Strategies to Improve School Meal Consumption: A Systematic Review

School meals can play an integral role in improving children’s diets and addressing health disparities. Initiatives and policies to increase consumption have the potential to ensure students benefit from the healthy school foods available. This systematic review evaluates studies examining initiatives, interventions, and policies to increase school meal consumption. Following PRISMA guidelines, this review was conducted using four databases and resulted in a total of 96 studies. The research evidence supports the following strategies to increase school meal consumption: (1) offering students more menu choices; (2) adapting recipes to improve the palatability and/or cultural appropriateness of foods; (3) providing pre-sliced fruits; (4) rewarding students who try fruits and vegetables; (5) enabling students to have sufficient time to eat with longer (~30 minute) lunch periods; (6) having recess before lunch; and (7) limiting students’ access to competitive foods during the school day. Research findings were mixed when examining the impact of nutrition education and/or offering taste tests to students, although multiple benefits for nutrition education outside the cafeteria were documented. There is some evidence that choice architecture (i.e., “Smarter Lunchroom”) techniques increase the proportion of students who select targeted meal components; however, there is not evidence that these techniques alone increase consumption. There were limited studies of the impact of increasing portion sizes; serving vegetables before other meal components; and strengthening local district and/or school wellness policies, suggesting that further research is necessary. Additionally, longer-term studies are needed to understand the impact of policies that limit students’ access to flavored milk. Several studies found increases in students’ meal consumption following the Healthy Hunger-Free Kids Act (HHFKA) and concerns regarding an increase in food waste following the HHFKA were not supported. Overall, there are a range of effective strategies to increase school meal consumption that can be implemented by schools, districts, and policymakers at the local, state, and federal levels (PROSPERO registration: CRD42021244688).

Using Local School Wellness Policies to Build a Culture of Health for Students With Chronic Health Conditions: The School Nurse Role

Local school wellness policies (LWP) guide school districts’ efforts to establish school environments that promote students’ health, well-being, and ability to learn that include school U.S. Department of Agriculture nutrition and physical activity requirements. Looking through the lens of the Whole School, Whole Community, Whole Child model and NASN’s Framework for 21st Century School Nursing Practice™, LWP can be expanded beyond the tradition focus of nutrition and physical activity to address the health and academic needs of students with chronic health conditions. School nurses need to be actively involved on district wellness councils as schools prepare to conduct their required triennial assessment of current LWP equipped with an understanding of the Alliance for a Healthier Generations’ updated model wellness policy and NASN’s supplemental wellness policy language to address management of students with chronic health conditions.

An Assessment of Schools’ Wellness Policies and Teachers’ Perspectives and Confidence in Teaching Nutrition in Elementary Schools in Jeddah, Saudi Arabia

Objectives This study aimed to evaluate the content of school wellness policies and understand teacher perspectives about teaching nutrition education at their schools in Jeddah, Saudi Arabia. Methods In 2020, electronic surveys were used to evaluate the wellness policies in 11 elementary all-female government schools and teachers’ perspectives about the nutrition education offered in three elementary all-female government schools. Sixty-one teachers and eleven principals participated in this study. Fisher's exact tests were used to test the differences between teachers’ perspectives and their confidence level and characteristics. A P-value of less than 0.05 was considered statistically significant. Results Results showed that most schools (N = 10) have a formal school wellness policy that provides a healthy environment for students and ensures facilitate their access to healthy eating and exercise. Many teachers (55.2%) agreed that there are adequate resources are available to them to teach nutrition in the schools, and (58.6%) of them agreed that they have had adequate training from qualified people on nutrition education. Most teachers (94.7%) were confident in teaching nutrition and physical activity to their students. Teachers between 30–50 years of age were more interested in teaching nutrition than teachers whose age is more than 50 years old (P < 0.05). Conclusions In summary, schools operated very efficiently to offer nutritional education for students, and most teachers are confident and interested in teaching nutrition. There is a need for further studies investigating nutrition education in schools in Saudi Arabia. Funding Sources No funding sources

To Harm and Heal: Digital Disclosure and Support-Seeking for IPV Victims

Technology is used both to harm and assist people in romantic relationships. For intimate partner violence (IPV) victims, online forums, social media, and digital resources are used to cope with and/or seek support. What remains unknown is the extent to which in-person and digital abuse experiences affect victims’ subsequent preferences for and likelihood of using such channels to reveal and get help for their IPV. This study explored how abuse types and victims’ personal and relational characteristics affected preferences for and reported use of technology-mediated-disclosure and -support-seeking. Quantitative self-reports of IPV victims (N = 495; 157 men and 338 women) indicated sought target and media type (in-person or online, sex-specific or co-ed groups, open or closed digital platforms, professional- or lay-managed resources) each varied according to multiple personal (age, sex) and IPV-specific (physical, psychological, and digital abuse) factors; technological experiences; and disclosure and support-seeking practices and preferences of victims. Findings are discussed in terms of implications for digital wellness policies and practices.

Local Data for Action: Statewide Dissemination of School Wellness Policy Evaluations in Wisconsin

School settings can influence child health, including physical activity and diet, through the promotion of high-quality wellness policies. Many studies have analyzed the quality of school wellness policies, but evidence is lacking regarding the dissemination of the policy evaluation results to school districts. This study describes the process the Wisconsin Health Atlas followed to disseminate tailored school wellness policy data reports and interactive dashboards to school districts throughout the state and the results of the statewide dissemination efforts. Prioritizing the translation of research to practice, the process included collaborating with key stakeholders and partners to provide formative feedback on the dissemination activities. The electronic and hard copy reports were disseminated to 232 districts through email and U.S. mail. Each district received a tailored report featuring an executive summary, local data for action, personalized policy recommendations, best practices, and a unique code to enter into interactive data dashboards to explore additional local, regional, and state-level data. In the utilization follow-up survey (20.3% response rate), respondents indicated that the report will help their district to improve the quality of their school wellness policy. Additionally, respondents who had used the report specified they used the data to identify areas for policy improvement and to support their triennial assessment, suggesting that districts value the technical support. To support school districts in improving the quality of school wellness policies, we recommend researchers prioritize collaborative dissemination efforts and provide actionable policy data when conducting school wellness policy evaluations.

Program Evaluation of Environmental and Policy Approaches to Physical Activity Promotion in a Lower Income Latinx School District in Southeast Los Angeles

There is alarming population wide prevalence of low adolescent physical activity as this represents a risk factor for later chronic disease development. There is evidence to suggest that schools with strong wellness policies have students that are more frequently active. We designed an intervention to enhance students’ physical activity levels in five majority Latinx, underserved school districts. Evaluation consisted of assessment of written quality of school-district wellness policies; observation of student’s physical activity during leisure times; and after-school program practices and policies. We examined one of these district’s results more closely, the only participating district with a community coalition, and extracted lessons learned. On the physical activity section of the wellness policy, this district covered a moderate extent of recommended content areas using weak language. Compared to previous reports, we identified low vigorous activity levels for girls and boys at baseline (respectively, 12% and 18%). Finally, we identified that of four after school program sites assessed at baseline, no program reported the recommended 50% or more of program time dedicated to physical activity. Based on these evaluation findings, additional strategies are urgently needed to encourage all students and particularly more girls to be physically active throughout the school day.