Insights on the Intersection of Health Equity and School Nutrition Policy Implementation: An Exploratory Qualitative Secondary Analysis.

Background: Recent federal policies aimed to ensure that all children have equitable access to healthy school nutrition environments. However, historically, disparities have persisted in the quality of school nutrition environments across geographic and socioeconomic groups. There is limited literature addressing if and how recent efforts to reform the school nutrition environment have influenced such disparities. The main objective of this study was to explore stakeholders' insights on how school nutrition reform intersected with issues of inequity.

Method: Qualitative secondary analysis (QSA) offers a unique method to examine existing data with a related but distinct inquiry. This QSA analyzed three primary studies, including stakeholder interviews and focus group data with school professionals and students (total 60 transcripts). Two trained analysts iteratively coded all transcripts in Atlas.ti Version 7 and followed principles of constant comparative analysis. Measures to enhance "trustworthiness" were built into the primary studies and the QSA.

Results: Broadly, stakeholders' complex insights about the school food environments' ability to compensate for healthy dietary options and "whole child" education that were perceived to be lacking in home environments. Despite the majority of respondents' positive perceptions of reforms, they also noted the challenges of addressing disparities due to family home environments and complex socioeconomic conditions. Overall, respondents reported that school food reform and nutrition education had the potential for long-term impacts on students' health, including the potential to improve disparities through enhanced academic achievement for disadvantaged populations.

Discussion And Conclusion: QSA allowed for inquiry into frontline stakeholders' understandings of how school nutrition reform may affect health inequities. Qualitative methods allowed for the examination of complex motivations and perspectives involved in policy implementation. Understanding frontline stakeholders' perspectives is key to advance school nutrition reform in a sustainable manner, especially in light of the federal local school wellness policy final rule.