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Health Education Research Advance Access originally published online on November 9, 2006
Health Education Research 2006 21(6):848-861; doi:10.1093/her/cyl138
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© The Author 2006. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oxfordjournals.org

Lay people's views of school food policy options: associations with confidence, personal values and demographics

Anthony Worsley

Centre for Physical Activity and Nutrition Research, School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Highway, Burwood, Victoria 3125, Australia

E-mail: tonyw{at}deakin.edu.au


   Abstract
Top
 Abstract
Introduction
 Method
 Results
 Discussion
 Conclusions
 Conflict of interest statement
 Appendix 1 Confidence items
 Acknowledgements
 References
 
A random population survey administered by mail to examine lay people's views of children's food policies and their associations with demographics, personal values and confidence in authorities was conducted among adults in Victoria, Australia. Three hundred and seventy-seven people responded (response rate 57.6%). The questionnaire contained 35 items about children's healthy eating policy options plus details like personal values, confidence and demographic items. There was widespread support for healthy school food policies. The strongest support was for life skills education and school-based nutrition and physical education programmes. Many age-related associations indicated that people >48 years were more in favour of healthy eating policies than younger people. There were fewer statistically significant associations with parent status and sex. In contrast, many associations showed that respondents with strong equity–harmony values and those with least confidence in the authorities were most in favour of healthy eating policies for schoolchildren. It is concluded that there is widespread support for school-based health and nutrition education and for active school food policies. However, differences between demographic and values groups suggest the need for caution in the promotion of public health nutrition initiatives among schoolchildren.


   Introduction
Top
 Abstract
 Introduction
Method
 Results
 Discussion
 Conclusions
 Conflict of interest statement
 Appendix 1 Confidence items
 Acknowledgements
 References
 
The recent interest in the prevention of obesity among children [1, 2] has focussed attention on children's eating and physical activity. It is apparent that many children in affluent societies consume more energy-dense foods and undertake less physical activity than their parents' generation [1, 3, 4]. In part, this appears to be associated with intensive food marketing aimed at schoolchildren [5].

Many children rely on schools for much of their food. For example, 37% of the energy consumed by Australian primary students is estimated to be consumed at school (Bell and Swinburn, 2005). As many as one-quarter of children do not eat breakfast before coming to school [6, 7] and rely on school canteens or vending machines for sustenance. For example, it has been claimed that 98% of American high schools have vending machines [8], the quality of foods dispensed generally being poor [9]. Much concern has been expressed about the nutritional quality of school canteen food and particularly of products sold via vending machines [10–13].

Policy responses to this obesogenic situation are beginning to emerge. The House of Commons Health Committee [14] has suggested that school vending machines are central to the obesity epidemic and recommends that schools should avoid sponsorship deals with food and beverage markets. The New South Wales (NSW) Obesity Summit [15] made a similar series of recommendations to promote healthy eating in schools, several of which have now been recommended by the NSW government. More generally, policies which regulate the types of food and beverages which are supplied in schools are steadily being adopted, following models such as Starcap in Western Australia [16] or the World Health Organization Health Promoting Schools programmes. About 60% of primary schools in Victoria, Australia, for example, claim to have implemented school food polices, though the degree to which they actually influence daily school practices is unclear.

Despite their central role in their children's welfare, parents' views of school food policy options have rarely been examined. A recent study of American parents' opinions of school vending machine placements revealed widespread ignorance of their operation [9]. In a survey of adults in Victoria, Australia, many respondents were critical of current children's school food and nutrition education but held ambivalent attitudes towards the sales of snacks and food marketing in schools (A. Worsley, unpublished results).

The main aim of the present paper is to describe lay person's opinions of school food policy options, including some of those now being proposed by public health authorities such as the banning of vending machines in schools and the sales of high-fat and -sugar products. To date, most studies of lay people's health and nutrition opinions have focussed on demographic associations; the influence of other potential predictors such as personal values and confidence in food authorities being relatively under-explored.

There is considerable circumstantial support for possible associations between demographic characteristics and attitudes to food and nutrition policies. For example, women have stronger interests in health and nutrition than men [17–23] and so may be more supportive of healthy eating policies. Parents, too, might be expected to take a similar position as women [24, 25] as might tertiary-educated people and people from high-socio-economic status (SES) backgrounds since both tertiary education [26–28] and high SES [29–34] have been linked to healthier food and health habits. Older people tend to experience more health concerns than younger people [23]; therefore, it was expected that older adults might be more supportive of healthy eating policies than younger adults who may be more accustomed to the marketing of ‘fast foods’ and so perhaps less opposed to their sale.

