Resources,Barriers, and Tradeoffs: A Mixed Methods Analysis of School Pre-Consumer Food Waste

BackgroundFood waste is a global problem. School food waste before the point of purchase, pre-consumer waste, has been little studied.ObjectiveOur aim was to elicit a comprehensive assessment and understanding of pre-consumer food waste amounts, behaviors, policies, and attitudes.DesignThis study used mixed methods, featuring a convergent parallel design using key respondent interviews (n=20) and 80 hours of structured kitchen observations, including food waste measurement.Participants/settingSchool and district kitchens (n=14) using stratified random sampling to ensure school level and kitchen type reflected the population of three Colorado school districts in 2016-2017. Kitchen managers, district-level nutrition services directors, and sustainability staff were interviewed.Statistical analyses performedMean food waste volumes and percentages were calculated. Linear regressions were used to determine the relationship between school kitchen characteristics and food waste volumes. Interviews were coded to identify common themes.ResultsTrim waste and overproduction contributed the most to overall pre-consumer food waste; substandard foods and overproduction were the most common reasons for edible waste. Several competing priorities conflicted with schools’ and districts’ waste reduction efforts: food safety, promoting diet quality, food choice, and customer satisfaction. Batch cooking, production record use, shallow salad bar pans, and other inventory management techniques facilitated waste reduction. Staffing, space, and time constraints made it more difficult to implement these strategies. Increased food choice options were positively associated with pre-consumer waste volume (β=49.5, P=0.04), and this relationship remained significant once regression models adjusted for district, salad bar use, and new menu items (β=70.3, P=0.05).ConclusionsSchool nutrition programs are complex, and a systems approach is warranted to reduce overall waste in the context of existing food safety and nutrition policies. More research is needed to elucidate the impact of food choice on overall food waste of the school meal system.     

Getting a Taste for Food Waste: A Mixed Methods Ethnographic Study into Hospital Food Waste before Patient Consumption Conducted at Three New Zealand Foodservice Facilities

Foodservice organizations, particularly those in hospitals, are large producers of food waste. To date, research on waste in hospitals has focused primarily on plate waste and the affect of food waste on patient nutrition outcomes. Less focus has been placed on waste generation at the kitchen end of the hospital food system. We used a novel approach to understand reasons for hospital food waste before consumption and offer recommendations on waste minimization within foodservices. A mixed methods ethnographic research approach was adopted. Three New Zealand hospital foodservices were selected as research sites, all of which were contracted to an external foodservice provider. Data collection techniques included document analyses, observations, focus groups with kitchen staff, and one-on-one interviews with managers. Thematic analysis was conducted to generate common themes. Most food waste occurred during service and as a result of overproduction. Attitudes and habits of foodservice personnel were considered influential factors of waste generation. Implications of food waste were perceived differently by different levels of staff. Whereas managers raised discussion from a financial perspective, kitchen staff drew upon social implications. Organizational plans, controls, and use of pre-prepared ingredients assisted in waste minimization. An array of factors influenced waste generation in hospital foodservices. Exploring attitudes and practices of foodservice personnel allowed an understanding of reasons behind hospital food waste and ways in which it could be minimized. This study provides a foundation for further research on sustainable behavior within the wider foodservice sector and dietetics practice.     

Implementing a Multicomponent School-Based Obesity Prevention Intervention: A Qualitative Study

ObjectiveTo explore barriers and facilitators to implementing and sustaining Healthy Choices, a 3-year multicomponent obesity prevention intervention implemented in middle schools in Massachusetts.MethodsUsing purposive sampling, 56 in-depth interviews were conducted with middle school employees representing different positions (administrators, teachers, food service personnel, and employees serving as intervention coordinators). Interviews were recorded and transcribed. Emergent themes were identified using thematic analyses.ResultsState-mandated testing, budget limitations, and time constraints were viewed as implementation barriers, whereas staff buy-in, external support, and technical assistance were seen as facilitating implementation. Respondents thought that intervention sustainability depended on external funding and expert assistance.Conclusions and ImplicationsResults confirm the importance of gaining faculty and staff support. Schools implementing large-scale interventions should consider developing sustainable partnerships with organizations that can provide resources and ongoing training. Sustainability of complex interventions may depend on state-level strategies that provide resources for implementation and technical assistance.     

