Nutrition Education Lessons Research Articles

Ramadan-specific nutrition education improves cardio-metabolic health and inflammation-a prospective nutrition intervention study from Pakistan.

There are recent reports that Ramadan fasting (RF) results in weight gain instead of weight loss. In addition, the data on the efficacy of brief nutrition education on healthy eating practices in Ramadan for better health are scarce. Therefore, a study was conducted to investigate the effects of brief nutrition education before the start of RF on healthy eating practices during RF. For this purpose, a prospective observational study focused on "Dietary Education and Awareness for Ramadan (DEAR)" as an intervention was carried out. The participants (n = 74) were recruited and divided into two groups, i.e., intervention and control groups (n = 37 each). As an intervention, nutrition education lessons were given before and during RF month. The control group did not attend these nutrition education lessons. Data on anthropometrics, dietary intake, and other parameters were collected at three time points: before, in the end, and 4 weeks after RF. Weight was measured in kg; height, waist circumference (WC), and hip circumference (HC) were measured in cm; and body mass index (BMI) was calculated. Waist-to-hip ratio (WHR) was calculated by dividing the waist value by the hip value. Body composition analysis was performed by the body composition analyzer (BF-907). Blood pressure (BP) was measured using a validated automated blood pressure. A 3-5 ml of venous blood was collected, and plasma and serum were separated. Serum and plasma samples were processed for general blood chemistry (blood lipid profile, glucose, and CRP) within 2 h. CRP was determined by the immunoturbidimetry method using an auto-analyzer. An enzyme-linked immunosorbent assay (ELISA) was used to determine cytokine/chemokines. Adherence to nutrition education (intervention) was assessed. The results show that nutrition education has positive effects on overall nutrition. Significant improvement in dietary adherence to dietary advice in the intervention group was noted. Significant BW loss (mean loss: 1.21 kg) in the intervention group was observed. The majority (63.3%) had lost BW ≥ 1.0 kg. Other changes observed as a result of the intervention included improvements in blood glucose, cholesterol, CRP levels, and systolic and diastolic BP. There was a notable shift in pro- and anti-inflammatory cytokine concentrations: IL-7, IL-4, and TGF-α decreased, while IL-2, TNF-α and resistin, IL-1 RA, IL-17 A, and sCD40 increased. In conclusion, RF resulted in a loss in mean BW and an improvement in related blood chemistry and cytokine profiles. Furthermore, nutrition education before RF resulted in better nutrition practices during RF and a desirable healthy BW, blood lipid, and cytokine profiles.

A cross-sectional exploratory study of food literacy among Saudi parents of adolescent children aged 10 to 19 years.

Parental food literacy is fundamental in laying a solid foundation for healthy eating among their children. This study aimed to (1) evaluate the current state of food literacy among Saudi parents of 10-19 years old adolescent children, and (2) determine the correlates associated with parental food literacy. This cross-sectional study was conducted between April and June 2022, with a convenience sample of 1845 Saudi parents (mean age = 45.1 ± 11; mothers: 56%). A Short Food Literacy Questionnaire (SFLQ) was used to meet the study aims. Findings showed that around 46% of parents had poor food literacy. Fathers were 2.4 times more likely than mothers to be food illiterate (OR = 2.4, CI = 1.9-3.0, p < 0.001). Parents residing in Riyadh, Northern borders, Jawf, or Ha'il had a three times higher risk of being food illiterate than those residing in other provinces (OR = 3.2, CI = 2.6-3.9, p < 0.001). Parental overweight or obesity increased their risk of being food illiterate by 60% (OR = 1.6, CI = 1.3-2.1, p < 0.001). Healthy parents, in contrast to those having a chronic disease (s), had a 60% higher probability of food illiteracy (OR = 0.4, CI = 0.3-0.6, p < 0.001). Educated parents had a three times higher risk of being food illiterate (vs. uneducated parents, OR = 3.0, CI = 1.6-5.8, p = 0.001). Parents making less than 3000 Saudi Riyal (SR) per month (<798 USD/779 EUR) were 40% more likely to be food illiterate than those who reported 3000-25000 SR (798-6652 USD/779-6499 EUR) (OR = 0.6, CI = 0.4-0.9, p = 0.02), and 70% more likely to be food illiterate than those making more than 25000 SR (>6652 USD/6497 EUR) (OR = 0.3, CI = 0.2-0.6, p < 0.001). Parents who lived in crowded households were twice as likely to be food illiterate as those who did not (OR = 1.9, CI = 1.5-2.4, p < 0.001). The current study findings should be employed in future programming and policy-making approaches to reach Saudi parents for necessary food literacy interventions. These interventions could include bolstering their confidence while cooking, buying groceries, reading nutrition labels, and integrating them into nutrition education lessons with their children in school settings.

