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Background: The financing of nutrition in educational institutions is one of the cornerstones of the activities of local governments in Poland. Proper management of this area is crucial to ensuring that children and young people have access to wholesome meals, which directly affects their health, physical development, as well as educational effectiveness. Objective: This study aimed to examine how school principals and parents perceive the role of local governments in managing school nutrition in Poland, given the growing importance of nutrition programs for children's health. Methods: A survey was conducted with 200 school principals and 1000 parents, assessing satisfaction with the implementation, quality, and organization of nutrition programs overseen by local authorities. Results: The results revealed significant differences between the two groups. While 75% of principals expressed satisfaction with the quality of meals provided in schools, only 55% of parents shared this view. Similarly, 80% of principals rated the organization of cooperation with food suppliers positively, compared to only 50% of parents. Regarding allergen information, 65% of principals felt adequately informed, while only 30% of parents agreed. These differences were statistically significant in several key areas, including adherence to nutrition standards (p = 0.009), frequency of health inspections (p = 0.009), and availability of allergen information (p = 0.013). Conclusions: The findings highlight a need for improved communication and collaboration between schools, parents, and local governments to enhance the effectiveness of nutrition programs. It is recommended that regular informational meetings be held and that the flow of information be improved to increase parental satisfaction and the overall effectiveness of school nutrition initiatives. [ABSTRACT FROM AUTHOR]

The government of Nepal initiated the Mid Day Meal Program (MDMP) to reduce hunger and increase educational outcomes, including health status. However, limited studies have been conducted on these issues covering the nutritional status of students at the lower basic level at community schools in Nepal. The main objective of the study is to determine the factors associated with malnutrition among children from community schools in Nepal. A school-based cross-sectional study was conducted in 98 (46 basic and 52 secondary) community schools from 44 municipalities in Nepal. Altogether, 2727 students participated in the questionnaire survey and anthropometric measurement. Data collection was performed on May 10-31, 2023. WHO Anthro plus and LMS (Lambda Mu and Sigma) parameters were used: weight for age for national health and nutrition survey recommended by CDC/National Center for Health Statistics for ages older than ten years to analyze nutritional status, including z scores. Descriptive analysis, including inferential analyses such as the chi-square test and logistic regression, was performed using IBM SPSS Statistics v25. The prevalence of weight-for-age Z-score[WAZ], height-for-age Z-score [HAZ], and body mass index-for-age Z-score [BAZ] were 72%, 75%, and 82%, respectively. Students with z-scores outside the range of ± 2 were classified as malnourished. Of them, 27.3%, 23% and 16.6% were assessed as underweight, stunted and thin, respectively. Students' sociodemographic characteristics such as age, sex, family size and type, source of income, wealth status were significantly associated with malnutrition, while age group, sex, wealth status, residence setting, and geographical location were noted as significant predictors of nutritional status. The study found no statistical relationship between school feeding and good nutrition, questioning the quality of the midday meal program. The study concludes that existing school-based nutritional interventions need to be re-evaluated and re-designed since it is less potent to minimize malnutrition among students substantially. Policymakers could consider these findings when planning and implementing nutrition- related policies and programs. [ABSTRACT FROM AUTHOR]

Adolescence is a critical period of physical, cognitive, and social development that needs to be supported with healthy diets. Dietary behaviours of adolescents can be shaped by their nutrition‐literacy and their interaction with parents and peers as well as their school food environment. Therefore, the present study aimed to assess factors that influence dietary behaviours of adolescents in urban Ethiopia. Sex‐disaggregated, focused group discussions (n = 70) were conducted in 36 private and government schools (n = 12/city) among adolescents (n = 432) 15–19 years of age in Addis Ababa, Bahir Dar, and Dire Dawa. Photovoice was applied in a subgroup of participants (n = 216) to gain further insights into adolescents' perception of their school food environment. Key informant interviews were conducted among school principals (n = 36). Adolescents had a relatively good nutrition knowledge and recognised the importance of diverse diets, but misperceptions also existed. They identified fruit and vegetables as healthy foods, but their consumption was deterred by food safety concerns. The adolescents identified foods high in salt, fat, and sugar, including processed/packaged foods as unhealthy, but still consumed them frequently due to their taste, affordability, availability and accessibility in and around schools. Both undernutrition and overweight/obesity were linked to social exclusion and bullying in school. Effective behavioural change communication is required to address common misperceptions. School nutrition programs should integrate water, sanitation and hygiene programs to ensure food safety. Regulations promoting healthy eating while discouraging unhealthy dietary behaviours are vital. Interventions to make nutrient‐dense and healthy foods available, accessible, and affordable are urgently needed to improve the nutrition and health outcome of adolescents. Key messages: Adolescents had a relatively good nutrition knowledge, but misperceptions also existedFoods high in fat, sugar, and salt, but also processed/packaged foods were considered unhealthy, but were frequently consumedUnhealthy foods were widely available/accessible in the school food environmentComprehensive food safety and nutrition interventions are needed at schoolsRegulations for availability and advertising of unhealthy foods in and around schools are needed. [ABSTRACT FROM AUTHOR]

BACKGROUND: The US Department of Agriculture's (USDA) summer meal programs are designed to provide meals at no cost while school is out of session. In response to the COVID‐19 pandemic, several regulatory waivers were enacted to facilitate meal distribution. The aim of this study was to assess the rates of meal distribution before and after these waivers were in effect. METHODS: Meal distribution patterns for 2019, 2020, and 2021 were examined through (1) a descriptive comparison of the number of participating districts, sponsors, meal sites, and meals distributed statewide, and (2) repeated measures ANOVAs to examine changes among districts in operation all years. RESULTS: The waivers were associated with an increase in the total number of participating districts, sponsors, and meal sites; an increase in the total number of meals distributed to children during the summer months; and an increase in meal distribution among sponsors that had been in place since 2019. Conclusion: Expanding the area eligibility criteria and enabling flexibility in meal distribution methods increased the number of meals provided. This study provides important preliminary evidence to suggest that the USDA should consider permanent regulatory changes to this program to maximize its reach. [ABSTRACT FROM AUTHOR]

This study aimed to discover the prevalence of school nutrition state legislation and to identify the correlates of enactment. An online legislative database, Legiscan, was used to collect bills related to school nutrition from the US from 2010 to 2019. Bills were coded and compiled into a study database with state-level dietary variables (obesity prevalence, fruit, and vegetable intake, sugar-sweetened beverage consumption), community variables (percent White, poverty), and bill-characteristic variables (party affiliation in legislature, strength of language, party of governor, school gardens, vegetable intake, and other salient variables). Multivariable models were built to examine predictors of bill enactment. Of the 462 bills introduced, 38.7% (n = 156) were enacted. In a multivariable model, the strength of bill language, political party affiliation, implementation of school gardens, and vegetable intake were the variables associated with bill passage. Bills with strong language were less likely to be enacted (P <0.001). Bills introduced by Democrats were more likely to be enacted (P = 0.01). This study showed a better understanding of legislative support for child nutrition via policy surveillance of bills and their correlates of enactment. This information can be used to prioritize advocacy efforts and identify ways research can better inform policy. [ABSTRACT FROM AUTHOR]

