Three Years Later: Healthiness of Food in New Zealand Primary School Canteens Following Implementation of the Healthy Food and Drink Guidance.

Objective:To examine how school food policies and perceived barriers influence food provision in New Zealand primary school canteens, using the ‘Healthy Food and Drink Guidance for Schools’.Design:Cross-sectional analyses of school food menus and school food policy and practices surveys completed by school leaders/principals.Setting:New Zealand primary schools.Participants:239 primary schools completed the school food policies and practices survey, and eighty schools provided canteen menus.Results:Most schools reported having a healthy food and drink policy in their school (76·2 %) and promoted healthy eating during school hours (87·4 %). Two-thirds (69·5 %) identified barriers to healthy food and drink provision, most commonly the convenience of ready-made foods (39·3 %), and resistance from parents (34·3 %). The number of reported barriers was not a significant predictor for the presence of a school food policy (OR-1·034, P = 0·841). School menus (n 80) consisted of 16·4 % ‘green’ items, 34·7 % ‘amber’ items and 36·8 % ‘red’ items. There was no relationship between the percentage of ‘green’, ‘amber’ and ‘red’ items and the presence of a school food policy or reported barriers. More than a third (38·9 %) of menus from schools that reported they had a ‘Plain Milk and Water’ only policy still contained sugar-sweetened beverages.Conclusions:Although most New Zealand primary schools had healthy food policies, this was not consistently reflected in healthy food items on canteen menus. Further research is needed to understand how systemic barriers, such as cost, convenience and parental influence, affect policy implementation and school food provision.

Childhood obesity and overweight rates in New Zealand are considerably higher than that globally with one in three children aged between 2-14 years being overweight or obese(1). Children’s dietary knowledge and food preferences are influenced by various factors including the food environment. Schools are an excellent setting to influence children’s dietary behaviours since they have the potential to reach almost all children during the first two decades of their lives. However, previous analyses indicate many school canteens and food providers do not supply foods that promote healthy eating and nutrition behaviours (2,3). The Ministry of Health (MoH) recently implemented a ‘Food and Drink Guidance for Schools’ which utilises a traffic-light framework dividing foods into three categories: ‘green’, ‘amber’, and ‘red’(4). The aim of this study was to assess primary school canteen food menus against the newly implemented MoH Guidance. A convenience sample of 133 primary school canteen menus were collected in 2020 as part of the baseline evaluation of the Healthy Active Learning initiative across New Zealand. Four researchers (three nutritionists and one dietitian) developed a menu analysis toolkit to undertake the analysis of all menus collected. The toolkit provided a breakdown of commonly packaged foods and meals/menu items available to purchase within schools based on Health Star Ratings, ingredients, and/or standard recipes. Assumptions were created for menu items requiring additional detail to be categorised according to the guidance through consensus by all four researchers. Primary school menus were coded by two researchers, and intercoder reliability was ensured by independent coding and cross-checking of 10% of menus. Descriptive and inferential analyses were conducted using IBM SPSS and P<0.05 denoted significance. Analyses of canteen menus revealed that most menu items belonged to the less healthy amber (41.0%) and red (40%) food categories. Low decile schools had a lower percentage of green food items (8.6%) and a higher percentage of red food items (48.3%) compared to high decile schools (p = 0.028). Similarly, schools in low deprivation areas had a significantly higher percentage of green food items (14.2%) compared to high deprivation areas (8.6%) (p = 0.031). Sandwiches, filled rolls, and wraps were the most commonly available items (86%) followed by baked foods and foods with pastry (71%). Sugar-sweetened beverages were just as prevalent as water on school food menus (54% each). Over half of in-house catered canteen menu items were classified as 'red’ foods (55.3%). This study highlights that most school canteens were not meeting the guidelines for healthy food and drink provision outlined by the MoH. Improving school food availability for children in socioeconomically deprived areas needs to be prioritised to reduce inequities. Findings suggest the need for more robust national policies and mandated school guidance to improve the food environments in New Zealand schools.

School food in <scp>E</scp>ngland: Are we getting it right?

