Nutrition education intervention improves vegetable-related attitude, self-efficacy, preference, and knowledge of fourth-grade students

BACKGROUND: Impact of a classroom‐based, standardized intervention to address limited vegetable consumption of fourth graders was assessed. METHODS: A 4‐lesson, vegetable‐focused intervention, revised from extant materials was repurposed for Pennsylvania fourth graders with lessons aligned with state academic standards. A reliability‐tested survey was modified, then examined for face and content validity and test‐retest reliability. Lessons and evaluation materials were modified through an iterative testing process with educator feedback. A nonequivalent control group design was stratified by local Supplemental Nutrition Assistance Program Education (SNAP‐Ed) partnering organizations with random assignment of participating elementary schools as control (N = 68) or intervention (N = 72) treatments. Independent t‐tests compared control and intervention group changes. A mixed effects model was created to account for classroom effects from the nested sampling method of selecting classrooms within SNAP‐Ed partnering organizations. General linear model univariate analyses of variance were conducted to assess intervention effects considering gender, and food preparation/cooking experience. RESULTS: During a 3‐ to 5‐week time frame, 57 intervention classrooms (N = 1047 students) and 51 control classrooms (N = 890) completed pre‐ and post‐testing. Intervention students improved in vegetable‐related attitude, self‐efficacy, preference, and knowledge scores (p < .001). For example, intervention vegetable preference increased 1.56 ± 5.80 points; control group mean increase was only 0.08 ± 4.82 points. Group differences in score changes were not affected by gender or interactions between gender and food preparation/cooking experience with family. CONCLUSIONS: A defined intervention delivered in a SNAP‐Ed setting can positively impact mediators associated with vegetable intake for fourth‐grade students.     

Nutrition Knowledge,Attitudes, and Fruit and Vegetable Intake as Predictors of Head Start Teachers' Classroom Mealtime Behaviors

Objective

To examine the association between nutrition knowledge, attitudes, and fruit/vegetable intake among Head Start teachers and their classroom mealtime behaviors (self-reported and observed).

The Link Between Nutrition and Physical Activity in Increasing Academic Achievement

BACKGROUND

Research demonstrates a link between decreased cognitive function in overweight school‐aged children and improved cognitive function among students with high fitness levels and children engaging in regular physical activity (PA). The purpose of this study was to examine whether regular PA and proper nutrition together had a significant effect on academic achievement.

METHODS

Using the seventh wave of the Early Childhood Longitudinal Study, Kindergarten Class 1998–99 (ECLS‐K) dataset, linear regression analysis with a Jackknife resampling correction was conducted to analyze the relationship among nutrition, PA, and academic achievement, while controlling for socioeconomic status, age, and sex. A nonactive, unhealthy nutrition group and a physically active, healthy nutrition group were compared on standardized tests of academic achievement.

RESULTS

Findings indicated that PA levels and proper nutrition significantly predicted achievement scores. Thus, the active, healthy nutrition group scored higher on reading, math, and science standardized achievement tests scores.

CONCLUSIONS

There is a strong connection between healthy nutrition and adequate PA, and the average performance within the population. Thus, results from this study suggest a supporting relationship between students' health and academic achievement. Findings also provide implications for school and district policy changes.

     

Process Evaluation of a Policy,Systems, and Environmental Change Intervention in an Urban School District

Objective

To conduct a comprehensive process evaluation of a policy, systems, and environmental (PSE) change intervention.

Academic outcomes of flipped classroom learning: a meta‐analysis

Context

The flipped classroom (FC), reversing lecture and homework elements of a course, is popular in medical education. The FC uses technology‐enhanced pre‐class learning to transmit knowledge, incorporating in‐class interaction to enhance higher cognitive learning. However, the FC model is expensive and research on its effectiveness remains inconclusive. The aim of this study was to compare the efficacy of the FC model over traditional lecture‐based (LB) learning by meta‐analysis.

Methods

We systematically searched MEDLINE, PubMed, ERIC, CINAHL, EMBASE, reference lists and Association for Medical Education in Europe (AMEE) conference books. Controlled trials comparing academic outcomes between the FC and LB approaches in higher education were considered eligible. The main findings were pooled using a random‐effects model when appropriate.

