Measuring the 'obesogenic' food environment in New Zealand primary schools

Childhood obesity is an increasing health problem in New Zealand and many other countries. Information is needed to guide interventions that reduce the 'obesogenic' (obesity-promoting) elements of school environments. The aim of this study was to identify and measure the obesogenic elements of the school environment and the canteen sales of energy-dense foods and drinks. A self-completion questionnaire was developed for assessing each school's nutrition environment and mailed to a stratified random sample of New Zealand schools. The responses from primary schools (n = 200, response rate 61%) were analysed. Only 15.5% of schools had purpose-built canteen facilities and over half ran a food service for profit (31% profit to the school, 24.5% profit for the contractors). Only 16.5% of schools had a food policy, although 91% of those rated the policy as effective or very effective. The most commonly available foods for sale were pies (79%), juice (57%) and sausage rolls (54.5%). Filled rolls were the most expensive item (mean dollars 1.79) and fruit the least expensive (mean dollars 0.47). The ratio of 'less healthy' to 'more healthy' main choices was 5.6:1, for snacks it was 9.3:1 and for drinks it was 1.4:1. In contrast, approximately 60% of respondents said that nutrition was a priority for the school. Only 50% felt there was management support for healthy food choices and only 39% agreed that mainly nutritious food was offered by the food service. 'Less healthy' choices dominated food sales by more than 2:1, with pies being the top selling item (>55000 per week). We found that the food environment was not conducive to healthy food choices for the children at New Zealand schools and that this was reflected in the high sales of relatively unhealthy foods from the school food services. Programmes that improve school food through policies, availability, prices and school ethos are urgently needed.     

Assessing the Food Safety Attitudes and Awareness of Managers of School Feeding Programmes in Mpumalanga,South Africa

The managers of school feeding programmes are responsible for ensuring the safety of the food which is provided to schoolchildren, but very few studies have been conducted on the food safety knowledge and awareness of these managers. The objective of this study is to evaluate the food safety attitudes and awareness of managers of the National School Nutrition Programme (NSNP) in schools in Mpumalanga, a province of South Africa. A cross-sectional survey study was conducted in which questionnaires were used to collect data from 300 NSNP food service managers. The majority of schools offering NSNP meals were located in informal settlements and most were found to lack basic resources such as electricity (power supplies to the food preparation facility) and potable tap water in their kitchens. No school was found to have implemented the hazard analysis and critical control points (HACCP) programme, and only a few staff had received food safety training. Food safety implementation is worst in informal schools in rural areas due to limited resources and infrastructure. The NSNP food service managers in some schools—especially those located in rural settlements—were found to have little knowledge and awareness of HACCP. These results indicate an urgent need to provide NSNP managers with food safety training and resources (potable water supplies, electricity, dedicated food preparation facilities), particularly in schools in rural settlements.     

Investigation of a staphylococcal food poisoning outbreak in a centralized school lunch program.

The trend in many communities toward centralized school lunch preparation potentially increases the risk of foodborne illness. Foods often are prepared long before serving and may be distributed to satellite schools by persons with little formal training in safe techniques of food preparation or food service. In May 1990, an outbreak of staphylococcal food poisoning occurred in elementary schools in a Rhode Island community participating in such a program. In the investigation of the outbreak, students in schools that reported cases were interviewed. Food preparation, handling, and distribution were reviewed. At School E, 662 lunches were prepared and distributed to 4 additional schools (schools A-D). Schools A and B accounted for nearly all cases of the food poisoning, with rates of 47 percent and 18 percent. Eating ham increased the risk of illness (62 percent of those consuming ham and 3 percent of those who did not, relative risk = 18.0, 95 percent confidence interval = 4.0, 313.4). Large amounts of Staphylococcus aureus were cultured, and preformed enterotoxin A was identified in leftover ham. A food handler, who tested positive for the implicated enterotoxic strain S. aureus, reported having removed the casings from two of nine warm ham rolls 48 hours prior to service. Because of improper refrigeration, prolonged handling, and inadequate reheating, the ham was held at temperatures estimated at 10-49 degrees Celsius (50-120 degrees Fahrenheit) for a minimum of 15 hours. The potential for larger outbreaks prompted a statewide training program in safe food preparation for school lunch personnel, which may have applications for other communities.     

