Nutrition education

NUTRITION EDUCATION:

A Model For Effectiveness A Synthesis of Research CONTENTS INTRODUCTION 1 The Process of Nutrition Education: A MODEL FOR EFFECTIVENESS GOALS FOR ACHIEVEMENT S2 FACTORS INFLUENCING GOAL ACHIEVEMENT INSTRUCTIONAL STRATEGIES S6

S3

2 Nutrition Education's Theoretical Foundation

S8 PRESENT PRACTICE IN NUTRITION EDUCATION S8 NUTRITION KNOWLEDGE, ATIITUDE, AND BEHAVIOR

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3 A Meta-Analysis and Synthesis of Nutrition Education Research

S11 PREVIOUS REVIEWS S11 META-ANALYSIS DEFINED S12 OVERAll FINDINGS S14 FINDINGS IN JOURNAL ARTICLES S15 FINDINGS FOR THREE NUTRITION EDUCATION PROGRAMS S16 CORRELATIONS AMONG NUTRITION KNOWLEDGE, ATIITUDE, AND BEHAVIOR S19 GENERAL CHARACTERISTICS OF NUTRITION EDUCATION RESEARCH S19

4 Nutrition Education's Future

S20 NEED FOR THEORETICAL MODELS 520 RELATIONSHIPS AMONG KNOWLEDGE, ATIITUDES, AND BEHAVIOR S21 INSTRUCTIONAL METHODS 521 FUTURE DIRECTIONS FOR EDUCATIONAL PRACTICE FUTURE DIRECTIONS FOR RESEARCH 523

S21

REFERENCES S25 APPENDIX A Articles Included in the Meta-Analysis S28 APPENDIX B Articles Read Which Contained No Applicable Data

S36

S1

INTRODUCTION National Dairy Council has been conducting programs of nutrition education since it was founded in 1915. These programs are implemented to consumers of all ages and backgrounds through a nationwide network of 33 affiliated Dairy Council units. All organizations, in order to grow and improve, need to continuously study the effectiveness of their goals and strategies. Recognizing this, National Dairy Council made the decision in early 1984 to devote renewed attention to the question, "Does nutrition education make a difference?" The answer would guide long-range planning and policy for Dairy Council and for the field of nutrition education. A steering committee of representatives from universities, business and the Dairy Council organization was convened to suggest steps best designed to provide a response to the effectiveness question. Committee members were experts in the fields of sociology, psychology, marketing, education, nutrition and management. The advisory committee concluded that credible and valid documentation would be provided by a thorough integration of all existing research data on nutrition education effectiveness using the techniques of meta-analysis. They suggested this approach, although ambitious, since it met several important criteria: 1. Meta-analysis can best answer the broad question being

2. 3. 4.

5. 6.

asked about nutrition education. New research would focus only on specific programs in specific settings with specific audiences and would not answer the general questions about nutrition education or about the total synergistic nutrition education program of Dairy Council. Meta-analysis can provide the additional benefit of suggesting directions for future nutrition education program development and research. Meta-analysis is a technique not yet applied to the research in nutrition education and can make a major contribution to the field. Meta-analysis yields strong, statistically powerful information which can be used with confidence for longrange organizational planning. Meta-analysis is cost effective because it utilizes existing research. Meta-analysis, from identification of investigator to availability of final report, can be completed in 10-12 months.

Dr. David Johnson, an educational psychologist at University of Minnesota familiar with meta-analysis techniques, was selected by National Dairy Council as the principal

investigator to conduct the research integration. Work began in April 1984. The final report was submitted to National Dairy Council and its affiliated Dairy Council units in January 1985. They wish to make this report available to you, the practitioners and researchers in nutrition education. The report, NUTRITION EDUCATION: A MODEL FOR EFFECTIVENESS, A SYNTHESIS OF RESEARCH, is brought to you in cooperation with the Society for Nutrition Education and its Educational Services Policy Advisory Council as a special supplement of the Journal of Nutrition Education. It is presented in four chapters. Chapter 1 discusses a model which can be applied to the process of nutrition education. The authors' own research focuses extensively on the educational strategies commonly termed in the literature as "cooperative learning." Their expertise and experience has led to the proposition modeled in Figure 1. This model can have important implications for the ways in which nutrition education is conducted in the future. If, indeed, our goals are ultimately to develop healthful longterm discrimination, discovery and dietary behaviors in relation to nutrition and food, it seems clear from all we know about the learning process that direct involvement of the learner in that process is paramount. The key is to find improved methods for cognitively involving the learner. The discussion in this chapter provides some possibilities. Chapter 2 presents a bit of historical perspective about the practice of nutrition education. It also reaffirms the theoretical learning framework which we all know and love-the trinity of knowledge, attitude and behavior-and which provides the theoretical framework for the design used for this metaanalysis. Chapter 3 presents the "results." Here you will find the, answer to the question "Does nutrition education make a difference?" I'm confident you will be very pleased with that answer. Chapter 4 suggests "where we go next." Those of us concerned with the future of nutrition education, and especially with developing a stronger, more cohesive nationwide program of nutrition education research, will find clear guidance for the future. National Dairy Council is proud to be able to bring you the results of what we believe is a landmark study in nutrition education. In your hands now rests the responsibility for assuring that in 1995 we'll be able to say, "We need to conduct another meta-analysis. So much has happened in nutrition education and research since 1985!" Judy Brun, Supplement Editor Director of Research and Evaluation Division of Nutrition Education National Dairy Council

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The Process of Nutrition Education: A MODEl FOR EFFECTIVENESS Problems and issues involving food and nutrition are a major national and international agenda. Malnutrition. undernutrition. and overconsumption throughout the world. as well as accelerating urbanization and commercialism. are leading to imbalances in availability of products and knowledge about nutrition. Nutrition education is an essential process for coping with these problems and issues. In human societies. basic eating patterns are culturally defined (Gussow & Contento. 1984) and are becoming increasingly complex as children and adults in all parts of the world are exposed to unfamiliar but attractive food products. Accelerating urbanization is turning people from knowledgeable food producers into innocent food purchasers. Growing urban populations are confronted with an increasing number of unfamiliar foods whose relative nutritional worth is difficult to evaluate. Commercialism is another problematic factor. Because commercial messages are not designed to teach people how to purchase the best possible diet at the lowest cost, but rather to sell products. they can create a distorted image of which products are essential, desirable, and economical. Because traditional food environments and procedures for communicating food-related information are being overwhelmed by urbanization. commercialism. and other factors, nutrition education is a necessity throughout the world. Folk wisdom about acquiring. preparing, and consuming nutritious foods needs to be supplemented and replaced with scientific information communicated through nutrition education. Within the United States. there is evidence that having information about the nutrients contained within foods does not lessen the need for effective nutrition education programs. Making information available does not mean that consumers will use it to make wise decisions about which foods to consume. Bettman and Kakkar (1977) found that information placed on food packages was generally not understood by consumers and had little influence on consumers' decisions of what foods to buy. Jacoby. Chestnut, and Silberman (1977) concluded that even though consumers said they wanted much more information, they used only two to three percent of the information available in making their food purchasing decisions. Jacoby and his colleagues also found that VOLUME 17 NUMBER 2 SUPPLEMENT 1985

while consumers stated they wanted information and used some of the information they had, most had very little" comprehension of the available information and hence were unable to use it effectively in making food choices. Similar findings for energy conservation were reported by McDougall, Claxton, Ritchie, and Anderson (1981). It appears that American consumers are not equipped by prior education to effectively interpret and use product information. A necessary prerequisite for effectively interpreting and using information is prior relevant education. Even small amounts of education about balanced diets and good nutrition may be more useful than providing detailed information about individual products on packages (Jacoby, Chestnut, & Silberman. 1977). Therefore. it is our fundamental proposition that nutrition education is needed to promote the development of conceptual frameworks "that provide the basis for interpreting the meaning of product information to make consumer decisions. This proposition is based on the socialpsychological and educational research which has helped identify those factors influencing knowledge acquisition. attitude development. and behavioral change. Promoting the development of conceptual frameworks is one of many goals of nutrition education. Enduring attitudes and consumption patterns also need to be acquired. Instructional strategies that will promote the achievement of such long-term purposes need to be used within nutrition education programs. There is every reason to be optimistic that nutrition education can be effective in achieving enduring as well as short-term or proximal goals. Considerable evidence exists that the educational process increases knowledge, deepens receptivity to further knowledge. stimulates active seeking for new information, and creates value change in American adults long after they finish their formal schooling (Hyman & Wright, 1979; Hyman. Wright & Reed, 1975; Tyler, 1930. 1934; Ward & Davis. 1938). The remainder of this chapter integrates socialpsychological and educational literature that provides the theoretical basis for a model of the process of nutrition education. The process of nutrition education may be defined as the teaching of validated, correct nutrition knowledge in ways that promote the development and maintenance of JOURNAL OF NUTRITION EDUCATION Sl

positive attitudes toward. and actual behavioral habits of. eating nutritious food (within budgetary and cultural constraints) that contribute to the maintenance of personal health, well-being, and productivity. In order for the process to be effective in achieving goals it is necessary to use instructional strategies and curriculum materials that recognize the factors most likely to contribute to goal achievement. A model illustrating this process is outlined in Figure 1. The short-term and long-term goals of nutrition education, the ultimate outcome of the process. are achieved through employing instructional strategies that promote active involvement of participants and are related to factors of social context and interpersonal interaction that have been found to influence knowledge acquisition. attitude development, and behavioral change. Educational materials used in the nutrition education process need to reflect these factors and implement the desired instructional strategies. GOALS FOR ACHIEVEMENT Let us first consider the goals of nutrition education which are the outcome of the process. <;;enerally. the purpose of nutrition education is to create informed consumers who value good nutrition and consume nutritious foods throughout their lives. Within nutrition education there are both short-term or proximal goals

and long-term or distal goals (Bosley. 1947; Gussow & Contento. 1984; Pye. 1976; Shannon & Boykin. 1979; Todhunter, 1979; Zeitlin & Formacion. 1981). The shortterm goals include: 1. Mastering knowledge contained in nutrition units

being taught. This includes becoming a literate consumer who knows what foods provide essential nutrients and are culturally acceptable. 2. Building conceptual frameworks for nutrition (principles. generalizations, and applications of principles) that one spends the rest of life completing and revising. 3. Developing positive attitudes toward good nutritional habits. This includes: a. Developing motivation to use nutrition knowledge to promote health and well-being. b. Building interest in. and commitment to. continually acquiring knowledge about good nutrition and health. c. Developing a predisposition to respond to nutritious foods in a favorable manner. 4. Consuming nutritious foods. This includes using nutrition knowledge to make wise food choices.

The long-term goals include: 1. Using conceptual frameworks for nutrition to ad-

just to changing food supplies and to discriminate among differing kinds of dietary advice.

FACTORS

INSTRUCTIONAL STRATEGIES

GOALS

Group Norms

Cooperative Learning

Knowledge

Commitment Social Models

Inquiry Learning

Personalized Information

Nutrition Experiments and Experiences

Cognitive Processing

Out-of-Classroom Experiences

Teaching

Academic Controversies

Continuing Motivation Gain or Loss

Conceptual Frameworks Positive Attitudes Immediate Consumption Discrimination Among Conflicting Dietary Suggestions Seeking of Further Information Enduring Consumption

Figure 1. The Process Of Nutrition Education: A Model S2 JOURNAL OF NUTRITION EDUCATION

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2. Seeking out, and being receptive to, further knowledge about nutrition. 3. Intelligently selecting and consuming nutritious foods day after day throughout life to maintain health, well-being, and productivity. The achievement of these goals depends on the use of instructional strategies and curriculum materials that implement factors that have been demonstrated to impact knowledge acquisition. attitude development. and behavioral change.

Reference Group Norms

Following group norms is usually a requirement for continued membership in the group. Since norms specify the attitudes and behaviors appropriate for group members, reference groups (the groups to which individuals believe they belong or to which they aspire to belong) exert a powerful influence on individuals' attitudes, values. and actions. When individuals are subject to the stabilizing effects of a group's norms, three of the resulting dynamics are: 1. Continuing social support to hold attitudes and

FACTORS INFLUENCING GOAL ACHIEVEMENT Nutrition educators have often designed instructional programs that provide information about nutritious food practices, assuming that such information would automatically result in the adoption of the practices. The issues of creating enduring conceptual frameworks. positive attitudes, and behavioral habits of consumption have been slighted. It is through interpersonal influences that attitudes are acquired and behavioral patterns are changed. And it is through the cognitive processing resulting from interpersonal interaction that conceptual frameworks are developed and retained over long periods of time. In order to have an instructional program that will successfully promote the short-term and long-term goals of nutrition education. it is necessary to design strategies that implement a number of these essential factors. The factors of social context and interpersonal interaction most necessary for a successful effort to change nutrition knowledge, attitudes. and behavior are:

engage in recommended behaviors. 2. Reinforcement for following group norms and

punishment for deviating from them. to persuasive communications to change attitudes and behavioral patterns.

3. Resistance

As one's reference groups change. so do one's attitudes and behavioral patterns (D. Johnson & F. Johnson, 1982; Watson & Johnson. 1972). Individuals accept a new system of attitudes and behavior patterns when they accept membership in a new group. Furthermore. if a group decides to adopt new norms. its members' attitudes and behavior patterns change. The discussion and consensual validation that take place within a group result in personal commitment and encouragement for change that is not present when a person is isolated from a group. In other words, for changes in nutrition attitudes and behavior to be permanent, both the person and the social environment have to change. It is easier to promote learning. attitude acquisition, and behavioral change by changing the values and norms of the groups to which individuals belong than by changing each individual separately (D. Johnson & F. Johnson. 1982; Watson & Johnson. 1972).

1. Adopting and conforming to the norms of the

2.

3. 4.

5.

6. 7.

8.

reference groups to which one belongs and~aspires to belong. and with which one identifies. Publicly committing oneself to learn nutrition information and adopt relevant attitudes and behavior. and being held accountable by peers to fulfill one's public commitments. Being exposed to visible and credible social models. Being confronted with vivid and personalized nutrition information. Discussing nutrition information with peers in ways that promote active cognitive processing and the development of enduring conceptual frameworks. Teaching nutrition information one has learned to others. Acquiring continuing motivation to learn more about good nutrition. Framing nutrition information received as a gain or a loss.

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Public Commitment to Nutrition Attitudes and Behavior

Attitudes and commitments to engage in specified behavior patterns that are made public are more likely to be adopted than are those that are private, especially when peers hold one accountable to fulfill one's commitments. Commitment may be defined as the binding or pledging of the individual to an act or decision (Kiesler, 1971). To the extent that people act in the absence of coercion, commit themselves to act in front of others, or invest time, money, or personal prestige in an activity, they come to see themselves as believers in that sort of activity and develop a personal interest in it (Aronson, 1978; Wicklund & Brehm, 1976). The greater the personal willingness to adopt attitudes and behavior patterns. and the more explicit and public the attitudes and behaviors are, the greater are the subsequent reactions to attacks on or support for the attitudes and behaviors (Kiesler, 1971; Pallak. Mueller, JOURNAL OF NUTRITION EDUCATION S3

Dollar & Pallak, 1972) and the greater is the assumed responsibility for subsequent outcomes (Pallak. Sogin & Van Zante, 1974; Wicklund & Brehm, 1976). When individuals "take a stand" on an issue by committing themselves publicly to an attitude position. the attitude position and the implications of the position may become more salient and less easily denied or forgotten in subsequent situations. Individuals who are more publicly committed to their positions are more susceptible to subsequent consonant communications advocating an even stronger position. are more resistant to an attack on their position, and are more likely to comply with a subsequent request for additional attitude-related behavior than are individuals only privately committed to their position (Halverson & Pallak, 1978; Pallak, Mueller, Dollar & Pallak, 1972; Sullivan & Pallak, 1976). The classic studies by Lewin (1943) and his associates (Radke & Klisurich, 1947; Radke & Caso, 1948) on persuading Americans to eat foods they did not ordinarily consume indicate that if you wish to change people's nutrition attitudes and behavior: 1. They should be involved in group discussions that lead to public commitment to the ne.w attitudes and behaviors. 2. They should perceive that all members of the group support the new attitudes and behaviors. The influence of public commitment on attitudes and behavior patterns is considerably strengthened when group members hold individuals accountable for fulfilling their commitments. There is considerable evidence that many basic attitudes and values are influenced more by peers than by any other set of people (Johnson, 1981). When groups of peers in nutrition education classes require public commitments from each other to eat nutritious foods regularly and to decrease consumption of foods that are nutritiously less dense, and then hold each other accountable to fulfill their commitments to the group, considerable behavioral change takes place (Johnson & Johnson, 1983).

Social Models

Visible and credible models who demonstrate the recommended attitudes and behavior patterns and who directly discuss their importance are powerful influences (Johnson, 1979; Watson & Johnson, 1972). People are most likely to accept new attitudes and behaviors when they come into contact with others who have successfully adopted them (Aronson & O'Leary. 198283; Goldman, 1940; Nisbett, Borgida, Crandall & Reed. 1976; Rogers & Shoemaker, 1971). Visible and credible models and discussion with others who have already adopted the new attitudes and behaviors may be im84 JOURNAL OF NUTRITION EDUCATION

portant aspects of nutrition education. Discussions that allow participants to influence each other's motivation to learn, attitudes, and behaviors are essential to effective nutrition education.

Vivid and Personalized Information

People tend to weigh information in proportion to its vividness (Borgida & Nisbett, 1977; Hamill. Wilson & Nisbett. 1980; Nisbett, Borgida, Crandall & Reed. 1976; Taylor & Thompson, 1982). Statistical data summaries and impersonal information sources are less vivid than face-to-face interactions and case studies. Impersonal data summaries, though accurate and efficient. have been shown to have less impact on attitudes and behavior than more concrete information, even when the more vivid information is less representative. Thus, in order to have maximal impact on learning, attitudes, and behavior, nutrition information needs to be discussed face-to-face in ways that make clear the personal implications of the information.

Active Cognitive Processing of Information

For nutrition education to be successful, the information and arguments contained in a persuasive message must be comprehended and learned and then integrated into a coherent and reasoned position. Principles, generalizations, and applications of principles studied in such courses as biology, chemistry, geometry, and physics are remembered better over periods of months and even years than are more factual items such as symbols, formulas, and terminology (Eikenberry, 1923; Frutchey, 1937; Tyler, 1930; 1934; Ward & David, 1938). This means that in order for enduring learning, attitude modification, and behavioral change to take place, participants have to attend to nutrition information, comprehend it, engage in elaborative thinking about it, and integrate it into their conceptual frameworks. The active oral summarization and discussion with peers of the material being learned facilitate its acquisition and storage and are two of the most powerful influences on achievement and retention (Johnson & Johnson, 1983). The cognitive processes most necessary for deeper-level understanding and implanting the information into memory, such as rehearsal, elaboration, and meta-cognition, occur only through dialogue and interaction with other people (Baker, 1979; Johnson & Johnson, 1983; Markman, 1979; Schallert & Kleinman. 1979; Yager, Johnson & Johnson. 1984). When participants are passive learners. when they study alone. and when they are simply given information and asked to repeat it back, important cognitive processes do not occur. VOLUME 17 NUMBER 2 SUPPLEMENT

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Active cognitive involvement in the persuasion situation, furthermore, is crucial for the production of attitude change (Cook & Frey, 1978; Petty, 1977). Enduring attitude change usually depends on thoughtful consideration of issue-relevant argumentation and on the issue being related to existing attitudes and cognitive frameworks. The more cognitive processing of issues that takes place and the more elaboration participants engage in, the greater the likelihood of attitude acquisition or change occurring and enduring. It is difficult to produce lasting attitude and behavioral change simply by exposing people to persuasive information. Recipients must be motivated and able to process the information in the communication and the information presented must elicit favorable cognitive responses that are rehearsed and stored in long-term memory. Favorable cognitive responses will be elicited only if the message's arguments are compelling. If the arguments are not compelling, if people counterargue the message, or if the arguments are too complex to be understood fully, people's thoughts will be guided by their preexisting attitudes (which may be antagonistic to the arguments being presented). Determining whether new eating practices will increase one's health, well-being, and productivity is a complex task, requiring the participant to evaluate myriad qualitative and quantitative factors. Yet it is clear that people often have difficulty in combining quantitative and qualitative information (Kahneman & Tversky, 1979; Yates, 1982), and often do not properly integrate all information relevant to choosing which food to consume (Kempton, Gladhart & Keefe, 1983; Kempton & Montgomery, 1982). There is considerable evidence that making decisions in groups integrates complex information more effectively than when individuals work alone (D. Johnson & F. Johnson, 1982; Watson & Johnson, 1972). The more complex the nutrition information, the greater the need to have it discussed in small groups of participants. The more integrated the qual,itative and quantitative information, the more likely learning, attitude modification, and behavioral change will result. Therefore, in order for nutrition education to promote knowledge acquisition, attitude development, and behavioral change, the process must emphasize the interpersonal discussion of the material being learned in ways that promote oral summaries of the material, by elaborating or relating it to previously learned material and by integrating the information into existing conceptual frameworks.

1. People learn things better if they learn it in order to teach someone else (Allen, 1976; Benware, 1975; Gartner, Kohler & Riessman, 1971). 2. Higher-level conceptual understanding and rea-

soning are promoted when participants have to teach each other a common way to think about problem situations (Johnson & Johnson, 1979,1983; Murray, 1983). The way people conceptualize material and organize it cognitively is markedly different when they are learning material for their own benefit than when they are learning material to teach others (Annis, 1983; Bargh & Schul, 1980; Murray, 1983). Material learned to be taught is learned at a higher conceptual level than is material learned for one's own use. 3. Peers are frequently able to teach their classmates more effectively than specially trained experts (Fisher, 1969; Sarbin, 1976). 4. People are particularly prone to increase their own commitment to a cause that they have attempted to persuade another to adopt (Nel, Helmreich & Aronson, 1969).

Continuing Motivation

In nutrition programs, what is important is not the memorization of current facts but rather the building of an interest in, and commitment to, continually acquiring knowledge about good nutrition and health. Consumers must continually update their knowledge about nutrition and sort through many contradictory claims about the value of different food products. Nutrition programs need to stress development of a continuing motivation to learn. Continuing motivation is motivation to seek further information about the topic being studied in the future. There are two major reasons why such motivation is necessary. First, individuals must continually revise their knowledge about nutrition as new information becomes available. Second, in addition to distractions, interruptions, interference, and other barriers to retaining and utilizing nutrition knowledge, there is opposition and cognitive conflict created by disagreement among experts as to what foods contribute to good health. Only through continually updating one's knowledge about nutrition and resolving conflicts between information being presented by different sources can constructive consumption patterns be protected.

The Learner As Teacher Framing Information: Loss Versus Gain

There are at least four major reasons that nutrition programs should be designed to have participants 'explain and teach what they are learning to fellow participants, friends, spouses, neighbors, and children: VOLUME 17 NUMBER 2 SUPPLEMENT

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The purpose of nutrition information presentations can be to (a) promote aspects of health that participants strongly desire or (b) prevent something feared from JOURNAL OF NUTRITION EDUCATION S5

happening. The threat-appeal approach has been found effective in changing attitudes and behavior in many cases (Higbee, 1969). Threat appeals have been used in public health campaigns concerning dental health (Janis & Feshbach, 1953), smoking (Leventhal & Watts, 1966), and cancer (Gollob & Dittes, 1965). Although the early research found mixed results, more recent studies focusing on such issues as dental hygiene, smoking, driving practices, and tetanus shots indicate that a positive relationship exists between fear level and amount of persuasion (Hewgill & Miller, 1965; Leventhal. Jones & Trembly, 1966; Leventhal & Niles, 1965; Leventhal. Watts & Pagano, 1967). Rogers, Deckner, and Mewborn (1978) found high-fear messages were superior to lowfear messages in promoting sustained behavior change over a year's time. Studies dealing specifically with nutrition education, however, have not found promising results for the effectiveness of fear compared with optimistic appeals (Becker, Haefner, Maiman, Kirsht & Drachman, 1977; Looker, 1983; Van Den Heuvel. 1982). Fear appeals can be contrasted with optimistic or gain appeals which emphasize the benefits to be gained from adhering to recommendations made. In the case of nutrition there are definite benefits to be accrued from adopting the recommended practices' over and above avoiding the threat of developing nutrient deficiency or toxicity symptoms. Studies that have contrasted fear and optimistic appeals have either found no difference (Dabbs, 1964; Leventhal & Perloe, 1962; Looker, 1983) or superiority of optimistic appeals (Evans & Hall, 1978). Generally, people respond more seriously to a loss than they do to a gain (Kahneman & Tversky, 1979; Yates, 1982). People who fear a loss may be more open to adopting new attitudes and behaviors than people who hope to gain. Fear appeals that emphasize disease and death may be more effective than appeals to hopes of improved health. People may not go out of their way to improve their health status, but they may be willing to act to avoid losing good health. INSTRUCTIONAL STRATEGIES Nutrition education is qualitatively more complex than are many other subject areas taught in schools. Besides the short-term mastery of facts and information, nutrition programs have to be concerned with the achievement of a wide variety of short-term and longterm goals. The social context and interpersonal interaction factors that have been demonstrated to impact learning, attitude acquisition, and behavior change need to be incorporated into the instructional strategies and curriculum materials used by nutrition programs if these goals are to be successfully achieved. Perhaps the major conclusion that can be made from the research on the social context and interpersonal interaction factors is that the competitive or in56 JOURNAL OF NUTRITION EDUCATION

dividualistic learning of nutrition information, where participants read materials and learn on their own without interacting with others, is not appropriate. Competitive and individualistic learning do not create the social context and interpersonal interactions necessary for deeper-level learning and the modification of relevant attitudes and behaviors. Most research in nutrition education has been in situations where a mixture of instructional strategies have been used. Few attempts have been made in the field of nutrition education to compare single teaching strategies with each other. Evaluation research especially, because of its focus on examining the effectiveness of nutrition programs, has generally not tested a single strategy because most programs use a mixture of methodologies (McKenzie & Mumford, 1965). One reason for this may be that educational researchers have traditionally concluded that one teaching method seems to be as effective as another (Siegel & Siegel. 1967; Wallen & Travers, 1963). Nutrition educators, therefore, may have believed it is unproductive to compare the effectiveness of different instructional methods, especially when knowledge learned was the primary focus of the studies being conducted. Yet within the educational and social psychological literature there are recent research findings relating to the promotion of knowledge and conceptual frameworks and validated theories relating to promoting attitude and behavioral change that do suggest instructional procedures which are more effective than others. Instructional procedures that implement the social context and interpersonal interaction factors important to the goals of nutrition education are: 1. Cooperative learning, 2. Inquiry learning, 3. Hands-on nutrition experiments and activities, 4. Out-of-the-classroom experiences, and 5. Academic controversy consensus. All of these strategies are active and require participants to take action and to be involved in the instructional sessions. Cooperative learning situations are structured so that participants work together to achieve mutual learning goals. In contrast to other types of group learning, cooperative learning creates a sense of positive interdependence (where participants become committed to each other's learning), promotes individual accountability (where each participant is held accountable to learn the assigned material), and requires participants to master the small group and interpersonal skills necessary for effective collaboration. Collaborative skills include orally exchanging information and conceptual analyses, teaching each other, holding each other accountable for learning, and providing support and assistance to others when needed. Procedures to guide educators in using cooperative learning effectively have been developed (D. Johnson & Johnson, 1975, 1984; R. Johnson & Johnson, 1984) and hundreds of research studies have validated the efficacy of cooperative learnVOLUME 17 NUMBER 2 SUPPLEMENT

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INSTRUCTIONAL STRATEGIES FACTORS

Cooperative Learning

Group Noms

X

Public Co....it••nt

X

Social Models

X

PersouU%ed Info....tion

X

Cognitive Procesaina

X

Teacbina Otbers

X

Continuing Hotivation

X

G.in v•• Lou App••l.

