Canteen purchasing practices of year 1-6 primary school children and association with SES and weight status

OBJECTIVE: To identify sources of food eaten during the school day, the types of foods and frequency of purchases from the canteen and association with SES and weight status in primary school-aged children. METHOD: This cross-sectional study was conducted in the Hunter region of New South Wales. Primary schools were randomly selected from a list of government schools and 5,206 students in years 1-6 from the 16 participating schools were invited to participate in the study. RESULTS: Findings show the majority of children in the study bring their recess snack and lunch from home. However, the majority of children do use the school canteen and less healthy foods and high-sugar drinks are commonly purchased. CONCLUSIONS: This study confirms the relevance of the school canteen as a means of affecting children's eating habits. IMPLICATIONS: Improvement in the foods sold through schools provides an important contribution to model supportive environments for healthy food choices. Strategies should also be directed towards affecting the content of lunchboxes and the home environment.     

The Food Environment of Primary School Learners in a Low-to-Middle-Income Area in Cape Town,South Africa

Rapid changes in food environments, where less nutritious foods have become cheaper and more accessible, have led to the double burden of malnutrition (DBM). The role food environments have played in shaping the DBM has attained global interest. There is a paucity of food environment research in low-to-middle-income countries. We conducted a case study of the food environments of school aged learners. A primary school in Cape Town was recruited. A multi-method design was used: a home food and eating behaviours questionnaire completed by 102 household respondents and four questions completed by 152 learners; learner participatory photography; a semi-structured school principal interview; a tuckshop inventory; observation of three-day tuckshop purchases. Foods that were commonly present in households: refined carbohydrates, fats/oils, chicken, processed meats, vegetables, fruit, legumes, snacks/drinks. Two thirds of households had rules about unhealthy drinks/snacks, ate supper together and in front of the TV, ate a home cooked meal five–seven times/week and ate breakfast together under two times/week. Vegetables were eaten under two times/week in 45% of households. A majority of learners (84%) took a lunchbox to school. Twenty-five learners photographed their food environment and 15 participated in semi-structured interviews. Six themes emerged: where to buy; what is available in the home; meal composition; family dynamics; peer engagement; food preparation. Items bought at informal food outlets included snacks, drinks and grocery staples. The principal interview revealed the establishment of a healthy school food environment, including a vegetable garden, although unhealthy snacks were sold at the tuckshop. Key dimensions of the food environment that require further investigation in disadvantaged urban and informal settlement areas include the home availability of unhealthy foods, eating behaviours in households and healthfulness of foods sold by informal food outlets.     

Would Students Prefer to Eat Healthier Foods at School?

BACKGROUND: This study sought to elucidate students' perceptions of school food environments and to assess correlations between perceptions and purchasing and consumption behaviors at school. METHODS: Seventh and ninth graders (n = 5365) at 19 schools in multiethnic, low‐income California communities participating in the Healthy Eating Active Communities program completed questionnaires assessing their attitudes and behaviors regarding school food environments during spring 2006. RESULTS: Most students (69%) reported that fresh fruit was important to be able to buy at school; more than chips (21%), candy (28%), or soda (31%). Reported importance of food offerings was correlated with the consumption of those items. Most students did not perceive foods/beverages offered at school to be healthy; fewer than a quarter reported eating fruits or vegetables (FV) at school. Students eating school lunch were more than twice as likely to consume FV, though if they also purchased from competitive venues, their consumption of candy, chips, and soda was similar to their peers who purchased only competitive foods. CONCLUSION: Students report healthy foods to be important to be able to buy at school, but do not perceive their school food environment to be healthy and consume more unhealthy foods at school. Students served healthy items via school lunch are more likely to consume them; however, they also purchase and consume unhealthy items if available. Findings suggest that modifying school food environments to facilitate consumption of healthy foods and limit unhealthy foods will better match students' preferences and could lead to improved dietary intake.     

