Effects of School-Based Nutrition Education Programon Behavioral Changes in Dietary Habits- Analysis of Elementary School Fourth Grade TOMOKO Noma

KANAKO Uchida1 YOKO Nakano2 KATUYUKI Yamasaki1

Previously, we developed a nutrition education (shokuiku) program according to the theory of
behavioral science and reported that psychological factors (e.g., cognition, emotion, and behavior)
play an important role in the optimization and improvement of dietary habits with third-grade students
in the elementary school.
In the present study, we carried out nutrition education to fourth-grade students in Tokushima
Prefecture, Japan, to examine the versatility and issues related to the nutrition education program forthe elementary school students. Evaluation analysis indicates that there was an educational impact on
both genders, showing that the educational program promoted behavioral changes in dietary habits.
This finding confirms that nutrition education is applicable to forth-grade students. Since the impactof the nutrition education varies greatly by the difference of one grade in school-aged children, ourstudy suggested that the continuity of the nutrition education program that considers cognitive
development at school age is important for the acquisition of dietary literacy.
Key words： Behavioral Modification，Behavioral Science，Health Promotion,
Lifestyle-Related Diseases，Nutrition Education㻝㻚㻌㻵㼚㼠㼞㼛㼐㼡㼏㼠㼕㼛㼚㻌
Both the increase of lifestyle diseases associated with long-term inappropriate lifestyle habits1） andthe elevated national medical expenses2）indicate the importance of nutrition education provided byregistered dietitians and nutritionists. However, currently, nutrition education for patients with lifestylediseases does not always achieve its fully expected effect. The main reason for the difficulties facedin nutrition education is maintaining the adherence to the improved dietary habits following nutrition
education. So far, Heckman reported the importance of nutrition education during the childhood. He
demonstrated that investing in the education during the preschool-aged children is more effective thanfor school-aged children or later3）, indicating that the factor which determines the effectiveness of theeducation once children start school is the education that each receives before they enter school.
Therefore, to overcome the difficulties in nutrition education, we focused on the childhood whenlifestyle habits are established and the possible effects of nutrition education intervention during thisperiod.
On the other hand, the Basic Act on Food Education was enacted in 20054）and the public promotionof “food education” commenced5）in the educational environment. Recently, the age of those who aresusceptible to lifestyle diseases has decreased6）, and effective food education in schools is urgently
required to prevent lifestyle diseases. Nutrition education is defined by the glossary of Nutrition
Practice7） as “an activity that supports behavioral modification of people according to various sciences
associated with nutrition science, such as behavioural science and pedagogy, toward the actualizationof desired nutritional status and dietary behavior with the objective of health promotion andimprovement of quality of life (QOL).”In schools, the approach of modifying the behavior of school children using skills based on
1 Center for the Science of Prevention Education, Naruto University of Education
2 Narutonishi Elementary School―1―

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behavioral science is becoming important. From the 1970s to the 1980s, an individual approach was
primarily taken8） according to a theory for understanding individual health behavior according tosocio-psychology. For example, it was demonstrated that psychological factors are involved in theonset of lifestyle diseases, and the preventive effect of psychological support for school-aged children
has been reported for the onset of diabetes mellitus, a lifestyle disease9）. According to the social
cognition theory proposed by Bandura in 198610）, cognition is closely involved with social learningby humans, with strong self-efficacy leading people to achievement and well-being (good condition)
while also playing an important role in the promotion of good health. The belief in self-efficacy
impacts an individual’s way of thinking, feeling, motivation, and behavior. For example, increased
motivation and the belief that one can control their own behavior play a very important role inchanging adverse health habits. Therefore, in the previous study we hypothesized that cognition,
emotion, and behavior play an important role in the optimization and improvement of dietary habits,
and developed a nutrition education program according to behavioral science theory11 ） .We also
developed novel visual aids to support this nutrition education program12）and applied this approachto the field of nutrition education to examine its effect with third-grade students in the elementary
school.
In this study, to examine the versatility and problems associated with this nutrition education
program, we extended nutrition education to fourth-grade students and examined its efficacy.
㻞㻚㻌㻹㼑㼠㼔㼛㼐㼟㻌The nutrition education program to prevent lifestyle diseases used in this study was developed
previously11）. We briefly describe the methods below.
㻞㻙㻝㻌㻺㼡㼠㼞㼕㼠㼕㼛㼚㻌㼑㼐㼡㼏㼍㼠㼕㼛㼚㻌㼜㼞㼛㼓㼞㼍㼙㻌This nutrition education program has hierarchical educational goals with the ultimate goal being“improved maintenance of physical health”. The hierarchical educational goals are classified into
three goals. The high-level goal is “improved dietary habits to prevent lifestyle diseases.” The middlelevel goal has three items that are set for dietary habits: “self-monitoring,” “cognition,” and “emotion
and behavior.” For the low-level goal, we set the operational goals as the scales to measure whether
the meaning of three items is understood, and whether the points to be improved is grasped, andwhether modified nutritional behaviour is promoted (Table 1). The nutrition education program wasdesigned so that the hierarchical educational goals can be reached in 3 classes (45 min each) and 3
lunch times (5 min each) as shown in Figure 1.
The program contains Shokuiku at regular class; 45 min 4 times, Shokuiku using school lunch time;
5 min 3 times, and Challenge work; 1 week.
㻞㻙㻞㻌㻿㼡㼎㼖㼑㼏㼠㼟㻌㼍㼚㼐㻌㼑㼠㼔㼕㼏㼍㼘㻌㼏㼛㼚㼟㼕㼐㼑㼞㼍㼠㼕㼛㼚㼟㻌
A total of 62 students (33 boys and 29 girls) from two fourth-grade classes of N elementary schoolin Tokushima Prefecture participated in the study. As procedure for participating in this study, we
provided oral and written explanations regarding the objective and methods of this study to teachers
and the principal of N elementary school in N city, and obtained informed consent from them forparticipation. Next, we explained the objective and methods of this study through homecommunication to the guardians about the subjects to obtain informed consent.

