Jennifer Black

The 2019 Professional Standards for BC Educators state that “educators care for students and act in their best interests”. While addressing students’ food and nutrition needs is not listed as an explicit role for teachers, evidence suggests that teachers are left to fill a variety of unmet food needs for students. Still, very little Canadian research has examined teachers’ experiences, how they understand and enact their perceived responsibilities for caring for students’ food and nutrition needs, or how they interpret the notion of “healthy eating”. This study therefore interviewed fourteen (n=14) grade 5-7 teachers in BC to explore their experiences with school food with a focus on teachers’ perceived roles and tensions related to ensuring that students are well-fed and educated about healthy eating. Teachers expressed conflicting beliefs about their food-related roles and responsibilities. Although, teachers largely believed that they should not be responsible for ensuring that students are well-fed, they felt accountable for ensuring that hungry students had access to food during the school day, and frequently purchased food at the expense of their own time, money, and mental energy. Teachers described purchasing, storing and providing students with food and engaging in formal or informal conversations about food as an expression of care for students. Teachers perceived meeting students’ food needs to be an unwritten expectation of their jobs. While teachers often felt accountable for what students ate at school, many felt overwhelmed and under-resourced for successfully meeting children’s food and nutrition needs. Meanwhile, they reported that nutrition guidelines and recommendations, the emotional, social, and mental components of eating, balance and moderation, being fed, and eliminating food shame were all important components of healthy eating, but felt an internal conflict about how best to model healthy behaviours to their students. Insights from this research can inform emerging school-based food and nutrition programs and policy given ongoing momentum towards expanding national school meal programs.

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Despite evidence showing suboptimal dietary quality among Canadian school children, Canada remains an outlier among affluent countries in that it does not have a national school food program. Instead, parents and guardians are primarily responsible for sending their children to school with lunch. With calls for a national school food program in Canada, some proponents are advocating for programs available to all students, rather than targeting students “in need”. Scholars and school food program operators have suggested that middle class families “opting out” can be problematic for programs’ financial viability and quality and may contribute to stigma for program users if school food programs are perceived to be for families “in need”. The purpose of this thesis was to explore middle class mothers’ experiences and perceptions of school lunch. Drawing on 14 interviews with mothers of elementary aged children in a British Columbia school district that recently introduced a district-wide lunch program, I analyzed how middle class mothers 1) experience and make meaning of packing school lunch and 2) perceive the school lunch program in their children’s schools and make decisions about participation. Findings show that mothers view lunch packing as part of their responsibility to cultivate their children’s health, that they perform diverse forms of labour in an effort to enact intensive feeding and mothering ideals, and that this foodwork is a potent source of emotions, judgement, and scrutiny. Findings highlight the importance of not only practical, but also ideological and sociocultural factors that can act as barriers and facilitators to lunch program participation. Due to the confluence of parenting and nutritional ideals and the dominant belief that feeding children is a private, rather than public responsibility, using school lunch programs may be perceived as a moral failure to fulfill parental responsibilities, leading some middle class families to “opt out” from participating. This thesis advances scholarly understanding of the complexities of feeding children lunch during the school week. The findings can help inform school meal programs and broader social policies to benefit school age children and their families.

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Background: Sleep deficits, which include social jetlag, poor sleep quality, and short sleep duration, have been commonly observed in adolescents due to development-specific late chronotype, early school start time, and other physiological and environmental factors. Recent findings indicate that sleep is potentially associated with unhealthy eating habits, such as frequent consumption of sugar-sweetened beverages (SSB). The associations may also differ by gender. This thesis examined the gender-specific associations between three different types of sleep deficits and SSB consumption among adolescents. Methods: This thesis used a cross-sectional study design and included 1031 adolescents from Wave 6 (Spring 2012) of the British Columbia Adolescent Substance Use Survey (BASUS) (mean age: 15±0.7 years). Descriptive statistics analyzed the prevalences of self-reported sleep deficits and SSB consumption by gender. Multivariable logistic regression models using interaction terms examined the associations between each sleep deficit variable and three measures of SSB consumption, by gender. Additional confounders were included in the sensitivity analyses to test the robustness of results. Results: Compared to no social jetlag (≤ 1h), consistent positive associations of higher social jetlag levels were observed with above-median (OR 1.63 (95% CI: 1.01, 2.65)) and any weekly SSB intake (1.97 (1.06, 3.66)) in girls; boys showed a similar positive but non- statistically significant OR trend with any SSB intake. Non-significant positive associations were seen between more frequent restless sleep and daily SSB intake in girls, but only boys with occasional restless sleep (1-2 days/week) had significantly higher odds of any SSB intake (3.21 (1.31, 7.88)), compared to no restless sleep (1 day). For every one-hour increase in sleepduration, boys consumed significantly less SSBs using above-median (0.77 (0.61, 1.00)) and any ii(0.71 (0.52, 0.97)) SSB intake, but girls showed inconsistent and non-significant results for sleep duration and SSB. Conclusion: This study adds new insights on gender-specific associations between different sleep deficits and SSB consumption in adolescents in BC. Social jetlag was associated with increased SSB consumption in girls; whereas sleep duration, and potentially restless sleep, were associated with SSB intake in boys. Results should be replicated longitudinally in larger cohorts using comprehensive dietary and objective sleep assessments.

