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Program Portfolio

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Nutrition Program for Seventh Grade Students in Duval County

Rebecca Barnes, Paige Davis, Jamie Herndon, Elizabeth Ashley Lewis,

Sarah Napolitano, Kristen Schroeder

Assessing Need

Triggers & Rationale:

The obesity epidemic in the United States has, in recent years, been gaining widespread

concern. With that concern has come many efforts to rally support for the development of

obesity intervention programs and preventative strategies. With one third of Americans

overweight and another one third classified as obese, something needs to be done to better the

quality of life for Americans. People develop lifelong habits at an early age and it is known that

it is easier to change poor habits and develop good habits at a younger age; it is this reason why

we have chosen to develop a nutrition program targeted at children ages 11-14. At this age

children are old enough to understand the importance of eating right and are cognitively

developed to a point at which they can take what they have learned and apply it to their everyday

lives. Targeting children at this age will allow them to feel more in control because we will be

providing them with information they can use to better themselves. At this young age, children

given the knowledge needed to sustain a healthy lifestyle can develop the habits necessary to live

and maintain a higher quality way of life throughout adulthood. Providing students with quality

health programs should improve their knowledge, attitudes, and skills needed to encourage

healthy behaviors, with the ultimate goal of reducing their risk for obesity and other chronic

diseases. The increased prevalence of type 2 diabetes, also known as adult-onset diabetes, in

children is a disturbing trend that signifies that our nation is in dire need of a health make over.

Children should not have to succumb to the chronic ailments that are most often experienced in

adulthood. By increasing the nutritional knowledge of our younger generation we are paving the

way for a healthier America in later years; we will be decreasing the widespread presence of

obesity in adulthood, as well as decrease the commonness of other disease including but not

limited to heart disease, type 2 diabetes, cancer and chronic kidney failure. Improving the health

of young Americans will also aid in bettering students’ self-image and confidence which

provides students with the foundation to develop healthier relationships among family members

and peers. It is imperative to design a program for the younger generation because these children

are our future and as they grow older they can then pass on the knowledge they’ve received to

even younger generations and family members in order to establish a healthier community.

Area of Need:

The area of need we will address is the lack of nutrition education among the middle school aged

population.

Available Data:

Dr. Debby Demory-Luce and Dr. Craig Jensen stated that the “nutritional needs during

adolescence are increased because of the increased growth rate and changes in body composition

associated with puberty. The dramatic increase in energy and nutrient requirements coincides

with other factors that may affect adolescents’ food choices and nutrient intake, and thus

nutritional status. These factors, including the quest for independence and acceptance by peers,

increased mobility, and greater time spent at school and/or work activities, and preoccupation

with self-image, contribute to the erratic and unhealthy eating behaviors that are common during

adolescence. Sound nutrition can play a role in prevention of several chronic diseases, including

obesity, coronary heart disease, and certain types of cancer, stroke, and type 2 diabetes. National

and population-based surveys have found that adolescents often fail to meet dietary

recommendations for overall nutritional status and for specific nutrient intakes. Many

adolescents receive a higher proportion of energy from fat and/or added sugar and have a lower

intake of vitamin A, folic acid, fiber, iron, calcium, and zinc than is recommended.”

There is a multitude of information about the dietary behaviors of the adolescents in the

United States. The Centers for Disease Control and Prevention (also known as the CDC), an

article in the Journal of the American Dietetic Association, and the School Health Policies and

Programs Study (also known as SHHPS) can help understand the problem from a national

standpoint. When examining the problem from a state level it is important to look at the Youth

Risk Behavior Survey (also known as YRBS), the School Health Profiles (also known as

Profiles), an article in the Journal of School Health, and the Youth Physical Activity and

Nutrition Survey. Lastly, the YRBS can also help understand the problem from a county

standpoint. With these resources combined we can accurately evaluate the magnitude of the

problem from a national level, state level, and county level.

National Level:

The CDC provides key nutrition facts, consequences of a poor diet, eating behaviors of

young people, and diet and academic performance information for the United States. Some of

the key nutrition facts they provide are, “healthy eating is associated with reduced risk of many

diseases, including several of the leading causes of death: heart disease, cancer, stroke, and

diabetes. Healthy eating in childhood and adolescence is important for proper growth and

development and can prevent health problems such as obesity, dental cavities, iron deficiency,

and osteoporosis. The Dietary Guidelines for Americans recommend a diet rich in fruits and

vegetables, whole grains, and fat-free and low-fat dairy products for persons aged 2 years and

older. The guidelines also recommend that children, adolescents, and adults limit intake of solid

fats (major sources of saturated and trans fatty acids), cholesterol, sodium, added sugars, and

refined grains. Unfortunately, most young people are not following the recommendations set

forth in the Dietary Guidelines for Americans. Schools are in a unique position to promote

healthy eating and help ensure appropriate food and nutrient intake among students. Schools

provide students with opportunities to consume an array of foods and beverages throughout the

school day and enable students to learn about and practice healthy eating behaviors. Schools

should ensure that only nutritious and appealing foods and beverages are provided in school

cafeterias, vending machines, snack bars, schools stores, and other venues that offer food and

beverages to students. In addition, nutrition education should be part of a comprehensive school

health education curriculum.” Some of the consequences of a poor diet that the CDC provides

are: “a poor diet can lead to energy imbalance (e.g., eating more calories than one expends

through physical activity) and can increase one’s risk for overweight and obesity. A poor diet

can increase the risk for lung, esophageal, stomach, colorectal, and prostate cancers. Individuals

who eat fast food one or more times per week are at increased risk for weight gain, overweight,

and obesity. Drinking sugar-sweetened beverages can result in weight gain, overweight, and

obesity. Providing access to drinking water gives students a healthy alternative to sugar-

sweetened beverages. Hunger and food insecurity (i.e., reduced food intake and disrupted eating

patterns because a household lacks money and other resources for food) might increase the risk

for lower dietary quality and undernutrition. In turn, undernutrition can negatively affect overall

health, cognitive development and school performance.” The CDC states that most United

States youth, “do not meet the recommendations for eating 2 ½ cups to 6 ½ cups of fruits and

vegetables each day; do not eat the minimum recommended amounts of whole grains (2-3

ounces each day); and eat more than the recommended maximum daily intake of sodium (1,500-

2,300 mg each day)”. The CDC also discovered that, “empty calories from added sugars and

solid fats contribute to 40% of daily calories for children and adolescents aged 2-18 years old,

affecting the overall quality of their diets. Approximately half of these empty calories come

from six sources: soda, fruit drinks, dairy desserts, grain desserts, pizza, and whole milk”.

