Food and beverage marketing in primary and secondary schools in Canada.

BACKGROUND: Unhealthy food marketing is considered a contributor to childhood obesity. In Canada, food marketing in schools is mostly self-regulated by industry though it is sometimes restricted through provincial school policies. The purpose of this study was to document the type of food marketing activities occurring in Canadian schools and examine differences by school characteristics. METHODS: An online survey was sent to public primary and secondary schools from 27 school boards in Ontario, British Columbia, and Nova Scotia and was completed by 154 Principals in spring 2016. This survey queried the type of food marketing occurring in schools including advertisements, food product displays, fundraising, exclusive marketing agreements, and incentive programs, among others. The occurrence of food marketing was described using frequencies, medians, and ranges. Chi-square and Fisher Exact tests were conducted to assess school-level differences in the frequency of marketing activities by school type (primary versus secondary), province (Ontario versus British Columbia), and the socio-economic status of most students (low versus middle/high income). The significance level was set at α < 0.05 for all tests. RESULTS: Overall, 84% of schools reported at least one type of food marketing and the median number of distinct types of marketing per school was 1 (range 0-6). The most frequently reported forms of marketing were the sale of branded food, particularly chocolate, pizza, and other fast food, for fundraising (64% of schools); food advertisements on school property (26%), and participation in incentive programs (18%). Primary schools (n = 108) were more likely to report participating in incentive programs (25%) and selling branded food items (72%) compared to secondary schools (n = 46; 2 and 43% respectively; p < 0.01). Conversely, secondary schools were more likely to report food advertising on school property (56%), exclusive marketing arrangements with food companies (43%), and food product displays (19%) than primary schools (13, 5 and 2%, respectively; p < 0.01). CONCLUSION: The presence of food marketing in most participating schools suggests that the current patchwork of policies that restrict food marketing in Canadian schools is inadequate. Comprehensive restrictions should be mandated by government in both primary and secondary schools to protect children and youth from this marketing.

Assessing exposure to food and beverage advertisements surrounding schools in Vancouver, BC.

Recent policy initiatives call for restricting food marketing to children, yet little is known about children's current exposure to outdoor advertisements. This paper describes the prevalence and characteristics of food- or beverage-related advertisements surrounding 25 public elementary and secondary schools in Vancouver, Canada and assesses whether the informational food environment differs by neighbourhood or school characteristics. All but four schools had at least one food- or beverage-related advertisement within 400 m (median: 18, range: 0-96) and approximately 90% of food or beverage advertisements were for items not recommended for frequent consumption by provincial school food guidelines. After controlling for commercial density, secondary schools were associated with more outdoor food and beverage advertisements overall in comparison with elementary schools. The presence of an additional limited-service food outlet within 400 m was associated with a 7% increase in the number of overall advertisements (p < 0.001) while an additional grocery store was associated with fewer advertisements (IRR: 0.69, p < 0.001), controlling for commercial density. Findings suggest the need to consider the informational food environment as part of broader assessments of the school and retail food environments.

Food and Beverage Marketing in Schools: A Review of the Evidence.

Despite growing interest from government agencies, non-governmental organizations and school boards in restricting or regulating unhealthy food and beverage marketing to children, limited research has examined the emerging knowledge base regarding school-based food and beverage marketing in high-income countries. This review examined current approaches for measuring school food and beverage marketing practices, and evidence regarding the extent of exposure and hypothesized associations with children's diet-related outcomes. Five databases (MEDLINE, Web of Science, CINAHL, Embase, and PsycINFO) and six grey literature sources were searched for papers that explicitly examined school-based food and beverage marketing policies or practices. Twenty-seven papers, across four high-income countries including Canada (n = 2), Ireland (n = 1), Poland (n = 1) and United States (n = 23) were identified and reviewed. Results showed that three main methodological approaches have been used: direct observation, self-report surveys, and in-person/telephone interviews, but few studies reported on the validity or reliability of measures. Findings suggest that students in the U.S. are commonly exposed to a broad array of food and beverage marketing approaches including direct and indirect advertising, although the extent of exposure varies widely across studies. More pervasive marketing exposure was found among secondary or high schools compared with elementary/middle schools and among schools with lower compared with higher socio-economic status. Three of five studies examining diet-related outcomes found that exposure to school-based food and beverage marketing was associated with food purchasing or consumption, particularly for minimally nutritious items. There remains a need for a core set of standard and universal measures that are sufficiently rigorous and comprehensive to assess the totality of school food and beverage marketing practices that can be used to compare exposure between study contexts and over time. Future research should examine the validity of school food and beverage marketing assessments and the impacts of exposure (and emerging policies that reduce exposure) on children's purchasing and diet-related knowledge, attitudes and behaviors in school settings.

