School Lunch Research Articles

School health and nutrition services for children and adolescents in Tanzania: A review of policies and programmes.

School health and nutrition programmes are effective strategies to address the health problems among school-going children and adolescents. We examined the policy environments, successesand bottlenecks associated with school health and nutrition programmes in Tanzania. We used the 'policy triangle framework' to examine 22 national and regional school health and nutrition policies and programmes in Tanzania. We also interviewed 16 key informants to gain further insights into school health and nutrition programmes. Several school health and nutrition policies in Tanzania outline the basic elements of school-based health and nutrition services. Yet, these documents neither recognise vulnerable groups, recommend age-appropriate strategies to address children's and adolescents' varied and transient needs, nor provide a framework for implementing and tracking recommended activities. In these documents, underweight and infectious diseases, including humanimmunodeficiency virus/acquired immunodeficiency syndrome, are frequently identified as major concerns of young people, with little or no consideration of social determinants. Diverse strategies including school feeding, water and sanitation services, health and nutrition educationand promotion of healthy behaviours are identified. In doing so, these documents adequately define the roles and responsibilities of all government actors, but young people and their guardians are not actively engaged in design and implementation. Additionally, there are several challenges to implementing these policies including budgetary constraints, limited resources, a lack of inter-sectoral coordinationand insufficient capacity within targeted schools. To improve the health and nutritional status of school-going children and adolescents in Tanzania, adequate budgets, strengthened coordination and implementation efforts, the development of school-based stakeholders' capacity, as well as the involvement of all other stakeholders, including adolescents, are imperative.

Identifying Future Study Designs and Indicators for Somatic Health Associated with Diets of Cohorts Living in Eco-Regions: Findings from the INSUM Expert Workshop.

Diets, but also overall food environments, comprise a variety of significant factors with direct and indirect impacts on human health. Eco-Regions are geographical areas with a territorial approach to rural development, utilizing organic food and farming practices, and principles and promoting sustainable communities and food systems. However, so far, little attention has been given to quantifying aspects of the health of citizens living in these sustainable transition territories. The project "Indicators for Assessment of Health Effects of Consumption of Sustainable, Organic School Meals in Eco-Regions" (INSUM) aims to identify and discuss research approaches and indicators that could be applied to effectively measure the somatic, mental, and social health dimensions of citizens in Eco-Regions, linked to the intake of organic foods in their diets. In this paper, we focus on the somatic (physical) health dimension. A two-day workshop was held to discuss suitable methodology with an interdisciplinary, international group of experts. The results showed the limitations of commonly used tools for measuring dietary intake (e.g., relying on the memory of participants), and nutritional biomarkers (e.g., variations in correlations with specific intakes) for research understanding dietary intake and the health effects of diets. To investigate the complexity of this issue, the most suitable approach seems to be the combination of traditional markers of physical and mental health alongside emerging indicators such as the microbiome, nutrigenomics, metabolomics, or inflammatory biomarkers. Using new, digital, non-invasive, and wearable technologies to monitor indicators could complement future research. We conclude that future studies should adopt systemic, multidisciplinary approaches by combining not only indicators of somatic and mental health and social wellbeing (MHSW) but also considering the potential benefits of organic diets for health as well as aspects of sustainability connected to food environments.

School health and nutrition environments: A multicountry survey in five countries of sub-Saharan Africa region-Burkina Faso, Ethiopia, South Africa, Sudan, and Tanzania.

Schools are increasingly regarded as a key setting for promoting the health, well-being, and development of children and adolescents. In this multicountry cross-sectional survey, we describe the health, nutrition, and food environments of public primary schools in five urban settings in Africa region: Ouagadougou, Burkina Faso; Addis Ababa, Ethiopia; Durban; South Africa, Khartoum, Sudan; and, Dar es Salaam, Tanzania. We evaluated the school health and nutrition (SHN) environments in three main areas: (1) the availability of health-related policies, guidelines, and school curricula, (2) the provision of health, nutrition, and water, sanitation, and hygiene (WASH)services in schools, and (3) the school food environments and eating habits of adolescents. We used stratified random sampling to recruit 79 schools from five countries. Trained fieldworkers collected standardized questionnaire data from 79 school administrators, 765 food vendors, and 4999 in-school adolescents aged 10-15 years. In our study, 24 out of 79 school administrators were aware of their school's health-related policies and guidelines while 30 schools had a specific SHN curriculum. In general, health, nutrition, and WASH services were inadequate. Possibly due to a lack of school kitchens, 14.4% of students bought snacks and unhealthy foods from food vendors. Our study indicates that schools' food and nutrition environments are insufficient to improve adolescent health and nutrition in the African region, including limited coverage of SHN policies, suboptimal facilities and nutrition services, and unregulated food environments. Schools in sub-Saharan Africa need to improve their health and nutrition environments.

