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F K, A W, S S, K B, R L. Primary-school-aged children inspire their peers and families to eat more vegetables in the KiiDSAY project: a qualitative descriptive study. BMC Pediatr 2024; 24:175. [PMID: 38461327 PMCID: PMC10924354 DOI: 10.1186/s12887-024-04643-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 02/13/2024] [Indexed: 03/11/2024] Open
Abstract
BACKGROUND While vegetable intakes in Australia remain sub-optimal across all age groups, children are rarely consulted about their ideas on how to increase consumption. Qualitative research involving children provides an opportunity to consider their views. The aim of the Kids initiative inspires Dietary Success in Adults and Youth (KiiDSAY) project was to explore the views of school-aged children, who had participated in a school-based nutrition education program, about inspiring their peers and families to eat more vegetables. METHODS A total of 26 children (15 boys) aged 10-12 years from four primary schools in New South Wales, Australia, participated in seven focus group interviews. Purposeful sampling was used to recruit participants. The study involved open-ended semi-structured questions conducted via Zoom that were audio-recorded, transcribed verbatim and analysed using thematic analysis with deductive and inductive coding in NVivo. RESULTS Four major themes emerged: (i) taste; (ii) family environment; (iii) healthy eating; and (iv) change makers; with subthemes that were embedded within Social Cognitive Theory and Ecological Model of Health Behaviour theoretical frameworks. CONCLUSIONS Children's inputs hold great potential for informing future interventions, particularly when designing or refining school-based nutrition programs. Children offered suggestions on how to inspire increased vegetable consumption among their peers and families that could be taken into consideration for future research and practice. These included: cooking activities in the home and school settings using recipes that creatively hide/mask/enhance the flavour of vegetables, involving positive role models and supportive school environments. Additionally, children recommended a sequential approach to the delivery of recipes starting from fruit-based and transitioning to vegetable-based recipes. Given the challenges faced in increasing children's vegetable consumption, particular focus on future research in this area is warranted. TRIAL REGISTRATION FEAST Trial registered 14th December 2020 with the Australian and New Zealand Clinical Trials Registry (ACTRN12620001347954).
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Affiliation(s)
- Karpouzis F
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Melbourne, VIC, 3125, Australia.
| | - Walsh A
- School of Behavioural and Health Sciences, Australian Catholic University, VIC, Melbourne, Australia
| | - Shah S
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Ball K
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Melbourne, VIC, 3125, Australia
| | - Lindberg R
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Melbourne, VIC, 3125, Australia
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2
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Karpouzis F, Lindberg R, Walsh A, Shah S, Abbott G, Ball K. Impact and process evaluation of a primary-school Food Education and Sustainability Training (FEAST) program in 10-12-year-old children in Australia: pragmatic cluster non-randomized controlled trial. BMC Public Health 2024; 24:657. [PMID: 38429629 PMCID: PMC10905805 DOI: 10.1186/s12889-024-18079-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 02/12/2024] [Indexed: 03/03/2024] Open
Abstract
BACKGROUND Environmentally sustainable food initiatives accompanying nutrition education, such as the Food Education and Sustainability Training (FEAST) program, have gained traction in school settings. The aim of this trial was to conduct an impact and process evaluation of FEAST, to evaluate its effect on children's fruit and vegetable (F&V) intakes, and secondary outcomes: F&V variety consumed, nutrition knowledge, food preparation/cooking skills, self-efficacy and behaviours, food waste knowledge and behaviours, and food production knowledge. METHODS FEAST was a 10-week curriculum-aligned program, designed to educate children about healthy eating, food waste, and sustainability, while teaching cooking skills. It was implemented by classroom teachers, face-to-face and online, during COVID-19 school closures, in Australia in 2021. A custom designed survey was used to collect baseline and post-intervention data from students. Generalised linear mixed models (GLMM) estimated group differences in pre-post changes for primary and secondary outcomes. Surveys were also administered to students and teachers to evaluate intervention implementation. RESULTS Twenty schools participated and self-selected to be either intervention schools (n = 10) or wait-list control (WLC) schools (n = 10). A total of 977, 5th and 6th grade children participated in the trial with a mean age of 11.1 years (SD ± 0.7). The FEAST intervention, compared to WLC, did not result in significant increases in primary outcomes nor secondary outcomes. The process evaluation revealed FEAST was well-received by students and teachers, but COVID-19 school closures hindered implementation fidelity with a less intense program delivered under the constraints of pandemic lockdowns. CONCLUSIONS This is the first cluster non-randomized controlled trial designed to independently evaluate FEAST in the primary-school setting. No evidence was found for improved F&V intakes in children, nor secondary outcomes. However, the positive process evaluation results suggest that further trials of the program are warranted. If implemented as originally designed (pre-pandemic), with increased duration and complemented by supporting school policies, such programs have the potential to improve children's daily F&V intakes, cooking skills and food waste behaviours. This would support the Australian curriculum and contribute to: health promotion within schools and sustainable schools initiatives, the national agenda to reduce food waste and sustainable development goals. AUSTRALIAN AND NEW ZEALAND CLINICAL TRIALS REGISTRY: [ACTRN12620001347954]- Registered prospectively on 14/12/2020.
