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>800 Kindergarten to grade 6 youth from five schools in California, United States |
40 high school peers developed and performed 20-min nutrition education performances in primary schools (performed for all grades at two schools and only for grade 5 students at three schools) based on social cognitive theory under the supervision and guidance of two nutrition professionals. The content was informed by discussions with 70 Kindergarten to grade 6 youth. The evaluation was conducted by performers and guided by an interview script. |
73% of youth responded positively to the performance and only 3% did not like it 66% of youth reported planning to make healthy changes after the performance and only 13% did not Most common planned changes included cutting back on ‘junk food’, eating more healthful foods (e.g. vegetables, fruit) and engaging in more exercise or active play outside |
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113 grade 9 students from two high school classes in Saskatoon and two classes in Prince Albert, Saskatchewan, Canada One intervention and one control class per locale |
Intervention: a 6-session (45 min each over 6 weeks) interactive nutrition education program based on the constructivist theory of learning. Saskatoon: delivered by six trained same-age peers, two older peers and five University of Saskatchewan undergraduate students Prince Albert: delivered by an older peer (registered dietitian) Control: handouts (self-taught) Outcomes included milk, juice, carbonated sugary beverage and total sugary beverage intake, and were measured at 3 months and 1 year post-intervention |
Saskatoon intervention: decrease in sugary beverage intake at 3-month follow-up (P < 0.02); higher level of satisfaction than control (P < 0.05) Saskatoon control: increase in juice intake at 3-month follow-up (P < 0.02) Prince Albert control: decrease in carbonated sugary beverage intake 1-week post-intervention (P < 0.02), returned to baseline after 3 months All other outcomes measured were not significant. |
Goals for health Forneris et al. (2010) |
2120 grade 6 students from 23 rural middle schools in Virginia and New York, United States 12 intervention and 11 control schools |
Intervention: a 12-session (12-weeks) goal-setting and life-skills program taught by trained high school students (supervised by project staff). The program measured impact on self-efficacy and knowledge related to healthy eating using trained survey administrators. Control: no intervention Outcomes included attitudes towards healthy eating, healthy eating knowledge, fruit, vegetable, fat, and fibre intake, and were measured at 3 months, 1 year, and 2 years post-intervention using questionnaires. |
Intervention students: increase in self-efficacy for healthy eating (P = 0.05) at 3-months, decreased to level of control at 2 years Increase in fat and fibre knowledge scores (P < 0.003, greater than control) at 3-months, maintained for 1 year (P = 0.04) but at 2 years was not different than control Both groups saw no change in fat food intake at 3-months, reduced intake from 3-months to 1 year, and saw no change between 1 and 2 years (P < 0.001); fruit and vegetable intake decreased over time (P < 0.001) for both groups. |
Healthy Buddies Campbell et al. (2012) |
1280 Kindergarten (K) to grade 7 students from eight schools in British Columbia, Canada Six intervention and two control schools |
Intervention: a 21-lesson (1 academic year) teacher-guided, peer-led initiative focused on physical activity, healthy eating and positive body image. Each week, grade 4–7 students received a 45-min lesson from a teacher, and then taught K to grade 3 peers in a 30-min lesson. Control: no intervention Outcomes included knowledge, habits, attitudes and behaviors towards healthy eating measured using questionnaires. Student and teacher satisfaction were measured using surveys. Height, weight and BMI were measured only in the intervention. |
K to grade 3: improvement in health knowledge (P < 0.001, no change in control) and healthy habits scores (P < 0.001, no change in control); greater increase in behavior scores compared with control (P < 0.001) Grade 4–7: improvement in health knowledge (P < 0.001, greater than control); increase in healthy habits scores in both intervention and control (P < 0.001) All youth: improvement in all five attitude questions in intervention (P ≤ 0.002), but only two questions improved in the control Program positively received by most students and teachers, made students feel healthier and enjoy working with a buddy The impact of the program on height, weight and BMI could not be estimated because physical measures were not taken in the control schools. |
Healthy Buddies Stock et al. (2007) |
360 Kindergarten (K) to grade 7 students from 2 schools in British Columbia, Canada 1 intervention and 1 control school |