The INFINITE Study: Pilot Research Exploring Plant-Based Nutrition in Treatment for Substance Use Disorders

Standard treatment for substance use disorders (SUDs) rarely incorporates a dietary intervention. The purpose of this research is to explore how nutrition might influence early recovery outcomes. Participants (N = 33) self-selected into the 10-week treatment (whole food, plant-based diet) or control group (standard treatment center diet). Both received weekly nutrition education lessons to complement the diet. At baseline, week 3, and week 10, participants completed assessments to track mental health markers. Mean values were calculated for Healthy Eating Index-2015 (HEI-2015) and Plant-based Diet Indices (PDI). Semi-structured interviews were gathered and analyzed using grounded theory. The intervention group had significantly higher scores for HEI-2015 and PDI scores (all P’s &lt; .001). For all psychosocial outcomes, there was a statistically significant effect of time ( P’s &lt; .001-.02), but not by condition. A significant condition by time interaction was seen with the Rosenberg Self-Esteem outcome ( P = .043). Resilience at 10-weeks was significantly higher in the high PDI group ( P = .031). Qualitative data showed that all participants found meaning and value in the experience. Early addiction treatment outcomes show modest but important effects of whole food plant-based nutrition and suggest value in further exploration of its use in SUD treatment.

Application of a sensory evaluation methodology for recipes utilized in federal nutrition education programs

Federal nutrition education programs utilize recipe demonstrations to engage with low-income participants and promote healthy eating behaviors; however, recipes created for these programs are developed in state extension offices or in collaboration with local cooks/chefs, and the fit of the recipes within their educational programming is subjective. Thus, a sensory evaluation methodology was developed to support recipe and curricula development. It is intended for use with a unique population of low-income participants of federal nutrition education programs in central locations. The inclusion of sensory evaluation methods allows state extension staff to make sensory attribute-specific improvements to their recipes prior to implementing them in their curricula. This article will detail the methodology that has been used for two successful studies in the community and briefly explain the researchers' “lessons learned,” suggested statistical analyses and relationships to analyze, and the future implications of this methodology. Practical Applications To encourage behavior change and promote healthy eating, nutrition education programs can utilize this sensory evaluation methodology to guide their recipe development and curricula decisions. The inclusion of sensory evaluation may present with an upfront higher recipe testing cost and increased time required by stakeholders to provide feedback, but it offers a deeper understanding of the target audiences' likes and dislikes. This information can be used to determine gaps in information on specific foods or nutrients within nutrition education lessons, to improve upon the recipe offerings in direct education, and to inform recipe development as new recipes are introduced to the target audience. Finally, the addition of questions related to preparation or purchase intent may allow content developers of these programs to infer the practicality of the recipes and predict behavior change.

Outcomes of a Multi-Component School-Based Nutrition Program.

This paper presents the effectiveness of a multi-component elementary school-based nutrition education program, the Integrated Nutrition Education Program (INEP), which has been in existence for over 25 years. INEP includes components to address multiple layers of influence: hands-on nutrition education lessons in the classroom (student-level), parent education, and outreach (home-level), and facilitation of a planning process to implement policy, system, and environmental (PSE) school changes (school-level). Three evaluation tools assessed the effectiveness of the program: (1) classroom plate waste measurement in intervention (N=149 students) and demographically-matched comparison schools (N=131 students), (2) pre/post classroom surveys completed by students who participated in INEP (N=204), and (3) PSE change data from participating schools (N=47 schools). Students who participated in the nutrition education program were more likely to consume vegetable-based recipes and vegetables included in classroom nutrition lessons compared to students in comparison classrooms (Chinese vegetable salad: p < .001; couscous salad: p < .001; snap peas: p = .001). Classroom survey analyses showed improvements in student self-efficacy (p < .001), preference for vegetables (p=.005), and knowledge (p < .001). In addition, through a wellness planning process, schools implemented an average of 3.7 PSE changes per school. Results demonstrate a multi-component school-based nutrition education program improves student nutrition-related outcomes.