Modifying the food environment holds promise for instilling healthier behaviours in children and may be an effective public health strategy for preventing childhood obesity and adverse health outcomes. The school food environment is a valuable setting to influence most children's dietary behaviours from an early age, yet evidence suggests that the New Zealand and Australian school food environment is not conducive to healthy food and drink consumption. The present study aimed to investigate the level of compliance in New Zealand and Australia with government guidelines for food and drink availability within schools and the subsequent effect on food consumption and purchasing behaviours of children. A systematic review utilising three databases, PubMed, Scopus and the Cochrane Library, was conducted. The research covered peer-reviewed studies from both New Zealand and Australia that met predefined inclusion criteria. Fifteen studies focused on assessing food availability within schools on the basis of government guidelines, and ten studies explored food purchasing and consumption by students influenced by changes to the school food environment. Results showed low compliance with government healthy food guidelines for schools, and significant socioeconomic disparities. Western Australia's clear targets as well as the mandatory monitoring systems in place stand out as being a significant enabler of greater compliance with government food policies. Interventions aimed at improving healthy food availability and promoting healthy options in the canteen may positively influence student purchasing and consumption habits. Strategies such as feedback models and incentivisation hold promise for promoting healthier school environments and influencing children's food choices.

Nutritional Quality of Canteen Foods and Knowledge, Attitude and Practice of Food Handlers in Health Promoting and Non-Health Promoting Private Secondary Schools of Pune City

Schools are an important food environment to cultivate and promote healthy food choices and practices among children and adolescents. The aim of the present study was to assess the type and quality of food and beverages sold in school canteens in public primary and secondary schools in Kelantan, Malaysia. Eligible schools were randomly selected from the list of all schools and detailed information of all food and beverage items sold in the school canteens were collected during school days. Food and beverages were classified based on food groups derived from the Malaysian Food Dietary Guideline and the Recommended Foods for Healthy Cafeteria Guideline. An assessment of the traffic-light nutrition food-labelling system of the total sugar content in all pre-packaged foods was also undertaken. A total of 568 food items were identified, with secondary school canteens selling a greater proportion of food items than the primary schools (55.5% vs. 44.5%). In terms of the main food groups, grains and cereal products represented the largest food group served (33–36%), followed by beverages (21–25%) and confectionary and sweet foods (12–13%). In contrast, the vegetable and fruit group represented the smallest proportion of food items sold (1–3%). Comparisons between primary and secondary schools showed a similar trend and pattern of food types and quality of foods sold, except for animal-based foods. A greater percentage of food items in this category was found among secondary schools (12.1%) versus primary schools (6.7%). When total sugar content of all pre-packaged foods was quantified based on the traffic-light nutrition-labelling system, almost one-third of foods and beverages were classified as high (29.1%). Confectionary (19.1%) and flavoured milk and fruit drinks (10.0%) both exceeded the recommended sugar levels of >22.5 g per 100 g and >11.25 mL per 100 m L, respectively. Only one of these packaged foods and beverages (0.9%) was classified as a healthy food choice. About a quarter of the food items available in school canteens were classified as prohibited based on a new revised list of prohibited food and beverage items. These findings indicate that, despite the Guidelines, a large number of unhealthy food items are being sold in school canteens. Hence, interventions such as sustainable healthy school canteen menus should be implemented to promote healthy food choices amongst school-aged children.

Parents and teachers have expressed concerns about the adequacy of time allocated to eat lunch at primary schools in Australia(1). Short school lunch durations can result in negative outcomes such as insufficient food consumption, resulting in hunger and inadequate energy and nutrition(2). A recent study reported that students consumed less fruits and vegetables when given 10 minutes to eat compared to 20 minutes(3), leading to increased food waste. We aimed to explore parents’ perceptions regarding time-related aspects associated with school lunch including the sufficiency of time to eat school lunch, children requesting and parents providing quick-to-eat food, and the perception that healthy food takes longer time to eat. Additionally, we aimed to explore whether these time-related perceptions and children’s age are associated with how often children finish their lunches. An online survey was conducted in 2022 to explore Victorian parents’ perceptions regarding primary school lunches including the aspects mentioned above. Frequencies and percentages were calculated for all variables. Chi-square tests were used to explore the relationship between parents’ perceptions of time-related aspects and child’s age and how often children finish their lunches. Out of 359 parents, 29% reported that their child sometimes, rarely, or never finishes their lunches. When asked about reasons for this, 20% chose ‘not enough time is provided to finish lunch’ and 19% chose ‘my child is more interested in playing than eating during lunchtime’. About half of parents strongly agreed or agreed (SA/A) that the allocated time at their child’s school is not sufficient to eat school lunch (48%). Fifty percent of parents SA/A that their child asks them to pack easy-to-eat food and 60% SA/A that they provide such food for school lunches. However, the majority of parents (62%) strongly disagreed or disagreed (SD/D) that healthy foods take longer than less healthy food to eat during school lunchtime. More parents who SA/A with the statement ‘the allocated time at my child’s school is not sufficient to eat school lunch’ reported their child finishes lunch sometimes, rarely or never compared to parents who SD/D with this statement (36% vs 16%, Chi-sq = 11.372, p = 0.003). Parents’ perceptions regarding other time-related aspects were not associated with finishing lunches. More parents of children in prep to grade 2 compared to parents of children in grades 3 to 6 reported their child finishes their lunch sometimes, rarely or never (73% vs 49%, Chi-sq = 16.813, p &lt; 0.001). The findings indicate that parents have concerns about the time allocated to eat lunch at primary schools. Increasing the time allocated to eating school lunches would help to ease these concerns and allow children, especially the younger primary school children, to eat comfortably and finish their lunches if they wish to do so.