Long COVID and the Higher Risk of Food Insecurity Among Participants and Nonparticipants of Food Assistance Programs in the United States

BackgroundIn the aftermath of the COVID-19 public health emergency, it is important to understand the extent of socioeconomic burdens of long COVID, defined as continuation of symptoms after initial infection, including food insecurity. ObjectiveThis study aimed to assess the association between long COVID and family food insecurity among low-income individuals (or any of their family members living with them) who were participants and nonparticipants in public food assistance programs (Supplemental Nutrition Assistance Program [SNAP], Special Supplemental Nutrition Program for Women, Infants, and Children [WIC], and National School Lunch Program [NSLP]) in the United States. DesignThe study used an observational cross-sectional design. Participants/settingData on 7151 adults (aged 18+ years), with family income of < 200% of the Federal Poverty line, from the 2022 National Health Interview Survey, were analyzed. Main outcome measuresLevel of family food security, based on responses to a set of 10 questions measuring family’s food security during the past 30 days. Statistical analyses performedMultinomial logistic regression models were estimated to obtain relative risk ratios of marginal and low/very low food security, relative to the base outcome of high food security, for long COVID status. Multivariable models were estimated separately for the full sample and for subgroups of food assistance participants and nonparticipants. A seemingly unrelated regression (SUR) specification was estimated to assess whether the estimates were different across the participant and nonparticipant subgroups. ResultsCompared with individuals who never had COVID-19, the adjusted relative risks of experiencing marginal and low/very low food security were 1.42 (95% CI, 1.00–2.02) and 1.43 (95% CI, 1.08–1.91) times higher, respectively, for individuals who had long COVID. Although the adjusted risks were not observed to be statistically significant in the participant subgroup, among nonparticipants, adjusted relative risk ratios were 2.34 (95% CI, 1.43–3.82) and 1.56 (95% CI, 1.02–2.39), respectively. SUR results showed that relationships between long COVID and food insecurity were only different for marginal and not low/very low levels of food security between food assistance participant and nonparticipant groups. ConclusionsStudy findings highlight a significantly higher risk of marginal and low/very low- food security among low-income adults who had long COVID, especially those who were nonparticipants in public food assistance programs. Further research is warranted to explore the causal pathways of this relationship for informing policies to mitigate the burden of long COVID.

Universal Free School Meals and School and Student Outcomes

The White House National Strategy on Hunger, Nutrition, and Health included expanding free school meals to all students, regardless of income, which has sparked debate in the United States. To assess the association between universal free school meals (UFSMs) and school and student outcomes in the United States. An expert panel-informed protocol was developed to evaluate intervention or cohort studies comparing UFSM programs, such as the Community Eligibility Provision (CEP), with non-UFSM programs in US schools from August 2012 (excluding 2020-2021 due to the COVID-19 pandemic) in peer-reviewed publications or government reports. Outcomes included meal participation rates, attendance, dietary intake and quality, food waste, economic impact, food insecurity, anthropometrics, disciplinary actions, stigma, and shaming. A search of Medline, Econlit, Business Source Ultimate, ERIC, Agricola, Cab Abstracts, and CINAHL was performed in April 2024. Two researchers screened articles for inclusion, extracted data, and assessed risk of bias, using the Risk of Bias in Nonrandomized Studies of Interventions tool, for each included study. Grading of Recommendations, Assessment, Development, and Evaluations was used to assess the certainty of evidence for each outcome. The search identified 2784 records, with 6 studies included, representing more than 11 000 elementary, middle, and high schools. Nonrandomized intervention studies performed difference-in-difference or rate ratio analysis to investigate CEP participation rates, attendance, anthropometrics, and/or suspensions. CEP was associated with increased lunch (3 studies; moderate certainty) and breakfast (1 study; very low certainty) participation. School attendance was unchanged or improved in schools with CEP compared with schools without UFSM (2 studies; low certainty). CEP was associated with lower obesity prevalence (1 study; very low certainty) and fewer suspensions (1 study; very low certainty). Reasons for downgrading the certainty ratings included indirectness (data not fully representative of the United States) and inconsistency (small number of studies limiting ability to assess consistency). Despite the limitations, the evidence reflected well-designed longitudinal intervention studies appropriate for decision-making. In this systematic review, UFSMs were associated with increased meal participation, no or slight improvements in attendance, and decreased obesity prevalence and suspension rates; certainty of evidence was moderate for lunch participation and low or very low for other outcomes. Studies did not report several important outcomes, such as diet quality and food security, suggesting the need for more high-quality research encompassing policy-relevant indicators.

