Unbundling Outcomes of a Multilevel Intervention to Increase Fruit, Vegetables and Whole Grains Parents Pack for their Preschool Children in Sack Lunches

Abstract

Background Packing fruit, vegetables, and whole grains in preschool children’s sack lunches is a powerful way for parents to teach their children eating habits and food preferences to support a lifetime of good health. A multilevel intervention pilot-tested in childcare settings increased servings of vegetables and whole grains, but the lunches still fell short of the intervention goals. Purpose Secondary analyses were conducted to identify specific behavior changes underlying achieved increases in servings of vegetables and whole grains. Methods Food records from direct observation of 769 parent-packed lunches were investigated to unbundle and measure multiple aspects of lunch packing behavior. Changes from baseline to six week follow-up for the intervention (N=81) and comparison (N=51) parent-child dyads were evaluated in multilevel modeling. Results The increase for whole grains was explained by more parents packing whole grain items whereas increase for vegetables was explained by parents packing vegetables on more days. Discussion Tailored options were identified for further strategies to increase vegetables and whole grains in parent-packed sack lunches. Translation to Health Education Practice Linking achieved outcomes to specific behaviors can be an aid in assessing needs and designing interventions to maximize the chances for success.

A Comparison of Fruits, Vegetables, Sugar-Sweetened Beverages, and Desserts in the Packed Lunches of Elementary School Children

“…Very few studies have interventions aimed at increasing the nutritional quality of packed lunches or attempted to discern the factors that motivates parents to pack, [37][38][39][40][41] and interventions that have done so have produced moderate results. 37,38 Additional research is needed to fully understand parent and child motivations for packing lunches and the decision processes that influence the inclusion of certain food items before effective interventions to increase the nutritional value of packed lunches can be developed.…”

Nutritional contents of lunch packs of primary school children in Nnewi, Nigeria

“…Mothers often cite lack of knowledge in addition to lack of time or resources and family or child preferences as barriers to providing adequate diets for their children. [7]…”

“…[6] Packing adequate meals including fruits and vegetables is also a powerful way for parents to teach their children healthy eating habits and food preferences to support a lifetime of good health. [7]…”

“…On the contrary, more than 94% of schools (both public and private) in U.S.A. participate in the National School Lunch Program, which ensures that every child in school is served a nutritious and balanced meal in compliance with the United States Department of Agriculture dietary guidelines for Americans. [7]…”

Nutritional Intervention to Improve the Quality of Lunchboxes Among Mexican School Children

“…Previous studies have documented that the majority of the foods in lunchboxes made at home do not meet the standards of a healthy diet [8][9][10][11].…”