―2―Effects of School-Based Nutrition Education Program㼀㼍㼎㼘㼑㻌㻝㻌 㻱㼐㼡㼏㼍㼠㼕㼛㼚㼍㼘㻌㻳㼛㼍㼘㼟㻌㼍㼚㼐㻌㼀㼕㼙㼑㼠㼍㼎㼘㼑㻌㼒㼛㼞㻌㼠㼔㼑㻌㻿㼔㼛㼗㼡㼕㼗㼡㻌㻼㼞㼛㼓㼞㼍㼙㻌Intermediate goals (I - III)
Sub-goals (1 - 6)
I. Understanding one’s own eating
habits1. Knowing your current eating habits
2.Understanding your current eating
habitsII. Understanding the relationshipbetween health and eating habits,
and recognizing that you should
ensure your own health
3. Understanding lifestyle habits andtheir development mechanisms

Operational goals
a. I can understand my own breakfast intake.
b. I can understand my own vegetable intake.
c. I can understand my own snacking intake.
d. I can understand the current state andissues with my eating habits in comparison
with friends.
e. I can understand the current state and issues
with my eating habits in comparison withnational survey results.
f. I can understand what lifestyle-relateddiseases are.
g. I can understand that a worsening ofeating habits leads to lifestyle-relateddiseases and deterioration of health.

h. I can understand what appropriate eating
habits are.
4. Understanding that you can achievei. I can understand the need for vegetableappropriate eating habits byintake.
yourself
j. I can recognize that eating habits are not
fixed, but are easily changeable.
k. I can find the causes of poor eating habits
and solve them by myself.
III. Controlling your own eating
habits by increasing your l. I can find the issues with my current
eating habits while mutually assisting
motivation to “ensure your own
my friends.
health”
5. Finding the ways to improve your m. I can set my own goals to improve myeating habits.
current eating habits and increase
your motivation to become healthy n. I can find ways to improve my eating
habits.
o. If the state of my eating habits deteriorates
in the future, I know how to address it.
6. Adopting and maintaining
p. I can adopt behaviors to improve my eating
behaviors to improve your eating
habits.
habitsq. I can aim to improve my eating habits withthe cooperation of my family.

Classes

1st(45 min)2nd(45 min)3rd(45 min)3rd(45 min)4th(45 min)Schoollunch
4th(45 min)
CW**CW indicates homework outside of school hours
Note: the primary goal is the development and improvement of eating habits to prevent lifestyle-related diseases㻲㼕㼓㼡㼞㼑㻌㻝㻌 㼀㼔㼑㻌㼒㼘㼛㼣㻌㼛㼒㻌㼠㼔㼑㻌㼚㼡㼠㼞㼕㼠㼕㼛㼚㻌㼑㼐㼡㼏㼍㼠㼕㼛㼚㻌㼜㼞㼛㼓㼞㼍㼙㻌

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㼀㼍㼎㼘㼑㻌㻞㻌 㻾㼑㼘㼕㼍㼎㼕㼘㼕㼠㼥㻌㼛㼒㻌㼠㼔㼑㻌㼑㼐㼡㼏㼍㼠㼕㼛㼚㼍㼘㻌㼕㼙㼜㼍㼏㼠㻌㼑㼢㼍㼘㼡㼍㼠㼕㼛㼚㻌㼝㼡㼑㼟㼠㼕㼛㼚㼚㼍㼕㼞㼑㻌㻙Cronbach’s αcoefficient
OverallSelf-monitoring (before/after).62 / .58

