BEVERAGE CONSUMPTION IN SASKATCHEWAN SCHOOLS: A SURVEY

OF POLICIES AND PRACTICES

Carol J. Henry

Research indicates that there has been a shift in children and adolescents= beverage choices from milk to primarily soft drinks. The recent commercialization of schools including the availability soft drinks in school vending machines is cause for concern. This study seeks to gain an understanding of the policies and practices pertaining to beverage consumption in Saskatchewan schools. The theoretical framework adopted is based on Parsons technical, managerial, and institutional level. An in-depth review of the literature will be conducted for insights about the nutrition, education and economic effects of beverages consumed by children and adolescents. Surveys of policies and practices, attitude towards beverages consumed by children and adolescents, issues, and challenges will be explored at each technical, managerial, and institutional levels. Content analysis will clarify underlying themes and typology. Healthy eating and drinking habits in childhood and adolescents promote optimal health, growth and intellectual development; prevent immediate and future health problems. Schools and their communities have a shared responsibility to provide the environment that will help to shape the eating and drinking behaviors of children and adolescents.

OF POLICIES AND PRACTICES

About a year ago I attended the First North American conference on School Milk Matters in Toronto. The conference was sponsored by the Dairy Farmers of Ontario, Canada= s Dairy Industry, and Food and Agriculture Organization of the United Nations (FAO), and brought together delegates from around the world to share their experiences and research, and to encourage future growth of school milk programs. In his opening remarks, FAO= s director Michael Giffen (2001) suggested that school milk programs can be divided into three categories: long-standing programs found in most of Europe, North America, and Japan; more recently established programs in South East Asia, China, and some Latin American countries; and regenerated programs in countries where such programs had ceased. There is growing international interest in school milk programs, as indicated above. Since 1997, FAO and member countries have conducted several regional and international conferences aimed at supporting the growth of school milk programs. Member countries such as Canada, have also engaged in various efforts to promote the provision and consumption of milk in schools. These efforts are generally sponsored by local dairy farmers= associations, government agencies and community organizations.

It is perhaps ironic that the First North American Conference on School Milk Matters was held in Toronto, given that the Toronto Amalgamated School Board had recently signed the largest pouring rights contract in the history of Canada. The $6-million, three year contracts

that caused immediate removal of all Pepsi machines from several schools. Globe and Mail reporter, Wente (2000), quotes the school board controller as saying, A if there are millions available from the sale of these products, do we leave it with corporations, or leave it in the school system for the benefit of children?@ Pouring rights contracts have evolved in schools in the USA and Canada over the past ten years. These rights allow soft drink companies to secure exclusive rights for the sale of their specific brand of beverage in schools= vending machines and otherwise (Nestles, 2000).

The National Association of State Boards of Education (NASBE, 2001) estimates that there are approximately 175 US school districts with exclusive arrangements with the soft drink companies, Coca-Cola or Pepsi. Though data was not available on the number of schools with signed contracts in Canada, evidence suggests that such contracts do exist, especially in large urban school districts in several provinces (Edmonton Journal, 1998; Wente, 2000). A recent Ontario Secondary School Federation of Teachers (OSSFT, 2001) report suggested that just under half (48.2 percent) of schools who responded to the questionnaire have an exclusive drink agreement with Coke (27%) or Pepsi (15.3%) in their schools.

While several US states have taken steps to reduce the lucrative business of selling soft drinks in school, school boards and school administrators in other states have mounted strong challenges to protect what has become a valuable source of revenue for schools (NASBE, 2001). In Canada, cuts in education funding have also led school boards to establishing a range of business-partnerships to fund various school activities. While few, if any, would argue that soft drinks are nutritious, lucrative contracts have become a way of life for many school districts and universities across North America (Wente, 2000).

