Evaluation of implementation of a healthy food and drink supply strategy throughout the whole school environment in Queensland state schools, Australia

The healthiness of New Zealand school food environments: a national survey

OBJECTIVE

To evaluate the healthiness of New Zealand school food environments.

METHODS

In 2016, primary and secondary schools were invited to complete a cross-sectional questionnaire. School nutrition policies were analysed using an adapted Wellness School Assessment Tool. Canteen menus were analysed using the National Food and Beverage Classification System, and a sample of menus (n=54) were validated using fieldworker observations.

RESULTS

In total, 819 schools (response rate 33%) participated. Forty per cent had a nutrition policy, and those analysed (n=145) lacked comprehensiveness and contained weak statements. Seventy-one per cent sold food and beverages during the school day. The school food service offered mainly unhealthy items. Many schools (81%) used food and beverages for fundraising with 90% of them using 'less healthy' items. Most had vegetable gardens (80%), included nutrition education in the curriculum (90%), were not sponsored by food and beverage companies (94%) and did not have commercial advertising on school grounds (97%).

CONCLUSION

New Zealand school nutrition policies are weak, and canteen and fundraising items are largely unhealthy, which undermine other positive efforts.

IMPLICATIONS FOR PUBLIC HEALTH

This study provides evidence of unhealthy school food environments and supports the need for stronger national-level policy.

Enough time for lunch? The duration and governance of lunch eating times in Australian primary schools: A mixed-methods study

Developing healthy eating behaviours is important to assist children in maintaining good health and decrease the risk of chronic health conditions. Recent nutrition promotion efforts in Australian primary schools have mainly focused on canteen guideline compliance and obesity prevention interventions. The aim of this study was to investigate the primary school food environment, specifically, allocated lunch eating duration and the governance of children's lunch breaks. Parents (n = 402) and teachers (n = 123) were asked via an online survey, about school allocated lunch eating duration and its adequacy. Respondents were asked about the supervision, monitoring and feedback of children's lunches, as well as how they felt about these practices. Parents (n = 308) and teachers (n = 102) also responded to the open-ended question "What could be done to improve the school food environment at your school?". Ten minutes was the allocated lunch eating duration reported by most parents and teachers and 58% of those parents and 30% of those teachers rated this as inadequate. Increasing the allocated lunch eating duration was frequently cited as a way to improve the school food environment. A similar proportion of parents and teachers agreed with teachers monitoring food intake, not providing feedback on food brought to school, and that parents should decide what children eat. More parents (44%) than teachers (23%) believed that teachers should eat their own lunch with the children. These findings provide an insight into the primary school lunch environment and the views of two key stakeholder groups. School food policies should consider these findings in future revisions, particularly with regards to eating times.

Rise and demise: a case study of public health nutrition in Queensland, Australia, over three decades

This case study describes the delivery and achievements of the public health nutrition programme in Queensland, Australia, over more than three decades. Analysis of publicly available documents related to statewide nutrition policy and programmes from 1983 to 2014 identified key inputs and programme impacts and outcomes, including an increase in fruit and vegetable intake by 1.1 serves per person per day and rates of exclusive breastfeeding for the first 6 months quadrupled. Mapping factors and milestones against a framework on determinants of political priority highlighted correlation with effective nutrition promotion policy and practice. Identified enablers included the influence of policy champions and advocates, quality of governance, focus on whole-of-population approaches, and periods of political will and economic prosperity. Key barriers included changes of ideology with government leadership; lack of commitment to long-term implementation and evaluation; and limited recognition of and support for preventive health and nutrition promotion. The case study shows that a coordinated, well-funded, intersectoral approach to improve nutrition and prevent chronic disease and malnutrition in all its forms can be achieved and produce promising impacts at state level, but that sustained effort is required to secure and protect investment. Political support for long-term investment in nutrition is essential to reduce the high cost of all diet-related diseases. Public health leadership to better prepare for risks around political cycles, secure adequate resources for evaluation, and better communicate impacts and outcomes may help protect future investments and achievements.

