Objective of the survey
As salt intake in children was the theme for Salt Awareness Day 2003, it was decided to conduct an unique survey which would give us a feel for children's attitude towards salt and their understanding of the issues surrounding excessive salt intake.
Analysis of data
CASH conducted a pilot of 20 questionnaires in 2 schools to find out whether there were any problems with the questions in the survey. There were no significant changes, so the data from these questionnaires was used in the final analysis.
We then asked five schools to complete as many surveys as possible with a range of ages (12-16 years). These were all mixed comprehensive schools in St Albans (Hertfordshire), Tooting (London), Durham, Boroughbridge (North Yorkshire) and Angus in Scotland.
Once permission was gained we posted copies of the survey to the schools in Tooting, Durham, Boroughbridge and Angus. As St Albans was a local school to the project coordinator, this was visited and the questionnaires distributed during the first lesson of the day.
Each school was then given a deadline of about 4 weeks to complete and return the surveys. Once surveys were returned it was all entered into an Excel spreadsheet to be analysed.
At the end of each questionnaire, the children were offered the chance to enter into a prize draw. Three children were picked out for a prize which were donated by the Co-op.
SALT AND CHILDREN SURVEY (12-16yr olds)
Name of School: …………………………………………………………………………………
This survey aims to find out how much you know and understand about salt and how it may affect your health.
There will be a prize draw for completed questionnaires once all the surveys have been returned
Year group: ........... Age: ...................
1 If you were to think about how healthy your diet is, what points would you need to consider?
(Tick as many answers you think apply)
a) I should try and eat mostly low calorie foods
b) I should not eat lots of sugar
c) I should include 5 lots of fruit and vegetables in my diet
d) I should be careful about the amount of salt I eat
e) I should not eat lots of wheat in my diet
2 What is the chemical name for salt (used in cooking and sprinkled on food for flavour)?
(Tick the answer you think is right)
a) Sodium chloride
c) Sodium bicarbonate
d) Don't know
3 Tick one answer which you think best describes the amount of salty foods you eat:
a) I eat a lot of salty foods
b) I sometimes eat salty food
c) I hardly eat any salty foods
4 Tick one answer that you think best describes the amount of salt you add to food:
a)I often add extra to my food
b)I sometimes add extra salt to my food
c) I hardly ever add extra salt to my food
5 List these foods in increasing order of salt content:
(Enter the number in each answer with 1 being the least salty and 4 the saltiest)
a) Crisps per bag (25g)
b) Cornflakes per bowlful (40g)
c) Bread 1 medium slice (30g)
d) Tomato ketchup per portion (5g)
6 Where do you think the average person gets the majority of their daily salt intake from?
(tick the answer you think is right)
a) The salt they add from the salt cellar
b) Basic foods like meat, vegetables and milk.
c) Factory made food such as biscuits, breakfast cereals and ready-meals
7 What are the possible health consequences of eating lots of salt?
(You can tick more than one answer)
a) Problems with your heart
b) Problems with your eyes
c) More likelihood of bones breaking
d) Eating too much salt does not cause any health problems
8 What do you think is the maximum recommended daily amount of salt for an adult?
(Tick the answer you think is right)
a) No more than about ½ teaspoon
b) No more than about 1 teaspoon
c) No more than about 1½ teaspoons
d) No more than about 2 teaspoons
9 What do you think is the current average daily intake of salt?
(Tick the answer you think is right)
a) ½-1 teaspoon
b) 1-1½ teaspoons
c) 1½-2 teaspoons
d) 2-2½ teaspoons
10 Are you concerned about the amount of salt you eat?
(tick one answer)
Thanks very much for your time
There were a total of 367 pupils surveyed from St. Albans (30%), Angus (26%) Durham (19%), Leeds (19%) and Tooting (6%).
The ages ranged from 12-16 but only 2% of the sample were actually 16. This is because most of the analysis to place in the autumn term among year 8-11 of the school year, and so few of the year 11 pupils had reached 16. The other age ranges were fairly evenly distributed as were the mix of boys (48%) and girls (52%).
Q1 Healthy eating messages
The importance of eating 5 portions of fruit and vegetables was the most significant health message in terms of a healthy diet (86%), followed by the importance of watching salt intake (70%) and sugar intake (69%). Interestingly, 44% thought that following a low calorie diet was an important health message, which was actually a statement put there as a red herring.
Q2 Chemical name of salt
The majority (60%) knew that salt was sodium chloride, but 13% thought it was sodium. However this is knowledge that school children should acquire early in their secondary school education, although younger pupils were more likely to get the chemical name of salt wrong, as were pupils from schools in Durham and Tooting. Previous surveys (Markettiers Salt survey 2002) have shown that many adults today think that sodium and salt are the same thing - which makes the current trend of just labelling sodium very misleading.
