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Parental Views on School Lunches:

An Insight into Childhood Overweight

by

Zoey Verdun

A Thesis Submitted in Partial Fulfillment of the Requirements for the Honours Degree

of Bachelor of Art in the Department of Economics

Supervised by: Dr. Chris Auld

We accepted this extended essay as conforming to the required standard

Dr. Pascal Courty, Honours Co-Advisor (Department of Economics)

Dr. Herbert Schuetze, Honours Co-Advisor (Department of Economics)

© Zoey Verdun, 2014 University of Victoria

All rights reserved. This extended essay may not be reproduced in whole or in part, by

photocopy or other means, without the permission of the author.

Abstract The obesity epidemic constitutes a large and growing share of public health spending. This paper investigates parental views on providing healthy food choices in school in an attempt to contribute to a better understanding of the parents’ role in addressing childhood overweight. I created a survey that was circulated at an elementary school in Victoria, B.C. The results are discussed using a standard microeconomic framework in which parental choices of their children’s lunches depend on their views (“utility”) as well as the restrictions they face. My results suggest that parents perceive price not to be a major factor in the decision to include fruits or vegetables in their child(ren)’s school lunch. The reason provided most frequently by parents for not including fruits or vegetables every day is the expectation that their child(ren) would refuse to eat them, or have too little time at school to eat them. Some parents also mention preparation time as a reason for not including fruits and vegetables.

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Table of Contents

1. Introduction ......................................................................................................................2 2. Literature Review .............................................................................................................5

2.1 Taxes and Subsidies .............................................................................................................. 5 2.2 The Provision of Food in Schools ......................................................................................... 8 2.3 The Provision of Information in Schools .............................................................................. 9 2.4 The Debates Surrounding Monitoring of Obesity in Schools ............................................. 11 2.5 Changes in Food Over Time ............................................................................................... 12

3. Creating the Survey ........................................................................................................12 3.1 Methodology ....................................................................................................................... 12

3.1.1 Canadian versus US Data ............................................................................................. 12 3.1.2 Designing the Survey .................................................................................................... 13 3.1.3 Why Breakfast? ............................................................................................................ 14 3.1.4 Difficulties .................................................................................................................... 15

3.2 Survey Design ..................................................................................................................... 15 3.2.1 Parental Views on School Programs ............................................................................. 16 3.2.2 Parental Views on Taxes and Subsidies ....................................................................... 17 3.2.3 Parental Views on School Lunches .............................................................................. 17 3.2.4 Leverage ....................................................................................................................... 17 3.2.5 Parental Views on PAC Lunches .................................................................................. 18 3.2.6 Perceptions on Childhood Overweight ......................................................................... 18 3.2.7 Demographics ............................................................................................................... 19

4. Data ................................................................................................................................19 4.1 Description of Data ............................................................................................................. 19 4.2 Health Education and Physical Activity in Schools (Q1-Q4) ............................................. 20 4.3 Explanation for Eliminating Half the Observations for the Willingness to Pay

Follow-up Survey Questions ................................................................................................ 21 4.4 Willingness to Pay Question Breakdown ............................................................................ 23

4.4.1 Fruit and Vegetables Subsidy (Q5-Q7) ........................................................................ 23 4.4.2 Soda and Other Sugared Beverages Tax (Q8-Q10) ...................................................... 25

5. Discussion ......................................................................................................................25 5.1 Discussion of Health Education and Physical Activity in Schools (Q1-Q4) ...................... 26 5.2 First Willingness to Pay Question (Q5-Q7): Subsidizing Fruits and Vegetables ............... 29

5.2.1 Initial Question (Q5) ..................................................................................................... 28 5.2.2 Follow-up Questions (Q6-Q7) ...................................................................................... 32

5.3 Second Willingness to Pay Question (Q8-Q10): Taxing Soda and Other Sugared Beverages ............................................................................................................................. 33

5.4 Possible factors for Why Some Children do not Bring Fruits and Vegetables to School Every Day (Q12-Q14) .......................................................................................................... 34

5.5 PAC Lunches (Q18-Q21) .................................................................................................... 37 5.6 Perceptions of Parents Regarding Percentage of Children Who Have an Unhealthy Excess

Weight (Q22-Q25) ............................................................................................................... 38 5.7 Limitations ........................................................................................................................... 40

6. Conclusion .....................................................................................................................40 References ..........................................................................................................................45 Appendix ............................................................................................................................49

A1 List of Survey Questions ..................................................................................................... 49 A2 Human Ethics Approval ...................................................................................................... 52 A3 School Board Approval ....................................................................................................... 53

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1. Introduction

Levels of obesity among children and adolescents have tripled over the last thirty years

(Evans, Finkelstein, Kamerow and Renaud 2005, 26). Obesity is understood to be ‘a

condition in which someone is too fat in a way that is dangerous for their health’

(Macmillan dictionary 2014).1 The causes of obesity are many including genetics,

physical activity, social norms around weight, food quality and quantity. Childhood

obesity differs from ‘adult’ obesity in that adults make their own choices and are

responsible for their own health, including what they eat and their physical activity. By

contrast, children do not determine on their own what they eat or their level of fitness.

Rather their parents, guardians2, and schools have a large influence on food intake and

activity levels. As a result, childhood obesity has an extra layer of complexity compared

to adult obesity.

This Honours thesis focuses on the food quality dimension of childhood obesity. It

poses the following research question: what factors impact the choices of parents

regarding their children’s school lunches?

To analyse this question I created a survey, which I circulated among the parents

of children of a local elementary school. This survey included questions about parents’

views on (1) school programs about healthy choices; (2) taxing ‘unhealthy’ foods and

subsidizing ‘healthy’ foods; (3) a lunch program provided by the school’s Parents

Advisory Council (PAC); and on (4) the lunches parents packed for their children, the

restrictions parents faced, and their perceptions on childhood overweight. I collected 57

responses to the survey.                                                                                                                1 The World Health Organization (WHO) considers children obese if they are 2 standard deviations away from the average and they are considered overweight if they are 1 standard deviation away (WHO 2013). 2 Henceforth, when I refer to ‘parents’, I am referring to both parents and guardians.

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I analyse the responses to the survey using a standard microeconomic framework

in which parental choices of their children’s lunches depend on their views (“utility”) as

well as the restrictions they face. The restrictions considered differ depending on the

actual survey question analysed, but include the idea that parents do not always have

leverage over what part of the lunch their children will actually eat at school.3 Other

possible restrictions could be money, time (including but not limited to preparation time,

consumption time at school, and time available to buy fresh produce), and knowledge.

Because of the small sample statistical significance is often an issue. Nevertheless

I find the following patterns in my sample: (1) parents who perceive childhood

overweight to be a greater issue in the school are more willing to support school

programs that provide health education and physical activities; (2) parents who perceive

childhood overweight to be a greater issue in British Columbia are more willing to

support subsidizing fruits and vegetables; (3) parents are less likely to provide fruits and

vegetables in the lunch when they face restrictions (such as lack of time, child refusal

and/or peer pressure); (4) parents indicate the cost of fruits and vegetables is not one such

restriction; and (5) parents who perceive childhood overweight in their family to be less

of an issue than other parents are more willing to support making PAC lunches healthier.

In economics we look at the cost of goods and how it affects consumption. This research

shows that the parents who participated in the survey support increasing the costs so as to

ensure their children obtain healthier lunches (i.e. increased content of fruits and

vegetables).

                                                                                                               3 As in a Principal-Agent setting, where parents are the Principal and children the Agents. In this context it could be that parents are more interested than their children to see that they have a serving of fruits and veggies in their lunch every day.

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There is a vast quantity and scope of scholarly literature on childhood obesity. For the

purpose of this thesis I have subdivided the relevant literature into four broad areas,

which I will review in Section 2: (1) taxing unhealthy foods and subsidizing healthy

foods; (2) the provision of food in school (such as school lunch programs); (3) health

education and physical activity in schools; and (4) the debate surrounding monitoring of

obesity in schools.

Canadian data that connects food quality or food pricing to obesity in children is

absent. Data exists on the United States (US) but may not transfer adequately to the

Canadian context. However, a number of insights from research using US data do apply.

For instance, that parents have to make trade-offs when determining what to pack in their

child(ren)’s lunch. Furthermore there is very little data on parental views on school

lunches. It is important to learn about parental views, as these should provide us insights

into parents’ role in providing children with healthy lunches. Thus, for this study, I

collected my own small sample of data. I surveyed parents whose child(ren) attend(s) one

local elementary school.4 I inquired into what influences them in providing healthy

lunches to their children. Earlier studies on childhood obesity, that examine parents’

perceptions, have used a series of questions.5 I have adapted some of these questions and

created others (see Appendix A1 for the full list of my questions). In the survey I used the

term ‘overweightness’ instead of ‘obesity’ since the latter may be considered to have

negative connotations (Jancin 2012).

                                                                                                               4 In order to obtain approval to conduct the survey, the school board required that the name of elementary school surveyed to be kept confidential. 5 An example of such a study is Evans, Finkelstein, Kamerow and Renaud (2005, 30), in particular see Table 3 of that study.

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The structure of my thesis is as follows: to situate my research I start with a

literature review. Next I describe my methodology and survey design. I then present my

findings followed by a discussion. Finally I summarize my main findings and offer some

suggestions for future research.

