School food policy at Dutch primary schools: room for improvement? Cross-sectional findings from the INPACT study

Background: Schools can play an important role in the prevention of obesity, e. g. by providing an environment that stimulates healthy eating habits and by developing a food policy to provide such an environment. The effectiveness of a school food policy is affected by the content of the policy, its implementation and its support by parents, teachers and principals. The aim of this study is to detect opportunities to improve the school food policy and/or implementation at Dutch primary schools. Therefore, this study explores the school food policy and investigates schools' (teachers and principals) and parents' opinion on the school food policy. Methods: Data on the schools' perspective of the food policy was collected from principals and teachers by means of semi-structured interviews. In total 74 principals and 72 teachers from 83 Dutch primary schools were interviewed. Data on parental perceptions about the school food policy were based on a cross-sectional survey among 1,429 parents from the same schools. Results: Most principals (87.1%) reported that their school had a written food policy; however in most cases the rules were not clearly defined. Most of the principals (87.8%) believed that their school paid sufficient attention to nutrition and health. Teachers and principals felt that parents were primarily responsible to encourage healthy eating habits among children, while 49.8% of the parents believed that it is also a responsibility of the school to foster healthy eating habits among child Conclusion: Dutch primary schools could play a more important role in fostering healthy eating habits among children. The school food policy could be improved by clearly formulating food rules, simplifying supervision of the food rules, and defining how to enforce the food rules. In addition, the school food policy will only influence children's dietary behaviour if both the school and the parents support the policy

Children's snack consumption: role of parents, peers and child snack-purchasing behaviour. Results from the INPACT study

Background: Parents and peers are both likely to influence children's dietary behaviour. However, their actual influence may depend on the age and life stage of the individual child. Therefore, this study examined the influence of parents ( home snack availability and consumption rules) and peers on 11- year- old children's snack consumption, and whether these associations were mediated by children's snack- purchasing behaviour. It was hypothesized that children are more likely to buy unhealthy snacks if these are not always available at home, if restrictive rules apply to their consumption and if a child is sensitive to peer influence. It was also assumed that children who buy snacks out of their pocket money would consume more snacks. Methods: Data were taken from 1203 parent- child dyads who completed a questionnaire in the INPACT study ( IVO Physical Activity Child cohorT). Multivariable regression models were used to ( i) analyze associations between children's consumption and parents' and peers' influence and ( ii) determine whether these associations were mediated by children's snackpurchasing behaviour. Results: Of the parental factors, home availability of snacks was associated with higher snack consumption ( B = 1.03, P < 0.05). Parental factors and children's snack- purchasing behaviour were not associated. Children who were sensitive to peer influence consumed more snacks ( B= 3 07, P < 0.01) and bought more snacks out of their pocket money ( odds ratio 3.27, P < 0.0.01). Children's snack- purchasing behaviour explained part ( 8.6%) of the association between peer influence and children's snack consumption. Conclusion: As these findings indicate that both parents and peers influence children's snack consumption, health promotion may benefit from targeting the broader social environment

Is there an association between the home food environment, the local food shopping environment and children's fruit and vegetable intake? Results from the Dutch INPACT study

Objective: To examine: (i) the association between home availability of fruit and vegetables and children's fruit and vegetable intake; (ii) the association between parental perception of the local food shopping environment and the home availability of fruit and vegetables; and (iii) whether the home availability of fruit and vegetables mediates the association between parental perception of the local food environment and children's fruit and vegetable consumption. Design: Cross-sectional study. Setting: A total of ninety-one primary schools in the Netherlands. Subjects: In total 1501 primary caregivers completed a questionnaire to measure children's fruit and vegetable consumption, home availability of fruit and vegetables, parental perceptions of the local food shopping environment (price, quality and availability), the child's socio-economic status, the child's ethnicity and maternal height and weight. Results: The home availability of fruit and vegetables was positively associated with children's fruit and vegetable intake (P < 0.01 and P < 0.001, respectively). Negative parental perceptions of the local food shopping environment were associated with less fruit available at home (P < 0.05, P < 0.01 and P < 0.05 for price, quality and availability of fruit, respectively). No significant associations were found between parental perception of the local food shopping environment and children's fr Conclusions: Interventions focusing on improving the home availability of fruit and vegetables may help to increase children's fruit and vegetable consumption. However, more data are required on factors influencing the home availability of fruit and vegetables

Maternal educational level and children's healthy eating behaviour: role of the home food environment (cross-sectional results from the INPACT study)

Background: The aims of this study are 1) to investigate the association between maternal educational level and healthy eating behaviour of 11-year-old children (fruit, vegetables and breakfast consumption), and 2) to examine whether factors in the home food environment (parental intake of fruit, vegetables and breakfast; rules about fruit and vegetables and home availability of fruit and vegetables) mediate these associations. Methods: Data were obtained from the Dutch INPACT study. In total, 1318 parent-child dyads were included in this study. Multilevel regression models were used to investigate whether factors of the home food environment mediated the association between maternal educational level and children's healthy eating behaviour. Results: Children of mothers with a high educational level consumed more pieces of fruit per day (B = 0.13, 95% CI: 0.04-0.22), more grams of vegetables per day (B = 23.81, 95% CI = 14.93-32.69) and were more likely to have breakfast on a daily basis (OR = 2.97, 95% CI: 1.38-6.39) than children of mothers with a low educational level. Home availability, food consumption rules and parental consumption mediated the association between maternal education level and children's fruit and vegetable consumption. Parental breakfast consumption mediated the association between maternal education level and children's breakfast consumption. Conclusions: Factors in the home food environment play an important role in the explanation of socio-economic disparities in children's healthy eating behaviour and may be promising targets for interventions