Food and Physical Activity Behaviours of Grade 6 Students in
Waterloo Region
Supported by Region of Waterloo Public Health
January 2, 2007.
We gratefully acknowledge the contributions of:
Daniela Seskar-Hencic, BA, MA, Manager, Planning and Evaluation
Pat Fisher, MA and Lisa Wenger, MA, Public Health Planners
Lewinda Knowles, MHSc, Epidemiologist
Sheri Armstrong, RN, BScN, MS, CHES, and Carol Popovic, RN, BScN, Public Health Nurses
Region of Waterloo Public Health
and
Sarah Woodruff, MSc, PhD candidate
Pete Driezen, MSc, Data Analyst
University of Waterloo
and
Clint MacDonald BEng, MSc
Interglobal Solutions,
Prepared by:
Rhona Hanning, PhD, RD
Associate Professor
Department of Health Studies & Gerontology
Jenn Toews, BSc and Lindsay Hogsden, BSc, MPH
Research Project Managers
Population Health Research Group (PHR)
University of Waterloo
Executive Summary
It is generally accepted that obesity results from a combination of environmental, behavioural,
psychosocial and genetic factors that promote long-term positive energy balance. Modifiable risk
factors for chronic disease, including obesity, physical inactivity and unhealthy diets, are of
increasing concern for Canadian children and adolescents (Shields, 2005; Ball & McCargar, 2003;
Tremblay & Willms, 2000; Tremblay et al, 2002). Indeed, the prevalence of overweight and obesity
in Canadian children and adolescents has increased dramatically since the early 1980s (Ball &
McCargar, 2003; Tremblay & Willms, 2000). Since overweight and obesity in adolescence often
continues to adulthood (Whitaker et al., 1997) and the consequences in terms of chronic disease and
health complications are severe (Must et al., 1999; WHO/FAO, 2003), emphasis must be directed to
health promotion and early identification and management of risk factors.
Study Overview
In this study, Region of Waterloo Public Health, in partnership with the University of Waterloo,
aimed to assess food and physical activity behaviours among grade six students in Waterloo Region,
and to reveal the social and environmental factors influencing these behaviours.
A sample of approximately 500 grade six students was selected from schools from the Waterloo
Region District School Board. Schools were grouped into 10 “clusters” to represent a cross section
of neighborhoods in Waterloo Region, using socioeconomic and demographic variables from the
2001 Statistics Canada Census and the 2001 Urban Poverty data. Schools were then recruited to
represent all neighbourhood clusters. The final sample included 405 grade six students from 15
Waterloo Region District School Board schools.
With parental consent, participants completed the web-based University of Waterloo Food Behaviour
Questionnaire (Hanning et al., 2003; Minaker et al., in press; Hanning et al., in press). This survey was
designed to assess nutrient intake, food behaviours, and the physical activity patterns of children and
adolescents through the use of a 24-hour dietary recall, food frequency questionnaire, and other
nutrition and physical activity behavioural questions. To ensure that the data represented school
days for the 24-hour dietary recall measurements, surveys were typically conducted from Tuesday to
Friday. While students indicated their perception of their height and weight in the survey, public
health nurses were on-site to take physical measurements of height and weight, as self-reported
measures may be inaccurate. Data collection took place between November 2005 and April 2006.
2
Results Overview
Body Mass
Body Mass Index (BMI) is a number calculated from a weight and height measurement, and is a
reliable indicator of body fatness for most adolescents when calculations consider age and gender
implications. Using these calculations, one quarter of grade six students in Waterloo Region
were considered “at risk of overweight” or “overweight”. This is similar to the national average
(26%; Shields, 2005) and represents a significant health concern.
The mean BMI for the sample of Waterloo Region students (BMI of 19.2) was in a healthy weight
range, and was slightly lower than national rates (22.1 for 2 to 17 year olds from across Canada;
Shields, 2005). From both physical measurements, and web survey estimates, girls were significantly
taller than boys, but no differences were found in terms of weight or BMI between genders.
Girls were more likely to say that they were concerned about their weight being too high (27%)
compared to boys (18%). However, girls and boys responded similarly in agreeing with the
statement “I am eating less than usual to lose weight”. Since dieting behaviours are typically found in
both healthy weight and overweight girls (McVey et al, 2004), body image needs to be discussed
earlier than middle school.
Nutrient and Food Group Intakes
Canada’s Food Guide to Healthy Eating (CFGHE) provides daily recommendations for dietary
intake from four food groups: grain products, vegetables and fruit, milk products, and meat and
alternatives. The survey revealed that many children in the Region were not consuming
adequate servings of each food group recommended for health.
Two thirds of students (68%) did not meet the minimum CFGHE recommendations for vegetable
and fruit intake (5 - 10 servings/day). Almost half (48%) did not meet minimum recommendations
for grain products (5-12 servings), which was reflected in inadequate folate intakes among half of
students. Further, fibre was below Adequate Intakes for virtually all (90%) students. Nearly half of
all students (45%) did not meet minimum recommendations for milk products (3-4 servings) and, as
a result, calcium and vitamin D intakes were found to be suboptimal. Meat and alternatives intakes
fell below recommendations (2 - 3 servings) for close to half of the students (46%), with the
prevalence of inadequate intakes of iron and zinc being 11% and 31%, respectively.
Boys consumed significantly more milk products and meat and alternatives servings than girls. Over
half of the girls surveyed did not meet CFGHE recommendations for any of the food groups. Data
from the current study agree with other studies of Canadian children and adolescents showing that
marginal intakes from nutrient-rich food groups were common, especially in girls (Gray-Donald et
al., 2000; Jacobs-Starkey et al., 2001).
CFGHE recognizes that “other” foods, which do not fall within food group classifications, may be
higher in fat and calories, and should be consumed in moderation. Increased energy intakes from
“other” foods, such as sweetened beverages, have been observed in Canadian youth (e.g. Garriguet,
2006; Gray-Donald et al., 2000). In Waterloo Region, more than one fifth (21%) of energy intake
and one quarter of fat intake (24%) came from “other” foods of low nutrient density. For example,
12% of the students reported daily consumption of pop drinks, while over half (56%) said they
drink pop at least once a week. About 46% of the students indicated that soft drinks are “always” or
3
“usually” available in their home. The high frequency of consumption of foods of low energy
density is alarming, especially given the low intakes from the nutrient-rich food groups.
Daily Breakfast Consumption
Girls in the Waterloo Region were significantly more likely to report skipping breakfast as
compared to boys (90% of boys reported eating breakfast everyday, while only 79% of girls did).
Since girls were also more likely to report that they were concerned their weight is too high, reasons
for skipping breakfast may, in part, relate to misguided efforts at weight control. Breakfast
consumption rates in the Region are higher than has been reported in other recent Canadian surveys
of similar aged students (Evers et al., 2001). Since breakfast frequency generally declines as students
enter high school – especially for girls (Cohen et al., 2003)– the relatively high baseline is
encouraging.
Family Food Environment
Recent studies show that more frequent family meals are associated with healthier eating and the
frequency of family meals eaten together appears to decline over time (Neumark-Sztainer et al.,
2000, 2003). Three-quarters of students surveyed (76%) reported that they ate dinner with at least
one family member 6 or 7 days of a week. The vast majority of students reported that vegetables,
fruit and milk were “usually” or “always” available in their home (98%). Similarly, the majority of
students reported that vegetables and milk are “usually” or “always” served with meals (92% and
79%, respectively). In this group of grade 6 students, 60% were “very sure” that they could choose
to eat healthy foods when eating with family.
Few students had high fat (26%), salty snack foods (37%) or pop (46%) available in the home
“usually” or “always”. The family food environment in Waterloo Region appears to offer healthy
choices to students. Of note is that snacks were often eaten alone and only 41% of students were
‘very sure’ that they could choose to eat healthy foods when eating alone.
Food Prepared Away From Home
Compared to foods prepared at home, foods prepared elsewhere tend to be higher in energy and fat
(French et al., 2001; Lin et al., 1999) and positive associations have been found between frequency
of eating foods away from home and proportion of body fat (Gillis & Bar-Or, 2003). Less than 5%
of students reported eating lunch or dinner at a restaurant or fast food outlet on the weekday prior
to the survey. This is much lower than was reported for participants in the Canadian Community
Health survey. However, many students reported consuming foods prepared away from home
at least once a week. More boys than girls said they ate foods prepared at fast food restaurants
(29% boys, 19% girls), vending machines (23% boys, 8% girls), and foods from a snack bar or tuck
shop (36% boys, 20% girls) on a weekly basis. Boys were also more likely than girls to report eating
foods for lunch, afternoon snack and/or dinner that had been purchased from a vending machine
on a weekly basis as compared to girls. Elementary school would seem to be an appropriate time to
talk with students about making healthy food choices when away from home.
Physical Activity
The influence of physical activity on body weight and composition of children and adolescents is
widely recognized (McGinnis, 1992; Gillis et al., 2002; Kemper et al., 1999; McMurray et al., 2000).
A decline in levels of physical activity in North American children and adolescents has been
documented, especially among females (French et al., 2001; Sallis et al., 2000; Talama et al., 1997,
4
James et al., 1998). Boys were more likely than girls to report participating in extracurricular physical
activity with greater frequency (4 or more times per week) before or after school (46% versus 29%,
respectively) and in the evenings (53% versus 38%, respectively). In addition, boys were more likely
to run and play hard at recess as compared to girls (42% versus 16%, respectively). Boys and girls
were comparable in activity during physical education at school. Nearly two-thirds of students in
the Region (64%) reported walking, biking or roller blading to and/or from school 5 days in the past
week.
Sedentary Activity
Boys were more likely than girls to spend more time surfing the internet or playing
computer or video games. Results for Waterloo Region suggest that time spent watching TV and
doing other screen activities may not be as high as in other regions of Canada. However, among
students classified as “at risk of overweight” or “overweight” over a third of the students are
spending 3 hours in front of the TV or computer each night.
Recommendations
This study has contributed new information on the food and physical activity behaviours of
Waterloo Region grade six students. The findings are consistent with patterns documented in other
studies of Canadian and U.S. students, which support the need for interventions to promote
physical activity and healthy eating, to prevent obesity in children and youth (e.g. Garriguet,
2006; Veugelers & Fitzgerald, 2005; Troiano, 2000).
For children, school represents a key environment for promoting healthy lifestyles (Raine, 2004). In
Nova Scotia, grade five students from schools with curricular and environmental supports for
healthy eating had lower rates of overweight/obesity, healthier food intake and more physical
activity than students in schools without such programs (Veugelers & Fitzgerald, 2005). The U.S.
Institute of Medicine (2004) report on preventing childhood obesity recommended that schools
work in concert with government, public health and other organizations to facilitate cross-cutting
programs and community-wide efforts. These baseline data may serve as a benchmark for
monitoring change in response to new obesity prevention initiatives.