Another important discovery that the CDC found was that, “adolescents drink more full-calorie

soda per day than milk. Males aged 12-19 years drink an average of 22 ounces of full-calorie

soda per year, more than twice their intake of fluid milk (10 ounces), and females drink an

average of 14 ounces of full-calorie soda and only 6 ounces of fluid milk”. The CDC states the

correlation between diet and academic performance is, “eating a healthy breakfast is associated

with improved cognitive function (especially memory), reduced absenteeism, and improved

mood.”

According to the article, Nutrition Quality and Education in K-12 Schools, in the 2005

Journal of the American Dietetic Association, “In 2003, 61% of US schools had no nutrition

education coordination program. With recent emphasis on students meeting standardized test

scores, few teachers can spare any time to teach nutrition in the classroom. As a result, our

children are missing out on valuable knowledge that is essential to creating lifelong healthful

habits.” After surveying the nutrition education of 1,409 US public schools, it was discovered

that, “Approximately half (52%) of respondents have had formal training to teach nutrition in the

classroom, yet 88% reported that they taught nutrition lessons to students. [Also] the mean

number of hours in a school year spent on teaching nutrition education was 13. (According to

the survey authors, 50 hours is the minimum amount of time believed to be necessary for impact

on behavior.) Nutrition was taught as a separate subject by 35% of respondents, whereas other

respondents (39% and 33%, respectively) integrated the lessons into health/physical education

and science curricula. [Lastly, they also discovered that] approximately 21% reported not having

enough materials for all students in the classroom.”

The 2006 SHPPS found the percentage of middle schools in which teachers taught

nutrition and dietary behavior topics as part of required instruction: 67% of middle schools

taught students the topic of Dietary Guidelines for Americans, 76.1% of middle schools taught

students the topic of food guidance using MyPyramid, and 75.9% of middle schools taught

students the topic of preparing healthy meals and snacks. However, this study also found that

“among classes in which nutrition and dietary behavior was taught, the median number of hours

of required instruction teachers provided on nutrition and dietary behavior decreased from 4.6 in

2000 to 3.4 in 2006 among middle school classes”. They also found that “19% of middle

schools offered brand-name fast foods from companies such as Pizza Hut, Taco Bell, or

Subway”. Another important statistic they found was that “71.3% of middle schools had either a

vending machine or school store, canteen, or snack bar where students could purchase foods or

beverages”. This survey also found that: “4% of state and 6.6% of districts required that schools

make fruits or vegetables available to students whenever food was offered or sold. 18.4% of

states required and 17% of districts required that schools make healthful beverages such as

bottled water or low-fat milk available to students whenever beverages were offered or sold.

25.4% of middle schools allowed students to purchase foods and beverages high in fat, sodium,

or added sugars from a vending machine or in a school store, canteen, or snack bar during lunch

periods. 28.7% of middle schools allowed students to buy soda pop, fruit drinks that are not

100% juice, or sports drinks from a vending machine or in a school store, canteen, or snack bar

during lunch periods. Only 12.9% of middle schools in the United States provide students the

opportunity to purchase 1% or skim milk from vending machines or school stores. Only 15.4%

of middle schools provide students the option to purchase 2% of whole milk from vending

machines or school stores. Only 41.1% of middle schools give students the option to purchase

100% fruit juice from vending machines or school stores. Only 63.2% of middle schools give

students the option to purchase water from vending machines or school stores. Only 8.7% of

middle schools give students the option to purchase fruits or vegetables from the vending

machine or school stores”. This survey also discovered that when organizations sold specific

foods and beverages for fund-raising in middle schools 56.2% was chocolate candy, 55.8% was

baked goods not low in fat, 42.6% was non-chocolate candy, 30.3% was soda pop or fruit drinks

that were not 100% juice, 24.0% was sports drinks, and only 20.7% was fruits and vegetables.

State Level:

According to the research article, Dietary and Physical Activity Behaviors of Middle

School Youth: The Youth Physical Activity and Nutrition Survey, in the January 2008 Journal of

School Health, “the Florida Department of Health developed the Youth Physical Activity and

Nutrition Survey (YPANS) for monitoring middle school students’ knowledge and practices

related to physical activity and nutrition”. There were 73 participating middle schools in the

2003 survey. This survey found data for dietary behaviors, such as the consumption of fruits and

vegetables, milk consumption, soda consumption, daily breakfast consumption and nutrition

knowledge. When they looked specifically at the consumption of fruits and vegetables they

discovered that, “slightly less than one fourth (22.8%) of respondents reported consuming 5 or

more fruits and vegetables per day. [They also found some significant differences between grade

levels of middle school students.] More sixth-grade middle school peers (26.6%) consumed 5 or

more fruits and vegetables per day than their seventh-grade (23.9%) and eighth-grade (18.6%)

middle school peers.” When they looked specifically at milk consumption, they found that, “just

more than one fifth (21.9%) of survey respondents reported that they drank 3 or more glasses of

milk per day during the past 7 days. There were statistically significant differences for sex.

