The role of the school food environment in improving the healthiness of school canteens and the readiness to reopen post COVID-19 pandemic: A study conducted in Indonesia

https://doi.org/10.4081/jphr.2021.2287
  • Hamam Hadi
    Alma Ata Graduate School of Public Health; Alma Ata Center for Healthy Life and Foods (ACHEAF), University of Alma Ata, Yogyakarta, Indonesia.
    https://orcid.org/0000-0002-1945-2539
  • Resti K. Triastanti
    Department of Nutrition, Faculty of Health Sciences, University of Alma Ata, Yogyakarta, Indonesia.
  • Devita Anggraeni
    Department of Nutrition, Faculty of Health Sciences, University of Alma Ata, Yogyakarta, Indonesia.
  • Esti Nurwanti
    Alma Ata Graduate School of Public Health; Alma Ata Center for Healthy Life and Foods (ACHEAF), University of Alma Ata, Yogyakarta, Indonesia.
  • Emma C. Lewis
    Center for Human Nutrition, Department of International Health, Bloomberg School of Public Health, The Johns Hopkins University, Baltimore, United States.
    https://orcid.org/0000-0001-7360-396X
  • Uriyoan Colon-Ramos
    Department of Global Health, Milken Institute School of Public Health, George Washington University, Washington DC, United States.
  • Yunhee Kang
    Center for Human Nutrition, Department of International Health, Bloomberg School of Public Health, The Johns Hopkins University, Baltimore, United States.
  • Miwa Yamaguchi
    International Center for Nutrition and Information, National Institute of Health and Nutrition National Institutes of Biomedical Innovation, Health and Nutrition, Tokyo, Japan.
    https://orcid.org/0000-0001-6084-1539
  • Joel Gittelsohn
    Center for Human Nutrition, Department of International Health, Bloomberg School of Public Health, The Johns Hopkins University, Baltimore, United States.
    https://orcid.org/0000-0003-2761-3280

ABSTRACT

Background: Indonesian school children spend one-third of their time in school, where they are exposed to a variety of foods at school canteens. However, the healthiness of school canteens is not yet well understood. This study was conducted to (1) characterize the healthiness and quality of management of school canteens, and (2) measure readiness of school canteens to reopen following COVID-19 closures.
Design and Methods: Mixed-methods were used to conduct a cross-sectional study. Data were collected from schools located in the Bantul District of Indonesia. Primary schools (n=152) were randomly selected, with a final sample size of 147. Data were collected using Google Forms, delivered via WhatsApp or email. School canteens were classified as healthy if they had a Healthy Canteen Score (HCS) >= 10, or unhealthy if they had a HCS < 10.
Results: Less than half (43.5%) of school canteens were deemed to be healthy. School canteens were more likely to be healthy if the canteen manager had a formal decision letter (OR=15.2; 95% CI=3.7-62.5); used print material messaging (OR= 3.2 to 4.6 times); or received inspection by external officers periodically (OR=2.8; 95% CI= 1.04-7.5). Readiness to reopen was 4.5 (OR=4.5; 95%CI: 1.1-17.9) times higher among schools that had their own canteen, and 4 (OR=3.9; 95% CI =1.1-13.8) times higher among schools located in rural areas, adjusting for the remaining variables.
Conclusions: School canteen healthiness can be improved by implementing national food policy and healthy school canteen standards accompanied by the existence of good management practices within schools, particularly following the COVID-19 pandemic.

