Article

Knowledge, Attitudes, Self-Efficacy, and Healthy Eating Behavior Among Children: Results From the Building Healthy Communities Trial

Authors:
To read the full-text of this research, you can request a copy directly from the authors.

Abstract

Background/aim: Increased knowledge, attitudes, and beliefs about a topic and behavioral capability and self-efficacy for healthy eating are often a precursor to behavior change. The purpose of this study is to determine the effectiveness of the multicomponent school-based program on children's healthy eating knowledge, attitudes, and self-efficacy for healthy eating, and on their eating habits over time. Method: Quasi-experimental (4 treatment, 2 comparison) in a metropolitan area using a pretest-posttest method. Participants were 628 fifth-grade youth (377 treatment, 251 comparison) with a mean age of 9.9 years. The Building Healthy Communities (BHC) program is an 8-month school-wide healthy school transformation program and includes six main components. Outcome measures include children's healthy eating knowledge, attitudes, self-efficacy, and behavior. Missing data were imputed, confirmatory factor analysis tested scale factor structure, and path analysis determined a parsimonious path explaining behavior change. Results: The Student Attitudes and Self-Efficacy (SASE) scale had good measurement model fit. BHC group's healthy eating knowledge and behaviors increased significantly, while SASE remained moderate. For both groups, the students' knowledge and SASE significantly predicted their healthy eating behaviors; however, the intervention group accounted for a greater amount of variance (35% vs. 26%). Discussion: The BHC program was effective in improving healthy eating knowledge and behavior among youth, and the relationship between variables did not vary by group. Healthy eating knowledge is a significant predictor of both future knowledge and behavior.

No full-text available

Request Full-text Paper PDF

To read the full-text of this research,
you can request a copy directly from the authors.

... However, few studies reported a link of self-efficacy enhancement to behavioral outcomes among children. Kulik et al. (2019) reported that eating self-efficacy significantly predicted healthy eating behaviors among children with a mean age of 9.9 years [49]. Meanwhile, in the present study, an increase in self-efficacy over a short duration of three months might be supposed, although it was not measured. ...
... However, few studies reported a link of self-efficacy enhancement to behavioral outcomes among children. Kulik et al. (2019) reported that eating self-efficacy significantly predicted healthy eating behaviors among children with a mean age of 9.9 years [49]. Meanwhile, in the present study, an increase in self-efficacy over a short duration of three months might be supposed, although it was not measured. ...
Article
Full-text available
Background: We aimed to examine whether the Healthy Children, Healthy Families, and Healthy Communities Program, consisting of multi-level strategies for obesity prevention tailoring the context of socioeconomically vulnerable children based on an ecological perspective, would be effective on improving their healthy lifestyle behaviors and obesity status. Methods: Participants were 104 children (and 59 parents) enrolled in public welfare systems in Seoul, South Korea. Based on a cluster-randomized controlled trial (no. ISRCTN11347525), eight centers were randomly assigned to intervention (four centers, 49 children, 27 parents) versus control groups (four centers, 55 children, 32 parents). Multi-level interventions of child-, parent-, and center-level strategies were conducted for 12 weeks. Children’s healthy lifestyle behaviors and obesity status were assessed as daily recommended levels and body mass index ≥85th percentile, respectively. Parents’ parenting behaviors were measured by the Family Nutrition and Physical Activity scale. Results: Compared to the control group, the intervention group showed significant improvements in total composite scores of healthy-lifestyle behaviors—including 60-minutes of moderate physical activity—but not in obesity status among children. Moreover, the intervention group showed significant improvements in parenting behaviors among parents. Conclusion: The multi-level strategies for obesity prevention based on an ecological perspective may be effective for promoting healthy lifestyles among socioeconomically vulnerable children.
... Improving knowledge, attitudes, and beliefs, as well as behavioural competence and self-efficacy about healthy eating, is often a precursor to behavioural changes [20]. Attitudes are known to influence and guide people's behaviour. ...
Article
Full-text available
Health promotion activities in secondary schools are scarce and have little involvement of the teaching staff. Most often, activities are developed from the curriculum that appears in school materials, with little capacity for adaptation and innovation. The aim of this study was to construct and validate a tool to find out teachers’ attitudes towards activities to promote healthy eating in secondary schools. For this purpose, a descriptive study was conducted. The total sample of the study consisted of 200 teachers from secondary schools. Internal consistency was determined by Cronbach’s alpha coefficient globally and by dimension, and with the corrected item–test correlation. The construct validity of the questionnaire was assessed by means of an exploratory factor analysis, for which the principal components method with Varimax rotation was used. A Likert-type scale with nine items and four response options about attitude was designed. The exploratory factor analysis showed a nine-factor solution, of which two had eigenvalues greater than 1. These two factors explained 63.4% of the variance. The Cronbach’s alpha internal consistency index obtained for the global scale was 0.81, and 0.75 and 0.85 for each component. The results obtained with this structure confirmed an adequate reliability and validity of the questionnaire.
... Beyond parents, schools have also become the scene of interventions aimed at improving the attitudes and healthy food intake of students (Dudley et al., 2015;Kulik et al., 2019). For example, Francis et al. (2010) examined the impact of a nutritional education program on attitudes related to healthy dietary habits. ...
Article
Full-text available
The successful impact of healthy eating campaigns often depends on the extent to which messages are effective in changing attitudes and behaviors over time. The present work proposes that healthy eating campaigns can be designed taking into consideration elaboration and validation processes so that the degree of attitude change is maximally influenced and is consequential. The first set of studies described in this review demonstrates the importance of considering elaboration in determining initial attitudes toward healthy foods as well as the subsequent attitude strength consequences (e.g., stability, prediction of behavior, spreading). The second set of studies focuses on the role of perceived validity of one’s thoughts in the domain of eating as a potential mediator of the persuasion process. These studies include campaigns promoting positive attitudes toward healthy eating (e.g., eating of vegetables and fruits), and interventions oriented to decreasing the intake of unhealthy food (e.g., taxing junk food). We also discuss the role of modality of information presentation (e.g., verbal and visual information vs. direct physical experience) in those studies. Finally, the review offers a tutorial with concrete recommendations that researchers, practitioners and public policy makers can follow in order to predict both short and long-term attitude and behavior changes.
... (Sahoo et al. 2015;Sevaliev et al. 2019). Choosing healthy foods, avoiding junk food, eating as much as the body needs by evaluating the status of hunger and fullness effectively, not resorting to eating to get rid of negative emotions and preventing overeating due to the influence of the environment or social environment are all indicators of the level of healthy eating self-efficacy (Kulik et al. 2019;Chae et al. 2018;Bagherniya et al. 2017;Isa et al. 2019;Suorsa et al. 2016). Self-efficacy was proposed by Albert Bandura (1997), and it is defined as the belief of individuals in their own abilities to develop and implement the strategy they need for managing the situations that they encounter or may encounter. ...
Article
Full-text available
The prevalence of obesity in children has greatly increased, and many reasons account for the increase. Self-efficacy in controlling eating behaviour is known to be inversely related to obesity prevalence. Moreover, the level of self-efficacy can be increased. However, there is no scale adapted to the Turkish setting that can evaluate self-efficacy in controlling eating behaviour. This study aimed to adapt the Weight Efficacy Lifestyle Questionnaire Short-Form to the Turkish language. The study sample included 392 adolescents aged 14–18. Data were collected through a socio-demographic data collection form and the Weight Efficacy Lifestyle Questionnaire Short-Form. The mean and percentage calculations were used in the analysis of the socio-demographic data. The principal components analysis determined that the scale consisted of one dimension. The explained variance was determined as 49.1%, and the factor loadings were .57–.78. The confirmatory factor analysis yielded a root mean square error of approximation of .06 and fit indices greater than .96. The Cronbach’s alpha coefficient for overall scale was .84. The Cronbach’s alpha values of both halves of the split-half method and the Spearman–Brown and Guttman’s split-half coefficients were found to be greater than .70. The correlation of the items with the total score was positive and greater than .20. Thus, the Weight Efficacy Lifestyle Questionnaire Short-Form had a high level of validity and reliability for the Turkish adolescent sample. This scale can be used to determine self-efficacy in controlling eating behaviour change according to the current status of adolescents.
... The literature indicates the social cognitive theory (SCT) as the most commonly used theory for childhood obesity prevention efforts. [10][11][12][13] The SCT is an interpersonal theory that posits human behavior as the outcome of bidirectional interactions (i.e., reciprocal determinism) between personal, behavioral, and environmental factors. Thus, the SCT explains how a child's or caregiver's behavior is influenced by their environment (e.g., availability and accessibility to resources that promote the health behavior), behavioral capability (i.e., knowledge and skills to perform the health behavior), moral disengagement (i.e., ways of thinking to accept harmful behaviors), self-efficacy (i.e., level of confidence to ...
Article
Full-text available
The social cognitive theory (SCT) has been used to explain and promote childhood obesity prevention behaviors. We examined whether the SCT concepts predicted outcome expectations of childhood obesity among the children of African American caregivers. Caregivers (n = 128) completed the childhood obesity perceptions paper-based survey. A multiple linear regression was conducted to determine the direct effects of moral disengagement, environment, self-efficacy, and behavioral capability on outcome expectations (p < .05). A mediation analysis using a bootstrapping bias correction method was used to test whether self-efficacy and behavioral capability mediated the effect of moral disengagement and environment on outcome expectations. Caregivers reported high levels of moral disengagement (M = 4.13; standard deviation [SD] = 0.70) and self-efficacy (M = 4.26; SD = 0.64) and moderate levels of behavioral capability (M = 2.83; SD = 0.75) and environment (M = 2.92; SD = 0.74). Findings indicated the hypothesized relationships in the SCT were not fully supported. In addition, the indirect effects of environment on outcome expectations were not statistically significantly mediated by behavioral capability. This research warrants more attention in testing the SCT concepts for the development of childhood obesity prevention efforts that prioritize African American families in rural communities.
... In contrast with the widely studied psychosocial factors towards nutrition [4][5][6][7], there is a potential interest in emphasizing on psychosocial factors towards hands-on healthy meal preparation and cooking to impart nutrition education in school-age children [8,9]. Amid the obesity epidemic, it is suggested that basic food preparation and healthy meal planning skills need to be part of the long-term solution to the said epidemic [8,10]. ...
