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A start to educating Head Start preschoolers on fruits and vegetables

December 2006, Vol. 11, No. 2
ISSN 1540 5273

Sheila Fleischhacker, Ph.D., J.D. Candidate
Law student at the Loyola University of Chicago School of Law
(At the time of the study was a Nutrition Sciences Fellow in the
Huck Institute of the Life Sciences at the Pennsylvania State University)
25 East Pearson
Chicago, Illinois 60611
312-502-1060
sfleisc@luc.edu

Katherine Cason, Ph.D., R.D.
Professor of Food Science and Human Nutrition
(at the time of the study was an associate professor in the
Department of Food Science at the Pennsylvania State University)
207 Poole Agricultural Center
Department of Food Science and Human Nutrition
Clemson University
Clemson, South Carolina 29634-0316
864-656-0539 phone
864-656-0775 fax
kcason@clemson.edu

Cheryl Achterberg, Ph.D.
Dean of the College of Human Sciences
(at the time of the study was a professor of nutritional sciences)
Iowa State University
E262 Lagomarcino Hall
Ames, Iowa
515-294-7800 phone
515-294-7802 fax
docach@iastate.edu

Acknowledgements

The United States Department of Agriculture Food and Nutrition Services Food Stamp Nutrition Education Program (Fund Number 89EM) and the Children, Families, and Youth Consortium of the Pennsylvania State University provided financial support. Leann Birch, Linda Burton, Tracy Fleischhacker, Terryl Hartman, Linda Kronheim, and Carla Miller were of great help during the research process. Thanks are also due to the children, primary care providers, and Head Start employees who participated in this study.

Abstract

The purpose of this study was to explore a sample of inner-city Head Start preschoolers’ knowledge and current concepts of fruits and vegetables. The exploratory, theory-based, qualitative study included semi-structured interviews with preschoolers (n=24), along with observations of an inner-city Head Start center’s school day for eight months. Maps were used to qualitatively analyze and compare the preschoolers’ responses. The preschoolers’ mean score for accurately identifying the fruits and vegetables was 74 percent. The preschoolers who could respond to the interview questions discussed where, when, and how they ate fruits and vegetables; where fruits and vegetables came from; what fruits and vegetables could do for their bodies; and their preferences for fruits and vegetables. These results demonstrate that most of the preschoolers had very little understanding of fruits and vegetables or had misconceptions. If this data is validated by future research, then curriculum developers may want to elaborate on utilizing meals in childcare centers to expose preschoolers to fruits and vegetables while potentially increasing preschoolers’ preference and intake of them. This data also implies that using mealtime to increase preschoolers’ knowledge of fruits and vegetables may help their cognitive development.

Keywords: Fruits and vegetables, Head Start, and preschoolers

Introduction

Low-income and African-American children not only report low intakes of fruits and vegetables (f/v) but also endure disproportionate rates of obesity and type II diabetes (Munoz et al. 1997; Neumark-Sztainer et al. 2002; Troiano and Flegal 1998; Fagot-Campagna 2000). Reducing these disparities is one of the Healthy People 2010 objectives (Healthy People 2010 2000). The National Cancer Institute (NCI), among others, is targeting f/v consumption in at-risk populations (U.S. National Cancer Institute 2004). One reason for this effort is that f/v may protect individuals from developing certain chronic diseases (Van Duyn and Pivonka 2000).

Early intervention can be one of the most effective methods of creating or changing dietary patterns; yet, limited research is available on strategies that either help or hinder healthy eating in at-risk preschoolers (Birch 1999). According to the Theory of Meaning Learning, the Theory for the Ecology of Human Development, and Ecological Model of Predictors of Childhood Overweight, a dietary intervention should incorporate the context of the target audience, including the food the audience eats and intermediary variables such as childcare (Novak and Gowin 1984; Bronfenbrenner 1979; Davison and Birch 2001). An assessment of a child’s social environment is critical in understanding what a child knows and could potentially learn. As described in the Theory for the Ecology of Human Development, a child’s food experiences in Head Start can be instrumental in her developing eating habits and nutrition knowledge (Bronfenbrenner 1979). The childcare center, while just one context, is an increasingly strong component in a preschooler’s ecological niche (Bronfenbrenner 1979; Davison and Birch 2001).

