Lifting Universal Masking in Schools - Covid-19 Incidence among Students and Staff.

BACKGROUND: In February 2022, Massachusetts rescinded a statewide universal masking policy in public schools, and many Massachusetts school districts lifted masking requirements during the subsequent weeks. In the greater Boston area, only two school districts - the Boston and neighboring Chelsea districts - sustained masking requirements through June 2022. The staggered lifting of masking requirements provided an opportunity to examine the effect of universal masking policies on the incidence of coronavirus disease 2019 (Covid-19) in schools. METHODS: We used a difference-in-differences analysis for staggered policy implementation to compare the incidence of Covid-19 among students and staff in school districts in the greater Boston area that lifted masking requirements with the incidence in districts that sustained masking requirements during the 2021-2022 school year. Characteristics of the school districts were also compared. RESULTS: Before the statewide masking policy was rescinded, trends in the incidence of Covid-19 were similar across school districts. During the 15 weeks after the statewide masking policy was rescinded, the lifting of masking requirements was associated with an additional 44.9 cases per 1000 students and staff (95% confidence interval, 32.6 to 57.1), which corresponded to an estimated 11,901 cases and to 29.4% of the cases in all districts during that time. Districts that chose to sustain masking requirements longer tended to have school buildings that were older and in worse condition and to have more students per classroom than districts that chose to lift masking requirements earlier. In addition, these districts had higher percentages of low-income students, students with disabilities, and students who were English-language learners, as well as higher percentages of Black and Latinx students and staff. Our results support universal masking as an important strategy for reducing Covid-19 incidence in schools and loss of in-person school days. As such, we believe that universal masking may be especially useful for mitigating effects of structural racism in schools, including potential deepening of educational inequities. CONCLUSIONS: Among school districts in the greater Boston area, the lifting of masking requirements was associated with an additional 44.9 Covid-19 cases per 1000 students and staff during the 15 weeks after the statewide masking policy was rescinded.

The School Nutrition and Meal Cost Study-I: Overview of Findings Related to Improving Diet Quality, Weight, and Disparities in US Children and Policy Implications.

The national school breakfast and lunch programs administered by the United States Department of Agriculture (USDA) are a cornerstone of the nation's nutrition safety net for children from low-income families [...].

Wisconsin School Wellness Policies after Federal Legislation Change: Understanding Key Mechanisms of Policy Improvement.

BACKGROUND: The Final Rule of the Healthy Hunger Free Kids Act, published in 2016, required school districts participating in the federal Child Nutrition Programs to update their local wellness policies to reflect the more stringent requirements effective June 30, 2017. OBJECTIVE: Our aim was to investigate whether Wisconsin school wellness policies (SWPs) were updated after the Final Rule, measure policy quality change, and describe mechanisms of successful policy change. DESIGN: From 2016 through 2018, an explanatory sequential mixed-methods study examined change in SWP quality before and after the Final Rule was published. SWPs were collected in 2 waves reflecting policies written before and updated after the July 21, 2016 publication of the Final Rule. Semi-structured key-informant interviews were conducted with districts that demonstrated significant policy improvement. PARTICIPANTS/SETTING: Quantitative analysis examined 442 Wisconsin school districts' SWPs. Semi-structured interviews were conducted with 14 school districts that demonstrated significant change between waves. MAIN OUTCOME MEASURES: WellSAT 2.0 strength and comprehensiveness scores measured SWP quality among districts that updated their policies. Themes from interviews were identified using framework analysis. STATISTICAL ANALYSIS PERFORMED: First, we calculated the proportion of Wisconsin school districts participating in federal Child Nutrition Programs for which SWPs were obtained at both waves of policy collection (n = 192 districts, 43.4%). Among districts that updated SWPs in wave II, repeated-measure analysis of variance tests described policy quality and policy quality change, respectively. RESULTS: Among the 192 districts that updated their SWPs, policy quality increased overall and for 5 of 6 domains. Nutrition education scores did not show significant change. Interviewees commonly cited wellness leadership, support and resources, and buy-in and culture change as key components of policy improvement. CONCLUSIONS: Fewer than half of Wisconsin school districts updated their policies in the 10 months after the Final Rule was published. SWP from these districts showed policy quality improvement in most areas. Interviews with successful districts indicate the common need for empowered leaders and supportive environments to facilitate culture change around student wellness.