2. Literature Review

2.1 Taxes and Subsidies

In economics the behaviour of the consumer is influenced by price. Therefore the

government can encourage or discourage the consumer by decreasing or increasing the

price of certain goods: subsidies and taxes. How much a consumer changes his or her

behaviour depends on his or her price sensitivity and the price-elasticity of the good.

Governments use the policy instrument of taxation to discourage consumption (or

overconsumption) of goods that are viewed to have negative externalities to society.

Regarding the taxation of unhealthy food, there has been discussion around the

implementation of a so-called ‘fat tax’ (Mason 2012). Subsidies can be targeted to a

small group for a host of reasons: to promote consumption of a particular good over

another or if there is a concern that a subsample of the population cannot afford certain

goods at full price (for example: Herman, Harrison, Afifi and Jenks 2008).

The first area of the literature I review is taxing unhealthy foods and subsidizing

healthy ones. Below I discuss a selection of the literature. Some argue that unhealthy

weight would decrease as a result of taxes or subsidies whereas others argue that this

outcome would be the most likely scenario if there were less or no substitution effect.

Caraher and Cowburn (2005) offer a policy analysis of food taxes to study how such

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taxes could influence food consumption and behaviour. They find the impact of taxing

foods, as a way to target obesity, unclear and argue that taxation alone is not enough to

change behaviour.6 Caraher and Cowburn make a case for using taxes and subsidies

together as well as suggesting that policy should additionally target production,

manufacturing and advertising.

Another component of food taxation is that of soft drinks or sugar-sweetened

beverages (SSB). Suggestions and analyses for SSB taxation are growing as per capita

consumption of SSB keeps rising; over the past three decades per capita caloric intake

from SSB has risen 170% in the US, with ‘beverages now account[ing] for 10 to 15% of

the calories consumed by children and adolescents’ (Brownell and Frieden 2009, 1805-

6). However, the literature is neither clear nor consistent on whether SSB should be

taxed. Fletcher, Frisvold and Tefft (2010a) argue that taxing soft drinks will have an

influence on decreasing body mass index (BMI), but that the order of magnitude is small.

In another study Fletcher, Frisvold and Tefft (2010b) find that soft drink taxation would

also lead to a moderate decline in soft drink consumption in the US by children and

adolescents. This reduction would be offset, however, by a substitution towards other

high-calorie drinks, consequently not reducing individuals’ BMI.7 Thus the evidence of

the impact of taxation on BMI suggests that taxation can be effective but it would need

careful policy planning.

The literature also examines various types of taxation and their pros and cons.

Brownell and Frieden (2009) argue that when taxing SSB, it should be an excise tax, a

penny-per-ounce of sugar added, rather than a sales tax. The reasoning is that if the total

                                                                                                               6 Edwards (2012) and Winkler (2012) also make this argument with regards to the taxation of soft drinks. 7 Edward (2012) also mentions this subsequent substitution. He is another one of the scholars who mentions that taxation of soda drinks would not work because there are too many cheap substitutes available.  

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quantity of sugar is taxed then consumption will decrease. A sales tax, by contrast, will

result in substitution towards either a cheaper brand or a larger size, both of which would

be cheaper per unit. Another reason is that an excise tax will most likely be passed down

to consumers and therefore directly into the shelf price (the price consumers face when

making their purchasing decision), rather than a sales tax that is only seen at the till.

Brownell and Frieden find that the penny-per-ounce excise tax could reduce consumption

by as much as 10% and suggest that the revenue raised could go towards subsidizing

‘healthful foods’ (Brownell and Frieden 2009, 1807). This would help counteract the

regressive nature of the excise tax, as these types of taxes typically affect the low-income

consumers more than those with higher incomes.

Andreyeva, Chaloupka and Brownell (2011) argue that a beverage tax could lead

to substantial health benefits if there is no substitution. However this ‘if’ is important to

keep in mind as we saw above that various studies identify such a substitution effect

when taxing soft drinks and/or sugar-sweetened beverages. However if there were not a

perfect substitution effect this tax would of course generate revenue. Andreyeva,

Chaloupka and Brownell argue that the revenue raised by such a tax could be used to

support obesity prevention programs thereby leading to even more health benefits.

Finally, Powell and Chaloupka (2009) offer a policy analysis on the impact of

altering the price of food either via a tax or a subsidy. They try to determine if this

change in price will result in a change in food consumption and diet, enough to reduce

significantly individuals’ weight. They find that small price changes via either tax or

subsidy will not produce any significant change in either an individual’s BMI or the

prevalence of obesity. However, they do find that there may be some measurable effect,

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particularly among children and adolescents, of ‘nontrivial pricing interventions’ (Powell

and Chaloupka 2009, 229). In other words, a major change in price will have an effect

where as few cents will not. Nonetheless, their conclusion is that in order to provide solid

policy recommendations about the effectiveness of taxes and subsidies to reduce obesity

further research is necessary (Powell and Chaloupka 2009, 230).

This literature review of the impact of taxes and subsidies is not fully conclusive.

The effect of either price increases or decreases depends on a multitude of factors. Such

as the scope of the tax/subsidy, availability of substitute goods, the size of the tax/subsidy

and whether the substitute goods have negative health impacts. Without key insights into

these factors it is tricky to make blanket statements about the success of a tax or a

subsidy. At the same time, schemes could be devised that would more likely provide the

desired outcomes.

2.2 The Provision of Food in Schools

The literature demonstrates clearly that children who are well nourished perform better in

schools than those who are malnourished (Government of British Columbia n.d.). As a

result there have been programs that offer meals at schools. Traditionally this was done to

ensure that children from lower income families had access to nutritious foods. The

theory was that by providing meals at school the children would eat healthier. In Canada

there have been much more local initiatives as there is not a federal or even province

wide school meal program. By contrast the US does have such programs.8

                                                                                                               8 It appears that the Canadian government does not subsidize school meals programs as much as other advanced economies. For instance, according to one source the US government subsidizes their school meal programs 30 times more than does Canada (Centre for Science in the Public Interest 2009).

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There is little literature that analyzes the provision of meals to children in

elementary schools in Canada. There is, however, literature on US school meal programs.

In particular there is emphasis on two of these programs and their effect on childhood

obesity: the National School Lunch Program (NSLP) and the School Breakfast Program

(SBP). Millimet, Tchernis and Husain (2010) found that the SBP did not contribute to

obesity; it may actually help counter it. Yet, they did find that the NSLP contributed to

obesity. Not all authors come to the same conclusions. Gleason and Dodd (2009)

emphasized that for better or worse school meal programs have a significant impact on

children’s diets and therefore can influence their weight. Gleason and Dodd found that

the SBP was associated with significantly lower BMI, and therefore the authors conclude

that this finding is because it encourages students to eat breakfast more regularly.

Gleason and Dodd did not find any relationship between child BMI and the NSLP. They

also acknowledge that the literature on these meal programs is a little sparse and

sometimes contradictory. There are few, if any, Canadian studies that look at what

children bring to school for lunch.

I interpret the literature as suggesting that the socio-economic status of the

families at the school may be a larger determinant of whether the lunch provided at

school would be better or worse than their own lunch brought from home.

2.3 The Provision of Information in Schools

One of the difficulties in providing advice, not just in schools, but more generally is that

information is not always consistent. Different sources can provide a variety of,

sometimes contradictory, information. Sometimes advisors come to opposite conclusions.

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An example of such a contradiction regards one of the many causes of obesity. Whereas

Cutler, Glaeser and Shapiro argue that ‘the rise in obesity involves increased caloric

intake, not reduced caloric expenditure’ (Cutler et al. 2003, 104), literature provided by

Foresight claims the opposite, namely that ‘it is not increased calories but decreased

caloric expenditure that is the problem’ (Foresight (n.d.), 8). Further, the causes of

obesity might not simply be one of these factors but a combination of both. In the United

States 44 of the 50 states require that schools provide health education within the

curriculum. Nearly 70% of these states include a nutrition and dietary behaviour

component. Even so, there is not enough time spent on health education as it competes

with teaching the traditional academic curriculum (Story, Kaphingst and French 2006).

The BC government has created a School Meal and School Nutrition Program

Handbook to support schools in feeding students by providing them with a wealth of

well-researched information in a single report. The guidelines ‘apply to all vending

machines, school stores, cafeterias and fundraising sales of food and beverages in the

school setting’ (School Meal and School Nutrition Program Handbook n.d., 1). This 86-

page handbook consists of a wealth of information. But also here recommendation are

sometimes unclear (unsubstantiated). For instance on page 14 while discussing fruits and

vegetables the handbook has a list of recommended and not recommended foods. It

recommends dried fruits but puts banana chips in the category ‘not to be served’. One

might think that they might be assuming that banana chips are always sweetened.

However, the handbook permits to ‘choose sometimes’ applesauce and/or fruit blends

with sugar added.

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2.4 The Debates Surrounding Monitoring of Obesity in Schools

There are two main reasons for measuring BMI in schools (Nihiser, Lee, Wechsler,

McKenna, Odom, Reinold, Thompson and Grummer-Strawn 2007). The first is for

surveillance purposes. Surveillance refers to using the data ‘to identify the percentage of

students in a population who are at risk for weight-related problems’ (Nihiser et al., 2007,

651). This practice is considered widely accepted. In contrast, measuring BMI in schools

for the purpose of screening is rather controversial.

