GREEN Project: HERO Campaign

1. GREEN Project: HERO Campaign Somawina Nwegbu, Lauren Todd, Lauren Wood, Emily Wong

2. BackgroundDiets of US Children 80-90% of 4-13 year olds do not meet recommendations for fruit and vegetable consumption (ADA 2008) 17% of children aged 2-19 were classified as obese in 2010 (Ogden 2010) Adulthood chronic diseases are now impacting children

3. BackgroundFood in the School • Opportunity to make an impact • Up to two meals and multiple snacks consumed by students daily • 55.8 million children participate in National School Lunch Program (USDA 2011) • Problem • Access and availability does not always translate to consumption of healthful foods

4. BackgroundFood Waste • An estimated 12% of total calories of school lunches are wasted (Ralston 2008) • What about forcing children to take food? • No impact on consumption • Doubles waste (Price & Just 2009) • Food waste tend to be lower calorie foods with higher levels of nutrient density, particularly fruits and vegetables

5. Past Interventions • Healthy Eating Focus • Cafeteria Power Plus Intervention • Project FIT • Plate Waste Focus • Great Taste, Less Waste • International Programs • General Healthfulness • Healthy Buddies • What It Means to Be Healthy

6. Formative Research Process • Key Information Interviews (Part 1) • Population Representative • Columbus Elementary School in Medford, MA • Middle class, diverse environment • Interest in improvement of childhood nutrition • Key Informant Interviews (Part 2) • Cafeteria and Kitchen Staff • Cafeteria Observation • Focus Groups • Eight 3rd Graders • Six 4th Graders

7. Focus Group Guide • Attitudes and Beliefs towards Fruits and Vegetables • Taste • Presentation • Other Characteristics • Expectations about Fruits, Vegetables, and Food Waste • Subjective Norms about Food Waste • Campaign Ideas

8. Formative Research Findings Focus Group Findings: • Acceptability of fruits and vegetables • Taste • Some Texture • Strong parental and teacher influence • Favor for interactive, hands-on activities • Posters in hallways and cafeteria space Observation Findings: • Disregard for food waste and ecological impact

9. Aims, Hypotheses, & Limitations • Aims • Increase fruit and vegetable consumption by 3rd and 4th grade children (compared to baseline) • Reduce plate waste of fruits and vegetables served in schools by 3rd and 4th grade children(compared to baseline • Hypothesis • A school-based, year-long Social Marketing campaign guided by key constructs from Social Cognitive Theory will significantly increase consumption and decrease waste of fruits and vegetables by third and fourth grade children compared to baseline. • Limitations • Communications-based campaign, not an intervention • Timing, cost, and uncontrollable factors

10. Logic Model

11. Campaign Components and Materials Social Marketing Materials (Environment) Interactive Components (Behavior) Newsletter to Influence the Home Environment

12. Social Marketing Materials Logo Posters and Decorated Trash Cans Mascots Glass Cling

13. Branding &Logo Implementation ealthy ating ewards every ne

14. Mascots • Mascots • Diverse, heroic • Focus on saving the Earth • Three Appearances • Beginning of the first semester • Goal: to introduce the campaign • Statement through PA system • Appearance in the cafeteria • End of the first semester • Incorporated into already existing assembly • End of the year to announce contest winners

15. Posters and Decorated Trash Cans Posters in the cafeteria space Posters on the trash cans to discourage waste of fruits and vegetables Glass cling icons and food descriptions on the lunch line in front of fruit and vegetable offerings Table top cling signs (semester 2) reinforcing messages

16. Sample Poster 1

17. Sample Poster 2

18. Sample Poster 3

19. Glass Cling

20. Table Top Cling

21. Interactive School-based Components “Be a HERO” Contest Public Announcement System Jingle Public Announcement System Messages

22. “Be a HERO” Fruit & Vegetable Consumption Contest • Goal: Create a competition in which students track fruits and vegetables that they try • Method • Utilization of a “passport” to track fruit and vegetable consumption at lunch • Child gets a sticker for each day he or she tries a fruit or vegetable • Lunch monitors already in place will distribute the stickers • In line with HERO theme, appropriate rewards distributed to everyone, with greater incentives for higher consumption

23. Public Announcement System: Jingles • Based on formative research • Students accustomed and attentive to PA system announcements • Excited about integration of music and campaign messaging • Requested variety of musical styles • Logistics: • Mimicking morning announcements • Played every Friday during Semester 1 • Sample: “You can be a Hero”

24. Public AnnouncementSystem: Student HERO Messages • Goal: provide students with opportunity to share positive, personal messages that support the HERO message over the PA system at lunch • Messages created over holiday break: their favorite fruits and vegetables, how they are a HERO • 2 students selected to deliver message each Friday: • Sample: “I’m Makayla and my favorite fruit and vegetables are strawberries and red peppers. I’m a HERO because I eat fruits and veggies from all the colors of the rainbow!

