Home Articles Reader Opinion Editorial Book Reviews Discussion Writers Guide About TCRecord
transparent 13
Topics
Discussion
Announcements
 

Thinking about Nutrition Education: What to Teach, How to Teach It, and What to Measure


by Isobel Contento - 1980

Past and present nutrition education efforts are described and issues to be considered in evaluating the effectiveness of nutrition education are discussed. (Source: ERIC)

The pilot announced over the loud speaker system: "I have some good news for you and some bad news. First, for the bad news—we're lost. Now, for the good news—we are making better than usual time”


—Richard Manoff, speaking at the National Conference on Nutrition Education, September, 1979


With the passage in 1977 of P.L. 95-166 authorizing each state to expend 50 cents per school child in federal funds for "nutrition education and training" in its schools, the seal of official approval was placed on a phenomenon of the 1970s—the growing popular conviction that nutrition was something worth knowing about.1 Inspired to a large measure by moves toward "self-improvement" coupled with a conviction that there are relationships between diet and health, educators, parents, and the public at large have seized on "dietary" information from all kinds of sources, hoping to find guidance about what to eat in the face of a bewildering ten thousand-item supermarket.


Not surprisingly, this upsurge of interest in foods and nutrition has also resulted in the appearance of a plethora of educational and informational materials, curriculum guides, films, and other resources coming from the food industry and food industry trade associations as well as from more official sources such as universities and federal, state, and local government agencies. They differ not only in comprehensiveness, quality of production, and depth, but also in their content and approach.


For any educator looking over this diverse collection of resource materials, some obvious questions arise: How does one decide what to teach and how to teach it to any given audience? How does one decide what to measure in order to evaluate the effectiveness of one's efforts? The present review—which attempts to place in the educational mainstream some past and present efforts in nutrition education—suggests that there are a number of subsidiary issues that must be dealt with before one can begin to answer these major questions.


To begin to decide what needs teaching in nutrition education, one must first be clear about its ultimate goal. From the perspective of society, this has remained the same over the years—to have a healthy, productive people. At the turn of the century, when poverty and malnutrition were rampant, this goal was expressed as a need to upgrade the nutritional quality of the diet by supplementing it with highly nutritious foods—so that children could benefit from schooling and adults could be productive workers. People were urged to add more calories and protein to their diets. Indeed, in 1908, a Dr. Emerson of Boston developed a "nutrition Class" method where underweight children were encouraged to compete with each other in weight gains.2 The results were so spectacular that he was invited all over the country to train people in his methods of encouraging weight gain. With the discovery during the 1930s and 1940s of the importance of vitamins and minerals, education came to involve teaching people to add "protective" foods—fruits and vegetables—as well as calories and protein to their diets.


Today, however, the average American eats twice as much protein as he needs, deficiencies of the major vitamins and minerals are not widespread, and 30 percent of the citizens are overweight. To have a healthy, productive population today, we still need people who are normal in weight. But now, most often they need to lose weight; and they must primarily seek to avoid not nutrient deficiencies, but such apparently nutrition-related degenerative diseases as heart disease, diabetes, cancer, and hypertension.


Because of this changed context in which health is sought, the needs of the individual consumer or learner have changed. Earlier in this century, the learner, whether child or adult, needed, on the cognitive level, to learn which foods provided the required protein and protective substances—vitamins and minerals—so that he or she could be certain to include these in his or her diet. On the affective level, the learner needed to be willing to try a number of nutritious foods that may have been new or unfamiliar.


Today's consumer or learner needs, on the cognitive level, to know how to select from the vast array of foods in the average supermarket those foods he or she needs for optimal health in today's context. He or she also needs to know how to be discriminating about dietary advice that comes, sought and unsought, from a variety of unequally reliable sources such as popular books, advertising, packaging labels, newspapers, and materials from food industry sources or "health" food stores. On an affective level, the learner needs to learn self-restraint—particularly in light of the sedentary life-styles of most Americans, and to develop attitudes toward food selection that are conducive to long-term health. As Hegsted puts it: "In the past, the message was, in essence, to eat more of everything. Now we are faced with the more difficult problem of teaching the public to be more discriminating. Increasingly, the message will be to eat less."3


In trying to satisfy the goal of producing healthy people while meeting the needs of the learner or consumer in implementing that goal, the field of nutrition education has been in conflict over the extent to which it needs to relate to its disciplinary roots in the field of biochemistry. As a consequence, nutrition educators have sometimes rather narrowly focused their attention on teaching people how to apply nutrition science principles to food selection, failing to take into sufficient account the rapid changes in the food supply or the consequent changed educational needs of consumers. The field has also not drawn as much as it might from the disciplines of anthropology, sociology, psychology, and economics—to name just a few—in elucidating why we eat what we do, how food and its use affect the well-being of individuals and society, or how we might design nutrition education strategies that are more appropriate to the task at hand. And, despite (or perhaps because of) their scientific orientation, many curricula and materials based on nutrition science concepts seem able to answer fewer and fewer of the serious questions people ask about what they are eating and about how to be nutritionally healthy: Should I eat eggs? Does nitrite in food cause cancer? Is sugar bad for me? Should I drink skimmed milk rather than whole milk? Thus we find an explosion of interest in nutrition and a proliferation of nutrition education efforts, but no clear understanding of what nutrition education is trying to accomplish and of how best to accomplish it. It is not surprising, therefore, that we are making good time but are thoroughly lost.


How then do we decide what to teach that will be helpful to consumers in today's society?

WHAT TO TEACH


A review of a wide selection of the available curricula and materials in nutrition indicates clearly that there are two underlying, philosophically different, approaches to answering this question.4 While both view the goal of nutrition education as the promotion of individuals' good eating practices within their budgetary and life-style constraints, one approach attempts to promote this goal by providing individuals with guidelines about which specific foods to eat and which dietary practices to follow for optimal nutritional health in today's world, and the other approach emphasizes providing extensive information about nutrients in food, leaving the decision as to which foods to eat up to the consumer, American free-enterprise style. In this case knowledgeable decision making is considered the intervening variable toward the goal of eating well.


Through the years, nutrition education efforts, especially those aimed at the public at large, have not hesitated to teach people what specific foods to eat—usually through the use of dietary guidelines. The first national food guide was developed at the U.S. Department of Agriculture by Caroline Hunt in 1916 under the direction of Langworthy.5 Foods were classified into five groups and presented in simple, nontechnical language. The groupings were based on the biochemical findings of the time about human nutrient needs. Hunt's groups were: (1) milk, meat, poultry, eggs, and meat substitutes, (2) bread and other cereals, (3) butter and wholesome fats, (4) vegetables, and (5) simple sweets. In 1921, the five groups were published as a family food guide.6 This early guide, "A Week's Food for an Average Family” clearly specified the quantities of food that should be consumed by a family of five from each of the five groups; among them, for example, 70 pounds of fresh produce, 15 pounds of dry cereal, and 14 quarts of milk plus lOH pounds of flesh foods, cheese, eggs, and peanuts. Although the need for protein, "ash," and "vitamins" was becoming known, it was the energy needs of the family that formed the basis of the recommended amounts of food.


