Disparities in the Healthfulness of School Food Environments and the Nutritional Quality of School Lunches
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design and Sample
2.2. Measures of the Healthfulness of School Food Environments
2.3. Measure of the Nutritional Quality of NSLP Lunches
2.4. Definition of Poverty and Race/Ethnicity Subgroups
2.5. Statistical Methods
3. Results
3.1. Sample Characteristics
3.2. Disparities in School Food Environments
3.2.1. School Poverty Level
3.2.2. Racial/Ethnic Composition
3.3. Disparities in the Nutritional Quality of NSLP Lunches
3.3.1. School Poverty Level
3.3.2. Racial/Ethnic Composition
4. Discussion
5. Conclusions
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
References
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Maximum Score | Standard for Maximum Score a | Standard for Minimum Score of Zero a | |
---|---|---|---|
Adequacy Components (Higher Scores Reflect Higher Concentrations in NSLP l Lunches) | |||
Total fruit b | 5 | ≥0.8 c equivalent per 1000 kcal | No fruit |
Whole fruit c | 5 | ≥0.4 c equivalent per 1000 kcal | No whole fruit |
Total vegetables d | 5 | ≥1.1 c equivalent per 1000 kcal | No vegetables |
Greens and beans d | 5 | ≥0.2 c equivalent per 1000 kcal | No dark green vegetables, beans, or peas |
Whole grains | 10 | ≥1.5 oz equivalent per 1000 kcal | No whole grains |
Dairy e | 10 | ≥1.3 c equivalent per 1000 kcal | No dairy |
Total protein foods f | 5 | ≥2.5 oz equivalent per 1000 kcal | No protein foods |
Seafood and plant proteins f,g | 5 | ≥0.8 oz equivalent per 1000 kcal | No seafood or plant proteins |
Fatty acids h | 10 | (PUFAs i + MUFAs j)/saturated fatty acids ≥ 2.5 | (PUFAs + MUFAs)/saturated fatty acids ≤ 1.2 |
Moderation components (higher scores reflect lower concentrations in NSLP lunches) | |||
Refined grains | 10 | ≤1.8 oz equivalent per 1000 kcal | ≥4.3 oz equivalent per 1000 kcal |
Sodium | 10 | ≤1.1 g per 1000 kcal | ≥2.0 g per 1000 kcal |
Empty calories k | 20 | ≤19% of energy | ≥50% of energy |
Total Score | 100 |
Analysis: School Poverty (n = 1207) | Analysis: Race/Ethnicity (n = 1198) | |||
---|---|---|---|---|
% | 95% CI | % | 95% CI | |
School Level | ||||
Elementary School | 59.7 | (57.4, 61.8) | 59.9 | (57.7, 62.1) |
Middle School | 18.2 | (16.8, 19.8) | 17.8 | (20.4, 24.2) |
High School | 22.1 | (20.3, 24.1) | 22.2 | (16.4, 19.4) |
School Urbanicity | ||||
Urban | 21.8 | (18.1, 26.0) | 21.9 | (18.2, 26.1) |
Suburban | 43.3 | (38.6, 48.2) | 43.1 | (38.4, 48.0) |
Rural | 34.9 | (30.5, 39.6) | 35.0 | (30.5, 39.7) |
School Size | ||||
Small (fewer than 500 students) | 48.7 | (44.5, 53.0) | 48.9 | (44.6, 53.2) |
Medium (500 to 999 students) | 39.3 | (35.2, 43.5) | 39.3 | (35.3, 43.6) |
Large (1000 or more students) | 12.0 | (10.3, 13.9) | 11.8 | (10.1, 13.7) |
Region | ||||
Midwest | 18.8 | (15.1, 23.2) | 18.9 | (15.2, 23.3) |
Southeast | 16.4 | (12.8, 20.8) | 16.5 | (12.9, 20.9) |
Western | 16.6 | (13.0, 21.1) | 16.6 | (12.9, 21.0) |
Southwest | 14.4 | (11.1, 18.5) | 14.4 | (11.0, 18.5) |
Mountain Plains | 13.2 | (9.5, 18.0) | 13.2 | (9.5, 18.0) |
Mid-Atlantic | 13.3 | (10.2, 17.1) | 13.1 | (10.0, 16.9) |
