research topic about school canteen

• Research article
• Open access
• Published: 16 October 2018

Consumption habits of school canteen and non-canteen users among Norwegian young adolescents: a mixed method analysis

• Arthur Chortatos   ORCID: orcid.org/0000-0002-1052-329X 1 ,
• Laura Terragni 1 ,
• Sigrun Henjum 1 ,
• Marianne Gjertsen 1 ,
• Liv Elin Torheim 1 &
• Mekdes K Gebremariam 2 , 3  

BMC Pediatrics volume  18 , Article number:  328 ( 2018 ) Cite this article

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Food/drinks available to adolescents in schools can influence their dietary behaviours, which once established in adolescence, tend to remain over time. Food outlets’ influence near schools, known to provide access to unhealthy food/drinks, may also have lasting effects on consumption behaviours. This study aimed to gain a better understanding of the consumption habits of adolescents in the school arena by comparing different personal characteristics and purchasing behaviours of infrequent and regular school canteen users to those never or seldom using the canteen.

A convergent mixed methods design collected qualitative and quantitative data in parallel. A cross-sectional quantitative study including 742 adolescents was conducted, with data collected at schools via an online questionnaire. Focus group interviews with students and interviews with school administrators formed the qualitative data content. Quantitative data were analysed using descriptive statistics and logistic regression; thematic content analysis was used to analyse qualitative data.

Sixty-seven percent of adolescents reported never/rarely using the school canteen (NEV), whereas 13% used it ≥2 times per week (OFT). When the two groups were compared, we found a significantly higher proportion of the NEV group were female, having parents with a high education, and with a high self-efficacy, whilst a significantly higher proportion of the OFT group consumed salty snacks, baked sweets, and soft-drinks ≥3 times per week, and breakfast at home < 5 days in the school week. The OFT group had significantly higher odds of purchasing food/drink from shops near school during school breaks and before/after school compared to the NEV group (adjusted odds ratio (aOR) = 1.80, 95% CI 1.07–3.01, and aOR = 3.61, 95% CI 2.17–6.01, respectively). The interviews revealed most students ate a home packed lunch, with the remainder purchasing either at the school canteen or at local shops.

Conclusions

Students using the canteen often are frequently purchasing snacks and sugar-soft drinks from shops near school, most likely owing to availability of pocket money and an emerging independence. School authorities must focus upon satisfying canteen users by providing desirable, healthy, and affordable items in order to compete with the appeal of local shops.

Peer Review reports

The school environment is an arena where many dietary norms and habits are established which potentially affect the individual throughout their future lives [ 1 ]. Owing to the considerable amount of time adolescents spend at school during the average weekday, it has been estimated that approximately one third of their food and drink is consumed in the school environment [ 2 , 3 ].

Environments which encourage a high energy intake and sedentary behaviour amongst adolescents are termed obesogenic environments, and such environments are considered to be one of the main elements behind the rapid increase in overweight and obesity among children and adolescents [ 4 ].

In this regard, the local food environment of schools, including arenas such as supermarkets and convenience stores close to the schools, is an environmental influence potentially affecting the quality of the food intake of attending adolescents [ 5 ]. Providing healthy food and drinks to adolescents in schools via canteens or vending machines plays an important role in modelling a healthy diet, particularly for those who may not have access to healthy food outside school hours, thereby making school nutrition policies a powerful tool for improving students’ nutritional status and academic achievement [ 6 ]. Yet in the school environment, foods consumed are not always obtained from on-campus sources. Research upon supermarkets and convenience stores located in the vicinity of schools has reported that these venues provide an increased accessibility to unhealthy foods and drink for school-going adolescents [ 7 ].

The Øvre Romerike region, located in the eastern part of Norway, has a total area of 2,055,550 km 2 , and composed of 6 municipalities housing approximately 100,000 people [ 8 ]. The 2016 average net income for all households in the region was 456,667 NOK, compared to the national average of 498,000 NOK for the same period [ 9 ]. In our recent investigation upon adolescents in Øvre Romerike, we reported that 33% of participants purchased food or drink in their school canteen at least once a week [ 10 ]. In addition, 27% and 34% of participants reported purchasing food and drinks from shops around schools one or more times a week, either during school breaks or on their way to or from school, respectively [ 10 ].

Investigations on adolescent behaviour in Norway and elsewhere have reported similar results, whereby approximately 30% of school-going adolescents visit local food stores for nourishment, whilst the majority are consuming their lunches at school [ 11 , 12 ].

In Norway, the average school day includes a lunch period in the middle of the day [ 13 ], and most students travel to school with a home packed lunch, usually consisting of bread slices with various toppings [ 14 , 15 ]. School canteens are often run by catering staff, with students in need of more practical education sometimes included in food preparation and selling. It is not uncommon for the canteen to be managed on a daily or occasional basis by students together with a teacher as a part of their education. School canteens most commonly offer baguettes, waffles, milk (regular or chocolate), juice, cakes and, perhaps, fruit [ 16 , 17 ]. The Norwegian Directorate of Health regularly publishes guidelines concerning school meals and eating environments, with the most recent published in 2015 [ 18 ]. The latest guidelines offer suggestions regarding topics such as length of meal times, hygiene, fresh water accessibility, the absence of sugar-rich foods and drinks, and the reduction of saturated fats on offer. The guidelines are published as a tool to assist school administration in their management of school canteens.

Eating behaviour amongst adolescents is a complex theme often involving an interplay of multiple influences and factors such as peer influence [ 19 ] and a desire to socialise whilst eating [ 20 ], a combination which often leans toward unhealthy eating practices. Furthermore, it is not uncommon for young Norwegian teens to receive pocket money [ 21 ], and this emerging autonomy aided by pocket money increases the prospect for a disruption of dietary behaviour established in the home [ 22 ].

As the school food environment has such a significant impact on food choices [ 23 , 24 ], a better understanding of adolescent’s consumption behaviour demands further attention. In particular, understanding student’s shift away from home packed lunches and canteen foods towards the appeal of off-campus shop food is necessary for implementing the successful promotion of healthier lunch alternatives at school.

The aim of the present study was to gain a better understanding of the consumption habits of adolescents in the Norwegian school lunch arena. Unlike previous ESSENS studies, here we use quantitative data combined with qualitative interviews among adolescents and school administration, in order to explore the purchasing behaviour and lifestyle demographics of the sample grouped as frequent and infrequent school canteen users compared to those never or rarely using the canteen.

Design and sample

The participants in this study were students and staff from eleven secondary schools participating in the Environmental determinantS of dietary behaviorS among adolescENtS (ESSENS) cross-sectional study [ 10 , 25 ]. Recruitment of students and staff was initiated by our making contact with principals of the twelve secondary schools in the Øvre Romerike district, after first having received permission from district school leaders. The school principals were each sent a letter detailing key elements of the proposed intervention, as well as information regarding the ESSENS study, together with a permission form requesting their school’s participation. Of the twelve secondary schools invited to participate in the study, eleven accepted the invitation.

In this mixed method approach, our sample were grouped as being part of either a quantitative or qualitative data source.

Recruitment of sample

Quantitative recruitment.

In October 2015 we recruited 8th grade adolescents for participation in a questionnaire survey. An informative letter was sent home with all 1163 adolescents in the 8th grade (average age of 12–13 years) from the 11 participating schools, containing a consent form for signing and with additional questions relating to parental education levels. A total of 781 (67%) received parental consent for participation. As the range of ages of the sample represents the lower end of the adolescent scale (10–19 years), the use of the term ‘adolescent’ here implies ‘young adolescent’. A total of 742 adolescents (64% of those invited and 95% of those with parental consent) participated in the survey. Quantitative data collection took place between October and December 2015.

Qualitative recruitment

Recruitment of adolescents to participate in the qualitative part of the study was also facilitated by approaching principals of district schools as described above, and was completed between October 2015 and January 2016. Six of the 11 participating schools were selected for qualitative data collection based upon criteria such as location (being in one of the six municipalities of Øvre Romerike), and size (based upon number of students attending). The aim was to include schools with a varied profile, with proximity to city centers, shops, and collective transport as determining factors. Thereafter a selection process for participation in the focus groups was conducted, whereby two students per class were sought after, representing both sexes. Further inclusion criteria stipulated that the students be in the 9th grade, had attended Food and Health classes, and currently lived in the Øvre Romerike area with either one or both parents.

Data collection

Quantitative data.

A web-based questionnaire was used to collect data from the adolescents, using the LimeSurvey data collection tool. The questionnaires were answered at school, taking approximately 30–45 min to complete, and queried respondents about their nutritional intake, parental rules regarding food and drink consumption, students’ school canteen and surrounding shop use, physical activity, and sedentary behaviour habits. Research group members were present during data collection to answer questions and make sure the adolescents responded independently from each other. The questionnaire relating to food behaviours completed by the sample is available online (see Additional file 1 : Appendix 1 ESSENS questionnaire relating to food behaviours).

A pilot test of the survey was conducted parallel with this process in a neighboring municipality with similar age students from the 8th grade ( n  = 23). The students spent approximately 30–40 min to complete the survey, and then provided feedback regarding comprehension. The questionnaire was subsequently shortened and some questions rephrased for clarity. The results of the pilot test were not included in the final results.

Qualitative data

Focus group interviews were conducted over a period of 10 weeks, from November 2015 to January 2016. Focus group settings were favoured as they provide a more relaxed setting for data collection, facilitating the flow of a natural conversation amongst peers, especially when adult researchers interact with young subjects [ 26 ].

Six focus group interviews including a total of 55 students (29 girls, 26 boys) from the 9th grade with an average age of 13–14 years were conducted. Interviews had a duration of approximately 60 min. In addition, interview sessions with headmasters and teachers for the 9th grade students from the participating schools were also conducted. Interviews with 6 teachers (4 women and 2 men) and 6 headmasters (3 women and 3 men) were conducted from October 2015 to January 2016. The interviews with principals and teachers were each conducted separately.

Qualitative data collection took place at the selected schools using an audio recorder, with a semi-structured interview guide used for the interviews, partially inspired by a previous study conducted amongst 11–13 year old Norwegian adolescents [ 27 ]. The main themes explored by the focus group sessions were students’ eating habits, their definition of healthy and unhealthy food, attitudes towards and their impact upon diet and physical activity, as well as the student’s assessment of opportunities and barriers attached to health-promoting behaviour. School administration interviews probed food availability and meals served at the school, as well as physical activity options available for students at the schools. The interview guides used for the focus groups and the school administration are available online (see Additional file 2 : Appendix 2 Interview guide for focus group interviews, and Additional file 3 : Appendix 3 Interview guide for headmasters and teachers).

Interviews were transcribed verbatim, with names of the participants and of the schools anonymised. Interviews were analysed using a thematic analysis approach [ 28 ]. Codes were developed after an initial reading of all the transcripts and were based on the main interview questions, prior research, and emergent concepts from the current data. The initial codes were discussed among researchers and a codebook was developed. The codes were further refined during coding of subsequent transcripts. Codes were then successively grouped into general themes. The data analysis was supported by the use of NVivo software (version 10.0; QSR International, Cambridge, Mass).

Pilot testing of the intended focus group question guide was performed in October 2015 in a school belonging to a neighbouring district. After written consent was obtained from the principal of the school, 6 students from the 9th grade were selected by a 9th grade teacher from the school. Three girls and 3 boys were included in the focus group pilot test. A moderator conducted the focus group following an interview guide in order to test comprehension and flow of the planned themes. The pilot test proved effective and consequently no changes were made to the interview guide. Data from the pilot testing was not included in the results of the study.

Recruitment of school staff for participation in in-depth interviews was also facilitated by the agreement with administrative school leaders as described above. A written invitation was sent to principals and teachers of the 9th grade classes from the same 6 schools participating in focus group interviews. Those agreeing were later contacted by phone to arrange a place and time for the interview.

Pilot testing of school staff interviews was performed in October 2015 in a school belonging to a neighbouring district. Two interviews were conducted with one headmaster and one teacher separately in order to assess the comprehension and flow of the various themes probed, as well as the time used for the interview. Data from the pilot testing was not included in the results of the study.

The following measures obtained from the questionnaire were used in the quantitative analyses of the present study.

Sociodemographic measures

Two questions assessing parental education (guardian 1 and guardian 2) were included on the parental informed consent form for the adolescent. Parental education was categorised as low (12 years or less of education, which corresponded to secondary education or lower) or high (13 years or more of education, which corresponded to university or college attendance). The parent with longest education, or else the one available, was used in analysis. Participants were divided into either ethnic Norwegian or ethnic minority, with minorities defined as those having both parents born in a country other than Norway [ 29 ].