Inquiry Learning

Nutrition Experim.nts

Out-of-Class Academic Experiments Controversies X

X

X

X

X

X

X

X

X

Figure 2. The Presence or Absence of Essential Educational Factors in Five Instructional Strategies

X

X

X

X

X

X

ing (Johnson & Johnson. 1975; 1983; Johnson. Johnson & Maruyama. 1983; Johnson. Maruyama, Johnson. Nelson & Skon, 1981). Cooperative learning experiences promote achievement. retention. higher level reasoning. elaborative and integrative thinking. positive attitudes toward the subject area being studied. group cohesion. identification with and willingness to be influenced by collaborators. and continuing motivation to learn more about the subject area. Inquiry learning involves stating a problem, selecting data sources. gathering data. processing data. and making inferences. A complete description of the process of using inquiry learning procedures can be found in Johnson (1979). There is a tradition within foods and nutrition programs of involving participants in hands-on nutrition experiments and activities (such as feeding high-nutrient foods to one rat and low nutrient foods to another and noting the resulting effects) and in such activities as planning menus. and purchasing. preparing and tasting various foods. Out-ot-classroom experiences. such as field trips of various sorts where participants must apply what they

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X

X

have learned to actual shopping and consumption situations. are frequently used in nutrition programs. The use of structured academic controversies involves having participants take opposing sides on an issue. explore their differences in opinion and information. and come to a consensus that incorporates the best ideas from both sides. Such a procedure has dramatic effects on achievement. retention, higher-level reasoning. positive attitudes toward the subject area. and continuing motivation to learn about an issue (Johnson. 1979. 1982; Johnson & Johnson. 1984). The specific procedures for using controversy within the classroom can be found in Johnson (1979) and Johnson and Johnson (1979). In Figure 2 the presence or absence of the factors essential to achieving both the short-term and the longterm goals of nutrition education for each of these five instructional strategies is noted. Considerably more attention may need to be focused on training nutrition educators to more frequently and effectively use cooperative learning. academic controversies, inquiry learning, nutrition classroom experiments. and out-ofclassroom experiences and on developing curriculum materials that promote these strategies.

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2

Nutrition Education's Theoretical Foundation In any field of endeavor, if there is to be movement from the "what is" to the "what can be," there needs to be clear recognition of the foundations upon which present practice in that field is based. This chapter will present recommendations, concerns and issues in the field of nutrition education as found in its literature. The three major domains of learning-knowledge, attitude, and behavior-which are commonly the framework for research designs in the field will be discussed. The complex relationships among these three domains will also be identified. This will help build a bridge between the preceding discussion of a model for effectiveness and the findings of the extensive literature integration presented in Chapter 3.

PRESENT PRACTICE IN NUTRITION EDUCATION In her comprehensive review of 269 nutrition education efforts with adults and children from 1900 to 1970, Whitehead (1973) found that most nutrition education emphasized disseminating nutrition information. Cooper and Go (1976) analyzed the major K-12 nutrition curriculum guides in use. They concluded that the suggested learning activities were strongly teacherdominated, with active student participation in only a little over half. Furthermore, the objectives given for the teaching units were primarily in the cognitive domain with most of them at the lower levels of the cognitive taxonomy, that is, requiring only knowledge and comprehension. Absent were objectives focusing on the ability to analyze, synthesize, and evaluate good and bad nutrition information and to apply it. The necessary skills of making wise food choices and discriminating among diverse bits of dietary advice were infrequently taught and evaluated. More recent curriculum materials use computer-assisted instruction, programmed instruction, and other self-instructional materials so that students work by themselves at their own pace to learn fixed knowledge. skills. and behaviors. The emphasis on learning facts through lecture and individualistic efforts in nutrition classes is not congruent with the conclusions of reviews of the research on effectiveness of various instructional strategies. Whitehead (1973) concluded that the aspects of successful instructional methods should: 1. Create learning situations in which people recognize their own nutrition problems and are then led S8 JOURNAL OF NUTRITION EDUCATION

2.

3.

4. 5.

step-by-step through the active process of problem-solving so that they learn to solve their own nutritional problems. Emphasize the development of concepts of nutrition through guiding participants to see relationships between nutrition facts and their own experiences. Actively involve participants in the problem-solving and decision-making processes before they are told what and how much to eat or shown how to prepare nutritionally adequate food. Use small group discussions to lead to group decisions that commit all members to better food habits. Use coordinated, community approaches in which home, community, and school people all participate in planning. conducting. and evaluating nutrition education programs. (Hyman and Wright [1979] note that courses can have little impact if participants are being taught contradictory information in their families and communities.)

In addition to the discrepancy between how nutrition is commonly taught and how the research indicates it should be taught, there are a number of problems with the implementation of nutrition curricula (Gussow & Contento, 1984): 1. Lack of time due to pressures to teach math, reading, and other curriculum areas. 2. Lack of teacher training in nutrition content and educational methodology. 3. Focus on knowledge rather than attitude development and behaviors. 4. Focus in curriculum materials on teacher-dominated lessons that do not provide for active participation of students. A possible alternative to education is mass media. The evidence, however, does not support its effectiveness. The acceptance of new attitudes and behaviors rarely, if ever, occurs simply as a function of appeals through mass media (Aronson, 1980. Yates & Aronson, 1983). Although mass media has been effective in inducing people to choose one brand of almost identical products over others. getting people to adopt new and different behaviors is a much more difficult process involving direct interpersonal influence. Katz and Lazarsfeld (1955) found that personal influence is five and one-half times as effective as newspapers. Changes in choices of what style of clothing to buy was found to be affected VOLUME 17 NUMBER 2 SUPPLEMENT

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twice as much by personal influences as by magazines. A series of laboratory experiments conducted during the 1930's and 1940's indicate that face-to-face contact is a more effective means of persuasion and instruction than is radio, recorded voice, or print. There is, therefore, no substitute for nutrition education through interpersonal interaction. The question is: How can nutrition education be delivered in the most effective way possible? NUTRITION KNOWLEDGE, ATTITUDE, AND BEHAVIOR In most research and evaluation studies in nutrition education. one finds that knowledge. attitude and/or behavior are the dependent or criterion variables being measured. The foundations for this focus are strongly supported in educational theory. Instructional methods and curriculum materials in nutrition classes are aimed at influencing the knowledge, attitudes, and behavior specific to the field. There has been some debate as to the extent that these three outcomes of nutrition education are related. Although several social-psychological theories state that knowledge, attitudes, and behavior should be consistent (e.g., Insko & Schopler. 1967). a number of studies indicate that their relationships are not simple or automatic (e.g., Liska, 1975; Swanson, 1972; Wicker, 1969). The relationships among knowledge, attitudes, and behavior are more intricate than many of the studies in nutrition education acknowledge. Behavior typically has multiple causes. The view that nutrition knowledge and attitudes will determine nutrition behavior oversimplifies the complexity involved in food selection, preparation, and consumption. Behavior is almost always determined by many motivations operating at the same time; therefore, nutrition-related behaviors are usually the result of many motivations rather than one. Most individuals value health so it is assumed that they will adopt a lifestyle commensurate with assuring lasting health. Whether they do, however. depends on both internal influences such as nutrition knowledge and attitudes, personality characteristics, and anxiety/ depression and external factors such as cultural expectations. food availability, cost of food, advertising appeals, food popularity, and a desire to be similar to peers. Despite the fact that the external factors may have more impact on immediate behavior than do internal influences. the degree to which knowledge, attitudes, and behavior are related has been the subject of considerable debate. Knowledge and Behavior

The process through which nutrition education affects nutrition knowledge, attitudes. and behavior begins with nutrition information being presented to particiVOLUME 17 NUMBER 2 SUPPLEMENT 1985

pants. Presenting information does not mean that the information will be attended to, learned, retained, or applied. Knowledge does not, in and of itself. cause changes in behavior or even attitudes except under a very limited set of conditions (Watson & Johnson, 1972). In many cases people do not assign weight to information in strict accordance with its importance (Hogarth, 1981; Kahneman & Tversky, 1979; Nisbett & Ross, 1980; Tversky & Kahneman. 1974). Being informed does not mean that people will act intelligently in promoting health and preventing disease. Information is often disregarded, altered, and used to justify and rationalize current behavior rather than to stimulate behavioral change. It takes prior education to effectively interpret and use information in choosing which foods to consume. Attitude aod Behavior

Because attitudes are thought to be predispositions to action, the failure to find a high correlation between attitudes and behavior in early social psychological research was frustrating (Fishbein & Ajzen, 1972; Wicker, 1969). Nutrition educators have shared this frustration as the correlations between nutrition-related attitudes and behavior have been found to range from approximately 0.01 to 0.55 in studies that sampled different populations. attitudes, and behaviors. In energy consumption research, furthermore, attitudinal variables have indicated little association with energy consumption (McDougall, Claxton, Ritchie & Anderson, 1981; Ritchie, McDougall & Claxton, 1981). Bickman (1972) interviewed some 500 people about the responsibility for picking up litter and 94 percent expressed an attitude favorable to removing litter. On leaving the interview situation, however, only about 2 percent of the interviewees picked up litter that had been planted by the investigator. Millions of people, furthermore. aspire to health and are aware of the link between well-balanced meals and health, yet still persist in undesirable nutritional practices. More recent research in social psychology, however, indicates that attitudes can predict behavior and that attitudes may have causal predominance over behavior (Andrews & Kandel, 1979; Cialdini, Petty & Cacioppo, 1981; Kahle & Berman, 1979). The questions concerning the strength of the relationship seem to have much to do with the difficulty of measuring attitudes in a valid way and with other constraints of research designs. Attitudes seem to be most predictive of behavior when the criterion identified in the instrument used to measure attitude corresponds closely in level of specificity with the behavioral criterion (Ajzen & Fishbein, 1977; Jaccard, King & PomazaI. 1977). Thus, the failure to find a relationship between attitudes and behavior might be explained in part by lack of correspondence between the JOURNAL OF NUTRITION EDUCATION S9

attitude measure and the behavior measure, i.e., predicting smoking behavior from scores obtained from a general measure of attitude toward health. Development of attitude measures in nutrition that have high criterion validity needs to be a goal of nutrition education researchers. Another situation that can affect the predictive utility of attitude measures is the period of time which lapses between administration of the different measures. A longer time period between measures results in lower predictive utility of the attitude, possibly because the attitude changes in the interim (Davidson & Jaccard, 1979; Schwartz, 1978). Fishbein and Ajzen (1981) maintain that the best predictor of behavior is the person's intention to perform the behavior. Support for this theory has been obtained in several studies that measured behavioral intentions and actual behavior in a variety of areas (Davidson & Jaccard, 1979; Hom, Katerberg & Hulin, 1978; Kilty, 1978). This, too, suggests direction for nutrition education research. Degree of self-awareness, of commitment, and of direct exposure, and presence of peer accountability are also thought to be strong predictors of behavior. High self-awareness, created by asking participants to indicate their attitude in the presence of a mirror, increases the consistency between attitudes and behavior (Pryor, Gibbons, Wicklund, Fazio & Hood, 1977), perhaps because the self-attention produced by the mirror leads the participants to be more introspective and accurate when reporting their attitudes. Producing high commitment by having participants believe they would actually have to perform the behavior increases the consistency between attitudes and behavior (Gabrenya & Arkin, 1979). Attitudes formed by having direct experience with the object of the attitude predict behavior more accurately than do attitudes formed without direct experience (Regan & Fazio, 1977). When peers hold

SlO JOURNAL OF NUTRITION EDUCATION

individuals accountable to behave in a manner congruent with their attitudes, attitudes have been found to be more related to actual behavior (Johnson & Johnson, 1983). These research findings suggest that when nutrition education emphasizes high self-awareness, high commitment to eat nutritious foods, direct experience with nutritious foods, and strong presence of accountability to peers, nutrition-related attitudes can be expected to influence food consumption. Whether foods dense in nutrients are frequently consumed or not can depend on a host of internal and external factors in addition to nutrition knowledge and attitudes. Mastery of isolated facts and the acquisition of general attitudes, furthermore, may not greatly affect nutrition-related behaviors. But when nutrition classes emphasize the acquisition of conceptual frameworks and general principles as well as specific attitudes and behavioral intentions, the research indicates that knowledge and attitudes can be predictive of food consumption patterns. In summary, nutrition education is far more complex than is the teaching of other subject areas. This complexity results from the need to create informed consumers who value good nutrition and consume nutritious foods throughout their lives. Mastery of information and facts is only one small part of the overall goal of nutrition education. To successfully achieve the .short-term and long-term goals of nutrition education, the curriculum materials and instructional methods used need to reflect the social context and interpersonal interaction factors that theory suggests, and current research findings indicate, are important in influencing enduring knowledge acquisition, positive attitude development, and nutritious behavioral habits. This does not mean that other factors may not be validated in future research. However, present knowledge already suggests directions for improving the impact and effectiveness of nutrition education.

VOLUME 17 NUMBER 2 SUPPLEMENT 1985

3

A Meta-Analysis and Synthesis of Nutrition Education Research Since the early 1900s there has been a great deal of research on the impact of nutrition education on participants' nutrition knowledge, attitudes, and behavior. Despite the large number of studies conducted, scientists disagree as to the conclusions that may be drawn from the literature. Although there have been a number of reviews of the research and evaluation of nutrition education programs, there is an absence of an exhaustive and comprehensive examination of the impact of nutrition education on participants. The efficacy of nutrition education programs has never been firmly established for: 1. The mastery, retention, integration, and application of nutrition concepts and information. 2. The acquisition and maintenance of positive attitudes toward nutritious eating habits and good nutrition. 3. The adoption and lifelong maintenance of nutritious eating habits. In response to the need for a comprehensive review of all available research in nutrition education, a metaanalysis was conducted. The goals of the meta-analysis were twofold: to assess current effectiveness of nutrition education and to delineate new directions for future research in nutrition education. The report of the meta-analysis that follows first discusses previous reviews of nutrition education effectiveness. Next, the nature and methods of metaanalysis are defined. Then, the method and procedures for this meta-analysis are presented and the overall findings are described. PREVIOUS REVIEWS Selected reviews of research and evaluation studies that examined the effects of nutrition education on knowledge, attitudes, and behavior have been conducted by a number of educators, social scientists, and nutritionists. These reviews have yielded discussions of the problems and shortcomings of nutrition education research and evaluation, but have not provided a strong case for the efficacy of nutrition education. Swope (1962) included 44 studies in her bibliography and indicated that she used 43 in her review. Only about one-half of these studies examined the effectiveness of VOLUME 17 NUMBER 2 SUPPLEMENT 1985

nutrition education programs. McKenzie and Mumford (1965) reviewed some 40 studies on nutrition education selected from the numerous ones available. Of the 40 that met their criteria for inclusion. they reported on only 17 of the studies. Whitehead (1973) provided a review of studies published between 1900 and 1970. Out of the 268 articles. reports, theses, and books reported in her references, Whitehead discussed about 60. Levy. Iverson, and Walberg (1980) reviewed 22 studies on nutrition education published between 1968 and 1978. For six of these studies, individual effect sizes were computed, but these were too few to be summed to give an overall indication of the success of nutrition education. Thus, while the methodology they used was more advanced, the small sample limits generalizability of the findings. All these reviews contained relevant studies. With the exception of Levy. Iverson, and Walberg (1980), the reviews all used the "summary impression" method in which the authors read the studies, decided which ones to include, and gave their own impressions of the meaning of the collective results. Little attempt was made to measure the size of the effect. combine them statistically, or test their speculations about why different studies found different findings. A number of other problems common to each of these reviews may distort their conclusions and create unnecessary doubt and disagreement within the field of nutrition education. First, too few studies have been included in anyone review to portray accurately the overall empirical findings in the area. Second. each review included only a subset of possible studies. It is possible that some bias may have influenced the reviewers to include only studies that supported their position and exclude those that did not. Third, reviewers have relied only on their impressions as to what variables may influence the effectiveness of nutrition education programs. They have made little attempt to systematically identify the mediating or moderating variables. Finally, the reviews have ignored the issue of relationship strength. This may have allowed (a) weak disconfirmation or (b) the equal weighting of conclusions based on a few studies with conclusions based on several dozen studies (see Cooper. 1979). Given the uncertainty about the effectiveness of nutrition education and the basic limitations of the previous reviews. there was need for a comprehensive JOURNAL OF NUTRITION EDUCATION Sl1

review of existing nutrition education research, using a more powerful method of combining results than summary-impression. The best methodology for such a purpose is meta-analysis. Meta-analysis quantifies the findings of studies using a common metric so that it becomes possible to examine the magnitude of any differences between conditions as well as the probability of finding such differences.

META-ANALYSIS DEFINED Glass (1977) defines meta-analysis as the process of combining results of independent experiments for the purpose of integrating their findings. More powerful than the summary-impression method for combining results of existing research, meta-analysis quantifies findings of studies using a common metric. A metaanalysis is conducted on a group of studies with a common conceptual hypothesis or common operational definitions of independent or dependent variables. A meta-analysis usually results in a significance level that gives the probability that a set of studies exhibiting the found results could have been gener:ated if no actual relation had existed and describes the degree of overlap among different experimental conditions on a normal curve. Thus, when used in a complete survey of studies from a specific research area, meta-analysis procedures allow a characterization of the tendencies of the research (the probability of finding such differences again) and also yield information about the magnitude or extent of any differences among conditions. Meta-analysis is applicable to the research in nutrition education because a considerable number of research studies have used conceptually similar operationalizations of (a) nutrition education and (b) knowledge, attitudes, and behavior. This allows reliable application of statistical procedures. Meta-analysis allows for more precise and confident statements than a summaryimpression review about the relative impact of nutrition education programs on participants' nutrition-related knowledge, attitudes, and behavior patterns. To establish the current state of knowledge about the effectiveness of nutrition education, the meta-analysis process was applied to the research literature in the field. The following steps were followed: 1. Conducted an extensive and thorough search for all

published and unpublished studies. 2. Read over 670 studies and identified 303 that had

useable research findings. 3. Established and applied a coding procedure to classify the 303 studies into a common framework. 4. Classified each of the 4,108 findings in the 303

studies into: a. Negative findings (nutrition education had statistically significant but negative impact). S12 JOURNAL OF NUTRITION EDUCATION

b. Findings of no difference (nutrition education had no statistically significant impact). c. Positive findings (nutrition education had positive, statistically significant impact). 5. Transformed the findings into an effect size whenever enough information was given to conduct the required statistical computations. 6. Transformed the findings into a z-score whenever enough information was given to conduct the required statistical computations. 7. Integrated the existing research on the effects of nutrition education in several ways, including: a. All 303 studies. b. Studies published only in refereed journals. c. Studies of National Dairy Council's FOOD .. Your Choice (FYC) programs for school-age and young adult populations. d. Studies of the Expanded Food and Nutrition Education (EFNEP) for low-income families. e. Studies of the Special Supplemental Food Program for Women, Infants and Children (WIC), a food assistance and nutrition information program for low income pregnant and lactating mothers and their children. Independent and Dependent Variables

Nutrition education programs were defined as any planned teaching of nutrition knowledge aimed at affecting the acquisition of nutrition knowledge, positive attitudes toward good nutrition. and eating of nutritious foods. Nutrition knowledge was defined as performance on tests assessing mastery and retention of the knowledge taught within the nutrition education program. Attitude toward good nutrition was defined as performance on measures of the importance of good nutrition and commitment to eating nutritiously. Constructive nutrition behavior was defined as patterns of intake of foods dense in nutrients relative to nutrient and energy requirements for age, body composition and activity level. Statistical Methods

Three methods of meta-analysis were used: the voting method, the effect-size method. and the z-score method. For the voting method, each study was read carefully and all findings considered by the original author( s) to be significantly positive, significantly negative. or nonsignificant were counted. If a plurality of findings fell into one of these three categories. the modal category was declared the winner and assumed to give the best estimate of the direction of the true relation between the independent and dependent variables. Although this is a common method of reviewing literature, the practice of VOLUME 17 NUMBER 2 SUPPLEMENT

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declaring the modal category ignores sample size. Large samples produce more statisti<;ally significant findings than do small samples. The voting method also disregards important information about the strength and importance of relations among variables. Its value is primarily that of giving a rough estimate of the direction one will likely find after closer statistical analysis. In many of the studies of nutrition education, authors stated that the results were positive without specifying a significance level and without presenting enough data from which to compute a statistical test. In such cases the results were counted as being positive in the votingmethod analysis but could not be included in the effectsize or z-score analyses. For the effect-size method the difference between the means of pairs of treatment conditions is divided by the within-group standard deviation of the treatment conditions, yielding a standardized mean difference (Glass, 1977). In this review, the estimate of the total standard deviation used for the variance term is a weighted average of standard deviations for all groups. The effect size for each finding of a study was treated as an observation so that the overall strength of effect (mean effect size) could be computed and so that relations of effect sizes to characteristics of the' study could be examined. The effect size allows for the examination of the strengths of the relations between the independent and dependent variables. The z-score method was originally developed by Stouffer (1949) and is comprised of the following steps: (a) compute the exact p value of the test statistic used by the author(s) of each study, dividing the exact pvalue by two if they used a two-tailed test; (b) compute the exact z-score for each p value; (c) sum these z-scores, and divide this sum by the square root of the number of findings involved; and (d) refer this z-score back to the table, and determine the appropriate probability level. This probability describes the likelihood that the overall pattern of results was generated by chance. In this review the z-score results are understated since many studies did not state exact probability levels or include the specific t, F, and X2 scores. In such studies, nominal rather than exact p values had to be used. If the finding was described as being statistically significant. the probability level was set arbitrarily at the lowest p = .05 and if the finding was described as being statistically nonsignificant, the z's were assumed to zero. The z-score results, therefore, tend to be conservative and probably understate the significance of the findings. The basic unit of analysis for the three meta-analysis methods is the finding, not the study. When the number of findings are analyzed. studies that have numerous findings end up having more weight than do studies with only one measure of nutrition knowledge, attitudes, or behavior. To control for a possible bias resulting from studies with multiple measures. the effect size and zVOLUME 17 NUMBER 2 SUPPLEMENT

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score for knowledge, attitude, and behavior findings were reanalyzed so that each finding was weighted inversely proportional to the number of knowledge, attitude, or behavior findings from that study. This resulted in each study being given the same overall weight in the analyses. It also resulted in the sample size being reduced and in the findings being independent from each other. Although every attempt was made to find all relevant unpublished literature, there always remains the possibility that research reports exist in scattered file drawers. In order to take this possibility into account, a fail-safe n was calculated (Rosenthal, 1978). This procedure determines how many additional studies with summed z-scores totaling zero were needed to decrease the overall probability level of a Stouffer z-score above the .05 level. Bases for Including Articles

The procedure included searching the literature, coding the data from each study, statistically analyzing the results, and reporting the findings. A variety of methods of locating all relevant studies were used. Source-bysource searches were carried out by examining the contents of all relevant journals and dissertation abstracts. Several computer searches were conducted. Existing bibliographies were carefully examined. Finally, relevant organizations and researchers were contacted and interviewed. Every attempt was made to locate all relevant studies. The criteria used to determine whether a study was included in the meta-analysis were as follows: 1. The study specifically dealt with nutrition educa-

tion. 2. The study contained measurements of participants'

nutrition knowledge, attitudes, and/or behavior. 3. It was possible to make conclusions about the

effectiveness of the educational program either through comparison with a control group or through comparison of pre- and post-scores. 4. Studies were written or summarized in English. Studies included are original reports of nutrition education research that provide evidence of whether or not the educational program resulted in improved nutrition knowledge, attitudes. and behavior. Out of the 673 studies located, these criteria resulted in a preliminary analysis of 303 studies that yielded 4108 findings. Three-hundred and seventy studies contained no applicable data. The majority of these articles contained no data for all. Six judges independently read the articles included in this review. Two of the judges had master's degrees in nutrition education, three had B.A. degrees in psychology and education. and one had a doctorate in psycholJOURNAL OF NUTRITION EDUCATION 813

ogy. Twenty articles were randomly selected, and the six judges independently read the articles and made the ratings needed for each study. The interrater reliability was 94 percent. All statistics on every study included were double-checked. The primary purposes were to (a) determine the efficacy of nutrition education programs and (b) examine explanatory variables in an attempt to better understand the reasons that nutrition education is effective. The three meta-analyses techniques of voting, effect size and z-score and the fail-safe n procedure were conducted to accomplish the first purpose. To accomplish the second purpose, preliminary analyses examined the distribution of the various characteristics and eliminated variables for which there were either too few observations or little or no variability in responding. The preliminary analyses were also used to cluster variables in meaningful ways so they could be analyzed either by analysis of variance or by correlational techniques. The ANOVA and correlational analyses. however, produced fewer statistically significant findings than would be expected by chance. The random error within the studies seemed to eliminate the possibility of identifying possible mediating or moderating variables through statistical analysis. :rhe ANOVA and correlational analyses are, therefore, not reported. For the limited number of studies that contained measures of more than one of the dependent variables, Pearson correlation coefficients were calculated among weighted measures of nutrition knowledge, attitudes, and behavior.

