title: An Innovative Method of Measuring Changes in Access to Healthful Foods in School Lunch Programs: Findings from a Pilot Evaluation.
abstract: BACKGROUND
  A large local health department in Colorado partnered with 15 school districts to develop an approach to evaluate changes in access to healthy foods in reimbursable school lunches and a la carte offerings.
  
  
  METHODS
  School district nutrition managers were engaged at the start of this project. Health department dietitians developed criteria to classify food items as "Lower Fat and less added Sugar" (LFS) and "Higher Fat and more added Sugar" (HFS) based on the percentage of calories from fat and grams of added sugar. Lunch production sheets were obtained for two time periods, food items and the number of planned servings recorded. LFS and HFS planned servings were summed for each time period, and a LFS to HFS ratio calculated by dividing LFS planned servings by HFS planned servings. Additional analyses included calculating LFS: HFS ratios by school district, and for a la carte offerings.
  
  
  RESULTS
  In 2009, the LFS: HFS ratio was 2.08, in 2011, 3.71 (P<0.0001). The method also detected changes in ratios at the school district level. For a la carte items, in 2009 the ratio of LFS: HFS was 0.53, and in 2011, 0.61 (not statistically significant).
  
  
  CONCLUSIONS
  This method detected an increase in the LFS: HFS ratio over time and demonstrated that the school districts improved access to healthful food/drink by changing the contents of reimbursable school lunches. The evaluation method discussed here can generate information that districts can use in helping sustain and expand their efforts to create healthier environments for children and adults. Although federal regulations now cover all food and beverages served during the school day, there are still opportunities to improve and measure changes in food served in other settings such as child care centers, youth correction facilities, or in schools not participating in the National School Lunch Program.
authors.affiliation: Tri-County Health Department, Greenwood Village, Colorado, United States of America.
authors.forename: Allison P
authors.initials: AP
authors.lastname: Hawkes
authors.affiliation: Tri-County Health Department, Greenwood Village, Colorado, United States of America.
authors.forename: Stacy L
authors.initials: SL
authors.lastname: Weinberg
authors.affiliation: Tri-County Health Department, Greenwood Village, Colorado, United States of America.
authors.forename: Ruth
authors.initials: R
authors.lastname: Janusz
authors.affiliation: Tri-County Health Department, Greenwood Village, Colorado, United States of America.
authors.forename: Christine
authors.initials: C
authors.lastname: Demont-Heinrich
authors.affiliation: Tri-County Health Department, Greenwood Village, Colorado, United States of America.
authors.forename: Richard L
authors.initials: RL
authors.lastname: Vogt
mesh_terms: D000293:Adolescent; D001628:Beverages; D002648:Child; D002664:Child Nutritional Physiological Phenomena / Q000502:physiology*; D003120:Colorado / Q000453:epidemiology; D004032:Diet; D002149:Energy Intake / Q000502:physiology; D005502:Food / Q000145:classification; D005509:Food Dispensers, Automatic; D005522:Food Services; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D062409:Lunch; D009753:Nutritive Value; D063766:Pediatric Obesity / Q000453:epidemiology / Q000517:prevention & control*; D010865:Pilot Projects; D012572:School Health Services; D012574:Schools