Stacy Cliff Judith Garrett Ashley Lamp Huma Ahmad Tsz-Kiu Chui

Nutrition Education Module

Introduction and purpose: Our nutrition education module consists of two, 30-45 minute lessons, and one culminating activity. These nutrition focused lessons can be easily implemented into a teachers current curriculum. They have been designed to complement the required general education curriculum and to provide teachers with another resource to enhance nutrition and health related knowledge. Each nutrition lesson can be completed within the proposed time allotment for that curriculum subject. We attempt to ensure the validity of our program through a review of current literature on topics such as effective learning and teaching methods, behavior modification, active nutrition curriculums, and eating behaviors of children. Our desired result, is to confidently present an excellent nutrition curriculum, including: two lessons and one culminating activity to second grade teachers and receive their feedback, and constructive criticism, pertaining to the efficacy of our project. Included in this module:

1. A review of the literature we evaluated, found relevant and interesting, and thus used to
assist in the creation of our nutrition module. In the literature review, we will discuss:

Effective teaching techniques and how we will apply them in our finished product Social learning and why we believe it is effective in improving eating behaviors Methodologies

2. Learn NC curriculum goal for 2nd Graders 3. Age appropriate topics to be covered by individual lessons and our culminating activity 4. Pre- and post-test to measure the efficacy of our module 5. List of references

A review of the literature

Effective teaching techniqueA new teaching technique, known as spaced learning, was created at Monkseaton High School in Tyne and Wear, England. This concept is a high speed learning technique. It involves a teacher presenting an eight minute PowerPoint presentation on a subject. Students sit through this without taking notes so that they only read and listen to the presentation in an effort to absorb as much information as they can. A ten minute break is then administered where students participate in a different activity such as dribbling a basketball or playing a board game. After the break, students return to the lesson. A similar presentation is given where students fill in blanks and ask questions. Along with this, students complete drills and activities on the lesson. This technique has shown to be very effective in learning concepts, presumably because the information is seen multiple times, and therefore, better understood. In addition, this process allows information to be stored in long term memory so concepts are understood months later. This technique has contributed to higher scores for individuals. Students grades went up by letters. Louise Dickson, a science teacher who has used this technique and found it successful, has said, 'Instead of four months of revision, we did one hour of spaced learning and the whole year got better marks than previously.1 In implementing spaced learning into our lesson plan we hope to find students are retaining knowledge long term. A successful teaching method for educating elementary school students, according to Moore,2 incorporates drama. Drama in this paper refers to role playing, where students teach a topic to the

class. Using drama as a teaching method allows students to be actively engaged in the learning experience, enabling them to have some control over the process. This method contributes to better learning because it uses different, and more intelligences, than standard teaching methods. For instance, students combine visual, auditory, and kinesthetic learning which allows for greater success because not all students learn the same way. By explaining material in a variety of ways more students can be reached and the information can be reiterated. Drama also teaches students social, problem solving, and critical thinking skills which are essential for learning. In addition, this method permits the student to be fully immersed in the subject being taught. They are able to engage all their senses allowing for a better understanding of the topic as well as greater chance of long term recall.2 Social LearningPsychologists have spent a significant amount of time devoted to understanding how others behaviors affect learning in children. The majority of this research, however, deals with artifacts and has not examined the effect eating behaviors have on children. The review article by Shutts et al,3 focuses on eating as a social phenomenon and the role others play in effecting childrens successes, and failures, in their interaction with food. Understanding what guides elementary childrens eating behaviors is essential to promoting their health and well-being. Considering the prevalence of obesity in American youths, and the implications childhood obesity has on adult health, early nutrition intervention should be considered. Social learning plays a significant role in determining what children will eat. Humans rarely face the challenge of food selection alone and usually eat in social contexts. Children, at a young age, begin to watch those around them and their eating behaviors. Findings highlighted in this review article include: young children are more likely to eat unfamiliar foods if they watch an adult eat it first, children increase their consumption when foods are presented in positive, highly social situations, and social modeling can change how much children like foods they initially dislike. This study also suggests that

