What Do Parents Think About School Meals? An Exploratory Study of Rural Middle School Parents' Perceptions.

Interventions targeting school meals have been used to combat obesity in rural youth. Parents play a powerful role in childhood nutrition; however, we know little about parents' perceptions of school meal programs. This study aimed to understand parents' perceptions of school meal programs. Surveys were administered to middle school parents (n = 576) at six schools in a rural state. We conducted univariate and multivariate analyses to measure parents' overall perceptions of the school meals program and to identify differences in perceptions by their children's participation in the Free and Reduced Price School Meals (F&RM) program. Parents had largely negative views of school meals but agreed that they met students' needs. Results of the multivariate analysis revealed differences in perceptions by participation in F&RM including the relative importance of meal components. Including parents in meal-related experiences and decision making could improve their perceptions and increase children's participation in school lunch programs.

Middle School Students' Perceptions of the Lunchroom: Implications for Future Interventions.

The National School Lunch Program provides nutritious and inexpensive lunches, but low participation and food waste are challenges in many schools. Interventions aim to improve participation in the program, but little is known about how students' perceptions affect their participation. This study explored how middle school students in a rural state perceive school food service staff, food served, and lunchroom atmosphere. An online survey was administered to middle school students at six schools participating in a larger lunchroom intervention. Mean perception scores were calculated for all measures. Multilevel logistic regression was used to examine the relationship between perceptions and consumption. Overall perceptions of staff, food, and atmosphere were positive, and students classified as school lunch eaters had more positive perceptions in all three areas than noneaters. Interventions to increase participation in school lunch programs and promote consumption of healthy food items should address multiple factors that contribute to school lunch participation.

Implementation and outcome evaluation of a team nutrition intervention: increasing knowledge, attitudes, and preferences.

Low-income, rural children are at a greater risk for poor dietary intake. Schools offer a venue to deliver appropriate interventions. Our aim was to evaluate the implementation and effectiveness of Healthy Schools, Healthy Students (HSHS). We conducted a mixed-methods evaluation using a cluster-randomized trial design with 20 schools in a rural, Midwestern state. HSHS included education sessions, cafeteria coaching and taste testing. We interviewed implementers (n = 13) and nutrition educators (n = 8), conducted six focus groups with cafeteria coaches, and surveyed fourth graders (n = 1057) about their nutrition knowledge, attitudes toward and preferences for fruits and vegetables (F&V), F&V consumption and MyPlate awareness. We used multi-level linear models to estimate the intervention effect and qualitative data were coded. There were very few challenges to implementation. HSHS participation was positively associated with knowledge, attitudes toward F&V, preferences for vegetables from the taste tests, MyPlate awareness and vegetable consumption. HSHS was viewed as beneficial and easy to deliver, suggesting this type of intervention could be widely implemented. Improving knowledge and attitudes through nutrition education and preferences through taste testing have the potential to improve dietary intake among rural students. Low-cost nutrition interventions can be successfully implemented in rural elementary schools with positive outcomes.

Actively Involving Middle School Students in the Implementation of a Pilot of a Behavioral Economics-Based Lunchroom Intervention in Rural Schools.

School-based interventions can play an important role in improving childhood and adolescent nutrition and preventing obesity. Schools offer a unique opportunity to implement policy, systems, and environmental interventions targeting healthy eating behaviors. An intervention was piloted in six middle schools featuring behavioral economics-based changes to the lunchroom, communication training, and communicate cues for food service staff. The pilot study employed a multicomponent evaluation with students and food service directors and staff including a lunchroom assessment, online surveys, production records, and interviews. Five schools increased their scores on the lunchroom assessment tool, and four schools increased the number of servings produced of healthy food items. Interviews with food service directors indicated the interventions was feasible and well received. School-based policy, systems, and environmental interventions targeting healthy eating behaviors may play a role in preventing obesity in children and adolescents.

Building Relationships and Capacity in Rural Lunchrooms: Lessons from a Process Evaluation of a Pilot Behavioral Economics-Based Intervention.

