Outcomes of Children's Cooking Programs: A Systematic Review of Intervention Studies

OBJECTIVE

To examine the factors that make such programs successful, this systematic review compared the outcomes of children's participation in cooking interventions based on intervention characteristics.

DESIGN

Systematic review of randomized controlled trials of children's participation in cooking interventions published between 1998 and 2022 guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement.

SETTING

All settings PARTICIPANTS: Children and parents.

MAIN OUTCOME MEASURES

Cooking skills, food acceptance and dietary behavior.

ANALYSIS

Systematic search of 1,104 articles and review of 23 studies (42 articles) meeting inclusion criteria.

RESULTS

Interventions varied in participant age, settings, cooking sessions, and program length. Knowledge of cooking skills, self-efficacy, and child cooking involvement were the most frequent positive outcomes; improvements in dietary intake were rarely achieved. Seven studies had a high rating for research quality.

CONCLUSION AND IMPLICATIONS FOR RESEARCH AND PRACTICE

Lack of standardized assessment, large variability in program characteristics, and insufficient intervention description made it difficult to discern best practices for children's cooking programs. Improvements in intervention development and measurement instruments are needed. Interventions that include hands-on cooking lessons seem promising in improving knowledge and self-efficacy; however, further exploration is required on the factors that make cooking programs successful in the long term.

The relationship between modifiable lifestyle behaviours and self-reported health in children and adolescents in the United Kingdom

Obesity, along with its associated health issues, is closely tied to lifestyle habits. While certain elements affecting childhood health, such as genetics and ethnicity, are beyond individuals' control, there exists modifiable lifestyle behaviours that can facilitate healthier living. This study employed multiple regression analysis to investigate the relationship between specific modifiable lifestyle behaviours and self-reported health. The independent variables considered included days of moderate to vigorous physical activity (MVPA), fruit and vegetable consumption, breakfast frequency, school night sleep duration, and non-school night sleep duration. These variables were chosen for their practical modifiability within participants' daily lives. The analysis revealed a highly significant overall model (F(13,11363) = 191.117, p < .001), explaining 17.9% of the variance in self-reported health. Notably, higher MVPA levels were associated with improved self-reported health (B = 0.136 to 0.730, p < .001). Additionally, regular breakfast consumption and increased fruit and vegetable intake exhibited positive associations with self-reported health (B = 0.113 to 0.377, p < .001), while girls reported lower self-reported health (B = -0.079, p < .001). School night sleep duration was positively linked to self-reported health (B = 0.071, p < .001). Furthermore, a dose-response relationship between MVPA, dietary habits, and health was identified. These findings hold substantial potential for public health campaigns to promote healthy behaviours and prevent chronic diseases in young individuals. It is imperative to emphasise that all the variables considered in this study are readily modifiable aspects of individuals' lives, offering a promising avenue for personal health and well-being enhancement.

Influence of culinary skills on ultraprocessed food consumption and Mediterranean diet adherence: An integrative review

The Mediterranean diet is a diet pattern with several healthy characteristics, including a high consumption of fresh fruits, vegetables, whole-grain products, and extra virgin olive oil as the main fat source. It is also characterized by a low consumption of processed foods and high-fat meats. However, there has been a nutritional transition such that, because of globalization and economic growth, the consumption of ultraprocessed foods is increasing, comprising 14% to 57% of total energy intake. North America and Australia have the worst prognosis. Further, the younger population consumes greater amounts of ultraprocessed foods compared with adults, whereas the older population has the lowest rates. Among the various factors responsible for the nutritional transition, culinary skills seem an important function of diet quality, but, unfortunately, culinary skills have been little investigated by the scientific community. Higher culinary skills may be related to increased consumption of homemade meals, higher diet quality, and greater consumption of vegetables and fruits and may be associated with higher Mediterranean diet adherence. Consequently, ultraprocessed foods, ready-to-eat food, and delivered meals, as well as meals outside the home, are reduced. Unfortunately, the process of generational transmission of cooking skills is progressively weakening, aggravated by the reduction of free time for home cooking. Still, even though there are few interventions conducted to improve culinary skills, especially those focused on children, the available results suggest that there have been positive changes in the direction of a healthier dietary pattern. This integrative review analyzes consumption levels of ultraprocessed foods. We then consider the extent to which culinary skills affect ultraprocessed food consumption levels and the relative impact on obesity.

Cooking at Home: Correlates of Frequency and Intention in Fifth Graders

Cooking at home is associated with health benefits, and 10- and 11-year-old children are capable of participating in meal preparation. However, opportunities for children to cook at home have declined. This study aimed to identify determinants of the frequency and the intention to cook at home in fifth graders using the Theory of Planned Behavior as a framework with quantitative methodology. A total of 241 participants across five elementary schools of the Chaudière-Appalaches region (Quebec, Canada) took part in this correlational study. Data were collected via a self-administered questionnaire based on the Theory of Planned Behavior. Regression analyses led to the identification of determinants of frequency and intention to cook at home. More than two-thirds of participants (69%) declared having cooked at home in the past 7 days. Intention was the only significant variable explaining 18% of the variance for frequency. Intention was determined by perceived behavioral control, attitude, descriptive norms, subjective norms, perceived barriers, being a girl, and normative beliefs, which explain 74% of the variance. Whereas other studies aiming at better understanding children's involvement in meal preparation at home focused on self-efficacy for cooking, this study highlights other behavioral determinants. For example, support from parents appears to be crucial to promote this behavior in this age group. Future research and interventions should be oriented toward determinants such as subjective norms and normative beliefs, and focus on children's autonomy.