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Affiliation(s)
- F Karpouzis
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Melbourne, VIC, Australia.
- , Rose Bay Nth, Australia, PO Box 2108, NSW, 2030.
| | - R Lindberg
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Melbourne, VIC, Australia
| | - A Walsh
- School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, VIC, Australia
| | - S Shah
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - G Abbott
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Melbourne, VIC, Australia
| | - K Ball
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Melbourne, VIC, Australia
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3
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Stewart HG, Young SK, Carlson AC. Adherence to Federal Dietary Recommendations for Total Fruit Consumption and the Intake of Underconsumed Nutrients: Findings from the National Health and Nutrition Examination Survey, 2015 to 2018. J Nutr 2023; 153:1476-1482. [PMID: 36948249 DOI: 10.1016/j.tjnut.2023.03.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 03/05/2023] [Accepted: 03/14/2023] [Indexed: 03/24/2023] Open
Abstract
BACKGROUND A persistent gap exists between U.S. consumers' actual fruit consumption and Federal dietary recommendations for fruit. Individuals who most deviate from recommendations may be at greater risk of underconsuming some nutrients. OBJECTIVE We investigate how widely total fruit consumption varies across adult consumers and whether those who most deviate from recommendations also consume less vitamins A and C, calcium, magnesium, and potassium. The 2020 Dietary Guidelines Advisory Committee has identified each of these nutrients as being underconsumed by the U.S. population in general. METHODS Data used were from the National Health and Nutrition Examination Survey (NHANES), 2015-16 and 2017-18 cycles. For 9,832 adults (age > 18), we compared their total fruit consumption to recommendations for their age and sex. We also calculated 2015 Healthy Eating Index (HEI-2015) scores. Component scores for Total Fruit and Whole Fruit were subtracted from total HEI-2015 scores to measure adherence with dietary recommendations outside of the fruit group. Two-way and 3-way contingency tables were then used to measure the association between adherence to fruit recommendations and the intake of underconsumed nutrients before and after controlling for adherence to other food group recommendations, respectively. RESULTS About two-thirds of adults eat less than half the recommended amount of fruit on any given day. Those who routinely unconsume fruit may be at greater risk of underconsuming potassium and vitamin C. Calcium, magnesium, and vitamin A consumption do not show a consistent relationship with fruit intake relative to recommendations after controlling for diet quality outside the fruit group. CONCLUSIONS There is much variation across the U.S. population in fruit consumption relative to recommendations. The present study suggests that individuals who deviate the most are at a particularly increased risk of underconsuming vitamin C and potassium.
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Affiliation(s)
- Hayden Glenn Stewart
- U.S. Department of Agriculture, Economic Research Service, Food Economics Division.
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4
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Grimes A, Lightner JS, Eighmy K, Wray BD, Valleroy E, Baughn M. Physical Activity and Nutrition Intervention for Middle Schoolers (Move More, Get More): Protocol for a Quasi-Experimental Study. JMIR Res Protoc 2022; 11:e37126. [PMID: 35507392 PMCID: PMC9118081 DOI: 10.2196/37126] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 04/21/2022] [Accepted: 04/22/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Physical activity and nutrition behaviors are important to reducing the prevalence of childhood obesity. Previous research has identified school-based interventions as effective strategies to improve physical activity and nutrition. However, the results are often mixed, and middle schoolers are an under-studied population. OBJECTIVE Our study aims to fill this gap by developing an after-school intervention to increase physical activity and fruit and vegetable consumption that is influenced by national guidelines and formative research. METHODS This study was an after-school, quasi-experimental study spanning 9 months. Enrollment began in September 2021 and continued on a rolling basis through February 2022. Weekly, middle schoolers were offered 2-3 physical activity sessions and 1 produce kit. Physical activity was measured using accelerometers and questionnaires. Nutrition behaviors were assessed using questionnaires, and physical literacy was assessed using researcher observations. Follow-up data collection occurred in December 2021 and in April 2022. Difference scores will be calculated and analyzed for each outcome variable. RESULTS The intervention started in September 2021 and will conclude in May 2022. Published study results are expected in late 2022. CONCLUSIONS An increase in physical literacy, physical activity, and fruit and vegetable consumption is expected. If successful, future studies will focus on reach and sustainability. Lastly, this study may serve as a model for improving health outcomes in middle schools. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/37126.
