Community-based culinary and nutrition education intervention promotes fruit and vegetable consumption

Analysing the behaviour change techniques in an effective food literacy program to inform future program design

AIM

Food literacy programs aim to improve food related skills and knowledge and are selected Governments as a strategy to address dietary intakes at a community level. The purpose of this research is to identify behaviour change techniques in a food literacy program, which were assessed by the achievement of participant goals related to food literacy and dietary behaviour changes.

METHODS

Consensus methods were applied to map behaviour change techniques to an adult food literacy program. A second phase investigation applied content analysis of participant process evaluation data (collected between 2016 and June 2021) to align target behaviours and behaviour change techniques. Chi-square and ANCOVA were used to assess the statistically significant demographic characteristics, food literacy, and dietary behaviour scores for participants who set goals and recorded changes.

RESULTS

A total of 4697 program participants provided evaluation data from the 4-week food literacy program. Participants who set goals and made changes were statistically more likely to have higher food literacy factor scores (p < 0.001) and fruit serves (p = 0.004). Statistical analysis showed that participants were more likely to have set goals and recorded changes if they were female (p < 0.001), older (p < 0.001), higher education level (p < 0.001), had a higher socioeconomic status (p = 0.049), lived with children (p = 0.014), were born in Australia (p = 0.019), or did not identify as Indigenous (p < 0.001). The behaviour change technique mapping process identified nine techniques used weekly and a total of 22 techniques used over the entire 4 week program curriculum.

CONCLUSIONS

This is the first Australian study to link the contribution of behaviour change techniques to food literacy and dietary behaviour change in an established effective food literacy program. Knowing the behaviour change techniques associated with effective programs will facilitate replication of effective interventions.

Racial/Ethnic Differences in Chronic Disease Predictors Among American High School Students

BACKGROUND

Few studies have attempted to define clusters of chronic disease predictors with additional focus on racial/ethnic differences. The purpose of this study was to highlight differences in predictors of chronic diseases among American high school students by identifying subgroups using latent class analysis (LCA).

METHODS

The chronic disease predictor variable used in the analysis was created from 5 modified items in the 2019 Youth Risk Behavior Surveillance that were identified to be critical to healthy lifestyles in Healthy People 2020. Descriptive, bivariate, multinomial logistic regression and LCA were performed using SAS 9.4 and Mplus in 9th to 12th grade students, using data from the Youth Risk Behavior Survey (N = 13,677).

RESULTS

Three distinct classes emerged for US high school students and were characterized as high, moderate, and low risk of chronic disease (38%, 33%, and 29%, respectively). Black and Asian students had a higher chance of being in the high-risk class of chronic diseases.

IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY

Emphasis should be placed on sociocultural and socio-environmentally structured prevention programs for at risk/students, ensuring that policy formation reflects the language, identity, and needs of the populations at risk.

CONCLUSIONS

The behavioral similarities of the classes identified highlight the need for continued research, novel interventions, and culturally sensitive strategies and policies in US high schools.

Recipes for Health: A Community-Based Nutrition and Culinary Intervention

BACKGROUND

 Obesity is a major public health concern in the United States, especially since it has been associated with an increased incidence of multiple co-morbidities. Positive eating behavior modifications learned through nutrition education sessions are the main interventions proposed to target overweight and obesity.

OBJECTIVE

 The aim of this study was to determine if nutrition education and hands-on cooking classes will result in improvement in eating habits and cooking skills to manage chronic disease.  Methods: A convenience sample of 21 participants were recruited from primary health clinics in Miami-Dade, Broward, and Palm Beach counties. A total of eight weekly virtual lessons were conducted, which included both a culinary and a nutrition education portion. At baseline and post-intervention, participants filled out a validated questionnaire with questions related to nutrition knowledge and behavior, fruit and vegetable consumption, and cooking skills. Weight was self-reported. Statistical analysis was conducted using IBM SPSS Statistics for Windows, Version 27.0 (Released 2020; IBM Corp., Armonk, New York, United States) and included descriptive statistics and a paired t-test to compare pre- and post-intervention data.