Mapping the existing evidence of the effects of school food policies on health, acceptance and affordability of secondary school children in Europe: a scoping review protocol

IntroductionUnhealthy diets pose a significant public health risk among European children, contributing to the increasing prevalence of overweight and non-communicable diseases. Children spend a substantial amount of time at school...

Family meals are associated with lower substance use in female adolescents.

Adolescents, especially female youth, who have more family meals tend to be at lower risk for substance use. The present study tested whether family meals relate to substance use count and frequency during high school, whether associations differ by gender, and whether other family-related variables explain these associations. A community sample of 316 adolescents (Mage = 16.40, SD = 0.74; 56.96% female; 41.77% Latine, 23.10% Asian American, 29.11% European American, 6.01% from other ethnic backgrounds including Middle Eastern and African American) reported the number of substances they have ever used and how often they used alcohol, marijuana, and cigarettes, and completed measures of parental support and family cohesion. Across 15 days, they reported whether they had a family meal, got along with parents, and spent leisure time with their family each day. Regression models tested associations between frequency of family meals and substance use, whether associations differed by gender, and whether associations were explained by other family-related variables. Results indicated that more frequent family meals were associated with lower substance use count and less frequent alcohol, marijuana, and cigarette use among female adolescents but not male adolescents. Other daily family experiences were unrelated to substance use, and family meal frequency was independently related to lower substance use after accounting for parental support and family cohesion. Taken together, more frequent family meals in high school may reduce substance use risk for female adolescents, and interventions could consider promoting family meals in addition to other positive family values.

Increasing Access to Free and Reduced-Price School Meals through Social Service Programs: Findings from a Direct Certification with Medicaid Demonstration

Increasing Access to Free and Reduced-Price School Meals through Social Service Programs: Findings from a Direct Certification with Medicaid Demonstration

Contribution of school lunch programme to intake of micronutrients among preschool children in semi arid areas of Kilifi County, Kenya

Contribution of school lunch programme to intake of micronutrients among preschool children in semi arid areas of Kilifi County, Kenya

Challenges With School Meal Provisions in K-12 Public Schools: Findings From the National School COVID-19 Prevention Study.

School meals play a vital role in supporting student health. Access to school meals was disrupted during COVID-19-related school closures, impacting student nutritional intake and household food insecurity. Data from the National School COVID-19 Prevention Study Survey and school staff focus groups were used to examine challenges to school meal provision in K-12 public schools. Data were analyzed using R and MAXQDA. Survey data indicated that most schools served breakfast and lunch in the cafeteria or classroom during the 2021-2022 school year. City schools were less likely to experience challenges with receiving the foods and supplies needed for school meal programs. Qualitative data revealed that school meal participation increased during the COVID-19 pandemic, however schools encountered challenges when implementing the program including staff shortages and supply chain issues. Findings from this study can help strengthen the K-12 school meal system to equitably serve students in future public health emergencies.

