Project Title: Effect of an integrated nutrition-math curriculum to improve food-purchasing behavior of children. Data show that nearly 25% of children aged four to eight years consumed fast food on a typical day. These trends in fast food consumption are more acute among low-income urban dwellers where higher rates of overweight and childhood obesity are seen. This has led to a focus on providing fast food consumers with point-of-purchase nutrition information, such as the calorie posting mandates, in the hopes that these decision cues will help consumers make better informed dietary decisions. These efforts began in New York City in 2008 and spread to California by 2009 before being finally incorporated into federal law. But even prior to the federal roll out, local studies regarding their influence on purchasing behavior were conflicting. Moreover, studies revealed an even lower yield on behavior among low-income obesogenic populations. Barriers to the use of calorie postings not only include economic, affective and behavioral dimensions but also cognitive dimensions related to low literacy and poor numerical skills, especially among low literacy populations and the youth. Indeed studies evaluating the effect of calorie postings on parental purchases for children found no difference before and after calorie-posting legislation despite parents noticing the calorie postings. Most children chose their own meals at the point-of-purchase, and continued to choose the same items before and after legislation. It is clear that additional strategies are needed to encourage the point-of-purchase use of calorie postings, however available studies provide little insight into best practices or the types of approaches needed. It is with this in mind that we developed a school-based approach to improve point-of-purchase use of calorie postings, by creating a novel intervention that targets menu board calorie literacy as a means of improving food-purchasing behaviors. We have named this program, ?Hip Hop HEALS? (Healthy Eating And Living in Schools; HHH). HHH is a novel behaviorally focused multimedia, musical school health rap toolkit that targets what we refer to as menu board calorie literacy. We have integrated 4th grade common core math standards into our HHH program in a manner that incorporates evidence-based nutrition education recommendations by the Institute of Medicine and the CDC. We propose to test the efficacy of our integrative approach on food purchasing behaviors of children in an adequately powered, controlled trial. We will test the intervention in the after-school setting among economically disadvantaged children and incorporate parental engagement in our outcome evaluations. We have partnered with New York City's largest after-school program vendor, Sports and Arts in Schools foundation, for the implementation of this study. After-school sites will be randomly assigned to either the intervention arm or a wait-list control.
We propose to test a behavioral intervention to positively affect children's and their parent's understanding of ?menu board? language; specifically, to teach them about calories, what they are, how they affect one's weight, how to regard them in the context of one's own metabolic needs, increase their self-efficacy for using calorie postings as a dietary decision support tool (we have termed this menu board calorie literacy), and motivate them to use these postings at the point-of-purchase. Post-intervention, our main outcome is actual food purchases at food sale counters set up in schools, using trackable coupons that the children can spend without being aware that their purchases are being tracked, thus providing an objective measure of the effect of the intervention.
