Background

1. Impacting the Quality of Elementary School Children’s Diets using an After-school Nutrition Program N.L. Lowenstein, MS, RD, CSO, LD, CNSC ; J.C. Conkin, MEd Results Background Reported Intake A 24-hour recall administered on the first day of the program was collected from the group of 22 participants in the after-school program. The children were asked to write down everything they ate or drank from dinner the night before through their after-school snack. At the outset of the program 0% of the participating children reported a single fruit or vegetable. At the end of the program 15 remaining children repeated the 24 hour recall. 53% of remaining children reported no fruit or vegetable consumption , 29% reported consuming 1 serving, and 20% reported 2 servings. Children were asked to report whether they had eaten any of the 19 fruits and vegetables trialed during the program at home during this past year. Sixty percent of the class reported eating foods from class at home with fruits faring slightly better than vegetables (66% verses 54% respectively). The need to increase fruit and vegetable consumption in school age children has been well documented. Several approaches to increase children’s fruit and vegetable consumption have been reported including community based education, parent based education and school based education. Within schools a variety of methods have been reported including education incorporated into curriculum, manipulation of school lunch offerings, modeling by teachers, and school based gardening projects. All of these interventions resulted in moderate success. With increased pressure on teachers in Texas to teach toward successful performance on standardized tests as a measure of teacher effectiveness, health and nutrition education within the school day is limited. One possible means to increase children’s exposure to nutrition education is to incorporate content and or activities into after school programs. This project incorporated a combination approach by providing foods for tasting, educational content about nutrition in lecture/discussion format, art and craft projects and “hands on” student participation in a school garden. The program was added to the curriculum of a pre-existing 1 hour after-school program attended by 4th grade students. Sample Tool Discussion Objectives Overall we met our objectives. We successfully developed a curriculum for an after-school program that resulted in an increase in reported intake of fruits and vegetables. Each session included a sensory/tactile experience (taste testing, garden cultivation); a knowledge based component (lecture, multimedia, worksheets ) and an opportunity for skill demonstration (art projects, computer based games and quizzes and meal planning). Although not specifically measured,the familiarity and accuracy of what types of food go in each section on MyPlate and which foods constitute good sources of different nutrients improved substantially by year end.Pre-post testing of for nutrition knowledge and skills would be an enhancement to the next group and provide supportive data. An additional enhancement might be increased parental involvement in the process. While we did send every child home with a reusable plastic MyPlate, a booklet containing recipes, nutritional information, and activities about the fruits and vegetables we grew and tasted; parental involvement throughout the program would be a goal going forward, particularly since behavior modeling has been shown to be effective and has greater sustainability. The three objectives of this project were: Develop a curriculum for an after-school program to increase exposure to nutrition information and healthy eating Increase exposure to fresh fruits and vegetables that results in increased reported fruit and vegetable overall consumption by end of school-year Provide interactive activities that support these educational goals that children would enjoy Prior Exposure Our Garden Materials and Methods Materials and curriculum were developed for the program by a Registered Dietitian in collaboration with an elementary school teacher. Efforts were made to make the curriculum educational, fun, hands-on, and consistent with Texas Assessment of Knowledge and Skills (TAKS) outcomes. A donation from Lowe’s Home Improvement Center in the local area provided the materials to build and cultivate a schoolyard garden. The curriculum included a variety of educational experiences including lecture/discussion, small group projects, art and craft projects, computer based learning modules and games, weekly exposure to a different fruit or vegetable and participation in the planting, maintenance, and harvesting of an onsite schoolyard garden. The USDA MyPlate materials and method served as the foundation for educational content. Fruit and vegetable tasting was incorporated into each lesson and was tied to the items grown in the garden when possible. Twenty-two children were enrolled in the program at the beginning of the school year, with 15 children participating at program end. At the outset of the program children were asked to complete a 24 hour recall of all foods consumed. This was repeated at the end of the program. Weekly to bi-weekly forms were completed by the children to assess prior exposure and likelihood of repeat consumption of foods tasted. At the end of the program a final survey was administered to determine if the participants reported eating any of the new foods at home during the course of the program. References • Wright, W. Rowell, L. Examining the effect of gardening on vegetable consumption among youth in kindergarten through fifth grade, Wis. Med J, 2010, 109 (3):125-129. • Robinson-O’Brien, R, Story, M, Heim, S. Impact of garden-based youth nutrition intervention programs: a review J Am Diet Assoc. 2009 109 (2) 273-280 • Krebs-Smith SM, Cook A, Subar AF, Cleveland L, Friday J, Kahle LL. Fruit and vegetable intakes of children and adolescents in the United States.Arch PediatrAdolesc Med. 1996;150(1):81–86 • Timperio A, Ball K, Roberts R, Campbell K, Andrianopoulos N, Crawford D. Children's fruit and vegetable intake: Associations with the neighborhood food environment.Prev Med. 2008;46(4):331–335 • Reynolds KD, Franklin FA, Binkley D, et al. Increasing the fruit and vegetable consumption of fourth-graders: Results from the high 5 project.Prev Med. 2000;30(4):309–319 • Morgan PJ, Warren JM, Lubans DR, Saunders KL, Quick GI, Collins CE. 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(11):1931–1940 • Delgado-Noguera M, Tort S, Martinez-Zapata MJ, Bonfill X. Primary school interventions to promote fruit and vegetable consumption: A systematic review and meta-analysis.Prev Med. 2011;53(1-2):3–9 • Evans CE, Christian MS, Cleghorn CL, Greenwood DC, Cade JE. Systematic review and meta-analysis of school-based interventions to improve daily fruit and vegetable intake in children aged 5 to 12 y. Am J ClinNutr. 2012;96(4):889–901 • Wardle J, Cooke LJ, Gibson EL, Sapochnik M, Sheiham A, Lawson M. Increasing children's acceptance of vegetables; a randomized trial of parent-led exposure. Appetite. 2003;40(2):155–162 • Author email: nlowens@texaschildrens.org