Consumption of ultra-processed foods and low dietary diversity are associated with sedentary and unhealthy eating behaviors: A nationwide study with Brazilian Schoolchildren

BACKGROUND

Consumption of ultra-processed foods and low dietary diversity are risk factors for chronic diseases.

AIM

To evaluate the association between food consumption and sedentary and unhealthy eating behaviors of Brazilian schoolchildren between 6 and 11 years old.

METHODS

Cross-sectional study. A prevalence sample was calculated considering the number of children enrolled in elementary school. This sample was distributed proportionally to Brazil's macro-regions and the type of school (public or private). The questionnaire was developed in Google Forms and disseminated through the snowball technique. The questionnaire was filled in by the children's parents, with information about the child's identification and health. Afterward, the child completed a questionnaire by her/himself. We used the previously validated Illustrated Questionnaire on Food Consumption for Brazilian Schoolchildren and the Illustrated Questionnaire on Eating and Sedentary Behaviors. Food consumption was analyzed using the NOVA score and the dietary diversity score. Poisson's regression with robust variance was performed (p<0.05).

RESULTS

The study included 2,021 dyads. Of these, 27.6% of children reported eating five or more ultra-processed foods and 39.0% four or fewer natural or staple foods the previous day. Using screens, proxy of sedentary behavior (Prevalence Ratio-PR = 1.8, Confidence Interval-CI95%1.2-2.8) and eating at irregular hours (PR = 1.6, CI95%1.2-2.2) were risk factors for high consumption of ultra-processed foods and low dietary diversity in schoolchildren. In addition, eating the three main meals on the previous day (PR = 0.6, CI95%0.4-0.8) was identified as protective factors against the consumption of ultra-processed foods and in favor of dietary diversity among schoolchildren.

CONCLUSION

Sedentary and unhealthy eating behaviors were associated with the consumption of ultra-processed foods and low dietary diversity in Brazilian schoolchildren.

Experiences and perceived outcomes of a grocery gift card programme for households at risk of food insecurity

OBJECTIVE

This study explored programme recipients' and deliverers' experiences and perceived outcomes of accessing or facilitating a grocery gift card (GGC) programme from I Can for Kids (iCAN), a community-based programme that provides GGC to low-income families with children.

DESIGN

This qualitative descriptive study used Freedman et al's framework of nutritious food access to guide data generation and analysis. Semi-structured interviews were conducted between August and November 2020. Data were analysed using directed content analysis with a deductive-inductive approach.

PARTICIPANTS

Fifty-four participants were purposively recruited, including thirty-seven programme recipients who accessed iCAN's GGC programme and seventeen programme deliverers who facilitated it.

SETTING

Calgary, Alberta, Canada.

RESULTS

Three themes were generated from the data. First, iCAN's GGC programme promoted a sense of autonomy and dignity among programme recipients as they appreciated receiving financial support, the flexibility and convenience of using GGC, and the freedom to select foods they desired. Recipients perceived these benefits improved their social and emotional well-being. Second, recipients reported that the use of GGC improved their households' dietary patterns and food skills. Third, both participant groups identified programmatic strengths and limitations.

CONCLUSION

Programme recipients reported that iCAN's GGC programme provided them with dignified access to nutritious food and improved their households' finances, dietary patterns, and social and emotional well-being. Increasing the number of GGC provided to households on each occasion, establishing clear and consistent criteria for distributing GGC to recipients, and increasing potential donors' awareness of iCAN's GGC programme may augment the amount of support iCAN could provide to households.

Mothers' descriptions of their feeding strategies in response to fussy eating with children of different levels of trait fussiness

Parent feeding practices influence a child's dietary intake. Many studies examining how parents react to children's fussy eating behaviours have been limited to questionnaire measures, which assess a limited number of feeding practices. There is a lack of research exploring the range of strategies parents use when their child is being fussy and/or refusing to eat. Therefore, the aims of this study are to describe the strategies used by mothers when their child is being fussy or refusing to eat, and to assess differences in the strategies depending on the child's trait fussiness levels. In 2018, 1504 mothers of children aged 2-5 years completed an online survey. Trait fussiness was assessed using the Children's Eating Behaviour Questionnaire. Mothers were also asked the open-ended question "What are the strategies you use when your child is being fussy or refusing to eat?". Inductive thematic analysis was conducted using NVivo. Themes were compared by child trait fussiness levels. Seven main themes were identified: child-led feeding/trust in child's appetite, spectrum of pressure, home or family strategies, different types of food offerings, communication, avoid certain strategies, and never or rarely fussy. Mothers of children with severe trait fussiness levels reported more pressuring or persuasive strategies. This study provides novel information regarding the diverse range of feeding practices parents use in response to children's fussy eating behaviours. Mothers used more feeding strategies typically associated with unhealthy dietary intake for children of high levels of trait fussiness. It is important that future interventions tailor the information to provide support to parents of children with high levels of trait fussiness regarding the use of feeding practices recommended to support healthy dietary intake.