• Dietary behaviours

Frequency of carbonated sugar-sweetened soft-drink intake (hereafter referred to as soft-drinks) during weekdays was assessed using a frequency question with categories ranging from never/seldom to every weekday. Weekday frequency was categorised as less than three times per week and three or more times per week.

The questions assessing the intake of soft-drinks have been validated among 9- and 13-year-old Norwegians using a 4-day pre-coded food diary as the reference method, and moderate Spearman’s correlation coefficients were obtained [ 30 ].

Consumption of fruits and vegetables (raw and cooked) were assessed using frequency questions with eight response categories ranging from never/seldom to three times per day or more. These were further categorised as less than five times per week and five or more times per week. The questions assessing intake of fruits and vegetables have been validated among 11-year-olds with a 7-day food record as the reference method and were found to have a satisfactory ability to rank subjects according to their intake of fruits and vegetables [ 31 ].

The consumption of snacks [sweet snacks (chocolate/sweets), salty snacks (e.g. potato chips), and baked sweets (sweet biscuits/muffins and similar)] was assessed using three questions with seven response categories ranging from never/seldom to two times per day or more. These were further categorised as less than three times per week and three or more times per week. Acceptable to moderate test-retest reliability have been obtained for these measures of dietary behaviours in a previous Norwegian study conducted among 11-year-olds [ 27 ].

Self-efficacy related to the consumption of healthy foods was assessed using a scale with six items [e.g. Whenever I have a choice of the food I eat. .., I find it difficult to choose low-fat foods (e.g. fruit or skimmed milk rather than ‘full cream milk’)]. Responses were further categorised as those with ‘high’ self-efficacy (score of 3.5 or higher, from a scale of 1–5) or ‘low’ self-efficacy (under 3.5, from a scale of 1–5). The scale has been found to have adequate reliability and factorial validity among 13-year-olds [ 32 ].

Adolescents’ breakfast consumption was assessed using one question asking the adolescents on how many schooldays per week they normally ate breakfast. The answers were categorised as those eating breakfast 5 times per week or less than 5 times per week. This question has shown evidence of moderate test-retest reliability (percentage agreement of 83 and 81% respectively for weekday and weekend measures) and moderate construct validity (percentage agreement of 80 and 87% respectively for weekday and weekend measures) among 10–12 year old European children [ 27 ].

Food/drink purchases in school environment

The adolescents were asked how often they purchased foods or drinks from school canteens and on their way to and from school (answer categories ranging from ‘never’ to ‘every day’). The frequency of purchase of food/drinks at the school canteen were then re-categorised into ‘never/rarely’, ‘once per week’, or ‘two or more times per week’. The frequency of purchase of food/drinks at off-campus food stores were re-categorised into ‘never/rarely’, or ‘one or more times per week’. They were also asked about the presence of food sales outlets (e.g. supermarket, kiosk, or gas station) in a walking distance from their school (with answer categories ‘none’, ‘yes, one’, ‘yes, two’, and ‘yes, more than two’), with results categorised as ‘less than 3’ or ‘3 or more’.

Further details regarding data collection and methodology in the ESSENS study have been described previously [ 10 ]. Ethical clearance for the study was obtained from the Norwegian Social Science Data Service (NSD 2015/44365). Written informed consent was obtained from all parents of participating students.

Statistical analyses

The study sample was divided into three groups, those who reported ‘never or rarely’ using the school canteen (NEV), those using the canteen once per week (SEL), and those reporting use of the school canteen ‘two or more times during the week’ (OFT). Results are presented as frequencies (%), with chi-square tests performed to examine differences in sociodemographic, behavioural, and dietary characteristics between the three groups. A further logistic regression analysis was performed to assess the adjusted associations between canteen use and dietary habits (salty snacks, baked sweets, soft-drinks, and home breakfast frequency). Adjustment was made for significant sociodemographic and behavioural characteristics (gender, parental education, self-efficacy) and shop use (during school break and before/after school). Logistic regression was also used to explore the adjusted association between visiting shops during school breaks or before/after school (‘never/rarely’, ‘one or more times per week’), and use of canteen (NEV, SEL, OFT). Results are presented as crude odds ratios (cOR) and adjusted odds ratios (aOR) with 95% confidence intervals (95% CIs). Cases with missing data were excluded from relevant analyses. Because schools were the unit of measurement in this study, we checked for clustering effect through the linear mixed model procedure. Only 3% of the unexplained variance in the dietary behaviours investigated was at the school level, hence adjustment for clustering effect was not done.

A significance level of 0.05 was used. All analyses were performed using SPSS 24.0 (IBM Corp, Armonk, NY, USA).

Sample demographics

The mean age of the survey sample was 13.6 years ±0.3 standard deviation, 53% of participants were females, and 60% had parents with a high level of education (≥13y, Table  1 ). The proportion of adolescents who never or rarely used the school canteen was 67.4%. When comparing demographics and behavioural characteristics for the sample grouped as those using the school canteen never/rarely (NEV), those using the canteen once a week (SEL, 19.7%), and those using the canteen two or more times a week (OFT, 12.9%), we found a significantly higher proportion of the NEV group were female, having parents with a high education, and with a high self-efficacy.

Canteen use and dietary habits

When analysing the dietary habits for the sample grouped by frequency of canteen use, a significantly higher proportion of the OFT group reported consuming salty snacks, baked sweets, and soft-drinks ≥3 times per school week, and a significantly higher proportion of the NEV group reported eating breakfast 5 days in the school week compared to the SEL and OFT groups (Table  2 ). A multiple logistic regression was conducted to assess whether these significant associations between canteen use and dietary behaviours persisted after adjustment for gender, parental education, self-efficacy, and use of shops (both during and before/after school). The difference between NEV, SEL, and OFT adolescents regarding baked sweets thereafter became non-significant. However, the difference between NEV and OFT adolescents regarding salty snacks, soft-drinks, and breakfast consumption remained significant, indicating that adolescents using the canteen ≥2 times per week had increased odds for consuming salty snacks and soft-drinks (aOR 2.05, 95% CI 1.07–3.94, p  < 0.03, and aOR 2.32, 95% CI 1.16–4.65, p  < 0.02, respectively, data not shown). Additionally, the OFT group had reduced odds of consuming breakfast at home daily (aOR 0.48, 95% CI 0.28–0.80, p  = 0.005, data not shown). No significant differences between the three groups were found for the other food items explored.

School environment

When comparing the frequency of food purchases at shops during school breaks or on the way to/from school for the NEV, SEL, and OFT groups, we found that a significantly higher proportion of OFT adolescents reported purchasing food/drink from a shop near school either during school breaks or else before or after school, one or more times during the week (Table  3 ). Logistic regression analyses revealed that the OFT group had significantly higher odds of purchasing food/drink from a shop near school, either during school breaks or else before or after school, than the NEV group (aOR = 1.80, 95% CI 1.07–3.01, and aOR = 3.61, 95% CI 2.17–6.01, respectively, Table  4 ).

Results of focus group and interview analyses

The data from the focus group interviews indicated that students were aware of issues related to food and health. A number of the relevant themes which emerged are outlined below.

Student’s lunch habits

The majority of students confirmed that most foods consumed at school were brought from home. Some students, however, stated that the other option was to purchase foods from either the canteen or local shops:

Interviewer: ….do you bring a packed lunch from home regularly? Boy2: We usually tend to buy something from the canteen. Girl5: It’s kind of both in a way. Girl5: Yes. Ehm, it is usually both, there are many who have food with them also. Also you are free to buy something. Boy1: Yes, that’s common…there are quite a few who tend to buy food at the canteen and, yes, the shop.

One teacher suggested it was the presence of pocket money that determined the source of a student’s lunch:

Teacher1: It is an incredibly large amount of money they have to buy canteen food with, especially in the 8th grade…so that means they do not have so much food with them from home, but buy it instead.

Types of foods purchased at school canteen, students’ impression of canteen

In response to the types of foods available for purchase at the canteen, student’s representing different schools reported similar food items. Overall, the students at all schools expressed a level of dissatisfaction with the healthiness of the food/drinks offered by the canteen:

Interviewer: What is the most popular items people buy [at the canteen]? Boy2: Mainly toasted sandwiches Boy2: And wraps Boy3: Eh, maybe a baguette with ham and cheese Boy1: Whole-wheat bread with cheese and ham. Capsicum maybe. Boy2: There are many different drinks one can buy, as well as yoghurt of various kinds. There is also a main thing available too, such as a baguette, pizza, or something similar. Boy2: There are many who buy toasted sandwiches and wraps. Interviewer: What can be done better in order to make other students or yourselves eat healthier from the school’s part?. Girl3: They can begin to sell more fruit and such at the canteen. Boy4: We could have healthier drink offers [from the canteen]…such as smoothies… Girl2:…and switch chocolate milk with plain milk. Boy3: [The canteen] should have healthier alternatives, not just unhealthy white-flour baguettes …with a little cheese, bit of ham and a little butter…..

Peer influence, perceived peer self-efficacy regarding healthy eating

There were questions designed to assess if students perceived other students as being more concerned with healthy eating. Those bringing food from home or considered ‘sporty’ were often perceived as eating healthy food, with the overall impression that those perceived as eating healthy tended to not purchase food at the canteen:

Interviewer: …do you think there are some in your class then, that are more concerned with eating healthy than others? Boy3: Yes, there are. Interviewer: Who are they then? Boy3: Those who ski. Interviewer: How do you know that? Or, what is it that makes them stand out? Boy2: They….don’t buy food at the canteen. Boy4: They eat healthy food Boy1: Those that eat relatively healthy food as a rule usually prepare food themselves.

A number of school staff commented upon the influence some students’ lunch habits had upon others:

Teacher6: …if there is one who begins to drop home brought food because it is boring, it become contagious over other’s behaviour I think, and then it isn’t cool to eat home packed lunches. They are at a very vulnerable age, and very affected by such things I believe. Teacher2: …(food choices are affected by) what food they have at home, how much money they have in their pocket, and what their friends eat. I think it is these three things. And I think some….won’t bring out their home packed lunch because it is not cool enough.

Prices, timing, and permission for visiting shops

In many instances, it was reported that although leaving school grounds was not allowed during school hours in individual school policy, many students frequently did so in order to visit local food shops during breaks. There were reports of shop visits outside school hours as well (before/after school). Some students also discussed the cheaper prices at the shops, as compared to the school canteen, as being an incentive to purchase from shops.

Girl2: We have some in the class that shoot off to the shops to buy some sort of fast food every day. Interviewer: So you are allowed to leave the school in your free time to buy food? Girl2: No, but after school or right before. Girl4:......They go over [to the shops] when the lunch break starts, then you see them come back when everyone has to go outside then. Boy4: Because then there are no teachers out......and then it is easy to take a trip to the shops and... Boy1: Buy cheaper things. Because they sell at a high price here.

The paradox between students visiting shops in school hours, although not allowed, was also pointed out by school staff:

Teacher1: …no, it is not allowed (to go to the shops), but there are some that do it anyway. Headmaster6: ...of course the schools must represent counterculture in some way….so our students go to the shops…and then they make use of the offers that are there…as long as they have money from home. Teacher2: …and they prefer to go (to the shops) in a group at the same time, because it is social and fun.

Types of foods purchased in shops

When questioned about the types of items purchased at the shops, the majority were in consensus that unhealthy snacks such as sweets, baked goods, and soft-drinks were mainly purchased. No participant mentioned the purchase of healthy food from the shops.

Interviewer: What do people mostly buy there then? You mentioned sweet buns..[Looks at Girl1] Boy2: Both sweet buns and doughnuts. Girl1: There are many that buy candy after school and such. Boy4: There are always some who always have money and always buy candy and such. Just like one I know who bought 1 kg of gingerbread dough here after school one day and sat down and ate it. Girl2: Mostly those….soft drinks Girl1: Soft drinks Boy1: Candy and ice-tea. Boy2: People don’t buy food at the shop…most buy themselves candy.

Adherence of school administration to guidelines for school meals

When school staff were asked about the implementation of the latest guidelines from the Norwegian Directorate of Health, most pointed out that they already offered the suggested timespan suggested for lunch, whilst others had yet to read the document.

Teacher1: We have heard there is something new that has come, but we have not spent a lot of time discussing it amongst ourselves. Teacher2: No, no relationship with them (new guidelines). I'm not sure. We do not sell sodas and juice in the cafeteria, but they [students] have it from home. Teacher3: Hehe, I don’t think I’ve seen them, no…(laughs). Headmaster1: So, what we do is to make sure that they have a good place to eat and that they have peace….we offer supervision and they do have a long enough lunch break, is it 20 minutes they should have? Headmaster2: I just have to be honest, I do not think we have come far with these.

