The development and validation of measures to assess cooking skills and food skills

Feasibility and acceptability of a culinary nutrition programme for adults with mild-to-moderate intellectual disability: FLIP Food and Lifestyle Information Programme

BACKGROUND

Culinary nutrition education can support improved diet-related health and wellbeing. This pre-post pilot study aimed to assess feasibility and acceptability of an eight-session culinary nutrition programme, the Food and Lifestyle Information Programme (FLIP), for adults with mild-to-moderate intellectual disability. A secondary aim was to evaluate preliminary programme effectiveness.

METHOD

Participants were recruited through a disability service provider. Feasibility measures were: recruitment and retention; implementation; engagement and participation; adverse outcomes; and feasibility of outcome measures. Acceptability was assessed using an interactive process evaluation. Effectiveness measures included cooking frequency, cooking and food skill confidence and diet quality.

RESULTS

Six of eight participants completed the intervention with high attendance and programme engagement. FLIP was well received by participants and support workers. No adverse outcomes occurred. Diet quality was feasible to assess.

CONCLUSIONS

Findings can inform content, delivery and evaluation of future culinary nutrition programmes for adults with mild-to-moderate intellectual disability.

"I find it hard to change poor food habits": Measuring food choice motives in an emerging economy

Food choices are driven by an array of motives that have been approached, determined and quantified in a number of ways, mainly in developed countries. The objective of this study was to better understand the motives behind food choices in an emerging economy by collecting information from urban people in South Africa in a series of four studies. (1) Items generated through focus group discussions with low, middle and high income participants by Magano et al. (2023) were checked for content and face validity and (2) 123 statements derived from them were evaluated by 621 respondents. After exploratory factor analysis (EFA), 46 statements best representing the motivational space were (3) presented to another group of respondents (n = 259). Here, the EFA resulted in a 31-item, 7-factor food choice questionnaire for emerging economies (FCQ-EE) which was (4) confirmed by a nationwide sample (n = 814) and further refined to an alternative 19-item, 7-factor solution. The emerging factors were: Healthy eating constraints (HEC), Frugality (FR), Emotional eating (EE), Meat appeal (MA), Weather (WE), Quality seeking (QS) and Cooking constraints (CC). Whether used in the 31-item or 19-item format, this set of statements highlights factors underlying food choice in an emerging economy and offers a way to study their importance in similar contexts. Further research is needed to show the extent to which these factors can predict actual food choices.

Cooking and food skills and their relationship with adherence to the Mediterranean diet in young adults attending university: A cross-sectional study from Türkiye

Adherence to the Mediterranean diet has decreased among university students in many countries. Cooking skills (CS) and food skills (FS) have been suggested as potential targets for reversing this decline. This study aims to determine CS and FS and to examine their relationship with adherence to the Mediterranean diet in young adults attending university in Türkiye. This cross-sectional study was conducted between March 2022 and April 2022 at Ondokuz Mayıs University in Samsun, Türkiye, and included 859 university students (56.1% women; mean age 22.57 ± 2.75 years). Sociodemographic characteristics were collected. The CS and FS measure and the Mediterranean Diet Adherence Screener (MEDAS) were administered. The mean MEDAS, CS and FS scores were 4.77 ± 1.97, 59.10 ± 18.17 and 77.81 ± 22.27, respectively. Those with higher MEDAS scores (quartile three and quartile four-Q3 and Q4) had significantly higher CS scores than those with lower scores (Q1 and Q2), while those in the lowest quartile (Q1) had lower FS scores than all other quartiles (p < 0.001). Total scores of CS and FS positively, although weakly, correlated with MEDAS (r = 0.227 and r = 0.296; p < 0.001). Two separate models for CS and FS were analysed; along with access to kitchen facilities, CS and FS contributed the most variability, accounting for 8.9% and 11.8% of the variance in MEDAS, respectively (p < 0.001). This research indicates that higher CS and FS in university students are associated with higher adherence to the Mediterranean diet. It is also recommended that kitchen facilities be provided for them to practice these skills.

Designing the Food and Lifestyle Information Program (FLIP) culinary nutrition intervention for adults with mild-to-moderate intellectual disability

BACKGROUND

People with intellectual disability have diverse needs and experience higher rates of diet-related chronic disease such as type 2 diabetes compared to people without disability. However, they are infrequently included in development and implementation of interventions to address diet-related chronic disease. The present study describes the process to plan, develop and refine the Food and Lifestyle Information Program (FLIP) culinary nutrition intervention for adults with mild-to-moderate intellectual disability.

METHODS

The project was initiated by a disability service provider and was guided by the Cook-Ed™ model and inclusive research principles. Initially the disability service provider and academic research team members co-designed pre-program consultation and pilot studies, and draft program resources. Pre-program consultation explored paid disability support worker (n = 10) perceptions of cooking and food skills, nutrition priorities and optimal program format, which guided further program drafting. Program resources and pilot study design were further developed and refined with co-researchers with lived experience of intellectual disability who attended a pre-pilot and then pilot study sessions as remunerated co-facilitators.