Interventions targeting preschoolers’ consumption of f/v should also take into account an individual preschooler’s baseline knowledge and current concepts of f/v (Novak and Gowin 1984; Bronfenbrenner 1979). Concepts, according to the Theory of Meaningful Learning, are defined as perceived regularities in events or objects designated by some label; they are what individuals think with; and they are useful in trying to determine a young child’s knowledge of a subject (Novak and Gowin 1984). The Theory of Meaningful Learning suggests that a preschooler with a rich base of concepts on a certain subject is more likely to succeed in future learning endeavors on that subject. If a child does not have a rich base of concepts, then future learning may be impoverished as well. Thus, a preschool child with few concepts of f/v may have a weak foundation for understanding the more complex, but important concepts of f/v later in life, such as how antioxidants in f/v help prevent certain chronic diseases.

Minimal research on a child’s eating environment from the child’s perspective exists (Matheson et al. 2002). Programs such as 5-A-Day have laid the foundation for designing, implementing, and evaluating f/v interventions targeted toward low-income and African-American populations (Havas et al. 1994). These interventions have helped identify constructs such as knowledge as specific means of how to understand f/v in children. 5-A-Day programs, however, have not provided sufficient evidence on how any of these constructs operate in preschool-aged children. Studies have argued specifically for further analyses in childcare centers as these social environments help lay the foundation within which food-related behaviors among young children are developed (Nicklas et al. 2001; Anderson et al. 2003; Task Force on Community Preventive Services 2003).

Food-related research in childcare centers, particularly in Head Start centers, is needed because these centers increasingly factor into low-income preschoolers’ development. Head Start is a federally funded preschool program that specifically serves more than 800,000 low-income children a year; it is also of interest because it receives specific funds for food provision and nutrition education (U.S. Department of Health and Human Services 2004). Scarce studies are available to guide nutrition educators on theory-based curriculum and activities for preschool programs, especially inner-city Head Start centers.

The purpose of this qualitative study was to explore a sample of inner-city Head Start preschoolers’ knowledge and current concepts of f/v. The authors hope that the findings will facilitate nutrition education efforts that may help increase at-risk preschoolers’ consumption of f/v.

Methods

The Pennsylvania State University Institutional Review Board approved all study protocols. Child assent and parental informed consent were obtained. Assent from the children was obtained once in front of their primary care providers. The children were also asked for their assent at the beginning of each of their individual interviews. All children and their primary care providers, with the exception of one primary care provider who could not participate due to time constraints, agreed to participate. Compensation included child-size water bottles for children in all six of the center’s classrooms. Nutrition education for all of the children, primary care providers, and center staff at all of the Head Start centers was provided after data collection.

Study design and sample

Direct observation of an inner-city Head Start center took place during their school day (Monday—Friday, 8:30 a.m. to 2:30 p.m.) from January—August 2002. One field researcher observed the center and made notations away from the childcare center after the school day. The observations focused on all the food served to the children, any health education provided at the center, and any other relevant findings. These observations provided a contextual component to the study. The field notes were reviewed and discussed among study investigators while analyzing the children’s interview responses.

The primary study center had six classrooms and each classroom was composed of twenty children and two teachers. This center was located in and served a primarily low-income, African-American community. Besides the classrooms, the center housed the unit specialists (e.g., nutrition and education) for six other centers. The children interviewed were recruited from three randomly selected classrooms at the primary study site.

The first classroom (n=11 children) served as a pilot. All of the pilot children lived in households below the United States poverty guidelines and were African-American. There were five boys and six girls. The children’s ages were as follows (n=the number of children participating of that age): three-year-olds (n=3), four-year-olds (n=5), and five-year-olds (n=3). Based on the pilot study, revisions to improve the protocol were made. These revisions included not asking the preschoolers to try to group the food cards (e.g., by color, shape, or food group) and adding the question “What does ‘healthy’ mean?” The subsequent two classrooms were used for data collection. All of the children in the primary data collection lived in households below the United States poverty guidelines and were African-American. There were twelve boys and twelve girls. The children’s ages were as follows (n=the number of children participating of that age): three-year-olds (n=5), four-year-olds (n=11), and five-year-olds (n=8).

