Impact of Workplace on the Risk of Severe COVID-19

Indiscriminate regional lockdowns aim to prevent the coronavirus disease 2019 (COVID-19) infection by restricting the movement of people; however, this comes with psychological, social, and economic costs. Measures are needed that complement lockdowns and reduce adverse effects. Epidemiological studies, to date, have identified high-risk populations, but not workplaces appropriate for closure. This study was conducted to provide evidence-based measures that used exact and reliable follow-up data of the PCR-positive COVID-19 cases to complement lockdowns. The data are not subjected to selection or follow-up biases, since the Japanese government, by law, must register and follow all the PCR-positive cases until either recovery or death. Direct customer exposure may affect the quantity of viral inoculum received, which, in turn, may affect the risk of the severity of disease at infection. Therefore, the professions of the cases were grouped according to their frequency of direct customer exposure (FDCE) based on subjective observations, which resulted in five workplaces; hospital, school, food service, outdoor service, and indoor office being identified. Analyzing the follow-up data, we obtained precise estimates for the risk of severe disease, defined as intensive care unit (ICU) hospitalization or death, for the workplaces adjusted for age, sex, family status, and comorbidity. Major findings are as follows: hospital and school are the lowest risk, food and outdoor services are, despite higher FDCE, safer than indoor office. Unemployed and unclear are the highest risk, despite low FDCE. These results suggest the following workplace-specific measures complementing the lockdown: school should not be closed and indiscriminate closing of food and outdoor service industries should be avoided, since it would be more effective to reinforce their efforts to promote adherence to public health guidelines among students and customers. These actions would also reduce the adverse effects of the lockdown. This study is the first to address the causality between the workplaces and severe disease. We introduce FDCE and adherence to public health guidelines (APHGs) to associate the workplace characteristics with the risk of COVID-19 severity, which provided the basis for the measures complementing lockdowns.

Opportunities for Partnership in Local Food Procurement: Mississippi Delta Schools

Objectives Procuring food for school meals is costly in a region like the fertile MS Delta. Hence, efforts to procure foods locally may yield substantial benefits in terms of economic return to the area and positive impacts on children's diets. The objective of this study was to determine food procurement amounts in two Mississippi Delta school districts, one participating in the Fresh Fruit and Vegetable Program (FFVP) and illustrate potential economic impacts of purchasing local. Methods Procurement data from two Mississippi Delta school districts, academic years 2018–2019 and 2019–2020, were compiled and grouped into 8 food categories. The food categories were fruits, vegetables, grains, protein, dairy, added sugars, fats, and miscellaneous. Amounts of procured foods were converted to weight in pounds and cost in dollars. Results For the FFVP district, dairy accounted for the largest cost (34%) followed by protein (23%), grains (19%), fruits (13%), and vegetables (10%) in 2018–2019. In 2019–2020, grains accounted for the largest cost (26%) followed by fruit (20%), protein (19%), and vegetables (12%). For the non-FFVP district, protein accounted for the largest cost (25%) followed by grains (24%), dairy (18%), fruits (14%), and vegetables (14%) in 2018–2019. In 2019–2020, grains accounted for the largest cost (26%) followed by protein (24%), dairy (19%), fruits (16%), and vegetables (11%). Conclusions Although school districts purchase substantial amounts of dairy, grains, protein, fruits and vegetables, very little if any is procured locally. Encouraging school food service administrators to connect with and purchase foods from local farmers may provide an economic boost to the agricultural community and will facilitate serving fresh, nutrient rich foods, such as fruits and vegetables, to school children. Funding Sources This research was funded by the USDA Agricultural Research Service.

School food offer at lunchtime: Assessing the validity and reliability of a web-based questionnaire