In the USA, the United States Department of Agriculture (USDA), the federal department that oversees school food service programs has established regulations to control the sale of food and beverages of minimal nutritional value, in the food service area during mealtimes. Foods of minimal nutritional value are defined as carbonated beverages (pop), hard candies, water ices (flavored ices), and chewing gums. However, state education departments do have the flexibility to set their own standards for food and beverages sold at other times. In Canada, there is no national or provincial umbrella to coordinate child nutrition or school milk programs. There are no national or provincial policies guiding the provision or sale of food or beverage in schools. Consequently, a variety of school milk and meal programs and practices have been identified across Canada, with most operating at the local school board or individual school level (Health Canada, 2000; Henry, 2000; Price-Owens, 2001).

There is reason to believe that a similar trend occurred in Canada, however, national or provincial data is not available. The Canadian Soft Drink Association (1995.1996) estimates that the average Canadian consumed 108 liters of soft drinks in 1995, up 22 percent from 1988. A recent University of Saskatchewan study (Whiting, Healey, Psiak, Mirwald, Kowalski, Bailey, 2001) found that boys and girls drank 429 ml per day of beverages that are of minimal nutritional value. The study was completed in 1997, and intakes of these beverages have likely increased since. The study also reported that girls in their teens who drank soft drinks instead of milk were likely to have increased risk of fractures and osteoporosis, a disease leading to fragile and broken bones.

The availability of soft drinks and other low nutrient foods and beverages in snack bars, cafeterias, and vending machines, and their use as fund-raisers in Canadian Schools, have also become cause for concern (Crawford, 1977). Research shows that vending machine purchase accounts for about three percent of all adolescents’ eating occasions. This amounts to approximately $736 million sales yearly. Unfortunately, about 78 percent of these purchases occur at school (Spears, 2002). Children and adolescents are in their most formative years for developing soft drink brand preferences and lifelong loyalty. Easy access to beverages low in nutrients is likely to reduce the child’s opportunity to form healthy beverage consumption habits. In addition, the availability of beverages that are less nutritious is likely to send a mixed message as school nutrition education curriculum seeks to promote healthy drinking and eating behaviors among schoolchildren.

The changes in school-aged children= s consumption patterns have been attributed to a number of phenomena. For example, perceptions exist that milk is A just for kids@ (Brumback, 1995), that whole milk and 2 percent milk are high-fat foods that should be replaced in children= s diets (Sigman-Grant, Simmerman, & Kris-Etherton, 1993), and that milk treated by bovine somatotropin is A tainted@ (Wall Street Journal, 1994). In addition, aggressive marketing of soft drinks as A fun@ foods (Guenther, 1986), a steady increase in container size from a six and one-half ounce bottle in the 1950's to today= s twenty-ounce bottle (Jacobson, 2001), and the competitive need to generate profit (Better Nutrition for Children= s Act, 1993) have undoubtedly contributed to the dramatic changes in the beverage consumption patterns.

Critics of the increased availability of soft drinks in schools note that childhood obesity is reaching epidemic proportions in North America, with more than four million children aged six to twenty-four now overweight or obese (Troiano, Fegal, Kuczmarski, Campbel, & Johnson, 1995). Recent data demonstrates increases in the prevalence of obesity among children in Canada that are alarming and a cause for concern (Tremblay & Willms, 2000). The relationship of soft drink consumption to childhood obesity is uncertain, but a recent study suggests a causal link (Ludwig, Peterson, & Gortmaker, 2001). The large purchasing power of many students has made them a target of large-scale advertising.

When left to make their own decisions, children= s food and beverage consumption has little to do with nutritional considerations. Instead their choices may be enabled or impeded by environmental factors, such as the availability of products. The way beverages are supplied, purchased, and presented may also enable or impede consumption. Thus food service provisions and nutrition education have to operate against a background of children= s desire for autonomy

over their food and beverage choices, and a flourishing market aimed at encouraging them to purchase non-traditional beverages and foods such as fast foods and soft drinks.