Intervention: a 21-lesson (21 weeks) teacher-guided, peer-led initiative focusing on healthy eating, physical activity and body image. Each week, grade 4–7 students received a 45-min lesson from a teacher and then taught their K to grade 3 peers in a 30-min lesson. Control: no intervention Anthropometric measures were taken by volunteer physicians and all other outcomes were measured by trained volunteers using self-report questionnaires. |
K to grade 3: no change in systolic blood pressure in intervention, but increased in control (P = 0.025); greater increase in health knowledge (P < 0.001) and health attitude (P = 0.043) scores compared with control; increase in health behavior in both intervention and control (each P < 0.001) Grade 4–7: smaller increase in weight and BMI in intervention school versus control school (P < 0.008); no change in systolic blood pressure with intervention, but increased in control (P = 0.006); greater increase in health knowledge scores (P < 0.001) and health behavior scores (P = 0.025) in intervention compared with control; healthy attitudes scores increased (P < 0.001, no change in control) |
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179 Kindergarten (K) to grade 12 students from three schools in remote First Nations communities in British Columbia, Canada Two intervention schools and one control school |
Intervention: a 21-lesson (21 weeks) teacher-guided, peer-led initiative focused on healthy eating, physical activity and body image. Grade 4–7 students received a 45-min lesson from a teacher and then taught their K to grade 3 peers in a 30-min lesson. Control: no intervention Anthropometric measures were taken by a trained research team member and all other outcomes were measured using questionnaires completed under the supervision of the teacher and research team |
Mean BMI z-score: decreased in intervention and increased in control school (P = 0.028) Mean blood pressure z-score increased less in the intervention schools (P < 0.05) Self-esteem score increased, but decreased in control school (P = 0.005) Nutritious food knowledge, nutritious food consumption and healthy body image increased in intervention, but were not significantly different from those in the control No changes in diet |
Lift + Program Wilson et al. (2012) |
1119 grade 7 students from 10 middle schools in rural Central Virginia, United States Five intervention and five control schools |
Intervention: eight workshops (1 h each over 8 weeks) on the harms of tobacco and benefits of vegetables and fruit based on social cognitive theory and the theory of reasoned action. Program delivered to grade seven students by high school peer leaders. The following year, grade 8 students who had received the program served as peer leaders for grade 6 students. Control: no intervention (delayed) Outcomes were collected by research staff and taken immediately after and at 1-year post-program. |
Greater vegetable and fruit intake post-program (P = 0.039) and after 1 year (P = 0.040) compared with control Higher fruit consumption post-program (P = 0.018) but not maintained over 1 year (P = 0.060) Higher vegetable consumption post-program (P = 0.010) but maintained over 1 year for White students only (P = 0.036) Greater proportion of intervention students correctly identified vegetable and fruit intake recommendation compared with control students (P = 0.002) but not maintained over 1 year Those with ≥ 4 positive role models more likely to be confident they could consume ≥ 5 servings of fruits and vegetables compared with controls (P = 0.022). |
Peer Power Program Thomas and Ward (2006) |
805 students from three middle schools in a primarily rural northeastern region in North Carolina, United States |
A school program that trained high school students as health educators and mentors for middle school students. The program included 2–3 weekly lessons promoting physical activity, nutrition and avoiding tobacco. Outcomes were measured by the North Carolina Institute for Public Health through interviews and focus groups, and by the Kate B. Reynolds Charitable Trust’s SELF Improvement Program through surveys pre- and post-semester. |
Program was well received by students, teachers and parents Parents reported increased self-esteem, responsibility, confidence and skills for youth Improvement in nutrition and physical activity related choices BMI decreased by 4% for 66% of students |
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399 grade 7 students from a middle school in Los Angeles, California, United States |
A school program where 140 grade 7 peers learned to distribute healthy samples of cafeteria food and bookmarks with educational messages to other students during lunchtime over 5 weeks. New leaders were recruited each week. Sliced fruit and signage with nutrition information were added to the cafeteria. Outcomes included students’ attitudes towards cafeteria food and the intake of soda, sports and fruits drinks, and healthy entrees. Measurements were taken using surveys administered at 1-month post-intervention. |
