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Objectives. We evaluated the quality of snacks and beverages served at YMCA after-school programs before and after the programs' participation in a YMCA Learning Collaborative. Methods. We collected data on the types and brands of snacks and beverages (including fresh fruits and vegetables, whole grains, foods with trans fats, water, and sugar-sweetened beverages) served daily during 3 different time periods spanning 14 months in total, and the components of the healthy eating standards. We compared snack and beverage quality before and after the intervention. Results. Weekly servings of fresh fruits and vegetables (1.3 vs 3.9; P=.02) and weekly servings of fruits and vegetables as a whole (1.9 vs 5.2; P=.009) increased from baseline to postintervention; weekly servings of desserts (1.3 vs 0.5; P=.049), foods with added sugars (3.9 vs 2.4; P=.03), and foods containing trans fats (2.6 vs 0.7; P=.01 ) decreased. After the intervention, all YMCAs offered water daily, and none served sugar-sweetened beverages. The percentage of calories from fruits and vegetables significantly increased after the intervention, whereas the percentage of calories from foods containing trans fats and added sugars decreased. Conclusions. A learning collaborative can disseminate healthy eating standards among participating organizations and facilitate improvements in the quality of after-school snacks and beverages. (Am J Public Health. 2010;100: 925-932. doi: 10.2105/AJPH.2008.158907)

Background Intrusions in dietary recalls may originate in confusion of episodic memories manifested as temporal dating errors. Objective Data from a validation study (concerning reporting accuracy over multiple recalls) and school foodservice production records were used to investigate origins of intrusions in school meals in children's 24-hour recalls. Design/subjects/setting During the 1999-2000 school year, 104 fourth-grade children were observed eating school meals on 1 to 3 nonconsecutive days separated by [greater or equal to] 25 days, and interviewed about the previous day's intake in the morning on the day after each observation day. Statistical analyses performed For breakfast and lunch separately, logistic regression was used to investigate the effect of time (ie, days) before the interview day on the probability that intrusions referred to items available in the school foodservice environment. Exploratory analyses were conducted for breakfast options observed and/or reported eaten. Results For interviews in which reported meals met criteria to be considered school meals and that contained intrusions, of 634 and 699 items reported eaten at breakfast and lunch, respectively, 394 and 331 were intrusions. Availability in the school foodservice environment of items referred to by intrusions in reports of lunch, but not breakfast, decreased as days increased before the interview day (P=0.031 and P=0.285, respectively). Concerning breakfast, children observed eating a cold option (ie, ready-to-eat cereal, milk, juice, crackers [graham or animal]) almost always reported a cold option, whereas children observed eating a hot option (ie, non-ready-to-eat cereal entree [eg, sausage biscuit], milk, and fruit or juice) reported a cold option in approximately 50% of interviews. Conclusions In children's 24-hour recalls, confusion of episodic memories contributes to intrusions in school lunch, and generic dietary information (eg, cold option items available daily) or confusion of episodic memories may contribute to intrusions in school breakfast. Understanding the origins of intrusions may help in developing interview methods to decrease the occurrence of intrusions.

Managers of onsite retail foodservice operations, particularly those in centralized school foodservice operations, are called on to provide meals during emergencies, yet there is a paucity of research on their readiness to handle emergencies. Qualitative research and a cross-sectional survey design were used to conduct a needs assessment for emergency preparedness (emergency readiness, food recalls, and food defense) in centralized school foodservice operations, including warehousing. An open-ended written questionnaire was mailed to eight foodservice directors, and responses were used to develop a written questionnaire that was mailed to school foodservice directors in 200 districts identified as having centralized food production and warehousing. Directors from 78 districts responded (39% response rate). Most districts (n=72) had an emergency response team, and foodservice was included as part of 63 of those teams. Not all districts had written procedures for food recalls (47 of 73), natural disasters (37 of 74), or food defense (30 of 74). Barriers to implementing emergency preparedness policies and procedures included limited money, emergency equipment, and time. Most current training related to food safety with little training related to emergency preparedness. Training on the emergency preparedness plan was done in 61 of 78 districts. Training on emergency procedures was done by less than half of the districts during the previous year. This study identified best practices related to emergency preparedness that can be implemented in onsite retail foodservice operations. Results indicate a need to emphasize emergency preparedness, develop written standard operating procedures, and train employees to be prepared to respond to emergencies.