To obtain feedback from school nutrition stakeholders on an agent-based model simulating school lunch to inform model refinement and future applications. Qualitative study using online discussion groups. School nutrition professional stakeholders across the US. Twenty-eight school nutrition stakeholders. Perceptions and applicability of MealSim for school nutrition stakeholders to help reduce food waste. Deductive approach followed by inductive analysis of discussion group transcripts. Stakeholders appreciated the customizability of the cafeteria characteristics and suggested adding additional characteristics to best represent the school meal system, such as factors relating to school staff supervision of students during meals. The perceived utility of MealSim was high and included using it to train personnel and to advocate for policy and budgetary changes. However, they viewed MealSim as more representative of elementary than high schools. Stakeholders also provided suggestions for training school nutrition administrators on how to use MealSim and requested opportunities for technical assistance. Although agent-based models were new to the school nutrition stakeholders, MealSim was viewed as a useful tool. Application of these findings will allow the model to meet the intended audience's needs and better estimate the system. [ABSTRACT FROM AUTHOR]

Specialty fruit crop species that are commonly served in school lunch programs include apples, citrus, and bananas. Among these three specialty crops, student food waste in primary and secondary schools in North America is enormous. In this postharvest sensory analysis study, schoolchildren were asked to rank and score for preference and acceptance of apples, oranges, and pomegranates. Minimally processed samples were used for each fruit type and the sensory analysis took place in classrooms in California, USA. ‘Red Delicious’ apple was generally less acceptable for multiple scored traits, and less preferred in consumer rankings, when compared with navel orange and ‘Wonderful’ pomegranate. Traits that were assessed by panelists included color, sweetness, tartness, texture, bitterness, and overall desirability. Both prepackaged arils and manually processed arils were used in the study and prepackaged arils were ranked lower when served alongside orange and apple compared with manually extracted, intact arils. Bitterness, color, tartness, and texture scores were significantly different among fruit types. This investigation indicates that Red Delicious is possibly a poor choice of apple cultivar for California schoolchildren and that pomegranate may be a possible alternative to apple, especially considering almost all apple cultivars develop brown flesh when cut. Whether pomegranate is feasible for school lunch programs remains to be seen; more research is needed to determine if pomegranate is a fruit that can be used to increase nutritive value and reduce food waste in public school nutrition programs.

The reciprocal relationship between education and health is well-established, emphasizing the need for integrating health, nutrition, and well-being components into educational sector planning. Despite widespread acknowledgment of this need, countries lack concrete measures to achieve this integration. We examine challenges that countries have faced and the progress they have made in integrating these components into education sector plans and review the extent to which existing educational planning guidelines and tools address health and well-being. The review reveals a significant underrepresentation of health, well-being, and related themes in existing educational planning frameworks. Recent tools and frameworks developed to support a more holistic approach to education have not yet been widely adopted in standard education sector planning processes. The implementation of such approaches remains inconsistent, with significant barriers including limited cross-sectoral collaboration, lack of capacity, and insufficient funding, among others. Addressing these gaps requires improved guidance, technical support, and a multisectoral approach to education planning that includes health, nutrition, and well-being as fundamental components of foundational learning, supported by political commitment, capacity, and adequate financing.

Context Globally, 1 in 3 children under 5 years is undernourished or overweight, and 1 in 2 suffers from hidden hunger due to nutrient deficiencies. As children spend a considerable time at school, school-based policies that aim to improve children's dietary intake may help address this double burden of malnutrition. Objective This systematic review aimed to assess the effects of implementing policies or interventions that influence the school food environment on children's health and nonhealth outcomes. Data sources, extraction, and analysis Eleven databases were searched up to April 2020 and the World Health Organization (WHO) released a call for data due in June 2020. Records were screened against the eligibility criteria, and data extraction and risk-of-bias assessment were conducted by 1 reviewer and checked by another. The synthesis was based on effect direction, and certainty of evidence was assessed using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach. Conclusions Seventy-four studies reporting 10 different comparisons were included. The body of evidence indicates that interventions addressing the school food environment may have modest beneficial effects on certain key outcomes. Nutrition standards for healthy foods and beverages at schools, interventions that change how food is presented and positioned, and fruit and vegetable provision may have a beneficial effect on the consumption of healthy foods and beverages. Regarding effects on the consumption of discretionary foods and beverages, nutrition standards may have beneficial effects. Nutrition standards for foods and beverages, changes to portion size served, and the implementation of multiple nudging strategies may have beneficial effects on energy intake. Regarding effects of purchasing or selecting healthier foods, changes to how food is presented and positioned may be beneficial. This review was commissioned and supported by the WHO (registration 2020/1001698-0). WHO reviewed and approved the protocol for the systematic review and reviewed the initial report of the completed systematic review. Systematic Review Registration PROSPERO registration no: CRD42020186265. [ABSTRACT FROM AUTHOR]

PURPOSE/OBJECTIVES The purpose of this study was to qualitatively assess Elementary Education (El Ed) students' readiness to implement breakfast in the classroom (BIC) and identify whether an educational video could improve their perception of BIC as a model for breakfast delivery. METHODS A pre-test, post-test intervention methodology was utilized for this study. A convenience sample of university students majoring in El Ed from one university were recruited to participate in the study. Participants completed the pre-test survey and were then asked to complete the post-test survey one week later. Just prior to taking the post-test survey, participants watched an educational video about the benefits of school breakfast programs and the logistics of BIC. Qualitative content analysis was used to analyze open-ended questions from the pre and post-test surveys. RESULTS Three themes emerged from the qualitative thematic analysis process (include type of analysis) and included 1) knowledge and readiness, 2) logistics, and 3) social implications. Initial responses showed an unfamiliarity with BIC. Participants varied in their willingness to implement BIC in their classrooms with some being apprehensive, while others were enthusiastic. Participants expressed several concerns about not knowing how BIC would logistically work and they believed social stigma prevented students from participating in school breakfast programs. Post-test responses revealed that the educational video was effective in educating participants about alternative breakfast programs. Post-test responses were generally more favorable towards accepting BIC after viewing the educational video in the post-test responses. APPLICATIONS TO CHILD NUTRITION PROFESSIONALS Suggestions to improve receptiveness of alternative breakfast programs include educating El Ed students and student teachers on the benefits of school breakfast and BIC prior to their career. The use of an educational video has the potential to improve perception of BIC amongst school teachers. El Ed programs should consider including curriculum related to the logistics and benefits of school breakfast models. [ABSTRACT FROM AUTHOR]

Background: Only a few adolescents are meeting their daily vegetable requirement. At the same time, spicy food is increasingly popular and familiar across cultures. Objectives: To explore the implementation of spicy vegetables into school meals, the primary objective is to determine adolescents’ preferred degree of hot spice on steamed broccoli. Secondary objectives include estimating the appropriateness and acceptability of spicy vegetables in the National School Lunch Program and identifying strategies to promote spicy vegetables within school meals. Methods: One hundred participants between the age 11 and 17 y sampled 4 steamed broccoli florets with varying levels of a ground red and cayenne pepper spice blend (0, 0.9, 2.0, and 4.0 g). Participants rated their likeability of each broccoli sample on a 9-point hedonic scale and answered a survey assessing chili liking, chili consumption patterns, appropriateness, and acceptability. An interview assessed perspectives on spicy vegetables within school lunch.Regression analyses assessed relationships between participant attributes and sample ratings and survey outcomes. Agglomerative hierarchical cluster analysis was conducted to cluster together participants with similar sample liking ratings. Results: Seventy-seven percent of participants reported that chili pepper makes food taste better, and 67% consumed spicy food weekly or daily. Chili likers (n = 41) were the dominant cluster group, compared with moderates (n = 31) and chili dislikers (n = 28). Thematic analysis results suggested that most participants support incorporating spicy vegetables into school lunch but mushy vegetable texture may undermine the impact of changing school vegetable spice levels. Conclusions: Spicy foods are commonly consumed by adolescents, and these findings support the inclusion of spicy vegetables in school lunch. Additional research is needed to identify policies and practices to improve the texture of vegetables in school meals and determine additional strategies to support cultural humility in child nutrition programs.

