Poor compliance with school food environment guidelines in elementary schools in Northwest Mexico: A cross-sectional study

Background In Mexico, 35.5% of school-age children were overweight or obese in 2018. The school food environment is important because children spend a significant part of their time at school and consume one-third to one-half of their daily meals there. In 2014, a Federal Government guideline for the sale and distribution of food and beverages in Mexican schools was published (the AGREEMENT) but the extent of its implementation is not known. Methods Descriptive cross-sectional study in a representative, random sample of elementary schools, using the tools of the INFORMAS network. Data collection included: a) an interview with a school authority; b) a checklist of items available in the school canteen; c) a checklist of the school breakfast menu; and d) an evaluation of the physical environment. The main indicators were: percentage of implementation (self-report) of the AGREEMENT and percentage of compliance (researcher verified) with the AGREEMENT (based on tools b and c). Results 119 schools participated (response rate 87.5%), with 15.1% (95%CI 9.2–22.8) of the schools reporting having fully implemented the AGREEMENT. However, only 1% (95%CI 0–5.3) of the school canteens and 71.4% (95%CI 57.8–82.7) of the school breakfast menus fully complied with the AGREEMENT. A variety of sugar-sweetened beverages and energy-dense, nutrient poor products were found in the school canteens. Further, only 43.7% of the water fountains in schools were functional and 23.4% were clean. In only 24.4% of schools had the school authorities received formal training related to the AGREEMENT and in 28.6% of schools had the parents received information about the AGREEMENT. Conclusion The AGREEMENT has been poorly implemented in elementary schools in Mexico. Actions are needed to encourage and support its full implementation to improve the food environment in Mexican schools.

Unboxing the bento box: An arts-informed inquiry into Japanese families’ experience at Canadian school lunch time

Bento, a Japanese style boxed lunch, has a distinct cultural meaning for Japanese people as a medium of affective communication between children and parents. However, in Canadian schools governed by the Anglo-Western food norms, their culinary practices may stand out. This study employed an arts-informed participatory design to explore how school-aged children (6-12 years old) of Japanese origin and their parents describe their experience bringing Japanese food to school in Canada. We conducted arts-informed workshops with 16 children who created artworks about their lunchboxes, and focus groups with 19 parents (all mothers). Children’s artworks illuminated a common aesthetics about “good” lunch that closely reflected mothers’ commitment to preparing nutritionally balanced and aesthetically appealing bento boxes. Both children and mothers reported that Canadian school food environment (e.g., short eating periods, snack times, built environment) sometimes misaligns with their food practices. Some families were compelled to modify their bento to accommodate children’s needs to fit in at school. Meantime, participants’ narratives indicate the prevalence of stigma toward “junk” food that may perpetuate food shaming at school. A more inclusive, diverse and culturally appropriate discussion on “healthy eating” at school can embrace children’s and their families’ intercultural food identities.

Characteristics of the School Food Environment Affect the Consumption of Sugar-Sweetened Beverages Among Adolescents

Sugar-sweetened beverages are widely available and accessible in school environment, and their presence and characteristics of this environment can influence their consumption. This study examines the association of drinking fountains per 100 students, soft drink sales, soft drink advertising, and the presence of street vendors and sugar-sweetened beverages consumption among adolescents in Brazil. This cross-sectional study was carried out using data from the Study of Cardiovascular Risk in Adolescents that was conducted between March 2013 and December 2014. The sample comprised 71,475 adolescents aged 12–17 years from 1,247 public and private schools in Brazilian cities. Sugar-sweetened beverages consumption was the dependent variable. The main effect was the school food environment, which was evaluated based on drinking fountains per 100 students, soft drink sales, soft drink advertising, and the presence of street vendors. Public and private schools that sold soft drinks were associated with higher average sugar-sweetened beverages consumption among adolescents. Our study highlights the importance of creating healthy school food environments by banning sugar-sweetened beverages in schools accordingly.

The influence of the urban food environment on diet, nutrition and health outcomes in low-income and middle-income countries: a systematic review

IntroductionDiet and nutrition are leading causes of global morbidity and mortality. Our study aimed to identify and synthesise evidence on the association between food environment characteristics and diet, nutrition and health outcomes in low-income and middle-income countries (LMICs), relevant to urban settings, to support development and implementation of appropriate interventions.MethodsWe conducted a comprehensive search of 9 databases from 1 January 2000 to 16 September 2020 with no language restrictions. We included original peer-reviewed observational studies, intervention studies or natural experiments conducted in at least one urban LMIC setting and reporting a quantitative association between a characteristic of the food environment and a diet, nutrition or health outcome. Study selection was done independently in duplicate. Data extraction and quality appraisal using the National Heart Lung and Blood Institute checklists were completed based on published reports using a prepiloted form on Covidence. Data were synthesised narratively.Results74 studies met eligibility criteria. Consistent evidence reported an association between availability characteristics in the neighbourhood food environment and dietary behaviour (14 studies, 10 rated as good quality), while the balance of evidence suggested an association with health or nutrition outcomes (17 of 24 relevant studies). We also found a balance of evidence that accessibility to food in the neighbourhood environment was associated with diet (10 of 11 studies) although evidence of an association with health outcomes was contradictory. Evidence on other neighbourhood food environment characteristics was sparse and mixed. Availability in the school food environment was also found to be associated with relevant outcomes. Studies investigating our other primary outcomes in observational studies of the school food environment were sparse, but most interventional studies were situated in schools. We found very little evidence on how workplace and home food environments are associated with relevant outcomes. This is a substantial evidence gap.Conclusion‘Zoning’ or ‘healthy food cart’ interventions to alter food availability may be appropriate in urban LMIC.PROSPERO registration numberCRD42020207475.