Personal values (guiding principles in people's lives [35]) are another set of factors which have been associated with food and nutrition beliefs and habits [36–38]. Values are an essential conceptual element of attitude-behaviour models [39] and are likely to influence people's attitudes to nutrition policy. Previous research has shown that communitarian values (such as equity and harmony) derived from Schwartz's values taxonomy [35] are related to concerns about food and health issues [40], trust in sources of nutrition information [41], vegetarian food patterns [22, 42] and food choices [43]. Therefore, it was hypothesized that equity–harmony (and related communitarian values such as tradition) would be positively linked to support for healthy eating policies, particularly as policies are usually created to protect community interests such as the protection of children's health. Conversely, it was expected that self-oriented values such as hedonism would be negatively related to such policies.

Finally, trust in food regulatory authorities is positively related to perceptions of food safety [44, 45]. Further, in an earlier study, high confidence in food authorities was linked to acceptance of the current status quo in schools (Worsley, submitted for publication). Therefore, it was expected that confidence in the food authorities would be related to opposition to policy options which promote healthy eating at school.


   Method
Top
 Abstract
 Introduction
 Method
Results
 Discussion
 Conclusions
 Conflict of interest statement
 Appendix 1 Confidence items
 Acknowledgements
 References
 
Survey administration
A mail survey was administered to a random sample of 1000 adults selected from the electoral roll in Victoria, Australia, during August to October 2003. Electoral roll enrolment is compulsory for persons aged ≥18 years. A preliminary letter was sent to potential respondents, and then 1 week later, copies of the questionnaire and covering letters were mailed to them. Reminder/thanks postcards were sent 2 weeks afterwards, followed by replacement questionnaires to non-respondents 2 weeks later [46]. Final reminder letters were mailed to non-respondents 2 weeks after the mailing of the replacement questionnaires. No financial incentives were offered to potential respondents. Ethics permission was granted by the Deakin University Human Ethics Committee.

The questionnaire included the following.

(i) Thirty-five statements representing various food policy options. These items were based, in part, on views expressed in a stakeholder study of children's healthy eating [47] as well as on prior research experience in this area. Five-point response scales were used (from strongly disagree = 1, neutral = 3 to strongly agree = 3; listed in Table I).
(ii) Six items about the respondents' confidence in the authorities responsible for school food services (Cronbach's alpha = 0.80; Appendix 1). Respondents' ratings of these items were summed to yield a ‘confidence in food authorities’ scale (Cronbach's alpha = 0.81).
(iii) Twenty-one personal values statements selected from the Schwartz Personal Values inventory [35] measured on five-point, not to very important, scales, to assess three sets of values.
(a) Equity–harmony values: equality (equal opportunity for all), inner harmony (peace with myself), unity with nature (fitting into nature), a world of beauty (beauty of nature and the arts) and protecting the environment (preserving nature) (Cronbach's alpha = 0.74).
(b) Tradition security values: social order (stability of society), national security (protection of my nation from enemies), self-discipline (self-restraint), family security (safety for loved ones), authority (the right to lead or command), honouring of parents and elders (showing respect), obedient (dutiful, meeting obligations) and devout (holding to religious faith and belief) (Cronbach's alpha = 0.61).
(c) Hedonistic values: pleasure (gratification of desires), an exciting life (stimulating experiences), a varied life (filled with challenge, novelty and change), daring (seeking adventure and risk) and enjoying life (enjoying food, sex, leisure, etc) (Cronbach's alpha = 0.61).
These value scales were derived by summing responses to the relevant items, and then converting them to z scores.
(iv) Several demographic questions including sex (coded as 1 = female and 2 = male), parent status (1 = parent and 0 = not a parent), age (1 = <35 years ‘young’, 2 = 36–48 years ‘middle aged’ and 3 = >48 years ‘old’) and educational background (0 = not tertiary educated and 1 = tertiary educated).


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  		Table I Comparisons of policy perceptions of three age groups, ordered by principal components analysis

 
Data analysis
Bivariate analyses
The participants' responses to the food policy items were recoded into three-point scales (strongly disagree and agree = 1, called disagree; neutral = 2; agree and strongly agree = 3 = agree). Similarly, the respondents' confidence and values scores were divided into tertiles (low, medium and high).