25. Influencing the Home Environment: Parent Newsletters • Literature and formative research confirmed the strong parental influence on food behaviors of children at this age • Goals: Provide information and support to parents around campaign elements, fruit and vegetable purchasing, consumption and preparation • Monthly Newsletter components: • Update on campaign events • Recipes highlighting specific fruits and vegetables • Spotlight on individuals adhering to tenets of campaign • Packing and shopping guides • Talking points and suggestions for FV-based activities

26. Process Evaluation Ongoing measure of progress of campaign materials to reach the desired aims Includes measures of reach, dose delivered, dose received and fidelity of each campaign component Insert screen shot of portion of chart???

27. Outcome Evaluation Intermediate outcomes: 1) Improved self-efficacy and attitudes towards fruits and vegetables Validated survey modified from GREEN project(baseline and end line) 2) Parents read and act on strategies from newsletters Detachable portions of newsletters request feedback Long term outcomes: 1) Increased fruit and vegetable consumption Collect the contest passports (baseline, every 2 months, and end line) Plate waste serves as a proxy 2) Decreased plate waste of fruits and vegetables Tally the number of food trays with leftover fruits and vegetables Conducted by research assistants at baseline, midline and end line

28. Should I put long term outcomes on this slide (and ST on the previous?) Or leave them on one slide?

29. Implementation Timeline Screen shot of implementation timeline. Honestly I think we could get rid of the next 2 slides and just go over the screen shot????

30. Timeline ReviewFirst Semester • September • 1-15: Begin training • 16-30: Campaign Implementation • Overview • Mascot Introduction (3rd week of school) • “Be a HERO” Contest • PA System Jingle • Glass clings • Posters • Signs on Trash Cans • Mascot Assembly • Parent Newsletters

31. Timeline ReviewSecond Semester • Overview • “Be a HERO” Contest (all semester) • Glass clings (continues all semester) • Posters (rotated in January, remain hung all semester) • Table-top clings (beginning this semester) • Signs on Trash Cans (continues all semester) • Parent Newsletters (monthly) • Student HERO Messages (all semester) • Mascot Assembly

32. Q & A ealthy ating ewards every ne

33. Bibliography American Dietetic Association. Position of the American Dietetic Association: Nutrition Guidance for Healthy Children Aged 2 to 11 Years. Volume 108, Issue 6, Pages 1038-1047. June 2008. Baik JY, H. Lee. Habitual plate-waste of 6- to 9-year-olds may not be associated with lower nutritional needs or taste acuity, but undesirable dietary factors. Nut Res. 2009 Dec;29(12):831- Begley, K, AR Haddad, C Christensen, and E Lust. A Health Education Program for Underserved Community Youth Led by Health Professions Students. American Journal of Pharmaceutical Education 73.6 (2009): 98. Print. Bergman E, NS. Buergel; TF Englund; and A Femrite. Relationships of Meal and Recess Schedules to Plate Waste in Elementary Schools. Journal of Child Nutrition & Management, Spring 2004. No.24. Bryant, CA., A Courtney, R. McDermott, M Alfonso, J. Baldwin, J Nickelson, K. McCormack Brown, R DeBate, LM. Phillips, Z Thompson, and Y Zhu. Promoting Physical Activity Among Youth Through Community-Based Prevention Marketing. Journal of School Health 80.5 (2010): 214-24. Buzby, J.C., and J.F. Guthrie (2002). Plate Waste in School Nutrition Programs: Final Report to Congress, E-FAN-02-009, U.S. Department of Agriculture, Economic Research Service, March 2002. Story M, Kaphingst KM, Robinson-O'Brien R, Glanz K. Creating healthy food and eating environments: Policy and environmental approaches. Annual Review of Public Health. 2008;29:253-+.