As knowledge about vitamins and minerals accumulated, the food selection guides shifted their focus so as to encourage people to obtain adequate amounts of these elements as well as sufficient calories and protein.7 McCollum coined the phrase "protective foods" to denote those often neglected foods that are rich sources of vitamins and minerals. He emphasized their importance by saying, "Eat what you want after you have eaten what you should."8 Sherman recommended that half the required calories come from protective foods.9


During World War II, to serve as goals in planning adequate nutrition for the civilian population, the Committee on Food and Nutrition of the National Research Council converted what was then known from research findings about human nutrient needs into a set of Recommended Dietary Allowances (RDA), which listed daily intakes for a number of specific nutrients. These nutrient recommendations provided a set of specific target levels around which all subsequent food guides could be developed. In addition, food guides took into account the existing dietary patterns of the American public, determining which foods needed emphasizing and which needed de-emphasizing in terms of the ''needed" nutrients.


These food guides have undergone a number of revisions over the years. The number of groups was increased to eight and then reduced again to seven during the war years. It was then further reduced to four in 1954—the current "Basic Four"—consisting of the meat and meat substitute group, the milk group, the bread and cereals group, and the fruits and vegetables group.


In the years since, the food supply has changed markedly.10 As a consequence the usefulness of the twenty-five-year-old Basic Four is being increasingly questioned. Since the underlying purpose of this food guide was to ensure that people using it obtained sufficient amounts of protein, minerals, and vitamins in their diet, it does not distinguish well between foods in each group that are high in calories and those that are low. For example, it does not distinguish between a meal consisting of fish, broccoli, skimmed milk, and whole wheat bread, and a meal made up of hamburger, potato chips, a milk shake, and a white bread bun.


In 1977, in a move well in keeping with the tradition of providing guidelines to the American public for what to eat, the Senate Select Committee on Nutrition and Human Needs issued a new set of recommendations, which attempted to take into account the current health status, sedentary life-styles, and needs of Americans as well as the realities of today's food supply. The Dietary Goals for the United States, drawing on extensive testimony before the committee on the relationships between contemporary U.S. diets and contemporary U.S. patterns of disease, suggests that, to increase the probability of optimal health, people should eat fewer calories; less fat—especially animal fat; less cholesterol, refined sugar and carbohydrates, and salt; and more complex carbohydrates and unprocessed foods.11 While this document does not provide a new food grouping system, replete with specified numbers of servings from each group, it does suggest which foods people should eat more of and which foods people should eat less of. It is of interest that despite their relatively obvious admonitions, the Dietary Goals have produced rather heated controversy within the nutrition community—at least partly because they were not the product of consensus within the nutrition community but were produced by a Senate committee, and at least partly because they appear to affect the economic interest of certain producer groups. At the present writing, a new food guide (prepared by government nutritionists) has appeared that takes many of the Dietary Goals' principles into account.12


The food groups approach has been criticized, however, as inadequate in the present food supply. With the introduction of increasing numbers of highly processed or fabricated foods whose nutrient composition may not be consistent with that of any traditional foods and that do not, thus, easily fit any of the food groups, there has evolved another approach, which can best be described as nutrient education. The placing of nutrient information on the labels of food packages is an example of this approach. It is hoped that consumers using these nutrient labels will be able to choose foods from the ten thousand items in the supermarket on the basis of their nutrient composition so that their combination will supply the major nutrients needed. This approach has the virtue of being applicable to processed, fortified, and fabricated foods as well as to whole or traditional foods. The goal of nutrition education in this context is to provide the consumer with the knowledge needed to make rational food choices. In one study, consumers with no more than a high school education were reported as able to use successfully and enthusiastically just such a nutrient approach to plan and evaluate meals.13


Both the food group and the nutrient approaches also appear in curricula designed for more formal settings. A brief description of two curriculum guides will illustrate these two approaches. One is a food-based curriculum whose goal is "to give children accurate fitness and nutrition information as well as strong support for making healthy lifestyle choices. . . . . It links the classroom to the home and encourages a life-long commitment to keeping fit."14 The activities suggested include familiarizing children with foods, where they come from, and what they come from, and what is in them in terms of sugar, fat, and salt as well as in terms of the traditional nutrients. The food grouping system used combines the dietary guidelines outlined in the Dietary Goals with the Basic Four.


The second curriculum guide is. based on the concept of Nutrient Density or the Index of Nutritional Quality, which is a means of measuring a food's nutritive value based on a comparison of its nutrient to energy or calorie content. This program, according to the introduction, "does not tell students what they can or cannot eat. Such rules too often impose unacceptable or unreasonable dietary restrictions. Instead, students are encouraged to 'mix and match' foods to meet their nutrient needs within calorie requirements while satisfying their own individual taste preferences. This approach to dietary selection allows for the use of non-traditional food combinations and encourages the use of ethnic foods."15 Nutrient principles are discussed through the use of Food Profile cards, listing the content of nine nutrients, including calories, for each of several hundred foods. Students learn to use transparent overlays to perform nutrient addition and thus to evaluate foods on the basis of their nutrient composition, or to select foods that are nutritionally complementary, balancing strengths and weaknesses of individual foods.


In between these two extremes are many other curriculum materials that are predominantly nutrient in approach. Foods are discussed and the Basic Four is used more often than not. However, the foods are generally discussed primarily in terms of their nutrient contribution to the diet. For example, a number of curricula have adopted the concepts outlined by the 1969 White House Conference on Food, Nutrition, and Health as a suggested basis for nutrition education efforts.16 The most widely used of these concepts are:


1. Food is made up of certain chemical substances that work together and interact with body chemicals to serve the needs of the body.


2. The way a food is handled influences the amount of the nutrients in the food, its safety, appearance, taste, and cost.


3. Nutrition is the process by which food and other substances eaten become you.17


In implementing these concepts, of course, the various curricular guides differ in the relative weight they give to food issues or to nutrient information. However, it is clear that the concepts intrinsically lend themselves to a nutrient approach.


Another recent comprehensive curriculum that hopes to produce nutritionally literate high school graduates uses a nutrient approach based on exploring these questions: Why do we need nutrition? What nutrients do we need and how much? How do we get our nutrients? How do our nutritional needs change? How do we study nutrition?18


As the educator tries to decide what to teach and whether to use a foods approach or a nutrient one, two questions should be asked and answered. The first is: What assumptions or values are implied by the approach? The second is: Is the information useful—will it contribute to the health of the nation?


Since food guides are devised to help people choose healthy diets, there would appear to be no need to inquire further into their underlying values or assumptions. However, it has been argued elsewhere that all food guides, in addition to providing guidelines for selecting foods that would meet the current RDAs, also express a whole set of cultural assumptions.19 The educator must therefore note how curriculum guides and materials talk about foods, as well as which foods they talk about (or do not talk about).


Most materials use the Basic Four in one form or another even though their emphasis may be predominantly nutrient-oriented. This food guide was certainly designed to promote healthy eating habits. When it is actually used in curricular materials, however, a number of implied assumptions become obvious. For example, if a teaching resource includes both milk and milk shakes in the milk group, and includes in the cereal group whole grains and breakfast cereals that may contain 60 percent sugar, the implication is that these foods are nutritionally equivalent. At one time, when calories, protein, vitamins, and minerals were at a premium, this may have been an acceptable implication. However, in light of today's nutritional problems, nutrition education materials must distinguish between foods in each group that are high in calories, animal fat, and salt and those that are not.


