Abstract
Background
In an attempt to elucidate broader determinants of adolescent dietary intake and habits, food intakes and selected food behaviours of grades 9 and 10 students from Ontario and Alberta were examined according to school region socio-economic status and urban/rural locale.
Methods
Using a stratified random sample framework, 53 high schools from 28 school boards were recruited (45 public and 8 private; 33 urban and 20 rural). Median family income for Canada Post’s forward sortation area of the school was used to define school region SES. Public and private schools were compared as a proxy measure of SES. A webbased survey of food intake and behaviours, including a 24-hour diet recall and food frequency questionnaire, was completed by 2,621 students in grades 9 and 10. Comparison of intakes and behaviours by school designation as urban/rural, public/private or regional SES (generalized linear model procedure) controlled for student gender and grade distribution and number of participants within schools.
Results
School region SES ranged from $40,959 to $85,922/year. Vegetable and fruit consumption (p<0.001), fibre intake (p<0.001) and frequency of breakfast consumption (p<0.01) increased with increasing income, while added sugar intake decreased (p<0.01). Private versus public school students had lower intakes of sweetened drinks (p<0.01) and higher intakes of fibre (p=0.02). Rural students reported higher mean intakes of calcium (1106 vs. 995 mg/day, respectively, p=0.03) and milk products (2.7 vs. 2.3 servings/day, p<0.01) than urban students.
Conclusion
Selected food behaviours of youth from Ontario and Alberta improve with increasing school SES and vary with rural/urban school locale. Identifying regional demographics may be useful in tailoring healthy eating programs to the specific school.
MeSH terms: Nutrition, population health, adolescent, cross-sectional studies
Résumé
Contexte
Pour élucider les grands déterminants des habitudes et apports alimentaires des adolescents, nous avons analysé les rations et certains comportements alimentaires d’élèves de 9e et de 10e année de l’Ontario et de l’Alberta selon le statut socioéconomique (SSE) du territoire de l’école et son emplacement en milieu urbain ou rural.
Méthode
À partir d’un échantillon aléatoire stratifié, nous avons recruté 53 écoles secondaires dans 28 conseils scolaires (45 écoles publiques et 8 écoles privées; 33 en milieu urbain et 20 en milieu rural). Le revenu familial médian pour la région de tri d’acheminement de Postes Canada dans laquelle se trouvait l’école a servi à définir le SSE régional. Comme variable de substitution au SSE, nous avons aussi comparé les écoles publiques et privées. Deux mille six cent vingt et un élèves de 9e et de 10e année ont répondu à un sondage en ligne sur les rations et les comportements alimentaires, qui comprenait une feuille de rappel des aliments ingérés pendant les 24 dernières heures et un questionnaire sur la fréquence de consommation des produits alimentaires. Notre comparaison des apports et des comportements selon le profil de l’école (urbaine, rurale, publique, privée) ou le SSE régional (par modèle linéaire généralisé) a tenu compte des effets du sexe des élèves et de leur niveau, ainsi que du nombre de répondants dans chaque école.
Résultats
Le SSE régional des écoles variait entre 40 959 $ et 85 922 $ par année. La consommation de fruits et de légumes (p<0,001), l’apport en fibres (p<0,001) et la fréquence de consommation du petit déjeuner (p<0,01) augmentaient avec le revenu, tandis que l’apport en sucre ajouté diminuait (p<0,01). Par rapport aux élèves des écoles publiques, les élèves des écoles privées affichaient une consommation inférieure de boissons sucrées (p<0,01) et des apports supérieurs en fibres (p=0,02). Par rapport aux élèves en milieu urbain, les élèves en milieu rural ont déclaré des apports moyens de calcium plus élevés (1 106 c. 995 mg/jour respectivement, p=0,03) et une consommation supérieure de produits laitiers (2,7 c. 2,3 portions/jour, p<0,01).
Conclusion
Certains comportements alimentaires des jeunes de l’Ontario et de l’Alberta s’améliorent avec l’accroissement du SSE régional et changent selon que l’école se trouve en milieu rural ou urbain. Il peut donc être utile de définir le profil démographique régional pour adapter les programmes de saine alimentation à une école en particulier.
Footnotes
Acknowledgement: This study was supported by a grant from the Beef Information Centre, Canada. The authors are grateful to Dr. Steve Brown, University of Waterloo for guidance in randomization procedures.
