Do primary schools in New Zealand promote a positive food environment? : a menu analysis of primary schools participating in the Healthy Active Learning initiative : a thesis presented in partial fulfilment of the requirements for the degree of Master of Science in Nutrition and Dietetics, Massey University, Albany, New Zealand

Abstract

Background: Childhood nutrition is key to developing positive health outcomes that persist into adulthood. The school food environment represents an important setting to direct public health interventions. There is limited data on how New Zealand (NZ) primary school menus contribute to the availability of healthy food to improve the school food environment. This study seeks to fill this knowledge gap by examining the alignment of primary school menus with current Ministry of Health (MoH) guidelines. Aim: This study aims to assess the alignment of NZ primary school menus to the MoH Healthy Food and Drink Guidance and explore their contribution to healthy food availability within primary schools in Aotearoa, NZ. Methods: Quantitative assessment of primary school menus using a quick menu analysis to determine alignment with the MoH guidelines and exploring associations with seven school characteristics (school type, decile, equity index, size, area, region, and deprivation level). In the context of this research, a menu is defined as all foods available for purchase by students at a school on a regular basis. Results: School menus (n=133) had a low alignment to guidelines with 12.8% ‘green’, 41% ‘amber’ and 40% ‘red’ items. Wellington and Auckland had higher percentages of ‘green’ items compared to other regions (Auckland against Northland (p=0.046), Bay of Plenty (p=0.002) and South Island (p=0.026), Wellington against Bay of Plenty (p=0.043)). Wellington had the lowest percentage of ‘red’ items compared to Auckland (p=0.037), Bay of Plenty (p=0.048) and South Island (p=0.041). Schools in urban areas had a higher alignment than rural, 36.9% and 50% of ‘red’ items, respectively (p<0.001) and a higher percentage of ‘green’ items (p=0.006). Small schools had less 'green' items and more ‘red’ items than medium (p=0.002, p<0.001) and large schools (p<0.001, p=0.020). Socioeconomic measures were related to a lower percentage of ‘green’ menu items in schools with low decile compared to high decile p=0.011), a high and medium equity index compared to low (p=0.02 and p<0.001), respectively and medium and high deprivation compared to low, p=0.046 and p<0.007, respectively. Conclusion: Primary schools in NZ do not align with MoH guidelines, with rural schools facing greater challenges. Public health interventions could drive change by engaging schools and food suppliers to limit 'red' items and increase 'green' items. This study shows the need for strategies to reduce the availability of ‘red’ menu items in primary schools, as this poses an increased risk for unhealthy eating in children.