The effect of a healthy school tuck shop program on the access of students to healthy foods

The objective of this study was to evaluate the effect of a healthy school tuck shop program, developed as a way of creating a healthy and nutritional school environment, on students'' access to healthy foods. Five middle schools and four high schools (775 students) participated in the healthy school tuck shop program, and nine schools (1,282 students) were selected as the control group. The intervention program included restriction of unhealthy foods sold in tuck shops, provision of various fruits, and indirect nutritional education with promotion of healthy food products. The program evaluation involved the examination of students'' purchase and intake patterns of healthy foods, satisfaction with the available foodstuffs, and utilization of and satisfaction with nutritional educational resources. Our results indicated that among of the students who utilized the tuck shop, about 40% purchased fruit products, showing that availability of healthy foods in the tuck shop increased the accessibility of healthy foods for students. Overall food purchase and intake patterns did not significantly change during the intervention period. However, students from the intervention schools reported higher satisfaction with the healthy food products sold in the tuck shop than did those from the control schools (all P < 0.001), and they were highly satisfied with the educational resources provided to them. In conclusion, the healthy school tuck shop program had a positive effect on the accessibility of healthy food. The findings suggest that a healthy school tuck shop may be an effective environmental strategy for promoting students'' access to healthy foods.     

Customer Characteristics and Shopping Patterns Associated with Healthy and Unhealthy Purchases at Small and Non-traditional Food Stores

Small and non-traditional food stores (e.g., corner stores) are often the most accessible source of food for residents of lower income urban neighborhoods in the U.S. Although healthy options are often limited at these stores, little is known about customers who purchase healthy, versus less healthy, foods/beverages in these venues. We conducted 661 customer intercept interviews at 105 stores (corner stores, gas marts, pharmacies, dollar stores) in Minneapolis/St. Paul, Minnesota, assessing all food and beverage items purchased. We defined three categories of “healthy” and four categories of “unhealthy” purchases. Interviews assessed customer characteristics [e.g., demographics, body-mass index (BMI)]. We examined associations between healthy versus unhealthy purchases categories and customer characteristics. Overall, 11% of customers purchased ≥1 serving of healthy foods/beverages in one or more of the three categories: 8% purchased fruits/vegetables, 2% whole grains, and 1% non-/low-fat dairy. Seventy-one percent of customers purchased ≥1 serving of unhealthy foods/beverages in one or more of four categories: 46% purchased sugar-sweetened beverages, 17% savory snacks, 15% candy, and 13% sweet baked goods. Male (vs. female) customers, those with a lower education levels, and those who reported shopping at the store for convenience (vs. other reasons) were less likely to purchase fruits/vegetables. Unhealthy purchases were more common among customers with a BMI ≥30 kg/m² (vs. lower BMI). Results suggest intervention opportunities to increase healthy purchases at small and non-traditional food stores, particularly interventions aimed at male residents, those with lower education levels and residents living close to the store.     

2010年许昌市市直初中学生饮食行为调查

[目的]了解初中学生日常饮食相关行为状况,为卫生、教育行政部门和学校制定促进中学生健康成长相关政策与干预措施提供依据。[方法]2010年6月,对许昌市市直4所初中的学生进行问卷调查。[结果]调查1 106名学生,调查前1周内,每天吃早餐的占67.63%,每天喝牛奶的占29.66%,每天吃蔬菜的占72.51%,每天吃水果的占43.22%;没在地摊吃过东西的占53.89%,没吃油炸食物的占26.13%,没喝碳酸饮料的占40.05%,不吃甜点心的占11.03%。[结论]许昌市市直初中学生每天都吃早餐、进食健康食物者所占比例较低,进食非健康食物者所占比例较高。     

The national school lunch and competitive food offerings and purchasing behaviors of high school students