School Nutrition Action Groups and their effect upon secondary school-aged pupils' food choices

Summary  The aim of this intervention was to affect a change in the food choices of adolescents (11–16 years old) at school by giving pupils more control over the food provision in their school through the establishment of the School Nutrition Action Groups. The study compared food selections and pupils' views of the catering service between 12 schools implementing School Nutrition Action Groups and 12 control schools. Schools were selected to reflect educational achievement, ethnic mix and gender. Pupils completed a baseline and a 2-year follow-up questionnaire. In addition, data of the sales of food in the school dining rooms in all schools were collected at baseline and follow-up. There was a significant increase in the sales of main meals and snack meals in the intervention schools suggesting that School Nutrition Action Groups can be an effective and relevant way of changing food choices in schools.     

Impact of the Pick the Tick food information programme on the salt content of food in New Zealand

The Pick the Tick programme of the National Heart Foundation of New Zealand aims to provide a framework for cooperation with the food industry to improve nutrition labelling and to develop a healthy food supply. Food manufacturers, whose products meet defined nutritional criteria, are able to display the Pick the Tick logo on food labels. The tick is used by 59% of shoppers in assisting them make healthy food choices. Food companies are encouraged to reformulate product composition if they fail to meet criteria and develop new products to specifically meet the Pick the Tick criteria. The objective of this study was to evaluate the impact of the programme on food formulation. The main outcome measure was the amount of salt not added to food products. Changes to sodium levels were multiplied by the volume of sales and then converted to salt in tonnes to provide a tangible measure of the impact of the programme. In a 1-year period, July 1998 to June 1999, Pick the Tick influenced food companies to exclude approximately 33 tonnes of salt through the reformulation and formulation of 23 breads, breakfast cereals and margarine. Breakfast cereals showed the largest reduction in sodium content by an average of 378 mg sodium per 100 g product (61%). Bread was reduced by an average of 123 mg per 100 g product (26%) and margarine by 53 mg per 100 g (11%). Pick the Tick appeals to the food industry as a tool for marketing food products and has provided an incentive to improve the nutritional value of foods. The tick on approved products not only acts as a 'nutrition signpost' for consumers but can also significantly influence the formulation of products without sacrificing taste or quality.     

Examining the interaction between food outlets and outdoor food advertisements with primary school food environments

Schools are commonly seen as a site of intervention to improve children's nutrition, and prevent excess weight gain. Schools may have limited influence over children's diets; however, with home and community environments also exerting an influence within schools. This study considered the environment of food outlets and outdoor food advertisements surrounding four case study primary schools in New Zealand, and the impact of that external environment on within-school food environments. The shortest travel route between school and home addresses, and the number of food outlets and advertisements passed on that route, was calculated for each student. Interviews with school management were conducted. The schools with a higher percentage of students passing food outlets and advertisements considered that their presence impacted on efforts within schools to improve the food environment. Limiting students’ exposure to food outlets and outdoor food adverts through travel route planning, reducing advertising, or limiting the location of food outlets surrounding schools could be explored as intervention options to support schools in promoting nutrition.     

澳大利亚与新西兰对新食品的管理概述

作者旨在对澳大利亚和新西兰管理新食品(novel food)的方式进行概述。澳大利亚和新西兰对符合其新食品定义的食品或原料实施上市前审批,管理法规为澳大利亚与新西兰食品标准法典(Australia New Zealand Food Standard Code)。管理部门为澳大利亚与新西兰食品标准局(Food Standards Australia New Zealand)。审批的过程根据风险评估的原则,对不同种类的新食品,所要求的技术资料也各有侧重。获得批准的新食品产品及其生产厂商将可获得15个月的专属使用期,然后进入不限生产厂商和品牌的通用批准阶段。     

Food sales outlets, food availability, and the extent of nutrition policy implementation in schools in British Columbia

