School Stores Research Articles

'I Knew I Should Stop, but I Couldn't Control Myself': a qualitative study to explore the factors influencing adolescents' consumption of sugar-sweetened beverages and sugary snacks from a socio-ecological perspective.

To explore the factors influencing Taiwanese adolescents' consumption of sugar-sweetened beverages (SSB) and sugary snacks from a socio-ecological perspective. This study adopted a qualitative design by using face-to-face, in-depth interviews guided by a semistructured questionnaire. Eight junior high schools in New Taipei City and Changhua County, Taiwan, September to November 2018. Fifty-nine participants aged 12-14 years participated in this study. Reflexive thematic analysis was used to analyse the data. This study identified four themes to address the multifaceted factors that influence adolescents' consumption of SSB and sugary snacks. At the intrapersonal level, physiological factors, psychological factors, individual economic factors and taste preferences were mentioned in connection with people's consumption of SSB and sugary snacks. Positive or negative influences of parents, siblings, peers and teachers on SSB and sugary snack intake were identified at the interpersonal level. The availability of SSB and sugary snacks at home, their availability in vending machines or in school stores in the school environment and participants' access to convenience stores and hand-shaken drink shops in the broader community influenced SSB and sugary snack consumption. Additionally, food culture and food advertising were identified as influencing societal factors. Overall, this qualitative study determined not only that the consumption of SSB and sugary snacks is influenced by intrapersonal factors but also that interpersonal, environmental and societal factors affect adolescents' increased sugar intake. The findings are helpful to broaden the options for designing and developing interventions to decrease SSB and sugary snack consumption by adolescents.

Association between Nutrition Policies and Student Body Mass Index.

In response to concerns about childhood obesity, many US states have implemented policies to limit the sale of unhealthy foods and beverages (e.g., snacks, desserts, and sugary drinks) sold in competition with school meal programs (i.e., competitive foods) in order to improve the nutritional environment of schools and support student health. This study measured state-level competitive food and beverage policies that require foods and beverages sold in à la carte lines, vending machines, and school stores to meet strong nutrition standards and tested the hypothesis that students living in states with stronger laws would have lower body mass index (BMI)-for-age percentiles. BMI data from a national sample of 1625 students attending 284 schools from the School Nutrition and Meal Cost Study were linked to state laws coded as part of the National Wellness Policy Study. A survey-adjusted linear regression model accounting for student and school-level characteristics showed that stronger state nutrition policies were associated with lower student BMI scores (coefficient: −0.06, 95% CI: −0.12, −0.00). Additional models indicated that stronger state policies were significantly associated with fewer unhealthy foods and beverages available in schools. These findings suggest that strong regulations on competitive foods and beverages may lead to improvements in the nutritional quality of the school environment and student BMI. Thus, current federal standards regulating snacks in US schools (i.e., Smart Snacks) are an important element of a comprehensive strategy to improve the school nutrition environment and reduce rates of childhood obesity.

Basic school pupils' food purchases during mid-morning break in urban Ghanaian schools.

Unhealthy food vending can expose children to malnutrition and other diet related challenges such as obesity. This study sought to describe types and sources of food in basic schools in urban Accra, and to describe food purchases by pupils. This was a cross-sectional study of five basic schools (3 public; 2 private) and 644 pupils in the Ga-East Municipality in Ghana. Check-lists were used to document available sources of foods during school hours. Pupils were intercepted after making purchases during breaktime and the type, cost and sources of foods purchased documented. Energy content of foods were read from labels when available or estimated using the Ghana Food Composition database when unlabelled. Frequencies and crosstabs were used to compare food type by source and school type. Foods were purchased from school canteen, school store, private stores, and 'table-top' vendors. Meals were most frequently purchased (38%) although single purchases were sweetened drinks, savoury snacks and confectioneries. About 53% of retailers located within the schools sold relatively healthier food options. Similar foods with comparable energy content were purchased within and outside of school. Basic schools in urban Ghana provide ready access to energy dense food options, which are purchased by pupils both within and outside of school premises. Timely interventions inclusive of school food policies can encourage healthier diets among pupils.

