Despite the health benefits of a diet rich in fruits and vegetables (FV), US children do not consume the recommended levels of these foods; this is particularly true of children living in low-income families. Because low-income children tend to eat school provided lunch (which includes FV), elementary school cafeterias are a convenient location for improving dietary decision-making in this important population. The social-learning theory approach to improving healthy eating has proven effective in schools (see meta-analysis by Evans et al., 2012); this approach uses role modeling and tangible incentives to encourage the repeated tasting of FV. Although the social-learning approach yields good short- and long-term outcomes (e.g., Jones et al., in press) it is impractical - schools cannot afford tangible rewards and they do not have the discretionary labor needed to implement these interventions. This impracticality motivated the development of the FIT Game, a school- based intervention that integrates social-learning theory with game-design principles. The result is a low-cost, low-effort healthy eating intervention that has significantly increased FV consumption in four economically diverse elementary schools (Jones et al., 2014a, b; Joyner et al., in preparation).
The first aim of the current proposal is to modify the FIT Game so that it further encourages the development of long-term healthy eating habits. This will be accomplished in two ways. First, with the aid of game design experts at Schell Games (Pittsburgh, PA) the duration of the FIT Game will be expanded from ~6 weeks to 10 weeks; the latter is an interval across which new eating habits reach their asymptote of automaticity (Lally et al., 2010). Second, the expanded FIT Game will target three potential mediators of long-term healthy eating: intrinsic motivation to consume FV, knowledge of the health-promoting properties of a diet rich in FV, and dietary self-efficacy. The proposal's second aim is to evaluate the short- and long-term effects of the FIT Game on FV consumption of 1st-5th graders. This will be accomplished in a randomized clinical trial enrolling four low-income schools. Two schools will play the FIT Game and two will serve as no-intervention control schools. The measurement of FV consumption will be identical across schools. FV consumption will be assessed twice during the FIT Game and at 2-weeks, 3-months, and 9-months after the FIT Game concludes. The proposal's third aim is to evaluate if the three potential mediators targeted by the FIT Game (intrinsic motivation, knowledge of the health- promoting properties of FV, and dietary self-efficacy) prove to be significant mediators of changes in FV consumption. We hypothesize that they will. If successful, the FIT Game will encourage the development of healthier eating habits and will maintain high levels of FV consumption after the game concludes. Because the FIT Game is a low-cost intervention that is easy for schools to implement, success in this project will prepare us to scale-up the intervention so that it may impact children's healthy eating habits in far more schools.
This project will expand the duration of an empirically supported game-based intervention designed to increase healthy eating in elementary school cafeterias. The proposed expansion of the game will target three potential mediators of long-term healthy eating: intrinsic motivation, knowledge of the health benefits of a diet rich in fruit and vegetables, and dietary-choice self-efficacy. The project, if successful, will significantly impact the healthy eating habits of participating children and will support larger-scale implementation of this low-cost low- labor game at the state and national level.