Association between Nutrition Policies and Student Body Mass Index.

In response to concerns about childhood obesity, many US states have implemented policies to limit the sale of unhealthy foods and beverages (e.g., snacks, desserts, and sugary drinks) sold in competition with school meal programs (i.e., competitive foods) in order to improve the nutritional environment of schools and support student health. This study measured state-level competitive food and beverage policies that require foods and beverages sold in à la carte lines, vending machines, and school stores to meet strong nutrition standards and tested the hypothesis that students living in states with stronger laws would have lower body mass index (BMI)-for-age percentiles. BMI data from a national sample of 1625 students attending 284 schools from the School Nutrition and Meal Cost Study were linked to state laws coded as part of the National Wellness Policy Study. A survey-adjusted linear regression model accounting for student and school-level characteristics showed that stronger state nutrition policies were associated with lower student BMI scores (coefficient: -0.06, 95% CI: -0.12, -0.00). Additional models indicated that stronger state policies were significantly associated with fewer unhealthy foods and beverages available in schools. These findings suggest that strong regulations on competitive foods and beverages may lead to improvements in the nutritional quality of the school environment and student BMI. Thus, current federal standards regulating snacks in US schools (i.e., Smart Snacks) are an important element of a comprehensive strategy to improve the school nutrition environment and reduce rates of childhood obesity.

Disparities in the Healthfulness of School Food Environments and the Nutritional Quality of School Lunches.

The Healthy, Hunger-Free Kids Act (HHFKA), a public law in the United States passed in 2010, sought to improve the healthfulness of the school food environment by requiring updated nutrition standards for school meals and competitive foods. Studies conducted since the passage of the HHFKA indicate improvements in the food environment overall, but few studies have examined whether these improvements varied by the socioeconomic and racial/ethnic composition of students in schools. To better understand the extent of disparities in the school food environment after HHFKA, this paper examined differences in the healthfulness of school food environments and the nutritional quality of school lunches by the school poverty level and racial/ethnic composition of students using data from the School Nutrition and Meal Cost Study. Results from chi-square analyses showed lower proportions of high poverty, majority black, and majority Hispanic schools had access to competitive foods, while higher proportions of these schools had a school wellness policy in addition to a district wellness policy. The overall nutritional quality of school lunches, as measured by total Healthy Eating Index (HEI)-2010 scores, did not vary significantly across school types, although some HEI component scores did. From these findings, we concluded that there were disparities in the school food environment based on the socioeconomic and racial/ethnic composition of students in schools, but no significant disparities in the overall nutritional quality of school lunches were found.

Assessing the Relationship between District and State Policies and School Nutrition Promotion-Related Practices in the United States.

School environments are an optimal setting to promote healthy student diets, yet it is unclear what role state and district policies play in shaping school contexts. This study examined how state and district policies are associated with school-reported practices for promoting student participation in school lunch programs. School nutrition manager data were obtained from the School Nutrition and Meal Cost Study's (SNMCS) sample of 1210 schools in 46 states and the District of Columbia (DC) during school year 2014-2015. Relevant state laws and district policies were compiled and coded. Multivariable logistic and Poisson regressions, controlling for school characteristics, examined the relationship between state/district laws/policies and school practices. Compared to schools in districts or states with no policies/laws, respectively, schools were more likely to provide nutritional information on school meals (AOR = 2.59, 95% CI = 1.33, 5.05) in districts with strong policies, and to promote school meals at school events (AOR = 1.93, CI = 1.07, 3.46) in states with strong laws. Schools in states with any laws related to strategies to increase participation in school meals were more likely to seek student involvement in menu planning (AOR = 2.02, CI = 1.24, 3.31) and vegetable offerings (AOR = 2.00, CI = 1.23, 3.24). The findings support the association of laws/policies with school practices.

Hiring Requirements and Qualifications of School Food Authority Directors Changed in Some Districts After Implementation of US Department of Agriculture Professional Standards.

