Heart healthy eating and exercise: introducing and maintaining changes in health behaviors.

The Heart Program is a health education project developed for elementary school students. It was designed to 1) increase their consumption of complex carbohydrates, and decrease their consumption of saturated fat, cholesterol, sodium, and sugar; 2) increase their level of habitual physical activity; and 3) generalize these changes to other family members. The overall program and 12 class lessons were designed using informative instruction, participatory classroom activities, personal goal setting, parent handouts, feedback, and reinforcement. The program was evaluated using a time-series experimental design with all students in three 4th grade classes at School 1 and three 5th grade classes at School 2. Evaluation was conducted using direct observations of eating and activity, as well as paper-and-pencil assessments of knowledge and attitude. Results indicated substantial changes in eating behavior at school, knowledge about heart health, food preferences, and family eating patterns are reported by parents. Observed changes in exercise were minimal during treatment, and were related to seasonal sports activities at follow-up. Eating which spanned summer vacation. These outcomes suggest that school programs developed using specific techniques can be effective in facilitating important behavior changes at school and at home.     

Development and Validation of a Beverage and Snack Questionnaire for Use in Evaluation of School Nutrition Policies

School nutrition policies limiting access to sweetened beverages, candy, and salty snacks have the potential to improve the health of children. To effectively evaluate policy success, appropriate and validated dietary assessment instruments are needed. The objective of this study was to develop and validate a beverage and snack questionnaire suitable for use among young adolescents. A new 19-item Beverage and Snack Questionnaire (BSQ) was administered to middle school students on two occasions, 2 weeks apart, to measure test-retest reliability. The questionnaire inquired about frequency of consumption, both at school and away from school, of soft drinks, salty snacks, sweets, milk, and fruits and vegetables. Students also completed 4-day food records. To assess validity, food-record data were compared with BSQ data. Forty-six students of diverse backgrounds from metropolitan Seattle, WA, participated in this study. Participants answered the BSQ during class time and completed the food record at home. Pearson correlation coefficients assessed test-retest reliability and validity. Using frequency per week data, the test-retest reliability coefficients were r=0.85 for fruits and vegetables consumed at school and r=0.74 and r=0.72 for beverages and sweets/snacks, respectively, consumed at school. Correlations ranged from r=0.73 to 0.77 for foods consumed outside of school. Compared with the criterion food record, validity coefficients were very good: r=0.69 to 0.71 for foods consumed at school and r=0.63 to 0.70 for foods consumed away from school. The validity coefficients for the 19 individual food items ranged from r=0.56 to 0.87. This easy-to-administer 19-item questionnaire captures data on sugar-sweetened beverages, salty snacks, sweets, milk, and fruit and vegetables as well as a more lengthy and expensive food record does. The BSQ can be used by nutrition researchers and practitioners to accurately evaluate student consumption of foods that are the focus of school nutrition policies.     

中国农村营养改善计划地区2019年学生零食消费及影响因素

目的 分析中国中西部贫困农村中小学生的零食消费情况及影响因素,为正确引导儿童合理消费零食、促进健康成长提供基础数据.方法 2019年,在实施“农村义务教育学生营养改善计划”的中西部22个省699个县中,分片选取1～3个国家试点县,共选取50个重点监测县.按照不同供餐模式,随机各抽取2所小学和2所初中作为重点监测学校.从...     

Great Sensations: A Program to Encourage Heart Healthy Snacking by High School Students

The Great Sensations program consisted of three interrelated educational strategies--classroom instruction, parent outreach, and media campaign. These strategies were designed to teach inner-city high school students about salt and high blood pressure, and to encourage them to eat more low-salt snacks and fewer high-salt snacks. Eight classes at the experimental school were randomly assigned to class instruction or parent outreach in a factoral design. All students in the experimental school were exposed to the media campaign. Students at a nearby high school served as the comparison group. All but a few of the 490 students at the two schools were black. Students who received the classroom instruction reported lower Salty Snack selection and higher Target Snack selection at posttest and eight-week follow-up. Students receiving media only reported lower Salty Snack selection at posttest but this condition returned to baseline by eight weeks. The control group reported little change in snack selection at posttest and eight weeks. After six months, program effects were no longer evident for either experimental group.     

