A Comparison of Dietary Practices at or En Route to School between Elementary and Secondary School Students in Vancouver, Canada.

BACKGROUND
There is evidence that dietary quality declines as children age in North America, but few studies have explored whether food environment exposures in secondary schools as opposed to elementary schools are associated with changes in students' school-day food choices.

METHODS
This study examined differences in dietary practices (at or en route to and/or from school) between students in their last years of elementary school (grades 5 to 7) and first year of secondary school (grade 8) in Vancouver, Canada, controlling for sociodemographic characteristics and school-level socioeconomic status. Demographic characteristics and dietary data were collected through a cross-sectional survey (n=950 from 26 schools) and combined with school-level socioeconomic data derived from the 2006 Canadian Census.

RESULTS
Multilevel logistic regression analyses indicated that secondary school students were significantly more likely to report daily consumption of fast foods (odds ratio=1.92; 95% CI 1.18 to 3.12) and minimally nutritious packaged snacks (eg, candy or chocolate bars) (odds ratio=1.60; 95% CI 1.05 to 2.45), and to report regular purchases from off-campus retailers (odds ratio=1.63; 95% CI 1.10 to 2.42). Gender, food insecurity, lower acculturation to Canada, and access to more weekly spending money were associated with nutritionally poor practices. Students attending schools drawing from lower-income neighborhoods were also significantly more likely to consume fast foods and packaged snacks daily. The majority of students sampled did not report consuming healthy foods, such as fruit and vegetables, daily at or en route to and/or from school. Intake of fruit, vegetables, and low-fat milk did not differ significantly between elementary and secondary school students.

CONCLUSIONS
Findings suggest that research and intervention strategies should address modifiable school-level exposures and policies to improve dietary practices for both elementary and secondary school-aged youth, while at the same time addressing sociocultural factors associated with eating behavior.