Implementing Food Environment Policies at Scale: What Helps? What Hinders? A Systematic Review of Barriers and Enablers

Background: Policies that support healthier food environments, including healthy retail food availability and promotion, are an important strategy for obesity prevention. The aim of this systematic review was to examine the evidence for barriers and enablers to successful implementation of healthy food and drink policies, delivered at scale. Methods: MEDLINE, SCOPUS and INFORMIT were searched to May 2019 for peer-reviewed studies. Google and Google Scholar were searched for grey literature. Studies of any design relating to a healthy food and drink policy delivered at scale (≥10 sites) in non-commercial food settings, for specific retail outlets (e.g., vending machines, cafes, cafeterias, school canteens), and that reported on implementation barriers and/or enablers were included. Studies in commercial food retail environments (e.g., supermarkets) were excluded. Studies were appraised for quality and key information was extracted and summarised. Extracted information on barriers and enablers was further grouped into overarching themes relating to perceptions of the policy itself, organisational and contextual factors influencing policy implementation, stakeholder responses to the implemented policy and perceived policy impacts. Results: Of 19 studies, 16 related to policies implemented in schools, two in hospital/health facilities and one in a sport/recreation setting. Most studies were conducted in North America or Australia, and policy implementation occurred mainly at state/regional or federal levels. The most commonly cited barriers across overarching themes and intervention settings were: lack of stakeholder engagement or prioritisation of the policy (11 studies); resistance to change from school stakeholders or customers (8 studies); and concern over profitability, revenue and/or commercial viability (8 studies). Few studies reported on mitigation of barriers. Enablers most commonly raised were: stakeholder engagement, whole-school approach and/or prioritisation of the policy (9 studies); policy level or higher-level support in the form of information, guidance and/or training (5 studies); and leadership, school/policy champion, management commitment and/or organisational capacity (4 studies). Conclusions: Key considerations for policy implementation ranged from building stakeholder support, prioritising policy implementation within organisations, to implementing strategies that address financial concerns and implementation barriers.

Business outcomes of healthy food service initiatives in schools: A systematic review

Fear of unfavorable business outcomes, including negative financial impacts, deters implementation of school food service initiatives to support healthy student eating behaviors. There have been no systematic reviews to guide feasible long-term healthy school food initiatives. This review aimed to synthesize evidence on the effect of school food service initiatives on business outcomes, including commercial viability, stakeholder perceptions, customer perceptions, and initiative maintenance and scale-up. Business, education, and health peer-reviewed databases, and grey literature were systematically searched. Eligible studies reported on the business impact of initiatives encouraging sales of healthier foods within school cafeterias, canteens, vending machines, or online canteens. Synthesis incorporated a count of studies addressing business outcomes, health behavior outcomes, and the favorability of those outcomes. Of 5173 studies screened, 16 studies were included for analysis. Commercial viability was the most frequent theme (n = 12/16 studies), followed by stakeholder perceptions (n = 9/16), customer perceptions (n = 6/16), and initiative maintenance and scale-up (n = 2/16). Favorable business outcomes were identified in cafeterias/canteens (n = 8/10) and online canteens (n = 1/1). All vending machine initiatives (n = 7/7) reported unfavorable, mixed, or neutral outcomes. Future research should determine which types of healthy food retail initiatives deliver the most favorable business outcomes long-term for schools while optimizing student nutrition outcomes.

Prevalence of current school-level nutrition policies and practices of secondary schools in NSW, Australia

ISSUE ADDRESSED

Lowering the rates of adolescent overweight and obesity is a public health priority. The implementation of nutrition policies and practices in schools is recommended by various health organisations, but there is little information on the extent of their implementation. The aim of this study is to describe the prevalence of the implementation of recommended school-level nutrition policies and practices in secondary schools in New South Wales (NSW), Australia, and reported barriers and facilitators to the adoption of such policies and practices in school plans.