It has been pointed out that the meat and milk groups are almost always pictured first and second (or second and first depending on who produced the visual aid), conveying the impression that these requirements must be satisfied first, with foods from the other groups filling in. It has also been noted that although the numbers of servings suggested for each of the four groups are not the same (two each for the milk and meat groups, and four servings each of the vegetables/fruits and breads/cereals groups), many teaching materials imply that a "balanced meal" is one that contains one item from each of the four food groups.20 This process results in an overemphasis on the importance of animal foods, with their high fat content, and an underemphasis on plant foods.


Another example: If the educational activities recommended include making brownies with lots of butter and sugar instead of whole wheat bread, a message is conveyed to the child about valued activities and foods. Finally, what is not talked about in resource materials expresses values just as much as what is talked about and how it is talked about. For example, many curricula remain silent on such issues as advertising, "junk" foods, the ecological and economic context of food production and marketing, and the health implications of current trends in the American diet. Materials that do not distinguish between fresh potatoes and dehydrated ones or between fresh and frozen corn, except in nutritional terms, imply that the energy used to produce food is not an important factor to consider in making food choices.


Contrast the materials described above with a curriculum guide that uses the four food groups system, but lists the fruits/vegetables and grain groups first and the meat and milk groups last; that distinguishes within each group foods that can be eaten "anytime," "in moderation," or "now and then"; that talks about the fat, sugar, and salt content of foods as well as their protein, vitamin, and mineral content; that considers the energy cost of foods; that provides activities for children to make cheese and bake bread,21 and it becomes clear how different are the values and assumptions expressed in the wide variety of materials that are presumably designed to help people make wise food choices and develop desirable eating habits.


In contrast with any method based on recommending specific foods or food groups, the nutrient-based approach, and especially the nutrient-density approach, appears at first glance to be utterly free from bias about which foods to eat or not to eat. Since much of the primary research data in nutrition is subject to a wide variety of interpretation, such an "objective" system would seem to offer nutritionists a welcome opportunity to get off their soap boxes about the virtues of milk or the vices of junk foods. Convert all foods to nutrients, devise some scoring procedures, teach these to children and adults, and let them decide for themselves what to eat.


Even in nutrient education, however, there are implied values if not explicit ones. For example, no usable food product label can carry information on all the forty or so nutrients known to be essential for growth and good health. Just leaving out some nutrients and including others biases the information. Omitting information on the percent of calories supplied by refined sugar or saturated fat in a product, for example, implies that these are not important factors to consider. On the other hand, displaying the information that a given product contains 100 percent of the RDAs of a limited number of nutrients may imply that the product is nutritious. Most important, by supplying information on only a limited number of "standard" nutrients, the system cannot distinguish between, say, broccoli and sawdust fortified with the same amounts of six or eight of the major nutrients of the broccoli. Eight or so nutrients used to be enough to permit one to judge the nutritional value of a food. If a diet of whole foods was adequate in these "indicator" nutrients, it could be assumed that the diet was adequate in the forty or so others as well. But if a significant proportion of the daily intake of the indicator nutrients is supplied by highly fortified, processed, or fabricated foods, the indicator nutrient concept is no longer of value. The presence of other nutrients—especially trace nutrients, which are so easily lost in processing—can no longer be assumed from such nutrient calculations.


In addition to the question of underlying values and assumptions, a second question that must be raised in choosing between a food and a nutrient approach is one of usefulness. A curriculum can be scientifically accurate, appropriate for the age or intellectual level of its intended audience, and widely accepted by teachers or health educators, but this does not mean that the information conveyed or the activities planned will contribute usefully to the nation's health. For example, the inclusion of chocolate milk as a good source of calcium is scientifically accurate. But in light of the high-fat and high-sugar diet of most Americans, does that information contribute more usefully to developing appropriate eating habits than emphasizing low-fat milk? How do activities designed to help students recognize that a banana split is a mixed food while a banana is not, or that ice cream feels smooth in one's mouth but an orange does not, assist students to make better food choices? Further, materials that make statements about nutrients such as proteins or vitamins in the abstract are much less useful than statements such as: "One two-ounce candy bar has about as much sugar as three pounds of apples"; or "A hot dog contains about 30 percent fat and about the same amount of protein as an egg." And materials that make no mention of additives, saturated fat, junk foods, or other realities of the U.S. marketplace, with its bewildering array of more than ten thousand items, cannot in the long run be useful to either children or adult consumers in choosing foods more wisely.


A nutrient or nutrient density approach would appear to overcome some of the disadvantages of a foods approach. However, as pointed out earlier, materials or curricula that do not provide information on the saturated fat, fiber, sugar, salt, and cholesterol content of the food or its array of additives also fall short of their promise to be useful.


It is clear from this brief review that when we decide what to teach, the more important question than whether a nutrient or foods approach is taken is whether the content and its underlying values or assumptions will contribute usefully to the health of the nation within the context of the current food supply.

HOW TO TEACH IT


The creation of a healthy population depends not only on what is taught about nutrition, but on how it is taught. Obviously it is good for people to "know" nutrition. However, it is even better if people also develop desirable eating behavior. Nutrition education has tried to produce both effects.


As mentioned earlier, Emerson's "class method" was highly successful in bringing about weight gains in underweight children and was emulated throughout the country. Dr. Lydia Roberts in 1917 used both the "individual method" and the "class method" with children in a clinic setting in Chicago.22 Advanced nutrition students from the University of Chicago assisted in the clinic and received training in methods of improving child nutrition. Meantime, Mary Harper, nutritionist for the New York Association for Improving the Conditions of the Poor, and Dr. Mary Swartz Rose of Teachers College, Columbia University, developed similar programs in New York City.23 However, both Roberts, who came into the field as an experienced teacher, and Rose, who worked in a teacher's college, recognized that nutrition education could be done more effectively in a school situation than in clinics. Through the public schools every child could be reached, not just the "under par." Other educators, too, as early as 1913, began to see opportunities for nutrition education within school programs.24 Although the goal of nutrition education was still the improvement of child nutrition, the emphasis became placed on the "teaching" of nutrition.


And, over the years, the teaching of nutrition, like the teaching of other subjects, has drawn from educational theories and practices in vogue at any given time. In the early part of this century, this meant drawing on the educational ideologies of Dewey and others who, in reaction to the rote learning of an earlier era, emphasized the importance of the learner and the real-world context in which learning took place.25 An integrated approach was therefore advocated, combining the teaching of nutrition with science lessons, number work, spelling, cooking lessons, and work in school gardens, to name but a few. Langworthy considered school lunch programs (which were offered in forty-one cities in the United States at the time) as "a working laboratory for giving instruction concerning the pure food movement, food costs, food values, and the relation of food to working efficiency."26


Classroom instruction was also influenced by Dewey's emphasis on the importance of thinking in experience, and on education for a democracy as education in thinking. "Learning by doing" and problem solving rather than rote learning became the core of educational practice. Rose, for example, believed that the appropriate tool for teaching nutrition was food.27 Each lesson was built around a specific food that was a regular part of the children's diets. Since she agreed that children learn by doing, activities were part of each class and children were responsible for conducting the activities. The nutrition subject matter, she urged, should be graded to take into account the background of experience and understanding of the students; facts to be taught should relate to individual and community needs; parents should be involved. The ultimate goal of nutrition education was to help the child "deal wisely with his appetite and make habitually profitable selections of food for himself."28


Variations of the problem-solving approach, with its emphasis on education in thinking, have been used over the years. "Discovery learning" strategies have been used with high school students with some success in changing food preferences29 and in teaching about the concept of energy,30 and with college students to develop analytical skills.31 Nutrition self-experiments have also been used with college students to help them to gain an understanding of problems associated with dietary modifications.32


Most nutrition education in school and college settings, particularly in the 1960s and early 1970s, however, has relied on strategies that can best be described as information transmission methods ultimately derived from associationist or behaviorist theories. For example, in a comprehensive review of 269 nutrition education efforts with adults as well as with children from 1900 to 1970, Whitehead found that most of the efforts were "directed toward the purpose of disseminating nutrition information."33 And an analysis of the major K-12 curriculum guides in use in 1976 showed that the learning activities suggested in most of the guides were strongly teacher dominated and that active student participation was found in only a little over half of them.34 Furthermore, the objectives given for the teaching units were primarily in the cognitive domain with most of them at the lower levels of the cognitive taxonomy, that is, requiring only knowledge and comprehension.


