Nutrition knowledge, attitudes, and practices among nutrition educators in the south.

Abstract; The objective was to assess nutrition knowledge, attitudes, and weight control behaviors among teachers--from South Carolina. A sample of 93 teachers was randomly selected from all state public schools. Univariate analysis, chi-squares and t-tests were used for analysis. Teachers had fair knowledge levels and positive nutrition attitudes. Media was the preferred approach for training, panel discussions the most effective method of teaching. Over three fourths were concerned about their weight and 33.5% were overweight/obese. During the past month, 4.6% used diet pills and 45% used other methods to control weight. Results provide baseline data for planning nutrition education programs.

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Current data regarding nutrition behaviors among children suggest that the majority of children in America do not meet the minimum national dietary recommendations, which include the consumption of less than 30% of calories from fat and the consumption of at least five fruit and vegetables (FV) per day, as depicted by the Food Guide Pyramid (Neumark-Sztainer, Story, Hannan, & Croll, 2002). Data from a recent study conducted with children in the South indicate that only 16% met the recommendations for fruit and vegetable intake, and 31% of children in 5th grade did not meet any of the Food Guide Pyramid recommendations (Rafiroiu, Anderson, Sargent, Parra-Medina, Jackson, & Thompson, 2000).

According to theoretical frameworks such as the Social Cognitive Theory (Bandura, 1986) or Bronfenbrenner's Ecological Model (Bronfenbrenner, 1979), schools are an important environmental influence for the dietary behaviors of children and young adolescents. Because approximately 97% of children and adolescents are enrolled in school, where they spend the majority of their day, the school environment can either encourage or hinder healthy eating. Consequently, researchers have taken advantage of the large captive audience of children in schools and have implemented school-based health promotion programs. Previous research indicates that comprehensive, well-implemented school based nutrition interventions, as well as intervention focusing on other health behaviors such as physical activity and tobacco-use prevention, can promote healthy behaviors (Kandiah & Jones, 2002; Little, Perry, & Volpe, 2002; Luepker, Perry, & McKinlay, 1996; Must, Spadaon, Coakley, Field, Colditz, & Dietz, 1999).

One gap in the literature related to school-based interventions is the role of teachers on students' dietary behaviors. Because teachers have regular contact with students, they potentially have a great influence on children's dietary behaviors (Killen, Telch, & Robinson, 1988). Teachers can facilitate nutrition education and the development of healthy eating habits by the dissemination of nutrition information through formal interactions and by serving as a role model through informal interactions. However, many school teachers do not have any formal training in nutrition and may transmit incorrect information or model unhealthy dietary behaviors (Neumark-Sztainer, Story, & Harris, 1999). Results from a study conducted by Kubik, Lytle, Hannan, Story, and Perry (2002) indicated that current teachers' behaviors are not necessarily conducive to the development of healthy eating patterns by young adolescents. Frequent use of vending machines (purchasing soft drinks or snacks high in sugar/fat), and distribution of snacks in the classroom as a reward were two common examples of unhealthy behaviors demonstrated by teachers (Connell, Turner, & Mason, 1985). Additionally, teachers may unintentionally create harmful effects if they transfer negative attitudes to students including poor self-body image, inappropriate weight loss behaviors, and bias towards students (e.g. treat overweight students differently than other students). Thus, teachers have the opportunity to transmit both healthy or unhealthy attitudes and behaviors through both formal and informal interactions with students.

Given the salience of teachers as part of the environmental influence on nutrition information and behavior of children, it is important to examine and understand teachers' knowledge, attitudes, and behaviors. Thus, the primary purpose of this descriptive study was to assess knowledge, attitudes, body size perception and weight control behaviors of a sample of public school teachers from elementary, middle, and high schools in a Southern state. Sources of nutrition information and perceived barriers/facilitators for teaching nutrition were also assessed. A secondary objective was to assess whether the teachers' responses differed according grade taught (Kindergarten/elementary, middle school, or high school). This information is important for understanding messages that may be given by teachers to students (either through formal or informal interactions) and for planning training programs for teachers interested in implementing school-based nutrition programs/activities.