REFERENCES

1. Ford ND, Patel SA, Narayan KMV. Obesity in Low- and Middle-Income Countries: Burden, Drivers, and Emerging Challenges. Annu Rev Public Health. 2017;38(1).
2. Webber L, Kilpi F, Marsh T, Rtveladze K, Brown M, McPherson K. High rates of obesity and non-communicable diseases predicted across Latin America. PLoS One. 2012;7(8).
3. Cetthakrikul N, Phulkerd S, Jaichuen N, Sacks G, Tangcharoensathien V. Assessment of the stated policies of prominent food companies related to obesity and non-communicable disease (NCD) prevention in Thailand. Global Health. 2019;15(1).
4. Kilpi F, Webber L, Musaigner A, Aitsi-Selmi A, Marsh T, Rtveladze K, et al. Alarming predictions for obesity and non-communicable diseases in the Middle East. Public Health Nutr. 2014;17(5).
5. Misra A, Khurana L. Obesity-related non-communicable diseases: South Asians vs White Caucasians. Vol. 35, International Journal of Obesity. 2011.
6. Wei C, Ye S, Ru Y, Gan D, Zheng W, Huang C, et al. Cohort profile: The Lanxi Cohort study on obesity and obesity-related non-communicable diseases in China. BMJ Open. 2019;9(5).
7. Hall ME, do Carmo JM, Juncos LA, Wang Z, Hall JE. Hypertension and chronic kidney disease. Adv Hypertens Res. 2014;7:185–225.
8. Riantoro BD, Kristina SA, Endarti D. Estimating premature mortality cost of cancers attributable to obesity in Indonesia. Asian Pacific J Cancer Prev. 2019;20(1).
9. Masters RK, Powers DA, Link BG. Obesity and US mortality risk over the adult life course. Am J Epidemiol. 2013;177(5).
10. de Siqueira JVV, Almeida LG, Zica BO, Brum IB, Barceló A, de Siqueira Galil AG. Impact of obesity on hospitalizations and mortality, due to COVID-19: A systematic review. Vol. 14, Obesity Research and Clinical Practice. 2020.
11. Abdelaal M, le Roux CW, Docherty NG. Morbidity and mortality associated with obesity. Vol. 5, Annals of Translational Medicine. 2017.
12. Badan Penelitian dan Pengembangan Kesehatan. Laporan_Nasional_RKD2018_FINAL.pdf. Badan Penelitian dan Pengembangan Kesehatan. 2018. p. 198.
13. Nurwanti E, Hadi H, Chang JS, Chao JCJ, Paramashanti BA, Gittelsohn J, et al. Rural–urban differences in dietary behavior and obesity: Results of the riskesdas study in 10–18-year-old Indonesian children and adolescents. Nutrients. 2019;11(11).
14. Kelly B, Hebden L, King L, Xiao Y, Yu Y, He G, et al. Children’s exposure to food advertising on free-to-air television: An Asia-Pacific perspective. Health Promot Int. 2016;31(1):144–52.
15. Hadi H, Nurwanti E, Gittelsohn J, Arundhana AI, Astiti D, West KP, et al. Improved Understanding of Interactions between Risk Factors for Child Obesity May Lead to Better Designed Prevention Policies and Programs in Indonesia. 2020;
16. Nurwanti E, Hadi H, Julia M. Faktor risiko terjadinya obesitas pada anak sekolah dasar kota dan desa di Daerah Istimewa Yogyakarta. J Gizi dan Diet Indones. 2013;1(1):59–70.
17. Santika D. Hubungan Pengetahuan Dan Sikap Mengenai Jajanan Aman Dengan Perilaku Memilih Jajanan Pada Siswa Kelas V Di Sdn Wanasari 01 Tahun 2019. Skripsi Inst Med Drg Suherman Cikarang Bekasi. 2017;53(9):21–5.
18. Chen P, Antonelli M. Conceptual Models of Food Choice : Influential Factors Related to Foods ,. Foods. 2020;9(1898):1–21.
19. Nepper MJ. The Relationship between the Home Food Environment and Weight Status among Children and Adolescents, ages 6–17 years. ProQuest Diss Theses. 2016;(May):176.
20. BPOM RI. Pedoman Pangan Jajanan Anak Sekolah untuk Pencapaian Gizi Seimbang Bagi Orang Tua, Guru dan Pengelola Kantin. Direktorat Stand Prod Pangan Deputi Bid Pengawas Keamanan Pangan Dan Bahan Berbahaya Badan Pengawas Obat Dan Makanan Republik Indones. 2013;37.
21. Kementerian Pendidikan dan Kebudayaan. Jumlah Data Satuan Pendidikan (Sekolah) Perk Kabupaten/ Kota: Kab Bantul. Data Referensi Kementerian Pendidikan dan Kebudayaan. 2019.
22. Stattrek. Sample Size Calculator. 2016.
23. Clinton-McHarg T, Janssen L, Delaney T, Reilly K, Regan T, Nathan N, et al. Availability of food and beverage items on school canteen menus and association with items purchased by children of primary-school age. Public Health Nutr. 2018;21(15).
24. Gustafson A, Jilcott Pitts S, McDonald J, Ford H, Connelly P, Gillespie R, et al. Direct effects of the home, school, and consumerfood environments on the association between food purchasing patterns and dietary intake among rural adolescents in Kentucky and North Carolina, 2017. Int J Environ Res Public Health. 2017;14(10).
25. Wills W, Danesi G, Kapetanaki AB, Hamilton L. Socio-economic factors, the food environment and lunchtime food purchasing by young people at secondary school. Int J Environ Res Public Health. 2019;16(9).
26. Healthy food in school canteens, policy directions and deviations: A cross sectional study from Sri Lanka. J Community Heal Manag. 2020;5(1).
27. Varman S, Bullen C, Tayler-Smith K, Van Den Bergh R, Khogali M. Primary school compliance with school canteen guidelines in Fiji and its association with student obesity. Public Heal Action. 2013;3(1).
28. Machado CO, Höfelmann DA. Canteens of state schools in curitiba in the state of Paraná, Brazil: Adaptation to the food supply regulation law. Cienc e Saude Coletiva. 2019;24(10).
29. Aldubayan K, Murimi M. Compliance with school nutrition policy in saudi arabia: A quantitative study. East Mediterr Heal J. 2019;25(4).
30. Karim SA, Chen HF. Deaths From COVID-19 in Rural, Micropolitan, and Metropolitan Areas: A County-Level Comparison. J Rural Heal. 2021;37(1).
31. Kulu H, Dorey P. The contribution of age structure to the number of deaths from Covid-19 in the UK by geographical units. medRxiv. 2020.
32. Bakar A, Kuncoroaji TI, Lee A, Lee S-C, Ningrum V. Epidemiological Characteristics of Early COVID-19 Case Outbreaks in Indonesia. Preprints. 2020;2019(March).