Objectives The objective of this research was to develop and test a low-burden method to gather diet quality data that is comparable across countries, consistently implemented, and easily understood by respondents. A common method for collecting dietary diversity data consists of open-ended food group questions, e.g., Yesterday, did you eat any porridge, bread, rice, pastaor otherfoods made from grains? Our hypotheses were (1) the majority of consumption of each food group could be represented by a few foods in each country setting (sentinel foods); (2) respondents who did not eat the listed examples might misclassify other foods they ate as belonging to the same food group. We sought to refine the method by modifying each question to be closed-ended. Methods We developed a 26-item diet quality questionnaire (DQ-Q), where each yes/no question asks about consumption of a distinct food group in the previous day or night. We tested the first hypothesis using 24-hour nationally representative dietary intake data from Brazil (Individual Food Intake Survey 2008–2009) and the United States (NHANES 2009–2014). We categorized each food and beverage item into the 26 food groups of the DQ-Q, and identified the most commonly consumed foods in each. Individuals were categorized according to whether they had consumed at least one item in each food group (1) or not (0). We tested the second hypothesis through 82 cognitive interviews in five languages São Paulo and New York City, in which we compared responses to closed-ended sentinel food questions to open-ended food group questions. Results On average, 1–7 sentinel foods captured 96–97% of people who consumed each food group (range 85–100%). Respondents in both countries sometimes miscategorized foods when asked open-ended food group questions, and open-ended questions presented an additional cognitive burden. The DQ-Q took 3–5 minutes to administer. Conclusions The DQ-Q is a rapid low-burden method to collect diet quality data. Closed-ended questions using sentinel foods capture the vast majority of consumption and are better understood by respondents than open-ended list-based methods, for measuring dietary diversity and other aspects of diet related to NCD risk. Funding Sources Funding for this work was provided by the Global Alliance for Improved Nutrition (GAIN) and the Swiss Agency for Development and Cooperation (SDC).

School meals play a major role in supporting children’s diets and food security, and policies for universal school meals (USM) have the potential to contribute to positive child health outcomes. During the COVID-19 pandemic, schools provided free school meals to all students in the United States, but this national USM policy ended in school year (SY) 2022–2023; however, a few states have adopted policies to continue USM statewide for SY 2022–2023. Research examining the challenges and strategies for successful continuation of USM is essential, along with studying pandemic-related challenges that are likely to persist in schools. Therefore, we conducted a study in Maine (with a USM policy) to evaluate the impact of COVID-19 and the concurrent implementation of USM, as well as examine differences in implementation by school characteristics, throughout the state. A total of n = 43 school food authorities (SFAs) throughout Maine completed surveys. SFAs reported multiple benefits of USM including increased school meal participation; reductions in the perceived stigma for students from lower-income households and their families; and no longer experiencing unpaid meal charges and debt. SFAs also experienced challenges due to the COVID-19 pandemic, particularly regarding costs. When considering future challenges, most respondents were concerned with obtaining income information from families, product and ingredient availability, and the costs/financial sustainability of the school meal programs. Overall, USM may have multiple important benefits for students and schools, and other states should consider implementation of a USM policy.

In the United States, many children who come from low-income backgrounds and experience food insecurity do not take and eat school lunch, despite it being a nutritious meal. Teachers could play a role in encouraging students’ consumption of school lunch; however, teachers in America are traditionally uninvolved in the lunch period. The purpose of this research was to understand the resources kindergarten through twelfth grade (K-12) teachers need to encourage students to take and eat school lunch. Two data collection workshops and semi-structured follow-up interviews were conducted with K-12 teachers. The workshops and interviews were recorded, transcribed, and analyzed for salient themes. Ten teachers participated in the workshops and six teachers participated in the follow-up interviews. In general, teachers believe school meals are essential for students’ focus and behavior in the classroom. However, to encourage students to take and eat school lunch, teachers need support and resources. From the workshops and interviews, three themes emerged: (1) improvements in the food quality; (2) school community support; and (3) professional development. The data suggests professional development is the greatest resource teachers need, as professional development can enhance teachers’ motivation to advocate for better food quality and engage school community support. Greater teacher involvement in school lunch could lay the groundwork for future healthier generations.

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