Children Select Unhealthy Choices when Given a Choice among Snack Offerings

Out-of-school-time programs serve snacks to millions of children annually. State and national snack policies endorse serving more-healthful options, such as fruits, yet often allow less-healthful options, such as cookies and chips, to be served simultaneously. To date, no studies have examined the choices children make when provided with disparate snack options in out-of-school-time programs. An experimental study with randomized exposures was conducted that exposed children (5 to 10 years old) to the following conditions: whole or sliced fruit; whole/sliced fruit, sugar-sweetened snacks (eg, cookies) and flavored salty (eg, nacho cheese−flavored tortilla chips) snacks; and whole/sliced fruit and less-processed/unflavored grain snacks (eg, pretzels), during a 2-week period representing 18 snack occasions (morning and afternoon) during summer 2013. The percentage of children who selected snacks, snack consumption, and percent of serving wasted were calculated and analyzed using repeated-measures analyses of variance with Bonferroni adjustments. A total of 1,053 observations were made. Sliced fruit was selected more than whole fruit across all conditions. Fruit (sliced or whole) was seldom selected when served simultaneously with sugar-sweetened (6% vs 58%) and flavored salty (6% vs 38%) snacks or unflavored grain snacks (23% vs 64%). More children consumed 100% of the sugar-sweetened (89%) and flavored salty (82%) snacks compared with fruit (71%); 100% consumption was comparable between fruit (59%) and unflavored grain snacks (49%). Approximately 15% to 47% of fruit was wasted, compared with 8% to 38% of sugar-sweetened, flavored salty, and unflavored grain snacks. Snack policies that encourage out-of-school-time programs to serve fruit require clear language that limits offering less-healthful snack options simultaneously.     

Appalachian adolescents' snack patterns: morning, afternoon, and evening snacks

The snack patterns of 225 adolescents selected from four metropolitan and three rural schools in eastern Tennessee were examined with the use of 24-hour food records kept on a school day. Most (89%) of the respondents ate at least one snack on the day of the survey. Morning snacks, most of which were obtained from school stores or school vending machines, were more likely to include candies and salty snack foods than were afternoon and evening snacks, most of which were eaten at home. Breads and cereals were popular choices for afternoon and evening snacks. Carbonated beverages and desserts were popular during all time periods. Nutrient densities of snacks were low in all time periods but lowest in morning snacks. Nutrients present in lowest amounts were iron, calcium, and vitamin A. Snack patterns of boys and girls were similar, although boys' intakes of energy, calcium, and riboflavin were higher than those of girls.     

Development of a school-based nutrition intervention for high school students: Gimme 5

PURPOSE: To describe a 4-year intervention targeting fruit/vegetable consumption by high school students. DESIGN: This is a cohort study involving six pairs of schools (n = 12) matched on gender, race, enrollment, and location with schools randomly assigned within pairs to intervention or control conditions. SETTING: Twelve Archdiocese of New Orleans high schools. SUBJECTS: Cohort was defined as students (n = 2339) who were ninth-graders in the 1993-94 school year who provided baseline data. INTERVENTION: Four components of the intervention are: (1) school-wide media-marketing campaign, (2) school-wide meal and snack modification, (3) classroom workshops and supplementary subject matter activities, and (4) parental involvement. MEASURES: Focus groups were conducted for target population input and program development. Process evaluation included student feedback on media-marketing intervention materials and activities reported here. Process measures also included school meal participation, student characteristics, and verification of intervention activities. RESULTS: Focus groups identified barriers to increased consumption of fruit and vegetables as lack of availability, variety, and inconsistency in taste. Student attitudes were favorable regarding a school program to improve diet and parental involvement. Low consumption of fruits/vegetables was reported. After a 2-month school-wide program introduction utilizing various media-marketing materials and activities, 93% of students were aware of the program and 96% could identify the healthy eating message. CONCLUSIONS: Program development can be guided and enriched by student input via focus groups. Media-marketing activities effectively delivered health messages and attracted students' attention. Materials and activities used were acceptable channels for increasing awareness, positive attitudes, and knowledge about fruits/vegetables.     

