{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T09:07:43Z","timestamp":1789117663597,"version":"build-2803163510"},"reference-count":31,"publisher":"MDPI AG","issue":"18","license":[{"start":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T00:00:00Z","timestamp":1789084800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001691","name":"Japan Society for the Promotion of Science","doi-asserted-by":"publisher","award":["22K13603"],"award-info":[{"award-number":["22K13603"]}],"id":[{"id":"10.13039\/501100001691","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Background\/Objectives: This study examined whether sharing a class with a peer with physician-diagnosed food allergy (FA) was associated with post-intervention FA comprehension among preschool children. Methods: A four-month ARCS motivation model-based digital nutrition education program was delivered to 163 five-year-old preschoolers from nine public kindergartens. The program provided instruction on knowledge of balanced diets and FA. Preschoolers were classified as inclusive (at least one peer with physician-diagnosed FA in the same class; n = 75) or non-inclusive (n = 88). Dietary balance and FA comprehension were assessed using illustrated worksheets. Ordinal logistic generalized estimating equations (GEE) accounted for clustering within kindergartens. Results: The inclusive environment was associated with higher FA comprehension (Wald \u03c72(1) = 4.750, p = 0.029; OR = 4.219, 95% CI: 1.156\u201315.399), whereas no association was observed for dietary balance (Wald \u03c72(1) = 0.053, p = 0.818; OR = 0.912, 95% CI: 0.414\u20132.008). Conclusions: The presence of a peer with FA was associated with higher post-intervention FA comprehension.<\/jats:p>","DOI":"10.3390\/nu18182972","type":"journal-article","created":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T08:17:42Z","timestamp":1789114662000},"page":"2972","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Association Between Inclusive Educational Environments and Food Allergy Comprehension Among Preschool Children: A Quasi-Experimental Digital Intervention Study"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-3414-0377","authenticated-orcid":false,"given":"Tomoko","family":"Noma","sequence":"first","affiliation":[{"name":"Department of Health and Nutrition, Hijiyama University, 4-1-1 Ushitashin-machi, Higashi-ku, Hiroshima 732-8509, Japan"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"validation","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"resources","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"visualization","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"},{"role":"project-administration","vocabulary":"credit"},{"role":"funding-acquisition","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-0085-312X","authenticated-orcid":false,"given":"Kyosuke","family":"Nowaki","sequence":"additional","affiliation":[{"name":"Department of Nutrition, Koshien University, 10-1 Momijigaoka, Takarazuka-shi 665-0006, Japan"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"software","vocabulary":"credit"},{"role":"validation","vocabulary":"credit"},{"role":"resources","vocabulary":"credit"},{"role":"visualization","vocabulary":"credit"}]},{"given":"Mei","family":"Nunoya","sequence":"additional","affiliation":[{"name":"Department of Nutrition, Koshien University, 10-1 Momijigaoka, Takarazuka-shi 665-0006, Japan"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"resources","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"}]},{"given":"Haruna","family":"Koyama","sequence":"additional","affiliation":[{"name":"Department of Nutrition, Koshien University, 10-1 Momijigaoka, Takarazuka-shi 665-0006, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ayano","family":"Nishizoe","sequence":"additional","affiliation":[{"name":"Department of Nutrition, Koshien University, 10-1 Momijigaoka, Takarazuka-shi 665-0006, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,11]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1016\/j.jaci.2017.11.003","article-title":"Food Allergy: A Review and update on epidemiology, pathogenesis, diagnosis, prevention, and management","volume":"141","author":"Sicherer","year":"2018","journal-title":"J. Allergy Clin. Immunol."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Loh, W., and Tang, M.L.K. (2018). The Epidemiology of food allergy in the global context. Int. J. Environ. Res. Public Health, 15.","DOI":"10.3390\/ijerph15092043"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"e20181235","DOI":"10.1542\/peds.2018-1235","article-title":"The public health impact of parent-reported childhood food allergies in the United States","volume":"142","author":"Gupta","year":"2018","journal-title":"Pediatrics"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"e14192","DOI":"10.1111\/pai.14192","article-title":"Prevalence of food allergy increased 1.7 times in the past 10 years among Japanese patients below 6 Years of Age","volume":"35","author":"Yoshisue","year":"2024","journal-title":"Pediatr. Allergy Immunol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"370","DOI":"10.1016\/j.alit.2020.03.004","article-title":"Japanese guidelines for food allergy 2020","volume":"69","author":"Ebisawa","year":"2020","journal-title":"Allergol. Int."