Eat Smart! Workplace Cafeteria Program: A Valuable Tool to Implement in The Ottawa Hospital Alicia McKellar, Dietetic Intern, Ted Paluch, General Manager, Retail Food Services Research Advisor

This article is based on Alicia McKellar’s dietetic internship report, which was completed under the supervision of Ted Paluch and Joe Murphy, RD. Appreciation goes to: Erinn Salewski, RD - development of the questionnaire Louise Gariepy, Ph.D. - statistical support Frances Furmankiewicz, Director - peer reviewer VanHoutte Coffee - donation of prizes TOH Research Ethics Board TOH Translation Services TOH Printing Services TOH Cafeteria Services (Café 501 & The Greenery) Research participants Acknowledgements

Outline Research Problem Research Objectives Literature Review Methodology Results Discussion Limitations The Next Step… Conclusion References

Is implementing Eat Smart! in The Ottawa Hospital cafeterias worthwhile provided that customers would utilize the program? Research Problem “A company with healthy employees has a positive impact on its community and customer” (1).

The study will determine whether: Customers of Café 501 and The Greenery cafeterias are… 1)Aware of the Eat Smart! program 2)Want healthier food choices 3)Would be influenced to make healthier food choices if a healthy promotion program such as Eat Smart! is implemented in the cafeterias Research Objectives

Overall Goal: contribute to the reduction of food-borne illness and chronic diseases in Ontario (3). Increased awareness and knowledge of healthy eating, food safety and the advantages of being tobacco free Increased availability of healthier food choices in a smoke free environment Promotion of safe, healthier food choices in the cafeteria Eat Smart! programs: Ontario’s Healthy Restaurant Program Healthy School Program Healthy Recreation Centre Program Eat Smart! Workplace Cafeteria Program

Public health units across Ontario give an award of excellence to restaurants that meet specific standards in nutrition, food safety, and non-smoking seating Must meet the standards to qualify Registered Dietitian visit: Review Eat Smart! standards Inspection of the cafeteria Confirm food handler certification Recognized with an Award of Excellence Certificate How to Become Eat Smart! Certified

“ The eating habits of Ontarians can be improved” (1). The Ontario Public Health Association claims the workplace as an ideal setting to implement a health promotion program, as it is a convenient way to reach the adult population through many existing communication channels (1). TOH cafeterias feed meals to thousands of employees, volunteers, patients and visitors daily. “Research shows that healthy, supportive environments are critical for productive and satisfied employees. Health and wellness programs like Eat Smart! help to reduce absenteeism, staff turnover, worker compensation claims, and health insurance claims” (3) Benefits of a Health Promotion Program

Studies have been executed on the Eat Smart! Ontario’s Healthy Restaurant Program: Participating Restaurant Operators: 98% participated to have their establishment known as clean and healthy (4). Eat Smart! is on track in achieving its program objectives (4). Intend to continue participating in the program (4). Non-participating Restaurants: Misunderstandings about how to qualify Lack of time Non-smoking bylaws Potential loss of revenue (5). Research on Eat Smart!

Evaluation of the Nutrition Component: ESWCP -chronic care hospital in Hamilton, ON Assessed: Staff’s frequency of visits and purchases Attitudes about the program Short-term eating behavior change Suggestions to improve the ESWCP (2) Conclusion: Many aware of the program Positive comments Positive changes in eating habits (2) Research on Eat Smart! Continues…

Participants: Convenience sampling Clientele entered the retail area of Café 501 (General campus) or The Greenery (Civic campus) cafeterias (n=747) Clientele consisted of: Patients Employees Volunteers Visitors Inviting all clientele conveyed that everyone’s feedback and suggestions were equally important Methodology

Developed by a dietetic intern Self-administered Bilingual Six closed ended questions: First three: addressed the objectives Last three: revealed demographics of the subject population Introduction Paragraph: Purpose of the study Ensured participants confidentiality Concluding Paragraph: Instructions for submission of completed questionnaires Name and contact information for a draw Pilot test Questionnaire

Dietetic intern distributed the questionnaires Data collection: 2 days (1 day/campus) for 2 hours during lunch Questionnaires accessible to all cafeteria customers Prize: Van Houtte gift basket The Ottawa Hospital research ethics and review committee provided ethical approval for the study Sampling Procedure

