Advance Quantity Meal Preparation Pilot Program Improves Home-Cooked Meal Consumption,Cooking Attitudes,and Self-Efficacy

ObjectiveTo evaluate the effects of a group-based Advance Quantity Meal Preparation (AQMP) program on the consumption of home-cooked meals, cooking attitudes, and self-efficacy in healthy adults.MethodsParticipants (n = 10) in a group setting prepared healthy meals weekly consisting of 10 entrees and 5 snacks for 6 weeks. A survey assessing cooking attitudes, cooking self-efficacy, and cooking behavior and consumption at 3 time points: preprogram, postprogram (T2), and 3 months postprogram (T3).ResultsThe AQMP program increased the proportion of overall home-cooked meal consumption (T2, P = 0.03), home-cooked dinner consumption (T2, P = 0.04), cooking attitudes (T3, P = 0.01), and cooking self-efficacy (T2, P = 0.002).Conclusions and ImplicationsThis pilot study indicates that AQMP may increase home-cooked meal consumption, cooking attitudes, and cooking self-efficacy.     

Impacts of A Taste of African Heritage: A Culinary Heritage Cooking Course

ObjectiveTo examine changes in cooking and dietary behaviors and health outcomes following participation in A Taste of African Heritage, a culinary heritage cooking course.DesignOne group, pre-post program design, surveys, and physical assessments.SettingCommunity centers, churches, health care settings, homes, and housing complexes.ParticipantsParticipants (n = 586, 84% women) were recruited by partner organizations from 2013–2018 across 21 states and the District of Columbia.Intervention(s)A 6-week cooking curriculum that teaches history, nutrition, and cooking techniques to reconnect participants with the vibrant, healthy traditions of the African Diaspora.Main Outcome Measure(s)Weekly frequency of cooking, food group intake, and exercise assessed by surveys, measured weight, waist circumference, and blood pressure.AnalysisLinear and logistic mixed-effects models with random intercepts for participant and teacher, sex and site type as covariates comparing pre-post physical measurements and binary behavioral outcomes, P < 0.0033 for statistical significance after Bonferroni correction.ResultsIntake frequencies of fruit, vegetable, and greens and exercise frequency were improved from preprogram to postprogram (all P < 0.0021). Weight, waist circumference, and systolic blood pressure were also improved from preprogram to postprogram (all P <0.0001).Conclusions and ImplicationsParticipation in A Taste of African Heritage was associated with positive behavior changes and health outcomes. Integrating cultural heritage and behaviors are positive components to connect participants to healthy old ways or traditions.     

An Evaluation of a Positive Youth Development Program for Adolescents with Chronic Illness

PurposeYouth with chronic illness often struggle transitioning to adulthood and adult medical care. This article examines the outcomes of a group mentoring program called The Adolescent Leadership Council (TALC) that brings together high school participants and college mentors, all with chronic illness. TALC uses a positive youth development (PYD) approach, emphasizing strong relationships between youth and adults in an environment where youth can learn important life skills and take a leadership role.MethodsA pre-/postprogram participant survey was conducted for high school participants using a loneliness scale and a transition readiness survey. An alumni survey was conducted with all high school and college mentor graduates to assess educational-, vocational-, and health care-related outcomes.ResultsProgram records review and the alumni survey indicated that TALC was consistent with the PYD program model. Twenty high school students participated in the pre-/postprogram outcomes evaluation, which demonstrated a decrease in loneliness from 46 to 38.5 (p < .001) and an increase in health care self-advocacy from 3.8 to 4.2 (p < .001). Thirty-four alumni participated in the alumni survey. All high school and college mentor alumni had graduated from high school and college, respectively, and all were either currently in school or working. The majority of alumni were seeing adult providers for medical care.ConclusionsThe TALC program applies the principles of PYD to support positive educational, vocational, and health care outcomes for youth with chronic illness. Program development using the PYD perspective is an important new approach for supporting adult development of youth with chronic illness.     

