Challenging Dogma - Fall 2009

Thursday, December 17, 2009

A Critique of the California School Garden Program Using Social and Behavioral Science Principles – Jessica Lyon

I. Introduction

The obesity epidemic in the United States has become a large concern for public health officials because of the major health risks with which it is associated. However, even more alarming is the rate at which childhood obesity has continued to climb over the past thirty years, suggesting that future generations may be even more at risk for obesity related health complications.1 A review of the National Health and Nutrition Examination Survey (NHANES) showed that in 2002, 30.6% of adults in the United States were obese. In 2006, 16.3% of children ages 2-19 were obese and 31.9% were overweight.2,3
Childhood “obesity” is defined as being over the 95th percentile for a child’s expected weight and “overweight” is between the 85th and 95th expected percentiles as determined by gender, age, and BMI. 4 These percentiles are measured using charts created by the CDC, which determine childhood obesity while taking into account differences between a child’s growth patterns versus an adult. This means that a BMI of 19 is considered obese for a 6-year-old boy, while the same BMI would be underweight for a 19-year-old boy. Obesity related complications manifest in a variety of ways ranging from psychological effects such as depression and loss of self-esteem to physical complications including hypertension, type-2 diabetes, cardiovascular disease, and many types of cancers.5
In response to the increasing percentage of children who are overweight and obese, the CDC has released guidelines for schools to help promote health and lifelong healthy eating. These guidelines include seven recommendations a school based healthy eating program should include: a school policy on nutrition, a sequential and coordinated curriculum, appropriate instruction for students, integration of school food service with nutrition education, staff training, family and community involvement, and program evaluation.6 From these guidelines, many public health programs have been created at the community and state level in an attempt to curb the growing percent of obese children.
One of these programs is the Garden in Every School Program in founded in 1995 in the state of California. In this program, students grow and eat their own fruits and vegetables in school. In 2006, Assembly Bill 1535, known as the California Instructional School Garden Program, authorized the California Department of Education to award $15 million in grants to develop, promote, and sustain gardens in schools. Currently, there are more than 3,000 gardens in schools across the state of California. The creators of the School Garden Program argue student’s participating in the program “discover fresh food, make healthier food choices, and are more active.” 7 The following section of this paper focuses on three major problems with the School Garden Program using social and behavioral health models. The third section of this assessment offers answers to those three critiques and provides ways in which the School Garden Program could be improved to be more effective in reducing the rate of childhood obesity at the both the state and national levels.
II. Critique of the California School Garden Program

Using several social and behavioral health models, there are three main critiques of the School Garden Program in California. These critiques include: the intervention occurs in the school environment while failing to recognize the importance of modeling behaviors of parents at home; the intervention assumes behavior is rational, static, and planned; and the intervention ineffectively attempts to sell the idea of health itself rather than appealing to the core values of the students.

A. The School Garden Program focuses on only the school environment and fails to recognize that behaviors are often modeled from parents and role model figures

