Source: RUTGERS, THE STATE UNIVERSITY OF NEW JERSEY submitted to NRP
PEOPLE, PLANTS, & THE PLANET: A MULTI-METHOD STUDY TO DEVELOP, IMPLEMENT & EVALUATE A FOOD & CLIMATE CHANGE INTERVENTION TO EMPOWER ADOLESCENTS TO MAKE HEALTHY & SUSTAINABLE PLANT-BASED FOOD CHOICES.
Sponsoring Institution
National Institute of Food and Agriculture
Project Status
COMPLETE
Funding Source
Reporting Frequency
Annual
Accession No.
1028290
Grant No.
2022-69015-36756
Cumulative Award Amt.
$298,290.00
Proposal No.
2021-08216
Multistate No.
(N/A)
Project Start Date
Jan 15, 2022
Project End Date
Jan 14, 2025
Grant Year
2022
Program Code
[A1344]- Diet, Nutrition and the Prevention of Chronic Disease
Recipient Organization
RUTGERS, THE STATE UNIVERSITY OF NEW JERSEY
3 RUTGERS PLZA
NEW BRUNSWICK,NJ 08901-8559
Performing Department
Family & Community Health Sci
Non Technical Summary
The diets of adolescents are poor and fail to meet dietary recommendations. While adolescents exceed recommendations for added sugar, saturated fat, sodium, and refined grains, and consume sufficient quantities of meat, poultry, and eggs, they are under-consuming plant-based food groups such as fruits and vegetables, whole grains, legumes, nuts, and seeds. Shifting adolescents' food choices towards increasing their plant-based food choices (i.e., fruits, vegetables, whole grains) has the potential to improve health and reduce chronic disease risk. It also has the potential to reduce the environmental impact of their diets, especially given that dietary patterns established earlier in life tend to continue through adulthood. This project aims to develop, implement, and pilot-test an innovative planetary health curriculum that will encompass the impact of food on planetary and human health that is grounded in their decision-making processes to increase plant-based foods that support the prevention of chronic disease among adolescents. This curriculum will be responsive to the recent New Jersey climate change education requirement for K-12 schools.The overarching goal of this Seed Grant is to a) gain an understanding of factors affecting the plant-based food choices of adolescents. b) develop a behaviorally focused, theory-driven intervention using a community-based participation approach to gather input and feedback from adolescents aimed at increasing intake of plant-based foods, c) refine the intervention based on a pilot-test, and d) scale up the products of this Seed Grant by seeking funding to conduct a rigorous, randomized controlled multi-state trial in school cafeterias throughout the United States.
Animal Health Component
100%
Research Effort Categories
Basic
0%
Applied
100%
Developmental
0%
Classification

Knowledge Area (KA)Subject of Investigation (SOI)Field of Science (FOS)Percent
70304303020100%
Knowledge Area
703 - Nutrition Education and Behavior;

Subject Of Investigation
0430 - Climate;

