KA 703. Nutrition Education and Behavior

Kitchen Creations Diabetes Cooking Schools: Two Kitchen Creations Diabetes Cooking Schools in Spanish were provided to the residents of northern and southern Dona Ana County.

Our first class series was held in Radium Springs at the Community Resource Center from 10:00 - 2:00 p.m. on four consecutive Saturdays beginning Jamuary 27, 2007. A van of clients from the Ben Archer Health Clinic in Hatch came each week for the classes. Fifteen individuals were present for instruction on the Diabetes Food Guide Pyramid, balancing their meals with low and high carbohydrate foods, and the inportance of identifying serving sizes and number of servings. The evaluations were very positive and one of our male diabetics lost 7 pounds since he started the class. One of the comments read, "I liked using Native New Mexican recipes during our cooking lab."

The second Kitchen Creations Cooking School was taught at the Saint Anthony's Catholic Church fellowship hall in Anthony, New Mexico. This is the first Kitchen Creations class series offered in the Anthony area that has been well attended. We had previously used the home economics labs at the Gadsden High School located outside the city limits. This taught us that the location is very important. We put flyer advertising the class in the church bulletin as well as other community b uildings. The priest visited our class twice and was very appreciative of NMSU's educational services in Anthony.

We had 26 participants with 5 males and 20 females. At the end of each session, class members were asked to set a goal for the following week. The evaluation sheets were positive and all of them wanted more Kitchen Creations classes in Anthony. The test tubes showing the amount of fat in commonly consumed food made a great impact on the class. Several participants said that they would reduce the number of times they bought fast foods that were high in saturated fat.

Rio Arriba County

Childhood obesity has been identified as a major health concern throughout the U.S. Three times as many children are overweight today as compared with 20 years ago. The New Mexico Department of Health reports a 57% increase in obesity/overweight prevalence among adults and that 24% of high school students are overweight or at-risk for becoming overweight.

The ICAN/Just Be It! Healthy and Fit Program (JBI) promotes healthy lifestyles by reducing risk factors for 5th grade students in 3 counties – Rio Arriba, Santa Fe and Los Alamos.
To kick off the program, Extension Agents from Los Alamos, Rio Arriba and Santa Fe counties conducted the Just Be it! Healthy and Fit field trip, a tri-county, educational nutrition and fitness school enrichment program offered to fifth graders in each of the named counties. This year's field trip began with a JBI Jeopardy game - setting the tone for the 4 workshops. The field trip consists of four, 45 minute workshops: MyPyramid, Vary Your Veggies and Focus on Fruits, Power up With Exercise, and Fun with Food. Workshops are aligned to the NM Health Education Standards and Benchmarks. The extension agents from each county presented or participated in each of the workshops. Three field trips were conducted by September 30th, 2007. Los Alamos - 131 students from three elementary schools, 94 W, 1 AI, 26 H, 10 A. 67 females and 64 males. In Rio Arriba: 116 students from 2 elementary schools participated, 3 wH, 2 black, 2 AI, 108 H, 1 A, 62 male, 54 female. Santa Fe - 103 students from one elementary school, 7 w, 1 B, 5 NA, 88 H, 2 A. 51 male, 52 female. Students and teachers participating in the field trip also received a student/parent handout developed by Extension agents, containing information and activities about healthy eating, food safety, goal setting and physical fitness. Sixteen teachers from the 3 counties participated in the field trips and received a classroom exercise kit consisting of exercise bands, jump ropes, pedometers, flying disks, hula hoops and an exercise booklet. Teacher classroom resource kits included USDA MyPyramid lessons for grades 5-6, CDC Health Stores, MyPyramid handouts for each student, 4-H pamphlets and other health and nutrition information. A total of 350 students participated in the field trip. Based on the average results from the pre and post tests in participating counties, students indicated a knowledge gain of 28%.


Other components of the JBI program include follow-up classroom instruction, intensive evaluation regarding behavior change, parent education, and community awareness of childhood obesity issues. Classroom instruction usually begins in October through April/May in each county.

For the classroom component, the agent conducted approximately 12 classes in each of the 3 counties from October through April/May 2006-2007. Approximately 140 students participated in the classroom program. JBI classroom instruction included intense activities to learn the major all food groups, fats, fast food consumer decision making, goal setting, fun ways to exercise including dance pads and numerous other physical fitness activities, as well as food safety, label reading, serving sizes, how the media influences our food choices and healthy snacks.

