A new tool: Canadian school nutrition policy briefs link policy, practice, and research

1. A new tool: Canadian school nutrition policy briefs link policy, practice, and research Mary McKenna and Michelle Vine CPHA, Toronto, May 28, 2014

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

3. Nourishing School Communities Project 2013-2016 • 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

4. Policy Brief Project • 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.

5. Tentative Topics • Provincial/Territorial school nutrition policies • School food programs • Food and nutrition in Aboriginal schools • Farm to School Initiatives in Canada • TBD • TBD

6. #1 Provincial/Territorial School Nutrition Policies • Developments • Research • Analysis • Evaluation • Recommendations

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

8. . . . the Informed Choice?

9. . . . the Usual Choice?

10. . . . the Sustained Choice?

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

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

13. 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_guidance_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.

14. Research from British Columbia • 2008/2009 guidelines on food and beverages • School surveys: 2007/8 (n=513); 2011/12 (n=490)

15. Research from British Columbia • 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

16. Research from British Columbia • 2007/8 – surveys of grade 7-12 students • 2007/8 – school surveys

17. Analysis of School Nutrition Policies • 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

18. Evaluation of PEI Policy: Are Strict Nutrition Guidelines Feasible? • 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

19. Commentary • 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

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

21. Foods Available in the Cafeteria

22. Recommendations (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

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