Objective: The overall objective of this research was to evaluate the impact and feasibility of the Individual Nutrition Health Plans (INHP), an innovative 8-week nutrition and exercise pilot curriculum focused on improving beverage choice, physical activity, fruit and vegetable consumption, and fast food consumption behaviors. This was completed by comparing the intervention group, who initially participated in the curriculum, and the comparison group, who participated in the curriculum later in the school year. The curriculum is administered using social networking technology, i.e. text messaging, Facebook, and Twitter, as a way to communicate and reinforce healthful behaviors to participating students.
Design: Eight-week, 2x2 randomized control trial of a newly developed SNAP-Ed nutrition curriculum using SurveyMonkey to collect baseline and post-test data.
Setting: Central Falls High School of Central Falls, RI served as the site for the embedded SNAP-Ed nutrition curriculum delivered Spring 2011.
Participants: Central Falls High School ninth grade students (n=106) served as the intervention group (received INHP) and Central Falls High School tenth grade students (n=86) served as the comparison group (received standard approaches). The mean age for the entire sample was 15 years old (range of 14–17), 50% of which were male and 69% of which were Hispanic. One hundred and six students completed the post-test, leaving an attrition rate of 44.8%.
Intervention: SNAP-Ed developed an 8-week nutrition curriculum including a pre-test with computer-operated goal-setting, access to health information customized for the student's stage of change, social networking groups that promote the chosen goal, and weekly motivational text messages. The four major topics included sweetened beverage intake, physical activity, fruit and vegetable intake, and fast food intake. Students were provided goal-related items to promote mindfulness regarding these health topics.
Main Outcome Measures: Improved beverage choice, increase in physical activity and fruit and vegetable consumption, and a decrease in fast food consumption. Change will be assessed from baseline (pre-intervention) measures.
Analysis: The Statistical Analysis Software (SAS) version 9.2 was utilized to analyze all data. Between and within-group differences will be assessed by analysis of variance (ANOVA) and independent t-tests. Correlation statistics will be used to assess relationships between additional selected variables.
Results: There were no significant between group differences except age and, for completers, gender. Eighty-nine students (84%) chose the sweetened beverages goal. Analysis showed that there were no significant between or within group differences with the sweetened beverages, fruit and vegetable, and fast food goals. Although there was no significant between group differences in physical activity, there was a significant within group increase of 0.34 ± 0.88 hours in physical activity performed each day observed in the intervention group (n=7, p<0.01). At post-test, there was no significant within group increase of physical activity by 0.75 ± 0.96 hours in the intervention group (n=4) and 0.33 ± 1.52 hours in the comparison group (n=3). For those that chose the fast food goal, there was a significant within group decrease of weekly fast food consumption by 1.25 ± 0.50 times in the intervention group (n=4, p<0.05). There was a significant change in Stage of Change from baseline to post-test within the intervention group (p<0.0001). Of the eleven students who started at the precontemplation/contemplation stage at baseline, 27% progressed to preparation at post-test. Of the fifty-three students who started at the preparation stage at baseline, 21% regressed to precontemplation/contemplation and 17% progressed to action/maintenance at post-test. Of the six students who started at the action/maintenance stage at baseline, 17% regressed to precontemplation/contemplation.
Conclusions and Implications: Future interventions with high school students should focus on sweetened beverages. Incentives may be required to motivate students to participate in social media techniques, as voluntary participation by students was limited. Further studies are required to determine the effectiveness of utilizing social networking to promote behavior change in students.