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
ChapterTitle 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 successfulrole 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 severalbarriers 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 recreationalfacilities and resources. Families of low-income not only have access to
fewer recreationalfacilities 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 successfulprogram (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

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;
Paeratakulet 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 severalproblems 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 severalhealth 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; Pareatakulet 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 unsuccessfulin 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

successfulapproaches 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;
Paeratakulet 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; Paeratakulet 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 recreationalservices 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 successfulintervention
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 successfulprograms 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-schoolphysical
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 wellas 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 PeelRegion. Since then, the program has been piloted in severalschools 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 federalgovernment 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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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 factualdata 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 successfulimplementation 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 successfulprogram. The data will also be able to
distinguish which area’s of effectiveness each schoolwas 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 successfulways 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. InternationalJournal of
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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 ofResearch Question #1:
What factors contribute to the successfullaunch of the Balanced School Day Program?
Theme: Principals
Sub-theme: Researching
School 1:
Conducting research on othersurrounding school boards that have implemented the Balanced School
Day Programand then distributing this information to otherindividuals.
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 programto gatherresearch 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 programand 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 fornutritional 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 forfinancial 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. Allsorts 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 parentsand 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 componentsof 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 valuesand 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, studentsand 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 themtake on the leadership role in the investigating and the implementation processof 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 programwere similar as to the onesthat 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 programimplemented 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 packagesfor
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 programto 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 schoolsthat had promoted the program
b) Promotional material
Quotes:
a) “The fact it had been successfulsomewhere 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 Programin newsletters
b) promotional posters
c) nutrition and fitnessfocus 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’sduring 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’shave 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’sability 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 studentsand providing themwith 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 programimplementation 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 programvalues and promoting themto 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 programby using existing data that providesinformation 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 classroomto promote the valuesof 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 conformto the programrequirements.
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 programis 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 programis 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 programis essential.
Quotes:
“Students were very receptive to the program.”
School 4:
Students were informed about what the programwas 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!”
Interview Open and Axial Analysis of Participants
Analysis ofResearch Question #2:

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 severaldifferent 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 feellike? 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 appliesto 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

FINAL THESIS WRITTEN

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