Girl Scouting: An Effective Channel for Nutrition Education

Wellness-Promoting Practices Through Girl Scouts: A Pragmatic Superiority Randomized Controlled Trial With Additional Dissemination

PURPOSE

To evaluate the effectiveness of in-person versus online Girl Scout leader wellness training for implementation of wellness-promoting practices during troop meetings (phase I) and to assess training adoption and current practices across the council (phase II).

DESIGN

Pragmatic superiority trial (phase 1) followed by serial cross-sectional study (phase II).

SETTING

Girl Scout troop meetings in Northeast Kansas.

PARTICIPANTS

Eighteen troop leaders from 3 counties (phase 1); 113 troop leaders from 7 counties (phase II).

INTERVENTION

Phase I: Troop leaders attended 2 wellness training sessions (first in groups, second individually), wherein leaders set wellness-promoting practice implementation goals, self-monitored progress, and received guidance and resources for implementation. Leaders received the intervention in person or online.

MEASURES

Phase I: At baseline and postintervention, leaders completed a wellness-promoting practice implementation questionnaire assessing practices during troop meetings (max score = 11). Phase II: Leaders completed a survey about typical troop practices and interest in further training.

ANALYSIS

Phase I: Generalized linear mixed modeling.

RESULTS

Phase I: In-person training increased wellness-promoting practice implementation more than online training (in person = 2.1 ± 1.8; online = 0.2 ± 1.2; P = .022). Phase II: Fifty-six percent of leaders adopted the training. For 8 of 11 wellness categories, greater than 50% of leaders employed wellness-promoting practices.

CONCLUSION

In-person training was superior to online training for improvements in wellness-promoting practices. Wellness training was adopted by the majority of leaders across the council.

A Systematic Review of Methods for Increasing Vegetable Consumption in Early Childhood

Purpose of Review

This study aims to synthesise the body of research investigating methods for increasing vegetable consumption in 2- to 5-year-old children, while offering advice for practitioners.

Recent Findings

Repeated exposure is a well-supported method for increasing vegetable consumption in early childhood and may be enhanced with the inclusion of non-food rewards to incentivise tasting. Peer models appear particularly effective for increasing 2–5-year-olds’ vegetable consumption. There is little evidence for the effectiveness of food adaptations (e.g. flavour-nutrient learning) for increasing general vegetable intake among this age group, although they show some promise with bitter vegetables.

Summary

This review suggests that practitioners may want to focus their advice to parents around strategies such as repeated exposure, as well as the potential benefits of modelling and incentivising tasting with non-food rewards. Intervention duration varies greatly, and considerations need to be made for how this impacts on success.

A systematic review of children's dietary interventions with parents as change agents: Application of the RE-AIM framework

INTRODUCTION

Interventions targeting children's dietary behavior often include strategies that target parents as implementation agents of change, though parent involvement on intervention effectiveness is unclear. The present study systematically assessed (1) reporting of reach, effectiveness, adoption, implementation and maintenance (RE-AIM) of child dietary intervention studies with parents as change agents and (2) evaluated within these studies the comparative effectiveness of interventions with and without a parent component.

METHODS

The search was conducted in PubMed, PsycINFO, and Cochrane Library. Eligible studies were required to include a condition with a parental component, a comparison/control group, and target a child dietary behavior outcome. Forty-nine articles met criteria. Raters extracted RE-AIM and parent implementation information for each study.

RESULTS

Effectiveness (72.5%) was the highest reported RE-AIM element, followed by reach (27.5%), adoption (12.5%), implementation (10%), and maintenance (2.5%). Median reporting of parent implementation was highest for adoption and enactment (20%), followed by receipt (7.5%), and maintenance (2.5%). Six studies tested comparative effectiveness of parental involvement on child dietary outcomes.

CONCLUSION

Current RE-AIM reporting among children's dietary interventions is inchoate. The contribution of parental involvement on intervention effectiveness remains unclear. Increased focus should be placed on reporting of external validity information, to enable better translation of research to practical applications.

A Cosmetic Content-Based Nutrition Education Program Improves Fruit and Vegetable Consumption Among Grade 11 Thai Students

OBJECTIVE

To examine and compare the effectiveness of a cosmetic content-based nutrition education (CCBNEd) program and a health content-based nutrition education (HCBNEd) program on the promotion of fruit and vegetable (F&V) consumption.

