Understanding environmental factors associated with the availability of specific food/beverage items at school is an important first step to ensure students have the opportunity to make healthy nutritional decisions at school. As previously found, the availability of food and beverages was much lower in elementary schools than in middle/high schools [3–5]. Overall, three school environmental factors were associated with the availability of specific food/beverage items at schools: (1) having more nutritional resources, (2) participation in provincial/state nutritional programs, and (3) having nutritional practices that align with upcoming mandated provincial/state nutritional guidelines. Associations among these environmental factors with availability of specific food/beverage items were complex as they varied by the type of food/beverage items examined and differed by grade.
We found that fruit and vegetable availability was significantly higher in elementary schools that have more nutritional resources. To better understand these findings, it is important to highlight the nutritional context of Canadian schools in BC. Unlike other countries, Canada does not have a federally mandated school meal/breakfast program . As a result, many elementary schools in BC lack the amenities to refrigerate and store fresh fruit and vegetables and to prepare (cook or reheat) school meals. This partly explains why the availability of fruit and vegetables in BC elementary schools were found to be much lower than U.S. elementary schools (27% versus 68%, respectively ). In the context of BC, our findings might highlight the need to equip elementary schools with an appropriate refrigeration system to enable them to provide more fruit and vegetables to their students. Furthermore, fruit and vegetable availability may be limited to being available as snacks only as many of the permanent food outlets (i.e., school stores, cafeteria, or vending machines) in elementary schools are not preparing meals. However, many elementary schools (82%) have external vendors bringing A La Carte school lunch options (e.g., pizza, hamburgers, and hot dogs) at varied frequencies (e.g., multiple times a week to once a month) . Potentially, fruit and vegetable availability might be increased by having external vendors change their offerings which could be achieved through policy strategies or incentive programs. In addition, nutritional resources were found to influence availability of food in middle/high schools; however, only an association with vegetable availability was observed. While food and beverages are more widely available in middle/high schools , there are still a large number of schools that do not offer lunch options. This might explain why we observed an association between vegetable availability and school nutrition resources in middle/high schools. Unlike elementary schools, middle/high schools reported greater availability of fruit at schools which may explain why we did not find an association between fruit availability and nutritional resources in these schools.
We found that participation in the BCSFVNP was associated with fruit availability in elementary schools. These findings may suggest that fruit availability in elementary schools is a result of participating in the BCSFVNP. If this were the case, it would not reflect the broader availability of fruit on a daily basis since the BCSFVNP does not provide enough servings of fruit and vegetables to meet the required daily for each student. While the intent of the program is to encourage students to eat fresh fruit and vegetables, participation in such programs while important, is not enough to ensure that students eat fresh fruit and vegetables every day while at school. Alternatively, fruit availability in elementary schools might be higher in schools that participate in BCSFVNP as they have greater capability to store fresh fruit snacks. As the nutritional context of elementary schools in BC may be better equipped to provide fruit and vegetables as snacks rather than integrating them into the lunch meal (as lunch meals are often brought by external vendors), it might explain why we did not find an association with vegetables as fresh fruit snacks might be easier to sell since they require little or no preparation. Lack of significant associations in middle/high schools may have resulted since participation in the BCSFVNP is much lower in these schools. Although the program is equally available to all grades, more elementary schools than middle/high schools participate in this program (43% versus 26%, respectively). Participation in the program is free; however, it requires schools to identify a volunteer to administer and manage the distribution of these food every other week. Therefore, participation might be easier to manage in elementary schools, as these schools are typically smaller and have less complex schedules. Finally, the difference in associations between elementary and middle/high schools may be reflective of the fact that the availability of all food and beverages in middle/high schools is markedly higher than in elementary schools . Furthermore, we found that elementary schools participating in the BC Milk Program had more fruit availability. This finding can be explained by the nutrition environment of elementary schools in BC. Participation in the BC Milk Program requires schools to have an appropriate refrigeration system. Once they are equipped with such a system, they are in a better position to store food items. Again, finding an association with fruit might reflect that it is easier to sell fruit as snacks compared to vegetables. Freshly prepared vegetables require more preparation and appropriate storage while many whole fruit do not. Fresh fruit snacks may also be more appealing than vegetable snacks and are, therefore, more likely to be purchased. This association was only observed in elementary schools and may be explained by the fact that middle/high schools participate less in the program (38% versus 26%, respectively).
Finally, we found that middle/high schools that have healthier nutritional practices aligning with upcoming mandated provincial/state guidelines were less likely to have chocolate candy, sugar-sweetened beverages, and french fried potatoes (although the latter was a trend). Our data was collected 6-months prior to the deadline at which BC schools were expected to comply with the mandated guidelines introduced in 2005. While we do not know whether the schools have changed their environment as a result of the mandated guidelines, limiting availability of less healthful food and beverages through policy change has been associated with improved dietary intake in students [42–44]. As policies are increasingly being used to modify the school environment, it is important to assess the extent to which schools have implemented these guidelines/policies as intended to ensure decreased availability of less healthful food and beverages in schools.
The findings of this study should be interpreted in light of the limitations of the study. Firstly, associations were examined in a cross-sectional sample which precludes us from identifying factors that predict availability of food and beverages at schools. Secondly, we did not examine the extent to which the school environmental factors influenced dietary intake as this study focussed on availability as an important first step in ensuring a healthier nutritional environment. Thirdly, all measures were assessed with self-report which is known to be associated with a number of limitations. As many of the measures were developed or adapted for this study, we have limited information about the validity of these measures and whether the constructs we used were optimally operationalized. We evaluated the psychometric properties of these measures to improve the validity of our findings; however, future studies should further examine the properties of these measures. Furthermore, the availability of food and beverages was measured with an established measure ; however, the measure does not distinguish whether or not healthier versions were served. As schools are increasingly encouraged to provide healthier versions of less healthful food (e.g., pizza, hamburgers, and hot dogs), future studies are encouraged to incorporate this distinction in their measurement. Lastly, the food environment in public schools in Canada can vary greatly by province/state as policies or mandated guidelines are primarily set at the provincial/state level. Therefore, our findings may not be generalized to other provinces/states and countries with different structures governing the school food environment.
Students have widespread access to less healthful food and beverages at school. Therefore, there is strong support for developing school food policies/guidelines to influence the school environment. The extent to which schools can implement mandated policies/guidelines will depend to a certain extent upon factors within the school environment. This study found three environmental factors were associated with the availability of specific food/beverage items at school: having more nutritional resources, participation in provincial/state nutritional programs, and having nutritional practices that align with upcoming mandated provincial/state nutritional guidelines. As school policies/guidelines are increasingly being considered to modify the eating behavior of children at school, it is important to gain a better understanding of the factors associated with availability of certain food/beverage items at school to better understand factors that may facilitate attempts to change the school food environment.