Emm, S. , Extension Educator, University Of Nevada Cooperative Extension
Harris, J., Community-based Instructor III, University of Nevada Cooperative Extension
Bishop, C., Extension Educator, University of Nevada Cooperative Extension

ABSTRACT

University of Nevada Cooperative Extension created an elementary in-school nutrition program that utilizes traditional American Indian foods, tribal language, and USDA guidelines to increase fruit and vegetable intake. Evaluation results show statistically significant increases (p < .001) in knowledge with students identifying food groups in MyPlate. Pre-test and post-test responses for students recognizing squash, a native food, in the beginning of the program (15.5%) and the end of the program (57.6%) reported a 42% difference. Results indicate that education and food tasting experiences linked to the local environment create a foundation for school-aged children to make improved dietary choices.

Introduction

Nevada is home to Washoe, Shoshone and Paiute American Indians. There are 19 federally recognized American Indian tribes, with 27 reservations and colonies geographically dispersed across the State of Nevada. Several of these reservations are near Nevada’s small rural towns where access to fruits and vegetables is limited; often there is only one local grocery store or no grocery stores at all within a 60-mile radius.

Historically, Nevada tribes survived on hunting, gathering and farming activities. As federal policy changed, reservations were established in Nevada, which limited some of the hunting and gathering activities. During this time, it was realized that traditional food sources were not available and the government began providing support through a food distribution program (Great Lakes Inter-Tribal Council, 2018). The Government at the same time encouraged American Indians to initiate more farming and ranching activities.

The Food Distribution Program on Indian Reservations (FDPIR) is the US Government food distribution program that serves the majority of tribes in the United States, and still serves Nevada Indian Tribes. FDPIR has been integrated into Nevada American Indian food systems, where commodity cheese and the flour to make Indian tacos has become a regular part of the Nevada tribal diet (Nevada Native Foodways, 2018). Published findings from the Strong Heart study (Weidman, 2005) show that vegetable and fruit intake are significantly less than recommended, the variety is limited, and the use of traditional foods (derived largely from plant sources, fish and wild game) is decreasing. 

The Veggies for Kids:Grow Strong program created in 2008 by the University of Nevada Cooperative Extension utilizes traditional American Indian foods and language as a pathway to increasing fruit and vegetable intake among school-aged children in rural areas (Seymour and Dibble, 2008). Awareness of the health benefits of traditional fruits and vegetables available, promotion of their consumption, and subsistence or supplementary vegetable gardening are methods to promote the desired intake of fruits and vegetables recommended in the dietary guidelines and USDA’s MyPlate (USDHHS and USDA, 2005).

Overview of the Veggies for Kids Program

The “Veggies for Kids: Grow Strong” program was created integrating USDA guidelines (DHHS, USDA, 2005) and the traditional knowledge of Nevada participating tribes: the Walker River Paiute, Pyramid Lake Paiute and the Duck Valley Paiute and Shoshone. The program integrates traditional foods and tribal language to increase fruit and vegetable intake for students in rural Nevada. Funding for Veggies for Kids has come from the federal Supplemental Nutrition Assistance Program - Education (SNAP-Ed). The core goals of the program are the following:

• Reinforcing the importance and integration of nutrition education in schools, with lesson content linked to Nevada  education standards;
• Promoting adequate intake of vegetables and fruits through increased exposure;
• Promoting use of water and low-fat milk as preferred beverages over sweetened beverages;
• Promoting daily physical activity;
• Reinforcing American Indian cultural connections to traditional health promoting behavior through use of traditional foods, food gathering, and Paiute and Shoshone translations;
• Providing an introduction to gardening through in-class experiences and school gardens;
• Engaging parents through take-home assignments.

 

The Veggies for Kids program goals directly support healthy eating, as its intent is to promote increased intake of vegetables and fruits, whole grains, high protein foods, low-fat dairy foods, water and nutrient dense beverages. In addition, education focuses on an increased appreciation and use of healthy traditional American Indian foods available in Nevada, and an introduction to vegetable growing concepts and experiences. There are a series of in-school lessons, 45-60 minutes in length for kindergarten, second grade, third grade, fourth grade and fifth grade. Updates to the currently published curriculums are ongoing. The kindergarten curriculum, which focuses on American Indian and Hispanic traditional foods, was piloted in Washoe County School District in 2016, and will be officially published with the University of Nevada Cooperative Extension in 2019.

Implementation of the 2018 Program

The Veggies for Kids program consists of a twelve-lesson curriculum that incorporates USDA’s MyPlate emphasizing an adequate and varied intake of vegetables, fruits, protein, grains, and dairy, as well as increased awareness and consumption of healthy traditional Native American and Hispanic foods. This program also included a four-day “Summer Institute” where students participated in hands-on gardening experiences based on Veggies for Kids lessons and traditional food components.

