Assessment of Changes in School Nutrition Programs and the School Environment as a Result of Following the HealthierUS School Challenge Program
Jennifer S. Brown, MS, SNS; Carolyn Bednar, PhD, RD, LD;
Nancy M. DiMarco, PhD, RD, LD, CSSD; Priscilla L. Connors, PhD, RD, LD
The purpose of this study was to determine changes in school nutrition programs and the school environment as reported by school nutrition directors who are following the U.S. Department of Agriculture's HealthierUS School Challenge (HUSSC) program. The objective was to determine before and after changes in the average lunch participation rate, food cost, labor cost, nutrition education (minutes/week), physical education (minutes/week), and food/beverage sales according to the following: level of award received from HUSSC; school nutrition directors' education level and credentials; and type of management and menu planning for the school nutrition program.
A survey was developed by the researchers, validated, converted to an online format, and pilot tested. All 149 school nutrition directors who had received HUSSC awards were invited to participate in the online survey, and those who did not respond were mailed printed survey forms. Survey data was summarized and statistically analyzed using ANOVA and MANOVA.
Seventy-six surveys were returned from 29 states (51% response rate). The three most frequent challenges reported were availability of whole-grain items, increased food costs, and student acceptance. Compared to the period prior to the award, average lunch participation had increased slightly, while current nutrition education minutes per week, food cost, and labor cost had increased significantly (p = 0.011, p = 0.002; p = 0.043, respectively).
Applications to Child Nutrition Professionals
Results suggest that school nutrition directors may improve nutritional quality of school lunches while maintaining or increasing lunch participation rates by participating in the HUSSC program. In addition, results indicate that enlisting support from school staff and administrators is critical to achieving HUSSC standards.
The need for increased nutrition and physical activity is evident as 16. 9% of American children and adolescents aged 2-19 years old are obese (Ogden & Carroll, 2010). Healthy eating in childhood and adolescence is associated with a reduced risk for many chronic diseases and can prevent health problems such as obesity (Centers for Disease Control and Prevention, 2008). A positive relationship between the consumption of school meals and children's intakes of key food groups at breakfast and lunch has been reported (Clark & Fox, 2009). For example, in the School Nutrition Dietary Study (SNDA-III), more than twice as many National School Lunch Program (NSLP) participants consumed at least one vegetable when compared to nonparticipants (Condon, Crepinsek, & Fox, 2009).
The Healthy, Hunger-Free Kids Act of 2010 requires that the U.S. Department of Agriculture (USDA) establish national nutrition standards for all foods sold and served in schools at any time during the school day. Earlier in 2010, the Institute of Medicine (IOM) Committee on Nutrition Standards recommended nutrient targets rather than nutrition standards and advocated use of food-based menu planning. The committee also recommended that the USDA adopt standards increasing the amounts and variety of fruits, vegetables, and whole grains in school meals, set minimum and maximum levels of calories, and consider reducing saturated fat and sodium (Stallings, Suitor, & Taylor, 2010).
Some schools are receiving awards by participating in programs that encourage children to eat nutritious foods and engage in physical activity. The Healthier US School Challenge (HUSSC) program was established by the USDA in 2004 as a voluntary initiative to recognize schools that create healthier school environments by promoting nutrition and physical activity. The program provides four levels of awards with monetary incentives as follows: Gold Award of Distinction ($2,000), Gold ($1,500), Silver ($1,000), and Bronze ($500) (U.S. Department of Agriculture [USDA], Food and Nutrition Service [FNS], 2010).
As of April 2011, 1,296 awards were given to schools in 41 states. There were 715 schools with current awards and 581 schools with awards that had expired (A. Arrowsmith, personal communication, April 14, 2011). Each award remains active for four years. HUSSC is open to all schools that participate in the NSLP (USDA, 2011a). In addition to monetary awards, schools receive a plaque, banner, and recognition through the HUSSC website, newspaper articles, and other publications. The program is designed to bring schools closer to compliance with the Dietary Guidelines for Americans, 2010 (USDA & U.S. Department of Health and Human Services [HHS], 2011) and the IOM's recommendations for meals and foods in schools (Stallings et al., 2010). The Let's Move! Initiative, introduced by First Lady Michelle Obama in 2010, includes HUSSC as part of its plans to raise a healthier generation of children (USDA, FNS, 2010).
