Food Environment in Secondary Schools: À La Carte, Vending Machines, and Food Policies and Practices

Objectives. This study described the food environment in 20 Minnesota secondary schools.

Methods. Data were collected on school food policies and the availability and nutritional content of foods in school à la carte (ALC) areas and vending machines (VMs).

Results. Approximately 36% and 35% of foods in ALC areas and in VMs, respectively, met the lower-fat criterion (≤ 5.5 fat grams/serving). The chips/crackers category constituted the largest share of ALC foods (11.5%). The median number of VMs per school was 12 (4 soft drink, 2 snack, 5 other). Few school food policies were reported.

Conclusions. The availability of healthful foods and beverages in schools as well as school food policies that foster healthful food choices among students needs greater attention.

     

Food store types, availability, and cost of foods in a rural environment

OBJECTIVE: To characterize the built nutritional environment in terms of types and number of food stores, availability, and cost of selected food items in a rural area. DESIGN: A cross-sectional survey of food stores conducted in 2004. SUBJECTS/SETTING: We selected a rural county (population 91,582; 1,106 square miles). Food stores identified from a database were mapped and presence, location, and store type verified by ground-truthing. Stores were surveyed for availability and cost of selected foods. MAIN OUTCOME MEASURES: Price and availability of a limited number of staple foods representing the main food groups. STATISTICAL ANALYSES PERFORMED: Availability comparisons used least square means models and price comparisons used t tests. RESULTS: Of 77 stores identified, 16% were supermarkets, 10% grocery stores, and 74% convenience stores. There were seven stores per 100 square miles and eight stores per 10,000 residents. Availability of more healthful foods was substantially higher at supermarkets and grocery stores. For instance, low-fat/nonfat milk, apples, high-fiber bread, eggs, and smoked turkey were available in 75% to 100% of supermarkets and groceries and at 4% to 29% of convenience stores. Foods that were available at both supermarkets and convenience stores tended to be substantially more expensive at convenience stores. The healthful version of a food was typically more expensive than the less healthful version. CONCLUSIONS: In this rural environment, stores offering more healthful and lower-cost food selections were outnumbered by convenience stores offering lower availability of more healthful foods. Our findings underscore the challenges of shopping for healthful and inexpensive foods in rural areas.     

Nutrition services and foods and beverages available at school: results from the School Health Policies and Programs Study 2006

BACKGROUND: Schools are in a unique position to promote healthy dietary behaviors and help ensure appropriate nutrient intake. This article describes the characteristics of both school nutrition services and the foods and beverages sold outside of the school meals program in the United States, including state- and district-level policies and school practices. METHODS: The Centers for Disease Control and Prevention conducts the School Health Policies and Programs Study every 6 years. In 2006, computer-assisted telephone interviews or self-administered mail questionnaires were completed by state education agency personnel in all 50 states plus the District of Columbia and among a nationally representative sample of school districts (n=445). Computer-assisted personal interviews were conducted with personnel in a nationally representative sample of elementary, middle, and high schools (n=944). RESULTS: Few states required schools to restrict the availability of deep-fried foods, to prohibit the sale of foods that have low nutrient density in certain venues, or to make healthful beverages available when beverages were offered. While many schools sold healthful foods and beverages outside of the school nutrition services program, many also sold items high in fat, sodium, and added sugars. CONCLUSIONS: Nutrition services program practices in many schools continue to need improvement. Districts and schools should implement more food preparation practices that reduce the total fat, saturated fat, sodium, and added sugar content of school meals. In addition, opportunities to eat and drink at school should be used to encourage greater daily consumption of fruits, vegetables, whole grains, and nonfat or low-fat dairy products.     

Peer Reviewed: Association Between Food Opportunities During the School Day and Selected Dietary Behaviors of Alternative High School Students,Minneapolis/Saint Paul,Minnesota, 2006

Introduction

Availability of competitive foods in schools has been linked to unhealthful dietary behaviors of students. Little is known about the food environment of alternative high schools, schools that enroll students at risk of academic failure. We examined correlations between food opportunities during the school day and selected dietary behaviors of students attending alternative high schools.

