Abstract
Purpose: In fall 2012, Massachusetts schools implemented competitive food and beverage standards that are similar to USDA's Smart Snacks in School standards. Compliance, finances, and major themes raised by food service directors were explored. Methods: Mixed-methods study. Data were collected during school site visits, 2012-2014 (n=36). Direct observation data were used to calculate the percentage of compliant competitive food and beverage products available to students. Revenue and participation data were collected from a subset of participating school districts (n=11) and analyzed using multi-level modeling. Semi-structured interviews with school food service directors were conducted in 2013 (n=27) and 2014 (n=21) and analyzed for major themes as related to compliance. Results: By 2014, 60% of competitive foods and 79% of competitive beverages in NOURISH schools were compliant. Schools experienced initial revenue loss; yet school food service revenues were largely not impacted by standards implementation (p≤0.05). More than 66% of food service directors raised the same seven themes: successful transition measures; vendor communication; identifying compliant products; leadership support; anticipating sales changes. Importantly, these themes were more likely to be raised by compliant vs. noncompliant districts [range: 65-81%]. Conclusions: The Massachusetts standards appear to create healthier school food environments. Compliance with the standards was high and financial concerns appeared generally unwarranted. There is also a correlation between compliance and seven major themes uncovered in food service director interviews. NOURISH results may be useful for school districts implementing the final USDA Smart Snacks in School standards in 2016.