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Recent global statistics estimate 20% of all cancer incidence could be prevented if Americans would modify their eating habits to increase fruit and vegetable intake to the minimum recommended level of five servings daily. Educational strategies to change eating behavior would benefit from a greater understanding of psychosocial and demographic factors related dietary behavior. Secondary analysis of a nationally representative survey of 2655 adults was completed to assess differences between low-income and high-income adults in psychosocial, demographic, and educational factors related to fruit and vegetable intake. Significant differences in self-efficacy, awareness/knowledge, and cost and availability of fruits and vegetables were found between the low-income and high-income groups. In the low-income group, 37% of the variance in total fruit and vegetable consumption was explained by psychosocial and demographic factors, with demographics, self-efficacy and awareness/knowledge being the most significant predictors. In the high-income group, 34% of the variance in total fruit and vegetable consumption was explained by psychosocial and demographic factors, with self-efficacy alone accounting for 14% of the variance. This research suggests that, regardless of income category, social cognitive factors, in particular self-efficacy and knowledge/awareness of the health message, are stronger predictors of fruit and vegetable consumption than are perceived barrier factors. Given the weaknesses of the survey instrument, the findings need to interpreted with caution. Policy inferences can be suggested from this research, but would need further research findings before implementation of nutrition policy recommendations. The implications of these research findings are that nutrition education interventions to increase fruit and vegetable consumption should be aimed at affecting those psychosocial factors that are predictive of behavior change. In particular, differences by income level between psychosocial, education, and behavior responses underscore the need for tailoring educational interventions by income group for greater impact. The most relevant psychosocial predictors of fruit and vegetable consumption in adults are self-efficacy, awareness/knowledge of the health message, social support, and weak intent. The most relevant demographic predictors were smoking status, educational level, and age. Income level appears to share variance with other demographic variables and should be explored in further research. / Ph. D.

In response to the dramatic increase in the prevalence of childhood overweight, a provision of the Child Nutrition and WIC Reauthorization Act of 2004 required school divisions participating in the National School Lunch and Breakfast Programs to adopt local school wellness policies (LWP) by the fall of 2006. The local school wellness policies were to include guidelines for nutrition education, physical education (PE) and physical activity, and foods offered on campus. The purpose of this study was two-fold: 1) compare and contrast proposed goals versus adopted policies in Virginia; and 2) analyze the rigor of LWPs in Virginia. All LWPs in Virginia were reviewed with each item scored as required or recommended and specific or broad. Chi-square analyses were used to compare policies that were proposed and adopted. Eighty-one local wellness policies were matched to goals. In general, school divisions did not adopt as many policies as proposed. LWPs met only the minimum requirements mandated. Only 56 (69.1%) had policy language for more than one category in each of the three areas studied with nutrition education policies more popular than physical education/physical activity and nutrition guidelines. For example, 60 schools adopted policies to promote classroom nutrition education, whereas no LWPs contained policy language to improve PE teacher-student ratio. Further, specificity proved to be a concern. The results suggest that while schools may be meeting the minimum requirements, the LWPs may not be promoting school health to the degree intended. / Master of Science

The purpose of the present study was to gain insight on the real and perceived needs of food stamp recipients for use in developing nutrition education programs. Six focus group interviews with 26 food stamp recipients were conducted in six Virginia counties. Transcripts of the meetings were analyzed to identify themes prevalent in all of the focus group interviews. Ninety-two 24-hour food recalls from a different sub-group of food stamp recipients were also analyzed for food consumption frequencies, trends in food preparation, and common food purchasing locations. A key finding was that most focus group participants made food-related decisions while in the grocery store. Explanations for incidences of food resource scarcities included beliefs that the amount of food stamps was insufficient and that poor food purchasing decisions were made. Predominant food behavior changes that had been previously attempted were decreasing consumption of fat and fried foods and reducing portion sizes. Most of the reasons for attempting those behavior changes involved a desire for weight loss. Prevalent nutrition education interests were low-fat cooking and child nutrition. Results of the 24-hour food recall analysis indicated an inadequate consumption of fruits, vegetables, whole grain cereals, and dairy products. Seventy-five percent of the subjects purchased food in a grocery store and prepared meals at home. / Master of Science

