Mothers

International Journal of Behavioral Nutrition and Physical Activity BioMed Central Research Open Access Mothers' involvement in a school-based fruit and vegetable promotion intervention is associated with increased fruit and vegetable intakes – The Pro Children study Saskia J Te Velde*1, Marianne Wind2, Carmen Perez-Rodrigo3, KnutInge Klepp4 and Johannes Brug5,6 Address: 1EMGO institute, VU University Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands, 2Department of Nutrition, Faculty of Medicine, University of Oslo, PO Box 1046, Blindern, 0316 Oslo, Norway, 3Community Nutrition Unit, Department of Public Health, Luis Briñas 18; 4 Planta E 48013 Bilbao, Spain, 4Department of Nutrition, Faculty of Medicine, University of Oslo, PO Box 1046, Blindern, 0316 Oslo, Norway, 5Brug J, EMGO institute, VU University Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands and 6Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands Email: Saskia J Te Velde* - ; Marianne Wind - ; Carmen PerezRodrigo - ; Knut-Inge Klepp - ; Johannes Brug - * Corresponding author Published: 15 October 2008 International Journal of Behavioral Nutrition and Physical Activity 2008, 5:48 doi:10.1186/1479-5868-5-48 Received: 24 December 2007 Accepted: 15 October 2008 This article is available from: http://www.ijbnpa.org/content/5/1/48 © 2008 Te Velde et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Background: Several school-based fruit and vegetable interventions include activities to involve parents, but not much is know about the effectiveness of such a family component on child and parent intake levels. The current study evaluated the effects of the multi-component school-based intervention, 'the Pro Children Study', on mothers' intake levels. Furthermore, associations between level of involvement in the project and improvement in the mothers' intake levels were assessed. Methods: Effect was evaluated in a cluster randomized controlled trial in Spain, Norway and the Netherlands among mothers of 11-year-olds. Of the 1253 mothers with complete data at baseline, 754 and 476 had complete data at first and second follow-up respectively. Fruit and vegetable intake, level of involvement and demographic variables were assessed by a parental questionnaire. Data was analyzed using multilevel regression analyses. Results: Results showed no effect of the intervention on mothers' fruit and vegetable intake after one year and two year follow-up. Participation rate for the different activities varied by activity and by country, e.g. 3.7–9.4% visited the website, while 26.4–72.6% of the mothers participated in the home work assignments. Results further showed that higher involvement levels were associated with higher intake at follow-up. Conclusion: The Pro Children Intervention could not increase the fruit and vegetable consumption of the mothers of participating pupils, which might be explained by the low involvement in the project. More research is needed to increase mothers' involvement in schoolbased interventions. Page 1 of 10 (page number not for citation purposes) International Journal of Behavioral Nutrition and Physical Activity 2008, 5:48 http://www.ijbnpa.org/content/5/1/48 Background Methods A large proportion of the Western populations does not meet the recommendations for fruit and vegetable intake [1-3], while epidemiological studies show beneficial effects of diets high in fruit and vegetables [4-6]. Therefore, several programs have been developed to encourage fruit and vegetable intake. The Pro Children Intervention is one example, which was implemented and evaluated in a cluster randomized controlled trial in three European countries, namely Norway, Spain and the Netherlands [7], and which has proven to be successful in increasing fruit and vegetable intake among 11-year-old schoolchildren [8]. The intervention The Pro Children intervention consisted of different components: a classroom component, a school component, a family component and one optional component, which differed slightly by intervention site, as described in more detail elsewhere [8,9]. The Pro Children Intervention was a multi component intervention consisting of a class room component, a school component and a family component in which parents were encouraged to participate in various activities [9]. Since parents were encouraged to be involved in the project and children were taught skills to ask for fruit and vegetables at home, the intervention may also have improved fruit and vegetable intakes of the parents. Several school-based fruit and vegetable interventions comprising family components have been described in the literature [10], however, only one described effects in intake among parents [11]. The High 5 Intervention resulted in higher fruit and vegetable consumption in parents in the experimental group compared to the control group at first follow-up at 12 months, but this effect was not sustained at second follow-up, one year later. A Social marketing inspired intervention including newsletters and parent events (duration 4 weeks) resulted in more frequent serving of fruit and vegetables during dinner and more frequent serving of fruit as a snack among the parents at post-test, compared to the pre-test [12]. If schoolbased interventions are successful in promoting fruit and vegetable intake among parents, this will be an additional positive effect, which might be relevant for policymakers deciding upon large scale implementation of school based interventions. Moreover, parents who increase their own fruit and vegetable intake may also serve as better role models for their (other) children [13-15]. Such an effect among parents is most likely if parents are actively involved in the school-based project. In the Pro Children intervention study, data is available on fruit and vegetable intake of the parents of the participating pupils, therefore, the aim of the current study was to evaluate the effects of a school based intervention on parents' fruit and vegetable intake after one year and two year follow-up. A second aim was to assess whether a potential effect was mediated by the level of involvement in the project. The classroom curriculum consisted of school education materials containing of a set of 16 worksheets with guided activities and a web-based computer-tailored feedback tool. These educational classroom activities addressed the knowledge of recommended intake levels, awareness of the children's own intake, taste and preferences for different kinds of fruits and vegetables and specific skills to prepare or ask for fruit/vegetables. The school (...truncated)