Increasing fruits, vegetables and whole grains in preschool sack lunches
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The purpose of this study was to revise the Lunch Box Program using the Intervention Mapping process to design a program for parents of preschool age children in the childcare setting. Program development was guided by input from group interviews (n = 3) that were held with parents (n = 31) at three child care centers. Four major themes were revealed 1) interest in receiving information in written format; 2) activities that stimulate parent interaction; 3) workshops and activity stations; and 4) recommendations for support from local supermarkets. Lunch Is In The Bag emphasizes packing fruits, vegetables and whole grains in lunch daily. In a quasi-experimental design, six childcare centers were paired by size before being randomly assigned to intervention (n=3) and comparison (n=3) groups. The parents with primary lunch packing responsibility for the three to five year old children were enrolled as parent-child dyads. Primary outcome measures included lunch contents of fruits, vegetables and whole grains. Secondary outcome measures included change in behavioral constructs and process outcome measures included fit of program into operations and curriculum. A total of 132 parent-child dyads completed the study, 81 in the intervention group and 51 in the comparison group. Direct observation of children’s lunches from the intervention group showed a significant increase in predicted mean number of servings of vegetables, from 0.41 to 0.65 (P < 0.001) and whole grains, from 0.54 to 1.06 (P < 0.001), but not fruit. The intervention demonstrated a significant effect on knowledge of meal patterns (p = 0.010); outcome expectations for packing whole grains (p < 0.001); and subjective norms for packing fruit (p = 0.002), vegetables (p = 0.046), and whole grains (p = 0.015). Perceived behavioral control (p = 0.000), expectations (p = 0.007), and intentions (p = 0.048) were significant independent predictors for packing vegetables. Knowledge significantly predicted packing whole grains (p = 0.000). Process outcome data indicated Lunch is in the Bag was a feasible nutrition education program that fit well into both the childcare center operations and curriculum.