Abstract Adolescence is a critical period of physical, cognitive, and social development that needs to be supported with healthy diets. Dietary behaviours of adolescents can be shaped by their nutrition‐literacy and their interaction with parents and peers as well as their school food environment. Therefore, the present study aimed to assess factors that influence dietary behaviours of adolescents in urban Ethiopia. Sex‐disaggregated, focused group discussions (n = 70) were conducted in 36 private and government schools (n = 12/city) among adolescents (n = 432) 15–19 years of age in Addis Ababa, Bahir Dar, and Dire Dawa. Photovoice was applied in a subgroup of participants (n = 216) to gain further insights into adolescents' perception of their school food environment. Key informant interviews were conducted among school principals (n = 36). Adolescents had a relatively good nutrition knowledge and recognised the importance of diverse diets, but misperceptions also existed. They identified fruit and vegetables as healthy foods, but their consumption was deterred by food safety concerns. The adolescents identified foods high in salt, fat, and sugar, including processed/packaged foods as unhealthy, but still consumed them frequently due to their taste, affordability, availability and accessibility in and around schools. Both undernutrition and overweight/obesity were linked to social exclusion and bullying in school. Effective behavioural change communication is required to address common misperceptions. School nutrition programs should integrate water, sanitation and hygiene programs to ensure food safety. Regulations promoting healthy eating while discouraging unhealthy dietary behaviours are vital. Interventions to make nutrient‐dense and healthy foods available, accessible, and affordable are urgently needed to improve the nutrition and health outcome of adolescents.

The National School Lunch Program (NSLP) is a federal program that provides free and reduced priced lunch to millions of low-income children in urban schools. Empirical research shows mixed results on the physical and nutritional health of urban students participating in the program. However, a considerable limitation of this literature is that it focuses on student participation in the NSLP rather than what students consume when they receive a school lunch. By directly collecting a random of sample of school lunches, we analyze the nutritional content of both selected and consumed school lunches (n = 141) at a Title I middle school in a large US city. Results indicated that the food items that students select for school lunch are low in nutrients and high in sugar. Furthermore, food that students ultimately consumed during lunch had even lower nutritional value while consumption of sugar remained high. Future research is needed to investigate school-based interventions that leaders can deploy to foster healthy eating in urban schools. [ABSTRACT FROM AUTHOR]

ObjectiveThis paper identifies implementation leadership characteristics in the school nutrition setting and places findings in the context of implementation leadership literature.MethodsFourteen interviews were conducted with school district leadership/staff in an urban school district. Modified grounded theory was employed.ResultsFour themes emerged: (1) understanding of technical/operational intervention details; (2) ability to proactively develop and communicate plans; (3) supervisory oversight; and (4) intervention framing. Themes were consistent with 4 of the 5 dimensions comprising the Implementation Leadership Scale: knowledgeable, proactive, perseverant, and distributed leadership. The supportive domain was not a major finding. An additional domain, how leaders message the intervention to staff, was identified.Conclusions and implicationsImplementation leadership in school nutrition appears similar, but not identical, to leader behaviors present in the Implementation Leadership Scale. School nutrition leaders might consider involving staff early in implementation planning, incorporating technical expertise, and clearly communicating the intervention purpose to support successful implementation. Future research might explore the interplay between leadership and implementation outcomes.

Abstract Background In South Africa, overweight and obesity affect 17% of children aged 15–18. School food environments play a vital role in children’s health, influencing dietary behaviours and resulting in high obesity rates. Interventions targeting schools can contribute to obesity prevention if evidence-based and context-specific. Evidence suggests that current government strategies are inadequate to ensure healthy school food environments. The aim of this study was to identify priority interventions to improve school food environments in urban South Africa using the Behaviour Change Wheel model. Methods A three-phased iterative study design was implemented. First, we identified contextual drivers of unhealthy school food environments through a secondary framework analysis of 26 interviews with primary school staff. Transcripts were deductively coded in MAXQDA software using the Behaviour Change Wheel and the Theoretical Domains Framework. Second, to identify evidence-based interventions, we utilised the NOURISHING framework and matched interventions to identified drivers. Third, interventions were prioritised using a Delphi survey administered to stakeholders (n = 38). Consensus for priority interventions was defined as an intervention identified as being 'somewhat' or ‘very' important and feasible with a high level of agreement (quartile deviation ≤ 0.5). Results We identified 31 unique contextual drivers that school staff perceived to limit or facilitate a healthy school food environment. Intervention mapping yielded 21 interventions to improve school food environments; seven were considered important and feasible. Of these, the top priority interventions were to: 1) “regulate what kinds of foods can be sold at schools”, 2) “train school staff through workshops and discussions to improve school food environment”, and affix 3) “compulsory, child-friendly warning labels on unhealthy foods”. Conclusion Prioritising evidence-based, feasible and important interventions underpinned by behaviour change theories is an important step towards enhanced policy making and resource allocation to tackle South Africa’s childhood obesity epidemic effectively.

Introduction: Significantly fewer children participate in the U.S. Department of Agriculture–sponsored summer meal programs than in the federal school meal programs during the academic year. During the summer of 2021, several pandemic-related waivers supported more flexible operations for summer meal programs, such as allowing grab-and-go meals and the distribution of meals for multiple days at once. This study assessed how summer meal site characteristics and geographically targeted outreach methods were associated with summer meals served in 2021 in Connecticut. Methods: Weekly meal count data were requested from all sponsors of the Summer Food Service Program and the National School Lunch Program Seamless Summer Option. Data were received from 78 sponsors with 763 sites. Geographically targeted outreach (e.g., billboards, bus ads, and flyers) was tracked by location each week. Mixed methods ANOVA was used to examine the predictive value of outreach efforts, program characteristics, and meal distribution methods on meals served each week. The program characteristics examined included the hours open per week, the number of weeks serving meals, the maximum number of meals distributed at one time, and the number of open and closed sites in a school district. Results: Between June 21 and August 20, 2021, a total of 1,188,669 breakfasts and 1,389,347 lunches were served. Sites that were open more hours per week (mean=7.60 hours per week; range=0.17–35) and gave multiple meals to parents at each visit (mean=4.68 meals; range=1–15) reported greater rates of meal distribution. The outreach efforts assessed were not significantly associated with changes in meal distribution at nearby sites. Conclusions: The U.S. Department of Agriculture's waivers in response to COVID-19 permitted extended operating hours and multiple-meal distribution. These operational flexibilities should be considered for permanent regulation changes owing to their positive association with summer meal participation.