Screening refers to ‘assess[ing] the weight status of individual students and

provid[ing] this information to parents with guidance for action’ (Nihiser et al., 2007,

651). Nihiser et al. suggest that more research is needed but that there seems to be

promising results coming from screening as a way to address childhood obesity. Fayter,

Nixon, Hartley, Rithalia, Butler, Rudolf, Glasziou, Bland, Stirk and Westwood (2007)

also emphasize that there is a lack of data on the potential impact and effectiveness of

screening in schools, and that more research is needed. Ikeda, Crawford and Woodward-

Lopez (2006) explain that although screening can provide useful information it can also

result in children being labelled as overweight. This can adversely affect these children

and result in eating disorders, increased suicide rates, lower self-esteem, depression and

social isolation. Furthermore there is not enough evidence that the monitoring of obesity

through BMI or from sending ‘fat letters’ home actually leads to changes in behaviour

(Ikeda, Crawford and Woodward-Lopez 2006). By contrast the situation is different in

Canada. As was recently discussed in Canadian media there is not much public support in

Canada for obesity monitoring in schools through BMI (Oved 2013). Yet Toronto this

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year will test 12,000 students in grades 7 to 12 on a voluntary basis. No ‘fat letters’ will

be sent home.

Given the controversy around BMI screening and its possible adverse effects on

children, I preferred not to include weight testing in my research due to possible harm.9

2.5 Changes in Food Over Time

There is another part of the obesity literature that should be mentioned, but just briefly as

it goes beyond the scope of this paper to discuss it in detail: food changes over time.

Cutler et al. (2003) look at how food has changed over time; some of the changes are as a

result of new technologies. These changes have led to mass production of food, pre-

packaged food (including snack foods), and decreased time cost in preparing food. They

find that the increase in calories comes from an increase in the number of snacks people

eat, not from eating more at each meal or snack. This increase in the frequency of meals

is made possible by the decreased cost both in terms of time and money of making meals

to eat.

3. Methodology

3.1 Creating the Survey

3.1.1 Canadian versus US Data

There is some research that studies the impact of food prices (fast food, grocery food or

restaurant food) on peoples’ behaviour (e.g. Cutler et al. 2003). Most of this literature

                                                                                                               9 As for monitoring of children’s weight in schools, although attractive in terms of being able to connect the children’s weight to their eating behaviours, the literature suggests there are high risks to monitoring. Furthermore it is a much less common practice in Canada than in United States. For these reasons I decided not to incorporate this element into my study

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focuses on US data. I decided to collect my own data, as I could not find any studies

using Canadian data. It is also unclear whether US data is representative of the Canadian

context. For example in the US the National School Lunch Program is a federal program

that gives all public and not for profit private schools the option to participate for free.

Over 100,000 schools participate and provide daily lunches to their students. In Canada,

there is no such federal program. For most Canadian students most lunches are packed

lunches provided by parents. At the school that I surveyed parents are expected to

provide a lunch. There is also an optional program organized by the Parents Advisory

Council that offers lunches once a month (in my thesis I will refer to this as the PAC

lunch program). Besides the difference in the scope of lunch programs in the US and

Canada, food regulations also differ between the US and Canada (Government of Canada

2011).

3.1.2 Scope of the Survey and Sample

I decided to approach parents rather than children to learn about the children’s lunches. I

approached parents for two reasons. First, because it is easier to apply for human ethics to

survey adults than it is children. Second, most primary school aged children do not make

their own lunch; rather it is made by their parents. As well, it is the parents that typically

decide what ingredients to purchase for making the lunches. I asked parents what factors

they thought influenced them in providing school lunches for their children. In particular

my goal was to collect data on what influences parents’ decisions in providing fruits and

vegetables in school lunches and other similar decisions.

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Ideally I would have collected a large sample of responses from parents from a

variety of schools that together reflect Canadian socio-economic average statistics.

However there are some practical issues with approaching many schools. For each school

I would have surveyed I had to receive permission from the school principal and also had

to coordinate with the secretary of each school to ensure when and how my survey would

be delivered to the parents, and when and how often to send a reminder. Therefore

support from the school is crucial to success. To make this research feasible, given my

own time restrictions, I had to approach just one school. I verified that the school I

selected represents an average income school in Victoria.10

3.1.3 Why Breakfast?

Let us take a step back a minute and look at why I decided to focus my research on

lunches rather than for example breakfasts or dinners, which presumably also affect

childhood overweight. Looking at these other meals would have been interesting as well,

but I chose lunch because it is a meal that is typically not eaten in the presence of parents

and therefore presumably less controlled than breakfast and dinner.11

Lunch is also an interesting meal because parents face some constraints when

putting together lunches and this may affect healthy choices. These constraints may

include: packability of the lunch, children’s lack of access to fridges or microwave ovens

while at school, and time constraints in the morning or night before. Due to these                                                                                                                10 According to Statistics Canada the median income in Victoria in 2011 was $79,350 (Statistics Canada 2013). The Fraser Institute lists parents’ average income in BC schools. The school I have chosen had an average parental income between $50,000-$60,000 (Fraser Institute 2014). As it seemed low for this school, I checked a few other schools as well to check if the income made intuitive sense. Assuming the Fraser Institute is correct, the selected school has parental income that is below the median reported by Statistics Canada and not above. 11 Specifically most days children eat packed lunches at school. On occasion the Parents Advisory Council (PAC) offers school lunches as an option (typically once per month).

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constraints, there are fewer options to choose from and therefore it is easier to compare

parents’ responses. By contrast, dinner can vary greatly as to where and what people eat

(home-cooked food, takeout or restaurant meals).

3.1.4 Difficulties

Because I had to focus on a single primary school, it was important to get a high enough

response rate. I implemented two strategies to ensure an as high as possible response rate.

The first was to use the term ‘overweightness’ rather than ‘obesity’ to prevent possibly

offending participants. Some individuals see the term ‘obesity’ as offensive or derogatory

when referring to children. The second action I undertook was on the recommendation of

a parent who read the draft of the survey questions. Her advice was to not start the survey

with the technical questions. I took her advice and moved them further down the survey,

after some of the more straightforward opinion questions.

Research approval from the School Board of School District 61 and approval

from the principal of the participating elementary school were required (Appendix A2

and A3 contain the approval certificates). Although initially I was concerned that a short

data collection timeframe (2 weeks) would hurt the total number of responses, in

hindsight it seems that the response was good. Most people responded within the first

week and another peak in responses came when a reminder was sent out a week later.

The final reminder (two weeks in) generated just a few responses.

3.2 Survey Design

Obesity is now such a widespread epidemic that any child not offered healthy food

choices is at risk of gaining excess weight. The goal of my survey is to get an insight into

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what barriers parents face when providing their children with nutritious lunches and to

learn how parents think in order to understand what drives them to make healthy choices

for their children. Healthy and less healthy options can be chosen by parents for

numerous possible reasons, including cost (both financial and time), knowledge and

commitment to children’s health. Contrary to other studies my survey does not try to

measure obesity or link parents’ behaviours to the actual weight of their child(ren) and/or

whether they are overweight. My survey questions, discussed below, are grouped into 7

different themes.

3.2.1 Parental Views on School Programs (Q1-Q4)

The first theme is parents’ views on school programs. Schools can or do offer programs

that provide information on healthy eating and nutrition and physical activity programs

such as recess, daily physical activity (DPA) and intramural sports. Evans, Finkelstein,

Kamerow and Renaud (2005)12 find that parents are generally supportive of these

programs, but are less supportive when these programs take away time from traditional

curriculum. Questions 1-4 in my survey, about these school programs, are very similar to

those in Evans et al. (2005). They have however been modified for the Canadian

context.13

                                                                                                               12 Evans et al. (2005) did a household survey in the US involving approximately 1000 households. I used this paper’s survey questions to inspire my own questions (See Appendix A1 for the survey questions).  13 From Evans et al. (2005) I adapted in particular the questions focusing on (1) teach students healthy eating and exercise habits, (2) physical education classes in school, (3) recess and supervised intramural activities in school and (4) changes in school curriculum if it meant less time for traditional academic courses.

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3.2.2 Parental Views on Taxes and Subsidies (Q5-Q10)

The second theme is parents’ views on taxes and subsidies. As mentioned in the literature

review above, governments can use tax or subsidy programs to try and influence

consumption behaviour thereby trying to address one aspect of obesity. Although the

literature review indicates that the findings of studies are inconclusive about the

effectiveness of taxing ‘unhealthy’ foods and subsidizing ‘healthy’ foods, I ask several

questions in my survey to try and investigate parental views on these government

programs. One of the questions asks about whether parents would support subsidizing

fruits and vegetables, reducing their price by 10%, if it increases their household's income

tax by $100 per year.

3.2.3 Parents Views on School Lunches (Q12-Q14)

The third theme is parents’ views on school lunches. My survey questions (Q12-Q14) try

and investigate parents’ knowledge of healthy choices and its perceived importance. A

parent may have certain knowledge but if they do not perceived it to be important, this

knowledge may still not affect a parent’s choice in what they put in their child’s school

lunch. One of the questions asks about whether parents feel confident they know what a

nutritious lunch is.