The promotion of milk as an essential drink for school-aged children is contentious, however. There are arguments for and against milk and other beverages in school, as demonstrated in internet sites such as A Got Milk A or A Not Milk,@ A Soda Fountain@ versus A Health Fountain,@ and finally, A Debate Over Milk: Time To Look at Facts. @ One of the criticisms of beverages such as soft drinks in schools is that they appear to be there purely for economic benefits, but one reason for the promotion of other beverages such as milk is also for economic reasons.

Given the concerns relayed above, I became interested in understanding the issues, challenges, and related concerns pertaining to beverage consumption in schools. For this reason, I have decided to take a closer look at the policies and practices pertaining to beverage consumption in Saskatchewan schools, and will asked the following questions:

1. What literature is available regarding the nutritional, educational, and economic effects associated with beverage consumption by children and adolescents in general and, more particularly, by children and adolescents involved in school programs sponsoring or promoting consumption of selected beverages?

2. Are there pertinent research-based conclusions regarding the nutritional, educational, and economic effects of consumption of beverages by children and adolescents children? Do effects appear to vary according to type of sponsorship program?

3. How do opinion leaders, policymakers and educational leaders understand the issues involved in school sponsorship of beverage consumption (Institutional Level)? What goals are seen to be attained through adopting school-sponsored beverage programs? What are seen as the major impediments to establishing such programs?

4. What policies or other authoritative statements influence provision of beverages in schools (Managerial Level)? What, if any, specific provisions are made? What, if any, rationale or justification is given?

5. What are current arrangements for supplying, purchasing, handling, distributing and consuming beverages in schools (Technical level)? How did these provisions come to be established? What intended goals are served? How are current provisions justified? What are seen as the major impediments to establishing and maintaining such programs in schools?

6. What are the characteristics of school-sponsored beverage programs? Can a reliable typology of such programs be determined?

7. What conclusions and implications can be drawn from the results of this inquiry?

The theoretical framework adopted to guide the inquiry is adapted from the literature on organizational theory and school health. Figure1 describes elements of the framework. The framework laid out by Parsons (1960) describes three levels or layers of a schooling organization technical, managerial, and institutional. The technical level is concerned with the  teaching and learning process. The managerial level refers to the leadership, administration and reorganization of schooling. The institutional level connects the educational system with its external environment.

The Comprehensive School Health (CSH) Framework that defines a healthy environment as having hygiene, safety, foods and nutrition, has been adopted by the Saskatchewan Department of Education. The CSH model is an integrated approach to promoting healthy students in healthy schools. The World Health Organization (WHO) has promoted health in schools for over twenty years. In recent years, several countries have launched a comprehensive approach to school-based health promotion. These include Health Promoting Schools (HPS) which is widely used in Europe and Australia, the Comprehensive or Coordinated School Health Program (CSHP) which is commonly used in the United States, and the Comprehensive School Health (CSH) which is widely used in Canada (OPHA, 2002).

In Canada, the CSH model combines four elements: instruction, support services, social support, and a healthy environment, including hygiene, safety, nutrition, food and beverage service. For the most part CSH programs are voluntary, with individual schools and school boards expected to buy into the concept. Some provinces, including Saskatchewan, expect all health education initiatives to integrate the CSH the model. It is not known whether school boards in the province have responded to this framework by developing food and nutrition policies. There are two primary opportunities for nutrition intervention within the CSH model. School-aged children can be educated about nutrition and healthful diets including beverage drinking habits in the classroom, and food service systems can be used as a means of reinforcing educational messages by providing policies and guidelines at the board or managerial level. These policies would support food service activities such as food and beverage sold in vending machines, at school stores, snack bars, sporting events, and special activities, and as part of fundraising activities.

The school environment can significantly influence students’ attitudes, preferences, and behaviours related to food and beverages (Contento, Balch, Browner, 1995). Without a coordinated nutrition and food service policy, schools risks negating the nutrition education delivered in the classroom by allowing actions that discourage healthy eating and drinking behaviours (US. Department of Health and Human Services, 1996).

