Mothers' involvement in a school-based fruit and vegetable promotion intervention is associated with increased fruit and vegetable intakes – The Pro Children study

International Journal of Behavioral Nutrition and Physical Activity 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 2 Marianne Wind 1 Carmen Perez-Rodrigo 0 Knut- Inge Klepp 1 Johannes Brug 3 4 0 Community Nutrition Unit, Department of Public Health , Luis Brinas 18; 4 Planta E 48013 Bilbao , Spain 1 Department of Nutrition, Faculty of Medicine, University of Oslo , PO Box 1046, Blindern, 0316 Oslo , Norway 2 EMGO institute, VU University Medical Center , Van der Boechorststraat 7, 1081 BT, Amsterdam , The Netherlands 3 Department of Public Health, Erasmus University Medical Center , Rotterdam , The Netherlands 4 Brug J, EMGO institute, VU University Medical Center , Van der Boechorststraat 7, 1081 BT, Amsterdam , The Netherlands 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. - Background 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 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. Methods 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 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 component consisted of the provision of fruit and vegetables, either for free (Netherlands), by means of a subscription program (Norway) or as part of the school meals (Spain). Providing fruit and vegetables increased the school availability, accessibility and exposure to fruit and vegetables. The family component encouraged parents to be involved in the project by means of their children's homework assignments, parental newsletters and a parent version of the web-based computer-tailored tool that enabled them to get personalized feedback on their own fruit and vegetable intake levels [16]. The newsletters included a variety of information on fruit and vegetables, announcements about ongoing activities and tips for parents to encourage their children to eat more fruit and vegetables. These activities tried to influence the parents as important role models, by advising them on how to support their children in eating fruit and vegetables, and how to increase home availability and accessibility. The computer-tailored tool add (...truncated)