DESIGN

Quasi-experimental.

SETTING

Three secondary schools in Nonthaburi, Thailand.

PARTICIPANTS/INTERVENTIONS

Three classes of students were randomly assigned to 3 study groups: experimental group 1 (n = 41) participated in the CCBNEd program, experimental group 2 (n = 35) experienced the HCBNEd program, and a comparison group (n = 37) did not participate in a program. All groups received F&V information. Data were collected between July and September, 2013.

MAIN OUTCOME MEASURES

Knowledge about F&V, attitude toward F&V consumption, and the amount and variety of F&V consumed were measured at baseline, posttest, and follow-up.

ANALYSIS

Nonparametric statistics were used to compare the programs' effectiveness.

RESULTS

After the test, experimental group 1 had significantly increased knowledge scores, attitude scores, and the amount and variety of F&V consumed compared with those at baseline (P < .001). These positive changes were maintained until follow-up. In experimental group 2, knowledge and attitude scores increased (P < .001) at posttest and then decreased at follow-up whereas the comparison group positively changed only in knowledge.

CONCLUSIONS AND IMPLICATIONS

The CCBNEd program was most effective at increasing F&V consumption.

Influence of behavioral theory on fruit and vegetable intervention effectiveness among children: a meta-analysis

OBJECTIVE

To test the hypotheses that interventions clearly based on theory, multiple theories, or a formal intervention planning process will be more effective in changing fruit and vegetable consumption among children than interventions with no behavioral theoretical foundation.

DESIGN

Systematic review and meta-analysis.

SETTING

Identification of articles in PubMed, PsycInfo, Medline, Cochrane Collaborative database, and existing literature reviews and meta-analyses.

PARTICIPANTS

Children aged 2-18 years.

INTERVENTIONS

Change in fruit and/or vegetable consumption in dietary change interventions.

METHODS

Meta-analysis, meta-regression analysis, and summary reporting for articles.

CONCLUSIONS AND IMPLICATIONS

Predicating an intervention on behavioral theory had a small to moderate enhancement (P < .001) of outcome effectiveness. Differences in mean Hedges' g effect sizes between theory and non-theory interventions were 0.232 for fruit, 0.043 for vegetables, and 0.333 for fruit and vegetables combined. There was mixed support, however, for enhanced dietary change with multiple theories or a formal planning process. After controlling for study quality, theory use was related only to vegetable consumption (β = 0.373; P < .001). More research is needed on theory's influences on dietary behaviors to guide future interventions among children. More research is also needed to identify what may be effective practical- or experience-based procedures that complement theory, to incorporate into interventions.

Community-based interventions for enhancing access to or consumption of fruit and vegetables among five to 18-year olds: a scoping review

BACKGROUND

Low fruit and vegetable ( FV) consumption is a key risk factor for morbidity and mortality. Consumption of FV is limited by a lack of access to FV. Enhanced understanding of interventions and their impact on both access to and consumption of FV can provide guidance to public health decision-makers. The purpose of this scoping review is to identify and map literature that has evaluated effects of community-based interventions designed to increase FV access or consumption among five to 18-year olds.

METHODS

The search included 21 electronic bibliographic databases, grey literature, targeted organization websites, and 15 key journals for relevant studies published up to May 2011. Retrieved citations were screened in duplicate for relevance. Data extracted from included studies covered: year, country, study design, target audience, intervention setting, intervention strategies, interventionists, and reported outcomes.

RESULTS

The search located 19,607 unique citations. Full text relevance screening was conducted on 1,908 studies. The final 289 unique studies included 30 knowledge syntheses, 27 randomized controlled trials, 55 quasi-experimental studies, 113 cluster controlled studies, 60 before-after studies, one mixed method study, and three controlled time series studies. Of these studies, 46 included access outcomes and 278 included consumption outcomes. In terms of target population, 110 studies focused on five to seven year olds, 175 targeted eight to 10 year olds, 192 targeted 11 to 14 year olds, 73 targeted 15 to 18 year olds, 55 targeted parents, and 30 targeted teachers, other service providers, or the general public. The most common intervention locations included schools, communities or community centres, and homes. Most studies implemented multi-faceted intervention strategies to increase FV access or consumption.