California’s School Garden Program is based on the idea that children who grow their own fruits and vegetables at school will then adapt a healthier lifestyles and make better choices about food in their everyday lives. However, the question is raised as to what happens when the child goes home? If a child is eating only lunch at school, then presumably he or she has two other meals throughout the day eaten at home as well as two full days over the weekend in which he or she will be eating meals outside of their school. This means in actuality, the majority of the child’s meals will be eaten in a completely different environment the one in which this public health intervention is being staged. The School Garden Program fails to recognize that the environment in which a behavior, such as making food choices, takes place, inevitably plays a very important role in the decision making process.
Moreover, this intervention fails to recognize the importance of the behavior that the child is surrounded by while away from school. Many children learn behavior by modeling the actions they witness taking place around them.8 Therefore, if the majority of food choices are made either in the home or amongst friends outside of the school environment, then the people in those situations, especially role model figures, are of great importance in determining the child’s behavior. If a child lives in a home in which their parents overeat, do not adequately exercise, and are overweight, then these factors greatly increase the likelihood that a child will replicate the same behaviors whether or not they have a garden at their school.
The School Garden Program also fails to recognize that many students bring their own bag lunch to school. Most specifically, for children who do not consume a bag lunch and do not purchase their own food, the lunch is comprised solely of food that was bought by someone else in the home, presumably a parent. It is the parent then, who is making the decision about what the child will be able to eat. In this case, the public health intervention of teaching children about fruits and vegetables does not reach the person responsible for making the decision of what the child will eat, but instead food choices are directly made for the child by another person.
By failing to recognize the importance of the environment in which a behavior takes place, the School Garden Program is falsely assuming that teaching a child about fruits and vegetables in school will increase the likelihood they will continue to eat healthy foods outside of school. Unfortunately, the effect of modeling behaviors performed by their role models will have a stronger effect on the child and could lead to the ineffectiveness of this public health intervention.

B. The School Garden Program assumes that behavior is rational, static, and planned

Another major critique of the School Garden Program is it assumes the decision making process for food selection is rational, static, and planned. This means the reasoning behind the School Garden Program is assuming the child is in control of their food choices, food choices are not spontaneous, and food choices do not change depending on the situation. Each of these three assumptions is flawed because they fail to take into account the situational context in which the behavior is occurring.9
Obesity is clearly not a rational decision. The complications both physical and psychological are extensive and no rationally thinking person would chose to take on these problems. Even at a young age, children with a background knowledge of the negative effects of obesity, will still willingly engage in unhealthy eating habits. This fact negates the idea that an intervention based on education alone will be effective at reducing childhood obesity. Instead a soundly based nutrition program needs to recognize eating habits, similar to many behaviors, are voluntarily acts of irrational behavior.
Similarly, food choices are not typically planned, but instead are generally spontaneous decisions made by hunger or impulse. Even if a child had knowledge that a particular food is unhealthy, they may still voluntarily consume that food for reasons other than its health content. This contradicts the idea that while making a food choice, a child is in complete control of his or her actions and will always respond with a planned and well thought out decision. It is not atypical to witness a person commit to eating a certain way, but chose differently when their impulse strikes. It would then not be practical to assume that solely the education of fruits and vegetables would have a sound impact on the food choices of a child.
Finally, eating habits are not static, meaning they can depend completely on the situational context in which they are occurring. This is similar to the idea of non-spontaneity, but also suggests certain situations may bring about changes in food choice behavior that are discordant with previous knowledge of healthy food choices. If one of the greatest factors affecting food choice behavior is the situational context, then any lessons learned in a controlled environment, like the School Garden Program, may not be applicable or relevant to the students at the decision making time.

C. The School Garden Program ineffectively attempts to sell the idea of health rather than appealing to the core values of the students

A third critique of the School Garden Program is its core message attempts to sell the idea of health to children, which may be ineffective. This is typical of many public health interventions, which focus solely on the health behavior that they are trying to encourage instead of appealing to a person’s core values and needs. Unfortunately, in moments of impulse and stress, the lessons learned about healthy food choices may give way to temptation and the message of the public health intervention is lost completely.
In this program, the “promise” or basic message, is unclear except that it promotes overall health and it is a mandatory program for all children within the participating schools. This provides little selling power to the students who don’t necessarily have to believe or adhere to the message to successfully complete the program. Instead, a public health program aimed at healthy food choices should use general marketing theory, which first asks the question of “what do people want?” and then attempts to form an intervention around those desires. Unfortunately the premise of selling health, especially to children will be less influential than some of their other desires, thus resulting in another major flaw in this public health program.

III. Suggestions for improvement in all three areas previously critiqued for California’s School Garden Program

In this section, solutions to all three previously outlined problems with the California School Garden Program are outlined in order to make constructive criticism and hopefully improve the success of this public health intervention. These suggestions include the involvement of parents and the larger community, recognizing eating habits are predictably irrational, and using marketing theory to appeal to the core values of the children.