Cognition (before/after).34 / .52

Emotion and behavior (before/after).73 / .84

Health Locus of Control for children (before/after).71 / .79㻌㻞㻙㻟㻌㻱㼢㼍㼘㼡㼍㼠㼕㼛㼚㻌㼙㼑㼠㼔㼛㼐㼟㻌As shown in Figure 1, the nutrition education program was implemented for 1 month starting on
September 3, 2014. The implementation dates were September 3, 10, 17, and 24. The educational
effects were measured before and after the implementation of the program. For evaluating the
educational effects of the program, each student in the nutrition education program answered to asurvey. We measured the level of increased understanding and improvement in three items of the goals:“self-monitoring,” “cognition,” and “emotion and behavior” as the index. Therefore, we used a scale
prepared for each goal11）
In this study, we evaluated the educational impact on the class regarding the middle goals. This
involved the students evaluating “how the whole class is changed,” and three items were set as follows;“whether everyone in the class understands what should be corrected in their dietary habits,” “whether
everyone in the class understands that they can protect their own health,” and “whether everyone in
the class can set up a goal and work toward improving their dietary habits.” The students were asked
to answer these questions according to a five-point scale (1: not true at all to 5: very much true). In
addition, the scale used in this study was the one for which content validity was confirmed in ourprevious study11）. For reliability, we confirmed the α coefficient among the fourth-grade students.
Although it was somewhat lower for “cognition” than that in the previous study (0.34–0.52), the otheritems were ≥0.6, showing sufficient reliability (Table 2).
Furthermore, as the previous study, to evaluate an individual internal control of health, we used thescale from Health Locus of Control (HLC) for children, which measures internal control (internality
and self-responsibility for the behavior, [i.e., the idea that solves health problems depends on the
person’s own effort])12）. The reliability and validity of this scale have been shown to be high, and its
clinical utility has also been confirmed13）. The high reliability were also confirmed by retest in thisstudy (Table 2). 
To examine whether improvement in each evaluation item through the implementation of thenutrition education program leads to behavior modification in dietary habits, as the previous study11）,
we surveyed the condition of the students’ dietary habits using a self-administered questionnaire.
Whether behavioral modification in dietary habits occurred was surveyed in a questionnaire on dietary
habits consisting of eight items prepared as shown in Figure 2. Considering the eight questions
regarding breakfast, sleep, snacks, and nighttime snacks, we asked students to retrospectively review
the intakes over the past 5 days for “breakfast” and the past 4 days for “snacks” and “nighttime snacks.”
For “sleep,” we asked the students to note their bedtime the night before and the time when they woke
up on the day of the questionnaire. However, for the question “what do you do if there is food you do
not like ?” we used four-point scale (1 = I force myself to eat all the food, 2 = I try to eat at least some,
3 = I will not eat any, and 0 = I do not dislike any food). Furthermore, to determine intake habits for“soft drinks, etc.,” we asked, “how much do you take drinks each day?” To identify the extent ofvegetable intake during breakfast, we asked: “please write down everything you ate for breakfast”(Figure 2).―4―

Effects of School-Based Nutrition Education Program

Questions

day of the week 

1

Did you eat breakfast? Please circle each day you
had breakfast.

M

T

W

Th

F

2

Did you eat snacks? Please circle each day you had
snacks.

M

T

W

Th

F

3

Did you have nighttime snacks (eating after dinner
but before bedtime)? Please circle each day you hadnighttime snacks.

M

T

W

Th

F

4

What time did you go to bed last night?

5

What time did you wake up this morning?
“Your current condition”
Please circle the condition that is closest to
your current condition.



Question

I try to eat all the food.

I try to eat some.

I will not eat any.

I do not dislike any food.

6

What do you do if there is food
you do not like?

1

2

3

4

How many drinks other than green tea and milk do you drink each day?
(e.g., one bottle with 350 mL of juice).
7*If you do not drink any other drinks, please state 0(zero).
()

Please write down everything you ate this morning.
(e.g., rice, rice ball, toast, melon bread, sandwich, udon noodle, ramen, miso soup [with tofu,
wakame, green onion, etc.], corn soup, ham and eggs, milk, orange juice, tomatoes, bananas,
8
apples, etc.)*If you did not eat breakfast, please write down “nothing.”()
㻲㼕㼓㼡㼞㼑㻌㻞㻌 㻌 㻽㼡㼑㼟㼠㼕㼛㼚㼚㼍㼕㼞㼑㻌㼛㼚㻌㼐㼕㼑㼠㼍㼞㼥㻌㼔㼍㼎㼕㼠㼟㻌
Question items include: breakfast intake days / 5 days, snack ingestion days / 4 days, dinner intake days / 4 days,
sleeping / getting up / sleeping time, responses when dislike comes out (the higher the score Good), intake other thantea and milk, how much intake of drinking water and the number of breakfast-items.

㻞㻙㻠㻌㻿㼠㼍㼠㼕㼟㼠㼕㼏㼍㼘㻌㼍㼚㼍㼘㼥㼟㼕㼟㻌
PAWS Statistics ver.20 software was used for the statistical analyses（SPSS, Chicago, IL）. A pvalue < 0.05 was considered statistically significant. Mainly, two-factor analyses of variance （period
×gender）were conducted.

―5―奈良佐保短期大学研究紀要

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㻟㻚㻌㻾㼑㼟㼡㼘㼠㼟㻌㻟㻙㻝㻌㻵㼚㼐㼕㼢㼕㼐㼡㼍㼘㻌㼑㼢㼍㼘㼡㼍㼠㼕㼛㼚㻌㼛㼒㻌㼑㼐㼡㼏㼍㼠㼕㼛㼚㼍㼘㻌㼕㼙㼜㼍㼏㼠㻌㼎㼑㼒㼛㼞㼑㻌㼍㼚㼐㻌㼍㼒㼠㼑㼞㻌㼠㼔㼑㻌㼕㼙㼜㼘㼑㼙㼑㼚㼠㼍㼠㼕㼛㼚㻌㼛㼒㻌㼠㼔㼑㻌㼒㼛㼛㼐㻌㼑㼐㼡㼏㼍㼠㼕㼛㼚㻌㼜㼞㼛㼓㼞㼍㼙㻌The scores for “individual evaluation” before and after the program implementation are shown in
Figure 3A–C. The results of the two-factor analysis of variance (period ×gender) are shown in Table
3.
A self-monitoring         Bcognition
Score㻌

  C emotion and behavior
㻌
㻌
㻌
㻌
㻌
㻌
㻌
㻌
㻲㼕㼓㼡㼞㼑㻌㻟㻌 㻵㼚㼐㼕㼢㼕㼐㼡㼍㼘㻌㼑㼢㼍㼘㼡㼍㼠㼕㼛㼚㻌㼎㼑㼒㼛㼞㼑㻌㼍㼚㼐㻌㼍㼒㼠㼑㼞㻌㼠㼔㼑㻌㼜㼞㼛㼓㼞㼍㼙㻌㼕㼙㼜㼘㼑㼙㼑㼚㼠㼍㼠㼕㼛㼚㻌A, The mean score of “self-monitoring”.