We found the NEV group were mainly female, having a high self-efficacy regarding the consumption of healthy foods, and with parents having an education over 12 years. By contrast, the OFT adolescents had a significantly higher proportion of males consuming salty snacks, baked sweets, and soft-drinks 3 or more times a week, as well as consuming breakfast less than 5 times a week when compared to the other groups, also when controlling for gender, parental education, self-efficacy, and use of shops (both during and before/after school).

When comparing the frequency of purchasing food and drink from local shops for these groups, we found the OFT group had a significantly higher proportion purchasing food/drink from shops near the school, both during the school break as well as before or after school, one or more times per week. Logistic regression analyses revealed the OFT group had nearly twice the odds for visiting shops during the school break, and significantly higher odds for visiting shops before/after school than the NEV group of adolescents.

Of the adolescents featured in this sample, females were revealed as more likely to never or rarely use the school canteen, a finding supported by previous research amongst adolescents [ 33 , 34 ]. That females have been previously reported as having a greater self-efficacy related to healthy eating [ 35 ] may help to explain this result, although another study involving over 1200 students of comparable age found no significant difference in self-efficacy regarding gender [ 36 ]. As 67% of the sample stated that they never or rarely use the school canteen, this then begs the question of what form of lunch this group are consuming. Many of the interviews have mentioned the consumption of home packed lunches, and studies of school lunch habits amongst Norwegian adolescents have previously detailed the importance and predominance of the home packed lunch in Norwegian culture [ 37 , 38 ], with over 60% of young Norwegians reporting a packed lunch for consumption at school, a proportion similar to the results we present here. This figure is also consistent with global reports examining school lunch eating practises [ 39 ].

Our results profile the OFT group as being mostly male, skipping breakfast, with a high frequency of shop visits during and on the way to/from school, and with a higher frequency of snacks, baked sweets, and soft-drinks, elements which have featured in previous studies regarding adolescent consumer behaviour [ 12 , 40 , 41 , 42 , 43 ]. A clear association between adolescents skipping breakfast and subsequent purchases of foods from shops and fast food outlets, usually on the way to or from school [ 42 , 44 , 45 , 46 ], in addition to other health-compromising behaviours [ 47 ] have been previously reported.

Although direct questions regarding pocket money were absent from our study, its role in the behaviour of this sample is evident from statements mentioning money use in the school administration interviews as well as alluded to in focus group interviews. Additionally, it stands to reason that adolescents using the school canteen often (i.e. the OFT group) would be equipped with money in order to make such purchases, as financial purchases are the norm in Norwegian secondary schools [ 48 ]. Research directed upon adolescents and pocket money has presented a number of findings that support our results regarding the OFT group, whereby access to spending money was associated with an increase of nutritionally poor food choices by adolescents, such as the increased consumption of fast-foods, soft-drinks, and unhealthy snacks off campus [ 40 , 41 , 42 , 43 , 49 , 50 , 51 , 52 , 53 ]. These results may also be indicative of a gender imbalance in regards to pocket money provisions, where some studies report upon more males than females receiving pocket money [ 54 , 55 ].

The mean age of this sample previously has been described as a stage in life of an emerging autonomy for young individuals, an autonomy which is exercised in terms of disposable income use and consumption of foods away from home [ 42 , 56 , 57 ]. This period of emerging autonomy may also manifest unhealthy eating behaviours as a strategy to forge identity amongst adolescents [ 58 ]. Frequent mention by students and staff in this study of themes relating to peer influence and defiance of school rules support the link between rebelliousness and unhealthy eating. Moreover, it has been reported previously that foods independently purchased by adolescents are often unhealthy, forbidden or frowned upon by parents, and express a defiant period of appearing ‘cool’ among peers, especially amongst males [ 37 , 59 , 60 , 61 ], all of which support our findings here, particularly regarding gender, self-efficacy, and peer influence.

Value for money and dissatisfaction with the school canteen were frequently mentioned in the focus group interviews, and are elements that may be affecting choices made by the groups in this study. Statements concerning student dissatisfaction with canteen prices and/or the limited healthy options available have also appeared in previous research [ 35 , 37 , 38 , 42 ]. That many of the school administrators interviewed seemed barely aware of the guidelines published by the Norwegian Directorate of Health is an alarming result, and likely adds some degree of weight upon student discontent with the school canteen. Although nearly all reports from the focus groups indicate the shops were used for unhealthy purchases, the possibility that shop purchases are a result of some adolescent’s need for healthier lunch alternatives cannot be dismissed completely.

The focus group interviews together with the quantitative data support the notion of healthy eaters avoiding the school canteen, opting instead for a home packed lunch. This view is further supported by previous reports that home prepared lunches help contribute to a healthy dietary pattern [ 39 , 62 , 63 ]. Furthermore, it has been reported that students consuming a lunch from home have significantly lower odds of consuming off-campus food during the school week [ 41 ], which further concurs with the results presented here.

By contrast, those often using the canteen – which, by all reports, could improve the healthiness of items offered – are using the off-campus shops often, purchasing mainly unhealthy snacks and drinks.

The strengths of the study include a large sample size with a high response rate at the school level, and moderate response rate at the parental level. Using a mixed method approach also provides a more comprehensive assessment of adolescent school lunch behaviours, allowing a fuller understanding of this and other adolescent food-behaviour settings by contrasting the adolescent’s own experiences with quantitative results. That the quantitative material, based on cross-sectional data, precludes any opportunity for causal inference to be made may be one of the prime weaknesses of this study. Quantitative data regarding adherence to national policy regarding school canteens, pocket money and what items it was spent upon, as well as data regarding the content and frequency of home packed lunch consumption, were also lacking from the study, where inclusion of these elements in the various analyses would have considerably strengthened the quality of results. Furthermore, reliance upon self-reported data may have led to issues regarding validity and reliability, particularly with a sample of young adolescents.

We found the majority of adolescents (67.4%) in this sample rarely or never used the school canteen. Those adolescents using the school canteen two or more times a week were also the group most likely to be purchasing food/drink from a shop near the school, either during school breaks or before/after school. This group also tended to skip breakfast and consume snacks and soft-drinks more frequently compared to the adolescents who rarely or never used the school canteen. These findings highlight a lack of satisfaction of items available for consumption at the school canteen, with adolescents intending to use the school canteen preferring instead the shops for foods that are cheaper and more desirable. Future strategies aimed at improving school food environments need to address the elements of value for money and appealing healthy food availability in the school canteen, as well as elements such as peer perception and self-identity attained from adolescent food choices, especially in contrast to the competitiveness of foods offered by nearby food outlets.

Abbreviations

Adjusted odds ratio

Confidence interval

Crude odds ratio

Environmental determinantS of dietary behaviorS among adolescENtS study

Adolescents never or rarely using the school canteen

Norwegian kroner

Adolescents using the school canteen two or more times a week

Adolescents using the school canteen once a week

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Acknowledgements

The ESSENS study is a collaborative project between OsloMet – Oslo Metropolitan University and the public health project Folkehelseforum Øvre Romerike (FØR). We would like to thank all the participants who took part in this study.

The study was supported by internal funds from OsloMet – Oslo Metropolitan University.

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AC conducted the data analyses and wrote the first draft of this manuscript. MKG2 designed the study, led the project planning and implementation of the intervention, and participated in data collection and analyses. LT1, SH, MG1, LET2 and MKG2 substantially contributed to the conception, design, and implementation of the study, as well as providing content to the final manuscript. MG1 recruited participants, conducted and transcribed focus group interviews, and contributed to data analyses. All authors have critically read and given final approval of the final version of the manuscript.

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Appendix 1. ESSENS questionnaire relating to food behaviours ESSENS Study. (DOCX 33 kb)

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Appendix 2. Interview guide for focus group interviews. (DOCX 13 kb)

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Appendix 3. Interview guide for headmasters and teachers. (DOCX 14 kb)

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Chortatos, A., Terragni, L., Henjum, S. et al. Consumption habits of school canteen and non-canteen users among Norwegian young adolescents: a mixed method analysis. BMC Pediatr 18 , 328 (2018). https://doi.org/10.1186/s12887-018-1299-0

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STUDY PROTOCOL article

School-based intervention to improve healthy eating practices among malaysian adolescents: a feasibility study protocol.

• 1 Department of Social and Preventive Medicine, Faculty of Medicine, Centre of Population Health, University of Malaya, Kuala Lumpur, Malaysia
• 2 South East Asia Community Observatory (SEACO), Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Subang Jaya, Malaysia
• 3 Department of Paediatrics, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
• 4 Department of Sports Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
• 5 Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Bristol, United Kingdom
• 6 Department of Nutrition, Faculty of Public Health, Universitas Airlangga, Surabaya, Indonesia

Introduction: School environments can influence students' dietary habits. Hence, implementing a healthy canteen intervention programme in schools is a recommended strategy to improve students' dietary intake. This study will evaluate the feasibility of providing healthier food and beverage options in selected secondary schools in Malaysia by working with canteen vendors. It also will assess the changes in food choices before and after the intervention.

Methods: A feasibility cluster randomised controlled study will be conducted in six secondary schools (intervention, n = 4; control, n = 2) comprising of rural and urban schools located in Selangor and Perak states in Malaysia. Four weeks of intervention will be conducted among Malaysian adolescents aged 15 years old. Two interventions are proposed that will focus on providing healthier food options in the canteen and convenience shops in the selected schools. Interventions 1 and 2 will entail training the canteen and school convenience shop operators. Intervention 2 will be applied to subsidise the cost of low energy-dense kuih (traditional cake), vegetables, and fruits. The control group will continue to sell the usual food. Trained dietitians will audit the canteen menu and food items sold by the school canteen and convenience shops in all schools. Anthropometric measurements, blood pressure and dietary assessment will be collected at baseline and at the end of 4-week intervention. Focus group discussions with students and in-depth interviews with headmasters, teachers, and school canteen operators will be conducted post-intervention to explore intervention acceptability. Under this Healthy School Canteen programme, school canteens will be prohibited from selling “red flag” foods. This refers to foods which are energy-dense and not nutritious, such as confectionery and deep-fried foods. They will also be prohibited from selling soft drinks, which are sugar-rich. Instead, the canteens will be encouraged to sell “green flag” food and drinks, such as fruits and vegetables.

Conclusion: It is anticipated that this feasibility study can provide a framework for the conception and implementation of nutritional interventions in a future definitive trial at the school canteens in Malaysia.

Introduction

There is a concern about the growing prevalence of obesity and unhealthy eating habits among adolescents ( 1 , 2 ). Obesity and unhealthy diets are associated with chronic diseases, such as cardiovascular disease ( 3 , 4 ). Promoting healthy eating among adolescents has become an important public health and research priority because the incidence of obesity and overweight among adolescents continues to increase and tends to persist into adulthood ( 5 , 6 ). Skipping breakfast and high consumption of energy-packed foods are considered among risk factors that lead to overweight and obesity in adolescents ( 7 , 8 ). A National Health and Morbidity Survey (NHMS) reported that, among Malaysians aged 10–17, the prevalence of obesity had risen from 5.7% in 2011 to 11.9% in 2015 ( 9 – 11 ).

An unhealthy diet contributes significantly to weight gain and obesity. Studies have shown that the quality of the diet declines when children enter adolescence ( 12 ). The consumption of fruit, vegetables, and milk decrease, while the intake of sugar-sweetened beverages and confectionery increases through adolescence and early adulthood ( 13 ). Fruits and vegetables are key foods that will reduce fat, energy density and increase fibre that are related to lower cardiovascular disease risk in adolescents ( 14 ). A cohort study in the UK revealed that childhood dietary habits, namely low fibre intake and consumption of high fat and energy-dense food, are linked to increased adiposity in adolescence ( 15 ). Therefore, a healthy diet can lower the risk of obesity among younger people ( 15 ). A longitudinal study (MyHeARTs) in Malaysia suggested that students who live in rural areas consumed more sugar, cholesterol, and energy compared with their peers in urban schools ( 16 ). Several observational studies ( 16 , 17 ) have been conducted to understand the dietary patterns among Malaysian adolescents. The findings show that Malaysian adolescents are prone to consume unhealthy foods ( 18 ), and have unhealthy eating behaviours ( 19 ). The current available data on school-based interventions are not culturally relevant to schools and students in Malaysia. Thus, it is important to design a dietary intervention programme that is evidence-based and culturally relevant for Malaysian adolescents and can be delivered and evaluated in the Malaysian setting. Malaysian foods are influenced by the preparation methods that differ across the Malay, Indian, and Chinese ethnicities. Different ethnic groups have different cuisines and variety of food preparation methods. This leads to different food preferences and eating habits among the ethnicities in Malaysia. Hence, it is important to incorporate cultural differences into designing dietary interventions for better acceptance of healthy foods among school-going adolescents.