Validity and Reliability of a Nutrition Knowledge Questionnaire for High School–Aged Adolescents

ObjectiveTo determine the validity and reliability of a nutrition knowledge questionnaire for adolescents.MethodsAn adult questionnaire was administered to 4 high school student convenience samples with and without known prior nutrition education. Questionnaire refinement was determined by item-total correlation, item discrimination, and item difficulty. Mean percentage of correct answers was calculated, and the group difference was assessed using an independent samples t test. A post hoc regression analyzed the association between mean percentage of correct answers and group while controlling for school.ResultsThe questionnaire, with 1 question eliminated, had good internal consistency reliability (Cronbach α = 0.83). The nutrition education group (n = 174) demonstrated significantly (P < 0.0001) higher mean percentage of correct answers compared with the no nutrition education group (n = 136). The association between mean percentage of correct answers and the group remained with school controlled.Conclusions and ImplicationsResults suggest that the questionnaire is valid and reliable for measuring nutrition knowledge in high school–aged adolescents.     

Facebook Is an Effective Strategy to Recruit Low-income Women to Online Nutrition Education

ObjectiveNutrition education research recruitment expense and effort are substantial; sample selection is crucial for intervention assessment. Effectiveness and cost of Facebook to recruit low-income women to an online nutrition program were examined, including biopsychosocial characteristics of Facebook responders.MethodsAn ad appeared on the Facebook page of low-income women, 18-45 years old, living in Pennsylvania to invite access to an online nutrition program. Eligible persons completed surveys about food-related behaviors including eating competence, food security, and assistance program use.ResultsOf 465 people who clicked on the ad, 81 completed the eligibility survey, and 62 were eligible; 52 completed a preprogram survey. Completers were mostly white (79%), overweight/obese (mean body mass index 36.2 ± 12.9), and not eating competent (75%). Low-income status was identified for 75% (n = 39) of completers. Total recruitment cost over 19 days was $596.71.Conclusions and ImplicationsFacebook appears to be an effective tool to recruit low-income women to nutrition education projects.     

Evaluation of a school-based teen obesity prevention minimal intervention

ObjectiveA school-based nutrition education minimal intervention (MI) was evaluated.DesignThe design was experimental, with random assignment at the school level.SettingSeven schools were randomly assigned as experimental, and 7 as delayed-treatment.ParticipantsThe experimental group included 551 teens, and the delayed treatment group included 329 teens.InterventionThe minimal intervention was Present and Prevent, a commercially available PowerPoint program presented in two 30-minute time slots over 1 week.Main Outcome MeasuresThe dependent variables were nutrition knowledge, attitudes, peer and family influences, behavioral intentions, and program satisfaction. The independent variable was group assignment.AnalysesA matched-pairs and 2-sample t test were used respectively to assess within-group and between-group changes.ResultsSignificant experimental posttest improvements occurred in the following: knowledge (P < .001); intention to maintain a healthy body weight because of importance to friends (P < .001); and intention to eat fewer fried foods, eat fewer sweets, look more at food labels, and limit TV watching (all P < .001). Program satisfaction measures were significantly associated with each of the healthy weight maintenance behavioral intentions.Conclusions and ImplicationsThe MI teen obesity prevention program made an impact on nutrition knowledge and positive behavioral intentions in only 2 classroom sessions and was well received by participants.     

The Theory of Planned Behavior and the USDA Summer Food Service Program

ObjectiveExamine the impact of the Summer Food Service Program (SFSP) on the intentions to positively change fruit and vegetable consumption in a rural, low-income adolescent population using the Theory of Planned Behavior.DesignQuantitative data collected via a pre-post intervention survey to determine predictors of positive nutrition behaviors and changes in self-reported fruit and vegetable consumption.SettingA mid-sized university.ParticipantsFifty-seven high school students. Participants were primarily female (n = 36) and white (n = 56).InterventionParticipants followed the standards of the SFSP for 5 weeks and were provided with mandatory and optional nutrition education sessions.Main Outcome MeasureIntentions to change nutrition behaviors.AnalysisMultiple regression.ResultsPaired-sample t test showed a significant increase in knowledge from pretest (mean [M] = 11.18, SD = 1.68) to posttest (M = 12.91, SD = 1.76); t[56] = −8.09, P < 0.001; (t[56] = −8.09, P < 0.001) and in self-reported fruit and vegetable intake from pretest (M = 13.96, SD = 4.23) to posttest (M = 16.80, SD = 5.42); (t[56] = −3.20, P = 0.002). Regression demonstrated that all constructs of the Theory of Planned Behavior were significant (F[4, 52] = 14.56, P < 0.001 with an R² of 0.53) for their effects on behavior intentions with perceived behavioral control being the most salient predictor.Conclusions and ImplicationsOpportunities for shaping adolescent nutrient intake and eating behaviors during enrollment in the SFSP exist. Reinforcing positive attitudes, subjective norms, and perceived behavioral control may help to increase nutrition behavioral intentions and nutrition behaviors.     