The investigation uses two approaches, a comprehensive investigation of the literature and a survey design to gain an understanding of the policies and practices relating to beverage consumption in Saskatchewan elementary schools. I have chosen the Saskatchewan situation for several reasons. Firstly, it is economical and convenient. Concentrating on one province allows more coherence on the analysis of the policies and practices pertaining to beverage consumption in schools. Schools are a provincial jurisdiction, and therefore a full complement of stakeholders is represented at each provincial level, such as a trustee association. As well, there is a solid research presence in child nutrition in Saskatchewan, at the university level and elsewhere.

Two approaches will be used for data gathering. Firstly, to satisfy questions 1 and 2, several bodies of literature will be searched. These include official government documents, and published sources and unpublished manuscripts concerning the nutrition, education and economic effects of beverage consumption on children and adolescents. All relevant references, articles, and studies will be retrieved. In addition, a search of pertinent data bases and the World Wide Web will be conducted. The analysis will cover literature from 1980 to present, when the most noticeable changes have been documented about beverage consumption habits of children. Content analysis will be used to identify general themes and possible typology This literature review will establish what relevant work has already been completed in the field.

I have worked with the literature on child nutrition for several years, and have drawn on it for my MEd thesis, School Meals in Canada and other Countries (Henry, 2000), class presentations, and for other studies. I have broad familiarity with the literature, including several studies that have investigated the nutritional effects of beverage choice on children and adolescents. These include studies at the University of Saskatchewan. For example, Whiting, et al, (2001) examined the relationship between carbonated drinks and other beverages of minimal nutritional value, Illiano-Burns, Whiting, Faulkner, and Baily (1999) investigated the levels and source of dietary calcium in children and adolescents enrolled in the University of Saskatchewan Pediatric Bone Mineral Accural Study, and Whiting, Colleaux and Bacchetto (1995), investigated the dietary intakes of children 8-15 living in Saskatoon, Saskatchewan. The studies reported above have provided an initial understanding of the nutritional effect of beverage consumption on school-aged children. However, I believe that a more comprehensive understanding is needed, particularly about the educational and economic effects of beverage consumption on school-aged children. Findings from the literature search will clarify and refine survey tools described next.

Three surveys will be conducted. In the first survey, a letter will be mailed to all agencies in Saskatchewan, requesting information about the recipient’s awareness of policies and practices pertaining to beverage consumption in schools. For example, Saskatchewan Department of Education, Saskatchewan Trustees Association, Saskatchewan Dairy Foundation, Saskatchewan Soft Drinks Association may have interest the policies and practices in schools. A follow-up telephone interview will be arranged following the receipt of responses. Interested respondents will be invited to share their understanding of the issues and challenges relating to beverage consumption in schools (e.g., policy and guidelines, funding, facilities, marketing approaches, etc.), and attitudes toward types of beverages provided in schools. I am anticipate conducting 4-6 interviews.

In the second survey, a letter will be mailed to all 114 directors of school divisions (school boards) in Saskatchewan, soliciting information about the nature of the policies and programs that guide provision or sale of beverages in schools. After responses are received, interested participants will be invited to participate in a telephone interview to explore attitudes towards beverage provision. This will include attitudes toward milk in school, toward soft drink sales in schools, and barriers to the development and implementation of policies pertaining to food and beverages consumption in school. I anticipate conducting 6-8 interviews.

The third survey will be a self-administered questionnaire mailed to the principals of all public schools in Saskatchewan. The total approach is important to allow all schools the opportunity to comment on the practices, issues, and challenges relating to beverage consumption in schools. There are 775 schools in Saskatchewan (elementary and secondary), so this is feasible. Recipients will be asked to provide information on school demographics, schools’ beverage program, including availability and type of program, current arrangements such as purchasing, handling, distribution, and challenges and issues to the type(s) of beverage provided. Principals or or designee (e.g. nutrition coordinator) will be asked to complete the questionnaire. Previous experience suggests that I should expect about a 40-50 percent return from these questionnaires. Nevertheless, this responses will provide me with an informed understanding of the issues, challenges and related concerns pertaining to beverage consumption in schools. The data will be critical for gaining a perspective of the characteristics of programs currently being offered.

