BACKGROUND Schools can promote healthy eating in adolescents. This study used a qualitative approach to examine barriers and facilitators to healthy eating in schools. METHODS Case studies were conducted with 8 low-income Michigan middle schools. Interviews were conducted with 1 administrator, the food service director, and 1 member of the coordinated school health team at each school. RESULTS Barriers included budgetary constraints leading to low prioritization of health initiatives; availability of unhealthy competitive foods; and perceptions that students would not eat healthy foods. Schools had made improvements to foods and increased nutrition education. Support from administrators, teamwork among staff, and acknowledging student preferences facilitated positive changes. Schools with a key set of characteristics, (presence of a coordinated school health team, nutrition policies, and a school health champion) made more improvements. CONCLUSIONS The set of key characteristics identified in successful schools may represent a school’s health climate. While models of school climate have been utilized in the educational field in relation to academic outcomes, a health-specific model of school climate would be useful in guiding school health practitioners and researchers and may improve the effectiveness of interventions aimed at improving student dietary intake and other health behaviors.

Background The Child Nutrition and WIC Reauthorization Act of 2004 mandated written school wellness policies. Little evidence exists to evaluate the impact of such policies. This study assessed the quality (comprehensiveness of topics addressed and strength of wording) of wellness policies and the agreement between written district-level policies and school-reported nutrition policies and practices in 48 low-income Michigan school districts participating in the School Nutrition Advances Kids study. Method Written wellness policy quality was assessed using the School Wellness Policy Evaluation Tool. School nutrition policies and practices were assessed using the School Environment and Policy Survey. Analysis of variance determined differences in policy quality, and Fisher’s exact test examined agreement between written policies and school-reported practices. Results Written wellness policies contained ambiguous language and addressed few practices, indicating low comprehensiveness and strength. Most districts adopted model wellness policy templates without modification, and the template used was the primary determinant of policy quality. Written wellness policies often did not reflect school-reported nutrition policies and practices. Conclusions School health advocates should avoid assumptions that written wellness policies accurately reflect school practices. Encouraging policy template customization and stronger, more specific language may enhance wellness policy quality, ensure consistency between policy and practice, and enhance implementation of school nutrition initiatives.

The purpose of this study was to determine core food changes of African Americans with type 2 diabetes before and after a 6‐month nutrition education intervention using two different methods. Changes in core foods were assessed in a 6‐month randomized controlled trial, pre‐ and post‐intervention. Food intake was collected using the Block food frequency questionnaire (FFQ) (both groups) and food logs (intervention group). Core foods were foods consumed at a high frequency using both methods. Thirty in the control group and 29 in the intervention group provided complete data. Mean age was 54 years, mean A1C was 7.6% and BMI was 35.5 for all subjects. Control group core food changes included broccoli, green beans/peas, other fresh fruit, cooked spinach became core foods, and cheese was no longer a core food, using the FFQ method. Changes in core foods of the intervention group included tomatoes, nuts, yogurt and tuna became a core food and salty snacks were no longer a core food, using the FFQ method. Nuts and seeds, sugar‐free beverages, peanut butter, high‐fat bread and rice became a core food using the food logs method. Changes in core foods happened without an intervention. Core food changes will differ by method used and may not be appropriate to assess change because of a nutrition education intervention.