Two years ago, the Center for Health and Health Care in Schools surveyed its web site users about “what’s happening” at their school concerning nutrition, physical exercise, and obesity prevention. In October 2005, the Center re-posted the survey to learn if things have changed or remained the same. The survey, posted on the site from October through July 2006, received 1,177 responses. The earlier survey, October 2003 – January 2004, received 1,005 responses. The following paragraphs describe results from the 2005/2006 survey, with comparisons to the 2003/2004 survey.

In brief, our comparisons showed some areas of positive change as well as areas of little change.

  • The number of respondents reporting that school efforts to improve the nutritional quality of food at school increased from 38% in 2003/2004 to 49% in 2005/2006. A much smaller number of respondents reported increases in PE and recess time. Fourteen percent reported their schools as taking actions to increase PE compared to 11% two years earlier and 10% reported their schools as increasing recess compared to 7% two years earlier.
  • A smaller number of respondents reported their schools were improving nutrition by changing lunch menus, reducing access to vending machines, changing vending machine selections, and extending the lunch period. Ten percent fewer respondents reported that their schools were increasing physical activity through sports teams and intramural activities.

The following paragraphs summarize the 2005/2006 survey results, with comparisons to the 2003/2004 survey.

Professions. From October to July 2006, 1,177 web site visitors filled out the survey. 65% of respondents described themselves as school nurses, 12% were teachers, 4% school-based health center staff, 4% school administrators, and 14% “other.” In 2003, 1,005 responded to the survey with respondents identifying themselves as follows: 57% school nurses, 14% teachers, 11% school administrators, 6% school-based health center staff, and 11% “Other”. Table 1.

Table 1. Survey Respondent Characteristics

2003/2004 Survey
% respondents
2005/2006 Survey
% respondents

School nurse

57% 65%

Teacher

14% 12%

Counselor

1% 1%

SBHC staff member

6% 4%

School administrator

11% 4%

Other

11% 14%

 

View a complete description and summary of the 2003/2004 survey results.

Location of School

In the 2005/2006 survey, 40% of respondents worked at suburban schools, 37% worked in rural schools, and 24% in urban schools. Twenty-eight percent of respondents were located at elementary schools, 26% were in high schools, and 17% were in middle or junior high schools. Twelve percent described themselves as located in K-12 schools and 6% were in K-8 schools. Eleven percent described their locale as “other.” See Table 2. While the school locations of survey respondents are similar in the two surveys, there were significantly more high schools and fewer elementary schools represented in the 2005/2006 survey.

Table 2. Geographic location and type of schools

2003/2004 Survey
Percent of respondents
2004/2005 Survey
Percent of respondents
Geographic location of schools
Suburban 38% 40%
Rural 33% 37%
Urban 30% 24%
Type of schools
Elementary 43% 28%
Middle/junior high 16% 17%
High School 15% 26%
K – 12 School 11% 12%
K – 8 School 6% 6%
Other locale 9% 11%

Seventy-seven percent of respondents were employed in schools, 23% were not.  Fifty-four percent of respondents were employed full-time in one school; 15% were part-time in two or three schools, 8% were part-time in four or more schools, and 23% were not employed at a school location. The 2003 survey data reported nearly identical results for employment status.

Is obesity a concern in respondents’ school community?

The survey asked if obesity was a concern in the respondent’s community and whether efforts were being made to improve the nutritional quality of snacks and meals at schools. In response to the initial question, there was no increase in the number of respondents who said obesity was a concern in their school community. However, over the past two years there has been an increase in both the awareness about childhood obesity and in the activities to improve the nutritional quality of meals and snacks for students. There has been an 11% increase in the number of respondents who reported that significant efforts are being made at schools to improve the nutritional quality of meals and snacks available to students. Also, school staff supporting these efforts has increased by 5%. These data suggest that within the school environment, while there has not been a significant increase in perception that the school community as a whole is concerned about childhood obesity, school staff members are reported as markedly more interested in the topic than two years previously. There also appears to be an increase in the importance of keeping children healthy by providing more nutritional meals and snacks.

Table 3. Obesity concern in school community

Questions Answers
1 = Yes, a lot; 10 = No, not much
1-2
3-4
5-6
7-8
9-10
Is obesity a concern in your community? 2005/2006 Survey
27%
27%
18%
17%
11%
2003/2004 Survey
24%
27%
21%
18%
11%
Are efforts being made in your school to improve the nutritional quality of meals and snacks available to students? (N=994) 2005/2006 Survey
25%
24%
17%
17%
17%
2003/2004 Survey
15%
23%
21%
18%
23%
Do school staff support efforts to improve nutritional quality of meals and snacks, for example, reduce fat and/or caloric content or replace sugared drinks with water or 100% juices?
(N=1164)
2005/2006 Survey
21%
23%
21%
17%
17%
2003/2004 Survey
16%
25%
22%
18%
20%
Do parents support efforts to improve nutritional quality of meals and snacks, for example, reduce fat and/or caloric content or replace sugared drinks with water or 100% juices?
(N=1157)
2005/2006 Survey
11%
19%
33%
23%
14%
2003/2004 Survey
9%
21%
31%
23%
17%

Nutrition activities

Survey respondents were asked whether their schools had adopted nutrition improvement strategies as a way to combat childhood overweight in school years 2002/2003 and 2004/2005. As indicated in Table 4, 2004/2005 data indicate a decrease in four of six nutrition-improving activities (changing lunch menu, reducing access to vending machines, changing vending machine selections, and extending lunch period). Two categories, removal of vending machines and changing foods sold at school events, increased very slightly.

