Product reformulation and nutritional improvements after new competitive food standards in schools.

OBJECTIVE: In 2012, Massachusetts enacted school competitive food and beverage standards similar to national Smart Snacks. These standards aim to improve the nutritional quality of competitive snacks. It was previously demonstrated that a majority of foods and beverages were compliant with the standards, but it was unknown whether food manufacturers reformulated products in response to the standards. The present study assessed whether products were reformulated after standards were implemented; the availability of reformulated products outside schools; and whether compliance with the standards improved the nutrient composition of competitive snacks. DESIGN: An observational cohort study documenting all competitive snacks sold before (2012) and after (2013 and 2014) the standards were implemented. SETTING: The sample included thirty-six school districts with both a middle and high school. RESULTS: After 2012, energy, saturated fat, Na and sugar decreased and fibre increased among all competitive foods. By 2013, 8 % of foods were reformulated, as were an additional 9 % by 2014. Nearly 15 % of reformulated foods were look-alike products that could not be purchased at supermarkets. Energy and Na in beverages decreased after 2012, in part facilitated by smaller package sizes. CONCLUSIONS: Massachusetts' law was effective in improving the nutritional content of snacks and product reformulation helped schools adhere to the law. This suggests fully implementing Smart Snacks standards may similarly improve the foods available in schools nationally. However, only some healthier reformulated foods were available outside schools.

How do we actually put smarter snacks in schools? NOURISH (Nutrition Opportunities to Understand Reforms Involving Student Health) conversations with food-service directors.

OBJECTIVE: 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. DESIGN: 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. SETTING: Massachusetts school districts (2013: n 26; 2014: n 21). SUBJECTS: Data collected from FSD. RESULTS: 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 %). CONCLUSIONS: 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.

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

OBJECTIVES: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.

Height and Weight Measurement and Communication With Families in Head Start: Developing a Toolkit and Establishing Best Practices.

Background: Head start (HS) programs are required to collect children's height and weight data. Programs also communicate these results to families. However, no standardized protocol exists to guide measurements or communicate results. The purpose of this article was to describe the development of a measurement toolkit and best practices for communication. Methods: HS programs contributed to the development and pilot testing of a toolkit for HS staff to guide child measurement. We used a three-phase iterative approach and qualitative methods to develop and test the toolkit, which included a video and handout. In addition, we convened an advisory group to draft best practices for communication. Results: HS program staff appreciated the toolkit materials for their simplicity and content. The advisory group highlighted the importance of weight stigma and the need to be cautious in the way that information is communicated to families. The group underscored the role of emphasizing health behavior change, instead of focusing solely on BMI. Best practices were organized into (1) Policies and procedures for communicating screening results, (2) training for HS program staff to improve communication related to screening and health behaviors, and (3) other best practices to promote health behaviors and coordinate data systems. Conclusions: Our toolkit can improve anthropometric measurements of HS to ensure that potential surveillance data are accurate. Advisory group best practices highlight opportunities for HS to develop and implement policies, procedures, and trainings across the country to improve communication with HS families. Future research should test the implementation of these best practices within HS.

Chryseobacterium angstadtii sp. nov., isolated from a newt tank.

As part of an undergraduate microbiology course, a yellow-orange-pigmented, Gram-staining negative, rod-shaped, non-motile bacterial strain was isolated from a glass tank housing several red-spotted newts (Notophthalmus viridescens). The sequence of the 16S rRNA gene of this strain, designated KM(T), was 97.4-98.0 % similar to those of the type strains of Chryseobacterium luteum, C. shigense and C. vrystaatense, while the similarity levels for protein-coding genes were less than 94.7 % for rpoB, less than 92.1 % for groEL and less than 87.1 % for gyrB. These values are lower than for many other established distinct species. Polyphasic characterization and comparison to these relatives revealed that strain KM(T) was similar to other Chryseobacterium strains in that it contained MK-6 as its major respiratory quinone and phosphatidylethanolamine as the most abundant polar lipid, produced flexirubin-type pigments, oxidase and catalase and primarily contained the fatty acids iso-C15 : 0, iso-C17 : 1ω9c, iso-C17 : 0 3-OH and summed feature 3 (comprising C16 : 1ω6c and/or C16 : 1ω7c). Based on the results of this study, strain KM(T) represents a novel species, for which the name Chryseobacterium angstadtii sp. nov. is proposed. The type strain is KM(T) ( = ATCC BAA-2160(T) = NRRL B-59516(T) = KCTC 23297(T)).