This paper aims to explore Victoria parents' perceptions of their current practices and barriers in providing school lunches for their primary school children. Respondents were asked via an online survey about their lunch provision practices, perceptions of the healthiness of school lunches, and barriers to providing healthy school lunches. Data were analysed using different statistical techniques: Chi-square test, Spearman correlation analysis, Mann-Whitney U test, and Kruskal-Wallis test. In total, 359 respondents completed the survey. Most respondents (84%) reported their child takes a home-packed lunch to school every day. Most respondents provided fruits (94%), vegetables (57%), and sandwiches (54%) every day for school lunches, whilst other core food items such as milk, meats, and legumes were provided less frequently. A substantial proportion of respondents provided some discretionary food items frequently (e.g., the proportion of respondents providing selected discretionary food items daily or 3-4 times/week: salty crackers-50%, sweet cookies/biscuits-40%, chips-20%). Respondents strongly agreed or agreed with several barriers; examples include not packing certain foods due to food spoilage concerns (50%) (school-related), the allocated time at their child's school is not enough to eat and enjoy school lunch (48%) (school-related), need more meal ideas (61%) (parent-related), healthy foods take more time to prepare (51%) (parent-related), and children request easy-to-eat food for school lunches (50%) (child-related). Core food score (an indicator of frequency of preparing/packing core food) was negatively correlated with parent-related and child-related barrier scores, whilst discretionary food score (an indicator of frequency of preparing/packing discretionary food) was positively correlated with these barrier scores. Overall, home-packed lunches remain the main option in primary schools in Victoria, and parents face several challenges in providing healthy lunches for their primary school children. SO WHAT?: The findings suggest the need for strategies from school leaders, education authorities, and policymakers to improve the quality of lunch content and address the barriers faced by parents.

Childhood obesity rates appear to be more pronounced among youth in rural areas of the USA. The availability of retail food outlets in rural communities that sell quality, affordable, nutritious foods may be an important factor for encouraging rural families to select a healthy diet and potentially reduce obesity rates. Researchers use the term 'food desert' to describe communities where access to healthy and affordable food is limited. Understanding the ways in which the food environment and food deserts impact childhood obesity may be a key component to designing interventions that increase the availability of healthy and affordable foods, thus improving the health of rural communities. The food environment was investigated in 6 rural low-income Maine communities to assess how food environments affect eating behaviors and obesity rates of rural children enrolled in Medicaid/State Children's Health Insurance Program in Maine ('MaineCare'). Focus groups were conducted with low-income parents of children enrolled in MaineCare to ask them about their food shopping habits, barriers faced when trying to obtain food, where they get their food, and what they perceive as healthy food. Cost, travel distance, and food quality were all factors that emerged as influential in rural low-income family's efforts to get food. Parents described patterns of thoughtful and creative shopping habits that involve coupons and sales. Grocery shopping is often supplemented with food that is harvested, hunted, and bartered. The use of large freezers for storing bulk items was reported as necessary for survival in 'tough' times. Families often travel up to 128.8 km (80 miles) to purchase good quality, affordable food, recognizing that in rural communities travelling these distances is a reality of rural life. Parents appeared to know what qualities describe 'healthy food'. Rural families may have greater flexibility and opportunity to be methodical in their food shopping than urban families since many have access to cars and large freezers. This creates a buffer around these rural communities that might otherwise be considered food deserts. Although the meaning of food desert may be different in rural areas than in urban, it does not negate the fact that low-income rural families are struggling. The combination of challenges that rural low-income families face call for more rigorous study to identify promising interventions for increasing food access and quality in these communities. Participants have developed creative skills for getting food on the table and they know what healthy food is. Despite having acquired this knowledge and these skills, rural families are struggling. With these struggles in mind, policy-makers should consider the shopping patterns reported in this study when thinking about how to help rural residents better access affordable, healthy and quality foods. Customary approaches to remedying the problem of food deserts in urban areas, such as building more grocery stores, may not be necessary in rural areas. More creative approaches for food-access policy changes, subsidies and incentives are needed to match the complex and multi-faceted strategies that low-income residents utilize to feed their families.

