Program

Jul 01, 2009

OVERVIEW

High 5 is a multi-component, school-based dietary
intervention for 4th 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: 4th grade students

High 5 is a multi-component intervention based on social
cognitive theory. The program includes a 14-lesson curriculum for 4th
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.

Cost and ordering information is available
here. Curriculum
costs $20.

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: A total of 1,698 families served as the
study sample for this investigation. Each family included a child enrolled in 3rd
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’ 4th 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 5th grade.

Baseline assessments were administered at the end of the
target children’s 3rd grade year. Follow-up assessments occurred one
and two years later, at the end of 4th and 5th 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://oldwayspt.org/shop/oldways-webstore/high-five-curriculum

References:

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 Medicine, 30, 309-319.

KEYWORDS: Middle Childhood (6-11), Children (3-11),
Elementary School, School-based, White or Caucasian, Black or African American,
Life Skills Training, Problem-Solving Skills, Parent or Family Component,
Physical Health, Nutrition, Overweight, Obesity, Self Efficacy

Program information last updated on 7/1/09.