Methods

Baseline data were collected in fall 2006 as part of the Team COOL (Controlling Overweight and Obesity for Life) pilot study, a group randomized obesity prevention trial. Students (n = 145) attending 6 alternative high schools in Minneapolis/Saint Paul, Minnesota, completed a survey on food opportunities during the school day and selected dietary behaviors. We used mixed-model multivariate cross-sectional analysis and adjusted for demographic characteristics to examine associations of interest.

Results

Food opportunities during the school day were positively associated with overall consumption of sugar-sweetened beverages, high-fat foods, and fast-food restaurant use.

Conclusions

Having many food opportunities during the school day at alternative high schools was linked to the consumption of foods and beverages high in sugar and fat and low in nutrients. School-based interventions should focus on changing the food environment in alternative high schools to decrease less healthful eating opportunities and to increase the availability of healthful foods and beverages.     

Poverty-related factors associated with obesity prevention policies in Utah secondary schools

To address the childhood obesity epidemic, numerous national agencies have outlined specific school policy recommendations for nutrition and physical activity. The extent to which current policies differ by socioeconomic status and geographic location is yet to be determined. This cross-sectional study examined select school nutrition and physical activity policies by markers for poverty among 209 middle and high schools in Utah (82% response rate). The results show that students' opportunities to establish healthful dietary and physical activity patterns differed by economic circumstances and geographic location. Schools with the highest percentage of free and reduced-price lunch enrollment and schools in rural areas were both less likely to offer a variety of healthful foods outside of the school meal program (ie, competitive foods and drinks) and intramural activities or physical activity clubs. Schools with highest free and reduced-price lunch enrollment were more likely to allow the purchase of unhealthful snacks during lunchtimes than schools with low enrollment (28.4% vs 7.6%, P=0.01). Schools in rural communities were less likely to promote walking and bicycling to school compared with other locations (47.4% rural vs 67.1% urban and 63.6% suburban, P=0.06). Current school policies related to nutrition and physical activity may not be conducive to reducing the childhood overweight problem among children attending schools in areas with increased risk factors due to poverty or rural location in Utah.     

Elementary School Participation in the United States Department of Agriculture's Team Nutrition Program Is Associated With More Healthful School Lunches

ObjectiveTo assess school-level characteristics associated with Team Nutrition (TN) program participation, and compare the availability of food items in school lunches in participating vs nonparticipating schools.MethodsCross-sectional study with a nationally representative sample of 2,489 elementary schools in the United States. A mail-back survey was used to collect school administrator–reported annual data on availability of selected healthful and unhealthful lunch items between 2006-2007 and 2009-2010. Multivariate regression analyses was used to predict the availability of food items in school lunches based on TN participation.ResultsTeam Nutrition participation was higher among schools in the south, in rural areas, and in states with stronger nutrition policies. Program participation was higher in schools with mostly low-income students and where a dietitian was on staff. Participating schools were more likely to offer healthful items and less likely to serve unhealthful items during lunch.Conclusions and ImplicationsThe TN program has the potential to help schools offer healthier school meals.     

Influencing healthful food choices in school and home environments: results from the TEENS study

BACKGROUND: The purpose of this research is to examine the effects of an intervention designed to increase the availability of fruits, vegetables and lower fat foods in homes and schools. This research is part of the TEENS study, a school-based intervention study. METHODS: Sixteen schools in Minnesota were recruited to be in the study, and approximately 3600 middle school students in the eight intervention schools were exposed to a multi-component intervention. The TEENS intervention included classroom-based curricula, family newsletters, and changes in the school food environment including increasing more healthful options on a la carte and on the school lunch line. In addition to student-level outcomes, changes in availability of fruits, vegetables, and lower fat snacks in home and school environments were evaluated. The TEENS study was conducted from 1997 to 2000. RESULTS: Parents of students in intervention schools reported making healthier choices when grocery shopping as compared to parents of students in control schools (P = 0.01). No intervention effects were evident from a home food inventory. Compared to control schools, intervention schools offered (P = 0.04) and sold (P = 0.07) a higher proportion of healthier foods on a la carte, but no effects were seen for fruit and vegetables sales as part of the regular meal pattern lunch. CONCLUSION: Our results show mixed results for positively influencing adolescents' school and home environments.     

