COVID-19 Driven Adaptations in the Provision of School Meals in the Baltic Sea Region

The instability, rapid changes, and restrictions generated by the COVID-19 pandemic tested the provision of school meals in the Baltic Sea Region (BSR). School meal services were affected by factors such as full or partial lockdowns, strict hygiene regimes, lay-offs or staff shortages, stressful working environments, supply shortages, and changes to storing, cooking, and serving models. However, the responses to the COVID-19 crisis were highlighted by innovation, new opportunities, and cooperation. This paper reviews several examples of COVID-19 crisis management at school canteens in five BSR countries [Estonia, Finland, Poland, Russia (Saint Petersburg), and Sweden] between March 2020 and March 2021. The paper reveals the significant operational, logistical, and systemic problems that appeared because of the pandemic; the solutions and adaptations that were developed are also identified. The preparatory processes, logistics, and services that were adapted during the COVID-19 pandemic resulted in a new school meal provision model—a takeaway model; that includes similar features and unique characteristics across the different countries. Overall, the provision of school meals was carried out successfully in the BSR during the pandemic. Responsible, competent, and innovative professionals used their organizational skills, flexibility, and responsiveness to feed school pupils in a highly restricted and rapidly changing environment. It is expected that several of the COVID-19-driven innovations will remain in use following the pandemic.

Pre-pandemic to early-pandemic changes in risk of household food insecurity among Maryland families with children

Objective: The objective was to examine risk and protective factors associated with pre- to early-pandemic changes in risk of household food insecurity (FI). Design: We re-enrolled families from two statewide studies (2017-2020) in an observational cohort (May-August 2020). Caregivers reported on risk of household FI, demographics, pandemic-related hardships, and participation in safety net programs (e.g. CARES stimulus payment, school meals). Setting: Maryland, United States. Participants: Economically, geographically, and racially/ethnically diverse families with preschool to adolescent-age children. Eligibility included reported receipt or expected receipt of the CARES stimulus payment or a pandemic-related economic hardship (n=496). Results: Prevalence of risk of FI was unchanged (pre-pandemic: 22%, early-pandemic: 25%, p=0.27). Risk of early-pandemic FI was elevated for non-Hispanic Black (aRR=2.1 [95% CI 1.1, 4.0]) and Other families (aRR=2.6 [1.3, 5.4]) and families earning ≤300% federal poverty level. Among pre-pandemic food secure families, decreased income, job loss, and reduced hours were associated with increased early-pandemic FI risk (aRR=2.1 [1.2, 3.6] to 2.5 [1.5, 4.1]); CARES stimulus payment (aRR=0.5 [0.3, 0.9]) and continued school meal participation (aRR=0.2 [0.1, 0.9]) were associated with decreased risk. Among families at risk of FI pre-pandemic, safety net program participation was not associated with early-pandemic FI risk. Conclusions: The CARES stimulus payment and continued school meal participation protected pre-pandemic food secure families from early-pandemic FI risk but did not protect families who were at risk of FI pre-pandemic. Mitigating pre-pandemic FI risk and providing stimulus payments and school meals may support children’s health and reduce disparities in response to pandemics.

Nutrition Supports Deconstructed and Disrupted: An Evaluation of a Multilevel School-Based Intervention during the Time of COVID

The Best Food Forward (BFF) project aims to provide multiple nutrition supports and interventions to improve family food security (FS) and health outcomes associated with FS within two metropolitan school districts. A quasi-experimental time-series design guided a multilevel evaluation for BFF through surveys, biometric screenings, focus groups, and observations among a random sample of caregiver–child dyads. FS, utilization of school meal programs, and nutrition behaviors were observed and analyzed at three time points: preintervention, postintervention pre-COVID-19, and postintervention post-COVID-19. Participants included 122 parents and 162 youth. Families reported (1) an income less than $35,000 annually (48.8%) and (2) a COVID-19-related job loss (36.9%). Parents used Supplemental Nutrition Assistance Programs or Women, Infants, Children benefits prior to (51.1%) and following COVID-19 (50.0%). No significant differences in FS were found. RM-ANOVA indicated an increase in breakfast consumption at home and a decrease in use of the school breakfast program (F(1.78, 74) = 19.64, p < 0.001, partial η2 = 0.21) and school lunch program (F(1.51, 74) = 23.30, p < 0.001, partial η2 = 0.24). Rates of FS and eating behaviors did not change significantly over time. Correlations of program usage and eating behaviors demonstrate the importance of promoting participation in school meal programs. BFF may have prevented significant decreases in FS during COVID-19.