This study tests the hypothesis that fruits and vegetables taken on students' lunch trays are usable proxies for fruits and vegetables eaten, and that the proxy is useful with children in the youngest school grade (ie, grade 1; ages 6 to 8 years). A total of 1,168 randomly selected students in grade 1 and grade 3 (ages 8 to 10 years) in 26 schools in the Twin Cities, MN, metropolitan area were observed before and after an intervention that was applied to 13 randomly selected schools. Trained observers recorded food quantities on a child's tray and measured food consumed during the meal. Correlations between amounts of fruits and vegetables taken and eaten ranged from 0.74 to 0.96. The median correlation in grade 1 was the same, 0.82, as in the combined sample. Food taken and food eaten as alternative response variables resulted in the same conclusions about the effects of intervention. The hypothesis is strengthened that food taken can be used as a proxy for consumption in future nutrition education research.

The objective of this study was to describe the extent and locations of soft drink advertisements on high school campuses in Pennsylvania and identify factors related to extent of these advertisements. Surveys were distributed to 271 school foodservice directors in a random sample of high schools in Pennsylvania. These high schools were selected to be representative of the entire population of high schools in Pennsylvania based on chosen demographic characteristics. A three-phase survey strategy was used, involving distribution of a postcard reminder 1 to 2 weeks after the initial survey distribution, and mailing of a second survey to nonrespondents 1 to 2 weeks after mailing of the postcard. Two hundred twenty-eight school foodservice directors (84%) returned surveys. Linear multiple regression analyses were done using SPSS (version 11.5.1, 2002, SPSS Inc, Chicago, IL). Approximately two thirds (66.5%) of respondents indicated soft drink advertisements exist in at least one location in their school, with the most prevalent locations being on vending machines (62%) and school grounds, such as playing fields (27%). Slightly more than 10% of respondents indicated soft drink advertisements displayed in the cafeteria. Extent of soft drink advertisement locations was positively related to existence of a pouring-rights contract, subscription to Channel One, and receipt of incentives from soft drink bottlers based on sales, but negatively related to average daily participation in school lunch. These findings suggest that commercialization and sales incentives might interact to contribute to school environments that are not "nutrition-friendly." Schools' efforts to establish wellness policies as mandated by the Child Nutrition and WIC Reauthorization Act of 2004 provide ideal opportunities to examine school environments for advertising that might conflict with the healthful environments they are aiming to establish, and perhaps to develop policies to address these practices. J Am Diet Assoc. 2006;106:2052-2056.

The purpose of this research was to evaluate factors influencing the implementation of the Coordinated Approach to Child Health (CATCH) Eat Smart School Nutrition Program in Texas using data from the CATCH dissemination study. A mail survey was sent to school foodservice personnel (N = 213) who attended a CATCH training from August 2000 through January 2002. A response rate of 40% (n = 85) was achieved. The mean score for the percentage of CATCH Eat Smart guidelines implemented was 80.44. Multivariate linear regression analysis revealed that, after adjusting for age and number of years employed in school foodservice, the following factors were significantly associated with the percentage of CATCH Eat Smart guidelines implemented: utility of CATCH and CATCH Eat Smart in meeting requirements for Coordinated School Health Programs (P = 0.006), school foodservice personnel's satisfaction with food made using the CATCH Eat Smart guidelines (P=0.008), utility of CATCH in facilitating interschool communication about children's health (P = 0.019), and perceived student satisfaction with food made using the CATCH Eat Smart guidelines (P = 0.046). These results suggest that dissemination approaches for Coordinated School Health Programs should focus on ways to enhance program satisfaction, be consistent with legislated mandates, and increase interschool staff communication to increase program implementation by school foodservice personnel. J Am Diet Assoc. 2006; 106:2039-2044.