3.2.4 Leverage (Q15-Q17)

The fourth theme concerns questions that try to capture the “leverage” of parents over a

child’s lunch consumption. Ultimately what is in the lunch matters only in so far as it

influences what the child actually eats. An example of low leverage would be if a child

  18  

does not eat the fruits or vegetables a parent might include in his or her child’s packed

lunch. By contrast, parents with high leverage can effectively impose what the child eats.

One of my survey questions asks about whether parents consult their children when

making their school lunches. Lunch consultation may be a way for parents to increase

their leverage. Another survey question asks whether parents include fresh fruits and

vegetables everyday in their child’s school lunches. If parents say that they do not include

them everyday I ask about possible restrictions: cost of fruits and vegetables, preparation

time, child refuses to eat them and peer pressure. The “child refuses to eat them”

restriction may indicate that the parent does not have much leverage.

3.2.5 Parental Views on PAC Lunches (Q18-Q21)

The fifth theme is the parents’ views on the Parent Advisory Council (PAC) lunches. As

mentioned in the literature review there is very little literature on school meal programs.

The little literature there is is inconclusive about for example whether or not the US

National School Lunch Program contributes to childhood obesity. My survey questions

(Q18-Q21) ask the parents whether they participate and their views on their child’s PAC

lunch program, such as the healthiness of the lunches and support for making them

healthier by including more fruits or vegetables.

3.2.6 Perceptions on Childhood Overweight (Q22-Q25)

The sixth theme is parents’ perceptions on childhood overweight. In questions 22-25 the

survey asks parents’ perceptions that childhood overweight is an issue: in British

Columbia (Q22), in their child’s school (Q23) and in the respondent’s family (Q24). He

  19  

(2007) finds that many parents are not aware that their children are overweight or obese.

The data from these questions may not, and should not, be assumed to represent the

actual prevalence of childhood overweight. The survey asks one question (Q25) that tries

to gauge how accurately parents perceive childhood overweight to be an issue in Canada.

3.2.7 Demographics (Q28-Q34)

The seventh and final theme asked some demographic questions. These questions asked

about gender, age, the number of 19+ individuals in the household, whether all

parents/guardians work, the number of children in the household, how many of them go

to the selected school and what grades they are in (including whether they are in the

French immersion stream or the English stream). I had initially also wanted to ask the

household’s income bracket however that question was removed per the request of

School District 61. The best I can do is to use the Fraser Institute’s data to determine the

school’s average household income.

4. Data

4.1 Description of Data

The survey got 57 responses. The school that participated had approximately 400

students, and fewer parents because there are students with siblings at school. For

example, 35% of survey participants had two children at the school. If this percentage

were representative of the entire school, then there are approximately 260 families that

could have responded. The response rate would have been 57/260 or 22%.

  20  

Here are some descriptive statistics of the sample: 91% of participants were

female, 9% male. 79% of participants were ages 35-44, 16%, ages 45-54 and 5% ages 25-

34. 84% of participants said that all parents worked. 70% of participants had children in

French immersion14, 26% had children in the English stream15 and 4% (2 participants)

did not answer the question. This is fairly similar to the French-English distribution in the

school: 65% French, 35% English16. Also approximately two-thirds of the participants’

children were in lower grades (Kindergarten – 2) and approximately one-third were in the

upper grades (grades 3 – 5), see Figure 1 below.

Figure 1 demonstrates the ratio of French to English children of the participants, approximately two-thirds French, one-third English. This ratio is very similar to the school as a whole. This figure also demonstrates that there were significantly more participants of younger children, approximately two-thirds.

4.2 Health Education and Physical Activity in Schools (Q1-Q4)

There was unanimous support for having the school teach students healthy eating and

exercise habits (Q1). Both the question asking about support for the Daily Physical

                                                                                                               14 Henceforth French immersion will be for simplicity referred to as ‘French’. 15 Henceforth English stream will be for simplicity referred to as ‘English’ 16 Based on the ratio of English to French classrooms in the school. In addition, the Fraser Institute calculated that this school had 66% French (Fraser Institute 2014).

0"

4"

8"

12"

16"

20"

K" 1" 2" 3" 4" 5"

Num

ber'o

f'children'

School'grade'

Figure 1: Number of respondents' children in each grade

English"

"French"

  21  

Activity (DPA) program and physical education classes in school (Q2) and the question

asking about support for recess and supervised intramural activities in school (Q3) had

almost unanimous support. Only 2% (1 participant) broadly disagreed with these two

questions. However, the question that asks the parents their opinion of the trade off

between teaching students healthy eating and exercise habits and DPA and traditional

academic courses (Q4) had more variation in its responses than the previous three

questions. 39% of participants broadly agreed, 35% broadly disagreed and 26% neither

agreed nor disagreed.

4.3 Explanation for Eliminating Half the Observations for the Willingness to

Pay Follow-up Survey Questions

A last minute change in the order of the survey questions led to an editing error in two of

the survey questions, the questions 6 and 7, which were follow-up questions to question 5

and the follow-up questions 9 and 10 to question 8, did not refer to the correct questions.

Instead of referring to questions 5 and 8, the follow-up questions referred to questions 1

and 4, respectively. This editing error was discovered and corrected after the first 28

responses had already been received. Having looked at the data it seems that many of the

participants did not read the details of these questions carefully, such as which questions

to answer or to skip based on their previous answer. It is unclear whether, and if so to

what extent, the editing error has affected the results.

Questions 5 to 10 were split into two groups trying to get at willingness to pay.

Specifically, questions 5-7 ask about subsidizing fruits and vegetables, while questions 8-

10) asked about and taxing sugared beverages. The first question in each set (question 5

  22  

and 8 respectively) was a statement to which the participant had to chose to varying

degrees whether they agreed or disagreed. The follow-up questions were then split up

into if you disagreed to the previous question or if you agreed with it. A participant had to

answer one of the two follow-up questions. The ‘disagree’ follow-up question reduced

the amount the person had to be willing to pay, whereas the ‘agree’ follow-up question

increased that amount.

I calculated the accuracy17 of responses both before and after the correction of the

editing error. First I calculated it with the statement ‘neither agree nor disagree’ being not

a correct answer. In the ‘before’ set of responses I found that for the fruit and vegetable

subsidy set of questions response accuracy was only 57% and for the sugared beverages

taxation set of questions response accuracy was only 64%. On average the response

accuracy before I corrected the editing error was 61%. By contrast the accuracy values

after the editing correction were in both cases 90%. Which had an average of 90%.

Second I calculated the accuracies with the statement ‘neither agree nor disagree’ being

considered a correct response. Not surprisingly the accuracy percentages went up. For the

‘before’ set of responses the accuracy values 82% and 68%, with an average of 75%.

Whereas the ‘after’ editing error correction results were 100% and 93%, with an average

of 96.5%. As a result I decided to just use the ‘after’ editing error correction responses to

do the willingness to pay calculations for the follow-up questions. I assume that the last

29 participants are representative of my entire sample of 57, as there does not appear to

be much difference between those individuals who answered the survey when there was

still an editing error and after it was corrected.

                                                                                                               17 I consider the follow-up question to be chosen “accurately” if the respondent picked the logical one.

  23  

Some participants chose to answer both questions. For the purpose of calculating

the accuracy of individual responses I chose to categorize the ‘both’ responses as a

correct response, because the so-called ‘wrong’ response simply does not provide any

new information and thereby is redundant. To give an example, if someone is willing to

pay 100 dollars for a change, then they will also always be willing to pay 50 dollars for

the same change. The ‘correct’ response would have been to tell me if they agreed or

disagreed with paying an even higher amount for this change.

4.4 Willingness to Pay Question Breakdown

As explained in section 4.2, for the willingness to pay (WTP) analysis I only use all the

responses for the initial questions and the last 29 survey responses for analyzing the

follow-up questions.

4.4.1. Fruit and Vegetables Subsidy (Q5-Q7)

For the first WTP question (Q5) regarding the subsidizing of fruits and vegetables the

results were mixed (see figure 2 below).

3.5%%

22.8%%17.5%%

29.8%%26.3%%

0.0%%

10.0%%

20.0%%

30.0%%

40.0%%

1%.%Strongly%Disagree%

2%.%Disagree% 3%.%Neither%Agree%nor%Disagree%

4%.%Agree% 5%.%Strongly%Agree%

Figure 2: Support to subsidize fruits and vegetables by 10% for increase in income tax by $100 (5

response categories)

  24  

Figure 2 shows the breakdown of the responses into the five categories in which the

question was asked. Only 3% strongly disagreed, 23% disagreed, 30% agreed and 26%

strongly agreed to subsidize fruits and vegetables. Another 18% neither agreed nor

disagreed with the statement. For the purpose of the analysis I have taken together the

response categories of ‘agree’ and ‘strongly agree’ and likewise for ‘disagree’ and

‘strongly disagree’. The terminology I use for that is ‘broadly’ agree and ‘broadly’

disagree (see figure 3 below). I did so to simplify and to show a stronger contrast

between the two broad categories.

Figure 3 shows the results when the responses are into three response categories: ‘broadly

agree’, ‘broadly disagree’ and ‘neither agree nor disagree’. The results show that 62% of

the participants broadly agreed with the initial statement, 26% broadly disagreed and

18% neither agreed nor disagreed with the initial subsidy question (Q5). Of the last 29

responses, those that broadly agreed with the initial question (Q5) 44% broadly agreed,

39% broadly disagreed and 17% neither agreed nor disagreed with the follow-up (Q7).