Creating the Scratch Cooked School Food Framework: Qualitative Data Analysis of a Scratch Cooking Pilot

The purpose of this study is to develop a novel framework that outlines the system required to implement scratch cooking in school kitchens. The data used in this study were 57 interviews with key stakeholders during the Return to Scratch Cooking Pilot that occurred in two New York City school kitchens in 2018–2019 and made significant modifications to many aspects of the existing school food system. The guiding framework for the data analysis was Meadows’s Intervention Level Framework. Intervention Level Framework describes analyzing systems by examining five layers: (1) paradigm shift, (2) goals, (3) system structure (4) feedback and delays, and (5) structural elements. It also provides a framework for describing a system by defining its elements, interconnections, and purpose. Data analysis revealed four elements of the school food system: ingredients and recipes, kitchen, cooking, and the community. The interconnections that played a role in each of these elements were policies, practice, people, and promotion. Together, these four elements and four interconnections comprise the Scratch Cooked School Food framework, which has the purpose of being a tool for researchers and practitioners to utilize when planning, implementing, and evaluating scratch cooking in the school food environment.

‘It’s Hard to Make Good Choices and It Costs More’: Adolescents’ Perception of the External School Food Environment

Research on the impact of school and community food environments on adolescent food choice is heavily reliant on objective rather than subjective measures of food outlets around schools and homes. Gaining the perspective of adolescents and how they perceive and use food environments is needed. The aim of this study was to explore adolescent’s perception and use of the food environment surrounding their schools. Purposive sampling was used to recruit schools. Mapping exercises and discussion groups were facilitated with 95 adolescents from six schools. Thematic analysis showed that adolescents are not loyal to particular shops but are attracted to outlets with price discounts, those with ‘deli’ counters and sweets. Cost, convenience and choice are key factors influencing preference for food outlets and foods. Quality, variety and health were important factors for adolescents but these features, especially affordable healthy food, were hard to find. Social factors such as spending time with friends is also an important feature of food environments that deserves further attention. Adolescents’ perceptions of their food environment provide insights into features that can be manipulated to enable healthy choices.

Beyond Health & Nutrition: Re-framing school food programs through integrated food pedagogies

In this paper, we present findings from a community-based research project on school food environments in 50 elementary and high schools in a mid-sized city in Ontario, Canada. Our findings highlight that schools' privilege five intersecting domains in the school food environment: 1) health and nutrition; 2) food access; 3) education and food literacy; 4) environment and sustainability; and 5) the socio-cultural aspects of food. These results illustrate that the dominant discourses about school food mainly revolve around health, nutrition and food access, yet many of the K-12 principals also identified food literacy and learning about sustainable food systems and the environment, in addition to the relational or socio-cultural aspects of foods as important elements of their school food environments. This integrative approach to food extends our understanding of food beyond charity, and opens up conversations about food as a human right. Ouranalysis shows the need to go beyond a health or nutrition school food program and consider integrative food pedagogies which will promote social and environmental food justice in the school food environment.

Disparities in the Healthfulness of School Food Environments and the Nutritional Quality of School Lunches

The Healthy, Hunger-Free Kids Act (HHFKA), a public law in the United States passed in 2010, sought to improve the healthfulness of the school food environment by requiring updated nutrition standards for school meals and competitive foods. Studies conducted since the passage of the HHFKA indicate improvements in the food environment overall, but few studies have examined whether these improvements varied by the socioeconomic and racial/ethnic composition of students in schools. To better understand the extent of disparities in the school food environment after HHFKA, this paper examined differences in the healthfulness of school food environments and the nutritional quality of school lunches by the school poverty level and racial/ethnic composition of students using data from the School Nutrition and Meal Cost Study. Results from chi-square analyses showed lower proportions of high poverty, majority black, and majority Hispanic schools had access to competitive foods, while higher proportions of these schools had a school wellness policy in addition to a district wellness policy. The overall nutritional quality of school lunches, as measured by total Healthy Eating Index (HEI)-2010 scores, did not vary significantly across school types, although some HEI component scores did. From these findings, we concluded that there were disparities in the school food environment based on the socioeconomic and racial/ethnic composition of students in schools, but no significant disparities in the overall nutritional quality of school lunches were found.