Mixed Methods Study Investigating Adolescent Acceptance and Implementation Outcomes of Serving Spicy Vegetables in School Lunch

BackgroundOnly a few adolescents are meeting their daily vegetable requirement. At the same time, spicy food is increasingly popular and familiar across cultures. ObjectivesTo explore the implementation of spicy vegetables into school meals, the primary objective is to determine adolescents’ preferred degree of hot spice on steamed broccoli. Secondary objectives include estimating the appropriateness and acceptability of spicy vegetables in the National School Lunch Program and identifying strategies to promote spicy vegetables within school meals. MethodsOne hundred participants between the age 11 and 17 y sampled 4 steamed broccoli florets with varying levels of a ground red and cayenne pepper spice blend (0, 0.9, 2.0, and 4.0 g). Participants rated their likeability of each broccoli sample on a 9-point hedonic scale and answered a survey assessing chili liking, chili consumption patterns, appropriateness, and acceptability. An interview assessed perspectives on spicy vegetables within school lunch.Regression analyses assessed relationships between participant attributes and sample ratings and survey outcomes. Agglomerative hierarchical cluster analysis was conducted to cluster together participants with similar sample liking ratings. ResultsSeventy-seven percent of participants reported that chili pepper makes food taste better, and 67% consumed spicy food weekly or daily. Chili likers (n = 41) were the dominant cluster group, compared with moderates (n = 31) and chili dislikers (n = 28). Thematic analysis results suggested that most participants support incorporating spicy vegetables into school lunch but mushy vegetable texture may undermine the impact of changing school vegetable spice levels. ConclusionsSpicy foods are commonly consumed by adolescents, and these findings support the inclusion of spicy vegetables in school lunch. Additional research is needed to identify policies and practices to improve the texture of vegetables in school meals and determine additional strategies to support cultural humility in child nutrition programs.

The SABER School Feeding policy tool: a 10-year analysis of its use by countries in developing policies for their national school meals programs.

Since its launch in 2011, 59 governments have used the World Bank's Systems Approach for Better Education Results (SABER) policy tool to design their national school-based health and nutrition programs. This tool guides governments to self-evaluate their education system policies against international benchmarks and identify actionable priorities to strengthen national programs. Thirty-two of the 49 countries in sub-Saharan Africa (65%) have undertaken a SABER review, and globally the approach has been adopted by 68% of the world's low-income countries and 54% of lower-middle-income countries. Analysis of 51 comparable SABER School Feeding surveys suggests that countries with longer established national school meals frameworks tend also to be more advanced in other policy areas, and vice versa. The SABER reviews consistently identify, perhaps predictably, that the weakest policy areas relate to program design, implementation and fiscal space. This analysis also found that the tool had an additional value in tracking the evolution of policies when implemented over several time points, and showed that policy areas become more advanced as national programs mature. These benefits of the tool are particularly relevant to the 98 countries that co-created the global School Meals Coalition in 2021. The Coalition member countries have the specific goal of enhancing coverage and support for the well-being of schoolchildren and adolescents affected by the school closures during the COVID-19 pandemic. The SABER tool has the demonstrated potential to implement, accelerate and track changes in school meals policy and, since it has been previously used by 74% (31/42) of low- and lower-middle-income countries in sub-Saharan Africa, is an already accepted element of the political economies of those countries and so has the potential to be deployed rapidly.

Low Birth Weight as Predictor of Underweight and Stunting Among Female Students Aged 6-9 Years: an Observational Study in Surakarta

&lt;p&gt;&lt;strong&gt;Introduction:&lt;/strong&gt; Undernutrition remains a leading cause of premature mortality among children in developing countries. Previous studies discussed that the risk of undernutrition elevated with child’s age, stressing the need to address undernutrition in older children. Maternal factors also caused undernutrition through intergenerational transmission. However, data related to nutritional status of female children age &amp;gt;5 years in Indonesia are lacking. This study aimed to elucidate determinants associated with nutritional status among primary school girls in Surakarta.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This was an observational, cross-sectional study. A total of 61 female students aged 6-9 years from Nur Hidayah Primary School Surakarta participated in this study. Data were collected through online questionnaire filled by parents who were directed to follow the procedures of anthropometric measurement at home. Z-score was calculated using WHO AnthroPlus software. Nutritional status of children was measured in weight-for-age and height-for-age. Statistical analyses were performed using Spearman’s correlation and backward linear regression. Variables with p&amp;lt;0.05 from the final model were considered as the determinants.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results:&lt;/strong&gt; Among study participants, 4.9% were underweight and 9.9% were stunted. Our study found one common determinant of nutritional status by weight-for-age and height-for-age, namely birth weight (p=0.027 and p=0.011 respectively). Maternal height was, in particular, associated with nutritional status by height-for-age (p=0.001).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion:&lt;/strong&gt; Birth weight was significantly associated with nutritional status by weight-for-age and height-for-age, while maternal height was significantly correlated with only nutritional status by height-for-age. Nutrition programs for female students such as school lunch and multivitamin supplementation could be implemented to prevent the intergenerational effects of stunting and underweight.&lt;/p&gt;

