Bonnie Dudovitz

Changing fruit and vegetable consumption among children: the 5-a-Day Power Plus program in St. Paul, Minnesota.

OBJECTIVES A randomized school based trial sought to increase fruit and vegetable consumption among children using a multicomponent approach. METHODS The intervention, conducted in 20 elementary schools in St. Paul, targeted a multiethnic group of children who were in the fourth grade in spring 1995 and the fifth grade in fall 1995. The intervention consisted of behavioral curricula in classrooms, parental involvement, school food service changes, and industry support and involvement. Lunchroom observations and 24-hour food recalls measured food consumption. Parent telephone surveys and a health behavior questionnaire measured psychosocial factors. RESULTS The intervention increased lunchtime fruit consumption and combined fruit and vegetable consumption, lunchtime vegetable consumption among girls, and daily fruit consumption as well as the proportion of total daily calories attributable to fruits and vegetables. CONCLUSIONS Multicomponent school-based programs can increase fruit and vegetable consumption among children. Greater involvement of parents and more attention to increasing vegetable consumption, especially among boys, remain challenges in future intervention research.

Development and evaluation of a school intervention to increase fruit and vegetable consumption among 4th and 5th grade students

THOMPSON,3 SANDRA B. LEONARD,4 PATRICIA RILEY,2 JANICE BARANOWSKI,3 BONNIE DUDOVITZ, 6 AND MARY SMYTH 6 lGeorgia Prevention Institute, Department of Pediatrics, Medical College of Georgia, Augusta, Georgia 30912-3715; 2Division of Behavioral Sciences and Health Education, School of Public Health, Emory University, Atlanta, Georgia 30329; 30fIice of Biostatistics, Medical College of Georgia, Augusta, Georgia 30912-4900; 4Georgia Institute of Human Nutrition, Department of Medicine, Medical College of Georgia, Augusta, Georgia 30912-3102; sOfIice of Public Health Practice, School of Public Health, Emory University, Atlanta, Georgia 30329; and 6Department of Epidemiology, University of Minnesota, Minneapolis, Minnesota, 55454.

Healthy Home Offerings via the Mealtime Environment (HOME): Feasibility, Acceptability, and Outcomes of a Pilot Study

The primary objective was to develop and test the feasibility and acceptability of the Healthy Home Offerings via the Mealtime Environment (HOME) program, a pilot childhood obesity prevention intervention aimed at increasing the quality of foods in the home and at family meals. Forty‐four child/parent dyads participated in a randomized controlled trial (n = 22 in intervention and n = 22 in control conditions). The intervention program, held at neighborhood facilities, included five, 90‐min sessions consisting of interactive nutrition education, taste testing, cooking skill building, parent discussion groups, and hands‐on meal preparation. Children (8–10‐year olds) and parents (89% mothers) completed assessments at their home at baseline, postintervention, and 6‐month follow‐up, including psychosocial surveys, anthropometry, 24‐h dietary recalls, and home food availability and meal offering inventories. Feasibility/acceptability was assessed with participant surveys and process data. All families completed all three home‐based assessments. Most intervention families (86%) attended at least four of five sessions. Nearly all parents (95%) and 71% of children rated all sessions very positively. General linear models indicated that at postintervention, compared to control children, intervention children were significantly more likely to report greater food preparation skill development (P < 0.001). There were trends suggesting that intervention children had higher consumption of fruits and vegetables (P < 0.08), and higher intakes of key nutrients (all P values <0.05) than control children. Obesity changes did not differ by condition. Not all findings were sustained at 6‐month follow‐up. Obesity prevention programming with families in community settings is feasible and well accepted. Results demonstrate the potential of the HOME program.

Project Northland High School Interventions: Community Action to Reduce Adolescent Alcohol Use

Project Northland is a randomized community trial initially implemented in 24 school districts and communities in northeastern Minnesota, with goals of delaying onset and reducing adolescent alcohol use using community-wide, multiyear, multiple interventions. The study targets the Class of 1998 from the 6th to 12th grades (1991-1998). The early adolescent phase of Project Northland has been completed, and reductions in the prevalence of alcohol use at the end of 8th grade were achieved. Phase II of Project Northland, targeting 11th- and 12th-grade students, uses five major strategies: (1) direct action community organizing methods to encourage citizens to reduce underage access to alcohol, (2) youth development involving high school students in youth action teams, (3) print media to support community organizing and youth action initiatives and communicate healthy norms about underage drinking (e.g., providing alcohol to minors is unacceptable), (4) parent education and involvement, and (5) a classroom-based curriculum for 11th-grade students. This article describes the background, design, implementation, and process measures of the intervention strategies for Phase II of Project Northland.