METHOD

RECRUITMENT

Data collection for the Teacher Survey was part of a larger study entitled the 1997 Nutrition Education and Training Assessment Plan, conducted by the nutrition education component of the Child Nutrition Program administered by the South Carolina Department of Education, Office of School Food Services and Nutrition. The purpose of the larger study was to obtain baseline information for the development of more effective school-based interventions. After receiving appropriate university IRB approval, nine school districts and three alternates were randomly selected from a list of all South Carolina school districts in January 1996. Five of these school districts declined to participate because of administrative constraints, resulting in 7 participating districts. All public school teachers in the selected district were identified and asked to complete the Teacher Survey. Surveys and stamped return envelopes were mailed to nutrition educators during October 1997. A cover letter explaining the purpose of the study and the cooperative effort with the State Department of Education outlined directions for completing the survey. The cover letter also included information about voluntary participation, confidentiality of results, and a name/phone number to contact for clarification. By completing and mailing back the survey, informed consent was assumed. A variety of nutrition education materials, including brochures and pamphlets were given to teachers as incentives for their participation.

INSTRUMENTATION

The research instrument was developed in 1993 by the Department of Human Services, Nutrition Education and Training Program at Austin, Texas. The original instrument included items to ascertain sociodemographic factors, nutrition knowledge, attitudes, school cafeteria participation, income and prior exposure to nutrition education (i.e., prior courses on nutrition topics), and current dietary behaviors. The teachers were also asked to rank factors that inhibit teaching nutrition, and identify which sources of nutrition education they used to obtain information. In addition, responses were solicited on teachers' perceptions of nutrition education support by administrators and food service personnel, and the potential role of the school cafeteria as a learning laboratory. A computer program (Fry's readability graph) and experienced public school teachers reviewed the initial instrument for readability. The knowledge and attitude scales were evaluated for validity using factor analysis and for reliability using Chronbach alpha coefficients. Revisions based on factor analyses and Chronbach alpha coefficients and the test length were made. For the current study, several modifications were made to the original questionnaire for the teachers. Three previously validated scales addressing weight-control behaviors, body-size perception, and personal eating concerns were added (Kubik et al., 2002; Kumanyika, 2001; Luepker, Perry, & McKinlay, 1996). The operational definitions of variables and the reliability coefficients for all scales used in the study are described in Table 2.1

Nutrition knowledge. Thirty-one multiple-choice items were used to measure the study participants' nutrition knowledge on topics like nutrition needs, Dietary Guidelines for Americans, healthy meal and snack choices, nutrition and health/fitness, food safety/ sanitation and self-responsible choices for food intake. A sample question in the scale reads "Which of the following food groups would improve a breakfast of orange juice, whole wheat toast and low-fat milk? With the response options bread, cereal, pasta group; fruit and vegetable group; meat, poultry, bean group; milk, yogurt, cheese group". Correct responses received a score of 1, while incorrect responses received a score of 0. A higher score on this scale indicated a higher level of nutrition knowledge, for a maximum value of 31.

Nutrition attitudes. A five-point Likert scale with 32 items was used to assess the nutrition attitudes of educators about nutritional needs, functions of nutrients in maintaining health, Dietary Guidelines for Americans, healthy food choices, nutrition and scholastic achievement and self-responsibility for food intake (maximum score = 64). A higher score on this scale indicated more positive, favorable attitudes toward nutrition in general.

Body size perception. Body size perception was assessed with two multiple questions. Responders were asked to indicate if they perceive themselves to be about the right height or very/slightly tall or small, and about the right weight or very/slightly under- or overweight.