Participation in School Food and Nutrition Activities among Grade 6-8 Students in Vancouver.

This study examined student-reported participation in school food and nutrition activities in Vancouver, British Columbia (BC), and whether engagement differed by gender and between elementary and secondary school students. A cross-sectional survey of grade 6-8 public school students (n = 937) from 20 elementary and 6 secondary schools assessed student-reported participation in a range of food and nutrition activities. Statistical analyses included descriptive statistics and multilevel logistic regression to examine associations between participation with gender and school type. Overall, <50% of students reported engaging in most of the food and nutrition activities examined in the 2011-2012 school year, including: food preparation (36%), choosing/tasting healthy foods (27%), learning about Canada's Food Guide (CFG) (45%), learning about foods grown in BC (35%), gardening (21%), composting (32%), and recycling (51%). Females were more likely to report recycling and learning about CFG and BC-grown foods (P < 0.05). Secondary students were more likely to report activities focused on working with or learning about food/nutrition (P < 0.05). Despite local and provincial efforts to engage students in food and nutrition experiences, participation in most activities remains relatively low, with few students exposed to multiple activities. Continued advocacy is needed from the dietetics community to improve student engagement in food and nutrition activities.

A Comparison of Dietary Practices at or En Route to School between Elementary and Secondary School Students in Vancouver, Canada.

BACKGROUND: There is evidence that dietary quality declines as children age in North America, but few studies have explored whether food environment exposures in secondary schools as opposed to elementary schools are associated with changes in students' school-day food choices. METHODS: This study examined differences in dietary practices (at or en route to and/or from school) between students in their last years of elementary school (grades 5 to 7) and first year of secondary school (grade 8) in Vancouver, Canada, controlling for sociodemographic characteristics and school-level socioeconomic status. Demographic characteristics and dietary data were collected through a cross-sectional survey (n=950 from 26 schools) and combined with school-level socioeconomic data derived from the 2006 Canadian Census. RESULTS: Multilevel logistic regression analyses indicated that secondary school students were significantly more likely to report daily consumption of fast foods (odds ratio=1.92; 95% CI 1.18 to 3.12) and minimally nutritious packaged snacks (eg, candy or chocolate bars) (odds ratio=1.60; 95% CI 1.05 to 2.45), and to report regular purchases from off-campus retailers (odds ratio=1.63; 95% CI 1.10 to 2.42). Gender, food insecurity, lower acculturation to Canada, and access to more weekly spending money were associated with nutritionally poor practices. Students attending schools drawing from lower-income neighborhoods were also significantly more likely to consume fast foods and packaged snacks daily. The majority of students sampled did not report consuming healthy foods, such as fruit and vegetables, daily at or en route to and/or from school. Intake of fruit, vegetables, and low-fat milk did not differ significantly between elementary and secondary school students. CONCLUSIONS: Findings suggest that research and intervention strategies should address modifiable school-level exposures and policies to improve dietary practices for both elementary and secondary school-aged youth, while at the same time addressing sociocultural factors associated with eating behavior.

Sustainability and public health nutrition at school: assessing the integration of healthy and environmentally sustainable food initiatives in Vancouver schools.