Table 1.

OVERALL FINDINGS Findings from the meta-analysis are strong and clear. If there have truly been doubts as to the effectiveness of nutrition education in achieving the goal of developing knowledgeable consumers who value good nutrition and consume nutritious foods, the results of this metaanalysis should set those doubts aside. The first analysis was of the overall effectiveness of nutrition education in promoting the acquisition of nutrition knowledge. the development of positive attitudes toward good nutrition, and constructive nutrition behavior patterns. Meta-analyses were conducted for the voting method, the effect-size method, and the Stouffer z-score method. Both unweighted and weighted effect size and z-scores are reported in Table 1. The weighted results are emphasized in the text, as the smaller sample size and independence pf results make them more conservative. Knowledge

The voting method indicates that nutrition education promotes significantly greater knowledge by 587 to 19 with 293 no differences. The weighted effect size of .96 indicates that the average participant in nutrition education performs at the 83rd percentile of the control (which is at the 50th percentile) on knowledge tests. The weighted z-score of 22.34 indicates the probability that the difference is due to chance is less than .001. The

Meta-Analyses for all Nutrition Education Studies* Knowledge Voting

N ND P

19 293 587

Effect Size

M SD n

.96 1.36 81 22.34 96 17,501

Weighted

z-Score Unweighted Effect Size z-Score

z

n fail-Safe n M SD n z n fail-Safe n

.71

1.25

574 46.20 636 497,886

Attitude

Behavior

23 228 201

74 1,069 1,599

.37

.47 .82 102 19.88 122 17,585

.26

38 11.61 45 2,181 .27

.44

238 19.39 255 34,962

.40 .94 1,004 53.19 1,192 1,237,658

=

*N Negative findings ND = No significant differences P = Positive findings mean M SD = Standard Deviation n = Number of studies

=

814 JOURNAL OF NUTRITION EDUCATION

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fail-safe n for such a finding is 17,501. The unweighted effect size is .71 (at the 76th percentile of control group) and the unweighted z-score is 46.20 (p<.OOl). The voting-method, effect-size and z-score results clearly indicate that nutrition education is effective in increasing knowledge about nutrition.

of 19.88 favoring nutrition education indicates the probability that the difference is due to chance is less than .001. The fail-safe n for such a finding is 17,585. The unweighted effect size is .40 (at the 66th percentile of control group) and the unweighted z-score is 53.19 (p<.OOl). All results clearly indicate that nutrition education is effective in improving consumption of nutritious foods.

Attitude

The voting method analysis indicates that nutrition education promotes significantly more positive attitudes toward good nutrition by 201 to 23 with 228 no differences. The weighted effect size of .37 indicates that the average nutrition education program participant's attitudes are at the 64th percentile of the control. The weighted z-score of 11.61 favoring nutrition education indicates the probability that the difference is due to chance is less than .001. The fail-safe n for such a finding is 2,181. The unweighted effect size is .27 (at the 61st percentile of control group) and the unweighted z-score is 19.39 (p<.OOl). The results of these three methods clearly indicate that nutrition education is effective in developing positive attitudes about good nutrition.

FINDINGS IN JOURNAL ARTICLES

All studies were coded for source: journal (52 percent of the findings), technical report (36 percent), master's thesis (7 percent), doctoral dissertation (4 percent), or book (1 percent). Since journal articles have passed a peer review process to certify the quality of the research design and data analysis, a separate analysis was conducted of findings from this source to indicate the degree of impact of nutrition education programs when Studied by what could be assumed to be more rigorous research methods. It is these studies that may most accurately portray the impact of nutrition education programs on nutrition knowledge, attitudes, and behavior. The results appear in Table 2.

Behavior Knowledge

The voting method indicates that nutrition education promotes significantly better nutrition behavior by a score of 1,599 to 74 with 1,069 no differences. The weighted effect size of .47 indicates that the average participant in nutrition education eats nutritiously at the 69th percentile of the control. The weighted z-score Table 2.

The voting method indicates that nutrition education promotes significantly greater knowledge by 244 to 5 with 139 no differences. The weighted effect size of 1.12 indicates that the average participant in a nutrition education program achieves at the 87 percentile of the

Meta-Analyses for Journal Articles·

Knowledge N ND P

Effect Size z-Score

Unweighted Effect Size z-Score

Behavior

5 139 244

8 101 88

37 596 810

M SD N z N Fail-Safe n

1.12 1.65 50 19.21 61 8,210

.44 .26 19 8.18 24 566

.48

M SD N z n Fail-Safe n

1.05 1.49 184 31.90 223 83,137

.43

Voting

Weighted

Attitude

.53 77

14.03 86 6,130

.52 60 16.76 77 7,868 .52 1.17 511 39.32 630 357,162

·N = Negative findings ND = No significant differences P = Positive findings M= mean SD = Standard Deviation n = Number of studies VOLUME 17 NUMBER 2 SUPPLEMENT 1985

JOURNAL OF NUTRITION EDUCATION S15

control. The weighted z-score of 19.21 indicates the probability that the effectiveness of nutrition education is due to chance is less than .001. The fail-safe 0 for such a finding is 8,210. The unweighted effect size is 1.05 (at the 85th percentile of control group) and the unweighted z-score is 31.90 (p<.OOl). The voting method, effectsize and z-score results clearly indicate that nutrition education as described in journal research articles is effective in promoting nutrition knowledge. Attitude

The voting method indicates that nutrition impacts attitudes toward good nutrition by 88 to 8 with 101 no differences. The weighted effect size of .44 indicates that the average participant's attitudes toward good nutrition are at the 67th percentile of the control. The weighted z-score of 8.18 favoring nutrition education indicates the probability that the difference is due to chance is less than .001. The fail-safe 0 for such a finding is 566. The unweighted effect size is .43 (at the 67th percentile of the control group) and the unweighted zscore is 14.03 (p<.OOl). The voting method, effect size and z-score results clearly indicate tha.t nutrition education as described in journal research articles is effective in promoting positive nutrition attitudes. Behavior

The voting method indicates that nutrition education promotes significantly better nutrition behavior by 810 to 37 with 596 no differences. The weighted effect size of .48 indicates that the average participant in a nutrition education program eats nutritiously at the 68th percentile of the control. The weighted z-score of 16.76 indicates the probability that the superiority of nutrition education is due to chance is less than .001. The fail-safe o for such a finding is 7,868. The unweighted effect size is .53 (at the 70th percentile of the control group) and the unweighted z-score is 39.32 (p<.OOl). The results of these three methods clearly indicate that nutrition education as described in journal research articles is effective in increasing the consumption of nutritious foods. While the effect-size findings for the journal studies are slightly higher for knowledge and behavior, the zscores are slightly lower. A common criticism of metaanalysis is that when all the available studies are included, the overall effect size and z-score are meaningless because the poorly conducted studies overpower the adequately conducted studies. Given that studies published in journals are considered to be of higher quality than are unpublished studies, the results of these metaanalyses indicate that the results of published and unpublished studies do not differ significantly. 816 JOURNAL OF NUTRITION EDUCATION

FINDINGS FOR THREE NUTRITION EDUCATION PROGRAMS A variety of educational packages and programs have been developed for delivering nutrition education and directly improving diet. Of these, three have been the focus of a number of research studies, yielding data which enabled us to conduct separate meta-analyses for them. FOOD ... Your Choice, designed by the National Dairy Council, provides curriculum materials for preschool, elementary aod secondary school teachers to use in teaching general nutrition concepts. These programs are one component of Dairy Council programming which also focuses on adult consumers and health professionals. The FOOD ... Your Choice curriculum packages contain written and audio-visual materials as well as suggested instructional activities. The program is implemented nationally through a network of affiliated Dairy Council units. All levels of the program have been thoroughly pilot tested. In addition, it is National Dairy Council's policy to commission rigorous national evaluations using general nutrition instruments after the programs have been introduced in the nation's schools. The Special Supplemental Food Program for Women, Infants, and Children (WIG) provides food assistance to low-income pregnant, postpartum, and lactating women and their infants and children under five years of age who are at risk nutritionally. The program is designed to serve as an adjunct to good health care and includes nutrition information in addition to the food assistance. Begun in 1972, it is administered by the United States Department of Health and Human Services. The Expanded Food and Nutrition Education Program (EFNEP) uses paraprofessionals to work with hard-toreach rural and urban poor. It is designed to improve nutritional practices, self-image and future expectations, especially for families with young children. The program basically consists of one-on-one and smallgroup teaching. The nutrition content emphasizes: vitamins, fruits and vegetables, cardiovascular disease, fatcontrolled diet, nutrition during child-bearing and infant nutrition. Begun in 1968, the program is administered by the United States Department of Agriculture. FOOD . .. Your Choice

Knowledge. The voting method indicates that the National Dairy Council curriculum, FOOD ... Your Choice (FYG), significantly increases participants' knowledge about nutrition by a score of 57 to 5 with 61 no differences (see Table 3). The weighted effect size of .39 indicates that the average participant in the nutrition education courses performs at the 65th percentile of the control on knowledge tests. The weighted z-score of6.13 VOLUME 17 NUMBER 2 SUPPLEMENT

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Table 3.

Meta-Analyses for National Dairy Council's Food ... Your Choice·

Knowledge

Attitude

Behavior

5 61 57

11 63 34

11 82 52

M SD N z N Fail-Safe n

.39 .22 10 6.13 11 141

.64 .60

.29

M SD N z n Fail-Safe n

.30 1.20 106 13.92 112 7862

N ND P

Voting

Weighted Effect Size z-Score

Unweighted Effect Size z-Score

5 5.34 6 57 .14 .41

94

8.01

99

2235

.63 5 3.48 5 17 .13 .37 103 9.05 113 3286

·N = Negative findings ND = No significant differences P = Positive findings M= mean SD = Standard Deviation n = Number of studies

favoring National Dairy Council materials indicates that the probability of the difference being due to chance is less than .001. The fail-safe n for such a finding is 141. The unweighted effect size is .30 (at the 62nd percentile of the control group) and the unweighted z-score is 13.92 (p<.OOl). The voting method, effect-size and z-score results indicate that FOOD ... Your Choice is effective in increasing nutrition knowledge. Attitude. The voting methon indicates that FOOD ... Your Choice significantly increases participants' positive attitudes toward nutrition by a score of 34 to 11 with 63 no differences. The unweighted Table 4.

effect size of .64 indicates that the average FOOD ... Your Choice participant's attitudes were at the 71st percentile of the control. The wei,ghted z-score of 5.34 favoring FOOD ... Your Choice indicates the probability that the difference is due to chance is less than .001. The fail-safe n for such a finding is 57. The unweighted effect size is .14 (at the 56th percentile of the control group) and the unweighted z-score is 8.01 (p<.OOl). The voting method. effect-size and z-score methods indicate that FOOD. . . Your Choice is effective in promoting positive attitudes toward good nutrition.

Meta-Analyses for WIC·

Attitude

Behavior

0 2 6

0 2 2

13 48 151

M SD N z N Fail-Safe n

.61 .41 2 2.87 2 4

.16 1 .28 1

.19 .16 7 4.80 8

M SD N z n Fail-Safe n

.83 .25 4 6.28 5 68

.16 .15 2 2.24 4 3

.24 .31 39 12.47 72 4040

Knowledge N ND P

Voting

Weighted Effect Size z-Score

Unweighted Effect Size z-Score

60

·N = Negative findings ND = No significant differences P = Positive findings M= mean SD = Standard Deviation n = Number of studies VOLUME 17 NUMBER 2 SUPPLEMENT 1985

JOURNAL OF NUTRITION EDUCATION S17

Meta-Analyses for EFNEP*

Table 5.

N NO P

Voting Weighted Effect Size z-Score Unweighted Effect Size z-Score

0 3 85

0 5 10

.25

.30

M SO N z N Fail-Safe n

3 5.44 5 49

M SO N z n Fail-Safe n

.23 10 33 15.66 39 3474

Behavior

Attitude

Knowledge

.06

2 67 243 .33

.12

.05 2 2.98 2 5

9 7.37 13

246

.27

.31

.20

.07 8 6.59 8 119

80

22.19 124 22,294

=

*N Negative findings ND = No significant differences P = Positive findings M = mean SD = Standard Deviation n = Number of studies

Behavior. The voting method indicates that FOOD . . Your Choice significantly improves the eating of nutritious foods by a score of 52 to 11 with 82 no differences. The weighted effect size of .29 indicates that participants using FOOD ... Your Choice consume nutritious foods at the 61st percentile of the controls. The weight z-score of 4.02 favoring FOOD ... Your Choice indicates the probability that the difference is due to chance is less than .001. The fail-safe n for such a finding is 30. The unweighted effect size is .13 (at the 55th percentile of the control group) and the unweighted z-score is 9.05 (p<.OOl). The results of the three methods indicate that FOOD ... Your Choice is effective in improving the consumption of nutritious foods.

interpretation needs to be made cautiously due to the small number of findings available. In terms of behavior, the major goal of the program, the voting method indicates that the WIC Program significantly increases consumption of nutritious foods by a score of 151 to 13 with 48 no differences. The weighted effect size of .19 indicates that the average participant in the WIC program consumes at the 58th percentile of the control. The weighted z-score of 4.80 favoring the WIC Program indicates the probability that the difference is due to chance is less than .001. The fail-safe n for such a finding is 60. The unweighted effect size is .24 (at the 60th percentile of the control group) and the unweighted zscore is 12.47 (p<.OOl).

Women, Infants, and Children (WIC) Program

Expanded Food and Nutrition Education Program (EFNEP)

The impact of the WIC Program appears in Table 4. The few findings for knowledge and attitude indicate that WIC is effective in these areas, although this

Knowledge. The voting method indicates that EFNEP significantly increases participants' knowledge about nutrition by a score of 85 to 0 with 3 no differences (See

Table 6.

Correlations Among Nutrition Knowledge, Attitude, and Behavior Variables

Knowledge and Attitude: Effect Size Knowledge and Behavior: Effect Size Attitude and Behavior: Effect Size Knowledge and Attitude: z-Score Knowledge and Behavior: z-Score Attitude and Behavior: z-Score

518 JOURNAL OF NUTRITION EDUCATION

Correlation

Number

Significance Level (p)

.17

29

.19

.50

38

.001

.20

23

.18

.09

35

.31

.32

44

.02

.47

28

.006

VOLUME 17 NUMBER 2 SUPPLEMENT 1985

Table 5). The weighted effect size of .25 indicates that the average participant in EFNEP performs at the 60th percentile of the control. The weighted z-score of 5.44 favoring EFNEP indicates the probability that the difference is due to chance is less than .001. The fail-safe n is for such a finding is 49. The unweighted effect size is .23 (of the 59th percentile of the control group) and the unweighted z-score is 15.66 (p<.OOl). Attitude. The voting method indicates that EFNEP increases positive attitudes toward nutrition by a score of 10 to 0 with 5 no differences. There are too few studies to compute a meaningful weighted effect size or z-score. The unweighted effect size is .27 (at the 61st percentile of the control group) and the unweighted z-score is 6.59 (p< .001). Behavior. The voting method indicates that EFNEP increases the consumption of nutritious foods by a score of 243 to 2 with 67 no differences. The weighted effect size of .33 indicates that the average person in the EFNEP program performs at the 63rd percentile of the participants in the control. The weighted z-score of 7.37 favoring the EFNEP program indicates that the probability of the difference being due to chance is less than .001. The fail-safe n for such a finding is 246. The unweighted effect size is .31 (at the 62nd percentile of the control classes) and the unweighted z-score is 22.19 (p< .001). CORRELATIONS AMONG NUTRITION KNOWLEDGE, ATTITUDE, AND BEHAVIOR A number of studies measured more than one dependent variable and, therefore, it was possible to compute correlations among nutrition knowledge, attitude, and behavior. Calculations for both effect size and z-scores were computed. The results appear in Table 6. Significant relationships exist between nutrition knowledge and behavior as evidenced by statistically significant (p<.02) correlations for both sets of data. The relation between nutrition attitude and behavior is also significant, as indicated by the z-score correlation. The relation

Table 7.

Decades in Which Studies Were Published

Decade

Date Not Given

1910-1919 1920-1929 1930-1939 1940-1949 1950-1959 1960-1969 1970-1979 1980-1984

TOTALS

Studies 6

2 2

o

23

13

17 125 115 303

VOLUME 17 NUMBER 2 SUPPLEMENT 1985

Findings

88

2

11

o

294 105 315 1645 1648 4108

Table 8.

Frequency of Use of Instructional Strategies Percent

lectures Written materials Directed small group activity Displays Individual counseling Movies, slide shows, closed circuit T.V. Commercial mass media Computers

75.7 69.4 50.3 44.8 33.1 31.3 11.0 01.9

between nutrition knowledge and attitude did not reach statistical significance for either set of data. GENERAL CHARACTERISTICS OF NUTRITION EDUCATION RESEARCH The studies that have been conducted in nutrition education began in the early 1900's. Most of the available studies, however, were conducted in the past 25 years. These recent studies have included more findings per study than did the studies of previous decades (see Table 7). Seventeen percent of the findings were from studies that randomly selected a sample, 22 percent were from studies in which subjects were randomly assigned to conditions, and 64 percent included a control group. Eighty-seven percent of the findings were from studies conducted in North America. Fifty-nine percent of the findings were from studies conducted in the elementary and secondary schools. Fifty-two percent of the findings were from studies published in journals. Forty-six percent of the findings were from studies with sample sizes between 100 and 500 subjects. Nineteen percent of the findings were from studies containing national samples while 57 percent contained only local samples. A wide variety of instructional procedures have been employed. A number of studies have directly involved participants in planning menus and preparing and tasting foods. Studies have lasted from a few minutes to several months. A variety of measures of dietary intake have been used. Participants have varied widely as to sex, economic status, age, and cultural background. The findings of this meta-analysis. therefore, have wide generalizability. Unfortunately, 81 percent of the findings are from studies that used more than one educational method, creating interactions among the instructional strategies that make it difficult, if not impossible, to determine the relative effectiveness of each. The percents for the occurrence of each instructional strategy in the studies is shown in Table 8. This indicates the popularity of using the more traditional methods of lecture and the reading of written materials. It also shows the extent of use of multiple strategies in the nutrition education settings studied. JOURNAL OF NUTRITION EDUCATION 819

4

Nutrition Education's Future

The nutrition education studies included in the metaanalysis discussed in Chapter 3 were conducted in a wide range of settings by investigators with markedly different orientations using participants of different ages and backgrounds working on a wide variety of learning tasks. Therefore, the findings based on the three methods of meta-analysis probably have considerable generalizability to all nutrition education programs. If there has been any doubt as to the efficacy of nutrition education, the results of this meta-analysis should set that doubt aside. In addition, the results have important implications for the direction and focus of future nutrition education research. The practice of nutrition education. especially as reflected in the design of curriculum materials and the selection of teaching strategies. should also be positively influenced by this study. There are three basic findings coming from the metaanalyses that have significant impact for the future. The first is that nutrition education results in a marked increase in knowledge about nutrition. Twenty-two percent of the findings reported in the meta-analyses are measurements of participants' nutrition knowledge. Taken as a whole. the efforts of nutrition education programs to promote increased knowledge about good nutrition have been very successful. This is true for all age groups (the largest gains are found in college students), for both males and females, for all socioeconomic classes, for all decades, and for all settings. The second general conclusion is that nutrition education results in some increase in positiveness of attitudes toward eating nutritiously. Eleven percent of the total findings included in this review are measurements of attitudes. The results are valid for all age groups (although the attitudes of primary school participants are easier to influence than are the attitudes of older participants), for both males and females, regardless of the instructional strategies used, for all socio-economic classes, for unpublished as well as published studies, and for all decades. The third general conclusion is that nutrition education results in constructive changes in participants' patterns of food consumption. Sixty-seven percent of the findings reported in this review focused on actual consumption of nutritious foods. These results are valid for all age levels, for both males and females, for all szo JOURNAL OF NUTRITION EDUCATION

socio-economic levels, regardless of the instructional procedures used, and for unpublished as well as published articles (results being somewhat stronger for journal articles and technicai re-ports). The results are especially strong for positive changes in the consumption of fluid milk, of dairy products as a whole, of meat and fruits, and of the nutrients protein, fat, calcium, thiamin. riboflavin, and niacin. The results of the meta-analyses, therefore. provide strong evidence that nutrition education is effective in promoting informed consumers who value good nutrition and consume nutritious foods. The findings have been basically consistent throughout 74 years of research. They should provide considerable encouragement to nutrition educators on the efficacy of nutrition education. NEED FOR THEORETICAL MODELS A shortcoming of the research on nutrition education is the failure to base the research on theoretical models. Most of the studies included in this review did not have a clear theoretical base from which to determine the variables that explain how nutrition education programs positively affect nutrition knowledge, attitudes. and behavior. Possible mediating variables, therefore, were not directly studied or measured in most of the studies on nutrition education. The short-term and long-term goals of nutrition education may be most effectively achieved through employing instructional strategies that operationalize factors which social-psychological and educational research have found to influence knowledge acquisition, attitude modification, and behavior change (this process was discussed in Chapter 1 and illustrated in Figure 1). However, very few of these instructional methods and social context and interpersonal interaction factors have been systematically studied by nutrition education researchers to determine their relationship to goal attainment. When nutrition education programs are systematically designed and implemented to test instructional strategies that appear to best operationalize factors essential to influencing specific short- and long-term goals, even stronger effects for knowledge, attitude, and behavior may be found. A strong coordinated, research focus in nutrition education is needed to provide the data base for the design of these education programs if the field is to advance and mature. VOLUME 17 NUMBER 2 SUPPLEMENT

1985

RELATIONSHIPS AMONG KNOWLEDGE, ATTITUDES, AND BEHAVIOR There has been mixed evidence as to whether knowledge, attitudes, and behavior are related. The relationship among the three variables is considered to be complex and incompletely understood. Within the research in nutrition education, there were a number of studies that measured two or more of the three variables and, therefore, it was possible to compute Pearson correlations among them. The results indicate statistically significant relationships between nutrition knowledge and behavior and between nutrition attitudes and behavior. These findings will be of interest to social psychologists interested in attitude modification and change.

INSTRUCTIONAL METHODS Due to the confounding interactions created among the various instructional methods employed within 81 percent of the findings, it is impossible to determine from the meta-analyses which instruclional method is the most effective in influencing nutrition knowledge, attitudes, and behavior. Each method has its advocates, although methods such as lecturing and the use of textbooks and individual worksheets are not generally aimed at impacting attitudes and behavior. A most important area for future research is to determine the relative efficacy of each of the variety of instructional methods appropriate for nutrition education.

FUTURE DIRECTIONS FOR EDUCATIONAL PRACTICE In 1978 the National Assessment of Educational Progress published a report of their study of health awareness in two national samples-17 year olds attending school and 26-35 year olds. Approximately 1300 respondents were sampled for each question at each age level. The 200 questions dealt with accident prevention and good health practices. Respondents were stratified by sex, ethnic membership, socio-economic class, size of community, region of U.S., and healthrelated job experience and education. They found that the adult scored much higher on the health-related questions than did the 17 year olds. They thus concluded that much health- and nutrition-related information is learned after graduation from high school. As an example of their findings, 81 percent of the adults recognized water as more critical than carbohydrates, protein, or fat for survival, but only 64 percent of the 17 year olds did so. They also found that the greater one's education VOLUME 17 NUMBER 2 SUPPLEMENT

1985

and the higher one's income, the greater one's nutrition knowledge. Some of the major conclusions derived from the survey's results were: 1. A large part of nutrition and health education is not presently occurring in the schools. 2. Nutrition and health education should focus more on changing behavior and less on informing. 3. Peer influence is a key variable in changing behavior. 4. Nutrition and health education reflect too much fact-giving and not enough experiential learning. 5. Nutrition and health education programs rarely exist in a planned, organized, and sequential way. In short, the results of this assessment suggest that regardless of how effective nutrition education programs could be, at present they are not as effective as they could be in reaching most school-age children and adolescents. Yet there is every reason to be optimistic about the potential for greater effectiveness of nutrition education programs, for school-age children especially. The data clearly indicate that nutrition education programs can and do impact knowledge, attitudes, and behavior. What is now needed is a long-term, large-scale implementation effort to increase the emphasis on nutrition education in the schools, the workplace, in hospitals, and in other relevant settings. The basic directions for work in nutrition education programming are to: 1. Specifically design nutrition education programs that are based on validated theoretical models and are aimed at achieving the field's short-term and long-term goals. 2. Utilize instructional strategies that have proven effective in general educational research in promoting the achievement of the field's goals. 3. Continually develop, refine, and improve the curriculum materials already available. 4. Broaden the implementation of nutrition education so that it occurs throughout the year in every classroom in every school so that the amount of time spent teaching good nutrition is increased. 5. Utilize the existing knowledge base developed through research on successful innovation in education to improve the implementation of nutrition education programs. 6. Implement nutrition education programs in organizational settings where older adult populations can be found who often do not eat nutritious foods. 7. Develop nutrition education programs in family, community, and leisure-time settings that support, supplement, and extend the nutrition education programs now in existence. Based on the existing theoretical models and the future validation of such models, nutrition education programs should be specifically designed to achieve the JOURNAL OF NUTRITION EDUCATION 521

discipline's short-term and long-term goals. Curriculum designs should focus on incorporating: 1. Instructional strategies that operationalize the

factors essential to acquiring knowledge, modifying attitudes, and promoting behavioral change. 2. State-of-the-art curriculum materials. 3. Increased instructional time. 4. Delivery in diverse settings.