A Home-Based Prevention Program for Sixth-Grade Alcohol Use: Results from Project Northland

Project Northland is designed to prevent alcohol use among young adolescents. The project is ongoing in 24 school districts, randomly assigned to intervention or reference conditions. Multiple interventions begin with sixth graders and continue through eighth grade. The reference districts offer their standard health curricula. Evaluation consists of school surveys with the cohort (N = 2201) and telephone surveys of half their parents. This article describes the sixth-grade home-based intervention, the Slick Tracy Home Team. Findings of broad-based participation across sex, race, and risk status were documented, as well as some increases in knowledge and family communication about alcohol use.

The Healthy Home Offerings via the Mealtime Environment (HOME) Plus study: Design and methods☆

BACKGROUND Informed and engaged parents and healthful home environments are essential for the health of youth. Although research has shown health benefits associated with family meals, to date, no randomized controlled trial (RCT) has been developed to examine the impact of a family meals intervention on behavioral and health outcomes. METHODS/DESIGN The Healthy Home Offerings via the Mealtime Environment (HOME) Plus study is a two-arm (intervention versus attention-only control) RCT being conducted in Minneapolis/St. Paul. Built on previous pilot research, HOME Plus aims to increase the frequency and healthfulness of family meals and snacks and reduce childrens sedentary behavior, particularly screen time, to promote healthier eating and activity behaviors and prevent obesity. HOME Plus is delivered to families in community settings. The program includes 10 monthly sessions focused on nutrition and activity education, meal planning and preparation skill development. In addition, five motivational goal-setting phone calls are conducted with parents. The primary outcome measure is age- and gender-adjusted child BMI-z score at post-intervention by treatment group. Secondary household-level outcomes include family meal frequency, home availability of healthful foods (fruits/vegetables) and unhealthful foods (high-fat/sugary snacks) and beverages (sugar-sweetened beverages), and the quality of foods served at meals and snacks. Secondary child outcomes include dietary intake of corresponding foods and beverages and screen time. CONCLUSIONS The HOME Plus RCT actively engages whole families of 8-12 year old children to promote healthier eating and activity behaviors and prevent obesity through promotion of family meals and snacks and limited media use.

Providing Obesity Prevention Counseling to Children during a Primary Care Clinic Visit: Results from a Pilot Study

The purpose of this study was to evaluate parent response to a clinic-based primary prevention intervention to increase the proportion of 5- to 10-year-old children receiving annual body mass index screening and counseling about physical activity, dietary practices, and sedentary practices. A posttest-only, quasiexperimental design was used. Two clinics that provide routine health care to school-aged children agreed to participate in the pilot study. A multicomponent intervention was implemented in one clinic; the other provided care as usual. A convenience sample of parents (n=117) completed a survey after a clinic visit. Descriptive statistics, Fishers exact, and chi(2) tests of significance and logistic regression were used to examine study outcomes. Most parents (>80%) believed it was important for health care providers to share information with them about their childs weight and physical activity, diet, and sedentary practices. Intervention parents were significantly more likely to report receiving information from their health care provider about their childs weight and weight-related behavior counseling than control parents. More intervention than control parents reported they intended their child to get five or more servings of fruits/vegetables on most days during the next 30 days (25% vs 9%; P=0.049). Outcomes suggest parents regard the take-home message they receive from health care providers about their childs weight and weight-related lifestyle practices as relevant and a potential motivating factor when considering behavior change. Further development of the intervention and testing in a larger experimental trial are warranted to determine effects on behavior change and body weight.

An evaluation of a theatre production to encourage non-smoking among elementary age children: 2 Smart 2 Smoke

OBJECTIVE To evaluate the impact of a theatre production on smoking-related attitudes, norms, and intentions of children in grades 1–6 (aged 6–12 years). DESIGN Seventeen schools were randomly selected among 160 that were participating in the implementation of the theatre production 2 Smart 2 Smoke. Schools that participated in the theatre production after 3 December 1997 were assigned as control schools. Assignment of schools to a given date for the theatre production was a random process. Students in grades 1–6 were surveyed before and after the theatre production and associated activities. The data were examined for pretest–posttest differences and intervention-control differences. The school was the unit of analysis. SETTING Elementary schools in the Twin Cities metropolitan area. PARTICIPANTS Students in grades 1–6 in 17 elementary schools. INTERVENTION Two plays2 Smart 2 Smoke for grades 1–3 (6–8 year olds) and grades 4–6 (9–12 year olds), respectively, with follow-up activities for the classroom and home. A national theatre company performed the plays at the schools. MAIN OUTCOME MEASURES Intention to smoke in the future, normative expectations about how many people smoke, functional meanings of smoking, expected outcomes of smoking. RESULTS 10% more students reported that they would never smoke a cigarette after the theatre production. Students in grades 4–6 showed changes in the functional meanings and expected outcomes of smoking. Students in grades 1–3 showed changes in normative expectations. CONCLUSIONS Further research on the impact of live theatre productions as a smoking prevention strategy is recommended.