References
- 1.Shields M. Measured obesity: Overweight Canadian children and adolescents. Nutrition: Findings from the Canadian Community Health Survey, Issue no. 1, Statistics Canada Catalogue no. 82-620-MWE2005001. Available online at: https://doi.org/statcan.ca/cgi-bin/downpub/listpub.cgi?catno=82-620-MIE (Accessed March 27, 2006).
- 2.Ball GD, McCargar L. Childhood obesity in Canada: A review of prevalence estimates and risk factors for cardiovascular diseases and type 2 diabetes. Can J Appl Physiol. 2003;28:117–140. doi: 10.1139/h03-010. [DOI] [PubMed] [Google Scholar]
- 3.Tremblay MS, Katzmarzyk PT, Willms JD. Temporal trends in overweight and obesity in Canada, 1981–1996. Int J Obes. 2002;26:538–43. doi: 10.1038/sj.ijo.0801923. [DOI] [PubMed] [Google Scholar]
- 4.Freedman DS, Dietz WH, Srinivasan SR, Berenson GS. The relation of overweight to cardiovascular risk factors among children and adolescents: The Bogalusa Heart Study. Pediatrics. 1999;103:1175–1182. doi: 10.1542/peds.103.6.1175. [DOI] [PubMed] [Google Scholar]
- 5.Dietz WH. Childhood weight affects adult morbidity and mortality. J Nutr. 1998;128(suppl):411S–414S. doi: 10.1093/jn/128.2.411S. [DOI] [PubMed] [Google Scholar]
- 6.Hulshof KFAM, Burssaard JH, Kruizinga AG, Telman J, Lowik M. Socio-economic status, dietary intake and 10y trends: The Dutch National Food Consumption Survey. Eur J Clin Nutr. 2003;51:128–137. doi: 10.1038/sj.ejcn.1601503. [DOI] [PubMed] [Google Scholar]
- 7.Crawford PB, Obarzanek E, Schrieber GB, Barrier P, Goldman S, Frederick MM, Sabry ZI. The effects of race, household income, and parental education on nutrient intakes of 9- and 10-year-old girls. Ann Epidemiol. 1995;5:360–368. doi: 10.1016/1047-2797(95)00033-4. [DOI] [PubMed] [Google Scholar]
- 8.Brown JL, Pollitt E. Malnutrition, poverty and intellectual development. Sci Am. 1996;274:38–43. doi: 10.1038/scientificamerican0296-38. [DOI] [PubMed] [Google Scholar]
- 9.Xie B, Gilliland FD, Li YF, Rockett HR. Effects of ethnicity, family income, and education on dietary intake among adolescents. Prev Med. 2003;36:30–40. doi: 10.1006/pmed.2002.1131. [DOI] [PubMed] [Google Scholar]
- 10.Laitinen S, Rasanen L, Viikari J, Akerblom HK. Diet of Finnish children in relation to the family’s socio-economic status. Scand J Soc Med. 1995;23:88–94. doi: 10.1177/140349489502300203. [DOI] [PubMed] [Google Scholar]
- 11.Turrell G, Hewitt B, Patterson C, Oldenburg B. Measuring socio-economic position in dietary research: Is choice of socio-economic indicator important? Public Health Nutr. 2003;6:191–200. doi: 10.1079/PHN2002416. [DOI] [PubMed] [Google Scholar]
- 12.Lien N, Jacobs DR, Jr, Klepp KI. Exploring predictors of eating behaviour among adolescents by gender and socio-economic status. Public Health Nutr. 2002;5:671–681. doi: 10.1079/PHN2002334. [DOI] [PubMed] [Google Scholar]
- 13.McMurray RG, Harrell JS, Bangdiwala SI, Deng S. Cardiovascular disease risk factors and obesity of rural and urban elementary school children. J Rural Health. 1999;15:365–374. doi: 10.1111/j.1748-0361.1999.tb00760.x. [DOI] [PubMed] [Google Scholar]
- 14.Centers for Disease ControlPrevention. Guidelines for school health programs to promote lifelong healthy eating. MMWR. 1996;45:1–37. [PubMed] [Google Scholar]
- 15.Hanning RM, Jessup L, Lambraki I, MacDonald C, Minaker L, McCargar L. A web-based approach to assessment of food intake and behaviour of school children and adolescents. Can J Diet Prac Res. 2003;64:S110–S111. [Google Scholar]
- 16.McPherson RS, Hoelscher DM, Alexander M, Scanlon KS, Serdula MK. Dietary assessment methods among school-aged children: Validity and reliability. Prev Med. 2000;31:S11–S33. doi: 10.1006/pmed.2000.0631. [DOI] [Google Scholar]
