Practically all public schools (99 percent) offer nutrition education somewhere within the curriculum and many integrate it within the total curriculum (70 percent ) (Table 1). The most common placement is within the health curriculum (84 percent), but many schools also teach nutrition through science classes (72 percent), or through a school health program (68 percent). While this does not provide information about the intensity or quality of the nutrition messages students are receiving, it shows that the messages are being conveyed in a variety of ways within the schools.
Given their classroom organization, elementary schools (80 percent) tend more than schools at other instructional levels to offer nutrition education integrated within the total school curriculum, although half or more of middle and high schools also reported this. High schools are most likely to place nutrition education within the health curriculum (93 percent) and the home economics curriculum (92 percent). The health curriculum is also the most common placement for nutrition education in middle schools (85 percent). Fifty-three percent of rural schools offer nutrition education through the home economics curriculum, compared with 29 percent of city schools.
Nutrition is taught in each and every grade from kindergarten through tenth grade in over 90 percent of all public schools; it is taught in eleventh and twelfth grades in over 80 percent of schools (Figure 1 and Table 2). These statistics do not reflect the proportion of students participating at each grade level, but give a broad overview of nutrition education offerings. The percent of schools with nutrition education requirements is substantially lower at each grade level than the percent of schools that teach nutrition. For each grade from kindergarten through eighth, at least 50 percent of all schools have district or state requirements for students to receive nutrition education; 40 percent have these requirements for ninth and tenth grades; about 20 percent for eleventh and twelfth grades (Figure 1 and Table 3 ).
Among all schools, 99 percent teach nutrition in at least one of their grades, and 64 percent require nutrition education in at least one of their grades (Figure 2). Substantially more elementary schools than high schools require nutrition education in at least one of their grades (68 versus 54 percent).
Nutrition education in the classroom is intended to accomplish three important objectives. 9 The first is to convey needed information, or the facts about nutrition, so students are knowledgeable about healthy eating practices. The second is to change unhealthy attitudes so students have the motivation to establish healthy eating practices. The third is to teach positive skills so students have all the tools to accomplish their nutritional goals. The challenge is to further these objectives in ways that are age-appropriate and that respect personal and cultural preferences. The survey included a list of 17 nutrition topics that were divided into the following 3 categories: knowledge, motivation and attitudes, and behavior. 10 Respondents reported which of the topics are covered in any grade in the school, the extent of coverage (for those topics covered), and which topics represent a main focus of nutrition education at the school.
Schools reported covering a wide range of topics. Each of the 17 topics are covered in the nutrition curricula of at least 60 percent of schools (Table 4). Topics covered by more than 90 percent of schools, and covered thoroughly by the greatest percent, are the following:
Many topics are covered at all instructional levels. However, high schools are more likely to cover such age-appropriate topics as healthy weight control, body image, eating disorders, and the association between eating and stress; middle schools are next most likely; and elementary schools are least likely to cover these topics (Table 5).
Schools were asked to select the three topics that represent a main focus of nutrition education at their schools. The Food Guide Pyramid and the relationship between diet and health were each selected by 47 percent of all schools surveyed. Nutrients and their food sources were selected by 42 percent of schools, and 35 percent selected dietary guidelines and goals as part of the school's main focus (Table 4).
Research has shown that schools or districts where the nutrition education efforts are coordinated by a person or group have an opportunity to present a more focused message to students about the importance of healthy eating. Coordination can integrate the curriculum across grades so the nutrition lessons at each grade level build on the previous year's lessons, can integrate the nutrition messages across subjects within a grade, and can integrate classroom nutrition lessons with related nonclassroom activities. In addition, coordinators can act as repositories and resources for materials received by the school or district.
Schools reported the manner in which their nutrition education efforts are coordinated by a person or group. The majority of public schools (61 percent) have no nutrition education coordination, meaning each teacher is responsible for his or her nutrition lessons (Table 6). About 9 percent of the schools have one person within the school coordinating nutrition education; 24 percent coordinate using a group or committee; and about 6 percent have someone outside the school, for example from the district, coordinate nutrition education.
Coordination from outside the school is more likely for elementary schools (8 percent) compared with middle schools (3 percent), and for city schools (13 percent) compared with town (3 percent) or rural schools (3 percent). A school's type of nutrition education coordination does not affect the curriculum placement of nutrition education within the school (Table 7). 11
The educational background and training of the people responsible for coordination of nutrition education varies among the small number of schools that have a single coordinator on staff (Figure 3). Seventy-two percent have a coordinator with a bachelor's degree or higher in nutrition or a nutrition-related area. About 61 percent have a coordinator, regardless of education level, who has completed some inservice or other training in nutrition or a nutrition-related area (not shown in a table).
