Effect of School-Based Food and Nutrition Education Interventions on the Food Consumption of Adolescents: A Systematic Review and Meta-Analysis
Abstract
:1. Introduction
2. Materials and Methods
2.1. Search Strategy
2.2. Eligibility Criteria
2.3. Data Extration
2.4. Risk of Bias Assessment
2.5. Summary and Data Synthesis
3. Results
3.1. Literature Search Results
3.2. Methodological Quality of Included Studies
3.3. Study Characteristics
3.4. Intervention Characteristics
3.5. Food Consumption
3.6. Meta-Analysis of Fruit and Vegetables Consumption
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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First Author, Year | Theory or Model | Component | Duration | Foods * | Instrument | Effect | Risk of Bias |
---|---|---|---|---|---|---|---|
Amani, 2006 [15] | ___ | Classroom | 2 months | Semiquantitative food frequency scores (five main food groups of the US Food Guide Pyramid) | FFQ | The food frequency scores were elevated in the education group (p < 0.05), but the control group had a non-significant fall in its scores after the campaign (p < 0.1) | Some Concerns |
Amaro, 2006 [16] | ___ | Classroom | 24 weeks, 15–30-min-long play sessions once a week | Vegetables (serving/day) | FFQ | A significant difference between the treated group and control group at post-assessment (p < 0.01) | Some Concerns |
Bessems, 2012 [27] | Behavior change theories; Self-Regulation Theory; TPB, Attitude-Social Influence-Self Efficacy Model, and the action planning literature | Classroom | 8 weeks | Fruit (serving/day) | FFQ | The significant mean difference between the experimental and control group 0.15 servings at both posttests (p < 0.001) | Low |
Birnbaum, 2002 [32] | SCT | Classroom curriculum, school environment, and peer leaders. Parent Packs | 1 year period, 10 curriculum sessions | FV (serving/day) | FFQ | A significant difference in the group of interventions “peer leaders plus classroom curriculum plus school environment interventions” (p < 0.05) | Some Concerns |
Bjelland, 2015 ** [33] | Social-ecological framework incorporating elements from SCT | Class, home/parents, school-wide, and leisure time activities | 20 months | Fruits and vegetables (times/week) | FFQ | Significant difference between groups post-intervention for fruits (p < 0.001), not to vegetables (p = 0.46) | Some Concerns |
Bukhari, 2011 [31] | SCT and the social-ecological model | Classroom and Teacher Development | 19 weeks | Healthful eating (score) | FFQ | There was an overall increase in score of 4.9 points, (p < 0.01). Improved scores correlated with reporting increases in eating vegetables as snacks (r = 0.64, p < 0.001), preparing healthful snacks for self (r = 0.48, p < 0.01), and having sit-down meals with family (r = 0.55, p < 0.004) | Some Concerns |
Cunha, 2013 [34] | Pedagogy of the Oppressed, by Paulo Freire | Classroom curriculum and parents (participation of the family) | 9 months, monthly 1 h sessions in the classrooms | Fruits, beans, cookies, sodas, and juice (per day) | FFQ and 24 h dietary recall | Significant reduction in the frequency of daily consumption of cookies (p < 0.001) and sodas (p = 0.02) and an increased frequency of consumption of fruits (p = 0.04) in the intervention group, compared with that of the control group | Low |
Dzewaltowski, 2009 ** [35] | ___ | Project level, school level, and place level | 3 year period | FV, fruit, and vegetables (servings/day) | FFQ | The intervention and control schools did not change differently over time on FV, fruits, or vegetables | Some Concerns |
Forneris, 2010 [36] | ___ | Classroom | 12 weeks | FV (score) | FFQ | No significant change patterns were found at follow-up for fruit and vegetable intake | Low |
Francis, 2010 ** [37] | Bloom’s mastery of learning model | Classroom | 8 months (10 min/day) | Fried food (servings/day) and HFSS (kJ/day) | FFQ | Average reported daily servings of fried foods were significantly lower in the intervention group than in the control group. In multivariate regression equations controlling for age, gender, BMI, and baseline value, the intervention was associated with lower intake levels of fried foods, HFSS, and sodas (p < 0.05) | Low |
Ghaffari, 2019 [38] | SCT | Student, family, and school levels | 1 year period | FV (score) | FFQ | The difference was significant between the intervention and control groups for 2 months after the intervention (p < 0.002). No significant difference between the groups before the intervention | Some Concerns |
Gratton, 2007 [17] | TPB | Classroom | 3 weeks | FV (score) | 7-day food diary | Both interventions (volitional and motivational) were found to increase fruit and vegetable consumption significantly (p <0.001), although only the volitional intervention demonstrated a significant increase in fruit and vegetable consumption over the control intervention | Some Concerns |
Gray, 2015 [18] | SCT and self-determination theory | Student/classroom and Teacher Professional Development | 8–10 weeks, 24 lessons were taught | Fruits, vegetables, packaged snacks, fast food, and sweetened beverages | FFQ | Students from the high ‘Teacher Implementation’ classes significantly consumed fewer packaged snacks (p < 0.016) and fast food value/combo meals (p < 0.047), and smaller sizes of fast food (p < 0.001), compared with control students. There was no significant difference in any eating behavior outcomes between medium ‘Teacher Implementation’ classes and the control group | High |
Haerens, 2007 [19] | TPB | Student/classroom and teachers | 1 year | Fruits (servings/day) | FFQ | The intervention was not effective in increasing self-reported fruit intake | High |
