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A Multicomponent, School-Based Intervention, the Shaping Healthy Choices Program, Improves Nutrition-Related Outcomes

Published:February 08, 2017DOI:https://doi.org/10.1016/j.jneb.2016.12.007

      Abstract

      Objective

      To evaluate the effectiveness of the Shaping Healthy Choices Program (SHCP).

      Design

      A clustered, randomized, controlled intervention lasting 1 school year.

      Setting

      Schools in northern and central California.

      Participants

      Fourth-graders (aged 9–10 years) at 2 control schools (n = 179) and 2 intervention schools (n = 230).

      Intervention

      Garden-enhanced education, family, and community partnerships; increased regionally procured produce in the lunchroom; and school-site wellness committees.

      Main Outcome Measures

      Changes in body mass index (BMI) percentiles/Z-scores; nutrition knowledge, science process skills, and vegetable identification and preferences; and reported fruit and vegetable intake.

      Analysis

      Student t test, chi-square, ANOVA of change, and multilevel regression mixed model to evaluate change in outcomes with school as a random effect to account for cluster design effects. Statistical significance was set at P < .05.

      Results

      There was a greater improvement in BMI percentile (−6.08; P < 0.01), BMI Z-score (−0.28; P < .001), and waist-to-height ratio (−0.02; P < .001) in the intervention compared with the control schools.

      Conclusions and Implications

      The SHCP resulted in improvements in nutrition knowledge, vegetable identification, and a significant decrease in BMI percentiles. This supports the concept that the SHCP can be used to improve the health of upper elementary school students.

