Healthy Eating Healthy Living Program 2000

School-based healthy eating initiatives: Recommendations for success

Tracey Setter Antigone Kouris-Blazos Mark Wahlqvist

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Healthy Eating Healthy Living Program 2000

Professor Mark Wahlqvist, Director Dr. Antigone Kouris-Blazos, Co-Director Ms Tracey Setter, Project Officer Healthy Eating Healthy Living Program (Appendix 2) C/O Asia Pacific Health & Nutrition Centre Monash Asia Institute, level 8, Menzies Building Wellington Road, Clayton, Victoria 3800 URL: http://www.healthyeatingclub.com Email: [email protected]

Other monographs in this series (Appendix 2): Wood B, Ross K, Kouris-Blazos A. Healthy Eating for Nutritionally Vulnerable Groups. Some Health Promotion Initiatives. Healthy Eating Healthy Living Program, Monash University, Victoria 2000. Gill T, Setter T, Kouris-Blazos A, Wahlqvist M. Healthy Weight and Physical Activity Interventions in Victoria: the current situation and recommendations for the future. Healthy Eating Healthy Living Program, Monash University, Victoria 2000.

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Healthy Eating Healthy Living Program 2000

Acknowledgments

The authors acknowledge the contribution made by the co-ordinators and staff of organizations who assisted us in the search for this material. This collection is not complete and could never be so. If we have inadvertently omitted a program report we will be pleased to review it for inclusion on the HEHLP website (www.healthyeating.org). The recommendation is made to conduct a prospective review of programs in the future. The Healthy Eating Healthy Living Program was funded by the Victorian Health Promotion Foundation (VicHealth) for this purpose.

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Healthy Eating Healthy Living Program 2000

Contents SUMMARY .................................................................................................................... 5 INTRODUCTION.................................................................................................................... 8 WHY USE THE SCHOOL AS A SETTING FOR NUTRITION EDUCATION?............ 9 AIMS AND OBJECTIVES ................................................................................................... 10 METHODS ............................................................................................................................. 11 RESULTS................................................................................................................................ 14 A)

CANTEENS ........................................................................................................................ 15 Strengths and weaknesses ................................................................................................ 15 Barriers ............................................................................................................................ 16 Outcomes.......................................................................................................................... 16 Evaluation ........................................................................................................................ 17 Future implications .......................................................................................................... 17 B) CURRICULUM .................................................................................................................... 18 Strengths and Weaknesses................................................................................................ 18 Barriers ............................................................................................................................ 19 Outcomes.......................................................................................................................... 20 Evaluation ........................................................................................................................ 21 Future Implications .......................................................................................................... 21 DISCUSSION ......................................................................................................................... 22 A) CANTEENS ........................................................................................................................ 25 B) CURRICULUM (AND POLICY) ............................................................................................. 26 C) COMBINATION OF CANTEEN AND CURRICULUM ................................................................ 27

THE HEALTH PROMOTING SCHOOLS APPROACH................................................. 27 ESSENTIAL ELEMENTS OF SCHOOL PROGRAMS ................................................... 28 RECOMMENDATIONS AND CONCLUSIONS ............................................................... 29 REFERENCES ....................................................................................................................... 33

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Healthy Eating Healthy Living Program 2000

Summary The role of nutrition education in schools has long been a contentious issue. Nutrition is often cast aside in favour of subjects perceived to be of greater importance such as English and mathematics. Nutrition programs when implemented in schools, often receive little funding, time and support, so it becomes difficult to run a program, especially an efficient and effective program. As such researchers, project officers and teachers are often faced with an information deficit when it comes to designing, implementing and evaluating a nutrition program in a school. The authors of this report attempt to break down the barriers of information dissemination regarding healthy eating programs in schools, with a view to providing recommendations to ensure success. The main focus was on nutrition programs run in Victorian and Australian schools from 1990-2000, while also drawing on the experience of programs implemented in other countries. The report is broken into two sections; one section focuses on canteen-based program, while the other focuses on curriculum-based programs. Results indicate that it is more effective to implement a program across the entire school that includes both the canteen and the curriculum, and the school environment as a whole; canteens can sell only healthy foods and still be very profitable; and practical, hand-on lessons such as cooking are the most effective way for students to learn. It was also apparent that Victoria seems to be lacking with regards to nutrition education in comparison with other Australian states. Key recommendations emerging from this review have been stated below: 1. One-off unsupported interventions, such as talks by health professionals, are ineffective

(2)

.

Nutrition education needs to be sequential and implemented in every year level from kindergarten to year 12.

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Healthy Eating Healthy Living Program 2000

2. Establishment of a central system or database in Victoria where teachers and project officers can access details on all nutrition education programs implemented in schools. A government funded centre that can act as a clearinghouse would be ideal. The Healthy Eating Information Web-Centre has begun the clearinghouse process by making information about healthy eating programs available on the Internet (http://www.healthyeating.org/health-professionals/projects.htm). The availability of these programs in such a centre (or library) would reduce the incidence of teachers having to design an entire program or develop a curriculum from scratch because they would be able to get at least an idea of the elements they need to include to ensure success.

3. Establish a team of project officers to design, implement and evaluate nutrition education programs for Victorian primary and secondary schools. Many Health Promotion graduates have difficulty finding a job, but graduate positions such as these would be ideal and would allow them to put the skills they learnt at university to use.

4. All states of Australia should have a canteen accreditation program run by its state canteen association. If it were compulsory for all Australian canteens to be accredited, then we would be well on the way to creating healthy schools for our children because the canteen is an effective way to improve the eating habits of children while they are at school.

5. Explore other avenues to communicate the nutrition message. Using other classes as an outlet to teach nutrition to students may be as effective as having a specialised health or nutrition class. For example, computer classes are one of the most favoured by students and so could be an ideal way for children to

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Healthy Eating Healthy Living Program 2000

learn about nutrition in a practical and hands-on environment. Interactive computer based learning is ideal when teacher time is limited and allows children to move at their own pace (6, 43).

6. Train and educate teachers about nutrition on a regular basis. In most cases it is the classroom teacher who teaches the students about nutrition. It is therefore logical that they receive appropriate training and support. In-service training programs that allow time release for teachers would be the most appropriate because it would mean that teachers do not have to take time out of their already busy schedule to attend training. Due to time constraints on both teachers and the curriculum, nutrition education goals and objectives need to be clear so that the few hours that are spent on nutrition education are spent as productively as possible (31).

7. Encourage Home Economics classes in schools. Studies have shown that cooking skills seem to be diminishing in today’s youth (42)

, so eliminating home economics from the curriculum would just be a step back

in teaching important life skills to students. More studies are needed to demonstrate whether learning how to cook actually increases cooking skills, and in addition, whether eating habits improve as a result of increased cooking skills.

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Healthy Eating Healthy Living Program 2000

Introduction The last few decades have seen much activity in health promotion in schools. Health education is a very contentious issue with regards to school curriculum

(1)

, and has

had to fight for many years for time in the school curriculum and for resources within schools

(2)

. Health and nutrition have often been cast aside in favour of subjects

perceived to be of more importance such as English, mathematics and physical education, however, good nutrition results in good health and ultimately prevention of disease. Prevention of health problems is likely to cost less than treatment in the long run

(3)

, which suggests that health must be seen to be of greater importance in the

school curriculum than is currently the case. Nutrition education in schools will ultimately result in a more knowledgeable and healthier population. Each individual has something to gain from incorporating nutrition education into the school curriculum. Students would be happier and healthier and miss less days of school (thus increasing knowledge); parents would not have to take days off work to care for sick children; businesses, whether large or small, would have decreased absenteeism and thus decreased costs (don’t have to replace absent staff) and increased profit. Overall the population would be healthier and rates of obesity, diabetes, cardiovascular disease, and other associated diseases would decrease thus reducing the burden on the health system. As such, the Australian Government should aim to influence the food supply through nutrition education and improved relationships with health, education, and industry and consumer bodies (4).

Health and education are very closely linked

(2)

. Recent reports have suggested that

children learn better if they are healthy, and are more successful academically

(3)

. If

children are not well nourished or are hungry they may lack concentration and be disruptive in class, they may also be late or absent from school more days than adequately nourished children, and may also experience learning difficulties (2,5).

Eating behaviours are generally formed in childhood so it is important to teach children how to choose healthy foods

(6)

and why nutrition is important in the

formative years. Recent reports suggest that children learn better and more quickly if

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Healthy Eating Healthy Living Program 2000

they are healthy

(7)

. As such, food plays an important role in the life of a child. Not

only does it provide them with the nutrients essential for growth and development, but many celebrations or cultural events also centre around consumption of or abstinence from food

(8)

. Family resources such as income and proportion of money spent on

food may also play a large role in influencing children’s attitudes toward food and food preferences (1). Literature that evaluates nutrition programs in schools is limited and patchy (2,5). It is not uncommon for school nutrition programs to remain unevaluated, which may be due to limited funds or resources, or even to a lack of health promotion knowledge. Many schools implement nutrition programs without reading past literature or program reports (5) and so may develop a program identical to one in the past, with no warning of possible weaknesses to their method or barriers to the program. The basis of this report is to attempt to break down the barriers of information dissemination regarding healthy eating programs in schools, with a view to providing recommendations to ensure success. Currently, there appears to be no research that has looked into the differences in the education and health outcomes between schools who have adopted a health promoting schools approach and those who teach health mostly in the classroom

(7)

. Information such as this (if available) needs to be more

accessible to health professionals and teachers who may be running these programs in schools. Why use the school as a setting for nutrition education? The school is an ideal setting to conduct health promotion programs because children spend the majority of their time at school, sometimes more time than they spend with their parents. The school is the biggest influence in children’s lives next to the family (3)

. During the school years (especially at primary school) children’s minds and bodies

are still forming so they are more receptive to health messages at this age (9). Schools provide close contact with the teacher (especially in primary schools) and can reach all children regardless of socio-economic status, ethnicity or location (2). As such, the school is naturally an ideal place to conduct nutrition education programs (10).

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Healthy Eating Healthy Living Program 2000

Childhood is a critical time for establishing healthy eating habits and behaviours

(11)

,

and if children are taught how to choose healthy, nutritious foods early in life, they are more likely to continue these behaviours into adulthood. It is now thought that promoting positive health attitudes and behaviours at an early age may be more effective than attempting to change established health-compromising behaviours at a later age

(12)

. If positive health behaviours are not taught at school, children have a

greater risk of developing disease later in life (5). Families increasingly have two working parents, or one-parent families, and more children are buying their lunch at school or making their own at home

(1)

.

Convenience and fast foods are also now more available than they used to be, and as a result, parents are increasingly unable to monitor their children’s food habits

(6)

, so it

is important that children have the knowledge and ability to choose healthy foods themselves. Aims and Objectives The aims of this report are: 1. To report on the evidence base for effective health promotion initiatives on healthy eating relating to Victorian and Australian schools. 2. Outline the current situation in Victoria with regards to healthy eating initiatives in schools in a) canteens and b) curriculum. 3. To provide recommendations based on available evidence from Australia and overseas, of the essential components of healthy eating programs to ensure success. 4. To make the programs assessed available on the ‘Healthy Eating Information Web-Centre’ at http://www.healthyeating.org/health-professionals/projects.htm Research questions to be answered in this assessment are: •

Is it adequate for schools to implement only a canteen-based intervention, or should it be implemented in conjunction with a curriculum-based intervention?

•

Is it better for canteens to sell only healthy foods or can they also sell some ‘junk’ food?

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Healthy Eating Healthy Living Program 2000

•

Is there evidence that indicates that practical, behaviourally based interventions (such as those that teach cooking skills) are more effective than theoretical knowledge based interventions?

Methods The first criterion for inclusion in the assessment was that the programs had to be run in Australian primary or secondary schools within the specified timeframe (19902000). Programs had to be based on healthy eating/nutrition and have a canteen or curriculum focus, or a combination of the two.

A comprehensive search for appropriate programs was conducted using various methods. Medline and the Health Education And Promotion System (HEAPS) were searched as well as the VicHealth Grant Management Scheme. Search terms used were: healthy eating, schools, nutrition, health education, canteens, children, and curriculum. Reference lists from sourced articles were searched manually for further references, and many programs were also found using personal contacts and project officers. Relevant professional journals were searched, as was a comprehensive compilation by the National Heart Foundation and Anti-Cancer Council of Victoria of unpublished studies (13).

Once collected, program information was recorded using a specific outline, which was completed in table format. The details taken from each study and adapted for the online directory are outlined in table 1 below:

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Healthy Eating Healthy Living Program 2000

Title of program

Key findings identified by authors

Authors

Future implications

Reference description

Strengths identified by authors

Key words

Weaknesses identified by authors

Abstract/annotation/report summary

Barriers identified by authors

Stated aims/goals of the program

Outcomes

Year conducted

Unexpected outcomes Was an evaluation carried out? If

Methods

yes, what type?

Study design and setting

Contact address

Description of population group Table 1: Details examined in programs assessed.

If a detail was not identified, it was recorded as ‘not stated’. In order to eliminate bias and judgement, the programs were assessed using the author’s identification of strengths, weaknesses, outcomes, key findings, and barriers. It is understood that project officers may have a biased view of the success of their program, especially if the only evaluation carried out was by anecdotal evidence or observation. External evaluators are less likely to be biased; however in many cases, programs conducted in schools do not have the available funding to employ an external evaluator. Due to a lack of Victorian based nutrition interventions; programs from other Australian states were also assessed. In addition, some overseas programs were drawn upon for information about elements of success and recommendations for future programs. Overall, 16 programs were assessed with only 4 being Victorian. The programs reviewed and included in the online directory are as follows: Victorian: •

Foodsmart – National Heart Foundation (App 1a).

•

Healthy Eating – Healthy Schools Project (App 1b).

•

Healthy Eating in Schools (App 1c). 12

Healthy Eating Healthy Living Program 2000

•

Visy Care’s Healthy Eating to Start the Day (App 1d).

Other Australian States: •

Working Health into Armidale High (App 1e).

•

Body Owner’s Manual Intervention Trial (App 1f).

•

Breads and Cereals – Good Tucka – we tried them! (App 1g)

•

An empowerment approach to school-based nutrition education (App 1h).

•

Fairburn school canteen project (App 1i).

•

Introduction to Good Nutrition for Primary School Students. Gilles Street School Nutrition Program (App 1j).

•

Hunter Region Health Promoting Schools Project (App 1k).

•

Munchiecard. Smart and healthy, the school of the future (App 1l).

•

Seaford School Canteen Support Project (App 1m).

•

‘Cool’ Canteens Accreditation Program (TASCAP) (App 1n).

•

Western Australian School Canteen Project (WASCA) (App 1o).

•

Accreditation 2000 (NSWCA) (App 1p).