5
TECHNICAL REPORT
GLOSSARY OF TERMS .......................................................... 8
INTRODUCTION ................................................................... 9
OBJECTIVES.......................................................................... 10
METHODS ............................................................................. 10
Study Population........................................................................................................................ 10
Survey Design ............................................................................................................................ 10
Demographic Data................................................................................................................. 11
24-hour Dietary Recall ........................................................................................................... 11
Food Behaviours.................................................................................................................... 11
Physical Activity..................................................................................................................... 12
Statistical Analyses ..................................................................................................................... 12
1.0 DEMOGRAPHIC CHARACTERISTICS OF
RESPONDENTS.................................................................... 13
2.0 ANTHROPOMETRIC MEASURES.............................. 14
Section 2.0.1
Section 2.0.2
Mean Weight, Height and BMI .......................................................................... 14
BMI Distribution ............................................................................................... 14
3.0 FOOD GROUP INTAKES .............................................. 16
4.0 NUTRIENT INTAKES ................................................... 18
5.0 FOOD BEHAVIOURS..................................................... 20
Section 5.0.1
Section 5.0.2
Section 5.0.3
Section 5.0.4
Section 5.0.5
Section 5.0.6
Section 5.0.7
Section 5.0.8
Meal Frequency.............................................................................................. 20
Where and With Whom Respondents Ate Their Meals .................................. 22
Food Sources ................................................................................................. 24
Pop Consumption.......................................................................................... 26
Food Preparation ........................................................................................... 27
Confidence to Eat Healthy Foods .................................................................. 29
Family Influences ........................................................................................... 30
Television and Meals...................................................................................... 32
6.0 PERCEPTIONS OF BODY WEIGHT .......................... 33
7.0 PHYSICAL ACTIVITY AND INACTIVITY............... 34
Section 7.0.1
Section 7.0.2
Section 7.0.3
Section 7.0.4
Section 7.0.5
Self-Reported Physical Activity .......................................................................... 34
Active Transportation ........................................................................................ 35
Physical Activity during School .......................................................................... 35
Extra-curricular Activities................................................................................... 37
Sedentary Activities ............................................................................................ 37
REFERENCES ....................................................................... 41
APPENDIX A: ADDITIONAL TABLES............................. 47
6
APPENDIX B: SAMPLE SCHOOL REPORT ................... 50
APPENDIX C: POSTER PRESENTATION...................... 63
APPENDIX D: LETTER TO PRINCIPALS ...................... 64
APPENDIX E: CONSENT LETTER TO PARENTS....... 66
APPENDIX F: WEB-BASED SURVEY ............................... 69
TABLES
Table 1.1: Age, grade and gender of respondents, Waterloo Region, 2005-6.........................................13
Table 2.1 Physical measurements of body weight, height and BMI.........................................................14
Table 3.1: Median food group intakes ..........................................................................................................16
Table 3.2: Number of students with no servings of a food group ...........................................................16
Table 3.3: Percent of students below minimum Canada’s Food Guide to Healthy Eating
recommendations ..........................................................................................................................17
Table 4.1: Adequate nutrient intakes.............................................................................................................19
Table 5.1: Meal frequency...............................................................................................................................21
Table 5.2: People with whom respondents ate their meals........................................................................23
Table 5.3: Frequency of consuming foods prepared outside the home ..................................................25
Table 5.4: Locations where food consumed was purchased .....................................................................26
Table 5.5: Who prepared the food consumed .............................................................................................28
Table 5.6: Involvement in food preparation................................................................................................29
Table 5.7: Confidence to eat healthy foods..................................................................................................29
Table 5.8: Family influences ...........................................................................................................................31
Table 5.9: TV viewing during meals..............................................................................................................32
Table 5.10: TV influence to eat specific foods ............................................................................................32
Table 7.1: Extracurricular activities ...............................................................................................................37
Table 8.1: Estimated median nutrient intakes .............................................................................................47
Table 8.2: Physical activity in the past 7 days ..............................................................................................48
FIGURES
Figure 2.1: BMI distribution from physical measurements .......................................................................15
Figure 3.1: Energy and fat from the “other” food group ..........................................................................17
Figure 5.1: Meal consumption........................................................................................................................20
Figure 5.2: Frequency of consuming dinner with at least one parent ......................................................23
Figure 5.3: Pop consumption.........................................................................................................................27
Figure 6.1: Weight perceptions ......................................................................................................................33
Figure 6.2: Weight concerns...........................................................................................................................33
Figure 7.1: Activities in the past 7 days.........................................................................................................34
Figure 7.2: Active transportation to and from school ................................................................................35
Figure 7.3: Activity during school breaks .....................................................................................................36
Figure 7.4: Activity during physical education class....................................................................................36
Figure 7.5: Television watching after school ...............................................................................................38
Figure 7.6: Time spent surfing the internet or playing computer/video games .....................................38
Figure 7.7: Television watching by BMI classification ...............................................................................39
Figure 7.8: Computer use and video game playing time by BMI classification ......................................40
7
GLOSSARY OF TERMS
Adequate Intakes (AI) – only used when Estimated Average Requirements (EAR) cannot be
established; an AI is determined by estimating how much of a nutrient is being eaten
by a group of healthy people and assumes that the amount they consume is adequate
for others (Health Canada, 2003)
Anthropometric – related to the measurement of the size and proportions of the human body
Body Mass Index (BMI) – a measurement of the relative percentages of fat and muscle mass in
the human body; BMI is measured by dividing weight (kg) by height (m2), and in this
study we used the categories of underweight, healthy weight, at risk of overweight or
overweight, according to the Centers for Disease Control BMI-for-age percentiles
(http://www.cdc.gov/nchs/data/nhanes/growthcharts/bmiage.txt)
Canadian Community Health Survey (CCHS) – A survey conducted by Statistics Canada to
provide cross-sectional estimates of health determinants, health status and health
system utilization (Statistics Canada, 2003)
Demographic – a statistic describing a segment of a human population (e.g. age, gender)
Dietary Reference Intakes (DRI) – recommendations for nutrient intakes; based on amounts of
vitamins and minerals needed in the diet to prevent deficiencies and lower the risk of
disease (Health Canada, 2003)
Estimated Average Requirements (EAR) – the amount of a nutrient that is estimated to meet the
requirements of half of all healthy people of a certain age and gender (Health
Canada, 2003)
Intraclass Correlation Coefficient (ICC) – a statistical test of reliability
Mean – the average
Median – the median is the number that divides a sample in half; the middle number in a sequence
of numbers
Validity – well founded in logic or truth
8
INTRODUCTION
Today, approximately one-third of Canadian children from 5 to 13 years of age are considered either
overweight or obese. Obesity is attributed to an interaction between biological factors as well as
behavioural and environmental factors.
Until recently, little was known about the food intake and behaviours of Ontario adolescents.
Dr. Hanning and colleagues at the University of Waterloo developed a web-based survey
which has been used to survey students from grades six to ten. The current survey extends
that research to grade six students attending schools in the Waterloo Region, Ontario.
Nutritional Intake of Children and Adolescents
Unhealthy food behaviours in adolescence have the potential to exert strong
negative consequences on future health, including increased risk of chronic diseases
in later life (Ball & McCargar, 2003)
Research suggests that many Canadian children and adolescents are not consuming
the servings of milk products or vegetables and fruit recommended by Canada’s
Food Guide to Healthy Eating. Moreover, in excess of a fifth of energy intake
comes from “other” foods (CCHS Cycle 2.2)
Omission of breakfast or consumption of inadequate breakfast may be a factor that
contributes to dietary inadequacies (Cohen et al., 2003)
Healthy eating patterns formed early in childhood may persist into adulthood (Dietz,
1998)
Physical Inactivity of Children and Adolescents
Participation in regular physical activity reduces the risk for the development of diabetes
and other chronic diseases, while improving cardiovascular function and helping to maintain
a healthy body weight. (Hu et al., 1999; Eismann et al., 2002)
Physical activity positively influences choices pertaining to nutrition and the decisions not to
smoke. It is also associated with improved academic performance, healthy self-esteem and
reduces the risk of depression and the effects of stress. (Pate et al., 1996; Strauss et al., 2001)
Better understanding of eating and physical activity patterns in Waterloo Region adolescents
and variables that influence these patterns will assist in the development and evaluation of a
targeted strategy to address poor nutrition and physical activity patterns and associated health
concerns such as obesity.
9
OBJECTIVES
A sample of grade six students from fifteen Waterloo Region public elementary schools, stratified to
reflect the socioeconomic mix of Waterloo Region, completed a survey to describe their food intake,
selected food behaviours, physical and leisure activity patterns. Height and weight measurements
were obtained for assessment using the Body Mass Index (BMI).
METHODS
Ethics approval for the Food Behaviour Survey was obtained from the University of Waterloo
Office of Research Ethics and the Waterloo Region District School Board.
Study Population
Grade six students from 15 schools in the Waterloo Region District School Board were selected to
represent a cross section of neighborhoods in Waterloo Region based on a comparison of
socioeconomic and demographic variables from the 2001 Statistics Canada Census and the 2001
Urban Poverty data for an expected sample size of 500 to 600 students. An information letter
(Appendix C) was sent to school principals from 51 schools that had been identified according to 10
clusters. The a-priori intent was to recruit 15 schools (1 to 3 per cluster, depending on the size of the
cluster). Schools were recruited until the target sample for the specific cluster had been achieved.
Although this required an extension in the initial timelines, the sampling framework was achieved as
planned. Parent/guardian information and active consent forms were also distributed to students to
take home (Appendix D). The survey was conducted in class, with the investigator (Rhona Hanning)
or a graduate student (Sarah Woodruff) present. Data collection took place between November
2005 and April 2006. To ensure that the data represented school days for the 24 hour dietary recall
measurements, surveys were typically conducted from Tuesday to Friday.
Survey Design
This study used data collected from the Food Behaviour Questionnaire (FBQ)(Appendix E) which was
developed at the University of Waterloo (Hanning et al., 2003; Minaker et al., in press; Hanning et
al., in press). This survey was designed to assess nutrient intake, food behaviours, and the physical
activity patterns of children and adolescents through the use of a 24-hour dietary recall, food
frequency questionnaire, and other nutrition and physical activity behavioural questions. The webbased survey offers several logistical and methodological advantages including (1) the ability to
survey a large number of participants; (2) the incorporation of interactive elements to increase the
likelihood of proper reporting; (3) enjoyment and ease for participants; (4) direct individual feedback
to the students on their food group intake relative to Canada’s Food Guide to Healthy Eating
recommendations; and (5) direct data transfer which reduces data entry errors.
A number of approaches have established the validity and reliability of this tool. When compared
with direct observation of the noon meal from the previous day, the survey produced 87%
10
agreement in food items selected (n=15, grade 9-10). Compared with dietitian-administered food
recall interviews for the same 24-hour period, there was good agreement for calories and key
nutrient intakes (intraclass correlation coefficients >0.65, n=51, grade 6-8). Furthermore, test-retest
reliability for the Food Frequency Questionnaire (FFQ), completed 6.5 (±5.1) days apart, produced
strong overall percentage agreements, e.g. 79% for cola intake, 73% for intake of French fries, and
71% for candy intake (n=159, grade 9-10) (Hanning et al., 2003).
Demographic Data
Students were asked to provide demographic data including age, grade, gender, height (in either cm
or inches), weight (in either lb or kg) as well as weight and height self-perceptions as below average,
average or above average. In addition, physical height and weight measurements, without shoes,
were taken by public health nurses and recorded using each student’s unique identification code,
which was later match to the web-survey. Height was measured by taping two measuring sticks
directly to a wall (one directly on the ground and the other on top of the first in a straight line).
Height was measured to the nearest 1.0 cm using a set square. Weight was measured using a Tanita
HD314W digital scale that was zeroed before each participant’s weight was measured to the nearest
0.2 lbs. Students were asked to stand backwards on the “platform” so they could not read their
weight. Body Mass Index (BMI) was calculated by dividing height (m) by weight (kg2).
24-hour Dietary Recall
Dietary intake data were collected using a 24-hour dietary recall within the survey. Students were
asked to provide a detailed description of their food intake during the previous day, including
breakfast, lunch, dinner and “other times” or snacks. Students chose from close to 800 foods to
compile a list of foods eaten the previous day. Students were instructed to choose a food that was
“close” to the one they ate in the event that they could not find the exact food they had eaten.
Foods were listed both alphabetically, as well as within their food group to increase respondents’
ease of use.
The weight of one serving of each item contained in the food list was based on the visual and/or
text description of the item’s size and/or weight. For example, if the web-based survey described
one serving of milk as an eight ounce glass, the nutrient breakdown for milk corresponded to eight
ounces of milk. ESHA Nutrient Software (Version 7.9) was used to compile a nutrient profile of
each food item on the web-based survey using the Canadian Nutrient File 2001 database. This
nutrient breakdown was subsequently used to analyze the 24-hour dietary recall data.
The food group designations found on the Canadian Nutrient File 2005 (CNF) website were used to
compute the number of servings of a given food group in each food that was part of only one food
group. For combination foods, the food group definitions from the 2001b CNF were used to
calculate food group servings. For example, a single serving of Caesar salad as described on the web
survey is broken down into one vegetable and fruit serving and one serving of other.
Food Behaviours
Other aspects of the survey included questions on usual meal consumption, e.g. breakfast skipping, a
description of where and with whom students had eaten on the previous day, frequency of
11
purchasing meals and snacks prepared away from home, family influences on eating behaviours,
including frequency of eating dinner with at least one parent and availability of fruit and vegetables,
and snack food in the home, food sources, involvement in preparation of food, consumption of pop
drinks, and how much influence students perceive television commercials and programs have on
their eating habits.
Physical Activity
The physical activity portion of the survey was adapted from the validated Physical Activity
Questionnaire for older children (PAC-Q) (Crocker et al., 1997) and asked students to identify the
frequency with which they participated in a variety of typical childhood and adolescent activities in
the previous seven days using a scale that ranged from “1-2 times” to “7 or more times”. Students
were also given the option to respond “no” if they did not engage in a given activity.
Students were also asked to report activities they would like to participate in, physical activity during
the school day (at school breaks/recess or in physical education class), how many days in the past
week they walked, biked or skated to and/or from school and how many times they were active
before and right after school, in the evenings and on the past weekend.
Sedentary activity was gauged by the questions, “On average, how many hours of television do you
watch between the time you come home from school and the time you go to bed?” and “On
average, how many hours of surfing the internet or playing computer/video games do you do
between the time you come home from school and the time you go to bed?”. Responses ranged
from “1 hour or less” to “7 hours or more”.