Training of Registered Dietitian Nutritionists to Improve Culinary Skills and Food Literacy

ObjectiveTo understand if a culinary medicine training program increases food literacy, culinary skills, and knowledge among practicing registered dietitian nutritionists (RDN).MethodsPrepost study design evaluating pilot test of RDN train-the-trainer curriculum from September, 2019 to January, 2020.ResultsOn average, results indicate an increase in culinary nutrition skills (mean difference, 6.7 ± 4.4; P < 0.001; range, 10–30) and a significant increase in 5 of the 8 food literacy factors. Through process evaluation, RDNs rated the training as extremely useful to their practice (mean, 4.4 ± 0.3).Conclusions and ImplicationsRegistered dietitian nutritionist participants increased culinary nutrition skills with statistically significant scores across all individual measures. This study describes an RDN training curriculum in culinary medicine across a diverse group of practicing RDNs from a large county health care system. Culinary medicine shows a promising impact on promoting nutrition skills and confidence; however, it warrants further assessment.     

Development and Evaluation of the Infant Feeding Education Questionnaire for the Expanded Food and Nutrition Education Program

ObjectiveDevelop and evaluate the Infant Feeding Education Questionnaire (IFEQ) to measure the impact of the Expanded Food and Nutrition Education Program (EFNEP) infant-feeding education on knowledge, attitudes, and behavioral intent.MethodsEvaluation included content validity testing through expert reviews and cognitive interviews with low-income mothers (n = 37); construct validity using the known-groups technique (n = 679); convergent validity testing using the Infant Feeding Practices Study II questionnaire (n = 66); and test-retest reliability (n = 66).ResultsThe IFEQ had strong construct validity for knowledge and attitudes; IFEQ scores were significantly higher for the high-knowledge/attitude group (29.6 ± 3.08) than the low-knowledge/attitude group (14.5 ± 5.81; P < .001). The IFEQ failed to show convergent validity. The percent agreement between baseline and retest questions was moderate to high, indicating reliability over time.Conclusions and ImplicationsThis study represents the first steps in the development of the IFEQ. There's a need to perform further testing to establish convergent validity and pilot-test the questions following EFNEP infant-feeding education.     

An evaluation of Indigenous Tobacco Program smoking prevention workshops with First Nations youth in Ontario,Canada

SettingThe Indigenous Tobacco Program (ITP) operated by the Indigenous Cancer Care Unit at Cancer Care Ontario provides customized tobacco prevention workshops to First Nations youth across Ontario, in partnership with First Nations communities and partner organizations.InterventionFirst Nations youth in Canada are more likely than non-Indigenous youth to be smokers. The ITP aims to address the negative health impacts of commercial tobacco, using culturally relevant approaches, tools and resources while remaining respectful to the significance of sacred tobacco. This paper aims to determine whether a culturally tailored tobacco prevention workshop increases tobacco-related knowledge among First Nations youth in Ontario.OutcomesThe workshops exhibited promise in impacting First Nations youth knowledge on the harms of commercial tobacco, as after the workshop intervention, all indicators showed improved knowledge. Building strong and ongoing relationships with communities and partner organizations is vital to the success of the program.ImplicationsCulturally tailored workshops grounded in traditional knowledge and values provide an opportunity to increase the knowledge of the harms of commercial tobacco among First Nations youth in Ontario. With commercial tobacco use and exposure having tremendous health consequences, such interventions are essential.     