Article
Involving school-age children in the preparation of healthy meals is shown to be associated with positive eating behavior. Yet, it remains unclear whether this can extend to their nutritional status. The present study aimed to determine the association of school-age children’s psychosocial factors (knowledge, attitude, practice, self-efficacy) towards healthy meal preparation with their nutritional status (BMI-for-age, waist circumference, body fat percentage). Stratified random sampling was used to select primary schools (n = 8) in Kuala Lumpur, Malaysia. Two hundred school children aged between 9–11 years old were involved. Psychosocial factors towards healthy meal preparation were assessed using validated questionnaire. Anthropometry measures were determined using standard protocol. Almost half (46 %) of the school-age children were obese/overweight, 39 % were abdominally obese and 40 % were overfat. Approximately half had poor knowledge (49 %), poor practice (45 %), good attitude (56 %) and good self-efficacy (47 %) towards healthy meal preparation. Significant positive correlations were observed between knowledge with attitude (r = 0.23, p < 0.001); knowledge with self-efficacy (r = 0.30, p < 0.001); attitude with practice (r = 0.34, p < 0.001); attitude with self-efficacy (r = 0.59, p < 0.001) and practice with self-efficacy (r = 0.50, p < 0.001). Adjusted logistic regression revealed that school-age children with good attitude were less likely to be abdominally obese (OR = 0.87, 95 % Cl = 0.78 to 0.96) and overfat (OR = 0.84, 95 % Cl = 0.76 to 0.94). Children with good knowledge had lower risk of being abdominally obese (OR = 0.84, 95 % Cl = 0.72 to 0.97). Findings revealed that children’s psychosocial factors were interrelated, and improvements may have the potential in affecting nutritional status. Hands-on healthy meal preparation should be explored further as an innovative approach to address the obesity epidemic.
... Hence, there existed a gap between declarative knowledge and behaviors. Several studies have confirmed that healthy eating knowledge is a significant predictor of both future knowledge and behavior [30][31][32][33]; however, knowledge alone is not sufficient to change the food behaviors of consumers, as such behaviors can also be influenced by personal, intra-individual, and environmental factors, including motivations [34][35][36]. The results of our cluster analysis underline that one such factor could be "Emotional" motivations; at least, for Emotional eating consumers. ...
Article
Full-text available
Healthy food choices are crucial for a healthy lifestyle. However, food choices are complex and affected by various factors. Understanding the determinant factors affecting food choices could aid policy-makers in designing better strategies to promote healthy food choices in the general public. This study aims to evaluate the food choice motivations and to segment consumer groups, according to their food choice motivations, in a sample of 531 Italian consumers (collected by convenience sampling), through offline and online survey platforms. K-means cluster analysis was applied to identify consumer groups using six food choice motivation categories (health, emotional, economic and availability, social and cultural, environmental and political, and marketing and commercial). The results suggest that the strongest determinants for the food choices of Italian consumers are Environmental factors and Health. Two consumer profiles were identified through the segmentation analysis: Emotional eating and Health-driven consumers. The respondents were found to have a good awareness of what comprises a healthy diet. There is a potential market for healthy and sustainable food products, especially products with minimal or environmentally friendly packages. Food labels and information strategies could be promoted as tools to assist consumers to make healthy food choices.
... Skor pengetahuan dan sikap tentang gizi memiliki kaitan yang sangat erat antara keduanya dan merupakan penentu perilaku pola makan remaja usia sekolah (Sharma et al., 2019). Selain itu, pemberian edukasi gizi memiliki pengaruh yang positif tentang gaya hidup sehat dan efektif sebagai intervensi kesehatan berbasis sekolah yang dapat mengubah perilaku makan sehat di masa depan (Kulik et al., 2019;Sharif Ishak et al., 2020). ...
Article
Full-text available
Background : The problem of nutrition in adolescents, especially the problem of obesity, is one of the focuses of government attention. Nutrition education is one of the most effective ways to increase the knowledge and attitudes of adolescents to maintain their diet so that obesity does not occur. Purpose : This study purposed to analyze the effectiveness of nutrition education in the video media "Piring Makanku" towards increasing the knowledge and attitudes of students at SMP Negeri 1 Tumijajar. Methods : The design in this study was a quasi-experiment. The sample in this study amounted to 30 students of class IX through random sampling divided into 2 groups, namely intervention and control . The Mann-Whitney test was used to analyze differences in the effectiveness of nutrition education on students' knowledge and attitudes. Results : The education provided was able to increase students' knowledge (p = 0.001) and attitudes (p = 0.001) in both the intervention group and the control group. Conclusion : Nutrition education is effective in increasing students' knowledge and attitudes.
... Although barriers exist, including time, resources, and educator training, extensive research supports the effectiveness of school-based nutrition education interventions to reduce childhood obesity and support academic achievement [9][10][11][12][13][14][15][16]. Specifically, health promotion interventions can improve nutrition knowledge, attitudes, and preferences for healthy foods [17,18] and serve to predict future behavior [19]. Further, a systematic review and meta-analysis of 34 studies [20] suggests a positive impact on student nutritional knowledge and dietary behaviors when nutrition education is taught by teachers. ...
Article
Full-text available
Childhood obesity prevalence trends involve complex societal and environmental factors as well as individual behaviors. The Healthy Schoolhouse 2.0 program seeks to improve nutrition literacy among elementary school students through an equity-focused intervention that supports the health of students, teachers, and the community. This five-year quasi-experimental study follows a baseline–post-test design. Research activities examine the feasibility and effectiveness of a professional development series in the first program year to improve teachers’ self-efficacy and students’ nutrition literacy. Four elementary schools in Washington, DC (two intervention, two comparison) enrolled in the program (N = 1302 students). Demographic and baseline assessments were similar between schools. Teacher participation in professional development sessions was positively correlated with implementing nutrition lessons (r = 0.6, p < 0.001, n = 55). Post-test student nutrition knowledge scores (W = 39985, p < 0.010, n = 659) and knowledge score changes (W = 17064, p < 0.010, n = 448) were higher among students in the intervention schools. Students who received three nutrition lessons had higher post knowledge scores than students who received fewer lessons (H(2) =22.75, p < 0.001, n = 659). Engaging teachers to implement nutrition curricula may support sustainable obesity prevention efforts in the elementary school environment.
... Additionally, healthy eating self-efficacy gives people the necessary confidence in their ability to engage in healthy eating behavior, and it is gained through knowledge, understanding, and skill development [54]. Previous studies suggested a complex role of self-efficacy in affecting healthy eating behavior [55,56]. More research is needed in the future to confirm whether there are factors that affect the relationship between healthy eating self-efficacy and healthy eating behavior. ...
Article
Full-text available
College students experience new pressures and choices as they transition to independent living and can easily develop unhealthy eating habits, resulting in obesity and obesity-related chronic diseases in later life. This study aimed to test the hypothesis that nutrition literacy (NL) mediated the relationship between multi-level factors influencing healthy eating behavior identified from the social-ecological model and healthy eating behavior of college students. A four-part questionnaire was completed by 412 participants recruited from six different four-year universities in Taiwan (effective response rate = 85.8%). Data were analyzed using descriptive statistics, an independent samples t-test, hierarchical multiple regression, and mediation analysis. The results indicated that the students’ mean nutrition literacy score was 4.32 (SD = 0.78, range = 1–6). In the social-ecological framework, nutrition literacy significantly predicted healthy eating behavior (β = 0.28, p < 0.001; ΔF = 32.54, p < 0.001; ΔR2 = 0.05) with control variables of background, intrapersonal, interpersonal, environmental, and macrosystem factors. Nutrition literacy mediated the effects of seven factors on healthy eating behavior across four levels. These findings suggested that strengthening influential multi-level factors associated with healthy eating behavior not only enhanced NL, but also improved individuals’ healthy eating behavior.
... This may indicate a need for further nutrition education components within interventions to support parents in making healthy eating decisions for their families [71]. Since neither fruit nor vegetable intake increased over time, community partners-especially food banks-should work to identify the culturally relevant fruits and vegetables their school district families prefer and aim to consistently make those options more available [72,73]. In turn, the partners designing the intervention could pilot healthier food boxes that are more aligned with community supported agriculture boxes as an alternative to sourcing processed foods by utilizing USDA programs like Farm to Table or Farmers to Families [47,69]. ...
Article
Full-text available
The Best Food Forward (BFF) project aims to provide multiple nutrition supports and interventions to improve family food security (FS) and health outcomes associated with FS within two metropolitan school districts. A quasi-experimental time-series design guided a multilevel evaluation for BFF through surveys, biometric screenings, focus groups, and observations among a random sample of caregiver–child dyads. FS, utilization of school meal programs, and nutrition behaviors were observed and analyzed at three time points: preintervention, postintervention pre-COVID-19, and postintervention post-COVID-19. Participants included 122 parents and 162 youth. Families reported (1) an income less than $35,000 annually (48.8%) and (2) a COVID-19-related job loss (36.9%). Parents used Supplemental Nutrition Assistance Programs or Women, Infants, Children benefits prior to (51.1%) and following COVID-19 (50.0%). No significant differences in FS were found. RM-ANOVA indicated an increase in breakfast consumption at home and a decrease in use of the school breakfast program (F(1.78, 74) = 19.64, p < 0.001, partial η2 = 0.21) and school lunch program (F(1.51, 74) = 23.30, p < 0.001, partial η2 = 0.24). Rates of FS and eating behaviors did not change significantly over time. Correlations of program usage and eating behaviors demonstrate the importance of promoting participation in school meal programs. BFF may have prevented significant decreases in FS during COVID-19.
... Furthermore, our findings indicated that students in higher grades were more likely to engage in oral health behaviors and that they made more progress in self-efficacy than those in lower and middle grades. This finding was similar to those of previous studies that showed that children with high self-efficacy are more likely to engage in this behavior [41,42]. In addition, as students grow older, they are better able to understand the relationship between health concepts and their behaviors; consequently, they change their behaviors to promote health [43]. ...
Article
Full-text available
Background We evaluated the effects of health-promoting school (HPS) strategy on plaque control and behavior change in high-caries schoolchildren in Taitung, Taiwan. Methods A quasi-experimental design was adopted; six intervention schools (intervention group [IG]) and six comparison schools (comparison group [CG]) were selected from elementary schools with higher-than-average caries rates (> 68%). The IG was selected using cluster sampling, and the CG was selected to match the IG. In total, the IG and CG groups included 166 and 174 children each. The selected schools implemented the HPS framework for 3 months in the 2019 academic year. An oral examination of dental plaque was administered, and a self-administered questionnaire regarding knowledge, attitude, self-efficacy, and behaviors was distributed at baseline and at 2-week follow-up. A linear and logistic regression model using generalized estimating equations (GEEs) was used to analyze the differences between baseline and the follow-up data. Results Compared with the CG, the IG had a greater reduction in plaque index among second graders (β = − 0.36) and plaque control record scores among second, fourth, and sixth graders (β = − 27.48, − 26.04, and − 18.38, respectively). The IG also exhibited a greater increase at follow-up with respect to oral health–related knowledge among second graders and fourth graders (β = 1.46 and β = 0.92, respectively), attitude toward oral hygiene behaviors among sixth graders (β = 1.78), and self-efficacy regarding flossing for sixth graders (β = 1.43). Sixth graders in the IG were significantly more likely to brush before sleeping (adjusted odds ratio [aOR] = 2.99) and use fluoride toothpaste (aOR = 5.88) than those in the CG. Conclusions The HPS strategy was effective in reducing dental plaque and promoting preventing behaviors in rural high-caries schoolchildren.