As an additional step, I plan to select ten or so schools to visit, to gain a more in-depth look at their programs, and to discuss possible issues and challenge facing such programs. I will ask respondents at the managerial or school division level to suggest the names of one or two schools who currently either operate a milk program or provide soft drinks in school. Our pilot survey of schools in Saskatchewan revealed that not all schools offer a milk program (Henry, 2000). Approximately 33 percent of the 90 elementary schools participating in the study did not offer a milk program. The most recent survey of the Saskatchewan Dairy Foundation (2000) reported that more than 385 elementary schools in the province participated in their school milk programs. The report indicated another 92 schools had registered in the past but did not renew their membership. The survey did not solicit data about why schools failed to renew memberships Barriers probably exist to the implementation and maintenance of beverage programs such as milk in schools, and some of the barriers maybe related to infrastructure concerns.

Data Analysis. Data analysis will involve mainly content analysis to determine underlying themes and typology.

Potential Outcomes: Potential outcomes include: a more comprehensive understanding of the nutritional, educational, and economic effects of beverage consumption among children and adolescents, especially among those in schools offering beverage programs; an understanding of the issues, challenges and concerns relating to beverage consumption in schools, and the development of possible typology of such programs.

Ethical Approval. Written consent will be obtained from the Saskatchewan Department of

Education, Directors of School Division, and local School administration, and all other participants prior to the beginning of the study. Ethical approval will be obtained from the University of Western Ontario’s Review Board for Health Science Research involving Human Subjects, and the University of Saskatchewan’s Advisory Committee on Ethics in Human Experimentation. Each interviewee will be given an opportunity to validate or correct the information collected from the interview (Surveys 1&2).

Healthy eating and drinking habits in childhood and adolescents promote optimal health, growth and development; and prevent immediate and future health problems. Studies indicate that there has been a shift in the beverage choice of children and adolescents from milk to primarily soft drinks. Research into the issues, challenges and concerns regarding beverage consumption in schools, is essential. This research will assist in the development of effective health education and health promotion practices, as well as programs and practices designed to target children and adolescents. A better understanding of the factors that influence the provision of beverages such as milk or soft drinks may contribute to the development of effective interventions for supporting nutritious beverage consumption in school. Schools and their communities have a shared responsibility to provide the environment that will help shape the eating and drinking behaviors of children and adolescents.

REFERENCE CITED

Better Nutrition and Health for Children Act of 1993. (1995). Estimating deficiencies in a population from dietary records: The use of probability analyses. Nutrition Research, 2, 409-415.

Borrud, L, Enns, C., & Mickle, S. (1997). What we eat: USDA surveys food consumption changes. Nutrition Week, April 18, pp. 4-5.

Brumback, N. (1995). Milk groups detail fight plan against rival drinks. Supermarket News, 45: 29-31.

Canadian Soft Drink Association (CSDA, (1995). The Canadian Soft Drink Association, What should we know about it? http://www.softdrink.ca/prow96en.htm.

Center for Commercial and Public Education (NASBE). (1998). Soft drinks undermining America’s health: teens consuming twice as much "liquid Candy" as milk. CSPI News Release.

Contento, I., Balch, G., Bronner, Y. (1995). Nutrition Education for school-aged children. Journal of Nutrition Education. 27 (6): 298-311.

Crawford, L. (1977). Junk Food in our schools? A look at student spending in School vending machines and concessions. Journal of Canadian Dietetic Association. 38(3), 193-197.

Edmonton Journal (1998). Cola Wars in cafeteria. February 12.

Griffen, M. (2001). The success and role of school milk programs around the world.

Food and Agricultural Organization and the United Nations. Paper presented at the 1st North American Conference on School Milk, Toronto, Canada, June 4-6.

Guenther, P.M. (1986). Beverage in the diets of American Teenagers. American Dietetic Association Journal. 86: 403-499.

