School food intake of Australian children is not comprehensively described in literature, with limited temporal, nationally representative data. Greater understanding of intake at school can inform school-based nutrition promotion. This study aimed to describe the dietary intake of primary-aged children during school hours and its contribution to daily intake.

This secondary analysis used nationally representative, cross-sectional data from the 2011 to 2012 National Nutrition and Physical Activity Survey. Dietary intake was assessed using validated 24-h dietary recalls on school days. Descriptive statistics were undertaken to determine energy, nutrients, food groups and food products consumed during school hours, as well as their contributions to total daily intake. Associations between school food intake and socio-demographic characteristics were explored.

Australia.

Seven hundred and ninety-five children aged 5–12 years.

Children consumed 37 % of their daily energy and 31–43 % of select nutrient intake during school hours, with discretionary choices contributing 44 % of school energy intake. Most children consumed less than one serve of vegetables, meat and alternatives or milk and alternatives during school hours. Commonly consumed products were discretionary choices (34 %, including biscuits, processed meat), bread (17 %) and fruit (12 %). There were limited associations with socio-economic position variables, apart from child age.

Children’s diets were not aligned with national recommendations, with school food characterised by high intake of discretionary choices. These findings are consistent with previous Australian evidence and support transformation of the Australian school food system to better align school food consumption with recommendations.

The current study sought to examine Guatemalan adolescents’ consumption of sugar-sweetened beverages (SSB), identify which individual-level characteristics are associated with SSB consumption and describe school characteristics that may influence students’ SSB consumption.

Within this observational pilot study, a questionnaire was used to assess students’ consumption of three varieties of SSB (soft drinks, energy drinks, sweetened coffees/teas), as well as a variety of sociodemographic and behavioural characteristics. We collected built environment data to examine aspects of the school food environment. We developed Poisson regression models for each SSB variety and used descriptive analyses to characterize the sample.

Guatemala City, Guatemala.

Guatemalan adolescents (n 1042) from four (two public, two private) secondary schools.

Built environment data revealed that students from the two public schools lacked access to water fountains/coolers. The SSB industry had a presence in the schools through advertisements, sponsored food kiosks and products available for sale. Common correlates of SSB consumption included school type, sedentary behaviour, frequency of purchasing lunch in the cafeteria, and frequency of purchasing snacks from vending machines in school and off school property.

Guatemalan adolescents frequently consume SSB, which may be encouraged by aspects of the school environment. Schools represent a viable setting for equitable population health interventions designed to reduce SSB consumption, including increasing access to clean drinking-water, reducing access to SSB, restricting SSB marketing and greater enforcement of existing food policies.

Sudden cardiac death (SCD) is responsible for 5%-10% of all deaths among children 5-19 years-of-age. The incidence of SCD in youth in Michigan (USA) and nationwide is higher in racial/ethnic minorities and in certain geographic areas. School cardiac emergency response plans (CERPs) increase survival after cardiac arrest. However, school cardiac emergency preparedness remains variable. Studying population-level factors associated with school cardiac emergency preparedness and incidence of SCD in the young may improve understanding of disparities in the incidence of SCD.

The objective of this pilot study was to determine the association of elements of high school cardiac emergency preparedness, including Automated External Defibrillator (AED) distribution and the presence of CERPs with county sociodemographic characteristics and county incidence of SCD in the young.

Surveys were sent to representatives from all public high schools in 30 randomly selected Michigan counties. Counties with greater than 50% response rate were included (n=19). Association of county-level sociodemographic characteristics with incidence of SCD in the young and existence of CERPs were evaluated using Spearman correlation coefficient.

Factors related to the presence of AEDs were similar across counties. Schools in counties of lower socioeconomic status (SES; lower-median income, lower per capita income, and higher population below poverty level) were less likely to have a CERP than those with higher SES (all P<.01). Lack of a CERP was associated with a higher incidence of SCD in youth (r=-0.71; P=.001). Overall incidence of SCD in youth was higher in lower SES counties (r=-0.62 in median income and r=0.51 in population below poverty level; both P<.05).

County SES is associated with the presence of CERPs in schools, suggesting a link between school cardiac emergency preparedness and county financial resources. Additionally, counties of lower SES demonstrated higher incidence of SCD in the young. Statewide and national studies are required to further explore the factors relating to geographic and socioeconomic differences in cardiac emergency preparedness and the incidence of SCD in the young.

