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Article Excerpt
This study analyzed data on students' food purchases linked to their school records to examine factors affecting the healthiness of their food choices and the impacts of reforms to promote healthier eating in a high school lunch program. U.S. Department of Agriculture's Healthy Eating Index was used to evaluate the nutritional quality of the foods purchased, as well as an alterative ranking developed by the school dietitian. The new lunch program was associated with an improvement in the nutritional quality of students' food choices. Girls tended to purchase relatively healthier food than boys, but male students had a greater improvement in the healthiness of their food choices.
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Ninety-nine percent of U.S. public schools and 83% of public and private schools combined participate in the National School Lunch Program (NSLP). These schools receive cash subsidies and commodities from the U.S. Department of Agriculture (USDA) for each meal served. In return, they are supposed to satisfy USDA's nutritional requirements and provide free or reduced-price lunch to eligible children. During 2004-2005, the reimbursement rates for free, reduced-price, and paid lunches were $2.24, $1.84, and $0.21, respectively (USDA, Food and Nutrition Service [FNS] 2005b, 2005c). In 2004, U.S. schools served 4.8 billion lunch meals, reaching over 25 million children (Guthrie 2003; USDA, FNS 2005c). For many, especially students from lower-income families enrolled in federally subsidized free and reduced-price lunch programs, these are the main meals of the day. In addition to these federally subsidized meals, millions of students choose foods from a la carte offerings provided by most school food services. These are not part of the NSLP and are referred to as "competitive foods" by USDA.
The American Obesity Association (2005) reported that 30.3% of children ages 6-19 were overweight or obese in 2000. This figure tripled from the early 1970s to 2000. Many factors are behind this trend, but there is evidence that meals served in many schools contributed to poor nutrition and obesity (Cooper and Holmes 2006). In a nationwide assessment, USDA found that the average lunch served in 1998-99 met its dietary guidelines of fewer than 30% of total calories from fat and less than 10% from saturated fat in only one out of seven secondary schools (USDA, FNS 2001). Many secondary students eat high-fat cheeseburgers, French fries, and pizzas on a daily basis. In some cases, they eat only a candy bar and a super-sized soft drink. Two reporters visiting six schools in New York City and Montgomery County, Maryland (an affluent Washington, DC, suburb), observed hundreds of students eating lunch and saw only five who took the green vegetable offered with the full meal (Becker and Burros 2003).
School food service directors often must focus on ease of preparation rather than healthy options because they lack both the skilled staff and facilities necessary to do more. Many schools depend on major food service vendors to supply highly processed foods that require little more than heating to prepare. Faced with tight budgets, food service operations are driven by cost considerations and a need to serve what students will eat. Major fast food chains' products are being served in a substantial number of schools, because that is what students want. School districts have also signed vending contracts with snack and soda companies for the commission generated to fund their programs. Schools have begun to be heavily criticized for not providing healthier food choices and guiding students toward healthy lifelong eating habits (Cooper and Holmes 2006; USDA, FNS 2001).
Recently, some school districts have taken steps to change their food programs. A 2005 USDA study, Making It Happen! School Nutrition Success Stories, reports on 32 schools and school districts that have made innovative changes to improve the nutritional quality of their food programs. The encouraging message from these case studies is that "students will buy and consume healthful foods and beverages, and schools can make money from healthful options" (USDA, FNS 2005a, executive summary). Hopkins School District 270 in Minnesota has been one of the innovators. Its food service program has improved the quality of food served, the variety of healthful choices available, and the school food service environment. Moreover, the Hopkins food service program demonstrated its financial viability. The program is able to operate on a revenue-neutral basis, not requiting a subsidy from the school district (Royal Cuisine 2006). Because of these changes, Hopkins High School provided an opportunity to study the lunch choices of adolescents and how they might be changed.
In previous research using cross-sectional data, Akin, Guilkey, and Popkin (1983) found that students who participated in the NSLP had higher intakes of vitamins and minerals over a 24-hour period compared to nonparticipants and that the impact was stronger for low-income children. In a similar study, Gleason and Suitor (2003) examined the effect of NSLP participation on students' dietary intakes, also in comparison to nonparticipants. Using a fixed-effects model, the researchers found that NSLP participation had an improvement in the 24-hour intake of six vitamins and minerals. Participants consumed higher levels of fat but fewer added sugars than nonparticipants.
A relationship between childhood obesity and school feeding programs was established by Anderson and Butcher (2005), who linked the availability of snack foods and beverages in schools to adolescent obesity. They found that an association between schools with vending machine contracts and increased body mass index levels. The nutrition literature suggests that interventions to promote healthy eating can work. Studies typically focus on evaluating the impact of controlled interventions designed by the researchers that are implemented on a trial or temporary basis. For example, Perry et al. (2004) and French et al. (1997) assigned schools randomly to a control or an intervention group, in which interventions were successfully initiated to encourage fruit and vegetable consumption.
Simply offering nutritious foods does not necessarily improve students' diets, if the foods are not appealing. Students will avoid these choices or leave them uneaten. Ralston, Buzby, and Guthrie (2003) outlined strategies to increase the appeal of school lunches and breakfasts, suggesting that schools expand the offerings available, allow student input in food service decisions, improve the selection of USDA commodities, increase the use of fresh produce and local foods, and improve methods of preparation. Beyond the food itself, the school lunchroom is frequently chaotic and students must rush to eat in the very short time allotted.
With access to a unique data set, we examined the school lunch choices over three years (2002-2005) in Hopkins High School, located in a western suburb of Minneapolis, and the impact of the food service changes on measures of nutritional quality. Students at Hopkins use debit accounts and personal identification numbers to purchase food. This point-of-sale (POS) data allowed students to be linked with their purchases on the cash registrar records and with their demographic and other information through their school records. USDA's Healthy Eating Index (HEI) was used to evaluate the nutritional quality of the specific food items offered. An alternative nutritional ranking developed by the school dietitian was also utilized, for reasons explained below. This approach provided a measure of the overall healthiness of foods purchased for lunch by a student over a 10-day period. Econometric methods were then used to examine factors affecting a student's food choices and whether they changed after the program innovations.
To our knowledge, this is the first study to use POS data linked to students' records to...
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