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This dissertation focuses on dietary intake patterns of children from low-income communities, and specifically the relationships of diet to food insecurity and school nutrition programs, respectively. The dissertation is divided into two parts. Part I discusses issues surrounding the measurement of food insecurity among children and provides support for the use of self-reported food insecurity measures, and for investigating effects that may differ by gender. Paper 1 explores the relationship between self-reported food insecurity and diet separately for boys and girls, using a dataset of 3,582 fourth and fifth grade students from San Diego area elementary schools. It concludes that among food-insecure children, gender may interact with food insecurity to influence eating behavior, with girls more prone than boys to alter their eating. Findings support a rationale to reduce child food insecurity and to address eating patterns that may place girls at greater risk for energy imbalances during critical periods of development. Part II focuses on the role of school nutrition programs in reducing food insecurity and improving dietary intake among participants. It introduces the Community Eligibility Provision (CEP), discusses relevant legislation and political trends, and provides a conceptual framework for hypothesized pathways through which CEP may influence student outcomes. Paper 2 examines associations between CEP and school meal participation among students who are eligible for free or reduced-price meals (FRPM), near the eligibility cutoff but possibly eligible, or above the cutoff and ineligible, using a difference-in-difference framework and a cross-sectional national sample of 2,305 students from grades K-8. It finds that CEP is associated with higher participation in school breakfast and lunch, particularly among those who were above the cutoff and would not have had access to free or reduced-price meals through a 3-tiered application and certification model. Paper 3 investigates associations among school meal participation, CEP, and dietary intake patterns using a larger sample of 4,124 students from grades K-8. It uses a regression framework to identify whether CEP is an effect modifier of relationships between school meal participation and dietary measures. It concludes that CEP is modestly associated with improved dietary intakes and may help reduce nutritional disparities for students in high-poverty schools. Finally, a special supplemental section explores the extent to which endogeneity in meal participation at CEP schools is a potential threat to these conclusions, using an instrumental variable approach to help control for omitted variables. There was no evidence to support the hypothesis that the dietary effects identified in Paper 3 resulted from shifting the source of student meals from home to school for the subset of students whose participation was induced by CEP. The dissertation concludes with a discussion of alternative explanations for the relationships found.
The purpose of the research was to explore and describe the current school nutrition environment in North Carolina's public schools. Current practices to increase the availability of healthful foods and beverages in the school breakfast and lunch programs were analyzed. Barriers that limit the availability of healthful foods and beverages in school meals programs were identified and strategies to overcome the barriers were described. A survey instrument was administered to all Child Nutrition Directors and Supervisors in North Carolina. Of 239 instruments distributed, 211 were returned resulting in an 88.3% response rate. The research found that Child Nutrition Directors and Supervisors were keenly aware of the serious public health problems posed by the epidemic of childhood overweight and recognized that poor food and beverage choices and inadequate physical activity contribute to weight gain among children and adolescents. While healthful foods and beverages were available to students in the school breakfast and lunch programs, competitive foods, which undermined the nutritional and financial integrity of the school meals programs, were also available in approximately one-fourth of elementary schools, half of middle schools and three-fourths of high schools. The leading barrier that limited the availability of more healthful foods and beverages in school meals programs was school finances; financial goals for the programs outweighed nutritional goals for students. Other barriers included lack of support from school administrators and local Boards of Education, principals, teachers and parents. Student taste preferences for foods high in fat, sugar and calories was also a barrier. Other barriers included too little nutrition education in the classroom to influence student's food choices, conflicting nutrition messages on school campuses, limited time and space for school meals and the perception that school meals were not a valued part of the instructional day. Mu.
The Food and Nutrition Service (FNS) of USDA sponsored the third School Nutrition Dietary Assessment study (SNDA-III) to provide up-to-date information on the school meal programs, the school environments that affect the food programs, the nutrient content of school meals, and the contributions of school meals to children's diets.
Abstract: This publication provides basic information about the relationship between nutrition and learning and includes steps for ensuring that students benefit from nutrition programs. This text may be used in the initiation of school meal programs and the incorporation of nutrition education into classroom learning.
