FINAL THESIS WRITTEN

Exploring the BSD Program 1

Running Head: Exploring the Balanced School Day Program

Exploring the Balanced School Day Program

Megan L. Sutherland

Honors Student

Department of Sport Management

April 2008


Table of Contents

Chapter Title Page

Title Page…………………….…………………………………………..……….. 1

Table of Contents………..……………………...…………………….….……….. 2 1 Introduction……………………………………….……………….……………... 4

Introduction References……………………………………….……….……..….. 8 2 Literature Review………………………………………………………………...10 2.1 Childhood Obesity Rates…………………………………………………….10 2.2 Child Obesity Rates within Niagara Region…………………………………10 2.3 Body Mass Index…………………………………………………………….11 2.4 Health Concerns……………………………………………………………...12 2.5 Individual/Behavioral Determinants of Obesity……………………………..13 2.6 Environmental Determinants of Obesity……………………………………..13 Intervention and Prevention Models 2.7 Social Change Model…………………………………………………............14 2.8 Ecological Change Model…………………………………………………....15 2.9 Health Promotion Change Model…………………………………………….15 2.10 Models within Niagara Region……………………………………………...16 2.11 Nutrition……………………………………………………………………..17 2.12 Nutrition in Schools……………………………………………………….....18 2.13 Physical Activity……………………………………………………………..19 2.14 Physical Activity in Schools…………………………………………………20 2.15 Intervention Strategies within Schools………………………………………21 2.16 Implementing Policy Programs……………………………………………...23 2.17 Existing Research……………………………………………………………24 Literature Review References………………………………………………….....26 3 Methodology………………………………………………………………………34 3.1 Qualitative…………………………………………………………………......34 3.2 Quantitative……………………………...…………………………………….36 Methodology References………………………………………………………….38 4 The Results…………………………………………………………………………39 4.1 Analysis of Research Question #1……………………………………………...40 4.2 Analysis of Research Question #2……………………………………………...51 4.3 Analysis of Research Question #3…………………;;;…………………………62


5 Discussion of the Results……………………………………………………………65 Discussion of the Results References……………………………………………….85 6 Conclusion…………………………………………………………………………...89 Conclusion References………………………………………………………………95


Chapter 1: Introduction

The daily physical activity/education program initiated by Ontario’s government in 2006 requires

students in grade 1-8 participate in health and physical education as part of a curriculum requirement.

However, no minimum instructed time is required within the elementary school’s curriculum. The

components of the elementary health education curriculum are organized around three specific strands

that include: 'Healthy Living' (healthy development, growth, eating), 'Fundamental Movement Skills'

(locomotion, stability, traveling), and 'Active Participation' (physical activity, physical fitness, and living

skills) (Ministry of Health Promotion, 2006). In an attempt to add structure to the ‘Active Participation’

strand of the curriculum, the 'Daily Physical Activity’ program was implemented in 2006 by the Ontario

government as an additional educational component to raise student’s physical activity levels. This

program requires students to complete 20 minute of moderate to vigorous physical activity each school

day (Ministry of Health Promotion, 2006). The programs specific focus is on increasing 'Active

Participation' by students, yet it does not incorporate the two other strands the health education

curriculum is organized around.

Past physical activity/education programs implemented by the Ontario Federal and Provincial

government included the endorsement of the ‘Canadian Sport for Life’ (LTAD) model. This model

presented a case for the optimal role of elementary system as a contributor to physical development. The

implementation of this LTAD model allowed students to learn physical literacy. These skills include basic

movement such as: running, jumping, throwing, and catching. There have also been the historical

programs that have been implemented by the Ontario government that have included the ‘Canada Fitness

Awards’ program (Ministry of Health Promotions, 2006). This program was implemented in the 70’s in

public schools and played a successful role in promoting sport and physical activity. Though, these

programs were beneficial on certain levels. These past programs are simply not sufficient to promote

healthy lifestyles to children and address the issue of obesity rates that are a significant issue among

children in Ontario. The need for educational systems to provide healthy active living programs to

students is essential in promoting an overall healthy lifestyle.


Childhood youth obesity is an important issue that needs to be further researched as more than

one-third of all cancers is attributed to diet, obesity and inactivity (WHO, 2000). The outcomes of being

overweight and obese comprise a list of aliments including: cardiovascular disease; heart disorders;

strokes; hypertension; various cancers; type 2 diabetes; gall-bladder disease; impaired respiratory

function; liver disease; and urinary stress (Drewnowski, 2006). The importance of instilling an

appreciation for healthy lifestyle behaviors necessitates further examination of educational system’s

nutrition and fitness programs because most critical long-term consequences of childhood obesity are

persistent in adulthood (National Cancer Institute, 2004).

As years have evolved, youth specifically have oriented their nutritional diets around consuming

fats, starches and sugars. Due to the fast paced lifestyles of parents and the continual growth of cheap

fast-food outlets, parents have unlimited access to purchasing meals from these types of outlets. Foods

high in sugars, starches, and fats are less expensive food selections that have become another contributing

factor (Cullen et al., 2007). Healthy options are made available at these outlets but society continues to

select foods high in fats and sugars. The economic factor of income is a large contributing factor in

creating barriers for individuals being able to afford foods that constitute a healthy balanced diet (Taylor

et al., 2006; Drewnowski, 2006).

This issue surrounding obesity is a matter of politics and economics (Thatcher, 2004). It is not a

private issue that’s solution involves health counseling and campaigns urging healthy food selections. The

issue of individuals being overweight and obesity should be treated as a public-policy matter and helped

through government assistance. For years, past research has been conducted and results have indicated

that the socio-economic factor of income has been found to have a continually strong correlation to

obesity rates (Estabrooks et al., 2003).

A high percentage of children do not have access to resources, facilities, and/or foods that are part

of a healthy balanced diet. This has created several barriers in attempts to reduce youth obesity rates, as

balanced nutrition is just as important as exercise in living an overall healthy lifestyle. This issue has been


publicly promoted by our societal environment, creating barriers for individuals to integrate healthy

eating and physical activity into the traditional fast paced lifestyles. This has been of concern to Dr. Peter

Katxmarzyk from the Heart and Stroke Foundation (Thatcher, 2004). The expenses associated with sport

participation can be extremely high and may prohibit a child’s participation, inevitably decreasing

children’s sport participation rates. These costs include: registration, equipment, uniform costs,

tournament, and accommodation fees.

Another barrier reducing children’s involvement in organized sport and physical activity is the

limited access to recreational facilities and resources. Families of low-income not only have access to

fewer recreational facilities and resources but communities of low-income do not have as many 'free for

use' facilities available for use (Estabrooks et al., 2003; Reidpath et al., 2002) Socio-economic status has

been found to have a stronger correlation to obesity than any other demographic indicator (Cullen et al.,

2007).

Therefore, the purpose of this research is to evaluate the success of one school-based program:

The Balanced School Day program. This research aims to address the need for additional educational

programs that promote healthy active habits youth will continue to practice in the future (Chater &

Lafond, 2003). In particular, this research will explore the Balanced School Day program that has been

implemented in over half of the District School Board of Niagara’s elementary schools.

The Balanced School Day Program has changed the traditional school day schedule to consist of

two nutritional/fitness breaks. The programs goal is to promote nutritional habits and provide additional

time for youth to participation in physical activity (Halton District School Board, 2003; Walmsley, 2001).

The program has been used as a pilot project in a wide variety of school boards across Ontario. Results of

pilot school studies have indicated students had improved academic performance, consumed a more

balanced diet, physical activity levels increased, and the schedule change allowed for more learning time

in class (Halton District School Board, 2003).

The socio-economic status of a community can affect prevention and intervention programs

implementation process and effectiveness (Taylor et al., 2006; Lee & Cuba, 2003).


Research has indicated that an efficient implementation process is essential to running an

effective and successful program (Taylor et al., 2006; Lee & Cuba, 2003; Estabrooks et al, 2003). The

purpose of this exploratory study is to assess variances in the effective implementation process of the

Balanced School Day program in four selected public schools within the Niagara region. The specific

socio-economic factor differentiating each school will be based upon income of the neighborhood in

which the school is situated. There will be one public school that will be classified as high-income vs.

three public schools that will be classified as low-income. These classifications are based upon

demographic (income) information about the neighborhoods in which the schools under study are situated

with in the Niagara region (Statistics Canada, 2001). This data will determine which school classified as

high income and which is of low income.

The research will be based upon existing data shown in the academic literature (Taylor et al.,

2006; Lee & Cuba, 2003; Estabrooks et al., 2003) that examines the relationship between the socio-

economic factor of income and contributing factors to youth obesity rates. The effects socio-economic

influences on the implementation process of the Balanced School Day program within the three selected

schools will be explored. Interviews with principals from each selected school will be conducted to get a

more extensive understanding of the components involved in the implementation process at each school.

This will allow trends and differences between the schools to surface. They will be further examined to

see if it corresponds with past research involving socio-economic factors creating barriers for students to

have access to optimal daily physical activity/education programs.


References

Charter, M. & Lafond, L. (2003). The Balanced Day: An assessment by the teachers at St. Clair

elementary school. Ontario English Catholic Teachers Association – St. Clair Elementary

Unit.

Cullen, K., Hartstein, J., Reynolds, K. D., Resnicow, Ken., Greene, N. & White, M. A. (2007).

Improving the school food environment: results from a pilot study in middle schools.

Journal of American Dietetic Association, 107, 3, 484-489.

Drewnowski, A (2004). Obesity and the food environment: Dietary energy density and diet

costs. Am J Prev., 27, 3, 154-162.

Estabrooks, P.A., Lee, R. E. & Gynresik, N. C. (2003). Resources for physical activity

participation: does availability and accessibility differ by neighbourhood socioeconomic

status. Ann Behav Med., 25, 2, 100-104.

Halton District School Board (2003). The Balanced Day Survey’s Report. Community Relations,

Research and Accountability.

Lee, R. E. & Cubbin, C. (2002). Neighbourhood context and youth cardiovascular health

behaviours. American Journal of Public Health, 93, 428-436.

National Cancer Institute. Cancer Facts. 2004. http://cis.nci.nih.gov/fact/3_70.htm

Ontario Ministry of Health Promotion. Ontario’s Action Plan for Healthy Eating and Active

Living, 2006. http://www.mhp.gov.on.ca/english/news/2006/062006.asp

http://cis.nci.nih.gov/fact/3_70.htm

http://www.mhp.gov.on.ca/english/news/2006/062006.asp


Reidpath, D. D., Burns, C., Garrard, J., Mahoney, M. & Townsend, M. (2002). An ecological

study of the relationship between social and environmental determinants of obesity.

Health Place, 8, 141-145.

Statistics Canada. (2001). Census: Population by Income Status. Niagara Region, Municipalities

and Ontario.

Thatcher, R. (2004). The Political Economy of the ‘War on Fat’. Canadian Dimension.

Taylor, W., Poston, W., Jones, L. & Kraft, M. (2006). Environmental Justice: Obesity,

Physical Activity, and Healthy Eating. Journal of Physical Activity and Health.

3(1), 125-136.

World Health Organization. (2000). Obesity: Preventing and Managing the Global Epidemic.

WHO Technical Report Series 894, Report of a WHO Consultation, Geneva, 2000.


Chapter 2: Literature Review

Childhood Obesity Rates

Adult obesity rates are becoming an increasing concern because overweight and obese conditions

in childhood often persist into adulthood causing additional health concerns. This decline in health is

specifically in reference to nutritional and physical activity patterns that have been documented as a cause

for the increase in obesity rates in adulthood (Addressing childhood obesity, 2003; Canning et al., 2004;

Cullen et al., 2007; Estabrooks et al., 2003). Though there is not an accurate indication of how severe the

impact of obesity has been on children, one trend has shown to stand true throughout all research which is

that children in low-income, multi-ethnic homes, who live in urban neighborhoods appear to be at

particular risk of obesity (Estabrooks et al., 2003; Laitinen et al., 2001; Lillie-Blanton & Laveist, 1996;

Paeratakul et al., 2002).

Limited data on the impact of overweight and obesity in children has been documented in the

past. This has been a result of past research including similar surveys to the 1981 Canada Fitness Survey

and the 1996 National Longitudinal Survey of Children and Youth having all reported figures on youth

documented by parents instead of actual measurements (Canning et al., 2004; Cordain et al, 1998;

Improving the Health of Canadians, 2004; Macintyre et al., 2002). This has posed several problems in

retrieving accurate data figures on the prevalence of obesity in children. This has been due to self-

reported figures of height and weight that may be misconstrued and underpinned. Research based upon

self-reported data indicated that obesity rates in boys have increased from 2.0% to 10.2% from 1981 to

1996. Girls had similar results, indicating an increase from 1.7% to 8.9% over the same time period

(Macintyre et al., 2002; Overweight and obesity in Canada, 2004; Srinivasan et al., 1999).

Child Obesity Rates within Niagara Region

Obesity rates within the Niagara Region are of great concern. In 2001, a staggering 54.7% of the

residences within the Niagara Region were classified as overweight/obese based up the measurement of


BMI (Shields, 2006; Statistics Canada, 2004). In 2003, 30% of adolescents within the Niagara Region

were classified as overweight/obese in comparison to the rate of 21.2% for the remaining adolescents in

Ontario. Research conducted in 2005 indicated the Niagara Region rate had declined to 21.7% but due to

sampling variability, this figure may not be accurate. The remainder of Ontario’s rate in 2005 was still

less than the Niagara Region, with a percentage of 19.7% (Shields, 2006; Statistics Canada 2005).

Local and provincial obesity data for children under the age of 12 is not available due to the

limited accurate research conducted on this specific age group. The most accurate data that indicated the

prevalence of obesity within this age range was retrieved from the 2004 Canadian Community Health

Nutrition Survey (Shields, 2006), but it only represented national data. The results indicated that 19% of

Canadian boy’s ages 2 to 5 and 25% of boys ages 6- 11 were considered overweight/obese. Figures for

girls were similar with 24% between the ages 2 to 5 and 26% of girl’s ages 6-11 fell into the classification

of overweight/obese based upon the measurement of body mass index (Shields, 2006; Statistics Canada,

2005).

Body Mass Index

The most commonly known form of obesity indicator is the measurement of body mass index.

An individual with a BMI of 25 or more indicates they are considered overweight and are at an increase

risk of developing health problems. A rate of 30 or more indicates obesity and a high to extremely high

risk of developing health problems (Chinn & Rona, 2001; Laitinen et al., 2001; Macintyre et al., 2002;

Tremblay, 2000; World Health Organization, 2000). Though this type of measurement is used most

commonly, it does have its limitations. One of these limitations is that body mass index is based upon

weight and height and does not consider body composition or fat distribution. This creates problems for

classification of very muscular individuals, youth who have yet to meet their full height potential and the

elderly (Chinn & Rona, 2001; Tremblay, 2000; World Health Organization, 2000). The main limitation

using body mass index as a form of measurement for classifying overweight/obesity is there is no


systematic surveillance of obesity in Canada where height and weight is measured by health professionals

and is not self-reported.