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International appeals from the United Nations and a growing group of nutrition, policy, and environmental science experts have called for integration of sustainability into national food policies. As of 2018, at least fifteen countries had sustainability considerations in their food-based dietary guidelines (FBDG) or supporting documentation, yet little scholarship has examined sustainability framing within these guidelines. This study therefore examined sustainability inclusion and framing in international FBDG. Qualitative content analysis was used to analyze FBDG distinguished by the UN as having considered sustainability. The aim of this study was to explore the sustainability inclusion process within international FBDG and to identify common elements regarding sustainability inclusion. Eleven documents used by 15 countries were analyzed. This content analysis revealed five main themes about the framing and inclusion of sustainability in international FBDG: i) explicit sustainability documents were recently published, and the process for inclusion varied with country context; ii) multiple sectors and myriad stakeholders contributed to guidelines, instilling broad interests and a wide conceptual framing; iii) sustainability was primarily framed through health and nutrition, yet other sustainability domains also emerged as salient; iv) the most explicit sustainability considerations were found in documents that are focused more on the context of eating, with less explicit focus on specific nutrients; and v) consistent main messages were revealed across explicit sustainability documents. Based on these analyses, a proposed framework was developed to examine how sustainability has been included in dietary guidelines. The analysis of FBDG documents informed the development of a framework adapted from existing literature on food policy. The resulting framework to assess the interconnected inclusion of sustainability concepts in FBDG has five core domains: health and nutrition, food security and agriculture, markets and value chains, environment and ecosystems, and sociocultural and political. The framework developed can be used in future studies to compare and examine how sustainability considerations are integrated into emerging FBDG.

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The newly released 2019 Canadian dietary guidelines recommend consuming more plant- based foods, especially plant-based sources of protein as part of a healthy eating pattern. While plant-based dietary practices (PBDPs) have been recommended to improve both population health and environmental sustainability outcomes, no nationally representative study has described Canadian trends regarding exclusions of animal-based foods. This thesis therefore aimed to: 1) operationalize definitions for PBDPs based on animal source food exclusions to estimate the prevalence of Canadians who adhere to PBDPs; and 2) explore potential correlates of PBDPs. Nationally representative data on dietary exclusions drawn from the 2015 Canadian Community Health Survey–Nutrition were used to operationalize definitions of PBDPs and examine their prevalence. Potential correlates of PBDPs were explored through bivariate analyses using chi-square tests and multivariable analyses using logistic regression models, including sex-stratified models. Respondents’ PBDPs were categorized as: 1) vegan (excluded red meat, poultry, fish, eggs, and dairy); 2) vegetarian (excluded red meat, poultry, and fish); 3) pescatarian (excluded red meat and poultry); and 4) meat-excluder (excluded red meat). In 2015, approximately 5% of Canadians reported adhering to PBDPs (all categories combined) with the majority (2.8%) identifying as a meat-excluder, 1.3% categorized as vegetarian, 0.7% as pescatarian and 0.28% as vegan. The significant determinants of vegetarian status after including sex, age, urban/rural residence, Canadian province of residence, self-identified racial/cultural group, immigration status, education, marital status and income in the model were self-identifying as South Asian relative to White (OR:16.70, 95%CI:8.01, 34.82) and living in Quebec (OR:0.24, 95%CI: 0.09, 0.63) or the Prairies (OR:0.43, 95%CI:0.19, 0.96) relative to the Atlantic Provinces. While self-identified South Asian ethnicity was significant in both male and female stratified models, immigrant status and province of residence were only significant in the female-only model. Despite growing public discourse around PBDPs, few Canadians reported total exclusion of animal products in 2015. Reported PBDPs were strongly associated with racial/cultural group: across all multivariable models, the main predictor of vegetarian status was self-identified South Asian ethnicity. Understanding factors shaping adherence to PBDPs among Canadians is valuable for informing strategies aimed at promoting environmentally sustainable diets.

