An in-home intervention of parent-implemented strategies to increase child vegetable intake: results from a non-randomized cluster-allocated community trial

Francine M Overcash, Zata Vickers, Allison E Ritter, Traci Mann, Elton Mykerezi, Joseph Redden, Aaron K Rendahl, Cynthia Davey, Marla Reicks, Francine M Overcash, Zata Vickers, Allison E Ritter, Traci Mann, Elton Mykerezi, Joseph Redden, Aaron K Rendahl, Cynthia Davey, Marla Reicks

Abstract

Background: Less than 2% of children in the U.S., ages 9-13, meet the minimum dietary recommendations for vegetable intake. The home setting provides potential opportunities to promote dietary behavior change among children, yet limited trials exist with child vegetable intake as a primary outcome. Strategies to increase vegetable intake grounded in behavioral economics are no/low cost and may be easily implemented in the home by parents.

Methods: This non-randomized, controlled study tested whether an intervention of parent-led strategies informed by behavioral economics and implemented within a series of 6 weekly parent-child vegetable cooking skills classes, improved dietary outcomes of a diverse sample of low-income children (ages 9-12) more than the vegetable cooking skills classes alone. The primary outcomes were total vegetable intake, dietary quality (HEI scores), total energy intake, vegetable liking, variety of vegetables tried, child BMI-z score, and home availability of vegetables. Outcome measures were collected at baseline, immediate post-treatment, 6 and 12 months follow-up. Mixed model regression analyses with fixed independent effects (treatment condition, time point and treatment condition x time interaction) were used to compare outcomes between treatment conditions.

Results: A total of 103 parent/child pairs (intervention = 49, control = 54) were enrolled and 91 (intervention = 44, control = 47) completed the weekly cooking skills program. The intervention did not improve child total vegetable intake. Intervention children increased dark green vegetable intake from immediate post-treatment to 12 months. The number of vegetables children tried increased and mean vegetable liking decreased over time for both control and intervention children.

Conclusions: Findings from this study suggest that the strategies and the manner in which they were implemented may not be effective in low-income populations. The burden of implementing a number of strategies with potentially higher food costs may have constrained the ability of families in the current study to use the strategies as intended.

Trial registration: This trial has been retrospectively registered at : # NCT03641521 on August 21, 2018.

Keywords: Behavioral economics; Child; Intervention; Vegetable intake.

Conflict of interest statement

The author(s) declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Study Flow Chart
Fig. 2
Fig. 2
Within-group changes over time for mean number of vegetables (out of 37) tried at the four time points. Intervention parents were taught behavioral strategies to help increase their child’s vegetable intake. Error bars represent standard errors. Control:, Intervention
Fig. 3
Fig. 3
Within-group changes over time for mean child liking ratings across all vegetables. Children were asked to rate liking for 37 different vegetables. Ratings were made on a scale from 1 = “Hate it” to 10 = “Love it.” Intervention parents were taught behavioral strategies to help increase their child’s vegetable intake. Error bars represent standard errors. Control:, Intervention

