Abstract
Objectives
The rate of obesity and associated risk factors in Canadian youth is increasing at an alarming rate. Nutrition plays an important role in weight maintenance. This study reports the effectiveness of Action Schools! BC–Healthy Eating, a school-based fruit and vegetable (FV) intervention, in effecting change in: 1) students’ intake of FV, 2) students’ knowledge, attitudes and perceptions regarding FV, and 3) students’ willingness to try new FV.
Methods
Five schools that represented geographic, socio-economic and size variation were recruited as Action Schools! BC–Healthy Eating intervention schools. A second set of five schools were selected as matched healthy eating usual practice schools. Student outcomes were measured at baseline and at 12-week follow-up using self-report questionnaires. Classroom logs and progress reports were used to assess implementation dose and fidelity. The intervention included school-wide activities based on individualized Action Plans addressing goals across six Action Zones.
Results
Significant differences were found between conditions over time while controlling for baseline levels. Fruit servings, FV servings, FV variety, and percent of FV tried from a fixed list increased in intervention schools. Teachers implemented a mean of 64% of requested classroom dose, and school Action Teams implemented activities across 80% of the whole-school model.
Discussion
A whole-school framework can impact FV intake, but results were modest due to implementation issues. Further implementation and evaluation are necessary to fully understand the effectiveness of this initiative.
Key words: Schools, health promotion, eating, initiative
Résumé
Objectifs
Le taux d’obésité et ses facteurs de risque augmentent à un rythme alarmant chez les jeunes Canadiens. La nutrition joue un rôle important dans le maintien du poids. Nous avons cherché à déterminer si Action Schools! BC–Healthy Eating, une initiative en milieu scolaire axée sur les fruits et légumes (F et L), a fait naître des changements dans: 1) la consommation de F et L par les élèves; 2) les connaissances, les attitudes et les perceptions des élèves sur les F et L; et 3) la volonté des élèves d’essayer de nouveaux F et L.
Méthode
Nous avons sélectionné en tant qu’écoles d’intervention cinq écoles représentatives de l’initiative Action Schools! BC–Healthy Eating sur le plan géographique, socioéconomique et numérique. Nous leur avons assorti cinq autres écoles, sélectionnées parmi les établissements ayant des pratiques courantes en matière d’alimentation saine. Les résultats des élèves ont été mesurés au début et après 12 semaines à l’aide de questionnaires d’auto-évaluation. Des journaux de classe et des rapports d’étape ont servi à évaluer la dose de mise en œuvre et l’assiduité. L’intervention comportait des activités pour toute l’école, inspirées de plans d’action personnalisés assortis d’objectifs dans six catégories d’intervention.
Résultats
Après avoir apporté des ajustements pour tenir compte des niveaux de référence, nous avons observé une évolution significative de la situation au fil du temps. Les portions de fruits, les portions de F et L, |la variété des F et L et le pourcentage de F et L essayés d’après une liste type ont augmenté dans les écoles d’intervention. Les enseignants ont mis en œuvre en moyenne 64 % de la dose recommandée dans leur classe, et les « équipes d’intervention » ont mis en œuvre 80 % des activités prévues à l’échelle de l’école.
Discussion
Une intervention à l’échelle d’une école peut avoir un effet sur la consommation de F et L, |mais les résultats obtenus ont été modestes en raison de problèmes de mise en œuvre. Il faudrait pousser la mise en œuvre et l’évaluation de cette initiative pour bien connaître son efficacité.
Mots clés: écoles, promotion de la santé, alimentation, initiative
Footnotes
Acknowledgements: AS! BC–HE was funded by the British Columbia Ministries of Health and Education, in partnership with the 2010 Legacies Now Society.
