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Food as a Reward in the Classroom: School District Policies Are Associated with Practices in US Public Elementary Schools
RESEARCH Research and Practice Innovations
Food as a Reward in the Classroom: School District Policies Are Associated with Practices in US Public Elementary Schools Lindsey Turner, PhD; Jamie F. Chriqui, PhD, MHS; Frank J. Chaloupka, PhD
ARTICLE INFORMATION
ABSTRACT
Article history:
The use of food as a reward for good student behavior or academic performance is discouraged by many national organizations, yet this practice continues to occur in schools. Our multiyear cross-sectional study examined the use of food as a reward in elementary schools and evaluated the association between district policies and school practices. School data were gathered during the 2007-2008, 2008-2009, and 2009-2010 school years via mail-back surveys (N⫽2,069) from respondents at nationally representative samples of US public elementary schools (1,525 unique schools, 544 of which also participated for a second year). During every year, the corresponding district policy for each school was gathered and coded for provisions pertaining to the use of food as a reward. School practices did not change over time and as of the 2009-2010 school year, respondents in 42.1% and 40.7% of schools, respectively, indicated that food was not used as a reward for academic performance or for good student behavior. In multivariate logistic regression analyses controlling for school characteristics and year, having a district policy that prohibited the use of food as a reward was significantly associated with school respondents reporting that food was not used as a reward for academic performance (P⬍0.05) or for good student behavior (P⬍0.05). School-level respondents in the West and the Midwest were less likely to report that food was not used as a reward than were respondents in the South and Northeast. As of 2009-2010, only 11.9% of the districts in our study prohibited the use of food as a reward. Strengthening district policies may reduce the use of food rewards in elementary schools.
Accepted 14 March 2012 Available online 26 May 2012
Keywords: Obesity Schools Reward Policy Copyright © 2012 by the Academy of Nutrition and Dietetics. 2212-2672/$36.00 doi: 10.1016/j.jand.2012.03.025
J Acad Nutr Diet. 2012;112:1436-1442.
R
ECENT DATA INDICATE THAT 32.6% OF ELEMENTARYschool–aged children—those ages 6 to 11 years—are obese or overweight.1 Schools play a key role in shaping children’s dietary intake habits,2 and national authorities have recommended that food not be used as a reward in schools.3 The use of food as a reward for good student behavior or academic performance is problematic for many reasons, including academic, psychological, and health considerations. For the past 4 decades, education researchers have examined the effects of external reinforcement or rewards on academic and behavioral outcomes, with conflicting results. Although numerous reviews and meta-analyses4-6 have examined the influence of a variety of types of rewards on academic performance and student behavior, there is still no clear consensus on whether rewards are pedagogically appropriate. On one hand, some educators argue that when teachers provide students with external rewards for academic performance it reduces students’ own internal motivation,4,7 but others disagree, citing research that indicates no harmful effects from external rewards.5,8 Further, it has also been asserted that the use of rewards may adversely affect students’ development of goal orientations for learning.9,10 1436
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A variety of rewards are common in the classroom; a study of 86 elementary school teachers indicated that all teachers used rewards, and although praise and prizes were most common, many teachers used food rewards for learning engagement and behavior management.9 Further, among 490 middle school teachers, 73% of teachers used candy as a reward or incentive, 37% used cookies/doughnuts, and 28% used pizza.11 These energy-dense products may have adverse health consequences, particularly among younger children because when sugary foods are used as rewards, children learn to associate good behavior with these products,12,13 setting an expectation that is difficult to discourage14 and that persists into adulthood.15 Accordingly, many national organizations recommend that food should not be used as a reward in schools.3,16-18 Although an increasing percentage of schools, districts, and states have developed policies to restrict the use of food as a reward in classrooms, much room for improvement remains. At the school level, the Centers for Disease Control and Prevention (CDC) found that the percentage of schools that prohibited or discouraged teachers from using food or food coupons as a reward for good student behavior or good academic performance increased from 24% in 200019 to 36% in 2006.20 © 2012 by the Academy of Nutrition and Dietetics.
RESEARCH Nationally representative research from the Bridging the Gap project found that during the 2008-2009 school year, 40% of public elementary school students attended school in a district that prohibited or limited the use of food as reward or punishment, up from 32% and 36% during the 2006-2007 and 2007-2008 school years, respectively.21 Nationwide research shows that more states are addressing the use of food as a reward, with the percentage of states that discouraged schools from using food or food coupons as a reward increasing from 13% in 2000 to 45% in 2006.20 Although national studies such as Bridging the Gap and the CDC’s School Health Policies and Programs Study have tracked policies pertaining to food as a reward, thus far no work has examined the association between district policies and school practices. The purpose of our study was to examine the prevalence of using food as a reward in public elementary schools, and to examine the association between school practices and corresponding district policies. It was hypothesized that the use of food as a reward would be less common in schools where district policy prohibited this practice.
METHODS Study Design Data were gathered via a larger annual study on health-related practices and policies in public elementary schools and districts. Analyses used cross-sectional survey data from nationally representative samples of public US elementary schools during the 2007-2008, 2008-2009, and 2009-2010 school years. A total of 2,069 surveys were returned, from 1,525 unique schools across the 3 years (981 schools participated for 1 year, 544 schools participated for 2 years, and no schools participated for all 3 years). All research protocols and survey materials were approved by the Institutional Review Board at the University of Illinois at Chicago.