Harnack, L., Stang, J., & Story, M. (1999). Soft drink consumption among US children and adolescents: Nutritional consequences. Journal of the American Dietetic Association, 99; 436-441.

Henry, C. (2000). School meals in Canada and other developed countries. Masters Thesis, University of Western Ontario.

Henry, C, and Saskatchewan Child Nutrition Network (2001). A Survey of Food Security Programs in Saskatchewan: An Interim Report. Saskatoon. Child Hunger and Education Program.

Jacobson, M. F. (2000). Liquid Candy: how soft drinks are harming Americans’ Health. http://www.cspinet.org.sodapop/.

Ludwig, D..S., Peterson, K. E., & Gortmaker, S. L. (2001). Relation between consumption of sugar_sweetened drinks and childhood obesity: a prospective, observational analysis. Lancet. 17 ,357, 505_8.

Nestles, M. (2000). Soft Drinks "Pouring Rights": Marketing Empty Calories. Public Health Reports. 115: 308-319. July/August.

Ontario Secondary School Teachers’ Federation (OSSTF). Commercialization in Schools: Executive Summary. http://www.google.com.

Ontario Public Health Association (OPHA, 2002). Healthy Schools Workgroup/ Ontario Healthy School Coalition. Toronto. Ontario Public Health Association. March 27.

Price-Owen, N. (2001). School Milk in Canada: Ten different systems from government to private sector. Toronto. First North American Conference of School Milk Matters.

Saskatchewan Dairy Foundation (2000). School Milk Program Survey 1999-2000 Elementary School. Regina. Saskatchewan Dairy Foundation.

Scott , W. R. (1998). Organizations: Rational, Natural, and Open Systems. New Jersey: Prentice-Hall.

Sigman-Granti, M., Zimmerman, S., Kris-Etherton, P. (1993). Dietary Approaches for reducing fat intake of pre-school age children. Pediatrics. 91, 955-960.

Story, M., Hayes, M., Kalima, B. (1996). Availability of foods in high school: Is there a case for concern? Journal of American Dietetic Association. 96: 123-126.

Spears, B. (2002). Adolescent growth and development. Journal of the American Dietetic Association. 102 (23): S23-S29.

Squires, S. (2001). Soft Drinks, hard facts: research suggest kids who drink a lot of soft drinks risk becoming fat, weak-boned, early-prone and caffeine addicted. Washington Post; Feb. 27. p. HE10.

Tremblay, M. S. & Willims, J. D. (2000). Secular trends in body mass index of Canadian children. Canadian Medical Association Journal.163: 1429-1433; 2001; 164(7): 970.

Troiana, R. P., Fegal, K. M., Kuczmarski, R. J., Campbel, S., & Johnson, C. (1995). Overweight prevalence and trends for children and adolescents- The National Health and Nutrition Examination Surveys, 1963-1991. Archives Pediatric and Adolescent Medicine. 149: 1085-1091.

United States Department of Agriculture (USDA, 1996). Press Release: What and when our children eat - 1994 National Survey Results. Press Release No 0197.96.

United States Department of Health and Human Services (1996). Guidelines for School Health Programs to promote Lifelong Healthy Eating. Georgia. Center for Disease Control. U.S. Department of Health and Human Services, Public Health Service.

Wall Street Journal. (1994). Wisconsin parent want milk alternative. May 10. P.1

Went, M. (2000). The fountain of money: Coke or Pepsi? Globe and Mail. Tuesday, March; A15

Whiting, S.J., Colleaux, C., Bacchetto, T. (1995). Dietary intakes of children age 8 to 15 years living in Saskatoon. Journal of Canadian Dietetics Association. 56: 119-125.

Whiting, S. J., Healey, A., Psiak, S., Mirwald, R., Kowalski, K., & Bailey, D. A. (2001). Relationship between carbonated drinks and other low nutrient dense beverages and bone mineral content of adolescents. Nutrition Research. 21:1107-1115