Diet quality of elementary and middle school teachers is associated with healthier nutrition-related classroom practices.

Many schools have implemented policies and programs to address childhood obesity. However, few have evaluated obesity-related health behaviors among teachers, or how these behaviors may be associated with teachers' nutrition-related practices in the classroom setting. This cross-sectional study utilized data from teachers employed in 20 schools representing three public school districts in a mid-Atlantic state from 2017 to 2019 to examine associations between teachers' diet quality and their nutrition-related classroom practices (e.g. rewarding students with food; modeling healthy diet behaviors). Measures included: one 24-h dietary recall summarized via healthy eating index (HEI-2015; higher scores indicate better diet quality; Range: 0-100); demographics, self-reported height/weight (BMI; ≥25 kg/m2 = overweight/obese), and nutrition-related classroom practices (10 item survey; sum score range: 0-40; alpha = 0.65; higher score = more health-promoting practices). Associations between HEI and nutrition-related classroom practices were assessed in multilevel models, adjusting for covariates (gender, race/ethnicity, age, income, BMI, years teaching) and controlling for within-school effects. Of 331 teachers recruited, 116 (35.0%) completed both the optional dietary recall and incentivized survey (analytic sample: 89% female; 45% black; 79% overweight/obese; BMI = 30.5 ± 7.1; aged 41.1 ± 11.8 years). Means and standard deviations were calculated for HEI (52.2 ± 12.2) and nutrition-related classroom practices sum score (25.4 ± 5.9). For every one-unit increase in HEI, there was a 0.20 increase in nutrition-related classroom practices score (SE = 0.05; p < 0.001), which remained significant in the adjusted model. To better inform obesity prevention efforts, future studies should collect data among both students and teachers and explore the mechanisms through which teacher health behaviors may impact student health behaviors.

Longitudinal Sedentary Time Among Females Aged 17 to 23 Years.

INTRODUCTION: Time spent in sedentary behaviors is a newer risk factor for poor cardiometabolic health. This study examined longitudinal correlates of sedentary time among a cohort of females from about age 17 to age 23 years. METHODS: The cohort included females originally participating in the Trial of Activity for Adolescent Girls Maryland site who had assessments in 2009 and 2015 (n=431). Percentage daily time in sedentary behaviors was determined from accelerometers. Sociodemographics, psychosocial factors, and health behaviors were assessed by questionnaire. Lasso variable selection identified potential variables included in linear mixed effects models. As a secondary analysis, a k-means algorithm for longitudinal data identified homogeneous clusters of individual sedentary time trajectories. RESULTS: Percentage daily sedentary time did not change over time (67% to 68%). Not of black race (p=0.04), higher father's education (p<0.001), more weekday computer hours (p<0.001), more weekend TV hours (p=0.01), more physical activity barriers (p=0.003), fewer days per week driving (p=0.01), and more vehicles in the household (p=0.02) were associated with greater sedentary time. Cluster analysis resulted in two patterns: more (70%) versus less (60%) time being sedentary. The more sedentary individuals were more likely to be college graduates (p<0.001), have a higher income (p=0.03), and work fewer hours (p=0.009). They were also less likely to be married or in a common-law relationship (p=0.05) or in a parenting role (p=0.02). CONCLUSIONS: Time spent in sedentary behaviors remained stable. Factors associated with sedentary time were significant across the socioecologic framework and included several factors indicating higher SES.

Longitudinal Associations of Physical Activity Among Females from Adolescence to Young Adulthood.

PURPOSE: We sought to identify individual, social, and environmental factors associated with moderate-to-vigorous physical activity (MVPA) among females from ages 14 to 23years. METHODS: A cohort was formed from females originally participating in the Trial of Activity for Adolescent Girls Maryland site. The cohort was recruited from a randomly generated list of eighth grade girls in participating middle schools. A total of 428 females had complete assessments in 2006 (n = 730), 2009 (n = 589), and 2015 (n = 460). The outcome, MVPA, was assessed from accelerometers. Individual and social factors were assessed by questionnaire; body mass index was measured in 2006 and 2009 and self-reported in 2015. Perceived environment was assessed by questionnaire; number of parks near home and distance to parks and schools was assessed by geographic information systems. RESULTS: Participants were diverse (45.7% white, 24.8% black, 9.9% Hispanic, and 19.6% other). Over time 274 participants had continuously low MVPA, 123 decreased MVPA from age 17 to 23years, and 31 participants continuously increased MVPA. For each .16-unit decrease in body mass index, MVPA increased 1 minute over time (p = .007). For every 1-unit increase in self-management strategies or social support from friends, there was a 4- to 5-minute increase in MVPA (p < .0001 and p = .03, respectively). A little less than one extra park (.71 parks) within a mile of an individual's home was associated with a 1-minute increase in MVPA (p < .0001). CONCLUSIONS: Behavioral strategies combined with neighborhood enhancements may produce the best results for increasing MVPA as adolescent females' transition into adulthood.

