Phase II Full report FINAL - thriveRI - Rhode Island … · · 2015-10-05Purpose of technical assistance project ... Final report. Santa Cruz, CA: ... • The foods or beverages

Rhode Island School Nutrition Environment Evaluation: Vending and a La Carte Food

Policies

Phase II Summary Report

June 2007

Prepared for the Rhode Island Department of Education

by The Research Department of

ETR Associates

Funding provided by: Centers for Disease Control and Prevention Division of Adolescent and School Health

Table of Contents

Acknowledgements ...........................................................................................................2

Introduction ..........................................................................................................................3

Purpose of technical assistance project ...........................................................3

Background..........................................................................................................................3

Site selection process .............................................................................................3

Description of selected site ...................................................................................3

Initial site visit ...........................................................................................................4

Methods ................................................................................................................................4

Evaluation questions and goals ..........................................................................5

Evaluation design/approach ..............................................................................6

Approvals ................................................................................................................8

Sample.....................................................................................................................8

Incentives ..............................................................................................................10

Instrumentation ....................................................................................................10

Pilot testing ............................................................................................................11

Data collection ....................................................................................................12

Data Analyses.......................................................................................................13

Results (by evaluation questions) ...................................................................................14

Section 1 - Policies ................................................................................................14

Section 2- Implementation..................................................................................18

Section 3 – Impact ................................................................................................27

Discussion............................................................................................................................35

Generalization.....................................................................................................35

Limitations.............................................................................................................35

Implications and recommendations ...............................................................36

Appendices........................................................................................................................38

Instruments used in study....................................................................................38

Permission/assent forms ......................................................................................90

Individual data collection activity summaries................................................95

Pricing and Sales Data Analysis ........................................................................163

RI Phase II Summary –6/11/07 1

Acknowledgements

The Rhode Island School Nutrition Environment Evaluation was supported by funding from the Division of Adolescent and School Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (Contract # 200-2002-00800). The ETR evaluation team was headed by Lisa Russell, PhD, Principal investigator, and BA Laris, MPH, Project coordinator. A number of other ETR staff played instrumental roles during the evaluation including: Karin Coyle, PhD (evaluation design consultation); Alyssa Steiner (logistics and data collection); Sue Potter and Heather Franks (data analysis and data collection); Tracy Unti and Gina Lepore (data collection and data entry); Krystin Martens and Greg Thrush (data collection). Michelle Bliesner, PhD, Kris Freiwald, and Amy Takemoto assisted with qualitative analyses. Jill Glassman, PhD, provided guidance on quantitative data analyses, and Nancy Calvin provided administrative support. Several other individuals provided support in shaping the evaluation. Leah Robin, PhD, Mary McKenna, PhD, and Karen DeBrot, DrPH, Division of Adolescent and School Health, Centers for Disease Control and Prevention, provided guidance and feedback throughout the evaluation. The evaluation could not have occurred without the support of Jan Mermin, MSW and Linda Nightingale Greenwood of the Rhode Island Department of Education, and the school district representatives, superintendents, principals, teachers, other school personnel, students, and parents who welcomed us at their schools. For further information on the Rhode Island Healthy Schools Coalition contact: Rhode Island Department of Education Office of Progressive Support and Intervention Jan Mermin 255 Westminster Street, 6th floor Providence, RI 02903 401-222-8954 [email protected] http://www.ride.ri.gov or www.thriveri.org For information on the Rhode Island School Nutrition Environment evaluation contact: Leah Robin, PhD, Evaluation Research Team Leader Surveillance and Evaluation Branch, Division of Adolescent and School Health (DASH) Centers for Disease Control and Prevention (770) 488-6187 [email protected] Lisa Russell, PhD ETR Associates (831) 438-4060 [email protected] Suggested citation: Russell, L., & Laris, BA. (2007). Rhode Island school nutrition environment evaluation: Final report. Santa Cruz, CA: ETR Associates. RI Phase II Summary –6/11/07 2

mailto:[email protected]

http://www.ride.ri.gov/

http://www.thriveri.org/



Rhode Island School Nutrition Environment Evaluation: Vending and a La Carte Food Policies

Rhode Island Department of Education

Introduction Description of selected site

The Rhode Island Vending and a La Carte Food program is a cluster of initiatives that have focused on the development and promotion of policies to enhance the nutritional value of vending machine and a la carte food offerings in Rhode Island’s public schools. The program, administered through the Rhode Island Department of Education (RIDE), applied for evaluation technical assistance from the Centers for Disease Control and Prevention Division of Adolescent and School Health (CDC-DASH) in the spring of 2004. The Rhode Island Vending and a La Carte Food program was identified by staff from CDC-DASH as a promising candidate for rapid evaluation technical assistance and was granted this technical assistance. Since 2001, the Rhode Island Department of Education has focused on providing all 36 Rhode Island school districts with technical assistance in the development and promotion of policies to enhance the school nutrition environment. In 2002, RIDE and other stakeholders in the Rhode Island Healthy School Coalition identified the need to focus on a nutrition related goal adapted from the Surgeon General’s Call to Action to Prevent and Decrease Overweight and Obesity (12/01). During the Action for Healthy Kids National Summit, stakeholders agreed to concentrate on the following:

• By October 2007, ALL schools in Rhode Island will adopt policies ensuring that foods and beverages available on school campuses and at school events contribute toward eating patterns that are consistent with dietary guidelines for Americans.

The nutrition-related goal was expressly focused at the policy level to provide a stronger foundation on which to build broader health promotion programs. Coalition members noted that individual-level interventions would not be as successful if the school environment did not reinforce and reflect the messages given in the individual-level interventions. It is expected that establishing district policy for vending and a la carte food will modify the school nutrition environment and therefore, improve nutritional health of students.


Background Background on purpose of technical assistance project Initial site visit

Methods

CDC-DASH seeks to prevent the most serious health risk behaviors among children, adolescents, and young adults. One approach that CDC-DASH uses is to support grantees (state and local education agencies) in the implementation of innovative school-based programs for the prevention of childhood obesity. To further assist local and state education agencies in their understanding of the most effective aspects of their programs, CDC responds to requests for technical assistance to conduct rapid evaluations. Rapid evaluations are designed to be completed within one year from initiation and provide agencies information about the impact of their innovative programs, policies, and initiatives taking place in the schools.

ETR Associates provides rapid evaluation technical assistance (TA) to state and local education and health agencies identified by CDC. ETR Associates serves as a technical assistance provider through a TA contract with CDC (#200-2002-00800). ETR’s role in this partnership includes providing technical assistance to the state or local education agency with designing the evaluation; implementing the rapid evaluation; and helping to prepare reports and manuscripts for dissemination. Although each evaluation is designed to collect information that is valid and reliable, the rapid evaluation does not typically rely on a rigorous experimental design. Instead, rapid evaluations aim to describe short-term impacts and outcomes, enhance understanding of program activities, and/or allow for insight into program improvement.

In April, 2004, CDC/DASH staff and ETR evaluation team leaders met with representatives of the Rhode Island Department of Education and members of the Rhode Island Healthy School Coalition including Kids First, New England Dairy and Food Council, and American Cancer Society. This site visit was designed to provide CDC and ETR Associates an opportunity to learn more about the vending and a la carte food programs and policies and to begin to explore the possibility of providing in-depth technical assistance to help design and implement an assessment of these program efforts. In June 2004, CDC selected RIDE for evaluation technical assistance to assess Rhode Island school districts’ progress in implementing policies or directives to enhance the school nutrition environment. The Rhode Island Healthy School Environment Study involved two phases. In Phase I, one-time interviews were conducted with 72 district level administrators from 31 school districts. In Phase II detailed case studies were conducted with selected school districts.


