Food environment intervention improves food knowledge, wellbeing and dietary habits in primary school children: Project Daire, a randomised-controlled, factorial design cluster trial

The feasibility and acceptability of a rewards system based on food purchasing behaviour in secondary school cashless canteens: the Eat4Treats (E4T) cluster feasibility, non-randomised, controlled intervention study

BACKGROUND

Using rewards may be an effective method to positively influence children's eating behaviour but evidence to date is limited, particularly in older children. The cashless canteen systems in schools provides a unique opportunity to implement a food-based reward scheme but intervention development work and feasibility testing is needed. The overall aim of the E4T feasibility study was to examine the feasibility and acceptability of implementing a rewards scheme based on the food purchasing behaviour of pupils in cashless canteens in secondary schools.

METHODS

A non-randomised, controlled, parallel-group cluster feasibility study conducted in four secondary schools (two intervention and two control) serving areas of the highest social deprivation in Northern Ireland. During the 4-month trial, pupils earned points for foods purchased at the school canteen, with better nutritional choices having a higher value. Pupils could exchange the points they earned for rewards (e.g. stationery, vouchers, sports equipment) via the E4T website. Qualitative and quantitative data was collected from year 9 and 10 pupils (boys and girls aged 12-14 years), teachers and canteen staff to address the feasibility questions.

RESULTS

Two intervention (one urban, one rural) and one control (urban) school completed the study. Seventy-one percent of 12-14-year-old pupils consented to take part; 1% of parents opted their child out of the study. Questionnaire completion rates were high (6 and 11% of questionnaires were partially completed at baseline and follow-up respectively). Collecting data on food consumed in the canteen was challenging logistically. Focus groups with pupils indicated that the overall concept of E4T was well received and there was a high degree of satisfaction with the rewards available. Pupils and teachers made several suggestions for improvements.

CONCLUSIONS

E4T was successfully implemented as a result of collaboration between schools, school canteens and cashless canteen providers working with a multidisciplinary research team. It was acceptable to pupils, teachers and canteen staff. The findings suggest a few areas for refining implementation and evaluation processes that would need to be considered in the design of a larger trial, particularly resources required to streamline implementation and ways to optimise pupil engagement.

TRIAL REGISTRATION

Under review with https://www.

CLINICALTRIALS

gov (retrospective registration-reg number and weblink to be added).

The relationship between subjective well-being and food: a qualitative study based on children's perspectives

PURPOSE

Despite the lack of consensus regarding which life satisfaction domains should be included in the study of children's subjective well-being (SWB), some domains are frequently considered, such as satisfaction with health. However, some others, such as satisfaction with food, are barely taken into account, despite the impact eating habits have on children's health and well-being. We adopt a qualitative approach to explore the role food plays in children's SWB, providing for a more in-depth analysis of children's perceptions and evaluations on a still insufficiently known domain of life satisfaction.

METHOD

Sixteen discussion groups were held with 112 Spanish students (10-12 years old) from six schools. The transcripts were analy sed and themes reflecting the key concepts were defined using reflexive thematic analysis.

RESULTS

Five themes emerged from the children's discourses on the relationship between food and SWB: health, pleasure, emotions, commensality-i.e., eating together-and food-empowerment-thus offering new insights from children's perspectives.

CONCLUSION

Almost all of the participants established a relationship between their SWB and their eating behaviour, meaning that, within the challenges facing public health, SWB must be taken into account when promoting healthy eating programmes for children. Also, group discussion is found to be a very powerful tool for exploring topics with subjective connotations among child populations.