CONCLUSIONS

While consumption measures were commonly reported, this review identified a small yet important subset of literature examining access to FV. This is a critically important issue since consumption is contingent upon access. Future research should examine the impact of interventions on direct outcome measures of FV access and a focused systematic review that examines these interventions is also needed. In addition, research on interventions in low- and middle-income countries is warranted based on a limited existing knowledge base.

Decaying behavioral effects in a randomized, multi-year fruit and vegetable intake intervention

OBJECTIVE

To examine the effects of a multi-component, theory-based, 2.5-year intervention on children's fruit and vegetable consumption, preferences, knowledge and body mass index.

METHODS

Four inner city elementary schools in the Northeastern United States were randomized to an intervention (n=149) or control group (n=148) in 2005. Fruit and vegetable consumption during school lunch (measured by plate waste), preferences, and knowledge, as well as body mass index, were assessed five times across 3.5 years (pre-intervention, spring 2006, 2007, 2008 and 2009). Hierarchical linear modeling was used to analyze program outcomes.

RESULTS

At the first post-test assessment, children in the experimental group ate 0.28 more servings/lunch of fruit and vegetable relative to children in the control group and changes in fruit and vegetable consumption were found in each year throughout the program. However, this effect declined steadily across time so that by the delayed one-year follow-up period there was no difference between the groups in fruit and vegetable consumption. There were persistent intervention effects on children's knowledge. There were no effects on fruit and vegetable preferences and body mass index throughout the study.

CONCLUSION

Although there was initial fruit and vegetable behavior change, annual measurements indicated a gradual decay of behavioral effects. These data have implications for the design of school-based fruit and vegetable interventions.

Parental involvement in interventions to improve child dietary intake: a systematic review

OBJECTIVE

Interventions that aim to improve child dietary quality and reduce disease risk often involve parents. The most effective methods to engage parents remain unclear. A systematic review of interventions designed to change child and adolescent dietary behavior was conducted to answer whether parent involvement enhanced intervention effectiveness, and what type of involvement was most effective in achieving desired outcomes.

METHOD

In 2008, Pub Med, Medline, Psych Info, and Cochrane Library databases were searched to identify programs designed to change child and adolescent dietary intake that also involved parents. Methods of parental involvement were categorized based on the type and intensity of parental involvement. These methods were compared against intervention design, dietary outcomes, and quality of reporting (evaluated using CONSORT checklist) for each study.

RESULTS

The literature search identified 1774 articles and 24 met review criteria. Four studies systematically evaluated parent involvement with inconsistent results. Indirect methods to engage parents were most commonly used, although direct approaches were more likely to result in positive outcomes. Four studies met >70% of CONSORT items.

CONCLUSION

Limited conclusions may be drawn regarding the best method to involve parents in changing child diet to promote health. However, direct methods show promise and warrant further research.

A group-randomized controlled trial for health promotion in Girl Scouts: healthier troops in a SNAP (Scouting Nutrition & Activity Program)

BACKGROUND

Girl Scouting may offer a viable channel for health promotion and obesity prevention programs. This study evaluated the effectiveness of an intervention program delivered through Girl Scout Junior troops that was designed to foster healthful troop meeting environments and increase obesity prevention behaviors at home.

METHODS

Seven Girl Scout troops were randomized to intervention (n = 3, with 34 girls) or standard-care control (n = 4, with 42 girls) conditions. Girls ranged in age from 9 to 13 years (mean 10.5 years). Intervention troop leaders were trained to implement policies promoting physical activity (PA) and healthful eating opportunities at troop meetings, and to implement a curriculum promoting obesity-prevention behaviors at home. The primary outcome variable was child body mass index (BMI) z-score. Secondary outcomes included accelerometer-assessed PA levels in troop meetings, direct observations of snack offerings, time spent in physically active meeting content, and leader encouragement of PA and healthful eating.

RESULTS

The intervention was delivered with good fidelity, and intervention troops provided greater opportunities for healthful eating and PA (x2 = 210.8, p < .001), relative to control troops. In troop meetings, intervention troop leaders promoted PA (x2 = 23.46, p < .001) and healthful eating (x2 = 18.14, p < .001) more frequently, and discouraged healthful eating and PA less frequently (x2 = 9.63, p = .002) compared to control troop leaders. Most effects of the intervention on individual-level variables of girls and parents were not significantly different from the control condition, including the primary outcome of child BMI z-score (F1, 5 = 0.42, p = .544), parent BMI (F1, 5 = 1.58, p = .264), and related behavioral variables. The notable exception was for objectively assessed troop PA, wherein girls in intervention troops accumulated significantly less sedentary (x2 = 6.3, p = .011), significantly more moderate (x2 = 8.2, p = .004), and more moderate-to-vigorous physical activity, (x2 = 18.4, p < .001), than girls in control troops.

