Effectiveness of Gardening-Only, Cooking-Only and Combined Cooking and Gardening Programs in Elementary Schools to Improve Fruit and Vegetable Intake: A Systematic Review.

The objective is to compare the gardening, cooking, and combined cooking and gardening programs in elementary schools from the past decade (2011-2022) in improving six psychosocial and behavioral outcomes related to fruit and vegetable intake. This review was conducted following the PRISMA guidelines. Five scientific databases were searched to identify 4763 potential articles, 44 articles were retained after screening the studies' abstract, and 36 articles were included after further investigation into each intervention. This review included 9 gardening-only programs, 8 cooking-only programs, and 19 combined cooking and gardening programs. The included studies were from 14 different countries with half of these studies took place in the United States (n = 18). Of the outcomes assessed, 100% (10/10) of the studies were effective in improving knowledge/skills, 90% effective in improving attitudes and self-efficacy to consume F and V (9/10), 80% produced significant results for gardening and cooking attitudes/behaviors (8/10) and willingness to try F and V (4/5), 68% (11/16) programs resulted in increase in F and V intake, and 62% (10/16) programs improved F and V preference. This review suggests that gardening-only programs (89%) and cooking-only programs (88%) were slightly more effective in producing significant findings compared to combined programs (84%), but more high-quality interventions are needed to confirm these findings.

Qualitative Evaluation of University Students' Experience Delivering an Obesity Prevention Programme in Elementary Schools.

The Coordinated Approach to Child Health (CATCH) programme is an accredited obesity prevention programme in the United States, teaching children about nutrition, physical activity, and screen time limits. This study aimed to evaluate the perceptions of undergraduate and graduate student leaders' about their experience delivering the CATCH programme in elementary schools in Northern Illinois school districts during the 2019-2020 school year and its impact on their personal and professional skills and on programme participants. An email questionnaire was sent to eligible students. Grounded theory was used to analyze the students' responses. Two researchers assigned codes to the data and identified themes. Twenty-one students responded (50% response rate). Six identified themes include "purpose of CATCH programme," "school facilities and resources," "university students experience with CATCH lessons and activities," "benefits to university student," "benefits to children and teachers," and "identified weaknesses and suggested improvements to CATCH." University students delivering the CATCH programme appreciated the opportunity to practice in a real-world setting, gained transferable professional skills, increased programme content knowledge, identified CATCH programme benefits/strengths, and planned to apply lessons learned to future practice.

Using Process Evaluation Results to Compare Peer and Adult Leader Delivery of the PAWS (Peer-Education about Weight Steadiness) Club Program.

To date, there is limited published literature on process evaluation of adolescent health promotion programs. In this paper, we describe the methods and results of PAWS Club process evaluation over 2 years of implementation to compare the effectiveness of delivery by peer and adult leaders. PAWS (Peer-education About Weight Steadiness) Club was a 12-week healthy lifestyle program, delivered to 6th and 7th graders by peer and adult educators, using cluster randomized controlled design. Peer educators were 8th graders in the program schools and adult educators were staff/teachers in the program schools. Trained university students filled out fidelity logs at each session led by peer and adult educators to assess program delivery. The fidelity logs included questions to collect information about the number of participants, duration of the session, percent of activities completed, and if lessons started on time, lesson objectives were clearly stated, lesson objectives were emphasized, demonstrations were visible to participants, all activities were completed, the leader was familiar with lessons, the leader maintained an appropriate pace, the leader kept participants on track, and the leader asked if participants had any questions. Adult educators had a higher mean performance for all questions compared to peer leaders. Significant differences were observed for emphasizing lesson objectives (p = 0.005), making demonstrations visible to participants (p = 0.031), being familiar with the lesson plan (p = 0.000), maintaining an appropriate pace (p = 0.000), keeping participants on track (p = 0.000), and asking if participants had any questions (p = 0.000). Significance was set at p < 0.05. Findings from the current study have implications for designing and conducting a process evaluation of complex healthy lifestyle programs with adolescents in schools. Additional training of peer educators may be needed to enhance program delivery.

Parent Involvement in Diet or Physical Activity Interventions to Treat or Prevent Childhood Obesity: An Umbrella Review.

Parents substantially influence children's diet and physical activity behaviors, which consequently impact childhood obesity risk. Given this influence of parents, the objective of this umbrella review was to synthesize evidence on effects of parent involvement in diet and physical activity treatment and prevention interventions on obesity risk among children aged 3-12 years old. Ovid/MEDLINE, Elsevier/Embase, Wiley/Cochrane Library, Clarivate/Web of Science, EBSCO/CINAHL, EBSCO/PsycInfo, and Epistemonikos.org were searched from their inception through January 2020. Abstract screening, full-text review, quality assessment, and data extraction were conducted independently by at least two authors. Systematic reviews and meta-analyses of diet and physical activity interventions that described parent involvement, included a comparator/control, and measured child weight/weight status as a primary outcome among children aged 3-12 years old were included. Data were extracted at the level of the systematic review/meta-analysis, and findings were narratively synthesized. Of 4158 references identified, 14 systematic reviews and/or meta-analyses (eight treatment focused and six prevention focused) were included and ranged in quality from very low to very high. Our findings support the inclusion of a parent component in both treatment and prevention interventions to improve child weight/weight status outcomes. Of note, all prevention-focused reviews included a school-based component. Evidence to define optimal parent involvement type and duration and to define the best methods of involving parents across multiple environments (e.g., home, preschool, school) was inadequate and warrants further research. PROSPERO registration: CRD42018095360.