The feasibility and effectiveness of video instruction as an alternate means of delivering nutrition education to low-income homemakers were examined in this study. Demographic and mediating variables that may affect the success of video instruction were also investigated. Consenting EFNEP and SCNEP homemakers (N=105) were randomly assigned to receive either video lessons with follow-up telephone discussions and intermittent home visits (Video Group) or face-to-face home visits/small group sessions (Traditional Group). Assessments of locus of control and cooking reinforcement values (RVs) were conducted at baseline. Dietary and food-behavior changes were assessed using 24-hr recalls and a 14-item behavior checklist questionnaire, respectively. Questionnaires were used to assess the Program Assistants' (PAs) and participants' perceptions of video instruction. Analytic measures included multivariate analyses of variance, analyses of variance, <I>t</I>-tests, chi-squared tests, and frequency calculations. Experiment-wise significance was set at <I>p</I> < 0.05 with correction using the Bonferroni method. Seventy-three participants completed the study. For both groups, significant improvements were seen from pre to post intervention in vitamin C intakes, the number of servings consumed from the Fruit Group, and food behavior checklist scores. The Traditional Group also increased their intakes of vitamin A, vitamin B₆, calcium, and fiber. There was no difference in the change of dietary intakes and behavior checklist scores between the two groups. No effects were found for race, age, residence, locus of control, or cooking RV. Video instruction was well received by most participants and PAs and was substantially less expensive than traditional instruction. Due to the effectiveness and acceptability of video instruction, it should be considered when delivering nutrition education to low-income homemakers. / Master of Science

Thesis (M. Tech. - Food Service Management, Dept. of Hospitality, Tourism and PR management)--Vaal University of Technology / Malnutrition amongst pre-school children age two-to-five-years is a growing world-wide concern. This is mainly due to poverty, diseases and inadequate dietary intake. Malnourished children are also a problem in South Africa. Pre-schools play an important role in the prevention of malnutrition because most young children consume about two thirds of their food and therefore their daily nutritional intake at the pre-schools. There are various factors that affect a child's nutrition in pre-schools, such as food choices, meal plans, the environment and the nutritional knowledge of the caregivers. Pre-schools can only fulfill this responsibility through the proper nutritional knowledge and training. The nutritional education and knowledge of food service assistants/caregivers are very important, because they compile the meal plans and menus for pre-schools. The objectives of this study were to evaluate a Nutrition Education Programme (NEP) to address the lack of nutritional knowledge of service assistants/caregivers who plan the menus in pre-schools in terms of existing menu content and food choices required for children between two to five years of age and by using the existing menus and food choices applied to make recommendations for nutritional skills training. Also in terms of basic nutrition, health and safety, to recommend more appropriate alternatives acceptable to children between two to five years of age. Lastly to integrate recommendations for nutritional skill training with regard to the alternative meal plan, eating habits and food choices for the menu through a NEP that would be implemented and evaluated. The study design was a combination of an exploratory and quantitative-descriptive research design in the form of a survey. A pilot study was used mainly to test the nutrition knowledge questionnaires for content validity. The study population of this research project was randomly selected pre-schools chosen from the Eatonside informal settlement. Procedures for data gathering and the different methods used for data analysis were divided into four phases. Descriptive statistics were used to determine the percentage of pre-schools who answered the questions correctly for selected nutrition knowledge, portion sizes questions and menu planning, as well as food safety and health. Paired t-tests were carried out to measure the statistically significant difference (pS0.05) before and after the implementation of the NEP. The results of the t-test indicate that only nine of the questions in the post-test questionnaire showed a confidence interval of the difference. There is statistical significance in these questions through either increase or decrease. It can be concluded that the Nutrition Education Programme (NEP) was successful, but that more training is needed due to the limitations experienced. The menu analysis tested the respondent's menus in terms of the average daily nutrient intake level given to the pre-school children. The data of the pre- and post-test menus were then compared to EAR in order to determine any change in the menus nutritional values after the NEP was completed. The results showed that there were differences in the post-test results that both decreased and increased.

Childhood obesity rates are on the rise. There are detrimental physical and psychological health effects associated with childhood obesity. Society needs proven methods of delivering nutrition and physical activity education to children. The Teens Reaching Youth (TRY) 4-H model has been shown to be effective at delivering curriculum in a variety of topics. To assess the effectiveness of the TRY 4-H model at delivering nutrition and physical activity education to youth, grades third through sixth. The program's objectives were to increase youth participants' nutritional knowledge, improve youth participants' eating and fitness habits, and improve leadership and life skills of the teens involved in the TRY 4-H program. We compared three groups of youth grades third through sixth in Northern Utah. We looked at the youth's nutrition knowledge and food preferences as well as their parents/guardians' behaviors. Then two of the groups participated in a nutrition and physical activity education program. One group was taught by TRY 4-H teams and the other group was taught by adult volunteers from the community. After participating in the program, the youth's nutrition knowledge and food preferences and their parents/guardians' behaviors were re-assessed. The control group was unavailable for re-assessment due to limited access. Teen leadership was assessed using a teen leadership and life skills assessment tool. At baseline, the three samples had no statistical differences. The TRY 4-H treatment and Adult Volunteer treatment were found to produce statistically similar nutrition knowledge out-comes. Parents/guardians reported improvements in youth participant nutrition and physical activity habits. Teen members of the TRY teams experienced an increase in leadership and life skills. Teens from the TRY 4-H program are as effective as adult volunteers at teaching younger youth about nutrition. This education delivery method should be utilized in additional communities to aid in the fight against childhood obesity.