METHODS

A cross-sectional study was undertaken with school principals and canteen managers. All eligible secondary schools in NSW were approached to participate in a telephone survey (n = 440). Descriptive statistics were used to describe prevalence, and associations between school characteristics and implementation were examined using univariate statistics.

RESULTS

A total of 137 school principals and 80 canteen managers completed the survey. The implementation of practices on drinking water during class, healthy food and beverage marketing and learning opportunities regarding healthy eating was high (>90% of participating schools). The implementation of practices regarding the restriction of unhealthy drinks in school canteens, healthy school fundraisers and staff training related to healthy eating was reported in under 25% of participating schools. There were no significant differences in implementation by school sector, socio-economic status and geographic location. The main barrier to inclusion of nutrition policies and practices in the school plan was having other priorities and commitments (28.5%), and the main facilitator was support from stakeholders, the staff, students and their parents (37.2%).

CONCLUSIONS

There is opportunity to improve the implementation of nutrition policies and practices in NSW secondary schools. SO WHAT?: Strategies are needed for targeting barriers. These include: gaining support from school staff, students and parents, provision of resources and funding and staff training.

Examining school-level implementation of British Columbia, Canada's school food and beverage sales policy: a realist evaluation

OBJECTIVE

To identify key school-level contexts and mechanisms associated with implementing a provincial school food and beverage policy.

DESIGN

Realist evaluation. Data collection included semi-structured interviews (n 23), structured questionnaires (n 62), participant observation at public events (n 3) and scans of school, school district and health authority websites (n 67). The realist heuristic, context + mechanism → outcome configuration was used to conduct the analysis.

SETTING

Public schools in five British Columbia (BC), Canada school districts.

PARTICIPANTS

Provincial and regional health and education staff, private food vendors and school-level stakeholders.

RESULTS

We identified four mechanisms influencing the implementation of BC's school food and beverage sales policy. First, the mandatory nature of the policy triggered some actors' implementation efforts, influenced by their normative acceptance of the educational governance system. Second, some expected implementers had an opposite response to the mandate where they ignored or 'skirted' the policy, influenced by values and beliefs about the role of government and school food. A third mechanism related to economics demonstrated ways vendors' responses to school demand for compliance with nutritional Guidelines were mediated by beliefs about food preferences of children, health and food. The last mechanism demonstrated how resource constraints and lack of capacity led otherwise motivated stakeholders to not implement the mandatory policy.

CONCLUSION

Implementation of the food and beverage sales policy at the school level is shaped by interactions between administrators, staff, parent volunteers and vendors with contextual factors such as varied motivations, responsibilities and capacities.

Population-based interventions addressing food insecurity in Australia: A systematic scoping review

AIM

Food insecurity (FI) is a critical public health issue in Australia. Population-based interventions aiming to address the socio-ecological determinants of FI are critical for relieving and preventing it. This review aimed to map and summarise the characteristics of population-based interventions addressing household and/or community FI in Australia.

METHODS

A systematic scoping review was undertaken. Five databases, selected for range and relevance to FI in Australia ("CINAHL plus", "Ovid MEDLINE", "Sociological Abstracts", "Australian Public Affairs Information Service", and "Rural and Remote Health") were searched in May 2018 using the terms and relevant synonyms "FI" and "interventions". In addition a systematic grey literature search using multiple Google searches was undertaken. Data synthesis included categorisation and counting intervention type. Interventions were defined and charted by influence of at least one dimension of food security and impact on the socioeconomic, cultural and environmental conditions.

RESULTS

A total of 3565 published and grey literature records were identified, with the final 60 records describing 98 interventions. Few national interventions were identified, with approaches predominantly in Victoria, Northern Territory and Tasmania. Determinants related to living and working environments, food availability and food utilisation were most frequently addressed. Interventions addressing the key determinant of FI economic access were limited. A number of interventions did not appear to be associated with rigorous evaluation.

