Administration of the GSK Respiratory Syncytial Virus Vaccine to Pregnant Persons in Error.

The GSK and Pfizer respiratory syncytial virus (RSV) vaccines are both indicated for adults aged 60 years and older, but only the Pfizer product is approved for use in pregnancy to prevent RSV-associated lower respiratory tract disease in infants aged younger than 6 months. To assess for vaccine administration errors (ie, administration of the GSK RSV vaccine to pregnant persons) VAERS (Vaccine Adverse Event Reporting System), a U.S. passive reporting system, was searched for the time period from August 2023 to January 2024. A total of 113 reports of these administration errors were identified. Most reports (103, 91.2%) did not describe an adverse event. These administration errors are preventable with proper education and training and other preventive measures.

Challenges and opportunities during the COVID-19 vaccination efforts in long-term care.

From December 2020 through March 2023, the COVID-19 vaccination efforts in long-term care (LTC) settings, identified many gaps and opportunities to improve public health capacity to support vaccine distribution, education, and documentation of COVID-19 vaccines administered to LTC residents and staff. Partner engagement at the local, state, and federal levels helped establish pathways for dissemination of information, improve access and delivery of vaccines, and expand reporting of vaccine administration data to monitor the impact of COVID-19 vaccination in LTC settings. Sustaining the improvements to the vaccine infrastructure in LTC settings that were created or enhanced during the COVID-19 vaccination efforts is critical for the protection of residents and staff against COVID-19 and other vaccine preventable respiratory outbreaks in the future.

Coverage with Influenza, Respiratory Syncytial Virus, and Updated COVID-19 Vaccines Among Nursing Home Residents - National Healthcare Safety Network, United States, December 2023.

Nursing home residents are at risk for becoming infected with and experiencing severe complications from respiratory viruses, including SARS-CoV-2, influenza, and respiratory syncytial virus (RSV). Fall 2023 is the first season during which vaccines are simultaneously available to protect older adults in the United States against all three of these respiratory viruses. Nursing homes are required to report COVID-19 vaccination coverage and can voluntarily report influenza and RSV vaccination coverage among residents to CDC's National Healthcare Safety Network. The purpose of this study was to assess COVID-19, influenza, and RSV vaccination coverage among nursing home residents during the current 2023-24 respiratory virus season. As of December 10, 2023, 33.1% of nursing home residents were up to date with vaccination against COVID-19. Among residents at 20.2% and 19.4% of facilities that elected to report, coverage with influenza and RSV vaccines was 72.0% and 9.8%, respectively. Vaccination varied by U.S. Department of Health and Human Services region, social vulnerability index level, and facility size. There is an urgent need to protect nursing home residents against severe outcomes of respiratory illnesses by continuing efforts to increase vaccination against COVID-19 and influenza and discussing vaccination against RSV with eligible residents during the ongoing 2023-24 respiratory virus season.

Development of COVID-19 vaccine policy - United States, 2020-2023.

COVID-19 vaccines represent a great scientific and public health achievement in the face of overwhelming pressures from a global pandemic, preventing millions of hospitalizations and deaths due to COVID-19 vaccines in the United States. Over 675 million doses of COVID-19 vaccines have been administered in the United States, and over 80% of the U.S. population has had at least 1 dose of a COVID-19 vaccine. Over the course of the COVID-19 pandemic in the United States, over one million people died from COVID-19, and over six million were hospitalized. It has been estimated that COVID-19 vaccines prevented more than 18 million additional hospitalizations and more than 3 million additional deaths due to COVID-19 in the United States. From the beginning of the COVID-19 pandemic in 2020 through June 2023, ACIP had 35 COVID-19 focused meetings and 24 votes for COVID-19 vaccine recommendations. ACIP had the critical task of rapidly and thoroughly reviewing emerging and evolving data on COVID-19 epidemiology and vaccines, as well as making comprehensive population-based recommendations for vaccine policy and considerations for implementation through a transparent and evidence-based framework. Safe and effective COVID-19 vaccines, recommended through transparent policy discussions with ACIP, remain the best tool we have to prevent serious illness, hospitalization and death from COVID-19.

Qualitative Conceptual Content Analysis of COVID-19 Vaccine Administration Error Inquiries.