BACKGROUND: In 2015, the US Department of Agriculture set minimum education and training requirements (ie, professional standards) to ensure that school nutrition professionals have the knowledge and experience to operate school meal programs. No study to date has examined whether hiring requirements and qualifications of school food authority (SFA) directors have changed since 2015. OBJECTIVE: To assess changes in hiring requirements and qualifications of SFA directors since the US Department of Agriculture professional standards were established, overall and by district size. DESIGN: Cross-sectional analysis of nationally representative district-level data from the 2012 and 2016 cycles of the School Health Policies and Practices Study. PARTICIPANTS/SETTING: In 2012, 660 sampled districts completed the School Health Policies and Practices Study Nutrition Services questionnaire. In 2016, 599 sampled districts completed the questionnaire. MAIN OUTCOME MEASURES: Hiring requirements for newly hired SFA directors and reported qualifications of SFA directors. STATISTICAL ANALYSES PERFORMED: Differences in prevalence estimates from 2012 to 2016 for all districts and by district size were assessed with χ2 tests. RESULTS: Significant increases were found for 3 hiring requirements: degree in nutrition or related field, registered dietitian credential, and food safety certification. Significant changes in 4 of the 5 reported qualifications were found including an increase in the percentage of district directors with a degree in nutrition or a related field and decreases in the percentage of directors with a School Nutrition Specialist credential from the School Nutrition Association, School Nutrition Association certifications, and certified dietary managers. Changes were found in small and medium districts, but not large districts. CONCLUSIONS: District hiring requirements and SFA director qualifications have changed since the implementation of the US Department of Agriculture professional standards, including some differences by district size. Future research could identify challenges facing districts in hiring directors who have a degree in nutrition or related fields or who have specialized nutrition credentials or certificates (eg, registered dietitians).

Food and beverage marketing in schools: school superintendents' perspectives and practices after the healthy, Hunger-Free Kids Act.

OBJECTIVE: Children are surrounded by ubiquitous forms of unhealthy food marketing at home and in schools. The US Department of Agriculture now restricts food and beverage marketing that does not meet Smart Snacks in School standards. School superintendents, as districts' top administrators, play a critical role in ensuring marketing policies are implemented and adhered to; however, there is limited research involving this stakeholder group. The current study examined superintendents' perspectives on food marketing in schools and the marketing provision in wellness policies, as well as experiences with the implementation of such policies. DESIGN: Qualitative focus groups and follow-up interviews (with focus group participants) were conducted by trained researchers. SETTING: Focus groups occurred at The School Superintendents' annual meeting; follow-up interviews were over the telephone. PARTICIPANTS: Superintendents and assistant superintendents (n 39) from twenty-three states participated. Interviews were recorded and professionally transcribed; transcripts were team-coded in Atlas.ti using an iteratively revised coding guide to facilitate theme generation. RESULTS: Despite common concerns that marketing to children was 'insidious', superintendents reported a wide range of food and beverage marketing policies. In addition, the main issue is fundraising - such as 'restaurant nights' - that results in marketing that occurs on- and off-campus and afterschool. CONCLUSIONS: Discrepancies between perspectives and practices point to the challenges that superintendents face with budgetary constraints, as well as relationships with parent-teacher organisations. These findings provide important insights about superintendents' perspectives and challenges, particularly for government and child health advocates supporting school districts, to implement these policies.

Stories of success: a qualitative examination of contributors to excellence in school drinking water access.

OBJECTIVE: Drinking water instead of beverages with added sugar can help prevent obesity and cavities and promote overall health. Children spend much of their day in school, where they have variable access to drinking water. In 2010, federal and state law required California public schools to provide free potable water to students in areas where meals are served and/or eaten. The current study aims to identify factors associated with an excellent drinking water culture in schools. DESIGN: A qualitative assessment of barriers and facilitators to providing excellent water quality and access in a purposive sample of California schools. In-depth interviews with key informants were conducted using a snowball sampling approach, after which data were analysed using both inductive and deductive methods. SETTING: California public elementary, middle/junior and high schools. PARTICIPANTS: Knowledgeable individuals involved in initiatives related to school drinking water accessibility, quality or education at each selected school. RESULTS: Thirty-four interviewees participated across fifteen schools. Six themes emerged as prominent facilitators to a school's success in providing excellent water access to students: active and engaged champions, school culture and policy, coordination between groups, community influences, available resources and environmentalism. CONCLUSIONS: While policy is an important step for achieving minimum standards, resources and interest in promoting excellence in drinking water access and quality can vary among schools. Ensuring that schools have dedicated staff committed to advancing student health and promoting the benefits of water programs that are more salient to schools could help reduce disparities in drinking water excellence across schools.