Adolescents' dietary behaviour is likely to be strongly influenced by environmental factors ( 20 , 21 ). The school food environment is often considered as a target for nutritional intervention as school children consumed ~40% of their daily dietary intake at schools ( 22 ). Two promising school food environment policies have been introduced by providing fresh fruits and vegetables (F&V) in addition to restricting the sale of sugar-sweetened beverages (SSBs) ( 23 – 26 ). It has been shown that a higher intake of F&V and reduced consumption of SSBs (sodas, sports, and energy drinks) may be beneficial for children by reducing the incidence of cardiometabolic disease ( 27 ). Previous interventions conducted in schools in Norway, the Netherlands and US have tried to provide free or subsidised fresh fruits and vegetables, usually as snacks in addition to school meals ( 28 – 30 ).

Interventions targeting the consumption of beverages is essential as many Malaysian adolescents consume large amounts of SSBs, milk, coffee, cordials, and fruit-flavoured drinks with added sugars ( 31 ). An 18-month trial among 641 normal-weight children in the Netherlands revealed that replacing SSBs with zero-calorie beverages decreased weight gain and fat accumulation in normal-weight children. This suggests that reducing SSBs intake can cause an impact on body weight in children ( 32 ). A systematic review indicated that school-based education programmes focusing on the reduction of SSBs intake with follow-up modules could provide chances for conducting effective and sustainable interventions ( 33 ). In addition, by modifying the school environment (e.g., providing water and reorganization of beverages by promoting less SSBs) and having peer-support group to promote health educational programmes could improve their effectiveness ( 33 ). Home delivery of more proper drinks has a major effect on the reduction of SSBs consumption and related weight loss ( 33 ).

Several initiatives have been implemented in Malaysia and across the world to ensure adherence to established nutritional guidelines and standards, healthy canteen policies, and strategies for all foods served in school canteens ( 34 – 36 ). However, the impact of these programmes and their long-term sustainability are unclear. Addressing this gap is particularly important in Malaysia, where the school is an important provider of two main meals (breakfast and lunch) ( 37 ). In a recent systematic review about Malaysian adolescents' dietary intake, there was a small difference in dietary patterns according to ethnic diversity, which indicated that Malays had higher SSBs intake and lower diet quality than Chinese and Indian adolescents ( 21 ). Furthermore, Malay adolescents preferred Western-based and local-based dietary patterns while Chinese adolescents intended to follow a healthy-based food pattern, which may reflect the effect of socio-cultural diversity on food preferences ( 21 ).

In Malaysia, the schoolchildren purchased food from the canteen and koperasi (school convenience shop) which are run by the canteen operators and school administration, respectively. The koperasi sells mostly energy-dense snacks and beverages. The staple foods usually was sold at the canteen such as noodles, fried rice, nuggets, and fried chicken, energy-dense traditional cakes (e.g., Rempeyek, Kuih Peneram, Kerepek Ubi Kayu, Kuih Baulu , etc.), and SSBs.

Environmental interventions are suggested as more likely to be effective in producing behavioural change ( 38 ). Evidence from systematic reviews, which mostly comprised studies implemented in the US, indicated that school-based strategies can be effective in cultivating healthy eating habits and food purchasing behaviours among school children ( 39 – 41 ). These reviews found that by widening choices of healthy foods, limit the sales of junk foods, and affordable price of healthy food options may help to increase intake of fruits and vegetables and reduced intake of saturated fat among school children ( 39 – 41 ). Nevertheless, few studies explored the extent to which school canteens implemented promotion and pricing strategies to promote the purchasing of healthy foods and drinks ( 42 ). Studies on food environments in schools have concentrated on reporting the accessibility of healthy foods sold in canteens, in school lunch programmes, or sold by using vending machines with limited information on other practices ( 42 – 44 ). Therefore, the purpose of this study is to evaluate the feasibility of delivering a new programme that will promote the availability of healthy food and drink options, especially at school canteens and school convenience shops in Malaysian secondary schools. We also seek to examine the feasibility of collecting data to assess this intervention approach to determine if a larger evaluation is warranted.

The general aim of this study is to assess the feasibility of an intervention programme to improve availability of healthy food items at the school canteen and convenience shop and promote healthy eating practices among school students in Malaysia. The study will be conducted in cooperation with stakeholders (canteen and school convenience shop operators) in secondary schools. The specific objectives are:

• To test the feasibility of providing healthier food options (such as minimising SSBs, more availability of fruits and vegetables) at the school canteen in cooperation with food vendors.

• To test the feasibility of assessing changes in food choices to healthier options while at school among adolescents pre- and post-intervention.

• To test the feasibility of assessing changes in anthropometric measurements of adolescents, pre- and post-intervention.

Overview of Study Methodology

This study is part of the MyHeARTBEaT project (IF017-2017) approved by Research Ethics Committee at the University of Malaya Medical Centre (MREC ID NO: 2018214-6029). The study was registered at the ISRCTN registry: ISRCTN 89649533. The trial design is a three-arm, parallel-group, un-blinded, feasibility cluster randomized controlled study undertaken within six schools in Selangor and Perak states in Malaysia. It will compare two intervention arms (1 and 2) against a usual practice control conducted in six secondary schools, of which four schools will receive the interventions and two will serve as controls. Two interventions are proposed which will focus on providing healthier food options available for sale at the school canteen and convenience shops in the selected schools. Intervention 1 will entail training the canteen and school convenience shop operators to prepare healthier food options in the canteen. The research team will train food operators on the benefits of selling healthy food. Intervention 2 also will create awareness, with the cooperation of food vendor operators among students on consuming healthy food. It will include subsidising the price of vegetables, fruits, and low energy-dense kuih (traditional cake). The training of the canteen and school convenience shop operators will follow intervention ( 1 ) and focus on training the staff who will sell subsidised fruits, vegetables, and low-energy kuih . The control group will continue to sell the usual food.

Trained dietitians will audit the canteen menu and food items sold by the school canteen and convenience shops in all schools (during the 4-week intervention phase, once a week). The menu audit process has been implemented in other studies ( 45 ). The study outcome measures will be assessed at the individual level and will consist of a 3-day diet history assessment and anthropometric measurements that will be conducted at baseline and post-intervention (4 weeks after intervention). Focus group discussions with students who will be involved in the intervention and interviews with teachers, school headmasters, and canteen operators will be conducted post-intervention to explore the acceptability and barriers in implementing the proposed intervention (see Supplementary Material 1). Estimation of sales will be done based on weekly receipts from the canteen and school convenience shop operators of healthy food items, such as vegetables, fruits, and low-calorie kuih . The data will be collected at baseline (August to September 2018) and the following intervention will be carried out after 3 months the year after (January to April). The summary of intervention assessment and logic model are shown in Figures 1 , 2 , respectively.

Figure 1 . Summary of enrolment, intervention and assessment procedures based on the SPIRIT figure.

Figure 2 . Logic model of intervention.

Sample Size Estimation

The National Institute for Health Research guidelines indicated that no formal power calculation is required for feasibility study ( 46 ). As this study will be a feasibility study, a formal power calculation based on identifying evidence for effectiveness will not be performed and no sample size calculation will be undertaken. The sample size of six schools (four intervention and two control arms) will be grouped based on the minimum recommended for a pilot cluster randomized trial ( 47 ).

Based on recent experience in local secondary schools, we predict that between 75 and 80 students from each school will reach the age of 15. Therefore, we assume that the sample size will range between 450 and 480 adolescents. This is a pragmatically chosen sample to detect the feasibility evidence, recruitment rates, and any barriers to implement the research methodology. Feasibility study is conducted to determine the necessary sample size needed to evaluate the intervention. It is premature to specify the required sample size for a future trial, however it is useful to get a broad indication of the estimated sample size for the trial. Thus, the sample size for this study will be chosen to provide a sufficient number of schools and students to test each of the three conditions in urban and rural areas and provide an indication of the likely sample size for a full trial.

Recruitment and Randomisation Procedures

The sample will consist of six schools in Selangor and Perak states in Malaysia as the rural and urban areas, respectively. The sample of six schools will be randomly selected from a list of secondary schools that had previously participated in the MyHeARTs cohort study ( 48 ). The previous cohort study followed a stratified sampling design. First, a complete list of the public secondary schools in the selected regions was obtained from the Ministry of Education (MOE) in Malaysia and used as the sampling frame. The schools were classified as urban and rural-based on the criteria provided by the Department of Statistics Malaysia. A total of 15 schools from a cohort that was consisted of eight urban and seven rural schools was chosen as the study sampling frame ( 48 ).

The six schools in this study will be first randomly selected from 15 schools, and then the schools will be randomly allocated to the intervention 1, 2, and control arms (two schools per arm). Two schools will be allocated to the intervention 1 group and will receive training only, while two other schools will receive training and subsidies on healthy foods. Another two schools will make up the control group without any involvement in the interventions. However, the control groups will receive manual on healthy canteen at the end of the study. The random selection and allocation of the six schools from the urban and rural locations and division to intervention and control arms will be performed (computer-generated allocation) by an independent statistician from the University of Bristol who will be blind to the school identity. The primary sampling units will be six schools and the secondary sampling will include all 15 years old students of six selected schools who will be invited.

Participants will be recruited from six government-funded secondary schools located in the Selangor (urban) and Perak (rural) areas in Malaysia (three schools from each area). Eligible participants will be Malaysian adolescents (15 years of age) from “secondary three class” (known as “Form three”). The students and their parents or guardians will receive written information about the study as well as consent form 1 week before conducting the intervention and then will be requested to submit the completed consent form next day if possible. The participants will have to speak and write the national language (Malay). Students from religious and vernacular schools will be excluded from the sample since most of them tend to be from a mono-ethnic group.

Intervention Development

The intervention was developed based on data obtained from systematic reviews ( 21 , 49 ), reports of the MyHeARTs cohort study ( 48 ), and a related qualitative study ( 50 ). The findings suggested that a school canteen intervention had merit. The qualitative study was also useful to operationalise the intervention content ( 50 ). Focus group discussions with selected adolescents aged 15 years were conducted to understand the available canteen food. The key informants were school headmasters and canteen operators who were interviewed on the dietary habits of students to develop a priority list for intervention ( 50 ). All transcripts were analysed and coded. The themes on healthy eating suggestions were availability of healthy options, subsidising healthy foods, and health education and training ( 50 ). Stakeholders thought that adolescents' misperceptions, affordability, unhealthy food preferences, and limited availability of healthy options were important barriers preventing healthy eating at school. Furthermore, affordability was a major problem for adolescents in rural schools. Stakeholders perceived that a future school-based intervention might improve the availability and subsidies for healthy foods ( 50 ). The intervention was developed and its components guided by the Theoretical Domains Framework for use in behaviour change ( 51 ). The research team then mapped potential behaviour change techniques (implementation strategies) to the identified barriers, which will be refined based on considerations of feasibility, potential impacts and context. As a result, two implementation strategies formed the intervention.

Intervention Overview

This study will explore the feasibility of conducting a dietary intervention in different types of schools (urban or rural) and its potential (evidence of promise) for improving healthy eating practices in adolescents from different socioeconomic backgrounds. It will focus on offering healthy food and beverage options in the school canteen and convenience shop. School canteens will be supposed to support healthy eating based on the healthy canteen guidelines designed by the Ministry of Education (MOE) ( 52 ). This will be achieved by increasing the availability and promotion of an extensive range of foods that should make up the majority of a healthy diet (GREEN). AMBER foods can be consumed only sometimes, choosing healthier alternative foods and avoiding large serving sizes that should be eaten in moderation. RED foods are “stop and think foods” that do not meet specified minimum nutrient criteria (RED). The intervention will try to overcome barriers to healthy canteen guidelines implementation and adherence. Specifically, the intervention will assist schools to remove “red-flagged” and “ban” food items from the canteen menu while increasing the availability of “GREEN” menu items. The objective will be to ensure more than 50% of all canteen menu items are in the “GREEN” category. Examples of “GREEN”, “AMBER,” and “RED” food items are indicated in Table 1 .

Table 1 . Food classification description.

Intervention Components and Implementation

Intervention (1) (training only).