Effectiveness of School-Based Interventions in Europe for Promoting Healthy Lifestyle Behaviors in Children

The objective of this narrative review was to summarize existing literature on the effectiveness of school-based interventions, implemented in Europe, under the aim of promoting healthy lifestyle behaviors in children (6-10 years old). A search of PubMed, Scopus, EFSA and Google Scholar databases was performed for studies published from January 2016 to June 2022. Specific search terms and exclusion criteria were used. Based on the results, diet and physical activity interventions had favorable effects on a series of health outcomes, including anthropometric parameters, biomarkers, eating behavior and self-efficacy. Diet-only interventions had a positive impact specifically on eating habits, mostly on water consumption. Most successful interventions lasted for 1 school year, and they were characterized by parental involvement and teachers' training.

Capturing the whole-school food environment in primary schools

OBJECTIVE

The school food environment (SFE) is an ideal setting for encouraging healthy dietary behaviour. We aimed to develop an instrument to assess whole-SFE, test the instrument in the school setting and demonstrate its use to make food environment recommendations.

DESIGN

SFE literature and UK school food guidance were searched to inform instrument items. The instrument consisted of (i) an observation proforma capturing canteen areas systems, food presentation and monitoring of food intake and (ii) a questionnaire assessing food policies, provision and activities. The instrument was tested in schools and used to develop SFE recommendations. Descriptive analyses enabled narrative discussion.

SETTING

Primary schools.

PARTICIPANTS

An observation was undertaken at schools in urban and rural geographical regions of Northern Ireland of varying socio-economic status (n 18). School senior management completed the questionnaire with input from school caterers (n 16).

RESULTS

The instrument captured desired detail and potential instrument modifications were identified. SFE varied. Differences existed between food policies and how policies were implemented and monitored. At many schools, there was scope to enhance physical eating environments (n 12, 67 %) and food presentation (n 15, 83 %); emphasise healthy eating through food activities (n 7, 78 %) and increase parental engagement in school food (n 9, 56 %).

CONCLUSIONS

The developed instrument can measure whole-SFE in primary schools and also enabled identification of recommendations to enhance SFE. Further assessment and adaptation of the instrument are required to enable future use as a research tool or for self-assessment use by schools.

'It was called a grab bag and nobody wanted to grab them': Teachers' perceptions of school lunches during the COVID-19 pandemic - a regional case study

Background

The COVID-19 pandemic brought changes to primary school lunches leading to concerns over nutritional quality and uptake of lunches by vulnerable children. Regional data from Tayside, Scotland, showed that only 55% of children who were eligible for free school meals took these (normal uptake pre-pandemic was 66%). The current work aimed to identify teachers' perceptions of meal provisioning in primary schools during the first year of the COVID-19 pandemic.

Design and methods

A cross-sectional online survey was carried out among primary school teachers across Tayside, Scotland. Using an online survey (21 questions combining multiple choice formats and open text) and interviews, primary school teachers shared their views on food quality, quantity, meal choices and factors influencing uptake of primary school lunches. Interviews were recorded, transcribed and thematically analysed with respect to factors influencing consumption.

Results

The survey was completed by 41 teachers and 8 participated in a follow up interview. Around one-third (29%) of primary school teachers believed the quality of lunches had decreased and cited poor appearance of food, use of takeaway containers and food wastage. The lunch format was viewed negatively principally relating to the substitution of hot lunches with cold sandwiches, portion sizes, choice and perceived value for money. Concerns were expressed about acceptability and how far the meals contributed to food security.

Conclusions

Further work on food provisioning is needed in order to identify ways to provide a nutritional safety net for vulnerable children.

Effectiveness of Gardening-Only, Cooking-Only and Combined Cooking and Gardening Programs in Elementary Schools to Improve Fruit and Vegetable Intake: A Systematic Review

