High School Student and Caregiver Preferred Communication Method Regarding School Meals: A Qualitative Approach.

BACKGROUND: This study examined student and caregiver preference for school communication and explored the feasibility and acceptability of a digital tool to assist with communication about school meal program between schools and families. METHODS: The study used qualitative methodology through youth focus groups and caregiver semi-structured phone interviews. The study was conducted in 4 high schools in a large, urban city. The phenomenon of interest included the exploration of preferences regarding communication around school meal programs and feasibility and acceptability of a digital tool for communication and promoting the ordering of healthful foods in the school environment. Interviews were transcribed, coded, and analyzed through NVivo qualitative software using thematic analysis approach to examine themes. RESULTS: Forty-seven students (ages 14-21, grades 9-12) participated in 7 focus groups and 24 caregivers participated in semi-structured phone interviews. Three themes emerged around (1) communication preferences, (2) accessibility, and (3) extrinsic motivational factors for engagement in healthy eating behaviors. CONCLUSION: Results indicated that communication methods could potentially influence motivation and engagement in youth school meal participation.

Health, wellbeing and nutritional impacts after 2 years of free school meals in New Zealand.

In 2020, a government-funded healthy school lunch program was introduced in a quarter of New Zealand schools, selected due to high levels of socio-economic barriers. This study assesses the impact of the introduction of the school lunch program from family (whanau), student and school principal perspectives. Across four schools, we conducted five focus groups (two with secondary students and three with family members) and four school principal interviews. Participating schools represented a range of contexts: primary and secondary, schools with cooks in on-site kitchens and schools receiving meals delivered by external caterers. Thematic analysis was used to develop themes describing the health, wellbeing and nutritional impact of the program. Family participants were 82% Indigenous Maori and self-identified as having 'borderline' (73.5%) or no financial security (8.8%). Seven positive impact themes were identified: improved food security, enhanced equity, increased appreciation of healthy foods for students, enhanced mana (wellbeing) for all, reduced financial hardship/stress for families, opportunities for nutritional learning and recognition that appreciation and uptake happen over time. Four negative impact themes were identified: low uptake that created food waste, perception that healthy food is not palatable for students, lack of knowledge of the program and loss of agency for students. This is the largest intervention in nutrition and food security for children implemented in New Zealand since the 1930's. The first 2 years have offered wellbeing and financial benefits for students and families, particularly when school environments promote uptake. More involvement of students and family members in the program planning is essential.

Factors contributing to school food program acceptance: a Review of Canadian literature.

Diet quality and food security are a concern in school-aged children in Canada. In 2019, the Canadian federal government announced the intention to work towards a national school food program. Understanding the factors that impact school food program acceptability can inform planning to ensure that students are willing to participate. A scoping review of school food programs in Canada completed in 2019 identified 17 peer-reviewed and 18 grey literature publications. Of these, five peer-reviewed and nine grey literature publications included a discussion of factors that impact the acceptance of school food programs. These factors were thematically analyzed into categories: stigmatization, communication, food choice and cultural considerations, administration, location and timing, and social considerations. Considering these factors while planning can help to maximize program acceptability.

Diet quality and having sufficient food to eat are concerns in school-aged children in Canada. In 2019, the Canadian federal government announced the intention to work towards a national school food program. Providing food to children in schools can only address diet concerns if children participate. Understanding the factors that impact school food program acceptability can inform planning to contribute to program acceptance. Themes of factors contributing to school food program acceptance discussed in 14 publications were identified. Themes included stigmatization, communication, food choice and cultural considerations, administration, location and timing, and social considerations. Considering these factors while planning can help to maximize school food program acceptability.

Perspective: School Meal Programs Require Higher Vitamin D Fortification Levels in Milk Products and Plant-Based Alternatives-Evidence from the National Health and Nutrition Examination Surveys (NHANES 2001-2018).

Poor vitamin D status impairs bone growth and immune defense in school-aged children and adolescents, particularly in minorities. Vitamin D insufficiency/deficiency increases the risk of acute viral respiratory infection, underscoring the need for adequate vitamin D intakes during school sessions when viral exposure may be greatest. We studied available vitamin D-related survey data and published findings based on NHANES (2001-2018) to assess the dependency of vitamin D status {25-hydroxyvitamin D [25(OH)D]; in nmol/L} on vitamin D intake (µg/d) in elementary school-aged children (4-8 y), middle school children (9-13 y), and high school adolescents (14-18 y). We sought evidence supporting the need for school programs to facilitate vitamin D adequacy. Usual vitamin D intakes from food and beverages by children/adolescents (NHANES 2015-2018) examined at the 50th percentile intake by race/ethnicity (non-Hispanic White, non-Hispanic Black, Hispanic) showed all age groups consumed less than half of the Estimated Average Requirement (EAR) for vitamin D (10 µg/d), independent of race/ethnicity. NHANES (2001-2010) analyses show evidence of lower vitamin D status in school-aged children that is linked to lower intakes of fortified milk varying over race/ethnicity and age. Adolescents had lower vitamin D status and milk intake than younger children. A total of 22-44% of vitamin D intakes occurred away from home, with larger percentages of total intakes at breakfast and lunch, at times consistent with school meals. Ever-present inadequate vitamin D intakes with a large percentage consumed away from home together with well-established benefits to growth, bone, and immune defense from enriched vitamin D-fortified milk in school intervention trials provide strong justification to require enriched vitamin D-fortified foods in school meals. An easy to implement plan for improving vitamin D intakes is possible through the FDA's amendment allowing higher vitamin D fortification levels of dairy and plant-based milk alternatives that could increase vitamin D intakes beyond the EAR with just 2 daily servings.