CONCLUSIONS

While there is evidence of population responses to FI in Australia, the effectiveness of these remains limited. Importantly there is a lack of coordinated and coherent national responses that address the range of FI determinants.

Objective assessment of compliance with a state-wide school food-service policy via menu audits

OBJECTIVE

The Healthy Food and Drink Policy was implemented in Western Australian government schools in 2007. The aim of the present study was to assess the compliance of Western Australian school canteen menus with the policy a decade after its introduction.

DESIGN

The traffic-light system that underpins the Healthy Food and Drink Policy categorises foods and drinks into three groups: 'green' healthy items, 'amber' items that should be selected carefully and 'red' items that lack nutritional value. Canteen menus were collected online and each menu item was coded as a green, amber or red choice.

SETTING

Western Australia.ParticipantsOnline canteen menus from 136 primary and secondary government schools.

RESULTS

The majority of audited school menus met policy requirements to include ≥60 % green items (84 %) and ≤40 % amber items (90 %), but only 52 % completely excluded red items. Overall, approximately half (48 %) of school canteen menus met all three traffic-light targets. On average, 70 % of the menu items were green, 28 % were amber and 2 % were red. Primary-school canteen menus were more likely than those from secondary schools to meet the requirements of the policy.

CONCLUSIONS

While the sampled Western Australian government school canteen menus were highly compliant with most of the requirements of the Healthy Food and Drink Policy, many offered red foods and/or drinks. Providing all schools with further education about identifying red items and offering additional services to secondary schools may help improve compliance rates.

Hungry for more: key stakeholders' support for more stringent school food policies

OBJECTIVE

School food policies are an important component of comprehensive strategies to address child obesity and improve children's health. Evaluations have demonstrated that these policies can be initially well accepted and appropriately implemented, however little is known about how acceptance levels may change over time. The present study aimed to re-evaluate a school food policy 10 years after its introduction to assess key stakeholders' support for various policy extensions that would strengthen the scope of the policy.

DESIGN

Online surveys administered 1 year after policy introduction (n 607, 2008) and 10 years after policy introduction (n 307, 2016).

SETTING

Western Australia.ParticipantsSchool principals, teachers, canteen managers and presidents of parents & citizens associations from Western Australian Government primary schools.

RESULTS

At both time points, and especially at time 2 (10 years post policy implementation), high levels of support were reported for the policy and possible policy extensions. Support was strongest for an additional requirement to integrate the canteen menu with the classroom health curriculum.

CONCLUSIONS

The results suggest that once a policy has become embedded into school practices, stakeholders may be receptive to modifications that strengthen the policy to enhance its potential effects on children's diets.

Factors underlying compliance with a healthy snacking initiative in the school environment: accounts of school principals in Montevideo (Uruguay)

OBJECTIVE

To evaluate the implementation of the Uruguayan healthy snacking initiative in primary and secondary schools in the capital, and to explore the factors underlying compliance from the perspective of school principals.

DESIGN

A mixed-method approach was used, which included semi-structured interviews with school principals and a survey of the foods and beverages sold and advertised in the schools.

SETTING

Primary and secondary schools in Montevideo (the capital city of Uruguay).

PARTICIPANTS

School principals.

RESULTS

The great majority of the schools did not comply with the initiative. Exhibition of non-recommended products was the main cause for non-compliance, followed by advertising of non-recommended products through promotional activities of food and beverage companies. Although school principals were aware of the healthy snack initiative and showed a positive attitude towards it, the majority lacked knowledge about its specific content. Factors underlying compliance with the healthy snacking initiative were related to its characteristics, characteristics of the schools, and external factors such as family habits and advertising.

CONCLUSIONS

Results showed that the rationale underlying the selling of products at schools favours the availability of ultra-processed products and constitutes the main barrier for the promotion of healthy dietary habits among children and adolescents. Strategies aimed at facilitating the identification of unhealthy foods and beverages and provision of incentives to canteen managers to modify their offer are recommended.

