Assessing the impact of the primary school-based nutrition intervention Petits cuistots--parents en réseaux

OBJECTIVES: This study sought to provide an intermediate impact assessment of the nutrition intervention Petits cuistots--parents en réseaux (Little Cooks--Parental Networks) on: 1) knowledge, attitude, capacity and experience with regard to nutrition, diet and cookery, and 2) parental and/or family participation in school. PARTICIPANTS: A total of 388 students from grades 5 (participants) and 6 (non-participants). SETTING: The evaluation of the nutrition intervention took place in each of the seven participating elementary schools, all of which are located in Montreal's most disadvantaged neighbourhoods. INTERVENTION: The program component "Little Cooks" is a nutrition workshop run by community dieticians. Each of the eight annual workshops features a food item and nutrition theme with a recipe for a collective food preparation and tasting experience. Classroom teachers participate to provide classroom management and program support. The "Parental Networks" component of the program invites parents to assist with the nutrition workshop, and offers additional parent and family activities which link to nutrition workshop themes (e.g., dinners or visits to local food producers). OUTCOME: The program had some impact on knowledge of the nutrient content of food, food produce and cooking; attitude and experience with tasting of new or less common foods; and perceived cooking capacity. Families with students participating in the program participated more in school activities than did families of students not in the program. CONCLUSIONS: Our assessment indicates a potential program impact upon several intermediate impact measures, and in so doing highlights a promising nutrition capacity-promoting intervention.     

Men can cook! Development, implementation, and evaluation of a senior men's cooking group

This study reports on the process and outcome evaluation of a community-based nutrition and cooking education program for senior men. As part of Evergreen Action Nutrition, a community-organized, nutrition education program, a registered dietitian led a Men's Cooking Group in a seniors' recreation facility. Written questionnaires were completed by most of the men (n = 19) at the beginning and end of the evaluation year, and ten men participated in personal key informant interviews. The majority of participants gained cooking confidence, increased their cooking activities at home, developed healthy cooking skills, and improved cooking variety through the program. The men also identified social benefits to the program. Overall, this preliminary evaluation suggests that community-based nutrition and cooking education for older men is a beneficial nutrition education activity.     

WA health practitioners and cooking: How well do they mix?

Aim: The aim of the present study was to assess the views and experiences of WA practitioners on the use of cooking as a public health nutrition intervention. Methods: A 39‐point online questionnaire was constructed using Survey Monkey. The questionnaire was distributed via email distribution lists targeting practitioners working in public health nutrition. Questions were focused around four objectives relating to: the value of cooking skills in public health, practitioner cooking skills and training, practitioner views on cooking as a health intervention and practitioner experiences in conducting cooking demonstrations. Results: A total of 84 practitioners completed the questionnaire, of which over half (58%) were employed in dietetic specific positions at the time of the survey. There was overwhelming agreement that cooking skills are an important factor in the prevention of nutrition‐related disease, and that cooking skill interventions have the potential to change dietary intakes. However, only one quarter of practitioners indicated that cooking skill interventions were a significant part of their current role. Over half (58%) of the practitioners surveyed had either conducted or assisted in a cooking demonstration or cooking class in the last 12 months. Conclusions: WA practitioners place a high value on the use of cooking as a public health nutrition intervention. Practitioners felt they have good knowledge and skills in cooking but indicated the need to know more about conducting cooking skill interventions. The findings suggest the need to improve outcome evaluation as a component of cooking skill interventions to assess long‐term behaviour change.     

The impact of an intervention taught by trained teachers on childhood overweight

The purpose of this study was to assess the effects of a six-months' nutrition program, delivered and taught by classroom teachers with in-service nutrition training, on the prevention of overweight and obesity among children in grades 1 to 4. In this randomized trial, four hundred and sixty four children from seven elementary schools were allocated to a nutrition educational program delivered by their own teachers. Intervened teachers had 12 sessions of three hours each with the researchers throughout six months, according to the topics nutrition and healthy eating, the importance of drinking water and healthy cooking activities. After each session, teachers were encouraged to develop activities in class focused on the learned topics. Sociodemographic, anthropometric, dietary, and physical activity assessments were performed at baseline and at the end of the intervention. In the intervention group the increase in Body Mass Index (BMI) z-score was significantly lower than in the control group (p = 0.009); fewer proportion of children became overweight in the intervened group compared with the control (5.6% vs. 18.4%; p = 0.037). Our study provides further support to decrease the overweight epidemic, involving classroom teachers in a training program and making them dedicated interventionists.     

