Combining the school and home environment

Nutrition and physical activity interventions in children mostly focus on the school setting; however, evidence suggests that children have greater access to unhealthy food and are less active at home^{1, 2}.

Funded by the Health Research Council, Healthy Homework is a school-based intervention, that was piloted in two New Zealand schools, with the lowest and highest decile ratings, in 2009 (four intervention, and four control classes). The main aim of the study was to improve dietary and physical activity behaviours in participating children (n=100; aged 9-11 years).

Healthy eating as your homework task– study design

In this study, we developed, implemented, and evaluated the first compulsory homework syllabus aimed at improving key health behaviours outside of school. Ten nutrition and physical activityrelated health behaviours were identified, one of them being fruit and vegetable consumption. The programme consisted of a six-Week homework schedule complemented by an in-class teaching unit, and was designed to support the achievement objectives associated with the New Zealand Health and Physical Education Curriculum.

The fruit and vegetable homework component was not only designed to increase general awareness and promotion relating to fruit and vegetable consumption, but more specifically to encourage students to actively consume the recommended servings i.e. at least two fruit servings and three vegetable servings each day for a week as part of  their homework task. Tasks were designed to include family and parental involvement wherever possible, and also included a related question to encourage independent inquiry. Food diaries were used (i.e. four-days; two week days and two weekend days) to assess nutrition intake before and after the intervention. Food diary completion was part of the homework task and it was anticipated that the compliance and accuracy of recording would be adequate. Changes in fruit and vegetable consumption were compared within each group (intervention and control) and between groups pre and post intervention.

Increases in fruit and vegetable consumption shown

In the intervention group there was a significant increase in fruit and vegetable consumption between baseline and follow-up on the weekend (p=0.001). Fruit consumption increased by one half serve (0.5 to 1 serve); vegetable consumption increased by 1.5 serves (0.5 to 2.0). Upon comparison between intervention and control groups, a positive effect was shown for vegetable consumption on weekends (0.83 servings per day, 95% CI: 0.24-1.43; p = 0.007) and overall (0.45 servings per day, 95% CI: 0.09-0.82; p = 0.016), with no significant effect on weekdays. No significant interactions with gender or school were observed.

Importance of findings

This increase in vegetable consumption represents an approximate 28% of the daily vegetable recommendation (three servings per day)³ and is a noteworthy finding. Our findings are comparable with those of other studies conducted with children but that have focused exclusively on fruit and vegetable intake, which show increases of 0.2-0.6 servings of fruit and vegetables post intervention^4,5. An improvement in fruit and vegetable consumption was one of the key priorities for the Healthy Homework initiative. Our favourable findings may represent small changes in the home environment that have the potential to extend to other healthy lifestyle patterns.

Future directions

A key question is whether the increase in vegetable consumption extended beyond the timeframe of the intervention, as a longer term follow-up period was not included in this pilot study. A larger Healthy Homework study is currently being conducted in 20 schools across both the North and South islands of New Zealand. A six-month followup period has been incorporated into this study, which will enable both short and long-term effects of the intervention to be determined. At this stage we believe that homework centred on health behaviours that includes family member participation and the home environment is a promising way to enhance fruit and vegetable consumption in children, among other health behaviours. Results from the larger study will hopefully verify this. Future investigations taking a similar approach of encouraging children to actively change their behaviour as a component of their homework to support any theory learned in class time are warranted.