Northeast | 7.4 | (5.2, 10.4) | 7.4 | (5.2, 10.4) |
Low Poverty (n = 226) | Mid-Low Poverty (n = 376) | Mid-High Poverty (n = 330) | High Poverty (n = 275) | p-Value | |||||
---|---|---|---|---|---|---|---|---|---|
% | 95% CI | % | 95% CI | % | 95% CI | % | 95% CI | ||
Presence and Sources of Competitive Foods | |||||||||
Offers competitive foods | 91.4 | (86.3, 96.6) | 86.5 | (81.9, 91.2) | 85.2 | (79.8, 90.6) | 75.5 | (68.2, 82.9) | <0.01 * |
Sells foods other than milk on an a la carte basis | 83.1 | (75.8, 90.3) | 74.7 | (68.6, 80.9) | 73.5 | (66.6, 80.4) | 62.6 | (54.6, 70.5) | <0.01 * |
Sells foods in a vending machine | 36.3 | (29.7, 42.9) | 32.8 | (26.8, 38.8) | 30.0 | (23.7, 36.4) | 22.9 | (16.8, 29.0) | 0.03 * |
Sells foods in a school store, snack bar, food cart, kiosk, or fund-raiser | 15.8 | (9.3, 22.2) | 17.8 | (12.0, 23.6) | 11.6 | (7.5, 15.7) | 17.4 | (10.2, 24.6) | 0.36 |
School Food Policies and Programs | |||||||||
Operates a school garden | 12.4 | (5.7, 19.1) | 3.6 | (1.4, 5.9) | 8.0 | (3.5, 12.4) | 8.0 | (3.7, 12.2) | 0.06 |
Participates in FFVP a | 12.2 | (6.0, 18.5) | 13.3 | (8.0, 18.6) | 19.9 | (12.9, 27.0) | 26.6 | (19.6, 33.7) | 0.01 * |
Participates in Farm to School | 22.3 | (13.9, 30.8) | 17.0 | (10.7, 23.2) | 15.9 | (8.5, 23.4) | 15.2 | (8.6, 21.8) | 0.58 |
SFA offers branded foods | 13.4 | (6.6, 20.2) | 10.0 | (5.8, 14.1) | 9.3 | (4.7, 13.9) | 4.5 | (0.7, 8.2) | 0.08 |
SFA has pouring rights contract | 22.2 | (12.9, 31.5) | 28.0 | (20.5, 35.6) | 31.9 | (23.0, 40.9) | 17.0 | (10.7, 23.4) | 0.02 * |
Has a school wellness policy in addition to SFA wellness policy | 15.9 | (9.7, 22.0) | 19.0 | (13.1, 24.8) | 12.9 | (7.9, 17.9) | 25.5 | (18.0, 32.9) | 0.02 * |
SFA fully implemented Smart Snacks in School standards | 61.7 | (50.0, 72.2) | 63.2 | (54.4, 71.1) | 62.4 | (52.7, 71.1) | 53.3 | (44.1, 62.3) | 0.34 |
SFA has standards that exceed Smart Snacks in School standards | 22.9 | (15.6, 32.4) | 29.4 | (22.8, 37.0) | 36.9 | (28.5, 46.3) | 28.5 | (21.3, 37.1) | 0.13 |
Nutrition Promotion and Outreach | |||||||||
Shared information about school meal program with nutrition advisory council | 43.1 | (32.5, 53.8) | 34.7 | (27.0, 42.4) | 32.8 | (25.2, 40.3) | 47.5 | (39.2, 55.8) | 0.03 * |
Conducted a nutrition education activity in the classroom or food service area | 50.2 | (39.7, 60.7) | 44.2 | (36.9, 51.5) | 54.9 | (46.2, 63.6) | 54.6 | (46.4, 62.9) | 0.20 |
Encouraged students to select fruit | 88.7 | (83.2, 94.3) | 90.7 | (86.9, 94.5) | 87.1 | (81.7, 92.5) | 90.5 | (85.3, 95.7) | 0.67 |
Involved students in planning of menus | 45.0 | (34.6, 55.5) | 45.5 | (37.7, 53.3) | 40.1 | (32.5, 47.7) | 37.2 | (29.1, 45.3) | 0.41 |
Sought student input into vegetable offerings | 46.0 | (35.6, 56.4) | 48.7 | (40.9, 56.5) | 50.0 | (41.9, 58.1) | 50.0 | (41.7, 58.3) | 0.93 |
Majority White (n = 643) | Majority Black (n = 89) | Majority Hispanic (n = 156) | Diverse (n = 310) | p-Value | |||||
---|---|---|---|---|---|---|---|---|---|
% | 95% CI | % | 95% CI | % | 95% CI | % | 95% CI | ||
Presence and Sources of Competitive Foods | |||||||||
Offers competitive foods | 85.5 | (81.6, 89.5) | 67.6 | (52.2, 83.0) | 77.3 | (67.4, 87.1) | 90.0 | (85.5, 94.6) | <0.01 * |