Table 4. School actions undertaken to improve nutrition

Improved Nutrition
2003/2004 Survey
Activities undertaken in school year: 2002/2003

(N=734)*
2005/2006 Survey
Activities undertaken in school year: 2004/2005

(N=1596)*
Changed lunch menu/choices 48% 35%
Reduced access to vending machines 31% 22%
Changed vending machine selections 28% 22%
Changed food/drinks sold at school events or door-to-door 9% 10%
Removal of vending machines 7% 9%
Longer lunch periods 4% 2%

*Respondents were able to select multiple answers

Physical activity

The survey also asked whether the respondents’ schools had undertaken activities to increase physical activity at schools. As Table 5 indicates, there were few differences between responses in 2003/2004 and those in 2005/2006. From both surveys, nearly a third of respondents reported that schools encouraged walking and biking to schools. While 31% of respondents reported efforts to increase sports teams and intramural activities in 2003/2004, only 21% reported such efforts in 2005/2006.

Table 5. School actions undertaken to increase physical activity

Increased Physical
Activity
2003/2004 Survey
Activities undertaken in school year: 2002/2003

(N=734)
2005/2006 Survey
Activities undertaken in school year: 2004/2005

(N=949)
Promoting walking/biking to school 29% 27%
Changed PE curriculum 30% 29%
Increase in sports teams, intramural activities 31% 21%
Increased PE time 11% 14%
Increased recess time 7% 10%

Barriers to Promoting Physical Activity and Improving Nutritional Activity in Schools

Survey participants were asked about barriers at school to promoting physical activity and improving nutritional activity at schools. This open-ended question allowed respondents to list several barriers. Thirty-six percent of respondents said that money and teachers’ contracts were the biggest barriers, followed by time (32%), attitudes by students (10%), vendor contracts (9%), and parents (9%) and school administrators’ attitudes (3%). (Table 6).

Table 6. Barriers to promoting physical activity and improving nutritional activity

Barriers Percent and number of responses
Survey 2003/2004*
Percent and number of responses
Survey 2005/2006
Money
27% (41)
35% (400)
Teacher’s contracts
1% (15)
Time
19% (29)
32% (371)
Vendor contracts
17% (25)
9% (100)
Student attitudes
15% (22)
10% (119)
Parent attitudes
22% (33)
9% (101)
School administrators attitudes
3% (38)
Total
100% (150)
100% (1144)

*Respondents were able to select multiple answers; For Survey 2003/2004, only 100 survey questionnaires were randomly selected for analysis.

Prevention activities

Survey participants were asked about their time spent on prevention activities such as classroom presentations, individual and group counseling, and learning new skills to improve knowledge and behaviors towards physical activity and nutrition. Nearly 70% of participants reported spending up to 20% of their time on such activities. As indicated in Table 7, the amount of time spent on prevention work has remained relatively the same over the past two years.

Table 7. Time allocated to prevention work

% of Time
% of Respondents % of Respondents
2003/2004 Survey 2005/2006 Survey
1 – 20% 65% 65%
21 – 40% 18% 20%
41 – 60% 6% 7%
61 – 80% 5% 4%
81 – 100% 7% 44%

Discussion

Within the last few years, there has been growing attention to the childhood obesity epidemic and the role schools should play in reversing the trends. While survey results indicate that the awareness of childhood obesity within the school community has remained constant during the last two years, efforts to improve nutrition at schools have increased. School staff and parents have supported efforts to improve the nutritional quality of meals and snacks available to students. While Table 3 shows the increase of support for more nutritious food in school, Table 4 suggests a decrease in schools changing the lunch menu, reducing access to vending machines, and changing vending machine selections. The decrease may reflect earlier efforts to improve nutrition at school. A number of schools and school districts have already addressed the vending machine issue by either limiting access to vending machines or changing vending machine selections to healthier options. For information on state legislation on vending machines, nutritional standards for schools, physical activity requirements and other policy options for addressing childhood obesity, please go to: http://www.ncsl.org/research/health/childhood-obesity-legislation-2013.aspx

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These survey data complement an August 2005 brief survey conducted by the Center on the types of health services schools provided to students and their families to address childhood obesity. In this survey, nearly 70% of respondents reported that their school provided classroom education about healthy eating and physical activity. Forty-eight percent of respondents said that their schools provided one-on-one guidance about healthy eating and physical activity. Other health services provided to students and their families included measuring student’s BMI, reporting BMI to student’s family and physician, and working with providers and families to help overweight students and those at risk to become more active and adopt healthy eating habits. For complete survey results, please visit www.healthinschools.org/sh/overweight.asp.

Acknowledgment
The Center would like to thank those who participated in filling out this survey. We encourage others who have not filled out the survey to do so. The survey can be found at http://www.healthinschools.org/obesitysurvey.asp.

Related Links:

Issue Brief: The Role of School Health Professionals in Preventing Childhood Overweight
Childhood Overweight: What the Research Tells Us
Keeping Kids Healthy: Overweight, Nutrition & Physical Exercise