A. The School Garden Program should include involvement and education of the families and outside community

As it is currently being utilized, California’s School Garden Program takes place exclusively in schools, while failing to recognize the majority of children’s meals are eaten away from the school environment. In order to make this public health program more effective, the intervention needs to occur in all areas in which the behavior takes place. This recognizes the influence of families and communities in the decision making process of each student and their food choices.
In an effort to improve this program, parents should be educated along with their children on healthy food choices. This may mean encouraging the growth of family gardens not only in school, but also at home. One way the School Garden Program could facilitate this would be to invite the parents and families to the school to learn about the school’s garden and send them home with the tools and resources to plant their own fruits and vegetables. Fruit and vegetable education would also be important in order to persuade parents to participate in the project not only for the school program, but for the well being of their family. Educational classes on gardening and the benefits of eating fresh fruits and vegetables could be offered at the school in exchange for free or discounted gardening supplies to families who are willing to engage in the program.
Similarly, since peer groups and other social networks are involved in the decision making process of children, a community wide program of health food education is necessary to ensure the message will not be lost to children once they leave school grounds. A community garden and community wide educational classes would benefit the public as a whole, but would also greatly increase the probability that students would retain and adhere to the information taught in the School Gardening Program outside of the school setting.

B. Eating habits are predictable irrational, but we can frame the intervention to fit this irrationality

The second major problem with the School Garden Program is that it fails to recognize food habits, like many behaviors, depend on the situational context in which they occur. Currently, the intervention is focused only on the school environment, but even situations within the school such as stress and impulse, may lead a child to make poor food choices. The intervention needs to recognize, that although people may not behave in a rational, static, and planned manner, we can use known qualities of predictably irrational behavior to form an intervention that will still steer people towards healthy food choices.
Behavior is affected by expectation, ownership, framing, self-control, and the fundamental attribution error. While each of these characteristics plays a part in the irrationality of actions, we can use an understanding of them to form a persuasive public health campaign. Human behavior is based on previous expectations or experiences that become somewhat of a self-fulfilling prophecy. If a person labels his or herself as being overweight and gets stuck within that identity, they will lack the power to break out of it and shed the label they have placed upon themselves. People also feel ownership over their decisions such as food choices. By asking a person to change their behavior, you are asking them to give up their ownership of a behavior, which may result in an irrational act in order to retain ownership. In order to ensure that rebellion is not the result of the public health intervention, students need to feel ownership over the decision to eat more fruits and vegetables instead of simply being told to do so. Framing is another key attribute for the intervention. If public health officials can frame the issue of healthy eating around the idea that children will be positively gain something by participating, the program will be more successful. This is because the idea of gaining a positive quality is generally more persuasive than acting to lose a negative one. At all times during the program, the child should feel that he or she is in complete control of their actions. The feeling that a person is in complete control over personal actions and decisions, will make the program much more successful than if the children were simply forced to participate. Finally, the fundamental attribution error is false belief that a person’s actions are a direct result of their character and neglect that all behaviors are based in a situational context.
From these five characteristics of predictably irrational behavior, a successful public health intervention can be created. Initially, the new program should address the psychological ideology that people place on themselves with counseling. Second, the program should allow the student to claim ownership over the new healthy eating habits by choosing which fruits and vegetables to plant and creating their own weekly menus, which incorporate healthy food choices. Third, public health officials should frame the program as eating healthy promotes a child to gain power, self-control, and independence rather than framing the issue around weight loss. Fourth, the students should feel in complete control of the decision making process, and not that participation is mandatory. Finally, the new program should recognize the contextual implications of food choices, by giving students tools to deal with stress and impulses in healthy outlets rather than eating. This could be done through educational workshops and could promote physical activity as a positive act of stress relief, which would also help to decrease obesity among children.