SPSS for Windows, Rel Chicago: SPSS Inc. Descriptive Statistics Percentages calculated for each cafeteria separately and together Percentages calculated for differences between age and gender of participants Unanswered questions: results were based on the number of responses Statistics

265 questionnaires completed and returned = 35.5% response rate 146- General 119- Civic Observational Estimation: 75% of customers at the General took a questionnaire 65% of customers at the Civic took a questionnaire Results: Response Rate

Results: Demographics

Results: Demographics continued…

Results: Awareness of Eat Smart! 35% have heard or read about Eat Smart! General 32.6%Civic 37.8% No significant difference between gender 50 years old were more aware

Results: Want Healthier Food Choices 96.2% want healthier food choices in the cafeterias General 95.1% Civic 97.5% 2% do not want healthier choices 2% undecided No significant difference between males and females No significant difference between age groups

Results: Influence of a Health Promotion Program 90.5% would be influenced to make healthier food choices with the implementation of a health promotion program. General 86.1% Civic 94.9% 3.1% would not be influenced 6.9% undecided 90% females 86% males No significant difference between age groups

Summary of Results

Discussion Response Rate: fewer responded compared to other Eat Smart! studies Demographics: More females than males More females use the cafeteria? More inclined to complete a questionnaire? Greater interest in nutrition? Dutch worksite study Employees are the largest customer Age of participants did not show a significant difference in results

Awareness of Eat Smart! 1/3 aware of the program 25% Toronto residents aware in % aware of ESWCP once implemented in workplace promotional materials: on tables, in foodservice area TOH: heard or read about Eat Smart! through a variety of different channels Eat Smart! certified: 788 restaurants 235 schools 147 workplaces

Want Healthier Choices Large majority want healthier choices available in the cafeterias Many do not purchase the healthier choices Comments from other Eat Smart! surveys: “Salad is more expensive than french fries, so where is the incentive to eat healthier while remaining on a budget?” “When offering fruit, lower the prices: a banana in the cafeteria cost 99 cents, I can buy a bunch at the grocery store for that price.”

Influence of a Health Promotion Program TOH statistic: 90.5% Ontario Public Health Association statistic: “70% of employees support employer involvement in workplace health promotion programs”

Limitations Distribution only 2 hours Large entrance/ exit at The Greenery 2 entrances at The Greenery Incentives unavailable Writing materials Statutory Holiday Response rate Personalize questionnaires Follow up / send reminders

The Next Step…. Program promotion Point of purchase table stands Postcards Promotional messages Infonet Increase variety of healthier food choices Influence Behaviour Incentives Coupons

Conclusion The Ottawa Hospital should implement the Eat Smart! Program Further Research: Once implemented, observational research must be conducted to evaluate the program’s actual influence on customer food choice.

The Ottawa Hospital Mission “playing an active role in promoting and improving health within our community”

References (1)Ontario Public Health Association. Nutrition Resource Centre. Toronto. June (2) Dawson J, Dywer JJM, Evers S, et al. Eat Smart! Workplace Cafeteria Program: Evaluation of the Nutrition Component. Can J Diet Prac Res 2006;67: (3) Eat Smart! Workplace cafeteria program manual. Ottawa: Ottawa Public Health Nutrition. (4) Macaskill LA, Dywer JJM, Uetrecht CL, et al. Eat Smart! Ontario’s Healthy Restaurant Program: A Survey of Participating Restaurant Operators. Can J Diet Res 2003 ;64: (5) Dwyer, JJM, Macaskill LA, UetrechtCL, et al. Eat Smart! Ontario’s healthy Restaurant Program: Focus Groups with Non-participating Restaurant Operators. Can J Diet Res 2004:65:6-9 (6) The Ottawa Hospital Retail Food Services Masterplan. July 2006.

References continued… (7) Steenhuis I, Van Assema P, Van Breukelen G, et al. The impact of educational and environmental interventions in Dutch worksite cafeterias. Health Promotion Internatiional : (8)Health Information Team, Planning and Policy Services. Rapid Risk Factor Surveillance System- Toronto Residents: Eat Smart! Healthy Restaurant Program. Toronto Public Health. October (9) Eat Smart! and the Nutrition Resource Centre (10) French, SA. Symposium: Sugar and Fat-From Genes to Culture. Pricing Effects on Food Choices. The American Society for Nutritional Sciences. J. Nutr. March :841S-843S (11) The Ottawa Hospital. Mission