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Affiliation(s)
- Amanda Grimes
- School of Nursing and Health Studies, University of Missouri, Kansas City, MO, United States
| | - Joseph S Lightner
- School of Nursing and Health Studies, University of Missouri, Kansas City, MO, United States
| | - Katlyn Eighmy
- School of Nursing and Health Studies, University of Missouri, Kansas City, MO, United States.,Department of Population Health, University of Kansas Medical Center, Kansas City, KS, United States
| | - Bridget D Wray
- School of Nursing and Health Studies, University of Missouri, Kansas City, MO, United States.,School of Urban Planning, University of Kansas, Lawrence, KS, United States
| | - Ella Valleroy
- School of Nursing and Health Studies, University of Missouri, Kansas City, MO, United States.,Department of Population Health, University of Kansas Medical Center, Kansas City, KS, United States
| | - Maya Baughn
- School of Nursing and Health Studies, University of Missouri, Kansas City, MO, United States
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Strochlic R, Woodward-Lopez G, Hewawitharana S, Streng K, Richardson J, Whetstone L, Gorshow D. A Harvest of the Month Curriculum Increases Fruit and Vegetable Intake among 4th-6th Grade Students. THE JOURNAL OF SCHOOL HEALTH 2021; 91:750-760. [PMID: 34291460 DOI: 10.1111/josh.13066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 11/30/2020] [Accepted: 02/04/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Most children do not eat enough fruits and vegetables (FV). Schools are a critical setting for supporting children to consume FV. To fill a gap in available materials, a classroom curriculum was developed and evaluated to determine impacts on student FV-related knowledge, attitudes, and behaviors. METHODS A pre-/post-intervention survey was administered to 4th-6th grade students in 3 intervention and one comparison schools. Post-intervention student focus groups, parent/guardian surveys, and teacher surveys provided complementary information. RESULTS Intervention students had a significantly greater increase in total FV intake, fruit intake, and 100% juice consumption, and preference for several types of FV relative to comparison group students. Students, teachers, and parents reported overall high levels of satisfaction with the curriculum. CONCLUSIONS The Harvest of the Month curriculum is effective at increasing fruit intake among a low-income, diverse student population in grades 4-6, is acceptable to students, teachers, and parents, and is feasible to implement. Findings suggest this impact is the result of changes in preferences, skills, and motivation but not self-efficacy or perceived social norms. Some tailoring of the curriculum may be needed to increase its appropriateness for 6th-grade students, increase the impact on vegetable intake, and limit intake of juice.
