High 5

Guide to Effective Programs
for Children and Youth

HIGH 5

OVERVIEW

High 5 is a multi-component, school-based dietary intervention for 4^th graders. The intervention focuses on increasing students’ fruit and vegetable consumption. In a random assignment study involving 28 schools, schools assigned to implement the High 5 program were compared with schools that received no intervention. At both the one-year and two-year follow-ups, students from intervention schools reported consuming significantly more servings of fruits and vegetables than did students from control schools. Intervention students were also found to have significantly more nutritious diets overall. The program did not have an impact on lunchtime consumption of fruits and vegetables, as measured by cafeteria observations, however.

DESCRIPTION OF PROGRAM

Target population: 4^th grade students

High 5 is a multi-component intervention based on social cognitive theory. The program includes a 14-lesson curriculum for 4^th graders that discusses the importance of consuming five servings of fruits and vegetables every day. Lessons last 30-45 minutes and involve modeling, self-monitoring, problem-solving, reinforcement, and taste testing. Days on which lessons are taught are interspersed with “High 5 Days,” on which students are challenged to eat five servings of fruits and vegetables and record their consumption on a food record.

The program also includes an information session for parents and weekly homework activities for children to complete with their parents. Parents are provided with informational materials, skill-building materials (such as recipes), and other items intended to trigger healthy eating in the home (such as refrigerator magnets).

As part of the program, school food service managers and workers receive training on purchasing, preparing, and promoting fruit and vegetable consumption at school. Cafeterias receive regular visits from nutritionists and project staff who rate on a four-star system the extent to which they are in line with project goals.

EVALUATION(S) OF PROGRAM

Reynolds, K. D., Franklin, F. A., Binkley, D., Raczynski, J. M., Harrington, K. F., Kirk, K. A., & Person, S. (2000). Increasing the Fruit and Vegetable Consumption of Fourth-Graders: Results from the High 5 Project. Preventative Medecine, 30, 309-319.

Evaluated population: 1,698 families served as the study sample for this investigation. Each family included a child enrolled in 3^rd grade in the spring of 1994 at one of 28 Alabama elementary schools. 83% of these children were white, 16% were black, and 1% were of other racial background.

Approach: The 28 schools were grouped geographically and then randomly assigned to either the control group or the treatment group within geographic cluster. Schools assigned to the control group received no intervention. Schools assigned to the treatment group implemented the High 5 curriculum during students’ 4^th grade year. The curriculum was taught over the course of seven weeks by High 5 curriculum coordinators, employed and trained by the High 5 project. Three short booster sessions were delivered to students during 5^th grade.

Baseline assessments were administered at the end of the target children’s 3^rd grade year. Follow-up assessments occurred one and two years later, at the end of 4^th and 5^th grades. Both children and their parents filled out questionnaires at baseline and follow-ups. All children completed 24-hour diet recalls at each assessment point. Additionally, a subset of the children (n = 425) were observed during school lunch so that their lunchtime fruit and vegetable consumption could be assessed.

Results: As measured by 24-hour diet recalls, students at treatment schools did not differ from students at control schools on their daily consumption of fruits and vegetables at baseline. At both the one-year and two-year follow-ups, however, students at treatment schools reported consuming significantly more servings of fruits and vegetables than did students at control schools. Treatment children also scored significantly higher than control children on the 5-a-Day guidelines consumption survey at both follow-ups. Treatment children were not observed eating more fruits and vegetables than control children during lunchtime observations at either follow-up, however.

Diet recalls also revealed that children from treatment schools had significantly more nutritious diets than did children from control schools. At both follow-ups, children from treatment schools were found to have attained a lower percentage of their calories from fat, a lower percentage of their calories from saturated fat, and a higher percentage of their calories from carbohydrates. Treatment children were also found to be consuming significantly more fiber, folate, β-carotine, and vitamin C.

Follow-up surveys revealed that the intervention had an impact on a number of psychosocial variables as well. Relative to control children, treatment children had improved outcome expectancies, overall self-efficacy, and knowledge of the food guide pyramid and 5-a-Day servings at the one-year follow-up. Knowledge scores and some outcome expectancies remained significantly improved at the two-year follow-up.

Subgroup analyses revealed that the intervention was effective in most subsamples, rendering the research team confident that the results were generalizable to black and white children, to boys and girls, and to children with parents having low, medium, and high educational attainment.

Parents of treatment children were found to be consuming significantly more fruits and vegetables than parents of control children at the one-year follow-up. This was no longer the case at the two-year follow-up.

SOURCES FOR MORE INFORMATION

Curriculum materials available for purchase at:

http://rtips.cancer.gov/rtips/rtips_download.do?programid=37&topicid=9

References:

Program categorized in this guide according to the following:

Evaluated participant ages: 9-11

Evaluated participant grades: 4^th - 5^th

Program age ranges in the guide: Middle Childhood

Program components: School-Based, Parent or Family Component

Measured outcomes: Physical Health

Program information last updated on 7/23/07.