al., 1998). Finally, the Child and Adolescent Trial for Cardiovascular Health (CATCH) has demonstrated that school-based interventions can influence the dietary behavior of a child by influencing the school lunch and physical education environments (Nader et al., 1999; Perry et al., 1998a; Stone et al., 1996).
In summary, schools are an important environment where dietary behaviors in youth can be addressed. Schools are where children spend a large amount of their time, offer a system for reaching students in a defined setting that allows environmental change, and can involve the family through extracurricular activities. School-based interventions across multiple levels of the ecological model can result in significant improvements in the levels of fruit and vegetable consumption by children and reductions in the levels of fat intake. The need to create innovative programs that encourage additional parental involvement and environmental changes at home continues to be important for future work.
The AHRQ Diet Report denotes 24 community-based studies that address dietary behavioral change at the community level (Agency for Healthcare Research and Quality, 2001a). Of these, 10 addressed fat intake as the primary outcome (Baranowski et al., 1990a; Domel et al., 1993, Campbell et al., 1999b; Cox et al., 1995; Jaycox et al., 1983; Nader et al., 1983, 1989; Simmons-Morton et al., 1998; Stern et al., 1976; Stolley and Fitzgibbon, 1997; Turnin et al., 1992), six addressed fruit and vegetable consumption (Campbell et al., 1999a; Cullen et al., 1997; Havas et al., 1998; Lutz et al., 1999; Marcus et al., 1998a,c), and nine addressed fruit and vegetable consumption and fat intake combined (Brug et al., 1996, 1998, 1999; Fitzgibbon et al. 1996; Hartman et al., 1997; Knutsen and Knutsen, 1991; Pierce et al., 1997; Rodgers et al., 1994; Tudor-Smith et al., 1998). The Stanford Three-City Study primarily defined communities by geographical location (Farquhar et al., 1984). More recently, studies have recruited participants from community-based organizations, such as Girl Scout troops (Cullen et al., 1997), clinics that sponsor participants in the Special Supplemental Food Program for Women, Infants, and Children (WIC) (Havas et al., 1998), cancer registries (Marcus et al., 1998b), churches (Campbell et al., 1999a), and participants recruited from health maintenance organizations (Lutz et al., 1999).
Several studies targeted outcomes related to changes in levels of fruit and vegetable consumption with individual change strategies (e.g., goal setting) and inclusion of family components (Baranowski et al., 1990a; Fitzgibbon et al., 1996; Jaycox et al., 1983; Knutsen and Knutsen, 1991; Nader et al., 1983, 1989; Stolley and Fitzgibbon, 1997). Peer or lay approaches have been used to deliver interventions in multiple studies (Cullen