BACKGROUND: Across the nation, schools have become actively involved in developing obesity prevention strategies both in classrooms and in cafeterias. We sought to determine the type of foods being offered during lunch in the cafeteria of 3 public high schools in 1 county and if this reflects the purchasing patterns of students. By labeling foods based on nutrient density using a stoplight approach of green, yellow, and red colors, we were able to categorize all foods including the National School Lunch Program (NSLP) and competitive foods available in the cafeteria. METHODS: Over a 4-week cycle, daily food purchases were gathered and the proportions of green, yellow, and red foods offered and purchased was compared. RESULTS: Findings from this study suggest that students in these 3 high schools purchased foods in relative proportion to what was available in the school cafeteria for the NSLP. Green and yellow foods included in the NSLP comprised 77% of the offerings and 73% of the purchases. In contrast, 61% of the competitive foods were classified as red foods, and the purchasing of red foods made up 83% of competitive food sales. These results indicate that students purchase foods of minimal nutritional value at greater proportions in the school cafeteria. CONCLUSIONS: These results suggest that the nutritional policy for the NSLP promotes the offerings of a wide array of foods. Schools should consider a nutrition policy that regulates the sale of competitive foods.     

南通市中小学生不健康饮食行为调查分析

目的 了解南通市中小学生的饮食相关行为现状及其影响因素,制定有针对性的干预策略。方法 在学校采取网络答卷的方式,使用江苏省疾病预防控制中心统一制作的《学生健康状况及影响因素调查表》进行调查,用单因素及多因素统计方法分析不健康饮食行为与多种因素存在的关系。结果 共调查2 588名学生,有效问卷2 568份,有效应答率99.2%,年龄8～20岁,男生1 305人,女生1 263人;共有76.1%的学生存在着不健康的饮食行为,其中有64.4%的学生不能每天喝1杯奶,15.3%的学生不能每天坚持吃早餐;每天喝含糖饮料、吃甜食、吃油炸食品达1次及以上的学生分别占6.1%、17.9%、10.2%。学生不健康饮食行为的发生与住宿情况和家庭类型有关。结论 青少年学生中存在不经常喝牛奶、不吃早餐、喜食油炸、甜食等不健康饮食行为,家长和学校都应加强对学生的健康教育,促进良好饮食行为的形成。     

景德镇市学生营养与健康知识水平调查分析

目的了解景德镇市大、中、小学学生营养与健康知识的掌握情况,为有针对性地指导与实施学校健康教育与健康促进工作提供依据。方法采取随机抽样的方法抽取调查对象,采用自行设计的问卷调查表,对全市6所学校的672名学生进行调查。结果只有5%的学生知道"中国学生营养日";76.2%的学生每天食用早餐;早餐结构以米、面为主的占82.6%;饮食搭配为荤素各半的占70.5%;有不合理饮食习惯的占92.7%;有48.5%的学生每天参加体育锻炼;93.6%的学生不吸烟;父母吸烟的学生占62.8%;78.7%的学生对营养与健康知识略有了解。结论学生不合理饮食情况较为普遍;不参加体育锻炼的学生占一定比例;家长吸烟率较高;学生对营养与健康知识的了解较少。建议加强学校健康教育,与家长合作进行膳食指导,推广卫生营养餐。     

Measuring the 'obesogenic' food environment in New Zealand primary schools

Childhood obesity is an increasing health problem in New Zealand and many other countries. Information is needed to guide interventions that reduce the 'obesogenic' (obesity-promoting) elements of school environments. The aim of this study was to identify and measure the obesogenic elements of the school environment and the canteen sales of energy-dense foods and drinks. A self-completion questionnaire was developed for assessing each school's nutrition environment and mailed to a stratified random sample of New Zealand schools. The responses from primary schools (n = 200, response rate 61%) were analysed. Only 15.5% of schools had purpose-built canteen facilities and over half ran a food service for profit (31% profit to the school, 24.5% profit for the contractors). Only 16.5% of schools had a food policy, although 91% of those rated the policy as effective or very effective. The most commonly available foods for sale were pies (79%), juice (57%) and sausage rolls (54.5%). Filled rolls were the most expensive item (mean dollars 1.79) and fruit the least expensive (mean dollars 0.47). The ratio of 'less healthy' to 'more healthy' main choices was 5.6:1, for snacks it was 9.3:1 and for drinks it was 1.4:1. In contrast, approximately 60% of respondents said that nutrition was a priority for the school. Only 50% felt there was management support for healthy food choices and only 39% agreed that mainly nutritious food was offered by the food service. 'Less healthy' choices dominated food sales by more than 2:1, with pies being the top selling item (>55000 per week). We found that the food environment was not conducive to healthy food choices for the children at New Zealand schools and that this was reflected in the high sales of relatively unhealthy foods from the school food services. Programmes that improve school food through policies, availability, prices and school ethos are urgently needed.     