Training: canteen and school convenience shop operators will be requested to provide healthy foods and drinks and consider alternative methods of cooking by using a training manual (canteen and school convenience shop operators), which will be developed based on the Malaysian Healthy Canteen Guidelines ( 52 ). Canteen managers and staff will be invited to attend a 1-h training workshop to educate them on healthy eating policy, nutrition, canteen stock, and change management. They will also be provided with a “Healthy Canteen Booklet” and will be trained in choosing healthy cooking methods, such as steaming and grilling.

Intervention (2) (Training + Subsidy)

The intervention will intend to increase the (i) intake of fruits and vegetables and (ii) consumption of healthy and lower energy kuihs (e.g., keladi rebus (steamed yam), apam (pancake) , and non-sweetened beverages (e.g., water), rather than high energy-dense snacks and drinks (measured by their sales receipts, dietary intake, coupons).

➢ Training: Canteen and school convenience shop operators will have to provide healthy food options and consider alternative methods of cooking by using the Training Manual developed based on the Malaysian Healthy Canteen Guideline ( 52 ). A trained dietitian who is the main investigator of this study (HM) will deliver the training in these two schools, and the canteens will be assessed each week on the foods they sell.

➢ Fruits, vegetables, and low energy-dense (low ED) kuih (traditional cakes) will be subsidised. The canteen operators in this group of interventions will receive a weekly allowance (the amount will be modified when necessary) to sell fruit, vegetables, and low ED kuih (e.g., Ketayap, Cakoi, Cucur cempedak, Apam ) at subsidised prices.

➢ All students (Form three students) will receive (Ringgit Malaysia RM 2) coupons that subsidise the price of fruits (will provide 2 days weekly over 4 weeks) and low ED kuih (given 2 days weekly over 4 weeks). Therefore, the total value of coupons per week for one student will be RM 4. This coupon will be given to the students weekly. When they buy fruit/ kuih , the coupon will be placed in a specific box, and the teacher in charge will collect them daily and keep a record of how many coupons have been used as the subsidy.

➢ In the subsidised group, schools will be provided with funds to prepare healthy food. This will give them additional money for their weekly purchases to prepare extra vegetables for the study participants. For example, if they purchase vegetables worth 200 Ringgit (RM) per week, they will get 100 Ringgit (RM) subsidy so that they can prepare an extra tray of vegetables per week. The dietitian will visit the school on a weekly basis for evaluation. The receipts of the vegetables will be given to the dietitian, who will monitor them by visiting the school every week to examine the report by the teacher in charge.

➢ Providing free drinking water by installing a proper water container/tank to dispense drinking water. The dietitian will check every week whether the water will be filled up during the school period and whether it will be utilised by the students. This will be recorded by the teacher in charge and cross-checked during the weekly visit of the dietitian.

The control group will consume the food are typically available at the school canteen and convenience shop. No intervention will be made in terms of their food choices as well as no advice nor resources will be provided during this intervention period. The canteen and convenience shop operators will have their usual service without changes at two schools, which will be considered as the controls. The control school will receive usual healthy canteen guidelines as given by the Ministry of Health.

Data Collection

Data will be collected at baseline and post-intervention. All six eligible governmental schools with an operational canteen will be required to complete baseline data collection. The schools' characteristics, including school size, location, and the number of days the canteen operates, will be captured before randomisation. Furthermore, canteen vendors will be asked to show the serving menu that captures all foods (even snacks and beverages) available for sale at school canteens to the research team before the canteen checklist assessment.

Dietary Assessment

A questionnaire will be used to obtain information regarding adolescents' dietary intake. This study will use a validated 3-day diet history to ensure greater accuracy, namely to estimate the respondents' energy intake ( 16 ). The tool was pre-tested on 40 participants from two different schools (one school each from rural and urban areas, respectively) ( 16 ). Qualified and trained dietitians will conduct an open-ended interview with adolescents to collect information on their food habits through the day (breakfast, mid-morning snacks, lunch, afternoon tea, dinner, and supper). A flip chart will be used as an additional tool to assess the subjects' diet and help estimate their portion size. Nutritionist Pro™ Diet Analysis software will be used to assess the nutritional content of the food ( 16 ).

Any misreporting may be heightened in dietary intervention studies. A reliable and valid short form of the Marlowe-Crowne social desirability scale will be administered to identify and control participants prone to these traits ( 53 ).

Anthropometric Measurements

Height will be measured using a vertical stadiometer (Seca Portable 217, Seca, UK) and will be recorded to the nearest millimetre or one-tenth of a centimetre (0.1 cm). Body weight will be assessed using a digital, electronic weighing scale (Seca 813, Seca, UK). It will be based on the nearest one-tenth of a kilogram (0.1 kg). Body fat composition will be evaluated using a portable body composition analyser (Tanita SC-240 MA, the Netherlands). Waist circumference (WC) and hip circumference (HC) will be measured using a non-elastic Seca measuring tape (Seca 201, Seca, UK), to the nearest millimetre.

Blood Pressure

The help of two qualified medical officers will assess the blood pressure and pulse rate of the participants. The participants will seat in the upright position with their right upper arm position at the level of the heart with both feet flat on the floor. Systolic and diastolic arterial blood pressure will be obtained using a stethoscope and a mercury sphygmomanometer.

Potential Trial Outcomes

As this is a feasibility study, the focus of the current study will be whether the intervention can be delivered as intended and desired outcomes can be attributed. It is envisaged that if we have to move to a larger trial that the primary outcome will be the participants' consumption of healthy canteen items. The participants will be deemed as consuming healthy canteen items or green foods based on their dietary intake of more than 50% of listed menu items. The canteen operators will be tasked with auditing the green items available for sale at the school canteen. During follow-up, two dietitians will audit the results based on the canteen audit and discussion with canteen staff. Food classification tools and guidelines published by the Ministry of Education in Malaysia will be used to categorise the food (see Table 1 ).

Secondary Trial Outcomes

The secondary outcome of the trial will be changes in the dietary intakes and nutritional status of adolescents at school.

Process Evaluation of the Intervention

Two methods will be used for process evaluation of the intervention, namely external and internal audit using a checklist and qualitative assessment.

External and Internal Audit

The process of evaluation will include a checklist for Healthy School Canteens by dietitians to check the availability of healthy food and drink options, cooking with less oil or less salt, preparing more low energy-dense kuih , putting extra vegetables in some dishes and ensuring they provide fewer foods from the amber group and more foods from the green group. Furthermore, there will be an observation (log) of the training for the canteen and school convenience shop operators. The Healthy School Canteen Checklist will comprise five sections; two sections on the vendor and school information (section A and B), three evaluation sections where the basic criteria will be evaluated for healthy dishes (section C), healthy food serving method (section D), and traffic light method (section D). Each of the three evaluation sections will carry a percentage for a total score of 100%. Section C will account for 45%, while sections D and E will account for 20 and 35% of the assessment scores (see Supplementary Material 2). The assessment scores must be ≥80% to be recognised as a healthy cafeteria based on MOE Healthy Canteen Guidelines.

The dietitians will have access to the canteen, observe, and check, and they will ask questions about cooking methods. Before the evaluation period using the Healthy School Canteen Checklist, two external dietitians will be trained to ensure consistency in data evaluation. Each external dietitian will be independently assigned to evaluate the same intervention schools (canteen and school convenience shop vendors) over the 4-week period. Any discrepancies arising between two qualified and trained dietitians will be resolved via discussion between the two dietitians, when an agreement could not be reached, a discussion will be held with the principal investigator.

Qualitative Assessment

The use of qualitative research methods is essential to gain insights into the implementation process and context and participants' perspectives on the intervention. Qualitative methods will be used to assess the acceptability and feasibility of the interventions, as well as the study procedures. Interviews with canteens and school convenience shop operators will be conducted to explore the acceptability and barriers in the implementation of the proposed intervention, and their understanding of healthy and unhealthy foods based on the traffic light concept. A total of 12 participants, one canteen operator and one school convenience shop operator per intervention school will be asked about any changes in cooking methods after the training sessions and any changes in their knowledge and attitudes toward preparing healthy foods, which should be reflected in their cooking practices. In addition, focus groups will be conducted with adolescents to explore their opinions on the availability of healthy food and acceptability of the food environment. A total of 80 students will participate in focus groups, 20 per intervention school (10 boys and 10 girls), and they represent the major ethnic groups in Malaysia (Malay, Chinese, Indian). Interviews with school teachers ( n = 12) will also be conducted to obtain their feedback for the changes at canteens and school convenience shops. The interview guide is as attached in the Supplementary Materials .

Planned Analysis

Feasibility studies are not designed to evaluate the effectiveness of interventions ( 54 ). As this is a feasibility study, no formal comparison between the study arms will be undertaken and no significance testing will be conducted. Descriptive statistics such as the mean (standard deviation) for continuous variables and frequency and proportions ( n , %) for categorical variables will be used to evaluate the research hypotheses. In light of the feasibility study and the associated lack of statistical power, all effects will be evaluated based on effect size and p -values will not be reported. The analysis will be reported using the relevant CONSORT checklists ( 55 ). For quantitative data analysis, the SPSS software (Version 25.0, Chicago, IL, US) will be used. All focus group discussions and interviews will be audio-recorded, transcribed verbatim and entered into NVivo software to analyse quantitative data and facilitate data coding. Field notes and memos will be also analysed and the framework approach for qualitative data analysis will be used ( 56 ).

Participant Confidentiality

All study personnel will be trained in the requirements to ensure the participants' confidentiality. The principal investigator will protect the confidentiality of participants' information. Participant identification code will be assigned upon study enrolment. The data will be kept centrally by the principal investigator and will be anonymised and identified by a unique code. Moreover, access to personally identifiable information will be limited to members of the research team. Documents that will not be anonymised, such as signed informed consent forms will be held by the principal investigator in a locked cabinet in the department at the university.

Discussion and Conclusion

The MyHeARTBEaT study proposes the design and rationale for a school-based intervention to facilitate the adoption of a healthy canteen policy in Malaysian schools. The study will try to determine if the audit and subsidisation for healthy foods can improve/increase the availability of the healthy food and drinks option at the school canteen and convenience shop, improve the number of school canteens, which offer healthy food options, increase the number of students who consume greater amounts of fruits and vegetables, and decrease the intake of SSBs by students. This strategy may have the potential to offer cost-effective and sustainable support to improve the school canteen food environment. The insights into the effects of price-related approaches to improve food consumption and purchasing behaviours may provide evidence to build appropriate policy and programme responses to the epidemic of obesity and poor diet quality currently facing Malaysian adolescents ( 49 ).

Limited healthy lifestyle school-based interventions were conducted in Malaysia. As such, this study addresses a significant research gap and a potentially valuable missed opportunity in efforts to promote healthy eating behaviours among Malaysian adolescents. The research may contribute to the literature on the adverse effects of poor nutrition and associated adverse health outcomes, including obesity, in the Malaysian population and worldwide. While the impacts of school-based canteen interventions have been examined in other studies in Malaysia, the upcoming trial will be the first to analyse the impact of healthy food subsidisation in Malaysian school canteens and targeting both school convenience shops and canteens for intervention. The intervention will be considered to warrant evaluation via a full trial if the study achieves more than 50% of all healthy canteen menu items in the “GREEN” category and recruits 80% of eligible participants. Based on this feasibility, we shall plan either to use interventions such as training of canteen and school convenience shop operators only (intervention 1) or training with some financial subsidy (intervention 2) for the full trial.

This school-based study is intended to provide new insights regarding the implementation of healthy foods and drinks environment in Malaysian schools, including distribution of subsidised fruits and vegetables and low ED kuih that may improve healthy food intake among Malaysian adolescents. The possible implication of this study includes minimizing the availability of SSBs sold in school canteen in the future. We also want to see the availability of fruits and vegetables at the school canteen and the acceptance of healthier food options among the school adolescents. By offering more of healthier option of foods and beverages in school, it will be good to evaluate if changes toward environment may enable the students for better healthy options. From this healthy canteen and convenience shop interventions, we would like to see any changes on anthropometric measurements within a month of intervention. This will enable us to plan for larger scale study in the future. With all the intervention planned, it is anticipate it should be acceptable as we do take into account the diversity of Malaysian ethnic background.

This study is anticipated to be useful in intervention development process and identifying ways to improve the availability of healthy foods within the school environment and modifying healthy canteen guidelines and policy development. It is expected that the findings from this study can provide a framework for the conception and implementation of nutritional interventions at the school canteens in Malaysia that will be tested for efficacy in a future definitive trial.

Ethics Statement

Ethical approval was given by the Medical Ethics Committee at University of Malaya Medical Centre, reference number 2018214-6029. Written informed consent to participate in this study was provided by the participants' legal guardian/next of kin.