The launch of the COVID-19 vaccination program was the largest vaccination campaign in U.S. history, with an unprecedented demand for vaccine and new vaccination providers, warranting significant education and communication efforts. NIP-INFO (nipinfo@cdc.gov) is the Centers for Disease Control and Prevention's (CDC's) immunization inquiry response service, and it receives inquiries for COVID-19 and routine non-COVID vaccines. A qualitative analysis of NIP-INFO's content was performed to better characterize and understand some of the knowledge gaps and reasons that COVID-19 vaccine administration errors occur. A total of 734 COVID-19 vaccine administration error inquiries were received between January 2021 and April 2022. The most frequent inquiries related to storage (n = 191; 26.0%), incorrect dosage or product (n = 190; 25.9%), unauthorized age group (n = 108; 14.7%), and schedule (n = 105; 14.3%). Training and communication strategies are imperative to ensure proper vaccine administration and build and maintain vaccine confidence.

Interim Recommendations from the Advisory Committee on Immunization Practices for the Use of Bivalent Booster Doses of COVID-19 Vaccines - United States, October 2022.

Four COVID-19 vaccines are currently approved for primary series vaccination in the United States under a Biologics License Application or authorized under an emergency use authorization (EUA) by the Food and Drug Administration (FDA), and recommended for primary series vaccination by the Advisory Committee on Immunization Practices (ACIP): 1) the 2- or 3-dose monovalent mRNA BNT162b2 (Pfizer-BioNTech, Comirnaty) COVID-19 vaccine; 2) the 2- or 3-dose monovalent mRNA mRNA-1273 (Moderna, Spikevax) COVID-19 vaccine; 3) the single-dose adenovirus vector-based Ad26.COV.S (Janssen [Johnson & Johnson]) COVID-19 vaccine; and 4) the 2-dose adjuvanted, protein subunit-based NVX-CoV2373 (Novavax) COVID-19 vaccine. The number of doses recommended is based on recipient age and immunocompromise status (1). For additional protection, FDA has amended EUAs to allow for COVID-19 booster doses in eligible persons (1). Because COVID-19 vaccines have demonstrated decreased effectiveness during the period when the Omicron variant (B.1.1.529) of SARS-CoV-2 predominated, bivalent booster doses (i.e., vaccine with equal components from the ancestral and Omicron strains) were considered for the express purpose of improving protection conferred by COVID-19 vaccine booster doses (2). During September-October 2022, FDA authorized bivalent mRNA vaccines for use as a booster dose in persons aged ≥5 years who completed any FDA-approved or FDA-authorized primary series and removed EUAs for monovalent COVID-19 booster doses (1). Pfizer-BioNTech and Moderna bivalent booster vaccines each contain equal amounts of spike mRNA from the ancestral and Omicron BA.4/BA.5 strains. After the EUA amendments, ACIP and CDC recommended that all persons aged ≥5 years receive 1 bivalent mRNA booster dose ≥2 months after completion of any FDA-approved or FDA-authorized monovalent primary series or monovalent booster doses.

Interim Recommendation of the Advisory Committee on Immunization Practices for Use of the Novavax COVID-19 Vaccine in Persons Aged ≥18 years - United States, July 2022.

The NVX-CoV2373 (Novavax) COVID-19 vaccine is a recombinant spike (rS) protein nanoparticle vaccine with Matrix-M adjuvant to protect against infection with SARS-CoV-2, the virus that causes COVID-19. On July 13, 2022, the Food and Drug Administration (FDA) issued Emergency Use Authorization (EUA) for the Novavax vaccine for primary COVID-19 immunization of unvaccinated adults aged ≥18 years, administered as 2 doses (5 µg rS and 50 µg Matrix-M adjuvant in each dose) 3 weeks apart (1). On July 19, 2022, the Advisory Committee on Immunization Practices (ACIP) issued an interim recommendation for use of the Novavax vaccine in persons aged ≥18 years for the prevention of COVID-19.* In the per-protocol† efficacy analysis, vaccine efficacy (VE) against reverse transcription-polymerase chain reaction (RT-PCR)-confirmed symptomatic COVID-19 was 89.6% (95% CI = 82.4%-93.8%). The Alpha variant (B.1.1.7) of SARS-CoV-2 was the predominant circulating variant during the period of case accrual for VE assessments. Cases of myocarditis or pericarditis were reported in temporal association with vaccination, suggesting a possible causal relationship. The ACIP recommendation for the use of the Novavax COVID-19 vaccine is interim and will be updated as additional information becomes available. The adjuvanted, protein subunit-based Novavax COVID-19 vaccine provides an additional option for unvaccinated adults, increasing flexibility for the public and for vaccine providers. Vaccination is important for protection against COVID-19.