Again from the last 29 responses, of those that broadly disagreed with the initial question

26.3%&

17.5%&

56.1%&

0.0%&

10.0%&

20.0%&

30.0%&

40.0%&

50.0%&

60.0%&

Broadly&disagree& neither&agree&nor&disagree& Broadly&agree&

Figure 3: Support to subsidize fruits and vegetables by 10% for increase in income tax by $100 (3

response catergories)

  25  

(Q5) 37.5% broadly agreed and 62.5% broadly disagreed with the follow-up question

(Q6). The results are discussed in Section 5.2.

4.4.2 Soda and Other Sugared Beverages Tax (Q8-Q10)

For the second WTP question regarding the taxation of soda and other sugared beverages

the results were more homogenous. 88% of the responses broadly agreed with the initial

statement, 7% broadly disagreed, 4% neither agreed nor disagreed and 2% (1 participant)

did not answer. All but 1 of the last 29 respondents, broadly agreed with the initial

question about taxing soda and other sugared beverages, where 81% broadly agreed with

the follow-up, 4% (1 participant) broadly disagreed, 8% (2 participants) neither agreed

nor disagreed and 8% (2 participants) did not answer. Again from the last 29 responses

only one broadly disagreed with the initial question and this participant again broadly

disagreed. Section 5.3 discusses the results.

5. Discussion of Results

When I analyse the responses to the survey I have in mind a standard microeconomic

framework in which parental choices regarding their children’s lunches depend on their

views (“utility”) as well as the restrictions they may face.

𝐶ℎ𝑜𝑖𝑐𝑒 = 𝑓(𝑣𝑖𝑒𝑤𝑠, 𝑟𝑒𝑠𝑡𝑟𝑖𝑐𝑡𝑖𝑜𝑛𝑠, 𝑐𝑜𝑛𝑡𝑟𝑜𝑙𝑠)

Here the ‘Choice’ that is made by parents impacts their children’s health. In concrete

terms, in the survey these choice variables are found in question Q4 (More focus in

curriculum on healthy choices at expense of other programs?), Q5 (Government subsidies

of fruits and vegetables?), Q15 (Do you provide fruits and vegetables daily?) and Q21

  26  

(Would you pay for healthier PAC lunches?). Depending on the exact ‘Choice’ the

‘views’ include questions Q22, Q23 and Q24 (perceptions of childhood overweight in

school, province, and family). The ‘restrictions’ include child refusal, prep time, peer

pressure, and cost. The ‘controls’ are the demographic questions Q28-Q34 (gender, age,

number of 19+ adults, if all parents work, number of children, how many attend selected

school, and grades of children at selected school). Due to my small sample, 57

observations, I decided not to do econometrics. If I had had more observations the above

framework depicts what I would have done. However, the remainder of my discussion is

based on the above microeconomic framework.

5.1 Health Education and Physical Activity in Schools (Q1-Q4)

The first three questions of the survey regarding the provision of health education and

infrastructure for physical activity had or nearly had unanimous agreement. Yet the

fourth question regarding the trade-offs between these provisions and traditional

academic curriculum less than half the participants were in support.

Looking more closely at the results of these questions. My results, 100% in

favour, for my survey question that asked about support for having the school teach

students healthy eating and exercise habits (Q1) were similar to the same question asked

in the survey done by Evans et al. (2005) where the responses were 94% in favour. For

the question regarding physical education (Q2) my survey received 98% support, the

other survey received 82% support. The question in my survey regarding recess and

intramural activities (Q3) received 98% support whereas the other survey received 69%

support. Finally there was the question regarding the trade-offs between the provision of

  27  

health education and infrastructure for physical activity and traditional academic

curriculum (Q4). My survey received a support rate of 39% and similarly the Evans et al.

(2005) survey received a support rate of 34%.

I believe part of the discrepancy among the first three questions has to do with my

relatively small sample size. I have 57 observations; the survey by Evans et al. (2005)

had, depending on the question, approximately 300-1000 observations. I do not have as

much variation, possibly due to self-selection of my participants. However, there was

much more variation in the question regarding trade-offs. Even with a small sample my

results of 39% were quite similar (34%) to the results of the survey of Evans et al. (2005),

which had a bigger sample size.

From both surveys it is clear that although the majority of parents support

providing health education and infrastructure for physical activities (recess and

intramurals) they do not want it at the expense of time for the traditional academic

curriculum. This finding has policy implications. Some of these include not reducing time

spent providing health education and physical activity infrastructure. Furthermore, if

there is an interest in increasing these provisions, it should not come at the expense of the

time to teach traditional academic curriculum. An alterative to that reduction in current

curriculum time is to increase the total hours of school in a week, allowing for both types

of curriculum (including more time for physical activities) to be taught.

With more observations I would have regressed the choice variable Q4 (support

for school programs even at the cost of reduced traditional curriculum) on the relevant

view variable Q23 (perceptions of childhood overweight in the school), and with Q28-

Q34 being the control variables. (There are no ‘restrictions’ in this context). However due

  28  

to my small sample I instead looked at the tentative relationship between Q4 and Q23.

The correlation between these two variables was positive and significant at the 10% level.

An arguably more informative way to sketch the relationship between Q4 and Q23 is

found in Figure 4 below.

The figure also shows the positive relationship between Q4 and Q23. This can be seen by

noticing that as agreement to Q4 increases from left to right along the horizontal axis, so

does agreement increase for Q23 (the green part) and disagreement decrease for Q23 (the

red part) along the vertical axis. As parents perceive childhood overweight in the school

to be a more serious issue there is more support by parents for the school program.

0%#

10%#

20%#

30%#

40%#

50%#

60%#

70%#

80%#

90%#

100%#

Q4#.#strongly#disagree#(n=3)#

Q4#.#disagree##(n=17)#

Q4#.#neither#agree#nor#

disagree#(n=15)#

Q4#.#agree#(n=9)# Q4#.#strongly#agree#(n=13)#

Figure'4:'Support'for'healthy'lifestyle'school'programs'vs'percep7ons'on'childhood'overweight'in'school''

Q23#.#agree#(n=5)#

Q23#.#neither#agree#nor#disagree#(n=30)#

Q23#.#disagree#(n=21)#

  29  

5.2 First Willingness to Pay Question (Q5-Q7): Subsidizing Fruits and

Vegetables

5.2.1 Initial Question (Q5)

The initial question to the first WTP question, regarding a subsidy for fruits and

vegetables, has a decent amount of variation. It should be noted that at least two

participants disagreed with the statement regarding subsidizing fruits and vegetables not

because of the cost of the subsidy through the income tax but because these participants

wanted to purchase organic and/or local products instead. For another participant

avoiding Genetically Modified Organisms (GMO) was a concern. Therefore before

policy recommendations can be made it is important to do more research into the

variation in desires for fruits and vegetables. To learn whether it would be important to

subsidize local, organic and/or GMO-free varieties as well as or instead of the more

standard fruits and vegetable varieties. This policy question is not quite as

straightforward as I had believed, which is reflected in the possibly too broad WTP

question regarding subsidizing fruits and vegetables.

I divided the data into participants with children in French and in English. There

was a positive correlation for the French parents of 0.4118 between the first fruits and

vegetables subsidy question19 and the question regarding paying an extra $0.50 per lunch

to include another serving of fruits or vegetables in the PAC lunches.20 The correlation

for the English parents for the same comparison was statistically insignificant (-0.09).

Although my literature review did not specify any distinction between the views of

parents in either the French or the English programs it could be that these parents as a                                                                                                                18 Correlation of 0.41 was significant for the two-tailed test at 0.02. 19 Question 5. 20 Question 21.

  30  

group may have different attitudes to various aspects of their child(ren)’s upbringing.

This finding suggests more research is needed about parents of French immersion

children versus parents of the English stream.

The correlation between French parents and the willingness to subsidize fruits and

vegetables was the only statistically significant correlation found when correlating Q5

(the willingness to subsidize fruits and vegetables) with the sub-categories of many of the

demographics asked in my survey, such as: gender, age brackets, having children in

French versus English, whether the participants’ children were in lower grades or upper

grades, and whether all parents worked or not. In general there were almost no

statistically significant correlations found due to two limitations: many of the subsamples

were too small to achieve statistically significant correlations and some correlations were

using sections of the data that had very little variation which resulted in non-meaningful

correlations.

The two other statistically significant correlations that I found were (1) between

support for subsidizing fruits and vegetables (Q5) and support to trade-off traditional

curriculum for nutrition education and provision of physical activities (Q4) and (2)

support for subsidizing fruits and vegetables (Q5) and support for paying more for

healthier PAC lunches (Q21) (see Table 1).

  31  

With more observations I would have regressed the choice variable Q5 (support for

subsidizing fruits and vegetables) on the relevant view variable Q22 (perceptions of

childhood overweight in British Columbia), with Q28-Q34 being the control variables.

(There are no ‘restrictions’ in this context). However due to my small sample I instead

look at the relationship between Q5 and Q22 (see Figure 5 below) since the correlation is

not statistically significant.