Fourth-Grade Cooking and Physical Activity Intervention Reveals Associations With Cooking Experience and Sex

OBJECTIVE

Examine the impact of Fuel for Fun: Cooking with Kids Plus Parents and Play (FFF) on children's culinary self-efficacy, attitude, fruit and vegetable (FV) preferences, physical activity (PA), and body mass index.

DESIGN

Randomized controlled trial.

SETTING

Eight elementary schools in 2 Northern Colorado districts.

PARTICIPANTS

Fourth-grade students; 7-month interventions: school (S.FFF)-theory-based cooking + tasting lessons, active recess, lesson-driven cafeteria promotions; or school + family (S+F.FFF) with added family nights and home activities.

MAIN OUTCOME MEASURE(S)

Cooking self-efficacy and attitudes, FV preferences, PA, and measured height/weight.

ANALYSIS

Individual outcomes nested by classroom, school, and district and assessed > 12 months with repeated measures controlled by sex and baseline cooking experience, with a significance level of P < 0.05.

RESULTS

The sample included 1,428 youth, 38 teachers, 4 cohorts, 50% boys, 75% White, and 15% Hispanic. No intervention effect was observed. Those who cooked retained higher self-efficacy, attitude, and FV preferences (P < 0.001). Girls reported higher self-efficacy and attitude than boys. Moderate-to-vigorous PA and metabolic equivalent minutes increased for all students; boys retained higher levels (P < 0.001). Body mass index percentile remained stable.

CONCLUSIONS AND IMPLICATIONS

Cooking and sex were associated with all outcome measures and should be considered for intervention tailoring. Treatment impacts were not evident nesting by classroom, school, and district. Accurate assessment of school-based interventions requires rejecting student independence from group assignment assumptions.

Family Facilitators of, Barriers to and Strategies for Healthy Eating among Chinese Adolescents: Qualitative Interviews with Parent-Adolescent Dyads

Healthy eating is vital in preventing obesity and long-term non-communicable diseases. This study explores potential family facilitators of, barriers to and strategies for healthy eating among adolescents in Chinese families to guide the development of effective interventions in the future. Parent-adolescent dyads were purposively sampled by age, gender, fruit and vegetable intake and household income. Key family factors were identified by thematic analysis. Fourteen themes under five domains were identified: family health with (1) illness experienced in the family; parental knowledge of (2) dietary recommendations, (3) the preparation of healthy food and (4) healthy food choice; parental attitudes towards (5) the importance of healthy eating and (6) the priority of family health; socioeconomic factors of (7) time concerns and (8) cost concerns; and food parenting practices in (9) nutritional education, (10) role modeling, (11) food provision, (12) child involvement, (13) parental supervision and (14) the cultivation of food preference. Useful strategies included incorporating healthy ingredients in adolescents' favorite recipes and providing a variety of fruit and vegetables at home. There is a need to empower parents with practical nutrition knowledge, to be more authoritative in food parenting practices, to discuss healthy eating with children and to acquire practical skills related to time- and cost-saving healthy cooking.

Fuel for Fun Process Evaluation Reveals Strong Implementation and Approval with Varied Parent Engagement

OBJECTIVE

To describe the implementation and process characteristics of Fuel for Fun: Cooking with Kids Plus Parents and Play (FFF).

DESIGN

Mixed methods.

SETTING

Elementary schools in 2 Northern Colorado school districts.

PARTICIPANTS

Fourth graders (aged 9-11 years), parents, school staff, and implementation researchers; measured over 2 consecutive years in 8 schools (851 students, 45 classrooms).

INTERVENTION(S)

Social Cognitive and active learning theory-based classroom cooking with tasting lessons, active recess games, cooking with tasting food promotion during school lunch, family nights, and take-home intervention reinforcements. A 7-month program delivered by a trained intervention team.

MAIN OUTCOME MEASURE(S)

Implementation measures (observations and debriefings) assessed context, reach, dose delivered, fidelity, and dose received; process measures (surveys) assessed student and parent perceptions and intervention participation.

ANALYSIS

Descriptive statistics for quantitative and themes for qualitative data.

RESULTS

Minor adjustments in program delivery plans were required to accommodate changes in school schedules and policies. Process measures demonstrated > 90% achievement of goals for nearly all child-centered activities. One-quarter of eligible families participated in evening events, with strong parent and student approval. Fifty out of 116 parents (43%) completing an online survey reported preparing ≥ 1 of 5 recipes with their child. Fifty-nine percent of eligible students completed >1 of 10 take-home activity sheets with their parents.

CONCLUSIONS AND IMPLICATIONS

Engagement and commitment of the intervention team and school staff supported strong implementation. Participant responses were positive, but improvement in parent engagement requires investigation.