Impact of a School-Based Gardening,Cooking, Nutrition Intervention on Diet Intake and Quality: The TX Sprouts Randomized Controlled Trial

School gardens have become common school-based health promotion strategies to enhance dietary behaviors in the United States. The goal of this study was to examine the effects of TX Sprouts, a one-year school-based gardening, cooking, and nutrition cluster randomized controlled trial, on students’ dietary intake and quality. Eight schools were randomly assigned to the TX Sprouts intervention and eight schools to control (i.e., delayed intervention) over three years (2016–2019). The intervention arm received: formation and training of Garden Leadership Committees; a 0.25-acre outdoor teaching garden; 18 student lessons including gardening, nutrition, and cooking activities, taught weekly in the teaching garden during school hours; and nine parent lessons, taught monthly. Dietary intake data via two 24 h dietary recalls (24 hDR) were collected on a random subsample (n = 468). Dietary quality was calculated using the Healthy Eating Index 2015 (HEI-2015). The intervention group compared to control resulted in a modest increase in protein intake as a percentage of total energy (0.4% vs. −0.3%, p = 0.021) and in HEI-2015 total vegetables component scores (+4% vs. −2%, p = 0.003). When stratified by ethnicity/race, non-Hispanic children had a significant increase in HEI-2015 total vegetable scores in the intervention group compared to the control group (+4% vs. −8%, p = 0.026). Both the intervention and control groups increased added sugar intake; however, to a lesser extent within the intervention group (0.3 vs. 2.6 g/day, p = 0.050). School-based gardening, cooking, and nutrition interventions can result in significant improvements in dietary intake. Further research on ways to scale and sustain nutrition education programs in schools is warranted. The trial is registered at ClinicalTrials.gov ({"type":"clinical-trial","attrs":{"text":"NCT02668744","term_id":"NCT02668744"}}NCT02668744).     

Growing community: the impact of the Stephanie Alexander Kitchen Garden Program on the social and learning environment in primary schools

This article presents results from a mixed-method evaluation of a structured cooking and gardening program in Australian primary schools, focusing on program impacts on the social and learning environment of the school. In particular, we address the Stephanie Alexander Kitchen Garden Program objective of providing a pleasurable experience that has a positive impact on student engagement, social connections, and confidence within and beyond the school gates. Primary evidence for the research question came from qualitative data collected from students, parents, teachers, volunteers, school principals, and specialist staff through interviews, focus groups, and participant observations. This was supported by analyses of quantitative data on child quality of life, cooperative behaviors, teacher perceptions of the school environment, and school-level educational outcome and absenteeism data. Results showed that some of the program attributes valued most highly by study participants included increased student engagement and confidence, opportunities for experiential and integrated learning, teamwork, building social skills, and connections and links between schools and their communities. In this analysis, quantitative findings failed to support findings from the primary analysis. Limitations as well as benefits of a mixed-methods approach to evaluation of complex community interventions are discussed.     

Outcomes from a school-based nutrition education program alternating special resource teachers and classroom teachers

This study modified a successful nutrition program to improve its transferability and potential for institutionalization. Specific aims were to determine: 1) if 16 nutrition lessons taught alternately by special resource teachers (SRT) and classroom teachers, could produce outcomes equivalent to 24 SRT lessons; and 2) teachers' reactions to the program. The quasi-experimental design used classrooms (19 treatment and 19 comparison) in matched schools. Surveys and plate waste measured children's outcomes, and classroom teachers were observed and interviewed. Treatment students showed greater knowledge and self-efficacy scores and consumed 0.36 more servings of fruits and vegetables at lunch. Behavioral differences between groups were greater when SRTs provided all instruction. Teachers supported the program and anticipated teaching more nutrition on their own, but noted serious structural barriers. Findings support the need for long-term contact to induce behavior change and the advantage of using teachers specifically trained in nutrition and experiential education.     

Contribution of regional networks to the nutrition education of physicians.

