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Assessment of Dietary Pattern in Primary Schools 2008

Part 1 – Questionnaire Survey of

Students, Parents and Schools

Central Health Education Unit Centre for Health Protection

Department of Health

July 2009

Copyright of this report is held by the Department of Health

Assessment of Dietary Pattern in Primary Schools 2008 – Part 1

Table of Contents

Executive Summary i Chapter 1: Introduction 1 1.1 Background 1 1.2 Objectives of the Study 2 1.3 Study Components 2 Chapter 2: Research Methodology 3 2.1 Study Design 3 2.2 Study Population 3 2.3 Selection and Recruitment of Primary Schools 3 2.4 Selection and Recruitment of Students and Parents 5 2.5 Ethics 5 2.6 Assessment Tools 5 2.7 Pilot Study 5 2.8 Data Collection 6 2.9 Fieldwork Period 6 2.10 Quality Control 7 2.11 Data Analysis 7 Chapter 3: Descriptive Results 9 3.1 Results of Questionnaire Survey of Students 9 3.2 Results of Questionnaire Survey of Parents 21 3.3 Results of Questionnaire Survey of Schools 39 Chapter 4: Analytic Results 51 4.1 Analytic Findings from the Student Questionnaire 51 4.2 Analytic Findings from the Parent Questionnaire 76 4.3 Analytic Findings from the School Questionnaire 99 4.4 Results of Stepwise Logistic Regression 101 Chapter 5: Comparison between the Survey on Healthy Eating in Primary Schools 107 (2006) and the Current Survey (2008)

5.1 Comparison of the Participating Schools 1075.2 Comparisons of the Questionnaire Findings 108


Chapter 6: Discussion and Conclusion 114 Chapter 7: Recommendations 118 References 119 Acknowledgements List of Tables List of Charts Annex


Executive Summary

Introduction A rising trend of obesity has been observed among primary school students, increasing from 16.4% in 1997/98 to 21.3% in 2006/07. In the light of this rising trend, a study titled ‘Baseline Assessment of Promoting Healthy Eating in Primary Schools’ (‘the Baseline Assessment’) was conducted by the Department of Health (DH) in the first quarter of 2006 to identify the needs of schools, students and their parents in healthy eating promotion. Findings from the Baseline Assessment were used in the formulation of intervention strategies for the [email protected] Campaign launched since 2006. In order to describe changes in primary schools’ nutritional environment and awareness, knowledge, attitudes and practices among students and parents on healthy eating, this “Assessment of Dietary Pattern in Primary Schools” (‘the Study’) was conducted by the DH in December 2007 to January 2008. The objectives of part 1 of the Study were:

(a) to assess the knowledge, attitudes and practices of primary school students in healthy eating; (b) to assess the attitudes of parents towards promotion of healthy eating in school, considerations

and practices in choosing food for their children, and their own eating and cooking habit; (c) to understand the nutritional environments in primary schools, including healthy eating

policies, their monitoring mechanism, school lunch and snacks provision; and (d) to describe the changes in the primary schools’ nutritional environment and the awareness,

knowledge, attitude and practice among students and parents on healthy eating by comparing findings with those of the Baseline Assessment in 2006

Methodology Primary 4 and Primary 5 students, their parents and principals / school representatives of primary schools in Hong Kong were selected to participate in the Study by stratified cluster sampling method. A total of 51 schools were drawn in proportion to the number and funding types of schools from 18 districts. Three sets of self-administered questionnaires for students, parents, and principals / school representatives were used in the Study. The Study was carried out between January and February 2008. A total of 11180 sets of questionnaires for students and parents were distributed. And 9152 for students and 8265 for parents were returned with response rates of 81.9% and 73.9% respectively. By successfully matching the 7921 student, parent and school questionnaires, comparative analysis was conducted to assess the associations between student, parent and school parameters.

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Key Findings Demographics Of all students participating, 48.0% were Primary 4 and 45.7% were males. Majority (77.6%) of parent respondents were mothers. Among parents, 58.6% attained secondary education level or above and 21.4% had a monthly household income of less than $10,000. Among participating schools, 70.6% were Government or Aided primary schools. Nearly four-fifths (78.4%) were whole-day schools. Students Knowledge, Attitude, Perception and Practice Findings from the current study showed that students possessed good knowledge of healthier food options did not necessarily synchronise with what they chose in food preference. When choosing food, students considered ‘cleanliness and hygiene’, ‘good for health’ and ‘taste’ the key factors. While most students perceived their eating habits as ‘healthy’ or ‘acceptable’, 9.8% to 25.6% reported that they did not have any fried/deep-fried food, food high in fat / sugar / salt, or drinks with added sugar in the week prior to the survey. Compliance with the recommended intake of fruit, dairy products and vegetables by the students was 57.5%, 77.4% and 78.7%, respectively. Behavioural Change Compared with the 2006 baseline data, positive changes were noted in students’ preference for healthier food choices, consumption of vegetables and dairy products, and reduced consumption of high fat, high salt or high sugar food / drinks. There was a statistically significant increae in the rate of skipping breakfast on the day of the survey as compared with the 2006 baseline data. Gender Difference A marked gender difference was observed in healthy eating knowledge, attitude, perception and practice with girls performing better in most aspects. Girls were more knowledgeable about the healthier food options and could meet the recommended intake of fruit and vegetables better than boys. In addition, boys were more likely to skip breakfast. At the same time, girls who were aware of the [email protected] campaign, were more supportive of healthy eating promotion in school and were more likely to have participated in school-based healthy eating promotion

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activities. Modifying Factors Children’s positive knowledge of healthy food choices was directly associated with parental education level, household income, parental knowledge of healthy eating, and parental support for schools to impose nutritional requirements on tuck shop sales and school lunch. Schools played an important role in fostering students’ food preference and healthy eating habits. Students who were aware of the [email protected] campaign, and students who supported or participated in healthy eating promotion in school were more likely to have healthy food preference and eating habits. Respondents studying in School NutriAgent Project (SNAP) schools were also more likely to take healthier food choices.

Parents Knowledge About 70% of parents were familiar with general knowledge on healthy eating but a smaller proportion was familiar with snack categorisation. Parents with higher education level, household income or with children studying in DSS & private schools did better in the knowledge part of the survey. Meanwhile, parents who expressed a higher degree of support for imposing nutritional requirements on tuck shop sales or school lunch, parent who were aware of [email protected] campaign and parents who had participated in healthy eating activity in the schools also possessed better knowledge. At the same time, parents’ general healthy eating knowledge were positively associated with children’s general healthy eating knowledge, children’s awareness of and participation in healthy eating promotion activities in schools. Perception While most students (91.4%) perceived their eating habit as ‘healthy’ or ‘acceptable’, only 71.0% of parents perceived their children’s eating habit as ‘healthy’. Over half of responding parents thought that healthy eating habits were difficult to sustain. Parents with higher education level, higher household income, better knowledge in snack categorisation, children perceiving their eating habit as ‘unhealthy’, or both parents and children not participating in school-based healthy eating activities were factors associated with parents’

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perception that healthy eating habits were difficult to sustain. These parents were more likely to demand more knowledge or support for healthy eating. On the contrary where supportive factors existed in schools, such as establishment of healthy eating school policies and membership of SNAP, more parents felt healthy eating were easier to sustain. Imposing Nutritional Requirements on Food Served in School Overall, majority of parents (ranged from 61.3% to 92.1%) indicated support for imposing nutritional requirements on tuck shop sales and school lunch. A significant increase in support as compared with that from the 2006 baseline data was noted. Parents with higher education level, higher household income, parents who were aware of DH healthy eating campaign in school, or parent who had participated in healthy eating activities in the school showed a higher level of support for nutritional requirements. On the contrary, parents showed a high level of support for nutritional requirements on tuck shop sales and lunch when their children studied in a school without any form of healthy eating promotional activity or did not join SNAP. Decision-making Parents were the major decision maker on food choices at home. When choosing food for children, parents considered ‘nutritional value’ and ‘cleanliness and hygiene’ were the two most important factors. This study also found that 30.8% children dined out in the evening 2 to 4 times per week. Schools Eating Environment All whole-day schools arranged lunch for their students. Tuck shops and vending machines were provided in 35.3% and 58.8% of schools respectively. Teachers were the key decision maker in lunch choices, followed by parents. Schools reported ‘nutritional value’ and ‘food safety’ as their top two considerations for choosing food for lunch, consistent with parents’ wishes. Healthy Eating Policy Although nearly all schools agreed that healthy eating was important for school education and student development, only 53.0% of them had developed their healthy eating school policy.

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Where policies existed, they focused primarily on school lunch, followed by snacks. SNAP schools were more likely to develop healthy eating school policies. Use of Nutritional Guidelines A significant gap existed between awareness and incorporation of lunch and snacks nutritional guidelines in the school setting. While most schools were aware of the guidelines (lunch guidelines: 92.2%; snacks guidelines: 82.4%), only a proportion of them had incorporated into their contract with food suppliers (lunch: 70.7%; tuck shop: 50.0%; vending machines: 40.9%). School Type Compared with DSS and private schools, many more government and aided schools participated in healthy eating promotion activities (91.7% vs 46.7%) or took part in SNAP (47.2% vs 6.7%). Impact of [email protected] Campaign On schools About 68.6% of responding schools had participated in at least one DH healthy eating promotion activity, with the Fruit Day being the most popular. About one-tenth (9.8%) of the schoolsreported that they had participated in activities organised by organisations other than DH to promote healthy eating in school. On the other hand, 21.6% schools had not taken part in any healthyeating promotion activity during the period of study.

On Students Of all responding students, 72.7% supported healthy eating promotion at school but only 15.7% could recall participating in any of the healthy eating promotional activities. About 56.4%students were aware of the [email protected] campaign. Students’ awareness of healthy eating, their support for healthy eating promotion in school and their participation in school-based healthy eating campaign were inter-related, and the cause and effect could not be readily discerned.

On Parents About 55.9% of parents responded that they were aware of the [email protected] campaign. Parents’ participation in healthy eating promotion activities organised by the school was low at 7.6%. Participation rate increased with parents’ education level, household income, and degree of support for imposing nutritional requirements on tuck shop sales and school lunch.

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Parents’ Satisfaction Among parents who were aware of the [email protected] campaign, 3.5% expressed dissatisfaction and 22.2% rated it as ‘fair’. Their reasons included ‘school lunch caterers and tuck shop contractors had not been mandated to follow and implement nutritional guidelines on lunch and snacks’, ‘not all schools had participated in the campaign’, ‘students’ knowledge had increased but was not sufficient to change behaviour’ and ‘lack of parents’ involvement’. Parents who had higher education level, higher household income, better knowledge of general healthy eating and snack categorisation, and higher degree of support for imposing nutritional requirements on tuck shop sales or school lunch were more likely to express dissatisfaction towards the campaign. On the contrary, parents with children studying in government and aided schools, schools with healthy eating policies, schools participating in a healthy eating promotion activity or schools taking part in SNAP showed a higher degree of satisfaction towards the campaign.

Recommendations 1. The [email protected] Campaign made a positive impact on improving knowledge,

attitudes and practices in healthy eating among students. Sustained government leadership and political commitment are essential for enhanced coordination and multi-sectoral action to strengthen and consolidate the Campaign.

2. The Government should work towards encouraging all schools to take an active part in the

[email protected] Campaign or similar healthy eating promotion activities. The pace and extent of school involvement would depend on individual circumstance, and DH should ensure its technical capacity and professional support could fulfill the needs of participating schools.

3. The Government should explore innovative means to inform, engage and mobilise parents for

supporting healthy eating promotion.

4. The Government should strengthen parental education to empower them with knowledge and skills in making lunch and snack choices in accordance with the DH’s nutritional guidelines on lunch and snacks.

5. The Government and academia should consider conducting research to understand the gender

difference in healthy eating knowledge, attitude and practice. It should also explore gender sensitive modes of education and ways to address boys’ need for healthy eating promotion.

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6. Schools should communicate with and engage parents more fully in healthy eating promotional

efforts, through means which are sensitive to parents’ needs and circumstances. Moreover, schools should establish and implement healthy eating policies with stakeholders according to their school situation.

7. Schools should ensure that food suppliers comply with the Nutritional Guidelines on School

Lunch for Primary School Students and the Nutritional Guidelines on Snacks for Primary School Students, to provide a supportive environment for students to practice what they have learnt.

8. Parents should work closely with schools to continuously support children’s healthy eating

habits.

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Chapter 1 Introduction

1.1 Background

Like many other countries in the world, the local obesity epidemic in Hong Kong is increasing. A rising trend of obesity is observed among primary school students, increasing from 16.4% in 1997/98 to 21.3% in 2007/08. This is worrying as studies have shown that obese children have a tendency to remain obese in their adulthood.1-2 Excessive energy intake through diet and low levels of physical activity are the major modifiable risk factors for obesity. Adopting a healthy eating habit is the mainstay for prevention of chronic diseases including cardiovascular diseases, diabetes, stroke, cancer, dental caries and asthma. A balanced diet is also essential for children’s physical and cognitive development. Childhood is the stage for developing attitudes and habits, at which decision-making is learned. Eating habits adopted during childhood are more likely to be maintained in adulthood. 3-4 It is therefore imperative to promote establishment of a healthy eating habit among young children. The 2005-2006 Policy Address undertook to promote healthy eating habits among school children to reduce their risk of developing chronic illness. To describe the situation and identify the needs of schools, children and their parents in healthy eating promotion, a study titled ‘Baseline Assessment of Promoting Healthy Eating in Primary Schools’ (aforesaid ‘the Baseline Assessment’) was conducted by the Department of Health (DH) in the first quarter of 2006. The study assessed the knowledge, attitudes and practices on healthy eating among primary school children, parents’ perception of their children’s eating habit, and the nutritional environments in primary schools. Findings from the Baseline Assessment were used to formulate intervention strategies for the [email protected] Campaign, a healthy eating movement organised by the DH for all primary schools since 2006. Further studies would be needed to enable better service planning and development, and subsequent evaluation. To describe changes in primary schools’ nutritional environment and awareness, knowledge, attitudes and practices among students and parents on healthy eating, the “Assessment of Dietary Pattern in Primary Schools” (aforesaid ‘the Study’) was conducted by the DH in December 2007 to January 2008. The Centre of Health Education and Health Promotion (CHEP), School of Public Health, the Chinese University of Hong Kong was commissioned to conduct the Study.

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1.2 Objectives

The objectives were: (a) to assess the knowledge, attitudes and practices of primary school students in healthy eating; (b) to assess the attitudes of parents towards promotion of healthy eating in school, considerations

and practices in choosing food for their children, and their own eating and cooking habit; (c) to understand the nutritional environments in primary schools, including healthy eating

policies, their monitoring mechanism, school lunch and snacks provision; (d) to describe the changes in the primary schools’ nutritional environment and the awareness,

knowledge, attitude and practice among students and parents in healthy eating by comparing findings with those of the Baseline Assessment in 2006;

(e) to assess the concurrence of students’ popular lunch choices with DH’s nutritional guidelines; and

(f) to assess the concurrence of students’ snack choices with DH’s nutritional guidelines. The part 1 (Questionnaire Survey of Students, Parents and Schools) of the Study was carried out in accordance with the first 4 objectives. Objectives (e) and (f) would be addressed in part 2.

1.3 Study Components

The Study included the following five components: (a) Questionnaire survey of students (b) Questionnaire survey of parents (c) Questionnaire survey of the school (d) Appraisal of tuck-shop and vending machine items (e) Physical inspection and weighting of food ingredients in the sample of the most popular lunch

choices

This report presents information and key findings of the questionnaire surveys pertaining to students, parents and schools. The results of school lunch and snack provision are summarised in a separate report.

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Chapter 2 Research Methodology

2.1 Study Design

The Study was a cross-sectional study conducted among primary schools in Hong Kong in January 2008. Only students from Primary 4 (P4) and Primary 5 (P5) were selected because students of the younger classes (i.e. from Primary 1 to 3) might find some of the questions difficult to understand or answer on their own while students of Primary 6 would be expected to be busily preparing for the entrance examination for the secondary schools. In addition, a study by the University of Hong Kong in 2002 showed that no significant difference was found among the P1 to P6 students in their dietary habit.

2.2 Study Population

Target participants of the Study included: (a) Students studying in P4 and P5; (b) Parents of the P4 and P5 students selected in (a); and (c) Principals / school representatives of primary schools at which students in (a) studied.

2.3 Selection and Recruitment of Primary Schools

A stratified cluster sampling method was used to select schools invited to participate in the Study. The sampling was based on a full list of primary schools in Hong Kong provided by the Education Bureau. Special schools were excluded from this Study. The remaining primary schools were stratified by the district (of which there were 18) and the types of financial support the schools were receiving (namely ‘government’, ‘aided’, ‘English Schools Foundation’, ‘direct subsidy scheme’ (DSS), ‘private’ and ‘private independent’). In the sampling of schools, primary schools belonged to the ‘government’ and ‘aided’ finance types were grouped under one category, whereas the remaining four finance types were grouped into another category. As such, primary schools were stratified into 36 subsets (18 districts by the aforementioned two categories of finance type). Table 2.3a illustrated the criteria for deciding the number of schools to be recruited from each subset, which was decided based on the total number of primary schools in that particular subset.

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Table 2.3a Number of schools to be recruited for the Study

Government or aided primary schools DSS or private primary schools

(including DSS, English Schools Foundation, private and private independent schools)

No. of schools in each No. of schools to be No. of schools in each No. of schools to be district recruited for the Study district recruited for the Study

14 or below 0 4 or below 0 15 – 29 1 5 – 9 1 30 – 44 2 10 or above 2

45 or above 3 Based on the above criteria, it was found that a total of 51 primary schools (6.1% of the total number of primary schools in Hong Kong) were to be recruited. Within each individual subset, schools were assigned a random number. Based on the assigned number, schools were listed in sequential order for the invitation sequence. Several batches of invitation letters were sent according to the random number of schools until the targeted number of schools in each subset was recruited successfully. Invitation letters were sent to the principals of the selected schools, inviting principals / school representatives, all the P4 and P5 students as well as their parents to take part in the Study. Table 2.3b illustrated the actual number of schools recruited in each district and the school type. Table 2.3b Actual number of schools recruited in each district School

type Government or aided primary schools

DSS or private primary schools

Central and Western 1 3 Eastern 3 0 Islands 1 0 Southern 1 2 Wan Chai 1 2 Kowloon City 2 3 Kwun Tong 2 1 Sai Kung 2 1 Sham Shui Po 2 1 Wong Tai Sin 2 0 Yau Tsim Mong 2 0 North 3 0 Shatin 3 1 Tai Po 2 0 Kwai Tsing 2 0 Tsuen Wan 1 0 Tuen Mun 3 0 Yuen Long 3 1 Total 36 15 Overall 51

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2.4 Selection and Recruitment of Students and Parents

After seeking the schools’ agreement to participate in the Study, a study brief (Annex A) together with a sample of written consent (Annex B) was sent to schools for their issuance of invitation and consent documentation to all the parents of the P4 and P5 students. For those parents who agreed to join the evaluation, they needed to return through their children the signed consent to teachers.

2.5 Ethics

Ethical approval was obtained from the Ethics Committee of DH prior to the commencement of the Study. Written consent from each student’s parent was obtained prior to his/her participation in the questionnaire survey.

2.6 Assessment Tools

Three structured bilingual (Traditional Chinese and English version) questionnaires were used for the Study: (a) Student questionnaire for all P4 and P5 students to assess their current knowledge, attitudes

and practices on healthy eating (Annex C); (b) Parent questionnaire for all the parents of P4 and P5 students to assess their current attitudes

towards the promotion of healthy eating in school, their considerations and practices in choosing food for their children, and their own eating and cooking habit (Annex D);

(c) School questionnaire for principals or school representatives to investigate the current nutritional policies and environments in their schools (Annex E).

These questionnaires were modified from the ones used in the Baseline Assessment in 2006, with some questions remaining identical or very similar.

2.7 Pilot Study

A pilot study was conducted in November 2007 to assess the clarity and comprehensibility of all the measurement tools and to test the logistics of the Study. A total of six primary schools, which were not recruited in the main Study, were invited to participate. From 15th to 28th November, a total of 56 students, 30 parents and 6 school representatives participated in the pilot study and all the measurement tools were tested for data collection (Table 2.7).

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Table 2.7 Number of subjects tested for the different measurement tools Measurement tools No. of subject tested Total

Questionnaires for students Chinese version 29

56 English version 27

Questionnaires for parents Chinese version 25

30 English version 5

Questionnaires for schools Chinese version 5

6 English version 1

Based on the feedback and comments from participants and investigators of the pilot study, measurement tools and the logistics were revised in the main Study.

2.8 Data Collection

Student and Parent Questionnaires Teachers distributed the student questionnaires to all P4 and P5 students whose parents had formerly indicated willingness for their children to participate in this study. All of them were asked to complete the self-administered questionnaire in school during a classroom session. After collecting all student questionnaires, school teachers also distributed the parent questionnaires, with paired barcode and serial number to the corresponding student questionnaire, to parents of all P4 and P5 students for completion at home. Completed questionnaires were returned to the school via the students. Afterwards, representatives from CHEP would collect all student and parent questionnaires from all participating schools. School Questionnaires School questionnaires were sent to all participating schools in December 2007 for the school representatives to complete. Professional research staff visited all participating schools in January 2008 to conduct a one-hour interview with the school representatives for verification of the provided information in the school questionnaire.

2.9 Fieldwork Period

Questionnaires for students, parents and school were distributed to the 51 schools between 2nd and 4th January 2008. Completed questionnaires of students and parents were returned and collected via the schools from 18th January to 18th February 2008. School visits for verification of provided information in the school questionnaires were conducted in January 2008.

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2.10 Quality Control

The following quality control (QC) measures were incorporated in the Study: The data collected were subjected to range checking and logical checking. Unclear and

illogical answers were recoded as invalid. Questionnaires with more than half of the questions unanswered were regarded as incomplete

questionnaire and excluded from analysis. Any missing answer in a corresponding question would be excluded from analysis.

Quality checking procedures were applied to at least 10% of the data collected prior to analysis and use.

2.11 Data Analysis

Descriptive Statistics Descriptive statistics were used to summarise the findings of the study and they were reported in frequency, percentages, means and standard deviations (SD), wherever appropriate. Some percentages in the descriptive figures might not add up to the total or 100% because of rounding. Moreover, the sample bases for each question might vary due to the missing answers. Analytic Statistics Three types of statistical tests were used for sub-group analysis in this Study, namely Pearson chi-square test, Kruskal-Wallis test (KW test) and Spearman’s rank correlation. When both variables were nominal, the chi-square test was used. When one variable was nominal and the other was ordinal, the Kruskal-Wallis test was adopted. Spearman’s rank correlation was performed when both variables were ordinal. Univariate odds ratio (OR) with 95% confidence interval (CI) were also shown where appropriate. Stepwise logistic regression model was employed to explore the relationships between the variables in multivariate condition using the significant factors obtained in the univariate analyses. Adjusted OR with 95% confidence interval of the factors remaining in the final model were presented. All statistical analyses were performed using SPSS for Windows version 13.0 and a p-value <0.05 was taken to indicate a level of statistical significance. Data from certain questions of the student, parent and school questionnaires in this Study were compared with corresponding data in the Baseline Assessment (Table 2.11). Chi-square test was used for comparison of significant differences.

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Table 2.11 List of questions in the Study (2008) for comparison with the Baseline Assessment (2006)

Questionnaire Question

Student

Students’ knowledge on healthier choices Students’ food preference Students’ breakfast-eating habits Students’ general eating habits Students’ self-perceived eating habits

Parents

Parents’ perception of child’s eating habits Parents’ agreement to impose nutritional requirements on school tuck shop Parents’ agreement to impose nutritional requirements on school lunch Parents’ perception of ease to sustain healthy eating habits

School Establishment of healthy eating policies at school

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Chapter 3 Descriptive Results

3.1 Results of Questionnaire Survey of Students

A total of 11180 copies of questionnaire were distributed to students in 51 participating schools by the teachers. A total of 9152 copies of completed questionnaires were collected with a response rate of 81.9%. Of the questionnaires collected, 17 questionnaires were rejected as more than half of the questions in these questionnaires were unanswered. The remaining 9135 (81.7%) student questionnaires were used for further analysis.

3.1.1 Demographics

The demographic characteristics are summarised in Table 3.1.1. Around half (48.0%) of the respondents were studying in P4 and 45.7% were males. More than 70% of students were studying in government or aided primary schools, and 74.2% of students were attending whole-day schools. Majority of the students (86.4%) were studying in co-educational schools and nearly 40% were from schools located in the New Territories. Table 3.1.1 Demographic background of students

Variables No. of students % Grade of study (n=9135)

Primary 4 4384 48.0%Primary 5 4751 52.0%

Gender (n=8611)Male 3934 45.7%Female 4677 54.3%

School type of funding (n = 9135)Government or aided primary school 6610 72.4%DSS or private schools 2525 27.6%

School mode (n=9135)Whole-day school 6778 74.2%Mixed-mode school 1480 16.2%Half-day school 877 9.6%

School type (n=9135) Co-educational school 7892 86.4%Girls’ school 978 10.7%Boys’ school 265 2.9%

School district (n = 9135)Hong Kong 2341 25.6%Kowloon 3173 34.7%New Territories 3621 39.6%

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3.1.2 Descriptive Data

3.1.2.1 Students’ knowledge of healthier food choices

Students were given six pairs of food ordrinks and asked to choose the relatively healthier choices among each pair. In general, knowledge on healthy food choice was good (mean number of correct answers was 5.67 out of 6) (Table 3.1.2.1). Majority of students (ranging from 89.6% to 97.3%) could identify correctly the relatively healthier choices among the six pairs of foods or drinks (Chart 3.1.2.1). Chart 3.1.2.1 Proportion of students correctly answered the questions regarding knowledge of

healthier food choice (Questions S9a to S9f)

89.6%94.3% 97.3% 94.6% 94.6% 95.5%

10.4%5.7% 2.7% 5.4% 5.4% 4.5%

soya saucedrumstick

pure orangejuice

raisin whole-meal bread

yogurtspaghetti withfresh tomatoes

chicken ricewith vegetables

Group FGroup A Group B Group C Group D Group E

deep-frieddrumstick

carbonateddrinks

hot dog ice-cream Hamburgerwith fries

Healthierchoices

Unhealthierchoices

fried rice noodleswith beef

Base: Group A 8874; Group B: 8967; Group C: 8960;Group D: 8923; Group E: 8922; Group F: 8903

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Table 3.1.2.1 Number and percentage of students correctly answered the questions regarding knowledge of healthy food choices (Questions S9a to S9f)

Number of correct answers No. of students % 0 – 2 248 2.9% 3 – 4 325 3.8% 5 – 6 8169 93.4%

Mean (95% CI) 5.67 (5.65 - 5.69) SD 0.96

Base: All respondents who answered S9a to S9f =8742

3.1.2.2 Students’ knowledge of general healthy eating messages promoted by DH

70.8% to 87.4% of the students correctly answered the questions on the three general healthy eating messages promoted by DH (Table 3.1.2.2a). The mean number of correct answers given by students was 2.29 out of 3 (Table 3.1.2.2b). Table 3.1.2.2a Proportion of students correctly answered the general healthy eating messages

promoted by DH (Questions S4, S5 & S6)

Healthy eating messages promoted by DH No. of

students %

The type of food should be provided most by a healthy lunch box is grains (related message: 3:2:1 lunch box ingredient proportions)

6134 70.8%

The ingredient that should be present as 'High' in content in the '3 Low, 1 High' message refers to the amount of fibre (related message: 3 Low 1 High)

6723 75.3%

The recommended servings of fruit and vegetables are “2” and “3” respectively. (related message: ‘2+3’ campaign for the promotion of fruit and vegetables)

7758 87.4%

Base: for “3:2:1” = 8669; for “3 Low 1 High” = 8923;, for “2+3” = 8873

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Table 3.1.2.2b Number and percentage of students correctly answered the general healthy eating messages promoted by DH (Questions S4, S5 & S6)

Number of correct answers No. of students % 0 – 1 1497 16.6% 2 3084 34.2% 3 4429 49.2%

Mean (95% CI) 2.29 (2.27 – 2.31) SD 0.83

Base: All respondents who answered S4 to S6 =9010

3.1.2.3 Students’ food preferences

Using the same six pairs of food/drinks listed in questions asking about the students’ health knowledge, students were asked to choose the one they preferred in each pair. Around half to two-third of students (45.5% to 68.0%) preferred the healthier choices among the pairs (Chart 3.1.2.3). These percentages were in general lower than the prevalence of students who correctly identified the healthy choices when their knowledge was tested. For instance, despite the fact that most of the students knew raisin whole-meal bread, chicken rice with vegetables, and spaghetti with fresh tomatoes were healthier options, less than half expressed they preferred eating these food items. The average number of healthier choices selected by the students was only 3.25 out of 6 (Table 3.1.2.3).

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Chart 3.1.2.3 Eating preference of students (Questions S1a to S1f)

35.4%

53.4% 49.7% 50.9% 54.5%

64.6% 68.0%

46.6% 50.3% 49.1% 45.5%

32.0%

soya saucedrumstick

pure orangejuice

raisin whole-meal bread

yogurtspaghetti withfresh tomatoes

chicken ricewith vegetables

Group FGroup A Group B Group C Group D Group E

deep-frieddrumstick

carbonateddrinks

hot dog ice-cream Hamburgerwith fries

fried rice noodleswith beef

Healthierchoices

Unhealthierchoices

Base: Group A 9012; Group B: 9017; Group C: 8952; Group D: 9036; Group E: 8988; Group F: 9015

Table 3.1.2.3 Percentage of choosing healthier food choices (Questions S1a to S1f)

Number of healthier choices No. of students % 0 – 2 3222 36.7% 3 – 4 3010 34.2% 5 – 6 2554 29.1%

Mean (95% CI) 3.25 (3.21 – 3.29) SD 1.85

Base: All respondents who answered S9a to S9f =8786

3.1.2.4 Matters for consideration in choosing food by students

When choosing food, students considered cleanliness and hygiene (74.4%), good for his/ her own health (66.3%), taste (66.2%), and price (51.1%) as the four most important factors in decision making (Table 3.1.2.4).