Weight control behavior. Weight control behavior was assessed using multiple-choice questions adapted from the Youth Risk Surveillance System Survey (Kann, Kinchen, & Williams, 1999). Teachers who reported that they "did not try to lose weight" or "keep from gaining weight" were classified as non-dieters. Educators who indicated that "they made themselves vomit" and/or "took diet pills" during the past 30 days for the purpose of weight loss were classified as extreme dieters. Teachers who indicated that they had "used some other method, but had not vomited or taken diet pills" were classified as moderate dieters.

Perceived role of school cafeteria. Teachers' perceptions of school cafeteria in general and of school food services' integration in the school educational environment in particular were also assessed. Questions were asked to assess to what extend teacher participate in nutrition education in the school cafeteria and view the cafeteria as a potential laboratory for instruction. Also, teachers were asked to select from a list educational methods that they used or currently using in the cafeteria, such as posted menu for breakfast and/or lunch, display posters, public announcements, talks about nutrition. Finally, teachers were asked if they perceive the school cafeteria to be a cheerful and relaxing room for students to eat their school meal. The questionnaire also contained items to investigate teachers' sources of nutrition education during the past year.

Demographic information. Demographic variables items measured age, gender, ethnic background, years of teaching experience, grade presently teaching and highest educational degree received. All items were closed-format design with categorical response options.

Body mass index (BMI). Teachers were asked to record their height and weight, from which BMI was calculated (kg/[m.sup.2]). They were classified as obese (BMI >30), overweight (BMI>25), or normal/underweight (BMI <25) using the classification of National Heart, Lung, and Blood Institute (Gluck & Geliebter, 2002).

DATA ANALYSIS

The project statistician coded the data, and support staff entered the data into EPIINFO (version 6.0). Data were randomly checked for accuracy and quality control. Statistical procedures were performed using SAS (version 8, 1998, SAS Institute, NC). Sample size varied from question to question because of different response rates. Univariate analyses were used as a summary measure to describe the population. Chi-squares and t-tests were used to examine differences by race (African American or white), gender, and grade taught. A p-value less than or equal to .05 was required to consider test results statistically significant.

RESULTS

DEMOGRAPHICS OF TEACHERS

A total of 99 teachers from a possible of 200 participants responded to the survey, for a response rate of 49.5%. For this study, data were analyzed for 92 teachers. Data from 7 teachers who had missing values for gender, ethnicity and grade presently teaching were excluded from the analysis. The sample demographic characteristics are presented in Table 1. The majority of the responders were female (90%), white (82.5%), and were teaching nutrition fewer then 10 hours per week (62.5%). More than half (52%) held a Master's degree, and 3% had a doctoral degree. Years of teaching experience ranged from 1 to more than 30 years. The three groups (Kindergarten and elementary, middle school, and high school teachers) were compared and significant differences were noticed in that more high school and middle school teachers reported currently teaching ten or more hours of nutrition per week. In addition, middle school teachers were more likely to participate in nutrition education in the school cafeteria and perceive using activities in the school cafeteria as an effective method to teach nutrition.

NUTRITION KNOWLEDGE

The total score for the nutrition knowledge scale was based on 31 items. Scores ranged from 11 to 25, with a mean of 19.6. Overall, the nutrition knowledge level of educators was fair, with mean scores for the three groups of teachers (Kindergarten + Elementary, Middle school and High school teachers) almost identical (Table 2). Most of the teachers selected the correct answers for questions related to the Food Guide Pyramid, breakfast and lunch school program, Dietary Guidelines for Americans, and self-responsible choices for food intake. However, only about one-third responded correctly to the questions on absorption and functions of minerals and vitamins. Nearly all of the responders could correctly identify the food safety/ sanitation rules (Table 2).

ATTITUDES TOWARD NUTRITION

The nutrition attitudes assessment of all teachers included 32 items developed on a 5-point Likert-type scale. Value points on the scale were represented from 5 as "strongly agree" to 1 as "strongly disagree". Results presented on Table 2 indicate that teachers had positive attitudes toward nutrition, with an overall mean/ standard devistion of 51.47 [+ or -] 4.43. Teachers in all grades showed rather positive attitudes toward nutrition and no significant differences were detected among grades. The most positive attitude held by teachers was about the positive impact of nutrition on students' scholastic achievement (M/SD = 57.73 [+ or -] 0.54). Their least positive attitude was toward self-responsibility for food choices (M/SD = 45.38 [+ or -] 3.71).

