Hashtag Healthy: Literature Review

Sharon Belcarris
HLTH 634: Health Communication and Advocacy
November 13, 2016

Sharon Belcarris
HLTH 634
November 13, 2016

Introduction
Childhood obesity has increased over the past few decades in every age category. In
order to encourage a reduction in obesity throughout the community, it is vital that negative
health behaviors are addressed through intervention and health education. Providing community
based educational programs that enhance the health knowledge of participants including parents
and children, especially, assists with this goal. It is also important to address specific
environmental and policy constraints on food security, distribution, and marketing that effect
particular communities. Though reducing childhood obesity focuses on intervention with the
child, research implicates that parental involvement in the implementation of healthful activity
increases reception.
The purpose of this literature review is to propose a community and educational based
program that will combat the obesity epidemic. HashtagHealthy is an after school program
currently aimed at decreasing childhood obesity in teens. Several aspects of current youth habits
has prompted a need for programs such as HashtagHealthy. More than two hours of screen time
(including television, game, and computer time), less than recommended daily intake of fruits
and vegetables, and less than recommended aerobic and muscle strengthening activity
contributes to this health adversity among all age groups of children. HashtagHealthy assists with
combating these negative health habits. The current program consists of three days of
participation after school. Each day the participants will rotate between gardening, healthy snack
preparation, and physical activity. After the initial implementation of the program has been
accomplished, movement into elementary and middle school is desired. In addition to youth
participation, HashtagHealthy aims to provide several lines of communication to parents of
participants that will encourage follow through of program activities at home. Communication

Sharon Belcarris
HLTH 634
November 13, 2016

will include weekly newsletters, the HashtagHealthy website, and periodic parent meetings and
forums. Parental input on how to implement program objectives within the home is very much so
encouraged in order to inspire home participation among other parents and spread word of the
program throughout the community. Parental and organizer input will be included in the resource
and blog section of the HashtagHealthy website. The website will also be made available in both
English and Spanish in order to reach ease of use for as many families as possible.
Paying particular attention to the cultural habits amongst the community will also make
this program successful. Program activities will take into account the different influences among
the community in order to reach inclusion of participant families. With many communities
having a range of affordability, the program will also assess the areas food security, grocery
suppliers locations, and the economic status of participant families. Included in the resources to
parents will be places to shop or order from and activities that can be conducted at home with the
most affordable costs.
Body of Evidence
The collection of literature included in this review were based on specific criteria. The literature
must have been published no earlier than 2012 and the research must focus on implementing or
reviewing interventions based on childhood obesity prevention, youth gardening, physical
activity, and/or increasing nutrient intake. The literature will also be grouped according to the
fore mentioned categories. Articles were not included if there was a conflict of interest of the
authors or a vast amount of confounding or bias within the methods or results was discovered.
The first article of review will be that of Mayfield et al in Recipe for growing health
children: child care culinary workshops lead to improved menus, mealtime environments and
nutrition education.1 The focus of this article was on training childcare foodservice providers

Sharon Belcarris
HLTH 634
November 13, 2016

whom provide food and snacks to be more knowledgeable in nutrition and food preparation in
order to provide more diverse and healthful menus for the children they serve. The program
facilitators also focused on creating a family style eating environment. A portion of their
RECIPE program focuses on involving children in food preparation of nutritious snacks. At
follow up, about 30% of participants responded and about half implemented or planned to
implement the family style dining in their facility. Three fourths of responding participants also
cited planning nutrition education activities and 64% of responders were attempting new forms
of communication with parents.
The next article by Heim et al- A garden pilot project enhances fruit and vegetable
consumption among children2, implemented a garden program during a summer program. The
program included gardening activities, vegetable taste tests, fruit and vegetable snack
preparation, and parent newsletters. This pilot program evaluation proved to be successful in
providing exposure that equated to heightened vegetable preference and increase in the
participating children asking for fruits and vegetables at home. Children also reported enjoyment
in garden and snack preparation.
Triador et al3 explored a school based program in which participants tended to the growth
of fruits and vegetables in their classroom garden. This group of participants were an at risk
group composed of Canadian Natives. The risk of diabetes, heart disease, and obesity are
exceedingly high compared to the rates in non-Aboriginal Canadian population. Once garden
fruits and vegetables had grown, students participated in preparing snacks from the food grown.
At the conclusion of the program, participants reported higher preference for fruits and
vegetables increased over the 7 month period.