Author Contributions

HM, SM, and TS conceptualised the study and drafted the initial study protocol. SM, HM, TS, AP, ZT, MD, MJ, MA, and RJ participated in the design of the protocol. All authors critically reviewed the draft of the manuscript and approved the final version.

This study was conducted as part of the MyHeARTBEaT (Malaysian Health and Adolescents Longitudinal Research Team) (Behavioural Epidemiology and Trial) project (IF017-2017) in Malaysia funded by the Academy of Sciences Malaysia (Newton Ungku Omar Fund) and the UK Medical Research Council (grant number MR/P013821/1). The sponsors will have no role in the design of this study, management, data collection, interpretation of data, analysis, writing of the report, and the decision to submit the article for publication. They will not have ultimate authority over any of these activities.

Conflict of Interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Acknowledgments

The authors would like to thank Dr. Laura Johnson (Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, United Kingdom) for her valuable support and cooperation during manuscript preparation.

Supplementary Material

The Supplementary Material for this article can be found online at: https://www.frontiersin.org/articles/10.3389/fpubh.2020.549637/full#supplementary-material

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Keywords: Malaysian adolescents, school canteen, dietary habits, eating practices, school-based

Citation: Mohammadi S, Su TT, Jalaludin MY, Dahlui M, Azmi Mohamed MN, Papadaki A, Jago R, Toumpakari Z and Majid HA (2020) School-Based Intervention to Improve Healthy Eating Practices Among Malaysian Adolescents: A Feasibility Study Protocol. Front. Public Health 8:549637. doi: 10.3389/fpubh.2020.549637

Received: 08 April 2020; Accepted: 19 August 2020; Published: 22 September 2020.

Reviewed by:

Copyright © 2020 Mohammadi, Su, Jalaludin, Dahlui, Azmi Mohamed, Papadaki, Jago, Toumpakari and Majid. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

*Correspondence: Hazreen A. Majid, hazreen@ummc.edu.my

Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

• Open access
• Published: 25 October 2023

Private school canteens: an analysis of the economic and financial aspects of the traditional and the healthy models

• Luisa Arantes Vilela 1 ,
• Bruna Vieira de Lima Costa 1 ,
• Mariana Zogbi Jardim 2 ,
• Luiza Delazari Borges 2 ,
• Ariene Silva do Carmo 3 ,
• Monique Louise Cassimiro Inácio 4 &
• Larissa Loures Mendes 1  

BMC Public Health volume  23 , Article number:  2102 ( 2023 ) Cite this article

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One of the reasons for the more prominent resistance of canteen managers to implementing healthy canteens is based on the belief in the economic infeasibility of these models. The research aimed to verify the economic and financial viability of traditional and healthy models of school canteens in a Brazilian metropolis.

The case study was carried out with 36 companies in the school canteen sector in a Brazilian metropolis. The classification of items sold in canteens considered the extent and purpose of food processing according to the NOVA Classification. The characterization and definition of traditional canteens and healthy canteens were proposed considering the amount of in natura or minimally processed foods and culinary preparations without the presence of ultra-processed foods; the percentage of ultra-processed foods or processed foods or culinary preparations with the presence of ultra-processed foods; and the existence of prohibited foods. The economic and financial analysis was carried out mainly through the evaluation of profitability. Data were collected through an electronic self-administered questionnaire sent to canteen managers. The Mann-Whitney test was used to compare medians and the Chi-Square/Fisher’s Exact Test to compare proportions.

The study included six companies, responsible for 36 canteen units in private schools, 30 classified in the traditional model (83.3%), and six in the healthy model (16.7%). The median percentage of natural, minimally processed foods and commercialized culinary preparations was higher among the healthy model canteens (87.9% vs. 60.0%, p < 0.001). While the median percentage of ultra-processed, processed, or preparations with the presence of ultra-processed (40.0% vs. 12.1%, p < 0.001) and prohibited foods (10.0% vs. 0%, p < 0.001) sold was higher in the traditional model canteens. The results indicated that the profitability in the healthy canteens was higher (p < 0.001) than in the traditional ones.

Conclusions

Healthy school canteens showed better financial and economic results compared to traditional canteens with emphasis on greater profitability and a shorter recovery time of the initial investment.

Peer Review reports

In Brazil, the sale of food in schools differs between public and private education networks in terms of the contract, the form of administration of the canteens, and the presence of the National School Feeding Program (PNAE in the Portuguese acronym) [ 1 ]. The canteen is understood to be an establishment located inside the school that aims to offer food services to the school community for a fee [ 2 ].

In private schools, the main option for access to food by students is the canteen. Data from the National School Health Survey - PENSE (2019) revealed the presence of canteens in three out of ten public schools and nine out of ten private schools [ 3 ]. These canteens can be managed by the school itself or by an outsourced company [ 1 ]. Studies show that the presence of canteens in private schools is associated with greater availability and consumption of unhealthy foods (ultra-processed foods and beverages - UPF) by students [ 4 , 5 , 6 , 7 , 8 , 9 ], which characterizes these spaces as a more obesogenic environment when compared to public schools [ 4 , 5 ].

In addition, positive associations are observed between the consumption of unhealthy snacks sold in school cafeterias and students’ overweight/obesity [ 9 , 10 , 11 , 12 ]. On the other hand, regulations and interventions that reduce the availability of UPFs and increase the supply of in nature and minimally processed foods in canteens have shown positive results concerning improvements in food consumption, nutritional profile, and adherence to a healthy diet by the student population [ 13 , 14 , 15 , 16 , 17 ].

In Brazil, a healthy diet based on in nature and minimally processed foods has a higher cost trend. However, due to the low cost of grains (rice and beans), healthy diets are still cheaper than those consisting of ultra-processed foods [ 18 ]. From this angle, Brazilian outsourced companies, those specialized in school lunches, which sell mostly in nature and minimally processed foods and beverages, have shown to be economically viable [ 1 , 19 , 20 ]. A project entitled “The School Promoting Healthy Eating Habits”, carried out by the Observatory of Food Security and Nutrition Policies at the University of Brasilia, carried out a survey that showed that 66.7% of school canteens that promoted and offered healthy snacks had an increase in profit between 30.0 and 50.0%, adding value to your business [ 21 ].

Despite this, there are some limitations to the provision of healthy foods and beverages in Brazilian schools, such as the low coverage of regulations in private schools, the lack of a national law that prohibits or restricts the sale of UPF in the school environment [ 6 ], inefficient supervision [ 22 , 23 , 24 , 25 , 26 ] and resistance to adherence and compliance with legal provisions by private schools [ 1 ]. In addition, it is common for canteen owners to report that the sale of healthy foods is low, generating little profit, which is, therefore, a limiting factor in the implementation of healthy canteens [ 22 ], in addition to restrictions on workers’ time to produce healthier meals, since there are reports of a low number of employees in the canteens considering the number of students in the school [ 27 ].

Some systematic reviews have also shown that concerns on the part of school principals or owners of food services on the loss of profitability, revenue and/or commercial viability constitute one of the main barriers to implementing healthy canteens [ 28 , 29 ]. Thus, considering that one of the barriers identified for the implementation of healthy canteens is the greatest resistance on the part of canteen managers due to the belief about the economic unfeasibility of healthy models, studies that assess the economic viability of school canteens can contribute with evidences that will be important to in raising awareness and training canteen owners. Also, it contributes to the promotion of a healthier school food environment. However, there are still few studies that assess the economic viability of healthy canteens.

The objective of this study was to evaluate the economic and financial aspects of different models of companies in the school canteen sector in a Brazilian metropolis.

Design and setting of the study

This is a case study that evaluated the economic and financial aspects of private school canteens carried out in the city of Belo Horizonte, Brazil. Belo Horizonte is the sixth most populous city in the country with approximately 2,375,151 inhabitants [ 30 ]. In 2010, the Municipal Human Development Index (IDHM in the Portuguese acronym), which considers the dimensions of longevity, education, and income, was 0.810, ranking the city in 20th position among Brazilian municipalities [ 30 ].

Participants

To participate in the study, the companies managing the school canteens had to have a service contract with private schools, which offered Elementary School and/or High School. Schools that only had Early Childhood Education were excluded since in these cases it is more common for the school itself to administer the canteen (self-management) and/or for the parents to send the child a snack from home.

According to data from the Minas Gerais State Department of Education (SEE/MG in the Portuguese acronym), in 2019, Belo Horizonte had 902 schools in the private network, 499 of which were exclusively for kindergarten. In this way, 403 schools were contacted by telephone to obtain information on how the canteen is managed (self-management or outsourced) and on the responsible manager. Of these, 84 had an outsourced canteen, 174 did not have a canteen or canteen with a third-party service (they were self-managed), 23 reported not having the authorization to provide data, and 122 did not answer the phone, even after two attempts in days and periods (morning and afternoon) alternated. Ethical approval for the study was granted by the Ethics in Research and Human Beings Committee of the Federal University of Minas Gerais (CAAE: 38003220.4.0000.5149; Opinion number: 4.454.467). Informed consent was obtained from all managers participants included in the study.

The team responsible for data collection was composed of graduate students and researchers from a Research Group, who were duly trained. In the training, a pattern of approach was defined, by telephone or e-mail, and recording the answers. Most schools that had outsourced canteens provided the contact of the canteen manager who was later invited to participate in the research. Of the 84 schools with an outsourced canteen, 37 companies and managers were identified. All companies were contacted and 6 managers agreed to participate in the research, representing 42.9% (n = 36) of private schools with an outsourced canteen. Thus, the sample of school canteens was characterized by not being probabilistic, considering that random selection methods were not used.

Data collection took place between March and July 2021 and consisted of electronically sending a questionnaire to be self-completed by canteen managers. The questionnaire was sent to all managers of eligible companies and was prepared by the researchers of the study and reviewed by UFMG Consultoria Júnior (UCJ in the Portuguese acronym), a business management consulting company composed of students from the courses of Administration, Economic Sciences, Accounting Sciences, International Economic Relations, and Controllership and Finance at the Federal University of Minas Gerais (UFMG in the Portuguese acronym). The information investigated referred to the identification of the outsourced company, the linked school, number of canteens and students served, menu of commercialized products, product offering, number of employees, investment value and recovery time, profit margin of the most sold, monthly gross revenue, monthly expenses, company profitability, manager’s perceptions about the identification of healthy canteens, implementation feasibility and attempt to include healthy foods. It is noteworthy that all the information collected referred to the year 2019, before the beginning of the COVID-19 pandemic in Brazil. Caused by the SARS-CoV-2 betacoronavirus, COVID-19 was considered a public health emergency of international importance, forcing several countries to adopt social distancing measures, in addition to travel and street movement restrictions [ 31 , 32 ]. Social distancing measures have involved school closures in approximately 137 countries [ 33 ]. In Brazil, it has been estimated that 189,707,136 students were affected by the closure of schools in the year 2020 [ 34 ]. Consequently, the entire canteen sector came to a halt considering the sanitary measures imposed to reduce the transmission of SARS-CoV-2.

Classification of foods sold in canteens

The classification of items sold in the canteens considered the extent and purpose of food processing, according to the NOVA Classification [ 35 , 36 ], present in the Food Guide for the Brazilian Population [ 37 ], which are classified as in nature or minimally processed, processed, ultra-processed, and culinary ingredients. The Food Guide presents the following golden rule for healthy eating: always prefer natural or minimally processed foods and culinary preparations to ultra-processed foods. These culinary preparations would be based on in nature or minimally processed foods and may include culinary ingredients and, eventually, processed foods [ 37 ].

Considering the diversity of culinary preparations existing in school canteens, two food groups were created: (1) in nature, minimally processed foods and culinary preparations without the presence of ultra-processed foods; (2) processed foods, ultra-processed foods and culinary preparations with the presence of ultra-processed foods. It is noteworthy that for the classification of “culinary preparations with the presence of ultra-processed foods”, the presence of at least one ultra-processed food was considered as an ingredient in the preparation as mentioned in the menu description.

Healthy canteen and traditional canteen

The characterization and definition of which establishments would be considered traditional canteens and healthy canteens was based on articles 21 and 22 of Resolution nº 6 of May 8, 2020, of the PNAE [ 38 ] at least 75.0% in nature or minimally processed foods; (2) no more than 20.0% processed and ultra-processed foods; (3) the prohibition of certain ultra-processed foods and beverages, such as soft drinks and artificial refreshments, beverages or concentrates based on guarana or currant syrup, ready-to-drink teas and other similar beverages, cereals with additives or sweetened, candies and the like, confectionery, candy, chocolate bars and granules, cookies or filled cookies, cake with icing or filling, cereal bars with additives or sweetened, edible ice cream, gelatin, seasonings with monosodium glutamate or sodium salts, mayonnaise, and powdered or reconstituted foods.

