Nutrition: School-Based Programs Promoting Nutrition and Physical Activity

The Task Force finding is based on evidence from a systematic review conducted on behalf of the Task Force by a team of specialists in systematic review methods, and in research, practice, and policy related to promoting good nutrition.

Forty-five reports in forty-one studies qualified for the systematic review.

• A wide variation was seen in:
  • Combinations of components (activities)
  • Length of study (< 3 months to 60 months)
  • Age of study population (K–12, median age 9.3 years; most students were in grades 3–5)
  • Length of follow-up period (55% immediate follow-up to 2% at 48 months)
• Results were measured in terms of behavioral outcomes including changes in intake of fruit and vegetables, fat, and saturated fat.
• Study outcomes were based on self-report of dietary intake, which is probably subject to reporting bias (e.g., social desirability—the possibility that answers may be influenced by what the respondent thinks is socially acceptable).
• Although reported changes were in the desired direction, they were small and are questionable because of the potential bias of self-reports.

An economic review of this intervention was not conducted because the Task Force did not have enough information to determine if the intervention works.

Applicability of this intervention across different settings and populations was not assessed because the Task Force did not have enough information to determine if the intervention works.

Summary Evidence Table – Effectiveness Review [PDF – 453 kB]

The number of studies and publications do not always correspond (e.g., a publication may include several studies or one study may be explained in several publications).

Arbeit ML, Johnson CC, Mott DS, Harsha DW, Nicklas TA, et al. The Heart Smart Cardiovascular School Health Promotion: behavioral correlates of risk factor change. Preventive Medicine 1992;21:18-32.

Auld GW, Romaniello C, Heimendinger J, Hambridge C, Hambridge M. Outcomes from a school-based nutrition education program using resource teachers and cross-disciplinary models. J Nutr Ed 1998;30:268-80.

Baranowski T, Baranowski J, Cullen KW, et al. Squire’s Quest! Dietary outcome evaluation of a multimedia game. Amer J Preventive Medicine 2003;24(1):52-61.

Baxter AP, Milner PC, Hawkins S, Leaf M, Simpson C, et al. The impact of heart health promotion on coronary heart disease lifestyle risk factors in schoolchildren: lessons learnt from a community-based project. Public Health 1997;111:231-7.

Birnbaum AS, Lytle LA, Story M, Perry CL, Murray DM. Are differences in exposure to a multicomponent school-based intervention associated with varying dietary outcomes in adolescents? Health Ed Behavior 2002;29:427-43.

Bush PJ, Zuckerman AE, Theiss PK, Taggart VS, Horowitz C, et al. Cardiovascular risk factor prevention in black schoolchildren: two-year results of the “Know Your Body” program. Amer J Epidemiol 1989;129:466-82.

Davis SM, Lambert LC, Gomez Y, Skipper B. Southwest Cardiovascular Curriculum Project: study findings for American Indian elementary students. J Health Ed 1995;26:S72-81.

Dollahite J, Hosig KW, White KA, Rodibaugh R, Holmes TM. Impact of a school-based community intervention program on nutrition knowledge and food choices in elementary school children in rural Arkansas Delta. J Nutr Ed 1998;30:289-301.

Edmundson E, Parcel GS, Feldman HA, Elder JP, Perry CL, et al. The effects of the Child and Adolescent Trial for Cardiovascular Health upon psychosocial determinants of diet and physical activity behavior. Preventive Medicine 1996;25:442-54.

Ellison RC, Goldberg RJ, Witschi JC, Capper AL, Puleo EM, et al. Use of fat-modified food products to change dietary fat intake of young people. Am J Public Health 1990;80:1374-6.

French SA, Jeffrey RW, Story M, Breitlow KK, Baxter JS, et al. Pricing and promotion effects on low-fat vending snack purchases: the CHIPS study. Am J Public Health 2001;112-7.