White MJ , Loccoh EC , Goble MM , Yu S , Odetola FO , Russell MW . High School Cardiac Emergency Response Plans and Sudden Cardiac Death in the Young. Prehosp Disaster Med. 2017;32(3):269–272.

In autumn 2012, Massachusetts schools implemented comprehensive competitive food and beverage standards similar to the US Department of Agriculture’s Smart Snacks in School standards. We explored major themes raised by food-service directors (FSD) regarding their school-district-wide implementation of the standards.

For this qualitative study, part of a larger mixed-methods study, compliance was measured via direct observation of foods and beverages during school site visits in spring 2013 and 2014, calculated to ascertain the percentage of compliant products available to students. Semi-structured interviews with school FSD conducted in each year were analysed for major implementation themes; those raised by more than two-thirds of participating school districts were explored in relationship to compliance.

Massachusetts school districts (2013: n 26; 2014: n 21).

Data collected from FSD.

Seven major themes were raised by more than two-thirds of participating school districts (range 69–100 %): taking measures for successful transition; communicating with vendors/manufacturers; using tools to identify compliant foods and beverages; receiving support from leadership; grappling with issues not covered by the law; anticipating changes in sales of competitive foods and beverages; and anticipating changes in sales of school meals. Each theme was mentioned by the majority of more-compliant school districts (65–81 %), with themes being raised more frequently after the second year of implementation (range increase 4–14 %).

FSD in more-compliant districts were more likely to talk about themes than those in less-compliant districts. Identified themes suggest best-practice recommendations likely useful for school districts implementing the final Smart Snacks in School standards, effective July 2016.

The aims of the present study were to assess the reliability and validity of the Food Choice Questionnaire (FCQ) and to determine the factors associated with food-choice motives in public junior-high-school students in Jakarta, Indonesia.

Cross-sectional study with self-administered questionnaires. Trained research assistants measured height and weight of the participants on the day of the data collection.

Fourteen randomly selected public junior-high schools in East Jakarta, Indonesia.

Public junior-high-school students (n 681) in grades 7 and 8, aged 13–14 years (377 girls and 304 boys).

Three food-choice motives (subscales) were obtained from factor analysis and reliability testing: (i) comfort; (ii) convenience and price; and (iii) health. The subscale with the greatest mean value was health. Family affluence was inversely associated with the convenience and price subscale (β=−0·05, P=0·01) and with the health subscale (β=−0·04; P=0·02). Females were less likely than males to consider health when choosing foods (β=−0·16; P=0·03).

While its factor structure differed from those found in previous studies of adults, the FCQ can provide reliable measures of food-choice motives among these adolescents. Students from less affluent families placed more importance on food’s convenience and price, but more affluent students did not necessarily make healthier choices. Compared with females, males were more likely to choose healthy foods. Future interventions should be tailored based on the socio-economic status of the target group.

To describe the development and application of the School Food Environment Assessment Tools and a novel scoring system to assess the integration of healthy and environmentally sustainable food initiatives in elementary and secondary schools.

The cross-sectional study included direct observations of physical food environments and interviews with key school personnel regarding food-related programmes and policies. A five-point scoring system was then developed to assess actions across six domains: (i) food gardens; (ii) composting systems; (iii) food preparation activities; (iv) food-related teaching and learning activities; and availability of (v) healthy food; and (vi) environmentally sustainable food.

Vancouver, Canada.

A purposive sample of public schools (n 33) from all six sectors of the Vancouver Board of Education.

Schools scored highest in the areas of food garden and compost system development and use. Regular integration of food-related teaching and learning activities and hands-on food preparation experiences were also commonly reported. Most schools demonstrated rudimentary efforts to make healthy and environmentally sustainable food choices available, but in general scored lowest on these two domains. Moreover, no schools reported widespread initiatives fully supporting availability or integration of healthy or environmentally sustainable foods across campus.

More work is needed in all areas to fully integrate programmes and policies that support healthy, environmentally sustainable food systems in Vancouver schools. The assessment tools and proposed indicators offer a practical approach for researchers, policy makers and school stakeholders to assess school food system environments, identify priority areas for intervention and track relevant changes over time.

