Abstract
Background
Interventions designed to encourage fruit and vegetable (F/V) consumption within schools
are increasingly common. Thus, there is a need for valid, practical dietary assessment
instruments to evaluate their effectiveness.
Objective
The aim of this study was to examine the validity of a group-administered, paper-and-pencil
questionnaire to assess F/V selection and consumption at school lunch relative to
digital photography.
Design
This was a five-phase, method-comparison study in which the questionnaire was iteratively
modified between each phase.
Participants/setting
The study examined sets of questionnaires and photographs of lunch trays (n=1,213)
collected on 44 days between May 2015 and June 2016 among second-grade students from
three New York City schools (phases 1 to 4) and second- and third-grade students from
20 schools across eight states (phase 5).
Main outcome measures
Outcomes assessed were selection, amount eaten, preference, and intention to consume
F/V.
Statistical analyses performed
Validity was assessed by percent agreement (categorized as “match, omission, or intrusion”
for items on or off tray and “match, overestimation, or underestimation” for amount
eaten), Spearman correlation coefficients, and intraclass correlation coefficients
(ICC).
Results
The total match rate for items on tray was substantial (phases 1 to 5: 83%, 84%, 92%,
93%, and 89%), with items more frequently intruded than omitted. For amounts eaten,
the total match rates were moderate, but generally improved throughout the study (phases
1 to 5: 65%, 64%, 83%, 83%, and 76%), with overestimations more frequent than underestimations.
There was good correspondence between methods in the estimates of amount eaten in
a quantitative, cup equivalent amount (fruit ICC=0.61; vegetables ICC=0.64). Significant
differences (α=.05) were not observed between second- and third-grade students, respectively,
in the match rate for fruits (86% and 89%) or vegetable (89% and 86%) items on tray
or fruit (69% and 73%) and vegetables (74% and 76%) amount eaten. Excellent correlations
were observed between amount eaten and preference for fruit (r=0.91) and vegetables (r=0.93).
Conclusions
The questionnaire offers a feasible, valid instrument for assessing F/V selection
and consumption among elementary students in schools participating in the National
School Lunch Program. Additional research is recommended to test the instrument’s
sensitivity and to reproduce these findings using an alternative reference method,
such as direct observations.
Keywords
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Biography
M. M. Graziose is a graduate research assistant, Department of Health and Behavior Studies Program in Nutrition, Teachers College Columbia University, New York, NY.
Biography
R. L. Wolf is associate professor of human nutrition, Ella McCollum Vahlteich Endowment, Department of Health and Behavior Studies Program in Nutrition, Teachers College Columbia University, New York, NY.
Biography
P. A. Koch is executive director, Laurie M. Tisch Center for Food, Education and Policy, and associate research professor, Department of Health and Behavior Studies Program in Nutrition, Teachers College Columbia University, New York, NY.
Biography
I. R. Contento is the Mary Swartz Rose Professor of Nutrition and Education, Department of Health and Behavior Studies Program in Nutrition, Teachers College Columbia University, New York, NY.
Biography
H. L. Gray is an assistant professor, Department of Community and Family Health, College of Public Health, University of South Florida, Tampa.
Article info
Publication history
Published online: May 31, 2018
Accepted:
February 27,
2018
Received:
July 18,
2017
Footnotes
Supplementary materials: The Figure and Table 2 are available at www.jandonline.org
STATEMENT OF POTENTIAL CONFLICT OF INTEREST No potential conflict of interest was reported by the authors.
FUNDING/SUPPORT This study was funded by FoodCorps, Inc.
AUTHOR CONTRIBUTIONS M. M. Graziose drafted the manuscript, led data collection, and conducted statistical analyses. H. L. Gray contributed to data cleaning, coding, and statistical analyses. R. L. Wolf, P. A. Koch, and I. R. Contento obtained funding for the study, conceptualized the study design, and oversaw all study activities. All authors contributed to the development of the questionnaire instrument that is the subject of this study and to the writing of the manuscript.
Identification
Copyright
© 2018 by the Academy of Nutrition and Dietetics.
