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Getachew-Smith H, King AJ, Marshall C, Scherr CL. Process Evaluation in Health Communication Media Campaigns: A Systematic Review. Am J Health Promot 2021; 36:367-378. [PMID: 34878312 DOI: 10.1177/08901171211052279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective. The objective is to examine the scope of health communication media campaign process evaluation methods, findings, and dissemination practices. Data Source. A systematic review of peer-reviewed literature was conducted using database searches. Study Inclusion and Exclusion Criteria. Published studies on process and implementation evaluation of health campaigns with a media component were included. Exclusion criteria included not health, non-empirical, no media campaign, or a focus on other evaluation types. Data Extraction. Articles were assessed for general campaign information, theory use, and details about process evaluation plan and procedures. Data Synthesis. A coding scheme based on 9 process evaluation best practice elements (e.g., fidelity and context) was applied. Process evaluation methods, measures, and reporting themes were synthesized. Results. Among 691 unique records, 46 articles were included. Process evaluation was the main focus for 71.7% of articles, yet only 39.1% reported how process evaluation informed campaign implementation strategy. Articles reported 4.39 elements on average (SD = 1.99; range 1-9), with reach (87.0%) and recruitment (73.9%) described most frequently, yet reporting was inconsistent. Further, the level of detail in reporting methods, theory, and analysis varied. Conclusions. Process evaluation provides insight about mechanisms and intervening variables that could meaningfully impact interpretations of outcome evaluations; however, process evaluations are less often included in literature. Recommendations for evidence-based process evaluation components to guide evaluation are discussed.
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Affiliation(s)
| | - Andy J King
- Greenlee School of Journalism & Communication, 1177Iowa State University, Ames, IA, USA
| | - Charlotte Marshall
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, 25798Emory University, Atlanta, GA, USA
| | - Courtney L Scherr
- Department of Communication Studies, 3270Northwestern University, Evanston, IL, USA
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Vegetable intake in Australian children and adolescents: the importance of consumption frequency, eating occasion and its association with dietary and sociodemographic factors. Public Health Nutr 2019; 23:474-487. [PMID: 31551110 DOI: 10.1017/s136898001900209x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE We aimed to profile vegetable consumption and its association with dietary and sociodemographic factors. DESIGN Secondary analysis of a nationally representative nutrition survey. 'Vegetables' refers to non-discretionary 'vegetables and legumes/beans' as defined by the Australian Dietary Guidelines (ADG). Prevalence of vegetable consumption, frequency of intake, proportion meeting ADG recommendations, most popular food groups, intake at each reported eating occasion, and the profile of high and low vegetable consumers (based on the median servings) were determined. SETTING Australian 2011-2012 National Nutrition and Physical Activity Survey. PARTICIPANTS Children and adolescents aged 2 to 18 years (n 2812). RESULTS Vegetables were consumed by 83·0% (95% CI 81·6, 84·4%) of participants, but the median vegetable servings was less than a third of the ADG recommendations. 'Leaf and stalk vegetables' and 'potatoes' were the most popular vegetable-dense food groups at lunch and dinner, respectively. Sixty-four percent had vegetables once a day, and predominantly at dinner. Vegetable frequency was positively associated with daily vegetable servings and variety. Participants who consumed vegetables twice a day generally had vegetables at both lunch and dinner and had nearly double the servings (2·6, sd 1·9) of those who consumed them once (1·5, sd 1·5). High vegetable consumers were older, had higher total energy, but lower discretionary energy intake and were less likely to be at risk of metabolic complications. CONCLUSION Increasing the frequency of vegetable consumption may assist with increasing daily vegetable servings. A focus on consuming vegetables at lunch may assist with increasing both total servings and variety.
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Łuszczki E, Sobek G, Bartosiewicz A, Baran J, Weres A, Dereń K, Mazur A. Analysis of Fruit and Vegetable Consumption by Children in School Canteens Depending on Selected Sociodemographic Factors. ACTA ACUST UNITED AC 2019; 55:medicina55070397. [PMID: 31336674 PMCID: PMC6681238 DOI: 10.3390/medicina55070397] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 07/10/2019] [Accepted: 07/19/2019] [Indexed: 12/20/2022]
Abstract
Background and Objectives: Eating habits acquired or changed during childhood are likely to track into adulthood. Due to the fact that nutritional behaviours are not so strongly formed among children, it is easier to change and develop them in children than in adults. The aim of this study was to assess the impact of selected sociodemographic factors affecting fruit and vegetable consumption (i.e., age, parents' body mass index, parents' level education, duration of breastfeeding, child's time spent in front of computer/television) among children in school canteens. Materials and Methods: The sample consisted of 106 participants (52 girls, 54 boys) aged 6-12. The frequency of consuming fruits and vegetables at a school canteen was assessed using bar code cards for two weeks. Body composition estimates were obtained using a foot-to-foot bioelectrical impedance analysis, body height was measured using a stadiometer Seca 213. The questionnaire contained questions about selected factors which can have an influence on fruit and vegetable consumption. In the study group, 13.2% of participants were overweight and 17.9% were obese. Results: Our results showed a statistically significant relationship between age and fruit and vegetable consumption, and it increased with age in both sexes. Conclusions: Bearing in mind the various conditions discussed when shaping the eating habits of pre-school- and early-school-aged children, the importance of proper nutritional education should be stressed both among children and parents.
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Affiliation(s)
- Edyta Łuszczki
- Institute of Nursing and Health Sciences, Faculty of Medicine, University of Rzeszow, 35-959 Rzeszow, Poland
| | - Grzegorz Sobek
- Institute of Nursing and Health Sciences, Faculty of Medicine, University of Rzeszow, 35-959 Rzeszow, Poland
| | - Anna Bartosiewicz
- Institute of Nursing and Health Sciences, Faculty of Medicine, University of Rzeszow, 35-959 Rzeszow, Poland.
| | - Joanna Baran
- Institute of Physiotherapy, Faculty of Medicine, University of Rzeszow, 35-959 Rzeszow, Poland
| | - Aneta Weres
- Institute of Physiotherapy, Faculty of Medicine, University of Rzeszow, 35-959 Rzeszow, Poland
| | - Katarzyna Dereń
- Institute of Nursing and Health Sciences, Faculty of Medicine, University of Rzeszow, 35-959 Rzeszow, Poland
| | - Artur Mazur
- Institute of Nursing and Health Sciences, Faculty of Medicine, University of Rzeszow, 35-959 Rzeszow, Poland
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Stage VC, Kolasa KM, Díaz SR, Duffrin MW. Exploring the Associations Among Nutrition, Science, and Mathematics Knowledge for an Integrative, Food-Based Curriculum. THE JOURNAL OF SCHOOL HEALTH 2018; 88:15-22. [PMID: 29224221 PMCID: PMC5728171 DOI: 10.1111/josh.12576] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Revised: 03/14/2017] [Accepted: 09/19/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Explore associations between nutrition, science, and mathematics knowledge to provide evidence that integrating food/nutrition education in the fourth-grade curriculum may support gains in academic knowledge. METHODS Secondary analysis of a quasi-experimental study. Sample included 438 students in 34 fourth-grade classrooms across North Carolina and Ohio; mean age 10 years old; gender (I = 53.2% female; C = 51.6% female). Dependent variable = post-test-nutrition knowledge; independent variables = baseline-nutrition knowledge, and post-test science and mathematics knowledge. Analyses included descriptive statistics and multiple linear regression. RESULTS The hypothesized model predicted post-nutrition knowledge (F(437) = 149.4, p < .001; Adjusted R = .51). All independent variables were significant predictors with positive association. CONCLUSIONS Science and mathematics knowledge were predictive of nutrition knowledge indicating use of an integrative science and mathematics curriculum to improve academic knowledge may also simultaneously improve nutrition knowledge among fourth-grade students. Teachers can benefit from integration by meeting multiple academic standards, efficiently using limited classroom time, and increasing nutrition education provided in the classroom.