C. A successful program should appeal to the core values of the child instead of trying to sell health itself

The final critique of the School Garden Program was its ineffective attempts to sell the message of health as a reason for changing behavior. Unfortunately, this will likely not be persuasive enough, especially to a group of children, to change unhealthy habits. Instead, the intervention should use marketing theory in order to appeal to their core needs and values and shape an intervention around these desires that will achieve the same message of healthy eating.
Using the principles of marketing theory, public health professionals would first review the needs and desires of their target audience. In this case, this would entail speaking directly with the children to learn about what core values appeal to them the most. This is strikingly different than traditional public health programs in which the program directors use their own intuition about what people may or should want and try to sell that idea to the public. Once the public health professionals have a good idea of the core values of the children, they can frame the intervention of gardening at school around these values to make it seem like eating healthy foods will make the desired core values more attainable.
An example of such an intervention could include a marketing campaign appealing to the student’s desire for independence and autonomy from their parents. After hearing this core value voiced from students, public health professionals would use the idea of independence to frame the School Garden Program to make it seem that by gardening at school and eating fruits and vegetables, would help students gain independence from their parents. The marketing campaign could focus on the benefits of children growing their own food, therefore allowing the children to be less reliant on their parents ultimately creating more self-sufficient and independent children. This message would be much more persuasive to children seeking independence than simply the message of promoting health, and may be more effective at reducing childhood obesity than the current program.


IV. Conclusion

California’s School Garden Program shows promise at educating children about growing their own food, but several changes could make this program more effective at altering overall eating choices. A successful intervention should recognize that the parents and greater community influence a child’s eating habits and would reach out to involve and educate these influential role models that are outside of the school environment. The intervention should also provide counseling the children for their reasons behind overeating, which would deal with the psychological effects of labels and self-expectations. The program should allow the children to take ownership over the garden by choosing the fruits and vegetables to be planted and creating their own weekly menus incorporating the foods that they have grown themselves. The program should also use marketing theory to frame the issue of healthy eating around the idea of self-control and autonomy since this is likely what the students will tell public health officials that they view as a very high characteristic. A successful public health program would incorporate all of these traits in order to encourage healthy eating among school children and hopefully reduce the percentage of overweight and obese children in the United States.
References
1. Dehghan M, Akhtar-Danesh N, Merchant AT. Childhood Obesity, Prevalence and Prevention. Nutrition Journal 2005 4:24.

2. Hedley AA, Ogden CL, Johnson CL. Prevalence of Overweight and Obesity Among US Children, Adolescents and Adults, 1999-2002. JAMA. 2004;291:2847-2850.

3. Ogden CL, Carroll MD, Flegal KM. High Body Mass Index for Age Among Children and Adolescents, 2003-2006. JAMA. 2008;299(20):2401-2405.

4. Ogden CL, Flegal KM, Carroll MD, et al. Prevalence and Trends in Overweight Among US Children and Adolescents. JAMA 2002; 288:1728-1732.

5. Veugelers PJ, Fitzgerald AL. Effectiveness of School Programs in Preventing Childhood Obesity: A Multilevel Comparison. Am Jour of Pub Heal. 2005; 95(3):432-435

6. Centers for Disease Control and Prevention. Guidelines for School Health Programs to Promote Lifelong Healthy Eating. MMWR Recomm Rep. 1996; 45 (RR-9):1-41.

7. California Department of Education. School Garden Program Overview. http://www.cde.ca.gov/LS/nu/he/gardenoverview.asp

8. Decker, PJ. & Nathan BR. Behavior Modeling Training. New York: Prager, 1985

9. Ajzen I. From Intentions to Actions: A Theory of Planned Behavior. (pp. 11-39). In: J. Kuhl & J. Beckmann eds. Action-Control: From Cognition to Behavior Heidelberg: Springer, 1985.

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