"I was pushed over the edge, but I didn't die" - A qualitative case study of Danish school children's food literacy at FOODcamp

Food literacy (FL) is a goal for many food camps aimed at improving school children's culinary skills and food knowledge. FL in relation to children has been defined as constituting five competencies: "to do" (practical skills),"to know" (knowledge), "to sense" (sensory experiences), "to care" (care for self and others), and "to want" (to be willing to act). However, understanding the processes and mechanisms that relates to school children's FL remain underexplored. The aim of this study was to identify underlying mechanisms operating at a food camp and elucidate how they relate to FL competencies among school children. A qualitative embedded case study design was used to explore this with a Danish food camp programme 'FOODcamp' targeting school-going children aged 12-14 years, constituting an instrumental case. A theory-driven abductive research strategy was used to facilitate analytical generalization. Five schools and nine classes participating in FOODcamp were recruited for the study. Data comprised 10 focus group discussions conducted with children, nine interviews conducted with teachers, and 10 days of observation at FOODcamp. The analysis resulted in 12 conceptually derived mechanisms operating at a food camp namely 'hands-on with food and kitchen utensils', 'use of all senses', 'help and recognition', 'theoretical reflection', 'from farm to table', 'try new and scary things', 'experimenting', 'genuine participation', 'cook from scratch', 'principles', 'meal group community' and 'food group community'. These mechanisms were in various combinations and in a dynamic interplay with contextual conditions related to school children's five FL competencies. The conceptually derived mechanisms may guide future research and practice by highlighting various processes and contextual conditions, given that they are adapted to the specific possibilities of a given context and age group.

Food Insecurity, Dietary Intakes, and Eating Behaviors in a Convenience Sample of Toronto Youth

BACKGROUND

Food insecurity has been shown to be associated with poor dietary quality and eating behaviors, which can have both short- and long-term adverse health outcomes in children. The objective was to investigate the food security status, dietary intakes, and eating behaviors in a convenience sample of youth participating in the Maple Leaf Sports Entertainment LaunchPad programming in downtown Toronto, Ontario.

METHODS

Youth aged 9-18 years were recruited to participate in the study. Food security status, dietary intakes, and eating behaviors were collected using parent- or self-reported questionnaires online.

RESULTS

Sixty-six youth (mean ± SD: 11.7 ± 1.9 years) participated in the study. The prevalence of household food insecurity was higher than the national average with at least one child under 18 years of age (27.7% vs. 16.2%). Dietary intake patterns were similar to the national trends with low intakes of fiber, inadequate intakes of calcium and vitamin D; and excess intakes of sodium, added sugar, and saturated fat. Despite a low prevalence of poor eating habits, distracted eating was the most frequently reported poor eating habit.

CONCLUSIONS

Although youth were at high risk for experiencing household food insecurity, inadequate dietary intake patterns were similar to the national trends. Our findings can be used to develop future programming to facilitate healthy dietary behaviors appropriate for the target community.

Adolescent Knowledge, Attitudes and Practices of Healthy Eating: Findings of Qualitative Interviews among Hong Kong Families

To tackle unhealthy eating among adolescents, it is crucial to understand the dietary knowledge, attitudes, and practices (KAP) on which adolescent eating habits are based. This qualitative study identifies the gaps in KAP by exploring what Chinese adolescents know, perceive, and practice regarding healthy eating to better inform targeted interventions for this important health problem. Parent–adolescent dyads were purposively sampled based on, for example, the dietary intake, age, and gender of the adolescent and household income, and each completed a 30 to 60 min interview. Twelve themes were synthesized: knowledge: (1) dietary recommendations, (2) health outcomes of healthy eating, (3) nutrition content in food, and (4) access to healthy meals; attitudes: (5) outcome expectation for healthy eating, (6) food preferences, and (7) self-efficacy regarding adopting healthy eating; and practices: (8) going grocery shopping for healthy food, (9) eating home-prepared meals. (10) eating out in restaurants or consuming takeaway food, (11) fruit and vegetable consumption, and (12) snacking, perceived unhealthy eating to be low risk, made unhealthy choices regarding snacking and eating out, and had insufficient fruit and vegetable intake. Programs should emphasize the positive short-term health outcomes of healthy eating and empower adolescents to acquire food preparation skills to sustain healthy eating habits.

Facilitating the planning and evaluation of narrative intervention reviews: Systematic Transparency Assessment in Intervention Reviews (STAIR)

Narrative reviews offer a flexible way to report intervention results and comprise the majority of reviews published in top medical journals. However variations in their transparency pose evaluation challenges, compromising their value and potentially resulting in research wastage. Calls have been made to reduce the number of narrative reviews published. Others argue narrative reviews provide an important platform and should even be placed on an equal footing to systematic reviews. We believe narrative intervention reviews can provide a vital perspective when transparent, and thus support Systematic Transparency Assessment in Intervention Reviews (STAIR). This research evaluates the transparency of 172 health-related narrative and literature reviews (K = 172), by assessing how they communicate information about the interventions they review. Eight points supporting transparency, relating to sample sizes, traceability, article numbers, and references, were assessed. Half of the reviews reported on at least four of the eight points, but 24% reported on none. Only 56% of the reviews clearly communicated full references. The STAIR* (Sample sizes, Traceability, Article numbers, Intervention numbers, References*) checklist comprises five sections, and nine points. It is proposed as a convenient tool to address STAIR and complement existing review guidelines to assist authors in planning, reviewers in evaluating, and scholars in utilising narrative reviews. The objectives of STAIR* are to: 1) encourage narrative review transparency and readability, 2) facilitate the incorporation of narrative reviews results into other research; and 3) enrich narrative review methodology with a checklist to guide, and evaluate, intervention reviews.