More boys (27.5%) than girls (16.0%) drank 3 or more glasses of milk per day during the

previous 7 days. When asked what kind of milk they usually drank (respondents could select

more than 1 response), the most common answers were whole milk (40%), chocolate milk

(34%), and 2% milk (25.8%). About 1 (9.2%) of 10 respondents did not know what kind of milk

they drank.” When they looked specifically at soda consumption they discovered that,”

approximately one fourth (26%) of middle school students drank 2 or more sodas per day during

the previous 7 days. Among students, 12.9% did not drink any soda during the previous 7 days,

50.4% drank some soda, but less than 1 per day, and 10.7% drank 1 soda per day.” When they

looked specifically at daily breakfast consumption they found that, “Almost half (46.6%) of

middle school students reported eating breakfast every day during the previous 7 days. There

were statistically significant differences for sex and grade level. More boys (52.4%) than girls

(40.9%) ate breakfast every day during the previous 7 days. More sixth graders (52.3%) reported

eating breakfast every day during the previous week compared to seventh graders (45.9%) and

eighth graders (41.7%).” When they specifically looked at nutrition knowledge they discovered

that, “when youth were asked about the expert recommendations for daily fruit and vegetable

consumption, les than one fifth (17.8%) correctly identified consumption of 5 or more servings

per day. About one fifth (20.8%) were not sure, and 61.4% answered between 1 and 4 servings

per day. When asked to indicate where they had learned about eating healthy (youth could

indicate more than one response), 62.2% reported learning from their parents, 56.7% reported

learning from school, 42.7% said learning from a doctor or nurse, 31.2% reported learning from

television, and 13.7% answered learning from some other source.”

The Florida Department of Health administered the Youth Physical Activity and

Nutrition Survey again in 2005. This time 70 middle schools participated in the survey. They

looked again at the nutrition knowledge and dietary behaviors of middle school students. They

found, “[When] students were asked where they learned about healthy eating, the most common

responses were: parents 63.2% and schools 60.7%. The role of the schools in providing healthy

nutrition information is quite clear. [When] students were asked in which class they learned

about eating healthy, the most common responses were: health education 42.3%, science 37.3%,

and physical education 28.8%. [When] students were asked how many fruits and vegetables

experts recommend that they should eat in a day, 22.8% correctly identified five. [When]

students were asked the question: ‘Do you read food labels for ‘low fat’, or ‘less calories’, or

‘low carbs’ before you choose or buy food or snacks?’, overall 34.5% responded never and an

additional 15.7% responded hardly ever. More males (42%) than females (27.1%) responded

never. More eighth graders (37%) than sixth graders (30.7%) responded never.” They also

discovered that, “overall, 22% of students consumed five fruits and vegetables a day. More

males (23.6%) than females (20.3%) consumed five fruits and vegetables a day. More sixth

graders (24.2%) than eighth graders (20.6%) consumed five fruits and vegetables each day.

[When] asked how many times [they] drink punch, sports drinks, or other fruit-flavored drinks

that are not 100 percent fruit juice, 28.5% [said they] drank fruit-flavored drinks two or more

times per day. More males (25.5%) than females (24.4%) consumed these drinks. [When] asked

a question about soda consumption (both diet and regular soda), 22.9% consumed two or more

sodas each day during the past seven days. More males (25.9%) then females (19.8%) consumed

two or more sodas each day. More eighth graders (25.8%) than both seventh graders (22%) and

sixth graders (20.8%) consumed two or more sodas each day. [When] asked the question ‘during

the past seven days, how many glasses of milk did you drink? (Include milk you drank in a glass

or cup, from a carton, or with cereal. A milk shake counts as a glass of milk. Count the half pint

served at school as equal to one glass.)’, 19% of students drank three or more glasses of milk

each day. More males (24.6%) than females (13.3%) drank three or more glasses of milk each

day. More sixth graders (22.3%) than eighth graders (16.3%) drank three or more glasses of

milk each day.” When they asked students about eating breakfast, “less than half (44.2%) of

middle school students ate breakfast every day during the previous seven days. More males

(51.2%) than females (37.2%) ate breakfast every day during the previous seven days. More

sixth graders (49.5%) than either seventh graders (41.6%) or eighth graders (41.7%) ate breakfast

every day during the previous days.” They also discovered that, “more than half of the students

(51.1%) ate at a fast food restaurant on two or more days during the previous seven days. More

eighth graders (53.7%) and seventh graders (51.7%) than sixth graders (47.8%) ate at fast food

restaurant on two or more days during the previous seven days. [When] asked the question,

‘during the past five school days, how many days did you buy a la carte or single items instead of

the school lunch?’, 34.1% of middle school students bought a la carte instead of the school lunch

on one or more days during the past five school days. The major reasons for buying a la carte

items were: I don’t like the lunch offered (32.6%) and I the food better than the line lunch

(17.4%). Overall, 58.4% of middle school students had a snack vending machine from which

they could buy snacks. Of those who had a snack vending machine at school, 20.4% purchased

one of more snacks each day during the previous five school days. Of those who purchased

snacks from a vending machine, the types of snack purchased most often were: chips, pretzels, or

crackers (42.1%) and candy bars (18.2%). Overall, 47.8% of middle school students, when they

purchased snacks from a vending machine, thought about whether or not it is a healthy snack

always or sometimes. More sixth graders (54%) than either seventh (46.4%) or eighth (42.5%)

graders thought about whether or not the snack that they are purchasing was healthy.

Approximately 86% had a drink vending machine from which they could buy drinks. Of those

who had a drink vending machine at school, 31.6% purchased one or more drinks each day

during the previous five school days. The most common drinks purchased from the vending

machine at school were soda (33.2%) and sports drinks (33.1%). Overall, 19.5% of middle

school students bought a snack or drink form the vending machine instead of buying lunch or

eating lunch brought from home on one or more days during the past five schools days. [When]

asked the question, ‘does your teacher or the staff at your school give you candy or sweets as a

reward for good or extra work?’, 65.2% answered sometimes. More females (71.7%) answered

sometimes than males (58.9%). More sixth graders (68%) than eighth graders (63.5%) were

given candy or sweets as a reward. The last question on dietary behaviors, ‘do you sell candy to

raise money for your school, your school band, or a school sport?’ Overall, 27.9% of middle

school students sold candy. More females (33.1%) than males (22.8%) sold candy.

After examining the results of the 2003 and 2005 Youth Physical Activity and Nutrition

Surveys separately, it is also important to look at the trend that progressed within those two

years. Although the nutritional patterns of the middle school youth did not get any worse per

say, there wasn’t any improvement either. They both discovered that school is one of the main

places that these students learn about nutrition. The schools need to continue to strive to do more

and more to help these students understand the importance of nutrition.