Some programs were unavailable because they were not formally evaluated and therefore no report was written up, or because the report was not available for public distribution. A large amount of back up literature was also examined. This included government reports and other articles such as review articles, with a large number of these being from overseas studies. The following articles and reports were utilised as background and supporting reference material: •

24 Australian articles, books and guideline documents (1-8, 11-27).

•

16 overseas review articles (mainly US) (6, 9, 10, 30-33, 38-45, 55, 57).

•

14 published program reports from overseas programs (mainly US) (34-39, 46-54).

The programs assessed in this review are attached in Appendix 1 and can also be accessed

on

the

‘Healthy

Eating

Information

Web-Centre’

at

http://www.healthyeating.org/health-professionals/projects.htm. They can be searched by keyword, setting or location and provides a short outline of the programs as well as contact details of the organization that ran the program.

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Healthy Eating Healthy Living Program 2000

Results The two main areas that school nutrition programs address are the curriculum and the canteen. Integration of health and nutrition into the curriculum is the most common method used to increase children’s knowledge, and a healthy canteen can reinforce the ideas taught in the classroom. Results from programs dealing with these two areas are explained in more detail below.

A number of difficulties were encountered in the collection of data. Many programs were not yet fully implemented, some were not adequately evaluated (some were not evaluated at all), several did not have a written report, outcomes were vague, and some did not incorporate a follow-up assessment. Of the 16 programs assessed, five were not evaluated thoroughly. Although there are probably more school based nutrition interventions running in Victorian schools, it was difficult to locate them and also to obtain reports. This may be because schools run short internal programs or one off activity days and do not evaluate them or make the program known. Even if a program was familiar, sometimes reports were not written, or the report was not available to the public or health professionals.

Another difficulty that arose when collecting data was that there was a distinct lack of information about and reports on Victorian based nutrition interventions in schools. As a result, programs were collected from other states and overseas programs were also drawn on for more information. Of the programs assessed: •

Four were from Victoria

•

Five were from South Australia

•

Three were from New South Wales

•

One was from Western Australia

•

One was from Queensland

•

One was from Tasmania

•

One was from New Zealand.

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Healthy Eating Healthy Living Program 2000

Of the programs assessed, eight can be classified as canteen based, and eight can be classified as curriculum based. As such, the results of this assessment have been divided into two sections: the canteen and the curriculum. Canteen based interventions were mainly centred around the sale and promotion of healthy foods in the canteen, whereas curriculum based interventions had more of a knowledge focus, but also may have included some practical cooking lessons.

a) Canteens Canteen based nutrition interventions generally focussed on providing healthy food for sale in the canteen, with three Australian States running Canteen Accreditation Programs. Evidence suggests that canteen-based programs seem to focus only on children’s eating habits at school, with no thought of the food they consume out of school. Students may eat well in school, but once they leave they may not eat well at all. Thus school nutrition programs may not be as effective as they presume to be because they have no idea of the types of foods children consume out of school.

Strengths and weaknesses Strengths and weaknesses identified by canteen-based programs were many and varied. Strengths: •

Three of the eight programs identified the main strength as support from staff (especially canteen staff), students, and dietitians.

•

One program believed that organisation was a key factor to success.

•

One program thought that adequate access to facilities was important.

Weaknesses: •

One program found that high staff turnover was a problem.

•

One program had difficulties working in a school with no prior experience in the area.

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Healthy Eating Healthy Living Program 2000

•

One program found that collection of statistical data proved difficult.

•

One program also found it difficult to meet demand as they had underestimated the popularity of the program.

Barriers Of the programs that identified barriers to the success of the program, some were similar to weaknesses identified in others. Different authors may have different perceptions of which factors are barriers and which are weaknesses. Barriers identified by authors include: •

Two of the eight canteen programs identified lack of time as a barrier.

•

One program thought the timing of the program was poor.

•

One program identified availability of principals and teaching staff as a barrier.

•

One program identified high staff turnover as a barrier as another identified it as a weakness.

•

One program identified budgetary constraints.

•

One program thought that poor provision of policy documents was a barrier.

•

One program identified varying literacy levels of participants as a problem in that communication became difficult (reading of recipes, etc).

Outcomes Many positive outcomes emerged from these programs despite the difficulties. •

Two of the canteen accreditation programs experienced an increase in the number of schools seeking accreditation each year, but the actual number of schools seeking accreditation was not specified.

•

One canteen accreditation program influenced curriculum changes in the Canteen Management TAFE course.

•

One program reported increased profits in the canteen (1997 - $20,000; 1998 $20,000; 1999 - $30,000.)

•

One program reported increased profile of the canteen.

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Healthy Eating Healthy Living Program 2000

•

Two of the eight canteen-based programs reported an increase in the availability of healthier foods for sale, but it was not indicated as to how much the availability of healthier foods increased.

•

One program had developed a canteen policy.

•

Two programs had successfully linked the canteen program with other curriculum areas.

Evaluation Only five of the eight canteen programs indicated that they had evaluated their program. Of the programs that were evaluated, some evaluations were not completely thorough. A variety of methods were used to evaluate canteen-based programs. •

Two programs based their evaluation on sales figures.

•

The three canteen accreditation programs indicated that they conducted an evaluation each year and altered the program accordingly. The evaluation methods used by the accreditation programs include: obtaining feedback from stakeholders

(adjudicators

and

schools),

conducting

workshops

with

representatives from participating schools and evaluating them identifying positive outcomes and barriers, conducting a survey, and establishing a register of contacts. •

One program used statistical data for evaluation.

•

One program relied on anecdotal information.

•

One program used observation as an evaluation method.

•

One program administered a survey.

•

One program used process, impact and outcome evaluation.

Future implications Five of the eight canteen based programs assessed provided information about future implications.

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Healthy Eating Healthy Living Program 2000

•

One author thought that increasing the number of Western Australian canteens that offer healthy food was important for the immediate and long term health of our children.

•

One program believes they created an impetus for food manufacturers to provide healthy food to school canteens.

•

One program suggested that the development of a formal network of canteens could assist in increasing the number of canteens providing healthy food.

•

One program thought that increased media attention might improve the profile of healthy canteens.

•

One program indicated that the implementation period might need to be longer in the future.

•

One program believed that their program demonstrated that healthy canteens could be profitable.

b) Curriculum Three of the eight nutrition programs with a focus on curriculum reported a large increase in the knowledge of students after the program and one found that implementation needs to be flexible. In-service training for teachers was found to be very useful for one program and personal contact with parents was found to be important in another. Two programs indicated that the amount of children eating healthy lunches increased, while one author believed that children generally ate healthy lunches already. Overall, it seems that the majority of students enjoy the programs. Strengths and Weaknesses Five of the eight curriculum-based programs indicated the perceived strengths of their programs, while only three identified weaknesses. This may indicate an unwillingness to point out problems experienced with the program. Strengths identified: •

Two authors of the eight programs assessed indicated that high parent participation was important for success.

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Healthy Eating Healthy Living Program 2000

•

Three programs indicated that staff involvement and canteen staff involvement was crucial to the success of their program.

•

One program suggested that time release for teachers to attend workshops and involvement of the canteen manager and school council were important.

•

One program mentioned promotion of the program through the school newsletter as a strength.

•

One school suggested that adequate funds and well-managed budget was a strength.

•

One program indicated that flexibility was important.

•

One program reported strong links with the Health Promoting Schools Association as a strength.

Weaknesses identified: •

Two of the eight programs indicated that high costs were a weakness of their program.

•

One program identified lack of parental involvement as a weakness.

•

One program suggested that lack of support from staff presented difficulties in implementing programs.

•

One author felt that they had set unrealistically high standards for themselves.

•

One program mentioned that the time frame of the program might have been too short.

Barriers Five of the eight curriculum-based programs identified barriers to success. Main barriers identified: •

Three of the eight programs identified time, especially for teachers, as a major barrier.

•

Two programs identified staff changeover as a barrier.

•

Two programs suggested that limited resources or facilities were a major barrier. 19

Healthy Eating Healthy Living Program 2000

•

Two programs identified conflicting demand on the curriculum.

•

One program identified lack of experience as a barrier.

•

One program suggested that high costs were a barrier (this was mentioned by two other programs as a weakness).

•

One program suggested that low parental involvement was a potential barrier (this was mentioned as a weakness by another two programs).

Outcomes Despite the many barriers encountered in these types of programs many favourable outcomes were reported. •

One program of the five that indicated outcomes reported increased knowledge of students, but did not specify the amount by which knowledge had increased.

•

One school managed to obtain increased funds for nutrition, but the extent of this increased funding was not specified.

•

One school established a breakfast club.

•

One school developed a canteen policy.

•

One school changed the types of foods available in the canteen to include more healthy foods.

•

Two programs resulted in the development of a teacher and student friendly workbook.

•

One program developed valuable networks with key organisations.

•

One program reported significant increases in health and nutrition knowledge of students, but this regressed to baseline levels by the second year of the intervention.

•

One program found no significant changes in the sum of five skinfolds and blood lipids, and decreases in total cholesterol and triglycerides, and diastolic blood pressure in the intervention group.

•

Although some programs indicated that they had incorporated cooking lessons into the curriculum, it was not reported as to whether the children’s cooking skills improved and to what extent. 20

Healthy Eating Healthy Living Program 2000

Evaluation Evaluation was carried out on five of the eight curriculum-based programs assessed. Evaluation methods used: •

Four programs used questionnaires (measuring satisfaction with the program, nutrition and healthy lifestyles, and policies in place) as evaluation tools.

•

Three programs used process (consisting of focus tests, anecdotal reports, questionnaires, class attendance, popularity of recipes tried, number of parent helpers each week) and impact (measuring increases in knowledge, selfreported food preparation, selection and consumption, questionnaires, quizzes, journals, written evaluations, documenting policies) to measure success.

•

Three programs used anecdotal evidence as an evaluation method.

•

Two programs used journals kept by the students to evaluate success.

•

Two programs used quizzes to assess the students’ knowledge.

•

One program used the Statistical Analysis Software Package (SAS) to analyse anthropometrical measurements.

•

One program used anthropometrical measurements such as sum of five skinfolds, cholesterol and triglyceride concentrations and blood pressure.

•

One program used class attendance to measure success.

•

One program thought that the number of parent helpers attending each week was a good indicator of success.

•

One program used observation as an evaluation method.

•

One program assessed evaluation forms completed by students.

Future Implications Many thoughts and ideas emerged for the implementation of future programs. Five programs indicated future implications

21

Healthy Eating Healthy Living Program 2000

•

One program indicated that follow up programs would be beneficial to students (App 1f)

, and that more opportunities for physical activity and healthy food

choices are needed in schools. •

One author suggested that when using recipes, it is a good idea to use pictures as well as words, because many young children cannot read (App 1g).

•

One program suggested in-service training for teachers.

•

One program indicated an intention to work with the canteen manager to introduce new foods into the school canteen.

•

One program indicated the need to conduct pre-cooking education sessions.

•

One program thought it would be ideal to have more adult helpers in practical sessions.

•

One program indicated that providing for differences in culture was important.

•

One program indicated that gaining support from the school community was crucial to success.

•

One program thought that including a combination of theory and practical sessions in the curriculum was important.

Discussion After completing the assessment of nutrition programs in schools, it has become apparent that there is a distinct lack of nutrition programs implemented in Victorian schools. Much difficulty was experienced in obtaining reports or information about nutrition programs based in Victorian schools. This may be due to a lack of implemented programs, or a lack of written reports. Government or non-government organizations run many of the programs in other states, so programs are more structured and are more likely to be evaluated. It seems that in Victoria, schools implement their own individual small, sometimes one-off programs that do not get evaluated and reports, if written, are not available to the public or even health professionals. New South Wales and South Australia in particular, are very active in implementing nutrition programs in schools, so Victoria would do well to mirror their actions. Three states (NSW, Western Australia and Tasmania) have canteen accreditation programs run by the canteen association in their state, however Victoria does not. The Victorian

22

Healthy Eating Healthy Living Program 2000

Canteen Association has only limited funding, and discussions with the association suggest that they would like to run an accreditation program however current funding does not permit it. Examination of the evidence indicates that only 10 out of 16 programs were evaluated, and even then, some were not evaluated thoroughly. Lack of evaluation seems to be a significant problem in school based interventions (5). Evaluation of school nutrition programs is important because it indicates which methods are effective and why they are effective (18). If teachers/project officers can identify the most effective methods they can be repeated or refined for future projects. Granted, there are many factors working against the implementation of a successful program such as time, money and resources (these will be discussed later) which may not allow for evaluation to be carried out, but some programs have managed even with a relatively small budget, to conduct a successful program. Data collection is more useful when information is collected from many sources of the school community, and when a variety of methods are used to gather this (16)

information

. Although the programs assessed in this study used a variety of

evaluation methods, it may be best to go straight to the source and ask the students themselves what they want in a program, or alternatively what they thought of a program

(16)

. This is more likely to result in a more successful program and will

provide feedback as to what to include in future programs to ensure success. One of the major difficulties encountered by schools wishing to conduct a nutrition education program, whether they chose the canteen or curriculum as a basis, was finding time. Five of the 16 programs assessed identified time as a barrier to success. It was suggested that it was difficult to find time in the curriculum to teach nutrition, or teachers or canteen staff were extremely busy with other commitments. The timing of the program and the time frame also seemed to be influencing factors. Many programs are taught for only short lengths of time and lack continuity, which may explain why some are not achieving the desired results

(5, 31)

. Programs in schools

need to be implemented for longer periods of time, and on a consistent basis. Staff support was difficult to obtain, as indicated by four of the assessed programs, but this may be overcome if teachers are provided with appropriate in-service training, and if the program does not require any time outside of school hours. Lack of 23

Healthy Eating Healthy Living Program 2000

support from teachers may also be due to lack of confidence in teaching the required material, so appropriate teacher training may be a positive factor when it comes to ensuring the success of nutrition education programs

(57)

, and may result in more

enthusiastic teachers and more class time being spent on nutrition (31). Four programs identified staff turnover as a barrier that may affect the success and continuity of the program. Either the teacher who is running the program leaves the school, or other teachers may leave, which means that the support of the new teacher must be gained. This may diminish the effect of the program on the school community and may ultimately lead to the cessation of the program.

Another common problem identified in five of the programs assessed is limited budget and resources (5). Sometimes it is difficult for teachers or the project officer to find a way to implement the program within the strict budgetary limitations. Limited funds and resources, and high costs, may also cause extra stress for teachers.

