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Teacher attitudes, perceived influences, and self-reported classroom behaviors related to school nutrition environments

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Title:
Teacher attitudes, perceived influences, and self-reported classroom behaviors related to school nutrition environments
Physical Description:
Book
Language:
English
Creator:
Girard, Beverly
Publisher:
University of South Florida
Place of Publication:
Tampa, Fla
Publication Date:

Subjects

Subjects / Keywords:
Local Wellness Policy
Classroom Rewards
Efficacy
Education
Child Nutrition
Dissertations, Academic -- Curriculum and Instruction -- Masters -- USF   ( lcsh )
Genre:
non-fiction   ( marcgt )

Notes

Abstract:
ABSTRACT: This study determined attitudes of kindergarten through fifth grade teachers about school nutrition environments, their perceived influence on school nutrition environments, and self-reported classroom behaviors. Specific objectives were to: (a) identify perceived factors that influence the school nutrition environment, according to teachers surveyed; (b) examine relationships between elementary school teacher attitudes about school nutrition environments and perceived influence on the environment; (c) examine relationships between elementary school teachers' attitudes about school nutrition environments, and self-reported classroom behaviors; (d) examine relationships between perceived influence over the school nutrition environment and self-reported classroom behaviors; and, (e) examine relationships between teachers' demographic characteristics and attitudes and perceived influence on school nutrition environments, and self-reported classroom behaviors. Research was conducted in a mid-size Florida school district including 501 participants from 23 elementary schools. The Teacher Survey on School Nutrition Environments instrument was developed and validated by the researcher. Teachers identified the Food and Nutrition Services department as having the greatest impact on school nutrition environments, followed by student lunches and snacks sent from home. Responses to open-ended questions identified parents as part of the problem in developing healthy school nutrition environments. The Food and Nutrition Services department and parents were identified as having primary responsibility for encouraging healthy food choices at school, followed by administration, then teachers. Teachers did not perceive opportunities to provide input or to impact the school nutrition environment beyond their classrooms. The greater self-efficacy the teachers possessed, the more they felt they influenced the nutrition environment, and the more likely they were to offer menu suggestions, to sit or eat with students, to discuss food-related topics, and to integrate nutrition into lessons. Similar results were noted for teachers with college coursework in nutrition and those who were more experienced teachers. Classroom teachers should be encouraged to become involved and to recognize their role in developing and maintaining a healthy school nutrition environment. Increased communication should occur between school nutrition programs and teachers. Local wellness policy development and implementation should emphasize teachers' influence.
Thesis:
Dissertation (PHD)--University of South Florida, 2010.
Bibliography:
Includes bibliographical references.
System Details:
Mode of access: World Wide Web.
System Details:
System requirements: World Wide Web browser and PDF reader.
Statement of Responsibility:
by Beverly Girard.
General Note:
Title from PDF of title page.
General Note:
Document formatted into pages; contains X pages.

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University of South Florida
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usfldc doi - E14-SFE0004757
usfldc handle - e14.4757
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SFS0028049:00001


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ABSTRACT: This study determined attitudes of kindergarten through fifth grade teachers about school nutrition environments, their perceived influence on school nutrition environments, and self-reported classroom behaviors. Specific objectives were to: (a) identify perceived factors that influence the school nutrition environment, according to teachers surveyed; (b) examine relationships between elementary school teacher attitudes about school nutrition environments and perceived influence on the environment; (c) examine relationships between elementary school teachers' attitudes about school nutrition environments, and self-reported classroom behaviors; (d) examine relationships between perceived influence over the school nutrition environment and self-reported classroom behaviors; and, (e) examine relationships between teachers' demographic characteristics and attitudes and perceived influence on school nutrition environments, and self-reported classroom behaviors. Research was conducted in a mid-size Florida school district including 501 participants from 23 elementary schools. The Teacher Survey on School Nutrition Environments instrument was developed and validated by the researcher. Teachers identified the Food and Nutrition Services department as having the greatest impact on school nutrition environments, followed by student lunches and snacks sent from home. Responses to open-ended questions identified parents as part of the problem in developing healthy school nutrition environments. The Food and Nutrition Services department and parents were identified as having primary responsibility for encouraging healthy food choices at school, followed by administration, then teachers. Teachers did not perceive opportunities to provide input or to impact the school nutrition environment beyond their classrooms. The greater self-efficacy the teachers possessed, the more they felt they influenced the nutrition environment, and the more likely they were to offer menu suggestions, to sit or eat with students, to discuss food-related topics, and to integrate nutrition into lessons. Similar results were noted for teachers with college coursework in nutrition and those who were more experienced teachers. Classroom teachers should be encouraged to become involved and to recognize their role in developing and maintaining a healthy school nutrition environment. Increased communication should occur between school nutrition programs and teachers. Local wellness policy development and implementation should emphasize teachers' influence.
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Teacher Attitudes, Perceived Influences, and Self-Reported Cl assroom Behaviors Related to School Nutrition Environments by Beverly Lawler Girard A dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy Department of Interdisciplinary Education College of Education University of South Florida Major Professor: Waynne B. James, Ed.D. Victor Hernandez-Gantes, Ph.D. Arthur Shapiro, Ph.D. William Young, Ed.D. Date of Approval: November 4, 2010 Keywords: Local Wellness Policy, Classroom Rewards, Efficacy, Education, Child Nutrition Copyright 2010, Beve rly Lawler Girard

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Dedication To Ellery . your love, support, and co mmitment are unequalled. We have been through so much together, yet you always k eep your smile and upbeat attitude. You are an amazing gift, and I will be forever grateful that you are my husband and my very best friend. Thank you for every cup of coffee and every meal you made while I toiled away in front of the computer. It is my turn to give back to you. To Mom and Dad . your sacrifices for your family remain an amazing testament to your love for God and family. Mom, thank you example of compassion and for helping me realize my potential and making me want to continue to strive for my goals. Dad, you are no longer with us, but I will always be grateful for the example of hard work and dedication you provided to each of us. I have been blessed in life to be your daughter. To Dr. Waynne James . thank you for taking me on as your student. You are the perfect example of teacher, mentor, and friend.

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Acknowledgements My sincere thank you to my committee me mbers who helped me complete my doctoral program. Dr. Waynne B. James was my rock, who helped me to navigate the system and to keep my dream alive to completion. There are not enough words to describe the compassion and dedication Dr. James has for her students. Dr. Arthur Shapiro was supportive and encouraging, and has allowed me to view my own work with a more critical eye. Dr. Victor Hernandez-Gant es motivated me to dig further, to look for connections, and to fully develop my written work. Dr. Bill Young inspired me to see the possibilities that my research may have for the future of my chosen field of work. Thank you to the teachers who participat ed in this study, whose interest in children and school nutrition environments allo wed me to present this research. Thank you to the principals who supported the rese arch, and district leadership and my colleagues in Sarasota, who believed in me, and gave me the opportunities to obtain my Ph.D. while working in a position I love with in the School Board of Sarasota County. Thank you to the central staff and every em ployee of Food and Nutrition Services. The work you do every day inspired me to select this topic. Your efforts on behalf of children are tireless, and your contribu tions worthy. God bless each of you. Thank you, my friends at New Hope, w ho provided constant encouragement. Thank you, God, for hearing my late night prayers, especially when Ellery was sick. Alone, I would have never completed this dissertation, but with God, all things are possible (Matthew 19: 26). The Lord is my strength and my song (Exodus 15: 2).

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i Table of Contents List of Tables................................................................................................................. ....iv Abstract....................................................................................................................... .......ix Chapter 1: Introduction....................................................................................................... 1 Background of the Problem.....................................................................................5 Statement of the Problem.........................................................................................7 Purpose of the Study..............................................................................................10 Research Questions................................................................................................11 Significance of the Study.......................................................................................11 Theoretical Framework..........................................................................................12 Limitations.............................................................................................................13 Definition of Terms................................................................................................13 Organization of the Study......................................................................................15 Chapter 2: Review of the Literature..................................................................................17 Ecological Systems Theory....................................................................................18 Macrosystem..............................................................................................20 School Nutrition Policies...............................................................20 A National Perspective on Nutrition Education.............................30 Exosystem..................................................................................................33 External Influences on Children’s Nutrition..................................33 Mesosystem................................................................................................36 School Nutrition Environment.......................................................36 Factors that Influence Food Intake................................................46 Teacher Surveys of School Nutrition Programs............................56 Microsystem...............................................................................................62 Nutrition and Achievement............................................................63 Teacher Attitudes, Influence, Behavi ors, and Demographic Characteristics........68 Attitudes.....................................................................................................68 Influence....................................................................................................74 Behaviors...................................................................................................77 Classroom Rewards.......................................................................80 Teacher Characteristics..............................................................................83 Social Cognitive Theory........................................................................................87 Summary................................................................................................................91 Chapter 3: Methods...........................................................................................................9 3 Research Design.....................................................................................................94

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ii Population..............................................................................................................95 Instrumentation......................................................................................................96 Development of the Survey.......................................................................97 Development of Demographic a nd Meal Participation Questions…......100 Use of the Survey Instrument......................................................102 Field Testing............................................................................................103 Validity....................................................................................................103 Reliability.................................................................................................104 Collection of Data................................................................................................104 Data Analysis Procedures....................................................................................105 Summary of Methods...........................................................................................108 Chapter 4: Findings.........................................................................................................10 9 Characteristics of Participants..............................................................................110 Results..................................................................................................................114 Teacher Participation in the School Meals Program................................114 Variables Influencing Sc hool Nutrition Environment.............................117 Attitude Descriptive Results........................................................117 Perceived Influence Descriptive Results.....................................127 Self-Reported Behavior Descriptive Results...............................131 Relationship of Attitudes and Perceived Influence..................................137 Relationship Between Attitudes and Self-Reported Classroom Behaviors...........................................................................................141 Relationship Between Perceived Influence and Self-Reported Classroom Behaviors.........................................................................144 Relationship Between Teacher Characteristics, Attitudes, Perceived Influence, and Self-R eported Classroom Behaviors.........158 Teacher Demographic Fact ors and Teacher Attitudes.................159 Teacher Demographic Fact ors and Perceived Influence.............166 Teacher Demographic Factors and Self-Reported Behaviors......173 Teacher Responses to Open-Ended Questions........................................177 Observations from the Study...................................................................178 Observations on the Survey Instrument.......................................179 Summary..............................................................................................................181 Chapter 5: Summary, Conclusions, Im plications, and Recommendations......................183 Summary of the Study.........................................................................................184 Conclusions..........................................................................................................185 Attitudes, Perceived Influence, and Self-Reported Behaviors.................185 Attitudes and Perceived Influence ..........................................................186 Attitudes and Self-Reported Classroom Behaviors.................................187 Perceived Influence and Self -Reported Classroom Behaviors................188 Demographic Characteristics, Atti tudes, Perceived Influence, and Self-Reported Classroom Behaviors .................................................188 Implications..........................................................................................................189 Implications for Teachers and Teacher Preparation ...............................189

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iii Implications for Child Nutrition Personnel .............................................191 Implications for School and Sc hool District Administrators ..................193 Implications for Parents ..........................................................................193 Implications for Local We llness Policy Implementation ........................194 Recommendations for Further Research .............................................................195 References..................................................................................................................... ...198 Appendices..................................................................................................................... ..212 Appendix A: Local Wellness Policy Frequently Asked Questions...................213 Appendix B: Nutrition Educator Observations.................................................215 Appendix C: Teacher/Administrat or School Foodservice Survey (Meyer, 2002)..............................................................................217 Appendix D: Draft of Teacher Surv ey on School Nutrition and Healthy School Nutrition Environments...................................................220 Appendix E: Draft of Copy of NFSMI Permission Letter................................233 Appendix F: Signed Permission Letter.............................................................234 Appendix G: Directions for Validation and Usability by Elementary Principals and School F ood Service Directors.............................235 Appendix H: Names of Expert Panel Members................................................237 Appendix I: Directions for Valida tion and Usability of Instrument by Expert Panel.................................................................................238 Appendix J: Principa l Notification Letter........................................................240 Appendix K: Teacher Survey on School Nutrition Environments....................241 Appendix L Teacher Responses to Open-Ended Questions............................252 About the Author ............................................................................................End Page

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iv List of Tables Table 1. Survey Items Linked to Attitudes, Perceived Influence, and SelfReported Behaviors........................................................................................106 Table 2. Number and Percentage of El ementary Teachers Compared to Survey Responders.....................................................................................................111 Table 3. Demographic Character istics of Teacher Responders...................................113 Table 4. Teacher Self-Reported Particip ants and Reasons for Participation in the School Breakfast and Lunch Programs....................................................114 Table 5. Summary of Participants’ Res ponses to Item 16 Regarding Barriers for Integrating Nutrition Education ....................................................................118 Table 6. Summary of Participants’ Res ponses to Item 17 Regarding Impact on School Nutrition Environment.......................................................................119 Table 7. Item 19: Entity with Responsibility to Encourage Healthy Food Choices at School...........................................................................................119 Table 8. Item 20: Entity with Responsibility to Encourage Healthy Food Choices in Cafeteria.......................................................................................120 Table 9. Item 21: Entity with Responsibility to Encourage Healthy Food Choices in Classroom....................................................................................121 Table 10. Item 22: Healthy Nutri tion Environment in School, School’s Cafeteria, and Classroom...............................................................................122 Table 11. Item 24: Influence of Ha ving Candy or Sweets as Rewards in the Classroom......................................................................................................122 Table 12. Items 30: Factors Determin ing Student Rewards Provided in the Classroom......................................................................................................123 Table 13. Item 33: Teacher Provided Opportunity for Input and Impact Nutrition Environment...................................................................................................124

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v Table 14. Item 35: Level of Difficu lty Providing Nutrition Environment in School and Classroom....................................................................................125 Table 15. Item 36: Barriers to Provid ing a Healthy Nutrition Environment at School............................................................................................................125 Table 16. Item 37: Barriers to Providi ng a Healthy Nutrition Environment in the Cafeteria.........................................................................................................126 Table 17. Item 38: Barriers to Providi ng a Healthy Nutrition Environment in the Classroom......................................................................................................127 Table 18. Item 18: Top Three Factors in Which Teachers Have the Most Influence........................................................................................................128 Table 19. Item 23: Teacher Influen ces Nutrition Environment at School, Cafeteria, and Classroom...............................................................................129 Table 20. Item 25: Teacher Influence on Snack Choices and Sweets Available in Their Classrooms ..........................................................................................129 Table 21. Item 39b and c: Children Imita te Others and Teachers Should Model Healthy Eating ..............................................................................................130 Table 22. Item 40: Teacher Can Make a Difference in Providing a Healthy Nutrition Environment ..................................................................................131 Table 23. Item 15: Teacher Behavior s Relative to Making Menu Suggestions, Eating with Students, Discussing Fo od-Related Topics in Classroom and Integrating Nutrition into Lessons .........................................................132 Table 24. Item 26: Frequency of Stude nt Rewards Consisting of Food or Candy in the Classroom............................................................................................133 Table 25. Item 27: Single Food Item Pr ovided Most Often for Student Rewards in the Classroom............................................................................................134 Table 26. Item 28: Frequency to Wh ich Celebrations Include Food and/or Candy in the Classroom.................................................................................134 Table 27. Item 29: Single Food Item Pr ovided Most Often for Celebrations in the Classroom.................................................................................................135 Table 28. Item 32: Rewards Provi ded Most Often in the Classroom...........................136

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vi Table 29. Items 17 and 18: Top Thr ee Factors Impacting School Nutrition Environment and Perceived Teacher Influence.............................................138 Table 30. Items 22 and 23: Degree to Which Healthy Nutrition Environment Exists and Perceived Teacher Influence........................................................139 Table 31. Items 24 and 25: Impact of Candy or Other Sweets on Student Behavior and Eating Habits and Perceived Teacher Influence......................141 Table 32. Items 15d and 16a, b, c, d, e, and f: Barriers to Integrating Nutrition into Lessons and Degree to Which Teacher Integrates Nutrition into the Lessons.....................................................................................................142 Table 33. Items 35a and b and 41: Diffi culty in Providing a Healthy Nutrition Environment in School and Classroo m and Teacher Approach to Own Healthy Eating...............................................................................................144 Table 34. Items 15a and 23: Teacher Discusses Menu Prior to Lunch and Perceived Teacher Influence..........................................................................146 Table 35. Items 15b and 23: Teacher Sits or Eats with Students during Lunch and Perceived Teacher Influence...................................................................147 Table 36. Items 15c and 23: Teacher Discusses Food-Related Topics in Classroom and Perceived Teacher Influence.................................................147 Table 37. Items 15d and 23: Teacher In tegrates Nutrition into Lessons and Perceived Teacher Influence..........................................................................148 Table 38. Items 15a and 25a and b: T eacher Makes Menu Suggestions Prior to Lunch and Teacher Influence over Snack Choices, Candy, and Sweets in the Classroom............................................................................................149 Table 39. Items 15b and 25a and b: Teach er Sits and Eats Lunch with Students and Teacher Influence over Snack Choices, Candy, and Sweets in the Classroom......................................................................................................150 Table 40. Items 15c and 25a and b: Teacher Discusses Food-Related Topics in the Classroom and Teacher Influence over Snack Choices, Candy, and Sweets in the Classroom................................................................................151 Table 41. Items 15d and 25a and b: Teach er Integrates Nutrition into Lessons and Teacher Influence over Snack Choices, Candy, and Sweets in the Classroom......................................................................................................152

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vii Table 42. Items 15a, b, c, d and 34b: Pe rceived Influence Related to Teacher Making Menu Suggestions, Eating w ith Students, Discussing FoodRelated Topics, and Integrat ing Nutrition into Lessons................................153 Table 43. Items 15a, b, c, d and 39 c: Responsibility to Mo del Healthy Eating Related to Making Menu Suggest ions, Eating with Students, Discussing Food-Related Topics, an d Integrating Nutrition into Lessons...........................................................................................................154 Table 44. Items 15a and 40: Teacher Makes Menu Suggestions Prior to Lunch and Teacher Can Make a Difference in Providing a Healthy Nutrition Environment...................................................................................................155 Table 45. Items 15b and 40: Teacher Sits or Eats with Student during Meals and Teacher Can Make a Difference in Providing a Healthy Nutrition Environment...................................................................................................156 Table 46. Items 15c and 40: Teacher Discusses Food-Related Topics in Classroom and Teacher Can Make a Difference in Providing a Healthy Nutrition Environment...................................................................................157 Table 47. Items 15d and 40: Teacher In tegrates Nutrition into Lessons and Teacher Can Make a Difference in Providing a Healthy Nutrition Environment...................................................................................................158 Table 48. Demographic Characteristics and Item 16 Regarding Barriers to Integrating Nutrition Education.....................................................................160 Table 49. Demographic Characteristics and Item 17 Regarding Impacts of School Nutrition Environment.......................................................................161 Table 50. Demographic Characteristics a nd Item 22 Regarding Healthy Eating..........162 Table 51. Demographic Characteristics and Item 24 Regarding Influence of Candy or Sweets as Rewards in the Classroom.............................................163 Table 52. Demographic Characteristic s and Item 35 Regarding Level of Difficulty in Providing a Healthy Nutrition Environment.............................165 Table 53. Demographic Characteristics and Item 39a Regarding Impact of Nutrition and Healthy Eating on Child’ s Ability to Learn and Perform........166 Table 54. Demographic Characteristic s and Item 18a Re garding Factors Teachers Most Influence................................................................................167

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viii Table 55. Demographic Characteristic s and Item 23 Regarding Teacher Influence on Nutrition Education...................................................................168 Table 56. Demographic Characteristic s and Item 25 Regarding Teacher Influence of Snack Choices and Sweets Available in Classrooms................169 Table 57. Demographic Characteristic s and Item 34b Regarding Teacher Influence in Promoting Healthy Eating Behaviors in Students.....................170 Table 58. Demographic Characteristic s and Item 39b and 39c Regarding Children Imitate Eating Behavi ors and Teachers Should Model Healthy Eating...............................................................................................171 Table 59. Demographic Characteristics and Item 40 Regarding Teachers Can Make a Difference in Providing a Healthy School Nutrition Environment...............172 Table 60. Demographic Characteristic s and Item 15 Regarding Teacher Behaviors Related to Making Menu S uggestions, Eating with Students, Discussing Food-Related Topics in the Classroom and Integrating Nutrition into Lessons....................................................................................174 Table 61. Demographic Characteristic s and Item 39d Regarding Teachers Modeling Healthy Eating Habits to Their Students.......................................175 Table 62. Demographic Characteristics and Item 41 Regarding Teachers Own Approach to Healthy Eating...........................................................................176

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ix Abstract This study determined attitudes of kindergarten through fifth grade teachers about school nutrition environments, their pe rceived influence on school nutrition environments, and self-reported classroom beha viors. Specific objectives were to: (a) identify perceived factors that influence th e school nutrition environment, according to teachers surveyed; (b) examine relationships between elementary school teacher attitudes about school nutrition environments and pe rceived influence on the environment; (c) examine relationships between elementary school teachers’ attitudes about school nutrition environments, and self -reported classroom behaviors; (d) examine relationships between perceived influence over the school nutrition environmen t and self-reported classroom behaviors; and, (e) examine relationships between teachers’ demographic characteristics and attitudes and perceived influence on school nutrition environments, and self-reported classroom behaviors. Research was conducted in a mid-size Florida school distri ct including 501 participants from 23 elementary schools. The Teacher Survey on School Nutrition Environments instrument was develope d and validated by the researcher. Teachers identified the Food and Nutriti on Services department as having the greatest impact on school nutrition environmen ts, followed by student lunches and snacks sent from home. Responses to open-ended que stions identified parents as part of the problem in developing healt hy school nutrition environments The Food and Nutrition Services department and parents were iden tified as having primary responsibility for

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x encouraging healthy food choices at school, followed by administration, then teachers. Teachers did not perceive opportunities to prov ide input or to impact the school nutrition environment beyond their classrooms. The greater self-efficacy the teachers possessed, the more they felt they influenced the nutrition environment, and th e more likely they were to offer menu suggestions, to sit or eat with students, to discuss food-related topi cs, and to integrate nutrition into lessons. Similar results were noted for teachers with college coursework in nutrition and those who were more experienced teachers. Classroom teachers should be encouraged to become involved and to recognize their role in developing and maintaining a healthy school nutrition environment. Increased communication should occur between school nutrition programs and teachers. Local wellness policy development and implementation should emphasize teachers’ influence.

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1 Chapter 1 Introduction Teachers may not be actively engaged in addressing the issues of childhood nutrition (Baxter, 1998; Gross & Cinelli, 2004; MacLellan, Taylor, & Freeze, 2009; Murimi, Sample, & Hunt, 2008), even though th ese issues are featured in the media almost daily, and childhood obesity has been declared a national health emergency (Ebbeling, Pawlak, & Ludwig, 2002; Larson & Story, 2010; Ogden, Carrroll, Curtin, McDowell, Tabak, & Flegal, 2006). Resear ch conducted by Hartline-Grafton, Rose, Johnson, Rice, and Webber (2009) suggests th at some teachers and school personnel may actually serve as negativ e role models to children con cerning nutrition, wei ght status, and overall health status. Second only to parents, elementary teacher s influence children to attempt and/or accept new food items in ways that the teach ers themselves may not be aware (Hendy & Raudenbush, 2000; Savage, Fisher, & Birch, 2007) The role of school board members, district superintendents, prin cipals, food service directors, parents, and students regarding influence on child nutrition programs and diet ary development exists in the literature (Brown, Akintobi, Pitt, & Berends, 2004; Cho & Nadow, 2004; Fisher, Mitchell, Smiciklas-Wright, & Birch, 2002), but few studi es have considered the role of the teacher. Rafiroui and Evans ( 2005) suggest that inadequate attention has been paid to teachers and that a “gap in the literature” ( p. 30) exists regarding teachers’ influence on dietary behavior development in children.

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2 Due to the regular contact teachers have w ith students, teachers have the potential to influence children’s dietary behaviors, as reported by Killen, Telch, and Robinson over 20 years ago in 1988, and more recently by Mu rimi, Sample, and Hunt in 2008. Teachers can facilitate nutriti on education and healthy eating ha bit development through formal instruction and, informally, as role models. Perez-Rodr igo and Aranceta (2003) claim that nutrition educati on and promotions geared for childr en must address the role of the teacher, and must be creative, engaging, inexpe nsive, and widely disseminated. Earlier studies by Contento, Balch, Bronner, and Maloney (1995) and Lytle (1994) cautioned that nutrition educat ion that increases knowledge without a focus on behavioral change has short-term effects, at best, and is insufficient to make long-term changes. The environment in which a child receive s information and is encouraged to develop and practice good habits provides the basis of the he althy school nutrition environment (USDA, 2001). A healthy school nutrition environment is one in which nutrition and physical activity are taught and sup ported in the classroom, in the cafeteria, and throughout the school. Positive messages are provided and students have opportunities to practice healthy ha bits. The United States De partment of Agriculture has identified six components of an healthy school nutrition environment (USDA, 2003). The six components are: a commitment to nu trition and physical ac tivity, quality school meals, other healthy food choices, pleasant eating experiences, nut rition education, and marketing. An approach originally conceived to ai d in the promotion of a healthy school nutrition environment, with at tention to behavior modification, is the local wellness policy. The Child Nutrition Reauthorization Ac t of 2004 required each school district in

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3 the United States participating in the Nationa l School Lunch Program (NSLP) to have its own unique, school board-approved local wellness policy by July 1, 2006 to address the issue of school-based nutrition and physical ac tivity programs. The implementation of the policy and broad variations of interpretation from state to state a nd within states are problematic. The development of local welln ess policies, which we re intended to bring direction and clarity to school nutrition and physical activity issues within schools and local school districts, may have had the uni ntended effect of addressing key issues without providing answers to the toughest questions of implementation (Longley & Sneed, 2009; Moag-Stahlberg, Howley, & Luscri 2008). The Institute of Medicine has proposed a national nutrition policy to provide a more unified, cohe sive approach, and more measurable criteria for implementation. Interest is growing fo r the introduction of a national nutrition policy from the Institute of Medicine, as th e thousands of local wellness policies range from being highly restrictive to very lenient. See Appendix A for an explanation of the local wellness policy. The intent of the local wellness policy wa s to affect and to modify the overall school nutrition environment. However, the call for change has been accompanied by a tendency to blame schools for the increases in childhood obesity instead of recognizing schools as a vehicle for change, and to de mand immediate action instead of recognizing the long-term efforts that will be required (K. Ayoob, personal communication, March 1, 2009). The challenge of implementation of loca l wellness policies, of turning policy into practice, is left to the indi vidual school. The declared ch ildhood obesity epidemic, fueled by well known individuals such as First Lady Michelle Obama and President Bill Clinton; interest groups to in clude the Alliance for a Healthier US Generation, Action for

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4 Healthy Kids, the Robert Wood Johnson F oundation, the American Heart Association, and the American Medical Association; and, the media have sometimes identified specific foods as good or bad, often identified school cafeterias as a key contributor to childhood obesity, and have demanded additiona l school nutrition regulations. None of these entities, however, has b een able to identify sustaina ble, funded solutions to the challenges (Anonymous, Briggs Safaii, & Beall, 2003). Complicating the issue, federal funding fo r the National School Lunch Program is not consistent with food and labor costs. Recent headlines from across the country indicate that finances are low and costs are high. Newspaper articles with titles such as, “Schools get a lesson in lunc h line economics: food costs unr avel nutrition initiatives” (Glod, 2008, p. A01); “As food costs rise, so do school lunch prices” (Hu, 2008, p. B2); “Food costs driving up meal prices” (Ramir ez, 2008, p. 7); “School cafeterias struggling to keep food on the table” (Toppo, 2008, p. D6); and “Schools will limit variety to keep prices low: rising costs will cut fruit and vegetable choices” (Winchester, 2008, p. B1), herald a difficult time fo r child nutrition programs. Increasing nutritional demands and risi ng food and labor costs have not been accompanied by dedicated funding for operations or nutrition education at the local school district level (Wharton, Long, & Schw artz, 2008). The early 1980s to the present date have been a time of unprecedented growth in weight for height, sedentary lifestyles, and poor eating behaviors, especially among scho ol-aged children. It is a reality that these issues have taken place when the government touts the need for nutrition intervention, but fails to f und nutrition education at the local school district level (Gordon, Crepinsek, Briefel, Clark, & Fox, 2009) Even the federal stimulus dollars

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5 provided by the American Recovery and Reinve stment Act are earmarked only for school cafeteria equipment replacement, not for escal ating food or labor costs, or for nutrition education. Research indicates that parents, teachers, school board members, superintendents, principals and school nutrition personnel typically deflect responsibility regarding ownership for quality lunch and nutriti on education programs (Cho & Nadow, 2004; Fisher, Mitchell, Smiciklas-Wright, & Birch, 20 02). The government has issued mandates for the National School Lunch Program to m eet Local Wellness Policy guidelines without providing essential funding (Gordon et al., 2009). School nutriti on programs are, therefore, at a crossroads in a nation demanding an increas ed emphasis on the nutritional integrity of school meals, without a cl early defined champion of the cause. Background of the Problem Schools participating in the National School Lunch Program serve over 30.5 million students daily, repr esenting over 101,000 schools throughout the nation, with estimated expenditures of $8.7 billion in 2007 (School Nutrition Association, 2008). Countless school-aged children benefit from th e availability of federally funded child nutrition programs in public sc hools in all 50 states in the United States. The National School Lunch Program, established in 1946, wa s originally charge d with a mission of providing one-third of the Recommended Daily Allowance of nutrients and calories for children of varying ages and development. Over the past 60 years, this mission has remained the same, with an evolving, special emphasis on the over 18 million economically disadvantaged youth in the Unite d States who rely on meals served through the National School Lunch Program.

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6 The purpose of the National School Lunch Program is to provide nutritious foods to school-aged children at no, or a reduced, cost. Eligib ility for free lunches is determined by a family income at or below 130% of the poverty level. Reduced priced meals are available to families whose incomes range from 130% to 185% of the poverty level. Approximately 58% of school lunches nationwide are served to children at less than the 185% poverty level. However, th e National School Lunch Program subsidizes all meals, including paid meals, so all school children and their families may derive a benefit from this federal program (School Nutrition Association, 2008). A shift has occurred in recent years, howev er, from the task of providi ng meals to the more difficult task of promoting and providing good nutrition, and leading the way in the establishment of appropriate nutrition behaviors among child ren in a nation concerned about nutrition issues, but lacking the connections between values and practice (Newman, Ralston, & Clauston, 2008). Children mimic adults and model their f ood selections and eating behaviors after adults (Birch & Fisher, 1998; Kremers, Brug, de Vries, & En gels, 2003). The presence of school nutrition programs within elementary schools and the oppor tunities for teacher involvement in shaping children's nutritional behaviors seem appare nt, but there is a dearth of research to make the case for gr eater involvement of teachers in the promotion and maintenance of healthy school nutrition environments (MacLellan, Taylor, & Freeze, 2009). A disconnect also exists between the prio rities of establishing and implementing local wellness policies a nd the perceptions of school dist rict personnel in assuming a role in the establishment of an healthy school nutrition environment. A special emphasis

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7 needs to be placed on the role of teachers, th ose adults who exert the most influence on children in a school setting. School nutriti on programs are being held responsible to implement local wellness policies, but they are not the only parties to determine the importance and immediacy of developing hea lthy school nutrition environments and the quality of such environments. United Stat es Department of Agri culture funding for the continuation of school meal programs depends upon adherence to lo cal wellness policies, but child nutrition programs cannot be the sole pl ayers in this initiative. No defined role and no budgetary implication is in place for any entity in a school district to influence children’s nutrition, other than the school nutrition program. Statement of the Problem Limited research existed to address teach er attitudes and perceived influence on school nutrition environments and related self -reported classroom behaviors. Teachers may be an overlooked resource in efforts to develop appropriate di etary behaviors with their students. School nutrition program di rectors and nutrition educators would benefit from information about teacher attitudes toward school nutrition environments, their perception of influence on school nutrition envi ronments, and how they relate to and are manifested in classroom behaviors. Speci fically, how teachers feel about the school nutrition environment and how they believe they influence the environment was of interest. As well, the sense of self-efficacy teachers have concerning the school nutrition environment, translated into behaviors, was of interest. However, no instrument had been developed to survey or measure attitu des and influence on the school nutrition environment, and related self-reported classroom behaviors prior to this study.

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8 According to Bauer, Yang, and Austin (2004) and Bell and Swinburn (2004), tremendous pressure is being exerted on school nutrition programs to provide foods and an atmosphere that promote and establis h good nutritional intakes among school aged children. The Child Nutrition Reauthorization Act of 2004 re quired the creation of local wellness policies by July 1, 2006, but the respon sibility of school districts did not end with the collaboration and c ooperation of interest ed parties in developing a document. The Child Nutrition Reauthorization Act require s the implementation of the local wellness policy, monitoring of the implementation, and detailed progress reports. Sixty-seven school districts in Florida de veloped local wellness policies, but concern had been voiced by child nutrition directors to the Departme nt of Food and Nutrition Management, under the Department of Education in Tallaha ssee, Florida, about how school nutrition programs can influence teachers, administrators, superintendents, school business officials and school staff to participate in the esta blishment and maintenance of healthy school nutrition environments. The School Board of Sarasota County has a history of promoting an effective school nutrition program, complete with a nutri tion educator who makes classroom visits and provides hands-on education and traini ng with special emphasis on kindergarten through third grade students. The position of Nutrition Educator is not specifically funded by the National School Lunch Program under the United States Department of Agriculture, but the administration of the F ood and Nutrition Services department feels strongly about the resources provided by a tr ained, qualified Nutrition Educator who provides direct classroom nut rition activities an d instruction. Food and Nutrition

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9 Services programs across the nation have not cr eated or funded this position, but Sarasota County has since 1996. The Food and Nutrition Services Department of Sarasota County is also unique in the aspect that it has one of only two school district-based dietetic internships in the nation approved by the Commission on Dietetic Registration, the credentialing agency of the American Dietetic Association. The depart ment currently has five registered dietitians on staff, including the director, three area s upervisors, and the nutrition educator. The number of registered dietitians on staff in th e Food and Nutrition Services department is greater than any other school district of its size in the United States. The Food and Nutrition Services program has won numerous state and national awards for promoting nutritional integrity while maintaining financ ial solvency, including the first Action for Healthy Kids “Healthy Schools Hero” award in 2002. A challenge for Food and Nutrition Services is the ratio of one Nutrition Educator to over 900 elementary school teachers. Obse rvations made by Nutrition Educators and Food and Nutrition Services employees indicat e that while some teachers in Sarasota County voice concern about promoting good nutr ition with their students, other teachers appear to be uninterested or disengaged. Limited collaborati on takes place with teachers, and teacher feedback, despite the efforts of Food and Nutrition Services to provide a sound nutrition program, is sometimes negati ve. Teachers often appear to hold the school nutrition program responsible for providing good nutrition, but continue to provide food rewards and treats in the classroom that are not allowed in the Food and Nutrition Services program. The Food and Nutr ition Services program is interested in learning more about teacher attitudes and perceived infl uence on the school nutrition

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10 environment, as well as self-reported behavi ors to attempt to identify better ways to connect with teachers, and to partner to pr ovide an enhanced overall school nutrition environment. Results of this study may serve as a source to improve dialogue between kindergarten through fifth grade teachers and school districts' nutrition programs within the School Board of Sarasota County, Flor ida. Potential benefits may occur for kindergarten through fifth grade students, with secondary benefits for other teachers, parents, school nutrition pe rsonnel, curriculum writers, pr incipals, the superintendent, school board members and the industry whic h supports child nutrition programs. Purpose of the Study The purpose of this study was to determine the attitudes of kindergarten through fifth grade teachers about school nutrition e nvironments, their perceived influence on school nutrition environments, and self-repor ted classroom behaviors. The specific objectives of this study were to: (a) identify teacher attitudes, perceived influence, and self-reported behaviors related to the sc hool nutrition environment; (b) examine the relationship between elementary school te acher attitudes about school nutrition environments and perceived influence on the environment among kindergarten through fifth grade teachers; (c) exam ine the relationship between elementary school teachers’ attitudes about school nutrition environments and self-reported classroom behaviors; (d) examine the relationship between perceived influence over the school nutrition environment and self-reported classroom behaviors; and, (e) examine the relationship between teachers demographic characteristics and attitudes and perceived influence on school nutrition environments, and self-reported classroom behaviors.

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11 Research Questions The following research questions were examined in this study: 1. What attitudes, perceived influences, a nd self-reported behaviors do kindergarten through fifth grade teachers identify rega rding the school nutrition environment? 2. Are teacher attitudes about school nutri tion environments and their perceived influence on the environment related? 3. Are teacher attitudes about school nutr ition environments and self-reported classroom behaviors related? 4. Are perceived influences on the school nutrition environment and self-reported classroom behaviors related? 5. Are teacher demographic characteristic s related to attitudes and perceived influence on school nutrition environm ents and self-reported classroom behaviors? Significance of the Study The issues investigated may provide in sight into how school nutrition programs can work more collaboratively and effec tively with kindergarte n through fifth grade teachers. Teachers who perceive the im portance of the overall school nutrition environment may help to promote a healthy school nutrition environment. Teachers who perceive that they influence the school nutr ition environment may convey their beliefs to students in their own behavior and classroom practices. An identification of teachers’ perceptions of importance and influence may assist school nutrition administrators in learning how to communicate more effectively with teachers, and develop, promote, and maintain healthier school nutrition environments.

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12 Theoretical Framework Parents, teachers, other adu lts, and even other children have the potential to serve as influencers and models within the envir onment (Bronfenbrenner, 1979). According to Bronfenbrenner (1977), developmen t occurs within the context of the individual child and their environment, including family, school and community environments. Ecological systems theory recognizes five related, yet separate, systems: microsystem, mesosystem, exosystem, macrosystem, and chronosystem (Bronfenbrenner, 1977, 1979); and examines the interrelatedness of each system. The environment in which a child learns about nutrition, how adult role model attitudes affect behaviors of children, a nd how nutrition information and behaviors are transmitted to students, may be the greatest influences on and determinants of school nutrition environments, which may affect nut rition-related attitude s and behaviors among children. A study of teacher attitudes, percei ved influence, and self-reported classroom behaviors that may have an effect on th e development of heal thy school nutrition environments may be examined utilizing Bronfenbrenner's ecological systems theory Many studies surrounding nutri tion research also employ social cognitive theory to explain and describe the variables that affect human nutrition (Chapman-Novakofski, 2005; Contento, Balch, Bronner, & Maloney, 1995; Cantrell, Y oung, & Moore, 2003; Fahlman, McCaughtry, Martin, Shen, Flory, & Tischler, 2009; Rinderknecht & Smith, 2001). Social cognitive theory attempts to explain how different variables, (including personal factors such as thought s, feelings) and attitudes affect perceptions and how perceptions affect beha vior (Bandura, 1986).

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13 Bandura (2004) states that self-efficacy, or the confidence to carry out or fulfill an intended behavior, is needed to adopt and maintain healthy behaviors. Self-efficacy enhances an individual’s abilities and sk ills to act on motivations, despite perceived barriers. Although individuals have the cap acity to exert infl uence over their own behaviors and their environments, the envi ronment also shapes behaviors (Contento, 2007). The attitudes that teachers have abou t school nutrition environments may be related to perceived influences over the sc hool nutrition environm ent and related selfreported classroom behaviors. As the level of self-efficacy increases, the more effort may be expended to persist in a behavior despite potential challenges or difficulties (Bandura, 1997). Limitations The following limiting conditions apply: 1. The population was confined to kinde rgarten through fifth grade teachers in the School Board of Sarasota County, Florida; this limited the generalizability of the study’s findi ngs to teachers outside this school district. 2. All participants were volunteer respondents. 3. Data relied on self-reports fr om survey instruments. Definition of Terms The following terms and definitions are used in this study: Attitude: A judgment that can change as a function of experience (Tesser, 1993). In this study, attitudes about school nutrition environments were explored.

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14 Behavior: The collection of behavi ors exhibited by human be ings and influenced by culture, attitudes, emotions, values, ethics, authority, rapport, persua sion, and/or genetics (Arbrey, 1970). In this study, teachers self-reported classr oom behaviors and activities that occurred within their own classrooms are examined Child Nutrition Reauthorization Act of 2004: Public Law 108-265. Every four years, Congress reauthorizes the National School Lunch Program. In 2004, in addition to numerous other requirements, the developm ent of a Local Wellness Policy for every school district in the United States participation in th e National School Lunch Program was mandated, with an effective date of intr oduction and implementation of July 1, 2006. Influence: The power or capacity to cause an effect in an indirect way (Bandura, 1986). In this study, how teachers feel they a ffected the school nutrition environment was examined. Local Wellness Policy (LWP): A component of the Child Nu trition Reauthorization Act of 2004 which required each school district in the United States participating in the National School Lunch Program to develop a plan to address nutrition guidelines, nutrition education, physical act ivity, and other school-bas ed activities designed to promote student wellness. National School Lunch Program (NSLP): Established in 1946, the National School Lunch Program is a federally funded progr am administered by the United States Department of Agriculture (USDA) that assi sts in providing school meals to students in 96,000 schools in the United States. Participation (or Meal Participation): The total number of students eating school lunch in relation to daily attendance (also known as Average Daily Participation).

