A new tool: Canadian school nutrition policy briefs link

policy, practice, and researchMary McKenna and Michelle Vine

CPHA, Toronto, May 28, 2014

Nourishing School Communities CLASP Policy Brief Project Policy Brief #1(sign up if interested) Commentary and Recommendations

Overview

Project to create healthy food environments in schools

$2.4 million funded by the federal government through the Canadian Partnership Against Cancer’s (CPAC) Coalitions Linking Action & Science for Prevention (CLASP) initiative

Heart and Stroke, Farm to Cafeteria Canada, Federation of Saskatchewan Indian Nations, YMCA, University of NB, U Waterloo (Propel) ◦ Health Check in Schools, Farm to School Programs and

Learning Labs, School-community gardens, after school food and nutrition frameworks, national conference on school food and nutrition, evaluation, policy info & tools

Nourishing School Communities Project 2013-2016

Objective: To disseminate bilingual policy briefs that synthesize developments in policy-related practices and research pertaining to school nutrition.

Target groups: Canadian health and education agencies involved with school nutrition programs, policies, and research.

Activities: Briefs are based on experts’ reviews of information from federal/provincial/territorial levels, school and health agencies, and academic literature.

Policy Brief Project

Provincial/Territorial school nutrition policies

School food programs Food and nutrition in

Aboriginal schools Farm to School

Initiatives in Canada TBD TBD

Tentative Topics

Developments Research Analysis Evaluation Recommendations

#1 Provincial/Territorial School Nutrition Policies

What is the role of policy in making the Healthy Choice. . . the Easy Choice?

. . . the Informed Choice?

. . . the Usual Choice?

. . . the Sustained Choice?

Enable tracking a common, comparable set of indicators over time for both student health and comprehensive school health

Use consistent measures to generate and report comparable indicators to:◦ more rapidly advance knowledge of what types of interventions

work in different settings with different populations◦ help inform change (for example, program and policy decisions)◦ minimize duplication and reduce burden on respondents (for

example, schools) by coordinating efforts

Assess student food intakes and school food and nutrition environments

Core Indicators and Measureshttp://www.propel.uwaterloo.ca/youthexcel/index.cfm?section=19&page=302

All provincial school nutrition policies contain guidance on healthy foods

Interest in increasing pan-Canadian consistency◦ Leverage resources, decrease duplication, increase

collaboration, facilitate product development by food industry

Scope◦ Develop nutrient criteria for food groups and

combination dishes fat, sodium, sugar, calcium, protein, sugar substitutes

◦ Not to represent patterns of eating◦ Feasibility

Provincial and Territorial Guidance Document for the Development of Nutrient Criteria for Foods and Beverages in Schools

Intended Uses◦ Guide and support P/T

2013 Ministers of Health agreed to encourage use when provinces revise guidance

◦ Facilitate food industry product development

Document:◦ http://foodsecurecanada.org/sites/default/files/pt_guidan

ce_doc_presentation_slides_feb19-2014.pdf Slideshow backgrounder:

◦ Google the title and go to the PDF file from Feb 21, 2014 foodsecurecanada.org/.../pt_guidance_doc_presentation_slides_feb19-20.

Provincial and Territorial Guidance Document for the Development of Nutrient Criteria for Foods and Beverages in Schools

2008/2009 guidelines on food and beverages School surveys: 2007/8 (n=513); 2011/12

(n=490)

Research from British Columbia

Food outlet % middle high schools reporting full implementation

20011/12 (n=125)Vending 66Snack bars 45Cafeterias 36Fundraising 10Special events 8

2007/8 AND 2011/12:◦ <10% of elementary schools reported: sugar-sweetened

beverages, baked goods, French fries, chocolate and candy, or salty snacks (low-fat and regular)

2011/12 compared with 2007/8:◦ Higher odds ratios of having fruit (2.13), vegetables

(2.87), ◦ Lower odds ratio of 100% fruit juice (0.40)

No change in pizza, hamburgers, hotdogs, or low-fat baked goods

Research from British Columbia

2007/8 – surveys of grade 7-12 students 2007/8 – school surveys

Research from British Columbia

Student Consumption Odds RatioOdds of higher consumption of sugar sweetened beverages (SSBs) were higher in schools where they were available

1.15 (1.02-1.30)

Students reporting increased consumption of less healthy foods had higher odds of overweight

1.03 (1.00-1.06)

Students had greater odds of being obese where SSBs were available

1.50 (1.12-2.01)

Document analysis of policies (ON and Prov, n=58)◦ Factors shaping school food environments

nutrition standards are common components of policies while nutrition education and access to nutritious foods are less so

Key informant interviews (n=22 in ON) ◦ Cost of healthy foods◦ Loss of revenue generation◦ Proximity of schools to off-site food outlets◦ Link between healthy eating and student learning◦ Restrictive nature of policy◦ Role of stigma◦ School culture

Analysis of School Nutrition Policies

CIHR funded evaluation 2007-2012 Principals perceived improvements 2007 to 2010

◦ Schools price food to promote healthy choice◦ Foods sold or provided adhere to nutrition policy

School assessments indicated that implementation decreased for lunches (p=<.01) and canteens (NS) and did not change for vending machines (NS)

Challenges◦ Lost revenue◦ Costs of food for students◦ Sourcing allowed foods◦ Parental responsibility◦ Limited supports◦ Strictness of policy

Evaluation of PEI Policy: Are Strict Nutrition Guidelines Feasible?

Effort to develop core common indicators Recognize that nutrient criteria are insufficient to

ensure positive school food environments Results indicate mixed: levels of implementation,

outcomes, responses to policy School food environments affect intake and health Need to consider nutrient criteria in relation to

other initiatives: food, education, access, services, and environments, and other policy components

Important for decision-makers to have access to these results to inform future planning

Commentary

What kind of policies and programs will lead to desired food and health outcomes?

Foods Available in the Cafeteria

(1) Adopt consistent measures for monitoring SNPs to facilitate information sharing across jurisdictions

◦ Informed by consideration of desired outcomes of school food and nutrition

◦ Based on a Comprehensive School Health approach

(2) Create a repository for Canadian SNP information targeted to health AND education AND others

(3) Increase collaboration across jurisdictions and sectors to maximize the effectiveness of SNPs--eg, public health, school food programs, farm to school, policy, food and nutrition education, parent and community outreach

Recommendations

Additional references . . . BC Research

◦ Masse & de Niet., IJBNPA, 2013, 10:26◦ Masse et al., IJBNPA, 2014, 11:29◦ Watts et al., IJBNPA, 2014:11:50

Analysis◦ Vine & Elliot, Health Promotion Practice, 2013◦ Vine & Elliot, Public Health Nutrition, 2013

Evaluation in PEI◦ http://

www.interprofessional.ubc.ca/Obesity/presentations/Hernandez.pdf

Contact:mmckenna@unb.ca; 506-451-6872