Changing fruit and vegetable consumption among children: the 5-a-Day Power Plus program in St. Paul, Minnesota

Prompting methods affect the accuracy of children's school lunch recalls

OBJECTIVES

To evaluate the feasibility of implementing 3 specific prompting methods among students in the first and fourth grades (mean age = 7.2 and 10.1 years, respectively), to validate recall accuracy of first- and fourth-grade students against observation, to develop a single measure of inaccuracy that cumulated errors in reporting food items and amounts without allowing underreporting and overreporting to cancel each other, and to establish information regarding the measure of inaccuracy for use in future studies.

DESIGN

Children were interviewed the morning after they were observed eating lunch provided by the school. Interviews included free recall, nonsuggestive prompted recall, and specific prompted recall (either preference, food category, or visual).

SUBJECTS/SETTING

Ninety-six children (48 students per grade) were studied--32 per the specific prompting method--stratified by grade, sex, and ethnicity (African-American or white). Specific prompting method was randomly assigned to children within strata.

STATISTICAL ANALYSIS

Food items were categorized and weighted as: combination entree = 2, condiments = 1/3, and other = 1. To calculate inaccuracy of recall, absolute differences between amounts reported and observed eaten were calculated for each item and then multiplied by each item's weight; these values were then summed across all items for each child. Inaccuracy of recall was determined before specific prompting and after specific prompting and for the difference (inaccuracy after specific prompting minus inaccuracy before specific prompting).

RESULTS

Before specific prompting, median inaccuracy was 2.7 servings for the 48 first-grade students and 1.7 servings for the 48 fourth-grade students. The median difference in inaccuracy from before to after specific prompting was 0 for both grades. Specific prompting increased recall accuracy for 9 first-graders and 12 fourth-graders, but decreased recall accuracy for 21 first-graders and 7 fourth-graders, and did not change recall accuracy for 18 first-graders and 29 fourth-graders. Among children whose recall accuracy increased after specific prompting, 5 first-graders and 8 fourth-graders received prompting for food category.

APPLICATIONS/CONCLUSIONS

Among first-grade students, specific prompting (either preference, food category, or visual) may hurt more than help recall accuracy. Among fourth-grade students, prompting for food category yields small gains in recall accuracy with minimal losses. Validation studies are needed with larger sample sizes to determine prompting methods that produce more accurate dietary recalls from children of various socioeconomic status groups, other racial/ethnic groups, and at other meals.

Increasing the fruit and vegetable consumption of fourth-graders: results from the high 5 project

BACKGROUND

This study evaluated the effects of a school-based dietary intervention program to increase fruit and vegetable consumption among fourth-graders.

METHODS

Twenty-eight elementary schools were randomized to an immediate intervention condition or to a delayed intervention control condition. Measures of diet and psychosocial variables were collected at base line and 1 and 2 years post-baseline. The intervention included classroom, parent, and cafeteria components.

RESULTS

Mean daily consumption of fruit and vegetables was higher for the intervention children compared with controls at Follow-up 1 (X(t) = 3.96, X(c) = 2.28) and at Follow-up 2 (X(t) = 3.20, X(c) = 2.21). Macro- and micronutrient changes favoring the intervention children were also observed at both Follow-up 1 and Follow-up 2. Mean daily consumption of fruit and vegetables was higher for intervention parents compared with controls at Follow-up 1 (X(t) = 4.23,X(c) = 3.94) but not at Follow-up 2.

CONCLUSIONS

Strong effects were found for the High 5 intervention on fruit and vegetable consumption, on macro- and micro-nutrients, and on psychosocial variables. Future work is needed to enhance the intervention effects on parents' consumption and to test the effectiveness of the intervention when delivered by classroom teachers.

5-a-day Power Plus: process evaluation of a multicomponent elementary school program to increase fruit and vegetable consumption

The 5-a-Day Power Plus program targeted multiethnic fourth- and fifth-grade students in 10 intervention and 10 control urban elementary schools in St. Paul, Minnesota, to increase fruit and vegetable consumption. The intervention included behavioral curricula in classrooms, parental involvement, school food service changes, and food industry support. Process evaluation was conducted by using surveys and classroom and lunchroom observations to assess the characteristics of teachers and food service staff, the degree the intervention was implemented as intended, and exteral factors that may have affected the program results. Results showed high levels of participation, dose, and fidelity for all of the intervention components, with the exception of parental involvement. The process evaluation findings help explain why the increase in fruit and vegetable consumption occurred mostly at school lunch and not at home. Future intervention research should focus on creating new and potent strategies for parental involvement and for increasing the appeal and availability of vegetables.