Collaborating for impact: a multilevel early childhood obesity prevention initiative.

This article presents Healthy Kids, Healthy Futures, a multilevel initiative in Boston, Massachusetts, which brings major institutions' missions and resources together to address early childhood obesity prevention. Programming is designed to facilitate healthy eating and physical activity in preschool children's home, school, and community environments by engaging parents and early childhood educators in the places where they live, learn, and play. This article describes how established interventions were implemented in a novel setting to engage the parents of children attending Head Start and staff, and presents pilot data from the first 2 years of the initiative. Healthy Kids, Healthy Futures is a feasible initiative, which has shown concrete, positive results that can be replicated.

BMI Data Collection and Communication Practices in a Multistate Sample of Head Start Programs.

Background: Although there is a federal mandate to collect anthropometric data in Head Start (HS), little is currently known about the processes used to collect the height and weight measurements across programs and how the results are communicated to parents/guardians. The goal of this study was to understand anthropometric data collection and dissemination procedures in a sample of HS programs serving children 3-5 years. Methods: A convenience sample of HS Health or Nutrition managers were recruited via personal contacts and HS state directors to complete an electronic survey. Quantitative data were analyzed using descriptive statistics (means, standard deviations and frequencies). Open-ended questions were coded using thematic analysis. All protocols and procedures were approved by the Institutional Review Board at Miami University. Results: Approximately half of the programs reported that they have a protocol in place to guide measurements (57.1%) and those measurements are primarily taken by HS staff (64.5%). Most programs explain measurements to parents (82.3%) and report that collecting height/weight data is helpful in supporting children's health (76.0%). Most programs (80.3%) provide resources to parents of children with overweight or obesity. Four themes emerged from open-ended responses: (1) Role of Community Partners (e.g., providing information that conflicts with others); (2) Communicating Children's Weight Status with Families (e.g., using sensitive communication methods); (3) Challenges Measuring Children's Weight Status (e.g., accuracy of data, children's awareness); and (4) Family Reaction to Weight Status Communication (e.g., positive or negative experiences). Conclusion: Opportunities for quality improvement include wider use of standardized, written protocols and policies on data collection and enhanced communication practices to share information with parents.

Decaying behavioral effects in a randomized, multi-year fruit and vegetable intake intervention.

OBJECTIVE: To examine the effects of a multi-component, theory-based, 2.5-year intervention on children's fruit and vegetable consumption, preferences, knowledge and body mass index. METHODS: Four inner city elementary schools in the Northeastern United States were randomized to an intervention (n=149) or control group (n=148) in 2005. Fruit and vegetable consumption during school lunch (measured by plate waste), preferences, and knowledge, as well as body mass index, were assessed five times across 3.5 years (pre-intervention, spring 2006, 2007, 2008 and 2009). Hierarchical linear modeling was used to analyze program outcomes. RESULTS: At the first post-test assessment, children in the experimental group ate 0.28 more servings/lunch of fruit and vegetable relative to children in the control group and changes in fruit and vegetable consumption were found in each year throughout the program. However, this effect declined steadily across time so that by the delayed one-year follow-up period there was no difference between the groups in fruit and vegetable consumption. There were persistent intervention effects on children's knowledge. There were no effects on fruit and vegetable preferences and body mass index throughout the study. CONCLUSION: Although there was initial fruit and vegetable behavior change, annual measurements indicated a gradual decay of behavioral effects. These data have implications for the design of school-based fruit and vegetable interventions.

Effects of a teacher training program to promote physically active play among preschoolers with autism spectrum disorders.