Results

Forty‐six studies (9026 participants) were included, comprising four randomised controlled trials (RCTs), 19 quasi‐experimental studies and 23 cohort studies. Study populations were health science (n = 32) and non health science (n = 14) students. The risk of bias was high (36/37 articles). Meta‐analyses revealed that the FC had significantly better outcomes than the LB method in examination scores (post‐intervention and pre–post change) and course grades, but not in objective structured clinical examination scores. Subgroup analyses showed the advantage of the FC was not observed in RCTs, non‐USA countries, nursing and other health science disciplines and earlier publication years (2013 and 2014). Cumulative analysis and meta‐regression suggested a tendency for progressively better outcomes by year. Outcome assessments rarely focused on behaviour change.

Conclusions

The FC method is associated with greater academic achievement than the LB approach for higher‐level learning outcomes, which has become more obvious in recent years. However, results should be interpreted with caution because of the high methodological diversity, statistical heterogeneity and risk of bias in the studies used. Future studies should have high methodological rigour, a standardised FC format and utilise assessment tools evaluating higher cognitive learning and behaviour change to further examine differences between FC and LB learning.     

School‐Level Practices and Perceptions Associated With Salad Bars in Schools

BACKGROUND

Salad bars are placed in schools to promote fruit and vegetable consumption among students. This study assessed differences in school nutrition practices and perceptions in schools with and without salad bars.

METHODS

Cross‐sectional surveys were completed by school nutrition managers (N = 648) in Arizona schools participating in the National School Lunch Program during 2013–2014. Mixed general estimating equation binomial regressions assessed factors related to having a salad bar after mutually adjusting for clustering within districts, school level, free/reduced rate, and respondents' time in current position.

RESULTS

On average, 61% of schools reported having a salad bar. After adjustment, school nutrition managers were significantly more likely to report having a salad bar if they served lunch by grade level (vs mixed grades), had a full‐service kitchen, and their personal perception of salad bars was positive; schools were less likely to have a salad bar if menu and food service decisions were made at the school level.

CONCLUSIONS

Several school‐level nutrition practices and perceptions were associated with having a salad bar in schools. Enhancement of these factors may facilitate having salad bars in schools.

     

Association of School‐Based Physical Activity Opportunities,Socioeconomic Status,and Third‐Grade Reading

BACKGROUND

Socioeconomic status (SES) is the most accurate predictor of academic performance in US schools. Third‐grade reading is highly predictive of high school graduation. Chronic physical activity (PA) is shown to improve cognition and academic performance. We hypothesized that school‐based PA opportunities (recess and physical education) would moderate the negative association between SES and third‐grade reading.

METHODS

Schools serving third‐grade students were surveyed (N = 1279) for minutes/week of PA opportunities. Allotted weekly PA time and achievement data from participating schools (N = 784) were recorded and analyzed. To test the moderator hypothesis, moderated multiple regression analysis was conducted.

RESULTS

The interaction of PA opportunities and SES explained a significant increase in variance in third‐grade reading (b = .053, p < .001), thus moderating the relationship between SES and third‐grade reading. Further analysis showed that schools offering greater than 225 minutes/week of PA opportunities experienced a greater (+5%) moderating effect.

CONCLUSION

School‐based PA opportunities positively moderate the relationship between SES and third‐grade reading, and lowest SES schools experience greater moderating effects. Future research should consider PA opportunities as a moderator of the SES‐academic achievement relationship, and school policy makers should consider the influence that PA opportunities have on student achievement at varying SES levels.     

Theory‐informed nutrition education curriculum Tools For Feeling Good promotes healthy eating patterns among fifth grade pupils: cross‐sectional study

Background

The eating patterns of school‐aged children rarely meet recommendations: meal frequency is irregular and the consumption of vegetables is lower and sugar‐sweetened products higher than recommended. Although school is an excellent arena for nutrition education to support pupils eating patterns, teachers usually lack efficient tools. The present study aimed to develop a curriculum for nutrition education to be used by teachers and to examine its efficacy in the school environment with respect to the eating patterns of pupils.

Methods

The curriculum was developed in collaboration with school teachers using self‐determination theory as a theoretical standpoint. The Health at Every Size concept and sensory‐based food education were utilised in the curriculum. Self‐reported questionnaires were used to assess the feasibility and impact of the curriculum. Fourteen teachers implemented the curriculum during 2012–2013 with 194 pupils aged 10–13 years (fifth and sixth grades). The control schools included 140 pupils of the same age not following the curriculum.