The program implemented an experimental research design using control and treatment groups in 2006-2007. Validity and reliability were established for the nutrition knowledge test. Sixty-two students in the control group and 121 students in the treatment group completed pre and post tests on nutrition knowledge, intake of fruits and vegetables, and on physical activity. Control group subjects included 37 students from Rio Arriba County and 25 from Los Alamos County.

A statistical analysis on the program data in the 1st year (2006-2007) showed that students gained knowledge on nutrition from the beginning of the school year to the end of the school year. The control group of students, who did not receive the nutrition classes, raised their test scores 0.7 points or 4%, while the test scores for students who received the nutrition classes went up 4.35 points or 27%. There was a statistically significant difference in knowledge gain between the control and experimental groups at the .05 level. In terms of percent of students who gained knowledge, 98.4% of students gained knowledge from the classroom program and field trip. Using a control and experimental group verified that there was a statistically significant difference in the groups' nutrition knowledge as a direct result of receiving instruction from the program. This finding is especially important because it is the first step in documenting that the curriculum is evidenced-based.

The data from the fruit and vegetable intake and the physical activity survey were not usable. Students could not accurately remember what they ate or what physical activity they did in the previous week. Although it was disappointing to not use the data, this finding was critical in revising the evaluation instruments for physical activity and food recalls in 2007-2008.

Parents and teachers were also evaluated. In order to provide nutrition knowledge to families for the Just Be It! program, 8 newsletters were given to fifth grade students in the 3 counties of Los Alamos, Rio Arriba, and Santa Fe. Students took the newsletters home to their parents during the school year of 2006-2007. An evaluation tool which asked parents to rate their knowledge before and after reading the take-home newsletter was developed. These rating sheets were distributed to 140 children to take home in May, 2007. Teachers from the 6 participating classes in the 3 counties were also asked to complete the form. The return rate for newsletter evaluations was 26% (n=32).

Results from all 3 counties showed that the percentage of parents and teachers who reported knowing a little about nutrition knowledge before reading the newsletter ranged from 19 to 58%. The percentage who reported knowing a lot after reading the newsletters ranged from 84 to 100%. There was a knowledge gain reported as a result of distributing the 8 newsletters. In addition, almost everyone wrote comments about the program. Comments made about the program were: “My child liked the healthy snacks and physical games. My child learned to eat healthier. I wish the classes could have been longer and more of them. Now when we go to the store we buy more vegetables. Good program, I wish there could be more programs like this.” Average knowledge gain for parents and teachers was 28%. However, 100% of parents and teachers who returned the survey had gained knowledge.

Chimayo Boys and Girls Club 9-12 year olds
Students participating in this program became aware of the importance of and practiced strategies for leading a healthy lifestyle. The agent conducted 6 food and nutrition workshops utilizing the USDA Nutrition and Food Safety Classroom Activities. Hands-on lessons included understanding MyPyramid, preparing low-cost healthy snacks, and understanding the importance of physical activity. 22 students scored an average of 74% on the evaluation instrument. Selected evaluation results:
90% of students understood the need for 60 minutes of physical activity each day.
81% of students understood that skipping meals, and not eating a variety of food is unhealthy.
90% of students understood the importance of washing of washing hands for at least 20 seconds.

Chimayo Boys and Girls Club 6-8 year olds

Students participating in this program became aware of the importance of and practiced strategies for leading a healthy lifestyle. Students participated in 6 food and nutrition workshops utilizing the USDA Nutrition and Food Safety Classroom Activities. Hands-on lessons included understanding MyPyramid, preparing low-cost healthy snacks, understanding the importance of physical activity were taught. 12 students scored an average of 81% on the evaluation instrument. Selected evaluation results:
91% of students knew the correct number of servings needed daily from the milk group.
100% of students understood that fruits and vegetables give you vitamins and minerals.
100% of students understood that too much sugar and fat is not good for the body.

Cloverbud Day Camp
The agent conducted a series of 5 health and nutrition workshops with the Cloverbud Day Camp participants. 22 students from 5 – 8 years old participated in the program. Through a verbal assessment and show of hands at the end of the program students knowledge gain is as follows
95% of students understood the importance of eating fruits and vegetables.
95% of the students understood the importance of handwashing.
95% of students understood the importance of the milk group for bone health.