Wellness Enhancing Physical Activity for Young Children (WE PLAY) is an intervention intended to promote physical activity (PA) among typically-developing preschool children in child care settings. It was adapted for use by teachers who educate children with Autism Spectrum Disorders (ASD). This study used a multiple baseline design across participants to evaluate the impact of WE PLAY-Autism on teachers' PA facilitating behaviors and on the PA levels of children with ASD. Visual analysis and effect size estimates indicated that two of the three teachers increased their PA facilitating behavior, although this was insufficient to demonstrate a functional relation. Children's (n = 5) PA was measured daily during school hours using accelerometry. Visual analysis, which was further supported by effect size calculations, indicated higher average levels of moderate-to-vigorous PA (MVPA) among preschoolers with ASD in the intervention phase (Tau-UA vs. B = 0.53, p < .001, Hedges' g = 0.99, 95% CI [0.56, 1.43]) and post-training phase (Tau-UA vs. B = 0.55, p < .001, Hedges' g = 1.17, 95% CI [0.73, 1.60]) in comparison to the baseline phase. WE PLAY-Autism is an intervention deserving of further investigation given its meaningful impact on the MVPA of preschoolers with ASD paired with its potential for broad implementation in preschools.

Longitudinal behavioral effects of a school-based fruit and vegetable promotion program.

OBJECTIVE: This study examined the longitudinal effects of a school-based program on kindergarten and first grade children's fruit and vegetable (F&V) consumption. METHODS: The program included lunchroom, classroom, school-wide, and family components. The primary dependent variable, F&V consumed at lunch, was assessed using weighed plate waste. Hierarchical linear models were used to analyze the differences between intervention and control groups and to account for repeated measurements. RESULTS: Children in the experimental group consumed more F&V (F = 29 g; V = 6 g; 0.43 portions/lunch; 0.28 servings/lunch) at the end of Year 1 compared with children in the control group. At the end of Year 2, children in the experimental group consumed more fruit (21 g; 0.23 portions/lunch; 0.15 servings/lunch), but not more vegetables compared with children in the control group. CONCLUSIONS: The intervention resulted in increased F&V consumption, with more pronounced and enduring effects for fruits than vegetables.

Addressing the Consequences of School Closure Due to COVID-19 on Children's Physical and Mental Well-Being.

Prolonged school closures are one of the most disruptive forces in the COVID-19 era. School closures have upended life for children and families, and educators have been forced to determine how to provide distance learning. Schools are also an essential source of nonacademic supports in the way of health and mental health services, food assistance, obesity prevention, and intervention in cases of homelessness and maltreatment. This article focuses on the physical and emotional toll resulting from school closures and the withdrawal of nonacademic supports that students rely on. The COVID-19 pandemic is shining a spotlight on how important schools are for meeting children's nonacademic needs. We argue that when students return to school there will be a more acute and wider-spread need for school-based nonacademic services and supports. Further, we expect that COVID-19 will serve as a focusing event opening a window of opportunity for programmatic and policy change that improves nonacademic services and supports in the future.

Retrospect and prospect regarding school psychology scholarship: Reflections of Lightner Witmer award winners.

This article provides reflections on several key elements important for establishing and sustaining successful research trajectories and scholarship within the field. Developed by several Lightner Witmer Award recipients, the article highlights several of Lightner Witmer's experiences and pioneering contributions, including the importance of his own mentors, collaborations with interdisciplinary professionals, and his emphasis on the relevance of scientific research programs and the practical implications for helping children. In an effort to move the field forward, we discuss important elements relevant to developing and sustaining successful research programs in school psychology including the importance of mentorship, collaboration, research methodologies, replicability, extramural funding, and dissemination. Throughout, we emphasize the importance of conducting research within the school context, which is consistent with the important influence of ecological systems articulated by Conoley, Powers, and Gutkin (2020), and reflects the hallmark of school psychology scholarship as an applied science. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Online preschool teacher training to promote physical activity in young children: A pilot cluster randomized controlled trial.