Vegetables are an essential component of a healthy dietary pattern in children; however, their consumption is often insufficient due to lack of preference. To address this, the influence of combining vegetables (mixed peas and carrots—MPACs) with potatoes, a generally liked food, on overall vegetable consumption among children aged 7–13 years was explored. The research involved a cross-over study design with 65 participants who completed five lunchtime meal conditions, each with different combinations of MPACs and potatoes versus a control (MPACs with a wheat roll). The meals were provided in a cafeteria setting, and plate waste was used to measure vegetable consumption. Anthropometric data and other variables were also measured. Notably, self-reported hunger did not significantly differ between conditions. Meal condition was a significant predictor of MPACs (F = 5.20; p = 0.0005), with MPAC consumption highest when combined with shaped potato faces in the same bowl (+8.77 g compared to serving MPACs and shaped potato faces in separate bowls) and lowest when combined with diced potatoes in the same bowl (−2.85 g compared to serving MPACs and diced potatoes in separate bowls). The overall model for MPAC consumption was influenced by age, height z-score, body fat percentage z-score, and condition (likelihood ratio = 49.1; p < 0.0001). Age had the strongest correlation with vegetable consumption (r = 0.38), followed by male gender, height z-score (r = 0.30), and body fat z-score (r = −0.15). The results highlight the positive impact of combining potatoes with vegetables in school meals, particularly when using shaped potato faces. These findings emphasize the potential of potatoes as a valuable vegetable option in promoting healthier eating habits among children. Additionally, future research could explore the impact of different potato combinations and investigate other factors influencing meal consumption in school settings. [ABSTRACT FROM AUTHOR]

Background: The school environment, consisting of the physical environment and social‐emotional climate (SEC), plays a crucial role in both student and employee health; however, there is a lack of recent literature synthesizing school environment interventions in K‐12 settings. We describe updated evidence about school environment interventions to support K‐12 student and employee health in the United States. Methods: A 2‐phase search included a review of reviews (2010‐2018), followed by a search for individual articles (2010‐2020) that targeted school physical environment and/or SEC to address physical activity (PA) and/or nutrition. We also investigated how nutrition and PA interventions with an SEC component improves social‐emotional and/or mental health outcomes. Because research on dietary and PA behaviors for school employees is limited; we included studies on other worksites (eg, hospitals and offices) to provide insight for school employees. Findings: We identified 40 articles describing 40 unique studies and 45 interventions and grouped them by intervention type. Physical environment interventions demonstrated significant and positive nutrition and PA behavioral outcomes for students; outcomes among employees were mixed. Interventions with SEC components reported improvements in some mental health outcomes. Implications: The school environment can affect dietary and PA behaviors as well as mental health for students and employees. Conclusions: Establishing healthy school environments can support student and employee PA, dietary behaviors, and mental health. [ABSTRACT FROM AUTHOR]

BACKGROUND: Changes to policies at the federal, state, and local levels over the last decade have influenced the school nutrition environment and services. METHODS: This systematic review includes an analysis of individual research articles and government reports published from 2010 to 2021 that examine interventions to improve the school nutrition environment and services and increase the availability, selection, and consumption of healthier foods and beverages in K‐12 schools in the United States. RESULTS: Nutrition standards for school meals and food outside of meals improved access to healthier options in school. Providing school nutrition professionals with professional development, improving the palatability of school meals, offering taste tests, pre‐slicing fruit, providing recess before lunch, offering incentives for trying healthier options, and providing access to drinking water resulted in increased selection and consumption of healthier items. There were inconclusive or mixed findings for some intervention strategies including adequate seat time for meals. CONCLUSIONS: Despite demonstrated improvements to school meal programs and competitive foods, more work is needed to change the selection and consumption of healthier options among K‐12 students. Schools can use multiple interventions to improve the school nutrition environment and services and help students adopt food and beverage choices that support health. [ABSTRACT FROM AUTHOR]

URPOSE/OBJECTIVES This study evaluated the effects of the COVID-19 pandemic on children within the U.S. by assessing how parents' perceptions of children's nutritional patterns changed in relationship to school nutrition assistance program participation. METHODS A cross-sectional survey of American parents was used to evaluate changes to their children's nutritional patterns during the pandemic. Participants were recruited through Facebook advertisements and snowball sampling. Data was collected through an electronic survey. Descriptive statistics and Pearson correlation were calculated. Qualitative data was organized by question stem. Once organized, responses were summarized by topics and sub-topics. RESULTS There was not a significant change in the perceived intake of foods from the major food groups, however parents reported increased snacking behavior, including processed foods. Participation in school nutrition assistance programs, including free or reduced price meals did increase during the pandemic and parents perceived these programs as more important. APPLICATIONS TO CHILD NUTRITION PROFESSIONALS School nutrition programs were perceived as increasingly important as families navigated the fallout of the pandemic which was complicated by financial strain and food insecurity. The increase in snacking behavior raises concerns about the long term consequences of the pandemic. It is possible the change in snacking behavior was the product of food access concerns and children being at home during the pandemic. Administrators and policymakers should build upon what was learned during the pandemic to improve community infrastructure and capacity to support school nutrition assistance program participation. [ABSTRACT FROM AUTHOR]

Introduction: Children aged two to five years old are influenced by the behaviors of their guardians and Early Care Education (ECE) teachers. This study aims to determine the relationship between adults' and children's health behaviors in home and ECE settings. This study is novel in examining this correlation between multiple environments. Method: Surveys were conducted across 32 ECE centers. Guardians and teachers reported on their and their children's health behaviors within the home and ECE. Matched child-adult responses (n = 1,140) were analyzed from a representative sample of 32 ECE centers throughout Georgia. Frequency of consumption of fruits, vegetables, and water, as well as frequency of physical activity were measured. Spearman rho correlations were analyzed using SPSS software, with p < 0.05 indicating significance. Results: Spearman rho correlations indicated significant positive correlations between guardian and child behavior (rho = 0.49 to 0.70, p < 0.001) for all data. Teacher and child correlations were inconsistently significant across categories (rho = -0.11 to 0.17, p < 0.001). Discussion: The influence of guardian behavior modeling on child health outcomes is critical for improving ECE programming and child obesity outcomes. This research can be used to inform future health interventions for young children. Significance: Children's behaviors are influenced by the behaviors of guardians in their life. Childhood obesity rates are increasing in the United States, and increased physical activity and improved dietary practices are key methods to prevent obesity. This study assessed the degree to which children's health behaviors model those of their guardians and teachers. Children's health behavior practices were significantly correlated with the practices of their guardians but not with teachers, indicating home-based health promotions can have positive impacts on both adults and children. [ABSTRACT FROM AUTHOR]

ObjectiveThis study determined the extent to which schools adhered to select nutrition and wellness provisions of the 2010 Healthy, Hunger-Free Kids Act and examined differences by US region and school poverty level.DesignComparison of cross-sectional observational data from the Healthy Communities Study (2013-2015) by region and school poverty level.ParticipantsA total of 401 US elementary and middle schools.Main outcome measuresAdherence with federal nutrition standards for meals and competitive foods; extent of implementation of select aspects of school wellness policies.AnalysisDescriptive statistics and multivariate regression were used. Differences were examined by school poverty level and region, adjusting for other school- and community-level covariates.ResultsMost schools reported meeting reimbursable school meal nutrition standards (74%); more schools in the West met nutrition standards (82%) than in the Midwest (64%). Most grains offered at lunch were whole grain-rich (82%), and most competitive foods complied with standards (78%) before they were required. Most schools had a wellness coordinator (80%). Lowest levels of adherence were reported for guidelines for classroom or school event foods. No differences were observed by school poverty level.Conclusions and implicationsFindings suggest that Healthy Hunger-Free Kids Act provisions were feasible across a wide variety of schools, and schools successfully implemented reimbursable school meal nutrition standards regardless of school poverty level.

Schools are a key setting for curbing student intake of sugar-sweetened beverages (SSBs). While studies suggest that restrictions on SSBs, increased access to healthier beverages, and education about the importance of drinking water instead of SSBs can promote healthier beverage patterns among students, there is little known about the impact that teachers' own beverage choices can have on those of their students. Data were drawn from cross-sectional surveys administered as part of a larger evaluation of a drinking water access and promotion intervention in public elementary schools in the San Francisco Bay Area region of California. Descriptive statistics were used to examine teacher (n = 56) and student (n = 1176) self-reported beverage consumption at school. Mixed-effects logistic regression was used to examine associations between teacher and student beverage intake adjusting for clustering of students by teacher. Teachers were also surveyed via open-ended questions about strategies to increase student water consumption at school. Nearly all teachers reported drinking water during the school day (95%), often in front of students. Teacher SSB intake was rare (9%). Students whose teachers drank water in front of their classes were significantly more likely to report drinking water during the school day. Teachers tend to select healthy beverages at work and may serve as role models to encourage student consumption of water instead of SSBs.