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Table 3.1.2.4 Consideration in choosing food (Question S10) Matters for consideration No. of students %

Cleanliness and hygiene 6667 74.4% Good for own health 5942 66.3% Taste 5930 66.2%Price 4580 51.1% Freshness 4269 47.6% Easy to get 1766 19.7% Preference of parents 1141 12.7% Choice of other schoolmates 307 3.4%

Base: All respondents = 8964

* Remarks: multiple answers allowed

3.1.2.5 Students’ perceived eating habits

Majority of the students considered themselves having a very healthy, healthy or acceptable eating habit (91.4%), whereas only 3.7% considered their eating habits as unhealthy or very unhealthy (Chart 3.1.2.5). Chart 3.1.2.5 Students’ perception of their own eating habit (Question S11)

Don't k

Acceptable 39.5%

now 4.8%

Very unhealthy 1.0%

Healthy 39.6%

Very healthy 12.3%

Unhealthy 2.7%

Base : All respondents = 8878

14


3.1.2.6 Students’ habit of taking breakfast

More than 84% of the students reported that they had breakfast on the day of survey (Chart 3.1.2.6). For those who did not have breakfast on the survey day, majority reported that inadequate time (40.8%), not used to having breakfast (23.9%) and no appetite (21.2%) to be the reasons (Table 3.1.2.6). Chart 3.1.2.6 Students’ breakfast eating status on the day of survey (Question S2)

Have not takenbreakfast

15.3%

Have takenbreakast84.7%


Table 3.1.2.6 Reasons for not having breakfast (Question S2)

No. of students %

Not having enough time 542 40.8

Not used to having breakfast 318 23.9

No appetite 282 21.2

No one prepared breakfast for him/her 75 5.6

On diet 38 2.9

To save money 24 1.8

Other reasons 50 3.8 Base: All respondents who did not had breakfast on the day of survey= 1329

3.1.2.7 Lunch provision and satisfaction

Around 60% of the students’ lunches were provided by their schools (Chart 3.1.2.7). Among them, 76.0% of students felt satisfied with their school lunch (Table 3.1.2.7).

15


Chart 3.1.2.7 Provision of lunch during schools days (Question S7)

Not by schools39.3%

By schools60.7%


Table 3.1.2.7 Students’ satisfaction on school lunch (Question S7)

No. of students

% among students whose lunch was provided by the schools

Satisfied 4045 76.0%Not satisfied 1275 24.0%

Base: All respondents whose lunch was provided by schools = 5320

The common reasons quoted by students for being dissatisfied with the school lunch included: Meals provided were not tasty Meals provided were not healthy Meals provided were lack of variety Meals provided were not of enough portions Vegetable provided was not tasty Inadequate frequency of fruit provision

3.1.2.8 Students’ snack-eating habits

More than two-thirds of the students had the habits of eating snacks (Chart 3.1.2.8a). The most common source of their snacks was from their home (80.5%) and 12.1% of students would buy snacks from school tuck shops or vending machines. The other sources of snacks were convenient stores, supermarkets, grocery stores, fast food restaurants, peers, and other family members (Chart 3.1.2.8b).

16


Chart 3.1.2.8a Students’ snacking habits (Question S8)

Did not havethe habit of

eating snacks31.9%

Had the habitof eating snacks

68.1%


Chart 3.1.2.8b Students' sources of snacks (Question S8)

School tuckshop or vending

machines12.1%

Home80.5%

others7.4%

Base: All students who had snack habits = 5795

3.1.2.9 Students’ daily dietary habit

Students were asked to self-report their daily dietary habits, on average, in the week prior to survey. More than half of the students reported consuming fruit at least twice daily, 77.4% reported consuming vegetables at least twice daily and 74.2% reported consuming dairy products at least once daily. On the other hand, only 9.8% to 25.6% of students reported that they did not have any fried/deep-fried food, food high in fat/sugar/salt, and/or drinks with added sugar in the week prior to the survey (Table 3.1.2.9a).

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Regarding to the percentage of students who reached the recommended frequency, it was found that 57.5% and 78.7% of students could reach the fruit and vegetables recommendations respectively (Table 3.1.2.9b). Table 3.1.2.9a Eating habits of various food categories on average every day in the week prior

to the survey (Questions S3a to S3j) Eating Food category

frequency No. of

students

% of students > 2

times 2 times Once < 1 time Never

Don’t know

Fruit 9087 33.1 23.0 35.1 4.9 1.4 2.4Vegetables 9053 45.0 32.4 17.2 2.6 1.1 1.7Dairy products 9051 19.9 16.3 38.0 14.9 6.8 4.1Meat, fish, eggs, peas and beans 9027 36.4 34.0 23.6 3.5 0.7 1.8 Grains and cereals 9043 67.0 21.6 8.8 1.1 0.5 0.9 Fried and deep-fried food 9063 6.1 8.4 27.1 44.2 9.8 4.4 Drinks with added sugar 9054 8.7 11.7 30.7 34.6 10.3 3.9 Food high in sugar 9052 9.1 11.7 30.3 33.3 11.7 3.9 Food high in salt 9067 4.2 6.2 20.1 37.5 25.6 6.4 Food high in fat 9074 7.3 8.4 25.5 39.8 14.0 5.0

Table 3.1.2.9b Percentage of students whose average intake of the food categories in the week

prior to the survey reached the corresponding recommended frequency

Recommended eating frequency of various food categories

No. of

students*

No. of students (%) Reached recommended

frequency Not reached

recommended frequencyFruit ≥ 2 times 8866 5098 (57.5%) 3765 (42.5%) Vegetables ≥ 2 times 8902 7009 (78.7%) 1893 (21.3%) Dairy products ≥ 1 time 8680 6715 (77.4%) 1965 (22.6%) Meat, fish, eggs, peas and beans ≥ 1 time 8869 8489 (95.7%) 380 (4.3%) Grains and cereals ≥ 2 times 8960 8016 (89.5%) 944 (10.5%) Not having fried and deep-fried food 8667 887 (10.2%) 7780 (89.8%) Not having drinks with added sugar 8697 935 (10.8%) 7762 (89.2%) Not having food high in sugar 8696 1061 (12.2%) 7635 (87.8%) Not having food high in salt 8488 2318 (27.3%) 6170 (72.7%) Not having food high in fat 8620 1273 (14.8%) 7347 (85.2%) * All respondents excluding ‘don’t know’

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3.1.2.10 Students’ awareness of the ‘[email protected]’ campaign

More than half of the students (56.4%) had heard of the ‘[email protected]’ campaign (Chart3.1.2.10).

Chart 3.1.2.10 Students’ awareness of the '[email protected]' campaign (Question S12)

Yes 56.4%

Don't know 19.9%

No 23.6%


3.1.2.11 Students’ support in promoting healthy eating in schools

When asked if they would support the promotion of healthy eating in school, 72.7% of the students indicated that they would support while only 5.7% claimed that they would not (Chart 3.1.2.11). Chart 3.1.2.11 Students’ support in promoting healthy eating in school (Question S13)

Yes72.7%

Don't know21.6%

No5.7%


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3.1.2.12 Participation in school-based healthy eating activities

In the year prior to survey, 15.7% of students reported that they had ever participated in any healthyeating promotional activities organised by the schools. While 23.9% of students reported that theirschools did not have such activities, 11.1% of students did not want to join such activities. In fact,nearly half of the students (49.3%) were not sure whether they had participated in these activities ornot (Chart 3.1.2.12).

Chart 3.1.2.12 Students’ participation in healthy eating promotional activities organised by

schools in the year prior to the survey (Question S14)

No, because don'twant to join

11.1%

No, because no suchNot sure49.3%

activities23.9%

Yes15.7%

Base: All respondents = 8949 Among the students who reported to have participated in healthy eating activities, majority of them recalled that they had participated in activities that promoted the consumption of fruit, healthy breakfast and healthy snack.

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3.2 Results of Questionnaire Survey for Parents

A total of 11180 copies of questionnaire were distributed to parents in 51 schools by the teachers through the students and 8265 (73.9%) copies of completed questionnaires were collected. Among the collected questionnaires, 33 questionnaires were rejected due to more than half of the questions in these questionnaires being unanswered. The remaining 8232 (73.6%) valid parent questionnaires were used for analysis.

3.2.1 Demographics

The demographics characteristics of parents are summarised in Table 3.2.1. Nearly 80% of respondents were mothers. More than 90% of respondents had secondary educational level or above. One-fifth of the respondents had monthly household income less than or equal to $9999. Table 3.2.1 Demographic background of parents

Variables No. of parents % Relationship with the children (n = 8110) Father 1603 19.8% Mother 6297 77.6% Grandparents 120 1.5% Others 90 1.1% Education level (n = 8087) Primary education or below 751 9.3% Secondary education 4737 58.6% Matriculation 707 8.7% College or above 1892 23.4% Monthly household income (n = 7868) $9,999 or less 1684 21.4% $10,000 - $19,999 1982 25.2% $20,000 - $29,999 1228 15.6% $30,000 - $59,999 1786 22.7% $60,000 or more 1188 15.1%

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3.2.2.1 Knowledge of general healthy eating messages promoted by DH

Majority of the parents (at least 70%) answered correctly the questions assessing their knowledge of general healthy eating messages promoted by DH and the mean number of correctly answered questions was 1.46 out of 2. (Table 3.2.2.1a and Table 3.2.2.1b). Table 3.2.2.1a Proportion of parents correctly answered the general healthy eating messages

promoted by DH (Questions P13 & P14)

Healthy eating messages promoted by DH No. of parents % A healthy lunch box should provide grains and cereals, vegetables and meat in the ratio of 3:2:1 6171 76.1%(related message: 3:2:1 lunch box ingredient proportions) The recommended servings of fruit and vegetables is “2” and “3” (related message: ‘2+3’ campaign for the promotion of fruit and 5737 70.9%vegetables)

Base: for “3:2:1” = 8109; for “2+3” = 8092

Table 3.2.2.1b Number and percentage of parents correctly answered the general healthy

eating messages promoted by DH (Questions P13 & P14) Number of correct answers No. of parents %

0 790 9.7%1 2878 35.2%2 4515 55.2% Mean (95% CI) 1.46 (1.44 – 1.47) SD 0.66


3.2.2.2 Knowledge of snack categorisation

22

Parents were given 10 snacks and asked to categorise them into three groups based on the principles outlined in the snack guidelines issued by DH in 2006: ‘Red’ (snack to choose less), ‘Yellow’ (snack to choose in moderation) or ‘Green’ (snack to choose more) snack. The average number of snacks correctly categorised by the parents was only 4.54 (Table 3.2.2.2a). With respect to correct categorisation of snacks, over two-thirds (68.7%) of the parents correctly categorised pastries and nearly half (46.4%) classified 3-in-1 instant drinks as ‘Red’. About one-third (31.4%) knew that sandwich biscuits belonged to the ‘Red’ snack category. Majority of


the parents (58.6%) correctly classified ‘fish meat siu mai’ as ‘Yellow’. Nearly half grouped steamed dumplings (48.8%) and whole-fat milk (47.6%) as ‘Yellow’ snacks. Around one-third of the parents correctly regarded roasted peas with salt and salted seaweeds as ‘Yellow’ snacks (34.2% and 27.0% respectively). More than half (52.9%) of the parents correctly categorised boiled egg as a ‘Green’ snack and over 37% (37.2%) knew that baked apple chips belonged to the ‘Green’ snack category (Table 3.2.2.2b). Table 3.2.2.2a Number and percentage of correctly categorised snacks by parents

(Questions P15a to 15j) Number of correct answers No. of parents %

0 – 3 2226 29.6% 4 – 6 4267 56.9% 7 – 10 1017 13.5%

Mean (95% CI) 4.54 (4.50 – 4.58) SD 1.78

Base: All respondents who answered P15a to P15j = 7510

Table 3.2.2.2b Categorisation of different snacks by parents (Questions P15a to P15j)

Snacks No. of

parents %

‘Red’ snacks ‘Yellow’ snacks ‘Green’ snacksPastries 7973 68.7% * 29.1% 2.2%3-in-1 instant drinks 7921 46.4% * 47.6% 6.0%Sandwich biscuits 7940 31.4% * 63.0% 5.5%Fish meat ‘siu mai’ 7939 22.2% 58.6% * 19.3% Steamed dumplings 7944 8.3% 48.8% * 42.9% Whole-fat milk 7915 21.7% 47.6% * 30.7% Roasted peas with salt 7930 55.9% 34.2% * 9.9% Salted seaweeds 7943 69.3% 27.0% * 3.8% Boiled eggs 7968 6.9% 40.2% 52.9% * Baked apple chips 7952 22.6% 40.2% 37.2% *

* = Correct answers

3.2.2.3 Parents’ perception of child’s eating habits

More than 70% of parents perceived their child’s eating habit as healthy while 12.4% of parents perceived their child’s eating habit as unhealthy (Chart 3.2.2.3).

23


Chart 3.2.2.3 Parents’ perception of their children’s eating habits (Question P8)

Healthy71.0%

U

Not sure/ don't know

nhealthy12.4%

16.7%

Base: All respondents = 8133 For parents who considered their children’s diet as unhealthy, the most common reasons quoted were: Their children were picky eaters Consumed too much meat Consumed too much snacks and fast food

Consumed high fat/ sugar/ salt snacks / sweetened beverages frequently Consumed inadequate vegetables Consumed inadequate fruit Drank too little water Dined out or had takeaway food frequently Skipped breakfast in the morning Ate too slowly

3.2.2.4 Perception of ease to sustain healthy eating habits

More than half of the parents (52.5%) thought that healthy eating habits were difficult to sustain (Chart 3.2.2.4). Some major reasons quoted were healthy food did not taste good (42.2%), inadequate time to prepare food (30.9%), and lack of healthy food variety (30.7%) (Table 3.2.2.4).

24


Chart 3.2.2.4 Parents’ perception of ease to sustain healthy eating habits (Question P16)

Difficult tosustain52.2%

Easy to sustain47.8%


Table 3.2.2.4 Reasons for healthy eating habits difficult to sustain (Question P16) No. of parents %

Healthy food does not taste good 1740 42.2% No time to prepare healthy food 1273 30.9% Healthy food lacks variety 1266 30.7% Healthy food is more expensive 961 23.3% Eating out is frequent 598 14.5% Others – Examples:

Too much temptation in society (e.g. snacks choices, advertisements of unhealthy food, peer influence)

Meals were arranged by grandparents and/or maids who usually provided unhealthy food

Children preferred unhealthy food which tasted better Difficult to identify healthy food choices Lack of other family members’ support

353 8.6%

Base: All respondents who thought healthy eating is difficult to sustain = 4121

* Remarks: multiple answers allowed

3.2.2.5 Imposing nutritional requirements on school tuck shop sales

Parents were asked whether they agreed to impose some forms of nutritional requirements on the food and drinks supplied in the school tuck shops. The proportion of parents who supported the imposing of nutritional regulations on the six food or drink items listed in Chart 3.2.2.5 ranged from 61.3% to 69.6%. Around 15.4% to 17.3% of parents did not support the imposing of requirements

25


relating the sale of food high in salt, food high in fat, food high in sugar and drinks with added sugar. Less than 7% of parents objected to the compulsory provision of fresh fruit and vegetables for sale. Some parents suggested the following requirements on school tuck shops:

Provide more choices of low-fat, low-sugar or low calorie snacks and beverages in tuck shops Restrict the provision of large portion sized snacks in tuck shops Prohibit rather than restrict the sales of unhealthy food. Close down tuck shop in all schools

Chart 3.2.2.5 Parents’ agreement to impose nutritional requirements on school tuck shop sales

(Questions P11a to P11f)

26.7% 25.7%20.0% 21.4% 22.5% 21.4%

6.8% 4.7% 15.4% 16.6% 16.2% 17.3%

66.5% 69.6%64.6% 62.0% 61.3% 61.3%

Compulsory saleof vegetables

every day

Compulsory saleof fresh fruits

every day Restricted sale offood high in salt

Restricted sale offood high in fat

Restricted sale ofdrinks with added

sugar

Restricted sale offood high in sugar

Agree

Disagree

Nocomment

Base: 7844 7823 7822 7767 7823 7823

3.2.2.6 Imposing nutritional requirements on school lunch

The percentage of parents who supported for imposing nutritional requirements on school lunch were higher than those percentage of supporting tuck shop. Among the six suggestedrequirements, 88.0% to 92.1% of parents supported to regulate the amount of vegetables, grains and cereals, meat and its alternatives in lunch box supplied everyday and the frequency of serving fruit alongside with lunch on a weekly basis. At the same time, less than 70% of parents agreed to limit the frequency of using processed or preserved meat and deep-fried food in the lunch box per week (Chart 3.2.2.6).

26


Other suggestions raised by parents relating school lunch arrangement included: The portion size for students of different grades should be different Sauces should be provided separately Food temperature, taste and freshness were important attributes

Chart 3.2.2.6 Parents’ agreement to impose nutritional requirements on school lunch

(Questions P12a to P12f)

11.3%13%9.4%9.8%8%6.3%

20.4%17.2%

1.6% 1.9% 1.8% 2.5%

68.3%69.8%

88%88.3%90.1%92.1%

Regulation of theamount ofvegetables

provided by thelunch box every

day

Regulation of theamount of grains

and cerealsprovided by thelunch box every

day

Regulation of theamount of meat,

f ish, poultry,eggs andlegumes

provided by thelunch box every

day

Regulation of thefrequency ofserving fruits

alongside lunchper w eek

Limits on thefrequency of

using processedor preserved

meat in the lunchbox per w eek

Limits on thefrequency of

using deep-friedfood as the maindish of the lunchbox per w eek

Agree

Disagree

No comment

Base: 8110 8118 8077 7889 8060 8067

27


3.2.2.7 Effects of food package labels Majority of the parents (88.5%) reported that the label on food packages would affect their choiceof food for their children (Chart 3.2.2.7). The areas of greatest concern were the dates indicating‘use by’ or ‘best before’ (Table 3.2.2.7).

Chart 3.2.2.7 Effect of food package labels on parents’ choice of food for children (Question

P2)

Affected 88.5%

Not paying attfood packag

ention toe label

2.9% Not sure/ don't know

8.2%

0.5%

Not affected

Base: All respondents = 7836 Table 3.2.2.7 Food label information parents paid most attention to (Question P2)

No. of parents % Date indicating “use by” or “best before” 5623 81.9% Ingredients of food 3112 45.3% Manufacturer / place of production 2498 36.4% Statement of special conditions for storage or instructions for use 1622 23.6% Others – examples:

Nutrition label on various nutrient contents (especially calories)

Use of preservatives Use of genetically modified ingredients

183 2.7%

Base: All respondents who were affected by the food label = 6864

*Remarks: multiple answers allowed

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3.2.2.8 Decision maker at home

Parents and guardians were the main decision makers on food at home (83.0%) (Chart 3.2.2.8) Chart 3.2.2.8 Decision maker on food at home (Question P3)

Domestichelper4.7%

Others0.7%

Children5.9%

Parents/Guardian

83.0%

Grandparents5.7%


3.2.2.9 Parents’ considerations in choosing food for children

Parents pointed out that nutritional value (78.6%), cleanliness and hygiene (75.8%), and freshness (73.5%) were three main considerations in choosing food for their children (Chart 3.2.2.9). Chart 3.2.2.9 Parents considerations in choosing food for children (Question P5)

78.6%75.8% 73

80.0%.5%

12.9%

10.0%

70.0%

0%

value and hygiene and taste ofchild

90.

64.7%

60.0%

37.5%

30.3%

20.0%

30.0%

40.0%

50.0%

0.0%Nutritional Cleanliness Freshness Preference Taste Price Convenience



29


3.2.2.10 Commonly used cooking methods at home

As reported by parents, the three commonest cooking methods at home were steaming (92.2%), stir-frying (66.6%) and pan-frying (39.2%). Among them, only ‘steaming’ was considered as a healthier cooking method (Chart 3.2.2.10a). Overall, around one-fifth of the families reported using three commonest cooking methods that were all regarded as relatively healthier (Chart 3.2.2.10b). Chart 3.2.2.10a Commonly used cooking methods at home (Question P4)

92.2%

66.6%

39.2%

29.3% 26.9% 25.6%

5.9% 5.2% 3.8% 3.5% 1.2% 0.3%0.0%

20.0%

10.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

100.0%

Steaming*

Stir-fr

ying

Pan-fr

ying

Boiling*

Stewing*

Quick fr

ying w

ith lit

tle oi

l*

Baking*

Micr

owav

e*

Braisi

ng*

Deep fr

ying

Grillin

g*

Others


* Relatively healthier cooking methods

30


Chart 3.2.2.10b Among the top three commonest cooking methods adopted at home, the number of cooking methods regarded as healthier (Question P4)

None0.6%

Two48.0%

Three21.4%

One30.0%


3.2.2.11 Parents’ breakfast-eating habits

More than four-fifths of the parents (83.9%) always had breakfast in the morning. On the other hand, 2.3% of the parents did not have this habit (Chart 3.2.2.11). Chart 3.2.2.11 Parents’ breakfast habit (Question P1)

Always 83.9%

Never 2.3%

Sometimes13.8%

Base: All respondents =8188

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3.2.2.12 Parents’ dinner-eating habits

More than half of the parents (53.9%) reported always having dinner with their child, while 34.5% and 9.2% of parents often and sometimes had dinner with children respectively (Chart 3.2.2.12). Chart 3.2.2.12 Frequencies of parents having dinner with their child (Question P6)

Rarely2.3%

Never0.1%Sometimes

9.2%

Always53.9%

Often34.5%

Base: All respondents =8188 When asked about the location of dinner of their children, majority of parents (91.1%) reported having dinner at home for at least 5 times per week. About one-third (30.8%) dined out 2 to 4 times weekly prior to the survey (Table 3.2.2.12). Table 3.2.2.12 Parents’ replies to where their children had dinner in the week prior to the

survey (Question P7) No. of parents (%)

% Total < 1 time per 2 – 4 times > 5 times per week per week week

At home 55 (0.7%) 641 (8.2%) 7121 (91.1%) 100.0% Dine outside / buy take away 5320 (68.1%) 2408 (30.8%) 89 (1.1%) 100.0% food Did not have dinner 7800 (99.8%) 12 (0.2%) 5 (0.1%) 100.0%

Base: All respondents =7817

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3.2.2.13 Parents’ awareness of students’ snack-eating habits

Only 15.2% of parents were aware of the types of food and drinks children bought at school tuck shops (Chart 3.2.2.13a). For those who were aware, the commonest snacks bought at tuck shops were:

Carbonated or beverages with added sugar (e.g. lemon tea, soy-milk with added sugar) Crisp and chips Meat / processed meat (e.g. fish balls, ‘siu mai’, chicken wings, sausage) Candies Sandwiches Seaweeds

Chart 3.2.2.13a Parents’ awareness of what food and drinks their children bought at school

tuck shops (Question P9)

Not applicable as thatis not allowed 21.1%

Not aware 17.7%

Aware 15.2%

Not applicable as thereis no tuck shop 46.0%


33


Around three quarters (73.7%) of parents reported that their children always or sometimes brought snacks to school. Whereas 23.5% of parents claimed that their child did not bring snacks to school (Chart 3.2.2.13b). Chart 3.2.2.13b Bring snacks to school by children (Question P10)

Always 35.4%

Sometimes 38.3%

Not sure/ don't know2.7%

Never23.5%

Base: All respondents = 8194 Parents reported the commonest snacks their children brought to schools included:

Sandwiches, cake, bread, biscuit (including sweet flavoured ones) Candies, chocolates Crisps and chips Seaweed Drinks with added sugar Milk

34


3.2.2.14 Parents’ awareness of healthy eating campaigns in schools

More than half of the parents (55.9%) were aware of the healthy eating campaigns launched by DH in the two years prior to the survey and 28.2% of parents could recall the name as ‘[email protected]’ (Chart 3.2.2.14). Chart 3.2.2.14 Parents’ awareness of healthy eating campaign launched by DH in the 2 years

prior to the survey (Question P17)

Not sure24.1%

No19.9%

Yes, but cannot recall thename of the campaign

27.7%

Yes, and can recall thename was

'[email protected]'28.2%


35


3.2.2.15 Parents’ satisfaction with the healthy eating campaign at schools conducted by DH

More than one-fifth of the parents (22.3%) were satisfied with the healthy eating campaign organised by DH and 3.5% of parents were not satisfied with it. 51.8% of parents did not have any comment about the campaign (Chart 3.2.2.15). Chart 3.2.2.15 Parents’ satisfaction with DH’s healthy eating campaign (Question P18)

Annex A Study Brief

3.5%

Fair22.3%

Satisfied22.3%

No comment Annex B Sample of Written Consent

51.8%

Base: All respondents who were aware of the healthy eating campaign launched by DH = 4467

Some reasons given by parents for being ‘satisfied’ with the healthy eating promotional campaign in schools were:

School setting was a good starting point to promote healthy eating to children The campaign increased children’s awareness of and knowledge about healthy eating and its

importance The campaign helped to build up healthy eating habits Food in tuck shops and lunchboxes were healthier than before DH put much efforts on publicity work via different means which helped to foster

atmosphere of healthy eating Some reasons given by parents for rating the campaign as ‘fair’ were:

School lunch caterers and tuck shop contractors were not mandated to follow and implement the contents of Lunch and Snack guidelines issued by DH

Not all schools participated in the campaign Students’ knowledge were increased but they still preferred and chose unhealthy food Lack of parents’ involvement There was only a few healthy eating promotional activities (e.g. Fruit day) implemented, and

36


that might not be able to change children’s eating behaviours The campaign focused much on publicity work and it was hard to measure the effectiveness in

changing children’s eating behaviours For parents who were dissatisfied with the campaign, their views included:

The depth of promotional and publicity work was not adequate. The healthy eating campaign was not mandatory for all schools. As a result, some of the

parents were not aware of the campaign or its related promotional activities Caterers did not incorporate lunchbox guidelines and continued to use unhealthy ingredients in

lunch. Some tuck shops were still selling many unhealthy snacks and drinks Parents did not receive enough healthy eating information/publications

3.2.2.16 Parents’ participation in healthy eating promotion activities organised by schools

More than 70% of the parents did not participate in any healthy eating promotion activities. Nearly two-fifth (38.4%) of parents reported that they were too busy and 32.9% of parents reported that they were not aware of such activities. Less than one-tenth (7.6%) of parents had participated in healthy eating campaigns organised by the school (Chart 3.2.2.16). The most popular activities parents ever participated were the Fruit Day, healthy breakfast day, School “NutriAgent” Project (SNAP)1 and health talks with themes on healthy eating. Chart 3.2.2.16 Parents’ participation in healthy eating promotion activities organised by

children's schools in the year prior to survey (Question P19)

Yes 7.6%t s

N

No ure/ cannotremember

21.0%

No, too busy38.4%

o, not aware ofsuch activity

32.9%

Base: All respondents = 8086 1 School ‘NutriAgent’ Project (SNAP) is a core component of the [email protected] campaign launched since the academic year 2006/07. It aims to empower teachers and parents of primary schools and increase their self-efficacy to implement healthy eating policy and activity, to create and enhance environment and culture supporting healthy eating, and to nurture healthy eating habit for children through continuous support and nutrition training.

37


3.2.2.17 Further knowledge or other kinds of support parents wished to acquire to help their child to maintain a healthy eating habit

More than half of the parents (55.6%) wished to acquire more knowledge or other kinds of support to help their child to maintain a healthy diet (Chart 3.2.2.17). The common kinds of knowledge or support quoted by parents were:

Healthy cooking tips and recipes on appropriate food combination Nutrition information and energy content of various food items Healthy food shopping guide Health talks/workshops about healthy eating conducted by health professionals (e.g. dietitians) Samples of healthy daily menu for school children Health educational materials (e.g. pamphlets, booklets, VCD, website materials) covering the

points raised above Chart 3.2.2.17 Parents’ wish to acquire more knowledge or other kinds of support to help

their child to maintain a healthy eating habit (Question P20)

No44.4%

Yes55.6%


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3.3 Results of Questionnaire Survey for Schools

School questionnaires were distributed to 51 participating schools for completion by school representatives. All 51 questionnaires were collected and no questionnaire was rejected after the quality control process.