The interviews were designed according to the study’s theoretical framework, which includes the Theory of Meaningful Learning, the Theory for the Ecology of Human Development, and Ecological Model of Predictors of Childhood Overweight. The questions were used to explore the preschoolers’ knowledge and current concepts of f/v. Similar studies have demonstrated that semi-structured interviews with preschoolers are an age-appropriate means of generating valuable and reliable data (Matheson et al. 2002; Achterberg 1986). Both of these studies also guided the qualitative design and analysis of the children’s interview responses and served as comparative bases.

Data Collection

Cards with images of f/v were used throughout the children’s interviews and included apple, banana, broccoli, canned peaches, carrot sticks, collard greens, corn, French fries, grapes, green peas, orange, and tossed salad. The f/v represented on the cards were selected from those listed on the center menus. Also, the selected f/v represented foods thought to be common in the community. The names that a particular preschooler gave the f/v cards (n=12) were used throughout his or her interviews. After the qualitative interviews, the children were asked to name actual versions of these foods (e.g., a real apple) and then were told the correct name if they did not come up with it on their own.

The interviewer used a structured set of questions with follow-up probes that each preschooler was asked to answer. The set included such questions as “Where do fruits come from?” The number of interview sessions held with each preschooler to get through the full protocol varied from child to child. The number of interviews ranged from two to seven. The order of the questions—i.e., fruit questions first, then vegetable questions—was switched equally among the children by age and gender so as not to bias one section over the other. If the preschoolers had difficulty understanding any of the questions such as: “Where do you eat fruits?”, then probes such as “Do you eat these foods at home?” were used.

Data Analysis

The Theory of Meaningful Learning guided our data analysis (Novak and Gowin 1984). While we focused on the concepts generated from the children’s interview responses, we were unable to use the traditional concept map. The majority of the preschoolers’ limited responses did not map as elaborately as needed for the traditional concept maps to be a useful representation of the preschoolers’ concepts. Their responses also did not have the breadth or depth to use the traditional concept-scoring scheme.

The figures or maps used for this study noted the central concept, i.e., fruits or vegetables, in the middle, and then used selected questions from the interview protocol to illustrate the preschoolers’ responses to these questions. Misconceptions were noted with an “M”. The preschoolers’ individual maps were then combined into one fruit and then vegetable common map to capture all of the concepts generated by the studied preschoolers. Frequency scores were given to each concept to note the number of times this concept was generated within the entire sample.

Inter-rater reliability was conducted by two independent assessments. Both researchers independently reviewed each preschooler’s responses to the study questions. Independently, both researchers noted a preschooler’s responses to the questions and then constructed and scored a map based on these responses. Agreement on the preschoolers’ responses, maps, and concept scores was 89 percent.

Statistical Analysis

Correlations were calculated using SAS (Cody and Smith 1997). Significance was set at p<0.05. Comparisons were based on prior research findings and trends that seemed to be emerging in the sample (Matheson et al. 2002; Achterberg 1986).

Results

Children’s identification of fruits and vegetables scores

The children’s average score for identifying the f/v by using picture cards and actual foods was 74 percent and ranged from a score of 25 percent to 100 percent. The f/v cards and actual foods scores were not significantly different (p=0.71). The children’s scores approached significance but did not significantly differ by age (p=0.06). No significant difference was found by gender (p=0.10).

Children’s concepts of fruits and vegetables

The ordering of the questions (e.g., fruit questions first, then vegetable questions) did not have an effect on the children’s fruit (p=0.11) or vegetable (p=0.31) concept scores. When and where people eat fruits and vegetables were often not understood, and as a result, probes were used in most of the interviews. No significant differences were noted by age (p=0.36 for total concepts, p=0.28 for fruit concepts, and p=0.94 for vegetable concepts) or gender (p=0.41 for total concepts, p=0.24 for fruit concepts, and p=0.51 for vegetable concepts).