Each HUSSC award level has specific criteria. All elementary schools receiving HUSSC awards must be enrolled as a Team Nutrition school and meet USDA nutrition standards for reimbursable lunches. A minimum level of ADP for lunches is not designated for Bronze awards, but ADP must meet or exceed 60% for the Silver level and 70% for the Gold level or the Gold Award of Distinction (USDA, 2011a). Other HUSSC award requirements for elementary schools are shown in Table 1.
Table 1. HUSSC Award Standards for Elementary Schools (USDA, 2011a)
|Vegetables||Different each day; dark green or orange > 3 times/week; legumes > 1 time/week|
|Fruits||Different each day; fresh fruit 1 day/week for bronze/silver, 2 days/week for gold or gold-D*; canned fruit only in juice or light syrup; 100% fruit juice counts as vegetable 1 day/week|
|Whole grains||Different each day; >3 servings/week for bronze/silver; > 5 servings/week for gold or gold-D*|
|Milk||Only low-fat (1 % or less) and fat-free fluid milk, flavored or unflavored|
|Competitive foods||Calories per serving of total fat (≤35%) and saturated fat (<10%); limit of ≤0. 5 g trans fat per serving; total sugar ≤35% by weight; sodium ≤480 mg for non-entrée and ≤600 mg per entrée|
|Competitive beverages||Only low-fat and fat-free milk, 100% fruit and vegetables juices, or water|
|Nutrition education||Provided in at least ½ but no fewer than 2 grade levels; part of a structured and systematic unit of instruction; multiple channels of communication; classroom food prohibited as a reward except for holiday parties|
|Physical education||Minimum of 45 minutes/week for bronze/silver; 90 minutes/week for gold; 150 minutes/week for gold-Da|
|Wellness policy||School wellness policy in place|
aGold-D = Gold with Distinction (the highest level award)
The purpose of this study was to assess changes in school nutrition programs and school environments associated with achieving standards for the HUSSC program. The study was intended to document changes that award-winning schools made for a healthier school environment and to create awareness of challenges faced and actions that led to success in meeting award standards.
This study was approved by the Texas Woman's University Institutional Review Board.
All school nutrition directors at school districts in the United States with at least one school previously receiving a HUSSC award were invited to participate in the study. Names of award-winning schools were obtained from the USDA's Food and Nutrition Service HealthierUS School Challenge website, http://www.fns.usda.gov/tn/HealthierUS/index.html. When this study was conducted (January 2011), 149 school districts had received awards. Of these schools, 142 were elementary and 7 were secondary.
A survey questionnaire was developed by the researchers and validated by three educators and two school nutrition professionals. Surveys for the pilot study and the actual study included questions requiring yes/no, multiple choice, and Likert scale answers. Questions focused on school characteristics, average lunch participation rate, sales of foods and beverages in the cafeteria , menu planning and computer systems, nutrition education, physical education, school nutrition director background and experience, food and labor costs, and current practices that led to receiving a HUSSC award. PsychData software (2011, PsychData LLC. , State College, PA). was used to convert the survey to an online format.
The researchers then conducted a pilot study to test survey reliability. Forty-two school nutrition directors in Texas who were currently making efforts to apply for an award from the HUSSC program were invited by email to participate in the pilot study, and 11 completed it. Cronbach's alpha analysis of pilot study results determined inter-item reliability for various groups of questions using a likert-scale as follows: foods α = 0. 741; beverages α = 0. 835; average lunch participation, nutrition education, and physical education α = 0. 662; food and labor cost α = 0. 746. Cronbach's alpha is a coefficient of statistical reliability; values greater than 0. 70 are viewed as respectable while scores between 0.65 and 0.70 are considered minimally acceptable (DeVellis, 1991).
Feedback from the pilot study participants was used in revising the survey format for the actual study. Questions about how nutrition education is offered and director credentials were changed to accept more than one answer. Questions asking for the food cost per meal and labor cost per meal were provided with examples of the desired format, e. g., $X. XX. To reduce the amount of time to complete the survey, a list of data items needed were provided in the email so that participants could assemble data prior to beginning the survey.
In January 2011, a cover letter containing a link to the online survey was sent to 149 school nutrition directors who had received HUSSC awards. The letter provided information about the study and encouraged participation by offering the incentive of participating in a drawing for one of four gift cards ($100, $50, $25, and $25). This mailing was followed by e-mail reminders to the school nutrition directors at one week and two week intervals after the initial mailing. In February 2011, paper surveys were mailed to the remaining school nutrition directors who had not responded. Ten days later, a postcard reminder was mailed. Data was collected and organized through PsychData, 2011.