Disaster Management and School Nutrition: A Qualitative Study of Emergency Feeding During the COVID-19 Pandemic

BackgroundSchool nutrition programs mitigate child food insecurity across the United States. With the onset of the coronavirus disease 2019 (COVID-19) pandemic, kindergarten through grade 12 physical school campuses closed, which led to those programs transitioning to emergency feeding. The Sendai Framework for Disaster Risk Reduction has 4 action priorities that guided the assessment of school nutrition employees’ emergency response during the COVID-19 pandemic.ObjectiveOur aim was to explore the experience of school nutrition employees as they provided emergency feeding services during the COVID-19 pandemic and evaluate their actions based on the Sendai Framework for Disaster Risk Reduction .DesignA qualitative study with semi-structured interviews (n = 34) was conducted via videoconferencing software. A purposive sample of school nutrition employees across all 7 US Department of Agriculture regions who were involved in the COVID-19 emergency feeding response participated during April and May 2020.Participants/settingSchool nutrition employees were selected randomly for participation from those indicating willingness to be interviewed during their participation in a related survey. Recruitment continued until all 7 US Department of Agriculture regions were represented. Participants held various roles, ranging from state agency leaders to front-line supervisors, although most were district-level directors or assistant directors.AnalysisData were analyzed using a phenomenological qualitative analytic approach.ResultsFour themes emerged. First, participants described the progression of the initial shock associated with the pandemic and service disruption, the flexibility they practiced, and the development of new routines. Second, keeping people (children, coworkers, and the community) safe was highlighted. The next theme captured participants’ feeling that they came “out of the shadows” as communities and stakeholders recognized their important contribution to children’s food security. Finally, they shared insight on communication and accountability during the emergency feeding response.ConclusionsThese programs demonstrated flexibility, resilience, and commitment to children during this crisis. As the pandemic continues and future disasters are considered, school nutrition programs and leaders can use the Sendai Framework for Disaster Risk Reduction’s “build back better” concept to refine disaster preparedness plans and advocate for changes that will continue to combat child food insecurity in the United States.     

农村义务教育学生营养改善计划智能化管理实践探究及建议

基于客观实际深入研究营养改善计划实施以来的成效以及可持续发展的制约因素,对智能化管理进行探索与实践。在福建省选取尤溪县等试点县区实行综合改革,探究新时期营养改善计划智能化管理可持续模式,包括健全机构人员、健全管理机制,提出大力推广应用“互联网+”技术实行智能化监管,确保食品和资金安全,提高资金使用效益,管控粮食浪费现象等新时期营养改善计划智能化管理的建议。     

Understanding Barriers to Implementing Quality Lunch and Nutrition Education

Food services and nutrition education are priorities for the Coordinated School Health Program in Massachusetts, which is a CDC funded partnership between the Massachusetts Departments of Education and Public Health. Despite funding and resources provided by governmental and non-governmental agencies, schools are facing barriers in effectively creating a healthy nutritional environment. A qualitative survey was conducted to understand barriers to implementing quality lunch and nutrition education programs perceived by superintendents, principals, food service directors, nurses, and health educators in Massachusetts. The results suggest that while funding can initially enable schools to provide quality lunch, but without changes in students' preference for unhealthy food and parental and community involvement in fostering students' healthy eating behavior, the lunch programs cannot achieve a sustainable success. Lack of opportunity for communication among food service staff, health educators, and teachers appears to hinder the coordination necessary to promote school lunch as well as school-wide nutrition education. Respondents acknowledged that the state's academic assessment system is the priority issue in their schools, but expressed that the interests and initiatives of superintendents and principals in the lunch and nutrition education programs can be enhanced. Overall, the results suggest that successful implementation of quality lunch and nutrition education programs require not only the collaborative efforts of school administration and staff but also the support of parents, community, and the mass media.     

Environmental Sustainability of Hospital Foodservices across the Food Supply Chain: A Systematic Review