Effective school food environment interventions for the prevention of childhood obesity: systematic review and meta-analysis

BackgroundThe food environment is a modifiable enabler of dietary choices that can have a great impact on the prevention of childhood obesity in the UK. It is defined as a combination of physical, economic, political, and sociocultural surroundings as well as opportunities and conditions that influence food choice. Many interventions have been undertaken at the school level but evidence of their effectiveness in the reduction of childhood obesity is scarce. Therefore, we aimed to synthesise and evaluate the evidence of food environmental interventions around and within schools to determine effective parameters that can aid in childhood obesity prevention. MethodsWe searched CINAHL, Embase, Global Health, MEDLINE, Scielo, and Cochrane databases. The considered population were children aged 18 years or younger. Interventions focused on modification of the food environment in schools to prevent obesity and improve dietary intake. Outcomes included anthropometrical measures and dietary intake. The protocol was registered with PROSPERO (CRD42019125039). A second reviewer did a reliability check on 10% of abstracts, bias, and full-text review. FindingsBetween Jan 1, 2000, to Feb 12, 2019, we retrieved 4307 studies, of which 21 were included after screening. Interventions (13; 62%), policies (two; 10%), and laws (three; 14%) from eight countries, including the UK, were included. Four (19%) interventions focused on vending machines. Study designs included natural experiments (one; 5%), quasi-experiments (two; 6%), non-randomised (one; 5%), and randomised (four; 19%). The main outcomes were body-mass index z score (13; 62%) and dietary intake (n=4, 19%). A positive association (p=0·0451) was found in 15 (71%) studies between 0·89% and 1·29% reduction in obesity prevalence. The most frequent interventions were vending machines, school stores, cafeterias, and menu offering regulations. InterpretationIdentified effective interventions in the prevention of childhood obesity were banning of sugary drinks in schools and an increase in availability and accessibility of fruits and vegetables for children from an early age. Multisystem approaches, such as stringent and monitored school meal programmes, alongside the collaboration, training, education, and integration of the school staff, parents, and students, increased acceptability and adaptability according to the local needs and sustainability of the food environment interventions. Changes in the environment lead to individual behaviour modifications. FundingEuropean Commission (H2020 SC2).

Why are restricted food items still sold after the implementation of the school store policy? the case of South Korea

The South Korean government has banned sales of unhealthy foods in school stores since 2009; however, most school stores still sell restricted foods. This study aimed to understand the implementation processes and the reasons for incomplete implementation of the school nutrition policy in South Korea. Semi-structured interviews were conducted with 33 policy actors including school store owners, school staff, public officials, politicians, employees of food companies, and experts. Observations of foods sold in school stores were conducted. Interview transcripts were analyzed using both emergent codes and an a priori code list (participants, base values, perspectives, and effects) based on Lasswell’s social process model using NVivo 10. All interviewees perceived that school stores complied with the policy well; however, restricted foods were found in all interviewed school stores during the observations. Although all policy actors understood the intent of the policy; some of them were not interested in the policy or were unsatisfied with the policy and its outcomes such as profit loss. Perspectives and values towards the policy were different for each policy actor group. Poor monitoring of school store foods, lack of awareness of the policy, profit-seeking, and lack of interest in school stores were identified as reasons for incomplete implementation of the policy. The findings support the needs for consideration of various actors’ perspectives, especially for those who are affected by the policy, when implementing school nutrition policies. A stronger understanding of various actors’ involvement in policy processes can inform strategies to enhance implementation and thereby reach outcomes that align with the original policy intent.

Financial literacy and classroom practices among early childhood and elementary teachers in India and the US

ABSTRACTThis study compared the financial literacy and teaching practices of 82 early and elementary teachers in India and US using a 43-item survey. Analysis showed that financial literacy of Indian teachers was lower than their American counterparts. Teachers in India enjoyed teaching financial literacy more than teachers in the US. Indian teachers received more professional development training than American teachers. Indian teachers reported using the school store, children’s literature and pictorial worksheets while American teachers reported using learning centres, play money, fake credit cards, technology and games to teach financial literacy.

Changes in School Competitive Food Environments after a Health Promotion Campaign.