Curriculum trade-off (Q4)

WTP fruits and vegetables subsidy (Q5)

WTP healthier school lunches (Q21)

0.2911(0.0280)*

0.0376 0.2984(-0.7814) (0.0241)*

Table 1: Correlations between Q4, Q5 and Q21 (*significant at 5%)

1

1

Curriculum trade-off (Q4)

WTP fruits and vegetables subsidy (Q5)

WTP healthier school lunches (Q21)

1

0%#

10%#

20%#

30%#

40%#

50%#

60%#

70%#

80%#

90%#

100%#

Q5#.#strongly#disagree#(n=2)#

Q5#.#disagree#(n=13)#

Q5#.#neither#agree#nor#

disagree#(n=10)#

Q5#.#agree#(n=17)#

Q5#.#strongly#agree#(n=15)#

Figure'5:'Support'for'subsidizing'fruits'and'vegetables'vs'percep8ons'on'overweight'in'Bri8sh'Columbia''

Q22#.#strongly#agree#(n=15)#

Q22#.#agree#(n=30)#

Q22#.#neither#agree#nor#disagree#(n=12)#

  32  

The figure also shows that there is a positive relationship between Q5 and Q22. As

parents perceive childhood overweight in British Columbia to be a more serious issue

there is more support by parents for the government program of subsidizing fruits and

vegetables.

5.2.2 Follow-up Questions (Q6-Q7)

When asked the initial question (Q5) whether they would support subsidizing the price of

fruits and vegetables by 10% while increasing their household's income tax by $100 per

year, 62% broadly agreed. In the corresponding follow-up question (Q7), where asked if

they still supported the statement if their household’s income tax would increase by $200,

44% of participants still broadly agreed. Of the 26% who broadly disagreed with the

initial question (Q5) 62.5% of those still broadly disagree to the corresponding follow-up

question (Q6) when their household’s income tax was lowered to $50 per year.

A majority is willing to pay $100 extra for a subsidy of fruits and vegetables, but

less than half of those would be willing to pay $200 for the subsidy. Those that disagreed

to paying the $100, a majority would still disagreed to pay even if the amount were

dropped down to $50. This suggests that although there is strong support for subsidizing

fruits and vegetables a minority is still not willing to pay for such a subsidy. One possible

explanation could be that these disagreeing participants prefer not to pay extra taxes (as

mentioned by two participants in the comment section of the survey). Another possible

reason could be that participants prefer to choose on what products to spend their income

and not be constrained by the subsidy.

  33  

As mentioned earlier, for at least some participants their disagreement with the

subsidy stemmed from their want for specific varieties of fruits and vegetables (local,

non-GMO, organic, etc.). When doing further research, possibly through more surveys, I

recommend these types of wants to be taken into consideration and incorporated in the

data collection questions. This should help avoid getting statements of disagreement that

are actually agreement to the general concept just not with the details.

5.3 Second Willingness to Pay Question (Q8-Q10): Taxing Soda and Other

Sugared Beverages

The results from the second WTP question21 were very clear. The suggestion of a 10%

tax implementation on sugared beverages and sodas was broadly agreed to by almost

90% of participants. The follow-up question regarding a tax without compensation still

had 81% broadly agree. There are several possible reasons for this result. One possible

reason that these participants are in favour of taxation is because they do not consume

these products; an income tax rebate would allow them to spend their income on products

they want to consume. A similar argument can be made for those participants that spend

less on sugared beverages and sodas in total than the income tax rebate amount. An

alternative reason could be that parents would like an incentive put in place to reduce

their purchasing of sugared beverages and sodas. To determine the optimal value of such

a tax, another survey could be undertaken with higher taxation values. Similarly one

could investigate support for investing the revenue in programs to combat obesity.

Finally, there is the question of whether a tax on sugared beverages and sodas should

                                                                                                               21 The question was: “If the government proposed taxing soda and other sugared beverages by 10%, and reduced my household’s income taxes by $25 per year, I would support this proposal.”

  34  

even be considered, as the literature suggests there may be a large substitution effect

towards non-taxed sweetened beverages thereby failing to achieve the goal of the tax,

which is to reduce BMI and the prevalence of obesity.

5.4 Possible factors for Why Some Children do not Bring Fruits and

Vegetables to School Every Day (Q12-Q17)

All participants broadly agreed with the survey question regarding whether children

should ideally bring fruits and vegetables to school in their lunches everyday. This

unanimity did not surprise me. However, when asked if this was a reality for their

child(ren) only 84% of participants broadly agreed. If the parents did not broadly agree I

asked them what were possible factors for why they did not provide their child(ren) fruits

and vegetables in their lunch every day. By far the most selected answer (i.e. 85% of

participants) was the refusal by the children to eat them. Then came the problem of too a

high a preparation time (23%), then peer pressure of alternatives being deemed ‘cooler’

(15%) and finally cost being too excessive was selected by just one participant (8%).

These findings suggest that at least for this school the cost of fruits and

vegetables for most parents is not a barrier to putting them in lunches everyday. For

most parents who do not put fruits and vegetables in the lunch every day it is the

fact that children refuse to eat them, which could be due to a lack of leverage. What

is noticeable is that as parents face restrictions they are less likely to provide fruits

and vegetables in their child’s lunch everyday (Figure 6).

  35  

The fact that price is for most parents not a restriction suggests that for

schools with many families at this income level a subsidy, although possibly

effective in encouraging parents to buy more fruits and vegetables, may not induce

those last families to provide fruits and vegetables in the lunches everyday, as price

is not the problem. How to encourage children to eat them is a whole other

problem, which a taxation or subsidy type policy may not be able to address.22

However, it could possibly be addressed by providing children more time to eat. As

one participant mentioned:

What I find is the problem is that children are not given enough time to eat their lunches and

therefore parents have to resort to pre-packaged foods and when a child is given 10 minutes

to eat lunch, they will eat the “treats” first and leave the veggies and healthy choices for last.

If lunchtime was increased to 30 minutes … I believe that we would see better eating habits

and healthier kids.

                                                                                                               22 That being said, if a school with a fair number of low-income families had been surveyed, a subsidy may have assisted the parents in providing their child(ren) with fruits and vegetables in their lunch daily.

0%#

10%#

20%#

30%#

40%#

50%#

60%#

70%#

80%#

90%#

100%#

Q15#.#disagree#(n=6)#

Q15#.#neither#agree#nor#disagree#

(n=3)#

Q15#.#agree#(n=15)# Q15#.#strongly#agree#(n=33)#

Figure'6:'Parents'who'face'restric4ons'more'o6en'do'not'include'fruits'and'vegetables'daily'in'school'

lunch'

Q16#.#no#restric@ons#

Q16#.#Face#restric@on(s)#

  36  

Time to eat lunch, or lack thereof, seems to be another constraint that influences

what parents put in their child(ren)’s lunches (not just in regard to fruits and vegetables),

that was mentioned by several parents in the comments section of the survey. As a result

of this short lunch break, some parents choose to pack a lunch that is quick to eat.

Similarly, a different participant mentioned that:

The foods given in lunches is restricted by the short time in which children are allowed to

eat, therefore options like soup or something that takes more time to eat are eliminated.

“Snacks” become the primary focus.

As part of the survey I looked at the number of adults working in the household.

The assumption was that if there is one homemaker, that he or she might have more time

dedicated to making the lunch. The difference between such a family and the ‘all parents

working’ family could be hypothesized as making a difference in what lunches the

children bring to school. For example a homemaker might have more time to spend on

making lunches and buying designated lunch ingredients. There may not necessarily be

more money to buy lunch ingredients as I hypothesized that a single breadwinner

normally would earn less than a two or more working parent household. In my survey

only 16% of participants had a designated homemaker within the family. I checked the

results on a few survey questions23 where I had hypothesized there might have been a

difference in responses, but could not find significant differences between the two

groups. This result may not be as meaningful as the 16% of participants represents only

nine participants.

In summary, although 84% of all participants indicate that they put fruits and

vegetables in school lunches everyday, those who do not, list as a reason that children do

                                                                                                               23 Q5, Q13, Q15 and Q17.

  37  

not eat the fruits and vegetables. This refusal may be due to a lack of leverage.

Presumably participants do not want the produce to go to waste. Some participants

suggested that increasing the time for children to eat their lunch might increase the

likelihood of them eating (more) fruits and vegetables. Other than that, this study did not

address how to deal with children who refuse to eat fruits and vegetables at school.

5.5 PAC Lunches (Q18-Q21)

Several participants expressed that they view the school Parent Advisory Council (PAC)

lunches as treats or not very healthy. They expressed an interest for increased healthy

options. There is also high participation (91%) among the participants with regards to the

PAC lunches, even though 83% of these participants find their own lunches healthier than

the PAC’s lunches. 73% of survey participants, not just the PAC lunch participants,

broadly agreed that they would be willing to pay an additional $0.50 per lunch, so that the

PAC lunches always include an extra serving of fruits or vegetables. Participants in the

survey do not consider the PAC lunches very healthy. As an economist this result is

noteworthy because PAC lunches are provided as a way for the PAC to fundraise, not

necessarily as a way to provide children with healthy meals. Some of the current lunches

provided include Subway sandwiches and Booster Juice with pizza. The PAC meets its

objectives of fundraising, but does not necessarily meet the desires of the

parents/guardians for healthy lunches.

Again due to a lack of observations I did not regress the choice variable Q21

(support for making the PAC lunches healthier) on the view variable Q24 (perceptions of

childhood overweight as a big issue in the respondent’s family) with Q28-Q34 being the

  38  

control variables. (There are no ‘restrictions’ in this context). But looking at the

relationship between Q21 and Q24 I do find a negative relationship (Figure 7), which can

also be found when looking at correlations however it is not statistical significant.