Sells foods other than milk on an a la carte basis | 75.3 | (70.5, 80.1) | 67.1 | (52.3, 81.9) | 60.2 | (48.8, 71.6) | 74.7 | (67.1, 82.3) | 0.07 |
Sells foods in a vending machine | 33.9 | (29.7, 38.0) | 21.4 | (9.9, 32.9) | 14.2 | (9.0, 19.4) | 32.2 | (25.4, 39.1) | <0.01 * |
Sells foods in a school store, snack bar, food cart, kiosk, or fund-raiser | 14.3 | (10.4, 18.3) | 19.8 | (3.3, 36.2) | 18.8 | (9.5, 28.0) | 15.6 | (10.0, 21.3) | 0.73 |
School Food Policies and Programs | |||||||||
Operates a school garden | 7.6 | (4.7, 10.5) | 5.1 | (0.0, 11.0) | 10.3 | (3.1, 17.6) | 6.6 | (2.9, 10.4) | 0.67 |
Participates in FFVP a | 19.6 | (15.2, 23.9) | 26.7 | (13.2, 40.1) | 21.7 | (10.9, 32.4) | 12.6 | (6.8, 18.4) | 0.17 |
Participates in Farm to School | 17.2 | (11.8, 22.5) | 21.3 | (9.3, 33.3) | 14.2 | (4.8, 23.6) | 16.1 | (9.6, 22.6) | 0.81 |
SFA offers branded foods | 7.7 | (4.4, 10.9) | 3.4 | (0.0, 7.7) | 9.9 | (2.4, 17.5) | 12.5 | (6.6, 18.5) | 0.18 |
SFA has pouring rights contract | 30.2 | (23.4, 37.1) | 23.4 | (11.1, 35.7) | 11.4 | (2.7, 20.1) | 22.3 | (14.5, 30.2) | 0.02 * |
Has a school wellness policy in addition to SFA wellness policy | 16.6 | (12.7, 20.4) | 31.7 | (17.5, 45.9) | 25.4 | (14.9, 35.9) | 14.8 | (9.2, 20.4) | 0.02 * |
SFA fully implemented Smart Snacks in School standards | 59.6 | (52.0, 66.8) | 58.3 | (40.4, 74.3) | 53.2 | (40.5, 65.5) | 64.8 | (55.2, 73.3) | 0.57 |
SFA has standards that exceed Smart Snacks in School standards | 29.8 | (23.6, 36.8) | 29.3 | (16.3, 46.9) | 32.9 | (22.4, 45.5) | 29.4 | (21.4, 38.8) | 0.97 |
Nutrition Promotion and Outreach | |||||||||
Shared information about school meal program with nutrition advisory council | 35.2 | (29.5, 40.9) | 52.2 | (38.7, 65.6) | 43.9 | (31.7, 56.1) | 39.5 | (30.7, 48.2) | 0.12 |
Conducted a nutrition education activity in the classroom or food service area | 49.1 | (42.6, 55.5) | 54.9 | (40.8, 68.9) | 50.4 | (38.6, 62.3) | 54.2 | (45.5, 62.8) | 0.75 |
Encouraged students to select fruit | 90.3 | (87.1, 93.5) | 87.2 | (76.6, 97.9) | 96.3 | (93.4, 99.3) | 84.4 | (78.0, 90.8) | 0.05 |
Involved students in planning of menus | 43.0 | (36.7, 49.3) | 42.0 | (28.1, 56.0) | 37.5 | (25.8, 49.2) | 41.2 | (32.8, 49.6) | 0.87 |
Sought student input into vegetable offerings | 50.1 | (44.1, 56.2) | 49.1 | (34.7, 63.5) | 48.1 | (36.3, 59.9) | 47.0 | (38.7, 55.3) | 0.94 |
Low Poverty (n = 226) | Mid-Low Poverty (n = 376) | Mid-High Poverty (n = 330) | High Poverty (n = 275) | p-Value * | |||||
---|---|---|---|---|---|---|---|---|---|
Adequacy Components (Higher Scores Reflect Higher Concentrations in NSLP Lunches) | |||||||||
∞ Total fruit | 100 | (100, 100) | 100 | (100, 100) | 100 | (99.0, 100) | 100 | (98.9, 100) | 0.37 |
∞ Whole fruit | 100 | (100, 100) | 100 | (100, 100) | 100 | (100, 100) | 100 | (100, 100) | 0.98 |
Total vegetables | 79.2 | 1.8 | 81.7 | 1.5 | 84.1 | 1.5 | 83.8 | 1.9 | 0.17 |
Greens and beans | 65.8 | 2.9 | 72.8 | 2.0 | 74.0 | 2.5 | 74.6 | 2.7 | 0.11 |
∞ Whole grains | 100 | (100, 100) | 100 | (100, 100) | 100 | (100, 100) | 100 | (100, 100) | 0.19 |