Objectives To develop and validate a web-based self-diagnostic questionnaire on school food service offer aimed at food service managers (FSMs) by: i) identifying relevant indicators of school food offer, developing a questionnaire and validating the concept using an expert panel, ii) validating the questions by comparing the food service manager’s responses with observations by dietitians, and iii) undergoing a qualitative evaluation of the tool through direct observation and short interviews. Design Mixed methods. Setting Quebec, Canada. Participants Nine experts validated the theoretical constructs and indicators on which the questionnaire was based. Inter-rater reliability tests were conducted with 39 food service managers, who then participated in interviews about platform functionality satisfaction. Twenty school stakeholders participated in the survey pertaining to their use of the personalised report. Results The questionnaire focused on the main school food service’s lunchtime offer and comprised 26 questions. The overall strength of agreement was good, and all questions’ strengths of agreement were fair to excellent except for one question. Qualitative data reached saturation and showed that navigation through the questionnaire was fluid. Improvements were suggested to increase user-friendliness and simplicity of both the platform and questionnaire. Results from the survey showed that all respondents were either satisfied or very satisfied with their personalised report. Conclusions We successfully developed and validated a web-based self-diagnostic questionnaire. The final version facilitates knowledge mobilisation with school stakeholders and offers a new opportunity for the assessment and surveillance of school food offer.

Dedication, innovation, and collaboration: A mixed-methods analysis of school meals in Connecticut during COVID-19

When school buildings across the U.S. closed in March 2020 due to the COVID-19 pandemic, many school districts mobilized to establish emer­gency school meal programs to operate outside the setting of school cafeterias. The aim of this conver­gent mixed-methods study is to (a) examine the structure and rates of participation in the spring 2020 meal programs in Connecticut, and (b) obtain insight about the challenges, strategies used, and lessons learned during this time by food service leaders. We obtained quantitative data from the Connecticut State Department of Education and district websites, and qualitative data from nine one-hour interviews with school food service lead­ers. Although the National School Lunch Program provides meals at standard price, reduced-price, or no cost based on student household income, all emergency meals during spring 2020 were provided at no cost following the school closures resulting from the COVID-19 public health emergency dec­lara­tion. The average number of meals distrib­uted from March to May 2020 was significantly lower than the overall participation rates (i.e., paid, free, and reduced-price meals combined) prior to COVID-19. However, participation rates in April and May 2020 approached those of free and reduced-price meal participation a year earlier. Four key action themes emerged from the interviews: (1) tailor the program to community needs and resources; (2) identify strategies to facilitate partici­pation; (3) develop partnerships to coordinate school, municipal, and community efforts; and (4) establish programs that encourage resiliency. The interviewees also saw this event as an oppor­tunity to improve the perception of school meals. Inno­vations developed during the spring 2020 school building closures provide a road map for best prac­tices for the 2020–2021 school year and beyond.

Middle School Students’ Perceptions of the Lunchroom: Implications for Future Interventions

The National School Lunch Program provides nutritious and inexpensive lunches, but low participation and food waste are challenges in many schools. Interventions aim to improve participation in the program, but little is known about how students’ perceptions affect their participation. This study explored how middle school students in a rural state perceive school food service staff, food served, and lunchroom atmosphere. An online survey was administered to middle school students at six schools participating in a larger lunchroom intervention. Mean perception scores were calculated for all measures. Multilevel logistic regression was used to examine the relationship between perceptions and consumption. Overall perceptions of staff, food, and atmosphere were positive, and students classified as school lunch eaters had more positive perceptions in all three areas than noneaters. Interventions to increase participation in school lunch programs and promote consumption of healthy food items should address multiple factors that contribute to school lunch participation.

Contracting school meals in a rural Florida district

Purpose The purpose of this paper is to examine the decision to contract school meal services and the associated nutritional and financial impacts on school districts. Given the increase in the use of competitive contracting of public school meal services and the critical role that school meal services play in public health, this is an important subject to investigate. Design/methodology/approach A case study was performed using one US school district with privatized food service. Face-to-face interviews were conducted with school food service decision makers. Other data collection included the analysis of public documents such as the school district’s budgets and financial statement reports (the cost per lunch and breakfast meals, the cost for labor, contract, transport, supplies and food expenses) and school food service policies (contract policies). Supplementary data pertaining to district social-demographic profiles and full-time equivalent enrollment figures were also collected from state departments. Findings Analysis of interviews revealed that positive financial motivations and impacts were dominant factors related to contracting food services in the district. A significant finding was the relatively short turnaround in the district’s negative financial situation as a result of contracting out the food services. These findings provide valuable insight and support for rural school districts in similar negative financial situations seeking to contract out food services. Originality/value Many studies have examined contracting out of technical services, such as transport and waste management, and social services, such as correctional services and health; however, there is a lack of studies documenting the effects of contracting out of school meal services.

