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Scholarly Works (6 results)

  • Thesis
  • Peer Reviewed
UC Berkeley Electronic Theses and Dissertations (2020)

Despite the link between school-lunch participation and student health, only half of adolescents with the program in their schools participate on a given day. A multi-pronged school lunch promotion intervention was implemented in middle and high schools in an urban, low-income school district to improve school lunch participation and reduce food waste. This dissertation assesses the impact of the intervention on student and teacher perceptions of school lunch and explores how leadership shaped intervention implementation.

Using student survey data, paper 1 explores the theoretical pathways (perceptions of school-lunch quality and convenience) through which the intervention was expected to increase school-lunch participation and decrease plate waste. We observed modest changes in perceptions of school-lunch quality and no changes in perceptions of school-lunch convenience. Results suggest that additional efforts are needed to improve school-lunch participation and dietary intake.

Paper 2 utilizes teacher survey data to assess the impact of the intervention on teacher perceptions, modeling, and encouragement related to school lunch. Results indicate that the intervention had a modest effect on teacher-reported frequency of eating in the cafeteria with students and on encouraging students to participate in the school lunch program. There was no change, however, in teacher perceptions of or participation in the school lunch program. The paper concludes that improvements in teacher perceptions of school meals may not be needed in order for teachers to promote the school-lunch program to students.

Paper 3 focuses on the implementation of the intervention. Through qualitative interviews, the paper characterizes implementation leadership in the context of the intervention; and contextualizes emergent findings in the existing implementation science literature. Four major themes emerged reflecting the ways in which leaders are perceived to influence implementation effectiveness: (1) leader understanding of the technical and operational details of the intervention; (2) leader ability to develop and communicate intervention plans; (3) leader supervisory oversight over implementation staff and contractors; and (4) leader acknowledgment that ‘innovation’ requires time and stakeholder input —the absence of which can threaten cohesion and buy in. Implementation leadership functions in a school nutrition context appear similar to those identified in the implementation science literature. Results are the first to illustrate how these leadership dimensions are performed in a school nutrition setting.

    Cover page: Improving Student Nutrition through a School Dining Redesign: A Mixed-Methods Evaluation
    • Article
    • Peer Reviewed
    UC Berkeley Previously Published Works (2020)
    School lunch programs provide an opportunity to improve students' diets. We sought to determine the impact of a multifaceted intervention (cafeteria redesigns, increased points-of-sale and teacher education) on secondary students' perceptions of school-lunch quality and convenience and fruit and vegetable intake. Surveys (n = 12,827) from middle and high school students in 12 intervention and 11 control schools were analyzed. We investigated change in school-lunch perceptions and lunchtime and daily fruit and vegetable consumption from 2016 to 2018. Among 8th graders, perceptions that school lunch tastes good and that school lunch was enough to make students feel full increased 0.2 points (on a 5-point scale; p < 0.01) in intervention schools relative to control schools. Among 10th graders, lunchtime fruit and vegetable consumption increased 6% in intervention relative to control schools (p < 0.05 and p < 0.01 respectively). Daily fruit intake increased 0.1 cups/day in intervention relative to control schools among 9th graders (p < 0.01). This study provides important evidence on the limited effect of design approaches in the absence of meal changes. We observed only modest changes in school lunch perceptions and fruit and vegetable consumption that were not consistent across grades, suggesting that additional efforts are needed to improve school-lunch uptake.
      Cover page: The Impact of a Multi-Pronged Intervention on Students’ Perceptions of School Lunch Quality and Convenience and Self-Reported Fruit and Vegetable Consumption
      • Article
      • Peer Reviewed
      UC Berkeley Previously Published Works (2021)
      Traditional health education efforts rarely align with youth social justice values. The Bigger Picture (TBP), a spoken word arts campaign, leverages a social justice approach to activate youth around the social determinants of type 2 diabetes (T2D). This quasi-experimental study examines the impact of embedding TBP in urban, low-income high schools (3 intervention schools received TBP; 3 comparison schools received a non-health related spoken word program) with respect to (1) health-related mind-sets and expectations; (2) sense of belonging; and (3) civic engagement among youth. Adults and youth who participated in programming at all 6 schools were interviewed, and a content analysis of students' poems was performed. TBP was well-received by adults and students. While students in both TBP and comparison programs described multiple social determinants of T2D, intervention students more frequently articulated the connections between race/ethnicity and T2D as a social justice issue. Further, all comparison students explicitly mentioned individual dietary behavior as a T2D determinant while most, yet not all, intervention students did. Students in both programs reported a high sense of belonging at school and confidence in civic engagement. Content analysis of TBP students' poems revealed youth's detailed understanding of T2D determinants. Future studies might explore program scalability, and how the integration of civic engagement opportunities into TBP curriculum might impact students' capacity to create positive social change.
        Cover page: Seeing “The Bigger Picture:” Impact of an Arts-Focused Type 2 Diabetes Education Program in High Schools
        • Article
        • Peer Reviewed
        UC Berkeley Previously Published Works (2022)
        While school meals are often the healthiest option for students, lunch participation remains relatively low. Few approaches for increasing participation have leveraged teachers' potential social influence. We determined if a teacher intervention about the benefits of school lunch could improve teachers' perceptions of, and participation in, school lunch, and encouragement of students to eat school lunch. This repeated cross-sectional study included teacher/student survey administration in spring of 2016 and 2018 in 19 public secondary schools (9 intervention, 10 comparison) educating students of ages ≈ 11-18. Intervention teachers received monthly newsletters; lunch taste tests; and a promotional video and website. Mixed effects models with a random effect for school showed the proportion of teachers that reported eating with students increased in intervention schools relative to control schools (difference-in-change: 7.6%; 95% CI: 3.578%, 14.861%), as did student agreement that adults at their schools encouraged them to eat school lunch (difference-in-change: 0.15 on a 5-point scale; 95% CI: 0.061, 0.244). There were no between-group differences in teachers' perceptions of school meals or teachers' lunch participation. These findings suggest that teachers' perceptions of school meals do not necessarily need to improve to promote the school lunch program to students. However, to see meaningful change in teacher lunch participation, the taste of school meals likely needs improving.
          Cover page: Impact of a Teacher Intervention to Encourage Students to Eat School Lunch.
          • Article
          • Peer Reviewed
          UC Berkeley Previously Published Works (2019)