Instructional Strategies

Nutrition education is qualitatively different from mathematics, reading, and most other school subjects. Nutrition education is aimed at impacting attitudes and behavior as well as knowledge and, therefore, the instructional strategies used may need to be considerably more sophisticated. Thus, to implement effective nutrition education programs a great deal of attention must be paid to building in the needed instructional strategies and to training teachers how to teach more effectively. A number of studies have demonstrated that throughout the United States teachers tend to lecture and give individual seat-work from 80 to 94 percent of the time (Johnson & Johnson, 1983). Small group methods are rarely used and, when they are, often are used poorly. As an illustration, science education research has repeatedly shown the importance of direct involvement procedures through inquiry/discovery procedures and classroom experiments. However, science is now almost entirely taught from textbooks. Any effort to implement more effective nutrition education, therefore, may have to include teacher training in methods of direct student involvement and cooperative learning. Building the use of cooperative learning groups into nutrition education classes ensures that students cognitively process the information being learned, implant it into their conceptual systems and memory, form positive attitudes toward the area being studied, publically commit themselves to learn about nutrition and eat nutritious foods, and hold each other accountable for fulfilling their commitments. Such collaborative discussions that lead to cognitive processing, public commitment and peer accountability are essential to successful nutrition education.

Curriculum Materials

There are few nutrition curriculum materials that have been evaluated and validated by research. The National Dairy Council has produced what is the only nationally learner-verified and validated curriculum for preschool, elementary, and secondary schools. Continued efforts in this direction are needed. S22 rOURNAL OF NUTRITION EDUCATION

Successful refinement and advancement of curriculum materials means anticipating where educational materials and technologies are moving and providing state-of-the-art materials adapted to the latest technology and research results. The computer is now becoming a factor in education, for example, and a combination of video-disk and computer may be increasingly used in the future. Information banks that students can access through a computer will soon be common. The field of nutrition education may wish to stay in the forefront of curriculum development and incorporate state-of-theart technology in order to influence more teachers to use the materials to incorporate nutrition education into their classrooms.

Teaching Time

In most settings, participants receive very little nutrition education compared to math, reading, social studies, science, technical skills, and other subject areas. The actual amount of time per year which individuals spend studying nutrition needs to be increased if the complex goals of nutrition education are to be attained. This may be achieved by integrating nutrition education into other subject areas, such as science and social studies, and by convincing local school boards and State Departments of Education to increase the emphasis on nutrition education within the school day.

Program Synergism

In most math and reading classes there may be distractions, interruptions, and even barriers to learning, but there is typically little or no opposition. There is general consensus that everyone should know how to read. This is not always the case, however, in nutrition education and this creates the distinct possibility that nutrition education programs will be opposed and obstructed. In order to maximize the impact of nutrition education programs, therefore, a configuration of programs needs to be developed and implemented simultaneously within the schools, family, church, youth groups, community, and work place. Any single nutrition education program needs to strengthen, support and complement the other nutrition education programs. The potency of anyone nutrition education program is directly enhanced by potency of other related experiences. Many of the individuals who most need to change their eating habits and make informed decisions as to which foods to consume are adults. They cannot be found in schools and colleges. Nutrition education programs need to be implemented in major business, corporation, and community settings. VOLUME 17 NUMBER 2 SUPPLEMENT

1985

Innovation

There has been considerable research on the procedures by which new programs are successfully implemented within elementary and secondary schools (Johnson, 1970, 1979). Teachers do not appear to learn how to implement programs from reading instructions or from participating in a short, introductory workshop. They learn how to implement new education programs such as nutrition by actually teaching the nutrition material in their classrooms and receiving ongoing encouragement and assistance from peers and resource· personnel. More specifically, based on the research conducted on the failures and successes of innovation in the 1950's, 1960's, and 1970's (Berman & McLaughlin, 1978; Lawrence, 1974; Little, 1981; Johnson, 1970, 1979; McLaughlin & March, 1978) the following conclusions can be applied to nutrition education: 1. From the beginning, the nutrition education programs to be implemented need to be carefully and clearly defined so that everyone involved understands the programs and shares the same definitions. 2. The training of teachers and other educators to deliver the nutrition education programs needs to focus on concrete strategies and specific skills: The translation from the theory to the practical strategies has to be clear. 3. Ongoing training needs to be provided when individual teachers want and need it. Workshops are not enough. Training needs to be extended throughout the school year, so that teachers can tryout the new strategies and ask for the kind of assistance they need when they need it. Local resource personnel who can provide "on-call" advice when it is needed are essential. 4. the training needs to"emphasize demonstrations, "hands-on" trying out of the materials and strategies, and feedback about how well the teachers being trained are implementing the nutrition education program. Observation of successful implementation (demonstration) in other classrooms or schools is important because it creates a situation in which teachers can receive advice and encouragement from peers who have had a successful teaching experience in nutrition education. Teachers' attitudes toward. and commitment to. nutrition education are affected primarily by classroom assistance by peers or resource personnel. Formative evaluation, including a monitoring procedure to determine how well nutrition education programs are being implemented is necessary so that adjustments can be identified and made. 5. Regular project or team meetings where teachers can discuss and work out problems with implementation are essential. The meetings need to provide peer, administrative, and project staff support and be focused on having teachers work together to solve immediate problems. 6. Adaptation of curriculum materials and the development of local curriculum materials is desirable. VOLUME 17 NUMBER 2 SUPPLEMENT 1985

The training needs to allow teachers the freedom to adapt the innovation to their own subject areas, teaching styles. curriculum materials, circumstances, and students. 7. Implementing nutrition education programs within schools depends on creating a support system among the teachers being trained. It is the teachers who teach each other how to implement nutrition education and sustain each other's interest in doing so. Ideally, teachers will be trained in school building teams. With the support system (team) clear cooperative interdependence must be structured. There must be frequent, continuous. increasingly concrete and precise talk about how to implement nutrition education. Teachers must frequently observe each other teaching nutrition education and provide each other with useful feedback. And teachers must frequently plan. design, prepare, and evaluate nutrition education materials and lessons together. 8. Participation of school principals is vital. Principals need to gain the knowledge that will enable them to help teachers with program objectives and to show teachers that their efforts are supported. 9. The time perspective for the implementation process to take place needs to be realistic. Adoption of a new teaching practice by a teacher may require substantial shifts in habits and routines. These shifts take time. When teachers are expected to learn to do too many new things in too short a time, they tend to feel overwhelmed and unable to cope. The nutrition education program then induces helplessness and "role overload" rather than a sense of increased competence. Major changes in teaching procedures usually take years to implement. 10. Innovations spread through opinion leaders who serve as translators and demonstrators to other teachers. Opinion leaders should be recruited and trained and then involved in training other teachers within their buildings and districts. 11. Innovations should be initiated at several places and on several levels at the same time. A coordinated initiation of nutrition education needs to be conducted at several places simultaneously within the curriculum and school day.

FUTURE DIRECTIONS FOR RESEARCH There is considerable research indicating that nutrition education is effective in promoting informed consumers who value good nutrition and consume nutritious food. The meta-analyses reported here should move nutrition education researchers away from basic concerns about the effectiveness of nutrition education toward systematic study of the variables that may moderate or mediate the relationships between nutrition JOURNAL OF NUTRITION EDUCATION S23

education and increased nutrition knowledge, positive attitudes toward nutrition. and actual consumption of nutritious foods. A long-term large-scale program of field experiments is needed to illuminate the conditions under which nutrition education programs will have maximum impact on knowledge. attitudes. and behavior. The first step in a future program of nutrition education research is to develop a generic theory as to how nutrition education programs should be designed and implemented. An example of such a theory is discussed in Chapter 1. It provides a general conceptualization of short-term and long-term goals of nutrition education and instructional strategies needed to operationalize variables most likely to impact knowledge. attitudes. and behavior. The second step is to validate the theory through a series of experimental studies in field settings. The third step is to specifically design nutrition education programs to operationalize the variables that

S24 JOURNAL OF NUTRITION EDUCATION

the research has shown to have the greatest potential for maximizing the effectiveness of nutrition education programs. Finally. the fourth step is to conduct largerscale field evaluations of the nutrition education programs to verify that in actuality the programs built on the validated theory do work. More studies to determine in general whether nutrition education has an effect are not needed. That question has been answered in the existing literature as documented in these meta-analyses of that literature. What is needed is a systematic program of highquality research to validate a theoretical model that can be operationalized into actual nutrition education programs. In this way the potential for nutrition education to develop conceptual frameworks for knowledge. enduring positive attitudes and nutritious food choice behaviors has the potential for being even more effectively achieved in the future.

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REFERENCES Ajzen, I., & Fishbein, M. (1977). Attitude-behavior relations: A theoretical analysis and review of empirical research. Psychological Bulletin, 84, 888. Allen, V. (1976). Children as teachers: Theory and research on tutoring. New York: Academic Press. Andrews, K., & Kandel, D. (1979). Attitude and behavior: A specification of the contingent consistency hypothesis. American Sociological Review, 44, 298. Annis, l. (1983). The processes and effects of peer tutoring. Human Learning, 2, 39-47. Aronson, E. (1978). The theory of cognitive dissonance: A current perspective. In l. Berkowitz (Ed.), Cognitive theories in social psychology. New York: Academic Press. Aronson, E. (1980). The social animal (3rd Ed.). San Francisco, CA: Freedman. Aronson, E., & O'leary, M. (1982-83). The relative effectiveness of models and prompts on energy conservation: A field experiment in a shower room. Journal of Environmental Systems, 12, 219-224. Baker, l. (1979). Comprehension monitoring: Identifying and coping with text confusions. (Technical Report NO. 145). Urbana, Il: Center for the Study of Reading, University of Illinois. Becker, M., Haefner, D., Maiman, l., Kirsht, J., & Drachman, R. (1977). The health belief model and prediction of dietary compliance: A field experiment. Journal 'of Health and Social Behavior, 18, 348. Benware, C. (1975). Quantitative and qualitative learning differences as a function of learning in order to teach another. Unpublished manuscript, University of Rochester. (As cited in E.l. Deci's Intrinsic motivation. New York: Plenum Press). Bettman, J., & Kakkar, P. (1977). Effects of information presentation format on consumer information acquisition strategies. Journal of Consumer Research, 3, 233-240. Bickman, l. (1972). Environmental attitudes and actions. Journal of Social Psychology, 87, 323-324. Borgida, E., & Nisbett, R. (1977). The differential impact of abstract vs. concrete information decision. Journal of Applied Social Psychology, 7, 258-271. Bosley, B. (1947). A practical approach to nutrition education for children. Journal of the American Dietetic Association, 35, 797-801. Cialdini, R., Petty, R., & Cacioppo, J. (1981). Attitude and attitude change. Annual Review of Psychology, 32, 357. Cook, T., & Flay, B. (1978). The temporal persistence of experimentally induced attitude change: An evaluative review. In l. Berkowitz (Ed.), Advances in experimental social psychology (Vol. II). New York: Academic Press. Cooper D., & Go, C. (1976). Analysis of nutrition curriculum guides. Journal of Nutrition Education, 8, 62-66. Cooper, H. (1979). Statistically combining independent studies: A meta-analysis of sex differences in conformity research. Journal of Personality and Social Psychology, 37, 131-146. Dabbs, J. (1964). Self-esteem, communicator characteristics and attitude change. Journal of Abnormal and Social Psychology, 69, 173. Davidson, A., & Jaccard, J. (1979). Variables that moderate the attitude-behavior relation: Results of a longitudinal survey. Journal of Personality and Social Psychology, 37, 1364. Eikenberry, D. (1923). Permanence of high school learning. Journal of Educational Psychology, 14, 463-482. Evans, R., & Hall, Y. (1978). Social-psychologic perspective in

VOLUME 17 NUMBER 2 SUPPLEMENT 1985

motivating changes in eating behavior. Journal of the American Dietetic Association, 72. 378. Fishbein, M., & Ajzen, I. (1972). Attitudes and opinions. Annual Review of Psychology, 23, 487. Fishbein, M., & Ajzen, I. (1981). Acceptance, yielding, and impact: Cognitive processes in persuasion. In R. Petty, T. Ostrom, & T. Brock (Eds.), Cognitive responses in persuasion. Hillsdale, New Jersey: lawrence Erlbaum Associates. Publishers. Fisher, R. (1969). An each-one-teach-one approach to music notation. Grade Teacher, 86, 120. Frutchey, F. (1937). Retention in high school chemistry. Journal of Higher Education. 8, 217-218. Gabrenya, W., & Arkin, R. (1979). The effect of commitment on expectancy value and expectancy weight in social decision making. Personality and Social Psychology Blllletin, 5. 86. Gartner, A., Kohler, M., & Reissman, F. (1971). Children teach children: Learning by teaching. New York: Harper & Row. Glass, G. (1977). Integrating findings: The meta-analysis of research. In l. Schulman (Ed.), Review of research in education. Itasca, Il: Peacock. Goldman, S. (1940). Personal manuscript. These papers are now part of the Smithsonian Collection and are quoted by C. Simons in "Supermarkets: How they grew," The Smithsonian, 1980, 112. Gollob, H., & Dittes, J. (1965). Effects of manipulated seffesteem on persuasibility depending on threat and complexity of communication. Journal of Personality and Social Psychology, 2, 290. Gussow, J., & Contento, I. (1984). Nutrition education in a changing world. World Review of Nutrition and Dietetics, 44,1-56. Halverson, R., & Pallak, M. (1978). Commitment, ego-involvement, and resistance to attack. Journal of Experimental Social Psychology, 14. 1-12. Hamill, R., Wilson, T., & Nisbett, R. (1980). Insensitivity to sample bias: Generalizing from a typical case. Journal of Personality and Social Psychology, 39, 578-589. Hewgill, M., & Miller, C. (1965). Source credibility and response to fear arousing communications. Speech Monographs, 32. 95. Higbee, K. (1969). Fitteen years of fear-arousal: Research on threat appeals: 1953-1968. Psychological Bulletin, 72, 426. Hogarth, R. (Ed.). (1981). Question framing and response consistency. San Francisco: Jossey-Bass. Hom, P., Katerberg, R., & Hulin, C. (1978). Comparative examination of three approaches to the prediction of turnover. Journal of Applied Psychology, 64. 280. Hyman, H., & Wright, C. (1979). Education's lasting influences on values. Chicago: Universitv of Chicago Press. Hyman, H., Wright; c., Reed, J. (1975). The enduring effects of education. Chicago: University of Chicago Press. Insko, c., & Schopler, J. (1967). TriadiC consistency: A statement of affective-cognitive-connotative consistency. Psychological Review, 74. 361-376. Jaccard, J., King, G., & Pomazal, R. (1977). Attitudes and behavior: An analysis of specificity of attitudinal predictors. Human Relations, 30, 817. Jacoby, J., Chestnut, R., & Silberman, W. (1977). Consumer use and comprehension of nutrition information. Journal of Consumer Research, 4, 119-124. Janis, I., & Feshbach, S. (1953). Effects of fear-arousing

JOURNAL OF NUTRITION EDUCATION S25

communications. journal of Abnormal and Social Psychology, 48, 78. Johnson, D.W. (1979). Educational psychology. Englewood Cliffs, New Jersey: Prentice-Hall. Johnson, D. W. (1981). Student-student interaction: The neglected variable in education. Educational Research, 10, 5-10. Johnson, D. W., & Johnson, F. (1982). joining together: Group theory and group skiffs (2nd Ed.). Englewood Cliffs, New Jersey: Prentice-Hall. Johnson, D.W., & Johnson, R. (1975). Learning together and alone: Cooperation, competition and individualization. Englewood Cliffs, New Jersey: Prentice-Hall. Johnson, D.W., & Johnson, R. (1979). Conflict in the classroom: Controversy and learning. Review of Education Research, 49, 51-70. Johnson, D.W., & Johnson, R. (1982). Effects of cooperative and individualistic instruction on handicapped and nonhandicapped students. journal of Social Psychology, 118, 257-268. Johnson, D.W., Johnson, R. (1983). The socialization and achievement crisis: Are cooperative learning experiences the solution? In l. Bickman (Ed.), Applied Social Psychology Annual 4. Beverly Hills, CA: Sage Publications. Johnson, D.W. Johnson, R., Holubec, E., & Roy, R. (1984). Circfes of learning: cooperation in the cfassroom. Alexandria, VA: Association for Supervision and Curriculum Development. Johnson, D.W., Johnson, R., & Maruyama, G. (1983). Interdependence and interpersonal attraction among heterogeneous and homogeneous individuals: A theoretical formulation and a meta-analysis of the research. Review of Educational Research, 53, 5-54. Johnson, D.W., Maruyama, G., Johnson, R., Nelson, D., & Skon, l. (1981). Effects of cooperative, competitive, and individualistic goal structures on achievement: A metaanalysis. Psychological Buffetin, 89, 47-62. Johnson, R., & Johnson, D.W. (Eds.). (1984). Structuring cooperative learning: Lesson plans for teache-rs. Minneapolis, MN: Interaction Book Company. Kahle, l., & Berman, J. (1979). Attitudes cause behavior: A cross-lagged panel analysis. journal of Personality and Social Psychology, 37, 315. Kahneman, D., & Tversky, A. (1979). Prospect theory: An analysis of decision under risk. Econometrica, 47, 263-291. Katz, E., & Lazarsfeld, P. (1955). Personal influence: The part played by people in the ffow of mass communications. Glencoe, IL: Free Press. Kempton, W., Gladhart, P., & Keefe, D. (1983). Home insulation: The user's view. In S. Goran, D. Greason, & J. McAllister (Eds.), Thermal insulation, materials and systems for energy conservation in the 1980's. Philadelphia: American Society for Testing and Materials. Kempton, W., & Montgomery, l. (1982). Folk quantification of energy. Energy, 7, 817-827. Kiesler, C. (1971). The psychology of commitment: Experiments linking behavior to belief. New York: Academic Press. Kilty, K. (1978). Attitudinal and normative variables as predictors of drinking behavior. journal of Studies on Alcohol, 39, 1178. Leventhal, H., Jones, S., & Trembly, G. (1966). Sex differences in attitude and behavior change under conditions of fear and specific instructions. journal of Experimental Social Psychology, 32, 459. Leventhal, H., & Niles, P. (1965). Persistence of influence for varying durations of exposure to threat stimuli. Psychological Reports, 16, 223.

S26 JOURNAL OF NUTRITION EDUCATION

Leventhal, H., & Perloe, S. (1962). A relationship between selfesteem and persuasibility. journal of Abnormal and Social Psychology, 64, 385. Leventhal, H., & Watts, J. Sources of resistance to feararousing communications on smoking and lung cancer. journal of Personality, 36, 155. Leventhal, H., Watts, J., & Pagano, F. (1967). Effects offear and instructions on how to cope with danger. journal of Personality and Social Psychology, 6, 313. Levy, S., Iverson, B., & Walberg, H. (1980). Nutritioneducation research: An interdisciplinary evaluation and review. Health Education Quarterly, 7(2), 107-126. Lewin, K. (1943). Forces behind food habits and methods of change. In The problem of changing food habits. (NRC Bulletin No. 108). Washington, D.C.: National Research Council; Committee on Food Habits. Liska, A.(Ed.). (1975). The consistency controversy: Readings on the impact of attitude on behavior. New York: John Wiley. Looker, A. (1983). A comparison of two persuasive strategies in changing the nutrition knowledge, attitudes, and behavior of adults. University Microfilms No. 83-12,649. Markman, E. (1979). Realizing that you don't understand: Elementary school children's awareness of inconsistencies. Child Development, 50, 643-655. McDougall, G., Claxton, J., Ritchie, J., & Anderson, C. (1981). Consumer energy research: A review. journal of Consumer Research, 8, 343-354. McKenzie, J., & Mumford, P. (1965). The evaluation of nutrition education programmes: A review of the present situation. World Review of Nutrition and Dietetics, 17, 91-149. Murray, F. (1983). Cognitive benefits of teaching on the teacher. Paper presented at American Education Research Association Annual Meeting, Montreal, Quebec. Nel, E., Helmreich, R., & Aronson, E. (1969) Opinion change in the advocate as a function of the persuasibility of his audience: A clarification of the meaning of dissonance. journal of Personality and Social Psychology, 12, 117-124. Nisbett, R., Borgida, E., Crandall, R., & Reed, H. (1976). Popular induction: Information is not always informative. In J. Carrol & J. Payne (Eds.), Cognition and social behavior. Hillsdale, NJ: Earlbaum. Nisbett, R., & Ross, l. (1980). Human inference: Strategies and shortcomings of social judgment. Englewood Cliffs, NJ: Prentice-Hall. Pallak, M., Mueller, M., Dollar, K., & Pallak, J. (1972). The effects of commitment on responsiveness to an extreme consonant communication. journal of Personality and Social Psychology, 23, 429-436. Pallak, M., Sogin, S., & VanZante, A. (1979). Bad decision: The effect of volunteering, locus of causality, and negative consequences on attitude change. journal of Personality and Social Psychology, 30, 217-227. Paul, B. (Ed.). (1955). Health, culture and community. New York: Russell Sage Foundation. Petty, R. (1977). A cognitive response analysis of the temporal persistence of attitude changes induced by persuasive communications. Unpublished doctoral dissertation, Ohio State University, Columbus. Pryor, J., Gibbons, F., Wicklund, R., Fazio, R., & Hood, R. (1977). Self-focused attention and self-report validation. journal of Personality, 45, 513. Pye, O. (1976). Retrospects and prospects in nutrition education. joumal of Nutrition Education, 8(4), 154-155. Radke, M., & Caso, E. (1948). Lecture and discussion-decision as methods of influencing food habits. journal of the American Dietetic Association, 24, 23-41.

VOLUME 17 NUMBER 2 SUPPLEMENT 1985

Radke, M., & Klisurich, D. (1947). Experiments in changing food habits. In K. lewin, (Ed.), Croup decision and social change; in Readings in social psychology. New York: Henry Holt and Company. Regan, D., & Fazio, R. (1977). On the consistency between attitudes and behavior: look to the method of attitude formation. Journal of Experimental Social Psychology, 13, 28. Ritchie, J. McDougall, C., & Claxton, J. (1981). Complexities to household energy consumption and conservation. Journal of Consumer Research, 8, 233-242. Rogers, R., Deckner, c., & Mewborn, C. (1978). An expectancy value theory approach to the long-term modification of smoking behavior. Journal of Clinical Psychology, 34, 562 Rogers, E., & Shoemaker, F. (1977). Communication of innovations: A cross-cultural approach. New York: Free Press. Rosenthal, R., Combining results of independent studies. Psychological Bulletin, 85, 185-193. (1978). Sarbin, T. (1976). Cross-age tutoring and social identity. In V. Allen (ed.), Children as teachers: Theory and research on tutoring. New York: Academic Press. Schallert, D., & Kleiman, C. (1979). Some reasons why the teacher is easier to understand than the textbook. (Reading Education Report No.9). Urbana: University of Illinois, Center for the Study of Reading. (ERIC DOCument Reproduction Service No. ED 172 189). Schwartz, S. (1978). Temporal instability as a moderator of the attitude-behavior relationship. Journal of Personality and Social Psychology, 36, 715. Siegel, l., & Siegel, l.c. (1967). A multivariate paradigm for educaton research. Psychological Bulletin, 68, 306. Stouffer, S. (1949). The American soldier; Vol. I.: Adjustment during army life. Princeton, NJ: Princeton University Press. Sullivan, J., & Pallak, M. (1976). The effect of commitment and reactance on action-taking. Personality and Social Psychology Bulletin, 2, 179-182. Swanson, J. (1972). Second thoughts on knowledge and attitude effects upon behavior. Journal of School Health, 42(6), 363-365.