In addition, the study by Rodrigues (2019) [ 39 ] was also used as a reference, as guidelines were established for the certification of healthy canteens, such as (1) expanding the supply of fresh and minimally processed foods; (2) limiting the supply of processed foods (reduction to 50.0% and then to 30.0%); (3) restrict the sale of ultra-processed foods (reduction to 40.0% and then to 20.0%); (4) prohibit the sale of candies, lollipops, chewing gum, stuffed cookies, soft drinks, artificial or sweetened juices, fried foods (such as rissoles, pastries, and drumsticks), mayonnaise, snacks with sausages, packaged snacks, industrialized popcorn, and others ultra-processed foods high in sodium, fat, and sugar. Table  1 presents the classification of canteens in the traditional and healthy models.

In this way, the analysis of the products sold in the canteens was carried out through the evaluation of the menu provided by the canteen manager. For this analysis, the number of items offered for sale was considered; the amount of in nature or minimally processed foods and culinary preparations without the presence of ultra-processed foods; the amount of processed food, ultra-processed foods, and culinary preparations that contain ultra-processed foods; and the amount of prohibited foods.

Economic and financial aspects of canteens

The analysis of the financial statements can be divided into economic analysis, which includes the interpretation of the results generated by the company, and financial analysis, which includes the financial availability of the company, its degree of liquidity, and its ability to pay. Thus, there are several techniques for the economic-financial analysis of a company, which are essential tools for controlling the organization’s financial situation and for decision-making by managers [ 40 , 41 ]. In the present study, it was proposed to use the analysis through the evaluation of profitability, which is all that is left net of the gross revenue of the establishment after all expenses have been paid [ 40 ]. This indicator is calculated from the income statement for the year (DRE in the Portuguese acronym), a financial statement that presents the company’s economic results determining the profit or loss in a period [ 40 ]. Dornelas (2012) [ 42 ] defines the DRE as an ordered and summarized classification of the company’s income and expenses in a given period. Taxes, allowances, and refunds granted are subtracted from total revenue, resulting in net revenue; from net revenue, the costs arising from products sold, products manufactured, or services rendered are deducted, to arrive at a gross profit; subsequently, operating expenses are subtracted from gross profit; and finally, the income tax is calculated, accounting at the end of the sum of profits and losses.

Information on the initial investment value was requested from the participants and in the present study, it refers to that fixed, which corresponds to the equipment, utensils, and furniture necessary for the operation of the enterprise, disregarding the value for the working capital [ 43 ]. To obtain the net profit value, the reported value was multiplied as a percentage of profitability over the gross revenue value, reported in reais. The calculation of the estimated total expenses of the canteens was performed by subtracting the net income from the gross revenue. The stratification of costs was classified into fixed costs which refer to those that are independent of the product sold and variable costs those that are directly related to the amount of product sold, as described by Kimura (2003) [ 44 ]. In this sense, expenses with infrastructure, employees, and financial services (accounting, sales management system, bank fees, fire insurance) were denominated as fixed costs, and as variable costs, expenses with foodstuffs, cleaning products, and extra expenses (office supplies, equipment maintenance, extermination, grease and water tank cleaning, or other expenses not mentioned). In addition to these data, the number of schools served by each company, the average number of people served, and the average number of employees that make up the company were also evaluated.

Statistical analyses

The descriptive analysis included the calculation of frequency distributions and measures of central tendency and dispersion. The Shapiro-Wilk normality test was applied. Median and interquartile ranges (25th and 75th percentiles) were calculated for non-parametric quantitative variables, and absolute and relative frequencies were calculated for categorical variables.

The Mann-Whitney Test was used to compare medians and the Chi-Square/Fisher Exact Test to compare proportions. In situations where statistical significance was found in the Chi-Square Test, the 2 × 2 analysis was used to identify possible differences. In this analysis, the Bonferroni correction was used, which changes the level of significance (p), to avoid type I errors derived from multiple comparisons [ 45 ].

All information obtained was recorded in a computerized database, prepared for this purpose with the aid of Excel 11.0 software. Data analyzes were performed using the statistical software Statistical Package for the Social Sciences (SPSS), version 19.0 [ 46 ]. The significance level adopted in all analyzes was 5.0%.

The study was carried out on a total of six outsourced companies that were responsible for 36 canteen units. According to the methodology proposed to classify the canteens of private schools, 83.3% (n = 30) followed the traditional food marketing model, and 16.7% (n = 6) the healthy food marketing model.

Table  2 presents the description of the items and types of food sold according to the canteen models. The average of items sold was higher in traditional canteens than in healthy ones (40 vs. 33, p = 0.003). The average percentage of in nature, minimally processed and preparations without the presence of ultra-processed foods was higher among the healthy model canteens (87.9% vs. 60.0%, p < 0.001). While the average percentage of ultra-processed, processed, or culinary preparations with the presence of ultra-processed (40.0% vs. 12.1%, p < 0.001) and prohibited foods (10 vs. 0, p < 0.001) sold was higher in the traditional model canteens when compared to the healthy model canteens (Table  2 ). Savory foods (96.7%, n = 29), followed by natural juice (80.0%, n = 24), were the most commercialized foods in the traditional model canteens. In the canteens of the healthy model, cheese bread (100.0%, n = 6) was highlighted in sales (data not shown).

Statistically significant differences were observed between the two canteen models for the average number of students served (p < 0.001), the time to recover the investment (p = 0.005), profit margin of the best-selling product (p < 0.001), costs fixed with infrastructure (p < 0.001), with financial services (p < 0.001), with disposables (p < 0.001), with cleaning products (p < 0.001) and with extra expenses (p < 0.001) (Table  3 ). We proceeded with the Bonferroni correction to verify in which pair or pairs of comparison there is a statistical difference (data not shown). After the Bonferroni correction, it was found that there was no difference in spending on employees according to the canteen model (Table  3 ).

The average number of people served in the canteens in the traditional models was greater than 500 students, while in the healthy models it ranged between 300 and 500 students (p < 0.001). In the healthy model canteens, a higher proportion of canteens that took less than a year to recoup their investment was observed (33.0% vs. 0.0%). While in the traditional model canteens there was a higher proportion of canteens that took 1 to 3 years to recoup the investment (96.7% vs. 66.7%). It was found that the profit margin of the most sold product was higher in the traditional model canteens (p < 0.001). In 76.7% of these a profit margin was greater than 100.0%, while in all (100.0%) canteens of the healthy model the profit margin was between 33.0 and 66.0% (Table  3 ).

Regarding fixed and variable costs, it was observed that among the traditional model canteens there was a greater proportion of the extremes of financial service expenses (76.7% and 20.0% of the traditional model canteens had expenses from 0 to R$1000.00 and > R$3000.00, respectively; while the healthy model canteens had expenses that varied between R$1000.00 and R$3,000.00) and with cleaning (76.7% and 16.7% of the traditional model canteens had expenses from 0 to R$200.00 and > R$600.00, respectively; while the healthy model canteens had expenses between R$200.00 and R$400.00). Healthy model canteens had a higher proportion of infrastructure expenses (66.7% of the healthy model canteens had expenses from 2.500 to 5.000, while 93.3% of the traditional model canteens had expenses from 0 to 2.500, p < 0.001), disposables (66.7% of the healthy model canteens had expenses from 400 to 800, while 76.7% of the traditional model canteens had expenses from 0 to 400, p < 0.001), and extra expenses (66.7% of the healthy model canteens had expenses from 700 to 1050, while 80.0% of the traditional model canteens had expenses from 0 to 350, p < 0.001) compared to traditional model canteens (Table  3 ). Among the healthy model canteens, higher median profitability was observed compared to the traditional model canteens [25.0% (18–25) vs. 10.0% (10–10), p < 0.001] (Table  3 ).

Furthermore, no statistically significant differences were observed between the two canteen models for the average number of employees, average initial investment value, gross revenue, total expenses, and net income (p > 0.05).

Considering the managers’ perception about the identification of healthy canteens, all considered it healthy, with two managers of traditional models and all managers of the healthy model classified as “totally healthy”, and two managers of the traditional model classified as “partially healthy”. healthy”. Managers also reported that the socioeconomic profile of students may vary from one school to another, however, the variety of products offered in different schools was similar, with a small change in some cases, generally determined by the contract of each school. Only one canteen manager classified as traditional reported not having tried to include healthier products among the foods and beverages already sold. The added items that were most reported in this case were 50% cocoa chocolate milk, homemade cookies, sweets with fruits or vegetables, fruit, natural sandwich, and natural fruit juice (data not shown).

Regarding the economic viability of healthy canteens, the managers of this model considered it viable, and one of them specified the need to have the snack kit service to increase the company’s revenues. To hire this service, the person responsible for the student signs a contract and when paying a monthly amount, the child receives a snack consisting of a carbohydrate source food (cake, sandwich, savory, biscuit), a drink (natural fruit juice or milk with cocoa or fruit smoothie) and a serving of fruit. As for those responsible for traditional canteens, two believe that the healthy canteen model is unfeasible, and one manager believes that this is due to the worsening economic crisis in the country. Of the managers of traditional canteen models who believe in the economic viability of healthy canteens, one of them justified the need to have the snack kit service in addition to the cafeteria service for profit (data not shown).

In the present study, most of the canteens analyzed were classified as traditional, in which there is a predominance of UPF commercialization. Although half of the managers of traditional canteens believe that healthy canteen models are unfeasible from an economic-financial point of view, the results indicated that in healthy canteens, profitability was higher and the payback time of the initial investment was shorter compared to traditional canteens. The average number of employees, average initial investment value, gross revenue, total expenses, and net income were similar between the canteen models. However, the highest profit margin on the best-selling product and the lowest expenses with infrastructure, disposables, and extra expenses were observed in traditional canteens. To the best of our knowledge, this was the first study to classify and compare the economic viability of traditional and healthy canteens. Thus, it was not possible to compare the findings of this study with the literature concerning traditional and healthy models, and in this sense, it was decided to make a comparison with general data on the profile of foods sold in school cafeterias.

Studies carried out in Brazil show a high frequency of commercialization of unhealthy foods in private school canteens [ 4 , 5 , 6 , 22 , 24 , 25 ] evidencing that the traditional canteen model is more frequent in the reality of schools. A study based on a three-year longitudinal dataset from 54 private schools in Brazil, covering purchases made by 20,333 children and adolescents, showed that more than 60.0% of the products offered in private schools have low nutritional value and only 11.0% high nutritional value [ 7 ]. Another study carried out in Rio Grande do Sul showed that the most sold foods in canteens were fried snacks and puff pastries, hot dogs, candies, chocolates, and soft drinks [ 25 ]. According to data from the PENSE, the products most sold in private canteens were baked snacks, natural fruit juice, and soft drinks [ 3 ].

Thus, the presence of canteens that provide more UPF in schools is associated with higher UPF consumption by children and adolescents in this environment [ 47 ]. In this sense, there is a growing body of evidence about the impact of UPF consumption on the health conditions of these groups. Studies carried out with children and adolescents have shown that UPF consumption was associated with increased concentrations of total cholesterol [ 48 , 49 , 50 , 51 ], LDL-c (low density lipoproteins cholesterol) [ 49 , 50 ], total triglycerides [ 48 , 49 ], abdominal [ 51 ] and body adiposity [ 52 , 53 ], and dental caries [ 54 ], in addition to a decrease in HDL-c (high density lipoproteins cholesterol) [ 49 ].

Given this scenario, there is a need to regulate the school food environment to implement healthy canteens in private schools. A study carried out in Brazil showed that adolescents covered by laws restricting the sale of food and beverages in school cafeterias had an 11% lower chance of obesity (adjusted OR = 0.89; 95% CI 0.88–0.91) [ 55 ]. In this context, countries such as Australia already evaluate the presence of healthy canteens as an important public health policy, with the school being an ideal place to promote healthy eating [ 56 ]. However, there are many barriers to promoting healthy school food environments, such as the lack of involvement of stakeholders (school principals or school food service managers), resistance to change on the part of students, family members, and canteen staff, in addition to stakeholder concern about the profitability, revenue and/or commercial viability of this trade model [ 28 , 29 ].

However, the results of the present study suggest that the profitability of healthy canteen models is higher than that of the traditional model, with this value being higher than expected for the segment of bars and restaurants (5.0 to 10.0%) [ 57 ]. In this perspective, a systematic review [ 58 ] showed that of the eight studies with school food services that reported favorable results for health, mainly through a decrease in the sale of unhealthy foods and a simultaneous increase in the sales of healthier products, only one study reported unfavorable commercial viability for this initiative.

