School-based Nutrition Intervention Research Articles

Pertinence of the recent school-based nutrition interventions targeting fruit and vegetable consumption in the United States:a systematic review.

Background: Schools are the major locations for implementing children’s dietary behavior related educational or interventional programs. Recently, there has been an increase in school-based nutrition interventions. The objective of this systematic review was to overview the evidence for the effectiveness of school-based nutrition intervention on fruit and vegetable consumption. Methods: PubMed was used to search for articles on school-based nutrition interventions that measured students’ fruit and vegetable consumption. Our search yielded 238 articles.The article was included if published in a peer-reviewed journal, written in English language,administered in the United States, and conducted among a population-based sample of children in Kindergarten through eighth grade. A total of 14 publications met the inclusion criteria. Results: Eight articles successfully showed the positive effect on increasing fruit and or vegetable consumption while the other six did not. Several factors, including (but not limited to) intervention duration, type of theory used, style of intervention leadership, and positively affecting antecedents of fruit and vegetable consumption were compared; however, no dominant factor was found to be shared among the studies with significant findings. Given that the criteria for selection were high, the lack of consistency between interventions and positive outcomes was surprising. Conclusion: With high levels of scrutiny and budget constraints on school nutrition, it is imperative that more research be conducted to identify the effective intervention components.

Using a mixed-methods approach to measure impact of a school-based nutrition and media education intervention study on fruit and vegetable intake of Italian children.

The purpose of the present study was to investigate the impact of a school-based nutrition and media education intervention on the promotion of fruit and vegetable consumption to help prevent childhood obesity. The 10-week-long intervention included sessions on nutrition education and media literacy. It also included a health communication media-based campaign workshop during which the children created posters, newsletters and video commercials related to fruits and vegetables targeted to their parents. For evaluation purposes, the study utilized a mixed-methods approach, including a quasi-experimental study (with one intervention group and one control group) and a focus group study. Four different elementary schools in Treviso (Veneto Region of Italy) agreed to participate in the research. The target population for the study included 10-year-old Italian children and their parents. Data indicate that this intervention was effective for children but not for parents. Evaluation results show that the intervention was effective in significantly increasing children's fruit and vegetable intake (P<0·05) and all psychosocial determinants (P<0·05). The study results confirm the efficacy of a school-based health and media education intervention to address the children's obesity issue and, in particular, to increase children's fruit and vegetable intake. The study also opens a new perspective on the theoretical constructs investigated, because the development of 'ability of expression' could be considered one of the most important factors to determine the efficacy of the intervention.

Increasing Access to Dietetic Services through a School-Based Nutrition Intervention Program

Increasing Access to Dietetic Services through a School-Based Nutrition Intervention Program

RE-AIM analysis of a randomized school-based nutrition intervention among fourth-grade classrooms in California.

Childhood overweight and obesity are major health problems. School-based programs enable intervening with large groups of children, but program overall health impact is rarely completely assessed. A RE-AIM (Reach, Efficacy, Adoption, Implementation, Maintenance) analysis tested the overall public health impact of the fourth-grade "Nutrition Pathfinders" school-based nutrition-education program. A randomized controlled trial in 47 fourth-grade California classrooms (1713 students) tested program efficacy, and a secondary analysis of archival data tested program dissemination. Desired effects were seen in child nutrition knowledge, attitudes, consumption of low-nutrient high-density foods, sugar-sweetened beverages, proteins, grains, and parent willingness to serve new foods. The program was disseminated to ∼25% of public school fourth-grade classrooms in California and cost about $1.00 per student to implement. The Nutrition Pathfinders program demonstrates potential for moderate to high public health impact due to its wide dissemination, effectiveness in altering attitudes and behaviors, and its relatively inexpensive cost of implementation.

The adaptation of a school-based health promotion programme for youth with intellectual and developmental disabilities: a community-engaged research process.