Shape of snack foods does not predict snack intake in a sample of preschoolers: a cross-over study

ABSTRACT: BACKGROUND: In the past decade, the proportion snacking has increased. Snack foods consumed are predominantly not nutritious foods. One potential venue to increase children's diet quality is to offer healthy snack foods and we explored if shaped snack foods would lead to increased consumption. METHODS: We investigated the consumption of high-fiber snacks (banana bread, pancakes, and sandwiches) served either in normal (round, square) or shaped (heart, hands, animals) form to preschoolers 2-5 years old attending a local child care center (n=21). The 9 weeks long, prospective, cross-over intervention study was designed to expose each child repeatedly to each snack in each shape (4 times per snack). Snacks were served as morning or afternoon snack and caretakers' reports were used to account for the child's consumption of a meal preceding the study snack (breakfast or lunch). RESULTS: There was no significant difference in snack consumption between the shaped and normal snacks. However, the mean energy intake from snacks was significantly greater for Caucasian children compared with Asian children. Further, Asian children consumed much less banana bread than the other two snacks. Overall, children who had not eaten breakfast or lunch prior to the morning or afternoon snack ate significantly more calories from the snacks (84.1 kcal, p-value<0.0001). CONCLUSION: Findings of this study confirm previous research that the shape of the foods does not affect snack consumption in children. However, we also report two unexpected findings: a) the strong interaction between ethnicity and snack consumption and b) that Asian children consumed much less banana bread than Caucasian children. The role of children's ethnic background profoundly affects snack preference and must be considered in the study of children's eating behaviors and in interventions to promote healthy eating habits.     

Improvements in middle school student dietary intake after implementation of the Texas Public School Nutrition Policy

Objectives. We assessed the effect of the Texas Public School Nutrition Policy on middle school student lunchtime food consumption.Methods. Three years of lunch food records were collected from middle school students in southeast Texas: baseline (2001–2002), after local district changes (2002–2003), and 1 year after implementation of the Texas Public School Nutrition Policy (2005–2006). Students recorded amount and source of foods and beverages they consumed. Analysis of variance and covariance and nonparametric tests were used to compare intake after the policy change with intake during the 2 previous years.Results. After implementation of the nutrition policy, student lunch consumption of vegetables, milk, and several nutrients increased (protein, fiber, vitamins A and C, calcium, and sodium), and consumption of less desirable items (sweetened beverages, snack chips) decreased, as did percentage of energy from fat. Most of the desired nutrients and foods (vegetables and milk) were obtained from the National School Lunch Program meal. Fewer sweetened beverages, candy, chips, and dessert foods were purchased and consumed, but more of these items were brought from home and purchased from the snack bar.Conclusions. Overall, state school nutrition policies can improve the healthfulness of foods consumed by students at lunch.Public health efforts to reduce the increasing rates of childhood obesity1 have recently focused on school food environments.2 Although regulations exist for National School Lunch Program (NSLP) meals, there are no federal rules for competitive foods sold elsewhere in the school such as in snack bars and vending machines, except for foods of minimal nutritional value (e.g., soda).3 This has become an issue because the school environment influences dietary behavior.4 For example, middle school students with access to snack bar and a la carte foods consumed more sweetened beverages and french fries, and fewer fruit and vegetables compared with elementary school students without snack bars.5^,6 The number of snack vending machines was negatively related to daily fruit consumption among middle school youth.7 In high schools where soft drink machines were turned off during lunch, students purchased fewer soft drinks compared with students in schools where these machines were on during lunch.8 Improving types and portion sizes of foods available in school snack bars and a la carte could reduce the source of kilojoules available for student purchase and possibly improve energy balance.9States, school districts, and individual schools have enacted laws and policies regarding foods and beverages available in school food environments.10 The beverage industry also developed a voluntary beverage vending policy for schools.11 Such changes are controversial, and barriers to improving school food environments exist. These include the revenue generated from vending and snack bar and a la carte sales,12 school staff, student and parent attitudes toward types of foods expected in schools,13 and the concern that limiting access to these foods at school will not improve overall student dietary intake.14 Critics suggest that if these items are not available in schools, students will compensate by increasing consumption of desired foods in out-of-school environments.14Few data exist for the effect of policy changes on actual food consumption by students at school. One recent study documented significant improvements in food consumption by Texas middle school students (more milk, calcium, and vitamin A; fewer sweetened beverages) after a local school district enacted a snack bar food policy change.15 Consumption of chips purchased from the snack bar declined, but consumption of chips from vending machines increased, because the school administration, which was responsible for vending machines, made no changes. These results suggest that all school food sources have to make similar changes to favorably influence consumption.The Texas Public School Nutrition Policy, an unfunded mandate to promote a healthy school environment for Texas students, was implemented statewide in the fall of 2004. The guidelines apply to all school food sources, including vending machines.16 For middle schools, the policy restricts the portion sizes of high-fat and sugar snacks (limits vary by food group), sweetened beverages (≤ 12 oz), and the fat content of all foods served (≤ 28 grams of fat per serving no more than 2 times per week). It also sets limits on the frequency of serving high-fat vegetables such as french fries (3 oz per serving no more than 3 times per week). We report the results of a naturalistic study that assessed the effect of the Texas Public School Nutrition Policy on lunch consumption of middle school students in southeast Texas. Student lunch consumption data for 2 previous years were available for comparison.15     