3.3.1 Demographics

The demographic characteristics of schools were summarised in Table 3.3.1. Over 70% (70.6%) of schools were government or Aided primary schools. Nearly four-fifth of schools (78.4%)operated in a whole-day mode and the majority (88.2%) were co-educational schools. Aroundtwo-thirds of the schools had a religious affiliation. Table 3.3.1 Demographics of schools

Variables No. of school % Type of funding Government or Aided primary school 36 70.6%

DSS or Private schools 15 29.4% School mode Whole-day school 40 78.4% Mixed-mode school 7 13.7% Half-day school 4 7.9% School type Co-educational school 45 88.2% Girls' school 5 9.8% Boys' school 1 2.0% Religion Without a religious background 18 35.3% Christianity 19 37.3% Catholics 11 21.6% Buddhism 1 2.0% Taoism 1 2.0% Others 1 2.0% Base: All schools = 51

39



3.3.2.1 General eating environment and facilities in the schools

The general eating environment and facilities available in the school was summarised in Table 3.3.2.1. Nearly all schools (96.1%) provided free-of-charge water to students and 92.2% of the schools provided school lunch. More than half (58.8%) had beverage vending machines available to students and more than one-third (35.3%) had a tuck shop. At the same time, nearly 30% of schools did not have a tuck shop or a beverage/ food vending machine in their campus. Table 3.3.2.1 School eating environment and facilities

Eating environment and facilities No. of schools % Provide free-of-charge water to students 49 96.1% Provide lunch to students 47 92.2% Has tuck shop 18 35.3% Has beverage vending machines 30 58.8% Has food vending machines 4 7.8% Has both tuck shop and beverage/ food vending machines 12 23.5% Has neither tuck shop nor beverage/ food vending machines 15 29.4% Base: All schools = 51

Remarks: multiple answers allowed

3.3.2.2 Tuck shops

Nearly four-fifths (77.7%) of the school tuck shops were operated by contractors (Chart 3.3.2.2a). Chart 3.3.2.2a Operator of tuck shop (Question T17)

Others5.6%

School staff16.7%

Contractor77.7%

Base: All schools with tuck shop = 18

40


Majority of the schools with tuck shops allowed students to buy food or beverages before class (72.2%) and during recess time in the morning (88.9%). Besides, 61.1% of them allowed students to buy food or beverages in tuck shop during lunch time (Chart 3.3.2.2b). Chart 3.3.2.2b School sessions when students were allowed to buy food or beverages from tuck

shops (Question T18)

72.2%

88.9%

61.1%

50.0%

22.2%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

100.0%

Before class Recess time in themorning

Lunch time Recess time in theafternoon

After school

Base: All schools with tuck shop = 18


3.3.2.3 Vending machines

Among the 30 schools with beverage vending machines available, the majority of them (76.7%)provided one to two machines in campus (Chart 3.3.2.3a).

41


Chart 3.3.2.3a Number of beverage vending machine(s) in schools (Question T20)

Four10.0%

One36.7%

Three13.3%

Two40.0%

Base: All schools with beverage vending machines = 30

Food vending machines were not common among the responding schools, with only 4 schools providing such machines. In one school, two food vending machines were provided. The remaining three schools provided only one machine. (Chart 3.3.2.3b). Chart 3.3.2.3b Number of food vending machine(s) in schools (Question T22)

Two25.0%

eOn75.0%

Base: All schools with food vending machines = 4

3.3.2.4 Lunch arrangement

Majority of the schools (86.3%) allowed students to bring their own lunch or parents to deliver lunch to their child. Nearly three-fourth of the schools (74.5%) had students’ lunch boxes ordered from caterer and around 15% of school lunches were served by caterer at school canteen. No student was allowed to buy their lunch from outside the school (Table 3.3.2.4).

42


Table 3.3.2.4 School lunch arrangement (Question T13)

School lunch arrangement No. of schools % Students can bring their own lunch / parents deliver their lunch 44 86.3% Lunch boxes ordered from caterer 38 74.5% Lunch served at school by caterer 8 15.7% Students can buy own lunch from school tuck shop 1 2.0% Students can buy own lunch from outside of the school 0 0.0% Half-day school 4 7.8% Base: All schools = 51


3.3.2.5 Healthy eating policies

Nearly all schools (98.0%) agreed that healthy eating should become a major component in school education and student development. More than half (53.0%) claimed that they had established healthy eating school policy to promote healthy eating but less than half of them (11 schools or 40.7%) had a written policy in place (Chart 3.3.2.5). Chart 3.3.2.5 Schools with “Healthy Eating Policy” in place to promote healthy eating

(Question T8)

N47.1

Yes, but nodocumentation

31.4%

o%

Yes, withdocumentation

21.6%

Base: All schools = 51

The areas covered in the ‘Healthy Eating Policy’ as reported by the schools are summarised in Table 3.3.2.5. Most schools (85.2%) reported that their healthy eating policy covered the area of ‘healthy lunch’ and over two-thirds (63.0%) covered the area of ‘healthy snack’.

43


Table 3.3.2.5 Coverage of healthy eating school policy (Question T9) Coverage of healthy eating policy No. of schools %

Healthy lunch 23 85.2% Healthy snack 17 63.0% Healthy eating at home 7 25.9% Others 3 11.1% Base: All schools with healthy eating policy = 27 *Remarks: multiple answers allowed

3.3.2.6 Catering working groups

Among the 47 schools that had lunch provision, 78.7% of them (37 schools) reported that there was a working group dedicated to oversee the arrangement and monitoring of the food/ catering services for students. Most of these schools included teacher representatives (94.6%) as members of the working group. Other members mainly included parent representatives (75.7%) and principals/vice principals (67.6%) (Chart 3.3.2.6). Chart 3.3.2.6 Composition of working group that arrange and monitor the catering service for

students in schools (Question T10)

75.7%

94.6%100.0%

80.0%

67.6%

40.0%

60.0%

29.7%

0.0%

20.0%

he Principalce principa

Catererresentati

Studentesentative n /

al

Others

8.1% 5.4% 8.1%

CommunityTeaching staffrepresentative

Parentrepresentative

Tvi

/l rep ve repr organizatio

professionrepresentative

Base: All schools with catering working group =37 *Remarks: multiple answers allowed Besides the catering working groups, other means like conducting surveys among students and parents, paying visits to lunch caterers, Parent-Teacher-Association meetings, etc., were other channels for teachers, parents and students to participate in the catering service arrangements.

44


3.3.2.7 Factors to be considered when choosing lunch caterers

The commonest factor that schools considered important in choosing lunch caterer was the ‘Nutritional value of food’. Among schools which gave this as a factor for consideration, 52.5% regarded this as most important. ‘History of food safety’ and ‘Price of the food’ were the second and third most commonly quoted factors (Table 3.3.2.7a). Table 3.3.2.7a Factors considered and their order of importance in choosing the current lunch

caterer (Question T11)

Factors for consideration Base

No. and % of schools regarded the factor as important

Most Second Third important important important N % N % N %

Nutritional value of food 40 21 5%52. 12 30.0% 7 17.5%

History of food safety 34 10 29.4% 12 35.3% 12 35.3%

Price of the food 25 1 4.0% 12 48.0% 12 48.0%

Size of the company 18 6 33.3% 6 33.3% 6 33.3%

Preferences of students on the taste of food 16 5 31.3% 3 18.8% 8 50.0%

Others 2 2 100.0% 0 0 0 0

Teachers (78.7%), lunch caterer (66.0%) and headmaster/ headmistress (63.8%) were the three most common parties deciding the choices available in the lunch menu provided by the caterers (Table 3.3.2.7b). Table 3.3.2.7b Parties deciding the choices of lunch menu provided by the caterer (Question

T14) Parties making the decision No. of schools %

Teachers 37 78.7%Lunch caterer 31 66.0% Headmaster /Headmistress 30 63.8% Parent-Teacher-Association 24 51.1%Parents 18 38.3%Students 11 23.4%School director 4 8.5% Others 2 4.3%

Base: All schools which provided lunch = 47

Remarks: Multiple answers allowed

45


3.3.2.8 Factors to be considered when choosing tuck shop contractor

Factors being considered and their priority when choosing tuck shop contractor were listed in Table 3.3.2.8. ‘Price of the food’ was the most commonly quoted factors by the schools. ‘The nutritional value of food’ was the second commonest factor. The third commonest factor was whether the tuck shop contractor was also ‘The same contractor as lunch caterer’ (Table 3.3.2.8). Table 3.3.2.8 Factors considered and their order of importance when choosing the current

tuck shop contractor (Question T12)

Factors for consideration Base

No. of schools (% of schools) regarded the factor as important

Most Second Third important important important N % N % N %

Price of the food 9 0 0 4 44.4% 5 55.6%The nutritional value of food 8 4 50.0% 3 37.5% 1 12.5%The same contractor as that of the lunch caterer

7 6 85.7% 0 0.0% 1 14.3%

Preferences of students on the taste of food 4 0 0 1 25.0% 3 75.0%Size of the company 2 0 0 2 100.0% 0 0 Others 3 3 100.0% 0 0 0 0

3.3.2.9 Comments on and application of lunch guidelines

Most schools (92.2%) reported that they were aware of the school lunch guidelines (2006) issued by DH. Nearly 70% of schools considered the contents as sufficient, and about one third of them (37.0%) found the guidelines easy to execute (Table 3.3.2.9a).

46


Table 3.3.2.9a Comments on the Nutritional Guidelines on School Lunch (Question T4) Base No. of schools % Aware of the guidelines 51 47 92.2%Considered the content as: Sufficient 32 69.6% Fair 46 14 30.4% Insufficient 0 0Rated applicability as: Easy to execute 17 37.0% Fair 46 29 63.0% Difficult to execute 0 0

Among the schools who were aware the lunch guidelines and provided lunch to their students, 70.7% of them reported that they had incorporated the guidelines content into the contract with school lunch caterer (Table 3.3.2.9b). For schools which did not incorporate the guidelines, the reasons quoted included:

The contract with lunch supplier was signed before the guidelines were issued The school already had a regular feedback mechanism in place to reflect opinions from parents

and staff The caterer had its own nutritionist to monitor the lunch box quality The school would consider to use the guidelines in future

Table 3.3.2.9b Application of the Nutritional Guidelines on School Lunch (Question T4) Base No. of schools % Has incorporated guideline content into the contract with school lunch caterer Yes 29 70.7% No

47 12 29.3%

NA 6 (4 : half-day schools

2: other reasons) --- Year of incorporation* School year 2005/06

29 2 6.9%

School year 2006/07 18 62.1% School year 2007/08 23 79.3% *Remarks: multiple answers allowed

47


3.3.2.10 Comments on and application of snack guidelines

Majority of the schools (82.4%) were aware that DH had issued the Nutritional Guidelines on Snacks. Around two-thirds of the schools (67.5%) considered the contents as sufficient, and more than one-third of them (38.1%) found the guidelines easy to execute (Table 3.3.2.10a). Table 3.3.2.10a Comments on and application of the Nutritional Guidelines on Snacks

(Question T5) Base No. of schools % Aware of the guidelines 51 42 82.4%Considered the content as: Sufficient 27 67.5% Fair 40 13 32.5% Insufficient 0 0Rated applicability as: Easy to execute 16 38.1% Fair 42 25 59.5% Difficult to execute 1 2.4%

Among those schools who were aware the snack guidelines and had tuck shop and vending machine, 50.0% and 40.9% reported having incorporated the guidelines into the contract with tuck shop contractors and vending machines suppliers respectively (Table 3.3.2.10b). For schools which did not incorporate the guidelines into their contract with tuck shop contractors, the reasons included:

The contract was signed before the guidelines were issued Regular feedback mechanism already existed to reflect opinions from parents and staff Guideline incorporation would affect snack sales volume Difficult to monitor

For schools which did not incorporate the guidelines into their contract with the vending machines suppliers, the reasons were:

The contract was signed before the guidelines were issued Only beverages were provided in vending machines (hence, less concern) Machines were maintained by suppliers Guidelines incorporation would affect sales volume Schools would like to start with lunch guidelines first

48


Table 3.3.2.10b Application of the Nutritional Guidelines on Snacks (Question T5) Base No. of schools % Has incorporated guideline content into the contract with school tuck shop contractor Yes 6 50.0% No

42 6 50.0%

NA 30 (27 : no tuck shops


6 0 0

School year 2006/07 1 16.7% School year 2007/08 5 83.3%Has incorporated guideline content into contract with the vending machine supplier Yes

42

9 40.9% No 13 59.1%

NA 20 (17: no vending machine


9 1 11.1%

School year 2006/07 1 11.1% School year 2007/08 7 77.8%


3.3.2.11 Participation in healthy eating promotion activities

More than two-thirds (35 schools, 68.6%) of the schools reported that they had participated in at least one healthy eating promotional activity organised by DH. Among these activities, 51.4% of them were related to the SNAP and 91.4% were in relation to the Fruit Day functions (Table 3.3.2.11). Table 3.3.2.11 Schools’ participation on healthy eating promotional activities organised by DH

(Question T1) Healthy eating promotional activities organised by DH No. of schools % Fruit day 32 91.4% SNAP 18 51.4%Slogan competition / e-card design competition 6 17.1% Popular lunch box election 4 11.4%

Base: schools which participated in at least one healthy eating activity organised by DH = 35


49


About one-tenth (9.8%) of the schools reported that they had participated in activities organised by organisations other than DH to promote healthy eating in school. These organisations included non-government organisations, universities and lunch caterers. Activities included:

Health talks on general healthy eating, healthy breakfast and healthy snacks; Series of activities on healthy eating, e.g., healthy breakfast, fruit and vegetables promotion,

healthy snacks tasting, simple cooking and organic farming. More than half (51.0%) of the schools reported that they had organised healthy eating promotional activities on their own. The total number of activities organised by the school ranged from 1 to 12 since March 2006. 21.6% of schools reported not participating in any activity including those organised by DH, other organisations or self-conducted ones to promote healthy eating.

50


Chapter 4 Analytic Results Student and the corresponding parent questionnaires were paired up according to the pre-assigned barcodes and serial numbers. The paired questionnaires would then be cross-checked by the background information, including the class number, gender and date of birth. Both student and parent questionnaires were also matched with the school questionnaires according to the pre-assigned school code. Among the 9135 students questionnaires, corresponding parents questionnaires could not be found for 903 of them. While for the 8232 parents questionnaires, no matched students questionnaires could be found for 311 of them due to the reason that two or more variables, including students’ class number, gender and date of birth were not matched. Finally, 7921 matched questionnaires were used to assess the associations among the findings from the students, their parents and the schools they were attending.

4.1 Analytic Findings from the Student Questionnaire

4.1.1 Students’ Knowledge of Healthier Food Choices

4.1.1.1 Association of students’ knowledge on healthier food choices with other variables in the student questionnaire

Regarding the knowledge of healthier food choices among all students, girls and students studying in DSS & private schools were more likely to answer most questions correctly (5 or 6 correct answers) than their counterparts. A weak positive correlation (R=0.181) was shown between the number of healthier food choices the students preferred and their knowledge on healthier choices. Students who had taken breakfast on the survey day (94.4%) or who perceived themselves as having a healthy eating habit (94.1%) were more likely to choose healthy food compared with their counterparts (Table 4.1.1.1). Moreover, students who were aware of the [email protected] campaign (95.2%), students who supported the promotion of healthy eating at school (95.1%), and students who have ever participated in any healthy eating activities organised by the school in the year prior to the survey (96.4%), were better able to choose the correct healthier food choices than their corresponding counterparts (Table 4.1.1.1).

51


Table 4.1.1.1 Association of students’ knowledge on healthier food choices (Questions S9a to S9f) with other variables in the student questionnaire

Variable No. of

student

No. of correct healthier

by students

food choices p-value

0-2 3-4 5-6 KW

test

Rank

correlation

Gender

p<0.001Male 3743 175 (4.7%) 196 (5.2%) 3372 (90.1%)

Female 4501 52 (1.2%) 108 (2.4%) 4341 (96.4%)

School type

p=0.019Government & aided 6304 183 (2.9%) 255 (4.0%) 5866 (93.1%)

DSS & private 2438 65 (2.7%) 70 (2.9%) 2303 (94.5%)

No. of healthier choices students

preferred R = 0.181,

p<0.001 0-2 3115 218 (7.0%) 135 (4.3%) 2762 (88.7%)

3-4 2920 15 (0.5%) 164 (5.6%) 2741 (93.9%)

5-6 2456 5 (0.2%) 6 (0.2%) 2445 (99.6%)

Students’ breakfast-eating habits

p<0.001Yes 7316 170 (2.3%) 238 (3.3%) 6908 (94.4%)

No 1302 58 (4.5%) 69 (5.3%) 1175 (90.2%)

Students’ perceived eating habits

p<0.001 Healthy 7907 197 (2.5%) 269 (3.4%) 7441 (94.1%)

Unhealthy 315 20 (6.3%) 22 (7.0%) 273 (86.7%)

Students’ awareness of

[email protected] campaign p<0.001

Aware 4913 84 (1.7%) 153 (3.1%) 4676 (95.2%)

Not aware 2048 108 (5.3%) 98 (4.8%) 1842 (89.9%)

Students’ support of healthy

eating promotion in school p<0.001

Support 6312 113 (1.8%) 196 (3.1%) 6003 (95.1%)

Not support 475 72 (15.2%) 29 (6.1%) 374 (78.7%)

Students’ participation in

school-based healthy eating

activity p<0.001

Yes 1375 14 (1.0%) 35 (2.5%) 1326 (96.4%)

No 3008 143 (4.8%) 134 (4.5%) 2731 (90.8%)

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4.1.1.2 Association of students’ knowledge on healthier food choices with other variables in the parent questionnaire and school questionnaire

Children with better-educated parents (secondary: 93.2%, post-secondary or above: 95.7%) were more likely to answer majority of the questions correctly than students with parents of lower educational attainment (91.5%). At the same time, children from families of higher monthly household income were also more likely to answer majority of the questions correctly ($30000 or above: 95.8%) (Table 4.1.1.2). The findings also suggested that children of parents who were more supportive of imposing nutritional requirements on tuck shop sales and lunch were able to answer more questions correctly. Besides, the number of healthier food choices indicated by the student was significantly associated with the number of general healthy eating messages answered correctly by his/her parent (Table 4.1.1.2). Table 4.1.1.2 Association of students’ knowledge on healthier food choices (Questions S9a to

S9f) with other variables in the parent questionnaire

Variable No. of

students


by students

food choice p-value

0-2 3-4 5-6 KW

test

Rank

correlation

Parents’ education level

R = 0.056,

p<0.001

Primary or below 682 24 (3.5%) 34 (5.0%) 624 (91.5%)

Secondary 4397 129 (2.9%) 170 (3.9%) 4098 (93.2%)

Post-secondary or above 2399 42 (1.8%) 62 (2.6%) 2295 (95.7%)

Monthly household

income

R = 0.074,

p<0.001

Below $10000 1539 54 (3.5%) 77 (5.0%) 1408 (91.5%)

$10000 - $19999 1839 62 (3.4%) 80 (4.4%) 1697 (92.3%)

$20000 - $29999 1150 21 (1.8%) 32 (2.8%) 1097 (95.4%)

$30000 - $59999 1674 26 (1.6%) 44 (2.6%) 1604 (95.8%)

$60000 or above 1088 19 (1.7%) 27 (2.5%) 1042 (95.8%)

No. of nutritional

requirements on tuck shop

sales parent supported

R = 0.034,

p=0.003 0-2 2292 76 (3.3%) 91 (4.0%) 2125 (92.7%)

3-4 1593 32 (2.0%) 71 (4.5%) 1490 (93.5%)

5-6 3416 82 (2.4%) 102 (3.0%) 3232 (94.6%)

53


Variable No. of

students


by students

food choice p-value

0-2 3-4 5-6 KW

test

Rank

correlation

No. of nutritional

requirements on lunch parents

supported

R = 0.035,

p=0.002 0-2 506 22 (4.3%) 16 (3.2%) 468 (92.5%)

3-4 1946 59 (3.0%) 85 (4.4%) 1802 (92.6%)

5-6 5081 117 (2.3%) 168 (3.3%) 4796 (94.4%)

No. of correct general health

messages answered by parents

p<0.001

0-1 3383 109 (3.2%) 141 (4.2%) 3133 (92.6%)

2 4181 89 (2.1%) 128 (3.1%) 3964 (94.8%)

Analysis of students’ knowledge and findings from the schools’ questionnaire did not show significant association between the students’ knowledge on healthier food choices and the school variables.

4.1.2 Students’ Knowledge on General Healthy Eating Messages

4.1.2.1 Association of students’ knowledge on general healthy eating messages with other variables in the student questionnaire

Same as students’ knowledge of healthier food choices, a gender difference was detected in students’ knowledge of general healthy eating messages. Girls and students studying in the government or aided schools scored more answers than their counterparts. A weak positive correlation (R=0.101) existed between the number of healthier food choices student preferred with his/her knowledge on general healthy eating (Table 4.1.2.1). For students who had breakfast on the survey day, students who perceived their own eating habit as healthy, students who were aware of the [email protected] campaign, supportive of healthy eating promotion in schools and had ever participated in healthy eating activities organised by their school in the year prior to the survey, were better able to give correct answers about general healthy eating messages than their counterparts (Table 4.1.2.1).

54


Table 4.1.2.1 Association of students’ knowledge on general healthy eating messages (Questions S4 to S6) with other variables in the student questionnaire

Variable No. of

students

No. of correct general healthy eating

messages by students p-value

0-1 2 3 KW test Rank

correlation

Gender

p<0.001 Male 3870 777 (20.1%) 1369 (35.4%) 1724 (44.5%)

Female 4623 609 (13.2%) 1539 (33.3%) 2475 (53.5%)

School type

p<0.001 Government & aided 6511 1000 (15.4%) 2196 (33.7%) 3315 (50.9%)

DSS & private 2499 497 (19.9%) 888 (35.5%) 1114 (44.6%)

No. of healthier choices

students preferred

R = 0.101,

p<0.001 0-2 3180 655 (20.6%) 1131 (35.6%) 1394 (43.8%)

3-4 2973 428 (14.4%) 1004 (33.8%) 1541 (51.8%)

5-6 2511 315 (12.5%) 833 (33.2%) 1363 (54.3%)

Students’ breakfast-eating

habits

p<0.001 Yes 7514 1124 (15.0%) 2568 (34.2%) 3822 (50.9%)

No 1359 312 (23.0%) 469 (34.5%) 578 (42.5%)

Students’ perceived eating

habits

p<0.001

Healthy 8109 1201 (14.8%) 2807 (34.6%) 4101 (50.6%)

Unhealthy 335 100 (29.9%) 92 (27.5%) 143 (42.7%)


[email protected]

campaign p<0.001

Aware 5045 576 (11.4%) 1633 (32.4%) 2836 (56.2%)

Not aware 2115 545 (25.8%) 789 (37.3%) 781 (36.9%)

Students’ support of

healthy eating promotion

in school

p<0.001

Support 6485 871 (13.4%) 2243 (34.6%) 3371 (52.0%)

Not support 504 186 (36.9%) 170 (33.7%) 148 (29.4%)


school-based healthy

eating activity

p<0.001

Yes 1408 144 (10.2%) 452 (32.1%) 812 (57.7%)

No 3125 644 (20.6%) 1145 (36.6%) 1336 (42.8%)

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4.1.2.2 Association of students’ knowledge on general healthy eating messages with othervariables in the parent questionnaire and the school questionnaire

Parents’ educational level and monthly household income were not found to be significantly associated with the number of correct answers the students scored for questions on general healthy eating messages. However, parents’ support for imposing nutritional requirements on tuck shop sales (R=0.03) or school lunch (R=0.035) was slightly correlated with the corresponding students’ knowledge on general healthy eating. Besides, children with parents who answered more questions correctly regarding healthy eating messages were more likely to give correct answers for all the questions on general healthy eating messages (Table 4.1.2.2a). Table 4.1.2.2a Association of students’ knowledge on general healthy eating messages

(Questions S4 to S6) with other variables in the parent questionnaire

Variable No. of

student

No. of correct answers about general

healthy eating messages by students p-value

0-1 2 3 KW test Rank

correlation

No. of nutritional



R = 0.030,

p=0.010 0-2 2364 437 (18.5%) 785 (33.2%) 1142 (48.3%)

3-4 1634 228 (14.0%) 578 (35.4%) 828 (50.7%)

5-6 3510 531 (15.1%) 1190 (33.9%) 1789 (51.0%)

No. of nutritional


supported

R = 0.035,

p=0.002 0-2 518 88 (17.0%) 172 (33.2%) 258 (49.8%)

3-4 2009 367 (18.3%) 691 (34.4%) 951 (47.3%)

5-6 5217 784 (15.0%) 1766 (33.9%) 2667 (51.1%)


messages answered by parents

p<0.001

0-1 3482 665 (19.1%) 1256 (36.1%) 1561 (44.8%)

2 4293 576 (13.4%) 1385 (32.3%) 2332 (54.3%)

For students whose school participated in any healthy eating promotion activities (50.8%) and whose school was member of the SNAP (53.4%), a higher proportion of them could give correct answers for all the three questions on general healthy eating messages, when compared with their counterparts (Table 4.1.2.2b).

56


Table 4.1.2.2b Association of students’ knowledge on general healthy eating messages (Questions S4 to S6) with other variables in the school questionnaire

Variable No. of

students

No. of correct answers about general

eating messages by students

healthy p-value

0-1 2 3 KW test

School’s participation in any

healthy eating promotion activity

p<0.001 Yes 7418 1153 (15.5%) 2493 (33.6%) 3772 (50.8%)

No 1592 344 (21.6%) 591 (37.1%) 657 (41.3%)

Member school of SNAP

p<0.001 Yes 3286 452 (13.8%) 1080 (32.9%) 1754 (53.4%)

No 3428 556 (16.2%) 1196 (34.9%) 1676 (48.9%)

4.1.3 Students’ Food Preferences

4.1.3.1 Association of students’ eating preferences with other variables in the student questionnaire

Similar to gender differences with respect to students’ knowledge, results showed that girls were more likely to choose healthier food choices than boys. Students who had breakfast on the survey day (30.7%) were more likely to prefer a larger number of healthier food options (Table 4.1.3.1). Students’ preference for a larger number of healthier food options (5-6 items) was found to be associated with their perceived eating habit (30.1%), their awareness of the [email protected] campaign (34.8%), their support of healthy eating promotion in school (34.7%), and whether they have participated in any healthy eating activity organised by their schools in the year prior to the survey (35.3%) (Table 4.1.3.1).

Table 4.1.3.1 Association of students’ eating preferences (Questions S1a to S1f) with other variables in the student questionnaire

Variable No. of

students

No. of healthier food choices students preferred p-value

0-2 3-4 5-6 KW test

Gender

p<0.001 Male 3752 1550 (41.3%) 1215 (32.4%) 987 (26.3%)

Female 4544 1466 (32.3%) 1642 (36.1%) 1436 (31.6%)

Students’ breakfast-eating habits

p<0.001 Yes 7361 2579 (35.0%) 2525 (34.3%) 2257 (30.7%)

No 1308 591 (45.2%) 453 (34.6%) 264 (20.2%)

57


Variable No. of

students


0-2 3-4 5-6 KW test


p<0.001 Healthy 7831 2722 (34.8%) 2748 (35.1%) 2361 (30.1%)

Unhealthy 316 212 (67.1%) 77 (24.4%) 27 (8.5%)


[email protected] campaign

p<0.001 Aware 4874 1502 (30.8%) 1677 (34.4%) 1695 (34.8%)

Not aware 2033 927 (45.6%) 689 (33.9%) 417 (20.5%)


eating promotion in school

p<0.001 Support 6253 1866 (29.8%) 2218 (35.5%) 2169 (34.7%)

Not support 478 319 (66.7%) 104 (21.8%) 55 (11.5%)



activity

p<0.001

Yes 1377 414 (30.1%) 477 (34.6%) 486 (35.3%)

No 2982 1204 (40.4%) 1010 (33.9%) 768 (25.8%)

4.1.3.2 Association of students’ eating preferences with other variables in the parent questionnaire and school questionnaire

The number of healthier food choices the students preferred increased with their parents’ educational level (R=0.045). Similar trend was observed between the students’ eating preferences with the number of nutritional requirements on tuck shop sales or lunch their parents supported. Results also showed that students with parents of better knowledge on general healthy eating were more likely to choose healthier food options (Table 4.1.3.2a). Table 4.1.3.2a Association of students’ eating preferences (Questions S1a to S1f) with other

variables in the parent questionnaire

Variable No. of

student


0-2 3-4 5-6 KW

test

Rank

correlation


R = 0.045,

p<0.001

Primary or below 691 300 (43.4%) 208 (30.1%) 183 (26.5%)

Secondary 4417 1627 (36.8%) 1482 (33.6%) 1308 (29.6%)


58


Variable No. of

student


0-2 3-4 5-6 KW

test

Rank

correlation

Monthly household

income

R = 0.033,

p=0.005

Below $10000 1553 629 (40.5%) 497 (32.0%) 427 (27.5%)

$10000 - $19999 1863 703 (37.7%) 603 (32.4%) 557 (29.9%)

$20000 - $29999 1148 367 (32.0%) 417 (36.3%) 364 (31.7%)

$30000 - $59999 1663 561 (33.7%) 621 (37.3%) 481 (28.9%)

$60000 or above 1078 385 (35.7%) 380 (35.3%) 313 (29.0%)

No. of nutritional


sales parent supported R = 0.045,

0-2 2290 884 (38.6%) 762 (33.3%) 644 (28.1%)

p<0.001

3-4 1616 615 (38.1%) 551 (34.1%) 450 (27.8%)

5-6 3415 1148 (33.6%) 1210 (35.4%) 1057 (31.0%)

No. of nutritional

requirements on lunch

parents supported R = 0.033,

p=0.005 0-2 515 209 (40.6%) 170 (33.0%) 136 (26.4%)

3-4 1946 745 (38.3%) 642 (33.0%) 559 (28.7%)

5-6 5092 1786 (35.1%) 1791 (35.2%) 1515 (29.8%)


messages answered by

parents p<0.001

0-1 3387 1387 (41.0%) 1103 (32.6%) 897 (26.5%)

2 4198 1357 (32.3%) 1517 (36.1%) 1324 (31.5%)

A higher proportion of students from the SNAP schools preferred to choose healthier food options. (Table 4.1.3.2b). Table 4.1.3.2b Association of students’ eating preferences (Questions S1a to S1f) with other

variables in the school questionnaire

Variable No. of

students


0-1 2 3 KW test


p<0.001 Yes 3220 1065 (33.1%) 1104 (34.3%) 1051 (32.6%)

No 3340 1345 (40.3%) 1084 (32.5%) 911 (27.3%)

59


4.1.4 Students’ Breakfast-eating Habits

4.1.4.1 Association of students’ breakfast-eating habits with other variables in the student questionnaire

Girls (OR=1.41) and students studying in DSS & private schools (OR=1.49) were more likely to report that they had breakfast on the day of survey. Students who perceived their eating habit as ‘unhealthy’ (OR=0.33) were less likely to have breakfast on the day of survey. Those who were not aware of the [email protected] campaign (OR=0.76), who were not supportive of healthy eating promotion at school (OR=0.55) and who did not participate healthy eating activities (OR=0.64) were less likely to have breakfast (Table 4.1.4.1). Table 4.1.4.1 Association of students’ breakfast-eating habits (Question S2) with other

variables in the student questionnaire

Variable No. of

student


habits p-value

OR (95% C.I.)

