Falling into a routine: from habits to situated practices

In line with the concept of ‘nudging’ people to change their behaviour, there has been increased attention on habit as a focus for psychologically‐based health interventions. It is hoped that behaviours initiated by interventions not only become so regular that they are normalised into people's everyday lives, but that through repetition they may eventually become fixed and habitual. In this paper we draw on people's accounts of participating in a trial designed to encourage greater physical activity, and attend to the ways they describe their engagement with interventions within wider narratives of their everyday lives. In contrast to the idea that habit refers to automatic behaviour cued by external stimuli and governed by unconscious cognitive processes, our study describes how people identify many diverse elements that are felt to have equal significance in achieving a routine. Paradoxically, the sense of stability derives not from exact repetition, but from the ability for an assemblage of elements to be configured slightly differently each time. We consequently argue that attending to the diverse range of contextual elements bracketed off from interventions designed to be tested in trials, and the idea that continuity might emerge from variation, demands a reconceptualisation of the concept of habit adopted within many areas of current health psychology.     

A Cross-Sectional Study of the Nutritional Quality of New South Wales High School Student Food and Drink Purchases Made via an Online Canteen Ordering System

Unhealthy dietary patterns in adolescence are associated with an increased risk of future chronic disease. This study aimed to assess online canteen lunch purchases made by high school students to identify: (1) the nutrient composition of purchases (energy, saturated fat, sugar, sodium, percent energy from saturated fat and total sugar); (2) the proportion of items classified as healthier (‘Everyday’) and less healthy (‘Occasional’ or ‘Should not be sold’) according to the New South Wales Healthy Canteen Strategy; (3) the frequency of purchases by product type (e.g., salty snacks), their classification and nutrient composition; and (4) associations between student characteristics and the nutrient composition and classification of purchases. The average order contained 2075 kJ of energy, 6.4 g of saturated fat, 18.4 g of sugar and 795 mg of sodium. Less healthy (‘Occasional’ and ‘Should not be sold’) items combined accounted for 56% of purchases. The most frequently purchased products were burgers and crumbed/coated foods. Students in higher grades purchased a significantly higher mean percent of ‘Everyday’ items, compared to students in grades 7 or 8. The majority of high school student purchases were less healthy (‘Occasional’ or ‘Should not be sold’) items, warranting further investigation of factors influencing online canteen purchasing behaviour in this setting.     

The contribution of school meals and packed lunch to food consumption and nutrient intakes in UK primary school children from a low income population

Background: The Low Income Diet and Nutrition Survey described the food consumption and nutrient intake of UK children in low income households in 2003–2005. Methods: To describe food consumption and nutrient intake associated with school meals and packed lunches, based on a cross‐sectional analysis of 680, 24‐h dietary recalls from 311 school children aged 4–11 years. Results: In children from low income households, pupils who took a packed lunch consumed more white bread, fats and oils, crisps and confectionery and fewer potatoes (cooked with or without fat) at lunchtime compared to other pupils. Many of these differences persisted when diet was assessed over the day. For younger pupils (4–7 years), packed lunches provided the least amount of folate, the highest amount of sodium, and the highest average percentage of food energy from fat and saturated fatty acids (SFA) compared to free school meals (FSMs). Over the whole day, in both younger (4–7 years) and older (8–11 years) children, there were no notable differences in energy or nutrient intake between those eating a packed lunch or a school meal. Older children’s packed lunches contributed a significantly higher proportion of fat, SFA, calcium and sodium to the day’s nutrient intake compared to a FSM. Conclusions: In children from low income households, packed lunches are less likely to contribute towards a ‘healthier’ diet compared to a school meal. The difference was more apparent in younger children. Key differences were the high consumption of sodium, SFA and non‐milk extrinsic sugars by pupils who had packed lunches.     

Digital photography as a tool to measure school cafeteria consumption

Background:  Assessing actual consumption of school cafeteria meals presents challenges, given recall problems of children, the cost of direct observation, and the time constraints in the school cafeteria setting. This study assesses the use of digital photography as a technique to measure what elementary-aged students select and actually consume from school cafeteria meals.
Methods:  Before and after still digital photographs were taken of labeled trays for every lunch served to elementary students over 4 lunch periods. Two analysts visually estimated the amount of each item consumed from every tray, and those estimates were compared to evaluate interrater reliability.
Results:  Collection of photographic data was rapid and did not disrupt the busy elementary cafeteria setting. Analysts' estimates of consumption levels of meal components (main and side dishes) were within 10% of each other in 92% of the cases. Only 0.2% of items could not be analyzed due to children playing with food or otherwise obstructed photographs.
Conclusions:  Digital photography offers researchers and school food service personnel a highly accurate and cost-effective tool to measure actual consumption of school cafeteria meals. Data collected through this method can be evaluated by simple counts of servings of produce or other food groups or by more detailed analyses of nutritional composition.     