In 2009, the Florida YRBS found that among high school students, “78% ate fruit and

vegetables less than five times per day during the 7 days before the survey; 67% ate fruit or

drank 100% fruit juices less than two times per day during the 7 days before the survey; 87% ate

vegetables less than three times per day during the 7 days before the survey; and 29% drank a

can, bottle, or glass of soda or pop at least one time per day during the 7 days before the survey”.

Even though we are not specifically working with high school students it is important to notice

that the percentage of students not eating the recommended amounts of healthy foods continues

to rise from middle school to high school. The trends these students picked up in middle school

seem to be sticking with them throughout high school and possibly throughout the rest of their

life. This is why nutrition education should be started at the middle school level when the

students are able to make their own decisions about food, but can still change their dietary

patterns before they are set in stone.

The 2010 Profiles produced data for the Florida secondary schools on nutrition

information. They found that: the “percentage of schools that always offered fruits or non-fried

vegetables in vending machines and school store, canteens, or snack bars, and during celebrates

when food and beverages are offered was 16.7%; the percentage of schools that used at least 3

different strategies to promote healthy eating was only 28.5%; and the percentage of schools that

taught 14 key nutrition and dietary behavior topics in a required health education course was

58.3%”.

In 2006, SHHPS produced a school health program report card for the state of Florida.

Some of the important findings for the state of Florida were: the state required the schools to

offer three or more different types of milk each day for breakfast, but it was only recommended

or encouraged that this was also offered to the students at lunch time; the state did not require,

recommend, nor encourage that schools offer two or more different fruits or types of 100% fruit

juice each day for lunch; the state did not require, recommend, nor encourage that schools offer

two or more different entrees or main courses each day for lunch; the state did not require,

recommend, nor encourage that schools offer two or more different non-fried vegetables each

day for lunch; the state did not require, recommend, nor encourage that schools make fruits or

vegetables available to students whenever other food was offered or sold; the state did not

require, recommend, nor encourage that schools make healthful beverages available to students

whenever other beverages were offered or sold; the state did not require, recommend, nor

encourage that schools prohibit junk food in the following school setting: after-school or

extended day programs, a la carte during breakfast or lunch periods, concession stands, meetings

attended by students’ family members, school stores, canteens, snack bars, staff meetings,

students parties, or vending machines; the state did not require, recommend, nor encourage that

schools restrict times of day junk foods can be sold in any venue; the state did not require,

recommend, nor encourage that schools prohibit the selling of junk foods for fundraising; the

state did not require, recommend, nor encourage that schools prohibit advertising for candy, fast

food restaurants, or soft drinks on school property; the state did not require, recommend, nor

encourage that middle or high schools prohibit some student access to vending machines; the

state did not prohibit nor discourage the using food or food coupons as a reward. Although

middle school students are old enough to make their own decisions about what is healthy or not,

the school environment and the choices offered to the students still have a huge impact on what

they choose to eat during school.

Local Level:

The 2009 Florida YRBS also produced specific data for Duval County, Florida. Twenty-

seven middle schools participated in the survey, which found that, “about 55% of students drink

at least one soda per day; and less than 15% of students ate the recommended amount of fruits

and vegetables”. Also, nineteen public high schools in Duval County participated in this survey

finding that, “about 30% of students drink at least one soda per day; over twice as many males

drank 3 or more glasses of milk than females; and less than 20% of students ate the

recommended amount of fruits and vegetables”. The data provided for the Duval County high

school students was further broken down to compare it to the United States. The study

discovered that Duval County high school students were more likely to engage in poor dietary

behaviors than the United States youth as a whole. Duval County high school students were

more likely, “to eat fruits and vegetables less than five times per day; to not drink 100% fruit

juice; to not eat fruit; to not eat green salad; to not eat carrots; to not eat other vegetables

(excluding green salad, potatoes, or carrots); to drink less than three glasses per day of milk; to

eat fruit or drink 100% fruit juices less than two times per day; and to eat vegetables less than

three times per day”. Again, even though our target population is middle school students, it is

important to look at how the trends continue throughout high school. This can give us valuable

information about the impact that proper nutrition education can have on middle school students

that will be progressing into high school soon. Middle school is the starting point when students

start making their own decisions about what they eat and drink. It is important to teach them

about nutrition education then so that we do not continue to see an increase in these numbers in

the future.

According to the Duval County’s Public Schools Wellness Program, which has been in

effect since 2006, “At the secondary school level, Comprehensive Health Education classes shall

continue to be taught by certified Health Education teachers as a separate course. At the middle

school level, students are required to take one quarter (nine consecutive weeks) of

Comprehensive Health Education in grades 6, 7 and 8. [They continue by saying that] health

education classes shall have an appropriate student/teacher ratio and shall be taught in a

classroom conducive to learning. [Also,] teachers shall be encouraged to integrate age &

developmentally appropriate nutrition education into other core curriculum area such as math,

science, social studies, and physical education and language arts as applicable.” It is really

important to understand that middle school students are at the age where they are really under a

lot of pressure whether it is to fit in with their friends or to do well in school. So the big question

to ask about this is nine consecutive weeks of Comprehensive Health Education enough for these

students? Looking over the multitude of research provided above, it does not appear to be

enough. Comprehensive Health Education should not only be offered to these students for nine

weeks in the entire school year. To really have an impact, these students need more than just the

required nine consecutive weeks that the county is mandating.

Data Available:While examining the data available on the dietary behaviors of the adolescents, most of

the information was found by giving surveys to middle and high school aged students during normal school hours. Most adolescents in the United States attend schools that could potentially

participate in these kinds of surveys if they so elected to. This type of data seems to work best for this topic and this specific age group. The surveys have been given to the students while they are in school so we have a better chance of almost all the students at these schools to participate as long as they were present the day the surveys were given. These surveys also seem to work best for this age group because when students get to middle school or high school they are more likely to buy their food or make their own snacks or meals when they get home from school. By asking them to fill out the survey they can give us a more accurate perspective of what they have had to eat and drink over the course of the past week. Surveys about adolescent dietary behaviors are readily available. Two important surveys that have been used to investigate middle school students’ dietary behaviors are the Youth Physical Activity and Nutrition Survey and the YRBS. The Youth Physical Activity and Nutrition Survey takes place every two years at participating middle schools throughout the state of Florida. Once the survey is conducted the data is then investigated and published in journals. This survey only produces data at the state level though. The YRBS investigates adolescents’ dietary behaviors by conducting a survey, which includes some questions about the students’ normal nutritional intake. These surveys are usually completed every two years to access the needs of the students in the school, county, state, and nation.