Feasibility of parents promoting fruit-infused water to reduce preschool children's sugar-sweetened beverage consumption

Background: Increasing water and decreasing sugar-sweetened beverage (SSB) consumption in preschoolers provide a strategy to reduce lifelong obesity risks. Aim: To determine feasibility/acceptability and examine preliminary findings of an innovative intervention for preschooler parents to promote fruit-infused water (FIW) to decrease SSB intake. Methods: Fourteen parents of preschoolers completed a pre-intervention survey, attended a presentation with a FIW demonstration/taste-testing, received pitchers/strainers, cutting boards, and FIW recipes/instructions, and received 8 supportive text messages over one month. Feasibility/acceptability was determined from analyzing parents' responses about participating. Descriptive statistics were conducted to analyze pre-/post-intervention survey data. Results: Three themes emerged: "Healthy Option Alternative"; "Feasible to Make FIW at Home"; and "Benefits for Parents". Preliminary findings from ten parents completing both pre-/post-intervention surveys indicated a decrease in preschoolers' total SSB amount/kcal intake, and an increase in parent self-efficacy and FIW knowledge/consumption. Conclusion: Preliminary findings provide valuable feasibility/acceptability information to guide a larger future study.

Cooking Matters for Kids Improves Attitudes and Self-Efficacy Related to Healthy Eating and Cooking

OBJECTIVE

To assess changes in self-efficacy and attitudes related to healthy eating and cooking in Cooking Matters for Kids participants.

DESIGN

Prepost study design.

SETTING

Cooking Matters for Kids programs offered by 35 organizations.

PARTICIPANTS

Predominantly third- to fifth-grade children participating in Cooking Matters for Kids lessons during fiscal years 2012-17 with matched presurvey and postsurveys (n = 18,113).

INTERVENTION(S)

Cooking Matters for Kids consists of six 2-hour experiential nutrition and cooking education lessons.

MAIN OUTCOME MEASURE(S)

Self-efficacy related to healthy eating and cooking and attitudes toward healthy foods assessed through the Cooking Matters for Kids Participant Survey.

ANALYSIS

Changes from the presurvey to postsurvey were assessed using mixed models and repeated measures ordered logistic regression accounting for clustering by course. Effect sizes were calculated using Cohen d for repeated measures. A Bonferroni adjustment was used to correct for multiple comparisons (α = 0.025).

RESULTS

Both overall and individual self-efficacy and attitude scores improved from presurvey to postsurvey (P < 0.0001). The effect sizes were 0.35 for overall self-efficacy score and 0.17 for overall attitude score.

CONCLUSIONS AND IMPLICATIONS

Participation in Cooking Matters for Kids was associated with improvements in self-efficacy and attitudes related to healthy eating and cooking.

How Does the Family Influence Adolescent Eating Habits in Terms of Knowledge, Attitudes and Practices? A Global Systematic Review of Qualitative Studies

Promoting healthy eating habits can prevent adolescent obesity in which family may play a significant role. This review synthesized findings from qualitative studies to identify family barriers and facilitators of adolescent healthy eating in terms of knowledge, attitudes, and practices (KAP). A literature search of four databases was completed on 31 July 2020; qualitative studies that explored family factors of adolescent (aged 10 to 19 years) eating habits were included. A total of 48 studies were identified, with the majority being from North America and sampled from a single source. Ten themes on how family influences adolescent dietary KAP were found: Knowledge—(1) parental education, (2) parenting style, and (3) family illness experience; Attitudes—(4) family health, (5) cultivation of preference, and (6) family motivation; Practices—(7) home meals and food availability, (8) time and cost, (9) parenting style, and (10) parental practical knowledge and attitudes. This review highlights five parental characteristics underlying food parenting practices which affect adolescents’ KAP on healthy eating. Adolescents with working parents and who are living in low-income families are more vulnerable to unhealthy eating. There is a need to explore cultural-specific family influences on adolescents’ KAP, especially regarding attitudes and food choices in Asian families.

Impact of a School-Based Gardening, Cooking, Nutrition Intervention on Diet Intake and Quality: The TX Sprouts Randomized Controlled Trial

