Abstract
Background/Objectives: Children spend the most time in school, which can be a friendly environment that encourages students to eat healthy foods, so school is a good place to learn and practice these behaviors. In Palau, public schools offer free lunches to students. Based on the constructs of Social Cognitive Theory, we conducted a pilot study to evaluate the effects of a school nutrition education program (NE) and the provision of more fruits and vegetables (FV) in school lunches on elementary school students' nutrition knowledge, as well as their attitudes and behaviors regarding fruit and vegetable consumption. Methods: A public elementary school participated in our trial from February to May 2017. While all students (ages 5-12) at the school were provided with free meals through the National School Meal program, only students in grades 4-8 were invited to participate in a four-month nutrition education program and taste-testing activities, during which more fresh fruits and vegetables were incorporated into the school lunches. Participants filled out questionnaires before and after the trial. Results: Our results showed that students in grades 4-8 (n = 92) had improved scores in all nutrition knowledge items after completing the nutrition education course compared to before the course. Among these, the food category, food servings, and total scores showed statistically significant differences. The scores for attitudes and behaviors regarding FVs intake showed an increasing trend after the completion of the course. Further, the age-based analysis revealed that fifth-grade students showed the greatest improvement in their nutrition knowledge scores, with an increase of 38.5%. However, after adjusting for gender, the significance was no longer observed. Regarding attitude and behavior scores toward fruit and vegetable consumption, fourth-grade students showed the greatest improvement, with increases of 10.9% and 6.3%, respectively. Additionally, we tracked the total amount of FVs consumed by the school annually, noting a consistent rise from 1853 pounds in 2017 to 6580 pounds in 2021, a 3.5-fold increase. Conclusions: This pilot study showed that school nutrition education and providing more fresh fruits and vegetables (FVs) can significantly improve children's nutrition knowledge, while there was only a slight upward trend in attitudes and behaviors toward FV consumption. However, regularly offering nutrition education courses combined with providing more fruits and vegetables in school lunches could effectively increase children's consumption of these healthy foods.