The EIT Food School Network: Integrating solutions to improve eating habits and reduce food wastage in secondary schoolchildren

Most European children and adolescents do not meet dietary guidelines. Therefore, there is a need to develop and implement effective strategies to help young people adopt healthier dietary habits and maintain these into adulthood. The amount of time that children and adolescents spend in the school setting makes this an ideal environment in which to develop interventions that target healthy eating. Schools, however, are complex systems and a whole‐school approach that promotes consistent messages within the school environment and across the curriculum is needed to support positive food choices. Given current concerns about climate change and the environment, it is also important to ensure that any nutrition interventions implemented in the school setting are environmentally friendly and do not increase food wastage. This paper presents the results of stakeholder discussions on the topic of secondary school food in Northern Ireland, conducted as part of the recently developed European Institute for Innovation and Technology (EIT) Food School Network. The Network was established to facilitate the exchange of information within existing national schools programmes and to identify and develop strategies that positively impact on food choice and food wastage in schools across Europe. Improving schools’ adherence to the Food in Schools Policy and engaging pupils and parents to encourage a sense of ‘ownership’ of the school food system were identified as potential ways to positively impact on the dietary habits of children and adolescents.     

Performance of Short Food Questions to Assess Aspects of the Dietary Intake of Australian Children

Single dietary questions are used as a rapid method of monitoring diet. The aim of this investigation was to assess the performance of questions to measure population group intake compared to the mean of two 24-h recalls. Data from the Australian National Children’s Nutrition and Physical Activity Survey 2007 was used (n = 4487). Children reported their intake on three questions relating to usual serves of fruit, vegetables and type of milk. Age, gender and body weight status were assessed as modifiers of the relationship between methods. There was a stepwise increase in fruit and vegetable intake (p < 0.001) measured by recall when grouped by response category of the short question. By recall, fruit consumption decreased with age (F = 12.92, p < 0.001) but this trend was not detectable from the short question (F = 2.31, p = 0.075). The difference in fruit intake between methods was greatest for obese children. Almost 85% of children who consumed whole milk by short question consumed mainly whole fat milk by recall, but agreement was lower for other milk types. Saturated fat and volume of milk was highest in whole milk consumers. Ease of administration suggests that short questions, at least for some aspects of diet, are a useful method to monitor population intakes for children.     

Lunch‐time food source is associated with school hour and school day diet quality among Canadian children

Background

There is limited research on the dietary behaviours of Canadian children at school, including where students obtain food from during school hours or whether lunch‐time food source influences diet quality.

Methods

Nationally representative cross‐sectional data from 24‐h dietary recalls were analysed from the 2004 Canadian Community Health Survey (n = 4589). Dietary outcomes included school hour and school day dietary intakes and School Healthy Eating Index (S‐HEI) scores. Survey‐weighted covariate‐adjusted linear regression models examined differences in dietary outcomes across lunch‐time food source groups.

Results

The majority of children (72.8%) reported bringing lunch from home, whereas fewer students obtained lunch from off‐campus locations (11.6%), schools (9.6%) or skipped lunch (5.9%). Compared to off‐campus lunches, home‐packed lunches were significantly higher in fibre, vitamins A, D and C, thiamin, magnesium, iron, grains, vegetables and fruit, but lower in total calories, fat and calories from minimally nutritious foods. Average school hour diet quality required improvement for all age groups, although S‐HEI scores did not differ significantly by lunch‐time food source among 6–8‐year‐old children. However, for children age 9–17 years, bringing a home‐packed lunch was associated with significantly higher S‐HEI scores compared to students obtaining lunch from off‐campus locations. After adjusting for age and sex, lunch‐time food source was also significantly associated with whole day dietary quality.

Conclusions

Although the nutritional quality of off‐campus lunches was lower than home‐packed lunches, the quality of foods was suboptimal, regardless of food source. Strategies are needed to enhance access to nutritious foods on campus and improve the nutritional quality of packed lunches, which supply the majority of lunch‐time foods consumed by Canadian children.     