SPSS version 15. 0 was used to summarize and analyze data. Frequencies and percentages within the entire sample were calculated for current food and labor costs, minutes of nutrition and physical education, foods and beverages sold in the school cafeteria, level of HUSSC award, and average lunch participation rate.
Analysis of variance (ANOVA) was used to determine if significant differences existed before and after receiving a HUSSC award for food and beverages sales based on the level of award received. Multivariate analysis of variance (MANOVA) was used to determine if significant differences existed before and after receiving a HUSSC award for average lunch participation rate, food cost, labor cost, nutrition education (minutes per week), and physical education (minutes per week). These differences were analyzed according to education level of the school nutrition director, credentials of the school nutrition director, and type of management and menu planning of the school nutrition program based on the level of award received. The level of significance was set at p< 0.05.
RESULTS AND DISCUSSION
Fifty-six surveys were submitted through the website and 25 paper surveys were completed and returned. Therefore, 81 surveys were returned, but 5 online surveys were unusable because of incomplete information. Seventy-six usable surveys were summarized and analyzed, giving an overall response rate of 51%. Respondents were located in 29 different states. Descriptive statistics were summarized for the following variables: average lunch participation rate, food cost, labor cost, nutrition education (minutes/week), physical education (minutes/week), and food and beverage sales. Statistical analysis was conducted to determine differences before and after the HUSSC award for the award level, school nutrition directors' education level and credentials, and type of menu planning for the school nutrition program.
School and School Nutrition Director Characteristics
Participants reported an average lunch participation rate of 78.5% and average price of $1.94 for a full-paid lunch. The current lunch participation rate ranged from 34% to 100%. Table 2 provides further information regarding the respondents, for example 63 of the 76 respondents used food-based menu planning. There were almost an equal number of participants from each award level. A majority, 70 of the 76 school nutrition directors, reported that the school nutrition department was self-operated. Almost half of the school nutrition directors held a BA or BS degree, while 20 held a graduate degree. The credential most often held by directors was the School Nutrition Specialist credential. To obtain this credential, one must pass the School Nutrition Specialist Credentialing Exam administered by the School Nutrition Association. Seven school nutrition directors reported having both the School Nutrition Specialist and Registered dietitian credentials.
Table 2. Demographic Characteristics of Schools Receiving HUSSC Awards (N=76)
|Award Levels |
Gold Award of Distinction
|School Menu Planning Type|
Food-based (enhanced or traditional)
Nutrient Standard Menu Planning or Assisted
Nutrient Standard Menu Planning
|School Management Type|
| School Nutrition Director Education Level|
High school or some college
BA or BS
|School Nutrition Director Credentialsa|
School nutrition specialist
Both RD and SNSb
None of the above
aSome participants did not answer this question. bRD = registered dietitian, SNS = School Nutrition Specialist. cOther credentials included state certification, SNA certification, culinary certificate, dietetic technician registered, licensed dietitian, and state- licensed purchasing agent.
HUSSC Challenges and Actions
Open-ended questions asked participants to name three challenges that they faced and to list three actions that led to success in receiving a HUSSC award. Researchers reviewed the responses to these questions and grouped them into categories based on similarity of answers. Table 3 lists all of the challenges and actions that were mentioned by three or more school nutrition directors. The most frequent challenges reported were the availability of whole-grain products, increased food costs, student acceptance, offering dark green and orange vegetables, and coordination/collaboration. Other challenges mentioned by at least 10% of participants were: including legumes in menus; physical education requirements; and time and paperwork.
Table 3. Challenges and Actions for Success in Receiving HUSSC Awards (N=72)
|Challengesa||Number of Participants|
|Availability of whole-grain products||23|
|Increased food cost||18|
|Offering dark green and orange vegetables||15|
|Including legumes in menu||10|
|Physical education requirements||9|
|Time and paperwork||7|
|Fresh fruits and vegetables||4|
|Actions for Successa|
|Support from school staff and administrators||45|
|Teamwork between foodservice and teaching staff||17|
|Changing menus to meet requirements||15|
|Already having healthy food choices||12|
|Parent and community support||11|
|Changing to whole-grain products||9|
|Organized fitness program||6|
|Publicity about program||5|
|Focusing on deep green and orange vegetables||5|
|Training foodservice staff||4|
|Completing application process||4|
|Including legumes in menus||3|
|Registered dietitian on staff||3|
aParticipants were asked to list three challenges that schools faced to meet the HUSSC program and three actions that led to success in receiving a HUSSC award; some participants did not answer this question while others listed fewer than three challenges and three actions. bOther challenges reported from two participants each include compiling all nutrient analysis data for menus, implementing lower sodium foods, snack restrictions, rewarding students with non-food items, and competitive food restrictions; other actions for success reported from two participants each include more time focusing on program particulars & program preparation, gradually introducing healthy options, changing/reducing a la carte, enthusiasm, trying different techniques and incentives to encourage students, not serving fried foods, and researching new items.