Since the Canadian Community Health Survey (2001), there has not been many studies conducted

that have not been based on accurate measurements of height and weight. Based upon the national survey

Nutrition Canada Survey 1970-1972, Canada Health Survey 1978-1979, and Canadian Heart Health

Survey 1986-1992 were conducted to examine body mass index change over time. Results indicated that

for both male and female, body mass index numbers increased as time progressed. Results have indicated

that individuals, especially in parents reporting youth’s figures, have had a tendency to underreport their

weight. Even still, body mass index is still used as an effective method for population comparisons in the

measurement of obesity.

Health Concerns

The rise in Canadian obesity rates has had significant health implications on its citizens and is the

cause of grave concern. As body mass index increases, so does the risk of health concerns. A high body

mass is associated with cardiovascular disease, hypertension, triglyceride levels (Barlow & Dietz, 1998;

Canning et al., 2004; Cossroe & Falkner, 2004; Freedman et al., 2001; Hedley et al., 2002; Lee & Cubbin,

2002). Children and adolescents with high body mass index are at risk of physical complications that

include cardiovascular disease, and also demonstrate increased prevalence of hypertension, heart

disorders, strokes, impaired immune system, gall-bladder disease, gout, and liver disease (Cossroe &

Falkner, 2004; Freedman et al., 2001; Hedley et al., 2002; Lee & Cubbin, 2002, Raine, 2004). As

childhood obesity increases, so does children diagnosed with type 2 diabetes: a disease that in the past

was predominately found in adults and rarely had any cases in children. Social and psychological

complications include reduced self-confidence, self-esteem, social withdrawal and clinical disorders such

as depression. Increased youth obesity rates suggest that obese children may be discriminated against by

their peers (Canning et al., 2004; Raine, 2004; Srinivascan et al., 1999).


Specialty clinics that focus on treatment for children have emerged to address the declining health

of children. These clinics focus on the need for a behavioral change, which essentially involves family to

encourage healthy eating and physical activity to promote healthy lifestyle changes. Overweight and

obesity is associated with several health care concerns.

Individual/Behavioral Determinants of Obesity

The causes of obesity have been documented as an individual’s interaction among individual,

behavioral and environmental determinants of health. The individual/behavioral determinants include the

factor of an individual’s genes that makes obesity possible. Genetic factors are estimated to contribute

20% to 75% of the variability in body weight and composition within a population (Reidpath et al., 2002;

Sundquist et al., 1999; Willms et al., 2003). However, the rapid increases in obesity rates suggest that

there are other determining factors other then obesity being based upon an individual’s genetic makeup.

Environmental Determinants of Obesity

Environmental contributions have also been suggested as a contribution to the growing obesity

rates as a result of living in an environment that promotes obesity more so that in the past. This is due to

the continuous promotion of sedentary lifestyles and the consumption of high-fat foods, sugars and salts.

This lifestyle not only promotes poor nutritional habits but promotes excessive food intake and

discourages physical activity (Brownson et al., 2001; Drewnowski, 2004; Lillie-Blanton & Laveist, 1996;

Morland et al., 2002; Reidpath et al., 2002). Further examination of both Canadian nutrition and physical

activity levels must be understood to gain a better understanding of why this rate continues to increase.

These environmental contributions include both micro and macro factors. Micro-environmental

obesity contributors include: homes, families, workplaces, schools, food retailers, food service outlets and

recreation facilities (Raine, 2004; Hedley et al., 2004; Sallis et al., 1997). The Macro-environmental


obesity contributions include: media, technology, food marketing, urban planning and transportation

system. A framework that to analyze both of these factors was referred to as the ANGELO framework

(analysis grid for environments linked to obesity). The framework gave some insight into these factors.

There needs to be a better understand of the burden of obesity, in terms of 1) individual health, 2) impact

on social context, and 3) impact on the health system. This must be completed in order to allocate the

proper resources towards prevention of overweight and obesity (Raine, 2004; Sallis et al., 1997; Wilson et

al., 2004).

Environmental strategies involve institutions and involvement of political, economic and social

locales to support behavioral change (Dufour, 2004; Estabrooks et al., 2003; Morland et al., 2002; Orthner

et al., 2007; Srinivasan et al., 1999; Veugelers & Fitzgerald, 2005; Wilson et al., 2004; Yekutel &

Orthner, 2007). This is an area where support could be increased, as relevant locale involvement is

essential to the success of intervention programs.

Knowledge about proper nutrition and the benefits of physical activity are very important in order

to live and maintain an overall healthy lifestyle. In order to analyze our changing environment, the

multiple contributing factors to the obesity problem must be examined using frameworks to organize and

implement effective interventions and prevention programs.

Intervention and Prevention Models

Social Change Model

Social factors are useful tools for understanding how determinants of obesity are interrelated and to

understand the need for intervention at multiple levels. These multiple levels include: international

factors, national/regional population, community locality, work/school/home and individual. All of these

levels include a variety of factors that contribute to the obesity epidemic at these multiple levels, which

require further examination for intervention and prevention strategies to be created (Canning et al., 2004;


Laitinen et al., 2001; Raine, 2004). The social context being the environment in which we live and how

we interpret them. These contributions to obesity is somewhat less understood and is the area of which

future research should be conducted to gain a better understanding of the contributing factors of obesity.

Ecological Change Model

This approach includes the multiple level groups and the variety of factors to formulate public health

strategies to promote health lifestyles and reduce obesity (Cordain et al., 1998; Pareatakul et al., Raine,

2004; Trakas et al., 1999; Veugelers & Fitzgerald, 2005). Past approaches to address these factors have

been identified by various authors who support an ecological approach to address the issue of obesity

(Laitinen et al., 2001; Raine, 2004; Wilson et al., 2004).

Ecological strategies to target obesity can be grouped into individual, environmental and population

classifications. Past prevention and intervention approaches have focused on environmental and

population classifications rather then focusing specifically on individuals. This is due to strategies to date

that have promoted change in dietary and physical activity behavior focusing on individuals specifically

have been unsuccessful in eliminating and reducing the obesity epidemic and the other classifications

have shown more positive results.

Health Promotion Change Models

Health Promotions is also another effective supported prevention approach that can assist in

organizing strategies to support healthy lifestyles among individuals. They have also been known to

influence policies that create opportunities for social and cultural change (Brownson, et al., 2000; Cossroe

& Falkner, 2004; Raine, 2004). Health promotion efforts dealing with seatbelts, tobacco, recycling and

breast feeding have generated a social change at levels similar to those needed to address obesity. These


successful approaches have predominately targeted environmental and population policies. This is what

has been identified as the types of policies that must be used to successfully address the issue of obesity.

To effectively be able to implement prevention and intervention programs, a more thorough explanation

of what classifies an individual as overweight or obese must be understood.

Models within Niagara Region

Due to the prevalence of obesity in the Niagara Region, especially in children, the community has

been taking action to improve nutrition and physical activity levels to promote healthy lifestyle changes.

There were nine specific areas of focus by the community to enforce these programs that focus on

improving nutrition and physical activity levels (Coppola, 2006; Statistics Canada, 2005).

The Niagara TREKZONE challenges residence to walk, run, rollerblade or cycle the length of the

Niagara Circle route. Incentives were used to encourage participation from the surrounding residence

(Coppola, 2006). To target the area of children’s involvement in physical activity, the community is

working on expanding physical activity options for children. This would be enforced by adopting physical

activity policies to increase these opportunities (Coppola, 2006). Also by improving the transportation

resources available to residence could improve physical activity. This could be done by improving and

expanding trail networks.

To improve nutrition, the FOODZONE campaign was established. The campaign was designed for

individuals to examine their food zones to make small changed towards selecting healthy choices

(Coppola, 2006). EATSmart is another challenge that was created in order to increase the number of food

outlets and school cafeterias that qualify for the EATSmart award for offering healthy choices (Coppola,

2006). Eventually the Niagara Region will adopt additional nutrition policies that will address the price

and promotion of healthy foods to make them more available to residence.


These models have shown promising results over the past year but to effect change to decrease the

magnitude of the obesity epidemic within the Niagara Region, additional programs to target youth

specifically should be focused on.

Nutrition

Canadian’s nutritional trends indicated that children and adolescents who reported eating fruits

and vegetables 5 or more times a day were substantially less likely to be overweight or obese than those

who consumed them less frequently during a typical day. Statistics have indicated that out of 10 children,

4 reported eating fruits and veggies 5 times a day or more (Cullen et al., 2007; Morland et al., 2002;

Raine, 2004). A correlation between an individual’s socio-economic status and an individual’s nutrition

has been documented. This has been supported by diets that are based upon consuming refined grains,

added sugars and added fats are more affordable than the recommended diets based on lean meats, fish,

fresh vegetables and fruits (Drewnowski, 2004; Gortmaker et al., 1999; Field et al., 1998). Due to cost

differences associated with food items, individuals may select items that contain energy dense foods. Past

research has indicated that people living in the areas with the poorest socio-economic status have 2.5

times the exposure to energy dense food outlets than people in wealthier areas (Estabrooks et al., 2003;

Paeratakul et al., 2002; Raine, 2004; Wilson et al., 2004; Yen et al., 1998).

Though promoting a healthy diet is essential in order to reduce obesity rates, the negative points

associated with this are the recommendation of diets to low-income families as a public health measure

that may cause conflicts amongst the poor and less-educated individuals. Obesity rates will continue to

increase if action is not taken to address the economic issue of nutrition surrounding obesity (Birmingham

et al., 2000; Laitinen et al., 2001; Paeratakul et al., 2002; Tatiana et al., 2004). This will also involve

examining our food intake as a nation and by changing food consumption patterns. Additionally,

addressing concerns around food retail outlets and fast-food outlets would also have implications on

Canadians obesity trends.


Nutrition in Schools

Nutrition knowledge put forth in schools is a step in the right direction. Past trends have shown

that school fundraising efforts regularly include selling candy bars, as well as schools having several

vending machines that contain high fat and high sugar food items. In 2004, an effective measure was

taken to withdrawal carbonated soft drinks from elementary schools, but additional steps similar to this

must be taken (Cullen et al., 2007; Field et al., 1998; Improving the Health of Canadians, 2004; Raine,

2004).

Portion sizes are also becoming a growing concern in terms of nutrition. An increased intake may

be associated with using portion sizes, “super sizing”. A current example is McDonalds “child size” soft

drink of 12 oz, the same serving in the 1950’s would have been sold as a “king size” product. This trend

is similarly found with the growing number of fast food outlets being placed near schools providing easy

access for children (Cullen et al., 2007; Field et al., 1998; Improving the Health of Canadians).

Along with portion sizes is the concern with marketing and advertising of fast food outlets that

consist of dense foods (Drewnowski, 2004; Raine, 2004; Reidpath et al., 2002). Exposure to food

advertising may influence individuals, especially children, choices towards foods of higher energy dense

foods with lower nutritional value. Children are exposed to this daily by cable/satellite television and print

media (Epstein et al., 2000; Goran et al., 1998, Raine, 2004; Sallis et al., 1997).

Dietary changes in schools have to be based upon evidence on nutrition and physical activity

policies. This includes having the dietary changes that meet these recommendation standards and

guidelines. These policies will need to include information from Canada’s food guide to healthy eating,

Canada’s physical activity guide to healthy active living, Canada’s guides for healthy eating and Canada’s

guidelines for body weight classification in adults (Barlow & Dietz, 1998; Brownson et al., 2000; Dufour,

2004; Lee & Cubbin, 2002; Wilson et al., 2004).

Historical policy changes in nutrition have shown promising results in school foodservice


programs (Cullen et al., 2007, Gortmaker et al., 1999; Morland et al., 2002; Raine, 2004; Wilson et al.,

2004). Implementing future long-term changes to healthy school foodservice, cafeterias and snack bars is

also another recommendation. Assessing cost issues will need to be completed for continuous success.

Physical Activity

Physical activity is as important as nutritional habits in terms of maintaining an overall healthy

lifestyle. Similar to nutrition, environmental factors play an important role on influencing physical

activity behaviors. Research has shown that similar to an individual’s socio-economic status playing a

crucial role on an individual’s nutrition, the same could be said about physical activity (Brownson et al.,

2000; Cordain et al., 1998; Epstein et al., 2000; Estabrooks et al., 2003; Sallis et al., 1997; Yen et al.,

1998). The likelihood of a child being overweight or obese tend to rise with time spent watching TV,

playing video games or using the computer. Similar results have indicated that individuals of low-income

experience additional challenges to become physically active (Raine, 2004; Trakas et al., 1999;

Wannamethee & Shaper, 2001; Wilson et al., 2004). This is supported by results from respondents to a

Geographic Information System that indicated individuals living in lower socio-economic status areas

reported engaging in less physical activity. These lower rates has been associated with the fact that people

from lower socio-economic status tend to have less access to free-for-use facilities (Brownson et al.,

2000; Raine, 2004; Wannamethee & Shaper, 2001).

Individuals from neighborhoods of low income may have limited ability to control their physical

activity by not having access to resources due to environment factors. Lowest income families, including

Aboriginals, experience a disadvantage in access to recreational services and facilities due to cost

associations shown in research by the National Longitudinal Survey of Children and Youth (2001). Low-

income families also must face obstacles from user fees for programs, unavailable transportation,

inadequate parental support, social and cultural barriers, and limited facilities, high costs of equipment

and lack of volunteers to run programs for children (Brownson et al., 2000; Cordain et al., 1998; Epstein


et al., 2000; Estabrooks et al., 2003; Sallis et al., 1997; Yen et al., 1998).

The importance of physical activity in schools and outside of schools for children cannot be

understated. With the increasing popularity of television, computers and video games during ones leisure

time, recreational activities are becoming less popular (Brownson et al., 2000; Canning et al., 2004;

Dufour, 2004; Goran et al., 1998; Orthner et al., 2007; Srinivasan et al., 1999; Yekutel & Orthner, 2007).

Sedentary behaviors have been associated with an increased risk of obesity and diabetes in youth (Barlow

& Dietz, 1998; Canning et al., 2004; Drewnoski, 2004, Lee & Cubbin, 2002). Decreasing sedentary

behaviors and increasing active leisure time reduces obesity rates.

Physical Activity in Schools

Within schools, physical activity is becoming more of an “option” than mandatory curriculum

requirement. Quebec is the only province in Canada that requires physical education as a mandatory

requirement that is part of the curriculum until graduation (Epstein et al., 2001; Macintyre et al., 2003;

Orthner et al., 2006; Srinivasan et al., 1999; Veugelers & Fitzgerald, 2005; Yekutel & Orthner, 2007).

Trends have indicated that physical education within other provinces can become optional as early as

grade 8 to students. In Canada, the amount of time in a school week devoted to physical education is less

than 1 hour, which puts Canada among the lowest in the world (Cullen et al., 2007; Goran et al., 1998;

Veugelers & Fitzgerald, 2005; Yekutel & Orthner, 2007). This is less than 40% of the 150 minutes

recommended to meet standards for Quality Daily Physical Education. Fewer than 5% of Canadian

schools meet these requirements of the Quality Daily Physical Education (Barlow & Dietz, 1998;

Canning et al., 2004; Epstein et al., 2000; Goran et al., 1998; Orthner et al., 2006; Veugelers & Fitzgerald,

2005; Yekutel & Orthner, 2007). There is an association between the declines in physical activity levels

of children at approximately the same age at which school physical educations is no longer required.