... It is important for schoolchildren to eat healthily, not only for their physical development but also as protection against disease. The growth and development of schoolchildren are dependent upon their being provided with a variety of nutrients, maintaining a healthy body weight, eating a balanced diet of starchy carbohydrates and fibre-rich foods, limiting the consumption of fat and sugar and getting an adequate supply of vitamins and minerals (Kulik et al., 2019). The effect of unhealthy dietary habits can be seen in childhood and adolescence in the form of overweight and obesity, which result in adverse health outcomes in an adult's life and significantly raise the risk of suffering from chronic disease and early death (Reilly & Kelly, 2011). ...
Article
Background: In this study we examined the nutritional behaviors of secondary school children and the factors affecting their nutritional self-efficacy as well as the relationship between nutritional behaviors and nutritional self-efficacy. Methods: We determined from the BMIs of the 462 students participating in the study in the Fethiye district of Muğla province that 48.5% were underweight, 46.5% were normal and 5% were overweight. Results: The participating children's grade in school and their father's education affected their nutritional behaviors. We observed at the same time that the "child's grade in school", "father's education" and "income level" affected the "Nutritional Self-Efficacy Scale" mean score. A positive and significant relationship was found between the Nutritional Self-Efficacy Scale and Nutritional Behavior Scale mean scores of the children participating in the study. Conclusions: We concluded that a useful recommendation for health professionals working in programs aiming to improve children's eating habits would be to focus on initiatives that improve nutritional self-efficacy and nutritional behaviors.
... This study reports the 8-month effects of a comprehensive schoolwide HE and PA intervention among 5th grade students in a suburban area in the Midwest region of the United States. Previous studies have reported positive behavior change for students participating in the BHC program including increased PA minutes and consumption of fruits and vegetables (Centeio et al., 2014;Kulik et al., 2018). Collectively, results from the current study indicate that BHC is an effective childhood obesity intervention, decreasing incidence and prevalence in a 5th grade sample. ...
Article
Obesity among children is highly prevalent and can lead to risk factors for chronic disease in adulthood. Key organizations have called on schools to play a larger role by increasing children's physical activity and nutrition by adopting an overall culture of health. This study examined the impact of a socioecological theory driven school-wide nutrition and physical activity intervention on 5th graders' central adiposity and obesity level. In 2015-2016, in the Midwest region of U.S., four treatment and two control schools, including 628 (377 treatment) 5th grade children participated in an eight-month intervention. Children in the treatment schools participated in a comprehensive healthy school transformation program consisting of six components. Waist-to-Height Ratio (WHtR) and Body Mass Index (BMI) was calculated and used as the measure of obesity. ANCOVA revealed a significant difference in WHtR among treatment and control groups at time two (T2) FMI(1,6148.14) = 4.43, p = .035, R2 = 0.64, R2Treament = 0.01, with no significant differences based on age, sex, and race. Additionally, the ANCOVA for BMI revealed a marginally significant lower BMI among the treatment than comparison group students FMI(1, 614) = 3.575, p = .059, R2 = 0.01 (MDIF = -0.23, 95%CI upper boundary: -0.03). The healthy school intervention led to significant differences in obesity levels, regardless of age, sex, or race, across the 8-month program between 5th grade children in treatment and non-treatment schools. This supports the ability of schoolwide programs to significantly and positively impact student health and chronic disease prevention.
Article
Kesehatan merupakan hal yang paling esensial dalam kehidupan manusia. Perilaku hidup sehat sangat berpengaruh terhadap pertumbuhan dan perkembangan anak di dalam kehidupannya. Anak dapat berkembang daya intelektualnya dengan baik harus didukung dengan gizi yang baik pula, dengan cara menjalankan pola hidup sehatnya. Kegiatan pengabdian ini bertujuan untuk memberikan pemahaman kepada guru untuk menggerakkan siswanya dalam menerapkan budaya hidup sehat. Dalam hal ini, tim pengabdian memberikan solusi berupa flashcard sebagai media untuk meningkatkan budaya hidup sehat siswa sekolah dasar. Peserta pelatihan terdiri dari 107 guru yang tersebar di wilayah Jakarta. Kegiatan ini dilakukan secara daring menggunakan apliaksi zoom meeting. Hasil pengabdian menunjukkan bahwa 88% guru memahami hakikat budaya hidup sehat, cara mengembangkan flashcard berbasis literasi hidup sehat dan cara memotivasi siswa dalam menerapkan budaya hidup sehat. kegiatan pengabdian ini dapat memberikan kontribusi dan mendukung pemerintah dalam menjunjung tinggi program sekolah sehat. Sekolah yang sehat dapat menumbuhkan jiwa dan kepribadian yang sehat pula sehingga melahirkan pemikiran-pemikiran yang kreatif dan inovatif demi memajukan bangsa ini.
Article
BACKGROUND Improving the academic achievement of youth in the United States is an area of interest and a critical indicator of the future success of the youth. The purpose of this study was to examine the impact of a comprehensive school physical activity and healthy eating program on 5th‐grade students' academic achievement, specifically reading and math. METHODS Overall, 628 (intervention: 377, 54% girls; comparison: 251, 49% girls) 5th‐grade children participated across the 6 schools in a year‐long comprehensive health intervention, completing curriculum‐based academic achievement measures at 2 time‐points. RESULTS Results showed that even after controlling for class clustering, age, sex, race, and T1 reading and math variables, students' T2 reading and math achievement were significantly higher in the intervention group than the comparison group. CONCLUSIONS Comprehensive health programming can enhance the health and academic achievement of youth.
Article
Full-text available
Eating self-efficacy refers to a person’s belief in their ability to regulate eating. Although the Weight Efficacy Life-Style questionnaire (WEL) is one of the most widely used eating self-efficacy tools, its French validation is lacking. The objective of this research was to validate a French version of the WEL in a general and a clinical sample, and to explore the links between eating self-efficacy and psychosocial variables. In study 1, the general population sample included 432 adults (93% of women, mean age = 43.18 ± 11.93 years). In study 2, the clinical sample included 2010 adults with overweight and obesity (87% of women, mean age = 44.44 ± 11.25 years). Exploratory and confirmatory factor analyses were performed. Two distinct versions of the WEL were retained: a 12-item questionnaire intended for use in the general population, named WEL-Fr-G, and an 11-item questionnaire for clinical samples, named WEL-Fr-C. The two French versions of the WEL presented strong reliability and sensibility. In addition, study 2 provided support for the measurement invariance of the WEL-Fr-C across sex and Body Mass Index. The two versions are therefore psychometrically sound instruments for assessing eating self-efficacy in the general population (WEL-Fr-G) and clinical samples (WEL-Fr-C).
Article
Background Obesity may cause physiological, psychological, social, and economic problems. Therefore, it is of considerable importance to implement preventive interventions for the factors that may cause obesity. Purpose This study aimed to evaluate the effectiveness of the obesity prevention program developed for secondary school students. Methods This study was conducted on 116 students assigned to intervention (n = 58) and control groups (n = 58). Data were collected at baseline and on months 6, 12 and 15 after the intervention. Multivariate analysis of variance, t-test with Bonferroni correction and Multi-chi-square test were used for repeated measurements. Results No significant difference was found in proportions of body mass index classification of children in the intervention group (p = .991), while a significant difference was found between measurements on month one and 15 in the control group (p < .05). There was no significant difference between mean total scores in the eating behavior questionnaire (p > .05). Dicussion In this study, it was thought that it would be more effective to add obesity prevention education to the school curriculum and to keep its duration longer and to include families in this education. Translation to Health Education Practice Parents play an enormous role in the nutrition of children. Therefore, parents should be supported for a healthy diet in children. Moreover, parents should be included in healthy eating initiatives for children. A AJHE Self-Study quiz is online for this article via the SHAPE America Online Institute (SAOI) http://portal.shapeamerica.org/trn-Webinars
Article
The purpose of this study was to examine the relation between measures of students' physical well-being and self-perception and their academic achievement. Specifically, we look at students' social support for physical activity, physical activity perceptions, self-concept, self-efficacy, health behaviors, and cardiorespiratory fitness (as measured by the progressive aerobic cardiovascular endurance run [PACER] test). Students (n = 697 fifth graders) were surveyed at the beginning of the school year. A two-group path analysis revealed notable relationships between the predictor variables and proximal and distal outcomes, with some paths moderated by sex. One relationship that was significant for both sexes was cardiorespiratory fitness, as it was the only significant predictor of achievement. This effect was moderate to large for the female students (R Math 2 36 = % ; R Read 2 15 = %) and small to large for the male students (R Math 2 26 = % ; R Math 2 10 = %). These
Article
Full-text available
Objective: Evaluate the effect of a community-based, experiential cooking and nutrition education program on consumption of fruits and vegetables and associated intermediate outcomes in students from low-income families. Design: Quasi-experimental program evaluation by pre-post survey of participating students and their parents. Setting: Underserved elementary and middle schools in Chicago. Participants: Students (n = 271; 65% girls, 44% Hispanic, 32% African American; 94% eligible for free/reduced price lunch) in grades 3-8 selected by school staff to participate by variable inclusion criteria. 59% of students who applied returned both pre- and post-surveys. Intervention(s): Ten-week (2 h/wk) chef-instructor-led program held in cafeteria kitchens after school. Main outcome measure(s): Changes in student nutrition knowledge, cooking self-efficacy, fruit and vegetable liking and consumption, and communication to family about healthy eating. Analysis: Changes from beginning to end of program were analyzed with paired t test. Results were considered significant at P < .05. Results: Increased nutrition knowledge score from 0.6 to 0.8, cooking self-efficacy score from 3.2 to 3.6, and vegetable consumption score from 2.2 to 2.4 (all P < .05). Increased score for communication about healthy eating (4.1 to 4.4; P < .05) 6 months after the end of the course. Conclusions and implications: Experiential cooking and nutrition education programs led by chef-instructors may be effective ways to improve nutrition in low-income communities.
Article
Full-text available
Key findings: Obesity is associated with health risks (1,2). Monitoring the prevalence of obesity is relevant for public health programs that focus on reducing or preventing obesity. No significant changes were seen in either adult or childhood obesity prevalence in the United States between 2003-2004 and 2011-2012 (3). This report provides the most recent national data on obesity prevalence by sex, age, and race and Hispanic origin, using data for 2011- 2014. Overall prevalence estimates from 1999-2000 through 2013-2014 are also presented.