      Key Words

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      References

        • Han J.C.
        • Lawlor D.A.
        • Kimm S.Y.
        Childhood obesity.
        Lancet. 2010; 375: 1737-1748
        • Bell C.G.
        • Walley A.J.
        • Froguel P.
        The genetics of human obesity.
        Nat Rev Genet. 2005; 6: 221-234
        • Koletzko B.
        • von Kries R.
        • Closa R.
        • et al.
        Can infant feeding choices modulate later obesity risk?.
        Am J Clin Nutr. 2009; 89: 1502S-1508S
        • Sleddens E.F.
        • Gerards S.M.
        • Thijs C.
        • de Vries N.K.
        • Kremers S.P.
        General parenting, childhood overweight and obesity-inducing behaviors: a review.
        Int J Pediatr Obes. 2011; 6: e12-e27
        • Briggs M.
        • Mueller C.G.
        • Fleischhacker S.
        • American Dietetic Association
        • School Nutrition Association
        • Society for Nutrition Education
        Position of the American Dietetic Association, School Nutrition Association, and Society for Nutrition Education: comprehensive school nutrition services.
        J Am Diet Assoc. 2010; 110: 1738-1749
        • Morris J.L.
        • Zidenberg-Cherr S.
        Garden-enhanced nutrition curriculum improves fourth-grade school children’s knowledge of nutrition and preferences for some vegetables.
        J Am Diet Assoc. 2002; 102: 91-93
        • McAleese J.D.
        • Rankin L.L.
        Garden-based nutrition education affects fruit and vegetable consumption in sixth-grade adolescents.
        J Am Diet Assoc. 2007; 107: 662-665
        • Morgan P.J.
        • Warren J.M.
        • Lubans D.R.
        • Saunders K.L.
        • Quick G.I.
        • Collins C.E.
        The impact of nutrition education with and without a school garden on knowledge, vegetable intake and preferences and quality of school life among primary-school students.
        Public Health Nutr. 2010; 13: 1931-1940
        • Parmer S.M.
        • Salisbury-Glennon J.
        • Shannon D.
        • Struempler B.
        School gardens: an experiential learning approach for a nutrition education program to increase fruit and vegetable knowledge, preference, and consumption among second-grade students.
        J Nutr Educ Behav. 2009; 41: 212-217
        • Ratcliffe M.M.
        • Merrigan K.A.
        • Rogers B.L.
        • Goldberg J.P.
        The effects of school garden experiences on middle school-aged students‘ knowledge, attitudes, and behaviors associated with vegetable consumption.
        Health Promot Pract. 2011; 12: 36-43
        • Jaenke R.L.
        • Collins C.E.
        • Morgan P.J.
        • Lubans D.R.
        • Saunders K.L.
        • Warren J.M.
        The impact of a school garden and cooking program on boys’ and girls‘ fruit and vegetable preferences, taste rating, and intake.
        Health Educ Behav. 2012; 39: 131-141
        • Reverdy C.
        • Chesnel F.
        • Schlich P.
        • Koster E.P.
        • Lange C.
        Effect of sensory education on willingness to taste novel food in children.
        Appetite. 2008; 51: 156-165
        • Schindler J.M.
        • Corbett D.
        • Forestell C.A.
        Assessing the effect of food exposure on children’s identification and acceptance of fruit and vegetables.
        Eat Behav. 2013; 14: 53-56
        • Resnicow K.
        • Davis-Hearn M.
        • Smith M.
        • et al.
        Social-cognitive predictors of fruit and vegetable intake in children.
        Health Psychol. 1997; 16: 272-276
        • Story M.
        • Mays R.W.
        • Bishop D.B.
        • et al.
        5-A-Day Power Plus: process evaluation of a multicomponent elementary school program to increase fruit and vegetable consumption.
        Health Educ Behav. 2000; 27: 187-200
        • Geller K.S.
        • Dzewaltowski D.A.
        Longitudinal and cross-sectional influences on youth fruit and vegetable consumption.
        Nutr Rev. 2009; 67: 65-76
        • American Dietetic Association
        Position of the American Dietetic Association: individual-, family-, school-, and community-based interventions for pediatric overweight.
        J Am Diet Assoc. 2006; 106: 925-945
        • US Department of Health and Human Services
        Dietary Guidelines for Americans 2015–2020.
        US Dept of Health and Human Services, Washington, DC2016
        • Hoelscher D.M.
        • Kirk S.
        • Ritchie L.
        • Cunningham-Sabo L.
        Position of the Academy of Nutrition and Dietetics: interventions for the prevention and treatment of pediatric overweight and obesity.
        J Acad Nutr Diet. 2013; 113: 1375-1394
        • Centers for Disease Control and Prevention
        Whole School, Whole Community, Whole Child: A Collaborative Approach to Learning and Health.
