Unbundling outcomes of a multilevel intervention to increase fruit, vegetables, and whole grains parents pack for their preschool children in sack lunches.

BACKGROUND

Packing fruit, vegetables, and whole grains in preschool children's sack lunches is a powerful way for parents to teach their children eating habits and food preferences to support a lifetime of good health. A multilevel intervention pilot-tested in childcare settings increased servings of vegetables and whole grains, but the lunches still fell short of the intervention goals. PURPOSE: Secondary analyses were conducted to identify specific behavior changes underlying achieved increases in servings of vegetables and whole grains. METHODS: Food records from direct observation of 769 parent-packed lunches were investigated to unbundle and measure multiple aspects of lunch packing behavior. Changes from baseline to six week follow-up for the intervention (N=81) and comparison (N=51) parent-child dyads were evaluated in multilevel modeling. RESULTS: The increase for whole grains was explained by more parents packing whole grain items whereas increase for vegetables was explained by parents packing vegetables on more days. DISCUSSION: Tailored options were identified for further strategies to increase vegetables and whole grains in parent-packed sack lunches. TRANSLATION TO HEALTH EDUCATION PRACTICE: Linking achieved outcomes to specific behaviors can be an aid in assessing needs and designing interventions to maximize the chances for success.