Many countries and institutions have adopted policies to promote healthier food and drink availability in various settings, including public sector workplaces. However, studies reporting barriers and facilitators experienced by food vendors and caterers in providing healthy and nutritious foods and drinks have not been collated and synthesised, representing a significant gap in workplace health promotion knowledge. Our objective was to systematically synthesise evidence on barriers and facilitators relative to the implementation of and compliance with healthy food and drink policies aimed at the general adult population in public sector workplaces internationally. Nine scientific databases, nine grey literature sources, and government websites in key English-speaking countries were searched between April and June 2021. All identified records (n = 8559) were assessed for eligibility. Studies reporting barriers and facilitators were included irrespective of the study design and methods used, but they were excluded if they were published before the year 2000 or in a non-English language. Methodological strengths and limitations of the included studies were assessed with the CASP Qualitative Studies Checklist. Drawing on a thematic synthesis approach, primary findings were generated through research question-led coding and theme development. Forty-one studies were eligible for inclusion, and they were mainly from Australia, the United States, and Canada. The most common workplace settings were healthcare facilities, sports and recreation centres, and government agencies. Generally, poorly reported data collection and analysis methods were observed. Preliminary findings suggest that although vendors encounter challenges, there are also factors that support healthy food and drink policy implementation in public sector workplaces. Generated codes indicate that barriers and facilitators fall into five broad categories of financial ramifications, availability of healthier products, existence of supporting tools and resources, institutional leadership support, and communication between stakeholders. Understanding barriers and facilitators to successful policy implementation will significantly benefit stakeholders interested in or engaging in healthy food and drink policy development and implementation.

Primary school food and nutrition education helps to establish healthy dietary patterns among young children. Teachers play an important role in the success of this form of education. This study aimed to explore teachers’ perceptions of opportunities and challenges associated with food and nutrition education in Sri Lankan primary schools. Individual face-to-face interviews were conducted in the Sinhala or Tamil languages with 21 primary school teachers from April to June 2019. The recorded interviews were transcribed and later translated into English. The themes were identified using the template analysis technique. Lack of time and resources for teaching, lack of support from parents in practising healthy dietary habits, and availability of unhealthy foods in the school canteen and near-by food outlets were identified as the main challenges associated with teaching food and nutrition concepts to the students. School mid-day meal programmes, simple food and nutrition-related subject contents, and practical activities were identified as opportunities that facilitate food and nutrition teaching. The findings indicate that teachers face some challenges in teaching food and nutrition-related subject matters in the primary school set-ups. Policy planners and education officials have to work with primary school teachers to find ways to overcome these challenges and to further take up new opportunities. This will help to uplift the status of this form of education.

Few studies have examined the relation between food consumption and related attitudes and dental pain among children. The objective of this study is to examine the associations of healthy and unhealthy food items, attitudes toward healthy food, and self-efficacy of eating healthy with dental pain among children. A cross-sectional analysis was performed using child survey data from the Texas Childhood Obesity Research Demonstration (TX CORD) project. Fifth-grade students ( n = 1,020) attending 33 elementary schools in Austin and Houston, Texas, completed the TX CORD Child Survey, a reliable and valid survey instrument focused on nutrition and physical activity behaviors. All nutrition questions ask about the number of times food and beverage items were consumed on the previous day. Dental pain was reported as mouth or tooth pain in the past 2 wk that made their mouth hurt so much that they could not sleep at night. Mixed-effects logistic regression models were used to test the association between 10 unhealthy food items, 9 healthy food items, 2 health attitudes, and self-efficacy with dental pain. All models controlled for sociodemographic variables. In total, 99 (9.7%) students reported dental pain. Dental pain was associated with intake of the following unhealthy items: soda, fruit juice, diet soda, frozen desserts, sweet rolls, candy, white rice/pasta, starchy vegetables, French fries/chips, and cereal (adjusted odds ratio [AOR], 1.27-1.81, P < 0.01). The intake of other vegetables (AOR, 1.56; P < 0.01), a healthy item, and the attitude that healthy food tastes good (AOR, 1.59; P = 0.04) were also positively associated with dental pain. The attitude of eating healthier leads to fewer health problems (AOR, 0.50) and self-efficacy for healthy eating (AOR, 0.44) were negatively associated with dental pain ( P < 0.01). Interventions should focus on improving oral health by reducing intake of unhealthy foods and educating children and families on the importance of diet as a means of reducing dental caries. Knowledge Transfer Statement: The results of this study can be used to inform researchers on potential food items and psychosocial measures to examine in low-income, minority populations for longitudinal research. These results would also be useful to educators who could incorporate oral health care and nutrition education into school curriculums.