Behaviour disorders in urban primary school children in Dhaka, Bangladesh

Data on the prevalence and correlates of behaviour disorders in children are scanty or absent in many countries, including Bangladesh. A sample of primary school children in Dhaka city, Bangladesh, was screened during February to April 1994 with the Rutter B2 Scale to estimate the prevalences of different types of behaviour disorders and to assess whether and how these prevalences were associated with the children's age and gender, and gender segregation at school. Of the 1288 children in grades 1 to 5 screened, 13.4% had some type of behaviour disorder, with males more than twice as commonly affected as females (20.4 vs 9.9%). Emotional, conduct, and undifferentiated disorders were detected in 3.2, 8.9 and 1.2%, respectively, of the children. All three disorders were more prevalent in males than in females. In multivariate logistic regression analyses, significant positive correlates were male gender (odds ratio (OR):3.1) and higher grades (reference:grades 1-2; OR for grade 3:9.1; OR for grade 5:4.2) for conduct disorder, and male gender (OR:3.1) and higher grade (OR for grade 3:6.2) for all disorders combined. None of the three independent variables examined was significantly associated with emotional disorder. Separate analyses could not be done for undifferentiated disorder because of the small numbers involved. The high prevalence of behaviour disorders in Dhaka city primary school children suggest that a mental health care programme for these children comprising screening and, if indicated, full evaluation and expert care would be worthwhile.     

Are primary school children gaining heart health benefits from their journeys to school?

Summary Information was collected in relation to 1133 children, aged 4–11 years, regarding methods of travel to and from school, together with distances involved. Ninety-seven per cent of the children walked, travelled by car or alternated between these 2 methods of travel. Some 584 children (51·5%) walked to school every day with an average one-way-distance of less than half a mile. It would seem therefore that few primary school children are walking far enough to gain heart health benefits from their journeys to school. Reasons are given, however, as to why it is important for young children to be encouraged to walk to school providing adequate safety considerations are taken into account.     

Monitoring consumption of 'extra' foods in the Australian diet: Comparing two sets of criteria for classifying foods as 'extras'

Aim: To compare two systems which classify energy‐dense, nutrient‐poor ‘extra’ foods which can be used to monitor the contribution of these foods in the diets of Australian children. The aim is to develop consistent criteria that may be used to monitor trends in the consumption of ‘extra’ foods in dietary surveys and, for research purposes, to examine associations between ‘extra’ food consumption and weight gain. Methods: The intake of ‘extra’ foods was investigated among 2‐ to 18‐year‐old children (n = 3007) who participated in the 1995 National Nutrition Survey. Two classification systems were used, both based on the Australian Guide to Healthy Eating: a simple food grouping system, and a more complex system based on specific fat and sugar cut‐points applied to food subgroups. Results: Both classification systems resulted in similar lists of commonly consumed ‘extra’ foods, and showed similar estimates for energy contribution from ‘extra’ foods, 41–42%, and similar, relatively low, contributions of micronutrients, 20–25%. Conclusion: A relatively simple food grouping classification system may be useful to estimate total energy and nutrient intake from ‘extra’ foods. However, for more detailed food‐specific analyses, a food criteria system based on cut‐points may be preferred. Nationally consistent criteria are needed for classifying ‘extra’ foods for both monitoring and research purposes, to enable comparisons of dietary data from surveys over time, and to investigate associations between ‘extra’ food consumption and nutrition outcomes such as weight gain and body mass index.     

Taste education reduces food neophobia and increases willingness to try novel foods in school children

BACKGROUND/OBJECTIVES

This study measured the effects of a taste education program developed in Korea on food neophobia and willingness to try novel foods in school children.

SUBJECTS/METHODS

One-hundred and twenty school children (aged 7-9 years) residing in Seoul participated in 12 sessions of a taste education program for 3 months. The Korean taste education program was adapted from "Les classes du goût" by J. Puisais and modified to suit a Korean education environment. The study subjected school children to pre- and post-programs on food neophobia and willingness to try novel foods (WTNF), in addition to children''s food neophobia in their parents. A total of 101 survey data were analyzed using SPSS 18.0.

RESULTS

Regarding the effects of taste education, scores of food neophobia significantly decreased (P < 0.01) in the posttest, mean (m) score (4.10 ± 1.19) decreased compared to the pretest (4.39 ± 1.00), and WTNF significantly increased (P < 0.001) in the pretest (m) score (0.48 ± 0.33) compared to the pretest (0.32 ± 0.34). This result indicates verification of the study hypothesis.

CONCLUSIONS

Food neophobia scale (FNS), an index that measures personal food preference [1,2], showed a very weak correlation with behavioral willingness to taste novel foods (WTNF). Therefore, it is expected that the two scales measure different things. However, considering that the traits of food neophobia are not easily changed, the taste education program was administered in a remarkably effective manner.     