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15 Role: In this study, the role of teacher may be de scribed as instructor. However, the role may also include modeling eating behaviors, or motivating, or f acilitating nutritional habits of students (Prelip, Erausquin, Slusser, Vecchiarelli, Weightman, Lange, & Neumann, 2006). Self-efficacy: People’s judgments of thei r capabilities to organize and execute courses of action required to attain designated t ypes of performances (Bandura, 1986). Teachers: Kindergarten through fifth grade teach ers who currently teach in schools throughout the School Board of Sarasota County, excluding charter schools. Organization of the Study Chapter 1 includes an introduction of th e research, background of the problem, statement of the problem, purpose of the st udy, research questions, significance of the study, theoretical framework, limitations, defin ition of terms, and an organization of the study. Chapter 2 included a review of the literature related to the study. This chapter contains research on ecological systems theory, teacher attitudes, influence, behaviors, and demographic characteristics, social cognitiv e theory, and a summary of the chapter. Chapter 3 describes the research methods and procedures used to conduct the study. An explanation of the research design, a description of the population, instrumentation developed and used in the st udy, data collection methods, a description of the data analysis used, and a summary of methods are included. Chapter 4 included the findings of the study. This chapter contained characteristics of participants, resu lts, and a summary of the chapter.

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16 Chapter 5 included the study summary, conc lusions, implications of the study, and recommendations.

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17 Chapter 2 Review of the Literature The purpose of this study was to ex amine kindergarten through fifth grade teachers' attitudes about school nutrition programs, their perceived influence on school nutrition environments, and self-reported classroom behaviors. The parts of this chapter explore the literature pertaining to ecological systems theory to include school nutrition policies, a national view of nutrition educa tion, external influences, the school nutrition environment, factors that influence food in take, teacher surveys of school nutrition programs, and nutrition and achievement. Secti ons are also presented on teacher attitudes, influences, and behaviors to include classroom rewards, and teacher characteristics. A discussion of social cognitive theory completes the review of literature. Limited studies exist that explore the relationship of teacher attitudes toward school nutrition environments and their pe rceived influence on the school nutrition environment. Rafiroui and Evans (2005) sugge st an overall gap in th e literature regarding teachers' influence on the nutrition environmen t at school and children's dietary behavior development. School board members' percep tions of factors infl uencing school nutrition policy have been studied (Brown, Akint obi, Pitt, & Berends, 2004). School nutrition policies, and the attitudes and practices of sch ool principals were th e variables of a study conducted by French, Story, and Fulkerson ( 2002). Perceived influence on the nutrition environment of combined groups, such as Cho and Nadow's study of superintendents, principals, foodservice directors, nurses a nd health educat ors (2004) and foodservice staff

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18 (Fulkerson, French, Story, Snyder, & Paddock, 2 002) have also been conducted. Little research, however, has focused on the teacher in relationship to h ealthy school nutrition environments. Teachers’ attitudes about school nutrition e nvironments, their perceived influence on the school nutrition environment, and self-re ported classroom behaviors were the focus of this research. Teachers, due to their re gular contact with children in the classroom environment, have the potential to affect nutrition behavior development and the broader school nutrition environment through their verb al and non-verbal messages, actions, and practices. To provide a background for this di scussion, a number of studies are presented under separate categories. Th e categories are ecological syst ems theory, teacher attitudes, influence, behaviors, and dem ographic characteristics, and so cial cognitive theory. A brief explanation of ecological systems theory follows. Ecological Systems Theory Environment has been defined as the physical and social surroundings of a person (Bubolz & Sontag, 1993). Environment may be described in the narrow context of a specific place and a specific time, but it can also be described as broadly as a culture or a nation in which an individual lives. Bronfenbrenner (1979) proposes that behavior results as a function between the person and their environment. Ecological systems theory (EST) provides a framework for considering the mutual accommodation th at occurs between a person and his/her immediate environment. The environments in which relationships develop are also affected by the broader scope of social context.

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19 EST provides a structure to examine the influences and connections between people and their environment. Systems a nd people are interconnected, with systems affecting people and people affecting systems (Anderson, 2003; Day, 2003). EST establishes that the whole is greater than the sum of its part s (Day, 2003; Newman & Newman, 1999). According to Bronfenbrenner, the interconnectedness of an individual and their environment affects behavior and responses. Functions and identity are sharedsuch is the case with a family, a clas sroom, and a school (Anderson, 2003; Day, 2003; Newman & Newman, 1999). EST attempts to examine how behaviors within environments are developed. Five interconnected, nested, yet separate systems describe EST: the microsystem, mesosystem, exosystem, macrosystem, a nd chronosystem (Bronf enbrenner, 1977, 1979; Bubolz & Sontag; 1993). The chr onosystem is the system that includes the dimension of time as a factor in the development of a pe rson within their vari ous environments, and does not usually appear in the typical Bronfenbrenner model (Berk, 2003). The chronosystem integrates the influence of a person’s development of changes over time in which the person is living. Bronf enbrenner refers to this sy stem as the individual’s life course. The chronosystem is the temporal change in children’s environments which produce new conditions that affect development. These changes can be imposed externally or can arise from within the child (Berk, 2003). Changes may then occur due to the life events imposed, or those that may have developed within the child. In ecological systems theory, development is neither controlled by environmental circumstances nor driven by inner dispositi ons. Instead, children are both products and producers of their environments in a network of interdep endent effects (Berk, 2003).

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20 Longitudinal studies, in which research participants are followed for a period of time, may describe the chronosystem, and the many va riables, influences, a nd relationships that lead to changes in macrosystems, exosyste ms, mesosystems and microsystems. For the purposes of this study, the chronosystem is not further discussed, as insufficient research has been conducted to explore the dimension of time as it relates to the school nutrition environment. The presentation of the remain ing separate systems of ecological systems theory follows, beginning with a review of th e broadest of the systems, the macrosystem. Macrosystem. The foundational elements of society, the blueprints that exist in a culture that establish patterns for structures and activities occurring at a concrete level, comprise the macrosystem (Bronfenbrenne r, 1977; Bubolz & Sontag, 1993). Certain macrosystems exist due to laws, regulations, and rules; however, most macrosystems are informal and develop through custom and rou tine practice in daily life. Macrosystems are conceived and examined not only in stru ctural terms, but also as carriers of information and ideology that, both implic itly and explicitl y, give meaning and motivation to agencies, social networks, role s, activities, and othe r interrelations. For example, if the consumption of high fat or hi gh sugar items routinely occurs in the home, these behaviors become custom and practi ce. Meaning and motivation from these customs and practices may be translated to peer groups, school activi ties, and an entire school system. Bronfenbrenner’ s ecological model provides a framework for considering ways in which intrafamilial processes are influenced by extrafamilial conditions and environments (Bronfenbrenner, 1986; Bubolz & Sontag, 1993). School nutrition policies Hippocrates recommended a balanced diet, sufficient physical activity, and a moderate lifestyle in order to maintain the good health needed to

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21 grow old (Olsterdorf, 2003) Early nutrition policy in the United States and throughout the developed and developing world was direct ed toward the goal of food security to produce sufficient amounts of food at reasonab le prices. During the past few decades, there has usually been enough safe and ine xpensive food available for consumption, at least in the United States. However, th e emphasis of food policy, even though food production continues to be profe ssionally controlled and regu lated by law, has shifted. Now, there are as many overfed people in the world as there are hungry people. The focus of nutrition policy has changed from one of food security to nutrition security. Olsterdorf suggests that more needs to be learned about human behavior to promote healthy lifestyles, beyond the establishment of policy; a return to the teachings of Hippocrates warrants consideration. Over 30 years ago, Teuterber g, a historian at the Univer sity of Munster organized a group of scientists with a common interest in food behavior research. Excerpts from the 1976 German Nutrition Report included Teuteberg’s belie fs about the need to foster nutrition research: Theory and concept: Eating and drin king is more than satisfying basic needs, hunger and thirst. Food habits are embedded in value systems of the individual and the society. . Food and health are more than body function and physiology. . Food behavi or is determined by individual psychological factors and so cio-cultural ones. Food behavior is the result of a socio-cultural process (socializa tion). The central construct of food behavior research is the Meal. Th e theoretical model adopts the basic models of Talcott Parsons (structura l, functional systems) and uses the following important explanatory values (preferences, avoidance); social communication . . Prevention has to recognize the socio-cultural determinants of food behavior. (pp. 36-37) Olsterdorf suggests that po licy makers are too focused on eating foods as a matter of individual choice. He suggests that polic y makers too often ignore social and cultural

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22 influences. Social marketing approaches and interdisciplinary nutrition research, Olsterdorf contends, should provide the basis for modern public health nutrition programs, with an emphasis on longitudinal pe rspectives. A consid eration of the time dimension in behavior changes related to social and cultural changes must occur, as well as, the effects of informati on and communication for change s in nutrition behavior. However salient Olsterdorf’s recommendati ons may be, the United States appears to be creating more policies, programs, recommendation and guidelines, all aimed at the nutritional well-being of its ci tizenry, but in particular, sc hool-aged children. The Child Nutrition Reauthorization Ac t of 2004, which required the establishment of local wellness policies by July 1, 2006 did not provi de specific details of what each policy should include, but indicated that the policie s must have local school board adoption by the stated date. This directive left many school districts, especially small districts, or those without highly trained administrators overseeing the child nut rition program, in a quandary. The School Nutrition Associati on, with support form the National Dairy Council analyzed the largest 100 school districts’ wellness policies in October, 2006, and also analyzed another 140 district policie s across regions of th e country, representing various sizes of school districts to better unde rstand the characterist ics of local wellness policies. Soon after the re sults of the October 2006 st udy were collected, the focus started to change from one of policy characteristics to implementation and evaluation. On May 3, 2007, an online survey was sent to 4,850 School Nutrition Association director level members, with a closing date of June 5, 2007. Responses were received from 1,350 members, of which 976 usable surveys were analyzed. The remaining 374 surveys were not utilized, due to incomplete or duplicate responses, or revealed that a

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23 district’s school board had not yet passed a local wellness policy (School Nutrition Association, 2007). Only 42% of respondents in dicated that their di strict was evaluating the impact or implementation of the local we llness policy; the remaining 48% indicated that they planned to evaluate the impl ementation. However, the evaluation of implementation, progress made, and identificat ion of on-going challenges to be addressed is a required component of the local wellness policy. No mention was made of progress or challenges. See Appendix A for freque ntly asked questions concerning the local wellness policy. An example of a well organized a nd thoughtfully administered national assessment is the School Health Policies and Programs Study (SHPPS), the largest, most comprehensive review of school health policies and programs. Conducted in 1994, 2000, and 2006, and sponsored by the Centers for Disease Control and Prevention, SHPPS researchers collected data from telephone interviews with st ate-level and district-level staff, and in-person interviews with school st aff (students were not interviewed). Eight components of school health programs were as sessed in this study: health education, physical education, health services, mental h ealth and social servic es, school policy and social services, school policy and environmen t, food service, faculty and staff health promotion, and family and community invol vement. The 2006 SHPPS study indicates that fried foods, the availability of low nutri ent dense foods, and the readily available but nutritionally questionable beverage selections ha ve not been addressed by the majority of states (O’Toole, Anderson, M iller, & Guthrie, 2007). The availability of healthier food items had increased, but too many schools, sc hool districts, and st ates had not taken

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24 action to limit foods high in sugar, fat, a nd sodium. The SHPPS study did not take an indepth look at teachers and the food pract ices that occur in classrooms. Researchers with Action for Healthy Kids (AFHK), a nationwide non-profit organization dedicated to improving health and education thr ough better nutrition and physical activity, indicate that budget challe nges and full agendas continue to present challenges for wellness policy implementa tion (Moag-Stahlberg, Howley, & Luscri, 2008). A convenience sample of 256 approved local wellness policies were compared with federal regulations and the AFHK We llness Policy Fundamentals, a tool which documented best practices for nutrition and physical activity in schools. Sixty-eight percent met the federal mandates, but 32% did not address one or more federal mandates, and 15% did not address evaluation or monitori ng goals. No policies included all of the suggested AFHK’s Fundamentals. Moag-Stahlberg et al. (2008) stated that schools need assistance to meet the federal mandates. According to the research ers, additional funds ar e needed; a lack of funding limits the degree of policy implementation, revision, and improvement. In a similar statement issued by Bergman and Gordon (2010), on behalf of the American Dietetic Association, implementation and eval uation of a strong nutri tion policy is linked to adequate funding of school meal programs. No additional funding had been provided for wellness policy implementation or eval uation at the time of the study. MoagStahlberg et al. concluded that wellne ss policy implementation will take time and patience, and that the impact on student he alth and learning may take many years to accomplish.

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25 States and individual sch ool districts have proposed that the Local Wellness Policy mandate, with insufficient parameters, geared toward the local level, leave too many variables unaddressed. The foodservice industry, manufacturers, vendors, and food science research and development teams, str uggle to meet the diverse requirements of school districts in stat es where nutritional requirements a nd standards vary widely, even within a given state. Foods ervice operators and industry, but also Congress, has called for the establishment of na tional nutrition standards by 2011, only a few years after the deadline for local wellness policies that re quired individualiz ed standards. The Institute of Medicine of the National Academies (IO M) convened a task force of 15 researchers, nutritionists, school board members, and nutrition advocacy representatives, who reported to the 110th Congress on May 10, 2007. The IOM Committee on Nutrition Standards for F oods in Schools produced a report, Nutrition Standards for Foods in Schools: Leadi ng the Way Toward Healthier Youth which stated that responses of school dist ricts to meeting wellness polic y requirements have not been consistent. In its recommendations, the IOM Committee proposed nutritional standards for “competitive” foods and beverages availa ble in schools, (i.e., foods outside the National School Lunch Program that may be so ld in ala carte cafet eria lines, vending machines, or school stores). The standards re commend limitations of saturated fat, salt, added sugars, caffeine, and total calories. The standards promote selection and consumption of fruits, vegetables, whole gr ains, and non-fat or lo w-fat dairy products consistent with the Dietary Guidelines for Americans and National School Lunch Program guidelines. Recommendations incl ude “11 Standards for Nutritive Food Components” and specific Tier 1 foods and dr inks, to be made available to all students

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26 during the school day, and Tier 2 foods and drin ks, available only to high school students after school hours. Alth ough the IOM report has many positive recommendations, according to the School Nutrition Associa tion, the reality of enforcing specific restrictions, especially among high school students, is questionable. In response to the Child Nutrition Reaut horization’s “patchwo rk” of policies and standards, from very general to very specifi c, and more recently, to the IOM report, the School Nutrition Association established a task force to develop recommendations for national school food and beverage guidel ines (National Standards for Food and Beverages in Schools, Task Force Update 2007). Foremost among the SNA committee’s task force concerns is the current availabilit y, or lack thereof, of appropriate foods and beverages to meet specific IOM recommendations. The SNA task force suggested a more realistic approach, as st udents can opt out of school meal programs as well as a la carte programs if they cannot have access to th e foods and beverages they prefer. Despite good intentions, the desired outcome of modi fying students’ nutri tional behaviors and food selections by limiting availability of food items will not be successful if students do not participate in the program. Specific, rele vant concerns of the S NA task force include: focus on nutrient density of foods served; appropriate portion sizes; foods as a meal or complete snack inst ead of “nutrient profiling” of specific, foods or beverages; reasonably enforceable standards; and, acknowledge diverse nutrient, caloric, and food security issues of the millions of school children served, from early childhood to adolescence.

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27 Confusing and frustrating as the dialogue may be at the national level, this lack of consistency and direction filters to the loca l level (Wharton et al., 2008). Teachers and parents, reading the latest headlines, and administrators and students, who can become overwhelmed with the changes in direction, may tire of the debate. School nutrition directors are charged with the responsibility of creating and maintaining a local wellness policy that may not be popular with students and staff. Sc hool nutrition directors have the additional burden of risking the loss of funding for the reimbursable meals programs (breakfast and lunch) if the policies are not enforced, since Child Nutrition Reauthorization governs USDA programs, a nd USDA is the parent agency of the National School Breakfast and Lunch Programs. An additional concern is that the local wellness policy and its implementation are expected to be monitored on a school-wide basis. School nutrition di rectors have jurisdiction only over the school nutrition programs and may make suggestions, but typica lly have no authority in decisions made outside the cafeteria regarding competitive f ood sales. The principal, not the foodservice director, has authority over the school. The role of the principal was deemed to be most a most important consideration, as identified by a study conducted among key stak eholders in the Canadian province of Prince Edward Island (PEI) aimed at identi fying enabling and barrier factors to the development, implementation, and evaluation of wellness policies (MacLellan, Taylor, & Freeze, 2009). As in the United States, childhood overweight and obesity is a concern in Canada, but specifically in PEI, with 25% of the adolescent male population classified as overweight or obese. Acknowledging the preven tion of future health problems through early intervention, wellness policies have gain ed attention and momentum. MacLellan et

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28 al. identified school principals as the most important person of influence on the school wellness policy. As stated by Evans (1996), principals are “Indisp ensable to innovation. No reform effort, however worthy, survives a principal’s indifference or opposition. He (or she) is the leader closes t to the action, the operational chief of the unit that must accomplish the change” (p. 202). An additional enabling factor in the MacL ellan et al. study was the existence of a strong policy work group; one that could bridge the gap between practicality and possibilities of the “school world,” and the nutrition guidelines, expectations, and parameters desired by the “ nutrition world.” Similarly, the process of policy development, an understanding of negative resp onses to change, and problem solving to modify approaches to the next steps in the initiative were suggested as enabling factors. Important barrier factors were also iden tified by MacLellan et al. (2009). Similar to a California study conducted by Brown et al. (2004) and a nati onal study conducted by Longley and Sneed (2009), cost, lack of time, and competing priorities were listed as barriers to the development, implementati on, and evaluation of wellness policies. Recognition that healthier foods cost more to purchase was reinforced by inadequate existing funding for child nutrition programs. Traditional fundraising initiatives that promote high profit, high calorie food items, such as candy and cooki es, present one of the biggest barriers to school nutrition policy implementation. A lack of time, lack of human resources, and competing priorities also proved to be a challenge. Stakeholders acknowledged the importance of good health and good nutrition, but did not consider it a top priority at their school. The researcher s offered that systemic change will require a comprehensive approach that involves parent, government, and communities.

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29 Despite the work and effort expended, researchers found that the local wellness policy may not have the single most important desired effect, that of changing students’ dietary behaviors. A study conducted in th e Los Angeles Unified School District found that students may respond negatively to en forced nutrition policies (Vecchiarelli, Takayanagi, & Neumann, 2006). Twelfth grade students were provided an opportunity to respond to the implementation of two separate policies in their school district, entitled the Obesity Prevention Motion and the Healthy Beverage Resolution, both developed to enforce nutrition policy through al a carte sales, student stor e sales, vending machines, and fund-raising. Although 55.5% of student s indicated that th e Healthy Beverage Resolution impacted the beverages they dra nk at school, only 16.2% of students reported the policy impacted the beverages consumed at home or outside of school. Similarly, the Obesity Prevention Motion resulted in 56.2% of students indicating that snack choices were impacted at school, w ith 20.2% indicating that the po licy had an impact on snacks selected and consumed at home, or outside of school (Vecchiarelli et al., 2006). Written responses from the high school se niors provide insight to th e perceptions the students have of the nutrition policies. “By taking away the food, it gives kids a reason to go home and eat all these junk foods and soda b ecause at school they haven’t eaten anything all day,” and “If anything, this ban makes me binge when I get home because I don’t like the enforced healthy food at school,” as well as “I really don’t th ink that changing the way a student eats at school will affect the way they eat outside of school. Unless it begins in elementary school.” Schwartz, of the Rudd Center for Food Po licy and Obesity at Yale University recently posted this comment:

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30 In my entire career of treating obesi ty, eating disorders, and studying food policies around the country, nothing has got ten people so worked up and upset as the idea of banning cupcakes or junk f ood from school parties. This issue has caused more disrespectful behavior among parents at PTO meetings than nearly anything else. (Schwartz, 2010, personal communication) Considering the responses from students a nd parents, Olsterdorf’s contention that behavior change is related to a time dime nsion, as well as social and cultural change, deserves consideration a nd further investigation. A national perspective on nutrition education A research gap exists regarding healthy eating determinants among children an d youth. Early studies conducted to assess teacher preparation related to nutrition edu cation influenced the federal government’s initiation of the Nutrition Education and Trai ning (NET) program. Teacher preparation was one of the key issues of the White H ouse Conference Panel on Nutrition Teaching in Elementary and High Schools as long ago as 1970. The panel recognized that preservice and inservice training could play key roles in the success of nutrition education programs. Nutrition education was, at one time, a pr iority of the government. The Nutrition Education and Training Program (NET) was es tablished in 1977, ei ght years after the 1969 White House Conference on Food, Nutri tion, and Health (Maretzki, 1977). Originally funded at $26.2 million per year, or $.50 per child enrolled in schools served by the NSLP, the initial funding was soon slashed (Martin & Oakley, 2007). The Omnibus Reconciliation Act of 1980 resulted in a reduction of child nutrition funding by $400 million, with $15 million remaining for NET. The following year, a second Omnibus Reconciliation Act (of 1981) remove d $1.4 billion, or approximately 25% of child nutrition funds to school districts nati onwide. Martin & Oakley reported that in addition to the 2 million children who no longer received meal benefits, NET funds were

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31 cut by another $10 million, leaving only $5 m illion in the program. The $5 million for NET funding remained until 1990. NET was funded at $7.5 in 1991 and $10 million in 1992 through 1996. However, in 1996, NET fu nding was changed from mandatory to discretionary for 1996-2002; NET was funded onl y once during that time period, in 1998. NET funds have since been replaced with T eam Nutrition funds, but those dollars are only available to state agencies, and rarely are available for direct use at the local school district level, and are not avai lable for direct use by teachers. Wardle, Parementer, and Waller (2000) s uggest that nutrition knowledge increases the likelihood of improved dietary behaviors and food consumption. Nutrition is not a required component, however, of elementary school curricula (Cline & White, 2000; Demas, 2003). Basic nutrition courses are generally not required by state education departments in elementary teacher prepar ation coursework (Anderson & Thorsen, 1998; Pratt & Wallberg, 1998). A gene ral lack of nutrition knowledg e and training increases the likelihood of incorrect information transmission and inappropriate modeling behaviors (Newmark-Sztainer, Story, & Harris, 1999). Teachers who possess little personal knowledge about their own nutritional needs or about child nutri tion, or who have a negative attitude toward their school's nutrition program may likewise negatively influence children's attitudes (Crockett & Sims 1995). A review of research conducted to study teachers and their attitudes and perceived roles relating to child nutrition follows. Researchers Taylor, Evers, and McKenna (2005) conducted a study to identify what they perceived to be important but had insufficient research related to issues that influence dietary behavior development. Identified knowledge gaps included: (a) the nature and extent of familial influences, including food practices; (b) the impact of the

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32 school environment on healthy eating, includ ing nutrition policies and modeling; (c) effects of mass media on healthy eating; (d ) food preferences a nd nutritional knowledge and skills in children and their impact on be havior change; (e) multiple determinants of healthy eating in children and youth, and their interactions; and, (f) longitudinal monitoring systems to identify national and re gional eating behaviors in children. Taylor et al. did note that teacher and peer modeli ng have been found to increase acceptance of healthy food choices in preschoolers. Howeve r, the gap in literature concerning teacher modeling begins in kindergarten, according to the researchers. The effect that modeling might have on children’s dietary behavior development and the promotion of healthy school nutrition environments has not been adequately investigated. One possible explanation or factor for this gap in research may be the timing of the Omnibus Reconciliation Act of 1981. Nutrition, Education, and Training (NET) funding was severely curtailed as a result of this federal deci sion, which also resulted in the reduction of 3,000 of the 94,300 schools in the National School Lunch Program in 1981 (Eisinger, 1998). NET funding had previo usly fueled training and research in school nutrition programs throughout the country. The timing of the Omnibus Reconciliation Act, just a decade before conc erns arose about the nutritional and overall health of America’s youth, is a phenomenon that deserves consideration and further investigation. What is known, however, is that childre n are in school for six hours or more per day and may be heavily influenced by the environment in which they live and learn. Policies that influence the environmen t represent key issues to consider in the overall examination of sc hool nutrition environments.

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33 Exosystem. The exosystem is the societal context in which mesosystems exist. The exosystem is an extension of the mesosytem that encompasses other social structures, formal and informal, that do not contain the developing person but affect, intrude upon, or include the immediate set ting in which an individual exists. The exosystem may influence or even determine what occurs within a mesosystem (Bronfenbrenner, 1977). The influence of the neighborhood, mass media, governmental agencies, and communication netw orks include and constitute exosystems. For example, school district local wellness policies are en forced through either the Department of Education or the Department of Agricultur e, depending on the state, in local schools within a community. Social systems beyond th e school and home exist that can affect individuals and settings thr ough forces, beliefs, values, a nd political actions (Bubolz & Sontag, 1993; Sallis & Owens, 2002). External influences on children’s nutrition. Food marketers recognize that schools represent a viable target to promot e products and convey messages to children during the academic day, and sometimes use that leverage to the disadvantage of children. Levine (1999) cited Coca-Cola and McDonald’s “cradle-to-grave marketing” (p. 291) as a relatively inexpensive, but hi ghly productive avenue for the food industry to capitalize on the schoo l environment to influence stude nt consumption. Elementary school environments may be encouraging pref erences for foods high in fat, sodium and sugar, putting children at risk for obesity and other chronic di seases, according to Levine. School health professionals must be aware of the external messages that reach children at school. Levine asserts that food coupons and products, school trips to fast food restaurants, and fund raisers that sell unhealthy food items are strategies that food

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34 companies use to influence children at school. Examples include Pizza Hut’s “Book It” reading program and McDonald’s McSpell It Club that offered administrators and teachers coupons to reward good behavior a nd achievement, along with a catalogue of nutrition education materials, replete with co mpany name and logo. Less subtle direct marketing strategies include Halloween pr omotions that contain safety advice and reminders about good behaviors during festiv ities, complete with product samples and coupons for candy, soft drinks, and other snacks. A study funded by Stanford University’s School of Medicine and the Robert Wood Johnson Foundation had preschoolers samp le identical McDonald’s foods in name-brand and unmarked wrappers. Presc hoolers identified the McDonald’s wrapped items as the tastiest foods. Almost 77% of the preschoolers indicated a preference for labeled French fries, and 54% preferred Mc Donald’s wrapped carrots. Fewer that one quarter of the children said both samples tasted the same. Strasburger, an author of the American Academy of Pediatrics policy to limit marketing to child ren, stated in 1992, “It’s an amazing study, and very sad. Advertiser s have tried to do exac tly what this study is talking about--to brand younger and younger children, to ins till in them an almost obsessional desire for a particular brand name product” (p. 150). The pervasive nature and persuasive messages of advertising to even our youngest children warrants immediate attention, according to Stasburger. His comments were published nearly two decades ago. A study conducted by Ohio State University and Indiana University found that obesity rose more than twice as fast when kindergarten and first-grade students were on summer vacation and not in school (von Hi ppell, Powell, Downey & Rowland, 2007).

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35 Downey, an Ohio State University sociol ogy professor and co-author of the study, was quoted in the Dayton Daily News on Ma y 3, 2007 in a commentary by Page entitled “School Cafeteria Is Not the Problem” as saying, “When it comes to childhood obesity, schools appear to be more a part of the solution than the problem. The problem of childhood obesity would actually be much worse if children were not in school” (p. 3). In contrast, findings from the School H ealth Policies and Programs Study (SHPPS) in 2000 indicated that 49 .9% of school districts had exclus ive bottling contracts with soft drink vendors. The study, which assessed data from individual schools, districts and states, indicated that 55% of teachers reporte d using foods as rewa rds, with the most common food items being candy, pizza, popcorn, soft drinks and ice cream (Wechsler, Brener, Kuester, & Miller, 2001). Alt hough the 2006 SHPPS report indicates some improvement in the past six years, the overall picture has changed very little, despite widespread attention to childhood obesity (O ’Toole, Anderson, Miller & Guthrie, 2007). According to the researchers, wherever th e responsibility lies for making a difference, schools remain at the forefront of the debate Schools are the public and common bond of nearly all children in the United States. Taking responsibility for good decision making as it pertains to the education and health of sc hool children is paramount to a healthy and productive society. Cho and Nadow (2004) contend that each s ector of the school community needs to work through perceived barriers and recogni ze their role in creating a healthy school environment. Adults in a school system n eed to address the challenges of implementing an appropriate, supportive environment, and work together to address the barriers for the benefit of the children to wh om they have been entrusted. Teac hers, those closest to

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36 students in a school setting, and who routinely collaborate for the educational benefit of children, may be the most logical choice to promote a healthy environment. Mesosystem. Mesosystems are represented by the relationships and connections between microsystems (Bronfenbrenner, 1977) which may include connections between microsystems such as the neighborhood, school, home, or developing child (Berk, 2003). A mesosystem is a system of microsyste ms. Mesosystem principles include a consideration of the elements of a setting or the joint impact of two or more settings, or sub-systems that exist across settings, and the magnitude in which the microsystem expands and contracts with transitional role shifts. The influence of the relationships of the home on the child entering school is an example of a mesosy stem (Bubolz & Sontag, 1993). School nutrition environments. Children's dietary patterns evolve within the contexts of the community, the family, and the school environment (Bronfenbrenner, 1977, 1979; Davison & Birch, 2001). Children consume a substa ntial proportion of their daily intake at school. One study by Wolf e and Campbell found that school lunches provided nearly 40% of the children's ba sic food group consumptions for the day and 40% of the different types of foods eaten in a day were eaten at school. School nutrition environments include much more than foods offered and served in the school cafeteria. A healthy school nutriti on environment encompasses the classroom, adult and peer modeling, after school functions, and the cafeteria; anywhere food is sold or eaten (Wechsler, Devereaux, Davis, & Collins, 2000). Frank (1994) pr oposed that schools present an entirely unique environment to monitor and assess foods eaten by children. Standardized recipes and cooking procedures, easily identifiable ingredients, and a

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37 common, controlled environment provide a fa r greater opportunity for group observation and analysis of foods selected and consumed than at any other time during a child’s day. A review of healthy school nutrition environm ents related to school meal programs is provided. A study by Rainville (2001) compared sc hool lunches to lunches brought from home in two southeastern Michigan school districts. Rainville intended to assess if a difference existed in total calories, fat, protein, calcium, Vitamin A, and iron between school lunches and lunches brought from ho me. School lunches were weighed and portion sizes recorded before the lunch peri od, whereas portion sizes of lunches brought from home were determined by visual obser vation. Food waste was visually estimated, recorded, and analyzed for nutrient content. Rainville found that lunches brought from home were lower in all measured nutrients, with the exception of fat and calories. School lunches were found to provide more nutrients and greater food variety than lunches from home. Rainville suggested an emphasis on the nutritive quality of school lunches, and that this information should be shared with parents through marketing efforts and publicity campaigns. Not only is the nutrient content of school meals an important consideration, but the actual time allowed in the school day for students to consume school meals deserves attention. Data collected over a 15-day time period in Ellensburg, Washington, were studied to determine if a difference existed in the time available for students to consume lunches during the school day. Fifty percen t of 450 first through third grade students brought lunch from home, and the remainder co nsumed school meals. The results, as reported by Buergel, Bergman, and Knutson ( 2002), indicated that students who brought

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38 lunch to school were provided more time to consume their food, as compared to students who purchased a meal or receive d a free meal, and were therefore required to stand in line to receive the meal. However, students who select school lunches consume higher intakes of nutrients (Gordon, Devaney, & Bur ghardt, 1995; Gordon & McKinney, 1995; Rainville, 2001), therefore Buergel et al. sugge sted a minimum amount of time should be determined regarding the length of school lunch periods to encourage participation in the school meal program. Two important factors that must not be overlooked include the realities of offering a school meal program to over 30.5 million child ren daily, and the steps that have been taken toward the goals of the School Nutrition Dietary Assessment (Snyder, Lytle, Pellegrino, Anderson, & Selk, 1995). School nutrition personnel recognize the need to offer lower fat, lower sodium, nutritious meals to children. However, participation in the school meal program, unlike mo st school programs, is not mandatory. Students may choose to opt out of the school meal program if they do not like the foods being served. Many other variables affect stude nts' decisions to participate in the school meal program: quality, value, whether or not their friends pa rticipate in the program, and whether or not the program is deemed to be socially accepta ble. Snyder et al. (1995) suggest that food selection behaviors and preferen ces are shaped by parents, other students, and classroom experiences. Parents and other adults are ge nerally more concerned than students about the healthfulness and nutritional content of foods. Students are most interested in taste. The school nutrition program shoul d ensure that quality and va lue conditions are met, but other environmental factors, such as the hom e, classroom, peers, and television influence the normative aspect of eating. The envir onment must be supportive of good nutrition;

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39 absent this support, the school nutrition progr am will struggle to su cceed. Teachers and parents who support and speak positively about the program, and classroom lessons that refer to school meals as ex amples of good, nutritious, and mo st importantly (to students) tasty food choices would be helpful in crea ting an environment more likely to attract student participation. Snyder et al. (1995) contend that school boards and dist rict administrators voice concern and support for nutritious school meals, but require the school nutrition program to cover its own expenses, usually at prices th at are much lower than any restaurant, even though the program must fund negotiated salari es, benefits, and food and supply costs. The school nutrition program is often required to pay monies into the district's general operating budget for direct and indirect cost s over which the nutrition program has little to no authority to question. Federal revenues he lp to defray some costs, but the overhead of running the program is assumed primarily by cafeteria sales. “The best lunches in the country will not improve the nutritional intake of children if the children do not buy and eat those lunches” (James, Rienzo, & Frazee, 1996, p. 131). The researchers, who conducted a study in the spring of 1995 to examine student attitudes toward school meals programs, and to determine factors that encourage student participation, concluded that too much responsibility for improving the health of America’s school children is placed on the schools nutrition programs. Four focus groups, composed of six to eight 9th grade students from a Florida school district, representing diverse economic and ethnic groups, were asked 12 main questions and additional probing questions. The focus group pa rticipants indicated that one reason for not participating in the reimbursable school m eal program is that “teachers bring their

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40 lunch to school.” Students commented that school meals prices are too high, but the students in the focus groups typically did not bring a lunch from home to school. Those who did not select a reimbursable school meal either opted for ala carte food items, or waited until after the school day to eat. As cited by Snyder et al. (1995), the authors of this study reiterated the importa nce of remembering that participation in school meal programs is not mandatory. Suggestions pr ovided to improve school lunches included improving the taste and appear ance of food, offering a wider variety of foods, serving more fresh fruits and vegetables, lowering the price, increasing serving sizes, and providing more condiments. Attempts to provide healthier opti ons, however, are not always successful, as students request greater variet y, but tend to eat th e same foods each day. Cho and Nadow (2004) indicate that st udent preferences for unhealthy foods, coupled with a lack of parental and commun ity involvement make it difficult for school meal programs to achieve sustainable su ccess. Cho and Nadow conducted a qualitative study with responses from 10 superintendents and principals, 18 foodservice directors, and 27 nurses and health educators by the Massac husetts Coordinated School Health Program, a Center for Disease Control and Prev ention funded partnership between the Massachusetts Departments of Education and Public Health, to examine the barriers to providing quality lunch programs and nutrition education. The intent of the researchers was to provide a more in-depth and holistic inve stigation of barriers, specifically related to quality lunch and nutrition education programs. Superintendents, foodservice directors, and nurses/health educators agreed that the two top barriers to providing a quality lunch program were lack of funding and students’ preferences for unhealthy foods. Third and

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41 fourth perceived barriers to providing a quality lunch program on the foodservice directors’ list were lack of communication with teachers and lack of leadership. Third and fourth items on the nurses/health educators’ lis t was lack of parental support and a lack of communication with foodservice staff. Rega rding barriers to the provision of nutrition education, the first response for all groups was a lack of time for coordination between foodservice staff. Superinte ndents’ and nurses/health educators’ second response was a lack of facilitating staff, and foodservice directors’ second response was a lack of leadership from the administration, which was also the third response from nurses/health educators. Overall, a lack of communi cation between school nutrition staff, health educators, and teachers was the primary f actor identified in this qualitative study conducted to identify barriers to implementing quality school nutrition programs and nutrition education programs. Cho and Nadow (2004) contend that his l ack of communication hinders coordination and promotion of school nutrition programs and school-wide nutrition education oppor tunities. Support of school and di strict administration, including all school staff, as well as parents, the comm unity and mass media is needed in order to make meaningful and long-term changes. A study conducted by Moag-Stahlberg (2003), entitled “What kids say they do and what parents think kids are doing,” unde rscores the importance of adults being informed and taking responsibility for th e development of healthy school nutrition environments. An online survey was de veloped in 2003 and completed by 615 parent members of the Knowledge Network Panel, and 471 students from the same household, 13 to 18 years of age, and te lephone interviews with 144 stud ents, ages 10 to 12 years.