        Centers for Disease Control and Prevention, Alexandria, VA2014
        • Contento I.
        Review of nutrition education research in the Journal of Nutrition Education and Behavior, 1998 to 2007.
        J Nutr Educ Behav. 2008; 40: 331-340
        • Katz D.L.
        • O'Connell M.
        • Njike V.Y.
        • Yeh M.C.
        • Nawaz H.
        Strategies for the prevention and control of obesity in the school setting: systematic review and meta-analysis.
        Int J Obes. 2008; 32: 1780-1789
        • Brown T.
        • Summerbell C.
        Systematic review of school-based interventions that focus on changing dietary intake and physical activity levels to prevent childhood obesity: an update to the obesity guidance produced by the National Institute for Health and Clinical Excellence.
        Obes Rev. 2009; 10: 110-141
        • Shaya F.T.
        • Flores D.
        • Gbarayor C.M.
        • Wang J.
        School-based obesity interventions: a literature review.
        J Sch Health. 2008; 78: 189-196
        • Khambalia A.Z.
        • Dickinson S.
        • Hardy L.L.
        • Gill T.
        • Baur L.A.
        A synthesis of existing systematic reviews and meta-analyses of school-based behavioural interventions for controlling and preventing obesity.
        Obes Rev. 2012; 13: 214-233
        • Summerbell C.D.
        • Waters E.
        • Edmunds L.D.
        • Kelly S.
        • Brown T.
        • Campbell K.J.
        Interventions for preventing obesity in children.
        Cochrane Database Syst Rev. 2005; : CD001871
        • Foltz J.L.
        • May A.L.
        • Belay B.
        • Nihiser A.J.
        • Dooyema C.A.
        • Blanck H.M.
        Population-level intervention strategies and examples for obesity prevention in children.
        Annu Rev Nutr. 2012; 32: 391-415
        • Bandura A.
        Social foundations of Thought and Action: A Social Cognitive Theory.
        Prentice Hall, Englewood Cliffs, NJ1986
        • US Department of Health and Human Services
        Dietary Guidelines for Americans, 2010.
        US Dept of Health and Human Services, Washington, DC2010
        • Scherr R.E.
        • Linnell J.D.
        • Smith M.H.
        • et al.
        The Shaping Healthy Choices Program: design and implementation methodologies for a multicomponent, school-based nutrition education intervention.
        J Nutr Educ Behav. 2014; 46: e13-e21
        • Linnell J.D.
        • Smith M.H.
        • Zidenberg-Cherr S.
        Discovering Healthy Choices.
        University of California, Davis, Davis, CA2015
        • Linnell J.D.
        • Zidenberg-Cherr S.
        • Briggs M.
        • et al.
        Using a systematic approach and theoretical framework to design a curriculum for the Shaping Healthy Choices Program.
        J Nutr Educ Behav. 2016; 48: 60-69.e1
        • Brian K.
        • Linnell J.D.
        • Zidenberg-Cherr S.
        Cooking Up Healthy Choices.
        University of California, Davis, Davis, CA2015
        • Nguyen L.M.
        • Scherr R.E.
        • Linnell J.D.
        • et al.
        Evaluating the relationship between plasma and skin carotenoids and reported dietary intake in elementary school children to assess fruit and vegetable intake.
        Arch Biochem Biophys. 2015; 572: 73-80
        • Adair J.G.
        The Hawthorne effect: a reconsideration of the methodological artifact.
        J Appl Psychol. 1984; 69: 334-345
        • Akaike H.
        Akaike’s Information Criterion.
        in: Lovric M. International Encyclopedia of Statistical Science. Springer, Berlin, Germany2011 (25–25)
        • Hoelscher D.M.
        • Springer A.E.
        • Ranjit N.
        • et al.
        Reductions in child obesity among disadvantaged school children with community involvement: the Travis County CATCH Trial.
        Obesity (Silver Spring). 2010; 18: S36-S44
        • Birnbaum A.S.
        • Lytle L.A.
        • Story M.
        • Perry C.L.
        • Murray D.M.
        Are differences in exposure to a multicomponent school-based intervention associated with varying dietary outcomes in adolescents?.
        Health Educ Behav. 2002; 29: 427-443
        • Prelip M.
        • Kinsler J.
        • Thai C.L.
        • Erausquin J.T.
        • Slusser W.
        Evaluation of a school-based multicomponent nutrition education program to improve young children’s fruit and vegetable consumption.
        J Nutr Educ Behav. 2012; 44: 310-318
        • Spronk I.
        • Kullen C.
        • Burdon C.
        • O’Connor H.
        Relationship between nutrition knowledge and dietary intake.
        Br J Nutr. 2014; 111: 1713-1726
      1. National Conference of State Legislatures. Childhood overweight and obesity trends. http://www.ncsl.org/research/health/childhood-obesity-trends-state-rates.aspx. Accessed September 22, 2016.