Although food insecurity affects a significant proportion of young children in New Zealand (NZ)(1), evidence of its association with dietary intake and sociodemographic characteristics in this population is lacking. This study aims to assess the household food security status of young NZ children and its association with energy and nutrient intake and sociodemographic factors. This study included 289 caregiver and child (1-3 years old) dyads from the same household in either Auckland, Wellington, or Dunedin, NZ. Household food security status was determined using a validated and NZ-specific eight-item questionnaire(2). Usual dietary intake was determined from two 24-hour food recalls, using the multiple source method(3). The prevalence of inadequate nutrient intake was assessed using the Estimated Average Requirement (EAR) cut-point method and full probability approach. Sociodemographic factors (i.e., socioeconomic status, ethnicity, caregiver education, employment status, household size and structure) were collected from questionnaires. Linear regression models were used to estimate associations with statistical significance set at p &lt;0.05. Over 30% of participants had experienced food insecurity in the past 12 months. Of all eight indicator statements, “the variety of foods we are able to eat is limited by a lack of money,” had the highest proportion of participants responding “often” or “sometimes” (35.8%). Moderately food insecure children exhibited higher fat and saturated fat intakes, consuming 3.0 (0.2, 5.8) g/day more fat, and 2.0 (0.6, 3.5) g/day more saturated fat compared to food secure children (p&lt;0.05). Severely food insecure children had lower g/kg/day protein intake compared to food secure children (p&lt;0.05). In comparison to food secure children, moderately and severely food insecure children had lower fibre intake, consuming 1.6 (2.8, 0.3) g/day and 2.6 (4.0, 1.2) g/day less fibre, respectively. Severely food insecure children had the highest prevalence of inadequate calcium (7.0%) and vitamin C (9.3%) intakes, compared with food secure children [prevalence of inadequate intakes: calcium (2.3%) and vitamin C (2.8%)]. Household food insecurity was more common in those of Māori or Pacific ethnicity; living in areas of high deprivation; having a caregiver who was younger, not in paid employment, or had low educational attainment; living with ≥2 other children in the household; and living in a sole-parent household. Food insecure young NZ children consume a diet that exhibits lower nutritional quality in certain measures compared to their food-secure counterparts. Food insecurity was associated with various sociodemographic factors that are closely linked with poverty or low income. As such, there is an urgent need for poverty mitigation initiatives to safeguard vulnerable young children from the adverse consequences of food insecurity.

Shopper Purchasing Trends at Small Stores on the Navajo Nation since the Passage of the Healthy Diné Nation Act Tax: A Multi-Year Cross-sectional Survey

Dietary habits established during childhood and adolescence influence behaviours in adulthood and may impact health later in life. Primary and secondary schools have the unique ability to reach almost all children and young people during the first two decades of their lives, making them ideal settings for influencing health. Healthy Active Learning (HAL) is a 5-year joint government initiative between Sport NZ, the Ministry of Health, and the Ministry of Education which seeks to improve the wellbeing of students through healthy eating and drinking, and quality physical activity in schools. A baseline evaluation of HAL undertaken by Massey University commenced in July 2020. School leaders, teachers, and parents and family were invited to complete surveys and participate in focus groups. Measures included an evaluation of the healthy food environment, including food policies, practices, and food availability (menus). Surveys were created using online survey software, and focus groups were facilitated by two experienced qualitative researchers. Food environment and food availability surveys were completed by 257 and 173 schools, respectively. Most schools had a healthy food and drink policy (82.9%); 59.2% of these schools stipulated water and milk only policies. Barriers to implementing a healthy food and drink environment included convenience and ease of access to processed and ready-to-eat foods, resistance from parents, and loss of profits. Survey responses from 1060 teachers (including 184 responses from principals/school leaders) were received. Teachers agreed that their schools saw healthy eating and drinking as a key part of student wellbeing (84.4%), yet only 57.4% of teachers felt that they upheld their school food policy. Food insecurity was identified from 53 teacher focus groups (n = 307 teachers) as a key barrier to implementing food policy. Support from the nutrition promotion workforce may help schools achieve a healthy food environment in an equitable way.