A Trial to Increase Child Vegetable Intake Through Behavioral Strategies

Study Overview
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Brief Summary
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A community nutrition trial among a diverse low-income population that tested the effect of parent-child cooking nutrition intervention on vegetable intake among 9-12 children.

Detailed Description
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This study was a nonrandomized, controlled trial to determine whether a series of 6 weekly parent-child vegetable cooking skills classes and parent-led strategies informed by behavioral economics (1/week) (intervention group) improved dietary and non-dietary outcomes of a racially and ethnically diverse sample of low-income children (ages 9-12) more than a vegetable cooking skills program alone (control group).

Official Title
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A Controlled-intervention Trial to Increase Child Vegetable Intake Through Parent-implemented Behavioral Strategies

Conditions
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Obesity, Childhood

Intervention / Treatment
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* Behavioral: Parent-led behavioral strategies


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Participant child must be 9-12 years old Parent must be the main food preparer for the household The family must qualify for some form of public assistance Have a phone Must not have participated in a previous Cooking Matters for Families in the past 3 years Be able to read, speak, and understand English (or Spanish for Spanish-only courses). Exclusion criteria: *No exclusions other than those that do not meet inclusion criteria

Ages Eligible for Study
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Minimum Age: 9 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Non-Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: controlled, non-randomized community nutrition intervention
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Intervention<br>The intervention consisted of an enhanced Cooking Matters® for Families program that included behavioral strategies derived from behavioral economics, to be implemented by parents at home for increasing vegetable intake of low-income 9-12 year old children | Behavioral: Parent-led behavioral strategies<br>* Intervention parents participated in an additional 20-25-min segment led by the nutrition educator during which the week's behavioral strategy was introduced. The following six behavioral strategies were introduced (one each week) as a segment of each cooking skills session: 1) have your child help prepare vegetables for meals (Child Help), 2) use a plate that shows the amount of vegetables to include for a meal (My Plate), 3) make vegetables visible and accessible by removing other foods from the dining area during the meal and leaving the vegetables (Make Avail/Visible), 4) serve at least 2 vegetables with the meal (Serve 2), 5) serve vegetables before the meal (Serve First), and 6) use a bigger spoon to serve the vegetables (Big Spoon).<br>|
| No Intervention: Control<br>The control arm consisted of the enhanced Cooking Matters® for Families program alone--without lessons about the behavioral strategies for the parents | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| change in # of vegetable servings consumed by child measured by averaging vegetable serving data extracted from 3, 24-hr recalls. | Number of vegetable servings were assessed from 3, 24-hr dietary recalls, collected by trained study personnel in-person and over the phone from each child, using Nutrition Data System for Research (NDSR®)software). The 3, 24-hr recalls were averaged to come up with an aggregate # of vegetable servings. | change from baseline to 9 weeks post-baseline (i.e., immediate post-intervention) | 
| change in # of vegetable servings consumed by child measured by averaging vegetable serving data extracted from 3, 24-hr recalls. | Number of vegetable servings were assessed from 3, 24-hr dietary recalls, collected by trained study personnel in-person and over the phone from each child, using Nutrition Data System for Research (NDSR®)software). The 3, 24-hr recalls were averaged to come up with an aggregate # of vegetable servings. | change from baseline to 6 months post-baseline | 
| change in # of vegetable servings consumed by child measured by averaging vegetable serving data extracted from 3, 24-hr recalls. | Number of vegetable servings were assessed from 3, 24-hr dietary recalls, collected by trained study personnel in-person and over the phone from each child, using Nutrition Data System for Research (NDSR®)software). The 3, 24-hr recalls were averaged to come up with an aggregate # of vegetable servings. | change from baseline to 12 months post-baseline | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| change in liking of vegetables by child (liking rating scale was comprised of values across a 10-point labeled hedonic scale (1 -Hate it to 5 - It's okay to 10 - Love it)) | Each child rated his/her liking of 37 different vegetables.The liking rating scale was comprised of values across a 10-point labeled hedonic scale (1 -Hate it to 5 - It's okay to 10 - Love it). This type of liking rating scale has been validated for testing with children. (Kroll, B.J. 1990. Evaluating rating scales for sensory testing with children. Food Technology, 44(11), 78-86.) An aggregate vegetable liking score representing mean liking rating across all vegetables was calculated for each child. | change from baseline to 9 weeks post-baseline (i.e., immediate post-intervention) | 
