Unbundling outcomes of a multilevel intervention to increase fruit, vegetables, and whole grains parents pack for their preschool children in sack lunches.

BACKGROUND: Packing fruit, vegetables, and whole grains in preschool children's sack lunches is a powerful way for parents to teach their children eating habits and food preferences to support a lifetime of good health. A multilevel intervention pilot-tested in childcare settings increased servings of vegetables and whole grains, but the lunches still fell short of the intervention goals. PURPOSE: Secondary analyses were conducted to identify specific behavior changes underlying achieved increases in servings of vegetables and whole grains. METHODS: Food records from direct observation of 769 parent-packed lunches were investigated to unbundle and measure multiple aspects of lunch packing behavior. Changes from baseline to six week follow-up for the intervention (N=81) and comparison (N=51) parent-child dyads were evaluated in multilevel modeling. RESULTS: The increase for whole grains was explained by more parents packing whole grain items whereas increase for vegetables was explained by parents packing vegetables on more days. DISCUSSION: Tailored options were identified for further strategies to increase vegetables and whole grains in parent-packed sack lunches. TRANSLATION TO HEALTH EDUCATION PRACTICE: Linking achieved outcomes to specific behaviors can be an aid in assessing needs and designing interventions to maximize the chances for success.