BackgroundHospitals have a responsibility to support human health, and given the link between human and environmental health, hospitals should consider their environmental impacts. Hospital foodservices can negatively affect the environment at every stage of the food supply chain (production/procurement, distribution, preparation, consumption, and waste management/disposal).ObjectiveTo systematically identify and synthesize the following across the hospital patient food/nutrition supply chain: environmental and associated economic impacts of foodservice; outcomes of strategies that aim to improve the environmental sustainability of foodservice; and perspectives of patients, staff, and stakeholders on environmental impacts of foodservice and strategies that aim to improve the environmental sustainability of foodservice.MethodsEight electronic databases (ie, Cumulative Index to Nursing and Allied Health Literature Plus, Embase via Ovid, Global Health, National Health Service Economic Evaluation Database, Ovid Medline, ProQuest Environmental Science Collection, Scopus, and Web of Science) were searched from database inception to November 2018 for original research conducted across any stage of the hospital food supply chain (from production/procurement to waste management/disposal) that provides food/nutrition to patients, with no restrictions on language or study design. Titles/abstracts then full texts were screened independently by two authors. The Mixed Methods Appraisal Tool was used for quality appraisal for included studies. Data were synthesized narratively.ResultsFrom 29,655 records identified, 80 studies met eligibility criteria. Results were categorized into production/procurement (n=12), distribution (n=0), preparation (n=6), consumption (n=49), waste management/disposal (n=8), and multiple food supply chain aspects (n=5). The environmental impact most widely explored was food waste, with many studies reporting on food waste quantities, and associated economic losses. Strategies focused on reducing food waste by increasing patients’ intake through various foodservice models. Perspectives identified a shared vision for sustainable foodservices, although there are many practical barriers to achieving this.ConclusionThe literature provides examples across the hospital food supply chain that demonstrate how environmental sustainability can be prioritized and evaluated and the opportunities for credentialed nutrition and dietetics practitioners to contribute. Future studies are warranted, particularly those measuring environmental impacts and testing the effects of sustainable strategies in the distribution, preparation, and waste management stages.     

Consumer perceptions on sustainable practices implemented in foodservice organizations in Korea

BACKGROUND/OBJECTIVESSustainable practices in foodservice organizations including commercial and noncommercial ones are critical to ensure the protection of the environment for the future. With the rapid growth of the foodservice industry, wiser usage of input sources such as food, utilities, and single use packaging should be reconsidered for future generations. Therefore, this study aims to investigate the customer''s perceptions on sustainable practices and to identify the relationship among sustainable practices, social contribution and purchase intention.SUBJECTS/METHODSThe study was conducted using content analyses by reviewing articles on sustainable food service practices published domestically and abroad. Thereafter, data were collected with a face-to-face survey using a questionnaire and analyzed with factor analyses and multiple regressions.RESULTSSustainable practices classified with factor analysis consisted of 6 dimensions of green food material procurement, sustainable food preparation, green packaging, preservation of energy, waste management, and public relations on green activity, with a total of 25 green activities in foodservice operations. Consumers were not very familiar with the green activities implemented in the foodservice unit, with the lowest awareness of "green food material procurement (2.46 out of 5 points)", and the highest awareness of "green packaging (3.74)" and "waste management (3.28). The factors influencing the perception of social contribution by foodservice organizations among 6 sustainable practice dimensions were found to be public relations on green activity (β = 0.154), waste management (β = 0.204) and sustainable food preparation (β = 0.183). Green packaging (β = 0.107) and the social contribution of the foodservice organization (β = 0.761) had strong relationships with the image of the organization. The purchase intentions of customers was affected only by the foodservice image (β = 0.775).CONCLUSIONSThe results of this study suggest that sustainable practices by foodservice organization present a good image to customers and increase the awareness of valuable contributions that benefit the customer as well as the community.     

Farm-to-School Programs: Perspectives of School Food Service Professionals

ObjectiveThis qualitative study used a case study approach to explore the potential of farm-to-school programs to simultaneously improve children's diets and provide farmers with viable market opportunities.DesignSemistructured interviews were the primary data collection strategy.SettingSeven farm-to-school programs in the Upper Midwest and Northeast regions of the United States.ParticipantsSeven school food service professionals, 7 farmers, and 4 food distributors recruited from 7 farm-to-school programs.Phenomenon of InterestInterviews probed why farmers, school food service professionals, and food distributors participate in farm-to-school programs and how they characterize the opportunities and challenges to local school food procurement.AnalysisData were analyzed using thematic coding and data displays.ResultsSchool food service professionals described 3 motivators for buying locally grown food for their cafeterias: (1) “The students like it,” (2) “The price is right,” and (3) “We're helping our local farmer.” Students' preference for locally grown food was related to food quality, influence of school staff, and relationships with farmers. Buying food directly from farmers and wholesalers was associated with lower prices and flexible specifications, and the “local feel.”Conclusions and ImplicationsUnderstanding school food service professionals' motivations for buying locally grown food is critical to the sustainability of farm-to-school programs.     