Friel S, Kelleher C, Campbell P, Nolan G. Evaluation of the Nutrition Education at Primary School (NEAPS) programme. Public Health Nutr 1999;2:549-55.

Fries E, Meyer A, Danish S, Stanton C, Figueiredo M, et al. Cancer prevention in rural youth: Teaching Goals for Health: the pilot. J Cancer Educ 2001;16:99-104.

Gans KM, Levin S, Lasater TM, Sennett L, Maroni A, et al. Heart healthy cook-offs in home economics classes: an evaluation with junior high school students. J School Health 1990;60:99-102.

Getlinger MJ, Laughlin CVT, Bell E, Akre C, Arjmandi BH. Food waste is reduced when elementary-school children have recess before lunch. J Amer Diet Assoc 1996;96:906-8.

Goldberg SJ, Allen HD, Friedman G, Meredith K, Tymrack M, et al. Use of health education and attempted dietary change to modify atherosclerotic risk factors: a controlled trial. Am J Clin Nutr 1980;33:1272-8.

Gortmaker SL, Peterson K, Wiecha J, Sobol AM, Dixit S, et al. Reducing obesity via a school-based interdisciplinary intervention among youth: Planet Health. Arch Pediatr Adolesc Med 1999;153:409-18.

Gortmaker SL, Cheung LWY, Peterson KE, Chomitz G, Cradle JH, et al. Impact of a school-based interdisciplinary intervention on diet and physical activity among urban primary school children. Arch Pediatr Adolesc Med 1999;153:975-83.

Hackett AF, Jarvis SN, Matthews JNS. A study of the eating habits of 11- and 12-year-old children before and one year after the start of a healthy eating campaign in Northumberland . J Human Nutr Diet 1990;3:323-32.

Holcomb JD, Lira J, Kingery PM, Smith DM, Land D, et al. Evaluation of Jump Into Action: A program to reduce the risk of non-insulin dependent diabetes mellitus in school children on the Texas-Mexico border. J School Health 1998;68:282-8.

Hopper CA, Gruber MB, Munoz KD, MacConnie S. School-based cardiovascular exercise and nutrition programs with parent participation. J Health Ed 1996;27:S32-9.

Killen JD, Telch MJ, Robinson TN, Maccoby N, Taylor B, et al. Cardiovascular disease risk reduction for tenth graders. JAMA 1988;260(12):1728-33.

Liquori T, Koch PD, Contento IR, Castle J. The Cookshop Program: outcome evaluation of a nutrition education program linking lunchroom food experiences with classroom cooking experiences. J Nutr Ed 1998;30:302-13.

Luepker RV, Perry CL, Murray DM, Mullis R. Hypertension prevention through nutrition education in youth: a school-based program involving parents. Health Psychology 1988;7:S233-45.

Lytle LA, Stone EJ, Nichaman MZ, Perry CL, Montgomery DH, et al. Changes in nutrient intakes of elementary school children following a school-based interventions: results of the CATCH Study. Preventive Medicine 1996;25:465-77.

Manios Y, Kafatos A. Health and nutrition education in elementary schools: changes in health knowledge, nutrient intakes and physical activity over a six year period. Public Health Nutr 1999;2:445-8.

Morris JL, Zidenberg-Cherr S. Garden-enhanced nutrition curriculum improves fourth-grade school children’s knowledge of nutrition and preferences for some vegetables. J Amer Diet Assoc 2002;102:91-3.

Morris JL, Neustadter A, Zidenberg-Cherr S. First-grade gardeners more likely to taste vegetables. California Agriculture 2001;55:43-6.

Nader PR, Stone EJ, Lytle L, Perry CL, Osganian SK, et al. Three-year maintenance of improved diet and physical activity: the CATCH cohort. Arch Pediatr Adolesc Med 1999;153:695-704.

Nicklas TA, Johnson CC, Myers L, Farris RP, Cunningham A. Outcomes of a high school program to increase fruit and vegetable consumption: Gimme 5–a fresh nutrition concept for students. J School Health 1998;68:248-53.