The role of peanut-free school policies in the protection of children with peanut allergy.

Peanut allergy that affects 1.4-4.5% of North American children, has increased in prevalence in the past 20 years, is often diagnosed early in life, and outgrown in fewer than 20-32% of children by age 6. Recent self-reported data suggest that over 50% of peanut allergic individuals have had a severe reaction. Because food (and peanut in particular) is a ubiquitous part of school attendance, this raises the potential for reactions to accidental peanut ingestion at school. Accordingly, there is increasing interest in creating policy to protect peanut allergic children in the school environment-sometimes as a ban on peanut-containing items either in the classroom, the lunchroom, or even in the entire facility. We review the evidence for, and against, peanut bans in schools.

Smoke-free-school-hours at vocational education and training schools in Denmark: attitudes among managers and teaching staff - a national cross-sectional study.

BACKGROUND: Tobacco is the main cause of non-communicable disease and premature death globally. Implementing restrictive school tobacco policies such as smoke-free-school-hours (SFSH) may have the potential to reduce smoking among Vocational Education and Training (VET) school students. To be effective, school tobacco policies that largely involve strict and consistent enforcement by both managers and teaching teaching staff must be implemented. This study investigated the attitudes towards the implementation of SFSH among the managers and teaching staff at Danish VET schools. METHODS: The analyses were based on cross-sectional survey data collected with an online survey among managers and teaching staff at Danish VET schools. The data was collected from March to June 2017. RESULTS: Managers and teaching staff (n = 571) from 71 out of 87 Danish VET schools (81.6%) took part in the survey. In the adjusted analysis, teaching staff were twice as likely as managers to have a favourable attitude towards SFSH. Furthermore, being female and of increasing age correlated with having a favourable attitude. A trend towards schools in favour of SFSH having more health promotion facilities, policy and practice, was identified. CONCLUSION AND IMPLICATIONS: Existing health promotion facilities and activities at the schools were associated with a favorable attitude among the management towards implementing SFSH. Thus, implementing other health promotion activities and policies might be an important first step to establish readiness to implement SFSH.

Association of state-level CPR training initiatives with layperson CPR knowledge in the United States.

STUDY AIM: Recent work has demonstrated low rates of layperson CPR training across the US. In an attempt to increase rates, some states passed legislation that requires CPR training before high school graduation. We hypothesized laypeople in states with required training would exhibit a greater likelihood of being currently trained in CPR when compared with laypeople in states without required CPR training. METHODS: We used a previously conducted nationwide cross-sectional random-digit dial survey of the US adult population (09/2015-11/2015). Survey weighted descriptive statistics and logistic regression were used to assess the primary association of likelihood of CPR training and required CPR training by graduation. RESULTS: Of the 9022 participants, 677 healthcare workers were excluded. Among those living in states with required training, 17% of laypersons were currently trained, while 14% of laypersons in states without required training were currently trained (p < 0.01). Amongst younger individuals (18-24), 29% were currently trained in states with required CPR training compared with 19% currently trained in states without required training (p < 0.01). Those in required training states were 34% more likely to be currently trained than individuals in states without required training (OR: 1.34, 95%CI: 1.20-1.50, p < 0.01). In a secondary analysis, younger laypersons in required training states were almost two times more likely to be currently trained (OR: 1.81, 95% CI: 1.18-2.78, p = 0.01). CONCLUSIONS: Individuals were more likely to be currently trained in CPR in states with mandatory CPR training for high school graduation, suggesting a need for additional research on this public policy.