Students’ Food Intake from Home-Packed Lunches in the Traditional versus Balanced School Day

Promoting healthy school food environments and nutrition in Canada: a systematic review of interventions, policies, and programs

CONTEXT

The school food environment is a critical interface for child and adolescent nutrition, and there is a need to understand existing literature on Canadian school food environments to identify equity gaps and opportunities, and empower decision-makers to plan for future action.

OBJECTIVE

Literature on Canadian school food and nutrition interventions, policies, programs, and their effects on diets and nutritional status are synthesized and appraised in this systematic review.

DATA SOURCES

A search strategy was developed for each database used (Medline, Embase, PsycINFO, ERIC, Cochrane Collaboration, Canadian Electronic Library, BiblioMap), with a combination of free text and controlled vocabulary, for articles published from 1990 to 2021. Unpublished data and grey literature were also searched.

DATA EXTRACTION

Quantitative and qualitative studies with an observational or intervention study design, reviews, or program evaluations conducted in Canadian schools with participants aged 5-19.9 years were included. Key study characteristics and risk of bias were extracted independently by 2 investigators using a standardized tool.

DATA ANALYSIS

A total of 298 articles were included (n = 192 peer reviewed and 106 from the grey literature), which were mostly conducted in Ontario (n = 52), British Columbia (n = 43), and Nova Scotia (n = 28). Twenty-four interventions, 5 nonevaluated programs, and 1 policy involved Indigenous populations. Overall, 86 articles measured and reported on effectiveness outcomes, including dietary intake; anthropometry; knowledge, attitudes, and practices; and physical activity. The literature remains largely heterogenous and primarily focused on nutrition education programs that use subjective assessments to infer changes in nutrition. A key facilitator to implementation and sustainability was community engagement, whereas key barriers were staff capacity, access to resources and funding, and consistent leadership.

CONCLUSIONS

This review provides insight into Canadian school food and nutrition interventions, programs, and policies and uncovers important evidence gaps that require careful examination for future evaluations. Governments must create supportive environments that optimize nutrition for children and adolescents through equitable policies and programs.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration no. CRD42022303255.

Acceptability, Helpfulness, and Utility of the Healthy Lunch Box Booklet (HLBB) for Parents and School-Age Children

Purpose: School lunches are of poor nutritional quality in Canada. Parents play an important role in the preparation of school lunches for young children. This study aimed to evaluate the acceptability and helpfulness of the Healthy Lunch Box Booklet (HLBB) to support parents in packing healthy school lunches for their children.Methods: The HLBB was distributed at four schools in London, Ontario to students in full-day Kindergarten to Grade three. Parents were asked to complete an online survey from April to November 2019.Results: Parents (n = 58) reported the HLBB to be helpful (96.3%) and found the sections on new school lunch and snack ideas and nutritional information (e.g., label reading) particularly useful. Some parents also stated that the HLBB created opportunities to interact with their children regarding school lunch preparation. In terms of perceived impacts, parents reported increased confidence (68.6%) and learning something new (79.6%) about school lunch preparation and felt that their children's diet was impacted accordingly.Conclusions: The HLBB was found to be an acceptable and useful nutrition resource that supports parents in packing healthy school lunches for their children and therefore warrants further study.

Fruit and Vegetable Intake Is Associated with Food Knowledge among Children Aged 9–14 Years in Southwestern Ontario, Canada

Interventions to improve dietary quality and intake of fruits and vegetables (FV) among Canadian children have had modest success, and it has been suggested that food knowledge could be key to improvement. Programs have been criticized for insufficiently connecting food knowledge with food skills and decision making about dietary intake. The objective of this study was to investigate factors associated with FV consumption by elementary school children, aged 9–14 years, in Ontario, Canada, including food knowledge, socioeconomic status, sociodemographic characteristics, and the food environment. In 2017–2019, a cross-sectional survey was administered to 2443 students at 60 elementary schools across Southwestern Ontario (SWO), Canada. A parent survey was used to validate self-reported sociodemographic variables. The mean intake of FV reported by these participants was 2.6 (SD 1.1) and 2.4 (SD 1.2) servings/day, respectively. A FV intake below WHO guidelines was reported by 40.7% of respondents. Knowledge score, child age, and parent employment status significantly predicted higher reported intake of FV. This study shows that FV intake among this population group is low, and increased intake is associated with higher food knowledge. To encourage healthy eating, school-based food and nutrition programs that incorporate multiple components and emphasize food literacy are needed.