Current Government Actions and Potential Policy Options for Reducing Obesity in Queensland Schools

School nutrition policies provide promising avenues towards the improvement of children's eating habits and the prevention of obesity. Childhood obesity rates and related chronic diseases are increasing in Queensland, in part as a result of unhealthy eating habits and lack of physical activity. There is a very high investment by the Queensland government in maintaining healthy weight and promoting nutrition and physical activity among schoolchildren through delivering a range of initiatives across the state. However, there is a lack of evidence concerning the effectiveness of nutrition/physical education and parental involvement programs addressing obesity delivered in Queensland schools. This paper can be used to guide government and policy-makers regarding the most effective policy options that will promote healthy eating and physical activity among Queensland schoolchildren. The aim of this paper is to: (i) summarize current evidence on Queensland government responses to obesity; and (ii) discuss potential policy options that could support healthy eating and regular physical activity, and examine the evidence base for each option and suggest new areas for future research.

Stakeholder perceptions of a school food policy ten years on

Objective

To assess (i) the extent to which stakeholders have accepted and implemented a Healthy Food and Drink Policy for schools a decade after its introduction and (ii) any resulting implications for canteen profitability.

Design

Online survey distributed via electronic newsletter to school principals.

Setting

Western Australian public schools.

Subjects

Principals, teachers, canteen managers, and parents and citizens committee presidents (n307).

Results

Large majorities of respondents reported that the policy has made the foods and drinks provided in schools healthier (85 %) and that the policy constitutes a good opportunity to teach children about healthy eating (90 %). Only small proportions of respondents felt it had been difficult to implement the policy in their schools (13 %) or that the policy fails to accommodate parents’ rights to choose the foods consumed by their children (16 %). Most of the policy outcomes assessed in both the initial post-implementation evaluation (2008) and the 10-year follow-up evaluation (2016) demonstrated significant improvement over time.

Conclusions

The study results indicate that comprehensive school food policies can favourably influence the foods and drinks provided on school premises and can be highly acceptable to key stakeholders, without adversely affecting profitability. The results are encouraging for policy makers in other jurisdictions considering the implementation of similar policies.

Validity of four measures in assessing school canteen menu compliance with state-based healthy canteen policy

Issue addressed In order to assess the impact of healthy school canteen policies on food availability for students, valid methods of measuring compliance are needed that can be applied at scale. The aim of this study is to assess the validity and direct cost of four methods to assess policy compliance: 1) principal and 2) canteen manager self-report via a computer-assisted telephone interview; and 3) comprehensive and 4) quick menu audits by dietitians, compared with observations. Methods A cross-sectional study took place in the Hunter region of NSW, Australia, in a sample of 38 primary schools that had previously participated in a randomised controlled trial to improve healthy canteen policy compliance. Policy compliance was assessed using the four methods specified above. Percentage agreement, kappa, sensitivity and specificity compared with observations was calculated together with the direct time taken and costs of each method. Indirect costs (including set-up costs) for all measures have not been included. Results Agreement with observations was substantial for the quick menu audit (kappa=0.68), and moderate for the comprehensive menu audit (kappa=0.42). Principal and canteen manager self-report resulted in poor agreement and low specificity with the gold standard. The self-reported measures had the lowest cost, followed by the quick menu audit and lastly the comprehensive menu audit. Conclusion The quick menu audit represents a valid and potentially low-cost method of supporting policy implementation at scale. So what? This study demonstrates that a quick menu audit represents a valid measure of undertaking assessment of school canteen policy compliance at a population level.

