nutrition standards for competitive foods sold on school campuses and can be used reliably by both research and nonresearch professionals., (Copyright 2010 American Dietetic Association. Published by Elsevier Inc. All rights reserved.)

Objectives: School meal improvement is a major component of UK government policy to improve children's diets. This study investigated the pragmatic influences on local education authority (LEA) and primary school policies affecting the food available during school mealtimes, together with the professional practices of catering staff that further influence the food served., Methods: A qualitative case study methodology involving interviews with primary school headteachers, catering managers and staff in a Welsh LEA., Results: Whilst reflecting the primary objective of national policy with respect to the nutritional content of the school meal, LEA and school policies were also influenced by multiple, competing interests including parental views, pupil's food preferences or organisational objectives, such as protecting school meal uptake. Tensions existed between food availability and choice such that menus incorporating choices based on children's preferences were viewed as facilitating service viability and prioritized over promoting healthy eating., Conclusions: Higher level policy interventions may be limited in their effectiveness if they are undermined by a lack of attention to lower level factors that may compromise their successful implementation. The critical role of school meal providers and school cooks needs to be recognised and strategic partnerships developed to minimise tensions between improved nutritional standards and school meal uptake.

Purpose: To determine extent and factors associated with implementation of California's school nutrition standards 1 year after standards became active., Methods: Information on competitive foods and beverages available in schools was collected from a representative sample of 56 public high schools in California. Adherence to nutrition standards was calculated for each item and summarized for each school by venue. The association between schools' sociodemographic characteristics and adherence to standards was determined by multivariate analysis., Results: The majority of schools were adhering to the required beverage standards. None of the schools selling competitive foods were 100% adherent to the food standards. Adherence to both standards tended to be highest in food service venues. In univariate analyses, percent nonwhite enrollment, population density, percent free/reduced-price (FRP) meal eligibility, and school size were significantly correlated with the beverage adherence rate. Percent nonwhite enrollment and population density remained significant in the multivariate regression model. Percent nonwhite enrollment and percent FRP meal eligibility were significantly correlated with the food adherence rate in univariate analysis, but neither remained significant in the multiple regression model., Conclusions: California high schools are making progress toward implementation of the state nutrition standards. Beverage standards appear easier to achieve than nutrient-based food standards. Additional support is needed to provide schools with resources to implement and monitor these policies. Simpler standards and/or a reduction in the foods and beverages sold could better enable schools to achieve and monitor adherence.

Purpose: This study identifies trends in the availability of various food choices in United States' middle and high schools from 2004 to 2007, and examines the potential associations between such food availability and students' self-reported eating habits and body mass index (BMI)-related outcomes., Methods: Data are based on nationally representative samples of 78,442 students in 684 secondary schools surveyed from 2004 to 2007 as part of the Youth, Education, and Society (YES) study and the Monitoring the Future (MTF) study. In the YES study, school administrators and food service managers completed self-administered questionnaires on their school's food environment. In the MTF study, students in the same schools completed self-administered questionnaires, providing data used to construct BMI and food consumption measures., Results: Overall, there was a decrease in the availability of regular-sugar/fat food items in both middle and high schools, and some indication of an increase in high school availability of reduced-fat food items through school lunch or a la carte. Some minimal evidence was found for relationships between the school food environment and student BMI-related outcomes and food consumption measures., Conclusions: United States secondary schools are making progress in the types of foods offered to students, with food items of lower nutritional value becoming less prevalent in recent years. Continued monitoring of food environment trends may help clarify whether and how such factors relate to youth health outcomes.

This review details the history of school meals in the UK, from their origin in the mid-19th Century, to the present day, and provides a summary of how each country has independently developed its own food and or nutrient-based standards for school meals. The standards in place in the UK are amongst some of the most detailed and comprehensive in the world. Regular monitoring to ensure that these standards are being met and that schools are improving healthy eating is essential to their success. Of no lesser importance are assessments to determine whether changes to school meals are having an impact on the diets of school children. It is early days in terms of evaluation because food-based standards have only recently been introduced and nutrient-based standards are in the process of being developed and implemented. Studies in England provide some evidence that the re-introduction of standards for school food is having a positive impact on both pupil's food choices and the nutritional profile of school lunches. At present, there does not appear to be a pattern between current obesity levels and the types of school meals provided, although it is anticipated that, in the long term, these comprehensive standards may contribute to a less obesogenic environment.