Perry CL, Bishop DB, Taylor G, Murray DM, Mays RW, et al. Changing fruit and vegetable consumption among children: The 5-a Day Power Plus Program in St. Paul, Minnesota. Am J Public Health 1998;88:603-9.

Petchers MK, Hirsch EZ, Bloch BA. A longitudinal study of the impact of a school heart health curriculum. J Community Health 1988;13:85-94.

Piper DL, Moberg DP, King MJ. The Healthy for Life Project: behavioral outcomes. J Primary Prevention 2000;21:47-73.

Ransome K, Rusk J, Field C. A school milk promotion program increases milk consumption and improves the calcium and vitamin D intakes of elementary school students. Revue Canadienne Prat Rech Dietet 1998;59:190-8.

Harrell JS, McMurray RG, Gansky SA, Bangdiwala SI, Bradley CB. A public health vs. a risk-based intervention to improve cardiovascular health in elementary school children: the Cardiovascular Health in Children study. Am J Public Health 1999;89:1529-35.

Resnicow K, Cohn L, Reinhardt J, Cross D, Futterman R, et al. A three-year evaluation of the Know Your Body Program in inner-city schoolchildren. Health Ed Qtrly 1992;19:463-80.

Reynolds KD, Franklin FA, Binkley D, Raczynski JM, Harrington KF, et al. Increasing the fruit and vegetable consumption of fourth-graders: results from the High 5 Project. Preventive Medicine 2000;30:309-19.

Sahota P, Rudolf MCJ, Dixey R, Hill AJ, Barth JH, Cade J. Randomised controlled trial of primary school based intervention to reduce risk factors for obesity. BMJ 2001;323:1029.

Sahota P, Rudolf MCJ, Dixey R, Hill AJ, Barth JH, et al. Evaluation of implementation and effect of primary school based intervention to reduce risk factors for obesity. BMJ 2001;323:1027.

Sallis JF, McKenzie TL, Conway TL, Elder JP, Prochaska JJ, et al. Environmental interventions for eating and physical activity: a randomized controlled trial in middle schools. Am J Prev Med 2003;24:209-17.

Simons-Morton BG, Parcel GS, Baranowski T, Forthofer R, O’Hara NM. Promoting physical activity and a healthful diet among children: results of a school-based intervention study. Am J Public Health 1991;81:986-91.

Stewart KJ, Seemans CM, McFarland LD, Weinhofer JJ. Social learning versus traditional teaching in an elementary school cardiovascular health promotion program. Am J Health Promotion 1997;11:194-7.

Tell GS, Vellar OD. Noncommunicable disease risk factor intervention in Norwegian adolescents: the Oslo Youth Study. In: BS Hetzel and GS Berenson, ed. Cardiovascular Risk Factors in Childhood: epidemiology and prevention. Elsevier Science Publishers B.V. 1987:203-17.

Thackeray R. The impact of a social marketing campaign on increasing fruit and vegetable consumption among middle school adolescents. 2000. Doctoral Dissertation, University of Utah: 1-228.

Turnin MC, Tauber MT, Couvaras O, Jouret B, Bolonella C, et al. Evaluation of microcomputer nutritional teaching games in 1,876 children at school. Diabetes Metab(Paris) 2001;27:459-64.

Vandongen R, Jenner DA, Thompson C, Taggart AC, Spickett EE, et al. A controlled evaluation of a fitness and nutrition intervention program on cardiovascular health in 10- to 12-year-old children. Preventive Medicine 1995;24:9-22.

Walter HJ, Hofman A, Vaughn RD, Wynder EL. Modification of risk factors for coronary heart disease. N Engl J Med 1988;318:1093-100.

Webber LS, Osganian SK, Feldman HA, Wu M, McKenzie TL, et al. Cardiovascular risk factors among children after a 2 1/2-year intervention–the CATCH study. Preventive Medicine 1996;25:432-41.