Let us go with the flow − Impact of a dynamic social norm nudge on parents’ school menu selection

Designing more sustainable school meal offerings not only contributes to environmental protection and climate change mitigation but also promotes children’s health, provides food education, and raises awareness on sustainability issues. The present study, using a between-subject experimental online survey (N = 617), proved the effectiveness of a dynamic social norm nudge in encouraging parents to make more environmentally friendly choices when selecting school menus for their elementary school children. In addition, nudging was more successful in promoting sustainable food choices among parents with lower levels of education and those who are more actively involved and responsible for child-related practices. Disentangling the individual traits that leverage the effectiveness of nudges should allow public entities to fully exploit the potential of these interventions and design tailored approaches for targeted subpopulations.

Impact of a school-based food assistance program on household food insecurity in Greece, 2012–2019: a multi-year evaluation of the DIATROFI program

BackgroundChildhood food insecurity can persist among low socioeconomic areas in high-income countries. Universal Free School Meal (UFSM) programs are designed to respond to this pressing issue. This study aimed to conduct a multi-year evaluation of the DIATROFI Program’s impact on household food insecurity in Greece. MethodsThis study utilized data from 18,716 students (618 kindergarten to high schools), from low socioeconomic areas participating in the school-level UFSM Program DIATROFI between 2012 and 2019. Parents of students completed annual baseline and follow-up paper-based self-completed questionnaires. The primary outcome was household food insecurity, measured using the Food Security Survey Module (FSSM) at both questionnaires, and evaluated through mixed linear and logistic regression models with repeated measurements. FindingsStudents’ median age was 9 years old (Interquartile range (IQR): 6·5, 12·0), 51·6% (n=9,658) were girls, and 82·2% (n=15,382) lived in low/medium socioeconomic affluence households. Households with food insecurity reduced from 51·5% (n=9,630) to 47·6% (n=8,901) after one school year. Food insecurity score declined steadily for four years of consecutive participation, compared to baseline score (one-year b:–0·26; 95% Confidence Interval (CI):–0·30, –0·22, and four-year –1·28; –1·53, –1·03). The likelihood of retaining food insecure status reduced from 17% after one-year participation (Odds Ratio (OR): 0·83; 95% CI: 0·79, 0·87) to 36% after four-year participation (0·64; 0·49, 0·82). The Program’s impact on household food insecurity alleviation was greater among households with low parental education and low socioeconomic affluence. InterpretationThe DIATROFI Program effectively improved household food security during and after the Greek socioeconomic crisis. School-level UFSM programs targeting underprivileged students can improve household food insecurity, with a more pronounced effect with increased years of participation, and among economically disadvantaged households. FundingThe DIATROFI Program was funded through various national and private organizations, including national prefecture authorities, Greek payment authorities, philanthropic/charitable organizations, and private companies.

Community Recommendations for Adapting an Evidence-Based Mental Health Intervention for Racially/Ethnically Diverse Schools: A Qualitative Study

AbstractThe goal of this qualitative study was to understand the perspectives of school community members (adolescents, parents, school administrators, teachers, mental health providers) regarding the adaptation of an evidence-based transdiagnostic mental health treatment, known as the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Adolescents, for delivery in racially/ethnically diverse schools. Thirty-three school community members (n = 9 adolescents, n = 4 parents, n = 5 school administrators, n = 10 teachers, n = 5 mental health providers) participated in a series of focus groups or individual interviews. We used a rapid qualitative analysis to summarize their recommendations for adapting our intervention across seven themes: (1) consider social determinants of health, (2) include content related to social media and digital literacy, (3) provide teachers and staff with training on identifying and referring to mental health services and basic psychoeducation, (4) build trust and reduce stigma, (5) use qualified mental health providers to conduct culturally relevant sessions in person during school hours, (6) consider flexible format offerings and extended intervention delivery window, and (7) anticipate low parental engagement. These data were critical for informing systematic content and procedural modifications to our adapted intervention, such as scheduling sessions for school lunch hours and identifying coaches (e.g., teachers, school administrators) to support students with check-ins regarding session attendance and skill practice. These adaptations may be applied more broadly to the implementation of evidence-based mental health interventions in diverse school settings.

