Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western Centre for Public Health and Family Medicine, University of Western Ontario, Room 313, 11465 Richmond Street, London, ON, N6G 2M1, Canada.
Department of Family Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada.
Can J Public Health. 2023 Aug;114(4):613-628. doi: 10.17269/s41997-023-00743-y. Epub 2023 Mar 28.
We investigated the impact of mandatory school nutrition policy on diet quality of Canadian school children using a quasi-experimental study design.
Using 24-h dietary recall data from the 2004 Canadian Community Health Survey (CCHS) Cycle 2.2 and 2015 CCHS - Nutrition, we constructed the Diet Quality Index (DQI). We used multivariable difference-in-differences regressions to quantify the DQI scores associated with school nutrition policy. We conducted stratified analyses by sex, school grade, household income, and food security status to gain additional insights into the impact of nutrition policy.
We found that mandatory school nutrition policy was associated with an increased DQI score by 3.44 points (95% CI: 1.1, 5.8) during school-hours in intervention provinces relative to control provinces. DQI score was higher among males (3.8 points, 95% CI: 0.6, 7.1) than among females (2.9 points, 95% CI: -0.5, 6.3), and the score among students in elementary schools was higher (5.1 points, 95% CI: 2.3, 8.0) than that among high school students (0.4 points, 95% CI: -3.6, 4.5). We also found that DQI scores were higher for middle-high income and food secure households.
Provincial mandatory school nutrition policy was associated with better diet quality among children and youth in Canada. Our findings suggest that other jurisdictions may consider implementing mandatory school nutrition policy.
本研究采用准实验设计，调查了强制性学校营养政策对加拿大学童饮食质量的影响。
利用 2004 年加拿大社区健康调查（CCHS）第 2.2 周期和 2015 年 CCHS-营养调查的 24 小时膳食回忆数据，构建饮食质量指数（DQI）。采用多变量差值法分析了与学校营养政策相关的 DQI 评分。按性别、学校年级、家庭收入和粮食安全状况进行分层分析，以深入了解营养政策的影响。
研究发现，与对照省份相比，干预省份在上学时间实施强制性学校营养政策后，DQI 评分在 3.44 分（95%CI：1.1，5.8）有所提高。与女性（2.9 分，95%CI：-0.5，6.3）相比，男性（3.8 分，95%CI：0.6，7.1）的 DQI 评分更高，小学学生的评分（5.1 分，95%CI：2.3，8.0）高于高中生（0.4 分，95%CI：-3.6，4.5）。此外，中高收入和粮食安全家庭的 DQI 评分也更高。
省级强制性学校营养政策与加拿大儿童和青少年的饮食质量改善有关。我们的研究结果表明，其他司法管辖区可能会考虑实施强制性学校营养政策。