BACKGROUND: The purpose of this study was to determine the number and types of different food sales outlets, the types of foods offered for sale in all school food outlets, and the extent of nutrition policy implementation in schools in British Columbia. We also directly measured the number and types of snack foods available for sale in each vending machine at each school. METHODS: Based on a thorough literature review and guided by an expert panel of nutritionists, we developed an instrument to measure the quantity and types of foods offered for sale in vending machines, the types of food for sale in all school food outlets, and the extent of nutrition policy development. RESULTS: The survey response rate was approximately 70%. Approximately 60% of surveyed schools had a permanent food sales outlet. Snack and beverage vending machines were most common in secondary schools, while tuck shops and food-based fundraisers were more common in elementary schools. While few snack vending machines were present in elementary schools, tuck shops stocked items commonly found in snack machines. Approximately 25% of schools had a formal group responsible for nutrition. These schools were more likely to have nutrition policies in place. CONCLUSION: "Junk" foods were widely available in elementary, middle, and secondary schools through a variety of outlets. Although snack machines are virtually absent in elementary schools, tuck shops and school fundraisers sell foods usually found in snack machines, largely cancelling the positive effect of the absence of snack machines in these schools. Schools with a group responsible for nutrition appear to have a positive impact on nutrition policy implementation.     

Guidelines for managing life-threatening food allergies in Massachusetts schools

During the past decade, prevalence of food allergies among children increased. Caring for children with life-threatening food allergies has become a major challenge for school personnel. Prior to 2002, Massachusetts did not provide clear guidelines to assist schools in providing a safe environment for these children and preparing for an emergency response to unintended allergic reactions. In 2001, the Asthma and Allergy Foundation of America/New England Chapter, Massachusetts Department of Education, Massachusetts Department of Public Health, Massachusetts School Nurse Organization, parents, and other professional organizations forged a successful collaboration to develop guidelines for managing life- threatening food allergies in schools. The guidelines assist schools by providing information on food allergies and anaphylaxis, emphasizing the need for team planning and development of an individualized health care plan, giving guidance on strategies to prevent accidental exposure to specific allergens in school settings, and offering information on emergency responses should unintended exposures occur. The collaborative process for developing the guidelines, which continued during the distribution and implementation phases, set a tone for successful multidisciplinary teamwork in local schools.     

Maintenance of effects of the eat smart school food service program: results from the CATCH-ON study.

The Child and Adolescent Trial for Cardiovascular Health (CATCH) Eat Smart Program targeted the food service of the 56 CATCH intervention elementary schools to effect positive changes in the total fat and saturated fat content of school lunch. Maintenance of the food service intervention in former intervention (n = 56) and control (n = 20) schools was evaluated 5 years postintervention. After 5 years of follow-up and no further intervention, the former CATCH intervention schools not only maintained prior levels but also had further decreases in the mean percentage of calories from total and saturated fat to 31% and 10.4%, respectively. Significant decreases in these nutrients were also observed in the former CATCH control schools; however, the former intervention schools more closely approached the Eat Smart goal for total fat Overall, sodium levels rose in both school conditions and did not differ significantly at follow-up.     

Innovation and effectiveness: changing the scope of school nurses in New Zealand secondary schools

OBJECTIVE: To describe the changing role of school nurses in eight New Zealand (NZ) secondary schools from low socio-economic areas with high Pacific Island and Māori rolls. METHODS: An evaluation of a pilot addressing under-achievement in low-decile schools in Auckland, NZ (2002-05). Annual semi-structured school nurse interviews and analysis of routinely collected school health service data were undertaken. RESULTS: Two patterns of school nurse operation were identified: an embracing pattern, where nurses embraced the concept of providing school-based health services; and a Band-Aid pattern, where only the basics for student health care were provided by school nurses. CONCLUSIONS AND IMPLICATIONS: School nurses with an embracing pattern of practice provided more effective school-based health services. School health services are better served by nurses with structured postgraduate education that fosters the development of a nurse-practitioner role. Co-ordination of school nurses either at a regional or national level is required.     

Is the food environment surrounding schools associated with the diet quality of adolescents in Otago,New Zealand?

Using a sample of adolescents from schools in Otago, New Zealand, associations between food outlets around schools and dietary quality were investigated. Food outlet environment data were derived using GIS data. Multivariate regression analysis results showed that outlet density, in an 800 m buffer around schools, of cafes and restaurants, supermarkets and takeaways was associated with higher Diet Quality Index scores in boys, and distance to nearest outlet for convenience stores, cafes and restaurants and supermarkets with lower scores for girls. Effect sizes were small, suggesting that the food environment around schools plays a minor role in adolescent diet quality.     