Improved cafeteria attitudes for peer advocates (P = 0.003) but not for non-peer advocates Reduced intake of sports/fruit drinks for peer advocates (P = 0.03) and non-significantly for non-peer advocates (P = 0.06) Fruit consumption increased in intervention and decreased in control at 1-month post-intervention (P < 0.001 for both) Proportion of students served a healthy entrée increased in intervention (P < 0.001) and decreased in control at 1-month post-intervention |
Teen Mentoring Program Smith (2011) |
72 grade 3 and 4 students from three schools in a rural Appalachian school district, United States 13 teen mentors from 2 nearby high schools Three intervention schools (controls were non-participants from same schools) |
Intervention: a curriculum with eight sessions (1 h each over 8 weeks) adapted from ‘Just for Kids!’ that taught healthy diet and physical activity. Teen mentors delivered the curriculum after school to 1–2 ‘mentees’, supervised by adult After School Network Leaders. Control: no mentorship. Outcomes included BMI percentile, nutritional knowledge, attitudes and self-efficacy towards healthy behaviors and perceived support for healthy behaviors. Outcomes were measured using questionnaires and height and weight measurements pre- and post-intervention. |
Teen-mentoring group: significant reduction in BMI percentile (−0.38 percentile, P = 0.03) and increase in behavioral intention to eat healthy (P = 0.02, but not in control) Increase in all theoretical concepts hypothesized to influence behavioral intention, including nutritional knowledge (P = 0.05) and attitudes toward eating healthy (P = 0.025), while these all decreased in control group (with exception to self-efficacy toward healthy eating which remained unchanged) |
TEENS Story et al. (2002) |
677 grade 7 students and 226 peer leaders from eight schools in the Minneapolis/St Paul, Minnesota area, United States Eight intervention and eight control schools |
Intervention: a 2-year program based on social cognitive theory. Peer leaders helped teachers to deliver the grade 7 curriculum (10 sessions, 40–45 min each) which included group discussion, hands-on activities, food preparation, facilitated group decision-making and problem solving. Control: no intervention. Measurements included perceptions of the TEENS program on various domains. |
Peer leaders: 89% enjoyed being a leader, 92% thought they did a good job, 81% would be a leader again, 85% thought they learned more about healthy eating by being a leader, 75% thought they learned more from the program by being a leader, 64% thought they ate healthier Students: 58% thought that the peer leaders were helpful Teachers: 93% thought that the peer leaders were useful or very useful, 75% thought peer leaders led station activities very well, 88% thought that peer leaders led all activities OK or very well |
TEENS Birnbaum et al. (2002) |
3503 grade 7 students from 16 schools in Minneapolis/St Paul, Minnesota, United States Eight intervention and eight control schools |
Four intervention doses: control (no intervention), school environment only, classroom curriculum and school environment, peer leaders and curriculum and school environment (n = 226) The curriculum included 10 sessions informed by social cognitive theory; peer leaders helped teachers to deliver lessons. Control: no intervention. Fruit and vegetable consumption and food choice scores were measured using questionnaires pre- and post-intervention. |
Highest dose group: increase in daily fruit (P = 0.014) and vegetable consumption (P = 0.059), with an average increase of 0.92 servings of vegetables and fruit 0.64-point increase in food choice score (tendency to choose lower fat foods) (P = 0.002) Curriculum and school environment group: 0.64-point increase in food choice score (P < 0.001) The highest dose of intervention (with peer leaders) had greatest impact on food choices (fruit, vegetables, lower fat foods). |
TEENS Lytle et al. (2004) |
455 (24-h recall), and 2883 (survey) grade 7 and 8 students from 16 schools in the Twin Cities, Minnesota area, United States Eight intervention and eight control schools |
Intervention: three delivery channels informed by social cognitive theory: classroom, family and school-wide components. Multiple doses of the intervention: control (no intervention), environment only, environment and curriculum, and environment, curriculum and peer leaders Peer leaders were involved in delivering segments of the grade 7 lessons in the intervention schools. Control: no intervention. Measurements included fruit and vegetable intake, food choice, and availability of food options at home and at school. |
No significant difference between treatment and control groups except for food choice score; schools in the treatment group had higher scores (made lower fat choices) When compared with the control group and those with ‘low dose’ (environmental intervention only without curriculum) of the intervention, those with a ‘high dose’ (participated in curriculum) had higher food choice score (difference of − 0.05, P = 0.01), and those participating in the peer-led seventh grade curriculum had the highest scores. |