Yes No Chi-square

test

Gender

p<0.001

Male 3850 3174 (82.4%) 676 (17.6%) 1.00

Female 4642 4034 (86.9%) 608 (13.1%) 1.41 (1.25, 1.59)

School type

p<0.001

Government & aided 6504 5421 (83.3%) 1083 (16.7%) 1.00

DSS & private 2492 2197 (88.2%) 295 (11.8%) 1.49 (1.30, 1.71)


p<0.001

Healthy 8004 6879 (85.9%) 1125 (14.1%) 1.00

Unhealthy 328 220 (67.1%) 108 (32.9%) 0.33 (0.26, 0.42)



p<0.001

Aware 4995 4319 (86.5%) 676 (13.5%) 1.00

Not aware 2074 1720 (82.9%) 354 (17.1%) 0.76 (0.66, 0.88)

Students’ support of healthy eating

promotion in school

p<0.001

Support 6406 5566 (86.9%) 840 (13.1%) 1.00

Not support 489 383 (78.3%) 106 (21.7%) 0.55 (0.43, 0.68)



activity p<0.001

Yes 1392 1229 (88.3%) 163 (11.7%) 1.00

No 3065 2541 (82.9%) 524 (17.1%) 0.64 (0.53, 0.78)

60


4.1.4.2 Association of students’ breakfast-eating habits with other variables in the parent questionnaire and school questionnaire

Students with better-educated parents (secondary: OR=1.34; post-secondary or above: OR=1.79) were more likely to have breakfast on the day of survey. Moreover, the higher their monthly household income, the higher proportion of students reported had breakfast on the day of survey (Table 4.1.4.2a).

The students’ breakfast-eating habits was positively associated with their parents’ general healthy eating knowledge (2 correct answers: OR=1.28). Students with parents who perceived theirchild’s eating habit as unhealthy were also less likely to have breakfast (OR=0.55). When thenumber of nutritional requirements imposed on tuck shop sales and school lunch parents supported increased to 5 or 6, students were more likely to have breakfast on the survey day (Table 4.1.4.2a).

Table 4.1.4.2a Association of students’ breakfast-eating habits (Question S2) with other


Variable No. of

student


habits p-value

OR (95% C.I.)

Yes No Chi-square

test

KW

Test


p<0.001 Primary or below 703 566 (80.5%) 137 (19.5%) 1.00

Secondary 4522 3829 (84.7%) 693 (15.3%) 1.34 (1.09, 1.64)

Post-secondary or above 2448 2157 (88.1%) 291 (11.9%) 1.79 (1.44, 2.24)

Monthly household

Income

p<0.001

Below $10000 1586 1279 (80.6%) 307 (19.4%) 1.00

$10000 - $19999 1896 1604 (84.6%) 292 (15.4%) 1.32 (1.11, 1.57)

$20000 - $29999 1178 1011 (85.8%) 167 (14.2%) 1.45 (1.18, 1.79)

$30000 - $59999 1715 1497 (87.3%) 218 (12.7%) 1.65 (1.36, 1.99)

$60000 or above 1101 989 (89.8%) 112 (10.2%) 2.12 (1.68, 2.67)

No. of correct healthy

eating messages answered

by parents

p<0.001

0-1 3469 2903 (83.7%) 566 (16.3%) 1.00

2 4294 3728 (86.8%) 566 (13.2%) 1.28 (1.13, 1.46)

Parent perceived child’s

eating habits

p<0.001

Healthy 5463 4796 (87.8%) 667 (12.2%) 1.00

Unhealthy 956 764 (79.9%) 192 (20.1%) 0.55 (0.46, 0.66)

61


Variable No. of

student


habits p-value

OR (95% C.I.)

Yes No Chi-square

test

KW

Test

No. of nutritional



p<0.001 0-2 2358 1958 (83.0%) 400 (17.0%) 1.00

3-4 1633 1397 (85.5%) 236 (14.5%) 1.21 (1.02, 1.44)

5-6 3506 3049 (87.0%) 457 (13.0%) 1.36 (1.18, 1.58)

No. of nutritional


parents supported

p<0.001 0-2 517 423 (81.8%) 94 (18.2%) 1.00

3-4 2001 1663 (83.1%) 338 (16.9%) 1.09 (0.85, 1.41)

5-6 5212 4516 (86.6%) 696 (13.4%) 1.44 (1.14, 1.83)

The breakfast-eating habit was found to be significantly associated with the participation of school in any healthy eating promotion activity (Table 4.1.4.2b). Table 4.1.4.2b Association of students’ breakfast-eating habits (Question S2) with other


No. of


habits p-value

Variable students

OR (95% C.I.)

Yes No Chi-square

test

Schools’ participation in any

healthy eating promotion activity p<0.001

Yes 7392 6213 (84.1%) 1179 (15.9%) 1.00

No 1604 1405 (87.6%) 199 (12.4%) 1.34 (1.14, 1.57)

4.1.5 Students’ Fruit-eating Habits

4.1.5.1 Association of students’ fruit-eating habits with other variables in the student questionnaire

Girls (OR=1.23) were more likely to comply with the recommended frequency of having fruit at least twice daily than boys. Besides, students who correctly answered the recommended number of servings of fruit and vegetables per day were more likely to have fruit twice per day or more. Students were less likely to comply with this fruit intake recommendation when they perceived their

62


eating habit as unhealthy (OR=0.60), not aware of [email protected] campaign (OR=0.71), not supportive of promoting healthy eating at school (OR=0.71) and did not participate in any healthy eating activity organised at school in past year (OR=0.76) (Table 4.1.5.1). Table 4.1.5.1 Association of students’ fruit-eating habits (Question S3a) with other variables in

the student questionnaire

Variable No. of

student

Frequency of having fruit per

day by students p-value

OR (95% C.I.)

≥ 2 times <2 times Chi-square

test

Gender

p<0.001 Male 3805 2080 (54.7%) 1725 (45.3%) 1.00

Female 4559 2727 (59.8%) 1832 (40.2%) 1.23 (1.13, 1.35)

Knowledge of correct fruit and

vegetables serving by students

p=0.001

Correct 7554 4426 (58.6%) 3128 (41.4%) 1.00

Incorrect 774 407 (52.6%) 367 (47.4%) 0.78 (0.68, 0.91)


habits

p<0.001

Healthy 7920 4625 (58.4%) 3295 (41.6%) 1.00

Unhealthy 319 146 (45.8%) 173 (54.2%) 0.60 (0.48, 0.75)



p<0.001

Aware 4962 3052(61.5%) 1910 (38.5%) 1.00

Not aware 2039 1084 (53.2%) 955 (46.8%) 0.71 (0.64, 0.79)



p<0.001

Support 6363 3822 (60.1%) 2541 (39.9%) 1.00

Not support 481 249 (51.8%) 232 (48.2%) 0.71 (0.59, 0.86)



activity

p<0.001

Yes 1385 854 (61.7%) 531 (38.3%) 1.00

No 3039 1670 (55.0%) 1369 (45.0%) 0.76 (0.67, 0.87)

63


4.1.5.2 Association of students’ fruit-eating habits with other variables in the parent questionnaire and the school questionnaire

Students with parents who perceived their child’s eating habit as healthy were more likely to consume fruit in accordance to the recommendation. However, this behaviour was not shown to have statistically significant association with parents’ educational level, monthly household income, parents’ knowledge on general healthy eating and their support on nutritional requirements of tuck shop sales or school lunch (Table 4.1.5.2). Table 4.1.5.2 Association of students’ fruit-eating habit (Question S3a) with other variables in

the parent questionnaire

Variable No. of

students

Frequency of having fruit per


OR(95% C.I.)

≥ 2 times <2 times Chi-square test

Parents’ perception on

child’s eating habits

p<0.001

Healthy 5402 3153 (58.4%) 2249 (41.6%) 1.00

Unhealthy 940 491 (52.2%) 449 (47.8%) 0.78 (0.68, 0.90)

Students’ fruit eating frequency was not found to be associated with the schools’ environmental factors, such as the establishment of healthy eating policies, schools’ participation in any healthy eating promotional activity and whether the schools were members of the SNAP.

4.1.6 Students’ Vegetable-eating Habits

4.1.6.1 Association of students’ vegetable-eating habits with other variables in the student questionnaire

Similar to students’ fruit eating habit, girls (OR=1.60) were more likely to report consuming vegetables at least two times daily. Students from DSS & private schools were also more likely to achieve the recommended intake (OR=1.32). Students’ vegetable eating habit was positively associated with their knowledge in the recommended number of servings of fruit and vegetables to be eaten daily, their perceived eating habit as ‘healthy’ their awareness of [email protected] campaign, their support of promoting healthy eating at school and their participation in healthy eating activities organised at school in the past year (Table 4.1.6.1).

64


Table 4.1.6.1 Association of students’ vegetable-eating habits (Question S3b) with other variables in the student questionnaire

Variable No. of

students

Frequency of having vegetables per


OR (95% C.I.)


test

Gender

p<0.001 Male 3810 2847 (74.7%) 963 (25.3%) 1.00

Female 4594 3791 (82.5%) 803 (17.5%) 1.60 (1.44, 1.78)

School type

p<0.001


DSS & private 2454 2012 (82.0%) 442 (18.0%) 1.32 (1.17, 1.49)

Knowledge of correct fruit

and vegetables serving by

students

p<0.001

Correct 7595 6097 (80.3%) 1498 (19.7%) 1.00

Incorrect 767 538 (70.1%) 229 (29.9%) 0.58 (0.49, 0.68)


habits

p<0.001

Healthy 7945 6368 (80.2%) 1577 (19.8%) 1.00

Unhealthy 317 189 (59.6%) 128 (40.4%) 0.37 (0.29, 0.46)

Parents’ awareness of

[email protected]

campaign p<0.001

Aware 4958 4073 (82.2%) 885 (17.8%) 1.00

Not aware 2048 1504 (73.4%) 544 (26.6%) 0.60 (0.53, 0.68)

Parents’ support of healthy


p<0.001

Support 6387 5258 (82.3%) 1129 (17.7%) 1.00

Not support 481 307 (63.8%) 174 (36.2%) 0.38 (0.31, 0.46)



activity

p<0.001

Yes 1388 1160 (83.6%) 228 (16.4%) 1.00

No 3042 2326 (76.5%) 716 (23.5%) 0.64 (0.54, 0.75)

65


4.1.6.2 Association of students’ vegetable-eating habits with other variables in the parent questionnaire and the school questionnaire

Students with better-educated parents or those with higher level of monthly household income were more likely to comply with the recommended vegetables intake frequency. Moreover, parents’ knowledge in general healthy eating, parents more supportive of imposing nutritional requirements on tuck shop sales and school lunch were positively associated with students’ vegetable intake frequency. Similar to fruit-eating habits, students whose parents perceived their child’s eating habit as ‘unhealthy’ were less likely to have the appropriate vegetable intake frequency (Table 4.1.6.2a). Table 4.1.6.2a Association of students’ vegetable-eating habits (Question S3b) with other


Variable No. of

student

Frequency of having

vegetables per day by studentsp-value

OR (95% C.I.)


test

KW

Test


p<0.001

Primary or below 700 500 (71.4%) 200 (28.6%) 1.00

Secondary 4480 3541 (79.0%) 939 (21.0%) 1.51 (1.26, 1.80)


Monthly household

income

p<0.001

Below $10000 1573 1181 (75.1%) 392 (24.9%) 1.00

$10000 - $19999 1877 1460 (77.8%) 417 (22.2%) 1.16 (0.99, 1.36)

$20000 - $29999 1172 947 (80.8%) 225 (19.2%) 1.40 (1.16, 1.68)

$30000 - $59999 1687 1360 (80.6%) 327 (19.4%) 1.38 (1.17, 1.63)

$60000 or above 1093 905 (82.8%) 188 (17.2%) 1.60 (1.32, 1.94)


eating messages

answered by parent

p<0.001

0-1 3421 2606 (76.2%) 815 (23.8%) 1.00

2 4260 3456 (81.1%) 804 (18.9%) 1.34 (1.20, 1.50)

No. of nutritional

requirements on tuck

shop sales parent

support p<0.001

0-2 2338 1791 (76.6%) 547 (23.4%) 1.00

3-4 1608 1253 (77.9%) 355 (22.1%) 1.08 (0.93, 1.26)

5-6 3469 2798 (80.7%) 671 (19.3%) 1.27 (1.12, 1.45)

66


Variable No. of

student

Frequency of having

vegetables per day by studentsp-value

OR (95% C.I.)


test

KW

Test

No. of nutritional


parent support p<0.001

0-2 506 365 (72.1%) 141 (27.9%) 1.00

3-4 1983 1527 (77.0%) 456 (23.0%) 1.29 (1.04, 1.61)

5-6 5161 4145 (80.3%) 1016 (19.7%) 1.58 (1.28, 1.94)

Parent perceived child’s

eating habits

p<0.001

Healthy 5415 4405 (81.3%) 1010 (18.7%) 1.00

Unhealthy 941 668 (71.0%) 273 (29.0%) 0.56 (0.48, 0.66)

Students whose school did not participate in any healthy eating promotion activities were more likely to comply with the recommended vegetables intake frequency (OR = 1.17). There was no association of students’ vegetable eating frequency with the schools’ establishment of healthy eating policies or whether they were members of the SNAP (Table 4.1.6.2b). Table 4.1.6.2b Association of students’ vegetable-eating habits (Question S3b) with other


Variable No. of

students

Frequency of having vegetables

per day by students p-value

OR (95% C.I.)


test

Schools’ participation in any


activity p<0.001

Yes 7335 5742 (78.3%) 1593 (21.7%) 1.00

No 1567 1267 (80.9%) 300 (19.1%) 1.17 (1.02, 1.34)

67


4.1.7 Students’ Awareness of [email protected] Campaign

4.1.7.1 Association of students’ awareness of [email protected] campaign with othervariables in the student questionnaire

Girls (OR=1.72) were more likely than boys to report that they were aware of [email protected] campaign. Students attending DSS & private schools were less aware of the campaign (OR=0.30). Students who perceived their eating habit as ‘unhealthy’ (OR=0.59), who did not support promoting healthy eating at school (OR=0.20) and who did not participate in any healthy eating activities organised by the school (OR=0.15) were less likely to be aware of the campaign than their counterparts (Table 4.1.7.1).

Table 4.1.7.1 Association of students’ awareness of [email protected] campaign (Question

S12) with other variables in the student questionnaire

Variable No. of

students


[email protected] campaign p-value

OR (95% C.I.)

Yes No Chi-square

test

Gender

p<0.001 Male 3090 1990 (64.4%) 1100 (35.6%) 1.00

Female 3676 2783 (75.7%) 893 (24.3%) 1.72 (1.55, 1.91)

School type

p<0.001


DSS & private 1944 994 (51.1%) 950 (48.9%) 0.30 (0.27, 0.34)


habits

p<0.001

Healthy 6539 4682 (71.6%) 1857 (28.4%) 1.00

Unhealthy 274 164 (59.9%) 110 (40.1%) 0.59 (0.46, 0.76)



p<0.001

Support 5393 4107 (76.2%) 1286 (23.8%) 1.00

Not support 421 162 (38.5%) 259 (61.5%) 0.20 (0.16, 0.24)



activity

p<0.001

Yes 1273 1133 (89.0%) 140 (11.0%) 1.00

No 2605 1419 (54.5%) 1186 (45.5%) 0.15 (0.12, 0.18)

68


4.1.7.2 Association of students’ awareness of [email protected] campaign with other variables in the parent questionnaire and the school questionnaire

Parents’ education level was negatively associated with the students’ awareness of the [email protected] campaign, although the effect was statistically significant only at the ‘post-secondary or above’ level. The monthly household income was also negatively associated with the students’ awareness of the campaign. On the other hand, students’ awareness increased when their parents’ knowledge in general healthy eating increased (Table 4.1.7.2a). Table 4.1.7.2a Association of students’ awareness of [email protected] campaign (Question

S12) with other variables in the parent questionnaire

Variable No. of

student



OR (95% C.I.)

Yes No KW test


p<0.001

Primary or below 578 435 (75.3%) 143 (24.7%) 1.00

Secondary 3618 2676 (74.0%) 942 (26.0%) 0.93 (0.76, 1.14)


Monthly household

income

p<0.001

Below $10000 1278 967 (75.7%) 311 (24.3%) 1.00

$10000 - $19999 1547 1193 (77.1%) 354 (22.9%) 1.08 (0.91, 1.29)

$20000 - $29999 968 708 (73.1%) 260 (26.9%) 0.88 (0.72, 1.06)

$30000 - $59999 1341 897 (66.9%) 444 (33.1%) 0.65 (0.55, 0.77)

$60000 or above 855 474 (55.4%) 381 (44.6%) 0.40 (0.33, 0.48)


messages answered by

parents

p<0.001

0-1 2734 1864 (68.2%) 870 (31.8%) 1.00

2 3467 2518 (72.6%) 949 (27.4%) 1.24 (1.11, 1.38)

Students studying in schools without established healthy eating policies (OR=0.64), schools not participating in any healthy eating promotion activity (OR = 0.30), or not taking part in SNAP (OR=0.40) were less likely to be aware of the [email protected] campaign (Table 4.1.7.2b).

69


Table 4.1.7.2b Association of students’ awareness of [email protected] campaign (Question S12) with other variables in the school questionnaire

Variable No. of

students



OR

(95% C.I.) Yes No

Chi-square

test

Establishment of school

healthy eating policies

p<0.001

Yes 3360 2529 (75.3%) 831 (24.7%) 1.00

No 3810 2524 (66.2%) 1286 (33.8%) 0.64 (0.58, 0.72)

Schools’ participated in any


activity

p<0.001

Yes 5932 4465 (75.3%) 1467 (24.7%) 1.00

No 1238 588 (47.5%) 650 (52.5%) 0.30 (0.26, 0.34)


p<0.001

Yes 2687 2280 (84.9%) 407 (15.1%) 1.00

No 2692 1856 (68.9%) 836 (31.1%) 0.40 (0.35, 0.45)

4.1.8 Students’ Support of Healthy Eating Promotion in Schools

4.1.8.1 Association of students’ support of healthy eating promotion in school with other variables in the student questionnaire

There was a significant gender difference seen in students’ attitudes towards healthy eating promotion in schools with girls being more supportive (OR=2.55). Compared with students studying in government & aided schools, students from DSS & private schools were less likely to show support to promoting healthy eating in schools (OR=0.48) (Table 4.1.8.1). Students who perceived their eating habits as ‘unhealthy’ (OR=1.00 vs as ‘healthy’: OR=5.60), who were not aware of [email protected] campaign (OR=0.20) and did not participate in any healthy eating activities organised at school last year (OR=0.22) were less likely to support the promotion of healthy eating in school (Table 4.1.8.1).

70


Table 4.1.8.1 Association of students’ support of healthy eating promotion in school (Question S13) with other variables in the student questionnaire

Variable No. of

students


promotion in school p-value

OR (95% C.I.)

Yes No Chi-square

test

Gender

p<0.001 Male 2919 2610 (89.4%) 309 (10.6%) 1.00

Female 3691 3527 (95.6%) 164 (4.4%) 2.55 (2.09, 3.10)

School type

p<0.001


DSS & private 1905 1692 (88.8%) 213 (11.2%) 0.48 (0.40, 0.58)


habits

p<0.001

Healthy 6448 6049 (93.8%) 399 (6.2%) 1.00

Unhealthy 241 176 (73.0%) 65 (27.0%) 0.18 (0.13, 0.24)


[email protected]

campaign p<0.001

Aware 4269 4107 (96.2%) 162 (3.8%) 1.00

Not aware 1545 1286 (83.2%) 259 (16.8%) 0.20 (0.16, 0.24)



activities

p<0.001

Yes 1211 1173 (96.9%) 38 (3.1%) 1.00

No 2434 2125 (87.3%) 309 (12.7%) 0.22 (0.16, 0.31)

4.1.8.2 Association of students’ support of healthy eating promotion in school with other variables in the parent questionnaire and the school questionnaire

Students were less supportive of promoting healthy eating at school when their parents’ educational level increased. Students with a household income of $60000 or above were also less supportive of healthy eating promotion at school (Table 4.1.8.2a).

71


Table 4.1.8.2a Association of students’ support of healthy eating promotion at school (Question S13) with other variables in the parent questionnaire

Variable No. of

student


promotion at school p-value

OR (95% C.I.)

Yes No KW test


p=0.025

Primary or below 546 513 (94.0%) 33 (6.0%) 1.00

Secondary 3561 3334 (93.6%) 227 (6.4%) 0.95 (0.65, 1.38)


Monthly household

income

p=0.001

Below $10000 1227 1152 (93.9%) 75 (6.1%) 1.00

$10000 - $19999 1515 1425 (94.1%) 90 (5.9%) 1.03 (0.75, 1.41)

$20000 - $29999 937 881 (94.0%) 56 (6.0%) 1.02 (0.72, 1.46)

$30000 - $59999 1333 1261 (94.6%) 72 (5.4%) 1.14 (0.82, 1.59)

$60000 or above 840 743 (88.5%) 97 (11.5%) 0.50 (0.36, 0.68)

Furthermore, students whose school did not participate in any healthy eating promotion activity (OR= 0.51) or who were not attending SNAP schools (OR=0.70) were less likely to support promoting healthy eating in school (Table 4.1.8.2b). Table 4.1.8.2b Association of students’ support in healthy eating promotion in school

(Question S13) with other variables in the school questionnaire

Variable No. of

students

Students’ Support healthy eating

promotion in school p-value

OR (95% C.I.)

Yes No Chi-square

test

School’s participation in


activity

p<0.001

Yes 5807 5440 (93.7%) 367 (6.3%) 1.00

No 1193 1193 (88.3%) 139 (11.7%) 0.51 (0.42, 0.63)


p=0.002

Yes 2548 2415 (94.8%) 133 (5.2%) 1.00

No 2683 2488 (92.7%) 195 (7.3%) 0.70 (0.56, 0.88)

72


4.1.9 Students’ Participation in School-based Healthy Eating Activities

4.1.9.1 Association of students’ participation in school-based healthy eating activities with other variables in the student questionnaire

In the year prior to the survey, girls (OR=2.53) were more likely to participate in healthy eating activities organised by the school than for boys. Students coming from DSS & private schools (OR=0.14), students who were not aware of the [email protected] campaign (OR=0.15) and students who were not supportive of healthy eating promotion in school (OR=0.22) were less likely to have participated in healthy eating activities organised by schools (Table 4.1.9.1). Table 4.1.9.1 Association of students’ participation in school-based healthy eating activities

(Question S14) with other variables in the student questionnaire

Variable No. of

student

Students’ participation in school-based

healthy eating activities p-value

OR (95% C.I.)

Yes No Chi-square

test

Gender

p<0.001 Male 2061 445 (21.6%) 1616 (78.4%) 1.00

Female 2213 909 (41.1%) 1304 (58.9%) 2.53 (2.21, 2.90)

School type

p<0.001


DSS & private 1352 115 (8.5%) 1237 (91.5%) 0.14 (0.11, 0.17)


[email protected]

campaign p<0.001

Aware 2552 1133 (44.4%) 1419 (55.6%) 1.00

Not aware 1326 140 (10.6%) 1186 (89.4%) 0.15 (0.12, 0.18)

Students’ support of


in school

p<0.001

Support 3298 1173 (35.6%) 2125 (64.4%) 1.00

Not support 347 38 (11.0%) 309 (89.0%) 0.22 (0.16, 0.31)

4.1.9.2 Association of students’ participation in school-based healthy eating activities with other variables in the parent questionnaire and the school questionnaire

Parents’ knowledge on general healthy eating messages and their perception of their child’s eating habit were both positively associated with the students’ participation in school-based healthy eating activities. However, students whose parents attained post-secondary or above educational level

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(OR=0.64) and parents with a monthly household income $30000 or above ($30000 - $59999: OR=0.70; $60000 or above: OR=0.45) were less likely to have participated in school-based healthy eating activities (Table 4.1.9.2a). Table 4.1.9.2a Association of students’ participation in school-based healthy eating activities

(Question S14) with other variables in the parent questionnaire

Variable No. of

student



activities

p-value

OR (95% C.I.)

Yes No Chi-square

test KW test


p<0.001

Primary or below 357 127 (35.6%) 230 (64.4%) 1.00

Secondary 2193 771 (35.2%) 1422 (64.8%) 0.98 (0.78, 1.24)


Monthly household

income

p<0.001

Below $10000 787 285 (36.2%) 502 (63.8%) 1.00

$10000 - $19999 916 348 (38.0%) 568 (62.0%) 1.08 (0.89, 1.32)

$20000 - $29999 605 219 (36.2%) 386 (63.8%) 1.00 (0.80, 1.25)

$30000 - $59999 855 243 (28.4%) 612 (71.6%) 0.70 (0.57, 0.86)

$60000 or above 604 122 (20.2%) 482 (79.8%) 0.45 (0.35, 0.57)

No. of correct general

healthy eating messages

answered by parent

p<0.001

0-1 1724 488 (28.3%) 1236 (71.7%) 1.00

2 2191 769 (35.1%) 1422 (64.9%) 1.37 (1.19, 1.57)


child’s eating habits

p=0.042

Healthy 2820 921 (32.7%) 1899 (67.3%) 1.00

Unhealthy 469 131 (27.9%) 338 (72.1%) 0.80 (0.64, 0.99)

The school factors, namely the establishment of healthy eating policies, schools’ participation in any healthy eating promotional activity, and being a member school of the SNAP showed positive associations with the students’ participation in school-based healthy eating activities (Table 4.1.9.2b).

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Table 4.1.9.2b Association of students’ participation in school-based healthy eating activities (Question S14) with other variables in the school questionnaire

Variable No. of

students


school-based healthy eating activitiesp-value

OR (95% C.I.)

Yes No Chi-square

test



p<0.001

Yes 2074 794 (38.3%) 1280 (61.7%) 1.00

No 2465 614 (24.9%) 1851 (75.1%) 0.53 (0.47, 0.61)

Schools’ participation in

any healthy eating

promotion activity

p<0.001

Yes 3558 1354 (38.1%) 2204 (61.9%) 1.00

No 981 54 (5.5%) 927 (94.5%) 0.09 (0.07, 0.13)


p=0.001

Yes 1460 585 (40.1%) 875 (59.9%) 1.00

No 1704 584 (34.3%) 1120 (65.7%) 0.78 (0.67, 0.90)

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4.2 Analytic Findings from the Parent Questionnaire

Statistical tests were applied to analyse the relationship between variables in the parentquestionnaires, as well as the relationship between the findings in the parent questionnaires and selected variables of the corresponding student questionnaire and school questionnaire. These results are summarised below.

4.2.1 Parents’ Knowledge of General Healthy Eating Promotion Messages

4.2.1.1 Association of parents’ knowledge on general healthy eating promotion messages with other variables in the parent questionnaire

Parents with higher level educational attainment and higher monthly household income were more likely to answer correctly for both questions on general healthy eating knowledge. The number of nutritional requirement imposed on tuck shop sales and school lunch supported by the parents were positively associated with parents’ knowledge on general healthy eating messages. Parents who were not aware of school-based healthy eating promotional campaign launched by DH (OR=0.67) or who did not participate in any healthy eating promotion activities organised by their child’s school (OR=0.64) were more likely to answer 0 to 1 questions on general healthy eating messages (Table 4.2.1.1). Table 4.2.1.1 Association of parents’ general healthy eating knowledge (Question P13 and P14)

with other variables in the parent questionnaire

Variable No. of

parents


healthy eating messages p-value

OR (95% C.I.)

2 0-1 Chi-square

test KW test


p<0.001 Primary or below 739 335 (45.3%) 404 (54.7%) 1.00

Secondary 4714 2553 (54.2%) 2161 (45.8%) 1.42 (1.22, 1.66)


Monthly household income

p<0.001

Below $10000 1669 816 (48.9%) 853 (51.1%) 1.00

$10000 - $19999 1969 1046 (53.1%) 923 (46.9%) 1.18 (1.04, 1.35)

$20000 - $29999 1222 692 (56.6%) 530 (43.4%) 1.36 (1.18, 1.58)

$30000 - $59999 1782 1072 (60.2%) 710 (39.8%) 1.58 (1.38, 1.81)

$60000 or above 1187 703 (59.2%) 484 (40.8%) 1.52 (1.31, 1.76)

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Variable No. of

parents


healthy eating messages p-value

OR (95% C.I.)

