Development of the iCook 4-H Curriculum for Youth and Adults: Cooking, Eating, and Playing Together for Childhood Obesity Prevention

Designing a Digital Culinary Education Intervention for Parents With Low Income

OBJECTIVE

To examine cooking practices, online information-seeking habits, and intervention preferences among parents with low income to inform the development of a digital cooking intervention on the basis of the Healthy Cooking Index.

METHODS

This formative research study included a brief survey followed by in-depth interviews (from February to April, 2021) with parents of a child aged 6-11 years with low income (n = 20; 100% female, 70% African American or Hispanic White). Interview transcripts were analyzed using a semistructured hybrid coding approach.

RESULTS

Three main themes were identified to inform the development of the intervention: (1) current Healthy Cooking Index behaviors, (2) preferences for digital cooking intervention content, and (3) design and delivery preferences. A 7-step process was used to develop the intervention and integrate qualitative findings.

CONCLUSIONS AND IMPLICATIONS

Online culinary programs targeting parents with low income may consider short, mobile-friendly video formats and focus on easy-to-prepare recipes adaptable to family preferences.

Effectiveness of multilevel interventions based on socio-ecological model to decrease sedentary time in children: a systematic review of controlled studies

Objectives

Preventive actions of sedentary behavior (SB) based on the socio-ecological model are needed among children and young adolescents. The aim of this systematic review is to ascertain the effectiveness of multilevel interventions (i.e., involving consideration of at least two interventional levels) in reducing sedentary time (ST) in children aged 5-12 years.

Methods

Adhering to PRISMA guidelines, a systematic literature search was conducted in three databases (PsyInfo, PubMed and ERIC) until July 2021.

Results

30 trials met the eligibility criteria and were included. They showed acceptable (< 8, n = 18) and high (≥ 8, n = 12) methodological quality. Among studies targeting 2 (n = 2), 3 (n = 19) and 4 levels (n = 9), 1 (50%), 9 (47%) and 7 (78%) were effective and reported significant reduction of ST, respectively.

Conclusion

Interventions tend to be more effective when they involve 4 levels, using both agentic and structural strategies (targeting intrinsic determinants, in the organizational environment of the child). Findings underline the relevance of multilevel strategies to reduce ST in children, but also raise issues about operationalization of the socio-ecological perspective.

Systematic review registration

PROSPERO, identifier: CRD42020209653.

Formative evaluation of a STEAM and nutrition education summer program for low-income youth

In-depth formative evaluations are vital for curriculum development and program planning but are often not conducted before a program pilots. A formative evaluation of Project stRIde was conducted to gain insight from experts and identify revisions to the curriculum. Project stRIde is a science, technology, engineering, arts, and mathematics (STEAM) and nutrition-based curriculum developed for 4th and 5th grade students from low-income and diverse families. Nine experts spanning the fields of nutrition education, cultural competency, elementary education, summer programs, and STEAM outreach were recruited to participate in an expert content review (ECR) survey and virtual interviews. Seven core themes were identified: effectively promoting student engagement, increased guidance or support needed, activity too difficult for age, time, confidence in teaching lessons, cultural appropriateness, and strengths of curriculum in promoting STEAM education and innovation. Across the lessons, all reviewers agreed that the lessons were accurate, incorporated STEAM concepts, and were culturally appropriate for this population. Future major edits to the curriculum include creating supplemental videos, modifying some activities for age level, and incorporating more opportunities for participant engagement. Overall, an ECR is an effective way to examine a program's strengths and limitations and should be included in the beginning stages of program planning.

Virtual Avatar Coaching With Community Context for Adult-Child Dyads with Low Income

OBJECTIVE

Examine the acceptability of an evidence-based, contextually tailored, virtual avatar coaching approach for nutrition education among adult-child dyads with low income.

DESIGN

Structured observations and semistructured interviews.

SETTING

Low-income communities in 2 midsized urban areas.

PARTICIPANTS

Fifteen African American adult and child (aged 5-10 years old) dyads recruited from community agencies.

PHENOMENON OF INTEREST

Structured observation during the use of the virtual avatar coaching program and qualitative feedback on program experience after using the program.

ANALYSIS

Transcripts were independently coded by 2 trained coders. Content analysis was conducted to determine trends and patterns in responses, and salient quotes were extracted from the manuscripts.

RESULTS

The program generated dialogue between the children and adults around preferences and dietary habits. Adults and children described the program as being helpful, informative, motivational, and fun. Adults and children liked that the avatar acknowledged them at a personal level, provided accountability, and was tailored to them and their environment. Children wanted the ability to customize the avatar, more gamification, and avatar demonstration of healthy behaviors. Children felt the program would improve their health behaviors and were interested in using it again.

CONCLUSIONS AND IMPLICATIONS

This study highlights information that can be used to improve avatar-based programs for nutrition education with children and their adult caregivers who have low income. Future work should assess the impact of user customization experience, program impact on dietary behaviors, and resources required to scale and maintain the program with community agencies.

The iCook 4-H Study: Report on Physical Activity and Sedentary Time in Youth Participating in a Multicomponent Program Promoting Family Cooking, Eating, and Playing Together

OBJECTIVE

To report physical activity and sedentary time outcomes of youth in iCook 4-H.