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1007\/s12016-018-8708-x","article-title":"Beyond Avoidance: The psychosocial impact of food allergies","volume":"57","author":"Feng","year":"2019","journal-title":"Clin. Rev. Allergy Immunol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"541","DOI":"10.1111\/josh.13181","article-title":"Self-reported anxiety ratings in children with and without food allergies and teacher knowledge of food allergies","volume":"92","author":"Kanter","year":"2022","journal-title":"J. Sch. Health"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"e70187","DOI":"10.1111\/pai.70187","article-title":"food-induced anaphylaxis and mental health in children and their parents: A Narrative Review","volume":"36","author":"Polloni","year":"2025","journal-title":"Pediatr. Allergy Immunol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"282","DOI":"10.1016\/j.anai.2010.07.011","article-title":"Bullying among pediatric patients with food allergy","volume":"105","author":"Lieberman","year":"2010","journal-title":"Ann. Allergy Asthma Immunol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"e10","DOI":"10.1542\/peds.2012-1180","article-title":"Child and parental reports of bullying in a consecutive sample of children with food allergy","volume":"131","author":"Shemesh","year":"2013","journal-title":"Pediatrics"},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Nocerino, R., Mercuri, C., Bosco, V., Aquilone, G., Guillari, A., Simeone, S., and Rea, T. (2024). Food allergy-related bullying in pediatric patients: A Systematic Review. Children, 11.","DOI":"10.3390\/children11121485"},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Nishida, N., Maeda, Y., Okafuji, I., and Ueki, S. (2025). Lived Experiences of School-Age Children with food allergies: A qualitative systematic review and meta-synthesis. Children, 12.","DOI":"10.3390\/children12081053"},{"key":"ref_13","unstructured":"Bandura, A. (1986). Social Foundations of Thought and Action: A Social Cognitive Theory, Prentice-Hall, Inc."},{"key":"ref_14","first-page":"1","article-title":"The Effect of Social Cognitive Theory-based interventions on dietary behavior within children","volume":"4","year":"2016","journal-title":"J. Nutr. Health Food Sci."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1146\/annurev.psych.52.1.1","article-title":"Social Cognitive Theory: An agentic perspective","volume":"52","author":"Bandura","year":"2001","journal-title":"Annu. Rev. Psychol."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Lave, J., and Wenger, E. (1991). Situated Learning: Legitimate Peripheral Participation, Cambridge University Press.","DOI":"10.1017\/CBO9780511815355"},{"key":"ref_17","unstructured":"Kolb, D.A. (1984). Experiential Learning: Experience as the Source of Learning and Development, Prentice-Hall."},{"key":"ref_18","first-page":"11","article-title":"The characteristics and effectiveness of school-based educational interventions in the management of children with food allergies: A Systematic Review","volume":"39","author":"Riccio","year":"2025","journal-title":"Ital. J. Pediatr. Allergy Immunol."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Sanagavarapu, P., Rika, S., Katelaris, C.H., Said, M., Collison, L., and Dadich, A. (2025). The management of children\u2019s food allergy in childcare centres, preschools, and schools: A Scoping Review. Nutrients, 17.","DOI":"10.3390\/nu17172722"},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Nocerino, R., Lotito, F., Montella, E., and Berni Canani, R. (2026). Integrating digital health into school nursing for food allergy management: A Systematic Review. Children, 13.","DOI":"10.3390\/children13010159"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1007\/BF02905780","article-title":"Development and use of the ARCS model of instructional design","volume":"10","author":"Keller","year":"1987","journal-title":"J. Instr. Dev."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Keller, J.M. (2010). Motivational Design for Learning and Performance: The ARCS Model Approach, Springer.","DOI":"10.1007\/978-1-4419-1250-3"},{"key":"ref_23","first-page":"53","article-title":"Development of a shokuiku program for elementary school children and evaluation of its intervention effects","volume":"9","author":"Noma","year":"2015","journal-title":"J. Jpn. Soc. Shokuiku"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"e30160","DOI":"10.2196\/30160","article-title":"Digital interventions to promote healthy eating in children: Umbrella Review","volume":"4","author":"Prowse","year":"2021","journal-title":"JMIR Pediatr. Parent."},{"key":"ref_25","unstructured":"Ministry of Health, Labour and Welfare (2020). Guidelines for Meal Provision in Child Welfare Facilities and Related Institutions, Ministry of Health, Labour and Welfare. (In Japanese)."},{"key":"ref_26","unstructured":"(2026, July 24). Food-Based Dietary Guidelines\u2014Japan. Available online: http:\/\/www.fao.org\/nutrition\/education\/dietary-guidelines\/regions\/japan\/en\/."},{"key":"ref_27","first-page":"159","article-title":"Development of \u201chand and spinning top shokuiku (nutrition education) program\u201d and its practical application","volume":"2","author":"Noma","year":"2008","journal-title":"J. Jpn. Soc. Shokuiku"},{"key":"ref_28","first-page":"425","article-title":"Development of \u201cdance program (hone-hone-dance)\u201d and its practice in nutrition education (shokuiku)","volume":"53","author":"Noma","year":"2010","journal-title":"J. Jpn. Diet. Assoc."},{"key":"ref_29","unstructured":"Bandura, A. (1977). Social Learning Theory, Prentice Hall."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1016\/j.actpsy.2006.09.005","article-title":"The \u201clike me\u201d framework for recognizing and becoming an intentional agent","volume":"124","author":"Meltzoff","year":"2007","journal-title":"Acta Psychol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"284","DOI":"10.1126\/science.1175626","article-title":"Foundations for a new science of learning","volume":"325","author":"Meltzoff","year":"2009","journal-title":"Science"}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/18\/18\/2972\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T08:29:40Z","timestamp":1789115380000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/18\/18\/2972"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,11]]},"references-count":31,"journal-issue":{"issue":"18","published-online":{"date-parts":[[2026,9]]}},"alternative-id":["nu18182972"],"URL":"https:\/\/doi.org\/10.3390\/nu18182972","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,11]]}}}