early intervention is necessary, as once children become involved in their own food selection, they begin to exhibit food neophobia, and pickiness and these qualities are negatively associated with fruit and vegetable consumption. The authors reference a handful of studies that suggest children dont copy others behavior without thought or consideration; rather, they observe social behaviors and actions, and this is what impacts food acceptance, choices, and consumption. Studies have narrowed this further by suggesting that it is peers, not parents or authority figures, that exert the most influence on childrens food preferences and choices. This article presents research findings suggesting healthy eating interventions with a social component may be more effective than interventions focused on nutrition education alone. For example, interventions focusing on increasing knowledge of biological components of foods like microand macronutrients, and their health implications, have not proved as useful as projected. Children can retain and regurgitate the knowledge, but improvements in actual consumption are not optimal. In fact, promoting the healthfulness of certain foods can result in even less acceptance of those foods. This research suggests interventions that approach eating and food selection as social phenomena are more successful at manipulating childrens eating behaviors.3 While one of our modules focuses on the health benefits of foods, and macro and micronutrients specifically, we believe the incorporation of this topic in a social learning context will improve the retention and utilization of concepts learned. This review article is intriguing in that it acknowledges peer influence, over parental influence, as a better predictor of dietary behavior change.

Social Cognitive Theory Effects of a Nutrition Education Program on the Dietary Behavior and Nutrition Knowledge of Second-Grade and Third-Grade Students4 presents the effect of a Social Cognitive Theory-based nutrition education program. This education program looks at target audiences dietary behavior and

nutrition knowledge in second- and third-grade students. The study shows that students who received nutrition education significantly improved in overall dietary behaviors and in consumption of dairy, fruits, and vegetables, as well as showed significant improvement in nutrition knowledge. The study also suggested that nutrition education programs teaching positive dietary messages may improve dietary behavior and increase nutrition knowledge in students. Pre- and post-assessments were conducted before and after the designed nutrition education program to collect data regarding dietary behaviors and nutrition knowledge. A game-based assessment method called Pizza Please was used in the research study and included a game, and an age-appropriated questionnaire (24 dietary behavior and 16 nutrition knowledge questions). The nutrition education program was conducted in between pre-assessment, and postassessment. The program included six weekly nutrition classes including: dairy consumption, fruit and vegetable consumption, Food Guide Pyramid knowledge, nutrient-food association knowledge, and nutrient-job association knowledge. A curriculum was provided to the nutrition educators and educational materials were selected from trusted sources and were age-appropriated. The six weeks of nutrition classes were based on the principles of Social Cognitive Theory as it incorporated the independent relationship between personal characteristics, behavioral factors, and environmental influences. To achieve this, target students were taught skills to select healthy foods both at home, and school. Nutrition educators also served as role models when having lunch with the target students, and nutrition concepts were reinforced in daily activities, bulletin boards, and cafeterias. After intervention, notable changes in dietary behavior and nutrition knowledge were noted. Students increased consumption of dairy, fruits and vegetables. Students also improved nutrition knowledge. Students were able to identify foods that did not belong to the appropriate Food Guide Pyramid food group, nutrient-food association, and knowledge of a specific nutrients

job. However, the authors indicate that the correlation between gains in overall dietary behavior and gains in overall nutrition knowledge was weak for the overall study group. The authors state that the short duration of the study may minimize dietary behavior changes of target students. The School Health Education Evaluation, found that a minimum of 50 hours are required to impact behavior; in this study, students only participated in a minimum of 6 hours of nutrition education classes. The authors suggest that an increase in nutrition educational hours could show a more positive impact on dietary behavioral changes. In short, the authors imply that results and findings from this research study suggest similar nutrition education programs can potentially improve dietary behavior and increase nutrition knowledge in second- and third-grade students. By showing appropriate dietary behavior from educators or school health officials can positively influence the dietary behavior and nutrition knowledge of the students. Our group feels this study is beneficial for our project as it suggests nutrition and dietary knowledge can be improved by nutrition education. We feel that a base of knowledge is important, so students can apply, analyze, and synthesize it, thus affecting long-term dietary behaviors. We feel that the teacher, as a social model, eating with the students was a strength of this study. We are concerned with the lack of follow up data and feel that it is a limitation of this study. We believe it is important to understand how a program such as this can affect change longitudinally. Follow up interviews would improve this constructs validity. Eating Behaviors The article by Eliassen5 also suggests the importance of adult modeling. Serving nutritious food and exposing children to healthy foods in a caring environment can encourage positive life-long behaviors. Negative strategies such as using food as reward or punishment, or involving pressure and restriction can have poor health implications and promote problematic behaviors. Eliassen encourages

social interaction by hosting classroom tasting parties, involving families in the classroom, and communal meal times where children are encouraged to participate in discussion about food and nutrition. She cautions against too much emphasis on the food itself because that could decrease the childs interest. Methodology reviewed: Blooms Taxonomy6