Schools can reduce student access to competitive foods and influence healthy food choices by improving the school nutrition environment. This study describes changes in competitive nutrition environments in 100 K-8 schools participating in the Philadelphia Campaign for Healthier Schools. Interviews with school staff were used to elicit information about policies, practices, and guidelines to restrict/limit competitive foods in schools, before and 1 year into the campaign. To increase the validity of responses, respondents provided documentation for reported policies and guidelines. Baseline interviews were conducted between April and June 2011 and follow-up interviews were conducted between April and June 2012. At follow-up, significantly more schools reported having policies and/or guidelines in place to regulate food as a reward in the classroom, food served at parties and celebrations, outside foods allowed in school, and the availability of sodas and sugar-sweetened beverages. There were no measurable effects on food available in school stores, fundraisers, or afterschool programs. Availability of concrete documentation of policies was limited, but when provided, it corroborated the interview responses. In the context of a comprehensive school wellness policy, school wellness councils were associated with increases in school-level policies and practices that improved the competitive nutrition environment.

Korean Adolescents’ Energy Intake of Selected Foods by Eating Place from 1998 to 2012 During Implementation of Two National School Nutrition Policies

ABSTRACTThis study examines changes in Korean adolescents’ energy intakes from selected foods that were offered in school stores over 15 years, during which 2 policies prohibiting unhealthy food sales in school stores were implemented in 2007 and in 2009, respectively. Using 24-h dietary recall from the Korea National Health and Nutrition Examination Surveys 1998–2012, adolescents’ energy intakes in each eating place were calculated. Energy intakes from instant noodles consistently decreased both at home and in school stores. Energy intakes from soft drinks away from home or school rapidly increased beginning in 2008. Policies regulating unhealthy food sales in school stores appear to have had a modest impact on adolescents’ overall consumption of unhealthy foods. Comprehensive policies targeting diverse eating places are needed to improve adolescents’ overall diet.

Design and evaluation of a campaign to promote the consumption of vegetables and fruits in Mexican school-age children.

In Mexican school-age children the consumption of vegetables and fruits (V&F) is less than 25% of the amount recommended by the World Health Organization. Evaluate the effectiveness of a promotion campaign about the consumption of V&F in urban school children from Hidalgo, Mexico. A non controlled community trial in 226 school-age children from private and public schools was conducted, we designed and distributed printed material for promoting the consumption of V&F among the school population, access to V&F was provided through planning and sales at school stores, and consumption was supervised by the teachers. At the end of the intervention vegetable consumption increased by 50 g and plain water in 100 mL (T-test, p < 0.05); the proportion of school-age children who identified the health benefits of the consumption of V&F increased significantly (68% initial, 87% final) and greater support from parents (61% initial, 92 final%) was achieved. A promotion campaign and improved access to vegetables, fruits and water in the school environment which is supported by parents and teachers can encourage healthier eating at school.

School Obesity Prevention Policies and Practices in Minnesota and Student Outcomes: A Longitudinal Cohort Study.

The School Obesity-related Policy Evaluation (ScOPE) Study uses existing public surveillance data and applies a rigorous study design to evaluate effectiveness of school policies and practices impacting student behavioral and weight outcomes. The ScOPE Study used a cohort of 50 combined junior-senior and high schools in Minnesota to evaluate the change in weight-related policy environments in 2006 and 2012 and test the effect of policy change on students attending those schools in 2007 and 2013. Exposure variables included school practices about foods and beverages available in school vending machines and school stores, physical education requirements, and intramural opportunities. Primary study outcomes were average school-level ninth grade student BMI percentile, obesity prevalence, daily servings of fruits/vegetables, and daily glasses of soda. Availability of fruits/vegetables in schools was associated with a significant increase in total daily intake among ninth grade students by 0.4 servings. Availability of soda in schools was associated with a significant increase in total daily intake among ninth grade boys by 0.5 servings. Less-healthy snack and drink availability in schools was associated with a small, significant increase (1%) in student BMI percentile at the school level. Use of a school-level longitudinal cohort study design over a 6-year period uniquely adds to the methodologic rigor of school policy and practice evaluation studies. The ScOPE Study provides marginal evidence that school policies and practices, especially those that restrict vending and school store offerings, may have small effects on weight status among ninth grade students.

