The impact of a population-level school food and nutrition policy on dietary intake and body weights of Canadian children

AbstractObjectiveThe objective of this study is to assess population-level trends in children's dietary intake and weight status before and after the implementation of a provincial school nutrition policy in the province of Nova Scotia, Canada.MethodSelf-reported dietary behavior and nutrient intake and measured body mass index were collected as part of a population-level study with grade 5 students in 2003 (n=5215) and 2011 (5508), prior to and following implementation of the policy. We applied random effects regression methods to assess the effect of the policy on dietary and health outcomes.ResultsIn 2011, students reported consuming more milk products, while there was no difference in mean consumption of vegetables and fruits in adjusted models. Adjusted regression analysis revealed a statistically significant decrease in sugar-sweetened beverage consumption. Despite significant temporal decreases in dietary energy intake and increases in diet quality, prevalence rates of overweight and obesity continued to increase.ConclusionThis population-level intervention research suggests a positive influence of school nutrition policies on diet quality, energy intake and healthy beverage consumption, and that more action beyond schools is needed to curb the increases in the prevalence of childhood obesity

Successful childhood obesity management in primary care in Canada: what are the odds?

Background. The management of a child presenting with obesity in a primary care setting can be viewed as a multi-step behavioral process with many perceived and actual barriers for families and primary care providers. In order to achieve the goal of behavior change and, ultimately, clinically meaningful weight management outcomes in a child who is considered obese, all steps in this process should ideally be completed. We sought to review the evidence for completing each step, and to estimate the population effect of secondary prevention of childhood obesity in Canada.Methods. Data from the 2009/2010 Canadian Community Health Survey and from a review of the literature were used to estimate the probabilities for completion of each step. A flow chart based on these probabilities was used to determine the proportion of children with obesity that would undergo and achieve clinically meaningful weight management outcomes each year in Canada.Results. We estimated that the probability of a child in Canada who presents with obesity achieving clinically meaningful weight management outcomes through secondary prevention in primary care is around 0.6% per year, with a range from 0.01% to 7.2% per year. The lack of accessible and effective weight management programs appeared to be the most important bottleneck in the process.Conclusions. In order to make progress towards supporting effective pediatric obesity management, efforts should focus on population-based primary prevention and a systems approach to change our obesogenic society, alongside the allocation of resources toward weight management approaches that are comprehensively offered, equitably distributed and robustly evaluated

Validation of the “Quality of Life in School” instrument in Canadian elementary school students

Background. School is an integral component of the life of a child, and thus quality of school life is an important part of the overall quality of life experienced by a child. There are a few instruments available to measure the quality of school life but they are often not available in English, or they are not appropriate for use alongside other instruments in a survey of young children. The Quality of Life in School (QoLS) instrument is a short, self-report measure to assess elementary school students’ perception of their quality of school life in four domains. The instrument was developed in Israel and has been validated among Hebrew-speaking children. The aim of the current study was to evaluate the psychometric properties of the QoLS measure in Canadian elementary school children.Methods. A total of 629 children attending grades 4–6 were recruited in a population-based cross-sectional study. The QoLS measure was administered to participating children by trained research assistants. In addition, their socio-demographic details and academic data were also obtained. The psychometric testing included exploratory factor analysis and reliability estimation using internal consistency (Cronbach’s Alpha). Construct validity was investigated using the known groups comparisons for discriminative validity and via convergent validity.Results. A four-factor structure was generated explaining 39% of the total variance in the model. The results showed good internal consistency and acceptable floor and ceiling effects. Cronbach’s Alpha ranged from 0.75 to 0.93. Known groups comparisons showed that the QoLS measure discriminated well between subgroups on the basis of gender, grade, and academic achievement, thus providing evidence of construct validity. The convergent validity was also appropriate with all the four domains demonstrating moderate to strong correlations to each other and to the total QoLS score.Conclusions. QoLS appears to be a valid and reliable measure for quality of school life assessment in young Canadian children

Aperçu - Un changement difficile à faire accepter : constats d’une analyse qualitative de l’offre d’aliments sains dans les installations récréatives et sportives

Les installations récréatives et sportives (IRS) font généralement la promotion de la santé par l’activité physique, mais la qualité de leur environnement alimentaire est souvent négligée. Nous avons exploré les perspectives des intervenants quant aux obstacles à l’offre d’aliments sains dans les IRS en effectuant des entrevues téléphoniques avec dix représentants d’IRS de l’ensemble de la Nouvelle-Écosse. Trois obstacles principaux ont été identifiés : 1) les normes culturelles associées à la nourriture dans les IRS et dans un environnement plus large, 2) la notion ancrée de choix et de responsabilité personnels et 3) les implications financières d’une offre alimentaire saine. Ces obstacles limitent l’offre d’aliments sains dans les IRS et exigent des stratégies variées pour surmonter les normes sociales qui nuisent aux comportements sains

