Date of Award

2016

Document Type

Open Access Dissertation

Department

Health Promotion, Education and Behavior

Sub-Department

The Norman J. Arnold School of Public Health

First Advisor

Edward A. Frongillo

Abstract

With the concern of unhealthy school food environments, the South Korean government enacted two school nutrition policies to reduce unhealthy foods in school stores. The first policy banned on soft drinks sales in school stores enacted in 2007. The second policy restricted energy-dense nutrient-poor (EDNP) food sales in school stores enacted in 2009. This study aims to examine the changes in adolescents’ food intake and foods sold in school stores due to the two policies and to understand the policy implementation processes.

The Korea National Health and Nutrition Examination Surveys were used to examine trends in adolescents’ energy intake from school store foods during 1998-2012. Energy intake from instant noodles consistently decreased both at home and in school stores. Energy intake from soft drinks away from home or school rapidly increased beginning in 2008. All foods sold in school stores were observed before (2006) and after (2013) the implementation of policies. The mean number of soft drinks sold in a school store significantly decreased in 2013 (0.3 items) compared to in 2006 (1.9 items, p=0.032). However, soft drinks were available in 50% of school stores observed in 2013 and all school stores observed in 2013 sold EDNP foods. In the qualitative interviews with policy actors, despite of the policy noncompliance, all interviewees perceived that school stores complied with the policy. Perspectives and values towards the policy were different for each actor group. Poor monitoring, lack of awareness of the policy, profit-seeking, and lack of interest in school stores were identified as reasons for incomplete implementation of the policy.

The two school store policies in South Korea appear to have had a modest impact on overall diet of adolescents and food availability in school stores. Comprehensive policies that target diverse eating places are needed to improve adolescents’ overall diet. This study supports the needs for consideration of perspectives of various actors, especially for those who are affected by the policy, when implementing school nutrition policies. Understanding of various actors’ involvement in policy processes can inform strategies to enhance implementation and thereby reach outcomes that align with the original policy intent.

Rights

© 2016, Seul Ki Choi

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