Healthy Eating Determinants and Food Security Resource Opportunities: Urban-Dwelling American Indian and Alaska Native Older Adults Perspectives

ObjectiveTo explore the perspectives of urban-dwelling American Indian and Alaska Native (AI/AN) older adults regarding determinants of healthy eating, food insecurity, and opportunities for an urban clinic to improve resources.MethodsSemistructured interviews (n = 24) with older adults (aged ≥ 60 years) at 1 urban AI/AN serving clinic. Telephone-based interviews were audio-recorded, professionally transcribed, and analyzed using thematic analysis.ResultsFour overarching themes were revealed: (1) hunger-mitigating resources exist but do not necessarily lessen food insecurity; (2) multiple layers of challenges related to social determinants of health present barriers to healthy nutrition for AI/AN older adults; (3) unique facilitators rooted in AI/AN culture can help decrease food insecurity; and (4) many clinic-based opportunities for programs to improve food insecurity exist.Conclusions and ImplicationsFindings provide a foundation for urban-serving AI/AN clinics to develop healthy eating resources for their older adult patients. Greater benefit would result from resources that build on cultural strengths and address older adult-specific challenges to healthy eating.     

Variables Affecting High School Students’ Perceptions of School Foodservice

Objective To determine if student satisfaction with high school foodservice is directly related to participation in the foodservice.

Design A valid and reliable survey was conducted in a variety of classes such as English, history, and health science in grades 9 through 12, representing students aged 13 through 19 years. Students were asked 38 questions concerning variety of food, food quality, foodservice staff, aesthetics of the serving and dining area, and demographics.

Subjects/setting The study was conducted with 1,823 students from 9 schools representing 4 geographic regions.

Statistical analysis Stepwise multiple regression was used to determine the independent variables (attributes desired by the students) that most highly correlated with the dependent variable (satisfaction with the school foodservice overall).

Results Variables most highly correlated with overall satisfaction were variety of food offered, flavor of food, attractiveness of food on the serving line, staff smiling and greeting students, quality of food choices, choices that allow students to meet cultural and ethnic preferences, courteousness of the staff, and quality of ingredients. Variety of food offered was the best predictor of satisfaction. A statistically significant difference was found (P<.01) between groups that never ate school lunch and those that ate school lunch 3 to 5 times per week on dining ambiance, food quality, and staff. The results indicate that satisfaction with foodservice is associated with purchase behavior in school foodservice programs.

Applications School foodservice and nutrition programs are critically important for providing nutrition to millions of our future leaders. Today it is not enough to prepare healthful, good-tasting food. High school students are sophisticated and are exposed at an early age to a variety of dining experiences including fast foods, ethnic cuisine, and fine dining. These factors have influenced the attributes students use to evaluate school foodservice. To maintain participation levels and financial stability, school foodservice professionals should evaluate student satisfaction with food quality, variety, and other variables that affect overall satisfaction and participation. These data may then be incorporated into continuous quality improvement and strategic planning. Marketing must be incorporated into the strategic plan to influence student participation. J Am Diet Assoc. 1998;98:1424–1428,1431.     

Barriers and facilitators to childhood obesity prevention among culturally and linguistically diverse (CALD) communities in Victoria,Australia

Objective: Childhood obesity is rising among culturally and linguistically diverse (CALD) groups who show poor engagement in obesity prevention initiatives. We examined the barriers and facilitators to the engagement of CALD communities in obesity prevention initiatives. Methods: We used the nominal group technique to collect data from 39 participants from Vietnamese, Burmese, African, Afghani and Indian origins living in disadvantaged areas of Victoria, Australia. Data analysis revealed ranked priorities for barriers and facilitators for CALD community engagement in obesity prevention initiatives. Results: CALD parents identified key barriers as being: competing priorities in the post‐migration settlement phase; language, cultural and program accessibility barriers; low levels of food and health literacy; junk food advertisement targeting children; and lack of mandatory weight checks for schoolchildren. Key facilitators emerged as: bicultural playgroup leaders; ethnic community groups; and school‐based healthy lunch box initiatives. Conclusion: This study has identified several policy recommendations including: the implementation of robust food taxation policies; consistent control of food advertising targeting children; improving CALD health literacy using bicultural workers; and matching health promotional materials with CALD community literacy levels. Implications for Public Health: These recommendations can directly influence public health policy to improve the engagement of CALD communities in obesity prevention services and ultimately reduce the widening obesity disparities in Australia.     