Evidenced-based health promotion programmes for youth with intellectual and developmental disabilities (I/DD) are notably absent. Barriers include a lack of understanding of how to adapt existing evidence-based programmes to their needs, maximize inclusion and support mutual goals of health and autonomy. We undertook a community-engaged process to adapt a school-based nutrition intervention in a residential school for youth with I/DD. Focus groups and interviews with school staff elicited recommendations for adaptation strategies; these were then reviewed by an expert panel. Adaptations were developed to address needs in three categories: food-related challenges among students, adjusting to change and transition and social environment factors. Choice and heterogeneity were overarching themes across the adaptation categories. Future research should consider community-engaged approaches for adaptation so that youth with I/DD can participate and benefit from evidence-based health promotion programmes to their maximum potential.

諸外国における学童・思春期の学校を拠点とした栄養・食教育に関する介入研究の動向:系統的レビューより

諸外国における学童・思春期の学校を拠点とした栄養・食教育に関する介入研究の動向:系統的レビューより

Eating Competence of Hispanic Parents Is Associated with Attitudes and Behaviors That May Mediate Fruit and Vegetable-Related Behaviors of 4th Grade Youth1–3

Parent self-efficacy, outcome expectancies, and behaviors toward cooking and fruits and vegetables mediate children's eating. Eating competence, an intra-individual approach to food-related attitudes and behaviors, is associated with healthful outcomes but has not been studied as a moderator of parent food-related behaviors that mediate healthful eating in 4th grade children. Parents (n = 339; 78% Hispanic, 89% female) of 4th graders who participated in an impact study of the Cooking with Kids curriculum in Santa Fe, NM schools eligible for Supplemental Nutrition Assistance Program Education completed the following surveys: Satter eating competence inventory for low-income (ecSI/LI) (16 items, Likert scale, possible score 0–48); modeling behaviors related to food preparation and fruits/vegetables (11 items, Likert scale, possible score 0–33); self-efficacy/outcome expectancies (SE/OE) (12 items, Likert scale, possible score 12–60); and availability of fruits/vegetables (20 items, possible score 0–20). Higher scores indicate more desired behaviors. The mean ecSI/LI score was 33.6 ± 8.5; 59% were eating competent, i.e., ecSI/LI ≥32. Eating-competent parents demonstrated more modeling (16.3 ± 5.0 vs. 14.0 ± 4.3; P < 0.001), greater SE/OE (53.7 ± 10.1 vs. 51.2 ± 8.5; P = 0.03), and greater in-home fruit/vegetable availability (12.7 ± 3.0 vs. 11.9 ± 3.2; P = 0.02). Two clusters of modeling behavior were defined: achievers and strivers. Modeling achievers (34.9 ± 6.9) were more eating competent (P < 0.001) than strivers (30.3 ± 8.9). Eating competence moderated parent food-related behaviors. Measuring eating competence may contribute to understanding parent behavior as a mediator in school-based nutrition interventions.

Assessing the Eating Behaviors of Low-income, Urban Adolescents

Background: There is a need for instruments that can accurately determine the effectiveness of nutrition interventions targeting low-income, inner-city adolescents. Purpose: To examine the development of a valid and reliable eating behavior scale (EBS) for use in school-based nutrition interventions in urban, inner-city communities dominated by high poverty, food insecurity and academic underperformance with primarily minority residents. Methods: The research was conducted with 387 minority adolescents in an inner-city urban school. Reliability was determined by administering the EBS to students twice on the same day, five hours apart. Convergent validity was determined by comparing the results of the EBS with 24-hour recalls conducted by trained dietitians. Spearman correlations and kappa statistics were used. Results: The EBS produced acceptable validity and reliability indices. Discussion: The EBS, designed specifically for use with minority urban adolescents who are both economically deprived and attend schools with documented low performance, provided preliminary evidence that it could produce valid and reliable scores with this population. Translation to Health Education Practice: The EBS which is easy for students to use and creates minimal disruption of instructional time can be used by researchers or practitioners to assess eating behaviors in low-income, minority adolescents.