Did School Meal Programs and SNAP Participation Improve Diet Quality of US Children from Low-Income Households: Evidence from NHANES 2013–2014?

Nutrition assistance programs such as school meals and the Supplemental Nutrition Assistance Program (SNAP) are designed to provide a safety net for the dietary intake of children from low-income families. However, compared with eligible non-participants, the relationship of diet quality with school meals only and school meals + SNAP is not well understood. The objectives of the study include: (1) To explore whether and to what extent nutrition assistance program participation (school meals only and school meals + SNAP) is related to diet quality; and (2) to examine the differences of diet quality between participating in school meals only, school meals + SNAP, or non-participation among American children. Children aged 5 to 18 years old from income eligible households who participated in the 2013–2014 National Health and Nutrition Examination Survey (NHANES) were included in this cross-sectional study (n = 1425). Diet quality was measured using the Healthy Eating Index (HEI)–2015 and its 13 subcomponents. A Rao-Scott Chi-square test, propensity scores approach, and Analysis of Covariance were performed. Covariates included age, sex, race/ethnicity, weight status, and family monthly poverty index. SAS survey procedures were used to incorporate the appropriate sample design weights. Participation in school meals + SNAP was not associated with higher diet quality compared to eligible non-participants or school meals-only participants. Participation in school meals + SNAP improved the intake of total dairy, but not added sugars or total vegetables compared to school meals only. Overall, school meal + SNAP participation did not significantly improve the overall diet quality of children in low-income households relative to comparable non-participants.

Strategies to Improve School Meal Consumption: A Systematic Review

School meals can play an integral role in improving children’s diets and addressing health disparities. Initiatives and policies to increase consumption have the potential to ensure students benefit from the healthy school foods available. This systematic review evaluates studies examining initiatives, interventions, and policies to increase school meal consumption. Following PRISMA guidelines, this review was conducted using four databases and resulted in a total of 96 studies. The research evidence supports the following strategies to increase school meal consumption: (1) offering students more menu choices; (2) adapting recipes to improve the palatability and/or cultural appropriateness of foods; (3) providing pre-sliced fruits; (4) rewarding students who try fruits and vegetables; (5) enabling students to have sufficient time to eat with longer (~30 minute) lunch periods; (6) having recess before lunch; and (7) limiting students’ access to competitive foods during the school day. Research findings were mixed when examining the impact of nutrition education and/or offering taste tests to students, although multiple benefits for nutrition education outside the cafeteria were documented. There is some evidence that choice architecture (i.e., “Smarter Lunchroom”) techniques increase the proportion of students who select targeted meal components; however, there is not evidence that these techniques alone increase consumption. There were limited studies of the impact of increasing portion sizes; serving vegetables before other meal components; and strengthening local district and/or school wellness policies, suggesting that further research is necessary. Additionally, longer-term studies are needed to understand the impact of policies that limit students’ access to flavored milk. Several studies found increases in students’ meal consumption following the Healthy Hunger-Free Kids Act (HHFKA) and concerns regarding an increase in food waste following the HHFKA were not supported. Overall, there are a range of effective strategies to increase school meal consumption that can be implemented by schools, districts, and policymakers at the local, state, and federal levels (PROSPERO registration: CRD42021244688).