Coordinated school health program and dietetics professionals: partners in promoting healthful eating

Although research indicates that school meal programs contribute to improved academic performance and healthier eating behaviors for students who participate, fewer than 60% of students choose the National School Lunch Program or School Breakfast Program. School meal programs have a difficult time competing with foods that are marketed to young people through sophisticated advertising campaigns. Youth's preferences for fast foods, soft drinks, and salty snacks; mixed messages sent by school personnel; school food preparation and serving space limitations; inadequate meal periods; and lack of education standards for school foodservice directors challenge school meal programs as well. A coordinated school health program offers a framework for meeting these challenges and provides children and adolescents with the knowledge and skills necessary for healthful eating. This article identifies challenges facing school foodservice directors in delivering healthful meals and acquaints dietetics professionals with the coordinated school health program to be used as a tool for addressing unhealthful weight gain and promoting healthful eating.     

What's in Children’s Backpacks: Foods Brought from Home

Forty-one percent of elementary schoolchildren bring lunch to school on any given day. Forty-five percent bring snacks. Surprisingly, little is known about the foods and beverages they bring. This cross-sectional analysis of baseline data from the GREEN (Growing Right: Eco-friendly Eating and Nutrition) Project Lunch Box Study sought to characterize foods and beverages brought from home to school by elementary schoolchildren and compare the quality of packed lunches with National School Lunch Program standards and packed snacks with Child and Adult Care Food Program requirements. Lunches and snacks from 626 elementary schoolchildren were assessed and evaluated using digital photography and a supplemental food checklist. Food and beverage types most likely to be provided for lunch were sandwiches (59%), snack foods (42%), fruit (34%), desserts (28%), water (28%), and sugar-sweetened beverages (24%). Twenty-seven percent of lunches met at least three of five National School Lunch Program standards. At snack, snack foods (62%), desserts (35%), and sugar-sweetened beverages (35%) were more common than fruits (30%), dairy foods (10%), and vegetables (3%). Only 4% of snacks met two of four Child and Adult Care Food Program standards. Future research is needed to understand the multiple determinants of food-packing behavior, including constraints faced by families. School wellness policies should consider initiatives that work collaboratively with parents to improve the quality of foods brought from home.     

Fruits, vegetables, milk, and sweetened beverages consumption and access to à la carte/snack bar meals at school

OBJECTIVES: We assessed the impact of access to school snack bars on middle school students' fruit, vegetable, milk, and sweetened beverage consumption. METHODS: Five hundred ninety-four fourth- and fifth-grade students completed lunch food records 4 times during a 2-year period. RESULTS: The fourth-grade cohort consumed fewer fruits, regular (not fried) vegetables, and less milk and consumed more sweetened beverages and high-fat vegetables during year 2. CONCLUSIONS: Middle school students who gained access to school snack bars consumed fewer healthy foods compared with the previous school year, when they were in elementary schools and only had access to lunch meals served at school. Healthy food choices and school policies that require healthier foods at school snack bars should be promoted.     

Sodium intake from meals and snacks consumed by college students

This investigation was designed to compute the total sodium intake from meals and snacks consumed by selected college students. Most students used carbonated beverages, candies, gums, cookies, and salted snack items. They consumed salted snack items mostly as evening snacks. Mean sodium intake was found to be 3,904 mg. for men and 2,628 mg. for women, without taking into consideration the use of table salt. Sodium density per kilocalorie per day was 1.40 and 1.41 for men and women, respectively, suggesting that the differences in intakes were due to women's lower caloric intake. Sodium intake was greater from regular meals than from snack foods. Evening snacks contributed more to the daily sodium intake than morning and afternoon snacks. It can be concluded that sodium intake of college students needs careful assessment. According to the Food and Nutrition Board, the most effective way to maintain intake within the suggested range is to reduce the amount of salt added at table or in cooking and to reduce moderately the selection of obviously salty foods (9). College students need to be made aware of the sodium content of foods they select for lunch, dinner, and evening snacks, as well as the amount of salt they add at the table.     