VOLUME 17 NUMBER 2 SUPPLEMENT 1985

Swope, M. (1962). A review of nutrition education research. In Nutrition education research project (mimeographed). New York: Columbia University, Teacher's College. Tversky, A., & Kahneman, D. (1974). Judgment under uncertainty: Heuristics and biases. Science, 185, 1124-1131. Tyler, R. (1930). What high school pupils forget. Educational Research Bulletin, 9, 490-497. Tyler, R. (1934). Some findings from studies in the field of college biology. Science Education, 18, 133-142. Van Den Heuvel, K. (1982). Teaching strategies in preschool nutrition education. M.S. thesis, The Pennsylvania State University, University Park. Wallen, N., & Travers. R. (1963). Analysis and investigation of teaching methods. In N. Gage (Ed.), Handbook of research on teaching. Chicago: Rand McNally. Ward, A., & Davis, R. (1938). Individual differences in retention of general science subject matter in the case of three measurable objectives. Journal of Experimental Education, 7, 116-125. Watson, G., & Johnson, D.W. (1972). Social psychology: Issues and insights, 2nd ed. Philadelphia: lippincott. Whitehead, F. (1973). Nutrition education research. World Review of Nutrition and Dietetics, 17, 91-149. Wicker, A. (1969). Attitudes versus action: The relationship of verbal and overt behavioral responses to attitude objects. Journal of Social Issues, 25, 41. Wicklund, R., & Brehm, J. (1976). Perspective on cognitive dissonance. Hillsdale, NJ: Erlbaum. Yager, S., Johnson, D. W. & Johnson, R. (1984). Oral discussion, group-to-individual transfer and achievement in cooperative learning groups. Manuscript submitted for publication. Yates, S. (1982). Using prospect theory to create persuasive communications about solar water heaters and insulation. Unpublished doctoral dissertation, University of California at Santa Cruz. Zeitlin, M., & Formacion, C. (1981). Nutrition intervention in developing countries, Study 1/. Nutrition Education. Cambridge, MA: Oelgeschlager, Cunn & Hain.

rOURNAL OF NUTRITION EDUCATION S27

APPENDIX A Articles Included in the Meta-Analysis Adamec, C. (1972). Survey of nutrition knowledge as a part of nutrition education. Journal of Nutrition Education, 4, 108-110. Alford, B., & Tibbets, M. (1971). Education increases consumption of vegetables by children. Journal of Nutrition Education, 3(1), 12-14. Alley, R., Narduzzi, J., Robbins, T., Weir, T., Sabeh, G., & Danowski, T. (1968). Measuring success in the reduction of obesity in childhood. Clinical Pediatrics, 7(2),112-118. Amstutz, M., & Dixon, D. (1981). The impact of the expanded food and nutrition education program on the diets of enrolled homemakers. College Park: University of Maryland, Cooperative Extension Service. Anderson, J. (1983). EFNEP evaluation in Colorado. Report to the Department of Food Science and Nutrition. Fort Collins: Colorado State University. Anderson, J., & Brown, G. (1983). The Healthy Heart Program at Colorado State University: A nutrition education program for change. Fort Collins: Colorado State University. Argeanas, S., Harrill, I. (1979). Nutrient intake of lactating women participating in the Colorado WIC program. Nutrition Reports Internationat 20(6), 805-810. Axelson, J., & DelCampo, D. (1978). Improving the teenagers' nutrition knowledge through the mass media. Journal of Nutrition Education, 10, 30-33. Bailey, L., O'Farrell-Ray, B., Mahan, c., & Dimperio, D. (1983). Vitamin B6, iron and folacin status of pregnant women. Nutrition Research, 3, 783-793. Baker, M. (1972). Influence of nutrition education on fourth and fifth graders. Journal of Nutrition Education, 4, 55-58. Baltimore, B. (1960). A school-wide experiment in nutrition education. Journal of the American Dietetic Association, 37,44-47. Banta, T., Cunningham, J., & Jozwiak, W. (1982). Evaluation of the implementation grant project of Tennessee's nutrition education and training program. Knoxville: University of Tennessee, Bureau of Educational Research & Service. Bell, c., & Lamb, M. (1973). Nutrition education and dietary behavior of fifth graders. Journal of Nutrition Education, 3, 196-199. Bell, G. (1943). An exploration in evaluating instruction in the area of nutrition with a selected group of home economics students. Unpublished master's thesis, University of Tennessee, Knoxville. Benson, M. (1943). An experimental study to determine the effectiveness of nutrition education in changing the food habits of rural children. Unpublished master's thesis, University of Minnesota, Minneapolis. Benson, M. (1944). A study of methods of changing food habits of rural children in Dakota County, Minnesota. Nutrition Education Series, Pamphlet No.5, 1-19. Beougher, J. (1979). The cognitive effects of a health education program on nutrition for selected primary grades. Unpublished doctoral dissertation, Ohio State University, Columbus. Blakeway, S. (1977). Journey through foodfand: One district's nutrition project. School Foodservice Journal, 31(7), 110-113. Blakeway, S., & Knickrehm, M. (1978). Nutrition education in the Little Rock school lunch program. Journal of the American Dietetic Association, 72, 389-391. Boone, E., & White, E. (1976). The effect of extension services youth nutrition lesson series on behavioral change S28 JOURNAL OF NUTRITION EDUCATION

in EFNEP youth, utilizing different education environments and teachers. Published by North Carolina Agricultural

Extension Service. Botvin, G., Cantlon, A., Carter, B., & Williams, C. (1979). Reducing adolescent obesity through a school health program. The Journal of Pediatrics, 95(6), 1060-1062. Bovee, D., & Downes, J. (1941). The influences of nutrition education in families of the Mulberry area in New York City. - the Milbank Memorial Fund- Quarterly, 19, 121-146. Bowering, J., Morrison, M., Lowenberg, R., & Tirado, N. (1976). Role of EFNEP aids in improving diets of pregnant women. Journal of Nutrition Education, 8(3),111-117. Bowering, J., Morrison, M., Lowenberg, R., & Tirado, N. (1977). Evaluating 24-hour dietary recalls. Journal of Nutrition Education, 9(1), 20-25. Bowser, L., Trulson, M., Bowling, R., & Stare, F. (1953). Methods of reducing. Journal of the American Dietetic Association. 53, 1193-1196. Boysen, S., & Ahrens, R. (1972). Nutrition instruction and lunch. surveys with second graders. Journal of Nutrition Education, 4(4), 172-175. Brent, C. (1974). TV commercials can teach nutrition. Journal of Home Economics, March, 21-23. Brown, A., & Pestle, R. (1981). Dietary intake and food behavior practices: Long-term effects of the Georgia expanded food and nutrition program. Home Economics Research Journal, 10(1), 62-68. Brown, G., Wyse, B., & Hansen, R. (1979). A nutrient densitynutrition education program for elementary schools. Journal of Nutrition Education, 11, 31-36. Brown, L. (1982). A comparison of two nutrition education curricula for seventh grade health students. Ph.D. disserta. tion, Brigham Young University, Provo. Brownell, K., & Kaye, F. (1982). A school-based behavior modication, nutrition education, and physical activity program for obese children. The American Journal of Clinical Nutrition, 35, 277-283. Brun, J. (1980). Food . .. Early Choices: A nutrition learning system for early childhood. Summative Evaluation, National Dairy Council, Rosemont, IL. Buford, L. (1975). Classes for mentally handicapped children. American Journal of Nursing, 75(11), 1994-1995. Burks, A., Olsen, L., & Redican, K. (1982). Analysis of the long range effects of the school health curriculum project: Grade 5. Health Values: Achieving High Level WeI/ness, 6(4), 26-32. Byrd-Bredbenner, C. (1980). The interrelationships of nutrition knowledge, attitudes toward nutrition, dietary behavior, and commitment to the concern for nutrition.

Ph.D. dissertation, Pennsylvania State University, University Park. Byrd-Bredbenner, c., O'Connell, L., & Shannon, B. (1982). Junior high home economics curriculum: Its effects on student's knowledge, attitude, and behavior. Home Economics Research Journal, 11(2),123-133. Byrne, J. (1980). Assessment of a cardiovascular education program. M.S. thesis, Pennsylvania State University, University Park. Capps, E. (1967). Some factors influencing food patterns of young college women. Ph.D. dissertation. Texas Woman's University, Denton. Cerqueira, M., Cassanueva, E., Ferrer, A., Fontanot, G., VOLUME 17 NUMBER 2 SUPPLEMENT

1985

Chavez, A., & Flores, R. (1979). A comparison of mass media techniques and a direct method for nutrition education in rural Mexico. journal of Nutrition Education, 11(2),133-137. Chapman,S., & Jeffrey, D. (1978). Situational management, standard setting and self-reward in a behavior modification weignt loss program. journal of Consulting and Clinical Psychology, 46(6), 1588-1589. Chase, H., larson, l., Massoth, D., Martin, D., & Niernberg, M. (1973). Effectiveness of nutrition aids in a migrant population. The American journal of Clinical Nutrition, 26, 849-857. Chicago Heart Association (1984). The Body Power Program: Foodwise Teacher's guide. Chicago, Il. Christakis, G., Sajecki, 5., Hillman, R., Miller, E., Blumenthal, 5., & Archer, M. (1966). Effects of a combined nutrition education and physical fitness program on the weight status of obese high school boys. Federal Proceedings, 25, 15-19. Clancy-Hepburn, K., Hickey, A., & Nevill, G. (1974). Children's behavior responses to TV food advertisements. journal of Nutrition Education, 6(3), 93-96. Cline, B. (1947). The development of units for teaching nutrition in the elementary grades. Unpublished master's thesis, Texas Technological College, lubbock. Coates, T., Jeffery, R., & Slinkard, l. (1981). Heart-healthy eating and exercise: Introducing and maintaining changes in health behaviors. American journal of Public Health, 71(1), 15-23. Coates, T., & Thoresen, C. (1981). Treating obesity in children and adolescents: Is there any hope? The Comprehensive Handbook of Behavioral Medicine, 2, 120-122 Cooke, T. (1977). Mass media and marketing approach to nutrition education. In Teaching nutrition in developing countries or The joys of eating dark green leaves. The Meals for Millions Foundation, Santa Monica, California, 75-86. Cosper,B., Hayslip, D., & Foree, S. (1977). The effect of nutrition education on dietary habits of fifth-graders. journal of School Health, 47, 475-477. Daelhousen, B., & Guthrie, H. (1982). A self-instruction nutrition program for pregnant women. journal of the American Dietetic Association, 81, 407-412. Dairy Council of California (1970). An analysis of the effect of the Dairy Council of California Education Program at the second grade level within selected school districts in the Los Angeles-Orange County Area. Sacramento: A Dairy Council of California Action Study. Dairy Council of Central States, Incorporated (1983). A threeweek nutrition education project: Is it effective? Ralston, Nebraska. Davis, D., & Rogers, T. (1982). Point-of-choice nutrition information for the modification of milk selection. journal of American College of Health, 30, 275-278. Desmond, A., & Baumgartner, l. (1944). Health education in nutrition: Adapting business promotion techniques to public health education. American journal of Public Health, 34, 967-973. Devadas, R., Sundari, K., Jayalakshmi, V., Mathews, l., Begum, R., Punithavathi, V., Usha, M., & Chandrasekhar, U. (1969). Impact of a nutrition education program conducted on the basis of findings of a diet and food consumption survey in a small village community in South India. journal of Nutrition and Dietetics, 6, 115-121. Dodds, J. (1978). Effect on food consumption of a nutrition message delivered by two methods. Columbia University, Teachers College, New York City. Domke, J., lando, H., & Robinson, D. (1981). A behavioral VOLUME 17 NUMBER 2 SUPPLEMENT

1985

weight control program for residence hall students. journal of Counseling Psychology, 28(4), 365-368. Downes, j. (1943). A study of food habits of tuberculous families in a Harlem area of New York City. The Milbank Memorial Fund Quarterly, 21(2), 164-181. Downes, J., & Baranovsky, A. (1945). An experiment in nutrition teaching by public health nurses. The Milbank Memorial Fund Quarterly, 23, 227-253. Drolet, J. (1982). Evaluation of the seaside health education conferences and nutrition education training programs in the Oregon school systems. ph.D. dissertation, University of Oregon, Eugene. Dunphy, M., & Bratton, B. (1980). Effective nutrition education program for medical students. journal of the American Dietetic Association, 76, 372-374. Eash, M., Talmage, H., Rasher,S., & Strachan, P. (1977). Report on the field tests of the National Dairy Council nutrition education K-2. Office of Evaluation Research. University of Illinois at Chicago Circle. Eash, M., Talmage, H., Rasher,S., & Strachan, P. (1977). Report on the field tests of the National Dairy Council nutrition education 5 and 6. Office of Evaluation Research. University of Illinois at Chicago Circle. Edozun, j., Switzer, B., & Bryan, R. (1979). Medical evaluation of the special supplemental food program for women, infants, and children. The American journal of Clinical Nutrition, 32, 677-692. Eichelberger, M. (1927). A study of the value of nutrition instruction in a school system. journal of Home Economics, june, 320-322. Ellis, R. (1944). The value of an educational program for changing food habits. Unpublished doctoral dissertation, New York University, New York City. Emerson, W. (1910). The hygienic and dietetic treatment of delicate children by the class method. Boston Medical and Surgical journal. 163(8), 326-327. Emerson, W. (1919). A nutrition clinic in a public school. American journal of Diseases of Children, 17, 251-263. Endres, J., Sawicki, M., & Casper, J. (1981). Dietary assessment of pregnant women in a supplemental food program. journal of the American Dietetic Association, 79, 121-126. Epstein, l., Masek, B., & Marshall, W. (1978). A nutritionally based school program for control of eating in obese children. Behavior Therapy, 9, 766-778. Epstein, l., & Wing, R. (1983). Reanalysis of weight changes in behavior modification and nutrition education for childhood obesity. journal of Pediatric Psychology, 8(1), 97-100. Epstein, l., Wing, R., Koeske, R., Andraski, F., & Ossip, D. (1981). Child and parent weight loss in family-based behavior modification programs. journal of Consulting and Clinical Psychology, 49(5),674-685. Epstein, l., Wing, R., Stranchak, l., Sickson, B., & Michelson, J. (1980). Comparison of family based behavior modification and nutrition education for childhood obesity. journal of Pediatric Psychology, 5(1), 25-36. Erickson, M., & Drake, D. (1977-1978). Multi-culture nutrition education program. South Bend, IN: South Bend Community Corporation. Ernst, N., & Frommer, P. (1983). Foods for health: Report of the pilot program. (National Institute of Health Publication No. 83-2036). U.S. Department of Health and Human Services. Farquhar, J., Wood, P., Maccoby, N., Alexander, J., Breitrose, H., Brown, B., Haskell, W., McAlister, A., Meyer, A., Nash, J., & Stern, M. (1977). Community education for cardiovascular health. The Lancet, 1,1192-1195. Feaster, J. (1972). Impact of the expanded food and nutrition education program on low-income families: An indepth JOURNAL OF NUTRITION EDUCATION S29

analysis (Agricultural Economic Report No. 220). Washing-

ton, DC: U.S. Department of Agriculture-Economic Research Service. Feldman, R. (1983). Communicating nutrition for high school students in Kenya. The Journal of School Health, 140-143. Fenton, F., largay, B., & Hyde, K. (1983). Prince George's public schools: Nutrition education within schools (NEWS).

Technical report, Prince George's County, Maryland. Fisk, D. (1979). A successful program for changing children's eating habits. Nutrition Today, 14, 6-33. Fitzgibbons, J., & Garcia, P. (1977). TV, PSAs, nutrition and the elderly. Journal of Nutrition Education, 9(3),114-118. Fortmann, S., Williams, P., Hulley, S., Haskell, W., & Farquhar, J. (1981). Effect of health education on dietary behavior: The Stanford three community study. The American Journal of Clinical Nutrition, 34, 2030-2038. French, A., Roesel, & Shieh, S. (1981). An assessment of the conduct of the expanded food and nutrition education program in selected sites. Washington, D.C: U.S. Depart-

c.,

ment of Agriculture, Science and Education Administration. Galst, J. (1980). Television food commercials and pronutritional public service announcements as determinants of young children's snack choices. Child Development, 51,

maintenance and changes in diet and exercise for behavioral counseling and nutrition education. Journal

of Counseling Psychology, 28(4), 295-304.

Gracianette, C. (1981). The application of behavioral techniques to change eating habits and/or exercise habits to effect weight reduction and maintenance in adolescents: A year-long study. Ph.D. dissertation, louisiana State University, Baton R:ouge. Grant, F. (1950). Effect on eating habits of nutrition education in the fifth grade. Journal of the American Dietetic Association, 26, 413-416.

Graves, K., Shannon, B., Sims, l., & Johnson, S. (1982). Nutrition knowledge and attitudes of elementary school students after receiving nutrition education. Journal of the American Dietetic Association, 8, 422-427.

Green, l., Wang, V., & Ephross, P. (1972). A three-year longitudinal study of the impact of nutrition aides on the knowledge, attitudes and practices of rural poor homemakers. Cooperative Extension Service, University of

Maryland, College Park. Greenberg, B., Harris, M., Mackinnon, C, & Chipman, S. (1953). A method for evaluating the effectiveness of health education literature. American Journal of Public Health, 43, 1147-1155.

Gassie, E., & Jones, J. (1972). Sustained behavioral change.

Greenberg, J. (1977). An analysis of various teaching modes in dental health education. Journal of School

Gelatko, K. (1980). Assessing the impact on achievement and attitudes of the fifth and sixth grade stl1dents in a selected

Greenburg, J., & Deputat, Z. (1978). Smoking intervention: Comparing three methods in a high school setting.

935-938.

Journal of Nutrition Education, Winter, 19-22.

unit in the Nutrition Education Program food. . . Your Choice, Doctoral dissertation, University of Pittsburgh,

Pittsburgh. : George, J. (1971). A nutrition education unit for a sixth grade.

Journal of Nutrition Education, Winter, 111-112. German, M., Pearce, J., Wyse, B., et al. (1980). Integrating nutrition into health education, Health Education, 11(5), 19-22. German, M., Pearce, J., Wyse, B., & Hansen, G. (1981). A

nutrition component for high school health education curriculums. Journal of School Health, 51, 149-153. Gillespie, A. (1978). Communication strategy to change nutritional practices. Unpublished doctoral dissertation, Iowa State University, Ames. Gillespie, A. (1981). Nutrition knowledge, attitudes and practices of elementary school children: Influences on them and programs to improve them. Final Report. Cornell University, Ithaca, New York. Gillespie, A. (1984). Evaluation of nutrition education and training mini-grant programs. Journal of Nutrition Education, 16(1), 8-12.

Gillespie, A., Yarbrough, J., & Roderuck, C. (1983). Nutrition communication program: A direct mail approach. Journal of the American Dietetic Association, 82(3), 254-259.

Glaser, A. (1964). Nursey school can influence food acceptance. Journal of Home Economics, 56(9), 680-683. Glogow, E. (1970). Effects of health education methods on appointment breaking. Public Health Report, 85(5), 441-450.

Gold, l. (1945). Changing student food habits through the school program. The Journal of School Health, 15,7-14. Goldberg, M., Gorn, G., & Gibson, W. (1978). TV messages for snack and breakfast foods: Do they influence children's preferences? Journal of Consumer Research, 5,73-81.

Gordon, H. (1982). An experimental study of the effects of training programs on children's eating behavior. Ph.D. dissertation, Fordham University, New York City. Cormally, J., & Rardin, D. (1981). Weight loss and

530 JOURNAL OF NUTRITION EDUCATION

Health, 47, 26-32.

Journal of School Health, 48, 498-502.

Gross, I., Wheeler, M., & Hess, K. (1976). The treatment of obesity in adolescents using behavioral self-control. Clinical Pediatrics, 15(10), 920-924.

Hagen, R. (1974). Group therapy versus bibliotherapy in weight reduction. Behavior Therapy, 5, 222-234. Harrill, I., Smith, C, & Gangever, J. (1972). Food acceptance and nutrient intake of preschool children. Journal of Nutrition Education, Summer, 103-106.

Hatcher, H. (1941). An experimental study to determine the relative effectiveness at the secondary level of two methods of instruction. Journal of Experimental Education, 10(1), 41-47.

Head, M. (1974). A nutrition education program at three grade levels. Journal of Nutrition Education, 6(2), 56-59. Heffernan, J., & Trahms, C. (1981). A model preschool for patients with phenylketonuria. Journal of the American Dietetic Association, 79, 306-308.

Heim, D., & Robinson, C (1983). Plate waste in a school lunch: Part of a three-week nutrition education program.

Technical Report. Dairy Council of Central States, Ralston, NE. Heim, D., & Robinson, C. (1983). The return of the Taste Buddies: A three-week nutrition education project. Technical Report. Dairy Council of Central States, Ralston, NE. Herzog, l., Stier, E., lachance, P., & Burkart, A. (1978). Evaluation of an informal nutrition education approach in a high school lunch program. School Foodservice Research Review, 2(2), 102-105.

Highberger, R., & Carothers, l. (1977). Modification of eating behavior of toddlers in a day care setting. Home Economics Research Journal, 6(1), 48-51.

Hill, D., & Madison, R. (1980). A health education program for weight reduction in a hypertension clinic. Public Health Reports, 95(3), 271-275.

Holme, D., & Kim, S. (1981). Nutrition education program for nursing home staff. Journal of the American Dietetic Association, 78, 366-369.

VOLUME 17 NUMBER 2 SUPPLEMENT

1985

Hopp, j., Zimmerman, G., Vyhmeister, I., & Stevens, R. (1978). A health education program for parents and children who exhibit high risk factors of coronary heart disease. Paper presented at the Annual Convention, Association for Health, Physical Education· and Recreation, Kansas City, Missouri. Hosokawa, M., Roberts, & Hansen, P. (1984). Health education in rural Missouri: Phase II. Health Education, 15(2), 18-26. Hunt, I., jacob, M., Ostergard, N., Masri, G., Clark, V., & Coulson, A. (1976). Effect of nutrition education on the nutritional status of low-income pregnant women of Mexican descent. The American Journal of Clinical Nutrition, 29, 675-684. Hustey, j. (1970). An evaluation of the expanded nutrition education program in Pennsylvania. Unpublished master's thesis, Pennsylvania State University, University Park. Ireton, & Guthrie, H. (1972). Modification of vegetableeating behavior in pre-school children. Journal of Nutrition Education, 4, 100-103. jeffery, R. Wing, R., & Stunkard, A. (1978). Behavioral treatment of obesity: The state of the art 1976. Behavior Therapy, 9, 189-199. jeffery, W., Pirie, P., Rosenthal, B., Gerber, W., & Murray, D. (1982). Nutrition education in supermarkets: An unsuccessful attempt to influence knowledge and product sales. Journal of Behavioral Medicine, 5(2), 189-200. jenkins, S., Stumo, M., & Voichick, j. (1975). Evaluation of the nutrition film series "Mulligan Stew". Journal of Nutrition Education, 7(1), 17-19. jennifer, E., Anderson, M., & Anderson, R. (1983). EFNEP Evaluation in Colorado. Report presented to Department of Food Science and Nutrition. Fort Collins, Colorado State University. johnson, S. (1977). Nutrition misconceptions. Health Education, 8(3), 36-38. jones, j. (1970). Evaluation of the Louisiana Nutrition Education Program. louisiana State University Cooperative Extension Service, Baton Rouge, LA. Kaiser, A., Norton, H., & Walker, E. (1926). The value of nutrition classes to the undernourished child. American Journal of Disabled Children, 31, 386-394. Kaplowitz, D., & Olson, C. (1983). The effect of an education program on the decision to breastfeed. Journal of Nutrition Education, 15(2), 61-65. Karvetti, R. (1981). Effects of nutrition education. Journal of the American Dietetic Association, 79, 659-667. Kennedy, E., & Gershoff, S. (1982). Effect of WIC supplemental feeding on hemoglobin and hematocrit of prenatal patients. Journal of the American Dietetic Association, 80, 227-230. Kennedy, E., Gershoff, S., Reed, R., & Austin, j. (1982). Evaluation of the effect of WIC supplemental feeding on birth weight. Journal of the American Dietetic Association, 80, 220-227. Kim, S., Schriver, j., & Campbell, K. (1981). Nutrition education for nursing home residents. Journal of the American Dietetic Association, 78, 362-366. Kingsley, R., & Shapiro, j. (1977). A comparison of three behavioral programs for the control of obesity in children. Behavior Therapy, 8, 30-36. Kirks, B., Hendricks, D., & Wyse, B. (1982). Parent involvement in nutrition education for primary grade students. Journal of Nutrition Education, 14(4),137-140. Konheim, B., & Naiman, D. (1954). An evaluation of free health literature in an adult education program: A study with parents of college students. American Journal of Public Health, 44, 216-222.

c.,

c.,

VOLUME 17 NUMBER 2 SUPPLEMENT 1985

Kopelke, C. (1975). Group education to reduce overweight. . . . In a blue-collar community. American Journal of Nursing, 75(11), 1993-1995. Kostas, G. (1980). A hypertensive diet education program for public health nurses. Journal of the American Dietetic Association, 77, 570-574. Kotelchuck, M., Schwartz, j., Anderka, M., & Finison, K. (1981). 1980 Massachusetts special supplemental food program for women, infants and children (WIC) evaluation project. Boston: Massachusetts Department of Public Health, Division of Family Health Services. Kunkel, N., & Hall, O. (1958). Influence of nutrition teaching on adolescents' eating habits. Journal of the American Dietetic Association, 34, 1220-1222. langham, R., Duprei, B., Atkins, E., & Schilling, P. (Undated), Impact of the WIC program in Louisiana. Technical Report. Privately circulated. larson, l., Massoth, D., & Chase, H. (1974). Using the discovery method in teaching nutrition. Ecology of Food and Nutrition, 3, 179-183. larson-Brown, l. (1978). Point-of-purchase information on vended foods. Journal of Nutrition Education, 10(3), 116-118. learning For life (1984). The changer and the changed. Evaluation Summary. Management Sciences for Health. Boston, MA. learning For life (1984). Self-discovery. Evaluation Summary. Management Sciences for Health. Boston, MA. learning for life (1979). The Doofus stories. Evaluation Summary. Management Sciences for Health. Boston, MA. learning For life (1980). From the inside out. Evaluation Summary. Management Sciences for Health. Boston, MA. leidenfrost, N. (1975). EFNEP . .. Accomplishments and future needs. Booklet put out by the Extension Service, USDA and the State Cooperative Extension Services. leidenfrost, N. (1975). The expanded food and nutrition education program: Historical and statistical profile. Published by the Science and Education Administration. lewin, K. (1942). The relative effectiveness of a lecture method and a method of group decision for changing food habits. Washington, D.C.: Committee on Food Habits, National Research Council. lewin, K. (1947). Group decision and social change. In Readings in Social Psychology. New York: Henry Holt and Company, 330-344. lockwood, j. (1970). The effectiveness of health programs for average and disadvantaged public school children. Journal of School Health, 40, 15-16. lohse, j. (1968). Nutrition knowledge, attitudes, and sources of nutrition information of young homemakers in Ohio. Unpublished master's thesis, Ohio State University, Columbus. looker, A. (1983). A comparison of two persuasive strategies in changing the nutrition knowledge, attitudes, and behavior of adults. Ph.D. dissertation, Pennsylvania State University, University Park. looker, A., Walker, S., Hamilton, l., & Shannon, B. (1982). Evaluation of two nutrition education modules for hospital staff members. Journal of the American Dietetic Association, 81, 158. lovett, R., Barker, E., & Marcus B. (1970). The effect of a nutrition education at the second grade level. Journal of Nutrition Education, 2(Suppl. 1). 81-95. Maccoby, N., Farquhar, j., Wood, P., & Alexander, j. (1977). Reducing the risk of cardiovascular disease: Effects of a community-based campaign on knowledge and behavior. Journal of Community Health, 3(2), 100-114.