Preschool and School Meal Policies: An Overview of What We Know about Regulation, Implementation, and Impact on Diet in the UK, Sweden, and Australia

School meals make significant contributions to healthy dietary behaviour, at a time when eating habits and food preferences are being formed. We provide an overview of the approaches to the provision, regulation, and improvement of preschool and primary school meals in the UK, Sweden, and Australia, three countries which vary in their degree of centralisation and regulation of school meals. Sweden has a centralised approach; all children receive free meals, and a pedagogical approach to meals is encouraged. Legislation demands that meals are nutritious. The UK system is varied and decentralised. Meals in most primary schools are regulated by food-based standards, but preschool-specific meal standards only exist in Scotland. The UK uses food groups (starchy foods, fruit and vegetables, proteins and dairy) in a healthy plate approach. Australian States and Territories all employ guidelines for school canteen food, predominantly using a "traffic light" approach outlining recommended and discouraged foods; however, most children bring food from home and are not covered by this guidance. The preschool standards state that food provided should be nutritious. We find that action is often lacking in the preschool years, and suggest that consistent policies, strong incentives for compliance, systematic monitoring, and an acknowledgement of the broader school eating environment (including home provided food) would be beneficial.

Are schools and alcohol a good mix? A qualitative study of school principals' experiences of adults' alcohol use in Australian secondary schools

OBJECTIVE

Parents, schools and the broader community influence children's socialisation to alcohol. In Australia, the UK and the USA, there have been media reports of adults consuming alcohol at family-focused school events such as fairs and graduations. The aim of this qualitative study was to describe school principals' experiences of adults' use of alcohol at school events, when children are present.

DESIGN/SETTING/PARTICIPANTS

A qualitative study was undertaken. Publicly available lists were used to invite 60 principals from government and Catholic secondary schools in Victoria, Australia. In-depth interviews were conducted and analysed thematically and reported using the Consolidated Criteria for Reporting Qualitative Research guidelines.

RESULTS

14 principals (5 female, 9 male) participated. Most (10) of the participating principals reported adults' use of alcohol at events when students were present. Regarding these events, most principals reported concerns regarding potential harms and responsibility for decision-making about alcohol availability in schools. Some (4) principals believed alcohol should not be present at such events and this was their practice. Half of the participating schools had recently made changes to reduce the availability or management of alcohol at school functions.

CONCLUSIONS

The findings confirm the common use of alcohol by adults at school events, the challenges this poses for school principals and suggests consideration needs to be given to identifying strategies for supporting schools and school principals in decision-making regarding the conduct of such events.

Improvement in primary school adherence to the NSW Healthy School Canteen Strategy in 2007 and 2010

ISSUE ADDRESSED

Since 2005, a government-endorsed strategy guiding food sold in New South Wales school canteens has been in place. This study describes the changes in school canteen food between 2007 and 2010 and characterises schools most likely to adhere to strategy guidelines.

METHODS

Menus obtained from a cohort of primary and central schools in the Hunter New England region of New South Wales were audited using a traffic light system of classification. Energy dense, nutrient-poor or 'red' items are restricted; 'amber' are to be selected carefully and healthier 'green' items are encouraged.

RESULTS

In 2007, 7% of schools had no red items on their menu. In 2010, this improved to 22% (P < 0.05). In 2010, small schools (OR = 1.9, 95% CI = 1.25-3.05, P = 0.003); lower socioeconomic schools (OR = 1.3, 95% CI = 1.02-1.78, P = 0.03); non-government (OR = 1.7, 95% CI = 1.22-2.23, P = 0.001) and rural schools (OR = 1.7, 95% Cl = 1.30-2.25, P < 0.001) had higher odds of having red items on the menu. No significant change occurred in the proportion of green foods listed for sale between 2007 and 2010.

CONCLUSIONS

Proportion of schools adhering to strategy guidelines had increased slightly, however, most continue to list red items for regular sale. SO WHAT? For health policies to improve public health they need implementation. Findings suggest more work is required, particularly in small schools, rural schools and non-government schools.

Behaviors and Knowledge of HealthCorps New York City High School Students: Nutrition, Mental Health, and Physical Activity

BACKGROUND

HealthCorps provides school wellness programming using curricula to promote changes in nutrition, mental health, and physical activity behaviors. The research objective was to evaluate effects of implementing its curricula on nutrition, mental health, and physical activity knowledge and behavior.

