RE-AIM Analysis of a School-Based Nutrition Education Intervention in Kindergarteners.

BACKGROUND: Few nutrition interventions in kindergarten classes have been evaluated, and none has been tested for program effectiveness, implementation, and dissemination. Building a Healthy Me (BHM) is a nutrition intervention for kindergarteners that is classroom-based and includes a family component. This study evaluated the public health impact of BHM in California kindergarten classrooms using the RE-AIM (reach, efficacy, adoption, implementation, and maintenance) framework. METHODS: A quasi-experimental design assessed pre-to-post changes in nutrition knowledge, dietary consumption, and parent behaviors of 25 intervention classrooms (414 students, 264 parents); and postintervention differences in nutrition knowledge between the intervention classrooms and 4 control classrooms measured at postintervention only (103 students). RESULTS: Intervention students improved in knowledge of food groups and healthy breakfast/snack options, and scored higher than control students in food group knowledge at postintervention (ps < .05). Parents of intervention group children increased their use of food labels, and intervention group children increased intake of several healthy foods and decreased intake of candy and fried potatoes (ps < .05). The BHM program reached 41% of kindergarteners attending public schools in California, and teachers implemented most lesson material. CONCLUSIONS: The BHM program was effective, implemented with fidelity, and broadly disseminated, highlighting its potential public health impact for kindergarteners.

RE-AIM analysis of a randomized school-based nutrition intervention among fourth-grade classrooms in California.

Childhood overweight and obesity are major health problems. School-based programs enable intervening with large groups of children, but program overall health impact is rarely completely assessed. A RE-AIM (Reach, Efficacy, Adoption, Implementation, Maintenance) analysis tested the overall public health impact of the fourth-grade "Nutrition Pathfinders" school-based nutrition-education program. A randomized controlled trial in 47 fourth-grade California classrooms (1713 students) tested program efficacy, and a secondary analysis of archival data tested program dissemination. Desired effects were seen in child nutrition knowledge, attitudes, consumption of low-nutrient high-density foods, sugar-sweetened beverages, proteins, grains, and parent willingness to serve new foods. The program was disseminated to ∼25 % of public school fourth-grade classrooms in California and cost about $1.00 per student to implement. The Nutrition Pathfinders program demonstrates potential for moderate to high public health impact due to its wide dissemination, effectiveness in altering attitudes and behaviors, and its relatively inexpensive cost of implementation.

Four Dietary Items of the School Physical Activity and Nutrition (SPAN) Questionnaire Form a Robust Latent Variable Measuring Healthy Eating Patterns.

OBJECTIVE: Evaluate the factor structure and stability of 4 dietary items (fruit, fruit juice, vegetables, and milk) from the School Physical Activity and Nutrition questionnaire-elementary school version. METHODS: Secondary analysis of intervention data from third graders measured at pre-intervention, post-intervention (10 weeks), and 3-month follow-up. The researchers conducted structural equation modeling invariance analysis to test the stability of the factor structure of the 4 items. RESULTS: Data from 1,147 students. Fit indices revealed good fit for a single factor remaining stable across time (χ(2)/degrees of freedom [DF] = 59.75/59, P = .45), gender (χ(2)/DF = 149.72/128, P = .09), and study groups (χ(2)/DF = 143.04/128, P = .17). CONCLUSIONS AND IMPLICATIONS: A healthy food factor consisting of the 4 items can be used in future data analysis. This offers several advantages in analysis, including the use of latent change scores that are more powerful, more informative, and more easily interpreted than traditional approaches.

Nutrition self-efficacy is unidirectionally related to outcome expectations in children.

OBJECTIVE: To clarify the underlying relationship between nutrition self-efficacy and outcome expectations because the direction of the relationship (unidirectional vs bidirectional) is debated in the literature. METHODS: Secondary data analysis of a 10-week, 10-lesson school-based nutrition education intervention among 3rd grade students (N = 952). Nutrition self-efficacy (7 items) and nutrition outcome expectations (9 items) were measured through student self-report at intervention pre- (time 1) and post- (time 2) assessments. A series of two time point, multi-group cross-lagged bivariate change score models were used to determine the direction of the relationship. RESULTS: A cross lag from nutrition self-efficacy at time 1 predicting changes in nutrition outcome expectations at time 2 significantly improved the fit of the model (Model 3), whereas a cross lag from nutrition outcome expectations at time 1 to changes in nutrition self-efficacy at time 2 only slightly improved the fit of the model (Model 2). Furthermore, adding both cross lags (Model 4) did not improve model fit compared to the model with only the self-efficacy cross lag (Model 3). Lastly, the nutrition outcome expectations cross lag did not significantly predict changes in nutrition self-efficacy in any of the models. CONCLUSIONS: Data suggest that there is a unidirectional relationship between nutrition self-efficacy and outcome expectations, in which self-efficacy predicts outcome expectations. Therefore, theory-based nutrition interventions may consider focusing more resources on changing self-efficacy because it may also lead to changes in outcome expectations as well.