Food for Thought: Utilizing after school programs to improve nutrition through mindfulness, advertising awareness, and nutritional literacy

The intervention class is based on a previously designed and classroom-tested course called “Community Voices for Health: Kids Take Action,” which has a focus on teaching media literacy and nutrition knowledge. The mindfulness component was taken from the book “Mindful Eating,” by Jan Chozen Bays, and from online exercises and personal experience. The class is mostly discussion-based, with some videos and hands-on activities, and is designed to fit the allotted time period (45 minutes per session at one site and 75 minutes per session at the other).

2014-10-31

2014-12-19

Primary Outcomes:
We hypothesize that participants in the experimental group will:
1) Report eating more fruits and vegetables
2) Report eating fewer highly processed foods, fast foods, and non-diet sodas (Food consumption survey
3) Have greater nutritional knowledge (Nutritional Knowledge Questionnaire score)
4) Report using more internal (vs. external) hunger cues (Mindul Eating Survey, Factor 3)
5) Show reduced mindless eating on the behavioral measure of mindless eating (stale popcorn test)

Additional Outcomes:
These outcome measures are denoted as “secondary outcomes” because I either have no strong a priori hypothesis about the outcome, they are unlikely to be affected by the intervention, or they are less important outcomes.
1) Mindful Eating Survey, Factor 1 (awareness of food sensations)
2) Mindful Eating Survey, Factor 2 (distraction while eating)
3) Mindful Eating Survey, Factor 4 (awareness of advertising and media influences)
4) Changes in BMI
5) Food addiction composite score (YFAS-C)
6) Physical activity and sedentary behavior (YRBS: Questions 1-3)
7) Subjective Stress (YRBS: Questions 9-10)
8) Home vs. Restaurant-prepared meals (Food consumption survey: Questions B5, B6, C1 – C5)
9) Sugary vs. healthier drink consumption (Food consumption survey: Questions E1-E4)
10) Increased nutrition facts label-reading ability (Nutrition Knowledge: Questions13-15)

Outcome/Variable Specifications:

Age: Months old at beginning of intervention (October 24, 2014)
Grades: 0 for “mostly F’s” - 4 for “mostly A’s”
Activity Level: (higher means more active)
Days active (YRBS Q1) + Days PE (Q4) – daily hours TV (Q2) – daily hours computer/games (Q3)
Stress Level: Home stress (0 – 4) + non-home stress (0 – 4) (higher means more stress)
Fruits and Vegetables: (higher means more fruits and vegetables)
for pre, A6 (0 – 4) + A10 (0 – 4) + B2 (0 – 5) + B3 (0 – 5) + B5 (0 – 5)
for post, A6 + A7 + B2 + B3 + B4 (same scaling)
note: post includes all school vegetables in A7 while pre has a separate question (A8, not included) for salad greens
Processed Food: (higher means more processed food)
B1 + C1 + C2 + C3 + D1 + D3 + D4 + E1
Home and Restaurant Meals: (higher means eating out more)
For pre, C1 + C2 + C3 + C4 + C5 – B7
For post, C1 + C2 + C3 + C4 + C5 – B6
Soda Drinking: E1
Non-sugary Drinks: E2 + E3 + E4
Nutritional Knowledge: # of questions correct (excluding #6, so out of 14 total)
Mindful Eating Survey:
For each factor, the average score (0 – 4) for all questions in the factor

In October – December 2014, I taught 5 sessions of a nutrition education and mindfulness class to pre-selected groups of 5th to 8th grade students attending one of two Boys & Girls Club after school program sites in Trenton, NJ. Students enrolled in either the soccer program or the cooking program received the intervention class. These classes were chosen to receive the class by the program director due to the applicability of nutrition to their other class (soccer or cooking). Among students in the soccer class, half of them were chosen by the program director to take the class; the remaining students had free play time instead and were part of the control group. All students in the cooking class also took the nutrition class. The control group is made up of students who attend the same after school programs.

Study Site Location:

The initial experimental plan was to conduct the intervention at two after school program sites –Village Charter School and Centre Street. However, one of the program sites, Village Charter School, ended up having unanticipated scheduling conflicts which prevented both the complete delivery of the intervention and complete post-intervention data analysis. Participants in the intervention group at this site received, on average, fewer than 2 sessions of the 5-session class. This high level of non-compliance with the treatment at Village Charter School was not caused by the participants or by any feature inherent to the intervention; rather, it was a lack of organization and communication at the program site itself that led other scheduled activities to interfere with the administration of the intervention classes. Therefore, only data from the Centre Street site will be included in program evaluation. While this failure to deliver the intervention at one site offers lessons for the expansion of such a program, including the failed program site in analysis would lead to inaccurate estimates of the effects of the intervention.

Pseudo-randomization. Those students who had already registered for the soccer and cooking classes on Friday (the day the classes were delivered) were chosen to receive the intervention and those taking other classes did not.

Classroom.

Yes

4 clusters - soccer, cooking, open gym, and other

45 students

22 students treatment, 23 students control