Prevalence of Healthy Eating Initiatives in Australian Primary Schools: A Cross-Sectional Survey

IntroductionSchools are recommended settings for promotion of healthy eating, but to achieve their intended impact, initiatives must be implemented population wide. There is currently limited data available to assess the implementation of Australian school-based healthy eating initiatives. ObjectiveTo assess the implementation of healthy eating initiatives in Australian primary schools and whether implementation is associated with school characteristics. MethodsA cross-sectional study of a nationally representative sample of Australian primary school principals from August 2022 to October 2023. Principals reported on implementation of 32 healthy eating initiatives grouped by guideline-informed opportunities: healthy food in the classroom, at school, brought to school, and outside of school. Prevalence estimates were weighted using iterative ranking to reflect population characteristics. Logistic regression models assessed the associations between initiatives and school characteristics. ResultsPrincipals or their representatives from 569 Australian schools completed the survey. Prevalence of initiative implementation varied considerably, ranging from 7% to 97%. The least and most frequently implemented initiative in the classroom was Teachers acted as healthy eating role models for students and Students supported to be healthy eating role models for peers (both 8%) and Permission or breaks to drink water in class time in [≥]80% of classes daily (97%); to increase healthy food at school was Provide incentives or rewards to children for purchasing/choosing healthy foods or drinks at school (11%) and Install water stations for free access to cooled plain or optionally carbonated water (64%); to improve healthy food brought to school was Workshops with parents on healthy eating (14%) and Information on healthy eating sent home to parents (88%); and to improve healthy eating outside of school was Promote healthy food options at shops close to school and Community members acted as healthy eating role models for students (both 15%) and Healthy eating programs delivered in partnership with community organisations or services (31%). A range of initiatives were associated with school size (5 initiatives) including Provide free fruits and vegetables to children and Provide free healthy school lunches; geographic remoteness (7 initiatives) such as Teachers acted as healthy eating role models for students and Implement healthy cooking programs or similar healthy eating experiences, or socio-economic status of school locality (3 initiatives) such as Implement healthy fundraising policies and Provide free breakfast to children. ConclusionThis first national study to comprehensively assess the implementation levels of a broad range of healthy eating initiatives reveals key insights into where policy and practice support is needed. Implementation of the initiatives varied significantly, with some associations with school characteristics. Initiatives with low implementation identifies opportunities for further investigation.