Does parental involvement make a difference in school-based nutrition and physical activity interventions? A systematic review of randomized controlled trials

Parental involvement is often advocated as important for school-based interventions, however, to date, only inconsistent evidence is available. Therefore, this study aimed at determining the impact of parental involvement in school-based obesity prevention interventions in children and adolescents. A systematic review of obesity prevention studies published from 1990 to 2010 including a comparison between school-based interventions with and without parental component was conducted. Only studies reporting effects on health behaviour-related outcomes were included. Some positive effects of parental involvement were found on children's behaviours and behavioural determinants. Parental modules including different strategies and addressing several home-related determinants and parenting practices concerning eating and physical activity behaviours were more likely to be effective. However, no conclusive evidence could be provided concerning the added value of parent involvement, because of the paucity of studies to test this hypothesis. The few studies that are available provide inconsistent evidence. There is a need for more studies comparing school-based interventions with and without a parental component, and dose, strategies and content of parental components of school-based interventions should be better reported in articles.

Mediating effects of home-related factors on fat intake from snacks in a school-based nutrition intervention among adolescents

The purpose of the present study was to investigate if the effects of the parental component of a school-based intervention on dietary fat intake from snacking were mediated by changes in home-related factors. A random sample of 10 schools with 2232 pupils aged 11-15 years was randomly assigned to one of two intervention groups [one with (n = 1226) and one without a parental component (n = 1006)]. Fat intake, home availability of low-fat foods and parental encouragement and support to eat a low-fat diet were assessed with validated self-administered questionnaires. Mediation was assessed with the product-of-coefficient test. Changes in home-related determinants were significantly related to changes in fat intake from snacks; therefore, school-based obesity programmes on adolescents should try to address these determinants. In the present study, one of the three investigated home-related factors, namely parental support, was affected by the parental component intervention. Decreases in parental support were prevented. These changes in parental support were found to mediate the parental intervention effects on changes in fat intake from snacks. Home-related factors appear to be related to changes in adolescents' snacking behaviours, therefore, school-based obesity programmes should target them. Nevertheless, more research is needed concerning effectively addressing the other determinants.

A Content Analysis of Kindergarten-12th Grade School-based Nutrition Interventions: Taking Advantage of Past Learning

Objective To review the literature, identifying proposed recommendations for school-based nutrition interventions, and evaluate kindergarten through 12th grade school-based nutrition interventions conducted from 2000-2008. Design Proposed recommendations from school-based intervention reviews were developed and used in conducting a content analysis of 26 interventions. Participants Twenty-six school-based nutrition interventions in the United States first published in peer-reviewed journals from 2000-2008. Variable Measured Ten proposed recommendations based on prior analyses of school-based nutrition interventions: (1) behaviorally focused, (2) multicomponents, (3) healthful food/school environment, (4) family involvement, (5) self-assessments, (6) quantitative evaluation, (7) community involvement, (8) ethnic/heterogeneous groups, (9) multimedia technology, and (10) sequential and sufficient duration. Analysis Descriptive statistics. Results The most frequent recommendations used were: (1) behaviorally focused components (100%) and (2) quantitative evaluation of food behaviors (96%). Only 15% of the interventions included community involvement or ethnic/heterogeneous groups, whereas 31% included anthropometric measures. Five of the 10 proposed recommendations were included in over 50% of the interventions. Conclusions and Implications Rising trend of overweight children warrants the need to synthesize findings from previous studies to inform research and program development and assist in identification of high-impact strategies and tactics.

HealthKick: a nutrition and physical activity intervention for primary schools in low-income settings.