Evaluation questions and goals

The goal for all Phase 1 and Phase II activities was to collect information to inform the existence of nutrition-related policies, implementation, and the impact. Data from each source contributed to understanding the school nutrition environment and answering the following research questions. Policies

What proportion of the Districts has written policies regarding vending or a la carte foods?

Implementation of Policies

To what extent are policies being implemented? What proportion of the Districts has a team or committee

that handles competitive foods? Who is responsible for vending and a la carte food issues at

the District and school levels? To what extent do District officials get involved in shaping

and implementing competitive food policies in their Districts?

What factors at the District and school level contribute to environmental changes?

What factors at the District and school level hinder environmental changes?

Impact of Policies

Does having a written policy lead to changes in the vending and a la carte practices?

How do changes in vending and a la carte policies affect revenue from these sources?

What are student and staff members’ awareness of and satisfaction with vending and a la carte food policies or procedures?

What are potential next steps for action to improve the nutrition environment?


Evaluation Design / Approach

Phase I During the Phase I interviews, district level administrators were asked about the written nutrition policies or informal nutrition procedures in place in each district. The respondents were asked if any of the following issues were addressed:

• The foods or beverages sold in vending machines • The hours of operation of school vending machines • The nutritional value of a la carte foods • The hours of operation of a la carte food • The food that can be sold at school stores or snack bars • The foods served during functions or classroom celebrations • The use of food or food incentives in the classroom by teachers • The food sold during or for school fundraisers • The types of foods served at school sporting events • Food and beverage advertising on school campuses

These responses were used as part of the Phase II selection process (see Table 1). Those districts with a written nutrition policy addressing multiple issues were considered farther along the continuum of nutrition policy implementation. In each district characterized as more advanced for Phase II, the district level administrators indicated there was a written nutrition policy and/or informal procedures addressing at least six nutrition issues. Districts classified as being in the early stages of nutrition policy implementation had a policy or procedures in place addressing at least one issue but less than six issues. Table 1: Districts with policies or procedures addressing the most common nutrition issues (n=6 with 3 early, 3 more advanced)

Districts A la carte food

Vending food

Vending Hours

School store food

Food incentives

Fund-raising

Early 1 0 2 0 0 0 More advanced

3 3 3 3 3 3

Phase II Six districts were selected to participate in case study activities, based on a multilayered analysis of the Phase I interview responses. The six case study districts were selected on the following factors:

• Ranking on their development and implementation of policies and procedures or directives (based on interview data)

• Geographic representation across the state • Demographic representation • Level of agreement between the three district level

administrators in interview data


Based on the factors described above, the selected districts were categorized as being in the early or more advanced stages of nutrition policy development. The case study districts included three districts (with a total of three middle and three high schools) representing the early stages and three districts (with a total of two middle and three high schools) representing the more advanced stages of nutrition policy development (see Table 2). Table 2: Phase II Case study Districts and Selected Demographic Characteristics

School District Policy develop process

District Enroll

Ethnicity Pop Density *

% eligible

sub. lunch

District 1-E Early 2995 95% white Mixed 7% District 2-E Early 3822 88% white Mixed 34%

District 3-E Early 6839 62% white 21% Hispanic

Mixed 60%

District 1-A More Advanced

2838

87% white Mixed 18%


1736 94% white Semi urban

12%


2231 98% white Mixed 15%

From: http://www.infoworks.ride.uri.edu/2004/reports/district.asp and http://www.infoworks.ride.uri.edu/2004/reports/schlist.asp, http://www.dlt.ri.gov/lmi/pdf/stateofstatehttp://www.infoworks.ride.uri.edu/2004/state/taxcharts.pdf accessed 8/10/04. *Population density: Urban=greater than 2501; rural=less than 750; semi-urban=751-2500

To provide evidence of what facilitates and hinders nutrition policy adoption and implementation, Phase II case study activities included:

• Focus groups with students • Focus groups with teachers • Interviews with principals • Interviews with Food Service Representatives (district level

managers who were employees of the contracted food service provider)

• Interviews with elected district School Committee (analogous to School Board) members

• Interviews with Parent-Teacher Organization (PTO) president • Observations of the school environment • Analysis of sales data of vending and a la carte food

This report presents central themes and results across all Phase II evaluation activities. Individual reports for each of the evaluation activities are attached in Appendix C.


http://www.infoworks.ride.uri.edu/2004/reports/district.asp

http://www.infoworks.ride.uri.edu/2004/reports/schlist.asp

http://www.dlt.ri.gov/lmi/pdf/stateofstate.pdf

http://www.infoworks.ride.uri.edu/2004/state/taxcharts.pdf

Sample

The sample for each data collection activity was determined independently. The sampling approach is described below for each data collection activity. Focus groups were held at each of the 11 schools within the six case study districts. A convenience sample of students and teachers were invited to participate by the school principal or the school nurse. Teachers represented a range of subjects taught and length of time teaching at the school. Students represented a mix of grades and gender. A total of 92 students and 99 teachers participated in the groups (see Table 3). Table 3: Focus Group Sample

School District School Type Number of Students

Number of Teachers

Middle School 10 9 District 1-E High School 9 9 Middle School 8 8 District 2-E High School 10 9 Middle School 10 8 District 3-E High School 8 9 Middle School 6 6 District 1-A High School 7 9

District 2-A High School 9 9 Middle School 8 10 District 3-A High School 7 13

Total 11 schools 92 99 Telephone interviews were conducted with other stakeholders, including principals, food service representatives, presidents of Parent-Teacher Organizations (PTO), nutrition advocates, and elected district-level School Committee members (see Table 4). (In Rhode Island elected district level School Committee members are analogous to elected School Board members in other communities.) All principals, all food services representatives, and all presidents of PTO from the participating schools were invited to participate. Principals or the president of the School Committee suggested one to two School Committee members to be interviewed for the evaluation. Nutrition advocates were identified by school principals, PTO presidents, and School Committee members.


Incentives

Table 4: Individual Stakeholder Interview Sample Stage of Nutrition Policy Development

Number of Districts

represented Type of Interview

Number of

interviews

Average number of

years in position (range)

3 School Committee Member 3 11.5

(1.75-23 years) 1 Nutrition Advocate 1 18

2 PTO president 3 2.67 (2-3 years)

3 Food Service Representative 3 12.67

(1-27 years)

Early

3 Principal 6 2.33 (1-7 years)

2 School Committee Member 3

1.98 (5 months-5

years)

2 Nutrition Advocate 3 10 (4-19 years)

2 PTO president 3 3.67 (3-4 years)

3 Food Service Representative 3 7.67

(1-27 years)

More Advanced

3 Principal 5 5.50 (1-19 years)

Total 6 33 7.60 years An Environmental Assessment Tool (EAT) was used to assess the nutrition environment in the schools. Observations using the EAT were conducted in all 11 case study schools. An analysis of the revenue and cost records of a la carte and vending food sales was used to assess the financial impact of offering healthier food choices. Records were requested from the Food Service Director or Business Manager from each participating district. Records were received from four of the six districts, representing two districts in the early stages of policy development and two districts in the more advanced stages of policy development. In recognition of individuals’ time and effort contributed to the Rhode Island School Nutrition Environment Evaluation, all participants in data collections activities received a small incentive. The specific incentive for each activity is outlined in Table 5.