CONCLUSIONS

Implementing a health promotion curriculum and supporting policies to provide more healthful environments in Girl Scout troop meetings appears feasible on a broader scale. Additional work is needed to bridge health promotion from such settings to other environments if lasting individual-level behavior change and obesity prevention remain targeted outcomes.

TRIAL REGISTRATION NUMBER

NCT00949637.

Fourth graders' reports of fruit and vegetable intake at school lunch: does treatment assignment affect accuracy?

OBJECTIVE

Dietary interventions with children often use self-reported data to assess efficacy despite that objective methods rarely support self-report findings in validation studies. This study compared fourth graders' self-reported to observed lunch fruit and vegetable intake to determine if the accuracy of self-reported intake varied by treatment condition.

DESIGN

Matched randomized follow-up design examined three treatment groups (high and low intensity interventions and control) post-intervention.

SUBJECTS/SETTING

Three hundred seventy-nine middle-school children participating in a randomized controlled trial of a school-based fruit and vegetable intervention were observed during school lunch one day and asked to recall intake the following day.

MAIN OUTCOME MEASURES

Food items were coded as: "match," "omission," or "intrusion." Students were classified as accurate if all food items matched, otherwise inaccurate. Matched foods' portions were compared for accuracy. Servings were computed for total fruit and vegetable intake.

ANALYSES

Accuracy for fruits and vegetables were compared in separate analyses and tested for multiple potential associates: treatment condition, sex, race, body mass index, subsidized meal eligibility, school district, fruit/vegetable availability, age, and test scores. Fitted multivariable regression models included variables found to be significant in univariate or chi(2) analyses.

RESULTS

Variables found to be significant for fruit item accuracy were availability at lunch, body mass index, and subsidized lunch eligibility. For vegetable item accuracy, availability at lunch was significant. No differences were found for food portions or for efficacy of the intervention between the two methods of dietary data collection: observation and self-report.

CONCLUSIONS

Condition assignment did not bias recalled fruit and vegetable intakes among fourth graders.

Supporting adherence and healthy lifestyles in leg ulcer patients: systematic development of the Lively Legs program for dermatology outpatient clinics

OBJECTIVES

The objective of our project was to develop a lifestyle program for leg ulcer patients at outpatient clinics for dermatology.

METHODS

We used the intervention-mapping (IM) framework for systematically developing theory and evidence based health promotion programs. We started with a needs-assessment. A multidisciplinary project group of health care workers and patients was involved in all five IM steps; formulating proximal program objectives, selecting methods and strategies, producing program components, planning for adoption and implementation and planning for evaluation. Several systematic literature reviews and original studies were performed to support this process.

RESULTS

Social Cognitive Theory was selected as the main theory behind the program 'Lively Legs' and was combined with elements of Goal-Setting Theory, the precaution adoption model and motivational interviewing. The program is conducted through health counseling by dermatology nurses and was successfully pre-tested. Also, an implementation and evaluation plan were made.

CONCLUSION

Intervention mapping helped us to succeed in developing a lifestyle program with clear goals and methods, operational strategies and materials and clear procedures.

PRACTICE IMPLICATIONS

Coaching leg ulcer patients towards adherence with compression therapy and healthy lifestyles should be taken on without delay. Systematic development of lifestyle programs for other patient groups should be encouraged.

Relationships of psychosocial factors to dietary intakes of preadolescent girls from diverse backgrounds

Family and personal factors that might be related to the development of food selection and eating patterns have not been well studied in children. The aim of this study was to examine whether such psychosocial factors differ in girls from four culturally diverse Girl Scout troops and how these factors are associated with dietary intakes. The social measures and dietary assessments were all obtained at baseline on subjects who were participating in a small nutrition education programme. The programme enrolled girls and one parent for each girl from four Girl Scout troops in Detroit, Michigan. The social factors assessed included girls' emotionality and use of food to regulate emotions, their general attitudes about health, eating and body image, and self-perceptions of their competence. Dietary intakes also were assessed in both the girls and their parents. There were large differences between troops in ethnicity and parent education level, and there were differences in dietary intakes as well. The psychosocial factors assessed in this study, however, did not differ significantly by troop. When the psychosocial factors were examined for their relationships to dietary factors, there was an indication that families which reported higher self-competence and academic competence in their daughters also had healthier eating patterns in their daughters. This was a small study, but the data suggest that simple comparisons between ethnic groups may not adequately capture the complexity of family and psychosocial factors contributing to good dietary practices.