Results of this indicate the growing importance of mandatory physical education in schools.


Intervention Strategies within Schools

Intervention steps must be taken to prevent obesity, especially in children. A good place to start is

specifically targeting prevention and intervention strategies at schools. Studies have concluded that there

is some doubt as to whether obesity is preventable in school-ages children using current available

intervention strategies (Cordain el al., 1998; Fox, 2003; Morland et al., 2002; The World Health

Organization, 2000; Wilson et al., 2004). This has indicated that new models and other effective school

intervention programs must be implemented within schools across Canada. These successful intervention

and prevention models have come from the States, not Canada. Schools in Nova Scotia have shown

promising results by having coordinated programs that promoted both healthy eating and physical

activity. Results of the programs indicated lower rates of overweight and obesity than schools that had no

such programs. This is definitely a step in the right direction but has not shown positive enough results to

enforce the implementation of this type of program throughout school boards across Canada (Barlow &

Dietz, 1998; Estabrooks et al., 2003; Forger, 2004; Lillie-Blanton & Laveist, 1996; Morland et al., 2002;

Wilson et al., 2004).

There has been an initiative focusing on increasing physical activity and healthy eating, which

has shown promising results within Canadian schools. These types of successful programs were derived

from different prevention and intervention programs from different countries around the world in

targeting the obesity epidemic (Brownson et al., 2000; Cullen et al., 2007; Epstein et al., 2001; Goran et

al., 1998; Orthner et al., 2006; Veugelers & Fitzgerald, 2005; Yekutel & Orthner, 2007). Some Canadian

programs include the Calgary Comprehensive Schools Heart Health Model, The Kahnawak Schools

Diabetes Prevention Project, Alberta’s Ever Active Schools program; Canada’s GO for Green active

living, Health Canada’s VITALITY program and Central Newfoundland “ACTIVE SCHOOLS”. These

school-based programs have a curriculum that focuses on physical activity, nutritional eating and tobacco

reduction (Barlow & Dietz, 1998; Canning et al., 2004; Dufour, 2004; Lee & Cubbin, 2002; Morland et

al., 2002; The World Health Organization, 2000; Veugelers & Fitzgerald, 2005; Yekutel & Orthner,


2007). The aspect of these programs that has been neglected in past school-based programs surrounds

healthy eating. Within Canada, there has been some effort to move towards school food polices but more

involvement and support by the government must take action. These food polices also must be embraced

by students, staff and parents to ensure these polices are followed. Often, these policy options are met

with resistance due to costs.

The element of the program, which several that are named above focus on is physical activity. It is

geared towards increasing the range of enjoyable, non-competitive activities that have also been part of

school-based environmental intervention for youth. The key rule to ensure its success is by adopting

school policies that promote mandatory physical education at schools as a viable policy option. This

would include providing adequate free playtime at recess and lunch breaks, and after-school physical

activity opportunities which would involve curriculum changes. (Canning et al., 2004; Epstein et al.,

2001; Estabrooks et al., 2003; Goran et al., 1998; Raine, 2004; Veugelers & Fitzgerald, 2005; Yekutel &

Orthner, 2007). Recent strategies have included the one launched by Ontario Physical and Health

Education Associations (OPHEA) that involves curriculum support for teachers as well as active-school

programs creating opportunities to enhance physical activity and well-being.

Another Canadian based program that has shown success is the Balanced School Day Program. The

first Balanced School Day Program was piloted 7 years ago in Ontario at Caledon East Public School in

the Peel Region. Since then, the program has been piloted in several schools across Ontario (Chater &

Lafond, 2003; Halton District School Board; 2003). The reasoning behind this program growing

implementation across Ontario is because the program incorporates both nutrition and physical activity

targeted at not only students but parents and teachers as well. Programs other than the Balanced School

Day Program have had a tendency to focus either on nutrition or on the importance of physical activity

rather than incorporating both components. The Balanced School Day Program does incorporate both

elements by replacing the school schedule of two recesses and a lunch with a new schedule that consists


of two 40 minute nutritional/activity breaks. The first 20 minutes of the break is allotted for students to

consume a healthy snack before participating in 20 minutes of outdoor/activity time (Chater & Lafond,

2003; Halton District School Board; 2003; Reid, 1996; Schoenstein; 1995). This program has shown

promising results because it promotes a better learning environment for the students. Enhanced student’s

academic performance has also been documented as a benefit as the revised daily schedule encourages

more time for learning. The program provides more quality time for physical activity then the shorter

recesses of the past. It also meets nutritional needs of students in a more balanced way, which allows

them to have two larger snacks during the day rather then one large lunch. These nourishment breaks

allow students to concentrate better near the end of the day (Chater & Lafond, 2003; Forger, 2004; Fox et

al., 2003; Halton District School Board, 2003; Schoenstein, 1995). Though this program has shown

positive results in the right direction to assist in decreasing overweight and obesity in youth, the

program’s values must be accepted by students, teachers and parents to be effective (Reid, 1996; Rettig &

Canady, 1996).

All programs have at least a few negative associations with them, as does this program. Some

negatives aspects of the Balanced School Day Program have included decreased student attention due to

long instructional blocks, teacher burnout and less time for teachers to meet and plan (Chater & Lafond,

2003; Halton District School Board, 2003). These disadvantages could be addressed quite simply by

involving more health professionals in program delivery instead of having teachers responsible for

planning and facilitating activities for students during activity breaks. These health care professionals

could also educate students about proper nutrition and physical activity as being crucial component of

living an overall healthy lifestyle.

Implementing Policy Programs

The challenges of implementing large-scale policy interventions include: limited action by policy-

makers, not sufficient evidence to base decisions upon, and the absence of community support


(Birmingham et al., 2000; Dufour, 2004; Lillie-Blanton & Laveist, 1996; Morland et al., 2002; Wilson et

al., 2004). Specific challenges in the case of obesity prevention programs include: lack of resources to

support programs, lack of knowledge of teachers/staff, and lack of counseling skills from health

professionals (Birmingham et al., 2000; Morland et al, 2002; Orthner et al., 2007; Srinivasan et al., 1999;

Veugelers & Fitzgerland, 2005; Yekutel & Orthner, 2007).

The gap in health information is a key example of what inhibits sound evidence to be presented for

decisions affect policy. There is also a gap in knowledge surrounding the psychosocial consequences of

obesity and this poses implications for developing large-scale intervention efforts (Barlow & Dietz, 1998;

Cullen et al., 2007; Estabrooks et al., 2003; Lee & Cubbin et al., 2002; Morland et al., 2002; Orthner et

al., 2007; The World Health Organization, 2002).

The economic impact on the Canadian Health Care System is going to continually increase if

these gaps are not addressed and action is not taken. Policy options will have to include a commitment of

resources to collect, analysis, interpret data, and report on the problem of obesity and its multiple impacts

so that effective interventions can be undertaken. In the end though, this will cost more money (Dufour,

2004; Epstein et al., 2000; Lee & Cubbin et al., 2002; Orthner et al., 2006; Veugelers & Fitzgerald, 2005).

This means having political support from municipal, provincial/territorial and federal government for

these policy interventions. Policies shaping dietary and physical activity programs in the past have been

focused on promoting healthy eating and increased physical activity that has involved dietary and

physical activity guidance from healthcare professionals (Gortmaker et al., 1999; Macintyre et al., 2002;

Orthner et al., 2007; Veugelers & Fitzgerald, 2005; Wilson et al., 2004).

Existing Research

Research has indicated that the increase in weight of the population has had complications beyond the

clinical impact of obesity for a health promotion approach to prevention (Cordown et al., 1998;


Drewnowski, 2004; Epstein et al., 2000; Goran et al., 1998; Lee & Cubbin, 2002). As indicated

previously, the need for a coordinated surveillance to monitor rates and impacts of interventions.

Surveillance of disease risk’s association with obesity rates must be gathered to help inform evidence-

based action upon the issue of obesity (Canning, 2004; Epstein & Roemmich, 2001; Lee & Cubbin, 2002;

Orthner et al., 2006; Srinivasan et al., 1999). There has been no accurate population based data for

children since 1981 due to results being based upon self-reported data which does not allow accurate

figures to indicate the severity of the obesity problem (Birmingham et al., 2000; Canning, 2004;

Drewnowski, 2004; Epstein et al., 2000; Macintyre et al., 2002; Wilson et al., 2004). A policy addressing

surveillance is one option to understand the problem and to appropriately target effective public health

interventions.

Schools present an environmental opportunity for prevention and management of childhood and

adolescent obesity unlike any other (Cullen et al., 2007; Dufour, 2004; Estabrooks et al., 2003; Lee &

Cubbin, 2002; Morland et al., 2002; Raine, 2004; Veugelers & Fitzgerald, 2005; Yekutel & Orthner,

2007). However, due to the lack of time, knowledge and resources available, barriers have been created

within schools to implement these types of programs such as the Balanced School Day Program. This can

also be accompanied by there being few well-controlled studies on the issues surrounding youth obesity

and school-based interventions (Raine, 2004; The World Health Organization, 2000; Veugelers &

Fitzgerald, 2005; Yekutel & Orthner, 2007).


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Chater, M. & Lafond, L. (2003). The Balanced School Day: An assessment by the teachers at St.

Clair elementary school. Ontario English Catholics Teacher’s Association-St. Clair

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Coppola, D. (2006). Our Community Strategy for a Healthy, Active Niagara. Final report of

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Estabrooks, P.A., Lee, R. E. & Gynresik, N. C. (2003). Resources for physical activity

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Chapter 3: Methodology

Data collection for this study will be conducted in cooperation with four elementary schools from

the District School Board of Niagara. All names and identifiers will be removed from the original data so

that confidentiality is ensured.

First, secondary sources of data (news clippings, reports from the District School Board of

Niagara, information from the Ontario Ministry of Education, scholarly articles on the Balanced School

Day Program) will be reviewed to provide contextual and factual data about the need for and benefits of

the Balanced School Day Program. Second, quantitative data from sources such as Statistics Canada will

be sought to glean demographic (income) information about the neighborhoods in which the schools

under study are situated (Statistics Canada, 2001). Finally, qualitative data will be gathered using

telephone interviews with the principal and one teacher from each of the four schools in this study.

Each school will be selected based upon the socio-economic status of the region in which the

school is situated determined by statistical data (Statistics Canada, 2001). There will be three schools

from the lower income areas and one from the higher income areas situated within the boundaries of the

Niagara region.

Qualitative Data

Interviews are a form of qualitative research that is a data collection method aimed to address

questions to gain an understanding of people’s responses to a particular topic and/or situation (Hutchinson

et al., 1994).

Four elementary school principals from schools within the District School Board of Niagara will

be interviewed. The importance of small samples rather than large samples has been identified for being

more effective and that is why the sample size for this study is small. The small sample will also assist in

keeping trends organized and in reporting results (Emden & Sandelowski, 1998).


The interviews will take over the phone in a quite setting. The interview will be over

speakerphone and audio-recorded. This will provide an atmosphere for open-ended questions to be asked

of each person being interviewed. The principal’s will be interviewed first to gain insight into the

rationales for and implementation of the Balanced School Day Program. If needed, a second interview

with the teacher responsible for implementing the program in each school will be requested.

Prior to the commencement of the interview, each participant will be provided with an informed

consent form. The consent form will be sent by fax or mail to each participant and when the form has

been filled out and received by the researcher, an interview time will be set up. The components of the

consent form will also be stated to each participant prior to the interview commencing to ensure a mutual

understanding is met. This will also involve informing each participant of important issues such as: the

interview being audio-recorded unless they select not to have it recorded, option to withdraw from study

without any form of penalty, the purpose for the data being gathered, and no anticipated risks involved in

participating in the study. In addition, if there are any additional questions regarding the study, they can

be answered then.

These interviews will be conducted to gain an insight from individuals who have went through

the implementation process and have an insight into the challenges schools face in implementing the

Balanced School Day program. By identifying these challenges, steps can be taken to clarify and address

the issues that schools face (Fossey et al., 2002).

The interview will be audio-recorded and transcribed. Once the interview is transcribed, each

participant will receive a copy by email to confirm that the interview was accurately documented from the

recording. Once the transcript is approved, each participant will be given a final opportunity to provide

additional information the participants feel is of importance. Following this, participants will be provided

with a letter of acknowledgement thanking them for their participation in the study.


Interview questions were formulated based upon different theories examining the different

measures of effectiveness (goal attainment theory, system resource approach). This was to ensure that all

components of evaluating an effective program implementation process were included. Each theory gives

different perspectives on important factors that contribute to a successful implementation process. An

example is Goal Attainment Theory, which measures effectiveness based on how the goals are achieved.

Though schools will differentiate by demographic (income) status in each schools neighborhood, this will

be taken into consideration when examining the data. It will also determine in the demographic (income)

status creates additional barriers in implementing a successful program. The data will also be able to

distinguish which area’s of effectiveness each school was able to accomplish and what other areas need

more attention. By examining all of the interview data, possible recommendations can be stated to

improve the effective implementation of the Balanced School Day Program for schools that may be

lacking in certain areas of effectiveness.

Data analysis will involve an open coding initially to develop categories during the first initial

reading. During the second reading, axial coding will be used to combine and/or branch off to form new

categories.

A comparison of data from the three schools will then be examined to identify if there is an

existing relationship between socio-economic variances and the implementation process of the Balanced

School Day Program.

Quantitative Data

Data regarding the socio-economic factor of income in the region of each school will be gathered

from secondary sources such as Statistics Canada and analyzed. Data regarding the youth obesity rates in

the Niagara region will also be gathered. The analysis of both sets of data will provide statistics about the

health/income of students for the selected schools in the District School Board of Niagara.

The other statistical data for this research will be obtained from secondary sources.


Each participant will be contacted initially by telephone and given a brief description of the study. If the

study is of interest, an invitation letter will be sent to the school outlining specific details pertaining to the

study. Contact information for the principal investigator will be included for the individual to confirm

their participation in the study.

This study will benefit the participating and surrounding schools within the District School Board

of Niagara by gaining insight into successful ways to launch the program. This particular study will also

provide the Ministry of Health Promotions Advisory Committee with a better understanding and insight

into the importance of educational programs that promote both physical activity and nutrition (Balanced

School Day program) in addressing the youth obesity epidemic. The results may also benefit both the

Ministry of Health Promotions and the Ministry of Education in possibly developing a uniform approach

to address the youth obesity rate.

The research will focus on three specific questions: 1) What factors contribute to the successful

launch of the Balanced School Day program? 2) Do the three selected schools use or can use the same

approach in implementing the Balanced School Day program? 3) Does the socio-economic context of the

school affect the implementation process and perceived success of the Balanced School Day program?


References

Emden, C. & Sandelowski, M. (1998). The good, the bad and the relative, part one:

conceptions of goodness in qualitative research. International Journal of

Nursing Practice. 4(4), 206-212.

