Effects of Nutrition Programs

on Third Grade Students

Helen M. Smith and Catherine L. Justice

A unique aspect of this study was a specially preparednutrition education program involving parents of students

SummaryA research study to measure the influence ofa nutrition pro­

gram for third grade students and a parent program concerningnutrition and school lunch was conducted in an urban schoolsystem. The comprehension of nutrition by students wasevaluated by answering items on a nutrition knowledge test. Toevaluate the application ofnutrition, the ability and willingnessof the students to use nutrition knowledge was shown in theirfood practices at lunch and in their attitudes toward specificvegetables on a rating scale. Four classrooms were used todevelop the evaluation instruments: a nutrition knowledge pre­and posttest, a vegetable preference rating scale, and a lunchquestionnaire. Eight other classrooms participated in theresearch project, with two classrooms in each of the followinggroups: I) Control, 2) Parent Education, 3) Student Education,and 4) Parent Education and Student Education (PE-SE). Thechanges in mean rank scores on the vegetable preference ratingscale were positive for the experimental groups but negative forthe control group. The PE-SE group did significantly increaseparticipation in the school lunch program (Omega < 0.05).Parents ofstudents in the parent program made favorable com­ments.

The Need for Early EducationThe general level of human health in the V.S. is not as high as

it should be (I). Nutrition education is frequently neededregardless of income, geographic location, cultural background,social status, or level of education (2). The affluent society doesnot seem to have a good diet. Obesity, anemia, and dental carieshead the list of nutritional problems of people living in the V.S.(3). An affluent but nutritionally illiterate population that eatsmore and more poorly is evidence enough to show a need fornutrition education. The real goal of nutrition education is tomake diets better-to have people eat a life-sustaining, life­enhancing diet (4-7). An understanding of the role of nutritionand its application to daily living can be regarded as preventivemedicine and is essential to the future health of everyone,especially children (5, 8-10). Since educators believe the eatinghabits of school-age children may be more easily influenced dur­ing the early elementary years than at any other time of life, in­struction in nutrition should be provided for the student (8),both in school and the home.

For example, vegetable acceptance seems to be a major prob­lem in the V.S. Studies done to measure food waste in the schoollunch program indicate that greater amounts of vegetables andfruits than other foods remain uneaten (II, 12). While the schoolfoodservice program provides students with food needed duringthe school day for physical, emotional, and intellectual develop­ment, it is also a function and obligation of the school foodser­vice to be a source of information to the student, school, andcommunity. The school lunchroom can be a living laboratory

THE A UTHORS are, respectively, Associate Professor, Depart­ment of Home Economics, Ball State University, Muncie, IN47306; and Associate Professor, IFoods and Nutrition, PurdueUniversity, West Lafayette, IN 47907.

where the student can practice desirable food and health habits(7, 8, 13).

Attitudes toward foods such as vegetables are surely and firm­ly transmitted by those who guide children at meals (14). Thehome continues to be the primary influence on the child (15).The preschool child does not form fixed food habits but may im­itate an adult model. Therefore, parents need to be reached earlyin parenthood, since impressions and attitudes developedtoward food by a child are often lasting ones (13).

Two nutrition education programs being used in the V.S. are"Big Ideas," developed by the Dairy Council of California, and"Mulligan Stew," prepared for the Cooperative ExtensionService (16, 17). Five of the eight published studies reviewedevaluated the effectiveness of a nutrition education curriculumbased on either "Big Ideas" or "Mulligan Stew" (17-21). All at­tempted to provide nutrition education for the child, and eachcited improvement in scores on cognitive tests following theeducational effort (11, 17-23).

Parents need to be reachedearly in parenthood, sinceimpressions and attitudes

developed toward food by a childare often lasting ones.

However, there is little evidence in the literature showingchanges in eating habits after students received nutrition educa­tion programs; and none of the nutrition studies reviewed ac­tually involved the parents of students in a specially preparednutrition education program. Therefore, the purpose of thisresearch study was to measure the influence of a student nutri­tion education program, a parent nutrition education program,and a combination of these two programs on the comprehensionand application of nutrition knowledge by third grade students.

Student and Parent ProgramsTwo nutrition programs, one for third grade students and one

for their parents, were prepared. Both programs were developedby a nutrition educator with experience in training elementaryteachers and school lunch personnel. The program for thestudents was called "More Vegetables, Please." After reviewingnutrition education materials currently available, concepts andbehavioral objectives were prepared for the curriculum. Thenutrition concepts were as follows:

Children need different kinds of food to maintain growthand health. Vegetables are important factors in the growthand health of children.

