Impact of multicomponent and multi-year school-based obesity prevention intervention on fruit and vegetable intake among elementary and secondary school children

Introduction: The HEROES (Healthy, Energetic, Ready, Outstanding, Enthusiastic Schools) Initiative is a multicomponent school-based obesity prevention program based on the U.S. Centers for Disease Control and Prevention's recommended coordinated school health approach. This study evaluated the impact of the HEROES Initiative on fruit and vegetable (F&V hereafter) intake among elementary and secondary school students (N=1458, 6 schools) who were exposed to the program for 18 months from Fall 2011 to Spring 2013.

Methods: Behavioral and physiological data were collected at baseline, 6 months, and 18 months. Sequential generalized estimating equations with the unstructured correlation structure were fit to model F&V intake changes using SAS 9.3 while accounting for clustering effects within the same school.

Results: A significant increase (p < .01) was observed in F&V intake during 18 months across all different models. Each school’s implementation fidelity score was significantly associated with F&V intake changes at the full model (p = .007). Subgroup analysis revealed that a significant effect of the implementation fidelity lied in schools with low socioeconomic status (SES) rather than schools with high SES (p = .003) and girls rather than boys (p = .010). A higher increase in F&V intake was associated with a higher frequency of eating full meals with family, drinking water, and participating in school physical education classes and team sports (ps < .05).

Discussion: Implementation of the HEROES Initiative may be effective in increasing fruit and vegetables intake among elementary and secondary students, particularly for girls who attend schools with low SES.