References

    1. Slavin J, Lloyd B. Health benefits of fruits and vegetables. Adv Nutr. 2012;3:506–516. doi: 10.3945/an.112.002154.506.
    1. NCI. Usual dietary intakes: food intakes, U.S. population, 2007-10. Epidemiology and genomics research Program. 2015. . Accessed 16 May 2016.
    1. Thornburg HD. Is early adolescence really a stage of development? Theory Pract. 1983;22:79–84. doi: 10.1080/00405848309543043.
    1. Kelder SH, Perry CL, Klepp KI, Lytle LL. Longitudinal tracking of adolescent smoking, physical activity, and food choice behaviors. Am J Public Health. 1994;84:1121–1126. doi: 10.2105/AJPH.84.7.1121.
    1. Mikkilä V, Räsänen L, Raitakari OT, Pietinen P, Viikari J. Longitudinal changes in diet from childhood into adulthood with respect to risk of cardiovascular diseases: the cardiovascular risk in young Finns study. Eur J Clin Nutr. 2004.
    1. Poti JM, Popkin BM. Trends in energy intake among US children by eating location and food source, 1977-2006. J Am Diet Assoc. 2011;111:1156–1164. doi: 10.1016/j.jada.2011.05.007.
    1. Buzby J, Guthrie J. Plate waste in school nutrition programs. 2002. . Accessed 12 Apr 2015.
    1. Winkler E, Turrell G. Confidence to cook vegetables and the buying habits of Australian households. J Am Diet Assoc. 2009;109:1759–1768. doi: 10.1016/j.jada.2009.07.006.
    1. Appleton KM, Hemingway A, Saulais L, Dinnella C, Monteleone E, Depezay L, et al. Increasing vegetable intakes : rationale and systematic review of published interventions. Eur J Nutr. 2016.
    1. Remington A, Añez E, Croker H, Wardle J, Cooke L. Increasing food acceptance in the home setting: a randomized controlled trial of parent-administered taste exposure with incentives. Am J Clin Nutr. 2012;95:72–77. doi: 10.3945/ajcn.111.024596.
    1. Fulkerson Jayne A., Friend Sarah, Horning Melissa, Flattum Colleen, Draxten Michelle, Neumark-Sztainer Dianne, Gurvich Olga, Garwick Ann, Story Mary, Kubik Martha Y. Family Home Food Environment and Nutrition-Related Parent and Child Personal and Behavioral Outcomes of the Healthy Home Offerings via the Mealtime Environment (HOME) Plus Program: A Randomized Controlled Trial. Journal of the Academy of Nutrition and Dietetics. 2018;118(2):240–251. doi: 10.1016/j.jand.2017.04.006.
    1. Upton D, Upton P, Taylor C. Increasing children’s lunchtime consumption of fruit and vegetables: an evaluation of the food dudes programme. Public Health Nutr. 2013;16:1066–1072. doi: 10.1017/S1368980012004612.
    1. Taylor C, Darby H, Upton P, Upton D. Can a school-based intervention increase children’s fruit and vegetable consumption in the home setting? Perspect Public Health. 2013;133:330–336. doi: 10.1177/1757913913506575.
    1. Touyz LM, Wakefield CE, Grech AM, Quinn VF, Costa DSJ, Zhang FF, et al. Parent-targeted home-based interventions for increasing fruit and vegetable intake in children: a systematic review and meta-analysis. Nutr Rev. 2018.
    1. List JA, Samek AS. The behavioralist as nutritionist: leveraging behavioral economics to improve child food choice and consumption. J Health Econ. 2015;39:135–146. doi: 10.1016/j.jhealeco.2014.11.002.
    1. Thaler RH, Sunstein CR, Balz JP. Choice architecture. Soc Sci Res Netw. 2010. 10.2139/ssrn.1583509.
    1. Thaler RH, Sunstein CR. Libertarian Paternalism. Am Econ Rev. 2003;93:175–179. doi: 10.1257/000282803321947001.
    1. Johnson EJ, Shu SB, Dellaert BGC, Fox C, Goldstein DG, Häubl G, et al. Beyond nudges: tools of a choice architecture. Mark Lett. 2012;23:487–504. doi: 10.1007/s11002-012-9186-1.
    1. Redden JP, Mann T, Vickers Z, Mykerezi E, Reicks M, Elsbernd S. Serving first in isolation increases vegetable intake among elementary schoolchildren. PLoS One. 2015;10:e0121283. doi: 10.1371/journal.pone.0121283.
