Abstract
Background
In 2012, Massachusetts implemented both the updated national school meal standards
and comprehensive competitive food/beverage standards that closely align with current
national requirements for school snacks.
Objectives
This study examines the impact of these combined standards on school meal and snack
food selections, as well as food choices outside of school. In addition, this study
examines the impact of these standards on nutrients consumed.
Design
The NOURISH (Nutrition Opportunities to Understand Reforms Involving Student Health)
Study was an observational cohort study conducted among students from spring 2012
to spring 2013.
Participants/setting
One hundred sixty students in 12 middle schools and high schools in Massachusetts
completed two 24-hour recalls before (spring 2012) and after implementation (spring
2013) of the updated standards.
Main outcome measures
Changes in school meals, competitive food, and after-school snack selection, as well
as nutrients consumed outside of school were examined.
Statistical analyses performed
Logistic regression and mixed-model analysis of variance were used to examine food
selection and consumption.
Results
After implementation, 13.6% more students chose a school meal (70.1% vs 56.5%; P=0.02). There were no differences in competitive food purchases but a significant
decrease in the number of after-school unhealthy snacks consumed (0.69 [standard error=0.08]
vs 1.02 [standard error=0.10]; P=0.009). During the entire day, students consumed, on average, 22 fewer grams of sugar
daily after implementation compared with before implementation (86 g vs 108 g; P=0.002).
Conclusions
With the reduction in the number of unhealthy school snacks, significantly more students
selected school meals. Students did not compensate for lack of unhealthy snacks in
school by increased consumption of unhealthy snacks outside of school. This provides
important new evidence that both national school meal and snack policies may improve
daily diet quality and should remain strong.
Keywords
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Biography
J. F. W. Cohen is an assistant professor, Department of Health Sciences, Merrimack College, North Andover, MA, and an adjunct assistant professor, Department of Nutrition, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA.
Biography
M. T. Gorski Findling is a post-doctoral fellow, Interfaculty Initiative in Health Policy, Harvard Graduate School of Arts and Sciences, Harvard University, Cambridge, MA.
Biography
L. Rosenfeld is a scientist and lecturer, Institute for Child, Youth, and Family Policy, The Heller School for Social Policy and Management, Brandeis University, Waltham, MA.
Biography
L. Smith is the managing director, FSG, Boston, MA.
Biography
E. B. Rimm is a professor, Departments of Nutrition and Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA.
Biography
J. A. Hoffman is an associate professor, Department of Applied Psychology, Bouvé College of Health Sciences, Northeastern University, Boston, MA.
Article info
Publication history
Published online: September 10, 2018
Accepted:
July 9,
2018
Received:
January 18,
2018
Footnotes
STATEMENT OF POTENTIAL CONFLICT OF INTEREST No potential conflict of interest was reported by the authors.
FUNDING/SUPPORT Funding for the NOURISH Study was provided by Harvard Catalyst and The Robert Wood Johnson Foundation. Juliana Cohen was supported by the Nutritional Epidemiology of Cancer Education and Career Development Program (grant no. R25 CA 098566). M. T. Gorski Findling was supported by the Agency for Healthcare Research and Quality (grant no. T32HS000055).
Identification
Copyright
© 2018 by the Academy of Nutrition and Dietetics.
