School Food Environment Research Articles

The Relationship Between Schools and the Food and Beverage Industry in Guatemala: In-Depth Interviews with School Principals

ABSTRACT Schools are considered a point of sale (POS) channel to reach students with ultra-processed foods and beverages (UPFB) advertising and products. We sought to determine the type of relationship between schools and the UPFB industry in Guatemala City. During 2020, we interviewed 20 school principals. Descriptive statistics and inductive thematic coding were used for the analysis. Schools struggle with commercialism by engaging in unregulated relationships with the industry where they become a place of commercial value mediated by events sponsorship and exclusive contracts based on trust, among other strategies. School commercialism needs to be restricted to improve school food environments.

School Nutrition Personnel Perceptions of School Salad Bars before and after COVID-19.

Many schools have salad bars as a means to increase students' fruit and vegetable intake. School nutrition programs experienced drastic changes to the school food environment due to COVID-19. The aim of the current study was to understand cafeteria personnel's experiences related to salad bar implementation before the COVID-19 pandemic and in the current school environment to inform efforts to enhance salad bar sustainability. Seven elementary schools (N = 30 personnel) installed salad bars prior to COVID-19; three of these schools (n = 13 personnel) re-opened salad bars after COVID-19. Cafeteria personnel completed surveys assessing their experiences with salad bars at both time points. Satisfaction with salad bar implementation and training was high pre- and post-COVID-19. Most agreed that salad bars increased students' fruit and vegetable intake, yet had concerns about cleanliness and waste. Perceived job difficulty increased post-COVID-19 (p = 0.01), and satisfaction with student salad bar training decreased (p = 0.001). Additional staff support and greater student training were needed post-COVID-19. Overall, salad bars were viewed favorably; however, more challenges and lower satisfaction were reported following COVID-19. Increasing support for cafeteria personnel is needed for salad bar sustainability and improving the school food environment.

Creating Healthy Environments for Schools: A Comprehensive Approach to Improving Nutrition in Arkansas Public Schools.

Nutrition plays a vital role in children's physical and emotional health. More than half of school age children's calories are provided in the school food environment, making school interventions an opportunity to address child nutrition. The Creating Health Environments for Schools (CHEFS) program is designed to leverage local resources to create customized solutions that improve the nutritional content of school food and encourage children to choose healthier food. There are 8 components: (1) customizing nutrition plans, (2) modifying/replacing menu items, (3) helping procure healthier food, (4) providing equipment grants, (5) training cafeteria staff, (6) implementing environmental changes and nudges, (7) engaging students and parents, and (8) supporting sustainability. Supporting child nutrition directors is key to facilitating cooperation with schools. Menu modifications and procurement are interrelated and depend on successfully collaborating with corporate, independent, and local food services organizations. Limited school budgets require low or no-cost solutions and staff training. Student and parent engagement are critical to facilitate culturally-appropriate solutions that increase awareness of healthy food. Every school district has particular resources and constraints. CHEFs engaged stakeholders to design customized solutions and encourage healthier nutrition for school children.

Conservative rhetoric against the regulation of the food environment in schools: the discussion of Bill n 4.198/2021 in the Legislative Assembly of Rio de Janeiro

Resumo Diante das evidências científicas acerca dos malefícios à saúde do consumo de alimentos ultraprocessados, a regulação dos ambientes alimentares vem sendo priorizada como forma de promover uma alimentação adequada e saudável. Nesse contexto, foi proposto o Projeto de Lei 4198/2021 na Assembleia Legislativa do Rio de Janeiro, para proibir o comércio de ultraprocessados nas escolas do estado. Na segunda sessão em plenário da proposição, houve ampla utilização de retóricas conservadoras pelos deputados contrários. Neste presente ensaio foram classificados esses posicionamentos, encontrando-se pontos comuns entre eles, à luz da análise da tramitação legislativa. Ao realizar essa categorização, foi possível identificar três bases argumentativas exploradas: a defesa da liberdade de comércio; o direito à “pátria família”, de primazia da família na educação infantojuvenil; e a responsabilização individual da obesidade. Tais retóricas foram analisadas em conjunto com suas contraposições, presentes nas conclusões da literatura especializada. Para além da pluralidade de ideias do debate legislativo, foi possível identificar como a discussão do PL 4198/21 foi permeada pela reprodução de desinformação e violência. Desse modo, o escrutínio das retóricas conservadoras utilizadas e a compreensão do contexto dessa discussão são contribuições aqui propostas para a consolidação do repertório de defesa da saúde de crianças e adolescentes.