BODY WEIGHT, WEIGHT CONTROL BEHAVIORS, AND BODY IMAGE

BMI ranged from 17.2 to 39.6 (21.7 [+ or -] 3.0), and 65.83% of the participants were of normal and low-normal weight (by NHLBI guidelines), 22.78% were overweight, and 10.7% were obese (Table 1). Obese participants were more likely to be African-American ([sup.~2] = 3.47, p < 0.05) and less likely to currently teach nutrition ([sup.~2] = 5.03, p < 0.05). Overweight participants were more likely to be men ([sup.~2] = 6.22, p < 0.05), less likely to currently teach nutrition ([sup.~2] = 5.36, p < 0.05), and less likely to have an advanced (Masters' or Ph.D.) degree ([sup.~2] = 5.29, p < 0.05).

As shown in Table 1, a high degree of body dissatisfaction was found among teachers, especially in terms of their weight. When asked about their current weight, 77% of the teachers surveyed indicated that they were concerned about their weight, and 64% perceived themselves as overweight. The gender difference in weight perception was statistically significant ([sup.~2] = 135.35; p < .001); females were more likely than males (33.4% vs. 20.1%, respectively) to have reported being slightly or very overweight. During the month preceding the survey, 4.6% used extreme methods such as diet pills and/or vomiting to control their weight. Almost half of the teachers (45%) used other methods to control their weight. There were no significant differences in these behaviors among the 3 groups of teachers.

ROLE OF SCHOOL FOOD SERVICES

The results of the survey revealed teachers' ambivalent perception of school food services' integration in the school educational environment (Table 1). Teachers rarely (19%) participate in nutrition education in the school cafeteria. Main educational methods reported by teachers in the cafeteria include, in order, posted menu (reported by 92.1% of responders), posters (72.9%), public announcement (36.1%), and talks about nutrition (13.1%). Only one out of five teachers participated in nutrition education in the cafeteria and only 6% perceived these activities to be the most effective in teaching nutrition. Twenty-six percent did not find the cafeteria to be a cheerful and relaxing room for students to eat their school meal. Teachers also acknowledged that school foodservice personnel was seldom (14%) asked to provide education in the classroom.

SOURCES OF NUTRITION INFORMATION

Sources of nutrition information during the year preceding the survey included, in order, books (98% of the responders), newspapers (91%), and TV (87%). Friends and family members were used as sources by approximately 75% of the teachers; much lower percentages were reported for school nurse and school cafeteria employees (14% and 33% respectively). Significantly more middle and high school teachers reported using computers and other teachers as sources of nutrition information during the year preceding the survey compared to elementary school teachers.

Overall, 91.3% of the educators participating in the survey would like to know more about nutrition. Over 75% of indicated that they wanted to know more about the function of nutrients to maintain health, healthy food choices and nutritional needs. When asked about the preferred method of nutrition training, teachers listed videotapes and/or media as the more preferred format (40% of elementary/kindergarten teachers, 35% middles school, and 52% high school teachers). Panel discussion was the least preferred format for nutrition training (7%, 5%, 5% respectively). The lecture format was also preferred by few teachers (5.3%, 2.9%, 0.5%).

Almost all of the teachers (93%) indicated that nutrition should be taught in all grades or in a combination of grades. Teachers responded to a list of problems that could inhibit or facilitate the effectiveness of teaching nutrition within the school system (Table 3). They ranked each of the five problems from "1" for highest to "5" for lowest. The salient inhibitors to nutrition education were lack of time to plan, coordinate, implement, and school calendars too full with academic activities. The most important factors that facilitated nutrition education were aid and encouragement from school administrators and from food school personnel. These two factors received the same overall score for all grades.