Hassapidou, 1997 [30] | ___ | Student/classroom and parents (leaflets) | 10 weeks | Pork, sausages, salami, yellow cheese, butter, olive oil, raw vegetables (salads), apples and pears, citrus fruit, bananas, grapes, kiwi fruit, fruit juice (natural), honey, jam, cake, and cocoa | 24 h dietary recall | The intervention did not result in significant changes in the fruits and vegetable intake. The boys in the intervention group decreased their intake of pork (p < 0.05), sausages (p < 0.05), salami (p < 0.01) and jam (p < 0.01) after the intervention. Girls in the intervention group reduced their consumption of cocoa (p < 0.05), sausages (p < 0.05) and animal butter (p < 0.01) | High |
Hoppu, 2010 [20] | SCT | Food environment and nutritional education (pupils, parents, and teachers) | 1 year | Fruits and vegetables (servings) | FFQ | Energy-adjusted consumption of fruit, including berries (g/MJ) remained constant in IG, whereas it decreased in CG (difference in change, p = 0.04). There was no significant change in the consumption of vegetables | Some Concerns |
Ickovics, 2019 ** [21] | ___ | Food environment and nutritional education (Pupils and parents) | 3 years | Healthy foods (fruit, vegetables, green salad, potatoes—not fried) and unhealthy foods (French fries, chips, candy, ice cream, other sweets) (serving/day) | 24 h dietary recall | Students (eighth grade) at schools randomized to the nutrition condition consumed fewer unhealthy foods (p < 0.03) | Low |
Lytle, 2004 [22] | SCT | Classroom curriculum, school environment, and peer leaders. Parent Packs | 2 years, 10 curriculum sessions per year | Fruits and vegetables (score) | 24 h dietary recall | No significant differences | Some Concerns |
Martens, 2008 [23] | ___ | Classroom and parents (a bag with information and food items for parents) | 3 months, eight school classes lasting 50 min each | Fruit (serving/day) | Written questionnaires | The significant difference between groups at T1 = 0.04. p ≤ 0.05 two tailed | Some Concerns |
Mihas, 2009 [24] | ___ | Pupils (classroom) and parents (seminars) | 12 h of classroom material for 12 weeks | Fruits and vegetables (servings/day), ready-to-eat breakfast cereals, red meat, poultry, and fish (meals/week) | FFQ | A significant increase in poultry, ready-to-eat breakfast cereals, and fruit consumption and a significant decrease in red meat consumption were found in the IG. There was no significant difference in the consumption frequency of any food category in the CG | Some Concerns |
Nicklas, 1998 [25] | ___ | (1) School-wide media-marketing campaign, (2) school-wide meal and snack modification, (3) classroom workshops and supplementary subject matter activities, and (4) parental involvement | 3 years | FV (servings/day) | Knowledge, Attitudes, and Practices questionnaire ** | No significant difference between groups | Low |
Ochoa-Avilés, 2017 [26] | ___ | Matrices for adolescents, parents, and school staff | 28 months. (30 min/day) | FV (servings/day) and unhealthy snacking (g/d) | 24 h dietary recall | No significant difference between groups | Low |
Rees, 2010 [29] | TPB and the Transtheoretical Model | Classroom | 3 months | Fruits, vegetables, whole grains, brown bread (servings/day) | 24 h dietary recall | The intervention group consumed approximately 0.35 more servings of brown bread weekly than the control group from baseline. Although this change between groups was statistically significant the magnitude was small. For the other foods, there were no significant effects of the tailored intervention | Some Concerns |
Wang, 2015 [28] | Bronfenbrenner’s ecological theory | Holistic HP’s approach (school environment and ethos, modified curriculum, and family/community involvement) | 3 months | Consumption score of fruit, vegetables, dairy products, breakfast, dessert, fried food, and soft drinks | FFQ | Students in the HPS school had the largest improvement in eating behaviors (from 3.16 to 4.13), followed by those in the HE school (from 2.78 to 3.54) | Some Concerns |
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Medeiros, G.C.B.S.d.; Azevedo, K.P.M.d.; Garcia, D.; Oliveira Segundo, V.H.; Mata, Á.N.d.S.; Fernandes, A.K.P.; Santos, R.P.d.; Trindade, D.D.B.d.B.; Moreno, I.M.; Guillén Martínez, D.; et al. Effect of School-Based Food and Nutrition Education Interventions on the Food Consumption of Adolescents: A Systematic Review and Meta-Analysis. Int. J. Environ. Res. Public Health 2022, 19, 10522. https://doi.org/10.3390/ijerph191710522
Medeiros GCBSd, Azevedo KPMd, Garcia D, Oliveira Segundo VH, Mata ÁNdS, Fernandes AKP, Santos RPd, Trindade DDBdB, Moreno IM, Guillén Martínez D, et al. Effect of School-Based Food and Nutrition Education Interventions on the Food Consumption of Adolescents: A Systematic Review and Meta-Analysis. International Journal of Environmental Research and Public Health. 2022; 19(17):10522. https://doi.org/10.3390/ijerph191710522
Chicago/Turabian StyleMedeiros, Gidyenne Christine Bandeira Silva de, Kesley Pablo Morais de Azevedo, Daniel Garcia, Victor Hugo Oliveira Segundo, Ádala Nayana de Sousa Mata, Anny Karoliny Pinheiro Fernandes, Raquel Praxedes dos Santos, Débora Danielly Barros de Brito Trindade, Isabel Morales Moreno, Daniel Guillén Martínez, and et al. 2022. "Effect of School-Based Food and Nutrition Education Interventions on the Food Consumption of Adolescents: A Systematic Review and Meta-Analysis" International Journal of Environmental Research and Public Health 19, no. 17: 10522. https://doi.org/10.3390/ijerph191710522