Fossey, E., Harvey, C., McDermott, F. & Davidson, L. (2002). Understanding and

Evaluating qualitative research. Australian and New Zealand Journal of

Psychiatry. 36(6), 717-732.

Hutchinson, W., Wilson, M. & Wilson, H. (1994). Benefits of participating in research

Interviews. Image Journal Nursing School. 26(2), 161-164.

Statistics Canada. (2001). Census: Population by Income Status. Niagara Region,

Municipalities and Ontario.


Chapter 4: The Results

Data collection for this study was conducted in cooperation with four elementary schools from

the District School Board of Niagara and with the approval of the District School Board of Niagara

Research Committee. Qualitative data was gathered using telephone interviews with the principal’s from

each of the four schools participating in this study. The interviews were audio-recorded and transcribed.

Data analysis involved open coding initially to develop categories during the first initial reading. During

the second reading, axial coding was used to combine and/or branch off to form new categories.

The categories (themes) and new categories (sub-themes) were selected from the data to answer

the three main research questions and were documented in the following charts. Charts were selected to

document these categories as it organized the data to facilitate coding and analysis and presented it in a

structured template.

Interview Open and Axial Analysis of Participants


School 1- Referred to as Low-income School 1



School 4- Referred to as High-income School 1

Analysis of Research Question #1:

What factors contribute to the successful launch of the Balanced School Day Program?

Theme: Principals

Sub-theme: Researching

School 1:

Conducting research on other surrounding school boards that have implemented the Balanced School

Day Program and then distributing this information to other individuals.

Quotes:

“I think Halton board seems to be a board that is pretty ahead of things. So I thought if they have every

school doing that then it must be pretty important stuff so I thought it would be great for this school.”

“I conducted research and it was distributed (staff, parents, school board) and it had to gain approval first

before it could be implemented.”

School 2:

Looking into the program to gather research to present to other people involved.

Quotes:


“Some principals would have to volunteer to pilot the program if their community was interested in it. I

believe the principal would have to be the one to research it.”

School 3:

Looking into research about the program and informing school council about the program.

Quotes:

“There was one year where I researched. We then took it to school council to get the school council’s

feedback on it before we went onto the implementation process.”

School 4:

The principal was looking into information and research about having the school as a pilot project.

Quotes:

“There were probably eight schools that were in the pilot that all met together, planned it together, and

researched it together. Everyone’s ultimate goal was student learning with the benefits being that the

children would have better nutrition, more physical activity, and less discipline on the playground.”

Sub-theme: Acquiring Resources

School 1:

a) school grant for nutritional foods

b) parent initiative money

c) healthy advice for announcements

Quotes:

a) “I applied for a grant through the ministry of education. It provides peanut butter sandwiches, fresh

fruit, vegetables, milk, cheese, fruit cups, applesauce, granola bars and raisons made available to students

during the two nutritional breaks. This grant paid for the healthy food choices. On behalf of schools

within our Ministry, I applied for a grant through Community Care. This grant was acquired specifically

to pay for these healthy food options.”

b) “I applied for $150 from my board. They gave me parent initiative money.” (this was for gifts for guest

speakers who came in to speak about the program)

c) “One of the parents in my school is a nurse; she gave me daily announcements everyday about heart

healthy stuff. It could be about nutrition, the heart, drugs. So

everyday I did announcements about heart healthy stuff.”


School 2:

Intramurals programs are available at that school.

Quotes:

“Intramurals are available for students and are held throughout the year.”

School 3:

a) Snack program

b) Intramurals

Quotes:

a) “The Snack program has allowed us to educate students as to what is a healthy snack and that is funded

form the Niagara Nutrition Partners and a grant from the Ministry.”

b) “We are trying to provide as many activities as possible for them to learn different games but to also be

active. Because you have a low-income area here, you try to provide as many opportunities as possible

because these kids wouldn’t have that opportunity otherwise.”

School 4:

a) Grant

b) Snack program

c) Theme days

d) Additional snack available for students for no cost

e) Certain students for financial reasons are provided with milk each day

f) Juice is available for students as well

g) Parent’s council

h) Education Foundation of Niagara

i) Intramurals

Quotes:

a) “The Snack program is funded from a grant through the ministry that gives us a certain amount of

money as a grant for the year. I believe every school could fill out an application for the grant depending

on the number of students, your grant would be more or less.”

b) “The Snack program has allowed us to educate students as to what is a healthy snack and that is funded


from the Niagara Nutrition Partners and a grant from the Ministry.”

c) “We have a vegetable day, salsa and nacho day, we have coup, salad, bagels and sandwich days.”

d) “Therefore, everyday, every child has access to that. In addition, in the room all the times they have

granola bars, pudding, cheese and crackers. All sorts of things so that if a child at second break is hungry

and has eaten everything had access to this as well.”

e) “I think we also have some kids; select kids that for financial reasons that we provide milk to

everyday.”

f) “Then there is juice everyday for anyone who wants it.”

g) “The parent council provides money for it. We do a couple of fundraisers during the year to add money

to the pot.”

h) “The other piece we have is the Education Foundation of Niagara, which is through the DSBN. It

provides additional funds to breakfast programs and Snack programs schools get to April and are running

low on money. You can apply to that as well. The goal is to feed them all year long.”

i) “The only thing we have made mandatory is intramurals. Every person is on a team, every child has to

come down to the gym and you have to participate to some degree in hopes of getting everyone active.”

Sub-theme: Educating

School 1:

Having educational information available, that promotes healthy lifestyles to parents and students.

Quotes:

“I sent information in the school agenda, like samples of what foods could be eaten each day.”

“I did morning announcements everyday about heart healthy stuff. I could be about nutrition, it could be

about the health, or it could be about drugs. So everyday I did announcements about heart healthy stuff.”

School 2:

The ability to educate everyone else involved about the components of the program.

Quotes:

“Principals have to educate all people involved about the program from the research they have found.”

School 3:

They made information available for parents and students to examine pertaining to healthy lifestyles.

Quotes:


“We had class meetings and we had information in the newsletter to educate both students and parents.”

School 4:

Keeping all involved well educated on the values and benefits of the program.

Quotes:

“We had a principal group, which consisted of eight principals that had initiated the process and went and

gathered educational data prior to the program being implemented.”

“It was a pilot project through a superintendent based on some research done about student learning and

larger blocks of time and looking at the influence of increased physical activity during the day and

increased nutrition. The goal was to improve student learning ultimately.”

Sub-theme: Leadership

School 1:

The principal took on the role to educate teachers, staff, students and parents.

Quotes:

“I had half my staff that did no think it was good and half of them thought it was great. Therefore, I

brought as much information as I could into it and then we went to another school to do a visit there and

the more other staff started to look at it, the more they thought it was a great idea as well.”

“I shared all my education at a school council meeting and the school council thought the idea was great

and trusted my opinion. They recognized that I had worked hard looking at all the information regarding

it and were in support of whatever I decided.”

“It’s what you start teaching the kids. The kids know they have to be eating fruits and vegetables. When

they go home at night, they tell their parents that. Therefore, I think its telling the kids and getting that

knowledge to go home and initiate that. That our teachers care about what we are eating.”

School 2:

Having them take on the leadership role in the investigating and the implementation process of the

program.

Quotes:

“Once they surveyed the community and staff to make sure people was in support of the program, then

they would have implemented it. The principal has to be the driving force behind it.”

School 3:

Taking on a leadership role in ensuring the goals of the program were similar as to the ones that wanted


to achieve at the school.

Quotes:

“The goal ultimately with the entire board has always been to increase student achievement and student

learning. This was one of the strategies that I felt would be one of the ways to address that.”

School 4:

Having the principal being the key initiator in having the program implemented at the school.

Quotes:

“I would say now when you are implementing a Balanced School Day in a school; it is still conditional or

still largely reliant on the principal seeing it as a need that can be addressed in an area.”

“Largely, right now, it is determined by a principal saying that is an area of need in our school and I think

I want to investigate it.”

Sub-theme: Promoting

School 1:

Effective communication aids used in the school.

(organized newsletters, morning announcements, open house, guest speakers, information packages for

staff, parents and students)

Quotes:

“I had a principal, parent and student from another school come in to speak. I send information in the

school agenda, like samples of what foods could be eaten each day.”

School 2:

Having promotional aids placed around the school that promote the program to students.

Quotes:

“No, I do not think so. I have not seen any around the school. Though, I was not here when it was

implemented but I am assuming when it was implemented, there would be posters up or some form of

promotional material.”

School 3:

a) They began to look to other schools that had promoted the program b) Promotional material

Quotes:

a) “The fact it had been successful somewhere else caused us to go and research it and say is this something we should do at the DSBN. The DSBN then started to promote it from there.”


b) “There was health information sent home in newsletters and information nights available for parents.”

School 4:

a) promotion for Balanced School Day Program in newsletters

b) promotional posters

c) nutrition and fitness focus in school

Quotes:

a) “Newsletters included suggestions on how to pack your lunch, suggestions for different types of food

they could be sending and talking about the success of the program.”

b) “We have posters up. What does the Balanced School Day looks like? What does the Balanced School

Day feel like? What does the Balanced School Day sound like?”

c) “We had a lot of nutrition focus and we implemented a couple of programs that happened on the

playground that dealt with physical activity because you wanted to increase the amount of physical

activity that was happening as well.”

Theme: Teachers

Sub-theme: Educating

School 1:

Educating the grade one’s during nutritional breaks.

Quotes:

“Teaching the kids that this part of your lunch should be eaten in the first break and this much should be

eaten at the second break. So staff really worked with it.”

School 2:

The teacher’s have the ability to educate students about healthy lifestyles.

Quotes:

“We do have a little “Tuck shop” at the school. A couple of student’s volunteer and one teacher

supervisor. It allows kids to be educated as to what some healthy choice snacks are.”

School 3:

The teacher’s ability use educational information to promote students about healthy lifestyles.


Quotes:

“Teachers continue to educate the students as to healthy food choices in the classroom. They seem

nutrition and physical activity to be very important.”

School 4:

Teaching students and providing them with healthy information.

Quotes:

“We spend a lot more time talking about healthy eating then we did before because the focus is on healthy

eating and the exercise. The teachers did do a lot of student education and they did have a lot of input.”

Sub-theme: Leadership

School 1:

a) setting a good example to promote healthy nutrition and fitness to students

b) running programs for students during fitness breaks

Quotes:

a) “Staff being supportive of the program. This included enforcing good, daily nutritious foods.”

b) “Teachers run the organized physical activity programs for students during the nutrition breaks. I have

one primary teacher who does many fun, weird games on scooter boards and stuff.”

School 2:

Take on a leadership role to students in creating awareness about components of program.

Quotes:

“You would also have to have your staff on board and have your staff take on a leading role.”

School 3:

Take on a leadership role in effectively monitoring the nutrition/fitness breaks.

Quotes:

“The staff takes on the role of monitoring healthy choices during lunch and then conducting intramurals

during the fitness breaks. They do a lot of work.”

School 4:

Having teachers take a leadership role in assisting with the program implementation process.


Quotes:

“We sent two teachers from the school to go up and spend a day at a school that had the Balanced School

Day. They talked to the staff from the school, came back, and reported to us.”

Sub-theme: Promotion

School 1:

Having the teachers take the program values and promoting them to the students.

Quotes:

“The first three weeks of school was important. This included enforcing good, daily nutritious foods. This

is something that our teachers really promoted.”

School 2:

Having teachers keeping parents informed with information pertaining to the program.

Quotes:

“It is important that your staff is on board and can promote the program, and it not just be the principal

driving the implementation.”

School 3:

Promotion of the program by using existing data that provides information pertaining to the programs

success.

Quotes:

“If you acknowledged qualitative data, teachers would tell you that at the end of the day, the children

were far more equipped to be doing academic work versus not being on the Balanced School Day.”

School 4:

Having teachers create a positive environment in the classroom to promote the values of the program.

Quotes:

“Teachers promoted the program with different health discussions they held in class. Student education

about nutrition and physical activity became a larger focus in the classroom.”

Theme: Parents


Sub-theme: Acceptance

School 1:

Having parents show acceptance of the program.

Quotes:

“The parents truly respect my opinion when I came here. They knew I was doing a lot of good things and

were thrilled. With me coming in with all these new ideas, they completed trust me (about implementing

the program). They were basically like, if you think this is great, then you do it!”

“I was completely stunned by the parent’s acceptance and there hasn’t been a single parent complaint.”

School 2:

Having parents show their support in the vote.

Quotes:

“One, you would have to convince the parents that it is a good idea. Then I would think that the program

would be successful.”

School 3:

Having parents willing to adapt and conform to the program requirements.

Quotes:

“Parents being informed are the biggest thing that will make or break it. They have to pack a lunch

differently, it is important to have their support as we do here.”

School 4:

Having parents accept and support the values of the program.

Quotes:

“The buy-in from the parents on the program is the thing that is going to make it successful.”

Theme: Students

Sub-theme: Cooperation

School 1:

Having student accept and embrace the program is very important in order to have it be successful.


Quotes:

“We made the students aware of this was going to be happening. Their biggest issue with this was if they

were going to have recess. They wanted to have the same amount of recess time and that is all they cared

about. Once they knew they were going to have the same time and get our 15 minutes earlier each day,

they loved the idea!”

School 2:

Having students enjoy and support the program is very important.

Quotes:

“Students seem to enjoy the program a lot and the discipline problems are down, so everyone is happy

about the program results.”

School 3:

Having student’s support in the program is essential.

Quotes:

“Students were very receptive to the program.”

School 4:

Students were informed about what the program was all about and they were in support of it.

Quotes:

“We made the students aware of this was going to be happening. Their biggest issue with this was if they

were going to have recess. They wanted to have the same amount of recess time and that is all they cared

about. Once they knew they were going to have the same time and get our 15 minutes earlier each day,

they loved the idea!”




Do the four selected schools use or can use the same approach in implementing the Balanced School Day

program?

Pre-program implementation

Similarities between participating schools

Theme: Principals

Sub-theme: Program Initiator in Researching

The participating school indicated that the principal of each school was the initiator in researching

the Balanced School Day program and was the driving force behind having it implemented in

each school. This indicated the importance of having a principal who supports the program and

has conducted research that indicated the program would be feasible and address a need at a

school.

School 1:

“I brought as much information I could into it and then we went to another school to do a visit

there. The more other staff started to look at it, the more they thought it was a good idea. I shared

it at school council and school council thought the idea was great and trusted my opinion and

recognized that I worked hard looking at information regarding it and supported whatever I

decided to do.”

School 2:

“Some school principals would have volunteered to pilot the program if their community were

interested in it.”

School 3:

“I conducted a great deal of research to see if the program would meet the needs of the school.

Once this was established, I continued to conduct additional research before presenting it to the

school board.”

School 4:

“Initially, I (principal) went to research session based on a study indicating that providing kids

with the opportunity to have more nutritious snacks during the day would allow them to do better

mentally in their classes.”


Sub-theme: Implementation Voting Process

School 1:

“You cannot just say I am changing to the Balanced School Day. You had to get the staff to vote

and have 70-75% say yes. Then you did your school council meeting and they have a vote. It was

the same thing and then you did it to the school community and did the vote.”

