Student Perception of Healthfulness,School Lunch Healthfulness,and Participation in School Lunch: The Healthy Communities Study

ObjectiveTo increase understanding about the healthfulness of school lunch and participation, this study measured 3 school lunch variables, students’ perception of healthfulness, objective healthfulness, and participation, and examined associations between each pair of variables (3 associations).MethodsMultilevel models were used for a secondary analysis of data from the Healthy Communities Study, a 2013–2015 observational study of schools (n = 423) and children (n = 5,106) from 130 US communities.ResultsStudents who reported that school lunches were sometimes, often, or very often healthy ate school lunches more frequently per week (β = .71; P < .001) than did students who responded never or rarely. No associations were found with objective school lunch healthfulness.Conclusions and ImplicationsStudent perception of healthfulness of school lunch is positively associated with participation but not with objective school lunch healthfulness. Understanding how student perception is associated with participation can inform effective communications to students to increase participation in the school lunch program.     

The effectiveness of mandatory-random student drug testing: a cluster randomized trial

PurposeThis article presents findings from the largest experimental evaluation to date of school-based mandatory-random student drug testing (MRSDT). The study tested the effectiveness of MRSDT in reducing substance use among high school students.MethodsCluster randomized trial included 36 high schools and more than 4,700 9th through 12th grade students. After baseline data collection in spring 2007, about half the schools were randomly assigned to a treatment group that was permitted to implement MRSDT immediately, and the remaining half were assigned to a control group that delayed MRSDT until after follow-up data collection was completed 1 year later, in spring 2008. Data from self-administered student questionnaires were used to compare rates of substance use in treatment and control schools at follow-up.ResultsStudents subject to MRSDT by their districts reported less substances use in past 30 days compared with students in schools without MRSDT. The program had no detectable spillover effects on the substance use of students not subject to testing. We found no evidence of unintentional negative effects on students' future intentions to use substances, the proportion of students who participated in activities subject to drug testing, or on students' attitudes toward school and perceived consequences of substance use.ConclusionsMRSDT shows promise in reducing illicit substance use among high school students. The impacts of this study were measured for a 1-year period and may not represent longer term effects.     

Campus Food Pantry Use Is Linked to Better Health Among Public University Students

ObjectiveTo examine retrospectively whether access to a campus food pantry (CFP) is related to improvements in sleep, mental health, and physical health among college students in a public university system.DesignRetrospective, cross-sectional study of student CFP users who completed an online survey in the summer of 2019.SettingTen-campus University of California system.ParticipantsA total of 1,855 students completed the survey.Main variables measuredStudents reported the number of CFP visits in a usual week or month. Students retrospectively rated their perceived health, depressive symptoms, and sleep sufficiency before and after having food pantry access. The difference between pre- and post-food pantry access responses was calculated.AnalysisPath analysis was used to examine direct and indirect paths of the relationship between CFP visits with self-reported changes in depressive symptoms and perceived health through positive changes in self-reported sleep sufficiency, controlling for sociodemographic factors.ResultsMore monthly CFP visits were directly related to decreased depressive symptoms and improved perceived health (β_depressive = 0.10, P < 0.001; β_health = 0.12, P < 0.001). In addition, more CFP visits were related to improved sleep sufficiency (β = 0.09, P = 0.001), which in turn was related to a decrease in depressive symptoms (β = 0.24, P = 0.001; indirect effect: 0.02, P < 0.01) and improved perceived health (β = 0.23, P < 0.001; indirect effect: 0.02, P < 0.01).Conclusions and ImplicationsFindings suggest that college campus emergency food access is associated with self-reported improvements in student health outcomes associated with food security. Until more long-term solutions that improve college student nutrition are developed, food pantries may be filling a gap.     