Article
Full-text available
Background Numerous studies in schools in the Western Cape Province, South Africa have shown that children have an unhealthy diet with poor diversity and which is high in sugar and fat. HealthKick (HK) was a three-year randomised controlled trial aimed at promoting healthy eating habits. Methods Sixteen schools were selected from two low-income school districts and randomly allocated to intervention (n = 8) or control school (n = 8) status. The HK intervention comprised numerous activities to improve the school nutrition environment such as making healthier food choices available and providing nutrition education support. Dietary intake was measured by using a 24-h recall in 2009 in 500 grade 4 learners at intervention schools and 498 at control schools, and repeated in 2010 and 2011. A dietary diversity score (DDS) was calculated from nine food groups and frequency of snack food consumption was determined. A school level analysis was performed. Results The mean baseline (2009) DDS was low in both arms 4.55 (SD = 1.29) and 4.54 (1.22) in the intervention and control arms respectively, and 49 % of learners in HK intervention schools had a DDS ≤4 (=low diversity). A small increase in DDS was observed in both arms by 2011: mean score 4.91 (1.17) and 4.83 (1.29) in the intervention and control arms respectively. The estimated DSS intervention effect over the two years was not significant [0 .04 (95 % CI: −0.37 to 0.46)]. Food groups least consumed were eggs, fruit and vegetables. The most commonly eaten snacking items in 2009 were table sugar in beverages and/or cereals (80.5 %); followed by potato crisps (53.1 %); non-carbonated beverages (42.9 %); sweets (26.7 %) and sugar-sweetened carbonated beverages (16 %). Unhealthy snack consumption in terms of frequency of snack items consumed did not improve significantly in intervention or control schools. Discussion The results of the HK intervention were disappointing in terms of improvement in DDS and a decrease in unhealthy snacking. We attribute this to the finding that the intervention model used by the researchers may not have been the ideal one to use in a setting where many children came from low-income homes and educators have to deal with daily problems associated with poverty. Conclusions The HK intervention did not significantly improve quality of diet of children.
Article
Full-text available
It is well documented in the literature that low socioeconomic status (SES) is associated with lower consumption of healthy foods and that these differences in consumption patterns are influenced by neighborhood food environments. Less understood is the role that SES differences in physical and social aspects of the home food environment play in consumption patterns. Using data on 4th grade children from the 2009–2011 Texas School Physical Activity and Nutrition (SPAN) study, we used mixed-effects regression models to test the magnitude of differences in the SPAN Health Eating Index (SHEI) by parental education as an indicator of SES, and the extent to which adjusting for measures of the home food environment, and measures of the neighborhood environment accounted for these SES differences. Small but significant differences in children’s SHEI by SES strata exist (-1.33 between highest and lowest SES categories, p<0.01). However, incorporating home food environment and neighborhood environment measures in this model eliminates these differences (-0.7, p=0.145). Home food environment explains a greater portion of the difference. Both social (mealtime structure) and physical aspects (food availability) of the home food environment are strongly associated with consumption of healthy and unhealthy foods. Our findings suggest that modifiable parent behaviors at home can improve children’s eating habits and that the neighborhood may impact diet in ways other than through access to healthy food.
Article
Full-text available
To deal with missing data that arise due to participant nonresponse or attrition, methodologists have recommended an “inclusive” strategy where a large set of auxiliary variables are used to inform the missing data process. In practice, the set of possible auxiliary variables is often too large. We propose using principal components analysis (PCA) to reduce the number of possible auxiliary variables to a manageable number. A series of Monte Carlo simulations compared the performance of the inclusive strategy with eight auxiliary variables (inclusive approach) to the PCA strategy using just one principal component derived from the eight original variables (PCA approach). We examined the influence of four independent variables: magnitude of correlations, rate of missing data, missing data mechanism, and sample size on parameter bias, root mean squared error, and confidence interval coverage. Results indicate that the PCA approach results in unbiased parameter estimates and potentially more accuracy than the inclusive approach. We conclude that using the PCA strategy to reduce the number of auxiliary variables is an effective and practical way to reap the benefits of the inclusive strategy in the presence of many possible auxiliary variables.
Article
Full-text available
Community-based interventions are promising approaches to obesity prevention, but few studies have prospectively evaluated them. The aim of this study was to evaluate a natural experiment-a community intervention designed to promote active living and decrease obesity within a small southern town. In 2011, community leaders implemented the Mebane on the Move intervention-a community-wide effort to promote physical activity (PA) and decrease obesity among residents of Mebane, North Carolina. We measured child PA and BMI before and after the intervention, using a nearby town not implementing an intervention as the comparison. In total, we assessed 64 children from Mebane and 40 from the comparison community 6 months before, as well as 34 and 18 children 6 months after the intervention. We assessed PA with accelerometers worn for 7 days and calculated BMI z-scores using children's height and weight. We conducted multivariable linear regressions examining pre- to postintervention change in minutes of PA and BMI z-score, adjusting for confounders. At follow-up, children in Mebane modestly increased their moderate-to-vigorous PA (1.3 minutes per hour; 95% confidence interval (CI): 0.2, 2.3; p=0.03) and vigorous activity (0.8 minutes per hour; 95% CI: 0.1, 1.5; p=0.04) more than comparison children. In intervention children, BMI z-scores decreased 0.5 units (kg/m(2); 95% CI: -0.9, -0.02; p=0.045), compared to children in the comparison community. We observed positive effects on PA level and weight status of children in Mebane, despite high rates of attrition, suggesting that the community-based intervention may have been successful.
Article
Full-text available
The impact of Comprehensive School Physical Activity Programs (CSPAPs) on urban children’s, educators’, and parents’ physical activity (PA) is relatively unknown. The purpose of this study was to explore overall changes in student, educator, and parent PA after an 8-month CSPAP-based program. This longitudinal, exploratory study implemented a CSPAP in 20 urban elementary schools, with six randomized for research. In-school PA was measured prepost for all fourth grade students using accelerometers. Parent and educator PA was self-reported using the IPAQ. RM-ANOVAs revealed significant prepost increases in minutes of student MVPA (P < .001). Parents significantly increased PA (P < .01) and although educators’ reported change in PA, it was not statistically significant (P = .50). This study provides unique information about the potential influence of one CSPAP on students’ overall PA, PA by individual context within the school, the differential PA patterns by race, and PA changes for educators and parents.
Article
Full-text available
Background: Eating more fruits and vegetables adds underconsumed nutrients to diets, reduces the risks for leading causes of illness and death, and helps manage body weight. This report describes trends in the contributions of fruits and vegetables to the diets of children aged 2-18 years. Methods: CDC analyzed 1 day of 24-hour dietary recalls from the National Health and Nutrition Examination Surveys from 2003 to 2010 to estimate trends in children's fruit and vegetable intake in cup-equivalents per 1,000 calories (CEPC) and trends by sex, age, race/ethnicity, family income to poverty ratio, and obesity status. Total fruit includes whole fruit (all fruit excluding juice) and fruit juice (from 100% juice, foods, and other beverages). Total vegetables include those encouraged in the Dietary Guidelines for Americans, 2010 (i.e., dark green, orange, and red vegetables and legumes), white potatoes, and all other vegetables. Results: Total fruit intake among children increased from 0.55 CEPC in 2003-2004 to 0.62 in 2009-2010 because of significant increases in whole fruit intake (0.24 to 0.40 CEPC). Over this period, fruit juice intake significantly decreased (0.31 to 0.22 CEPC). Total vegetable intake did not change (0.54 to 0.53 CEPC). No socio-demographic group met the Healthy People 2020 target of 1.1 CEPC vegetables, and only children aged 2-5 years met the target of 0.9 CEPC fruits. Conclusions: Children's total fruit intake increased because of increases in whole fruit consumption, but total vegetable intake remained unchanged. Implications for public health practice: Increased attention to the policies and food environments in multiple settings, including schools, early care and education, and homes might help continue the progress in fruit intake and improve vegetable intake.
Article
Full-text available
A series of Monte Carlo simulations were used to compare the relative performance of the inclusive strategy, where as many auxiliary variables are included as possible, with typical auxiliary variables (AUX) and a smaller set of auxiliary variables derived from principal component analysis (PCAAUX). We examined the influence of seven independent variables: magnitude of correlations, homogeneity of correlations across auxiliary variables, rate of missing, missing data mechanism, missing data patterns, number of auxiliary variables, and sample size on four dependent variables: raw parameter estimate bias, percent bias, standardized bias, and relative efficiency. Results indicated that including a single PCAAUX (which explained about 40% of the total variance) is as beneficial for parameter bias as the AUX inclusive strategy. Findings also suggested the PCAAUX method can capture a non-linear cause of missingness. Regarding efficiency, results indicate that the PCAAUX method is at least as efficient as the inclusive strategy and potentially greater than 25% more efficient. Researchers can apply the results of this research to more adequately approximate the MAR assumption when the number of potential auxiliary variables is beyond a practical limit. The dissertation is divided into the following sections: 1) an introduction to missing data; 2) a brief review of the history of missing data; 3) a discussion of auxiliary variables; 4) an outline of principal component analysis; 5) a presentation of the PCAAUX method; and finally, 7) a demonstration of the relative performance of the AUX and the PCAAUX methods in the analysis of simulated and empirical data.
Article
Full-text available
Background An emerging body of research suggests the trajectory of a family’s income affects children’s health and development more profoundly than the often-measured income at a single time point. The purpose of this study was to examine the associations between changes in family income status, early-life risk factors, and body mass index (BMI) z-score trajectory from age 2 to 15 years. Methods This longitudinal study employed a birth cohort (n = 595) located in a rural region of New York State. Data were collected through an audit of medical records and mailed questionnaires. Family low-income and BMI z-score trajectories were identified using latent-class modeling techniques that group children based on similar trends across time. We examined five early-life risk factors in relation to income and BMI z-score trajectories: maternal overweight/obesity, maternal gestational weight gain, maternal smoking during pregnancy, breastfeeding duration, and early-life weight gain trajectory. We used multinomial logistic regression models to estimate the odds of being in a BMI z-score trajectory group based on income trajectory and early-life risk factors. Results Children who remain low-income throughout childhood were more likely to maintain overweight (AOR = 2.55, 95% CI = 1.03, 5.42) and children who moved into low-income during childhood were more likely to be obese (AOR = 2.36, 95% CI = 1.12, 5.93) compared to children who were never low-income. Maternal overweight/obesity was significantly associated with a child become obese (AOR = 8.31, 95% CI = 3.80, 18.20), become overweight (AOR = 2.37, 95% CI = 1.34, 4.22), and stay overweight (AOR = 1.79, 95% CI = 1.02, 3.14). Excessive gestational weight gain was associated with increased likelihood of a child becoming overweight trajectory (AOR = 2.01, 95% CI = 1.01, 4.00). Conclusions Our findings further supports the growing evidence that there are several preventable early-life risk factors that could be targeted for intervention. This study provides new evidence that remaining in low-income and moving into low-income increases risk for adolescent overweight and obesity.