2 Vegetables taste good and provide necessary nutrients forthe body.

92 Journal of Nutrition Education Vol. II No.2 April-June 1979

3 Vegetables which are eaten come from many differentparts of the plant. Vegetables are available in manydifferent forms, such as fresh, frozen, canned, and dried.

4 Proper food habits may result in better health for the in-dividual.

Two lessons were developed for each of the four concepts to betaught by the researcher in the eight weeks of the nutritioneducation program. Each of the eight lessons included a briefformal introduction along with discussions, slides, or student ac­tivities emphasizing vegetables in nutrition.

The program for the parents consisted of a series of letters. Aninitial survey was conducted to compile information on whatparents of third grade students would like to know about nutri­tion and the school lunch program. From this data the followingbehavioral objectives were written for the parent education pro­gram:

The parents of third grade children should be aware that avariety of foods, especially vegetables, can make a dif­ference in the growth of children, the health of children,and the behavior of children and that the values of aschool lunch program include nutritionally adequatelunches, varieties of foods with fruits and/or vegetables,lunches prepared under sanitary conditions, high qualitylunches at low cost, and instruction in good food habits.

2 The parents of third grade children should become moresupportive of the school lunch program.

3 Third grade children of parents participating in the parenteducation program should better comprehend and applynutrition knowledge.

A series of six different one-page letters were then developedfrom these objectives for the parent education program. Ar­rangements were made for parents to visit the satellite lunchkitchen at a convenient time and to have lunch at school one dayduring the treatment period.

Twelve third-grade classrooms in five elementary schools in anurban school system took part in the research study. Fourclassrooms of students were used in the development of theevaluation instruments. The remaining eight classrooms provid­ed the control and experimental groups. Two classrooms wereincluded in each of the following groups:

• Control (C)• Parent Education (PE)-students' parents who received

the parent education program• Student Education (SE) - students who were taught the

nutrition program• Parent Education and Student Education (PE-SE)-par­

ents who received the parent education program andstudents who were taught the nutrition program.

To develop the evaluation instruments for the study, twoclassrooms were chosen to receive a free-response nutritionknowledge test, a trial vegetable preference rating scale, and apreliminary lunch questionnaire. The free-response nutritionknowledge test was written from the concepts, behavioral objec­tives, content, and test grid from the nutrition education pro­gram. The two remaining classrooms were selected to answeritems on a trial nutrition knowledge test which provided item­analysis data for the development of the written nutritionknowledge test used in the study. The trial nutrition knowledgetest was written by the researcher using the concepts, behavioralobjectives, test grid, and answers from the items on the free­response nutrition knowledge test. Twenty multiple-choice itemswere written for the try-out nutrition test with three distractorseach having a yes or no answer. The student was to circle the oneright answer.

The concepts, behavioral objectives, test grid, and try-outnutrition test were sent to three third-grade teachers not in­volved in the study in the urban school system. They evaluatedthe try-out nutrition test for content validity, ascertainingwhether the concepts and reading level were designed for thirdgrade students. The evaluations were read and considered in therevision of the try-out nutrition test.

The concepts, behavioral objectives, test grid, and try-outnutrition test were sent to an Associate Professor of Foods andNutrition at Ball State University. An evaluation was requestedto ascertain if the try-out nutrition test items had content validi­ty. The comments were read, and revisions were made in the testitems.

The method described by Tuckman was used to calculate anindex of discriminability and difficulty of items on the try-outnutrition test. The try-out nutrition test items were graded witheach being marked either right or wrong. To find the index ofdiscriminability and difficulty of each item on the try-out nutri­tion test, the students were subdivided into high-third, middle­third, and low-third scorers. The number of high- and low-thirdscorers who passed each item was identified. The index ofdiscriminability of each item was calculated by dividing thenumber of high-third scorers passing the item by the totalnumber in both the high- and low-third groups passing the item.All items on the test were found to have an index ofdiscriminability above 0.67. The items were then checked fordifficulty by dividing the total number who failed an item in thehigh- and low-third group by the total number in both groups(24). The index of difficulty between 0.33 and 0.67 was used.Those items found to be either too difficult or too easy wererevised. The answers to items were also placed in the computerfor item analysis. The computed KR-20=0.8137 was above theKR-20 = 0.75 accepted as the level needed to establish internalconsistency reliability. The original test difficulty average was0.49.

