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CASE STUDY
Baseline
For all participants, consumption of fruits and vegetables during snack time was zero bites.
Baseline
Consumption of fruits and vegetables increased from zero bites to a mean of 6.2 bites across the participants. Aaron showed the highest increase in consumption, going from zero bites to an average of 15.6 bites. Elliot and Kevin increased from zero bites to an average of 3.2 bites and 5.8 bites, respectively. Ben showed no change between the phases, with zero bites of fruits and vegetables consumed.
Good Nutrition Game
Consumption of fruits and vegetables increased from a mean of 6.2 bites to a mean of 13.8 bites across the participants. Elliot showed the highest increase in consumption, from an average of 3.2 bites to an average of 31.3 bites. Ben increased from a mean of zero bites to a mean of 8.0 bites. Kevin increased from a mean of 5.8 bites to a mean of 9.7 bites. Aaron showed a moderate decrease in consumption, from a mean of 15.6 bites to a mean of 12.8 bites.
Although the gains in fruit and vegetable consumption seem modest (consistent with other school nutrition programs),12 consumption that simply making healthy foods available (as in the baseline making them easily accessible (cut up rather than whole) by
reducing response cost may increase intake. However adding the consequences of the Good Nutrition Game was necessary to increase intake for three of the four participants.
These results are promising, but we faced several challenges at the stage of implementing the approach. First, while there were
10 available students, only two students from each of the classrooms returned consent forms. Additionally, there were a small number
of sessions and no opportunity for follow-up. Second, we relied on students’ self-report on counting the number of bites during this stage of implementation. We are in the process of consulting with classroom teachers how to objectively measure the number of bites instead of self-reports. Third, students had a variety of eating habits, ranging from simply not eating enough fruits and vegetables to eating both fruits and vegetables and junk food. Simply increasing the number of bites of fruits and vegetables might not be the best and appropriate solution to all students with different eating habits.
It is interesting to note that after the Good Nutrition Game began, teachers reported that students requested and purchased fruits and in the past these items were not requested. Future studies might
consider including multiple additional settings, such as the child’s home or the community. Parents and caregivers could be trained to record nutritious foods that their children consume outside of the classroom with the child earning points across all settings.
CONTRIBUTING AUTHORS
■ HEATHER J. CASSEY, M.Ed is a Board Certified Behavior Analyst who works as an Early Intervention Special Educator at Kindering Center in Bellevue, Wash.
■ YUKIKO WASHIO, PhD is a Maternal and Infant Health Researcher at Christiana Care Health System Value Institute in Newark, Del.
■ DONALD A. HANTULA, PhD directs the Decision Making Laboratory in the Department of Psychology at Temple University in Philadelphia, Penn.
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