Nutrition education resources available to schools include not only curriculum and other lesson materials but also the school meals program, guest speakers, and assemblies and other events. All of these can be coordinated to enhance positive nutrition messages. The FRSS survey asked schools about receiving these resources and the extent to which resources received are used at their schools.
Various types of materials are commonly used by schools to teach nutrition in the classroom. Most schools use materials developed by teachers in their schools (90 percent), health or science textbooks (89 percent), and materials developed for a specific grade level (83 percent) (Table 8). High schools are more likely than schools at other instructional levels to use state-recommended (79 percent) or statemandated (58 percent) materials for nutrition instruction, and elementary schools (44 percent) are more likely than middle schools (33 percent) to use materials developed by a district-level curriculum coordinator (Table 8).
Many schools use packaged materials and lesson plans for nutrition instruction. Given a list of 10 outside sources, schools were asked to identify those from which they received nutrition education resources for teaching, and the extent to which the resources were used at their school. Ninety-seven percent of schools report receiving nutrition lesson materials from at least one source outside of the school, most often from professional or trade associations (87 percent) and the food industry or commodities groups, such as the Dairy Council or the Potato Board (86 percent) (Table 9).
The two Federal government sources, the Cooperative Extension Service (also known as the USDA Extension Service) and the USDA Food and Nutrition Information Center, were identified by over 60 percent of schools as sources for lesson materials and other resources. The Cooperative Extension Service has as its mission to diffuse practical information about agriculture, home economics, and rural energy. Rural schools (78 percent) and small schools (75 percent) are most likely to receive materials from this source (Table 10). Because of the sample size for this survey, the effects of school size cannot be distinguished from the effects of metropolitan status through a multivariate analysis, but among all public schools in the U.S., small schools tend to be rural and rural schools tend to be small.
Of the materials from sources outside the school, schools reported the highest classroom usage for those received from the food industry or commodities groups, professional or trade associations, the USDA Food and Nutrition Information Service, and state education agencies (Table 9).
Healthy People 2000 states that "optimally, school nutrition education should include educational cafeteria experiences as well as classroom work." 12 It appears that most schools are taking some steps toward achieving this goal. Ninety-one percent of all schools offer nutrition education for students in some way through the school meals program: 93 percent of elementary, 88 percent of middle, and 86 percent of high schools (Table 11). More than half of elementary schools reported displaying nutrition information on the cafeteria bulletin board and sponsoring a "school lunch week" where parents eat with students and participate in other activities. Meals programs in elementary schools are more likely than those at other instructional levels to provide kitchen tours.
In addition to actively providing education, the meals program can support nutrition education by involving students in school menu planning and making healthy foods available at school for students to choose. About a third of all school meals programs solicit input from student advisory groups, and about 1 in 5 ask parents and students to pretest new foods (Table 13 and Figure 4).
Most respondents (84 percent) are of the opinion that their school meals programs follow generally healthy eating practices (as defined by the respondent) (Figure 5). In schools where this is not the case, students can receive inconsistent messages about food choices. In addition, schools reporting that their meals programs follow healthy eating practices are substantially more likely to be involved in nutrition education activities than those that are reported as not following them. For example, 25 percent of meals programs described as healthy provide nutrition education in the classroom versus 7 percent of those not described as healthy. Those described as healthy also more often serve meals coordinated with classroom activities (51 versus 17 percent), and more often have cafeteria bulletin boards with nutrition displays (72 versus 29 percent) (Table 14).
Nutrition lessons can also be imparted through special events such as assemblies, guest speakers, or health fairs. Just about three-quarters of schools reported using special events in the past year: 63 percent used guest speakers on nutrition and 25 percent held health fairs (Figure 6).
9Collins, Janet L., Leavy Small, M., Kann, L., Collins Pateman, B., Gold, R., and Kolbe, L., "School Health Education." Journal of School Health, 65(8) (October 1995):302.
10See Appendix C, Survey Form, Question 2.
11 Because of the smaller sample sizes for each type of coordination, the standard errors for these percents were large (see Table 7a in Appendix B). Therefore, the differences shown in table 7 are not statistically significant.
12Healthy People 2000, p. 127.