Do Food and Meal Organization Systems in Polish Primary Schools Reflect Students' Preferences and Healthy and Sustainable Dietary Guidelines? The Results of Qualitative Research for the Junior-Edu-Żywienie (JEŻ) Project.

The school environment, together with that of the family, shapes students' eating behaviors, and is an important element of formal and informal nutrition education. The informal and practical dimensions can be realized through the food and meals offered/sold in school canteens, shops, and vending machines. As children and adolescents spend 6-10 h/day in schools and consume at least two meals there, the school food environment is important from a public health perspective. The aim of this study is to assess food and meal organization in primary schools in Poland. The study was conducted using individual in-depth interviews (IDIs) involving 24 school headmasters and 24 representatives of people employed in school canteens or catering companies involved in meal organization in schools. The nutritional food on offer at schools is important for shaping students' food preferences and choices, consequently influencing the development, functioning, and health of this subpopulation. The school environment can be an ideal place for hands-on nutrition education. In addition to the knowledge provided, there must be a consistent message concerning the provision of nutrition information to students between the teachings of parents, teachers, and, indirectly, the food and meals available at school. Our qualitative study is confirmed by the results of quantitative research to better understand the organization of nutrition and the problems and needs of primary schools in this area.

Nutrition-Related Knowledge, Diet Quality, Lifestyle, and Body Composition of 7-12-Years-Old Polish Students: Study Protocol of National Educational Project Junior-Edu-Żywienie (JEŻ).

Increasing students' nutrition knowledge is an important goal of school education which may improve their lifestyle and consequently reduce the incidence of non-communicable chronic diseases, including obesity. This research aimed at assessing the dietary habits, nutrition-related knowledge and attitudes, and nutritional status of Polish students aged 7-12 years. Additional objectives included recognizing nutrition-related knowledge among their parents and teachers as well as the school food and nutrition environment. The final goal was to develop a nutrition education program. This study protocol presents a general and detailed approach for realizing the above-mentioned issues, including conducting quantitative and qualitative research. The study was designed as cross-sectional, covering primary school students from all over Poland, including rural, town, and metropolitan areas. Data on eating habits, lifestyle, nutrition-related knowledge, and attitudes were collected with questionnaires. Measurements of body weight, height, waist and hip circumferences, and handgrip strength were performed in accordance with the International Standards for Anthropometric Assessment (ISAK) recommendations. Body composition was assessed with bioelectrical impedance analysis. Ultimately, 2218 schools from all 16 voivodeships in Poland registered for the project. In total, quantitative data were collected among 27,295 students, 17,070 parents, and 2616 teachers. Anthropometric measurements were taken among 18,521 students. The results allow us to develop a multifaceted educational program based on knowledge and adapted to the perception of students. Our research may contribute to the identification of subpopulations of children and adolescents at risk of excessive body weight and define the predictors of obesity risk in Poland.

Evaluation of School Wellness Policies in Low-Income California Districts After the 2016 USDA Final Rule.

Districts with federal nutrition programs must have an updated local school wellness policy (LSWP) to promote nutrition, physical activity, and student wellness. This study evaluates factors associated with LSWP quality among low-income districts. In 2018, we collected LSWPs from websites of 200 randomly selected, county-stratified, low-income-serving California public districts. Multivariable linear regression assessed associations between district characteristics, model LSWP use (national, state, none), and adoption date on policy quality. On the WellSAT 3.0 scale of 0-100, mean (95% CI) comprehensiveness was 65.0 (63.2-66.7) and strength was 37.3 (35.3-39.2). Nearly verbatim adoption of model LSWPs was high(68.5% state model, 13.0% a national model). Half were adopted before mandated updates. District size (≥1000 students) and national model LSWP adoption were associated with higher comprehensive scores. National model LSWP adoption was associated with higher strength scores in updated policies compared with those not updated. LSWPs have improved school food and activity environments, but district engagement in LSWP is low. Integration into education frameworks that reduce learning barriers could provide synergy for re-engagement. High adoption of model policies and low update compliance indicate little district engagement in LSWP. Mixed methods studies of districts with high-quality LSWP are needed.