References
- 1.Tjepkema M, Shields M. Statistics Canada Catalogue no. 82-620-XWE2005001. 2005. Nutrition: Findings from the Canadian Community Health Survey-Overweight Canadian children and adolescents. [Google Scholar]
- 2.Sallis J, Chen A, Castro C. School-based interventions for childhood obesity. In: Cheung LWY, Richmond JB, editors. Child, Health, Nutrition, and Physical Activity. Champaign, IL: Human Kinetics; 1995. pp. 179–203. [Google Scholar]
- 3.Meininger J. School-based interventions for primary prevention of cardiovascular disease: Evidence of effects for minority populations. Annu Rev Nurs. 2000;18:219–44. doi: 10.1891/0739-6686.18.1.219. [DOI] [PubMed] [Google Scholar]
- 4.Simons-Morton B, Parcel G, Baranowski T, Forthofer R, O’Hara N. Promoting physical activity and a healthful diet among children: Results of a school-based intervention study. Am J Public Health. 1991;81(8):986–91. doi: 10.2105/AJPH.81.8.986. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5.Donnelly J, Jacobsen D, Whatley J, Hill J, Swift L, Cherrington A, et al. Nutrition and physical activity program to attenuate obesity and promote physical and metabolic fitness in elementary school children. Obesity Res. 1996;4(3):229–43. doi: 10.1002/j.1550-8528.1996.tb00541.x. [DOI] [PubMed] [Google Scholar]
- 6.Story M. School-based approaches for preventing and treating obesity. Int J Obesity. 1999;23(2):S43–S51. doi: 10.1038/sj.ijo.0800859. [DOI] [PubMed] [Google Scholar]
- 7.Perry C, Lytle L, Feldman H, Nicklas T, Stone E, Zive M, et al. Effects of the child and adolescent trial for cardiovascular health (CATCH) on fruit and vegetable intake. J Nutr Educ. 1998;30(6):354–60. doi: 10.1016/S0022-3182(98)70357-7. [DOI] [Google Scholar]
- 8.French S, Stables G. Environmental interventions to promote vegetable and fruit consumption among youth in school settings. Prev Med. 2003;37:593–610. doi: 10.1016/j.ypmed.2003.09.007. [DOI] [PubMed] [Google Scholar]
- 9.Statistics Canada. Community Profiles. Available online at. 2001. [Google Scholar]
- 10.Health Canada. Canadian Nutrient Files. 2005. [Google Scholar]
- 11.Lytle L, Murray D, Perry C, Eldridge A. Validating fourth-grade students’ self-report of dietary intake: Results from the 5-a-Day Power Plus program. J Am Dietet Assoc. 1998;98(5):570–72. doi: 10.1016/S0002-8223(98)00127-8. [DOI] [PubMed] [Google Scholar]
- 12.Van Horn L, Gernhofer N, Moag-Stahlberg A, Hart-Muller G, Lasser V. Dietary assessment in children using electronic methods: Telephones and tape recorders. J Am Dietet Assoc. 1990;90(3):412–16. [PubMed] [Google Scholar]
- 13.Mullenbach V, Kushi L, Jacobson C, Gomez-Marin O, Prineas R, Roth-Yousey L. Comparison of 3-day food record and 24-hour recall by telephone for dietary evaluation in adolescents. J Am Dietet Assoc. 1992;92(6):743–45. [PubMed] [Google Scholar]
- 14.National Cancer Institute. Eating at America’s Table Study: Quick Food Scan. Bethesda, MD: National Cancer Institute, National Institutes of Health; 2000. [Google Scholar]
- 15.House J. [Unpublished master’s thesis] Vancouver, BC: University of British Columbia; 2005. Effectiveness of the 5-Today program at increasing fruit and vegetable consumption in grade five and six children. [Google Scholar]