Statistical Analyses
Although the study was based on grade six students, several grade five students also completed the
survey, and were included in the analyses. Data cut-points were established for total caloric intake
(200 to 6,000 kcals) to control for unrealistically low or high records. In addition, a manual scan of
students who selected approximately three times the maximum recommended number of servings
per food group as specified by Canada’s Food Guide to Healthy Eating was conducted. Students
with dietary intakes that were unrealistic (e.g. went down the list of milk products and picked the
first 20 foods) were excluded.
Data collected from the web-survey were analysed using the SAS statistical software package
Version 9.0 (SAS Institute, Inc, Cary, NC). Comparisons between nutrient or food group means
were conducted via Students’ t-tests. Comparisons between medians were performed using the nonparametric Wilcoxon-ranks sum test. Chi-square analyses were conducted on all categorical data (e.g.
food behaviour and physical activity data). Data were compared by gender, and in some cases, by
grade. In this study, analyses were controlled for school cluster to prevent confounding by
socioeconomic status. The alpha level accepted as significant was p≤0.05.
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1.0 DEMOGRAPHIC CHARACTERISTICS OF RESPONDENTS
This section describes the demographic characteristics of 405 students attending schools in the
Waterloo Region who completed the surveys. Of the 403 respondents who identified their age, the
majority (84%) were 11 years old, while a few students were 10 years old (6%) or 12 years of age
(10%). While this study was directed towards Waterloo Region students in grade 6, a few grade 5
students also completed the web-based survey. Slightly more girls (52%) than boys (48%) completed
the survey. (See Table 1.1) The number of participants in each school ranged from seven students to
55 students.
Table 1.1: Age, grade and gender of respondents, Waterloo Region, 2005-6
Characteristics
Age
10 years
11 years
12 years
Grade
5
6
Gender
Boys
Girls
# respondents (n)
403
22
339
42
401
9
392
403
192
211
Percent (%)
100
6
84
10
100
2
98
100
48
52
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2.0 ANTHROPOMETRIC MEASURES
Students self-reported their weight and height on the web-based survey, and physical measurements
of height and weight were taken following the survey. These data were used to calculate a Body
Mass Index (BMI)1. From the BMI calculated, students were classified as underweight, healthy
weight, at risk of overweight or overweight, according to the Centers for Disease Control BMI-forage percentiles (http://www.cdc.gov/nchs/data/nhanes/growthcharts/bmiage.txt).
Section 2.0.1
Mean Weight, Height and BMI
Overall, 398 students consented to having their weight taken and 391 students had their height
measured. On the web-based survey, 317 students reported their weight. On average, students
underestimated their weight by about 2 kg, and underestimated their height by about 3cm. As a
whole, girls were 2cm taller than boys, but boys reported taller heights. Thus, only physical
measurements of body weight, height and BMI are presented.
Table 2.1 Physical measurements of body weight, height and BMI
Overall
Boys
Measure
N
Mean
SD
N
Mean
Weight
389
43.7 kg
11.0
185
43.3 kg
Height2
391
150 cm
8
186
149 cm
BMI
389
19.2
3.6
185
19.2
2Significant
N
204
205
204
Girls
Mean
44.1 kg
151 cm
19.2
difference by gender at p=0.004
Section 2.0.2
BMI Distribution
According to physical measurements taken, 2% of the students were classified as underweight, 74%
were at a healthy weight, 14% were at risk of being overweight and 10% were classified as
overweight, using the CDC BMI-for-age percentiles
(http://www.cdc.gov/nchs/data/nhanes/growthcharts/bmiage.txt). According to the CCHS Cycle
2.2 data (Shields, 2005), 26% of Canadian 2 to 17 year olds were overweight or obese. The CCHS
Cycle 2.2 data have not been reported for the grade 6 age cohort. It seems likely that the prevalence
of overweight and obesity at 24% is quite representative of that of the country as a whole,
recognizing that the prevalence of overweight/ obesity increases with age. Self reported estimates of
BMI showed a higher of percentage of students in the “underweight” and “overweight” categories,
compared to BMI distribution from physical measurements. Figure 2.1 presents the BMI
distribution for all students, and by gender. No significant differences were found between boys and
girls.
1
BMI = weight (kg) / height (m2)
14
Percent (%)
BMI distribution from physical measurements
100
90
80
70
60
50
40
30
20
10
0
Overall
Boys
Girls
74 72 77
14 16
2
2
12
10 10
9
2
Underweight
Healthy weight
At risk of
overweight
Overweight
Figure 2.1: BMI distribution from physical measurements
15
3.0 FOOD GROUP INTAKES
This section presents the median number of servings of all food groups respondents’ reported
consuming and the percentage of students consuming less than the recommended number of
servings per food group as outlined by Canada’s Food Guide to Healthy Eating (CFGHE).
Table 3.1 presents median intakes of food groups. Boys consumed significantly more servings of
milk products and meat and alternatives. Over a third (34%) of the students did not eat any foods
from the meats and alternatives food group (see Table 3.2).
Table 3.1: Median food group intakes
Overall Boys
Girls
Food Group
Median Median Median
Grain Products
5.1
5.5
4.7
(5 – 12 servings)
Vegetables and Fruits
3.4
3.2
4.0
(5-10 servings)
Milk Products1
3.2
3.7
2.8
(3-4 servings)
Meat and Alternatives1,2
2.1
2.2
1.8
(2-3 servings)
Other
4.6
4.4
4.9
1Significant
2Canadian
at p=0.012
Nutrient File 2001, 1 meat and alternatives serving = 50g
Table 3.2: Number of students with no servings of a food group
Food Group
n with 0 servings
Grain Products
9
Vegetables and Fruit
18
Milk Products
18
1
Meat and Alternatives
34
Other
11
1Canadian
Nutrient File 2001, 1 meat and alternatives serving = 50g
Almost half of all students in this sample did not meet minimum Canada’s Food Guide to Health
Eating recommendations for grain products (48%), vegetables and fruit (68%), milk products (45%),
and meat and alternatives (46%). These results are consistent with other recent Canadian surveys.
The Canadian Community Health Survey, Cycle 2.2 (CCHS) found that 64% of 4 to 18 year olds
from Ontario did not meet minimum serving recommendations for vegetables and fruit (Garriguet,
2006). The previous CCHS in 2004 similarly found that among 2 to 17 year olds, 21% consumed
fruit and vegetables less than three times per day, 37% three to five times and 41% five times or
more (Shields, 2005). This survey also found that children and adolescents who consumed five or
more servings of fruit and vegetables per day were less likely to be overweight or obese (Shields,
2005). In terms of consumption of “other” foods, about a quarter (23%) of total energy came from
these foods, with girls consuming a significantly higher percentage of their total energy from “other”
foods than boys (p=0.044). (See Figure 3.1) In addition, girls consumed a higher percentage of their
16
total fat (29%) and saturated fat intake (20%) from other foods compared to boys (21% fat, p=0.002
and 13% saturated fat, p=0.003).
Percent of energy and fat coming from the "other" food group
100
All students
Boys
Girls
90
Percent (%)
80
70
60
50
40
30
20
29
21
19
23
24
21
18
20
13
10
0
% of total energy*
% of total fat*
% of total saturated fat*
*Significant difference by gender at p<0.05
Figure 3.1: Energy and fat from the “other” food group
Girls were significantly more likely not to meet Canada’s Food Guide to Healthy Eating
recommendations for milk products and meat and alternatives. Boys were 2 times as likely to have
consumed the recommended number of milk product servings and 1.7 times more likely to have
consumed the recommended number of meat and alternative servings compared to girls (see Table
3.3). These results are similar to the most recent CCHS which found that 62% of 9 to 13 year old
boys and 68% of 9 to 13 year old girls did not consume the minimum servings of vegetables and
fruit (Garriguet, 2006). The results appear to be better for students from Waterloo Region than
Canadian students in general with respect to milk products, with 61% of 10 to 16 year old Canadian
boys and 83% of 10 to 16 Canadian girls falling below the minimum recommended servings of milk
products compared to 45% of students from Waterloo Region. Nevertheless, the age groupings are
not comparable. Interestingly, 53% of Waterloo female students did not meet recommended grain
product servings versus 26% of Canadian 9 to 13 year old girls (Garriguet, 2006). This could explain
some of the difference in energy intakes between the surveys. The CCHS Cycle 2.2 data on 9 to 13
year old boys had high sampling variability and were not released.
Table 3.3: Percent of students below minimum Canada’s Food Guide to Healthy Eating
recommendations
Food Group
Girls Boys Odds Ratio 95% Confidence Interval
Grain Products
53% 43%
0.65
0.39, 1.09
(5 – 12 servings)
Vegetables and Fruits
65% 71%
1.3
0.81, 2.08
(5-10 servings)
Milk Products1
53% 36%
0.51
0.31, 0.83
(3-4 servings)
Meat and Alternatives1,2
52% 39%
0.60
0.41, 0.87
(2-3 servings)
1Significant
2Canadian
at p=0.007
Nutrient File 2001, 1 meat and alternatives serving = 50g
17
4.0 NUTRIENT INTAKES
Students were asked to select all the foods and drinks they had consumed on the day prior to the
survey. This section presents estimated median nutrient intakes, as well as the percentage of students
not meeting recommendations for nutrients. Ten percent (10%) of the boys and 15% of the girls in
this sample reported that they had been prevented from their normal eating patterns the previous
day for reasons including: being sick or going to a party.
Median energy intake on the 24 hour diet recall was 1876 kcal, while the mean was 2002 kcal. These
energy intakes would not, on average, exceed predictive equations of dietary energy intakes of
children (Health Canada, 2003). Note that the mean energy intake was 2137 kcal for boys and 1879
kcal for girls. This is slightly below the average energy intakes of boys and girls age 9 to 13 of 2446
and 2035 kcal/day, respectively, obtained using one-on-one interviews by the CCHS Cycle 2.2
(Garriguet, 2006). This is to be expected because survey approaches tend to slightly under-estimate
dietary intake (Livingstone & Robson, 2000) and also because the CCHS Cycle 2.2 data extends to
an older age group, who tend to consume more. The percent of energy from fat in Waterloo Region,
32% for both boys and girls, was slightly higher than the 30.9% and 30.5% reported for Canadian 9
to 13 year old boys and girls, in the CCHS Cycle 2.2 (Garriguet, 2006). Nevertheless, most students
fell within the recommended range for dietary total fat of 25- 35% of energy. Nutrient intakes are
shown Table 8.1 in Appendix A.
Students had especially poor intakes of fibre, as 95% of the students were below the recommended
intake levels. In addition, over half of the participants did not consume the Adequate Intake (AI) for
calcium (57%) or the Estimated Average Requirement (EAR) for folate (52%). In addition, more
girls than boys did not meet the recommendations for fibre, vitamin D, calcium and zinc. (See Table
4.1)
The relatively low intakes of fibre and folate are not surprising given the large proportion (67%) of
students who did not meet even the minimum (five) number of servings of vegetables and fruits
recommended by Canada’s Food Guide to Healthy Eating. This is a problem for many Canadian
students. School snack programs, farm-to-table programs and parent newsletters are amongst the
approaches that have been adopted by Canadian schools to address this issue.
Although the prevalence of inadequate intakes of calcium and vitamin D cannot be estimated, the
low intakes of some students are not surprising given the low number of servings of milk products.
Displacement of milk by soft drinks is a potential contributing factor. Emphasis should be placed
on enhancing intakes of these nutrients given that puberty is a critical like stage for the accretion of
bone mineral (Heaney et al, 2000). Moreover, new research is linking calcium and body weight
regulation.
18
Table 4.1: Adequate nutrient intakes
Overall
n %
1
Fibre (g)
Below AI
376 95
At/Above AI
21 5
2
Vitamin D (µg) Below AI
157 40
At/Above AI
236 60
Folate (µg)
Below EAR
207 52
At/Above EAR 190 48
Calcium1(mg) Below AI
228 57
At/Above AI
169 43
Iron(mg)
Below EAR
45 11
At/Above EAR 352 89
Zinc1 (mg)
Below EAR
122 31
At/Above EAR 275 69
Nutrient
1Significant
2Significant
Boys
n %
184 97
5
3
59 31
129 69
94 50
95 50
96 51
93 49
19 10
170 90
44 23
145 77
Girls
n %
192 92
16 8
98 48
107 52
113 54
95 46
132 64
76 36
26 12
182 88
78 38
130 62
Estimated Average
Requirement (EAR)
Folate: 250µg/day
Iron: Boys – 5.9 mg/day
Girls – 5.7 mg/day
Zinc: 7 mg/day
Adequate Intake (AI)
Fibre: Boys – 31g/day
Girls – 26g/day
Calcium: 1300mg/day
Vitamin D: 5µg/day
difference by gender at p<0.05
difference by gender at p<0.001
19
5.0 FOOD BEHAVIOURS
This section of the report highlights respondents’ food behaviours. To control for a school bias, all
responses in this section have been controlled for clustering of students in schools.
