=Approximately 75 percent of U.S. adults and children do not consume the recommended 5 servings/day of fruits and vegetables. Our original High 5 program evaluated a school-based intervention with curriculum, cafeteria and family components for 4th graders that stimulated self-reported fruit and vegetable intake in children by 1.58 servings /day at 1 year follow-up and .87 servings/day at 2 year follow-up. The investigators hypothesize that an enhanced family intervention combined with the school-based intervention will further increase fruit and vegetable intake above that achieved by the original High 5 program.
Their specific aims are to: test the effect on fruit and vegetable intake of the enhanced family intervention; to replicate the efficacy of the High 5 program and to validate with direct cafeteria observation and parent observation the self-reported intakes in the children. Elementary schools (n=33) in 3 districts providing a biracial, broad socioeconomic (SES) sample (n=2253) of 4th graders will be blocked within district based on race and SES and randomly assigned to an enhanced family intervention group, an original intervention group, or a control group. Outcomes will be assessed at baseline and after 1 and 2 years follow-up with well-standardized measures from our original High 5 program. In the enhanced family intervention, well-documented social cognitive theory-based behavior change techniques will be combined with a """"""""cognitive map,"""""""" based on issues defined by parents using the nominal group technique. The investigators' preliminary studies defined 3 dimensions: practical aspects of fruit and vegetable consumption, food preparer's sense of control and facilitator orientation. After expanding the individual family to confirm the """"""""cognitive map,"""""""" we will develop instruments to assess the status of an individual family along these dimensions, develop a home-based intervention to target these specific issues, and evaluate the changes in the families. The successful conduct of a pilot enhanced family intervention suggests that we will achieve high rates of participation. A home-based intervention tailored to family-specified issues combined with an effective school-based program may achieve our overall goal of long-term improvement in children's diets for the prevention of cancer.