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42 One of the findings of this study was that child ren identified their parents as their most important role models, at a time when fam ily meals and physical activity within the family unit are on a decline. Only 15% of ch ildren reported physical activities, such as bike riding or a playing a sport with parents, with boys more likely than girls to report physical activity with a parent. Fifty-seve n percent reported television watching with a parent daily, and 42% reported going to a fast-f ood restaurant or food court as least once a week. Moag-Stahlberg’s report indicated th at parents reported hunge r to be the primary reason for children to eat, at 78.5%, but ch ildren reported hunger as the primary issue only 61.8% of the time. Depression and boredom were listed more often by children than by their parents. Parents also underestimated the time children eat in the evening after dinner, while doing homework, and while watchi ng television or playing computer/video games. Since parents are not as informed a bout their teenagers’ f ood practices as they think, the researchers questioned if schools are faring any better. Some would counter that schools should not be the primary target of the child nutrition debate. Frank (1994) stated that sc hools are the most likely places for children to receive a nutritionally balanced meal with appropriate portion sizes of foods served, regardless of household income level. Ayoob, an associate professor in the department of pediatrics at Albert Einstein College of Me dicine in New York City stated that schools should be commended for their e ffort in promoting healthy school nutrition environments. When asked to comment on the Institute of Medicine’s recent “competitive foods” recommendations in an ABC intervie w aired on April 26, 2006, Ayoob responded: Anyone who thinks the school food reform will solve the problem of childhood obesity is sadly mistaken. Kids are in school only six hours a day. The school breakfast and lunch are set and calorie-controlled. Now, possibly the other foods sold in schools will be as well. But there’s a dirty

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43 little secret about the obesity epidemic that no one wants to think about: what goes on at home. The obesity epidemic will continue until we address what’s happening during the ot her 18 hours of the day when kids are not in school. That’s when kids get the bulk of their calories. After school and at dinner, kids are no longer products of the school system. Rather, they’re heavily influenced by the eating environment at home, and what’s available. (K. Ayoob, Ap ril 26, 2006, personal communication) Removed from the classroom, but influential in establishing policy, an investigation of superintendents’ perceptions of student health issues was conducted by Winnail and Bartee (2002). The researchers re ported responses from 40 superintendents from a frontier state who completed three rounds of surveys designed to determine the top 10 concerns of school district superintendents, and where stude nt health issues might fall on the continuum of concerns. The concerns co uld be classified into one of three major areas: (a) school funding, (b) classroom education and student achievement, and (c) teacher-centered issues. Student health issues, although considered important in a general fashion, were not cited in the top 10 issues listed by school superintendents. Winnail and Bartee remarked that this absence speaks to the "potential futility" of using student health issues alone in gaini ng administrative suppor t for programming and intervention. Linking administrative concerns fr om the top 10 list, su ch as the provision of an adequate nutrition program to its eff ect on academic performance, may be a more effective way to gain administrative support fo r school health promotion efforts. Gaining support for the establishment of healthy school environments may have to start elsewhere. However, studies focused on school princi pals' and superintendents' perceptions of school nutrition programs have indicated that the more knowledge principals or superintendents have about nutrition, the more likely they are to support school nutrition

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44 programs (Bogden & Vega-Malos, 2000; Brown, Akintobi, Pitt, & Berends, 2004). Cho and Nadow (2004) suggest that this understanding and support increases the likelihood of student acceptance and participa tion in school nutrition progra ms. Since principals' and superintendents' attitudes toward school nut rition programs may have a positive effect on students, it is possible that a similar and even stronger effect could be expected between elementary students and their teachers. The decisions that adults make, including the appropriateness and acceptability of decisions that affect children’s health, have far reaching implica tions on school nutrition environments. A report from the University of Michigan indicated that 13 of 16 middle schools had extensive ala carte programs, which directly compete with the foods available in the National School Lunch Pr ogram. Kubik, Lytle, Hannan, Perry, and Story (2003) collected 24-hour dietary reca ll data from 598 sevent h grade students in Michigan. The investigation fo cused on fruits and vegetables served to students in school meals, foods offered and sold ala carte, and snacks and beverages sold in vending machines and school stores. Schools that di d not have ala carte programs reported fruit and vegetable intakes that met or came clos e to meeting dietary recommendations. The presence of ala carte programs and vending m achines in schools was related to decreased intakes of fruits and vegetables. The major ity of vended foods items were identified as high in calories and fat. Kubi k et al. (2003) maintain that interventions must be focused not only on school food service programs, but all other venues, such as vending and ala carte food sales. All school level environmental factors shou ld be targeted if healthy school nutrition environments are to become a reality. How adult attitudes and beliefs influen ce their decisions and the overall school

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45 nutrition environment was apparent in a study conducted by McDonnell, Probart, Weirich, Hartman, and Birkenshaw (2004). The purpose of the study was to identify perceptions and barriers to the initiation a nd promotion of school breakfast programs in Pennsylvania. Seventy-three school business officials, principals school food service directors, and parents were divided into nine focus groups. Despite evidence in the literature that links school breakfast progr ams to academic achievement and improved student behaviors and outcomes (Affenito, 2007; Rampersaud, Pereira, Girard, Adams, & Metzl, 2005), participants in the focus groups identified six major barriers to the implementation of school breakfast programs, including program costs, scheduling, bus schedules, school breakfast programs overstepping the bounds of schools’ responsibilities, interf erence with parental control, and the belief that school breakfast programs are only intended for low income students. Results indicated that school administrators and school food service directors identified parents as strong forces for change within a school, but pare nts did not identify a role fo r themselves in the initiation of a school breakfast program. The researcher s suggested that the id entification of other successful school breakfast programs, strong mark eting efforts, and th e identification of a key individual in the school district to support the program and act as an advocate are essential to overcoming the barriers to sc hool breakfast program implementation. An omission in the study is that teachers were not included in any of the focus groups. Another survey of school nutrition profe ssionals assessed the appropriateness of messages directed to children in the school environment. Ninety-seven percent of 417 respondents from members of the American Dietetic Association’s School Nutrition Services Dietetic Practice Groups and 339 members of the Society for Nutrition

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46 Education’s Division of Nutrition Educati on for Children agreed that environmental factors at school support, permit, encourag e, or discourage certain eating behaviors (Levine & Gussow, 1999). The 61-item ques tionnaire contained 13 questions about demographics, 23 knowledge questions, and 25 attitude questions. The researchers wanted to know if nutrition professionals per ceived an increase in student consumption of a sponsor’s product a fair trade-off for e ducational resources. Eighty-two percent indicated their response would be affected by the nutritional valu e of the food being promoted. Companies or agencies recogni zed as most likely to produce high quality nutritional materials included Dole, the Natio nal Dairy Council, and the Beef Industry Council. Least respected were candy compan ies or soft drink companies who provide nutrition education materials to schools. The reputation of a company, and the way in which foods are marketed, do appear to ha ve an influence on nut rition professionals. Factors that influence food intake What factors determine children’s food preferences and food intakes? Is the determ ination primarily biological, or are children influenced to a greater extent by the interreationships of the environment in which they live, and the modeling of adults and other children? That parents influence their children is expected, but when it comes to the development of dietary behaviors, parents impact children in ways that parents themselves might not anticipate. An arti cle published by Anliker, Laus, Samonds, and Bead (1990) noted that specific nutrition informati on shared with preschool children increases the likelihood that children will understand nutrition concepts. This is a reminder to parents to positively communicat e nutrition messages, and to communicate those messages as often as possible. However, in an age of lesser parent involvement, the

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47 role of the teacher in shaping the minds a nd behaviors of children has been heightened (Campbell & Sanjur, 1 992; Escobar, 1999). Nutritional behaviors of children are formed at a young age, and are largely attributable to environmental factors, in cluding the home and school environments, the media, and the larger community. Child ren need guidance during early childhood and their first few years of schooling when these nutritional behaviors are being developed and established (Picciano, Smiciklass-Wright, Bi rch, & Mitchell, 2000). Research indicates that health behaviors established during ch ildhood often prove difficult to modify during adulthood (Centers for Disease Control and Prevention, 2007). The importance of children’s early food preference was underscored by a five-year longitudinal study of children, ages 2 to 8 y ears (Skinner, Carruth, Bounds, & Ziegler, 2002). Mothers of the children involved in the study were asked to complete a Food Preference Questionnaire for their children at two to three years of age (T1), four years of age (T2), eight years of age (T3), and for them selves at T1 and T3. The parents were well educated and from middle to upper-middle so cioeconomic class, and the children were white and healthy at birth. The eight-year olds and their mothers completed a Food Neophobia Scale at T3. Skinner et al. found that children were more likely to taste and accept new foods between T1 and T2 than betw een T2 and T3. Mothers’ and children’s food preferences were significantly related. Mothers influence children via their own food preferences, the researchers suggested, in that they may limit access to foods offered to their children to those foods they prefer. Th e researchers also suggested that mothers may need assistance in teaching children to enjoy a wide variety of foods and should recognize their own role in shaping children’s food preferences.

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48 Birch, Johnson, and Fisher (1995) reject th e notion that children will dislike or refuse new foods, if that rejection is base d solely on an initial refusal. Changes in acceptance of new foods occurs over time, often requiring as many as 10 exposures before changes in acceptance are achieved (Sullivan & Birch, 1990). Often, children do not have the opportunity to eat new foods because parents interpret initial rejection as a food dislike that cannot be changed, and not attempt to serve the food again. Attempting to address the underlying issu es of why children typically eat few fruits and vegetables, an intervention study wa s funded by the National Cancer Institute as part of the 5-A-Day for Better Health In itiative (Reynolds, Baranowski, Bishop, Farris, Binkley, Nicklas, & Elmer, 1999). A sample of 414 third graders (46% male and 54% female; 86% white, 14% black; 34% eligible for free or reduced-priced school meals) were asked to complete a single 24-hour diet ary recall and to complete a simple food preference questionnaire. The questionnaire assessed children’s food preferences, nutrition education received, and sources of modeling fruit and vegetable consumption. Preferences were assessed for 20 common fruit and vegetables, and students were asked if they had ever eaten the food items, and whether they like the food a lot, a little, or not at all. Students were also asked how they l earned about fruits and vegetables, including specific people and media sources. Finally, th e students were asked to indicate the people they see who most often eat fruits and vegeta bles. Nutrition knowledge appeared to be a predictor of higher fruit and vegetable consumption, but since knowledge and consumption were measured at the same time Reynolds et al. suggested that children’s knowledge may be influenced by their consump tion. Children who eat more servings of

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49 fruits and vegetables may possess more knowledge due to their consumption, selection, purchasing, and preparation of fruits and vegetables. Availability also had a direct influence on consumption. Students who were more often exposed to fruits and vegetables, or wh o had tasted a greater number of fruits and vegetables were more likely to consume the foods. Predicted relationships with modeling were not found. The frequenc y of modeling, credibility of mo dels, or types of modeling behavior was not established in this study. Additionally, there was no effect of higher levels of nutrition education on consumption. No measure of the ag e appropriateness or quality of nutrition education provided was made. Nutrition messages geared to childre n must be simple, positive, and developmentally appropriate, according to Ly tle, Eldridge, Katz, and Piper (1997), who conducted a study to determine how children understand and use nutrition messages. One hundred and forty-one students in grades K-6 we re assigned to one of three age groupings, K to 2nd grade, 3rd and 4th grade, and 5th and 6th grade. Ten focus groups and 15 one-onone interviews were conducted to determin e how well children understood messages used in common nutrition education programs. Questions asked referenced the Food Guide Pyramid and the Dietary Guidelines for Amer icans, and included such questions as: “What do you think you should eat if someone told you to eat a variety of foods?” “What do you think it means to maintain a healthy weight?” “If someone told you to ‘Choose a diet lo w in fat,’ what do you think you should eat?”

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50 Children who participated in the one-on-one interviews were also asked to identify foods into the following categories: foods low in fat, foods high in fat, vegetables, fruits, grain products, foods high in sugar, and foods high in salt. The researchers hypothesized that abstract nutrition terms and nutrition messages are difficult for children to interpret and to us e; significant differences in understanding of abstract terms occurred between the age gr oupings. Messages that are scientifically correct, but too difficult for children to understand will not be effective. Lytle et al. stated that adults must realize that their attitude s and behaviors influence children more than their spoken statements, encouragement, or coercion, as revealed in the following studies. Researchers agree that the practice of limiting or withholding foods from children may increase a desire for the restricted foods, accompanied by a decreased desire for those foods strongly encouraged or forced on children (Birch & Fisher, 1998; Birch, Fisher, Grimm-Thomas, Markey, Sawyer, & Johns on, 2001; Fisher, 2002; Kremers, Brug, deVries, & Engles, 2003). A study conducted w ith 394 parents of 5-year old to 9-year old children (53 girls and 67 boys) enrolled in a primarily Caucasian private school in Denver, Colorado, and 126 parents of 7-year old to 11-year old children (63 girls and 63 boys) enrolled in a primarily Hispanic public school in Denver, Colorado, considered seven factors hypothesized to affect children’s eati ng behaviors (Birch et al., 2001). A Child Feeding Questionnaire was administered to all parents, which investigated the seven factors: perceived feeding responsibilities, perceived parent weight, perceived child weight, concerns regarding child’s weight, food restriction, pressure to eat, and food monitoring.

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51 Birch et al. concluded that high levels of parental control may impede children’s self-control based on responses to hunger and satiety cues. Forcing children to eat healthy foods decreases interest in eating these foods Additionally, when controls or limitations are removed after severely limiting access to desired foods, consumption of these “off limit” foods increases significantly. This finding supports an earlier study by Fisher and Birch (2000), which reported that restrictive feeding practices result in increased consumption of foods when restrictions are lifted and a child is allowed the freedom to choose. Variety and moderation, as opposed to restrictive feeding, should be encouraged among parents and their children. Fisher, Mitchell, Smiciklas-Wright, and Birch (2002) found that parents who eat few fruits and vegetables may exert pressure on their own children to eat these foods. A study of 191 white, non-Hispanic families with 5-year old girls revealed that pressuring children to eat fruits and vegetables decreas es their preference for these foods. The children and their parents lived in central Pennsylvania and were participating in the first year of a longitudinal study on the development of eating behaviors, including dieting, across middle childhood. All children in th e study consumed fewer than the five recommended servings of fruit and vegetables, but the higher the parents’ intake of these food items, the higher the intake of their daughters. According to the researchers, children whose parents routinely consume fruits and ve getables do not have to be coerced into eating the foods because they observe and follow their parents’ example. Participants in another study of 89 mother s of 5-year old to 18-year old children (40 boys and 49 girls) in their first three years of schooling in Adelaide, Australia indicated that they were aware of, concerned about, and did exert control over the food

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52 intake of their children (Tiggemann & Lowes, 2002). Although the level of control was determined to be high for mothers of boys and girls, mothers generally agreed that they made much more effort with their daughters to ensure that they “do not put on too much weight.” As noted by Birch et al. (1995), and Fisher and Birch (2000), restriction and control over food intake may have the opposite effect, with an increased desire for and consumption of restricted foods. Mothers who perceive themselves to be overweight tend to exert the most control over their daughter’s food intake, regardless of the child’s weight. The mother’s own concerns about weight, accompanied by her own insecurities about eating, may be manifested in more re strictive feeding practices, suggests Tiggemann and Lowes, who also contend that this leve l of control provides a vehicle for parental attitude and belief transmission to children. Parents also influence dietary behavior s of older children, according to a study by Kremers et al., (2003), conducted in the Nether lands. Data were collected at 643 schools of 1771 Dutch 16-and 17-year olds. Students were asked to describe their parent as authoritative, authoritarian, indulgent, or neglectful, according to the following parameters: Authoritative high strictness high involvement Authoritarian high strictness low involvement Indulgent low strictness high involvement Neglectful low strictness low involvement Kremers et al. were attempting to bette r recognize poorly understood mechanisms of influence and the impact of social environm ent in dietary behavior development. After students described parenting styles, they were asked about their personal fruit consumption. Fruit consumption by students was related to parenting styles in this order: authoritative, indulgent, authoritarian, and ne glectful. The researchers surmised that

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53 parental involvement is an important pred ictor of fruit consumption in the population studied. Involved parents are available and accessible to their children, which increases the likelihood of appropriate parent modeling. Feeding practices that diminish or ignore internal satiety cues, whether through restriction or rationing, should be replaced w ith modeling and an en joyment of foods and the environment in which the meal is c onsumed (Fisher & Birch, 2000). Children do develop food preferences based on an innate taste for sweet or slightly salty foods (Cowart, 1981; Cowart & Beauchamp, 1990), but they are not born with a predisposition for high-fat or calorically dense foods (B irch & Fisher, 1998). Allowing children to follow their own sense of taste and fullness shoul d be the norm, but this is not necessarily so, according to the literature. A convenience sample of 277 adults were recruited from four public schools in Minneapolis/St. Paul; 85% female, and 70% married (Boutelle, Birnbaum, Lytle, Murray, & Story, 2003). The number of children in the household ranged from one to nine years of age, with the mean numb er of children 2.6. Variables measured, through a telephone survey, were adult fruit and vegetable intake, fat intake, and perceptions of the mealtime environment. The majority of participants reported that television was frequently turned on during dinner time, and nearly one-third sa id their family was too busy to eat dinner together. A high frequency of television wa tching during dinner was associated with a low intake of fruit and vegetables and higher fat consumption. Forty-six percent of adults did not plan meals in advance, but of thos e who did plan meals in advance, a higher consumption of fruit and vegetables was re ported. Arguments during dinner, related to eating behaviors of children, were associated with higher fat intakes of adults. No

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54 mention was made of an association between mealtime television watching and arguments. Boutelle et al. concluded that nutrition messages designed for families must address the family meal environment and adult eating patterns. Is it possible for schools to be effective in influencing children’s dietary behaviors and food choices through nutrition education programs, given the overall environment in which a child first experiences foods, develops preferences for food items, and is affected by parents and other role models? Critics of the traditional “dry” approach to nutrition education, Seaman and Kirk (1995) examined approaches to improve nutrition knowledge, which are often unsuccessful, contrasted with food advertising and marketing techniques designed to create positive images for specific foods and food habits. Nutrition education programs are better received when they are exc iting, colorful, or trendy. Seaman and Kirk recommended a social marketing approach; a collaborative effort between nutritionists who understand the science behind nutriti on, and social marketers who understand customers and advertising environments. An identification of why some childre n choose to eat healthy foods and be physically active may assist parents and teachers in better understanding the motivating factors behind children’s health behaviors. O’Dea (2003) conducted a study with a goal of asking children and adolescents to rank perceived benefits of and barriers to healthful eating and physical activity, and to suggest stra tegies for overcoming barriers. Students in grades 2 through 11, ages 7 to 17, participated in this study from 34 randomly selected schools. Thirty-eight semi-structured, in-d epth focus groups were conducted with the 213 participants. Relevant to this review, students listed the benefits of healthy eating: improvement in academic and physical performance, fitness, endurance, psychological

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55 benefits, “feeling good” physically, and energy. Barriers included convenience, taste, and social factors. Students suggested that the barriers could be addressed through support from parents and school staff, better planni ng and time management, self motivation, and education. The results of this study support the notion that students do look to parents and teachers for support and encouragement, and for involvement in the development of healthful behaviors. Powers, Struempler, Guarino, and Parmer (2005) studied the ef fects of a nutrition education program on the dietary behavior and nutrition knowledge of second-grade and third-grade students. Over 1100 second-grade and third-grade students were studied at schools selected by a convenience sample from public schools in Alabama. Children in the treatment group ( n =702) participated in a pre-assessment, six weekly nutrition education classes, and a post-assessmen t. Children in the control group ( n =398) were involved in pre-assessment a nd post-assessment, but did not receive nutrition education. Children in the treatment group exhibited greater improvements in overall dietary behaviors than did children in the control group, which incl uded increased consumption of dairy products, fruits and ve getables. A fact is that child ren from the treatment groups and control groups were from the same school and 75% of the child ren within the school participated in the National School Lunch Program. The research ers suggest that the nutrition education program ma y have affected behavior change. Children in the treatment group exhibited an increase in nutrition know ledge, including a better understanding of the Food Guide Pyramid, a nd nutrient-food associations (such as knowing that oranges are high in Vitamin C). Six hours of nutrition education falls far short of the 50 hours suggested by C onnell, Turner and Manson (1985), but by

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56 participating in even a limited number of nut rition classes, increases in overall nutrition knowledge and certain behavior al changes are possible. Canada and the United States are similar in the respect that a research gap exists concerning teacher modeling, starti ng in the kindergarten classroom and beyond, and the effect that modeling might have on children's dietary behavior development and the promotion of healthy school nutrition envi ronments. Canadian researchers Taylor, Evers, and McKenna (2005) conducted a review of literature to identify research gaps in the area of determinants of healthy eati ng among children and youth. Economic factors, food security, the content of media nutritional messages, and the issues of flavors, food neophobia, and food preferences were the pr imary factors investigated. Identified knowledge gaps included: (a) the nature and extent of familial influences, including family food practices ; (b) the impact of the school environment on healthy eating, particularly nutrition policies and modeling; (c) effects of mass media on healthy eating; (d) food preferences and nutri tional knowledge/skills in children and their impact on behavior change; (e) multiple determinants of healthy eating in children and youth, and their interactions; and, (f) longitudinal mon itoring systems to identify national and regional eating behaviors in youth. A comme nt provided by the researchers was that enthusiastic teacher and peer modeling has been found to increase acceptance of healthy food choices in preschoolers. Teacher surveys of school nutrition programs. The Teacher/Administrator School Foodservice Survey was developed by Meyer in 2002, who at the time, was a Research Scientist at the National Food Servi ce Management Institute. The purpose of the instrument was to determine teachers’ a nd administrators’ satisfaction with school

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57 nutrition programs. Meyer acknowledged th at the primary customer for school foodservice and nutrition programs is the stud ent, but secondary customers, such as teachers, may influence the perceptions of st udents, and possibly student participation in the school meal program. The Meyer survey was one of five customer service surveys designed for high school, middle/junior high school, upper elem entary school, lower elementary school parents, and teachers/administrators. Meyer’ s original 45-item instrument contained 30 questions that loaded into one of six factors: food quali ty and preferences, staff, ambience, price, nutrition, and time. Analysis of variance was conducted to identify differences for teachers and administrators according to grade level, fre quency of eating school lunch, length of the school lunch, and years of experi ence. A significant difference ( p <.005) was found for grade level among teachers in the kindergart en, elementary, middle, and high schools for overall satisfaction. The same was true for the factors of Food Quality and Preferences, Staff, Price, Nutrition, and Time. Factor m ean scores were highest for elementary school teachers and administrators and lowest for mi ddle school teachers and administrators. No difference was found by grade level for the factor Ambience. Frequency of eating in the school cafeteria impacted all six factors and overall satisfaction. When teachers or administrators ate three to five tim es per week in the cafeteria, they were significantly more satisfied ( p <.005) than those who ate less often. A significant difference ( p <.005) for overall satisfaction was noted for teachers and administrators according to the length of the lunch period among the factors of Food Quality and Preference, Staff, Ambience, and Price. Interestingly, when the lunch period

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58 was longer, the satisfaction with the factor Time did not increase. No significant differences were noted according to years of experience or whether or not they had a duty-free lunch, free of supervisory duties. Th e scores, however, for the factors of Staff, Nutrition, and Time were higher when t eachers possessed three to five years of experience. Teachers scored the factors Staff and Ambience higher when they had a duty-free lunch; the factor Nutr ition was higher when they did not have a duty-free lunch. Focusing on foodservice di rectors, teachers, and pr incipals, Lambert and Carr (2006) developed two instruments to obtai n information regarding perceptions and practices of providing nutriti on education to elementary st udents in Arkansas and Idaho. The first survey contained 28 statements, desi gned to measure perceptions and practices of foodservice directors and teachers rela ted to providing nutrition education to elementary students, and 14 questions. Six of the 14 questions solicited feedback on how nutrition education was being incorporated into the elementary classroom, seven questions requested demographic informa tion, and the final, open-ended question allowed respondents to provide feedback to issues related to providing nutrition education in elementary classrooms. The second survey, designed for principals contained the same 28 questions as did the first survey. The questions were re worded, however, to reflect the position of the principal in responding to per ceptions and practices of foods ervice directors and teachers in providing nutrition education to elementary school students. Factor analysis of the 28 survey statements produced six factors that we re identified by the researchers: parents, nutrition education, self (direc tor, teacher, or principal), National School Lunch Program guidelines, and funding. The study addressed an issue not frequently found in the

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59 literature, being that of the individual’s role in promoting, su pporting, or directly providing nutrition education. All groups responded that nutrition educati on is important and valued at their schools, but that inadequate funding existed to support nutrition edu cation. Principals responded that teachers and foodservice sta ff needed training to provide nutrition education, while teachers and foodservice sta ff responded that they were adequately trained to provide instruction. The statement, “nutrition education shou ld be a part of our elementary students’ curriculum,” revealed agreement among foodservice directors (93%), teachers (93%), and principals (98%). The statement, “nutrition education is a part of our elementary students’ curriculum,” revealed a lower perc entage of agreement; foodservice directors (47%), teach ers (71%), and principals (90 %). Forty-nine percent of foodservice directors and 76% of teachers indi cated that they provide nutrition education to students. Results for teachers are simila r to those of Stang, Story, and Kalina (1998), who reported that teachers in Minnesota overwhelmingly supported nutrition education, but 69% actually provided nutriti on education in the classroom. In another study led by Lambert, Raidl, Carr, Safaii, and Tidwell (2007), the researchers investigated school nutrition directors’ and te achers’ perceptions of the advantages, disadvantages, and ba rriers to participation in the school breakfast program. Although separate, the related programs of the National School Lunch Program and the National School Breakfast Program are federally funded initiatives of the United States Department of Agriculture. Student partic ipation in the school breakfast program has been shown to support better academic perf ormance, better school attendance, and improved overall dietary inta ke than non-participating st udents (Rampersaud, Pereira,

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60 Girard, Adams, & Metzl, 2005). However, stude nt participation in the school breakfast program is much lower than that of the school lunch program (Murphy, Pagano, Nachmani, Sperling, Kane, & Kleinman, 1998). During the study, Lambert et al. used fo cus group methods to conduct discussions with school nutrition directors a nd teachers in one school each, in the states of Utah, New Jersey, and Illinois. Three primary questi ons, “What are the advantages to students participating in your school’s breakfast program?” “What are th e disadvantages to students for participating in the school breakfa st program?” and “What are the barriers to students participating in the school breakfa st program?” were asked of the 27 school nutrition directors and 31 teachers who partic ipated in the seven focus groups conducted. Six themes emerged from the question a bout the advantages of school breakfast programs. An emphasis was placed on the social aspects of consuming a breakfast at school, followed by parent benefits better nutrition, the fact that the school “feeds them,” and the fifth theme was school performance, followed only by student preferences. The finding that school performance wa s fifth of sixth themes liste d may indicate that greater exposure should be provided to teachers a bout the academic benefits of the school breakfast program. The six themes that surfaced from the focus group interviews concerning disadvantages of the school br eakfast program were time issues and conflicting events, low nutritional value, a so cial stigma of being “poor,” meal quality, parent concerns, and the social aspects of breakfast at school (w hich was also listed as the primary advantage of a school breakfast program). Barriers to school breakfast participation centered on the themes of school staff support, time issues and conflicting events, parental influence, social stigma, student prefer ences, and financial issues.

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61 The researchers concluded that, in orde r for school breakfast programs to be successful in reaching and serving children, pe rceived disadvantages and barriers must be addressed. Based upon the feedback received from the school nutrition directors and teachers, recommended strategies include: 1. select teacher representatives to act as liaisons between teachers and foodservice staff; 2. to improve communication; 3. involve teacher representati ves in some aspects of meal planning to educate teachers on nutritional and funding requirements for school meals, 4. include teachers in school nutrition advisory councils; 5. pursue creative marketing strategies to improve teacher awareness of foods offered in school breakfast programs; 6. establish a relationship with the sch ool’s Parent/Teacher Association to educate parents and gain support fo r school breakfast programs; and, 7. provide taste testing opp ortunities for teachers and students, emphasizing foods available in the sc hool breakfast programs. Kubik, Lytle, Hannan, Perry, and Story ( 2003) maintain that the school food environment, beyond that of only the foods serv ed in the school’s cafeteria, has an effect on the dietary behavior development of young adolescents. A study conducted in 16 schools with 598 seventh graders revealed that as ala cart e food selections increased, student consumption of fruits a nd vegetables decreased, and in take of fats and saturated fats increased. The authors suggested that the decisions made by adults in the school setting, the admissibility and av ailability of food choices, and the examples set in school,

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62 in the cafeteria and the classroom, have a great effect on overall student dietary behaviors. From high schools to middle schools and elem entary schools, to day care centers, how eating habits are developed, the influe nce of the school environment, and the influence of adults in these settings, warrant s further investigation. Schwartz, a fellow at the Rudd Center for Food Policy and Obesity at Yale University, developed a Caregiver Attitude Scale, used to assess the degree to which caregivers believe children’s eating behaviors and food preferences are malleable, and the degree to which they believe preschool is responsible for helping children develop healthy eating behaviors. Schwartz conducted this preliminary research at tw o preschools in New Ha ven, Connecticut, but intends to expand the use of this instrume nt (M. Schwartz, personal communication, July 25, 2007). Since preschool children will ente r public schools and participate in the school meals programs, making connections between early childhood to school-aged children’s dietary behavior developmen t warrants further investigation. Microsystem. The microsystem is the immediate setting in which a person lives, with the setting defined as a place with specifi c features in which the person engages in specific activities for specific periods of time. A microsystem can be described as a set of relationships between and among the factors of place, time, physical features, activity, participant, and role (Bronfenbrenner, 1977, 1979). The microsystem consists of interpersonal interactions in specific settings which may include family members, social acquaintances, and work groups (Bubolz & Sontag, 1993). Bronfenbrenner (1977) indicated that the principles of recipr ocity, recognition, and awareness underlie the microsystem. Reciprocal interactions that have an enduring impact on development,

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63 recognition of the totality of the functional system, and an awareness of the indirect impact of physical factors on a setting comprise the microsyste m. A child’s home, school, neighborhood, and the individual developing child are examples of microsystems (Berk, 2003). Nutrition and achievement. The effect of policies, ex ternal factors, and the mesosystem, or the relationships between micr osystems in a school setting, and how they influence the school nutr ition environment have been discussed. How these factors influence the developing child, related to achi evement, is examined below. School nutrition programs ar e essential to the physical and educational requirements of children during the school day (Content o, Balch, Bronner, & Maloney, 1995). Children who experience hunger during the school day ha ve lower math scor es (Alaimo, Olson, & Frongillo, 1993), and run a grea ter risk of overall behavior al, emotional, and academic problems (Kleinman, Murphy, Paga no, Wehler, Regal, & Jellinek, 1998). Children who experience hunger during the school da y are more likely to be hyperactive, and absent or tardy in addition to having more behavioral and attention problems than other children (Murphy, Wehler, Pagano, Little Kleinman, & Jellinek, 1998). An understanding of how stud ent health impacts educat ional outcomes should be a primary concern of all parents and educators (T aras & Potts-Datema, 20 05). Alaimo et al. reported that children from food insufficient households experience negative academic and social outcomes, as revealed in the Third National Health and Nutrition Examination Survey (NHANES III). Lower math scores and a gr eater likelihood of repeat ing a grade, seeing a school psychol ogist, and difficulty getting along with other childr en were evidenced among food insecure children.

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64 Studies indicate that elementary stude nts who participate in school nutrition programs have better test scores, behavior, attitudes and general health than do students who do not participate in organized child nutrition programs (Enns, Mickle, & Goldman, 2002). Winnicki and Jemison (2003) noted that kindergarten students from food insecure households scored lower on initia l tests than peers, and made less learning gains over the course of the year. Children from the Early Childhood Longitudinal Study, 1998-1999 Kindergarten Co-hort, a nati onally representative samp le of nearly 22,000 children enrolled in approximately 1000 kindergarte n programs during the 1998-1999 school year, were followed to assessment in first grad e in 1999-2000. Researchers Kowaleski-Jones and Dunifron (2006) found that participation in the NSLP initially appear s to be related to lower test scores. However, controlling for fr ee and reduced priced meal eligibility as a marker for lower socioeconomic status, boys who consumed school meals had better test scores than boys who did not consume school meals. Similar results were not noted for girls. One of the original studies investigati ng linkages between school meal programs and performance outcomes was conducted by Meyers in 1989. The study compared achievement, as measured by test scores, be fore and after the implementation of the National School Breakfast Program. The study fo cused on the effects of the initiation of a NSBP, but the relationship between th e school-based food assistance program and academic outcomes was evidenced. Higher te st scores were found among children who participated in the NSBP, as were improve d school tardiness a nd absenteeism rates. The National Evaluation of School Nutri tion Programs, conducted over 20 years ago, indicated that National School Lunch Program participants had better overall

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65 nutrient intakes than non-participants (Han es, Vermeersch, & Gale, 1984; Radzikowski, 1984; Cho & Nadow, 2004). Teachers concerne d about optimizing student performance should consider the nutritional status of th e child an important predictor of academic success. Numerous studies have been conducted on the impact that the morning meal can have on student behavior and achievement, and the benefits of br eakfast for children. Students and parents from two elementary sc hools in Baltimore, MD and two elementary schools in Philadel phia, PA received a batt ery of psychosocial, academic, food insufficiency, and hunger measures before th e initiation of a school brea kfast program. Teachers were asked to complete a standardized behavior prob lem questionnaire before and after a universal free breakfast program began. In all four schools the free breakfast program was made available at the beginning of the second semester. Only children in grades 3 and higher were asked to participate in the st udy, although all childre n were eligible for a free breakfast. Ninety-four complete pa rent and child pa ired interviews in Philadelphia and 110 paired interviews from Baltimore resulted in a total of 204 of a possible 679 pairings. Prior to the free breakfast program, 65% of the children were classified as not hungry, 27% were classified “at risk” for hunge r, and 8% were classified as hungry (M urphy, Pagano, Nachmani, Sperling, Kane & Kleinman, 1998). Parents reported a hi gher hunger score as sociated with incr eased psychosocial dysfunction. Teachers re ported greater emoti onal, behavioral, and attention problems among children classified as hungry. Additionally, hungry and “at ri sk” children’s absenteeism and tardy rates were twice that of the children classi fied as not hung ry. The researchers stated an obvious but important fact : beyond the incr eased problems at that o ccur at school, a child is

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66 less likely to be educated if the child is not present during the school day to receive instruction. Afte r the start of the breakfast progra m, many of the hung er-related issues subsided. Murphy et al.(1998) em phasized the need for adults who work with children and their families to ensure that parents are aware of programs th at exist to provide food and nutrition programs to those w ho need it most, such as th e National School Breakfast Program, the National School Lunch Program, the Suppleme ntal Nutrition Assistance Program (formerly referred to as the Food Stamp Program), and the federal program for pregnant women, mothers and th eir young children--Women, Infa nts, and Children (WIC). Severe food insufficien cies can have a grea ter effect on children than short-term behavioral and attention problems. An estim ated 15% of America’s children, despite the availability of federal nutr ition programs, are chronically hungry (School Nutrition Association, 2008). Iron defi ciency anemia (Gordon, 2003) and zinc deficiency (Black, 2003) have been linked to signific antly compromised cognitive ab ilities. Lack of iron can adversely affect brain devel opment, but confounding factor s range from other nutrient deficiencies to overall caloric shortfalls, making it difficult to identify the most important factors in brain developm ent. However, what is certain is that children must have an adequate supply of calories and nutrients to reac h their academic and physical potential. Despite the presence of hunge r in America, the issue fo r many children has shifted from under-nutrition to over-nutrition, and rela ted obesity. While an emphasis on general child nutrition research is important, recent associations between childhood obesity and academic outcomes have become critically important. Does ob esity affect student performance or attendance at sc hool? A study of 1 05 children, ages 5-18, referred by their physicians to a nutr ition clinic or gastroenterologist, in dicated obese children were absent a

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67 median of one day of school in the preceding month, as compared to zero days for healthy children. The mean num ber of days absent wa s 4.2 days for severely obese chil dren and 0.7 days for healthy children (Schwimme r, Burwinkle, & Varni, 2003). Another study of 104 third and fourth grad e children in Philadelphia, PA did not reveal an association between obesity and cla ssroom failure or absenteeism, but researchers reported that obese childr en were twice as likely to be placed in special education or remedial classes (Tershakovec, Weller, & Gallagher, 1994). Similar findings by Falkner, NeumarkSztainer, Story, Jeffery, Beurhing and Resnick (2001) revealed that of 10,000 students in 7th, 9th, and 11th grades, obese girls were 1.5 times more likely to be re tained a grade in school and 2.1 times more like ly to consider themselves poor students compared to female classmates of average weight. Obese boys were 1.5 times more likely to consider themselves poor students and 2.2 times more likely to drop out of school. Datar, Sturm, and Magnabasco (2004) indica ted that kindergarten and first gr ade students evidence lower math and reading scores than non-overweight students These statistics u nderscore the need for greater attention and in volvement of all adults concerned about the car e and development of children. A Brazilian study of 65 obese children, ages 8 to 13, comp ared to a control group of 35 children from th e same community who were at normal weight for height, revealed that children of normal weight for height scored signific antly higher on an IQ test than those in the obese group (Campos, Sigulem, Mo rales, Escrivao, & Fisberg, 1996) Non-obese children had a wider range of interests, greater sp eed and dexterity, and greater social adaptability. A stro nger correlation was shown between weight status and IQ test

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68 performance than for income level and test performance, which de creases the apparent impact of socioeconomic status on academic achievement, ac cording to the researchers. Teacher Attitudes, Influence, Behavi ors, and Demographic Characteristics The following review examines teachers’ attitudes and perceived influence on the school nutrition environment, as well as self -reported classroom behaviors to include classroom rewards, followed by teacher characteristics. Attitudes A study published in 1983 repor ted on the knowledge, attitudes, personal practices, and nutrition educati on practices of 109 kindergarten through 6th grade teachers from 97 schools in Kansas A 115-item questionnaire contained 55 questions to measure nutriti on knowledge, and 60 questions to measure nut rition-related attitudes, and personal and nutrition education practices (Soliah, Newell, Vaden, & Dayton, 1983). Approximately 40% of the teach ers indicated that they sometimes or always ate school meals, about three-quarter s indicated the meals tasted good, and 57% agreed the meals were nutritious. However, even among those teachers who reported that school meals were nutritious or good tasting, ma ny indicated that they did not participate because the meal was too expensive, too salty, too high in calories, or that they wanted more or larger servings of ve getables and salads. Almost a ll of the teachers indicated that nutrition should be taught in the elementary grades, but few taught nut rition concepts in their classroom. Soliah et al. (1983) found that two-thirds of the teachers rarely or never talked with parents about th eir nutritional needs or eating practices of their children. Those who had taken one or more college courses or nutriti on-related continuing education, or who were currently teaching nut rition in the classroom had higher nutrition knowledge, attitudes, and practi ce scores that those without training or who were not

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69 teaching nutrition. The researchers noted a strong positive correlation between nutrition knowledge scores, and attitudes and practices. These findings are consistent with the la ter work of Norton, Falciglia, and Wagner (1997), who reported that Ohio elementary teach ers agreed nutrition education should be taught in the classroom, but ha d no conviction about who should take the leadership role on the issue. Although teachers generally had positive attitudes about nutrition education and indicated a degree of receptivity, the res earchers were concerned about the lack of nutrition education actually occu rring in the classroom. Primary reasons given for not including nutrition education in the classroom included lack of time, followed by a lack of appropriate nutrition education tools, la ck of support from school administration, the subject of nutrition too advanced for elem entary students, or an opinion that the responsibility for providing nutrition education resided with the parent. Time, insufficient funds, large class sizes, and lack of appropriate tools were given by the 530 Ohio teachers for not providing nutrition edu cation in the classroom. Of the 99% who thought elementary schools should have a ro le in promoting nutrition education, twothirds rated themselves as very or extrem ely interested in teaching about foods and nutrition, but most did not teach the subject. Teachers did not feel supported by parents, with the teachers indicating that parents typically have a low interest level in teaching or learning about foods and nutrition. The researchers concluded that effective nutrition education interventions requi re the expertise and understa nding of nutrition educators who acknowledge the role, responsibilities, and challenges faced by elementary teachers. Nutrition education activities need to be st reamlined and coordinated with teachers to provide the training and skills needed to improve children’s diets and health.

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70 Seeking to assess the nutrition knowledge, attitudes, and behaviors among teachers in South Carolina to understand envi ronmental influences on dietary behaviors of children, Rafiroiu and Evans (2005) reve aled that teachers co rrectly answered 63.2% of questions on a nutrition knowledge scale. Nutrient needs, Dietary Guidelines for Americans, healthy meal and snack choices, an d nutrition and health were the topics from which questions were derived. In gene ral, teachers knew more about dietary recommendations than specific nutrients. Teachers listed books, newspapers, and television as their major sour ces for nutrition education. This is an alarming finding, according to the researchers, as the media are more likely to report recent findings and trends than substantiated, sc ientifically supported informa tion. Most educators in the study reported teaching less than 10 hours of nutrition per year, but 93% indicated that nutrition education should be taught in all grad es. Barriers to teaching nutrition included lack of time to plan, coordinate, and impleme nt, as well as too many competing interests, consistent with the findings of Soliah et al. ( 1985) and Norton et al (1997). A lack of collaboration between teachers and school nutrition program personnel was noted. Additionally, about 33% of teachers in the study self-reported being overweight or obese, based on the guidelines provided, which mirrored national statistics (USDHHS, 2001). However, nearly two-thirds expressed concerns about weight, and half were using a method to lose weight. Rafiro iu et al. expressed concern ov er this finding. If teachers were modeling extreme weight control behavior s to students, this might influence eating disorders in students. However, moderate methods, such as exercising and controlling caloric intake might provide a positive message to students. The researchers commented that this is an area need ing further investigation.