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Affiliation(s)
- Ron Strochlic
- Academic Coordinator, , Division of Agriculture & Natural Resources, Nutrition Policy Institute, University of California, 1111 Franklin Street, 5th Floor, Oakland, California, 94607., USA
| | - Gail Woodward-Lopez
- Associate Director of Research, , Division of Agriculture & Natural Resources, Nutrition Policy Institute, University of California, 1111 Franklin Street, 5th Floor, Oakland, California, 94607., USA
| | - Sridharshi Hewawitharana
- Research Data Analyst, , Division of Agriculture & Natural Resources, Nutrition Policy Institute, University of California, 1111 Franklin Street, 5th Floor, Oakland, California, 94607., USA
| | - Katharina Streng
- Health Program Specialist, , California Department of Public Health, Nutrition Education and Obesity Prevention Branch, 1616 Capitol Avenue, Sacramento, California, 95814., USA
| | - Jackie Richardson
- Health Program Manager, , California Department of Public Health, Nutrition Education and Obesity Prevention Branch, 1616 Capitol Avenue, Sacramento, California, 95814., USA
| | - Lauren Whetstone
- Research Science Supervisor, , California Department of Public Health, Nutrition Education and Obesity Prevention Branch, 1616 Capitol Avenue, Sacramento, California, 95814., USA
| | - Derek Gorshow
- Program Director, College of Education, , Alameda County Office of Education, 313 West Winton Avenue, Hayward, California, 94544., USA
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Karpouzis F, Lindberg R, Walsh A, Shah S, Abbott G, Lai J, Berner A, Ball K. Evaluating OzHarvest's primary-school Food Education and Sustainability Training (FEAST) program in 10-12-year-old children in Australia: protocol for a pragmatic cluster non-randomized controlled trial. BMC Public Health 2021; 21:967. [PMID: 34022839 PMCID: PMC8140478 DOI: 10.1186/s12889-021-10302-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 01/20/2021] [Indexed: 11/10/2022] Open
Abstract
Background The promotion of healthy eating is a public health priority. Poor dietary behaviours, including low fruit and vegetable (F&V) consumption are of particular concern among children. Novel nutrition promotion strategies are needed to improve F&V consumption. Sustainability education could be used to support nutrition education within the school context. The purpose of this paper is to report the protocol for impact and process evaluation of the school-based Food Education and Sustainability Training (FEAST) program, designed to educate children about sustainability, food waste and nutrition, using hands-on cooking activities. Methods A pragmatic, parallel, cluster non-randomized controlled trial with pre- and post-measures, will be implemented among 20 primary schools (10 intervention vs 10 wait-list-control) within NSW, Australia, involving children in Grades 5–6. FEAST is a curriculum-aligned program, delivered as a 1.5-h lesson/week, for a 10-week unit of inquiry, incorporating theory and cooking. FEAST was developed using theoretical frameworks which included Social Cognitive Theory and the Precede-Proceed Planning model. Primary outcomes include children’s self-reported F&V intakes (serves/day). Food literacy constructs such as: nutrition knowledge, food preparation and cooking skills, self-efficacy and behaviours, food waste knowledge and behaviours and food production knowledge, will be assessed as secondary outcomes. Process evaluation will assess program reach, adoption, implementation, maintenance, satisfaction and perceived benefits by teachers and students. An online survey (including quantitative and qualitative questions) was developed for administration at baseline (impact evaluation) and immediately post-intervention (impact and process evaluation). Intervention effects on quantitative study outcomes will be estimated with generalised linear mixed models, including random effects and will follow the intention-to-treat principles. Open-ended questions embedded within the surveys will be analysed qualitatively using content and thematic analyses. Discussion Results from this trial will provide valuable information on the value of adding environmental sustainability strategies to nutrition education in schools. Results will inform the design of future research and programs focused on primary-school children’s nutrition, sustainability-related behaviours and experiential school-based interventions. Trial registration Trial registered 14th December 2020 with the Australian and New Zealand Clinical Trials Registry (ACTRN12620001347954). Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-10302-0.
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Affiliation(s)
- F Karpouzis
- Faculty of Health, Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Melbourne, VIC, Australia.
| | - R Lindberg
- Faculty of Health, Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Melbourne, VIC, Australia
| | - A Walsh
- School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, VIC, Australia
| | - S Shah
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - G Abbott
- Faculty of Health, Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Melbourne, VIC, Australia
| | - J Lai
- eResearch, Deakin University, Melbourne, VIC, Australia.,Intersect Australia, Sydney, NSW, Australia
| | - A Berner
- OzHarvest, Sydney, NSW, Australia
| | - K Ball
- Faculty of Health, Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Melbourne, VIC, Australia
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Using the Veggie Meter in Elementary Schools to Objectively Measure Fruit and Vegetable Intake: A Pilot Study. Methods Protoc 2021; 4:mps4020033. [PMID: 34066275 PMCID: PMC8162554 DOI: 10.3390/mps4020033] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 05/08/2021] [Accepted: 05/08/2021] [Indexed: 12/15/2022] Open
Abstract
Self-reported fruit and vegetable (FV) consumption in children has limitations that could be overcome with objective measures that are easy to implement. The Veggie Meter (VM) is a non-invasive portable device that measures skin carotenoid levels, a concentration biomarker of usual FV intake. While VM has been used to measure FV consumption in adults, few studies have explored its use in elementary school settings. Designing research studies using the VM with elementary school-age children requires an understanding of how well this device can be used in a school setting and of the distribution of VM scores in this population. We used VM to measure skin carotenoids in a diverse sample of 143 elementary school children who also answered commonly asked questions about consumption frequency of FV the previous day. Multivariable regression was used to assess the independent association of demographic variables with VM scores. VM scores were also compared with student-reported FV intake. There was a weak but statistically significant correlation between reported frequency of total vegetable consumption the previous day and observed VM scores (r = 0.174, p = 0.042). This study provides an example of the successful use of the VM in a school setting to collect an objective measure of FV intake and provides important description of data that can inform future studies.