The Healthy, Hunger-Free Kids Act of 2010, implemented nationwide in 2012, was intended to improve the nutritional quality of meals served in the National School Lunch Program (NSLP). To assess whether there was an association between the Healthy, Hunger-Free Kids Act of 2010 and dietary quality of lunch for students participating in the NSLP, stratified by income. Design, Setting, Participants: Serial cross-sectional study design, using National Health and Nutrition Examination Survey (NHANES) data 2007-2008, 2009-2010, 2013-2014, and 2015-2016, of students surveyed in NHANES and attending schools participating in the NSLP. Individuals who were aged 5 to 18 years, in kindergarten through 12th grade, enrolled in a school that served school lunch, and had a reliable weekday dietary recall were included. The Healthy, Hunger-Free Kids Act of 2010 (pre-policy period: 2007-2010; post-policy period: 2013-2016), with participation in the NSLP estimated based on an algorithm. Main Outcome and Measure: The primary outcome was dietary quality of intake for lunch, measured by Healthy Eating Index-2010 (HEI-2010) score (range 0-100; 0 indicates a diet with no adherence to the 2010 Dietary Guidelines for Americans and 100 indicates a diet with complete adherence to the guidelines). Among 6389 students included in the surveys (mean age, 11.7 [95%CI, 11.6-11.9] years; 3145 [50%] female students; 1880 [56%] were non-Hispanic white), 32%were low-income, 12% were low-middle-income, and 56% were middle-high-income students.A total of 2472 (39%) were participants in the NSLP. Among low-income students, the adjusted mean prepolicy HEI-2010 score was 42.7 and the postpolicy score was 54.6 among NSLP participants and the adjusted mean prepolicy score was 34.8 and postpolicy score was 34.1 among NSLP nonparticipants (difference in differences, 12.6 [95%CI, 8.9-16.3]). Among low-middle-income students, the adjusted mean prepolicy HEI-2010 score was 40.4 and postpolicy score was 54.8 among NSLP participants and the adjusted mean prepolicy score was 34.2 and postpolicy score was 36.1 among NSLP nonparticipants (difference in differences, 12.4 [95%CI, 4.9-19.9]). Among middle-high-income students, the adjusted mean HEI-2010 prepolicy score was 42.7 and postpolicy score 55.5 for NSLP participants and the adjusted mean prepolicy score was 38.9 and prepolicy score was 43.6 for NSLP nonparticipants (difference in differences, 8.1 [95%CI, 4.2-12.0]). In a serial cross-sectional study of students, the Healthy, Hunger-Free Kids Act of 2010 was associated with better changes in dietary quality for lunch among presumed low income, low-middle income, and middle-high income participants in the National School Lunch Program compared with non-participants.
Strengthen programs of family and community engagement to promote equity and increase student success! When schools, families, and communities collaborate and share responsibility for students′ education, more students succeed in school. Based on 30 years of research and fieldwork, the fourth edition of the bestseller School, Family, and Community Partnerships: Your Handbook for Action, presents tools and guidelines to help develop more effective and more equitable programs of family and community engagement. Written by a team of well-known experts, it provides a theory and framework of six types of involvement for action; up-to-date research on school, family, and community collaboration; and new materials for professional development and on-going technical assistance. Readers also will find: Examples of best practices on the six types of involvement from preschools, and elementary, middle, and high schools Checklists, templates, and evaluations to plan goal-linked partnership programs and assess progress CD-ROM with slides and notes for two presentations: A new awareness session to orient colleagues on the major components of a research-based partnership program, and a full One-Day Team Training Workshop to prepare school teams to develop their partnership programs. As a foundational text, this handbook demonstrates a proven approach to implement and sustain inclusive, goal-linked programs of partnership. It shows how a good partnership program is an essential component of good school organization and school improvement for student success. This book will help every district and all schools strengthen and continually improve their programs of family and community engagement.