School-Level Data Collection Surveys were mailed to the principal at each school with a request that the survey (approximately 200 items total) be completed by the principal or other staff with knowledge of nutrition and physical activity practices. Surveys were gathered during the second half of each school year, during January to June, with a small number of responses during the summer following each school year. A $100 incentive was offered to the school or respondent. Surveys were processed and double-entered for quality assurance. Response rates were calculated using the American Association for Public Opinion Research Method Two,22 counting partial responses as complete. Response rates and number of responding schools across the 3 years, respectively, were 70.6% (748 schools), 61.8% (641 schools), and 64.5% (680 schools). Analyses used two survey items developed by the research team to assess use of food as a reward. The items remained identical across the 3 years of data collection. The lead-in asked respondents to “indicate whether the following practices occur at your school.” Items were “food (eg, candy) is used as a reward for good academic performance” and “food (eg, candy) is used as a reward for good behavior.” Response options were: “No;” “Yes, it is up to the teacher;” and “Yes, but it is discouraged.” Before mailing the surveys, cognitive interviews were conducted with three school principals at nonsampled schools, and these items were well-comprehended. September 2012 Volume 112 Number 9
Sampling and Weighting. The school samples were developed at the Institute for Survey Research at the University of Michigan, using sampling frames based on datasets from the National Center for Education Statistics. Because elementary schools vary in grade composition (eg, kindergarten to third grade, second to fifth grade), all schools were required to include third grade. Public schools from all coterminous US states were eligible for sampling. School weights were adjusted for potential nonresponse bias by modeling every school’s propensity to respond. Variables used to model these adjustments included: student enrollment; percent of black, white, and Latino students; percent of students eligible for free or reduced-price lunch; US census region; and urbanicity. Data were weighted to provide inference to all public elementary schools in the United States. The school samples were designed to be nationally representative in each year; some schools participated in multiple years, but analyses were conducted as a stacked cross-sectional design. A total of 2,069 surveys were returned during the 3 years, with 981 schools participating for 1 year only, and 544 schools participating in 2 of the 3 years (each observation was treated as a separate entry, with analyses designed to account for clustering of schools within district and over time). Contextual Factors. To control for school-level factors that could confound the influence of district policies on school practices, data were obtained from the National Center for Education Statistics Common Core of Data for each survey year. Data were obtained on the total number of students in the school, the percentage of students eligible for free or reduced-price lunch, student race/ethnicity, US census region, and locale. School size was divided into tertiles: small (⬍451 students), medium (451 to 621 students), and large (⬎621 students; referent). Racial/ethnic composition was coded as one of four exhaustive and mutually exclusive categories: majority (ⱖ66%) white (referent), majority (ⱖ50%) Latino, majority (ⱖ50%) black, and diverse (no majority).
District-Level Policy Data Collection Formal policy documents (eg, policy manuals and wellness policies as mandated by the Child Nutrition and WIC Reauthorization Act of 2004, PL 108-265, Section 204) were collected from the corresponding school district for each elementary school in the sample, for the corresponding year of data collection. Policies were gathered by trained research assistants using an established protocol via Internet searches, with telephone calls, and/or mailings to find policies that were unavailable online and to verify complete policy collection for policies that were available online. District policies were obtained or verified to not exist for, respectively across the 3 years, 99.3%, 97%, and 98.9% of all schools that returned surveys. Most policies were obtained by Internet search; across the 3 years respectively, 57.2% (n⫽264 of 462), 68.8% (n⫽287 of 417), and 70.4% (n⫽324 of 460) of districts had policies online and the rest were obtained by mail/telephone request. Characteristics of the district policy (eg, strength) did not vary by policy source.23 A total of 879 unique districts were represented (ie, had a school that provided survey data) across the 3 years, 469 of which were represented in 1 year only, 360 for 2 years, and 50 for all 3 years. However, even where districts JOURNAL OF THE ACADEMY OF NUTRITION AND DIETETICS
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RESEARCH Table 1. Demographic characteristics of elementary schools participating in a multiyear cross-sectional study examining the use of food as a reward in elementary schools and evaluating the association between district policies and school practices, by school yeara 2007-2008 (nⴝ748)
2008-2009 (nⴝ641)b
2009-2010 (nⴝ680)c
n
%e
n
%e
n
%e
P valued
Lowest (ⱕ33% eligible)
256
34.4
195
30.9
205
30.1
0.090
Middle (⬎33%-66% eligible)
278
37.3
219
34.7
242
35.6
Highest (⬎66%-100% eligible)
211
28.3
217
34.4
233
34.3
380
50.8
297
46.3
296
43.5
Characteristic Percentage of students eligible for free or reduced-price lunch
Race/ethnicity Majority white students Majority black students
68
9.1
67
10.5
79
11.6
Majority Latino students
129
17.2
120
18.7
108
15.9
Diverse students
171
22.9
157
24.5
197
29.0
City
213
28.5
190
29.6
190
27.9
Suburb
277
37.0
224
35.0
269
39.6
0.035*
Locale
Town
86
11.5
86
13.4
77
11.3
Rural
172
23.0
141
22.0
144
21.2
South
274
36.6
247
38.5
256
37.6
Northeast
110
14.7
93
14.5
101
14.9
Midwest
187
25.0
147
22.9
153
22.5
West
177
23.7
154
24.0
170
25.0
Small (⬍451 students)
280
37.5
221
34.5
253
37.2
Medium (451-621 students)
241
32.3
223
34.8
220
32.4
Large (⬎621 students)
226
30.2
197
30.7
207
30.4
0.572
Region .938
School size 0.665
a
Estimates are unweighted and represent the number (%) of schools at which a respondent returned a survey, broken down into subgroups by demographic characteristics. Among the 641 schools that returned surveys during 2008-2009, 218 also participated during the 2007-2008 school year. c Among the 680 schools that returned surveys in 2009-2010, 326 also participated during the 2008-2009 school year (none participated in both 2007-2008 and 2009-2010, and no schools participated during all 3 years). d Based on 2 test. e Percents sum by column to 100 within category, but due to rounding some may not sum to exactly 100%. *Significant at the 0.05 level (two-tailed). b
were represented for multiple years, the responding schools from within each district often differed across years. All district policies were reviewed and 100% double-coded and analyzed by two trained researchers using an adaptation of a coding scheme developed by Schwartz and colleagues24 and presented by Chriqui and colleagues.21,25,26 After doublecoding was complete, a consensus review was conducted to discuss any discrepancies. In the rare instances (⬍1% of cases) where the coders could not resolve the discrepancy, the policy study lead (a coauthor of this article) made the final determination as to how to code the policy. For our analyses, policy provisions were coded as “1” where a strong policy explicitly prohibited the use of food as a reward, vs “0” otherwise (ie, 1438
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policy discouraged but did not prohibit the use of food as a reward or punishment, encouraged healthier foods as rewards, or did not address the topic). Policy data were entered into a Excel (Microsoft Corp) spreadsheet and a quality assurance review was conducted on 100% of data to resolve any data entry discrepancies.