Nutrition Knowledge and Food Choices of Elementary School Children

This research investigated the effect of a three-week school based nutrition education program on the nutrition knowledge and healthy food choices of 187 fifth graders who were randomly divided into a control ( n =97) or an experimental ( n =90) group. The control group received no nutrition education while the experimental group received 45 minutes of nutrition education, 4 days a week for 3 weeks. Nutrition knowledge scores and 3-day food records were collected at the beginning of the study and after 3 weeks. Food records were used to evaluate healthy food choices ( i.e. Dietary Guideline's recommended intake for macronutrients and the recommendations of the Food Guide Pyramid for each food group). In the experimental group there was a significantly greater increase in nutrition knowledge score ( p =0.001) and significant change in compliance in meeting the Dietary Guidelines ( p =0.0001) and the Food Guide Pyramid's recommendations ( p =0.0001). This study showed the effectiveness of a nutrition education program on nutrition knowledge scores and healthy food choices of fifth grade children.     

Nutrition Curriculum Training and Implementation Improves Teachers’ Self-Efficacy,Knowledge, and Outcome Expectations

ObjectiveTo examine the effects of training and implementation of Forecasting Your Future: Nutrition Matters on teachers’ self-efficacy to teach nutrition and teachers’ nutrition knowledge and explore outcome expectations for students.MethodsA mixed-methods study, with Indiana Family and Consumer Sciences high school teachers randomized to control and intervention, was conducted using baseline surveys, implementation of new or usual curriculum, follow-up survey(s), and semistructured interviews. Self-efficacy and knowledge were analyzed by hierarchical linear modeling. Interviews were thematically analyzed using a 5-phase process to identify outcome expectations.ResultsIntervention teachers (n = 17) had greater increases in nutrition knowledge (P = 0.028) and self-efficacy (P = 0.010) compared with controls (n = 18). Interviews revealed that teachers sought to affect students’ long-term health by providing knowledge and skills to make healthy choices.Conclusions and ImplicationsThis training with updated curricula and implementation improved theoretical determinants of effective nutrition instruction. Teachers expected student learning will contribute to future eating behaviors.     

Associations among School Characteristics and Foodservice Practices in a Nationally Representative Sample of United States Schools

ObjectiveDetermine school characteristics associated with healthy/unhealthy food service offerings or healthy food preparation practices.DesignSecondary analysis of cross-sectional data.SettingNationally representative sample of public and private elementary, middle, and high schools.ParticipantsData from the 2006 School Health Policies and Practices Study Food Service School Questionnaire, n = 526 for Healthy and Unhealthy Offerings analysis; n = 520 for Healthy Preparation analysis.Main Outcome MeasuresScores for healthy/unhealthy foodservice offerings and healthy food preparation practices.AnalysisMultivariable regression to determine significant associations among school characteristics and offerings/preparation practices.ResultsPublic schools and schools participating in the United States Department of Agriculture (USDA) Team Nutrition reported more healthy offerings and preparation than private or nonparticipating schools, respectively. Elementary schools reported fewer unhealthy offerings than middle or high schools; middle schools reported fewer unhealthy offerings than high schools. Schools requiring foodservice managers to have a college education reported more healthy preparation, whereas those requiring completion of a foodservice training program reported fewer unhealthy offerings and more healthy preparation than schools without these requirements.Conclusions and ImplicationsResults suggest the school nutrition environment may be improved by requiring foodservice managers to hold a nutrition-related college degree and/or successfully pass a foodservice training program, and by participating in a school-based nutrition program, such as USDA Team Nutrition.     