Section 5.0.1
Meal Frequency
Eighty-five percent (n=411) of the students reported eating something before they went to school
on the day prior to participating in the survey. Eighty-eight percent of the respondents said they ate
lunch, 90% ate dinner and 65% consumed an evening snack on the day prior to completing the 24
hour diet recall. About the same percentage of boys and girls reported eating these meals. (See
Figure 5.1)
At what times did you eat anything yesterday?
100
86
84
87
90
88
90
Girls
80
Percent (%)
Boys
64
66
60
40
20
0
Breakfast
During the
school day
After school or
evening snack
Dinner
Figure 5.1: Meal consumption
Students were also asked “How often do you eat…” the following meals: breakfast; during the
school day; dinner; and evening snacks. (See Table 5.2)
Boys were significantly more likely than girls to report eating breakfast every day (90% boys, 79%
girls). Other research has found a trend where as children get older, they are less likely to eat
breakfast (Evers et al., 2001; Hanning et al., 2003; Cohen et al., 2003). It is also interesting to note
that Clifton et al (2005) observed that grade nine and ten breakfast consumers from Ontario and
Alberta were more likely to be male, non-smokers, not reportedly “eating less to lose weight” and
infrequent consumers of cola. Hence, breakfast consumption may be a proxy index for other diet
behaviours. Thus the relatively high breakfast frequency in the Waterloo Region students is
encouraging.
20
No significant differences were found by gender in terms of how often students ate lunch or dinner.
Ninety-four percent of students indicated that they usually eat dinner every day. (See Poster
Presentation, Appendix B)
Almost half of the students who responded said that they usually consume an evening snack every
day, with more girls than boys eating an evening snack on 4 or more evenings of the week (80% and
70%, respectively). The prevalence of children and adolescents snackers in the United States
increased from 77% in 1977 to 91% in 1996 (Jahns et al., 2001). While snacks made up about one
fifth of energy intake in 1977, this proportion increased to about one quarter of energy intake in
1996 (Jahns et al., 2001). Indeed, the Canadian CCHS cycle 2.2 found that Canadian children
consumed more daily energy as snacks than as breakfast (Shields, 2005, Garriguet, 2006). Whether
this is a problem or not is uncertain. In a sample of Guelph adolescent males, more frequent snack
consumption was associated with higher nutrient intakes (Stockman et al, 2006; Shenkel et al, 2006).
However, it has also been found that snacks tend to be more energy dense (contain more calories
for a smaller portion) and are higher in fat than non-snack meals (Jahns et al., 2001). Providing
children and adolescents with healthier snack alternatives, like cereal in the evening, may combat
excessive energy intake and weight gain (Waller et al., 2004).
Table 5.1: Meal frequency
How often do you eat…
Boys
% n
Girls
% n
Breakfast1
every day
≥ 4 times/week, not everyday
less often
During the school day
every day
≥ 4 times/week, not everyday
less often
Dinner
every day
≥ 4 times/week, not everyday
less often
Evening snacks1
every day
≥ 4 times/week, not everyday
less often
1Significant
90 160 79 158
4
8 11 22
6 10 10 20
87 151 86 172
11 18 9 18
2
4
5
9
95 171 94 191
4
7
5 11
1
2
1
2
45
24
31
73
40
50
43
37
20
80
68
37
at p=0.01
21
Section 5.0.2
Where and With Whom Respondents Ate Their Meals
The web-based survey asked students where and with whom they had eaten meals or snacks with the
day before completing the survey.
Students’ responses to the question “Where did you eat yesterday” corresponded with what would
be expected. Most students ate breakfast at home (97%), consumed lunch at school (86%) and had
dinner (95%) and an evening snack (93%) at home. A few students said they ate lunch (13%) at
home. No significant differences were found between boys and girls in the locations where they ate
their meals and snacks.
Students were asked “who did you eat with yesterday” with the following response options: “by
myself”; “with one or more family members”; “with friends”; and “did not eat this meal or snack”.
Significant differences were found between boys and girls in terms of people whom respondents ate
with before school on the day before the survey. More boys than girls reported eating breakfast by
themselves (32% boys, 26% girls, p=0.04). As expected, most students reported eating lunch with
their friends (85%) and dinner with at least one family member (93%). In addition, three quarters of
the boys and girls in Waterloo Region reported that they eat dinner or supper with at least one
parent on 6 or 7 days of the week. However, afternoon and evening snacks were often consumed
alone (47%). (See Table 5.2 and Figure 5.2)
The family directly determines the physical and social environment which can ultimately influence
behaviours, habits, and attitudes through socialization and modeling (Richie, Welk, Styne, Gerstein,
and Crawford, 2005). Among North American children and adolescents, approximately 25% - 57%
reported consuming meals together with their family on a regular basis (5 or more meals/week),
whereas 14% - 35% consumed meals with family members only on some days or never (Gillman et
al., 2000; Neumark-Sztainer et al., 2003; Neumark-Sztainer et al., 2004; Story et al., 2002; Veugelers
et al., 2005; Videon and Manning, 2003). Similar to the issue of declining rates for eating breakfast,
the number of family dinner/meals consumed during a typical week seemes to decline with
increasing age (Gillman et al., 2000; Granner et al., 2004; Story et al., 2002). Since family dinners
appear to have a positive effect on consumption of healthy foods (Gillman et al., 2000; NeumarkSztainer et al., 2003; Videon and Manning, 2003), and a negative effect on the consumption of fried
foods (Gillman et al., 2000) and soft drinks (Gillman et al., 2000; Neumark-Sztainer et al., 2003),
family meals are to be encouraged. In a large sample of grade five students from Nova Scotia
(Veugelers et al., 2005), the relative risk for having a poor diet quality was 14% lower for those
children consuming dinner with family members more than five times per week than for those
eating with their family only one to two times per week. The high frequency of family dinner
consumption in Waterloo Region is encouraging.
22
Table 5.2: People with whom respondents ate their meals
All Students
Who did you eat with yesterday?
%
n
Before school
By myself
With family
With friends
Did not eat this meal
29
66
1
4
111
250
5
16
By myself
With family
With friends
Did not eat this meal
After school or evening snack
By myself
With family
With friends
Did not eat this meal
Dinner
By myself
With family
With friends
8
6
85
1
32
25
326
2
47
40
6
7
172
147
21
28
5
93
2
20
357
8
During school
*Note: Only “before school” was found to be significant by gender
Typically, how many days per week do you eat dinner
with at least one parent?
100
Percent (%)
80
76
60
40
20
11
13
0 to 2 days/week
3 to 5 days/week
0
6 or 7 days/week
Figure 5.2: Frequency of consuming dinner with at least one parent
23
Section 5.0.3
Food Sources
Students were asked how often they ate foods prepared or sold from the school cafeteria (including
‘special’ meals such as ‘pizza day’), fast food or take out restaurants, other restaurants, vending
machines, tuck shops/snack bars at the school or an arena, convenience stores and friend/relative’s
home. (See Table 5.3)
Nine percent of the students in this sample reported eating food prepared at school at least once a
day. This would include special days like pizza days. In addition, 4% of the respondents said that
they eat foods prepared at a friend or relative’s home on a daily basis and 4% also ate foods from a
school tuck shop or arena snack bar at least once a day. In terms of weekly consumption, more boys
than girls reported eating foods prepared at fast food restaurants (29% boys, 19% girls), other
restaurants (18% boys, 16% girls), vending machines (23% boys, 8% girls), and foods from a snack
bar or tuck shop (36% boys, 20% girls) at least once a week. Girls were more likely to report that
they rarely or never consume foods prepared or purchased at any of the venues listed compared to
boys, with the exception of eating at a friend or relative’s home. This is consistent with the CCHS
Cycle 2.2 data which found that more 9 to 13 year old boys than girls had consumed food prepared
at fast food outlets (Garriguet, 2006).
Among US adolescents, the proportion of energy coming from foods prepared outside the home
increased from 16% in 1977 to 29% in 1996 (Nielsen et al, 2002). Compared to foods prepared at
home, foods prepared elsewhere tend to be higher in energy and fat (French et al., 2001; Lin et al.,
1999) and positive associations have been found between frequency of eating foods away from
home and proportion of body fat (Gillis & Bar-Or, 2003). Given that 9% of the respondents
reported daily consumption of foods prepared at the school cafeteria and about 40% of both boys
and girls reported weekly consumption of these foods, policies to promote healthy food choices in
the school cafeteria are needed.
24
Table 5.3: Frequency of consuming foods prepared outside the home
How often do you eat meals or
Boys
Girls
snacks prepared away from home?
%
n
%
n
School Cafeteria (including pizza days and other special meals)
Once/week 40 43 41
58
Once/month 6
6
4
5
Rarely/never 54 57 55
77
Fast food restaurant or take out1
Once/week 29 46 19
36
Once/month 43 68 48
90
Rarely/never 28 45 33
63
1
Other restaurants
Once/week 18 28 16
31
Once/month 55 84 47
89
Rarely/never 27 41 37
71
Vending machines1
Once/week 23 34
8
15
Once/month 13 20 14
24
Rarely/never 64 94 78 136
Tuck shop/snack bar at school or an arena2
Once/week 36 52 20
37
Once/month 17 25 24
44
Rarely/never 47 69 56 101
Convenience stores
Once/week 26 40 23
39
Once/month 31 46 33
56
Rarely/never 43 65 44
76
At a friend/relative’s home
Once/week 39 62 43
82
Once/month 34 53 35
66
Rarely/never 27 42 22
43
1Significant
2Significant
at p<0.05
at p<0.001
Students were also asked “Where did you or your family buy the food you ate yesterday?” As
expected, the majority of the students consumed foods purchased at a grocery store or market on
the day before the web-based survey. A few students reported eating foods from a restaurant or
cafeteria, or from a convenience store, vending machine or other location. Boys and girls reported
significantly different locations where they or their family had bought the food they ate for lunch
and dinner on the day before completing the web-based survey. Boys were more likely to report
eating foods for lunch (8% boys, 2% girls) and/or dinner (5% boys, 1% girls) that had been
purchased from a convenience store, vending machine or other location compared to girls. Girls
were more likely to report eating foods purchased from a restaurant or cafeteria for lunch (4% girls,
2% boys) and/or dinner (6% girls, 3% boys) compared to boys. In terms of where snacks consumed
were purchased, significant differences were found only in where students reported that they, or
their family, had purchased an afternoon snack. More girls (89%) reported that their afternoon snack
had been purchased at a grocery store compared to boys (75%). More boys reported that their
afternoon snack came from a convenience store/vending machine/other compared to girls (9%
boys, 3% girls). (See Table 5.4)
25
Table 5.4: Locations where food consumed was purchased
Where did you or your family buy
the food you ate yesterday?
Breakfast
Grocery store/market
Convenience/vending/other
Did not eat this meal
Morning snack
Grocery store/market
Convenience/vending/other
Did not eat this meal
1
Lunch
Grocery store/market
Restaurant/cafeteria
Convenience/vending/other
Did not eat this meal
Afternoon snack1
Grocery store/market
Restaurant/cafeteria
Convenience/vending/other
Did not eat this meal
Dinner/supper1
Grocery store/market
Restaurant/cafeteria
Convenience/vending/other
Did not eat this meal
Evening snack
Grocery store/market
Restaurant/cafeteria
Convenience/vending/other
Did not eat this meal
1Significant
Boys
% n
Girls
% n
93 165 93 183
3
6
2
3
4
6
5 10
70 109 79 144
6
9
2
4
24 37 19 35
90 158 93 185
2
4
4
7
8 13 2
4
0
0
1
2
75 122 89 168
1
1
1
1
8 14 3
6
16 26 7 14
91 161 93 183
3
5
6 12
5
9
1
2
1
1
0
0
76 124 82 151
2
3
0
0
8 13 5 10
14 24 13 24
at p<0.05
Section 5.0.4
Pop Consumption
Pop consumption was determined by the question “How often do you drink pop drinks?” (see
Figure 5.3)
Twelve percent of the respondents reported that they consume pop drinks at least once a day, and
over half of the students (56%) said they drink pop at least once a week. In the overall model of pop
consumption by gender, significant differences were found (p=0.006). More boys reported more
consumption of pop drinks at a rate of 2-6 times per week, as compared to girls (21% boys, 12%
girls), while girls were more likely to say that they rarely or never drink pop (29% girls, 18% boys).
In the 2003 study of Peel grade six to eight students, it was observed that more than 28% of boys
and 14% of girls reported consuming cola-type pop at least once per day, however, non-cola type
pop consumption was not assessed (Hanning et al., unpublished observation). Nevertheless, the
Waterloo Region data indicate lower total consumption of pop.