Many factors were identified that contributed to the success of these programs. One factor identified by two authors, particularly in primary schools, was that family involvement in curriculum-based programs could prove to be very useful and was more evident in the younger grades

(31, 55, App 1g)

. Studies suggest that if the family

supports the nutrition messages the school is teaching their children, the program is more likely to be successful

(6)

. Parental involvement should consist of activities

designed for the parent and child to do together, which will not only enhance the classroom element

(31)

, but will also involve the parent in the child’s school life and

increase both the parent and child’s nutrition knowledge and eating behaviours (6).

Staff involvement was also suggested as a strength of six of the programs assessed even though it may sometimes be hard to obtain. Teaching staff are crucial to the success of curriculum-based programs, and canteen staff are instrumental in the success of canteen-based interventions.

24

Healthy Eating Healthy Living Program 2000

Seven of the 16 programs assessed adopted a behavioural approach, which proved to be successful. This evidence and that from other reviews suggests that a behavioural approach to nutrition education is more effective than a knowledge-based approach (31)

. Even if children have the knowledge to recognize which foods are good and bad

for them, it will be worthless unless they know how to put it into practice

(1, 40)

.

Whereas if education is both behaviourally based and practical, students can draw on the theoretical lessons to implement practical skills learnt. Behaviourally based programs involve students in practical, hands-on lessons which may involve cooking lessons, interactive computer classes or creating and maintaining a vegetable garden for example, and are more likely to result in behavioural changes and more effective learning (31, 43), however more studies are needed to determine if learning how to cook will improve eating habits.

Intervening in the school environment has also been shown to reinforce the messages taught in the classroom or promoted in the canteen (1, 31). This may be through holding activity days with a food related theme (for example: foods of the world/other cultures)

(8)

, which will not only be fun for the students, but also attract their interest

and attention. Another way to increase interest in nutrition is through taste testing at lunchtime or recess, poster competitions, articles in the school newsletter and involvement of all sectors of the school (3).

a) Canteens The school canteen is a significant part of the school and should complement classroom lessons on nutrition and health

(25)

. Many students may bring their lunch

from home or may leave the school to purchase their lunch from a milk bar; nevertheless, the school canteen is still important in regards to nutrition of staff and students alike (19). Contrary to popular belief, canteens can sell healthy foods and also make a profit, as has been demonstrated by three programs in this review program reporting a profit of $30,000 in 1999

(App 1p, App 1i, App 1m)

, with one

(App 1i)

. This is not to say that the

canteen should not sell certain foods, but rather that the canteen menu should contain

25

Healthy Eating Healthy Living Program 2000

a majority of healthy foods

(19)

. Regardless of the type of food the canteen sells, the

students ultimately have final control over the foods they consume

(25)

so curriculum

based nutrition education may be important to complement the healthy canteen. If the school makes the decision to change to a healthy canteen, it is important to get the key stakeholders on side. The principal is probably the most important person because if he/she is interested in nutrition, changes generally happen more quickly (25). The best teachers to get involved in the canteen program are the home economics, PE, health education and science teachers. Other teachers that may get some use from the canteen program include art, English and geography (25). It may also be beneficial to get the students involved. They could set up a vegetable garden and grow vegetables to sell to the canteen (19). The vegetable scraps can then be put then on a compost heap to fertilize their garden beds.

b) Curriculum (and policy) Many curriculum based nutrition education programs are one-offs and run for only a short period of time. If a school decides to implement a nutrition education curriculum, it should be sequential from kindergarten throughout secondary school (6). With the current restrictions on time within the school curriculum, a multi-year sequential curriculum may be the best way to teach students about nutrition within a limited amount of time (33).

One way to ensure the curriculum is followed is to implement a nutrition or health education policy within the school

(16)

. If a school decides to develop a policy,

consultation should occur with members of the school community, as this is more likely to result in a more culturally supportive curriculum (16).

Although developing a curriculum policy is beneficial to the school, it will be of no use unless there is adequate curriculum time allocated for its implementation. Three of the programs in this study found time to be a major barrier in curriculum-based programs, and two reported that they had experienced difficulties due to conflicting demands on the curriculum. One way to increase the amount of curriculum time

26

Healthy Eating Healthy Living Program 2000

nutrition education receives is to incorporate it into other subject areas

(2, 33)

. For

example, the students could design nutrition related posters in art classes, they could calculate canteen sales in maths class, or they could look at foods from different parts of the world in geography. As mentioned previously, behaviourally focussed programs are likely to achieve better results than knowledge focussed programs

(31)

. Knowledge or cognitive

focussed curricula often results in increased knowledge, but often has little or no effect on behaviour

(6)

. Children are more likely to adopt healthy eating behaviours

when the things they are learning about are fun and practical, rather than theoretically based. They are also more willing when lessons focus on the positive aspects of eating healthy foods rather than the negative aspects of eating bad foods. Students also need to be able to taste foods often that are low in fat, sodium and added sugar, and high in vitamins, minerals and fibre.

c) Combination of canteen and curriculum In order for nutrition education programs to be effective they need to be integrated across the whole school, not just taught in the classroom. If children are being taught to eat fruit and vegetables but can go to the canteen at lunchtime and buy a pie and a chocolate bar

(6)

, nutrition education, no matter how good, will be ineffective.

Nutrition education links to many other health related messages and activities within the school. It is a good idea to link them all together to support one another

(6)

,

because students are more likely to adopt good eating habits if they receive constant messages through multiple channels and from multiple sources (6). It is also shown to be beneficial to actively involve the community in nutrition education programs

(App

, as this ensures the sustainability of the program (8).

1d, App 1k)

The Health Promoting Schools Approach The Health Promoting Schools (HPS) approach is thought to be the best model on which to base health promotion programs within a school. A health promoting school places emphasis on altering the school environment rather than individual behaviour (3)

. When speaking of changing the school environment, this includes the canteen,

27

Healthy Eating Healthy Living Program 2000

recreation facilities

(8)

, opportunities for student and teacher interaction and physical

environment, which is more likely to result in a more successful program. Essential elements of school programs From examining the results of this review and studying the literature, it becomes apparent that certain elements of programs are effective while others are not. One of the main ideas to emerge is that it is important to involve the whole school in the program. A comprehensive approach that combines curriculum-based activities with environmental modification and policy change is ideal

(2)

. Involving the canteen in

nutrition programs is a good way to increase environmental support in the school (15). The canteen can help to reinforce the messages taught in the classroom by selling healthy foods more often. Programs should also aim to involve students, teachers, parents, experts, and local community groups

(2)

to ensure that the program achieves

its goals and objectives.

It has also been demonstrated that focusing on food related behaviour rather than increasing knowledge is a more effective method of nutrition education

(31, 40)

. If the

program is curriculum based, the lessons should be practical and hands-on, such as cooking, performing skits and plays, watching videos or creating a vegetable garden (2)

. A program run by the Victorian division of the Australian Nutrition Foundation

(ANF) in the late 1970’s called the ‘Nutrition Circus’, was very successful in teaching children about nutrition in an enjoyable manner, which received a positive response from students, parents and teachers alike

(56)

. Practical lessons such as these, aid the

development of skills, especially cooking skills in cooking classes, which are an important tool in empowering students

(2)

and may prove to be useful in years to

come.

In order for programs to experience some success, adequate time needs to be allocated in the curriculum. The National Health and Medical Research Council (2) suggests that more than 50 hours per year is needed for students to gain adequate knowledge. However allocating time to nutrition may be of no use if the teaching staff are not adequately trained. Successful programs have well trained teachers, who not only

28

Healthy Eating Healthy Living Program 2000

receive initial training, but they also receive on-going training to ensure they maintain their knowledge and enthusiasm (2). Another element of a successful program is ensuring an appropriate evaluation tool is in place (2). Evaluation provides valuable feedback, which can be used to improve the content of the current program or it can be used in the development and implementation of future programs. Self-evaluation can be a useful tool in programs aimed at older children

(31)

, and anecdotal evidence can also provide an indication of

success in younger children. Recommendations and Conclusions Examination of the data and supporting literature shows some very concrete outcomes that should be acted upon to ensure optimum success in regards to nutrition education. •

Both teachers and project officers need to recognize that one-off unsupported interventions, such as talks by health professionals, are ineffective

(2)

. Nutrition

education needs to be sequential and implemented in every year level from kindergarten to year 12.

•

There is a notable problem in school-based nutrition interventions with loss of information. Many programs carried out in schools are either not evaluated for success or if they are evaluated, the report may sit on a dusty shelf in an office where no one can find it. As a result there is a lot of replication and many mistakes are repeated. To avoid this happening, there needs to be a central system or database in Victoria where teachers and project officers can access details on all nutrition education programs implemented in schools. A government funded centre that can act as a clearinghouse would be ideal. The Healthy Eating Information Web-Centre has begun the clearinghouse process by making information about healthy eating programs available on the Internet http://www.healthyeating.org/health-professionals/projects.htm). The availability of these programs in such a centre (or library) would reduce the incidence of teachers having to design an entire program or develop a curriculum from scratch because they would be able to get at least an idea of the elements they need to include to ensure success. Although this suggestion would allow access to all

29

Healthy Eating Healthy Living Program 2000

nutrition programs, teachers could not take a program and implement a carbon copy in their own school. They would need to tailor the program to meet the needs of their individual community and school. All health education programs, regardless of their success, should be evaluated thoroughly (17) if for no other reason, than they can provide information to teachers implementing future programs, and possibly act as a warning of what not to do.

•

One way to ensure that all schools implement quality nutrition programs, is to have a team of project officers (at the Department of Human Services, Victorian Branch, for example) to design, implement and evaluate nutrition education programs for Victorian primary and secondary schools. Many Health Promotion graduates have difficulty finding a job, but graduate positions such as these would be ideal and would allow them to put the skills they learnt at university to use.

•

Three of the programs assessed were canteen accreditation programs (NSW, WA, Tasmania). These programs seem to be very successful in helping canteens gain accreditation and incorporate more healthy foods into their canteen. All states of Australia should have a canteen accreditation program run by its state canteen association. If it were compulsory for all Australian canteens to be accredited, then we would be well on the way to creating healthy schools for our children because the canteen is an effective way to improve the eating habits of children while they are at school.

•

Evidence has also demonstrated that there is a lack of allocated time and money in the curriculum for nutrition education. This has been a bone of contention for many years and continues to cause controversy. It may therefore be worth exploring other avenues to get the nutrition message across. Mass media campaigns and interactive computer technology may be worth looking into

(31)

.

Using other classes as an outlet to teach nutrition to students may be as effective as having a specialised health or nutrition class. For example, computer classes are one of the most favoured by students and so could be an ideal way for children to learn about nutrition in a practical and hands-on environment. This could include 30

Healthy Eating Healthy Living Program 2000

exploring the Internet for high-quality nutrition sites for kids or playing computer based nutrition games. Interactive computer based learning is ideal when teacher time is limited and allows children to move at their own pace (6, 43).

•

In most cases it is the classroom teacher who teaches the students about nutrition. It is therefore logical that they receive appropriate training and support. In-service training programs that allow time release for teachers would be the most appropriate because it would mean that teachers do not have to take time out of their already busy schedule to attend training. Due to time constraints on both teachers and the curriculum, nutrition education goals and objectives need to be clear so that the few hours that are spent on nutrition education are spent as productively as possible (31).

•

Another excellent way for children to learn about nutrition is through home economics classes. Home economics has been gradually eliminated from the curriculum at many schools to make way for other subjects, however it may be useful to reintroduce it to provide students with a fun, practical and life relevant class to break up the monotony of a theoretically based day. Studies have shown that cooking skills seem to be diminishing in today’s youth

(42)

, so eliminating

home economics from the curriculum would just be a step back in teaching important life skills to students. More studies are needed to demonstrate whether learning how to cook actually increases cooking skills, and in addition, whether eating habits improve as a result of increased cooking skills.

So to answer the research questions outlined earlier: •

Is it adequate for schools to implement only a canteen-based intervention, or should it be implemented in conjunction with a curriculum-based intervention?

Assessment of the data and associated literature clearly indicates that it is more effective to implement a program across the entire school that includes both the canteen and the curriculum, and the school environment as a whole.

31

Healthy Eating Healthy Living Program 2000

•

Is it better for canteens to sell only healthy foods or can they also sell some ‘junk food’?

Evidence suggests that canteens can sell a small amount of ‘junk’ food as snacks in the canteen while ensuring that the majority of foods sold are healthy and nutritious. However, programs assessed in this study have demonstrated that canteens can sell only healthy foods and still be very profitable.

•

Is there evidence that indicates that practical, behaviourally based interventions (such as those that teach cooking skills) are more effective than theoretical knowledge based interventions?

Evidence from the programs assessed indicates that practical, hand-on lessons such as cooking are the most effective way for students to learn. Knowledge-based programs alone, do not give students the skills they need to be able to put their knowledge into practice.

Victoria seems to be lacking with regards to nutrition education in comparison with other Australian states. Victoria’s canteen association currently has little if any funding, and so is operating on a voluntary basis. As such, it cannot implement any interventions in schools and therefore cannot implement a canteen accreditation program as recommended above. If the Victorian Canteen Association received government funding they could then implement a canteen accreditation program to be in line with a number of other states. Improving the quality of foods sold in the canteen is a positive step in improving the health of our children and preventing obesity. The recommendations and conclusions offered, if adopted, would result in more effective use of the already restricted time for nutrition education in the curriculum. It is important for children to learn about the importance of nutrition from an early age because this is the time when eating behaviours are developed and if the habits formed are unfavourable, they can be very hard to change. As the saying goes, ‘old habits die hard’.

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Healthy Eating Healthy Living Program 2000

References 1. Reynolds, J., Dommers, E., Spillman, D. (1996) Toward a framework for food and nutrition education in Australian schools. Home Economics Institute of Australia. 2. National Health and Medical Research Council. (1996) Effective school health promotion. Towards health promoting schools. Australian Government Publishing Service, Canberra. 3. Anderson, A., Kalnins, I., Raphael D., McCall (1999) Partners for Health. Schools, communities and young people working together. A joint project of the University of Toronto, the Canadian Association for Health, Physical Education, Recreation and Dance (CAHPERD), the Canadian Association for School

Health

(CASH)

and

Health

Canada.