Developing a Policy for Healthy Schools Food: A Plan of Action

Background and Objectives: Childhood obesity is a pressing global health concern, particularly in low- and middle-income countries like Palestine. This study aims to address the prevalence of childhood obesity in Palestine and its association with the school food environment. The objective is to propose and advocate for the implementation of a "healthy schools' food policy" to promote the consumption of nutritious food while prohibiting the sale of unhealthy items. Methods: A comprehensive analysis of the sociocultural, economic, political, ethical, and legal contexts surrounding childhood obesity in Palestine was conducted. This included a review of existing studies, stakeholder analyses, and an evaluation of policy alternatives. A legislative strategy was developed to guide the implementation of the proposed policy. Results: The study identified the widespread prevalence of childhood obesity in Palestine, with contributing factors rooted in sociocultural, economic, and political contexts. The analysis of policy alternatives revealed that establishing and enforcing a written protocol for "Food and Beverage Services" in schools emerged as the most effective option. This policy approach received the highest score in terms of effectiveness, access and fairness, cost-effectiveness, and administrative and political feasibility. Conclusion: The findings highlight the urgent need for policy interventions to address childhood obesity in Palestine. The proposed "healthy schools' food policy" offers a promising avenue to promote nutritious food consumption while curbing the availability of unhealthy options. Collaborative efforts involving stakeholders, including schools, the Ministry of Education, healthcare professionals, parents, and the community, are crucial for successful policy implementation. Regular evaluations and community feedback will be essential to monitor the policy's impact and make necessary adjustments. This study underscores the significance of prioritizing children's health within the broader context of societal well-being.

Lunchbox shaming: recollections of school lunchtime by young Canadians of Asian descent

ABSTRACT Children’s home-packed lunches to school reflect family’s culinary cultures, social locations, and unique food norms. At Canadian elementary schools, children of Asian heritage sometimes experience “lunchbox shaming” – feeling embarrassed for bringing foods that are seen deviant from dominant food norms. This study explored the recollections of school lunchtime by 25 young adults (aged 17–25 years) from three largest Asian ethnocultural groups (Chinese, Indian, and Filipino) in Toronto, Canada. Two parents of the participants also joined follow-up interviews to provide their insights. Our analysis focused on four layers of meanings at micro-level (personal experiences and emotions), meso-level (family food practices, school food environment), macro-level (socio-historical discourses), and interactional-level (researchers’ positionalities). Many participants recalled painful experiences being teased by classmates of their “stinky” lunch, throwing away homemade lunches, or asking parents to pack “normal” lunches to fit in. Conversely, a few shared positive memories of their lunches being praised and felt proud of their culinary heritage. Many reportedly felt a need to balance affiliation to both their home and school food cultures while growing up in Canada. We conclude by discussing the implications of the study findings for the ongoing debate on Canada’s national school food program and food literacy education.

Knowledge and Utilisation of Iodised Salt by School Children and Food Vendors in Dar es Salaam, Tanzania.

Universal Salt Iodisation (USI) is globally accepted as a cost-effective strategy for controlling Iodine Deficiency Disorders (IDD). However, there is a paucity of data on the proper use of iodised salt among food vendors. Thus, the present study assessed the School food environments and iodised salt practices among school food vendors in Tanzania. A cross-sectional study was conducted involving 322 school children and 30 school food vendors. A stratified multistage followed by a systematic random sampling technique was used to recruit schools and children. Salt samples were collected from food vendors and analyzed using the iodine rapid field test kit and then analyzed quantitatively using an iodometric titration method. The data on knowledge, attitude, and practices was collected using customized Iodine deficiency-related questionnaires recommended by FAO to assess iodine deficiency-related factors. For school food environments, 3 tools were designed and used to get information; the teachers, students, and school food vendors' tools. A chi-square test was used to establish an association between variables. About 76.7% of the salt samples from school food vendors were adequately iodised (≥15 ppm) with the mean iodine content of 39.26 ± 11.06. More than half (70%) of the food sold around school compound were junk food. Half (63.3%) of the food vendors had poor practices of iodised salt utilisation. A substantial achievement has been made in awareness creation of the importance of using iodised salt. Nonetheless, there is a limited knowledge on salt handling practices including discretionary salt use exacerbated by poor school food environment. To optimally eliminate IDDs, the government should now place more emphasis on proper salt handling practices from the production site, food handlers, and much more to consumers. School children should be encouraged on healthy eating habits, by improving school feeding programs and change the current food environments in schools.

