Whole grain intake is associated with reduced risk for various chronic diseases, such as coronary heart disease (CHD), type 2 diabetes, and overweight/obesity. However, current consumption by children is only about one-third of the recommended level. The 2005 Dietary Guidelines and My Pyramid recommend that half of all the grains consumed should be whole grains [1, 2]. Despite this recommendation, several attributes of whole grain foods that may deter liking by children include the dark color, bitter taste, and tough texture compared to refined grain foods.
In recent years, school nutrition programs have actively sought to increase the availability of whole grain products served as part of school breakfast and lunch in an effort to follow the recommendations of the 2005 Dietary Guidelines for Americans. However, little research has been conducted to examine effective approaches to increase children's whole grain consumption through school meals. The research described in this dissertation consists of three diverse and interrelated studies which include both quantitative and qualitative research methods: Study I reported results based on a gradual incorporation of red and white whole wheat flour into bread products served for lunch in elementary schools (Fall 2005-Spring 2006); Study II included the development and testing of psychosocial variables that might be associated with whole grain intake by elementary school children (Spring 2006); and Study III involved the development of an innovative method to observe whole grain consumption during school lunches by videotaping followed with focus group interviews (Spring 2007 and Fall 2007).
Study I tested the feasibility of an innovative approach whereby the whole wheat content of bread products in school lunches was gradually increased to enhance whole grain intake by children. A convenience sample included children in K-6th grade from two elementary schools in a Midwestern city. Whole red and white wheat flour content of buns and rolls served twice weekly was increased from 0% to 91% in 16 and 7 incremental levels, respectively over the school year. Red wheat products were served in one school and white wheat products in the other. Plate waste methods were used on a whole school basis to estimate consumption. Mean consumption of whole grain (g/child) increased as the level of red and white whole wheat flour increased in modified bread products. Consumption of modified bread products did not differ statistically from baseline (0% whole grain flour) until the 72% level for red and 67.5% level for white wheat was served. Consumption of buns and rolls varied with type of accompanying menu items regardless of wheat type or level. A gradual increase in whole wheat content in menu items resulted in favorable whole grain consumption by children.
In study II, an instrument to measure the influence of psychosocial variables on children's whole grain consumption was developed and tested. Ninety-eight children in grades 4th - 6th in one elementary school participated in one 24 hour dietary recall interview and completed a questionnaire measuring self-efficacy, outcome expectations, preferences and knowledge on two occasions (approximately 14 days apart). Seventy-six parents completed a supplemental home inventory checklist to assess the availability of whole grain foods in the home. Mean total grain intake was 7.7 servings (SD 3.2) per day while mean intake of products containing whole grain (whole grain + some whole grain) was slightly over 2 servings/day. Internal consistency for psychosocial scales was modest or acceptable (alpha = .55 - .70). Test-retest correlation coefficients were acceptable (r =0.55 - 0.63) for the three psychosocial scales but not for a knowledge item. Total scores on the home inventory checklist ranged from 1 to 38 for whole grain items with a mean of 15 (SD 7). Reported home availability and refined grain intake were significantly related to whole grain intake while psychosocial variables were not. Availability in the home may be a more important variable associated with whole grain intake than preferences, self-efficacy and outcome expectations. Intake of whole grain foods was based on only one 24-hour recall interview which may not be representative of a usual intake and therefore represents a limitation regarding the interpretation of the results.
The final study III further investigated children's eating behaviors related to whole grain products using an innovative technique of video recording cafeteria lunches in a local school district. Approximately 90 children were taped on several occasions (range = 1 to 18 times / child) while eating a variety of grain foods including whole grain products served in a typical elementary school lunch. Focus groups (n~30) were used to collect in-depth information regarding students' response to new product introductions. Video analysis was based on a modified Dyadic Interaction Nomenclature for Eating (DINE). DINE is a valid behavioral coding system developed to assess parent-child mealtime interactions in young children [3, 4]. DINE is comprised of three categories of behaviors: parent behaviors, child behaviors, and child eating behaviors. The modified DINE was renamed Student Lunch Observation Nomenclature Eating (SLONE) to investigate eating patterns and behaviors of children during a school lunch. This study specifically used SLONE to investigate how whole grain products were consumed by children in a typical school environment. Results indicate that at higher grade levels children decreased the number of food items selected and time spent eating. Desserts made with grains, such as cookies and cakes, were taken by twice as many children when offered with a pizza meal compared to when fruits were served as a dessert. Differences in consumption of the main entrée approached significance when consumed with desserts made with grains compared to fruit desserts. Although the frequency of bites and sips varied among children, general eating patterns were categorized as "typical", "nibblers", and "cyclic" eaters. This baseline data provides a foundation for further exploring the use and acceptability of foods in school meals at the elementary school level. This information can be helpful in facilitating whole grain product development and introduction in an interactive and realistic cafeteria environment for children.