          Background

          In the United States, the National School Lunch Program (NSLP) is the healthiest lunch option for students, yet participation is suboptimal and fruit and vegetable waste remains high. Improving school meal convenience, engaging teachers in the school-lunch program, and enhancing the cafeteria environment are promising strategies to improve participation and dietary intake, yet little evidence is available on their impact.

          Methods/design

          The Multi-Pronged Intervention to Increase Secondary Student Participation in School Lunch (MPI) is a 3-year quasi-experimental study in a large urban school district in California. A total of 24 middle and high schools participated in the study: half received the intervention and half served as controls. The intervention consisted of additional school lunch points of sale (vending machines and mobile carts), a school meal outreach program for teachers, and cafeteria redesigns. School meal participation, student-reported fruit and vegetable consumption, and school lunch plate waste were assessed at baseline and in years 1 and 2 of the intervention. Change in meal participation and fruit and vegetable consumption were compared between intervention and control arms to determine the impact of the intervention on school meal participation and dietary intake.

          Discussion

          This study is positioned to provide evidence on the feasibility and efficacy of a multi-level intervention to increase school meal participation and consumption of fruits and vegetables.
            Cover page: Multi-pronged intervention to increase secondary student participation in school lunch: Design and rationale.
            • Article
            • Peer Reviewed
            UC Berkeley Previously Published Works (2022)

            Objective

            This paper identifies implementation leadership characteristics in the school nutrition setting and places findings in the context of implementation leadership literature.

            Methods

            Fourteen interviews were conducted with school district leadership/staff in an urban school district. Modified grounded theory was employed.

            Results

            Four themes emerged: (1) understanding of technical/operational intervention details; (2) ability to proactively develop and communicate plans; (3) supervisory oversight; and (4) intervention framing. Themes were consistent with 4 of the 5 dimensions comprising the Implementation Leadership Scale: knowledgeable, proactive, perseverant, and distributed leadership. The supportive domain was not a major finding. An additional domain, how leaders message the intervention to staff, was identified.

            Conclusions and implications

            Implementation leadership in school nutrition appears similar, but not identical, to leader behaviors present in the Implementation Leadership Scale. School nutrition leaders might consider involving staff early in implementation planning, incorporating technical expertise, and clearly communicating the intervention purpose to support successful implementation. Future research might explore the interplay between leadership and implementation outcomes.
              Cover page: Implementation Leadership in School Nutrition: A Qualitative Study
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