JOURNAL OF NUTRITION EDUCATION S31

MacKenzie, L., & Arbor, E. (1979). Cross-age teaching-An important concept for nutrition education. Journal of Nutrition Education, 11(3), 138-140. Mahoney, M. (1974). Self-reward and self-monitoring techniques for weight-control. Behavior Therapy, 5, 48-57. Mangham, D., & Vickery, C. (1981). Introducing nutrition education. The Journal of School Health, 51(2), 110-112. Manoff, R., Cooke, T., & Romweber, S. (1977). Radio nutrition education-using the advertising technique to reach rural families: Philippines and Nicaragua. Technical

Report, Office of Nutrition, Agency for International Development, Washington, D.C. Martilotta, M., & Guthrie, H. (1980). Impact of providing milk options and nutrient information in school lunch programs. Journal of the American Dietetic Association, 77, 439-443. Massey, M. (1964). The influence of adult education in foods and nutrition on food selection by senior citizens. M.A. thesis, Marshall University, Huntington, W. Va. Matsuno, A., Hankin, J., & Dickson, L. (1974). Four factors affect weight control for obese children. Journal of Nutrition Education 6(3), 104-107. Mayeske, G. (1981). An assessment of the objectives,

implementation and effectiveness of the adult expanded food and nutrition education program. Technical

summary. Washington, D.C.: U.S. Department of Agriculture, Extension Service Science and Education. McDonald, W., Brun, J., & Esserman, J. (1981). In-home interviews measure positive effects of a school nutrition program. Journal of Nutrition Education, 13(4), 140-144. McLeod, C. (1943). An experiment in nutrition with children in the early elementary grades. Unpublished master's thesis, Florida State College for Women, Tallahassee, Florida. Medved, E. (1966). Television in nutrition education. Journal of Home Economics, 58(3), 167-170. Meyers, L., & Jansen, G. (1977). A nutrition approach in the fifth grade. Journ'al of Nutrition Education, 9(3), 127130. Milczarek, G. (1976). External evaluation of Selected Concepts for Educational Nutrition Training (SCENT).

Unpublished manuscript, Eastern Washington State University College, Cheney. Mojonnier, M., Hall, Y., Berkson, D., Robinson, E., Wethers, B., Pannbacker, B., Moss, D., Pardo, E., Stamler, J., Shekelle, R., & Raynor, W. (1980). Experience in changing food habits of hyperlipidemic men and women. Journal of the American Dietetic Association, 77, 140-148. Montgomery, D. (1971). An evaluation of a youth nutrition education program by age, Calcasieu Parish, 1970. Unpublished master's thesis, Louisiana State University, Baton Rouge. Moody, D., Wilmore, J., Girandola, R., & Royce, J. (1972). The effects of a jogging program on the body composition of normal and obese high school girls. Medicine and Science in Sports, 4(4), 210-213. Moore, M. (1947). Nutrition education in the elementary school: An evaluation of selected activities used in the primary and fifth grades. Master's thesis, University of Chicago. Mullis, R. (1984). The effect of a behaviorally oriented nutrition education curriculum on nutrition knowledge and behaviors of elementary students. Presented at the Society for Nutrition Education meeting, Philadelphia, PA. Munger, S. (1982). The generalizability of evaluation protocols for nutrition education. In B. Schurch (Ed.), S32 JOURNAL OF NUTRITION EDUCATION

Evaluation of nutrition education in Third World communities. Bern, Switzerland: Hans Huber Publishers.

Munoz de Chavez, M. (1972). Improving nutrition in less developed areas. Journal of Nutrition Education, 4(4), 167-170. Munves, E. (1953). Dietetic interview or group discussiondecision in reducing? Journal of the American Dietetic Association, 29, 1197-1203. Musgrave, K., & Thornbury, M. (1976). Weight control program for university students conducted by nutrition seniors. Journal of the American Dietetic Association, 68, 462-466. Nance, E. (1984). Evaluation of the impact of a food based nutrition education curriculum on nutrition knowledge, attitudes, and food practices of kindergarten through sixth grade students. Paper presented at the Society for

Nutrition Education meeting, Philadelphia, PA. Napier, T., & Wharton, C. (1974). An Ohio case study. The expanded food and nutrition education program: An experiment in behavioral change. Research Bulletin 1070, Wooster, Ohio: Ohio Agricultural Research and Development Center. National Dairy Council (1976-1977). Food . . . . your choice. A nutrition learning system. (Summary report 19761977 field test studies Kindergarten-grade six.) University of Illinois at Chicago Circle: Office of Evaluation Research. Neel, R. (1946). Nutrition education for the very young. Journal of Home Economics, May, 265-268. Niedermeyer, F., & Moncrief, M. (1975). Primary-graders study nutrition. Elementary School Journal, 75, 305-310. Norton, V. (1974). A nutrition education program for selected third grades and its effect on nutrition knowledge,. attitudes, practices and iron nutriture. Ph.D. dissertation, _University of Maryland, College Park. O'Connell, L., Shannon, B., & Sims, L. (1981). Assessing nutrition-related attitudes and beliefs of teachers. journal of Nutrition Education, 13(1), S80-S85. O'Connell, M. (1943). Study of the influence of nutrition knowledge on the food selection habits of high school students. Unpublished master's thesis, University of North Carolina, Greensboro. O'Donnell, N., & Alles, W. (1983). School nurse demonstrates that mini-grant funding can improve elementary nutrition education. The Journal of School Health, 53(5), 316-319. Office of Evaluation Research (1977). Comparison of nutrition achievement of students of inserviced and non-inserviced teachers. OER Technical Report No. 89c. University of

Illinois at Chicago Circle. O'Keefe, P. (1956). Research in action. The Journal of School Health, 26, 58-64. Oliver, M. (1967). Program aides work with the needy. Part 4. Pilot study in Alabama. Journal of the American Dietetic Association, 50, 483-486. Olson, c., Bisogni, c., & Thonney, P. (1982). Evaluation of a supermarket nutrition education program. Journal of Nutrition Education, 14(4), 141-145. Paulsen, B., & Beneke, W. (1979). Long-term results from a weight loss program. Journal of Nutrition Education, 11(1), 42-45. Paulsen, B., Beneke, W., Wrinkle, S., Davis, c., & Bender, M. (1981). Long-term results of a statewide behaviorallnutritiona! weight loss program with home economists as therapists. Journal of Nutrition Education, 13(1),' S106S110. Paulsen, B., Lutz, R., McReynolds, W., & Kohrs, M. (1976). Behavior therapy for weight control: Long term results of two programs with nutritionists as therapists. The American Journal of Clinical Nutrition, 29, 880-888. VOLUME 17 NUMBER 2 SUPPLEMENT

1985

Pelto, J. (1982). Results of a nutrition intervention program: The WIC program in Alaska. Alaska Medicine, 24(2), 14-17. Penner, K., & Kolasa, K. (1983). Secondary teachers' nutrition knowledge, attitudes, and practices. Journal of Nutrition Education, 15(4), 141-145. Perkin, J. (1983). Evaluating a nutrition education program for pregnant teen-agers: Cognitive vs. behavioral outcomes. Journal of School Health, 53(7), 420-422. Picardi, S., & Porter, D. (1976). Multidimensional evaluation of a food and nutrition minicourse. Journal of Nutrition Education, 8(4), 162-168. Plovanich, T. (1970). A study of the expanded nutrition education program in three southeast Louisiana Parishes,

1969. Unpublished master's thesis, louisiana State University, Baton Rouge. Podell, R., Gary, l., Keller, K., & Mulvihill, M. (1975). The public seminar as a nutrition education approach. Journal of the American Dietetic Association, 67, 460-463. Podell, R., Keller, K., Mulvihill, M., Berger, G., & Kent, D. (1978). Evaluation of the effectiveness of a high school course in cardiovascular nutrition. American Journal of Public Health, 68(6), 573-576. Prince Edward Island Department of Health and Social Services, (1983). Prenatal nutrition intervention program evaluation report. Prince Edward Island, Canada. Radke, M., & Caso, E. (1948). lecture and discussion-decision as methods of influencing food habits. Journal of the American Dietetic Association, 24, 23-31. Radke, M., & Klisurich, D. (1947). Experime.nts in changing food habits. Journal of the American Dietetic Association, 23, 403-409. Ramsey, c., & Cloyd, M. (1979). Multiple objectives and the success of educational programs. Journal of Nutrition Education, 11 (2), 141-145. Rivinus, T., Drummond, T., & Combrinck-Graham, l. (1976). A group-behavior treatment program for overweight children: Results of a pilot study. The Adipose Child. Pediatric Adolescent Endocrinology, 1, 212-218. Roberts, l. (1963). The Dona Elena Project: A better living program in an isolated rural community. Washington, D.C.: U.S. Department of Education. (ERIC Document Reproduction Service No. ED 024 521) Romanczyk, R. (1974). Self-monitoring in the treatment of obesity: Parameters of reactivity. Behavior Therapy, 5, 531-540. Rosander, K., & Sims, l. (1981). Measuring effects of an affective-based nutrition education intervention. Journal of Nutrition Education, 13(3), 102-105. Roth A., & Wunderlich, K. (1976). The effect of an instructional unit incorporating live animals on knowledge of nutrition for different age levels. Paper presented at the Annual Meeting of the American Educational Research Association, San Francisco, California. Rumps, K., Caster, W., & Peisher, A. (1983). Effects of a nutrition education program on the diet of homemakers of low-income families. Food group and nutrient intakes. Nutrition Research, 3(3), 271-277. Ruppenthal, B., & Gibbs, E. (1979). Treating childhood obesity in a public school setting. The Journal of School Health, 49, 569-571. Sanders, B., & Sanders, R. (1974). Nutrition program changes students' eating habits. School Foodservice Journal, 28(9), 25-26. Sanderson, M. (1984). An assessment of the food consumption patterns of Starr County W/C participants. Executive Summary. 1-8, Rio Grande City, Texas. Sariderson, M., & Randall, E. (1984). Food consumption patterns of Starr County, Texas W/C participants. Paper VOLUME 17 NUMBER 2 SUPPLEMENT 1965

presented at 1984 Society for Nutrition Education Conference, Philadelphia. Schelzel, G., & Britton, M. (1978). As assessment of the W/C program in Pennsylvania. State Report, Scranton. Schroeder, l., & thiele, V. (1981). Renal diet therapy-a computer-assisted instruction model. Journal of Nutdtlon Education, 13(1), S111-S114. Schumacher, N. (1979). Successful weight control program for employees. Journal of the American Dietetic Association, 74, 466-467. Schwartz, N. (1975). Nutritional knowledge, attitudes, and practices of high school graduates. Journal of the American Dietetic Association, 66, 28-31. Schwartz, N., Dalrymple, J" & Vivian, V. (1974). High school nutrition education: How effective is it? Journal of Home Economics, 66, 16-18. Seiders, R., Carter, c., & Dotson, R. (1972). Dietary adequacy of homemakers participating in extension's expanded food and nutrition education program in selected Tennessee counties, 1971. Agricultural Extension Service, University

Tennessee. Shannon, B. (1976). A self-instructional/lecture approach to nutrition for non-majors. Journal of Nutrition Education, 8(3), 107-110. Shannon, B. (1982). A nutrition education emphasis for junior/senior high school students. Proceedings of International Symposium: Adolescent Nutrition and Food . Behavior, University of Prince Edward Island, Canada. Shannon, B., Bell, P., Marbach, E., O'Connell, l., Graves, K., & Nicely, R. (1981). A K-6 nutrition curriculum evaluation: instruction and teacher preparation. Journal of Nutrition Education, 13(1),9-13. Shannon, B., Graves, K., & Hart, M. (1982). Food behavior of elementary school students after receiving nutrition education. Journal of the American Dietetic Association, 81, 428-434. Shannon, B., Thurman, B., & Schiff, W. (1979). Food SenSe: A pilot TV show on nutrition issues. Journal of Nutrition Education, 11(1),15-18. Shapiro, S., Bale, R., Scardino, V., & Cerva, T. (1974). An evaluation of the Mulligan Stew 4-H television series Volume I: Executive summary. (Report No. AAI-74-120). Cambridge, MA: Abt Associates Incorporated. Shaver, E., Esler, E., Mosley, W., & McHenry, E. (1948). Nutritional aspects of the Hartman Jones Memorial School health study. Canadian Journal of Public Health, 39, 395-400. Shimberg, B. (1952). Pretesting a nutrition filmstrip. U.S. Public Health Service, Publication #212, Pretesting and Evaluating Health Education, (Public Health Monograph No.8), Washington, D.C., 11-16. Shimberg, B., & Harris, J. (1952). Evaluating a nutrition education program. U.S. Public Health Service, Publication #212, Pretesting and Evaluating Health Education, (Public Health Monograph No.8), Washington, D.C., 17-21. Shorr, J. (1981). The effects of nutrition food television commercials on the subsequent food choice behavior of college students. Ph.D. dissertation, University of

Cincinnati, Ohio. Shoup, E. (1975). Teens teach children nutrition. Journal of Nutrition Education, 7, 107-108. Shovic, A. (1982). Effect of nutrition education on obesity and hypertension within a family planning clinic. Ph.D. dissertation, Washington State University, Pullman. Shovic, A., & Jennings, G. (1979). Effects of nutrition education on nutrition knowledge, vegetable acceptability, and plate waste. School Foodservice Review, 3(1), 21-23. JOURNAL OF NUTRITION EDUCATION S33

Simmons, J. (1977). lessons for health educators. American Journal of Public Health, 67(12), 1137-1138. Simmons, W. (1954). The group approach to weight reduction. Journal of the American Dietetic Association, 30, 437-441. Singleton, N., & Rhoads, D. (1984). An assessment of the nutrition education of students in grades 3 to 12. Journal of the American Dietetic Association, 84(1), 59-63. Skinner, J., & Woodburn, M. (1983). Nutrition-related characteristics of high school teachers and student performance. Journal of Nutrition Education, 15(3), 99-104. Smith, H., & Justice, C. (1979). Effects of nutrition programs on third grade students. Journal of Nutrition Education, 11(2),92-95. Smith,S., & James, M. (1980). School lunch as a nutrition education resource for fourth graders. Journal of Nutrition Education, 12(2),46-49. Spitze, H. (1976). Curriculum materials and nutrition learning at the high school level. Journal of Nutrition Education, 8(2), 59-61. Stark, c., & Johnson, E. (1981). An effective inservice nutrition workshop for home economics teachers. Journal of Nutrition Education, 13, 137-139. Stern, M., Farquhar, J., Maccoby, N., & Russell, S. (1976). Results of a two-year health education campaign on dietary behavior: The Stanford three community study. Circulation, 54(5), 826-833. Stuart, R. (1967). Behavioral control of overeating. Behavior Research and Therapy, 5, 357-365. Studdiford, D., & Guthrie, H. (1972). Programmed instruction in basic nutrition for college students. Journal of Nutrition Education, Winter, 23-26. Stunkard, A. (1977). The results of treatment for obesity. From: Behavioral Treatment of Obesity, Fariyt, J. (Ed.). Elmsford, NY: Pergamon Press. St. Pierre, R. (1981). An evaluation of the nutrition education and training program: Program summary. Office of Policy, Planning and Evaluation, Program Evaluation Report, Food and Nutrition Service of U.S. Department of Agriculture, Abt Associates, Cambridge, MA. St. Pierre, R., Cook, T., & Straw, R. (1981). An evaluation ofthe nutrition education and training program. Evaluation and Program Planning, 4, 335-344. St. Pierre, R., & Glotzer, J. (1981). An evaluation of Georgia nutrition education and training program. Report presented to Office of Policy, Planning and Evaluation, Program Evaluation Report of Food and Nutrition Service of U.S. Department of Agriculture, Abt Associates, Cambridge, MA. St. Pierre, R., & Glotzer, J. (1981). An evaluation of Nebraska's experience nutrition curriculum: Executive summary.

Report presented to Office of Policy, Planning and Evaluation, Program Evaluation Report of Food and Nutrition Service of U.S. Department of Agriculture, Abt Associates, Cambridge, MA. St. Pierre, R., & Rezmovic, V. (1982). An overview of the National Nutrition Education and Training Program Evaluation. Journal of Nutrition Education, 14(2), 61-66. Sunseri, A., Alberti, J., Schoenberger, J., Kent, N., Amuwo, 5., Sunseri, J., & Vickers, P. (1983). Children as reinforcers of adult health education. In F. landry, (Ed.), Health risk estimation,

risk

reduction,

and

health

promotion.

Proceedings of the Society of Prospective Medicine. Ottawa, Canada: Canadian Public Health Association, 617-628. Sunseri, A., Dolecek, T., Amuwo, 5., Kent, N., Cullinan, J., & Allendorf, S. (1982). Urban families as willing respondents S34 JOURNAL OF NUTRITION EDUCATION

to a school heart-health curriculum. Chicago Heart Health Curriculum Program, Chicago Heart Association.

Sutnick, M. (1981). The Q sort technique applied to nutrition attitudes investigation. Journal of Nutrition Education, 13 (1),5102-5105. Sutton, M. (1980). Nutrition education and manipulated diet as causative factors in industrial worker's self-reported

dietary practices, their physical status, and job perfor-

mance. Ph.D. dissertation, University of New Mexico, Albuquerque. Sutton, W. (1956). An appraisal of health attitudes and practices of college students. The Journal of School Health, 26, 125-130. Tabbut, M. (1967). A study of the influence of nutrition education on the dietary habits of home economics students at Concordia College. Unpublished master's thesis, Concordia College, Moorhead, Minnesota. Taggart, M. (1968). The influence of specific nutritional instruction to mothers on the home-eating patterns of selected preschool children. Unpublished master's thesis, University of Utah, Salt lake City. Talmage, H. (1978). Food . .. Your Choice: A second year follow-up study for National Dairy Council (Technical Report No. 101). Chicago: University of Illinois at Chicago Circle. Talmage, t't. (1978). Food . .. Your Choice, levels 1,2 and 3 summative evaluation (Technical Report No. 98). Chicago: University of Illinois at Chicago Circle. Talmage, H., Junker, l., & Duggan, J. (1981). Food . .. Your . Choice, levels 1, 2 and 3: A follow-up study (Technical Report No. 136). Chicago: University of Chicago at Chicago Circle. Talmage, H., & Rasher, S. (1978). An initial exploration of impact of Food. . . Your Choice on participating school sites for National Dairy Council (Technical Report No. 102). Chicago: University of Chicago at Chicago Circle. Talmage, H., Rasher,S., & Junker, l. (1980). Food . .. Your Choice, level 4: Achievement study I (Health and Home Economics Programs) (Office of Evaluation Research, Technical Report No. 130). Chicago: University of Chicago at Chicago Circle. Talmage, H., Rasher,S., & Junker, l. (1981). Food . .. Your Choice, level 4: Achievement and Environment Study II (Science and Social Studies Programs) (Office of Evaluation Research, Technical Report No. 134(A)). Chicago: University of Chicago at Chicago Circle. Talmage, H., Rasher,S., & Duggan, J. (1983). Food . .. Your Choice, level 4: Implementation evaluation study year 1: 1982-1983, A look at student effects (Office of Evaluation Research, Technical Report No. 208). Chicago: University of Illinois at Chicago Circle. Teske, P. (1967). Nutrition education as an influence on the dietary habits of adolescent girls. Unpublished master's thesis, Texas Technological College, lubbock. Thomas, E. (1943). Some effects of self-teaching and selfevaluation devices on the food habits and practices of a group of home economics students in the Middletown Senior High School. M.A. Thesis, Ohio State University,

Columbus. Tinsley, W. (1947). Development of instruments for evaluating food practices, nutrition information, and school lunch programs and their use in nutrition education at the elementary level. Unpublished doctoral dissertation,

University of Minnesota, Minneapolis. Tinsley, A., Houtkooper, l., Engle, M., & Gibbs, J. (1981). A nutrition and physical fitness test for fifth and sixth graders. Journal of Nutrition Education, 13(3),95-96. Tolin, D., Newell, K., Greig,S., & Staab, J. (1979). A VOLUME 17 NUMBER 2 SUPPLEMENT 1985

comparison of two approaches to nutrition education at the third grade level. School Food Service Research Review, 3(1), 24-28. Trebella, N. (1983). A weight control program for the elderly. Journal of Nutrition Education, 15, 100C. Trotter, J. (1971). An evaluation of the low-income youth nutrition

program

in

Tangipahoa

Parish,

Louisiana.

Unpublished master's thesis, Louisiana State University, Baton Rouge. Tyndall, E. (1983). A comparison of two nutrition education programs for weight control. Ph.D. dissertation, The University of North Carolina at Greensboro. U.S. Department of Agriculture. (Unknown). State and local agency evaluations of the WIC Program-States of Arizona

(1976), Florida(1975), Michigan (1976). U.S. General Accounting Office. (1984). WIC evaluations

provide some favorable but no conclusive evidence on the effects expected for the special supplemental program for women, infants, and children. Technical Report, Washing-

ton, D.C. Verma, S., & Jones, J. (1973). Educational participation and dietary changes of EFNEP homemakers in Louisiana. Home Economics Research Journal, 2(2), 94-104. Wade, c., & Thiele, V. (1973). Computer assisted instruction in a college nutrition course. Journal of Nutrition Education, 5(4), 246-248. Walbeck, N. (1973). Precepts, paragons, and practice: The effects of various methods of nutrition instruction on attitudes, knowledge, and behavior. The Journal of Social Psychology, 91, 197-205. Wang, M., & Dwyer, J. (1975). Reaching Chinese-American children with nutrition education. Journal of Nutrition Education, 7(4),145-148. Wang, V., & Ephross, P. (1970). Poor But Not Forgotten, Cooperative Extension Service, University of Maryland, College Park. Wang, V., Green, L., & Ephross, P. (1972). Not Forgotten But Still Poor, Cooperative Extension Service, University of Maryland, College Park. Washington Dairy Products Commission Marketing Research. (1981). Washington State Dairy Council nutrition program research. Herbert, McNabb and Associates, Seattle. Weiler, P., Stalker, H., Jennings, S., & Fister, W. (1979).

Anemia as a criterion for evaluation of a special supplemental food program for women, infants, and children. Pediatrics, 63(4), 584-590. Weisenberg, M., & Fray, E. (1974). What's missing in the treat-

VOLUME 17 NUMBER 2 SUPPLEMENT 1985

ment of obesity by behavior modification? Journal of the American Dietetic Association, 65, 410-414. Wheeler, M., Hess, K. (1976). Treatment of juvenile obesity by successive aoproximation control of eating. Journal of Behavioral Therapy and Experimental Psychiatry, 7,

235-241. Whitehead, F. (1947). Research in nutrition education. Journal of the American Dietetic Association, 23, 310-317. Whitehead, F. (1952a). Dietary studies of school-age children in Ascension Parish, Louisiana. American Journal of Public Health,42, 1547-1551.

Whitehead, F. (1952b). Studies in nutrition education. Journal of the American Dietetic Association, 28, 622-627. Whitehead, F. (1960). How nutrition education can affect adolescents' food choices. Journal of the American Dietetic Association, 37, 348-356. Willerman, B. (1943). Group decision and request as means of changing food habits. A preliminary study directed by Kurt Lewin, Child Welfare Research Station, State University of Iowa, Iowa City. Williams, L. (1970). A study of the expanded nutrition education program in three northeast Louisiana parishes,

1969. Unpublished master's thesis, Louisiana State UniverBaton Rouge. Williams, R. (1979). Evaluation report of the Dairy Council of Rochester. Health Science Department, State University of New York, Brockport. Witsch, J., Singer, M., Wu-Lee, M., & Stare, F. (1978). Family cooperation and effectiveness in a cholesterol-lowering diet. Journal of the American Dietetic Association, 72, 384-388. Wodarski, L., Adelson, c., Todd, M., & Wodarski, J. (1980). Teaching nutrition by teams-garnes-tournaments. Journal of Nutrition Education, 12(2), 61-65. Wollersheim, J. (1970). Effectiveness of group therapy based upon learning principles in the treatment of overweight women. Journal of Abnormal Psychology, 76(3), 462474. Young, c., Berresford, K., & Waldner, 8. (1956). What the homemaker knows about nutrition. Journal of the American Dietetic Association, 32, 321-326. Zakus, G., Chin, M., Cooper, H., Makovsky, E., & Merrill, C. (1981). Treating adolescent obesity: A pilot project in a school. The Journal of School Health, 51(10), 663-666. Zifferblatt, S., Wilbur, c., & Pinsky, J. (1980). Changing cafeteria eating habits. Journal of the American Dietetic Association, 76, 15-20. s~ty,