Children's School-Day Nutrient Intake in Ontario: A Cross-Sectional Observational Study Comparing Students' Packed Lunches from Two School Schedules

This study compared the caloric and nutrient values of packed lunch contents and consumption in the Balanced School Day (BSD) (two 20 min eating periods) versus the Traditional Schedule (TS) (one 20 min lunch). Foods consumed during school were assessed by direct food observation in 321 grade 3 and 4 students, aged 7−10 years, at 9 BSD and 10 TS elementary schools in Ontario. Packed lunch contents in the BSD were significantly higher than the TS in energy (3128.14 ± 1100.36 vs. 2658.98 ± 951.34 kJ, p < 0.001, respectively). Similarly, carbohydrates, total sugar, protein, fat, saturated fatty acids (SFA), calcium, iron, and sodium were significantly higher in the BSD versus TS packed lunches. Correspondingly, students in the BSD consumed significantly more energy, carbohydrates, total sugar, and SFA compared to the TS. Overall, lunches brought by students in the BSD schedule provided more energy across all macronutrients, with only a few micronutrients showing increased amounts, suggesting two 20 min eating opportunities could contribute to excess caloric intake during school, potentially contributing to the prevalence of childhood overweight and obesity in Canada. Furthermore, packed lunches in both schedules had excess amounts of nutrients of concern and much work is needed to ensure that children in Canada receive nutritious lunches at school.

The Good Food for Learning Universal Curriculum-Integrated Healthy School Lunch Intervention: Protocol for a Two-Year Matched Control Pre-Post and Case Study

Background

Good nutrition affects children’s health, well-being, and learning, and schools offer an important setting to promote healthy behaviors that can last a lifetime. Once children reach school age, they spend more of their waking hours in school than in any other environment. Children’s eating habits may be easier to influence than those of adults. In Canada, households with children are more likely to experience food insecurity, and school food programs that are universally available to all children can support the development of healthy eating patterns across groups of varying socioeconomic status. There is a significant gap in the rigorous community-engaged academic research on the impact of school meal programs, especially universal ones.

Objective

The aim of this population health intervention research is to study the impact of a 2-year universal, curriculum-integrated healthy school lunch program in elementary schools in Saskatoon, Saskatchewan, Canada, on food consumption, dietary quality and food and nutrition-related knowledge, attitudes, and practices.

Methods

This population health intervention study will be conducted in 2 intervention elementary schools matched with 2 control schools. We will collect preintervention data, including objective measurements of food eaten at school and food-related knowledge, attitudes, and behaviors. This will be followed by the intervention itself, along with qualitative case studies of the intervention process in the 2 intervention schools. Then, we will collect postintervention data similar to the preintervention data. Finally, we will finish the data analysis and complete the ongoing sharing of learning from the project.

Results

This study was funded in April 2020 but because of the COVID-19 pandemic, data collection did not begin until May 2021. The intervention will begin in September 2021 and end in June 2023, with end point data collection occurring in May and June 2023. The case study research will begin in September 2021 and will be ongoing for the duration of the intervention.

Conclusions

The opportunity we have to systematically and comprehensively study a curriculum-integrated school lunch program, as well as the promising practices for school food programs across Canada, is without precedent.

International Registered Report Identifier (IRRID)

DERR1-10.2196/30899

Picky Eating Is Associated with Lower Nutrient Intakes from Children's Home-Packed School Lunches

The objective was to assess the relationship between children’s picky eating (PE) status and nutrient intake from home-packed school lunches. The lunches of 321 students, aged 7–10 years, were quantified via cross-sectional direct observation. Children were classified as having PE (n = 155) or not (non-PE; n = 166) based on food neophobia scores and parental perceptions of PE. The PE group consumed significantly less protein, folate, magnesium, potassium, zinc, and vitamins B1, B2, B3, B6, D, and E than the non-PE group; however, both groups consumed amounts exceeding Dietary Reference Intakes (DRIs) for protein, carbohydrates, sugar, sodium, iron, and vitamins B1, B2, B3, B6, B12, and C. Conversely, both groups consumed amounts significantly lower than DRIs for calcium, fibre, folate, magnesium, potassium, zinc, and vitamins A, D, E, and K. The PE group ate significantly less meat and alternatives, vegetables and fruit, and fruit than the non-PE group, and did not meet any of Canada’s Food Guide (2007) recommendations. The non-PE group met recommendations for meat and alternatives only. PE impacts the dietary intake of children’s home-packed lunches; however, many packed lunches were of low nutritional quality. Focus should be placed on provision of nutritionally complete school lunches for all children.

What's for Lunch? Investigating the Experiences, Perceptions, and Habits of Parents and School Lunches: A Scoping Review

BACKGROUND

Research indicates home-packed school lunches are lower in nutritional value compared with school-provided meals. Due to the lack of a school lunch program, most of what Canadian children consume during the school day is determined by parents and caregivers through packed lunches. Despite this, little research has focused on the school lunch packing habits and attitudes of parents. The purpose of this scoping review was to improve understanding of parental perceptions, experiences, and habits with respect to home-packed school lunches.

METHODS

We conducted a scoping review of peer-reviewed and gray literature. We reviewed only studies published from January 2000 to January 2019 with a focus on parents' lunch packing habits for their school-aged children.

RESULTS

The review included 7 studies, with articles from the United Kingdom, Australia, and Canada. The studies identified 6 themes influencing parental decisions regarding what to pack in their child's lunch-school environment, food as fuel, convenience, child's influence, cost, and the lunch experience.

CONCLUSIONS

The decisions that influence what is packed in a school lunch are complex and indicate the need for support. Parents, schools, districts, and government policymakers need to work collaboratively to improve the healthiness of home-packed school lunches.