School gardens have become common school-based health promotion strategies to enhance dietary behaviors in the United States. The goal of this study was to examine the effects of TX Sprouts, a one-year school-based gardening, cooking, and nutrition cluster randomized controlled trial, on students' dietary intake and quality. Eight schools were randomly assigned to the TX Sprouts intervention and eight schools to control (i.e., delayed intervention) over three years (2016-2019). The intervention arm received: formation and training of Garden Leadership Committees; a 0.25-acre outdoor teaching garden; 18 student lessons including gardening, nutrition, and cooking activities, taught weekly in the teaching garden during school hours; and nine parent lessons, taught monthly. Dietary intake data via two 24 h dietary recalls (24 hDR) were collected on a random subsample (n = 468). Dietary quality was calculated using the Healthy Eating Index 2015 (HEI-2015). The intervention group compared to control resulted in a modest increase in protein intake as a percentage of total energy (0.4% vs. -0.3%, p = 0.021) and in HEI-2015 total vegetables component scores (+4% vs. -2%, p = 0.003). When stratified by ethnicity/race, non-Hispanic children had a significant increase in HEI-2015 total vegetable scores in the intervention group compared to the control group (+4% vs. -8%, p = 0.026). Both the intervention and control groups increased added sugar intake; however, to a lesser extent within the intervention group (0.3 vs. 2.6 g/day, p = 0.050). School-based gardening, cooking, and nutrition interventions can result in significant improvements in dietary intake. Further research on ways to scale and sustain nutrition education programs in schools is warranted. The trial is registered at ClinicalTrials.gov (NCT02668744).

Examining the Correlates of Adolescent Food and Nutrition Knowledge

Food literacy is a set of skills and knowledge that are integral to diet. It is common among teenagers to not have basic food literacy skills needed to consume a healthy diet. This study examined: (1) the current state of food and nutrition knowledge among adolescents 13–19 years of age in the census metropolitan area of London, ON, Canada; and (2) correlates of food knowledge and nutrition knowledge among adolescents. Data for this study were drawn from baseline youth and parent survey data collected from a larger population health intervention study. Statistical analysis of the survey data indicates that higher parental education and higher median neighbourhood family income, the use of mobile health applications, liking to cook, as well as confidence in reading and understanding food labels were all consistently associated with increased food and nutrition knowledge. Findings may help guide future research towards optimal methods for delivering food literacy interventions to effectively educate teenagers. Results of this study may help guide policy makers, researchers, and public health professionals in developing appropriate food and nutrition programs and curriculums to combat the decline in food literacy skills.

Are fathers' and mothers' food parenting practices differentially associated with children's eating behaviors?

Little is known about how fathers' food parenting practices (FPP) are linked with children's eating behaviors and whether these associations differ from mothers. This study examined associations between paternal and maternal FPP and eating behaviors among children aged 5-12 years. A sample of 565 parents (53% fathers) completed: 1) the FPP item bank, which measured 11 FPP constructs from three domains of parenting (control, autonomy promotion, and structure) and 2) the Children's Eating Behavior Questionnaire (CEBQ), to assess four constructs (emotional overeating, food responsiveness, satiety responsiveness and food fussiness). Multivariable linear regressions evaluated associations between FPP and CEBQ constructs, and models were run separately for fathers and mothers. Similarities emerged between fathers and mothers: 1) use of restriction for weight practices were positively associated with emotional overeating and food responsiveness; 2) use of practices to accommodate the child around food and use of practices to involve the child were positively and negatively associated, respectively, with food fussiness; and 3) use of practices to accommodate the child, or coercive controlling practices, was positively associated with emotional overeating. Differences emerged between fathers and mothers in terms of FPP associated with children's food and satiety responsiveness, with a greater number of fathers' FPP predictive of these behaviors. Although similarities exist between mothers and fathers, these findings suggest that fathers likely exert a unique influence on their children's eating behaviors and stress the need for interventions to account for the role each parent plays promoting healthy eating habits.

Involvement of children in hands-on meal preparation and the associated nutrition outcomes: A scoping review

BACKGROUND

Emerging research has explored hands-on meal preparation as a strategy to improve children's nutrition-related outcomes. This scoping review was conducted to describe the extent of studies on children's involvement in hands-on meal preparation and the related psychosocial outcomes, actual nutrition behaviour/food consumption and weight status.

METHODS

Scoping review methodology was used to select relevant studies, as well as extract and collate the data. Four databases (PubMed, Google Scholar, Science Direct and Cochrane Database of Systematic Reviews) were searched from the earliest available time up to December 2020. Observational studies, experimental studies and reviews that were conducted among children aged 5-12 years old and published from 2010 to 2020 were retrieved. Studies extracted involved children in hands-on healthy meal preparation activities and explored the associated nutrition outcomes.

RESULTS

In total, 28 studies (5 observational studies, 21 experimental studies, 2 reviews) were included in the final review. Studies conducted demonstrated improvement in children's psychosocial outcomes and actual nutrition behaviour/food consumption after participating in hands-on meal preparation activities, despite differences in methodology, programme content and settings (countries/cultural origins). Limited studies assessed children's nutrients intake and weight status.

CONCLUSIONS

The current review suggests that hands-on meal preparation comprises approach for instilling positive perceptions towards nutrition/healthy foods, potentially improving children's diet. Future studies should include the assessment of nutrient intake and weight status. The long-term sustainability of these nutrition outcomes should be explored.

Supporting Positive Parenting and Promoting Healthy Living through Family Cooking Classes

BACKGROUND

The family is an important setting in the promotion of child health. The parent-child relationship affects the social and health development of children, and children's healthy behaviors are associated with positive parenting strategies. The parent-child relationship is bi-directional and the connection between parenting and child health is complex. However, few parenting interventions work with parents and children together, and more knowledge is needed on how to develop and implement interventions promoting healthy parent-child relationships. Focusing on a family cooking class program, this study addresses how community initiatives engaging parents and children together can contribute to integrating parenting support with local health promotion.

