Presentation - Canadian Public Health Association

Mary 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
Project to create healthy food environments in
$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
Objective: To disseminate bilingual policy briefs
that synthesize developments in policy-related
practices and research pertaining to school
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
school nutrition
School food programs
Food and nutrition in
Aboriginal schools
Farm to School
Initiatives in Canada
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
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
◦ Develop nutrient criteria for food groups and combination
 fat, sodium, sugar, calcium, protein, sugar substitutes
◦ Not to represent patterns of eating
◦ Feasibility
Intended Uses
◦ Guide and support P/T
 2013 Ministers of Health agreed to encourage use when
provinces revise guidance
◦ Facilitate food industry product development
Slideshow backgrounder:
◦ Google the title and go to the PDF file from Feb 21, 2014
2008/2009 guidelines on food and beverages
School surveys: 2007/8 (n=513); 2011/12 (n=490)
Food outlet
% middle high schools reporting
full implementation 20011/12
Snack bars
Special events
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
◦ Lower odds ratio of 100% fruit juice (0.40)
No change in pizza, hamburgers, hotdogs, or lowfat baked goods
2007/8 – surveys of grade 7-12 students
2007/8 – school surveys
Student Consumption
Odds Ratio
Odds of higher consumption of sugar
sweetened beverages (SSBs) were
higher in schools where they were
1.15 (1.021.30)
Students reporting increased
consumption of less healthy foods
had higher odds of overweight
1.03 (1.001.06)
Students had greater odds of being
obese where SSBs were available
1.50 (1.122.01)
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
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)
Lost revenue
Costs of food for students
Sourcing allowed foods
Parental responsibility
Limited supports
Strictness of policy
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
(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
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
◦ Vine & Elliot, Health Promotion Practice, 2013
◦ Vine & Elliot, Public Health Nutrition, 2013
Evaluation in PEI

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