Instrumentation

Table 5: Data Collection Incentives Data Collection Activity Incentive provided Principal interview $400 for school plus project coffee mug PTO/PTA president interview $25 gift certificate plus project coffee mug School Committee member interview

Project coffee mug

Food Service Representative interview

$25 gift certificate plus project coffee mug

Focus group with teachers $50 gift certificate for each participating teacher, plus snacks during group

Focus group with students $10 gift certificate for each participating student, plus snacks during group

School observation by ETR staff member

NA

The evaluation instruments were developed to match the evaluation goals and objectives. Table 6 provides an overview of the evaluation measures and the constructs addressed. All of the instruments were developed by ETR Associates, informed by previously used and validated survey and interview protocols. The instruments for Phase II are attached in Appendix A. Table 6: Data Collection Instruments and Constructs

Instrument Developed Constructs

Principal interviews

ETR Associates

• District and school nutrition policies and implementation

• Vending and a la carte operations, decision making and revenue

• Efforts to improve nutrition education and school nutrition environment

• Staff and admin roles for vending and a la carte • Revenue patterns, budget implications • Monitoring policy implementation procedures • Changes made to improve school nutrition

environment

Student Focus Group

ETR Associates

• Perception of food environment • Buying habits • Ability to get foods they like • Awareness of and satisfaction with policy changes • Involvement in changes

Teacher Focus Group

ETR Associates

• Policy awareness • Interpretation of polices in classroom • Perceptions of importance and effectiveness • Consistency of implementation • Awareness of state level efforts in nutrition

PTO/PTA president

ETR

• Current themes emphasized by PTO/PTA • Fundraising approaches • Struggle to balance nutrition and fundraising

income


Pilot testing Data Collection

interviews Associates • Other things the school should be doing around nutrition

• Awareness of state level efforts in nutrition

School Board Committee interview

ETR Associates

• Nutrition policy development • Nutrition activities • Balance between promoting nutrition and revenue • Awareness of state level nutrition efforts

Nutrition Advocacy Group interview

ETR Associates

• Activities and experiences with developing and implementing nutrition policy

• Reaction of others in the community • Successes and challenges • Other things the school should be doing around

nutrition • Awareness of state level efforts in nutrition

Food Service Supply Representative Interview

ETR Associates

• Contracts &revenue • Incentives & purchasing • Purchases • Pre/post policy implementation vending records • Marketing policies and practices

School observation

ETR Associates adapted from Samuels and Associates

• Snack vending machines • Beverage vending machines • School stores • A la carte lines (breakfast, lunch, snack bar) • Cafeteria set-up and logistics • Cafeteria environment • Advertising (health promotion and competitive

foods)

Prior to the implementation of Phase II pilot testing of the principal interview was attempted. However, no principals approached agreed to participate. After the first principal interview of Phase II, the protocol was shortened slightly by removing the section on linkages to community collaborations and consolidating the sections on policies and procedures. Evaluation data was collected using three primary data collection methods: (1) focus group interviews, (2) individual interviews, and (3) observations. Each data collection method is described below. Focus group interviews were held during the spring of 2005. Each group was limited to 8-10 students or school staff. Potential participants were selected by the school contact (the principal or school nurse) and received written invitations requesting their voluntary participation. Passive permission was sought from parents of student participants. Students’ written assent was also solicited prior to each student focus group. (See Appendix B for focus group permission and assent forms.) Focus groups were held on school


campus at a time convenient for participants (i.e., during lunch for students and after school for teachers). A trained facilitator and note taker were present during each focus group and utilized pre-developed, scripted protocols to facilitate the interview. Focus groups lasted approximately 40-60 minutes for each group. All focus groups were audio taped only when permission was granted by every participant in the group. Individual interviews were conducted in person and via telephone with school principals, school committee members, PTO/PTA presidents, nutrition advocates, and school food service personnel. Participants received written invitations requesting their voluntary participation. Because all interview participants were adults reporting on activities conducted in the course of their regular job duties, individuals’ agreement to take part in the interview was evidence of their consent. Individuals not responding to an initial invitation for an interview received up to two follow up invitations (by phone or mail) approximately two and three weeks after the initial invitation. Those not responding to these follow up invitations were dropped from the interview sample.

Interviews were conducted by trained ETR staff using use pre-developed, scripted protocols to ensure consistency across all interviews. Individual interviews lasted for approximately 15-40 minutes per interview, depending on the individual. Environmental observations were conducted by ETR staff at each school campus during the Phase II case study data collection period with consent from the school principals. The environmental scan included observing and recording elements of the school food environment, such as number of vending machines, vending machine offerings, a la carte offerings, cafeteria offerings, and food advertising and nutrition information. ETR staff spent approximately three hours (including the lunch periods) scanning the nutrition environment. Observation data were recorded directly on an observation protocol using pencil or pen. Observation forms were coded by school using a school identification number. Revenue records were requested from the district administrative office or the food service provider by ETR staff. Between May 2005 and August 2006, ETR staff attempted to collect economic data from the six Phase II districts. The request for this data occurred in two stages. During the first stage, between May 2005 and March 2006, pricing and sales records for vending and a la carte foods were requested for the 2004-2005 school year. During the second stage,


Data Analyses Results Section I: Policies Three of six districts have written policies regarding vending and/or a la carte food.

between April 2006 and August 2006, we expanded our request to include USDA meal records and created a specific document allowing districts to select the format easiest for them to report the data. The quantitative analyses included preliminary descriptive analyses. The purpose of the preliminary descriptive analyses was to describe the demographic and other characteristics of the participants in the evaluation, thereby providing background information to describe cases. Additional economic analyses were conducted based on the monthly revenue and cost data provided by three districts. The monthly revenue changes in all three food venues (USDA, A La Carte, and Vending) were examined. Next, a monthly revenue cost ratio was calculated for each food venue, as well as a monthly profit, annual profit, and profit cost ratio. Qualitative data, such as interview responses and focus group transcripts were reviewed and coded for themes, and the data was analyzed for pattern matching and process tracing. Pattern matching identifies patterns in the responses of the case that match the hypothesized model. Process tracing tries to identify evidence in the data that patterns match what is expected, that patterns are the result of a causal process and that the results are of the magnitude expected. For ease of review, the results are presented in three major sections—Policies, Implementation of policies, and Impact of policies. Within each section, the results are presented by research question. What proportion of districts has written policies regarding vending or a la carte foods? To examine the school level awareness of nutrition policies and procedures, multiple school level stakeholders were asked about nutrition issues. The responses differed within districts depending on the staff interviewed.

• Principals from four schools reported that there were written district or school policies guiding the food available in vending machines; (administrators from these districts had also indicated the existence of district level policies).


According to the principals, five of six districts had written district or school level nutrition policies.

• Principals from two schools reported that there were written

district or school policies guiding the nutritional content of a la carte food; both schools were from a district where the administrators has reported this type of policy.

• District level administrators from two other districts reported

that there were written district policies guiding a la carte foods; however principals did not report being aware of these policies.