Temporal Associations of Popularity and Alcohol Use Among Middle School Students

PurposeThe goal of this study is to better understand the longitudinal cross-lagged associations between popularity, assessed through self-rating and peer nominations, and alcohol use among middle school students.MethodsThe analytical sample comprises 1,835 sixth- to eighth-grade students who were initially recruited from three California middle schools and surveyed in the fall and spring semesters of 2 academic years. Students reported on their background characteristics, past-month alcohol use, and perceived popularity. Additionally, students provided school-based friendship nominations, which were used to calculate peer-nominated popularity. A cross-lagged regression approach within a structural equation modeling framework was used to examine the longitudinal relationship between popularity (self-rated and peer-nominated) and alcohol use.ResultsThere was a statistically significant (p = .024) association between peer-nominated popularity and the probability of alcohol consumption at the subsequent survey, but not vice versa. Our results suggest that in a scenario where 8% of students are past-month drinkers, each increase of five friendship nominations is associated with a 30% greater risk of being a current drinker at the next wave. We found no evidence of longitudinal associations between past-month alcohol consumption and self-rated popularity.ConclusionsPopularity is a risk factor for drinking during the middle school years, with peer-nominated popularity being more predictive of use than self-perceptions of popularity. To inform alcohol prevention efforts for middle school students, additional research is needed to better understand why adolescents with a larger number of school-based friendship ties are more inclined to drink.     

Comparison of eating habits and inappropriate weight control efforts of secondary school students enrolled in a weight control program

BACKGROUND/OBJECTIVESNumerous school-based weight control programs have been initiated for weight loss among adolescents. However, the relationship between these programs and inappropriate weight control efforts, dietary habits and behavior of students, have not been investigated sufficiently. This study was undertaken to investigate the association between body mass index (BMI) of adolescents, and their health status and inappropriate weight-control efforts. We further examined the relationship between attendance to school-based weight-control programs and attempting inappropriate weight-control efforts, dietary habits, and behavior.SUBJECTS/METHODSA survey of 1,742 students was conducted in Korea. Logistic regression was used to assess differences in the health status (grouped by BMI and improper weight control) and dietary habits, based on attendance to the weight-control programs.RESULTSObese students were significantly more dissatisfied with physical, mental and spiritual health. Students who attended weight-control programs were likely to be underweight (P < 0.001), whereas those who did not attend weight-control programs were likely to attempt weight control improperly (P < 0.001). Students who participated in the program also had relatively healthy dietary habits (P < 0.001–0.027), and students who did not attend had comparatively unhealthy dietary habits (P < 0.001–0.008). Students who attended weight-control programs were likely to be underweight (P < 0.001) with relatively healthy dietary habits (P < 0.001–0.027), whereas students who did not attend the programs were likely to attempt weight control improperly (P < 0.001) and had comparatively unhealthy dietary habits (P < 0.001–0.008).CONCLUSIONSAttending school-based weight-control programs was significantly associated with not attempting inappropriate weight-control efforts, as well as following healthy dietary habits. Our data indicates that offering school-based weight-control programs is valuable to student health, and is anticipated to reducing the public health burden.     

Serving Breakfast Free to All Students and Type of Breakfast Serving Model Are Associated with Participation in the School Breakfast Program

BackgroundMany students experience challenges participating in the School Breakfast Program (SBP) when breakfast is served before school in the cafeteria. Serving breakfast free to all students or offering innovative breakfast serving models, such as breakfast in the classroom (BIC), grab n’ go, or second chance breakfast, may encourage higher SBP participation rates.ObjectiveTo examine the association between offering breakfast free to all students as well as breakfast serving model with student participation in the SBP in October 2017 among public schools in North Carolina.DesignCross-sectional study using data from the North Carolina Department of Public Instruction.Participants/settingThis study included data from 2,285 North Carolina public schools who served breakfast in October 2017 with 1,445,287 students.Main outcome measuresThe main outcome measures are the odds of a student participating in the SBP among students overall, students eligible for free or reduced-price (FRP) meals, and students not eligible for FRP meals.Statistical analyses performedMultiple logistic regression assessed the association between offering breakfast free to all students and breakfast serving model with the probability of participating in the SBP (number of students participating out of number of students enrolled) for students overall, eligible for FRP meals, and not eligible for FRP meals. Statistical models were stratified by school type (elementary, middle, and high schools).ResultsBreakfast serving models positively associated with SBP participation were BIC and BIC plus grab n’ go for elementary and high school students and grab n’ go and second chance for middle and high school students (P<0.05). Serving breakfast free to all students was positively associated with SBP participation alone and in combination with BIC, second chance, and BIC plus grab n’ go (P<0.05).ConclusionsServing breakfast free to all students and breakfast serving model were associated with SBP participation, and different relationships existed for different school levels.     