DISCUSSION

This descriptive study provides the reader with information about the knowledge, attitudes, and perceptions of a convenience sample of public school teachers in the South. Results of this study are particularly salient because of the current emphasis of environmental influences on dietary behaviors of children. Because teachers are an integral part of the school environment, which is an important environmental influence on dietary behaviors among youth, it is important to increase our understanding of teachers' levels of knowledge, attitudes, and perceptions to teaching nutrition. This information can be used to plan appropriate teacher in-service trainings, with a focus on providing nutrition-related information, encouraging positive attitudes towards health eating, and encouraging both health eating behaviors and healthy weight reduction behaviors. In-service trainings should emphasize the teachers' role as a model to his/her students and provide effective ways so that teachers can facilitate the effective transmission of health messages (both through formal and informal routes) to their students.

Results revealed that, overall, the nutrition knowledge level of teachers was fair, with teachers correctly answering 63.2% of the questions asked in the knowledge scale. This score is slightly lower than results from a study in which the nutrition knowledge test had a mean score of 70% (Soliah, Newell, Vaden, & Dayton, 1983). However, it is difficult to compare knowledge scores when not using the same instrument. In general, teachers knew more about dietary recommendations than specific biological mechanisms of nutrients. These results make sense in that other studies indicate that many teachers have never had formal nutrition education (Neumark-Sztainer et al., 1999). In addition, educators listed books, newspapers and TV as their major sources for nutrition education. These sources, especially the last two, are more likely to discuss current recommendations than more specific biological mechanisms. However, they are not consistently reliable sources of nutrition information (Whitney & Rolfes, 2001). Lastly, because most teachers are teaching nutrition less than 10 hours per year, there is no great need or incentive for them to become more educated in topics related to biological mechanisms. Thus although knowledge in some areas was fairly high, more education about other areas in nutrition is needed.

Interestingly, although teachers were not teaching much nutrition, they did indicate a desire to learn more about nutrition (60% of responders). Ninety one percent of the respondents wanted to learn more about nutrition, especially topics related to healthy choices, nutrition and fitness, and dietary guidelines. A good nutrition education curriculum and in-service training were listed by the educators as the most effective factors in learning about nutrition. Videos, workshops and group discussions were the preferred approaches for learning about nutrition, while cooperative learning and demonstrations were listed as the most effective methods of learning nutrition. Health educators need to take advantage of this desire to learn and offer more nutrition education for teachers in the preferred format (i.e., videotapes).

Although most educators reported teaching less than 10 hours of nutrition per year, 93% indicated that more nutrition education should be taught in all grades. Other studies have also found a strong support for school-based nutrition education, especially education targeting obesity prevention programs (Neumark-Sztainer, 2002). Barriers to teaching more nutrition include lack of time to plan, coordinate, implement, and school calendars already being too full with more academic activities. The most salient factors that facilitated nutrition education were encouragement from school administrators and school food personnel. These results indicate that if administration, including principals and school food personnel make nutrition a priority at their schools and encourage teachers to teach more nutrition, teachers are more likely to do so. These results indicate the need for more comprehensive approaches for school-based nutrition intervention, where not only children are the target of the intervention, but school administration and school food personnel are educated about the importance of nutrition education as well.

Another interesting finding from this study was that even though teachers indicated that they would teach more nutrition if they felt more support from the school food personnel, they had ambivalent perceptions about integrating school food personnel into the nutrition curriculum. It is apparent from the results that teachers and school food personnel do not often collaborate to teach nutrition. In order for nutrition education to be more effective, it will be important for these two groups to begin collaborating. While teachers can "teach" the information in the class room, school food personnel can reinforce newly learned materials by serving more healthy foods, serving more fruits and vegetables, labeling foods with nutrition information and creating a physical environment more conducive to healthy eating (Shannon, Story, & Fulkerson, 2002). More research is needed to determine how to best get these two groups to collaborate. Also, more research is needed on the knowledge and perceptions of the school food personnel.