Separate cross-tabulation analyses of the three-point food policy variables, utilising chi-square tests, were conducted by age group (Table I), educational background, sex, parental and income status (Table II), equity–harmony and traditional value tertiles (Table III) and confidence tertiles (Table IV).


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  		Table II Other demographic differences in lay people's perceptions of school food policy

 

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  		Table III Comparison of the equity–harmony and traditional value groups' views of school food policy

 

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  		Table IV Comparisons of lay people's views of school policies by confidence tertiles

 
Multivariate analyses
A principal components analysis (with varimax rotation) was conducted on the respondents' original five-point responses to the food policy items (Table I). Cronbach's alpha was calculated for each of the component scores.

One-way analysis of variance (ANOVA) was conducted on each of the component scales utilising sex, age group, education, income group, parenting status, tertile categories of personal values (equity–harmony, tradition security and hedonism) and confidence in food authorities, as main factors (Table V). Subsequently, multiple regression analyses of each scale were performed using those independent variables which the ANOVA had shown were significantly associated with the scale scores (Table VI).


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  		Table V Summary of ANOVAs of respondents' food policy component scores

 

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  		Table VI Summary of multiple regression analyses of respondents' food policy components

 
SPSS for Windows Version 11.5 was used for all data analyses [48].


   Results
Top
 Abstract
 Introduction
 Method
 Results
Discussion
 Conclusions
 Conflict of interest statement
 Appendix 1 Confidence items
 Acknowledgements
 References
 
Demographic characteristics
Despite the request in the cover letter for everyone to answer the questionnaire, many respondents contacted the investigators to say they did not have young children and were unable to give any opinions. After allowance was made for these refusals (179) and for 20 confirmed non-deliveries, the response rate was 57.6%. The final sample of 377 persons was more highly educated than the Victorian population (e.g. 41% were university educated compared with 21.8% of 25- to 64-year olds in the general population) and it contained more women (62%) and parents (70%) than the Victorian population [49].

However, all demographic groups were well represented, for example 26% reported gross household incomes of <$30 000 per annum, 19% between $30 000 and $50 000 per annum, 31% between $50 001 and $80 000 per annum while 25% reported earning >$80 000 per annum. Seventy per cent identified themselves as Anglo-Australian, 6% as Italian Australian, 2.4% as Greek Australian, 1.6% as Aboriginal Australian and 18.5% as other or no ethnicity. Over two-thirds (67.6%) were married/cohabiting, and the mean age of the sample was 43.47 years (standard deviation 15.46 years).

The respondents' opinions of food policy options
The principal components analysis yielded five components which accounted for 50% of the variance in the ratings of the food policy options. These are displayed in Table I along with comparisons of the three age groups' agreement and disagreement with the items. The components were provisionally named below according to the interpretation of the items which loaded on them.

Healthy food at school
Most respondents wanted control of foods served at school including bans on the sale of foods rich in fat, salt and sugar from canteens and the banning of soft drink and confectionery vending machines and the marketing of high-energy and -fat foods.

There were many age group differences. Compared with people >35 years, young people were generally not supportive of strong school food control policies. Fewer young respondents supported restrictions on the sale of high-fat, -salt and -sugar food; vending machines; the marketing activities of food companies and chocolate fund-raisers. Fewer of them supported the sale of healthy foods at school (Table I). Overall, the older age groups were more in favour of healthy food at school (Table V).

More parents supported bans on high-fat, -salt and -sugar food; chocolate fund-raisers and the sale of cola, and more supported the sole sale of healthy foods in the canteen (Table II).

More of the non–tertiary-educated respondents expressed agreement with all of the propositions associated with the promotion of healthy food at school. There were statistically significant differences in relation to the banning of soft drink and confectionery vending machines, chocolate fund-raisers and the marketing of high-energy, high-fat products. Comparison of the healthy food at school component scores showed that women were more in favour of these policies than men (Table V). More respondents in the two highest income groups opposed the sale of junk foods in the canteen (Table II). The group with the lowest confidence in the authorities was the most supportive of healthy food at school (Tables IV and V).

Meal subsidies
A substantial minority of respondents wanted government to subsidize school meals (41%) or healthy school meals (41%); just over a third wanted paid staff to prepare food for children. Most respondents, however, did not want schools to provide breakfast or other main meals. (Table I). Significantly fewer of the tertiary-educated respondents wanted schools to provide breakfast for children (Table II) Generally, the more confidence respondents had in the authorities, the less they wanted subsidized meals (Tables IV and V). There were statistically significant two-way interactions between confidence and traditional value, and equity–harmony and traditional value tertiles. Respondents in the mid-traditional tertile which had the lowest confidence scores supported meal subsidies most, and those with the highest confidence were least in favour of them (0.6391 versus –0.4759, respectively). Similarly, respondents in the mid-traditional tertile who had low equity–harmony scores supported meal subsidies least and those with the highest equity–harmony scores supported them most (means = –0.2753 versus 0.3409, respectively, Table V).