Getting children to eat more fruit and vegetables: a systematic review

BACKGROUND

There is growing recognition of the need to increase consumption of currently suboptimal levels of fruit and vegetables by children, given their known beneficial effects for health. There is, however, a need for a synthesis of the evidence on interventions that might achieve this policy goal.

METHODS

A systematic review of published and unpublished studies was carried out by searching 14 publication databases and contacting experts in the fields. All papers in eight languages were considered if they described individual- and population-based interventions and promotion programmes that encouraged the consumption of a diet relatively higher in fruit and/or vegetables in free-living, not acutely ill children of both genders, with follow-up periods of at least 3 months, measurement of change in intake and a control group.

RESULTS

Fifteen studies focusing on children met the criteria for inclusion in the systematic review. None of the studies reviewed had a detrimental effect on fruit and vegetable consumption. Ten studies had a significant effect, ranging from +0.3 to +0.99 servings/day.

CONCLUSIONS

More research is needed to examine in more depth, for longer follow-up periods, the effectiveness of interventions promoting fruit and vegetable consumption. The evidence is strongest in favor of multi-component interventions to increase fruit and vegetable consumption in children.

Determinants of fruit and vegetable consumption among 6-12-year-old children and effective interventions to increase consumption

PURPOSE

To review the current literature about potential determinants of fruit and vegetable intakes and effective intervention strategies to increase the consumption of fruits and vegetables among 6-12-year-old children.

METHODS

A structured review of literature located in PubMed and Psychinfo electronic literature databases.

RESULTS

Of all determinants, the availability and accessibility of fruit and vegetables and taste preferences were most consistently and most positively related to consumption. There was some evidence that parental fruit and vegetable intakes, knowledge of intake recommendations and skills had a positive association with children's intakes, whereas television viewing, exposure to television advertisement, and having a snack bar at school were associated with lower intakes of fruit and vegetables. Multi-component school-based interventions that combined classroom curriculum, parent and food service components showed the greatest promise for fruit and vegetable promotion among children. School fruit and vegetable subscription programmes, scout-based interventions, and fruit and vegetables education via computer multi-media channels also appear promising.

CONCLUSIONS

Interventions should improve the availability and accessibility of fruit and vegetables to children, and should aim to improve their taste preferences for them. Such interventions should be of a multi-component nature, school-based or use other social channels and may include multi-media channels.

Testicular cancer awareness and self-examination among adolescent males in a community-based youth organization

BACKGROUND

Testicular cancer (TC) is the most common neoplasm affecting males between 15 and 35, and testicular self-examination (TSE) has been recommended for early detection. Studies have found that young adult men have poor awareness of TC and low rates of performing TSE, but little research has examined adolescents.

METHODS

In a comprehensive survey of health behaviors among adolescent boys (n = 213, mean age 15.4 years) who participated in a community-based youth organization (Boy Scouts of America), we assessed whether respondents had heard of TC and the frequency of performing TSE.

RESULTS

Nearly 73% of scouts had heard of TC, but only 10.3% performed TSE at levels consistent with current recommendations (10 or more times per year). Compared to whites, blacks were less knowledgeable about TC and less likely to perform TSE. Knowledge of TC also was associated with participation in physical education classes and the intention to graduate from college. TSE was associated with greater health care access and the use of personal flotation devices during water activities.

CONCLUSION

TSE is underutilized as an early cancer detection tool. Efforts are needed to increase TC knowledge among black adolescents and to integrate TSE education with promotion of healthy behaviors in community organizations.

Measurement characteristics of diet-related psychosocial questionnaires among African-American parents and their 8- to 10-year-old daughters: results from the Girls' health Enrichment Multi-site Studies

OBJECTIVE

This paper presents the reliability and validity of several diet-related psychosocial questionnaires.