Association between food marketing exposure and adolescents' food choices and eating behaviors

The present study examined associations between food marketing exposure and adolescents’ food choices and reported consumption of energy-dense and nutrient-poor (EDNP) foods. A cross-sectional survey of 12,188 Australian secondary students aged 12-17 years was conducted, using a web-based self-report questionnaire. Measures included students’ level of exposure to commercial television and non-broadcast types of food marketing, whether they had tried a new product or requested a product they had seen advertised, and their reported consumption of fast food, sugary drinks and sweet and salty snacks. Results indicated greater exposure to commercial television, print/transport/school food marketing and digital food marketing were all independently associated with students’ food choices. High commercial television viewers (>2 h/day) were more likely to report higher consumption of EDNP foods (ORs ranged from 1.31 for fast food to 1.91 for sweet snacks). Some associations between digital food marketing exposure and students’ eating behaviors were found; however, print/transport/school food marketing was only related to sweet snack consumption. These study results suggest that cumulative exposure to television food advertising and other food marketing sources are positively linked to adolescents’ food choices and eating behaviors. Policy changes to restrict food marketing to young people should include both television and non-broadcast media.     

What Works? Process Evaluation of a School‐Based Fruit and Vegetable Distribution Program in Mississippi

BACKGROUND: During the 2004–2005 school year, the Mississippi Department of Education, Office of Child Nutrition, initiated a pilot program to distribute free fruit and vegetable snacks to students during the school day. This article describes the first‐year implementation of the Mississippi Fruit and Vegetable Pilot Program. METHODS: The process evaluation addressed where, when, and how produce was distributed; what was distributed; challenges and successes; and recommended modifications. Five of the 25 program schools were selected to participate in the evaluation; selection was based on grade levels served and demographic characteristics. Data were collected from program staff (N = 11) and administrators (N = 6) via interviews and logs; student (N = 42) and parent (N = 19) focus groups; student questionnaires (N = 660); and school staff questionnaires (N = 207). RESULTS: Distributing fresh fruit and vegetable snacks at school was well received by staff and students. Most schools distributed the fresh fruit and vegetable snacks at morning break in classrooms or a central courtyard. Twenty‐two types of fresh fruit, 4 types of dried fruit, and 7 types of vegetables were served to students during the program year. Commonly distributed fruit included apples, oranges, pears, bananas, and tangerines. Carrots were the staple vegetable, followed by celery. Key challenges included getting students to try new foods and receiving the produce in a timely manner without spoiling. Main successes included seeing students try new fruit and vegetable snacks, having the program run smoothly, and teacher support. CONCLUSIONS: The program fit well within the school structure and could be an effective component of a multifaceted approach to enhancing child nutrition.     

成都市学龄儿童零食行为研究

目的了解成都市学龄儿童零食行为现状,为指导儿童合理消费零食提供依据。方法整群抽取成都市城区2所小学四～六年级学生1290名,对近6个月的零食行为进行问卷调查。结果近6个月以来调查对象吃零食频率在3次/d以内者达93.4%;最常吃的零食为水果(54.1%),冰激凌(35.3%),糖果、巧克力(28.2%);选择高糖高脂高盐零食者达93.7%;在非饥饿状态下吃零食的比例为69.0%,因饥饿而吃零食的比例为31.0%;选择零食的依据主要是味道(83.4%)、营养(52.2%)、父母准备(17.7%)和家人常吃(15.0%);吃零食的时间依次为晚餐前(53.3%)、晚餐后(28.7%)和晚上睡觉前(9.2%);零食来源主要是自己购买(54.3%)和父母准备(43.5%)。结论成都市学龄儿童零食行为仍存在一定问题,亟待引导和改善。     

Storing Empty Calories and Chronic Disease Risk: Snack-Food Products,Nutritive Content,and Manufacturers in Philadelphia Corner Stores