Promoting Cooking, Nutrition, and Physical Activity in Afterschool Settings.

Objective: In this study, we evaluated the afterschool PAWS (Peer-education About Weight Steadiness) Club program delivered by peer or adult educators to improve food choices, physical activity, and psychosocial variables related to healthy eating. Methods: We had 109 adolescents (53 in adult-led group; 56 in peer-led group) participate in a cluster randomized controlled intervention. The 12-session curriculum framed within Social Cognitive Theory (SCT) and Stages of Change addressed mediators of behavior change related to cooking skills, food intake, and physical activity. Anthropometric, dietary intake, physical activity, and SCT mediators were assessed at baseline, post-intervention, and 6-months post-intervention. Results: Adolescents in the peer-led group significantly improved whole grain intake at post-intervention (p = .017) and 6-months post-intervention (p = .014). Both peer-led and adult-led groups had significant reductions in caloric intake at 6-months post-intervention (p = .047). Only the adult-led group improved self-efficacy (SE) and social/family support (SS) for healthy eating at post-intervention [p = .019 (SE); p = .048 (SS)] and 6-months post-intervention [p = .036 (SE); p = .022 (SS)]. Conclusions: The PAWS Club program promoted lower caloric intake by adolescents. Peer educators were effective at increasing whole grains in adolescents, and adult educators contributed to positive changes in SE and SS related to healthy eating.

A Community-Based Participatory Assessment of the Health Status and Obesity Risks in Children From Rural Farmworker Families in the Midwest.

Obesity prevalence is higher among Hispanic children (22.4%) compared with general U.S. children (17%). Children of migrant and seasonal farmworking families are at heightened risk for obesity and related conditions. Limited research, including needs assessments and health promotion programs, has been conducted in Latino migrant farm working communities. Our objective was to identify needs, opportunities, and barriers for designing health promotion programs for children attending a community agency in a small Midwestern town. As part of a community-based participatory research project, a needs assessment was undertaken with 38 children aged 5 to 12 years (74% Latino). Measures included demographics, dietary patterns, physical activity (PA), and anthropometrics. The study was approved by the university's institutional review board and written parental consent, and child assent, was obtained. More than half of the sample had overweight (29%) or obesity (26%); 31% had elevated blood pressure levels. Participants did not meet the U.S. Department of Agriculture recommendations for most food groups and nutrients; 13% fell into the "poor" and 87% into the "needs improvement" category based on Healthy Eating Index scores. PA levels were low; only 34% of respondents engaged in sufficient exercise. Findings indicate the need for programs promoting improvements in dietary intake and increased PA.

Narrative Review of Culinary Interventions with Children in Schools to Promote Healthy Eating: Directions for Future Research and Practice.

Policymakers, scientists, and food and nutrition practitioners suggest that there is a societal decline in culinary skills, which is predictive of poor dietary habits contributing to childhood obesity. A narrative review was conducted to critically evaluate culinary skill interventions for children ages 5-12 y in schools to identify specific programs and programmatic factors associated with improvement in the quality of diet, body mass index (BMI), and positive changes in psychosocial variables. The culinary interventions were implemented in urban and rural areas in the United States, Australia, and England. PubMed and Medline, the Cochrane database, and a hand-search of publications identified 131 articles; 6 articles were selected for further examination on the basis of the inclusion criteria. Study designs included 1 randomized controlled trial and 5 quasi-experimental studies. Three interventions were grounded in behavioral theory, of which 2 incorporated the Social Cognitive Theory framework. The target population and setting included children and early adolescents in schools. The study methodology primarily included cooking classes combined with nutrition education lessons, parent and community components, gardening classes, tasting sessions, school lunchroom components, trips to a farmers market, or visits to a restaurant. Qualitative evaluations of the programs indicated positive findings in terms of program appeal and improvement in cooking skills and healthy eating. Quantitative analysis indicated improvement in food preferences, cooking skills, cooking self-efficacy, cooking behavioral intentions, food-preparation frequency, knowledge, healthy dietary intake, BMI, and blood pressure. The findings from this review support a positive relation between culinary interventions with children in schools and improvement in cooking skills, consumption of a healthy diet, and positive changes in anthropometric assessments. This review also suggests that integration with the academic curriculum and school lunch program may be potential avenues to explore for improving the longevity and success of the cooking programs. Further research should emphasize rigorous methodologic standards, develop theory-based standardized frameworks, and evaluate long-term effects of culinary interventions.

Feel American, Watch American, Eat American? Remote Acculturation, TV, and Nutrition Among Adolescent-Mother Dyads in Jamaica.