What I find is that as parents more strongly perceive childhood overweight to be an issue

in their family they are less supportive of making PAC lunches healthier. In other words,

as parents perceive childhood overweight to be less of a concern in their family they tend

to support more strongly making the PAC lunches healthier for a slight rise in PAC lunch

cost.

5.6 Perceptions of Parents Regarding Percentage of Children Who Have an

Unhealthy Excess Weight (Q22-Q25)

When looking at parents’ perceptions of childhood overweight as an issue in British

Columbia, in the school and in the home there is a noticeable pattern. As the issue of

childhood overweight gets closer to home, parents tend to report childhood overweight as

0%#

10%#

20%#

30%#

40%#

50%#

60%#

70%#

80%#

90%#

100%#

Q21#.#disagree#(n=5)# Q21#.#neither#agree#nor#disagree#(n=10)#

Q21#.#agree#(n=17)# Q21#.#strongly#agree#(n=24)#

Figure'7:'Support'for'healthier'PAC'lunches'vs'percep9ons'on'overweight'in'the'family'

Q24#.#agree#(n=4)#

Q24#.#neither#agree#nor#disagree#(n=2)#

Q24#.#disagree#(n=20)#

Q24#.#strongly#disagree#(n=31)#

  39  

not being a big issue. When asking about the provincial level 79% of parents indicated

that childhood overweight was a big issue. When asking about the school level 9%

indicated it was a big issue, with 40% indicating it was not a big issue. In contrast, when

asking their perceptions about their own household 7% indicated it was a big issue, but

89% said it was not. The key point to take away is that at the provincial level many of the

parents indicated childhood overweight is a big issue, at the school level many parents

are unsure and at the household level the large majority of parents indicate it is not a big

issue. This can be seen in Table 2 below.

When asked ‘what percentage of children do you think have an unhealthy excess weight

in Canada today?’ Eighty-one percent of participants chose either the correct bracketed

answer (25-34%)24 or the bracketed answer just above (35-44%) or below (15-24%) the

correct one; but only 28% chose the correct bracketed answer. It seems that the

participants have a fairly decent understanding of the magnitude of childhood obesity as

only 19% of participants picked bracketed answers that were far from the correct one.

One model I considered was that participants that had underestimated the

percentage of children in Canada with excess weight (Q25) would be less supportive of

excess weight reducing policies, such as willing to trade-off traditional curriculum for

nutrition education and provision of physical activities (Q4), willingness to subsidize

fruits and vegetables (Q5) and willingness to pay more for healthier PAC lunches (Q21).                                                                                                                24 The correct answer was 29%, as found by Statistics Canada in 2007 (Child Obesity Foundation, n.d.)

Broadly(agree Broadly(disagree Neither(agree(nor(disagreeQ22((BC) 79% 0% 21%Q23((School) 9% 39% 51%Q24((home) 7% 89% 4%Table(2:(Questions(22F24,(broken(down(into(three(response(categories

  40  

Similarly, those who overestimated the percentage of children in Canada with excess

weight (Q25) would be more supportive of such policies. Using a regression and holding

constant key demographics (gender, whether the participant’s children were in French or

English and the number of children in the participant’s family) I found no statistically

significant relationship between a participant’s perception of the percentage of children in

Canada with excess weight and the participant’s support for the three policies mentioned.

5.7 Limitations

One of the limitations in this paper is the small sample size of the data. It makes

generalizing the results difficult. The small sample size also meant that frequently I could

not divide the data into meaningful subsets. Many of the attributes did not have enough

observations, once split into groups, to be able to make reliable conclusions. Another

limitation that was discussed in section 4.2 in great detail was the elimination of half my

sample when analysing the willingness to pay follow-up questions due to an editing error.

As well, this study only reported those parents that participated in the survey. It is

possible that these participants are those who are most engaged in this issue. Therefore

they would show more awareness than is representative for the whole population. As a

consequence, the results may reflect the parents’ intentions and may not necessarily

represent the parents’ actual behaviour.

6. Conclusion

This thesis has focused on the food quality dimension of childhood obesity. It has

examined in particular the factors that impact the choices of parents regarding their

  41  

children’s school lunches. By conducting a survey at an elementary school I was able to

create a dataset of 57 responses, which proved too small for statistically significant

multiple regression analysis. Nevertheless I studied correlations among numerous

variables and provided some insights using a more qualitative approach.

One of the aims was to draw conclusions from this dataset that could be compared

to results in other studies. My study comes to the following conclusions. Compared to

Evans et al. (2005) in my dataset parents are more willing to support teaching children in

school about healthy eating and exercise habits. They are also more willing to support

these school programs even if it means a reduction in hours spent on teaching the

traditional curriculum.

The four tentative correlations I found were (1) as parents perceive childhood

overweight in the school to be a more serious issue there is more support by parents for

the school program on teaching children healthy eating and exercise habits as well as

providing physical activities; (2) as parents perceive childhood overweight in British

Columbia to be a more serious issue there is more support by parents for the government

program of subsidizing fruits and vegetables; (3) as parents face restrictions they are less

likely to provide fruits and vegetables in their child’s lunch everyday; and (4) as parents

more strongly perceive childhood overweight to be an issue in their family they are less

supportive of making PAC lunches healthier.

Contrary to my initial predictions, I found that parents perceive price not to be a

major factor in determining whether or not parents include fruits and vegetables in their

child(ren)’s school lunch. In fact, the reason provided most frequently by parents not to

include the fruits and vegetables was that the child(ren) did not eat them (suggesting a

  42  

possible lack of leverage of the parents on what the children eat), followed by too high a

preparation time. Some participants explained that for some children the fruits and

vegetables were not eaten due to a shortage of time to eat during the lunch break. They

recommended increasing the duration of the eating portion of the lunch break (the other

portion is for the children to play outside). Participants also mentioned that due to the

short eating portion of the lunch break many feel they cannot provide a slower and

typically healthier lunch, such as soup, but must instead provide more ‘snack’ like foods.

One policy suggestion would be to consider increasing the time allowed for

school children to eat their lunch. Which could increase the consumption of fruits and

vegetables and other ‘slow eating’ foods, reducing the quick snack like foods (which are

typically viewed as less healthy).

Furthermore, price was not a constraint as participants indicated willingness to

pay more for the PAC provided lunches to be healthier. Several participants mentioned

they viewed the current PAC lunches as ‘treats’. Therefore the PAC could consider

providing healthier lunches even if at a higher cost to parents. One reason the willingness

to pay question regarding subsidizing fruits and vegetables (with a corresponding

increase in income tax) did not generate as high a positive response as I had anticipated

was probably due to the broadness of the survey question (only two-thirds agreed to the

subsidy). Several participants indicated that they would have supported the willingness to

pay subsidy question if it had been a subsidy for fruits and vegetables that were organic,

GMO-free and/or local. For future research these details should be included in such

survey questions. Another reason mentioned by a couple of participants was the

unwillingness to be taxed further.

  43  

I found that participants are quite aware of the seriousness of childhood obesity

and the importance of providing a healthy lunch; participants also make a serious effort to

provide one. There is unanimous support among parents for having schools be involved

in teaching healthy eating and exercise habits; however not all parents support this at the

expense of the currently taught traditional academic curriculum. As a policy

recommendation I would suggest adding hours not replacing them if there is a desire to

provide more information about nutrition and exercise in schools.

Furthermore there was very strong support for a specific tax on sodas and other

sugared beverages. The exact amount of the tax would have to be estimated in future

research. However, the literature suggests that there is either no real effect on reducing

obesity from such a tax or that even if there is a change in behaviour it is typically a

substitution towards other sweetened beverages that are not taxed and not towards

healthier products. So whether a soda and sugared beverages tax can actually be effective

in helping to reduce obesity remains to be seen. My research has simply shown there is

generally support for such a tax; at least from the participants of my survey.

There was an interesting observation about the data concerning parents of

children in the French immersion and the English stream. The responses of parents of the

former showed a significant relationship between support for subsidizing fruits and

vegetables and support for paying more for healthier school lunches. By contrast, there

was no significant relationship among the English stream parents. As mentioned above,

more research is needed to explore the reasons for this difference.

Finally, I started off doing this research believing that to understand the obesity

problem better one could focus on food consumption. School lunches seemed a good way

  44  

to narrow down the study of meals consumed by children. I was particularly keen to learn

about the role of parents in this process. I though that if obesity was a widespread

problem we should be able to see this issue reflected in parents’ views. Yet, my research

has shown that many parents are aware of the problem. From economics we learn that

price plays an important role in determining what people buy. This research shows that

on the whole parents are willing to pay more for healthy lunches. In fact if left on their

own they would typically provide fruits and vegetables in their child(ren)’s school

lunches every day. Further research would be needed to investigate the parents who did

not participate in my study to make sure there is not some kind of bias in the sample of

parents I have researched. Moreover, this particular research method may have the

problem that there might be a discrepancy between what participants declare and what

they actually do. Therefore further research would also need to take this possible

discrepancy into account.

  45  

References

Andreyeva, T., F.J. Chaloupka & K.D. Brownell (2011). ‘Estimating the potential of

taxes on sugar-sweetened beverages to reduce consumption and generate

revenue’, Preventative Medicine, 52(6): 413-416.