Priority Population: Adolescent youth ages 11-14 (middle school), 7th grade

■ According to the Youth Risk Behavior Surveillance Survey completed in 2009, data shows that there are high rates of poor nutrition and obesity when looking at statistics among adolescents 15-19 years old, therefore the target population needs to be younger adolescents in order to prevent the occurrence of these health problems. Youth ages 11-14 however are old enough to understand the importance of nutrition and be able to apply it.

■ According to the Duval County’s Public School’s Wellness program adolescent youth are at an age where they are becoming independent and are in more control of what they eat and their nutrition. They are at an age where they can be educated on proper nutrition in order to reduce the occurrence of obesity and increase the use of proper nutrition. This will give them the tools to prevent an array of illnesses that are associated with poor nutrition and obesity.

Initial Assumptions:

Nutrition health is very important for all individuals. We as a group feel that children between the ages of 11-14 would be most impacted and have a greater likelihood of making changes to their eating lifestyles if they are taught good dietary habits and choices now rather

than in the future. We feel that poor nutrition is impacting young adolescents for a variety of reasons such as: the convenience and swiftness of unhealthy food (fast foods) as well as their cost-effective prices in comparison to healthier foods. There are many adolescents who choose unhealthy snacks from vending machines or through the lunch line and many that arrive at home in the afternoon before a parent gets there leaving them to make unhealthy choices in regards to eating. Many adolescents may experience stress and peer pressure which can also contribute to unhealthy eating habits as a coping measure.

Intrapersonal and interpersonal factors play a role in the poor nutritional decisions made by those in the 11-14 age range as well; some intrapersonal factors are adolescents’ confidence level and self-worth. Interpersonal factors consist of the influence and support of parents and friends and the overall environment in which they interact and live in. Each of these factors along with many others plays an important role in what foods are available and consumed by adolescents.

Goals & Objectives

Goal: Improve the nutrition knowledge of adolescents between the ages of 11 to 14 to reduce the rates of obesity

Objectives:1. By completion of the program participants will be able to identify 80% of healthier food choices when given a questionnaire comparing two food options. 2. By completion of the program students will be able to complete the post food label exam with a minimum score of 80%.

3. By completion of the program, participants’ food logs will replicate portion control according to the Dietary Guidelines of America in 65% of their entries. 4. By completion of the program, participants will be able to identify the five core components of a balanced meal as identified by My Plate on their post exam. 5. By completion of the program, participants and their families will attend a banquet featuring dishes prepared by each family, utilizing the nutritional concepts learned throughout the program. Each participant will provide the recipe and methods of cooking to be evaluated based on nutritional factors.

Program Development The program will be implemented in the school system. It will be required for 7th graders to take this year long nutrition course. The course will meet two to three times a week. The instructor for the course will motivate and encourage participants to make healthier food choices by educating the participants on healthy foods, portion control, and how to read and understand food labels by utilizing many methods of teaching. The structure of the course will consist of questionnaires and Pretest and Posttest to evaluate the students’ knowledge over the period of the program as well as lectures and videos. The Tests will be implemented at the beginning, middle and end of the program. The program’s participants will be required to keep a journal of the food they eat on their “food logs”. The food logs will be due weekly containing a parent or guardian’s signature. Participants will also participate in activities conducted by the assigned health instructor these activities will include: compiling healthy food options for their lunch boxes, building a cookbook with healthy recipes they bring to class, and having guest speakers. The guest speakers will include a Pediatrician and a Nutritionist discussing the risks of obesity and other health problems due to poor nutrition. The program will also teach the importance of understanding and using MyPlate as well as learning the Dietary Guidelines of America; also during the program students will prepare healthy snacks to bring and share with the class as part of their Show and Tell. Parents will be involved with the Nutrition Program by attending the school’s open house where they will receive the students’ backpacks filled with workbooks and nutrition information. At the end of each semester there will be a banquet held where the students and parents work together to come up with a healthy dish to present as well as the nutritional information for that dish. The Banquet will be graded on participation and there will be awards given for the healthiest dishes. At the end of the program participants will write a Reflection Paper demonstrating what they have learned as well as how they have implemented that knowledge.

Timeline: First Quarter: 1. Open House- Parents come and meet the Health Educator to gather material including

backpacks and workbooks.2. Administer Pretest3. Introduce food logs and MyPlate4. Start Working on Cookbook recipes due at end of the quarter5. Show and Tell- Bring in a healthy snack to share with the class.

Second Quarter: 1. Continue with food logs2. Guest Speaker- Pediatrician3. Cookbook recipes due at end of Second Quarter4. Process Evaluation (Mid-Term Evaluation Test) Given5. First Banquet- Students and Parents prepare healthy dish and submit recipe. Awards will

be given at the Banquet for most creative healthy dish Third Quarter: 1. Continue with food logs2. Guest Speaker- Pediatrician3. Field Trip to Grocery store4. Video on Supermarket Savvy5. Show and Tell- Lunch party. Students will bring in one healthy dish along with the

recipe.6. Cookbook recipes due at end of Third Quarter Fourth Quarter: 1. Continue with food logs2. Questionnaire implemented for healthier food options3. Finalize Cookbook compiled with students recipes4. Reflection Paper Due5. Post Test Implemented6. Banquet- Students and Parents prepare healthy dish and submit recipe. Awards will be

given at the Banquet for most creative healthy dish

Logic Model:

Step 1: Long Term Outcomes and Problem Solution-Improve the nutrition knowledge of adolescents in 7th grade to reduce the rates of obesity throughout life.Step 2: Intermediates Outcomes (through customers) –· Improve nutrition knowledge by educating on dietary guidelines and portion sizesStep 3: Short-Term Outcomes-· Improved ability to read nutrition label· Improved ability to choose healthy food options· Improved ability to assess their progress through tracking food consumptionStep 4: Clients: 7th grade students both male and female of diverse ethnic and racial backgroundsStep 5: Activities: · Pretest/Posttest· Food logs· Video Supermarket Savvy· MyPlate Worksheet· Questionnaire with healthy and not so healthy options· Banquets· Compile recipes for cookbook-4 times throughout the program· Show and Tell-Healthy Snack· Guest Speaker- Pediatrician· Guest Speaker- Nutritionist· Reflection Paper on changes in food log· Supermarket Field trip on how to shop for healthy foods· Lunch Party with healthy food choices· Food Label quiz· Backpacks with tools for parents and studentsStep 6: Resources:

● Backpacks● Workbooks● Worksheets● Pretest/Posttest● Video● Questionnaire● Guest Speakers● Lectures● Staff

Step 7: External Factors● Income/Socioeconomic Status● Parental support/timing● Child’s willingness to participate

● Extracurricular activity time commitment● Peer acceptance of program● School Policies

Evaluation Standards IVs DVs Evaluation Design

Types of data/measures needed

How will data be collected (and how frequently)

Long Term Outcomes

1. How will nutrition knowledge improvement be measured?

1. The posttest will measure their increase in nutrition knowledge.

Posttest Nutrition knowledge

One group Pretest-Posttest

Pretest, midterm test, posttest

Before implementation, midway, and end of program posttest

2. How will the participants change in food consumption be observed?

2. The food log will be used to monitor behavior change.

Program Curriculum

Program materials provided to participants


Food logs, reflection paper on food log changes

Students will turn logs weekly

Intermediate Outcomes

1. How will student’s attitudes and behaviors toward the program be measured

1. Students’ attitudes and behaviors will be measured by their willingness to comply and actively participate in the program.

Completion of program materials

Program creativity and interactive components


Completion of required coursework

Assigned due dates, approximately weekly

2. How will improvement of students’ nutrition behaviors be measured?

2. Students will be required to demonstrate correct portion sizes for each component of myplate through their food log

Program Curricula

Food logs and myplate worksheets


Tracking of food logs

Weekly

Short-term Outcomes

1. How will student’s ability to read a food label be measured?

1. Students will be required to pass the post food label exam with an

Program Curricula (nutrition lectures)

Scores of 80% on post food label exam


Post food label exam

Before intervention and After Intervention

80% or higher.

2. How will student’s ability to choose healthy food be evaluated?

2. Students will be required to pass the healthy choice questionnaire with an 80% or higher.

Program Curricula

Scores of 80% on the healthy choice questionnaire


Healthy Choice Questionnaire

Before and after intervention

Participants/Clients

1. How will participants be selected?

1. Participants will be in a 7th grade class in a public school in Duval County.

Grade Level Participation in the program


Successful completion of the 6th

grade

Enrollment in the 7th grade

2. Have participants passed the 6th grade FCAT?

2. Students will be required to have passed the 6th grade FCAT to ensure complete comprehension of the program.

FCAT Completion of FCAT


FCAT Scores Scores will be reviewed the summer before 7grade

Activities 1. Have participants completed required activities?

1. Participants will be required to complete 95% of the activities.

Completion of required curriculum

Participation of 95% of activities


Completed program activities

Students will turn in assigned activities weekly

2. Are activities designed for comprehension at the appropriate

2. The program will encompass age appropriate

Program Activities

Grade Level/Reading Level


Readability level and successful completion of 6th grade

Curriculum materials will be assessed for reading and grade

grade level? activities that can be realistically performed by the participants.

level

Resources 1. What credentials will the staff be required to have in order to teach the program?

1. Staff will be required to have a health education certification or degree.

Staff delivering/teaching the program

Staff certification or degree


Staff degrees and certifications

Degree/Certification will be collected prior to becoming staff

2. Is the curriculum age and developmentally appropriate for the target population?

2. Curriculum will be written at a 7th grade level of comprehension.

Program Curricula

Age-Appropriate


Measured by 7th grade comprehension software

Curriculum will be assessed for comprehension levels before program implementation

External Influences

1. How will parental support be encouraged and measured?

1. Parental involvement will be measured by attendance of school banquets and use of backpack materials.

Parental Involvement

Requirement of attendance to program events


Attendance Record of parents at events

Attendance of events will be recorded throughout the program

2. How will peer rejection of the program be minimized?

2. There will be school wide support of the nutrition program.

Peer Acceptance

School support of the program


Involvement and participation of school

Participation in events will be measured off attendance

Program EvaluationEvaluation Design: One group Pretest Posttest Design

E O1------X1(knowledge)----O2 X2(behavior)----------------O3

Evaluation Conduction:

Pretest/Posttest Scores from the Experimental group (7th grade class receiving implementation), Midterm evaluations, Food log checks

Data Collection:

We will develop our own measures which will include a survey, pretest, posttest, food logs, midterm test

Plans for Evaluation Findings:

The findings from the midterm test will be used to improve the program during the current implementation. The pretest and posttest will be used to improve the program for future intervention and prove its causality.

Used by:The stakeholders (school officials, school board, funders) and program evaluators will use the information from the evaluation. Others who want to implement a nutrition program among other 7th graders can utilize the information from the program evaluations.

Pretest/Posttest: Nutrition Survey 7th Nutrition Class

April 1, 2012

ID NUMBER: ______________

Purpose of this studyThis survey was designed to evaluate the nutrition knowledge of 7 th grade students. This pretest will be used in comparison with the posttest administered at the end of the program to evaluate the overall effectiveness of the program in increasing nutrition knowledge. RisksThere are no risks associated with filling out this survey. Confidentiality Your identity will be kept completely confidential and your results will not be recorded with your name. We will only use the ID number to compare pre and post test scores.

Instructions

For the following questions select the answer that completes each statement best. These next questions will assess your general nutrition knowledge.