Field Of Science
3020 - Education;
Goals / Objectives
The long-term goal of this projectis to reduce the prevalence of obesity and associated chronic diseases among adolescents. The shorter-term goals and supporting objectives for this proposal include:Goal 1: To examine the influence of adolescents' climate change knowledge and beliefs on their food choices with the goal of informing the development of an educational intervention to increase plant-based foods (i.e., fruits, vegetables, whole grains) and subsequently reduce the prevalence of chronic diseases among adolescents. This curriculum will not support excluding food groups from adolescents' diets, rather will support the inclusion of more plant-based foods (i.e., fruits, vegetables, whole grains). This curriculum will be responsive to the recent New Jersey climate change education requirement for K-12 schools.Goal 2: To develop, implement, and pilot-test an innovative planetary health curriculum to increase plant-based foods (i.e., fruits, vegetables, whole grains) that support the prevention of chronic disease among adolescents.
Project Methods
OBJECTIVE 1. Identify how sustainability and health considerations influence plant-based food choices among adolescents.Rationale: Using a combination of focused qualitative methods to describe adolescents' cognitive models--how they perceive and organize information and the value judgments they make about it--we will design lessons to increase adolescents' plant-based dietary choices.Sample: We will purposively select a sample of adolescents to participate in semi-structured interviews that involve free listing, pile sorting, and rating. To ensure racial/ethnic and SES diversity, we will recruit approximately 20 participants from each of the following middle school types: 1) urban, low-income; 2) urban, middle income; 3) suburban, middle income. Our subgroup sample size (20 students per school type) is aligned with the recommended sample size for the proposed methodologies.Methods- Data collection: We will conduct two semi-structured interviews with individuals in our sample (n=60 total; 20 from each school type) for the cognitive mapping exercise. Cognitive mapping provides a systematic approach for including qualitative data in the design of tailored intervention.24 In the first interview, we will use free listing to produce a list of sustainability and health factors that influence food choices. In the second interview, we will use pile sorting and rating of the factors identified through free listing to examine the relationship between food groups and food choice influencers. Dr Downs has previously used these methods to inform the design of nutrition interventions.Methods- Data analysis: Key themes from the interview transcripts will be identified through content analysis, and transcripts will be coded by two research team members using NVivo. All transcripts will be open, axial, and selectively coded as per accepted approaches to analyzing qualitative data.A codebook will be created and maintained in an iterative process - the coders will meet regularly to review the codebook, identify new codes, and discuss coding discrepancies. Thereafter, all codes and findings will be discussed with the larger research team. Food choice influencers identified through the free listing exercise will be ordered by salience.Salient items are those that are more familiar, important, or relevant in a particular culture or community.Salience will be calculated using Smith's S index, which incorporates both the frequency of mention and order of recall of items.Similarities and differences between the most salient foods and influencers for different subgroups will be compared using correlation matrices. The analysis will be conducted using FLARES and R software. We will use the ratings of the food by the different influencers (property-fitting analysis) as well as interview transcripts to interpret how participants grouped the different foods.Key themes, the influencers for different foods, and differences among different subgroups, will be used to inform the design of the labels that will be tested in Objective 3.OBJECTIVE 2: Develop Food and Climate Curriculum.The team will examine scholarly work of educational programs for K-12 schools that promote change in student eating habits and related psychology-oriented approaches utilized in successful environmental and health campaigns across the U.S. and beyond. Findings from this scoping literature review will be informative for determining what has or has not worked in prior environmental and health educational programs in changing student's perceptions of plant-based foods (i.e., fruits, vegetables, whole grains). Develop online materials for the People, Plants, and the Planet curriculum. The goal of this stage of the project will be to develop lessons that can be presented online or in-person on topics indicated as salient in Objective 1. The lessons will include short educational videos which we will partner with Rutgers Teaching & Learning with Technology office to professionally develop. The team will create lesson plans for teachers that meet the NJ Student Learning Standards, Food Education Standards, and the new state climate education requirements. All educational videos and lesson plans will be reviewed by Content Expert Advisors to ensure accuracy and cultural sensitivity. In addition to the online video content, the team will partner with Rutgers Game Research and Immersive Design (GRID) to create video games for students that are associated with the curriculum. The games will be immersive and engaging with the goal of reinforcing the concepts students learn in the lessons. Games will be easily adaptable to both in-person and virtual learning environments. We anticipate we will develop twelve one-hour lessons with supplemental education online based on well-documented research indicated that 40 to 50 hours of intensive education is needed for behavior change.Once the curriculum is developed it will undergo cognitive testing to ensure adolescents understand it and it is acceptable to them.OBJECTIVE 3: Compare the impact of a food and climate curriculum on plant-based food choices among adolescents.Rationale: A pilot study will examine the influence of adolescents' climate change knowledge and beliefs on their plant-based food choices. The pilot study in two school districts will assess shifts in selection and consumption behaviors of adolescents before and after the inclusion the People, Plants, and the Planet curriculum in their classrooms through tray observations in the cafeteria. Drs. Elnakib and Policastro have previously used these methods in NJ Schools.Sample: We will conduct a selection and consumption audit in the cafeterias of five middle schools in NJ. We will randomly select and follow five classes which will receive the People, Plants, and the Planet curriculum (i.e. promoting plant-based diets for sustainability and health); Each group will consist of 30 students, for a total n=150. The sample size is based on the number of participants needed to evaluate the feasibility of protocols, as well as the number of observations needed to conduct statistical analyses examining differences among sub-groups.Methods- Data collection: The experiment will last a total of 16 weeks. In weeks 1 and 2, data will be collected on food selection and consumption (primary outcome) by students in both districts. Students' trays will be examined following food selection and items selected will be recorded. Students will also be instructed to leave their trays behind after completion of the meal, and food waste (which is used as a proxy for consumption) will be measured in grams. During weeks 3-14, students in the experimental group will receive the food and climate curriculum; 1 lesson a week for 12 weeks by cooperative extension personnel. For weeks 15 and 16 food selection and consumption (measured with food waste) will again be collected in both schools. Following the completion of observations, students who were exposed to the People, Plants, and the Planet curriculum will be asked post-observation questions about their use and perceptions of the education program using the PME scale (secondary outcomes).Methods- Data analysis: Our primary outcomes will be food selection and consumption before and after the People, Plants, and the Planet curriculum. To estimate the impact of the People, Plants, and the Planet curriculum on selection and consumption we will use a difference-in-differences approach comparing the control and experimental schools. Linear regression models will be fitted for each outcome, with explanatory variables that include the intervention indicator, time, and intervention by time interaction. The interaction term is of primary interest, as it summarizes mean changes in food selection and consumption pre- and post- the People, Plants, and the Planet curriculum. Secondary outcome will be assessed using descriptive statistics.

