Inequalities in availability and compliance of school food programs in Canadian elementary schools

BACKGROUND: School food programs (SFP) are essential to promoting healthy eating in children. Canada lacks a federally funded and standardized SFP, resulting in a patchwork of SFP offerings. We examined SFP availability and compliance with Alberta Nutrition Guidelines for Children and Youth (ANGCY) in elementary schools from different socioeconomic settings. METHODS: Data were collected from 2 repeat cross-sectional surveys between 2008-2021: (1) REAL Kids Alberta (Raising healthy Eating and Active Living Kids in Alberta), a provincially representative population-based survey; and (2) APPLE Schools (A Project Promoting healthy Living for Everyone in Schools), a health promotion intervention targeting elementary schools in socioeconomically disadvantaged settings. School principals reported on availability and compliance of breakfast/snack and lunch programs with ANGCY. School-level socioeconomic characteristics included: Pampalon index (from Census data) and rural/small vs. large population centre (PC). RESULTS: Provincially, less than 50% schools offered breakfast/snack program. Lunch program was offered in over 85% schools. Over half of SFP complied with ANGCY by including 3-4 food groups (breakfast/snack: 62%, lunch: 52%). SFP availability in more vs. less deprived schools increased over time (2008: 25% vs. 26%, 2014: 58% vs. 40%). More schools located in rural/small vs. large PC offered SFP and availability increased over time (2008: 29 % vs. 18%, 2014: 56% vs. 46%). There were no consistent trends in compliance of SFP by socioeconomic characteristics. SPF availability and compliance in APPLE Schools improved from 68% to 73% and 53% to 68%, respectively. SPF availability was higher in more vs. less deprived APPLE schools (Y1: 85% vs. 54%, Y6+: 78% vs. 69%). CONCLUSIONS: Higher availability and compliance of SFPs with nutrition guidelines in deprived and rural settings emphasize the critical role of SFPs in mitigating socioeconomic inequalities in healthy eating. KEY MESSAGES: • School food programs are essential to promoting healthy eating in children. • School food programs may play a critical role in mitigating socioeconomic inequalities in healthy eating.