Life skills education
Almost all respondents supported the provision of life skills education (such as food gardening, cooking, shopping and dealing with marketing; Table I). However, tertiary-educated respondents were significantly less supportive of school gardens and (anti-) marketing education (Table II). Fewer young respondents were as concerned with the need for life skills education as middle aged and older respondents. Women tended to favour aspects of life skills education (such as school gardening) more than men (Table I). Fewer of the lowest income and the $50 000- to 80 000-per annum groups supported the proposition that all boys and girls should learn how to shop and cook (Table II). Generally, as respondents' equity–harmony scores rose, so did their support for life skills education (Table V). Respondents who had mid tradition and low confidence scores supported life skills education most, while those who had low tradition and high confidence or high tradition and moderate confidence scores were least in favour of this form of education (0.2594 versus –0.3344 and –0.3063, respectively).

Anti-marketing at school
There were divided opinions about the desirability of specific marketing activities such as chocolate fund-raisers and sponsorships. Younger respondents were more tolerant of these activities than older people (Tables I and V); women and parents tended to be less tolerant than men and non-parents (Table II). The more confidence respondents had in the authorities, the less they opposed marketing at school (Table V). The two-way interaction between confidence and equity–harmony suggested that those respondents in the highest equity–harmony and lowest confidence tertiles were most opposed to marketing at school (followed by those with moderate equity–harmony and lowest confidence), while those in the highest equity–harmony and highest confidence tertiles supported marketing at school (0.4019 and 0.3434 versus –0.4585, respectively).

Nutrition and physical education promotion
Daily physical education (PE) programmes and greater spending by government on the promotion of nutrition and physical activity in school were popular but less than half of the respondents were willing to pay more taxes to support such programmes and only slightly more than half felt that parents should volunteer for the school canteen (Table I). A two-way parental status x sex interaction approached statistical significance (Table V), fathers favouring nutrition and PE least and mothers most.

The multiple regression analyses of the factor scores confirmed the predictive roles of the personal values and confidence variables, particularly in relation to healthy food at school (Table VI).


   Discussion
Top
 Abstract
 Introduction
 Method
 Results
 Discussion
Conclusions
 Conflict of interest statement
 Appendix 1 Confidence items
 Acknowledgements
 References
 
These findings suggest that in Australia there is strong but not unanimous support for policies which foster healthy eating among schoolchildren. The most widespread support was for life skills, nutrition and PE. There was mixed support for more structural policies which might restrict parents' and children's choices. For example, while some adults were willing to pay more tax to provide better food services, others were opposed to proposed restrictions on food companies' marketing activities at school or to the sales of high-fat products such as chocolate. These findings are congruent with evidence from other countries such as the United Kingdom which demonstrates general discontent with school food services but lack of unanimous support for reform (e.g. House of Commons [14]). The findings suggest that while the time is ripe for change, it may be wise to reform areas for which there is general, widespread support such as the introduction of school-based nutrition and PE programmes. The issue of canteen reform, while pressing, needs to be approached cautiously since there are strong differences of opinion about the best ways forward. The equity–harmony associations with the various proposals put forward to reform school food services suggest that, in Victoria at least, there are groups of people who hold conflicting opinions (values or ‘world views’) about the proper roles of parents, children and government. For example, some respondents thought all school meals should be subsidized by government, while others did not. It would be interesting to compare these views with those of respondents from other states where strong canteen reform policies have been implemented, such as NSW where a comprehensive healthy food service programme has been introduced.

The demographic associations with the various policy options were relatively novel. For example, older respondents (>48 years of age) were generally more critical of the present ‘laisser-faire’ status quo in school food services than younger respondents. This may be because more of the younger respondents were likely to have to deal with daily problems associated with having school-aged children (such as preparing their lunches). To some extent, this age differential is consistent with previous findings that older people are more in favour of healthy eating than young people [23]. However, further research to replicate and understand this finding is required.