Little published research explores the perceptions of school nutrition professionals and youth regarding existing school nutrition marketing materials. A two-phased approach was taken to address this gap. In Phase 1, a national convenience sample of US school nutrition professionals (n = 1546; 89% female; 83.3% white; mean age 50 ± 10.2 years) evaluated a sample of marketing materials via a web-based survey. Phase 2 involved a sample of youth (n = 61; 51% female, 52.5% Hispanic; 98% participation in free/reduced price lunch) living in the Phoenix, Arizona metro area who completed interviews on the top-rated materials from the school nutrition professionals (Phase 1). Main outcome measures included perceived attractiveness/appeal, comprehension, relevance, motivation/persuasion, and uniqueness of marketing materials. In Phase 1, means/standard deviations of school nutrition professionals' perceptions across materials are provided. For Phase 2, a thematic/subtheme analysis of the youth interviews is provided. School nutrition professionals found the materials easy to understand (82%); however, they rated the materials low in motivational appeal (48%) and low in their ability to influence the selection or consumption of fruits/vegetables (95%). Youth participants discussed their likes, dislikes, comprehension, social aspects, and health aspects of the materials. Results indicate that existing marketing materials were not highly rated by professionals or youth. Greater investment and research are needed to test and develop nutrition marketing materials for schools, with a focus on enhancing their appeal and impact on fruit/vegetable consumption. [ABSTRACT FROM AUTHOR]

The 2010 Healthy, Hunger-Free Kids Act (HHFKA) improved the nutritional quality of food served in schools. This longitudinal study examined school food offerings over time from school year 2010-11 to 2017-18 in public schools (n = 148) in four New Jersey cities. Six food indices were used to assess the number of healthy and unhealthy items offered as part of the National School Lunch Program (NSLP), in vending machines, and à la carte (i.e., competitive foods). Multilevel, multivariable linear regression with quadratic terms was used to model the trends over time. Interaction terms were added to examine whether the time trends varied by school-level factors, such as proportion of students eligible for free or reduced-price meals (FRPMs), race/ethnicity of enrolled students, and school level. Over the study period, healthy items offered in the NSLP increased (p < 0.001), while unhealthy items in the NSLP decreased (p < 0.001). Significantly different rates of declines in NSLP unhealthy offering were observed among schools at the two extremes of FRPM eligibility (p < 0.05). The trends for healthy and unhealthy foods offered in competitive foods showed significant non-linear trends, and differences were observed for school-level race/ethnicity, with worse outcomes for schools with majority Black student enrollment. [ABSTRACT FROM AUTHOR]

ObjectiveSchool-based interventions and policies encourage youths to include and consume fruits and vegetables at lunchtime via school lunches, but limited research has examined how these behaviours compare when youths have home-packed lunches. The objective of the present study was to compare fruit and vegetable contents and consumption among students having school or home-packed lunches over the school week.DesignParticipants were observed over five consecutive days at school lunchtime. Trained analysts estimated students' lunchtime fruit and vegetable contents and consumption using digital imaging. Mixed models examined associations between fruit and vegetable dietary behaviours and lunch source (school v. home-packed), controlling for student gender, grade and school.SettingThree elementary schools in northern California, USA.ParticipantsFourth-, fifth- and sixth-grade students (nchildren 315; nobservations 1421).ResultsStudents were significantly less likely to have and to consume fruits and vegetables (all P

Purpose: In two related studies, we examined how equity-based arguments featured in news debate over federal school nutrition policy. Methods: We conducted content analyses of national and local print and broadcast news (September 1, 2014-December 31, 2015), examining arguments rooted in appeals about equity and/or disparities. Results: Equity and/or disparities appeals appeared in 24% television, 14% national print, and 5% local print stories. Socioeconomic inequities were mentioned most; racial/ethnic inequities appeared minimally. Conclusions: Neither equity nor disparity featured prominently in this news debate over policy created to address children's nutritional inequities. When included, arguments focused on overcoming inequities' effects rather than addressing root causes.

This study examined perceptions of healthy eating by middle school students in one low-income rural Mississippi Delta school using 10 focus groups (n = 62). The Social Ecological Model was framework for inductive and deductive thematic coding to analyze transcripts. Results indicated students had a "good food, bad food" approach to health. Students believed the school environment was not conducive to a healthy lifestyle, citing poor food and water quality in addition to a lack of staff. An intervention aimed at increasing self-motivation through school- or community-based initiatives may be successful. Including the community and key stakeholders would improve potential intervention success. [ABSTRACT FROM AUTHOR]

Background: Universal school meals (USM) aim to eliminate barriers to school meal access by providing free meals to all students regardless of family income. During the COVID-19 pandemic, United States Department of Agriculture waivers allowed schools nationwide to offer meals free of charge to all students. While USM programs have demonstrated positive effects on student health and participation, limited research has focused on the perspectives of Food Service Directors (FSD) who manage them., Objective: The study aims to explore the operational benefits and challenges encountered by FSDs, and their perceptions of the benefits of USM for students and parents during the implementation of USM during the 2021-22 school year., Design: Qualitative using semi-structured interviews., Participants/setting: Twenty-nine California FSDs selected through purposive sampling to ensure diversity in district size, urbanicity, and student eligibility for free or reduced-price meals. Interviews were conducted via Zoom in Spring 2022., Analysis: Thematic analysis using an immersion-crystallization approach., Results: FSDs perceived multiple benefits of USM, including increased meal participation, reduced stigma around free meals, and strong support for USM from parents and school communities. They believed consistent access to meals improved learning readiness and behavior. Operationally, FSDs reported increased administrative efficiency and the elimination of student meal debt. However, higher meal demand led to increased workloads compounded by staffing shortages, challenges in hiring and retention, and supply issues exacerbated by the pandemic. California's Kitchen Infrastructure and Training grants supported equipment upgrades. Despite challenges, FSDs were optimistic about the future of USM and expressed a strong desire for its continuation., Conclusions: FSDs perceived USM as beneficial for improving meal access, reducing stigma, and enhancing administrative efficiency. However, sustaining these benefits requires addressing operational challenges through targeted support and investments. Future research should assess the long-term viability of USM and strategies for overcoming challenges outside the pandemic context., (Copyright © 2024. Published by Elsevier Inc.)

Background: The evidence-based nutrition standards of the Healthy, Hunger-Free Kids Act of 2010 significantly improved school meal nutrition, yet little is known about how school food authorities (SFAs) were supported to translate the standards into practice in schools., Objective: This study tested whether or not 2 implementation supports, SFA receipt of training/technical assistance (TA) and purchase of new equipment, for implementing the nutrition standards were associated with the nutritional quality of school lunches., Design: This study used a cross-sectional design., Participants/setting: The study sample included 365 SFAs derived from the US Department of Agriculture's School Nutrition and Meal Cost Study (2014 to 2015 school year), the only national data of school nutrition environments since the Healthy, Hunger-Free Kids Act of 2010., Main Outcome Measures: Implementation supports included reported participation in training/TA and the purchase of new equipment between the 2012 to 2013 (year of policy adoption) and 2014 to 2015 school years. The primary outcome, nutritional quality of school lunches served, was defined as low/high Healthy Eating Index 2010 scores during the 2014 to 2015 school year. Secondary implementation supports included the number of areas covered by training/TA, the adequacy of training/TA, and the degree of implementation challenges., Statistical Analyses: Multivariable-adjusted logistic regression models assessed if receipt of implementation supports was associated with lunch Healthy Eating Index 2010 scores., Results: The median lunch Healthy Eating Index 2010 score was 81.7 (95% CI 80.4 to 82.9). Most SFAs (78.4%, 95% CI 72.0% to 85.0%) reported having participated in training/TA and one-third (33.8%, 95% CI 24.4% to 43.2%) reported having purchased new equipment-neither were associated with the odds of having higher Healthy Eating Index 2010 scores for lunches served at the time of data collection., Conclusions: Many SFAs accessed implementation supports to adopt the nutrition standards. Information on dose, quality, and nutrition-related impact of implementation supports using measures of change are needed to determine how best to support SFAs with implementation of new nutrition standards., (Copyright © 2024 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.)

