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Teens Eating for Energy and Nutrition at School (TEENS)

TEENS is a school-based, multicomponent program aimed at increasing the consumption of fruits, vegetables, and low-fat foods in students in grades 7 and 8. The novel component of the TEENS program was the involvement of peer leaders in curriculum delivery in the first year of intervention implementation. The TEENS program was developed using the Social Cognitive Theory as its theoretical basis. The intervention consisted of three components: 1) a classroom-based component that was given in Health or Consumer Sciences class by the classroom teacher, which focused on skill-building and decision-making with regard to food choices; 2) a family component, which included the delivery of information packets (including newsletters, behavioural coupons, etc.) to parents/caregivers emphasizing making healthy foods available in the home; 3) a school-wide environmental component, which included changes to school food service and food policies, that aimed at increasing healthful food choices available on campus. TEENS was evaluated over the course of the two years that it was given. Interim evaluation showed improvements in fruit, vegetable and low-fat food consumption in peer leaders and students who had received both the classroom and environmental components, although students who only received the environmental component showed decreased fruit, vegetable and low-fat food consumption. However, these results were not maintained after the second year of the program, at follow-up. Program materials are available from the RTIPS website (link below) and at the intervention website. Visit Website

I. Citation Information and Links

Primary Source Document

Authors: AS Birnbaum, LA Lytle, M Story, CL Perry & DM Murray Document Title: Are differences in exposure to a multicomponent school-based intervention associated with varying dietary outcomes in adolescents? Publication or Source: Health Education & Behavior 29(4): 427-443 Date: 2008-10-17

Type of Source

Published journal

The Canadian Best Practices Portal for Health Promotion and Chronic Disease Prevention - Public Health Agency of Canada




Web Links

For reports about the intervention, etc.: LA Lytle, CL Perry (2001) Applying research and theory in program planning: An example from a nutrition education intervention. Health Promotion Practice 2(1): 68-80. M Story, LA Lytle, AS Birnbaum & CL Perry (2002) Peer-led, school-based nutrition education for young adolescents: Feasibility and process evaluation of the TEENS study. Journal of School Health 72(3): 121-127. For systematic reviews which include article/report: H Thomas, D Ciliska, S Micucci, J Wilson-Abra and M Dobbins (2004) Effectiveness of physical activity enhancement and obesity prevention programs in children and youth. Health Canada. For site where document is available: For document references or commentaries: KEN Effective school-based nutrition interventions English%20files%20heading/pdf%20not%20in%20publications%20section/KEN%20-%20Children%20School-based%20 Nutrition_567321674.ashx R-TIPS: Teens Eating for Energy and Nutrition at School (TEENS) M Frenn (2003) Peer leaders and adolescents participating in a multicomponent school based nutrition intervention had dietary improvements. Evidence Based Nursing 6(2):44.

Systematic Review

Linked to systematic review evidence


URL of Systematic Review this intervention is linked to

II. About the Intervention: General Characteristics

Intervention's Country of Origin

United States

The Canadian Best Practices Portal for Health Promotion and Chronic Disease Prevention - Public Health Agency of Canada


Health Issues Addressed

Chronic Disease Prevention

q q

Cancer: primary prevention [primary focus] General Chronic Disease Prevention: primary prevention

Health Promotion & Behaviour-related Protective Factors


Healthy Eating [primary focus]

Determinants of Health

q q q q q

Education and literacy [primary focus] Personal health practices and coping skills Healthy child development Physical environment Social environments [primary focus]

Priority/Target Population for Intervention Delivery:

Life Stage

q q

Children (age 6-12) Teenagers/Youth (age 13-17) [primary focus]

The population addressed in the intervention faces the following challenges/risks

q q

Low income Access to affordable, nutritious food

Relevant Ecological Levels

q q q

Individual level (e.g., individual behaviour, knowledge, beliefs, attitudes) Interpersonal level (e.g., family, friends) Organizational level (e.g., workplaces, schools, NGOs, health service organizations/institutions/systems)

Geographic Level of Intervention




Educational Settings:


Elementary school

The Canadian Best Practices Portal for Health Promotion and Chronic Disease Prevention - Public Health Agency of Canada


Other Community Settings:

q q

Home School cafeteria

Policy/Administrative Level of Intervention:

q q

Municipal/Regional Local community

III. Foundations of the Intervention

Developers of the Intervention

The intervention was designed by: an individual or group of individuals (but not by a formal organization)

Intervention Goals and Objectives

The goal of the TEENS program was to increase the consumption of fruits, vegetables and low-fat foods in grade 7 and 8 students.