School and district wellness councils and availability of low-nutrient, energy-dense vending fare in Minnesota middle and high schools

The Child Nutrition and WIC Reauthorization Act of 2004 required school districts participating in the federal school meals program to establish by the start of the 2006-2007 school year policies that included nutrition guidelines for all foods sold on school campus during the school day and policy development involving key stakeholders. For many schools, policy development was done by wellness councils. This study examined the association between having a wellness council and availability of low-nutrient, energy-dense foods/beverages in school vending machines following enactment of the federal legislation. In 2006-2007, Minnesota middle (n=35) and high (n=54) school principals reported whether their school and district had a wellness council. Trained research staff observed foods/beverages in vending machines accessible to students. Low-nutrient, energy-dense foods/beverages (snacks >3 g fat or >200 calories/serving, and soda, fruit/sport drinks and reduced-fat/whole milk) were grouped into seven categories (eg, high-fat baked goods) and a food score was calculated. Higher scores indicated more low-nutrient, energy-dense vending fare. Multivariate linear regression, adjusted for school characteristics, was used to examine associations between scores and a three-category council variable (district-only; district and school; no council). Among schools, 53% had district-only councils, 38% district and school councils, and 9% had no council. Schools with both a district and school council had a significantly lower mean food score than schools without councils (P=0.03). The potential of wellness councils to impact availability of low-nutrient, energy-dense vending fare is promising. There may be an added benefit to having both a school and district council.     

Factors influencing food choices of adolescents: findings from focus-group discussions with adolescents.

OBJECTIVE: To assess adolescents' perceptions about factors influencing their food choices and eating behaviors. DESIGN: Data were collected in focus-group discussions. SUBJECTS/SETTING: The study population included 141 adolescents in 7th and 10th grade from 2 urban schools in St Paul, Minn, who participated in 21 focus groups. ANALYSIS: Data were analyzed using qualitative research methodology, specifically, the constant comparative method. RESULTS: Factors perceived as influencing food choices included hunger and food cravings, appeal of food, time considerations of adolescents and parents, convenience of food, food availability, parental influence on eating behaviors (including the culture or religion of the family), benefits of foods (including health), situation-specific factors, mood, body image, habit, cost, media, and vegetarian beliefs. Major barriers to eating more fruits, vegetables, and dairy products and eating fewer high-fat foods included a lack of sense of urgency about personal health in relation to other concerns, and taste preferences for other foods. Suggestions for helping adolescents eat a more healthful diet include making healthful food taste and look better, limiting the availability of unhealthful options, making healthful food more available and convenient, teaching children good eating habits at an early age, and changing social norms to make it "cool" to eat healthfully. APPLICATIONS/CONCLUSIONS: The findings suggest that if programs to improve adolescent nutrition are to be effective, they need to address a broad range of factors, in particular environmental factors (e.g., the increased availability and promotion of appealing, convenient foods within homes schools, and restaurants).     

Schools and Obesity Prevention: Creating School Environments and Policies to Promote Healthy Eating and Physical Activity

Context: Research consistently shows that the majority of American children do not consume diets that meet the recommendations of the Dietary Guidelines for Americans, nor do they achieve adequate levels of daily physical activity. As a result, more children are overweight today than at any other time in U.S. history. Schools offer many opportunities to develop strategies to prevent obesity by creating environments in which children eat healthfully and engage regularly in physical activity. Methods: This article discusses the role of schools in obesity prevention efforts. Current issues in schools' food and physical activity environments are examined, as well as federal, state, and local policies related to food and physical activity standards in schools. The article is organized around four key areas: (1) school food environments and policies, (2) school physical activity environments and policies, (3) school body mass index measurements, and (4) school wellness policies. Recommendations for accelerating change also are addressed. Findings: The article found that (1) competitive foods (foods sold outside of federally reimbursed school meals) are widely available in schools, especially secondary schools. Studies have related the availability of snacks and drinks sold in schools to students' high intake of total calories, soft drinks, total fat and saturated fat, and lower intake of fruits and vegetables; (2) physical activity can be added to the school curriculum without academic consequences and also can offer physical, emotional, and social benefits. Policy leadership has come predominantly from the districts, then the states, and, to a much lesser extent, the federal government; (3) few studies have examined the effectiveness or impact of school‐based BMI measurement programs; and (4) early comparative analyses of local school wellness policies suggest that the strongest policies are found in larger school districts and districts with a greater number of students eligible for a free or reduced‐price lunch. Conclusions: Studies show that schools have been making some progress in improving the school food and physical activity environments but that much more work is needed. Stronger policies are needed to provide healthier meals to students at schools; limit their access to low‐nutrient, energy‐dense foods during the school day; and increase the frequency, intensity, and duration of physical activity at school.     