The overarching objective of the research included in this dissertation was to identify program models that support healthy behaviors in school-age children. Special emphasis was given to models and methods that focus on the sustainability of community-based health and wellness programs. Chapter I of this dissertation provides a review of literature that explores the prevalence, definition, consequences, and potential causes of childhood overweight and obesity as well as potential methods, theories, and approaches designed to help ameliorate the problem. This review recognizes obesity as a complex issue and presents a variety of approaches that requires coordinated, multifaceted and collaborative approaches that target not only the individual, but also the whole community. In addition to providing a comprehensive review of behavior change theories and examples of their application in the school setting, this review concludes with a proposed solution to a secondary issue: the long-term sustainability of school-based health and nutrition programs and their outcomes. Chapters II provides a Statement of Purpose for the research discussed in Chapters III through Chapter V. Chapter III describes a study conducted in collaboration with the California Department of Education. The purpose of this study was to develop, implement, and assess the impact of a statewide professional development program designed to equip school nutrition directors with the knowledge and skills needed to cost-effectively implement federal health and wellness initiatives and policies at the local level. The professional development program was entitled, the "Stepping Up To the Challenge: Creating a Healthy School Environment" and was a unique partnership among state education agency staff, university researchers, and practitioners. Post-professional development questionnaire identified key "insights, inspirations, and strategies" as (a) marketing of school foods pro- gram, (b) expansion of salad bars, and (c) collaboration with community partners. A six-month follow-up questionnaire identified that 86% of participants made progress toward implementing at least one of their five insights, inspirations, and strategies in their school districts. Most common areas that were implemented were marketing and branding (32%), revamping salad bars (18%), and motivating staff (16%). School and Community Actions for Nutrition survey analysis showed a significant increase in the use of marketing methods in school nutrition programs from baseline to six-month post-program implementation (p = .024). The nutritional impact of several of the techniques presented in this program were tested in a farm to school (F2S) project funded by a specialty block grant program sponsored by the California Department of Food and Agriculture described in Chapter IV. Chapter IV describes a study designed to evaluate the impact of F2S programming on dietary behavior outcomes, specifically fruit and vegetable preferences and consumption patterns, among school aged children attending schools in three distinct California school districts. To ensure that the intervention methods were appropriate for each unique school community, the intervention plan was designed in conjunction with school nutrition directors. As an outcome of this study, the surrounding community benefited through the establishment of a sustainable relationship between local farmers and the school nutrition directors. Data collected from a series of behavioral questionnaires and plate waste observations were assessed pre- and post-F2S programming. Results in the small, rural school district showed an increase in the percent of students able to correctly identify asparagus (34.5% to 58.6%; p= 0.02), an increase in the amount of fruit consumed; (53% to 94%; p = 0.01), and an increase in total produce consumed; (59% to 94%; p = 0.01). Results in the medium rural/urban school district showed an increase in the percent of students able to correctly identify red bell pepper (79% to 92%; p = 0.0415). Students increased their consumption of fruit and total produce at follow-up as compared to baseline (25% to 50%; p = 0.04 and 33% to 58%, p = 0.04). Results in the large, urban school district showed an increase in the percent of students able to correctly identify cucumber (39% to 61%; p=0.05). No significant positive changes were observed in student's willingness to taste a feature produce item, with a decrease willingness to taste a radish at the small, rural school district (90% to 62%; p= 0.01). Overall, results showed that limited intervention strategies yielded positive nutrition behavior changes in school-aged children's eating behavior. Results from these findings informed the wellness component of a multi-component project entitled the Shaping Healthy Choices Program. The Shaping Healthy Choices Program is a school-based intervention that integrated five components: nutrition education; family and community partnerships; regional agriculture; foods available on school site; and school wellness policies. The research discussed in Chapter V used a mixed-methods approach to assess the effectiveness of site-specific school wellness committees (SSWCs) to supplement Shaping Healthy Choices Program activities, and create a best practices model for sustainability of SHCP components. Community-Based Participatory Research principles and approaches were utilized to develop SSWC objectives. Baseline results from the School and Community Actions for Nutrition (SCAN) Survey served as a platform to launch SSWC objectives. An ethnographic approach was to analyze the level of community involvement during each phase of the project. The wellness committee was also involved in a smaller research project through which they identified the strengths and weakness of their school environment and implemented activities based on this information. Results from the wellness committee's study were compared with community-based principals in order to draw any relationships with the wellness committee outcomes and the level of community based participation. Results suggested that the more the community was involved in the planning, implementation, and maintenance phases of an activity, the more likely the School Sites were to implement these activities into the second year. More research is needed to assess the sustainability of the program outcomes over a longitudinal course. This dissertation concludes with Chapter VI, a discussion of research results, implications, conclusions, and future directions.