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8
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Masis N, McCaffrey J, Johnson SL, Chapman-Novakofski K. Evaluation of Preferences Among Students Participating in the US Department of Agriculture Fresh Fruit and Vegetable Program. THE JOURNAL OF SCHOOL HEALTH 2021; 91:401-409. [PMID: 33768549 DOI: 10.1111/josh.13015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 09/09/2020] [Accepted: 02/03/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Improving children's fruit and vegetable (FV) preferences may be important as preferences can predict FV consumption. The purpose of this study was to evaluate FV preferences over time, with repeated experience, as part of the Fresh Fruit and Vegetable Program (FFVP). METHODS Fruits (F; N = 28) and vegetables (V; N = 29) were distributed twice a week, over 35 weeks, at a participating FFVP school (N = 236 students, 12 teachers, K-2nd grade). Preference ratings using 3-point Likert scale were analyzed over 35 weeks. RESULTS For 57 FVs rated for preference, ratings revealed that F had higher frequency of children choosing "I like it" than for V (78% F; 38.2% V; p < .05) and liking distribution was different between F and V (p < .001). Significant relations were found between liking and: (1) grade (r = -0.02, p = .02), and (2) time (r = -0.09, p < .001). Models indicated that V served (β = -0.40), timepoint (β = -0.07), and grade level (β = -0.02) accounted for significant variance for preference ratings (R2 = 0.17, p < .001), indicating that preference ratings declined over time. CONCLUSIONS Fruits were preferred over vegetables. Overall preference ratings were negatively impacted by time, grade level, and vegetables served. Being exposed one time to a variety of FVs did not improve ratings for vegetables.
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Affiliation(s)
- Natalie Masis
- Medical Science Liaison, , Scientific and Medical Affairs, Abbott, 2900 Easton Square Place, Columbus, OH, 43219, USA
| | - Jennifer McCaffrey
- Assistant Dean, , Family and Consumer Sciences, University of Illinois Extension, 520 Bevier Hall MC-184, 905 South Goodwin Avenue, Urbana, IL, 61801, USA
| | - Susan L Johnson
- Professor of Pediatrics; Director, , The Children's Eating Laboratory, University of Colorado School of Medicine, Anschutz Medical Campus, 12631 East 17th Avenue, Box F561, Aurora, CO, 80045, USA
| | - Karen Chapman-Novakofski
- Professor, , Nutrition, University of Illinois at Urbana-Champaign, 343 Bevier Hall, 905 South Goodwin Avenue, Urbana, IL, 61801, USA
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Ben Cheikh A, Maatoug J, Ghammam R, Chouikha F, Mallat A, Ghannem H. Effect of a school-based intervention in eating habits among school children: quasi experimental study, Tunisia. Int J Adolesc Med Health 2020; 33:157-164. [PMID: 32549142 DOI: 10.1515/ijamh-2018-0206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 10/04/2018] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The present study aimed to assess whether six months intervention program with parents' implication in primary schools is able to decrease morning snack consumption among children aged 6-12 years. METHODS We carried out a quasi-experimental study with two groups of schoolchildren in the region of Sousse (Tunisia) from 2015 to 2016. One primary school in each group was selected. In each school, we randomly selected a sample size of schoolchildren and their parents. The intervention was based on healthy eating habits promotion. RESULTS The consumption of morning snacks the day before data collection, reported by children, decreased significantly in post-intervention in both intervention and control groups. The decrease of consumption of morning snacks was significantly higher in intervention group (p=0.009). According to parents, the proportion of children who had the habit of eating morning snack decreased significantly from pre to post-intervention in intervention group (p<0.001). CONCLUSION A healthy environment should be created through effective school policies to prevent obesity.