B, The mean score of “cognition”.

C, The mean score ofC㻌 and behavior”. The individual score before and after in self-monitoring, cognitive, emotion and“emotionbehavior were measured to evaluate the intervention effects in each item using the three questions
with 5-point rating scale developed in the previous study11）.

㼀㼍㼎㼘㼑㻌 㻟㻌 㼀㼔㼑㻌 㼞㼑㼟㼡㼘㼠㼟㻌 㻔㻲㻌 㼢㼍㼘㼡㼑㻕㻌 㼛㼒 㼠㼔㼑㻌 㼠㼣㼛㻙factor analysis of variance (period ×gender)㻌 㼛㼚㻌 㼠㼔㼑㻌mean values of “self㻙monitoring,” “cognition,” and “emotion and behavior”㻌 㼎㼑㼒㼛㼞㼑㻌㼍㼚㼐㻌㼍㼒㼠㼑㼞㻌㼠㼔㼑㻌㼜㼞㼛㼓㼞㼍㼙㻌㼕㼙㼜㼘㼑㼙㼑㼚㼠㼍㼠㼕㼛㼚㻌

*Main effectInteraction

GenderPeriodPeriod×Gender

Self-monitoring.29

56.64**.69

Cognition
Emotion and behavior

1.13
.70

131.63**65.89**.22.48

p < 0.05, **p < 0.01, F value is df = (1,57)(1) Self-monitoring
Figure 3A presents the scores for “self-monitoring” before and after the implementation of the
program. In both boys and girls students, scores increased after the implementation of the
program. As shown in Table 3, the analysis of variance revealed the high mean value, showing
the significant main effect in the “period” (F (1, 57) = 56.64, p < 0.01). On the other hand, there―6―Effects of School-Based Nutrition Education Program

was no significant difference according to the interaction of “gender × period” and “gender”,
indicating no difference in educational impact on gender.
(2) Cognition
Figure 3B shows the scores for “cognition” before and after the implementation of the program.
In both boys and girls students, the scores were increased after the implementation, indicatingthat there was a significant main effect for the “period” (F (1, 57) = 131.63, p < 0.01) (Table 3).
There was no significant difference according to the interaction of “gender × period” and“gender”, confirming that there was no difference regarding to gender.
(3) Emotions and behavior
Figure 3C shows the scores for “emotions and behavior” increased after the implementationof the program. The analysis of variance shows that there was significant main effect for “period”(F (1, 57) = 65.89, p < 0.01) (Table 3). There was no significant difference according to theinteraction of “gender × period” and “gender”, confirming that there was no difference ineducational impact according to gender.
㻟㻙㻞㻌㻯㼘㼍㼟㼟㻌㼑㼢㼍㼘㼡㼍㼠㼕㼛㼚㻌The scores of the “class evaluation” before and after the implementation of the program are shownin Figure 4A–C. The results of the two-factor analysis of variance (period ×gender) are shown in Table
4.
A self-monitoring

C

B

 

cognition

emotion and behavior










㻲㼕㼓㼡㼞㼑㻌㻠㻌 㻌 㻯㼘㼍㼟㼟㻌㼑㼢㼍㼘㼡㼍㼠㼕㼛㼚㻌㼎㼑㼒㼛㼞㼑㻌㼍㼚㼐㻌㼍㼒㼠㼑㼞㻌㼠㼔㼑㻌㼜㼞㼛㼓㼞㼍㼙㻌㼕㼙㼜㼘㼑㼙㼑㼚㼠㼍㼠㼕㼛㼚㻌A, The mean “class evaluation (self-monitoring)” score. B, The mean “class evaluation (cognition)” score. C, Themean “class evaluation (emotion and behavior)” score. The class score before and after in self-monitoring, cognitive,
emotion and behavior were measured to evaluate the intervention effects in each item using one question with 5-point
rating scale developed in the previous study11）.

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㼀㼍㼎㼘㼑㻌㻠㻌 㼀㼔㼑㻌㼞㼑㼟㼡㼘㼠㼟㻌㻔㻲㻌㼢㼍㼘㼡㼑㻕㻌㼛㼒㻌㼠㼔㼑㻌㼠㼣㼛㻙㼒㼍㼏㼠㼛㼞㻌㼍㼚㼍㼘㼥㼟㼕㼟㻌㼛㼒㻌㼢㼍㼞㼕㼍㼚㼏㼑㻌㻔㼜㼑㼞㼕㼛㼐㻌×㻌㼓㼑㼚㼐㼑㼞㻕㻌㼛㼚㻌㼠㼔㼑㻌mean value of “class evaluation” before and 㼍㼒㼠㼑㼞㻌㼠㼔㼑㻌㼜㼞㼛㼓㼞㼍㼙㻌㼕㼙㼜㼘㼑㼙㼑㼚㼠㼍㼠㼕㼛㼚㻌
Main effectInteraction

GenderPeriodPeriod×Gender

.00
2.66
1.20

56.27**
13.45**
32.18**

.22
.83
.03

“Self-monitoring”“Cognition”“Emotion and behavior”
p < 0.05, **p < 0.01, F value is df = (1,57)*