METHODS

Participant-driven photo-elicited interviews (nine families), focus group evaluations (nine parents/14 children) and observations during cooking classes (10 classes) were applied to analyze the tools and mechanisms that can support positive parenting.

RESULTS

The study found that visual, practical and sensory learning techniques, applied in a context-sensitive learning environment that ensured guidance, safety and a friendly social atmosphere, contributed to positive parent-child interaction and bonding.

CONCLUSION

The cooking program facilitated parenting practices that support child involvement and autonomy. Thus, the program constituted an effective intervention to strengthen parent-child relationships and positive parenting.

The number of household members as a risk factor for peptic ulcer disease

Peptic ulcer disease (PUD) is caused by many sociodemographic and economic risk factors other than H. pylori infection. However, no studies reported an association between PUD and the number of household members. We showed the number of family members affected by PUD based on sex in a Korean population. This cross-sectional study used 1998–2009 data from the Korea National Health and Nutrition Examination Survey of the Korea Centers for Disease Control and Prevention. Multiple binary logistic regression models adjusted for confounders were constructed to analyze the association of PUD with the number of household members. The number of household members was associated with PUD, age, body mass index (BMI), waist circumference, systolic blood pressure, hemoglobin, glucose, location (urban/rural), income, education level, stress, current drinking, and smoking in both sexes. Men with other household members had a higher PUD risk compared to men or women living alone (reference), and the opposite was observed for women. Men with 4 household members had a higher PUD risk than men living alone in the model adjusted for age, BMI, income, location, education, and stress (OR = 2.04 [95% CI 1.28–3.27], p value = .003). Women with more than 6 household members had a lower PUD risk than women living alone in the adjusted model (OR = 0.50 [0.33–0.75], p value = .001). Women with more household members had a lower PUD risk. However, more men had PUD than women regardless of the number of household members.

Caregivers' Role in the Effectiveness of Two Dutch School-Based Nutrition Education Programmes for Children Aged 7-12 Years Old

Childhood eating behaviours can track into adulthood. Therefore, programmes that support early healthy eating, including school-based nutrition education programmes, are important. Although school-based programmes may be beneficial in improving nutrition knowledge, impact on actual fruit and vegetable (FV) intake is generally limited as FV intake is also influenced by the home environment. The current study includes secondary analyses of data from an evaluation study on Dutch nutrition education and examined the role of caregivers’ health promotion behaviours (HPB) in influencing healthy eating behaviours in primary school children (n = 1460, aged 7–12 years) and whether caregivers’ HPB contribute to programme effectiveness. Children’s nutrition knowledge, FV intake and caregivers’ HPB (FV/sugar-sweetened beverages/sweets provision to take to school, cooking together and talking about healthy food at home) were measured by child-reported questionnaires at baseline, during, and 6 months post-programme. Results indicated that caregivers’ HPB was positively associated with children’s healthy eating behaviours and that programme effectiveness was highest in those in the lower HPB subcategory. In conclusion, children with less encouragement to eat healthily at home potentially benefit more from school-based nutrition education programmes than children receiving more encouragement. This highlights the important role of the home environment in supporting healthy eating behaviour in children.

Children's psychosocial factors of healthy meal preparation as predictors for nutritional status measures

Involving school-age children in the preparation of healthy meals is shown to be associated with positive eating behavior. Yet, it remains unclear whether this can extend to their nutritional status. The present study aimed to determine the association of school-age children's psychosocial factors (knowledge, attitude, practice, self-efficacy) towards healthy meal preparation with their nutritional status (BMI-for-age, waist circumference, body fat percentage). Stratified random sampling was used to select primary schools (n = 8) in Kuala Lumpur, Malaysia. Two hundred school children aged between 9-11 years old were involved. Psychosocial factors towards healthy meal preparation were assessed using validated questionnaire. Anthropometry measures were determined using standard protocol. Almost half (46 %) of the school-age children were obese/overweight, 39 % were abdominally obese and 40 % were overfat. Approximately half had poor knowledge (49 %), poor practice (45 %), good attitude (56 %) and good self-efficacy (47 %) towards healthy meal preparation. Significant positive correlations were observed between knowledge with attitude (r = 0.23, p < 0.001); knowledge with self-efficacy (r = 0.30, p < 0.001); attitude with practice (r = 0.34, p < 0.001); attitude with self-efficacy (r = 0.59, p < 0.001) and practice with self-efficacy (r = 0.50, p < 0.001). Adjusted logistic regression revealed that school-age children with good attitude were less likely to be abdominally obese (OR = 0.87, 95 % Cl = 0.78 to 0.96) and overfat (OR = 0.84, 95 % Cl = 0.76 to 0.94). Children with good knowledge had lower risk of being abdominally obese (OR = 0.84, 95 % Cl = 0.72 to 0.97). Findings revealed that children's psychosocial factors were interrelated, and improvements may have the potential in affecting nutritional status. Hands-on healthy meal preparation should be explored further as an innovative approach to address the obesity epidemic.