METHODS

Pre- and postsurvey data were collected (N = 2255) during the 2012-2013 academic year from 14 New York City public high schools. An 18-item knowledge questionnaire addressed 3 domains; 26 behavioral items were analyzed by factor analysis to identify 6 behavior domains, breakfast being a seventh 1-item domain. We examined the effects stratified by sex, applying mixed-effects models to take into account clustering effects of schools and participants adjusted for age.

RESULTS

The HealthCorps program significantly increased all 3 knowledge domains (p < .05), and significantly changed several key behavioral domains. Boys significantly increased fruits/vegetables intake (p = .03). Girls increased acceptance of new fruits/vegetables (p = .03) and breakfast consumption (p = .04), and decreased sugar-sweetened beverages and energy dense food intake (p = .03). The associations between knowledge and behavior were stronger in boys than girls.

CONCLUSION

The HealthCorps program significantly increased participants' knowledge on nutrition, mental health, and physical activity. It also improved several key behavioral domains, which are targets of the 2010 Dietary Guidelines to address obesity in youth.

Exploring primary school headteachers' perspectives on the barriers and facilitators of preventing childhood obesity

BACKGROUND

Headteachers of primary schools in England are a crucial partner for childhood obesity prevention. Understanding how this works in practice is limited by their views being underrepresented or missing from the evidence base. The aim of this study was to explore primary school headteachers' perspectives on childhood obesity and the perceived barriers and facilitators of prevention.

METHODS

A qualitative study with a purposive sample of 14 primary school headteachers from the Yorkshire and Humber region of England was conducted. Semi-structured interviews were audio-taped, transcribed and analysed using an inductive thematic approach.

RESULTS

An extensive range of barriers and facilitators emerged within four key themes; understanding childhood obesity, primary school setting, the role of parents and external partners. A lack of knowledge, awareness and skills to deal with the sensitivity and complexity of childhood obesity across all school stakeholders presents the most significant barrier to effective action.

CONCLUSIONS

Headteachers recognize primary schools are a crucial setting for childhood obesity prevention; however their school's often do not have the capability, capacity and confidence to make a meaningful and sustainable impact. To increase headteachers' ability and desire to prevent childhood obesity, schools require specialist and tailored training, resources and support from external partners such as public health teams and school nursing services.

School nutrition guidelines: overview of the implementation and evaluation

Objective

To holistically evaluate the extent of implementation of dietary guidelines in schools and present various monitoring systems.

Design

The study comprises three methods: (i) a cross-sectional survey (process evaluation); (ii) an indicator-based evaluation (menu quality); and (iii) a 5 d weighed food record of school lunches (output evaluation).

Setting

Slovenian primary schools.

Subjects

A total 234 food-service managers from 488 schools completed a self-administrated questionnaire for process evaluation; 177 out of 194 randomly selected schools provided menus for menu quality evaluation; and 120 school lunches from twenty-four schools were measured and nutritionally analysed for output evaluation.

Results

The survey among food-service managers revealed high levels of implementation at almost all process evaluation areas of the guidelines. An even more successful implementation of these guidelines was found in relation to organization cultural issues as compared with technical issues. Differences found in some process evaluation areas were related to location, size and socio-economic characteristics of schools. Evaluation of school menu quality demonstrated that score values followed a normal distribution. Higher (better) nutrition scores were found in larger-sized schools and corresponding municipalities with higher socio-economic status. School lunches did not meet minimum recommendations for energy, carbohydrates or dietary fibre intake, nor for six vitamins and three (macro, micro and trace) elements.

Conclusions

The implementation of the guidelines was achieved differently at distinct levels. The presented multilevel evaluation suggests that different success in implementation might be attributed to different characteristics of individual schools. System changes might also be needed to support and improve implementation of the guidelines.