Results

The teachers reported that the curriculum was easy to integrate in the school environment. The fifth graders improved their breakfast frequency, increased their consumption of vegetables and reduced their consumption of ice cream, sweets and sugar‐sweetened drinks. No improvement was found in the fifth graders at the control schools. In the sixth graders, no dietary changes were detected in the intervention or control schools.

Conclusions

The pupils in the fifth grade appeared to comprise a responsive target group for nutrition education at schools. The curriculum offers a promising approach for developing healthy eating patterns among fifth graders. Collaboration with teachers in developing the curriculum likely enhanced its feasibility and teacher commitment for implementation.

     

A pilot study to examine the effects of a nutrition intervention on nutrition knowledge, behaviors, and efficacy expectations in middle school children

BACKGROUND: This was a pilot study to determine the impact of the Michigan Model (MM) Nutrition Curriculum on nutrition knowledge, efficacy expectations, and eating behaviors in middle school students. METHODS: The study was conducted in a large metropolitan setting and approved by the Institutional Review Board. The participants for this study were divided into an intervention group (n = 407) and a control group (n = 169). An MM instructor trained health teachers in the use of the curriculum, and the teacher subsequently taught the curriculum to students in the intervention group. A valid and reliable questionnaire was used to determine pre-post differences. It consisted of 3 subscales assessing eating habits, nutrition knowledge, and efficacy expectations toward healthy eating. Subscale scores were analyzed using a 2 groups (intervention vs control) x 2 times (pre vs post) analysis of variance. RESULTS: The intervention group increased their nutrition knowledge at post. There was also a significant main effect for groups in the subscales "Eating Behaviors" and "Efficacy Expectations Regarding Healthy Eating." Subsequent post hoc analysis revealed that the intervention group was significantly more likely to eat fruits and vegetables and less likely to eat junk food than the control group. Students in the intervention group also felt more confident that they could eat healthy. CONCLUSIONS: The results of this pilot study suggest that the MM Nutrition Curriculum delivered by trained professionals resulted in significant positive changes in both nutrition knowledge and behaviors in middle school children. Further research needs to be conducted to determine the long-term impact.     

Impact of a School-Based Cooking Curriculum for Fourth-Grade Students on Attitudes and Behaviors Is Influenced by Gender and Prior Cooking Experience

ObjectiveTo compare effects of the Cooking With Kids (CWK) cooking and tasting curriculum (CWK-CT) with a less-intense, tasting-only curriculum (CWK-T) and to conduct a non-treatment comparison on fourth graders' cooking self-efficacy (SE), cooking attitudes (AT), and fruit and vegetable preferences (FVP).DesignPre–post, quasi-experimental, 2 cohorts.SettingEleven low-income public schools in a Southwestern city.ParticipantsFourth-grade students, 50% female and 84% Hispanic.InterventionsSchool-based experiential nutrition education program of 5 2-hour cooking and/or 5 1-hour fruit and vegetable tasting lessons throughout the school year.Main Outcome MeasuresCooking self-efficacy, AT, and FVP were assessed with 3 tested, validated scales administered in a 37-item survey pre- and post-classroom intervention.AnalysisGeneral linear modeling with gender and prior cooking experience were fixed factors.ResultsAmong 961 students, CWK positively affected FVP, especially in CWK-CT students and males (P = .045 and .033, respectively); vegetable preference drove this outcome. Independent of treatment, students without cooking experience (61% male) had more than twice the gains in cooking self-efficacy (P = .004) and an improved AT response (P = .003).Conclusions and ImplicationsCooking With Kids increased FVP, especially with vegetables. Greatest gains in preferences and self-efficacy were seen in boys without prior cooking experience. For fourth graders, experiential nutrition education improved cognitive behaviors that may mediate healthful food choices.     

The Shaping Healthy Choices Program: Design and Implementation Methodologies for a Multicomponent,School-Based Nutrition Education Intervention