This study tested the Wellness Enhancing Physical Activity in Young Children (WE PLAY) program, a 4-week online preschool teacher training, on children's moderate-to-vigorous physical activity (MVPA). In this cluster RCT, six Head Start preschools were randomized to an intervention and comparison group. Children's MVPA was measured using accelerometers at pre- and posttest. The magnitude of the difference in MVPA between groups at posttest was small, but in the expected direction: Δ min/hour = 1.60, 95% CI [-0.97, 4.18], p = .22, Cohen's d = 0.32. We observed a pre/post within group increase in average minutes per hour of MVPA in school with a medium effect size for the intervention group: Δ mean min/hour = 2.09, 95% CI [0.51, 3.67], p = .0096, Cohen's d = 0.42. An increase was not seen for the comparison group: Δ mean min/hour = 0.44, 95% CI [-0.70, 1.59], p = .45, Cohen's d = 0.07. WE PLAY children in 6 hr/day programs gained 63 min of MVPA per week in school, providing preliminary evidence of the benefits of WE PLAY on children's physical activity levels. WE PLAY deserves further testing with larger groups of children and teachers. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

The theoretical foundation, fidelity, feasibility, and acceptability of a teacher training to promote physical activity among preschoolers in child care: A pilot study.

This article describes the Wellness Enhancing Physical Activity in Young Children (WE PLAY) teacher training, which was designed to assist early childhood educators to promote physical activity among preschoolers in child care. We describe the WE PLAY intervention and its grounding in constructs from theories of health behavior and an implementation science framework. Fidelity, feasibility, and acceptability data from the WE PLAY pilot study, a cluster randomized controlled trial (RCT) with six Head Start programs in Massachusetts. Data, collected between October 2017-May 2018, are from teachers and supervisors at 3 preschool programs who participated in the WE PLAY (intervention) group. To understand program feasibility and acceptability, we used the Usage Rating Profile-Intervention (URP-I; n = 13) and key informant interviews (n = 5). The URP-I is a validated teacher survey with 6 subscales (Acceptability, Understanding, Feasibility, Family-School Collaboration, Systems Climate, and Systems Support). It was administered twice; immediately after users completed the first component, an online training (week 2), and after implementation of all program components (week 4). WE PLAY was implemented as it was intended, and it was considered acceptable and feasible to users. There was an increase in users' understanding of how to implement the program between weeks 2 and 4, and a concomitant decrease in the amount of additional systems-level supports users thought they would need to implement WE PLAY between weeks 2 and 4. WE PLAY was easily understandable and feasible to implement in real world settings, it was highly acceptable to users, and it deserves further testing.

The Effects of Varying Structured Physical Activity Duration on Young Children's and Parents' Activity Levels.

Purpose: The purpose of this study was to examine whether structured physical activity (PA) in a family-based community exercise program affects PA of young children and parents. Method: Twenty-two children (mean ± SD; age, 4.9 ± 2.1 years) and their parents (age, 34.3 ± 7.6 years) participated in unstructured PA sessions followed by either short- or long-duration structured PA sessions, while wearing an ActiGraph GT9X activity monitor on their right hip to estimate PA. Independent t-tests compared children's and parents' PA during short- and long-structured PA sessions. Paired t-tests compared short- versus long-structured PA sessions. A mixed model ANOVA compared PA during unstructured versus structured sessions and between children and parents. Results: Children spent proportionately more time in moderate-to-vigorous PA (MVPA) and had higher accelerometer counts/min than parents during short-structured PA (children:60.9 ± 18.8% vs. parents:17.7 ± 6.8%, children:3870 ± 742 vs. parents:1836 ± 556 counts/min, p < .05) and long-structured PA (children:61.1 ± 20.1% vs. parents:12.6 ± 4.9%, children:3415 ± 758 vs. parents:1604 ± 633 counts/min, p < .05). No statistical differences were found between short- and long-structured PA sessions for proportion of time spent in MVPA or counts/min for children or parents (all, p > .05). Children spent proportionally more time in MVPA and had higher counts/min during unstructured PA compared to structured PA (unstructured MVPA:54.4 ± 3.9% vs. structured MVPA:38.2 ± 4.2%, unstructured counts/min:3830 ± 222 vs. structured counts/min:2768 ± 239 counts/min; p < .05). Conclusions: Children were more active than parents during both the unstructured and structured PA sessions. However, unstructured PA sessions resulted in 63-77% and 10-11% of PA recommendations for children and adults, respectively. Family-based exercise programming can provide an opportunity for children and their parents to attain MVPA during the week.

The Impact of 1 Year of Healthier School Food Policies on Students' Diets During and Outside of the School Day.