METHODS

At baseline and 12 weeks follow-up, parents/caregivers of one hundred fifty 8- to 10-year-old African-American completed questionnaires on food preparation habits for their daughter, perceived home barriers to healthy eating, and fruit, juice, vegetable (FJV), low-fat and high-fat food availability. Girls completed a sweetened beverage preferences questionnaire and two 24-h dietary recalls to assess intake. Principal components analyses were conducted for two newly designed measures. Internal consistency was calculated and construct validity was assessed between the psychosocial scales and obesity-related dietary variables.

RESULTS

Low-fat and high-fat food preparation for daughters, and perceived home barriers to eating low-fat food and FJV subscales were derived from the new questionnaires. Internal consistency reliabilities were moderate (0.58) to substantial (0.80) across all new and existing scales. Test-retest reliabilities were moderate (0.44) to substantial (0.79). Girls' intake of fat as a percentage of energy was positively related to parental high-fat food preparation for daughters (P < 0.01) and negatively related to parental low-fat food preparation practices for daughters (P < 0.05).

CONCLUSIONS

Measures of family influences on FJV, fat, and sweetened beverage consumption were internally consistent with moderate to substantial stability. Scales for low-fat and high-fat food preparation practices for daughters achieved construct validity with fat consumption in the hypothesized direction. Family food preparation habits appear to be important targets for future interventions.

The efficacy of behavioral interventions to modify dietary fat and fruit and vegetable intake: a review of the evidence

BACKGROUND

The evidence suggesting that nutrition, particularly dietary saturated fat and fruit and vegetable intake, is related to chronic disease risk has prompted considerable research on behavioral interventions focusing on dietary change. No clear understanding has emerged, however, of the degree to which these interventions can materially influence dietary change, or the types of intervention that are most effective and for whom. Therefore, the primary objective of the current study was to evaluate the overall effectiveness of behavioral dietary interventions in promoting dietary change related to chronic disease risk reduction. A secondary goal was to explore the relative effectiveness of specific intervention features and among different population subgroups.

METHODS

We conducted an evidence-based review and secondary analysis of existing literature. Our data sources included reports of randomized controlled trials and other study designs identified from multiple searches of MEDLINE, EMBASE, PsycINFO, CINAHL, AGELINE, and AGRICOLA. We included all studies on humans (including children, adolescents, and adults) published in English since 1975 that had been conducted in North America, Europe, or Australia; that had sample sizes of at least 40 subjects at follow-up; that were not based on controlled diets; and that otherwise met inclusion criteria. Through dual review, we abstracted detailed information on study characteristics, methodology, and outcomes relating to consumption of fruits, vegetables, and fats.

RESULTS

From 907 unduplicated articles originally identified, we retained 104 articles reporting on 92 independent studies. The studies were similarly successful in reducing intake of total and saturated fat, and increasing fruit and vegetable intake. More than three-quarters of the studies (17 of the 22 reporting results for fruit and vegetable intake) reported significant increases in fruit and vegetable intake, with an average increase of 0.6 servings per day. Similar consistent decreases were seen in intake of saturated fat and total fat (7.3% reduction in the percentage of calories from fat). Interventions appeared to be more successful at positively changing dietary behavior among populations at risk of (or diagnosed with) disease than among general, healthy populations. Two intervention components seemed to be particularly promising in modifying dietary behavior-goal setting and small groups.

CONCLUSIONS

The majority of the interventions reviewed resulted in meaningful improvements in dietary factors behaviors associated with the prevention of chronic disease, particularly among individuals at elevated disease risk. The lack of similarity across studies in outcome measures, study design, analysis strategy, and intervention technique hampered our ability to draw broad conclusions about the most effective behavioral dietary interventions, but our findings offer insight into intervention components that may hold promise for future research efforts.

Behavioral science research in the prevention of diabetes : status and opportunities

Recent studies show diabetes can be prevented. Growing knowledge of its biological bases opens further prevention opportunities. This article focuses on behavioral science research that may advance these opportunities. An ecological model guides attention to how prevention research may be pursued at the individual, group, or community levels. Three key areas are reviewed: risk communication, screening, and preventive interventions. Research on diabetes risk communication is limited but suggests that many are relatively unaware of risks and may have misconceptions about the disease. Amid policy debates and research regarding the potential benefits and costs of screening, identification of diabetes may itself be risky in terms of psychological and social consequences. The Diabetes Prevention Program and other studies make clear that diabetes can be prevented, both by the combination of weight loss and physical activity and by medications. Research needs to address promoting these methods to individuals as well as to groups and even whole communities. Fundamental as well as applied research should address how risks of diabetes are understood and may be communicated; how to enhance benefits and minimize psychological and other risks of screening; how to promote healthy eating and weight loss, physical activity, and appropriate use of medications to prevent diabetes; and how to reduce socioeconomic and cultural disparities in all these areas.