Statistical Analysis Analyses were conducted in STATA/SE (version 10.1, 2009, StataCorp LP) with the svy command for survey data, and the design statement accounted for sampling stratum and clustering of schools within districts. Two multivariate logistic September 2012 Volume 112 Number 9
RESEARCH Table 2. The percentages of surveys from school-level respondents reporting the use of food as a reward, by school yeara School Year Variable
2007-2008 (nⴝ748)
2008-2009 (nⴝ641)
2009-2010 (nⴝ680)
4™™™™™™™™™™™™™™™™™™™™™ % ™™™™™™™™™™™™™™™™™™™™3 Use of food as a reward for good academic performance Yes, but discouraged
29.3
29.8
28.0
Yes, up to teacher
31.3
28.3
29.9
No
39.4
41.9
42.1
29.1
28.5
29.2
Use of food as a reward for good behavior Yes, but discouraged Yes, up to teacher
29.6
30.4
30.1
No
41.4
41.2
40.7
a
Estimates are weighted at the school level.
regression models were calculated, the first with use of food as a reward for academics as the outcome and the second with use of food as a reward for good behavior as the outcome, with both coded as “1⫽food not used as a reward.” Models included a term for district policy, and two dummy variables to compare the 2007-2008 school year vs 2008-2009 and 2009-2010. Controls were entered for contextual covariates, which were selected to account for characteristics that might influence school practices (school size, race/ethnicity, percent free/reduced-price lunch eligibility, locale, and region). All variables were entered simultaneously into the regression models.
RESULTS During the 2007-2008, 2008-2009, and 2009-2010 school years a total of 2,069 surveys were returned, from 1,525 unique schools (981 schools participated for 1 year, 544 schools participated for 2 years, and none participated during all 3 years). Respectively for each of the 3 years, survey response rates were 70.6%, 61.8%, and 64.5%. Across years, schools were clustered within 462, 417, and 460 districts, with an average number of schools (⫾standard error) within each district, respectively, of 1.61⫾0.05 schools, 1.54⫾0.05 schools, and 1.47⫾0.04 schools. The percentages of districts with a strong policy prohibiting the use of food as a reward across the 3 years was, respectively, 8.4%, 11.2%, and 11.9%; this did not differ significantly across time. The characteristics of schools in the sample were comparable across the 3 years (see Table 1). School-level survey data indicated that food continues to be used as a reward in elementary school classrooms, despite national recommendations against this practice. The use of food as a reward did not change significantly over time, and during the 2009-2010 school year, food was not used as a reward for academic performance or as a reward for good student behavior at 42.1% and 40.7% of schools, respectively (see Table 2). Although the presence of strong district policies prohibiting the use of food as a reward was relatively low, with approximately 10% of districts having such a policy, these policies September 2012 Volume 112 Number 9
were significantly associated with school practices. Multivariate analyses controlling for school contextual factors and year (see Table 3) indicated that where district policy prohibited the use of food as a reward, school respondents were significantly more likely to report that food was not used as a reward for academic performance (odds ratio 1.71, 95% CI 1.09 to 2.67; P⬍0.05) nor for good student behavior (odds ratio 1.66, 95% CI 1.03 to 2.51; P⬍0.05). Logistic regression analyses also revealed significant regional differences in school practices (see Table 3). Schoollevel respondents were less likely to report that food was not used as a reward for good academic performance in the West (37.6%) and the Midwest (27.9%) than in the South (45.6%) and Northeast (56.8%). Likewise, respondents were less likely to report that food was not used as a reward for good behavior in the West (37%) and the Midwest (28.1%) than in the South (44.9%) and Northeast (58.5%).
DISCUSSION Although the educational merits of not using food as a reward may be debatable, the health consequences of having energydense products widely available to students are documented; at schools where energy-dense products are available in competitive venues—such as vending machines, school stores, fundraising, or given as rewards—students report higher energy intake27 and higher body mass index.28 The estimates reported here indicate that approximately 40% of schools did not allow the use of food-based rewards in 2009-2010, which is comparable to prior nationwide estimates from the CDC during 2006 showing that 36% of schools did not allow the use of food or food coupons as rewards.20 Research in middle schools indicated that the use of food as rewards or incentives was common, occurring at 69% of schools, and that such schoolwide food practices were associated with higher student body mass index.29 Although our study did not examine student weight outcomes, and no research thus far has demonstrated that using food as rewards is associated with body mass index among students in elementary school grades, given the demonstrated weight outcomes JOURNAL OF THE ACADEMY OF NUTRITION AND DIETETICS
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RESEARCH Table 3. Results of multivariate logistic regression models to predict use of food as a reward for academic performance and for good behavior in US public elementary schools Reward for Academic Performancea
Reward for Good Behaviora
Independent variables
Odds ratio (95% CI)
P value
Odds ratio (95% CI)
P value
Strong district policy
1.71 (1.09-2.67)
0.019*
1.66 (1.03-2.51)
0.015*
Year 2007-2008
1.00
2008-2009
1.15 (0.89-1.47)
0.286
1.00 1.00 (0.78-1.28)
0.999
2009-2010
1.13 (0.87-1.80)
0.367
0.97 (0.74-1.26)
0.794
Percentage of students eligible for free or reduced-price lunch Lowest (ⱕ33% eligible)
1.00
Middle (⬎33%-66% eligible)
0.84 (0.61-1.15)
0.274
1.00 1.11 (0.81-1.52)
0.507
Highest (⬎66%-100% eligible)
0.86 (0.59-1.27)
0.460
0.90 (0.59-1.36)
0.611
Race/ethnicity Majority white students
1.00
Majority black students
0.62 (0.36-1.05)
1.00 0.077
0.63 (0.37-1.07)
0.090
Majority Latino students
1.32 (0.85-2.04)
0.218
1.41 (0.90-2.21)
0.138
Diverse students
0.83 (0.60-1.14)
0.249
0.92 (0.67-1.27)
0.610
Locale City
1.00
1.00
Suburb
0.85 (0.60-1.20)
0.357
0.80 (0.56-1.12)
0.192
Town
0.60 (0.37-0.97)
0.035*
0.64 (0.41-1.00)
0.050
Rural
0.69 (0.45-1.05)
0.083
0.87 (0.58-1.30)
0.486
Region South
1.00
Northeast
1.27 (0.85-1.89)
1.00 0.236
1.61 (1.09-2.38)
0.017*
Midwest
0.41 (0.28-0.59)
0.000*
0.44 (0.31-0.63)
0.000*
West
0.63 (0.44-0.91)
0.013*
0.66 (0.46-0.95)
0.027*
School size Large (⬎621 students)
1.00
1.00
Medium (451-621 students)
1.06 (0.81-1.38)
0.680
1.07 (0.80-1.43)
0.639
Small (⬍451 students)
1.31 (0.96-1.80)
0.090
1.23 (0.89-1.70)
0.211
a Outcome coded as 1⫽food not used as a reward, 0⫽use of food as a reward discouraged or up to each teacher. *P⬍0.05.