In both gender, the scores were increased after
the program implementation. In the analysis ofvariance for all items (Table 4),  “period”
exhibited a significant㻌 “self-monitoring” with㻌
F (1, 57) = 56.27, 㻌 p < 0.01, “internal control㻌ofhealth (cognition)” with F (1, 57) = 13.45, p <0.01, and“ internal control of health (emotions
and behavior)” with F (1, 57) = 32.18, p < 0.01).
These results indicated the impact of the
there was no significant difference according to 㻲㼕㼓㼡㼞㼑㻡 㻌 Score of the “HLC for Children”
educational implementation on “period”, while the  㼎㼑㼒㼛㼞㼑㻌㼍㼚㼐㻌㼍㼒㼠㼑㼞㻌㼠㼔㼑㻌㼜㼞㼛㼓㼞㼍㼙㻌interaction of “gender × period” and “gender”.
㼕㼙㼜㼘㼑㼙㼑㼚㼠㼍㼠㼕㼛㼚This finding means that there is no difference in class educational impact according to gender.
㻟㻙㻟㻌㻴㻸㻯㻌㼒㼛㼞㻌㼏㼔㼕㼘㼐㼞㼑㼚㻌
Figure 5 shows the mean score from the survey on the health control associated with cognition
before and after the implementation. In both the boys and girls students, the scores increased after the
program implementation. Furthermore, according to the results of the analysis of variance shown in
Table 5, the significant main effect with “period” (F (1, 57) =21.35, p < 0.05), demonstrating the
educational impact of the intervention. However, there was no interaction between “gender × period”
and “gender”，showing that there was no difference in the educational impact according to gender.
Figure 5. Score of the “HLC for Children” before and after the program implementation. The score
was measured as described in the section of methods.
㼀㼍㼎㼘㼑㻌㻡㻌 㼀㼔㼑㻌㼞㼑㼟㼡㼘㼠㼟㻌㻔㻲㻌㼢㼍㼘㼡㼑㻕㻌㼛㼒㻌㼠㼔㼑㻌㼠㼣㼛㻙㼒㼍㼏㼠㼛㼞㻌㼍㼚㼍㼘㼥㼟㼕㼟㻌㼛㼒㻌㼢㼍㼞㼕㼍㼚㼏㼑㻌㻔㼜㼑㼞㼕㼛㼐㻌×㻌㼓㼑㼚㼐㼑㼞㻕㻌㼛㼚㻌㼠㼔㼑㻌mean value of “Health Locus of Control for Children” before and 㼍㼒㼠㼑㼞㻌㼠㼔㼑㻌㼜㼞㼛㼓㼞㼍㼙㻌㼕㼙㼜㼘㼑㼙㼑㼚㼠㼍㼠㼕㼛㼚㻌
Main effect

Health Locus of Control for Children*

Interaction

GenderPeriodPeriod×Gender

3.88

21.35**.023

p < 0.05, **p < 0.01, F value is df = (1,57)

㻟㻙㻠㻌㻿㼡㼞㼢㼑㼥㻌㼛㼒㻌㼐㼕㼑㼠㼍㼞㼥㻌㼔㼍㼎㼕㼠㼟㻌
Figures (6A to 6I) show the mean scores for boys and girls students for the dietary habit survey before
and after the implementation of the education program.

―8―

Effects of School-Based Nutrition Education Program

A Days the students ate breakfast   B C Days the students ate nighttime snacks

DDays the students ate snacks

BedtimeE Wake-up time             F  Duration of sleep

G Response to food students do not like the meal

 H  Soft drink intak

I 㻌 Items for breakfast㻲㼕㼓㼡㼞㼑㻌㻢㻌 㻯㼔㼍㼚㼓㼑㼟㻌㼕㼚㻌㼐㼕㼑㼠㼍㼞㼥㻌㼔㼍㼎㼕㼠㼟㻌㼍㼟㼟㼛㼏㼕㼍㼠㼑㼐㻌㼣㼕㼠㼔㻌㼠㼔㼑㻌㼜㼞㼛㼓㼞㼍㼙㻌㼕㼙㼜㼘㼑㼙㼑㼚㼠㼍㼠㼕㼛㼚㻌A, Number of days the students ate breakfast. B, Number of days the students ate snacks. C, Number of days thestudents ate nighttime snacks. D, Bedtime. E, Wake-up time. F, Duration of sleep. G, Response to food students do not
like. H, Soft drink intake. I, Number of items for breakfast.

―9―

奈良佐保短期大学研究紀要

第25号

2017年

Both boys and girls students showed an improvement in dietary habits according to the scores ofthe following items: “breakfast,” “snacks,” “nighttime snacks,” “bedtime,” “duration of sleep,” “howto handle food they dislike,” “soft drink intake,” and “number of items for breakfast.” Specifically, thenumber of days when the students had “breakfast” exhibited a ceiling effect in both boys and girls
students, with no change noted in the scores before and after the education program. The number ofdays when the students had “snacks” decreased after the education program for both boys and girls
students. In addition, the number of days the students had a “nighttime snack” significantly decreased
after the education program for boys students and girls students. “Bedtime” also improved for boththe boys students and girls students. On the other hand, “wake-up time” did not substantially change
in either the boys students or girls students. Since the bedtime is improved, the “duration of sleep”
increased for both boys and girls students. “Response to food one dislikes” improved for both the boys
and girls students so that foods they disliked were decreased. “Soft drink intake” significantly
decreased for both the boys and girls students, and an improvement was confirmed regarding theamount of sugar intake other than the meals that had decreased. The “number of items for breakfast”
increased for both the boys and girls students, resulting in the improvement of dietary balance. Table
6 presents the results of the analysis of variance.
For the items “number of days one had breakfast over 5 days,” “response to meals one dislikes,”and “wake-up time,” the significant main effect of “period” was observed. The results for “the numberof days one had snacks over 4 days” (F (1, 57) = 22.32, p < 0.01), “the number of days one hadnighttime snacks over 4 days” (F (1, 57) = 7.52, p < 0.01), “soft drink intake” (F (1, 57) = 14.79, p <0.01), “duration of sleep” (F (1, 57) = 9.47, p < 0.01), and “the number of items for breakfast” (F (1,57) = 4.07, p < 0.05) indicated that these items had significantly increased the mean score after thenutrition education, indicating that the nutrition intervention promoted behavioral modification.
㼀㼍㼎㼘㼑㻌㻢㻌 㻭㼚㼍㼘㼥㼠㼕㼏㼍㼘㻌㼞㼑㼟㼡㼘㼠㼟㻌㻔㻲㻌㼢㼍㼘㼡㼑㻕㻌㼛㼒㻌㼠㼔㼑㻌㻰㼕㼑㼠㼍㼞㼥㻌㻿㼡㼞㼢㼑㼥㻌㼟㼏㼛㼞㼑㻌
Main effectInteraction