Impact of Nutrition Standards on Competitive Food Quality in Massachusetts Middle and High Schools.

To examine changes in competitive foods (items sold in à la carte lines, vending machines, and school stores that "compete" with school meals) in Massachusetts middle and high schools before and after implementation of a statewide nutrition law in 2012. We photographed n = 10 782 competitive foods and beverages in 36 Massachusetts school districts and 7 control state districts to determine availability and compliance with the law at baseline (2012), 1 year (2013), and 2 years (2014) after the policy (overall enrollment: 71 202 students). We examined availability and compliance trends over time. By 2014, 60% of competitive foods and 79% of competitive beverages were compliant. Multilevel models showed an absolute 46.2% increase for foods (95% confidence interval = 36.2, 56.3) and 46.8% increase for beverages (95% confidence interval = 39.2, 54.4) in schools' alignment with updated standards from 2012 to 2014. The law's implementation resulted in major improvements in the availability and nutritional quality of competitive foods and beverages, but schools did not reach 100% compliance. This law closely mirrors US Department of Agriculture Smart Snacks in School standards, suggesting that complying with strict nutrition standards is feasible, and schools may experience challenges and improvements over time.

Comparison of Food Availability in School Stores in Seoul, South Korea Before and After Implementation of Two National Food‐ and Nutrient‐Based Policies

Public health interest in preventing childhood obesity and chronic diseases by improving school food environments has been growing around the world. As part of this movement, the South Korean government implemented two policies restricting unhealthy food sales in school stores: 1) a food‐based policy enacted in 2007 restricts specific food sales (e.g., soft drinks), and 2) a nutrient‐based policy enacted in 2009 restricts energy‐dense, nutrient‐poor (EDNP) food sales in school stores. The purpose of the study was to assess the effects of the two policies on the school store food environment.Foods sold in stores located in middle and high schools in Seoul, South Korea were observed before (2006, 15 stores) and after (2013, 12 stores) implementation of the two school store policies. After controlling for the total number of food types offered in school stores and school characteristics (school level, private/public, students’ sex, and income level), numbers and percentages of food types in each category were compared between 2006 and 2013. Also, number and percentage of EDNP foods in 2013 were examined using mixed models with school districts as random effects. All statistical analyses were conducted using SAS 9.4 (SAS Institute, Inc., Cary, NC).The mean number of food types offered in school stores was significantly higher in 2013 (102.3 items) than in 2006 (41.1 items; p&lt;0.001), even after adjusting for school characteristics (p=0.022). When controlling for the total number of food types and school characteristics, the mean number of soft drinks offered in a school store in 2013 (0.3 items) was significantly lower than in 2006 (1.9 items, p=0.032). Soft drinks, the target of the 2007 policy, were still available in 50% of school stores observed in 2013, while 60% of school stores observed in 2006 offered soft drinks. In contrast, EDNP foods, the target of the 2009 policy, were available in all school stores observed in 2013, and represented about 7.6% of food types offered.In school stores in South Korea, a food‐based policy that prohibits soft drinks appears to have been more effective for decreasing availability of restricted items than a nutrient‐based policy. Neither of the two policies, however, eliminated access to unhealthy foods in school stores. To improve school store food environments, alternative strategies such as requiring healthy food sales are likely needed.Support or Funding InformationThis study was supported by the Walker Institute of International and Area Studies, University of South Carolina.

Assessment of a Districtwide Policy on Availability of Competitive Beverages in Boston Public Schools, Massachusetts, 2013.

