The 5 A day Virtual Classroom: an on-line strategy to promote healthful eating

Web-based Food Behaviour Questionnaire: Validation with Grades Six to Eight Students

Purpose: The web-based Food Behaviour Questionnaire (FBQ) includes a 24-hour diet recall, a food frequency questionnaire, and questions addressing knowledge, attitudes, intentions, and food-related behaviours. The survey has been revised since it was developed and initially validated. The current study was designed to obtain qualitative feedback and to validate the FBQ diet recall.

Methods: “Think aloud” techniques were used in cognitive interviews with dietitian experts (n=11) and grade six students (n=21).Multi-ethnic students (n=201) in grades six to eight at urban southern Ontario schools completed the FBQ and, subsequently, one-on-one diet recall interviews with trained dietitians. Food group and nutrient intakes were compared.

Results: Users provided positive feedback on the FBQ. Suggestions included adding more foods, more photos for portion estimation, and online student feedback. Energy and nutrient intakes were positively correlated between FBQ and dietitian interviews, overall and by gender and grade (all p<0.001). Intraclass correlation coefficients were ≥0.5 for energy and macronutrients, although the web-based survey underestimated energy (-10.5%) and carbohydrate (-15.6%) intakes (p<0.05). Under-estimation of rice and pasta portions on the web accounted for 50% of this discrepancy.

Conclusions: The FBQ is valid, relative to 24-hour recall interviews, for dietary assessment in diverse populations of Ontario children in grades six to eight.

Evaluation of a computer-based nutrition education tool

Objective:

To evaluate the efficacy and feasibility of using a computer-based teaching tool (http://www.coolfoodplanet.org) for nutrition and lifestyle education developed for primary school children.

Design:

This was a 2-week school-based intervention in third and fourth grades. The study design was multi-factorial with repeated measures of nutrition knowledge, at three points in time, of dependent samples from control and intervention groups. Control schools (n=7) used ‘traditional’ nutrition education materials and intervention schools (n=8) additionally used the computer-based educational tool. Qualitative information was collected in focus group discussions with student teachers and pupils, and by observing the nutrition lessons.

Setting/subjects:

Pupils aged 8–11 years (n=271) from participating schools in Vienna, Austria.

Results:

Nutrition knowledge increased significantly in both intervention and control schools, irrespective of the teaching tool used (P<0.001). The significant effect was maintained at 3 months' follow-up. There was no detectable difference in nutrition knowledge post intervention or at follow-up between the two study groups. In intervention schools, younger pupils (8–9 years) had better nutrition knowledge than older pupils (10–11 years) (P=0.011).

Conclusion:

This computer-based tool increases the possibilities of school-based nutrition education. If the tool's weaknesses identified during the formative evaluation are eliminated, it has the potential to make learning about nutrition more enjoyable, exciting and effective. This is of great importance considering that ‘healthy’ nutrition is not necessarily a topic that easily attracts pupils' attention and in view of the potential long-term health benefits of early and effective nutrition education.

Activating multi-ethnic youth for smoking prevention: design, baseline findings, and implementation of project SPLASH

BACKGROUND

Achieving significant reductions in tobacco use by youth is an important challenge. There is a pressing need to develop and evaluate innovative strategies that stimulate youth involvement and are effective in multi-ethnic populations. This article describes an innovative tobacco prevention trial, and reports baseline characteristics of participants and findings about implementation of the curriculum.

METHODS

The aim of Project SPLASH is to evaluate the impact of a school-based smoking prevention intervention that emphasizes active involvement of middle school students, on rates of smoking initiation and regular smoking in a multi-ethnic cohort of youth in Hawaii. Project SPLASH is a group randomized trial that compares a 2-year innovative intervention with a social influence prevention program, in 20 public schools in Hawaii. The main outcome is mean 30-day smoking prevalence rates.

RESULTS

The response rate was 78.4%. Approximately 1 in 4 students had tried smoking and 30-day smoking prevalence at baseline was 8%. Intervention and control groups were comparable in terms of tobacco use, gender, ethnicity, behavioral, environmental, and psychosocial characteristics. Differences in ethnic identification, socio-economic status, acculturation, and involvement in prevention activities may be due to chance. The intervention was well implemented by teachers across both the intervention and control school classes.

CONCLUSION

For this study, 20 schools in Hawaii with close to 4000 participating students were recruited. Student smoking behavior and curriculum implementation were comparable by group status. The intervention study has the potential to elucidate how youth respond to an intervention with student involvement that incorporates cognitive and social action components.

Evaluating changeability to improve fruit and vegetable intake among school aged children

Background

The purposes of this paper are two fold. First, to describe an approach used to identify fruits and vegetables to target for a child focused dietary change intervention. Second, to evaluate the concept of fruit and vegetable changeability and feasibility of applying it in a community setting.