      2. Consortium to Lower Obesity in Chicago Children. Prevalence of childhood overweight and obesity. http://www.clocc.net/about-childhood-obesity/prevalence/. Accessed September 22, 2016.

      3. New York Department of Health. Student weight status category reporting results: Beginning 2010. https://health.data.ny.gov/Health/Student-Weight-Status-Category-Reporting-Results-B/es3k-2aus. Accessed September 22, 2016.

        • Linnell J.
        • Smith M.
        • Scherr R.
        • et al.
        A multi-component nutrition intervention utilizing a learner-centered, garden-based nutrition curriculum improves nutrition knowledge among fourth-grade children (379.4).
        FASEB J. 2014; 28: 3794
        • Simsek P.
        • Kabapinar F.
        The effects of inquiry-based learning on elementary students' conceptional understanding of matter, scientific process skills and science attitudes.
        Proc Soc Behav Sci. 2010; 2: 1190-1194
        • Mitchell G.L.
        • Farrow C.
        • Haycraft E.
        • Meyer C.
        Parental influences on children’s eating behaviour and characteristics of successful parent-focussed interventions.
        Appetite. 2013; 60: 85-94
        • Durlack J.A.
        • DuPre E.P.
        Implementation matters: a review of research on the influence of implementation on program outcomes and the factors affecting implementation.
        Am J Commun Psychol. 2008; 41: 327-350
      4. US Department of Agriculture. Promoting healthy eating: an investment in the future. https://www.fns.usda.gov/promoting-healthy-eating-investment-future. Accessed September 22, 2016.

        • Graham H.
        • Zidenberg-Cherr S.
        California teachers perceive school gardens as an effective nutritional tool to promote healthful eating habits.
        J Am Diet Assoc. 2005; 105: 1797-1800
        • Jones A.M.
        • Zidenberg-Cherr S.
        Exploring nutrition education resources and barriers, and nutrition knowledge in teachers in California.
        J Nutr Educ Behav. 2014; 42: 162-169
        • Scherr R.E.
        • Cox R.J.
        • Feenstra G.
        • Zidenberg-Cherr S.
        Integrating local agriculture into nutrition programs can benefit children’s health.
        Calif Agric. 2013; 67: 30-37
        • Moreno G.
        • Johnson-Shelton D.
        • Boles S.
        Prevalence and prediction of overweight and obesity among elementary school students.
        J Sch Health. 2013; 83: 157-163
        • Range L.M.
        • Embry T.
        • MacLeod T.
        Active and passive consent: a comparison of actual research with children.
        Ethical Hum Sci Serv. 2001; 3: 23-31
        • Livingstone M.B.
        • Robson P.J.
        • Wallace J.M.
        Issues in dietary intake assessment of children and adolescents.
        Br J Nutr. 2004; 92: S213-S222
        • Cullen K.W.
        • Watson K.
        • Zakeri I.
        Relative reliability and validity of the Block Kids Questionnaire among youth aged 10 to 17 years.
        J Am Diet Assoc. 2008; 108: 862-866
        • Carroll R.J.
        • Midthune D.
        • Subar A.F.
        • et al.
        Taking advantage of the strengths of 2 different dietary assessment instruments to improve intake estimates for nutritional epidemiology.
        Am J Epidemiol. 2012; 175: 340-347
      5. University of California, Davis. UC Davis Center for Nutrition in Schools. http://cns.ucdavis.edu/. Accessed September 22, 2016.

      Linked Article

      • Corrigendum
        Journal of Nutrition Education and BehaviorVol. 50Issue 8
        • Preview
          The May 2017 issue of the Journal of Nutrition Education and Behavior carried a Research Article titled “A Multicomponent, School-Based Intervention, the Shaping Healthy Choices Program, Improves Nutrition-Related Outcomes” (JNEB 2017;49:368-379. http://dx.doi.org/10.1016/j.jneb.2016.12.007 ). The authors would like to amend some of the statements made in the paper. Additional analyses were conducted to control for clustering and as a result, the authors have clarified that results of the subanalysis of weight-related outcomes were only observed in the district that fully implemented the program.
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      • A Comment on Scherr et al “A Multicomponent, School-Based Intervention, the Shaping Healthy Choices Program, Improves Nutrition-Related Outcomes”
        Journal of Nutrition Education and BehaviorVol. 50Issue 3
        • Preview
          We write in response to the article by Scherr et al1 entitled “A multicomponent, school-based intervention, the Shaping Healthy Choices Program, improves nutrition-related outcomes.” We admire Scherr et al for undertaking such a challenging study on so important a topic, and for wisely using a randomized controlled design, the design that allows for the strongest causal inferences.
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