Food service representatives were asked specifically about the existence of policies or procedures that affected the nutritional content of the a la carte or vending machine food. Three of six food service representatives responded that the districts they worked with had policies or procedures regulating foods sold in the vending machines and a la carte lines. However, these did not all align with district level responses. In one district in the early stage, the district level administrators indicated there was no policy or procedure, but the food service representative (and one of the two school principals) indicated that there was. In two districts in the more advanced stage, the district level respondents said there were policies or procedures in place guiding the selection of the a la carte and vending food, and the food service representative indicated there was not (one of the three principals in these districts also indicated there was no policy).

Awareness of Nutrition Policies Overall by Respondent In the principal interviews, principals were asked about the existence of either formal written policies at the district or school level or more informal district or school level procedures or directives. According to the principals, five of six districts had written district or school level nutrition policies while all schools reported having either nutrition policies or procedures or both in place. When comparing principal responses to district level responses, there was some discrepancy about the types of issues addressed by policies and procedures (see Table 7). In the schools in the early stages of policy development, the principals agreed with the district administrators that the majority of issues were not addressed. There were a few incidences (7 out of 36) where there was disagreement, either the principal indicated an issue was addressed when the district said it was not, or the principal indicated it was not addressed when the district had indicated that it was. In the schools in which the district was in the more advanced stages of policy development,


There was a lack of agreement on details of nutrition policy between the district and school level stakeholders. School Committee members are aware of nutrition policy development activities; PTO leadership are not as consistently aware of nutrition policies.

there were many instances (12 out of 30) when the administrators reported that there was a policy or procedure in place to address issues and the principal indicated that this issue was not addressed. In districts in the process of developing nutrition policies, there is more activity and opportunity for individuals to have varying degrees of information. Table 7: Principal agreement with district level administrators on the type of nutrition issues addressed by policies and/or procedures

Districts Agreement Disagreement Early* 81% 19% More advanced 60% 40%

*Districts in the early stage of policy development had more “agreement” because both the principal and administrator agreed that there were no policies.

Stakeholder awareness of existence of nutrition policies In schools and districts in the early stages of nutrition policy development, School Committee members and nutrition advocates were aware of the progress being made to develop nutrition policies while PTO presidents were less aware of policy committees. In schools and districts with nutrition policies in place, the School Committee Members, nutrition advocates, and presidents of the PTO were all aware of the policies and the efforts to implement them. Teachers differed in their awareness of district and school policies and procedures. All teachers were aware of some efforts to change foods available at their schools; however, few teachers attributed these changes to new policies. Teachers at only three of the eleven schools attributed changes in food availability to district-wide policies being implemented. At these schools, teachers reported that they were notified of the policy changes via email or written copies of the new or proposed policy. The majority of teachers stated that they were not aware of any food or nutrition policies in place. Students were also asked about their awareness or observation of policies or procedures regarding nutrition issues. Student comments varied by school and appeared to reflect their satisfaction or dissatisfaction with changes made to the nutrition environment. Student responses also provided insight into the strength of implementation of aspects of policies (see implementation section). Types of issues covered by existing nutrition policies

Through the interview process across stakeholders (district administrators, school principals, food service representatives, teachers, and students) and across stages of policy development, the most prevalent nutrition issues emerged. In order of frequency,


The most common issues addressed by nutrition policies and procedures were the hours of vending machine use, the food sold during or for school fundraisers the foods and beverages sold in the vending machines, and the nutritional content of a la carte food.

these included: • The hours of operation of school vending machines • The nutritional value of a la carte foods • The types of foods or beverages sold in vending machines • The food sold during or for school fundraisers • The types of food that can be sold at school stores or snack bars • The use of food or food incentives in the classroom by teachers

Similarly, during the Phase I interviews with district level superintendents, business managers and food service directors from 22 districts with nutrition policies and/or directives, the three most prevalent topics addressed were the nutritional value of a la carte foods, the types of foods or beverages sold in vending machines, and the hours of operation of school vending machines. During Phase II data collection activities, four issues were identified as less likely to be covered by policy mandates for the following reasons: 1. The hours of operation of a la carte food

Schools indicated that a la carte food was available only during meal times 2. The types of foods served during special school functions and classroom

celebrations Schools indicated that they discouraged use of food, but it was left to teacher

discretion 3. The types of foods served at school sporting events

Schools indicated that this activity was organized by the boosters and was separate from the administration

4. Food and beverage advertising on campuses Schools indicated that this was no longer permitted by state law

Principals were asked about the inclusion of all ten of these issues in their nutrition policies or procedures. Policies were defined as any mandate that affects the nutrition environment in the school, officially adopted at the school OR district level. Directives or procedures were defined as any orders that have been given or any standard practice or guidelines at the school or district level that affects the nutrition environment in the school. Across schools in both the early and more advanced stages of nutrition policy development, the hours of vending machine use, the foods or beverages sold in the vending machines and the nutritional content of the a la carte food were most commonly identified as guided by a policy or procedure. Compared to schools in the early stages of nutrition policy development, schools in the more advanced stages were more likely to address nutrition issues with policies rather than procedures. In addition, a larger number of issues were addressed in these schools.


Section II: Implementation of policies

Other school-level stakeholders (nutrition advocates, teachers, students, PTO presidents) were also given opportunities to discuss nutrition topics addressed by policies or procedures. There was not a clear consensus across respondents (see Table 8). This lack of agreement highlights the existence of divergent experiences and opinions of stakeholders within schools and between the school and the district administration. Table 8: Level of agreement between district administrators, principals, food service representatives, teachers, and students on the existence of policies or procedures addressing nutrition topics

Schools in the early stage of policy development

Level of agreement A La carte

Vending food

Vending Hours

School store

Food incentives

Fund-raising

All say “yes” within school and at district 1 3 All say “no” within school and at district 2 2 2 5 2 3 All say “yes” within school but district says “no” 1 2 1 Mixed opinion within school and between school & district 2 2 1 1 4 2 Total 6 6 6 6 6 6

Schools in the more advanced stage

Level of agreement A La carte

Vending food

Vending Hours

School store

Food incentives

Fund-raising

All say “yes” within school and at district 2 2 4 2 0 1 All say “no” within school but district says “yes” 1 3 3 Mixed opinion within school and between school & district 3 3 3 2 1 Total 5 5 5 5 5 5

To what extent are policies being implemented? The implementation of nutrition policies is dependent on many factors. One of the key factors affecting implementation of nutrition policy is the existence of an individual or group to monitor or enforce the policy. Data collected across sources indicated that the level and intensity of the monitoring and enforcement varied by school


The implementation of nutrition policies is dependent on monitoring the implementation of policies and procedures. Schools with nutrition policies in place had a greater percentage of approved healthier snack items* in the vending machines and snack bars.

and by type of issue covered by the policy.

Responsibility for monitoring implementation of policies Principals reported that the monitoring and enforcement of policies and procedures varied depending on the issue. Depending on the school and district, several different stakeholders such as principals, food service providers, teachers, district level staff, and departments or department heads may be involved in monitoring aspects of the nutrition environment. In addition to the principals, other stakeholders (food service representatives, teachers, and students) were also asked their impression of the implementation or existence of policies or procedures guiding an array of nutrition issues. Responses were different depending on the respondent.