At-a-glance - “A tough sell”: findings from a qualitative analysis on the provision of healthy foods in recreation and sports settings

Recreation and sport settings (RSS) typically promote health in the form of physical activity, but the healthfulness of their food environment is often neglected. We explored stakeholder perspectives on barriers to healthy food provision in RSS through telephone interviews with ten representatives from RSS across Nova Scotia. Three key barriers were identified: 1) cultural norms associated with food in RSS and the broader environment, 2) the persisting notion of personal choice and responsibility, and 3) financial implications of healthy food provision. These barriers challenge healthy food provision in RSS and require multi-faceted strategies to overcome social norms that undermine health behaviours

Public perception of a range of potential food risks in the United Kingdom

This study aimed to use a standard questionnaire to obtain a nationally representative sample of opinions on a range of potential food risks. Participants were a national sample of 1182 subjects selected using three different approaches: random and sentinel postal samples and a telephone survey. A modified psychometric questionnaire (the Perceived Food Risk Index) was administered to subjects on three occasions, spanning five time-points. Baseline data collection was undertaken from October to December 1998 (phase 1). The second wave of data collection was undertaken over three time-points in February, April and July 1999 (one-third of respondents to phase 1 at each time-point – data combined as phase 2), and the final phase of data collection was between October and December 1999 (phase 3). Principal components analysis was used to assess the intercorrelations between the items on the questionnaire. Two main components were identified as ‘dread’ and ‘knowledge’. Saturated fats were perceived as the least dreaded and the most known of the potential risks considered, while bovine spongiform encephalopathy and Salmonella were the risks dreaded the most. There was a slight perception that the potential risks had become more known over the year, especially for growth hormones. This study has raised a number of important issues for risk communicators. Despite current policy aimed at reducing fat intake, this will be difficult to achieve at a population level since people are not worried about its impact, yet food safety continues to be a significant concern to the public

Interventions to Support System-level Implementation of Health Promoting Schools: A Scoping Review

Health promoting schools (HPS) is recognized globally as a multifaceted approach that can support health behaviours. There is increasing clarity around factors that influence HPS at a school level but limited synthesized knowledge on the broader system-level elements that may impact local implementation barriers and support uptake of a HPS approach. This study comprised a scoping review to identify, summarise and disseminate the range of research to support the uptake of a HPS approach across school systems. Two reviewers screened and extracted data according to inclusion/exclusion criteria. Relevant studies were identified using a multi-phased approach including searching electronic bibliographic databases of peer reviewed literature, hand-searching reference lists and article recommendations from experts. In total, 41 articles met the inclusion criteria for the review, representing studies across nine international school systems. Overall, studies described policies that provided high-level direction and resources within school jurisdictions to support implementation of a HPS approach. Various multifaceted organizational and professional interventions were identified, including strategies to enable and restructure school environments through education, training, modelling and incentives. A systematic realist review of the literature may be warranted to identify the types of intervention that work best for whom, in what circumstance to create healthier schools and students

Interventions to Support System-level Implementation of Health Promoting Schools: A Scoping Review

Health promoting schools (HPS) is recognized globally as a multifaceted approach that can support health behaviours. There is increasing clarity around factors that influence HPS at a school level but limited synthesized knowledge on the broader system-level elements that may impact local implementation barriers and support uptake of a HPS approach. This study comprised a scoping review to identify, summarise and disseminate the range of research to support the uptake of a HPS approach across school systems. Two reviewers screened and extracted data according to inclusion/exclusion criteria. Relevant studies were identified using a multi-phased approach including searching electronic bibliographic databases of peer reviewed literature, hand-searching reference lists and article recommendations from experts. In total, 41 articles met the inclusion criteria for the review, representing studies across nine international school systems. Overall, studies described policies that provided high-level direction and resources within school jurisdictions to support implementation of a HPS approach. Various multifaceted organizational and professional interventions were identified, including strategies to enable and restructure school environments through education, training, modelling and incentives. A systematic realist review of the literature may be warranted to identify the types of intervention that work best for whom, in what circumstance to create healthier schools and students

Let the Children Play: Scoping Review on the Implementation and Use of Loose Parts for Promoting Physical Activity Participation

Active play has become a critical focus in terms of physical activity participation in young children. Unstructured or child-led play offers children the opportunity to interact with the environment in a range of different ways. Unstructured materials, often called loose parts, encourage child-led play, and therefore may also promote physical activity. The purpose of this scoping review was to determine what is currently known about how loose parts may influence physical activity participation. Following a systematic literature search, a total of 16 articles were retrieved, reviewed and categorized according to: (1) types of loose parts; (2) types of play; and (3) types of thinking. We found that there are currently a range of loose parts being used to support play, but the way in which they are implemented varies and there is a lack of clarity around how they might support the development of active outdoor play and physical literacy skills