Awareness of and Participation in School Food Programs in Youth from Six Countries.

BACKGROUND: School-based meal programs can promote healthy dietary intake in youth. However, limited data exist regarding the impact of income-targeted school meal programs across countries, particularly among food-insecure youth. OBJECTIVES: We examined self-reported awareness of and participation in free school meal programs, and associations with dietary intake in youth from 6 countries with differing national school meal policies. METHODS: Data were collected through the 2019 International Food Policy Study Youth Survey, a cross-sectional survey of 10,565 youth aged 10-17 y from Australia, Canada, Chile, Mexico, the United Kingdom, and the United States. Regression models examined: 1) country differences in awareness of and participation in breakfast and lunch programs; and 2) associations between lunch program participation and intake of fruit and vegetables, and "less healthy" foods during the previous school lunch day. RESULTS: Awareness of and participation in free breakfast and lunch programs varied across countries. Approximately half of USA and Chilean students participated in school lunch programs-the countries with the most comprehensive national policies-compared with one-fifth of students in the United Kingdom, and ∼5% in Australia, Canada, and Mexico (P < 0.001 for all contrasts). In the United States and Chile, more than two-thirds of youth with the highest level of food insecurity participated in lunch programs, compared with 45% in the United Kingdom, 27% in Canada, and ≤20% in Australia and Mexico. In all countries, youth reporting school lunch program participation were more likely to report fruit and vegetable intake during their previous school lunch (P < 0.001), and higher intake of "less healthy" food in all countries except the United States and Chile. CONCLUSIONS: More comprehensive national policies were associated with greater participation in school meal programs, particularly among youth at greatest risk of food insecurity, as well as healthier dietary intake from school lunches.

Effects of students' satisfaction with school meal programs on school happiness in South Korea.

BACKGROUND/OBJECTIVES: School meals are not just meals consumed at school, they are part of the culture, education, and life experience at school. Nevertheless, few studies have revealed the influence of school meals on students' school lives. The purpose of this study was to investigate the effect of satisfaction with the school meal program on students' school happiness. SUBJECTS/METHODS: A survey conducted in December 2015 asked 2,336 students (1,062 elementary school students, 880 middle school students, and 394 high school students) about their satisfaction with the school meal program and their school happiness. Multiple regression analyses were used to examine the relation between the students' school meal satisfaction and their happiness level. RESULTS: The average level of satisfaction with school meals of elementary school students was 4.1 out of 5 points, comparatively higher than that of middle and high school students, with a significant difference between school levels (P < 0.001). In addition, school happiness, as well as overall happiness, of elementary school students was higher than that of middle and high school students (P < 0.001). The school meal operation factor (0.232, P < 0.001) had the most influence on students' school happiness, followed by the school meal environment factor (0.219, P < 0.001) and school meal quality factor (0.136, P < 0.001). Overall satisfaction (0.097, P = 0.001) and school meal hygiene factor (0.095, P = 0.001) also had significant influences on students' school happiness. CONCLUSIONS: Students' satisfaction with the school meal program was related to their school happiness. Therefore, plans to enhance students' satisfaction with a school meal program needs to be implemented, with emphasis on placing a priority on school meal operation and school environment factors, in order to improve students' level of happiness.

Effects of students' satisfaction with school meal programs on school happiness in South Korea