The series of lessons, in order, are:

• Play Hard
• The Busy Body Book
• Eat Smart! Grow Strong with My Plate
• Vegetables: Tops and Bottoms
• Eat a Rainbow
• Grains
• Dairy
• Protein
• Growing Garden Friends
• Through the Eyes of the Eagle
• Grow Strong with American Indian Foods
• What have we learned - Review

 

 

Methods of Data Collection and Evaluation

The Veggies for Kids program has been a practice-based program under SNAP-Ed for several years to build lessons, and authors are currently working on getting the program evidence-based. University of Nevada, Reno Institutional Review Board (IRB) has reviewed the pre-test and post-test evaluation instruments, parent letters that are sent out by the school notifying parents about the program and asking about allergies, and a passive consent form that is sent home for all students. Historically, IRB provided yearly exempt protocols for the Veggies for Kids collection of evaluation data. For the last 2 years, the University IRB stated that an annual IRB protocol is not needed to collect evaluation data and publish results as long as there are no individual student identifiers on the evaluation data. However, the program still utilizes IRB approved protocols and documents that were previously approved, and coordinates evaluation collection with the University yearly in case of policy and procedure changes.

The Veggies for Kids program utilized a survey (pre-post method) to collect data at the beginning of the program and again at the end of the program. Both pre- and post- tests are identical. The tests were printed and distributed to each instructor to begin their program. All instructors were trained on how to implement the pre-test and post-test survey to elementary students, and were IRB certified to collect data. Consistency in language and survey methods was essential for getting accurate data.

Testing was conducted individually with each student tested outside of the classroom or in a quiet location within the classroom. The test is proctored by the Veggies for Kids instructor, with all questions being asked and responses written by the instructor. Each individual testing session took between 5 to 10 minutes to complete depending the student’s skill set. During the pre-test and post-test survey, the students were asked to identify a selection of real fruits and vegetables that are taught during the curriculum and asked to identify MyPlate food groups. In addition, the student is asked if they are willing to sample the fruit or vegetables and if they like it. Correct or incorrect answers are not discussed after testing. The student is simply told they are finished and can return to their class. The pre-test and post-test responses are matched together by a student identifier and entered into the statistical software SPSS (Statistical Package for Social Sciences) for overall program evaluation.

 

Results

Evaluation data was collected to access each student’s ability to visually identify and name a variety of selected vegetables and fruits. There were 1,007 elementary school students served in the Veggies for Kids program funded by SNAP-Ed in 2018 in four Nevada counties. Each of the participating 13 school sites began week one with a student pre-test, conducted 12 lessons, and ended on week 12 with a post-test.

Following Dillman et al. (2014), a questionnaire was administered to evaluate each student’s ability to identify the following at both pre-testing and post-testing: 1) students are shown an outline of MyPlate with the Food Group names blanked out and asked if they’ve see the graphic before; 2) if they can name each of the food Groups; 3) students are shown a picture and actual vegetable to name; and 4) asked if they like it and are willing to try it. Seventy-one percent of the students were at a kindergarten grade level. The ethnicity of students was American Indian (22%), Hispanic (24%), white (50%), Black (2%), and Asian/Pacific Islander (2%).

Impact data obtained from pre-test and post-test interviews was analyzed using statistical analysis software for quantitative data to measure short-term knowledge gains. The number of students (N) is variable in the results below due to student absence, student non-response, and one class room was not post-tested. Therefore we were not able to match pre- and post-tests for all 1007 students.

At the beginning and end of the in-classroom direct education program, students were shown a graphic of MyPlate and asked if they had seen the graphic before. Pre-test data shows that 45.9% (N=736) of students self-reported that they had seen the graphic before, while 53.3% said they had not seen the graphic before. Post-test data showed that 92.6% (N=741) of students self-reported they had seen the graphic after completion of the 12 in-school lessons.

Table 1 reports the percentage of students that could correctly name the MyPlate food groups from pre-test to post-test. Table 2 shows the student’s ability to correctly name selected fruits and vegetables before and after the in-school instruction. Paired t-tests illustrate that program indicators (selected fruits and vegetables) resulted in statistically significant knowledge gains (p <.01) with students’ ability to correctly name fruits and vegetables.

 

Table 1. Students correctly naming MyPlate food groups in the 2017-2018 school year for all direct education sites. Differences between pre-test and post-test scores are statistically significant at a p < .001 for all MyPlate food groups shown.

Correctly Naming MyPlate Food Group	N	Pre-test Percent	Post-test Percent	Difference Percent
Fruits	738	13.6	79.6	66
Vegetables	738	14.1	79.5	65.4
Protein	737	6.4	60.5	54.1
Grains	737	7.3	59	51.7
Dairy	738	9.9	75.9	66

 

 

Table 2. Student preference and ability to correctly name selected fruits and vegetables. Differences between pre-test and post-test scores are statistically significant at a p < .01 for all questions shown.