The objective is to compare the gardening, cooking, and combined cooking and gardening programs in elementary schools from the past decade (2011-2022) in improving six psychosocial and behavioral outcomes related to fruit and vegetable intake. This review was conducted following the PRISMA guidelines. Five scientific databases were searched to identify 4763 potential articles, 44 articles were retained after screening the studies' abstract, and 36 articles were included after further investigation into each intervention. This review included 9 gardening-only programs, 8 cooking-only programs, and 19 combined cooking and gardening programs. The included studies were from 14 different countries with half of these studies took place in the United States (n = 18). Of the outcomes assessed, 100% (10/10) of the studies were effective in improving knowledge/skills, 90% effective in improving attitudes and self-efficacy to consume F and V (9/10), 80% produced significant results for gardening and cooking attitudes/behaviors (8/10) and willingness to try F and V (4/5), 68% (11/16) programs resulted in increase in F and V intake, and 62% (10/16) programs improved F and V preference. This review suggests that gardening-only programs (89%) and cooking-only programs (88%) were slightly more effective in producing significant findings compared to combined programs (84%), but more high-quality interventions are needed to confirm these findings.

The ALINFA Intervention Improves Diet Quality and Nutritional Status in Children 6 to 12 Years Old

The study aimed to evaluate the efficacy of a new nutritional intervention, focused on improving the quality of the diet in children aged 6 to 12 years. A 2-month parallel, controlled randomized trial was conducted in the Spanish child population. The children were randomized to ALINFA nutritional intervention, which consisted of a normocaloric diet that incorporates products, ready-to-eat meals and healthy recipes specifically designed for the study, or a control group, which received the usual advice on healthy eating. The change in diet quality was assessed through the Kidmed index. The secondary outcomes were anthropometry, glucose and lipid profiles, inflammation markers, dietary intake and lifestyle. The participants in the intervention group showed an increase in the mean score of the Kidmed index (p < 0.001). Alongside that, these children decreased their intake of calories (p = 0.046), and total and saturated fat (p = 0.016//p = 0.011), and increased fiber intake (p < 0.001). Likewise, the children in the ALINFA group increased the intake of white fish (p = 0.001), pulses (p = 0.004), whole grains (p < 0.001) and nuts (p < 0.001), and decreased fatty meat (p = 0.014), refined grain (p = 0.008), pastry (p < 0.001), fast food (p < 0.001) and sugar (p = 0.001) intake. Moreover, these children had a significantly decreased BMI (p < 0.001), BMI z-score (p < 0.001), waist circumference (p = 0.016) and fat mass (p = 0.011), as well as leptin (p = 0.004). Participants in the control group did not report significant changes in diet quality. In conclusion, ALINFA nutritional intervention is possibly a useful strategy to increase the diet quality in children, which is associated to improvements in the nutritional status. These results highlight the importance of developing well-designed nutritional interventions.

Understanding school food systems to support the development and implementation of food based policies and interventions

BACKGROUND

Schools provide opportunities to improve the quality of children's diet, whilst reducing inequalities in childhood diet and health. Evidence supports whole school approaches, including consistency in food quality, eating culture and food education. However, such approaches are often poorly implemented due to the highly complex environments in which schools operate. We aimed to develop a school food systems map using a systems thinking approach to help identify the key factors influencing primary school children's dietary choice.

METHODS

Eight workshops were conducted with 80 children (from schools from varying locations (region of England/UK; urban/rural), deprivation levels and prioritisation of school food policies)) and 11 workshops were held with 82 adult stakeholders across the UK (principals, teachers, caterers, school governors, parents, and local and voluntary sector organisations) to identify factors that influence food choice in children across a school day and their inter-relationships. Initial exploratory workshops started with a 'blank canvas' using a group model building approach. Later workshops consolidated findings and supported a wider discussion of factors, relationships and influences within the systems map. Strengths of the relationship between factors/nodes were agreed by stakeholders and individually depicted on the map. We facilitated an additional eight interactive, in-person workshops with children to map their activities across a whole school day to enable the production of a journey map which was shared with stakeholders in workshops to facilitate discussion.