GenderPeriodPeriod×Gender

How many days did you have breakfast during the past
5 days?

7.75

0

0

How many days did you have snacks during the past 4
days?

0.38

22.32**

0.07

How many days did you have nighttime snacks during
the past 4 days?

2.99

7.52**

0.96

Number of items for breakfast

12.2**

4.07*

1.16

The number of drinks

2.59

14.79**

0.32

What time did you go to bed last night?

1.62

9.87*

0.49

What time did you wake up this morning?

0.21

0.37

0.02

Duration of sleep

2.36

9.47*

0.49

What do you do if you do not like the meal?

2.38

3.06

0.3

*

p < 0.05, **p < 0.01, F value is df = (1,57)㻌㻠㻚㻌㻰㼕㼟㼏㼡㼟㼟㼕㼛㼚㻌It is important for nutrition education and pedagogy in schools to incorporate behavioral scienceand encourage behavioral modification in students. In this study, we studied the efficacy of thenutrition education program to the fourth-grade students in elementary school. We analyzed the― 10 ―

Effects of School-Based Nutrition Education Programeducational impact of the nutrition education program on dietary habits by promoting behavioral
modification.
㻠㻙㻝㻌㻱㼒㼒㼑㼏㼠㼕㼢㼑㼚㼑㼟㼟㻌㼛㼒㻌㼠㼔㼑㻌㼚㼡㼠㼞㼕㼠㼕㼛㼚㻌㼑㼐㼡㼏㼍㼠㼕㼛㼚㻌㼜㼞㼛㼓㼞㼍㼙㻌㼠㼛㻌㼜㼞㼑㼢㼑㼚㼠㻌㼘㼕㼒㼑㼟㼠㼥㼘㼑㻌㼐㼕㼟㼑㼍㼟㼑㼟㻌For the middle-level goals such as “self-monitoring,” “cognition,” and “emotions and behavior,” allmean scores were improved in both boys and girls students with the main effect of the “period.” Thisfinding indicates that with the implementation of the nutrition education program, elementary school
students were educated to learn and understand their own dietary habits along with the relationshipbetween health and dietary habits, leading to the perception that “one can protect one’s own health”,
increasing the motivation to “protect one’s own health”, and in turn making students capable of selfcontrolling their dietary habits.”
㻠㻙㻞㻌㻯㼘㼍㼟㼟㻌㼑㼢㼍㼘㼡㼍㼠㼕㼛㼚㻌㼛㼒㻌㼠㼔㼑㻌㼚㼡㼠㼞㼕㼠㼕㼛㼚㻌㼑㼐㼡㼏㼍㼠㼕㼛㼚㻌㼜㼞㼛㼓㼞㼍㼙㻌For the class evaluation, the mean score increased for both the boys and girls students combinedwith the main effect of “period” for all items, confirming that the entire class was engaged with thelecture. The present nutrition education program involves group work-based lectures, with lecture
content designed to take the full advantage of “peer support.” Therefore, there was a psychologicaleffect of “even if one cannot do it on his or her own, if close friends are able to engage, he or she may
be able to do it as well.”㻠㻙㻟㻌㻱㼐㼡㼏㼍㼠㼕㼛㼚㼍㼘㻌㼕㼙㼜㼍㼏㼠㻌㼠㼔㼍㼠㻌㼜㼞㼛㼙㼛㼠㼑㼟㻌㼠㼔㼑㻌㼎㼑㼔㼍㼢㼕㼛㼞㼍㼘㻌㼙㼛㼐㼕㼒㼕㼏㼍㼠㼕㼛㼚㻌㼛㼒㻌㼐㼕㼑㼠㼍㼞㼥㻌㼔㼍㼎㼕㼠㼟㻌In this study, for all dietary habit items, there was an improvement in the scores after the program
implementation for both boys and girls students.
Firstly, a significant difference was recognized regarding the intake of “soft drinks” after the
program implementation. Before the intervention, the mean for boys and girls students was 406 mL,
which was nearly twice as high as the 2015 national mean14）; however, it drastically decreased to 173
mL, which is below the national mean. In the nutrition education program used in this study, we let
the children monitor their intake of “soft drinks” by themselves, and allow them to improve. This is
one of the big problems to be improved in Tokushima prefecture since Tokushima prefecture reported
the worst mortality rate caused by diabetes for 14 consecutive years from 1993 to 2006 and a highproportion of children with obesity tendency15). While the N elementary school has been so far dealing
with a substantial number of children with risk factors for obesity because of the large intake of softdrinks, there was no visible improvement. In this study, the remarkable educational impact was foundby a measurable improvement. This finding made teachers at the N elementary school surprised
including the principal, and clearly presented the advantage of this nutrition education program.
Secondly, it is important to note that there was an increase in “the number of items for breakfast”
reported by the students. Both the boys and girls students presented a significant increase in the numberof items they consumed at breakfast after the program implementation. The main possible factor
attributed to this result was that the operational goal of the program. Because it prompted the students
to find out factors for the poor dietary habits and then let the students understand how they can correct
the problem on their own and change behavior to improve dietary habits including the “dietarybalance”16). Naturally, students cannot increase the number of items for breakfast by themselves,indicating that there was cooperation with other family members. Therefore, we assume that nutrition
education in school involves families and a ripple effect of the nutrition education. Indeed, somestudents stated in the interview “My family is trying to make me a better breakfast now”. This
comment indicates that the operational goal, “aim to improve the dietary habits with the support of thefamily” was achieved. In addition, a notable improvement was also observed in the item of “nighttime
snack intake”. The number of “nighttime snack” was significantly decreased from 1.72 days to 1.05
― 11 ―