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Affiliation(s)
- Asma Ben Cheikh
- Faculty of medicine of Sousse, University of Sousse, Sousse, Tunisia
| | - Jihène Maatoug
- Faculty of medicine of Sousse, University of Sousse, Sousse, Tunisia.,Department of Epidemiology - Sousse, University Hospital Center Farhat Hached, Sousse, Tunisia
| | - Rim Ghammam
- Faculty of medicine of Sousse, University of Sousse, Sousse, Tunisia.,Department of Epidemiology - Sousse, University Hospital Center Farhat Hached, Sousse, Tunisia
| | - Firas Chouikha
- Department of Epidemiology - Sousse, University Hospital Center Farhat Hached, Sousse, Tunisia
| | - Amal Mallat
- Department of Epidemiology - Sousse, University Hospital Center Farhat Hached, Sousse, Tunisia
| | - Hassen Ghannem
- Faculty of medicine of Sousse, University of Sousse, Sousse, Tunisia.,Department of Epidemiology - Sousse, University Hospital Center Farhat Hached, Sousse, Tunisia
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Marshall A, Bounds G, Patlovich K, Markham C, Farhat A, Cramer N, Oceguera A, Croom T, Carrillo J, Sharma S. Study Design and Protocol to Assess Fruit and Vegetable Waste at School Lunches. Behav Sci (Basel) 2019; 9:E101. [PMID: 31540381 PMCID: PMC6770865 DOI: 10.3390/bs9090101] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 09/14/2019] [Accepted: 09/14/2019] [Indexed: 12/16/2022] Open
Abstract
This paper has two main aims: (1) to describe the design, implementation, and testing of a protocol to assess longitudinal changes in F&V plate waste conducted as part of a quasi-experimental study, (2) to provide baseline descriptive data on school demographics and study participants. This paper describes the protocol development and implementation, and presents baseline data of a longitudinal fruit and vegetable (F&V) plate waste study. The protocol was developed to determine the preliminary impact of Brighter Bites, a 16-week school-based nutrition intervention, on F&V wasted and nutrients wasted from school lunches. We measured plate waste using a quasi-experimental design (n = 2 intervention schools receiving Brighter Bites, n=1 comparison school; n = 115 4th and 5th grade children). We measured plate waste for five days at each of four time points over the 2017-2018 academic year (baseline prior to intervention, three additional time points). Data collectors measured lunch F&V waste using digital scales and recorded weights on a data collection app. This study was conducted in three central Texas public elementary schools serving predominantly low-income families (>89% of children on free/reduced lunch program). On average, at baseline, 59.1% of all F&V were wasted and children tried <1 F&V at meals. Foods most wasted were legumes and foods least wasted were par-fried baked potatoes. Final retention rate across the four time points was 75.70%. Measurement inter-rater reliability was 100% (r = 0.99). Our study presents a protocol for detailed, individual-level, longitudinal plate waste assessment in elementary schools.
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Affiliation(s)
- Allison Marshall
- Michael & Susan Dell Center for Healthy Living, The University of Texas Health Science Center (UTHealth) School of Public Health, Austin Regional Campus, Austin, TX 78701, USA.
| | - Gregory Bounds
- Department of Epidemiology, Human Genetics and Environmental Sciences, Michael & Susan Dell Center for Healthy Living, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Houston, TX 77030, USA.
| | - Krista Patlovich
- Department of Epidemiology, Human Genetics and Environmental Sciences, Michael & Susan Dell Center for Healthy Living, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Houston, TX 77030, USA.
| | - Christine Markham
- Department of Health Promotion and Behavioral Sciences, Center for Health Promotion and Prevention Research, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Houston, TX 77030, USA.
| | | | - Nan Cramer
- Houston Independent School District Food Service Support Facility, Houston, TX 77028, USA.
| | - Amanda Oceguera
- Houston Independent School District Food Service Support Facility, Houston, TX 77028, USA.
| | - Travis Croom
- Department of Epidemiology, Human Genetics and Environmental Sciences, Michael & Susan Dell Center for Healthy Living, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Houston, TX 77030, USA.
| | | | - Shreela Sharma
- Department of Epidemiology, Human Genetics and Environmental Sciences, Michael & Susan Dell Center for Healthy Living, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Houston, TX 77030, USA.