Most of the newly developed curriculum materials for use with school-age youngsters are strongly activity oriented. However, "learning outcomes," "behavioral objectives," and "mastery learning" predominate, and specific behavioral and knowledge performance outcomes are expected.


In the college setting, a number of educational technologies that are widely used in other fields have come into use in nutrition education. These include the use of a personalized system of instruction,35 self-instructional materials,36 computer-assisted instruction,37 and programmed instruction.38 Competency-based education has been instituted as the preferred mode of training for nutrition and dietetics personnel.39 While most of these methods stress the individual learner, learning at his own pace, they are still designed to transmit sets of fixed knowledge or skills and to produce fixed behavioral outcomes, and are therefore basically behaviorist in their orientation.


It is fortunate that there have been nutrition educators such as Bosley, who, as far back as 1946, noted: "Nutritionists and educators should not lose sight of the real reason for nutrition education in their eagerness to disseminate information. The aim of nutrition education is a simple one: to establish good habits which will result in intelligent food selection, day by day, throughout life."40 But while there is much current interest in the subject of nutrition "behavior," we do not really know why people eat what they do, what features are unique to eating behavior as opposed to other behaviors, or whether there are approaches, unique to nutrition education, that could be used to develop desirable eating behavior.


Those nutrition education efforts that have sought to promote good food habits, just as much as those directed at teaching nutrition, have therefore drawn their techniques for doing so from the fields of psychology and education. Nutrition education efforts designed specifically to influence eating behavior have used techniques derived from a number of "schools": cognitive problem-solving approaches, behavior modification, and social-psychologic methodologies.


Whitehead concluded from her review of the literature that the nutrition education efforts that were most effective in improving dietary practices were those in which the methodology was designed with that as a purpose, the learner had an active part in the process of decision making, and people learned to solve their own nutritional problems.41 Even the class method of Emerson had elements of this approach. Children and their mothers attended weekly classes where the problems of weight gain were discussed along with procedures for remedying the problems. Children's individual weight charts formed the core of the discussions and special attention was given to those who had failed to gain, in an endeavor to find the cause. Class competition was encouraged.


The most widely quoted example of this problem-solving approach in the field of nutrition education is a series of experiments in attempted food-habit change designed by the cognitive field-theorist Kurt Lewin in 1942-1943.42 He showed that food habits of students and homemakers could be changed successfully by a method he called "group decision." In this process a brief statement of the food and nutritional problem was followed by group discussion on possible solutions. This in turn was followed by a group decision for actions to be taken either individually or collectively. Conformity to a group norm was also an element in this behavior-change strategy. This method was found to be more effective than methods involving requests to change or admonition by lecture. Lewin's method was later repeated with success in improving junior high school students' food choices in the school lunch program.43 A rather similar "experimental method" was used by Hatcher in 1941.44 Striking improvements were obtained when students were given the opportunity to analyze their own diets and to decide what they needed to do to improve them. On the other hand, when the teacher decided what should be studied and how it should be done, and analyzed students' diets for them, there was no significant improvement in the diets of the students.


Given these reports of success, the lack of similar reports in the literature is at first surprising. On second viewing it appears most likely that while use of "involving" methods has become quite

commonplace, they are no longer evaluated because they are simply assumed to be effective.


In a recent example of a slightly different cognitive approach, a study was designed "to determine whether cognitive information could be employed to influence the food buying behavior of individuals on a large scale."45 The presentation of caloric values of food in a cafeteria appeared to be an effective way of decreasing the total caloric intake of a large number of individuals of all weight groups.


Nutrition educators, such as Archibald in 1950, also advocated that the nutrition program should be thought of as involving the home and the community as well as the school, and that it should be cooperatively planned, conducted, and evaluated by the individuals concerned.46 Whitehead used this approach in two extensive studies—one in Louisiana from 1944 to 1950, and the other in Kansas City from 1952 to 1955.47 She indeed found that long-term improvements in food choices could be achieved when that was set as the specific goal of the program and when teachers, parents, students, and community leaders were all directly involved in its planning, implementation, and evaluation. The length of time the nutrition education effort was conducted, she found, was less important than the approach and the methods used.48 Similar strategies have been found to be effective in health-related community development work carried out in developing countries.49


Just as in the teaching of nutrition, behavioral-change strategies used in nutrition education have been influenced by trends in the psychological and educational literature. Thus most of the studies reported in the nutrition education literature in recent years have used change strategies derived largely from behaviorist theories. Behavior modification techniques have been used widely in treating problems of obesity.50 They have also been used to a lesser extent in other areas of nutrition education. For example, they have been used to produce desirable vegetable eating behavior in preschool children,51 and with Head Start mothers in a group setting to bring about positive attitudes and home food practices.52 Behavioral methods have also been advocated for nutritional counseling in health care settings.53


A third set of strategies, most often used in food advertising (which is a form of nutrition education) and least used by nutrition professionals, is that derived from social learning theory with its emphasis on imitative learning or modeling, role relations, and social attributions. Social-psychologic approaches have been used with some success in bringing about desirable changes in health behavior and are advocated for motivating changes in eating behavior as well.54 In one study that specifically tested the notion of modeling in nutrition education, researchers found that the number of children who ate spinach or rutabaga was greater after they had observed the cartoon Popeye or live models eating those vegetables than when they had not.55


How then do we bring about behavioral change? The literature seems to indicate that a variety of approaches can be used effectively depending on the outcome desired and the circumstances—cognitive problem-solving approaches, behavior-modification techniques, and modeling. They do, however, derive from different educational ideologies and psychological theories, with different assumptions about the learner, the learning process, and the nature of behavioral change. The nutrition educator should become familiar with these differences. It is not necessary for nutrition educators to become educational and social psychologists; but if the field is to accumulate any generalizable body of data, it is necessary that nutrition educators clearly articulate the theory or theories that underly their research or educational efforts, and draw the appropriate conclusions therefrom.