Globalization prompts remote acculturation toward U.S. culture in Jamaica; this study used a bioecological systems approach to examine its proximal impact on nutrition through U.S. cable TV consumption, and maternal influences in the home. Overall, 330 randomly selected adolescent-mother dyads from schools in Kingston, Jamaica (Madolescent_age  = 13.8 years, SDadolescent_age  = 1.8) completed questionnaires reporting American identity and behavioral preferences, daily time spent watching U.S.-produced TV programs, and frequency of eating unhealthy foods. Actor-partner interdependence models revealed that girls' American identity/behavior directly predicted their unhealthy eating, whereas girls' mothers and boys' American identity/behavior indirectly predicted unhealthy eating as mediated by their U.S. TV hours. Additionally, mothers' American identity/behavior predicted daughters' unhealthy eating as mediated by mothers' U.S. TV hours. Remote acculturation theory may facilitate more targeted research and prevention/intervention.

Grocery Store (or Supermarket) Tours as an Effective Nutrition Education Medium: A Systematic Review.

OBJECTIVE: To evaluate evidence regarding grocery store tours as an effective nutrition education medium for improving nutrition knowledge and food-related behaviors. DESIGN: A systematic literature review of studies published from 1984 to 2015 concerning grocery store (or supermarket) tours and impact on nutrition knowledge and behaviors. Three investigators independently reviewed articles, extracted details, and assessed the quality of each study. RESULTS: Of 307 citations identified, 8 were reviewed and 6 were of neutral quality. Increases in nutrition knowledge were reported in 4 studies, as evaluated by investigator-designed quizzes, with short intervals between tours and assessments. Six programs assessed behavior change using subjective reports or objective purchasing behavior measures; 2 studies did not perform statistical analyses. The 6 studies that reported positive health-related outcomes had varying topics, tour lengths, and target audiences. CONCLUSIONS AND IMPLICATIONS: Grocery store tours are increasingly used as an avenue for nutrition education to improve knowledge and/or alter food selection behaviors and may result in positive outcomes, but it is unknown whether these outcomes persist for longer than 3 months after the tour and whether there are common attributes of effective grocery store tours. More rigorous studies with uniform methodology in study design and outcome measures are needed to confirm the effectiveness of supermarket tours.

The impact of web-based HOT (Healthy Outcomes for Teens) Project on risk for type 2 diabetes: a randomized controlled trial.

BACKGROUND: The HOT (Healthy Outcome for Teens) Project is an innovative online educational intervention for middle school children for prevention of diabetes and obesity by balancing food intake with physical activity. The objective was to improve knowledge, outcome expectations, self-efficacy, and self-reported food intake and skills and to compare a passive online learning (POL) control group with an active online learning (AOL) treatment group by implementing a social cognitive theory (SCT)-grounded online intervention. SUBJECTS AND METHODS: In total, 214 participants were recruited from three middle schools. Full data were secured for 181 students. Six valid, reliable questionnaires were administered online, pre/post, to both the AOL and POL groups to assess knowledge gain, self-reported intake, and meal planning skills, as well as change in SCT constructs. RESULTS: Subjects in the AOL group improved significantly for all five categories of planning a meal questionnaire (P=0.001) and also for outcome expectations for exercise (P=0.001). At postintervention, no significant differences were found for composite scores of exercise self-efficacy, weight efficacy lifestyle, and rapid eating assessment plan questionnaires between AOL versus POL (by Mann-Whitney test). CONCLUSIONS: We conclude that teens participating in the AOL version of the HOT Project intervention acquired skills for planning a meal and improved outcome expectations for exercise.

The HOT (Healthy Outcome for Teens) project. Using a web-based medium to influence attitude, subjective norm, perceived behavioral control and intention for obesity and type 2 diabetes prevention.

We hypothesized that Theory of Planned Behavior (TPB) constructs (behavioral belief, attitude, subjective norm, perceived behavioral control, knowledge and behavioral intention) regarding preventive behaviors for obesity and type 2 diabetes will change favorably after completing the web-based intervention, HOT (Healthy Outcome for Teens) project, grounded in the TPB; and that passive online learning (POL) group will improve more than the active online learning (AOL) group. The secondary hypothesis was to determine to what extent constructs of the TPB predict intentions. 216 adolescents were recruited, 127 randomly allocated to the treatment group (AOL) and 89 to the control group (POL). The subjects completed a TPB questionnaire pre and post intervention. Both POL and AOL groups showed significant improvements from pretest to posttest survey. However, the results indicated no significant difference between POL and AOL for all constructs except behavioral belief. Correlational analysis indicated that all TPB constructs were significantly correlated with intentions for pretest and posttest for both groups. Attitude and behavioral control showed strongest correlations. Regression analysis indicated that TPB constructs were predictive of intentions and the predictive power improved post intervention. Behavioral control consistently predicted intentions for all categories and was the strongest predictor for pretest scores. For posttest scores, knowledge and attitude were the strongest predictors for POL and AOL groups respectively. Thus, HOT project improved knowledge and the TPB constructs scores for targeted behaviors, healthy eating and physical activity, for prevention of obesity and type 2 diabetes.