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Affiliation(s)
- Virginia C Stage
- Department of Nutrition Science, College of Allied Health Sciences, East Carolina University, 4310J Health Sciences Building, Greenville, NC 27858
| | - Kathryn M Kolasa
- Department of Family Medicine, Department of Pediatrics, Brody School of Medicine, East Carolina University, Greenville, NC 27858
| | | | - Melani W Duffrin
- Department of Nutrition Science, College of Allied Health Sciences, East Carolina University, Greenville, NC 27858
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Frerichs L, Brittin J, Sorensen D, Trowbridge MJ, Yaroch AL, Siahpush M, Tibbits M, Huang TTK. Influence of school architecture and design on healthy eating: a review of the evidence. Am J Public Health 2015; 105:e46-57. [PMID: 25713964 PMCID: PMC4358206 DOI: 10.2105/ajph.2014.302453] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2014] [Indexed: 11/04/2022]
Abstract
We examined evidence regarding the influence of school physical environment on healthy-eating outcomes. We applied a systems perspective to examine multiple disciplines' theoretical frameworks and used a mixed-methods systematic narrative review method, considering both qualitative and quantitative sources (published through March 2014) for inclusion. We developed a causal loop diagram from 102 sources identified. We found evidence of the influence of many aspects of a school's physical environment on healthy-eating outcomes. The causal loop diagram highlights multilevel and interrelated factors and elucidates the specific roles of design and architecture in encouraging healthy eating within schools. Our review highlighted the gaps in current evidence and identified areas of research needed to refine and expand school architecture and design strategies for addressing healthy eating.
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Affiliation(s)
- Leah Frerichs
- At the time of the study, Leah Frerichs, Jeri Brittin, Amy L. Yaroch, Mohammad Siahpush, Melissa Tibbits, and Terry T.-K. Huang were with the College of Public Health, University of Nebraska Medical Center, Omaha. Dina Sorensen is with VMDO Architects, Charlottesville, VA. Matthew J. Trowbridge is with the School of Medicine, University of Virginia, Charlottesville
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Carraway-Stage V, Hovland J, Showers C, Díaz S, Duffrin MW. Food-based science curriculum yields gains in nutrition knowledge. THE JOURNAL OF SCHOOL HEALTH 2015; 85:231-240. [PMID: 25731197 PMCID: PMC7489299 DOI: 10.1111/josh.12243] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Revised: 07/31/2014] [Accepted: 10/22/2014] [Indexed: 06/04/2023]
Abstract
BACKGROUND Students may be receiving less than an average of 4 hours of nutrition instruction per year. Integrating nutrition with other subject areas such as science may increase exposure to nutrition education, while supporting existing academics. METHODS During the 2009-2010 school year, researchers implemented the Food, Math, and Science Teaching Enhancement Resource (FoodMASTER) Intermediate (FMI) curriculum in 18 fourth-grade classrooms, whereas 16 classrooms served as comparison. FMI is a hands-on, integrative curriculum for children in grades 3-5 that uses food as a tool to teach mathematics and science. Researchers developed a 28-item multiple-choice questionnaire to assess students' nutrition knowledge in 6 content areas. Students were evaluated at baseline and post-intervention. Data were analyzed using independent t tests. Analysis of covariance was employed to control for differences at baseline when assessing the effectiveness of the FMI curriculum to increase nutrition knowledge. RESULTS A significant improvement was observed in total nutrition knowledge at post-intervention (adjusting for baseline) between groups (F [1] = 128.95; p < .01) and in all content areas post-intervention. CONCLUSIONS Findings from this study suggest teachers were successfully able to integrate science and nutrition to meet multiple academic standards. More specifically, results showed implementation of the integrative FMI curriculum effectively improved fourth-graders' nutrition knowledge compared with students not exposed to FMI.
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Affiliation(s)
- Virginia Carraway-Stage
- Department of Nutrition Science, East Carolina University, Nutrition Science, E 1000 5th St, Rivers 266, Greenville, NC 27834.
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Christian MS, Evans CEL, Cade JE. Does the Royal Horticultural Society Campaign for School Gardening increase intake of fruit and vegetables in children? Results from two randomised controlled trials. PUBLIC HEALTH RESEARCH 2014. [DOI: 10.3310/phr02040] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundChildren’s fruit and vegetable intake in the UK is low. Changing intake is challenging. Gardening in schools might be a vehicle for facilitating fruit and vegetable intake.ObjectivesTo undertake the first clustered randomised controlled trials (RCTs) of a gardening intervention. To evaluate the impact of a school gardening programme, the Royal Horticultural Society (RHS) Campaign for School Gardening, on children’s fruit and vegetable intake.MethodsPrimary school children aged 8–11 years from eight London boroughs were included in one of two related RCTs. Trial 1 consisted of 23 schools, randomised to receive either a RHS-led or teacher-led intervention. Trial 2 consisted of 31 schools, randomised to either the teacher-led intervention or a comparison group. A 24-hour food diary [the Child And Diet Evaluation Tool (CADET)] collected baseline and follow-up dietary intake. Questionnaires measured children’s knowledge and attitudes towards fruit and vegetables and assessed intervention implementation. Data were collected by fieldworkers who were blind to the original allocation of the school. The primary outcome was change in fruit and vegetable intake analysed using a random effects model, based on intention to treat.ResultsTotal sample size at baseline for both trials (2529 children) was lower than the original aim of 2900 children. The final sample size was 1557, with 641 children completing trial 1 (RHS-led,n = 312; teacher-led,n = 329) and 916 children completing trial 2 (teacher-led,n = 488; control,n = 428). The response rate at follow-up for the two combined was 62%.Baseline analysis of children’s fruit and vegetable intake showed that eating a family meal together, cutting up fruit and vegetables, and parental modelling of fruit and vegetable intakes were all associated with higher intakes of fruit and vegetables in children.The primary trial outcome, combined fruit and vegetable intake, showed that in trial 1 the teacher-led group had a mean change in intake of 8 g [95% confidence interval (CI) –19 to 36 g], compared with a mean of –32 g (95% CI –60 to –3 g) in the RHS-led group. However, this difference was not significant (intervention effect –43 g, 95% CI –88 to 1 g;p = 0.06). In trial 2, the teacher-led group consumed 15 g (95% CI –36 to 148 g) more fruit and vegetables than the comparison group; this difference was not significant. No change was found in children’s knowledge and attitudes. However, if schools improved their RHS gardening score by three levels, children had a higher intake of 81 g of fruit and vegetables (95% CI 0 to 163 g;p = 0.05) compared with schools with no change in gardening score.ConclusionResults from these trials provide little evidence that school gardening alone can improve children’s fruit and vegetable intake. In both trials, gardening levels increased across all groups from baseline to follow-up, with no statistically significant difference between groups in terms of improvement in gardening level. This lack of differentiation between groups is likely to have influenced the primary outcome. However, when the gardening intervention was implemented at the highest intensities there was a suggestion that it could improve children’s fruit and vegetable intake by a portion. Analysis of the baseline data showed that family support for fruit and vegetable intakes was associated with higher intakes of fruit and vegetables in children. This study highlights the need for more sophisticated and accurate tools to evaluate diet in children. Future intervention designs should include a greater level of parental involvement in school interventions, along with related components such as cooking, to substantially improve children’s fruit and vegetable intake. In addition, the home environment has been demonstrated to be an important focus for intervention.Trial registrationCurrent Controlled Trials ISRCTN11396528.FundingThis project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full inPublic Health Research; Vol. 2, No. 4. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Meaghan S Christian
- Nutritional Epidemiology Group, School of Food Science and Nutrition, University of Leeds, Leeds, UK
| | - Charlotte EL Evans
- Nutritional Epidemiology Group, School of Food Science and Nutrition, University of Leeds, Leeds, UK
| | - Janet E Cade
- Nutritional Epidemiology Group, School of Food Science and Nutrition, University of Leeds, Leeds, UK