RESULTS

The final 'CONNECTS-Food' systems map included 202 factors that were grouped into 27 nodes. Thematic analysis identified four key themes: leadership and curriculum; child food preference; home environment; and school food environment. Network analysis highlighted key factors that influence child diet across a school day, which were largely in keeping with the thematic analysis; including: 'available funds/resources', 'awareness of initiatives and resources', 'child food preference and intake', 'eligibility of free school meals', 'family circumstances and eating behaviours', 'peer/social norms', 'priorities of head teachers and senior leaders'.

CONCLUSIONS

Our systems map demonstrates the need to consider factors external to schools and their food environments. The map supports the identification of potential actions, interventions and policies to facilitate a systems-wide positive impact on children's diets.

Community at the Centre of Future Food Systems

Have you thought about what it is you love about food [...].

Career sacrifice unpacked: From prosocial motivation to regret

In the ever more uncertain career context, many individuals engage in a form of career sacrifice (CS) at some point in their career journey; that is, giving up of certain career goals/actions or reshaping career decisions to accommodate specific work or life demands. This conceptual paper unpacks CS as an important yet little explored dimension of career decision making. Specifically, the paper examines possible triggers of CS as well as the diverse nature of CS, ranging from short-term (usually minor) type of sacrifice to more significant and long-term sacrifice. We explore the context of this type of career decision making, specifically the intersection of work and non-work-related triggers and conclude by discussing possible work and non-work outcomes both at the individual as well as organizational level. CS outcomes range from enhanced career self-management and relational benefits to positive organizational contributions, but at times can also lead to regret. Areas for future research are identified, especially exploration of demographic and more macro level variables as possible moderators in CS decisions. Future theoretical development of CS is discussed too.

An Exploration of Nutritional Education within the Holiday Activities and Food Programme in England

Nutritional education is a recent, mandatory inclusion within the quality standards framework for the Holiday Activities and Food (HAF) programme in England; funded by the Department for Education (DfE). Whilst research has been conducted regarding nutritional education in other contexts, such as schools and community organisations, to the authors’ knowledge, no published research has yet explored nutritional education within HAF. The current study therefore aimed to explore the implementation, delivery, and perceived facilitators, barriers and impacts of nutritional education across a number of Local Authorities delivering HAF in England. Purposive sampling (n = 11) was used to recruit HAF leads involved in nutritional education, to participate in semi-structured interviews. Thematic analysis showed that nutritional education is currently delivered through a variety of modes including face-to-face, online, and take-home methods, all of which require a range of considerations in terms of implementation, delivery, and associated impacts, with some holiday clubs offering no nutritional education. According to participating HAF leads, nutritional education was used as a mechanism to enhance children’s and parents’ cooking confidence and competence, to improve dietary intake, and to increase understanding of issues such as food sustainability, environmental impacts, and food provenance. Although there are many examples of innovative practice, the findings suggested that COVID guidelines proved challenging for providers to include nutritional education within HAF delivery during 2021. Further, whilst the quality standards framework for nutritional education provides flexibility in terms of implementation and delivery, specific guidance, and monitoring of provision is required to ensure quality assurance and consistency across the HAF programme.

Improved food literacy among schoolchildren as an effect of a food camp intervention: Results of a controlled effectiveness trial

Food literacy (FL) refers to an individual's prerequisites for their engagement with food. Schoolchildren's FL has been defined in terms of five competencies: "to know"(e.g food-related knowledge), "to do" (e.g cooking skills), "to sense" (e.g. less well-explored sensory experiences), "to care" (e.g. taking care of oneself and others) and "to want" (e.g. willingness to take a stand and act). A cluster-based quasi-experimental effectiveness trial on the effects of a school-based intervention, "FOODcamp," on FL, health literacy, and school well-being was conducted. A total of 640 school children in grades 6 and 7 (mean age = 12 years) attended this one-week camp and participated in different food-related classes and activities. Linear mixed models controlling for the nested structure of data showed small but significant effects for the following FL dimensions: "to do (E = 0.098, CI (0.035-0.161), p = 0.002), "to sense" (E = 0.152, CI (0.073-0.232), p < 0.001), and "to know" (E = 0.086, CI (0.022-0.150), p = 0.009) as well as for overall FL (E = 0.078, CI (0.034-0.122), p = 0.001). No effects were found for the dimensions "to want" or "to care". The intervention also had a small but significant effect on children's health literacy but not on school well-being. These findings demonstrate the value of FOODcamp and the positive impacts of a relatively brief intervention on children's FL.