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71 Minnesota teachers cited the importance of the topic and their enjoyment of teaching as the two most important reasons for teaching nutrition (Stang, Story, & Kalina, 1998). Results from surveys of 894 elementary and secondary teachers indicated that secondary teachers were more likely to teach about nutrition, and integrated the topic into other subjects, such as math, science, and health classes. Although few of the respondents involved community resources in providing nutrition education, those who did reported using the assistance of Cooperative Extension Serv ice, registered dietitians or nutritionists, public health nurses or educators, non-profit organizations, and grocers. Teachers were much more likely to invite re presentatives from the community resources to speak in the classroom than they were to ask for assistance or gui dance in planning or developing nutrition education lessons. On ly a few teachers reported working with foodservice personnel, even though they expressed an interest in doing so. Lack of time to meet with the foodservice staff, lack of time and training of foodservice personnel, and lack of experience in working collaboratively with foodservice personnel were the stated barriers to providing coordi nated nutrition education. Meyer, Conklin, Lewis, Marshack, Cousin, Turnage, and Wood (2000) investigated middle school nutri tion environments and the promotion of healthy eating. Reports from three focus groups identified co mponents of and barriers to healthy school nutrition environments. Results from a valid ated mail survey indicated that 68% of school foodservice personnel, but only 39% of other school personnel placed a high priority on the establishment and promotion of healthy school nut rition environments. The researchers expressed concern about th e attitudes of teachers and other school

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72 personnel who do not understand or agree with the need to promote a healthy school nutrition environment. Responses from 685 surveys mailed to 3,500 school nutrition directors, school nutrition managers, principals, Pre-K teacher s, and early education directors were received by research scientists at the National Food Service Management Institute (Nettles, Carr, & Johnson, 2006). Significant di fferences in serving the nutritional needs of Pre-K children in the public school setting were identified for four of seven practice factors: encouragement, administrative suppor t, nutritious meals and meal experiences, and communication and training. Three of th ese four factors--e ncouragement, meal experiences, and communication--may be rela ted to the classroom teacher’s attitudes about the importance of student nu trition during the school day. A survey of 96 food service directors, 482 teachers, and 91 principals were asked to respond to the following statement, “Nut rition education should be a part of our elementary students’ curriculum” (Lambert & Carr, 2006). Ninety-three percent of directors, 93% of teachers and 98% of prin cipals responded affirmatively. However, when asked to respond to the statement, “Nutri tion education is a part of our elementary students’ curriculum,” only 47% of directors, 71% of teachers, and 90% of principals agreed that nutrition educa tion was, in fact, a compone nt of elementary school curriculum. This study again underscores the find ings that positive attitudes or a belief in nutrition education does not necessarily ensure that nutrition education will be provided. Similar results were observed by Stang, Story, and Kalina (1998) in a study of 894 elementary and secondary teachers in Minne sota public schools. Ninety-five percent of teachers thought nutrition e ducation was an important to pic to teach, with 79% of

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73 teachers reporting that they taught nutrition. Of the reported 79%, 8% replied that they taught nutrition or nutrition concepts daily, 37% once per week, 37% once per semester, and 12% once per year. Cons idering that the School Hea lth Education Evaluation found that 50 hours of nutrition education were needed to impact be havior, it is doubtful whether the majority of the education provide d in the Minnesota study had any real effect on student outcomes (Connell, Turner, & Mans on, 1985). Stang et al (1998) declared that “Teachers must be encouraged to eat m eals in the cafeteria on a weekly basis, to share nutrition educatio n materials and ideas with foodser vice staff, and to use school menus and the cafeteria as a learning laboratory for food a nd nutrition lessons.” (p. 402). The main objective of a study of 115 science, health, home economics, and physical education teachers, school nurses, and social workers in 17 schools within a large urban school district was to assess atti tudes and beliefs, not about the immediate school nutrition environment, but about perc eived contributors to obesity and teacher attitudes toward obese students (Neumark -Sztainer, Story, & Harris, 1999). The information would be used to increase th e understanding of subtle messages given to overweight students, and to plan training programs for st aff interested in providing obesity prevention programs. Over half of th e respondents believed th at obesity is caused by individual factors such as overeating, poor eating habits, and lack of physical activity, but also believed that biological factors can contribute to obesity. Approximately 25% of the respondents perceived obese students as more emotional, less tidy, less likely to succeed, having “different personalities” (p. 7), or having more family problems than non-obese students. The resear chers concluded that staff ma y need to be trained on the complexities of obesity and the many factors that influence body weight, including

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74 genetics, behavioral, familial, societal, and ps ychological factors. Te acher attitudes about individual children or groups of childr en may affect the overall school nutrition environment. Influence. Kubik, Lytle, Hannan, Story, and Perry (2002) conducted a study resulting from their concern that no recent published studies examining the influence of food-related role modeling of teachers to stude nts existed. The researchers believed that teachers have the opportunity to influence ea ting behaviors of youth due to their close proximity and repeated contact. They ci ted an increase in research regarding the influence of food availability at school, examining such fact ors as vending and ala carte sales in schools, but indicated that the influence of food-re lated classroom behaviors of teachers had received little attention. Th e study of 490 middle school teachers, based on Bronfenbrenner’s ecological model, recognized the significance of adult influences on youth behavior development through role modeling, normative practices, and social support. Results revealed that most middle school teachers used foods as rewards, and the foods used were not typically classified as healthy foods. The researchers, who reported high fat intakes among teachers, low perceived personal hea lth of teachers, and low support of a healthy school nutrition environment, conclude d that the teachers did not perceive a personal influence on the school nutrition environment and did not model healthy eating at school. Based upon the findings of the 2002 st udy, Kubik, Lytle, and Story (2005) conducted a follow-up investigation with middl e school teachers and parents. Survey items were developed by the researchers base d on available litera ture, focus groups, and key informant interviews with students, pa rents, and school personnel. Three hundred

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75 and fifty parents and 490 teachers completed su rveys, revealing that both groups believe nutrition and school food programs are important but do not perceive school nutrition programs to be healthy enough. However, when questioned, 40% of parents and over one quarter of the teachers said that food-re lated fund raising is acceptable, even though the products are usually high in fat or are chocolate candies. The reasons for the positive responses were typically relate d to the consensus that student s like or prefer these foods. Most parents agreed that parents do influe nce children’s eating practices, but only onethird of teachers agreed that they pers onally have an influe nce on student eating behaviors and practices. Most parents and teachers agre ed that product advertising influences students to purchase advertised items, but only half of parents and just over three-quarters of the teachers believed that schools should prohibit food-related advertising. The schools’ financial needs fo r fund raising and stude nt preferences for snack and beverage items were given as jus tifications for advertis ing. The researchers concluded that teacher and pa rental beliefs, influence, and support for healthy school nutrition environments are not consistent, and that a dichot omy of beliefs and practices exist. An earlier study of the sources of nutriti on information and beliefs of health and physical education teachers revealed that 66% of teachers felt they had some influence on the dietary practices of students, and 80% ha d attempted to influence students’ practices (Pratt & Wallberg, 1998). Only 28% of the re spondents, however, had ever participated in a nutrition class. Most teachers obtained their nutrition information from newspapers and magazines, followed by friends as the next source of information. Even though teachers were generally knowledgeable about fluid needs before, during, and after

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76 training and athletic events, 27% stated that an electrolyte drink, such as Gatorade, was preferable to water. Most teachers agreed that carbohydrate and fa t are the main sources for muscular energy, but 35% erroneously indi cated protein as the primary source for muscular activity. The researchers concl uded that nutrition education is needed for health and physical education teachers to ad dress balanced diets and fluid replacement. How teachers perceive their influence on school nutrition programs was the topic of a study conducted in the late 1970s. Fiftythree surveys to determ ine attitudes toward school nutrition programs were mailed in 1978 to 98 elementary teachers at seven schools in a medium-sized Midwestern city; responses were received from 85%. Most teachers ranged in age from 26 to 50, and had ta ught between 6 and 20 years. The largest percentage of teachers indicated that they ate a school lunch only once a month or never participated in the school meal program, but about one-fourth indicated that they ate lunch at school once a week or mo re (Perkins, Vaden, & Roach, 1980). Overall, teachers had a favorable impre ssion of the school nutr ition program, but disagreed that it was enjoyable to eat a school lunch. A strong negative response was reported regarding teachers eating with their cl ass. Teachers indicated that they did not believe their presence would influence students’ eating habi ts. Reasons given included needing time away from students and students needing time away from teachers. Some teachers indicated that the lunch period was their only planning period. A two-way analysis of covariance was co mputed to determine if significant differences in responses occurred based on grad e levels (lower, grades 1-4; upper, grades 5-6). Teachers of upper grade levels expre ssed more negativity and dissatisfaction with the school nutrition program than did lower grade level teachers. Teachers at all grade

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77 levels disagreed that student participation in the school nut rition program would increase if they ate with their stud ents. A significant differen ce was found between teachers’ perceived view of food quality and student participation. If te achers believed food quality was good, this may have been reflect ed in their own behavior, and may have positively influenced student participation in the school meal program. Interestingly, teachers with high student meal participati on rates in the lunch program expressed the most disagreement about eating with their st udents. The researchers did not indicate if the higher participation rates were linked to higher percentages of socio-economically needy children, but schools with lower socio economic student status are linked to higher student meal participation rates (School Nutrition Association, 2008). More recently, results from a study of 373 teachers and school personnel from 55 schools in Louisiana indicated that 31% a nd 40% of the sample were overweight and obese, respectively. Hartline-Grafton, Rose Johnson, Rice and Webber (2009) expressed concern about reaching out to teachers and personnel, and that further research should be conducted to understand and improve the diet s of school employees, given their high rates of overweight and obesity, poor diets, but important role in influencing student health. Changing the overall school environment for the bene fit of students and teachers should be a priority. Behaviors. Despite evidence that school meals ar e nutritionally superior to meals sent from home (Rainville, 2001), schools do se nd mixed messages to students, according to Lynn-Garbe and Hoot (2004/2005). Nu trition education programs designed to encourage healthy eating behaviors are coun tered by teachers who provide high fat and high sugar foods in classroom activities and celebrations, and as rewards for good

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78 behavior or performance. Teachers who cons ume soft drinks at their desks, who snack on candy while teaching, or who purchase high calorie or high fat foods from vending machines are not setting a good example. Birch and Fisher (1998) maintain that teachers serve as role models for children; their atti tudes and behaviors are influential in shaping children’s food preferences and behaviors. A report from the National Food Service Management Institute, entitled Healthy School Nutrition Environment: Results fr om a Nationwide Survey of School Personnel (Rainville, Choi, & Brown, 2003) revealed the following: Approximately 73% of over 1200 respondents said their school provided a healthy school nutrition environment; Approximately 55% indicated teachers and administrators used foods as rewards; and, Fundraisers, featuring candy and baked goods as the most frequently sold items, were used by 99% of the respondents. When asked whether their schools provide a healthy school nutrition environment for students, 77% of school food service pers onnel and 70% of othe r school personnel responded that they agreed or strongly ag reed. However, since 87% of high schools, 70% of middle and junior high schools, and 42% of elementary sc hools reported vending machines as accessible to students, the re searchers questioned the understanding of a “healthy school nutrition environment” among the 1222 superintendents, principals, school business officials, teachers, coaches a nd school food service personnel. Fifty-five percent of respondents reported that teachers and administrators used foods as rewards, and 99% reported fundraisers featuring ca ndy and baked goods as the most prevalent

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79 items sold. The researchers expressed c oncern about not only improving school nutrition environments, but questioned whether those who believe they are already providing a healthy school nutrition envi ronment would recognize the di chotomy, and be willing to improve school environments. Staff identi fied barriers to providing healthy school nutrition environments, includ ing inadequate funding for school food service programs, competitive foods including ala carte options, children’s peer pre ssure, television and media, menus, funding for school activities, cafe teria atmosphere, and parental attitudes. Nowhere on the list, according to Rainville et al. (2003) did school staff recognize their potential role, through attitudes or practices, in serving as a barrier to the development of healthy school nutrition environments. When 73% of respondents claim a HSNE, but 55% acknowledge foods are used as rewards and 99% report foods are routinely us ed as fundraisers, the questions must be asked, “What is an HSNE, and what does it l ook like? Who is responsible for promoting the HSNE? Do teachers and other adults at school perceive a role in the development or maintenance of healthy school nutrition enviro nments?” An avowed interest in nutrition by arguably some of the most influential players in children’s lives is accompanied by no real sense of urgency, with the responsibi lity for action typically placed elsewhere. Story, Newmark-Sztainer, and French ( 2002) proposed a conceptual model for understanding factors that determine eati ng behaviors and food choices within an integrated, theoretical fram ework based on social cognitive theory and an ecological perspective. Eating behavior is conceptu alized as a function of individual and environmental influences, with four broad leve ls of influence: intrapersonal (individual influences), social environmental (interpe rsonal influences), phys ical environmental

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80 (community settings), and macrosystem (socie tal). Multiple factors must always be considered when trying to understand, influe nce or provide interventions focused on the eating behaviors of children and adolescents (Story, Newmark-Sztain er, & French, 2002). Psychosocial, biological and lifestyle issues (intrapersona l) heavily influence eating behaviors. Less understood, however, and just as powerful, are influences such as the family and peers (interpersonal), school environments, fast food restaurants, the availability of vending machines, convenience stores, and foods available at worksites (community settings), and consumerism, advertising and media (societal). The researchers suggest that further identification of factors predictive of eating behaviors is needed to assess the dietary behaviors of children, adolescents and adults. Classroom rewards Academic competition is the driver behind most classroom reward systems (Kohn, 1992), followed by clas sroom control, such as encouraging students to quietly stand in line. How re ward systems affect children, the types of rewards used, and specifically, the use of f ood rewards is the subj ect of this review section. The most effective rewards are intrinsic, or extrinsic, if they are related directly to a behavior, are given promptly after positive be havior occurs, and if they are awarded on a consistent basis, and meet the mission of the classroom (Puhl & Schwartz, 2003). Providing extrinsic rewards unrelated to specif ic behaviors or the educational mission, to simply incentivize actions have, however, become commonplace (Deci, Koestner, & Ryan, 2001). Rewarding students for academic achieveme nt or learning gains in the form of merit certificates, credit at th e school store, cash, or coll ege-fund contributions have

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81 contributed to improved reading scores acros s grade levels, although no impact was noted in mathematics performance (Raymond, 2008). A study sponsored by the Center for Research on Education Outcomes at Stanford University found a consistent impact of rewards on achievement gains and achievement te sts. However, the long-term benefit of extrinsic rewards is questi onable, according to some educators (Lepper, Green, & Nisbett, 1973). Deci and Ryan (1985) contend that pers onality characteristics may lead some students to be more self-motivated than ot hers, and therefore intrinsically strive to succeed. However, the proliferation of extrin sic rewards may create a damaging situation in which the self-motivated child becomes re liant on extrinsic rewards, and the child who does not receive the rewards becomes defeated. A study of the type and choice of reward offered to students, and the effect on subsequent reading among third graders wa s conducted by Marinak and Gambrell (2008). A study of 800 students in three elementary schools in a large mi d-Atlantic suburban school district examined the difference between the type of reward (a book or a token for candy or toys). A second variable was the choi ce available to actually select the type of reward (book or token) or to receive no reward. Stude nts who were given a book and students who received no reward were more motivated to engage in subsequent reading than students who received a token for candy or toys. According to Rossiter, Glanville, Taylor and Blum (2007), teachers need to be aware of the allure and common practice of re warding children with extrinsic rewards, but especially food items. One hundred and thre e students enrolled in th eir last year of a bachelor of education program completed a Teens Eating for Energy and Nutrition at

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82 School teaching staff survey. Si xty-five percent of the resp ondents had a high fat intake, and 72% had mid-to-low nutri tion knowledge. Ninety-three percent believed that a healthy school nutrition envi ronment was important, but tw o-thirds reported unhealthy classroom food practices. Unhealthy classroom food practices were more prevalent in students planning to teach at the secondary level, those who expr essed a high personal health belief, and those who demonstrated less support for a hea lthy school nutrition environment. The researchers concluded that knowledge, attitudes, and food behaviors of prospective teachers may be barriers to prom oting healthy food habits to their students, and that compulsory nutrition education should be included in teacher training curriculum. Caregivers and children themselves were the focus of research conducted with six Native American Indian nations (Gittlesohn, Toporoff, Story, & Evans, 2000). Cultural norms prevailed, despite the iden tification of fruits and vegeta bles as healthy choices by all caregivers. High fat, high sugar meal selections, abundant food rewards in the classroom, rules about finishing all the food on a child’s plate, and limited resources to purchase healthier food items present a challenge to maki ng meaningful, sustainable changes in children’s diets, and specifically in affecting change in school environments. Puhl and Schwartz (2003) suggest that re gardless of past practice or cultural norms, it is the responsibility of schools to teach and model healthy eating behaviors. Non-food rewards, if extrinsic rewards are o ffered, should be the only type of incentives available. Classroom rewards that teach children to eat when they are not hungry encourage over-eating, compromise health wi th low nutritive value foods, and undermine classroom learning.

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83 Teacher characteristics. The Nebraska Department of Education does not require a nutrition course during teacher preservice, but does require a course from a general health area, with nutrition offered as one of the course options. Responses received from teachers representing 65 of 93 Nebraska counties resulted in 464 completed questionnaires, with two-thirds indicating “some training” in nutrition. Results of the questionnaire, te sted by 10 registered dietitia ns for content validity, and 20 teachers for clarity, indicated that over twothirds of the teachers believed nutrition should have a high priority in elementary curriculum. However, teachers 50 years and older were much more likely to teach nut rition concepts than younger teachers. The researchers suggested reasons for this obser ved difference. Younger teachers may feel less comfortable teaching nutrition concepts and may not have developed the time management skills needed to organize instruction with sufficient time in the school day to provide nutrition education. More experienced teachers ma y have the opportunity to attend a greater number of nutrition presenta tions or in-service training programs. Another suggestion presented by the researcher s for the differences in teaching nutrition between younger and older teachers centers ar ound the notion that as nutrition becomes more important to the teacher personally, it becomes a greater teaching priority. The question of how to develop a greater pe rsonal interest in nutrition among teachers regardless of age, however, remains. Olson, Devine, and Frongillo (1993) colle cted data from 1,312 of 2,122 seventh through twelfth grade teachers who had rece ived training conducted by the New York State Department of Edu cation on a curriculum called Nutrition for Life designed for health education and home economics te achers. The researchers found that home

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84 economics teachers were 6.25 times more likely th an health education teachers to use the curriculum after receiving training on its us e. However, among teachers who taught 11 or more hours from the curriculum, health teachers were 2.39 times more likely to use the curriculum. Teachers in low socioeconomic sc hools were nearly two times more likely to utilize the curriculum, and teachers from big city schools were only one-third as likely to use the curriculum as were teachers from rural, suburban, or medium to small city schools. As overall teaching experience and ye ars of experience teac hing nutrition in the classroom increased, so did the likelihood that teachers used the Nutrition for Life curriculum. Similar results were obtained in a study of 534 elementary teachers from a sample of 1000 teachers, representing 1.6% of all elemen tary teachers in Ohio (Norton, Falciglia, & Wagner, 1997). Results revealed that the availability of nutrition programs developed for elementary schools alone have minimal im pact on children’s eating behaviors, but prior experience in teaching nutrition is an important factor in the dissemination of nutrition information by elementary teachers. A study conducted to measure the success of training delivery included three approaches to teacher training with a set of 125 kindergarten through sixth grade teachers, divided into three experiment al groups and three control groups (Shannon, Marbach, Graves, & Sims, 1981). The only difference between the experimental and control groups was that the experimental group provided student instruction for a 10week period following a pre-assessment a nd prior to the post-assessment. One experimental and control group received t eacher guide materials and curriculum; the second paired group participated in a three-hour inservice that explained the curriculum

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85 materials and suggested teaching approaches. Th e third paired group participated in a 45hour postgraduate nutrition course. The study revealed that the 45hour course had the most positive influence on test scores, but resu lts also indicated that positive changes in attitudes about providing nutri tion education in schools corr elated with higher student gains in nutrition knowledge. As students showed interest and learned, teachers felt more compelled to teach about nutrition. Shannon et al. (1981) concluded that more research should be undertaken to study the relations hips between teacher training and student interest, and teacher training a nd teacher characteristics. Eleven years later, Shannon, Mullis, Ervin, and Poeheler (1992) conducted telephone interviews with st ate agency personnel responsib le for state-level nutrition education activities directed to schools to assess the status of school-based nutrition education. All 50 states were included in th e study; the District of Columbia did not participate. Nine states responded that th ey mandated nutrition be taught and another 21 included nutrition as a required topic in mandated subjects. The remaining states did not require nutrition education, but had initia tives to promote school-based nutrition education. An underlying question of the inve stigators was the issue of which subject area should serve as the best avenue for provi ding nutrition instruction. It was found that nutrition is typically a topic taught in home economics, but this is an optional course in most states. Additionally, students who elect to enroll in a home economics course do not necessarily do so when the topic of instruc tion is nutrition. The re searchers suggested a more appropriate placement for nutrition instru ction would be mandated health education courses. However, the quality and quantity of nutrition education ma y not be appropriate even in health education courses, and only 20 states required coursework in nutrition for

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86 teacher certification in hea lth education. Health education curricula often contain references to nutrition as it applies to gene ral health, but not necessarily an emphasis on eating habits and eating behavi ors. Shannon et al. (1992) in dicated that an emphasis on health education teacher preparation, with a focus on practical nutrition education, might serve as an appropriate basis on which to build influence and interest in classroom based nutrition education. Another perspective was presented on th e characteristics of schools instead of individual teachers in relati on to overall school health clim ates. Results were obtained from the Teach Well project, which followed teachers from 16 Atlanta public schools who had access to the Live for Life teacher wellness program, comprised of 36 health workshops over the course of a school year each approximately 30 minutes in length, and teachers from 16 control schools who were not offered the training (Cullen, Baranowski, Baranowski, Hebert, deMoor, Hearn, & Resnicow, 1999). Teachers from schools with high organizational climate scores reported higher fru it and juice intake among teachers than treatment schools with lo w organizational climate scores. Higher fruit and juice intake, and lowered fat intake was reported by treatment school teachers with high job satisfaction scor es, compared with treatment school teachers with low job satisfaction scores. Patterns of fruit, juice, vegetable, a nd fat intake in control schools were variable. Cullen et al. suggested that the camaraderie provi ded by attending health promotions may have influence the results The researchers also suggested that additional research be conducted to determin e the influence of teacher wellness programs on student outcomes.

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87 Social Cognitive Theory Social cognitive theory s uggests that behavior is th e result of personal and environmental factors that influence each ot her in a dynamic and reciprocal fashion. Personal factors, including thoughts and f eelings, behavioral factors, including knowledge and skills, and environmental factor s, including external factors from the social and physical environment, help indi viduals bridge the gap from intention to behavior, and make desired actions easier to understand and fulfill (Contento, 2007). Social cognitive theory is, therefore, reflect ive of how our behavior is influenced by our thoughts or beliefs about ourselves Of particular interest in this study, individuals with a higher degree of self-efficacy can overcome barriers to adopting and maintaining healthy behaviors (Bandura, 2004). The higher the le vel of perceived self-efficacy, the more effort will be expended to persist in a behavior despite potential challenges or difficulties (Bandura, 1997). A lack of self-efficacy contributes to lowered nutrition education-related outcome expectancies and outcome values (Fah lman, McCaughtry, Martin, Shen, Flory, & Tischler, 2009). An intervention group of 30 teachers participated in a day-long training to prepare them to teach the Michigan Model for Nutrition Education, designed for grades 7 and 8. The control group was comprised of a similar group of teachers who did not receive training. A 42-item survey cont ained questions about the person’s beliefs about his/her capabilities to perform certain behaviors (self-efficacy), that the behavior would lead to a desired outcome (outcome expectancy), and that the outcome was meaningful (outcome value). An analysis re vealed that the in-ser vice training increased the number of lessons the intervention t eachers intended to teach, as well as their

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88 confidence in delivering the instruction. This finding is important in the study of nutrition in schools, as teachers’ sense of self-efficacy is on e of the few characteristics consistently related to student achieve ment (Cantrell, Young, & Moore, 2003). Ongoing staff development in nutrition is not a priority for many teachers or school districts, as a lack of time and comp eting priorities makes the delivery of such training difficult to achieve (Bandura, 2000). A study of 103 seventhgrade teachers in Louisiana, primarily white females, indicat ed that the teachers were interested in including nutrition as a subject in their classroom (92%), a nd that they were confident teaching nutrition (93.2%), but only 12% had received staff development in nutrition in the past years (Murimi, Sample, Guthrie, & Landry, 2007). The researchers concluded that teachers determined the importance of nutrition topics to be taught, and may ignore more important nutrition topics not perceived as being as important by the teachers. Selfefficacy may be high, but a lack of nutriti on knowledge and education methods may limit the topics taught, making teacher perceptions of important topics the only criteria for nutrition information taught to students. Gr oss and Cinelli (2004) indicate that teachers may need guidance in developing and strengthening nutrition curricula. Murimi, Sample, and Hunt (2008) conduc ted another study in Louisiana with teachers who did ( n = 75) or did not ( n = 28) have a background in family and consumer sciences. The study compared attitudes a nd confidence levels regarding classroom nutrition education of seventh grade teacher s. Teachers who reported a family and consumer sciences background, which includes courses in nutrition, were significantly more confident teaching nutri tion and were more likely to influence student nutrition

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89 behaviors than teachers who did not have th e family and consumer sciences background and training. Researchers investigated the effect of a three-credit health education course on pre-service teachers’ confidence in teaching coordinated school health concepts at a large northeastern university (Mane y, Monthley, & Carner, 2000). One hundred and seventy education majors pursuing elementary educ ation certification or health and physical education certification signifi cantly improved confidence levels for teaching nutrition, as well as the content areas of mental health, drugs, body systems, and safety. There were no significant differences noted in confidence levels for teaching sexualit y, chronic and communicable disease, personal health, consum er health, and environmental health. The researchers suggested that confidence in teaching health issues may be tied to the controversial nature of the cont ent, such as human sexuality or HIV. They also suggested that prior familiarity with the subject a nd general attitudes toward the subject may influence teaching confidence. Data was not provided to assess the pretest and posttest responses between students pursuing elementary education certification versus health and physical education certification, which may have added depth a nd detail to the results of this study. Despite studies that indicate in-service training is an important issue related to the self-efficacy of teachers who deliver classr oom nutrition instruction (Maretzki, 1979; Shannon, Mullis, Bernardo, Ervin, & Poehler, 1992), a study that used data from the 1990-92 Hawaii Nutrition Education and Tr aining Program needs assessment ( n = 324 elementary teachers) indicated that time spent teaching nutrition was not related to attending in-service training (B ritten & Lai, 1998). The rese archers found th at nutrition

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90 knowledge predicted self-efficacy for teaching nutrition, but a belief that nutrition was important did not predict time spent teaching nutrition. Among elementary teachers, selfefficacy for teaching nutrition had a greater influence on actual delivery of nutrition instruction than did in-servi ce training, and was related to nutrition knowledge and time spent teaching nutrition. In 1979, Maretzki stated that, in her experience, “Teachers often lack selfconfidence about and enthusiasm for nutrition education because they view nutrition as a college-level subject dealing with concepts wh ich they themselves do not fully grasp.” (p. 11). Britten and Lai (1998) s uggest that teachers’ self-effica cy to teach nutrition has not been adequately addressed in nutrition studi es, and that nutrition research funding be devoted to developing and assessing innovati ve approaches to improve teacher selfefficacy. A Nutrition-Teaching Self-Efficacy Scale (NTSES) was developed by Brenowitz and Tuttle (2003) to investigate time spent teaching nutrition and nut rition self-efficacy of Maryland elementary school teachers. The NTSES instrument was adapted from science and health self-efficacy scales, va lidated by experts, and pre-tested with elementary teachers. A total of 80 elementa ry teachers completed the validated and pretested instrument to measure self-efficacy of teachers to teach nutrition. The researchers concluded that higher self-efficacy scores were associated with teachers who spent more time teaching nutrition. Brenowitz and Tuttle also suggested that the NTSES may be a useful tool for determining self-efficacy re lated to teaching nutrition, and recommended the NTSES as part of a nutrition edu cation needs assessment among teachers.

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91 Summary Teacher attitudes about school nutriti on environments and their perceived influence on the environments, is an area that has not been adequately addressed by child nutrition program researchers, de spite great interest in the underlying causes of childhood overweight and obesity. Interest has been increasing for over a decade regarding the promotion of healthy school nutrition envir onments, but how teachers perceive that they influence these environments and the variable s that affect the nutr ition environment have not been evaluated. There is a dearth of re search to connect the issues, namely, teacher attitudes about school nutrition environments, their perceived influence on the nutrition school nutrition environment, and se lf-reported classroom behaviors. Background information was provided in th is review of literature from an ecological systems theory perspective to unders core the overall tre nds in school nutrition programs nationwide, including informati on regarding school nut rition policies. Emphasis was given to the requirement and es tablishment of Local Wellness Policies in school districts throughout the United States including their intende d purposes, and their actual impacts. Studies of school nutrition envi ronments were also included. Factors that influence food intake were reviewed, which pr ovided an objective view of the challenges school nutrition programs may face in view of shrinking budgets, and increasing demands. Surveys used to gather information about teachers’ attitudes or perceptions toward school nutrition programs were revi ewed. Studies regarding nutrition and achievement revealed that a link does exis t between adequate nutrition and academic success, and that school nutrition programs and the nutrition environment can play a critical role in the support of children’s success at school.

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92 Teachers’ attitudes, influence, behaviors, and characteristics regarding the school nutrition environment were reviewed. Rewa rd systems in the classroom were also addressed. A discussion of social cognitive theory and specifically, teacher self-efficacy indicated that teachers who felt they c ould or should provide nutrition education opportunities in the classroom were more likely to follow through with nutrition education. However, the resear ch indicated that teachers gene rally lacked confidence in providing nutrition education opportunities.

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93 Chapter 3 Methods The purpose of this study was to determine the attitudes of kindergarten through fifth grade teachers about school nutrition e nvironments, their perceived influence on school nutrition environments, and self-repor ted classroom behaviors. The specific objectives of this study were to: (a) identify teacher attitudes, perceived influence, and self-reported behaviors related to the sc hool nutrition environment; (b) examine the relationship between elementary school te acher attitudes about school nutrition environments and perceived influence on the environment among kindergarten through fifth grade teachers; (c) exam ine the relationship between elementary school teachers’ attitudes about school nutrition environments and self-reported classroom behaviors; (d) examine the relationship between perceived influence over the school nutrition environment and self-reported classroom behaviors; and, (e) examine the relationship between teachers demographic characteristics and attitudes and perceived influence on school nutrition environments, and self-reported classroom behaviors. This chapter presents the research methods and procedures used to conduct the study. Specifically, the part s of this chapter include population, instrumentation, collection of data, data anal ysis, and summary of methods.

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94 Research Design This correlational study was designed to de termine if relationships exist between two or more variables, with teacher attit udes, perceived influence, and self-reported behaviors being the variables of interest. Specifically, the intent was to assess the covariance of the stated variables, and as one variable increased, whether or not another variable increased or decreased. A survey instrument was developed to elicit responses about the attitudes of kindergarten through fifth grade teachers rega rding school nutrition environments, their perceived influence on the nutrition environmen t, and self-reported classroom behaviors. The following research questions were addressed: 1. What attitudes, perceived influen ces, and self-reported behaviors do kindergarten through fifth grade teac hers identify regarding the school nutrition environment? 2. Are teacher attitudes about school nutri tion environments and their perceived influence on the environment related? 3. Are teacher attitudes about school nutr ition environments and self-reported classroom behaviors related? 4. Are perceived influences on the sch ool nutrition environment and selfreported classroom behaviors related? 5. Are teacher demographic characteristic s related to attitudes and perceived influence on school nutrition environm ents and self-reported classroom behaviors?

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95 Population A computer survey-based study was c onducted in Sarasota County, a mediumsized school district in Southwest Florida wi th a student population of 42,000 enrolled in 50 school sites, composed of 39 regular public schools, eight charte r schools, and three drop-out prevention sites. Over 5000 instruct ional, non-instructional, and administrative staff work for the school district. The School Board of Sarasota County, Florida employs over 920 kindergarten through fifth grade teachers in 24 regular elementary schools, who were asked to participate in the study. The number of teachers by elementary grade level, as reported on the Elementary Enrollmen t County by Class, Ma y 5, 2010, follows: kindergarten n = 142, first grade n = 149, second grade n = 138, third grade n = 142, fourth grade n = 125, fifth grade n = 116, combined grades or teacher of special classes (mixed grades for physical educa tion, music, and art), and others n = 108. Demographic data exist only for all teachers, and was not broken down according to elementary, middle and high school levels. According to the School District and State Public Accountability Report for 20092010, 92.59% of all of the teachers in the sc hool district were white, 3.72% were black, 2.73% were Hispanic, 0.63% were Asian, and 0.3 3% were identified as Indian. Nearly 80% of all teachers were female. The major ity of teachers in the school district were classified as Masters + 45 (32.10%), follo wed by 31.59% with a Ma sters degree, 18.50% with a Bachelors + 30, and 15.81% with a Bachel or’s degree. Nearly 2% held doctoral degrees. As of March 3, 2010, 16,945 students were enrolled in 24 regular elementary schools in kindergarten through fifth grades in Sarasota County (School Board of

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96 Sarasota County, Florida Enrollment Report, 2010). Teachers across the school district are responsible for a diverse population of stude nts, with free and reduced meal program enrollment (an indicator of economic need) at a low of 4% to a high of 92% (School Board of Sarasota County Food and Nutriti on Services Free and Reduced Priced Meal Summary, March 2010). In 2007, the percentage of students eligible to receive free and reduced priced meals was 33%, which was the norm for Sarasota County for many years. The nation’s economic downturn and the seri ously affected local economy has had a major effect on free and reduced priced meal eligibility in Sarasota County. The free and reduced percentage rose to 37% in 2008, 42% in 2009, and increased to 46% in 2010. This represents a projected increase of over 5000 students eligible to receive meal benefits in a four year time period. Sixty-seven percent of students in the target county were identified as White, 10% were identifie d as Black, 14% were Hispanic, 1.75% were Asian, .25% were American Indian, and 6% we re reported as multi-racial (School Board of Sarasota County, Florid a, Enrollment Report, 2009) Ten Title One schools received the Fresh Fruit and Vegetable Program grant in the 2009-2010 school year, which allowed the Food and Nutrition Services program to provide snacks of fresh produce to stude nts and staff on a daily basis. Instrumentation The instrument used in this study was de veloped to reflect un derstandings from the literature, as well as observations, experiences, and c oncerns of the school district’s two previous Nutrition Educators, and the current Nutrition Educator. See Appendix B for the observations made by the Nutrition E ducators. The item construction process was also influenced by the author’s personal a nd professional experien ces, observations, and

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97 understandings. Survey questions addressed the attitudes teachers have about school nutrition environments, their perceived infl uence on the school nutrition environment, and self-reported classroom behaviors. Th e relationship between teachers’ demographic characteristics, attitudes, perceived influence, and self-reported classroom behaviors were also examined. Demographic questions contained in the original Teacher/ Administrator School Foodservice Survey were adapted and expanded by the researcher to provide information relevant to this study. See Appendix C for the original version of the Meyer instrument. Development of the survey. The item construction process for the survey, which explores attitudes, perceived influence, and self-reported classroom behaviors, was influenced by a number of factors: 1. The researcher’s personal and profe ssional experiences, observations, interactions, and understandings; 2. A thorough review of the literature a nd surveys related specifically to the association of the school food environment w ith dietary behaviors of young adolescents (Kubik, Lytle, Hannan, Perry, & Story, 2003), per ceptions of elementary school nutrition education practices by school f oodservice directors, teachers, and principals (Lambert & Carr, 2005), and teachers’ and administrators’ satisfaction with customer service (Meyer, 2002); 3. Input from the school district’s prev ious two Nutrition Educators and the current Nutrition Educator. Their front-lin e observations and expe riences provide an informed perspective in the development of appropriate, meaningful questions (see Appendix B for a listing of their comments) Since 1996, Food and Nutrition Services

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98 has employed a Nutrition Educator. The Nu trition Educator must be a Registered Dietitian, with a minimum of a bachelor’s degree in dietetics and nutrition. No formalized funding has existed for this pos ition, but nutrition education has been and continues to be a pr iority for Food and Nu trition Services and the school district. Nutrition Educators are tasked with deliver ing direct classroom instruction, with an emphasis on kindergarten through third grades. Th ree separate individua ls have held the position of Nutrition Educator since the ince ption of the nutrition education program, and all three individuals remain employed by the department. Observations of the three Nutrition Educator s were used in the initial steps for the perception section of the survey instrume nt. The previous and current Nutrition Educators were interviewed by the researcher separately, then togeth er. Their input was important in the development of meaningful survey questions When asked to reflect on scenarios they had witnessed or experienced in the classroom as related to the promotion of a healthy school nutrition environment, re sponses were given based on their direct contact with teachers and students in the cl assroom. This anecdotal information was useful as a basis for formulating a series of questions for teachers about their perceptions of a healthy school environment. A multi-step process was used to develop, modify, and validate the instrument, as follows. Step 1: Questions reflecting personal expe riences of the researcher, a thorough literature review, and input of the Nutrition Educators were developed. See Appendix D for the first draft of the instrument and directions.

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99 Step 2: Permission was requested from the National Food Service Management Institute to use the Teacher/Administrator Sc hool Foodservice Survey as a part of this study. See Appendix E for the letter request ing permission. See Appendix F for the signed permission letter from the Executive Director of the National Food Service Management Institute. Step 3: Individuals familiar with the fields of education and/or nutrition, but who do not directly teach children, were asked to complete the survey. Clarity of written directions, questions asked, time required fo r survey completion, and ease of completing a computer-based survey were the primary concerns. Eleven reviewers, representing elementary school principals, professional development personne l, school district research and assessment personnel, and school nutrition administrators completed the survey and provided their feedback. Step 4: Revisions were made to the inst rument to reflect the input of the individuals who provide d the initial review. Step 5: Selected Food and Nutrition Service directors in Florida and elementary school principals within the School Board of Sarasota County were asked to review the revised instrument. See Appe ndix G for a copy of the letter requesting the directors and principals to review the survey and provi de feedback, and directions for providing feedback. Clarity of written directions, questions asked, time required for survey completion, and ease of completing a computer-based survey were the primary considerations for this review. Step 6: Revisions were made to the instrument to reflect the input of the directors and elementary school principals.

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100 Step 7: An expert validation team was identi fied and selected, based upon their expertise in child nutrition and their knowledge of child nut rition research. The expert validation team was requested to review the inst rument as part of the process. Among the panel members were Rainville (2003), author of the Healthy School Nutrition Environment survey, and Meyer (2002), aut hor of the Teacher/Administrator School Foodservice Survey. Two of the members we re higher education faculty members at the University of Southern Mississippi’s Nati onal Food Service Management Institute, a national program devoted to child nutrition research and training, and instrumental in developing Local Wellness Policy guidelines. One member of the panel was a current child nutrition practitioner in AZ, who also se rved as a member of the School Nutrition Research Committee, and one member was a national consultant specializing in child nutrition. All members were active in the fi eld, and most were we ll-published, current contributors to journals and pr esenters at professional conf erences. Panel members were first contacted by e-mail to determine if they agreed to evaluate the instrument. Each expert contacted agreed to review the inst rument and provide feedback. The names of panel members, and their positi ons, are included in Appendix H Step 8: The survey was e-mailed to all pane l members. A letter of introduction, an explanation of the purpose of the study, as well as directions for completing the survey and providing feedback are included in Appendix I. Step 9: Revisions were made to the instrume nt to reflect the i nput of the expert panel. Development of demographic and meal participation questions. The Teacher/Administrator School Foodservice Survey was developed by Meyer in 2002,

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101 who at the time, was a Research Scientis t at the National Food Service Management Institute, to determine teachers’ and admini strators’ satisfaction with school nutrition programs. Meyer acknowledged that the pr imary customer for school foodservice and nutrition programs is the student, but sec ondary customers, such as teachers, may influence the perceptions of students and possi bly student participati on in the school meal program. The Meyer survey was one of five cust omer service surveys designed for high school, middle/junior high school, upper elem entary school, lower elementary school parents, and teachers/administrators. Meyer’ s original 45-item instrument contained 30 questions that loaded into one of six factors: food quali ty and preferences, staff, ambience, price, nutrition, and time. Responses to the survey were based on a 7-point scale (1 = very strongly disagree, 7 = very strongly agree, with an eighth category = “Do not know”). The original teacher/administrator surve y, composed of 45 questions about school foodservice, and 10 demographi c and behavioral questions, was generated from a focus group of 14 individual teachers and administrators who were asked about the important characteristics of a school meal program. The methods used to develop the survey included a focus group and a survey. Volunteer food service directors, supervisors, and managers pilot tested the survey as part of the validation process. Surveys were then mailed to other volunteer foodservice director s and supervisors, who were asked to solicit responses from teachers and administrators at one high school, one middle school, and one elementary school in their district. Par ticipants from Maine, Florida, Massachusetts, Texas, Tennessee, Colorado, Illinois, and Loui siana provided input. A return rate of 32%

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102 (558 of 1,737) yielded a total of 473 usable su rveys for the pilot testing, received from suburban and rural districts from eight states. Use of the survey instrument. The Teacher/Administrator Survey was part of a series of five instruments developed by the National Food Service Management Institute, and has been available for use in school districts to survey customer groups. An explanation of the instrume nt and its use was contained in the Fall, 2002 issue of The Journal of Child Nutrition & Management The survey had not been utilized in any empirical studies. Although the Teacher Admi nistrator School Food Service survey was appropriate and well analyzed for its intended purpose, this research er wanted to delve further into teacher attitudes and perceive d influence on school nutrition environments and self-reported classroom beha viors. Demographic variable s considered in this study included the teachers’ assigned grade level of students and number of children in the classroom, the name of their school, educa tional background, gender, race/ethnicity, the number of years spent teaching, and two questio ns about college coursework in nutrition. The following questions were modified or added to provide richness of detail and information for comparative analysis. In the original instrument, the options to the following question, “What grade level do you teach?” were kindergarten, elem entary school, middle/junior high school, and high school. The revised instrument prov ides the options of kindergarten, grade 1, grade 2, grade 3, grade 4, and grade 5, as we ll as Combined grades, Specials (mixed grades such as PE, music, ar t), and Other. “How many child ren are in your classroom,” “What is the highest degree you have earned,” “What is your gender,” and questions with an age range, racial/ethnic background, a nd questions about college coursework in

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103 nutrition were added to this section of the survey. Questions about the frequency and reasons for eating school breakfast and lunch were also adapted from the Teacher/Administrator Survey. The National Foodservice Management Inst itute (NFSMI) owns th e rights to the survey developed by Meyer. Permission wa s requested and received from NFSMI to adapt and utilize the demographic portion of the instrument. A permission letter was requested and received from NFSMI to comply with the University of South Florida’s Institutional Research Board. See Appendix D for a copy of the request for permission and Appendix E for the signe d permission letter. Field testing. The survey was tested at one randomly selected elementary school, based upon an average representation of ethni city, and whose student enrollment met the criteria of mid-level free and reduced lunch eligibility. Four teen of the 33 teachers at the school completed the survey and did not rece ive the final survey. Teachers responsible for direct instruction of students enrolled in kindergarten through fi fth grades only were included in this study. Revisions were made to the instrument based on feedback from the teachers. Validity The instrument was validated by a pr ocess initiated with reviewers that included elementary principals, professiona l development personnel, school district research and assessment personnel, and dist rict school nutrition administrators. Following revisions, Food and Nutrition Servic es directors in Fl orida and additional principals reviewed the instrument and pr ovided feedback. Additional revisions were made to control for redundancy and resulted in the removal of questions to shorten the survey. An expert validation team pr ovided suggestions that included greater

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104 clarification of the teacher le tter that preceded the survey que stions and the elimination of customer service questions. Fina lly, the field test with teachers at the one di strict school resulted in additional questions being removed from the survey. Reliability Respondents were not expected to an swer survey items in the same or similar ways, therefore no predictions were made in this study a nd no reliability scores were calculated or presented. Since the survey did not lend itself to a reliability measure, future studies to vary the situations are pl anned, which could provide an opportunity to determine reliability. Collection of Data The researcher contacted the Director of Research Assessment and Accountability for the Sarasota school district employing the teachers for permission to conduct the study. An application form explaining the purpose of the st udy, population to be surveyed, survey methods, description of pr oposed data analysis and time schedule was approved. After school distri ct approval, the proposed study was forwarded to the Institutional Review Board of the University of South Florida. Following school district and IRB appr oval, the researcher contacted the remaining 23 elementary principals, notifying them of the upcoming survey. Following principal notification, a letter and the survey instrument, containe d in an electronic message attachment, was e-mailed to the principals, with a request to forward the survey instrument to their kindergarten through fift h grade teachers who did not participate in the pilot study. See Appendix J for a copy of the principal no tification letter. Teachers completed the survey utilizing Zoomerang, an online survey tool approved for use within the School Board of Sarasota County. See Appendix K for the final survey.