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Terry-McElrath YM, O'Malley PM, Johnston LD. Accessibility over availability: associations between the school food environment and student fruit and green vegetable consumption. Child Obes 2014; 10:241-50. [PMID: 24872011 PMCID: PMC4088349 DOI: 10.1089/chi.2014.0011] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND No national studies have examined associations between (1) school food availability and accessibility and (2) secondary student fruit and vegetable (FV) consumption. This article uses 5 years of nationally representative data from secondary school students to examine associations between the school food environment and student fruit and green vegetable consumption. METHODS From 2008 to 2012, cross-sectional, nationally representative data from US middle and high school students were collected annually on self-reported fruit and green vegetable consumption. Each year, data from administrators at each relevant school were collected on food item availability (any venue) and accessibility (total number of school sources). Data were obtained from 10,254 eighth-grade students in 317 schools and 18,898 tenth- and 12th-grade students in 518 schools. Associations were estimated by multi-level models controlling for student- and school-level characteristics. RESULTS Availability showed minimal association with student consumption. Candy/regular-fat snack accessibility was associated negatively with middle school fruit consumption. Salad bar availability and accessibility were positively associated with middle school green vegetable consumption; FV accessibility was associated positively with high school fruit and green vegetable consumption. Significant associations were consistent across student racial/ethnic and socioeconomic groups. CONCLUSIONS Forthcoming USDA nutrition standards for school foods and beverages sold outside of reimbursable meal programs should result in the removal of school candy/regular-fat snacks. In deciding which items to make available under the new standards, schools should consider increasing the number of FV sources-including salad bars-thereby potentially increasing student FV consumption.
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Langford R, Bonell CP, Jones HE, Pouliou T, Murphy SM, Waters E, Komro KA, Gibbs LF, Magnus D, Campbell R. The WHO Health Promoting School framework for improving the health and well-being of students and their academic achievement. Cochrane Database Syst Rev 2014:CD008958. [PMID: 24737131 DOI: 10.1002/14651858.cd008958.pub2] [Citation(s) in RCA: 272] [Impact Index Per Article: 27.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The World Health Organization's (WHO's) Health Promoting Schools (HPS) framework is an holistic, settings-based approach to promoting health and educational attainment in school. The effectiveness of this approach has not been previously rigorously reviewed. OBJECTIVES To assess the effectiveness of the Health Promoting Schools (HPS) framework in improving the health and well-being of students and their academic achievement. SEARCH METHODS We searched the following electronic databases in January 2011 and again in March and April 2013: Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, PsycINFO, CINAHL, Campbell Library, ASSIA, BiblioMap, CAB Abstracts, IBSS, Social Science Citation Index, Sociological Abstracts, TRoPHI, Global Health Database, SIGLE, Australian Education Index, British Education Index, Education Resources Information Centre, Database of Education Research, Dissertation Express, Index to Theses in Great Britain and Ireland, ClinicalTrials.gov, Current controlled trials, and WHO International Clinical Trials Registry Platform. We also searched relevant websites, handsearched reference lists, and used citation tracking to identify other relevant articles. SELECTION CRITERIA We included cluster-randomised controlled trials where randomisation took place at the level of school, district or other geographical area. Participants were children and young people aged four to 18 years, attending schools or colleges. In this review, we define HPS interventions as comprising the following three elements: input to the curriculum; changes to the school's ethos or environment or both; and engagement with families or communities, or both. We compared this intervention against schools that implemented either no intervention or continued with their usual practice, or any programme that included just one or two of the above mentioned HPS elements. DATA COLLECTION AND ANALYSIS At least two review authors identified relevant trials, extracted data, and assessed risk of bias in the trials. We grouped different types of interventions according to the health topic targeted or the approach used, or both. Where data permitted, we performed random-effects meta-analyses to provide a summary of results across studies. MAIN RESULTS We included 67 eligible cluster trials, randomising 1443 schools or districts. This is made up of 1345 schools and 98 districts. The studies tackled a range of health issues: physical activity (4), nutrition (12), physical activity and nutrition combined (18), bullying (7), tobacco (5), alcohol (2), sexual health (2), violence (2), mental health (2), hand-washing (2), multiple risk behaviours (7), cycle-helmet use (1), eating disorders (1), sun protection (1), and oral health (1). The quality of evidence overall was low to moderate as determined by the GRADE approach. 'Risk of bias' assessments identified methodological limitations, including heavy reliance on self-reported data and high attrition rates for some studies. In addition, there was a lack of long-term follow-up data for most studies.We found positive effects for some interventions for: body mass index (BMI), physical activity, physical fitness, fruit and vegetable intake, tobacco use, and being bullied. Intervention effects were generally small but have the potential to produce public health benefits at the population level. We found little evidence of effectiveness for standardised body mass index (zBMI) and no evidence of effectiveness for fat intake, alcohol use, drug use, mental health, violence and bullying others; however, only a small number of studies focused on these latter outcomes. It was not possible to meta-analyse data on other health outcomes due to lack of data. Few studies provided details on adverse events or outcomes related to the interventions. In addition, few studies included any academic, attendance or school-related outcomes. We therefore cannot draw any clear conclusions as to the effectiveness of this approach for improving academic achievement. AUTHORS' CONCLUSIONS The results of this review provide evidence for the effectiveness of some interventions based on the HPS framework for improving certain health outcomes but not others. More well-designed research is required to establish the effectiveness of this approach for other health topics and academic achievement.
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Affiliation(s)
- Rebecca Langford
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, UK, BS8 2PS
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Neuhaus M, Healy GN, Fjeldsoe BS, Lawler S, Owen N, Dunstan DW, LaMontagne AD, Eakin EG. Iterative development of Stand Up Australia: a multi-component intervention to reduce workplace sitting. Int J Behav Nutr Phys Act 2014; 11:21. [PMID: 24559162 PMCID: PMC3936706 DOI: 10.1186/1479-5868-11-21] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Accepted: 02/17/2014] [Indexed: 12/04/2022] Open
Abstract
Background Sitting, particularly in prolonged, unbroken bouts, is widespread within the office workplace, yet few interventions have addressed this newly-identified health risk behaviour. This paper describes the iterative development process and resulting intervention procedures for the Stand Up Australia research program focusing on a multi-component workplace intervention to reduce sitting time. Methods The development of Stand Up Australia followed three phases. 1) Conceptualisation: Stand Up Australia was based on social cognitive theory and social ecological model components. These were operationalised via a taxonomy of intervention strategies and designed to target multiple levels of influence including: organisational structures (e.g. via management consultation), the physical work environment (via provision of height-adjustable workstations), and individual employees (e.g. via face-to-face coaching). 2) Formative research: Intervention components were separately tested for their feasibility and acceptability. 3) Pilot studies: Stand Up Comcare tested the integrated intervention elements in a controlled pilot study examining efficacy, feasibility and acceptability. Stand Up UQ examined the additional value of the organisational- and individual-level components over height-adjustable workstations only in a three-arm controlled trial. In both pilot studies, office workers’ sitting time was measured objectively using activPAL3 devices and the intervention was refined based on qualitative feedback from managers and employees. Results Results and feedback from participants and managers involved in the intervention development phases suggest high efficacy, acceptance, and feasibility of all intervention components. The final version of the Stand Up Australia intervention includes strategies at the organisational (senior management consultation, representatives consultation workshop, team champions, staff information and brainstorming session with information booklet, and supportive emails from managers to staff), environmental (height-adjustable workstations), and individual level (face-to-face coaching session and telephone support). Stand Up Australia is currently being evaluated in the context of a cluster-randomised controlled trial at the Department of Human Services (DHS) in Melbourne, Australia. Conclusions Stand Up Australia is an evidence-guided and systematically developed workplace intervention targeting reductions in office workers’ sitting time.