By far the most frequently reported action that led to success in receiving an award was support from school staff and administrators, listed by 45 respondents. Other actions named frequently were teamwork between school nutrition and teaching staff, changing menus to meet HUSSC requirements, already having healthy food choices, parents and community support, and changing to whole-grain products. Availability of whole-grain products was the top challenge listed by 23 respondents and was also listed as an action for success by 9 participants. This underscores the importance of finding methods to successfully add whole-grain items to school menus.
Before and After HUSSC Award
Table 4 reflects a comparison of school data prior to and after receiving a HUSSC award. The average lunch participation rate at these schools was 78.5+13. 6%, indicating a slight mean increase of 1. 9% from the participation rate prior to receiving the award. However, half of the districts reported no difference in the average lunch participation rate. Current minutes per week of physical education increased to 129.7+91. 1. Nutrition education minutes per week, food cost, and labor cost per meal increased significantly compared to prior to the award. Nutrition education minutes per week increased from 36.2±34.6 to 43. 3±35.4 (p = 0. 011), food cost per meal increased from $1.26±0. 62 to $1.33±0.65 (p = 0.002) while labor cost per meal increased from $1.21±0.87 to $1.25±0.87 (p = .043).
Table 4. Comparison of School Data Prior to and After Receiving a HUSSC Award
Prior to Award ±
Mean ± SD
|65||76.6 ± 17.4||78.5 ± 13.6||2.49||0.120|
(minutes per week)
|42||36.2 ± 34.6||43.3 ± 35.4||7.14||0.011|
(minutes per week)
|60||119.3 ± 66.1||120.7 ±67.4||0.71||0.791|
|Food cost per meal||51||$1.26 ± 0.62||$1.33 ± 0.65||10.52||0.002|
|Labor cost per meal||50||$1.21 ± 0.87||$1.25 ± 0.87||4.32||0.043|
Note. Not all participants answered all questions.
The average lunch participation rate at these schools was 78.5+13.6%, indicating a slight mean increase of 1.9% from the participation rate prior to receiving the award. However, half of the districts reported no difference in the average lunch participation rate. Current minutes per week of physical education increased to 129.7+91.1. Nutrition education minutes per week, food cost, and labor cost per meal increased significantly compared to prior to the award. Nutrition education minutes per week increased from 36.2±34.6 to 43.3±35.4 (p = 0.011), food cost per meal increased from $1.26±0.62 to $1.33±0.65 (p=0.002) while labor cost per meal increased from $1.21±0.87 to $1.25±0.87 (p = .043).
For the food and labor cost analyses, there is a year effect with the current year greater than prior to receiving an award. Only 42 participants supplied information on minutes of nutrition education offered prior to receiving an award. One reason for this may have been that minutes of nutrition education possibly were not tracked or recorded prior to working towards receiving a HUSSC award.
Changes in Food and Beverage Sales
Compared to the period prior to the award, food items that were sold much more frequently were whole-grain foods (43 schools), fresh fruits (34 schools), and fresh vegetables (30 schools) (See Table 5).
Table 5. Changes in Sales of Foods and Beverages at HUSSC Award-Winning Schools Compared to Before Receiving an Award (N=75)
| ||Change in Sales|
|3 ||3||35 ||22 ||10 ||2|
|Skim or low-fat|
|Soy or rice milk||6||0||12||3||1||53|
|100 % fruit juice||1||3||47||10||7||7|
|Juice drinks w/|
less than 50% juice
Results also indicated trends towards sales of more low-fat foods, low or reduced sodium foods, yogurt, and legumes. The Dietary Guidelines for Americans, 2010 emphasizes consuming more of these types of foods (USDA & HHS, 2011). There was also some increase in local-grown fruits and vegetables, even though 24 schools did not offer them. A national survey showed that 98.8% of school districts offered fresh fruits and vegetables; 96.3% whole-grain items; 87.9% yogurt or yogurt drinks; 76.1% low-fat prepared or packaged foods; 38.3% low-sodium or reduced sodium prepared or packaged foods; 37.0% locally-grown fruits and vegetables; and 4.1% organic, hormone-free or pesticide-free foods (School Nutrition Association, 2009). Although there is a nationwide trend toward higher consumption of organic foods, 53 schools in this study did not offer organic foods.