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11
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Colley P, Myer B, Seabrook J, Gilliland J. The Impact of Canadian School Food Programs on Children’s Nutrition and Health: A Systematic Review. CAN J DIET PRACT RES 2019; 80:79-86. [DOI: 10.3148/cjdpr-2018-037] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
The quality of children’s diets has declined over the past few decades, giving rise to a variety of health-related consequences. In response to this trend, school food programs have become an increasingly effective method to support nutrition and lifelong healthy eating habits. This systematic review synthesizes current academic literature pertaining to school nutrition programs in Canada to identify existing interventions and their impacts on children’s nutritional knowledge, dietary behaviour, and food intake. The review was conducted through a search of the following databases: ERIC, Education Source, CINAHL, PubMed, SagePub, SCOPUS, EMBASE, and CBCA. Information extracted from the articles included the program objectives, intervention design and components, research evaluation, and primary outcomes. A total of 11 articles evaluating Canadian school nutrition programs were identified. The programs incorporated a variety of intervention components including policy, education, family and community involvement, and/or food provision. These multi-component interventions were positively associated with children’s development of nutrition knowledge, dietary behaviour changes, and intake of healthy foods; however, barriers associated with intervention duration, intensity, and availability of resources may have influenced the extent to which these programs impacted children’s diets and overall health.
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Affiliation(s)
- Paige Colley
- Health and Rehabilitation Sciences, Western University, London, ON
| | - Bronia Myer
- Medical Sciences and Psychology, Western University, London, ON
| | - Jamie Seabrook
- School of Food and Nutritional Sciences, Brescia University College at Western University, London, ON
- Department of Paediatrics and Epidemiology & Biostatistics, Western University, London, ON
| | - Jason Gilliland
- Department of Geography, Health Studies, Paediatrics, and Epidemiology & Biostatistics, Western University, London, ON
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12
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Yoshida Y, Schmaltz CL, Jackson-Thompson J, Bouras A, Rahmani E, Simoes EJ. Five Fruit and Vegetable a Day Does Not Reflect the Upward Trend of Obesity in the U.S. ACTA ACUST UNITED AC 2019; 5. [PMID: 33469568 PMCID: PMC7812612 DOI: 10.23937/2572-3278.1510038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective After almost three decades of U.S. surveillance in fruit and vegetable (F&V) intake and obesity, it is important to evaluate their usefulness for monitoring prevention and health promotion efforts in public health. We used U.S. surveillance data to evaluate whether the 16-year trends of F&V intake, measured by the prevalence of eating five or more servings of fruits and vegetables a day (FV5/day) is related to obesity trend as measured by its prevalence in the same period. We also evaluated whether trends in the prevalence of FV5/day by important sociodemographic factors (age, race/ethnicity, etc.) could explain the findings. Study design A secondary analysis of U.S. adults (≥ 18 years) from the Behavioral Risk Factor Surveillance System (BRFSS) (1994-2009). Methods We categorized survey subjects for their F&V intake derived from the BRFSS six-question food frequency questionnaire into two groups: < FV5/day vs. ≥ FV5/day. Obesity was defined as BMI ≥ 30. We used logistic regressions to compute predicted prevalence of FV5/day and obesity, and to estimate the odds ratio of FV5/day by obesity and levels of sociodemographic, stratified by year. Results Between 1994 and 2009, the prevalence of FV5/day hovered around 25% among U.S. adults, while the obesity prevalence steadily increased from 14.8% to 27.4%. As measured through odds ratio, an inverse association between FV5/day and obesity was only observed in 55+, but not in other age, racial/ethnic or education groups. Conclusions Between 1994 and 2009, we could not confirm a decrease in the prevalence of FV5/day associated with an increase in obesity prevalence, except for age 55+ group. Known disparities in FV5/day and obesity across sociodemographic factors persisted over the study period. FV5/day may be an inappropriate measure of total calories derived from eating fruits and vegetables. Its use to measure impact of public health strategies to improve nutrition and prevent obesity may be questionable.