The Impact of Online Nutrition Education on WIC Client Retention and Redemption of the Cash Value Benefit of Fruit/Vegetables

Describe the effectiveness that online nutrition education has on WIC participants in maintaining program participation. All participants of the Indiana Special Supplemental Nutrition Program for Women Infant and Children (WIC) receive supplemental foods, nutrition education, and health care referrals. The Indiana WIC program established an online nutrition education program to help eliminate barriers to participants who are unable to be physically present for their second nutrition education appointments. The aim of this study was to compare the participation of WIC participants enrolled in standard in-person appointments with WIC participants enrolled in the Online Nutrition Education (ONE) pilot program by assessing the completion of the ONE lessons and the cash value benefit usage at 3 months after participants’ acceptance into the WIC program. A quasi-experiment was performed using a time series comparison of WIC participant attendance at their in-person nutrition education appointment to participants completion of an online nutrition education lesson. A second comparison of the two groups observed the participants redemption of their cash value benefit on fruits and vegetables (CVB). A total of 68,748 participants attended the traditional second nutrition education contact appointment during February 1 – September 7, 2019 and with the addition of the ONE pilot a total of 78,857 participants attended in 2020. The increase in participation from 2019 to 2020 was statistically significant (P=0.035). Analysis showed that there was a significant difference (P ≤ 0.001) between the 2019 and 2020 CVB mean redemption rates. This study provides evidence that WIC participants are more likely to maintain their participation when offered the addition of an online nutrition education appointment type.

O37 Fruit and Vegetable Preparation Changes During and After Cost-Offset Community Supported Agriculture and Nutrition Education

<h3>Background</h3> Most adults and children in the US do not consume recommended levels of fruit and vegetables (FV). Providing subsidized or cost-offset community supported agriculture (CO-CSA) alongside nutrition education is 1 approach to increase FV intake among rural, low-income families. <h3>Objective</h3> This analysis assessed change in the frequency and method of FV preparation during and after a CO-CSA plus nutrition education intervention. <h3>Study Design, Setting, Participants</h3> Participants were caregivers in low-income households (<185% FPL) living in rural areas of 4 U.S. states (n = 148). Half-price weekly summer CSA shares of farm produce and 9 seasonal nutrition education lessons were provided. Attendance was recorded at lessons and other data were collected via online surveys at baseline, 1 season later, and 1 year later. <h3>Measurable Outcome/Analysis</h3> Outcomes included monthly frequency of preparing 9 different, seasonal FV for children's snacks and 6 different vegetables for dinner with preparation methods for each. Repeated measures ANOVA and pairwise comparisons with Bonferroni correction tested change in FV preparation frequency over time at 95% confidence. Moderation analysis assessed whether changes in FV preparation frequency varied by lesson attendance. <h3>Results</h3> At baseline, caregivers prepared fruit for snacks and vegetables for dinner almost every day, and vegetables for snacks every other day. Preparation frequency for total snack fruit, celery, cucumber, peppers, other vegetables, total snack vegetables, lettuce, cabbage, greens, squash, and total dinner vegetables all increased during the intervention; and, increases in vegetables for both snacks (celery, cucumber, and total) and dinner (greens and total) were maintained one-year later. At baseline, the majority of participants (>70%) reported using healthy methods to prepare vegetables, and no changes were observed over time. Observed increases in FV preparation frequency were not moderated by lesson attendance. <h3>Conclusion</h3> CO-CSA plus education was associated with increases in FV preparation frequency, increases in vegetable preparation were maintained 1 year later, but improvements were not associated with attending nutrition education.

Eating Smart and Moving More for Head Start: A Pilot Study With Head Start Teachers

Our study examined the relationship between improved personal health behaviors of Head Start teachers and the promotion of positive health behaviors in their classrooms. Thirty-three Head Start teachers across seven centers received six 30-min nutrition education lessons. Dietary intake, physical activity, and self-efficacy for promoting positive health behaviors in the classroom were measured at baseline and following intervention. Significant improvements were observed for dietary intake and physical activity. Self-efficacy for promoting health behaviors in the classroom did not significantly improve. Additional education is needed to improve health promotion practices. Lessons learned contributed to program refinement. Implications for Extension are discussed.