Implementation of policies regarding the types of foods or beverages sold in vending machines

Across schools, there were more “healthier beverage” options in vending machines than “healthier snack foods” observed by data collectors. Information collected with the Environmental Assessment Tool (EAT) highlighted that schools with nutrition policies in place had a greater percentage of the preferred healthier snack items* in the vending machines and snack bars, compared to schools without nutrition policies (30% versus 14%). Schools in the early stages of policy development offered students a larger number of foods that were not on the healthier snack list. *Kids First, a community-based nutrition education organization and a member of the Rhode Island Healthy Schools Coalition, has a list of snack and beverage items meeting stringent nutritional guidelines for healthier snacks. This is separate than the guidelines developed by theRhode Island Healthy Schools Coalition. Kids First conducts a nutritional analysis on a wide range of snack foods and beverages on a continuing basis to continue to add to the approved list. In the January 2005 edition of the list used for these analyses, there were 326 beverages and 634 snacks identified as “healthier foods”.

Implementation of policies regarding the hours of operation of school vending machines

The hours of operation of the vending machines were variable (see Table 9). Although several schools had policies or procedures limiting the hours of vending machine use, in practice, this was not observed


Although many districts reported the existence of policies or procedures in place to limit the use of vending machines, the school level implementation varied greatly. The contracted food service provider for each district was primarily responsible for implementing and monitoring changes to the a la carte food.

unless the machines were on a timer or locked behind a gate. In many schools, students were observed using the vending machines during prohibited hours, sometimes with a pass from a classroom teacher and sometimes unknown to the classroom teachers. Table 9: Access to snack and beverage vending machines

Policy level Total # vending machines (VM)

# of VM with policy to limit access

VM with observed limited access

Snack Vending Early 8 5 5 More Advanced

6 6* 1

Beverage Vending Early 26 16 15 More Advanced

21 21* 5

* In one school, the district administrators indicated there was a policy limiting hours, but the school principal and students said there was not.

Implementation of policies regarding the nutritional value of a la carte foods

In all of the schools observed, the a la carte food items available during breakfast and lunch were provided by the food service provider. Some of the items available for sale were the same as components of a National School Lunch or Breakfast Program and could be purchased as extra or separate servings. In addition, other items were sold that were not eligible elements of a USDA meal, such as chips, granola bars, cookies and drinks. Most schools offered a mix of healthier and traditional items for sale a la carte. The implementation of policies or procedures to improve the nutritional content of the food was left primarily to the food service provider. Schools with nutrition policies had more “healthier options” through the food service in the breakfast a la carte items and snack bars than schools in the early stages of policy development (see Chart 1, *Healthier options as defined by Rhode Island Healthy Schools Coalition). However, there are still areas with room for improvement.


School stores sell many items that are not available for purchase in the vending machines and a la carte lines. The majority of schools did not have an active policy or procedure to guide what food could be sold.

Chart 1: Healthy Options on Campus by Food Source (n=11 schools)

0%10%20%30%40%50%60%70%80%90%

100%

Early policy stage Advanced policy stage

% o

f hea

lthy

food

cho

ices

A la carte breakfast A la carte lunch Snack bar School store

Implementation of policies regarding the types of food that can be sold at school stores

The vast majority of school stores observed were run independently of the food service, by school groups, classes, clubs, or departments. In many schools, candy, soda, and other items not available in the cafeteria were sold in the school stores. District administrators at all three districts with nutrition policies indicated that there were policies or procedures about the food sold at school stores. At three of the five schools within these districts, the principals indicated that there were no policies or procedures guiding what was sold in the school store. Schools with policies in place had slightly more healthier items in the school stores (17% versus 11%).

Implementation of policies regarding the use of food or food incentives in the classroom by teachers

At the three districts in the early stages of policy development this issue was not currently addressed according to district level administrators. District level administrators at all three districts with nutrition policies in place indicated that there were policies or procedures to guide the use of food incentives in the classroom. However, at four of the five schools, the principals indicated that there were no policies or procedures guiding the use of food incentives in the classroom. Across policy implementation levels, there was a lack of consensus on this issue at nine schools, both within schools and between the district and schools (see Table 10).


Implementation of nutrition policies has begun to improve the nutrition environment; more intense monitoring and enforcement of policies is necessary for greater impact.

Table 10: Stakeholder response to the existence of policies or procedures guiding the use of food incentives in the classroom

District Administrators (n=3)

Principals (n=11)

Teachers (n=11)

Students (n=11)

Early Yes 0 1 2 2 No 3 5 4 4 More Advanced Yes 3 1 2 0 No 0 4 3 5

Implementation of policies on the food sold during or for school fundraisers

At the three districts in the early stages of policy development, this issue was not currently addressed according to district level administrators. District level administrators at all three districts with nutrition policies in place indicated that there were policies or procedures to guide the types of food sold for fundraisers. At seven schools, there was a lack of consensus on this issue (see Table 11). Table 11: Are there policies or procedures guiding the type of foods sold for fundraisers? Responses by stakeholder, by school (yes or no)

District (n=3)

Principal (n=11)

Teachers (n=11)

Students (n=11)

Agreement

Early School 1 - - - School 2 - - - - Consensus School 3 - School 4 - - School 5 - - - - Consensus School 6 - - - - Consensus More Advanced School 1 - - - - School 2 - - School 3 - Consensus School 4 - - - - School 5 - - - -

- is a no response; is a yes response

Timing of implementation of nutrition policies Many changes were made gradually to a la carte and vending choices during the process of policy adoption. Frequently, changes were made over the summer to make the transition less abrupt. Other changes were implemented in advance of official policy change so that changes were made in stages, allowing students and staff to become accustomed to the idea that changes were on-going. Principals reported that removing or changing less healthy foods gradually is better, and helps avoid student over-reaction.


100% of the case study districts had a nutrition committee or team. According to food service representatives, the selection of foods for vending machines and a la carte lines was impacted by federal and state nutrition guidelines, contract agreements, food availability, cost and district-level stakeholders’ input.

Students also acknowledged that over time, the students become accustomed to the changes and accept them.

Overall impact of implementation of nutrition policies

The implementation of nutrition policies varied across issues. Although many changes have occurred across schools, the data from all sources indicated that there are gaps in policy implementation. In both schools in the early and more advanced stages of nutrition policy development offered students an array of less healthy food from a variety of sources on campus.

What proportion of the Districts has a team or committee that handles competitive foods? All districts in both early and more advanced stages of policy development had one or more committees in place to address nutrition issues. For many districts, this was a district wide committee; some schools also had school-level committees. Principals from six schools (three in the early stages and three in the more advanced stages of nutrition policy development) indicated that a district-wide committee had been involved in initiating the process of addressing nutrition concerns. Three food service representatives (two from the early and one from a more advanced policy stage district) indicated that they served on the nutrition policy committee. Who is responsible for vending and a la carte issues at the District and school levels? In all of the schools represented, the a la carte food was provided by a contracted food service provider. Vending machines were also operated by the food service provider; in some schools, additional vending machines were operated on campus by groups or individuals. Food for school snack bars or stores was provided by a combination of sources (the food service provider, other vendors, school departments, and school clubs). All principals indicated that it was primarily the food service provider that decided what would be sold in the a la carte lines as well as in the school vending machines. In 36% of the schools, the principal was also involved in decisions about the a la carte food selections; in 64% of the schools, the principal or other school staff members were involved in decisions about the vending machine selections.


School Committee members are key to moving nutrition policies through the approval process; other school and district level stakeholders are involved in shaping the contents of food policies.