among older students,29 it is prudent to avoid the use of energy-dense products as rewards in elementary schools. Alternatives such as privileges (eg, extra recess or playing an educational computer game) or nonfood rewards (eg, water bottles or stickers) can be appealing, inexpensive, and effective.30 This is the first study to examine the association between district policies and school practices pertaining to the use of food as a reward in a nationally representative sample of elementary schools. Indeed, district policies were associated with school practices, suggesting a potential opportunity for improving the school environment through policy changes. It is important to note that in our study the district food-as-a1440
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reward policies were assessed based on their inclusion in formal wellness policies and related district policy documents. In other words, this work evaluated formal policies “on the books” rather than informal guidelines or policies “in practice” that may also exist at the district level. Thus, the estimates of district policy prevalence are conservative, but given the relationship documented here between formal policies and school practices, additional informal policies would strengthen the relationship between policy and practice. Our work considered only strong policy provisions (ie, prohibitions) but not weaker policies framed as recommendations. As reported elsewhere,21 nationwide district data showed that 11% of public elementary students were enrolled in a September 2012 Volume 112 Number 9
RESEARCH district with a strong policy, and an additional 29% of students were in a district that had a weaker policy, such as a recommendation against using food as a reward or punishment, or encouragement to use only healthy food as a reward. For our analyses, weaker policies were grouped with “no policies” because it was not possible to independently assess the criteria used by schools to determine whether foods were healthy or not; however, given that many districts have weaker policies framed as recommendations but not absolute prohibitions, revisions to strengthen those policies may be warranted. As the US Department of Agriculture develops technical assistance materials and regulations related to wellness policies and competitive food/beverage standards as required by the Healthy, Hunger-Free Kids Act of 2010 (PL 111-296), an opportunity exists to include provisions regarding the use of food as a reward in schools. Early evaluation of school-level implementation of the federal wellness policy mandate indicated that even where districts had developed policies, few evidence-based practices were implemented at schools.31,32 However, more districts continue to develop and strengthen policies,21,33 and research is accumulating to show that district and state policies are associated with school practices. For example, district policies are associated with school sugar-sweetened beverage availability34 as well as student consumption of such beverages.35 Studies in individual states have shown significant improvements in the school food environment following development of laws and policies pertaining to foods in schools.36-38 Nevertheless, future research is needed to identify conditions that facilitate schoollevel implementation of district policies and state laws. Other non-immediate types of rewards such as coupons for food or beverage from outside businesses (eg, national restaurant chains or local stores) may be another source of foodbased rewards, but this study did not examine such incentives nor whether district policy affects such practices. There are important practice implications for food and nutrition practitioners as well as educators in helping schools to identify and implement alternative strategies for classroom management that do not involve energy-dense products. Furthermore, additional research into the effectiveness of nonfood rewards is warranted. Strengths of this study include the large nationally representative sample spanning multiple school years. However, there are also several limitations. The data are cross-sectional and do not allow for inference that district policies improved school practices, only that the two variables are associated. As with all surveys, it is possible that the estimates were biased (eg, desirability bias, nonresponse bias); however, the weights were adjusted to account for nonresponse. Consistency in school-level estimates across the 3 years suggests that the survey measure was reliable, although validity is not guaranteed. The survey was pilot tested with three principals to ensure comprehension; however, some respondents may have misunderstood the question. Further, some respondents may have had incomplete knowledge about what was actually happening at school, and thus future work should use objective measures of the frequency of teachers using food as a reward in classrooms. The survey items specifically mentioned candy as a type of reward, which may have reduced estimates of using food as a reward if it biased respondents to only consider candy but not other foods (eg, cookies, cupSeptember 2012 Volume 112 Number 9
cakes, or pizza), or healthier foods (eg, fruit or vegetables). However, research in middle schools found that teachers more commonly use candy as a reward (73% of teachers) than pizza (28%) or fruits/vegetables (9%).11
CONCLUSIONS Despite national recommendations against the use of food as a reward, this practice remains common in elementary schools. Where district policy prohibited the use of food as a reward, school respondents were significantly more likely to report that food was not used as a reward. Strengthening formal district policies may improve the elementary school food environment by reducing the prevalence of food-based rewards in classrooms. However, additional research is necessary to examine barriers to school-level implementation of district policies and the effectiveness of alternative classroom management strategies, as well as examining the potential effects of using food as a reward on student weight outcomes.
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Chriqui JF, Schneider L, Chaloupka FJ. School District Wellness Policies: Evaluating Progress and Potential for Improving Children’s Health Three Years After the Federal Mandate. School Years 2006-07, 2007-08 and 2008-09. Vol 2. Chicago, IL: Bridging the Gap, University of Illinois at Chicago; 2010.
31.
Belansky ES, Cutforth N, Delong E, et al. Early effects of the federally mandated Local Wellness Policy on school nutrition environments appear modest in Colorado’s rural, low-income elementary schools. J Am Diet Assoc. 2010;110(11):1712-1717.
32.
22.
American Association for Public Opinion Research. Standard definitions: Final dispositions of case codes and outcome rates for surveys, 2011. http://www.aapor.org/Content/aapor/AdvocacyandInitiatives/ StandardsandEthics/StandardDefinitions/StandardDefinitions2011. pdf. Accessed June 20, 2011.
Gaines AB, Lonis-Shumate SR, Gropper SS. Evaluation of Alabama public school wellness policies and state school mandate implementation. J Sch Health. 2011;81(5):281-287.
33.
Taber DR, Chriqui JF, Chaloupka FJ. Geographic disparities in state and district policies targeting youth obesity. Am J Prev Med. 2011;41(4); 407-414.
23.
Chriqui JF, Chaloupka FJ. Transparency and oversight in local wellness policies. J Sch Health. 2011;81(2):114-121.
34.
24.
Schwartz MB, Lund AE, Grow HM, et al. A comprehensive coding system to measure the quality of school wellness policies. J Am Diet Assoc. 2009;109(7):1256-1262.
Johnson DB, Bruemmer B, Lund AE, Evens CC, Mar CM. Impact of school district sugar-sweetened beverage policies on student beverage exposure and consumption in middle schools. J Adolesc Health. 2009;45(3 suppl):S30-S37.
35.
25.
Chriqui JF, Schneider L, Chaloupka FJ, Ide K, Pugach O. Local Wellness Policies: Assessing School District Strategies for Improving Children’s Health. School Years 2006-07 and 2007-08. Chicago, IL: Bridging the Gap, University of Illinois at Chicago; 2009.
Jones SJ, Gonzalez W, Frongillo EA. Policies that restrict sweetened beverage availability may reduce consumption in elementary-school students. Public Health Nutr. 2010;13(4);589-595.
36.