STUDY DESIGN AND SETTING

iCook 4-H was a 5-state, randomized, control-treatment, family-based childhood obesity prevention intervention promoting cooking, eating, and playing together.

PARTICIPANTS AND INTERVENTION

Youth aged 9-10 years and the main preparer of their meals participated in the 12-week program followed by monthly newsletters and biyearly booster sessions until 24 months.

MAIN OUTCOME MEASURE(S)

A total of 155 youth were fitted with an Actigraph GT3X+ accelerometer, which they wore for 7 days at baseline and 4, 12, and 24 months to measure mean daily minutes per hour of waking wear time for sedentary time (ST), light physical activity (PA) (LPA), moderate PA, vigorous PA, and moderate to vigorous PA. Self-reported PA was assessed using the Block Kids Physical Activity Screener and additional questions querying for the program goal of the frequency of family actively playing together. Linear mixed models were used to determine differences from baseline to 24 months. Significance was set at P ≤ .05.

RESULTS

There was a significant (P < .05) group × time interaction for LPA (adjusted interaction B estimate, 95% confidence interval; 0.18 [0.05, 0.30]) and ST (-0.15 [-0.26, -0.04]); ST increased and LPA decreased in the treatment group. There were no differences in other accelerometer-derived PA measures, self-report Block Kids Physical Activity Screener measures, or frequency of family actively playing together at any time point.

CONCLUSIONS AND IMPLICATIONS

iCook 4-H was a multicomponent program observing youth aged 9-10 years for 24 months that focused on enhancing cooking skills, mealtime behavior and conversation, and PA through daily family activities. Greater emphasis on developing PA skills, changing environmental factors, and increasing PA both in and after school may be needed.

The iCook 4-H Study: An Intervention and Dissemination Test of a Youth/Adult Out-of-School Program

OBJECTIVE

To describe outcomes from intervention and dissemination of iCook 4-H.

DESIGN

Five-state, community-based participatory research and a randomized, controlled trial followed by a 5-state, nonrandomized dissemination test of the iCook 4-H curriculum with control and treatment groups.

SETTING

Community and university sites.

PARTICIPANTS

Youths aged 9-10 years and their adult food preparer; 228 dyads in the intervention and 74 dyads in dissemination.

INTERVENTION(S)

Theoretical frameworks were Social Cognitive Theory and the experiential 4-H learning model. Six 2-hour, biweekly sessions on cooking, eating, and playing together followed by monthly newsletters and boosters until 24 months, expanded to 8 sessions for dissemination.

MAIN OUTCOME MEASURE(S)

Youth body mass index (BMI) z-scores, measured height and weight, and youth/adult program outcome evaluations surveys.

ANALYSIS

Linear mixed models, group, time, and group × time interaction for BMI z-score and program outcomes changes. Significance levels = P ≤ .05; interaction term significance = P ≤ .10.

RESULTS

In intervention, treatment BMI z-scores increased compared with controls based on significant interaction (P = .04). For odds of being overweight or obese at 24 months, there was no significant interaction (P = .18). In dissemination, based on significant interaction, treatment youths increased cooking skills (P = .03) and treatment adults increased cooking together (P = .08) and eating together (P = .08) compared with controls.

CONCLUSIONS AND IMPLICATIONS

iCook 4-H program outcomes were positive for mealtime activities of cooking and eating together. The program can be successfully implemented by community educators. The increase in BMI z-scores needs further evaluation for youths in cooking programs.

Development and Testing of Program Evaluation Instruments for the iCook 4-H Curriculum

OBJECTIVE

To develop and test the validity of program outcome evaluation instruments for cooking, eating, and playing together for obesity prevention during iCook 4-H.

DESIGN

Instrument development for both youth and adults through pre-post testing of items newly constructed and compiled to address key curriculum constructs. Testing occurred throughout program intervention and dissemination to determine dimensionality, internal consistency and test-retest reliability, and validity.

SETTING

A 5-state out-of-school program in cooperative extension and other community sites.

PARTICIPANTS

Youths aged 9-10 years; adults were main food preparers; the first phase involved 214 dyads and the second phase, 74 dyads.

MAIN OUTCOME MEASURE(S)

Youth measures were cooking skills, culinary self-efficacy, physical activity, and openness to new foods. Adult measures were cooking together, physical activity, and eating together.

ANALYSIS

Exploratory factor analysis to determine initial scale structure and confirmatory factor analysis to confirm factor structures. Longitudinal invariance tests to see whether the factor structure held over time. Test-retest reliability was determined by Pearson r and internal consistency was determined by coefficient Ω and Cronbach α. Validity testing was determined by Pearson r correlations.

RESULTS

Youth cooking skills, openness to new foods, and adult eating together and cooking together showed strong evidence for dimensionality, reliability, and validity. Youth physical activity and adult physical activity measures showed strong evidence for dimensionality and validity but not reliability. The youth culinary self-efficacy measure showed strong evidence for reliability and validity but weaker evidence for dimensionality.

CONCLUSIONS AND IMPLICATIONS

Program outcome evaluation instruments for youths and adults were developed and tested to accompany the iCook 4-H curriculum. Program leaders, stakeholders, and administrators may monitor outcomes within and across programs and generate consistent reporting.