THE SCHOOL NUTRITION ENVIRONMENT: EXAMINING THE CONTEXT OF A HEALTH PROMOTION INTERVENTION

Abstract

<p>Obesity is a major public health issue across all age groups. The obesity-related health outcomes of children and adolescents are unique and varied, and therefore need to be studied separately. In response, obesogenic environments have been the focus of attention in recent research. Important contributions have been made to focus on social (e.g., economic) and physical (e.g., geographical) environments based on their role in either hindering or facilitating opportunities for healthy eating. However, research on the policy environment is noticeably absent. Schools have been the setting for focused interventions, particularly in the area of obesity and nutrition. However, there is a paucity of research in this area in Ontario, and virtually no Canadian research has examined the secondary school setting. Therefore, this research focuses on local level factors shaping school nutrition policy implementation in Ontario, Canada.</p> <p>The Analysis Grid for Environments Linked to Obesity (ANGELO) Framework was adopted to organize and conceptualize the local level policy environment. In the first phase of the study, a documentary analysis was undertaken to investigate the relationship between regional and upper level policies and technical reports. Results reveal distinct differences across federal, provincial and regional levels, including: 1) the availability of nutritious food in schools and having nutrition education as part of the curriculum were key components of the physical environment across federal and provincial levels; 2) federal and provincial priorities are guided by a health promotion framework, and a partnership approach to policy implementation; and, 3) gaps in regional level policy include incorporating nutrition education in the curriculum, and making the link between nutrition and obesity.</p> <p>The second phase of study includes qualitative key informant interviews with community-and school-level school nutrition policy and program stakeholders (n=22) in nine schools three Ontario school boards, in order to understand local level factors shaping school nutrition policy implementation. The cost of healthy food for sale, revenue loss (economic), proximity of schools to off site food outlets (physical), the restrictive nature of policy, and the role of key stakeholders (political), the role of stigma and school culture (sociocultural), act as local level barriers to policy implementation. Findings suggest the need for consultation and communication between stakeholders, and strategies to reduce stigma and improve the school nutrition culture.</p> <p>In the third and final phase of study three focus group interviews were conducted with secondary students (n=20) in two Ontario school boards in fall 2012. School boards were selected to represent both high-and low-income neighbourhoods. Results reveal high priced policy-compliant food for sale, lower revenue generation capacity, and more students purchasing food off-campus at nearby outlets. Limited designated eating spaces, and time constraints act as local level barriers to healthy eating. Student input on cafeteria menus and school community gardens, can facilitate healthy school nutrition environments. Community partnerships with key external stakeholders are needed to leverage financial and human resources to support school nutrition. Future policies need to consider the social context and conditions surrounding school nutrition. This research makes a number of theoretical, methodological and substantive contributions to the public health, adolescent health, and school health policy literature. Policy implications and future research directions are provided.</p>