The beverage item that received the highest rating for an increase in sales, by 14 school nutrition directors, was skim or low-fat milk. Sixty-one school districts indicated that they did not offer whole milk, and seven indicated that sales of whole milk were a lot less than prior to the award. Sales of flavored milk were reported as "a lot more" at eight schools. One reason that school nutrition programs may offer flavored milk is a perception that children may consume less milk when flavored options are not available. One study found a reduction in milk sales at all grade levels, even when enrollment increased, when only unflavored milk was offered (Patterson & Saidel, 2009).
Both bottled water and 100% fruit juice were reported as sold more frequently by 14 and 10 school nutrition directors respectively. Soy or rice milk, which might be an option for children who are lactose-intolerant or have milk allergies, was not offered at 53 of the schools, and 6 directors indicated that soy or rice milk was sold less frequently. Sixty-three school nutrition directors indicated that they did not offer juice drinks containing less than 50% juice. This compares to a national survey showing the percentage of schools offering various beverages was as follows: fat-free (skim) or low-fat milk, 99.0%; 100% juice, 97.6%; three or more milk flavors, 70.9%; juice drinks with less than 50% juice, 20.5%; and whole milk, 10.0% (School Nutrition Association, 2009).
Labor cost differed significantly by the education level of the school nutrition director. For school nutrition directors who held a graduate degree, labor cost increased the least ($0.01) for the current year compared to before receiving an award. There was also a difference in nutrition education offered according to the credential of the school nutrition director. Minutes of nutrition education offered increased the most at schools where school nutrition directors were registered dietitians (175 minutes) compared to schools where directors were not registered dietitians (48 minutes). Also, for schools using food-based menu planning, the average lunch participation rate was not different from prior to current year, while schools using nutrient standard menu planning had higher lunch participation of 70.01% in the current year compared to 64. 15% prior to the award.
A difference was found by award level for the change in sales of low-fat milk, whole milk, and soy or rice milk. The Bronze level reported selling low-fat milk more frequently than the other award levels compared to the period prior to an award. The Bronze level also reported selling whole, soy or rice milk less frequently than the other award levels compared to before receiving an award.
CONCLUSIONS AND APPLICATION
To the knowledge of the researcher, this was the first study to assess the perceived changes in the school environment by school nutrition directors as a result of following the HUSSC. Comparing the before and after changes in the average lunch participation rate, food cost, labor cost, nutrition education (minutes/week), physical education (minutes/week), and food/beverage sales revealed several differences. Overall, results show that HUSSC award-winning schools seem to be promoting a healthier school environment more than before receiving an award.
Also, the healthier menu items added to school menus appear to be well received by the students. Before receiving a HUSSC award, the mean average lunch participation rate was 76.6%, compared to 78.5% after receiving an award. According to HUSSC standards, the Average Daily Participation (ADP) for elementary and middle schools must be maintained at least 60% for Silver and 70% for Gold and Gold Award of Distinction. The ADP for high schools must be maintained at least 45% for Silver and at least 65% for Gold and Gold Award of Distinction. There is no minimum requirement for a school's ADP for Bronze (USDA, 2010).
The total number of students participating in the NSLP nationwide has been increasing over the past five years (USDA, 2011b). A national survey showed that 83.5% of 538 school districts reported increases in free/reduced participation for the 2009/2010 school year (School Nutrition Association, 2010). In general, participation by students eligible for free and reduced-price meals has increased continuously over the years. During 1983-2005, free and reduced-price meals served increased by an average annual rate of 1.9 % per year (Ralston et al., 2008).
Food costs increased for all of the award levels from prior to receiving an award to the current year. The increase in food and labor costs associated with the award-winning schools in this study may be due to the increased cost of purchasing fresh fruits, fresh vegetables and whole-grain products. Other factors that can affect food costs include supply and demand, weather, taxes, minimum wage, and energy prices (USDA, Economic Research Service, 2007). According to the United States Department of Labor, Bureau of Labor Statistics (2011), the Consumer Price Index rose 1.6% from 2009 to 2010.