More recently, in light of the increasing complexity of the American food supply and of nutrition issues, there has been a renewed call for more "educating" to develop the thinking skills necessary for problem-solving and nutritional literacy, and less training for externally prescribed performance criteria.56 "Discovery" type activities have been used with college students to bring about active learning and to develop analytical skills.57 In one study a Piagetian-based approach was used to enhance the problem-solving skills of graduate nutrition students.58


It has also been argued that nutrition education should teach children how to think about food—that is, how to "use symbols appropriate for communicating about food" and how to analyze "those food systems which impact on their own lives." In an era in which foods are changing rapidly, this process would lay "the foundation for a lifetime of decision making."59


In this context, reference is often made to a by-now cliched proverb: Give a person a fish and you will feed him for a day; teach him to fish and he can feed himself for a lifetime. We need to be careful about the metaphor, however. What often seems to be meant—to continue the metaphor further—is that we will give him a line but not a net, and a small rowboat but not a large fishing vessel. Thus he will be able to fish only in a limited area and not in the open sea. Furthermore, we will teach him enough to be able to carry out the tasks of fishing, but not enough for him to evaluate whether, in light of the high concentration of the pollutant mercury in the water, he should be eating fish at all.


We do need to teach people knowledge and skills that will enable them to choose food wisely for a lifetime. However, educators should be careful not to interpret that mandate too narrowly. We must teach people principles that will enable them to choose between this food and that. But we must also teach them how to think in ways that will empower them to understand the health effects, energy costs, ecological consequences, and moral implications of their food choices; to analyze the impact of the food system on society as a whole; and to act self-reliantly in providing nourishing meals for themselves and others.

WHAT TO MEASURE AND HOW TO MEASURE IT


An upsurge of interest in evaluation has taken place in nutrition education somewhat later than in the educational endeavor as a whole. This is in part due to the late maturing of the field. Nutrition educators are now, however, increasingly aware of the need to find out how effective their programs or teaching strategies really are, not the least because of the budgetary implications of evaluation results and the desire of the public or of funding agencies to know whether their money is being spent usefully.


Changes in knowledge, attitudes, and behavior, as well as improvement in nutritional status, have all been used as measures for evaluating nutrition education. These outcomes differ in their ease of measurement, with knowledge gains probably the easiest to measure and behavioral changes the most difficult. A brief review of the use of each of these outcomes will make clear some of the issues that nutrition educators must consider in deciding which measures to use.


Although the intended goal of nutrition education has always been, presumably, to promote good eating practices, until the current wave of interest in evaluation, success was either not assessed at all or was assumed to have been achieved if there were gains in nutrition knowledge. Thus, as recently as 1976, an analysis of then-current nutrition curriculum guides revealed that evaluation procedures were included in only a little more than half of them.60 When evaluations were included, they were all measures of knowledge. All of these measures tested the students' knowledge of previously given information. Only about one-fifth of them, in addition, even measured the ability of students to apply previously given information in new settings, let alone analyze and evaluate information.


The more recently designed curriculum guides have attempted to overcome these shortcomings and to include evaluation measures at the conclusion of each of the teaching units.61 These measures are still mostly of gains in knowledge—as is appropriate in formal education settings—but they are better adapted to the developmental levels of learners and test the ability of students to use cognitive skills that are higher on the cognitive taxonomy, where this is appropriate. Knowledge measures are of course used routinely in college courses as well as in the training of professionals. They have also been used in mass media campaigns, both to evaluate the success of these efforts and to stimulate further interest in nutrition.62


More recently, changes in attitudes and in food preferences have also become widely used as measures of success of nutrition education efforts. Food preference scales of various kinds have been used with individual food items, various vegetables, and whole menus.63 Attitude measures, using in particular the Likert scale and the semantic differential, have been adapted from the social sciences for use in nutrition education of the public and with nutrition students.64 Many studies have used a combination of gains in nutrition knowledge and changes in attitudes to evaluate nutrition education efforts.65


Much more difficult to measure are changes in eating behavior. And measures for such changes are not easy to borrow from other fields. Nutritionists have usually used changes in the nutritional quality of the foods consumed as a measure of changes in eating behavior.66 An estimation of the foods consumed can be obtained by asking persons to recall all the foods and beverages they have taken in the previous twenty-four hours, or by asking persons to record their intake of foods and beverages over a three-day period. These food-intake records, taken before and after nutrition education efforts, are compared to evaluate whether there has been an improvement in the nutritional value of the foods eaten as a result of the educational intervention. There are a number of problems with food-intake records, however. People do not always remember or record everything they eat or drink. They often estimate portion sizes inaccurately. Most importantly, there is a suspicion that people will tell the interviewer what they think that the interviewer wants to hear. Such pre- and post-inventories, therefore, may not measure improvements in the foods eaten but improvements in knowledge about what they should say.


Other methods have also been used: measuring plate waste at school lunches,67 lunch questionnaires,68 photographing food trays in the school lunch line,69 or estimating the amount of specific food(s) eaten at school lunch by direct observation.70 Changes in sales of vended foods were used in one study to measure the effectiveness of nutrition information posted on vending machines in influencing consumers to choose the more nutritious foods.71 In another study, changes in food bought in a cafeteria as estimated by direct observations were used to measure the influence on food choices of the caloric labeling of food items.72


Since the goal of nutrition education is to produce nutritionally healthy people, improvement in nutritional status would appear to be the ultimate measure of the success of nutrition education efforts. However, there are many aspects to nutritional status and measures of these are unevenly reliable and difficult to obtain. Clinical indices of the vitamin and mineral status of populations are routinely measured in national surveys of nutritional status, but such biochemical measurements are more difficult to obtain than food-intake records. The results obtained are also difficult to interpret when used to evaluate individual nutrition education efforts since so many other factors may have contributed to the changes observed. Furthermore, measurements of vitamin and mineral status may not be very useful in a society where such nutrition-related diseases as diabetes, heart disease, hypertension, and cancer—rather than vitamin and mineral deficiencies—are the major health problems.


Weight gain was used as the measure of success of nutrition education at a time when malnutrition and underweight were prevalent in this country. It has been proposed that weight—in this case weight loss—be reintroduced as a way of evaluating nutrition education. Since overweight is a risk factor in so many of the currently prevalent health problems, and since some 30 percent of Americans are overweight, the attainment of normal weight would be a useful indicator of appropriate eating behavior.


In thinking about what to measure, several considerations must be borne in mind. In a time when children and adult consumers need to acquire the knowledge and skills to make wise food choices in a complex food system and to be discriminating about dietary advice, measurements of gains in knowledge should include measurements of the ability to analyze, synthesize, and evaluate food and nutrition information as well as to know, comprehend, and apply it.


A second issue to consider is that the relationships between knowledge, attitudes, and behavior are not at all clear. While it is traditional to assume that knowledge influences attitudes, which in turn influence behavior, we cannot depend on this. For example, in a recent survey conducted by Louis Harris for Pacific Mutual Life Insurance, "fully 67% [of the people surveyed] recognize that they would be healthier if they ate more of some foods and less of others"—but do not.73 In a second survey, conducted by Yankelovich, Skelly, and White for General Mills, those responding showed great respect for traditional food habits—for other people.74 A gap clearly exists between knowledge and action. It has also been noted that "it is more likely that changing a behavior will change an attitude than that changing an attitude will change a behavior."75 We eat what we like, as has often been pointed out, but we also like what we eat. Thus evaluation measures must be chosen, interpreted, and extrapolated with care.


A third issue arises from the attempt of the young discipline of nutrition education to become more rigorous and scientific. As in other fields, this means becoming more quantitative. The literature of nutrition education has become filled with such terms as "ANOVA," "regression analysis," "multidimensional scaling," "correlation coefficients," and the like. Indeed, one gets the impression that next to nutrition science, a nutrition educator needs to know statistics rather than educational theory and practice.