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Affiliation(s)
- Maike Neuhaus
- The University of Queensland, School of Population Health, Cancer Prevention Research Centre, Herston, Queensland, Australia.
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Krølner R, Rasmussen M, Brug J, Klepp KI, Wind M, Due P. Determinants of fruit and vegetable consumption among children and adolescents: a review of the literature. Part II: qualitative studies. Int J Behav Nutr Phys Act 2011; 8:112. [PMID: 21999291 PMCID: PMC3260149 DOI: 10.1186/1479-5868-8-112] [Citation(s) in RCA: 201] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2011] [Accepted: 10/14/2011] [Indexed: 11/30/2022] Open
Abstract
Background Large proportions of children do not fulfil the World Health Organization recommendation of eating at least 400 grams of fruit and vegetables (FV) per day. To promote an increased FV intake among children it is important to identify factors which influence their consumption. Both qualitative and quantitative studies are needed. Earlier reviews have analysed evidence from quantitative studies. The aim of this paper is to present a systematic review of qualitative studies of determinants of children's FV intake. Methods Relevant studies were identified by searching Anthropology Plus, Cinahl, CSA illumine, Embase, International Bibliography of the Social Sciences, Medline, PsycINFO, and Web of Science using combinations of synonyms for FV intake, children/adolescents and qualitative methods as search terms. The literature search was completed by December 1st 2010. Papers were included if they applied qualitative methods to investigate 6-18-year-olds' perceptions of factors influencing their FV consumption. Quantitative studies, review studies, studies reported in other languages than English, and non-peer reviewed or unpublished manuscripts were excluded. The papers were reviewed systematically using standardised templates for summary of papers, quality assessment, and synthesis of findings across papers. Results The review included 31 studies, mostly based on US populations and focus group discussions. The synthesis identified the following potential determinants for FV intake which supplement the quantitative knowledge base: Time costs; lack of taste guarantee; satiety value; appropriate time/occasions/settings for eating FV; sensory and physical aspects; variety, visibility, methods of preparation; access to unhealthy food; the symbolic value of food for image, gender identity and social interaction with peers; short term outcome expectancies. Conclusions The review highlights numerous potential determinants which have not been investigated thoroughly in quantitative studies. Future large scale quantitative studies should attempt to quantify the importance of these factors. Further, mechanisms behind gender, age and socioeconomic differences in FV consumption are proposed which should be tested quantitatively in order to better tailor interventions to vulnerable groups. Finally, the review provides input to the conceptualisation and measurements of concepts (i.e. peer influence, availability in schools) which may refine survey instruments and theoretical frameworks concerning eating behaviours.
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Affiliation(s)
- Rikke Krølner
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark.
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Schulbasierte Prävention der Adipositas. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2010; 53:207-20. [DOI: 10.1007/s00103-009-1017-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Beydoun MA, Wang Y. Parent-child dietary intake resemblance in the United States: evidence from a large representative survey. Soc Sci Med 2009; 68:2137-44. [PMID: 19375837 PMCID: PMC2730650 DOI: 10.1016/j.socscimed.2009.03.029] [Citation(s) in RCA: 95] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2008] [Indexed: 10/20/2022]
Abstract
We studied the association in dietary intakes and patterns between parents (aged 20-65 years) and their children (aged 2-18 years), using nationally representative data collected by the US Department of Agriculture (USDA) in the Continuing Survey of Food Intake by Individuals 1994-96. We analyzed two 24-h recall dietary data for 1061 fathers, 1230 mothers, 1370 sons and 1322 daughters. All analyses adjusted for sampling design complexity. We assessed multivariate-adjusted parent-child correlations in selected nutrients, food groups and overall dietary quality assessed using the new USDA 2005 Healthy Eating Index score (HEI(n)). The parent-child correlations were weak or moderate (0.20-0.33) for most intake measures. There were clear patterns of interaction with gender dyads in the intakes of calcium and dairy products (P<0.05 for dyadxparental intake), whereby multivariate-adjusted correlations in mother-daughter or mother-child dyads were significantly stronger compared to their father-child counterparts. The reverse was true for multivariate-adjusted correlations in HEI(n). Hispanics and other ethnic groups had significantly stronger resemblance than Non-Hispanic whites and blacks in soft drinks and HEI(n). Resemblance in general was stronger among older children, though the reverse was true when considering agreement in HEI(n)'s upper quintile. The influence of family income and parental education on the resemblance was small. In conclusion, parent-child dietary resemblance in the US is relatively weak, and varies by nutrients and food groups, and by the types of parent-child dyad and population groups. Factors other than parental eating behaviors seem to play an important role in affecting American young people's dietary intake.
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Affiliation(s)
| | - Youfa Wang
- Johns Hopkins School of Public Health, Center for Human Nutrition, Department of International Health, 615 N Wolfe St., Room E2546, Baltimore, MD 21205, United States
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te Velde SJ, Twisk JWR, Brug J. Tracking of fruit and vegetable consumption from adolescence into adulthood and its longitudinal association with overweight. Br J Nutr 2007; 98:431-8. [PMID: 17433126 DOI: 10.1017/s0007114507721451] [Citation(s) in RCA: 126] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The objective of the present study was to assess to what extent fruit and vegetable intakes track over a 24-year time period and to assess longitudinal associations between fruit and vegetable intakes and (change in) BMI and sum of skinfolds. Dietary intake and anthropometrics were repeatedly assessed for 168 men and women between the ages of 12 and 36 years. Linear general estimating equations analyses were applied (1) to estimate tracking coefficients, (2) to estimate predictability for meeting the national recommendation for fruit and vegetable intake and for being in the highest quartile for fruit and vegetable intake, and (3) to estimate the association between fruit and vegetable intake and BMI and sum of skinfolds. We found that tracking coefficients were 0·33 (P < 0·001) for fruit intake and 0·27 (P < 0·001) for vegetable intake. Mean fruit intake decreased over a 24-year period. For fruit intake, predictability was higher in men than in women (OR 6·02 (P < 0·001) and 2·33 (P = 0·001) for meeting the recommendation for men and women respectively). After adjustment, fruit intake was not associated with BMI, but being in the lowest quartile of fruit intake was significantly associated with a lower sum of skinfolds. Women in the lowest quartiles of vegetable intake had significantly higher BMI and sum of skinfolds and also greater positive changes in these parameters. In conclusion, tracking and predictability for fruit and vegetable intake appear to be low to moderate, which might indicate that fruit and vegetable promotion should be started at an early age and continued into adulthood. Despite the fact that we only observed beneficial weight-maintaining effects of vegetable intake in women, promoting vegetables is important for both sexes because of other positive properties of vegetables. No evidence was found for promoting fruit intake as a means of weight maintenance.