Interviews with food service providers yielded more insight into the process of selecting foods. Apart from district policies, the selection of foods for the vending machines and a la carte lines was impacted by federal and state nutrition guidelines, contractual agreements between districts and food service providers, food availability, cost and district-level stakeholders’ input. To what extent do District officials get involved in shaping and implementing competitive food policies in their Districts? School Committee members play an important role in shaping competitive food policies across all districts. In interviews with School Committee Members and nutrition advocates, respondents indicated that the impetus for developing the policies sometimes came from the School Committee and sometimes from motivated individuals at the school level. Regardless of where the idea for nutrition policy change originated, in all districts, individuals found that it was important to have an advocate or ally on the School Committee to move the policy development forward. To aid in soliciting district-level stakeholders’ input in deciding the types of foods, all food service representatives reported having regular meetings with district and school administrators. Food service representatives also collaborated with districts and schools in nutrition policy development. Highlights from the Phase I data report show the extent of district-level administrative involvement and support for nutrition policies:

44% of superintendents, business managers, and food service directors interviewed (n=39) indicated that they thought policies and procedures have been very effective in improving the nutritional value of a la carte practices on school campuses; 55% felt it was very important to have a district-wide policy or procedure about a la carte issues.

48% of superintendents, business managers, and food service directors interviewed (n=48) indicated that they thought policies and procedures have been very effective in improving the nutritional value of vending issues; 66% felt it was very important to have a district-wide policy or procedure about vending issues

63% of respondents from 30 school districts indicated that administrators or administrative groups actively participate in improving vending and a la carte policies in their district.


Districts able to infuse the whole community with the interest and commitment to changing nutrition policies were able to move forward with wellness policy development.

What factors at the District and school level contribute to environmental changes? All participants in Phase II data collection activities identified factors that have contributed environmental changes to the school nutrition environment. Pace of change

Principals indicated that gradual changes to the nutrition environment worked better, as the students and staff had time to adjust to the changes.

Nutrition advocates indicated that striking a balance between the variety of needs and demands within the district helped ensure success.

“360o” whole school participation

According to interviews with School Committee members and nutrition advocates districts with active partnerships between the School Committee and other stakeholders in the school have been able to move forward with nutrition policy development.

Principals identified the need to have the support of students, parents, and staff, in particular, those most affected by the changes.

Nutrition advocates reported that the active involvement of people who are open to changes and also have responsibility for decision making is important.

Students and teachers identified the importance of including them in the planning and implementation of changes to the nutrition environment.

Work with food service providers

Principals and food service representatives reported that a positive relationship between the district and the food service provider enhances the ability to make changes in the food offerings.

Principals reported the need to work closely with food service providers to make feasible changes to the food choices.

Food service representatives indicated that district guidelines and benchmarks facilitate the change process

Administrative support

Principals reported that support from the district helps give the Nutrition Committee authority to recommend changes. The district can also place pressure on the food service provider.


Written policies

Principals indicated that written policies help clarify guidelines and standards.

Education

Principals and nutrition advocates added that educating the staff, students, and parents about the benefits and rationale of the changing nutrition environment helped make the process easier.

Dedicated staff

Districts and schools with a diverse group of dedicated stakeholders involved on the nutrition policy committee were able to move more easily through the stages of policy development.

Schools with principals actively engaged in changing the nutrition environment have been able to make changes at the building level, even in the absence of district policies.

Remember taste and quality

Students and teachers reported that they want healthier food available on campus that is fresh and good tasting.

What factors at the District and school level hinder environmental changes? All participants in Phase II data collection activities identified factors that have hindered environmental changes to the school nutrition environment.

Lack of transparency around food contracts and regulations

• Lack of information about contracts and regulations may discourage stakeholders such as teachers from participating.

Financial limitations

• Principals indicated that budget constraints make vending machines an attractive option for individuals and groups to raise money and they were concerned about the risk of forgoing these resources.

• Two schools principals reported that Pepsi sponsored their sport teams and had paid for their scoreboards so they were not able to limit of the Pepsi soda and products from the school vending machines.


Concerns over conflicting needs and priorities of multiple stakeholders can hinder changes to the nutrition environment.

Balancing multiple priorities at district level

• School Committee members and nutrition advocates observed that conflicting priorities at the district level may have impeded the progress of nutrition policy development (e.g. leadership, facility, union, and budget issues).

Perceived lack of cooperation from food service providers

• Many teachers felt that the food service providers were not willing to change the food options for financial reasons or unwillingness to identify appropriate vendors.

• Principals and teachers suggested that difficulties working with food service providers made it challenging to increase the number of more nutritious and appetizing foods.

Lack of communication

• Many students and teachers reported that they had not been informed in advance of changes to the nutrition environment. This lack of information created frustration and resentment.

• Students were frustrated that their opinions do not matter to school administrators and food service personnel.

• Students across schools report that they were not involved in nutrition policy changes. Not being involved in the decision-making process contributed to widespread student resistance to changes.

Cafeteria Logistics

• Teachers, principals, and food service representatives all reported that there are some high fat lunch items (such as pizza, hamburgers, chicken nuggets, and cookies) that are served everyday in the cafeteria.

• Teachers and students indicated that short lunch periods encouraged students to select the quickest food options, not necessarily the healthiest items.

• Teachers and students and EAT observations noted that the atmosphere of the cafeteria varied, depending on school and number of lunch periods. When the cafeteria atmosphere was not appealing, it discouraged use.

• Students reported that healthy food options were often at the end of the cafeteria serving line and they did not see them until after they had already selected other food items.


Section III: Impact of policies Over the past two years, all districts had made efforts to increase the number of low fat choices, low sugar options, and fruits and vegetables. Principals noted both positive and negative changes to the nutrition

Does having a written policy lead to changes in the vending and a la carte practices? Interviews with food service providers revealed that regardless of whether written policies were in place or not, all districts had made some changes over the past two years. Specifically, food service providers shared that all districts were making an effort to increase the number of low fat choices, low sugar options, and fruits and vegetables (see Chart 2).

Chart 2: How food items changed in the last 2 years (n=6 Districts)

0

1

2

3

4

Removedcarbonatedbeverages

Increasedfresh fruits and

vegetables

Increased lowfat choices

Increased lowsugar choices

Decreasedhigh fatchoices

Decreasedhigh sugar

choices

Food Changes

# of

Dis

trict

s

Early Policy Stage Districts

More Advanced Policy StageDistricts

Across districts, the food service provider were interested in partnering with the schools in the process of improving the nutrition environment by working to find alternative products, meeting with administrators and nutrition committees, and strategizing about options to meet district needs and policies. In seven of the participating schools (four in the early stages of policy development and three in the more advanced stages) there were beverage vending machines operated by both the food service provider as well as by an outside vendor through an independent school level contract. The beverage machines operated by the food service providers had a higher percentage of healthier options. In general, principals agreed that written policies were important in helping to clarify guidelines and standards. Principals reported that changes had followed the implementation of several types of nutrition policies and procedures. The vast majority of the changes described were positive. Positive changes included an improved school environment, improved student performance, increased participation in the breakfast and lunch programs, availability of


environment following the implementation of policies. Students were mostly vocal about the changes they did not like, e.g. the disappearance of candy and cookies.