OBJECTIVE: To describe the development and application of the School Food Environment Assessment Tools and a novel scoring system to assess the integration of healthy and environmentally sustainable food initiatives in elementary and secondary schools. DESIGN: The cross-sectional study included direct observations of physical food environments and interviews with key school personnel regarding food-related programmes and policies. A five-point scoring system was then developed to assess actions across six domains: (i) food gardens; (ii) composting systems; (iii) food preparation activities; (iv) food-related teaching and learning activities; and availability of (v) healthy food; and (vi) environmentally sustainable food. SETTING: Vancouver, Canada. SUBJECTS: A purposive sample of public schools (n 33) from all six sectors of the Vancouver Board of Education. RESULTS: Schools scored highest in the areas of food garden and compost system development and use. Regular integration of food-related teaching and learning activities and hands-on food preparation experiences were also commonly reported. Most schools demonstrated rudimentary efforts to make healthy and environmentally sustainable food choices available, but in general scored lowest on these two domains. Moreover, no schools reported widespread initiatives fully supporting availability or integration of healthy or environmentally sustainable foods across campus. CONCLUSIONS: More work is needed in all areas to fully integrate programmes and policies that support healthy, environmentally sustainable food systems in Vancouver schools. The assessment tools and proposed indicators offer a practical approach for researchers, policy makers and school stakeholders to assess school food system environments, identify priority areas for intervention and track relevant changes over time.

Food and beverage promotions in Vancouver schools: A study of the prevalence and characteristics of in-school advertising, messaging, and signage.

The purpose of this study was to provide a descriptive profile of food-related advertising, messaging, and signage in Vancouver schools and to examine differences in the prevalence and characteristics of promotions between elementary and secondary schools. All food-related promotions were photographed in 23 diverse Vancouver public schools between November 2012 and April 2013. Key attributes, including the location, size, and main purpose of each promotion, as well as the type of food and/or beverage advertised and compliance with provincial school nutrition guidelines, were coded. Descriptive statistics assessed the prevalence and characteristics of promotions. Cross-tabulations examined whether the promotional landscape differed between elementary and secondary schools. All secondary and 80% of elementary schools contained food or beverage promotions (median = 17, range = 0-57 promotions per school). Of the 493 promotions documented, approximately 25% depicted "choose least" or "not recommended" items, prohibited for sale by provincial school nutrition guidelines. Nearly 1/3 of promotions advertised commercial items (e.g., brand name beverages such as Pepsi), in violation of the Board of Education's advertising policies and only 13% conveyed nutrition education messages. Close to half of all promotions were created by students for class projects, many of which marketed minimally nutritious items. In Vancouver schools, food-related promotions are common and are more prevalent in secondary than elementary schools. Students are regularly exposed to messaging for nutritionally poor items that are not in compliance with provincial school nutrition guidelines and which violate school board advertising policies. Stronger oversight of food-related promotional materials is needed to ensure that schools provide health promoting food environments.

Associations between socio-economic status and school-day dietary intake in a sample of grade 5-8 students in Vancouver, Canada.

OBJECTIVE: To examine associations between students' socio-economic status (SES) and school-day dietary intake, and the roles of parents and peers in shaping these associations. DESIGN: A cross-sectional survey measured school-day intake of vegetables, whole grains, low-fat milk, packaged snack foods and sugar-sweetened beverages. Logistic regression models examined associations between SES (parental education and food insecurity status) and dietary outcomes during or en route to or from school, and examined whether peer modelling or parental norms potentially mediated the associations between SES and dietary outcomes. SETTING: Twenty-six public schools in Vancouver, Canada in 2012. SUBJECTS: Nine hundred and fifty students in grades 5-8. RESULTS: Students whose parents completed some college, compared with those completing high school or less, were significantly more likely to consume vegetables daily (unadjusted OR = 1.85; 95 % CI 1.06, 3.22) and students whose parents completed college or university were significantly less likely to consume sugar-sweetened beverages daily (unadjusted OR = 0.67; 95 % CI 0.47, 0.94). Food secure students were also significantly less likely to consume sugar-sweetened beverages daily compared with food insecure students (unadjusted OR = 0.52; 95 % CI 0.29, 0.92). Parental norms, but not peer modelling, emerged as a potential mediator of the association between SES and vegetable intake. SES was not significantly associated with the remaining dietary outcomes. CONCLUSIONS: Higher SES was significantly associated with two of five school-day dietary outcomes and predicted higher likelihood of daily nutritious food choices at school. The present study suggests that there is room for improvement in school-day dietary quality for students from all SES backgrounds in Vancouver.