Mendoza JA, Watson K, Cullen KW. Change in dietary energy density after implementation of the Texas Public School Nutrition Policy. J Am Diet Assoc. 2010;110(3):434-440.
37.
Samuels SE, Bullock SL, Woodward-Lopez G, et al. To what extent have California high schools been able to implement state-mandated nutrition standards? J Adolesc Health. 2009;45(3 suppl):S38-S44.
38.
Phillips MM, Raczynski JM, et al. Changes in school environments with implementation of Arkansas Act 1220 of 2003. Obesity. 2010; 18(suppl):S54-S61.
26.
27.
Chriqui JF, Schneider L, Ide K, Gourdet C, Bruursema A. Bridging the Gap program school district wellness policy-coding tool, Version 2. http://www.bridgingthegapresearch.org/research/district_wellness_ policies/. Accessed December 6, 2011. Briefel RR, Crepinsek MK, Cabili C, Wilson A, Gleason PM. School food environments affect dietary behaviors of US public school children. J Am Diet Assoc. 2009;109(2 suppl):S91-S107.
AUTHOR INFORMATION L. Turner is a senior research specialist and J. F. Chriqui is a senior research scientist, Health Policy Center, and F. J. Chaloupka is a distinguished professor, Department of Economics, and director, Health Policy Center, University of Illinois at Chicago. Address correspondence to: Lindsey Turner, PhD, Health Policy Center, University of Illinois at Chicago, 1747 W Roosevelt Rd, No. 558, Chicago, IL 60608. E-mail: [email protected]
STATEMENT OF POTENTIAL CONFLICT OF INTEREST No potential conflict of interest was reported by the authors.
FUNDING/SUPPORT Funding for this research was provided by the Robert Wood Johnson Foundation.
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September 2012 Volume 112 Number 9
Food as a Reward in the Classroom: School District Policies Are Associated with Practices in US Public Elementary Schools Lindsey Turner, PhD; Jamie F. Chriqui, PhD, MHS; Frank J. Chaloupka, PhD
ARTICLE INFORMATION
ABSTRACT
Article history:
The use of food as a reward for good student behavior or academic performance is discouraged by many national organizations, yet this practice continues to occur in schools. Our multiyear cross-sectional study examined the use of food as a reward in elementary schools and evaluated the association between district policies and school practices. School data were gathered during the 2007-2008, 2008-2009, and 2009-2010 school years via mail-back surveys (N⫽2,069) from respondents at nationally representative samples of US public elementary schools (1,525 unique schools, 544 of which also participated for a second year). During every year, the corresponding district policy for each school was gathered and coded for provisions pertaining to the use of food as a reward. School practices did not change over time and as of the 2009-2010 school year, respondents in 42.1% and 40.7% of schools, respectively, indicated that food was not used as a reward for academic performance or for good student behavior. In multivariate logistic regression analyses controlling for school characteristics and year, having a district policy that prohibited the use of food as a reward was significantly associated with school respondents reporting that food was not used as a reward for academic performance (P⬍0.05) or for good student behavior (P⬍0.05). School-level respondents in the West and the Midwest were less likely to report that food was not used as a reward than were respondents in the South and Northeast. As of 2009-2010, only 11.9% of the districts in our study prohibited the use of food as a reward. Strengthening district policies may reduce the use of food rewards in elementary schools.
Accepted 14 March 2012 Available online 26 May 2012
Keywords: Obesity Schools Reward Policy Copyright © 2012 by the Academy of Nutrition and Dietetics. 2212-2672/$36.00 doi: 10.1016/j.jand.2012.03.025
J Acad Nutr Diet. 2012;112:1436-1442.
R
ECENT DATA INDICATE THAT 32.6% OF ELEMENTARYschool–aged children—those ages 6 to 11 years—are obese or overweight.1 Schools play a key role in shaping children’s dietary intake habits,2 and national authorities have recommended that food not be used as a reward in schools.3 The use of food as a reward for good student behavior or academic performance is problematic for many reasons, including academic, psychological, and health considerations. For the past 4 decades, education researchers have examined the effects of external reinforcement or rewards on academic and behavioral outcomes, with conflicting results. Although numerous reviews and meta-analyses4-6 have examined the influence of a variety of types of rewards on academic performance and student behavior, there is still no clear consensus on whether rewards are pedagogically appropriate. On one hand, some educators argue that when teachers provide students with external rewards for academic performance it reduces students’ own internal motivation,4,7 but others disagree, citing research that indicates no harmful effects from external rewards.5,8 Further, it has also been asserted that the use of rewards may adversely affect students’ development of goal orientations for learning.9,10 1436
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A variety of rewards are common in the classroom; a study of 86 elementary school teachers indicated that all teachers used rewards, and although praise and prizes were most common, many teachers used food rewards for learning engagement and behavior management.9 Further, among 490 middle school teachers, 73% of teachers used candy as a reward or incentive, 37% used cookies/doughnuts, and 28% used pizza.11 These energy-dense products may have adverse health consequences, particularly among younger children because when sugary foods are used as rewards, children learn to associate good behavior with these products,12,13 setting an expectation that is difficult to discourage14 and that persists into adulthood.15 Accordingly, many national organizations recommend that food should not be used as a reward in schools.3,16-18 Although an increasing percentage of schools, districts, and states have developed policies to restrict the use of food as a reward in classrooms, much room for improvement remains. At the school level, the Centers for Disease Control and Prevention (CDC) found that the percentage of schools that prohibited or discouraged teachers from using food or food coupons as a reward for good student behavior or good academic performance increased from 24% in 200019 to 36% in 2006.20 © 2012 by the Academy of Nutrition and Dietetics.
RESEARCH Nationally representative research from the Bridging the Gap project found that during the 2008-2009 school year, 40% of public elementary school students attended school in a district that prohibited or limited the use of food as reward or punishment, up from 32% and 36% during the 2006-2007 and 2007-2008 school years, respectively.21 Nationwide research shows that more states are addressing the use of food as a reward, with the percentage of states that discouraged schools from using food or food coupons as a reward increasing from 13% in 2000 to 45% in 2006.20 Although national studies such as Bridging the Gap and the CDC’s School Health Policies and Programs Study have tracked policies pertaining to food as a reward, thus far no work has examined the association between district policies and school practices. The purpose of our study was to examine the prevalence of using food as a reward in public elementary schools, and to examine the association between school practices and corresponding district policies. It was hypothesized that the use of food as a reward would be less common in schools where district policy prohibited this practice.