(http://www.cahperd.ca/cahperd/Programs/QSH/partners.htm) 4. Powles, J., Wahlqvist, M., Robbins, J., King, C., Hicks, N. (1992) The development of food and nutrition policy in Australia, with special attention to the State of Victoria. Asia Pac. J. Clin. Nutr. 1: 47-60. 5. Australian Health Promoting Schools Association. (1997) Priorities for research into health promoting schools in Australia. University of Sydney. 6. CDC. (1996) Guidelines for school health programs to promote lifelong healthy eating. MMWR 45(RR-9); 1-33. 7. St Leger, L.H. (1999) The opportunities and effectiveness of the health promoting primary school in improving child health – a review of the claims and evidence. Health Educ. Res. 14(1): 51-69. 8. Curriculum Corporation. (1996a) Food and nutrition in action. A curriculum development package. Workshop manual (A professional development program for school-based curriculum development in food and nutrition education). Curriculum Corporation, Vic. 33

Healthy Eating Healthy Living Program 2000

9. Bowley, A. (2000) School feeding programs help children learn. Nutriview (Micronutrients and health). 2000/2. 2-4. 10. Lavin, A.T., Shapiro, G.R., Weill, K.S. (1992) Creating an agenda for schoolbased health promotion: A review of 25 selected reports. J. of School Health. 62(6): 212-228. 11. Cooper, C., Freeman, K. (1993) FoodSmart. A nutrition education program for upper primary school students. National Heart Foundation, Victoria. 12. Garrard, J. (1991) The art and science of community – school health education: The Victorian health education pilot project. In: Youth Health Promotion. (Eds.) Nutbeam, D. et al. Forbes Publishing Company, London. Pp311-335. 13. Dixon, H., Janarthanan, P., Kelly-Dalgety, L. (1999) Compilation of unpublished Australian studies relevant to public acceptance of advice about food and nutrition. National Heart Foundation and Anti-Cancer Council of Victoria. 14. Curriculum Corporation. (1996b) Health Promoting Schools in Action. A resource booklet to accompany the video. Curriculum Corporation, Vic. 15. Robinson, Y. Clarke, A. (1993) Assessment of school based breakfast programs in South Australia. Report of a study funded under the National Health Promotion Program. Nutrition Report Series No. 3. Health Development Foundation, South Australia. 16. Education Department of Victoria. (1985) Decision making in health education. A guide to curriculum planning for schools. 17. Scott, J.A. (1991) Conducting community-based nutrition education programs. A dietitians guide. Dietitians Association of Australia. 34

Healthy Eating Healthy Living Program 2000

18. Nutbeam, D., Smith, C. (1991) Evaluating youth health education how can we do it, and what should we measure? In: Youth health promotion. (Eds) Nutbeam, D. et al. Forbes Publishing Company, London. Pp50-68. 19. Martin, S., Macoun, E. (1996) Food and nutrition strategic directions 19962000: Healthier food choices for school canteens. NSW Health Department. State Health Publication No: (FN) 970080. 20. Riddell, S.R. (1984) The implications of adolescent food practices and attitudes for the nutrition educator. Thesis, University of Melbourne. 21. Vandongen, R., Jenner, D.A., Thompson, C. Taggart, A.C., Spickett, E.E., Burke, V., Beilin, L.J., Milligan, R.A., Dunbar, D. (1995) A controlled evaluation of a fitness and nutrition intervention program on cardiovascular health in 10 to 12 year old children. Prevent. Med. 24: 9-22. 22. Simons, L.A., Simons, J. (1984) Healthy lifestyle education in high schools. A three-year follow-up study. MJA. August 4: 158-162. 23. Ministry of Education and The Health Department of Victoria. (1989) The school canteen. Canteen guidelines for school communities. Statewide School Support and Production Centre, Melbourne. 24. Young, R.E., Weston, P.J. (2000) Providing breakfast at school: the NSW experience. Aust J Nutr Diet. 57; 2: 84-89. 25. Australian Nutrition Foundation. (1985) The complete school canteen book. Reed Books Pty Ltd. NSW. 26. Food and Nutrition Project (??) Teachers Resource Handbook. Food and Nutrition Project, Health Promotion Unit, Melbourne.

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27. Cooper, C., Freeman, K. (1995) Foodsmart for five to 10 year olds. National Heart Foundation, Victoria. 28. Hanes, S., Vermeersch, J., Gale, S. (1984) The national evaluation of school nutrition programs: program impact on dietary intake. Am. J. Clin. Nutr. August: 390-413. 29. Shannon, B., Chen, A. (1988) A three-year school-based nutrition education study. J. Nutr. Ed. 20(3): 114-124. 30. Contento, I.R., Manning, A.D., Shannon, B. (1992) Research perspective on school-based nutrition education. J. of Nutr. Educ. 24(5): 247-260. 31. Contento, I., Balch, G.I., Bronner, Y.L., (Lytle and Achterberg 1995), L.A., Maloney, S.K., Olsen, C.M., Swandener, S.S. (1995) The effectiveness of nutrition education and implications for nutrition education policy, programs and research: a review of research. J. of Nutr. Educ. 27(6): 277-418. 32. McConnell, P.E., Shaw, J.B. (1986) Position of the American Dietetic Association: Child and adolescent food and nutrition programs. 33. Olsen, C.M. (1994) Position of the ADA, SNE, and ASFSA: School-based nutrition programs and services. 34. Perry, C.L., Bishop, D.B., Taylor, G., Murray, D.M., Warren Mays, R., Dudovitz, B.S., Smyth, M., Story, M. (1998) Changing fruit and vegetable consumption among children: The 5-a-day power plus program in St. Paul, Minnesota. Am. J. Publ. Health. 88(4): 603-609. 35. Simons-Morton, B., Parcel, G., Baranowski, T., Forthofer, R., O’Hara, N. (1991) Promoting physical activity and a healthful diet among children: Results of a school-based intervention study. Am. J. Publ. Health. 81(8): 986991.

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36. Angelico, F., Del Ben, M., Fabiani, L., Lentini, P., Pannozzo, F., Urbinati, G.C., Ricci, G. (1991) Management of childhood obesity through a schoolbased programme of general health and nutrition education. Publ. Health. 105: 393-398. 37. Williams, C.L., Squillace, M.M., Ballella, M.C., Brotanek, J., Campanaro, L., D’Agostino, C., Pfau, J., Sprance, L., Strobino, B.A., Spark, A., Boccio, L. (1998) Healthy Start: A comprehensive health education program for preschool children. Prev. Med. 27: 216-223. 38. Manios, Y., Moschandreas, J., Hatzis, C., Kafatos, A. (1999) Evaluation of a health and nutrition education program in primary school children of Crete over a three-year period. Pre. Med. 28: 149-159. 39. Jackson, S.A. (1994) Comprehensive school health education programs: Innovative practices and issues in standard setting. J. Sch. Health. 64(5): 177179. 40. Johnson, D., Johnson, R. (1985) Nutrition Education: a model of effectiveness, a synthesis of research. J. of Nutr. Educ. 17; 2(suppl): S1-S44. 41. Cline, T., White, G. (2000) Position of the American Dietetic Association: Local support for nutrition integrity in schools. J Am Diet Assoc. 100: 108111. 42. Caraher, M., Lang, T. (1999) Can’t cook, won’t cook: A review of cooking skills and their relevance to health promotion. Int. J. Health Prom. & Educ. 37(3): 89-100. 43. Lytle, L., Achterberg, C. (1995) Changing the diet of America’s children: What works and why? J. of Nutr. Educ. 27(5): 250-260. 44. Strategic Inter-Governmental Nutrition Alliance (SIGNAL). (1999) The National Public Health Nutrition Strategy 2000-2010. Draft. (Unpublished). 37

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45. Aldinger, C.E., Jones, J.T. (1998) WHO information series on school health, document four. Nutrition: An essential element of a health promoting school. Education International, Brussels and Food and Agriculture Organisation, United Nations. 46. Webber, L.S., Osganian, S.K., Feldman, H.A., Wu, M., McKenzie, T.L., Nichaman, M., Lytle, L.A., Edmundson, E., Cutler, J., Nader, P.R., Luepker, R.V. (1996) Cardiovascular risk factors among children after a 2 ½ year intervention – The CATCH Study. Prev. Med. 25: 432-441. 47. Osganian, S.K., Ebzery, M.K., Montogmery, D.H., Nicklas, T.A., Evans, M.A., Mitchell, P.D., Lytle, L.A., Snyder, M.P., Stone, E.J., Zive, M.M., Bachman, K.J., Rice, R., Parcel, G.S. (1996) Changes in the nutrient content of school lunches: Results from the CATCH Eat Smart food service intervention. Prev. Med. 25: 400-412. 48. Lytle, L.A., Stone, E.J., Nichaman, M.Z., Perry, C.L., Montgomery, D.H., Nicklas, T.A., Zive, M.M., Mitchell, P., Dwyer, J.T., Ebzery, M.K., Evans, M.A., Galati, T.P. (1996) Changes in nutrient intakes of elementary school children following a school-based intervention: Results from the CATCH study. Prev. Med. 25: 465-477. 49. Kennedy, E., Davis, C. (1998) US Department of Agriculture School Breakfast Program. Am. J. Clin. Nutr. 67(suppl): 798S-803S. 50. Burghardt, J.A., Devaney, B.L. (1995) Background of the school nutrition dietary assessment study. Am. J. Clin. Nutr. 61(suppl): 178S-181S. 51. Chapman, N., Gordon, A.R., Burghardt, J.A. (1995) Factors affecting the fat content of National School Lunch Program lunches. Am. J. Clin. Nutr. 61(suppl): 199S-204S.

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52. Gleason, P.M. (1995) Participation in the National School Lunch Program and the School Breakfast Program. Am. J. Clin. Nutr. 61(suppl): 213S-220S. 53. Gordon, A.R., Devaney, B.L., Burghardt, J.A. (1995) Dietary effects of the National School Lunch Program and the School Breakfast Program. Am. J. Clin. Nutr. 61(suppl): 221S-231S. 54. Moffitt, R. (1995) Commentary on who participates in the National School Lunch Program and the School Breakfast Program. Am. J. Clin. Nutr. 61(suppl): 250S-251S. 55. Guldan, G.S. (1998) Special issues relevant to nutrition education in primary versus secondary schools. Aust. J. Nutr. Diet. 55(1 suppl): S15-S17. 56. Australian Nutrition Foundation (1979) The Nutrition Circus. Program Report. The Australian Nutrition Foundation (Victorian Division). 57. Gussow, J., Contento, I. (1984) Nutrition Education in a changing world. World Rev. Nutr. Diet. 44: 1-56.

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Appendices

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Healthy Eating Healthy Living Program 2000

Appendix 1a. Program title

Foodsmart – National Heart Foundation.

Reference description Graham, C. Primary School Nutrition Education Pilot Project. Phase 1 Evaluation. Edited by: Dommers, E. and Charlwood, R. National Heart Foundation. Dommers, E. Foodsmart. Primary School Nutrition Education Pilot Project. Phase 2 Evaluation. 1992. National Heart Foundation. Key words Foodsmart, nutrition, schools, health, nutrition education, curriculum. Annotation The National Heart Foundation Primary School Nutrition Education Project (“Foodsmart”) was conceived in 1990 by the Education and Nutrition Units of the National Heart Foundation, with the Phase 1 pilot stage being implemented in 1991. Phase 1 objectives were to: 1. produce a nutrition education resource manual comprising a series of nutrition education lessons for upper primary school students, focussing on healthy food selection and preparation skills. 2. pilot the manual in a minimum of 6 primary schools at grades 5 and 6 via the demonstrator model 3. a) to gauge support at the school level from teachers, administrators, parents and students for the concept of practical nutrition education, b) to assess the appropriateness of the resource manual of nutrition education lessons, 4. rewrite the manual based on evaluation outcomes. During 1991 eight lessons outlined in the “Foodsmart” draft manual were taught to children in seven self-selected pilot project schools by demonstrators trained by the NHF. An evaluation design was developed as part of Phase 1 planning and was also undertaken by NHF staff during 1991. This evaluation report provides a summary of NHF documentation of the project’s rationale, the process of development and the compilation and analysis of Phase 1 evaluation data. Description of population group: Grade 5 and 6 students (male and female) at selected Victorian schools and Primary school teachers. Program design and setting Develop Personal skills and knowledge. Resource – Teacher Manual – spiral bound- in school setting. Year the program was conducted Phase 1 (Pilot) 1991. Phase 2 1992. Full address and contact details of organization who conducted the program: Heart Foundation of Australia 411 King St West Melbourne Vic, 3003

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Healthy Eating Healthy Living Program 2000

Additional information derived from the program report Were the aims/goals of the program stated? • Overall – To provide schools with the opportunity by the provision of a teacher resource package, to positively impact on the eating habits of school-aged children; to increase children’s awareness and knowledge of the relationship between food and health; To increase children’s knowledge of healthy food selection and preparation skills. • Phase 1 - To develop a Primary Nutrition Education Program, which incorporates healthy food selection and preparation skills. The aim of such a program would be to enhance the opportunities for dietary change amongst grade 5 and 6 students. The learning constructs include cognitive development, skill development and social learning theory, and must be appropriate to the Personal Development Frameworks. It is anticipated that this program, if successful, could then be taught on a 'train the trainer' model to primary school teachers. • Phase 2 - To determine teachers' own perception of their ability to implement the FoodSmart nutrition education program within their own school context by providing teachers with a FoodSmart manual and an in-service education program that supports the use of the FoodSmart manual; and to investigate teachers' opinions regarding the most effective means of marketing the FoodSmart program. Were any key findings identified by authors? • Having an in-service training program was very valuable and preferable, if not absolutely necessary for each teacher participating in the program. • A positive trend was identified in terms of the student’s knowledge and reported and reported eating behaviours. • Parents reported that their children had been talking about the Foodsmart program at home and had indicated their enjoyment of the program. Were any strengths identified by the authors? • Very strong parental support was given. • Manual was well set out and easy to use; the program flexible; • Have taken teachers' suggestions on board and adapted the program accordingly. • Construction of the program was widely praised for it’s logical sequencing, its ease of use, its detail and concision, its flexibility and cost effectiveness. The educational method was also praised. Were any weaknesses identified by the authors? • The time frame given for implementation was thought by some teachers to be too short; • Some teachers thought the manual adopted a 'preachy' tone and set unrealistically high standards; • The cost of the program to both the school and parents was commented on as a potential weakness. Weaknesses identified in phase 2 include: program cost, program planning time requirements, worksheet quality, and recipes. Were any barriers to the program identified by the authors?

YES Yes

NO

Yes

Yes

Yes

Yes

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Healthy Eating Healthy Living Program 2000

• Teachers felt they had trouble finding a 2 hour block (as suggested in the Foodsmart manual) in the school day. • The preparation time required to buy ingredients and to organize the utensils and food required. Also the need to be able to supervise children in the classroom while also needing to supervise cleaning up which more often than not occurs outside the classroom. Most teachers stated that they did not feel they could implement “Foodsmart” without the assistance of either a parent/s or teachers’ aide. Although one teacher did suggest that student monitors could provide assistance to the teacher. • The lack of sinks or running water in most classrooms. • The cost. There was general concern about how the cost of food required for the making of healthy “Foodsmart” recipes would be covered. Suggestions ranged from requesting parents to pay $4 per term toward food costs, even though the unit may be taught in one term; asking parents to pay $1 per week for a term and pointing out that on the “cooking” day they do not need to provide children with snacks; to teachers planning recipes whereby parents could easily send the ingredients along to school with the child (for e.g. fruit salad.) • The biggest practical difficulty is fitting nutrition education into the already overloaded curriculum. Were any outcomes recorded by the authors? • Teachers seemed to be very happy with the program overall, a few suggested small changes but, nothing that would change the whole scope of the program. • One principal emphasised that it is critical that information about “Foodsmart” be distributed to schools early in term 4. The reason is that schools start to make decisions about the priorities of the school plan for the following year at this time. • 25% of Vic, primary schools purchased the resource. Assisted in implementing practical nutrition education in classrooms. Were there any unexpected outcomes recorded by the authors?