Overall, prices of healthier snack and beverage items did not appear to be different than the price of less healthy items in the schools.

healthier food options, increased number of students selecting healthy items, and student identification of healthier fund raising options. Negative changes observed included decreased profits in the vending machines, negative reactions from students, and increased cases of students bringing unhealthy food from home to school. From students’ perspectives, while they were aware of the schools’ efforts to offer healthier items and also understood that the school was trying to promote a healthier lifestyle, they were nonetheless mostly vocal about the changes they did not like. The most prominent negative comments were those expressing frustration with the disappearance of their favorite foods such as candy, ice cream, cookies, chips and soda. Students were also unhappy about the quality of food options in their vending machines. On the other hand, students at one school appreciated having a vending machine that had only healthy food in it. How do changes in vending and a la carte policies affect revenue from these sources? Revenue information was most often managed by the food service provider or the district level Business Manager or Food Service Director. Revenue was affected by the cost of the items and the number of items sold. Food service providers, with input from school level staff and the district, were responsible for setting a la carte prices. Profits from vending and a la carte sales were often included in the food service providers’ contract with the district. The use of the profits from the district level contract was most often determined by the district level Business Manager or Food Service Director.

Cost Responses were mixed when food service representatives were asked to compare the costs of healthier items to the costs of less healthy items in the vending machines and a la carte lines.

• Three respondents said that healthy items cost the same as less healthy items in both the vending machines and a la carte lines

• Two respondents reported that healthy items cost more than less healthy items in vending machines

• One respondent stated that healthy items cost more than less healthy items in a la carte lines


Food service representatives described different experiences when they were asked whether revenue had decreased at their schools.

Comparisons between the prices of healthier and less healthy food and beverage items were made during EAT observations. The two types of items most conducive to comparisons were salty snacks (chips) and beverages (because there were adequate numbers of items that could be classified as either less healthy or healthy). Overall, prices of healthier snack and beverage options did not appear to be different than the price of less healthy items available in the schools, in fact, they were even slightly less expensive. The mean price of healthier chips was $0.74 compared to $0.76 for fried chips; the mean price of healthier beverages was $1.13 compared to $1.20 for other beverages. These price differences between less healthy and healthier chips and beverages were similar when the prices were compared within the sub-sample of districts that provided vending and a la carte sales and revenue data for analysis. Sales

Sales data were collected both qualitatively through interviews with food service representatives and quantitatively through an analysis of sales records of vending and a la carte foods. Changes in policies may affect sales and corresponding revenue from vending and a la carte food items. However, the effect was not always a decrease in revenue. Of five food service providers interviewed who reported that the district had requested changes to the vending or a la carte line food and beverage options, they indicated perceived impact on revenue:

• two reported a decrease in revenue • One reported no impact on revenue • One reported that revenue dropped at first then stabilized • One reported an increase in revenue

Food service representatives also provided their impressions on how sales of healthier items compared to sales of the less healthy items in the vending machines and a la carte lines.

• In one district, healthy vending machine items sell more than less healthy items

• In one district, healthy items sell equally well as less healthy items in both the vending machines and a la carte lines

• In three districts, healthy items sell less than less healthy items in both the vending machines and a la carte lines

Revenue Records Analysis

The analyses of the revenue records from three districts showed that the monthly revenues generally fluctuate in the same direction across the three food venues in each district, indicating that there is no food consumption switch from one venue to another. The


Policy implementation level did not necessarily affect profitability of food sales. Students voiced their unhappiness at not being involved in nutrition policy changes before they occurred. Teachers were ill-informed about impending nutrition policy changes. Teachers at only three of the 11 schools reported they had been notified of the new nutrition policies.

fluctuation patterns are very similar across the districts, which indicate that the monthly revenue is mainly affected by a common factor, the number of school days in each month. Within each district, the monthly revenue cost ratios remain the same or vary in a narrow range over the 10 months. This means that there was no pricing change during the school year. The average ratios vary slightly across the three food venues within each district. To compare profitability among the districts, a profit cost ratio was used; the profit cost ratios vary across the districts and do not seem to be related to implementation status. See Appendix D for more detailed information on these analyses. What are students’ and staff members’ awareness of and satisfaction with vending and a la carte food policies or procedures? Students across schools reported that while they were aware of changes in vending and a la carte food policies, they were not as aware of the reasons for the changes in food options. Students at the majority of schools were not informed of the changes ahead of time; they found out the day the offerings changed. Students also expressed unhappiness at not being involved in nutrition policy changes. This lack of student involvement appeared to have elevated the level of student resistance to these policy changes. Students’ description of the current climate at their schools depicts an environment lacking in communication between students and school administrators. Students perceived that their opinions do not matter to school administrators and food service personnel. Students at 10 of the 11 schools reported having no involvement in decision-making regarding changes in food options. Teachers agreed they were also “out of the loop” when it came to being notified of new policies. From the focus groups, teachers at only three of the 11 schools reported they had been notified of the new food policies by their administration, though teachers at almost all of the participating schools were aware of some changes to vending and a la carte food policies and procedures. At some schools, teachers voiced their belief that their schools’ food service provided foods that would generate the most money. Teachers expressed that because food service providers did not believe that salads and other fresh foods were profitable, decisions were made to offer limited amounts of fresh foods, while more than sufficient quantities of pizza, cookies, and in most schools, nachos


Possible next steps for school in the process of improving the nutrition environment are to continue improving healthy choices available in all food outlets on campus and creating a cafeteria environment that supports the selection of healthy food.

and French fries were offered daily. Teachers believed there was an information gap in the schools, where information on nutrition policies, pricing and revenue were not made clear to staff or administrators. Satisfaction with new vending and a la carte policies and procedures varied greatly among schools. Teachers at schools in which the most changes had been made appeared to be most satisfied with the healthier food options. Teachers who expressed dissatisfaction with policies and procedures appeared to be at schools in which inconsistent changes were made. For example, teachers at schools where sodas were replaced by fruit and milk drinks containing just as much, if not more, sugar and fat were not sure that these changes would positively affect students’ vending choices. What are potential next steps for action to improve the nutrition environment? Numerous recommendations and suggestions were gathered through the multi-pronged data collection efforts. Based on input from principals, food service representatives, School Committee members, PTO presidents, nutrition advocates, students, and teachers, the evaluation team identified various strategies that would support improvement to the school nutrition environment. Guidance for next steps for schools Access to food A la carte lines

Start/ continue offering healthier food choices on a la carte lines (e.g. yogurt, whole grain cereals, fresh fruits and vegetables).

Limit the amount of pizza, cookies and fries one student is allowed to buy at one time.

Limit the number of days pizza, cookies, fries and other less healthy food choices are offered.

Vending machines

Start/ continue offering healthier options in the vending machines.

Ensure that all vending machines operated by all providers on campus provide food and beverages of equal or comparable nutritional content.


Additional nutritional education for students, staff and parents will continue to support changes to the nutrition environment.

Lunch periods Schedule sufficient time during lunch periods to provide

students with enough time to purchase food and eat it without rushing.

Develop strategies to decrease the lunch line wait times to encourage the selection of healthier food.

Ensure that sufficient healthy food options are available for all lunch periods.

Place healthier food at the beginning of the lunch line to increase the likelihood of these items being selected.

Maintain the cleanliness of the cafeteria during and in between the lunch periods.

Student access to healthy snacks and beverages in classroom

Revise policies and procedures to allow students to have food and water or snack breaks throughout the day.

Support teachers in the use of alternative incentives

Provide examples and encourage teachers to use alternatives to candy and other unhealthy food as classroom incentives.