2 0-1 Chi-square

test KW test

No. of nutritional



p<0.001 0-2 2476 1217 (49.2%) 1259 (50.8%) 1.00

3-4 1703 930 (54.6%) 773 (45.4%) 1.24 (1.10, 1.41)

5-6 3681 2199 (59.7%) 1482 (40.3%) 1.54 (1.39, 1.70)

No. of nutritional


parents supported

p<0.001 0-2 546 228 (41.8%) 318 (58.2%) 1.00

3-4 2095 1048 (50.0%) 1047 (50.0%) 1.40 (1.15, 1.69)

5-6 5474 3209 (58.6%) 2265 (41.4%) 1.98 (1.65, 2.36)

Parents’ awareness of DH

healthy eating campaign in

schools

p<0.001

Yes 4505 2671 (59.3%) 1834 (40.7%) 1.00

No 1604 792 (49.4%) 812 (50.6%) 0.67 (0.60, 0.75)

Parents’ participation in


promotion activity

p<0.001

Yes 615 404 (65.7%) 211 (34.3%) 1.00

No 5740 3157 (55.0%) 2583 (45.0%) 0.64 (0.54, 0.76)

4.2.1.2 Association of parents’ knowledge on general healthy eating messages with other variables in the student questionnaire and the school questionnaire

Results suggested that parents from DSS & private schools were more likely to answer correctly questions on general healthy eating messages than those from government and aided schools. Moreover, for students who answered more general healthy eating messages correctly, their parents were also more likely to answer the general healthy eating messages correctly. Parents with children who were not aware of the [email protected] campaign or had not participated in any healthy eating activities organised by schools were more likely to give a smaller number of correct answers (Table 4.2.1.2).


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Table 4.2.1.2 Association of parents’ general healthy eating knowledge (Questions P13 and P14) with other variables in the student questionnaire

Variable No. of

parents

No. of correct general healthy

eating messages by parents p-value

OR (95% C.I.)

2 0-1 Chi-square

test KW test

School type

p<0.001 Government & aided 5808 3132 (53.9%) 2676 (46.1%) 1.00

DSS & private 2375 1383 (58.2%) 992 (41.8%) 1.19 (1.08, 1.31)



by students

p<0.001 0-1 1241 665 (53.6%) 576 (46.4%) 1.00

2 2641 1385 (52.4%) 1256 (47.6%) 0.96 (0.83, 1.09)

3 3893 2332 (59.9%) 1561 (40.1%) 1.29 (1.14, 1.47)


[email protected]

campaign p<0.001

Aware 4382 2518 (57.5%) 1864 (42.5%) 1.00

Not aware 1819 949 (52.2%) 870 (47.8%) 0.81 (0.72, 0.90)



eating activity

p<0.001

Yes 1257 769 (61.2%) 488 (38.8%) 1.00

No 2658 1422 (53.5%) 1236 (46.5%) 0.73 (0.64, 0.84)

The number of correct answers on general healthy eating messages did not show significant association with the variables in the school questionnaire.

4.2.2 Parents’ Knowledge of Snack Categorisation

4.2.2.1 Association of parents’ knowledge of snack categorisation with other variables in the parent questionnaire

Parents’ educational level (R=0.118) and monthly household income (R=0.159) were positively correlated with the number of correct snack categorisation. Parents who supported more nutritional requirements imposed on tuck shop sales were more likely to categorise the snack correctly. Similarly, the number of school lunch regulations preferred by the parents showed a positive correlation with the number of snacks correctly categorised (R=0.139). Moreover, parents who were aware of the school-based healthy eating promotion campaign launched by DH or who


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reported to have participated in any healthy eating promotion activities organised by their child’s school were more likely to categorise snacks correctly (Table 4.2.2.1). Table 4.2.2.1 Association of parents’ knowledge of snack categorisation (Questions P15a to

P15j) with other variables in the parent questionnaire

VariableNo. of

parent

No. of correct snacks categorization by parents p-value

0-3 4-6 7-10 KW

Test

Rank

correlation


R = 0.118 ,

p<0.001

Primary or below 661 263 (39.8%) 346 (52.3%) 52 (7.9%)

Secondary 4334 1356 (31.3%) 2434 (56.2%) 544 (12.6%)



R = 0.159,

p<0.001

Below $10000 1476 589 (39.9%) 773 (52.4%) 114 (7.7%)

$10000 - $19999 1808 586 (32.4%) 1018 (56.3%) 204 (11.3%)

$20000 - $29999 1141 321 (28.1%) 637 (55.8%) 183 (16.0%)

$30000 - $59999 1664 391 (23.5%) 993 (59.7%) 280 (16.8%)

$60000 or above 1122 242 (21.6%) 680 (60.6%) 200 (17.8%)

No. of nutritional


sales parent supported R = 0.087,

p<0.0010-2 2260 782 (34.6%) 1232 (54.5%) 246 (10.9%)

3-4 1566 450 (28.7%) 922 (58.9%) 194 (12.4%)

5-6 3407 909 (26.7%) 1957 (57.4%) 541 (15.9%)

No. of nutritional


parents supported R = 0.139,

p<0.0010-2 468 194 (41.5%) 226 (48.3%) 48 (10.3%)

3-4 1874 684 (36.5%) 1042 (55.6%) 148 (7.9%)

5-6 5110 1327 (26.0%) 2969 (58.1%) 814 (15.9%)



schools p<0.001

Yes 4151 1183 (28.5%) 2349 (56.6%) 619 (14.9%)

No 1472 479 (32.5%) 824 (56.0%) 169 (11.5%)



activity at schools p<0.001

Yes 581 136 (23.4%) 340 (58.5%) 105 (18.1%)

No 5266 1567 (29.8%) 2996 (56.9%) 703 (13.3%)


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4.2.2.2 Association of parents’ knowledge of snack categorisation with other variables in the student questionnaire and the school questionnaire

Parents of students from DSS & private schools (16.7%) were more likely to correctly categorise most of the snacks (7 to 10 items) into corresponding categorises. At the same time, parents of children with better knowledge on general healthy eating messages tended to categorise more snacks correctly. Other variables such as students’ perception of their eating habit, their awareness of the [email protected] campaign, their support towards promoting healthy eating at school and their participation in healthy eating activities were not associated with parents’ knowledge of snack categorisation (Table 4.2.2.2). Table 4.2.2.2 Association of parents’ knowledge of snack categorisation (Questions P15a to

P15j) with other variables in the student questionnaire

VariableNo. of

parents

No. of correct snacks categorisation by parents p-value

0-3 4-6 7-10 KW

Test

Rank

correlation

School type

p<0.001Government & aided 5293 1719 (32.5%) 2928 (55.3%) 646 (12.2%)

DSS & private 2217 507 (22.9%) 1339 (60.4%) 371 (16.7%)



by students R =0.039,

p=0.0010-1 1102 355 (32.2%) 620 (56.3%) 127 (11.5%)

2 2431 741 (30.5%) 1376 (56.6%) 314 (12.9%)

3 3611 1027 (28.4%) 2059 (57.0%) 525 (14.5%)

Parents’ knowledge of snack categorisation was not associated with variables in the school questionnaire.

4.2.3 Parents’ Perception of ease to sustain healthy eating habits

4.2.3.1 Association of parents’ perception of ease to sustain healthy eating habits with other variables in the parent questionnaire

Parents with higher educational level were more likely to think that healthy eating habits were difficult to sustain. Similar findings were observed among parents with higher monthly household income. Parents who correctly answered both questions on general healthy eating messages were slightly more likely to perceive healthy eating habits as easy to sustain. On the other hand, parents who categorised snacks better were less likely to think that healthy eating habits were easy to sustain (Table 4.2.3.1).


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Parents who supported 3-4 school lunch arrangement requirements were more likely to think healthy eating habits were easy to sustain, compared with those who supported 0-2 requirements (OR=1.29). Parents who perceived their child’s eating habit as unhealthy and did not participate in healthy eating activities at school were less likely to perceive healthy eating habits as easy to sustain (Table 4.2.3.1). Table 4.2.3.1 Association of parents’ perception of ease to sustain healthy eating habits

(Question P16) with other variables in the parent questionnaire

VariableNo. of

parents

Parents’ perception of ease to

sustain healthy eating habits p-value

OR (95% C.I.)

Easy DifficultChi-square

test

KW

test


p=0.003Primary or below 697 388 (55.7%) 309 (44.3%) 1.00

Secondary 4622 2184 (47.3%) 2438 (52.7%) 0.71 (0.61, 0.84)


Monthly household

income

p=0.006

Below $10000 1596 815 (51.1%) 781 (48.9%) 1.00

$10000 - $19999 1925 920 (47.8%) 1005 (52.2%) 0.88 (0.77, 1.00)

$20000 - $29999 1210 554 (45.8%) 656 (54.2%) 0.81 (0.70, 0.94)

$30000 - $59999 1764 801 (45.4%) 963 (54.6%) 0.80 (0.70, 0.91)

$60000 or above 1177 557 (47.3%) 620 (52.7%) 0.86 (0.74, 1.00)


healthy eating messages

answered by parents p=0.049

0-1 3553 1653 (46.5%) 1900 (53.5%) 1.00

2 4436 2162 (48.7%) 2274 (51.3%) 1.09 (1.00, 1.19)

No. of correct snacks

categorization by parents

p=0.0030-3 2164 1074 (49.6%) 1090 (50.4%) 1.00

4-6 4186 2003 (47.8%) 2183 (52.2%) 0.93 (0.84, 1.03)

7-10 1010 439 (43.5%) 571 (56.5%) 0.78 (0.67, 0.91)


child’s eating habit p<0.001

Healthy 5603 3194 (57.0%) 2409 (43.0%) 1.00

Unhealthy 997 201 (20.2%) 796 (79.8%) 0.19 (0.16, 0.22)


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Variable No. of

parents



OR (95% C.I.)

Easy Difficult Chi-square

test

KW

test

No. of nutritional


parents supported

p=0.013 0-2 533 240 (45.0%) 293 (55.0%) 1.00

3-4 2013 1035 (51.4%) 978 (48.6%) 1.29 (1.07, 1.57)

5-6 5401 2515 (46.6%) 2886 (53.4%) 1.07 (0.89, 1.27)



activity in schools

p=0.006

Yes 601 314 (52.2%) 287 (47.8%) 1.00

No 5639 2611 (46.3%) 3028 (53.7%) 0.79 (0.67, 0.93)

4.2.3.2 Association of parents’ perception of ease to sustain healthy eating habits with other variables in the student questionnaire and the school questionnaire

Parents with children who perceived their own eating habit as ‘unhealthy’ (OR=0.62) and children who did not participate in school-based healthy eating activities (OR=0.81) were less likely to think that healthy eating habits were easy to sustain (Table 4.2.3.2a). Table 4.2.3.2a Association of parents’ perception of ease to sustain healthy eating habits

(Question P16) with other variables in the student questionnaire

Variable No. of

parents



OR (95% C.I.)


test

Students’ self-perceived eating

habit

Healthy 6886 3355 (48.7%) 3531 (51.3%) p<0.001

1.00

Unhealthy 272 101 (37.1%) 171 (62.9%) 0.62 (0.48, 0.80)



activities

Yes 1232 640 (51.9%) 592 (48.1%) p=0.002

1.00

No 2592 1207 (46.6%) 1385 (53.4%) 0.81 (0.73, 0.92)


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Parents with children attending schools without established healthy eating policies or schools not joining the SNAP were less likely to think that healthy eating habits were easy to sustain (Table 4.2.3.2b). Table 4.2.3.2b Association of parents’ perception of ease to sustain healthy eating habits

(Question P16) with other variables in the school questionnaire

Variable No. of

parents



OR (95% C.I.)


test



Yes 3550 1747 (49.2%) 1803 (50.8%) p=0.022

1.00

No 4467 2083 (46.6%) 2384 (53.4%) 0.90 (0.83, 0.98)


Yes 2783 1365 (49.0%) 1418 (51.0%) p=0.005

1.00

No 3121 1418 (45.4%) 1703 (54.6%) 0.87 (0.78, 0.96)

4.2.4 Parents’ Agreement to Impose Nutritional Requirements on School Tuck Shop Sales

4.2.4.1 Association of parents’ agreement to impose nutritional requirements on school tuck shop sales with other variables in the parent questionnaire

The number of tuck shop nutritional requirements parents supported imposing was weakly and positively correlated with parents’ educational level and the monthly household income. Parents who were aware of the healthy eating campaigns organised by DH at school, who had participated in healthy eating activities in schools or who were more supportive on school lunch arrangement requirements also supported more tuck shop regulations at school (Table 4.2.4.1).


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Table 4.2.4.1 Association of parents’ agreement of imposing nutritional requirements on tuck shop sales (Question P11a to P11f) with other variables in the parent questionnaire

Variable No. of

parents

No. of imposing nutritional requirements

on tuck shop sales parents support p-value

0-2 3-4 5-6 KW test Rank

correlation


R = 0.141,

p<0.001

Primary or below 707 331 (46.8%) 146 (20.7%) 230 (32.5%)

Secondary 4562 1508 (33.1%) 993 (21.8%) 2061 (45.2%)



R = 0.176,

p<0.001

Below $10000 1601 703 (43.9%) 349 (21.8%) 549 (34.3%)

$10000 - $19999 1905 665 (34.9%) 425 (22.3%) 815 (42.8%)

$20000 - $29999 1202 337 (28.0%) 235 (19.6%) 630 (52.4%)

$30000 - $59999 1719 408 (23.7%) 388 (22.6%) 923 (53.7%)

$60000 or above 1138 264 (23.2%) 237 (20.8%) 637 (56.0%)

No. of nutritional


supported

R = 0.380,

p<0.001 0-2 535 366 (68.4%) 89 (16.6%) 80 (15.0%)

3-4 2002 1035 (51.7%) 466 (23.3%) 501 (25.0%)

5-6 5332 1079 (20.2%) 1152 (21.6%) 3101 (58.2%)


healthy eating campaigns at

schools p<0.001

Yes 4355 1262 (29.0%) 921 (21.1%) 2172 (49.9%)

No 1544 516 (33.4%) 345 (22.3%) 683 (44.2%)



activity at school p<0.001

Yes 599 138 (23.0%) 124 (20.7%) 337 (56.3%)

No 5541 1731 (31.2%) 1216 (21.9%) 2594 (46.8%)


85

4.2.4.2 Association of parents’ agreement to impose nutritional requirements on school tuck shop sales with other variables in the student and school questionnaire

Parents from DSS & private schools were more likely to support imposing more nutritional requirements on tuck shop sales (Table 4.2.4.2a). Table 4.2.4.2a Association of parents’ agreement on imposing nutritional requirements on tuck

shop sales (Question P11a to P11f) with other variables in the student questionnaire

Variable No. of

parents

No. of imposing nutritional requirements on tuck shop sales parents support

p-value

0-2 3-4 5-6 KW test

School type p<0.001 Government & aided 5618 1957 (34.8%) 1244 (22.1%) 2417 (43.0%)

DSS & private 2286 536 (23.4%) 469 (20.5%) 1281 (56.0%)

Parents whose children studied in school that did not participate in any healthy eating promotion activities were more likely to support more tuck shop nutritional requirements (Table 4.2.4.2b). Table 4.2.4.2b Association of parents’ agreement on imposing nutritional requirements on

tuck shop sales (Question P11a to P11f) with other variables in the school questionnaire

Variable No. of

parents

No. of imposing nutritional requirements on tuck shop sales parents support

p-value

0-2 3-4 5-6 KW test

Schools’ participation in any healthy eating promotion activity

p<0.001

Yes 6486 2128 (32.8%) 1409 (21.7%) 2949 (45.5%)

No 1418 365 (25.7%) 304 (21.4%) 749 (52.8%)

4.2.5 Parents’ Agreement to Impose Nutritional Requirements on School Lunch

4.2.5.1 Association of parents’ agreement to impose nutritional requirements on school lunch with other variables in the parent questionnaire

The number of school lunch arrangement regulations parents supported was positively correlated with the parents’ educational level (R=0.219) and the monthly household income (R=0.268). Parents who were aware of the healthy eating campaigns organised by DH at school or parents who had participated in the healthy eating activity in schools were likely to support more nutritional requirements on school lunch (Table 4.2.5.1).


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Table 4.2.5.1 Association of parents’ agreement to impose nutritional requirements on school lunch (Questions P12a to P12f) with other variables in the parent questionnaire

Variable No. of

parents

No. of imposing nutritional requirements on

school lunch parents support p-value

0-2 3-4 5-6 KW Test Rank

correlation


R = 0.219,

p<0.001

Primary or below 744 116 (15.6%) 301 (40.5%) 327 (44.0%)

Secondary 4695 305 (6.5%) 1365 (29.1%) 3025 (64.4%)



R = 0.268,

p<0.001

Below $10000 1665 212 (12.7%) 674 (40.5%) 779 (46.8%)

$10000 - $19999 1969 140 (7.1%) 604 (30.7%) 1225 (62.2%)

$20000 - $29999 1213 52 (4.3%) 260 (21.4%) 901 (74.3%)

$30000 - $59999 1774 60 (3.4%) 305 (17.2%) 1409 (79.4%)

$60000 or above 1176 56 (4.8%) 160 (13.6%) 960 (81.6%)

No. of nutritional



R = 0.380,

p<0.001 0-2 2480 366 (14.8%) 1035 (41.7%) 1079 (43.5%)

3-4 1707 89 (5.2%) 466 (27.3%) 1152 (67.5%)

5-6 3682 80 (2.2%) 501 (13.6%) 3101 (84.2%)


healthy eating campaign at

schools p<0.001

Yes 4478 252 (5.6%) 1038 (23.2%) 3188 (71.2%)

No 1597 116 (7.3%) 458 (28.7%) 1023 (64.1%)



activity in schools p=0.039

Yes 612 28 (4.6%) 142 (23.2%) 442 (72.2%)

No 5719 366 (6.4%) 1439 (25.2%) 3914 (68.4%)

4.2.5.2 Association of parents’ agreement to impose nutritional requirements on schoollunch (Questions P12a to P12f) with other variables in the student and schoolquestionnaire

Parents from DSS & private schools were more likely to support imposing more nutritional requirements on school lunch (Table 4.2.5.2a).


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Table 4.2.5.2a Association of parents’ agreement to impose nutritional requirements on school lunch (Questions P12a to P12f) with other variables in the student questionnaire

Variable No. of

parents



0-2 3-4 5-6 KW test

School type


DSS & private 2355 86 (3.7%) 383 (16.3%) 1886 (80.1%)

Parents belonging to schools that did not participate in any healthy eating promotion activities and were not a member of SNAP were both more likely to support to impose a higher number nutritional requirements on school lunch (Table 4.2.5.2b). Table 4.2.5.2b Association of parents’ agreement to impose nutritional requirements on school

lunch (Questions P12a to P12f) with other variables in the school questionnaire

Variable No. of

parents



0-2 3-4 5-6 KW test

School participated in any healthy

eating promotion activity

p<0.001 Yes 6700 492 (7.3%) 1827 (27.3%) 4381 (65.4%)

No 1451 65 (4.5%) 279 (19.2%) 1107 (76.3%)


p=0.002 Yes 2832 227 (8.0%) 795 (28.1%) 1810 (63.9%)

No 3188 206 (6.5%) 831 (26.1%) 2151 (67.5%)

4.2.6 Parents’ Awareness of Healthy Eating Campaign in Schools Promoted by DH

4.2.6.1 Association of parents’ awareness of healthy eating campaign in schools conducted by DH with other variables in the parent questionnaire

Parents’ awareness of the DH healthy eating promotion campaign in schools was not related to their educational level or the monthly household income. Parents who supported imposing more tuck shop and school lunch nutritional requirements were more aware of the DH healthy eating promotion campaign. Parents who did not participate in any healthy eating promotion activity at school were less likely to be aware of the healthy eating campaign organised by DH at school (Table 4.2.6.1).


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Table 4.2.6.1 Association of parents’ awareness of healthy eating campaign by DH (Question

P17) with other variables in the parent questionnaire Parents’ awareness of DH

Variable No. of

parents


schools

p-value

OR (95% C.I.)

Aware Not aware Chi-square

test

KW

test

No. of nutritional


sales parents supported

p<0.001

0-2 1778 1262 (71.0%) 516 (29.0%) 1.00

3-4 1266 921 (72.7%) 345 (27.3%) 1.09 (0.93, 1.28)

5-6 2855 2172 (76.1%) 683 (23.9%) 1.30 (1.14, 1.49)

No. of nutritional


parents supported

p<0.001 0-2 368 252 (68.5%) 116 (31.5%) 1.00

3-4 1496 1038 (69.4%) 458 (30.6%) 1.04 (0.82, 1.33)

5-6 4211 3188 (75.7%) 1023 (24.3%) 1.43 (1.14, 1.81)



activity in schools

p<0.001

Yes 554 505 (91.2%) 49 (8.8%) 1.00

No 4408 3094 (70.2%) 1314 (29.8%) 0.23 (0.17, 0.31)

4.2.6.2 Association of parents’ awareness of healthy eating campaign in schools promoted by DH with other variables in the student questionnaire and the schoolquestionnaire

Parents of students from government and aided schools were more aware of the healthy eating campaign organised by DH. Students’ awareness of the campaign or their participation in healthy eating activities organised at school were positively associated with parents’ awareness of the campaign (Table 4.2.6.2a).


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Table 4.2.6.2a Association of parents’ awareness of healthy eating campaign by DH (Question P17) with other variables in the student questionnaire

Variable No. of

parents

Parents’ awareness of DH healthy eating campaign in schools

p-value OR (95% C.I.)

Aware Not aware Chi-square test

School type p<0.001


DSS & private 1791 1227 (68.5%) 564 (31.5%) 0.69 (0.61, 0.78)

Students awareness of [email protected] campaign p<0.001

Aware 3419 2675 (78.2%) 744 (21.8%) 1.0

Not aware 1335 884 (66.2%) 451 (33.8%) 0.55 (0.47, 0.63)

Students’ participation in school-based healthy eating activity

p<0.001

Yes 995 819 (82.3%) 176 (17.7%) 1.0

No 2005 1371 (68.4%) 634 (31.6%) 0.46 (0.39, 0.56)

Parents of students from schools without healthy eating policies (OR=0.68), schools which did not participate in any healthy eating activities (OR=0.62), or did not join SNAP (OR=0.65) were less likely to be aware of the healthy eating campaign organised by DH at schools (Table 4.2.6.2b). Table 4.2.6.2b Association of parents’ awareness of healthy eating campaign by DH (Question

P17) with other variables in the school questionnaire

Variable No. of

parents

Parents’ awareness of DH healthy eating campaigns in schools


Aware Not aware Chi-square

test

Establishment of school healthy eating policies

p<0.001

Yes 2817 2189 (77.7%) 628 (22.3%) 1.00

No 3317 2332 (70.3%) 985 (29.7%) 0.68 (0.60, 0.76)


p<0.001

Yes 5053 3812 (75%). 1241 (24.6%) 1.00

No 1081 709 (65.6%) 372 (34.4%) 0.62 (0.54, 0.71)

Member school of SNAP p<0.001

Yes 2219 1776 (80.0%) 443 (20.0%) 1.00

No 2337 1686 (72.1%) 651 (27.9%) 0.65 (0.65, 0.74)


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4.2.7 Parents’ Satisfaction with the Healthy Eating Campaign in School Promoted by DH

4.2.7.1 Association of parents’ satisfaction with the healthy eating campaign in school promoted by DH with other variables in the parent questionnaire

Parents’ education level (R=-0.224), monthly household income (R=-0.219), and the number of snacks correctly categorised by parents (R=-0.128) were negatively correlated with parents’ satisfaction with the healthy eating campaign promoted by DH at school. Parents who expressed that healthy eating habits were difficult to sustain were more likely to rate their satisfaction to the campaign as ‘fair’ or ‘not satisfied’. A weak correlation existed between the number of tuck shop nutritional requirements (R=-0.087) or school lunch nutritional requirements (R=-0.143) with parents’ satisfaction with the campaign. Parents who participated in school-based healthy eating activities were more satisfied with the healthy eating campaign promoted by DH at school (Table 4.2.7.1). Table 4.2.7.1 Association of parents’ satisfaction with healthy eating campaign in school

promoted by DH (Question P18) with other variables in the parent questionnaire

Variable No. of

parents

Parents’ satisfaction with DH healthy eating campaign in schools

p-value

Not Satisfied Fair Satisfied KW Test

Rank Correlation

Parents education level

R = -0.224

p<0.001 , Primary or below 140 8 (5.7%) 31 (22.1%) 101 (72.1%)

Secondary 1151 54 (4.7%) 499 (43.4%) 598 (52.0%)



R = -0.219

p<0.001 ,

Below $10000 318 13 (4.1%) 106 (33.3%) 199 (62.6%)

$10000 - $19999 488 24 (4.9%) 184 (37.7%) 280 (57.4%)

$20000 - $29999 336 23 (6.8%) 167 (49.7%) 146 (43.5%)

$30000 - $59999 535 47 (8.8%) 268 (50.1%) 220 (41.1%)

$60000 or above 407 41 (10.1%) 240 (59.0%) 126 (31.0%)

No. of correct general healthy eating messages by parents

p=0.003 0-1 826 60 (7.3%) 346 (41.9%) 420 (50.8%)

2 1342 99 (7.4%) 658 (49.0%) 585 (43.6%)

No. of correct snacks categorisation by parents

R = -0.128,

p<0.001 0-3 529 29 (5.5%) 208 (39.3%) 292 (55.2%)

4-6 1127 88 (7.8%) 534 (47.4%) 505 (44.8%)

7-10 345 29 (8.4%) 194 (56.2%) 122 (35.4%)


91

Variable No. of

parents

Parents’ satisfaction with DH healthy eating campaign in schools

p-value


Rank Correlation

Parents’ perception of healthy eating habit sustainability

p<0.001

Easy 1040 51 (4.9%) 424 (40.8%) 565 (54.3%)

Difficult 1083 105 (9.7%) 565 (52.2%) 413 (38.1%)

No. of nutritional requirements on tuck shop sales parent supported

R = -0.087

p<0.001 ,

0-2 529 25 (4.7%) 212 (40.1%) 292 (55.2%)

3-4 401 30 (7.5%) 199 (49.6%) 172 (42.9%)

5-6 1159 96 (8.3%) 555 (47.9%) 508 (43.8%)

No. of nutritional requirements on lunch parents supported

R = -0.143

p<0.001 ,

0-2 75 9 (12.0%) 33 (44.0%) 33 (44.0%)

3-4 441 16 (3.6%) 148 (33.6%) 277 (62.8%)

5-6 1637 132 (8.1%) 814 (49.7%) 691 (42.2%)

Parents’ participation in healthy eating promotion activity in schools

p=0.044

Yes 328 19 (5.8%) 143 (43.6%) 166 (50.6%)

No 1539 125 (8.1%) 720 (46.8%) 694 (45.1%)

4.2.7.2 Association of parents’ satisfaction with the healthy eating campaign in school promoted by DH with other variables in the student questionnaire and the school questionnaire

Parents of students from the government and aided schools were more satisfied with the healthy eating campaign promoted by DH at school. Parents with children who were not aware of the [email protected] campaign or did not participate in any school-based healthy eating activities were more likely to rate the campaign as ‘fair’ or ‘not satisfied’ (Table 4.2.7.2a).


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Table 4.2.7.2a Association of parents’ satisfaction with healthy eating campaign in school promoted by DH (Question P18) with other variables in the student questionnaire

Variable No. of

parents

Parents’ satisfaction with DH healthy eating

campaign at schools

p-value

Not satisfied Fair Satisfied KW Test

School type


DSS & private 662 77 (11.6%) 358 (54.1%) 227 (34.3%)

Students’ aware of


p<0.001 Aware 1251 78 (6.2%) 538 (43.0%) 635 (50.8%)

Not aware 452 44 (9.7%) 226 (50.0%) 182 (40.3%)



activities

p<0.001

Yes 397 20 (5.0%) 146 (36.8%) 231 (58.2%)

No 656 55 (8.4%) 310 (47.3%) 291 (44.4%)

Parents of students from schools with established healthy eating policies, schools participated in any healthy eating promotional activity, and schools which were members of the SNAP were more satisfied with the healthy eating campaign promoted by DH (Table 4.2.7.2b). Table 4.2.7.2b Association of parents’ satisfaction with healthy eating campaign in school

promoted by DH (Question P18) with other variables in the school questionnaire

Variables No. of

parents

Parents’ satisfaction with DH healthy eating campaign at schools

p-value



p<0.001 Yes 1056 70 (6.6%) 439 (41.6%) 547 (51.8%)

No 1120 90 (8.0%) 567 (50.6%) 463 (41.3%)


p<0.001 Yes 1821 108 (5.9%) 827 (45.4%) 886 (48.7%)

No 355 52 (14.6%) 179 (50.4%) 124 (34.9%)

Member school of SNAP p<0.001 Yes 836 43 (5.1%) 333 (39.8%) 460 (55.0%)

No 804 53 (6.6%) 404 (50.2%) 347 (43.2%)


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4.2.8 Parents’ Participation in Healthy Eating Promotion Activities Organised by Schools

4.2.8.1 Association of parents’ participation in healthy eating promotion activities organised by schools with other variables in the parent questionnaire

Parents’ educational level, monthly household income or the number of tuck shop or school lunch nutritional requirements of which parents supported were positively associated with parents’ participation in school-based healthy eating activities. At the same time, parents who were not aware of the healthy eating campaign promoted by DH at school were less likely to participate in school-based healthy eating activities (Table 4.2.8.1). Table 4.2.8.1 Association of parents’ participation in healthy eating promotion activities

organised by schools (Question P19) with other variables in the parent questionnaire

Variable No. of parent

Parents’ participation in school-based healthy eating

campaigns p-value

OR (95% C.I.)