Yes

Was any evaluation conducted by the authors? • Yes - Phase 1 - Both process and impact. Process consisted of focus tests, anecdotal reports, and questionnaires. Impact evaluation focused on student's nutrition knowledge and selfreported food preparation, selection and consumption behaviours. • Phase 2 - used questionnaires, focus groups, journals and classroom observation. Evaluation design focussed on: the inservice education program, FoodSmart program implementation, and FoodSmart promotion and marketing strategies. Were any future implications recorded by the authors? • In order to learn effectively, students need a combination of theory and practical lessons. The practical lessons enable the students to implement what they have learnt in the classroom. • FoodSmart in-service education programs should be offered at a range of locations, within a range of appropriate timeframes, and costs kept below $35 per teacher, including a manual. • It was suggested that perhaps the lesson content could be spread over more lessons, allowing for the theory component to be more activity based, using more visual resources. • The major content recommendation was for the manual to include more practical activities in the theory lessons. Other comments • Looks promising even though it is still in the pilot stages.

Yes

Not stated

Yes

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Appendix 1b. Program title

Healthy Eating - Healthy Schools Project

Reference description Swan Hill District Hospital. (2000) Health Eating – Healthy Schools Project. Swan Hill District Hospital, Primary Care Division. Project evaluation report. Key words Health, schools, nutrition, policy, curriculum, Healthy Eating Annotation In 1999 a grant was received from VicHealth to fund a project working with local schools in our district in developing a holistic ‘School Food and Nutrition Policy.’ This involved facilitating a workshop with parents, teachers and students from twelve schools. An audit was conducted using a manual developed by our department based on the ‘Health Promoting Schools’ framework. That then formed the basis for school representatives to develop policies that covered curriculum, school organization, ethos and partnerships with services. Seven schools, two secondary and five primary, completed the project and submitted comprehensive policies and implementation plans for 2000. Description of population group Primary and Secondary schools in the district. Program design and setting School setting Year the program was conducted 1999 Full address and contact details of organization who conducted the program: Kristina Basile Head, Health Promotion Department Swan Hill District Hospital Primary Care Division PO Box 483 Swan Hill Vic 3585. Phone: 61 3 5033 1450 Fax: 61 3 5033 1663 E-mail: [email protected]

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Additional information derived from the program report

Were the aims/goals of the program stated? • To continue to improve the effectiveness of school based nutrition through the development of food and nutrition policies for all local schools. Were any key findings identified by authors? Were any strengths identified by the authors? • Went through the school council and by getting their commitment to the project it then endorsed within the school the importance of the project and the issues that needed to be addressed. • Schools had a sense of ownership and were motivated to participate. Established a good relationship with schools and agencies. Were any weaknesses identified by the authors?

YES Yes

Not stated Yes

Not stated

Were any barriers to the program identified by the authors? Were any outcomes recorded by the authors? • Development of a user-friendly workbook based on the Health Promoting Schools framework. This gave schools an opportunity to analyse what was happening in their school and then use it to devise a draft policy. The aim was to produce a workbook that would make the whole policy development process as easy as possible. • Establishment of a networking group which enhanced coordination and communication; support and acknowledgement for what already exists; current information about regional/local resources; best practice; avoidance of duplication; increased sharing of resources, and a 'whole' school approach. • Two secondary and five primary schools submitted their comprehensive Food and Nutrition policies. These policies were based on the Health Promoting Schools framework and provided a cohesive, coordinated approach to food and nutrition education in schools. Were there any unexpected outcomes recorded by the authors? Was any evaluation conducted by the authors? • Not specified - seemed to gauge success on the amount of submissions they received. Were any future implications recorded by the authors?

NO

Not stated Yes

Not stated Not stated

Not stated

Other comments • Not a very comprehensive report. Only focussed on the good aspects of the program and didn't identify any negative aspects or things they would change for next time.

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Appendix 1c. Program title

Healthy Eating in Schools

Reference description Murphy, S. (1999) Health eating in schools (Health Promoting schools project). North East Health Promotion Centre, project evaluation report. Key words Healthy eating, school, curriculum, primary, secondary, policy. Annotation The Health Promoting Schools Project is run by the North East Health Promotion Centre, which is based at Darebin Community Health Services and employs a full time Director and project officer. Four primary and two secondary schools agreed to participate in the project. Each participating school was asked to designate a contact person to co-ordinate the project at the school level. The project officer organised an initial workshop for the coordinators from all the participating schools to learn about the Health Promoting Schools framework, and also to meet each other and discuss the project. There were also community agency personnel invited to attend the workshop and make initial links with their schools. Similar workshops were held regularly throughout the project to give schools an opportunity to share experiences and ideas, and also to encourage community agency involvement with the schools. Each school was initially asked to complete an interview and a written survey, which gave an overview of the position of each school at the start of the project in relation to food and nutrition issues. Issues discussed included the place of nutrition/health in the curriculum, the school environment, including current canteen management and practices, and any links between the school and community agencies. Activities of the project include: seminars/workshops for school and community agency personnel (Health Promoting Schools, Gorgeous Girls Project, Working Together: Schools and Community agencies, Mental Health in Schools: Gatehouse Project); Developed the Health Promoting Schools (HPS) Working Group, the Healthy Eating in Schools Project Advisory Group, the Healthy Eating in Schools Project Team Workshops; and used many community resources for help with the project. Description of population group: Program design and setting Health Promoting Schools Framework, school setting. Year the program was conducted 1998-1999. Full address and contact details of organization who conducted the program: Sharrin Murphy - Project Officer North East Health Promotion Centre C/o/ Darebin Community Health Service Cnr Blake & Crevelli Streets East Reservoir Vic, 3073. Phone: 61 3 9478 5711 Ex 238/213 Fax: 61 3 9478 1155 E-mail: [email protected]

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Additional information derived from the program report.

Were the aims/goals of the program stated? • To use the Health Promoting Schools (HPS) approach to support a small number of local primary and secondary schools to develop plans and policies to complement nutrition education through the curriculum. • To create a network linking primary and secondary schools with each other and with community resources to support the implementation of school food and health policies and plans. • To develop a more planned and strategic approach to intersectoral collaboration between the organisations within the North East Health Promotion Centre and local primary and secondary schools to support development, implementation and ongoing review of school food and health policies and plans. Were any key findings identified by authors? • Children’s school lunches have become more healthy – healthier choices from canteen and healthier lunches from home (primary school). Were any strengths identified by the authors? • Personal commitment and enthusiasm of school project coordinators to the project. • Time release available for teachers to attend project workshops and forums and work on project tasks. • Regular workshops of Healthy Eating in Schools Project Team to share experiences, explore different strategies and discuss progress. • Interest and participation of canteen manageress in project from commencement. • Strong links with the statewide Health Promoting Schools project gave a wider perspective and opportunities for further support for schools on a regional basis. • Having "Health and Wellbeing" as a School Charter priority in one school ensured a whole-school approach and links to other health issues. • Visits to each participating school by project officer to meet with school project coordinators and discuss individual progress. Were any weaknesses identified by the authors? Were any barriers to the program identified by the authors? • The busy time for teachers and schools at the beginning and end of each term, and at mid-year reporting time significantly reduces the amount of productive time which can be spent on project tasks (especially within a 12 month project). • Staff changeover for both schools and community agencies makes relationships with individuals less sustainable. • Low level of active involvement by parents in project despite school invitations and offers to participate.

YES Yes

NO

Yes

Yes

Not stated Yes

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Healthy Eating Healthy Living Program 2000

Were any outcomes recorded by the authors? • Increased funds allocated to nutrition in school budget • Food and nutrition policy developed incorporating the areas of curriculum, school environment and community partnerships (primary school) • Teacher-friendly units of work with nutrition focus complied for teachers to use with home groups (secondary school). • Daily Breakfast Club established – staffed by teachers on volunteer roster (primary school) – children who belong have laminated Breakfast Club membership badges – Breakfast Club vouchers also given as rewards in the classroom. • New breakfast menu successfully introduced in canteen before school – replaced complete range of foods previously available (secondary school). • New canteen policy reviewed and amended (primary school). • Significant changes made to canteen menu – pies only available Mondays (instead of every day) no chocolates available, sugar-free lollies introduced, only juice and milk drinks available – no soft drinks (primary school). • New whole-school food and nutrition policy developed as part of Health and Well-being school charter priority (primary school). • Developed networks/linkages with the Department of Education (Northern Metropolitan Region), the Victorian Health Promoting Schools Project, The Northern Schools Mental Health Network, the School Focussed Youth Service (SFYS), and other school projects such as: the “Youth Speak Out” project, The Boys’ Transition Project, and The Gresswell Healthy Schools Group. Were there any unexpected outcomes recorded by the authors?

Yes

Was any evaluation conducted by the authors? • Questionnaire (very comprehensive). One for project coordinators (in schools) and one for canteen staff, and one for parents regarding foods sold in the canteen. Were any future implications recorded by the authors? • The different workplace cultures of secondary and primary schools needs to be taken into account when working with both sectors • Timing of projects in line with school years is something to consider in the future. Other comments • Very comprehensive and wide reaching project.

Yes

Not stated

Yes

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Program title

Appendix 1d. Visy Care’s Healthy Eating to Start the Day. Hume City Council – Upfield Secondary College Breakfast Program

Reference description Hume City Council. (2000) Visy Care’s Healthy Eating to Start the Day. Hume City Council – Upfield Secondary College Breakfast Program. Project report. Key words School, nutrition, breakfast program, children, Project report summary In conjunction with Upfield Secondary College, Hume City Council, Visy Care –the Pratt Foundation and VicHealth, the breakfast program has been running for two years. Initially it was envisaged that the third year would see the program continue with the input of a specifically employed youth worker. However, the logistics involved in running the program as well as the benefit to the young people attending of a youth worker, meant that it was deemed necessary to secure further funding for the continuation of a worker. This has been achieved… Description of population group: Secondary school students at Upfield Secondary College, both male and female. Program design and setting School Setting Year the program was conducted 1998-present Full address and contact details of organization who conducted the program: Suzanne Prosser – Project officer Phone: 61 3 9376 2268 or 0409 131 875 E-mail: [email protected]

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Additional information derived from the program report.

Were the aims/goals of the program stated? • To provide a healthy, nourishing, sustaining and culturally relevant start to the day for Upfield Secondary College students. • To maximise student involvement in the daily organisation of the program • To provide a club type environment that is fun and has the positive values of acceptance, mutual respect, belonging, warmth and encouragement which fosters a sense of trust. • In 2000, they will be aiming to increase the participation of the young people who attend as well as looking for ways to incorporate the program into the school curriculum. Were any key findings identified by authors? • An average of 15 students attend each morning and these students have a sense of ownership, but there is probably up to 40 students who go every so often. • Some people come because of lack of food at home, others because their friends are there, others because a teacher has suggested it. Were any strengths identified by the authors? • The program is supported by the staff at the school and in particular, the student welfare co-ordinator. • There is a staff member present at the breakfast each day. • Good links between the school and the local council • Good relationship between the worker and the students. • Solid network of support. The program would probably not have been successful without it. • Teachers are encouraged to interact with students on a social and non-disciplinary or academic level.

YES Yes

NO

Yes

Yes

Were any weaknesses identified by the authors? • Turnover of program workers (longest position 8 months) Were any barriers to the program identified by the authors? • Limited budget Were any outcomes recorded by the authors? • It benefits the students socially as well as nutritionally. • It was hoped that the breakfast program could be integrated into other parts of the curriculum (e.g. economics - budget, home economics - analysis of the food's nutritional value) but as yet this has not happened. Were there any unexpected outcomes recorded by the authors? • It was hoped that by the third year the program would be selfsustaining. It has been found that from a logistical point of view, a worker is required.

Yes

Was any evaluation conducted by the authors? • Anecdotal and observational Were any future implications recorded by the authors?

Yes

Other notes • Don't really have enough info on it to make good judgement. This school doesn't have much money to throw around. It also sounds like their canteen needs a good overhaul. Kids go and eat a healthy breakfast then go and buy a chocolate donut from the canteen. This defeats the purpose of having the healthy breakfast in the first place.

Yes

Yes Yes

Yes

Not stated

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Appendix 1e. Program title

Working Health into Armidale High

Reference description Glen, S., Hopkins, A., Woodward, G. (1994) Working Health into Armidale High. Armidale Community Health Centre, project report. Key words Schools, health, nutrition, healthy eating, children, students Abstract Two second year Nutrition and Dietetics students from the University of Newcastle undertook a four week placement assignment at Armidale High School in Armidale. This is in the New England district of northern New South Wales. The assignment forms part of an ongoing project titled WHISC – “Working Health into School Canteens.” The students implemented a series of marketing strategies promoting healthy breakfasts that were sold at the school canteen. The marketing strategies included meal deals, promoting healthy food as ‘cool’ and novel and not mentioning that it is healthy, and an incentive plan of prizes which were sponsored by businesses in Armidale. The promotion was successful in increasing the total amount of ‘healthier’ food sold from the canteen during that four week period, and also demonstrated an increase in the students’ awareness of healthier food. Description of population group: Secondary school students in a northern New South Wales High School. Program design and setting School Year the program was conducted 1994 Full address and contact details of organization who conducted the program: Gillian Woodward – Community Dietician University of Newcastle, Faculty of Medicine & Health Armidale NSW, 2350 Phone: 61 2 4921 5649 Fax: 61 2 4921 6921

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Additional information derived from the program report. Were the aims/goals of the program stated? • To improve the nutritional status of students at Armidale High School through increasing the consumption of healthy foods by all students within the month of September. Were any key findings identified by authors? • The meal deals sold best at recess rather than before school; after implementation sales of pies, etc went down and sales of rolls and sandwiches and the meal deals went up. Were any strengths identified by the authors? • The canteen manager was very keen and eager to participate, and thinks she will continue to provide the 'big brunch' in the future due to outstanding sales. • Well organised, had many facilities at their disposal, and had the assistance of 2 dietician facilitators. Were any weaknesses identified by the authors? • At times, demand exceeded supply, and time was a problem. It took longer to make all the different combinations of salads. Were any barriers to the program identified by the authors? • Time Were any outcomes recorded by the authors?

