In fall 2003, the Center for Health and Health Care in Schools posted a survey on its web site entitled “Nutrition, Physical Exercise, and Obesity: What’s Happening in Your School?” During a 10 week period between October 2003 and mid-January 2004, over 1,000 web site visitors filled out the survey. More than half the respondents described themselves as school nurses (56.8%), 14.1% were teachers, 10.9% school administrators, 6.4% school-based health center staff, 1.1% counselors, and 10.7% “other.” Thirty-eight percent of respondents were from suburban areas, 32.9% from rural areas, and 29.5% from urban areas. While 42.8% were located at elementary schools, 16.2% were in middle or junior high schools and 15.6% were in high schools. 5.5% described themselves as located in k-8 schools and 10.8% were in K-12 schools. 9.1% described their locale as “other.” 58.7% were employed full-time in one school; 15.8% were part-time in two or three schools, 6.1% were part-time in four or more schools, and19.4% were not employed at a school location.
Additional notes on the data: When the survey was posted to www.healthinschools.org, the webmaster informed potentially interested audiences of the survey via 10 listservs whose members are involved in various aspects of health issues at school. The survey was also reported in several e-newsletters. This narrative summarizes the survey responses.
Table 1. Obesity concern in school community
1 = Yes, a lot; 10 = No, not much
|Is obesity a concern in your community? (N=995)||24.12%||26.53%||20.60%||18.09%||10.76%|
|Are efforts being made in your school to improve the nutritional quality of meals and snacks available to students? (N=994)||14.59%||23.44%||20.63%||18.41%||22.93%|
|Do school staff support efforts to improve nutritional quality of meals and snacks, for example, reduce fat and/or caloric content or replace sugared drinks with water or 100% juices?
|Do parents support efforts to improve nutritional quality of meals and snacks, for example, reduce fat and/or caloric content or replace sugared drinks with water or 100% juices?
Efforts to increase students’ physical activity at school appear on the increase – though modestly so.
Survey respondents reported that their school undertook the following activities to increase physical activity among students in SY 2002-2003 (N = 734) or plan to increase physical activity among students in SY 2003-2004 (N = 637).
Table II. School actions undertaken to increase physical activity
|Promoting walking/biking to school||29.16%||34.69%|
|Changed PE curriculum||29.56%||31.08%|
|Increase in sports teams, intramural activities||31.34%||23.08%|
|Increased PE time||10.76%||12.40%|
|Increased recess time||6.81%||13.19%|
Efforts to improve nutrition at school are also underway; some modest increases have occurred between last year and this year.
Survey respondents reported that their school has undertaken the following activities to improve nutrition for students in school year 2002-2003 (N = 734) or intend to improve nutrition for students in school year 2003/2004 (N = 637).
Table III. School actions undertaken to improve nutrition
|Changed lunch menu/choices||47.96%||46.78%|
|Reduced access to vending machines||31.61%||29.67%|
|Changed vending machine selections||28.75%||30.14%|
|Changed food/drinks sold at school events or door-to-door||9.13%||13.66%|
|Removal of vending machines||7.22%||8.01%|
|Longer lunch periods||4.91%||5.02%|
Barriers to healthier eating and greater exercise at school are reported as varied and serious. The survey included one open-ended question asking respondents to comment on barriers to improvements at their school. An initial subset of 100 randomly-selected questionnaires has been examined to learn how front-line professionals assess their situation.
Time constraints were identified as the main barrier to increasing physical activity, with most noting that physical education had either been cut back to gain more academic time or that it was not being increased for the same reason. This barrier is likely enhanced by what 16 respondents described as “administrators not seeing nutrition and physical activity as critical activities.”
Vending machine food and drink choices and students’ access to these machines during lunch were the primary complaints regarding the vending machines. One respondent expressed concern that one soft drink seller seemed to gain a free hand with the vending machines by making donations to the school system to purchase needed equipment.
Student attitudes also constitute a challenge to improving exercise opportunities and nutrition at school, according to respondents. Several noted that students’ preference for video games and the reluctance of overweight students to exercise contributed to their inadequate activity levels. More respondents focused on the poor food choices students made, with one respondent noting that “Students eat high carb/high calorie foods on the school lunch menu and then buy sugars at the a la carte station.”
Other barriers or comments worth noting included the following: One respondent commented that in his neighborhood it would not be responsible to encourage walking to school because the neighborhood was too dangerous. Staffing and training of food service employees was identified as a barrier by several. They noted that if the cafeteria were consistently short-handed, it put a premium on ease of preparation and/or serving. In a similar vein, another respondent noted that there were insufficient resources and training for senior staff who should be responsible for planning the menus or supervising execution of vendor contracts. Still another respondent noted that the available facilities would determine if a school cafeteria had to depend exclusively on food brought in – a circumstance that the respondent saw as increasing the likelihood of bland food and increased student purchases from a la carte services.
Table IV. Top five barriers to change named by a sample of respondents
(N = 100, Responses could name an unlimited number of barriers)
Table V. Time Allocated to Prevention Work
(N = 974)