34. Bibliography Comstock EM, RG St. Pierre, YD Mackiernan. Measuring individual plate waste in school lunches. Visual estimation and children's ratings vs. actual weighing of plate waste. Journal of the American Dietetic Association.1981, 79(3):290-6. Eisenmann, JC., K Alaimo, K Pfeiffer, H Paek, J. Carlson, H Hayes, T Thompson, D Kelleher, HJ. Oh, J Orth, S Randall, K Mayfield, and D Holmes. Project FIT: Rationale, Design and Baseline Characteristics of a School- and Community-based Intervention to Address Physical Activity and Healthy Eating among Low-income Elementary School Children. BMC Public Health 11.1 (2011): 607. Guthrie J.F. and J. C. Buzby, Several Strategies May Lower Plate Waste in School Feeding Programs. FoodReview, Vol. 25, Issue 2, Economic Research Service, USDA Harris, J., J. Bargh, K. Brownell. “Priming effects of television food advertising on eating behavior.” Health Psychology. 28.4 (2009): 404-413. Hoelscher, D., E. Alexandra, G. Parcel, S. Kelder. Designing Effective Nutrition Interventions for Adolescents. The American Dietetic Association 102.3 Supplement (2002): S52-S63. Hoffman, J., D. Franko, D. Thompson, T. Power, V. Stallings. Longitudinal Behavior Effects of a School-Based Fruit and Vegetable Promotion Program. J of Pediatric Psychology 35.1 (2010): 61-71. U.S. Department of Agriculture Economic Research Service. The Food Assistance Landscape. Economic Information Bulletin No. 6-8. March 2011.

35. Bibliography Howe, C. A., P. S. Freedson, S. Alhassan, H. A. Feldman, and S. K. Osganian. "A Recess Intervention to Promote Moderate-to-vigorous Physical Activity." Pediatric Obesity 7.1 (2012): 82-88. Print. C. Knai, J. Pomerleau , K. Lock , M. McKee, Getting children to eat more fruit and vegetables: a systematic review. Prev. med. 2006 Feb;42(2):85-95. Epub 2005 Dec 20 National Cancer Institute. (2005). Theory at a Glance: A Guide for Health Promotion Practice. (2nd ed.). Washington, DC: U.S. Department of Health and Human Services. CL. Ogden.; MD. Carroll.; BK. Kit and KM. Flegal. NCHS Data Brief Prevalence of Obesity in the United States, 2009–2010. Number 82, January 2010. Perry, C., D. Bishop, G. Taylor, M. Davis, M. Story, C. Gray, S. Bishop, R. Warren Mays,L. Lytle, L. Harnack. Randomized school trial of environmental strategies to encourage fruit and vegetable consumption among children. Health Education and Behavior 31.65 (2004): 65-76. Price, J.P. and Just, D.R. Getting Kids to Eat Their Veggies. Presented at the International Association of Agricultural Economists 27th Triennial Conference, Beijing, China. 2009. U.S. Department of Agriculture Food and Nutrition Service. Office of Research, Nutrition and Analysis, School Nutrition Dietary Assessment Study-III, Vol. I: School Foodservice, School Food Environment, and Meals Offered and Served, by Anne Gordon, et al. Project Officer: Patricia McKinney. Alexandria, VA: 2007.

36. Bibliography Ralston K, Newman C, Clauson C, Guthrie J, and Buzby J. The National School Lunch Program: Background, Trends, and Issues Economic Research Report Number 61, July 2008. R. Robinson-O’Brien, M. Story, S. Heim, Impact of garden-based youth nutrition intervention programs: a review. J Am Diet Assoc. 2009 Feb; 109 (2): 273-80 Stebbins, Samuel, JS. Downs, and CJ. Vukotich. Using Nonpharmaceutical Interventions to Prevent Influenza Transmission in Elementary School Children: Parent and Teacher Perspectives. Journal of Public Health Management and Practice 15.2 (2009): 112-17.. Stock, S., C. Miranda, S. Evans, S. Plessis, J. Ridley, S. Yeh, and J.-P. Chanoine. Healthy Buddies: A Novel, Peer-Led Health Promotion Program for the Prevention of Obesity and Eating Disorders in Children in Elementary School. Pediatrics 120.4 (2007): E1059-1068. Print. Williams P., K. Walton, Plate waste in hospitals and strategies for change. e-SPEN, The European e-Journal of Clinical Nutrition and Metabolism, Volume 6, Issue 6 , Pages e235-e241, December 2011 U.S. Department of Agriculture Food and Nutrition Service. Evaluation of the Fresh Fruit and Vegetable Program (FFVP) Interim Evaluation Report. July 2008.