Q3 How much/often do children think they eat salt
The majority answered that they ate salt 'sometimes' (61%), but 16% admitted to eating lots of salt. There was no difference between boys and girls. One must remember, that these are subjective answers and children may not be aware or there may be differences in what is considered 'hardly ever', 'sometimes' or 'a lot of salt'.
Q4 Adding salt to food
41% rarely added salt to food while 40% sometimes did. Only 16% often added salt to food. Boys (19%) were more likely than girls to often add salt, while girls were most likely to rarely add salt (50%). These are not statistics to be complacent about as most salt in the diet (75%) comes from salt already present in the bought processed food - and the type of food that kids eat these days tends to be quite high in salt.
Q5 Ranking salt content of food
The aim of this question was to find out whether children really had any idea of how much salt there is in common processed foods. An overall incorrect answer would mean that they would have found it difficult to correctly judge whether they are high medium or low salt consumers (Q3).
Cornflakes were ranked as having the least salt (by 39% of sample), followed by bread (31%), while crisps were by far ranked as having the most salt (66%).
In fact the least salty food for the amounts stipulated was tomato ketchup, while cornflakes contained the most salt.
Whilst in part this suggests ignorance about the amount of salt in processed foods, it is also a result we anticipated: cornflakes do not taste as salty as crisps or ketchup, and yet cornflakes contain more salt than the other foods listed. This is a situation which the food industry should aim to address.
Q6 Where does most salt in the diet come from
59% correctly identified most salt in the diet as coming from processed foods. However, it was interesting to note that basic non-processed foodstuffs were thought to contribute more salt to the diet (by 26% of respondents) compared to what is added by the salt cellar (by 15% of respondents).
Q7 Health implications of a high salt diet
It is encouraging that 96% understood salt to be linked to heart problems, but only 13% linked it to osteoporosis. Only 4% thought that there was no link to health from excess salt consumption.
Q8 The recommended intake for salt.
The majority (48%) correctly identified the RDA for salt as 1 teaspoon, while the next largest group (24%) thought it was only half a teaspoon. 28% incorrectly identified it as more than a teaspoon.
Q9 Average adult salt intake
On average, we consume between 9-12g of salt a day, or 2-21/2 tsp of salt. Only 12% got the right answer, the rest assuming the average adult ate less than this. This is hardly surprising, as accurate figures for salt intake do not currently exist. Government figures suggest the amount is around 9g whereas researchers in the area who have measured 24-hour sodium levels in urine reckon it is more like 12g. Either way, these levels are higher than those believed by the children in this sample.
Q10 Concerns about salt
70% said they were not concerned about the amount of salt they ate while 30% were concerned. Out of all the questions, this showed the most variation in scores with pupils in Durham being most concerned about salt (50%). Girls show more concern about salt than boys and concern seems to increase with age.
Salt awareness score
Overall awareness scores were good. The topmost score, indicating the highest awareness was 7 and 59% got 4 or more and 82% got 3 or more. Girls got slightly higher scores than the boys (and were also more concerned about salt than boys). It has always been assumed that girls are more tuned into health issues than boys.
Conclusions and recommendations
Overall there was a good level of awareness about the amount of salt that should not be exceeded and the health implications of a high salt diet, there was a poor awareness of the amount of salt currently consumed and the amounts found in processed foods. There seemed to be a lack of concern in the amount of salt being consumed.
Although the children surveyed knew that salt was bad for them and could cause heart problems if consumed to excess, indeed awareness was quite high, almost half didn't care enough to question their consumption - a bit of the 'I'm too young to worry about it' - highlighting the importance of educating that the diet consumed when young is one of the building blocks for a healthy future.
We need to address the fact that although the next generation of adults will be more aware of the implications of salt in the diet, they will possibly not care about the consequences to themselves. Perhaps they will become more health conscious in this respect as they get older? What also needs addressing is the fact that boys seem less concerned than girls, especially as men currently get more cardiovascular disease than women.
Despite a high salt awareness in some respects, there was a lack of understanding of the issues of 'hidden salt' e.g. cereals versus crisps. Even though children were aware that processed foods contain the most salt, presumptions about the salt in certain foods was poor. This issue could be addressed by more consumer education on nutritional labeling and clear labeling of salt on packaging.
Although understanding the recommended upper limit of salt intake, the vast majority of pupils did not realize how high general salt consumption really is and indeed with regards to their own diet, there was a general feeling that most children thought they were not adding very much salt, or indeed generally not eating a high salt diet (Q3 and 4). Could this account for the complacency about salt?
However, children seem to find it hard to judge the amount of salt in processed foods, so would therefore find it hard to judge the amount of salt they were eating. Again this points to a need for the food industry to act to ensure that children do not consume too much salt by eating the foods they enjoy. Action is also needed to ensure that when children do eat processed foods, the label provides clear information with which the children can easily find out how much salt they are eating.
Also, children are unaware the amount of salt an average person consumes. Indeed true accurate figures do not currently exist. This needs to be rectified so that a baseline can be identified in both children and adults, so that changes in salt consumption can be tracked.