Objective: The purpose of this study was to review randomized controlled trial (RCT) studies using nutrition/health education to prevent lifestyle-related diseases in pre-school children, and published between 2000 and 2012.
Methods: A PubMed and Igaku Chuo Zasshi (ICHUSHI) search was performed with the key words “diet/nutrition”, “health education” and “intervention” to identify nutrition interventions targeting children aged 2-5, and published in English or Japanese between 2000 and 2012. The search retrieved 173 articles, of which there were ten RCT studies eligible for this review. References from the resulting papers were also examined for relevance. Two researchers, working separately, conducted the literature screening, hand searches, and intensive reading of the full texts, whereupon they discussed their findings to determine final article selection and interpretation.
Results: After screening, 16 papers (15 studies) were included for this review. Studies implemented in Japan were not available. Most of the studies employed a cluster randomized controlled trial design based upon a pre-school unit. Behavioral science theories such as the social cognitive theory and the ecological model of health behavior were used, suggesting that interventions were not only directed at children but also towards parents and pre-school teachers. Interventions that increased vegetable intake, and those that combined nutrition interventions with exercise showed decreases in BMI and the proportion of overweight participants.
Conclusion: Similar to pre 1999 reviews, the importance of applying the social cognitive theory and environment approach in nutrition education for pre-school children was reaffirmed. Also, research evaluations using physical indices such as BMI increased.

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Objective: To determine differences in food classification between what school dieticians usually used (usual classification) and what they believed to be the appropriate food classification (dieticians' classification). School dieticians also provided their perceptions of the nutrients in each food group, using the three-color classification system.
Methods: Anonymous and cross-sectional questionnaires were handed out to 442 school dieticians in Tokyo and Aichi, between May October, 2012. Dieticians were asked to provide the following: demographic information, classification of food using the three-color system, a definition of each food group, and a classification of the nutrients in the three food groups. Dieticians were asked to classify 21 food items from three groups according to the usual- and dieticians' classifications. The agreement ratio between these classifications was calculated.
Results: 237 replies were received (response rate: 53.6%). The food items (ratio %) with high agreement between the usual- and the dieticians' classifications were soybean (99.5%), mushrooms (99.0%), and green bean sprouts (98.0%), and items with a low ratio were konjac (57.5%), brown seaweed (67.7%) and kelp (69.1%). For konjac, the dieticians differed in their classifications between the groups; red group - 2 (1.0%), yellow group - 27(14.0%) and green group - 82 (42.5%).
Conclusion: Using the three-color classification system, the classification by color groups usually used by dieticians for foods differed from those that they believed to be appropriate, and their understanding of the food classification system was different. This indicates that a quantitative index is needed for this classification system to function appropriately.

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Objective: Company health promoters, an occupational health nurse and external exercise specialists collaborated to hold a stretching class. The class process was evaluated (recruitment, collaborative framework, class curriculum and participant satisfaction) and pre- and post-class comparisons were made in stretching frequency and shoulder/back pain.
Methods: After receiving support from an occupational health nurse and external exercise specialists, health promoters at the Tokyo Headquarters of Sanden Corporation held a stretching class to relieve shoulder/back pain once a week for four weeks. Before and after comparisons were made without a control group. Of the 48 participants, 35 (28 men and seven women) also completed the post-class survey and were analyzed. Questionnaires were administered before and after the class asking about sex, age, lifestyle habits, stretching frequency, level of shoulder/back pain and impression of the class.
Results: Thirty participants joined one class, three joined two classes and two joined an unknown number of classes. Over 90% of participants gave positive responses concerning the class length, class instructions and overall satisfaction. In a free answer question, positive comments were given for impression of the class and health promoter activities. Stretching frequency did not increase after the class, but analysis excluding participants without shoulder/back pain before the class revealed a significant improvement in these symptoms.
Conclusion: Participants had good impressions of the stretching class and showed improvement in shoulder/back pain. Challenges remain in recruiting participants, keeping them coming back and increasing the stretching frequency.