1. Milk and __________belong to the same food group.a. Breadb. Applec. Cheesed. Both A and C

2. A balanced diet includes these basic nutrients:a. Carbohydratesb. Proteinsc. Fatsd. A, B, and C

3. ________foods are foods that do not provide proteina. Green Vegetablesb. Meatsc. Milk Productsd. Kidney Beans

4. A healthy 7th grader should eat about ________ calories a day.a. 4000 to 5000b. 1000 to 2000c. 2400 to 2900d. 500 to 1000

5. One serving of meat is about the size of a ________.a. Deck of cardsb. Golf ballc. Spoonfuld. Plate

6. ______________is a good example of a healthy lunch for a 7th grader.a. Peanut-butter sandwich, fresh apple, non-fat milkb. Slice of pizza, celery sticks, sodac. Double cheeseburger, French fries, chocolate milkd. A, b and c

7. People who are overweight have more health problems than other people who are not overweight.

a. Trueb. False

8. French fries are a healthy vegetable option.a. True b. False

9. How many total servings of fruits and vegetables should you eat each day?a. At least 2 servings b. At least 3 servings c. At least 4 servings d. At least 5 servings

10. What you eat can make a difference in your chances of getting heart disease or cancer. a. True b. False

11. People who are underweight are more likely to have a higher risk of health problems that people who are not underweight.

a. True b. False

12. Skipping meals such as breakfast or lunch affects my ability to do well in my classes. a. True b. False

Instructions: After each statement, circle the word that best describes you.

13. I eat a nutritious, well-balanced luncha. Alwaysb. Oftenc. Sometimesd. Never

14. I eat vegetables at dinnera. Alwaysb. Oftenc. Sometimesd. Never

15. I drink at least one glass of milk every daya. Always

b. Oftenc. Sometimesd. Never

16. Being healthy is important to mea. Alwaysb. Oftenc. Sometimesd. Never

Instructions For the following questions select the answer that answers each statement best. These next questions will assess your nutrition label knowledge

17. How many servings of milk are in this package?

a. Oneb. Twoc. Fourd. Eight

18.

19.

20.

21.

Instructions For the following questions select the answer that completes each statement best. These next questions will assess your MyPlate knowledge

23. What two food groups are balanced on MyPlate?a. Fruits and Vegetablesb. Dairy and Proteinc. Grains and Vegetablesd. Protein and Grain

24. How many glasses of milk should you drink during a day to get the recommended amount of dairy?

a. Noneb. 1 glassc. 2 glassesd. 3 or more

22.

25. What is the minimum and maximum amount of serving of vegetables you should have every day?

a. 1b. 3c. 4d. 5e.6 f. 7

26. Your plate should look like MyPlate at every meal.a. Trueb. False

27. What would be a great vegetarian source of protein?a. Steakb. Celeryc. Onionsd. Beanse. Peasf. Bread

28. How much sodium is the limit per day for most people 2 years to 50 years old? a. 1500mg

b. 1700mgc. 2000mgd. 2200mge. 2300mg f. 2500mg

29. What food will give you a large amount of protein with the least amount of fat?a. Egg yolkb. Steakc. Egg whited. Fried chicken

For the following questions refer to the MyPlate Diagram

30. What food group is supposed to be in the green section?a. Grainb. Vegetablesc. Proteind. Fruite. Dairy

31. What food group is supposed to be in the red section? a. Grainb. Vegetablesc. Proteind. Fruite. Dairy

32. What food group is supposed to be in the purple section? a. Grainb. Vegetablesc. Proteind. Fruite. Dairy

33. What food group is supposed to be in the blue section? a. Grainb. Vegetablesc. Proteind. Fruite. Dairy

34. What food group is supposed to be in the brown section? a. Grainb. Vegetablesc. Proteind. Fruite. Dairy

35. What food can you eat that you burn more calories digesting then you get from consuming the food?

a. Peasb. Celeryc. Applesd. Pearse. Orangesf. Skinless Chicken

36. Trans fats raise the risk of heart diseasea. Trueb. False

37. Trans fats are found in fruits.a. True b. False

38. Trans fats are manmade.a. True b. False

Instructions

Circle the appropriate choices for each question below.

These next questions will assess your food group knowledge.

Thank you for taking the time to complete this survey.

Question Response Options Variable being measured

Scaled Origin of item

1. Milk and __________belong to the same food group.

Bread Apple Cheese Both A and C

General nutrition knowledge

No Adapted from

2. A balanced diet includes these basic nutrients:

Carbohydrates Proteins Fats A, B, and C


No

3. ________foods are foods that do not provide protein

Green Vegetables Meats Milk Products Kidney Beans


No

4. A healthy 7th

grader should eat about ________ calories a day.

4000 to 5000 1000 to 2000 2400 to 2900 500 to 1000


No

5. One serving of meat is about the size of a ________.

Deck of cards Golf ball Spoonful Plate


No

6. _________is a good example of a healthy lunch for a 7th

grader.

Peanut-butter sandwich, fresh apple, non-fat milk

Slice of pizza, celery sticks, soda

Double cheeseburger, French fries, chocolate milk

A, b and c


No

7. People who are overweight have more health problems than other people who are not overweight.

True False


No Adapted from CSC Broward

8. French fries are a healthy vegetable option.

True False



9. How many total servings of fruits and vegetables should you eat each day?

At least 2 servings At least 3 servings At least 4 servings At least 5 servings



10. What you eat can make a difference in your chances of getting heart disease or cancer.

True False



11. People who are underweight are more likely to have a higher risk of health problems that people who are not underweight.

True False



12. Skipping meals such as breakfast or lunch affects my ability to do well in my classes.

True False



13. I eat a nutritious, well-balanced lunch

Always Often Sometimes Never

Participant’s current eating behaviors

Yes. Designed to measure participant’s eating behaviors

14. I eat vegetables at dinner




15. I drink at least one glass of milk every day




16. Being healthy is important to me




17. How many servings of milk are

One Two

Nutrition label knowledge

No.

in this package? Four Eight

18. How many calories are in one serving of whole milk?

70 125 150 240


No.

19. What percent of your recommended daily value of calcium will you get from one serving of milk?

0% 6% 30% 100%


No.

20. How many grams of protein are in one serving of milk?

8 grams 11 grams 12 grams 0 grams


No.

21. Whole milk is a good source of Vitamin D

Yes No


No.