ICAN Program-Taos County

Enos Garcia Elementary School – 4th grade
An adjusted version of the Just Be It! Healthy and Fit classroom program was conducted to reach 4th graders in 2 classes, reaching 31 students. Students participating in this program became aware of the importance of and practiced strategies for leading a healthy lifestyle. Students participated in a series of 7 nutrition and fitness workshops in each class from November through April 2006-2007. Students were evaluated through a pre and post test knowledge gain instrument. Combined scores for both classrooms resulted in a 22% knowledge gain.

Taos Pueblo Day School – 5th grade
For Taos Pueblo, a “condensed” version of the Just Be It! Healthy and Fit classroom program was conducted in 1 class, reaching 17 Native American students. Students participating in this program became aware of the importance of and practiced strategies for leading a healthy lifestyle. Students participated in a series of 8 nutrition and fitness workshops in each class from November through April 2006-2007. Students were evaluated through a pre and post test knowledge gain instrument. The JBI classes resulted in a 25% knowledge gain.

Taos Community Center Summer Program
Students participating in this program became aware of the importance of and practiced strategies for leading a healthy lifestyle. Students participated in 4 food and nutrition workshops utilizing the USDA Nutrition and Food Safety Classroom Activities. Hands-on lessons included understanding MyPyramid, preparing low-cost healthy snacks, understanding the importance of physical activity, and the importance of eating fruits and vegetables, as well as foods from all the food groups. 19 students scored an average of 96% on the evaluation instrument. The majority of students: new the correct number of servings needed daily from the milk group, understood that fruits and vegetables give you vitamins and minerals, understood that too much sugar and fat is not good for the body, among other important health and nutrition facts.

RMCH Diabetes Support Group completes “Kitchen Creations” a school for people with diabetes and their families. RMCH Dietician, Carolyn Manke requires new patients to enroll in “Kitchen Creations” as a way of helping them cope with the new changes in their eating habits. “Kitchen Creations” provides them with useful information about the serving sizes, 50/50 Method, preparing meals traditional and other using lean meats with less oil/fat usually accomplished without compromising flavor. A Traditional New Mexican Recipe Book is used for the classes. The patients enjoyed preparing and tasting the recipes and learning about the types of foods that are healthier when eaten in moderation. This group met once a month at Red Rock’s Methodist Church. 13 adult and 2 youth participants completed the series and received their certificates in April of 2007. Evaluation showed healthier changes in their eating habits and finally that they were more conscious about their daily activities.

This year's Indian Livestock Day's was held at McGee Park in Aztec, NM on May 16-17, 2007. A Nutrition component workshop and poster sesion was added this year. The food demonstrations included audience participation and the treat was that everyone reeped the benefits by tasting the foods that was preapared during the sessions. The audience participation was great Dr. Guiterez assisted with the preparation of Soy Burgers and Jenny Benally also volunteered to help with one of the other recipes. Other recipes prepared by the group were; Goofy Waldorf Salad and yogurt in a bag. There were about 12 participants for the sessions. During the poster session participants received Gobblin' Granola prepared by the San Juan County Nutrition Educator. Poster session included information on Portion Distortion, Super's Made Easy, How Much Fat in Fast Foods? MyPyramid and more. Home Economist from San Juan, McKinley and Sandoval counties lead the activities.

ICAN Nutrition Education for 11 Crownpoint Home Care Providers was required with the emphasis on rural living. The ICAN 12 lesson series began in October of 2006 and met once a month at the Navajo Housing Authority Building in Crownpoint, New Mexico. Many homes of the elderly living in rural communities lack electricity and indoor plumging, therefor special attention for their safety falls to Home Care Providers. Adult Home Care Providers make weekly visits to their elderly population in rural communities. Helping them to make do with what they have is sometimes a challenge, but home based education is the one way of helping them that does not require them to travel. Ces Nutrition Educators train the Home Care Providers to accomodate the elderly in the areas of Nutrition and Food Safety by providing hands on activities to them that will benefit people who lack running water and electricity. The ICAN 12 lesson series was completed by 11 participants in May of 2007.