Yes No Chi-square

test KW test


p=0.048

Primary or below 513 35 (6.8%) 478 (93.2%) 1.0

Secondary 3684 353 (9.6%) 3331 (90.4%) 1.45 (1.01, 2.08)



p=0.00

5

Below $10000 1231 81 (6.6%) 1150 (93.4%) 1.0

$10000 - $19999 1523 151 (9.9%) 1372 (90.1%) 1.56 (1.18, 2.07)

$20000 - $29999 964 106 (11.0%) 858 (89.0%) 1.75 (1.30, 2.37)

$30000 - $59999 1447 169 (11.7%) 1278 (88.3%) 1.88 (1.42, 2.48)

$60000 or above 972 87 (9.0%) 885 (91.0%) 1.40 (1.02, 1.91)

No. of nutritional requirements on tuck shop sales parent supported

p<0.00

1 0-2 1869 138 (7.4%) 1731 (92.6%) 1.0

3-4 1340 124 (9.3%) 1216 (90.7%) 1.28 (0.99, 1.65)

5-6 2931 337 (11.5%) 2594 (88.5%) 1.63 (1.33, 2.01)

No. of nutritional requirements on lunch parents supported

p=0.03

9 0-2 394 28 (7.1%) 366 (92.9%) 1.0

3-4 1581 142 (9.0%) 1439 (91.0%) 1.29 (0.85, 1.97)

5-6 4356 442 (10.1%) 3914 (89.9%) 1.48 (0.99, 2.20)


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Variable No. of parent

school-based healthy eating campaigns


Yes No Chi-square KW

test test Parents’ awareness of DH promoting healthy eating at school p<0.001

Yes 3599 505 (14.0%) 3094 (86.0%) 1.0

No 1363 49 (3.6%) 1314 (96.4%) 0.23 (0.17, 0.31)

4.2.8.2 Association of parents’ participation in healthy eating promotion activities organised by schools with other variables in the student questionnaire and the school questionnaire

Parents from DSS & private schools (OR=0.53) were less likely to participate in school based healthy eating activities. Parents with children who were not aware of the Eatsmart@school campaign (OR=0.52) or not participating in school-based healthy eating activities (OR=0.21) were less likely to participate in school-based healthy eating activities (Table 4.2.8.2a). Table 4.2.8.2a Association of parents’ participation in healthy eating promotion activities

organised by schools (Question P19) with other variables in the student questionnaire

Variable No. of

parents

Parents’ participation in school-based

healthy eating campaigns p-value

OR (95% C.I.)

Yes No Chi-square test

School Type

p<0.001


DSS & private 1901 118 (6.2%) 1783 (93.8%) 0.53 (0.43, 0.65)


[email protected]

campaign p<0.001

Aware 3441 410 (11.9%) 3031 (88.1%) 1.00

Not aware 1440 94 (6.5%) 1346 (93.5%) 0.52 (0.41, 0.65)



eating activities

p<0.001

Yes 1014 224 (22.1%) 790 (77.9%) 1.00

No 2132 118 (5.5%) 2014 (94.5%) 0.21 (0.16, 0.26)


95

Parents of students from schools with established healthy eating policies, school participated in any healthy eating promotion activities or member of SNAP were positively associated with the parents’ participation in school-based healthy eating activities (Table 4.2.8.2b). Table 4.2.8.2b Association of parents’ participation in healthy eating promotion activities

organised by schools (Question P19) with other variables in the school questionnaire

Variable No. of

parents

Parents’ participation in school-based

healthy eating campaigns p-value

OR (95% C.I.)

Yes No Chi-square

test



p<0.001

Yes 2877 423 (14.7%) 2454 (85.3%) 1.00

No 3508 195 (5.6%) 3313 (94.4%) 0.34 (0.29, 0.41)

Schools’ participation in

any healthy eating

promotion activity

p<0.001

Yes 5200 853 (11.2%) 4617 (88.8%) 1.00

No 1185 35 (3.0%) 1150 (97.0%) 0.24 (0.17, 0.34)

Member school of

SNAP

p<0.001

Yes 2220 284 (12.8%) 1936 (87.2%) 1.0

No 2466 203 (8.2%) 2263 (91.8%) 0.61 (0.51, 0.74)

4.2.9 Knowledge or Other Kinds of Support Parents Wished to Have to Help Their Child to Maintain a Healthy Eating Habit

4.2.9.1 Association of parents’ wish to have more knowledge or other kinds of support to help their child to maintain a healthy eating habit with other variables in the parent questionnaire

The proportion of parents who wanted to acquire additional knowledge or support to help their children to maintain healthy eating habits increased with the parents’ educational level, monthly household income, number of snacks correctly categorised, as well as the number of tuck shop and school lunch nutritional requirements they supported imposing. Besides, parents who thought healthy eating habits were difficult to sustain were more likely to request more knowledge or support, whereas parents who did not participate in school-based healthy eating activities were less likely to make such request (Table 4.2.9.1).


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Table 4.2.9.1 Association of parents’ wish to have more knowledge or other kinds of support to help their child to maintain a healthy eating habit (Questions P20) with other variables in the parent questionnaire

Variable No. of

parents

Parents’ wish for more

knowledge or support p-value

OR (95% C.I.)

Yes No Chi-square

test

KW

test

Parents education level

p<0.001

Primary or below 721 295 (40.9%) 426 (59.1%) 1.0

Secondary 4591 2515 (54.8%) 2076 (45.2%) 1.75 (1.49, 2.05)


Monthly household

income

Below $10000 1621 728 (44.9%) 893 (55.1%)

p<0.001

1.0

$10000 - $19999 1924 1031 (53.6%) 893 (46.4%) 1.42 (1.24, 1.62)

$20000 - $29999 1196 689 (57.6%) 507 (42.4%) 1.67 (1.43, 1.94)

$30000 - $59999 1741 1104 (63.4%) 637 (36.6%) 2.13 (1.85, 2.44)

$60000 or above 1159 692 (59.7%) 467 (40.3%) 1.82 (1.56, 2.12 )

No. of correct snack

categorization by parents

p<0.001

0-3 2152 1109 (51.5%) 1043 (48.5%) 1.0

4-6 4145 2323 (56.0%) 1822 (44.0%) 1.20 (1.08, 1.33)

7-10 994 611 (61.5%) 383 (38.5%) 1.50 (1.29, 1.75)

No. of nutritional

requirements on tuck

shop sales parent

supported p<0.001

0-2 2397 1133 (47.3%) 1264 (52.7%) 1.0

3-4 1649 889 (53.9%) 760 (46.1%) 1.31 (1.15, 1.48)

5-6 3592 2245 (62.5%) 1347 (37.5%) 1.86 (1.67, 2.07)

No. of nutritional


parents supported p<0.001

0-2 525 203 (38.7%) 322 (61.3%) 1.0

3-4 2004 1026 (51.2%) 978 (48.8%) 1.66 (1.37, 2.03)

5-6 5346 3155 (59.0%) 2191 (41.0%) 2.28 (1.90, 2.75)

Parents’ perception of

healthy eating habit

sustainability

p<0.001

Easy 3706 1772 (47.8%) 1934 (52.2%) 1.0

Difficult 4050 2543 (62.8%) 1507 (37.2%) 1.84 (1.68, 2.02)


97

Variable No. of

parents

Parents’ wish for more

knowledge or support p-value

OR (95% C.I.)

Yes No Chi-square KW

test test



activity in schools p<0.001

Yes 599 388 (64.8%) 211 (35.2%) 1.0

No 5609 3165 (56.4%) 2444 (43.6%) 0.42 (0.35, 0.50)

4.2.9.2 Association of parents’ wish to have more knowledge or other kinds of support to help their child to maintain a healthy eating habit with other variables in the student questionnaire and the school questionnaire

Parents of students coming from DSS & private schools (OR=1.53), those with children who were unaware of the [email protected] campaign (OR=1.20) and students who did not participate in any school-based healthy eating activities (OR=1.15) were more likely to want additional knowledge or support to help their child in maintaining a healthy eating habit (Table 4.2.9.2a). Table 4.2.9.2a Association of parents’ wish to have more knowledge or other kinds of support

to help their child to maintain a healthy eating habit (Questions P20) with other variables in the student questionnaire

Variable No. of

parents

Parents’ wish for more knowledge

or support p-value

OR (95% C.I.)

Yes No Chi-square

test

School type

p<0.001


DSS & private 2309 1454 (63.0%) 855 (37.0%) 1.53 (1.39, 1.69)


[email protected]

campaign p=0.002

Aware 4269 2327 (54.5%) 1942 (45.5%) 1.0

Not aware 1742 1027 (59.0%) 715 (41.0%) 1.20 (1.07, 1.34)

Students’ participation

in school-based healthy

eating activity

p=0.041

Yes 1227 661 (53.9%) 566 (46.1%) 1.0

No 2584 1483 (57.4%) 1101 (42.6%) 1.15 (1.01, 1.32)


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Parents of students from schools without healthy eating policies (OR=1.16), schools did not participate in any healthy eating activities in the year prior to survey (OR=1.24), and schools did not participate in SNAP (OR=1.28) were more likely to want to acquire more knowledge or support to help their children maintain healthy eating habits (Table 4.2.9.2b). Table 4.2.9.2b Association of parents’ wish to have more knowledge or other kinds of support

to help their child to maintain a healthy eating habit (Questions P20) with other variables in the school questionnaire

Variable No. of

parents

Parents’ wish for more knowledge

or support p-value

OR (95% C.I.)

Yes No Chi-square

test



p=0.001

Yes 3509 1879 (53.5%) 1630 (46.5%) 1.00

No 4439 1879 (57.2%) 1899 (42.8%) 1.16 (1.06, 1.27)

School participated in any


activities

p<0.001

Yes 6528 3569 (54.7%) 2959 (45.3%) 1.00

No 1420 850 (59.9%) 570 (40.1%) 1.24 (1.10, 1.39)


p<0.001

Yes 2760 1421 (51.5%) 1339 (48.5%) 1.00

No 3111 1792 (57.6%) 1319 (42.4%) 1.28 (1.16, 1.42)


99

4.3 Analytic Findings from the School Questionnaires In this section, statistical tests were applied to study the relationship between variables in the school questionnaire and results are summarised below.

4.3.1 Establishment of Healthy Eating Policies

Regarding healthy eating policies in the schools, it was found that a higher percentage of government and aided schools had established such policies (55.6%) compared with DSS and private schools (46.6%), although the difference did not reach statistical significance. On the other hand, SNAP schools were more likely to establish healthy eating policies (77.8%) compared with non-SNAP schools (39.4%) (Table 4.3.1). Table 4.3.1 Association of establishment of school healthy eating policies (Questions T9) with

other variables in the school questionnaire

Variable No. of schools



Yes No Chi-square

test School type

p=0.56

Government & aided 36 20 (55.6%) 16 (44.4%) 1.00 DSS & private 15 7 (46.6%) 8 (53.3%) 0.70 (0.21, 2.34)

SNAP school p=0.009

Yes 18 14 (77.8%) 4 (22.2%) 1.00 No 33 13 (39.4%) 20 (60.6%) 0.19 (0.05, 0.69)

4.3.2 Participation in Healthy Eating Promotional Activities

Majority of government and aided schools (91.7%) participated in some healthy eating promotion activities while less than half of DSS & private schools (46.7%) participated in such activities (Table 4.3.2). Table 4.3.2 Association between participation in any healthy eating promotional activity

(Questions T1) with other variables in the school questionnaire


Participation in any healthy eating promotional activity


Yes No Fisher Exact

test School type

Government & aided 36 33 (91.7%) 3 (8.3%) p < 0.001

1.00 DSS & private 15 7 (46.7%) 8 (53.3%) 0.08 (0.02, 0.38)


100

4.3.3 Participation in SNAP

Nearly half of the government and aided schools (47.2%) joined SNAP, whereas only 1 DSS/private school (6.7%) joined SNAP (Table 4.3.3). Table 4.3.3 Association between participation in SNAP (Questions T1) with other variables in

the school questionnaire


Participation in SNAP p-value OR (95% C.I.)

Yes No Chi-square

test

School type

Government & aided 36 17 (47.2%) 19 (52.8%) p < 0.001

1.00

DSS & private 15 1 (6.7%) 14 (93.3%) 0.08 (0.01, 0.67)


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4.4 Results of Stepwise Multiple Logistic Regression

Stepwise logistic regression model was employed to explore the relationships between the variables in multivariate conditions using the significant factors that were identified in the univariate analyses. Adjusted odds ratios of factors remaining in the final model were obtained.

4.4.1 Factors Associated with Students’ Eating Preferences

The findings from stepwise multiple logistic regression indicated that female students (adjusted OR, AOR=1.46) were more likely to make healthy food choices than male students. Students who supported healthy eating promotion at school (AOR=3.75), who perceived their eating habits as healthy (AOR=2.45), who were aware of the [email protected] campaign (AOR=1.46), or who participated in school-based healthy eating activities the year before (AOR=1.27) were more likely to make healthy food choices than their counterparts. The likelihood of students making more healthy food choices also increased with the education level of their parents (Secondary: AOR=1.66, Post-secondary or above: AOR=2.14, as compared with primary or below). Students who reported to have a snack eating habit were less likely to make more healthy food choices (Table 4.4.1). Table 4.4.1 Factors associated with students’ eating preferences

Variables Adjusted OR (95% C.I.) Support healthy eating promotion at Not support 1.00 school by students Support 3.75 (2.53, 5.54) Perceived eating habit by students Unhealthy 1.00

Healthy 2.45 (1.45, 4.12) Education level of parents Primary or below 1.00

Secondary 1.67 (1.22, 2.27) Post-secondary or above 2.14 (1.55, 2.97)

Students’ awareness of Not aware 1.00 [email protected] campaign Aware 1.46 (1.20, 1.79) Gender of student Male 1.00

Female 1.46 (1.22, 1.73) Students’ participation in school-based healthy eating activities last year

No 1.00Yes 1.27 (1.05, 1.53)


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4.4.2 Factors Associated with Students’ Breakfast Eating Habits

As for student’s breakfast eating habit, it was found that students who perceived they had a healthy eating habit (AOR= 2.44), who supported healthy eating promotion at school (AOR= 1.58), or who participated in school-based healthy eating activities in the past year (AOR= 1.41) were more likely to have breakfast on the day of survey. Regarding the influence of parents, students who were perceived by their parents to have a healthy eating habit (AOR= 1.83), or whose parents supported a greater number of nutritional requirements imposed on tuck shop sales were more likely to have breakfast on the survey day (Table 4.4.2). Table 4.4.2 Factors associated with students’ breakfast eating habit on the survey day

Variables Adjusted OR (95% C.I.) Perceived eating habit by students Unhealthy 1.00

Healthy 2.44 (1.41, 4.20) Parent perceived child’s eating habits Unhealthy 1.00

Healthy 1.83 (1.34, 2.51) Support healthy eating promotion at Not support 1.00 school by students Support 1.58 (1.07, 2.33) No. of tuck shop requirements which 0-2 1.00parent support 3-4 1.02 (0.73, 1.42)

5-6 1.42 (1.07, 1.89) Students’ participation in school-based healthy eating activities last year

No 1.00Yes 1.41 (1.07, 1.86)

4.4.3 Factors Associated with Students’ Fruit Consumption

Students who perceived their eating habits as healthy or who had the correct knowledge about fruit and vegetables serving were more likely to consume enough portions of fruit in the week prior to the survey. The findings also indicated that students who were aware of the [email protected] campaign and participated in school-based healthy eating activities in the past year were more likely to consume the recommended servings of fruit in the week prior to the survey (Table 4.4.3).


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Table 4.4.3 Factors associated with students’ daily fruit consumption which reached recommend frequency in the week prior to the survey

Variables Adjusted OR (95% C.I.) Perceived eating habit by students Unhealthy 1.00 Healthy 1.69 (1.09, 2.63) Knowledge about fruit and vegetables Incorrect 1.00 serving Correct 1.43 (1.09, 1.88) Students’ awareness of Not aware 1.00 [email protected] campaign Aware 1.24 (1.03, 1.49) Students’ participation in school-based healthy eating activities last year

No 1.00Yes 1.21 (1.01, 1.45)

4.4.4 Factors Affecting Students’ Vegetable Consumption

The statistical results indicated that female students were more likely to achieve the recommended daily vegetable consumption in the week prior to the survey (AOR=1.41). Student’s knowledge about servings of fruit and vegetables (AOR= 1.60) and their awareness of [email protected] campaign (AOR= 1.48) were found to be positively associated with student’s vegetable consumption. The results also indicated that students of parents who perceived their children’s eating habit to be healthy, students of parents who had a higher educational level, or students from a DSS or private school were more likely to meet the recommended daily vegetable consumption than their counterparts (Table 4.4.4). Table 4.4.4 Factors associated with students’ daily vegetable consumption which reached

recommend frequency in the week prior to the survey Variables Adjusted OR (95% C.I.)

Parent perceived child’s eating habits Unhealthy 1.00 Healthy 1.79 (1.43, 2.24)

Knowledge about fruit and vegetable Incorrect 1.00 serving Correct 1.60 (1.22, 2.10) Education level of parents Primary or below 1.00 Secondary 1.47 (1.11, 1.95)

Post-secondary or above 1.54 (1.12, 2.11) School type Government or aided school 1.00

DSS or private schools 1.48 (1.19, 1.85) Students’ awareness of Not aware 1.00 [email protected] campaign Aware 1.48 (1.21, 1.81) Gender of student Male 1.00

Female 1.41 (1.19, 1.68)


104

4.4.5 Factors Associated with Parents’ Knowledge on Snack Categorisation

Monthly household income of parents and the number of lunch nutritional requirements that parents supported were found to be positively associated with the parents’ knowledge on snackcategorisation. Parents who participated in healthy eating promotion activity in schools and parents of students from DSS or private schools were also slightly more likely to give correct answers for the snack categorisation questions (Table 4.4.5). Table 4.4.5 Factors associated with parents’ knowledge on snack categorisation

Variables Adjusted OR (95% C.I.)Monthly household income $9999 or less 1.00

$10000 - $19999 1.35 (1.15, 1.60) $20000 - $29999 1.61 (1.34, 1.95) $30000 - $59999 1.84 (1.54, 2.20) $60000 or more 1.72 (1.40, 2.12)

No. of lunch arrangement requirements which parent support

0-2 1.003-4 0.98 (0.76, 1.26) 5-6 1.33 (1.04, 1.69)

Parents’ participation in healthy eating promotion activity in schools

No 1.00Yes 1.22 (1.02, 1.46)

School type Government or aided school 1.00 DSS or private schools 1.18 (1.02, 1.35)

4.4.6 Factors Associated with Parents’ Perception on Sustainability of Healthy Eating Habits

Parents who perceived their children’s eating habit to be healthy were significantly more likely to perceive healthy eating habits were easy to sustain (AOR= 5.63). Parents of children who participated in school-based healthy eating activities in the past year, or parents of students from schools that had established a healthy eating policy were more likely to perceive that healthy eating habits were easy to sustain (Table 4.4.6). Table 4.4.6 Factors associated with parents’ perception on whether healthy eating habits were

easy to sustain Variables Adjusted OR (95% C.I.)

Parent perceived child’s eating habits Unhealthy 1.00 Healthy 5.63 (4.42, 7.17)

Students’ participation in school-based healthy eating activities last year

No 1.00 Yes 1.20 (1.03, 1.41)

Established healthy eating policy at schools No 1.00 Yes 1.17 (1.01, 1.36)


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4.4.7 Factors Associated with Parents’ Awareness of Healthy Eating Campaign in Schools Promoted by DH

Parents who participated in healthy eating promotion activity in schools or who supported a greater number of tuck shop nutritional requirements were more likely to be aware of the healthy eating campaigns in schools promoted by DH. For the students who participated in school-based healthy eating activities last year, the students who were aware of the [email protected] campaign, and the students from a member school of SNAP, their parents were also more likely to be aware of the healthy eating campaign in schools promoted by DH (Table 4.4.7). Table 4.4.7 Factors associated with parents’ awareness of healthy eating campaign in schools

promoted by DH Variables Adjusted OR (95% C.I.)

Parents’ participation in healthy eating No 1.00 promotion activity in schools Yes 4.11 (2.38, 7.10) Students’ participation in school-based No 1.00 healthy eating activities last year Yes 1.61 (1.22, 2.11) No. of tuck shop requirements which parent 0-2 1.00 support 3-4 1.22 (0.88, 1.71)

5-6 1.42 (1.07, 1.87) Students’ awareness of Eatsmart@school Not aware 1.00 campaign Aware 1.40 (1.06, 1.85) Member school of SNAP No 1.00

Yes 1.31 (1.02, 1.69)

4.4.8 Factors Associated with Parents’ Degree of Satisfaction with the Healthy Eating Campaign Promoted by DH at Schools

Parents who supported 3-4 nutritional requirements on lunch (OR= 3.08) were significantly more likely to be satisfied with the healthy eating campaigns promoted by DH compared to those who supported 0-2 requirements. Furthermore, parents’ perceptions of the ease of sustainability of healthy eating habits were found to be positively associated with parents’ satisfaction with the healthy eating campaigns promoted by DH at schools. However, parents of students from DSS or private schools were less likely to be satisfied with the healthy eating campaigns (Table 4.4.8).


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Table 4.4.8 Factors associated with parents’ satisfaction with the healthy eating campaign promoted by DH at schools

Variables Adjusted OR (95% C.I.) No. of lunch arrangement requirements which parent support

0-2 1.00 3-4 3.08 (1.24, 7.63) 5-6 1.51 (0.70, 3.26)

Parents’ perception on the ease of sustainability of healthy eating habits

No 1.00 Yes 1.97 (1.39, 2.80)

School type Government or aided 1.00 school DSS or private schools 0.47 (0.33, 0.65)

4.4.9 Factors Associated with Parents’ Participation in Healthy Eating Promotion Activities Organised by Schools

Parents who were aware of DH healthy eating campaign at school (OR= 3.74) and parents whose children participated in school-based healthy eating activities in the previous year (OR= 3.56) were significantly more likely to participate in healthy eating promotion activities organized by schools. Parents of students from schools with established healthy eating policy were more likely to participate as well (OR= 2.55). However, parents of students from DSS or private schools were less likely to participate. It was also found that monthly household income was positively associated with the parents’ participation in healthy eating promotion activities organized by schools (Table 4.4.9). Table 4.4.9 Factors associated with parents’ participation in healthy eating promotion

activities organised by schools Variables Adjusted OR (95% C.I.)

Parents’ awareness of DH healthy eating campaign at school

Not aware 1.00 Aware 3.74 (2.45, 5.71)

Students’ participation in school-based healthy eating activities last year

No 1.00 Yes 3.56 (2.68, 4.73)

Established healthy eating policy at school

No 1.00 Yes 2.55 (1.93, 3.36)

Monthly household income $9999 or less 1.00 $10000 - $19999 1.44 (0.94, 2.19) $20000 - $29999 1.69 (1.08, 2.65) $30000 - $59999 2.48 (1.64, 3.77) $60000 or more 2.57 (1.56, 4.24)

School type Government or aided 1.00 school DSS or private schools 0.65 (0.44, 0.97)


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Chapter 5 Comparison Between the Baseline Assessment

(2006) and the Current Survey (2008) This chapter presents selected comparative findings from the 2006 Baseline Assessment and the current survey.

5.1 Comparison of the Participating Schools

The demographics data of 44 schools from the 2006 baseline assessment and 51 schools from the current survey are shown in Table 5.1. The distribution of P4 and P5 students were similar in both studies, while the current survey consisted of more females than 2006. There is a higher proportion of higher household income groups in the current survey compared with the baseline assessment. While the percentages of school funding types were similar for both studies, more schools were included from Hong Kong and Kowloon in the current survey. Table 5.1 Comparison between 2006 baseline assessment and current survey

2006 % 2008 % Grade of study Primary 4 48.5% 48.0% Primary 5 51.5% 52.0%Gender Male 52.1% 45.7% Female 47.9% 54.3% Monthly household income $9,999 or less 32.2% 21.4% $10,000 - $19,999 28.0% 25.2% $20,000 - $29,999 12.7% 15.6% $30,000 - $59,999 14.7% 22.7% $60,000 or more 12.4% 15.1% Type of funding Government or aided school 72.8% 72.4% DSS or private school 27.3% 27.6%School district Hong Kong 25.0% 27.4% Kowloon 31.9% 35.3% New Territories 43.2% 37.3%


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5.2 Comparisons of the Questionnaire Findings

5.2.1 Students’ Knowledge of Healthier Food Choices

In the two surveys, the same questions were used to assess the students’ knowledge of healthier food choices (Table 5.2.1). There was a slight decrease in the correct answers scored by the students in the 2008 survey. Table 5.2.1 Students’ knowledge of healthier choices in 2006 and 2008 surveys

% of students

p-value#

2006 2008 % change Soya sauce drumstick* is relatively healthier than deep-fried drumstick

95.2 94.3 - 0.9 0.019

Pure orange juice* is relatively healthier than carbonated drinks

97.9 97.3 - 0.6 0.008

Raisin whole-meal bread* is relatively healthier than hotdog

95.9 94.6 - 1.3 <0.001

Yogurt* is relatively healthier than ice cream 95.9 94.6 - 1.3 <0.001 Spaghetti with fresh tomatoes and beef* is relatively healthier than hamburger and fries

96.8 95.5 - 1.3 <0.001

Chicken rice with vegetables* is relatively healthier than fried rice noodles with beef

90.9 89.6 - 1.3 0.004

* relatively healthier choices #Chi-square test

5.2.2 Students’ Food Preferences

Compared with the 2006 survey, findings from the current survey showed that students indicated preference for the healthier options from four pairs of food items, but preference for the less healthy option from two pairs of food items (Table 5.2.2).


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Table 5.2.2 Students’ eating preferences in the 2006 and 2008 surveys

% of students

p-value#

2006 2008 % change Preferred soya sauce drumstick* over deep-fried drumstick

65.9 64.6 -1.3 NS

Preferred pure orange juice* over carbonated drinks

65.3 68.0 2.7 <0.001

Preferred raisin whole-meal bread* over Hotdog 48.9 46.6 - 2.3 0.003 Preferred yogurt* over Ice cream 48.7 50.3 1.6 0.045 Preferred spaghetti with fresh tomatoes* and beef over hamburger and fries

43.7 49.1 5.4 <0.001

Preferred chicken rice with vegetables* over fried rice noodles with beef

44.3 45.5 1.2 NS

* relatively healthier choices #Chi-square test

5.2.3 Students’ Breakfast-eating Habits

There was a significant increase in the proportion of students who skipped their breakfast on the day of survey in the 2008 study (15.3%) compared with results of the 2006 study (13.8%) (Table 5.2.3). Table 5.2.3 Students’ breakfast-eating habit in the 2006 and 2008 surveys

% of students

p-value#

2006 2008 % change Students who skipped breakfast 13.8 15.3 1.5 0.004 #Chi-square test

5.2.4 Students’ General Eating Habits

Significant increases in students’ compliance with recommendations on food groups, based on recommendations of the food guide pyramid, were observed. These food groups included vegetables, dairy products, meat and its alternatives, grains and cereals. Compared with the 2006 results, the percentage of children who achieved the recommended fruit eating frequency remained similar (2008: 57.5%, 2006: 57.4%). On the other hand, in the current survey, more students restricted their consumption of unhealthy food. There were increases in the percentage of students who did not have drinks with added sugar, food high in sugar, food high in salt or food high in fat in the week prior to the survey. There was also a slight increase in the percentage of students who did not have fried/deep-fried food in the prior week (Table 5.2.4).


