HIGH FIVE PLUS

摘要=大约75%的美国成年人和儿童每天不摄入推荐的5份水果和蔬菜。我们最初的高五项目评估了一项以学校为基础的干预措施，其中包括针对四年级学生的课程、自助餐厅和家庭成分，该干预措施刺激了儿童自我报告的水果和蔬菜摄入量，一年后为1.58份/天，两年后为0.87份/天。研究人员假设，加强家庭干预和学校干预相结合，将进一步增加水果和蔬菜的摄入量，超过最初的高五计划。他们的具体目标是：测试加强家庭干预对水果和蔬菜摄入量的影响；复制High 5计划的效果，并通过直接自助餐厅观察和家长观察验证儿童的自我报告摄入量。3个区的33所小学将根据种族和社会经济状况随机分配到强化家庭干预组、原始干预组或对照组，提供四年级学生的混血、广泛的社会经济(SES)样本(n=2253)。结果将在基线时进行评估，并在1年和2年后通过我们最初的High 5计划中标准化的措施进行随访。在强化的家庭干预中，基于社会认知理论的行为改变技术将与“认知地图”相结合，该技术基于父母使用名义团体技术定义的问题。调查人员的初步研究确定了3个维度：水果和蔬菜消费的实际方面、食物制备者的控制感和促进者导向。在扩展个别家庭以确认“认知图谱”后，我们将开发工具来评估个别家庭在这些维度上的地位，制定针对这些具体问题的以家庭为基础的干预措施，并评估家庭中的变化。加强家庭干预试点的成功开展表明，我们将实现高参与率。针对家庭特定问题量身定做的家庭干预措施与有效的学校计划相结合，可能会实现我们的总体目标，即长期改善儿童饮食以预防癌症。

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.