School 2:

“Some principals would have volunteered to pilot the program if their community were interested

in it. Once the community and staff voted and were in support of the program, then they would

have implemented the program.”

School 3:

“Once I presented all the research I had found to the surrounding community and staff, a vote was

conducted and you had to have majority support from all to have the program implemented.”

School 4:

“Several votes were conducted before you could have the Balanced School Day program

implemented in your school. The program had to fit a need to be able to gain all the support

needed to have the program accepted.”

Pre-program implementation

Differences between participating schools

Theme: Program Acceptance

Sub-theme: Initial resistance

Out of all interviewed schools, school 2 was the only school that stated that initially the program

idea was rejected. Additional research had to be conducted to show the significant benefits the

program had on children. The staff realized they wanted to do what was best for the students and

majority of the staff voted in support of the program.

School 2:


“I initiated it once and I was turned down. The staff just turned it right down. They did not like

the timetable stuff. They didn’t like the idea of a timetable change.”

During Implementation Process

Similar between the participating schools

Theme: Teachers

Sub-theme: Facilitating Intramurals

All participating schools stated that teachers took on the leadership role of facilitating intramurals

programs during the fitness breaks because they understood how important these games were in

promoting physical activity to the students.

School 1:

“Teachers run intramurals during the fitness breaks. This could be baseball, basketball, soccer,

dodge ball or capture of the flag. I have one primary teacher who does many fun, weird games on

scooter boards and stuff.”

School 2:

“There are intramurals that are held during the fitness breaks as well as school team practices.

One of our teachers organizes and facilitates the intramurals programs for the students.”

School 3:

“Teachers sanction intramurals at the school that involves a wide variety of games to try to get

the students active during the fitness breaks.”

School 4:

“The only thing that we have made mandatory is intramurals. Every person is on a team, every

child has to come down to the gym and you have to participate to some degree in hopes of getting

everyone active. This is supervised by two teachers.”




Theme: Program Promotion

Sub-Theme: Promotional Aids

All the participating schools used different promotional aids to create awareness about the

programs values and components. Some schools used several different aids quite frequently,

while other schools used almost no promotional aids and when they did, they used them very

rarely.

School 1: (open house, agenda, newsletter and announcements – frequently)

“I sent information in the school agenda, like samples of what foods could be eaten each day.”

“I did morning announcements everyday and it was all about heart healthy messages. One of the

parents in my school is a nurse and she works in the region. She gave me daily announcements

everyday about heart healthy stuff. It could be about nutrition, it could be about the heart, it could

be about drugs.”

“Information was given out in the newsletter about the program.”

“We had an open house where we gave out information to parents about the program.”

School 2: (newsletter – rarely)

“We occasional put information in from the Niagara Regional Health Unity in our newsletters.

However, this is not too often.”

School 3: (newsletter – frequently)

“Healthy education information was given out in the newsletters on a regular basis. It allowed

parents and students to educate themselves together at home when they would read the newsletter

together. There would be helpful tips of becoming more active and examples of healthy snacks

that students could be having either at home or at school.”

School 4: (posters, newsletters – frequently)

“We had something in the newsletter every month. This included suggestions on how to pack

your lunch, suggestions for different types of food they could be sending and talking about the

success of the program.”

“We have posters up. What does the Balanced School Day look like? What does the Balanced

School Day feel like? What does the Balanced School Day sound like?”




Theme: Teachers

Sub-theme: Monitoring

Three of the four participating schools stated the importance of having teachers monitor as well

as educating students about their lunches. This included making sure they had understood how to

split their lunch into two but more importantly that they were eating healthy food items.

All schools except school two had teachers monitoring lunches. School four indicated that the

school would phone call home to notify parents that children had to bring in healthy food choices.

School 1:

“The teachers especially monitored student food choices for the first month, especially for the

grade ones. They did not understand how to split a lunch up into two for each nutritional break so

teachers would have to show them how to. They also monitored that the students were eating

healthy choices. If they repeatedly brought unhealthy food choices, students were made aware

and would make their parents aware.”

School 2:

“There was no monitoring done at this school. Kids just brought in their snacks from home. I

guess it comes down to whatever mom and dad would give them to eat is what they would eat.”

- more individualized School 3

“Teachers monitored nutrition break snacks by walking around the classroom to check out what

kids were eating. Teachers tried to educate students continually about the importance of fruits and

vegetables.”

School 4:

“There was monitoring done by teachers. There would be reporting to the office that this student

did not have a lunch or did not have healthy things in their lunch. Phone calls home would be

made if we felt that what parents were sending was high in sugar content and therefore making

the day very difficult after the child had eaten the snack.”




Theme: School Nutrition Programs

Sub-theme: Grants

School 1, 3 and 4 have a Snack program implemented at their schools that make healthy food

options available to students at no cost. School 2 has a few food items available for purchase at

the school.

Applied and received grant to pay for healthy food options:

School 1:

“Healthy food choices are available for students through our Snack program. This program is

funded by a grant that I applied for through the Ministry.”

School 3:

“The Snack program is paid for by a grant through the Ministry of Education, so the students

don’t have to pay.”

School 4:

“A grant through the Ministry pays for our Snack program along with additional funding

provided by the parent council, fundraisers and the Education Foundation of Niagara that also

have other grants you can apply for to cover costs of breakfast and Snack programs.

The school did not apply for a grant to pay for healthy food options. A cost applies to students for

food options:

School 2:

“We have a “Tuck” shop at the school. Therefore, if parents send their kids with money, they can

get something healthy.”

Sub-theme: Healthy Food Choice Options

All of the participating schools differ in what food selections they offer. Schools with the Snack

program have a lot more variety in food options and these choices are at no cost to students.


School 1:

“We have peanut butter sandwiches, fresh fruit (fruit kabobs), vegetables, milk, cheese, fruit

cups, applesauce, raisons, and granola bars.”

School 2:

“We have fruit juices, sun chips and a couple others.”

School 3:

“Fruit, vegetables, granola bars, milk and a few other healthy choices are available to students

with no cost through the Snack program.”

School 4:

“We have theme days that include fruit day, vegetable day, salsa and nacho day, soup day, salad,

bagels and sandwich day. In addition, in the room at all times they have granola bars, cheese and

crackers and juices.”

After Program was Implemented

Similarities between all participating schools

Theme: Program Successes

Sub-theme: Increased physical activity level

All participating schools have found the program has increased student physical activity levels.

The intramural programs have also been a large contributor to these increased levels.

School 1:

“The program allowed for more focus on nutrition and especially physical activity. Students

activity levels improved and I know that was also due to the contribution of intramurals

(organized games) during the fitness breaks that allowed all students to get involved.”

School 2:

“Student activity levels improved and were a lot more positive.”


School 3:

“The program allowed you to focus on physical activity because you needed to do that in order

for the program to be successful. It also improved physical activity levels immensely by

implementing intramurals that involved all students.”

School 4:

“We implemented a couple of programs that happened on the playground that dealt with physical

activity and it increased the amount of physical activity that was happening as well.”

Sub-theme: Improving Nutritional Habits

All participating schools indicated that student’s nutritional habits improved drastically. This was

due to the contribution of the Snack program and nutritional education distributed in student’s

agendas and newsletters.

School 1:

“The program improved kids eating habits. We have much better lunches here. The junk food has

really cut down.”

School 2:

“The student’s nutritional habits have improved with having two smaller snacks rather than one

lunch. The attitude of the kids is a lot more positive.”

School 3:

“The Balanced School Day program improved nutrition within the school and parents have stated

it has improved their nutrition habits at home to promote healthy lifestyles to their children.”

School 4:

“Healthy information was sent home to parents frequently in newsletters and as time went by, the

amount of nutritious foods students were bringing in improved significantly.”

Sub-theme: Increased Mental Focus

All participating schools indicated how much the program improved the mental alertness of

students in the afternoon. They all stated that by have two snacks instead of one meal for lunch as

the big contributor to students being able to focus and improve performance.

School 1:

“By the last period, it just dragged on and it was like ok let’s get out here. Now they are perkier to


get things taught to them later in the day because they have had food in their system.”

School 2:

“Students are a lot more mentally focused after being given the opportunity to snack throughout

the day.”

School 3:

“At the end of the day, the children and more equipped to be doing academic work versus not

being on the Balanced School Day.”

School 4:

“Personally having experienced the regular day and the Balanced School Day at two schools,

students are able to focus far better in the afternoon because you are giving them more time to run

around and have another snack. You can get more academic learning done in that third block for

sure.”

Sub-theme: Discipline issues

All participating schools indicated that by having two shorter fitness breaks where children were

outside and active has decreased the discipline problems at the schools.

School 1:

“The Balanced School Day program improved their behavior. The last 10-15 minutes of the

traditional day was brutal. That was when they were all sent to the office at the end of the day, so

before that even happens, the bell rings and boom they are back inside. That was a huge

difference to me.”

School 2:

“Shortening the lunch hour was better to avoid discipline problems on the playground.”

School 3:

“Having shorter breaks for activity outside, students discipline problems have decreased

substantially since the Balanced School Day program has been running.”

School 4:

“We also tracked the discipline issue over the fitness breaks and it significantly declined. Because

of the traditional 40 minute lunch, the last ten minutes was where it fell apart and now with

having them out for 25 minutes each you didn’t get to the point where kids were frustrated with

one another and ending up at the office and that sort of thing.”


After Program was Implemented


Theme: Challenges of Implementing

Sub-theme: Regional Issues

The particular regional issue stated by School 4 had to do with crossing guards and students going

home for lunch. Instead of students having their lunch during the nutrition/fitness break at school,

some students go home. This has caused problems for schools that are considering implementing

the Balanced School Day program that have students that are used to going home for lunch.

Crossing Guards

School 4:

“There are a lot of implications for regional things, like crossing guards. Some schools, when

researching the program, couldn’t get the crossing guards moved to a different time and therefore

there were some schools that were not able to move ahead.”

Students going home for lunch

School 4:

“If you’re at a school where a lot of the kids go home at lunch makes the program difficult. We

had to flex it so that the morning break is short and the afternoon break is longer because there

was not enough time for kids to come home and some of the parents really want their kid’s home

at lunch. It might be better at some schools to say that students stay here and therefore you can

keep it to the two 45 minute breaks and that might reduce the amount of kids that would

disappear after lunch normally.”

Sub-theme: Challenges Surrounding The New Timetable

The school participants indicated different challenges they encountered with the new timetable.

These ranged from challenges for supply teachers, kindergarteners, principals trying to conduct

calls, and people resisting change.


Supply teachers

School 2:

“The one problem that has arisen is with the supply teachers. This is because supply teachers

work either a half-day or a full day. If they work a half-day, they do not have the same lunch

break as other schools that do not have the program. This would result in them leaving in the

middle of a teaching section. It causes problems, especially if it’s a day when they have a

workshop they have to go to or something.”

Kindergarteners

School 2:

“The kindergartens have their nutrition break mixed in with some free time. Therefore, they are

not on the exact same schedule as the other students. It is only a different schedule because the

kindergartens have to leave after half a day and we have to provide a lunchtime for the

kindergarten teachers before the next set of kindergartens come in for the afternoon.”

Principals conducting calls

School 1:

“However, the new timetable was also hard for me as a principal. This was because the second

block when kids are in school, from 12-1 o’clock, I cannot call people at the board office because

they are all on their lunches. That was a negative for me but in the big scheme of things, we are

all about children and the program is better for the children and that is why I am in the job.”

Resistance to change

School 1:

“The teachers that did resist the program were the ones that were going to retire within two years.

Change was a huge thing and they did not think the program was a good idea.”

School 3:

“You had more resistance when it was first being implemented then you did when it was done. I

think people in general aren’t great with change.”

School 4:

“Implementing the program involves talking about changing teacher practice or different routines

that you are going to establish at the school. I think the issue isn’t as much the Balanced School

Day program but the issue of change.”




Does the socio-economic context of the school affect the implementation process and perceived success

of the Balanced School Day program?

Results overview: There were no specific examples of the socio-economic context of a school

affecting the implementation process of Balanced School Day program in the participating

schools.

However, the ultimate goal of the program is to improve student learning and there was a

consensus by participating schools indicated that this goal had been achieved. This was due to the

program allowing students to snack more frequently during the two nutrition breaks allowing

them to be able to concentrate more in the afternoon.

Having healthy food choices available to students was extremely important to achieve this goal.

To ease in the ability to achieve this goal, a factor that contributes to the success of the program is

schools applying for grants that provide students with healthy food choices at no cost.

The factor of a school’s socio-economic context would not create a barrier in implementing the

program because schools are given the opportunity to apply for different grants that would cover

the costs associated with the healthy food choices the school would make available to students.

Even if parents could not afford healthy food choices to put in their children’s lunches, the school

would be able to make these available for the students at no cost.

Theme: Principal

Sub-theme: Applying For Grants

The acquisition of resources to ease in the transition of the implementation of the program was

based more on an individual basis of the drive and motivation of the administrative team from the

individual schools. Each participating school indicated that this was based on how hard the

principal pushed to acquire different resources.

School 4, the high-income school, does offer a wider selection of healthy food choices. This was

due to this particular school having access to more funding because they had applied for several

more grants than the other participating schools.


Quotes:

School 4:

“I applied for a grant from the ministry that involved a long application with a lot of math

calculations. I have funding through the parent council and the Education Foundation of Niagara,

which is through the DSBN that provides additional funds to breakfast and Snack programs.”

School 2, one of the low-income schools, did not apply for a grant from the Ministry and had only

a few healthy food choice options

Quotes:

School 2:

“We do have a “Tuck” shop that kids can purchase a snack if the kid’s parents send them with

money.”

School 1 applied for $150 from the board to pay for gifts for guest speakers who came to talk to

the school to give insight into the Balanced School Day Program.

Quotes:

School 1:

“I asked for about $150 from my board. I had a principal and student from another school come

in so I bought them a gift with the parent initiative money.”

Sub-theme: Organized sports

Having programs available for student to be active during the fitness breaks are very important.

It was indicated that some students do not have after school activities. By having programs

available during the fitness breaks gives the student’s opportunities to try new activities that they

would not otherwise have the opportunity.

Quotes:

School 3:

“Organized sports are very important here. Some of the kids at this school in particular do not do

anything in the evening, they do not belong to clubs and they do not belong to volleyball leagues.

Therefore, we are trying to provide as many activities as possible for them to learn different

games but also to be active. Because we have a low-income area here, you have to try to provide

as many opportunities as possible that these kids wouldn’t have otherwise.”


Sub-theme: Hiring Crossing Guards

The issue of having crossing guards available for those schools who have students that go home

at lunch is another concern. Having two nutritional breaks instead of the one long lunch implies

having more crossing guards available to assist students during these two breaks. This creates

concerns surrounding the availability of getting crossing guards for this time as well as the

financial burden of having to possible hire additional crossing guards to be available during

these breaks.

Quote:

School 4:

“Schools that have students that go home at lunch would need the crossing guards to be available

during the two nutritional breaks instead of the traditional long lunch break for students that need

assistance while traveling home. This can create an inconvenience and financial strain for the

school to endure.”