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Table 5.2.4 Students’ general eating habit in the 2006 and 2008 surveys

% of students

p-value#

2006 2008 % change Eating fruit ≥ 2 times per day 57.4 57.5 0.1 NS Eating vegetables ≥ 2 times per day 76.4 78.7 2.3 <0.001Eating dairy products ≥ 1 time per day 71.9 77.4 5.5 <0.001Eating meat, fish, eggs, peas and beans ≥ 1 time per day

93.2 95.7 2.5 <0.001

Eating grains and cereals ≥ 2 times per day 87.3 89.5 2.2 <0.001Never had fried/ deep fried food in the past one week

9.5 10.2 0.7 NS

Never had drinks with added sugar in the past one week

8.8 10.8 2.0 <0.001

Never had food high in sugar in the past one week

10.7 12.2 1.5 0.001

Never had food high in salt in the past one week

24.6 27.3 2.7 <0.001

Never had food high in fat in the past one week

13.7 14.8 1.1 0.043

#Chi-square test

* Excluded respondents who answered ‘don’t know’

5.2.5 Students’ Self-perceived Eating Habits

The proportions of students who perceived their eating habit as ‘healthy’ remained high, with 96.2% in the 2006 survey and 96.0% in the current study (Table 5.2.5). Table 5.2.5 Students’ self-perceived eating habits in the 2006 and 2008 surveys

% of students p-value#

2006 2008 % change Healthy 96.2 96.0 -0.2 NS #Chi-square test



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5.2.6 Parents’ Perception on Child’s Eating Habits

Compared with the 2006 study, results from the current study indicated a significant increase in thepercentage of parents who perceived their child’s eating habit as ‘healthy’ (Table 5.2.6). Table 5.2.6 Parents’ perception on children’s diet in the 2006 and 2008 surveys

% of parents p-value#

2006 2008 % change Healthy 79.1 85.2 6.1 <0.001 #Chi-square test


5.2.7 Parents’ Support for Imposing Nutritional Requirements on Tuck shop Sales

Comparing results of the current study with those of 2006, there were significant increases in the proportion of parents showing support to all six tuck shop nutritional requirements. Except for the requirements for the compulsory sale of fresh fruit, all other requirements in relation to the sale of vegetables, drinks with added sugar, food high in sugar, salt or fat received an increase in parents’ support of more than 5% (Table 5.2.7). Table 5.2.7 Parents’ support for imposing nutritional requirements on tuck shop sales in the

2006 and 2008 surveys

% of parents

p-value#

2006 2008 % change Compulsory sale of vegetables 84.8 90.7 5.9 <0.001 Compulsory sale of fresh fruit 91.8 93.7 1.9 <0.001 Restricted sale of drinks with added sugar 72.5 79.1 6.6 <0.001 Restricted sale of food high in sugar 70.8 78.0 7.2 <0.001 Restricted sale of food high in salt 72.1 80.7 8.6 <0.001 Restricted sale of food high in fat 71.6 78.8 7.2 <0.001 #Chi-square test



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5.2.8 Parents’ Support for Imposing Nutritional Requirements on School Lunch

Compared with 2006, the current survey showed significant increases in parents’ support for 3 out of 6 school lunch nutritional requirements. These three requirements included the amount of vegetables and meat/meat alternatives to be provided in the lunch box, as well as the weekly frequency of using deep-fried food as the main dish in lunch box (Table 5.2.8). Table 5.2.8 Parents’ support for imposing nutritional requirements on school lunch in the

2006 and 2008 surveys

% of parents

p-value#

2006 2008 % change Amount of grains and cereals provided by the lunch box every day

97.9 98.0 0.1 NS

Amount of vegetables provided by the lunch box every day

97.8 98.3 0.5 0.028

Amount of meat, fish poultry, eggs and legumes provided by the lunch box every day

96.5 98.0 1.5 <0.001

Limits on the frequency of using processed or preserved meat in the lunch box per week

79.2 80.2 1.0 NS

Limits on the frequency of using deep-fried food as the main dish of lunch box per week

72.5 77.0 4.5 <0.001

Frequency of serving fruit alongside lunch per week

97.1 97.2 0.1 NS

#Chi-square test


5.2.9 Parents’ Perception of Ease to Sustain Healthy Eating Habits

Compared with findings in the 2006 survey, the current study found that less parents (-13.5%) thought that healthy eating habits were easy to sustain (Table 5.2.9). Table 5.2.9 Parents’ view on healthy eating habits sustainability in the 2006 and 2008 surveys

% of parents

p-value#

2006 2008 % change Easy to sustain 61.3 47.8 - 13.5 <0.001 #Chi-square test



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5.2.10 Establishment of Healthy Eating Policies in School

Compared with 2006, findings from the current study showed that fewer schools had established any healthy eating policy, although the changes were not statistically significant (Table 5.2.10). Table 5.2.10 Healthy eating policies in school to promote healthy eating in the 2006 and 2008

surveys % of schools p-value#

2006 2008 % changeEstablished any healthy eating policy (including healthy 70.5 53.0 -17.5 0.081snacks, healthy lunch and healthy eating at home)

#Chi-square test


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Chapter 6 Discussion and Conclusion

The [email protected] Campaign was probably the single most comprehensive and intensive healthy eating promotional programme conducted throughout Hong Kong in the primary school setting between the 2006 Baseline Survey and the 2008 Dietary Assessment, and accounting for the changes observed. In 2008, students’ knowledge of healthy eating remained at a high level. Majority of students correctly identified the healthier options among six food pairs, and more than 70% answered the general health message questions correctly. In terms of practice, there were statistically significant increases in the proportion of students reporting “taking vegetable at least twice a day”, “not having food high in fat”, “not having food high in salt” or “not having food high in sugar”, and “not taking drinks with added sugar”. There was also an increase in the proportion of students taking fruit at least twice a day, although the level did not reach statistical significance when compared with findings from the 2006 study. More than 70% of the students indicated support for the promotion of healthy eating in school. It would be fair to say that the [email protected] Campaign has made a positive impact on enhancing knowledge, attitude and practices in healthy eating among students. However, behavioural practices require environmental and other incentives to support and sustain. In line with WHO’s Ottawa Charter for Health Promotion and Bangkok Charter for Health Promotion in a Globalized World, there is room for enhanced coordination and multi-sectoral collaboration to make healthy choices easier for students and their significant others. For this to happen, government leadership and political commitment are critically important. Students The 2008 Dietary Assessment showed that girls had better knowledge, attitude and practices of healthy eating than boys, much in line with findings from overseas studies. Girls liked to consume ‘healthy food’, such as fruit and vegetables5-7, and were more likely to consume food and beverages to maintain health and wellness8. However, there was little explanation for this observed difference. Possible theories included the gender difference on perceived taste and genetic influences9, and development of eating patterns in both genders10. This phenomenon merits further study and research. In the meantime, gender sensitive modes of education and learning should be considered to address boys’ need for healthy eating promotion.


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Parents and Family Parents and family play an important role in children’s development of eating habits11-13. The current survey found that most parents considered nutritional value of primary concern in determining the choice of food for their children. The same view was true in schools. Hence, one would expect parents and schools to be the best partners in healthy eating promotion for children. On the contrary, the survey found that only 7.6% of responding parents participated in healthy eating promotion activities organised by the schools. It is worth noting that parents wished to be engaged in healthy eating promotional efforts undertaken by the schools, as more than half of responding parents expressed the desire to receive more information on food, nutrition and healthy eating. Moreover, where parents were aware of and had participated in school-based healthy eating activities, they were more knowledgeable about the subject and showed stronger support for nutritional requirements on lunch and snacks. At the same time, children’s general healthy eating knowledge, their awareness of and participation in healthy eating promotion activities in schools were positively associated with parents’ general healthy eating knowledge. There is thus a strong case for schools to engage parents more in healthy eating promotional efforts, through means which are sensitive to parents’ needs and circumstances. Effective two-way communication in all aspects of healthy eating promotion for students should be established and fostered. In addition, Government departments, namely Department of Health and Education Bureau, should explore innovative means to inform, engage and mobilise parental support for healthy eating promotion. This study further showed that majority of parents possessed good knowledge of general healthy eating messages but less so on snack categorisation. A possible explanation could be that the concept and method of application underpinning the Nutritional Guidelines on Snacks for Primary School Students were relatively new and less adequately promoted among parents. Since snack consumption is a common practice among children, an easy-to-understand guide and simple-to-use tool would go a long way to empower parents to make healthy food choices for children and other members of the family. The Department of Health should consider more effective means to strengthen parental education in order that key messages and practical tips to aid selection of snacks could be imparted. This study revealed that about a third of students dined outside 2 to 4 times per week. Food prepared by restaurants is generally regarded as high in salt, sugar and fat. Some of them may contain high levels of trans fat. Thus, it is important for parents to look for healthier dishes when dinning out. The [email protected] Campaign was launched by DH in 2008. The Campaign works in partnership with restaurants committing to provide at least five “EatSmart” dishes during specified hours of the day. “EatSmart” dishes are prepared from fruit or vegetable ingredients and / or are low in salt, sugar and fat. Parents may select “EatSmart” restaurants for an informed and wider choice of healthier dishes for the family.


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Schools School eating environment plays a key role in shaping students’ behaviour14-15. This study showed that students who were aware of the [email protected] Campaign and those who supported and participated in healthy eating promotion in school were more likely to show positive food preference and eating habits. However, while most schools agreed that healthy eating was important for school education and student development, as many as 21.6% had not taken part in any healthy eating promotion activity during the period under study. Furthermore, compared with DSS and private schools, more government and aided schools participated in healthy eating promotion activities or took part in SNAP. Schools joining SNAP were more likely to have developed healthy eating school policies and engaged parents and students in healthy eating educational and promotional activities. Since healthy eating promotes students’ health and optimises learning performance, it is advisable that all schools take an active part in the [email protected] Campaign or similar healthy eating promotion activities. The pace and extent of school involvement would depend on individual circumstances, and the Department of Health should ensure its technical capacity could meet the needs of participating schools. Professional Support The current study found that while most schools were aware of the Nutritional Guidelines on School Lunch for Primary School Students and Nutritional Guidelines on Snacks for Primary School Students, the rate of use was relatively low. Between 61% and 92% of parents supported imposing certain nutritional requirements on lunch and snacks supplied in the school. The level of support was significantly greater than that in 2006. Schools have a duty to provide a nutrition-friendly environment for students. To protect students from the harmful effect of regular or unchecked consumption of unhealthy food items, schools are advised to take proactive steps to enlist the support of parents and to require school lunch suppliers to stop the supply of unhealthy lunch items and limit the supply of meals prepared using less healthy ways of cooking, e.g. deep-frying. In this regard, inclusion of the Nutritional Guidelines on School Lunch for Primary School Students in the lunch supply contract, ongoing monitoring of the food quality and timely feedback to suppliers should be instituted in all whole-day schools. Schools should also consider the need to keep the tuck shop and vending machines in operation if the school cannot exercise control over the nutritional quality of snacks (including beverages) sold. As a first step, schools may consider eliminating snacks belonging to the ‘red’ category. Useful reference could be obtained from the Nutritional Guidelines on Snacks for Primary School Students.


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Limitations There are certain limitations in the study. Data from the study were collected using self-administered questionnaires. Reporting of dietary pattern by students and parents were subject to recall bias. Moreover, students completed the questionnaire under the supervision of teachers in classroom settings. It is possible that some respondents might provide socially acceptable answers that did not reflect their true attitude and practice in healthy eating. These factors could not be excluded from the 2006 and 2008 studies. It should also be noted that the current study is a cross-sectional one. The analytical findings presented in this report provide rich information about the inter-relationships between different variables, but they do not show causal relationships, as the temporal sequence of related variables cannot be ascertained. Only Primary 4 and Primary 5 students were included in this study. It could be argued that they might not represent the entire primary school population. Moreover, despite the use of clustered sampling method to ensure randomness in recruiting schools, bias could still have been introduced when schools declined to take part. Characteristics of these schools had not been spelled out. Despite these limitations, the study provided useful information on primary students’ knowledge, attitudes and practices of healthy eating; their parents understanding, perception, attitudes and practices of healthy eating; and the existing nutritional environments among primary schools. The results generated will have significant reference value for future planning of healthy eating promotion programme in schools.


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Chapter 7 Recommendations 1. The [email protected] Campaign made a positive impact on improving knowledge,

attitudes and practices in healthy eating among students. Sustained government leadership and political commitment are essential for enhanced coordination and multi-sectoral action to strengthen and consolidate the Campaign.

2. The Government should work towards encouraging all schools to take an active part in the

[email protected] Campaign or similar healthy eating promotion activities. The pace and extent of school involvement would depend on individual circumstance, and the Department of Health should ensure its technical capacity and professional support could meet the needs of participating schools.

3. The Government should explore innovative means to inform, engage and mobilise parents for

supporting healthy eating promotion. 4. The Government should strengthen parental education to empower them with knowledge and

skills in making lunch and snack choices in accordance with the DH’s nutritional guidelines on lunch and snack.

5. The Government and academia should consider conducting research to understand the gender

difference in healthy eating knowledge, attitude and practice. It should also explore gender sensitive modes of education and ways to address boys’ need for healthy eating promotion.

6. Schools should communicate with and engage parents more fully in healthy eating promotional

efforts, through means which are sensitive to parents’ needs and circumstances. 7. Schools should ensure that food suppliers comply with the Nutritional Guidelines on School

Lunch for Primary School Students and the Nutritional Guidelines on Snacks for Primary School Students.

8. Parents should work closely with schools to support children’s healthy eating.


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References

1. Reilly JJ, Methven E, McDowell ZC, Hacking B, Alexander D, Stewart L, Kelnar CJH. Health

consequences of obesity. Arch. Dis. Child. 2003; 88: 748-752.

2. Freedman DS, Khan LK, Serdula MK, Dietz WH, Srinivasan SR, Berenson GS. Racial

Differences in the Tracking of Childhood BMI to Adulthood. Obesity Research. 2005;

12(5):928-35.

3. Singer MR, Moore LL, Garrahie EJ, Ellison RC. The tracking of nutrient intake in young

children: The Framingham Children’s Study. Am J Public Health. 1995; 85: 1673-77.

4. Wan YF, Bentley ME, Zhai FY, Popkin BM. Tracking of dietary intake patterns of Chinese from

childhood to adolescence over a six-year follow-up period. J. Nutr. 2002; 132: 430-438.

5. B. Shiferaw, L. Verrill, H. Booth, S. Zansky, D. Norton, S.Crim, O. Henao. Are There Gender

Differences in Food Consumption? The FoodNet Population Survey, 2006-2007. (Abstract)

Presented in 2008 International Conference on Emerging Infectious Diseases Program and

Abstracts Book, p. 178.

6. van Sluijs EM et al. Physical activity and dietary behaviour in a population-based sample of

British 10-year old children: the SPEEDY study (Sport, Physical activity and Eating behaviour:

environmental Determinants in Young people). BMC Public Health. 2008; 14, 8: 388.

7. Cooke LJ and Wardle J. Age and gender differences in children’s food preferences. British

Journal of Nutrition. 2005; 93: 741-746.

8. The 3rd annual IFIC Foundation Food & Health Survey. Cited from:

http://www.ific.org/newsroom/releases/womenvsmenrelease.cfm

9. A large-scale experiment conducted in 2008 by Danish Science Communication and the Faculty

of Life Sciences (LIFE) at University of Copenhagen. Cited from:

http://www.life.ku.dk/English/Nyheder/2008/963_children.aspx

10. Faith MS, Rhea SA, Corley RP, Hewitt JK. Genetic and shared environmental influences on


120

children’s 24-h food and beverage intake: sex differences at age 7 y. Am J Clin Nutr. 2008; 87(4):

903-11.

11. Klesges RC. Stein RJ. Eck LH. Isbell TR. Klesges LM. Parental influence on food selection in

young children and its relationships to childhood obesity. American Journal of Clinical

Nutrition. 53(4):859-64, 1991 Apr.

12. Fisher JO. Mitchell DC. Smiciklas-Wright H. Birch LL. Parental influences on young girls' fruit

and vegetable, micronutrient, and fat intakes. Journal of the American Dietetic Association.

102(1):58-64, 2002 Jan.

13. Brown, Rachael; Ogden, Jane. Children's eating attitudes and behaviour: a study of the

modelling and control theories of parental influence. Health Education Research. 19(3):261-271,

June 2004.

14. World Health Organization. WHO Information Series on School Health: Healthy Nutrition: An

Essential Element of a Health-Promoting School. Geneva: World Health Organization, 1998.

15. Centre for Health Education and Health Promotion, The Chinese University of Hong Kong.

Report on Eating Behaviour in School Children. Hong Kong: Centre for Health Education and

Health Promotion, CUHK, 2007.


Acknowledgements We would like to acknowledge the support of the following schools for their participation in thestudy (school name listed in alphabetical order): 1. ALDRICH BAY GOVERNMENT PRIMARY SCHOOL 2. ALLIANCE PRIMARY SCHOOL, TAI HANG TUNG 3. AMERICAN INTERNATIONAL SCHOOL 4. BISHOP WALSH PRIMARY SCHOOL 5. BONHAM ROAD GOVERNMENT PRIMARY SCHOOL 6. BUDDHIST WONG SEWAI MEMORIAL SCHOOL 7. C.N.E.C. LUI MING CHOI PRIMARY SCHOOL 8. CANOSSA PRIMARY SCHOOL 9. CANOSSA SCHOOL (HONG KONG) 10. CHAI WAN FAITH LOVE LUTHERAN SCHOOL 11. CHAN'S CREATIVE SCHOOL 12. FUNG KAI NO.2 PRIMARY SCHOOL 13. G.T. (ELLEN YEUNG) COLLEGE 14. GIGAMIND ENGLISH PRIMARY SCHOOL 15. HONG KONG RED SWASTIKA SOCIETY TUEN MUN PRIMARY SCHOOL 16. HONG KONG STUDENT AID SOCIETY PRIMARY SCHOOL 17. HONG KONG TAOIST ASSOCIATION SHEK WAI KOK PRIMARY SCHOOL 18. INTERNATIONAL CHRISTIAN SCHOOL - ELEMENTARY & KINDERGARTEN 19. KAM TIN MUNG YEUNG PUBLIC SCHOOL 20. KOWLOON TRUE LIGHT MIDDLE SCHOOL (PRIMARY SECTION) 21. KOWLOON WOMEN'S WELFARE CLUB LI PING MEMORIAL SCHOOL 22. LINGNAN PRIMARY SCHOOL AND KINDERGARTEN 23. LOK SIN TONG PRIMARY SCHOOL 24. LOK SIN TONG YEUNG CHUNG MING PRIMARY SCHOOL 25. MA ON SHAN METHODIST PRIMARY SCHOOL 26. MARYKNOLL FATHERS' SCHOOL 27. MUNSANG COLLEGE 28. PEGASUS PHILIP WONG KIN HANG CHRISTIAN PRIMARY SCHOOL CUM JUNIOR

SECONDARY SCHOOL 29. PO LEUNG KUK TIN KA PING PRIMARY SCHOOL 30. PO LEUNG KUK WONG CLAN ASSOCIATION PRIMARY SCHOOL 31. PUI TAK CANOSSIAN PRIMARY SCHOOL 32. RAIMONDI COLLEGE


33. S.K.H. TAK TIN LEE SHIU KEUNG PRIMARY SCHOOL 34. S.K.H. TSEUNG KWAN O KEI TAK PRIMARY SCHOOL 35. S.K.H. YAN LAAP PRIMARY SCHOOL 36. SACRED HEART CANOSSIAN SCHOOL, PRIVATE SECTION 37. SAI KUNG SUNG TSUN CATHOLIC SCHOOL (PRIMARY SECTION) 38. SHA TIN GOVERNMENT PRIMARY SCHOOL 39. SHEK WU HUI PUBLIC SCHOOL 40. ST. CLARE'S PRIMARY SCHOOL 41. ST. FRANCIS' CANOSSIAN SCHOOL 42. ST. ROSE OF LIMA'S SCHOOL 43. ST. STEPHEN'S COLLEGE PREPARATORY SCHOOL 44. TAI PO OLD MARKET PUBLIC SCHOOL (PLOVER COVE) 45. THE CHURCH OF CHRIST IN CHINA HEEP WOH PRIMARY SCHOOL 46. THE INDEPENDENT SCHOOLS FOUNDATION ACADEMY 47. THE SALVATION ARMYM LAM BUTT CHUNG MEMORIAL SCHOOL 48. THE TRUE LIGHT MIDDLE SCHOOL OF HONG KONG (PRIMARY SECTION) 49. TIN SHUI WAI GOVERNMENT PRIMARY SCHOOL 50. TUEN MUN GOVERNMENT PRIMARY SCHOOL 51. YUK YIN SCHOOL


List of Tables 2.3a Number of schools to be recruited for the Study 4 2.3b Actual number of schools recruited in each district 4 2.7 Number of subjects tested for the different measurement tools 6 2.11 List of questions in the Study (2008) for comparison with the Baseline 8

Assessment (2006) 3.1.1 Demographic background of students 9 3.1.2.1 Number and percentage of students correctly answered the questions 11

regarding knowledge of healthy food choices 3.1.2.2a Proportion of students correctly answered the general healthy eating messages 11

promoted by DH 3.1.2.2b Number and percentage of students correctly answered the general healthy 12

eating messages promoted by DH 3.1.2.3 Percentage of choosing healthier food choices 13 3.1.2.4 Consideration in choosing food 14 3.1.2.6 Reasons for not having breakfast 15 3.1.2.7 Students’ satisfaction on school lunch 16 3.1.2.9a Eating habits of various food categories on average every day in the week 18

prior to the survey 3.1.2.9b Percentage of students whose average intake of the food categories in the 18

week prior to the survey reached the corresponding recommended frequency 3.2.1 Demographic background of parents 21 3.2.2.1a Proportion of parents correctly answered the general healthy eating messages 22

promoted by DH 3.2.2.1b Number and percentage of parents correctly answered the general healthy 22

eating messages promoted by DH 3.2.2.2a Number and percentage of correctly categorised snacks by parents 23 3.2.2.2b Categorisation of different snacks by parents 23 3.2.2.4 Reasons for healthy eating habits difficult to sustain 25 3.2.2.7 Food label information parents paid most attention to 28 3.2.2.12 Parents’ replies to where their children had dinner in the week prior to the 32

survey 3.3.1 Demographics of schools 39 3.3.2.1 School eating environment and facilities 40 3.3.2.4 School lunch arrangement 43 3.3.2.5 Coverage of healthy eating school policy 44 3.3.2.7a Factors considered and their order of importance in choosing the current 45


lunch caterer 3.3.2.7b Parties deciding the choices of lunch menu provided by the caterer 45 3.3.2.8 Factors considered and their order of importance when choosing the current 46

tuck shop contractor 3.3.2.9a Comments on the Nutritional Guidelines on School Lunch 47 3.3.2.9b Application of the Nutritional Guidelines on School Lunch 47 3.3.2.10a Comments on and application of the Nutritional Guidelines on Snacks 48 3.3.2.10b Application of the Nutritional Guidelines on Snacks 49 3.3.2.11 Schools’ participation on healthy eating promotional activities organised by 49

DH 4.1.1.1 Association of students’ knowledge on healthier food choices with other 52

variables in the student questionnaire 4.1.1.2 Association of students’ knowledge on healthier food choices with other 53

variables in the parent questionnaire 4.1.2.1 Association of students’ knowledge on general healthy eating messages with 55

other variables in the student questionnaire 4.1.2.2a Association of students’ knowledge on general healthy eating messages with 56

other variables in the parent questionnaire 4.1.2.2b Association of students’ knowledge on general healthy eating messages with 57

other variables in the school questionnaire 4.1.3.1 Association of students’ eating preferences with other variables in the student 57

questionnaire 4.1.3.2a Association of students’ eating preferences with other variables in the parent 58

questionnaire 4.1.3.2b Association of students’ eating preferences with other variables in the school 59

questionnaire 4.1.4.1 Association of students’ breakfast-eating habits with other variables in the 60

student questionnaire 4.1.4.2a Association of students’ breakfast-eating habits with other variables in the 61

parent questionnaire 4.1.4.2b Association of students’ breakfast-eating habits with other variables in the 62

school questionnaire 4.1.5.1 Association of students’ fruit-eating habits with other variables in the student 63

questionnaire 4.1.5.2 Association of students’ fruit-eating habit with other variables in the parent 64

questionnaire 4.1.6.1 Association of students’ vegetable-eating habits with other variables in the 65

student questionnaire 4.1.6.2a Association of students’ vegetable-eating habits with other variables in the 66


parent questionnaire 4.1.6.2b Association of students’ vegetable-eating habits with other variables in the 67

school questionnaire 4.1.7.1 Association of students’ awareness of [email protected] campaign with 68

other variables in the student questionnaire 4.1.7.2a Association of students’ awareness of [email protected] campaign with 69

other variables in the parent questionnaire 4.1.7.2b Association of students’ awareness of [email protected] campaign with 70

other variables in the school questionnaire 4.1.8.1 Association of students’ support of healthy eating promotion in school with 71

other variables in the student questionnaire 4.1.8.2a Association of students’ support of healthy eating promotion at school with 72

other variables in the parent questionnaire 4.1.8.2b Association of students’ support in healthy eating promotion in school with 72

other variables in the school questionnaire 4.1.9.1 Association of students’ participation in school-based healthy eating activities 73

with other variables in the student questionnaire 4.1.9.2a Association of students’ participation in school-based healthy eating activities 74

with other variables in the parent questionnaire 4.1.9.2b Association of students’ participation in school-based healthy eating activities 75

with other variables in the school questionnaire 4.2.1.1 Association of parents’ general healthy eating knowledge with other variables 76

in the parent questionnaire 4.2.1.2 Association of parents’ general healthy eating knowledge with other variables 78

in the student questionnaire 4.2.2.1 Association of parents’ knowledge of snack categorisation with other 79

variables in the parent questionnaire 4.2.2.2 Association of parents’ knowledge of snack categorisation with other 80

variables in the student questionnaire 4.2.3.1 Association of parents’ perception of ease to sustain healthy eating habits with 81

other variables in the parent questionnaire 4.2.3.2a Association of parents’ perception of ease to sustain healthy eating habits with 82

other variables in the student questionnaire 4.2.3.2b Association of parents’ perception of ease to sustain healthy eating habits with 83

other variables in the school questionnaire 4.2.4.1 Association of parents’ agreement of imposing nutritional requirements on 84

tuck shop sales with other variables in the parent questionnaire 4.2.4.2a Association of parents’ agreement on imposing nutritional requirements on 85

tuck shop sales with other variables in the student questionnaire


4.2.4.2b Association of parents’ agreement on imposing nutritional requirements on 85 tuck shop sales with other variables in the school questionnaire

4.2.5.1 Association of parents’ agreement to impose nutritional requirements on 86 school lunch with other variables in the parent questionnaire

4.2.5.2a Association of parents’ agreement to impose nutritional requirements on 87 school lunch with other variables in the student questionnaire

4.2.5.2b Association of parents’ agreement to impose nutritional requirements on 87 school lunch with other variables in the school questionnaire

4.2.6.1 Association of parents’ awareness of healthy eating campaign by DH with 88 other variables in the parent questionnaire

4.2.6.2a Association of parents’ awareness of healthy eating campaign by DH with 89 other variables in the student questionnaire

4.2.6.2b Association of parents’ awareness of healthy eating campaign by DH with 89 other variables in the school questionnaire

4.2.7.1 Association of parents’ satisfaction with healthy eating campaign in school 90 promoted by DH with other variables in the parent questionnaire

4.2.7.2a Association of parents’ satisfaction with healthy eating campaign in school 92 promoted by DH with other variables in the student questionnaire

4.2.7.2b Association of parents’ satisfaction with healthy eating campaign in school 92 promoted by DH with other variables in the school questionnaire

4.2.8.1 Association of parents’ participation in healthy eating promotion activities 93 organised by schools with other variables in the parent questionnaire

4.2.8.2a Association of parents’ participation in healthy eating promotion activities 94 organised by schools with other variables in the student questionnaire

4.2.8.2b Association of parents’ participation in healthy eating promotion activities 95 organised by schools with other variables in the school questionnaire

4.2.9.1 Association of parents’ wish to have more knowledge or other kinds of 96 support to help their child to maintain a healthy eating habit with other variables in the parent questionnaire

4.2.9.2a Association of parents’ wish to have more knowledge or other kinds of 97 support to help their child to maintain a healthy eating habit with other variables in the student questionnaire

4.2.9.2b Association of parents’ wish to have more knowledge or other kinds of 98 support to help their child to maintain a healthy eating habit with other variables in the school questionnaire

4.3.1 Association of establishment of school healthy eating policies with other 99 variables in the school questionnaire

4.3.2 Association between participation in any healthy eating promotional activity 99 with other variables in the school questionnaire


4.3.3 Association between participation in SNAP with other variables in the school 100questionnaire

4.4.1 Factors associated with students’ eating preferences 1014.4.2 Factors associated with students’ breakfast eating habit on the survey day 1024.4.3 Factors associated with students’ daily fruit consumption which reached 103

recommend frequency in the week prior to the survey. 4.4.4. Factors associated with students’ daily vegetable consumption which reached 103

recommend frequency in the week prior to the survey 4.4.5 Factors associated with parents’ knowledge on snack categorisation 1044.4.6 Factors associated with parents’ perception on whether healthy eating habits 104

were easy to sustain 4.4.7 Factors associated with parents’ awareness of healthy eating campaign in 105

schools promoted by DH 4.4.8 Factors associated with parents’ satisfaction with the healthy eating campaign 106

promoted by DH at schools 4.4.9 Factors associated with parents’ participation in healthy eating promotion 106

activities organised by schools 5.1 Comparison between 2006 baseline assessment and current survey 1075.2.1 Students’ knowledge of healthier choices in 2006 and 2008 surveys 1085.2.2 Students’ eating preferences in the 2006 and 2008 surveys 1095.2.3 Students’ breakfast-eating habit in the 2006 and 2008 surveys 1095.2.4 Students’ general eating habit in the 2006 and 2008 surveys 1105.2.5 Students’ self-perceived eating habits in the 2006 and 2008 surveys 1105.2.6 Parents’ perception on children’s diet in the 2006 and 2008 surveys 1115.2.7 Parents’ support for imposing nutritional requirements on tuck shop sales in 111

the 2006 and 2008 surveys 5.2.8 Parents’ support for imposing nutritional requirements on school lunch in the 112

2006 and 2008 surveys 5.2.9 Parents’ view on healthy eating habits sustainability in the 2006 and 2008 112

surveys 5.2.10 Healthy eating policies in school to promote healthy eating in the 2006 and 113

2008 surveys


List of Charts 3.1.2.1 Proportion of students correctly answered the questions regarding 10

knowledge of healthier food choice 3.1.2.3 Eating preference of students 13 3.1.2.5 Students’ perception of their own eating habit 14 3.1.2.6 Students’ breakfast eating status on the day of survey 15 3.1.2.7 Provision of lunch during schools days 16 3.1.2.8a Students’ snacking habits 17 3.1.2.8b Students' sources of snacks 17 3.1.2.10 Students’ awareness of the '[email protected]' campaign 19 3.1.2.11 Students’ support in promoting healthy eating in school 19 3.1.2.12 Students’ participation in healthy eating promotional activities organised by 20

schools in the year prior to the survey 3.2.2.3 Parents’ perception of their children’s eating habits 24 3.2.2.4 Parents’ perception of ease to sustain healthy eating habits 25 3.2.2.5 Parents’ agreement to impose nutritional requirements on school tuck shop 26

sales 3.2.2.6 Parents’ agreement to impose nutritional requirements on school lunch 27 3.2.2.7 Effect of food package labels on parents’ choice of food for children 28 3.2.2.8 Decision maker on food at home 29 3.2.2.9 Parents considerations in choosing food for children 29 3.2.2.10a Commonly used cooking methods at home 30 3.2.2.10b Among the top three commonest cooking methods adopted at home, the 31

number of cooking methods regarded as healthier 3.2.2.11 Parents’ breakfast habit 31 3.2.2.12 Frequencies of parents having dinner with their child 32 3.2.2.13a Parents’ awareness of what food and drinks their children bought at school 33

tuck shops 3.2.2.13b Bring snacks to school by children 34 3.2.2.14 Parents’ awareness of healthy eating campaign launched by DH in the 2 35

years prior to the survey 3.2.2.15 Parents’ satisfaction with DH’s healthy eating campaign 36 3.2.2.16 Parents’ participation in healthy eating promotion activities organised by 37

children's schools in the year prior to survey 3.2.2.17 Parents’ wish to acquire more knowledge or other kinds of support to help 38

their child to maintain a healthy eating habit 3.3.2.2a Operator of tuck shop 40


3.3.2.2b School sessions when students were allowed to buy food or beverages from 41 tuck shops

3.3.2.3a Number of beverage vending machine(s) in schools 42 3.3.2.3b Number of food vending machine(s) in schools 42 3.3.2.5 Schools with “Healthy Eating Policy” in place to promote healthy eating 43 3.3.2.6 Composition of working group that arrange and monitor the catering service 44

for students in schools


Annex Annex A Study Brief Annex B Sample of Written Consent Annex C Questionnaire for Student Annex D Questionnaire for Parent Annex E School Questionnaire

Annex A Study Brief Study Brief of the

Assessment of Promoting Healthy Eating in Primary Schools 2008

Objectives:

This study aims to evaluate the territory-wide healthy eating promotion campaign introduced in 2006/2007 school year by the

Department of Health and to explore the strategies for effective promotion of healthy eating among school children.