1) Knowledge- provides the basis for greater understanding and is a crucial first step. 2) Comprehension- student understands material given. 3) Application- uses information given. 4) Analysis- critical thinking, compare and contrast. Example given: label reading and
product substitutions

5) Synthesis- doing something new with information learned. Culminating project. 6) Evaluation- is the student ready to move on to more advanced topics in nutrition? Are
they capable of teaching others what they have learned? Jigsaw7 The Jigsaw method encourages cooperative learning and may be useful in our social learning approach to nutrition education. Students are placed into groups and each members contribution is essential to the success of that group. Teamwork is utilized to accomplish the academic goal provided by the teacher. Through the Jigsaw methodology we wish to incorporate peer influence and group discussions on good dietary behaviors. The Jigsaw in 10 easy steps7:

1) Divide students into 5- or 6-person jigsaw groups. 2) Appoint one student from each group as the leader. 3) Divide the day's lesson into 5-6 segments.

4) Assign each student to learn one segment, making sure students have direct access only
to their own segment.

5) Give students time to read over their segment at least twice and become familiar with
it. There is no need for them to memorize it.

6) Form temporary "expert groups" by having one student from each jigsaw group join
other students assigned to the same segment. Give students in these expert groups time to discuss the main points of their segment and to rehearse the presentations they will make to their jigsaw group.

7) Bring the students back into their jigsaw groups. 8) Ask each student to present her or his segment to the group. Encourage others in the
group to ask questions for clarification.

9) Float from group to group, observing the process 10) At the end of the session, give a quiz on the material so that students quickly come to
realize that these sessions are not just fun and games but really count.

General Education Curriculum Goals Achieved This module corresponds with 2nd grade curriculum through encompassing healthful living, computer science/technology, English, and information skills. There is also an enrichment activity that allows students to practice social skills and memorization. The incorporation of each subject within the nutrition module curriculum meets at least one goal listed in Learn NC curriculum standards for the second grade classroom. The curriculum goals achieved through our module are as follows:9 1. Healthful living: The learner will apply knowledge in area of nutrition for healthy growth, development, and maintenance.

2. Computer science/technology: The learner will demonstrate knowledge and skills in the use of computer and other technologies. 3. English: The learner will make connections through the use of oral language, written language, and media and technology. The learner will apply strategies and skills to create oral, written, and visual texts. 4. Information skills: The learner will communicate reading, listening, and viewing experiences. 5. Mathematics: Data Analysis and Probability - The learner will understand and use data and simple probability concepts.9 Module topics

1) A well-balanced diet is essential for health and growth. 2) Food is made up of different nutrients needed for health and growth. 3) Review and preparation for the culminating project Five Food Groups Fair.

Lesson Plan 1:
SUBJECT: Nutrition/Health, 2nd Grade General Curriculum: Physical Education, Healthful Living Education, Math THEME: A well-balanced diet is essential for health and growth. DURATION: 40 minutes OBJECTIVES: Student will be able to:

Differentiate between the five major food groups. Give reasons why it is important to eat foods from all five food groups. Show understanding of placing various food items into one of the major food groups. Increase fruit and vegetable consumption

STANDARDS MET:

Healthful Living Education: The learner will apply knowledge and behavior, self-management skills to areas of nutrition and physical activity for healthy growth, development, and maintenance.

Math: Collect, organize, describe and display data using pictographs where symbols represent multiple units (2's, 5's, 10's).