In this sense, to ensure the implementation of healthy canteens that are economically viable, it is essential to invest in the training of canteen owners and/or managers [ 59 , 60 ]. In addition, it is essential to draw up an action plan to plan in an organized and gradual manner the changes necessary for the transformation of the school food environment, considering the cost, feasibility, and execution time of the activities, in addition to having the support and encouragement of all actors involved such as parents/guardians, students, teachers, directors, employees and canteen owners [ 61 ]. In this context, documents such as the Food Guide for the Brazilian Population [ 37 ], the Healthy Canteens Manual [ 21 ], and the Practical Guide to a Healthy Canteen [ 62 ] can be used as a reference to help in the process of transforming school canteens into healthier environments.

The results point to the need to establish awareness-raising actions with canteen managers and school directors to deconstruct the idea linked to the low profitability of healthy canteens. In addition, it is necessary to implement national guidelines that guide canteen owners to adapt the marketing of food to promote adequate and healthy food and that consider the local food culture in the school environment, in line with the recommendations of the Food Guide for Brazilian Population [ 37 ], and it is essential to monitor the effectiveness of regulation to achieve the proposed objectives [ 63 ].

It is also expected that the results of this study can be used to guide public policies aimed at promoting adequate and healthy eating, as well as the prevention and control of obesity and other chronic non-communicable diseases in childhood and adolescence, in addition to supporting actions in favor of a health-promoting school food environment, to contribute to the adequate nutritional status of students and, consequently, to their maximum potential for growth and development.

Strengths and limitations

The strengths of our study include the novelty in the analysis of the economic viability of canteens in private schools is considered, especially in the model of canteens that sell healthy foods. In this sense, the results address an existing gap in the literature and provide data that can support legislators and decision-makers in the adoption of strategies aimed at promoting a healthy school food environment.

This study has limitations related to carrying out the research remotely and only in the city of Belo Horizonte, which may not reflect the situation of private canteens in other cities and regions of the country; there is also a memory bias due to the data being self-reported by canteen managers. The research focused on descriptive aspects, not having analyzed fiscal documents, accounting, or management reports related to the sale of products, as well as the costs and expenses of the company. In addition, the questionnaire was not validated and a pilot study was not carried out. However, it is emphasized that this instrument was prepared in partnership with specialists in the areas of Administration, Economic Sciences, Accounting Sciences, International Economic Relations, and Controllership and Finance at the Federal University of Minas Gerais. Finally, the food and drinks offered were not checked since only the menu was analyzed, which may not reflect the reality of all products sold in the canteen, the analysis of the list of ingredients of the culinary preparations and of some foods that did not have the brand described on the menu was not carried out, and the presence of nutritionists on the company’s staff was not investigated, which could influence in the availability of food offered in school canteens.

Healthy school canteens showed better financial and economic results compared to traditional canteens, with emphasis on greater profitability and a shorter recovery time of the initial investment. Traditional canteens demonstrated higher profit margins on the best-selling product and lower infrastructure, disposables, and extra expenses. In the latter model, there was greater commercialization of ultra-processed foods and beverages. The need for actions to clarify the economic and financial feasibility of implementing healthy canteens in school units is reinforced.

Data Availability

The datasets used and/or analysed during the current study available from the corresponding author on reasonable request.

Abbreviations

National School Feeding Program

National School Health Survey

Ultra-processed foods and beverages

Municipal Human Development Index

Minas Gerais State Department of Education

UFMG Consultoria Júnior

Federal University of Minas Gerais

Income statement for the year

Statistical Package for the Social Sciences

Low density lipoproteins cholesterol

High density lipoproteins cholesterol

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Acknowledgements

We thank the Dean of Research of Federal University of Minas Gerais (PRPq/UFMG).

This project was funded by the National Council for Scientific and Technological Development (CNPq), Brasília, Brazil (Granting number: 442851/2019-7).

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LAV and LLM designed the study. LAV collected data, performed the analyses, and drafted the manuscript. BVLC and ASC performed the analyses and were involved in interpreting the data. MZJ, MLCI, and LDB supported writing manuscript and collecting data. All authors reviewed the manuscript.

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Vilela, L.A., de Lima Costa, B.V., Jardim, M.Z. et al. Private school canteens: an analysis of the economic and financial aspects of the traditional and the healthy models. BMC Public Health 23 , 2102 (2023). https://doi.org/10.1186/s12889-023-16965-1

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Research shows LGBTQI+ health-related content in medical school has increased

by Boston University School of Medicine

Reducing barriers to comprehensive and affirming health care for lesbian, gay, bisexual, transgender, queer and intersex (LGBTQI+) populations requires physicians to receive LGBTQI+ health content during undergraduate medical education (UME).

With more than 7% of the U.S. adult population, 4% of the Canadian adult population and 20% of persons in the U.S. ages 18–25 who are LGBTQI+, there is a critical need to train health care professionals on their specific health care needs. LGBTQI+ people experience a higher prevalence of tobacco, alcohol, substance use, and mental health concerns like anxiety, depression and suicidality, as well as elevated cardiovascular disease morbidity and mortality.

The Association of American Medical Colleges (AAMC) recommends core competencies regarding LGBTQI+ health-related content. Researchers at Boston University Chobanian & Avedisian School of Medicine and Boston Medical Center (BMC), report time dedicated to these topics did increase in 2022, as compared to a study done in 2011; but they also found the breadth, efficacy, or quality of instruction continues to vary substantially.

The work is published in the journal BMC Medical Education .

"Despite the increased hours, the numbers still fall short based on recommended LGBTQI+ health competencies from the AAMC," says lead author Carl G. Streed, MD, MPH, FACP, FAHA, associated professor of medicine at the school.

"While most deans of medical education reported their institutions' coverage of LGBTQI+ health as 'fair,' 'good,' or 'very good,' there continues to be a call from UME leadership to increase curricular content. This requires dedicated training for faculty and students," said Streed.

To determine the frequency and extent of institutional instruction in 17 LGBTQI+ health-related topics, strategies for increasing LGBTQI+ health-related content and faculty development opportunities, researchers invited the deans of medical education (or their equivalent) at 214 allopathic or osteopathic medical schools in the U.S. and Canada to complete a 36-question, web-based questionnaire between June 2021 and September 2022.

The responses revealed that the time dedicated to LGBTQI+ health-related content in medical school in 2022 was a median of 11 hours, a significant increase of 6 hours since 2011. However, the number of hours in the required curriculum, as well as number of LGBTQI+ health-related topics covered, remained varied from school to school.

According to the researchers, gaps in UME curricula and outcomes are well documented and persist in the face of calls to action.

"Consequently, student comfort with caring for LGBTQI+ populations has lagged. Similar gaps in knowledge and comfort have been reported internationally. These results are contemporary with our findings, suggesting that even a median of 11 hours of LGBTQI+ content is insufficient," explains Streed, who also is research lead of the GenderCare Center at BMC.

Streed believes that successful incorporation of LGBTQI+ health into UME requires thoughtfully developed LGBTQI+ health competencies and objectives with appropriate instructional methods and assessments to ensure mastery.

"While the optimal solution to improving LGBTQI+ training is likely institution- and context-dependent, without a mandate from governing bodies such as the AAMC we will continue to see a dearth of physicians prepared to care for these populations. Additionally, graduate medical education must complement UME to ensure trainees receive specialty-specific training on LGBTQI+ health."

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ICON conference gives students opportunity to present research - Elmore Family School of Electrical and Computer Engineering - Purdue University

ICON conference gives students opportunity to present research

A conference held by the Institute for Control, Optimization and Networks ( ICON ) at Purdue University recently brought outstanding students together to share their most recent research on a wide variety of topics, such as complex networks, multi-agent system optimization data science for autonomy and control, human-autonomy interaction, and much more. ICON, co-directed by Shaoshuai Mou, Elmer Bruhn Associate Professor in Purdue’s School of Aeronautics and Astronautics, and Shreyas Sundaram, Marie Gordon Professor in the Elmore Family School of Electrical and Computer Engineering, carries the mission of enhancing research collaboration, educational coordination and external engagement at Purdue to address fundamental challenges in autonomous, intelligent and robotics systems

The student-run ICON Student Research Conference , is one major event of ICON’s educational activities. It gave participants the opportunity to network with faculty members and keynote speakers to explore new research avenues and interdisciplinary partnerships.

The conference included two keynote speakers, Andrea Serrani, Professor of Electrical and Computer Engineering from Ohio State University, and Necmiye Ozay, Chen-Luan Family Faculty Development Professor of Electrical and Computer Engineering from the University of Michigan. Serrani delivered a talk entitled “Dynamic Control Allocation: from Theory to Applications through Geometric and Adaptive Control.” Ozay’s talk was called “Formal Methods for Cyber-Physical Systems: State of the Art and Future Challenges.”

ICON also included presentation and poster sessions. The conference served as an invaluable platform for graduate and undergraduate engineering students, offering them the opportunity to gain insights from distinguished academics and connect with peers. This facilitated exposure to cutting-edge developments in the field while fostering valuable networking opportunities.

This was the second ICON Student Research Conference. Student organizers plan to continue it as an annual event. Philip E. Paré, Rita Lane and Norma Fries Assistant Professor of Electrical and Computer Engineering, is the ICON SRC Faculty Advisor,

"The growth between the inaugural ICON Student Research Conference and the second was remarkable,” says Paré. “The whole event was so smooth and well run. I am excited to see how the conference continues to grow in years to come."

The conference is an excellent example of cross-disciplinary collaboration, having been organized entirely by graduate students from across the College of Engineering within ICON :

Ian Walter: ECE, 4th year PhD, General co-chair and Logistics co-chair. Alex Shi: AAE, 3rd year PhD, General co-chair and Presentation co-chair. Madeleine Yuh: ME, 4th year PhD, Team Coordinator and Poster co-chair. Antonio Valdivia: ME, 3rd year PhD, Logistics co-chair. Pranoy Das: ECE, 2nd year PhD, Logistics co-chair. Sheeraz Athar: IE, 3rd year PhD, Presentation co-chair. Sibibalan Jeevanandam: ME, 2nd year PhD, Presentation co-chair. Ritika Sachdeva: ECE, 1st year MS, Poster co-chair. Shaurya Shrivastava: AAE, 2nd year PhD, Poster co-chair Pandu Dewanatha: ME, 2nd year MS, Photographer.

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UW’s School of Energy Resources Launches ‘Energy Frontier’ Podcast

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Institutional Communications Bureau of Mines Building, Room 137 Laramie, WY 82071 Phone: (307) 766-2929 Email:   [email protected]

Published May 08, 2024

The inaugural episode -- hosted by Kara Fornstrom, director of SER’s Center for Energy Regulation and Policy Analysis -- introduces listeners to the permanent podcast host, SER Executive Director Holly Krutka, and is set to air today (May 8).

In the pilot episode, listeners can learn more about Krutka, SER and the goals of launching the podcast.

“The energy industry is fundamentally entrenched in Wyoming while, at the same time, it is dynamic, transformative and ever-expanding,” Fornstrom says. “We wanted a platform for listeners to become more familiar with Wyoming’s intimate history with energy, as well as an opportunity to learn more about emerging technologies and the landscape of Wyoming’s energy future.”

Nestled at the heart of innovation and education at UW, SER is dedicated to energy-driven economic development for the state of Wyoming. SER directs and integrates cutting-edge energy research and academic programs at UW, and bridges academics and industry through targeted outreach programs. 

“SER is constantly exploring new opportunities to share what we and our collaborators across UW and Wyoming are up to, and we’re hoping this podcast reaches the far corners of Wyoming and beyond, to help folks understand all that is being done to positively impact the Cowboy State,” Krutka says. “We place a high value on transparency, education and engagement. If you at all are interested in energy innovation and education in Wyoming, we hope you will tune in.”

Ultimately, the podcast examines energy trends, offers fresh insights and promotes a better understanding of today’s energy issues, solutions and careers, she says.

“Energy has really propelled the development of civilization and yet is something that can be easily taken for granted,” Krutka adds. “Now, we have a new way to share entertaining discussions on the how and the why and address important topics, such as what new technologies will mean for Wyoming and its workforce.”

Topics to be covered include nuclear, oil and gas, coal and carbon engineering, and carbon capture utilization and storage, as well as education, leadership, land management, policy and regulation, and tax frameworks.

With episodes initially scheduled to be released weekly, the podcast will be available to stream on all audio platforms and will be accessible through the SER website at www.uwyo.edu/ser .