Progress 01/15/23 to 01/14/24

Outputs
Target Audience:Goal 1: We have accomplished the major objectives of this goal entirely. We have completed semi-structured cognitive interviews with Three school districts across New Jersey representing different community structures: Newton School District (rural), Paterson School District (urban), and Long Branch School District (coastal). A convenience sample of 41 students was obtained. 24.4% (n=10) were 10 years old, 58.5% (n=24) were 11 years old, and 4.9% (n=2) were 12 years old. 51.2% (n=21) were female, 46.3% were male (n=19), and 2.4% (n=1) was of unknown gender. Changes/Problems:We need additional time to complete the manuscripts in development, we have submitted for a no-cost extension to complete this stage of the proposal. What opportunities for training and professional development has the project provided?Formally and informally trained graduate and undergraduate students on interview skills and development of lesson materials, plans, videos, and worksheets. Created ten units, including lesson plans, lesson materials, PowerPoint presentations, and videos on food systems, environmental concerns, and the integration of both. Implemented process evaluation techniques, monitored data collection activities, and analyzed data using multiple software and techniques that were led by students and supported by the PIs. How have the results been disseminated to communities of interest?Results have been disseminated via posters and oral presentations at professional conferences for nutrition, education, and extension both nationally and internationally. Additionally, multiple manuscripts and conference proceedings are being developed or have been submitted to share the results of this project. Finally, once the final revisions of the curriculum are completed based on the process evaluation results, cooperative extension personnel will distribute the curriculum at the county-wide superintendent round table to support dissemination across the state of New Jersey. What do you plan to do during the next reporting period to accomplish the goals?We hope to finalize the manuscripts that are currently in development and publish them in refereed journals as well as attend professional conferences to share the program.

Impacts
What was accomplished under these goals? Based on these goals, we conducted interviews with 41 students across three school districts within New Jersey to gain a better understanding of the factors that drive their food choices and what they feel they can do to care for the environment. From these interviews, we were able to develop a 5-unit, 10-lesson curriculum that centered around food systems, the connection between environmental concerns and food systems, different types of eating patterns, and ways in which students could choose foods that were both healthy for their body and good for the environment. Within these lessons, we also created videos for each unit in the curriculum with corresponding visuals, video guides, and PowerPoint presentations, which included interactive components such as response guides, worksheets, and experiments. Lastly, food waste audits were conducted in all schools prior to and after the intervention to measure changes in plant-based eating. This project also helped to mentor both undergraduate and graduate students in gaining knowledge on these topic areas and then teaching them to the 5th-grade classes.