There is significant concern about the high consumption of pop and other sweetened beverages by
children and adolescents. This relates to concern that sweetened beverages may contribute to excess
26
energy consumption, and hence weight gain (Malik et al., 2006; Troiano et al., 2000; Bellisle &
Rolland-Cachera, 2001). Ludwig et al (2001) found a 60% increase in odds of obesity with each
355mL soft drink serving. In the large US NHANES survey, ~8% of adolescent energy intakes
came from soft drinks (Troiano et al., 2000). Some studies also found an association between the
increased prevalence of sweetened beverage consumption and decreased milk consumption (Nielsen
& Popkin, 2004; Whiting et al., 2001).
Frequency of pop consumption
100
Boys
90
Girls
Percent (%)
80
70
60
50
40
30 27
30
20
10
21
11 12
29
20 20
18
12
0
once/day
2-6
times/week*
once/week
once/month rarely/never*
*Significant at p <0.05
Figure 5.3: Pop consumption
Section 5.0.5
Food Preparation
Students were asked who prepared the food they ate yesterday, as well as how often they are
involved in preparing their own meals. (See Tables 5.5 and 5.6)
No significant differences were found by gender in terms of who prepared the food students’ ate
yesterday. Most students indicated that either they or family members had prepared their breakfast
(53% myself, 41% family), morning snack (41% myself, 30% family), lunch (29% myself, 64%
family), and afternoon snack (58% myself, 27% family). Dinner was most often prepared by family
members (93%) and the majority of those who responded to the question said they had prepared
their evening snack themselves (70%). Very few students indicated that their meals had been
prepared by a restaurant or cafeteria.
Over a quarter (28%) of the students indicated that they are involved in preparing their own meals
or cooking or baking at least once a day. In addition, 77% of those who responded to the question
said they are involved in preparing meals at least once a week. No significant differences were found
in the frequency with which boys and girls are involved in meal preparation.
Who prepared the meal (Boutelle et al., 2001; Neumark-Sztainer et al., 1999; Neumark-Sztainer et
al., 2000); and the impact of convenience (Neumark-Sztainer et al., 1999) and take out food
(Clauson, 1999; Lin et al., 1999a; Lin et al., 1999b) may all influence diet quality of students.
27
Table 5.5: Who prepared the food consumed
Who prepared the food you ate yesterday?
All students
(e.g. cooked, put together or assembled your sandwich) %
n
Breakfast
Myself 53
204
Family 42
159
Other
2
6
Did not eat this meal
3
13
Morning snack
Myself 42
141
Family 29
98
Friends
1
4
Other
1
2
Did not eat this meal 27
92
Lunch
Myself 30 112
Family 63
241
Friends
4
16
Restaurant/cafeteria
2
6
Other
1
5
Afternoon snack
Myself 58
209
Family 27
95
Friends
2
7
Other
2
7
Did not eat this meal 11
40
Dinner/supper
Myself
3
12
Family 94
359
Friends
1
2
Restaurant/cafeteria
2
9
Evening snack
Myself 72
249
Family 12
43
Friends
1
4
Did not eat this meal 15
53
*Note: No significant differences by gender
28
Table 5.6: Involvement in food preparation
How often are you involved in preparing your own meals or
cooking/baking foods?
Once/day
2 to 6 times/week
Once/week
Once/month
Rarely/never
All students
%
n
28
105
31
117
18
66
10
38
13
49
*Note: No significant differences by gender
Section 5.0.6
Confidence to Eat Healthy Foods
Students were asked to report on their confidence to eat healthy foods in a variety of different
situations. (See Table 5.7)
Significant differences were found between boys and girls in their self-efficacy to eat healthy foods
at home with their family, at school with their friends and during social times with friends. Girls
were significantly more likely to report that they were “very sure” (score of 5 or 6) that they could
choose to eat healthy foods at home with family (69% girls, 52% boys), at school with friends (83%
girls, 54% boys) and during social times with friends (83% girls, 63% boys), while boys were more
likely to report that they were “not sure” (score of 1 or 2) or “somewhat sure” (score of 3 or 4).
Overall, more students indicated that they were “very sure” they could choose to eat healthy foods
at home with family (61%) than at school with friends (38%), during social times with friends (27%)
or alone (41%).
Table 5.7: Confidence to eat healthy foods
How sure are you that you could choose to eat healthy
foods when you are eating… (on a scale of 1-6)
…at home with your family?1
Not sure (1 or 2)
Somewhat sure (3 or 4)
Very sure (5 or 6)
2
… at school with your friends?
Not sure (1 or 2)
Somewhat sure (3 or 4)
Very sure (5 or 6)
… during social times with your friends?2
Not sure (1 or 2)
Somewhat sure (3 or 4)
Very sure (5 or 6)
… alone?
Not sure (1 or 2)
Somewhat sure (3 or 4)
Very sure (5 or 6)
1Significant
2Significant
Boys
% n
Girls
%
n
13 23 7 13
35 60 24 47
52 90 69 137
22 38 16
46 79 41
32 54 43
32
81
83
31 51 24
47 79 47
22 37 29
46
90
56
26 44 24
37 64 32
37 63 44
46
61
83
at p<0.001
at p<0.05
29
Section 5.0.7
Family Influences
Students were asked to respond with “never”; “sometimes”; “usually”; or “always” to statements
about how often foods are available in their home or served with meals. (See Table 5.8)
In terms of foods available in the home, the majority indicated that fruits and vegetables, fruit juice
and milk are usually or always available in the home. Over a quarter of the sample indicated that soft
drinks are always available in the home and about a fifth said that potato chips or other salty snacks
are always available at home. No significant differences were found in terms of the availability of
selected foods in the home. Overall, the home meal environment of most students appears to
support healthy eating.
Students were also asked whether fruits and vegetables and milk are served with meals in their
homes. The majority of the students indicated that both fruits and vegetables and milk are “always”
or “usually” served with meals in their home. Girls were significantly more likely to report that milk
is “always” served with meals (52% girls, 47% boys, p=0.006).
30
Table 5.8: Family influences
How often are the following true?
All students
%
n
Fruits & vegetables are available in my home
Sometimes
2
9
Usually
15
57
Always
83
316
Vegetables are served at dinner in my home
Sometimes
8
30
Usually
40
152
Always
52
197
We have fruit juice in my home
Never
1
2
Sometimes
9
35
Usually
30
115
Always
60
228
Milk is served at meals in my home (including soy and rice milk)
Never
3
11
Sometimes
18
70
Usually
29
109
Always
50
189
Potato chips or other salty snack foods are available in my home
Never
4
14
Sometimes
59
225
Usually
26
99
Always
11
41
Chocolate or other candy is available in my home
Never
5
19
Sometimes
69
260
Usually
20
77
Always
6
22
Soft drinks are available in my home
Never
9
32
Sometimes
45
171
Usually
30
114
Always
16
60
Milk is available in my home (including soy and rice milk)
Sometimes/Never
2
3
Usually
6
7
Always
92
112
*Note: Only “milk is served at meals” was found to be significant by gender
31
Section 5.0.8
Television and Meals
This section reports on questions about watching television (TV) while eating meals and students’
perceptions around how much influence TV has over their food choices. (See Tables 5.9 and 5.10)
No significant differences were found between boys and girls in response to the question “How
often is the TV on during meals?”. Over half (55%) of the respondents indicated that they watch TV
during meals once a month or less often. Even if eating together as a family, research has found that
students in grades 6-8 who watched television while eating consumed higher amounts of pizza,
snack foods, and soda and less fruits and vegetables than children who did not watch television
while eating (Coon et al, 2001; Brown et al., 2004).
Students were also asked how much they thought TV commercials and TV programs influenced
them to eat specific foods. Significant differences were found between boys and girls in terms of
whether they believed TV commercials influenced them to eat specific foods. More boys indicated
that TV commercials had a large influence on what they ate (8% boys, 4% girls reported “very
much”), while more girls reported being fairly neutral (score of 3) on the scale of perceived
television commercial influence. No differences were found by gender in terms of TV program
influence. Over half of the sample believed TV programs do not influence them to eat specific
foods. The literature suggests that food-related advertisements on TV may indeed promote
unhealthy eating behaviours (Caroli et al., 2004; Halford et al, 2004).
Table 5.9: TV viewing during meals
How often is the TV on during meals?
Once or more a day
2 to 6 times a week
Once a week
Once a month
Rarely/never
All students
%
n
19
57
17
50
11
34
45
133
8
25
*Note: No significant differences by gender
Table 5.10: TV influence to eat specific foods
On a scale of 1-5, how much do you think the
following influence you to eat specific foods?
Television COMMERCIALS1
1 (very little)
2
3
4
5 (very much)
Television PROGRAMS
1 (very little)
2
3
4
5 (very much)
1
Boys
% n
49
22
14
7
8
Girls
% n
80 51 96
35 21 40
22 19 35
12 7 14
13 4 4
51 84 52 97
23 38 22 41
18 29 18 34
4 6 6 11
4 7 2 3
Significant at p=0.001
32
6.0 PERCEPTIONS OF BODY WEIGHT
Of 344 respondents, 72% perceived their weight to be average, while 16% believed their weight was
below average and 13% reported their weight to be above average.
I would describe my weight as...
80
72
70
Percent (%)
60
50
40
30
20
16
13
10
0
Above Average
Average
Below Average
Figure 6.1: Weight perceptions
Students were asked whether they were concerned their weight was too high and whether they were
eating less than usual to lose weight or more than usual to gain weight. (see Figure 6.2) Girls were
significantly more likely to say that they were concerned about their weight being too high (27%)
compared to boys (18%). Almost all of the respondents reported that they were not concerned that
their weight was too low, and that they were not eating more than usual to gain weight.
Concerns about body weight and the presence of dieting behaviour have been reported in other
studies of Ontario girls (Jones et al, 2001; McVey et al, 2004). As in the current study, these
behaviours occur across body weight categories. Body image is a focus of Ontario middle school
curriculum. The current findings suggest that the issue should be raised with younger students.
Percent (%)
Students concerned that their weight is too high*
100
90
80
70
60
50
40
30
20
10
0
27
18
Boys
Girls
*Significant difference at p=0.002
Figure 6.2: Weight concerns
33
7.0
PHYSICAL ACTIVITY AND INACTIVITY
This section describes the physical activity behaviours of respondents. Specifically, it outlines the
amount of time students reported engaging in physical activities: (a) during the past week, (b) on the
way to school and at school, and (c) during their free time. This section also describes the amount of
time spent watching television, surfing the internet and playing computer or video games after
school until bedtime.
Section 7.0.1
Self-Reported Physical Activity
Students reported on the number of times they did a number of activities in the past seven days.
This section reports on activities that at least 50% of the students participated in.
Over half (51%) of the students reported walking for exercise at least five times in the past seven
days. Students also frequently engaged in active games, like tag (42% “5 times or more”), and a third
of the respondents (33%) reported running or jogging at least five times in the past seven days. (See
Figure 7.1)
Activities in the past 7 days
0 times
Basketball
1-4 times
Hockey
5+ times
Soccer
Volleyball
Jogging/running
Walking for exercise
Active games
0%
10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Percent (%)
Figure 7.1: Activities in the past 7 days
Significant differences were found between boys and girls in their weekly participation in lacrosse,
gymnastics, basketball, hockey, skateboarding, football, dance, baseball, bicycling, walking for
exercise and skipping. While girls were more likely to report having skipped, walked for exercise,
danced, and participated in gymnastics at least once in the past week, boys were significantly more
likely to report weekly participation in bicycling, baseball, football, skateboarding, hockey, basketball,
and lacrosse (see Table 8.2, Appendix A). Students were also asked to report on what type of
activities they would like to participate in. Significantly more girls said they’d like to try roller
blading, swimming, dance, racquet sports, volleyball, ice skating, and gymnastics. Boys were
significantly more likely to say they’d like to participate in lacrosse, hockey, and football.
34
Section 7.0.2
Active Transportation
Students were asked to report on the number of days in the previous week that they walked, biked
or skated to or from school. (See Figure 7.2)
The majority (64%) indicated that they walked, biked or skated to and/or from school five times in
the past week. Twenty percent of the students got to school actively – either by walking, biking, or
roller blading - on one day or less in the past week. No significant differences were found by gender.
Active transportation to and from school increases student activity level and thereby has positive
affects on their health. Reducing car trips to and from school improves air quality by reducing the
number of airborne pollutants emitted by automobiles. The proportion of students walking or
biking to school may change, depending on the time of the year in which the web survey is
completed.
How many days did you walk, bike, or skate to or
from school?
63
5 times
Girls
68
6
7
8
4 times
2-3 times
Boys
10
8
Once
3
15
12
None
0
20
40
60
80
100
Percent (%)
Figure 7.2: Active transportation to and from school
Section 7.0.3
Physical Activity during School
Students reported a variety of possible activities they might do during their recess or other school
breaks. The overall model for activity during school breaks was found to be significant. More boys
than girls said that they “ran and played hard” during their school breaks (42% boys, 16% girls),
while twice as many girls than boys reported that they “walked around a bit” (30% girls, 15% boys).
