Exploring the limitations of an adult-led agenda for understanding the health behaviours of young people

Children's perspectives and experiences of the COVID-19 pandemic and UK public health measures

Background

The COVID‐19 pandemic has had profound impacts on how we live our lives; yet, the implications for children and the effects on children's everyday lives have been relatively underacknowledged. Understanding children's views on COVID‐19 and related restrictions on their lives provides an important opportunity to understand how children have responded to the pandemic, including the impacts on their social and emotional well‐being.

Objective

This study explored the experiences and perspectives of children in relation to the COVID‐19 pandemic and related restrictions on everyday life.

Method

A qualitative study using semistructured online interviews with participatory drawings was undertaken between May and July 2020. Eighteen children from England and Wales, aged 7–11 years, participated in interviews.

Findings

Themes included children's reflections on (1) COVID‐19 as a deadly contagion; (2) fears and sadness and (3) social responsibility and opportunities to respond positively.

Conclusions

Young children offer insightful reflections on their experiences during the first wave of the COVID‐19 pandemic in the United Kingdom. Children and young people's perspectives must be considered in future public health discourse.

Patient or Public Contribution

This work was informed by conversations with my own three primary school‐aged children and the children of friends. A formal Patient and Public Involvement (PPI) group was not established due to the speed with which the project was undertaken. Any future research in this area would benefit from formal PPI in the design, methods and questions.

Socio-Economic Factors, the Food Environment and Lunchtime Food Purchasing by Young People at Secondary School

The aim of this paper is to report on the lunchtime food purchasing practices of secondary school students and some of the factors related to this purchasing, including the influence of socio-economic status (SES) and the food environment within and around schools. A mixed-methods study incorporating an online purchasing recall questionnaire and multiple qualitative methods was undertaken at seven UK secondary schools. The analysis shows that SES was intricately woven with lunchtime food practices. Three-quarters of participants regularly purchased food outside of school; those at low SES schools were more likely to report regularly leaving school to buy food. Young people’s perception of food sold in schools in areas of low SES was often negative and they left school to find “better” food and value for money. Taste, ingredients and advertisements were factors that mattered to young people at schools with low or mixed SES; health as a driver was only mentioned by pupils at a high SES school. For public health initiatives to be effective, it is critical to consider food purchasing practices as complex socio-economically driven phenomena and this study offers important insights along with suggestions for designing interventions that consider SES. Availability of food outlets may be less important than meeting young people’s desires for tasty food and positive relationships with peers, caterers and retailers, all shaped by SES. Innovative ways to engage young people, taking account of SES, are required.

'There is such a thing as too healthy!' The impact of minimum nutritional guidelines on school food practices in secondary schools

BACKGROUND

Pressure to improve school meals has resulted in stringent nutritional guidelines across the UK. In Wales, the 'Appetite for Life' guidelines of 2008 resulted in significant changes to the provision of food in Welsh schools. Although evaluation of these changes has focussed on nutritional quality, there is little evidence of how pupils perceive these changes and their impact on school food practices. Using a Collective Lifestyles approach, the present study reports how secondary school pupils perceive and negotiate menu changes and the implications for lunchtime practices.

METHODS

Seven focus groups (52 pupils) were undertaken in four secondary schools within one local authority in Wales. Participatory techniques were used to facilitate discussion, and the focus groups were recorded, transcribed and analysed using a framework approach. Analysis was underpinned by a Collective Lifestyles approach, which provides a framework to understand behaviour in context using three domains: (i) patterns of consumption; (ii) the construction and maintenance of identity; and (iii) power relationships.

RESULTS

Pupils reported that the new menus were unpopular in terms of content and meal type; the preference was for portable and snack style foods. In terms of power relationships, pupils' ability to negotiate within the school setting was constrained by the institutional nature of school dining. As a result, pupils tended to opt out of school food provision, accessing alternatives where possible.

CONCLUSIONS

The development of the healthy eating agenda within the school setting needs to consider the complexities of adolescent consumption preferences, identities and social networks if they are to be successful.