Cook Like A Boss: An effective co-created multidisciplinary approach to improving children's cooking competence

Cooking interventions are emphasised as promising methods for changing children's food-related preferences, attitudes and behaviours. However, criticisms remain, including relatively weak intervention designs; lack of validated tools, and limited underpinning theory. Therefore, this research aimed to assess the effectiveness of a theory-driven co-created children's cooking intervention with underpinning rationale for the content, using a validated measure. 'Cook Like A Boss' was a one week, controlled cooking camp style intervention. Thirty two children aged 10-12 years participated. The intervention was developed using the Cook-Ed model for planning, implementing and evaluating cooking programs and was underpinned by Social Learning theory and Experiential Learning theory. The intervention content was developed in a co-creation process with the research team, a chef and the children. The underlying developmental skills required for the recipes were assessed to ensure they were age-appropriate. Children completed pre and post measurements including perceived cooking competence. Process evaluations were also gathered. There was a significant increase in perceived cooking competence after the intervention (P < 0.05) and a significant difference between the intervention and control group (P < 0.001). Additionally, process evaluations found the intervention to have high fidelity and dose received and that it was received extremely positively. The 'Cook Like A Boss' children's cooking camp was an effective multidisciplinary co-created intervention with a vulnerable group, e.g. children, guided by a model and underpinned by theory. The content was developed to ensure it was age-appropriate and achievable for the children. This approach could act as a template for future children's cooking interventions.

CooC11 and CooC7: the development and validation of age appropriate children's perceived cooking competence measures

BACKGROUND

Learning cooking skills during childhood and adolescence is associated with positive dietary outcomes in adulthood as well as being tracked from adolescence to adulthood. In addition studies have found that perceived competence to be a greater motivator to perform a behaviour than actual competence. However, a lack of validated tools that effectively measure behavioural and dietary changes including cooking confidence in children is a limitation. Therefore, this research aimed to develop and validate age-appropriate perceived cooking competence measures for younger and older primary school aged children.

METHODS

Two measures of perceived Cooking Competence (CooC11 and CooC7) for older (8-12 years) and younger (6-7 years) children were developed from a critical evaluation of publically available recommendations and expert consultation. The cooking skills within the measures were illustrated by a graphic designer in consultation with a chef and reviewed in an iterative manner by the research team. The measures were piloted for clarity, ease of use and initial face validity. Multiple studies were used for both CooC11 and CooC7 to establish psychometric properties of the measures, temporal stability, internal consistency reliability, construct validity, as well as responsiveness to change for CooC11. Analysis included Exploratory Factor Analysis, Confirmatory Factor Analysis, Intraclass Correlation Coefficients, Pearson's Correlations, ANOVAs and Cronbach's Alphas.

RESULTS

Both measures had high levels of face validity and received positive user feedback. Two factors were shown in both measures with the measures showing excellent temporal stability (ICC > 0.9) and good internal consistency (Cronbach's Alphas > 0.7). Both measures showed initial discriminant validity, with significant differences (P< 0.001) between those who reported assisting their parents with dinner preparation and those who did not. Additionally, CooC11 was significantly correlated with an adult cooking measure and had a significant responsiveness to change (P< 0.01).

CONCLUSIONS

The CooC11 and CooC7 are the first validated age-appropriate measures for assessing children's perceived Cooking Competence for ages 8-12 and 6-7 years respectively. They can be used to evaluate the efficacy of children's cooking intervention studies or school nutrition education programmes.