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105 An initial response rate of 186 on Day One was followed by another 49 responses on Day Two. Day Three resulted in an addi tional 33 returned surveys, so the Executive Director of Elementary Education sent an e-mail to all principals, asking that they remember to forward the survey to teachers. Day Four of survey collection resulted in an additional 72 responses. Day Five of surv ey collection resulted in an additional 27 surveys, which at the end of the day, totaled 367 returned surveys. Following Day Five, the researcher receive d a telephone call from the president of the local teachers’ bargaining unit. The pres ident indicated that sh e had received calls from teachers who were interested in comp leting the survey, but were concerned that their comments could be traced back to the individual teacher. Af ter being assured that that responses cold not be tracked back to the individual teach er, the bargaining unit president made a number of calls to teachers. Day Six resulted in another 89 completed surveys, for a total of 456 returned surveys. The Assistant Superintendent of Busine ss and the Food and Nutrition Services Nutrition Educator wrote e-mails to principals to encourage participation to return the surveys at the end of Day Six. Over the ne xt four days, another 45 completed surveys were received. The administration and pr incipals preferred th at the survey be discontinued at the end of 10 days, indicati ng that teachers had been provided sufficient time to respond if they were inte rested in completing the survey. Data Analysis Procedures All of the survey data were extracted from Zoomerang.com in a Microsoft Excel spreadsheet. The data were then uploade d into the SPSS (Version 17.0) data analysis system for analysis. Research question one was addressed by computing the descriptive

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106 statistics for the survey items measuring t eacher attitudes, teacher perceived influence, and teacher self-reported behaviors. The li nkage between the survey items and each of the three dependent vari ables is provided in Table 1. However, some of the items listed in Table 1 also had several sub-items. The items that were nominal were analyzed using percentages. For example, items that asked participants to check all that apply were no minal because the participant either selected it (coded as a va lue of one) or did not select it (coded as a value of zero). Table 1 Survey Items Linked to Attitudes, Percei ved Influence, and Self-Reported Behaviors Source Survey Item Numbers Attitudes 16, 17, 19, 20, 21, 22, 24, 30, 33, 34a, 35, 36, 37, 38, 39a Perceived influence 18, 23, 25, 34b, 39b, 39c, 40 Self-reported behaviors 15, 26, 27, 28, 29, 31, 32, 39d, 41 Therefore the percentage of participants selecting the response choice was computed. The Likert scale survey items we re descriptively anal yzed by computing the percentage of participants selecting each response and by computing a mean value for each item. The second research question was tested by examining the relationship between the attitude items that were matched to th e perceived influence items. When perceived influence was dichotomous (only two possible response outcomes such as selected or not selected), then logistic re gression was used (Cronk, 2008; Field, 2009). However, when perceived influence was scaled (Likert scale items), linear regression was used (Cronk,

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107 2008; Field, 2009). The results from the logi stic and linear regression analyses were summarized by providing the unstandardized regression coefficients, the corresponding standard errors and the signifi cance values. In addition, an effect size was provided by presenting the odds ratios for the logistic re gression models and standardized regression coefficients for the linear regr ession models. Statistical sign ificance was set at an alpha of .05. The third research question was tested by examining the relationship between the attitude items that were matched to the self -reported behavior items When self-reported behavior was dichotomous (only two possible response outcomes such as selected or not selected), then logistic re gression was used (Cronk, 2008; Field, 2009). However, when self-reported behavior was s caled (Likert scale items), lin ear regression was used (Cronk, 2008; Field, 2009). The results from the logi stic and linear regression analyses were summarized by providing unstandardized re gression coefficients, the corresponding standard errors and the signifi cance values. In addition, an effect size was provided by presenting the odds ratio for the logistic re gression models and standardized regression coefficients for the linear regr ession models. Statistical sign ificance was set an alpha of .05. The fourth research question was tested by examining the relationship between the perceived influence items that were matc hed to the self-reported behavior items. When self-reported behavior was dichotom ous (only two possible response outcomes such as selected or not selected), then l ogistic regression was us ed (Cronk, 2008; Field, 2009). However, when self-reported behavior was scaled (Likert scale items), linear regression was used (Cronk, 2008; Field, 2009). The results from the logistic and linear

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108 regression analyses were summarized by providing the unstandardized regression coefficients, the corresponding standard errors and the significance values. In addition, an effect size was provided by presenting th e odds ratios for the logistic regression models and standardized re gression coefficients for th e linear regression models. Statistical significance was set at an alpha of .05. The fifth and final research questions was addressed by correlating the ordinalevel comparison survey items that were found to be statistically si gnificant in research questions two through four. Comparisons ba sed on race and gender were not conducted given that 94% of the sample was female and 95% of the sample was white. Furthermore, for analysis purposes, the numbe r of nutrition classes taken was recoded into three levels (no classes, one class, and two or more cl asses) because so few of the participants had taken more than two nutrition courses. Summary of Methods Chapter 3 described the research methods used in this study. This included an overview of the research design, study population, and a description of the instrumentation developed for use in this study. The instrument was analyzed, sent to an expert validation team for revi ew, and modified to assure the validity of its use with elementary school teachers. The study investig ated the relationship between attitudes of kindergarten through fifth grade teachers about school nutrition environments, their perceptions of influence on the school nutriti on environment, and self-reported classroom behaviors.

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109 Chapter 4 Findings The purpose of this study was to determine the attitudes of kindergarten through fifth grade teachers about school nutrition e nvironments, their perceived influence on school nutrition environments, and self-repor ted classroom behaviors. The specific objectives of this study were to: (a) identify teacher attitudes, perceived influence, and self-reported behaviors related to the sc hool nutrition environment; (b) examine the relationship between elementary school te acher attitudes about school nutrition environments and perceived influence on the environment among kindergarten through fifth grade teachers; (c) exam ine the relationship between elementary school teachers’ attitudes about school nutrition environments and self-reported classroom behaviors; (d) examine the relationship between perceived influence over the school nutrition environment and self-reported classroom behaviors; and, (e) examine the relationship between teachers demographic characteristics, and attitudes and perceived influence on school nutrition environments, and self-reported classroom behaviors. This chapter presents the demographi c characteristics of the teachers who participated in the research and the results of each research question. The following research questions were addressed: 1. What attitudes, perceived influen ces, and self-reported behaviors do kindergarten through fifth grade teac hers identify regarding the school nutrition environment?

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110 2. Are teacher attitudes about school nutri tion environments and their perceived influence on the environment related? 3. Are teacher attitudes about school nutr ition environments and self-reported classroom behaviors related? 4. Are perceived influences on the sch ool nutrition environment and selfreported classroom behaviors related? 5. Are teacher demographic characteristic s related to attitudes and perceived influence on school nutrition environm ents and self-reported classroom behaviors? Characteristics of Participants There were 501 teachers from 23 elemen tary schools from the School Board of Sarasota County who participated in this st udy; approximately 885 teachers were eligible to take the survey. The response rate was 57%. Teachers from kindergarten to grade 5 completed the study, as well as teachers w ho self-identified as teaching “combined grades,” “specials,” or classified themselves as “other.” See Table 2 for a summary of the number and percentages of responders as compared to the total number of teachers, and the percentages from each cate gory that completed the survey. The greatest numbers of surveys were submitted by kindergarten teachers ( n = 72, 14% of 501 respondents), and second grade teachers ( n = 68, 14% of 501 responses). Fifty-one percen t of all kindergarten teachers completed the survey, and 49% of all second grade teachers completed the survey. Fifth grade teachers submitted the lowest number of completed surveys ( n = 43, 9% of 501 respondents) among those

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111 Table 2 Number and Percentage of Elementary Teachers Compared to Survey Responders Grade n Teachers % n Responders % K 142 51 72 14 1 149 41 61 12 2 138 49 68 14 3 142 47 67 13 4 125 42 53 11 5 116 37 43 9 Combined grades NR* 48 10 Specials NR 35 7 (mixed grades for PE, music, art) Other NR 54 11 Total 501 100 NR* = None reported on the Elementary Enrollment County by Class, May 5, 2010 categorized as kindergarten through fifth grad e teachers, with 37% of all fifth grade teachers submitting a completed survey. Seven percent of completed surveys were submitted by teachers who identified themselves as “specials” teachers ( n = 35), and whom were provided the opportunity to self-ide ntify as a teacher of “combined grades,” “specials,” or “other.” The actual number and categorization of t eachers that may have identified themselves in one of these three categories is not reflected on the Elementary Enrollment Count by Class, May 5, 2010. Although 35 teachers identified themselves as teaching “specials” (mixed grades for combined grade classes such as PE, music, and art), when asked for a description of their teaching positions, 48 responses were provided. Music ( n = 11) was the predominant response, with art ( n = 6), exceptional student education ( n = 6), physical education/wellness ( n = 6), science ( n = 5), and technology ( n = 5), also eliciting higher response rates. Additional responses included speech and language ( n = 2), dance ( n =

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112 1), drama ( n = 1), English learners of other languages ( n = 1), horticulture ( n = 1), varying exceptionalities ( n = 1), and volunteer coordinator ( n = 1). One respondent who chose to self-identify him/herself as a teacher of “specials” indicat ed “not applicable.” Fifty-four teachers identified themselves as “other” for which no applicable category on the survey was provided. Exceptional student education ( n = 13) was reported most often, follow ed by Pre-kindergarten ( n = 6), English learners of other languages ( n = 5), guidance/counseling ( n = 5), speech/language ( n = 5), resource teacher ( n = 4), support staff ( n = 4), reading resource ( n = 3), and K-5 combined grades ( n = 2). Single responses were received by the following: administrator, autism, fourth and fifth grade combined classes, literacy, te chnology, and varying exceptionalities. The majority of teachers had 16 to 20 students in their classroom ( n = 285, 57%), and held master’s degrees ( n = 288, 57%). The majority of the teachers were female ( n = 461 of 493 respondents, 94%) and were white ( n = 463 of 485 respondents, 95%). The teachers had spent from zero to more than 30 years teaching, with a mode of 6 to 10 years ( n = 127, 25%). Thirty percent ( n = 149) reported college cour sework in nutrition, with 74 of 142 respondents (52%), indicating they had taken at least one college nutrition course. See Table 3 for detailed demographics. The majority of teachers ( n = 42, 82%) indicated they never participate in the breakfast program, with another 15% indicating that they participate very infrequently or on special occasions only Three percent of teachers indica ted that they participate in the breakfast program 1 to 3 times per month or more. However, 42 % of teachers indicated that they participate in the school lunch program 1 to 3 times per month or more. Sixty percent more teachers indicated participati on in the school lunch program than in the

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113 Table 3 Demographic Characteristics of Teacher Responders Characteristic n Teacher % n Total % Number of children in classroom 501 100 5 or less 21 4 6-10 26 5 11-15 5311 16-20 28557 21-25 7916 26-30 13 3 31+ 24 5 Highest Degree 501 100 Bachelor 17234 Master 28857 Specialist 13 3 Doctorate 5 1 Other 23 5 Gender 493 98 Male 32 6 Female 46194 Race/Ethnicity 485 98 White 463 95 African American/Black 4 1 Hispanic/Latino 11 2 Asian 3 1 Native American Indian 1 0 Multi-cultural 3 1 Number of Years Teaching 501 100 0-5 6413 6-10 12725 11-15 8717 16-20 8617 21-25 45 9 26-30 4810 More than 30 44 9 College coursework in nutrition 501 100 Yes 14930 No 35270 Number of nutrition courses 142 28 1 7452 2 4834 3-4 1410 5 or more 6 4

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114 school breakfast program, with 22 percent ( n = 111%) indicating that they never participate in the school lunc h program. See Table 4 for de tails on school breakfast and school lunch participation fr equencies and percentages. When asked the reasons for school breakfast participation, the majority indicated I do not eat school breakfast ( n = 404, 35%). It is convenient was the second most common response ( n = 53, 11%). However, it is convenient ( n = 209, 42%) was listed most often as the reason for school lu nch participation, with another 27% ( n = 134) indicating I do not eat school lunch Results This section of the chapter provides the results for each research question. Therefore the statistical results are presen ted in narrative and tabular form for each research question in sequential order. Before the discussion of results to each research question, results of survey questions 11 th rough 14 are provided regarding teacher participation in school meals programs. Teacher participation in school meals programs. When asked questions about participation in the school meals program, a difference existed between teachers who ate school breakfast and teachers who ate school lu nch. Of the teachers surveyed, 412 (82%) indicated they never ate a school brea kfast, with 39 teachers (8%) indicating very infrequently two teachers who ate school breakfast on a daily basis, one teacher who reported eating school breakfast three to f our times a week, and six teachers who ate breakfast at school one to two times a week. Reasons given for participating in the school breakfast program included convenience ( n = 53, 11%) and good food ( n = 19, 4%). Additional comments provided

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115 Table 4 Teacher Self-Reported Participation and Re asons for Participation in the School Breakfast and Lunch Programs Participation/Reason n % n % School breakfast participation frequency 501 100 Daily 20 3-4 times per week 10 1-2 times per week 61 1-3 times per month 82 Very infrequently 398 On special occasions only 337 Never 41282 Reasons for school breakfast participation The prices are good 112 The food is good 194 I have no other choice 82 It is convenient 5311 Other teachers eat there 00 I do not eat school breakfast 40435 Other 357 School lunch participation frequency 501 100 Daily 265 3-4 times per week 418 1-2 times per week 6513 1-3 times per month 8016 Very infrequently 105 21 On special occasions only 75 15 Never 111 22 Reasons for school lunch participation The prices are good 6814 The food is good 9820 I have no other choice 469 It is convenient 20942 Other teachers eat there 51 I do not eat school lunch 13427 Other 8717

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116 by respondents indicated that teachers ate sc hool breakfast when a preferred menu item was served ( n = 8), such as oatmeal, fresh fruit, or cheese omelets. Six teachers reported that they ate school breakfast when they forg et their breakfast at home, and one teacher reported not being aware that teachers could eat a school brea kfast. Thirty-five percent of teachers ( n = 404) indicated I do not eat school breakfast. Participation at the mid-day meal wa s much higher than breakfast, with 26 teachers (5%) eating school lunch on a daily ba sis, 41 teachers (8%) eating three to four times a week, and 65 teachers (13%) reporti ng school lunch participation one to two times a week. Contrasted with the 412 teach ers who reportedly never participate in the school breakfast program, a much lower number of teachers ( n = 111, 22%) never participate in the school lunch program. The primary reason given for participati on in the school lunch program, as for breakfast, was convenience ( n = 209, 42%), followed by good food ( n = 98, 20%), good prices ( n = 68, 14%), and I have no other choice ( n = 46, 9%). Additional comments from respondents indicated teachers ate school lunch when a preferred menu item was served ( n = 46), such as nachos, certain popular salads, macaroni and cheese, or yogurt parfaits. Seventeen teachers re ported that they ate school lu nch when they ran out of time at home or forgot to pack a lunch; nine i ndicated they ate school lunch only on special occasions, such as the annual Thanksgiving Dinn er. Three teachers indicated they were interested in the foods their students were eating at l unch or chose to spend time with their students. Another three teachers reporte d they would not ever select a school lunch due to the types of foods served. A total of 134 teachers (27%) indicated I do not each school lunch Table 4 itemizes the frequencies and reasons for eating school meals.

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117 Variables influencing the school nutrition environment. The first research question asked “What attitudes, perceived influences, and self-reported behaviors do kindergarten through fifth grade teachers identify regarding th e school nutrition environment?” The results are broken down by dependent variable: (a) attitudes, (b) perceived influence, and (c) self-reported behaviors. Attitude descriptive results. Overall, the attitude results indicated that teachers reported no barriers to implementing nutrition into their lessons/curriculum, followed by a lack of time, too many other responsibiliti es, and inadequate fina ncial resources. The biggest impact on student nut rition resulted from student school meals followed by student lunches from home. The Food and Nutrition Services Department was perceived to be mostly responsible for student nutriti on in the school cafeteri a and the school as a whole, while teachers were perceived to be mostly responsible for student nutrition in the classroom. Additional results included per ceptions that a relatively healthy nutrition environment exists at their school, cafeteri a and classroom, and that nutrition had an effect on student learning and performance. Table 5 provides a descriptive summary of participants’ responses to Item 16 on the survey, which asked “What barriers do you think exist for integrating nutrition into lessons?” The results indicate that part icipants were most likely to select lack of time (64%) as a barrier followed by too many other responsibilities (39%), lack of curriculum resources (29%), and does not fit in to curriculum (23%). No barriers exist (13%) and inadequate financial resources (11%) were the items least likely to be selected.

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118 Table 5 Summary of Participants’ Responses to Item 16 Regarding Barri ers for Integrating Nutrition Education Barrier n % Lack of time 321 64 Too many other responsibilities 195 39 Lack of curriculum resources 145 29 Does not fit into curriculum 115 23 No barriers exist 65 13 Inadequate financial resources 55 11 The participants’ summarized responses to survey Item 17 are presented in Table 6. Item 17 asked teachers to select the ite ms that have the most impact on the school nutrition environment. The top three results indicated that student school meals have the most impact on the school nutri tion environment (84%) followed by student lunches from home (50%) and snacks from home (46%). Food/treats in classroom (35%) followed, with a sharp decrease from after school snacks (14%), student class parties (12%), school-wide celebrations (7%), adult school meals (7%), adult lunches from home (5%), and fundraisers (2%). Participants’ summarized responses to It em 19 are provided in Table 7. Item 19 asked participants to indicat e who has the primary responsib ility to encourage healthy food choices at their school. The results indi cate that 45% of the teachers identified the Food and Nutrition Services Department as responsible for encouraging healthy food choices at their school and 25% selected parents as those with the prim ary responsibility.

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119 Table 6 Summary of Participants’ Responses to It em 17 Regarding Impact on School Nutrition Environment Impact n % Student school meals 421 84 Student lunches from home 251 50 Snacks from home 230 46 Food/treats in classroom 175 35 After school snacks 70 14 Student class parties 60 12 School-wide celebrations 35 7 Adult school meals 35 7 Adult lunches from home 25 5 Fundraisers 10 2 Table 7 Item 19: Entity with Res ponsibility to Encourage Healthy Food Choices at School Entity n % Food & Nutrition Services Department 225 45 Parents 123 25 School administration 71 14 Teachers 57 11 Other 22 4 Students 3 1

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120 School administration (14%), teachers (11%), other (4%), and students (1%) were identified less often as the entities with th e primary responsibility to encourage healthy food choices at school. Item 20 asked participants who had th e primary responsibility to encourage healthy food choices in the cafeteria. The summarized responses in Table 8 indicated that a large majority selected the Food and Nutrition Services Department as having the primary responsibility to enc ourage healthy food choices in the cafeteria (78%). Only 10% or less of the participants se lected other options, to include parents (10%), teachers (3%), school administration (3%), other (3%), and students (2%). Table 8 Item 20: Entity with Respons ibility to Encourage Healthy Food Choices in Cafeteria Entity n % Food & Nutrition Services Department 392 78 Parents 52 10 Teachers 17 3 School administration 16 3 Other 13 3 Students 11 2 The summarized responses to Item 21 are presented in Table 9. Item 21 asked participants to indicate who had the primary responsibility to encourage healthy food choices in the classroom. The results indicated that the overwhelming majority selected teachers as having the primary responsibility to encourage healthy food choices in the

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121 Table 9 Item 21: Entity with Responsibility to En courage Healthy Food Choices in Classroom Entity n % Teachers 411 82 Parents 58 12 School administration 11 2 Food and Nutrition Services Department 10 2 Other 7 1 Students 4 1 classroom (82%). The next highest percentage was parents (12%), followed by school administration (2%), Food and Nutrition Services Department (2%), other (1%), and students (1%). Item 22 on the survey asked teachers to i ndicate their level of agreement (strongly disagree = 1; strongly agree = 5) that a healthy nutrition environment exists in their school, school’s cafeteria, and classroom. Th e results in Table 10 indicated that teachers were most likely to agree that a healthy nut rition environment existed in their classroom ( M = 4.02) and least likel y to agree that a he althy nutrition environm ent existed in their school’s cafeteria ( M = 3.41). Teachers were more li kely to show some level of agreement than they were to show some le vel of disagreement for all three sources. Item 24 on the survey asked participants to indicate how negative (very negative = 1) or positive (very positive = 5) the in fluence of having candy or other sweets as rewards in the classroom was on student behavior and students’ overall eating behaviors. The summarized responses in Table 11 indicated that on average, teachers believed that

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122 Table 10 Item 22: Healthy Nutrition Environment in School, School’s Cafeteria, and Classroom Source Strongly Disagree % Disagree % Do Not Know % Agree % Strongly Agree % Mean School 3.0 20.2 3.6 59.3 14.0 3.61 School's cafeteria 6.6 24.0 3.2 54.1 12.2 3.41 Classroom 1.4 7.0 3.4 64.7 23.6 4.02 Table 11 Item 24: Influence of Having Candy or Sweets as Rewards in the Classroom Influence Very Negative Influence % Negative Influence % Do Not Know % Positive Influence % Very Positive Influence % Mean Student classroom behavior 3.0 20.2 3.6 59.3 14.0 3.61 Students' overall eating behaviors 1.4 7.0 3.4 64.7 23.6 4.02 passing out candy or sweets as a reward ha d a mostly positive impact on student classroom behavior ( M = 3.61) and a positive impact on students’ overall eating behaviors ( M = 4.02). Item 30 asked participants which factor s determined student rewards in the classroom. The summarized responses in Tabl e 12 indicated that t eachers were most likely to select cost (56%) followed by student preference (42%) and convenience (35%). Only 6% of teachers said that no rewards in the form of candy or sweets were provided.

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123 Table 12 Item 30: Factors Determining Student Rewards Provided in the Classroom Factor n % Cost 281 56 Student preference 210 42 Convenience 175 35 Availability 155 31 No rewards provided 30 6 Item 33 asked participants to state their level of agreement (strongly disagree = 1; strongly agree = 5) that their school’s culture promotes teacher input on issues such as healthy school nutrition environments and the teacher had been given opportunities to impact the nutrition environment at his/her school. The summarized results in Table 13 indicated that the teachers were more likely to disagree than they were to agree that their school’s culture promotes teacher input on issues such as healthy school nutrition environments ( M = 2.69) and that they had been given opportunities to impact the nutrition environment at their school ( M = 2.55). The majority of teachers disagreed (42.1%) that teacher input was promoted, and also disagr eed (47.9%) that teachers had an opportunity to impact the school nutrition environment. However, 29.1% of teachers agreed that teacher input was promoted, and 26.1% agreed that they had opportunities to impact the school nutrition environment. Item 34a asked participants to indicate the level of influen ce (no influence = 1; major influence = 5) that teachers should have as role models for healthy eating behavior development for students. The mean respons e to the Likert scal e was 4.26, indicating

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124 Table 13 Item 33: Teacher Provided Opportunity for Input and Impact on Nutrition Environment Nutrition Environment Strongly Disagree % Disagree % Do Not Know % Agree % Strongly Agree % Mean Teacher input promoted 13.4 42.1 11.2 29.1 4.2 2.69 Opportunities to impact 15.6 47.9 6.6 26.1 3.8 2.55 that the level of influence as a role mode l was high. The responses indicated that teachers believed that they should have some influence (59.5%) to a major influence (35.3%) as role models for healthy eating beha vior development for students. The lowest categories, no influence (.6%), little influence (3.2%), and do not know (1.4%), only accounted for 5.2% of the total. Item 35 asked teachers to determine how difficult (very difficult = 1; very easy = 5) it was to provide a healthy nu trition environment at their sc hool and in their classroom. The summarized results in Table 14 indicated th at teachers tended to rate the level of difficulty at their school as difficult (44.3%), but tended to rate the level of difficulty in their classroom as easy (49.3%). In addition, teachers we re not likely to provide extreme ratings such as extremely difficult or extremely easy. Item 36 asked teachers what barriers existed, if any, in providing a healthy nutrition environment at their school The summarized responses in Table 15 indicated that participants were ab out equally likely to say too many other responsibilities (34%) and lack of time (34%). In addition, as many as 30% of teachers said that inadequate financial resources were a barrier in providing a healt hy nutrition environment at their

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125 school. Additional responses included no opportunity for input (22%), lack of curriculum resources (21%), no barriers exist (16%), and lack of interest (10%). Table 14 Item 35: Level of Difficu lty Providing Nutrition Envir onment in School and Classroom Nutrition Environment Very Difficult % Difficult % Do Not Know % Easy % Very Easy % Mean At your school 10.2 44.3 13.0 28.3 4.2 2.72 In your classroom 2.6 24.4 5.2 49.3 18.6 3.57 Table 15 Item 36: Barriers to Providing a Hea lthy Nutrition Environment at School Barrier n % Too many other responsibilities 175 35 Lack of time 170 34 Inadequate financial resources 150 30 No opportunity for input 110 22 Lack of curriculum resources 105 21 No barriers exist 80 16 Lack of interest 50 10 Item 37 asked which barriers, if any, ex isted in providing a healthy nutrition environment in their school’s cafeteria Summarized results in Table 16 indicated that 37% of the teachers said that no opportunity for input was a barrier in providing a healthy

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126 Table 16 Item 37: Barriers to Providing a Health y Nutrition Environment in the Cafeteria Source n % No opportunity for input 185 37 No barriers exist 110 22 Inadequate financial resources 105 21 Lack of time 80 16 Too many other responsibilities 80 16 Lack of interest 35 7 Lack of curriculum resources 25 5 nutrition environment in their sc hool’s cafeteria followed by 22% of teachers saying that no barriers exist and 21% saying inadequate financial resources are barriers. Lack of time and too many other responsibilities were both reported by 16% of teachers, followed by lack of interest (7%) and lack of curriculum resources (5%). Item 38 asked teachers what barriers existed, if any, in providing a healthy nutrition environment in their classroom The summarized results in Table 17 indicated that teachers were about e qually likely to say that no barriers exist (35%) as they were to say that a lack of time was a barrier (34%), followed by too many other responsibilities (28%), inadequate financial resources (19%), and lack of curriculum resources (19%). Only 3% of teachers indicated no opportunity for input and lack of interest. Item 39a on the survey asked teachers to indicate their le vel of agreement (strongly disagree = 1; strongly agree = 5) that nutrition and healthy eating had an impact on a child’s ability to learn and perform during the day. More than 96% of the

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127 Table 17 Item 38: Barriers to Providing a Health y Nutrition Environment in the Classroom Source n % No barriers exist 175 35 Lack of time 170 34 Too many other responsibilities 140 28 Inadequate financial resources 130 26 Lack of curriculum resources 95 19 No opportunity for input 15 3 Lack of interest 15 3 teachers either agreed or strongly agreed with the statement. Perceived influence descriptive results. The perceived influen ce results indicated that teachers perceived that they had some influence over student nutrition and student eating habits, with the biggest influence being directly in the classroom and the smallest influence in the school cafeteria. Item 18 asked teachers to determine the top three factors in which they have the most influence. The summarized responses in Table 18 indicated that teachers were most likely to select food/treats in the classroom (76%) as a something that they had the most influence over followed by student class parties (63%) and snacks from home (48%). A noticeable decrease occurred after the first th ree items reported, to include, in descending order, adult lunches from home (30%), student school meals (15%), student lunches from home (9%), school wide celebrations (6%), adult school meals (6%), after school snacks (5%), and fundraisers (2%).

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128 Table 18 Item 18: Top Three Factors in Wh ich Teachers Have the Most Influence Factor n % Food/treats in classroom 381 76 Student class parties 316 63 Snacks from home 240 48 Adult lunches from home 150 30 Student school meals 75 15 Student lunches from home 45 9 School-wide celebrations 30 6 Adult school meals 30 6 After school snacks 25 5 Fundraisers 10 2 Item 23 asked teachers to indicate the degree to which they agree (strongly disagree = 1; strongly agree = 5) that they have an influe nce on the nutrition environment in their school, their school cafeteria, and th eir classroom. The summarized responses in Table 19 indicated that teachers were most lik ely to disagree (49.1%) that they had an influence on the nutrition environment at their school followed by agree (26.1%). They were also most likely to disagree that they had an influence on the nutrition environment in their school’s cafeteria (52.1%) followed by strongly disagree (26.7%). Finally, teachers were most likely to strongly agree that they had an influence on the nutrition environment in their classroom (50.7%) followed by agree (45.3%).

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129 Table 19 Item 23: Teacher Influences Nutrition En vironment at School, Cafeteria, and Classroom Source Strongly Disagree % Disagree % Do Not Know % Agree % Strongly Agree % Mean School 15.8 49.1 5.8 26.1 3.2 2.52 School's cafeteria 26.7 52.1 6.6 12.6 2.0 2.11 Classroom 0.4 1.0 2.6 45.3 50.7 4.45 Item 25 asked teachers to indicated their level of agreement (strongly disagree = 1; strongly agree = 5) that th ey influenced the snack choice s in their classroom and they influenced the candy or other sweets available in their classroom. The results in Table 20 indicate that teachers were most likely to agree (46.9%) followed by strongly agree (37.9%) that they influence the snack choices in their classroom. In addition, teachers were most likely to strongly agree (4 6.7%) followed by agree (43.1%) that they influence the candy or other sweets available in their classroom. Table 20 Item 25: Teacher Influence on Snack Choices and Sweets Available in Their Classrooms Influence Strongly Disagree % Disagree % Do Not Know % Agree % Strongly Agree % Mean Influence on snack choices 1.8 10.2 3.2 46.9 37.9 4.09 Influence candy or sweets 3.4 4.4 2.4 43.1 46.7 4.25

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130 Item 34b asked teachers to indicate the leve l of influence (no influence = 1; major influence = 5) that teachers had in promoting healthy eating behaviors with their students. The majority of the teachers said that they had some influence in promoting healthy eating behaviors with their studen ts (61.7%), whereas 19.8% indicated major influence Seventeen percent of teachers indicated they had little influence (15.2%) or no influence (1.8%) on healthy eating behaviors of students, with 1.6% indicating do not know. Item 39b and 39c on the survey asked teachers to indicate their level of agreement (strongly disagree = 1; strongly agree = 5) that children imitate teachers’ eating and those Table 21 Items 39b and 39 c: Children Imitate Othe rs and Teachers Should Model Healthy Eating Source Strongly Disagree % Disagree % Do Not Know % Agree % Strongly Agree % Mean Children imitate eating behaviors 2.8 12.8 4.0 42.1 38.3 4.00 Teacher should model healthy eating 2.2 7.8 2.0 46.1 41.9 4.18 of others around them and that teachers ha d a responsibility to model healthy eating behaviors to students in th eir classrooms. The summarized responses in Table 21 indicated that teacher s were most likely to agree (42.1 %) or strongly agree (38.3%) that children imitate eating habits of teachers and those around them. In addition, teachers were most likely to agree (46.1%) or strongly agree (41.9%) that they had a responsibility to model healthy eating behaviors to students in th eir classroom.

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131 Finally, Item 40 asked teachers to state thei r level of agreement (strongly disagree = 1; strongly agree = 5) that they can make a difference in providing a healthy nutrition environment at their school, in their school cafeteria and in their classroom. The summarized results in Table 22 indicated that te achers were most likely to agree that they can make a difference in providing a healt hy nutrition environment at their school (42.1%), although as much as 30.5% disagreed. In addition, teachers were most likely to disagree that they could make a difference in providing a healthy nutrition environment in their school’s cafeteria (42.5%), although 24.6% agreed. Finally, teachers were most likely to agree (50.7%) or str ongly agree (41.3%) that they can make a difference in providing a healthy nutriti on environment in their classroom ( M = 4.29). Table 22 Item 40: Teacher Can Make a Difference in Providing a Healthy Nutrition Environment Source Strongly Disagree % Disagree % Do Not Know % Agree % Strongly Agree % Mean School 4.6 30.5 12.4 42.1 10.4 3.23 School's cafeteria 15.0 42.5 11.4 24.6 6.6 2.65 Classroom 0.6 3.0 4.4 50.7 41.3 4.29 Self-reported behavior descriptive results. The self-reported behavior results indicated that teachers believe d that while teachers sometimes provided candy or sweets as rewards or during celebrations, in general, they tried to promote healthy eating habits of students and they had a good or very good personal approach to healthy eating.

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132 Item 15 asked teachers to indicate the fre quency to which (never = 1; often = 5) they made menu suggestions to their student s or discussed the menu prior to lunch, sat with or ate with their stude nts during lunch or other meal times, discussed food-related topics in their classroom and integrated nut rition into their lessons. The summarized results in Table 23 indicated that teache rs were most likely to say that they never (34.7%) or they rarely (22.4%) made menu suggestions to th eir students or discussed the menu Table 23 Item 15: Teacher Behaviors Related to Making Menu Suggesti ons, Eating with Students, Discussing Food-Related Topics in Classroom and Integrating Nutrition into Lessons Behavior Never % Rarely % Do Not Know % Sometimes % Often % Mean Make menu suggestions 34.7 22.4 1.8 21.2 20.0 2.69 Sit or eat with students 36.5 32.3 1.2 23.6 6.4 2.31 Discuss foodrelated topics 7.2 15.2 1.4 48.9 27.3 3.74 Integrate nutrition into lessons 11.2 26.1 1.0 47.1 14.6 3.28 prior to lunch; although 21.2% said sometimes and another 20.0% said often Teachers were also most likely to say that they never (36.5%) or rarely (32.3%) sat or ate with their students during lunch or other meal times; although as many as 23.6% said sometimes With regard to discussing food-relate d topics in their classroom, teachers were most likely to say that they sometimes (48.9%) discussed food-related topics in

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133 their classroom. Finally, teachers we re most likely to say that they sometimes (47.1%) integrated nutrition into their lessons. Item 26 asked teachers to indicate how often they rewarded students using food and/or candy in their classroom. The summ arized results in Table 24 indicated that teachers were not likely to rewarded student s with food or candy in the classroom given that the majority of teachers reward students with food or candy 1-3 times per month or less. Item 27 on the survey asked teachers to indicate which food item was provided most often for student rewards or r ecognitions in their classroom The responses in Table 25 indicated that teachers were most likely to select candy (38%) followed by crackers (18%). Table 24 Item 26: Frequency of Student Rewards Consisting of Food or Candy in Classroom Frequency Frequency Percent Daily 34 7% 3-4 times per week 21 4% 1-2 times per week 78 16% 1-3 times per month 66 13% Very infrequently 99 20% On special occasions only 146 29% Never 57 11% Item 28 asked teachers how often celebrations included food and/or candy in their classroom. The summarized responses in Table 26 indicated that teac hers were not likely

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134 Table 25 Item 27: Single Food Item Provided Most Often for Student Rewards in the Classroom Food item n % Candy 190 38 Crackers 89 18 Cookies 55 11 Fruit 36 7 Cake or cupcakes 27 5 Vegetables 18 4 Dairy items 8 2 Nuts 5 1 Table 26 Item 28: Frequency to Which Celebrations Include Food and/or Candy in the Classroom Frequency n % Daily 2 0 3-4 times per week 1 0 1-2 times per week 8 2 1-3 times per month 81 16 Very infrequently 101 20 On special occasions only 279 56 Never 29 6

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135 to include food and/or candy in the classroom during celebrations give n that the majority of the teachers said that they very infrequently includedfood or candy as part of their classroom celebrations (20 %) or they only did it on special occasions (56%). Six percent said that they never included food and/or candy in thei r classrooms during celebrations. Item 29 asked teachers to indicate the single food item provided most often for celebrations in their classroom. The results in Table 27 indicated that teachers were most likely to select cake or cupcakes (44%) followed by cookies (24%) and fruit (11%). Item 31 asked teachers to indicate the rewards that they provided most often in their classrooms. The results in Table 28 indicated th at the majority of the teachers said that they used stickers (61%) or pencils/writing tools (55%) as a reward source most often. Table 27 Item 29: Single Food Item Provided Most Often for Celebrations in the Classroom Source n % Cake or cupcakes 221 44 Cookies 118 24 Fruit 53 11 Crackers 33 7 Vegetables 28 6 Candy 26 5 Dairy items 11 2 Nuts 2 0

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136 Another 41% of teachers indicated permission for a popular activity and 30% of the teachers indicated that they used food as a reward most often. Colorful papers or notebooks (16%) and small stuffed animals (15%) were the least likely to be used as classroom rewards. Table 28 Item 32: Rewards Provided Most Often in the Classroom Reward n % Stickers 307 61 Pencils or other writing tools 276 55 Permission for a popular activity 206 41 Food rewards 150 30 Colorful papers or notebooks 81 16 Small stuffed animals 73 15 Item 39d asked teachers to indicate their level of agreement (strongly disagree = 1; strongly agree = 5) that they modeled heal thy eating habits to their students. The vast majority of teachers agreed (48.1%) or strongly agreed (41.3%) that they modeled healthy eating habits to their students. Finally, Item 41 on the survey asked teach ers to rate their own approach to healthy eating from very poor (value of one) to very good (value of five). The vast majority of the teachers said that they modeled good (54.7%) or very good (38.9%) healthy eating behaviors.