Do Brazilian regulatory measures promote sustainable and healthy eating in the school food environment?

BackgroundRegulatory measures regarding food in the school environment aim to promote a healthier food environment in public and private schools. In Brazil, implementing regulations in the school food environment does not occur the same way across states and cities, and no national regulation covers public and private schools. The present study aims to analyze regulatory measures for school food environments in Brazilian states and cities and develop a score to evaluate them.MethodsA systematic search of the regulatory measures in force and implemented until 2021 was conducted. The score was developed based on the Model Law Project prepared by the Brazilian Institute for Consumer Protection. It considered food and nutrition education actions, restrictions on the sale and distribution of food, a ban or restriction on food advertising and marketing, and points of excellence. These points included regulations that addressed the importance of supervision and social control, laws regulated by decree, the mention of a ban on ultra-processed foods, and whether the regulatory measures covered public and private schools.ResultsSixty-five cities and states regulatory measures in force were found to be evaluated jointly by a federal entity (n = 43). Among the federal entities evaluated, only 13.95% fulfilled the function of promoting sustainable and healthy eating (8–12 points).ConclusionsBrazilian children and adolescents are exposed to a school food environment with regulations that partially fulfill the function of promoting an adequate, healthy, and sustainable diet. In this sense, it is necessary to improve regulatory measures or to encourage states and cities to develop effective legal provisions that are in line with the food guide for the Brazilian population and with the perspective of a healthy school food environment for the effective promotion of adequate, healthy and sustainable and healthy food in schools.

How School Food Environments Influence Food Choices: Evidence from Citizen Science and Focus Groups

Abstract Background Adolescents, as lucrative targets of food producers, encounter high-choice school food environments that offer an excess of highly processed foods. However, there is limited data on the actual food supply inside and around Austrian schools, adolescents preferences, and how it affects their food choices. To bridge this gap, our study employs an innovative mixed-methods approach to explore adolescents’ food choices. Methods In Study 1, we conducted a citizen science study with students as volunteer scientists who categorized 953 food items from 144 food suppliers in and around their schools based on the Austrian food pyramid. Study 2 explored students’ food preferences in four focus groups with 25 students (11 male, 14 female) aged between 12 and 15, each conducted at a different school in Tyrol. We then correlated the results of individual preferences with the documented food supply. Results The results of Study 1 revealed that the food supply in the investigated schools was predominantly categorized as unhealthy. The students classified 46% of the items as ‘unhealthy,’ 32% as ‘intermediate,’ and only 22% as ‘healthy.’ In Study 2, we identified three influential factors in students’ food choices: 1) individual factors (such as taste and preferences), 2) social factors (such as interactions with peers), and 3) structural factors (such as physical environment and accessibility). Conclusions The study indicates that current school food environments are dominated by unhealthy products, which cater to unhealthy preferences among adolescents. To address this issue, policies should aim to create accessible and fun spaces where food supplies are presented in an attractive way. This includes providing areas where students can mingle and express their identities. Key messages • Attractive presentation of healthy foods in locations, which cater to the social needs of adolescent students, are key to foster and consolidate healthy food choices. • Improve accessibility and supply of healthy food choices in school food environments.

Food Environments Within and Outside of Schools Play a Critical Role in Curtailing the Rise in Obesity among School-Aged Children over Time

