Objective: To determine whether a social cognitive theory guided nutrition educational intervention in an after-school program is associated with improved nutrition and physical activity knowledge, attitudes, beliefs and behaviors for fourth and fifth grade participants. Design: A prospective comparative study with a quasi-experimental design over a six month period. Questionnaires were collected at baseline and at the end of the program for students at the intervention and comparison schools. Follow-up questionnaires were collected at the intervention school three months post program. Subjects/Setting: Fourth and fifth grade students enrolled in an after-school program targeted to reach students performing below grade level and/or living below the poverty level at an elementary school in southwest Virginia. Fourth and fifth grade students at another county elementary school with similar demographics served as comparison participants. Main Outcome Measures: Daily food intake, dairy intake, physical activity, sedentary behaviors, environment, self-efficacy for consuming dairy products, and food and activity beliefs. Statistical Analysis: Measures of central tendency (mean, median, and variance) were performed to describe participants. Independent t-tests (p<0.05) were used to compare changes from pre to post-questionnaire by treatment group. Paired t-tests (p<0.05) were used to test for differences from pre to post-questionnaire within group. Chi square analysis (p<0.05) was conducted to further investigate changes between groups. Results: Intervention participants significantly increased previous day's milk consumption (p=.006) and plans to drink low-fat milk instead of regular milk (p =.047) from pre to post-program. Significant change was also observed in previous day's milk consumption change from pre to post between groups (p=.004). Conclusion: Participation in an after-school program with nutrition education could change daily milk consumption and plans to drink low-fat over regular milk. Applications: After-school nutrition interventions can be effective in changing milk intake and plans to consume low-fat milk. / Master of Science

College students engage in poor dietary behaviors which put them at risk of weight gain and subsequent future health problems. This necessitates implementation of nutrition interventions which target dietary behaviors in college students so that healthy dietary patterns can be adopted and maintained through adulthood. Dairy intake is one of the many dietary behaviors which has declined substantially in young adults (18-30 years of age) - a period which includes the college age population. According to 2005 dietary guidelines for Americans three or more than three servings of low-fat/fat-free dairy foods is recommended for young adults, which is associated with overall nutrient quality of the diet and several health benefits. Still dairy consumption in this age group is below two serving per day. As emerging adults, college students may be more receptive to health advice than young adults older than traditional college years whose health habits are more established; nutrition intervention to improve dairy intake may be well received. Psycho-socio variables from Social Cognitive Theory (self regulation, social support, self-efficacy and outcome expectations) have been associated with adoption of healthy eating habits in college students and are associated with dairy consumption in adolescents. A series of studies were conducted to assess and improve dairy intake in college students by changing the mediating psycho social variables from Social Cognitive Theory (SCT) of behavior change including social support, self efficacy, outcome expectations and self regulation. A pilot web based nutrition education intervention was conducted to improve dairy intake in college students using SCT. The aim of this study was to evaluate the effect of the intervention on self efficacy, outcome expectations, self regulation, behavior and dairy product intake. Two hundred and ninety four students participated in the study and data on dairy intake and SCT variables were collected using 7 day food records and questionnaires. A 5 week electronic mail intervention was conducted. The intervention improved some social cognitive factors such as self regulation and self efficacy regarding increased dairy intake in college students, though dairy intake did not change. Next, to understand factors associated with dairy intake in college students, qualitative data were collected using focus group discussions (n=3), elicitation interviews (n=13) and online asynchronous discussion forums (n=3) using identical questions. Fifty students participated in the study and the aim was to identify relevant barriers, motivators and facilitators to dairy and low-fat dairy consumption. The results indicated that there was widespread lack of clarity regarding amount of dairy/calcium required and whether students felt they were getting enough. Major barriers to consuming dairy foods included short shelf life, storage issues, taste and accessibility to dairy foods on campus. Major facilitators included constant reminders, knowing immediate benefits, more accessibility and breakfast consumption. The aim of the final study was to improve social support, self efficacy, outcome expectations, self regulation and behavior related to dairy intake in college students using Social Cognitive Theory (SCT). One hundred and ninety one students participated in the study which included 8 week electronic mail intervention. Data collected included 7 day food records and for dairy intake and questionnaires for SCT variables. The intervention resulted in significant improvement in total dairy intake and use of self regulation strategies by college students. Taken together, these results suggest that theory-based nutrition education interventions can improve nutrition behavior in college students, a population prone to poor dietary habits. Developing mastery experiences to improve self efficacy may enhance self regulatory skills like goal setting, planning and monitoring to improve dairy intake in college students. Health care providers should aim at dietary behavior modification via theory based intervention. / Ph. D.