In many respects, this trend toward evaluation in quantitative terms is a healthy one. No longer is it sufficient to provide puppet shows and nutrition information and assume that they have benefits that are self-evident or that they are effective just because several of the clients or class members said so. A number of quantitative methods used in food-habits research could probably be adapted for use in evaluation procedures, such as multidimensional scaling, which has been used in analyzing children's food preferences;76 Guttman scaling, which has been used in analyzing food use frequency data;77 and Lewin's "Group Test for Determining Anchorage Points of Food Habits," which has been used in elucidating student's food attachments.78


However, nutrition educators must be cautious in their approach to quantification. Just as the content of nutrition education needs to expand beyond its disciplinary roots in the field of biochemistry, so do the research and evaluation procedures used need to expand beyond their methodological roots in a social science whose paradigm is derived from the natural sciences. Very often, trivial data of little practical significance look more valuable because they are expressed in tables and numbers. Quantitative methodologies also often overemphasize the technical aspects of reliability and validity in test instruments and underemphasize the question of whether the data thus obtained tell us what we want or need to know about actual behavior. Nutrition educators must not lose sight of the fact that "turning words into numbers, trends into prediction equations, and the behavior of people into probability tables or standardized regression coefficients"79 may frequently fail to help us understand better why people eat what they do, or whether our nutrition education efforts have been effective in terms that are meaningful to the participants.


Consequently, nutrition educators should investigate the use of field techniques from the anthropological tradition, in addition to those of the natural science tradition—techniques such as participant observation, in-depth interviewing, detailed description, and qualitative field notes.

CONCLUSIONS


This review has sought to place in the educational mainstream some of the past and present nutrition education efforts in order to elucidate some of the features that are unique to nutrition education. It has also sought to raise some of the issues that should be considered in deciding what to teach, how to teach it, and what to measure to evaluate the effectiveness of nutrition education.


We have seen that nutrition education has used many of the methodologies used by other educators both for the teaching of nutrition and for ways of assessing its effectiveness. The goals and content of nutrition education are what make it unique within the educational enterprise.


Most nutrition educators would agree that nutrition education should prepare people to "make intelligent food choices and to establish healthful dietary practices."80 Beyond this rather general statement, there is often little clarity as to what is meant by "intelligent food choices" or "healthful dietary practices," or how to bring these about. It is argued here that these statements must be

interpreted in terms of the ultimate goal of nutrition education as the production of a healthy, productive people in the context of today's nutrition-related health problems and the current food supply. It is from this central fact that all nutrition education efforts must flow. Indeed, rather than being enamored of our disciplinary subject matter and then seeking effective ways to transmit that to a given audience, we should start from what it is that we are seeking to accomplish and work backwards from there in terms of content and methodologies.


What we are seeking to accomplish is the development of "nutritionally literate consumers who can adjust their food selection to a changing food supply and be discriminating about dietary advice,"81 and who have established eating habits (and exercise patterns) that are conducive to long-term health. Therefore we need to teach people not only the knowledge that will help them to choose between this food and that, but also the analytical and evaluative skills necessary to think broadly about food and about nutrition in an ecologically sensitive and a globally interdependent world. We must also assist people to develop appropriate food preferences, attitudes, and eating behaviors, taking into account their complexity, embedded as they are in so many other aspects of a person's life-style.


A number of strategies from the mainstream of educational and social psychology have been used, with some success, both to "teach nutrition" and to bring about desirable behavior. In particular, teaching strategies derived from the developmental theories of Dewey and Piaget are being rediscovered and used to encourage the development of the reasoning skills needed for nutritional literacy in today's world. Nutrition educators are also discovering the usefulness of social learning theory as a source of methods for motivating behavioral change. Strategies derived from these two sets of sources seem especially powerful and useful for bringing about the needed skills and behaviors in nutrition education and their use needs emphasis.


The question of how we will teach people nutrition cannot be separated from the question of what we will teach them about food.82 Fundamental to any nutrition education effort is the question of content or "message." There are those who argue that nutrition education should, like teaching the 3 Rs, teach only the knowledge and skills of the discipline and should not presume to prescribe specific foods or behaviors. But even in the area of reading, teachers have discovered from the public outcry against certain books used in schools that parents want their children not only to be taught how to read, but also to be given practice in reading "good" books. It is doubtful, therefore, whether nutrition education should be "neutral" in light of its generally agreed-upon mandate to assist people to establish "healthful dietary practices," that is, that nutrition education should provide only food and nutrition information, and not provide specific instruction and practice in "good" eating habits. More importantly, it has been argued here that nutrition education cannot be value-free even if it wants to be. Any content carries with it implicit and explicit assumptions and values. Educators must be clear as to what these are in any curriculum materials they use. Educators must also keep in mind that these values change over the years because of the changing contexts in which "healthful" food choices have to be made.


The nutrition education content of the 1920s or even of the 1950s can no longer serve as the content of the 1980s. This review has pointed out that people at the turn of the century were urged to eat more calories and protein. Later, people were urged to add to their diets foods high in vitamins and minerals. It was out of a concern for nutrient deficiencies—then rampant—that there came the impetus both to fortify processed and fabricated foods with high levels of these nutrients and to place nutrient labels of the current content and format on packages. Out of this concern has also come most of the content of the curriculum materials that are still currently in use.


These materials have not yet caught up with the changed realities of the 1970s, which include the fact that a number of nutrition-related degenerative diseases and, possibly, deficiencies in trace elements—not deficiencies of the major vitamins and minerals—are the key health problems in the United States. The implicit and explicit content of these materials is therefore not as useful as it might be in contributing to the health of the nation in the context of the current food supply. Only a very few of the recent curricula are beginning to take into consideration the admonitions of the Senate Nutrition Committee's Dietary Goals for the United States to eat fewer calories; less fat, sugar, and salt; and more complex carbohydrates and unprocessed foods.83


However, even these guidelines may not be adequate for the decade ahead. It may well be that dietary guidelines for the 1980s will also need to include other values, such as a consideration of the energy costs of producing food—and the ecological consequences, if they can be easily measured. For example, perhaps the "caloric content" of the aluminum container for a diet soda—400 calories—should be considered as important in making food choices as that of the soda it contains—3 calories—when energy is in such short supply. And perhaps information on the energy used to produce a ready-to-eat cereal—to separate the constituents of the grain, to toast it, and to add a dozen or so vitamins, minerals, and flavorings—should be placed on package labels as well as the nutrient content of the product.


It may well be, too, that teaching good eating habits in the 1980s will have to mean teaching consumers eating behaviors that will contribute to producing not only optimal personal health, but also appropriate effects on the complex global ecosystems and on the politically interdependent world in which humans live.


Nutrition educators should welcome the upsurge of public interest in nutrition as an opportunity to reconceptualize nutrition education for the decade ahead. With that reconceptualization, nutrition education will not only be making good time but will be thoroughly on course in its mission to produce a nutritionally healthy and productive people.







1 The Perrier Study: Fitness in America, a survey conducted by Louis Harris and Associates for Great Waters of France, Inc., 595 Madison Avenue, New York, 1979.