Impact of the Updated USDA School Meal Standards,Chef-Enhanced Meals,and the Removal of Flavored Milk on School Meal Selection and Consumption

BackgroundIn Fall 2012, updated US Department of Agriculture school meal standards went into effect and did not result in increased food waste overall. However, consumption of school foods, especially fruits and vegetables, remains low. Therefore, strategies to improve school meal consumption are necessary.ObjectiveThis study evaluated the combined impact of the updated school meal standards and chef-enhanced, healthier meals, and the removal of flavored milk on students’ school food selection and consumption compared with students in control schools.DesignThe Project MEALS (Modifying Eating and Lifestyles at School) study was a cafeteria-based quasi-experimental intervention conducted during the 2012 to 2013 school year.Participants/settingParticipants were students (n=1,309) in grades 3 through 8 attending four intervention and four control schools in two low-income, urban school districts.InterventionChef-enhanced school meals and the removal of flavored milk combined with the updated US Department of Agriculture school meal standards.Main outcome measuresChanges in school meal selection and consumption were examined using plate waste methodology.Statistical analyses performedLogistic regression and mixed-model analysis of variance adjusting for student demographics and schools/students as a random effect (students nested within schools) were used to examine differences in selection and consumption before (Fall 2012) and after (Spring 2013) a chef-based intervention with the updated school meal standards.ResultsAfter the chef-based intervention was implemented, there were no significant differences in entrée, vegetable, or fruit selection. Significantly fewer students selected milk compared with students in control schools (56.8% vs 94.0%; P<0.0001) and milk consumption was significantly lower (54.8% vs 63.7%; P=0.004). However, consumption was significantly greater for vegetables (62.2% vs 38.2%; P=0.005) and fruits (75.2 vs 59.2%; P=0.04) in the intervention schools compared with control schools. There were no significant differences in entrée consumption.ConclusionsSchools collaborating with chefs can be an effective method to improve the consumption of fruits and vegetables with the updated US Department of Agriculture school meal standards. Further research should examine the longer-term impact of the removal of flavored milk from schools to determine whether the lower selection and consumption rates persist.     

Universal Access to Free School Meals through the Community Eligibility Provision Is Associated with Better Attendance for Low-Income Elementary School Students in Wisconsin

BackgroundBeginning in 2014-2015, schools nationwide have had the option of offering free meals to all students in qualifying schools through the Community Eligibility Provision (CEP). The CEP has been linked to greater likelihood of eating school meals, but little is known about its impact on broader outcomes.ObjectiveThe purpose of this study was to estimate the association between the CEP and school attendance among elementary school students (grades 1 to 5).DesignThis was a quasi-experimental study in which students’ attendance records were observed over 1 baseline and 2 follow-up years in a sample of CEP and eligible non-CEP schools.Participants/settingThe participants were elementary school students in Wisconsin during three consecutive school years beginning 2013-2014. The main sample included 92,126 observation-years for students in 37 CEP and 108 eligible non-CEP elementary schools.InterventionCEP-participating schools offered breakfast and lunch free to all students through the School Breakfast Program and the National School Lunch Program beginning in 2014-2015.Main outcome measuresThe outcome measures were the attendance rate (defined as the percentage of school days attended) and low attendance (defined as attending fewer than 95% of available days) during the first and second implementation years.Statistical analyses performedDifference-in-difference regression models with student fixed effects were estimated, with separate impacts for the first and second CEP years. Models adjusted for time-varying school and student characteristics.ResultsImplementing the CEP had no association with attendance in the initial year. The second year of CEP was associated with a 3.5 percentage point reduction in the percentage of students with low attendance (P=0.045). An association between CEP and attendance was only found for economically disadvantaged students.ConclusionsOffering meals free to all students through the CEP may modestly reduce the risk of low attendance among economically disadvantaged students in participating schools.     