MATERIALS:

Cut-out symbols representing the five food groups Large graph to display the frequency of food group consumption

LESSON SEQUENCE: Teacher Actions: 1. Exploring - 5 minutes Engage students to share their consumption of food groups eaten today at lunch. Explore the variety of foods consumed by initiating conversation between students. Record the frequency of fruit and vegetable intake at lunch for the entire class. 2. Introducing - 35 minutes 5 Minutes- Introduce the students to MyPlate through displaying a large poster and explaining the various food groups. 5 Minutes- Physical activity break (i.e jumping jacks, running track) 10 minutes- Bring students back together and repeat the MyPlate lesson. Using the poster you used previously, hide key topics with covers so the students cant see them. Test their knowledge by asking questions to see if they can remember what key terms are behind the covers. (See attachments 1, 2 and 3)

5 minutes- Physical activity break (activity of instructors choosing) 10 minutes- Bring students back together and initiate a discussion, using what they previously said they ate for lunch, have students decide which food group the lunch items fall into. Divide the students into evenly distributed groups and challenge each group to consume the highest frequency of fruits and vegetables. Introduce the Fruit and Vegetable Challenge. Student Actions: 1. Activity: The Fruit and Vegetable Challenge Steps:

Divide students into 5 evenly distributed groups. These will serve as their teams throughout the challenge.

Have students record the number of fruits and vegetables consumed during lunch for 5 school days.

Students will meet with group to encourage more fruit and vegetable consumption from teammates and to tally total consumption of group each day.

As a class, team totals will be displayed on a pictograph using symbols that represent the amount of fruits and vegetables consumed. (See attachment 4)

Teams are motivated to consume the highest frequency of fruits and vegetables in the class due to positive reinforcement and competition.

Module Objectives Implemented in this Nutrition Lesson:

Spaced learning- as mentioned in our literature review This lesson plan incorporates the idea of Social Learning. Children increase consumption when foods are presented in positive, highly social situations, and social modeling can change how much children like foods they initially dislike.

Blooms TaxonomyKnowledge- given to student about My Plate Comprehension- do they know the hidden term? Application- Uses information given and decides what category the various food items fall into.

Jigsaw- Students will be divided into groups and each team member is critical to the success of the team. Student leader in each group will record the amount of fruits and vegetable consumed by the team on the pictograph. Student leader can change each day.

Eating Behaviors- Students are educated and encouraged to increase fruit and vegetable intake, in hopes of encouraging life-long behavior changes.

Lesson Plan 2
SUBJECT: Nutrition/Health, 2nd Grade General Curriculum: English Language Arts, Health THEME: Food is made up of different nutrients needed for health and growth. Focusing on Carbohydrates, Protein, Fat, Vitamins and Minerals DURATION: 40 minutes OBJECTIVES: Students will be able to:

Explain that foods have nutrients that help us grow and stay healthy. Identify which macro-nutrients and micro-nutrients are in each food group Identify what foods to eat more of and explain why. Identify what foods to limit (Fats and Sugars)

STANDARDS MET: English Language Arts: Speaking and Listening Standard. Read with sufficient fluency to support comprehension. Health: The learner will develop knowledge and skills to enhance personal and consumer

health. MATERIALS: Headband 125 cards- 25 with foods, and 100 with descriptors Example:

* *

Comes from a cow

Grown on a tree

Come from chickens

Grown in the ground

Grown on a tree

Good source of calcium

Good source of Vitamin C

A delicious breakfast food

Good source of Vitamin A

Good source of potassium

Good for your bones Part of the dairy food group

Good for your immune system Part of the fruit food group

Good for building strong muscles Great source of protein

Good for your eyesight Part of the vegetable group

Sealed in a yellow peel A fruit

LESSON SEQUENCE: Review Last Lesson: Five Food Groups 5 minutes Teacher can start the lesson by reviewing the first module regarding five food groups. Engage students by asking them, Can anyone identify the five food groups? Next, ask What are some examples of different food groups? Teacher Actions: 1. Engaging 5 minutes Teacher leads discussion asking students if they know what macronutrients, vitamins and minerals are. 2. Introducing- 15 minutes Using MyPlate display, talk about the benefits of each food group and the nutrient it best represents. For example: Grains- Carbohydrate, energy Meat/Protein- Protein, growth and development Dairy- Calcium, strong bones and teeth Fruit-Vitamins- immune system, help fight off sickness Vegetable-Vitamins- vision, healthy heart STUDENT ACTIONS: Activity: Who am I? 30 minutes Steps: Ask students to get into their previous groups of 5 students. Each group will be given 5 cards, one with each food group on it. Students will have headbands on their heads, and without

