Krachtvoer: effect evaluation of a dutch healthful diet promotion curriculum for lower vocational schools.

OBJECTIVE: The aim of this study was to assess the behavioural effects of a school-based healthful diet promotion intervention implemented in lower vocational schools. DESIGN: A cluster-randomised pre-test-post-test experimental design was used, and data were collected by means of written questionnaires. SETTING: Students of 18 Dutch lower vocational schools. SUBJECTS: The final sample consisted of 10 experimental schools with 13 teachers, 37 classes and 879 students, and eight control schools with 10 teachers, 31 classes and 734 students (total n = 1613). RESULTS: Fixed regression analyses revealed beneficial effects on the behavioural measures relating to fruit intake (as assessed by a food frequency measure and fruit consumption during the previous day), and most behavioural measures related to high-fat snack intake (food frequency measure, and number of snacks and total fat intake from snacks during the previous day). The behavioural effects relating to breakfast habits were limited. Some positive behavioural effects occurred in the total target population, others mainly or only among students with more unfavourable intakes at baseline. Mixed regression analysis found comparable regression coefficients for the behavioural outcomes, but the effects related to fruit intake were no longer statistically significant. CONCLUSIONS: Although we did not find the expected effects on all outcome indicators, the total pattern of results suggest that Krachtvoer offered a surplus value over existing curricula. However, some programme elements need to be revised to improve effectiveness and prevent negative effects, and more information is needed about the long-term effects of the programme.