Getting comfortable with disability: The short- and long-term effects of a clinical encounter

BackgroundPhysicians report discomfort when interacting with patients with disabilities, which can negatively impact the quality of healthcare they provide.Objective/HypothesisAn intervention structured around a formative clinical encounter was assessed for its effectiveness in changing comfort towards treating patients with disabilities. It was predicted that this encounter would have a positive short- and long-term impact on medical students.MethodDuring the 2017–2018 academic year, 169 third-year medical students conducted a patient encounter with a person who had a disability. Students met individually with the “patient” and completed a brief social and medical history as if they were meeting a new patient to establish care. A measure of perceived comfort caring for patients with disabilities was administered to students before and after the encounter. One year after the patient encounter, 59 students were surveyed about their satisfaction and the impact of the patient encounter.ResultsThe impact of encountering people with disabilities in a clinical setting was positive, with statistically significant improvements across all items on the measure of perceived comfort. Students were highly satisfied with the experience and anticipated feeling more confident, more comfortable, less awkward, and more skilled and efficacious when encountering a person with a disability in their future practice. A thematic analysis of the one year follow-up data suggest that students valued the encounter and desired more content on disability throughout their education.ConclusionsMedical education should include dedicated exposure to persons with disabilities and a simulated patient experience allowing for a safe environment to gain skills and confidence.     

Implementation of a School-based Internet Obesity Prevention Program for Adolescents

ObjectiveTo evaluate the reach, adoption, and implementation of HEALTH[e]TEEN, a school-based Internet obesity prevention program, and examine differences in student participation and satisfaction by school, gender, age, and race/ethnicity.DesignConcurrent mixed method evaluation.SettingThree public high schools in Connecticut.ParticipantsThree hundred eighty-four adolescents, 8 teachers.Intervention(s)HEALTH[e]TEEN vs HEALTH[e]TEEN plus coping skills training.Main Outcome Measure(s)Demographic and state-available data, measurements of student satisfaction and participation, interviews with school administrators and teachers.AnalysisMixed and logistic models, content analysis.ResultsThe sample (n = 384) was diverse (35% white), with a mean age of 15.3 years and mean body mass index of 24.7 kg/m². Student participation (83% of lessons completed) and satisfaction (mean 3.6 out of 5) was high. Schools implementing the program in class had higher satisfaction and participation compared with schools that implemented the program as homework (P ≤ .001 and < .001, respectively). Girls had higher satisfaction and participation compared with boys (P = .02 and .03, respectively). Younger students had higher participation compared with older students, but no difference in satisfaction was noted (P = .03).Conclusions and ImplicationsTwo school-based Internet programs to decrease obesity reached diverse adolescents, and were adopted and implemented with high student satisfaction and participation. Implementation of the intervention was influenced by setting (classroom vs homework), teacher characteristics, student age, and gender.     

Violencia de género en estudiantes de enfermería durante sus relaciones de noviazgo

AimTo determine the prevalence of gender violence (GV) suffered by student nurses and to identify its relationship with some sociodemographic and personal variables (social support and self-esteem) and their perception about their role as primary care providers.DesignCross-sectional study.LocationFaculty of Medicine and Health Sciences (University of Oviedo).ParticipantsNursing students.Main measurementsThe CUVINO questionnaire was used. It measures 42 behavioral indicators and 8 GV factors and allows to identify technical and perceived violence during courtship and other related situations. The level of social self-esteem, support and variables related with the nursing role were also measured.ResultsUsing the standard of “zero tolerance”, 85.8% suffered technical violence, mainly by “detachment” and “coercion” (73.3%), while almost 1 in 5 also suffered “physical” violence (18.3%). A lower percentage (9.0%) reported having been really ill-treated, perception related to the global proportion of students who felt trapped (31.7%, P <.001), felt fear (13.8%, P <.001) and a further delay in breaking the relationship (13.2 months vs. 3.6; P <.05). Suffering technical violence was associated with less social support (P <.05) and less social self-esteem (P <.01). Academic training in GV improves recognition.ConclusionsThe prevalence of GV situations between student nurses is very high and recognition is poor. Academic training could improve the perception of the problem, thus it would be desirable to strengthen its inclusion in the university curriculum, together with specific skills training.     