BackgroundThe burden of non-communicable diseases, including type 2 diabetes, is growing in South Africa. This country has a complex mix of over- and under-nutrition, especially in low-income communities, and concerning levels of physical inactivity in children and youth. This paper describes HealthKick, a school-based nutrition and physical activity intervention in primary schools in these settings aimed at reducing diabetes risk factors.Methods/DesignThis study includes schools within historically disadvantaged, low-income communities from an urban area close to the city of Cape Town and from two rural areas outside of Cape Town, South Africa. The three Educational Districts involved are Metropole North, Cape Winelands and the Overberg. The study has three phases: intervention mapping and formative assessment, intervention development, and outcome and process evaluation. Sixteen schools were purposively selected to participate in the study and randomly allocated as intervention (eight schools) and control (eight schools).The primary aims of HealthKick are to promote healthful eating habits and increase regular participation in health-enhancing physical activity in children, parents and teachers, to prevent overweight, and reduce risk of chronic diseases (particularly type 2 diabetes); as well as to promote the development of an environment within the school and community that facilitates the adoption of healthy lifestyles.The components of HealthKick are: action planning, toolkit (resource guide, a resource box and physical activity resource bin), and an Educators' Manual, which includes a curriculum component.DiscussionThis study continues to highlight the key role that educators play in implementing a school-based intervention, but that developing capacity within school staff and stakeholders is not a simple or easy task. In spite of the challenges experienced thus far, valuable findings are being produced from this study, especially from Phase 1. Materials developed could be disseminated to other schools in low-income settings both within and outside of South Africa. Owing to the novelty of the HealthKick intervention in low-income South African primary schools, the findings of the evaluation phase have the potential to impact on policy and practice within these settings.

Using Teacher Ratings to Document Response to a School-based Nutrition Education Program for Preschoolers

Accurate and efficient measures are needed to evaluate school-based nutrition interventions. We determined the utility of teacher reports of preschoolers' lunchtime intake against a noninvasive fruit/vegetable intake biomarker (dermal carotenoid status assessed via resonance Raman spectroscopy).

Impact of a primary school-based nutrition and physical activity intervention on learners in KwaZulu-Natal, South Africa: A pilot study

No Abstract.

A review of school nutrition interventions globally as an evidence base for the development of the HealthKick programme in the Western Cape, South Africa

Aim: The aim of this study was to review all school interventions having a nutrition component, published in peer-reviewed literature between 1995 and 2006, and to document activities that were successful as well as those that were possible barriers in order to develop a best practice school intervention for the Western Cape Province, South Africa.Methodology: A systematic review of school studies revealed 85 interventions that complied with the predetermined search criteria. The following outcome measures were considered in the evaluation of the interventions: (i) changes in nutritional knowledge, attitudes and self-efficacy and stage of change; (ii) changes in dietary behaviours; (iii) changes in clinical/physical markers such as body weight or body mass index, blood pressure or serum cholesterol concentrations; and (iv) process and/or policy outcomes.Results: Key success factors of school-based interventions appeared to be the following: A nutrition-based curriculum offered at school by trained teachers generally improved behavioural outcomes. A physical activity programme and parental component were associated with most of the best practice clinical and behavioural outcomes. Furthermore, all best practice studies were grounded on a firm theory of behaviour, such as social cognitive, social marketing or stages of change. Most of the interventions that included a food service component had best practice behavioural outcomes.Conclusions: Numerous school-based nutrition interventions have shown significant improvements in children’s nutritional behaviours. Consequently, it is necessary to plan programmes based on existing evidence of best practice. The lessons learnt from this review have been applied in the development of the HealthKick programme initiated in schools in the Western Cape in 2007.

Biscuits, Sausage, Gravy, Milk, and Orange Juice: School Breakfast Environment in 4 Rural Appalachian Schools

The purpose of this study was to assess the school breakfast environment in rural Appalachian schools to inform school environment intervention and policy change. A total of 4 rural schools with fourth- and fifth-grade students in East Tennessee were assessed. A cross-sectional descriptive examination of the school food environment where food service managers submitted school menus, production sheets, and vendor bid sheets as part of the dietary data collection protocol for a school-based nutrition intervention study. The school breakfast environment was characterized in terms of calories, fat, saturated fat, and fiber from foods served on a per person basis using menus entered into Nutrient Data Systems for Research and production sheets for amounts of each food item served. Food items were grouped by the meal components of the School Breakfast Program (SBP) and ranked according to the items served most frequently. Total fat provided slightly less than half the calories (43%); 15% of calories were from saturated fat. The top-ranked foods for each meal component were biscuits, sausage, 2% milk, orange juice, and gravy. Results suggest that clearer policies or regulations for the SBP are warranted to support policy efforts to promote childhood health. These should include technical assistance and provision of resources for school food service managers to provide low-fat meal options. Further research is needed to determine whether what is offered at school breakfast is actually consumed and how that might affect children's weight because of the high fat content.