    1. Elsbernd SL, Reicks MM, Mann TL, Redden JP, Mykerezi E, Vickers ZM. Serving vegetables first: a strategy to increase vegetable consumption in elementary school cafeterias. Appetite. 2016;96:111–115. doi: 10.1016/j.appet.2015.09.001.
    1. Reicks M, Redden JP, Mann T, Mykerezi E, Vickers Z. Photographs in lunch tray compartments and vegetable consumption among children in elementary school cafeterias. JAMA. 2012;307:2012–2013. doi: 10.1001/jama.2012.170.
    1. Adams MA, Pelletier RL, Zive MM, Sallis JF. Salad bars and fruit and vegetable consumption in elementary schools: a plate waste study. J Am Diet Assoc. 2005.
    1. Cullen KW, Hartstein J, Reynolds KD, Vu M, Resnicow K, Greene N, et al. Improving the school food environment: results from a pilot study in middle schools. J Am Diet Assoc. 2007.
    1. Just David R., Lund Jesse, Price Joseph. The Role of Variety in Increasing the Consumption of Fruits and Vegetables Among Children. Agricultural and Resource Economics Review. 2012;41(1):72–81. doi: 10.1017/S1068280500004196.
    1. Miller N, Reicks M, Redden JP, Mann T, Mykerezi E, Vickers Z. Increasing portion sizes of fruits and vegetables in an elementary school lunch program can increase fruit and vegetable consumption. Appetite. 2015;91:426–430. doi: 10.1016/j.appet.2015.04.081.
    1. Cravener Terri L., Schlechter Haley, Loeb Katharine L., Radnitz Cynthia, Schwartz Marlene, Zucker Nancy, Finkelstein Stacey, Wang Y. Claire, Rolls Barbara J., Keller Kathleen L. Feeding Strategies Derived from Behavioral Economics and Psychology Can Increase Vegetable Intake in Children as Part of a Home-Based Intervention: Results of a Pilot Study. Journal of the Academy of Nutrition and Dietetics. 2015;115(11):1798–1807. doi: 10.1016/j.jand.2015.03.024.
    1. Leak TM, Swenson A, Rendahl A, Vickers Z, Mykerezi E, Redden JP, et al. Examining the feasibility of implementing behavioural economics strategies that encourage home dinner vegetable intake among low-income children. Public Health Nutr. 2017;20:1388–1392. doi: 10.1017/S1368980017000131.
    1. de Wild V, De GC, Boshuizen HC, Jager G. Influence of choice on vegetable intake in children: an in-home study. Appetite. 2015;91:1–6. doi: 10.1016/j.appet.2015.03.025.
    1. Decosta P, Møller P, Frøst MB, Olsen A. Changing children's eating behaviour - A review of experimental research. Appetite. 2017;113:327–357. doi: 10.1016/j.appet.2017.03.004.
    1. Birch LL. The role of experience in children’s food acceptance patterns. J Am Diet Assoc. 1987;87(9 Suppl):S36–S40.
    1. Brug J, Tak NI, te Velde SJ, Bere E, de Bourdeaudhuij I. Taste preferences, liking and other factors related to fruit and vegetable intakes among schoolchildren: results from observational studies. Br J Nutr. 2008;99(Suppl 1):S7–14. doi: 10.1017/S0007114508892458.
    1. Wardle J, Cooke LJ, Gibson EL, Sapochnik M, Sheiham A, Lawson M. Increasing children’s acceptance of vegetables; a randomized trial of parent-led exposure. Appetite. 2003;40:155–162. doi: 10.1016/S0195-6663(02)00135-6.
    1. Holley CE, Haycraft E, Farrow CHCE, Haycraft E, Farrow C. “why don”t you try it again?’ A comparison of parent led home based interventions aimed at increasing children’s consumption of a disliked vegetable. A 2015;87:215–22. “Why don’t you try it again?” a comparison of parent led, home based interventions aimed at increasing children’s consumption of a disliked vegetable. Appetite. 2015;87:215–222. doi: 10.1016/j.appet.2014.12.216.
    1. Anzman-Frasca S, Savage JS, Marini ME, Fisher JO, Birch LL. Repeated exposure and associative conditioning promote preschool children’s liking of vegetables. Appetite. 2012;58:543–553. doi: 10.1016/j.appet.2011.11.012.