Attention to food and beverage advertisements as measured by eye-tracking technology and the food preferences and choices of youth.

The purpose of this study was to examine how objective measures of attention to food/beverage advertising were associated with the unhealthy food/beverage preferences and choices of children and adolescents. A self-report survey and eye-tracking session were completed by 102 youth (mean age=11.6 years; 56.4% were white; 43.1% were female) between April and November 2010. Participants viewed 40 food/beverage advertisements on a computer and their eye movements were recorded. Objective attention measures included total viewing time, fixation length (time spent viewing characters/logos, unhealthy food/beverage items), and fixation count (number of times an individual stops to examine characters/logos, unhealthy food/beverage items). Food/beverage preferences and choices were measured by self-report. The preferences index summed responses to 12 questions measuring snack food and sugar-sweetened beverage preferences and the choices index summed responses to eight questions measuring consumption of snack foods and sugar-sweetened beverages. Regression models examined whether attention to food/beverage advertising was associated with food preferences and choices, controlling for sex, age, and body mass index z score. The length of time and number of times participants looked at unhealthy food and beverage items within advertisements were each significantly associated with unhealthy food/beverage preferences of youth (P<0.05). Associations were no longer significant after controlling for demographic characteristics. Attention to advertising was not significantly associated with food/beverage choices. Research with larger samples is needed to more fully understand the role of attention. Future research should also examine the association between attention to advertising and purchase requests, given the important role of parents in the decision-making process surrounding food choice.

Characteristics and behaviors of non-overweight college students who are trying to lose weight.

The purpose of the current study was to examine characteristics and behaviors of college students who perceive themselves as underweight or about the right weight, yet report trying to lose weight, as compared to their counterparts. Participants included 944 students (M = 20.4 years, 61.1 % White; 64.7 % female) at a southwestern university. A composite of perceived weight and weight-related behavior was created. Participants who reported they were under- or about the right weight and trying to lose weight were included in this composite group. Cross-sectional logistic regression analyses were run to assess characteristics and behaviors of the composite group. Individuals in this group were significantly more likely to be women, in a fraternity/sorority, have a lower body mass index, engage in regular vigorous physical activity, exercise and/or diet to lose weight, and engage in unhealthy weight-control behaviors. These individuals were not more likely than their counterparts to consume 5 or more servings of fruits/vegetables daily, to engage in moderate physical activity, or to report smoking cigarettes in the past month. Further research is needed to understand why individuals who perceive themselves as under- or about the right weight engage in certain weight-loss behaviors. Interventions to target weight-related perceptions and behaviors among college-age individuals may need to address unhealthy weight-control measures.

Who uses snus? A study of Texas adolescents.

INTRODUCTION: Snus, a smokeless tobacco product, was introduced in the United States in 2006. Because it is available in a variety of flavors and is relatively easy to conceal, snus might be particularly attractive to adolescents. Yet, no studies have examined snus use in U.S. adolescents. This brief report examined (a) differences between adolescent snus users and non-snus users on a variety of demographic, behavioral, and intrapersonal factors and (b) prevalence of snus use among current users of various other tobacco products versus nontobacco users. METHODS: Participants were 8,472 6th- to 12th-grade students who voluntarily completed the 87-item Texas Youth Tobacco Survey during class time. RESULTS: Overall, 7.1% of students reported ever trying snus; of these, 77% were male, 68% were in high school, and 46% were White. Mixed-effects regression models indicated that the prevalence of cigarette, chew, cigar, and alcohol use was higher among snus users than among non-snus users. Compared with non-snus users, snus users performed more poorly in school and perceived snus, cigarettes, chew, and cigars to be less dangerous. Finally, current users of cigarettes, chew, and cigars had a higher prevalence of snus use than did their peers who did not use the respective products. CONCLUSIONS: Among U.S. adolescents, snus use may be part of a constellation of health compromising behaviors. Additional research is needed to determine who is using snus and identify the determinants and consequences of snus use, all of which can inform interventions and policies aimed at decreasing tobacco use among youth.

