Implementation of school meal guidelines is often inadequate, and evidence for effective implementation strategies for school-based nutrition interventions is limited. The aim of the present study was to examine the implementation and effectiveness of a multi-strategy implementation intervention to increase adherence to the Norwegian national school meal guideline.

The study was a school-based hybrid implementation effectiveness trial with a pre–post non-equivalent control group design, testing three implementation strategies: internal facilitation, training and an educational meeting.

Primary schools and after-school services in two counties in south-east Norway.

School principals, after-school leaders and class teachers from thirty-three schools in the intervention county and principals and after-school leaders from thirty-four schools in a comparison county.

There was a significant difference of 4 percentage points in change scores between the intervention and the comparison groups at follow-up, after adjusting for baseline adherence (B = 0·04, se B = 0·01, t = 3·10, P = 0·003). The intervention effect was not associated with the school’s socio-economic profile. School-level fidelity was the implementation dimension that was most strongly correlated (rs = 0·48) with the change scores in the intervention group, indicating that principals’ support is important for gaining the largest intervention effects.

A school-based intervention with low intensity, based on trained teachers as internal facilitators, can increase adherence to the national school meal guideline among Norwegian primary schools, irrespective of local socio-economic conditions. Implementation fidelity, at an organisational level, may be a useful predictor for intervention outcomes in schools.

Drinking water instead of beverages with added sugar can help prevent obesity and cavities and promote overall health. Children spend much of their day in school, where they have variable access to drinking water. In 2010, federal and state law required California public schools to provide free potable water to students in areas where meals are served and/or eaten. The current study aims to identify factors associated with an excellent drinking water culture in schools.

A qualitative assessment of barriers and facilitators to providing excellent water quality and access in a purposive sample of California schools. In-depth interviews with key informants were conducted using a snowball sampling approach, after which data were analysed using both inductive and deductive methods.

California public elementary, middle/junior and high schools.

Knowledgeable individuals involved in initiatives related to school drinking water accessibility, quality or education at each selected school.

Thirty-four interviewees participated across fifteen schools. Six themes emerged as prominent facilitators to a school’s success in providing excellent water access to students: active and engaged champions, school culture and policy, coordination between groups, community influences, available resources and environmentalism.

While policy is an important step for achieving minimum standards, resources and interest in promoting excellence in drinking water access and quality can vary among schools. Ensuring that schools have dedicated staff committed to advancing student health and promoting the benefits of water programs that are more salient to schools could help reduce disparities in drinking water excellence across schools.

Results of the WHO European Childhood Obesity Surveillance Initiative indicated that on average one out of four primary-school children is overweight or obese. Portugal presented one of the highest prevalences of obesity. Childhood obesity prevention and treatment should be a top priority. The aim of the present study was to evaluate the effectiveness of Program Obesity Zero (POZ), a multi-component, community-, family- and school-based childhood obesity intervention.

Parents and children attended four individual nutrition and physical activity counselling sessions, a one-day healthy cooking workshop and two school extracurricular sessions of nutrition education. Waist circumference, BMI, physical activity level, sedentary behaviours, and nutrition and physical activity knowledge, attitudes and behaviour were assessed at baseline and after 6 months. Diet was assessed using two 24 h recalls, at baseline and at 6 months.

Five Portuguese municipalities and local communities.

Two hundred and sixty-six overweight children (BMI ≥ 85th percentile) aged 6–10 years, from low-income families in five Portuguese municipalities, were assigned to the intervention.

Children showed reductions in waist circumference (−2·0 cm; P < 0·0001), mean BMI (−0·7 kg/m2; P < 0·0001) and BMI-for-age percentile (−1·7; P < 0·0001) at 6 months. Overall, children's intake of fruit and vegetables was <400 g/d throughout the intervention. After 6 months, higher fibre consumption and an apparent decrease in sugary soft drinks intake to a quarter of that observed at baseline (mean intake: 198 ml/d at baseline), with improvements in physical activity levels and screen time <2 h/d, were also observed.