Making health information meaningful: Children's health literacy practices

Children's health and wellbeing is high on the research and policy agenda of many nations. There is a wealth of epidemiological research linking childhood circumstances and health practices with adult health. However, echoing a broader picture within child health research where children have typically been viewed as objects rather than subjects of enquiry, we know very little of how, in their everyday lives, children make sense of health-relevant information. This paper reports key findings from a qualitative study exploring how children understand food in everyday life and their ideas about the relationship between food and health. 53 children aged 9-10, attending two socio-economically contrasting schools in Northern England, participated during 2010 and 2011. Data were generated in schools through interviews and debates in small friendship groups and in the home through individual interviews. Data were analysed thematically using cross-sectional, categorical indexing. Moving beyond a focus on what children know the paper mobilises the concept of health literacy (Nutbeam, 2000), explored very little in relation to children, to conceptualise how children actively construct meaning from health information through their own embodied experiences. It draws on insights from the Social Studies of Childhood (James and Prout, 2015), which emphasise children's active participation in their everyday lives as well as New Literacy Studies (Pahl and Rowsell, 2012), which focus on literacy as a social practice. Recognising children as active health literacy practitioners has important implications for policy and practice geared towards improving child health.

Adolescents’ school lunch practices as an educational resource

Purpose

– The purpose of this paper is to examine Finnish ninth grade pupils’ (15-16 years) perspectives on hot school lunches and consider the potential of these perspectives as a resource for food and health education.

Design/methodology/approach

– Data include observations, essays, and visually elicitated focus group discussions from a larger qualitative case study. Data were collected during the term 2012-2013.

Findings

– Pupils considered the lunch break as their free time and valued discussions with friends. The taste of school food was important for them. Pupils solved contradicting expectations connected to school lunches through constructing social hierarchies, making compromises, and conforming to peers’ or general opinions. Desire for social belonging and independence were important justifications for breaking food-related rules.

Research limitations/implications

– Due to the focus on one school, further research needs to address contextual variation in different schools and age groups, as well as the viewpoint of teachers.

Practical implications

– To genuinely engage pupils, potential contradictions between adults’ and adolescents’ perspectives need attention. Understanding food-related social determinants and justifications for food practices from pupils’ perspective are valuable pedagogical assets for teachers. Pupils’ speech and activities that counteract formal aims can be seen also as possibilities for dialogue, rather than merely problems to be changed by adults.

Originality/value

– The paper describes how pupils’ perspectives to school lunch practices are in tension with the educational aims of school lunches, thus contributing to developing adolescent-centered food and health education in secondary schools.

Contrasting approaches to 'doing' family meals: a qualitative study of how parents frame children's food preferences

Family meals, as acts of domestic food provisioning, are shaped by the competing influences of household resources, food preferences and broader cultural norms around dietary practices. The place of children’s food tastes in family meal practices is particularly complex. Food tastes stand in a reciprocal relationship with family food practices: being both an influence on and a product of them. This paper explores how parents think about and respond to their children’s food preferences in relation to family meal practices. A qualitative study was conducted with residents of Sandwell, UK. The results presented here are based on the responses of nine key participants and their families. Photo elicitation methods generated participant food photo diaries that were used to inform subsequent interviews. A thematic analysis revealed two contrasting ways of incorporating children’s tastes into family meal routines: (1) ‘what we fancy’ and (2) ‘regulated’. The former entails repeatedly consulting and negotiating with children over what to cook for each meal. It is supported by the practical strategies of multiple and individually modified meals. The latter relies upon parents developing a repertoire of meals that ‘work’ for the family. This repertoire is performed as a series of ‘set meals’ in which any requests for variation are strongly resisted. Our findings add to the small body of literature on household food provisioning and suggest that achieving the idealised ritual of the family meal is underpinned by a range of values and strategies, some of which may run counter to health messages about nutrition.

How do adolescents view health? Implications for state health policy

OBJECTIVES

Policy-makers rarely consult adolescents during development of health policies. However, perspectives of adolescents on health can inform public health policies and programs. As part of the development of an Indiana state plan for adolescent health, we used qualitative methods to describe adolescents' "emic" views of health, and discuss implications for a state health policy for youth.

PATIENTS AND METHODS

We conducted eight adolescent focus groups in geographically and culturally diverse regions of Indiana. Each group was audio-recorded, transcribed, and analyzed using qualitative methods.

RESULTS

Participants described health as a shared responsibility between adolescents and adults in their lives. They identified a key role for supportive adults in initiating and maintaining health behaviors. Physical, financial, and informational environments could support or hinder healthy behaviors and outcomes. Although adolescents' descriptions of physical health and risk behaviors were similar to adult formulations, they described mental health as "stress and fatigue," an interaction between the adolescent and their environment, rather than depression and anxiety which are considered to be individual pathologies. Respect for decision-making capacity, seeking adolescent input, and providing harm reduction messages were identified as particularly important.

CONCLUSIONS

Adolescent's perception of health can inform policies and programs, and should be sought before the development of health policies.