We aimed to describe the successes and challenges of implementing a pilot program by working with students and food service staff in four rural high schools to encourage healthy eating among rural adolescents. The pilot program engaged students and school food service directors (FSDs) in identifying and making changes to the school lunchroom environment based on behavioral economics. As part of a multi-method evaluation, we conducted interviews with FSDs and staff, held focus groups with students, and recorded our observations as researchers. The lessons learned highlighted the importance of (1) the FSD's role in the school, (2) a faculty partner involved in the project, (3) the characteristics of the student group, and (4) setting realistic goals for the students. Our findings can guide future interventions designed to improve food choices in school lunchrooms and increase adolescents' fruit and vegetable consumption.

Using predicted marginal effects to assess the impact of rurality and free and reduced lunch eligibility on a school-based nutrition intervention.

PURPOSE: To estimate the impact of a school-based nutrition education intervention in rural schools and schools with high free and reduced lunch (FRL) eligibility rates. METHODS: As part of the evaluation of the Healthy Schools Healthy Students intervention, 20 schools were randomized to control and intervention conditions. Pre (October 2017) and posttest (April 2018) data were analyzed using multi-level linear regression models to estimate the intervention effect for multiple outcomes controlling for school-level demographic characteristics. We report the predicted marginal effect overall and specifically for rural; high FRL; and rural, high-FRL schools. RESULTS: We observed at least one significant intervention effect for food group knowledge, liking to eat fruit, beliefs about how healthy fruits are, non-taste test fruit preferences, liking to eat vegetables, beliefs about how healthy vegetables are, and taste test vegetable preferences. We observed differential intervention effects for all outcomes except taste test vegetable preferences based on rural and high-FRL status. CONCLUSIONS: Interventions do not necessarily have the same impact on all participants. Sub-analyses can reveal these important differential effects, as they have important implications for policymakers, program implementers, and evaluators. Resources and interventions should be allocated where they will have the greatest impact.

Exploring the Parents' Attitudes and Perceptions About School Breakfast to Understand Why Participation Is Low in a Rural Midwest State.

OBJECTIVE: To explore parental attitudes and perceptions about the school breakfast program in a state with low school breakfast participation. DESIGN: A cross-sectional study design that used an online survey completed by parents supplemented with district data from a state department of education. The survey included quantitative and qualitative components. SETTING: A rural Midwestern state with low school breakfast participation. PARTICIPANTS: Parents and caregivers of children in grades 1-12 were recruited through schools to complete a survey (n = 7,209). MAIN OUTCOME MEASURES: Participation in a school breakfast program. ANALYSIS: A generalized estimating equation model was used to analyze the data and account for the possible correlation among students from the same school district. Open-end survey items were coded. RESULTS: Parents identified several structural and logistic barriers in response to open-ended survey items. Factors associated with breakfast participation include perceived benefits, stigma related to those for whom breakfast is intended, and the importance of breakfast. CONCLUSIONS AND IMPLICATIONS: Interventions should be designed to test whether changing parent perceptions and decreasing stigma will lead to increased breakfast participation. Policy, systems, and environment changes addressing the structural and logistic barriers also may have the potential to increase participation.

Understanding Perceptions of School Administrators Related to School Breakfast in a Low School Breakfast Participation State.

BACKGROUND: The National School Breakfast Program (SBP) is a federally funded program that allows states to offer nutritious breakfast to K-12 students. However, rates of SBP participation are low in some rural states, and the reasons are not well understood. The purpose of the study was to explore administrators' perceptions, attitudes, and beliefs related to the SBP, and factors they identify as barriers or facilitators to increased participation. METHODS: Data were collected from a cross-sectional, online survey of K-12 school administrators (N = 152) in a rural, midsized Midwestern state fielded over an academic year. Descriptive statistics were calculated and open-ended questions were coded and analyzed for relevant themes. RESULTS: Administrators identified busing schedules, time constraints, and a lack of flexibility within the school schedule to accommodate breakfast as primary structural barriers to SBP participation. Administrators described family-centered norms as reasons for low participation in rural areas. Administrators are at varying stages of readiness to work on improving participation. CONCLUSIONS: Low SBP participation can be explained in part by a convergence of factors related to access, community norms, and structural barriers. Results may be used to inform ways in which administrators at the state, district, and school level can work to increase participation.