Correctly naming fruits and vegetables	N	Pre-test Percent	Post-test Percent	Difference  Percent
What is the name of Asparagus?	732	9.8	35.2	25.4
What is the name of Blueberries?	730	78.8	92.4	13.6
What is the name of Squash?	728	15.5	57.6	42.1
What is the name of Lemons?	737	74.5	89.1	14.6
What is the name of Spinach?	729	8.2	34.1	25.9
What is the name of Strawberries	737	93	98	5

 

 

Discussion and Conclusions

The design of the Veggies for Kids program utilizing traditional foods, tribal language, and growing experiences creates the building blocks to introduce healthy nutrition and increase fruit and vegetable intake among elementary students in rural areas of Nevada. Over 51% of the student population served in the 2017-2018 school year received free or reduced-rate lunch. The majority of the school sites served were in rural communities that were on or close to an American Indian reservation in Nevada. 

Evaluation results from 2017-2018 indicate significant knowledge gains. There was a statistically significant increase in knowledge with students correctly naming the MyPlate food groups. Fruits (66%), Vegetables (65%) and Dairy (66%) had the biggest difference between pre-test and post-test scores. Protein (54%) and Grains (52%) had a lower difference between pre-test and post-test scores, but were still were statistically significant.

There is a substantial increase in knowledge of students correctly naming fruits and vegetables as part of this educational program. All pre-test and post-test scores are statistically significant at a p < .01 level. The biggest difference and increase in knowledge were seen in students being able to correctly name squash, which was a 42% difference between pre-test and post-test scores. Strawberries were the most identifiable fruit with 93% identifying correctly at the pre-test and 98% identifying correctly at the post-test. Blueberries (14% difference) and lemons (15% difference) were more correctly identified than the vegetables used in the program.

Qualitative comments from teachers about the program report that students are responding to instruction. The following quotes are from Yerington elementary school staff:

"I appreciate the variety and diversity in the Veggies for Kids nutrition program.  My student thoroughly enjoyed learning about different types of foods – many found in our area.  I was especially impressed when Mrs. Halterman invited a Native American guest speaker. The program is put together in a sequential format that is very appropriate for my students."  Yerington Elementary School Teacher

 

"I see on a daily basis how the Veggies for Kids has had a positive impact on our students. As I walk through the lunch room, the students will show me their lunch and explain the 'healthy' food choices they are making. It’s a lot of fun seeing just how excited they get about their new knowledge!"  Yerington Elementary School Counselor

 

The Veggies for Kids goals directly support a focus on healthy eating. Evaluation data shows increased knowledge and teachers report that students are utilizing their new knowledge to make positive behavior changes. It is evident that the Veggies for Kids program has an impact on students being able to correctly name the MyPlate foods groups and to correctly identify fruits and vegetables.

Access to fruits and vegetables can be a problem in Nevada’s rural areas and this provides an opportunity for additional Extension education. The Veggies for Kids program implemented policy, systems and environmental (PSE) change approaches to the program that would work with local rural communities on access to fruits and vegetables, especially traditional foods. This work continues to be ongoing. Historically, Extension programs have had success in introducing farming experiences and practices to youth (Seevers et. al, 1997).

Additional research is needed to assess the impact of programming on individual behavior change and if programming is consistent with long-term community changes. Long-term community changes could include increasing access to fruits and vegetables through community and resident gardens, and recognizing the importance of growing traditional foods. Utilizing tribal historical foods and language to teach rural Nevada students has been the key to the success to the Veggies for Kids program.

 

References

Dillman, D., Smyth, J. and Christian, L. (2014). Internet, Phone, Mail and Mixed-Mode surveys: The Tailored Design Method. Hoboken, NJ: John Wiley & Sons, Inc.

Great Lakes Inter-tribal Council SNAP-Ed program. (2018). Retrieved on August 1, 2018 from https://glitcsnap.wordpress.com/2015/03/09/fry-bread-traditional-food/

Seevers, B., Graham, D. Gamon, J. and Conklin, N. (1997). Education Through Cooperative Extension. Albany, NY:  Delmar Publishers.

Seymour, K. & Dibble, J. (2008). Veggies for Kids. (CM-08-10). Reno, NV:  University of Nevada Cooperative Extension.

Nevada Native Foodways. (2018).  Retrieved on August 1, 2018 from http://sharedhistory.acs.unr.edu/nativeculture/exhibit-pages/nevada-native-foodways/

Weidman, D. (2005). American Indian diets and nutritional research: Implications of the strong heart dietary study, phase II, for cardiovascular disease and diabetes. Journal of the American Dietetic Association, 105 (12):1874-1880.

U.S. Department of Health and Human Services and U.S. Department of Agriculture. (2005). Dietary Guidelines for Americans, 2015-2020. 8^th edition; Washington, D.C. U.S. Government Printing Office.

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