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Affiliation(s)
- Saskia J te Velde
- Department of Public Health, Erasmus University Medical Centre Rotterdam, Room AE-130, PO Box 2040, 3000 CA Rotterdam, the Netherlands.
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Rao DR, Vijayapushpam T, Subba Rao GM, Antony GM, Sarma KVR. Dietary habits and effect of two different educational tools on nutrition knowledge of school going adolescent girls in Hyderabad, India. Eur J Clin Nutr 2007; 61:1081-5. [PMID: 17299495 DOI: 10.1038/sj.ejcn.1602622] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVES To assess dietary habits and nutrition knowledge levels of the adolescent girls from different schools and to study the efficacy of two different nutrition education tools in improving their nutrition knowledge in the classroom setting. DESIGN Purposive sampling technique was adapted for selecting the subjects in the study. SETTING Four secondary schools in Hyderabad, India. SUBJECTS In total, 164 adolescent girls belonging to eighth grade. INTERVENTIONS Two interventions (Intervention-1. Traditional method using print media such as folders leaflets and charts; Intervetion-2. Audio-visual CD) were carried out in a classroom setting for the experimental group. RESULTS FFQ data on dietary consumption of adolescent girls revealed more consumption of aerated drinks, bakery items, fast foods and less consumption of millets irrespective of their socio-economic conditions. However, consumption of vegetables, green leafy vegetables and fruits was moderate. A significant improvement in the nutrition related knowledge was observed among the experimental group after interventions-1 and -2 as compared to the baseline data. However, no significant difference in the improvement of nutrition knowledge levels was observed with the second intervention over the first intervention as already the children in the experimental group gained knowledge through print media. CONCLUSIONS Education on ill effects of aerated drinks, fast foods and the importance of nutrition during the adolescent phase should be emphasized in future programmes.
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Affiliation(s)
- D Raghunatha Rao
- Extension & Training Division, National Institute of Nutrition (ICMR), Jamai-Osmania, Hyderabad, Andhra Pradesh, India.
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Folta SC, Goldberg JP, Economos C, Bell R, Landers S, Hyatt R. Assessing the use of school public address systems to deliver nutrition messages to children: Shape up Somerville--audio adventures. THE JOURNAL OF SCHOOL HEALTH 2006; 76:459-64; quiz 482-4. [PMID: 17026639 DOI: 10.1111/j.1746-1561.2006.00141.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Given the current childhood obesity epidemic, it is especially important to find effective ways to promote healthful foods to children. School public address (PA) systems represent an inexpensive and a replicable way of reaching children with health messages. To test the effectiveness of this channel, messages were created to promote 2 dried bean (legume) dishes that had been added to the school lunch menu. Six elementary schools were pair matched, and 1 school from each pair was randomly chosen to play the messages. The impact of the intervention on choice of the 2 new entrees was assessed. Results indicate that for all schools combined, choice was not significantly affected. However, compared to their matched control schools, choice was significantly higher in the school that received the highest dose of the intervention and was significantly lower in the school that received the lowest dose. Choice was not changed in the school that received an intermediate dose. These results suggest that PA systems show promise as an effective and appropriate communications channel but only in schools that are able to play messages frequently.
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Affiliation(s)
- Sara C Folta
- John Hancock Center for Physical Activity and Nutrition, Gerald J. and Dorothy R Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA 02111, USA.
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te Velde SJ, Wind M, van Lenthe FJ, Klepp KI, Brug J. Differences in fruit and vegetable intake and determinants of intakes between children of Dutch origin and non-Western ethnic minority children in the Netherlands - a cross sectional study. Int J Behav Nutr Phys Act 2006; 3:31. [PMID: 16995936 PMCID: PMC1599740 DOI: 10.1186/1479-5868-3-31] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2005] [Accepted: 09/22/2006] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Fruit and vegetable consumption is low in the Netherlands and a key target in healthy diet promotion. However, hardly any information is available on differences in fruit and vegetable consumption between Dutch children and ethnic minority children. Therefore, the aim of present study was to determine differences in usual fruit and vegetable intake between native Dutch and non-Western ethnic minority children and to study differences in and mediating effects of potential psychosocial and environmental determinants. METHODS Ethnicity, usual fruit and vegetable consumption, psychosocial and environmental determinants and mothers' educational level were measured with a self-administered questionnaire during school hours in primary schools in Rotterdam, the Netherlands. Complete data was available for 521 10-11 year-old-children, of which 50.5% of non-Western origin. Differences between the groups regarding potential determinants and fruit and vegetable intake were assessed with Mann Whitney tests or multiple regression analyses. Multiple regression analyses were also conducted to assess mediating effects. RESULTS Ethnic minority girls ate fruit more frequently (1.41 +/- 1.0 times/day) than Dutch girls (1.03 +/- 0.82 times/day); no differences in frequency of intake were found for vegetables or among boys. Ethnic differences were found for almost all potential determinants. The Dutch children reported lower scores on these determinants than the ethnic minority children, except for perceived self-efficacy and barriers to eat fruit and vegetables. Knowledge of recommendations and facilitating behaviors of the parents mediated the association between ethnicity and fruit consumption among girls. CONCLUSION Ethnic minority girls in the Netherlands appear to have more favorable fruit intakes than Dutch girls, and ethnic minority children in general show more positive prerequisites for fruit and vegetable consumption. Interventions addressing multi-ethnic populations of children must take such differences into account.
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Affiliation(s)
- Saskia J te Velde
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, The Netherlands
| | - Marianne Wind
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, The Netherlands
| | - Frank J van Lenthe
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, The Netherlands
| | - Knut-Inge Klepp
- Department of Nutrition, Faculty of Medicine, University of Oslo, Norway
| | - Johannes Brug
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, The Netherlands
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Tercyak KP, Tyc VL. Opportunities and challenges in the prevention and control of cancer and other chronic diseases: children's diet and nutrition and weight and physical activity. J Pediatr Psychol 2006; 31:750-63. [PMID: 16820383 DOI: 10.1093/jpepsy/jsj126] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE The purpose of this article is to review the role of behavioral research in disease prevention and control, with a particular emphasis on lifestyle- and behavior-related cancer and chronic disease risk factors--specifically, relationships among diet and nutrition and weight and physical activity with adult cancer, and tracking developmental origins of these health-promoting and health-compromising behaviors from childhood into adulthood. METHOD After reviewing the background of the field of cancer prevention and control and establishing plausibility for the role of child health behavior in adult cancer risk, studies selected from the pediatric published literature are reviewed. Articles were retrieved, selected, and summarized to illustrate that results from separate but related fields of study are combinable to yield insights into the prevention and control of cancer and other chronic diseases in adulthood through the conduct of nonintervention and intervention research with children in clinical, public health, and other contexts. RESULTS As illustrated by the evidence presented in this review, there are numerous reasons (biological, psychological, and social), opportunities (school and community, health care, and family settings), and approaches (nonintervention and intervention) to understand and impact behavior change in children's diet and nutrition and weight and physical activity. CONCLUSIONS Further development and evaluation of behavioral science intervention protocols conducted with children are necessary to understand the efficacy of these approaches and their public health impact on proximal and distal cancer, cancer-related, and chronic disease outcomes before diffusion. It is clear that more attention should be paid to early life and early developmental phases in cancer prevention.