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Affiliation(s)
- Yilin Yoshida
- Department of Medicine, Section of Endocrinology, School of Medicine, Tulane University, USA.,Department of Health Management and Informatics, School of Medicine, University of Missouri-Columbia, Columbia, USA.,Missouri Cancer Registry and Research Center, University of Missouri-Columbia, Columbia, USA
| | - Chester L Schmaltz
- Department of Health Management and Informatics, School of Medicine, University of Missouri-Columbia, Columbia, USA.,Missouri Cancer Registry and Research Center, University of Missouri-Columbia, Columbia, USA
| | - Jeannette Jackson-Thompson
- Department of Health Management and Informatics, School of Medicine, University of Missouri-Columbia, Columbia, USA.,Missouri Cancer Registry and Research Center, University of Missouri-Columbia, Columbia, USA
| | - Adam Bouras
- Department of Health Management and Informatics, School of Medicine, University of Missouri-Columbia, Columbia, USA
| | | | - Eduardo J Simoes
- Department of Health Management and Informatics, School of Medicine, University of Missouri-Columbia, Columbia, USA
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13
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A process and outcome evaluation of an in-class vegetable promotion program. Appetite 2018; 125:182-189. [PMID: 29427693 DOI: 10.1016/j.appet.2018.01.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 01/18/2018] [Accepted: 01/22/2018] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Nutrition interventions that target both fruits and vegetables are effective in increasing fruit consumption, but have been limited in their ability to improve vegetable intake. To address the low proportion of children meeting vegetable intake guidelines, approaches specifically targeting vegetables are needed. This paper reports on a mixed-method analysis of a 10-week vegetable promotion pilot project that aimed to increase vegetable intake as part of the existing Crunch&Sip in-class fruit and vegetable break program. DESIGN The intervention was designed to promote vegetable consumption through the implementation of vegetable-focused resources, including curriculum resources and parent education materials. Teachers completed pre- and end-of-intervention surveys. Process measures related to the use of resources and teachers' perceptions of barriers to implementation. The outcome evaluation included measures of children's vegetable consumption during Crunch&Sip breaks and teachers' attitudes and confidence relating to educating students about the benefits of consuming vegetables. SUBJECTS Twenty-one Western Australian primary schools already participating in the Crunch&Sip program participated in the pilot intervention and evaluation. Coverage included 35 primary school teachers representing 818 students aged 4-11 years. RESULTS The proportion of children bringing vegetables for Crunch&Sip more than doubled over the 10-week intervention (21% vs 46%; p < 0.001). Improvements were observed in teachers' perceived knowledge about the nutritional benefits of vegetables (p = 0.001) and confidence to educate students about the benefits of vegetable consumption (p = 0.028). CONCLUSIONS Preferentially promoting vegetable consumption as part of an existing school-based nutrition program may be an effective strategy to increase children's vegetable intake.
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Mann G. Copycat snacks: Can students differentiate between school and store snacks? Appetite 2018; 121:63-68. [PMID: 29107768 DOI: 10.1016/j.appet.2017.10.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 10/09/2017] [Accepted: 10/21/2017] [Indexed: 11/25/2022]
Abstract
In 2014, the national Smart Snacks in School nutrition standards placed regulations on all snack foods sold in schools. Many food companies reformulated common snack food products for sale in schools, called "copycat snacks", which look similar to nutritionally different foods sold in stores. It is possible that these snacks create consumer confusion among students. The purpose of this study was to determine if middle school students could differentiate, in taste and appearance, between school (copycat) and store versions of common snacks. Seventy-six middle school students evaluated three different food products offered in schools: Froot Loops, Rice Krispy Treats, and Doritos. Students tasted snacks in a series of triangle tests for difference, one for each snack food, including school and store versions. Students were also presented with packages, school and store versions of the same products, and asked to determine the expected taste, purchase intentions, and perceived healthfulness. Students could determine taste differences between school and store Rice Krispy Treats yet could not differentiate between Froot Loop and Dorito varieties. Students rated store versions of all three snacks with greater expected taste, higher intention to purchase, and as less healthy. While it seems product confusion concerning copycat snacks may not be severe in this sample, snack food brands are still a prominent feature in schools. It is possible that these copycat snacks can confuse students' perceptions of healthy foods. Alternative packaging for school foods or reformation of store versions of snack foods may be viable solutions to this problem.
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Affiliation(s)
- Georgianna Mann
- The University of Mississippi, Department of Nutrition and Hospitality Management, United States.
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15
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Effects of a School-Based Intervention on BMI z-Scores and Fitness Parameters in Mississippi Delta Children. INTERNATIONAL JOURNAL OF SCHOOL HEALTH 2017. [DOI: 10.5812/intjsh.13793] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Knight KB, W. Cole J, M. Dodd L, B. Oakley C. Eating Good and Moving Like We Should: A Consideration for Registered Dietitians in Schools. INTERNATIONAL JOURNAL OF SCHOOL HEALTH 2016. [DOI: 10.17795/intjsh-43043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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