22. How many grams of fat are in one servings of skim milk

0 grams 5 grams 8 grams 12 grams


No.

23. What two good groups are balanced on MyPlate?

Fruits and Vegetables Dairy and Protein Grains and Vegetables Protein and Grain

MyPlate Knowledge

No.

24. How many glasses of milk should you drink during a day to get the recommended amount of dairy?

None 1 glass 2 glasses 3 or more

MyPlate Knowledge

No.

25. What is the minimum and maximum amount of serving of vegetables you should have every day?

1 3 4 5 6 7

MyPlate Knowledge

No.

26. Your plate should look like MyPlate at every meal.

True False

MyPlate Knowledge

No.

27. What would be a great vegetarian source of protein?

Steak Celery Onions Beans

MyPlate Knowledge

No.

Peas Bread

28. How much sodium is the limit per day for most people 2 years to 50 years?

1500mg 1700mg 2000mg 2200mg 2300mg 2500mg

MyPlate Knowledge

No.

29. What food will give you a large amount of protein with the least amount of fat?

Egg Yolk Steak Egg White Fried Chicken

MyPlate Knowledge

No.

30. What food group is supposed to be in the green section?

Grain Vegetables Protein Fruit Dairy

MyPlate Knowledge

No.

31. What food group is supposed to be in the red section?


MyPlate Knowledge

No.

32. What food group is supposed to be in the purple section?


MyPlate Knowledge

No.

33. What food group is supposed to be in the blue section?


MyPlate Knowledge

No.

34. What food group is supposed to be in the brown section?


MyPlate Knowledge

No.

35. What food can you eat that you burn more calories digesting then you get from consuming the food?

Peas Celery Apples Pears Oranges Skinless Chicken

MyPlate Knowledge

No.

36. Trans fats raise the risk of heart disease.

True False

MyPlate Knowledge

No.

37. Trans fats are found in fruits.

True False

MyPlate Knowledge

No.

38. Trans fats are manmade.

True False

MyPlate Knowledge

No.

Food Group Questions:1. Circle the foods that are in the Grain Group.

Bread Potato Bananas Pasta Cheese Candy Bar

Food Group Knowledge

No. Adapted from CSC Broward

2. Circle the foods that are in Vegetable Group.

Eggs Lettuce Carrots Orange Cereal Steak



3. Circle the foods that are in the Fruit Group

Corn Muffin Strawberries Eggs Plain Burger Apple



4. Circle the foods that are in the Milk Group.

Yogurt Bananas Eggs Peanut Butter Cheese Green Beans



5. Circle the foods that are in Meat and Beans Group.

Chicken Pasta Ice Cream Eggs Broccoli Potato



Questions 7-12; 1-5 food groups http://www.cscbroward.org/docs/Repository/SummerChallengeGPNutrition.pdf

Questions: 1-6; 13-16http://dentaleducation.pgschoolprograms.com/student-nutrition/pre-test.phpQuestions 17-22http://www.quia.com/quiz/681988.html?AP_rand=973006736

http://www.quia.com/quiz/681988.html?AP_rand=973006736

http://dentaleducation.pgschoolprograms.com/student-nutrition/pre-test.php

http://www.cscbroward.org/docs/Repository/SummerChallengeGPNutrition.pdf

Questions 23-38http://www.proprofs.com/quiz-school/story.php?title=choose-my-plate-knowledge-quiz

http://www.proprofs.com/quiz-school/story.php?title=choose-my-plate-knowledge-quiz

Plans for Reviewing of QuestionsTo test our pretest/posttest instrument and check for validity we will have the instrument

reviewed by officials from the Duval County Health Department. These individuals should be considered experts in the field of health and should be able to look at our instrument and determine the face and content validity of the questions on our survey. They will also be able to direct us to better formulate our questions should any of them be confusing or incomplete. In the event that our sample of questions is not wide enough they will be able to direct us to other instruments that have questions that cover the full spectrum of our topic. They can also verify the criterion validity of our survey by comparing its components to those components of established nutrition exams.

To ensure that our instrument is indeed ready for implementation we will also have it reviewed by established experts in the field of nutrition outside of Duval County. We will have our pretest/posttest reviewed by Dr. Delores James of the University of Florida. Her credentials make her a reliable source to check content of our instrument and she can also verify the wording of our questions.

Since this is a new curriculum, we will have to get the program and its instruments reviewed and approved by the Duval County School Board. We will have the health official for the school board review the questions in are pretest/posttest in order to ensure the questions are testing measurable outcomes and that they do relate to our overall outcome. Having a school board health official take our pretest/posttest will also help us to ensure that our questions are written at an understandable grade level for the students and that all answer choices are comprehensible.

To sample our instrument before implementation we will also sample 20 seventh grade students in Duval County. We will have them take the pretest/posttest and explain any confusion they may have. They will check for wording of questions, comprehension, and any other errors or formatting issues they may find. After completing all of these steps, our instrument should be ready for implementation.

Budget

Categories Cost

Personnel Evaluators (or Principal Investigators) Salary for Person 1 (% time on project) Salary for Person 2 (% time on project) Assistants Data transcriber Data entry person(s) Consultants (paid ~ $100 to $200 x hour - no benefits)

Teacher Level-1:(full-time)$37,300

Assistant:(part-time ~25 hours/week @ $9.00/hour)

$8,100

Benefits (calculate at 35% of total salary) $13,055

Materials/Equipment $1,944.50

Incentives $0.00

Travel $0.00

TOTAL DIRECT COSTS $60,399.50

Indirect Costs (at 20% of total direct costs) $12,079.90

TOTAL $72,479.40

Reporting of FindingsWe will continually keep the stakeholders informed throughout the program showing the

students improvements and the knowledge they have gained in implementing healthier choices. The stakeholders will be informed of the findings monthly through written reports. We will be holding formal meetings with the stakeholders after the midterm evaluation and posttest have been completed and the data has been compiled. We will present these finding to the stakeholders throughout the program by using the pretest, posttest, and food logs results. The pretest/posttest will be able to show the stakeholders the knowledge the students have gained, while the food logs will show the stakeholders the nutrition behavior the students engage in and whether or not their nutrition behavior has improved.

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