Sources of dietary fat in middle schools

BACKGROUND: The current study uses an ecological approach to describe the food environment at 24 middle schools and multiple food sources' dietary fat contribution. METHODS: Five consecutive days were sampled for collection of school meals, a la carte, and student store data. Bag lunch contents were observed on 3 days. Measurement included grams of saturated and total fat plus sales or participation data. RESULTS: Average total fat grams per meal were 21 g (SD = 2) for bag lunches, 14 g (SD = 5) for Type A breakfast, and 31 g (SD = 8) for Type A lunches. Average fat grams per item were 13 g (SD = 3) for a la carte and 6 g (SD = 2) for student stores. Students purchased or brought to school a mean of 26 g (SD = 3) of total and 8 g (SD = 1) of saturated fat. Contributions to total fat grams were 42% by Type A lunches, 27% by a la carte foods, 25% by bag lunches, 3% by Type A breakfast, and 2% by student stores. Findings for saturated fat were similar. CONCLUSIONS: Middle school students eat excessive amounts of fat at school, and multiple sources of food must be considered to understand the school food environment.     

How do children's eating patterns and food choices change over time? Results from a cohort study

PURPOSE: The purpose of this study was to investigate the change in eating patterns and food choices in a cohort of students as they moved from the third to the eighth grade. DESIGN: Dietary behaviors and food choices were abstracted from 24-hour recalls and compared across grade levels. SETTING: The setting for the study was elementary and junior high schools. SUBJECTS: The subjects were a cohort of 291 students from Minnesota. MEASURES: Individual 24-hour dietary recalls from a cohort of students were collected in the third, fifth and eighth grades. RESULTS: As students moved from elementary to junior high and middle school, their consumption of breakfast, fruits, vegetables, and milk decreased. Soft drink consumption increased. In the third grade, nearly 99% of the cohort reported eating breakfast; by the eighth grade, 85% reported eating breakfast. Fruit consumption fell by 41% between the third and the eighth grades while vegetable consumption fell by 25%. The proportion of beverage coming from soft drinks more than tripled between the third and the eighth grades with concomitant reductions in milk and fruit juice consumption. CONCLUSIONS: Family, school, and community-wide efforts are needed to promote healthful eating patterns and food choices among adolescents. Our research indicates that nutrition education is needed in the elementary and middle school years. In addition, we need to work on improving teens' social and physical environments to encourage and facilitate their choice of healthy foods.     

Meal and Snacking Patterns of Students

A 1981 survey of 3,309 students in grades 3–12 enrolled in 135 Louisiana schools was used to determine their meal and snacking patterns. The data were analyzed according to three grade divisions: elementary, 3–6; junior high, 7–8; and senior high, 9–12.
An analysis of variance was computed with grade division as the independent variable. Students' responses to questions concerning the consumption of meals, snacks and vitamin supplements, and tasting new, unfamiliar or disliked food were the dependent variables.
A majority of students consumed three meals daily; however, breakfast was frequently skipped. Breakfast was usually eaten at home; 15% ate the school breakfast. Most students consumed the school lunch; many reported tasting new, unfamiliar or disliked food as part of these meals. Students snacked, most doing so in the afternoon. Students in grades 9–12 consumed significantly more snacks than their counterparts. Many snacks were purchased at school, primarily from a concession stand. Almost 50% took a vitamin supplement.     