Brownell, K.D. & T.R. Frieden (2009). ‘Ounces of Prevention – The Public Policy Case

for Taxes on Sugared Beverages’, The New England Journal of Medicine,

360(18): 1805-1808.

Caraher, M. & G. Cowburn (2005). ‘Taxing food: implications for public health

nutrition’, Public Health Nutrition, 8(8): 1242-1249.

Centre for Science in the Public Interest (2009). ‘Backgrounder: A National Nutritious

School Meal Program for Canadian Children’. Accessed on March 27, 2014 from

http://cspinet.org/canada/pdf/child-nutrition-backgrounder-jan2009-budget.pdf

Child Obesity Foundation (n.d.). Statistics Accessed on February 20, 2014 from

http://www.childhoodobesityfoundation.ca/statistics

Cutler, D.M., E.L. Glaeser & J.M. Shapiro (2003). ‘Why Have Americans Become More

Obese?’, The Journal of Economic Perspectives, 17(3): 93-118.

Edwards, R.D. (2012). ‘Sugar-sweetened beverage taxes raise demand for substitutes and

could even raise caloric intake’, Preventative Medicine, 54(3-4): 284-285.

Evans, W.D., E.A. Finkelstein, D.B. Kamerow & J.M. Renaud (2005). ‘Public

perceptions of childhood obesity’, American Journal of Preventive Medicine,

28(1): 26-32.

Fayter D., J. Nixon, S. Hartley, A. Rithalia, G. Butler, M. Rudolf, P. Glasziou, M. Bland,

L. Stirk & M. Westwood (2007). ‘A systematic review of the routine monitoring

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of growth in children of primary school age to identify growth-related conditions’,

Health Technology Assessment, 11(22): 1-184.

Fletcher, J.M., D.E. Frisvold & N. Tefft (2010a). ‘Can soft drink taxes reduce population

weight?’, Contemporary Economic Policy, 28(1): 23-35.

Fletcher, J.M., D.E. Frisvold & N. Tefft (2010b). ‘The effects of soft drink taxes on child

and adolescent consumption and weight outcomes’, Journal of Public Economics,

94(11-12): 967-974.

Foresight (n.d.). ‘Trends and Drivers of Obesity: A Literature Review for the Foresight

Project on Obesity’, accessed on February 6, 2014 from

http://www.bis.gov.uk/assets/foresight/docs/obesity/literature_review.pdf

Fraser Institute (2014). Comparing academic rankings and ratings of British Columbia

schools

http://britishcolumbia.compareschoolrankings.org/elementary/SchoolsByRankLoc

ationName.aspx

Gleason, P.M., A.H. Dodd (2009). ‘School Breakfast Program but Not School Lunch

Program Participation Is Associated with Lower Body Mass Index’, Journal of

the American Dietetic Association, Supplement, 109(2): 118-128.

Government of Canada (2011). Joint Action Plan for the Canada-United States

Regulatory Cooperation Council, accessed on April 18, 2014 from

http://actionplan.gc.ca/sites/default/files/japlan_eng.pdf

He (2007). ‘Are parents aware that their children are overweight or obese?’, Cam Fam

Physicians, 53(9): 1493-1499.

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Herman, D.R., G.G. Harrison, A.A. Afifi and E. Jenks (2008). ‘Effect of a Targeted

Subsidy on Intake of Fruits and Vegetables Among Low-Income Women in the

Special Supplemental Nutrition Program for Women, Infants, and Children’,

American Journal of Public Health, 98(1): 98-105.

Ikeda, J.P., P.B. Crawford & G. Woodward-Lopez (2006). ‘BMI screening in schools:

helpful or harmful’, Health Education Research, 21(6): 761-769.

Macmillan dictionary (2014). ‘Obesity’ In macmillandictionary.com. Retrieved February

6, 2014, from http://www.macmillandictionary.com/dictionary/british/obesity

Mason, C. (2012). ‘Fat tax would benefit Kiwis – study’ The New Zealand Herald.

Accessed on March 24, 2014 from

http://www.nzherald.co.nz/lifestyle/news/article.cfm?c_id=6&objectid=10853536

Millimet, D.L., R. Tchernis & M. Husain (2010). ‘School Nutrition Programs and the

Incidence of Childhood Obesity’, The Journal of Human Resources, 48(3): 640-

654.

Nihiser, A.J., S.M. Lee, H. Wechsler, M. McKenna, E. Odom, C. Reinold, D. Thompson

& L. Grummer-Strawn (2007). ‘Body Mass Measurement in Schools’, Journal of

School Health, 77(10): 651-671.

Oved, M.C. (2013). ‘Toronto schools won’t send “fat letters” home’ The Toronto Star

(August 19, 2013). Accessed on March 9, 2014 from

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  49  

Appendix

A1 List of Survey Questions

List of Questions for Survey "Parental perceptions onnutritious school lunches"

Number Question Type

Question1

I support my school teaching students healthyeating and exercise habits.

Likert Scale

Type the answer options here,separated by semi-colons

Question2

I support the Daily Physical Activity (DPA) programand physical education classes in school.

Likert Scale

Type the answer options here,separated by semi-colons

Question3

I support recess and supervised intramuralactivities in school.

Likert Scale

Type the answer options here,separated by semi-colons

Question4

I would favour directing more time in the schoolcurriculum towards school teaching studentshealthy eating and exercise habits and DPA if itmeant less time for traditional academic coursessuch as math, science, English, and social studies.

Likert Scale

Type the answer options here,separated by semi-colons

Question5

If the government proposed subsidizing fruits andvegetables, reducing their price by 10% butincreased my household's income tax by $100 peryear, I would support this proposal.

Likert Scale

Type the answer options here,separated by semi-colons

Question6

(Answer this question if you disagreed withquestion 5, otherwise skip to the next question): Iwould support subsidizing fruits and vegetables,reducing their price by 10% but increasing myhousehold's income tax by $50 per year?

Likert Scale

Type the answer options here,separated by semi-colons

Question7

(Answer this question if you agreed with question 5,otherwise skip it): I would support subsidizing fruitsand vegetables, reducing their price by 10% butincreasing my household's income tax by $200 peryear?

Likert Scale

Type the answer options here,separated by semi-colons

Question8

If the government proposed taxing soda and othersugared beverages by 10%, and reduced myhousehold’s income taxes by $25 per year, I wouldsupport this proposal.

Likert Scale

Type the answer options here,separated by semi-colons

Question9

(Answer this question if you disagreed withquestion 8, otherwise skip to the next question): Iwould support the tax on soda if my household’sincome taxes were also reduced by $50.

Likert Scale

Type the answer options here,separated by semi-colons

Question10

(Answer this question if you agreed with question 8,otherwise skip it): I would support the tax on sodaif my household's income taxes did not change.

Likert Scale

Type the answer options here,separated by semi-colons

Question11

Now the questions will focus on your child’s schoollunch.

Insert a statement that does notrequire an answer

Type the answer options here,separated by semi-colons

Question12

I always ensure my child takes a nutritious lunch toschool.

Likert Scale

Type the answer options here,

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Question13

I feel confident I know what a nutritious lunch is. Likert Scale

Type the answer options here,separated by semi-colons

Question14

Ideally my child(ren) should have fruits orvegetables in their lunch every day.

Likert Scale

Type the answer options here,separated by semi-colons

Question15

My child(ren) bring(s) fresh fruits and vegetablesto school every day.

Likert Scale

Type the answer options here,separated by semi-colons

Question16

If disagree with the previous question, what aresome of the restrictions? (choose all that apply)

Multiple Checkbox

Cost is excessive; Preparation time istoo high (not convenient); Childrefuses to eat them; Peer pressures(e.g. fruits and vegetables aredeemed ‘less cool’ than alternatives)

Question17

In our household lunch is made in consultationwith my child.

Likert Scale

Type the answer options here,separated by semi-colons

Question18

My child(ren) participate(s) in the Parent AdvisoryCouncil (PAC) lunch program.

Likert Scale

Type the answer options here,separated by semi-colons

Question19

I find my own homemade lunches are morenutritious than the PAC's lunch program optionsthat I (would) choose.

Likert Scale

Type the answer options here,separated by semi-colons

Question20

I always choose the most healthy lunch options ofthe PAC’s lunch program.

Likert Scale

Type the answer options here,separated by semi-colons

Question21

I would be willing to pay an additional $0.50 perlunch, so that PAC lunches always include an extraserving of fruits or vegetables.

Likert Scale

Type the answer options here,separated by semi-colons

Question22

Childhood overweightness is a major issue inBritish Columbia.

Likert Scale

Type the answer options here,separated by semi-colons

Question23

Childhood overweightness is a major issue in mychild’s school.

Likert Scale

Type the answer options here,separated by semi-colons

Question24

Childhood overweightness is a major issue in myfamily.

Likert Scale

Type the answer options here,separated by semi-colons

Question25

What percentage of children do you think have anunhealthy excess weight in Canada today? (selectone)

Multiple Choice

<5%; 5-14%; 15-24%; 25-34%; 35-44%; 45-54%; 55-64%; 65-74%;75-84%; 85-94%; >95%

Question26

(optional) Please provide an example of yourchild’s typical school lunch?

Long Answer

Type the answer options here,separated by semi-colons

Question If you feel comfortable could you please answer Insert a statement that does not

  51  

  52  

A2 Human Ethics Approval

  53  

A3 School Board Approval