Figure 1 (fruits) and Figure 2 (vegetables) represent all of the interviewed preschoolers' responses to the selected interview questions. Some preschoolers articulated few, if any, concepts, while others had multiple, yet sometimes conflicting, concepts. Figures 1 and 2 are fairly similar; however, a negative preference towards vegetables was articulated more frequently than was a negative preference or attitude towards fruit. For example, YBB, a four-year-old boy, explained: “You buy them (referring to vegetables), you cook them, and throw them in the trash. They (referring to mom and grandma) make nasty stuff (referring to vegetables) for me. I don’t like that.” Although, YGK, a five-year-old girl, expressed: “I usually go to the (restaurant)—NO FRUIT! FOOD!” In addition, a contingency pattern (i.e., the idea that they had to eat their peas in order to eat or get more peaches) to eating f/v emerged from many children, especially for fruit.

The preschoolers’ definitions of healthy were as follows (number of times concept was used by the children): Helps particular body parts, e.g., eyes (11); you eat certain foods (9); good (7); keeps you from getting sick (6); bad (5); I don’t know (5); they help you (2); and taste (1). YGB, a three-year-old girl, is one of many children who explained how vegetables help your digestive system: “You eat (vegetables), you make noise, and you eat and you make noise.” Most (88 percent) of the preschoolers said they eat f/v and think f/v are healthy (81percent). Several children discussed how food affects their teeth. YBI, a five-year-old boy, said: “It (referring to fruit) might be cold and your teeth will go ‘wee’ it’s cool. And it might hurt ‘cause I got one (referring to cavity) right here. And it burns. It’s bleeding a lot. I have two (filled cavities). The other filled cavity came out.”

Children’s misconceptions of fruits and vegetables

Table 1 lists all of the expressed misconceptions for fruits, while Table 2 lists all of the expressed misconceptions for vegetables. The three-year-olds’ misconceptions of vegetables approached significance (p=0.06), but were not significantly different from the five-year-olds’ misconceptions. There was no gender difference in misconceptions for fruits (p=0.59) or vegetables (p=0.42). No significant difference occurred between the children’s misconceptions of fruits versus vegetables (p=0.52). The ordering of the questions did not have an effect (p=0.89 for fruit misconceptions and then p=1.00 for vegetable misconceptions)

Discussion

The results are unique, and they are building blocks for future Head Start nutrition education curriculum development. Food identification skills seem to be a starting point for Head Start preschoolers’ nutrition and possibly for cognitive development. The Theory of Meaningful Learning suggests that understanding the unique conceptual structure each child has about f/v is essential for developing effective education efforts pertaining to the intake of f/v (Novak and Gowin 1984). A fundamental aspect of these structures, however, is foundational elements such as the proper names of particular fruits and vegetables.

These findings illustrate that some (~25 percent) of these preschoolers do not know the names of common f/v, such as “banana.” Some preschoolers had no problem identifying the cards. Age, as expected, was associated with higher f/v identification scores. One method of improving a preschooler’s identification abilities may be to have the childcare providers name and talk about the foods as the children are eating them. Research has shown the positive role that Head Start and its teachers can play in children’s nutrition socialization and food acceptance (Gable and Lutz 2002; Hendy and Raudenbush 2000). Teachers were rarely observed to name the food served. If the teachers did name the food, then they often gave the food a generic name such as “food.” Preschoolers can also help each other in naming the foods, but this cannot occur if the preschoolers themselves do not know the correct name or cannot talk at mealtime.

While food grouping was a difficult task for our pilot classroom and in Matheson’s sample, these findings indicate that preschoolers have the ability to name and discuss individual foods and food groups (Matheson et al. 2002). The interview responses and observational data indicate that these Head Start preschoolers learn a tremendous amount about food and eating through their experiences at preschool. The hypotheses provided by the Theory for the Ecology of Human Development, along with other research, help validate the importance of using the childcare center—and particularly meals and snacks consumed at the center—as a focal point in early childhood nutrition education (Novak and Gowin 1984; Bronfenbrenner 1979; Davison and Birch 2001).