The reciprocal relationship between education and health is well-established, emphasizing the need for integrating health, nutrition, and well-being components into educational sector planning. Despite widespread acknowledgment of this need, countries lack concrete measures to achieve this integration. We examine challenges that countries have faced and the progress they have made in integrating these components into education sector plans and review the extent to which existing educational planning guidelines and tools address health and well-being. The review reveals a significant underrepresentation of health, well-being, and related themes in existing educational planning frameworks. Recent tools and frameworks developed to support a more holistic approach to education have not yet been widely adopted in standard education sector planning processes. The implementation of such approaches remains inconsistent, with significant barriers including limited cross-sectoral collaboration, lack of capacity, and insufficient funding, among others. Addressing these gaps requires improved guidance, technical support, and a multisectoral approach to education planning that includes health, nutrition, and well-being as fundamental components of foundational learning, supported by political commitment, capacity, and adequate financing., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Abduvahobov, Cameron, Ibraheem, Herat and Castle.)

BackgroundUnderstanding dietary patterns in a population is critical for decision making. This study aimed to identify the prevailing dietary patterns and their associated individual and school environment factors among school going adolescents in Lusaka, Zambia.MethodA cross-sectional study involving 404 Grade 10 pupils from 10 secondary schools in Lusaka district was conducted. A 108-item unquantified Food Frequency Questionnaire (FFQ) was used to assess the learner's food intake practices. Principal component analysis (PCA) was used to derive dietary patterns from the 108 food items. In addition, a mapping of food vendors and types of food sold was conducted in the same 10 schools using a semi-structured observation checklist. Bivariate and multivariate multilevel regression was used to analyse the individual and school level determinants of the adolescent dietary patterns.ResultsThe average age of learners was 16.1 years (SD 1.4 years); 234 (58%) were female while 170 (42%) male. “Snacking,” “vegetarian,” “health conscious,” and “traditional” dietary patterns accounting for 54.5% of variability in learner's diets were identified using PCA. At individual level, having weekly pocket money was significantly associated with snacking (p ≤ 0.0001). Self-identified poverty was associated with snacking (p ≤ 0.0001), vegetarian (p = 0.009) and traditional (p = 0.009) dietary patterns. School level factors like a school tuckshop (similar to canteen) that sells fast foods or a kantemba (semi-permanent makeshift store) within the school vicinity (p = 0.023) were significantly associated with a snacking dietary pattern. School tuckshop selling nshima (a thick maize based porridge) was significantly associated with vegetarian (p = 0.007), health conscious (p = 0.02) and traditional dietary patterns (p=0.01) while a tuckshop with fruit significantly predicted traditional (p ≤ 0.0001), vegetarian (p = 0.041), and snacking (p = 0.002), dietary patterns. Having a supermarket or fast food restaurants in the school vicinity did not significantly influence any dietary pattern.ConclusionBoth individual behavioral and school environment level factors were found to be significant determinants of the four dietary patterns identified in this study.

The National School Lunch and School Breakfast programs are a nutrition safety net for millions of children in the United States, particularly children in households with lower incomes. During Spring 2020 COVID-19 school closures, schools served school meals through the Summer Meal Programs. Despite efforts to increase access, meal participation declined and food insecurity increased. We aimed to (1) describe meal program features as communicated in low-income California school districts’ on-line resources (2) examine associations between meal program features and change in meal participation between May 2019 and May 2020 and (3) evaluate equity by describing meal site coverage and placement relative to the size of priority populations. Data from district online resources and meal reimbursement claims were collected for a stratified, random sample of 190 CalFresh Healthy Living-eligible districts. Linear regression was used to examine associations between district meal program features and percent change in meal participation. Meal site location and density were examined in relation to the size of priority populations. In May 2020, compared to May 2019, total meals served decreased by a median 46%. There were gaps in the information provided in district online resources and low variation in measured district meal program features. These features explained little of the variation in the percent change in meal participation. A greater proportion of meal sites were placed in areas with larger priority populations, yet the density of sites was not proportionate to the priority populations’ sizes. Findings show actionable areas for improving meal access during school closures.

Federally funded school meals, such as the National School Lunch Program and School Breakfast Program, can help alleviate food insecurity. Meals served as part of these programs are required by law to be modified when medically necessary, such as food allergies and special diets. The coronavirus disease 2019 (COVID-19) pandemic caused many schools across the United States to close, but schools quickly modified meal-serving models. The purpose of this study was to understand the experiences of school nutrition professionals relative to food safety and providing special diets through modified serving models. A survey was distributed to a convenience sample of child nutrition professionals via social media recruitment and e-mails (n = 504). The survey had both closed-ended questions and one open-ended question exploring food safety and special diet accommodations. At the time of the survey, most respondents (68.3%) had been involved in COVID-19 emergency feeding for 3 to 4 weeks. Results indicated that although most child nutrition professionals did not find food safety easier or more difficult during the initial onset of COVID-19, 34.8% of respondents were not taking food temperatures for hot and cold meals during meal service and were not able to obtain (or did not have enough) equipment necessary for holding hot foods (53.0%). Most respondents (60.2%) also indicated that they were not accommodating children with special diets. Themes from the qualitative analysis indicated participants had challenges obtaining specialty items, had little time to make accommodations, or had a limited supply from vendors to accommodate these diets. To prevent food insecurity and to maintain health during the pandemic, specific solutions for at-risk populations, such as those who experience food allergies, must be considered. COVID-19 changed school meal distribution in the early onset of the pandemic. During emergencies, modified serving models can address food safety concerns and special diets. School nutrition professionals were struggling to accommodate special diets. Specific solutions for populations needing special diets should be considered. [ABSTRACT FROM AUTHOR]

Abstract Background The aim of the current study is to describe the effectiveness of a school-based intervention when delivered by a non-nutrition specialist (trained schoolteachers) as compared to an expert in nutrition. Methods Two trials of the same school-based intervention using the same intervention package were delivered, one by nutritionists and another by trained schoolteachers. The intervention focused mainly on dietary behaviours, as well as physical activity. In both trials, purposively selected schools were randomized to intervention or control groups; students (aged 9–11 years) in both groups were compared at post-test on knowledge and self-efficacy scores, as well as dietary and physical activity behaviours, controlling for their baseline status on the various measures. All analyses accounted for clustering at the school level. Results In both trials, a statistically significantly greater improvement was observed for both the knowledge and self-efficacy scores in intervention vs. school students. When the programme was delivered by trained schoolteachers, frequency of breakfast intake was increased, crisps consumption was reduced, but no change in fruit and vegetable consumption was observed (latter increased when delivered by nutrition professionals only). Physical activity did not improve in both trials. Conclusion Trained schoolteachers can have a positive impact on students’ dietary behaviours with the appropriate training to ensure they are equipped with the right information, skills, and resources to deliver the programme with the highest fidelity. Trial registration ClinicalTrial.gov Identifier: NCT03040271. Retrospectively registered on 2 February 2017.