2 F. E. Whitehead, Nutrition Education Research Project: Report of Phase I (Washington, D.C.: Office of Nutrition, Technical Assistance Bureau, Agency for International Development, 1970). Also, F. E. Whitehead, "Nutrition Education for Children in the United States since 1900," pts. 1 and 2, Journal of the American Dietetic Association 33 (1957): 880.

3 M. Hegsted, interview quoted in "Nutrition and Health," by H. J. Anders, Chemical and Engineering News, March 26, 1979, p. 27.

4 In preparation for this article, this author examined several dozen curriculum guides published by universities, state and local educational agencies, the food industry, and commercial publishers, as well as numerous informational materials located in the Nutrition Education Resource Center, funded by USDA's Nutrition Education and Training Program, through the New York City Office of School Food Services and the New York State Department of Education. This resource center is located at Teachers College, Columbia University, New York, 10027; see also Isobel Contento, "Overview of Nutrition Education and Information Programs for Children and Adolescents," requested background paper for discussion at the National Conference on Nutrition Education, Washington, D.C., September 27-28, 1979.

5 A. A. Hertzler and H. L. Anderson, "Food Guides in the United States—an Historical Review," Journal of the American Dietetic Association 64 (1974): 19.

6 C. L. Hunt, A Week's Food for an Average Family, USDA Farmers' Bulletin 1228, 1921.

7 Hertzler and Anderson, "Food Guides in the United States," p. 19.

8 E. V. McCollum, The Newer Knowledge of Nutrition (New York: Macmillan, 1918), p. 82.

9 Hertzler and Anderson, "Food Guides in the United States," p. 19.

10 L. Brewster and M. Jacobson, The Changing American Diet (Washington, B.C.: Center for Science in the Public Interest, 1978).

11 Dietary Goals for the United States, 2nd ed., Select Committee on Nutrition and Human Needs, U.S. Senate (Washington, D.C.: U.S. Government Printing Office, December 1977).

12 U.S. Department of Agriculture and U.S. Department of Health, Education, and Welfare, Nutrition and Your Health: Dietary Guidelines for Americans (Washington, D.C.: U.S. Government Printing Office, February 1980).

13 G. R. Jansen et al., "Menu Evaluation—A Nutrient Approach for Consumers," Journal of Nutrition Education 9 (1977): 162.

14 Inside Out: A Guide to Food and Physical Fitness, a curriculum guide written by C. Bershad, D. Bernick, and II. J. Selig for the Newton Public Schools, Learning for Life Project (Newton Education Center, 100 Walnut Street, Newton, Mass. 02160).

15 Nutrient Density Nutrition Education Curriculum, developed by Department of Nutrition and Food Science, Utah State University (Utah State University Foundation, Logan, Utah 84322). See also A. J. Wittwer et al., "Nutrient Density—Evaluation of Nutritional Attributes of Foods," Journal of Nutrition Education 9 (1977): 26; and G. Brown, B. W. Wyse, and R. G. Hansen, "A Nutrient Density—Nutrition Education Program for Elementary Schools," Journal of Nutrition Education 31 (1979): 31.

16 Nutrition Teaching in Elementary and High Schools, recommendations of Panels on Nutrition Teaching and Education, The White House Conference on Food, Nutrition, and Health, reported in the Journal of Nutrition Education 1 (1970): 24.

17 K. A. Cooper and C. E. Go, "Analysis of Nutrition Curriculum Guides at the K-12 Level," Journal of Nutrition Education 8 (1976): 62

18 Nutrition Education in a Changing World: A User's Guide, School Nutrition Education Curriculum Study, Pennsylvania State University (Provo, Utah: Brigham Young University Press, 1979).

19 Joan Dye Gussow, "Why We Need Nutrition Guidelines," speech at the third Conference on Nutrition and American Food System, sponsored by the Community Nutrition Institute and the Food Marketing Association, Washington, D.C., October 2, 1979.

20 Ibid.

21 Inside Out.

22 Lydia Roberts, Nutrition Work with Children (Chicago: University of Chicago Press, 1927).

23 Whitehead, Nutrition Education for Children in the United States since 1900; and Roberts, Nutrition Work with Children.

24 C. F. Langworthy, "Home Economics Work for Men and Boys," Journal of Home Economics 5 (1913): 239; A. L. Legget, "The Introduction of Home Economics in a South Carolina Rural School," Journal of Home Economics 5 (1913): 139; and M. E. Creswell, "Girls' Club Work in Georgia for 1912," Georgia State College Agricultural Bulletin 1, no. 6 (1913).

25 John Dewey, The Child and the Curriculum (Chicago: University of Chicago Press, 1902); and idem, Democracy and Education (New York: Macmillan, 1916).

26 Langworthy, "Home Economics Work for Men and Boys."

27 Mary Swartz Rose, Teaching Nutrition to Boys and Girls (New York: Macmillan, 1932).

28 J. A. Eagles, O. F. Pye, and C. M. Taylor, Mary Swartz Rose, 1874-1941, Pioneer in Nutrition (New York: Teachers College Press, 1979).

29 H. T. Spitze, "Curriculum Materials and Nutrition Learning at the High School Level," Journal of Nutrition Education 8 (1976): 59.

30 A. Palgi et al., "Body Weight as a Health Index: A Minicourse in Nutrition, "Journal of Nutrition Education 8 (1976): 126.

31 Isobel Contento, "Teaching College Students Analytical Skills," Journal of Nutrition Education 7 (1975): 159.

32 N. W. Shier et al., "Nutrition Self-Experiments with Lipids, Carbohydrates and Protein," Journal of Nutrition Education 5 (1973): 237.

33 Whitehead, Nutrition Education Research Project.

34 Cooper and Go, "Analysis of Nutrition Curriculum Guides."

35 M. Z. Cross and G. Semb, "A Personalized University Course in Nutrition," Journal of Nutrition Education 1 (1975): 149.

36 B. Shannon, "A Self-Instruction/Lecture Approach to Nutrition for Non-Majors," Journal of Nutrition Education 8 (1976): 107.

37 C. W. Wade and V. F. Thiele, "Computer Assisted Instruction in A College Nutrition Course," Journal of Nutrition Education 5 (1973): 246.

38 D. Delfs Studdiford and H. A. Guthrie, "Programmed Instruction in Basic Nutrition for College Students," Journal of Nutrition Education 4 (1972): 23.

39 M. Hart, "Competency-Based Education," Journal of the American Dietetic Association 69 (1976): 616.

40 Bertlyn Bosley, "A Practical Approach to Nutrition Education for Children," Journal of the American Dietetic Association 23 (1947): 304.

41 Whitehead, Nutrition Education Research Project.

42 Kurt Lewin, "Forces behind Food Habits and Methods of Change," in The Problem of Changing Food Habits, Committee on Food Habits, National Academy of Sciences-National Research Council Bulletin no. 108, Washington, D.C., 1943.

43 M. Radke and E. K. Caso, "Lecture and Discussion-Decision as Methods of Influencing Food Habits," Journal of the American Dietetic Association 24 (1948): 23.

44 H. M. Hatcher, "An Experimental Study to Determine the Relative Effectiveness at the Secondary Level of Two Methods of Instruction," Journal of Experimental Education 10 (1941): 41.

45 T. Milich, J. Anderson, and M. Mills, "Effects of Visual Presentation of Caloric Values on Food Buying by Normal and Obese Persons," Perceptual and Motor Skills 42 (1976): 15.

