Effects of a School-Based Nutrition Program Diffused Throughout a Large Urban Community on Attitudes, Beliefs, and Behaviors Related to Fruit and Vegetable Consumption

In 18 of the 21 included studies, the stated primary outcome was improved knowledge of nutrition or obesity prevention.

“In 18 of the 21 studies [43–59, 61–64], the stated primary outcome was improved knowledge of nutrition or obesity prevention, highlighting the field’s didactic focus.”

Nutrition education covering definitions, food groups, and nutrient functions was included in 20 intervention programs.

“Nutrition education—covering definitions, food groups, and nutrient functions—was included in 20 intervention programs [43–59, 62–64].”

Behavioral and decision-oriented components were common in included interventions and included food choice, planning, goal-setting, portion awareness, self-efficacy, intention formation, and family or peer reinforcement.

“Behavioral and decision-oriented components were likewise common and included food choice, planning, goal-setting, portion awareness, self-efficacy, intention formation, and family or peer reinforcement [43, 44, 46, 47, 50, 52–56, 61–63].”

A substantial proportion of included interventions incorporated experiential and skill-based learning, particularly cooking, food preparation, tasting, and sensory activities.

“A substantial proportion of interventions incorporated experiential and skill-based learning, particularly cooking, food preparation, tasting, and sensory activities [45–48, 50, 52, 56, 59–61, 63].”

Sensory activities, such as repeated tasting, comparing varieties of fruits and vegetables, and discussing flavor, texture, and appearance, were used in included interventions to support acceptance of healthy foods.

“Sensory activities, such as repeated tasting, comparing varieties of fruits and vegetables, and discussing flavor, texture, and appearance, were used to support acceptance of healthy foods [46, 52, 61].”

Communication skills and social norms were targeted in included interventions through peer, parent, and teacher involvement.

“Communication skills and social norms were targeted through peer, parent, and teacher involvement [52, 61], while media literacy—though addressed less frequently—focused on interpreting advertisements and understanding environmental impacts of food choices [43, 44].”

Intervention components and curriculum content were delivered predominantly through school-based, classroom-oriented formats, reported in 18 studies.

“Intervention components and curriculum content were delivered predominantly through school-based, classroom-oriented formats, which were reported in 18 studies [43–47, 49, 51–59, 61–63].”

Classroom teachers were the principal facilitators in 19 included studies, often after brief training.

“Classroom teachers were the principal facilitators in 19 studies [43–49, 51–57, 59, 61–64], often after brief training.”

Meta-regression with a binary country variable (USA vs. other) yielded β ≈ −0.08 (95% CI: −0.47 to 0.31; p ≈ 0.56), indicating that the effects on nutritional behavior did not differ in any straightforward way between US and non-US trials.

“Meta-regression with a binary country variable (USA [50, 52, 56] vs. other [46, 61]) yielded β ≈ −0.08 (95% CI: −0.47 to 0.31; p ≈ 0.56), indicating that the effects on nutritional behavior did not differ in any straightforward way between US and non-US trials.”

Food and nutrition literacy, general nutrition knowledge, and obesity-related knowledge generally improved following intervention, although the magnitude and consistency of effects varied across studies.

“Including food and nutrition literacy, general nutrition knowledge, and obesity-related knowledge, generally improved following intervention, although the magnitude and consistency of effects varied across studies [43–55].”

Consistent improvements in knowledge-related outcomes were reported across several studies.

“Consistent improvements in knowledge-related outcomes were also reported across several studies [45, 48, 51–55].”

Practical skill practice (gardening, cooking, label reading, game-based challenges) appeared in 13 studies.

“Practical skill practice (gardening, cooking, label reading, game-based challenges) appeared in 13 studies [43, 45, 47–50, 52, 53, 55, 58, 61, 63, 64].”

Tools such as goal-setting worksheets, self-monitoring logs, and home tasks were used in included interventions to help children monitor and adjust their behaviors over time.

“Tools such as goal-setting worksheets, self-monitoring logs, and home tasks were used to help children monitor and adjust their behaviors over time [52, 56, 63].”