Preliminary Healthy Eating Outcomes of SNaX,a Pilot Community-Based Intervention for Adolescents

PurposeWe used principles of community-based participatory research to develop and pilot test a 5-week intervention for middle school students, Students for Nutrition and eXercise (SNaX). SNaX aimed to translate school obesity-prevention policies into practice with peer advocacy of healthy eating and school cafeteria changes.MethodsA total 425 seventh graders (63% of all seventh graders) in the intervention school were surveyed at baseline regarding cafeteria attitudes and sugar-sweetened beverage consumption; of the 425 students, 399 (94%) were surveyed again at 1-month post-intervention. School cafeteria records were obtained from two schools: the intervention school and a nonrandomized selected comparison school with similar student socio-demographic characteristics.ResultsA total of 140 students in the intervention school were trained as peer advocates. In the intervention school, cafeteria attitudes among peer advocates significantly improved over time (approximately one-third of a standard deviation), whereas cafeteria attitudes of non-peer advocates remained stable; the improvement among peer advocates was significantly greater than the pre-post-change for non-peer advocates (b = .71, p < .001). Peer advocates significantly reduced their sugar-sweetened beverage intake (sports and fruit drinks), from 33% before intervention to 21% after intervention (p = .03). Cafeteria records indicated that servings of fruit and healthier entrées (salads, sandwiches, and yogurt parfaits) significantly decreased in the comparison school and significantly increased in the intervention school; the magnitude of changes differed significantly between the schools (p < .001).ConclusionsAs compared with the non-peer advocates, peer advocates appeared to benefit more from the intervention. Future research should consider engaging parents, students, and other key community stakeholders to determine acceptable and sustainable cafeteria changes.     

In-school Snacking,Breakfast Consumption,and Sleeping Patterns of Normal and Overweight Iranian High School Girls: A Study in Urban and Rural Areas in Guilan,Iran

ObjectiveTo investigate the relationship of snacking during school hours, sleep time, and breakfast consumption by weight status of Iranian high school girls in urban and rural areas in Guilan Province, Iran.DesignData were collected by self-administered questionnaire and measure of body weight and height.SettingHigh schools in urban and rural areas in Guilan Province, northern Iran.ParticipantsRepresentative sample of 2302 school girls (1106 in Rasht City and 1196 in rural areas) selected by multistage cluster sampling.Main Outcome MeasuresBreakfast skipping, snacking habits at school, sleep habits, body weight, and height.AnalysisDifferences in the frequency of the measured variables between the urban and rural girls and overweight and normal weight girls were tested using the chi-square test, P < .05.ResultsPrevalence of obesity was significantly (P < .05) lower in urban areas (4.1%) than in rural areas (5.2%). Prevalence of overweight was significantly higher in those who usually skipped breakfast (P < .001). Consumption of food items of low nutrient density as snacks during the school day was common in this population, especially in rural areas.Conclusion and ImplicationsThe school environment may contribute to the high prevalence of overweight/obesity observed among Iranian adolescent females. Students should be encouraged to eat breakfast and choose nutritious snacks during the school day.     

E-cigarette use among students and e-cigarette specialty retailer presence near schools

ObjectiveThis study examined the association between presence of e-cigarette specialty retailers near schools and e-cigarette use among middle and high school students in Orange County (OC), CA.MethodsThe OC subsample of the 2013–2014 California Healthy Kids Survey (N=67,701) was combined with geocoded e-cigarette retailers to determine whether a retailer was present within one-quarter mile of each public school in OC. Multilevel logistic regression models evaluated individual-level and school-level e-cigarette use correlates among middle and high school students.ResultsAmong middle school students, the presence of an e-cigarette retailer within one-quarter mile of their school predicted lifetime e-cigarette use (OR=1.70, 95% CI=1.02, 2.83), controlling for confounders but no effect for current use. No significant effect was found for high school students.ConclusionsE-cigarette specialty retailers clustered around schools may be an environmental influence on student e-cigarette experimentation.     