奈良佐保短期大学研究紀要

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2017年

days after the intervention. It was thought that improvement in this “nighttime snack intake” item led
to an increase in the number of items for breakfast, creating a virtuous cycle.
Thirdly, for “snack intake,” the mean number of days for both the boys and girls students was 2.52
days before the intervention, however, it was significantly decreased to 1.60 days after the intervention.
It was thought that letting students recognize the negative impact on “continuous eating snacks” withstories regarding bacteria found in tooth cavities was likely effective.
Fourthly, for lifestyle habits, the mean “bedtime” of the boys and girls students improved
significantly from 22:12 to 21:42 after the intervention. The “duration of sleep” significantly improved
from 8 hours and 20 min to 8 hours and 48 min after the intervention. This result suggested that thestudents learned the effects of sleep during the lecture and actively incorporated a better sleep schedule
into their lives.
Fifthly, students in N elementary school have the higher ratio of children with obese, thereby theschool nurses repeatedly led lifestyle instructions to guardians to date; however, there was no
improvement.
Taken together, our nutrition education program modified a behavior in lifestyle habits, indicatingthat this nutrition education program had an educational impact.

㻌㻠㻙㻠㻌㻱㼐㼡㼏㼍㼠㼕㼛㼚㼍㼘㻌㼑㼒㼒㼑㼏㼠㼟㻌㼎㼥㻌㼓㼑㼚㼐㼑㼞㻌㼍㼚㼐㻌㼓㼞㼍㼐㼑㻌㼐㼕㼒㼒㼑㼞㼑㼚㼏㼑㼟㻌 㻌㻌In this study, differences in educational effect were not observed between boys and girls, which isthe same result as the previous study 11). Therefore, we concluded that nutrition education of the middle
grade (3rd and 4th) in the elementary school could be dealt as a gender common program. In addition,
we found that there were the statistical differences between before and after intervention in the
behavioral modification of dietary habits such as “the intake of soft drinks”, “number of items forbreakfast” “intake of snacks” “nighttime snacks” “bedtime” “duration of sleep”, whereas there was
the differences in two dietary habits “intake of snacks” and the “wake-up time” in our previous study
with third-grade students 11）. This difference suggests that the nutrition education program is more
effective for fourth-grade students. Kawasaki reported that the difference in one grade duringchildhood has an impact on the level of understanding and behavioral style associated with growth,by pointing out that classification capacity in diverse standard increases with the age in elementary
school 17）. Furthermore, Yuzawa reported that the simultaneous processing of different hierarchicalconcepts becomes possible in the fourth grade, indicating a possible involvement of developmental
changes in the segmentation of hierarchical concepts and processing capacity18）. Since in this study,
we found a difference in a one-grade age difference compared with our previous study. Therefore, it
is suggested that this developmental difference must be considered for nutrition education and alsosuggested that nutrition education for a single grade in elementary school is not enough, but thecontinuation of nutrition education utilizing the development in cognitive ability and implementing
sustainability appears to be more effective.
㻌㻡㻚㻌㻯㼛㼚㼏㼘㼡㼟㼕㼛㼚㻌With the objective of optimizing and improving the dietary habits of school children, we
implemented a nutrition education program with fourth-grade elementary school children according
to the behavioral science theory from the perspective of cognition, emotion, and behavior, andevaluated the results. The educational impact of the middle level goals for the students, including “selfmonitoring,” “cognition,” and “emotion and behavior” and the “HLC for children” were confirmed inboth genders with no significant difference. Our results demonstrated that the implementation of thisprogram resulted in improvement in the “internal control of health” (i.e., “protecting one’s own
health”). The class evaluation also confirmed a similar educational impact. When the behavioral
modification in dietary habits was established, it was recognized that educational impact involved― 12 ―