Barriers and Enablers to the Implementation of School Wellness Policies: An Economic Perspective.

BACKGROUND: Local wellness policies (LWPs) are mandated among school systems to enhance nutrition/physical activity opportunities in schools. Prior research notes disparities in LWP implementation. This study uses mixed methods to examine barriers/enablers to LWP implementation, comparing responses by student body income. METHOD: Schools ( n = 744, 24 systems) completed an LWP implementation barriers/enablers survey. Semistructured interviews ( n = 20 random subsample) described barriers/enablers. Responses were compared by majority of lower (≥50% free/reduced-price meals; lower income [LI]) versus higher income (HI) student body. RESULTS: In surveys, LI and HI schools identified common barriers (parents/families, federal/state regulations, students, time, funding) and enablers (school system, teachers, food service, physical education curriculum/resources, and staff). Interviews further elucidated how staffing and funding served as enablers for all schools, and provide context for how and why barriers differed by income: time, food service (HI schools), and parents/families (LI schools). CONCLUSIONS: Findings support commonalities in barriers and enablers among all schools, suggesting that regardless of economic context, schools would benefit from additional supports, such as physical education and nutrition education resources integrated into existing curricula, additional funding, and personnel time dedicated to wellness programming. LI schools may benefit from additional funding to support parent and community involvement.

Implementation of Local Wellness Policies in Schools: Role of School Systems, School Health Councils, and Health Disparities.

BACKGROUND: Written local wellness policies (LWPs) are mandated in school systems to enhance opportunities for healthy eating/activity. LWP effectiveness relies on school-level implementation. We examined factors associated with school-level LWP implementation. Hypothesized associations included system support for school-level implementation and having a school-level wellness team/school health council (SHC), with stronger associations among schools without disparity enrollment (majority African-American/Hispanic or low-income students). METHODS: Online surveys were administered: 24 systems (support), 1349 schools (LWP implementation, perceived system support, SHC). The state provided school demographics. Analyses included multilevel multinomial logistic regression. RESULTS: Response rates were 100% (systems)/55.2% (schools). Among schools, 44.0% had SHCs, 22.6% majority (≥75%) African-American/Hispanic students, and 25.5% majority (≥75%) low-income (receiving free/reduced-price meals). LWP implementation (17-items) categorized as none = 36.3%, low (1-5 items) = 36.3%, high (6+ items) = 27.4%. In adjusted models, greater likelihood of LWP implementation was observed among schools with perceived system support (high versus none relative risk ratio, RRR = 1.63, CI: 1.49, 1.78; low versus none RRR = 1.26, CI: 1.18, 1.36) and SHCs (high versus none RRR = 6.8, CI: 4.07, 11.37; low versus none RRR = 2.24, CI: 1.48, 3.39). Disparity enrollment did not moderate associations (p > .05). CONCLUSIONS: Schools with perceived system support and SHCs had greater likelihood of LWP implementation, with no moderating effect of disparity enrollment. SHCs/support may overcome LWP implementation obstacles related to disparities.

Multilevel correlates of physical activity for early, mid, and late adolescent girls.

BACKGROUND: We examined associations among multilevel variables and girls' physical activity to determine whether they vary at different adolescent ages. METHODS: All field sites of the Trial of Activity for Adolescent Girls contributed participants from 6th (n = 1576) and 8th grades (n = 3085). The Maryland site contributed an 11th grade sample (n = 589). Questionnaires were used to obtain demographic and psychosocial information (individual- and social-level variables); height, weight, and triceps skinfold to assess body composition; interviews and surveys for school-level data; and geographical information systems and self-report for neighborhood-level variables. Moderate to vigorous physical activity minutes (MVPA) were assessed from accelerometers. Mixed models (13 individual, 5 social, 15 school, 12 neighborhood variables) were used to determine multilevel associations. RESULTS: Variables at individual, social, school, and neighborhood levels were associated with MVPA, but differed across grades. Lower percent body fat, higher social support from friends, and lower school math scores were associated with higher MVPA at 6th and 8th grade. Higher physical activity self-efficacy was associated with higher MVPA at 11th grade. Only lower physical activity barriers were associated with higher MVPA at all grades. CONCLUSION: MVPA is a complex behavior with fluid, multilevel correlates that differ among girls across middle and high school.