Three years of COVID-19-related school restrictions and mental health of children and adolescents in Japan

During the 3 years of the COVID-19 pandemic, Japanese children had to live with strict mitigation measures at school, such as eating school lunches silently and wearing masks during physical exercise classes, even after those mitigation measures have been relaxed worldwide. Excursions and other school events were frequently cancelled, especially in 2020 and 2021. This study conducts a retrospective survey on school experiences to understand how the strict mitigation measures were related to children's mental health and well-being. Results revealed school excursion cancellation to be associated with a higher risk of developing depressive symptoms {odds ratio [OR] 1.543 [95% confidence interval (CI) 1.109–2.148]}, and high cancellation rate of other school events to be associated with dissatisfaction in school experience [OR 1.650 (95% CI 1.222–2.228)]. In the subsample analysis, we found that girls and children with no extracurricular activities tended to exhibit depressive symptoms due to the cancellation of school excursions. Overall, the study demonstrated that persistent strict mitigation measures at schools might be a key factor in understanding children’s mental health and psychological well-being during a long-lasting pandemic.

Socio-spatial networks and capital in small rural primary school voluntary activity

ABSTRACT Small primary schools and schools with the lowest number of free school meal (FSM) eligibility are increasingly reliant on voluntary activity for the provision of core services. Significant disparities in where and how this voluntary activity happens risk widening inequalities between schools, especially when policies directly encourage them (and funding cuts necessitate them) to turn to their communities for support. However, we do not know how these differences play out in practice or what the implications might be. Drawing on ethnographic research, this paper explores how voluntary activity undertaken in small rural primaries is facilitated through socio-spatial networks (interpersonal connections rooted in space) and how capital is mobilised (and converted) through these networks. This research revealed how the work of education is carried out through many socio-economic modes, by different people and across a range of spaces, and that this influences the education provided in these environments.

Is being clever enough? Young people’s construction of the ideal student in computer science education

ABSTRACT Popular discourses of computing and computer science can often frame the sector and the people within it as highly intelligent yet socially challenged, contributing to stereotypes that can potentially exclude those perceived to lack these skills or characteristics. For young people, such stereotypes can influence their educational and career aspirations, especially if there are discrepancies between their own identity and perceptions of what is desirable for computer science students. Drawing on open-ended questionnaire data from 3235 young people in England (aged 11–16), we collected 9442 keywords that students used to describe their “ideal student” in computer science education. An understanding of these perceptions allows us to recognise the prevailing stereotypes that may be shaping young people’s views and aspirations. In this paper, we employ an innovative large-scale descriptive analysis of the most common words that students use to describe the ideal computer science student, including its differences, if any, by students’ demographic background (e.g. gender, ethnicity, free school meal) and responses to the questionnaire (e.g. aspirations to be a computer scientist). We tentatively identified eight clusters of popular ideal student characteristics, namely being Smart & Clever; Knowledgeable & Interested; Determined & Hardworking; Kind & Helpful; Creative; Independent; Confident; and Collaborative. By examining how students imagine the ideal student in computer science, we gain better understanding of their educational aspirations and choice of study and provide educators with valuable insights to potentially challenge and reshape these perceptions. These insights can inform educational interventions to foster a more inclusive computing education.

Fortified whole grains and whole blends: A timely food systems shift

Grains are central to food systems in low- and middle-income countries (LMICs). Their predominant consumption in refined form contributes to the double burden of malnutrition and wastes precious food and natural resources in a world challenged by growing food insecurity and accelerating climate change and biodiversity loss. Shifting consumption from refined grain foods to fortified whole grain and whole blend foods can improve food security and make diets healthier. This would also make food systems more efficient and resilient, and help mitigate the food crisis. School meal programs and other institutional and safety net markets offer the best entry points to initiate this necessary shift in food systems within LMICs.