METHODS Study Design Data were gathered via a larger annual study on health-related practices and policies in public elementary schools and districts. Analyses used cross-sectional survey data from nationally representative samples of public US elementary schools during the 2007-2008, 2008-2009, and 2009-2010 school years. A total of 2,069 surveys were returned, from 1,525 unique schools across the 3 years (981 schools participated for 1 year, 544 schools participated for 2 years, and no schools participated for all 3 years). All research protocols and survey materials were approved by the Institutional Review Board at the University of Illinois at Chicago.
School-Level Data Collection Surveys were mailed to the principal at each school with a request that the survey (approximately 200 items total) be completed by the principal or other staff with knowledge of nutrition and physical activity practices. Surveys were gathered during the second half of each school year, during January to June, with a small number of responses during the summer following each school year. A $100 incentive was offered to the school or respondent. Surveys were processed and double-entered for quality assurance. Response rates were calculated using the American Association for Public Opinion Research Method Two,22 counting partial responses as complete. Response rates and number of responding schools across the 3 years, respectively, were 70.6% (748 schools), 61.8% (641 schools), and 64.5% (680 schools). Analyses used two survey items developed by the research team to assess use of food as a reward. The items remained identical across the 3 years of data collection. The lead-in asked respondents to “indicate whether the following practices occur at your school.” Items were “food (eg, candy) is used as a reward for good academic performance” and “food (eg, candy) is used as a reward for good behavior.” Response options were: “No;” “Yes, it is up to the teacher;” and “Yes, but it is discouraged.” Before mailing the surveys, cognitive interviews were conducted with three school principals at nonsampled schools, and these items were well-comprehended. September 2012 Volume 112 Number 9
Sampling and Weighting. The school samples were developed at the Institute for Survey Research at the University of Michigan, using sampling frames based on datasets from the National Center for Education Statistics. Because elementary schools vary in grade composition (eg, kindergarten to third grade, second to fifth grade), all schools were required to include third grade. Public schools from all coterminous US states were eligible for sampling. School weights were adjusted for potential nonresponse bias by modeling every school’s propensity to respond. Variables used to model these adjustments included: student enrollment; percent of black, white, and Latino students; percent of students eligible for free or reduced-price lunch; US census region; and urbanicity. Data were weighted to provide inference to all public elementary schools in the United States. The school samples were designed to be nationally representative in each year; some schools participated in multiple years, but analyses were conducted as a stacked cross-sectional design. A total of 2,069 surveys were returned during the 3 years, with 981 schools participating for 1 year only, and 544 schools participating in 2 of the 3 years (each observation was treated as a separate entry, with analyses designed to account for clustering of schools within district and over time). Contextual Factors. To control for school-level factors that could confound the influence of district policies on school practices, data were obtained from the National Center for Education Statistics Common Core of Data for each survey year. Data were obtained on the total number of students in the school, the percentage of students eligible for free or reduced-price lunch, student race/ethnicity, US census region, and locale. School size was divided into tertiles: small (⬍451 students), medium (451 to 621 students), and large (⬎621 students; referent). Racial/ethnic composition was coded as one of four exhaustive and mutually exclusive categories: majority (ⱖ66%) white (referent), majority (ⱖ50%) Latino, majority (ⱖ50%) black, and diverse (no majority).
District-Level Policy Data Collection Formal policy documents (eg, policy manuals and wellness policies as mandated by the Child Nutrition and WIC Reauthorization Act of 2004, PL 108-265, Section 204) were collected from the corresponding school district for each elementary school in the sample, for the corresponding year of data collection. Policies were gathered by trained research assistants using an established protocol via Internet searches, with telephone calls, and/or mailings to find policies that were unavailable online and to verify complete policy collection for policies that were available online. District policies were obtained or verified to not exist for, respectively across the 3 years, 99.3%, 97%, and 98.9% of all schools that returned surveys. Most policies were obtained by Internet search; across the 3 years respectively, 57.2% (n⫽264 of 462), 68.8% (n⫽287 of 417), and 70.4% (n⫽324 of 460) of districts had policies online and the rest were obtained by mail/telephone request. Characteristics of the district policy (eg, strength) did not vary by policy source.23 A total of 879 unique districts were represented (ie, had a school that provided survey data) across the 3 years, 469 of which were represented in 1 year only, 360 for 2 years, and 50 for all 3 years. However, even where districts JOURNAL OF THE ACADEMY OF NUTRITION AND DIETETICS
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RESEARCH Table 1. Demographic characteristics of elementary schools participating in a multiyear cross-sectional study examining the use of food as a reward in elementary schools and evaluating the association between district policies and school practices, by school yeara 2007-2008 (nⴝ748)
2008-2009 (nⴝ641)b
2009-2010 (nⴝ680)c
n
%e
n
%e
n
%e
P valued
Lowest (ⱕ33% eligible)
256
34.4
195
30.9
205
30.1
0.090
Middle (⬎33%-66% eligible)
278
37.3
219
34.7
242
35.6
Highest (⬎66%-100% eligible)
211
28.3
217
34.4
233
34.3
380
50.8
297
46.3
296
43.5
Characteristic Percentage of students eligible for free or reduced-price lunch
Race/ethnicity Majority white students Majority black students
68
9.1
67
10.5
79
11.6
Majority Latino students
129
17.2
120
18.7
108
15.9
Diverse students
171
22.9
157
24.5
197
29.0
City
213
28.5
190
29.6
190
27.9
Suburb
277
37.0
224
35.0
269
39.6
0.035*
Locale
Town
86
11.5
86
13.4
77
11.3
Rural
172
23.0
141
22.0
144
21.2
South
274
36.6
247
38.5
256
37.6
Northeast
110
14.7
93
14.5
101
14.9
Midwest
187
25.0
147
22.9
153
22.5
West
177
23.7
154
24.0
170
25.0
Small (⬍451 students)
280
37.5
221
34.5
253
37.2
Medium (451-621 students)
241
32.3
223
34.8
220
32.4
Large (⬎621 students)
226
30.2
197
30.7
207
30.4
0.572
Region .938
School size 0.665
a
Estimates are unweighted and represent the number (%) of schools at which a respondent returned a survey, broken down into subgroups by demographic characteristics. Among the 641 schools that returned surveys during 2008-2009, 218 also participated during the 2007-2008 school year. c Among the 680 schools that returned surveys in 2009-2010, 326 also participated during the 2008-2009 school year (none participated in both 2007-2008 and 2009-2010, and no schools participated during all 3 years). d Based on 2 test. e Percents sum by column to 100 within category, but due to rounding some may not sum to exactly 100%. *Significant at the 0.05 level (two-tailed). b
were represented for multiple years, the responding schools from within each district often differed across years. All district policies were reviewed and 100% double-coded and analyzed by two trained researchers using an adaptation of a coding scheme developed by Schwartz and colleagues24 and presented by Chriqui and colleagues.21,25,26 After doublecoding was complete, a consensus review was conducted to discuss any discrepancies. In the rare instances (⬍1% of cases) where the coders could not resolve the discrepancy, the policy study lead (a coauthor of this article) made the final determination as to how to code the policy. For our analyses, policy provisions were coded as “1” where a strong policy explicitly prohibited the use of food as a reward, vs “0” otherwise (ie, 1438
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policy discouraged but did not prohibit the use of food as a reward or punishment, encouraged healthier foods as rewards, or did not address the topic). Policy data were entered into a Excel (Microsoft Corp) spreadsheet and a quality assurance review was conducted on 100% of data to resolve any data entry discrepancies.