| change in liking of vegetables by child ( liking rating scale was comprised of values across a 10-point labeled hedonic scale (1 -Hate it to 5 - It's okay to 10 - Love it)) | Each child rated his/her liking of 37 different vegetables.The liking rating scale was comprised of values across a 10-point labeled hedonic scale (1 -Hate it to 5 - It's okay to 10 - Love it). This type of liking rating scale has been validated for testing with children. (Kroll, B.J. 1990. Evaluating rating scales for sensory testing with children. Food Technology, 44(11), 78-86.) An aggregate vegetable liking score representing mean liking rating across all vegetables was calculated for each child. | change from baseline to 6-months post baseline | 
| change in liking of vegetables by child ( liking rating scale was comprised of values across a 10-point labeled hedonic scale (1 -Hate it to 5 - It's okay to 10 - Love it)) | Each child rated his/her liking of 37 different vegetables.The liking rating scale was comprised of values across a 10-point labeled hedonic scale (1 -Hate it to 5 - It's okay to 10 - Love it). This type of liking rating scale has been validated for testing with children. (Kroll, B.J. 1990. Evaluating rating scales for sensory testing with children. Food Technology, 44(11), 78-86.) An aggregate vegetable liking score representing mean liking rating across all vegetables was calculated for each child. | change from baseline to 12-months post baseline | 
| change in number different of vegetables tried by child | Each child was asked the question Have you ever tried (name of vegetable) with following response options: Yes/No/Don't know. An aggregate score per child was tabulated by summing all yes answers. | change from baseline to 9 weeks post-baseline (i.e., immediate post-intervention) | 
| change in number different of vegetables tried by child | Each child was asked the question Have you ever tried (name of vegetable) with following response options: Yes/No/Don't know. An aggregate score per child was tabulated by summing all yes answers. | change from baseline to 6-months post-baseline | 
| change in number different of vegetables tried by child | Each child was asked the question Have you ever tried (name of vegetable) with following response options: Yes/No/Don't know. An aggregate score per child was tabulated by summing all yes answers. | change from baseline to 12-months post-baseline | 
| change in number of available vegetables in the child's home | Each of the child's parent was asked to complete a validated Home Food Inventory developed by Fulkerson and colleagues [Fulkerson JA, Nelson MC, Lytle L, Moe S, Heitzler C, Pasch KE. The validation of a home food inventory. Int J Behav Nutr Phys Act. 2008;5:55. doi:10.1186/1479-5868-5-55], to self-report the availability of different vegetables currently in their home. Response options for each question asking if the vegetable was currently in the home were yes /no/ don't know . Final number of available vegetables in the home was calculated by summing the number of vegetables for which the parent answered yes. | change from baseline to 9 weeks post-baseline (i.e., immediate post-intervention) | 
| change in number of available vegetables in the child's home | Each of the child's parent was asked to complete a validated Home Food Inventory developed by Fulkerson and colleagues [Fulkerson JA, Nelson MC, Lytle L, Moe S, Heitzler C, Pasch KE. The validation of a home food inventory. Int J Behav Nutr Phys Act. 2008;5:55. doi:10.1186/1479-5868-5-55], to self-report the availability of different vegetables currently in their home. Response options for each question asking if the vegetable was currently in the home were yes /no/ don't know .Final number of available vegetables in the home was calculated by summing the number of vegetables for which the parent answered yes. | change from baseline to 6-months post baseline | 
| change in number of available vegetables in the child's home | Each of the child's parent was asked to complete a validated Home Food Inventory developed by Fulkerson and colleagues [Fulkerson JA, Nelson MC, Lytle L, Moe S, Heitzler C, Pasch KE. The validation of a home food inventory. Int J Behav Nutr Phys Act. 2008;5:55. doi:10.1186/1479-5868-5-55], to self-report the availability of different vegetables currently in their home. Response options for each question asking if the vegetable was currently in the home were yes /no/ don't know . Final number of available vegetables in the home was calculated by summing the number of vegetables for which the parent answered yes. | change from baseline to 12-months post baseline | 
| change in child's body mass index (as measured by collected height (m) and weight (kg) from child) | Child Body Mass Index (BMI) was calculated from collected height and weight of child that were combined to report BMI in kg/m^2 | change from baseline to 9 weeks post-baseline (i.e., immediate post-intervention) | 
| change in child's body mass index (as measured by collected height (m) and weight (kg) from child) | Child Body Mass Index (BMI) was calculated from collected height and weight of child that were combined to report BMI in kg/m^2 | change from baseline to 6-months post baseline | 
| change in child's body mass index (as measured by collected height (m) and weight (kg) from child) | Child Body Mass Index (BMI) was calculated from collected height and weight of child that were combined to report BMI in kg/m^2 | change from baseline to 12-months post baseline | 