Position of the American Dietetic Association: local support for nutrition integrity in schools

It is the position of The American Dietetic Association that the school and community have a shared responsibility to provide all students with access to high-quality foods and nutrition services as an integral part of the total education program. Educational goals, including the nutrition goals of the National School Lunch Program and the School Breakfast Program, should be supported and extended through school district policies that create an overall school environment with learning experiences that enable students to develop lifelong, healthful eating habits. Local school policy, developed through a collaborative process that responds to community needs and priorities, should include the integration of the school nutrition program with education. Nutrition integrity policy provides a framework for the integration and coordination of all aspects of the school nutrition program. Nutrition integrity is defined as “a guaranteed level of performance that ensures that all foods available and consumed by children in schools are consistent with the Recommended Dietary Allowances and the Dietary Guidelines for Americans, and contribute to the development of lifelong, healthy eating habits.” Achieving nutrition integrity means taking a comprehensive approach to program planning, management, operations, and integration of nutrition into the total education program of the school. The community is a valuable resource for this effort. Collaboration between key school- and community-based constituents, including children and other stakeholders, will result in the most effective and relevant plans for local school nutrition programs. However, competing and profit-making food and beverage sales may create a conflicting environment and can contradict lessons taught in health and nutrition education. This position provides direction for the dietetics profession for addressing this issue along with providing a suggested action plan for local schools and their communities. J Am Diet Assoc. 2000;100:108-111.     

Using Focus Group Interviews to Understand School Meal Choices

ABSTRACT: Focus groups were used to examine adolescents' participation in school nutrition programs, their opinions about the meals served in these programs, and their suggestions for improving the meals. A pilot and four focus group interviews were conducted with ninth grade students in five geographically distinct regions of Florida. Male students and those from rural areas were more likely to participate in school meal programs than were females and those from suburban and urban areas. Students expressed intense dislike and distrust of school meals. School meals were criticized for taste, appearance, small serving sizes, and cost. Students overwhelmingly favored commercial food vendors serving lunch at school. Suggestions for improving school meals included improving the taste and appearance of food, offering a wider variety of foods, serving more fresh fruit and vegetables, lowering the price, increasing the serving sizes, teaching food service workers how to cook, and offering more condiments.     

Using Focus Group Interviews to Understand School Meal Choices

ABSTRACT: Focus groups were used to examine adolescents' participation in school nutrition programs, their opinions about the meals served in these programs, and their suggestions for improving the meals. A pilot and four focus group interviews were conducted with ninth grade students in five geographically distinct regions of Florida. Male students and those from rural areas were more likely to participate in school meal programs than were females and those from suburban and urban areas. Students expressed intense dislike and distrust of school meals. School meals were criticized for taste, appearance, small serving sizes, and cost. Students overwhelmingly favored commercial food vendors serving lunch at school. Suggestions for improving school meals included improving the taste and appearance of food, offering a wider variety of foods, serving more fresh fruit and vegetables, lowering the price, increasing the serving sizes, teaching food service workers how to cook, and offering more condiments.     

Peer Reviewed: Retooling Food Service for Early Elementary School Students in Somerville,Massachusetts: The Shape Up Somerville Experience

Background

Changes in the school food environment are a logical target to prevent childhood overweight. We describe the food service component of a 2-year research intervention to prevent excess weight gain in children.

Context

The goals of the food service component were to improve the presentation and nutrient quality of school meals and to incorporate more fruits and vegetables into students'' diets. The project engaged food service staff, students, parents, teachers, and school leaders to improve school nutrition.

Methods

Modifications addressed needs and barriers identified though dialogue with the food service director, focus groups, key informant interviews, and surveys of school employees, students, and parents and guardians. Attitudes and behavior changes were measured through surveys, direct observation, and sales data.

Consequences

More fruits, vegetables, whole grains, and low-fat dairy products were available during the intervention years; menus and à la carte choices were brought into closer compliance with recommended guidelines for children; attitudes of students, parents and guardians, school faculty, and food service staff improved; and policies related to food service were adopted.

Interpretation

Strategic modification to improve nutrition and increase acceptability of the food served in schools is feasible and sustainable. These results demonstrate that changes to food service can lead to improved nutrient profiles and more favorable attitudes toward food served at school meals. Such changes can help prevent childhood obesity.