Program Evaluation

Healthy Choices, Healthy Me! 2004-05 Evaluation Study:

Study Design
The evaluation was conducted with twenty first grade teachers who agreed to teach the Healthy Choices, Healthy Me! program from ethnically and socially diverse populations in both Northern and Southern California regions. The final analytical sample consists of 347 first graders at 20 schools who participated in pretest and at least one of the after program tests (post-test and 2-month follow-up test).

This evaluation project was designed to answer the following questions:

• To what extent are the teachers and students satisfied with the program?
• Are the revised components of the program better suited for first grade students?
• Do students improve their knowledge and food choices after going through the program?

Both quantitative and qualitative data were used to answer these questions. Quantitative data were collected from both students and teachers surveys. Teacher surveys were self-administered and WestEd staff proctored the pre-, post-, and 2-month follow-up tests. Qualitative data were collected on the school site through teacher interviews and classroom observations. No comparison group was used for this evaluation and therefore no causal inferences can be made about the program. The primary goal of the data collection in first grade classrooms was to assess the efficacy of the program and progress towards achieving student outcomes.

First Grade Student Results
The findings suggest that the Healthy Choices, Healthy Me! program had an impact on gains in knowledge and self-reported eating behaviors among first grade students in participating classrooms. The knowledge questions asked students to classify foods into groups and to identify healthy snacks. The eating behavior questions focused on whether they ate breakfast, what foods they typically ate for breakfast and whether they helped to choose their snacks. The physical activity questions asked students about their participation in physical activities and the importance of physical activity. Below are highlights of the evaluation results.

Knowledge

The percentage of first grade students correctly classifying food groups increased significantly for five of the six foods with the greatest increase for cereal, cheese, and peanut butter between pre- and post-test and between pre- and 2-month follow-up tests. (See Figure 1.)

Figure 1. Percent of first grade students correctly classifying foods

All differences significant at p < 0.05 for pre/post and pre/2-month follow-up except for green beans.
Source: Dairy Council 2004-05 Data
Notes: Table reports data for 331 first graders who participated in pre- and post-test

Students were asked to identify which of the follow are healthy snacks: string cheese, potato chips, banana, chocolate chip cookies, yogurt, and apple pie. There was a significant increase in identification of healthy food items in post- for all items and 2-month follow-up tests for string cheese and yogurt compared to the pre-test. There was a decrease in selection of the three remaining options, with the largest decrease in apple pie. Students recognized that food preparation transferred food group foods to the Extra group, which is an important life skill. (See Table 2.)

Table 2. Percentage of first graders identifying healthy snacks

Source: Dairy Council 2004-05 Data
Notes: Table reports data for 269 first graders who participated in all three tests: pre-, post- and follow-up.
** Significant differences from baseline (p < 0.05)

Behaviors
As expected, a high percentage of students ate breakfast the day of the tests and reported eating breakfast on most days. The Healthy Choices, Healthy Me! breakfast lesson teaches students to make healthy breakfast choices by including foods from three of the five food groups. Students who reported eating breakfast the day of the survey showed consumption of the food pyramid groups increased for meats, beans and nuts; milk and milk products; breads and grains; and fruits in the post-test and 2-month follow-up test compared to the pre-test. Significant increases from pre- to post-test in student reporting eating foods in the "Breads & Grains" (27.9%) and "Meats, Beans and Nuts" (9.7%) groups. (See Table 3.)

Table 3. Breakfast behavior for first graders

Source: Dairy Council 2004-05 Data
Notes: Table reports data for 269 first graders who participated in all three tests: pre-, post- and follow-up.
* Significant differences from baseline (0.05 < p < 0.10)
** Significant differences from baseline (p < 0.05)
A Significant differences from baseline on proportions of "Almost everyday/everyday" and "Never/sometimes" (0.05 < p < 0.10)

In addition to healthy eating habits, Healthy Choices, Healthy Me instructs students on the importance of physical activity for good health. Sixty percent (59.9%) of students reported playing hard everyday in the post- and 2-month follow-up tests, compared to 47.6% in the pre-test. Students recognized that it is important to play hard everyday and statistically fewer children reported never playing hard at both post-tests.

Teacher Survey Results
Each teacher participating in the Healthy Choices, Healthy Me! first grade curriculum was asked to complete and return a teacher survey following completion of the lessons with their students. The surveys were designed to answer these questions:

• To what extent are the teachers and students satisfied with the program?
• What, if any, challenges exist in the implementation and use of the program?

Teachers and students had very positive feedback on the program. All teachers indicated program implementation was easy for them and the teacher guide met their needs. The average amount of preparation time required for most lessons is 15 minutes and all teachers reported that this was an appropriate amount of time. They all felt that the student workbook met their classroom needs as did the length of the activities. Students enjoyed having their own color workbook to write in and share with parents once the program was complete. Parents reported to teachers that their students were classifying meals at home into the food groups and commenting on the balance of the meals prepared. Teachers indicated expanded home connections beyond the Note to Families would assist in communicating key nutrition concepts to families.

Teacher Comments
"It was just so teacher friendly! I had no problems planning my lessons. It was also easy for the students, and they comprehended the lessons."

"It gives practical application for the skills of classification and categorization."

"I teach my first graders that they are responsible for their personal health, and this program goes right along with that philosophy."

"We had an extension activity. a "Healthy Choice" party. Everyone selected their lunch, made it balanced, and had 1 helping from the extra group. Parents were surprised to see their child eating vegetables they didn't at home."

"It was very easy and sequential - and good idea to identify standards."

"Quick to prep & allows for lots of oral English language development in a meaningful way."

Conclusions
Specific teacher feedback to improve Healthy Choices, Healthy Me! such as stronger family connections and enhancing the physical activity component where reoccurring comments. These suggestions will be considered for incorporation into the program when it is revised to match the USDA's new Food Guidance System and Dietary Guidelines. The new program will be available to first grade teachers in the fall 2005.

The results suggest that the revised Healthy Choices, Healthy Me! program positively affects students' knowledge and behaviors. Retention of knowledge was high indicating the teachers reinforce the information throughout the school year. Teacher program feedback was positive indicating the revisions amply addressed comments on specific lessons from the original program. Dairy Council of California would like to thank those schools, teachers and students that participated in this project to help make healthy eating a part of every child's life.

If you are a first or second grade teacher in California you may order Healthy Choices, Healthy Me! free of charge. Feel free to submit this electronic order form or call 877-324-7901.

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