46 Juanita Archibald, "Some Comments on Nutrition Education," Canadian Journal of Public Health 41 (1950): 193.

47 F. E. Whitehead, "Dietary Studies of School Age Children in Ascension Parish, Louisiana," American Journal of Public Health 42 (1947): 1547; and idem, "How Nutrition Education Can Affect Adolescents' Food Choices," pts. 1 and 2, Journal of the American Dietetic Association 37 (1960): 348.

48 Whitehead, Nutrition Education Research Project; and idem, "Nutrition Education for Children in the United States since 1900."

49 T. Drummond. Using the Method of Paulo Freire in Nutrition Education: An Experimental Plan for Community Action in Northeast Brazil, Cornell International Nutrition Monograph series no. 3 (Ithaca, N.Y.: Cornell University, 1975); and L. Srinivasan, Perspectives on Nonformal Adult Learning (New York: World Education [1414 Sixth Avenue, 10019], 1977).

50 A. R. Weiss, "A Behavioral Approach to the Treatment of Adolescent Obesity," Behavior Therapy 8 (1977): 720; and E. E. Abrahamson, "A Review of Behavioral Approaches to Weight Control," Behavior Research and Theory 11 (1973): 547.

51 C. L. Ireton and H. A. Guthrie, "Modification of Vegetable-Eating Behavior in Preschool Children," Journal of Nutrition Education 4 (1972): 100.

52 R. R. Zimmerman and N. Munro, "Changing Head Start Mothers' Food Attitudes and Practices," Journal of Nutrition Education 4 (1972): 66.

53 M. J. Mahoney and A. W. Caggiula, "Applying Behavioral Methods to Nutritional Counseling;" Journal of the American Dietetic Association 72 (1978): 372.

54 R. I. Evans and Y. Hall, "Social-psychologic Perspective in Motivating Changes in Eating Behavior," Journal of the American Dietetic Association 72 (1978): 378.

55 M. B. Harris and H. Baudin, "Models and Vegetable Eating: The Power of Popeye," Psychological Reports 31 (1972): 510.

56 J. Moore, "Nutrition Education: Propagandizing vs. Merchandising," speech at the Society for Nutrition Education Annual Meeting, Minneapolis, Minn., July 17, 1978.

57 Contento, "Teaching College Students Analytical Skills"; and E. R. Mills, "Applying Learning Theory in Teaching Nutrition," Journal of Nutrition Education 4 (1972): 106.

58 Isobel Contento, "Measuring and Enhancing the Reasoning Abilities of Nutrition Graduate Students—A Piagetian Approach," Journal of Nutrition Education 11 (1979): 184.

59 A. N. Maretzki, "A Perspective on Nutrition Education and Training," Journal of Nutrition Education 11 (1979): 176.

60 Cooper and Go, "Analysis of Nutrition Curriculum Guides."

61 Nutrition Education in a Changing World; and Food . . . Your Choice: A Nutrition Learning System (Rosemont, Ill.: National Dairy Council, n.d.).

62 J. M. Axelson and D. S. DelCampo, "Improving Teenagers' Nutrition Knowledge through the Mass Media," Journal of Nutrition Education 10 (1978): 30; and M. T. Cerqueira et al., "A Comparison of Mass Media Techniques and a Direct Method for Nutrition Education in Rural Mexico," Journal of Nutrition Education 11 (1979): 133.

63 M. K. Head, "A Nutrition Education Program at Three Grade Levels," Journal of Nutrition Education 6 (1974): 56; M. J. Baker, "Influence of Nutrition Education on Fourth and Fifth Graders," Journal of Nutrition Education 4 (1972): 55; and N. B. Garton and M. A. Bass, "Food Preferences and Nutrition Knowledge of Deaf Children," Journal of Nutrition Education 6 (1974): 60.

64 M. L. Grotkowski and L. S. Sims, "Nutritional Knowledge, Attitudes, and Dietary Practices of the Elderly," Journal of the American Dietetic Association 72 (1978): 449.

65 Head, "A Nutrition Education Program"; S. M. Picardi and D. Porter, "Multidimensional Evaluation of a Food and Nutrition Minicourse," Journal of Nutrition Education 8 (1976): 162; and B. R. Carruth and K. O. Musgrave, "Changing Attitudes in Community Nutrition," Journal of Nutrition Education 11 (1979): 127.

66 Head, "A Nutrition Education Program;" and Baker, "Influence of Nutrition Education."

67 S. C. Boysen and R. A. Ahrens, "Nutrition Instruction and Lunch Surveys with Second Graders," Journal of Nutrition Education 4 (1972): 172.

68 H. M. Smith and C. L. Justice, "Effects of Nutrition Programs on Third Grade Students," Journal of Nutrition Education 11 (1979): 92.

69 F. W. Grant, "Effect on Eating Habits of Nutrition Education in the Fifth Grade— Determination by Photography," Journal of the American Dietetic Association 26 (1950): 413.

70 J. M. Dodds, "Effect on Food Consumption of A Nutrition Message Delivered by Two Methods" (Ed.D. Diss., Teachers College, Columbia University, 1978).

71 L. B. Larson-Brown, "Point-of Purchase Information on Vended Foods," Journal of Nutrition Education 10 (1978): 116.

72 Milich, Anderson, and Mills, "Effect of Visual Presentation of Caloric Values."

73 Health Maintenance, a survey conducted by Louis Harris and Associates for Pacific Mutual Life Insurance Co. (P. O. Box 9000, Newport Beach, Calif. 92660, 1979).

74 Family Health in an Era of Stress, a survey conducted by Yankelovich, Skelly and White for General Mills, Inc. (9200 Wayzata Blvd., Minneapolis, Minn. 55440).

75 Evans and Hall, "Social-psychological Perspective in Motivating Change."

76 L. L. Birch, "Dimensions of Preschool Children's Food Preferences/' Journal of Nutrition Education 11 (1979): 77.

77 J. H. Sabry et al., "Evaluative Techniques for Use with Children's Diets," Journal of Nutrition Education 6 (1974): 52.

78 E. R. Mills, "Psychosocial Aspects of Food Habits," Journal of Nutrition Education 9 (1977): 67.

79 M. Q. Patton, Alternative Evaluation Research Paradigm, monograph published by North Dakota Study Group, Center for Teaching and Learning (University of North Dakota, Grand Forks, N.D. 58201, 1975).

80 Food . . . Your Choice.

81 Orrea F. Pye, "Retrospects and Prospects in Nutrition Education," Journal of Nutrition Education 8 (1976): 175.

82 Maretzki, "A Perspective on Nutrition Education.

83 Dietary Goals for the United States.




Cite This Article as: Teachers College Record Volume 81 Number 4, 1980, p. 421-447
https://www.tcrecord.org ID Number: 1046, Date Accessed: 5/21/2022 9:11:37 AM

Purchase Reprint Rights for this article or review
 
Article Tools
Related Articles

Related Discussion
 
Post a Comment | Read All

About the Author
  • Isobel Contento
    Teachers College, Columbia University
    E-mail Author
    Isobel Contento is associate professor at the Department of Nutrition Education at Teachers College, Columbia University. Her research interest is the use of developmental theory in enhancing the reasoning skills of nutrition students and in understanding how children think and act with respect to food.
 
Member Center
In Print
This Month's Issue

Submit
EMAIL

Twitter

RSS