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137 Relationship of attitudes and perceived influence. The second research question asked “Are teacher attitudes about school nutrition environments and their perceived influence on the environment relate d?” In order to a ddress this research question, simple logistic regr ession and simple linear regres sion were used whereby each pair of attitude and perceived influence items on the survey were analyzed to determine the direction and degree or strength of the relationship between t eachers’ attitudes and their perceived influence with rega rd to the nutrition environment. The results for research question two i ndicate that there was a relationship between teacher attitudes about school nut rition environments and their perceived influence on the environment among kinderg arten through fifth grade teachers. In general, the higher the degree to which teach ers felt various nutri tional factors in the school environment effect or impact student s, the higher their pe rceived influence on those factors. The first set of analyses examined the relationship between Item 17 and Item 18 on the survey. Item 17 asked teachers to sel ect their top three choices from a list of 10 factors that had the most impact on the sc hool nutrition environment and Item 18 asked teachers to select the top three factors in which they had the most influence. The summarized results in Table 29 indicated that si x of the 10 relationships were statistically significant ( p < .05). Specifically, the results indicate that teachers who selected after school snacks as one of the top three factors influencing th e school nutrition environment were 2.907 times more likely to say that they have the most influence over after school snacks ( B = 1.607, p = .017); teachers who selected student lunches from h ome were 3.73 times more likely

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138 to say that they have the most infl uence over student lunches from home ( B = 1.316, p < .001); teachers who selected snacks from home were 1.903 times more likely to say that they have the most influe nce over snacks from home ( B = 0.643, p < .001); teachers who selected food/treats in the classroom were 2.541 times more likely to say that they have Table 29 Items 17 and 18: Top Three Fact ors Impacting School Nutrition Environment and Perceived Teacher Influence Source B SE B OR p Student school meals 0.497 0.396 1.643 0.210 After school snacks 1.607 0.446 2.907 0.017 Student lunches from home 1.316 0.373 3.730 < .001 Snacks from home 0.643 0.182 1.903 < .001 Food/treats in classroom 0.933 0.248 2.541 < .001 Student class parties 0.416 0.297 1.515 0.161 School-wide celebrations 0.788 0.569 2.200 0.166 Fundraisers 1.699 1.104 5.466 0.124 Adult school meals 1.329 0.494 3.778 0.007 Adult lunches from home 1.645 0.421 5.182 < .001 Notes: OR = odds ratio. the most influence over food /treats in the classroom ( B = 0.933, p < .001); teachers who selected adult school meals were 3.778 times more likely to say that they have the most influence over adult school meals ( B = 1.329, p = .007); and teachers who selected adult lunches from h ome were 5.182 times more likely to say that they have the most influence

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139 over adult lunches from home ( B = 1.645, p < .001). Therefore teachers were more likely to say that they had the most influence on f actors in which they felt they indicated the most impact on the school nutrition environment. The next set of relationshi ps tested were between Items 22 and 23 on the survey. Item 22 asked teachers to indicate the degree to which they agreed that a healthy nutrition environment existed in their school, their sc hool’s cafeteria and thei r classroom. Item 23 asked teachers to then indicate the extent to which teachers felt that they had an influence on the nutrition environment in their school, thei r school’s cafeteria, and their classroom. The summarized results in Table 30 indicated that all three relationships tested were statistically significant ( p < .05). Specifically, teacher s’ perceived influence was moderately and positively associated with the degree to which teachers agreed that a healthy nutrition environment existed in their school ( = .438, p < .001) in that stronger agreement that a healthy nutrition environmen t existed in their school was associated with stronger agreement that teachers had an influence on the nutrition environment in Table 30 Items 22 and 23: Degree to Whic h Healthy Nutrition Environment Exists and Perceived Teacher Influence Source B SE B p School 0.472 0.043 0.438 < .001 School cafeteria 0.325 0.036 0.378 < .001 Classroom 0.229 0.033 0.295 < .001 their school. Similarly, teachers’ perceive d influence was moderately and positively associated with the degree to which teacher s agreed that a healt hy nutrition environment

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140 exists in their sc hool’s cafeteria ( = .378, p < .001) in that stronger agreement that a healthy nutrition environment existed in their school’s cafeteria was associated with stronger agreement that teachers had an in fluence on the nutrition environment in the school’s cafeteria. Finally, teachers’ perc eived influence was weakly and positively associated with the degree to which teacher s agreed that a healt hy nutrition environment existed in their classroom ( = .438, p < .001) in that stronger agreement that a healthy nutrition environment existed in their classr oom was associated with stronger agreement that teachers had an influence on the nutri tion environment in their classroom. The next set of relationships that were examined included survey Items 24 and 25. Item 24 pertained to using candy or other swee ts as rewards in the classroom affecting student classroom behavior and students’ overall ea ting behaviors. Item 25 pertained to teachers’ level of agreement that they influe nced the candy or other sweets available in their classroom. The results in Table 31 indica ted that one of the two relationships tested was statistically significant ( p < .05). Specifically, the degree to which teachers agreed that candy or other sweets affected stude nt classroom behavior was weakly and negatively associated with their perceived influence on the candy and other sweets available in their classroom ( = -.089, p = .047) in that the stronger the agreement that candy or other sweets affected student classroom behavior, th e weaker the agreement that the teacher had an influence on candy or other sweets available in the classroom. However, the association was statistically significant. The final relationship tested for research question two pertained to survey Items 34a and 34b. Item 34a asked teachers to i ndicate the extent to which teachers should have an influence as role models for h ealthy eating behavior and development for

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141 students while Item 34b asked teachers to indica te the extent to which teachers actually had an influence in promoting healthy eating behaviors with their students. The results indicate that the relationship was positive, m oderate, and statistically significant in that the more teachers felt that they should in fluence students as role models for healthy eating behavior, the more teachers felt that they actually had an influence in promotion healthy eating behavior ( = .426 p < .001). Table 31 Items 24 and 25: Impact of Candy or Other Sweets on Student Behavior and Eating Habits and Per ceived Teacher Influence Impact of candy B SE B p Student classroom behavior -0.070 0.035 -0.089 0.047 Student overall eating habits -0.064 0.046 -0.062 0.167 Relationship between attitudes and se lf-reported classroom behaviors. The third research question asked “Are teacher at titudes about school nutrition environments and self-reported classroom behaviors relate d?” In order to address this research question, simple logistic regr ession and simple linear regres sion were used whereby each pair of attitude and self-reported behavior items on the survey were analyzed to determine the direction and de gree or strength of the re lationship between teachers’ attitudes and their self-repor ted behavior with regard to the nutrition environment. The results for research question three indicated that a relationship existed between teacher attitudes about school nutri tion environments and teacher self-reported classroom behaviors. Specifically, teacher s who believed that specific barriers to

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142 integrating nutrition into the lessons exis ted (e.g., lack of time, does not fit into curriculum, too many other respon sibilities) are less likely to in tegrate nutrition into their lessons than teachers who believed that no barrie rs exist. In addition, when teachers felt that certain nutritional aspects impact student learning and pe rformance, they tried to do more to model healthy eati ng habits and behaviors. The first set of analyses examined the relationship between Item 15d and Item 16a through 16f on the survey. Item 15d asked teacher s to indicate how often they integrated nutrition into their lessons (predicted or dependent variable). Items 16a through 16f asked teachers to select barriers that they t hought existed for integrating nutrition into the lessons (predictors or inde pendent variables). Each sub-item (16a, 16b, 16c, 16d, 16e, and 16f) represented a specific barrier in whic h the teachers could either select or not select. The results in Table 32 indicate that four of the six barrier s were statistically Table 32 Items 15d and 16a, b, c, d, e, and f: Barriers to Integrating Nutrition into Lessons and Degree to Which Teacher Integrates Nutrition into the Lessons S Barrier B SE B p Lack of curriculum resources 0.066 0.128 0.023 0.608 Inadequate financial resources 0.241 0.183 0.059 0.187 Lack of time -0.310 0.121 -0.114 0.010 Does not fit into curriculum -0.643 0.136 -0.208 < .001 Too many other responsibilities -0.364 0.118 -0.137 0.002 No barriers exist 0.662 0.168 0.174 < .001

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143 significant associated with the degree to wh ich teachers integrated nutrition into their lessons. Specifically, whether or not teacher s selected lack of time as a barrier was weakly and negatively associated with the degr ee to which they integrated nutrition into their lessons ( = -.114 p = .010) in that teacher s who selected a lack of time as a barrier were less likely to integrate nutrition into thei r lessons. Whether or not teachers indicated that nutrition did not fit into the curriculu m was weakly and negatively associated with the degree to which they integrat ed nutrition into their lessons ( = -.208 p < .001) in that teachers who indicated that nutrition did not f it into the curriculum were less likely to integrated nutrition into thei r lessons. Whether or not teachers indicated that they had too many other responsibilities was weakly and negatively asso ciated with the degree to which they integrate nutrition into their lessons ( = -.137 p = .002) in that teachers who said that they had too many other responsibili ties were less likely to integrate nutrition into their lessons. Finally, whether or not teachers said that no barriers existed was weakly and positively associated with the degr ee to which they integrated nutrition into their lessons ( = .174 p < .001) in that those who said th at no barriers existed were more likely to integrate nutrition into their lessons. The next set of relationships tested pe rtained to Items 35a and b, and Item 41. Items 35a and 35b asked teachers to indicate the extent to which it was difficult to provide a healthy nutrition envi ronment at their school and in their classroom. Item 41 asked teachers to rate their own approach to healthy eating. Th e results in Table 33 indicated that neither of the relationships tested reached stat istical significance ( p > .05) and therefore no relationship existed between the extent to which teachers believe it was difficult to provide a healthy nutrition environm ent at their school and in their classroom

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144 Table 33 Items 35a and b, and 41: Diffic ulty in Providing a Healthy Nutrition Environment in School and Classroom and Teacher Approach to Own Healthy Eating Source B SE B p School -0.026 0.067 -0.018 0.693 Classroom 0.124 0.067 0.082 0.067 and their rating of their own approach to healthy eating. The final relationship tested for research question three pertained to Item 39a and 39d. Item 39a asked teachers to indicate the ex tent to which they agreed that nutrition and healthy eating had an impact on a child’s ab ility to learn and perform during the day. Item 39d asked teachers to indicate the extent to which they agreed that they modeled healthy eating habits to their student s. The relationship was positive, moderate, and statistically significant ( = .346 p < .001) in that the more teachers agreed that nutrition and healthy eating had an impact on a child’s ability to learn and perform during the day, the more they agreed that they mode led healthy eating habits to their students. Relationship between perceived infl uence and self-reported classroom behaviors. The fourth research question asked “Are perceived influences on the school nutrition environment and self-reported clas sroom behaviors relate d?” In order to address this research question, simple logi stic regression and simple linear regression were used whereby each pair of perceived influence and se lf-reported behavior items on the survey were analyzed to determine th e direction and degree or strength of the relationship between teachers’ perceived influence and their self-reported behavior with regard to the nutrition environment.

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145 The results for research question four indicated that there was a relationship between perceived influence on the school nutrition environment and teacher selfreported classroom behaviors. In general, the more teachers believed that they had an influence on the nutritional environment, the more likely they were to offer menu suggestions to their students, sit or eat w ith students during meal times, discuss foodrelated topics in class, and inte grate nutrition into their lessons. The first set of relationships tested pe rtained to Items 15a through 15d and Items 23a through 23c. Item 15 asked teachers to i ndicate the extent to which they make menu suggestions to their students or discussed th e menu prior to lunch, they sat or ate with their students during lunch or other meal times, they discussed food-related topics in their classroom, and they integrated nutrition into their lessons. Item 23 asked teachers to indicate the extent to which they agreed that they had an influence on the nutrition environment at their school, their school’s cafeteria and in their classroom. The relationships between making menu suggestions prior to lunch and teacher perceived influence on the nutrition environmen t at the school, in the school cafeteria, and in their classroom is pr ovided in Table 34. The result s indicated that all three relationships were statistically significant ( p < .05). Specifically, perceived influence of the nutrition environment at the school was weakly and positively associated with the degree to which the teacher made menu suggestions prior to lunch ( = .155, p < .001) in that the more the teacher agreed that he/she had an influence, the more often the teacher made menu suggestions to students. In addition, perceived influence of the nutr ition environment in the school cafeteria was weakly and positively associated with the degree to which the teacher made menu

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146 Table 34 Item 15a and 23: Teacher Discusses Menu Prior to Lunch and Perceived Teacher Influence Source B SE B p School 0.218 0.062 0.155 < .001 School cafeteria 0.282 0.070 0.178 < .001 Classroom 0.295 0.111 0.118 0.008 suggestions to students prior to lunch ( = .178, p < .001) in that the more the teacher agreed that he/she had an influence, the mo re often the teacher made menu suggestions to students. Finally, perceived influence of th e nutrition environment in the classroom was weakly and positively associated with the degree to which the teacher made menu suggestions to students prior to lunch ( = .118, p < .001) in that the more the teacher agreed that he/she had an influence, the mo re often the teacher made menu suggestions to students. The results examining the relationships between teacher perceived influence in the school, cafeteria, and classroom and the ex tent to which teachers sat with or ate with students during lunch time or other meals are provided in Table 35. The results indicated that none of the relationships reached statistical significance ( p > .05) and therefore no relationship existed between the extent to which teachers sat and ate lunch with their students and the extent to which they agreed that they had an influence over the nutrition environment in their school, school’s cafeteria, or their classroom.

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147 Table 35 Items 15 b and 23: Teacher Sits or Eats with Students During Lunch and Perceived Teacher Influence Source B SE B p School 0.060 0.053 0.051 0.257 School cafeteria 0.032 0.060 0.024 0.596 Classroom 0.174 0.094 0.083 0.065 The results examining the relationships between teacher perceived influence in school, cafeteria, and classroom and the extent to which teachers discussed food-related topics in their classroom are provided in Tabl e 36. The results indi cated that two of the three relationships tested were statistically significant ( p < .05). Specifically, the extent to which teachers discussed food-related to pics in their classroom was weakly and positively associated with the extent to which they agree that they have an influence on the nutrition environment at the school ( = .105, p = .018) in that teachers who agreed more that they had an influence discussed f ood-related topics in their classroom more Table 36 Items 15 c and 23: Teacher Discusses Food-Related Topics in Classroom and Perceived Teacher Influence Source B SE B p School 0.113 0.048 0.105 0.018 School cafeteria 0.082 0.054 0.068 0.130 Classroom 0.409 0.083 0.215 < .001

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148 often. In addition, the extent to which teach ers discussed food-related topics in their classroom was weakly associated with the extent to which they agreed that they had an influence on the nutrition envi ronment in their classroom ( = .215, p < .001) in that teachers who agreed more that they had an influence discussed food-related topics in their classrooms more often. The results examining the relationships between teacher perceived influence in school, cafeteria and classroom and the extent to which teachers integrated nutrition into their lessons are provided in Table 37. Th e results indicated that two of the three relationships tested were statistically significant ( p < .05). Table 37 Items 15 d and 23: Teacher Integrates Nutrition into Lessons and Perceived Teacher Influence Source B SE B p School 0.111 0.051 0.096 0.031 School cafeteria 0.073 0.058 0.056 0.208 Classroom 0.351 0.090 0.172 < .001 Specifically, the extent to which teachers integrated nutrition into their lessons was very weakly and positively associated with the extent to which they agreed that they had an influence on the nutriti on environment at the school ( = .096, p = .031) in that teachers who agreed more that they had an influence integrated nutrition into their lessons more often. In addition, the extent to which teachers integrat e nutrition into their lessons was weakly associated with the extent to which they agreed that they had an

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149 influence on the nutrition envi ronment in their classroom ( = .172, p < .001) in that teachers who agreed more that they had an influence integrated nutrition into their lessons more often. Teachers’ responses to Item 15 were also correlated with their responses to Item 25a and 25b. Item 25 asked teachers to indicate th e extent to which they agreed that they influenced the snack choices in their classr oom and they influenced the candy or other sweets available in their classroom. The results examining the relationship be tween the degree to which teachers made menu suggestions or discussed the menu with students prior to lunch and teachers’ perceived influence over snack choices, ca ndy, and other sweets available in their classroom are presented in Table 38. The resu lts indicated that one of the relationships tested reached statis tical significance ( p < .05). Specifically, teachers’ perceived influence on snack choices in their classroom was weakly and positively associated with the extent to which teachers made menu suggestions to students ( = .169, p < .001) in that the more teachers agreed that they have an influence, the more likely they were to discuss menu options. Table 38 Items 15a and 25a and b: Teacher Makes Menu Suggestions Prior to Lunch and Teacher Influence over Snack Choices, Cand y, and Sweets in the Classroom Influence B SE B p Influence on snack choices 0.273 0.071 0.169 < .001 Influence on candy or sweets 0.136 0.074 0.082 0.068

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150 The results examining the relationship be tween the degree to which teachers sit and eat lunch with students a nd teachers’ perceived influe nce over snack choices, candy, and other sweets available in their classroom are presented in Table 39. The results indicated that both of the relationships tested reache d statistical significance ( p < .05). Specifically, teachers’ perceived influence on snack choices in their classroom was weakly and positively associated with the extent to which teachers sat and ate lunch with students ( = .136, p = .002) in that the more teachers ag reed that they had an influence, the more likely they were to sit and eat lunc h with their students. In addition, teachers’ perceived influence on candy or other sweets av ailable in their clas sroom was weakly and positively associated with the extent to whic h teachers sat and ate lunch with students ( = .107, p = .016) in that the more teachers agreed that they had an influence, the more likely they were to sit and eat lunch with their students. Table 39 Items 15b and 25a and b: Teacher Sits and Eats Lunch with Students and Teacher Influence over Snack Choices, Candy, and Sweets in the Classroom Influence B SE B p Influence on snack choices 0.185 0.060 0.136 0.002 Influence on candy or sweets 0.151 0.063 0.107 0.016 The results examining the relationship between the degree to which teachers discussed food-related topics in their classr ooms and teachers’ perceived influence over snack choices, candy and other sweets availabl e in their classroom ar e presented in Table 40. The results indicated that both of th e relationships tested reached statistical

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151 significance ( p < .05). Specifically, teachers’ per ceived influence on snack choices in their classroom was weakly and positively asso ciated with the extent to which teachers discussed food-related topi cs in their classroom ( = .200, p < .001) in that the more teachers agreed that they have an influence, the more likely they were to discuss foodrelated topics. In addition, teachers’ pe rceived influence on candy or other sweets available in their classroom was weakly and positively associated with the extent to which teachers discussed food-relate d topics in their classroom ( = .107, p = .016) in that the more teachers agree that they had an influence, the more likely they were to discuss food-related topi cs in their classroom. Table 40 Items 15c and 25a and b: Teacher Discusses Food-Related Topics in the Classroom and Teacher Influence over Snack Choices, Candy, and Sweets in the Classroom Influence B SE B p Influence on snack choices 0.246 0.054 0.200 < .001 Influence on candy or sweets 0.147 0.057 0.116 0.010 The results examining the relationship between the degree to which teachers integrated nutrition into their lessons a nd teachers’ perceived influence over snack choices, candy, and other sweets av ailable in their classroom ar e presented in Table 41. The results indicated that both of the relationships tested re ached statistical significance ( p < .05). Specifically, teachers’ perceived influence on snack choices in their classroom was weakly and positively associated with the extent to which teachers integrated nutrition into their lessons ( = .221, p < .001) in that the more teachers agreed that they

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152 had an influence, the more likely they were to integrate nutrition in to their lessons. In addition, teachers’ perceived influence on candy or other sweets available in their classroom was weakly and positively associat ed with the extent to which teachers integrated nutrition into their lessons ( = .132, p = .003) in that the more teachers agreed that they had an influence, the more likely they were to integrate nutrition into lessons. Table 41 Item 15 d and 25 a and b: Teacher Inte grates Nutrition into Lessons and Teacher Influence over Snack Choices, Candy, and Sweets in the Classroom Influence B SE B p Influence on snack choices 0.291 0.057 0.221 < .001 Influence on candy or sweets 0.180 0.060 0.132 0.003 The next set of relationships pertained to the Item 15 questions and Item 34b. Item 34b asked teachers to indicate the exte nt to which they had an influence in promoting healthy eating behaviors with thei r students. Table 42 provides the results based on the relationship between the extent to which teachers perceived that they had an influence in promoting healthy eating beha viors with their students and the four behaviors outlined in Item 15. The results i ndicated that all of the relationships were statistically significant ( p < .05). Specifically, the extent to which teachers believed that they had an influence in promoting healthy eating behaviors with thei r students was positively associated with the degree to which they made menu suggestions ( = .221, p < .001); the degree to which they sat or ate with students during meals ( = .124, p = .005); the degree to which they

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153 discussed food-related topi cs in their classroom ( = .265, p < .001); and the degree to which they integrated nutrition into their lessons ( = .242, p < .001). In all cases, the more they believed that they had an influence, the more likely they were to say that they engaged in the behavior. Table 42 Items 15a, b, c, d, and 34b: Teacher Perceived Influence Related to Making Menu Suggestions, Eating with Students, Discussing Food-Related Topics, and Integrating Nutrition into Lessons Behavior B SE B p Makes menu suggestions 0.361 0.071 0.221 < .001 Eats with students 0.170 0.061 0.124 0.005 Discuss fool-related topics 0.330 0.054 0.265 < .001 Integrates nutrition into lessons 0.322 0.058 0.242 < .001 The next set of relationships pertained to the Item 15 questions and Item 39c. Item 39c asked teachers to indicate the extent to which they agreed that they had the responsibility to model healt hy eating behaviors to students in their classroom. The results in Table 43 indicate that all of the relationships were statistically significant ( p < .05). Specifically, the extent to which teachers be lieved that they had a responsibility to model healthy eating habits was weakly and positively associated with the degree to which they made menu suggestions ( = .101, p = .023); the degree to which they sat or ate with students during meals ( = .120, p = .007); the degree to which they discussed

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154 food-related topics in their classroom ( = .215, p < .001); and the degree to which they integrated nutrition into their lessons ( = .224, p < .001). In all cases, the more they believed that they had a responsibility to model healthy eating habits, the more likely they were to say that they engaged in the behavior. Table 43 Items 15a, b, c, d, and 39c: Teacher Res ponsibility to Model Healthy Eating Related to Making Menu Suggestions, Eating with Students, Discussing Food-Related Topics, and Integra ting Nutrition into Lessons Behavior B SE B p Makes menu suggestions 0.168 0.074 0.101 0.023 Eats with students 0.169 0.062 0.120 0.007 Discuss fool-related topics 0.272 0.055 0.215 < .001 Integrates nutrition into lessons 0.303 0.059 0.224 < .001 The final set of relationships consisted of the four behaviors from Item 15 and Item 40a through 40c. Item 40 asked to teache rs to indicate the extent to which they thought they could make a difference in pr oviding a healthy nutrition environment in their school, their school’s cafeteria, and thei r classroom. The results based on the degree to which teachers provided menu suggestions to students and the extent to which teachers thought they could make a difference in pr oviding a healthy nutrition environment in their school, their school’s cafeteria, and thei r classroom are provided in Table 44. The results indicate that all three relatio nships were statistically significant ( p < .05). Specifically, the extent to which teachers thought they could make a difference in providing a healthy nutrition environment in their school was weakly and positively

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155 associated with the degree to which th ey made menu suggestions to students ( = .147, p = .001); the stronger the agreement that they could make a difference, the more often Table 44 Items 15a and 40: Teacher Makes Me nu Suggestions Prior to Lunch and Teacher Can Make a Difference in Providing a Healthy Nutrition Environment Source B SE B p School 0.207 0.062 0.147 0.001 School cafeteria 0.187 0.059 0.140 0.002 Classroom 0.277 0.096 0.129 0.004 teachers were to make menu suggestions to st udents. In addition, the extent to which teachers thought they could make a diffe rence in providing a healthy nutrition environment in their school cafeteria was weakly and positively associated with the degree to which they made me nu suggestions to students ( = .140, p = .002) in that the stronger the agreement that they could make a difference, the more often teachers were to make menu suggestions to students. Finall y, the extent to whic h teachers thought that they could make a difference in providi ng a healthy nutrition e nvironment in their classroom was weakly and positively associated with the degree to which they made menu suggestions to students ( = .129, p = .004) in that the str onger the agreement that they could make a difference, the more often teachers were to make menu suggestions to students. The results based on the degree to which teachers sat or ate with students during meal times and the extent to which teachers t hought that they could make a difference in

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156 providing a healthy nutrition environment in their school, their school’s cafeteria, and their classroom are provided in Table 45. Th e results indicated th at two of the three relationships were statistically significant ( p < .05). Table 45 Items 15b and 40: Teacher Sits or Ea ts with Students during Meals and Teacher Can Make a Difference in Providing a Healthy Nutrition Environment Source B SE B p School 0.137 0.053 0.115 0.010 School cafeteria 0.094 0.050 0.084 0.061 Classroom 0.201 0.081 0.110 0.013 Specifically, the extent to which teac hers thought that they could make a difference in providing a healt hy nutrition environment in their school was weakly and positively associated with the degree to which they sat and ate with students during meals ( = .115, p = .010) in that the strong er the agreement that they could make a difference, the more often teachers sat or ate with student s during meals. In addition, the extent to which teachers thought that they could make a difference in providing a healthy nutrition environment in their classroom was weakly and positively associated with the degree to which they sat or ate with students during meals ( = .110, p = .013) in that the stronger the agreement that they could make a differen ce, the more often teach ers sat or ate lunch with students during meals. The results based on the degree to which te achers discussed food-related topics in their classroom and the extent to which teachers thought that they could make a

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157 difference in providing a hea lthy nutrition environment in their school, their school’s cafeteria, and their cla ssroom are provided in Table 46. Th e results indicated that two of the three relationships were statistically significant ( p < .05). Table 46 Items 15c and 40: Teacher Discusses Food-Related Topics in Classroom and Teacher Can Make a Difference in Providing a Healthy Nutrition Environment Source B SE B p School 0.159 0.048 0.147 0.001 School cafeteria 0.070 0.046 0.069 0.123 Classroom 0.259 0.073 0.158 < .001 Specifically, the extent to which teac hers thought that they could make a difference in providing a healt hy nutrition environment in their school was weakly and positively associated with the degree to which they discussed food-related topics in their classroom ( = .147, p = .001) in that the stronger the agreement that they could make a difference, the more often teachers discussed food-related topics. In addition, the extent to which teachers thought that they coul d make a difference in providing a healthy nutrition environment in their classroom was weakly and positively associated with the degree to which they discuss food-re lated topics in their classroom ( = .158, p < .001) in that the stronger the agreement that they could make a differ ence, the more often teachers discussed food-related topi cs in their classroom. Finally, the results based on the degree to which teachers integrated nutrition into their lessons and the extent to which teacher s thought that they could make a difference

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158 in providing a healthy nutrition environment in their school, their school’s cafeteria, and their classroom are provided in Table 47. Th e results indicated th at two of the three relationships were statistically significant ( p < .05). Table 47 Items 15d and 40: Teacher Integrates Nutrition into Lessons and Teacher Can Make a Difference in Providing a Healthy Nutrition Environment Source B SE B p School 0.155 0.051 0.135 0.003 School cafeteria 0.085 0.049 0.078 0.081 Classroom 0.349 0.077 0.199 < .001 Specifically, the extent to which teac hers thought that they could make a difference in providing a healt hy nutrition environment in their school was weakly and positively associated with the degree to which they integrated nutrition into their lessons ( = .135, p = .003) in that the strong er the agreement that they could make a difference, the more often teachers integrated nutrition into their lessons. In addition, the extent to which teachers thought that they could make a difference in providing a healthy nutrition environment in their classroom was weakly and positively associated with the degree to which they integrated nutrition into their lessons ( = .199, p < .001) in that the stronger the agreement that they could make a diffe rence, the more often teachers integrated nutrition into their lessons. Relationship between teacher characteri stics, attitudes, perceived influence, and self-reported classroom behaviors. The fifth research question asked “Are teacher

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159 demographic characteristics related to at titudes and perceived influence on school nutrition environments and self-reported classroo m behaviors?” In order to address this research question, demographic factors were correlated with att itudinal, perceived influence, and self-reported behavior survey items. Teacher demographic factors and teacher attitudes. The relationships between teacher demographics and teach er attitudes indicated that some relationships exist. Teachers from higher grade levels were more likely to think that barriers existed to integrating nutrition into lessons; teachers with more experience perceived fewer barriers and teachers with more nutrition classes were associated with fewer perceived barriers. In addition, teachers with more experien ce were associated with more positive perceptions of the nutrition envi ronment at the school; they were also more likely to view the influence of candy and other sweets as less positive on student behavior and they thought that it was less difficult to provide a healthy nutrition environment than teachers with less experience. Furthermore, teachers wi th larger class sizes were more likely to feel that the influence of candy or sweets wa s less positive or more negative on students. Finally, teachers with more nutrition cla sses rated a healthy nut rition environment as having more of an influence on student lear ning and performance during the day than did teachers with fewer (zero or one) nutrition classes. The correlational results between the de mographic variables and Item 16, which pertained to barriers that existed for integr ating nutrition into le ssons, are provided in Table 48. The results indicated that grade leve l was statistically signi ficantly related to whether or not teachers selected a lack of time as a barrier ( rs = .105, p = .044); whether or not teachers selected a lack of f it into the curriculum as a barrier ( rs = .138, p = .009);

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160 and whether or not they indicat ed that no barriers exists ( rs = -.110, p = .036). Specifically, teachers from higher grade levels were more likely to select the barriers while teachers from lower grade levels were more likely to say that there were no barriers. However, all of the relationships were weak. None of the relationships between class size and teachers’ atti tudes about barriers regarding integrating nu trition into lessons were signifi cant. Furthermore, none of the relationships between educational attainme nt and teachers’ attitudes about barriers regarding integrating nutrit ion into the lessons were significant. Therefore no relationships are assumed to exist. Table 48 Demographic Characteristics and Item 16 Regarding Barriers to Integrating Nutrition Education Demographic Characteristics 16a Lack of curriculum resources 16b Inadequate financial resources 16c Lack of time 16d Does not fit curriculum 16e Too many other responsibilities 16f No barriers Grade level .004 -.082 .105* .138** .075 -.110* Class size -.063 -.011 .021 .041 .012 -.011 Education .038 -.068 -.002 .030 -.034 -.019 Years teaching -.084 -.107* -.102* -.062 .014 .093* Nutrition courses -.030 .058 .012 -.103* -.088* -.004 p < .05; ** p < .01. With regard to number of years teaching, some significant relationships emerged. Number of years teaching was statistically sign ificantly associated wi th the selection of inadequate financial resources as a barrier ( rs = -.107, p = .017); the selection of lack of

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161 time as a barrier ( rs = -.102, p = .023); and the perception that no barriers exist ( rs = .093, p = .038). Specifically, teachers with more expe rience were less likely to select barriers and more likely to say that no barriers exist. However, all of the re lationships were weak. Finally, the number of nutrition courses taken by teachers (none, one and two or more) was significantly associat ed with the perception that nutrition does not fit into the curriculum ( rs = -.103, p = .021) and the perception that they had too many other responsibilities ( rs = .088, p = .049). Specifically, teacher s with a fewer number of nutrition courses were more likely to select th e barriers. However, the relationships were weak. The correlational results between the demographic factors and Item 17 are presented in Table 49. Item 17 asked teachers to select the factors that they believed had the most impact on the school nutrition environment (17a = student school meals 17b = after school snacks 17c = student lunches from home 17d = snacks from home 17e = Table 49 Demographic Characteristics and Item 17 Regarding Impacts of School Nutrition Environment Demographic Characteristics 17a 17b 17c 17d 17e 17f 17g 17h 17i 17j Grade level .052 .012 .047 .108* -.081 -.079 -.141** .022 -.017 .006 Class size .005 -.056 -.025 -.054 -.063 .060 -.029 .042 .025 .001 Education -.083 -.053 .041 -.049 -.018 -.023 -.015 .037 -.038 -.005 Years teaching .000 -.026 .015 -.061 -.017 .026 -.019 .078 -.026 .030 Nutrition courses -.052 .079 -.016 .016 -.020 .015 .027 -.072 .018 .008 p < .05; ** p < .01.

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162 food/treats in the classroom 17f = student class parties 17g = school-wide celebrations 17h = fundraisers 17i = adult school meals 17j = adult lunches from home ). Results indicated grade level was significantly associated with teachers selecting snacks from home ( rs = .108, p = .039) and teachers selecting school-wide celebrations ( rs = -.141, p = .007). Teachers from older grade levels were more likely to select snacks from home while younger grade levels were more likely to select school school-w ide celebrations. Class size, educational atta inment of the teacher, numb er of years teaching, and number of nutrition courses taken were al l found to be non-significant and therefore no relationship was assumed to exist between cl ass size, teacher educational attainment, number of years teaching, number of nutriti on classes taken, and teachers’ beliefs about factors that had the most impact on the school nutrition environment. The correlational results between the demographic factors and Item 22 are presented in Table 50. Item 22 asked teachers to indicate their level of agreement that a healthy nutrition environment existed in thei r school, school cafeteri a, and classroom. Table 50 Demographic Characteristics and Item 22 Regarding Healthy Eating Demographic Characteristics 22a Items 22b 22c Grade level -.031 -.016 -.056 Class size -.064 -.088 -.039 Education -.013 -.061 -.056 Years teaching .056 .114* .033 Nutrition courses -.019 -.079 .018 p < .05.

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163 The results indicated that the only significan t relationship was between number of years of teaching and the degree to which teachers agreed that there was a healthy nutrition environment in their school’s cafeteria ( rs = .114, p = .011). Specifically, more teaching experience was associated with stronger agreement that the school cafeteria was a healthy nutrition environment. Therefore no relati onship was assumed to exist between grade level, class size, education, number of nutri tion courses taken, and teachers’ perceptions of their school’s nut rition environment. The correlational results between the demographic factors and Item 24 are provided in Table 51. Item 24 asked teach ers to determine the degree of positive influence that candy or other sw eets provided to students in the classroom as rewards had on student classroom behavior and students’ overall eating behaviors. The results indicated that class size was statistically si gnificantly associated with the extent to Table 51 Demographic Characteristics and Item 24 Regarding Influence of Candy or Sweets as Rewards in the Classroom Demographic Characteristics Item 24a 24b Grade level .044 .058 Class size -.099* -.073 Education -.064 -.070 Years teaching -.140** -104* Nutrition courses -.058 -.071 p < .05; ** p < .01.

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164 which teachers believed that candy or other sw eets provided in the classroom as rewards had a positive influence on student behavior ( rs = -.099, p = .026) in that teachers with larger class sizes were less likely to say that it had a positive influence on student behavior. However, the relationship was weak. In addition, number of years teaching was significantly associated with the extent to which teachers believed that candy or other sweets reported a positive influence on student classroom behavior ( rs = -.140, p = .002) and students’ overall eating behaviors ( rs = -.104, p = .020). Specifically, more teaching experience was associated with less positive in fluence ratings (or more negative influence ratings). Since no significant relationships were found between grade level, educational attainment, or number of nutrition courses taken and teachers responses to Item 24, no relationship was assumed to exist between those demographic factors and teachers’ attitudes about the influence of candy or othe r sweets provided to students as rewards on student classroom behavi or and students’ overall eating behaviors. The correlational results between the demographic factors and Item 35 are presented in Table 52. Item 35 asked teacher s to indicate the degree of difficulty in providing a healthy nutrition en vironment at their school and in their classroom. The results indicated that the only significant re lationship found was between number of years teaching and teachers’ difficulty ratings pe rtaining to providing a healthy nutrition environment in their classroom ( rs = .091, p = .042). Specifically, teachers with more teaching experience rated it as less difficult; however, the relationship was weak.

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165 Table 52 Demographic Characteristics and Item 35 Regarding Level of Difficulty in Providing a Healthy Nutrition Environment Demographic Characteristics 35a 35b Grade level -.007 -.005 Class size -.006 -.002 Education -.082 -.043 Years teaching .033 .091* Nutrition courses -.078 .073 p < .05. Grade level, class size, e ducational attainment and number of nutrition courses taken were not found to be statistically signi ficantly related to Item 35 in any way and therefore those demographic characteristics were not assumed to be related to teachers’ perceptions of the level of difficulty that existed in providing a healthy nutrition environment at their school or in their classroom. The last set of correlations relating to teacher demogra phics and teacher attitudes was conducted based on teachers’ responses to Item 39a, which asked teachers to indicate their level of agreement that nutrition and healthy eating had an impact on a child’s ability to learn and perform during the day. The results in Table 53 indicated that the only significant relationship found was between number of nutriti on courses taken and teachers’ level of agreement that nutrition a nd healthy eating had an impact on a child’s ability to learn and perform during the day ( rs = .104, p = .020). Specifically, teachers with more nutrition courses were more likely to agree that nutriti on and healthy eating

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166 Table 53 Demographic Characteristics and Item 39a Regarding Impact of Nutrition and Healthy Eating on Child’s Ability to Learn and Perform Demographic Characteristics 39a Grade level -.061 Class size -.006 Education -.011 Years teaching -.011 Nutrition courses .104* p < .05. had an impact on a child’s ability to lear n and perform during the day. However, the relationship was weak. Grade level, class size, educational attain ment, and number of years teaching were not found to be statistically sign ificantly associated with teac hers’ level of agreement that nutrition and healthy eating had an impact on a child’s ability to learn and perform during the day and therefore no relationship was a ssumed to exist between those demographic factors and teachers’ responses to Item 39a. Teacher demographic factors and teacher perceived influence. The results between teacher demographic factors and their perceived influence indicated that teachers with more education tended to believe that they had less of an in fluence on student eating behaviors or the nutritional environment while teachers with more nutrition courses and/or more teaching experience tended to be lieve that they had more of an influence.

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167 The correlational results between teache r demographic factors and Item 18 are provided in Table 54. Item 18 asked teachers to select the factors in which they had the most influence. The results indicated th at teachers from higher grade levels were statistically significantly more likely to select student lunches from home ( rs = .108, p = .039) and snacks from home ( rs = .109, p = .038) than teachers from younger grades. In addition, teachers with larger class sizes were less likely to select food/treats in the classroom ( rs = -.151, p = .001) and student class parties ( rs = -.102, p = .022) than were teachers with smaller class sizes. However, educational attainment, number of years teaching, and number of nutrition courses taken were not found to be stat istically significantly related to teachers’ responses to Item 18 and therefore no rela tionship was assumed to exist between those demographic factors and teachers’ perceived influence. Table 54 Demographic Characteristics and Item 18 Re garding Factors Teac hers Most Influence Demographic Characteristics 18a 18b 18c 18d 18e 18f 18g 18h 18i 18j Grade level -.042 .006 .108* .109* -.095 -.060 -.011 .018 -.051 .037 Class size -.042 .029 .071 .084 -.151** -.102* -.008 .086 .015 .010 Education -.034 -.054 -.005 -.035 -.011 .010 .041 .071 .017 .011 Years teaching .001 -.013 -.034 .028 -.029 .009 -.074 .043 .016 .020 Nutrition courses .068 -.038 .065 .006 .036 -.020 -.025 -.046 -.039 .046 p < .05; ** p <.01.

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168 The correlational results between teache r demographic factors and Item 23 are provided in Table 55. Item 23 asked teachers to determine their level of agreement that they had an influence on the nutrition envi ronment in their school, school cafeteria, and their classroom. The results indicated that la rger class sizes were associated with weaker agreement that teachers had an influence on the nutrition envir onment in the school cafeteria ( rs = -.134, p = .003) than smaller class sizes; teachers with higher educational attainment were associated with weaker agr eement that teachers had an influence on the Table 55 Demographic Characteristics and Item 23 Regarding Teacher Influence on Nutrition Education Demographic Characteristics 23a 23b 23c Grade level -.039 -.004 -.077 Class size -.049 -.134** .020 Education -.082 -.129** .005 Years teaching -.009 -.040 .009 Nutrition courses -.006 -.081 .107* p < .05; ** p <.01. nutrition environment in th eir school cafeteria ( rs = -.129, p = .005); and teachers with a higher number of nutrition courses were asso ciated with a stronger agreement that teachers had an influence on the nutritional environment in their classrooms ( rs = .107, p = .017). However, all of th e relationships were weak.

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169 Grade level and number of years teaching were not significantly associated with teachers’ level of agreement that they had an influence over the nutrition environment in their school, school cafeteria, or their classr oom. Therefore no relationship was assumed to exist between those two demographic fact ors and teachers’ responses to Item 23. The correlational results between the dem ographic factors and teachers’ responses to Item 25 are provided in Table 56. Item 25 asked teachers to indicate their level of influence on students’ snack choices and on candy or other sweets available in their classroom. The results indicated that teac hers with more teaching experience were associated with statistically signifi cantly higher perceived influence ( rs = .091, p = .043) than teachers with less teaching experien ce. However, the relationship was weak. The results in Table 56 also indicated th at grade level, class size, educational attainment and number of nutrition courses ta ken were not statistically significantly Table 56 Demographic Characteristics and Item 25 Regarding Teacher Influence on Snack Choices and Sweets Available in Classrooms Demographic Characteristics 25a 25b Grade level .004 .005 Class size .030 .065 Education .028 .054 Years teaching .091* .066 Nutrition courses .087 .071 p < .05.

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170 associated with teachers’ perceived levels of influence on students’ snack choices or the candy or other sweets availabl e in their classroom. Th erefore no relationship was assumed to exist between those demographic factors and teachers’ responses to Item 25. The correlational results between the dem ographic factors and teachers’ responses to Item 34b are provided in Ta ble 57. Item 34b asked teachers to indicate their perceived level of influence with regard to promoting healthy eating behaviors with their students. The results indicated that teachers with mo re nutrition courses were associated with a stronger perceived influence ( rs = .142, p = .001) than teachers with fewer nutrition courses; although the relationship was weak. Table 57 Demographic Characteristics and Item 34b Regarding Teacher Influence in Promoting Healthy Eating Behaviors In Students Demographic Characteristics 34b Grade level -.069 Class size -.029 Education .004 Years teaching .021 Nutrition courses .142* p < .01. Grade level, class size, educational attain ment and number of years teaching were not found to be significantly related to teach ers’ perceived influence with regard to

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171 promoting healthy eating behaviors with thei r students and therefor e no relationship was assumed to exist between these demographic factors and teachers’ responses to Item 34b. The correlational results between the demogr aphic factors and teachers’ responses to Items 39b and 39c are presented in Table 58. Item 39b and 39c asked teachers to indicate their level of agreement that children imitated their eating habits and those of others around them, and that teachers had a responsib ility to model healt hy eating behaviors to students in their classroom. The results indicated that teachers with more nutrition courses were more likely to agree that they had a responsibility to model healthy eating behaviors to their student s in their classroom ( rs = .132, p = .003) than teachers with fewer nutrition courses. However, the relationship was weak. Table 58 Demographic Characteristics and Item 39b and 39c Regarding Children Imitate Eating Behaviors and Teachers Should Model Healthy Eating Demographic Characteristics 39b 39c Grade level -.037 .021 Class size .014 .066 Education -.054 -.037 Years teaching -.021 .003 Nutrition courses .062 .132* p < .01.