The identification scores, as well as the common responses and misconceptions, guide future nutrition education efforts in designing curricula for Head Start and other preschool venues. That is, nutrition educators should develop curricula around the importance of properly naming common foods. The Theory of Meaningful Learning emphasizes that curricula should be based on children’s past experiences and current concepts (Novak and Gowin 1984). In this sample, the children seem able to discuss how foods affect their body and health. The children also appeared to have the capability to participate in basic preparing, cooking, and cleaning activities related to mealtime. Discussions of where foods come from also seem to be a topic of interest. Thus, nutrition educators should consider their preschool populations’ past experiences, e.g. their proximity to farms, and current concepts (e.g., vegetables help you go to the bathroom), when designing curriculum. In other words, nutrition educators should use preschooler’s current environment (e.g., farms or fruit stands) and concepts (e.g., several preschoolers from this sample thought vegetables helped them go to the bathroom) as a starting point for developing curricula on fruits and vegetables.

Even though nutrition knowledge is not the only factor (and often not the strongest factor) in predicting children’s f/v consumption, a rich base of f/v concepts may be an essential building block to instilling healthy eating habits and overall nutrition knowledge in children (Novak and Gowin 1984). Figures 1 and 2 demonstrate that some of this study’s preschoolers had some understanding of f/v, but these concepts varied tremendously. The knowledge and skill levels of low-income children entering Head Start are far below national averages (Karoly et al. 1998). Head Start outcome evaluations acknowledge that while the program is not eliminating the gap in educational skills and knowledge needed to prepare at-risk preschoolers for kindergarten, Head Start children are showing progress in cognitive skills, as well as, social and emotional development.

In this small study, age, as well as length of time in Head Start, seemed to influence concept content. The majority of preschoolers in this study were able to express lessons they have learned about f/v. Their concepts, as suggested by the Theory of Meaningful Learning and hypotheses generated from Achterberg’s similar study, may be the preschoolers’ own creative or logical way of dealing with foods, lessons, or messages they encounter in their Head Start classroom, home, or elsewhere (Novak and Gowin 1984; Achterberg 1986). The preschoolers commonly discussed that you eat f/v at home, school, and at meals. Some of the preschoolers identified that f/v were from the ground or trees. Yet, many preschoolers thought f/v came from the store or stove. Most of the preschoolers expressed a positive preference for the f/v. Negative preference for a particular f/v or, many times, for vegetables in general, was expressed.

The contingency pattern to eating f/v that emerged from many of the preschoolers was not surprising, given the observed teachers’ feeding practices. Most of the observed teachers did not serve the preschoolers fruit or allow them to eat it until they had a “happy plate” (a clean plate). Efforts should be made to correct these feeding practices as the Ecological Model of Predictors of Childhood Overweight indicate that these concepts, along with the teacher’s child feeding practices can have a negative repercussion on a child’s weight status (Davision and Birch 2001).

The majority of the preschoolers thought f/v were healthy. Most of them were able to discuss how f/v were good for the body because “they make you strong.” During the classroom mealtime observations, many of the preschoolers, sometimes classrooms at a time, would show their muscles off while eating or convincing other preschoolers to try their vegetables. Nevertheless, as illustrated in Figure 2, these preschoolers attributed negative things that vegetables do for the body, such as nothing or made you sick, as often as they noted that they were good for the body. This was not the only misconception that the preschoolers had. Although not extensive in this sample, misconceptions are difficult to change and they must be taken into consideration when evaluating concepts (Novak and Gowin 1984). For this sample, learning the difference between f/v is one method that might reduce misconceptions in this sample. This lesson can help preschoolers learn not only how to group but also identify individual items. Another misconception these preschoolers had was differentiating between actual fruit and fruit-flavored juices, candies, and snacks. Both of these misconceptions are understandably easy for preschoolers to have, but correcting these misconceptions is important to improving healthy eating patterns. Misconceptions, such as “vegetables come from the cow,” point nutrition educators to the food and nutrition concepts that the preschoolers are or are not learning.

Figures 1 and 2 direct nutrition educators to focus on the basics when working with similar preschoolers on increasing f/v knowledge: when, where, and how one can eat f/v; where f/v come from; and what f/v can do for the body. Many teachers told the preschoolers that “carrots are good for the eyes.” This was a common concept for the preschoolers, but some of them thought that every f/v must help one particular body part. It was not clear whether the preschoolers or teachers actually understood the relationship between carrots and eyes or if they were both echoing back something that they had been told. Emphasizing that f/v are good for the entire body along with a simple rationale may be an effective approach to developing life-long healthy eating habits. Nutrition educators should consider working with Head Start and other preschool programs more to design, implement, and evaluate how mealtime can be used to increase nutrition knowledge in preschoolers. These lessons could also aim to encourage improvements in other cognitive abilities by integrating other skill sets, such as counting.