Gimme 5 fruit and vegetables for fun and health: process evaluation

Gimme 5 (Georgia) was a school-based nutrition education effectiveness trial to help fourth- and fifth-grade students eat more fruit, 100% juice, and vegetables (FJV). Process evaluation assessed fidelity of implementation, reach, and use of intervention materials and environmental mediators: teacher training, curriculum delivery, participation in family activities, attendance at evening point-of-purchase grocery store activities, and availability and accessibility of FJV at home. Approximately half of the curriculum activities were implemented in fourth and fifth grades. The lowest proportion completed were those most pertinent to behavior change. Eighty-seven percent of parents reported participating in homework activities with their fourth grader, 66% with fifth graders. Sixty-five percent of parents reported viewing a video with their child in both grades. Ten percent attended evening point-of-purchase grocery store activities. The low level of implementation and modest level of participation in family activities suggest that higher levels of behavior change may have occurred if exposure to the intervention had been higher.

Gimme 5 fruit, juice, and vegetables for fun and health: outcome evaluation

A theory-based multicomponent intervention (Gimme 5) was designed and implemented to impact fourth- and fifth-grade children's fruit, juice, and vegetable (FJV) consumption and related psychosocial variables. Gimme 5 was a randomized controlled intervention trial with school (n = 16 elementary) as unit of random assignment and analysis. Participants included the cohort of students who were in the third grade in the winter of 1994 and students who joined them in the fourth and fifth grades. The intervention included a curriculum, newsletters, videotapes, and point-of-purchase education. Evaluation included 7-day food records and psychosocial measures from students, telephone interviews with parents, and observational assessments. Favorable results were observed for consumption of FJV combined, FJV consumed at weekday lunch, eating FJV self-efficacy, social norms, asking behaviors, and knowledge. A theory-based school nutrition education program can help change children's FJV consumption and impact factors at home that predispose to FJV consumption, but changes were small, and their persistence is unknown.

Outcomes from a school-based nutrition education program alternating special resource teachers and classroom teachers

This study modified a successful nutrition program to improve its transferability and potential for institutionalization. Specific aims were to determine: 1) if 16 nutrition lessons taught alternately by special resource teachers (SRT) and classroom teachers, could produce outcomes equivalent to 24 SRT lessons; and 2) teachers' reactions to the program. The quasi-experimental design used classrooms (19 treatment and 19 comparison) in matched schools. Surveys and plate waste measured children's outcomes, and classroom teachers were observed and interviewed. Treatment students showed greater knowledge and self-efficacy scores and consumed 0.36 more servings of fruits and vegetables at lunch. Behavioral differences between groups were greater when SRTs provided all instruction. Teachers supported the program and anticipated teaching more nutrition on their own, but noted serious structural barriers. Findings support the need for long-term contact to induce behavior change and the advantage of using teachers specifically trained in nutrition and experiential education.

Cardiovascular disease prevention among youth: visioning the future

Health behaviors among youth are interrelated and appear likely to extend into adult years. Thus cardiovascular disease prevention among youth will continue to be needed and may be critical to the prevention of high risk in the first place. These prevention efforts should be guided by behavioral models and etiological research. Healthy environments are important for the maintenance of healthy behaviors among young people and we need to know better how to change them. Moreover, successful prevention strategies among youth need to be disseminated globally as rapidly as they are found.

Comparison of 3 methods for counting fruits and vegetables for fourth-grade students in the Minnesota 5 A Day Power Plus Program

OBJECTIVE

To compare fruit and vegetable servings calculated from 24-hour dietary recall data using 3 methods: a counting scheme developed for the 5 A Day for Better Health study, a method developed by the University of Minnesota Cancer Prevention Research Unit to quantify total consumption of fruits and vegetables, and a counting scheme based on the US Food and Drug Administration's Reference Amounts. The counting methods differ by food items counted and by serving sizes for those items.

SUBJECTS/SETTING

Record-assisted 24-hour dietary recalls were collected from 617 randomly selected fourth-grade students (317 girls, 300 boys) from 23 schools in St Paul, Minn, participating in the Minnesota 5 A Day Power Plus Program.

DESIGN

The dietary recalls were analyzed using the Minnesota Nutrition Data System (version 2.6/8a/23). Total servings of fruits and vegetables, servings of vegetables, servings of fruits plus juices, servings of fruit juice, and servings of fruit excluding juice were tallied using each counting method.

STATISTICAL ANALYSES

A mixed-model Poisson regression analysis was conducted to compare numbers of servings calculated using the 3 methods.

RESULTS

Counts of daily total fruits and vegetables averaged 3.9 servings with the 5 A Day method, 4.1 servings using US Food and Drug Administration Reference Amounts, and 5.1 servings with the Minnesota Cancer Prevention Research Unit method (P < .0001).

APPLICATIONS

Because the different counting methods yield different tallies of fruit and vegetable intake, it is important for researchers and practitioners interested in fruit and vegetable consumption to be clear about their uses of the data before choosing a counting scheme.