Girls more often reported that they “ran around and played” as compared to boys (36% girls, 26%
boys). (See Figure 7.3)
35
Percent (%)
In the last 7 days, what did you do most of the time during school
breaks?
100
90
80
70
60
50
40
30
20
10
0
Boys
Girls
30
26
15
6
7
2
Sat down
9
2
Stood
around
42
36
Walked
around a
bit*
16
9
Ran around
Played
and played* intramural
games
Ran and
played
hard*
*Significant at p<0.05
Figure 7.3: Activity during school breaks
The majority of students are ‘always’ or ‘quite often’ physically activity during physical education
class. Boys were more likely to report that they are “sometimes” very active during physical
education classes in the past seven days compared to girls (13% boys, 6% girls). (See Figure 7.4)
Percent (%)
In the last 7 days, during your PE classes, how often
were you active?
100
90
80
70
60
50
40
30
20
10
0
Boys
Girls
57
47
35
13
5
2
Hardly ever
*Significant at p<0.05
35
6
Sometimes*
Quite often
Always
Figure 7.4: Activity during physical education class
36
Section 7.0.4
Extra-curricular Activities
Significant differences were found between boys and girls in terms of how many times they were
active in the past seven days both before and right after school and in the evening. Boys were more
likely to report being active four times or more compared to girls, before and right after school (46%
boys, 29% girls), and in the evenings (53% boys, 38% girls). However, boys were also more likely to
report no activity before or right after school (19% boys, 18% girls) and in the evening (13% boys,
10% girls) compared to girls. In terms of weekend activity, almost all students (80%) reported being
active at least two times or more, with no significant differences between boys (82%) and girls
(79%). (See Table 7.2)
Table 7.1: Extracurricular activities
In the last 7 days, how many times did you play sports, dance or
play in which you were very active at the following times?
BEFORE OR RIGHT AFTER SCHOOL1
None
1 times
2 or 3 times
4 or 5 times
6 or 7 times
1
In the EVENINGS
None
1 times
2 or 3 times
4 or 5 times
6 or 7 times
THIS PAST WEEKEND
None
1 times
2 or 3 times
4 or 5 times
6 or 7 times
1
Boys
% n
Girls
% n
19
10
25
23
23
32
17
44
40
40
18
22
31
18
11
35
42
60
34
22
13
6
28
34
19
23
10
48
59
32
10
17
34
23
15
20
33
67
45
29
7
11
32
26
24
12
18
53
44
40
8
13
38
24
17
17
25
74
47
34
Significant at p<0.05
The influence of physical activity on body weight and composition of children and adolescents is
widely recognized (Shields, 2005; McMurray et al., 2000). Research has shown a decline in levels of
physical activity during the teenage years in North America (French et al., 2001; Sallis et al., 2001).
Hence, programs like Quality Daily Physical Activity (QDPA) that can increase physical activity are
especially important and may influence behaviours in a way that can be sustained beyond elementary
school.
Section 7.0.5
Sedentary Activities
Students were asked to report on how many hours of television they usually watch from the time
they get home from school until the time they go to bed. The majority (75%) of the respondents
indicated that they watch two hours of TV or less each evening. (see Figure 7.5)
37
On average, how many hours of television do
you watch after school?
Percent (%)
100
80
60
40
35
40
17
20
4
3
5-6 hours
7+ hours
0
≤ 1 hour
1-2 hours
3-4 hours
Figure 7.5: Television watching after school
Significant differences were found by gender in the model for the number of hours spent surfing the
internet or playing computer or video games between the time respondents come home from school
to the time they go to bed. More boys than girls reported spending 3-4 hours (21% boys, 7% girls)
or 5-6 hours (7% boys, 1% girls) on the computer or playing video games. More girls than boys
reported spending less than an hour surfing the internet or playing computer or video games each
night (57% girls, 38% boys). A higher percentage of girls reported that they do not have a computer
or the internet at home (10% girls, 5% boys), but the difference was not significant. (See Figure 7.6)
Percent (%)
On average, how many hours of surfing the internet or
playing computer/video games do you do after school?
100
90
80
70
60
50
40
30
20
10
0
Boys
Girls
57
38
25 23
21
7
≤ 1 hour*
1-2 hours
7
1
3-4 hours* 5-6 hours*
4
2
7+ hours
5
10
No
computer/
internet
*Significant at p<0.05
Figure 7.6: Time spent surfing the internet or playing computer/video games
38
A greater percentage of students in Waterloo Region who were classified as “at risk of overweight”
or “overweight” watched three or more hours of TV (35% at risk of overweight/ overweight; 21%
underweight/healthy weight) and spent three or more hours on the internet or playing
computer/video games (31% at risk of overweight/ overweight; 16% underweight/healthy weight)
compared to those classified as “underweight” or “healthy weight”. (See Figures 7.7 and 7.8)
In Peel Region students, 26% of grade six to eight girls and an increasing 18%, 38% and 40% of
grade six, seven and eight boys, respectively, watched three hours or more of television per day
(p=0.004, Hanning et al., unpublished). Computer, videos and DVDs were not specified in the study
of Peel students. In grade five students from Nova Scotia, 39% spent more than four hours per day
in sedentary activities, with computer and video games being included in addition to television
(Veugelers et al., 2005). In the CCHS Cycle 2.2, 36% of 6 to 11 year old Canadian children spent
two or more hours per day doing on ‘screen time’ activities (Shields, 2005). In 12 to 17 year olds,
29% 20 to 30 hours per week on ‘screen time’ and 19% spent more than 30 hours per week in front
of the TV or computer. Since children whose screen time was greater than three hours versus those
viewing an hour or less per day were more likely to be overweight or obese (Shields, 2005), high
screen time is of concern. The results for Waterloo Region suggest that time spent with TV and
other screen activities may not be as high as in other regions of Canada, but among students
classified as “at risk of overweight” or “overweight” over a third of the students are spending three
hours in front of the TV or computer each night.
On average, how much time do you spend watching TV in
the evenings?*
100
At risk of overweight/ overweight
Underweight/ healthy weight
90
80
Percent (%)
70
60
50
42
40
30
37
35
35
30
21
20
10
0
1 hour or less
*Significant at p=0.007
1-2 hours
3 hours or more
Figure 7.7: Television watching by BMI classification
39
On average, how much time do you spend surfing the
internet/ playing computer or video games in the
evening?*
100
At risk of overweight/ overweight
Underweight/ healthy weight
90
Percent (%)
80
70
60
60
50
45
40
31
30
24
24
20
16
10
0
1 hour or less
1-2 hours
3 hours or more
*Significant at p=0.012
Figure 7.8: Computer use and video game playing time by BMI classification
40
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44
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46
APPENDIX A: ADDITIONAL TABLES
Table 8.1: Estimated median nutrient intakes
Nutrient
Overall Boys (n=189) Girls (n=208)
Median
Median
Median
1876
1980
1744
Energy1 (kcal)
Protein2 (g)
74
78
(AI: 34 g/day)
% Energy from Protein2
16
16
Carbohydrates (g)
249
258
(AI: 130 g/day)
% Energy from Carbohydrates1
53
53
Fibre (g)
12
11
(AI = 31g/day for boys; 26g/day for girls)
Fat1 (g)
65
69
% Energy from Fat
32
32
(<30% total energy)
1
Saturated Fat
24
28
% Energy from Saturated Fat1
12
12
(<10% total energy)
Added Sugar
47
47
1
Vitamin A (RE)
813
873
Vitamin D2 (µg)
6.0
7.5
(AI: 5µg/day)
Folate (µg)
238
251
(250 µg/day)
Calcium1 (mg)
1162
1283
(1300mg/day)
2
Iron (mg)
11.0
11.8
(EAR: 5.9mg/day for boys; 5.7mg/day for girls)
Zinc2 (mg)
9.2
9.8
(EAR: 7.0mg/day)
*Note that the mean energy intake was 2002 kcal
Eight students were excluded due to implausible dietary intake data
1
Significant difference by gender at p<0.05
2
Significant difference by gender at p<0.001
66
15
240
54
12
62
32
22
11
46
771
5.0
229
1055
10.0
8.8
47
Table 8.2: Physical activity in the past 7 days
Have you done the following activities in the past 7 days?
Boys
% n
Girls
% n
Skipping/jumping rope1
No 74 112 54 104
At least once 26 39 46 89
Roller blading
No 72 110 70 136
At least once 28 42 30 57
Active games (tag)
No 10 17 9 17
At least once 90 152 91 177
Walking for exercise1
No 16
At least once 84
26
36
6 12
94 181
No 41
At least once 59
66
94
61 118
39 76
Bicycling1
Jogging or running
No 17 28 18 36
At least once 83 133 82 161
Swimming
No 60
At least once 40
93
62
57 112
43 83
No 63
At least once 37
96
57
74 144
26 50
Baseball, softball1
Dance2
No 80 121 43 80
At least once 20 30 57 107
Football2
No
At least once
Racquet sports (badminton, tennis, racquet ball)
No
At least once
Skateboarding1
No
At least once
Soccer
No
At least once
Volleyball
No
At least once
Hockey2
No
At least once
Basketball2
No
39
61
62
98
73 140
27 51
60
40
93
61
68 129
32 60
61
39
95
60
78 148
22 42
37 59 46 90
63 102 54 105
40
60
65
98
36 70
64 125
28 46 60 116
72 120 40 76
37
61
58 112
48
At least once 63 103 42
81
Ice skating
No 54
At least once 46
84
73
59 113
41 78
Martial arts (karate, judo)
No 79 123 84 158
At least once 21 33 16 31
Gymnastics1
No 85 130 72 135
At least once 15 23 28 53
Lacrosse2
1
2
No 78 120 91 168
At least once 22 33 9 16
Significant at p<0.05
Significant at p<0.001
49
APPENDIX B: SAMPLE SCHOOL REPORT
Food
Behaviours
at
Laurelwood
Public
School,
Waterloo,
Ontario
50
This School Food Behaviour Report presents the results of a survey conducted at Laurelwood
Public School in March 2006, by the Population Health Research Group at the University of
Waterloo.
The survey helped to investigate food behaviour patterns of grade six students in Waterloo
Region, focusing on consumption of meat and alternates, milk and dairy products, fruit and
vegetables, and high fat and salty snack foods. The survey also helped to understand the
physical activity patterns of these students. Through better understanding of the eating and
exercise patterns of students in the Waterloo Region, and variables that influence these
patterns, targeted healthy eating and living programs and strategies can be designed and
evaluated.
The study was funded by the Region of Waterloo Public Health.
Your Confidential Report
Our research team will be distributing these individual reports only to schools that
participated in the study. Any results that are published or otherwise disseminated by the
researchers will maintain the anonymity of your school. School officials should decide how
best to distribute this report internally to meet their needs.
For more information on this report, or the research project associated with it, please contact:
Dr. Rhona Hanning
Principal Investigator
Dept. of Health Studies and Gerontology
University of Waterloo
200 University Avenue West
Waterloo, ON Canada N2L 3G1
Tel: (519) 888-4567 Ext. 5685
Fax: (519) 746-2510
Email: [email protected]
Lindsay Hogsden
Project Manager
Population Health Research Group
University of Waterloo
200 University Avenue West
Waterloo, ON Canada N2L 3G1
Tel: (519) 888-4567 ext. 3720
Fax: (519) 746-8171
Email: [email protected]
51
The Issue
Nutritional Intake of Children and Adolescents
¾ Nutrition problems in adolescence have the potential to exert strong deleterious impact on
future health and increase the risk of chronic diseases in later life. Energy and nutrient
excesses and deficiencies in adolescents’ food intakes may contribute to the development
of serious health problems. For example, researchers report that excesses in dietary
energy and saturated fat, and inadequate intake of dietary fiber may contribute to heart
disease and some forms of cancer.
¾ Research suggests that adolescents are not
consuming the servings of milk products
or vegetables and fruits recommended by
Canada’s Food Guide to Healthy Eating.
¾ Omission of breakfast or consumption of
inadequate breakfast may be factors
contributing to dietary inadequacies.
Nutrient losses are rarely made up by
other meals during the day.
Approximately 1 in 3 children in
Canada (from 5 to 13 years of age) is
considered overweight or obese.
Genetics are no longer viewed as the
main culprit. It is our current
surroundings that are enhancing this
obesity crisis through an interactive
combination of environmental factors:
diet, physical activity, as well as
societal, economic, psychological and
biological factors.
¾ Healthy eating patterns formed early in
childhood may persist into adulthood.
Physical Inactivity of Children and Adolescents
¾ Participation in regular physical activity reduces the risk the diabetes and other chronic
diseases, while improving cardiovascular function and helping to maintain a healthy body
weight.
¾ Physical activity positively influences choices pertaining to nutrition and the decisions
not to smoke. It is also associated with improved academic performance, healthy selfesteem and reduces the risk of depression and the effects of stress.