BackgroundSound evidence for effective community-based strategies is needed to curtail upward trends in childhood obesity in the United States (US). ObjectivesThe aim of the study was to assess the association between school and community food environments and the prevalence of obesity over time. MethodsData were collected from K–12 schools in 4 low-income New Jersey cities in the US. School-level obesity prevalence, calculated from nurse-measured heights and weights at 4 time points, was used as the outcome variable. Data on the school food environment (SFE) measured the healthfulness of school lunch and competitive food offerings annually. The community food environment (CFE), i.e., the number of different types of food outlets within 400 m of schools, was also captured annually. The count and presence of food outlets likely to be frequented by students were calculated. Exposure to composite environment profiles both within schools and in communities around schools was assessed using latent class analysis. Data from 106 schools were analyzed using multilevel linear regression. ResultsThe prevalence of obesity increased from 25% to 29% over the course of the study. Obesity rates were higher in schools that had nearby access to a greater number of limited-service restaurants and lower in schools with access to small grocery stores and upgraded convenience stores participating in initiatives to improve healthful offerings. Interaction analysis showed that schools that offered unhealthier, competitive foods experienced a faster increase in obesity rates over time. Examining composite food environment exposures, schools with unhealthy SFEs and high-density CFEs experienced a steeper time trend (β = 0.018, P < 0.001) in obesity prevalence compared to schools exposed to healthy SFE and low-density CFEs. ConclusionsFood environments within and outside of schools are associated with differential obesity trajectories over time and can play an important role in curtailing the rising trends in childhood obesity.

Participatory prioritisation of interventions to improve primary school food environments in Gauteng, South Africa

BackgroundIn South Africa, overweight and obesity affect 17% of children aged 15–18. School food environments play a vital role in children’s health, influencing dietary behaviours and resulting in high obesity rates. Interventions targeting schools can contribute to obesity prevention if evidence-based and context-specific. Evidence suggests that current government strategies are inadequate to ensure healthy school food environments. The aim of this study was to identify priority interventions to improve school food environments in urban South Africa using the Behaviour Change Wheel model.MethodsA three-phased iterative study design was implemented. First, we identified contextual drivers of unhealthy school food environments through a secondary framework analysis of 26 interviews with primary school staff. Transcripts were deductively coded in MAXQDA software using the Behaviour Change Wheel and the Theoretical Domains Framework. Second, to identify evidence-based interventions, we utilised the NOURISHING framework and matched interventions to identified drivers. Third, interventions were prioritised using a Delphi survey administered to stakeholders (n = 38). Consensus for priority interventions was defined as an intervention identified as being 'somewhat' or ‘very' important and feasible with a high level of agreement (quartile deviation ≤ 0.5).ResultsWe identified 31 unique contextual drivers that school staff perceived to limit or facilitate a healthy school food environment. Intervention mapping yielded 21 interventions to improve school food environments; seven were considered important and feasible. Of these, the top priority interventions were to: 1) “regulate what kinds of foods can be sold at schools”, 2) “train school staff through workshops and discussions to improve school food environment”, and affix 3) “compulsory, child-friendly warning labels on unhealthy foods”.ConclusionPrioritising evidence-based, feasible and important interventions underpinned by behaviour change theories is an important step towards enhanced policy making and resource allocation to tackle South Africa’s childhood obesity epidemic effectively.

Perceptions of food environments in the school and at home during Covid-19: An online cross-sectional study of parents, teachers and experts from Latin America.

The high prevalence of overweight and obesity in children from Latin America (LA) have been related to obesogenic food environments. Besides, the negative effects of the Covid-19 pandemic should also be considered. The objective of this research was to describe and compare the perceptions of parents, teachers, and experts in LA of food environments at home and school that favor healthy habits in schoolchildren in pre Covid-19 stage and during the pandemic. This study used a survey self-reporting regarding conditions at home and the school favoring healthy habits, for three profiles: parents, primary school teachers, and experts. A fisher exact test was used to establish the difference between the response categories between countries and profiles. Logistic regression models were used to determine the probability of response in the levels of importance adjusted for sex and nationality. Information from 954 questionnaires was reported: 48.4% experts, 32.0% teachers, and 19.6% parents. There were differences in the perception of food environments at school between profiles (p<0.001). In multivariate logistic regression models, experts and teachers were 20% more likely to give greater importance to elements of the food environment at school compared to parents (p<0.001). Our findings showed that parents were less likely to perceive important elements of the school food environment compared to experts and teachers. Interventions are required to improve healthy eating environments that consider children's interpersonal mediators.

