HIGH FIVE PLUS

摘要=大约75%的美国成年人和儿童没有摄入推荐的5份/天的水果和蔬菜。我们最初的高5计划评估了以学校为基础的干预与课程，自助餐厅和家庭组成部分的四年级学生，刺激自我报告的水果和蔬菜摄入量的儿童1.58份/天在1年的后续行动和.87份/天在2年的后续行动。研究人员假设，加强家庭干预与学校干预相结合，将进一步增加水果和蔬菜的摄入量，超过原来的High 5计划。其具体目标是：测试增强的家庭干预对水果和蔬菜摄入量的影响;复制High 5计划的功效，并通过直接的自助餐厅观察和家长观察来验证儿童自我报告的摄入量。3个地区的小学（n=33）提供了一个双向的，广泛的社会经济（SES）样本（n=2253）的四年级学生将被封锁在区内的种族和SES的基础上，并随机分配到一个增强的家庭干预组，一个原始的干预组，或对照组。将在基线时以及1年和2年随访后使用我们最初的High 5计划中的标准化措施评估结局。在强化的家庭干预中，有据可查的基于社会认知理论的行为改变技术将与“认知地图”相结合，“认知地图”基于父母使用名义团体技术定义的问题。调查者的初步研究定义了三个维度：水果和蔬菜消费的实际方面，食品制造商的控制感和促进者取向。在扩展单个家庭以确认“认知地图”之后，我们将开发工具来评估单个家庭的状况，沿着这些维度，针对这些具体问题开发基于家庭的干预措施，并评估家庭的变化。一项强化家庭干预试验的成功进行表明，我们将实现高参与率。针对家庭特定问题的家庭干预与有效的学校计划相结合，可以实现我们长期改善儿童饮食以预防癌症的总体目标。

ABSTRACT=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.