The majority of the educators in this sample were either of normal weight or underweight. About 33% were overweight or obese--this percentage mirrors the national statistics (Kumanyika, 2001; USDHHS, 1988). However, almost twice as many teachers had concerns about their weight and half of the teachers surveyed reported using some method to try to lose weight. This may be of concern, in that teachers may be modeling extreme weight control/loss behaviors to their students, which could eventually lead to eating disorders among the students. If however, teachers engage in moderate dieting methods, such as exercise or eating fewer calories to control their weight, this might be a positive message to the students. Future research using more sensitive measures and more frequent assessments of weight control behaviors and factors influencing these behaviors is needed.

When looking at differences between those teachers who were obese or overweight and those that were of normal weight, results indicated that overweight/ obese teachers were more likely to be African American, male, and less likely to teach nutrition. These results provide data for planning nutrition education programs for teachers, which should include elements to increase sensitivity to their own weight-related behaviors. Even though the 82.5% of participants were White, this study adds new information on nutrition attitudes, knowledge and behaviors of teachers from a state with a high percentage of African-American children.

LIMITATIONS

This study contributes to the literature in that this specific topic has not been well studied within the field but is extremely salient, especially with the new emphasis on environmental influences on dietary behaviors. However, there are several limitations that limit generalizability of results. The response rate for the Teacher Survey was low (49.5%), which may be because the survey was mailed. Because the response rate is low, the sample may be biased, including only teachers who are especially interested in this particular topic and motivated enough to complete the survey. No efforts were made to determine the characteristics of non-responders. Thus, in all likelihood, the results reported in this manuscript are somewhat optimistic. In addition, because the survey was self administered, all data are self-report data.

IMPLICATIONS FOR RESEARCH AND PRACTICE

This study has important implications for nutrition research and practice at schools. First of all, because nutrition educators seem to be very open to more education about nutrition, we need to provide more education to this specific group, taking into account their learning preferences. These educational experiences need to be tailored on teachers' level of knowledge, therefore more teachers in the US need to be surveyed regarding their nutritional knowledge. If teachers are more knowledgeable, they can model appropriate nutrition-related behaviors to students, which may consequently be adopted by students. In addition, more effort for collaboration between teachers and school food personnel need to be made. Because learning in the classroom can be reinforced in the school cafeteria, we need to take advantage of this specific learning opportunity. Lastly, we need to involve more administrative staff, which can help facilitate policy change at the school level. All these changes can eventually lead to healthier school environment, which can help students make healthier food choices.

CHES AREAS

Responsibility I--Assessing Individual and Community Needs for Health Education

Competency A--Obtain health related data about social and cultural environments, growth and development factors, needs, and interests.

Competency B--Distinguish between behaviors that foster and those that hinder well-being.

Competency C--Infer needs for health education on the basis of obtained data.

Competency D--Determine factors that influence learning and development.

Acknowledgments: This study was supported by the Office of School Food Services and Nutrition, S. C. State Department of Education, Columbia, S.C. 29201.

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Shannon, C., Story, M., & Fulkerson, J. A. (2002). Factors in the school cafeteria influencing food choices by high school students. Journal of School Health, 72, 229-34.

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(FOOTNOTES)

(1) A copy of the survey instrument can be obtained by contacting the first author.

Anca Codruta Rafiroiu, MD, PhD is an Assistant Professor in the Department of Health, Physical Education, Recreation, and Dance at Cleveland University. Alexandra Evans, MPH, PhD is an Assistant Professor in the Department of Health Promotion, Education, and Behavior at the Norman J. Arnold Scholl of Public Health at the University of South Carolina. Address all correspondence to Anca Codruta Rafiroiu, MD, PhD, Assistant Professor, Department of Health, Physical Education, Recreation, and Dance, Cleveland State University, Cleveland, Ohio 44115; PHONE: [phone]; FAX: [phone]; E-MAIL: [e-mail].