Methods

Steps for identifying changeable fruits and vegetables include (1) identifying a dietary database (2) defining geographic and (3) personal demographics that characterize the food environment and (4) determining which fruits and vegetables are likely to improve during an intervention. The validity of these methods are evaluated for credibility using data collected from quasi-experimental, controlled design among 7–9 year old children (n = 304) participating in a tutoring or mentoring program in St. Louis, MO. Using a 28-item food frequency questionnaire, parents were asked to recall for their child how often foods were eaten the past 7 days. This questionnaire was repeated eight months later (response rate 84%). T-test analyses are used to determine mean serving differences from baseline to post test.

Results

The mean serving differences from baseline to post test were significant for moderately eaten fruits (p < .001), however, not for vegetables (p = .312). Among the intervention group, significantly more children ate grapes (p < .001), peaches (p = .022), cantaloupe (p < .001), and spinach (p = .044) at post testing – all identified as changeable with information tailored to participants.

Conclusion

Data driven, food focused interventions directed at a priority population are feasible and practical. An empirical evaluation of the assumptions associated with these methods supports this novel approach. However, results may indicate that these methods may be more relevant to fruits than vegetables. This process can be applied to diverse populations for many dietary outcomes. Intervention strategies that target only those changeable fruits and vegetables are innovative and warrant further study.

Use of a Web-based component of a nutrition and physical activity behavioral intervention with Girl Scouts

This study describes the development and usage of a Web-based component of a nutrition and physical activity behavioral intervention to promote bone health among preadolescent girls. Thirty Girl Scout troops were randomized to either an intervention or control group for a 2-year period. Girls in the intervention troops (aged 10 to 12 years, N=194) were exposed to grade-specific Web sites that were developed to reinforce the content of the broader, face-to-face intervention. In 5th grade, 82% of the girls logged on once and 48% logged on more than once, compared to 56% and 23% of 6th graders, respectively. Results suggest that although Web-site usage decreased over time, a Web-site program may be useful as a component of a face-to-face, multicomponent intervention. More research is needed to determine ways to enhance and maintain Web-site use over time among youth in health-behavior intervention programs.

Nutrition education in schools: experiences and challenges

Health promotion from the early stages in life by fostering healthy eating practices and regular physical activity has the potential for a major impact on health and well-being during childhood and later stages in life.School-based nutrition education should consider the needs and interests of students, teachers and the school. Educational strategies include efforts to increase health awareness, communication and skill building. Previous literature reviews identified educational strategies directly relevant to a behavioural focus and theory-driven strategies among the elements conducive to successful programmes. Other features that contribute to gain effectiveness are the provision of adequate time and intensity for the intervention, involvement of families, particularly for younger children, and incorporation of self-assessment and feedback in interventions for older children. School meals provide a valuable opportunity for nutrition education. The emphasis on environmental and behavioural factors in successful school-based physical activity and nutrition interventions highlights the importance of involving parents and other community members.

Designing effective nutrition interventions for adolescents

By altering dietary behaviors, nutrition interventions during adolescence have the potential of affecting children at that time and later in life. The majority of interventions implemented in the teen years have occurred in schools, but other intervention sites have included after-school programs, summer camps, community centers, libraries, and grocery stores. Programs with successful outcomes have tended to be behaviorally based, using theories for the developmental framework; included an environmental component; delivered an adequate number of lessons; and emphasized developmentally appropriate strategies. One planning method that can be used in the development of nutrition interventions is Intervention Mapping. The steps of Intervention Mapping include conducting a needs assessment, developing proximal program objectives, mapping appropriate strategies and methods to address the objectives, planning the program design, planning program adoption and implementation, and evaluation. The use of intervention-planning techniques, coordination of nutrition and physical education interventions, using technological advances such as CD-ROMs, incorporation of policy changes into intervention efforts, and dissemination of effective programs are all trends that will influence the future development of effective nutrition programs for adolescents.

School-based nutrition education: lessons learned and new perspectives

Nutrition is a major environmental influence on physical and mental growth and development in early life. Food habits during infancy can influence preferences and practices in later life and some evidence suggests fair to moderate tracking of food habits from childhood to adolescence. Studies support that good nutrition contributes to improving the wellbeing of children and their potential learning ability, thus contributing to better school performance. Children and young people who learn healthy eating habits, are encouraged to be physically active, to avoid smoking and to learn to manage stress, have the potential for reduced impact of chronic diseases in adulthood. Nutrition education is a key element to promoting lifelong healthy eating and exercise behaviours and should start from the early stages of life; it should also address the specific nutritional needs associated with pregnancy, including reinforcing breastfeeding. Food habits are complex in nature and multiple conditioning factors interact in their development. Young children do not choose what they eat, but their parents decide and prepare the food for them. During infancy and early childhood the family is a key environment for children to learn and develop food preferences and eating habits. As they grow and start school, teachers, peers and other people at school, together with the media and social leaders, become more important. Progressively children become more independent and start making their own food choices. The peer group is very important for adolescents and has a major influence in developing both food habits and lifestyles. Community trials suggest that nutrition education is an accessible effective tool in health promotion programmes with a focus on the development of healthy eating practices.