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Objective: To evaluate the usefulness of a card method for promoting the involvement in discussion between employees during food and nutrition education (Shoku-iku).
Methods: Forty-one employees of a nursery school, including managers, childcare-workers, nutritionists, and cooks, participated in the discussions of a Shoku-iku workshop using a card method in January, 2011. In May 2012, questionnaires were mailed to employees asking, “can you express yourself?” and, “can you listen to the opinions of others?” to determine if they could actively participate in it. Participants were then divided into high-or low- involvement groups. Both groups were asked after the study if they would use a card method in future. Differences between the two groups were analyzed using the Fisher's Exact Test. Additional comments were categorized according to content, and differences in these categories between the two groups were analyzed.
Results: Of 30 participants, 7 belonged to the high-involvement group and 23 to the low-involvement group. More participants in the high-involvement group intended to use a card method in future than those in the low-involvement group. Advantages of a card method included “easy to classify opinions” and “able to know one's opinions” for both groups and “collecting outcomes of discussions easily” in the high-involvement group. Disadvantages included “time-consuming” in both groups and “unable to express myself with cards” in the low-involvement group.
Conclusions: The card method has advantages to allow participants to classify one's opinion and understand the opinion of other participants easily; however, it also has challenges such as ‘unable to express myself with cards to promote involvement.

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Objective: This article argued the objectives for educational evaluation in school, and summarized the methods of evaluation, and described information used for evaluation. It also explained educational evaluation based on each criterion used in Japan.
Contents: The aim of educational evaluation in schools is to help teachers to improve their teaching skills. Six types of evaluation have been identified: absolute evaluation, relative evaluation, intra-individual evaluation, evaluation of educational achievement, criterion-referenced assessment, and self-evaluation. Information used for evaluation includes types of functions evaluated, the methods used, and the criteria for evaluation. The criteria for educational evaluation in Japan are interest/motivation/attitude, thinking/judgment/expression, skills, and knowledge/comprehension. Criterion-referenced assessment is the standard throughout the world, and it includes standards for each criterion. Criteria are targets, and standards assess the degree to which students achieve these criteria. Fundamentally, these criteria should be different for each subject, but currently, they are the same in all subjects.
Conclusions: Recently, the “rubric” method has emerged. It employs criteria established based on the characteristics of each subject. However, room for improvement remains. Future research on educational evaluation is expected to further improve teachers' skills in that role.

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Background: One of major aims of health education is to accomplish conducting active behaviors that promote health, and better manage and improve it. It would be critical to assess whether given health education actually had a significant impact on one's health or alternatively influenced relevant factors that could possibly promote health. Health promotion, on the other hand, aims to improve quality of life first at an individual level. In addition, at environmental level, it aims to improve social determinants of health. Said evaluation should comprehensively examine those outcomes. Difficulty of conducting such evaluation, however, arises from broad and diverse factors associated with health promotion.
Contents: Methodologies may vary by when and what to make an evaluation for. Angles of such methodologies may include but not limited to planning, process, impact and outcome. In the case of school-based nutrition education, however, whether the same should be applied or another framework should be used leaves much room for discussion. Methodologies of such evaluations heavily depend on those of intervention studies in epidemiology. Before-after studies, Quasi-experimental studies, and controlled trials are valued in intervention studies. Randomized controlled trials (RCTs) are most rigorous studies to establish scientific evidence, but difficult to implement in school settings.
Conclusions: Schools are for educational practices for children, and not solely for research. Evaluation of nutrition education is important, but has not been always feasible. Further discussion will be necessary to explore ways for researchers to collaborate and share mutual interests with schools in an efficient yet a balanced manner.

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Background: In 2014, the Society for Nutrition Education in the Japanese Society of Health Education and Promotion held a workshop titled “Evaluation of Food and Nutrition Education in School-What is different or similar between academic evaluation and evaluation of health education or promotion?” Following a discussion about the unified theme, workshop participants studied evaluation from two different perspectives: academic evaluation and evaluation of health education or promotion practices. This article provides a summary of that discussion along with feedback from the participants, which was collected by a questionnaire.
Contents: The discussion consisted of two parts. First, participants were divided into 12 groups to discuss the theme from the viewpoints of various occupational and research fields. Discussion was done on two points: points of similarity and difference between evaluations from the two different perspectives, and evaluation of food and nutrition education in school in the future. Then, the participants, including the lecturers, presented their opinions and engaged in further discussion.
Conclusions: This workshop did not reach a conclusion about the evaluation of food and nutrition education in school in the future; however, it helped participants to understand the points of similarity and difference between evaluations from the two different perspectives and also to define tasks that should be addressed. We hope to continue studying and discussing the theme to suggest ways to further evaluate food and nutrition education in schools.

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