Perry, C. L., Bishop, D. B., Taylor, G. L., Davis, M., Story, M., Gray, C., Bishop, S. C., Warren Mays, R. A., Lytle, L. A., & Harnack, L. (2004). A randomized school trial of environmental strategies to encourage fruit and vegetable consumption among children. Health Education & Behavior, 31(1), 65-76.
Designed to increase fruit and vegetable consumption among elementary school students, this school-based intervention conducted in the cafeteria includes daily activities that increase the availability, accessibility, and appeal of fruits and vegetables and special activities that increase the motivation to eat fruits and vegetables through peer and adult support. The study showed an increase in servings of fruits consumed per day.
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Higher intake of fruits and vegetables has been associated with lower rates of some cancers, cardiovascular disease, stroke, Type 2 diabetes, obesity, and multiple other diseases. Despite substantial evidence for the importance of eating fruits and vegetables, American children and adolescents are not meeting recommendations for fruit and vegetable consumption. Effective intervention programs are critically needed to increase fruit and vegetable intake among young children, when eating habits are being formed.
High 5 Flyers is designed to increase student consumption of fruits and vegetables among elementary school children. Implemented in the school cafeteria, the program is based on social learning theory and focuses on key environmental factors that are predictive of children's eating behavior. Based on these factors, the program 1) increases opportunities to eat a variety of fruits and vegetables, 2) provides new healthful role models who eat fruits and vegetables, and 3) increases social support for children to eat fruits and vegetables at lunch.
The High 5 Flyers Cafeteria program includes "daily" and "special" activities that are implemented throughout the school year in the school cafeteria.
Daily activities aim to increase the availability, accessibility and appeal of fruits and vegetables. These activities include:
- Verbally encouraging students to take fruits and vegetables on the line
- Making fruits and vegetables look appealing
- Offering a wide variety of fruits and vegetables on the menu
- Increasing students' opportunities to choose among the fruits and vegetables served
Special activities aim to increase motivation and peer and adult support for eating fruits and vegetables. Special activities include:
- A 2-week kick-off, where the High 5 Flyers ("life-size" fruit and vegetable characters) are introduced as role models for eating fruits and vegetables
- Monthly sampling of new fruits and vegetables, served by students at their lunch tables and subsequently incorporated into the menu
- A mid-year Challenge Week, where children strive to eat 3 servings of fruits and vegetables each day at lunch to reach a classroom goal
- A program finale to end the program and remind students to continue eating fruits and vegetables
Community Preventive Services Task Force Finding
- Three hour training for food service staff at the beginning of the first year of the intervention
- Work closely with district food service staff to increase the variety and quantity of fruits and vegetables served in school lunch
- During regularly scheduled meetings with cook managers, discuss and share implementation issues and new ideas from individual cafeterias
- Daily activities take very little or no additional staff time
- Special events typically take about 15-20 minutes on the days they occur
The intended audience is elementary school children.
The intervention is suitable for implementation in cafeterias within grade-school settings.
The required resources are the High 5 Flyers Program Manual, Food Service Staff Training Packet, 10 High 5 Flyers character posters, a kickoff banner, an "Eat 3 at Lunch" banner, and a Challenge Week Scoreboard. Costs include reproduction of optional handout materials for students and parents and costs of fruits and vegetables for the samplings.
About the Study
High 5 Flyers was evaluated using a randomized control group research design involving 26 elementary schools and 1,668 participating first- and third-grade students over a 2-year period. Thirteen schools were randomly assigned to the intervention, and the remaining 13 served as a delayed-program control group. The outcomes included fruit and vegetable intake, measured through direct observation of randomly selected students by trained observers at baseline and 2 years later.
- At 2-year follow-up, students in High 5 Flyers schools consumed 0.16 more total daily servings of fruits/includes juice (p=.01) and 0.17 more total daily servings of fruit/no juices (p<.01) than students in control schools. While there was a reduction in vegetable intake, it was not statistically significant.
- A process evaluation of intervention components found that verbal encouragement from Food Service Staff was significantly associated with students selecting certain combinations of fruit and vegetable for consumption.