Impact of school nurse case management on students with asthma

This project determined asthma prevalence in a large school district, absentee rates, and potential effects of school nurse case management for student asthma over three years. Data were derived from an asthma tracking tool used by nurses in one school district for every student reported as having asthma by their parent. School nurses began collecting data in their schools in 1999-2000 when an asthma-management protocol was first developed. Nurses documented perceived asthma severity for each student, presence of medication and peak flow meters in school, and case management activities provided. This data base was cross matched with percentage of days students were absent for any illness. Prevalence of asthma, based on school nurse records of parent report, was between 5.1% to 6.2% during the three years. Between 13.5% and 15% were moderate or severe. Students with asthma were absent between one-half to one and one-quarter days more often than those without asthma. In year three, 39% of students with asthma had medication at school, and 12% had a peak flow meter. Contacting a parent was the nurse case management activity provided for the largest number of students (27% of students with asthma), followed by asthma education (16.5%), contact with physician (6%), and home visits (1%). Students who received at least one school nurse case management intervention were more likely the next year to have an asthma medication at school, to use a peak flow meter at school, and to have a change in asthma severity. School nurse case management activity had no association with student absences. Availability of medication and peak flow meters at school was low, suggesting standards of care for asthma were not followed. School nurse case management, when performed outside a project or intervention, offers a promising strategy to improve asthma management.     

Healthy Schoolhouse 2.0 Health Promotion Intervention to Reduce Childhood Obesity in Washington,DC: A Feasibility Study

Childhood obesity prevalence trends involve complex societal and environmental factors as well as individual behaviors. The Healthy Schoolhouse 2.0 program seeks to improve nutrition literacy among elementary school students through an equity-focused intervention that supports the health of students, teachers, and the community. This five-year quasi-experimental study follows a baseline–post-test design. Research activities examine the feasibility and effectiveness of a professional development series in the first program year to improve teachers’ self-efficacy and students’ nutrition literacy. Four elementary schools in Washington, DC (two intervention, two comparison) enrolled in the program (N = 1302 students). Demographic and baseline assessments were similar between schools. Teacher participation in professional development sessions was positively correlated with implementing nutrition lessons (r = 0.6, p < 0.001, n = 55). Post-test student nutrition knowledge scores (W = 39985, p < 0.010, n = 659) and knowledge score changes (W = 17064, p < 0.010, n = 448) were higher among students in the intervention schools. Students who received three nutrition lessons had higher post knowledge scores than students who received fewer lessons (H(2) =22.75, p < 0.001, n = 659). Engaging teachers to implement nutrition curricula may support sustainable obesity prevention efforts in the elementary school environment.     

Breakfast in the Classroom Initiative Does Not Improve Attendance or Standardized Test Scores among Urban Students: A Cluster Randomized Trial

BackgroundThe Breakfast in the Classroom (BIC) initiative, a common approach to implementing the federal School Breakfast Program, is advocated as a method to improve students’ academic performance. However, the influences of BIC on academic outcomes are unclear.ObjectiveTo examine the effect of a BIC initiative which provided free, universal BIC on attendance and standardized test performance over 2.5 years, vs free universal breakfast served in the cafeteria before school, among students in an urban school district serving a low-income population.DesignSecondary analysis of data from a cluster randomized controlled trial conducted between 2013 and 2016; 16 kindergarten through eighth-grade public schools in Philadelphia, PA, were enrolled and randomized to condition. Baseline data for 1,362 fourth- through sixth-grade students were provided by the school district. Midpoint data were collected after 1.5 years and endpoint data after 2.5 years.Participants/settingSchools were eligible in the case that ≥50% of students qualified for free or reduced-priced meals, did not offer BIC, and received programming as part of the US Department of Agriculture Supplemental Nutrition Assistance Program. Parents consented for their children to participate.InterventionIntervention schools provided BIC and breakfast-related nutrition-promotion activities. Control schools provided breakfast in the cafeteria before the school day.Main outcome measuresStudent attendance and standardized exam scores.Statistical analyses performedWeighted generalized estimating equations were used to evaluate differences in outcomes between conditions at midpoint and endpoint.ResultsThe BIC initiative did not influence attendance (β ± standard error = .004 ± .06; P = 0.94) or standardized reading exam scores (β ± standard error = .02 ± .06; P = 0.79) after 2.5 years. Students in BIC initiative schools had lower standardized math exam scores than those in control schools, although this difference was small (β ± standard error = –.20 ± .07; P = 0.005).ConclusionsBIC did not improve academic outcomes among students attending low-income, urban schools.     

