at the 2-year follow-up, there were no significant effects between groups for any of the dietary outcomes.

The Seattle 5 a Day Worksite Program randomized 28 worksites that had cafeterias and intervened in 14 sites with changes in the work environment and programs and activities targeting individual behavior change. Significant improvements in fruit and vegetable consumption were observed at the 2-year follow-up point (Beresford et al., 2001).

School-Based Interventions

Schools have been the setting for population-based interventions designed to lower the levels of fat intake and improve the levels of fruit and vegetable consumption of elementary and middle school children. As cited in the AHRQ Diet Report (Agency for Healthcare Research and Quality, 2001a), fruit and vegetable consumption was the focus of five school-based studies (Baranowski et al., 2000; Nicklas et al., 1998; Parcel et al., 1989; Resnicow et al., 1992), fat intake was the focus of four studies (Baxter et al., 1997; Harrell et al., 1996, 1998; Simons-Morton et al., 1991; Walter et al., 1988), and the combination of fruit and vegetable consumption and fat intake was the focus of three studies (Luepker et al., 1996; Perry et al., 1998a; Resnicow et al., 1992, 1998).

School-based interventions have generally focused on changing the dietary intakes of children in school settings in multiple ways, including through (1) one-to-one classroom instruction by teachers; (2) environmental change via modification of the foods served by the school cafeteria; and (3) family support through involvement in diet-related homework, activity packets, or group meetings (e.g., Gimme 5 [Baranowski et al., 2000], the Child and Adolescent Trial for Cardiovascular Health (CATCH) study [Luepker et al., 1996], 5 A Day Power Plus [Perry et al., 1998b]). For example, Parcel and colleagues (1989) included modeling, self-monitoring, and food demonstrations to enhance fruit and vegetable consumption, in addition to changes to the cafeteria environment. The Gimme 5 program attempted to improve fruit, juice, and vegetable consumption with changes to classroom curriculum and educational materials and programs for children and their parents (e.g., newsletters, videotapes, and point-of-purchase education) (Baranowski et al., 2000). Nicklas and colleagues (1998) included a media campaign with classroom, school lunch, and parental interventions. Finally, Perry and colleagues (1998b) collaborated with community food industries and the family and used other intervention components. In general, school-based behavioral interventions have yielded improvements in levels of fruit and vegetable consumption (Agency for Healthcare Research and Quality, 2001a). Studies such as the Cardiovascular Health in Children (CHIC) trial have also achieved significant reductions in total serum cholesterol levels (Harrell et



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