Effect of changes to the school food environment on eating behaviours and/or body weight in children: a systematic review

Previous school obesity-prevention reviews have included multi-component interventions. Here, we aimed to review the evidence for the effect of isolated food environment interventions on both eating behaviours (including food purchasing) and/or body weight. Five electronic databases were searched (last updated 30 November 2013). Of the 1,002 unique papers identified, 55 reported on school food environment changes, based on a review of titles and abstracts. Thirty-seven further papers were excluded, for not meeting the inclusion criteria. The final selection consisted of 18 papers (14 United States, 4 United Kingdom). Two studies had a body mass index (BMI) outcome, 14 assessed purchasing or eating behaviours and two studies assessed both weight and behaviour. Seventeen of 18 papers reported a positive outcome on either BMI (or change in BMI) or the healthfulness of food sold or consumed. Two studies were rated as strong quality and 11 as weak. Only three studies included a control group. A school environment supportive of healthy eating is essential to combat heavy marketing of unhealthy food. Modification of the school food environment (including high-level policy changes at state or national level) can have a positive impact on eating behaviours. A need exists, however, for further high-quality studies.

The vocational education setting for health promotion: a survey of students' health risk behaviours and preferences for help

BACKGROUND

Adolescence and young adulthood is a time of risky health behaviour initiation and experimentation. Smoking, risky drinking, poor nutrition and physical activity, and a lack of sun protection behaviour, often become established in early adulthood. Levels of health risk behaviours occurring amongst tertiary education and training students and their preferences for types of on-campus health promotion programs were examined.

METHOD

A cross-sectional pen-and-paper classroom survey was conducted at one Sydney-based TAFE New South Wales Institute campus in May 2010. The survey assessed demographics, smoking, alcohol use, sun protection, nutrition, physical activity and health promotion program preferences.

RESULTS

Two hundred and twenty-four students participated (97% consent); the majority were aged 16-24 years (59%) and female (51%). Current smoking (35%), risky drinking (49%) and inadequate physical activity (88%) rates were high. Adequate vegetable intake (3.6%) and sun protection behaviours (5.4%) were low and 33% of students were overweight or obese. Popular health promotion programs included food and activity subsidies, practical skills classes and social outings.

CONCLUSION

Participation in health risk behaviours among this sample was high. The setting of tertiary education and workplace training represents an opportunity for early intervention into risky health behaviours among young people. SO WHAT?: This study is the first to provide information on the prevalence of health risk behaviours and preferences for types of health promoting programs among students of an Australian community college. The results show that young adults regularly participate in multiple health risk behaviours, such as smoking, drinking, poor nutrition, physical activity and lack of sun protection.

Implementation of A Better Choice Healthy Food and Drink Supply Strategy for staff and visitors in government-owned health facilities in Queensland, Australia

Objective

The present paper reports on a quality improvement activity examining implementation of A Better Choice Healthy Food and Drink Supply Strategy for Queensland Health Facilities (A Better Choice). A Better Choice is a policy to increase supply and promotion of healthy foods and drinks and decrease supply and promotion of energy-dense, nutrient-poor choices in all food supply areas including food outlets, staff dining rooms, vending machines, tea trolleys, coffee carts, leased premises, catering, fundraising, promotion and advertising.

Design

An online survey targeted 278 facility managers to collect self-reported quantitative and qualitative data. Telephone interviews were sought concurrently with the twenty-five A Better Choice district contact officers to gather qualitative information.

Setting

Public sector-owned and -operated health facilities in Queensland, Australia.

Subjects

One hundred and thirty-four facility managers and twenty-four district contact officers participated with response rates of 48·2 % and 96·0 %, respectively.

Results

Of facility managers, 78·4 % reported implementation of more than half of the A Better Choice requirements including 24·6 % who reported full strategy implementation. Reported implementation was highest in food outlets, staff dining rooms, tea trolleys, coffee carts, internal catering and drink vending machines. Reported implementation was more problematic in snack vending machines, external catering, leased premises and fundraising.

Conclusions

Despite methodological challenges, the study suggests that policy approaches to improve the food and drink supply can be implemented successfully in public-sector health facilities, although results can be limited in some areas. A Better Choice may provide a model for improving food supply in other health and workplace settings.