The Bottom Line…
The purpose of this project is to examine the food and activity behaviour patterns of
adolescents in the Waterloo Region. A better understanding of the eating patterns of
adolescents in the Region, and variables that influence this pattern, will allow for
development and evaluation of a targeted strategy to address childhood obesity.
52
Food Behaviour
The following represents the food behaviour survey results from students at Laurelwood Public
School. The tables and graphs below summarize the response of students to various survey
questions. Not all students responded to all questions.
Fifty-six grade 6 students at Laurelwood Public School completed the survey. Forty respondents
indicated they were 11 years of age and 15 students said they were 12 years of age. Thirty boys
(54%) boys and 26 (46%) girls completed the survey.
Food Intake and Food Habits
Breakfast Frequency: How often do you eat breakfast?
Boys
%
97
3
Response
Every Day
Four or more days/week
Girls
%
76
24
Ninety-five percent of respondents at
Laurelwood Public School ate breakfast the
previous day and 87% reported that they
usually eat breakfast everyday. This is
slightly higher than the average in the
Region (84%). More girls skipped
breakfast than boys.
Median Food Group Intake: A comparison
Canada Food Guide
Recommendations*
Ontario Food
Behaviour Data
Waterloo Region
Laurelwood Public
School
Vegetables
and Fruit
Grain
Products
Milk
Products
Meat and
Alternatives
5 – 10
5 - 12
3-4
2-3
4.75
5
2.25
2
3.6
5.8
3.3
2.1
3.7
5.7
2.8
2.1
*Recommendations for children and adolescents
Compared to all Ontario respondents to the survey, the students from Laurelwood Public School
ate slightly fewer servings of vegetables and fruit but slightly more grain products, milk products
and meat and alternatives. On average, they met Canada’s Food Guide to Healthy Eating
recommend intakes grain products and meat and alternatives, but not for vegetables and fruit or
milk products. Compared with the Region as a whole, the students from Laurelwood Public
School ate slightly fewer servings of milk products but slightly more grain products and
vegetables and fruits.
53
How often do you drink pop drinks?
100
Boys
90
Girls
percent (%)
80
70
60
50
40
30
20
10
0
once/day
2-6
times/week
once/week
once/month
rarely/never
While only 7% of the respondents reported that they consume pop drinks at least once a day,
over half (52%) said they drink pop at least once a week. Boys were more likely than girls to
report daily consumption of pop, while more girls said that they rarely or never drink pop drinks.
Pop consumption may increase odds of overweight and obesity among school-aged children and
adolescents2.
Frequency of Meals Eaten Prepared Away from Home
Location
School Cafeteria
Fast food restaurant
or take out
Other restaurants
Vending machines
Tuck shop/Snack bar
at school or an arena
Convenience stores
At a friend/relative’s
home
Once or more
a week
58%
7%
Rarely or
Never
35%
29%
43%
28%
17%
18%
55%
11%
28%
71%
29%
18%
53%
18%
39%
43%
53%
25%
22%
Once per month
Of the students who responded to this set of questions, 58% purchased foods from the school
cafeteria, 53% ate a friend/relative’s home, and 29% ate at fast food restaurants or purchased
foods from a school tuck shop or arena snack bar at least once a week. Less than a quarter of the
students ate foods prepared at other restaurants, vending machines or foods sold at convenience
2
Ludwig DS, Peterson KE, Gortmaker SL. Relation between consumption of sugar-sweetened drinks and childhood
obesity: a prospective observational analysis. Lancet 2001;357:505-8.
54
stores on a weekly basis. People who often eat food prepared outside the home may have a
higher intake of fat and protein than people who generally eat food prepared at home3.
Who did you eat with yesterday?
by myself
with 1 or more family members
with friends
did not eat
100
90
Percent (%)
80
70
60
50
40
30
20
10
0
Before school
During school
After school or
evening snack
Dinner
Students were asked to report with whom they ate before school, during school, after school or
evening snacks, and dinner. The majority of students ate breakfast with one more family
member (73%) and the vast majority ate their lunch with friends (93%). This is to be expected
as most students ate lunch at school (87%). Afternoon and evening snacks were most often eaten
with by themselves (42%) and almost all the students ate dinner with one or more family
member (93%). The majority (81%) of students report eating dinner/supper with at least one
parent 6 days per week.
In terms of food preparation, most students reported that either they, or their parents had
prepared breakfast (49% myself, 47% parents), morning snack (37% myself, 31% parents), lunch
(33% myself, 62% parents), afternoon snack (64% myself), dinner (87% parents), and evening
snack (71% myself). In addition, 84% of the respondents reported that they are involved in
preparing their own meals (cooking, baking) at least once a week, and a quarter of the students
(25%) indicated that they prepare meals at least once a day. Over 80% of the respondents said
that they or their family purchased the food they ate for breakfast (100%), lunch (100%),
afternoon snack (92%), dinner (95%) and evening snack (85%) at a grocery store or market.
3
Kearney JM, Hulshof KF, Gibney MJ. Eating patterns--temporal distribution, converging and diverging foods, meals eaten
inside and outside of the home--implications for developing FBDG. Public health nutrition, 2001;4(2B):693-8.
55
How sure are you that you could choose to eat healthy foods
when you are eating...
not sure (1-2)
100
somewhat sure (3-4)
very sure (5-6)
Percent (%)
80
60
40
20
0
at home with
family?
at school with
friends?
during social
times with
friends?
alone?
Students were asked to rank, on a scale from 1 to 6, how confident they were in their abilities to
choose to eat healthy foods in different situations. While over three-quarters of the respondents
indicated that they were very sure (chose 5 or 6 on the scale) they could choose healthy foods
when they were at home with their family (76%), less indicated that they were very sure when
they are at school with friends (42%), during social times with friends (40%) and when they are
alone (42%).
How often are the following available in your home?
always
usually
sometimes
never
90
80
Percent (%)
70
60
50
40
30
20
10
0
Fruits and
vegetables
Fruit juice
Potato chips/salty
snacks
Chocolate/candy
Soft drinks
All of the students who responded to the question said that fruits and vegetables are “usually” or
“always” available in their home. Few respondents indicated that salty snacks (35%) and
chocolate and candy (19%) are always or usually available in the home, but almost half (44%)
said that soft drinks are “always” or “usually” available in their home. In addition, the majority
of the respondents (93%) said vegetables are “always” or “usually” served at dinner, and 85%
said milk is “always” or “usually” served with meals in their home.
56
Perceived Body Weight
I would desribe my weight as
100
Boys
Girls
Percent (%)
80
60
40
20
0
Below Average
Average
Above Average
Of the students who responded to the question, 69% reported that their weight is average while
21% felt their weight was below average, and 10% said their weight was above average. A
greater proportion of girls felt their weight was below average as compared to boys (32% versus
12%, respectively). A small percentage of both boys (12%) and girls (9%) perceived their weight
be above average.
Percent (%)
Are you concerned that your weight is too
high?
100
90
80
70
60
50
40
30
20
10
0
Boys
Girls
Yes
No
57
Percent (%)
Are you eating less than usual to lose weight?
100
90
80
70
60
50
40
30
20
10
0
Boys
Girls
Strongly disagree/disagree
Strongly agree/agree
When asked if they were concerned that their weight was too high, more girls than boys
indicated “strongly agree” or “agree” (35% girls, 22% boys). When asked if they were eating
less than usual to lose weight, 14% of boys and 15% of girls said they were. More boys than girls
reported that they were eating more than usual to gain weight (15% and 4%, respectively).
58
Physical Activity Behaviour
Time spent being very active
before or right after school
evenings
weekend
40
35
Percent (%)
30
25
20
15
10
5
0
none
once
2 or 3 times 4 or 5 times 6 or 7 times
Girls were more likely than boys to report being active 6 or 7 times in the evening (24% girls,
21% boys) and on the weekend (24% girls and 21% boys), while more boys reported being
active 6 or 7 times before or after school more often than girls (36% boys, 17% girls). Over half
of the respondents (52%) indicated they were active at least 4 times before and/or right after
school. With respect to evening physical activity, almost all of the students reported being active
at least 2 times, with similar rates of boys and girls reporting this (86% boys and 92% girls) .
Over half of both boys and girls were active at least 4 times on the past weekend (56% boys and
52% girls).
59
Activities in the past 7 days
Walking for exercise
Active games
Basketball
Bicycling
Ice Skating
Rollerblading
Volleyball
Dance
Skateboarding
Lacrosse
Other
0%
20%
40%
60%
80%
100%
Percent (%)
Respondents were asked to report on the activities they had participated in during the week
before the survey. The most common activity respondents participated in was walking for
exercise (96%). Other common types of activities reported during the previous week included
jogging or running (92%), active games, like tag (91%), racquet sports (66%) and basketball
(62%) and football (62%). Over half of the students also indicated that they would like to
participate in the following activities: bicycling (75%), swimming (65%), active games (60%)
and racquet sports (53%).
60
Number of days in past week you walked, biked or
skated to/from school
5 times
4 times
2-3 times
Once
None
0
10
20
30
40
50
60
70
80
Percent (%)
Students were asked to report on the number of days in the previous week that they walked,
biked or skated to or from school. The majority (71%) indicated that they walked, biked or
skated to and/or from school 5 times in the past week. Only 13% of the students got actively to
school on one day or less in the past week. Active transportation to and from school increases
student activity level and thereby has positive affects on their health. Reducing car trips to and
from school improves air quality by reducing the number of airborne pollutants emitted by
automobiles.
Time spent in sedentary activities after school
Watching television
60
Surfing internet/video
games
Percent (%)
50
40
30
20
10
0
1 hour or less
1 to 2 hours
3 to 4 hours
5 or more hours
Respondents were asked the average amount of time spent participating in sedentary activities,
such as watching television, surfing the internet, and playing computer or video games, from the
61
time they get home from school until the time they go to bed. On average, the majority of
respondents spent 2 hours or less watching television (88%) and surfing the internet/playing
computer or video games (70%). Eight percent of the respondents did not own a computer or
have the internet. Similar numbers of boys and girls watched more than three hours of television
(11% boys and 12% girls) per day. However, a greater proportion of boys (30%) spent more than
three hours an evening surfing the internet of playing video/computer games as compared to girls
(12%). Activities such as watching television and recreational computer usage are sedentary, and
contribute to a lesser level of physical activity in adolescents, having negative implications for
their health.
Influences to eat specific foods
70
TV commercials
Percent (%)
60
TV programs
50
40
30
20
10
0
very little (1)
2
3
4
very much (5)
In terms of how much television commercials, and television programs influence students to eat
specific foods, most respondents reported that they believe both commercials and TV programs
have very little influence on the foods they eat. Over three quarters of the students (77%)
indicated a 1 or 2 on the scale of influence for TV commercials, while 91% indicated a 1 or 2 on
the scale of influence for TV programs.
62
APPENDIX C: POSTER PRESENTATION
FAMILY DINNER FREQUENCY AND ENVIRONMENT OF GRADE SIX STUDENTS
FROM WATERLOO REGION DISTRICT SCHOOL BOARD
Sarah Woodruff1, Rhona Hanning1, Pat Fisher2
Studies & Gerontology and the Population Health Research Group, University of Waterloo, Waterloo, ON N2L 3G1
2Region of Waterloo Public Health, Waterloo, ON N2J 4V3
Rationale and Purpose
Number of days per week that dinner is consumed
with at least one parent
100
80
Normal
Weight*
Energy
(kcal/d)
Grain Products
(svg/d)
Vegetables
and Fruit
(svg/d)
Milk Products
(svg/d)
Meat &
Alternatives
(svg/d)
Other (svg/d)
0-2 d/wk
(n=15)
2154
7.8
3.3
5.1
1.9
3.2
3-5 d/wk
(n=9)
2188
6-7 d/wk
(n=78)
7.9
2.3
2.9
2.6
4.6
2317
6.9
4.3
3.8
2.7
5.0
0-2 d/wk
(n=2)
991
2.9
1.6
0.5
2.1
2.6
3-5 d/wk
(n=7)
1568
3.6
2.7
3.1
2.1
3.0
6-7 d/wk
(n=30)
2086
5.9
3.1
4.1
2.9
4.6
0-2 d/wk
(n=11)
1942
5.4
4.2
3.0
1.9
4.0
Normal
Weight***
3-5 d/wk
(n=13)
1555
4.2
3.7
2.9
2.1
2.5
6-7 d/wk
(n=105)
2239
6.7
4.5
3.4
2.3
5.3
0-2 d/wk
(n=8)
1998
5.8
5.4
3.9
1.6
3.4
3-5 d/wk
(n=10)
1775
4.3
5.2
3.9
1.8
3.5
6-7 d/wk
(n=29)
1719
5.2
4.5
2.9
1.9
3.9
Overweight / Obese
%
Normal Weight*
40
0
0-2 d/wk
6-7 d/wk
The Dinner Environment*
Where did you eat dinner?