On the basis of the trial scale, a vegetable preference ratingscale was written by the researcher to ascertain if any change oc­curred in the preferences of vegetables by third grade studentsafter the student and/or parent nutrition education programs.Utilizing information from the preliminary questionnaire, alunch questionnaire was developed by the researcher to calculatethe frequency of participation of third grade students in theschool lunch and their attitude and acceptance of the foodseaten at lunch. Therefore, the final evaluation instruments in­cluded:

• The completed written nutrition knowledge pre- and post­test using 20 multiple-choice items, each with threeresponses

• A hedonic scale with five different facial expressions usedto measure the vegetable preference of students

.. A lunch questionnaire with five items measuring the eatinghabits of students.

In the two-week periods before and after the nutrition educa­tion programs, the written nutrition knowledge pre- and posttestas well as the hedonic scale to measure vegetable preference weregiven to all third grade students in each of the eight classrooms.Concise instructions were given before the administration of thenutrition knowledge test. An example was given. Then each itemon the test was read aloud by the researcher, and any item wasrepeated if requested. A lunch questionnaire was checked by allthird grade students in each of the eight c1asssrooms every dayafter lunch in the two-week periods before and after the nutri­tion education programs.

The researcher taught eight 45-minute nutrition lessons infour of the third-grade experimental classrooms for a total of ap­proximately 6 hours in the eight-week period. In the two ex-

April-June 1979 Vol. II No.2 Journal of Nutrition Education 93

A more favorable reactionto nutrition lessons has been

found when the classroom teacherbecomes involved in a nutrition

workshop and teachesthe nutrition lessons.

perimental groups with parent education, students took homeone letter each week for six weeks. In addition, these parentswere invited to visit the satellite lunch kitchen and to have lunchwith their child at school one day during the treatment period.

Subjective ResultsIn the reporting of the subjective results of the study, the reac­

tions of the third grade students toward the activities planned foreach of the nutrition lessons were recorded. Many students par­ticipated in the discussions about the use of food in the humanbody, about the Four Food Groups, vegetables, and the growthneeds of animals and plants. Growing vegetables, playing nutri­tion games, solving puzzles, and feeling and tasting differentvegetables were of interest to the third grade students.

At the conclusion of the parent education program, a letter ofappreciation was sent to the parents along with an evaluationform requesting their opinion of the program. The resultstabulated from the evaluation forms returned indicated thatsome parents seemed to enjoy receiving the parent letters. Ap­proximately one-third of the parents included written commentswhich were very favorable toward the parent education and thenutrition education programs. A few of the parer.ts were criticalof the food wasted in the school lunch and suggested a variety ofpossible solutions to the problem.

The scores of the nutrition knowledge test were submitted toanalysis of variance (25). These scores revealed no statisticallysignificant differences when comparing the changes in the nutri­tion knowledge pre- and posttests for the control and ex­perimental groups. In Table I are presented the results of themean scores and standard deviations on the nutrition knowledgetests for each of the four groups in the study.

The hedonic scale for vegetable preferences of third gradestudents was assigned five integers on a continuum designating 5

for "dislike very much" to I for "like very much." Thevegetable rating scale was then scored. The results ofthe calcula­tions of the mean scores of each of the 16 vegetables for the con­trol group and the three experimental groups while comparingthe changes occurring between the pretest and posttest are in­dicated. See Table 2 for the change in mean rank for allvegetable preferences. A decrease in rank score indicated betteracceptance of vegetables. The change was given a positive signwhen vegetable preference improved. The pretest and posttestperiod ratings for each of the 16 different vegetables in the con­trol group and each of the three experimental groups were thenevaluated by analysis of variance. The only significant differencewas in lettuce, when comparing the C to PE groups (p < 0.05).

The lunch questionnaire, which was given to all students inthe study before and after the treatment period, was evaluatedby tabulating the frequency of each behavior listed on the ques­tionnaire. The percentages of these frequencies to the totalnumber of students answering the questionnaire in each groupfor each period were subjected to the Lawshe-Baker Nomograph(26). In Table 3, a significant difference is shown in participationin the school lunch program by the PE-SE group and the con­sumption of vegetables at lunch by the PE group and the PE-SEgroup (Omega< 0.05). Other significant differences are noted inthe comparison of groups in Table 3 (Omega < 0.05).

Trends EmergeAlthough all groups including the control group showed no

significant improvement in cognitive knowledge, the researcherbelieves that the third grade students in the experimental groupsmight have improved more if the treatment period could havebeen longer and included more than 45 minutes a week. Trendstoward more desirable nutritional behavior, although notsignificant, were apparent in the vegetable preference scores andin answers to some items on the lunch questionnaire. There weresome significant differences favoring nutrition education pro­grams in response to particular evaluation items, such as an in­crease in consumption of vegetables at lunch by the PE groupand the PE-SE group and increased participation in the schoollunch by the PE-SE group.