Statistical Analysis Analyses were conducted in STATA/SE (version 10.1, 2009, StataCorp LP) with the svy command for survey data, and the design statement accounted for sampling stratum and clustering of schools within districts. Two multivariate logistic September 2012 Volume 112 Number 9
RESEARCH Table 2. The percentages of surveys from school-level respondents reporting the use of food as a reward, by school yeara School Year Variable
2007-2008 (nⴝ748)
2008-2009 (nⴝ641)
2009-2010 (nⴝ680)
4™™™™™™™™™™™™™™™™™™™™™ % ™™™™™™™™™™™™™™™™™™™™3 Use of food as a reward for good academic performance Yes, but discouraged
29.3
29.8
28.0
Yes, up to teacher
31.3
28.3
29.9
No
39.4
41.9
42.1
29.1
28.5
29.2
Use of food as a reward for good behavior Yes, but discouraged Yes, up to teacher
29.6
30.4
30.1
No
41.4
41.2
40.7
a
Estimates are weighted at the school level.
regression models were calculated, the first with use of food as a reward for academics as the outcome and the second with use of food as a reward for good behavior as the outcome, with both coded as “1⫽food not used as a reward.” Models included a term for district policy, and two dummy variables to compare the 2007-2008 school year vs 2008-2009 and 2009-2010. Controls were entered for contextual covariates, which were selected to account for characteristics that might influence school practices (school size, race/ethnicity, percent free/reduced-price lunch eligibility, locale, and region). All variables were entered simultaneously into the regression models.
RESULTS During the 2007-2008, 2008-2009, and 2009-2010 school years a total of 2,069 surveys were returned, from 1,525 unique schools (981 schools participated for 1 year, 544 schools participated for 2 years, and none participated during all 3 years). Respectively for each of the 3 years, survey response rates were 70.6%, 61.8%, and 64.5%. Across years, schools were clustered within 462, 417, and 460 districts, with an average number of schools (⫾standard error) within each district, respectively, of 1.61⫾0.05 schools, 1.54⫾0.05 schools, and 1.47⫾0.04 schools. The percentages of districts with a strong policy prohibiting the use of food as a reward across the 3 years was, respectively, 8.4%, 11.2%, and 11.9%; this did not differ significantly across time. The characteristics of schools in the sample were comparable across the 3 years (see Table 1). School-level survey data indicated that food continues to be used as a reward in elementary school classrooms, despite national recommendations against this practice. The use of food as a reward did not change significantly over time, and during the 2009-2010 school year, food was not used as a reward for academic performance or as a reward for good student behavior at 42.1% and 40.7% of schools, respectively (see Table 2). Although the presence of strong district policies prohibiting the use of food as a reward was relatively low, with approximately 10% of districts having such a policy, these policies September 2012 Volume 112 Number 9
were significantly associated with school practices. Multivariate analyses controlling for school contextual factors and year (see Table 3) indicated that where district policy prohibited the use of food as a reward, school respondents were significantly more likely to report that food was not used as a reward for academic performance (odds ratio 1.71, 95% CI 1.09 to 2.67; P⬍0.05) nor for good student behavior (odds ratio 1.66, 95% CI 1.03 to 2.51; P⬍0.05). Logistic regression analyses also revealed significant regional differences in school practices (see Table 3). Schoollevel respondents were less likely to report that food was not used as a reward for good academic performance in the West (37.6%) and the Midwest (27.9%) than in the South (45.6%) and Northeast (56.8%). Likewise, respondents were less likely to report that food was not used as a reward for good behavior in the West (37%) and the Midwest (28.1%) than in the South (44.9%) and Northeast (58.5%).
DISCUSSION Although the educational merits of not using food as a reward may be debatable, the health consequences of having energydense products widely available to students are documented; at schools where energy-dense products are available in competitive venues—such as vending machines, school stores, fundraising, or given as rewards—students report higher energy intake27 and higher body mass index.28 The estimates reported here indicate that approximately 40% of schools did not allow the use of food-based rewards in 2009-2010, which is comparable to prior nationwide estimates from the CDC during 2006 showing that 36% of schools did not allow the use of food or food coupons as rewards.20 Research in middle schools indicated that the use of food as rewards or incentives was common, occurring at 69% of schools, and that such schoolwide food practices were associated with higher student body mass index.29 Although our study did not examine student weight outcomes, and no research thus far has demonstrated that using food as rewards is associated with body mass index among students in elementary school grades, given the demonstrated weight outcomes JOURNAL OF THE ACADEMY OF NUTRITION AND DIETETICS
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RESEARCH Table 3. Results of multivariate logistic regression models to predict use of food as a reward for academic performance and for good behavior in US public elementary schools Reward for Academic Performancea
Reward for Good Behaviora
Independent variables
Odds ratio (95% CI)
P value
Odds ratio (95% CI)
P value
Strong district policy
1.71 (1.09-2.67)
0.019*
1.66 (1.03-2.51)
0.015*
Year 2007-2008
1.00
2008-2009
1.15 (0.89-1.47)
0.286
1.00 1.00 (0.78-1.28)
0.999
2009-2010
1.13 (0.87-1.80)
0.367
0.97 (0.74-1.26)
0.794
Percentage of students eligible for free or reduced-price lunch Lowest (ⱕ33% eligible)
1.00
Middle (⬎33%-66% eligible)
0.84 (0.61-1.15)
0.274
1.00 1.11 (0.81-1.52)
0.507
Highest (⬎66%-100% eligible)
0.86 (0.59-1.27)
0.460
0.90 (0.59-1.36)
0.611
Race/ethnicity Majority white students
1.00
Majority black students
0.62 (0.36-1.05)
1.00 0.077
0.63 (0.37-1.07)
0.090
Majority Latino students
1.32 (0.85-2.04)
0.218
1.41 (0.90-2.21)
0.138
Diverse students
0.83 (0.60-1.14)
0.249
0.92 (0.67-1.27)
0.610
Locale City
1.00
1.00
Suburb
0.85 (0.60-1.20)
0.357
0.80 (0.56-1.12)
0.192
Town
0.60 (0.37-0.97)
0.035*
0.64 (0.41-1.00)
0.050
Rural
0.69 (0.45-1.05)
0.083
0.87 (0.58-1.30)
0.486
Region South
1.00
Northeast
1.27 (0.85-1.89)
1.00 0.236
1.61 (1.09-2.38)
0.017*
Midwest
0.41 (0.28-0.59)
0.000*
0.44 (0.31-0.63)
0.000*
West
0.63 (0.44-0.91)
0.013*
0.66 (0.46-0.95)
0.027*
School size Large (⬎621 students)
1.00
1.00
Medium (451-621 students)
1.06 (0.81-1.38)
0.680
1.07 (0.80-1.43)
0.639
Small (⬍451 students)
1.31 (0.96-1.80)
0.090
1.23 (0.89-1.70)
0.211
a Outcome coded as 1⫽food not used as a reward, 0⫽use of food as a reward discouraged or up to each teacher. *P⬍0.05.