BACKGROUND/OBJECTIVES: School meals are not just meals consumed at school, they are part of the culture, education, and life experience at school. Nevertheless, few studies have revealed the influence of school meals on students' school lives. The purpose of this study was to investigate the effect of satisfaction with the school meal program on students' school happiness. SUBJECTS/METHODS: A survey conducted in December 2015 asked 2,336 students (1,062 elementary school students, 880 middle school students, and 394 high school students) about their satisfaction with the school meal program and their school happiness. Multiple regression analyses were used to examine the relation between the students' school meal satisfaction and their happiness level. RESULTS: The average level of satisfaction with school meals of elementary school students was 4.1 out of 5 points, comparatively higher than that of middle and high school students, with a significant difference between school levels (P < 0.001). In addition, school happiness, as well as overall happiness, of elementary school students was higher than that of middle and high school students (P < 0.001). The school meal operation factor (0.232, P < 0.001) had the most influence on students' school happiness, followed by the school meal environment factor (0.219, P < 0.001) and school meal quality factor (0.136, P < 0.001). Overall satisfaction (0.097, P = 0.001) and school meal hygiene factor (0.095, P = 0.001) also had significant influences on students' school happiness. CONCLUSIONS: Students' satisfaction with the school meal program was related to their school happiness. Therefore, plans to enhance students' satisfaction with a school meal program needs to be implemented, with emphasis on placing a priority on school meal operation and school environment factors, in order to improve students' level of happiness.

Evaluation of educational school meal programs in Gyeonggi province, South Korea / 한국영양학회지

PURPOSE: School meal programs should be part of the educational process to promote good eating habits for students. The purpose of this study was to develop an evaluation scale for educational school meal programs and evaluate the achievement level of educational school meal programs using the developed scale. METHODS: The evaluation scale for educational school meal programs consisted of 23 items in eight categories and was developed using content validity ratio (CVR) analysis and analytic hierarchy process (AHP) by 15 related experts. The results of a survey on nutrition teachers or dietitians at 91 elementary, middle, and high schools in Gyeonggi province, South Korea were analyzed to evaluate the achievement levels of educational school meal programs. RESULTS: Overall, total average score was 45.7 out of 100, with significant differences among schools (p = 0.005). Elementary schools (51.9) showed a higher average score than middle (41.5) and high schools (37.1). The score for the category of regular nutrition and dietary education was the lowest (5.7 out of 33.7). In addition, school meal environment (5 out of 10), educational activities through school meal time (9.2 out of 19), and extra-curricular experiential activities (3.5 out of 10) also showed inadequate levels. CONCLUSION: The results show that the overall level of educational school meal programs is not adequate and needs to be improved, especially at middle and high schools. Government support polices need to be implemented to encourage educational activities related to school meal programs.

O nutricionista no programa de alimentação escolar: avaliação de uma experiência de formação a partir de grupos focais / The dietician in the school food program: evaluation of a training experience based on focus groups

OBJETIVO: O estudo objetivou analisar os resultados relativos à avaliação de um Programa de Formação para Nutricionistas que atuam no Programa Nacional de Alimentação Escolar da região Nordeste. Este programa foi desenvolvido pelo Centro Colaborador em Alimentação e Nutrição do Escolar da Universidade Federal da Bahia em parceria com o Fundo Nacional de Desenvolvimento da Educação, nos idos de 2007 e 2008. MÉTODOS: Os dados foram produzidos através da técnica de grupos focais com nutricionistas que participaram do Programa de Formação. Foram realizados quatro grupos focais e os dados produzidos foram organizados em duas categorias de análise: sobre a aprendizagem durante a formação e sobre a capacidade de instituição de mudanças. RESULTADOS: Os participantes eram predominantemente do sexo feminino, com idade variando entre 20 e 35 anos e haviam participado do Programa de Formação pelo menos três meses antes do estudo. Em relação à avaliação do programa de formação, pôde-se afirmar que o mesmo não apenas proporcionou um aprimoramento técnico-científico em torno dos temas pertinentes à prática profissional exigida, mas também à dimensão ético-política do trabalho. Enfatizou-se que estimulou a mobilização na perspectiva do fortalecimento da categoria, incentivou as parcerias entre os diferentes agentes e setores e fomentou o planejamento de novas ações valorizando o uso da legislação. CONCLUSÃO: A perspectiva dialógica foi marcante para os participantes, que puderam confrontar as suas realidades com as dos demais, possibilitando reflexão coletiva sobre a atuação do nutricionista no campo da alimentação escolar.

OBJECTIVE: This study assessed a training program for dieticians, actors of the Brazilian School Food Program, in Northeast Brazil. This program was developed by a partnership between the Schoolchildren's Food and Nutrition Collaborator Center from the Federal University of Bahia and National Education Development Fund, from 2007 and 2008. METHODS: The focus group method was administered to dieticians who participated in the training program. Four focus groups were done and the data were organized into two categories: one about learning during the training program and one about the ability to make changes. RESULTS: Most participants were females aged 20 to 35 years. Their participation in the training program had been at least three months before the study. Assessment of the training program showed that the program improved their technical and scientific knowledge about themes related to professional practice and about the ethical and political dimension of their work. The program encouraged mobilization for possibly strengthening the category, incentivized partnerships among different agents and sectors and promoted the planning of new law-enforcement actions. CONCLUSION: The dialogical perspective was striking for the participants, enabling them to confront their realities and collectively reflect on the dietician's role in the field of school food.