Article
Full-text available
Objective To investigate the effectiveness of a school based intervention to increase physical activity, reduce sedentary behaviour, and increase fruit and vegetable consumption in children. Design Cluster randomised controlled trial. Setting 60 primary schools in the south west of England. Participants Primary school children who were in school year 4 (age 8-9 years) at recruitment and baseline assessment, in year 5 during the intervention, and at the end of year 5 (age 9-10) at follow-up assessment. Intervention The Active for Life Year 5 (AFLY5) intervention consisted of teacher training, provision of lesson and child-parent interactive homework plans, all materials required for lessons and homework, and written materials for school newsletters and parents. The intervention was delivered when children were in school year 5 (age 9-10 years). Schools allocated to control received standard teaching. Main outcome measures The pre-specified primary outcomes were accelerometer assessed minutes of moderate to vigorous physical activity per day, accelerometer assessed minutes of sedentary behaviour per day, and reported daily consumption of servings of fruit and vegetables. Results 60 schools with more than 2221 children were recruited; valid data were available for fruit and vegetable consumption for 2121 children, for accelerometer assessed physical activity and sedentary behaviour for 1252 children, and for secondary outcomes for between 1825 and 2212 children for the main analyses. None of the three primary outcomes differed between children in schools allocated to the AFLY5 intervention and those allocated to the control group. The difference in means comparing the intervention group with the control group was –1.35 (95% confidence interval –5.29 to 2.59) minutes per day for moderate to vigorous physical activity, –0.11 (–9.71 to 9.49) minutes per day for sedentary behaviour, and 0.08 (–0.12 to 0.28) servings per day for fruit and vegetable consumption. The intervention was effective for three out of nine of the secondary outcomes after multiple testing was taken into account: self reported time spent in screen viewing at the weekend (–21 (–37 to –4) minutes per day), self reported servings of snacks per day (–0.22 (–0.38 to –0.05)), and servings of high energy drinks per day (–0.26 (–0.43 to –0.10)) were all reduced. Results from a series of sensitivity analyses testing different assumptions about missing data and from per protocol analyses produced similar results. Conclusion The findings suggest that the AFLY5 school based intervention is not effective at increasing levels of physical activity, decreasing sedentary behaviour, and increasing fruit and vegetable consumption in primary school children. Change in these activities may require more intensive behavioural interventions with children or upstream interventions at the family and societal level, as well as at the school environment level. These findings have relevance for researchers, policy makers, public health practitioners, and doctors who are involved in health promotion, policy making, and commissioning services. Trial registration Current Controlled Trials ISRCTN50133740.
Article
Full-text available
Diet quality indices add an important dimension to dietary assessment. The aim of this systematic review was to: (i) identify and describe the attributes and applications of diet quality indices developed for use or used in paediatric populations; (ii) describe associations between these diet quality indices and health-related variables in paediatric populations; and (iii) identify factors that are associated with diet quality in paediatric populations worldwide. Studies were identified by searching electronic databases for relevant papers from 1980 to October 2013 using keywords. Inclusion criteria were original studies that utilised a quantitative measure of diet quality in children and adolescents aged 0-18 years. One hundred and nineteen studies met the inclusion criteria, from which 80 different diet quality indices were identified. The majority of studies had >1000 participants and were of acceptable quality. Of the 56 studies that investigated health-related outcomes, weight status was the most researched. Europe produced the most number of diet quality indices (n = 27 indices). Of the 119 studies, seven intervention studies were identified. Paediatric diet quality indices were found to be associated with environmental, behavioural and maternal factors. The use of diet quality indices in paediatric populations is a rapidly expanding area of research in diverse populations internationally. In economically disadvantaged countries, diet quality indices may be predictive of child growth. However, prospective cohort, intervention and validation studies are required to draw stronger conclusions concerning risk of future disease in paediatric populations in general.
Article
Full-text available
To describe the association and its magnitude between body mass index category, sex, and cardiovascular disease risk parameters in school aged children in highly developed countries. Systematic review and meta-analysis. Quality of included studies assessed by an adapted version of the Cochrane Collaboration's risk of bias assessment tool. Results of included studies in meta-analysis were pooled and analysed by Review Manager version 5.1. Embase, PubMed, EBSCOHost's cumulative index to nursing and allied health literature, and the Web of Science databases for papers published between January 2000 and December 2011. Healthy children aged 5 to 15 in highly developed countries enrolled in studies done after 1990 and using prospective or retrospective cohort, cross sectional, case-control, or randomised clinical trial designs in school, outpatient, or community settings. Included studies had to report an objective measure of weight and at least one prespecified risk parameter for cardiovascular disease. We included 63 studies of 49 220 children. Studies reported a worsening of risk parameters for cardiovascular disease in overweight and obese participants. Compared with normal weight children, systolic blood pressure was higher by 4.54 mm Hg (99% confidence interval 2.44 to 6.64; n=12 169, eight studies) in overweight children, and by 7.49 mm Hg (3.36 to 11.62; n=8074, 15 studies) in obese children. We found similar associations between groups in diastolic and 24 h ambulatory systolic blood pressure. Obesity adversely affected concentrations of all blood lipids; total cholesterol and triglycerides were 0.15 mmol/L (0.04 to 0.25, n=5072) and 0.26 mmol/L (0.13 to 0.39, n=5138) higher in obese children, respectively. Fasting insulin and insulin resistance were significantly higher in obese participants but not in overweight participants. Obese children had a significant increase in left ventricular mass of 19.12 g (12.66 to 25.59, n=223), compared with normal weight children. Having a body mass index outside the normal range significantly worsens risk parameters for cardiovascular disease in school aged children. This effect, already substantial in overweight children, increases in obesity and could be larger than previously thought. There is a need to establish whether acceptable parameter cut-off levels not considering weight are a valid measure of risk in modern children and whether methods used in their study and reporting should be standardised.
Article
Full-text available
To our knowledge, no reviews have assessed the impact of a range of multi- and single-component school-based programs on daily fruit and vegetable intake by using a meta-analysis. The aim of this study was to quantify the impact of school-based interventions on fruit and vegetable intake in children aged 5-12 y. A systematic literature review was carried out to identify randomized and nonrandomized controlled trials that were based in primary schools and designed to increase portions of daily fruit and vegetable intake. MEDLINE, Cochrane libraries, EMBASE, PsycINFO, and Educational Information Centre were searched from 1985 to 2009. Data were extracted, and mean effect sizes were calculated by using random effects models. A total of 27 school-based programs involving 26,361 children were identified that met the inclusion criteria and assessed the daily weight of fruit and vegetable intake combined, fruit intake only, or vegetable intake only, and 21 studies were used in meta-analyses. The results of the meta-analyses indicated an improvement of 0.25 portions (95% CI: 0.06, 0.43 portions) of fruit and vegetable daily intake if fruit juice was excluded and an improvement of 0.32 portions (95% CI: 0.14, 0.50 portions) if fruit juice was included. Improvement was mainly due to increases in fruit consumption but not in vegetable consumption. The results of the meta-analyses for fruit (excluding juice) and vegetables separately indicated an improvement of 0.24 portions (95% CI: 0.05, 0.43 portions) and 0.07 portions (95% CI: -0.03, 0.16 portions), respectively. School-based interventions moderately improve fruit intake but have minimal impact on vegetable intake. Additional studies are needed to address the barriers for success in changing dietary behavior, particularly in relation to vegetables.
Article
Full-text available
The Be Active Eat Well (BAEW) community-based child obesity prevention intervention was successful in modestly reducing unhealthy weight gain in primary school children using a multi-strategy and multi-setting approach. To (1) examine the relationship between changes in obesity-related individual, household and school factors and changes in standardised child body mass index (zBMI), and (2) determine if the BAEW intervention moderated these effects. The longitudinal relationships between changes in individual, household and school variables and changes in zBMI were explored using multilevel modelling, with measurement time (baseline and follow-up) at level 1, individual (behaviours, n = 1812) at level 2 and households (n = 1318) and schools (n = 18) as higher levels (environments). The effect of the intervention was tested while controlling for child age, gender and maternal education level. This study confirmed that the BAEW intervention lowered child zBMI compared with the comparison group (-0.085 units, P = 0.03). The variation between household environments was found to be a large contributor to the percentage of unexplained change in child zBMI (59%), compared with contributions from the individual (23%) and school levels (1%). Across both groups, screen time (P = 0.03), sweet drink consumption (P = 0.03) and lack of household rules for television (TV) viewing (P = 0.05) were associated with increased zBMI, whereas there was a non-significant association with the frequency the TV was on during evening meals (P = 0.07). The moderating effect of the intervention was only evident for the relationship between the frequency of TV on during meals and zBMI, however, this effect was modest (P = 0.04). The development of childhood obesity involves multi-factorial and multi-level influences, some of which are amenable to change. Obesity prevention strategies should not only target individual behaviours but also the household environment and family practices. Although zBMI changes were modest, these findings are encouraging as small reductions can have population level impacts on childhood obesity levels.
Article
Full-text available
In 2005, we reported on the success of Comprehensive School Health (CSH) in improving diets, activity levels, and body weights. The successful program was recognized as a "best practice" and has inspired the development of the Alberta Project Promoting active Living and healthy Eating (APPLE) Schools. The project includes 10 schools, most of which are located in socioeconomically disadvantaged areas. The present study examines the effectiveness of a CSH program adopted from a "best practice" example in another setting by evaluating temporal changes in diets, activity levels and body weight. In 2008 and 2010, we surveyed grade 5 students from approximately 150 randomly selected schools from the Canadian province of Alberta and students from 10 APPLE Schools. Students completed the Harvard Youth/Adolescent Food Frequency Questionnaire, questions on physical activity, and had their height and weight measured. Multilevel regression methods were used to analyze changes in diets, activity levels, and body weight between 2008 and 2010. In 2010 relative to 2008, students attending APPLE Schools were eating more fruits and vegetables, consuming fewer calories, were more physically active and were less likely obese. These changes contrasted changes observed among students elsewhere in the province. These findings provide evidence on the effectiveness of CSH in improving health behaviors. They show that an example of "best practice" may lead to success in another setting. Herewith the study provides the evidence that investments for broader program implementation based on "best practice" are justified.
Article
Full-text available
To examine objectively measured physical activity levels by age, sex, and BMI for children and adolescents in a nationally representative sample. Data were from the 2003-2004 and 2005-2006 National Health and Nutrition Examination Surveys, which included physical activity assessment by accelerometer and measured height and weight. The authors calculated minutes of moderate and vigorous activity. Boys were more active than girls, and activity levels were lower at older ages. Younger children met daily recommendations for physical activity, whereas older children, especially girls, did not. Typically, weight status was inversely related to activity, though differences were less apparent among boys. Underweight children were not always more active than heavier peers.
Article
Full-text available
Multivariate Imputation by Chained Equations (MICE) is the name of software for imputing incomplete multivariate data by Fully Conditional Speci cation (FCS). MICE V1.0 appeared in the year 2000 as an S-PLUS library, and in 2001 as an R package. MICE V1.0 introduced predictor selection, passive imputation and automatic pooling. This article presents MICE V2.0, which extends the functionality of MICE V1.0 in several ways. In MICE V2.0, the analysis of imputed data is made completely general, whereas the range of models under which pooling works is substantially extended. MICE V2.0 adds new functionality for imputing multilevel data, automatic predictor selection, data handling, post-processing imputed values, specialized pooling and model selection. Imputation of categorical data is improved in order to bypass problems caused by perfect prediction. Special attention to transformations, sum scores, indices and interactions using passive imputation, and to the proper setup of the predictor matrix. MICE V2.0 is freely available from CRAN as an R package mice. This article provides a hands-on, stepwise approach to using mice for solving incomplete data problems in real data.