Development and Reliability Testing of a Nutrition Knowledge Questionnaire for Australian Children (the CNK-AU)

ObjectiveTo adapt and test an existing questionnaire to assess Australian children's level of nutrition knowledge.DesignThe child nutrition knowledge questionnaire for Australian children consists of 8 nutrition-related categories: healthy choices, portion and serving sizes, balanced meals, nutrition labels, nutrient functions, and food sources, safety, and categories. Participants completed the questionnaire at 2 time points, with 1 week in between.SettingThe questionnaire was completed online in a primary school classroom using an Android tablet.ParticipantsFifth- and sixth-year students (n = 94; aged 10.9 years; SD, 0.76) at a primary school in New South Wales, Australia.Variables MeasuredItem difficulty, item discrimination, and reliability.AnalysisItem analysis, interrater reliability, and test-retests.ResultsThe intrarater reliability per item between the first visit and 1 week later was moderate to substantial for the majority of items (mean κ = 0.50; SD, 0.21). Test-retest found a significant correlation for total score (r = 0.756), with all categories except portion and serving sizes showing significant correlations above r = 0.502.Conclusions and ImplicationsThe child nutrition knowledge questionnaire for Australian children has the potential to be a reliable and practical questionnaire for measuring Australian children's nutrition knowledge. The questionnaire may be useful for future work evaluating the effectiveness of nutrition education interventions and would potentially be adapted to other cultures.     

Determining the Effectiveness of an Adult Food Literacy Program Using a Matched Control Group

ObjectiveTo determine the effect of Food Sensations for Adults on food literacy behaviors and selected dietary behaviors.MethodsA quasi-experimental design using preprogram and postprogram questionnaires over 4 weeks with a control group (n = 75) matched for sex, age group, and socioeconomic disadvantage to program participants (n = 867). General linear mixed models assessed change in food literacy behavior frequency in 3 self-reported domains (plan and manage, selection, and preparation) and fruit and vegetable servings.ResultsPostprogram, Food Sensations for Adults participants reported modest yet statistically significant score improvements in 2 of the 3 domains of food literacy behaviors in the plan and manage (12.4%) and preparation (9.8%) domains, as well as servings of vegetables (22.6% or 0.5 servings).Conclusion and ImplicationsQuasi-experimental designs indicate food literacy programs can produce modest short-term changes across a range of food literacy and dietary behaviors.     

Taste Exposure Increases Intake and Nutrition Education Increases Willingness to Try an Unfamiliar Vegetable in Preschool Children: A Cluster Randomized Trial

BackgroundIntake of vegetables in children remains low.ObjectiveTo compare taste exposure (TE), nutrition education (NE) and TE+NE together on intake of an unfamiliar vegetable (mooli/daikon radish) in preschool-aged children.DesignChildren attending 11 preschools in England were randomly assigned by clusters to four intervention conditions using a 2×2 factorial design: TE, NE, TE+NE, and no intervention (control).ParticipantsTwo hundred nineteen children aged 2 to 5 years participated from September 2016 to June 2017.InterventionThe intervention period was 10 weeks preceded and followed by measurements of raw mooli intake as a snack. Preschools were randomized to receive weekly TE at snack time (n=62 children); NE (n=68) using the PhunkyFoods program; TE+NE (n=55) received both weekly taste exposures at snack and lessons from the PhunkyFoods program; and the control condition (n=34), received NE after the final follow-up measurement.Main outcome measuresIndividual measured intakes of mooli at Week 1 (baseline), Week 12 (postintervention), and Week 24 and Week 36 (follow-ups).Statistical analysisDifferences in intakes were analyzed by cluster. Logistic regressions were conducted to examine odds ratios for intake patterns.ResultsData from 140 children with complete mooli intake assessments were analyzed. TE increased intake from 4.7±1.4 g to 17.0±2.0 g and this was maintained at both follow-ups. Children assigned to the NE conditions were more likely to eat some of the mooli than children who were not in the NE conditions (odds ratio 6.43, 95% CI 1.5 to 27.8). Combining TE and NE produced no additional benefit to intake beyond TE alone.ConclusionsTaste exposures encouraged children to eat more of the unfamiliar vegetable, whereas nutrition education encouraged children who were noneaters to try the vegetable. Both approaches were effective and can be used to produce different outcomes.     