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172 The results also indicated that grade leve l, class size, educational attainment, and number of years teaching were not significantly related to teachers’ perceived influence and therefore no relationship is assumed to exist between these demographic factors and teachers’ responses to Item 39b and 39c. The last set of correlationa l results was conducted based on teachers’ responses to Item 40. Item 40 asked teachers to determine the degree to which they agreed that they could make a difference in providing a healthy nutrition environment at their school, their school cafeteria, and their classroom. The results in Table 59 indicated that teachers with higher educational attainment had weaker agre ement that they could make a difference in providing a healthy nutrition enviro nment in their school cafeteria ( rs = -.111, p = .015) than teachers with lower edu cational attainment. In a ddition, teachers with more Table 59 Demographic Characteristics and Item 40 Regarding Teachers Can Make a Difference in Providing a Healthy School Nutrition Environment Demographic Characteristics 40a 40b 40c Grade level -.030 -.031 -.034 Class size .037 -.058 -.074 Education -.053 -.111* .024 Years teaching -.024 -.034 -.042 Nutrition courses .102 -.045 .119** p < .05; ** p <.01.

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173 nutrition courses had stronger agreement that th ey could make a difference in providing a healthy nutrition environment in their classroom ( rs = -.119, p = .008) than teachers with fewer nutrition courses. However, both relationships were weak. The results also indicated that grade level, class size, and number of years teaching were not significantly related to teache rs’ perceptions of their ability to provide a healthy nutrition environment in their school, the school cafeter ia, or in their classroom. Therefore, no relationship was assumed to exist between those demographic factors and teachers’ responses to Item 40. Teacher demographic factors an d self-reported behaviors. The results based on the relationship between teacher demographi c characteristics a nd their self-reported behaviors indicated that teachers from younger grade levels were more likely to make menu suggestions to their students, discuss f ood-related topics in class, and integrate nutrition into their lessons. In addition, teach ers from larger class sizes were less likely to offer menu suggestions to their students, si t or eat with their students during meals, and integrate nutrition into their lessons. Furthermore, teachers with more teaching experience were less likely to sit or eat with students during meals, but more likely to discuss food-related topics and integrate nut rition into their lessons. Finally, teachers with more nutrition courses were more likely to sit or eat with students during meals, discuss food-related topics in class, inte grate nutrition into their lessons, and model healthy eating habits/behav iors to their students. The correlational results between the de mographic variables and Item 15 are provided in Table 60. The result s indicated that grade level wa s statistically significantly related to the extent to which teachers offered menu suggestions to students ( rs = .-.287, p

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174 < .001); the extent to which te achers discussed food-related topics in the classroom ( rs = .249, p < .001) and the extent to which teachers in tegrated nutrition into their lessons ( rs = -.260, p < .001). Specifically as grade level in creased, the extent to which teachers engaged in such behaviors decreased. The results in Table 60 also indicated that class size was statis tically significantly related to the extent to which teachers offered menu suggestions to students ( rs = -.123, p = .006); the extent to which teachers sa t or ate with students during meals ( rs = -.124, p = .005); and the extent to which teachers in tegrated nutrition into their lessons ( rs = -.090, p = .045). Specifically, as class size increased, the extent to which teachers engaged in such behaviors decreased. In addition, number of years teaching was statistically significantly associated with the extent to which teachers sa t or ate with students during meals ( rs = -.092, p Table 60 Demographic Characteristics and Item 15 Regarding Teacher Behaviors Related to Making Me nu Suggestions, Eating with Students, Discussing Food-Related Topics in the Classroom and Integrating Nutrition into Lessons Demographic Characteristics 15a 15b 15c 15d Grade level -.287*** .000 -.249** -.260** Class size -.123** -.124** -.049 -.090* Education -.024 .011 -.007 -.008 Years teaching .058 -.092* .121** .154** Nutrition courses .032 .102* 130** .125** p < .05; ** p < .01; *** p < .001.

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175 =.039); the extent to which teachers discusse d food-related topics in the classroom ( rs = .121, p = .007); and the extent to which teachers in tegrated nutrition into their lessons ( rs = .154, p = .001). Specifically, teachers with more experience were le ss likely to sit or eat with students during meals, but teachers with more expe rience were more likely to discuss food-related topics in their classrooms and integrate nutrition into their lessons. Finally, the number of nutrition course s taken was statistically significantly associated with the extent to which teacher s sat or ate with students during meals ( rs = .102, p = .022); teachers discussed food-rela ted topics in the classroom ( rs = .130, p = .004); and the extent to which teachers in tegrated nutrition into their lessons ( rs = .125, p = .005). Specifically, as the number of nutriti on classes increased, the extent to which teachers engaged in such behaviors also increases. The correlation results betw een teacher demographic factors and Item 39d are provided in Table 61. Item 39d asked teachers to indicate their level of agreement that they modeled healthy eating habits to their st udents. The results indicated teachers with Table 61 Demographic Characteristics and Item 39d Regarding Teachers Modeling Healthy Eating Habits to Their Students Demographic Characteristics 39d Grade level -.046 Class size -.011 Education -.015 Years teaching -.001 Nutrition courses .116*

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176 more nutrition courses were associated with higher agreement that they modeled healthy eating habits to their students ( rs = .116, p = .009). However, the relationship was weak. The results also indicated grade level, class size, educational attainment, and number of years teaching were not found to be significantly related to teachers’ level of agreement that they modeled healthy eating be haviors to their studen ts. Therefore those demographic factors were not assumed to be related to teachers’ responses to Item 39d. The last set of correlationa l results was based on teacher s’ responses to Item 41, which asked teachers to rate their own approach to healthy eating from very poor to very good. The results in Table 62 indicated that none of the relationships tested reached statistical significance ( p > .05) and therefore no relati onship was assumed to exist between teacher demographic characteristics and the teachers’ own approach to healthy eating. Table 62 Demographic Characteristics and Item 41 Regarding Teachers Own Approach To Healthy Eating Demographic Characteristics 41 Grade level -.021 Class size -.063 Education -.022 Years teaching -.038 Nutrition courses -.027

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177 Teacher responses to open-ended questions. Teachers were provided an opportunity to share additional remarks in a category marked “other” on 19 of the 47 survey questions. The responses conveyed additional insights into what teachers were thinking, and provided depth and richness to the study. Although not an exhaustive list of feedback, overall themes are presented, as well as specific statements that explain teachers’ attitudes, perceived influence, a nd behaviors. See Appendix L for a listing of responses. A number of comments were made which indicated that teachers had too little time to discuss food-related topics or too lit tle time to integrate nutrition into classroom lessons or activities. Many comments reflecte d teachers’ views that promoting a healthy school nutrition environment was difficult, time consuming, and possibly, not their responsibility. Teachers appeared to be divided on the appropriateness of food, especially candy, other snacks, or cupcakes as classroom re wards or celebration foods. However, the school cafeteria was often noted as providi ng a barrier to a he althy school nutrition environment at the school a nd in the school cafeteria. Responses revealed that teachers believed parents should take more responsibility in promoting nutrition and providing nutrition education at home. The Fresh Fruit and Vegetable Program was often cited as ma king a difference in the school nutrition environment. Some teachers indicated that they did not have an influence on the school nutrition environment, yet others indicated that everyone at school has a role and responsibility in promoting a healthy school nutrition environment.

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178 Observations from the study. Observations noted duri ng the study are reported in relation to response rates of teachers, incr eased interest in the school district’s Local Wellness Policy and classroom behaviors following the survey, and administrative support for and during the study. The role of the principal was critical to this study. The researcher worked in the school district and had access to and familiarity with the principals who were requested to distribute the survey to teachers. Following the initial request sent to principals, followup reminders were sent to principals from th e Executive Director of Elementary Schools, the Assistant Superintendent of Business S upport Services, and the Nutrition Educator from Food and Nutrition Services. Many princi pals responded with enthusiasm after the initial request was made, indica ting an interest in the study and a desire to review the findings. A timely communication from the pres ident of the school district’s collective bargaining unit, and an assurance from the researcher that results would be kept confidential, appeared to result in additional teacher responses. A response rate of 501 completed surveys fr om an eligible pool of 885 teachers indicates a relatively high response rate of 57%. The number of comments made by teachers to open-ended questions indicated an in terest in the issues being investigated. Following the survey, interest among teach ers, principals, and school district administrators appeared to heighten. Inte rest in the school dist rict’s Local Wellness Policy prior to the study had been limited to a few individuals who maintained that the school district’s Local Wellness Policy should be followed and enforced by the school district, and specifically the Superintendent and school boa rd. The school district’s approach had been to encourage change a nd adherence to the policy by providing options

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179 and suggestions to teachers, ra ther than legislating change s in the classroom, and to recognize that behavioral changes do not occu r as a result of legi slation. Additionally, some students, parents, and teachers have not been in favor of “healthy changes” made to the school district’s school lunch menu, and suggested alternatives such as “cupcakefree” birthday parties. Administration also c ited competing priorities for principals’ and teachers’ time, and a lack of monitoring and timelines as reasons why the Local Wellness Policy lacked strength and significance. Overall, the Teacher Attitude Survey on School Nutrition Environments appeared to prompt teachers and school administrators to think about their own role in the establishment and maintenance of healt hy school nutrition environments. Changing long-standing traditions regarding treats and foods as classroom rewards, food as a focal point of school celebrations and fundraising, and food as a mo tivator even in classroom lessons, will continue to take time to im plement; however, this survey appeared to heighten interest regarding th e relationship of teacher attitu des, perceived influence, and classroom behaviors related to the overall school nutrition environment. Observations on the survey instrument Four issues emerged as having an effect on the survey: the use of the word “belief” for a question about attitudes, the length of the survey, redundancy, and potential anonymity issues. Questions 17 stated, “I believe the following have the most impact on the sc hool nutrition environment.” Since attitudes are judgments and can change as a function of experience and beliefs are related to core values, a more appropriate wording for Qu estion 17 would have been, “The following have the most impact on the school nutrition environment.” Similarly, Question 22 stated, “I believe a healthy nut rition environment exists in my : school, school’s cafeteria,

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180 and classroom.” Since this question is not re lated to a teacher’s co re values, but is a matter of judgment and could be changed as a function of experience, a more appropriate wording for Question 22 would have been, “A healthy nutrition environment exists in my: school, school’s cafet eria, and classroom.” The survey instrument, at 47 questio ns, was too long. Comments received by teachers who responded to open-ended questi ons indicated an interest in providing feedback, but a reluctance to complete the survey, starting at Question 42. Wording on questions 17 and 18 was too similar, which may have resulted in some confusion among the respondents. Some of the survey questions were unn ecessary. For example, question asked: Do you have any other comments that you feel are important? If so, please take this opportunity to provide your thoughts. This question did not re sult in additional responses that contained new informa tion. Question 46 asked: Would you like to receive a copy of the results of this survey? If so, please indicate your name and school below, and a copy will be forwarded to you at the conclusion of the study. Very few teachers responded that they wanted copies of the survey results. Question 47 asked: Would you be willing to serve on a committee to address healthy school nutrition environments? If so, please indicate your name and school site Since both questions 46 a nd 47 requested teachers to provide contact information, concerns about th e anonymity of the su rvey were raised. Question 48 asked: Do you have any ideas or comment s that would help improve the Food and Nutrition program at your school? This question could have also been omitted since so few responses and new information was provided.

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181 Finally, a question should have been asked about the teachers’ fa miliarity with the school district’s Local Wellness Policy, since the intention of the Local Wellness Policy has been to affect and modify the overall school nutri tion environment. Summary This chapter described the characteristics of the 501 teacher participants. A demographic profile of the participants wa s provided. Linkages between survey items and each of the three variables, teacher atti tudes, perceived influence, and behaviors, were identified. A demographic profile of the study partic ipants was provided. Frequencies and means were provided for each of the rese arch questions regarding demographic information, teacher attitudes, perceived influe nce, and self-reported behaviors. Research question one results were assessed through descri ptive statistics. Research questions two, three, and four were assessed by examini ng the relationships between attitude and perceived influence, attitude and self-repor ted behaviors, and perceived influence and self-reported behaviors. L ogistic regression was used fo r dichotomous responses and linear regression was used for scaled responses The results from the logistic and linear regression analyses were summarized by providing unstandardized regression coefficients, corresponding standard errors, a nd significance values. An effect size was provided by presenting the odds ratio for the lo gistic regression mode ls and standardized regression coefficients for the linear regres sion models. Research question five was addressed by correlating the ordinal le vel comparison survey items found to be statistically significant in resear ch questions two through four.

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182 Results from the study indicate that th ere is a relationshi p between teacher attitudes about school nutrition environmen ts and their perceived influence on the environment, and on self-reported classroom be haviors. Likewise, a relationship exists between perceived influence on the school nutrition environment and self-reported classroom behaviors. Relationships also exist between certain teacher demographic characteristics and teacher attitudes a nd perceived influence on school nutrition environments, and self-reported behaviors. This chapter provided the data analysis results and addressed the five research questions associated with the study. Chapter 5 provided a discussion of these results with a focus on the conclusions and implications of the findings. In addition, recommendations for future research are provided.

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183 Chapter 5 Summary, Conclusions, Implications, and Recommendations The purpose of this study was to determine the attitudes of kindergarten through fifth grade teachers about school nutrition e nvironments, their perceived influence on school nutrition environments, and self-repor ted classroom behaviors. The specific objectives of this study were to: (a) identify the perceived factors that influence the school nutrition environment; (b) exam ine the relationship between elementary school teacher attitudes about school nutrition enviro nments and perceived influence on the environment; (c) examine the relationship be tween elementary school teachers’ attitudes about school nutrition environments and self-reported classroom behaviors; (d) examine the relationship between perceived influen ce over the school nutrition environment and self-reported classroom behaviors; and, (e) examine the relationship between teachers demographic characteristics, and attitudes a nd perceived influence on school nutrition environments, and self-reported classroom behaviors. The following research questions we re examined in this study: 1. What attitudes, perceived influences, a nd self-reported behaviors do kindergarten through fifth grade teachers identify rega rding the school nutrition environment? 2. Are teacher attitudes about school nutri tion environments and their perceived influence on the environment related? 3. Are teacher attitudes about school nutr ition environments and self-reported classroom behaviors related?

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184 4. Are perceived influences on the school nutrition environment and self-reported classroom behaviors related? 5. Are teacher demographic characteristic s related to attitudes and perceived influence on school nutrition environm ents and self-reported classroom behaviors? Summary of the Study The school nutrition environment has been i nvestigated in public school systems to determine the attitudes and influence of superintendents, principals, and child nutrition directors on the environment (Brown, 2004; Ra inville, 2003). However, limited research existed to address teacher attitudes and perceived influence on school nutrition environments, and related self-reported classr oom behaviors. No instrument had been developed to survey or measure attitu des and influence on the school nutrition environment, and related self-reported classroom behaviors prior to this study. The instrument designed for and used in this study was the Teacher Survey on School Nutrition Environments. A few dem ographic questions and questions regarding teacher participation in the National School Lunch and National School Breakfast Programs were adapted from the Teacher/Ad ministrator School Food Service Survey (Meyer, 2002). The comprehensive and detailed process of developing questions for the instrument and overall review of the instrument included reviews by public school administrators, university researchers with expertise in child nutrition, and public school teachers. Meyer reviewed and provided f eedback on the Teacher Survey on School Nutrition Environments instrument.

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185 In 2010, the instrument was administered in 23 elementary schools with 501 kindergarten through fifth grade teachers responding to the survey. Zoomerang survey software was utilized. The majority of teach ers were female and wh ite. The demographic characteristics revealed a range of years of teaching experience, college coursework in nutrition, and the number of nutrition courses taken. The results from the study revealed that teachers felt barriers to promoting a healthy school nutrition environment exist, a nd that they had little influence beyond their own classroom. Relationships between teacher attitudes about school nutrition environments, their perceived influence on the environment, and self-reported classroom behaviors were identified. Specifically, the mo re teachers believed they had an influence on the nutrition environment, the more likel y they were to try to employ behaviors consistent with impacting the environment, revealing a sense of self-efficacy. Demographic characteristics were found to be related to teacher attitudes, perceived influence on the school nutrition environment, and self-reported behaviors. Conclusions The conclusions for the study are discussed below. The results for each research question as determined by the study are also provided. Attitudes, perceived influence, and self-reported behaviors. Research question number one was: What attitude s, perceived influences, and self-reported behaviors do kindergarten through fifth gr ade teachers identify regarding the school nutrition environment? Teachers identified the Food and Nutrition Services department as having the greatest impact on the school nutrition enviro nment, followed by student lunches sent

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186 from home and snacks sent from home. Many responses to open-ended questions identified parents as problematic in the development of a healthy school nutrition environment. Teachers felt that the Food and Nutrition Services department and parents should have the primary responsibility for encourag ing healthy food choices at school, followed by school administration, then teachers. Th ey agreed that teach ers should have the primary responsibility for enc ouraging healthy food choices in the classroom, and that food and treats in the classroom are influe nced by the teacher. However, teachers reported that candy or sweets as classroom rewards can have a positive effect on classroom behaviors and overall eating hab its. Candy was reported as the single food item most often provided as a student reward, but according to the results, these rewards are provided less than 1 to 3 times per m onth. This finding was inconsistent with observations made by nutrition ed ucators in the classrooms. Teachers felt that a healthy school nutr ition environment ex isted in their own classroom, but not necessarily in the school cafeteria. They se emed to disagree that they had an opportunity to provide input or could impact the school nutri tion environment, and reported difficulty in providing an overall healthy school nutrition environment. It appeared that teachers felt that they ha d no voice, and possibly, no role outside the classroom in affecting the overall school nutrition environment. Attitudes and perceived influence Research question number two was: Are teacher attitudes about school nutrition envir onments and their perceived influence on the environment related?

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187 There was a relationship between teacher attitudes and their perceived influence on the school nutrition environment. In gene ral, the higher the de gree to which teachers felt various nutrition issues in the school nut rition environment affected or impacted students, the higher their perc eived influence on those issues. Teachers who felt that a healthy school nutrition environm ent existed in their school cafeteria were more likely to perceive an influence on the cafeteria. Similarly, teachers who felt that a healthy environment existed in their classroom had a stronger perceived influence on the classroom environment, both of wh ich indicated teacher self-efficacy. Regarding candy used as a classroom rewa rd, the more teachers reported candy as having an effect on student classroom beha vior, the lower their reported perceived influence. However, the more teachers felt they should influence students eating behaviors, the more likely they were to pe rceive an influence in promoting healthy student eating behaviors. Attitudes and self-reported classroom behaviors. Research question number three was: Are teacher attitudes about school nutrition environments and self-reported classroom behaviors related? Teachers who believed that barriers existed to integrating nutrition into lessons (e.g., l ack of time, does not fit into curriculum, too many other responsibilities) were less likely to integrat e nutrition into their lessons than teachers who perceived that no barriers existed. Teachers who felt that student learning and performance was affected by nutrition tried to do more to model hea lthy eating habits and behaviors. The teachers’ sense of self-effi cacy, or their confidence about the degree of personal responsibility they should have with their students, appeared to be a moderating factor regarding self-repor ted classroom behaviors.

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188 Perceived influence and self-rep orted classroom behaviors. Research question four was: Are perceived influences on th e school nutrition environm ent and self-reported classroom behaviors related? The more t eachers believed that they influenced the nutrition environment, the more likely they were to offer menu suggestions to their students, sit or eat with stude nts during meal times, discuss f ood-related topics in class, and integrate nutrition into their lessons. As a teacher’s perceived influence increased, self-reported classroom behaviors were manife sted in their responses. Self-efficacy, or the belief that they could make a difference with their students, a nd actually made the effort to do so, was apparent. Demographic characteristics, attitu des, perceived influence, and selfreported classroom behaviors. Research question five was: Are teacher demographic characteristics related to attitudes an d perceived influenc e on school nutrition environments and self-repor ted classroom behaviors? Demographic characteristics were found to be related to teacher attitudes and perceived influence on the school nutrition environment, and self-reported classroom behaviors. Teachers with more experien ce perceived fewer barriers to integrating nutrition into lessons, as did teachers who had taken more college nutrition courses. Teachers from higher grade levels were more likely to think that barriers existed to integrating nutrition into lessons, primar ily associated with lack of time. Teachers with more experience had more positive perceptions of the nutrition environment at their school, and thought it wa s less difficult to provi de a healthy school nutrition environment than teachers with less ex perience. They were also more likely to view the influence of candy and other sweet s as less positive on student behavior.

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189 More education among teachers was negativ ely associated with an influence on student eating behaviors, but te achers with more nutrition co urses and/or more teaching experience tended to believe they had more influence on student eating behaviors. Teachers with more teaching experience were le ss likely to sit or eat with students during meal times, but more likely to discuss food-rela ted topics and integrate nutrition into their lessons. Younger grade level teachers were more likely than their counterparts with older students to make menu suggestions to their stud ents, discuss food-related topics in class, and integrate nutrition into their lessons. Th e greater the number of college nutrition courses taken by teachers, the more likely they were to sit or eat with students during meals, discuss food-related topics in class, integrate nutrition in to their lessons, and model healthy eating habits and behaviors to their students. Implications This section discusses im plications of the study fo r teachers, child nutrition personnel, school and district administrators and parents interested in promoting a healthy school nutrition envi ronment. The study also ha s implications for involving teachers in the implementation and ev aluation of Local Wellness Policies. Implications for teachers and teacher preparation. Teachers have the potential to serve as influencers and models within their environments (Bronfenbrenner, 1979). Teachers, therefore, have the opportunity to affect children’s eating behaviors, both in the classroom, and potentially, beyond the classroom. Although teachers typically view the foodservice department as having the primary responsibility to affect the school nutrition environment, an incr eased understanding and acknowledgement of the role of the classroom teacher needs to occur.

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190 Teachers who feel removed from the overall school nutrition environment need to be encouraged to recognize the impact they can have, in their classroom, in their school cafeteria, and in their overall school. Teach ers who do not have a positive view of the overall school nutrition environment may tr ansmit their attitude s and behaviors to students, which have the potenti al to be adopted by their st udents. Teachers who have a more positive view of the school nutrition environment, and w ho feel that they can make a difference in their environments, need to be encouraged to exercise their influence (Contento, 2007). Classroom rewards and celebrations infl uence not only the classroom, but the overall school nutrition environment by esta blishing what is “acceptable.” Classroom rewards that reinforce the educational pro cess should replace food -related rewards. Teachers should also consider the effectiven ess of intrinsic rewards versus extrinsic rewards and how reward systems and the sel ection of the type of rewards offered may motivate, and in some cases, de-motivate st udents. A discussion with children may reveal that praise, increased re sponsibilities, or more computer time, play time, or general free time is preferred by students (Kohn, 1992). Teachers who feel that they have little influence on the selection of fundraising activities at their school could take a more active role in expressing their concern to their school’s administration, in cluding making suggestions for alternative fundraising strategies. The interrelatedness of school and home, and the behaviors that result as a function between a person and their e nvironment need to be acknowledged (Bronfenbrenner, 1979). Teachers concer ned about meals and snacks provided by

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191 parents may want to talk with parents and pr ovide ideas for healthy options. However, an acknowledgement of what is acceptable at home and may not be acceptable at school should be made, recognizing the societal, cultura l, and familial influences that affect the school nutrition environment. Teachers should be asked what they think and how they feel they influence the school’s nutrition environmen t (Bandura, 2000), instead of making assumptions based on school district administrators’ or child nutrition directors’ input. A respect for the role of the classroom teacher and recognition of their critical role in the lives of children may contribute to the development and main tenance of a healthy school nutrition environment. Finally, considering the positive effect th at exposure to college nutrition courses has on teacher attitudes, percei ved influence, and classroom behaviors, self-efficacy, and ultimately, on their students, nutrition could be a required course in teacher preparation. Implications for child nutrition personnel. Child nutrition personnel play an important role in the development and ma intenance of a heal thy school nutrition environment. Since teachers view the school cafeteria as the primary determinant of a healthy school nutrition environment, car e must be taken to provide effective communication and information, to serve as a re source for nutrition-re lated issues, and to solicit teacher feedback. Child nutrition directors and their staff members must al so recognize the integral role of the classroom teacher. Child nutri tion directors may be challenged by teachers and school administrators who have differing ideas of what constitutes a healthy school nutrition environment and healthy eating. Nutrition and food choices are highly

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192 subjective and very personal. A high calorie diet for an active, athletic teacher may be the appropriate diet for that individual, wher eas a lower calorie diet is more appropriate for a more sedentary teacher. Teachers w ho range from omnivore to vegan may choose to participate in their school’s foodservice program, and an attempt needs to be make to satisfy their needs. Child nutrition personnel are also tasked with the challenge of identifying and presenting foods that students will select and consume, at an age where food neophobia is prevalent. The question, “Yes, it is healthy, bu t will kids eat it?” is an issue that cannot be ignored. Directors of school foodservice operati ons are expected, in many cases, to manage a financially self-supporting program, and in some cases, a revenue producer, for the school district. Concom mitantly, they should serve as the morning and mid-day restaurant, and attempt to identify and sa tisfy a divergent student and staff population with myriad expectations, food likes and di slikes, and preconceived notions of what constitutes a healthy or acceptable meal. Th e requirements to follow local, state, and federal pressure to optimize the nutritional content of meals is increasing with each passing year, without additional funding. A ny and all of these responsibilities may conflict with each other unle ss teachers, parents, administrators, school district leadership, and the government recognize th e evolving nature of school-based child nutrition programs. Finally, child nutrition personnel must conti nue to identify effective methods to communicate with their diverse audiences, a nd provide a school cafeteria environment that supports and enhances the overall school nutrition enviro nment. Critical to this

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193 communication is the classroom teacher who may affect the attitudes and behaviors of an entire classroom of students. Implications for school and sc hool district administrators. As the official leader of the school, principals need to be encouraged to develop and maintain a healthy school nutrition environment at their school. Teachers could be encouraged to make appropriate decisions regardi ng classroom rewards and celebrations. Principals could encourage parents and parent groups to select fundraising ac tivities that support education and the mission of the school. They need to also maintain an open line of communication with the foodservi ce provider at their school and in their district. This communication alone could make a real difference in assuring that a healthy school nutrition environment exists at the school. Resistance from school administrators will sometimes thwart efforts to improve the overall school nutrition environment. Whether a popular food-related fundraising opportunity is allowed to take place, or a sc hool-wide resistance to changing the school nutrition environment exists, popula r traditions must be addre ssed. Bringing issues to the attention of all players at a school, even through the administ ration of a survey designed to solicit feedback, may be an appr opriate vehicle to effect change. Implications for parents. The influence of the home on the school environment has been established (Bronfenbr enner, 1979). Food choices made at school have always been impacted by family and cultural norms. A major shift in responsibility, however, has occurred in the past few years, “blaming” the school nutrition environment and school foodservice programs for the ch ildhood obesity epidemic. Children have approximately five years’ of dietary habits established befo re they reach school age.

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194 Children who participate daily in the school lunch program receive only about 18% of the meals they consume in a year at school. Cons ideration must be made for the effect of the home environment on the school environment. Teachers afraid to supersede what they perc eive as parental rights may be hesitant to speak up or make recommendations to pare nts, despite their concerns about the foods children bring to school. Respect for the ri ghts of parents may make it difficult to promote healthy eating in th e school cafeteria and in th e classroom. Communicating expectations to parents and helping parents make better decisions that affect the home and school environment could be a joint effo rt between teachers, parents and parent organizations. Parent organi zations that opt for high fat, high calorie, high profit food items may need to rethink fundraising st rategies to benefit the school nutrition environment and the children in the environment. Implications for Local Wellness Policy implementation. How to effectively communicate information about wellness policie s and how to implement the prescribed changes continues to be a challenge for school districts. Behaviors that no longer make sense or are no longer appropriate in the school setting need to be identified. Voices from one end of the spectrum to the other, including those who call for immediate and absolute change, and those whose indifferen ce is crippling, need to be acknowledged and an attempt made to find the common ground ne eded to focus on real istic, attainable, and sustainable changes. The 2004 Child Nutrition Reauthorization which called for the creation of Local Wellness Policies throughout the United States, has contributed to the confusion and lack of effective implementation, based on a mandate that lacked specific guidelines,

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195 timelines, monitoring, or ramifications. Nutrition education, which should be a component in the promotion of a healthy school nutrition environment, remains unfunded. It is hoped that subsequent Child Nutrition Reauthoriza tions will provide the financial support, direction, and tools necessary to effectively foster change and energize key stakeholders. Recommendations for Further Research The recommendations presented in this se ction relate to areas that future researchers may want to consider in st udying teachers and he althy school nutrition environments. An expansion of the survey to a broader audience and an investigation of programs and policies that affect the sc hool nutrition environment are suggested. This study was conducted exclusively w ith kindergarten through fifth grade teachers to gather data on teacher attit udes, perceived influence, and self-reported classroom behaviors. The research could be expanded to include middle school and high school teachers. Research expanded to the secondary level may identify relationships between attitudes, perceived influence, and behaviors not identified at the elementary school level. The study could also be expa nded to investigate attitudes, perceived influence, and behaviors of parents and students related to the school nutrition environment. Research for this study was conducted exclus ively at one mid-si ze school district in Florida. Additional resear ch is needed to determine if the results in other school districts throughout Florida are similar to the results contained herein. Additional research could be extended to a regional or national level.

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196 The majority of responders in this res earch were white females. Additional research is needed to determine if males a nd minorities report simila r attitudes, perceived influence, and self-reported behaviors. Si nce the study relied on self-reported classroom behaviors, additional observat ional studies to verify res pondent reporting are an option. The self-reporting technique does not allow fo r a verification of be havior. A study to observe teachers’ behaviors could determine if the behaviors a teacher reports actually occur. Another study might involve a personal profile of teacher eati ng habits, especially when they are with their students. Children could be surveyed to determin e if they want to receive classroom rewards, how they want to be rewarded, a nd what rewards would be most motivating. The issues of teachers who reported that ca ndy or sweets were appropriate for classroom rewards could be further studied. Likewise teacher expectations regarding the school nutrition environment in the classroom, school cafeteria, and overall school, and the disconnect in variables that teachers identify as constituting a healthy school nutrition environment warrant further investigation. Since teachers felt they influenced their cl assrooms, but to a much smaller degree, the overall school nutrition environment, a dditional studies coul d investigate the disposition and personality of teacher groups related to perceived influence in other issues that impact schools. The importance of teachers’ self-efficacy was evident in this study, therefore an identification of strategies to help improve teachers’ confidence in developing and promoting a healthy school nut rition environment could be conducted. A qualitative study to determine how and why a ttitudes are developed, and a more in-depth investigation of the determin ants of perceived influence could also be undertaken.

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197 The effect of the Fresh Fruit and Vegetable Program, mentioned by many respondents as having a positive effect on the overall school nutrition environment, to include an improved perception of the overall school meals program, could be studied. Research could investigate the improveme nts observed in promoting healthy school nutrition environments within individual school s, and between schools that participate in the Fresh Fruit and Vegetable Program vers us those school that do not participate. The effect of the Omnibus Reconciliati on Act of 1981, which effectively removed nutrition education from schools, to include nu trition education provided to teachers, and the related timeline to national increases in childhood obesity rates, could be explored. Finally, the degree to which local wellness policies have prompted changes to the school nutrition environments could be inves tigated. A longitudina l study regarding the variables, influences, and re lationships that affect the development, implementation, maintenance, and evaluation of local welln ess policies could also be conducted.

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203 Gordon, A. R., Crepinsek, M. K., Briefel, R. R., Clark, M. A., & Fox, M. K. (2009). The third school nutrition assessment st udy: Summary and implications. Journal of the American Dietetic Association, 109 (2), S129. Gordon, N. (2003). Iron deficiency anemia and the intellect. Brain Development, 25 (1), 3-8. Gordon, A., Devaney, B., & Burghardt, J. ( 1995). Dietary effects of the National School Lunch Program and School Breakfast Program. American Journal of Clinical Nutrition, 61(1S ), 2215-2315. Gordon, A., & McKinney, P. (1995). Sources of nutrients in students’ diets. American Journal of Clinical Nutrition, 61(1S), 232S-240S. Gross, S. M., & Cinelli, B. (2004). Coordi nated school health program and dietetic professionals: partners in promoting healthful eating. Journal of the American Dietetic Association, 104 (5), 793-798. Hanes, S., Vermeersch, J., & Gale, S. (1984). The national evaluation of school nutrition programs: Program impact on dietary intake. American Journal of Clinical Nutrition, 40 390-413. Hartline-Grafton, H. L., Rose, D., Johnson, C. C., Rice, J. C., & Webber, L. S. (2009). Are school employees role models of health ful eating? Dietary intake results from the ACTION worksite wellness trial Journal of the American Dietetic Association, 109 (9), 1548-1556. Hendy, H. M., & Raudenbush, B. (2000). Eff ectiveness of teacher modeling to encourage food acceptance in preschool children. Appetite, 34, 61-76. Hu, W. (2008, August 24). As school f ood costs rise, so do school lunches. The New York Times p. B2. James, D. C., Rienzo, B. A., & Frazee, C. (1997). Using focus groups to develop a nutrition education video for high school students. Journal of School Health, 67 (9), 376-379. Killen, J. D., Telch, M. J., & Robinson, T. N. (1988). Cardiovascular disease risk reduction for tenth graders: A multiple-factor school-based approach. Journal of the American Medical Association, 260 1728-1733.

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212 Appendices

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213 Appendix A Local Wellness Policy Frequently Asked Questions 1. What is the Local Wellness Policy? The Local Wellness Policy requirement is established by Section 204 of the Public Law 108-265, the Child Nutrition and WIC Reauthorization Act of 2004. It requires each lo cal education agency (LEA) or school distri ct participating in the National School Lunch Program and/or School Breakfast Program to develop a local wellness policy that promotes th e health of student s and addresses the growing problem of childhood obesity. 2. Why does a school district need a Local Wellness Policy? The Local Wellness Policy is important because it: Reaches beyond USDA-funded meal programs to influence children’s health; Acknowledges local community respons ibility to support or build on government efforts; Provides an opportunity for school dist ricts to create an environment conducive to healthy lifestyle choices; and Recognizes the critical role of sc hools in curbing the epidemic of childhood overweight and obesity. 3. What does the policy requi re from school districts? According to the Local Wellness Policy, school districts must at a minimum: Set goals for nutrition education; Set goals for physical activity; Set nutrition guidelines for all foods and beverages available on school campuses during the school day; Ensure that local guidelines for re imbursable school meals meet the program requirements and nutrition standards set forth by federal regulations; Set goals for other school-based activ ities designed to promote student wellness; Involve a broad group of members of the community (see question #6) draft a plan to measure the implementation of policies; and Designate Wellness Cont acts at each school. 4. What would a “plan to measure the implementation process” entail? Evaluation and feedback are very impo rtant in maintaining a local wellness policy. It is also important to assess st udent, parent, teacher, and administration satisfaction with the new policies. Y ou may want to document any financial impact to the school foodservice prog ram, school stores, or vending machine revenues. A good evaluation plan does not need to be extensive, formal or put additional undue burdens on staff that is involved in the process. Through the

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214 Appendix A (Continued) evaluation process, you will be able to answ er some basic questions that are very important to policymakers, students, school staff, parents, and the general public. Did the policy and implementation addre ss the issues identified in the needs assessment? For example: Is it making a difference? What’s working? What’s not working? How can the impact of the policy be increased to enhance its effect on student health and academic learning? 5. What avenues does the requirement, “nut rition guidelines for all foods and beverages available on school cam puses during the school day” include? Nutrition guidelines should be set for foods sold in the a la carte program, vending machines, fundraiser, student stores, snacks, school parties/cele brations/meetings. Concessions do not need to be included unless they are sold during the school day. 6. Who needs to be involved? A team of community members must be involved in the development of each local wellness policy. Parents, st udents, and representatives of the school food authority, the school board, school administrators, and the pub lic must be a part of the development process. 7. What are the deadlines? Working with local wellness policies is ongoing. They should be continuously implemented, evaluated, and updated. 8. What is the monitoring process for this policy? The State Agency (SA) will be responsib le for determining compliance through the regular Coordinated Review Effo rt, School Meals Initiative re view or any other type of on-site visit. In the case that a loca l educational agency (LEA) does not have a wellness policy in place when it is reviewe d, the SA should require the LEA to take corrective action. The SA has no obligation, how ever, to review and evaluate the content of a local wellness policy since the policy is a local decision. 9. Where can I get more information and technical support? USDA has developed wellness web-resources, as apart of the Team Nutrition website at www.teamnutrition.usda.gov. The Local Wellness Policy web pages are a clearinghouse for information, the web pages on policy require ments, sample policy language, examples of existing State and district policies in various wellness to pics, the local process (i.e. how to create and implement a local wellness policy), reference materials, and links to more resources. Answers are based on guidance from USDA and the 2004 Child Nutrition and WIC Reauthorization Act.

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215 Appendix B Nutrition Educator Observations Nutrition Educator #1: 1. Classes always went a lot smoother when teachers were involved with the nutrition education activity. Students were always more willing to try tasting (tasting parties with fresh fruits and vegetables) when t eachers participated, especially when the groups were new to the program. 2. Teachers had a great impact on the student participation (in th e nutrition education programs) in both the positive and negative (sense). 3. A 2nd grade teacher at (name of school) did not really like vegetables, but committed to the importance of nutrition. She tasted the vegetables with us and stayed positive the entire time. Cool thing was – she di scovered that she liked the vegetables she tasted now, including green peppers. She shar ed her story with the students and then after the nutrition education program continued to eat the vegetables! 4. A team at (name of school) did a food pl ay about healthy eating to follow up with what they learned during the FNS nutrition education. The students read additional books on nutrition, designed a script, and performed the “Healthy Eating Play”. 5. A teacher at (name of school) who was in the middle of severe morning sickness tasted (fruits and vegetables) the entire time in spite of the need to gag because of food aversions from pregnancy. Her students were always willing to participate in the program. 6. This was just recent. I observed (name of a dietetic intern) teaching a class I had taught way back when. The teacher was absent during the lesson, checking e-mails, etc. The students were less engaged with the nutrition education – the same experience I had years ago. The only thing that was constant was the teacher. I thought this was extremely interesting. 7. I wish I could have asked teachers a lot of que stions. Most of them I found to be very approachable, and I asked a lot of things, but I wondered some times if they ever thought about: a.) the importance of nutrition in the st udents’ lives (health, academic, overall performance), b.) what they felt their role was in shaping eating habits, c.) their role in shaping body image per ceptions and how their own issues with body image may have affected students, and d.) their influence in developing eat ing behaviors among their students. Nutrition Educator #2: 1. On several occasions I have arrived at a classroom at the scheduled time only to realize that they (students and teacher) are in the middle of a celeb ration of some sort with cupcakes and/or candy. 2. During the lesson, several teachers have been unwilling to participate, and sat at their desks eating cookies or cake and drinking soda. This is while the students are supposed to be tasting vegeta bles during a tasting party.

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216 Appendix B (Continued) 3. Teachers provide candy as a reward for various things. 4. During a tasting party, teachers have made faces and/or negative comments regarding the items. They would say things like, “I wouldn ’t eat that!” 5. At one school in particular, the teachers are notorious for gathering together at the back of the classroom to talk during the en tire presentation, whic h shows their lack of interest or concern for the various topics being discussed. Othe r teachers use it as a planning period to catch up on their ow n work or to do personal things. Nutrition Educator #3: 1. There was a teacher that participated in all of the nutrition education lessons. During the final tasting party, there was a student th at refused to try the foods. The teacher informed me that the student would not try anything new. With some encouragement, we got him to try the f oods. He did not like it, but it was a significant step. 2. In many classes I have taught, during the ve getable tasting party, some of the kids like enjoy the vegetables so much, they have second and third helpings. The teachers, on several occasions, have told the childre n that now that we know we enjoy these foods, they would make wonderful snacks to bring to the classroom. Essentially, the teachers and I encourage the children to bring healthier choices to share with the class. 3. (Name of school) – I saw a first grade teacher rewarding students with their choice of candy bars. She instructed them to put the candy away and take it home. When I came in (the classroom), she said (to me), “Don’t pay attention to this. I know it is not good, but the kids like it.” 4. Many teachers have large cont ainers of candy on their desks or in their room, or have soda cans on their desk. 5. I have had many teachers come up to me and question the lunch menu, asking why we don’t serve healthier choices. I had a teacher from (name of school) ask me why we did not offer more choices that are heal thy for elementary kids, like baked chips as a vegetable. FNS does not offer elementary kids potato chips as a vegetable choice! The teacher said that FNS was not doing “enough” to promote good nutrition in the cafeteria.