Article
Full-text available
To examine the sociodemographic, parental and child factors that predict fruit and vegetable consumption in 7-year-old children. Diet was assessed using three 1d unweighed food diaries. The child's daily fruit and vegetable consumption was calculated by summing the weight of each type of fruit, fruit juice and vegetable consumed. The various others factors measured were assessed by a questionnaire at different time points. The Avon Longitudinal Study of Parents and Children (ALSPAC). A total of 7285 children aged 7 years residing in the south-west of England during 1999-2000. Median daily fruit and vegetable consumption (201 g) was below the recommendations for this age group (320 g). Girls ate more fruit and vegetables per unit energy (30.3 g/MJ) than boys (26.7 g/MJ; P =< 0.001). The predictors of fruit and vegetable consumption were mostly similar. Fruit and vegetable consumption was associated with maternal consumption, maternal education status and parental rules about serving fruit/vegetables every day, food expenditure per person and whether the child was choosy about food. Vegetable consumption was also associated with the other characteristics of the child, such as whether the child enjoyed food and whether the child tried a variety of foods. Children are not eating recommended amounts of fruit and vegetables, particularly boys. Consumption of fruit and vegetables appears to be influenced by parental rules about daily consumption and parental consumption and by the child's choosiness. Parent's actions could influence this. These findings may prove useful for those planning healthy eating campaigns for children.
Article
Full-text available
Increasing fruit and vegetable consumption is an important health behaviour. Parental and other psychosocial influences on children's fruit and vegetable consumption are poorly understood. The contribution of a variety of psychosocial and environmental factors to consumption of fruit and vegetables by children aged 9-11 years was explored. Ninety-two mothers and children (48 girls and 44 boys) were recruited via urban primary health-care practices. Socio-economic and educational level, nutritional knowledge and health- and diet-related beliefs and attitudes were assessed in mothers and children by questionnaires and semistructured interviews. Mothers> diets were measured by a food frequency questionnaire, while children's diets were assessed by 3-day diaries (N=80). The pattern of influence of the various measures on fruit and vegetable consumption was compared with that on children's confectionery intake. The children's intakes of macronutrients were typical for the U.K. (37% fat, 50% carbohydrate and 13% protein by energy; 12 g/day fibre), while median fruit, fruit juice and vegetable intake amounted to about 2.5 servings/day. Univariate correlations and subsequent multiple regression analyses revealed quite different influences on the three food types. Independent predictors of children's fruit intake included mothers> nutritional knowledge (beta=0.37), mothers> frequency of fruit consumption (beta=0.30) and mothers> attitudinal conviction that increasing fruit and vegetable consumption by their children could reduce their risk of developing cancer (beta=0.27; multiple r2=0.37,p<0.0001). Children's vegetable consumption was independently explained by the child's liking for commonly eaten vegetables (beta=0.36) and the mother's belief in the importance of disease prevention when choosing her child's food (beta=-0.27 r2=0.20,p<0.001). Children's confectionery consumption was predicted by the mother's liking for confectionery (beta=0.32) and the children's concern for health in choosing what to eat (beta=-0.26 r2=0.16, p<0.005). Children's consumption of fruit and vegetables are related to different psychosocial and environmental factors. Promotion of this behaviour may require attention to nutritional education and child feeding strategies of parents.
Article
Full-text available
To evaluate the impact of a school-based health behavior intervention known as Planet Health on obesity among boys and girls in grades 6 to 8. Randomized, controlled field trial with 5 intervention and 5 control schools. Outcomes were assessed using preintervention (fall 1995) and follow-up measures (spring 1997), including prevalence, incidence, and remission of obesity. A group of 1295 ethnically diverse grade 6 and 7 students from public schools in 4 Massachusetts communities. Students participated in a school-based interdisciplinary intervention over 2 school years. Planet Health sessions were included within existing curricula using classroom teachers in 4 major subjects and physical education. Sessions focused on decreasing television viewing, decreasing consumption of high-fat foods, increasing fruit and vegetable intake, and increasing moderate and vigorous physical activity. Obesity was defined as a composite indicator based on both a body mass index and a triceps skinfold value greater than or equal to age- and sex-specific 85th percentiles. Because schools were randomized, rather than students, the generalized estimating equation method was used to adjust for individual-level covariates under cluster randomization. The prevalence of obesity among girls in intervention schools was reduced compared with controls, controlling for baseline obesity (odds ratio, 0.47; 95% confidence interval, 0.24-0.93; P = .03), with no differences found among boys. There was greater remission of obesity among intervention girls vs. control girls (odds ratio, 2.16; 95% confidence interval, 1.07-4.35; P = .04). The intervention reduced television hours among both girls and boys, and increased fruit and vegetable consumption and resulted in a smaller increment in total energy intake among girls. Reductions in television viewing predicted obesity change and mediated the intervention effect. Among girls, each hour of reduction in television viewing predicted reduced obesity prevalence (odds ratio, 0.85; 95% confidence interval, 0.75-0.97; P = .02). Planet Health decreased obesity among female students, indicating a promising school-based approach to reducing obesity among youth.
Article
Full-text available
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.
Article
Full-text available
The Cafeteria Power Plus project examined whether a cafeteria-based intervention would increase the fruit and vegetable (FV) consumption of children. Twenty-six schools were randomly assigned to either an intervention or control condition. Baseline lunch observations of a sample (N = 1668) of first- and third-grade students occurred in the spring of 2000; follow-up was in the spring of 2002. The intervention took place during two consecutive school years beginning in the fall of 2000 and consisted of daily activities (increasing the availability, attractiveness, and encouragement for FV) and special events (kick-offs, samplings, challenge weeks, theater production, and finale meal). Training of food-service staff and cook managers was ongoing throughout the intervention phase. Students in the intervention schools significantly increased their total fruit intake. Process measures indicated that verbal encouragement by food-service staff was associated with outcomes. The outcomes suggest that multicomponent interventions are more powerful than cafeteria programs alone with this age group.
Article
Full-text available
Background: In order to more effectively promote fruit and vegetable intake among children and adolescents, insight into determinants of intake is necessary. We conducted a review of the literature for potential determinants of fruit and vegetable intake in children and adolescents. Methods: Papers were identified from Medline and PsyclNFO by using all combinations of the search terms: "fruit(s) or vegetable(s)" and "children or adolescents". Quantitative research examining determinants of fruit and/or vegetable intake among children and adolescents aged 6-18 years were included. The selection and review process was conducted according to a four-step protocol resulting in information on country, population, design, methodology, theoretical basis, Instrument used for measuring intake, statistical analysis, included independent variables, and effect sizes. Results: Ninety-eight papers were included. A large number of potential determinants have been studied among children and adolescents. However, for many presumed determinants convincing evidence is lacking, mostly because of paucity of studies. The determinants best supported by evidence are: age, gender, socio-economic position, preferences, parental intake, and home availability/accessibility. Girls and younger children tend to have a higher or more frequent intake than boys and older children. Socio-ecconomic position, preferences, parental intake, and home availability/accessibility are all consistently positively associated with intake. Conclusion: The determinants most consistently supported by evidence are gender, age, socio-economic position, preferences, parental intake and home availability/accessibility. There is a need for internationally comparative, longitudinal, theory-based and multi-level studies taking both personal and environmental factors into account.
Article
Obesity among children is highly prevalent and can lead to risk factors for chronic disease in adulthood. Key organizations have called on schools to play a larger role by increasing children's physical activity and nutrition by adopting an overall culture of health. This study examined the impact of a socioecological theory driven school-wide nutrition and physical activity intervention on 5th graders' central adiposity and obesity level. In 2015-2016, in the Midwest region of U.S., four treatment and two control schools, including 628 (377 treatment) 5th grade children participated in an eight-month intervention. Children in the treatment schools participated in a comprehensive healthy school transformation program consisting of six components. Waist-to-Height Ratio (WHtR) and Body Mass Index (BMI) was calculated and used as the measure of obesity. ANCOVA revealed a significant difference in WHtR among treatment and control groups at time two (T2) FMI(1,6148.14) = 4.43, p = .035, R2 = 0.64, R2Treament = 0.01, with no significant differences based on age, sex, and race. Additionally, the ANCOVA for BMI revealed a marginally significant lower BMI among the treatment than comparison group students FMI(1, 614) = 3.575, p = .059, R2 = 0.01 (MDIF = -0.23, 95%CI upper boundary: -0.03). The healthy school intervention led to significant differences in obesity levels, regardless of age, sex, or race, across the 8-month program between 5th grade children in treatment and non-treatment schools. This supports the ability of schoolwide programs to significantly and positively impact student health and chronic disease prevention.
Article
The purpose of this study was to determine whether exposure to a manga comic (Japanese comic art) with messages promoting fruit consumption influenced psychosocial variables associated with increased fruit intake in middle-school youth. A three-group, randomized, single-session study was conducted in two public middle schools in central North Carolina. Participants were randomly assigned to one of three groups: (a) comic (manga comic promoting fruit consumption, (b) newsletter (newsletter about fruit), or (c) attention-control (newsletter about ancient Greece). Participants included N = 263 youth, with a mean age of 13.18 years (SD = 1.12). Outcome expectations, self-efficacy, and knowledge related to fruit intake were measured at baseline and immediately after reading. Secondary outcomes included transportation (degree to which participants are immersed in their media) and enjoyment, measured at posttest. Data were analyzed using regression analyses. Comic group participants tended to have greater change in outcome expectations related to fruit intake compared to the attention-control group and greater transportation and enjoyment than the newsletter and attention-control groups. Study results are promising and suggest that manga comics may be a useful format to promote positive health beliefs in youth.
Article
Background: Schools play a role in addressing childhood obesity by implementing healthy eating and physical activity strategies. The primary aim of this case study was to describe prevalence of overweight and obesity among elementary school students in a rural Mid-western community between 2006 and 2012. The secondary aim was to use a novel approach called "population dose" to retrospectively evaluate the impact dose of each strategy implemented and its estimated potential population level impact on changes in overweight and obesity. Methods: Weight and height were directly measured annually beginning in January 2006 to assess weight status, using BMI (kg/m(2)), for all kindergarten to fifth-grade students (N ≈ 2400 per year). Multiple evidence-based strategies were implemented in nine schools to increase physical activity and healthy eating behaviors. BMI reporting and revised school meal programs were implemented districtwide. Comprehensive school physical activity programs, school food environment, and supportive/promotional strategies were implemented at individual schools. Results: The absolute change in prevalence of obesity (BMI ≥95th percentile) decreased from 16.4% to 13.9%, indicating a 15.2% relative change in prevalence of obesity in 6 years. There was an inverse relationship between the number of strategies implemented and prevalence of overweight and obesity over time. Conclusions: District and school-level approaches have the potential to impact childhood obesity. Schools can successfully implement strategies to address overweight and obesity, but the extent of implementation between schools may vary. Population dose analysis can be used to estimate impact of clusters of strategies to address overweight/obesity.