Diet Quality and Associations with Food Security among Women Eligible for Indiana Supplemental Nutrition Assistance Program-Education

The diet quality among adults receiving nutrition education lessons through Supplemental Nutrition Assistance Program-Education (SNAP-Ed) is currently unknown. The objectives of this study were to characterize the diet quality of Indiana SNAP-Ed-eligible women; estimate their mean usual intake of fruits, vegetables, dairy, and whole grains compared to Dietary Guidelines for Americans (DGA) recommendations; and determine if these dietary outcomes differed by food security status. SNAP-Ed paraprofessionals recruited participants from August 2015 to May 2016 for this secondary analysis of cross-sectional data collected as the baseline assessment for a randomized controlled trial. Participants were SNAP-Ed-eligible women aged ≥18 y interested in nutrition education lessons. Dietary outcomes were assessed by one or two 24-h dietary recalls. The Healthy Eating Index (HEI)-2010 was used to characterize diet quality. Mean usual intake of food groups was estimated using the National Cancer Institute Method. Food security status was classified using the US Household Food Security Survey Module. Data were analyzed in October 2019. Mean±SEM HEI-2010 total score was 42±0.9 for the study sample. Mean±SE usual intake of servings of fruits (0.61±0.08 cups [144.32 ± 18.93 mL]), vegetables [1.4±0.10 cups (331.2 ± 23.66 mL)], dairy [1.5±0.11 cups (354.88 ± 26.02 mL)], and whole grains [0.48±0.06 ounces (13.61 ± 1.70 g)] did not differ by food security subgroup. Mean HEI-2010 total score was significantly higher by 4.8±2.0 points for the food-secure than for the food-insecure subgroup (P=0.01). Mean HEI-2010 component scores were 1.1±0.5 points higher for whole grain (P=0.01) and 1.0±0.5 points higher for dairy (P=0.05) in the food-secure than in the food-insecure subgroup. The proportions of the study sample not meeting the DGA recommendations for food group intake were ≥85% for both food-secure and -insecure subgroups. Indiana SNAP-Ed-eligible women reported poor diet quality, highlighting their need for nutrition interventions aiming to improve food security and diet as per DGA recommendations in low-income populations.

P60 The Effectiveness of Nutrition Education: Comparing Registered Dietitian Educators and Dietetic Interns

<h3>Background</h3> The Marshall University Nutrition Education Program (MUNEP) delivers nutrition education to needy elementary schools (grades K-2) in rural West Virginia. This dissertation research reviewed pre-/post-tests and teacher focus group findings comparing effectiveness of RDN educators and dietetic intern (DI) educators in program delivery. DI educators have no formal educational training or pedagogical practice compared to RDNs, yet they play a significant role in program implementation. <h3>Objective</h3> To examine differences in knowledge/behavior change based on pre-/post-scores after an intervention of nutrition education lessons by RDN educators/DI educators; and to compare the effectiveness of RDN educators/DI educators through teacher focus group findings. <h3>Study Design, Setting, Participants</h3> A mixed-methods, retrospective study of (15) knowledge/behavior-change questions on student pre-/post-tests (n = 1160) comparing RDN/DI educators; and results of teacher focus groups (n = 4), with teachers (n = 30) examining the effectiveness of RDN/DI educators in program implementation. <h3>Measurable Outcome/Analysis</h3> Quantitative analysis included independent t-tests comparing pre-/post-test scores for overall knowledge/behavior change; independent t-tests examining post-test scores for overall behavior/overall knowledge and comparing RDN/DI educators; post-hoc Bonferroni ANOVA analysis comparing post-test scores to free/reduced-priced (FR) meals in needy schools. Qualitative inquiry included thematic analysis to compare effectiveness of RDN/DI educators. <h3>Results</h3> Overall knowledge change from pre- to post-test was statistically significant (<i>P</i> = .000); no significant difference in overall behavior change from pre- to post-test (<i>P</i> = .710), or comparison between RDN/DI educators (<i>P</i> = .175 for knowledge change; <i>P</i> = .479 for behavior change) were found. Statistical significance existed for post hoc review of students' post-tests and socio-economic status based on percentage of FR school meals for students in the 50%-59% FR meal category vs students in the 90%-100% FR meal category (<i>P</i> = .017). Focus groups showed that RDN educators were empowered in the classroom and had better management than DI educators; taste-testing is a critical component for both RDN/DI educators. <h3>Conclusions</h3> This study adds to limited data comparing effectiveness of RDN/DI educators in nutrition education. Results will be used to inform DI training, improve MUNEP participant experience related to knowledge and behavior change, and to improve MUNEP experience in needy schools. <h3>Funding</h3> Supplemental Nutrition Assistance Program - Education.