Who did you eat dinner with?
5% didn't eat /
not answ ered
90% at home or
another home
4% restaurant /
cafeteria
0.5% betw een
places
Females
Overweight /
Obese
3-5 d/wk
*Family dinner frequency was significantly different from
overweight / obese participants (X2(2, 317)=6.723, p<0.05)
Males
Overweight /
Obese**
60
20
Energy intake and food group servings (CFGHE) by gender, weight status, and
family meal frequency
5% myself
91% one or
more f amily
members
2% friends
0.5% at school
2% didn't
answ er
Who prepared dinner?
Where was dinner bought?
*Intake of Vegetables and Fruit, and Milk Products different among family dinner frequency, p<0.05
** Intake of Vegetables and Fruit different among family dinner frequency, p<0.05
*** Intake of total energy and Grain Products different among family dinner frequency, p<0.05
4% didn't eat /
not answ ered
•Family dinner frequency was positively associated with total
energy (kcal/d), number of ‘meat and alternatives’, and ‘other’
food group servings (CFGHE)
90% parents /
other family
3% myself
2% restaurant /
cafeteria
4% restaurant /
cafeteria
89% grocery
store
4% not
answ ered
3%
convenience
store / vending
machine / other
0.5% friends
0.5% other
56% of students were involved in preparing their own meals
2-6 times/week or more
Energy consumed by gender,* weight status,* and
family dinner frequency*
*There were no differences between males/females or body weight status
2500
2000
1500
1000
500
0
•Among those that skipped the dinner meal on the previous
evening (9%, n=37), the majority (46%, n=13) reported
consuming dinner with at least one parent on 0-2 d/wk (X2(2,
320)=15.96, p<0.001).
0-2 d/w k
3-5 d/w k
Males
Overweight
/ Obese
Normal
Weight**
6-7 d/w k
Females
Summary and Implications
*Energy intake significantly different, p<0.05
Number of 'meat and alternatives' servings (CFGHE)
by gender,* and family dinner frequency*
Number of 'other foods' servings (CFGHE) by gender
and family meal frequency*
3
6
2.5
5
4
Males
3
Females
2
# svg/d
•Using the web-based survey “Food Behaviour Questionnaire”
that was developed at the University of Waterloo
(www.uweatwell.com), the following were assessed from a 24
hour diet recall (see sample screens):
•Total energy, macro- and micro-nutrients
•Number of food group servings of Canada’s Food Guide
to Healthy Eating (CFGHE)
•Participants also responded to questions regarding meal
patterns and food preparation (see sample screens).
•Nutrient analysis software, ESHA, processed the 24 hour
recall measures of food intake with the 2001b Canadian
Nutrient File database.
•Since nutrition data tend to be non-normally distributed,
square root transformations were completed to permit the use
of standard statistical tests.
•Body Mass Index (BMI) was calculated for each participant
based on measured height and weight and classified
according to Cole et al., BMJ 2000; 320(7244): 1240-1243.
•Dinner was consumed with at least one parent by 77% on 6-7
d/wk, 12% on 3-5 d/wk, and 11% on 0-2 d/wk.
Normal
Weight
Methods
Results (cont’d)
•Family dinner frequency was different between normal weight
and overweight/obese students
•Among males, 72%, 21%, 7% were classified as normal
weight, overweight, and obese, respectively. Among females,
74%, 19%, 7% were classified as normal weight, overweight,
and obese, respectively.
kcals/d
• Hypothesis: Family dinner meals will have a positive
influence on body weight status and dietary quality.
Results
•Data were obtained from 396 grade 6 (males=185,
females=206) students from the Waterloo Region District
School Board (n=15 schools).
# svg/d
•Purpose: To describe family dinner frequency, nutrient intake,
and body weight status among grade 6 students. The
secondary objective was to examine the impact of family
dinner environment.
Overweight
/ Obese
1Health
2
Males
1.5
Females
1
0.5
1
0
0
0-2 d/wk
3-5 d/wk
6-7 d/wk
*Number of servings significantly different, p<0.05
0-2 d/wk
3-5 d/wk
6-7 d/wk
*Number of servings significantly different, p<0.05
•Students who reported more family dinner meals consumed
more energy and food group servings according to CFGHE.
This greater intake, however, did not impact body weight
status. Moreover, there were differences in family dinner
frequency between normal weight and overweight/obese
students, which potentially suggests that family dinner meals
are protective against increased body weights. Additional
research among a larger sample is needed to better
understand this relationship.
This research was supported by the Region of Waterloo Public Health. Travel assistance was provided
by University of Waterloo Graduate Conference Travel Assistantships.
SJ Woodruff is funded by the Danone Institute of Canada.
Contact Information: Sarah Woodruff, MSc, PFLC. [email protected]
63
APPENDIX D: LETTER TO PRINCIPALS
[date]
[Name of Principal]
[School Name]
[Address]
Dear [Recipient Name]:
The Population Health Research Group, University of Waterloo and the Region of Waterloo Public Health have the
approval of the Waterloo Region District School Board to conduct a study examining food behaviour in Ontario
adolescents. The research will investigate the nutrition and activity choices of grade 6 students using a web-based
survey. Upon completing the web-based survey, each student will receive immediate individualized feedback on his
or her diet. Feedback based on the combined responses from all students participating in the survey will be available
to the teachers as well as a Nutrition Resource to facilitate curriculum-specific lesson planning.
Students in grade 6 are experiencing a time of physiological and psychological milestones, i.e.
the latter stage of adolescent growth spurt with rapid bone development and increasing autonomy
in food behaviours. There is little research information on the diet of Canadian teens. Dietary
surveys elsewhere indicate that adolescents consume insufficient amounts of energy, calcium and
iron but more than the recommended fat. Nutrition and lifestyle problems of Canadian
adolescents include obesity, physical inactivity and eating disorders. These have the potential to
exert a strong deleterious impact on future health and increase the risk of chronic disease in later
life. Through better understanding of the eating patterns of adolescents and variables that
influence this pattern, targeted health eating programs and strategies can be designed.
The proposed research will use a web-based tool to deliver a nutrition and activity survey to
Waterloo Region District School Board grade 6 students in schools. The survey will ask students
to recall what they ate the previous day and to identify the types of physical activity they engage
in and how frequently they do so. Students may choose to omit certain information if they wish.
The survey will take approximately 30-40 minutes (one class period to complete). Students will
also be invited to go back to the web site on another day to complete another diet recall. The
second portion of the research is optional, and may be done on a computer at school, at home, or
in the community. This will result in the most comprehensive assessment of adolescent diet and
physical activity to date in Canada.
In order to inform your school’s participation decision, please find attached: 1) a summary of the
project with more detail on the design, objectives and measures to be used for the study and 2) a
copy of the information letter that will be sent to parents. You can view the website at:
http://www.uweatwell.com/, login “s”, password “s”.
The research has been reviewed by and received ethics clearance from the Region of Waterloo
Public Health and through the Office of Research Ethics at the University of Waterloo. Any
comments or concerns you may have, concerning your school’s involvement may be directed to
____________________, Region of Waterloo Public Health.
64
We would like an opportunity to speak with you to discuss this project and your school’s
protocol for the approval of research projects. We appreciate the strain on schools at this time
and do not wish to create more pressure. If there is anything we can do to make it easy for your
school to participate, please let us know. One of our staff will call you within the next week to
determine your interest. In the meantime, if you have any questions, please call [Irene
Lambraki], Population Health Research Group, University of Waterloo at (519) 888-4567 ext.
[5219], or email at [[email protected]]. We look forward to further collaboration
with you on this exciting project.
Sincerely,
Rhona Hanning, PhD, RD
Principal Investigator,
Population Health Research
Group
Associate Professor,
Health Studies &
Gerontology
University of Waterloo
Daniela Seskar-Hencic,
Manager,
Planning and Evaluation,
Region of Waterloo Public Health
(519) 883-2258
[email protected]
65
APPENDIX E: CONSENT LETTER TO PARENTS
Dear Parent(s) or Guardian(s),
Region of Waterloo Public Health and the Population Health Research Group, University of Waterloo are
conducting a survey, to better understand food behaviour and physical activity patterns of children in Waterloo
Region. We would like to provide you with some information about the survey to help you decide if your son or
daughter should be involved.
Why is this study being done?
There is little research information available on what Canadian children eat. The few studies that have been
conducted elsewhere have shown that children’s diets are often low in energy, calcium and iron but high in fat.
Research has shown that a poor diet in childhood and adolescence can increase the risk of developing diabetes,
obesity, heart disease and other diseases in adulthood. Through better understanding of teens’ eating patterns, and
variables that influence these patterns, we can better identify effective strategies to reduce these health risks.
[Name of School] has granted us permission to approach the parents of their grade six students to ask for their son’s
or daughter’s participation in the study. Grade six students have been selected because of their grade level.
Information on what your son’s or daughter’s participation will involve follows.
Why is the survey web-based?
The web-based survey will allow access to a greater number of participants, and will result in a comprehensive
assessment of children’s diet in the Waterloo Region.
What will my son or daughter be asked to do?
All of the students in participating classes will be invited to complete a nutrition and physical activity survey on the
Internet during class time. The survey will ask your son or daughter to recall what s/he ate the previous day and to
identify the types of physical activity s/he engaged in and how frequently s/he did so. At the end a trained research
assistant will privately take the student’s height and weight measurements4. Participants may choose to omit any
information or discontinue their participation at ay time. The survey will take approximately 30-40 minutes to
complete. Upon completing the survey, your son or daughter will receive feedback on their diet.
Who will have access to my son’s or daughter’s information?
The survey is anonymous. Each participant will have a unique identification code and password. This means your
son’s or daughter’s name will not be on the survey. The web site will be password protected so that only authorised
users will be able to gain access. Only researchers at the University of Waterloo and Region of Waterloo Public
Health, who are involved in this study, will have access to this information, which will be stored on locked computer
files. Identification codes, not participant names, will be used in the data analysis. All data will be published in a
group format so that it will not be possible to determine the responses from any individual student. The school will
have access to the group results and we will provide grade level learning resources, so that the study can support and
enhance the curriculum. The data will be permanently stored on CD in electronic form.
Ethics Clearance and Approval for Project
4
The measurements will be taken according to the Guidelines for Collecting Heights and Weights of Children and
Adolescents in School Settings by Centre for Weight and Health, College of Natural Resources, University of
California, Berkeley
66
This project has been approved by the Research Committee of the Waterloo Region District School Board and has
the support of the principal at your child’s school. As well, it has been reviewed by and received ethics clearance
from the Research Ethics Committee of the Region of Waterloo Public Health and through the Office of Research
Ethics at the University of Waterloo. If you have any questions or concerns about your son’s or daughter’s
participation in the study, please call ______________ Region of Waterloo Public Health.
The final decision to participate in this study must be made by the individual student and her/his parent(s) or
guardian(s). Your co-operation in permitting your son or daughter to take part in this research is greatly appreciated.
However, there is no penalty of any kind if he/she does not participate. A student will not be included in the study if
a parent or guardian indicates that he or she does not want the student to participate, or if the student does not agree
to take part. If you agree to participate, but you or your son or daughter later change your minds, you and/or
your son or daughter can withdraw at any time. Taking part in this study does not pose any risks for your son
or daughter.
If you DO want your son or daughter to participate, please complete the
permission form below and return it to [Name of School] by [date]. If we have
not received the permission form by this date, we will assume that you are
NOT willing to have your son or daughter participate.
Sincerely,
Rhona Hanning, PhD, RD
Principal Investigator,
Population Health Research Group
Associate Professor,
Health Studies & Gerontology
University of Waterloo
Daniela Seskar-Hencic,
Manager,
Planning and Evaluation,
Region of Waterloo Public Health
(519) 883-2258
[email protected]
67
FOOD BEHAVIOUR AND PHYSICAL ACTIVITY OF GRADE SIX STUDENTS IN
WATERLOO REGION:
A WEB-BASED SURVEY
PERMISSION FORM
I agree to have my son or daughter participate in a study conducted by Region of Waterloo Public Health
and Dr. Rhona Hanning, University of Waterloo. I have made this decision based on the information I
have read in the Information Letter and have had the opportunity to receive any additional details I
wanted about the study. I understand that I may withdraw this consent at any time without penalty. I also
understand that this project has been reviewed by, and received ethics clearance from the Region of
Waterloo Public Health Research Ethics Committee and that I may contact this office if I have any
concerns or questions about my son or daughter’s involvement in the study.
Child’s Name:
(Please Print)
_______________________________________
Signed:
________________________________________
Name:
(Please Print)
________________________________________
Date:
________________________________________
68
APPENDIX F: WEB-BASED SURVEY
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72
73
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75
76
77
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