When parents were asked to evaluate the parent and studentnutrition education programs, favorable replies for both pro­grams were received. Parents also stated that they appreciatedthe information in their letters about nutrition and the schoollunch program.

Table 1 Comparison of mean scores and standard deviations on nutrition prelests and posttests for eachgroup of students

Control Parent Education Student Education Parent Education andNutrition Test Mean±SD Mean±SD Mean±SD Student Education

Mean±SD

Pretest 13.81 ± 3.13 12.51 ±3.50 13.29 ± 3.97 14.09±3.24Postlest 14.81 ±2.75 14.02±3.20 14.14±3.95 14.25 ± 3.50

Change + 1.00 + 1.51 +0.85 +0.15

Table 2 Comparison of tolal mean rank scores for all vegetable preferences by each group from the pre­test to posttesl periods

Vegetables

PretestPosttesl

Change

'p>O.05 10 p<O.l

ControlMean

35.7936.07

-0.27

bp >O.110 p<O.2

Parent EducationMean

38.8135.53

+3.28

Student EducationMean

40.5035.09

+5.40'

Parent Education andStudent Education

Mean

40.9236.14

+4.78b

94 Journal of Nutrition Education Vol. 11 No.2 April-June 1979

Table 3 Comparison of frequency and percentage of third grade students' answers to pre- and posttreatment lunch ques-tionnaire'

Control Parent Education Student EducationParent Education and

Student Education

Item Pre Post Pre Post Pre Post Pre Postn % n % n % n % n % n % % %n n

Kind of LunchSchool lunch 208 56 229 54 237 60 284 63 412 79 411 78 370 73* 467 81*Sack lunch 161 44 205 46 157 40 164 37 108 21 115 22 139 27* 112 19*

Foods Not Eaten

Milk 14 4 31 7 30 8 34 8 52 10 62 12 35 7 38 7Sandwich 27 7 39 9 52 13* 83 18* 47 9 46 9 61 12* 41 7*Fruit 25 7 20 5 56 14 58 13 76 14* 101 19* 99 19 94 16Vegetable 38 10 31 7 94 24* 77 17* 86 16 74 14 116 23* 102 17*Main dish 28 8 43 10 40 10 53 12 57 II 41 8 53 10 47 8Dessert 49 13 43 10 69 17 71 16 87 17* 69 13* 74 14 70 12

• A significant change in the Omega value at the 0.05 probability level'Number of students involved in answering test questions varies because each student did not answer every question.

In this particular research study there was no significant im­provement in the mean test scores on the cognitive nutrition testin any of the groups. There was a trend, although not signifi­cant, to a better acceptance of vegetables by the experimentalgroups over the control group as measured by the vegetablepreference rating scale. The experimental groups also par­ticipated more in the school lunch program than the controlgroup after the nutrition education and parent education pro­grams. Des\Jite these trends, the differences were not significantbetween the control and the experimental groups.

Although having the researcher teach the nutrition lessonsruled out any classroom teacher bias, it appeared from otherstudies that students can learn more about nutrition from theclassroom teacher. A more favorable reaction to nutritionlessons has been found when the classroom teacher becomes in­volved in a nutrition workshop and teaches the nutrition lessons(11, 17-21). Classroom teachers willing to give time for aneducational workshop are probably more interested, en­thusiastic, and motivated to teach that subject. If the classroomteacher included nutrition education in weekly lesson plans,then concepts of good nutrition could be reinforced throughoutthe school year. D

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Just a Reader?You can be a member, too, and receive the fullbenefIts of the Society for Nutrition Education-theJournal of Nutrition Education, the Society news­letter, the National Nutrition Education Clearing

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13 Van Edmond, D., School Foodservice, AVI Publishing Co.,Westport, CT, 1974, pp. 1-19.

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23 Boysen, D. C., and R. A. Ahrens, Nutrition instruction and lunchsurveys with second graders, J. Nutr. Ed., 4:172, 1972.

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House Resource Series at discount rates, reducedrates at the Society Annual Meeting, and oppor­tunities to participate in setting the policy anddirection of the Society. For more information,write Membership, Society for Nutrition Educa­tion, 2140 Shattuck Avenue, Suite III O-A,Berkeley, California 94704

April-June 1979 Vol. II No.2 Journal of Nutrition Education 95