5 a day Achievement Badge for African-American Boy Scouts: pilot outcome results

BACKGROUND

Boy Scouts are an important channel to complement school-based programs to enable boys to eat more fruit, 100% juice, and vegetables (FJV) for chronic disease prevention. The "5 a Day Achievement Badge" program was presented on a pilot study basis to African-American Boy Scout troops in Houston.

METHODS

Troops were the unit of recruitment and random assignment to treatment and control groups. The badge program was presented in Fall 1997 by trained dietitians and included activities to increase availability and accessibility of fruit and vegetables at scouts' homes, increase preferences for vegetables, and train in the preparation of FaSST (fast, simple, safe, and tasty) recipes. Weekly comic books demonstrated and reinforced what scouts were expected to do at home. A weekly newsletter with recipes was sent to parents. The program was revised and presented to the control group in Winter 1998. Two 24-h recalls were the primary assessment tools. Telephone interviews were conducted with parents.

RESULTS

The intervention resulted in a 0.8 FJV serving difference (post values of treatment versus control groups with pre value covaried).

CONCLUSIONS

The changes obtained suggest that the intervention was effective in promoting dietary change.

Using goal setting as a strategy for dietary behavior change

Recent reviews have noted that behavioral theory-based nutrition education programs are more successful at achieving food behavior change than knowledge-based programs and that a clear understanding of the mechanisms of behavior change procedures enable dietetics professionals to more effectively promote change. Successful dietary behavior change programs target 1 or more of the personal, behavioral, or environmental factors that influence the behavior of interest and apply theory-based strategies to influence or change those factors. Goal setting is a strategy that is frequently used to help people change. A 4-step goal-setting process has been identified: recognizing a need for change; establishing a goal; adopting a goal-directed activity and self-monitoring it; and self-rewarding goal attainment. The applications of goal setting in dietary interventions for adults and children are reviewed here. Because interventions using goal setting appear to promote dietary change, dietitians should consider incorporating the goal-setting strategies to enhance the behavior change process in nutrition education programs.

Content analysis of the use of fantasy, challenge, and curiosity in school-based nutrition education programs

The objective of this research was to document the extent to which elements of fantasy, curiosity, and challenge are used in existing nutrition education materials. A content analysis of 30 nutrition education curricula designed for elementary and middle-school grades was conducted. Print curricula, computer software, videotapes, and puppet shows were included in the sample. The use of challenge, curiosity, and fantasy, as defined in the Theory of Intrinsically Motivating Instruction (TIMI), was assessed in each curriculum. Approximately half of the curricula included elements of challenge, curiosity, or fantasy. All of the nonprint curricula and 30% of the print curricula incorporated these characteristics. Curiosity was most frequently used in these curricula, followed by fantasy and then challenge. The TIMI provided a useful theory to examine the instructional approaches frequently used in school-based nutrition education programs. Nutritionists may apply concepts from the TIMI to the design of future curricula so that these programs are interesting and entertaining for their target audience.

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

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

Intervention mapping: a process for developing theory- and evidence-based health education programs

The practice of health education involves three major program-planning activities: needs assessment, program development, and evaluation. Over the past 20 years, significant enhancements have been made to the conceptual base and practice of health education. Models that outline explicit procedures and detailed conceptualization of community assessment and evaluation have been developed. Other advancements include the application of theory to health education and promotion program development and implementation. However, there remains a need for more explicit specification of the processes by which one uses theory and empirical findings to develop interventions. This article presents the origins, purpose, and description of Intervention Mapping, a framework for health education intervention development. Intervention Mapping is composed of five steps: (1) creating a matrix of proximal program objectives, (2) selecting theory-based intervention methods and practical strategies, (3) designing and organizing a program, (4) specifying adoption and implementation plans, and (5) generating program evaluation plans.