Labor time for preparation of fresh fruits and vegetables may also increase food cost. Respondents indicated that one of their top challenges was the increased food cost associated with implementation of HUSSC nutrition standards. This supports the need for additional funding for healthier school meals. The Healthy, Hunger-Free Kids Act of 2010 provides an additional 6 cents per lunch for schools that are certified to be in compliance with final meal pattern regulations.
School nutrition directors may also meet this food cost challenge through creative use of resources available to them. Resources may include joining a purchasing cooperative, utilizing a computerized system to manage operational components, applying cost effective manufacturing principles to maximize efficiency and productivity, working with utility companies to find ways to decrease utility costs, and networking with other school nutrition directors to find out what has helped in their district.
School nutrition directors who want to create a healthier school environment and earn a HUSSC award may follow strategies similar to those used by participants in this study. Directors should plan ahead to gain support from students, school nutrition staff, other school staff, administrators, parents, and the community. A committee with representatives from all of these groups may be formed to discuss implementation of changes. Physical education and health education instructors who teach physical education and nutrition education in the school curriculum are key committee members.
New school menu planning requirements provide an increased incentive for suppliers to provide more fresh fruits and vegetables and whole-grain items to schools. The Dietary Guidelines for Americans, 2010 provides evidence-based nutrition information and advice for individuals age two and older (USDA & HHS, 2011). These guidelines include recommendations to consume more of certain foods such as fruits, vegetables, whole grains, legumes, and fat-free or lowfat milk. They also advise reducing the intake of sodium, and recommend drinking water instead of drinks high in sugar (USDA & HHS, 2011). The new menu planning requirements authorized in the Healthy, Hunger-Free Kids Act of 2010 incorporate these guidelines with the goal of increasing the amounts of fruits, vegetables, legumes, and whole grains served in schools.
With this focus on successfully incorporating whole-grain items, dark green and orange vegetables, and legumes into school menus, student panels may be organized to "taste test" new products and recipes. If recipes are prepared from "scratch," school nutrition employees may need additional training. Healthier menu items may be added over time instead of making changes all at once. School nutrition directors may also request that vendors and distributors provide more variety in whole-grain products that are appealing to children.
Since study participants were limited to school nutrition directors in the United States, results of this study cannot be generalized beyond the boundaries of the United States. Study participants were also limited to award winners for HUSSC and did not include school award winners from other programs, such as the Alliance for a Healthier Generation. Another limitation was that results represent perceptions of only one-half of school nutrition directors at HUSSC award-winning schools, and only a small number of directors from contract-managed school nutrition programs. Results of this study might have differed if more school nutrition directors had responded. Also, participants may not have had access to accurate records for the previous period prior to the award.
More research should be conducted to explore the benefits for school nutrition programs that follow a program supporting a healthier school environment. Additional research should also be conducted to discover differences in school nutrition programs based on the education level and credentials of the school nutrition director.
The Healthy, Hunger-Free Kids Act of 2010 proposed establishing a program of required education, training, and certification for all school nutrition directors and criteria for the selection of state directors. Raising the education and training standards for school nutrition directors is a potential strategy to improve the nutritional quality of school meals and promote a healthful school environment.
Additional studies of HUSSC award-winning schools are needed to confirm the findings of this study and to further explore other aspects of school nutrition programs. These could include competitive foods, fundraiser food items, and effective methods of offering nutrition education and physical education. More research should be conducted to determine if the health of children changed after their school followed the HUSSC program.
Results of this study may encourage and assist school nutrition directors who are considering following guidelines of the HealthierUS School Challenge program or making other changes for a healthier school environment. School nutrition programs need the continued support of students, parents, and the community in their efforts to promote positive eating and physical activity habits with children. School nutrition directors may serve as role models in their dedication and commitment to improving school environments through programs such as HUSSC. Students, school nutrition staff, other school staff, and the community will be more likely to give support with a strong and enthusiastic role model. The process to earn a HUSSC award is a lengthy one, but there is satisfaction in promoting a healthier school environment with the possibility of lifetime health benefits for children.
Researchers especially thank René Paulson, Ph.D., for her statistical advice. Paulson is Senior Statistical Consulting Director for Texas Woman's University.