YES Yes

Yes

Yes

Yes

Yes Not stated

Were there any unexpected outcomes recorded by the authors? Was any evaluation conducted by the authors? • Evaluation was based on sales figures Were any future implications recorded by the authors? • The implementation period needs to be longer next time. Other comments • The meal deal concept was a very good idea. Interesting to students, makes them think they are at Hungry Jacks or Subway or something similar. The intervention did not last long enough though.

NO

Not stated Yes Yes

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Appendix 1f. Program title

Body Owner’s Manual Intervention Trial.

Reference description Gore, C.J., Owen, N., Pederson, D., Clarke, A. (1996) Educational and environmental interventions for cardiovascular health promotion in socially disadvantaged primary schools. Aust. NZ J. of Publ. Health. 20(2): 188-194. Key words Schools, cardiovascular health, health promotion, education, diet, health knowledge, cholesterol, blood pressure. Abstract School-based cardiovascular risk-reduction programs have the potential to influence life-long habits intrinsic to good health. Following earlier Australian Body Owner's Manual (BOM) intervention trials, we examined the effects of two interventions on physiological indicators of risk of cardiovascular disease and on health knowledge: the BOM; and the BOM plus healthy lifestyle programs for teachers and school canteen interventions (BOM+) over two school years in socially disadvantaged primary schools. Each school was allocated to either a control condition or to one of two intervention conditions. In contrast to the findings of the earlier South Australian trials, there were no statistically-significant changes in aerobic fitness, body fatness or HDL cholesterol; there were significant reductions in diastolic blood pressure, total cholesterol and triglyceride concentration for those in the BOM+ schools. There were significant increases in health and nutrition knowledge for the BOM+ schools, and in health knowledge for the BOM schools. Description of population group: Twelve Priority-Project primary schools in metropolitan Adelaide. Program design and setting Intervention trial in school setting Year the program was conducted 1990-1991. Full address and contact details of organization who conducted the program: Professor Neville Owen School of Human Movement Deakin University 221 Burwood Hwy Burwood Vic, 3125. Fax: 61 3 244 6017.

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Additional information derived from the program report. Were the aims/goals of the program stated? • To ascertain whether the addition of school environmental supports to the use of curriculum materials could produce incremental reductions in precursors of CVD risk and in knowledge and attitudes about those lifestyle factors that can influence cardiovascular health, among socially disadvantaged primary school children. Were any key findings identified by authors? • The baseline mean for girls was significantly higher for girls than boys for health knowledge, nutrition knowledge, skinfold total, and systolic blood pressure, while the order was reversed for physical work capacity and HDL cholesterol. There were significant differences between the baseline means for physical work capacity and triglyceride concentration. • They found significant increases in health and nutrition knowledge for the Body Owner's Manual plus teacher programs (BOM+) group relative to the control group during the first year of the intervention, but these gains were lost during the second year. A similar pattern was observed in the BOM group for health knowledge only. • There were no statistically significant changes in the sum of the five skinfolds (body fatness). • Relative to the control group, there were no significant changes in any of the blood lipids for the BOM group, while the total cholesterol and triglyceride concentrations of the BOM+ group decreased significantly between the initial and final measures. • There was a significant increase in the diastolic blood pressure of the BOM+ group, relative to the control group. • For health knowledge, both the BOM and BOM+ groups increased their scores in year 1 of the intervention, but this regressed to the baseline levels by the end of the second year for each group. In the first year of the intervention, the improvement in health knowledge was superior in the BOM group. Were any strengths identified by the authors? Were any weaknesses identified by the authors? • Daily fitness lessons were not conducted at sufficient intensity, for sufficient duration, or at sufficient frequency to have a training effect. • The intervention was limited to the school and did not attempt to involve the children's parents. • "Since parental exercise habits can be a strong predictor of children's physical activity, it would seem that our school-based approach was destined to have limited success." Were any barriers to the program identified by the authors? • Conflicting demands on the curriculum probably mean that cardiovascular health promotion is a low priority unless there is strong external support to sustain such activities in the school setting. Were any outcomes recorded by the authors? • It is probable that unless adherence is driven rigorously by the research team, the effect of the intervention is likely to be transient. Were there any unexpected outcomes recorded by the authors?

YES Yes

NO

Yes

Not stated Yes

Yes

Yes

Not stated

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Was any evaluation conducted by the authors? • Use SAS for statistical analysis • Measured height, mass, sum of five skinfolds, girths, blood pressure, physical work capacity and blood lipids. • Administered a nutrition and healthy lifestyle questionnaire to 40 year 6 and 7 students. Were any future implications recorded by the authors? • It is important that gains from a program are followed up with ongoing programs and especially in secondary school. • "There is the need for further efforts to change the school context and create more opportunities for healthy physical activity and food choices. We also have an obligation to find better ways to equip children with the knowledge and skills to choose healthier habits in a technology driven society that encourages unhealthy food choices and physical inactivity." Other comments • Good program. Good book, useful resource like the NHF FoodSmart book.

Yes

Yes

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Program title

Appendix 1g. Breads and Cereals – Good Tucka – we tried them!

Reference description Port Augusta Hospital and Regional Health Service. (1994) Breads and cereals – good tucka – we tried them! Port Augusta Hospital and Regional Health Service, project evaluation report. Key words Breads, cereals, school, nutrition, Project report summary This project was a multi-faceted breads and cereals cooking program, targeting primary school children from low income families and their parents. The program was implemented in August/September 1994 and ran for nine weeks. The target school, Carlton Primary School is situated in Port Augusta. Most of the two hundred children attending the school are from Aboriginal and low income families (80% of school card). A major problem is that children attend school without breakfast and or lunch. A breakfast program (funded by the World Health Organisation) is already in place, which feeds 15 children on average each day. When families do have money, it is often spent on items with no or low cereal content and low nutritional value. The outcome of these problems can be poor nutrition or malnutrition, which then affect school performance and development. The issue of children attending school without food, or choosing inappropriate foods, is a large problem with multiple causes. Our project focussed on involving both children and their mothers in cooking and tasting of cheap, healthy bread and cereal based meals. Each child had the opportunity to cook once and taste a dish on two other occasions. This approach was used because children have a powerful influence over the food choices of both the food purchaser and preparer (usually women) and their peers. They can also pass on skills and knowledge to their parents. Involving parent helpers also creates a non-threatening environment for adult learning. The practical cooking sessions were complemented by education about breads and cereals: at the beginning of each session, in the classroom and via newsletters to parents. The newsletters, a canteen ‘special day’ and the production of a recipe book, also aimed to increase access to, and awareness of, cheap, healthy bread and cereal based meals and recipes. Description of population group: Primary school children (6-12 years) male and female (seen on 3-4 occasions) and adults (1845 years) at least 85 male and female. Program design and setting Campaign program in country area. Year the program was conducted 14/6/94-29/9/94. Full address and contact details of organization who conducted the program: Sarah Retallack Flinders Tce Health Centre C/o Port Augusta Hospital and Regional Health Service Hospital Rd Port Augusta SA, 5700

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Additional information derived from the program report.

Were the aims/goals of the program stated? • To raise the awareness of primary school children from lowincome families and their parents, of the importance of meals based around breads and cereals for good nutrition and school performance. Were any key findings identified by authors?

YES Yes

NO

Yes

• • •

Knowledge seemed to improve after the intervention. Need to be flexible when implementing programs in schools. Personal contact prior to and during the program is important to encourage parent involvement. • It is important to liase with many different groups when organising a large program. Were any strengths identified by the authors? • Promoting the program through the newsletter seemed to work best, as the associated raffle may have provided an incentive for the children to show the newsletter to their parents. • Recipes were easily prepared by the children but they needed help in following the steps. • Parent participation was fairly high, which they were pleased with, particularly since mostly Aboriginal parents attended. Were any weaknesses identified by the authors?

Yes

Not stated

Were any barriers to the program identified by the authors? • Sessions had to be held in the art room because the kitchen was unavailable, which meant there was little access to ovens. Were any outcomes recorded by the authors? • Children’s knowledge of breads and cereals increased. Were there any unexpected outcomes recorded by the authors?

Yes

Was any evaluation conducted by the authors? • Ran process and impact evaluations. • Process: class attendance, popularity of recipes tried, number of parent helpers each week, etc. • Impact: surveys completed by children after tasting each dish, quiz to assess children’s change in knowledge before and after the intervention. Were any future implications recorded by the authors? • Things they would do differently next time: Analyze quizzes completed at the beginning of the project before planning nutrition education focus; Have a short pre-education session about breads and cereals prior to each cooking session and then reinforce concepts again on the day; It may be more effective to introduce new foods at recess, when the children are hungrier and have not already spent their money; Work with canteen manager to introduce healthier alternatives into the canteen on a permanent basis; Have a greater Aboriginal culture component and more flexibility to incorporate skills of parents; Use pictoral recipes, as most of the younger children could not read and some of the older children had poor literacy skills; Attempt to have all the cooking occurring in one room, preferably in a kitchen. Other comments • Very practical, hands-on approach. Could have included some more educational sessions though. Proves the success of the hands-on approach.

Yes

Yes Not stated

Yes

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Appendix 1h. Program title An empowerment approach to school-based nutrition education. Reference description Reynolds, J. (1997) An empowerment approach to school-based nutrition education. HEIA Australia Inc. Home Economics: Challenge! Direction! Action! Key words Food, nutrition, nutrition education, schools, framework, empowerment, Food and Nutrition in Action. Abstract The imperative for a new approach to school-based nutrition education came at a time when research around the world indicated that knowledge is necessary but insufficient to bring about behaviour change. It also came at a time when practitioners were beginning to change their view of health from a medical "blame the victim" stance to a more socio-ecological view of health, which recognises the relationship of a wide range of environmental and contextual factors to the nutritional status of Australians. Acceptance of a socio-ecological view of health recognised the importance of socially critical and empowerment approaches to education which develop autonomy to bring about both personal and societal change - support for the concept of students working towards the reality of "healthy food choices being easy food choices". A review of the literature identified that there was no comprehensive theoretical framework for an empowerment approach to school-based nutrition education. This paper reports on a study which identified and refined for food and nutrition education in Australian schools a theoretical framework which synthesises constructs related to developmental, social and cognitive psychology with constructs related to effective learning and teaching in order to formulate an action oriented, empowerment approach to nutrition education. The study includes a rigorous evaluation of the theoretical framework when trialled in three Queensland high schools. The study is strongly linked with the National Nutrition Education in Schools project and its resource 'Food and Nutrition in Action.' Program design and setting Curriculum Framework for schools Year the program was conducted Full address and contact details of organization who conducted the program: Jan Reynolds Home Economics Institute of Australia Inc. PO Box 779, Jamison Centre Macquarie, ACT, 2614. Phone: 61 7 3235 4058 E-mail: [email protected]

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Additional information derived from the program report. Were the aims/goals of the program stated? • To develop, refine, implement, and evaluate an actionoriented, empowerment approach to school-based food and nutrition education aimed at developing health promoting foodrelated behaviours. Were any key findings identified by authors? • Found five key concepts.1). Health is multi-dimensional (social, emotional, cognitive, and spiritual dimensions) • 2). Autonomy and empowerment (students need to have a sense of control over what they eat, but also need to learn how to challenge those factors which impact on their and others' food choices, and from an informed position, take action.) • 3). Learning and teaching (students need to be sufficiently motivated by what they learn in the classroom to apply what they have learnt to their lives outside the classroom. • 4). Making the curriculum relevant to the students (It is critical that the unit of work planned for the students is relevant to them. An effective strategy to do this is to provide a democratic learning environment and to negotiate the curriculum with the students.) • 5). Co-operative learning (It is easier to bring about changes, whether personal or in the broader community, when students work in groups on a task.) • "With respect to understanding the empowerment process, competence in the steps of the empowerment process, and the combined score, the students who participated in the program scored significantly higher compared to the scores of the control studies." • “Participating in the approach on one occasion only is unlikely to facilitate continued student control of their food-related behaviours. Rather, students need to experience the approach in a number of contexts." • When students work co-operatively on a task, they can help each other understand the information, support each other in achieving their goals, and give each other ideas and encouragement. Were any strengths identified by the authors? • Democratic learning, deep approaches to learning and metacognition placed demands on teachers. However all teachers felt that these components were the essence of the success of the program. • "An action-oriented empowerment approach diverges from the traditional approach to teaching nutrition in schools. Such an approach sees far less emphasis on detailed knowledge of nutrients and their functions, and much more emphasis on student control over food-related behaviours." Were any weaknesses identified by the authors?

YES Yes

Yes

Yes

Not stated

Were any barriers to the program identified by the authors? Were any outcomes recorded by the authors? • Seems to be a good model for the curriculum. Presents some very valid points. Were there any unexpected outcomes recorded by the authors?

NO

Not stated Yes

Not stated

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Was any evaluation conducted by the authors? Were any future implications recorded by the authors? • "It is impossible for students to learn at school all they need to know for the rest of their lives in relation to food and nutrition." "Students need to know how to access information, and how to make judgements as to whether or not the information is valid." "Students need to learn how to learn." • "When students develop skills in being able to select food, prepare food and advocate for healthy food, then they are in a better position to develop a sense of control over the foods that they eat and the foods that are available for them to eat." • “This study has provided a foundation for future directions for nutrition education. It has provided data on the efficacy of an action-oriented, empowerment-based approach to the control of food habits and this has provided evidence on which both professional development of teachers and the development of resources can be based.” Other notes • Seems to be a good model for the curriculum. Presents some very valid points.

Not stated Yes

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Appendix 1 i.. Program title

Fairburn school canteen project

Reference description Buffett, H. (2000) Fairburn School Canteen Project, Otahuhu, New Zealand. (pers. comm.) Key words School nutrition, canteen, health promoting schools, Project report summary It is a decile 1 school, has a roll of approx. 750 students and caters for up to year 6 students. The school won the contract for the Intensive pilot in 1996 and became a Health Promoting School in 1997. In November of 1996 the existing contract (external) servicing the school expired and the school decided to take over the canteen. A typical school gate scene was children coming to school with a large bag of chips under one arm and a bottle of fizzy drink under the other - this substituted breakfast and lunch. Teachers experienced problems with a majority of these children being "off the planet" and were finding their concentration, behaviour and attitudes were being affected by what they ate. This is from observation before and after the change in the school menu and banning of certain foods. The processes are as follows. The first thing the school looked at was the infrastructure of the canteen so there were clear designated roles in running it. The executive officer was responsible for negotiating with distributors on best possible prices and is responsible for the money, invoicing, etc. They employed one full-time and one part-time person who are parents of children attending the school. The school went through a consultation process with their community and staff to get support in: * Banning junk food - this is defined in the policy * Development of policy * A review process that was done in 1998 (98.5% supported the change) The development of "combos" (6 in all) is standard and items cannot be singled out, this also applies to school staff. The cost of the combos, which includes 3-4 items in each is $2.50. Additional things can be brought at playtime and lunch. Anything new must be screened through the dietician or Heart Foundation and then approved by the Board of Trustees. The profits generated from the canteen are as follows: 1997 - $20,000 1998 - $20,000 - there was a price increase in July '98 but this was not passed onto students 1999 - $30,000 - approx. These figures are net and inclusive of GST. Benefits for all groups - students, better eating habits = better learning; staff, better behaviour = better achievements; parents, less pressure to buy expensive, trendy foods. Description of population group Students at Fairburn School, Otahuhu, New Zealand. Program design and setting Intervention program; School setting Year the program was conducted 1997-present

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Full address and contact details of organization who conducted the program: Hinemoa Buffett Health Promoting School Facilitator for Auckland Central E-mail: [email protected] Additional information derived from the program report.