Youth substance use and body composition: does risk in one area predict risk in the other?

Both substance use and obesity are prevalent among youth. As youth age, substance use rates increase and over the past three decades, obesity rates among youth have tripled. While these two factors have both short- and long-term health impacts, little research has explored how substance use and obesity among youth may be related. This study explores the bi-directional longitudinal relationships between substance use and body composition. Participants (N = 704; 50.7% female) were mostly white (86.4%) with a baseline mean age of 14.7 years. Objectively measured body composition was used to calculate body mass index z-scores (BMI z-score) and percent body fat. Cross-lagged structural equation models, accounting for clustering at the school level, were run to determine the longitudinal association between body composition and self-reported substance use (alcohol, cigarette, and marijuana), adjusting for socio-demographic characteristics, pubertal status, and weight satisfaction. Baseline alcohol use predicted decreased BMI z-score at follow-up and a similar association with percent body fat approached significance. Baseline cigarette use predicted increased percent body fat. No longitudinal associations were seen between baseline body composition and future substance use. Our results suggest that substance use contributes to subsequent body composition; however, body composition does not contribute to subsequent substance use. Continued research that explores these relationships longitudinally is greatly needed.

Associations between energy drink consumption and alcohol use behaviors among college students.

BACKGROUND: To explore associations between energy drink consumption and alcohol use among college students. METHODS: Participants included 585 students (m age=18.7; 47.0% White, 21% Hispanic, 25% Asian, 7% other race/ethnicity; 56.0% female). Energy drink behaviors included past month and past week consumption. Alcohol use behaviors included past month and past two week consumption, as well as heavy drinking and quantity of alcohol consumed. Consumption of energy drinks mixed with alcohol was also measured. Linear and logistic regression analyses between energy drink consumption and alcohol use were run controlling for gender, age, and race/ethnicity. RESULTS: For each one unit increase in past month (i.e., additional day used) energy drink use, the likelihood of past month alcohol use increased by 80%, heavy drinking by 80% and past month energy drinks mixed with alcohol use by 90%. Similar results were found for past week energy drink use. A positive relationship between energy drink use and quantity of alcohol consumed during a single episode of drinking was also found (p<0.001). Significant gender interactions between energy drink consumption and alcohol use as well as quantity of alcohol consumed were found, with relationships stronger among males than females. There were no significant interactions by race/ethnicity. CONCLUSIONS: Energy drinks are readily available to students and pose potential health risks. Students who report greater energy drink consumption also consume more alcohol, are more likely to mix energy drinks and alcohol, and experience heavy episodes of drinking, which is problematic given the potential negative consequences of these drinks.

Are adolescents' perceptions of dietary practices associated with their dietary behaviors?

Despite interventions designed to change behavior, many adolescents continue to consume unhealthy foods. Dietary patterns are important for disease prevention, making it necessary to understand the reasons for these poor choices. This cross-sectional study explored the relationship between perception of dietary practices and dietary behaviors among adolescents. Participants (n=15,283; mean age=15 years; 50.7% female) completed the 2004-2005 Texas School Physical Activity and Nutrition survey. Perception of dietary practices included fat content of foods usually eaten and healthiness of usual eating habits. Dietary behavior was measured by self-report of foods eaten the day before survey administration. Composite scores of unhealthy and healthy eating were created. Regression analyses examined whether perception of dietary practices was consistent with actual dietary behavior, controlling for sex, grade, and race/ethnicity, and accounting for the complex sampling design. Higher perceived fat content was associated with increased consumption of unhealthy foods, while higher perceived healthiness of eating was associated with increased consumption of healthy foods. For perceived fat content, the difference in the Healthy Eating Index between extreme categories was 26% (P<0.001), while the difference in the Unhealthy Eating Index between extreme categories was 81% (P<0.001). For perceived healthiness, the difference in the Healthy Eating Index between extreme categories was 23% (P<0.001), while the difference for the Unhealthy Eating Index was 44% (P<0.001). Self-perceptions of dietary practices were significantly associated with dietary behaviors, indicating awareness about the relative nutrient content of foods consumed. Interventions that move beyond dietary knowledge and create changes in the social and physical environment are needed.