Adolescent girls' exposure to physical activity-promoting environments.

OBJECTIVES: To examine self-reported exposure to a physical activity (PA) promoting intervention and changes to school environmental PA factors. METHODS: Randomly selected 8(th) grade girls in year 2 (N = 3469) and year 3 (N = 3462) completed surveys on exposure to the health education, PE components, PA programming, and PA supporting messages. Girls' perceptions of their school-environment and an assessment of school environmental factors by principals in support of PA also were measured. Analysis included generalized linear mixed models with random effects for site and school comparing intervention and control schools. RESULTS: Year 2 intervention girls reported greater exposure to all 4 components of the intervention compared to control school girls. In year 3, differences by treatment disappeared in all but 2 components. CONCLUSIONS: Intervention girls were exposed to TAAG in year 2 with effects diminishing in year 3.

Physical activity trajectories and multilevel factors among adolescent girls.

PURPOSE: Although the decline of physical activity in adolescent girls is well-documented, there are girls whose physical activity does not follow this pattern. This study examined the relationships between physical activity trajectories and personal, psychosocial, and environmental factors among adolescent girls. METHODS: Participants were from the University of Maryland field site of the Trial of Activity for Adolescent Girls. Of 730 girls measured in 8th grade, 589 were remeasured in 11th grade. Moderate-to-vigorous physical activity was assessed by accelerometers; participants were categorized as active maintainers (n = 31), inactive maintainers (n = 410), adopters (n = 64), or relapsers (n = 56). Height and weight were measured, personal and psychosocial information was collected from surveys, and distance from home to school and parks was assessed from Geographical Information Systems. Multivariable logistic regression was used for data analysis. RESULTS: Variables at individual, social, and environmental levels predicted active maintainers and inactive maintainers, while only individual-level variables predicted adoption. None predicted relapse. Higher (favorable) scores for physical self-concept, perceived body fat, friend and family physical activity support, frequency of physical activity with friends, and shorter distance from home to a park predicted active maintainers. Overweight/obese status, earlier age at menses, and lower scores for physical self-concept, perceived body fat, friend physical activity support, and frequency of physical activity with friends, and farther distance from home to school predicted inactive maintainers. High physical self-concept and not being overweight/obese predicted adopters. CONCLUSIONS: Multilevel factors appear to predict behavior maintenance rather than actual change.

Area-level attributes and esophageal adenocarcinoma in surveillance, epidemiology and end results registries.

PURPOSE: To examine the associations between area-level socioeconomic attributes and stage of esophageal adenocarcinoma diagnoses in 16 SEER cancer registries during 2000-2007. METHODS: Odds ratios (OR) and 95% confidence intervals (CI) were calculated using multivariable logistic regression models to assess the relationship between distant-stage esophageal adenocarcinoma and individual, census tract, and county-level attributes. RESULTS: Among cases with data on birthplace, no significant association was seen between reported birth within versus outside the United States and distant-stage cancer (adjusted OR=1.02, 95% CI: 0.85-1.22). Living in an area with a higher percentage of residents born outside the United States than the national average was associated with distant-stage esophageal adenocarcinoma; census tract level: >11.8%, (OR=1.10, 95% CI:1.01-1.19), county level: >11.8%, (OR=1.14, 95% CI:1.05-1.24). No association was observed between median household income and distant-stage cancer at either census tract or county levels. CONCLUSION: The finding of greater odds of distant-stage esophageal adenocarcinoma among cases residing in SEER areas with higher proportion of non-U.S. Natives suggests local areas where esophageal cancer control efforts might be focused. Missing data at the individual level was a limitation of the present study. Furthermore, inconsistent associations with foreign birth at individual- versus area-levels cautions against using area-level attributes as proxies for case attributes.

A cross-sectional and longitudinal study of travel by walking before and after school among eighth-grade girls.