Wechsler H, Basch CE, Zybert P, Shea S. Promoting the selection of low-fat milk in elementary school cafeterias in an inner-city Latino community: evaluation of an intervention. Am J Public Health 1998;88:427-33.

Whitaker RC, Wright JA, Koepsell TD, Finch AJ, Psaty BM. Randomized intervention to increase children’s selection of low-fat foods in school lunches. J Pediatr 1994;125(4):535–40.

Whitaker RC, Wright JA, Finch AJ, Psaty BM. An environmental intervention to reduce dietary fat in school lunches. Pediatrics 1993;91:1107-11.

Electronic searches of the literature were conducted by a public health librarian in the databases listed below. The team also reviewed the references listed in all retrieved articles, review articles, and systematic reviews, and consulted with experts on the systematic review development team and elsewhere to identify additional articles. Articles were excluded if they were not available in English. The initial literature search on the topic was conducted in 2002.

Total from 4 searches: 326 + 475 + 377 + 724 = 1902 (includes some overlap in results)

Database: MEDLINE, 326 Results

Timeframe: 1966 to October 5, 2002

Search for: 9 or 10 or 11 or 12

1. school based nutrition.tw. (28)
2. (nutrition: or diet or dietary or fruit or vegetable: or food habits or eating).tw,hw. (357251)
3. school:.tw,hw,jw. (112117)
4. 2 and 3 (5894)
5. 1 or 4 (5894)
6. 5 and ((education: or intervention: or program:).tw,hw. or ed.fs.) (2644)
7. limit 6 to english language (2253)
8. limit 7 to yr=1980-2003 (1974)

Database: MEDLINE, 475 Results

Timeframe: 1966 to March 3, 2003

1. schools/ (8051)
2. (nutrition$ or menu$ or meal$ or food$ or vending machine$ or lunch$ or breakfast$ or snack$).mp. (275580)
3. 2 not (foodborne.mp. or food poisoning/) (270459)
4. (physical activit$ or fitness).mp. or exercise/ or physical fitness/(49212)
5. consumer education.mp. or health education/ (34203)
6. media literacy.mp. (11)
7. exp marketing/ (17657)
8. (fund raising$ or fundraising$).mp. (2676)
9. 4 or 5 or 6 or 7 or 8 (102272)
10. 9 and 3 (7827)
11. exp diabetes mellitus/pc or exp obesity/pc or exp cardiovascular diseases/pc (78994)
12. 3 or 10 or 11 (345623)
13. 1 and 12 (738)
14. limit 13 to (human and english language and yr=1980-2003)

Database: Health Promotion and Education Database, 377 Results

Major Descriptor = (nutrition* or diet or food* or eating*) and (school* or high school* or elementary school* or junior high school*) and (intervention strategies or risk factor intervention or program*)
Form = not program
Year = 1980 – 2002

Databases searched: SYSTEM:OS – DIALOG OneSearch (724 Results)