Table 1. Description of participants (n=92)

          Variable               K-5      Middle school   High school
                               Teachers     Teachers       Teachers
                                (n=40)       (n=25)         (n=27)
                                  %             %              %

Gender
  Female                         90.0         73.1           66.7
  Male                           10.0         26.9           33.3
Race
  White                          82.5         68.0           88.9
  African American               17.5         32.0           11.1
Years of teaching experience
  <5 years                       10.0         15.4           16.7
  5-20 years                     65.0         57.7           44.4
  >20 years                      25.0         26.9           38.9
Highest educational degree
  Bachelor's                     39.5         56.0           55.6
  Master's                       60.5         44.0           44.4
  Doctoral                       --           --             --
Currently teaching nutrition
  No                             37.5 *       46.1 *         16.6 *
  Yes < 10 hrs/week              62.5         42.3           50.0
  Yes > 10 hrs/week               0 *         11.5 *         33.3 *
Obesity (BMI>30)
  Yes                             7.5         11.5           16.7
  No                             92.5         88.5           83.3
Weight-control Behavior
  Nondieters                     42.5         57.7           50.0
  Extreme Dieters                 2.5          3.9            5.6
  Moderate Dieters               47.5         30.8           44.4
Own Body-size Perception
  slightly/very tall              7.5          7.7            5.6
  slightly/very short            32.5         15.4           27.8
  about the right height         60.0         76.9           66.7
  slightly/very underweight       2.6          0              0
  slightly/very overweight       64.1         65.4           61.1
  about the right weight         33.3         34.6           38.9
Participate in nutrition
  education in the cafeteria     19.2 *       29.4 *          6.7 *
Find cafeteria to be a
  cheerful and relaxing room
  for students to eat their
  school meal                    70.4         80.0           73.3
Perceive activities in the
  cafeteria as the most
  effective methods in
  teaching nutrition              3.7 *       12.5 *          7.1 *

* significant differences between the groups based on chi-squared
analysis

Table 2. Definitions, descriptive statistics, and internal
consistency values for the scales used in the study

Continuous   Definition                All             Teachers
Variable                             (n=92)        Kindergarten +
                                                     Elementary
                                                        (n=40)

                                    Mean(SD)      Mean(SD)     [alpha]

Nutrition    Number of correct     19.63(3.12)   20.0(3.12)      .74
Knowledge    responses to 31
             general nutrition
             knowledge items
             (ie, 0=none correct
             out of 31)

Nutrition    Responses to 32       51.47(4.43)   51.87(3.53)     .69
Attitudes    items that show
             attitudes toward;
             nutrition (ie,
             64=very positive
             attitudes toward
             nutrition)

Continuous          Teachers              Teachers
Variable         Middle school           High school
                    (n=25)                 (n=27)

              Mean(SD)     [alpha]    Mean(SD)    [alpha]

Nutrition    19.1(2.75)      .88     20.1(3.72)     .84
Knowledge

Nutrition    50.73(5.31)     .81     51.5(4.90)     .83
Attitudes

[alpha] - Refers to Cronbach's alpha

Table 3. Factors that facilitate * and inhibit effective
nutrition education

                                   Teachers      Teachers   Teachers
                                Kindergarten +    Middle      High
                                  elementary      school     school
                                    (n=40)        (n=26)     (n=27)

Nutrition education inhibitors

Lack of time to plan,
coordinate, implement                 1             5          1

School calendars too full
with academic activities              2             3          4

Insufficient funds to support
nutrition education                   3             1          2

Shortage of educational
materials                             4             2          5

Lack of interest among school
administrators and teachers           5             4          3

Nutrition education facilitators

Aid and encouragement from
school administrators                 1             1          1

Aid and encouragement from
food school personnel                 2             2          2

Current information on key
nutrition issues                      4             4          4

In-service training for
teachers                              3             3          3

Nutrition education
curriculum                            5             5

* Teachers were asked to rank five factors, in order of importance
from 1 as most effective, that could facilitate/inhibit teaching
nutrition