Creaciones en la Cocina: A Culturally Adapted Nutrition Education Curriculum for Spanish-Speaking Latinos

As the Latino population in Utah continues to grow steadily, it lags behind several state health measures and indicators such as poverty, diabetes, cholesterol, physical activity, overweight/obesity and poor physical health. 1 Utah Department of Health. Utah Health Status Update: Measuring Health Disparities: Trends in Utah Racial and Ethnic Minorities. Salt Lake City: Utah Department of Health; 2017.https://ibis.health.utah.gov/ibisph-view/pdf/opha/publication/hsu/2017/1702_Disparity.pdf. Accessed September 11, 2019. Google Scholar To address these health concerns, the Utah Supplemental Nutrition Assistance Program-Education (SNAP-Ed) staff made concerted efforts to reach out to the Latino community by translating handouts into Spanish and hiring bilingual and/or ethnically matched educators who are trained using existing nutrition education curricula written in English. These educators found it challenging to translate and deliver nutrition education lessons in a consistent and culturally responsive way. To overcome these limitations, Utah SNAP-Ed staff identified the need for developing and pilot testing a culturally sensitive nutrition education curriculum.

Impact of a nutrition education programme on preschool children's willingness to consume fruits and vegetables.

To evaluate the impact of a preschool-based nutrition education programme consisting of twelve 'hands on' nutrition education lessons delivered during the school year on young children's willingness to consume fruits and vegetables. Quasi-experimental, pre-post design including the collection of plate waste evaluation data at the start and end of the 2015-2016 school year within two groups: (1) randomly selected classrooms receiving the intervention and (2) within conveniently sampled preschool classrooms not receiving the intervention serving as a comparison group. Centre-based preschool programmes serving low-income families in the Denver metro area. Three- to five-year-old children in preschool classrooms participating in the intervention during the 2015-2016 school year (n 308) and children enrolled in comparison classrooms (n 215). Repeated-measures logit models assessed whether increases in the odds of consuming small samples of fruits and vegetables between Time 1 (pre-intervention) and Time 2 (post-intervention) were different for children within the intervention group compared with the comparison group. Analyses showed that the change over time in consumption of the three vegetable samples varied by intervention status with greater change occurring among children within the intervention group (edamame: P = 0·001; cauliflower: P ≤ 0·0001 and red pepper: P ≤ 0·0001). Unlike vegetables, the change over time in consumption of the two fruit samples was not different between children within the intervention and comparison groups. An experiential-learning nutrition education programme can positively influence eating behaviours of low-income preschoolers in a centre-based setting by increasing willingness to consume vegetables.

An ethnographic study exploring factors that minimize lunch waste in Tokyo elementary schools.

To explore factors that minimize lunch waste in Tokyo elementary schools and to consider how such factors can be modified and applied in US schools. Focused ethnographic study using interviews, observation, participant observation and document review. Data were analysed using thematic analysis. Tokyo, Japan. Five school dietitians participated in the study. Data collection methods included in-depth interviews, observation of nutrition education lessons, participant observation of school lunchtime and review of relevant school documents (e.g. lunch menus, food waste records). Five themes emerged from the analysis: (i) reinforcement of social norms to eat without waste; (ii) menu planning to increase exposure to unfamiliar and/or disliked foods; (iii) integration of food and nutrition education into the school curriculum; (iv) teacher lunchtime practices related to portion sizes, distributing leftover food and time management; and (v) engagement of students in reducing school lunch waste. Practical and tangible applications to US schools include measuring and reporting lunch waste to influence social norms, teaching students about the importance of reducing food waste, offering flexible school lunch portion sizes and providing students with meaningful opportunities to contribute to solving the problem of school lunch waste. Japan offers a model for minimizing school lunch waste through a holistic approach that includes factors that operate at and interact across multiple levels of society. Modifying and applying such an approach in US schools is worth considering given the urgent need to address food waste in order to support healthy diets and sustainable food systems.

Effects of a School-Based Health Intervention Program in Marginalized Communities of Port Elizabeth, South Africa (the KaziBantu Study): Protocol for a Randomized Controlled Trial.