Publications

  • Type: Websites Status: Other Year Published: 2023 Citation: https://sites.rutgers.edu/ppp/
  • Type: Conference Papers and Presentations Status: Accepted Year Published: 2023 Citation: Barlow, S.A, Downs, S., Elnakib, S., Schoolman, E., Policastro, P. USDA â¿¿ People, Plants, and the Planet â¿¿ Determinants of Food Choice in Adolescents. 27th Annual Public Health Symposium; April 2023; New Brunswick, NJ
  • Type: Conference Papers and Presentations Status: Accepted Year Published: 2023 Citation: Barlow, S.A, Downs, S., Elnakib, S., Schoolman, E., Policastro, P. USDA â¿¿ People, Plants, and the Planet â¿¿ Factors Influencing How Adolescents Care for the Planet. 27th Annual Public Health Symposium; April 2023; New Brunswick, NJ
  • Type: Conference Papers and Presentations Status: Published Year Published: 2023 Citation: Elnakib, S., Barlow, S., Downs, S., Schoolman, E., & Policastro, P. (2023). People Plants and the Planet: Determinants of Food Choice and Factors Influencing How Adolescents Care for the Planet. Journal of Nutrition Education and Behavior, 55(7), 112.
  • Type: Conference Papers and Presentations Status: Published Year Published: 2023 Citation: Barlow, S.A, Downs, S., Elnakib, S., Schoolman, E., Policastro, P. People, Plants, and the Planet â¿¿ Determinants of Food Choice & Sustainability Factors in Youth & Adolescents. American Society for Nutrition â¿¿ Nutrition 2023 Conference; July 2023; Boston, MA.
  • Type: Journal Articles Status: Awaiting Publication Year Published: 2024 Citation: Elnakib, S., Subhit, S., Policastro, P., Schoolman, E., Downs, S., Quick, V. â¿¿People, Plants, and the Planet: A Climate Change Curriculum to Support Plant-Based Eating in U.S. Adolescents⿝ Accepted by IAFOR Research Archive.
  • Type: Conference Papers and Presentations Status: Accepted Year Published: 2024 Citation: Elnakib, S. People, Plants, and the Planet: A Climate Change Curriculum to Support Plant Based Eating in U.S. Adolescents. The IAFOR International Conference on Education. Honolulu, Hawaii. January 2024.