reading what is on their card they will place it in their headband. Group members will then take turns giving clues about what the card is on their head. After each member gives a clue, the guesser will try to guess what food group they are describing. The students giving the clues will use pre-made cards with micro- and macronutrient descriptors included among them. For example, if the card in the headband is broccoli, some of the cards used by students to describe broccoli will be: vegetable, vitamin C, green, looks like a tree. If the card is milk the cards could read: dairy, calcium, vitamin D, white, liquid. Module Objectives Implemented in this Nutrition Lesson:

Social cognitive learning theory- Game based assessment Jigsaw- Broken into groups, each member is the essential to the success of the guesser

Cumulative Lesson Plan

Students will display their knowledge in nutrition by participating in a Five Food Groups Fair. This fair can take place during class time or can be used as an opportunity to involve parents in their childs education. SUBJECT: Nutrition/Health, 2nd Grade General Curriculum: Healthful Living, Computer Skills, English, Information Skills THEME: Implement previous lessons through presentation of an assigned food group. DURATION: 30 minutes a day for 5 days OBJECTIVES: Students will be able to:

Explain characteristics of assigned food group. Explore qualities of all food groups, through class presentations. Implement lessons previously learned through presentation.

STANDARDS MET:

Healthful Living: The learner will apply knowledge and behavior, self-management skills to areas of nutrition and physical activity for healthy growth, development, and maintenance.

Computer Skills: The learner will demonstrate knowledge and skills in the use of computer and other technologies.

English: The learner will make connections through the use of oral language, written language, and media and technology. The learner will apply strategies and skills to create oral, written, and visual texts.

Information Skills: The learner will communicate reading, listening, and viewing experiences.

MATERIALS:

Access to internet for research. Supplies to create visual aid for presentation MyPlate supplies to illustrate to students the proportion of overall diet that should be encompassed by each food group.

LESSON SEQUENCE: Review Previous Lessons:

The Fruit and Vegetable Challenge - 2 minutes Who Am I? - 2 minutes

Teacher Actions: 1. Synthesize - 5 minutes Encourage students to synthesize information in lessons previously learned, through discussing the importance of consuming a balanced diet, comprised of food from all five major food groups. 2. Introduction - 5 minutes

Introduce the idea of mastering an assigned food group through presentation preparation. Remind the students that all of the food groups work collectively through your diet to improve ones health and development. STUDENT ACTIONS: Activity: Five Food Group Fair Preparation- 30 minutes per day for 4 days Steps:

In the original teams from previous lessons, each of the five groups will be assigned a major food group (including: fruits, vegetables, carbohydrates, protein, dairy).

Student groups will research their assigned food group using technology. Student groups will develop visual aid as well as oral script to use during preparation. Students will work as a team to create a well-developed presentation of their assigned food group.

Activity: Five Food Group Fair - 30 minutes

Students will attend the Five Food Group Fair, where groups will present their prepared project to the rest of the class.

Students will teach their fellow classmates about their assigned topic.

Module Objectives Implemented in this Nutrition Lesson:

Blooms Taxonomy: Knowledge- Obtained through computer research and previous lessons Comprehension- Understanding of topic so it is researched efficiently Application- Uses information obtained from research and decides what is relevant to present Analysis- Makes a creative display Synthesis- Presents the display and new information to students to expand their knowledge of the food.

Jigsaw: Students will be divided into groups and each team member is critical to the success of the team.

Drama: Students take the role of educator through teaching groups about their assigned food group through presentation at the Five Food Group Fair.