Effects of School-Based Nutrition Education Program

family members. Taken together, our nutrition education program was shown to be effective for
optimizing and improving dietary habits. It is expected that this program will be applied to educationalsettings. Further studies are required for the nutrition education program to establish the appropriate
number of interventions and the contents suitable for each grade, and the necessity of the continuityof nutrition education.
㻭㼏㼗㼚㼛㼣㼘㼑㼐㼓㼙㼑㼚㼠㼟㻌
We would like to extend our sincere appreciation toward all students and guardians who participatedin this study, and teachers of the elementary school who provided the venue for our research.
㻾㼑㼒㼑㼞㼑㼚㼏㼑㼟㻌1) Director-General for Statistics and Information Policy，Ministry of Health，Labor and Welfare：
Vital statistics in Japan：Trends up to 2015，http://www.mhlw.go.jp/ toukei/ list/dl/81-1a2.pdf（2017.9.10）
2) Ministry of Health，Labor and Welfare：Changes in Medical Costs during 2015，http://www.
mhlw.go.jp/topics/medias/year/15/dl/iryouhi_data.pdf（2017.9.10）
3) Heckman,J.J，Pinto,R.，Savely,P.：Understanding the mechanisms through which an influential
early childhood program boosted adult outcomes，The American Economic Review ， 103(6),pp.2052-2086（2013）
4) Cabinet Office，Government of Japan：Basic Act on Food Education Act No.63（2005）
5) Ministry of Education, Culture, Sports, Science and Technology：Guidelines on Elementary School
Instruction，General Rule，pp.29-31（2008）6) Ohzeki,T.：Metabolic Syndrome and Food Education for Children, Current Information of Maternal& Child Health，56，pp.57-62（2007）
7) NPO The Japanese Society of Nutrition and Dietetics：The Basic Model of Core Curriculum in
the Training of Registered Dietitians，Glossary of Nutrition Practice，Ishiyaku Pub，Inc，p.22（2014）
8) Inoue,K.：Theoretical Basis for Nutrition Education，“Nutrition Education Theory”，Gakubunsha
Inc，pp.13-29（2013）9) Trevino, R. P.，Pugh, J. A.，Hernandez,A. E.，Menchaca, V. D.，Ramirez, R. R.，Mendoza, M.：
Bienestar：A diabetes risk-factor prevention program，Journal of School Health.，68(2)，pp.6267（1998）
10) Bandura, A.：Social cognitive theory of self-regulation，toward a unifying theory of behavioral
change，Organizational Behavior and Human Decision Processes，50(2)，pp.248-287（1991）
11) Noma, T.，Uchida. K.，Yamasaki, K.：Development of a shokuiku program for elementary school
children and evaluation of its intervention effects，Journal of Japanese Society of Shokuiku，9(1) ,pp.53-65（2015）12) Noma,T.，Uchida,K.，Yamasaki,K.：Development and use of animation media “Health Promotion
Tour to the Country of Balance” in nutrition education，Bulletin of Seibi Junior College，44(1)pp.1-7（2016）13) Tanabe,K.：Validity and Reliability of the Children's Health Locus of Control Scale，Journal ofJapan Academy of Nursing Science，17(2)，pp.54-61（1997）14) Ministry of Health, Labor and Welfare：National Health and Nutrition Survey > Temporal Changes
in Main Health Indexes：Nutrition Intake Survey，http://www.mhlw.go.jp/ seisakunitsuite/bunya/kenkou_iryou/kenkou/kenkounippon21/eiyouchousa/kekka_syokuhin_chousa_nendo.html（2017.
9.10）
15) Tokushima Prefecture ： Current Status of Cause of Death in Tokushima Prefecture ，
http://www.pref.tokushima.jp/docs/2008111700039/（2017.9.10）― 13 ―

奈良佐保短期大学研究紀要

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16) Noma,T.，Kimura, S.，Sakamoto,R.， Takai, M.：Development of “Hand and Spinning Top
Shokuiku (Nutrition Education)Program” and its Practical Application, Journal of JapaneseSociety of Shokuiku, 2(4)，pp.159-166（2008）17) Kawasaki,K.: Conceptual Development of Preschool and School Children in a Group–Making
Task with Picture-Word Cards，Annual convention of the Japanese Association of Educational
Psychology，28，pp.590-591（1986）
18) Yuzawa, M.： Developmental Changes in Processing of Hierarchical Concepts，Annual conventionof the Japanese Association of Educational Psychology，28，pp.598-599（1986）― 14 ―

小学校における食行動に対する食育の効果
－小学校  年生の分析－
野間 智子 内田 香奈子 1 中野 容子 2 山崎 勝之 1
キーワード：行動変容，行動科学，健康増進，生活習慣病，食育
われわれは先行研究において，行動科学の理論に基づいた小学校中学年生向け栄養教育（食育）プログラムを開発した．本食育プログラムでは、食生活習慣を「セルフモニタリ
ング」，「認知」「感情・行動」の心理学的観点からとらえ，行動の自己責任，つまり人の健康問題の解決が自らの努力によることが大きいと考える内的統制力を向上させる内容とした．先行研究では，3 年生において，開発した栄養教育プログラムを実施し，一部に効果が得られている．
 本研究ではその食育プログラムの汎用性と課題を検討するために，徳島県の小学校 4 年生を対象に栄養教育を実施した．その結果，内的統制力 internality を含めた全ての項目において，教育前後で有意差が認められた．さらに，食生活習慣調査においても，「おやつと夜
食の摂取回数」，「嗜好飲料水の摂取量」，「朝食の品数」および「睡眠時間」に対して教育前後で有意差が確認された．以上から，本教育プログラムは，小学校 4 年生の食生活習慣の行
動変容を促す教育効果があることが認められた．一方，どの項目においても性差（男女）は認められず，性別が教育結果に影響を及ぼしていないことがわかった．


1
2

鳴門教育大学予防教育科学センター
鳴門市立鳴門西小学校― 15 ―