Changes in School Competitive Food Environments after a Health Promotion Campaign

BACKGROUND

Schools can reduce student access to competitive foods and influence healthy food choices by improving the school nutrition environment. This study describes changes in competitive nutrition environments in 100 K‐8 schools participating in the Philadelphia Campaign for Healthier Schools.

METHODS

Interviews with school staff were used to elicit information about policies, practices, and guidelines to restrict/limit competitive foods in schools, before and 1 year into the campaign. To increase the validity of responses, respondents provided documentation for reported policies and guidelines. Baseline interviews were conducted between April and June 2011 and follow‐up interviews were conducted between April and June 2012.

RESULTS

At follow‐up, significantly more schools reported having policies and/or guidelines in place to regulate food as a reward in the classroom, food served at parties and celebrations, outside foods allowed in school, and the availability of sodas and sugar‐sweetened beverages. There were no measurable effects on food available in school stores, fundraisers, or afterschool programs. Availability of concrete documentation of policies was limited, but when provided, it corroborated the interview responses.

CONCLUSIONS

In the context of a comprehensive school wellness policy, school wellness councils were associated with increases in school‐level policies and practices that improved the competitive nutrition environment.

     

School food practices of prospective teachers

BACKGROUND: Schoolteachers can affect students' eating habits in several ways: through nutrition knowledge, positive role modeling, and avoidance of unhealthy classroom food practices. In this study, the knowledge, attitudes, and eating behaviors of prospective teachers as determinants of intended classroom food practices and the school environment and its potential impact on classroom food practices were examined and explored. METHODS: One hundred and three students (response rate 79%) enrolled in the final year of a bachelor of education program with at least 22 weeks of practice teaching completed a self-administered questionnaire adapted from the Teens Eating for Energy and Nutrition at School teaching staff survey. Indexes related to classroom food practices, school food environment, personal health, fat intake, and nutrition knowledge were constructed and explored quantitatively using linear modeling techniques and contingency table analysis. RESULTS: The majority of respondents reported a high fat intake (65%) and had mid-to-low nutrition knowledge (72%). While most respondents (93%) believed that a healthy school food environment was important, two thirds reported unhealthy classroom food practices. Unhealthy classroom food practices were more likely to be used by those intending to teach at the secondary level, those who held a high personal health belief, and those who demonstrated less support for a healthy school environment. CONCLUSIONS: These findings suggest that knowledge, attitudes, and food behaviors of prospective teachers may be barriers to promoting healthy food habits to their future students. Further, prospective teachers would benefit from policies and programs that support healthy classroom practices and from compulsory nutrition education in the teacher training curriculum.     

Participation in the National School Lunch Program: Importance of School-Level and Neighborhood Contextual Factors

BACKGROUND: This study examined the effect of stigma (proxied by school-level peer participation), neighborhood food environment, and demographic characteristics on participation in the U.S. Department of Agriculture National School Lunch Program (NSLP).
METHODS: The 1997 and 2003 waves of the Child Development Supplement to the Panel Study of Income Dynamics were linked to external data on school-level free lunch eligibility rate, fast food restaurant availability in the school zip code, and food store availability and neighborhood socioeconomic status in the home zip code. Probit models examined the effects of contextual and demographic factors on NSLP participation and free/reduced-price NSLP participation, conditional on eligibility. Differences were analyzed by grade.
RESULTS: A 10% higher free lunch eligibility rate in a child's school was associated with a 1.8 percentage point increase in the probability of NSLP participation and 2.6 and 6.7 percentage points increase in free/reduced-price NSLP participation among all and high school eligible student, respectively. Fewer grocery stores and more convenience stores increased NSLP participation. Fast food restaurant availability in the school neighborhood decreased free/reduced-price NSLP participation for high school students only. The addition of the contextual factors reduced the estimated association with several of the demographic covariates, especially race.
CONCLUSIONS: The significant positive association between NLSP participation and school-level free lunch eligibility, especially for the free/reduced-price NSLP participation, suggested that stigma, or possibly peers, affected participation. Neighborhood and school contextual variables had significant effects on school lunch take-up and the results differed between high school and elementary/middle school students.     

School Vending Machine Purchasing Behavior: Results From the 2005 YouthStyles Survey

BACKGROUND: Competitive foods are often available in school vending machines. Providing youth with access to school vending machines, and thus competitive foods, is of concern, considering the continued high prevalence of childhood obesity: competitive foods tend to be energy dense and nutrient poor and can contribute to increased energy intake in children and adolescents. METHODS: To evaluate the relationship between school vending machine purchasing behavior and school vending machine access and individual-level dietary characteristics, we used population-level YouthStyles 2005 survey data to compare nutrition-related policy and behavioral characteristics by the number of weekly vending machine purchases made by public school children and adolescents (N = 869). Odds ratios (ORs) and corresponding 95% confidence intervals (CIs) were computed using age- and race/ethnicity-adjusted logistic regression models that were weighted on age and sex of child, annual household income, head of household age, and race/ethnicity of the adult in study. Data were collected in 2005 and analyzed in 2008. RESULTS: Compared to participants who did not purchase from a vending machine, participants who purchased ≥3 days/week were more likely to (1) have unrestricted access to a school vending machine (OR = 1.71; 95% CI = 1.13–2.59); (2) consume regular soda and chocolate candy ≥1 time/day (OR = 3.21; 95% CI = 1.87–5.51 and OR = 2.71; 95% CI = 1.34–5.46, respectively); and (3) purchase pizza or fried foods from a school cafeteria ≥1 day/week (OR = 5.05; 95% CI = 3.10–8.22). CONCLUSIONS: Future studies are needed to establish the contribution that the school-nutrition environment makes on overall youth dietary intake behavior, paying special attention to health disparities between whites and nonwhites.     