Assessment of Food Quality in School Canteens: A Comparative Quantitative Study between Primary and Secondary Schools in Malaysia

Schools are an important food environment to cultivate and promote healthy food choices and practices among children and adolescents. The aim of the present study was to assess the type and quality of food and beverages sold in school canteens in public primary and secondary schools in Kelantan, Malaysia. Eligible schools were randomly selected from the list of all schools and detailed information of all food and beverage items sold in the school canteens were collected during school days. Food and beverages were classified based on food groups derived from the Malaysian Food Dietary Guideline and the Recommended Foods for Healthy Cafeteria Guideline. An assessment of the traffic-light nutrition food-labelling system of the total sugar content in all pre-packaged foods was also undertaken. A total of 568 food items were identified, with secondary school canteens selling a greater proportion of food items than the primary schools (55.5% vs. 44.5%). In terms of the main food groups, grains and cereal products represented the largest food group served (33–36%), followed by beverages (21–25%) and confectionary and sweet foods (12–13%). In contrast, the vegetable and fruit group represented the smallest proportion of food items sold (1–3%). Comparisons between primary and secondary schools showed a similar trend and pattern of food types and quality of foods sold, except for animal-based foods. A greater percentage of food items in this category was found among secondary schools (12.1%) versus primary schools (6.7%). When total sugar content of all pre-packaged foods was quantified based on the traffic-light nutrition-labelling system, almost one-third of foods and beverages were classified as high (29.1%). Confectionary (19.1%) and flavoured milk and fruit drinks (10.0%) both exceeded the recommended sugar levels of >22.5 g per 100 g and >11.25 mL per 100 m L, respectively. Only one of these packaged foods and beverages (0.9%) was classified as a healthy food choice. About a quarter of the food items available in school canteens were classified as prohibited based on a new revised list of prohibited food and beverage items. These findings indicate that, despite the Guidelines, a large number of unhealthy food items are being sold in school canteens. Hence, interventions such as sustainable healthy school canteen menus should be implemented to promote healthy food choices amongst school-aged children.     

寄宿制学校学生营养知识及饮食行为调查

目的 了解青海省藏区寄宿制中小学学生营养知识和行为现状,为开展中小学学生营养教育和健康促进工作提供依据。方法 采用分层整群抽样方法,对青海省贵南和海晏2个藏族自治县4所寄宿制中小学校的2 532名学生进行问卷调查。结果 了解营养素缺乏引起的后果、早餐要合理搭配和预防缺钙方法的学生<20%;知晓优质蛋白来源、营养对生长发育的益处、吃蔬菜和水果的好处、油炸食品的危害、预防贫血食品的学生<40%;初中生大部分问题的知晓率均高于小学生（均P<0.05）;营养知识主要来自于广播、电视856人（33.81%）,来自教师777人（30.69%）;喜欢高盐食物1 865人（73.66%）,不食用动物肝脏1 668人（65.88%）。结论 青海省藏区寄宿制学校中小学学生营养知识知晓率低,饮食行为存在误区,应加强饮食营养知识的宣传教育。     

Introducing taxes, subsidies or both: the effects of various food pricing strategies in a web-based supermarket randomized trial

Objective

Fiscal policies may form a solution in improving dietary intake. This study aimed to examine the effectiveness of varying taxing and subsiding schemes to stimulate healthier food purchases.

Methods

A randomized controlled trial with three levels of price reduction on healthy foods (no; 25%; 50%) × three levels of price increase on unhealthy foods (5%; 10%; 25%) factorial design was used. 150 participants were randomized into one of nine conditions and were asked to purchase groceries at a web-based supermarket. Data were collected in the Netherlands in January-February 2010 and analyzed using analysis of covariance.

Results

Subjects receiving 50% discount purchased significantly more healthy foods than subjects receiving no (mean difference = 6.62 items, p < 0.01) or 25% discount (mean difference = 4.87 items, p < 0.05). Moreover, these subjects purchased more vegetables (mean difference = 821 g; p < 0.05 compared to no discount). However, participants with the highest discount also purchased significantly more calories. No significant effects of the price increases on unhealthy foods were found.

Conclusion

Price decreases are effective in stimulating healthy food purchases, but the proportion of healthy foods remains unaffected. Price increases up to 25% on unhealthier products do not significantly affect food purchases. Future studies are important to validate these results in real supermarkets and across different countries.     