BackgroundThe burden of poverty-related infectious diseases remains high in low- and middle-income countries, while noncommunicable diseases (NCDs) are rapidly gaining importance. To address this dual disease burden, the KaziBantu project aims at improving and promoting health literacy as a means for a healthy and active lifestyle. The project implements a school-based health intervention package consisting of physical education, moving-to-music, and specific health and nutrition education lessons from the KaziKidz toolkit. It is complemented by the KaziHealth workplace health intervention program for teachers.ObjectivesThe aim of the KaziBantu project is to assess the effect of a school-based health intervention package on risk factors for NCDs, health behaviors, and psychosocial health in primary school children in disadvantaged communities in Port Elizabeth, South Africa. In addition, we aim to test a workplace health intervention for teachers.MethodsA randomized controlled trial (RCT) will be conducted in 8 schools. Approximately 1000 grade 4 to grade 6 school children, aged 9 to 13 years, and approximately 60 teachers will be recruited during a baseline survey in early 2019. For school children, the study is designed as a 36-week, cluster RCT (KaziKidz intervention), whereas for teachers, a 24-week intervention phase (KaziHealth intervention) is planned. The intervention program consists of 3 main components; namely, (1) KaziKidz and KaziHealth teaching material, (2) workshops, and (3) teacher coaches. After randomization, 4 of the 8 schools will receive the education program, whereas the other schools will serve as the control group. Intervention schools will be further randomized to the different combinations of 2 additional intervention components: teacher workshops and teacher coaching.ResultsThis study builds on previous experience and will generate new evidence on health intervention responses to NCD risk factors in school settings as a decision tool for future controlled studies that will enable comparisons among marginalized communities between South African and other African settings.ConclusionsThe KaziKidz teaching material is a holistic educational and instructional tool designed for primary school teachers in low-resource settings, which is in line with South Africa’s Curriculum and Assessment Policy Statement. The ready-to-use lessons and assessments within KaziKidz should facilitate the use and implementation of the teaching material. Furthermore, the KaziHealth interventions should empower teachers to take care of their health through knowledge gains regarding disease risk factors, physical activity, fitness, psychosocial health, and nutrition indicators. Teachers as role models will be able to promote better health behaviors and encourage a healthy and active lifestyle for children at school. We conjecture that improved health and well-being increase teachers’ productivity with trickle-down effects on the children they teach and train.Trial RegistrationInternational Standard Randomized Controlled Trial Number (ISRCTN): 18485542; http://www.isrctn.com/ISRCTN18485542International Registered Report Identifier (IRRID)DERR1-10.2196/14097

O12 Exploring Factors that Minimize School Lunch Waste in Tokyo Elementary Schools

Background School lunch waste is a significant global issue with serious environmental, financial, and nutritional implications. In the US, students throw away more than 30% of their school lunch. In contrast, food waste generated through Japan's national school lunch program is approximately 7%. To date, few studies have focused on school lunch waste in Japan. Objective The objective of this study was to explore factors that minimize school lunch waste in Tokyo elementary schools. Study Design, Settings, Participants This focused, ethnographic study was conducted in Tokyo with five school dietitians who worked in elementary schools that varied on characteristics such as number of meals served, geographic location and school lunch program type (i.e. on-site kitchen versus school lunch center). Data were collected using in-depth interviews with school dietitians, observation of nutrition education lessons, participant observation of school lunchtime during which students and teachers eat the same meal together in their classrooms, and review of relevant school documents, including lunch menus and food waste records. Measurable Outcome/Analysis Data were coded and analyzed using thematic analysis. Results Five themes emerged from the analysis: reinforcement of social norms to eat without waste, menu planning to increase exposure to unfamiliar and/or disliked foods, integration of food and nutrition education on topics such as food gratitude and eating a balanced meal without likes and dislikes, into the school curriculum, teacher lunchtime practices related to portion sizes, distributing leftover food, and managing time during the lunch period, and engagement of students in reducing school lunch waste. Conclusion School lunch waste in Tokyo elementary schools is minimized through a holistic approach that includes factors that operate at, and interact across, multiple levels of the social ecological model. Modifying and applying such an approach in US schools is worth considering. Funding Fulbright US Scholar Program.

FP17 Changes in Nutrition Knowledge, Attitudes, and Behavior After Implementation of Serving Up MyPlate and Vegetable Taste Tests

