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 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

 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.

 Provincial/Territorial school nutrition policies  School food programs  Food and nutrition in Aboriginal schools  Farm to School Initiatives in Canada  TBD

 Developments  Research  Analysis  Evaluation  Recommendations

 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 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

 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: ◦ nce_doc_presentation_slides_feb pdf nce_doc_presentation_slides_feb 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.

 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 (n=125) Vending66 Snack bars45 Cafeterias36 Fundraising10 Special events8

 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

 2007/8 – surveys of grade 7-12 students  2007/8 – school surveys Student ConsumptionOdds Ratio Odds of higher consumption of sugar sweetened beverages (SSBs) were higher in schools where they were available 1.15 ( ) Students reporting increased consumption of less healthy foods had higher odds of overweight 1.03 ( ) Students had greater odds of being obese where SSBs were available 1.50 ( )

 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  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

 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  Analysis ◦ Vine & Elliot, Health Promotion Practice, 2013 ◦ Vine & Elliot, Public Health Nutrition, 2013  Evaluation in PEI ◦ s/Hernandez.pdf s/Hernandez.pdf