Exploring the Cross-Sectional Relationship Between Implementation Supports for Adopting Nutrition Standards and the Nutritional Quality of School Lunches Served

The evidence-based nutrition standards of the Healthy, Hunger-Free Kids Act of 2010 significantly improved school meal nutrition, yet little is known about how school food authorities (SFAs) were supported to translate the standards into practice in schools. This study tested whether or not 2 implementation supports, SFA receipt of training/technical assistance (TA) and purchase of new equipment, for implementing the nutrition standards were associated with the nutritional quality of school lunches. This study used a cross-sectional design. The study sample included 365 SFAs derived from the US Department of Agriculture’s School Nutrition and Meal Cost Study (2014 to 2015 school year), the only national data of school nutrition environments since the Healthy, Hunger-Free Kids Act of 2010. Implementation supports included reported participation in training/TA and the purchase of new equipment between the 2012 to 2013 (year of policy adoption) and 2014 to 2015 school years. The primary outcome, nutritional quality of school lunches served, was defined as low/high Healthy Eating Index 2010 scores during the 2014 to 2015 school year. Secondary implementation supports included the number of areas covered by training/TA, the adequacy of training/TA, and the degree of implementation challenges. Multivariable-adjusted logistic regression models assessed if receipt of implementation supports was associated with lunch Healthy Eating Index 2010 scores. The median lunch Healthy Eating Index 2010 score was 81.7 (95% CI 80.4 to 82.9). Most SFAs (78.4%, 95% CI 72.0% to 85.0%) reported having participated in training/TA and one-third (33.8%, 95% CI 24.4% to 43.2%) reported having purchased new equipment—neither were associated with the odds of having higher Healthy Eating Index 2010 scores for lunches served at the time of data collection. Many SFAs accessed implementation supports to adopt the nutrition standards. Information on dose, quality, and nutrition-related impact of implementation supports using measures of change are needed to determine how best to support SFAs with implementation of new nutrition standards.