To describe the activities of existing nutrition education consortia and their efforts to support nutrition education in medical schools and residency programs.

In an effort to improve nutrition education at member schools, regional consortia have: organized conferences and courses for faculty, fellows, residents, and students, developed curricula, fostered networking among faculty with shared interests, provided awards for excellence in teaching and research to faculty and students, collaborated with dieticians and non-physician faculty, prepared protocols for evaluation including formal tests, feedback techniques and preparation of Observed Structured Clinical Evaluation (OSCE). The structure and activities of two existing regional centers are described.

Goals and objectives for nutrition education have been established, but there remains a significant need for improvements in outcome measures.

Regional networks have been active in supporting nutrition education in those medical schools which have participated, and they have made contributions to the literature on nutrition education for medical students. A specific advantage of the regional center concept is the ability to pool the resources of many schools, each with a limited number of faculty interested and knowledgeable in nutrition.

The activities of the two Regional Centers suggest that medical school nutrition education programs can gather strength beyond that available at any single institution by forming a regional network. Collaboration of regional networks might offer a means to significantly improve medical student nutrition education. Future efforts, however, require closer attention to the need for evaluation of effectiveness.     

Evaluation of the Florida coordinated school health program pilot schools project

ABSTRACT: The Florida Department of Education, with CDC funding, designed the Florida Coordinated School Health Program Pilot Schools Project (PSP) to encourage innovative approaches to promote coordinated school health programs (CSHP) in Florida schools. Each of eight pilot schools received $15,000 in project funding, three years of technical assistance including on-site and off-site assistance, a project office resource center, mailings of resource materials, needs assessment and evaluation assistance, and three PSP Summer Institutes. Project evaluators created a context evaluation, approaching each school independently as a “case study” to measure the school's progress in meeting goals established at baseline. Data were collected using the How Healthy is Your School? needs assessment instrument, a School Health Portfolio constructed by each school team, a Pilot Schools Project Team Member Survey instrument, midcourse team interviews, final team interviews, and performance indicator data obtained from pilot and control schools. The PSP posed two fundamental questions: “Can financial resources, professional training, and technical assistance enable individual schools to create and sustain a coordinated school health program?” and “What outcomes reasonably can one expect from a coordinated school health program, assuming programs receive adequate support over time?” First, activities at the eight schools confirmed that a coordinated school health programs can be established and sustained. Program strength and sustainability depend on long-term resources, qualified personnel, and administrative support. Second, though coordinated school health programs may improve school performance indicators, the PSP yielded insufficient evidence to support that belief. Future projects should include robust measurement and evaluation designs, thereby producing conclusive evidence about the influence of a coordinated school health program on such outcomes.     

The child development milestone chart ‐‐ An approach to low cost programming in Indonesia

As nutrition, growth monitoring and immunization programs have dramatically increased the rates of child survival throughout the developing world there has been a ground swell of interest in going beyond survival to increase children's chances for optimal development. Past experience has shown that when developmental monitoring and stimulation programs are added to health and nutrition programs the rates of both physical and mental development may be improved. As a step toward a low cost developmental monitoring and early intervention program, a simple chart was developed in Indonesia. Based on the familiar growth monitoring chart and composed of items which are most predictive of long term developmental outcomes, the chart is designed to be used with existing nutrition or mother‐child welfare programs. For each developmental milestone in the first thirty‐six months of life the chart suggests simple stimulation activities which strengthen that milestone or encourage the child to achieve the next skill. The chart also teaches infant feeding and weaning practices supportive of child growth. A reliability and validity study conducted with a sample of 108 Indonesian children from birth to thirty‐six months of age established a tester‐observer reliability of .87 and a correlation with the Bayley Scales of Infant Development of .91. The use of charts of this type to educate parents, community workers and program planners about the need for child development interventions is discussed.     

