Study results add to the limited body of knowledge about stakeholder perceptions during early implementation of Canadian SNPs. Dietitians can foster communication, engagement, and education of stakeholders, which will increase the likelihood that students and their families will accept SNPs.

Concerns regarding the quality of children's diets and rising rates of childhood obesity have received considerable attention in recent years. [1][2][3][4] As of 2004, about 1.1 million (18%) Canadian boys and girls aged 2 to 17 years old were overweight, and another half million (8%) were obese. 5 School-age children in Prince Edward Island (PEI) have the second highest rate of overweight (22%) in the country. 5 These trends signify an important public health issue, given that recent reports indicate that obesity in childhood and adolescence persists or tracks into adulthood 6,7 and is associated with chronic diseases and increased mortality. 8,9 Canadian studies indicate that children's diets are not meeting current dietary recommendations, with low intakes of Vegetables and Fruit, Milk and Alternatives and Grain Products. [10][11][12] Dietary surveys suggest that children in PEI have lower intakes of vegetables and fruit and higher intakes of low nutrient density foods (low nutrients relative to energy content, such as soft drinks or candy) 13 compared to Ontario children. 14 Since poor diet quality and inadequate physical activity have been identified as key determinants of the observed increase in childhood overweight and obesity, there is an urgent need to implement preventive policies and programs designed to improve diet and physical activity in Canadian children. 15,16 The school food environment is increasingly recognized as having a significant influence over children's eating behaviours because of the amount of time spent at school and the large percentage of food intake consumed while at school. 4,15 Some studies have demonstrated the effectiveness of policies in improving students' dietary intake by modifying the school food environment. [16][17][18][19][20][21][22] One Canadian study provided persuasive evidence, for the first time, that comprehensive health promotion and wellness programs can have benefits for students. 18,23 Students attending health-promoting schools in Nova Scotia were less likely to be obese, had healthier diets and were more physically active. The majority of Canadian provinces have indicated that they have adopted new nutrition

AbstractObjectiveTo assess the nutritional quality of lunchtime food consumption among elementary-school children on Prince Edward Island according to the source of food consumed (homev. school).DesignStudents completed a lunchtime food record during an in-class survey. Dietary adequacy was assessed by comparing median micronutrient intakes with one-third of the Estimated Average Requirement; median macronutrient intakes were compared with the Acceptable Macronutrient Distribution Ranges. The Wilcoxon signed rank test was used to assess differences in nutrient intakes according to source of food consumed.SettingElementary schools in Prince Edward Island, Canada.SubjectsGrade 5 and 6 students (n1980).ResultsFoods purchased at school were higher in nutrient density for ten micronutrients (Ca, Mg, K, Zn, vitamin A, vitamin D, riboflavin, niacin, vitamin B6and vitamin B12) compared with packed lunch foods from home, which were higher in three micronutrients (Fe, vitamin C and folate). School lunches provided sufficient protein but were higher in sugar and fat than home lunches. Foods brought from home were higher in carbohydrates, fibre and Na than foods purchased at school.ConclusionsThe overall nutritional quality of lunches was poor, regardless of source. A significant proportion of foods consumed by the students came from home sources; these were lower nutritional quality and were higher in Na than foods offered at school. Findings suggest that improving the dietary habits of school-aged children will require a collaborative effort from multiple stakeholders, including parents.

While schools are making progress in implementing the SNP, challenges remain. Identifying and communicating strategies for healthy fundraising activities and finding ways to involve parents in SNP implementation are recommended.

Health promoting schools (HPS) is recognized globally as a multifaceted approach that can support health behaviours. There is increasing clarity around factors that influence HPS at a school level but limited synthesized knowledge on the broader system-level elements that may impact local implementation barriers and support uptake of a HPS approach. This study comprised a scoping review to identify, summarise and disseminate the range of research to support the uptake of a HPS approach across school systems. Two reviewers screened and extracted data according to inclusion/exclusion criteria. Relevant studies were identified using a multi-phased approach including searching electronic bibliographic databases of peer reviewed literature, hand-searching reference lists and article recommendations from experts. In total, 41 articles met the inclusion criteria for the review, representing studies across nine international school systems. Overall, studies described policies that provided high-level direction and resources within school jurisdictions to support implementation of a HPS approach. Various multifaceted organizational and professional interventions were identified, including strategies to enable and restructure school environments through education, training, modelling and incentives. A systematic realist review of the literature may be warranted to identify the types of intervention that work best for whom, in what circumstance to create healthier schools and students.