How (Un-)Healthy are Austrian school food environments? Evidence from focus groups and citizen science

BackgroundAdolescents face high-choice school food environments that offer plenty of highly processed foods. Processed food producers target young people in their marketing, but there is limited data on the actual food supply inside and in the vicinity of Austrian schools and its impact on adolescent food choices. This study employs an innovative mixed-methods approach to explore adolescents' food choices. MethodsIn Study 1, we conducted a citizen science study, with students as volunteer scientists. The students examined the food supply in and around their schools according to the Austrian food pyramid and categorized 953 food items in 144 food suppliers using photographs and descriptions. In Study 2, we explored students' food preferences in focus groups. We conducted four focus groups at four different schools in Tyrol, with 25 students (11 male, 14 female) between the ages of 12 and 15. We then linked the findings on individual preferences with the documented supply. ResultsStudy 1 found that the food supply in the investigated schools was predominantly categorized as unhealthy. The students categorized 46% as “unhealthy”, 32% as “intermediate”, and only 22% as “healthy”. Study 2 identified three influential factors in students' food choices: 1) individual factors (such as taste and preferences), 2) social factors (such as mingling with peers), and 3) structural factors (such as physical environment and accessibility). ConclusionThe study shows that unhealthy products cater to unhealthy preferences among adolescents and dominate current school food environments. Policies need to address unhealthy school food environments to tackle this issue. Food supplies should be presented in an attractive ways, in fun places where students can mingle and express their identities.

Capturing the whole-school food environment in primary schools.

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. 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. Primary schools. 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). 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 %). 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.

The influence of adolescents' nutrition knowledge and school food environment on adolescents' dietary behaviors in urban Ethiopia: A qualitative study.

Adolescence is a critical period of physical, cognitive, and social development that needs to be supported with healthy diets. Dietary behaviours of adolescents can be shaped by their nutrition-literacy and their interaction with parents and peers as well as their school food environment. Therefore, the present study aimed to assess factors that influence dietary behaviours of adolescents in urban Ethiopia. Sex-disaggregated, focused group discussions (n = 70) were conducted in 36 private and government schools (n = 12/city) among adolescents (n = 432) 15-19 years of age in Addis Ababa, Bahir Dar, and Dire Dawa. Photovoice was applied in a subgroup of participants (n = 216) to gain further insights into adolescents' perception of their school food environment. Key informant interviews were conducted among school principals (n = 36). Adolescents had a relatively good nutrition knowledge and recognised the importance of diverse diets, but misperceptions also existed. They identified fruit and vegetables as healthy foods, but their consumption was deterred by food safety concerns. The adolescents identified foods high in salt, fat, and sugar, including processed/packaged foods as unhealthy, but still consumed them frequently due to their taste, affordability, availability and accessibility in and around schools. Both undernutrition and overweight/obesity were linked to social exclusion and bullying in school. Effective behavioural change communication is required to address common misperceptions. School nutrition programs should integrate water, sanitation and hygiene programs to ensure food safety. Regulations promoting healthy eating while discouraging unhealthy dietary behaviours are vital. Interventions to make nutrient-dense and healthy foods available, accessible, and affordable are urgently needed to improve the nutrition and health outcome of adolescents.

Food environment around schools and adolescent consumption of unhealthy foods in Addis Ababa, Ethiopia.

Adolescent diets may be influenced by the retail food environment around schools. However, international research to examine associations between the proximity of retail food outlets to schools and diet provides equivocal support for an association. This study aims to understand the school food environment and drivers for adolescents' consumption of unhealthy foods in Addis Ababa, Ethiopia. Mixed-methods research was conducted, 1200 adolescents (10-14 years) from randomly selected government schools were surveyed, along with vendors within 5-min' walk of the schools and focus group discussions (FGDs)with adolescent groups. Mixed-effect logistic regression investigated the relationship between the number of vendors around the schools and the consumption of selected unhealthy foods. Thematic analysis was used to summarize findings from the FGDs. Consumption of sweets and sugar-sweetened beverages (S-SSB)and deep-fried foods (DFF)at least once a week was reported by 78.6% and 54.3% of the adolescents, respectively. Although all schools were surrounded by food vendors selling DFF and S-SSB,consumption was not associated with the number of vendors available around the school. However, adolescents' awareness and perception of healthy food, and their concerns about the safety of foods in the market, influenced their dietary choices and behaviours. Lack of financial resources to purchase food as desired also played a role in their selection of food and eating habits. Reported unhealthy food consumption is high among adolescents in Addis Ababa. Thus, further research is warranted to come up with school-based interventions that promote access and healthy food choices among adolescents.

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

BackgroundSchools 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.MethodsEight 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.ResultsThe 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'.ConclusionsOur 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.