LA Sprouts: a gardening, nutrition, and cooking intervention for Latino youth improves diet and reduces obesity

Evidence demonstrates that a gardening and nutrition intervention improves dietary intake in children, although no study has evaluated the effect of this type of intervention on obesity measures. The objective of this pilot study was to develop and test the effects of a 12-week, after-school gardening, nutrition, and cooking program (called LA Sprouts) on dietary intake and obesity risk in Latino fourth- and fifth-grade students in Los Angeles, CA. One hundred four primarily Latino children (mean age 9.8±0.7 years), 52% boys and 59% overweight, completed the program (n=70 controls, n=34 LA Sprouts participants). Weight, height, body mass index, waist circumference, body fat (via bioelectrical impendence), blood pressure, and dietary intake (via food frequency screener) were obtained at baseline and postintervention. LA Sprouts participants received weekly 90-minute, culturally tailored, interactive classes for 12 consecutive weeks during spring 2010 at a nearby community garden, whereas control participants received an abbreviated delayed intervention. Compared to subjects in the control group, LA Sprouts participants had increased dietary fiber intake (+22% vs −12%; P=0.04) and decreased diastolic blood pressure (−5% vs −3%; P=0.04). For the overweight subsample, LA Sprouts participants had a significant change in dietary fiber intake (0% vs −29%; P=0.01), reduction in body mass index (−1% vs +1%; P=0.04) and less weight gain (+1% vs +4%; P=0.03) compared to those in the control group. We conclude that a gardening, nutrition, and cooking intervention is a promising approach to improve dietary intake and attenuate weight gain in Latino children, particularly in those who are overweight.     

A national snapshot of local school wellness policies

Background: The federal mandate for local wellness policies (LWP) provides an unprecedented opportunity to improve schools’ practices that support student health, which, in turn, supports academic achievement. With a full agenda and budget challenges, districts need resources and support to turn policies into sustainable practices. The purpose of this study was to assess district policy goals and compare them to the federal mandate and benchmarks of best practices. It is hoped that this information will lead to development of specific assistance in the areas of policy implementation, evaluation, and revision. Methods: Action for Healthy Kids (AFHK) collected a convenience sample of 256 approved LWP. The sample included districts with small, medium, and large student enrollment from every state (except Hawaii). Policies were compared to federal requirements and the AFHK Wellness Policy Fundamentals, a tool which documents best practices for nutrition and physical activity in schools. Results: Sixty‐eight percent of policies sampled were consistent with the mandates set forth in the law. Thirty‐two percent did not address 1 or more goal areas set by the federal mandate with 15% not addressing goals for evaluation and monitoring. None of the policies addressed all components of AFHK’s Fundamentals. Less than 1% addressed all 4 of the evaluation components. Teacher requirements and training for nutrition and physical education were addressed by 43% and 45% of policies, respectively. Conclusions: This study’s findings indicate schools will need assistance to meet each of the mandates provided by the federal mandate. Areas lacking attention in policies, yet essential for sustaining wellness practices, include assurances of qualified staff, opportunities for staff development, and implementation, evaluation, and revision of the policy.     

The social dimensions of therapeutic horticulture

Harnessing nature to promote mental health is increasingly seen as a sustainable solution to healthcare across the industrialised world. The benefits of these approaches to well‐being include reduced symptoms of anxiety, depression and improved social functioning. Many studies assume that contact with nature is the main therapeutic component of these interventions yet ‘green care’ programmes typically include activities not based on ‘nature’ that may contribute to positive outcomes. This study explored the views of service users participating in a Therapeutic Horticultural programme on what factors promoted their engagement in the project, to identify variables other than ‘nature’ that may be responsible for successful engagement in these programmes. A secondary aim was to assess the significance ‘nature’ plays including, for example whether a prior interest in horticultural‐related activities, such as gardening, is significant. Two focus groups were held with mental health service users (n = 15) attending a gardening project in south‐east England. Findings revealed that the social element of the project was the key facilitator to engagement; the flexible structure of the gardening project was also significant and allowed service users to feel empowered. ‘Nature’ evoked a sense of calm and provided participants with a non‐threatening space that was engaging.     

