Marla Reicks

Impact of Cooking and Home Food Preparation Interventions Among Adults: Outcomes and Implications for Future Programs

OBJECTIVE Cooking programs are growing in popularity; however, an extensive review has not examined their overall impact. Therefore, this study reviewed previous research on cooking/home food preparation interventions and diet and health-related outcomes among adults and identified implications for practice and research. DESIGN Literature review and descriptive summative method. MAIN OUTCOME MEASURES Dietary intake, knowledge/skills, cooking attitudes and self-efficacy/confidence, health outcomes. ANALYSIS Articles evaluating the effectiveness of interventions that included cooking/home food preparation as the primary aim (January, 1980 through December, 2011) were identified via Ovid MEDLINE, Agricola, and Web of Science databases. Studies grouped according to design and outcomes were reviewed for validity using an established coding system. Results were summarized for several outcome categories. RESULTS Of 28 studies identified, 12 included a control group with 6 as nonrandomized and 6 as randomized controlled trials. Evaluation was done postintervention for 5 studies, pre- and postintervention for 23, and beyond postintervention for 15. Qualitative and quantitative measures suggested a positive influence on main outcomes. However, nonrigorous study designs, varying study populations, and the use of nonvalidated assessment tools limited stronger conclusions. CONCLUSIONS AND IMPLICATIONS Well-designed studies are needed that rigorously evaluate long-term impact on cooking behavior, dietary intake, obesity and other health outcomes.

Applying the Theory of Planned Behavior to Predict Dairy Product Consumption by Older Adults

OBJECTIVE The purpose of this study was to explain intention to consume dairy products and consumption of dairy products by older adults using the Theory of Planned Behavior (TPB). The factors examined were attitudes, subjective norms, and perceived behavioral control. DESIGN A cross-sectional questionnaire was administered. SETTING Community centers with congregate dining programs, group classes, and recreational events for older adults. SUBJECTS One hundred and sixty-two older adults (mean age 75 years) completed the questionnaire. Subjects were mostly women (76%) and white (65%), with about half having less than a high school education or completing high school. VARIABLES MEASURED Variables based on the TPB were assessed through questionnaire items that were constructed to form scales measuring attitudes, subjective norms, perceived behavioral control, and intention to consume dairy products. Dairy product consumption was measured using a food frequency questionnaire. ANALYSIS Regression analyses were used to determine the association between the scales for the 3 variables proposed in the TPB and intention to consume and consumption of dairy products; the alpha level was set at.05 to determine the statistical significance of results. RESULTS Attitudes toward eating dairy products and perceived behavioral control contributed to the model for predicting intention, whereas subjective norms did not. Attitudes toward eating dairy products were slightly more important than perceived behavioral control in predicting intention. In turn, intention was strongly related to dairy product consumption, and perceived behavioral control was independently associated with dairy product consumption. CONCLUSIONS AND IMPLICATIONS These results suggest the utility of the TPB in explaining dairy product consumption for older adults. Nutrition education should focus on improving attitudes and removing barriers to consumption of dairy products for older adults.

Children's perceived benefits and barriers in relation to eating breakfast in schools with or without Universal School Breakfast.

OBJECTIVE The purpose of this study was to identify and compare perceived benefits and barriers related to breakfast consumption and concerns about weight among children in schools with or without a Universal School Breakfast Program (USBP). DESIGN Teacher-administered survey at the end of a 3-year pilot program. SUBJECTS/SETTINGS Fourth-, fifth-, and sixth-grade students in six USBP pilot schools (n = 827) and four control schools (n = 615). Control and pilot sites were matched by geographic location and socioeconomic status of students. Response rates were > 70%. VARIABLES MEASURED Perceptions of benefits and barriers related to breakfast consumption and weight-related concerns. STATISTICAL ANALYSES PERFORMED Chi-square tests were used to assess statistical differences in categorical responses to survey items. RESULTS The majority of students perceived that eating breakfast provides benefits of increased energy and ability to pay attention in school. Commonly held perceptions of barriers to eating breakfast were lack of time and not being hungry in the morning. Compared with children in non-USBP schools, those in the USBP schools were less likely to wish they were thinner, to go on a diet, or skip breakfast because it might make them fat and more likely to believe that eating breakfast will give them energy and help them pay attention. IMPLICATIONS Based on the results of this study, nutrition educators may find it helpful to develop educational materials and programs based on the reciprocal determinism construct of Social Learning Theory to promote breakfast consumption. The focus should be on practical strategies to address barriers and encourage behavioral changes for both children and their parents.