TACOS French et al. (2004) |
Students from 20 secondary schools in the Minneapolis-St Paul area, Minnesota, United States 10 intervention and 10 control schools, with enrollment ranging from 812 to 3157 students. |
Intervention: a 2-year multicomponent environmental intervention to increase the availability of lower-fat foods in the cafeteria, and peer-based promotions of these foods. TACOS staff trained student groups to implement promotion activities including taste tests, food choice assessments and media campaigns. Control: no intervention. Outcomes included attitudes towards cafeteria food, cafeteria food sales based on fat content and food choice scores. |
Intervention group was more likely to agree that the cafeteria offered enough low-fat foods (P = 0.001), that is was easy to tell which foods were low-fat (P = 0.03), that it was easy to buy low-fat foods (P = 0.05), that their friends usually buy low-fat foods (P = 0.01), adults encourage them to buy low-fat foods (P = 0.007). Students were more likely to report seeing advertisements about foods in the cafeteria or participating in taste tests or contests in the cafeteria compared with the control group (P < 0.001). Significantly higher change in means sales of lower fat foods in year 1 as a percentage of food sales (10 versus −2.8%, P = 0.002) and higher mean total percentage of sales of lower fat foods in year 2 (33.6 versus 22.1%, P = 0.042) |
TACOS Fulkerson et al. (2003) |
Students from 20 secondary schools in Minneapolis-St Paul, Minnesota, United States 10 intervention and 10 control schools, with enrollment ranging from 812 to 3157 students. |
Intervention: a 2-year multicomponent intervention to increase the sales and choices of lower-fat foods in cafeterias via education, food service and school environment changes. Students groups planned, organized, and implemented promotional activities under the supervision of at least one trained staff member. Control: no intervention. Outcomes included cafeteria food sales and promotional activity data collected by TACOS staff. |
Number of promotions conducted was significantly associated with change in percentage of total food sales as lower-fat foods in year 1 (P = 0.033), but not in year 2 Duration of promotions was significantly associated with an increase in change in percentage of lower-fat food sales in year 2 (P = 0.029) but not in year 1 |
TACOS Hamdan et al. (2005) |
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A 2-year initiative to increase the number of lower-fat food items and increase the sales of lower-fat foods in high schools. The intervention schools incorporated student-led promotional activities with the support of TACOS staff and school faculty advisors. Highly involved (n = 54): voluntarily participated and were involved in planning, implementing, and evaluation activities. Less involved (n = 343): participated because teachers implemented the activities and were involved in assisting in the implementation of the program (≤5 h). Measurements included students’ perceptions of TACOS, cafeteria food sales, and attitudes towards healthy eating. |
Significant differences between highly involved and less involved students across all domains of eating behaviors, attitudes, social norms, student involvement and experiences gained (P < 0.001). Highly involved students more likely to perceive that TACOS changed the way they chose foods, gave them the opportunity to try lower fat foods and vegetables and fruit, influenced them to eat more fruits and vegetables, improved their attitudes towards lower-fat foods, and had an impact on the number of students eating lower-fat foods in the cafeteria (P < 0.001). |
Youth Can! Jones et al. (2011) |
98 grade 4 and 5 students (same students across 2 years) from five schools in a rural county of East Tennessee, United States Two intervention and three control schools |
Intervention: grade 4 youth leaders received youth development training (19, 45-min sessions). The following year, these now fifth grade leaders identified priorities for nutrition interventions and implemented their plans. They co-taught (with an adult) 12 nutrition and physical activity lessons from the CATCH curriculum to their peers. Control: CATCH nutrition education Measurements included food intake by % energy from fat, low fat milk servings, fruit and vegetable servings and healthy eating behaviors taken pre- and post-intervention. |
Increase in fruit consumption in both intervention schools (P < 0.001 and P = 0.03) and increase in vegetable consumption in one intervention school (P = 0.02) were significantly higher than in the controls. Marginal decrease in energy intake (P = 0.06) and % energy from fat (P = 0.05) for one of the intervention schools compared with the controls. Actual measurements for the controls were not reported. |