Chapter 5: Discussion of the Results

Data collection for this study was conducted in cooperation with four elementary schools from

the District School Board of Niagara and with the approval of the District School Board of Niagara

Research Committee. Qualitative data was gathered using telephone interviews with a representative from

each of the four schools participating in this study. The interviews were audio-recorded and transcribed.

Data analysis involved open coding initially to develop categories during the first initial reading. During

the second reading, axial coding was used to combine and/or branch off to form new categories.

The categories (themes) and new categories (sub-themes) were selected from the data to answer

the three main research questions and were documented in the following charts. Charts were selected to

document these categories as it organized the data to facilitate coding and analysis and presented it in a

structured template.

The interview questions were formulated to gain information pertaining to the three main

research questions for this study. This chapter has been framed in accordance to the three main research

questions. Each will be discussed in accordance, with a brief overview of the key findings that will be

further discussed at the end of the chapter. The research was focus on three specific questions: 1) What

factors contribute to the successful launch of the Balanced School Day program? 2) Do the three selected

schools use or can use the same approach in implementing the Balanced School Day program? 3) Does

the socio-economic context of the school affect the implementation process and perceived success of the

Balanced School Day program?

The major themes that emerged from the interviews for the first research question included:

principals, teachers, parents and students. The sub-themes for the major theme of principals included:

researching, acquiring resources, educating, leadership, and promotion. The sub-themes for teachers

included: educating, leadership, and promotion. The sub-theme for parents was acceptance. The sub-

theme for students was cooperation.


The second research question examined differences and similarities between the four

participating schools in the implementation of the program. Themes were selected based on comparing

the schools before the program was implemented, during the implementation process, and after the

implementation process.

Before the program was implemented, the theme that was selected when comparing similarities

between the four participating schools involved the principals. The sub-themes that emerged from the

research surrounding the principals involvement was the principals being the initiators of the research,

and their involvement in the voting process.

Prior to program implementation, the major theme that indicated the differences between the four

participating schools was program acceptance. The sub-theme that emerged from this theme was initial

resistance.

During the implementation process, there was also similarities and differences between each of

the four participating schools. The major theme that was selected when examining the similarities

involved the teachers. The sub-theme that emerged from this theme was their involvement in facilitating

intramurals.

The major themes that indicated the differences during the implementation process of the four

participating schools included: program promotion, teachers, and school nutritional programs. The sub-

theme that was selected from the theme of program promotion was promotional aids. The sub-theme that

was selected from the theme of teachers was their involvement in monitoring student’s lunches. The sub-

themes that emerged from the theme of school nutritional programs was grants and healthy food options.

After the program was implemented, the theme that was selected as similar between the four

participating schools involved the program successes. The sub-themes that emerged from this theme

included: increased physical activity, improved nutritional habits, increased mental focus, and discipline

issues.

After the program was implemented, the theme that was selected as indicating the differences

between the four participating schools was the challenges of the program. The sub-themes that were


involved in the challenges was regional issues and the new timetable.

The third research questions had one major theme that was selected from the interview data that

involved principals. The sub-themes that emerged from this theme included: applying for grants,

organized sports, and hiring crossing guards.

When exploring the first research question, several themes emerged from the interview data. It

was indicated in the interviews from the four participating schools that prior to the launch of the Balanced

School Day program; a great deal of research was conducted. The information was then analyzed before a

final decision of whether or not to have the program implemented could be determined as highlighted in

the following statement by School 1’s principal: “Every school is different with its own dynamics. I had

to conduct a lot of research to make sure that the program would be feasible within our school community

before further steps in having the program implemented could be taken.”

All four participating schools indicated the importance of the school principal being in charge of

researching the program and facilitating the implementation process. In the initial research, each of

principal stated that they first examined their school’s dynamics and needs to see if the program would

work in the schools community. The growing concerns surrounding children’s decline in health had

become an important issue that needed to be addressed. This decline in health was specifically in

reference to nutritional and physical activity patterns that have been documented as a cause for the

increase in obesity rates in adulthood. Having the Balanced School Day program within a school was

identified as a way to address these needs. This is important to have outlined to everyone to ensure the

program will gain acceptance from school council, staff and parents.

Each of the respondents from the four participating schools implemented the program to address

the need to improve nutrition, promote physical activity, improve student learning, and reduce discipline

on the playground. This was stated in the following statement by School 3’s principal: “The goal

ultimately with the entire board has always been to increase student achievement and student learning and

this was one of the strategies that they felt would be one of the ways to address that.” These were the

major goals that the four schools wanted to achieve by implemented the Balanced School Day program.


Schools present an environmental opportunity for prevention and management of childhood

and adolescent obesity unlike any other (Cullen et al., 2007; Dufour, 2004; Estabrooks et al., 2003; Lee &

Cubbin, 2002; Morland et al., 2002; Raine, 2004; Veugelers & Fitzgerald, 2005; Yekutel & Orthner,

2007). Principals who were looking into programs to implement realized this and wanted to implement a

program that would assist in promote healthy foods and physical activity. Principals looked to this

program hoping that it would possibly assist in decreasing youth obesity rates by promoting healthy

lifestyles. However, decreasing youth obesity was not the goal of the schools implementing the program

as highlighted by the following statement indicated by School 4’s principal: “The Balanced School Day is

great and addresses additional time for activity and healthy eating. However, it would not be successful in

focusing on the issue of youth obesity. Just having the Balanced School Day would not do that. You have

to have that as a focus.”

All study participants indicated that the principals were the motivators and the driving force

behind having the program implemented within their school. This included the principals conducting

hours of research, attending research seminars, and visited other schools that were on the Balanced

School Day program. The next step in the implementation process involved presenting all of the

information the principal had acquired to the school council, parents, staff, and students. According to the

interview respondents, the majority of parents, teachers, and students were very receptive to the idea of

the program after some initial resistance. Once they were all well informed of the program, they

supported it.

A principal was responsible for making all of the major decisions involving their school. This

involved making decisions on which programs to consider implementing by determining what was best

for the school. This could involve acquiring resources that include: expertise, posters, and equipment to

assist in running these types of programs. When implementing the Balanced School Day program,

important resources that the principals could acquire for the students benefit was applying for grants to

fund the nutritional programs and having intramurals held during the fitness breaks.

Three of the four participating school principals applied for a grant through the Ministry of


Education that provided funding for healthy food options that would be available to students at no cost.

However, it was stated in the interview from School 4’s principal that any school within the DSBN is able

to apply for the grant. The principals interviewed indicated that the application was a long process that

some principals just saw as an additional task to complete. School 3’s principal supported this observation

by stating: “The grant from the Ministry involves a long application that principals must fill out. In the

past, it has had a tendency of taking up a lot of time that some principals might not have. I support having

nutritional foods for my students, so I continue to apply for it each year.” School 4’s principal indicated

that they not only had received funding from that particular grant but also from the parent council and the

Education Foundation of Niagara. This indicated that there was another opportunity within the DSBN to

receive financial funding for school nutritional programs.

The participating schools that received the grant through the Ministry of Education indicated that the

financial contribution funded their breakfast and snack programs that made healthy food choice options

available to students at no cost. It has to be noted that breakfast and Snack programs was not part of the

Balanced School Day program. These programs do both however assist in achieving the goals of the

Balanced School Day program, which is to improve nutrition during the two fitness breaks. Interview

respondents suggested that parents may have initially rejected the idea of implementing the Balanced

School Day program because it involved parents having to purchase healthy food choices to put in their

child’s lunch, which can get expensive. Having these food choices available to students at no cost would

change apprehensions that parents could have towards the program because it would not put any financial

strain upon them.

It was stated by the interview respondents that the principal’s motivation and the leadership role they

displayed, determined wither the Balanced School Day program would be considered or not. If the

principal did not have a real motivation to instate the program, it would not be successful. School 1’s

principal also indicated the teacher’s initial resistance in the following statement: “The first time I

initiated the program the idea was turned right down. The teachers just turned it right down. They did not

like the timetable changes and were initially resistant to the change. Once they received more information


about the program and heard of the other successes other schools that had piloted the program were

experiencing, they began to support it. I just kept offering them more information and kept pushing the

program because I knew it would be good for the students.” Without a principal’s persistence, the

program would not have been implemented in several schools as it is today.

The principals conducted the research and initiated efforts to introduce the program, but they also

took on the responsibility of educating school council, the staff, and the parents. This education included:

presenting the research to the school council, facilitating information sessions for staff, and hosting open

houses for parents to educate them about the components of the program. This involved having parents

understand that they had to pack healthy food options for their child that would be eaten during the two

fitness breaks rather than the traditional long lunch. School 1’s principal indicated that educating is an

ongoing process at the school in the following statements: “Even though the program had been running

for several years, education about nutrition was still ongoing. The entire school not only promoted having

snacks that were of a nutritional value but focused on reducing waste.” The principals from schools 1 and

4 indicated the importance of students needing to consume a healthy diet that contains both fruits and

vegetables. They both stated that if they do not pick up these healthy habits when they are children, they

would not be expected to practice them when they are adults.

After the program was implemented in the four participating schools, the principals used

promotional aids very successfully to keep parents and students informed about the program and provided

helpful information about using healthy practices at home. Interviews with representatives from all of the

four schools indicated that the use of the school newsletter was a good method to pass along this

information. However, some schools put information regarding the program in the newsletter a lot more

often than others. The schools that used the newsletter regularly to display health conscious information

included examples of healthy snacks that children could have for snacks, recipes, and the successes the

school was experiencing with the program.

School announcements were also used as a means to promote the program on an ongoing basis.

By way of example, School 1’s principal took on the responsibility of conducting morning announcement


about health information received from a nurse who was a mother of a student at the school. School 4’s

principal indicated that posters had been placed around the school to provide additional information to

keep students informed that was indicated in the following statement: “The importance of using

promotional material to keep students informed of the changes the program was going to generate was

very important. We placed posters around the school. They focused on what the Balanced School Day

program was going to look like, feel like and sound like.” School 1, 3 and 4’s principals indicated the use

of the student agenda to pass along healthy information and messages to keep parents informed that they

would check daily was a good promotional aid.

Environmental contributions have also been suggested as a contributor to the growing obesity

rates because individuals are living in an environment that promotes obesity more so that in the

past(Brownson et al., 2001; Drewnowski, 2004; Lillie-Blanton & Laveist, 1996; Morland et al., 2002;

Reidpath et al., 2002). Children get to experience a positive environment that promotes healthy choices

while attending school on the Balanced School Day program. This program educates children about

healthy lifestyles, which gives them a break from other negative environmental contributors that they

experience daily.

Past research showed that the promotion of consumption high-fat foods, sugars and salts is

something that children are continually faced with in their daily lives. This lifestyle not only promotes

poor nutritional habits but also promotes excessive food intake and discourages physical activity

(Brownson et al., 2001; Drewnowski, 2004; Lillie-Blanton & Laveist, 1996; Morland et al., 2002;

Reidpath et al., 2002). The classroom is the environment that students spend most of their time in while

they are attending school. This is why it is important for teachers to educate the students about healthy

lifestyles, which is what the Balance School Day program advocates.

Respondents from the four participating schools indicated that teachers did focus on educating

children about healthy lifestyles and the importance of balanced nutrition. School 1’s principal indicated

the importance of this in the following statement: “Teachers played a vital role in educating the students

about the importance of healthy nutrition in the classroom. Teachers would educate students about the


different food groups and the importance of consuming foods from all the food groups. Teachers would

also focus on the importance of physical activity during the fitness breaks when they would run the

intramural programs from the students.” School 3’s principal indicated the importance of teachers

educating students about the nutritional components of the program in the following statement: “When

the program first implemented, teachers taught students how to split up their lunches into two. Students

were able to consume part of their lunch during the first nutrition break and the rest at the other nutrition

break.”

Teachers took on a leadership role to the students. In doing so, they not only had to consume and

promote eating healthy food items but they organized intramurals. The four participating schools

indicated that the teachers took on the responsibility of organizing and facilitating the intramural program

that were held during the fitness breaks at each school. School 1’s principal indicated the teacher’s

significant role in facilitating intramurals in the following statement: “After the initial resistance towards

the program by the teachers, they took on a leadership role in organizing the intramural programs for the

students. These sports range from soccer, basketball and even weird games on scooter boards.”

The teachers at each school also had the responsibility of promoting the program’s values to the

students in the classroom. Teachers collaborated with the principals to come up with new, effective ways

to promote the program. By way of example, these ideas included having nutritional theme days and even

coming up with new unique games to play during the fitness breaks to promote the core-values of the

Balanced School Day program. The four participating school indicated that all the teachers had done a

great job and the students really enjoyed the program and were very positive about it.

The parents also played a critical role in the successful launch and ongoing development of the

Balance School Day program in each of the four schools examined in this research. Even though schools

had to have the school council and staff vote in support of the program, the importance of the parents vote

and acceptance of the program was another crucial factor. School 1’s principal indicated the importance

of the parent’s acceptance in the following statement: “Parents truly respected my opinion when I came

here. They knew I was doing a lot of great things and were thrilled. They were like, if you think that this


is great, then you do it. So I was completely stunned by that and there hasn’t been a single parent

complaint.”

Parents played an important role in promoting the programs values to their children because they

packed their snacks for school, and they read all the information that was send home with their child.

However, it was the parent’s choice withier or not they use that information to promote a healthy lifestyle

at home. Still, parent’s advocacy for the values and practices inherent in the program at home was vital to

instilling longer-term educational benefits surrounding healthy nutritional habits and physical activity to

their child. For example, School 2’s principal indicated that other schools in the board had been

considering implementing the program but had the idea rejected by parents several times indicated in the

following statement: “I know some schools in the area were all for promoting the program but once the

information was presented to the parents, they just shut the idea down. I am not sure if it was because they

thought they were going to have to make several changes at home and were resistant to it. However, if the

parents are not supportive of the program, the program cannot be instated in a school. You have to have

the support of the parents, staff and school council.” It is important to make sure that the parents are well

educated on the program before the voting process begins so they fully understand the benefits of the

program and support the program.

In the broader area of advocacy for the Balanced School Day program following its initial launch,

the Student’s was another theme that emerged from the data. The students were the individuals who

participate in the program, thereby making them significantly involved in the program’s success. All of

the representatives from the four participating schools indicated the high degree of cooperation from the

students throughout the program. The respondent from School 2 indicated how positive the attitudes of

the students had become since the programs implementation as stated in the following statement: “After

the program had been implemented for some time, the attitudes of the kids are a lot more positive. The

students like the new timetable change and the fewer discipline problems could be a reason behind their

improved attitudes.”

When analyzing the second research question, many different themes and sub-themes developed. An


emerging theme when examining the similarities between the schools prior to the program being

implemented was the actions taken by the principals. Among the schools considering this research, all

four school principals took similar steps when embarking on the possibility of implementing the Balanced

School Day program, and conducting the initial investigation on the program. The research process was

based upon the principal’s level of interest in the program. Researching the program involved principals

being the initiator and taking on the responsibility. All four schools indicated that the research approach

was based primary on the principal seeing the program as a way to address a need and if it did, then they

would pursue the option of having it implemented. Conducting the research included visiting other

schools to gain insight into the program from other principals/teachers, attending information seminars,

and reading several studies.