- 16.Campbell M, Demark-Wahnefried W, Symons M, Kalsbeek W, Dodds J, Cowan A, et al. Vegetable and fruit consumption and prevention of cancer: The Black Churches United for Better Health project. Am J Public Health. 1999;89:1390–96. doi: 10.2105/AJPH.89.9.1390. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 17.Serdula M, Coates R, Byers T, Simoes E, Mokdad A, Subar A. Fruit and vegetable intake among adults in 16 states: Results of a brief telephone survey. Am J Public Health. 1995;85(2):236–39. doi: 10.2105/AJPH.85.2.236. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 18.Thompson F, Kipnis V, Subar A, Krebs-Smith S, Kahle L, Midthune D, et al. Evaluation of two brief instruments and a food frequency questionnaire to estimate daily number of servings of fruit and vegetables. Am J Clin Nutr. 2000;71:1503–10. doi: 10.1093/ajcn/71.6.1503. [DOI] [PubMed] [Google Scholar]
- 19.Pliner P, Hobden K. Development of a scale to measure the trait neophobia in humans. Appetite. 1992;19:105–20. doi: 10.1016/0195-6663(92)90014-W. [DOI] [PubMed] [Google Scholar]
- 20.Galloway A, Lee Y, Birch L. Predictors and consequences of food neophobia and pickiness in young girls. J Am Dietet Assoc. 2003;103(6):692–98. doi: 10.1053/jada.2003.50134. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 21.Patton M. Qualitative Research and Evaluation Methods. 3rd ed. Thousand Oaks, CA: Sage Publications, Inc.; 2002. [Google Scholar]
- 22.Baranowski T, Davis M, Resnicow K, Baranowski J, Doyle C, Lin L, et al. Gimme 5 fruit, juice, and vegetables for fun and health: Outcome evaluation. Health Education & Behavior. 2000;27(1):96–111. doi: 10.1177/109019810002700109. [DOI] [PubMed] [Google Scholar]
- 23.Reynolds K, Franklin F, Binkley D, Raczynski J, Harrington K, Kirk K, Person S. Increasing the fruit and vegetable consumption of fourth-graders: Results from the High 5 Project. Prev Med. 2000;30:309–19. doi: 10.1006/pmed.1999.0630. [DOI] [PubMed] [Google Scholar]
- 24.Foerster S, Gregson J, Beall D, Hudes M, Magnuson H, Livingston S, et al. The California children’s 5 a Day–Power Play! campaign: Evaluation of a large-scale social marketing initiative. Fam Commun Health. 1998;21(1):46–64. doi: 10.1097/00003727-199804000-00007. [DOI] [Google Scholar]
- 25.Ciliska D, Miles E, O’Brien M, Turl C, Tomasik H, Donovan U, Beyers J. Effectiveness of community-based interventions to increase fruit and vegetable consumption. J Nutr Educ Behav. 2000;32(6):341–52. doi: 10.1016/S0022-3182(00)70594-2. [DOI] [Google Scholar]
- 26.Thomas J, Sutcliffe K, Harden A, Oakley A, Oliver S, Rees R, et al. Children and healthy eating: A systematic review of barriers and facilitators. London: EPPI-Centre, Social Science Research Unit, Institute of Education, University of London; 2003. [Google Scholar]
- 27.Perry C, Bishop D, Taylor G, Murray D, Mays R, Dudovitz B, et al. Changing fruit and vegetable consumption among children: The 5-a-day power plus program in St. Paul, Minnesota. Am J Public Health. 1998;88(4):603–9. doi: 10.2105/AJPH.88.4.603. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 28.McPherson R, Hoelscher D, Alexander M, Scanlon K, Serdula M. Dietary assessment methods among school-aged children: Validity and reliability. Prev Med. 2000;31:S11–S33. doi: 10.1006/pmed.2000.0631. [DOI] [Google Scholar]
- 29.Frank R, Kalisewicz S. Food experience and willingness to try novel foods. Appetite. 2000;34(3):335. doi: 10.1006/appe.2000.0320. [DOI] [PubMed] [Google Scholar]
- 30.Falciglia G, Pabst S, Couch S, Goody C. Impact of parental food choices on child food neopho-bia. Children’s Health Care. 2004;33(3):217–25. doi: 10.1207/s15326888chc3303_4. [DOI] [Google Scholar]
- 31.Blanchette L, Brug J. Determinants of fruit and vegetable consumption among 6–12 year-old children and effective interventions to increase consumption. J Human Nutr Dietetics. 2005;18:431–43. doi: 10.1111/j.1365-277X.2005.00648.x. [DOI] [PubMed] [Google Scholar]