Date of Award

2018

Degree Type

Dissertation

Degree Name

Doctor of Philosophy in Biological and Environmental Sciences

Specialization

Sustainable Agriculture and Food Systems (SAFS)

Department

Nutrition and Food Sciences

First Advisor

Alison Tovar

Abstract

Childhood obesity is an important public health problem as it relates to several chronic diseases and continues to be high, particularly among low-socioeconomic (SES) and racial and ethnic minority populations. In 2011-2014, 25.0% of Hispanic 6-11-year-old school-aged children were considered to be obese or extremely obese, followed by 21.4% of non-Hispanic black children and 13.6% of non-Hispanic white children. When compared to higher-SES children of the same ethnicity and race, low-SES Hispanic, white, and black children were 2.7, 1.9 and 3.2 times more likely to be obese, respectively. Contributing to the obesity epidemic among children is the excess consumption of energy-dense snacks (EDS) and sugar-sweetened beverages (SSB) and not meeting the dietary recommendations for fruits and vegetables (FV). Given their wide reach, schools are an optimal location to educate on the importance of healthy foods and/or reduction of unhealthy foods that may influence dietary habits.

The majority of school-based nutrition interventions have focused primarily on increasing fruit and vegetable (FV) consumption. However, this is problematic because while EDS and SSB provide very little in terms of nutrients, they more than likely replace healthy foods and also provide a lot of calories which can lead to weight gain. Furthermore, students respond favorably to technology, a tool that has been shown to increase nutrition outcomes, yet has been sparsely used in EDS and SSB-targeted nutrition education with low-SES school-aged students. Therefore, the first chapter focuses on the primary aim of this study which was to test the effect of a 13-week school-based nutrition education program on EDS (sweet and salty) and SSB intake with low-SES 3rd grade students utilizing the technology-integrated Body Quest: Food of the Warrior curriculum enhanced with additional nutrition education materials. The treatment 3rd graders significantly decreased their EDS and SSB consumption from baseline (week 1) to post-assessment (week 13). When compared to the control group over time, the treatment 3rd graders significantly decreased their EDS consumption. These results indicate that the school-based nutrition education program is effective in decreasing EDS consumption in low-SES 3rd graders.

While school-based nutrition education programs help improve what foods students consume, there is room for improvement. One way to improve these programs is by incorporating student feedback into nutrition education programs. Moreover, students’ perspectives may help provide a more complete picture on how a school-based nutrition education program can impact what they eat. They may also provide insight into the students’ perceptions of the program to help guide future programming. However, few studies have incorporated feedback from low-SES, racially and ethnically diverse school-aged students. Thus, the second chapter concentrates on the secondary aim which was to determine the acceptability and appeal of the school-based program, as well as barriers and/or facilitators to behavior changes by the 3rd grade students, through semi-structured focus groups. Qualitative analysis found that the 3rd grade treatment students enjoyed the program, yet had suggestions for improvement; perceived that the program influenced their attitudes towards making healthy choices and also affected what their family was consuming; and shared barriers such as appealing taste to unhealthy food that prevented them from eating healthier. The students’ insights help to inform future program content and understand what facilitates and prevents behavior change.

Lastly, as parents/caregivers play a critical role in shaping the child’s environment and behaviors, they also need to be included in education efforts. However, parental involvement in nutrition education programs remains a challenge, and are often only provided indirect education through newsletters. Active involvement is successful in behavior change, yet is sparse, especially in the low-SES population. Therefore, the attention of the third chapter is of the third exploratory aim of this study. The third aim explored if students exposed to an additional group-based parental component would have greater improvement in EDS and SSB outcomes compared to those students who only receive the in school nutrition education program. As extensive recruitment and retention efforts were made for a 6-week “Family Night” program, this exploratory aim morphed into an opportunity to share “lessons learned” around recruitment, retention and family programmatic successes and challenges. Multiple modes of recruitment including flyers, stickers and text messages were used. Additionally, involving students in the program and reminder text messages encouraged repeated family attendance. From baseline (week 1) to post-assessment (week 6), parents improved in nutrition-related parental practices, children increased their confidence with cooking skills, and both parents and children improved in nutrition-related habits. While recruitment and retention was a challenge, the “Family Night” program was successful in improving the involved families’ well-being.

In conclusion, this multicomponent intervention targeted at low-SES 3rd graders successfully decreased unhealthy dietary consumption, improved family nutrition-related habits, and provided a mode for students to express their thoughts, share insight, and contribute in a meaningful way to future programming

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