Preliminary healthy eating outcomes of SNaX, a pilot community-based intervention for adolescents.
OBJECTIVE
We used principles of community-based participatory research to develop and pilot test a 5-week intervention for middle school students, Students for Nutrition and eXercise (SNaX). SNaX aimed to translate school obesity-prevention policies into practice with peer advocacy of healthy eating and school cafeteria changes.


METHODS
A total 425 seventh graders (63% of all seventh graders) in the intervention school were surveyed at baseline regarding cafeteria attitudes and sugar-sweetened beverage consumption; of the 425 students, 399 (94%) were surveyed again at 1-month post-intervention. School cafeteria records were obtained from two schools: the intervention school and a nonrandomized selected comparison school with similar student socio-demographic characteristics.


RESULTS
A total of 140 students in the intervention school were trained as peer advocates. In the intervention school, cafeteria attitudes among peer advocates significantly improved over time (approximately one-third of a standard deviation), whereas cafeteria attitudes of non-peer advocates remained stable; the improvement among peer advocates was significantly greater than the pre-post-change for non-peer advocates (b = .71, p < .001). Peer advocates significantly reduced their sugar-sweetened beverage intake (sports and fruit drinks), from 33% before intervention to 21% after intervention (p = .03). Cafeteria records indicated that servings of fruit and healthier entrées (salads, sandwiches, and yogurt parfaits) significantly decreased in the comparison school and significantly increased in the intervention school; the magnitude of changes differed significantly between the schools (p < .001).


CONCLUSIONS
As compared with the non-peer advocates, peer advocates appeared to benefit more from the intervention. Future research should consider engaging parents, students, and other key community stakeholders to determine acceptable and sustainable cafeteria changes.
Division of General Pediatrics, Department of Medicine, Children's Hospital Boston, 21 Autumn Street, Boston, MA 02215, USA. laura.bogart@childrens.harvard.edu
Laura M
LM
Bogart
Marc N
MN
Elliott
Kimberly
K
Uyeda
Jennifer
J
Hawes-Dawson
David J
DJ
Klein
Mark A
MA
Schuster
D000293:Adolescent; D055812:Community-Based Participatory Research; D004032:Diet; D015444:Exercise / Q000502:physiology*; D005247:Feeding Behavior / Q000502:physiology / Q000523:psychology; D005260:Female; D005522:Food Services / Q000592:standards / Q000639:trends; D015438:Health Behavior; D006801:Humans; D015141:Los Angeles; D008297:Male; D009765:Obesity / Q000517:prevention & control*; D010379:Peer Group; D010865:Pilot Projects; D012572:School Health Services
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