Interim recommendations of the advisory committee on immunization practices for use of Moderna and Pfizer-Biontech Covid-19 vaccines in children aged 6 months­5 years: United States, june 2022

On June 17, 2022, the Food and Drug Administration (FDA) issued Emergency Use Authorization (EUA) amendments for the mRNA-1273 (Moderna) COVID-19 vaccine for use in children aged 6 months­5 years, administered as 2 doses (25 µg [0.25 mL] each), 4 weeks apart, and BNT162b2 (Pfizer-BioNTech) COVID-19 vaccine for use in children aged 6 months­4 years, administered as 3 doses (3 µg [0.2 mL] each), at intervals of 3 weeks between doses 1 and 2 and ≥8 weeks between doses 2 and 3. On June 18, 2022, the Advisory Committee on Immunization Practices (ACIP) issued separate interim recommendations for use of the Moderna COVID-19 vaccine in children aged 6 months­5 years and the Pfizer-BioNTech COVID-19 vaccine in children aged 6 months­4 years for the prevention of COVID-19.* Both the Moderna and Pfizer-BioNTech COVID-19 vaccines met the criteria for immunobridging, which is the comparison of neutralizing antibody levels postvaccination in young children with those in young adults in whom efficacy had been demonstrated. Descriptive efficacy analyses were also conducted for both Moderna and Pfizer-BioNTech COVID-19 vaccines during the period when the Omicron variant of SARS-CoV-2 (the virus that causes COVID-19) predominated. No specific safety concerns were identified among recipients of either vaccine. ACIP recommendations for the use of the Moderna COVID-19 vaccine and the Pfizer-BioNTech COVID-19 vaccine in children aged 6 months­5 years and 6 months­4 years, respectively, are interim and will be updated as additional information becomes available. Vaccination is important for protecting children aged 6 months­5 years against COVID-19.

Interim Recommendations of the Advisory Committee on Immunization Practices for Use of Moderna and Pfizer-BioNTech COVID-19 Vaccines in Children Aged 6 Months-5 Years - United States, June 2022.

On June 17, 2022, the Food and Drug Administration (FDA) issued Emergency Use Authorization (EUA) amendments for the mRNA-1273 (Moderna) COVID-19 vaccine for use in children aged 6 months-5 years, administered as 2 doses (25 µg [0.25 mL] each), 4 weeks apart, and BNT162b2 (Pfizer-BioNTech) COVID-19 vaccine for use in children aged 6 months-4 years, administered as 3 doses (3 µg [0.2 mL] each), at intervals of 3 weeks between doses 1 and 2 and ≥8 weeks between doses 2 and 3. On June 18, 2022, the Advisory Committee on Immunization Practices (ACIP) issued separate interim recommendations for use of the Moderna COVID-19 vaccine in children aged 6 months-5 years and the Pfizer-BioNTech COVID-19 vaccine in children aged 6 months-4 years for the prevention of COVID-19.* Both the Moderna and Pfizer-BioNTech COVID-19 vaccines met the criteria for immunobridging, which is the comparison of neutralizing antibody levels postvaccination in young children with those in young adults in whom efficacy had been demonstrated. Descriptive efficacy analyses were also conducted for both Moderna and Pfizer-BioNTech COVID-19 vaccines during the period when the Omicron variant of SARS-CoV-2 (the virus that causes COVID-19) predominated. No specific safety concerns were identified among recipients of either vaccine. ACIP recommendations for the use of the Moderna COVID-19 vaccine and the Pfizer-BioNTech COVID-19 vaccine in children aged 6 months-5 years and 6 months-4 years, respectively, are interim and will be updated as additional information becomes available. Vaccination is important for protecting children aged 6 months-5 years against COVID-19.