Sex and parenthood status were generally unrelated to the respondents' views of policy options, which does not strongly support the hypotheses outlined in the Introduction. This is partly explained by the observation that most of the sample favoured policies which further nutrition and PE (for example). Nevertheless, there was some evidence that men were more tolerant of the status quo (e.g. of fat-rich food, food companies' marketing activities at school) than women and that parents tended to be more opposed to the sale of high-fat foods (like chocolate) than non-parents. Only seven statistical sex differences and five parent status differences were found.

Perhaps it is the views of the tertiary-educated respondents which provide the most novel findings. It was expected that the tertiary educated would hold positive views about the promotion of healthy eating at school because many studies have shown that they tend to be healthier and better informed about health matters than less educated people. However, in the present study, the tertiary educated opposed the promotion of healthy eating at school more than the less educated who consistently supported the promotion of healthy eating and opposed the sale and marketing of high-energy foods. This runs counter to most studies of the personal beliefs and health behaviours of tertiary- and non–tertiary-educated people. However, few studies have examined lay people's views of ‘policies’ rather than their ‘personal’ beliefs. In another study of policy conducted by our group, about lay people's views of the adequacy of the Australian Therapeutic Goods Administration's (TGA's) regulatory policies, we found the same theme, tertiary-educated people were less critical of the TGA and more supportive of the status quo than non–tertiary-educated people [50]. These findings suggest that tertiary education may be more an index of integration into societal power structures and thus support for the status quo than an indicator of critical thinking ability.

As hypothesized, equity–harmony and traditional values, but not hedonism, were positively related to support for healthy eating at school and for increased government investment in nutrition and PE. That is, the more respondents held equity–harmony or traditional values, the more they opposed current laisser-faire food polices. Multiple regression analyses showed that these relationships were independent of age and other demographic variables and tended to be stronger than them. These findings suggest that nutrition policy makers need to take psychographic segments into account as well as demographic differences. Policy makers should try to find consensus across values groups or propose policies which satisfy the various values segments. These findings add to the increasing body of knowledge linking personal values to food behaviours, beliefs and attitudes, as outlined in the Introduction.

Finally, confidence in the authorities was an important predictor of the proposed policy options. Generally, respondents who had little confidence in authorities such as school principals and the state government were more supportive of the promotion of healthy eating at school. These findings are consistent with other work linking confidence with perceptions of food safety [44, 45] and with acceptance of the status quo in school food services (Worsley A, unpublished results). This finding is similar to the relationship between low educational background and support for healthy eating policies in that those who do not trust ‘the system’ were most likely to be alienated from it (i.e. the non–tertiary educated were most likely to support radical change). Further investigation is required to examine these findings, and perhaps to test whether ‘social alienation’ [51] is a common causal variable which explains both the education and confidence findings observed here.

Despite its limited sample size and its cross-sectional design, the study underscores the importance of communication with, and the participation of, lay people in public health nutrition policy formulation and implementation.


   Conclusions
Top
 Abstract
 Introduction
 Method
 Results
 Discussion
 Conclusions
Conflict of interest statement
 Appendix 1 Confidence items
 Acknowledgements
 References
 
In Australia, there is widespread support for school-based health and nutrition education and for active school food policies. However, differences in respondents' demographics, personal values and confidence in public authorities suggest the need for caution in the promotion of public health nutrition initiatives among schoolchildren.


   Conflict of interest statement
Top
 Abstract
 Introduction
 Method
 Results
 Discussion
 Conclusions
 Conflict of interest statement
Appendix 1 Confidence items
 Acknowledgements
 References
 
None declared.


   Appendix 1 Confidence items
Top
 Abstract
 Introduction
 Method
 Results
 Discussion
 Conclusions
 Conflict of interest statement
 Appendix 1 Confidence items
Acknowledgements
 References
 
The federal government adequately regulates food companies' marketing to protect children's interests;

The state education department provides healthy food at school;

Your local primary school is providing healthy food;

The school nutrition curriculum adequately meets children's needs;

Children's television food advertising is properly regulated;

School teachers are properly educated in food and nutriton.


   Acknowledgements
Top
 Abstract
 Introduction
 Method
 Results
 Discussion
 Conclusions
 Conflict of interest statement
 Appendix 1 Confidence items
 Acknowledgements
References
 
The author thanks Annemarie Nevill for assistance in the conduct of the survey reported here. Funding was provided by a small grant from Deakin University.


   References
Top
 Abstract
 Introduction
 Method
 Results
 Discussion
 Conclusions
 Conflict of interest statement
 Appendix 1 Confidence items
 Acknowledgements
 References
 
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Received on January 24, 2006; accepted on September 29, 2006


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