Student and staff education Nutrition education

Provide nutrition education to students on how to make healthy food choices and understand food labels and the nutritional content of food within the context of what is being offered in schools.

Professional development for teachers and staff

Involve staff members early in the policy planning process. Provide education to teachers and staff on nutrition and the

guiding principles of wellness policy development. Partnering with food service providers

Work with food service providers to find affordable strategies for storing and providing high quality fresh fruits and vegetables.

Work with food service providers to increase the variety and availability of healthier food options in the vending machines.

Provide professional development to all food service staff to support their understanding of the changes being made to the nutrition environment.


Next steps for Rhode Island Department of Education and Health include continuing to provide technical assistance and resources to intercept district’s and school’s perceived barriers to change.

Revenue from food items Continue to track revenue and sales data changes over time

to ascertain long term financial impact of changes made as a result of changes in nutrition environment policies.

Strategize how to make up for potential lost revenue when changing to healthier products.

Address fundraising and nutrition with all school community members involved with food sales. Provide fundraising guidelines, healthier food options and alternative fundraising products to support efforts to balance nutrition and revenue.

Create “whole-school” involvement

Increase teacher involvement and buy-in to the changes to the nutrition environment.

Involve students in the decision-making process when making policy changes about improving the school nutrition environment.

Include the PTO in nutrition efforts, involving them in all stages of nutrition policy development.

Increase the visibility of nutrition efforts through the use of strategic plans, marketing plans, and publication of committee activities.

Possible next steps for Rhode Island Departments of Education & HealthTo continue to support changes to the school nutrition environment, the Rhode Island Department of Education could provide guidance in several areas: Promote positive impact of change

Highlight the positive outcomes that have occurred in districts that have begun the implementation of nutrition policies. Ask principals to share their change strategies and positive changes they have observed with other principals and food service directors and providers.

Provide technical assistance

Assist districts in transforming existing school procedures into written nutrition policies.

Advise districts in contract negotiations with food service providers; encourage the inclusion of a mechanism to include school level input.

Clarify USDA regulations on appropriate hours of access to competitive foods during the school day to administrators, students, teachers, and school level staff operating vending machines.


Discussion

Generalization

Provide resources/ strategies

Provide resources to promote nutrition education for students, parents and staff on selecting healthier food choices.

Provide strategies to districts to recuperate lost revenues from changes to the nutrition environment.

Identify strategies for districts to address any negative impacts experienced by districts that have begun the implementation of nutrition policies.

Provide recommendations/ action items

Prioritize the issues to be addressed in nutrition policies. Provide the rationale behind changing the different elements of the nutrition environment.

Provide guidelines for effective ways to change each of the nutrition issues, including viable alternatives to existing approaches (e.g. non-food fundraiser suggestions, healthier food and beverage options for snack bars, school stores, and sporting event concessions).

Encourage districts to increase the number of health promotion posters in the cafeteria serving and eating areas and remove posters promoting less healthy food.

Encourage districts to increase the visibility and promotion of the work of the district nutrition or wellness committees.

Promote centralized control of food purchasing and monitor the use of healthier foods to any groups or individuals selling food on campus. Due to the diverse control over school stores, fundraisers, snack bars located outside of the cafeteria, and food sales operated through teachers, school groups, or parents, district policies are difficult to implement and monitor, schools may be undermining their own efforts to improve the nutrition environment.

The Phase II evaluation study is based on 11 selected secondary schools in six school districts. Although efforts were made to select districts that showed the diversity of the state, the final selection of sites was not a representative sample. Therefore, it is not possible to generalize the results to all Rhode Island secondary schools. However, the results provide a snapshot of what is happening in the nutrition environment in several different areas of the state, in several different stages of nutrition policy development. These experiences are relevant to other schools and districts engaged in the process of nutrition policy change.


Limitations

Implications

Several limitations should be considered when interpreting the findings. First, the results are based on only 11 secondary schools included in the study is a limitation that could limit generalizability of the results. Second, data were collected at two different time points (spring 2005 and fall 2005). It is unknown the extent of the changes made over the summer between the 2004-05 and 2005-06 school years. The data collected in fall 2005 may have reflected changes to the nutrition environment made for the start of a new school year that were not similarly captured for the schools visited in spring 2005. The majority of the schools visited in fall 2005 were sites in the early stages of policy development. Anecdotal evidence supports that several changes were made over the summer and thus may have biased the results towards seeing these sites as farther along the change continuum. Limited information was available about some of the ALC foods (e.g., salad, potato, or pasta bar items). Third, although copies of nutrition policies were requested from all schools that indicated they had written nutrition policies or procedures, these were not obtained. It was not possible to verify self-reported information against the district or school policies. Fourth, there was a clear data limitation of the revenue records analyses. First, although constant efforts were made to collect financial data from all six case study school districts, only four districts provided data. Second, the revenue data provided by one of the four districts included reimbursement amount only and was not comparable to the other three districts. Thus, the profitability analysis was conducted based on the three districts that had comparable financial data. These limitations notwithstanding, the results of the study show how districts have been able to move forward to create policies and to improve the nutrition environments in schools in advance of federal mandates. Since 2001, RIDE has provided all 36 Rhode Island school districts with technical assistance in the development and promotion of policies to enhance the school nutrition environment. Districts have been encouraged to create and implement comprehensive wellness policies that include components to increase the nutritional value of vending machine and a la carte food offerings as well as promoting


nutritious choices in other areas where food is used or sold. Over the course of the evaluation study, the federal Child Nutrition and WIC Reauthorization Act of 2004 was passed requiring school districts across the nation to develop local wellness policies to address childhood obesity. In addition, in August 2005, the Rhode Island state law that required District Health & Wellness Subcommittees went into effect. The experiences and lessons learned by these early adopter districts can help guide districts across the country in the early stages of wellness policy development.

Changes to the food choices occurred over time as wellness policies were discussed, developed, and implemented. Schools with approved nutrition policies in place had more healthy snack items available for sale in the a la carte and vending machines. Many gradual changes were made to a la carte and vending choices during the process of policy adoption. Changes were more difficult to implement to food choices in school stores, fundraisers, and classroom incentives.

Although all schools were engaged in the process of making changes, there was still an abundance of unhealthy food options available to students from multiple sources throughout the day.

The process of developing and implementing wellness policies required active cooperation between the district-level School Committee (or School Board), and district and school level administrators. A positive and dynamic partnership between the schools, the district, and the food service providers enhances understanding of the best approach to putting written policies into practice.

School level involvement of students and teachers, early in the policy development process, increases awareness and acceptance of policies. A lack of understanding of the rational and compromises involved in policy development has led some students and teachers to resent or questions changes to the nutrition environment.

In districts that provided financial data for analysis, there was no clear link between profitability and offering more “healthier items” in the vending and a la carte food options. Qualitative impressions of food service representatives however were mixed. Interviewees reported that changes in vending food options have had a mixed impact on revenue, depending on


school and district. Across districts, changes in food offerings were perceived to be associated with a variety of revenue outcomes, including an increase in revenue, no change in revenue, a dip and then stabilization of revenue, and a decrease in revenue. Individual experiences and impressions may color the perceived success of wellness policies, without a more objective analysis of the impact.


Documents

Phase II Full report FINAL - thriveRI - Rhode Island … · · 2015-10-05Purpose of technical assistance project ... Final report. Santa Cruz, CA: ... • The foods or beverages