The advisory committee on immunization practices' recommendation for use of Moderna COVID-19 vaccine in adults aged ≥18 years and considerations for extended intervals for administration of primary series doses of mRNA COVID-19 vaccines: United States, february 2022

The mRNA-1273 (Moderna) COVID-19 vaccine is a lipid nanoparticle-encapsulated, nucleoside-modified mRNA vaccine encoding the stabilized prefusion spike glycoprotein of SARS-CoV-2, the virus that causes COVID-19. During December 2020, the vaccine was granted Emergency Use Authorization (EUA) by the Food and Drug Administration (FDA), and the Advisory Committee on Immunization Practices (ACIP) issued an interim recommendation for use among persons aged ≥18 years (1), which was adopted by CDC. During December 19, 2020­January 30, 2022, approximately 204 million doses of Moderna COVID-19 vaccine were administered in the United States (2) as a primary series of 2 intramuscular doses (100 µg [0.5 mL] each) 4 weeks apart. On January 31, 2022, FDA approved a Biologics License Application (BLA) for use of the Moderna COVID-19 vaccine (Spikevax, ModernaTX, Inc.) in persons aged ≥18 years (3). On February 4, 2022, the ACIP COVID-19 Vaccines Work Group conclusions regarding recommendations for the use of the Moderna COVID-19 vaccine were presented to ACIP at a public meeting. The Work Group's deliberations were based on the Evidence to Recommendation (EtR) Framework,* which incorporates the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach† to rank evidence quality. In addition to initial clinical trial data, ACIP considered new information gathered in the 12 months since issuance of the interim recommendations, including additional follow-up time in the clinical trial, real-world vaccine effectiveness studies, and postauthorization vaccine safety monitoring. ACIP also considered comparisons of mRNA vaccine effectiveness and safety in real-world settings when first doses were administered 8 weeks apart instead of the original intervals used in clinical trials (3 weeks for BNT162b2 [Pfizer-BioNTech] COVID-19 vaccine and 4 weeks for Moderna COVID-19 vaccine). Based on this evidence, CDC has provided guidance that an 8-week interval might be optimal for some adolescents and adults. The additional information gathered since the issuance of the interim recommendations increased certainty that the benefits of preventing symptomatic and asymptomatic SARS-CoV-2 infection, hospitalization, and death outweigh vaccine-associated risks of the Moderna COVID-19 vaccine. On February 4, 2022, ACIP modified its interim recommendation to a standard recommendation§ for use of the fully licensed Moderna COVID-19 vaccine in persons aged ≥18 years.

COVID-19 vaccine inquiries regarding children ages 5-11 years received by NIP-INFO.

We describe COVID-19 immunization inquiries regarding children age 5-11 years received by NIP-INFO, the Centers for Disease Control and Prevention's (CDC's) e-mail immunization inquiry service for health care professionals, at the launch of vaccination efforts for this age group, using descriptive qualitative analysis. From November 2 through November 30, 2021, NIP-INFO responded to 154 questions regarding COVID-19 vaccination for 5-11-year-old children. The most common questions related to formulation and dosage (39.6%), vaccination schedule (14.3%), CDC's educational materials for health care professionals (9.1%), and vaccine safety (8.4%); 16.2% of questions across all inquiry categories related to a vaccination error. We discuss CDC guidance related to the most common inquiries to inform further pediatric COVID-19 vaccination efforts, including future vaccination of younger pediatric age groups, which will be important to help to curb this pandemic.

The Advisory Committee on Immunization Practices' Recommendation for Use of Moderna COVID-19 Vaccine in Adults Aged ≥18 Years and Considerations for Extended Intervals for Administration of Primary Series Doses of mRNA COVID-19 Vaccines - United States, February 2022.