Culinary Education Programs for Children in Low-Income Households: A Scoping Review

Child obesity in the United States is at an all-time high, particularly among underserved populations. Home-cooked meals are associated with lower rates of obesity. Helping children develop culinary skills has been associated with improved nutrition. The purpose of this study is to report results from a scoping review of culinary education interventions with children from low-income families. Three databases and hand searches of relevant articles were examined. Retained articles met inclusionary criteria. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed, as appropriate. A data extraction template was developed. Data were independently extracted and verified. Only nine out of 370 articles met the inclusionary criteria and were included in the review. Most interventions were school-based, used a quasi-experimental design, and recruited minority children. Children-only was the primary intervention focus. Primary outcomes were mostly psychosocial from child self-report. Most interventions focused on children only and were guided by Social Cognitive Theory. Most reported stakeholder involvement; however, type and degree varied. All had an in-person component; only one used technology. Few reported training program leaders. Culinary education programs for children from low-income families could benefit from a broader theoretical grounding, program leader training, and greater parental involvement.

Create Our Own Kai: A Randomised Control Trial of a Cooking Intervention with Group Interview Insights into Adolescent Cooking Behaviours

Cooking is frequently associated with a healthier diet, however few youth cooking intervention studies have used control groups or follow-ups. Additionally, although cooking is associated with better mental well-being among adolescents, this has not been examined experimentally. This randomised controlled trial investigated whether a five-day intensive holiday cooking program, followed by six weeks of weekly meal kits with Facebook support groups, affected the cooking-related outcomes, diet quality and mental well-being among adolescents, with a 12-month follow-up. Adolescents aged 12–15 years (intervention: n = 91, 60% female; control: n = 27, 78% female) completed baseline, post-intervention and 12-month follow-up anthropometric measures, and questionnaire measures of mental well-being, diet quality and cooking attitudes, self-efficacy and behaviours. The intervention group’s post-intervention outcomes improved significantly more for mental well-being, diet quality, helping make dinner, cooking self-efficacy and positive cooking attitude, however body mass index (BMI) z-scores also increased. Differences were maintained at 12 months for self-efficacy only. Group interviews showed that participants’ cooking behaviours were strongly influenced by family factors. Adolescent cooking interventions may have many short-term benefits, however cooking self-efficacy appears most responsive and stable over time. Effects on BMI need further investigation. Family factors influence whether and what adolescents cook post-intervention.

Associations between Family Meal Context and Diet Quality among Preschool-Aged Children in the Guelph Family Health Study

Purpose: To explore the associations between family meal context and overall diet quality of Canadian preschool-aged children. Methods: Cross-sectional analysis of 95 preschool-aged children from 72 families. Measures about health behaviours and the family meal environment were drawn from selected questionnaire items. Three-day food records for children were assessed using the Healthy Eating Index 2010 (HEI-2010). Linear regression was used to explore the associations between the family meal variables and children's HEI-2010 scores. Results: In analyses adjusted for child age, sex, and household income, child involvement in meal preparation (β = 4.34; 95% CI: 0.56-8.12) and time spent preparing the evening meal (β = 3.77; 95% CI: 0.42-7.12) were associated with higher HEI-2010 scores. Serving fast food (β = -2.90; 95% CI: -4.79 to -1.02) and using screen-based devices during meals (β = -3.80; 95% CI: -7.38 to -0.21) were associated with lower HEI-2010 scores. Family meal frequency and serving prepared foods, sugar-sweetened beverages, and vegetables at meals were not significantly associated with preschoolers' diet quality. Conclusions: The context in which family meals take place influences child diet quality. Taking the time to include children in family meal preparation may benefit children's dietary intake.

A pilot study of an online produce market combined with a fruit and vegetable prescription program for rural families

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Rural families are at risk for diet-related diseases because of food disparities.

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An online produce market increases redemption of produce prescriptions.

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Photovoice illuminates the benefits and limits of produce prescription programs.

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Produce prescriptions, online produce market, and cooking lessons affect behavior.

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Fruit and vegetable consumption increases for families when they cook together.

Despite being surrounded by farms, rural families are often at risk for diet-related diseases because of food disparities. Barriers such as distance and transportation to a full service grocery store, lack of cooking knowledge and skills, and the cost of fresh produce, force families to shop at convenience stores that carry predominantly unhealthy, processed foods. We combined a Fruit and Vegetable Prescription Program (F&VRx) with family cooking/nutrition classes and a pilot online produce shopping to promote lifestyle dietary changes in rural families. In 2 rural upstate New York communities school health staff referred low income families with one or more children at risk for chronic disease related to obesity for this pilot program. Each family was given a weekly online produce credit for 5 months, September/October 2017 through January/February 2018. Two monthly nutrition/cooking lessons were provided for the entire family. Evaluation was done using pre and post program surveys and Photovoice. Families took photos in response to the question “How has the F&VRx program affected my family?”. Redemption of online produce credit was 94% and class attendance was 80%. Fruit and vegetable consumption rose for children. Confidence, culinary skills, and food literacy increased slightly. Three months after program completion, 60% of the families continued weekly online produce shopping without the F&VRx. Healthy behaviors for shopping, preparing, and consuming fruits and vegetables can be increased using a F&VRx, online produce ordering, and family cooking classes.