Article
This article covers both the historical and modern developments in structural equation modeling. The material is divided into what can be referred to as the ‘first generation’ and the ‘second generation’ of structural equation modeling. Topics discussed under the first generation include the history of structural equation modeling estimation, testing, and assessment of assumptions. Topics covered in the second generation include multilevel structural equation modeling and latent variable growth curve modeling.
Article
Identifying sustainable approaches to improving the physical activity (PA) and nutrition environments in schools is an important public health goal. This study examined the impact of Energy Balance for Kids with Play (EB4K with Play), a school-based intervention developed by the Academy of Nutrition and Dietetics Foundation and Playworks, on students' PA, dietary habits and knowledge, and weight status over 2 years. This cluster-randomized, controlled trial took place in four intervention and two control schools over 2 years (n=879; third- to fifth-grade students). PA (fourth and fifth grades only), dietary knowledge and behaviors, school policies, and BMI z-score were assessed at baseline (fall 2011), midpoint (spring 2012), and endpoint (fall 2012 for accelerometers; spring 2013 for all other outcomes). At endpoint, there were no group differences in change in PA or dietary behaviors, although BMI z-score decreased overall by -0.07 (p=0.05). Students' dietary knowledge significantly increased, as did the amount of vegetables schools served. Post-hoc analyses stratified by grade revealed that, relative to control students, fourth-grade intervention students reduced school-day sedentary time by 15 minutes (p=0.023) and third-grade intervention students reduced BMI z-score by -0.2 (0.05; p<0.05). There were no signicifant differences for older students. EB4K with Play, which leverages the existing infrastructure of two national programs, increases children's dietary knowledge and may improve weight status and decrease sedentary behaviors among younger children. Future iterations should examine programming specific for different age groups.
Article
This article describes the design, implementation, and evaluative findings of the HEROES (Healthy, Energetic, Ready, Outstanding, Enthusiastic, Schools) Initiative, a school-based multilevel childhood obesity prevention intervention. Based on the Centers for Disease Control and Prevention's recommended coordinated school health approach, the HEROES Initiative works to alleviate the burden of childhood obesity in Southern Indiana, Northwestern Kentucky, and Southeastern Illinois in the United States. Process evaluation was conducted with the 17 participating schools in spring 2012 based on interviews with school personnel and observation of the school environment. Findings showed that despite some variability, schools were generally able to implement the intervention with fidelity. School-level outcome evaluation was also based on observation of the school environment, and revealed that schools had implemented a number of new practices to encourage physical activity and healthy eating. Assessment of student-level outcomes was based on professionally collected physiological measurements and self-reported behavioral data collected over an 18-month period of time, last collected in spring 2012. Findings demonstrated that the HEROES Initiative has been successful in reducing the percentage of overweight children in participating schools and healthfully modifying their dietary, physical activity, and sedentary behaviors. Strategies that have facilitated success and challenges related to the intervention are discussed.
Article
We conducted a three-year nutrition education study in 12 Pennsylvania school districts. Within the districts we assigned schools to either the treatment (nutrition education) or control group and initiated the study with a cohort of third grade children. At the beginning of their third, fourth, and fifth grade years the children completed instruments that assessed nutrition knowledge, attitudes, and self-reported eating behaviors. Each year, children in the treatment group participated in 9 to 12 weeks of nutrition education. Compared to children in the control group, those in the treatment group exhibited significantly higher adjusted mean posttest knowledge scores throughout the study. Treatment group children who entered the study with attitude scores in a range where there was room for improvement exhibited a consistent tendency toward greater improvement than controls. This treatment effect was generated mainly in third grade. On one of the three eating-behavior assessments the treatment group moved with greater rapidity than controls toward a more desirable eating pattern, or maintained that pattern better. On two of the four attitude scales children with low third grade pretest (entry) scores exhibited improvements, independent of treatment, through fourth grade. This study shows it is difficult to demonstrate that increased nutrition knowledge dramatically affects nutrition attitudes and eating behaviors. However, taken together, the results indicate a positive nutrition education impact.
Article
Behavioral science researchers routinely use scale scores that sum or average a set of questionnaire items to address their substantive questions. A researcher applying multiple imputation to incomplete questionnaire data can either impute the incomplete items prior to computing scale scores or impute the scale scores directly from other scale scores. This study used a Monte Carlo simulation to assess the impact of imputation method on the bias and efficiency of scale-level parameter estimates, including scale score means, between-scale correlations, and regression coefficients. Although the choice of imputation approach had no influence on the bias of scale-level parameter estimates, it had a substantial impact on efficiency, such that item-level imputation consistently produced a meaningful power advantage. The simulation results clearly supported the use of item-level imputation. To illustrate the differences between item- and scale-level imputation, we examined predictors of 7th-grade academic self-efficacy in a sample of 595 low-income Mexican Origin adolescents in a planned missingness design. The results of the empirical data analysis were consistent with those of the simulation and also suggested that researchers should be cautious when implementing planned missing data designs that necessitate scale-level imputation.
Article
Objective: Attempts have been made to reduce childhood obesity through school-based programs. Systematic reviews of studies until 2006 reported a lack of consistency about effectiveness of such programs. Presented is an updated systematic review and meta-analysis. Design and methods: Replication of methodology used in previous comprehensive systematic review and meta-analysis of randomized controlled trials of school-based obesity prevention programs covering studies until 2006 to review studies thru January 2012. Results: Based on 32 studies (n = 52,109), programs were mildly effective in reducing BMI relative to controls not receiving intervention. Studies of children had significant intervention effects, those of teenagers did not, though the difference between the two groups was not statistically significant. Meta-regression showed a significant linear hierarchy of studies with the largest effects for comprehensive programs more than 1 year long that aimed to provide information on nutrition and physical activity, change attitudes, monitor behavior, modify environment, involve parents, increase physical activity and improve diet, particularly among children. Conclusions: Unlike earlier studies, more recent studies showed convincing evidence that school-based prevention interventions are at least mildly effective in reducing BMI in children, possibly because these newer studies tended to be longer, more comprehensive and included parental support.
Article
Objective: To evaluate implementation and effectiveness of nutrition promotion programmes using the health-promoting schools (HPS) approach, to indicate areas where further research is needed and to make recommendations for practice in this field. Design: The searched electronic databases included: CINAHL, Cochrane Library, Health Reference Center, Informit Search, MEDLINE, ProQuest, PsycINFO, PubMed, ScienceDirect, Scopus, Social Services Abstracts and Web of Science. Inclusion criteria were: (i) controlled or before-and-after studies evaluating a nutrition intervention and involving the HPS approach, either fully or in part; (ii) provision of information about components and delivery of the intervention; and (iii) report on all evaluated outcomes. Setting: Schools. Subjects: Students, parents and school staff. Results: All included studies described intervention delivery and six reported on process evaluation. In intervention schools school environment and ethos were more supportive, appropriate curriculum was delivered and parents and/or the community were more engaged and involved. Students participated in interventions at differing levels, but the majority was satisfied with the intervention. The evidence indicates that nutrition promotion programmes using the HPS approach can increase participants' consumption of high-fibre foods, healthier snacks, water, milk, fruit and vegetables. It can also reduce participants' 'breakfast skipping', as well as reduce intakes of red food, low-nutrient dense foods, fatty and cream foods, sweet drinks consumption and eating disorders. It can help to develop hygienic habits and improved food safety behaviours. Conclusions: More professional training for teachers in the HPS approach, further qualitative studies, longer intervention periods, improved follow-up evaluations and adequate funding are required for future school-based nutrition promotion programmes.
Article
Although the prevalence rates of childhood obesity have seemingly been stable over the past few years, far too many children and adolescents are still obese. Childhood obesity, and its associated metabolic complications, is rapidly emerging as one of the greatest global challenges of the 21st century. About 110 million children are now classified as overweight or obese. In this review we first describe the most recent data on the prevalence, severity, and racial/ethnic differences in childhood obesity. Obesity is associated with significant health problems in the pediatric age group and is an important early risk factor for much of adult morbidity and mortality. We review the metabolic complications associated with childhood obesity. Particular emphasis is given to the description of studies regarding the impact of varying degrees of obesity on the cardiometabolic risk factors in youth. We further describe studies in obese adolescents that have examined the importance of ectopic lipid deposition in the visceral abdominal depot and in insulin sensitive tissues in relation to the presence of insulin resistance. We end by describing studies that have examined beta-cell function in obese adolescents with normal glucose tolerance. The growing number of obese children and adolescents worldwide is of great concern. Many obese children and adolescents already manifest some metabolic complications, and these children are at high risk for the development of early morbidity. Understanding the underlying pathogenesis of this peculiar phenotype is of critical importance.
Article
To compare dietary knowledge, behaviors and self-efficacy of black middle school students of low socioeconomic status with their white counterparts of higher socioeconomic status. Cross-sectional, school-based survey. Large metropolitan area in the United States. Middle school students (1,208 of low socioeconomic and 978 of higher socioeconomic status). Dietary behaviors, dietary knowledge, and dietary self-efficacy were assessed by questionnaire. Differences between black students of low socioeconomic status and white students of higher socioeconomic status in the above variables. Black students of low socioeconomic status scored significantly lower than did white students of higher socioeconomic status on several of the variables. They were more likely to consume empty calorie food, meat, and fried food and less likely to eat fruit, vegetables, dairy products, and grains; they were less knowledgeable about dietary variables; and they had significantly lower self-efficacy regarding their ability to change dietary habits. The results of this study suggest that black students of low socioeconomic status should be targeted for early intervention related to dietary behaviors. This age group is amenable to change, and interventions designed specifically for them may result in lifetime reductions in risk of morbidity and mortality.
Article
The School Physical Activity and Nutrition (SPAN) questionnaire was developed as a surveillance instrument to measure physical activity, nutrition attitudes, and dietary and physical activity behaviors in children and adolescents. The SPAN questionnaire has 2 versions. This study was conducted to evaluate the validity of food consumption items from the elementary school version of the SPAN questionnaire. Validity was assessed by comparing food items selected on the questionnaire with food items reported from a single 24-hour recall covering the same reference period. 5 elementary schools in Indiana. Fourth-grade student volunteers (N = 121) from 5 elementary schools. Agreement between responses to SPAN questionnaire items and reference values obtained through 24-hour dietary recall. The agreement between the questionnaire and the 24-hour recall was measured using Spearman correlation, percentage agreement, and kappa statistic. Correlation between SPAN item responses and recall data ranged from .25 (bread and related products) to .67 (gravy). The percentage agreement ranged from 26% (bread and related products) to 90% (gravy). The kappa statistic varied from .06 (chocolate candy) to .60 (beans). Results from this study indicate that the SPAN questionnaire can be administered in the classroom quickly and easily to measure many previous day dietary behaviors of fourth graders. However, questions addressing consumption of "vegetables," "candy," and "snacks" need further investigation.