Alliance for a Healthier Generation. (2012). About the Alliance. Retrieved from http://www.healthiergeneration.org/about.aspx
Centers for Disease Control and Prevention. (2008). Adolescent and school health: Nutrition facts. Retrieved from http://www.cdc.gov/HealthyYouth/nutrition/index.htm
Clark, M. A., & Fox, M. K. (2009). Nutritional quality of the diets of US public school children and the role of the school meal programs. Journal of the American DieteticAssociation, 109(2S), s44-s56. doi:10.1016/j.jada.2008.10.060
Condon, E. M., Crepinsek, M. K., & Fox, M. K. (2009). School meals: Types of foods offered to and consumed by children at lunch and breakfast. Journal of the American Dietetic Association, 109(2S), s67-s78. doi:10.1016/j.jada.2008.10.062
DeVellis, R.F. (1991). Scale development. Newbury Park, NJ: Sage Publications.
Healthy, Hunger-Free Kids Act of 2010, Pub. L. No. 111-296, 124 Stat. 3183 (2010). National Alliance for Nutrtition & Activity (2010). School meal reimbursement. Retrieved from http://www.cspinet.org/new/pdf/reimbursement_fact_sheet.pdf
Ogden, C., & Carroll, M. (2010). Prevalence of obesity among children and adolescents: United States, trends 1963-1965 through 2007-2008. Retrieved from http://www.cdc.gov/nchs/data/hestat/obesity_child_07_08/obesity_child_07_08.htm
Patterson, J., & Saidel, M. (2009). The removal of flavored milk in schools results in a reduction in total milk purchases in all grades, k-12. Journal of the American Dietetic Association, 109(1S), A97. doi:10.1016/j.jada.2009.06.330
Ralston, K., Newman, C., Clauson, A., Guthrie, J., & Buzby, J. (2008). The National School Lunch Program: Background, trends, and issues (Economic Research Report No. 61). Washington, DC. Retrieved from http://www.ers.usda.gov/Publications/ERR61/ERR61.pdf
School Nutrition Association. (2009). The state of school nutrition 2009. Retrieved from https://my.schoolnutrition.org/productcatalog/product.aspx?ID=5007
School Nutrition Association. (2010). Back to school trends report 2010. Retrieved from https://my.schoolnutrition.org/productcatalog/product.aspx?ID=5678
Stallings, V. A., Suitor, C. W, & Taylor, C. L. (Eds.). (2010). School meals: Building blocks for healthy children. Washington, DC: The National Academies Press.
Stallings, V. A., & Yaktine, A. L. (Eds.). (2007). Nutrition standards for foods in schools: Leading the way toward healthier youth. Washington, DC: The National Academies Press.
U.S. Department of Agriculture. (2011a). HealthierUS School Challenge. Retrieved from http://www.fns.usda.gov/tn/HealthierUS/index.html
U.S. Department of Agriculture. (2011b). National School Lunch Program: Participation and lunches served. Retrieved from http://www.fns.usda.gov/pd/slsummar.htm
U.S. Department of Agriculture, Economic Research Service. (2007). Food CPI and expenditures: How changes in input costs affect food prices. Retrieved from http://www.ers.usda.gov/Briefing/CPIFoodAndExpenditures/howchangesininputcostsaffectfoodprices.htm
U.S. Department of Agriculture, Food and Nutrition Service. (2010, April). HealthierUS School Challenge monetary incentives memo (Technical Assistance Memo Code No. 04-2010). Retrieved from http://www.fns.usda.gov/tn/HealthierUS/hussc_incentives.pdf
U.S. Department of Agriculture & U.S. Department of Health and Human Services. Dietary Guidelines for Americans, 2010 (2011). Retrieved from http://www.cnpp.usda.gov/DGAs2010-PolicyDocument.htm
U.S. Department of Labor, Bureau of Labor Statistics. (2011). Consumer price index databases. Retrieved from http://www.bls.gov/cpi/data.htm
Brown is an Instructor, The College of Merchandising, Hospitality, and Tourism, The University of North Texas and Post-Baccalaureate student, Department of Nutrition and Food Sciences, Texas Woman's University. Bednar is Professor, Department of Nutrition and Food Sciences, Texas Woman's University. DiMarco is Director, Institute for Women's Health, and Professor, Department of Nutrition and Food Sciences, Texas Woman's University. Connors is Associate Professor, The College of Merchandising, Hospitality, and Tourism, The University of North Texas.