Agenda Public health perspectives in the Introduction research of - PDF document

Agenda Public health perspectives in the • Introduction research of children’s – Public health nutrition food and meals – Nutrients, food and meals • A comparative photo-based interview study Ida Husby, Ph.D. with children Institute of Preventive Medicine and Institute of Human – Method, results and discussion Nutrition, University of Copenhagen 4 th Norplus Course, Copenhagen, March 2009 • Discussion Resea rch Unit for Die tary Studies at Institute of Preventive Medicine w w w .kostforskning.dk Public health nutrition Evidence based health promotion • Public Health is a collective action taken by • The use of information derived from formal society to protect and promote the health of entire research and systematic investigation to identify: populations (Margetts 2004, Mason et al 1996) – Causes and contributing factors to health – Change – Effective health promotion actions – Nutrition epidemiology, recommendations, • Evidence derived from many disciplines intervention, policies, education etc. • New public health and empowerment strategies – • Formal evidence combined with the expertice of the process through which people gain greater individual practioners which guides the selection control over decisions and actions affecting their and application of evidence (Smith et al 2006) health (WHO 1986) Many types of evidence Meals • Three approaches to meal research • Evidence-based public health must rely on a variety types of evidence, often in – Format and contents – Meal patterns combination (Victora et al 2004) – The social organisation of meals – Randomized controlled trials • Definitions of meals (Douglas & Nicod 1974, Douglas – Evaluations 1975) – Process- and impact indicators – Meals – structured (food and social relations) • Important to document theory and central – Snacks – unstructured, but some are embedded concepts and principles (Green & Glasgow 2006) in social relations (drinks) 1

Children’s diet and health The diet of Danish children • The diet are associated with diseases and • Too much sugar obesity (WHO 2003, Hung et al 2004, Swinburn et al 2004, World • Too much soft drinks Cancer Fund 2007) • Health behaviours – and health – are • Not enough fruit and vegetables established in childhood (tracking studies) • Not enough dietary fibre (Kelder et al 1994, Lien et al 2001, Maynard et al 2003, Baker et al 2007) • Too much fat (and saturated fat) • Children’s diet and physical activity are (DTU-Food 2008) central elements in strategies to prevent obesity (Lobstein et al 2004, Müller et al 2005, WHO 2006) Associations between meals and Snacks – children and nutrion adolescents • Meal patterns (Anderson et al 1993, Siega-Ritz 1998, Zizza et al • Increasing prevalens of snacking (Jahns et al 2001, 2001, Nicklas et al 2004) Zizza et al 2001, Nielsen et al 2002) – Skip meals • 20-35 % of energy (Ruxton et al 1996, Summerbell et al 1995, Samuelson 2000, Zizza et al 2001, Fagt et al 2007) – Eat out • More snacks – in the afternoon (Cross et al 1994, – More snacks Bellisle & Rolland-Chachera 2007) • Family meals (Gilman et al 2000, Haapalati 2003, Videon & • Snacks have a poor nutrition quality (Summerbell Malling 2003, Neumark-Sztainer et al 2003, Feldman et al 2007) et al 1995, Sjöberg et al 2003, Fagt et al 2007 ) Meals are embedded in social and The meal and social context of cultural meanings food • Family meals – a frame for family life, care, • Food and meals are charged with meanings (Warde, 1997) control and healthy food (Charles & Kerr 1988, DeVault 1991, • The meal is not only understood by its contents Iversen & Holm 1999, Kaplan 2000, Roos 2002, Christensen 2003) but by the way it is eaten and what happens during • Snacks – a social community of children of the the meal in terms of behaviour ( Charles & Kerr, 1988) same age and of own control (Roos 2002, Sylow 2005) • The family need food and need the meal as a • Unhealthy food – autonomy, comfort and conflict medium to create the family (De Vault, 1991) (James 1979, Fischler 1986, Charles & Kerr 1988, Chapman & Mclean 1993) • Structured meals help to structure one’s life in general. The role, structure and content of a meal are gradually changing (Mäkelä, 2000) 2