Were the aims/goals of the program stated?

YES

NO Not stated

Were any key findings identified by authors?

Not stated

Were any strengths identified by the authors? • The students had better eating habits and therefore learnt better • The staff received better behaviour from their students and therefore they achieved more • The parents had less pressure to buy more expensive, trendy foods. Were any weaknesses identified by the authors?

Yes

Not stated

Were any barriers to the program identified by the authors? Were any outcomes recorded by the authors? • Profits from the canteen are rising every year (1997-$20,000; 1998-$20,000; 1999-$30,000) Were there any unexpected outcomes recorded by the authors?

Not stated Yes

Not stated

Was any evaluation conducted by the authors?

Not stated

Were any future implications recorded by the authors?

Not stated

Other notes

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Appendix 1j. Program title Introduction to Good Nutrition for Primary School Students. Gilles Street School Nutrition Program. Reference description Adelaide City Council (1998) Introduction to Good Nutrition for Primary School Students. Adelaide City Council, program evaluation report. Key words Health promotion, health, schools, nutrition, primary school, healthy diet. Project report summary Adelaide City Council in conjunction with Adelaide Central Community Health Service conducted an eight session “Good Nutrition” programme at Gilles Street Primary School in Term III 1998. This program included information sessions, practical food preparation skills and an excursion to the Central Market. Each session was supported with written information and exercises and follow up by classroom teachers. Description of population group Two classes of year 6 and 7 students made up of 26 mainstream and 14 from “New Arrivals Programme” from Gilles Street Primary School, which is categorized DSP i.e. disadvantaged programme school students from low-income families. Program design and setting Metropolitan school setting Year the program was conducted 6/8/98-24/9/98 Full address and contact details of organization who conducted the program: Beris Weatherly C/- City of Adelaide Community Centre 23 Coglin Street Adelaide Phone: 61 8 8203 7624 Fax: 61 8 8231 9939

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Additional information derived from the program report. Were the aims/goals of the program stated? • To raise awareness of a healthy diet; • Promote an understanding that a nutritious diet leads to improved health status; • To gain skills and knowledge in the preparation of nutritious simple meals; • To provide a flow on of knowledge to NESB families. Were any key findings identified by authors? • Quote from student: "I will miss the lessons because I like them very much and the lessons made our Thursdays more interesting and happier." • The majority of students were already eating healthy lunches. • Over the project time the high fat lunches decreased and the consumption of fruit had increased. • Of some concern was a rise in students who ate nothing, however some students ate their lunch at recess time, which tends to skew the results. • There was no significant change in breakfast consumption from the pre and post questionnaire, although a slight decrease in the number of students who ate no breakfast. Were any strengths identified by the authors? • Direct contact with students was the most effective promotion strategy, as is evident from the journal entries. • Involvement and enthusiastic support from school staff plus their commitment to the follow up was invaluable to the program. • Having a budget which allowed for the purchase of a wide range of quality ingredients enhanced the overall effect of the program. Were any weaknesses identified by the authors?

YES Yes

NO

Yes

Yes

Not stated

Were any barriers to the program identified by the authors?

Not stated

Were any outcomes recorded by the authors?

Not stated

Were there any unexpected outcomes recorded by the authors? • "The amazing 'depth' of the knowledge and understanding which students acquired during the course of the project which was evident during question time at beginning of each session."

Yes

Was any evaluation conducted by the authors? • Process and Impact. Outcome evaluation was not applicable. • Methods used included: children’s weekly journals, verbal feedback of 12345+ Food and Nutrition plan during question time, written evaluation on last day of project, improved food preparation skills observed during the course of project, children’s feedback re using recipes at home, comparison of pre and post questionnaire. Were any future implications recorded by the authors? • Next time it would be better to have several more adult helpers as well as longer session times. • Don't underestimate the depth of understanding that primary school students can 'take on board' if a program is stimulating and enjoyable. Other notes • Students seemed very happy with the program, found it enjoyable.

Yes

Yes

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Program title

Appendix 1k. Hunter Region Health Promoting Schools Project.

Reference description Lynagh, M., Knight, J., Schofield, M.J., Paras, L. (1999) Lessons learned from the Hunter Region Health Promoting Schools Project in New South Wales, Australia. J. of School Health. 69(6): 227-232. Key words School, nutrition, Health Promoting Schools, children Abstract This paper describes development, over a five-year period, of the Hunter Region Health Promoting Schools Project in New South Wales (NSW), Australia. The project implemented the principles and philosophy of the Health Promoting Schools concept and evaluated it's effectiveness using a randomised controlled trial involving 22 public secondary schools. An overview of the preliminary intervention model based on the health promoting schools philosophy and trialled in a pilot study is provided. The authors also outline barriers to, and difficulties in, implementing the philosophically based intervention model in the secondary school setting. The current intervention approach, which evolved over five years, is described in relation to the roles played by project team members and school communities. In addition, the authors outline guiding principles arising from the new approach which facilitated adoption of health promotion strategies in secondary school settings. Description of population group: 22 public secondary schools in the Hunter Region of New South Wales. Program design and setting School Year the program was conducted 1995-1997 Full address and contact details of organization who conducted the program: Marita Lynagh Lecturer, Discipline of Behavioural Sciences The University of Newcastle Callaghan, NSW, 2308 E-mail: [email protected]

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Additional information derived from the program report. Were the aims/goals of the program stated? • To determine the feasibility of a community action approach to encouraging 12 secondary schools to adopt the health promoting schools concept. • To evaluate the effectiveness of a health promoting schools intervention program in reducing the prevalence at two-year posttest of three health risk behaviours (smoking, unsafe alcohol consumption, inadequate solar protection) through randomised controlled trial involving a cohort of junior secondary school students from 22 state secondary schools in the Hunter region. • To develop strategies and resources for use by other schools communities to facilitate adoption of a health promoting schools philosophy. Were any key findings identified by authors?

YES Yes

Not stated

Were any strengths identified by the authors? Were any weaknesses identified by the authors? • Lack of support from educational staff, poor in-service training of teachers regarding health promotion, perceived lack of administrative support and commitment, competing demands on teacher time and energy, little parent and family involvement, and competition with other curriculum areas, timetabling and resource issues. • Costs were enormous and would be difficult to maintain on an ongoing basis. Were any barriers to the program identified by the authors? • Lack of allocated time for staff to attend meetings meant some teachers perceived their involvement as "over and above" their existing work commitments. • Lack of expertise and experience by community members has been noted as a limitation to a "grassroots" approach. • Laying the groundwork took 12 months, by which time there were changes in staff, or delegation of responsibilities by the principal to other school staff not as committed to the project. Were any outcomes recorded by the authors?

NO

Not stated Yes

Yes

Not stated

Were there any unexpected outcomes recorded by the authors?

Not stated

Was any evaluation conducted by the authors?

Not stated

Were any future implications recorded by the authors? • Actions and accompanying resources should be introduced to schools one at a time, with schools advising on their suitability and suggesting how to implement actions. • Strong support from school communities is crucial in the initial stages. Other notes • No evaluation indicated and no strengths identified. Good aspect of this program is the amount of parental involvement.

Yes

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Program title

Appendix 1l. Munchiecard. Smart and healthy, the school of the future.

Reference description Children’s Health Development Foundation. (2000) Munchiecard. Smart and Healthy, the school of the future. Children’s Health Development Foundation and the Women’s and Children’s Hospital, Adelaide. Key words Schools, children, healthy, canteens, smartcard. Project report summary “Become a Munchiecard Canteen: A smart and healthy school canteen of the future. School canteens now have the opportunity to become smart and healthy! The CHDF has developed the Munchiecard Canteen Program that combines healthy food promotion strategies with the latest smartcard technology available from Telstra. The aims of the program are to help school canteens provide and promote healthy food choices and become high profile, high tech, smart and healthy! It aims to encourage students to choose the healthy food options and to give them the opportunity to experience technology that will be part of their future. The Munchiecard Canteen Program now available to Australian schools consists of the Munchiecard smartcard, promotional strategies and materials, nutrition support, curriculum ideas and a telephone advisory service.” Description of population group: Male and female primary school children. Program design and setting School setting in South Australia Year the program was conducted (may be different to publication) 1998 Full address and contact details of organization who conducted the program: Children’s Health Development Foundation 8th Floor Samuel Way Building Women’s and Children’s Hospital 72 King William Rd North Adelaide, SA, 5006 Telephone: 61 8 8204 7777 Facsimile: 61 8 8204 7778 Email: [email protected] Home Page: http://www.chdf.org.au

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Additional information derived from the program report. Were the aims/goals of the program stated? • Pilot: To test and refine the technology for the school canteen, and to provide pilot schools with a stimulus to explore new curriculum opportunities in health, enterprise education, technology and financial management. Were any key findings identified by authors?

YES Yes

Not stated

Were any strengths identified by the authors?

Not stated

Were any weaknesses identified by the authors? • Parents expressed concern at children as young as 5 years old being responsible for a card worth $20. Were any barriers to the program identified by the authors?

Yes

Were any outcomes recorded by the authors? • Students were not buying health foods so lollies are now fruit based, there are healthy lunchtime specials each month which are extremely popular and a greater variety of foods is being sold. • The munchiecard is now linked with many other curriculum areas such as maths, society and environment, and health. Year 6 students can apply for positions in the canteen as helpers using written applications as a basis for selection. Were there any unexpected outcomes recorded by the authors?

Yes

Not stated

Not stated

Was any evaluation conducted by the authors? Were any future implications recorded by the authors? • May need two types of cards: red cards which are kept in the canteen on behalf of some students, and green cards which the students kept themselves. • In the future the munchie card will be used for a range of other cash payments in the school such as excursions, Internet access, on-line printing and photocopying, as well as providing for an integrated student ID, transport concession and library card. • Plans are also underway for the development of a Munchiecard for school staff, which will be the 'key' to a whole range of on-line school health services and information.

NO

Not stated Yes

Other notes • This program is still in its formative stages. • Incorporates the program into all areas of the school, as well as keeping up with technology.

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Appendix 1m. Program title

Seaford School Canteen Support Project

Reference description Noarlunga Health Services. (1997) Seaford School Canteen Support Project. Health Information & Promotion Service. Key words School, canteen, nutrition, Seaford Project report summary The project aims to employ a part-time project officer who will work with the new Seaford High School and the primary schools in it’s zone to facilitate the provision and promotion of healthy food choices. The project will be a collaborative effort between Noarlunga Health Services (NHS), Moana Primary, Seaford Rise Primary, Noarlunga Primary (at Old Noarlunga) and Seaford High. The other primary school in the zone, Seaford, has declined to participate at this stage but it may be possible to involve it as the project shows success. The project officer would be seen as a resource person who would work with school councils, canteen committees, staff and parents to develop food policies and facilitate the provision and promotion of healthy food choices. Preference will be given to a person who can be flexible and work more hours in term time and less in school holidays. Description of population group: Three schools committed: Seaford 6-12 School, Seaford Rise Primary School, Moana Primary School. Program design and setting School setting Year the program was conducted 1995-1996 Full address and contact details of organization who conducted the program: Chris Reed Noarlunga Health Village Alexander Kelly Drive Noarlunga Centre SA, 5168. Phone: 61 8 8384 9266 Fax: 61 8 8384 9248

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Additional information derived from the program report. Were the aims/goals of the program stated? • To increase the proportion of food purchased at schools in the Seaford area that is consistent with the Australian Dietary Guidelines (ADG’s) for children and adolescents. • To demonstrate the feasibility of working with a cluster of schools in a geographically defined area to improve the proportion of healthy foods purchased by students at school. Were any key findings identified by authors? Were any strengths identified by the authors? • All interested groups were brought together in a way that allowed the project to belong collectively and individually to each school community. Everyone acted as an advocate for the children, including parents, teachers and principals. • Despite many changes of key players throughout the course of the project, ownership was sustained and continuous. Supportive and interested principals were a tremendous asset. Were any weaknesses identified by the authors? • The school communities involved in the project had no prior experience of working with working with an outside agency and while the school communities were welcoming, initially the project had little credibility or acceptance and everyone was uncertain how the project and project officer would fit in. • The collection of statistical data proved to be a difficult task. Were any barriers to the program identified by the authors? • While all the principals involved in the project were positive and supportive of the general ideas of the project, some had more time available to them to be involved in the project. • For Seaford 6-12 the timing of the project was both good and bad. It was a challenging time for the administration and staff as they were establishing a new school and the last thing they wanted to take on was an outside project. However, it proved to be an ideal time to establish a health promoting school canteen, as experiences from other schools indicate that it is much easier to introduce these concepts and procedures in the early formation of the school than at a later date. Were any outcomes recorded by the authors? • Partnerships/ Networks/ Links were forged as a result of collaboration between the three schools. • Overall there was an increased profile of school canteens. A greater selection of healthy food choices were provided, while maintaining profitability. • Parents involved in the project have increased confidence and knowledge; and acquired additional skills in communication, group work, team work, planning and document writing. Overall parents felt more empowered. • Developed an Outsourced Canteen Food Service Document, which represented a collaborative effort of the three schools involved in the project. • The Seaford 6-12 School developed a School Canteen Policy. • Both Seaford Rise Primary School and Seaford 6-12 have advertised for Canteen Supervisor or Manager for 1997. Were there any unexpected outcomes recorded by the authors?

