Academic journal article Journal of School Health

A Formative Evaluation of the American Cancer Society Changing the Course Nutrition Education Program

Academic journal article Journal of School Health

A Formative Evaluation of the American Cancer Society Changing the Course Nutrition Education Program

Article excerpt

Increased consensus among professionals that dietary behavior patterns are related to risk of several major chronic diseases[1,2] led to increased interest in school health education addressing these behavior patterns. Nutrition education is a necessary and important component of any comprehensive school health education program. The Changing the Course curriculum, developed by the American Cancer Society (ACS), educates children about the relationship between nutrition and health and encourages them to adopt lifelong eating patterns that are health-promoting and that consequently also may lower their risk of developing certain cancers and other chronic conditions. This paper describes the framework, theoretical basis, and formative evaluation of the Changing the Course curriculum for elementary students.


The Theoretical Basis

Dietary recommendations for health promotion and cancer risk reduction published by ACS and other organizations provide the basis for the curriculum's dietary behavior goals.[1-3] Based on ACS guidelines, the behavioral goals are: 1) to eat a wide variety of vegetables and fruits, especially those high in vitamins A (beta carotene) and C, 2) to eat more high-fiber foods, and 3) to eat less fat and fewer fatty foods.

A variety of complex factors influence children's ability to adopt and maintain these dietary behaviors. To address these influencing factors, the curriculum used as its theoretical framework the PRECEDE model of Green et al[4] with a behavioral change process. The curriculum framework was described previously.[5] In brief, the PRECEDE model categorizes factors influencing health behavior into three types: 1) Predisposing factors such as knowledge, beliefs, attitudes, perception, and values that predispose or motivate people to take action, 2) Enabling factors, which include personal skills needed to carry out an action and objective resources in the environment, and 3) Reinforcing factors which include rewards from successful performances of the action and support of family and friends. Health and nutrition educators[4,5,7] note that linking education in schools with desirable future nutrition and health behavior proves difficult because of numerous intervening variables. Hence, Green et al[4] suggest school health education should address predisposing, enabling, and reinforcing factors to develop intermediate student outcomes - "health skills." The focus of Changing the Course is to provide students with knowledge, motivations, and behavioral skills to adopt health-promoting and cancer risk-reducing eating behaviors. A behavioral approach leads students through a decision-making, behavioral adoption/behavioral change process. Students not only learn about food and nutrition but look at their own food-related behavior and feelings, learn to make choices, and have the opportunity to practice the desired behavior. This behavioral approach forms the core around which lesson plans are structured.

Curriculum Organization

The Changing the Course curriculum for the lower elementary grades is organized around three learning goals: 1) to understand the relationship between health promotion and eating healthful foods, 2) to identify and sample health-promoting foods, and 3) to examine internal and external influences on food choice. Learning goals for the upper elementary grades are: 1) to understand the relationship between eating healthful food and lowering the risk of disease, emphasizing cancer prevention, 2) to identify cancer protector foods to eat more of, and cancer promoter foods to eat less of, 3) to examine how one's own eating patterns relate to cancer risk and health maintenance, 4) to examine internal and external influences on food choices, and 5) to modify food choices to reduce cancer risk and maintain health. Food and nutrition science information to support these learning goals is presented in terms of foods "to eat more of" and foods "to eat less of" (Figure 1). …

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