PURPOSE: To examine "travel by walking" (TBW) before and after school among eighth-grade girls. METHODS: Participants attended 36 middle schools from Arizona, Maryland, Minnesota, Louisiana, California, and South Carolina participating in the Trial of Activity for Adolescent Girls. The cross-sectional sample consisted of 3,076 eighth-grade girls, and the longitudinal sample included 1,017 girls who participated in both sixth and eighth grades. Before- or after-school TBW status was determined from the 3-Day Physical Activity Recall. The main outcomes were body mass index and physical activity, which was measured by accelerometry, estimated for total physical activity (light, moderate, vigorous) and moderate-to-vigorous physical activity (MVPA). RESULTS: Eighth-grade girls who reported TBW had 4 more minutes (95% confidence interval = 2.1-6.1) of MVPA before and after school than nonwalkers, and 2 more minutes of MVPA (95% confidence interval = 1.1-3.1) on an average weekday. In the longitudinal sample, girls who reported TBW before and after school in both sixth and eighth grades (consistent walkers) accumulated more minutes of MVPA for an average weekday than inconsistent walkers in both sixth (27 ± 2.2 vs. 25 ± 1.9 minutes; p = .03) and eighth (28 ± 2.6 vs. 25 ± 2.3 minutes; p = .003) grades. There were no differences in body mass index by walking status. CONCLUSIONS: Adolescent girls who reported TBW before and after school accumulated more minutes of MVPA than nonwalkers. Efforts to prevent the decline in walking to school in middle school girls could contribute to their overall physical activity.

Perceptions of the food marketing environment among African American teen girls and adults.

Obesity disproportionately affects African American adolescents, particularly girls. While ethnically targeted marketing of unhealthful food products contributes to this disparity, it is not known how African Americans perceive the food marketing environment in their communities. Qualitative methods, specifically photovoice and group discussions, were used to understand perceptions of African American adults and teen girls regarding targeted food marketing to adolescent girls. An advisory committee of four students, two faculty, and two parents was formed, who recruited peers to photograph their environments and participate in group discussions to answer "what influences teen girls to eat what they do." Seven adults and nine teens (all female) participated in the study. Discussions were transcribed, coded, and analyzed with ATLAS.ti to identify common and disparate themes among participants. Results indicated that adults and teens perceived the type of food products, availability of foods, and price to influence the girls' choices. The girls spoke about products that were highly convenient and tasty as being particularly attractive. The adults reported that advertisements and insufficient nutrition education were also influencers. The teens discussed that the places in which food products were available influenced their choices. Results suggest that the marketing of highly available, convenient food at low prices sell products to teen girls. Future work is needed to better understand the consumer's perspective on the food and beverage marketing strategies used.

Recruiting adolescent girls into a follow-up study: benefits of using a social networking website.

BACKGROUND: Recruitment and retention of adolescent research participants presents unique challenges and considerations when conducting epidemiological studies. PURPOSE: To describe the use of the social networking website in the re-recruitment and tracking of adolescent girls into a follow-up study of the Trial of Activity for Adolescent Girls (TAAG) at the University of Maryland field site. METHODS: 730 girls were recruited as 8th graders into TAAG. Re-recruitment efforts were conducted when they were 11th graders (TAAG 2). Traditional methods, including mailings and school visits, were conducted. A TAAG 2 Facebook site was created to search for girls not found through traditional recruitment methods. Chi-square and t-tests were conducted to identify differences in characteristics between those found and "friended" through Facebook and through traditional recruitment methods. RESULTS: There were 175 girls we were unable to locate using traditional recruitment methods. Of these, 78 were found on Facebook, 68 responded to our friend request, and 43 girls (6% of the girls previously recruited) participated in the study. Demographic data were similar for those who friended us on Facebook and traditional methods. 8th grade body mass index and percent body fat were lower for those recruited from Facebook (p=0.03 and 0.04, respectively). Number of daily minutes of moderate-to-vigorous physical activity tended to be lower among the TAAG 2 Facebook friends (19 ± 11 vs 21 ± 11, p=0.06). CONCLUSIONS: Loss to follow-up was minimized by contacting potential participants through Facebook. Social networking websites are a promising method to recruit adolescents.

Obesity and depressed mood associations differ by race/ethnicity in adolescent girls.