- 17.Health Canada Online. Canada’s Food Guide to Healthy Eating. 2002. [Google Scholar]
- 18.Health Canada Online. Relating Canada’s Food Guide to Healthy Eating to Canadian Nutrient File Foods. 2003. [Google Scholar]
- 19.Ness AR, Powles JW. Fruit and vegetables, and cardiovascular disease: A review. Int J Epidemiol. 1997;26:1–13. doi: 10.1093/ije/26.1.1. [DOI] [PubMed] [Google Scholar]
- 20.Steinmetz KA, Potter JD. Vegetables, fruit, and cancer prevention: A review. J Am Diet Assoc. 1996;96:1027–39. doi: 10.1016/S0002-8223(96)00273-8. [DOI] [PubMed] [Google Scholar]
- 21.French SA, Stables G. Environmental interventions to promote vegetable and fruit consumption among youth in school settings. J Prev Med. 2003;37:593–610. doi: 10.1016/j.ypmed.2003.09.007. [DOI] [PubMed] [Google Scholar]
- 22.FoodNutrition Information Center. Dietary Reference Intakes (DRI) and Recommended Dietary Allowances (RDA) 2004. [Google Scholar]
- 23.Gray-Donald K, Jacobs-Starkey L, Johnson-Down L. Food habits of Canadians: Reduction in fat intake over a generation. Can J Public Health. 2000;91(5):381–385. doi: 10.1007/BF03404812. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 24.Cavadini C, Siega-Riz AM, Popkin BM U. US adolescent food intake trends from 1965 to 1996. Arch Dis Child. 2000;83(1):18–24. doi: 10.1136/adc.83.1.18. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 25.Morgan KJ, Zabik ME, Leveille GA. The role of breakfast in nutrient intake of 5- to 12-year-old children. Am J Clin Nutr. 1981;34:1418–1427. doi: 10.1093/ajcn/34.7.1418. [DOI] [PubMed] [Google Scholar]
- 26.Cohen B, Evers S, Manske S, Bercovitz K, Edward HG. Smoking, physical activity and breakfast consumption among secondary school students in a southwestern Ontario community. Can J Public Health. 2003;94(1):41–44. doi: 10.1007/BF03405051. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 27.Cueto S. Breakfast and performance. Public Health Nutr. 2001;4:1429–1431. doi: 10.1079/PHN2001233. [DOI] [PubMed] [Google Scholar]
- 28.Storey ML, Forshee RA, Anderson PA. Associations of adequate intake of calcium with diet, beverage consumption, and demographic characteristics among children and adolescents. J Am Coll Nutr. 2004;23:18–33. doi: 10.1080/07315724.2004.10719339. [DOI] [PubMed] [Google Scholar]
- 29.Whiting SJ, Vatanparast H, Baxter-Jones A, Faulkner RA, Mirwald R, Bailey DA. Factors that affect bone mineral accrual in the adolescent growth spurt. J Nutr. 2004;134:696S–700S. doi: 10.1093/jn/134.3.696S. [DOI] [PubMed] [Google Scholar]
- 30.Veugelers PJ, Fitzgerald AL, Johnston E. Dietary intake and risk factors for poor diet quality among children in Nova Scotia. Can J Public Health. 2005;96(3):212–216. doi: 10.1007/BF03403693. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 31.Story M, Resnick MD. Adolescents’ views on food and nutrition. J Nutr Educ. 1986;18:188. doi: 10.1016/S0022-3182(86)80015-2. [DOI] [Google Scholar]
- 32.Gracey D, Stanley N, Corti B, Beilin L. Nutritional knowledge, beliefs and behaviours in teenage school students. Health Educ Res: Theory Prac. 1996;11:187–204. doi: 10.1093/her/11.2.187. [DOI] [Google Scholar]
- 33.Neumark-Sztainer D, Story M, Perry C, Casey M. Factors influencing food choices of adolescents: Findings from focus-group discussions with adolescents. J Am Diet Assoc. 1999;99:929–937. doi: 10.1016/S0002-8223(99)00222-9. [DOI] [PubMed] [Google Scholar]
- 34.Flynn MAT, McNeil DA, Maloff B, Mutasingwa D, Wu M, Ford C, Tough SC. Reducing obesity and related chronic disease risk in children and youth: A synthesis of evidence with ‘best practice’ recommendations. Obesity Reviews. 2006;7(Suppl1):7–66. doi: 10.1111/j.1467-789X.2006.00242.x. [DOI] [PubMed] [Google Scholar]