Comparing Physical Activity Behavior of Children During School Between Balanced and Traditional School Day Schedules

BACKGROUND

Some Canadian schools have modified their daily schedules from the traditional school day (TSD) schedule (two 15-minute breaks and one 60-minute break) to a balanced school day (BSD) schedule (two 40-minute breaks). While this change increases daily planning and instructional time, it also changes the amount of time available for moderate-vigorous physical activity (MVPA).

METHODS

This study uses a case-control design to examine differences in objectively measured MVPA between children in 3 schools using a BSD schedule and 3 schools using a TSD schedule. Study participants (aged 10-12 years) were recruited from schools in Ontario, Canada.

RESULTS

Regardless of schedule type, girls had lower MVPA than boys, and as both boys and girls got older their MVPA significantly decreased. The findings indicate there was no statistically significant difference in the total minutes of in-school MVPA between children from BSD schools and children from TSD schools. MVPA was significantly higher for older girls attending BSD schools than older girls attending TSD schools, suggesting that implementing a BSD may help curb declining MVPA as girls enter adolescence.

CONCLUSION

Despite encouraging findings, more rigorous studies (ie, pre-post experiments with control) are needed to better understand how changing schedules impacts children's health.

Parental Reports of Lunch-Packing Behaviours Lack Accuracy: Reported Barriers and Facilitators to Packing School Lunches

PURPOSE

Parents influence the foods their children consume and often provide proxy reports of this intake. One way parents exert this influence is by providing home-packed lunches. This study compared parental reports of foods packed in children's lunches with what was actually packed and identified parental barriers and facilitators to packing lunches.

METHODS

Grade 3 and 4 student-parent dyads (n = 321) in 19 elementary schools in Ontario participated. Parental reports and actual packed lunch contents were collected via self-administered surveys and direct observation, respectively. Parental barriers and facilitators were obtained through open and closed survey questions.

RESULTS

Median portions packed were significantly higher for sugar-sweetened beverages and snacks and significantly lower for fruits, fruit juice, vegetables, milk/alternatives, and meat/alternatives than parents reported. Packing a healthy lunch was "important/very important/of the utmost importance" for 95.9% of respondents, and 97.5% perceived their nutrition knowledge as "adequate/good/very good". Barriers to packing a lunch included: child's food preferences, time, finances, allergy policies, and food safety. Nutrition resources, observing other children's lunches, child's input, and planning ahead were identified as facilitators.

CONCLUSIONS

Strategies to improve packed lunches should move beyond parental nutrition knowledge and importance of lunch packing to address parental barriers and facilitators.

Draw and Tell: Dietary Acculturation as Lived by Black Immigrant Children of African and Caribbean Descent Residing in Canada

OBJECTIVE

Explore immigrant children's lived experience of dietary acculturation.

DESIGN

Draw and tell qualitative research.

PARTICIPANTS

A total of 167 school-aged children living in Ottawa, Canada, who had a mother born in sub-Saharan Africa or the Caribbean.

METHODS

Children made 2 drawings about foods, 1 related to Canada and the other to their home country, and explained their drawings and what they meant to them. These discussions were recorded and transcribed.

ANALYSIS

Foods were counted for each region (Canada/Africa/Caribbean). Thematic analysis was performed.

RESULTS

Most children drew different foods for Canada and their home country. Apples were the most frequently mentioned food for Canada. Pizza, juice and sugar-sweetened beverages, fries/poutine, and hamburgers were among the 10 most frequently mentioned foods for Canada, whereas none of the top 10 foods for African and Caribbean countries were highly processed. Rice, chicken, meat, and leafy vegetables were in the top 10 foods mentioned for the 3 regions. Emerging themes were food availability and variety, mothers' lack of time and fatigue, and the school eating environment.

CONCLUSION AND IMPLICATIONS

It seems that these black immigrant children experienced dietary acculturation and that changes in dietary habits have had mostly a negative impact on their diet.

Examining school-day dietary intakes among Canadian children

Understanding how dietary intakes vary over the course of the school day can help inform targeted school-based interventions, but little is known about the distribution or determinants of school-day dietary intakes in Canada. This study examined differences between school-hour and non–school-hour dietary intakes and assessed demographic and socioeconomic correlates of school-hour diet quality among Canadian children. Nationally representative data from the Canadian Community Health Survey were analyzed using 24-h dietary recalls falling on school days in 2004 (n = 4827). Differences in nutrient and food-group densities during and outside of school hours and differences in School Heathy Eating Index (School-HEI) scores across sociodemographic characteristics were examined using survey-weighted, linear regression models. Children reported consuming, on average, 746 kcal during school hours (one-third of their daily energy intakes). Vitamins A, D, B12, calcium, and dairy products densities were at least 20% lower during school hours compared with non-school hours. Differences in School-HEI scores were poorly explained by sociodemographic factors, although age and province of residence emerged as significant correlates. The school context provides an important opportunity to promote healthy eating, particularly among adolescents who have the poorest school-hour dietary practices. The nutritional profile of foods consumed at school could be potentially improved with increased intake of dairy products, thereby increasing intakes of protein, vitamin A, vitamin D, calcium, and magnesium.