BACKGROUND: In 2012, Massachusetts implemented both the updated national school meal standards and comprehensive competitive food/beverage standards that closely align with current national requirements for school snacks. OBJECTIVES: This study examines the impact of these combined standards on school meal and snack food selections, as well as food choices outside of school. In addition, this study examines the impact of these standards on nutrients consumed. DESIGN: The NOURISH (Nutrition Opportunities to Understand Reforms Involving Student Health) Study was an observational cohort study conducted among students from spring 2012 to spring 2013. PARTICIPANTS/SETTING: One hundred sixty students in 12 middle schools and high schools in Massachusetts completed two 24-hour recalls before (spring 2012) and after implementation (spring 2013) of the updated standards. MAIN OUTCOME MEASURES: Changes in school meals, competitive food, and after-school snack selection, as well as nutrients consumed outside of school were examined. STATISTICAL ANALYSES PERFORMED: Logistic regression and mixed-model analysis of variance were used to examine food selection and consumption. RESULTS: After implementation, 13.6% more students chose a school meal (70.1% vs 56.5%; P=0.02). There were no differences in competitive food purchases but a significant decrease in the number of after-school unhealthy snacks consumed (0.69 [standard error=0.08] vs 1.02 [standard error=0.10]; P=0.009). During the entire day, students consumed, on average, 22 fewer grams of sugar daily after implementation compared with before implementation (86 g vs 108 g; P=0.002). CONCLUSIONS: With the reduction in the number of unhealthy school snacks, significantly more students selected school meals. Students did not compensate for lack of unhealthy snacks in school by increased consumption of unhealthy snacks outside of school. This provides important new evidence that both national school meal and snack policies may improve daily diet quality and should remain strong.

A Validation Study of the Automated Self-Administered 24-Hour Dietary Recall for Children, 2014 Version, at School Lunch.

BACKGROUND: Obtaining valid and reliable estimates of usual dietary intake at a reasonable cost is a challenge in school-based nutrition research. The Automated Self-Administered 24-Hour Dietary Recall for Children, 2014 version (ASA24 Kids-2014), a self-administered, computerized 24-hour dietary recall, offers improved feasibility over traditional interviewer-administered 24-hour recalls. OBJECTIVE: This mixed-methods study examined ASA24 Kids-2014's validity for measuring dietary intake from National School Lunch Program lunches. PARTICIPANTS/SETTING: After 24% attrition, 96 middle-school students from three urban schools in eastern Pennsylvania participated in the study. A subsample of 27 participants completed qualitative interviews. Data were collected in the spring of 2014. MAIN OUTCOME MEASURES: Self-reported ASA24 Kids-2014 data were compared to direct observations of school lunch, which served as the criterion measure. Dependent variables included eight meal components selected from the National School Lunch Program guidelines (fruit, vegetables, grains, protein-rich foods, dairy, oils, solid fats, and added sugars). A supplemental interview collected qualitative data regarding students' perceptions of content and substantive validity. STATISTICAL ANALYSES: The Wilcoxon signed rank test and Spearman's ρ examined criterion-related validity; qualitative content analysis examined content and substantive validity. RESULTS: Participants inaccurately recalled food items eaten at lunch, as 58% of foods were reported in error. However, among foods recalled correctly, no statistically significant differences emerged for estimates of portions consumed for six meal components (fruit, vegetables, grains, protein-rich foods, oils, and added sugars). In addition, statistically significant positive correlations emerged between ASA24 Kids-2014 and direct observation for all estimates. Qualitative data identified students' interest and motivation, comprehension, memory, and English-language fluency as relevant sources of error. CONCLUSIONS: Middle school students have difficulty recalling food items eaten at school lunch; however, they are somewhat successful at estimating intake of accurately recalled foods using ASA24 Kids-2014. Like many self-administered computerized recalls, it remains limited by substantial error. Findings have implications for the development of ASA24 Kids-2014 among diverse youth in urban school settings.

Parent-administered computer-assisted tutoring targeting letter-sound knowledge: Evaluation via multiple-baseline across three preschool students.