| change in child's Healthy Eating Index 2010 score (a measure of dietary quality) | Child dietary data was assessed through from 3, 24-hr dietary recalls, collected by trained study personnel in-person and over the phone using Nutrition Data System for Research (NDSR) software.The 3, 24-hr recalls were averaged to come up with an aggregate score for each nutrient. NDSR data was imported into a SAS® program (version 9.4) (SAS Institute Inc. Cary, NC 2014), created by National Institutes of Health-NCI, Division of Cancer Control & Population Studies that calculated a Healthy Eating Index 2010 score, a validated measure of dietary quality, for each child (Guenther PM, Casavale KO, Reedy J, Kirkpatrick SI, Hiza HAB, Kuczynski KJ, et al. Update of the Healthy Eating Index: HEI-2010. J Acad Nutr Diet. 2013;113:569-80.. | change from baseline to immediate post-intervention (i.e, 9 weeks post-baseline) | 
| change in child's Healthy Eating Index 2010 score (a measure of dietary quality) | Child dietary data was assessed through from 3, 24-hr dietary recalls, collected by trained study personnel in -person and over the phone using Nutrition Data System for Research (NDSR) software.The 3, 24-hr recalls were averaged to come up with an aggregate score for each nutrient. NDSR data was imported into a SAS® program (version 9.4) (SAS Institute Inc. Cary, NC 2014), created by National Institutes of Health-NCI, Division of Cancer Control & Population Studies that calculated a Healthy Eating Index 2010 score, a validated measure of dietary quality, for each child. | change from baseline to 6-months post baseline | 
| change in child's Healthy Eating Index 2010 score (a measure of dietary quality) | Child dietary data was assessed through from 3, 24-hr dietary recalls, collected by trained study personnel in -person and over the phone using Nutrition Data System for Research (NDSR) software.The 3, 24-hr recalls were averaged to come up with an aggregate score for each nutrient. NDSR data was imported into a SAS® program (version 9.4) (SAS Institute Inc. Cary, NC 2014), created by National Institutes of Health-NCI, Division of Cancer Control & Population Studies that calculated a Healthy Eating Index 2010 score, a validated measure of dietary quality, for each child. | change from baseline to 12-months post baseline | 
| change in child's dietary energy (in kilocalories) intake | Child dietary data was assessed through from 3, 24-hr dietary recalls, collected by trained study personnel in -person and over the phone using Nutrition Data System for Research (NDSR) software.The 3, 24-hr recalls were averaged to come up with an aggregate score for each nutrient (e.g., dietary energy in kilocalories) | change from baseline to 9 weeks post-baseline (i.e., immediate post-intervention) | 
| change in child's dietary energy (in kilocalories) intake | Child dietary data was assessed through from 3, 24-hr dietary recalls, collected by trained study personnel in -person and over the phone using Nutrition Data System for Research (NDSR) software.The 3, 24-hr recalls were averaged to come up with an aggregate score for each nutrient (e.g., dietary energy in kilocalories) | change from baseline to 6-months post-baseline | 
| change in child's dietary energy (in kilocalories) intake | Child dietary data was assessed through from 3, 24-hr dietary recalls, collected by trained study personnel in -person and over the phone using Nutrition Data System for Research (NDSR) software.The 3, 24-hr recalls were averaged to come up with an aggregate score for each nutrient (e.g., dietary energy in kilocalories) | change from baseline to 12-months post-baseline | 
| change in child cooking skills self-efficacy as measured by a validated survey to measure child cooking self-efficacy | Child cooking skills self-efficacy was measured using scales that have shown internal consistency and test-retest reliability in a psychometric evaluation of a cooking-based nutrition education intervention among low-income 9-11 year old children (Cronbach α = ≥ 0.74, test-retest r ≥ 0.66).(Lohse B, Cunningham-Sabo L, Walters LM, Stacey JE. Valid and Reliable Measures of Cognitive Behaviors toward Fruits and Vegetables for Children Aged 9 to 11 Years. J Nutr Educ Behav. 2011;43:42-49. doi:10.1016/j.jneb.2009.12.006). Response options for the child self-efficacy questions: 1 = YES! - 5 = NO!). The child-self-efficacy scale was calculated by summing 8 items measuring self-efficacy. A lower score indicated greater self-efficacy and more positive attitudes toward cooking. | change from baseline to 9 weeks post-baseline (i.e., immediate post-intervention) | 
| change in adult cooking skills confidence as measured by a validated survey to measure adult cooking confidence. Response options for the cooking confidence questions: (4 items, 1 = not at all confident - 5 = very confident). | Parents completed the Cooking Matters for Families Before and After Course Survey to assess change in cooking skills confidence. Internal consistency and ability of the scales to reflect positive self-reported changes were previously among low-income adults (Pinard CA, Uvena LM, Quam JB, Smith TM, Yaroch AL. Development and testing of a revised cooking matters for adults survey. Am J Health Behav. 2015;39(6):866-873. doi:10.5993/AJHB.39.6.14). Response options for the 4 cooking confidence questions: (4 items, 1 = not at all confident - 5 = very confident). An aggregate score for each parent was tabulated by averaging the 4 questions. A higher score indicated greater cooking skills confidence. | change from baseline to 9 weeks post-baseline (i.e., immediate post-intervention) | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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intervention, child vegetable intake, behavioral strategy