School-based Nutrition Programs Produced a Moderate Increase in Fruit and Vegetable Consumption: Meta and Pooling Analyses from 7 Studies

Objective To evaluate, through study- and individual-level analyses of data from 7 studies, the effectiveness of school-based nutrition interventions on child fruit and vegetable (FV) consumption. Design To find original studies on school-based nutrition interventions, the authors searched electronic databases from 1990 to 2002. First authors of the 13 eligible studies were contacted to request their data. Data from 7 studies were received for inclusion in this pooled analysis. Setting Schools. Participants 8156 children were matched from pretest to posttest. Participants were primarily elementary school-aged (75.5%) and white (66%), and 50.4% were males. Main Outcome Measures Net FV difference and net FV relative change (%). Analysis Data were analyzed at both the study and individual levels. A fitted multivariable fixed-effects model was used to analyze the role of potential covariates on FV intake. Statistical significance was set at α = .05. Results At the individual level, the net difference in FV consumption was 0.45 (95% CI 0.33-0.59) servings; the net relative change was 19% (95% CI 0.15-0.23) servings. Conclusions and Implications School-based nutrition interventions produced a moderate increase in FV intake among children. These results may have implications for chronic disease prevention efforts, including cardiovascular disease and cancer.

P64: A School-based Nutrition Intervention Pilot Project, 2004-2005

Objects of this study are to evaluate the impact of a school-based nutrition intervention on nutritional status, educational achievement, school attendance, nutrition knowledge, eating habits and behaviors of children at fourth grade (8-11 years old). Three components are a nutrition education (group 1), a milk supplement (group 2), and control group (group 3). The subjects are mostly from low-income to middle-income families in three suburban elementary schools in Ho Chi Minh City. After 8 months of intervention, the results show that while means of z-score of weight for age (WAZ) in group 1 and group 2 had almost unchanged (P = .293 and P = .367, respectively), it had gone down significantly in group 3 (P = .001).

P90: Does a Multicomponent School-based Nutrition Intervention Program Increase Knowledge and Improve Attitudes about Fruits and Vegetable in Elementary School Students?

The objective of the pilot study was to test a multi-component school-based nutrition intervention program, Smart Bodies, to see if the curriculum increased nutrition knowledge and improved attitudes about fruits and vegetables in elementary school students. The Smart Bodies curriculum was conducted in the classrooms of four public schools in south Louisiana over a ten-week period and included nutrition related games, videos, and books. Two hundred fifty-five 4th and 5th grade students were included in the sample.

Assessing Intervention Effects in a School-Based Nutrition Intervention Trial: Which Analytic Model Is Most Powerful?

This article compares four mixed-model analyses valid for group-randomized trials (GRTs) involving a nested cohort design with a single pretest and posttest. This study makes estimates of intraclass correlations (ICCs) available to investigators planning GRTs addressing dietary outcomes. It also provides formulae demonstrating the potential benefits to the standard error of the intervention effect (sigma(delta)) from adjustments for both fixed and time-varying covariates and correlations over time. These estimates will allow other researchers using these variables to plan their studies by estimating a priori detectable differences and sample size requirements for any of the four analytic options. These methods are demonstrated using data from the Teens Eating for Energy and Nutrition at School study. Mixed-model analyses of covariance proved to be the most powerful analysis in that data set. The formulae may be applied to any dependent variable in any GRT given corresponding information for those variables on the parameters that define the formulae.