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Affiliation(s)
- Kenneth P Tercyak
- Department of Oncology and Pediatrics and Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, District of Columbia 20007-2401, USA.
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Abstract
Environmental intervention represents an effective strategy to promote the purchase and consumption of healthful foods in community-based settings. Three such studies promoted the consumption of healthier snacks and lower-fat foods at worksites and at schools. The first study examined lower prices and point-of-purchase promotion on sales of lower-fat snacks in vending machines in 12 worksites and 12 secondary schools. Price reductions of 10%, 25% and 50% on lower-fat snacks resulted in an increase in sales of 9%, 39% and 93%, respectively, as compared to usual-price conditions. The second study examined the impact of a 50% price reduction on the consumption of fresh fruit and baby carrots in 2 secondary school cafeterias. In the third study, 20 secondary schools were randomly assigned to either an environmental intervention or a control group for a 2-y period. The intervention increased the availability of lower-fat foods and implemented student-based promotions. School-based environmental interventions to increase availability and promotion of lower-fat foods and healthier snacks can increase purchase of these foods among adolescents.
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Affiliation(s)
- Simone A French
- Division of Epidemiology, School of Public Health, University of Minnesota, Minneapolis, MN 55454-1015, USA.
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Lowe CF, Horne PJ, Tapper K, Bowdery M, Egerton C. Effects of a peer modelling and rewards-based intervention to increase fruit and vegetable consumption in children. Eur J Clin Nutr 2004; 58:510-22. [PMID: 14985691 DOI: 10.1038/sj.ejcn.1601838] [Citation(s) in RCA: 182] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To measure children's consumption of, and liking for, fruit and vegetables and how these are altered by a peer modelling and rewards-based intervention. DESIGN In this initial evaluation of the programme, children's consumption of fruit and vegetables were compared within and across baseline and intervention phases. SETTING Three primary schools in England and Wales. SUBJECTS In total, 402 children, aged from 4 to 11 y. INTERVENTION Over 16 days, children watched six video adventures featuring heroic peers (the Food Dudes) who enjoy eating fruit and vegetables, and received small rewards for eating these foods themselves. MAIN OUTCOME MEASURES Fruit and vegetable consumption was measured (i) in school at lunchtime and snacktime using a five-point observation scale, with inter-rated reliability and weighed validation tests; and (ii) at home using parental recall. A questionnaire measured children's liking for fruit and vegetables before and after the intervention. RESULTS Consumption during the intervention was significantly higher than during baseline at lunchtime and at snacktime (P<0.001 in all instances). Consumption outside school was significantly higher during the intervention on weekdays (P<0.05) but not weekend days. Following the intervention, children's liking for fruit and vegetables also showed a significant increase (P<0.001). CONCLUSIONS The peer modelling and rewards-based intervention was shown to be effective in bringing about substantial increases in children's consumption of, and expressed liking for, fruit and vegetables. SPONSORSHIP : Horticultural Development Council, Fresh Produce Consortium, ASDA, Co-operative Group, Safeway, Sainsbury, Somerfield, Tesco and Birds Eye Wall's.
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Affiliation(s)
- C F Lowe
- School of Psychology, University of Wales, Bangor, UK.
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Nicklas T, Johnson R. Position of the American Dietetic Association: Dietary guidance for healthy children ages 2 to 11 years. ACTA ACUST UNITED AC 2004; 104:660-77. [PMID: 15054355 DOI: 10.1016/j.jada.2004.01.030] [Citation(s) in RCA: 152] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
It is the position of the American Dietetic Association that children ages 2 to 11 years should achieve optimal physical and cognitive development, attain a healthy weight, enjoy food, and reduce the risk of chronic disease through appropriate eating habits and participation in regular physical activity. The health status of American children has generally improved over the past three decades. However, the number of children who are overweight has more than doubled among 2- to 5-year-old children and more than tripled among 6- to 11-year-old children, which has major health consequences. This increase in childhood overweight has broadened the focus of dietary guidance to address children's over consumption of energy-dense, nutrient-poor foods and beverages and physical activity patterns. Health promotion will help reduce diet-related risks of chronic degenerative diseases, such as cardiovascular disease, type 2 diabetes, cancer, obesity, and osteoporosis. This position paper reviews what US children are eating and explores trends in food and nutrient intakes as well as the impact of school meals on children's diets. Dietary recommendations and guidelines and the benefits of physical activity are also discussed. The roles of parents and caregivers in influencing the development of healthy eating behaviors are highlighted. The American Dietetic Association works with other allied health and food industry professionals to translate dietary recommendations and guidelines into achievable, healthful messages. Specific recommendations to improve the nutritional well-being of children are provided for dietetics professionals, parents, and caregivers.
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Affiliation(s)
- Thersea Nicklas
- Children's Nutritional Research Center, Baylor College of Medicine, Houston, TX, USA
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Nicklas TA, O’Neil C, Myers L. The Importance of Breakfast Consumption to Nutrition of Children, Adolescents, and Young Adults. ACTA ACUST UNITED AC 2004; 39:30-39. [PMID: 15076708 DOI: 10.1097/00017285-200401000-00009] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Breakfast consumption has been identified as an important factor in nutrition, especially during growth stages. This article discusses data from nearly 2,500 children, adolescents, and young adults in Louisiana and considers the impact of breakfast consumption on their nutritional well-being.
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Affiliation(s)
- Theresa A. Nicklas
- Theresa A. Nicklas, DrPH, LN, is Professor of Pediatrics at the USDA/ARS Children’s Nutrition Research Center at Baylor College of Medicine, Department of Pediatrics. Her areas of expertise are cardiovascular health and nutritional epidemiology, child nutrition, and health promotion and chronic disease prevention.; Carol O’Neil, PhD, MPH, RD, is an Associate Professor and the Didactic Program Director at the Louisiana State University. Her research interests include food allergy, food security, and diet and health of low-income populations.; Leann Myers, PhD, is Associate Professor of Biostatistics at the Tulane School of Public Health and Tropical Medicine and the coauthor of more than 20 articles on nutrition
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Abstract
Individual dietary choices are primarily influenced by such considerations as taste, cost, convenience and nutritional value of foods. The current obesity epidemic has been linked to excessive consumption of added sugars and fat, as well as to sedentary lifestyles. Fat and sugar provide dietary energy at very low cost. Food pricing and marketing practices are therefore an essential component of the eating environment. Recent studies have applied economic theories to changing dietary behavior. Price reduction strategies promote the choice of targeted foods by lowering their cost relative to alternative food choices. Two community-based intervention studies used price reductions to promote the increased purchase of targeted foods. The first study examined lower prices and point-of-purchase promotion on sales of lower fat vending machine snacks in 12 work sites and 12 secondary schools. Price reductions of 10%, 25% and 50% on lower fat snacks resulted in an increase in sales of 9%, 39% and 93%, respectively, compared with usual price conditions. The second study examined the impact of a 50% price reduction on fresh fruit and baby carrots in two secondary school cafeterias. Compared with usual price conditions, price reductions resulted in a four-fold increase in fresh fruit sales and a two-fold increase in baby carrot sales. Both studies demonstrate that price reductions are an effective strategy to increase the purchase of more healthful foods in community-based settings such as work sites and schools. Results were generalizable across various food types and populations. Reducing prices on healthful foods is a public health strategy that should be implemented through policy initiatives and industry collaborations.