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Background: Household food insecurity (HFI), defined as limited access to adequate, safe, and nutritious food, was estimated to affect 13% of Canadian households in 2012. In Canada, one of the primary efforts to support food insecure households are food banks. Although food bank use is on the rise in Canada, few studies have described the diverse experiences of individuals who use them. This study examined characteristics and experiences of food bank users, including socio-demographic characteristics, severity of HFI, patterns of food bank use, and current challenges and preferences for services. Methods: This mixed-methods study involved interviewer-administered surveys (n=77) and 5 focus groups (n=27) with food bank members from Vancouver, BC. Surveys assessed socio-demographic and health characteristics, food bank use, and satisfaction with services. Focus groups examined experiences, challenges, and recommendations for improving services. Survey analyses included descriptive statistics and Fisher’s exact tests to explore associations with severe HFI. Thematic analysis was used for focus group data. Results: Inadequate income emerged as the most prominent factor influencing food bank use. Survey respondents reported severe food insecurity (66%), health challenges (77%), reliance on social assistance (84%), and long-term (>5 years) food bank use (54%). Monthly income level ($1800) and rental costs (>$500) were significantly associated with severe HFI (p0.05), however, frequency and duration of food bank use were not. Although survey and focus group participants indicated that food banks did not provide enough food to meet their needs, participants reported positive experiences at the food bank and most anticipated needing these services in future. Focus group discussions highlighted improving food provision quality and quantity, and creating more safe and supportive environments. Linking with health supports and participating in advocacy towards poverty reduction were also suggested. Significance: Food banks are an entrenched, long-term strategy for households driven by inadequate financial resources to access food. While gratitude for food bank services was apparent, this study supports growing evidence that food banks are an insufficient response to food insecurity. Participant envisioned ways that food bank organisations can adjust to better support their users included updates to current services that incorporate health, wellness, and advocacy.

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Background: Canada has seen a dramatic increase in the prevalence of childhood obesity in recent decades. Researchers have argued that this problem could be addressed through improvements to the “food environment”—the food vendors comprised in the built environment. Children's diets are poorer in nutritional quality during school hours, suggesting that the food environments surrounding schools may be an important area of inquiry. Objectives: This thesis sought (1) to identify the best available data set for assessing the distributions of food outlets in Vancouver, (2) to characterize the food environments surrounding Vancouver public schools, testing for demographic or socioeconomic disparities in access and (3) to examine the associations between school food environments and the dietary intakes of children and adolescents at- or en-route to school. Methods: Food outlet data were obtained from two municipal and two commercial sources and validated against primary data on the food outlets located within 800m of 26 schools. Outlet density and proximity to Vancouver schools (n=113) were evaluated with the best performing data set; negative binomial regression models examined whether disparities existed in environments according to % aboriginal students, % English Language Learners, and school poverty, controlling for neighbourhood-level factors. Multilevel logistic regression analyses evaluated the associations of school food environment measures and 950 children's odds of daily consumption, at or en-route to schools (n=26), of minimally nutritious foods. Results & Conclusions: The City of Vancouver Business Licenses data had the highest sensitivity (0.69) and positive predictive value (0.55). High-poverty schools had more convenience stores within 400m than low-poverty schools, even after controlling for commercial density and neighbourhood socioeconomic deprivation (IRR=1.74, 95% CI 1.003 - 3.032); no robust statistically significant relationships were identified between school food environments and school-level demographic factors. No consistent associations were identified between school food environment measures and students' intakes of minimally nutritious foods. The findings do not support policies to reduce student access to food outlets near schools.