• File 5:Biosis Previews(R) 1969-2003/Feb W4 (c) 2003 BIOSISALERT.
• File 10:AGRICOLA 70-2003/Feb (c) format only 2003 The Dialog Corporation
• 34:SciSearch(R) Cited Ref Sci 1990-2003/Feb W4 (c) 2003 Inst for Sci Info *
• File 35:Dissertation Abs Online 1861-2003/Feb (c) 2003 ProQuest Info7&Learning
• File 48:SPORTDiscus 1962-2003/Feb (c) 2003 Sport Information Resource Centre
• 50:CAB Abstracts 1972-2003/Jan (c) 2003 CAB International *
• File 51:Food Sci.&Tech.Abs 1969-2003/Feb W4 (c) 2003 FSTA IFIS Publishing
• File 53:FOODLINE(R): Food Science & Technology 1972-2003/Mar 03 (c) 2003 LFRA
• File 65:Inside Conferences 1993-2003/Mar W1 (c) 2003 BLDSC all rts. reserv.
• File 68:Env.Bib. 1972-2002/Jun (c) 2002 Internl Academy at Santa Barbara
• File 71:ELSEVIER BIOBASE 1994-2003/Mar W1 (c) 2003 Elsevier Science B.V.
• 73:EMBASE 1974-2003/Feb W4 (c) 2003 Elsevier Science B.V. *
• File 79:Foods Adlibra(TM) 1974-2002/Apr (c) 2002 General Mills *
• 91:MANTIS(TM) 1880-2002/Oct 2002 (c) Action Potential
• 94:JICST-EPlus 1985-2003/Mar W1 (c)2003 Japan Science and Tech Corp(JST) *
• File 98:General Sci Abs/Full-Text 1984-2003/Jan (c) 2003 The HW Wilson Co.
• 135:NewsRx Weekly Reports 1995-2003/Feb W2 (c) 2003 NewsRx *File 135
• 143:Biol. & Agric. Index 1983-2003/Jan (c) 2003 The HW Wilson Co
• 144:Pascal 1973-2003/Feb W4 (c) 2003 INIST/CNRS
• 149:TGG Health&Wellness DB(SM) 1976-2003/Feb W3 (c) 2003 The Gale Group
• 155:MEDLINE(R) 1966-2003/Feb W4 (c) format only 2003 The Dialog Corp.
• 156:ToxFile 1965-2002/Dec W4 (c) format only 2003 The Dialog Corporation *.
• File 162:CAB Health 1983-2003/Jan (c) 2003 CAB International *
• File 164:Allied & Complementary Medicine 1984-2003/Feb (c) 2003 BLHCIS
• File 172:EMBASE Alert 2003/Mar W1 (c) 2003 Elsevier Science B.V.
• File 203:AGRIS 1974-2003/Jan Dist by NAL, Intl Copr. All rights reserved
• File 266:FEDRIP 2003/Jan Comp & dist by NTIS, Intl Copyright All Rights Res
• File357:Derwent Biotech Res. _1982-2003/Mar W2 (c) 2003 Thomson Derwent & ISI *
• File 434:SciSearch(R) Cited Ref Sci 1974-1989/Dec (c) 1998 Inst for Sci Info
• File 442:AMA Journals 1982-2003/Jun B1 (c)2003 Amer Med Assn -FARS/DARS apply
• File 444:New England Journal of Med. 1985-2003/Mar W1 (c) 2003 Mass. Med. Soc.
• File 467:ExtraMED(tm) 2000/Dec (c) 2001 Informania Ltd.
• File 482:Newsweek 2000-2003/Feb 28 (c) 2003 Newsweek, Inc.

Set Items Description

S1 921069 SCHOOL OR SCHOOLS OR K12 OR K(1)12 OR KINDERGARTEN OR GRADE()SCHOOL? ?

S2 8375141 OBESITY OR NUTRITION OR EXERCISE OR PHYSICAL()ACTIVITY OR – FOOD? OR BREAKFAST? ? OR LUNCH? OR DINNER? OR SNACK? OR VENDI- NG()MACHINE? ? OR MENU OR MENUS OR DIABETES OR CARDIOVASCULAR OR FITNESS OR MEDIA()LITERACY OR CONSUMER()EDUCATION

S3 519892 MEALS OR ADVERTISING OR MARKETING

S4 146144 S1 AND (S2 OR S3)/1980:2003

S5 42 S/TI AND (S2/TI AND S3/TI) AND S4

S6 29 RD S5 (unique items)

S7 1406 S1/DE AND (S2/DE AND S3/DE) AND S4

S8 1100 RD S7 (unique items)

8/5/1 (Item 1 from file: 5)
DIALOG®File 5:Biosis Previews®
© 2003 BIOSIS. All rts. reserv.