Impact of the community eligibility provision program on school meal participation in Texas

Objective: To estimate the impact of opting into the community eligibility provision (CEP) on school meal participation among students in Texas. Design: A quasi-experimental design using a two-way fixed effects panel difference-in-difference model and the variation in adoption timing to estimate the impact of opting into CEP on student breakfast and lunch participation in eligible, ever-adopting schools. Setting: All public and charter K-12 schools in Texas participating in national school meals (breakfast and/or lunch) from 2013 to 2019 who are eligible for the CEP program in at least 1 year and choose to opt into the program in at least 1 year (n 2797 unique schools and 16 103 school-years). Participants: School-level administrative data from the Texas Department of Agriculture on meal counts, enrollment and summary characteristics of students merged with district-level educational and socio-demographic data from the Texas Education Authority. Results: We find opting into CEP increased school breakfast participation by 4·59 percentage points (P < 0·001) and lunch participation by 4·32 percentage points (P < 0·001), on average. The effect is slightly larger (4·64 and 4·61, respectively) and still statistically significant when excluding summer months. Conclusion: Our findings suggest that opting into CEP modestly increases school meal participation in Texas, with a similar impact on breakfast and lunch.

What works to improve school lunch nutritional quality - legislation or self-audit? Medium-term results from Sweden

BackgroundPoor monitoring and evaluation leads to a lack of evidence regarding what works in terms of improving school meal quality. Sweden has a long-standing policy of universal free school meals but updated legislation regarding nutritional quality came into effect in 2011. To coincide with this, we built a fully automated web-based self-audit tool for schools, called School Food Sweden, in order to i) establish a national database on overall meal quality, covering six domains, and ii) help schools and municipalities improve, based on the implementation strategy of audit and feedback. We have previously examined the pre- and post-legislation period. In this paper we describe changes in one domain – nutritional quality – in the years since the new legislation and examine if repeated use of the tool was associated with improvements.MethodsPrimary schools in Sweden self-selected to use the tool between March 2012 and July 2019 and audited a four-week lunch menu. Date of audit, number of audits per school (1-9), how often schools accessed their feedback (% of times) and school characteristics were noted. Factors associated with meeting nutritional criteria were examined using variance weighted least squares regression and logistic regression, using both repeated cross-sectional and longitudinal design.ResultsAlmost half of all ca 4800 primary schools in Sweden signed up to the tool. Nutritional quality was audited by 1500 schools at least once. Repeated cross-sectional analyses showed the proportion of all schools meeting the criteria increased significantly between 2012/13 and 2018/19 (from 11% to 34%). For all schools, each extra audit completed increased the odds of meeting nutritional criteria by 1.30 (CI 1.20-1.41), controlling for region and time since the introduction of legislation. In a longitudinal analysis (schools with repeat audits, n=774), both number of audits and the frequency of accessing previous feedback reports were predictors of meeting the nutritional criteria (OR 2.02, CI 1.23-3.31), even after adjusting for time since the introduction of legislation and number of days since the previous audit.ConclusionsBoth legislation and self-audit with automatic feedback appear effective in helping schools to improve school meal quality. Self-audit may be an essential complement to legislation, or a promising alternative in settings where regulation is not an option.

Mitigating Childhood Food Insecurity during COVID-19: A Qualitative Study of how School Districts in California’s San Joaquin Valley Responded to Growing Needs

Objectives: To explore best practices and challenges in providing school meals during COVID-19 in a low-income, predominantly Latino, urban-rural region. Design: Semi structured interviews with school district stakeholders and focus groups with parents were conducted to explore school meal provision during COVID-19 from June to August 2020. Data was coded and themes were identified to guide analysis. Community organizations were involved in all aspects of study design, recruitment, data collection, and analysis. Setting: Six school districts in California’s San Joaquin Valley. Participants: School district stakeholders (n=11) included food service directors, school superintendents, and community partners (e.g., funders, food co-operative). Focus groups (n=6) were comprised of parents (n=29) of children participating in school meal programs. Results: COVID-19-related challenges for districts included developing safe meal distribution systems, boosting low participation, covering COVID-19-related costs, and staying informed of policy changes. Barriers for families included transportation difficulties, safety concerns, and a lack of fresh foods. Innovative strategies to address obstacles included pandemic-EBT, bus-stop delivery, community pick-up locations, batched meals, and leveraging partner resources. Conclusions: A focus on fresher, more appealing meals and greater communication between school officials and parents could boost participation. Districts that leveraged external partnerships were better equipped to provide meals during pandemic conditions. In addition, policies increasing access to fresh foods and capitalizing on USDA waivers could boost school meal participation. Finally, partnering with community organizations and acting upon parent feedback could improve school meal systems, and in combination with pandemic-EBT, address childhood food insecurity.