RESULTS

 Throughout the eight weeks, subject attendance ranged from 61-95%. Nineteen participants completed the post-intervention questionnaire. Results showed a statistically significant mean weight loss of 3.74 ±5.26 lbs (p=0.006) and a statistically significant mean BMI change of -0.66 ±0.86 (p=0.004) at post-intervention compared to baseline. In addition, subjects reported increased confidence in dietary habits and culinary skills post-intervention.

CONCLUSION

 Our results show exciting data in support of this project's objectives that a healthy cooking intervention can increase nutrition knowledge, increase confidence in healthy food choices, increase confidence in food preparation skills, and improve weight and BMI in participants.

Effect of Brief Produce Exposure and Unconstrained Grocery Gift Cards on Caregiver Influence on Diet of Elementary Age Children: A Randomized Clinical Trial

IMPORTANCE

Children's diets affect health trajectories but are difficult to influence, especially for resource-constrained families.

OBJECTIVE

To assess the effectiveness of providing 4 weeks of grocery gift cards and small produce boxes to caregivers on their ability to support healthy shifts in children's diets.

DESIGN, SETTING, AND PARTICIPANTS

This 2-group randomized clinical trial was conducted from May to July 2021, with 4 weeks of intervention and follow-up at 8 weeks. Resources were provided curbside at 3 schools, 3 housing sites, and 1 after-school site for use at home. Participants consisted of 1 index child ages 5 to 11 years with 1 index caregiver from 68 low-income families. Data were analyzed from July 2021 through March 2022.

INTERVENTIONS

During each week for 4 weeks, caregivers were offered 10-lb (4.5 kg) boxes of fruits and vegetables, $10.00 grocery gift cards, an additional $10.00 gift card over the last 3 weeks triggered by a task completion, and a 1-time choice of a $25.00 food preparation tool.

MAIN OUTCOMES AND MEASURES

Index child and caregiver diets were measured together over the phone at baseline, 4 weeks, and 8 weeks using the 2019 to 2020 Texas School Physical Activity and Nutrition (SPAN) tool, which measures the number of times food items were eaten over the prior day to report a SPAN Healthy Eating Index (SHEI) score and subscores for specific categories of foods (range, 0-57, with higher scores indicating a more healthful diet).

RESULTS

Among 68 children (mean [SD] age, 8.2 [1.7] years; 35 [51.5%] girls) and caregivers (mean [SD] age, 37.9 [7.9] years; 63 mothers [92.6%]) from primarily low-income families, 26 caregivers were Hispanic or Latino (38.2%), while 18 caregivers were Black (26.4%), 25 caregivers were White (36.7%), and 24 caregivers had more than 1 race (35.3%). Most families were below the federal poverty level (41 of 60 families that reported income [68.3%]). Per participating caregiver, a mean (SD) 2.7 [1.4] fruit and vegetable boxes and $42.35 ($25.46) worth of gift cards were picked up over 4 weeks. Mean (SE) child SPAN SHEI increased from 32.03 (0.62) times/d to 33.75 (0.69) times/d at 4 weeks (ie, postintervention) and 34.03 (0.69) times/d 4 weeks later (ie, at 8 weeks of follow-up). Mean (SE) child fruit and vegetable intake increased from 5.31 (0.47) times/d to 5.78 (0.51) times/d postintervention and 6.03 (0.51) times/d at follow-up. Children in the control group did not have improved diet (overall mean [SE] SHEI: 31.48 [0.58] times/d at baseline, 31.68 [0.54] times/d postintervention, and 31.81 [0.52] times/d at follow-up; mean [SE] fruit and vegetable intake: 5.21 [0.45] times/d at baseline, 4.77 [0.45] times/d postintervention, and 4.68 [0.41] times/d at follow-up). Compared with children in the control group, mean SHEI was increased for children in the intervention group by 2.07 times/d postintervention and 2.23 times/d at follow-up. Improvements as a function of program dose were statistically significant for child SHEI (P = .01) and fruit and vegetable intake (P = .03). No significant changes in caregiver diets were found.

CONCLUSIONS AND RELEVANCE

This study found that easily accessed fruits and vegetables and unconstrained grocery store cards provided directly to caregivers over 4 weeks resulted in improvements in child diet, which were sustained over 4 additional weeks. Future work may investigate whether diet improvement from a brief intervention optimized for caregiver flexibility reflects a natural maximum or potential for greater improvements on extension.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT04827654.