The findings suggested that POZ is a promising intervention programme, at municipality level, to tackle childhood overweight and obesity.

To assess lunchtime provision of food and drink in English primary schools and to assess both choices and consumption of food and drink by pupils having school lunches. These findings were compared with similar data collected in 2005.

Cross-sectional data collected between February and April 2009. In each school, food and drink provision, including portion weights and number of portions of each item served at lunchtime, were recorded over five consecutive days. Caterers provided school lunchtime menus and recipes.

England.

A random selection of 6696 pupils having school lunches in a nationally representative sample of 136 primary schools in England.

Compared with 2005, schools in 2009 provided significantly more fruit, fruit-based desserts, vegetables and salad, water and fruit juice, and less ketchup, sauces and gravy, starchy foods cooked in fat, snacks and confectionery (P < 0·01). Pupils were also making healthier choices, choosing an average of 2·2 portions of fruit and vegetables from their ‘five a day’, but about one-third to two-fifths of these were wasted.

Lunchtime food provision and consumption in primary schools have improved substantially since 2005, following the introduction of new standards for school food in 2008. However, improvements still need to be made to increase the Fe and Zn content and to decrease the Na content of recipes, and in encouraging pupils to eat more of the fruits and vegetables taken at lunchtime.

To evaluate the long-term effects of the Schoolgruiten Project, a Dutch primary school-based intervention providing free fruit and vegetables (F&V). In addition, we assessed whether children’s appreciation of the project mediated these intervention effects.

Participating schoolchildren (mean age 9·9 years at baseline) and their parents completed parallel questionnaires at baseline, at 1-year and at 2-year follow-up, including questions on usual F&V intake of the child, potential behavioural determinants, their appreciation of the project and general demographics. Primary outcomes were usual F&V intakes as assessed by parent and child self-reported food frequency measures. Secondary outcome measures were taste preference, knowledge of daily recommendations, availability and accessibility for fruit intake. Multilevel linear regression analyses were used to assess differences at second follow-up adjusted for baseline values between control and intervention groups.

Reports were available for 346 intervention children (148 parents) and 425 control children (287 parents).

Both child and parent reports indicated that the intervention group had a significantly higher fruit intake at 2-year follow-up (difference, servings/d: 0·15; 95 % CI 0·004, 0·286 for child reports; 0·19; 95 % CI 0·030, 0·340 for parent reports). No significant effects on vegetable intake were observed. Significant positive intervention effects were also found for knowledge of fruit recommendations among boys. Some evidence was found for partial mediation analyses of the effects on fruit intake.

The present study indicates that the Schoolgruiten scheme was effective in increasing children’s fruit intake and that appreciation of the project partially mediated this effect.

Although many school-based diet and physical activity interventions have been designed and evaluated, relatively few have been tested for the after-school setting. After-school day-care programmes at either elementary schools or private locations provide a ready-made opportunity for health programmes that may be difficult to incorporate into an already-full school day. The purpose of this paper is to report on a pilot study of an after-school adaptation of the CATCH (Coordinated Approach To Child Health) elementary school programme called the CATCH Kids Club (CKC).

The CKC was pilot-tested and formatively evaluated in 16 Texas after-school programmes: eight in El Paso and eight in Austin (four intervention and four reference sites each). Evaluation consisted of direct observation of moderate to vigorous physical activity during play time, self-reported food intake and physical activity, and focus group interviews with after-school programme staff.

Students responded well to the physical activity and snack components and were less interested in the five-module education component. Routine staff training was a key variable in achieving proper implementation; the ideal would be a full day with repeated follow-up model teaching visits. Staff turnover was a logistic issue, as was programme leader readiness and interest in conducting the programme. Strong and significant effects were observed for the physical activity but not for the education component. The results of the physical education component suggest it is feasible, effective and ready for larger-scale evaluation or dissemination.