High 5 Fruit and Vegetable Intervention for 4th Graders

Fruit and vegetable consumption is linked to reduced risk for cancer. As a result, the National Cancer Institute advocates that Americans consume five or more servings of fruits and vegetables per day. Despite these guidelines, recent reports indicate that only 7% to 20% of children and adolescents eat five or more servings of fruits and vegetables per day. Since risk behaviors develop in childhood and continue into adulthood, interventions to increase fruit and vegetable consumption are essential to reduce cancer risk.

This school-based dietary program aims to increase fruit and vegetable consumption among fourth graders. Based on social cognitive theory, High 5 is a multi-component intervention targeting such key elements as outcome expectancies, perceived self-efficacy, social norms, behavioral skills, reinforcement, and environmental factors, such as fruit and vegetable availability. The classroom component includes 14 lessons, High 5 days where students are challenged to eat five servings of fruit and vegetables, and High 5 homework assignments. The parent component includes a kick-off party, parent-child homework assignments, and encouragement to increase their own fruit and vegetable consumption. The food service component includes staff training to increase fruit and vegetable purchasing, preparation, and promotion.

The 14-session curriculum is delivered 3 days per week. Lessons are 30-45 minutes in length. Food service staff requires 1 half-day of training. Parents attend a kick-off meeting lasting approximately 1.5 hours.

Participants were fourth grade students, their parents, and food service managers and workers in Alabama. Students were White (83%), African-American (16%), and other (1%).

This intervention is suitable for implementation in the school setting.

Required resources include the High 5 curriculum, the "Freggie Book" containing homework assignments, the parent component manual, and the food service training manual. Costs associated with the program's implementation are not provided.

Twenty-eight elementary schools were paired within three school districts and randomly assigned to the intervention or control condition. The High 5 intervention consisted of three components involving the classroom, the parent figure, and the school's food service. Students in the classroom component were exposed to different learning methods including modeling, self-monitoring, problem-solving, reinforcement, taste testing, and other methods. Fourteen lessons were taught by Curriculum Coordinators on three consecutive days each week. Once each week, students were challenged in a High 5 Day to eat five servings of fruits and vegetables and to record their consumption. Parents attended a kick-off event and received instructional materials to complete with their child, and they received brochures and other skill-building materials. Food service managers and workers received a half-day of training on purchasing, preparing, and promoting fruit and vegetables to meet High 5 guidelines. Assessments were completed at baseline and at 1-year (Follow-up 1) and 2-years (Follow-up 2) post-baseline. The baseline assessment was completed at the end of the third-grade. The intervention was delivered in the fourth grade and three short booster sessions were delivered in the fifth grade. Both the main and the booster intervention activities were terminated at least 1 month prior to the initiation of the follow-up assessments.

Results:

• At follow-up 1 and 2, intervention students consumed more servings of fruit and vegetables combined than control students.

• Intervention students also consumed more servings of fruit and vegetables separately than students in the control condition.

• At follow-up 1, intervention parents consumed more servings of fruit and vegetables combined than control parents. 

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  At follow-up 1 and 2, intervention students had lower caloric intake from fat and saturated fat than control students, and higher caloric intake from protein and carbohydrates than students in the control group.