Children's eating behavior: the importance of nutrition standards for foods in schools

BACKGROUND: To enhance the impact of school nutrition programs on children's health, more information is needed on the associations between healthy and unhealthy food offerings during school lunch periods and children's eating behavior. The purpose of this study is to evaluate the contributions of food offerings and participation in school lunch programs on children's overall (both in‐ and out‐of‐school) eating behavior. METHODS: A cross‐sectional observational study was conducted in which 2039 students in 12 elementary and 10 middle schools reported their eating behavior and the frequencies with which they purchased meals and à la carte items in the school cafeteria. Food service managers from each school provided information on the availability of foods and beverages during school lunch periods. Multilevel regression analyses were conducted to identify school‐ and student‐level predictors of children's eating behavior. RESULTS: The availability of nutritious foods during school lunch periods was associated with healthier eating behavior among students. However, this effect was observed only among children who infrequently purchased à la carte food items, and not among those who were frequent purchasers. CONCLUSION: Increased availability of fruits, vegetables, whole grains, and low‐fat dairy products as components of school meals may be an effective strategy to promote healthy eating behaviors among children. Improving the nutrition standards for foods offered in competition with federally reimbursable school meals may enhance the positive effects of school meal programs on student eating behavior.     

Assessing factors influencing food choice among 10–16-year-old schoolboys. A pilot study with a stacking box method

A new «stacking box>> method to study food choice is presented. Participants are required to select pictures of foods from a large selection according to differing instructions. The applicability of the stacking box methodology to increase understanding of factors affecting food choice decisions among schoolchildren was investigated. Forty-four school boys from three different age groups were instructed to choose foods for breakfast according to different instructions; for example, «Make up a breakfast you usually eat>> and «Make up a breakfast your parents would like you to eat>>. They were also asked for reasons behind their food choices. Milk, margarine, bread and breakfast cereal choices given in response to differing instructions were compared two by two using a non-parametric method. Evident systematic components in disagreement of choices could be adequately explained. Aspects of taste, availability and habit dominated among reasons for choices for a usually eaten breakfast.     

广东省佛山市南海区中小学生营养知识-态度-行为调查分析

目的了解广东省佛山市南海区中小学生关于营养的态度、营养知识的知晓情况和健康行为的形成情况,为有效开展营养健康教育提供支持。方法采用问卷调查方法,对18所中小学1747名学生进行营养知识-态度-行为调查。结果学生营养知识知晓率仅为58.70%,随学段升高知晓率明显提高;学生普遍认为营养知识很重要,对营养知识很感兴趣;有16.00%的学生不是每天吃早餐,学生早餐食物主要有米饭、面包等,蔬菜、水果较少。大部分的学生存在挑食、偏食的行为,37.70%的学生不喜欢吃猪肝,52.00%的学生喜欢吃煎炸食品,吃零食的时间多为"不定时"。近两成的学生喝老火汤不吃汤渣。50.70%小学生每天吃得最多的一餐是晚餐。结论南海区中小学生特别是小学生对营养知识比较感兴趣,但是营养知识掌握不够,存在不合理的进餐行为。营养健康教育有必要在中小学生中开展,以培养其健康的饮食习惯。     

Tongan adolescents' eating patterns: opportunities for intervention

The purpose of this mixed methods study was to examine the sources of food and dietary patterns of Tongan adolescents (n = 2084) and their perceptions of sociocultural influences. The study incorporated anthropometric measurements, a behavioral survey, and qualitative interviews. More adolescent Tongan females (82.5%) than males (74.3%) reported sourcing morning tea and/or lunch (females 81.9%, males 72.6%) from school canteens or nearby food outlets. More females than males reported consuming obesity-promoting foods such as packaged snack foods (females 38.2%, males 21.3%), chocolates (females 24.7%, males 15.0%), and soft drinks (females 55.3%, males 50.4%). Food purchased for consumption at schools was predominantly energy dense and nutrient poor. Ensuring that students have access to foods of high nutritional quality sourced from school or home, and restricting access to local food outlets that supply unhealthy products would improve the nutrition status of adolescents in Tonga. Furthermore, it is important that obesity prevention interventions are informed by culture-specific influences to optimize uptake of healthy diets.