Objective Improve student nutrition knowledge, attitudes, and consumption of legumes, dark green, and red/orange vegetables after implementation of nutrition education and taste test activities in the classroom. Description The Wisconsin Team Nutrition program works to promote nutrition education in schools to create environments that are conducive to the development of healthy behaviors related to food and nutrition. In an effort to increase nutrition knowledge and positively influence dietary habits of students, Wisconsin Team Nutrition provided funding to ten schools to implement nutrition education and taste testing activities in third and fourth grade classrooms. Students were taught using the We Are What We Eat lessons from the United States Department of Agriculture Team Nutrition's Serving Up MyPlate: A Yummy Curriculum and tasted recipes containing foods from the dark green, red/orange, and legume subgroups. Evaluation Surveys were used to measure changes in students’ nutrition knowledge, attitudes, and behaviors. Electronic surveys were distributed to participating classes with instructions to complete before and after implementation of the nutrition education lessons and taste testing activities. Descriptive and inferential statistics were used to analyze pre versus post nutrition education changes in students’ knowledge, attitudes, and behaviors. Conclusion and Implications Incorporating nutrition education and taste testing activities improved students’ attitudes towards legumes and increased self-reported consumption of dark green vegetables. In addition, students demonstrated an increase in nutrition knowledge between pre-survey and post-survey. Results support the implementation of nutrition education and/or taste testing activities in the classroom to improve student nutrition knowledge, attitudes, and behaviors. Future interventions should investigate the impact between nutrition education with and without taste testing. Grant Year 2016

Impact of a Supplemental Nutrition Assistance Program-Education (SNAP-Ed) Intervention on Usual Dietary Intake Among Indiana Adults (P04-025-19)

ObjectivesThe goal of the Supplemental Nutrition Assistance Program-Education (SNAP-Ed) is to assist low-income households to improve diet quality. The objective of this study was to evaluate the long-term effects of SNAP-Ed nutrition education lessons on diet quality and key nutrient and food group outcomes among Indiana SNAP-Ed-eligible adults. MethodsThe study design was a parallel-arm randomized controlled nutrition education intervention. The intervention consisted of the first 4 lessons of the Indiana adult SNAP-Ed curriculum delivered to participants during the 4 to 10 weeks after their baseline assessment. Participants (≥18 yrs) eligible for SNAP-Ed and interested in receiving nutrition education lessons (direct SNAP-Ed) were recruited from 31 Indiana counties (N = 261) and completed baseline assessments from August 2015 to May 2016. Follow-up assessments were conducted approximately 1-year after baseline from August 2016 to May 2017 (n = 103). Dietary intake was assessed using up to 2 24-hour dietary recalls at each assessment time point. The main outcome measures were mean usual nutrient (calcium; vitamins D, A, C, E; magnesium; folate; potassium; fiber; dairy; fruit; vegetable; whole grains) the proportion meeting Estimated Average Requirements, exceeding Adequate Intakes, or meeting daily recommended servings, and diet quality as measured by the Healthy Eating Index-2010. This study is registered at www.clinicaltrials.gov as NCT03436784. Significance was P ≤ 0.05. Analyses were completed using SAS 9.4. ResultsNo effect of direct SNAP-Ed was found on diet quality, nutrient, or food group intake in the treatment compared to the control group between baseline and the 1-year follow-up assessment (P > 0.05). ConclusionsDirect SNAP-Ed did not improve long-term diet quality, nutrient, or food group intake among Indiana SNAP-Ed eligible adults. Funding SourcesFunding for this research was provided by Purdue University as part of AgSEED Crossroads funding to support Indiana’s Agriculture and Rural Development, Purdue University Frederick N. Andrews Fellowship, Purdue University Center for Families Justice Family Nutrition Award, the Purdue University Nutrition Education Program, and a USDA NIFA Hatch Project.

Prevention Produce: A Student-Led Nutrition Education Community Intervention (P04-022-19)

ObjectivesPrevention Produce is a medical student-led preventative medicine program designed with two goals in mind: (1) to supplement student volunteers’ education on strategies to communicate nutrition knowledge to patients and, in doing so, (2) educate patients in the community about basic nutritional principles to have a long-lasting effect on health and wellness. MethodsParticipants over age 18 were identified through multiple sources within the Penn State Health System and matched with medical students who coordinated meeting with the participant at one of three local Central, PA farmers’ markets.Participants completed four visits to the market consisting of a 15–30-minute nutrition education lesson, followed by a shopping session with the student and a voucher approved for the expense of $10 per family member (up to four).A validated 60-item questionnaire to assess basic nutrition knowledge was given at the first and last meeting to assess what knowledge gaps were filled by the program. Data were collected and entered into a spreadsheet to compare pre-and post-program % correct.A focus group was held with six students to understand what was gained through participation. Conversations were recorded, transcribed and de-identified into a word-processing document. Data was then coded to identify emergent themes. ResultsMean score on questionnaires showed an increase from 42.98% pre-program to 68.42% post-program (n = 5).Four emergent themes identified from the focus group:The program enhanced students’ professional development by allowing them to apply nutritional knowledge with a patient.Students’ role as a health professional was affirmed through their patients’ post-program increase in nutritional knowledge.Lastly, scheduling for patients was the largest barrier to implementing the program. ConclusionsThese data suggest that students can serve as effective health educators in the community, that four short educational sessions can improve understanding of important but basic nutrition knowledge, and that this experience enriches education and practical patient communication skills for students. The sample size of this study is small but serves as a pilot for future student-led nutrition intervention initiatives. Funding SourcesThe Foundation for Enhancing Communities (TFEC).The Association of Faculty and Friends (AFF)

Impact of Food Preparation Video Exposure on Online Nutrition Education in Women, Infants, and Children (WIC) Program Participants: Retrospective Study.