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Affiliation(s)
- Simone A French
- Division of Epidemiology, School of Public Health, University of Minnesota, Minneapolis 55454-1015, USA.
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Kramer-Atwood JL, Dwyer J, Hoelscher DM, Nicklas TA, Johnson RK, Schulz G. Fostering healthy food consumption in schools: focusing on the challenges of competitive foods. JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION 2002; 102:1228-33. [PMID: 12792617 DOI: 10.1016/s0002-8223(02)90272-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Shannon C, Story M, Fulkerson JA, French SA. Factors in the school cafeteria influencing food choices by high school students. THE JOURNAL OF SCHOOL HEALTH 2002; 72:229-234. [PMID: 12212407 DOI: 10.1111/j.1746-1561.2002.tb07335.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
This study set three objectives: 1) to examine the perceived influence of health concerns, labeling and nutrition information, taste, cost, availability, and peers on adolescents' food choices, particularly in the school cafeteria; 2) to determine whether these factors vary by gender, grade level, or adolescents' health and weight concerns; and 3) to provide recommendations regarding promotion of low-fat foods in the school cafeteria based on factors associated with food choices. Data were collected from a school survey that assessed key influences on adolescents' food choices, including low-fat foods. Some 289 students in grades 10-12 from a senior high school in a metropolitan area served as subjects. Descriptive statistics, chi-square, and general linear models were used for analysis. Results indicated that, when choosing foods from the school cafeteria, taste and getting a lot for their money were important to most students (93.7% and 71.7%, respectively). Females, and students who thought about their health and weight more frequently when deciding what to eat, were more likely to report greater interest in labeling and nutrition information and availability of low-fat foods in the school cafeteria. Findings suggest that efforts to promote low-fat foods to adolescents need to address the taste of low-fat foods, availability of low-fat options, and point-of-purchase labeling of low-fat foods. Focusing on the value and cost of low-fat foods may offer a key strategy for promoting low-fat foods to males.
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Affiliation(s)
- Christine Shannon
- Order of the Fishermen Ministry Head Start, 10025 Grand River Ave., Detroit, MI 48204, USA.
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O'Neil CE, Nicklas TA. Gimme 5: an innovative, school-based nutrition intervention for high school students. JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION 2002; 102:S93-6. [PMID: 11902399 DOI: 10.1016/s0002-8223(02)90432-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Carol E O'Neil
- School of Human Ecology, Louisiana Agricultural Center, Louisiana State University, Baton Rouge, USA
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Nicklas TA, McQuarrie A, Fastnaught C, O'Neil CE. Efficiency of breakfast consumption patterns of ninth graders: nutrient-to-cost comparisons. JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION 2002; 102:226-33. [PMID: 11846116 DOI: 10.1016/s0002-8223(02)90053-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To assess the efficiency of breakfast consumption patterns in terms of nutrient-to-cost comparisons. DESIGN Twenty-four-hour dietary recalls were collected and food items named were priced (prices from local grocery stores and restaurants were averaged). Three breakfast consumption groups were identified: restaurant foods (fast foods), ready-to-eat (RTE) cereal, and other foods. SUBJECTS Subjects consisted of 567 ninth-grade students (57% female, 86% white, mean age 14.8 years) in New Orleans, La. STATISTICAL ANALYSES Analysis of variance techniques were used to test statistical significance for total nutrient intake levels, intake levels of nutrients per 1,000 kcal, and nutrient intake levels per dollar spent. Groupings were determined using the Duncan test or pairwise comparisons. RESULTS Five percent of students ate a fast-food breakfast, 30% ate RTE cereal, and 65% ate other breakfasts. The mean cost of the breakfast meals was significantly (P<.0001) higher for the fast-food breakfast than for the RTE cereal breakfast and the other breakfast (fast>other=RTE). For every dollar spent, the RTE cereal and other breakfasts provided significantly more energy, carbohydrate, fiber, sugar, and protein than the fast-food breakfast. The other breakfast provided significantly (P<.001) more total and saturated fat per dollar than the fast-food or RTE cereal breakfasts. The RTE cereal breakfast provided significantly (P<.001) more, per dollar spent, of folic acid, iron, niacin, vitamins A and D, and zinc than the other 2 breakfast meals. APPLICATIONS The importance consumers place on taste, cost, and convenience continues to influence types of foods consumed. Yet, their food choices may not be as efficient in terms of the nutrients obtained per dollar spent. With the increasing demands being placed on families and the decreasing amount of time being spent on food preparation, nutrition education programs should continue to promote a higher level of efficient food choices.
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Affiliation(s)
- Theresa A Nicklas
- Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, Tex 77030, USA
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Sharmer L. Knowledge and Attitude Outcomes Related to Different Instructional Techniques in Lead-Based Paint Abatement Training. AMERICAN JOURNAL OF HEALTH EDUCATION 2002. [DOI: 10.1080/19325037.2002.10604718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Laurel Sharmer
- a Department of Community Health , State University of New York at Potsdam , 44 Pierrepont Ave, Potsdam , NY , 13676 , USA
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Pérez-Rodrigo C, Klepp KI, Yngve A, Sjöström M, Stockley L, Aranceta J. The school setting: an opportunity for the implementation of dietary guidelines. Public Health Nutr 2001; 4:717-24. [PMID: 11683567 DOI: 10.1079/phn2001162] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Nutrition, physical activity and health related promotion programmes in schools have developed into a mature field of research over the past decades. A number of success factors have been identified and evidence-based interventions have been performed. However, the school setting as an arena for evidence-based health promotion programmes, is still not used to its full potential. Schools provide an excellent arena for reaching large segments of the population, such as young people, school staff, families and the surrounding community. There is a need for an overview regarding the current status of nutrition, physical activity, related health as well as support structures in the EU member states. Based upon such an analysis, a consensus report should be written, pointing out the major problems at hand. Self-assessment tools for national as well as for school level should be produced, in order to guide changes, but also to include an element of continuous assessment of change, for evaluation purposes.
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Pérez-Rodrigo C, Aranceta J. School-based nutrition education: lessons learned and new perspectives. Public Health Nutr 2001; 4:131-9. [PMID: 11255503 DOI: 10.1079/phn2000108] [Citation(s) in RCA: 124] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
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.
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Affiliation(s)
- C Pérez-Rodrigo
- Community Nutrition Unit, Department of Public Health, Bilbao, Spain.
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Ciliska D, Miles E, O’brien MA, Turl C, Hale Tomasik H, Donovan U, Beyers J. Effectiveness of Community-Based Interventions to Increase Fruit and Vegetable Consumption. ACTA ACUST UNITED AC 2000. [DOI: 10.1016/s0022-3182(00)70594-2] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Nicklas TA, Reger C, Myers L, O'Neil C. Breakfast consumption with and without vitamin-mineral supplement use favorably impacts daily nutrient intake of ninth-grade students. J Adolesc Health 2000; 27:314-21. [PMID: 11044703 DOI: 10.1016/s1054-139x(00)00113-0] [Citation(s) in RCA: 108] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE To assess the contribution of breakfast consumption (with and without dietary supplement intake) on total daily nutrient intake of ninth-grade students. METHODS Twenty-four-hour recall of dietary intake was collected from a random sample of 711 ninth-grade students attending 12 Archdiocesan high schools in New Orleans, Louisiana. Analysis of variance techniques, Pearson's Chi-square statistic, and Breznahn-Shapiro method with Scheffé probabilities were used to analyze nutrient intake data, dietary adequacy, and nonorthogonal comparisons, respectively. RESULTS Nineteen percent of 15-year-olds skipped breakfast, with more females skipping breakfast than males (23% vs. 14%, respectively). Thirty-six percent of nonwhite females versus 20% white females skipped breakfast. Eleven percent of subjects took some type of dietary supplement, most commonly a multivitamin and mineral supplement. Among those who ate breakfast, average energy intake from breakfast was 437 kcal. Percentage of total daily energy intake was higher from fats and lower from carbohydrates for adolescents who skipped breakfast, compared with adolescents who consumed breakfast. The percentage of subjects consuming at least two-thirds of the Recommended Dietary Allowance was significantly lower among adolescents skipping breakfast than those consuming breakfast. CONCLUSION Regardless of supplement use, breakfast consumption makes an important nutritional contribution to total daily intake of ninth-grade students. Encouraging breakfast consumption and healthful breakfast choices is an important step toward improving the nutritional quality of diets of this age group.