The voting process for the program involved the same protocol that was followed throughout all the

schools that wanted to have the program implemented that was indicated in the following statement by

School 1’s principal: “You cannot just say I am changing my school to the Balanced School Day

program. You have to have a vote with the school council, the parent community, and your staff. You had

to have between 70-75% in agreement and support of the program for each group to have the program

implemented.” All four schools had a similar voting process in order to have the program idea passed to

progress on to the implementation phase. This involved the principal presenting the idea to school

council, parents, teachers, and students. Even though the students did not get to vote, their thoughts were

taken into consideration during the implementation process to ensure there was a smooth transition with

the new timetable.

Although research was undertaken by the principles in each of the four schools included in this

study, the principles did meet with some resistance to this large-scale change in their respective schools.

The challenges of implementing large-scale policy interventions include limited action by policy-makers,

not sufficient evidence to base decisions upon, and the absence of community support (Birmingham et al.,

2000; Dufour, 2004; Lillie-Blanton & Laveist, 1996; Morland et al., 2002; Wilson et al., 2004). However,

implementing the Balanced School Day program is not a large-scale program but the four participating


schools did experience similar challenges with gaining overall community support.

The respondents from the four participating schools indicated the difficulty in initially gaining

acceptance for the program from the school council, parents and teachers. For example, School 1’s

principal indicated staff initially rejected the program idea when it was first voted on. However, the

principal persevered by bringing additional information to the staff and eventually got them in support of

the program. Throughout all the interviews, each school did indicate how lucky they were to have

received the support they had after the initial resistance. This was indicated in the following statement by

School 1’s principal: “In the big scheme of things, to have the school council, parents and finally

receiving the teacher’s support for the program was fantastic! All it took was to make sure everyone was

really informed about the program and then they were all in acceptance of it.” School 1’s principal also

indicated that parents from other schools in the area rejected the idea of the program in the following

statement: “In this school, I knew it would work. I know that in other schools in our board, parents are

totally opposed to it and because of that, are not able to have the program at the school.” This is why it is

of the utmost importance that everyone is informed and communication is kept between everyone

involved to ensure everyone is on the same page.

During the implementation process, there was one similarities found amongst the four

participating schools that was facilitated by the teachers. This similarity involved having intramurals

available to students during the fitness breaks that was organized by the teachers. The participating

schools all offered a wide variety of different sports/games available for students to participate in hopes of

increasing physical activity levels. By having organized sports facilitated by teachers, it allowed students

to become involved in an activity and feel accepted. By way of example, School 4’s principal made

intramurals mandatory within the school in an attempt to try to increase student’s activity levels, which

has shown positive results for the school indicated by the following statement: “Intramurals were made

mandatory at the school because some students were not participating during recesses and teachers made

this aware to me. Each student has a team they are part of and during the fitness breaks, they have to

come down to the gym and participate. This has improved students overall physical activity levels


because it ensures everyone gets involved and no one is left out for whatever reason.”

Research has shown that similar to an individual’s socio-economic status playing a crucial role on

an individual’s nutrition, the same could be said about physical activity (Brownson et al., 2000; Cordain

et al., 1998; Epstein et al., 2000; Estabrooks et al., 2003; Sallis et al., 1997; Yen et al., 1998). School 3’s

principal indicated the importance of the intramural programs for students, not just to improve activity

levels, but many of the students from that school are not able to participate in after school program due to

financial reasons. The principal understands the importance of intramurals highlighted in the following

statement: “Due to financial reasons, intramurals are the only organized sports these students get to

participate in. That is why we have been trying to offer as many activities/games to the students as

possible and this includes activities that they may not have the opportunity to participate in otherwise.”

Research has indicated that low-income families must face obstacles from user fees for programs,

unavailable transportation, inadequate parental support, social and cultural barriers, high costs of

equipment and lack of volunteers to run programs for children (Brownson et al., 2000; Cordain et al.,

1998; Epstein et al., 2000; Estabrooks et al., 2003; Sallis et al., 1997; Yen et al., 1998). These could be

some examples of why students are not able to participate in after school programs.

One trend has shown to stand true throughout all research which is that children in low-income

appear to be at particular risk of obesity (Estabrooks et al., 2003; Laitinen et al., 2001; Lillie-Blanton &

Laveist, 1996; Paeratakul et al., 2002). This is why it is extremely important for the lower-income

schools to offer intramural programs. Intramural programs not only provided the students with additional

opportunities to participate in physical activities they would not otherwise have, but also to increase the

students physical activity levels each day. Each of the four participating school offered intramural

programs that had a positive result in increasing student’s activity levels.

During the implementation process there were differences documented between the four

participating schools. The four schools seemed to follow the primary criteria of the beginning stages of

having the program implemented. This was promoting nutritious food choices that would be consumed

during the nutrition breaks and improve physical activity level to improve student learning. The way each


school went about achieving this goal was different. This is understandable as every school is different

and each school has its own dynamics. That means that what worked for one school, might not work for

another. The process would involve a lot of trial and error. It would be an ongoing learning process for all

involved.

Each participating school did have principals promote the program initially to staff, school

council, and parents. After the program was implemented, teachers had the responsibility of promoting

the program to the students in the classroom. These two examples of promotional efforts were similar

throughout the four participating school. However, differences arouse in the use of promotional aids in

the schools. The decision of what materials would be effective in promoting the program, creating

awareness and keeping everyone informed would have ultimately been decided by the principal and staff

as to what they thought would be effective.

Schools 1 and 4 had principals that really supported the values of the program in promoting

healthy lifestyles and displayed this with promotional aids they used. For example, School 4 had posters

up around the school promoting the Balanced School Day to students. These posters informed students

about what the Balanced School Day was going to look like, feel like, and sound like. Furthermore, the

respondents from Schools 1, 3 and 4 also articulated the importance of having promotional material

frequently exhibited in school, in newsletters and in meeting agendas about nutritious snack options,

importance of physical activity and the successes of the program. The respondents suggested that this was

very important in order to keep everyone informed. In contrast, the respondent from School 2 indicated

that they did not have any posters to promote the program up around the school and rarely had

information in the newsletter or agendas about the program. The reason why no promotional aids were

used was not stated but it would have been a choice that the principal and staff would have made.

Lunchroom monitoring, to assess whether or not the children’s lunch exhibited those espoused in

the Balanced School Day Program, was undertaken in three of the four schools included in this study.

Teachers that were familiar with the Balanced school Day Program undertook the monitoring. This

component of the implementation process was deemed important to implementing the program in


Schools, 1, 3 and 4 for School 1, 3 and 4. In comparison, School 2 indicated that there was no monitoring

done by teachers and students would simply eat what their parents packed for them. Schools 1 and 3 had

similar monitoring systems where the principal and staff would monitor what the students had in their

lunches. If staff found that a student continued to have unhealthy food items that contained a lot of sugar,

they would indicate this to the student, make the parents aware, and suggest appropriate food choices.

The respondent from School 4 indicated that if a student’s lunch continued to be unhealthy choices, the

principal would make a phone call home to speak with the parents of the students. They felt that parents

were receiving examples and recipes of healthy food choices and if the parents had been reading this

documentation, they would

Another important component of improving healthy foods in the schools was the nutritional

programs the schools offered to students. Three of the participating schools had a Snack program

available to the students while the remaining school had no programs. Even though the Snack program is

not part of the Balanced School Day program, it does provide students with healthy food items at no cost.

The Snack programs are funded by grants offered through the Ministry of Education. Schools may not

have the Snack program in their schools because of the lengthy application that must be filled out

accurately in order to receive this funding. School 3’s principal indicated this in the following statement:

“I believe any school in the District can apply for the grant. It is wither or not they chose to apply. The

application is quite long and involves a lot of math calculations. Some principals may feel the grant is a

good idea but do not have the time to fill out the application.”

Securing funding for the Balanced School Day program was another facet of the implementation

process undertaken by the schools. Among the schools included in this research, three of the four schools

applied for a grant through the Ministry of Education and the Niagara Nutrition Partners. Applying for

this grant involves the principal of the school filling out a long application that contained several

mathematical calculations. The grant provided funding for the three schools’ Snack programs. The Snack

program offered students a wide variety of healthy food options that are made available at no cost during

the nutrition breaks for students who may have forgotten their snacks, have eaten most of their snacks


during the first nutrition break, or are still hungry after their snacks and wanted something else to eat.

School 1 and 4 also offered a breakfast program that was funded in part from a grant from the

Ministry of Education. The breakfast program provided students with breakfast options they could have

when they arrive at school. The program was for students that may had forgot to have breakfast or were

unable to due to financial reasons, It allows students to start their morning off on the right foot with a

nutritious meal to energize their mind and body. School 2 was the only school that did not apply for a

grant or offer a food program to students at no cost. School 4’s principal also applied for additional

funding for the Snack and breakfast programs from the parent council, the Education Foundation of

Niagara, and hosting fundraisers throughout the year.

However, the three of the four participating schools offer the Snack program to their students, the healthy

food choices available between the four school’s were very different. There were no specific criteria as to

what food items have to be available to students because the Snack and the Balanced School Day program

are separate programs. The Balanced School Day program promotes healthy, nutritious foods and the

Snack program makes these items available to students. Both programs compliment each other.

Principals and staff were working towards improving student’s nutrition and are continually

educating the students as to healthy choices, so it is at their own discretion in selecting what items they

should have for the students at the school. Once again, the principal would examine which students were

consuming healthy foods prior to the program, would consider what food group’s students were not

consuming and have a focus on having them available in the Snack program. School 1 really focused on

promoting the importance of having both fruits and vegetables in your daily diet. The school also offered

sandwiches, granola bars, raisons dairy products, like milk and cheese to provide the students with more

calcium. School 2 offered fruit juices, sun chips and a few other options available in their “Tuck” shop for

students to purchase. School 3 had similar fruit, vegetables, granola bars, and juice available to students at

no cost. Milk was provided to certain students due to financial reasons.

After the program was implemented, the four participating schools indicated achieving similar

successes from implementing the program. These successes were documented in surveys, research


studies, and by observation after the program had been implemented for one year’s time. These successes

included; increased physical activity levels, improved nutritional habits, increased mental focus and

reduced discipline problems on the playground. The main objective of the program was to improve

student learning and all four schools indicated that they had achieved this goal as well as the others.

The extended nourishment breaks that were part of the Balanced School Day program allow

students to concentrate better near the end of the day (Chater & Lafond, 2003; Forger, 2004; Fox et al.,

2003; Halton District School Board, 2003; Schoenstein, 1995). School 4’s principal also highlighted this

in the following statement: “Personally having experienced the regular day and the Balanced School Day

at two schools, students are able to focus far better in the afternoon because you have given them time to

run around and have another snack. You can get more academic learning done in that third block for

sure.” This program has also shown positive results in the right direction to assist in decreasing

overweight and obesity in youth. However, students, teachers and parents to be effective must accept the

program’s values (Reid, 1996; Rettig & Canady, 1996).

After the program was implemented, goals were achieved which proved to show the program was

successes. However, with all successes come some challenges. Even though they may not have affected

the four participating schools, they have the potential to create barriers for other schools who are

considering the program. The principal has to be the one to examine the school dynamics to see if the

program would be a fit for that school or they have the option of fine-tuning the program to fit their

schools needs.

The literature on the Balanced School Day Programs suggests that some negatives aspects of the

Balanced School Day Program have included decreased student attention due to long instructional blocks,

teacher burnout and less time for teachers to meet and plan (Chater & Lafond, 2003; Halton District

School Board, 2003). Fortunately, the four participating schools did not indicate that they had

experienced any of these challenges within their schools.

One of the challenges that was indicated from the data collected from the interviews was

regarding regional issues. The two regional issues that were causing concerns dealt with crossing guards


and children going home at lunch. School 3 indicated that students from that school, even with the

timetable change, were still going home during one of the nutritional breaks. This is something that

parents had become accustomed to with the old school schedule and being able to have lunch prepared for

their child to have during their lunch break. The school had to fine-tune the timetable to allow a longer

afternoon nutrition break for the students who would go home. Having students going home at lunch also

involves having crossing guards available during the nutrition breaks to assist the students that are

traveling home. This particular school has worked out any concerns surrounding the issue of children

going home at lunch and crossing guards. However, several schools in the area were considering

implementing the program but had to shut the idea down when they could not get crossing guards

available for those times.

The new timetable also posed some challenges on the four participating schools. However, the

challenges differed from each of the four participating school. This was expected, as no two schools are

the same and would experience different struggles and conflicts. The new timetable caused two

challenges at School 2 that dealt with supply teachers and kindergarteners. It has to be noted that these

challenges were confronted and dealt with at this particular school. However, they could create barriers

for other schools who are considering implementing the program. By making people aware of these

challenges, schools may be able to consider potential solutions to the problem if they were to encounter

them. The problem surrounding the new timetable and supply teachers involved supply teachers who

would be working half-days. Half-day supply teachers would normally finish their day at the traditional

lunch period but with the new timetable, this traditional lunchtime would be scheduled during a teaching

block. This has the possibility of creating problems at schools, especially if the supply teacher has a

seminar in the afternoon or a place they have to be.

The other concern was surrounded the kindergarten students half day schedule. These students

were not able to follow the traditional Balanced School Day schedule as they are only at school for half of

the day. School 2 had to create a schedule just for the kindergarteners to allow them to participate in the

Balanced School Day program. This schedule did not allow follow the same schedule as the other


students. Morning students still had a nutrition/fitness break, but it was scheduled in during free time

before they would leave at noon hour. The same was for the afternoon students, as they would have an

afternoon nutrition/fitness break.

Even though the new timetable better assisted the students, the principal of School 1 found the

change to be difficult to adjust in having to make calls to the board and other schools. The principal

would make calls during the second instructional time, which was when other schools and the board

would be on their lunch breaks. Initially, it made it difficult to keep effective communication between

them all. Some found the timetable change not to be a big adjustment. Staff and students were still getting

the same allotted times to eat and have a break but this still came with some resistance. School 1’s staff

initially rejected the program. This was due to the staff resistance to change their traditional teaching

practices that they had been accustomed to. School 4’s principal stated that if the program is resisted at

first, it is not that the Balanced School Day program idea is being rejected; it is the idea of having to

change something that has caused the insecurities.

When examining the interviews to answer the third research question, no specific examples of the

socio-economic context of a school affecting the implementation process of Balanced School Day

program in the four participating schools. The three lower-income schools were able to implement the

program and achieve several successes. The ability to have the program implemented was not dependant

upon the socio-economic context of the school but based upon all the support of the school council, staff,

and parents. However, the ultimate goal of the program was to improve student learning and there was a

consensus by participating schools that this goal had been achieved. This was attributed to the program

allowing students to snack more frequently during the two nutrition breaks, which allowed them to be

able to concentrate more in the afternoon. However, even though the socio-economic context of a school

did not affect the implementation process, it did contribute to factors that caused and could potential

cause challenges for school that are or are considering implementing the Balanced School Day program.