The mRNA-1273 (Moderna) COVID-19 vaccine is a lipid nanoparticle-encapsulated, nucleoside-modified mRNA vaccine encoding the stabilized prefusion spike glycoprotein of SARS-CoV-2, the virus that causes COVID-19. During December 2020, the vaccine was granted Emergency Use Authorization (EUA) by the Food and Drug Administration (FDA), and the Advisory Committee on Immunization Practices (ACIP) issued an interim recommendation for use among persons aged ≥18 years (1), which was adopted by CDC. During December 19, 2020-January 30, 2022, approximately 204 million doses of Moderna COVID-19 vaccine were administered in the United States (2) as a primary series of 2 intramuscular doses (100 µg [0.5 mL] each) 4 weeks apart. On January 31, 2022, FDA approved a Biologics License Application (BLA) for use of the Moderna COVID-19 vaccine (Spikevax, ModernaTX, Inc.) in persons aged ≥18 years (3). On February 4, 2022, the ACIP COVID-19 Vaccines Work Group conclusions regarding recommendations for the use of the Moderna COVID-19 vaccine were presented to ACIP at a public meeting. The Work Group's deliberations were based on the Evidence to Recommendation (EtR) Framework,* which incorporates the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach† to rank evidence quality. In addition to initial clinical trial data, ACIP considered new information gathered in the 12 months since issuance of the interim recommendations, including additional follow-up time in the clinical trial, real-world vaccine effectiveness studies, and postauthorization vaccine safety monitoring. ACIP also considered comparisons of mRNA vaccine effectiveness and safety in real-world settings when first doses were administered 8 weeks apart instead of the original intervals used in clinical trials (3 weeks for BNT162b2 [Pfizer-BioNTech] COVID-19 vaccine and 4 weeks for Moderna COVID-19 vaccine). Based on this evidence, CDC has provided guidance that an 8-week interval might be optimal for some adolescents and adults. The additional information gathered since the issuance of the interim recommendations increased certainty that the benefits of preventing symptomatic and asymptomatic SARS-CoV-2 infection, hospitalization, and death outweigh vaccine-associated risks of the Moderna COVID-19 vaccine. On February 4, 2022, ACIP modified its interim recommendation to a standard recommendation§ for use of the fully licensed Moderna COVID-19 vaccine in persons aged ≥18 years.

The perception of school food-service professionals on the implementation of the Healthy, Hunger-Free Kids Act of 2010: a mixed-methods study.

OBJECTIVE: To: (i) understand the nutrition attitudes, self-efficacy, knowledge and practices of school food-service personnel (SFP) in Nebraska and (ii) identify potential barriers that schools face in offering healthy school meals that meet the US Department of Agriculture (USDA) nutrition standards. DESIGN: Convergent parallel mixed-methods study. SETTING: Kindergarten-12th grade schools in Nebraska, USA.ParticipantsSFP (260 survey participants; fifteen focus group participants) working at schools that participate in the USDA National School Lunch Program. RESULTS: Mixed-methods themes identified include: (i) 'Mixed attitudes towards healthy meals', which captured a variety of conflicting positive and negative attitudes depending on the situation; (ii) 'Positive practices to promote healthy meals', which captured offering, serving and promotion practices; (iii) 'Mixed nutrition-related knowledge', which captured the variations in knowledge depending on the nutrition concept; and (iv) 'Complex barriers', which captured challenges with time, support and communication. CONCLUSIONS: The study produced relevant findings to address the barriers identified by SFP. Implementing multicomponent interventions and providing training to SFP may help reduce some of the identified barriers of SFP.

INTEGRATING PUBLIC HEALTH IN LAND REUSE AND REDEVELOPMENT: Part 3: Public Health Indicators Associated With Land Reuse and Redevelopment: Results of a 40-Community Analysis.

The National Environmental Health Association is publishing a three-part series that highlights collaboration and partnerships with the Agency for Toxic Substances and Disease Registry (ATSDR) and redevelopment stakeholders to promote environmental health and land reuse as environmental and public health practices. This series will serve as a guide for identifying new and existing resources that can be adopted at the local environmental health level to safely reuse environmentally impacted land to improve community health outcomes. The conclusions in this series are those of the author(s) and do not necessarily represent the official position of the Centers for Disease Control and Prevention and ATSDR.

A Qualitative Phenomenological Exploration of Teachers' Experience With Nutrition Education.

Background: Nutrition education delivered by classroom teachers has become a popular intervention designed to combat childhood obesity. However, few qualitative studies have explored nutrition education with teachers Purpose: The purpose of this study was to explore how elementary teachers describe their experience with nutrition education. Methods: A qualitative phenomenological approach was used. Semistructured interviews, observations, and document analysis were conducted with 10 teachers who delivered nutrition education in their classrooms. Inductive coding was used to determine invariant constituents, reduce constituents to categories, and cluster categories into themes. Reliability and validity were accomplished through intercoder agreement, audio recording, triangulation, bracketing, and member checking. Results: Results identified 5 core themes related to roles teachers play in nutrition education, the importance placed upon nutrition, motivation for supplementary activities, barriers, and a triadic relationship between students, teachers, and curriculum. Discussion: Findings reveal interactions within the nutrition education experience in which teachers balance barriers with their value of nutrition education and motivation to help students make healthy choices. Translation to Health Education Practice: Health educators should work with classroom teachers at the program design, implementation, and evaluation stages of curriculum development to better address needs and facilitate the delivery of high-quality nutrition education for students.