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APPENDIX B Articles Read Which Contained No Applicable Data Abel, M. (1954). Teaching nutrition in the melting pot of the Pacific. Journal of the American Dietetic Association, 30, 148-154. Adelson, S. (1968). Changes in diets of households 1955 to 1965: Implications for nutrition education today. Journal of Home Economics, 60(6), 448-455. Alexander, ). (1981). What can nutrition educators learn from communication theories? Journal of Nutrition Education, 13(1), S27-S28. Aragona, ). Cassady, )., & Drabman, R. (1975). Treating overweight children through parental training and contingency contracting. Journal of Applied Behavior Analysis, 8(3), 269-278. Archibald, ). (1950). Some comments on nutrition education. Canadian Journal of Public Health. 41, 193-195. Asher, W. (Ed.) (1974). Treating the Obese. New York: MEDCOM PRESS. Asp, E. (1973). Analysis of food decision-making strategies used for solving a computer based menu planning problem. Unpublished doctoral dissertation, University of Minnesota, Minneapolis. Asp, E., & Gordon, J. (1981). Development of a computerassisted program for undergraduate instruction. Journal of Nutrition Education, 13(1), S91-S95. . Axelson, M., Federline, T., & Brinberg, D. (1984). Food and nutrition-related knowledge, attitudes, and behavior-a meta-analysis. Unpublished manuscript. Babcock, C. (1961). Attitudes and the use of food. Journal of the American Dietetic Association, 38, 546-551. Babicka, M. (1943). The current food situation inside Poland. Journal of the American Dietetic Association, 19, 261-264. Baily, l., Mahan, c., & Dimperio, D. (1980). Folacin and iron status in low-income pregnant adolescents and mature women. The American Journal of Clinical Nutrition, 33, 1997-2001. Baltimore, B. (1960). A school-wide experiment in nutrition education. Journal of the American Dietetic Association, 37,44-47. Bandura, A. (1977). Self-efficacy: Toward a unifying theory of behavioral change. Psychological Review, 84(2), 191-215. Barney, H. (1970). The use of nutrition and home economics aides. Journal of Home Economics, 62(2), 114-119. Barrick, M. (1947). Evaluation of three types of audio-visual material for teaching nutrition. Unpublished master's thesis, Iowa. State University, Ames. Bavly, S. (1966). Changes in food habits in Israel. Journal of the American Dietetic Association, 48, 488-495. Baxter-Slonim, A., Kolasa, K., Bass, M. (1981). The cultural appropriateness of the WIC program in Cherokee, North Carolina. Journal of the American Dietetic Association, 79, 164-168. Beck, K., & Frankel, A. (1978). A conceptualization of threat communications and preventive health behavior. Paper presented at the meeting of the American Psychological Association, Toronto, Canada. Becker, M., Maiman, l., Kirscht, J., Haefner, D., & Drachman, R. (1977). The health belief model and prediction of dietary compliance: A field experiment. Journal of Health and Social Behavior, 18, 348-366. Bell, D. (1981). Patient nutrition education follow-up in the hospital setting. Journal of the American Dietetic Association, 79, 309-310. Berg, N., Williams, S., & Sutherland, B. (1979). Behavior S36 JOURNAL OF NUTRITION EDUCATION

modification in a weight-control program. Family and Community Health, 1, 41-51. Bergevin, P. (1957). Telling vs. teaching-learning by participation. Journal of the American Dietetic Association, 33, 781-784. Berkenfield, J., & Schwartz, J. (1980). Nutrition intervention in the community-the "WIC" Program. New England Journal of Medicine, 302(10), 579-581. Beyer, N., & Morris, P. (1974). Food attitudes and snacking patterns of young children. Journal of Nutrition Education, 6(4), 131-133. Birch, l. (1979). Dimensions of preschool children's food preferences. Journal of Nutrition Education, 11(2),77-80. Birch, l. (1979). Preschool children's food preferences. Journal of Nutrition Education, 11(2), 77-80. Birch, l. (1980). Effects of peer models' food choices and eating behaviors on preschoolers' food preferences. Child Development, 51, 489-496. Birch, l. (1981). A call for the explicit recognition of affect in models of human eating behavior. Journal of Nutrition Education, 13(1),549-553. Birch, l. (1980). The relationships between children's food preferences and those of their parents. Journal of Nutrition Education, 12(1),14-18. Birch l., Zimmerman, S., & Hind, H. (1981). The influence of social-affective context on the formation of children's food preferences. Journal of Nutrition Education, 13(1), 5115-5118. Bissaillon, A. (1982). The nutritional cognizance, attitudes, and fluid milk consumption of Michigan State University students. Unpublished master's thesis, Michigan State University, East lansing. Blanchet, M. (1982). Is it possible to influence adolescent nutrition knowledge and food behaviour? Proceedings of International Symposium Adolescent Nutrition and Food Behavior. University of Prince Edward Island, Canada. Blouin, A. (1983). Diet and behavior in children: Methodological considerations. Topics in Early Childhood Special Education, July, 1-8. Bosley, B. (1947). A practical approach to nutrition education for children. Journal of the American Dietetic Association, 23, 304-309. Bosley, B., & Huenemann, R. (1968). Nutritional problems and educational programs in latin America: What can we learn from latin America? Journal of the American Dietetic Association, 53, 99-103. Bowering, J., lowenberg, R., Morrison, M., Parker,S., & Tirado, N. (1978). Infant feeding practices in East Harlem. Journal of the American Dietetic Association, 72(2), 148-155. Bowman, M., & Anderson, C. (1943). Nutrition education programs. The Annals of the American Academy of Political Science, 225, 150-157. Boykin, l. (1977). The impact of health education on nutritional risks of obesity and food life-style modification. Occupational Health Nursing, 25, 14-15. Bray, G. (1979). A look at diets and other treatments for obesity. Medical Times, 107(7),51-56. Briggs, G. (1969). The need for nutrition education. Journal of Nutrition Education, 1, 7-8. Brown, M. (1929). Teaching Health in Fargo. New York: The Commonwealth Fund Division of Publications. Brown, P., Bergan, J., & Murgo, C. (1979). Current trends in VOLUME 17 NUMBER 2 SUPPLEMENT

1985

food habits and dietary intakes of home economics students in three junior high schools in Rhode Island. Home Economic Research Journal, 7(5), 324-333. Brownell, K. (1980). Behavioral treatments for obesity. Ross Timesaver Dietetic Currents, 7(3), 13-18. Brownell, K., Heckerman, c., Westlake, R., Hayes, S. & Monti, P. (1978). The effect of couples training and partner co-operativeness in the behavioral treatment of obesity. Behavioural Research and Therapy, 16, 323-333. Brownell, K., & Stunkard, A. (1978). Behavioral treatment of obesity in children. American Journal of Disabled Children, 132, 403-411. Bruch, H. (1944). Dietary treatment of obesity in childhood. Journal of the American Dietetic Association, 20, 361-364.

Brun, j. (1979). Nutrition education research: Directions for the future. Conference Proceedings. Chicago, IL: National Dairy Council. Brun, j. (1981). Evaluation of nutrition education: A review. In j. Nestor & j. Glotzer (Eds.), Teaching nutrition. Cambridge, MA: Abt Associates Incorporated. Brun, j., & Rhoads, A. (1981). Nutrition education research: Strategies for theory building. Conference Proceedings. Lincolnshire, Illinois. Bryan, M., & Lowenberg, M. (1958). The father's influence on young children's food preferences. Journal of the American Dietetic Association, 34, 30-35. Bull, N., Buss, D., & Goodall, P. (1982). Dietary patterns and attitudes of young people in Britain. Proceedings of International Symposium: Adolescent Nutrition and Food Behavior. University of Prince Edward Island, Canada. Bunck, T., & Iwata, B. (1978). Increasing senior citizen

participation in a community-based nutritious meal program. Journal of Applied Behavior Analysis, 11(1),75-86. Burgess, A. (1961). Nutrition education in public health programs: What have we learned? American Journal of Public Health, 51(11), 1715-1726. Burt, j., & Hertzler, A. (1978). Parental influence in the child's food preference. Journal of Nutrition Education, 10(3),127-128.

Byrd-Bredbenner, C. (1981). A nutrition knowledge test for nutrition educators. Journal of Nutrition Education, 13(3), 97-99. Byrd-Bredbenner, c., & Shear, T. (1982). Nutrition knowledge, attitude, dietary behavior, and commitment to nutrition education of nutrition educators. Home Economic Research Journal, 11(2),167-174. Callahan, D. (1982). The role of school feeding and nutrition education on adolescent eating patterns: A practical approach. Proceedings of International Symposium Adolescent Nutrition and Food Behavior. University of Prince Edward Island, Canada. Campbell, V., & Dodds, M. (1967). Collecting dietary information from groups of older people. Journal of the American Dietetic Association, 51, 29-33. Carruth, B., & Musgrave, K. (1979). Changing attitudes in community nutrition. Journal of Nutrition Education, 11(2), 127-132. Cartwright, D. (1951). Achieving change in people: Some applications of group dynamics theory. Human Relations, 4,381-392. Cassel, j. (1957). Social and cultural implications of food and food habits. American Journal of Public Health, 47, 732-740. Chaney, M. (1942). Highlights in nutrition research. Journal

of Home Economics, 454-456. Chaney, M. (1945). Integrating nutrition education and activities in the school program. American Journal of Public Health, 35, 728-731. Chassy, J., Van Veen, A., & Young, F. (1967). The applications VOLUME 17 NUMBER 2 SUPPLEMENT

1985

of social science research methods to the study of food habits and food consumption in an industrializing area.

American Journal of Clinical Nutrition, 20(1), 56-64.

Chatfield, C. (1943). The preparation of an emergency ration for use in liberated countries. Journal of the American Dietetic Association, 19, 267-268. Chethik, B. (1976). Turning kids on to good nutrition. Teacher, 93(6), 44-46. Clancy, K. (1975). Preliminary observation on media use and food habits of the elderly. Gerontologist, 15, 529-532. Clark, R., & Fisher, R. (1975). A token reinforcement system applied to the school lunch program. Colorado Journal of Educational Research, 15, 17-20. Close, S., & Sabry, J. (1978). An experiment to influence vegetable acceptance of nursery school children. Journal of Canadian Dietetic Association, 39(3), 221-225. Coates, T. (1977). Theory, research and practice in treating obesity: Are they really all the same? Addictive Behaviors, 2,95-103. Coates, T. (1981). Eating-A psychological dilemma. Journal of Nutrition Education, 13(1), S34-S48. Coates, T., & Thoresen, C. (1978). Using generalizability theory in behavioral observation. Behavioral Therapy, 9, 605-613. Coates, T., & Thoresen, C. (1978). Treating obesity in children and adolescents: A review. American Journal of Public Health, 68(2), 143-151. Cohn, J., Johnson, M., & Randolph, M. (1972). Cooking in the kindergarten. Journal of Nutrition Education, 4, 26-27. Committee on Food Habits, National Research Council. (1943). Supplementing the role of the nutritionist at the household level. The Problem of Changing Food Habits, NRC Bulletin 108, Washington, D.C., 162-164. Committee on Food Habits, National Research Council. (1943). Feeding liberated countries and nutrition education. The Problem of Changing Food Habits, NRC Bulletin 108, Washington, D.C., 162-164. Conley, J., & Jackson, C. (1978). Is a mandated comprehensive health education program a guarantee of successful health education? Journal of School Health, 48, 337-340. Contento, I. (1980). Thinking about nutrition education: What to teach, how to teach it, and what to measure. Teachers College Record, 81(4),421-447. Contento, I. (1981). Children's thinking about food and eating: A Piagetian-based study. Journal of Nutrition Education, 13(1), S86-S9O. Cooper, B., & Phillip, M. (1974). Evaluation of nutrition education in everyday teaching environment. Journal of Nutrition Education, 6(3), 99-103. Cooper, K., & Go, C. (1976). Analysis of nutrition curriculum guides at the K-12 level. Journal of Nutrition Education, 8 (2),62-66. Cortes, M., & Standal, B. (1973). Nutrition education practices in elementary schools in Hawaii. Journal of Nutrition Education, 5(1), 18-21. Cross, M., & Semb, G. (1975). A personalized university course in nutrition. Journal of Nutrition Education, 7(4), 149-151. Cunningham, J., Skinner, J., Cagle, L., Miller,S., & Teets,S. (1981). Development of CANKAP: A multidimensional measure of nutritional beliefs. Journal of Nutrition Education 13(3), 109-114. Cussler, M., & DeGive, M. (1952). 'Twixt the cup and the lip: Psychological and socio-cultural factor affecting food habits. New York: Twayne Publishers.

D'Augelli, A. (1981). Healthy eating: A human development intervention perspective. Journal of Nutrition Education, 13(1 ),554-S58. JOURNAL OF NUTRITION EDUCATION S37

D'Augelli, A., & Smiciklas-Wright, H. (1978). The case for primary prevention of overweight through the family. journal of Nutrition Education, 10(2), 76-78.

Devadas, R., & Chandrasekhar, U. (1970). Nutrition education of illiterate people. journal of Nutrition Education, 1, 13-16. Dickins, D. (1965). Factors related to food preferences. journal of Home Economics, 57(6), 427-430. Duncker, K. (1938). Experimental modification of children's food preferences through social suggestion. journal of . Abnormal and Social Psychology, 33, 489-507. Dwyer, j. (1973). Psychosexual aspects of weight control and dieting behavior in adolescents. Medical Aspects of Human Sexuality, 7, 82-114. Dwyer, I., Feldman, L & Mayer, j. (1970). Nutritional literacy of high school students. journal of Nutrition Education, 2(2), 59-66. Dwyer, j., Stolurow, K., & Orr, R. (1981). A nutrition knowledge test for high school students. journal of Nutrition Education, 13(3),93-94. Edwards, I., Hotch, D., & Bickman, L. (1982). Measuring children's health-related attitudes and knowledge. In L. Bickman (Ed.), Applied Social Psychology Annual: Vol. 3 (pp. 249-277). Beverly Hills, CA: Sage. Eichelberger, M. (1950). Procedures for effective nutrition education studied. journal of Home Economics, 735-736. Eisenhower, M. (1943). The relevance of food at the time of occupation: Conditions in North Africa. journal of the American Dietetic Association, 19, 265-266. Elliot, M. (1944). Adventures in nutrition. journal of Home Economics, 36, 340-345. Emmons, L., Hayes, M., & Call, D. (1972). The lunch bunch study. School Foodservice journal, 26(8), 25-29. Emmons, L., & Hayes, M. (1973). Accuracy of 24-hour recalls of young children. journal of the American Dietetic Association, 62, 409-415. Emmons, L., & Hayes, M. (1973). Nutrition knowledge of mothers and children. journal of Nutrition Education, 5(2), 134-139. Eppright, E. (1947). Factors influencing food acceptance. journal of the American Dietetic Association, 23, 579-587. Eppright, E. (1958). The diffusion process in changing food habits. journal of the American Dietetic Assocition, 34, 1074. Eppright, E., Fox, H., Freyer, B., Lamkin, G., & Vivian, V. (1969). Eating behavior of preschool children. journal of Nutrition Education, 1, 16-19. Eppright, E., Fox, H., Freyer, B., Lamkin, G., & Vivian, V. (1970). Nutrition knowledge and attitudes of mothers. journal of Home Economics, 62(5), 327-32. Eppright, E., Fox, H., Freyer, B., Lamkin, G., & Vivian, V. (1970). Frequency of eating. journal of Home Economics, 62(6), 407-410. Evans, R., & Hall, Y. (1978). Social-psychological perspectives in motivating changes in eating behavior. journal of the American Dietetic Association, 72, 378-383. Fanslow, A., Brun, j., Hausafus, C. (1981). The NATs-Nutrition achievement tests for the elementary grades. journal of Nutrition Education, 13(3), 90-92. Fanslow, A., Pease, D., Njus, H., & Brun, j. (1982). A food intake assessment device for upper elementary school children. journal of Nutrition Education, 14(1), 27-30. Fathauer, G. (1960). Food habits - an anthropologist's view. journal of the American Dietetic Association, 37, 335-338. Feldman, R. (1984). The influence of communicator characteristics on the nutrition attitudes and behavior of high school students. journal of School Health, 54(4), 149-151.

S38 JOURNAL OF NUTRITION EDUCATION

Fisher, R. (1975). A reinforcement program designed to increase school lunch consumption. journal of School Applications of Learning Theory, 8, 1-9. Foley, c., Hertzler, A. & Anderson, H. (1979). Attitudes and food habits - a review. journal of the American Dietetic Association, 75, 13-18. Foreyt, j., Scott, L. & Gotto, A. (1980). Weight control and nutrition education programs in occupational settings. Health Promotion at the Worksite, 95(2), 127-136. Forman, M. (1966). Operation ninos-child feeding in Latin America. journal of the American Dietetic Association, 48, 513-514. Fortune, j. (1983). Testing elementary pupils' knowledge of nutrition. The Elementary School journal, 83(3), 231-238. Frank, G., Gereson, G., Schilling, P., & Moore, M. (1977). Adapting the 24-hour recall for epidemologic studies of school children. journal of the American Dietetic Association, 71, 26-31. Fruin, M. & Davison, M. (1978). Some considerations in the measurement of change. journal of the American Dietetic Association, 73, 15-19. Garrett, P., & Vaden, A. (1978). Influence of student-selected menus of participation, plate waste, and student attitudes. School Foodservice Research Review, 2(1), 28-33. Gillespie, A. (1981). A theoretical framework for studying school nutrition programs. journal of Nutrition Education, 13(4), 150-152. Gillespie, A. (1981). Applying communication theory in nutrition education research. journal of Nutrition Education, 13(1),529-533. Gillespie, A. (1982). A model for studying nutritional behavior of adolescents. Proceedings of the International Symposium Adolescent Nutrition and Food Behavior. Univer-

sity of Prince Edward Island, Canada. Gillespie, A. (1983). Assessing snacking behavior of children. Ecology of Food and Nutrition, 13, 167-172. Glanz, K. (1981). Social psychological perspectives and applications to nutrition education. journal of Nutrition Education, 13(1), 566-569. Glaser, A. (1957). Building food acceptances in nursery school children. journal of Home Economics, 49(1), 47-49. Godfrey, M., & Schutz, H. (1972). Acceptability of low-fat milk by school children. journal of the American Dietetic Association, 61, 525-528. Goldiamond, I. (1979). Behavioral approaches and liaison psychiatry. Psychiatric Clinics of North America, 2(2), 379-401. Gorelick, M. & Clark, E. (1981). Module 1,' Assessment evaluation. Technical report. Project number 59-3198-9-70. California State University, Northridge, California. Gormally, j., Rardin, D., & Black, S. (1980). Correlates of successful response to a behavioral weight control clinic. journal of Counseling Psychology, 27(2), 179-191. Goumas, D. (1972). Nutrition by practice. School Foodservice journal, 26(7), 43-45. Green, L. (1978). Determining the impact and effectiveness of health education as it relates to federal policy. Health Education Monographs, 6, 528-566. Green, L. (1982). Edmonton adolescent nutrition project: Stages I and II. Proceedings of International Symposium Adolescent Nutrition and Food Behavior, University of Prince Edward Island, Canada. Greist, E., & Markesbery, B. (1979). Making news-a nutrition education happening. journal of Nutrition Education, 11 (2), 90-91. Grivetti, L., & Pangborn, R. (1973). Food habit research: A review of approaches and methods. journal of Nutrition Education, 5(3), 204-208.

VOLUME 17 NUMBER 2 SUPPLEMENT

1985

Grotkowski, M., & Sims, l. (1978). Nutritional knowledge, attitudes, and dietary practices of the elderly. Journal of the American Dietetic Association, 72, 499-506. Gussow, J., & Contento, I. (1984). Nutrition education in a changing world. World Review of Nutrition Dietetics, 44, 1-56. Guthrie, H. (1978). The role of nutrition education in dietary improvement. Food Technology, September, 89-90. Hall, J., & Holmberg, M. (1974). The effect of teacher behaviors and food serving arrangements on young children's eating in a day care center. Child Care Quarterly, 3(2), 97-108. Hampton, M., Shapiro, l., & Huenemann, R. (1961). Helping teen-age girls improve their diets-Report of a pilot study. Journal of Home Economics, 53(10), 835-838. Harper, l., & Sanders, K. (1975). The effect of adult's eating on young children's acceptance of unfamiliar foods. Journal of Experimental Child Psychology, 20, 206-214.

Harper, R. (1957). Psychological aspects of food acceptance. Advancement of Science, 13, 297-299. Harper, R. (1960). Food assessment and food acceptance as a psychological theme. Occupational Psychology, 34(4), 233-240. Harris, M., & Baudin, H. (1972). Models and vegetable eating: The power of Popeye. Psychological Reports, 31, 570. Harrison, P., & Irwin, l. (1964). Certain harmful health misconceptions of junior high students public schools in metropolitan areas. The Research Quarterly, 35(4), 491-496. Hart, M. rf976). Lompete-ncy-=Das-ecreaucation. Journai of the American Dietetic Association, 69, 616-626. Heimendinger, J., & Laird, N. (1983). Growth changes measuring the effect of an intervention. Evaluation Review, 7(1), 80-95. Herbert-Jackson, E., Cross, M., & Risley, T. (1977). Milk types and temperature: What will young children drink? Journal of Nutrition Education, 9(2), 76-79. Hertzler, A., & Owen, C. (1976). Sociologic study of food habits: A review. Journal of the American Dietetic Association, 69, 381-384. Hicks, l., Langham, R., & Takenaka, J. (1982). Cognitive and health measures following early nutritional supplementation: A sibling study. American Journal of Public Health, 72(10),1110-1118. Hicks, l., Langham, R., & Takenaka, J. (1983). Interpretation of behavioral findings in studies of nutritional supplementation. American Journal of Public Health, 73(6), 695-697. Hill, M. (1962). Nutrition education from the laboratory to the dining table. Food and Nutrition News, 34(1), 3-4. Hinton, M. (1962). Factors related to the eating behavior and dietary adequacy of girls 12 to 14 years of age. Ph.D. dissertation. Iowa State University of Science and Technology. Hinton, M., Chadderdon, H., Eppright, E., & Wolins, l. (1962). Influences on girls' eating behavior. Journal of Home Economics, 54(10), 842-846. Hinton, M., Eppright, E., Chadderdon, H., & Wolins, l. (1963). Eating behavior and dietary intake of girls 12-14 years old. Journal of the American Dietetic Association, 43, 223-227. Hochbaum, G. (1977). Human behavior and nutrition education. Nutrition News, 40(1), 1-4. Hochbaum, G. (1981). Strategies and their rationale for changing people's eating habits. Journal of Nutrition Education, 13(1), S59-S65. Holmes, D. (1972). Nutrition health-screening services for the elderly. Journal of the American Dietetic Association 60, 301-305.

VOLUME 17 NUMBER 2 SUPPLEMENT 1985

Holmes, S. (1952). Nutrition programs in the South Pacific. Journal of Home Economics, 44(2), 127-128. Horton, M., Carter, c., & Dotson, R. (1973). Increase in

knowledge of homemakers participating in extension's expanded food and nutrition program in selected Tennessee counties, 1973. (Extension Study 47-5C-849).

Knoxville: University of Tennessee, Agriculture Extension Service. Howe, P. (1939). Can food habits be changed? Yearbook of Agriculture, 131-138. Hrboticky, N., & Krondl, M. (1982). An acculturation model for the study of food behavior adaptation of the adolescent. Proceedings of International Symposium Adolescent Nutrition and Food Behavior. University of Prince Edward

Island, Canada. Hudson, A., & Williams, S. (1981). Eating behavior, emotions and overweight. Psychological Reports, 48, 669-670. Huey, E. (1967). An evaluation of the effectiveness of an introductory nutrition course at college level. Master's thesis, Indiana University, Bloomington. Huth, K., & Green, l. (1982). Adolescent nutrition: a community project. Canadian Home Economics Journal, 32(2), 62-64. Improved food habits depend on changes in cultural patterns. (1960). Journal of the American Dietetic Association, 37, 471. Jacoby, J., Chestnut, R., & Silberman W. (1977). Consumer use and comprehension of nutrition information. Journal of Consumer Research, 4, 119-128. Jeffrey, R., Thompson, P., & Wing, R. (1978). Effects on weight reduction of strong monetary contracts for calorie restriction or weight loss. Behavior Research and Therapy, 16, 363-369. Jeffrey, R., Wing, R. (1979). Frequency of therapist contact in the treatment of obesity. Behavior Therapy, 10, 186-192. Jerome, N. (1982). Adolescent eating behavior: Multilayered, multi-textured. Proceedings of International Symposium: Adolescent Nutrition and Food Behavior.

University of Prince Edward Island, Canada. Jerome, N. (1982). Dietary patterning and change: A continuous process. Contemporary Nutrition, 7(6). Joint Subcommittee on Human Nutrition Research. (1982). Nutrition education research and professional personnel needs for nutrition education of professionals and the public. Technical report. Bethesda, MD.