Total dietary fiber intakes in the US population are related to whole grain consumption: results from the National Health and Nutrition Examination Survey 2009 to 2010.

Whole grain (WG) foods have been shown to reduce chronic disease risk and overweight. Total dietary fiber is associated with WG and its health benefits. The purpose was to determine whether associations exist between WG intake (no-WG intake, 0 ounce equivalent [oz eq]; low, >0-<3 oz eq; high, ≥3 oz eq) and total dietary fiber intake among Americans 2 years and older. One-day food intake data from the US National Health and Nutrition Examination Survey 2009 to 2010 (n = 9042) showed that only 2.9% and 7.7% of children/adolescents (2-18 years) and adults (≥19 years) consumed at least 3 WG oz eq/d, respectively. For children/adolescents and adults, individuals in the high WG intake group were 59 and 76 times more likely to fall in the third fiber tertile, respectively, compared with those with no-WG intake. Total dietary fiber intake from food sources varied by WG intake group for children/adolescents and adults with more total dietary fiber consumed from ready-to-eat (RTE) and hot cereals and yeast breads/rolls in the high WG intake group compared with the no-WG intake group. Major WG sources for children/adolescents and adults included yeast bread/rolls (24% and 27%, respectively), RTE cereals (25% and 20%, respectively), and oatmeal (12% and 21%, respectively). Among those with the highest WG intake, WG RTE cereal with no added bran was the greatest contributor to total dietary fiber compared with other RTE cereal types. Whole grain foods make a substantial contribution to total dietary fiber intake and should be promoted to meet recommendations.

Developing a Standard Definition of Whole-Grain Foods for Dietary Recommendations: Summary Report of a Multidisciplinary Expert Roundtable Discussion

Although the term “whole grain” is well defined, there has been no universal standard of what constitutes a “whole-grain food,” creating challenges for researchers, the food industry, regulatory authorities, and consumers around the world. As part of the 2010 Dietary Guidelines for Americans, the U.S. Dietary Guidelines Technical Advisory Committee issued a call to action to develop definitions for whole-grain foods that could be universally accepted and applied to dietary recommendations and planning. The Committee’s call to action, and the lack of a global whole-grain food definition, was the impetus for the Whole Grain Roundtable held 3–5 December 2012 in Chicago, Illinois. The objective was to develop a whole-grain food definition that is consistent with the quartet of needs of science, food product formulation, consumer behavior, and label education. The roundtable’s expert panel represented a broad range of expertise from the United States and Europe, including epidemiology and dietary intervention researchers, consumer educators, government policy makers, and food and nutrition scientists from academia and the grain food industry. Taking into account the totality, quality, and consistency of available scientific evidence, the expert panel recommended that 8 g of whole grain/30 g serving (27 g/100 g), without a fiber requirement, be considered a minimum content of whole grains that is nutritionally meaningful and that a food providing at least 8 g of whole grains/30-g serving be defined as a whole-grain food. Having an established whole-grain food definition will encourage manufacturers to produce foods with meaningful amounts of whole grain, allow consistent product labeling and messaging, and empower consumers to readily identify whole-grain foods and achieve whole-grain dietary recommendations.

Attitudes and behaviors of food donors and perceived needs and wants of food shelf clients.