The Influence of Physical and Social Contexts of Eating on Lunch-Time Food Intake Among Southern Ontario,Canada, Middle School Students

BACKGROUND: Among students, little is known about the physical and social context of eating lunch. The objective of this study was to determine if food intake (including the type of food and beverages and portion sizes) was associated with specific aspects of the physical and social lunch environment (location, with whom lunch was consumed, who prepared the food, and where the food was originally purchased). METHODS: A total of 1236 participants (males = 659, females = 566) in grades 6 (n = 359), 7 (n = 409), and 8 (n = 463) from southern Ontario, Canada, completed the Food Behavior Questionnaire during the 2005–2006 academic year. RESULTS: A total of 8159 foods and 2200 beverages were consumed during the lunch meal, which contributed to 552 kcal (SD = 429) or 30% (SD = 16) of total daily energy intake (kcal/day). Higher amounts of energy, meats and alternatives, other foods, fried foods, and pizza were consumed when participants ate in between places or at a restaurant/fast food outlet (compared with at home or school, p < 0.05) and/or when prepared by friends or others (compared with themselves or family members, p < 0.05). A large number of participants (46%) reported consuming sugar-sweetened beverages during lunch, despite a school board–level policy restricting the sales of “junk food,” which appears to be brought from home. CONCLUSIONS: Our findings support schools in policy efforts that restrict fast food access (by leaving school grounds, preventing fast food companies from coming onto school grounds, or restricting sugar-sweetened beverage sales in vending machines) and that eating in between places should be discouraged.     

Kiwis, food and cholesterol: New Zealand consumers' food concerns and awareness of nutritional guidelines.

New Zealand food shoppers' nutrition and food concerns and attitudes to cholesterol screening were assessed during four consecutive surveys. Over 1000 shoppers were interviewed during each survey, as part of the evaluation of the Heart Food Festival in 1988-89. Over two thirds of the respondents reported that they usually read the ingredients label on food products. Over a third were concerned about the presence of additives in foods (36 per cent), along with fat (27 per cent), salt (18 per cent), sugar (14 per cent) and fibre (5 per cent). Over half indicated that reductions in fat intake would make their diets healthier. One in five reported they were aware of the New Zealand nutrition guidelines. Only one third of respondents could correctly identify the bottom row of the healthy food pyramid. Almost one in eight respondents knew their cholesterol levels and a further two thirds wished to know them. Few differences were observed between the responses of early and late school leavers. In contrast, pronounced differences were associated with gender and the respondents' age groups. The results suggest that awareness of links between nutrition and heart disease is widespread. Educational and empowerment strategies are required to translate such awareness into dietary change.     

Sharing Singapore's experience in dietetic practice and school nutrition programmes

Dietetic practice in Singapore is mainly applied at the clinical settings, such as hospitals. The main scope of practice is in providing medical nutrition therapy to patients in a multidisciplinary team approach at both inpatient and outpatient clinics. This is delivered in the form of nutrition counseling and nutrition support. Dietitians are also involved in other areas such as conducting nutrition workshops and talks and provide consultation to the hospital's food service department. They set dietary guidelines for inpatient meal services and equip the food service personnel with the knowledge to plan and prepare healthier menus and therapeutic diets. In the schools, all the students are taught the basic principles of nutrition in the school curriculum. Healthy eating messages are reinforced through various interesting activities in schools. Nutrition guidelines on creating healthy and nutritious menus in the school tuckshops are available for schools to implement the Model School Tuckshop Programme. This programme is aimed at cultivating healthy eating habits among school children. For overweight students, they are referred to the students health centre for medical screening, assessment and for regular nutrition counseling at the Nutrition Clinic.     

Prevalence of food insecurity and utilization of food assistance program: an exploratory survey of a Vermont middle school

BACKGROUND: Access to sufficient food—in terms of both quality and quantity—is especially critical for children. Undernourishment during childhood and adolescence can have health implications, both short and long term. The prevalence of food insecurity was assessed in a sample of Vermont school children, as well as the relationship between food insecurity, participation in school breakfast or lunch, exercise and body mass index (BMI), all with a goal to identify needs to improve effectiveness of current programs. METHODS: A cross‐sectional, 23‐item self‐administered survey of students attending a public middle school in Vermont. RESULTS: Twenty percent of the children were residing in a food insecure household. No statistically significant differences were observed in terms of age, sex or BMI percentile and food security status. Food insecure (with or without hunger) participants were less likely to eat breakfast at home compared to food secure participants (67.1% vs 81.4%, p = .007). However, such differences were not observed between eating school breakfast or lunch. Sixty‐two percent of food insecure (with or without hunger) participants engaged in daily exercise compared to 75.9% food secure participants (p = .014). CONCLUSION: Children in food insecure households were less likely to be physically active and to eat breakfast at home. However, the school breakfast program is negating any difference between the 2 groups in terms of eating breakfast at all. We consider this a success given the short‐ and long‐term implications of food insecurity in children. We believe these findings have important implications for schools, policy makers, and programs to reduce food insecurity.     

