Marsha Davis

Gimme 5 Fruit, Juice, and Vegetables for Fun and Health: Outcome Evaluation

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.

A Randomized School Trial of Environmental Strategies to Encourage Fruit and Vegetable Consumption among Children

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.

Gimme 5 Fruit and Vegetables for Fun and Health: Process Evaluation

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.

Systematic risk factor screening and education: A community-wide approach to prevention of coronary heart disease☆

Within a community-wide heart disease prevention effort, it was hypothesized that personalized risk factor screening and education would result in modified health behaviors and reduced risk factor levels for coronary heart disease. Adults from a population sample were randomized to a community-wide screening and education program or were excluded from that program for 1 year. At the end of that year, both groups were measured for risk factor levels and related health behaviors. Those who received the screening and education program had significantly lower risk factor levels and other evidence of health behavior change, including lower blood cholesterol (206.9 vs 211.5 mg/dl), lower diastolic blood pressure (68.7 vs 70.0 mm Hg), lower resting heart rate (71.4 vs 72.7 bpm), and increased selection of low-fat and low-sodium meals in local restaurants. These data suggest that systematic risk factor screening and education may result in lower population risk for coronary heart disease.

Development of a Modified Picture-Sort Food Frequency Questionnaire Administered to Low-income, Overweight, African-American Adolescent Girls

There is essentially no ideal method of dietary assessment. Physiologic methods (i.e., doubly labeled water) probably come closest, but high cost, participant burden, and limited information limit their use. Furthermore, most dietary assessment methods have been designed for and tested in white adults. Very few have been designed for and tested in African-American adolescents. This study examined validity and reliability of a modified picture-sort food frequency questionnaire (FFQ) administered to 22 low-income, overweight, African-American adolescent girls, aged 11 to 17 years. The FFQ was administered to subjects twice during a 2-week period, and evaluated using the mean values of three 24-hour recalls. The natural log-transformed energy-adjusted, deattenuated correlation coefficients between the second FFQ and the mean from 3 recalls exceeded 0.50 for most nutrients, ranging from 0.32 (protein) to 0.87 (saturated fat). The energy and nutrient values from the first FFQ were greater than those from the second FFQ. Most correlation coefficients for the test-retest reliability of the FFQ were not significant. We conclude that although larger samples are needed to generalize results, the picture-sort dietary assessment method appears to be promising and merits further research.

A 7-item Versus 31-item Food Frequency Questionnaire for Measuring Fruit, Juice, and Vegetable intake among a Predominantly African-American Population

OBJECTIVE This study sought to determine which of 2 fruit and vegetable food frequency questionnaires (FFQs) most closely approximated intake measured by the average of four 24-hour dietary recalls. DESIGN Participants completed either a 31-item FFQ (n = 70) or 7-item FFQ (n = 76) on 2 occasions approximately 2 weeks apart. During the interval between FFQs1 participants provided four 24-hour dietary recalls via telephone interview. SUBJECTS/SETTING Participants were 146 persons with food preparation responsibilities in families of students in grades 3 through 5. Respondents were predominantly African-American women in Atlanta, Ga. STATISTICAL ANALYSIS Pearson correlation coefficients of log-transformed values estimated the reliability of each FFQ and compared FFQ estimates to reference values. The intraclass correlation coefficient evaluated consistency across 24-hour recalls. RESULTS The first FFQs overestimated intake approximately twofold. The 31-item FFQ estimates exceeded 7-item FFQ estimates by approximately 30% . Correlations with recall estimates were high for the 7-item FFQ and moderate to low for the 31-item FFQ. The second FFQ estimates were more highly correlated to reference values. From the first to the second administration, 7-item FFQ estimates dropped from 5.2 to 2.7 servings, and 31-item FFQ estimates dropped from 6.7 to 3.5 servings. Neither FFQ produced highly reliable estimates. CONCLUSIONS Mean total fruit and vegetable consumption was closer to reference estimates for the first 7-item FFQ and the second 31-item FFQ. The 7-item FFQ correlated more highly with reference estimates than did the 31-item FFQ. Therefore, we conclude that for African-American adults, a 1-time-administered FFQ using 7 broad food categories correlates more highly with reference values than a FFQ using 31 individual fruit and vegetable items.