Funding resources used to develop, implement and/or evaluate the intervention


No available information

Other resources used to develop, implement and/or evaluate the intervention


No information available

Program Sponsor/Funder



Duration/Timing for Implementation

Number of months required to implement the intervention: 2 years

Theories/Conceptual Frameworks:


Model of the etiology/origins of the health-related issue/problem

Use of Change Theories

The Canadian Best Practices Portal for Health Promotion and Chronic Disease Prevention - Public Health Agency of Canada


Communication Theories/concepts

Social Cognitive Theory

Values Inherent in the Intervention

q q q

Health (e.g., holistic health--physical, mental, spiritual health; optimal health for all) Power sharing (e.g., reduction of power differentials; empowerment) Social justice (e.g., fair distribution of resources; respect for diversity)


q q q q

Comprehensive literature review Unpublished prior intervention-based research/evaluation (from own or other organization) Consultation with members of the priority population Consultation with staff

IV. Implementation of the Intervention


q q q q q q

Individual education/skill development Individual behaviour change Health communication/social marketing Social environmental support Policy development Use of Peer Leaders, Development of a School Nutrition Advisory Council (SNAC)

Key Activities of the Intervention

q q

Group process/program Combination of classroom sessions, schoolwide programs (SNACs, changes to cafeteria choices, etc.) and family programs (parent packages sent home including newsletter, recipes, etc.)


q q q

Delivery Agents - Paid staff Trainer-of-trainers For the grade 7 curriculum, the program is given by the classroom teachers in conjunction with peer-elected peer leaders. Peer leaders received a full-day of intensive training. Grade 8 curriculum was taught only by teachers. Teachers received one day of centralized training.

Strengths of the Intervention


Strong understanding of the issue-related environment (physical, psychological, social, political, economic)

Challenges of the Intervention

q q

Competing issues/priorities Lack of resources such as funding, equipment, time, skills, organizational support and understanding


The Canadian Best Practices Portal for Health Promotion and Chronic Disease Prevention - Public Health Agency of Canada

V. Evaluation Design of the Intervention

Link to evaluation document/article

LA Lytle, DM Murray, CL Perry, M Story, AS Birnbaum, MY Kubik & S Varnell (2004) School-based approaches to affect adolescents' diets: Results from the TEENS study. Health Education & Behavior 31(2): 270-287.

Experimental Study/Evaluation Design


Experimental design (controlled studies with random assignment of participants in experimental conditions - e.g., RCTs, Solomon Four Group design, etc.)




Individual behaviour measures: 24-hour Food Recalls were completed by a subsample of students. All students were to complete the TEENS survey, which measured fruit, vegetable and low-fat food consumption, usual food choices, demographic variables, etc.

Mixed methods (quantitative and qualitative)

Some process evaluation data was also collected, including lesson checklists completed by teachers, observation of selected classroom sessions, and student and teacher evaluations of the curriculum. Data collected for process evaluation of the family component included the number of families that returned behavioural coupons and number of coupons returned, and the number of student homework assignments that were completed and returned.

Stakeholder Information Sources

q q q q

Members of priority population who are participants in the program Members of priority population who are not participants in the program Family/significant others of members of priority population Front-line implementers


School districts in the metropolitan area of Minneapolis and St. Paul, Minnesota were invited to participate. Originally 20 schools agreed to participate; one was chosen as a pilot school for the program, and 3 other schools had to drop out due to scheduling problems. Sixteen schools ultimately participated in the program.

Was rigour used in the recruitment/selection of participants?

Yes; In order to participate in the study, schools had to meet three eligibility criteria: schools had to have at least 20% of students in their district qualify for free or reduced-price school lunch, have both seventh and eighth graders attend their school, and enroll at least 30 in each of those grades. Within eligible schools, all students in the seventh grade during the baseline data collection were eligible to participate in TEENS.

Research protocol included a set of ethical guidelines


The Canadian Best Practices Portal for Health Promotion and Chronic Disease Prevention - Public Health Agency of Canada 6

Nature of Processes

Quality assurance methods were used

No information available

Ongoing results from research and evaluation were collected and acted on?

No available information

VI. Intervention Outcomes

What percentage of the interventions' process implementation objectives were achieved?

Medium (50-74%)

Specific Intervention Outcomes

Health and Behaviour Outcomes - Evidence provided regarding:

Mixed or neutral outcomes on health

VII. Adaptation

Has this initiative been adapted from another jurisdiction?


Circumstances that the intervention would fit best:

The program is acceptable for implementation in middle/junior high schools that have 10-81% of students being eligible for reduced-price meals and students belonging to various races.

The intervention is feasible for:

A wide range of circumstances

Are there resources and/or products associated with the intervention?


The Canadian Best Practices Portal for Health Promotion and Chronic Disease Prevention - Public Health Agency of Canada



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