A correlation between an individual’s socio-economic status and an individual’s nutrition has

been documented in the literature. This has been supported by diets that are based upon consuming


refined grains, added sugars and added fats are more affordable than the recommended diets based on

lean meats, fish, fresh vegetables and fruits (Drewnowski, 2004; Gortmaker et al., 1999; Field et al.,

1998). Having healthy food choices available to students was extremely important to achieve the goal of

improving nutrition and could pose a problem to some schools considering implementing the program

because of financial costs associated with healthy choice options.

Importantly, parents are a key component in the success of the Balanced School Day program, as

they have to pack their child’s lunch differently to allow it to be split into two healthy snack portions.

This could pose a problem for parents who cannot afford to purchase healthy food options to put in their

child’s lunch and may not be supportive of the program for this reason. Due to cost differences associated

with food items, individuals may select items that contain energy dense foods. Past research has indicated

that people living in the areas with the poorest socio-economic status have 2.5 times the exposure to

energy dense food outlets than people in wealthier areas (Estabrooks et al., 2003; Paeratakul et al., 2002;

Raine, 2004; Wilson et al., 2004; Yen et al., 1998).

Fortunately, three of the four participating schools indicated that they had Snack programs

available to students that provided them with healthy food options. Even if parents could not afford

healthy food choices to put in their children’s lunches, schools with this program or similar programs

would be able to make these healthy choices available for the students at no cost.

To ease in having the issue concerning healthy food item costs, schools principals have the

opportunity to apply for different grants that could cover the costs associated with the healthy food

choices the school would make available to students. However, if it had not been for the principals taking

initiative to acquire this funding, these food items would not be available to the students. Three of the four

participating schools have applied for the grant that is available through the Ministry of Education to

receive funding for their schools nutritional programs. The principals from School 1, 3 and 4 took the

initiative to apply for this particular grant to be able to provide these food options available for students.

School 2 however did not apply for a grant and has a few food items available to students with a cost

associated to them.


Improving student’s physical activity levels is another value of the program. In order to achieve

this, programs have to be available at the schools to allow the students the opportunity to participate. Each

of the low-income participating schools indicated the importance of having these intramural programs

available to students. School 3 stated that a lot of the students from the school do not participate in any

after school programs due to financial reasons. The principal and teachers at this particular school try to

offer as many intramural activities/games that they can for students and provide opportunities they may

not have otherwise.

The final socio-economic concern surrounds the issue of having to hire additional crossing guards

to assist students who are trying to get home during the nutrition/fitness breaks. School 3 indicated that

several of the students from the school go home during one of the nutrition/fitness breaks and have the

crossing guard situation figured out. However, for schools who are considering implementing the

program, this could be a major concern and could possible be a financial burden for the school if they had

to hire on additional crossing guard staff.


References

Addressing Childhood Obesity: The Evidence for Action. The Canadian Institute for Health Research

2003.

Birmingham, C. L., Palepu, A., Spinello, J. A. The cost of obesity in Canada. The Canadian Medical

Association Journal. 2000; 64(4), 483-488.

Brownson, R. C., Baker, E. A., Houseman, R. A., Brennan, L. K & Bacak, S.J. (2001). Environmental

and policy determinants of physical activity in the United States. Am J Pub Health., 91, 1995-2003.

Canning, P. M., Courage, M. L.& Frizzell, L. M. (2004). Prevalence of overweight and obesity in a

Provincial population of Canadian preschool children. The Canadian Media Association Journal.

171(3), 240-247.

Chater, M. & Lafond, L. (2003). The Balanced School Day: An assessment by the teachers at St. Clair

elementary school. Ontario English Catholics Teacher’s Association-St. Clair Elementary Unit.

Cordain, L., Gotschall, R. W., Eaton, S. B. (1998). Physical activity, energy expenditure and fitness: an

evolutionary perspective. International Journal of Sports Medicine. 19(3), 328-335.

Cullen, K., Hartstein, J., Reynolds, K. D., Resnicow, Ken., Greene, N. & White, M. A. (2007). Improving

the school food environment: results from a pilot study in middle schools. Journal of American

Dietetic Association, 107, 3, 484-489.

Drewnowski, A (2004). Obesity and the food environment: Dietary energy density and diet costs. Am J


Prev., 27, 3, 154-162.

Dufour, R. (2004). What is a professional learning community? Educational Leadership, 61, 6-11.

Epstein, L. H., Paluch, R. A., Gordy, C. C. & Dorn, J. (2000). Decreasing sedentary behaviours in treating

paediatric obesity. Arch Pediatr Adolesc Med. 154(2), 220-227.

Estabrooks, P.A., Lee, R. E. & Gynresik, N. C. (2003). Resources for physical activity participation: does

availability and accessibility differ by neighborhood socioeconomic status. Ann Behav Med., 25, 2,

100-104.

Forger, J. (2004). Scheduling alternatives: Options for student success. New York: Author. (ERIC

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Fox, S., Hoskin, B., Short, K. & Woehrle, T. (2003). Thinking outside the clock: Re-organizing the

school day. Ontario Principal Council (OPC) Register, 13-17.

Gortmaker, S. T., Peterson, K. & Wiecha, J. (1999). Reducing obesity via a school-based Interdisciplinary

intervention among youth: Planet Health. Arch Pediatr Adolesc Med. 153(4), 409-418.

Field, A. E., Colditz, G. A., Fox, M. K. (1998). Comparison of 4 questionnaires for assessment of fruit

and vegetables intake. AM J Public Health. 88(2), 1216-1218.

Halton District School Board (2003). The Balanced School Day Surveys Report. Community Relations,

Research and Accountability.

Laitinen, J., Power, C. & Jarvelin, M. (2001). Family social class, maternal body mass index, childhood


body mass index, and age at menarche as predictors of adult obesity, American Journal of Clinical

Nutrition. 74(3), 287-294.

Lee, R. E. & Cubbin, C. (2002). Neighbourhood context and youth cardiovascular health behaviours.

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Reid, W. (1996). The administrative challenges of block scheduling. The School Administrator,53(8), 26-

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Chapter 6: Conclusion

Youth obesity has become a growing concern over the past decade. The outcomes of being

overweight and obese comprise a list of aliments including: cardiovascular disease; heart disorders;

strokes; hypertension; various cancers; type 2 diabetes; gall-bladder disease; impaired respiratory

function; liver disease; and urinary stress (Drewnowski, 2006). The epidemic of youth obesity has been

putting a financial strain on our health care system. Action to prevent and address this growing problem

must be taken. A good environment to start specifically targeting prevention and intervention strategies is

with children at schools.

There has been an initiative focusing on increasing physical activity and healthy eating within

elementary schools. The reasoning behind the Balanced School Day programs growing implementation

across Ontario is because the program incorporates both nutrition and physical activity targeted at not

only students but parents and teachers as well. In the past, other educational health related programs had a

tendency to focus on either educating children on healthy nutrition or the importance of physical activity

rather than incorporating both components. The Balanced School Day Program does incorporate both

elements by replacing the school schedule of two recesses and a lunch with a new schedule that consists

of two 40 minute nutritional/activity breaks (Chater & Lafond, 2003; Halton District School Board;

2003).

Balanced School Day Program has changed the traditional school day schedule to consist of two

nutritional/fitness breaks. The programs goal is to promote nutritional habits and provide additional time

for youth to participation in physical activity. The program has been used as a pilot project in a wide

variety of school boards across Ontario. Results of pilot school studies have indicated students had

improved academic performance, consumed a more balanced diet, increased physical activity levels, less

discipline issues on the playground, and the schedule change allowed for more learning time in class.

Knowledge about proper nutrition and the benefits of physical activity are very important in order


to live and maintain an overall healthy lifestyle. In order to analyze our changing environment, the

multiple contributing factors to the obesity problem have to be examined using frameworks to organize

and implement effective interventions and prevention programs. Even though the Balanced School Day

program is not specifically an intervention and prevent program, it has improved nutrition and physical

activity levels.

Nutrition and physical activity are very important components in living and maintaining a healthy

lifestyle, which also includes having your body weight in a healthy range. There have been concerns

surrounding children’s weight with the expanding rates of youth obesity rising over the past several years.

Research is continually being conducted to formulate solutions to reduce these expanding rates. However,

the bottom line in reducing the obesity rates comes down to having children becoming more active and

eating healthier. These values are promoted through the Balanced School Day program. The Balanced

School day program aims to address the need for additional educational programs, which promote healthy

active habits that youth will continue to practice in the future.

It was significantly important that principals has researched the Balanced School Day program

details. This allowed the four participating schools to have the ability to address any challenges they may

potential experience by thoroughly researching the program to allow the school to progress and achieve

the successes other schools had with the program. The challenges the four participating schools

encountered varied once the program was implemented. These challenges were resolved based upon what

worked with the school dynamics.

The Balanced School Day program may be able to assist in the area of getting children more

health conscious about food choices and increasing activity levels, but the program solely cannot be the

answer to solving the catastrophic problem of youth obesity. Many other factors involved cannot be

addressed by the program and in schools. By making healthy information available is a step in the right

direction but it is the choice of the students and parents if they chose to use this information and apply it


to their lives.

Healthy active living is not just something that can be changed with the snap of a finger. It

involves a lifestyle change. That is why people struggle because they live a busy lifestyle and are on the

go all the time. It is harder for parents to find time to take their kids to all of the different organized sports

and paying the high costs associated with having their child participate in them. Parents also struggle

finding time to cook nutritious meals that involves time they do not have. At times, it is much more

convenient for parents to pick something up through the drive thru.

Within Canada, there has been some effort to move towards school food polices but more

involvement and support by the government must take action. These food polices also must be embraced

by students, staff and parents to ensure these polices are followed. Often, these policy options are met

with resistance due to costs. Parents do their best and that is why having a program such as the Balanced

School Day program to teach students about healthy foods and the importance of physical activity is

important.

The question of whether this program would be successful to be implemented as a universal

program in all elementary schools across Ontario is then challenged. No one is challenging that there are

not benefits from the program being implemented. Principals and teachers from the four schools

interviewed agreed that student’s activity levels, nutrition, behaviors outside during fitness breaks and

concentration in class near the end of the day improved significantly after the program had been

implemented.

However, several concerns must be indicated and resolved before the program can be

implemented. The first that was identified from the four interviewed participants was the struggle to gain

support from the school council, parents and teachers about the program. In the end, all four participating

schools did receive majority (70-75%) of support from all these groups but it came with some resistance.

These apprehensions were due to uncertainty and resistance to change which was what caused a rejected


for the program initially by the teachers in School 1. Majority of these doubts and uncertainties are based

around unanswered questions or unresolved concerns that people have surrounding the program.

A recommendation in an attempt to reduce doubts and peoples uncertainties is the importance of

keeping these groups informed through effective communication practices. Principals and teachers can do

this by thoroughly researching the program initially to ensure that it is feasible at the school. Also

conducting research to ensure that all potential challenges in implementing the program can be addressed

and resolved prior to the implementing of the program. The idea of having open houses where guest

speakers from other schools who have implemented the program come in and give insight to parents and

teachers about the program would be extremely beneficial. Sending information home regularly about

what is being done at the school in regards to improving nutrition and physical activity is essential to keep

parents informed and updated on the progress of the program. If a portion of the school newsletter each

month gave recipes and examples of nutritional snack, it could further assist parents in generated healthy

ideas. Any additional health information that could be sent home to parents to read and to share with their

children would be useful. All of these are different examples of how to keep an informed relationship

specifically between the school and parents, reducing apprehensions people may have about the program.

Each schools dynamics also has to be examined to see if there is a need or needs for the program

and if these needs can be met by implementing the program. Even though there has been a lot of positive

association’s with the Balanced School Day Program, the program is not for every school. Being able to

acquire the majority support for the program and ensuring that everyone is willing to work together to

make the program successful is the first obstacle. Each school has its own unique needs. The students

needs have to be examined as to what program would benefit them most. Then, you have to see what will

work for that specific community because there has to be a wide acceptance in order for the program to be

implemented with positive results.

One of the concerns surrounding regional issues involves school crossing guards. Some of the


participating schools indicated the regional issue surrounding the need for crossing guards during the

nutrition/fitness breaks to allow students to go home during the afternoon break. A recommendation to

address this issue is to have children stay at school during the nutrition/fitness breaks. There would then

be no need to have crossing guards available for those times.

Fine-tuning the program is an option for schools as well to consider. Out of the four participating

schools, two of them indicated that they had to make minor changes the Balanced School Day program

schedule to meet the needs of the school. One of the examples was pertaining to children going home

during the nutrition/fitness breaks. School 3 indicated that they had to make the second nutritional break a

little bit longer to allow time for students to go home and come back to school. School 2 indicated that

they had to change the kindergarteners schedule slightly from the other students to allow the half-day

kindergarteners to participate in the Balanced School Day program. Other than the timetable change, there

is not specific criteria a school absolutely must follow in order to implement the Balanced School Day

program. This allows school to have some control to fine-tune the program to fit the needs of their school.

Though the socio-economic context of the high-income and low-income schools did not indicate

a big difference in implemented the program, the cost associated with purchasing healthy food options

could pose a problem to the parents of the students in the low-income schools. Fortunately, two of the

three low-income schools provided a Snack program to the students that made healthy food choices

available to them without a cost. If parents object to the program because of cost associations, a

recommendation would involve having the school provide nutrition programs, such as the Snack program

that would be available to students at no cost. Three of the four participating schools indicated that they

had a Snack program available to students, which addressed parents concerns with food item costs.

Principals have the opportunity to apply for grants to provide funding for these programs. It is just there

choice whether they apply for them.

With the support of the Ontario Government, the Ministry of Health Promotions had been


working in conjunction with other initiatives programs to create the Healthy School Recognition

Program. This will allow all publicly funded schools to strive to achieve this recognition through

partnerships by school communities and the government. This recognition includes a certificate from the

Minister of Education and Ministry of Health Promotion. In hopes that it will assist in promoting schools

to get healthy (Ontario Ministry of Health Promotion, 2006).

Overall, to successful implement the Balanced School Day program it is important to have

support from school council, teachers, parents, and students. It is essential to keep all of these groups

informed by using effective communication practices to ensure the success of the program. The initial

implementation process is similar throughout all schools. Once the program has been implemented, there

is nothing wrong with schools fine-tuning the program to fit their schools needs. All schools are different

and have different needs that principals and staff work hard to meet. To ensure the socio-economic

context of a school does not create barriers to implementing the Balanced School Day program, principals

and staff have to work together to try to acquire as many additional resources as possible to ease in the

implementation and facilitation of the Balanced School Day program or similar programs.


References

Chater, M. & Lafond, L. (2003). The Balanced School Day: An assessment by the teachers at St.

Clair elementary school. Ontario English Catholics Teacher’s Association-St. Clair

Elementary Unit.


costs. Am J Prev., 27, 3, 154-162.

Halton District School Board (2003). The Balanced School Day Surveys Report. Community

Relations, Research and Accountability.




Documents

FINAL THESIS WRITTEN