Progress 01/15/22 to 01/14/23

Outputs
Target Audience: Goal 1: We have accomplished the major objectives of this goal entirely. We have completed semi-structured cognitive interviews with Three school districts across New Jersey representing different community structures: Newton School District (rural), Paterson School District (urban), and Long Branch School District (coastal). A convenience sample of 41 students was obtained.24.4% (n=10) were 10 years old, 58.5% (n=24) were 11 years old, and 4.9% (n=2) were 12 years old. 51.2% (n=21) were female, 46.3% were male (n=19), and 2.4% (n=1) was of unknown gender. Changes/Problems:The video games that we had intended to develop have taken longer than expected and we hope to have them ready before the student lessons however as of right now they are still being developed. What opportunities for training and professional development has the project provided?We have hired undergraduate and graduate students throughout this project to conduct literature reviews, analyze qualitative interviews and receive training on data collection. Dr. Ethan Schoolman,worked closely with two undergraduate students to review and analyze the literature on climate change curricula available and assess gaps in the literature. Through the analysis of the interviews, a graduate student, along with Drs. Shauna Downs and Sara Elnakib, created two posters highlighting the results of the free listing activities that were included in the interview. These posters were accepted as part of the poster session for the Rutgers Cooperative Extension Conference in December 2022. It will be submitted for consideration at various other conferences, providing professional development opportunities for the student workers on this grant.Shannon Barlow, the graduate student, has also received the Werner O' Schilling Endowment Scholarship for her work on this grant. A team of 12 undergraduate and graduate students were trained on January 5, 2023, on the project. Dr. Shauna Downs prepared the students with a presentation of food systems research and plant based eating. Dr. Sara Elnakib trained them ondata collection methods in process evaluations, impact evaluations, and outcome evaluations to prepare for the implementation of the program in the coming weeks. All students performed food waste audits and collected information on inter-rater reliability to ensure accurate data collection. Dr. Ethan Schoolman reviewed the curriculum with the students to prepare them for teaching the program. Dr. Ethan Schoolman will continue to have regular meetings with the students before starting any new lesson to ensure they are prepared to teach it in the 5th-grade classrooms. How have the results been disseminated to communities of interest?The following results have been shared through two posters developed by the PIs and a graduate student and have been shared at theRutgers Cooperative Extension Conference in December 2022. A manuscript is being developed and will be published in a peer reviewed journal. Results: Semi-structured interviews were conducted to understand drivers of adolescent food choice. The interviews included afree listing activity where we used Smith's Salience (S) Index to identify the most important factors that these fifth-grade students considered when deciding what foods they would choose to consume. Smith's Salience (S) Index utilizes both frequencies of mention and rank of order to determine the most salient terms. This study was approved by the Rutgers IRB.Results of the Smith's (S) Salience analysis indicate food choice factors of taste (0.312) and health (0.268) were the most salient among all 3 schools. Additional factors cited by the three schools as being most salient were friends' opinion and influence (0.089), discipline and family influence (0.128), food preference (0.077), flavors (0.081), price (0.053), texture (0.063), and sport performance (0.061).Results of the Smith's (S) Salience analysis indicate the sustainability factor of picking up litter (0.3069) was the most salient among all 3 schools. Additional factors cited by the three schools as being most salient were animal protection (0.1504), recycling (0.2276), preventing garbage in the ocean (0.1476), throwing away garbage (0.2096), avoiding plastic items (0.0598), energy & water conservation (0.0874), reuse & repurpose (0.1089), and preservation & protection of plants and trees (0.2423). What do you plan to do during the next reporting period to accomplish the goals?The primary focus of this upcoming year is to implement the program that has been developed in the three school districts that have been identified and evaluate our impacts. Three types of evaluations are planned. A process evaluation will document the implementation of the curriculum and ensure that the curriculum is implemented with fidelity. The impact evaluation includes a pre and post-test that students will take to assess their knowledge, attitudes, and beliefs around climate change and plant-based eating and assess if the curriculum has impacted the students in any way. And finally the outcomes evaluation will include food waste audits in the schools were the team will assess the selection and consumption behaviors of the students both before and after the curriculum is taught.

Impacts
What was accomplished under these goals? Goal 1: We have accomplished the major objectives of this goal entirely. We have completed semi-structured cognitive interviews with Three school districts across New Jersey representing different community structures: Newton School District (rural), Paterson School District (urban), and Long Branch School District (coastal). A convenience sample of 41 students was obtained.24.4% (n=10) were 10 years old, 58.5% (n=24) were 11 years old, and 4.9% (n=2) were 12 years old. 51.2% (n=21) were female, 46.3% were male (n=19), and 2.4% (n=1) was of unknown gender. We then analyzed the results of these interviews and developed research posters which we disseminated to colleagues and other professionals at the Rutgers Cooperative Extension Conference in December 2022. We also utilized the results in helping to inform the basis of the curriculum, which will be piloted in the schools this upcoming spring. The curriculum ties in with the NJ climate change education requirements. Goal 2: The objectives of this goal are currently in-progress. We have developed the curriculum that will be utilized in the schools and has developed supplemental information, including videos for each lesson, lesson plans, and PowerPoints. The implementation of this curriculum will begin in January and will conclude in May 2023.

Publications