Thesis (MNutr)--Stellenbosch University, 2014. / ENGLISH ABSTRACT: Objectives: To measure the impact on nutrition knowledge; to ascertain the opinions and practices related to nutrition and physical activity, tuck shop visits, and dietary quality of Grade 4 learners; as well as the perceptions on and acceptability of the ‗Fun Food Game‘ (FFG) as nutrition education tool as evaluated in selected Grade 4 learners and educators. Design: A before-after, experimental study with analytical components. Setting: A purposive sample of four schools in the City of Cape Town district of the Western Cape province. Schools A and B in a higher socio-economic area served as intervention school (HIS) and control school (HCS), whereas schools C and D were in a lower socio-economic area and served as intervention school (LIS) and control school (LCS). Subjects: Grade 4 English-speaking boys (n=85), girls (n=90) and Life Orientation educators (n=10). Methods: Pre-tested questionnaires were used to determine change in nutrition knowledge, opinions and practices, both related to nutrition and physical activities in a pre-and post-setting, as well as the perceptions on and acceptability of FFG as a nutrition education (NE) tool for Grade 4 learners and educators. A ‗Dietary Diversity Questionnaire‘ was used to establish the ‗Dietary Diversity Score‘ (DDS), and to note tuck shop visits. Questionnaires were pre-tested in a pilot study. Results: Increased nutrition knowledge and improved opinion on nutrition and physical activities were measured in all schools, but practices related to nutrition and physical activities as well as visits to the tuck shop showed mixed results. In the pre- and post-setting, a DDS of 5 was measured in the HIS and HCS, with a DDS of 5 in the pre- and 6 in the post-setting in the LIS and LCS. Fewer learners had a DDS<4 in the post-setting. Consumption of most food groups and eating breakfast were higher in the post-setting. Bringing lunch boxes to school scored lower in the intervention schools. More tuck shop visits were reported in the LIS and LCS. Most (80% n=8) educators indicated a strong need for NE for themselves. All educators indicated self-learning as a means of familiarising themselves with the content of NE. Sources of nutrition advice included magazines (90% n=9), the Internet (80% n=8) and textbooks (70% n=7). A strong need for NE was expressed by all educators; however, they stated that it should not increase their work load. Educators ‗strongly agreed‘ that the educational nutrition board game FFG can be classified as ‗Health Promotion‘. Overall, learners indicated that playing FFG was a positive experience. Conclusion: Playing FFG and/or having an increased awareness regarding nutrition and physical activities at schools could have had a positive impact on nutrition knowledge and behaviour that could have resulted in positive behaviour, but no definite conclusion can be made in this regard. Nutrition behaviour was more positively influenced in the lower socio-economic schools. Implementing the Health Promoting Schools concept, where Nutrition Education Programmes form part of a multi-component strategy, is recommended. / AFRIKAANSE OPSOMMING: Doel: Om die impak van voedingskennis, opinies en praktyke verwant aan voeding en fisiese aktiwiteite, snoepiebesoeke asook dieetkwaliteit van Graad 4 leerders te bepaal, sowel as die persepsie en aanvaarbaarheid van ‗Fun Food Game‘ (FFG) as hulpmiddel in voedingsopleiding soos geëvalueer deur geselekteerde Graad 4 leerders en -onderwysers. Ontwerp: ‗n Voor-na, eksperimentele studie met analitiese komponente Omgewing: ‗n Doelbewuste groepskeuse van vier skole. Skole A en B in ‗n meer gegoede area het as intervensie skool (HIS) en kontrole skool (HCS) gedien, terwyl skole C en D in ‗n minder gegoede area as intervensie skool (LIS) en kontrole skool (LCS) gedien het in die Stad Kaapstad distrik van die Westelike Provinsie. Deelnemers: Graad 4 Engelssprekende seuns (n=85), dogters (n=95) en Lewensoriënteringsonderwysers (n=10) Metodes: Voorafgetoetsde vraelyste is gebruik om te bepaal of voedingskennis, opinies en praktyke beide verwant aan voeding en fisiese aktiwiteite, voor en na die studie verander het, asook die persepsie en aanvaarbaarheid van FFG as ‗n hulpmiddel in voedingsopleiding vir geselekteerde Graad 4 leerders en onderwysers. ‗n Dieetdiversiteit Vraelys (‗Dietary Diversity Questionnaire‘ – DDQ) is gebruik om ‗n Dieetdiversiteit Telling (‗Dietary Diversity Score‘ – DDS), sowel as snoepiebesoeke te bepaal. ‗n Loodsstudie is uitgevoer om die vraelyste te toets. Resultate: ‗n Toename in voedingkennis en verbeterde opinies oor voeding en fisiese aktiwiteite is in alle skole gevind, maar praktyke oor voeding en fisiese aktiwiteite, asook snoepiebesoeke het gemengde resultate getoon. In die voor- en na-toetsing is ‗n DDS van 5 in HIS en HCS bepaal, met ‗n DDS van 5 in die voor- en 6 in die na-toetsing in LIS en LCS. Minder leerders het ‗n DDS<4 in die na-toetsing gehad. Inname van die meeste voedselgroepe sowel as ontbyt het in die skole toegeneem. Die bring van kosblikke het in die intervensie skole verminder. Die hoogste frekwensie snoepiebesoeke kom voor by die LIS en LCS. Meeste (80% n=8) onderwysers het ‗n sterk behoefte aan voedingsopleiding vir hulself aangedui. Alle onderwysers dui aan dat die inhoud van voedingskennis deur selfleer verhoog word. Tydskrifte (90%, n=9), Internet (80%, n=8) en handboeke (70%, n=7) word as bronne van voedingsadvies beskryf. ‗n Sterk behoefte vir opvoedkundige voedingsopleiding is deur al die onderwysers aangedui, maar sonder dat dit hul werkslading moet verhoog. Die onderwysers is ―sterk oortuig‖ daarvan dat die opvoedkundige voedingsbordspeletjie FFG, as ―Gesondheidsbevordering‖ geklassifiseer kan word. In die algemeen het leerders dit baie positief ervaar om FFG te speel. Samevatting: Die speel van FFG en/of ‗n groter bewusmaking van voeding en fisiese aktiwiteit wat by die skole plaasgevind het, kon ‗n positiewe impak op voedingskennis en -gedrag gehad het, wat kon lei tot positiewe gedrag, maar geen definitiewe gevolgtrekking kan gemaak word in die verband nie. Voedingsgedrag in die mindergegoede skole is meer positief beïnvloed. Implimentering van die Gesondheidsbevorderende Skole konsep, waar Voedingsopleidingsprogramme deel vorm van ‗n multi-komponent strategie, word aanbeveel.