YES Yes

NO

Not stated Yes

Yes

Yes

Yes

Yes

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• Some participants, as a result of being involved in the project gained employment managing and running school canteens. • Selection criteria for canteen supervisors and managers have been developed with an emphasis on both the promotion and provision of healthy food choices for students. • Schools now realise they can access and benefit from services outside of DECS. I.e. they are applying for grants from organizations to further focus on student health issues. • The Southern Canteen Support Network has been established. Currently about ten schools are involved and the group meets once a term. Was any evaluation conducted by the authors? • The evaluation took three forms: Process, impact and outcome. • Process evaluation consisted of documenting process of consulting with school community on food policy, new lines developed and sales; record companies visited, expo’s attended, new products trialled and their acceptance; promotion strategies used, how they were received by students, staff and parents and resulting sales; HDF and NHF strategies used and resulting sales; document training provided, attendances, feedback, etc; attendances at meetings and minutes, any joint initiatives that occur. • Impact evaluation consisted of documenting policies in place by July 1996, if not in place in all schools, discuss why not; monitoring of foods purchased will probably vary at different schools depending on practicalities. Important that monitoring be done regularly perhaps every two months, not just at beginning and end; what lines are being purchased or produced jointly and what other cooperation is occurring by July 1996. • Outcome evaluation consisted of surveying sales necessary to evaluate objective 2; used to determine if overall proportion of foods purchased at schools in Seaford that are consistent with ADG’s has increased. • Statistical data was collected and a wide range of people who were involved in the project were consulted. An afternoon tea was organised to acknowledge and recognise the efforts of all those who participated in the project as a means to receive some feedback, impressions and thoughts about the project. Were any future implications recorded by the authors? • Seaford Rise Primary School offered many healthy food choices and was very profitable, supporting the notion that it is possible for a healthy canteen to be a profitable canteen. Willunga High School is another prime example of this. • The nutrition discipline at NHS has recognised that school canteens are an important area of concern in the southern area and has dedicated a 0.1 FTE position to maintaining the canteen work. • A long term goal as a result of the project is to develop a formal network of school canteens in the southern area within the NHS catchment area where: formal ideas can be exchanged, support can be offered and current information can be provided. Other comments • Pretty good program. Evaluated very well, implemented very well. Encouraged parents to get involved and practically run things on their own.

Yes

Yes

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Program title

Appendix 1n. ‘Cool’ Canteens Accreditation Program (TASCAP)

Reference description Tasmanian School Canteen Association Inc. (2000) ‘Cool’ Canteens Accreditation Program. Information kit for schools. Tasmanian Health Promotion Council. Key words Canteen, Tasmania, Canteen Accreditation Program, TASCAP, schools, nutrition, Tasmanian Canteen Association. Project report summary Cool Cap is a Health Promotion project which will: • Develop, implement, and evaluate an accreditation and improvement program for Tasmanian School Canteens based on healthy food choices, marketing and promotions, food safety and hygiene and school community involvement. • Increase the availability and demand for healthy and safe food choices through the development of a school canteens registered product list. • Assist schools to develop and implement food safety strategies specified by the “Food Act 1998.” • Work through a coalition group with representation from School Canteens, Health, Education and Local Government. Annotation The Tasmanian school canteen accreditation project (TASCAP) is still in the preliminary stages and as yet have not signed up any schools. The project is very similar to the Western Australian School Canteen Accreditation Program (STARCAP) and they are currently liasing with the Tasmanian group to aid development. The major difference in the two programs lies in the food section. Description of population group: Primary and Secondary schools and their canteen managers in Tasmania. Program design and setting School setting Year the program was conducted 1999-present Full address and contact details of organization who conducted the program: Carol Nicholson – Project Officer Tasmanian School Canteen Association Inc. C/- Community Nutrition Unit 3rd Floor Repatriation Centre 90 Davey Street Hobart, 7000. Phone: 61 3 6222 7222 Fax: 61 3 6222 7252. E-mail: [email protected]

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Additional information derived from the program report. Were the aims/goals of the program stated? • To increase the availability and promotion of healthy food choices prepared in a safe and hygienic environment in Tasmanian school canteens. Were any key findings identified by authors? • 88% of workshop participants were satisfied with the quality of the workshop content. • 92% of workshops participants were satisfied with the quality of the Cool CAP kit. • 96% of participants felt that the style/content of the workshops would be suitable for future schools workshops. • 56% of schools were current members of the TSCA, 44% were not. Of those who were not members, 71% now wish to join the TSCA Were any strengths identified by the authors?

YES Yes

NO

Yes

Not stated

Were any weaknesses identified by the authors?

Not stated

Were any barriers to the program identified by the authors?

Not stated

Were any outcomes recorded by the authors?

Not stated

Were there any unexpected outcomes recorded by the authors?

Not stated

Was any evaluation conducted by the authors? • Preliminary evaluation still in progress Were any future implications recorded by the authors?

Yes Not stated

Other comments • This looks like it will be a good program. Is modelled on the NSW and WA canteen accreditation programs. Would be good for Victoria to get involved in canteen accreditation as well. Need funding though.

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Program title

Appendix 1o. Western Australian School Canteen Project (WASCA)

Reference description Western Australian School Canteen Association. (1998) Western Australian School Canteen Project. W.A. School Canteen Association Inc. Project report. Key words School, canteen, accreditation, nutrition, health eating Project report summary The School Canteen plays an important role in the majority of school communities. It provides a food service to students and staff, allows for active involvement of parents and in many cases raises much needed funds for other education necessities. There is a growing awareness of the need for the canteen to become part of the learning process, rather than simply a provider of food and funds. The recently released Dietary Guidelines for Children and Adolescents document states: “The school canteen provides children with the opportunity to select their own meals. Depending on the frequency with which children purchase their lunches from the canteen, this could make an important contribution to their views about food and their nutrient intake.” Whilst most school communities acknowledge the preference for selling wholesome foods rather than their high fat, high salt, high sugar and often low fibre counterparts, many remain unconvinced that healthy food can mean healthy profit. The WA School Canteen Project is an initiative of WASCA funded by Healthway. It will provide practical support to assist schools of all education systems to facilitate the adoption and maintenance of a healthy canteen operating at a ‘healthy’ profit. Description of population group: Primary Target Group: Canteen managers, their staff and canteen committee personnel representing parent bodies. Secondary Target Group: School principals, other key teaching staff, school nurses. Additional Target Group: Food industry. Program design and setting School setting Year the program was conducted May 1, 1996 to October 31, 1998. Full address and contact details of organization who conducted the program: Western Australian School Canteen Project Robin Bromley – Project officer P.O.Box 25 Hillarys WA, 6923. Phone: 61 8 9244 1992 Fax: 61 8 9244 1989 E-mail: [email protected]

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Additional information derived from the program report. Were the aims/goals of the program stated? • To actively promote the provision of a variety of foods in school canteens consistent with the Australian Dietary Guidelines for Children and Adolescents. • To increase the range of processed convenience foods of sound nutritional value available to school canteens. • To provide training to assist school canteen personnel to develop and maintain economically viable school canteens. • Monitor practices of school canteens in Western Australia, including canteen policy, staffing, foods sold, promotional activities, financial turnover and profitability. Were any key findings identified by authors? • Responses in workshops indicated that if a wide variety of foods was going to be actively promoted in school canteens, canteen policy needs to change in order for it to be sustained. Also focused on the importance of marketing and promotion of healthier choices consistent with objective 1.3. Were any strengths identified by the authors?

YES Yes

Yes

Not stated

Were any weaknesses identified by the authors? Were any barriers to the program identified by the authors? • Provision of menus/policy documents. Some participants felt threatened by this and did not comply. • Varying literacy/educational levels of participants. (Affected return rates of secondary evaluation forms. • The concept of health professionals following up secondary evaluations. Many have either moved elsewhere or have had role changes where school nutrition is no longer a priority. • The variables of each workshop have made evaluation difficult. No two workshops have been the same in content, target group balance, or category of school and/or size. • Inadequate time to cover content in sufficient depth. Were any outcomes recorded by the authors? • Star Choice Registered Product Food Industry Kit • Star Choice Canteen Buyer’s Guide • Membership of WASCA has grown during the course of the project. • Co-ordination of an annual Healthy Choice Food Expo. • Development and maintenance of a School Canteen Association newsletter. • Development and implementation of a Canteen Accreditation Program. • Assisted in curriculum changes in the TAFE Canteen Management Course and continue to represent WASCA at a national level in development of a nationally accredited training program for canteen managers and associated resources. • Formation of Canteen networks. A number of country regional centres have established canteen networks following workshops, co-ordinated in most cases by community dietician/nurses. Were there any unexpected outcomes recorded by the authors?

NO

Not stated Yes

Yes

Not stated

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Was any evaluation conducted by the authors? • Evaluated workshops, identified positive outcomes and barriers. • Conducted a survey. • Established a register of contacts. Were any future implications recorded by the authors? • An increase in the number of school canteens offering a variety of health choices. This should impact positively on student attitudes and result in an improved nutrient intake for those students who use the canteen every day as their main source of food. This is estimated by the Health Department of WA to be 25% of students. • An increase in the number of the primary target group who should demonstrate an awareness of the supportive role the canteen should play in the health promoting school. • It has provided a model for intersectoral collaboration when addressing nutrition issues in school canteens, rather than the fragmented approaches of the past carried out by individual bodies/agencies. • The amount of media generated by the project has created a climate for change and provided the resources necessary to affect it. The STARCAP should build on the positive outcomes. • It has created the impetus for food manufacturers to improve the range and nutritional quality of convenience products suitable for sale in school canteens. This has long term implications for the wider community. Other notes • Seems to be a pretty good program. Are now in collaboration with Tasmania to develop TasCAP.

Yes

Yes

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Appendix 1p. Program title

Accreditation 2000 (NSWSCA)

Reference description New South Wales School Canteen Association Inc. (2000) New South Wales Canteen Accreditation 2000. New South Wales School Canteen Association Inc, Application kit. Key words Canteen, schools, NSWCA, New South Wales, canteen accreditation, Annotation Accreditation 2000 is a program run by the New South Wales School Canteen Association. The program is reviewed each year and amended accordingly. The NSWCA do not distribute the results of the yearly review, however the revised program contains all of the recommendations made in the review. The application kit for accreditation includes an introduction letter, a letter to the school principal, ideas for classroom activities that are linked to the school canteen, a memo to all teachers about canteen accreditation, a sheet to record the details of any classroom activity conducted which has links to the school canteen, frequently asked questions, an accreditation application form, a NSW health events calendar, a brochure from the NSWCA, and a brochure for a canteen management handbook ‘Management $ense, Food Sense’. The kit is very comprehensive and provides all the information a school canteen needs to consider joining the program. Description of population group: Canteen managers in NSW Program design and setting School setting Year the program was conducted Developed 1990. Implemented 1993. Full address and contact details of organization who conducted the program: New South Wales School Canteen Association Inc. Bland Street Haberfield NSW, 2045. Phone: (02) 9798 6505. Fax: (02) 9799 4057.

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Additional information derived from the program report. Were the aims/goals of the program stated? • Mission statement: Support school communities wishing to operate economically viable hygienic and nutrition oriented school canteens. • To increase the number of nutritious foods available to school canteens. • Accreditation is a strategy to achieve these goals. The accreditation goal is: To recognise and reward canteens that are moving towards healthy food provision. Were any key findings identified by authors? Were any strengths identified by the authors? • Makes healthier choices easier. • Increases availability of healthy foods. • Acknowledgement and recognition of the work of canteen managers/volunteers. Were any weaknesses identified by the authors?

YES Yes (phone)

NO

Not stated Yes

Not stated

Were any barriers to the program identified by the authors?

Not stated

Were any outcomes recorded by the authors? • Each year sees a large increase in the number of schools seeking accreditation. Were there any unexpected outcomes recorded by the authors?

Yes

Was any evaluation conducted by the authors? • An evaluation is conducted each year and the accreditation program is changed accordingly. • Feedback is obtained from the two key stakeholders (adjudicators and schools). Were any future implications recorded by the authors? • The amount of schools accredited will continue to grow. • Healthy choices will be easy choices.

Yes

Not stated

Yes

Other comments • Good program. The NSW program was one of the first accreditation programs to be established in Australia. All the other states followed. Victoria is yet to establish an accreditation program.

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Appendix 2 The Healthy Eating, Healthy Living Program (HEHLP) was funded by the Victorian Health Promotion Foundation (1998-2000) Directors: Professor Mark Wahlqvist, Dr. Antigone Kouris-Blazos Research Officers: Katherine Ross, Tracey Setter Web-master: Callum Richardson Administrator: Cheryl Richards Consultants: Dr Beverley Wood, Dr Naiyana Wattanapenpaiboon, Dr Tim Gill

HEHLP was primarily an information development program which: (1) conducted an analysis of the 1995 National Nutrition Survey in relation to: a) the food insecure, b) low income and c) socially disadvantaged persons in Australia, especially Victoria (available as 3 reports); (2) conducted a critical analysis of available healthy eating programs developed and implemented in Australia and Victoria between 1990-2000 to: i. improve food security of vulnerable groups, ii. improve food habits of school-age children and iii. prevent and treat obesity (available as 3 reports and on-line directory at: http://www.healthyeating.org/health-professionals/projects.htm);

(3) developed an on-going web-site - http://www.healthyeating.org: a) providing credible nutrition information for students, teachers, professionals, government, media and the community b) operating as a clearinghouse/virtual directory for the maintenance and provision of up-to-date information resources in Australia, especially Victoria.

Reports produced by the HEHLP program include: *Documents from the analysis of the 1995 National Nutrition Survey: 1.

Wood B, Wattanapenpaiboon N, Ross, K, Kouris-Blazos A. 1995 National Nutrition Survey: All persons 16 years of age and over and all persons 16 years of age and over, by food security. Healthy Eating Healthy Living Program, Monash University, Victoria 2000.

2.

Wood B, Wattanapenpaiboon N, Ross, K, Kouris-Blazos A. 1995 National Nutrition Survey: All persons 16 years of age and over and all persons 16 years of age and over, by SEIFA. Healthy Eating Healthy Living Program, Monash University, Victoria 2000.

3.

Wood B, Wattanapenpaiboon N, Ross, K, Kouris-Blazos A. 1995 National Nutrition Survey: All persons 16 years of age and over and all persons 16 years of age and over, by low income. Healthy Eating Healthy Living Program, Monash University, Victoria 2000.

**Documents from the analysis of healthy eating programs: 1.

Wood B, Ross K, Kouris-Blazos A. Healthy Eating for Nutritionally Vulnerable Groups. Some Health Promotion Initiatives. Healthy Eating Healthy Living Program, Monash University, Victoria 2000.

2.

Setter T, Kouris-Blazos A, Wahlqvist M. School-based Healthy Eating Initiatives: Recommendations for Success. Healthy Eating Healthy Living Program, Monash University, Victoria 2000.

3.

Gill T, Setter T, Kouris-Blazos A, Wahlqvist M. Healthy Eating Programs for the Treatment and Prevention of Obesity. Healthy Eating Healthy Living Program, Monash University, Victoria 2000.

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