Head Start recognizes that “exposing very young children to print, books, and reading aloud provides them with important concepts and establishes a foundation for reading” (U.S. Department of Health and Human Services 2004). Head Start is working on innovative ways to prepare children for reading and ensuring their school readiness. For example, Head Start is trying to improve family literacy by increasing Head Start families' access to materials, activities, and services. These family literacy efforts assist primary care providers as adult learners and, in some cases, help primary care providers to recognize and address their own literacy skills. Early childhood educators may want to consider using books on foods served at Head Start or table-time discussions based on the meals eaten at Head Start. These books could potentially serve as an ingredient to enhancing at-risk preschoolers’ word recognition and reading readiness skills. One study has successfully shown that children’s books can affect preschoolers’ attitudes and behaviors towards vegetables (Byrne and Nitzke 2002).

Study Limitations

We acknowledge the study’s limitations, which include a small sample size and only selecting a sample of f/v. Further qualitative studies are needed to validate our findings. In addition, we only focused on twelve fruits and vegetables. Adding other fruits and vegetables may have provided more breadth and depth to these children’s understanding of fruits and vegetables. Our hope is that these limitations will be addressed in future research.

Implications for research and practice

Food provision and nutrition education activities in Head Start and other preschool programs may serve as a critical building block in building healthy bodies and brains. Additional research is needed with preschool children and Head Start seems to be a logical place to start. This research should include the development of valid study methodologies. Mealtime discussions in childcare centers may help to increase at-risk preschoolers’ nutrition knowledge. In the future, researchers might study how mealtime may serve as a learning opportunity for preschoolers. At mealtime, preschoolers could learn how to correctly identify the foods they are eating. They could also engage in a basic discussion on where these foods came from and what these foods can do for their bodies. Nutrition educators developing mealtime lessons and activities should also consider how to facilitate a partnership between the preschool program and the children’s households on increasing preschoolers’ food identification skills.

Designers of early childhood nutrition education curricula may want to consider the reading readiness emphasis in Head Start (U.S. Department of Health and Human Services 2004). A reading readiness focus gives designers an opportunity to develop more books or book-based nutrition interventions. Books that incorporate healthy messages may be essential to ensuring that nutrition education is incorporated into the classroom on a regular basis. Kitchen toys and activities that do not require extensive supervision may be an effective mode of nutrition education and method to incorporate nutrition in Head Start or other preschool programs. The input of Head Start teachers regarding classroom activities is a critical component to the ultimate success of the activity. Preschool teachers should play a vital role in the piloting and validation of these nutrition education efforts. Curricula designers must keep in mind the supervision level needed for various lessons or activities. The teacher to child ratio in some Head Start or childcare centers can be as high as 19:1 (Byrne and Nitzke 2002). The high turnover rate of teachers is another factor that must be taken into account (Bureau of Labor Statistics 2004).

References

Achterberg, C.L. 1986. “The Meaning of Food and Nutrition in Families with Young Children: A Study in Social Cognition” (thesis prepared for Cornell University).

Anderson, L.M., C. Shinn, M.T. Fullilove, S.C. Scrimshaw, J.E. Fielding, J. Normand,V.G. Carande-Kulis, the Task Force on Community Preventive Services. 2003. The effectiveness of early childhood development programs: a systematic review. American Journal of Preventive Medicine 24:32-46.

Birch, L.L. 1999. Development of food preferences. Annual Review of Nutrition 19:41-62.

Bronfenbrenner, U. 1979. The Ecology of Human Development: Experiments by Nature and Design. Cambridge, Massachusetts: Harvard University Press.

Byrne, E., S. Nitzke. 2002. Preschool children’s acceptance of a novel vegetable following exposure to messages in a storybook. Journal of Nutrition Education and Behavior34:211-214.