Jones, T~ (1954). Developing a nutrition program in the Virgin Islands. Journal of the American Dietetic Association, 30, 146-148. Jordan, H., Levitz, l., Utgoff, K., & Lee, H. (1981). Role of food characteristics in behavioral change and weight loss. Journal of the American Dietetic Association, 79, 24-29. Kahn, A. (1978). Group education for the overweight. American Journal of Nursing, 78, 254. Kautz, l., & Harrison, G. (1981). Comparison of body proportions of one-year-old Mexican-American and Anglo children. American Journal of Public Health, 71(3), 280-282. Kazdin, A. (1974). Self-monitoring and behavior change. In M.J. Mahoney and C.E. Thoresen (Eds.), Self-control: Power to the person. Monterey, CA: Brooks/Cole. Kelly, K. (1979). Evaluation of a group nutrition education approach to effective weight loss and control. American Journal of the Public Health, 69(8), 813-814. Kent, D. (1941). Nutrition education and the school lunch program. School Life, 26(8), 232-234. Kim, K., Kohrs, M., & Grier, M. (1984). Dietary calcium intakes of elderly Korean Americans. Journal of the American Dietetic Association, 84(2), 164-169. Kingsley, R., & Wilson, G. (1977). Behavior therapy for

JOURNAL OF NUTRITION EDUCATlON S39

obesity: A comparative investigation of long-term efficacy. Journal of Consulting and Clinical Psychology, 45(2), 288-298. Klapper, J. (1960). The effects of mass communication. Glencoe, Illinois: The Free Press of Glencoe. Knauer, V. (1971). Portable meals contribute to nutrition education efforts. Journal of Nutrition Education, 3, 59-61. Kohrs, M., O'Hanlon, P., & Eklund, D. (1978). Title VIINutrition program for the elderly. Journal of the American Dietetic Association, 72, 487-492. Kolasa, K. (1981). Nutrition education and changing behavior. Proceedings of the Western Hemisphere Nutrition Congress. In Nutrition in the 1980's: Constraints on our knowledge. New York: Alan R. liss, Inc. Kolasa, K., & Bass, M. (1974). Participant-observation in nutrition education program development. Journal of Nutrition Education, 6(3), 89-92. Kolbe, l. (1979). Evaluating effectiveness-the problem of behavioral criteria. Health Education, January/February, 12-16. Koos, E. (1943). A study of the use of the friendship pattern in nutrition education. In The problems of changing food habits by the Committee on Food Habits. (NRC Bulletin No 108). Washington, D.C: National Research Council. Kopachevsky, I. (1982). Knowledge, preferences and food choice: Trying to untangle a multivariate spaghetti. Proceedings of International Symposium: Adolescent Nutrition and Food Behavior. University of Prince Edward Island, Canada. Krantzler, N., Mullen, B., Comstock, E., Holden, c., Schutz, H., Grivetti, l., & Meiselman, H. (1982). Methods of food intake assessment-An annotated bibliography. Journal of Nutrition Education, 14(3),108-119. Krondl, M., George, R., & Coleman, P. (1982). Food perceptions in the dietary behavior of the adolescent. Proceedings of International Symposium: Adolescent Nutrition and Food Behavior. University of Prince Edward Island, Canada. lackey, C, Kolasa, K., & Mutch, B. (1981). Development of the NKT-a general nutrition knowledge test for teachers. Journal of Nutrition Education, 13(3), 100-101. lamb, M., & ling, B. (1946). An analysis of food consumption and preferences of nursery school children. Child Development, 17, 186-217. lansky, D., & Brownell, K. (1982). Comparison of schoolbased treatments for adolescent obesity. Journal of School Health, 52, 384-387. lantis, M. (1962). Cultural factors influencing children's food habits. In Proceedings of Nutrition Education Conference. (Miscellaneous Publication No. 913). Washington, D.C: U.S. Department of Agriculture. larrimore, E., & Galiher, C. (1956). Effective health teachinga school and community project. Journal of Health, Physical Education and Recreation, 27, 18-19. larson, l., Massoth, D., & Chase, H. (1974). A potpourri of nutrition education methods. Journal of Nutrition Education, 6(1), 21-23. lee, G. (1963). Texas community tackles teen-age food and nutrition program. Journal of Home Economics, 55(10), 763-766. le Gros Clark, F. (1944). Food habits and howto change them. The Lancet, 2, 53-54. leong, Y. (1970). Nutrition education for the aged and chronically ill. Journal of Nutrition Education, 1, 18-20. leventhal, H. (1973). Changing attitudes and habits to reduce risk factors in chronic disease. The American Journal of Cardiology, 31, 571-580. leventhal, H., Safer M., & Panagis, D. (1983). The impact of communications on the self-regulation of health beliefs,

540 JOURNAL OF NUTRITION EDUCAnON

decisions, and behavior. Health Education Quarterly, 10(1), 3-29. levine, R., McChesney, A., & Bush, M. (1979). An assessment of high school nutrition education. Journal of Nutrition Education, 11(3),124-126. levy,S., Iverson, B., & Walberg, H. (1980). Nutrition education research: An interdisciplinary evaluation and review. Health Education Quarterly, 7(2),107-126. lewin, K. (1943). Forces behind food habits and methods of change. In The problems of changing food habits by the Committee on Food Habits. (NRC Bulletin No. 108). Washington, D.C: National Research Council. lieberman, H., Hunt, I., Coulson, A., Clark, V., Swendseid, M., & Ho, l. (1976). Evaluation of a ghetto school breakfast program. Journal of the American Dietetic Association, 68, 132-138. light, l. (1976). Cameras help the elderly to improve food patterns. Journal of Nutrition Education, 8(2), 80-82. light, l. (1978). Nutrition education: Policies and programs. Nutrition Program News, lanuary-April, 12pp. lowenberg, M. (1974). The development of food patterns. Journal of the American Dietetic Association, 65, 263-268. lutwak, l. (1974). Continuing need for dietary calcium throughout life. Geriatrics, 29, 171-178. Madsen, C. H., Madsen, C K., & Thomspon, F. (1974). Increasing rural head start children's consumption of middle-class meals. Journal of Applied Behavior Analysis, 7(2),257-262. Mahoney, M. (1974). The behavioral treatment of obesity. Behavioral Research Data Review, 121-131. Mahoney, M. (1975). The obese eating style: Bites, beliefs, and behavior modification. Addictive Behaviors, 1, 47-53. Manoff, R. (1974). The effective use of mass media in nutrition education. PAG Bulletin, 4(1), 12-17. Marinho, H. (1942). Social influence in the formation of enduring preferences. Journal of Abnormal and Social Psychology, 37, 448-468. Martinez, G., & Stahle, D. (1982). The recent trend in milk feeding among WIC infants. American Journal of Public Health, 72(1),68-71. Mcintosh, W. (1982). Socio-cultural aspects of adolescent food behavior: The role of sociological theory in predicting and explaining food behavior: the role of sociological theory in predicting and explaining food behavior. Proceedings of International Symposium: Adolescent Nutrition and Food Behavior. University of Prince Edward Island, Canada. McKenzie, I. (1974). The impact of economic and social status on food choice. Proceedings Nutrition Society, 33, 67-73. McKenzie, I. (1982). Social and economic factors influencing food choice of different consumer groups. Proceedings of International Symposium: Adolescent Nutrition and Food Behavior. University of Prince Edward Island, Canada. McKenzie, J., Mattison, I., & Yudkin, I. (1967). Milk in schools: An experiment in nutrition education. British Journal of Nutrition, 21, 811-817. McKenzie, I., & Mumford, P. (1965). The evaluation of nutrition education programmes: A review of the present situation. World Review of Nutrition and Dietetics,S, 21-31. McMillan, T., & leverton, R. (1943). The self-chosen diets of college girls in a co-operative dormitory. Journal of Home Economics, 514-518 Mead, M. (1964). The factor of food habits. Annual of American Academic Political Social Science, 225, 136-141. Mead, M. (1949). Cultural patterning of nutritionally relevant behavior. Journal of the American Dietetic Association, 25, 677-680. Mead, M. (1964). Food habits research: Problems of the 1960's.

VOLUME 17 NUMBER 2 SUPPLEMENT

1985

(National Research Council Publication No. 1225). Washington, D.C: National Academy of Sciences. Metheny, N., Hunt, F., Patton, M., & Heye, H. (1962). The diets of preschool children: I. Nutritional sufficiency findings and family marketing practices. Journal of Home Economics, 54(4), 297-308. Meyers, A., Stunkard, A., & Coli, M. (1980). Food accessibility and food choice. Archives of General Psychiatry, 37, 1133-1135. Mills, E. (1972). Applying learning theory in tracking nutrition. Journal of Nutrition Education, 4, 106-107. Mills, E. (1977). Psychosocial aspects of food habits. Journal of Nutrition Education, 9(2), 67-68. Montandon, C. (1974). Fun food fest: Target PSA's. Journal of Nutrition Education, 6(2), 66-67. Moore, H. (1952). Psychologic facts and dietary fancies. Journal of the American Dietetic Association, 28, 789-794. Morse, W., Sims, L., & Guthrie, H. (1979). Mothers' compliance with physicians' recommendations on infant feeding. Journal of the American Dietetic Association, 75, 140-148. Neff, M. (1964). Helping low-income families use donated foods. Journal of the American Dietetic Association, 45, 358-361. Nelson, E., Catchings, M., & Pendleton, T. (1983). Weight reduction and maintenance for overweight, mentally retarded students, ages 9-17. Journal of School Health, 53(6), 380-381. Nestor, J., & Glotzer, J. (1981). Teaching nutrition: A review of programs and research. ABT Books: Cambridge, MA. New England Conference on Food, Nutrition and Health. (1979). Final Report: Vol. I: The Conference. Boston, MA. New England Conference on Food, Nutrition and Health. (1979). Final Report: Vol. 1/: The Position Papers. Boston, MA. Nickel, S. (1982). Teaching a nutrition unit utilizing a computerized analysis of students' diets. American Journal of Pharmaceutical Education, 46, 156-158. Niedermeyer, F., & Boscon, T. (1981). The development of a behavior-focused nutrition education program for fifth graders. Educational Development Specialists, lakewood, CA. Niedermeyer, F., Boscon, T., & Ice, K. (1982). Focusing nutrition education on student behavior. Science and Children, 19(5). Niehoff, A. (1967). Food habits and the introduction of new foods. Journal of the Washington Academy of Science, 57, 30-37. • Niehoff, A. (1969). Changing food habits. Journal of Nutrition Education, Summer, 10-11. Nielsen, H. (1982). Is it possible to influence adolescent nutrition behavior? Proceedings of International Symposium on Adolescent Nutrition and Food Behavior, University of Prince Edward Island, Canada. Norman, E. (1958). Group discussion on changing food habits. Journal of the American Dietetic Association, 34, 1187-1189. Office of Evaluation Research. (1977).Report on the learning environment results, field test logs, and team leader comments of the National Dairy Council nutrition education curriculum, K-6: fight major field sites, University of Illinois at Chicago Circle, Chicago, Illinois. Olson, C, Frongillo, E., & Schardt, D. (1983). Final report: An examination of nutrition education practices and materials in elementary schools. Ithaca, NY: Cornell University, Division of Nutritional Sciences. Olson, C, & Gillespie, A. (1981). Highlights ofthe discussions. Proceedings of the workshop on Nutrition education

VOLUME 17 NUMBER 2 SUPPLEMENT 1985

research: Applying principles from the behavioral sciences. Journal of Nutrition Education, 13(1),5576-5579. Olson, J., & Sims, L. (1980). Assessing nutrition knowledge from an information processing perspective. Journal of Nutrition Education, 12(3),157-161. O'Rourke, T., & Koizumi, K. (1982). Beyond the basic four: What does Johnny know about nutrition? The Journal of School Health, 52, 212-216. Orr, J. (1939). Milk and nutrition: New experiments reported to the Milk Nutrition Committee: Part 4. Shinfield, Reading, England: The National Institute for Research in Dairying. Osman, J. (1974). Instruction with misconceptions.lnstructor, 83,48-50. Pao, E., & Hill, M. (1974). Diets of the elderly, nutrition labeling and nutrition education. Journal of Nutrition Education, 6(3), 96-99. Parren, T. (1940). Improving America's diet. Science Digest, 21-26. Passin, H., & Bennet, J. (1943). Social process and dietary change. In The problem of changing food habits, (National Research Council Bulletin No. 108). Washington, D.C.: Committee on Food Habits. Pelcovitis, J. (1973). Nutrition education to group meals programs for the aged. Journal of Nutrition Education, 5(2), 118-120. Pelto, G. (1981). Anthropological contributions to nutrition education research. Proceedings of the workshop on nutrition education research: Applying principles from the behavioral sciences. Journal of Nutrition Education, 13(1), 552-558. Penfield, M. (1980). Food in contemporary society. StokeyVanCamp Annual Symposium Proceedings, University of Tennessee, Knoxville.; Perkins, K., Roach, F., & Vaden, A. (1980). Influence of teachers' attitudes toward the school lunch program on student participation, Journal of Nutrition Education, 12(2), 55-60. Peters, L. (1943). The contemporary food situation inside Holland. Journal of the American Dietetic Assocition, 19, 259-260. Phipard, E. (1943). Preparations for longer time feeding in liberated countries, Journal of the American Dietetic Association, 19, 269-270. Picardi,S., & Pariser, E. (1975). Food and nutrition minicourse for 11th and 12th graders. Journal of Nutrition Education, 7(1),25-29. Pirie, N. (1972). The direction of beneficial nutritional change. Ecology of Food and Nutrition, 1, 279-294. Pitkin, R., & Reynolds, W. (1981). Nutrition services in perinatal care. Washington, D.C.: National Academy Press. Pollitt, E., & lorimor, R. (1983). Effects of WIC on cognitive development. American Journal of Public Health, 73(6), 698-700. Poolton, M. (1972). Predicting application of nutrition education. Journal of Nutrition Education, 4, 110-113. Poolton, M. (1978). What can we do about food habits? Journal of School Health, 48, 646-648. Potgieter, M., & Everitt, V. (1950). A study of children's eating habits. Journal of Home Economics, 42, 363-366. Pye, O. (1976). Retrospects and prospects in nutrition education. Journal of Nutrition Educatio", 8(4), 154-155. Radin, G. (1943). Yugoslavian plans for restored food sufficiency. Journal of the American Dietetic Assocation, 19, 271-273. Rand, C (1976). Nutrition behavior: Exploring its sociological influences. Illinois Teacher, 19, 198-203. Reddin, J. (1982). A study of food behavior of Prince Edward

JOURNAL OF NUTRITION EDUCATION S41

Island adolescents: The hole in our holistic approach. Proceedings of International Symposium: Adolescent Nutrition and Food Behavior. University of Prince Edward Island, Canada. Rich, l. (1978). How munch changed lunch at Oakham. American Education, October, 24-29. Ritchie, j. (1950). Teaching people better habits of diet. journal of the American Dietetic Association, 26, 94-97. Roberts, l. (1944). Improvement of the nutritional status of American people. journal of Home Economics, 36, 401-404. Roberts, l., & Blair, R. (1950). A teacher-education project in improving child nutrition. School Life, 26(9), 273-276. Robinson, j. (1978). Special milk program evaluation and national school lunch program survey. United States Department of Agriculture: Food and Nutrition Service. Rody, N. (1978). Things go better with coconuts: Program strategies in Micronesia. journal of Nutrition Education, 10(1), 19-22. Rose, M. (1932). Teaching nutrition to boys and girls. New York: The Macmillan Company. Rountree, j., & Tinklin, G. (1975). Food beliefs and practices of selected senior citizens. Gerontologist, 15, 537-540. Rowntree, j. (1950). Influences on children's food habits. journal of Home Economics, 42(10), 805-807. Sabry, j., Ford, D., Roberts, M., & Wardlaw, j. (1974). Evaluative technical for use with children's diets. journal of Nutrition Education, 6(2), 52. Schachter,S., & Gross, l. (1968). Manipulated time and eating behavior. journal of Personality and Social Psychology, 10(2), 98-106. Schlechter, F. (1981). An experiment in group adolescent weight loss guidance. The journal of School Health, 51(2), 123-124. Schorr, B., Sanjur, D., & Erickson, E. (1972). Teen-age food habits. journal of the American Dietetic Association, 61, 415-420. Schuchat, M. (1973). The school lunch and its cultural environment. journal of Nutrition Education, 5(2), 116-118. Schuster, K., Bailey, l., & Mahan, C. (1981). Vitamin B6 status of low-income adolescent and adult pregnant women and the condition of their infants at birth. American journal of Clinical Nutrition, 34, 1731-1735. Shier, N., Sims, l., Narins, D., & Mickelsen, O. (1973). Nutrition self-experiments with lipids, carbohydrates and protein. journal of Nutrition Education, 5(4), 237-242. Sims, l. (1978). Dietary status of lactating women. journal of the American Dietetic Association, 73, 147-154. Sims, l. (1981). Further thoughts on research perspectives in nutrition education. journal of Nutrition Education, 13(1), 570-575. Sims, l., & light, l. (1980). Directions for nutrition education research: The Penn State Conferences: A proceeding. University Park, PA. Singleton, N., & Rhoades, D. (1982). Meal and snacking patterns of students. The journal of School Health, 52(9), 529-534. Sliepcevich, E. (1964). School health education study: A summary report. Washington, D.C. Sionim, A., Kolasa, K., & Bass, M. (1981). The cultural appropriateness of the WIC Program in Cherokee, North Carolina. journal of the American Dietetic Association, 79, 164-168. Smick las-Wright, H., & D'Augelli, A. (1978). Primary prevention for overweight: Preschool eating patterns (PEP) program. journal of the American Dietetic Association, 72, 626-629. Spindler, E., jacobson, M., & Russell, C. (1969). Action

S42 JOURNAL OF NUTRITION EDUCATION

programs to improve nutrition. journal of Home Economics, 61(8), 635-639. Stiebeling, H. (1964). Improved use of nutritional knowledge: Progress and problems. journal of the American Dietetic Association, 45, 321-326. St. Pierre, R., & Resmovic, V. (1982). An overview of the national nutrition education and training program evaluation. journal of Nutrition Education, 14(2), 61-66. Stronch, D. (1976). The need for nutrition education. The American Biology Teacher, 19-23. Stunkard, A., & Penick, S. (1979). Behavior modification in the treatment of obesity: The problem of maintaining weight loss. Archives of General Psychiatry, 36, 801-806. Sullivan, A., & Schwartz, N. (1981). Assessment of attitudes and knowledge about diet and heart disease. journal of Nutrition Education, 13(3),106-108. Sunseri, A., Alberti, j., Kent, N., Schoenberger, j., Sunseri, j., Amuwo. 5., & Vichers, P. (1983). Reading, demograhic, social and psychological factors related to pre-adolescent smoking and non-smoking behaviors and attitudes. journal of School Health, 53(4), 257-263. Sunseri, A., Albert, j., Schoenberger, j., Kent, N., Dolecek, T., & Sunseri, j. Design of an humanistic heart health curriculum. Publication unknown. Sutton, W. (1961). Misconceptions about health among children and youth. The journal of School Health, 347-351. Swanson, j. (1972). Second thoughts on knowledge and attitude effects upon behavior. journal of School Health, 42(6), 363-365. Sweeny, M. (1942). Changing food habits. journal of Home Economics, 457-462. Sydney, P. (1965). A proposal for using discussion-decision as a method of changing dietary patterns with the Indian villagers. Unpublished master's thesis, Cornell University, Ithaca, NY. Talmage, H. (1978). Nutrition education achievement test: Item analysis for National Dairy Council, Inc. Chicago: University of Illinois, Office of Evaluation Research. Talmage, H., Haertel, G., & Brun, j. (1981). Using learned environment data in formative curriculum evaluation. journal of Nutrition Education, 13 14-16. Talmage, H., & Rasher, S. (1978). Nutrition education achievement test item analysis for National Dairy Council, Inc. (Technical Report No. 105). Chicago: University of Illinois, Office of Evaluation Research. Talmage, H., & Rasher, S. (1978). Nutrition education achievement test item analysis for National Dairy Council, Inc. (Technical Report No. 106). Chicago: University of Illinois, Office of Evaluation Research. Talmage, H., & Rasher, S. (1979). Food: Your choice, level 4. (Technical Report No. 128). Chicago: University of Illinois, Office of Evaluation Research. Talmage, H., & Rasher, S. (1981). Validity and reliability issues in measurement instrumentation. journal of Nutrition Education, 13(3), 83-92. Talmage, H., & Rasher, S. (1981). Comparison of pre to post NAT and LEI results controlling for sit-social studies program FYC level 4. (Technical Report No. 134(c)). Chicago: University of Illinois, Office of Evaluation Research. Tax, S. (1957). Changing consumption in Indian Guatemala. Economic Development and Cultural Change,S, 147-158. Teaching nutrition. (1954). journal of the American Dietetic Association, 30, 1264. Teulon, H. (1968). Changes in dietary habits: Their importance in nutrition education program. Nutrition Newsletter, 6(1), 53-55. Thenen, S. (1982). Folacin content of supplemental foods for

VOLUME 17 NUMBER 2 SUPPLEMENT

1985

pregnancy. journal of the American Dietetic Association, 80, 237-241.

Thompson, J., & Schwartz, N. (1977). Nutritional knowledge, attitudes and practices of eighth grade students. journal of the Canadian Dietetic Association, 38(3), 222-228. Tisdall, F., Robertson, E., Drake, T., Jackson, S., Fowler, H., long, J., Brouha, l., Ellis, R., Phillips, A., & Rogers, R. (1951). The Canadian red cross school meal study. The Canadian Medical Association journal, 64(6), 477-489. Trulson, M. (1954). Assessment of dietary study methods. journal of the American Dietetic Association, 30, 991-995. Trulson, M., & McCann, M. (1959). Comparison of dietary survey methods. journal of the American Dietetic Association, 35, 672-676. Tyler, R. (1930). What high-school pupils forget. Educational Research Bulletin, November, 490-492. Tyler, R. (1934). Some findings from studies in the field of college biology. Science Education, 18(3),133-142. Underwood, B. (Ed.) (1983). Nutrition intervention strategies in national development. New York: Academic Press. U.S. Department of Agriculture. (1982). An assessment of the objectives and implementation of the 4-H expanded food and nutrition education program summary. Washington, D.C.: Extension Service, Science and Education. U.S. Department of Agriculture. (1982). A study of the implementation of the youth component of the expanded food and nutrition education program. Prepared by A. French, S. Shieh, & C. Roesel. (Contract No. 53-3KOG-1-96). Washington, D.C.: Extension Service. U.S. Department of Agriculture. (1982). An assessment of the objectives, implementation and effectiveness of the adult expanded food and nutrition education program summary. Washington, D.C.: Extension Service, Science and Education. U.S. Department of Agriculture. (1982). Implications of the results from "An assessment of the objectives, implementation and effectiveness of the adult expanded food and nutrition education program" for program policy and practice. Washington, D.C.: Extension Service, Science and Education. U.S. Department of Agriculture. (unknown). Appendix A: National perspective on the goals, objectives and implementation of the expanded food and nutrition education program. Washington, D.C. U.S. Department of Agriculture. (unknown). Appendix B: Study of targetting of funds and services. Washington, D.C. U.S. Department of Agriculture. (unknown). Appendix C: Review of literature to the EFNEP assumptions and logic. Washington, D.C. U.S. Department of Agriculture. (unknown). Appendix C: Abstracts of selected articles reviewed as part of the fFNEP literature review. Washington, D.C. U.S. Department of Agriculture. (unknown). Appendix C2: EFNEP special projects: A summary. Prepared by C. Novalis. Washington, D.C. U.S. Department of Agriculture. (1981). Case studies for an assessment of the conduct of the expanded food and nutrition education program in selected sites. Prepared by C. Roesel. (Contract No. 53-3KOG-0-l03). Washington, D.C.: Science and Education Administration. U.S. Department of Agriculture. (1981). Technical appendices for an assessment of the conduct of the expanded food and nutrition education program in selected sites. Prepared by A. French, D. Cavenaugh, C. Roesel, & S. Shieh. (Contract No. 53-3K06-Q-l03). Washington, D.C.: Science and Education Administration. U.S. Department of Agriculture. (1981). Instruments for an assessment of the conduct of the expanded food and

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nutrition education program in selected sites. (Contract No. 53-3K06-Q-l03). Washington, D.C.: Science and Education Administration. U.S. Department of Agriculture. (1980). Data base design for an assessment of the conduct of the expanded food and nutrition education program in selected sites. Prepared by A. French, & W. Mahoney. (Contract No. 53-3K06-0-103). Washington, D.C.: Science and Education Administration. U.S. Department of Agriculture. (1982). Executive summary: The comparative study of six USDA food and nutrition programs. Prepared by J. Roth, & B. Fontana. Washington, D.C. U.S. Department of Agriculture. (1982). The comparative study of six USDA food and nutrition programs. Prepared by J. Roth, & B. Fontana. Washington, D.C. U.S. Department of Agriculture. (1981). Approximating longitudinal analysis from cross-sectional diifa. Prepared by A. Beaton. Washington, D.C. U.S. Department of Agriculture. (1982). Approximating mean longitudinal curves using cross-sectional data. Prepared by A. Beaton. Washington, D.C. U.S. Department of Agriculture. (1973). Commonality. Prepared by A. Beaton. Washington, D.C. U.S. Department of Agriculture. (unknown). Appendix F3: EFNEP weight-for-height outcome effects. Washington, D.C. U.S. Senate Select Committee on Nutrition and Human Needs. (1974). The five imperatives of a national food policy recommended by the panel on nutrition and the consumer. journal of Nutrition Education, 6(3), i-viii. Vaden, A., Newell, G., Dayton, A., & Foley, C. (1983). Establishing the need for nutrition education: 1. Methodology. journal of the American Dietetic Association, 83(4), 441-453. Vance, T. (1932). Food selection of nursery school children. Child Development, 3, 169-175. Warland, R. (1982). Nutrition concerns of women not central in food choices. Science in Agriculture. 30(1). Werblow, J., Fox, H., & Henneman, A. (1978). Nutritional knowledge, attitudes, and food patterns of women athletes. journal of the American Dietetic Association, 73, 242-245. Werner, R. (1976). Weight reduction and weight control strategies for obese individuals: A case for behavior modification. The journal of School Health, 46(10), 602-606. White, R. (1962). Turkish and American women study feeding the family: An experiment in nutrition teaching in Ankara. journal of Home Economics, 54(4), 390-393. Whitehead, F. (1957). Nutrition education for children in the U.S. since 1900: Part I. journal of the American Dietetic Association, 33, 88D-889. Whitehead, F. (1973). Nutrition education research. World Review of Nutrition and Dietetics, 17, 91-149. Willerman, B. (1943). Food habits and methods of change. In The problem of changing food habits, (National Research Council Bulletin No. 108). Washington, D.C.: Committee on Food Habits. Wilson, A. (1961). Nutritional change: Some comments from social research. Proceedings of the Nutrition Society, 20, 133-137. Wing, R., & Jeffery, R. (1978). Successful losers: A descriptive analysis of the process of weight reduction. Obesity/ Bariatric Medicine, 7(5}, 190-191. Wing, R., & Jeffery, R. (1979). Outpatient treatments of obesity: A comparison of methodology and clinical results. International journal of Obesity, 3, 261-279. Wishik, S., & Van der Vynckt, S. (1976). The use of nutritional 'positive deviants' to identify approaches for modification

JOURNAL OF NUTRITION EDUCATION 543

of dietary practices. American journal of Public Health, 66(1), 38-42. Witherell, J. (1978). From pretzels and potato chips to liver and lettuce: A case history. Day Care and Early Education, 5, 15. Wolf, R. (1980). The role of evaluation in nutrition education. In H. Sinclair & G. Howat (Eds.), World nutrition and nutrition education. New York: Oxford University Press. Woody, E., Costanzo, P., Liefer, H., & Conger, J. (1981). The effects of taste and caloric perceptions on the eating behavior of restrained and unrestrained subjects. Cognitive Therapy and Research, 5(4), 381-390. Yarbrough, P. (1981). Communication theory and nutrition education research. journal of Nutrition Education, 13(1), 516-526. Yetley, E., & Roderuck, C. (1980). Nutritional knowledge and health goals of young spouses. journal of the American Dietetic Association, 77, 31-41. Yetley, E., Yetley, M., & Aguirre, B. (1981). Family role structure and food-related roles in Mexican-American families. journal of Nutrition Education, 13(1), 596-5101. Young, c., Berresford, K., & Waldner, B. (1956). What the

S44 JOURNAL OF NUTRITION EDUCAnON

homemaker knows about nutrition: I. Description of studies in Rochester and Syracuse, New York. journal of the American Dietetic Association, 32, 214-217. Young, c., Waldner, B., & Berresford, K. (1956). What the homemaker knows about nutrition: II. level of nutritional knowledge. journal of the American Dietetic Association, 32, 218-222. Young, c., Waldner, B., & Berresford, K. (1956). What the homemaker knows about nutrition: IV. Her food problems, shopping habits, and sources of information. journal of the American Dietetic Association, 32, 429-434. Yperman, A., & Vermeersch, J. (1979). Factors associated with children's food habits. journal of Nutrition Education, 11(2), 72-76. Yudkin, J. (1963). Changing food habits. Nature, 200, 728-729. Yudkin, J., & McKenzie, J. (1964). Changing food habits. london: Macgibbon & Kee. Zimbardo, P., Ebbesen, E., & Maslach, C. (1977). Influencing attitudes and changing behavior. Menlo Park, CA: Addison-Wesley Publishing Company. Zimmerman, R., & Munro, N. (1972). Changing head start mothers' food attitudes and practices. journal of Nutrition Education, 4, 66-68.

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