Corner stores are part of the urban food environment that may contribute to obesity and diet-related diseases, particularly for low-income and minority children. The snack foods available in corner stores may be a particularly important aspect of an urban child’s food environment. Unfortunately, there is little data on exactly what snack foods corner stores stock, or where these foods come from. We evaluated snack foods in 17 Philadelphia corner stores, located in three ethnically distinct, low-income school neighborhoods. We recorded the manufacturer, calories, fat, sugar, and sodium for all snack items, excluding candy and prepared foods. We then compared the nutritive content of assessed snack items to established dietary recommendations and a school nutrition standard. In total, stores stocked 452 kinds of snacks, with only 15% of items common between all three neighborhoods. Total and unique snacks and snack food manufacturers varied by neighborhood, but distributions in snack type varied negligibly: overall, there were no fruit snacks, no vegetable snacks, and only 3.6% of all snacks (by liberal definition) were whole grain. The remainder (96.4% of snacks) was highly processed foods. Five of 65 manufacturers supplied 73.4% of all kinds of snack foods. Depending on serving size definition, 80.0-91.5% of snack foods were “unhealthy” (by the school nutrition standard), including seven of 11 wholegrain products. A single snack item could supply 6-14% of a day’s recommended calories, fat, sugar, and sodium on average (or 56-169% at the extreme) for a “typical” child. We conclude that corner store snack food inventories are almost entirely unhealthful, and we discuss possible implications and next steps for research and intervention.     

Food-related beliefs,eating behavior,and classroom food practices of middle school teachers

This study examined classroom food practices and eating behavior of middle school teachers from 16 schools in a metropolitan area, located in the upper Midwest. In winter 1999-2000, teachers in sixth, seventh, and eighth grade were surveyed (response rate = 70%; n = 490/701). Questions addressed teachers' classroom food practices, eating behavior while at school, personal health, and attitudes about the school food environment. Use of food as an incentive/reward for students was a common classroom practice in middle schools, and most foods did not support development of health eating patterns by young adolescents. Candy was the most frequently used food item, reported by 73% of teachers, followed by cookies/doughnuts (37%), sweetened drinks (35%), and pizza (28%). Many middle school teachers did not role model healthy eating behavior at school. Prevalent use of vending was a particular concern, with beverage and snack vending use reported by 62% and 35% of teachers, respectively. Most vending items purchased were sweetened drinks (57%) and high-fat or high-sugar snacks (85%). Low perceived personal health, high-fat scores, and low support for the school food environment were some of the significant correlates of teachers' eating behavior. School and health professionals should continue to advocate for schoolwide policies and programs that support students and teachers if the goal of an integrated healthy school food environment is to be realized.     

Isocaloric meal and snack foods differentially affect eating behavior

The present study tested whether foods categorized as meals reduce subsequent intake more than isocaloric foods categorized as snacks. The study was repeated three times with variations. In each variation we manipulated whether subjects received meal or snack foods in an isocaloric load. In Variation 1, subjects consumed less following a load of meal foods than snacks. Variation 2 found this effect to be short-term, affecting food choice 20 min following a load but not 3 h later. Variation 3 demonstrated: (1) this effect occurs independent of the effects of the weights of foods, and (2) this effect varies specifically with subject perceptions of foods (i.e. whether they are part of a meal or snack). These results are discussed in terms of how cognitive representations of preload foods can influence subsequent consumption.     

Community Organization in a School Health Education Program to Reduce Sodium Consumption

This paper describes the important role of community organization in providing the enabling and reinforcing factors necessary for students to adopt dietary behavior changes recommended in a school health education program for cardiovascular health. The "Hold the Salt!" program was designed to teach sixth grade students and their families about the link between high sodium diets early in life and increased risk for cardiovascular disease, and to significantly reduce pupils' intake of high-sodium snacks. The program consists of four educational components: a classroom cafeteria curriculum unit built around a board game; parent outreach; health provider reinforcement; and community support. The program was tested in an experimental group (n = 55) of urban, black, sixth grade students, whose knowledge and behavior changes were compared to a control group (n = 23) with similar demographic statistics. Data collected before and after the school program showed a 20% increase in knowledge about sodium and health (p less than .01) and a 33% decrease in reported high-sodium snack consumption (p less than .05) in the experimental group compared to no significant knowledge or reported behavior changes in the control group. The program was piloted for two years in Baltimore City elementary schools, then adopted by the Maryland State Dept. of Education for dissemination as part of the Home Economics curriculum in all of the state's middle schools.