Effect of nutrition changes on foods selected by students in a middle school-based diabetes prevention intervention program: the HEALTHY experience

BACKGOUND: The HEALTHY primary prevention trial developed an integrated multicomponent intervention program to moderate risk factors for type 2 diabetes in middle schools. The nutrition component aimed to improve the quality of foods and beverages served to students. Changes in the School Breakfast Program (SBP), National School Lunch Program (NSLP), and à la carte venues are compared to the experience of control schools. METHODS: The intervention was implemented in 21 middle schools from winter 2007 through spring 2009 (following a cohort of students from sixth through eighth grades); 21 schools acted as observed controls. The nutrition component targeted school food service environmental change. Data identifying foods and nutrients served (selected by students for consumption) were collected over a 20‐day period at baseline and end of study. Analysis compared end of study values for intervention versus control schools. RESULTS: Intervention schools more successfully limited dessert and snack food portion size in NSLP and à la carte and lowered fat content of foods served. Servings of high‐fiber grain‐based foods and/or legumes were improved in SBP but not NSLP. Intervention and control schools eliminated >1% fat milk and added‐sugar beverages in SBP, but intervention schools were more successful in NSLP and à la carte. CONCLUSION: The HEALTHY program demonstrated significant changes in the nutritional quality of foods and beverages served in the SBP, NSLP, and à la carte venues, as part of an effort to decrease childhood obesity and support beneficial effects in some secondary HEALTHY study outcomes.     

What's cooking for dietetics? A review of the literature

Aim: There are issues surrounding the apparent decline and devaluing of cooking skills in the population, potential health impacts and the role of dietitians. The present paper aims to outline several arguments and raise questions on the relationship between cooking and dietetics. Methods: Evidence from dietetics and nutrition journals and other sources is used to develop positions for dietetics and its relationship to cooking and cooking skills Results: The historical relationship between dietetics and home economics has seen dietetics professionally distance itself by its scientific education on food and nutrition, rather than actual involvement with cooking. In pursuing this rational scientific approach there are concerns that dietitians have inadvertently supported the growth of the functional and convenience food market, particularly given the demise of home economics as a skill-based curricula in schools in several states. There is a need to consider what role cooking skills could have in dietetics training as a professional competency for practice, particularly for public health interventions. This is in the light of Commonwealth government funding that is legitimising cooking skill interventions as a policy response to obesity. There may be a role for dietitians to develop partnerships and train a new professional category or paraprofessionals and/or peer educators to deliver cooking skill interventions Conclusion: There is a need for research on dietitian's views and use of cooking skill interventions. This would help answer whether we should consider cooking and cooking skills as part of our professional practice and whether cooking should be a dietetic competency.     

Characteristics of older adult learners: a guide for dietetics practitioners

Characteristics of older adult learners are described and related to program development, implementation, and evaluation. The framework for designing learning experiences consists of four steps: assessment of the needs of the learner; development of learning objectives and determination of content; selection and implementation of appropriate learning activities; and evaluation of the results of learning. Four major assumptions about older adult learners are discussed based on a model designed specifically for adult learners. Active involvement through self-administered questionnaires, interviews, or focus groups helps ensure that nutrition education programs are responsive to the older adult's needs. Age-related changes (ie, in senses of sight and hearing, reaction time, and memory) and psychologic and social changes (ie, loneliness, depression, illness, financial difficulties, or loss of a loved one) may occur in many older learners and need to be considered when selecting appropriate learning activities. A single approach to nutrition education is unlikely to meet the needs and preferences of all older adults. To maximize their effect as educators, dietetics practitioners need to adjust their teaching styles and program development strategies to better fit the characteristics of older adult learners.     

Design and Implementation of a 5-Year School-Based Nutrition Education Intervention

ObjectiveTo describe the research methods of a multicomponent nutrition education program empowering teachers to improve nutrition literacy and prevent obesity among elementary school students.DesignProspective 5-year study following a pre-post intervention design.SettingFour elementary schools in a high-needs area in Washington, DC: 2 intervention and 2 comparison schools.ParticipantsApproximately 100 teachers (25/school) and 800 students (200/school) enrolled over the study period.InterventionHealthy Schoolhouse 2.0 will engage teachers as agents of change by designing, implementing, and evaluating a structured professional development program to support the integration of nutrition concepts in the classroom.Main Outcome MeasuresChange in pre-post survey assessment of students’ nutrition literacy, attitudes, and intent; change in teachers’ self-efficacy toward teaching nutrition; fruit and vegetable consumption data collected 6 times/y in the cafeteria.AnalysisProcess evaluation throughout the study to document implementation and challenges. Multilevel mixed modeling will be used to determine the impact of the intervention.