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Background: Diet-related health conditions, including obesity and type 2 diabetes, are a growing concern among Canadian youth. In Canada, there is also a rising interest in the impact of dietary choices on environmental sustainability. Several school food and nutrition programs (SFNPs) have been implemented to improve dietary quality and environmental sustainability, including gardening and food preparation programs. However, limited research has examined the links between participation in SFNPs and dietary psychosocial and behavioural outcomes. Purpose: To examine healthy and environmentally sustainable dietary attitudes, expectations, choices, and practices, and current participation rates in SFNPs among Vancouver students in grades 6-8, and to evaluate whether participation in SFNPs is associated with these outcomes.Methods: A cross-sectional study was conducted in 26 schools in Vancouver from March-June, 2012 (n=937 students). Schools were selected using non-probability sampling. A web-based survey, including a food frequency questionnaire, measured student demographic characteristics, participation in SFNPs, and dietary psychosocial and behavioural outcomes. Rao-Scott corrected chi-square tests were applied to assess associations between SFNPs and outcomes (p0.05).Results: Less than 50% of students reported participating in SFNP activities, with the exception of recycling (51.2%). Greater than 50% reported the importance of health and environmental sustainability when making food purchases, and agreement that food choices impact health or the environment. However, 50% of students reported daily intake of most healthy and weekly intake of most environmentally sustainable dietary choices. Approximately 1/3 of students reported weekly purchasing from convenience food establishments. Participation in activities specific to learning about food or nutrition was greater among females, and secondary school students reported greater participation in food-specific activities. Activities specific to learning about food or nutrition demonstrated expected associations with outcomes. Most associations between hands-on food-related activities were in the unanticipated direction. Conclusions: Findings demonstrate marginal participation in SFNPs and intake of healthy and environmentally sustainable dietary choices among Vancouver students. Results also reveal the possible role of activities specific to learning about food or nutrition in promoting healthy and environmentally sustainable diet-related outcomes. Further research on SFNPs to inform curriculum changes could improve student dietary behavioural outcomes, student health, and environmental sustainability.

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Since dietary intake varies from day to day, research on the timing of dietary behaviours is essential for understanding the complexity of contemporary dietary patterns needed to inform nutrition-related health policies and recommendations. Limited studies with inconsistent results have suggested that dietary intake differs on weekends versus weekdays. Although findings from outside of Canada have previously reported that energy intake is higher on weekend days, the nature of weekday-weekend variation in dietary intake among Canadians remains unknown. In response, this study evaluated the difference in energy, nutrient intake and diet quality on weekdays versus weekend days in the Canadian population and whether temporal differences were moderated by sex, age or employment status. Data were analyzed from participants aged >1 year, excluding pregnant or breastfeeding women (n=34,402) in the Canadian Community Health Survey Cycle 2.2, a nationally representative survey which included 24-hour dietary recall data. Linear regression models examined the difference in energy intake, nutrient intake and diet quality (assessed using Healthy Eating Index ) between weekdays (Monday-Thursday) and weekend days (Friday-Sunday). Caloric intake was found to be 62 kcal (SE = 23) higher on weekend days than on weekdays. Compared to weekdays, energy-adjusted weekend intakes of carbohydrates, protein, and the majority of micronutrients were significantly lower, ranging from 2.0% to 6.6% lower, while alcohol and cholesterol intakes were 66% and 10% higher on weekends, respectively. HEI was significantly lower on weekends than on weekdays (56.4 vs. 58.3 out of 100). With the exception of alcohol, the magnitude of weekday-weekend differences of most of the dietary outcomes did not differ substantially by sex, age or employment status. In conclusion, Canadians consume foods with a slightly less favorable nutrient profile and marginally poorer diet quality on weekends than on weekdays.

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Background: The majority of Canadian children and adolescents (9 to 18 years old) are not meeting Canada’s Food Guide recommendations for healthy eating. Moreover, evidence suggests that SES and dietary quality are positively associated. Yet little is known about the influence of parents, peers, and food purchasing practices on the associations between SES and dietary intake or about whether these associations are pertinent in the school context. The primary objective of this study is therefore to explore associations between SES and school-day dietary intake among Vancouver youth, before and after controlling for psychosocial factors and food purchasing practices. Methods: In 2012, grade 5-8 students (n=950 from 26 schools) completed a school-based survey and reported school-day intake of vegetables, whole grains, low fat milk, packaged snack foods, and sugar-sweetened beverages (SSB). Multivariate logistic regression examined associations between parent education and food security status with dietary intake, before and after controlling for peer modeling and parental normative beliefs of dietary intake, and frequency of purchasing food on school days. Results: Compared to students whose parents completed high school or less, students whose parents completed some college were significantly more likely to consume vegetables daily on school days (unadjusted OR=1.85, 95% CI=1.06, 3.22). Compared to food insecure students, food secure students were significantly less likely to consume SSB daily on school days (unadjusted OR=0.51, 95% CI=0.28, 0.93). Both vegetable and SSB intake were not significantly associated with SES measures in final adjusted models. In adjusted models, compared to students whose parents completed high school or less, students whose parents completed college or university were significantly less likely to consume packaged snacks daily on school days (adjusted OR=0.61, 95% CI=0.42, 0.90). Parent education and food security status were not significantly associated with the remaining dietary intake outcomes. Conclusions: SES was significantly associated with three of five dietary outcomes; however, we did not find that either SES measure was consistently a significant determinant of dietary intake across foods categories. Overall, there is room for improvement in dietary intake of Vancouver children and adolescents on school days and school nutrition interventions would benefit all students.

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