    1. Lakkakula A, Geaghan J, Zanovec M, Pierce S, Tuuri G. Repeated taste exposure increases liking for vegetables by low-income elementary school children. Appetite. 2010;55:226–231. doi: 10.1016/j.appet.2010.06.003.
    1. Rasmussen M, Krølner R, Klepp K-I, Lytle L, Brug J, Bere E, et al. Determinants of fruit and vegetable consumption among children and adolescents: a review of the literature. Part I: quantitative studies. Int J Behav Nutr Phys Act. 2006;3:22. doi: 10.1186/1479-5868-3-22.
    1. Draxten M, Fulkerson JA, Friend S, Flattum CF, Schow R. Parental role modeling of fruits and vegetables at meals and snacks is associated with children’s adequate consumption. Appetite. 2014;78:1–7. doi: 10.1016/j.appet.2014.02.017.
    1. 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;39:866–873. doi: 10.5993/AJHB.39.6.14.
    1. Willett WC. Nutritional Epidemiology. 3. New York: Oxford University Press; 2013. Nutritional Epidemiology; pp. 49–69.
    1. 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;113:569–580. doi: 10.1016/j.jand.2012.12.016.
    1. NCI Epidemiology and Genomics Research Program. HEI tools for researchers. 2016. .
    1. 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.
    1. CDC. Growth Chart Training. 2016. . Accessed 1 Jan 2017.
    1. Liang K-Y, Zeger SL. Longitudinal data analysis of continuous and discrete responses for pre-post designs. Sankhyā Indian J Stat Ser B. 2000;62:134–148.
    1. SAS Institute Inc SAS software 9.4. SAS Institute Inc MarketLine Company. 2014. p. 1–25. .
    1. Gardner B, Abraham C, Lally P, de Bruijn G-J. Towards parsimony in habit measurement: testing the convergent and predictive validity of an automaticity subscale of the self-report habit index. Int J Behav Nutr Phys Act. 2012;9:102. doi: 10.1186/1479-5868-9-102.
    1. Orbell S, Hodgkins S, Sheeran P. Implementation intentions and the theory of planned behavior. Personal Soc Psychol Bull. 1997;23:945–954. doi: 10.1177/0146167297239004.
    1. Cohen JFW, Richardson SA, Cluggish SA, Parker E, Catalano PJ, Rimm EB. Effects of choice architecture and chef-enhanced meals on the selection and consumption of healthier school foods a randomized clinical trial. JAMA Pediatr. 2015.
    1. Mancino L, Guthrie J. SNAP households must balance multiple priorities to achieve a healthful diet. Amber Waves. 2014:10.
    1. Hiza HAB, Casavale KO, Guenther PM, Davis CA. Diet quality of Americans differs by age, sex, race/ethnicity, income, and education level. J Acad Nutr Diet. 2013;113:297–306. doi: 10.1016/j.jand.2012.08.011.
    1. Nielsen SJ, Rossen LM, Harris DM, Odgen CL. Fruit and vegetable consumption of u.s. youth, 2009-2010. NCHS Data Brief 2014;:1–8. .
    1. King JC, Slavin JL. White potatoes, human health, and dietary guidance. Adv Nutr An Int Rev J. 2013;4:393S–401S. doi: 10.3945/an.112.003525.
    1. Storey M, Anderson P. Income and race/ethnicity influence dietary fiber intake and vegetable consumption. Nutr Res. 2014;34:844–850. doi: 10.1016/j.nutres.2014.08.016.
    1. Overcash F, Ritter A, Mann T, Mykerezi E, Redden JP, Rendahl A, et al. Positive impacts of a vegetable cooking skills program among low income parents and children. J Nutr Educ Behav. 2017.
    1. Rohlfs Domínguez P, Gámiz F, Gil M, Moreno H, Márquez Zamora R, Gallo M, et al. Providing choice increases children’s vegetable intake. Food Qual Prefer. 2013;30:108–113. doi: 10.1016/j.foodqual.2013.05.006.
    1. Birch LL, Zimmerman SI, Hind H. The influence of social-affective contact on the formation of children’s food preferences. J Nutr Educ Behav. 1981;13:S115–S118. doi: 10.1016/S0022-3182(81)80023-4.
    1. Zajonc RB. Attitudinal effects of mere exposure. J Pers Soc Psychol. 1968;9(2p2):1–27. doi: 10.1037/h0025848.

Source: PubMed

Sponsorzy i współpracownicy

Warunki medyczne

Interwencje lekowe

3
Subskrybuj