Differential prevalence of alcohol use among 2-year and 4-year college students.

PURPOSE: To determine whether alcohol use behaviors and alcohol-related consequences differed among students attending two-year versus four-year colleges. METHODS: Participants (N=13,700) from 7 two-year and 11 four-year colleges completed the 2010 College Student Health Survey. Alcohol use behaviors included past year alcohol use, past month alcohol use, and binge drinking over the past two weeks. Alcohol-related factors included average calculated blood alcohol level and average number of alcohol-related consequences. Cross-sectional mixed-effects regression analyses were conducted to determine if the prevalence of alcohol-related behaviors and consequences differed among two-year and four-year students. RESULTS: Students attending four-year colleges, particularly males, were more likely to report past year alcohol use, past month alcohol use, and binge drinking, as well as a higher average blood alcohol content and a greater number of alcohol-related consequences than their two-year counterparts (p<0.05). Among female students there were fewer differences between two-year and four-year college students. Many differences remained after adjusting for socio-demographic factors (e.g., age, race/ethnicity), however, with the addition of living situation as a covariate, several of the differences among males were no longer significant. CONCLUSIONS: Significant differences in alcohol-related behaviors and consequences exist among students attending two-year versus four-year colleges. While the prevalence of alcohol-related behaviors and consequences was lower among two-year college students, they are not a population to be over-looked. The prevalence of alcohol use remains high among both two-year and four-year college students, making it important for researchers to design appropriate interventions for all students regardless of the type of institution being attended.

Do high-risk urban youth also have older friends?

PURPOSE: The purpose of this study was to explore how behavioral, intrapersonal, and socio-environmental factors were associated with the likelihood of having at least one older friend. METHODS: Participants included 3,709 ethnically diverse eighth grade students in the Project Northland Chicago intervention trial. Socio-demographic characteristics included gender, family composition, language spoken at home, race/ethnicity, and age. Behavioral factors included cigarette, alcohol, and marijuana use, depressed feelings, willingness to wear alcohol-branded merchandise, and violent and delinquent behavior. Intrapersonal factors included low refusal self-efficacy, and outcome expectations and expectancies. Socio-environmental factors included alcohol offers and access, normative estimates and expectations, and peer alcohol use. Having an older friend was defined as having at least one friend aged 16 years or older (students' mean age = 14.2). Logistic mixed-effects regression models were used and controlled for gender, race/ethnicity, treatment status, and age. RESULTS: Adolescent girls and older eighth graders were significantly more likely to have at least one older friend. Students who scored higher on all the behavioral, intrapersonal, and socio-environmental risk factors were significantly more likely to have at least one older friend. Significant gender interactions were found for several of the relationships. CONCLUSION: Overall, this study showed that multiple risk-related factors are associated with having older friends in eighth grade. Particularly important factors appear to be cigarette, marijuana and alcohol use, having friends who use alcohol, having increased alcohol offers, and being willing to wear or use alcohol-branded merchandise.

Weight misperception and health risk behaviors among early adolescents.

OBJECTIVES: To examine associations between weight misperception and youth health risk and protective factors. METHODS: Three thousand ten US seventh-graders (72.1% white, mean age: 12.7 years) self-reported height, weight, risk, and protective factors. Analyses were conducted to determine cross-sectional and longitudinal associations between weight overestimation and health risk and protective factors. RESULTS: Risk and protective factors had significant cross-sectional associations with weight overestimation. However, only depressive symptoms and reduced optimism predicted weight overestimation in eighth grade. Weight overestimation did not predict engagement in risky behaviors. CONCLUSIONS: Weight overestimation and risk factors appear to co-occur, suggesting a constellation of risk that warrants further research.