among older students,29 it is prudent to avoid the use of energy-dense products as rewards in elementary schools. Alternatives such as privileges (eg, extra recess or playing an educational computer game) or nonfood rewards (eg, water bottles or stickers) can be appealing, inexpensive, and effective.30 This is the first study to examine the association between district policies and school practices pertaining to the use of food as a reward in a nationally representative sample of elementary schools. Indeed, district policies were associated with school practices, suggesting a potential opportunity for improving the school environment through policy changes. It is important to note that in our study the district food-as-a1440
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reward policies were assessed based on their inclusion in formal wellness policies and related district policy documents. In other words, this work evaluated formal policies “on the books” rather than informal guidelines or policies “in practice” that may also exist at the district level. Thus, the estimates of district policy prevalence are conservative, but given the relationship documented here between formal policies and school practices, additional informal policies would strengthen the relationship between policy and practice. Our work considered only strong policy provisions (ie, prohibitions) but not weaker policies framed as recommendations. As reported elsewhere,21 nationwide district data showed that 11% of public elementary students were enrolled in a September 2012 Volume 112 Number 9
RESEARCH district with a strong policy, and an additional 29% of students were in a district that had a weaker policy, such as a recommendation against using food as a reward or punishment, or encouragement to use only healthy food as a reward. For our analyses, weaker policies were grouped with “no policies” because it was not possible to independently assess the criteria used by schools to determine whether foods were healthy or not; however, given that many districts have weaker policies framed as recommendations but not absolute prohibitions, revisions to strengthen those policies may be warranted. As the US Department of Agriculture develops technical assistance materials and regulations related to wellness policies and competitive food/beverage standards as required by the Healthy, Hunger-Free Kids Act of 2010 (PL 111-296), an opportunity exists to include provisions regarding the use of food as a reward in schools. Early evaluation of school-level implementation of the federal wellness policy mandate indicated that even where districts had developed policies, few evidence-based practices were implemented at schools.31,32 However, more districts continue to develop and strengthen policies,21,33 and research is accumulating to show that district and state policies are associated with school practices. For example, district policies are associated with school sugar-sweetened beverage availability34 as well as student consumption of such beverages.35 Studies in individual states have shown significant improvements in the school food environment following development of laws and policies pertaining to foods in schools.36-38 Nevertheless, future research is needed to identify conditions that facilitate schoollevel implementation of district policies and state laws. Other non-immediate types of rewards such as coupons for food or beverage from outside businesses (eg, national restaurant chains or local stores) may be another source of foodbased rewards, but this study did not examine such incentives nor whether district policy affects such practices. There are important practice implications for food and nutrition practitioners as well as educators in helping schools to identify and implement alternative strategies for classroom management that do not involve energy-dense products. Furthermore, additional research into the effectiveness of nonfood rewards is warranted. Strengths of this study include the large nationally representative sample spanning multiple school years. However, there are also several limitations. The data are cross-sectional and do not allow for inference that district policies improved school practices, only that the two variables are associated. As with all surveys, it is possible that the estimates were biased (eg, desirability bias, nonresponse bias); however, the weights were adjusted to account for nonresponse. Consistency in school-level estimates across the 3 years suggests that the survey measure was reliable, although validity is not guaranteed. The survey was pilot tested with three principals to ensure comprehension; however, some respondents may have misunderstood the question. Further, some respondents may have had incomplete knowledge about what was actually happening at school, and thus future work should use objective measures of the frequency of teachers using food as a reward in classrooms. The survey items specifically mentioned candy as a type of reward, which may have reduced estimates of using food as a reward if it biased respondents to only consider candy but not other foods (eg, cookies, cupSeptember 2012 Volume 112 Number 9
cakes, or pizza), or healthier foods (eg, fruit or vegetables). However, research in middle schools found that teachers more commonly use candy as a reward (73% of teachers) than pizza (28%) or fruits/vegetables (9%).11
CONCLUSIONS Despite national recommendations against the use of food as a reward, this practice remains common in elementary schools. Where district policy prohibited the use of food as a reward, school respondents were significantly more likely to report that food was not used as a reward. Strengthening formal district policies may improve the elementary school food environment by reducing the prevalence of food-based rewards in classrooms. However, additional research is necessary to examine barriers to school-level implementation of district policies and the effectiveness of alternative classroom management strategies, as well as examining the potential effects of using food as a reward on student weight outcomes.
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Taras H, Duncan P, Luckenbill D, Robinson J, Wheeler L, Wooley S. Health, mental health and safety guidelines for schools. 2004. http:// www.nationalguidelines.org. Accessed June 20, 2011.
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AUTHOR INFORMATION L. Turner is a senior research specialist and J. F. Chriqui is a senior research scientist, Health Policy Center, and F. J. Chaloupka is a distinguished professor, Department of Economics, and director, Health Policy Center, University of Illinois at Chicago. Address correspondence to: Lindsey Turner, PhD, Health Policy Center, University of Illinois at Chicago, 1747 W Roosevelt Rd, No. 558, Chicago, IL 60608. E-mail: [email protected]
STATEMENT OF POTENTIAL CONFLICT OF INTEREST No potential conflict of interest was reported by the authors.
FUNDING/SUPPORT Funding for this research was provided by the Robert Wood Johnson Foundation.
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