IntroductionCompetitive beverages are drinks sold outside of the federally reimbursable school meals program and include beverages sold in vending machines, a la carte lines, school stores, and snack bars. Competitive beverages include sugar-sweetened beverages, which are associated with overweight and obesity. We described competitive beverage availability 9 years after the introduction in 2004 of district-wide nutrition standards for competitive beverages sold in Boston Public Schools.MethodsIn 2013, we documented types of competitive beverages sold in 115 schools. We collected nutrient data to determine compliance with the standards. We evaluated the extent to which schools met the competitive-beverage standards and calculated the percentage of students who had access to beverages that met or did not meet the standards.ResultsOf 115 schools, 89.6% met the competitive beverage nutrition standards; 88.5% of elementary schools and 61.5% of middle schools did not sell competitive beverages. Nutrition standards were met in 79.2% of high schools; 37.5% did not sell any competitive beverages, and 41.7% sold only beverages meeting the standards. Overall, 85.5% of students attended schools meeting the standards. Only 4.0% of students had access to sugar-sweetened beverages.ConclusionA comprehensive, district-wide competitive beverage policy with implementation support can translate into a sustained healthful environment in public schools.

Availability of Vending Machines and School Stores in California Schools.

This study examined the availability of foods sold in vending machines and school stores in United States public and private schools, and associations of availability with students' food purchases and consumption. Descriptive analyses, chi-square tests, and Spearman product-moment correlations were conducted on data collected from 521 students aged 8 to 15 years recruited from orthodontic offices in California. Vending machines were more common in private schools than in public schools, whereas school stores were common in both private and public schools. The food items most commonly available in both vending machines and school stores in all schools were predominately foods of minimal nutritional value (FMNV). Participant report of availability of food items in vending machines and/or school stores was significantly correlated with (1) participant purchase of each item from those sources, except for energy drinks, milk, fruits, and vegetables; and (2) participants' friends' consumption of items at lunch, for 2 categories of FMNV (candy, cookies, or cake; soda or sports drinks). Despite the Child Nutrition and Women, Infants, and Children (WIC) Reauthorization Act of 2004, FMNV were still available in schools, and may be contributing to unhealthy dietary choices and ultimately to health risks.

Association Between Student Body Mass Index and Access to Sports Drinks in Minnesota Secondary Schools, 2012-2013.

This ecologic study evaluated the association between school policy allowing students to purchase sports drinks from school vending machines and school stores and student body mass index (BMI). Data were from surveillance surveys of Minnesota secondary schools (n = 238) and students (n = 59,617), administered in 2012 and 2013, respectively. We used generalized linear models to assess the association between policies and mean age- and sex-adjusted BMI percentile. In adjusted multivariate analysis, school policy was positively associated with BMI percentile (P = .005). School policy restricting student access to sports drinks at school may contribute to decreasing consumption of sport drinks among school-aged youth and improving student weight outcomes in this population.

What is Needed to Improve Food Sales in Schools? Food Vendors' Opinion from El Salvador.

Latin America and the Caribbean are at the forefront of the double burden of malnourishment, with rocketing rates of overweight, obesity and stagnant prevalence of stunting in many countries. School children are at a crucial age for setting eating habits, physical activity, nutritional status and long term outcomes both in their health as well as their education and economic productivity. Save the Children International implements a school health and nutrition program in 45 rural schools in El Salvador, Central America. The program aims at increasing the consumption of protein and micronutrients while reducing intake of sugar and fats in school children. In addition, there is great emphasis on food hygiene and safe handling, through training of the food vendors. We developed a conceptual framework for school nutrition programs that is phrased around five different moments: school snacks, school stores, nutrition learning, bringing food to school and eating at home. Monitoring and control lies in the hands of student brigades, which fosters child participation. We present findings of a qualitative evaluation on sale regulation in school food stores, documenting additional interventions that were needed to foster compliance. We explore how vendors are making money on healthy food if head teachers and parents are involved in regulating food stores and children are motivated to cherish fruits and vegetables. Based on these findings, we discuss a model of an enabling environment for healthy food at school.

District wellness policies and school-level practices in Minnesota, USA.