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217 Appendix C Teacher/Administrator School Foodservice Survey (Meyer, 2002) Please answer the following questions about your school foodservice and nutrition program whether you eat school meals or not. Completely fill in the circle of your answer. Use a #2 pencil. Strongly Neither Strongly I Disagree Agree Agree Don’t Nor Know Disagree 1. Overall, I am happy with the school foodservice. 1 2 3 4 5 6 7 8 2. Food serving lines are clean. 1 2 3 4 5 6 7 8 3. The menu includes food I like 1 2 3 4 5 6 7 8 4. I like the aroma of the food. 5. The atmosphere in the dining area is cheerful. 1 2 3 4 5 6 7 8 6. Nutritious food is available daily. 7. Foodservice staff is friendly. 1 2 3 4 5 6 7 8 8. The serving lines move quickly. 1 2 3 4 5 6 7 8 9. The price of the food is reasonable for the portions served. 1 2 3 4 5 6 7 8 10. Tables in the dining area are clean. 1 2 3 4 5 6 7 8 11. A variety of food is available daily. 1 2 3 4 5 6 7 8 12. I like the taste of the food. 1 2 3 4 5 6 7 8 13. The noise level in the dining area is OK. 1 2 3 4 5 6 7 8 14. Low fat items are offered. 1 2 3 4 5 6 7 8 15. Foodservice staff is courteous. 1 2 3 4 5 6 7 8 16. Time available to eat once I have received my food is adequate. 1 2 3 4 5 6 7 8 17. The price of meals fits into my weekly budget. 1 2 3 4 5 6 7 8 18. Spills and trash in the dining area are cleaned quickly. 1 2 3 4 5 6 7 8 19. The choices of food available allow me to meet my religious needs. 1 2 3 4 5 6 7 8 20. Food on the serving line is attractively presented. 1 2 3 4 5 6 7 8 21. The number of seats in the dining area is comfortable. 1 2 3 4 5 6 7 8 22. Tables in the dining area are comforta ble. 23. Serving sizes are adequate. 1 2 3 4 5 6 7 8 24. Foodservice staff smile and greet me when I am served. 1 2 3 4 5 6 7 8 25. The number of serving lines is adequate. 1 2 3 4 5 6 7 8 26. Meal component/ala carte items are available for my purchase. 1 2 3 4 5 6 7 8 27. The floors in the dining area are clean. 1 2 3 4 5 6 7 8 28. The choices of food available allow me to meet special dietary needs. 1 2 3 4 5 6 7 8

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218 Appendix C (Continued) Strongly Neither Strongly I Disagree Agree Agree Don’t Nor Know Disagree 29. I like the quality of the brands offered. 1 2 3 4 5 6 7 8 30. Nutrition information on food products is posted. 1 2 3 4 5 6 7 8 31. Foodservice staff answer my questions. 1 2 3 4 5 6 7 8 32. Overall, time given for meals is adequate. 1 2 3 4 5 6 7 8 33. The dining area is clean. 1 2 3 4 5 6 7 8 34. I like the quality of the hot entrees. 1 2 3 4 5 6 7 8 35. Information on calories contained in food is available. 1 2 3 4 5 6 7 8 36. Foodservice staff treat me with respect. 1 2 3 4 5 6 7 8 37. No question 37 was listed. 1 2 3 4 5 6 7 8 38. I like the quality of the salads. 1 2 3 4 5 6 7 8 39. Information on fat contained in foods is available. 1 2 3 4 5 6 7 8 40. Meal component/ala carte items are priced reasonably. 1 2 3 4 5 6 7 8 41. I like the quality of the cold sandwiches. 1 2 3 4 5 6 7 8 42. Hot food is served hot and cold food is served cold. 1 2 3 4 5 6 7 8 43. A choice of beverages is offered. 1 2 3 4 5 6 7 8 44. I have a place to eat my meal without interruption. 1 2 3 4 5 6 7 8 45. The menu meets my special dietary needs (diabetes, low fat…). 1 2 3 4 5 6 7 8 We want to know more about you: 46. The number one reason I eat school breakfast is: 1. The prices are good. 2. The food is good. 3. I have no other choice. 4. It is convenient. 5. Other teachers eat there. 6. I do not eat school breakfast. 7. Other_________________ 47. The number one reason I eat school lunch is: 1. The prices are good. 2. The food is good. 3. I have no other choice. 4. It is convenient. 5. Other teachers eat there. 6. I do not eat school breakfast. 7. Other_________________ 48. How many times a week do you eat school breakfast? 0 1 2 3 4 5

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219 Appendix C (Continued) 49. How many times a week do you eat school lunch? 0 1 2 3 4 5 50. How many times a week do you bring your lunch or leave campus? 0 1 2 3 4 5 51. The length of our lunch period is? 1. 20 minutes or less 2. 21 to 30 minutes 3. 31 to 45 minutes 4. 46 to 60 minutes 52. I have a duty free lunch period? 1. yes 2. no 53. In what grade level do you teach? 1. kindergarten 2. elementary school 3. middle/junior high school 4. high school 54. How many years have you taught school? 1. Less than 2 2. 3 to 5 3. 6 to 10 4. more than 10 55. If you are a school admininstrator or staf f, in what school category do you teach? 1. elementary school 2. middle/junior high school 3. high school

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220 Appendix D Draft of Teacher Survey on School Nutrition and Healthy School Nutrition Environments

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233 Appendix E Draft of Copy of NFSMI Permission Letter (Address) (City, State, Zip) Date Dr. Charlotte Oakley, Executive Director National Food Service Management Institute (Street) (City, State, Zip) Dear Dr. Oakley, I am a doctoral candidate at the University of South Florida, and I would like to use the National Food Service Management Institute’s Teacher/Administrator School Food Service Survey in my doctoral study. The uni versity requires that I have your permission to use the instrument. Please sign the enclosed letter and return it to me in the stamped envelope, if I have your permission. Th ank you for considering this request. Sincerely, Beverly L. Girard, Doctoral Candidate University of South Florida

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234 Appendix F Signed Permission Letter Dr. Charlotte Oakley, Executive Director National Food Service Management Institute 6 Jeanette Phillips Drive P.O. Drawer 188 University, MS 38677-0188 November 6, 2009 Beverly L. Girard 1507 Robbins Road Nokomis, FL 34275 Dear Ms. Girard, Thank you for your interest in the Teacher/Administrator School Foodservice Survey. You have my permission to use the questionn aire as part of your dissertation work regarding teacher attitudes toward school nutrition programs and their perceived influence on healthy school nutrition environm ents, at the University of South Florida. Sincerely, Dr. Charlotte Oakley, Executive Director National Food Service Management Institute

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235 Appendix G Directions for Validation and Usability of In strument by Elementary Principals and School Food Service Directors E-mail address Date Dear (Name), As a leader who is interested in promoting good nutrition practices in schools, your input on the instrument I am developing for my dissert ation at the University of South Florida is critical. The Teacher Survey on School Nutrition Environments instrument assesses teachers’ perceived importance about nutrition -related policies and practices, as well as the teachers’ perceptions of their own influence school nutrition environments. It is very important to me that I receive your feedback. The first attachment contains a copy of the instrument, which I would like you to take. Before you complete the survey, however, please print off and review the sc oring sheet in the second attachment, which asks specific questions about the clarity of written directions, questions that should be omitted or reworded, the overall length of the survey, time required to complete the survey, and the ease of completing the survey. Plea se feel free to provide as much detail as you believe is necessary. If you have any questions, please send me an e-mail, and I will attempt to contact you immediately. Thank you for your assistance and your time. Sincerely, Beverly L. Girard PhD Candidate

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236 Appendix G (Continued) Scoring Sheet for the Teacher Survey on School Nutrition Environments Thank you again for taking time from your busy schedule to review the Teacher Survey on School Nutrition Environment instrument. As you complete the survey, please keep the following questions in mind. Please return a copy of your responses to the questions to me at Beverly_Girard@sarasota.k12.fl.us as soon as you are able. 1. Are the directions for completing the instrument clear? 2. Did you read any questions or statements that should not be included in the instrument, or which require rewording? If so, please indicate the questions or statements. 3. Do you have any suggestions for improving the clarity of the overall instrument or specific question/statements? 4. How long did it take you to complete the survey? 5. How long do you think it would have taken you to complete the survey if you were not also providing feedback on the design? 6. Do you think the survey is of reasonable length? 7. Was this survey relatively easy to complete? 8. Do you have any suggestions for improving the overall quality of the survey?

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237 Appendix H Names of Expert Panel Members Expert Position/Expertise Institution Kathy Glindmeier Director of Food and Nutrition Paradise Valley Services, Director of Dietetic Unified School Internship, and member of District, AZ School Nutrition Association Research Committee Dayle Hayes President of Nutrition for the Independent Future, and incoming Chair of the Consultant School Nutrition Services Dietetic Practice Group of the American Dietetic Association Dr. Mary Kay Meyer Author of Teacher /Administrator AL Department of School Foodservice Survey and Education; formerly former Research Scientist with the National Food Service Management Institute Dr. Mary Frances Director of App lied Research National Food Service Nettles Division at the National Food Management Institute Service Management Institute at the University of Southern Mississippi Dr. Charlotte Oakley Executive Direct or of National Food Service National Food Service Management Institute Management Institute at the University of Mississippi Dr. Alice Jo Rainville Professor and author of University of Healthy School Nutrition Central Michigan Environment Survey

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238 Appendix I Directions for Validation and Usabilit y of Instrument by Expert Panel E-mail address Date Dear (Name), As a recognized leader in child nutrition, your input on the instrument I am developing for my dissertation at the University of Sout h Florida is critical. The Teacher Survey on School Nutrition Environments instrument a ssesses teachers’ perceived importance about nutrition-related policies and practices, as well as the teachers’ per ceptions of their own influence school nutrition environments. It is very important to me that I receive your feedback. The first attachment contains a copy of the instrument, which I would like you to take. Before you complete the survey, however, please print off and review the sc oring sheet in the second attachment, which asks specific questions about the clarity of written directions, questions that should be omitted or reworded, the overall length of the survey, time required to complete the survey, and the ease of completing the survey. Plea se feel free to provide as much detail as you believe is necessary. If you have any questions, please send me an e-mail or call me at my office at 941-4862199, and I will attempt to contact you immediat ely. Thank you for your assistance and your time. Sincerely, Beverly L. Girard PhD Candidate

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239 Appendix I (Continued) Scoring Sheet for the Teacher Survey on School Nutrition Environments Survey Thank you again for taking time from your busy schedule to review the Teacher Survey on School Nutrition Environments instrument. As you complete the survey, please keep the following questions in mind. Please return a copy of your responses to the questions to me at Beverly_Girard@sarasota.k12.fl.us as soon as you are able. 1. Are the directions of completing the instrument clear? 2. Did you read any questions or statements that should not be included in the instrument, or which require rewording? If so, please indicated the questions or statements. 3. Do you have any suggestions for improving the clarity of the overall instrument or specific questions/statements? 4. How long did it take you to complete the survey? 5. How long do you think it would have taken you to complete the survey if you were not providing feedback on the design? 6. Do you think the survey is of reasonable length? 7. Was this survey relatively easy to complete? 8. Do you have any suggestions for improving the overall quality of the survey?

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240 Appendix J Principal Notification Letter Dear Principal, I know this is a busy time of year for you a nd your teachers! I am asking you to please take a few minutes to forward this lette r with the included survey link to your kindergarten through fifth grade teachers. The introductory letter on the first page of the survey was developed to explain that the su rvey asks teachers about their attitudes, influence, and behaviors related to school nutrition environments. Teachers’ participation in this survey will co ntribute to the knowledge base on attitudes and influence on school nutrition environments The responses are anonymous and the data are confidential. The estimated time to take the survey is 10 minutes. As an incentive for completing the survey, the sc hool with the highest number of eligible participants will be treated to a party at your school, complete with healthy foods, free massages, and other surprises. An identification of teachers’ attitudes, pe rceptions of influence, and behaviors may assist school nutrition administrators and nut rition educators in learning how to more effectively communicate with teachers, and develop, promote, and maintain healthier school nutrition environments. The link to the survey is: http://www.zoomerang.com/Survey/WEB22APCAM36XP If you have any questions, please contact me. Thank you very much for your participation at ________________ School. Sincerely, Beverly L. Girard Beverly L. Girard, MBA, MS, RD, LD Director of Food and Nutrition Services School Board of Sarasota County, Florida

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241 Appendix K Teacher Survey on School Nutrition Environments Dear Teacher, We hear a lot about nutrition at school, but teachers are rarely asked for feedback concerning their attitudes and influence on school nutrition environments. Your input is vital to the success of this study. The survey is confidential. The school name is the only identifier. Individual results cannot be traced back to the survey taker unless you provide permission to contact you with survey results. Toward the end of the survey, you will be asked if you would like to receive a copy of the results. The survey will take approximately 10 minut es to complete. As an incentive for completing the survey, the school with the highest percentage of eligible participants will be treated to a Party at your school, complete with healthy food, free massages, and other surprises. Thank you in advance for your participation. Sincerely, Beverly L. Girard Director of Food and Nutrition Services *Directions: Please check one response fo r each item unless otherwise indicated. 1. What grade level do you teach? Kindergarten Grade 1 Grade 2 Grade 3 Grade 4 Grade 5 Combined grades Specials (mixed grades such as PE, music, art) Other, please specify: _________________ 2. If you indicated that you teach a Special in Item 1, please specify area: _________________

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242 Appendix K (Continued) 3. How many children are in your classroom? 5 or less 6-10 11-15 16-20 21-25 26-30 More than 31 4. What is the name of your school? ________________ 5. What is the highest degree you have earned? Bachelors Masters Specialist Doctorate Other, please specify: _________________ 6. What is your gender? Male Female 7. What is your racial/ethnic background? White African American/Black Hispanic/Latino Asian Native American Indian Multi-Cultural 8. Number of years teaching (at all levels): 0 to 5 years 6 to 10 years 11 to 15 years 16 to 20 years 21 to 25 years 26 to 30 years More than 30 years 9. Have you taken college coursework in nutrition? ___________________ 10. If you answered yes to the previous question, please indicate the number of courses: ___________________

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243 Appendix K (Continued) 11. How often do you eat a school breakfast? Daily 3-4 times per week 1-2 times per week 1-3 times per month Very infrequently On special occasions only Never 12. The reason I eat school breakfast is (please check all that apply): The prices are good The food is good I have no other choice It is convenient Other teachers eat there I do not eat school breakfast Other, please specify: _________________ 13. How often do you eat a school lunch? Daily 3-4 times per week 1-2 times per week 1-3 times per month Very infrequently On special occasions only Never 14. The reason I eat school lunch is (please check all that apply): The prices are good The food is good I have no other choice It is convenient Other teachers eat there I do not eat school breakfast Other, please specify: _________________

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244 Appendix K (Continued) 15. Please indicated your response to the following statements: Never Rarely Sometimes Often Do Not Know I make menu suggestions to my students or we discuss the menu prior to lunch. I sit with or eat with my student s during lunch or other meal times. I discuss food-related topics in my classroom. I integrate nutrition into my lessons. 16. What barriers do you think exist for integrating nutrition into lessons? Please check all that apply: Lack of curriculum resources Inadequate financial resources Lack of time Does not fit into curriculum Too many other responsibilities No barriers exist Other, please specify: _________________ 17. I believe the following have the most im pact on the school nutrition environment. Please check your top 3 choices: Student school meals After school snacks Student lunches from home (brown bag) Food/treats in classroom Student class parties School-wide celebrations Fundraisers Adult school meals Adult lunches form home (brown bag) Other, please specify: _________________

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245 Appendix K (Continued) 18. Which of the following do you most infl uence? Please check your top 3 choices: Student school meals After school snacks Student lunches from home (brown bag) Food/treats in classroom Student class parties School-wide celebrations Fundraisers Adult school meals Adult lunches form home (brown bag) Other, please specify: _________________ 19. Who has the primary responsibility t encour age healthy food choices at your school? School administration Food & Nutrition Services Department Parents Students Teachers Other, please specify: _________________ 20. Who has the primary responsibility to encour age healthy food choices in the cafeteria? School administration Food & Nutrition Services Department Parents Students Teachers Other, please specify: _________________ 21. Who has the primary responsibility to encourage healthy food choices in the classroom? School administration Food & Nutrition Services Department Parents Students Teachers Other, please specify: _________________

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246 Appendix K (Continued) 22. I believe a healthy nutrition environment exists in my: Strongly Disagree Disagree Agree Strongly Agree Do Not Know School School’s cafeteria Classroom 23. I have an influence on the nutrition environment in my: Strongly Disagree Disagree Agree Strongly Agree Do Not Know School School’s cafeteria Classroom 24. Candy or other sweets provided as classr oom rewards have the following effect on: Very negative influence Negative influence Positive influence Very positive influence Do Not Know Student classroom behavior Students’ overall eating behaviors 25. Please indicate your response to the following statements: Strongly Disagree Disagree Agree Strongly Agree Do Not Know I influence the snack choices in my classroom. I influence the candy or other sweets available in my classroom.

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247 Appendix K (Continued) 26. How often do student rewards or recogn itions include food and/or candy in your classroom? Daily 3-4 times per week 1-2 times per week 1-3 times per month Very infrequently On special occasions only Never 27. Which single food item is pr ovided most often for student rewards or recognitions in your classroom? Candy Cake or cupcakes Cookies Crackers Dairy items (such as cheese) Fruit Nuts Vegetables Other, please specify: _________________ 28. How often do celebrations include f ood and/or candy in your classroom? Daily 3-4 times per week 1-2 times per week 1-3 times per month Very infrequently On special occasions only Never 29. Which single food item is provided most often for celebrations in your classroom? Candy Cake or cupcakes Cookies Crackers Dairy items (such as cheese) Fruit Nuts Vegetables Other, please specify: _________________

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248 Appendix K (Continued) 30 What factors determine student rewards pr ovided in your classroom? Please check all that apply: Cost Availability Student preference Convenience No rewards provided Other, please specify: _________________ 31. The rewards I provide most often in my classroom (please check all that apply): Food rewards Pencils or other writing tools Colorful papers or notebooks Stickers Small stuffed animals Permission for a popular activity Other, please specify: _________________ 32. Please indicate your response to the following statement: Never Rarely Sometimes Rarely Do Not Know How often do you provide coupons for fa st food or treats to your students? 33. Please indicate your response to the following statements: Strongly Disagree Disagree Agree Strongly Agree Do Not Know Our school’s culture promotes teacher input on issues such as healthy school nutrition environments. I have been given opportunities to impact the nutrition environment at my school. 34. Please indicate your response to the following statements: No Influence Little Influence Some Influence Major Influence Do Not Know What influence should teachers have as role models for healthy eating behavior development for students? How much influence do you have in prom oting healthy eating behaviors with your students?

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249 Appendix K (Continued) 35. How difficult is it to provide a healthy nutrition environment? Very Difficult Difficult Easy Very Easy Do Not Know At your school? In your classroom? 36. What barriers, if any, exist in providi ng a healthy nutrition environment at your school? Please check all that apply: Lack of curriculum resources Inadequate financial resources Lack of time Too many other responsibilities No opportunity for input Lack of interest No barriers exist Other, please specify: _________________ 37. What barriers, if any, exist in providi ng a healthy nutrition environment in your school’s cafeteria? Please check all that apply: Lack of curriculum resources Inadequate financial resources Lack of time Too many other responsibilities No opportunity for input Lack of interest No barriers exist Other, please specify: _________________ 38. What barriers, if any, exist in providi ng a healthy nutrition environment in your classroom? Please check all that apply: Lack of curriculum resources Inadequate financial resources Lack of time Too many other responsibilities No opportunity for input Lack of interest No barriers exist Other, please specify: _________________

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250 Appendix K (Continued) 39. Please indicate your responses to the following statements: Disagree Agree Strongly Disagree Strongly Agree Do Not Know Nutrition and healthy eating have an impact on a child’s ability to learn and perform during the day. Children imitate my eating habits and those of others around them. I have the responsibility to model healthy eating behaviors to students in my classroom. I model healthy eating habits to my students. 40. I think I can make a difference in providing a healthy nutrition environment: Disagree Agree Strongly Disagree Strongly Agree Do Not Know At my school. In my school’s cafeteria. In my classroom. 41. My own approach to healthy eating could be classified as: Very Poor Poor Good Very Good Do Not Know 42. Do you have any ideas for discussing f ood-related topics in the classroom? 43. Do you have any ideas for integratri ng nutrition into lessons or activities? 44. Do you have any other comments that you fe el are important? If so, please take this opportunity to provide your thoughts: 45. Would you like to receive a copy of the resu lts of this survey? If so, please indicate your name and school below, and a copy will be forwarded to you at the conclusion of this study. 46. Would you be willing to serve on a co mmittee to address healthy school nutrition environments? If so, please indicate your name and school site.

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251 Appendix K (Continued) 47. Do you have any ideas or comments that would help to improve the Food and Nutrition program at your school?

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252 Appendix L Teacher Responses to Open-Ended Questions Question 16. What barriers do you thin k exist for integrating nutrition into lessons? The 29 responses received as barriers for integrating nutrition into lessons focused on three primary themes: lack of time, competing priorities (such as FCAT testing and preparation for testing), and at titudes about nutrition not fitting into the elementary curriculum, with the possible excepti on of science or specif ic lessons, such as dental health or human body systems. Some teachers responded that their teaching assignment, such as resource teacher or music teacher, had no relationship to nutrition. Others cited a lack of knowledge, no pervious inclination to integr ate nutrition, and, “I’m just not doing it. It n eeds to be intentional.” Statements indicating that nutrition should be taught at home by parents, students and parents do not support healthy eating habits and the ability level of students, were suggested as barriers to integrating nutri tion into lessons. These statements were balanced by comments that explained how barri ers can be addressed, such as the Fresh Fruit and Vegetable Program, school garden s, and “teachable moments about choices.” Question 17. I believe the following have the most impact on the school nutrition environment. Teachers were given a list of options to indicate the items that most impact the school nutrition environment. Ten of the 43 teachers who responded to this question indicated that the question was confusing, or did not make sense. Seven teachers indicated that the habits lear ned at home have the most in fluence on the children’s dietary habits and the expectations and learned be haviors that children bring to school. The availability of the Fresh Fruit and Vegeta ble Program was reported by nine teachers as having a positive impact on the school nutrition environment. Attitudes of foodservice employees, both positive (“the effervescent personalities of the lunchroom staff who encourage my kids to try new things”) and negative, were reporte d as influencing the school nutrition environment. Seven teacher s commented on the quality of school meals and the availability of unhealthy options, while two others commented about healthy choices in the lunchroom and the availability of alternative choices. Individual teachers provided insight that reflect ed their attitudes about im pacts on the school nutrition environment. One teacher indicated that acce ss to food and our culture have an impact at school, whereas another cited the expense of healthy eating. Additional comments about impacts on the school nutrition environment included: “Teachers reward with junk all th e time, and it needs to stop.” “I believe that all the ab ove have an impact on the school nutrition environment and that junk food has no business in any part of these areas, includi ng teacher lunches if they are eating in front of the students.” Question 18. Which of the fo llowing do you most influence? The list of options to answer question 18 wa s identical to the options presented in question 17. Although ten teachers indicated that they did not understand question 17, only two teachers indicated that they did not understand this question. Nine teachers indicated that they had no influence upon th e school nutrition environment. Seven

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253 Appendix L (Continued) responses regarding healthy snacks and the Fr esh Fruit and Vegetable Program indicated that this program made it possible for them to have a greater in fluence on the school nutrition environment. Three responses commented that they had influence on the availability of food choices, and a single re sponse was provided regarding the teacher’s attitude about the importance of breakfast. Question 19. Who has the primary res ponsibility to enc ourage healthy food choices at your school? Although teachers were asked to select the entity with the primary responsibility to encourage healthy food choices at school eleven teachers indicated that “everyone” shares the responsibility. Four teachers re sponded that it is the responsibility of the foodservice department to encourage hea lthy choices at school, while two teachers indicated that it should be the resp onsibility of the classroom teacher. Question 20. Who has the primary res ponsibility to enc ourage healthy food choices in the cafeteria? “Everyone” was reported by four teachers as having the primary responsibility to encourage healthy food choices in the cafeteria Four teachers res ponded that the primary responsibility lies with foodser vice, with one teacher indica ting that “Our lunches are highly processed and filled with junk.” One teacher commented that poor district, state, and federal guidelines for health were a problem, and one teacher commented, “Just because it [a school lunch] has what a child n eeds does not mean that a child will like it or eat it.” Question 21. Who has the primary res ponsibility to enc ourage healthy food choices in the classroom? Five responses of seven to this questi on indicated that the responsibility to encourage healthy choices in the classroom is shared between the te acher and parents. One teacher indicated that the responsibility belongs to “Whoever is supervising the students,” and one teacher indicated that th e level of responsibility is dependent upon knowledge of nutrition. Question 27. Which single food item is pr ovided most often for student rewards or recognitions in your classroom? Seventeen of 173 respondents indicated th at candy was used as a reward or recognition in the classroom, although the majo rity said that they limit the candy to one to three M&M candies or other small candies Eighteen responded that ice cream or popsicles were provided as a reward. Ot her food items, such as popcorn, pretzels, crackers, chips, fruit juice, and cereal, were reported as being used by 44 teachers. Pizza as a reward was reported by ten teachers. On e teacher commented, “I have resorted to giving treats as a reward for behavior. This is a result from pressure from my principal to have all of my students behaving perfectly.” Sixty-one teachers reported “never” or “almo st never” using food as a reward, or indicated that only non-food rewards are avai lable in their classrooms. Additional responses included, “There have been two inst ances where only 60% of the students were rewarded by cupcakes. These forms of rewards are limited to 4 times maximum per year,” and “Parents usually send in cupcakes for birthdays. I rewa rd with a variety of these for each event, not just one; I like to teach choices and balance when MY

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254 Appendix L (Continued) STUDENTS plan a party.” Five teachers reported foods such as cup cakes, are available on special occasions only, such as birthdays, and one teacher indicat ed that fruits and vegetables are used for planned celebrations. Four teachers said they reward students with chewing gum. Question 29. Which single food item is pr ovided most often for celebrations in your classroom? In response to this question, pizza was reported by 30 teachers, popcorn by 22 teachers, 18 teachers indicated ice crea m, freeze pops, doughnuts, or bagels, and 17 reported that the food item depended on the situ ation (birthday celebra tions), or that the food items varied. Comments included: “Kindergarteners love cupcakes on their bi rthdays, but I try to discourage this.” “Cake (is provided) if coming from parents, and other if from me. My class loves vegetables and fruit if they are provided. They chose a soccer game over a pizza party as a reward.” “I don’t provide things. The student s bring in items and it is usually chips/cookies/fruit punch. I s uggest healthy things but j unk is usually what I get.” Question 30. What facto rs determine student rewards provided in your classroom? Fourteen teachers of 73 respondents an swered this question by stating, or restating, that food is not used as a rewar d, and three teachers offered that candy is not used as a reward. Sixteen teachers indicated that food parents send in, or the type of celebration determines student rewards. Te n teachers indicated that nutrition and “health” help determine the rewards, while si x indicated that the teacher determines the reward. “I try to minimize junk, but some is available at (a) co st that should keep junk to once per week,” “I usually buy my own reward s and they are generally not food related,” and “I spend much of my own time and m oney getting these items.” Five teachers responded that stickers ar e the reward of choice. Question 31. The rewards I provide most often in my classroom. Twelve teachers reported “verbal praise” or classroom encouragement as the rewards provided most often in the classroom, with two teachers sharing a special reward includes “eating lunch with the teacher,” and one teacher reporting, “a note to parents in (the) agenda book.” One teacher explained, “I do not provide extrinsic rewards.” Tokens, trinkets, and treasures were repor ted as the rewards provided most often by 62 of the 140 teachers who provided details for this question. Seven teachers indicated that food items were the rewards provided most ofte n. School supplies, such as books, were reported as rewards by nine teachers, whereas a homework pass was reported by ten teachers. Seven responses we re received indicating extra computer time, game time, or preferred activity time. Two teachers indicated that the reward provided most often in their classroom was for addi tional time at recess, or physical activity. Question 36. What barriers, if any, exist in providing a healthy nutrition environment at your school? The most frequently cited barrier to providing a healt hy school nutrition environment at school was pare ntal influence, and meals or snacks brought from home, according to 24 of 69 teachers. One teacher st ated, “Some parents resent ‘crossing the

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255 Appendix L (Continued) line.’ They think it is their job, and I agree.” The foodservice program was cited as a barrier by 19 teachers, with responses ranging from, “School lunches served ar e ALL CARBS! Very little non-starchy vegetable choices offered,” to “I don’t set the breakfast or lunch menu. Giving elementary kids raw broccoli is a waste of time…skip the middleman and just throw a couple of cases in the dumpster.” Four teachers shared that the Fresh Fru it and Vegetable Program had lessened the barriers to providing a hea lthy school nutrition environm ent, with one teacher commenting, “It was the best nut rition model ever!” The ex pense of providing healthier foods was noted by three teachers. Anothe r three teachers indicated inadequate or unavailable refrigeration made it impossi ble to offer perishable food items. Five teachers indicated that teachers them selves can be barriers to the promotion of a healthy school nutrition environment, with one noting, “Teachers who do not agree with promoting healthy eating habits, i.e., al ternative birthday celeb rations instead of 20 birthdays a school year of cupcakes and cookie cakes.” Four teachers reported competing intere sts, lack of pers onal knowledge about nutrition, or not knowing where to st art. However, another four teachers opined that it is not their responsibility or under their cont rol to provide a he althy school nutrition environment, with one teacher suggesting, “The children respond be st to food treats.” Question 37. What barriers, if any, exis t in providing a healthy school nutrition environment in your school’s cafeteria? Thirty-four of 79 teachers indicated th at foods provided by the foodservice department serve as barriers to a healthy school nutrition environment in the cafeteria, whereas government regulations or lack of funding are cited by seven teachers. Another six teachers indicated that parental influence and foods brought from home serve as a barrier to a healthy environment in the school cafeteria. Three teac hers indicated that student food preferences serve as a barrier to a healthy schoo l nutrition environment, with one commenting, “Children prefer unhealthy c hoices,” and another stating, “Students will only eat what they like (and) lear n from home.” Nineteen teac hers indicated that they did “not know” what barriers existed. Two teachers indicated that school m eals seem to be healthy, with one commenting, “Our cafeteria does a wonderful job of providing a healthy nutrition environment for our students. The healthy sn ack program this year was a great success and I hope it continues.” Question 38. What barriers, if any, exist in providing a healthy nutrition environment in your classroom? Parental influence and foods brought from home were cited as the primary barrier to a healthy nutrition environment n the cl assroom by 48 of 65 responders. Specific comments included: “Parents are asked to send in healthy snack s, yet send in cookies, chips, sodas, or other junk food.” “When parents send in snacks, etc., that ar e not healthy snacks, I do not feel right declining a snack that has been sent in when they spent their mone y on it. I do send a

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256 Appendix L (Continued) note at the beginning of the year stating that we want healthy snacks and make suggestions but as the year goes on th ey often send in what they want.” “I do not provide snacks. Students will bring snacks from home. I believe I have no authority to dictate what th ey eat. It is the parents’ responsibility, and they are accountable, NOT teachers or the school.” “Traditionally, kids eat cake for their birt hday…why would I want to change that? Parents should keep their kids active and involved…sports are cut to save money, then people complain that kids are fat.” Two teachers commented that students ar e unwilling to try new foods. Three teachers indicated that barriers to a he althy school nutrition environment are not applicable in the classroom, with one sta ting, “There are no barriers in my classroom related to a nutrition environment, because I do not feed the children lunch each day.. their nutrition is provided only by the cafeter ia and influenced by food services.” One comment was made about the positive effect of the Fresh Fruit and Vegetable Program, and the challenge of not having this program in the future. “Without the Healthy Snack Program…inadequate financial resources…too many responsibilities…if teachers are made to do it, they will do it at no cost to the teacher.” Question 42. Do you have any ideas for discussing food-related topics in the classroom? Sixty-seven of the 128 sugges tions made were related to integrating nutrition into science, math, art, stories, songs, school gardening activities, gue st speakers, and the nutrition education program provided by the F ood and Nutrition Services department. One teacher commented that the integrati on of nutrition into curriculum should be mandatory at all grade levels. Comments about better utilization of existing technology, such as ActivBoards and Safari Montage, a real-time instructional program that can be broadcast to multiple sites, were also offe red. The Fresh Fruit and Vegetable Program was again cited as providing an appropriate venue for initiating discussions about healthy foods by three teachers. One teacher said that the discussion of f ood-related topics in the classroom must start with parents, “[At] Open House, I talk to parents how important sleep and nutrition are to their child’s ability to function in the classroom each day. I do a mini-nutrition unit during the first weeks of school and we ta lk about ‘brain food’ and food that does NOTHING for us. WE make collages, watc h movies, and read books to learn how to give our bodies the best energy level we can.” Additional expressions of concern about discussing f ood-related topics in the classroom follow: “Before we can adequately teach studen ts about healthy eating and nutrition, we need to stop giving student junk food and prom oting going to fast food restaurants after school, and stop selling junk food to raise m oney, and stop providing junk food at school events or classroom parties.” “Hard to fit in our curriculum. The parent s have the greatest impact. Children’s habits are well established before they walk into the class. The healthy snacks provided are great, but those with poor eating habits were less apt to eat a healthy snack, choosing the less healthy snack from home instead.”

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257 Appendix L (Continued) “No, I think my job is academics, not nut rition. I think nutri tion should fall on the families.” “We are teaching every second of the day. Rarely do I have the time to talk about food. What the children eat in the cafeteria will affect their eating habits for the rest of their lives. Children learn by doing, not by h earing. A sermon seen has more impact than a sermon heard!” “We already have enough to do. Can’ t solve all of so ciety’s problems.” Question 43. Do you have any ideas for integrating nutrition into lessons or activities? Responses to question 43 were similar to those received for question 42. Little new information was presented. However, a few statements were made that provided additional insights to the challenges teachers face: “I’m not sure how to integrate nutrition in to the curriculum that I currently use. We are so focused on topics related to FCAT that it’s easy to forg et about nutrition. We do talk about the foods that help us learn and test best for FCAT.” “No. No. No. The children learn by what they eat in the cafeteria. You must be kidding. We barely have enough time to teach all the subjects required. The only way it could be integrated would be in the reading program.” Other teachers made recommendations that work in their classrooms or schools: “Our cafeteria manager does a great job of en tertaining students with games, facts, and contests about food and nutrition during lunchtime. It would be nice if she able to do it more often, but she’s a busy lady so the extr a effort is apprecia ted! Our school news program also does a pretty good job of spotli ghting healthy fruits and vegetables from time to time, and our PE teacher recognizes ‘Fit Kids of the Month’ and reminds them about healthy eating and exercise habits.” “I would recommend utilizing Nutrition Detectives program by Dr. Katz in computer labs. We should also remember th at there are alternatives to food and that celebrations and rewards do not have to include food. Some classes celebrate birthdays by reading a book that the birthday child se lects in his/her honor. They sing Happy Birthday and that is it. No junk food and no expense!” Question 44. Do you have any other co mments that you feel are important? An array of feedback was provided to th is question. Again, the Fresh Fruit and Vegetable Program was heralded as making a difference in the overa ll school nutrition environment. Teachers were very supportive of the continuation of this program, with one teacher stating, “This year of providing a fresh food snack for every day has really changed the school nutrition climate. Child ren have an understanding of how the food tastes better, is full of crunch, juice, texture, flavor, and variety. They prefer fresh food now. The Gocio garden can continue to be a learning lab for impor tant understanding of where food comes from and the effort a nd reward that comes with producing it.” However, even with the provision of the Fresh Fruit and Vegetable Program, teachers reported difficulty encouraging chil dren to try new foods, “Many children would not even try to eat the healt hy snack. They would rather go hungry than eat some of the items that were provided.” Some teachers point to the expense of hea lthy foods as a stumbling block to the

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258 Appendix L (Continued) maintenance of a healthy school nutrition enviro nment. Others suggested an overhaul of the child nutrition program at th eir school, citing flavored mil k, a la carte dessert items, and second helpings of food as culprit against healthy eating. A concern continued to be e xpressed about the role of pa rents and the effect of the home environment on the school nutrition envi ronment. Some teachers indicated that parents must be reached and educated if there is to be a meaningful change at school, but a divergence of views existed about who should own the respons ibility to create a healthy school nutrition environment.: “I believe our school has done a god job in taking the first step in promoting a healthier environment. We have a school-w ide policy that says students may not be rewarded with candy or food. For the most part I see this policy bei ng taken seriously. In addition, healthier choices of food are given food special nights/celebrations at school. This has been a great start. However, I feel were are now ready to take a closer look at all the times that students are offered a treat, i.e., birthdays, cla ssroom celebrations, etc. Some younger grades seem to have a lot of food involved at the end of the year. We do have a wellness committee that has been esta blished, but to my knowledge, the group has not met this year. I would also like to see th e parents educated. It is frustrating to see what some parents send in for a “healthy snack break.” “The schools are NOT the problem. The l unch provided is the best that some have all day. We need to get into the HOMES and re train the parents with junk food/meals. WE need a cultural revolution.” “Children eat one to two meal s at school. The majority of their nutrition is at home. This is the parents’ job. If you are trying to make changes, work with parents, NOT teachers. Also, try having a tasty lunch. My own children rarely eat school lunch.” “This is a very rough battle parents are not promoting healthy eating at home. I have had students show up having suga red cereal and soda for breakfast.” “It is not the teacher’s job to model hea lthy eating. It is a family/parent job. Schools and teachers have no control what parents send in for lunches.” Despite the concerns and challenges pres ented, some teachers expressed their own awakening of personal responsibility: “Taking this survey has really made me think about how I use ‘food’ in my classroom. I try to make an effort to provide healthy items but have to admit that I rely on the unhealthy too much. I am seriously going to revamp this next year.” “I will be more proactive next year when guiding pare nts in their choices as to what to send in for snacks and party treats. That could make a huge difference in healthy eating in my classroom. I can also provide more healthy treats for special events and rewards in my classroom.” Finally, one teacher summarized, succinctl y, with an expression of gratitude for being asked for feedback, “Thanks for asking. This is the first time anyone’s asked.” Question 45. Would you like to rece ive results of this survey? Eighteen teachers indicated that they wa nted results of the survey by providing their and school location. Although the que stion specifically requested the teachers’ names and school location eight teachers res ponded with a “yes” that they did want a copy of the survey results, but failed to include contact information. One teacher

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259 Appendix L (Continued) questioned, “Is this survey re ally going to cause change?” Question 46. Would you be willing to serve on a committee to address healthy school nutrition environments? Twenty-two teachers indicated that they would serve on a committee to address healthy school nutrition envir onments. Five of the teachers who responded favorably to receiving results of the survey from question 45 also expressed interest in serving on a committee. Question 47. Do you have any ideas or comments that would help improve the Food and Nutrition program at your school? Results ranged from “To me there seems to still be a lot of unhealthy choices and too much processed food,” to “How? I am just a teacher. This is WAY too big for me. This is the government serving processed food to our kids in order to make/save money,” to “Praise the good work, patie nce, and energy that our employees provide to our students. Stop the negative talk and look to the real problems. Sc hool lunch is the least of our students’ problems!” and “Actuall y, I think you serve a ve ry good balance of food in the cafeteria. Children at our school eat good nutritious food – at least from the cafeteria.” Again, specific examples of foods that teachers indicate should be removed or limited in the cafeteria were provided, with the elimination of ice cream, flavored milk, and processed food the most commonly cited. Many teachers acknowledged the challenges parents face in the home environm ent, and how student food preferences are affected in the school nutrition environment. One teacher made a compelling argument that underscores the mesosystemic relations hip between home and the school, “In today’s society and economy, families may not see this as a priority. They may not realize the long term impacts of how they feed their fami lies. Some are just getting by and the only goal is to feed them something. Healthy me nus are not as important. Also, with both parents working, a healthy menu plan may not be considered. If the families were somehow shown the difference of student perf ormances based on the food they send from home, healthier choices may be provided. Brain food versus sugary treats on a constant basis, fruit and veggies as a staple with a cookie and sandwich or juice, instead of many sweets and sodas in student lunches from home. I’m sure the nutrition program has already provided this, so it really is up to the families.”

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About the Author Beverly L. Girard received a Bachelor of Science in Nutrition from Purdue University in 1981, a Master of Science in Dietetics and Nutrition from Florida International University in 1986, and a Mast er of Business Administration from Nova University in 1991. Beverly worked in clinical dietetics a nd was an Area Supervisor for Palm Beach County Schools before becoming the Director of Food and Nutriti on Services for the School Board of Sarasota County in 1991, where she remains to date. Mrs. Girard has served numerous state and national child nutri tion organizations. She was the first Action for Healthy Kids “Healthy Schools Hero,” th e FAME 1996 Silver Rising Star and 2004 Golden Star, the National Restaurant Associ ation’s Silver Plate, and is a Purdue University Distinguished Alumnus. Beverly is a vocalist, plays the flute, a nd enjoys travel, her church work, nieces and nephews, and the dietetic interns she mentors each year.