Meals and snacks – the childs Research questions perspective Ida Husby, Berit Heitmann & Katherine • How do children experience their food and O’Doherty Jensen meals primarily whilst at home, but also when eating out? The overall aims of the study are to establish if there are differences among children with a • How do children experience that their food healthier diet opposed to a less healthy diet, and and meals are controlled? how children experience their food and meals with the intention of using the findings to promote healthy dietaty habits. Population Method • In 2002 a dietary survey was conducted • A comparative design with two groups of children • 17 children were followed up in 2006 • Semi structured interviews based on photos taken • Diet was defined as healthier or less healthy by the children • Healthier diet (n=9): • Interview guide – meal pattern, childrens roles, Max 10 E% from added sugar control over food and meals 15-25 g/d dietary fibre • Interview lasted between 40 and 65 minutes • Less Healthy diet (n= 8): • Digitally recorded and transcribed 15-25 E% from added sugar (Kvale 1999, Rasmussen 1999 and 2000, Winther 2004) Less than 15 g/d dietary fibre Photo based interviews Analysis • The children took pictures of their food and their • Index coding, inspired by the procedure of meals on different days and at different eating template analysis (King, 2004) events • Atlas.ti, version 5.2 • Single-use camera with 37 pictures • Meaning condensation • Establish the possibility to interview the children about concrete situations • Enable the maintance of details and atmosphere • Common trait, variation and differences • Record the childrens own experiences between the two groups 3

The everyday of the children Meal pattern • Fourth grade in municipal schools • Breakfast • After-school activities; club and activities as • 10 o’clock eating event football and dance • Lunch (packed lunch in school) • Be together with friends and families • Eating event in the after-school activity • Doing homework, play at the computer, • Eating event late afternoon at home watch television etc. • Dinner • Not very active in tasks in the household • Eating event later in the evening Eating event at school Lunch in school • ”Coco-Pops are only filling in the morning, • The children brought a packed lunch, then they stop having a filling effect. They provided by the parents don’t last very long, soon I am hungry • Sandwiches, vegetables and maybe again” something sweet (Sofie, Less Healthy Diet) • Occasionally some of the children bought their lunch in the school cantine Lunch at school, boys and girls Lunch at school, social context • ”We just eat. And then we can chat a bit and move • ”We are not allowed to sit out there (in the about. At the moment we talk about the football corridor)... We can’t sit there because he match I am going to play in Jutland. Otherwise we (the teacher) thinks that our class should be talk about, what do we talt about? Yeah, all sorts. Football, what we are doing in the club, anything, a class that eats together. [...] I think that if what we plan to do, or what we have done...” one sat out there, then I don’t think that (Mikkel, Healthier Diet) would be a real class.[...] A real class is one • “You don’t just go over and take some food. We that helps each other and is together.” can easily taste each others. If you have a pizza (Katrine, Healthier Diet) roll: “would you swap a bit for a grape?” or something like that.” (Camilla, Healthier Diet) 4

Dinner Eating event later in the evening • The third main meal of the day, the dinner, • Only one child had an ordinary meal or was eaten at home and often in the company eating event after dinner of their family • Most in weekends the children had sweets • Recreational activities and working hours in the evening could cause irregularity • Some had some fruit in the evening • Almost all the children told they enjoyed the family dinner Meal pattern, summing up Snacks and the social context • Both groups of children talked about sweets, chips • Almost the same meal pattern in the two and soft drinks groups • 3 main meals and 2-4 eating events • Healthier diet children: ate sweets and drank soft drinks in the company of others (with family or • Children from the group of Less Healthier friends) Diet more often had meals and eating events • Less healthy diet children: often ate sweets and alone drank soft drinks alone in their room or while • The parents prepared the main meals being alone in the afternoons Snacks and the social context Snacks and the social context • Healthier diet children: ate sweets and cakes and • ”Generally I eat them (chocolate) when I drank soft drinks in connection with special am playing with my playstation. In my occasions. (These could be Fridays, a family room I also have games and a computer” birthday or a special programme on the television) (Mads, Less Healthy Diet) • Less healthy diet children: ate sweets and cakes and drank soft drinks even when there were not special occasions (on weekdays, weekends) in addition to times when there were 5