Master of Public Health / Department of Human Nutrition / Mary L. Higgins / Nutrition education programs strive to help low-income people make optimal food choices while living on a limited budget. This study addressed perceived understanding, acceptance, and usability of Food and Nutrition Bytes, a set of 12 eight- to eleven-minute online Expanded Food and Nutrition Education Program (EFNEP) lessons. Clients in EFNEP during 2005-2006 were surveyed on internet usage and interest in online nutrition lessons. Lessons were developed and assessed for reading levels using two formulas. Clients and professionals in six Kansas counties completed a Likert scale survey and gave comments after they viewed one online lesson. Fifty-five percent of 75 EFNEP clients who had internet access indicated they were interested in taking nutrition lessons online. The new lessons averaged a 6.64 grade reading level. Two lessons had content that was rated too general to be useful. For the remaining lessons, both groups ranked their perceived understanding, helpfulness of graphics and audio, and usefulness of information at the first or second most-desirable rating. They rated length and amount of information as “Just Right.” The only difference found between the groups was when clients rated one lesson as having a little too much information and professionals rated it as having not quite enough (Mann-Whitney U = 35.0, p = 0.039). Within-sample associations were measured for two lessons. Clients older than 30 years of age found the Grains lesson’s pictures and graphics to be more helpful than did younger clients (Kendall tau-b = 0.593, p = 0.002). White clients evaluated the Cooking lesson as being easier to understand than did non-white clients (Kendall tau-b = -0.477, p = 0.020). The most frequent comments pertained to the importance of portion sizes and appropriate pictures and graphics. Overall, Food and Nutrition Bytes lessons were easy to read, and perceived by both clients and professionals to be easy to understand, helpful and useful, and also optimal in length and amount of information. Despite low numbers of EFNEP clients who had internet access, over half were interested in taking lessons online. Limitations of this study include small samples, convenience samples, subjects’ time constraints, and interviewer bias.