Nutrition status of primary school children in Townsville

OBJECTIVE: Much of the ill health of Australian Indigenous populations can be attributed to diet-related diseases. Many of these diseases and the deleterious dietary choices are thought to begin in early childhood. This project therefore aimed to assess the nutritional health status of children in Townsville. It enabled the Townsville Aboriginal and Islander community to identify and redress nutrition-related issues considered important in improving the overall health status of their community. DESIGN: Baseline urinalysis, anthropometrics, general overall health assessment, dietary and exercise histories were collected. This screening was repeated annually. Diet and exercise histories were recorded biannually. SETTING: Based in three Northern Queensland health region (pre)primary schools with a high proportion of Indigenous children. RESULTS: Baseline results demonstrated that more children are overweight to obese than underweight. There was no significant difference in body mass index between Indigenous and Non-Indigenous children. Indigenous children were shown to consume less vegetable and dairy products and were significantly more likely to suffer from anaemia, iron depletion and eosinophilia than non-Indigenous children. Indigenous children were also twice as likely to have runny noses and are more than three times more likely to have skin sores. CONCLUSION: These results support that the health status of the Indigenous children is poorer than that of non-Indigenous children. They demonstrate an immediate need to implement culturally appropriate nutritional and exercise programs within the school environment to improve dietary habits and overall health. Implementation of nutritional, drinking and exercise programs may significantly improve these children's overall awareness and behaviour concerning nutrition and health.     

Food and nutrient intakes of primary school children: a comparison of school meals and packed lunches

Background New school meal standards are currently being phased in by the government in an attempt to improve the nutritional composition of school food. However, no standards are applied to packed lunches. The present study aimed to compare the food and nutrient intakes of primary school children eating a school meal with those taking a packed lunch. Methods A sample of 120 children, aged 6–11 years, was observed once at a lunch time and all items consumed were recorded. Nutrient analysis was performed, and differences in nutrient intake between those children consuming packed lunches and school meals were determined. Results Mean energy and protein intakes were similar. The amount of energy provided by starchy carbohydrate was also similar but, compared with school meals, packed lunches provided twice as much energy from sugar (P < 0.001). School meals on average provided more energy from fat (P < 0.001), but intakes of saturated fat were lower in the school meals group (P = 0.021). Packed lunches provided more sodium (P < 0.001), calcium (P < 0.001) and iron (P = 0.016) than the school meals. Very few packed lunches contained vegetables, and fruit intake was particularly low for those having a school meal. Conclusions Children taking a packed lunch to school were consuming approximately double the amount of sugar and 50% more sodium and saturated fat in their midday meal compared with those having a school lunch. However packed lunches were providing children with more calcium, iron and fruit.     

An exploration of gender issues and their relevance to the perceptions of primary school children

The whole area of equal opportunities, sex and gender in particular, is full of issues about which we often hold firm opinions. These are formed partly through experience and partly through an acceptance of traditions and expectations. It is extremely difficult to stand back and take an objective view, to remove ourselves from cultural influences. We are "entrapped" in both our biological and cultural roles. We cannot alter our biology (sex), but we have some degree of control over our culturally determined, or gender, roles. However, changing these values, attitudes and behaviours is difficult and threatening. With this as an underlying element of my study, I have explored the broad contexts and concepts of gender issues in education today, including an examination of views and research into what is meant by "normal" and "natural". A review of approaches and attitudes towards policy making provides a background against which to evaluate current practice in schools.

Alongside the theoretical aspects, I have carried out my own investigation into primary children's perceptions of gender roles, both in school and at home. Their views need to be seen in relation to expectations and values conveyed in school, whether explicitly or as part of the "hidden curriculum", as well as in relation to the values of society at large. The purpose of this study is to identify some of the key issues which have to be addressed by schools. Teachers can then help children to understand the many messages presented to them which influence their perceptions of the world, and affect their view of themselves and their position in the world.     

Surveillance of dietary habits and lifestyles among 5-6 year-old children and their families living in Central-North Italy

Summary. Objectives: To study dietary habits and behaviours of a representative sample of 5–6-year-old children and their families.Methods: A stratified population sample of the general population (5508 children out of 5551 residents) born in 1997 and attending a nursery school was analysed. Weight and height were measured. Information was collected via questionnaire. A “normal” body mass index (BMI) ranged between 13.61–18.09 and 13.31–19.79 kg/m² for boys and girls respectively.Results: The response rate was 89%. 79% of the boys had a normal BMI, 0.9% had a low BMI, 18% were overweight, and 1.8% was obese; 87% of the girls had a normal BMI, 2.6% had a low BMI, 10% were overweight, and 0.7% were obese. The main sources of dietary information were professionals of the national health system and mass-media. The main barriers to healthy dietary habits were busy daily activities, working timetable, time needed to cook and tasty and healthy food cost. The main changes in dietary habits occurred in the family habits after a child’s birth.Conclusions: Our findings showed a crucial role played by professionals of the national health system and by mass-media on eating behaviours among children and their parents. Birth of a child is a receptive context to promote healthy habits.