Background: In 1995, the World Health Organization launched its Global School Health Initiative intending to expand this health promotion approach throughout schools globally. In this study, we aim to assess the preparedness of preschools in the adoption of intervention packages under the Nutrition Friendly School Initiative (NFSI) checklist., Methods: From three campuses of the Aga Khan School located in the Thatta and Sujawal districts of the Sindh province, Pakistan, all eligible preschool children were selected for this study. Using a pre-and post-intervention design, we assessed preschool preparedness using the NFSI checklist, knowledge of parents/caregivers regarding health and nutrition promoting behaviors, and anthropometric measurements (i.e., mid-upper arm circumference (MUAC), weight, and height) for preschool children. The NFSI checklist was analyzed with differential scores, while descriptive statistics were used for anthropometric and knowledge data. Continuous variables (i.e., height, weight, MUAC) were presented as means, while categorical variables (knowledge) were expressed as numbers and percentages. Paired t-tests for dependent samples were used to statistically assess mean differences in MUAC, height, weight, height-for-age Z-score, weight-for-age Z-score, weight-for-height Z-score, and changes in parental knowledge of preschool children., Results: Data from 164 preschool children (ages 24-84 months, mean age 56.7 months) were analyzed over 3 months. School preparedness scores improved from 10 to 22 points (out of 26). Parental knowledge on nutrition and health increased by 7.2 points (out of 25). Children showed mean increases in MUAC (0.27 cm), weight (0.36 kg), and height (0.62 cm) ( p  < 0.001). Stunting and overweight/obesity rates remained the same (7.3 and 4.3%), while underweight and wasting rates dropped from 10.4 to 7.3% and 7.9 to 6.1%, respectively. The initiative effectively reduced underweight and wasting but did not impact stunting and overweight., Conclusion: The NFSI has greatly enhanced preschool readiness for nutrition-friendly schools. Engaging the private sector in addressing nutritional challenges has paved the way for future public-private partnerships to tackle malnutrition. The nutrition policy formulated through this initiative could serve as a blueprint for a National School Nutrition Policy., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Samnani, Karmaliani, Nuruddin, Petrucka, Soofi and Karmaliani.)

Background: Only a few adolescents are meeting their daily vegetable requirement. At the same time, spicy food is increasingly popular and familiar across cultures., Objectives: To explore the implementation of spicy vegetables into school meals, the primary objective is to determine adolescents' preferred degree of hot spice on steamed broccoli. Secondary objectives include estimating the appropriateness and acceptability of spicy vegetables in the National School Lunch Program and identifying strategies to promote spicy vegetables within school meals., Methods: One hundred participants between the age 11 and 17 y sampled 4 steamed broccoli florets with varying levels of a ground red and cayenne pepper spice blend (0, 0.9, 2.0, and 4.0 g). Participants rated their likeability of each broccoli sample on a 9-point hedonic scale and answered a survey assessing chili liking, chili consumption patterns, appropriateness, and acceptability. An interview assessed perspectives on spicy vegetables within school lunch.Regression analyses assessed relationships between participant attributes and sample ratings and survey outcomes. Agglomerative hierarchical cluster analysis was conducted to cluster together participants with similar sample liking ratings., Results: Seventy-seven percent of participants reported that chili pepper makes food taste better, and 67% consumed spicy food weekly or daily. Chili likers ( n = 41) were the dominant cluster group, compared with moderates ( n = 31) and chili dislikers ( n = 28). Thematic analysis results suggested that most participants support incorporating spicy vegetables into school lunch but mushy vegetable texture may undermine the impact of changing school vegetable spice levels., Conclusions: Spicy foods are commonly consumed by adolescents, and these findings support the inclusion of spicy vegetables in school lunch. Additional research is needed to identify policies and practices to improve the texture of vegetables in school meals and determine additional strategies to support cultural humility in child nutrition programs., Competing Interests: The authors have no conflicts of interest or relevant financial interests to disclose., (© 2024 The Author(s).)

Objective: School-based interventions are common approaches to address childhood obesity; however, there is little understanding of strategies that can foster their implementation into schools. In this study, we aimed to identify goals and the specific strategies selected by school nutrition directors (SNDs) in Virginia to execute school-based interventions. Methods: Between 2018 and 2019, SNDs in Virginia participated in Team Nutrition workshops through which they created action plans. We carried out a content analysis of 132 action plans collected from 100 school divisions. We developed codes deductively and inductively. The codes captured plan completion, goals, and strategies. Each plan was independently coded by 2 coders. Results: Action plans included 1.2 goals (SD = 0.54) and 3.9 strategies per goal (SD = 2.1). Goals were most commonly related to improving menus or increasing participation in the school meal programs. The strategies varied based on the goals. However, obtaining buy-in from school personnel and students was the most commonly included goal (64.4%) across plans. The level of action plan completion decreased with each subsequent section of the worksheet. Conclusions: Emerging patterns identified in this study suggest SNDs' strategy selection is based on goals and that trainings should be tailored to promote the development of skills required to execute optimal strategies. [ABSTRACT FROM AUTHOR]

Environmental and health advocates are increasingly promoting food donations to reduce landfilled food waste and feed hungry people. Share tables are locations where students can put unwanted school food or beverage items, allowing their uneaten food items to be "shared" with other students and providing food donation opportunities for the 4.9 billion lunches served annually in the U.S. National School Lunch Program. The purpose of this qualitative study was to identify differences in health inspector interpretations of the Food Code as it relates to share table operations and risk mitigation techniques preferred by inspectors for preventing foodborne illness from recovered food. A snowball sampling technique was used to identify Illinois health inspectors (n = 13) engaged in share table inspections. Telephone interviews were audio recorded and transcribed verbatim. The transcripts were coded using a hybrid process of deductive and inductive content analysis. Participants considered contamination, rather than temperature abuse, to be the primary risk factor for foodborne illness. Those participants with permissive Food Code interpretations considered contamination risk in the context of the overall school environment. Participants had the lowest degree of consensus on whether to allow whole apple recovery via a share table. Participants also lacked consensus on reuse of unclaimed share table items in future meal programs (reservice). This lack of consensus indicates that further research is needed to develop data-driven strategies to assess and manage the microbial risks associated with share tables and ultimately to facilitate increased food recovery. Hand cross-contamination at share tables was the main risk factor for foodborne illness. Those who considered the school context had more permissive Food Code interpretations. Participants had the lowest consensus on whole apple recovery. [ABSTRACT FROM AUTHOR]

PURPOSE/OBJECTIVES The Mississippi Office of Child Nutrition provided a competitive grant program named Statewide Nutrition Integrity Assessment (NIA) that helped schools obtain combination steam and convection ovens (i.e. combi ovens) as a replacement for traditional deep fryers. While equipment and infrastructure are important determinants of child nutrition, literature is sparse on the topic. This study evaluates the current status of the adoption of combi ovens in schools across the state and identifies barriers to implementing the change. METHODS A two-tiered survey consisting of a structured questionnaire and a phone interview was used for data collection. Questionnaires were distributed electronically to all Child Nutrition Directors (CNDs) in the state, who were asked to provide information separately for each school within their respective districts. The CNDs were phoned for follow-up interviews for additional comments on challenges and plans. This study included data for 306 schools across the state that had onsite production kitchens and had surveys completed (34.6% response rate). RESULTS About three-fourths of schools in the sample had at least one functioning combi oven. Approximately 78% of schools had completely removed fryers from their kitchens. Respondents reported various funding sources utilized to obtain combi ovens, including federal grants, district funds, and internal discretionary funds, in addition to the NIA grant, which was the initial impetus. Barriers to purchasing and maintaining combi ovens included the cost of maintenance, infrastructure limitations such as plumbing and space deficiencies, and lack of staff training. APPLICATION TO CHILD NUTRITION PROFESSIONALS Findings that most child nutrition programs willingly made changes in their facilities after encouraged by a state-coordinated initiative suggest their commitment to feeding healthy foods to children. Financial, physical, and other obstacles that make it difficult to implement and maintain the change present opportunities for future areas of improvement. Findings from this study may apply to other child nutrition programs in the United States. [ABSTRACT FROM AUTHOR]