BackgroundThe impact of integrating video into health education delivery has been extensively investigated; however, the effect of integrating video on a learner’s subsequent performance in an online educational setting is rarely reported. Results of the relationship between the learner’s online video viewing and subsequent progression toward health behavior change in a self-directed online educational session are lacking.ObjectiveThis study aimed to determine the relationship between viewing a Health eKitchen online video and key engagement performance indicators associated with online nutrition education for women, infants, and children (WIC).MethodsThis study involved a retrospective cohort of users grouped on the basis of whether Health eKitchen exposure occurred before or after completing a nutrition education lesson. A two-sample test for equality of proportions was performed to test the difference in the likelihood of progression between the groups overall and when stratified by lesson type, which was defined by whether the lesson focused on food preparation. Welch two-sample t tests were performed to test the difference in average link depth and duration of use between groups overall and stratified by lesson type. Logistic regression was conducted to validate the impact of video viewing prior to lesson completion while controlling for lesson type and factors known to be associated with WIC key performance indicators.ResultsA greater stage of change progression was observed for both food preparation (χ2=12.6, P<.001) and non-food preparation (χ2=62.8, P<.001) lessons among early stage users who had viewed a Health eKitchen video before completing a lesson. Time spent viewing educational learning resource links within the lesson was also significantly longer for both food preparation (t=7.8, P<.001) and non-food preparation (t=2.5, P=.01) lessons. Logistic regression analysis corroborated these results while controlling for known confounding factors. The odds of user progression were nearly three times greater among those who viewed a Health eKitchen video prior to lesson completion (odds ratio=2.61; 95% CI=2.08-3.29). Type of lesson (food vs non-food preparation) was the strongest predictor of progression odds (odds ratio=3.12; 95% CI=2.47-3.95).ConclusionsUser access to a Health eKitchen video prior to completion of an online educational session had a significant impact on achieving lesson goals, regardless of the food preparation focus. This observation suggests the potential benefit of providing an application-oriented video at the onset of online nutrition education lessons.

P159 - Clearing the Path to Hispanic Health: Improving Awareness of Healthy Eating and Family Dynamics

Objective: This study aimed to examine Hispanic mothers' perceptions of the nutrition education and family routines lessons of Abriendo Caminos, a culturally-tailored childhood obesity prevention intervention. Target Audience: Hispanic mother-child dyads (n = 36) with at least one child between the ages of 6–18 in central Illinois. Theory, Prior Research, Rationale: There is a need to implement and evaluate health programs that address the high prevalence of obesity among Hispanic children. Community-based programs that are culturally-tailored and incorporate the family unit can facilitate the adoption of healthy behaviors. Evaluation findings will enable cultural adaptation of the lessons' content and activities. Description: Abriendo Caminos is a randomized-controlled intervention consisting of six 2-hour weekly workshops. Participants received nutrition lessons focused on healthy dietary patterns that follow federal dietary recommendations and include traditional Hispanic foods. The family routines lessons promote planning of shared family mealtimes, positive family interactions, and cultural traditions. Evaluation: Four focus groups were conducted with mothers in Spanish after workshop lessons were complete by bilingual and bicultural researchers. Two researchers took detailed notes. Data were analyzed using thematic coding analysis to consider areas of improvement for nutrition and family routines lessons. Major themes identified were: increased child self-efficacy in applying healthy dietary practices; mothers were motivated to incorporate new foods into meals; greater emphasis on family-oriented activities is needed, and inclusion of mental/emotional health topics would support positive parenting practices. Conclusions and Implications: Overall, mothers were satisfied with the Abriendo Caminos program. They reported learning new ways to improve their family's health and observed positive behavior changes in their children. However, mothers seek to learn about emotional health topics to improve communication with their children. Therefore, Abriendo Caminos adaptations will incorporate activities that foster the parent-child relationship and maintain program fidelity and goals. Funding: USDA.