ObjectiveTo provide a framework for implementation of multicomponent, school-based nutrition interventions. This article describes the research methods for the Shaping Healthy Choices Program, a model to improve nutrition and health-related knowledge and behaviors among school-aged children.DesignLongitudinal, pretest/posttest, randomized, controlled intervention.SettingFour elementary schools in California.ParticipantsFourth-grade students at intervention (n = 252) and control (n = 238) schools and their parents and teachers. Power analyses demonstrate that a minimum of 159 students per group will be needed to achieve sufficient power. The sample size was determined using the variables of nutrition knowledge, vegetable preference score, and body mass index percentile.InterventionA multicomponent school-based nutrition education intervention over 1 academic year, followed by activities to support sustainability of the program.Main Outcome MeasuresDietary and nutrition knowledge and behavior, critical thinking skills, healthy food preferences and consumption, and physical activity will be measured using a nutrition knowledge questionnaire, a food frequency questionnaire, a vegetable preferences assessment tool, the Test of Basic Science Process Skills, digital photography of plate waste, PolarActive accelerometers, anthropometrics, a parent questionnaire, and the School and Community Actions for Nutrition survey.AnalysisEvaluation will include quantitative and qualitative measures. Quantitative data will use paired t, chi-square, and Mann-Whitney U tests and regression modeling using P = .05 to determine statistical significance.     

Employability and employment outcomes of nutrition science graduates: A qualitative exploration

Aims

This study aimed to explore experiences of employability and employment for graduates of a three-year nutrition science degree.

Methods

Qualitative narrative interviews were conducted with a maximum variation sample of 22 nutrition science graduates from one large university in Australia. All graduates (n = 126) from the initiation of the degree in 2015 to current 2021 graduates were eligible for inclusion if they had not gone on to study dietetics. The interviews elicited their stories and experiences of employability and journeys to employment post-graduation. Interviews were analysed using the framework method.

Results

Analysis of the graduate interviews identified four themes: (1) from graduation to employment; (2) there are challenges to obtaining employment; (3) curriculum can enable employability; and (4) employability resources can support career prospects. In this group, the nutrition science degree on its own was not deemed sufficient to land employment in a desired nutrition-related field. The process of obtaining employment was supported by work experience, social networks, interpersonal skills, and a willingness to relocate.

Conclusion

Building employability skills in the curriculum through the development of professional social networks and a professional identity may be important in improving the employability of nutrition science graduates.     

Effectiveness Evaluation of It&#x27;s Your Game: Keep It Real,a Middle School HIV/Sexually Transmitted Infection/Pregnancy Prevention Program

Purpose

This study assessed the effectiveness of the HIV/sexually transmitted infection/pregnancy prevention program, It's Your Game: Keep It Real (IYG).

Food,Health, & Choices: Curriculum and Wellness Interventions to Decrease Childhood Obesity in Fifth-Graders

Objective

To evaluate Food, Health, & Choices, two 10-month interventions.

Healthy Schoolhouse 2.0 Health Promotion Intervention to Reduce Childhood Obesity in Washington,DC: A Feasibility Study

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.     

Effects of Student Perceptions of Teachers’ Motivational Behavior on Reading,English, and Mathematics Achievement: The Mediating Role of Domain Specific Self-Efficacy and Intrinsic Motivation

Background

In the Korean educational system, academic achievement is one of the crucial factors in assessing a student’s academic ability for postsecondary education. Thus, many researchers have been studying ways to improve students’ academic achievement.

Objective

The purpose of this study was to examine the relationship between students’ perceptions of teachers’ motivational behavior and students’ academic achievement, as well as the mediating effects of students’ motivation and self-efficacy on this relation.

Methods

Using the Korean Education Longitudinal Study data, we employed structural equation modeling to assess the impacts of different variables (i.e., students’ perceptions of their teachers’ motivational behavior, self-efficacy, and intrinsic motivation) on the academic achievements of 6227 middle school students’. We further examined whether these relationships differed depending on the school subject, specifically, reading, English, and mathematics.

Results

The results indicate that students’ self-efficacy and intrinsic motivation mediated the relation between students’ perceptions of teachers’ motivational behavior and students’ academic achievements in all three subjects.

Conclusion

This study suggests that students’ self-efficacy and intrinsic motivation increase when students perceive their teachers’ motivational behaviors positively, which ultimately improves their performance in reading, English, and mathematics.

