High 5 Fruit and Vegetable Intervention for 4th Graders

Highlights
Program Title High 5 Fruit and Vegetable Intervention for 4th Graders
Purpose School-based program designed to increase fruit and vegetable consumption. (2000)
Program Focus Behavior Modification
Population Focus School Children
Topic Diet/Nutrition, Obesity
Age Children (0-10 years)
Gender Female, Male
Race/Ethnicity Black, not of Hispanic or Latino origin, White, not of Hispanic or Latino origin
Setting School-based
Origination United States
Funded by NCI (Grant number(s): CA59776)
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The Need
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.
The Program
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.
Community Preventive Services Task Force Finding
Guide to Community Preventive Services This program uses intervention approaches recommended by the Community Preventive Services Task Force: meal and fruit and vegetable snack interventions to increase healthier foods and beverages provided by schools (Obesity) and multicomponent interventions to increase availability of healthier foods and beverages in schools (Obesity). This program also uses the following intervention approach for which the Community Preventive Services Task Force finds insufficient evidence: school-based programs promoting nutrition and physical activity (Diet/Nutrition). Insufficient evidence means the available studies do not provide sufficient evidence to determine if the intervention is or is not effective. This does not mean that the intervention does not work. It means that additional research is needed to determine whether the intervention is effective.

To expand understanding of this intervention category consider communicating with members from NCI's Research to Reality (R2R) community of practice who may be able to help you with your research efforts. Following is a link to start an online discussion with the R2R community of practice, after completing registration on the R2R site: https://researchtoreality.cancer.gov/discussions.

Time Required
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.
Intended Audience
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%).
Suitable Settings
This intervention is suitable for implementation in the school setting.
Required Resources
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.
About the Study

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.

Graph of Study Results

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

Graph of Study Results 

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

       Graph of Study Results

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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.
Publications
Primary
Secondary

Reynolds KD, Raczynski JM, Binkley D, Franklin FA, Duvall RC, Devane-Hart K, Harrington KF, Caldwell E, Jester P, Bragg C, Fouad M. (1998). Design of High 5: A School Based Study to Promote Fruit and Vegetable Consumption For Cancer-Risk Reduction. Journal of Cancer Education, 13, 169-177.

Campbell MK, Reynolds KD, Havas S, Curry S, Bishop D, Nicklas T, Palombo R, Buller D, Feldman R, Topor M, Johnson C, Beresford SAA, Motsinger BM, Morrill C, Heimendinger J. (1999). Stages of Change for Increasing Fruit and Vegetable Consumption among Adults and Young Adults Participating in the National 5-a-Day for Better Health Community Studies. Health Education & Behavior, 26(4), 513-534.

Reynolds KD, Yaroch AL, Franklin FA, Maloy J. (2002). Testing Mediating Variables in a School-Based Nutrition Intervention Program. Health Psychology, 21(1), 51-60.

Havas S, Heimendinger J, Reynolds K, Baranowski T, Nicklas TA, Bishop D, Buller D, Sorensen G, Beresford SAA, Cowan A, Damron D. (1994). 5-a-Day for Better Health: A New Research Initiative. Journal of the American Dietetic Association, 94(1), 32-36.

Reynolds KD, Hinton AW, Shewchuk RM, Hickey CA. (1999). Social Cognitive Model of Fruit and Vegetable Consumption in Elementary School Children. Journal of Nutrition Education, 31 (1), 23-30.

Reynolds KD, Franklin FA, Leviton LC, Maloy J, Harrington KF, Yaroch AL, Person S, Jester P. (2000). Methods, Results and Lessons Learned from Process Evaluation of the High 5 School-Based Nutrition Intervention. Health Education & Behavior, 27(2), 177-186.

Kratt P, Reynolds K, Shewchuk R. (2000). The Role of Availability as a Moderator of Family Fruit and Vegetable Consumption. Health Education & Behavior, 27(4), 471-482.

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Updated: 11/01/2017
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