School food service directors' perceptions of barriers to and strategies for improving the school food environment in the United States.

Objective: Despite school food service directors' (FSDs) important role in the school food environment, little research has been conducted to assess their perceptions of barriers to and strategies for improving the nutritional status of the nation's school children. The aim of this study was to examine FSDs' perceptions about the school food environment at the elementary, junior high, and high school levels. Design: A cross sectional survey of the school FSDs in the United States was conducted. The sampling frame was a total of 5,146 FSDs included in a list maintained by the School Nutrition Association. From this list, a random sample of 508 FSDs were selected. The self report questionnaire was conducted via mail and included the following three sections: (1) social and demographic characteristics of FSDs, (2) perceived barriers to improving healthy food choices in the school food environment, and (3) perceived strategies for improving healthy food choices in the school food environment. The overall response rate was 58.5% (n - 297), of which data was analyzed for the 259 respondents responsible for directing food services at the elementary, junior high school, and high school levels. Results: Of the 15 barriers presented, lack of nutrition education for parents (80%) and pressure to serve foods that children enjoy versus healthy foods (75%) had the greatest proportion of FSDs agreeing that they were probably or definitely barriers to improving the school food environment. Of the 16 presented, the strategies upon which there was the greatest agreement that would likely have a positive or very positive effect on the school food environment were encouraging taste testing of healthy dishes (95%) and increasing the availability of fresh fruit (87%). In general, FSDs' perceptions about barriers to and strategies for improving the school food environment were similar across the three school levels. Future policy initiatives may benefit from seeking the input of FSDs. FSDs can offer unique perspectives on where the attention should be focused in order to create healthier school environments. [ABSTRACT FROM AUTHOR]