Knowledge of letters sounds has been identified as a primary objective of preschool instruction and intervention. Despite this designation, large disparities exist in the number of letter sounds children know at school entry. Enhancing caregivers' ability to teach their preschool-aged children letter sounds may represent an effective practice for reducing this variability and ensuring that more children are prepared to experience early school success. This study used a non-concurrent multiple-baseline-across-participants design to evaluate the effectiveness of caregivers (N=3) delivering a computer-assisted tutoring program (Tutoring Buddy) targeting letter sound knowledge to their preschool-aged children. Visual analyses and effect size estimates derived from Percentage of All Non-Overlapping Data (PAND) statistics indicated consistent results for letter sound acquisition, as 6weeks of intervention yielded large effects for letter sound knowledge (LSK) across all three children. Large effect sizes were also found for letter sound fluency (LSF) and nonsense word fluency (NWF) for two children. All three caregivers rated the intervention as highly usable and were able to administer it with high levels of fidelity. Taken together, the results of the present study found Tutoring Buddy to be an effective, simple, and usable way for the caregivers to support their children's literacy development.

Healthier Standards for School Meals and Snacks: Impact on School Food Revenues and Lunch Participation Rates.

INTRODUCTION: In 2012, the updated U.S. Department of Agriculture school meals standards and a competitive food law similar to the fully implemented version of the national Smart Snack standards went into effect in Massachusetts. This study evaluated the impact of these updated school meal standards and Massachusetts' comprehensive competitive food standards on school food revenues and school lunch participation. METHODS: Revenue and participation data from 11 Massachusetts school districts were collected from 2011 to 2014 and analyzed in 2015 using multilevel modeling. The association between the change in compliance with the competitive food standards and revenues/participation was assessed using linear regression. RESULTS: Schools experienced declines in school food revenues of $15.40/student in Year 1 from baseline (p=0.05), due to competitive food revenue losses. In schools with 3 years of data, overall revenues rebounded by the second year post-implementation. Additionally, by Year 2, school lunch participation increased by 15% (p=0.0006) among children eligible for reduced-price meals. Better competitive food compliance was inversely associated with school food revenues in the first year only; an absolute change in compliance by 10% was associated with a $9.78/student decrease in food revenues over the entire school year (p=0.04). No association was seen between the change in compliance and school meal participation. CONCLUSIONS: Schools experienced initial revenue losses after implementation of the standards, yet longer-term school food revenues were not impacted and school meal participation increased among children eligible for reduced-price meals. Weakening the school meal or competitive food guidelines based on revenue concerns appears unwarranted.

Implementation of Competitive Food and Beverage Standards in a Sample of Massachusetts Schools: The NOURISH Study (Nutrition Opportunities to Understand Reforms Involving Student Health).

BACKGROUND: During 2012, Massachusetts adopted comprehensive school competitive food and beverage standards that closely align with Institute of Medicine recommendations and Smart Snacks in School national standards. OBJECTIVE: We examined the extent to which a sample of Massachusetts middle schools and high schools sold foods and beverages that were compliant with the state competitive food and beverage standards after the first year of implementation, and complied with four additional aspects of the regulations. DESIGN: Observational cohort study with data collected before implementation (Spring 2012) and 1 year after implementation (Spring 2013). PARTICIPANTS/SETTING: School districts (N=37) with at least one middle school and one high school participated. MAIN OUTCOME MEASURES: Percent of competitive foods and beverages that were compliant with Massachusetts standards and compliance with four additional aspects of the regulations. Data were collected via school site visits and a foodservice director questionnaire. STATISTICAL ANALYSES PERFORMED: Multilevel models were used to examine change in food and beverage compliance over time. RESULTS: More products were available in high schools than middle schools at both time points. The number of competitive beverages and several categories of competitive food products sold in the sample of Massachusetts schools decreased following the implementation of the standards. Multilevel models demonstrated a 47-percentage-point increase in food and 46-percentage-point increase in beverage compliance in Massachusetts schools from 2012 to 2013. Overall, total compliance was higher for beverages than foods. CONCLUSIONS: This study of a group of Massachusetts schools demonstrated the feasibility of schools making substantial changes in response to requirements for healthier competitive foods, even in the first year of implementation.