Availability of Lower-Sodium School Lunches and the Association with Selection and Consumption among Elementary and Middle School Students

BackgroundDuring 2010, the US Department of Agriculture updated the school meals standards, including three progressively decreasing sodium targets. The Target 1 standards went into effect in 2014, but during 2018, the US Department of Agriculture delayed the Target 2 standards until 2024 and eliminated the Target 3 standards citing concerns regarding the availability and acceptability of lower-sodium foods. In addition, there are currently no sugar standards, and it is unknown whether sugar is substituted for salt in lower-sodium school foods.ObjectiveTo examine the availability, selection, and consumption of school lunches already in alignment with the Target 2 and 3 sodium levels and the association between sodium and sugar.DesignAn observational cafeteria-based study conducted during fall 2018.Participants and settingStudents (n = 1985) in grades three through eight attending 13 elementary/kindergarten through eighth-grade schools in a large, urban school district in New England.Main outcome measuresAvailability, selection, and consumption were examined using plate waste methodology.Statistical analyses performedMixed-model analysis of variance accounting for student demographic characteristics with schools/students as a random effect (students nested within schools) were used to examine differences in availability, selection, and consumption. Linear regression was used to examine the association between sodium and sugar in the school foods.ResultsThe majority of meals selected (87%) and consumed (98%) were already in alignment with the Target 2 standards. There were significant inverse associations between sodium levels and consumption; each 100-mg increase in sodium was associated with a decrease in consumption by 2% for entrées (P = 0.002) and 5% for vegetables (P = 0.01). When examining the association between sodium and sugar, each 10-mg reduction in sodium was associated with 1-g increase in sugar among entrées (P < 0.0001), whereas there was a significant positive association between sodium and sugar with vegetables and condiments.ConclusionsThis study provides some evidence that schools may already have the ability to provide lower-sodium meals that are acceptable to students, and therefore the recent rollbacks to the sodium standards may be unwarranted. Study findings suggest that the US Department of Agriculture should take under consideration policies that would limit added sugar for school meals as sugar may be substituted for salt.     

Fourth-Grade Cooking and Physical Activity Intervention Reveals Associations With Cooking Experience and Sex

ObjectiveExamine the impact of Fuel for Fun: Cooking with Kids Plus Parents and Play (FFF) on children's culinary self-efficacy, attitude, fruit and vegetable (FV) preferences, physical activity (PA), and body mass index.DesignRandomized controlled trial.SettingEight elementary schools in 2 Northern Colorado districts.ParticipantsFourth-grade students; 7-month interventions: school (S.FFF)—theory-based cooking + tasting lessons, active recess, lesson-driven cafeteria promotions; or school + family (S+F.FFF) with added family nights and home activities.Main Outcome Measure(s)Cooking self-efficacy and attitudes, FV preferences, PA, and measured height/weight.AnalysisIndividual outcomes nested by classroom, school, and district and assessed > 12 months with repeated measures controlled by sex and baseline cooking experience, with a significance level of P < 0.05.ResultsThe sample included 1,428 youth, 38 teachers, 4 cohorts, 50% boys, 75% White, and 15% Hispanic. No intervention effect was observed. Those who cooked retained higher self-efficacy, attitude, and FV preferences (P < 0.001). Girls reported higher self-efficacy and attitude than boys. Moderate-to-vigorous PA and metabolic equivalent minutes increased for all students; boys retained higher levels (P < 0.001). Body mass index percentile remained stable.Conclusions and ImplicationsCooking and sex were associated with all outcome measures and should be considered for intervention tailoring. Treatment impacts were not evident nesting by classroom, school, and district. Accurate assessment of school-based interventions requires rejecting student independence from group assignment assumptions.