Valid and Reliable Measure of Adherence to Satter Division of Responsibility in Feeding

ObjectiveTo examine the validity and psychometrics of sDOR.2-6y, a 12-item measure of adherence to the Satter Division of Responsibility in Feeding (sDOR).DesignCross-sectional survey.SettingOnline respondents in central Pennsylvania.Participants117 parents (94% female, 77% White, 62% in ≥1 income-based assistance program) of preschoolers aged 2–6 years (28% moderate/high nutrition risk).Main Outcome MeasuresThe sDOR.2-6y and Nutrition Screening Tool for Every Preschooler (NutriSTEP), a measure of child nutrition risk and other validated measures of eating behavior and parent feeding practices.AnalysisRelationships were evaluated with Pearson r, t tests, ANOVA, or chi-square. Factor structure was investigated using principal components analysis with varimax rotation. Binary logistic regression and general linear model controlling for low-income status compared with sDOR.2-6y and NutriSTEP scores. Linear regression predicted NutriSTEP and Satter Eating Competence Inventory 2.0 scores from sDOR.2-6y.ResultsThe sDOR.2-6y ranged from 16–32 (mean, 25.9 ± 3.3; n = 114). Parents of youth at nutrition risk had lower sDOR.2–6y scores (P = 0.004). Each 1 point sDOR.2-6y increase decreased nutrition risk odds by 21% (95% confidence interval, 0.675–0.918; P = 0.002). The sDOR.2-6y scores were higher with less restriction and pressure to eat (both P < 0.001) and were associated with feeding style. Specificity was 87% with sDOR.2-6y cutoff ≥24; sensitivity was 66% with cutoff ≥26.Conclusions and ImplicationsThe sDOR.2-6y accurately and reliably indicated adherence of low-income mothers to sDOR. Larger, diverse samples for future studies are recommended.     

Carbohydrate Knowledge Observed to be Low in Vietnamese Women With Gestational Diabetes Mellitus

ObjectiveTo assess carbohydrate knowledge of Vietnamese women with gestational diabetes mellitus (GDM) and explore factors associated with carbohydrate knowledge.MethodsVietnamese women (n = 100) with GDM completed an online questionnaire about self-efficacy in managing blood glucose, the habit of regularly self-monitoring blood glucose activities at home, and an adapted culturally tailored carbohydrate quiz for the target population.ResultsParticipants (30 ± 4 years) answered on average 51% of the carbohydrate knowledge questions correctly, showing most difficulty in identifying honey, milk, and orange juice as carbohydrate sources. Only 46% of participants correctly identified carbohydrate content on nutrition labels, and 58% practice self-monitoring blood glucose activities at home. Carbohydrate knowledge was positively associated with self-efficacy in blood glucose management (r² = 0.101, P = 0.003) and practicing self-monitoring blood glucose (r² = 0.064, P = 0.013).Conclusions and ImplicationsThere is a need to provide nutrition education about carbohydrate knowledge and blood glucose control to Vietnamese women to manage GDM.     

The Shaping Healthy Choices Program: Design and Implementation Methodologies for a Multicomponent,School-Based Nutrition Education Intervention

ObjectiveTo provide a framework for implementation of multicomponent, school-based nutrition interventions. This article describes the research methods for the Shaping Healthy Choices Program, a model to improve nutrition and health-related knowledge and behaviors among school-aged children.DesignLongitudinal, pretest/posttest, randomized, controlled intervention.SettingFour elementary schools in California.ParticipantsFourth-grade students at intervention (n = 252) and control (n = 238) schools and their parents and teachers. Power analyses demonstrate that a minimum of 159 students per group will be needed to achieve sufficient power. The sample size was determined using the variables of nutrition knowledge, vegetable preference score, and body mass index percentile.InterventionA multicomponent school-based nutrition education intervention over 1 academic year, followed by activities to support sustainability of the program.Main Outcome MeasuresDietary and nutrition knowledge and behavior, critical thinking skills, healthy food preferences and consumption, and physical activity will be measured using a nutrition knowledge questionnaire, a food frequency questionnaire, a vegetable preferences assessment tool, the Test of Basic Science Process Skills, digital photography of plate waste, PolarActive accelerometers, anthropometrics, a parent questionnaire, and the School and Community Actions for Nutrition survey.AnalysisEvaluation will include quantitative and qualitative measures. Quantitative data will use paired t, chi-square, and Mann-Whitney U tests and regression modeling using P = .05 to determine statistical significance.