Relationships between nutrition-related knowledge, self-efficacy, and behavior for fifth grade students attending Title I and non-Title I schools.

The Social Cognitive Theory (SCT) is a widely used theory for nutrition education programming. Better understanding the relationships between knowledge, self-efficacy, and behavior among children of various income levels can help to form and improve nutrition programs, particularly for socioeconomically disadvantaged youth. The purpose of this study was to determine the relationships between knowledge, self-efficacy, and behavior among fifth grade students attending Title I (≥40% of students receiving free or reduced school meals) and non-Title I schools (<40% of students receiving free or reduced school meals). A validated survey was completed by 55 fifth grade students from Title I and 122 from non-Title I schools. Differences in knowledge, self-efficacy, and behavior scores between groups were assessed using t test and adjusted for variations between participating schools. Regression analysis was used to determine the relationships between knowledge, self-efficacy, and behavior. In adjusted models, the Title I group had significantly lower scores on several knowledge items and summary knowledge (P = 0.04). The Title I group had significantly lower scores on several behavior variables including intakes of fruits (P = 0.02), vegetables (P = 0.0005), whole grains (P = 0.0003), and lean protein (P = 0.047), physical activity (P = 0.002) and summary behavior (P = 0.001). However the Title I group scored higher on self-efficacy for meal planning (P = 0.04) and choosing healthy snacks (P = 0.036). Both self-efficacy (ß = 0.70, P < 0.0001) and knowledge (ß = 0.35, P = 0.002) strongly predicted behavior; however, only self-efficacy remained significant in the Title I group (self-efficacy, ß = 0.82, P = 0.0003; knowledge, ß = 0.11, P = 0.59). Results demonstrate disparities in nutrition knowledge and behavior outcomes between students surveyed from Title I and non-Title I schools, suggesting more resources may be necessary for lower income populations. Findings suggest that future nutrition interventions should focus on facilitating the improvement of children's self-efficacy.

Development and validation of a social cognitive theory-based survey for elementary nutrition education program.

BACKGROUND: The Social Cognitive Theory (SCT) is a widely used model for developing elementary nutrition education programs; however, few instruments are available to assess the impact of such programs on the main constructs of the SCT. The purposes of this study were: 1) to develop and validate a SCT-based survey instrument that focuses on knowledge, behavior, and self-efficacy for fifth grade students; 2) to assess the relationships between knowledge, behavior, and self-efficacy; and 3) to assess knowledge, behavior, and self-efficacy for healthy eating among the fifth grade students. METHODS: A 40-item instrument was developed and validated using content validity and tested among 98 fifth grade students for internal consistency reliability. Relationships between knowledge, behavior, and self-efficacy were assessed using Pearson Correlation Coefficients. Differences in behavior and knowledge scores between children with high and low self-efficacy were examined using t-test. RESULTS: Cronbach's alphas for self-efficacy (0.70) and behavior (0.71) subscales of the survey were acceptable, although lower for knowledge (0.56). Summary scores for self-efficacy and behaviors were positively correlated (r = 0.40, P = 0.0001); however, summary knowledge scores were not associated with self-efficacy (r = 0.02, P = 0.88) or behavior scores (r = 0.14, P = 0.23). Participants with high self-efficacy also had significantly higher scores on consuming fruits (P = 0.0009) and dairy products (P = 0.009), eating breakfast (P = 0.008), helping plan family meals (P = 0.0006) and total behaviors for healthy-eating (P = 0.001) compared to those with low self-efficacy. In addition, approximately two thirds of the fifth grade students reported that they did not eat any fruits or vegetables or ate them only once on a typical day. CONCLUSIONS: The developed instrument is a reliable and useful tool to assess SCT-based elementary nutrition education programs, particularly for self-efficacy and behavior. Our results also indicated that strategic interventions are necessary to improve dietary behaviors regarding fruit and vegetable consumptions among elementary school students.