How will we measure the efficacy of our program? The overarching goal of this nutrition education project is to positively affect the eating behaviors and nutrition knowledge of 2nd graders. In order to determine if our modules have made an impact we need quantifiable data to analyze. To obtain this data we will set up a pre-test, post-test study design. First, we will obtain IRB approval because we are using human subjects in our study. We will need to receive approval from school administrators and inform teachers of our purpose. We will determine the need for parental consent, and if required will draft a permission form. We will evaluate the students nutrition knowledge through researcher moderated interviews. We will also obtain students food preferences, and typical eating habits. We will attempt to collect 24 hour recalls from each student. Students will receive a nutrition score based on dietary behaviors that have evidencebased health implications. Data will be compiled and patterns of consumption will be noted for individual students. There will be no identifying information on compiled data, students will be randomly assigned a number and data will be recorded under that number. After completion of nutrition modules, our first measure will occur during the culminating project. The intention of the Five Food Groups Fair project is for the students to show their understanding of the five food groups, what makes them unique, and use critical thinking to make

creative presentations to teach their peers what they know. Our evaluation of students projects will be our initial measurable outcome. Second, we will give students a post-test to see if nutrition knowledge has improved and if behavior changes have been initiated. Third, we will return in 6 months to issue a second post-test, to see if changes initiated were maintained. At this time a final nutrition score will be obtained and compared to the first and second scores to determine if we were successful. Pre-test: 1) Name two fruits. 2) Name two vegetables. 3) Name two dairy products. 4) Name two grain products. 5) Name two proteins. 6) Name two unhealthy snacks. 7) Did you eat any fruits or vegetables during lunch today? This question is of special interest. Immediately after the implementation of our fruit and vegetable challenge, we expect this number to increase due to competition among students to eat more. What will be interesting is, if the number stays up or increases after the end of the challenge when there is no longer a competition. This will show if our module if effective at increasing fruit and vegetable consumption longitudinally. 8) Why is it important to eat food? 9) What do vitamins do for your body? 10) What does being healthy mean?

Post-test #1 after the last lesson and post-test #2, 6 months later 1) Name four fruits. 2) Name four vegetables.

3) Name three dairy products. 4) Name three grain products. 5) Name three proteins. 6) Name three unhealthy snacks. 7) Did you eat any fruits and vegetables at lunch today? 8) Why is it important to eat food? 9) What do vitamins do for your body? 10) What does being healthy mean?

References 1. Woods J. Revealed: new teaching methods that are producing dramatic results. The Telegraph. http://www.telegraph.co.uk/education/5166111/Revealed-new-teachingmethods-that-are-producing-dramatic-results.html. Published April 17,2009. Accessed October 29, 2013. 2. Moore M. Using Drama as an Effective Method to Teach Elementary Students. Senior Honor Theses: Eastern Michigan University. 2004. http://commons.emich.edu/cgi/viewcontent.cgi?article=1112&context=honors.

3. Shutts K, Kinzler K, DeJesus J. Understanding Infants and Childrens Social Learning About Foods: Previous Research and New Prospects. Developmental Psychology. 2013;49(3):419-425. http://www.ncbi.nlm.nih.gov/pubmed/22390670. Published June 1, 2011. Revised January 4, 2012. Accessed November 5, 2013. 4. Powers A, Struempler B, Guarino A, Parmer S. Effects of a Nutrition Education Program on Dietary Behavior and Nutrition Knowledge of Second-Grade and Third-Grade Students. Journal of School Health [serial online]. April 2005; 75(4):129-133. Available from: SPORTDiscus, Ipswich, MA. Accessed November 11, 2013.

5. Eliassen E. The Impact of Teachers and Families on Young Childrens Eating Behaviors. 2011:84-88. http://www.naeyc.org/files/naeyc/Eliassen_0.pdf. Accessed November 10, 2013. 6. Forehand M. Blooms Taxonomy: Original and revised. Emerging perspectives on learning, teaching, and technology. http://epltt.coe.uga.edu/index.php?title=Bloom%27s_Taxonomy. Published 2005. Revised October 30, 2012. Accessed November 10, 2013.

7. Aronson E. Jigsaw in 10 Easy Steps. Jigsaw Classroom. http://www.jigsaw.org/steps.htm. Accessed November 10, 2013. 8. Arkansas State Department of Education Little Rock. Nutrition Education Curriculum, Second Grade Curriculum. Institute of Education Sciences. http://eric.ed.gov/?id=ED248248. Published 1983. Accessed November 6th, 2013.

9. Learn NC, a Program of The University of North Carolina at Chapel Hill. Curriculum Standards. http://www.learnnc.org/scos/. Accessed November 18, 2013.