Sharon Belcarris
HLTH 634
November 13, 2016

The article by Jones et al4 focuses on the evaluation of the benefits perceived from
conducting nutrition education in the school setting. The results were promising in that they
experienced an increase of fruit and vegetable intake from stage 1 to the second stage of the
program. An increase was also associated with positive attitudes toward experience and program
activities. Results were based on self-reporting by the participants.
Wingert et al5 conducted research exploring the relationship between parents and their
children during food shopping trips. Children who accompanied parents often effected the items
bought negative. This study promotes the idea of the possibility of children who are educated on
healthy food sources may have the capability to have a positive effect on family buying habits.
Rodriguez et al6 conducted an intervention where participants were children who lived
between two homeless shelters in an urban area. These participants were effected by food
insecurity and shelter food service. Shelter food services were shown to need improvement in
order to effect change in the diet of its children occupants.
Schwartz et al7 discovered that after updated nutrition standards implemented in 20122013 following the 2010 Healthy, Hunger-Free Kids Act, there was an increase of fruit
consumption. Although there was a decline in vegetable choice by students, evidence showed
that children who chose vegetables ate more of them and there was a decrease of vegetable
waste.
Beets et al8 evaluated the efficacy of after school programs. After its one year evaluation
period, the article proved that twenty after school programs were able to increase student
physical activity that enabled them to meet or exceed the recommended 30 min/day moderate to
vigorous physical activity.

Sharon Belcarris
HLTH 634
November 13, 2016

The first few articles reviewed in the review all focused on interventions that increased
intake of fruits and vegetables and examined the overall health of the child thereafter. The
research concluded that there were positive correlations associated with these type of programs.
As well, programs that included gardening aspects increased fruit and vegetable intake and
preferences. Wingert et al studied the effect that children have on food choice of the home. Since
children effect food purchase, reaching them initially should in turn show complimentary results
in the other family members in the home. Afterschool physical activity programs assessed by
Beets et al also show promise for increasing exercise in children after observing this change in
their results after only one year.
Summary and Conclusions
The most significant outcomes in these studies provide several instances of positive
association with school based intervention programs that focus on increasing exposure and
knowledge of fruits and vegetables by implementing gardening and snack preparation activities
as well as including physical activity. Some of the above studies relied on self-reporting of
results. Participants at the target population may not have the best understanding of self-reporting
techniques and questionnaires. This can cause heavy reliance on others to help respond which
can then skew their responses. It is important that researchers include several measurements for
analysis when interpreting participant variations. Parental involvement and inclusion are
necessary in continuous implementation beyond the boundaries of the program. The resources
utilized in this review imply the need for the HashtagHealthy program that includes components
of school based intervention that includes the outside involvement of parents to implement the
after school gardening, physical activity and snack preparation.

Sharon Belcarris
HLTH 634
November 13, 2016

References:
1. Mayfield, B. J., & Graves, L. M. Recipe for Growing Healthy Children: Child Care
Culinary Workshops Lead to Improved Menus, Mealtime Environments, and Nutrition
Education. Journal of nutrition education and behavior. 2014: 46(6), 627-628.
2. Heim S, Stang J, Ireland M. A Garden Pilot Project Enhances Fruit and Vegetable
Consumption among Children. Journal of the American Dietetic Association. 2009:
109(7): 1220-1226. doi: 10.1016/j.jada.2009.04.009.
3. Triador, L., Farmer, A., Maximova, K., Willows, N., & Kootenay, J. A school gardening
and healthy snack program increased Aboriginal First Nations children's preferences
toward vegetables and fruit. Journal of nutrition education and behavior. 2015: 47(2),
176-180.
4. Jones, M., Dailami, N., Weitkamp, E., Salmon, D., Kimberlee, R., Morley, A., & Orme,
J. Food sustainability education as a route to healthier eating: evaluation of a multicomponent school programme in English primary schools. Health education research.
2013: 27(3), 448-458.
5. Wingert, K., Zachary, D. A., Fox, M., Gittelsohn, J., & Surkan, P. J. Child as change
agent. The potential of children to increase healthy food purchasing. Appetite 2014: 81,
330-336.
6. Rodriguez J, Applebaum J, Stephenson-Hunter C, Tinio A, Shapiro A. Cooking, Healthy
Eating, Fitness and Fun (CHEFFs): Qualitative Evaluation of a Nutrition Education
Program for Children Living at Urban Family Homeless Shelters. American Journal of
Public Health. 2013; 103(Suppl 2):S361-S367. doi:10.2105/AJPH.2013.301558.
7. Schwartz, M. B., Henderson, K. E., Read, M., Danna, N., & Ickovics, J. R. New school
meal regulations increase fruit consumption and do not increase total plate
waste. Childhood Obesity. 2015; 11(3): 242-247.
8. Beets, M. W., Weaver, R. G., Turner-McGrievy, G., Huberty, J., Ward, D. S., Pate, R. R.,
& Beighle, A. Making policy practice in afterschool programs: A randomized controlled
trial on physical activity changes. American journal of preventive medicine. 2015; 48(6):
694-706.