Objective To determine the effects of offering universal-free school breakfast in elementary schools on students' dietary outcomes. Design Experimental study with random assignment of 153 matched elementary schools in six school districts. Treatment schools offered universal-free school breakfast, and control schools continued to operate the traditional means-tested School Breakfast Program. Twenty-four--hour dietary recalls were collected from sample students near the end of the first year. Subjects About 30 students in second through sixth grades were randomly selected from each school (n = 4,358). Intervention Free school breakfasts were made available to all students in treatment schools, regardless of family income, for three consecutive school years (2000-2001 to 2002-2003). Main outcome measures Breakfast consumption and food and nutrient intake. Statistical analyses Hierarchical mixed-models and logistic regression, adjusting for age, sex, minority status, and income eligibility for the regular school meal programs, were used to estimate effects. Results Despite a significant increase in school breakfast participation among sample students in treatment schools (from 16% to 40%, P<0.01), the rate of breakfast skipping did not differ between groups (4% overall). Treatment school students were more likely to consume a nutritionally substantive breakfast (P<0.01), but dietary intakes over 24 hours were essentially the same. Conclusions Making universal-free school breakfast available in elementary schools did not change students' dietary outcomes after nearly 1 year. To improve children's diets overall, efforts should focus on ensuring all students have access to a healthful breakfast, at home or at school.

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.jada.2005.10.031 Byline: Claudia Probart, Elaine McDonnell, Terryl Hartman, J. Elaine Weirich, Lisa Bailey-Davis Abstract: The objective of this study was to identify factors that predict offering and sale of competitive foods, as well as factors that predict average daily participation in school lunch.

The object of this study was to determine whether students attending schools with self-service salad bars consume a greater amount of fruits and vegetables compared with students using preportioned servings and to evaluate the relationship between number of items offered and fruit and vegetable consumption. Two hundred ninety-four students in first through fifth grade were randomly selected from two schools with salad bars and two with preportioned servings. Weights of fruit and vegetable items were measured pre- and postconsumption and interobserver agreement [+ or -]1 g was [greater than or equal to]95%. Presence of a salad bar was not associated with greater fruit and vegetable consumption. Fruit and vegetable consumption was positively related to the number of fruit and vegetable items offered at salad bars (P<.05), adjusting for sex and grade. Fruit and vegetable variety was associated with elementary school-age children's fruit and vegetable consumption when using salad bars. J Am Diet Assoc. 2005;105:1789-1792.

Because plate waste reduces nutritional benefits of school lunches, the objective of this study was to determine the factors that influence waste. Lunches of 743 sixth graders in three middle schools were photographed after students made food selections and after eating. Sample items were purchased to determine initial portion weights. The Statistical Package for Social Sciences software (Base 10.0, 1995, SPSS Inc, Chicago, IL) was used for statistical analysis. Preparation method influenced acceptance rates and plate waste: Whole apples had lower acceptance (23%) and greater waste (62%) compared with applesauce (37% acceptance, 23% waste). Mashed potatoes and heated fries had similar acceptance (approximately 69%), but mashed potatoes were wasted less (19% vs 33%, respectively). Students who purchased competitive food items with lunch (n=250) had significantly greater waste of fruits (52% vs 36%, respectively, P=.0001), grain products (26% vs 14%, respectively, P=.009), meats (25% vs 16%, respectively, P=.015), and mixed dishes (30% vs 18%, respectively, P=.0001). Changing preparation methods and limiting availability of competitive food items may reduce plate waste. J Am Diet Assoc. 2005;105:1779-1782.

Objective: To investigate the accuracy of children's dietary recalls of school breakfast and school lunch validated with observations and obtained during in-person versus telephone interviews. Design: Each child was observed eating school breakfast and school lunch and was interviewed that evening about that day's intake. Setting: Ten elementary schools. Participants: A sample of fourth-graders was randomly selected within race (black, white) and gender strata, observed, and interviewed in person (n = 33) or by telephone (n = 36). Main Outcomes Measured: Rates for omissions (items observed but not reported) and intrusions (items reported but not observed) were calculated to determine accuracy for reporting items. A measure of total inaccuracy was calculated to determine inaccuracy for reporting items and amounts combined. Analysis: Analysis of variance; chi-square. Results: Interview type (in person, telephone) did not significantly affect recall accuracy. For omission rate, intrusion rate, and total inaccuracy, means were 34%, 19%, and 4.6 servings for in-person recalls and 32%, 16%, and 4.3 servings for telephone recalls of school breakfast and school lunch. Conclusions and Implications: The accuracy of children's recalls of school breakfast and school lunch is not significantly different whether obtained in person or by telephone. Whether interviewed in person or by telephone, children reported only 67% of items observed; furthermore, 17% of items reported were not observed. KEY WORDS: children, dietary recalls, observations, validity, in person, telephone