Pricing effects on food choices

Individual dietary choices are primarily influenced by such considerations as taste, cost, convenience and nutritional value of foods. The current obesity epidemic has been linked to excessive consumption of added sugars and fat, as well as to sedentary lifestyles. Fat and sugar provide dietary energy at very low cost. Food pricing and marketing practices are therefore an essential component of the eating environment. Recent studies have applied economic theories to changing dietary behavior. Price reduction strategies promote the choice of targeted foods by lowering their cost relative to alternative food choices. Two community-based intervention studies used price reductions to promote the increased purchase of targeted foods. The first study examined lower prices and point-of-purchase promotion on sales of lower fat vending machine snacks in 12 work sites and 12 secondary schools. Price reductions of 10%, 25% and 50% on lower fat snacks resulted in an increase in sales of 9%, 39% and 93%, respectively, compared with usual price conditions. The second study examined the impact of a 50% price reduction on fresh fruit and baby carrots in two secondary school cafeterias. Compared with usual price conditions, price reductions resulted in a four-fold increase in fresh fruit sales and a two-fold increase in baby carrot sales. Both studies demonstrate that price reductions are an effective strategy to increase the purchase of more healthful foods in community-based settings such as work sites and schools. Results were generalizable across various food types and populations. Reducing prices on healthful foods is a public health strategy that should be implemented through policy initiatives and industry collaborations.     

Kiwis,food and cholesterol: New Zealand consumers' food concerns and awareness of nutritional guidelines

Abstract: New Zealand food shoppers' nutrition and food concerns and attitudes to cholesterol screening were assessed during four consecutive surveys. Over 1000 shoppers were interviewed during each survey, as part of the evaluation of the Heart Food Festival in 1988-89. Over two thirds of the respondents reported that they usually read the ingredients label on food products. Over a third were concerned about the presence of additives in foods (36 per cent), along with fat (27 per cent), salt (18 per cent), sugar (14 per cent) and fibre (5 per cent). Over half indicated that reductions in fat intake would make their diets healthier. One in five reported they were aware of the New Zealand nutrition guidelines. Only one third of respondents could correctly identify the bottom row of the healthy food pyramid. Almost one in eight respondents knew their cholesterol levels and a further two thirds wished to know them. Few differences were observed between the responses of early and late school leavers. In contrast, pronounced differences were associated with gender and the respondents' age groups. The results suggest that awareness of links between nutrition and heart disease is widespread. Educational and empowerment strategies are required to translate such awareness into dietary change.     

Crunching the numbers: The affordability of nutritious food for New Zealand children

Aim: Good nutrition is vital to a growing child's health and development. It is unclear if New Zealand families are able to afford to provide meals that meet national nutritional guidelines for their children. The aim of the present study was to calculate the cost of meal plans, which include New Zealand European and Tongan food preferences and meet New Zealand national nutrition guidelines for children in three age groups (3–5, 5–10 and 13–14 years) in different regions of Auckland. Methods: Meal plan exemplars from New Zealand national Food and Nutrition Guidelines were used to define both the European plan and the Tongan plan for each age group. Meal ingredient prices were measured in shops in January 2008 within seven randomly chosen, ‘most deprived’ (decile 10) areas and seven ‘least deprived areas’ (decile 1) in the Auckland region. Results: The average annual cost of food for one child was, in New Zealand Dollars, $1472 (3–5 year old) to $4411 per year (13–14 year old) from supermarket pricings only. The Tongan adolescent ($3188) and 3–5 year olds' plans ($1665) were cheaper than their European equivalents ($4282, $1759, respectively). No difference was demonstrated between most and least deprived areas (P= 0.91). Large volume options were usually cheaper than small volume options. Conclusion: Providing diets for children that are nutritionally appropriate requires on average 33% of the child-related component of New Zealand Government provisions for low socioeconomic families in 2007. New Zealand should consider further strategies to make children's meals more affordable for low-income families.