     

Cross‐Sectional Study of U.S. Interns' Perceptions of Clinical Nutrition Education

Background. Medical students have historically perceived a lack of training in clinical nutrition. Rapid advances in medical science have compelled significant changes in medical education pedagogy. It is unclear what effect this has had on student's perceptions. Objective. To assess interns' perception of clinical nutrition education during medical school. Design. A cross‐sectional survey of medical, surgical, and obstetric interns from 6 academic hospitals across the United States during the middle of their first year in November of 2010 (n = 289). Bivariate analysis and logistic regression was used to describe interns' perceptions and evaluate for factors that determined these perceptions. Results. A total of 122 interns responded to the survey, for a response rate of 42%. These interns represented 72 different medical schools. Only 29% of interns reported they had been sufficiently trained in nutrition. On average, interns who reported being prepared reported a mean of 4 ± 3.4 weeks of training during medical school, while unprepared interns reported a mean of 2 ± 2.6 weeks of training (P = .02). Interns with prior graduate training in nutrition (n = 18) almost exclusively reported that medical school training was insufficient (94%, P = .02). After adjusting for age, gender, internship, undergraduate training, and being a foreign graduate, only the number of weeks of training remained significantly associated with perceived preparation (P = .03). Conclusion. Most interns in medicine, surgery, and obstetrics feel unprepared to handle cases requiring knowledge of clinical nutrition. Interns feel that medical school is not adequately preparing them for the needs of clinical practice.     

Health service nutrition practices and associations with clinical outcomes in patients undergoing resection for upper gastrointestinal cancer: Results from the multi-centre NOURISH point prevalence study

Background

The present study aimed to investigate health service nutrition practices of sites providing care to patients undergoing surgery for upper gastrointestinal cancer within Australia, including the provision of perioperative nutrition support services and outpatient clinics, as well as the use of evidence-based nutrition care pathways/protocols. Secondary aims were to investigate associations between the use of a nutrition care pathway/protocol and patient outcomes.

Methods

Principal investigator dietitians for the sites (n = 27) participating in the NOURISH point prevalence study participated in a purpose-built site-specific survey regarding perioperative nutrition practices and protocols. Data from the 200 patients who participated in the study (including malnutrition prevalence, preoperative weight loss and receipt of dietetics intervention, intraoperative feeding tube insertions, provision of nutrition support day 1 post surgery, length of stay, and complications) were investigated using multivariate analysis to determine associations with the sites' use of a nutrition care pathway/protocol.

Results

The majority of sites (>92%) reported having dietetics services available in chemotherapy/radiotherapy. Eighty-five percent of sites reported having some form of outpatient clinic service; however, a routine service was only available at 26% of sites preoperatively and 37% postoperatively. Most preoperative services were embedded into surgical/oncology clinics (70%); however, this was reported for only 44% of postoperative clinics. Only 44% had a nutrition care pathway/protocol in place. The use of a nutrition care pathway/protocol was associated with lower rates of malnutrition, as well as higher rates of preoperative dietetics intervention, intraoperative feeding tube insertions, and European Society of Clinical Nutrition and Metabolism (ESPEN) guideline compliant care day 1 post surgery.

Conclusions

The results of the present study demonstrate varied perioperative outpatient nutrition services in this high-risk patient group. The use of nutrition care pathways and protocols was associated with improved patient outcomes.

     

Dietitians' Perspectives on Teaching Nutrition to Medical Students

Objectives: The provision of nutrition care by health professionals can facilitate improved patient nutrition behaviors. Some education institutions include nutrition in their medical curriculum; however, doctors and medical students continue to lack competence in providing nutrition care. Dietitians are increasingly teaching nutrition to medical students, yet evidence on the topic remains anecdotal. It is important to understand the experiences of these dietitians to support improvements in undergraduate medical nutrition education. The aim of this study was to explore dietitians' perspectives of teaching nutrition to medical students.

Methods: A qualitative study was conducted in collaboration with the Need for Nutrition Education/Innovation Programme (NNEdPro). Twenty-four dietitians who had provided nutrition education to medical students participated in individual semistructured interviews. Participants were from Australia (n = 5), New Zealand (n = 1), the United States (n = 6), Canada (n = 5), the United Kingdom (n = 5), Germany (n = 1), and Finland (n = 1). Data analysis was conducted using a constant comparative approach to thematic analysis.

Results: The dietitians expressed confidence in their ability to teach medical students and believed that they were the most appropriate professionals to administer the education. However, they were not confident that medical students graduate with sufficient nutrition competence and attributed this to poor curriculum planning for nutrition. Dietitians had access to useful resources and tools to support education, with opportunity to contribute further to integration of nutrition throughout medical curricula.

Conclusion: This study suggests that dietitians are likely appropriate nutrition teachers in medical education. However, optimizing dietitians' role requires their further involvement in curriculum planning and development. Including dietitians as members of medical faculty would facilitate their input on nutrition throughout the curriculum, which could enhance the nutrition education of medical students.