Influencing Students' Food and Beverage Preferences and Choices by Implementing Evidence-Based Strategies Rooted in Economics, Marketing, and Psychology (P16-035-19)

Objectives To create environments that are conducive to healthy eating in twelve (12) unique, rural elementary schools in Louisiana by implementing evidence-based strategies rooted in economics, marketing, and psychology. Methods Professional Development to: •Coordinate and provide training for School Food Service (SFS) staff from 12 unique schools on the national Smarter Lunchrooms Movement (Smarter Lunchrooms)•Train SFS staff in implementing strategies to influence the food and beverage preferences and choices of students in the cafeteria•Provide follow-up through direct technical assistance•Technical Assistance to:•Deliver direct technical assistance to 12 unique schools to implement Smarter Lunchrooms strategies in the school cafeteria•Conduct a pre-assessment of each cafeteria using the Smarter Lunchrooms Scorecard (Scorecard), working with SFS staff•Work collaboratively with SFS staff to create an action plan to implement Smarter Lunchrooms strategies, based on the findings of the pre-assessment•Provide resources to implement strategies•Conduct a post-assessment of the cafeteria using the Scorecard to see change in number of strategies implemented Results • Out of a best possible score of 60, the average score on the pre-assessments from the 12 targeted schools is 29. • The results of the pre-assessments show that most schools score high in areas of lunchroom atmosphere and vegetable variety, and that most score low in areas of reimbursable meal and fruit promotion. • School cafeterias are implementing the evidence-based strategies and are observing changes in school meal participation numbers and food waste in the cafeteria. • According to 2018–2019 enrollment data from the Louisiana Department of Education, these changes are reaching a total of 4921 students. Conclusions Evidence suggests that students’ food and beverage choices and preferences can be influenced by making no-cost or low-cost changes to the cafeteria. This presents an invaluable opportunity to reinforce healthy habits at a young age in students worldwide. Funding Sources This work is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) through the Delta State Rural Development Network Grant Program (DELTA) to HEALTH ENRICHMENT NETWORK - D60RH25758.

The perception of school food-service professionals on the implementation of the Healthy, Hunger-Free Kids Act of 2010: a mixed-methods study

ObjectiveTo: (i) understand the nutrition attitudes, self-efficacy, knowledge and practices of school food-service personnel (SFP) in Nebraska and (ii) identify potential barriers that schools face in offering healthy school meals that meet the US Department of Agriculture (USDA) nutrition standards.DesignConvergent parallel mixed-methods study.SettingKindergarten–12th grade schools in Nebraska, USA.ParticipantsSFP (260 survey participants; fifteen focus group participants) working at schools that participate in the USDA National School Lunch Program.ResultsMixed-methods themes identified include: (i) ‘Mixed attitudes towards healthy meals’, which captured a variety of conflicting positive and negative attitudes depending on the situation; (ii) ‘Positive practices to promote healthy meals’, which captured offering, serving and promotion practices; (iii) ‘Mixed nutrition-related knowledge’, which captured the variations in knowledge depending on the nutrition concept; and (iv) ‘Complex barriers’, which captured challenges with time, support and communication.ConclusionsThe study produced relevant findings to address the barriers identified by SFP. Implementing multicomponent interventions and providing training to SFP may help reduce some of the identified barriers of SFP.

Dimensioning of the physical area and required number of food handlers for school food services

ABSTRACT Objective We aimed to establish equations for dimensioning of the physical area and determining the required number of food handlers in food services of schools and to compare them with reference equations. Methods It was visited 44 municipalities located in the states of São Paulo (n=36) and Rio de Janeiro (n=8) between 2013 and 2014. The physical area for school food services was evaluated using a measuring tape. For all food services, we calculated the Maximum Attendance Capacity, which is the sum of small and large meals served during the busiest shift. A validated checklist was used to evaluate food safety practices. Linear regression models were developed to establish the proposed equations. Results In total, we evaluated 205 school units. Based on the data, the following equations were established: Equation A: area of production=15.22+(maximum attendance capacity×0.02), which estimates the minimum area needed for a school food service; and Equation B: the number of food handlers=2.17+(maximum attendance capacity×0.002), to determine the minimum number of food handlers needed. These equations were established based on school food services that presented adequate food safety practices (i.e., low health risk). Conclusion It was established new equations for calculating the size of the physical area for school food services and the required number of food handlers. These new equations can be used as a starting point in management planning of a school food service.