Article
To review the published literature on the effectiveness of interventions to promote physical activity in children and adolescents. Systematic review. Literature search using PubMed, SCOPUS, Psychlit, Ovid Medline, Sportdiscus, and Embase up to December 2006. Two independent reviewers assessed studies against the following inclusion criteria: controlled trial, comparison of intervention to promote physical activity with no intervention control condition, participants younger than 18 years, and reported statistical analyses of a physical activity outcome measure. Levels of evidence, accounting for methodological quality, were assessed for three types of intervention, five settings, and three target populations. The literature search identified 57 studies: 33 aimed at children and 24 at adolescents. Twenty four studies were of high methodological quality, including 13 studies in children. Interventions that were found to be effective achieved increases ranging from an additional 2.6 minutes of physical education related physical activity to 283 minutes per week of overall physical activity. Among children, limited evidence for an effect was found for interventions targeting children from low socioeconomic populations, and environmental interventions. Strong evidence was found that school based interventions with involvement of the family or community and multicomponent interventions can increase physical activity in adolescents. Some evidence was found for potentially effective strategies to increase children's levels of physical activity. For adolescents, multicomponent interventions and interventions that included both school and family or community involvement have the potential to make important differences to levels of physical activity and should be promoted. A lack of high quality evaluations hampers conclusions concerning effectiveness, especially among children.
Article
To determine the effectiveness of school-based interventions that focus on changing dietary intake and physical activity levels to prevent childhood obesity. MEDLINE and EMBASE were searched (January 2006 to September 2007) for controlled trials of school-based lifestyle interventions, minimum duration of 12 weeks, reporting weight outcome. Thirty-eight studies were included; 15 new studies and 23 studies included within the National Institute for Health and Clinical Excellence obesity guidance. One of three diet studies, five of 15 physical activity studies and nine of 20 combined diet and physical activity studies demonstrated significant and positive differences between intervention and control for body mass index. There is insufficient evidence to assess the effectiveness of dietary interventions or diet vs. physical activity interventions. School-based physical activity interventions may help children maintain a healthy weight but the results are inconsistent and short-term. Physical activity interventions may be more successful in younger children and in girls. Studies were heterogeneous, making it difficult to generalize about what interventions are effective. The findings are inconsistent, but overall suggest that combined diet and physical activity school-based interventions may help prevent children becoming overweight in the long term. Physical activity interventions, particularly in girls in primary schools, may help to prevent these children from becoming overweight in the short term.
Article
Achievement of the nation's Year 2000 fruit and vegetable goal of five or more daily servings may relate to children's preferences for fruits and vegetables. There are, however, no easily administered instruments for measuring preferences for fruits and vegetables among children. An initial questionnaire systematically varied preparation methods after focus group discussions had indicated that this had an impact on fruit and vegetable preferences. The three-part questionnaire (fruits, vegetables, fruit and/or vegetable snacks) was classroom administered. Internal consistencies and test-retest reliabilities were acceptable. Principal components analyses, however, revealed food-specific rather than preparation factors; thus, preparation was eliminated from a revised questionnaire. Repeat classroom administration of the revised questionnaire yielded acceptable internal consistencies and test-retest reliabilities. Preferences were higher for fruits than vegetables. Principal components analyses indicated single fruit and vegetable factors and a two-factor solution for snacks (vegetables, fruits). Pearson correlations between preferences and consumption were significant, but accounted for only a small fraction of the variance. Correlations between fruit exposure and preferences, and between vegetable exposure and preferences were 0.55 and 0.51, respectively. The revised questionnaire provides a reliable, valid, and simple tool for assessing fruit and vegetable preferences of 4th- and 5th-grade students. The relationship between these preferences and actual consumption is weak; however, making fruits and vegetables more available may enhance preferences.
Article
This study evaluated the effects of a school-based dietary intervention program to increase fruit and vegetable consumption among fourth-graders. Twenty-eight elementary schools were randomized to an immediate intervention condition or to a delayed intervention control condition. Measures of diet and psychosocial variables were collected at base line and 1 and 2 years post-baseline. The intervention included classroom, parent, and cafeteria components. Mean daily consumption of fruit and vegetables was higher for the intervention children compared with controls at Follow-up 1 (X(t) = 3.96, X(c) = 2.28) and at Follow-up 2 (X(t) = 3.20, X(c) = 2.21). Macro- and micronutrient changes favoring the intervention children were also observed at both Follow-up 1 and Follow-up 2. Mean daily consumption of fruit and vegetables was higher for intervention parents compared with controls at Follow-up 1 (X(t) = 4.23,X(c) = 3.94) but not at Follow-up 2. Strong effects were found for the High 5 intervention on fruit and vegetable consumption, on macro- and micro-nutrients, and on psychosocial variables. Future work is needed to enhance the intervention effects on parents' consumption and to test the effectiveness of the intervention when delivered by classroom teachers.
Article
Gimme 5 (Georgia) was a school-based nutrition education effectiveness trial to help fourth- and fifth-grade students eat more fruit, 100% juice, and vegetables (FJV). Process evaluation assessed fidelity of implementation, reach, and use of intervention materials and environmental mediators: teacher training, curriculum delivery, participation in family activities, attendance at evening point-of-purchase grocery store activities, and availability and accessibility of FJV at home. Approximately half of the curriculum activities were implemented in fourth and fifth grades. The lowest proportion completed were those most pertinent to behavior change. Eighty-seven percent of parents reported participating in homework activities with their fourth grader, 66% with fifth graders. Sixty-five percent of parents reported viewing a video with their child in both grades. Ten percent attended evening point-of-purchase grocery store activities. The low level of implementation and modest level of participation in family activities suggest that higher levels of behavior change may have occurred if exposure to the intervention had been higher.
Article
Diets characterized by high intakes of fruits and vegetables and low-fat dairy products (for example, the DASH diet) have been shown to reduce blood pressure in adults. The effects of similar diets on children's blood pressure are unknown. We used 8 years of follow-up data from 95 children, initially 3 to 6 years of age at enrollment in the prospective Framingham Children's Study in 1986. The yearly clinic visits included 5 measures of blood pressure obtained with an automated device. Diet was assessed by means of replicate sets of 3-day food diaries during each year. Children who consumed more fruits and vegetables (4 or more servings per day) or more dairy products (2 or more servings per day) during the preschool years had smaller yearly gains in systolic blood pressure throughout childhood. By the time of early adolescence, children with higher intakes of fruits and vegetables and dairy products had an adjusted mean (+/- standard deviation) systolic blood pressure of 106 +/- 2.9 mm Hg, whereas those with lower intakes in both food groups had a mean systolic blood pressure of 113 +/-1.5 mm Hg. Those with higher intakes of fruits and vegetables alone or dairy alone had intermediate levels of systolic blood pressure in adolescence. The effects on diastolic blood pressure were weaker. These results suggest that a diet rich in fruits, vegetables, and dairy products may have beneficial effects on blood pressure during childhood.
Article
The Sandy Lake school-based diabetes prevention program is a culturally appropriate intervention for Ojibway-Cree students in the 3rd, 4th, and 5th grades. This paper reports the results of the program in changing dietary intake behaviors and related psychosocial factors. Physical activity results are not included. The study was a pretest/post-test, single-sample design conducted during the 1998-1999 school year. A total of 122 students completed all 4 measurements (anthropometry, 24-h dietary recall, and 2 questionnaires), at baseline and follow-up. There were significant increases (P < 0.0001) in dietary intention, dietary preference, knowledge, and dietary self-efficacy, and in the curriculum knowledge scale between baseline and follow-up. Intervention exposure was significantly associated with being in the highest category for knowledge about foods that were low in dietary fat [Medium Exposure odds ratio (OR): 3.4; P < 0.05; High Exposure OR: 6.4; P < 0.05], being in the highest category for dietary self-efficacy (Medium Exposure OR: 3.7; P < 0.05; High Exposure OR: 3.9; P < 0.1), being in the highest category for knowledge about curriculum concepts (Medium Exposure OR: 3.4; P < 0.05; High Exposure OR: 9.4: P < 0.01), and for having met the age + 5 g dietary fiber intake/d (Medium Exposure OR: 2.9; P < 0.1; High Exposure OR: 11.0; P < 0.01). Exposure to the intervention was not associated with dietary intent or the percentage of energy from dietary fat. This program was associated with improved knowledge and the psychosocial factors related to healthy eating and dietary fiber intake of students in a remote First Nations community.
Article
The goal of multiple imputation is to provide valid inferences for statistical estimates from incomplete data. To achieve that goal, imputed values should preserve the structure in the data, as well as the uncertainty about this structure, and include any knowledge about the process that generated the missing data. Two approaches for imputing multivariate data exist: joint modeling (JM) and fully conditional specification (FCS). JM is based on parametric statistical theory, and leads to imputation procedures whose statistical properties are known. JM is theoretically sound, but the joint model may lack flexibility needed to represent typical data features, potentially leading to bias. FCS is a semi-parametric and flexible alternative that specifies the multivariate model by a series of conditional models, one for each incomplete variable. FCS provides tremendous flexibility and is easy to apply, but its statistical properties are difficult to establish. Simulation work shows that FCS behaves very well in the cases studied. The present paper reviews and compares the approaches. JM and FCS were applied to pubertal development data of 3801 Dutch girls that had missing data on menarche (two categories), breast development (five categories) and pubic hair development (six stages). Imputations for these data were created under two models: a multivariate normal model with rounding and a conditionally specified discrete model. The JM approach introduced biases in the reference curves, whereas FCS did not. The paper concludes that FCS is a useful and easily applied flexible alternative to JM when no convenient and realistic joint distribution can be specified.
Article
To assess reproducibility of a School-Based Nutrition Monitoring (SBNM) questionnaire for fourth-grade students. Test-retest. Fourth-grade elementary school classrooms Multiethnic fourth-grade students from 2 area school districts (N = 322). Reproducibility coefficients with time intervals between questionnaire administrations of 2 hours for the yesterday food choice and physical activity questions or 2 weeks for the nutrition knowledge and attitude questions. Spearman rank order correlation, percent agreement, and Kappa statistic calculated for each individual questionnaire item. Of 43 questions that were included in the reproducibility analyses, test-retest kappa values were moderate to high (greater than 0.40) for more than 90% of the questions (39 questions). Spearman coefficients were greater than 0.70 for 24 questions, whereas percent agreement exceeded 75% for 28 questions. The SBNM questionnaire showed good to excellent reproducibility for nutrition behavior questions, physical activity, weight behavior, and food selection skills overall. However, questions that assessed nutrition knowledge and attitudes were not as reproducible, probably resulting from learning effects over time. Results from the study indicate that this questionnaire can be easily administered in an elementary school classroom and can be used to measure nutrition behaviors among 9- to 10-year-old school children.