OBJECTIVE Explore the attitudes and behaviors of individuals who donate foods to food shelves and the perceived needs of the clientele using the food shelves in terms of cultural, health, and nutritional concerns. DESIGN Qualitative methods (focus group interviews). SETTING Focus groups (5 client and 7 donor) were conducted at food shelves, churches, and community centers. PARTICIPANTS Client focus group members (n = 31) were mostly middle-aged and elderly individuals of mixed ethnicity and donor focus group members (n = 64) were mostly white and well educated and had incomes >

Eating Frequency is Associated With Energy Intake but Not Obesity in Midlife Women

50 000. MAIN OUTCOME MEASURE(S) In-depth focus groups were conducted to obtain information regarding attitudes and beliefs of individuals who donate food and perceptions of needs among food shelf clients. ANALYSIS Transcripts were analyzed systematically by coding comments according to categories and examining for common themes. RESULTS Food donations did not match client needs for people with different ethnic backgrounds or age groups and food safety concerns. CONCLUSIONS AND IMPLICATIONS This study demonstrates the need for nutrition educators to work with food shelf and food bank directors regarding the education of staff and general population on appropriate food donations.

Exercise as a Gateway Behavior for Healthful Eating among Older Adults: An Exploratory Study

Midlife women tend to gain weight with age, thus increasing risk of chronic disease. The purpose of this study was to examine associations between overweight/obesity and behavioral factors, including eating frequency, in a cross‐sectional national sample of midlife women (n = 1,099) (mean age = 49.7 years, and BMI = 27.7 kg/m2). Eating behaviors and food and nutrient intakes were based on a mailed 1‐day food record. BMI was calculated from self‐reported height and weight, and level of physical activity was assessed by self‐reported questionnaire. After exclusion of low‐energy reporters (32% of sample), eating frequency was not associated with overweight/obesity (P > 0.05) and was not different between BMI groups (normal, 5.21 ± 1.79; overweight, 5.16 ± 1.74; obese, 5.12 ± 1.68, P = 0.769). Adjusted logistic regression showed that eating frequency, snacking frequency, breakfast consumption, eating after 10 pm and consuming meals with children or other adults were not significantly associated with overweight/obesity. Total energy intake increased as eating frequency increased in all BMI groups, however, obese women had greater energy intake compared to normal weight women who consumed the same number of meals and snacks. Intake of fruit and vegetables, whole grains, dietary fiber, dairy, and added sugars also increased as eating frequency increased. While eating frequency was not associated with overweight/obesity, it was associated with energy intake. Thus, addressing total energy intake rather than eating frequency may be more appropriate to prevent weight gain among midlife women.

Applying the Theory of Planned Behavior to Fruit and Vegetable Consumption by Older Adults

CONTEXT The relationship between eating and exercise behavior change may influence effectiveness of interventions for older adults. OBJECTIVE To determine whether exercise is a potential gateway behavior for healthful eating behavior among older adults. DESIGN The Transtheoretical Model was applied to eating and exercise behaviors through the administration of a cross-sectional survey. SETTING/PARTICIPANTS 205 older adults (the majority were white women) participating in congregate dining programs in a large Midwestern city. VARIABLES MEASURED Perceived benefits and barriers, self-efficacy, and stage of change related to exercise and eating habits. ANALYSIS Differences in responses to survey items based on stage of change were determined by analysis of variance, P <.05. RESULTS Subjects in later stages for exercise behavior were also likely to be in later stages for eating adequate servings of fruit and dairy products but not for vegetables and avoiding fat. CONCLUSIONS AND IMPLICATIONS Exercise is a potential gateway behavior for some dietary behaviors for older adults, justifying further controlled, longitudinal research.

Healthy whole-grain choices for children and parents: a multi-component school-based pilot intervention

Abstract This study applied the Theory of Planned Behavior to fruit and vegetable intake among older adults. A crosssectional questionnaire was administered to older adults (N = 205, mean age = 77 years) at senior centers. Most were women (74%), white (77%), and had > 12 years of education. Regression analyses showed that the theory constructs explained more than 40% and 18% (p < 0.0001) of the variance in intention and reported intake of fruits and vegetables, respectively. Perceived behavioral control was most important in explaining both intention and intake, followed by attitudes and subjective norms. Important control beliefs were related to convenience, preferences, time, and availability when eating out. These beliefs should be addressed in education for older adults to increase fruit and vegetable intake.