Time Frame: January 2008

Details of the Assessment:

Items Target Group Content

1. Questionnaire Primary 4 AND The relevant students will be asked to complete a questionnaire (which takes about

Survey of Primary 5 Students 15 minutes) during a classroom session. The knowledge, attitude and practice

Students about healthy eating among students will be assessed.

2. Three-Day Among all The relevant students will be guided to keep a 3-day food diary for recording what

Prospective participated they have eaten and drunk in the next three days. The research staff from the

Food Diary schools, only 2 Chinese University of Hong Kong will visit the school and brief the students on

selected classes of how to complete the diary.

Primary 4 Students

3. Questionnaire Parents of Primary 4 The relevant parents will be given a questionnaire through their children for

Survey of AND Primary 5 completion at home. Attitude towards promoting healthy eating in school,

Parents Students considerations and practices in choosing food for their children, as well as family

practices will be assessed.

4. Survey on

Nutritional

Environment at

School

Schools will be invited to: (1) complete a questionnaire providing information on school environment and corresponding policy,

school lunch arrangement, vending machines, tuck shops, etc.; (2) provide a list of food / beverages sold in tuck shop and vending machines (where applicable); (3) provide the menu of school-provided lunch, together with the ordering quantity on each choic

January 2008 (where applicable).

e in

Roles of participating schools:

(i) distribute the questionnaires and encourage students and parents to complete them;

(ii) (if the P4 students in your school are selected) remind and encourage selected students to complete the food diary;

(iii) complete a questionnaire providing information on school environment and corresponding policy, school lunch

arrangement, vending machines, tuck shops, etc.;

(iv) (where applicable) provide a list of food / beverage sold in tuck shop and vending machines;

(v) (where applicable) provide the menu of school-provided lunch, together with the ordering quantity on each choice

in January 2008;

(vi) (where applicable) provide the daily most popular lunch set of a specified week in January for researchers to take

away for assessment.

Central Health Education Unit

Department of Health

13 September 2007

Annex B Sample of Written ConsentSchool letterhead

Date: Dear Parents/ Guardians,

Consent to participating the “Assessment of Dietary Pattern in Primary Schools 2008”

Childhood obesity put children at risk of developing serious illnesses. As a result of unhealthy diet

and inactive lifestyle, we are seeing an alarming increase in childhood obesity, i.e., almost one in five primary school students are overweight in 2006/07.

The Department of Health (DH) collaborated with stakeholders to launch the “[email protected]” campaign in school year 2006/07 to promote healthy eating among primary school students. In order to understand the current eating practice of the primary school students, DH has commissioned the Centre for Health Education and Health Promotion of the Chinese University of Hong Kong (CUHK) to conduct a territory-wide study of “Assessment of Dietary Pattern in Primary Schools 2008” in January 2008, and our school has been invited to

participate in the study. Your child is invited to complete a “Three-day Food Diary for Students” to record his/her eating habit for three successive days and to complete the “Survey on Diet of Students (For Students)”. At the same time, you are invited to complete the “Survey on Diet of Students (For Parents)”. The result of the study is crucial for DH to monitor the eating pattern of primary school students in Hong Kong, and continue to promote healthy eating in primary schools. The ultimate goal is to improve our children’s health.

The above mentioned study will be conducted in anonymity and all collected information will be restricted to researchers from DH and CUHK. It will not affect the academic performance or internal assessment of your child. I sincerely hope that you can agree in participating the study. Please complete the reply slip below and return it to the class teacher via your child. Thank you very much for your support.

Yours sincerely,

______________________________

Name and Signature of Principal -----------------------------------------------------------------------------------------------------------------------------------------------------------

Reply Slip I agree / disagree* to let my son / daughter* ________________________(student name) of class ____________ participate in the “Three-day Food Diary for Student”, and the “Survey on Diet of Students (For Students)” of the “Assessment of Dietary Pattern in Primary Schools 2008”.

Besides, I, myself agree /disagree* to participate in the “Survey on Diet of Students (For Parents)” of the “Assessment of Dietary Pattern in Primary Schools 2008”.

* Please delete the inappropriate.

Signature of Parent: __________________________ Name of Parent: __________________________

Date: __________________________

School letterhead

Date:

Dear Parents/ Guardians,

Consent to participating the “Assessment of Dietary Pattern in Primary Schools 2008”

Childhood obesity put children at risk of developing serious illnesses. As a result of unhealthy diet and inactive lifestyle, we are seeing an alarming increase in childhood obesity, i.e., almost one in five primary school students are overweight in 2006/07.

The Department of Health (DH) collaborated with stakeholders to launch the “[email protected]” campaign in school year 2006/07 to promote healthy eating among primary school students. In order to understand the current eating practice of the primary school students, DH has commissioned the Centre for Health Education and Health Promotion of the Chinese University of Hong Kong (CUHK) to conduct a territory-wide study of “Assessment of Dietary Pattern in Primary Schools 2008” in January 2008, and our school has been invited to

participate in the study. Your child is invited to complete the “Survey on Diet of Students (For Students)”. At the same time, you are invited to complete the “Survey on Diet of Students (For Parents)”. The result of the study is crucial for DH to monitor the eating pattern of primary school students in Hong Kong, and continue to promote healthy eating in primary schools. The ultimate goal is to improve our children’s health.

The above mentioned study will be conducted in anonymity and all collected information will be restricted to researchers from DH and CUHK. It will not affect the academic performance or internal assessment of your child. I sincerely hope that you can agree in participating the study. Please complete the reply slip below and return it to the class teacher via your child. Thank you very much for your support.

Yours sincerely,

______________________________

Name and Signature of Principal -----------------------------------------------------------------------------------------------------------------------------------------------------------

Reply Slip I agree / disagree* to let my son / daughter* ________________________(student name) of class ____________ participate in the “Survey on Diet of Students (For Students)” of the “Assessment of Dietary Pattern in Primary Schools 2008”.

Besides, I, myself agree /disagree* to participate in the “Survey on Diet of Students (For Parents)” of the “Assessment of Dietary Pattern in Primary Schools 2008”.

* Please delete the inappropriate.

Signature of Parent: __________________________ Name of Parent: __________________________

Date: __________________________

Survey on Diet of Students (For Students)

Hello, students! We would like to know about your daily eating habits. Please answer the following questions. Don’t get influenced by the others when completing the questionnaire. Please be assured that this is an anonymous questionnaire, only researchers can read the questionnaire and the information given by you will be used for data analysis only. Please fill the appropriate of your choices (→ ●) . Grade: P.4 P.5 Class: Sex: Male Female Class no.: Date of birth: Day Month 1. Which item do you prefer to eat in each of the following pairs of food or drinks?

In each of the following pairs, please fill the next to the food or drink that you prefer to eat(→ ●):

1a Yogurt

OR Ice cream

1b Hotdog

OR Raisin whole-meal bread

1c Soya sauce drumstick

OR Deep-fried drumstick

1d Pure orange juice

OR Carbonated drinks

1e Fried rice noodles with beef

OR Chicken rice with vegetables

1f Hamburger

and fries

OR Spaghetti with fresh tomatoes and beef

Annex C Questionnaire for Students

Please fill the appropriate of your choices (→ ●). For each question, please choose one answer only. 2. Have you had your breakfast today?

Yes I had: for breakfast go to Question 3.

No It’s because (Please choose one answer only): I do not have enough time I am on diet I want to save money I am not used to having breakfast

I don’t have appetite in the morning No one prepares the breakfast for me of other reasons:

3. In the past one week, the number of times I ate the following food on average

every day is about:

Daily More than twice

Twice Once Less than once

Never Don’t know

3a. Fruits 3b. Vegetables 3c. Dairy products

(e.g. milk, cheese, yogurt) 3d. Meat, fish, eggs, peas and

beans 3e. Grains and cereals

(e.g. rice, noodles , bread) 3f. Fried and deep-fried food

(e.g. fried pork chop, French fries)

3g. Drinks with added sugar (e.g. carbonated drinks, lemon tea with added sugar)

3h. Food high in sugar (e.g. sweets, chocolate)

3i. Food high in salt (e.g. preserved fruits, cheese rings)

3j. Food high in fat (e.g. potato crisps, ice cream)

4. A healthy lunch box should provide the most on: (Please choose one answer only):

Grains and cereals (e.g. rice noodles, noodles, rice) Vegetables Meat Fruits Don’t know

5. The '3 Low, 1 High' in NutriSnack includes 'Low fat', 'Low sugar', 'Low salt' and 'High

_______'?

Vitamin Fiber Nutrient Don’t know 6. How many fruit and vegetables should be eaten daily for good health?

Two servings of fruit and three servings of vegetables One serving of fruit and one serving of vegetable Five servings of fruit and five servings of vegetables Don’t know

7. On school days, is your lunch provided by school?

No

Yes Are you satisfied with the lunch provided by your school?

Yes, I am satisfied. No, I am not satisfied because:

8. Do you have the habit of eating snacks?

No Yes Your snacks are mainly from:

Take from home Buy from school tuck shop or vending machines

Other sources: 9. Which item do you think is the healthier choice in each of the following pairs of food or

drinks? In each of the following pairs

, please fill the next to the food or drink that you think is healthier (→ ●):

9a. OR

9b.

Soya sauce drumstick

Deep-fried drumstick

OR Pure orange juice

Carbonated drinks

Hotdog 9c.

OR

9d.

9e.

9f.

10. When yoption

Cle

Fre

Pre11. You con

Ver

Un12. Have yo

Ye13. Do you

Ye 14. Have y

school i No No Ye No

Raisin whole-mealbread

Yogurt Ice cream

Hamburger and fries

OR

OR

OR
Chicken rice with vegetables
Spaghetti with freshtomatoes and beef

ou choose food, what would you consider? (for this question)

anliness and hygiene

shness Price

ference of parents Choice of othersider your eating habits as: (Please choose

Good for your h

y healthy Healthy

healthy Very unhealthy u ever heard of the ‘[email protected]’ C

s No

support promoting healthy eating at school?

s No

ou ever participated in any activities that pron the past year? , I have not because my school did not organ, I have not because I do not want to join

s Please specify the theme of the activitiest sure / I cannot remember whether I have pa

☺ End of questionnaire. T

Fried rice noodles with beef

You may choose more than one

Taste

Easy to get

schoolmates one

ealth

answer only)

Acceptable

Don’t know ampaign?

Don’t know

No comment

mote healthy eating organized by the

ize this kind of activity

:rticipated or not. hanks! ☺

16. Do you think healthy eating habits are easy to sustain?

Yes No Why?

Healthy food is more expensive Healthy food lacks variation

No time to prepare healthy food Healthy food does not taste good

Eating out is frequent

Others. Please specify:

17. In the past two years, have you heard of the healthy eating at school campaign launched by the Department of Health?

Yes, but can not recall the name of the campaign Yes, the campaign is called ‘[email protected]’ No (please go to Q19) Not sure (please go to Q19)

18. Are you satisfied with the healthy eating campaign at school conducted by the Department of Health?

Satisfied. Please specify the reasons:

Fair. Please specify the reasons:

Not satisfied. Please specify the reasons:

No comment 19. In the past one year, have you participated any healthy eating promotion activity organized by your child’s school?

No, I have not because I didn’t aware there is any activity held by the school

No, I have not because I am too busy

Yes. Please specify the theme of the activities:

Not sure / Cannot remember whether I have participated or not.

20. Do you wish to acquire some more knowledge or other kind of support in order to help your child in maintaining a

healthy eating habit?

Yes, I want to acquire:

No

Annex D Questionnaire for Parent

Survey on Diet of Students (For Parents) Hello, parents/guardians!

We would appreciate it if you could spend five to ten minutes to fill in this questionnaire, which would enable us to learn more about your views and practices towards healthy eating. Your feedback can help the Department of Health to better implement and evaluate the health promotion activities aiming at improving the health of Hong Kong people. The questionnaire is anonymous. All personal information is confidential and will only be disclosed to researchers for data analysis. Please return the completed questionnaire to the class teacher via your child. Thank you.

Please complete this questionnaire on your own. Do not discuss w

Unless otherwise specified, please choose only oneith your child.

answer for each question. Please fill the appropriate of your choices (→ ●).

Information on child

Grade: P.4 P.5 Class:

Sex: Male Female Class no.

Date of birth: Day Month 1. How often do you eat breakfast?

Always Sometimes Never 2. When you choose food for your child, does the label on the food package affect your choice?

No

Yes, I pay most attention to the inform

Ingredients of food

Statement of special conditions for storage or instructions for use

ation below:

Indication of “use by” or “best before” date

Information on parent / guardian Relationship with your child: Father Mother Grandfather Grandmother

Others. Please specify: Your education level: Primary education or below Secondary education (Secondary 1-5) Matriculation College or above Monthly household income: $3,999 or less $4,000 - $7,999 $8,000 - $9,999 $10,000 - $14,999 $15,000 - $19,999 $20,000 - $24,999 $25,000 - $29,999 $30,000 - $39,999 $40,000 - $59,999

$60,000 or more

End of questionnaire. Thank you! Please return the completed questionnaire to the class teacher via your c

Manufacturer / place of production

Other. Please specify:

I have not been paying attention to the label on the food package

Not sure / Don’t know 3. When at home, who is usually the one to decide what kind of food to eat?

Parents / Guardian Children Grandparents Domestic helper

Others. Please specify: 4. The three most commonly use

hild.

d cooking methods at home are: (Please choose 3 options)

Stir-frying Quick frying with little oil Boiling Steaming

Pan frying Deep frying Stewing Braising

Baking Grilling Microwave Others. Please specify:

5. When you choose food for your child, your consideration would be: (You may choose more than one option for this question)

Cleanliness and hygiene Nutritional value Taste Freshness

Price Convenience Preference and taste of child 6. How often do you have dinner with your child?

Always Often Sometimes Rarely Never 7. In the past one week, where did your child have dinner?

Last Monday

Last Tuesday

Last Wednesday

Last Thursday

Last Friday

Last Saturday

Last Sunday

a. At home

b. Dining outside or buying take away food

c. Did not eat dinner

8. Do you consider the diet of your child healthy?

Healthy Not sure / Don’t know

9. Are you aware of what food or drinks your child usually buys at the school tuck shop?

No, I am not Yes, I am. They are:

Not applicable, because I do not allow my

Not applicable, because there is no tuck sho

10. Does your child bring snacks to school?

Yes, always. Snacks usually include:

Yes, sometimes. Snacks usually include: No Not sure/Don’t know

11. Do you agree that the following regulations should be adopted by the school tuck shop

Unhealthy. Please specify the reasons:

child to buy snacks p in school

? Agree Disagree No comment

a. Compulsory sale of vegetables (e.g. boiled corn, salad) every day

b. Compulsory sale of fresh fruits every day

c. Restricted sale of drinks with added sugar (e.g. carbonated drinks, lemon tea with added sugar)

d. Restricted sale of food high in sugar (e.g. sweets, chocolate)

e. Restricted sale of food high in salt (e.g. preserved fruits, cheese rings)

f. Restricted sale of food high in fat (e.g. potato crisps, ice cream)

g. Other regulations (Please specify):

12. Do you agree that the following regulations should be adopted for the school lunch arrangements? Agree Disagree No comment

a. Stipulation of the amount of grains and cereals (e.g. rice, noodles, pasta) provided by the lunch box every day

b. Stipulation of the amount of vegetables provided by the lunch box every day

c. Stipulation of the amount of meat, fish, poultry, eggs and legumes provided by the lunch box every day

d. Limits on the frequency of using processed or preserved meat (e.g. sausage) in the lunch box per week

e. Limits on the frequency of using deep-fried food (e.g. fried chicken wings, fried pork chop) as the main dish of the lunch box per week

f. Stipulation of the frequency of serving fruits alongside lunch per week

g. Other regulations (Please specify):

13. Refer to the “Smart Lunch” promoted by the Department of Health, a healthy lunch box should provide grains and

cereals, vegetables and meat in the ratio of :

1:1:1 (i.e. the proportion of the three groups are the same)

1:2:3 (i.e. 1 part for grains and cereals, 2 parts for vegetables and 3 parts for meat)

3:2:1 (i.e. 3 parts for grains and cereals, 2 parts for vegetables and 1 part for meat) Don’t know

14. In order to keep a balanced diet and to obtain sufficient nutrition, the Department of Health advocates at least how many

servings of fruit and vegetables in a daily basis?

Two servings of fruit, three servings of vegetables Three servings of fruit, two servings of vegetables

Five servings of fruits, five servings of vegetables Don’t know

15. Colours red, yellow and green are used by the Department of Health when promoting healthy snacks. They represent

'Snacks to Choose Less', 'Snacks to Choose in Moderation' and 'Snacks to Choose More' respectively. Please indicate which category does the following food belongs to:

Red 'Snacks to Choose Less'

Yellow 'Snacks to Choose in Moderation'

Green 'Snacks to Choose More'

a. Pastries b. Sandwich biscuits c. 3-in-1 instant drinks d. Steamed dumplings e. Fish meat 'siu mai' f. Salted seaweeds g. Whole-fat milk h. Salt roasted peas with salt i. Baked apple chips j. Boiled eggs

Survey on Nutritional Environment and Facilities in School Thank you very much for filling in this questionnaire. This survey aims at reviewing the nutritional environment and facilities in local primary schools. The results of the survey will provide significant information for the Department of Health to plan measures to promote healthy eating among primary school students. The questionnaire is by no means an appraisal or examination. All information collected will be used for the survey only. Information of individual school will not be disclosed. If you have any enquiry, please contact Miss Hilda Ma, Research Assistant of the Centre for Health Education and Health Promotion of the Chinese University of Hong Kong at 2693-3708. Please fill the □ or corresponding to your answers (→ █ or ●). Unless otherwise specified, please choose one answer only.

A. Basic information on school

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Reference No.:_____________

Official use only. Please do

Annex E School Questionnaire

ame of school: ________________________________________________________

ode of school: 1 A.M. School 2 P.M. School 3 Whole-day School ender of students: 1 Co-educational School

2 Boy’s School 3 Girl’s School

otal no. of students in school: ______________students

otal no. of Primary 4 and 5 students: _____________students

chool religious background:

1 With religious background 1 Buddhism 2 Catholics 3 Christianity

4 Islam 5 Taoism

6 Others. Please specify:_________________________

2 Without religious background

ame of school lunch caterer: _____________________________ Not applicable

ame of tuck shop contractor: _____________________________ Not applicable

ame of vending machines supplier: ________________________ Not applicable

ate of completing this questionnaire (Day/Month/Year): / 1 / 2008

ame of person completing this questionnaire: ______________________

osition / Rank: _______________________________________________

ontact number: ______________________________________________

not write.

Name of researcher: ______________

Signature of

Researcher:

______________

Date of Visit:

2008 / 01 / _____

Remarks:

B. Healthy eating policy in school

1. Since March 2006, has your school participated in any activity organised by the Department of Health to promote healthy eating in school?

1 No 2 Yes, our school has participated in the following activities organised by the

Department of Health: (You may choose more than one option) 1 School ‘NutriAgent’ Project, school number (3 digits): __ __ __

2 Slogan Competition / E-card Design Competition 3 Popular Lunch Box Election 4 Fruit Day 5 Others:__________________________________________________

2. Since March 2006, has your school participated in any activity organised by

organisations (other than the Department of Health) to promote healthy eating in school?

1 No 2 Yes, our school has participated in the following activities organised by other

organisationsName of Organisation Name of Activity Date of Activity

:

(You may use extra paper to provide the information)

Official use only. Please do not write.

Remarks:

3. Since March 2006, has your school organised any activity on your own to promote healthy eating in school?

1 No. 2 Yes, our school has organised the following healthy eating promotional

activities on our own:

Name of activity: ___________________________ Date: _____________

Nature: ________________________ Target participants: _____________






Nature: ________________________ Target participants:_____________



















(You may use extra paper to provide the information)


Remarks:


Remarks:

4. Do you know that the Department of Health had issued the ‘Nutritional Guidelines on School Lunch for Primary School Students’ to all Hong Kong primary schools in March 2006?

1 No (Please go to Question 5)

2 Yes (Please answer 4a – 4d to provide your comments on the Lunch Guidelines)

4a. Content 1 Sufficient 2 Fair

3 Insufficient. Please specify the reason: ___________________ 4b. Applicability 1 Easy to execute 2 Fair 3 Difficult to execute. Please specify the reason: ____________

__________________________________________________ 4c. Has the content of the guidelines ever been incorporated into the contract with

the school lunch caterer? (You may choose more than one option for the year of implementation if applicable)

1 Yes. Year of implementation: 1 2005/06 2 2006/07 3 2007/08 4 Others. Please specify:_____________

2 No. Please specify the reason :_________________________________ 3 Not applicable. Please specify the reason: 1No school lunch supply

2 Others: _______________ _____________________

4d. Other comments on the guidelines: ___________________________________ __________________________________________________________________

5. Do you know that the Department of Health had issued the ‘Nutritional

Guidelines on Snacks for Primary School Students’ to all Hong Kong primary schools in June 2006?

1 No (Please go to Question 6)

2 Yes (Please answer 5a – 5e to provide your comments on the Snacks Guidelines)

5a. Content 1 Sufficient 2 Fair

3 Insufficient. Please specify the reason: _________________ __________________________________________________

5b. Applicability 1 Easy to execute 2 Fair

3 Difficult to execute. Please specify the reason: ____________ _________________________________________________

5c. Has the content of the guidelines ever been incorporated into the contract with the school tuck shop contractor? (You may choose more than one option for the year of implementation if applicable)

1 Yes. Year of implementation: 1 2005/06 2 2006/07 3 2007/08 4 Others. Please specify:____________

2 No. Please specify the reason :_________________________________ 3 Not applicable. Please specify the reason: 1No tuck shop

2 Others: ______________ _____________________


Remarks:

5d. Has the content of the guidelines ever been incorporated into the contract with

the vending machines supplier? (You may choose more than one option for the year of implementation if applicable)

1 Yes. Year of implementation: 1 2005/06 2 2006/07 3 2007/08 4 Others. Please specify:_____________

2 No. Please specify the reason :_________________________________ 3 Not applicable. Please specify the reason: 1No vending machines

2 Others: ______________ 5e. Other comments on the guidelines: __________________________________

_________________________________________________________________ 6. Do you agree that ‘Healthy Eating’ should become a major component in school

education and student development? 1 Agree 2 Disagree. Please specify the reason:__________________ 3 No opinion

7. What kind of technical support do you want to get from the Department of Health

for promoting healthy eating in school? (You may choose a maximum of three options for this question)

1 Regulatory support 2 Consultation / Advisory support 3 Advocacy / Promotional support 4 Educational support 5 Financial support 6 Others. Please specify:__________________________________________ 7 Support from the Department of Health is not needed. Please specify the

reason: ______________________________________________________ 8. Is ‘Healthy Eating School Policy’ established in your school to promote healthy

eating in and/or outside school among your students? 1 No healthy eating policy established. Please go to Q10 2 Yes, but no documentation. 3 Yes, with documentation. Please also submit the documents on healthy

eating school policy.

9. Which of the following scope(s) does your ‘Healthy Eating School Policy’ cover? (You may choose more than one option)

1 Healthy snack 2 Healthy lunch 3 Healthy eating at home 4 Others. Please specify: ___________________________________________

9.

HS HL HH POO

10. Is there any working group dedicated in arranging and monitoring the catering

service for students formed in your school? 1 No 2 Yes. Members of the working group include: (You may choose more than

one option) 1 The principal / Vice principal(s) 2 Teaching staff representative(s)3 Parent representative(s) 4 Student representative(s) 5 Caterer representative(s) 6 Community organization(s) /

professional representative(s) (such as dietitian)

7 Others. Please specify: _____________________________________Apart from the working group, please specify if there is/are other channel(s) for teachers, parents and students to participate in catering service arrangements:

___________________________________________________________________ ___________________________________________________________________

3 Not applicable because there is no contract-out lunch caterer / there is no school lunch provided (Please fill the square on the left → )

11. When your school chose the current lunch caterer, the 3 most important factors for consideration were: (Please rank the factors in the boxes: “1” meaning the most important, “2” meaning the second most important and “3” the third)

1 Size of the company 2 Price of the food 3 Preferences of students on the taste of food 4 The nutrition value of food 5 History of food safety 6 Others. Please specify:__________________________________________

____________________________________________ 7 Not applicable because there is no contract-out lunch caterer / there is no

school lunch provided (Please fill the circle on the left →●)

12. When your school chose the current tuck shop contractor, the 3 most important factors for consideration were: (Please rank the factors in the boxes: “1” meaning the most important, “2” meaning the second most important and “3” the third)

1 The same contractor as the lunch caterer 2 Size of the company 3 Price of the food 4 Preferences of students on the taste of food products 5 The nutrition value of food 6 Others. Please specify: ___________________________________________

___________________________________________ 7 Not applicable because there is no tuck shop / the tuck shop is not contracted

out (Please fill the circle on the left → ●)


Remarks:

10.

PTA SQ PQ VTC Oth

C. Current school lunch arrangements

13. Currently, the school lunch is arranged in the following format(s): (You may choose more than one option for this question)

1 We are a half-day school Please proceed to Section (D) 2 Lunch boxes are ordered from caterer* 3 Lunch are served at school by caterer* 4 Students can bring their own lunch or parents deliver their lunch to school 5 Students can buy their own lunch from outside the school 6 Students can buy their own lunch from the school tuck shop 7 Others. Please specify:

* Please fill in Appendix 1 to provide the information and subscription amount of

school lunch in January 2008, and send to us by fax on or before 4, January 2008 (fax no.: 2694-0004).

14. Who can take part in deciding the choices of lunch menu provided by the caterer for

your students? (You may choose more than one option for this question) 1 Teachers 2 Students 3 Parents 4 Headmaster 5 Lunch caterer 6 Parent-Teacher Association 7 School director 8 Others. Please specify: __________________

D. Facilities 15. In what format is the drinking water (free of charge) provided to students in your

school?

1 Drinking fountains 2 Thermos bottle 3 Others. Please specify: ___________________________________________ 4 Not applicable because no free of charge water is provided.

E. Tuck shop

16. Is there a tuck shop in your school?

1 No Please go to Section (F) 2 Yes*

* Please fill in Appendix 2 to provide the record of food and beverages provided by

the school tuck shop.


Remarks:

End of Questionnaire. Thank you for your valuable information!


Remarks:

17. Who is operating the tuck shop in your school?

1 School staff 2 Contractor 3 Parents 4 Parent-Teacher Association 5 Others. Please specify: __________________________________________

18. The time interval(s) that allow(s) students to buy food or beverages from the tuck

shop include: (You may choose more than one option in this question) 1 Before class 2 Recess time in the morning 3 Lunch time 4 Recess time in the afternoon 5 After school

F. Automatic vending machines of food or beverages

19. Is there any automatic beverage vending machine in your school? 1 No Please go to Q21 2 Yes*

* Please fill in Appendix 3 to provide the record of beverage provided in the beverage vending machines.

20. How many beverage vending machine(s) is/are there in your school?

1 One 2 Two 3 Other amount: ______________ 21. Are there any automatic food vending machine in your school?

1 No End of Questionnaire, please read the Remarks at the end of the questionnaire

2 Yes* * Please fill in Appendix 4 to provide the record of food items provided in the food vending

machines. 22. How many food vending machine(s) is/are there in your school?

1 One 2 Two 3 Other amount: ______________

Remarks: Please also supply the following document(s) (if applicable)

(1) The documents on ‘Healthy Eating School Policy’;

(2) The menu and price of school lunch and the amount of lunch ordered from caterer for the

whole school as well as that for P4 and P5 students in January 2008 (please refer to

Appendix 1), and fax to us on or before 4, January 2008 (fax no.: 2694-0004);

(3) The record of food and beverages provided by the tuck shop and the three most popular

items over the past one week (please refer to Appendix 2);

(4) The record of beverages provided in the beverage vending machines and the three most

popular items over the past one week (please refer to Appendix 3);

(5) The record of food provided in the food vending machines and the three most popular

items over the past one week (please refer to Appendix 4).

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