Abstract Objectives. To evaluate bidirectional associations between obesity and depressed mood in adolescent girls, and determine if associations differed by racial/ethnic group. Methods. We analyzed data collected from 918 adolescent girls studied in 6(th) and 8(th) grades in the Trial of Activity for Adolescent Girls (TAAG). Racial/ethnic group was defined as non-Hispanic white, non-Hispanic black, and Hispanic. Height and weight were measured and obesity was defined as a body mass index-for-age ≥95(th) percentile. The Center for Epidemiologic Studies Depression Scale (CES-D) was used to measure depressive symptoms and depressed mood, defined as CES-D ≥24. Generalized estimating equations were used to examine associations between 6(th) grade obesity and 8(th) grade depressed mood, as well as 6(th) grade depressed mood and 8(th) grade obesity. Results. Racial/ethnic group was a statistically significant effect modifier in both directions of association (p<0.02). Among white girls, 6(th) grade obesity was associated with greater likelihood of depressed mood in 8(th) grade (odds ratio [OR]=2.47, 95% confidence interval [CI]: 1.85, 3.30), whereas for black and Hispanic girls this association was not observed (OR= 1.16 and 0.82, respectively). Also for white girls, 6(th) grade depressed mood was associated with greater likelihood of obesity in 8(th) grade (OR = 4.47, CI: 1.96, 10.24), whereas for black and Hispanic girls, OR=0.83 and 1.89, respectively. Conclusions. Associations between obesity and depressed mood may be most problematic among adolescent girls in the white racial/ethnic group. Our results are consistent both with depressed mood contributing to obesity and obesity contributing to depressed mood.

Recruiting a diverse group of middle school girls into the trial of activity for adolescent girls.

BACKGROUND: School-based study recruitment efforts are both time consuming and challenging. This paper highlights the recruitment strategies employed by the national, multisite Trial of Activity for Adolescent Girls (TAAG), a study designed to measure the effectiveness of an intervention to reduce the decline of physical activity levels among middle school-aged girls. TAAG provided a unique opportunity to recruit large cohorts of randomly sampled girls within 36 diverse middle schools across the United States. METHODS: Key elements of the formative planning, coordination, and design of TAAG's recruitment efforts included flexibility, tailoring, and the use of incentives. Various barriers, including a natural disaster, political tension, and district regulations, were encountered throughout the recruitment process, but coordinated strategies and frequent communication between the 6 TAAG sites were helpful in tailoring the recruitment process at the 36 intervention and control schools. RESULTS: Progressively refined recruitment strategies and specific attention to the target audience of middle school girls resulted in overall study recruitment rates of 80%, 85%, and 89%, for the baseline, posttest, and follow-up period, respectively. DISCUSSION: The steady increase in recruitment rates over time is attributed to an emphasis on successful strategies and a willingness to modify less successful methods. Open and consistent communication, an increasingly coordinated recruitment strategy, interactive recruitment presentations, and participant incentives resulted in an effective recruitment campaign.

Black, Hispanic, and white girls' perceptions of environmental and social support and enjoyment of physical activity.

BACKGROUND: This study examines the differences among black, Hispanic, and white adolescent girls in their perceptions surrounding physical activity (PA), including support within the school climate, friend and family social support, and personal enjoyment. METHODS: Participants included 1466 sixth-grade girls from 36 middle schools across the United States. Participants were 20% black, 21% Hispanic, 47% white, and 12% of other or mixed races. Multivariate analyses were performed on each scale, adjusting for body mass index and free and reduced-price lunch status. RESULTS: Results showed racial differences on several variables. Black girls, compared with white girls, perceived significantly lower PA enjoyment (p<.001) and teacher support for PA (p=.004). Hispanic girls experienced less PA enjoyment (p=.003) and perceived less support for PA from boys (p=.001) and their families (p=.008) than white girls. Black girls reported significantly higher levels of physical education (PE) enjoyment than did white girls (p=.003). CONCLUSIONS: Differences in perceived PA support and enjoyment across race raise questions about why these differences exist and how best to address disparities within interventions.

Travel by walking before and after school and physical activity among adolescent girls.