To qualitatively describe interventions by schools to meet children's needs after the May 2011 Joplin, Missouri tornado.

Qualitative exploratory study conducted six months after the tornado. Key informant interviews with school staff (teachers, psychologists, guidance counselor, nurse, principal), public health official, and physicians.

After the tornado, school staff immediately worked to contact every enrolled child to provide assistance and coordinate recovery services. Despite severe damage to half of the city's schools, the decision was made to reopen schools at the earliest possible time to provide a safe, reassuring environment and additional services. An expanded summer school session emphasized child safety and emotional wellbeing. The 2011-2012 school year began on time, less than three months after the disaster, using temporary facilities. Displaced children were bused to their usual schools regardless of their new temporary residence locations. In just-in-time training sessions, teachers developed strategies to support students and staff experiencing anxiety or depression. Certified counselors conducted school-based, small-group counseling for students. Selective referrals were made to community mental health providers for children with greatest needs.

Evidence from Joplin adds to a small body of empirical experience demonstrating the important contribution of schools to postdisaster community recovery. Despite timely and proactive services, many families and children struggled after the tornado. Improvements in the effectiveness of postdisaster interventions at schools will follow from future scientific evidence on optimal approaches.

KanterRK , AbramsonD . School Interventions After the Joplin Tornado. Prehosp Disaster Med. 2014;29(2):1-4.

As part of a larger evaluation of school nutrition programmes (SNP), the present study examined programme coordinators’ perceptions of strengths, weaknesses, opportunities and threats (SWOT) regarding their SNP and public health professionals’ support.

Qualitative interviews were conducted with twenty-two of eighty-one programme coordinators who had completed a programme evaluation survey. Interviews followed a SWOT framework to evaluate programmes and assessed coordinators’ perceptions regarding current and future partnerships with public health professionals.

The study was conducted in a large, urban region within Ontario.

The twenty-two coordinators who participated represented a cross-section of elementary, secondary, Public and Catholic schools.

SNP varied enormously in foods/services offered, how they offered them and perceived needs. Major strengths included universality, the ability to reach needy students and the provision of social opportunities. Major weaknesses included challenges in forming funding partnerships, lack of volunteers, scheduling and timing issues, and coordinator workload. Common threats to effective SNP delivery included lack of sustainable funding, complexity in tracking programme use and food distribution, unreliable help from school staff, and conflicts with school administration. Opportunities for increased public health professionals’ assistance included menu planning, nutrition education, expansion of programme food offerings, and help identifying community partners and sustainable funding.

The present research identified opportunities for improving SNP and strategies for building on strengths. Since programmes were so diverse, tailored strategies are needed. Public health professionals can play a major role through supporting menu planning, food safety training, access to healthy foods, curriculum planning and by building community partnerships.

The emphasis in school nutrition policy has been on vending and competitive items. Our study was designed to characterize and quantify the amount and source of other foods and beverages on school campuses.

A cross-sectional observational study was conducted using a specially designed objective nutrition observation system.

One low-income school district in southern California with six elementary and two middle schools.

Data were not collected from individual children. A total of 4033 students, 42 % of whom were Hispanic/Latino, 26 % African American and 21 % non-Hispanic white, were observed across school settings.

Data were collected continuously from 9 January 2008 to 16 June 2010. Healthy foods had, per serving, total energy ≤732 kJ (≤175 kcal), total fat content ≤35 %, total saturated fat ≤10 %, sugar less ≤15 g, sodium <200 mg and trans-fat ≤0·5 g. Healthy beverages were only 100 % juice or water, and unflavoured non-fat, 1 %, 2 % milk and soya or rice milk. The system had high inter-rater reliability (r = 0·78 to 0·99), percentage agreement (83 % to 100 %) and test–retest reliability (r = 0·81 to 0·98). Significantly more unhealthy foods and beverages than healthy items were observed on all campuses (P < 0·001). An average of 1·26 (sd 0·46) items per student per week was found with an average of 0·86 (sd 0·34) unhealthy items per child per week.

There were substantial amounts of unhealthy foods and beverages brought onto campuses for classroom rewards, celebrations and fundraising that should be targeted for intervention.