The US Department of Agriculture's school meal programs have wide reach during the school year, but food insufficiency among households with children increases during summer months. The US Department of Agriculture summer meal programs are designed to fill this gap, yet participation has historically been low. To examine the facilitators and barriers to participation in a 2021 summer meal program while the COVID-19 pandemic regulation waivers were in place. Cross-sectional mixed-methods survey research. All parents/guardians of children enrolled in a school district in Connecticut were invited to participate in an online survey in December 2021. The respondents included summer meal participants (n = 622) and nonparticipants (n = 294). Survey respondents reported demographic variables, current food sufficiency, communication preferences, satisfaction with the program, reasons for using or not using the program, and whether they found the program helpful financially. The survey included three open-ended questions about barriers to participation. Respondents who used the summer meal program indicated that the pandemic-related regulatory waivers were key to their decision to participate. Reported barriers included lack of awareness of the program, inability to travel to sites during the times they were open, lack of transportation, concerns about dietary restrictions, and lack of variety in the menu, and concerns about wasting food. Parents/guardians expressed strong preferences for receiving communication about summer meals directly from their child's school and being able to access meals outside of typical work hours. The pandemic waivers allowed sponsors to test different models of distribution. Parents/guardians responded positively to the opportunity to access grab-and-go meals, multiple meals at once, and meals without a child present. These findings can be used to inform potential policy changes to reduce barriers and increase participation. [ABSTRACT FROM AUTHOR]

Abstract Background Malnutrition among school children may contribute to adverse health consequences such as non-communicable diseases, poor cognitive performance, psychological distress and poor quality of life that may persist into adulthood. In order to prevent childhood malnutrition, an intervention programme that integrates nutrition education and healthy school food environment is needed to provide nutrition information and reinforce the skills on healthy eating behaviours in schools. This paper describes a study protocol of a school-based intervention programme that integrates nutrition education and healthy school food environment, namely School Nutrition Programme (SNP). The SNP is a primary prevention programme that promotes healthy lifestyle among primary school children in light of the high prevalence of malnutrition in Malaysian children. Methods/design This quasi-experimental study aimed to evaluate the effectiveness of the SNP between intervention and comparison groups before and after the SNP, and after a 3-month follow-up. The SNP consisted of two main components, whereby three nutrition education sessions were implemented by trained teachers using three standardised modules, and healthy school food environment was implemented by the canteen food handlers with the provision of healthy menu to children during school recess times. Children from intervention group participated in the SNP, in addition to the standard Physical and Health Curriculum. The comparison group attended only the standardised Physical and Health Curriculum and the school canteen food handlers were reminded to follow the standard canteen guidelines from the Ministry of Education Malaysia. The assessment parameters in evaluating the effectiveness of the programme were knowledge, attitude and practice on nutrition, eating behaviours, physical activity, body composition, psychological distress, cognitive performance and health-related quality of life. Assessments were conducted at three time points: pre-intervention, post-intervention and 3-month follow-up. Discussion It was hypothesised that the SNP would be effective in promoting healthy lifestyle among school children, and further contributes in preventing malnutrition problem, enhancing cognitive performance and improving health-related quality of life among school children. Findings of the present study can be expanded to other schools in future on ways to improve nutrition education and healthy school food environment. Trial registration UMIN Clinical Trial Registration UMIN000032914 (Date of registration: 7th June 2018, retrospectively registered). Protocol version 16th September 2019 & Version 4

Identify types of food packaging used in school nutrition programs and competing priorities, barriers, and facilitators for sustainable packaging waste use and recovery. Qualitative interviews (n = 20) and structured kitchen observations were conducted. Data were collected from 3 school districts in Northern Colorado. Three nutrition program directors, 14 kitchen managers, and 3 sustainability staff. Barriers and facilitators for sustainable food packaging waste practices among school nutrition programs. Interviews were recorded and transcribed, followed by inductive content analysis to identify themes. Commonly used food packaging included cardboard, aluminum, paper, plastic, and styrofoam. Four competing priorities were identified as impacting school nutrition programs' ability to reduce or recover food packaging: serving line speed, labor, food quality, and cost. One key barrier was that school staff had difficulty understanding the total system impact of their food packaging use and recovery decisions. Food packaging is commonly used in school nutrition programs, and participants felt that its use offered key benefits, such as facilitating faster serving lines. More research is needed to quantify the direct and indirect impacts of packaging waste reduction and recovery in school nutrition programs. [ABSTRACT FROM AUTHOR]

Sugar-sweetened beverages (SSBs) are a major source of calories in the diets of American children and adolescents. These beverages, which contain mainly sugar and few beneficial nutrients, have been linked to overweight, obesity, type 2 diabetes, heart disease, dental caries, and other adverse conditions. Children of all ages consume SSBs, and schools, aided by the knowledge and direction of school nurses, can help students understand the health harms of SSBs, implement programs to discourage SSB intake, and play important roles in school and community efforts to limit SSBs. [ABSTRACT FROM AUTHOR]

BACKGROUND: School districts participating in the US Child Nutrition program are required to have a wellness policy. Many state agencies provide model policies to aid districts in policy creation. However, use of model wellness policies has not been associated with higher quality policies. Therefore, the purpose of the present study was to assess the quality of model wellness policies and to determine if federal regulations are more likely to be included than evidence‐based best practices. METHODS: Model wellness polices available through state agency websites were analyzed for comprehensiveness and strength using the WellSAT 3.0 and item status as a federal regulation or best practice was assigned. We used linear regression to determine if federal regulation status was associated with inclusion in model wellness policies. RESULTS: Overall, 34 states had model wellness policies available online. The total comprehensiveness and strength of model wellness policies was 59.3 ± 17.5 and 21.4 ± 17.6, respectively, out of 100 possible points. Among policy sections, comprehensiveness was highest within Nutrition Education (73.2 ± 31.6) and lowest in Wellness Promotion and Marketing (49.8 ± 27.2). On average, WellSAT items that were federal regulations were covered in 71% of model policies, while best practices were only covered in 54% of model policies (p =.008). CONCLUSIONS: There is a need to improve the quality of model wellness policies. The development of a uniform model policy may be warranted to provide a comprehensive list of federal regulations and best practices, written with strong language, for inclusion within school wellness policies. [ABSTRACT FROM AUTHOR]

To explore the real-time personal/employee safety experiences and perspectives of school nutrition professionals ranging from frontline staff to state leadership across the US as they responded to the initial weeks of the coronavirus pandemic. A cross-sectional survey was administered electronically March 31–April 20, 2020, to school nutrition staff, managers, directors, and state agency personnel. Descriptive statistics were calculated, and a thematic analysis of an open-ended item was conducted. School nutrition professionals (n = 504) from 47 states responded. Most (86.6%) reported that ensuring employee safety was somewhat or much more difficult during the pandemic, and they were unaware of an emergency plan. Themes from open-ended responses regarding employee safety concerns included, exposure and transmission risk, processes, and personal concerns. Attention to the safety and concerns of school nutrition employees is vital for continuation of these programs during this pandemic and for future emergency situations. [ABSTRACT FROM AUTHOR]