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Zusammenfassung. Surveillance des Ernährungsverhaltens und Lebensstils bei 5- bis 6-jährigen Kindern und deren Familien in Zentral-Nord-ItalienFragestellung: Ernährungsverhalten und Lebensstil einer repräsentativen Stichprobe von 5- bis 6-jährigen Kindern und deren Familien untersuchen.Methoden: Eine geschichtete Bevölkerungsstichprobe (n = 295 Familien) der im Jahr 1997 geborenen Kinder, die den Kindergarten besuchten, wurde untersucht. Körpergewicht und -grösse wurden gemessen. Normalgewicht entsprach einem BMI im Bereich 13.61–18.09 kg/m² für Knaben und einem BMI im Bereich 13.31–19.79 kg/m² für Mädchen.Ergebnisse: Die Antwortrate der Eltern betrug 89%. Gemäss BMI waren 79% der Knaben normalgewichtig, 0,9% von niedrigem Körpergewicht, 18% übergewichtig und 1,8% adipös. Bei den Mädchen waren 87% normalgewichtig, 2,6% hatten ein niedriges Körpergewicht, 10% waren übergewichtig und 0,7% adipös. Die Kinder stammen aus Familien mit mittlerem bis hohem sozioökonomischen Status. Mehr als 50% der Eltern haben im Minimum eine Ausbildung auf Matura-Niveau und Jobs mit mittlerem bis höherem Berufsstatus. Die Hauptquelle für Ernährungsinformationen waren Anbieter des nationalen Gesundheitswesens und Massenmedien. Nach der Geburt eines Kindes veränderten Familien ihre Lebensgewohnheiten im positiven Sinne. Die Haupthinderungsgründe für gesunde Ernährungsgewohnheiten waren auslastende Alltagsaktivitäten, die Arbeitszeiten und die Zeit, die für das gemeinsame Kochen von gesundem und schmackhaften Essen benötigt würde sowie die Kosten für sog. gesunde Nahrungsmittel.Schlussfolgerungen: Unsere Ergebnisse zeigten, dass die Anbieter des öffentlichen Gesundheitswesens und Massenmedien einen entscheidenden Einfluss auf die Verzehrgewohnheiten von Kindern und deren Eltern nehmen. Die gute Ausbildung der Eltern spielt eine signifikante Rolle bei der Förderung von gesunden Essgewohnheiten. Die Geburt eines Kindes ist ein Kontext, in dem Familien für gesundheitsförderliche Massnahmen empfänglich sind.

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Résumé. Surveillance des comportements alimentaires et des modes de vie des enfants de 5-6 ans et de leurs familles en Italie (Centre nord)Objectifs: Etudier les comportements alimentaires et des modes de vie d’un échantillon représentatif d’enfants de 5–6 ans et de leurs familles.Méthodes: Analyse auprès den 5508 enfants sur 5551 habitants, nés en 1997 et allant dans une école enfantine. Le poids et la taille ont été mesurés. Les autres informations ont été récoltées par questionnaire. Pour les enfants de cet âge, un Body Mass Index (BMI) est considéré comme normal entre 13.61– 18.09 kg/m² pour les garçons et 13.31–19.79 kg/m² pour les filles.Résultats: Le taux de réponse est de 89%. 79% des garçons ont un BMI normal, 0,9% un BMI insuffisant, 18% sont en surpoids, et 1,8 sont obèses. 87% des filles ont un BMI normal, 2,6% un BMI insuffisant, 10% sont en surpoids, et 0,7% sont obèses. Les principales sources d’information sont les professionnels du service de santé national et les mass-médias. Les principaux obstacles à l’adoption de comportements alimentaires sains sont des journées très chargées, les horaires de travail, le temps nécessité par la préparation des repas et le coût des aliments sains et savoureux. Les principaux changements dans les comportements alimentaires de la famille se produisent à la naissance d’un enfant.Conclusions: Les professionnels du service de santé national et les mass-médias jouent un rôle prépondérant dans l’adoption des comportements alimentaires par les enfants et leurs parents. La naissance d’un enfant est un contexte propice à la promotion d’habitudes saines.