Dairy | 100 | 0.0 | 100 | 0.0 | 100 | 0.0 | 100 | 0.0 | n.a. |
Total protein foods | 81.4 | 1.8 | 90.9 a | 0.8 | 91.0 a | 0.9 | 90.2 a | 1.1 | <0.01 |
Seafood and plant proteins | 45.9 | 2.6 | 49.6 | 2.1 | 50.3 | 2.4 | 49.5 | 3.0 | 0.61 |
Fatty acids | 61.3 | 2.7 | 66.9 | 1.5 | 62.8 | 1.8 | 61.3 | 2.1 | 0.06 |
Moderation Components (Higher Scores Reflect Lower Concentrations in NSLP Lunches) | |||||||||
∞ Refined grains | 100 | (100, 100) | 100 | (100, 100) | 100 | (100, 100) | 100 | (100, 100) | 0.30 |
Sodium | 31.4 | 2.2 | 26.8 | 1.8 | 26.7 | 1.7 | 29.4 | 1.9 | 0.31 |
∞ Empty calories | 100 | (93.2, 100) | 100 | (92.5, 100) | 100 | (92.6, 100) | 100 | (93.3, 100) | 0.98 |
Total Score | 80.8 | 0.5 | 81.9 | 0.5 | 82.1 | 0.4 | 82.0 | 0.5 | 0.22 |
Majority White (n = 643) | Majority Black (n = 89) | Majority Hispanic (n = 156) | Diverse (n = 310) | p-Value * | |||||
---|---|---|---|---|---|---|---|---|---|
Adequacy Components (Higher Scores Reflect Higher Concentrations in NSLP Lunches) | |||||||||
∞ Total fruit | 100 | (97.8, 100) | 100 | (100, 100) | 100 | (98.4, 100) | 100 | (100, 100) | 0.08 |
∞ Whole fruit | 100 | (100, 100) | 100 a | (100, 100) | 100 | (100, 100) | 100 b | (100, 100) | <0.01 |
Total vegetables | 85.4 | 1.0 | 83.1 | 3.5 | 80.3 | 2.8 | 77.7 a | 1.8 | <0.01 |
Greens and beans | 73.1 | 1.7 | 84.2 a | 3.8 | 72.1 | 3.9 | 67.7 b | 2.6 | <0.01 |
∞ Whole grains | 100.0 | (100, 100) | 100 | (100, 100) | 100 | (100, 100) | 100 | (100, 100) | 0.99 |
Dairy | 100 | 0.0 | 100 | 0.0 | 100 | 0.0 | 100 | 0.0 | n.a. |
Total protein foods | 88.6 | 0.8 | 90.1 | 2.1 | 90.5 | 1.5 | 89.5 | 1.2 | 0.70 |
Seafood and plant proteins | 48.7 | 1.7 | 40.5 | 5.2 | 55.6 | 4.0 | 49.9 | 2.7 | 0.14 |
Fatty acids | 63.4 | 1.4 | 61.9 | 3.1 | 60.2 | 3.5 | 65.2 | 1.9 | 0.58 |
Moderation Components (Higher Scores Reflect Lower Concentrations in NSLP Lunches) | |||||||||
∞ Refined grains | 100 | (100, 100) | 100 | (98.3, 100) | 100 | (100, 100) | 100 | (100, 100) | 0.27 |
Sodium | 24.0 | 1.2 | 29.4 | 3.3 | 34.6 a | 2.8 | 33.4 a | 1.9 | <0.01 |
∞ Empty calories | 98.9 | (92.1, 100) | 100.0 | (95.6, 100) | 100.0 | (94.8, 100) | 100.0 | (94.6, 100) | 0.07 |
Total Score | 81.4 | 0.4 | 82.4 | 0.6 | 82.7 | 0.8 | 82.1 | 0.5 | 0.22 |
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Share and Cite
Bardin, S.; Washburn, L.; Gearan, E. Disparities in the Healthfulness of School Food Environments and the Nutritional Quality of School Lunches. Nutrients 2020, 12, 2375. https://doi.org/10.3390/nu12082375
Bardin S, Washburn L, Gearan E. Disparities in the Healthfulness of School Food Environments and the Nutritional Quality of School Lunches. Nutrients. 2020; 12(8):2375. https://doi.org/10.3390/nu12082375
Chicago/Turabian StyleBardin, Sarah, Liana Washburn, and Elizabeth Gearan. 2020. "Disparities in the Healthfulness of School Food Environments and the Nutritional Quality of School Lunches" Nutrients 12, no. 8: 2375. https://doi.org/10.3390/nu12082375
APA StyleBardin, S., Washburn, L., & Gearan, E. (2020). Disparities in the Healthfulness of School Food Environments and the Nutritional Quality of School Lunches. Nutrients, 12(8), 2375. https://doi.org/10.3390/nu12082375