Active Parent Consent for Health Surveys With Urban Middle School Students: Processes and Outcomes*

BACKGROUND: To achieve high participation rates and a representative sample, active parent consent procedures require a significant investment of study resources. The purpose of this article is to describe processes and outcomes of utilizing active parent consent procedures with sixth-grade students from urban, ethnically diverse, economically disadvantaged K-8 public schools involved in an evaluation of a middle school service-learning program. METHODS: As part of the evaluation of the Lead Peace-Plus service-learning program, active parent consent was obtained for participation in school-based health surveys conducted with sixth graders in 3 schools. To achieve acceptable rates of parent permission, we employed multiple procedures including regular communication with school staff, incentives for involved schools and teachers, a multipronged approach for reaching parents, and direct encouragement of students to return forms through repeated classroom visits, individual and classroom incentives. We used Fisher's exact tests to compare selected characteristics among students whose parents weren't reached, those whose parents refused, and those whose parents consented to survey participation. RESULTS: We achieved a parent response rate of 94.6% among sixth-grade students. No significant differences in student gender, race/ethnicity, school, or free/reduced lunch status were identified across parent consent status groups. Rates of absenteeism were significantly higher (p = .03) among students whose parents weren't reached compared to other groups. CONCLUSIONS: Employing a multifaceted active parent consent campaign can result in high rates of parental response with limited sampling bias among an urban, ethnically diverse and economically disadvantaged group of middle school students.     

Physical Activity and Healthy Eating in the After‐School Environment

BACKGROUND: No research to date has extensively described moderate and vigorous physical activity (MVPA) and healthful eating (HE) opportunities in the after‐school environment. The current study described the quality of the after‐school environment for its impact on children’s MVPA and HE. METHODS: An alliance of 7 elementary schools and Boys and Girls Clubs who worked with the Cooperative Extension Service in Lawrence, KS, was selected to participate in a larger intervention study. After‐school settings were observed for information regarding session type, session context, leader behavior, physical activity, and snack quality using validated instruments such as the System for Observing Fitness Instruction Time. Data presented are baseline measures for all sites. RESULTS: Participating children (n = 144) were primarily non‐Hispanic white (60%) and in fourth grade (69%). After‐school sites offered 4 different sessions per day (active recreation, academic time, nonactive recreation, and enrichment activities). Children were provided with a daily snack. On 36% of the days observed, this snack included fruit, fruit juice, or vegetables. There was significantly more time spent in MVPA during free play sessions (69%) compared to organized adult‐led sessions (51%). There was also significantly more discouragement of physical activity during organized adult‐led sessions (29%) as compared to the free play sessions (6%). CONCLUSIONS: The quality of after‐school programs can be improved by providing fruits and vegetables as snacks; offering more free play activities; training the after‐school staff in simple, structured games for use in a variety of indoor and outdoor settings; and training after‐school staff to promote and model MVPA and HE in and out of the after‐school setting.     

School Policies and Practices That Improve Indoor Air Quality*

BACKGROUND: To determine whether schools with a formal indoor air quality management program were more likely than schools without a formal program to have policies and practices that promote superior indoor air quality. METHODS: This study analyzed school-level data from the 2006 School Health Policies and Programs Study, a national study of school health programs and policies at the state, district, and school levels. Using chi-square analyses, the rates of policies and practices that promote indoor air quality were compared between schools with and schools without a formal indoor air quality program. RESULTS: The findings of this study show that 51.4% of schools had a formal indoor air quality management program, and that those schools were significantly more likely than were schools without a program to have policies and use strategies to promote superior indoor air quality. CONCLUSIONS: These findings suggest that schools with a formal indoor air quality program are more likely support policies and engage in practices that promote superior indoor air quality.     

Diet Quality and Academic Performance

BACKGROUND: Although the effects of nutrition on health and school performance are often cited, few research studies have examined the effect of diet quality on the academic performance of children. This study examines the association between overall diet quality and academic performance. METHODS: In 2003, 5200 grade 5 students in Nova Scotia, Canada, and their parents were surveyed as part of the Children's Lifestyle and School-performance Study. Information on dietary intake, height, and weight and sociodemographic variables were linked to results of a provincial standardized literacy assessment. Diet Quality Index-International was used to summarize overall diet quality. Multilevel regression methods were used to examine the association between indicators of diet quality and academic performance while adjusting for gender and socioeconomic characteristics of parents and residential neighborhoods. RESULTS: Across various indicators of diet quality, an association with academic performance was observed. Students with decreased overall diet quality were significantly more likely to perform poorly on the assessment. Girls performed better than boys as did children from socioeconomically advantaged families. Children attending better schools and living in wealthy neighborhoods also performed better. CONCLUSIONS: These findings demonstrate an association between diet quality and academic performance and identify specific dietary factors that contribute to this association. Additionally, this research supports the broader implementation and investment in effective school nutrition programs that have the potential to improve student access to healthy food choices, diet quality, academic performance, and, over the long term, health.