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Affiliation(s)
- T A Nicklas
- Department of Pediatrics, Children's Nutrition Research Center, Baylor College of Medicine, Houston, Texas 77030, USA
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Johnson CC, Shi R, Farris R, Webber LS, Nicklas TA. Social support and self‐efficacy for the consumption of fruit and vegetables by adolescents: “Gimme 5"—A fresh nutrition concept for students. Ecol Food Nutr 2000. [DOI: 10.1080/03670244.2000.9991624] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Nicklas TA, O'Neil CE. Process of conducting a 5-a-day intervention with high school students: Gimme 5 (Louisiana). HEALTH EDUCATION & BEHAVIOR 2000; 27:201-12. [PMID: 10768801 DOI: 10.1177/109019810002700206] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Gimme 5: A Fresh Nutrition Concept for Students (Gimme 5) was a 4-year intervention targeting increased fruit and vegetable consumption by high school students. Twelve schools were randomized to intervention or control conditions. The cohort (2,213 students; 56% female, 84% Euro-American) were followed from 9th to 12th grade. Interventions were composed of a school-based media campaign, classroom workshops, school meal modification, and parental involvement. For each of the four Gimme 5 intervention components, process evaluation measures were developed to assess program dose, penetration, and utilization, as well as external competing factors. Process evaluation results are presented to illustrate the various functions of process evaluation data. These include, but are not limited to, describing program implementation, quality control and monitoring, and explaining study outcomes. The implementation of process evaluation systems to complement the outcome measures in a high school-based intervention provides useful strategies for a more comprehensive approach to program evaluation.
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Affiliation(s)
- T A Nicklas
- Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, Texas 77030, USA.
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Campbell MK, Reynolds KD, Havas S, Curry S, Bishop D, Nicklas T, Palombo R, Buller D, Feldman R, Topor M, Johnson C, Beresford SA, Motsinger BM, Morrill C, Heimendinger J. Stages of change for increasing fruit and vegetable consumption among adults and young adults participating in the national 5-a-Day for Better Health community studies. HEALTH EDUCATION & BEHAVIOR 1999; 26:513-34. [PMID: 10435235 DOI: 10.1177/109019819902600409] [Citation(s) in RCA: 82] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Higher fruit and vegetable consumption is associated with a reduced risk of certain cancers and chronic diseases. The 5-a-Day for Better Health community studies are evaluating population-based strategies to achieving dietary behavior change using the stages-of-change model and associated theories. The authors present baseline comparisons of stages of change for fruit and vegetable consumption among adults and young adults in eight study sites representing diverse regions of the United States and diverse populations and settings. Three dominant stages, precontemplation, preparation, and maintenance, were found across sites. Women and those with college degrees were more likely to be in action/maintenance. Fruit and vegetable consumption, self-efficacy, and knowledge of the 5-a-Day recommendation were positively associated with more advanced stages of change in all study sites. The authors discuss the findings in relation to possible limitations of this and other dietary stages-of-change measures and suggest directions for future research.
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Affiliation(s)
- M K Campbell
- Department of Nutrition, University of North Carolina, Chapel Hill 27599-7400, USA.
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Beech BM, Rice R, Myers L, Johnson C, Nicklas TA. Knowledge, attitudes, and practices related to fruit and vegetable consumption of high school students. J Adolesc Health 1999; 24:244-50. [PMID: 10227343 DOI: 10.1016/s1054-139x(98)00108-6] [Citation(s) in RCA: 48] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
PURPOSE To assess the level of nutrition knowledge, attitudes and practices related to fruit and vegetable consumption of high school students attending participating parochial schools in the New Orleans area. METHODS The baseline data reported in this study, "Gimme 5: A Fresh Nutrition Concept for Students," represents one of the nine National Cancer Institute-funded projects from the national "5-A-Day for Better Health Program" initiated in 1991. A survey containing 22 nutrition-related items about fruit and vegetables was used to assess knowledge in 2213 students. RESULTS On average, adolescents reported 39% correct knowledge scores. A significant ethnic effect (p < .001) was noted, with White adolescents scoring higher than African American adolescents. Significant ethnic differences in the frequency of fruit and vegetable consumption were also observed, with African-American adolescents reporting a lower mean consumption (2.17 servings) than white adolescents (2.69 servings). Consumption by Hispanic youth (2.48 servings) was similar to those in the "other" ethnic category (2.55 servings). Girls reported being more confident in their ability to eat five servings of fruits and vegetables per day than did boys (p < .05). CONCLUSIONS Although the knowledge and consumption levels of adolescents with regard to fruits and vegetables were low, their attitudes toward learning about healthier eating practices were favorable.
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Affiliation(s)
- B M Beech
- Tulane Center for Cardiovascular Health, Tulane School of Public Health and Tropical Medicine, New Orleans, Louisiana 70112-2824, USA
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Position of the American Dietetic Association: dietary guidance for healthy children aged 2 to 11 years. JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION 1999; 99:93-101. [PMID: 9917742 DOI: 10.1016/s0002-8223(99)00026-7] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Effects of the Child and Adolescent Trial for Cardiovascular Health (CATCH) on Fruit and Vegetable Intake. ACTA ACUST UNITED AC 1998. [DOI: 10.1016/s0022-3182(98)70357-7] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Nicklas TA, Johnson CC, Myers L, Farris RP, Cunningham A. Outcomes of a high school program to increase fruit and vegetable consumption: Gimme 5--a fresh nutrition concept for students. THE JOURNAL OF SCHOOL HEALTH 1998; 68:248-53. [PMID: 9719999 DOI: 10.1111/j.1746-1561.1998.tb06348.x] [Citation(s) in RCA: 86] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
This paper describes an intervention to increase high school students' fruit and vegetable consumption. Twelve schools were randomized to intervention or control conditions. The cohort (2,213 students; 56% females, 84% Caucasian) were followed from 9th to 12th grades. Interventions comprised a media campaign, classroom workshops, school meal modification, and parental support. Usual daily servings of fruit/vegetables increased 14% in the intervention compared to the control group (p > 0.001) the first three years. At follow-up, consumption within the control group also increased, resulting in no significant difference between groups. Intervention group knowledge scores and awareness indicators were significantly higher than those of the control group (p < 0.0001). Gimme 5 provided a first model to show that dietary habits of high school students can be influenced by positive media messages relative to that age group, increased exposure to a variety of tasty products, and minimal classroom activity.
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Affiliation(s)
- T A Nicklas
- Dept. of Food and Nutrition, College of Human Development and Education, North Dakota State University, Fargo 58105-5057, USA
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