OBJECTIVE: To examine how "travel by walking" before and after school contributes to total physical activity of adolescent girls. DESIGN: Cross-sectional sample. SETTING: Thirty-six middle schools from Arizona, Maryland, Minnesota, Louisiana, California, and South Carolina participating in the Trial of Activity for Adolescent Girls (TAAG). PARTICIPANTS: Seventeen hundred twenty-one sixth-grade girls consented to participate; adequate information was available for 1596 participants (93%). MAIN EXPOSURE: Travel by walking before school, after school, and before and after school combined assessed from the 3-Day Physical Activity Recall. MAIN OUTCOME MEASURE: Mean minutes of physical activity measured by accelerometry were estimated for total physical activity (light, moderate, vigorous), moderate to vigorous activity (MVPA), and MVPA of 3 metabolic equivalents. RESULTS: Travel by walking was reported by 14% of participants before school and 18% after school. Girls who reported travel by walking before and after school (combined) had 13.7 more minutes (95% confidence interval, 1.2-26.3) of total physical activity and 4.7 more minutes (95% confidence interval, 2.2-7.2) of MVPA than girls who did not report this activity. Before-school and after-school walkers (but not both) accumulated 2.5 more minutes (95% confidence interval, 0.10-4.9) and 2.2 more minutes (95% confidence interval, 0.24-4.2) of MVPA on an average weekday, respectively, than nonwalkers. CONCLUSION: Our results provide evidence that walking to and from school increases weekday minutes of total physical activity and MVPA for middle-school girls.

A description of the social-ecological framework used in the trial of activity for adolescent girls (TAAG).

Social-ecological (SE) models are becoming more widely used in health behavior research. Applying SE models to the design of interventions is challenging because models must be tailor-made for each behavior and population, other theories need to be integrated into multi-level frameworks, and empirical research to guide model development is limited. The purpose of the present paper is to describe a SE framework that guided the intervention and measurement plans for a specific study. The trial of activity for adolescent girls (TAAG) is a multi-center study of interventions to reduce the decline of physical activity in adolescent girls. The TAAG framework incorporates operant learning theory, social cognitive theory, organizational change theory and the diffusion of innovation model in a multi-level model. The explicit and practical model developed for TAAG has already benefited the study and may have elements that can generalize to other health promotion studies.

Data to action: using formative research to develop intervention programs to increase physical activity in adolescent girls.

Formative research is used to inform intervention development, but the processes of transmitting results to intervention planners and incorporating information into intervention designs are not well documented. The authors describe how formative research results from the Trial of Activity for Adolescent Girls (TAAG) were transferred to planners to guide intervention development. Methods included providing oral and written reports, prioritizing recommendations, and cross-checking recommendations with intervention objectives and implementation strategies. Formative work influenced the intervention in many ways. For example, results indicated that middle schools offered only coeducational physical education and health education classes, so the TAAG intervention was designed to be appropriate for both sexes, and intervention strategies were developed to directly address girls' stated preferences (e.g., enjoyable activities, opportunity to socialize) and barriers (e.g., lack of skills, fear of injury) for physical activity. The challenges of using formative research for intervention development are discussed.

A pilot school-based healthy eating and physical activity intervention improves diet, food knowledge, and self-efficacy for native Canadian children.

The Sandy Lake school-based diabetes prevention program is a culturally appropriate intervention for Ojibway-Cree students in the 3rd, 4th, and 5th grades. This paper reports the results of the program in changing dietary intake behaviors and related psychosocial factors. Physical activity results are not included. The study was a pretest/post-test, single-sample design conducted during the 1998-1999 school year. A total of 122 students completed all 4 measurements (anthropometry, 24-h dietary recall, and 2 questionnaires), at baseline and follow-up. There were significant increases (P < 0.0001) in dietary intention, dietary preference, knowledge, and dietary self-efficacy, and in the curriculum knowledge scale between baseline and follow-up. Intervention exposure was significantly associated with being in the highest category for knowledge about foods that were low in dietary fat [Medium Exposure odds ratio (OR): 3.4; P < 0.05; High Exposure OR: 6.4; P < 0.05], being in the highest category for dietary self-efficacy (Medium Exposure OR: 3.7; P < 0.05; High Exposure OR: 3.9; P < 0.1), being in the highest category for knowledge about curriculum concepts (Medium Exposure OR: 3.4; P < 0.05; High Exposure OR: 9.4: P < 0.01), and for having met the age + 5 g dietary fiber intake/d (Medium Exposure OR: 2.9; P < 0.1; High Exposure OR: 11.0; P < 0.01). Exposure to the intervention was not associated with dietary intent or the percentage of energy from dietary fat. This program was associated with improved knowledge and the psychosocial factors related to healthy eating and dietary fiber intake of students in a remote First Nations community.