Bureau of Labor Statistics. Occupational Employment Statistics, 2001,http://www.bls.gov/oes/home.htm (accessed July 17, 2004).

Cody, R.P., J.K. Smith. 1997. Applied Statistics and the SAS Programming Language, Fourth Edition. New Jersey: Prentice Hall.

Davison, K.K., L.L. Birch. 2001. Childhood overweight: a contextual model and recommendations for future research. Obesity Reviews 2:159-171.

Fagot-Campagna, A. 2003. Emergence of type 2 diabetes mellitus in children: epidemiologic evidence. Journal of Pediatric Endocrinology Metabolism.13(suppl 6):1395-1405.

Gable, S., S. Lutz. 2002. Nutrition socialization experiences of children in the Head Start program. Journal of the American Dietetic Association101:572-577.

Havas, S., J. Heimendinger, K. Reynolds, T. Baranowski, T.A. Nicklas, D. Bishop, D. Buller, G. Sorensen, S.A. Beresford, A. Cowan, D. Damron. 1994. 5-A-Day for Better Health: a new research initiative. Journal of the American Dietetic Association 94:32-36.

Healthy People 2010, 2nd ed. 2000. Washington, D.C.: U.S. Dept of Health and Human Services, US Government Printing Office.

Hendy, H., B. Raudenbush. 2000. Effectiveness of teacher modeling to encourage food acceptance in preschool children. Appetite 34:61-76.

Karoly, L.A., P.W. Greenwood, S.S. Everingham, J. Hoube, R.M. Kilburn, P. Rydell, M. Sanders, J. Chiesa. 1998. Investing in Our Children. Santa Monica: Rand.

Matheson, D., K. Spranger, A. Saxe. 2002. Preschool children’s perceptions of food and their food experiences. Journal of Nutrition Education and Behavior 34:85-92.

Munoz, K.A., S.M. Krebs-Smith, R. Ballard-Barbash, L.E. Cleveland. 1997. Food intakes of US children and adolescents compared with recommendations. Pediatrics100:323-329.

Neumark-Sztainer D., M. Story, P.J. Hannan, J. Croll. 2002. Overweight status and eating patterns among adolescents: where do youth stand in comparison with Healthy People 2010 Objectives. American Journal of Public Health 92: 844-851.

Nicklas, T.A., T. Barnanowski, J.C. Baranowski, K. Cullen, L. Rittenberry, N. Olvera. 2001. Family and childcare provider influences on preschool children’s fruit, juice, and vegetable consumption. Nutrition Reviews 59:224-235.

Novak, J.D., D.B. Gowin. 1984. Learning How to Learn. Cambridge: Cambridge University Press.

Task Force on Community Preventive Services. 2003. Recommendations to promote healthy social environments. American Journal of Preventive Medicine 24(3S): 21-24.

Troiano, R.P., K.M. Flegal. 1998. Overweight children and adolescents: description, epidemiology, and demographics. Pediatrics 101:497-504.

United States Department of Health and Human Services. Head Start. http://www2.acf.dhhs.gov/programs/hsb/ (accessed November 4, 2006).

United States National Cancer Institute, Division of Cancer Control and Population Sciences, Applied Research Program website. NCI Eating at America’s Table. All-Day Fruit and Vegetable Screener. http://www.riskfactor.cancer.gov (accessed November 4, 2006).

Van Duyn, M.A., E. Pivonka. 2000. Overview of the health benefits of fruit and vegetable consumption for the dietetics professional: selected literature. Journal of the American Dietetic Association 100:1511-1521.

Figure 1: Common map for all the concepts of fruits generated from all the interviewed children (n=24) (number of times expressed by the children in the sample)

Common map for all the concepts of fruits generated from all the interviewed children as described in the text above

Figure 2: Common map for all the concepts of vegetables generated from all the interviewed children (n=24) (number of times expressed by the children in the sample)

Common map for all the concepts of vegetables generated from all the interviewed children as described in the text above

Table 1: Misconceptions (n=64) about fruits expressed by the children (n=24) (frequency of times expressed within the entire sample of children)

Table 2: Misconceptions (n=64) about fruits expressed by the children (n=24) (frequency of times expressed within the entire sample of children)

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