To compare the strength of district wellness policies with corresponding school-level practices reported by principals and teachers. District-level wellness policy data were collected from school district websites and, if not available online, by requests made to district administrators in the autumn of 2013. The strength of district policies was scored using the Wellness School Assessment Tool. School-level data were drawn from the 2012 Minnesota School Health Profiles principal and teacher surveys and the National Center for Education Statistics Common Core Data. Generalized estimating equations which accounted for school-level demographics and the nesting of up to two schools within some districts were used to examine ten district policy items and fourteen school-level practices of relevance to nutrition standards, nutrition education and wellness promotion, and physical activity promotion. State-wide sample of 180 districts and 212 public schools in Minnesota, USA. The mean number of energy-dense, nutrient-poor snack foods and beverages available for students to purchase at school was inversely related to the strength of district wellness policies regulating vending machines and school stores (P=0·01). The proportion of schools having a joint use agreement for shared use of physical activity facilities was inversely related to the strength of district policies addressing community use of school facilities (P=0·03). No associations were found between the strength of other district policies and school-level practices. Nutrition educators and other health professionals should assist schools in periodically assessing their wellness practices to ensure compliance with district wellness policies and environments supportive of healthy behaviours.

Using the SERVQUAL model to evaluate the quality of services for a farm school store

The main objective of this paper is to present and analyse the findings of research which aims to measure the services that a locally-based SME (Small-Medium Enterprise) campus store of a farm school provides to its customers. The examined start-up store is operated by the College students in the context of their entrepreneurship, business and marketing classes. After one year of operation students decided to evaluate the quality of the store’s services and measure the customers’ satisfaction by applying the well-known SERVQUAL model. The deployment of the model revealed at first the importance of the store know-how to measure services from the consumers’ perspective so as to better understand their needs. Secondly, the findings of the research highlighted ‘Security’, ‘Reliability’ and ‘Empathy’ as the most significant dimensions. The findings of this research can help small and medium enterprises to improve the services they provide to their customers by focusing on these three important dimensions. JEL classification: M300, M310, M390, M000

Why do school stores in South Korea still sell restricted foods four years after the school store policy?

The South Korean government has banned sales of energy‐dense low‐nutrient (EDNP) foods in school stores since 2009; however, most school stores still sell EDNP foods. The aim of this study was to describe the implementation process of the school store policy and to identify explanations for incomplete policy implementation. In‐depth interviews were conducted with 33 stakeholders of the school store policy, including school store owners, school staff, public officials, politicians, and experts, in 2013‐14. During school store owner interviews, foods sold were recorded. Interviews were recorded and transcribed. Data were analyzed using an a priori code list based on Lasswell's policy processes model. All stakeholders said that school stores complied with the policy, although school stores observed sold EDNP foods. School store owners and employees of food companies expressed support for the purpose of the policy, citing children's health, but were dissatisfied with the policy because of profit loss. Several governmental agencies concurrently monitor school stores. Most schools did not monitor foods in their school stores, and staff did not see such monitoring as a part of their job. Complicated EDNP criteria, lack of education about the policy, the competitive bidding system, and inadequate monitoring resulted in school stores continuing to sell EDNP foods. Establishing mechanisms to monitor and to provide policy information to school store owners would contribute to better policy implementation and improved nutritional quality of foods in school stores. [Funding: Walker Institute, University of South Carolina]

Snacks, sweetened beverages, added sugars, and schools.

Concern over childhood obesity has generated a decade-long reformation of school nutrition policies. Food is available in school in 3 venues: federally sponsored school meal programs; items sold in competition to school meals, such as a la carte, vending machines, and school stores; and foods available in myriad informal settings, including packed meals and snacks, bake sales, fundraisers, sports booster sales, in-class parties, or other school celebrations. High-energy, low-nutrient beverages, in particular, contribute substantial calories, but little nutrient content, to a student's diet. In 2004, the American Academy of Pediatrics recommended that sweetened drinks be replaced in school by water, white and flavored milks, or 100% fruit and vegetable beverages. Since then, school nutrition has undergone a significant transformation. Federal, state, and local regulations and policies, along with alternative products developed by industry, have helped decrease the availability of nutrient-poor foods and beverages in school. However, regular access to foods of high energy and low quality remains a school issue, much of it attributable to students, parents, and staff. Pediatricians, aligning with experts on child nutrition, are in a position to offer a perspective promoting nutrient-rich foods within calorie guidelines to improve those foods brought into or sold in schools. A positive emphasis on nutritional value, variety, appropriate portion, and encouragement for a steady improvement in quality will be a more effective approach for improving nutrition and health than simply advocating for the elimination of added sugars.