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There has been much attention paid to the diet of children in the media of late as concerns about childhood obesity continue to grow as more incidences are reported; a search on the web reveals results of about 80,600 for childhood obesity news items (0.32 seconds) (web search conducted on 14th April 2010). As food intake has an obvious link to obesity the article investigating school children's knowledge and awareness of food and nutrition may provide insights to this situation and perhaps offer suggestions to remedies that might improve children's diets.
The literature in this study is comprehensive citing work from the UK, USA, Australia and New Zealand. All of these countries are English speaking countries with a Western diet and lifestyle so any comparisons drawn from the study of Surrey schoolchildren could bear relevance on the issues discussed. Authors from Health Education Authorities and writers from nutritional education and medical backgrounds contribute work that dates from 1980 to 2001. As the article is dated 2002 some of the information may now be outdated regarding the guidelines provided by health authorities and the programmes of study contained in the Primary School curriculum in the UK at 2010 which has undergone changes and is now known as the National Strategy that incorporates food and nutrition education throughout the cross curricular themes and especially in the health education element of physical education. The literature covers a wide variety of topics pertaining to the investigation including quantitative information resulting from diet and nutrition surveys (Gregory et al, 2000), food guidelines (Department of Health,1998; FAO/WHO, 1998) and qualitative information from research conducted by various authors (Birch, 1980; Dobson et al., 1994; De Bourdeaudhuij, 1997). All literature was fully referenced to allow the reader to follow up points of interest or to verify facts and validate claims.
'The aims of the study were to elicit children's understanding of:
â€¢ aspects of parental control over food choices and food rules that interact with food provision;
â€¢ how diet and diseases are connected, specifically dental health and obesity; and
â€¢ the categorization of food into groups and the schemes children use to do this'.
The methods used for this investigation are clearly stated; they are based on the population coming from the percentage of Free School Meals (%age FSM) as an indicator of socio-economic status (SES) for 7-11 year olds in Guildford, Surrey. Following a grouping of the quartiles of %age FSM entitlement, a judgmental selection or systematic random sample was made from the top and bottom ends of the calculated figures. Children at either end of the age scale were chosen to provide a clear comparison between attitudes relevant to age and within the sample the sample framing was randomly achieved by selecting the identified category through single gender alphabetical listing from registration rolls. Thus seven girls and seven boys were selected from each participant school with reserves in case any child should drop out or be unavailable. Motivation and understanding form the two criteria being investigated regarding food choices by this pre-adolescent age group.
Though the study is limited to a small number of participants, 390 in all, it is hoped that generalisations might be made regarding the greater population. Focus group discussions were used to obtain data with open-ended questions (as prompts) on four core topics providing the instrument to be used by the same moderator for each group. Audio recordings were made of the discussions for transcription and narrative analysis. The moderator also expanded, where necessary, with further verbal explanation to stimulate discussion. Although the sample was refined and the questions pre-set, the group discussion method may not offer valid results as the language skills of children may vary greatly and prompting may have contained leading questions that could skew results. The analysis involved putting emerging themes into categories from participant quotes by two separate investigators working 'blind' on the data sources. As the information related to groups rather than individuals, the unit of analysis had to be the group and therefore possibly a dominant voice which is a weakness in this investigation. The researchers also state that descriptive summaries form the basis of the analysis and that, "No formal statistical tests were applied to the data, which are qualitative in nature." The lack of formal statistical results is another weakness as a more structured questionnaire might have provided a means of analysis with testable results. Using something like a Likert scale to show greater or lesser agreement with statements might have allowed this particular survey/investigation to be used elsewhere with independent interviewers over a much larger sample, both in numbers and geographically. Perhaps also employing stratification in the sampling would reveal clearer perceptions and attitudes specific to age groups and gender to separate the SES variable in responses.
"This study aimed to gain an insight into the current awareness of nutritional issues amongst primary school children and the language they use in association with these topics." This statement contained within the article does not uphold the original aims (mentioned earlier in paragraph 3) and so the integrity of this piece is compromised by the introduction of 'language' as a contributory factor to the outcome. None of the quotes or analysis statements qualifies 'fat' as being overweight/obese/health risk. "The focus group methodology proved successful in achieving this objective with a number of key themes emerging from the discourse which will be used to feed into the development of food based dietary guidelines for children." As the objective failed to mention the influence of language in its parameters this statement also fails to uphold the original aims. Despite stating, "By using qualitative methodology, it was anticipated that the full range of responses would be captured whilst avoiding 'pigeonholing' this dynamic population with pre-existing beliefs. Analysis was designed to examine how these areas of enquiry varied with gender, age and SES," the arguments presented are based on a subjective analysis that assessed the quotes on implied testimony and what the authors thought the children meant in their responses.
There are obviously difficulties and barriers to overcome when collecting qualitative data and considering the language element and the limitations on verbalisation particularly from younger children, the questions presented should perhaps have been more sympathetic to their cognitive ability and been supported by visual stimulus with foodstuffs and outcomes shown as picture alternatives that could be chosen to express the consequences of certain choices rather than relying on verbal language alone. Particularly as the research was addressing SES as a contributory factor to eating habits and knowledge and understanding of food the researchers failed to take into account the effect SES might have on the ability to express well any intended meaning which ultimately is open to interpretation by the investigators. "Although food-health links were reported more frequently by low as compared with high SES groups, the former were less likely to be correct in the associations made (44 and 84% correct for low and high SES groups, respectively). Gender differences in the accuracy of food-health and food-nutrient links were also apparent (85% correct for girls and 65% correct for boys)."
The article does provide a foundation for further study but the methods used, especially the design of the instrument, need further refinement to eliminate other influences on the outcomes. As the article is presented by the Centre for Nutrition and Dietetics, School of Biomedical and Life Sciences, University of Surrey, Guildford, Surrey, UK it would be reasonable to expect greater consideration to be given to the educational inconsistencies and language skill and ability to effectively articulate particularly when the literature contains references to Piaget, the Department of Education and Employment, children's interpretation of nutritional messages and Focus Groups: A Practical Guide for Applied Research. The authors do admit, "Our sample was drawn from a narrow demographic population and so these results cannot be generalized to the British primary school population as a whole." And they further state, "The focus group methodology itself has both advantages and disadvantages when applied to this age group. Although it did allow the children more freedom to express their opinions, highlighting language and trains of thought which would not have been covered by a more structured approach, a number of the children were reluctant to take up the opportunity to 'discuss' topics, being content with short, succinct answers. In these cases, probing by the moderator inevitably results in more direct questioning and the potential for unintentionally leading questions. Similarly, the problem of children 'parroting' learned responses or those, which they perceive to be correct regardless of personal beliefs, has been raised by other researchers (Lytle et al., 1997). The frequency of apparently accurate food classifications in the current study that were not substantiated by correct justifications would support this phenomenon." Rather than seeing differences in attitude in direct correlation to SES the research discovered that gender difference was the biggest factor in the study. The findings report, "the need to develop cognitively appropriate age and gender specific food based dietary guidelines for children." Though this may be interesting it was not part of the initial objective or aim of the research and in writing this article there should have been a clearer definition of the expectations and how extraneous variables were to be controlled. The questions used did not address how much information the children had received from their studies in school but assumed that much of the information was gained from peers, TV advertising and parents. There should have been a comparison with the knowledge already delivered (if not learned) at the Key Stages from the curriculum with the information expressed from the children and a clear differentiation between where they gained their information from. Dental health came across as a knowledgeable area which is unsurprising as it is delivered as part of the curriculum from nursery age but elements of healthy living like heart disease etc are not addressed until much later in the school programme of study.