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.     

Rural Disparities in the Distribution of Policies that Support Healthy Eating in US Secondary Schools

The distribution of food and nutrition policies and practices from 28 US states representing 6,732 secondary schools was evaluated using data from the 2008 School Health Profiles principal survey. School policies and practices evaluated were: availability of low-nutrient, energy-dense (LNED) snacks/drinks; use of healthy eating strategies; banning food marketing; availability of fruits and vegetables; and food package sizes. For each school, school-level demographic characteristics (percentage of students enrolled in free/reduced-price meals, minority enrollment, and geographic location) were also evaluated. Schools in small town/rural locations had significantly fewer policies that support healthy eating strategies and ban food marketing, and were less likely to serve fruits and vegetables at school celebrations, have fruits and vegetables available in vending or school stores, and limit serving-size packages. Schools serving the highest percentage of minority students consistently reported the same or better school food environments. However, schools serving the highest percentage of low-income students had varied results: vending and LNED vending policies were consistently better and fruit and vegetable availability–related policies were consistently worse. Disparities in the distribution of policies and practices that promote healthy school food environments seem most pronounced in small town/rural schools. The data also support the need for continued reinforcement and the potential for expansion of these efforts in urban and suburban areas and schools with highest minority enrollment.     

Outcome expectations, barriers, and strategies for healthful eating: a perspective from adolescents from low-income families

To better understand outcome expectations, barriers, and strategies for healthful eating, 5 structured focus groups were conducted with adolescents from low-income families (n = 48; 83% Black students; 10-14 years old). The focus group questions dealt with healthful eating in different settings: home, school, and other eating establishments. Results suggested that healthful eating is important to this population, but perceived barriers prevent the consistent consumption of healthful foods. Strategies suggested by participants to increase healthful eating (eg, parents and schools making healthy foods that look and taste good more available) should be considered when developing nutrition interventions for adolescents from low-income families.     

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.     

State but not District Nutrition Policies Are Associated with Less Junk Food in Vending Machines and School Stores in US Public Schools

Background

Policy that targets the school food environment has been advanced as one way to increase the availability of healthy food at schools and healthy food choice by students. Although both state- and district-level policy initiatives have focused on school nutrition standards, it remains to be seen whether these policies translate into healthy food practices at the school level, where student behavior will be impacted.

Objective

To examine whether state- and district-level nutrition policies addressing junk food in school vending machines and school stores were associated with less junk food in school vending machines and school stores. Junk food was defined as foods and beverages with low nutrient density that provide calories primarily through fats and added sugars.

Design

A cross-sectional study design was used to assess self-report data collected by computer-assisted telephone interviews or self-administered mail questionnaires from state-, district-, and school-level respondents participating in the School Health Policies and Programs Study 2006. The School Health Policies and Programs Study, administered every 6 years since 1994 by the Centers for Disease Control and Prevention, is considered the largest, most comprehensive assessment of school health policies and programs in the United States.

Subjects/setting

A nationally representative sample (n=563) of public elementary, middle, and high schools was studied.

Statistical analysis

Logistic regression adjusted for school characteristics, sampling weights, and clustering was used to analyze data. Policies were assessed for strength (required, recommended, neither required nor recommended prohibiting junk food) and whether strength was similar for school vending machines and school stores.

Results

School vending machines and school stores were more prevalent in high schools (93%) than middle (84%) and elementary (30%) schools. For state policies, elementary schools that required prohibiting junk food in school vending machines and school stores offered less junk food than elementary schools that neither required nor recommended prohibiting junk food (13% vs 37%; P=0.006). Middle schools that required prohibiting junk food in vending machines and school stores offered less junk food than middle schools that recommended prohibiting junk food (71% vs 87%; P=0.07). Similar associations were not evident for district-level polices or high schools.

Conclusions

Policy may be an effective tool to decrease junk food in schools, particularly in elementary and middle schools.