RESULTS

Key characteristics of the FLIP intervention arising from pre-program consultation included providing cooking task instruction in small steps, enabling participant choice in program activities, promoting an inclusive and social atmosphere, and providing paper-based resources.

CONCLUSIONS

FLIP intervention co-design was enabled through ongoing input from the disability service provider and people with lived experience of intellectual disability. Evaluation of FLIP feasibility, acceptability and preliminary effectiveness to improve diet-related health is underway.

An online qualitative study exploring wants and needs for a cooking programme during pregnancy in the UK and Ireland

BACKGROUND

Optimal maternal nutrition is associated with better pregnancy and infant outcomes. Culinary nutrition programmes have potential to improve diet quality during pregnancy. Therefore, this research aimed to understand the experiences of cooking and the wants and needs of pregnant women regarding a cooking and food skills programme in the United Kingdom (UK) and Republic of Ireland (ROI).

METHODS

Online focus group discussions with pregnant women and those who had experienced a pregnancy in the UK or ROI were conducted between February and April 2022. Two researchers conducted a thematic analysis. Seven focus groups with ROI participants (n = 24) and six with UK participants (n = 28) were completed.

RESULTS

Five themes were generated. These were (1) cooking during pregnancy: barriers, motivators and solutions; (2) food safety, stress and guilt; (3) need for cooking and food skills programmes and desired content; (4) programme structure; (5) barriers and facilitators to programme participation. Overall, there was support for a programme focusing on broad food skills, including planning, food storage, using leftovers and to manage pregnancy-specific physiological symptoms such as food aversions. Participants emphasised the importance of inclusivity for a diverse range of people and lifestyles for programme design and content.

CONCLUSIONS

Current findings support the use of digital technologies for culinary nutrition interventions, potentially combined with in-person sessions using a hybrid structure to enable the development of a support network.

Feasibility and preliminary efficacy of an online nutrition education intervention for those with a sleeve gastrectomy: A pilot randomised control trial

BACKGROUND

A sleeve gastrectomy (SG) is a lifelong treatment that improves health and better outcomes are associated with follow-up. However, there is lack of access or high attrition to aftercare. This potentially contributes to sub-optimal dietary intake and a lack of evidence for nutrition interventions. The present study assessed the feasibility and preliminary efficacy of a nutrition intervention to improve diet quality in Australian adults living with a SG.

METHODS

Adults (n = 96) post-SG were recruited into a cross-sectional diet quality study, with 68 eligible for randomisation to an intervention or wait-list control group. Over 10 weeks, a Facebook group was used to post daily nutrition education. Feasibility outcomes included participant recruitment, engagement, retention and acceptability. Preliminary efficacy was assessed using change in Australian Recommended Food Score (ARFS). Linear mixed models were used to measure differences in mean outcome between the experimental groups over time.

RESULTS

Sixty-eight participants (97% female) aged 48.2 ± 9.8 years, body mass index 33.1 ± 5.8 kg/m2, and mean ± SD ARFS 39 ± 9 points were randomised to the intervention, with 66% retention at 10 weeks. At follow-up, diet quality increased for the intervention group (mean ARFS, 95% confidence interval = 0.2 [-1.5 to 1.9]) and decreased for the control group (mean ARFS, 95% confidence interval= -2.0 [-5.2 to 1.2]) with no between group difference (p = 0.2). Participants (n = 30) rated the intervention positively.

CONCLUSIONS

Recruiting and retaining adults post-SG into a nutrition intervention is feasible. Low-cost recruitment attracted strong interest from women to identify greater support to know what to eat following SG. A future fully powered trial to assess intervention efficacy is warranted.

Scoping Review of Available Culinary Nutrition Interventions for People with Neurological Conditions

People with neurological conditions may face barriers to meal preparation. Culinary nutrition interventions aim to facilitate the building of knowledge and skills for meal preparation. This scoping review aims to map the available evidence for culinary nutrition interventions for people with neurological conditions and evaluate the quality of these interventions based on program design, delivery and evaluation. After a systematic search of online databases (MEDLINE, CINAHL, Embase, Scopus and Proquest) and reference lists, a total of ten publications describing nine interventions were included. Most interventions were designed for people with stroke and/or Transient Ischemic Attack (n = 3) and Multiple Sclerosis (n = 3); others were for traumatic brain injury (n = 1), mild dementia (n = 1) and Parkinson's Disease (n = 1). Overall, the included culinary nutrition interventions had good program delivery (inclusion of motivational experiences, delivered by appropriate health providers) but needed improvements in program design (lack of consumer engagement and neurological symptom accommodations) and evaluation (lack of complete process, outcome and impact evaluations). In conclusion, the evidence base for culinary nutrition interventions for people with neurological conditions remains sparse. To bridge the gap between theory and practice, it is important to consider the following aspects in culinary nutrition intervention planning/improvement: (I) the involvement of consumers; (II) the accommodation/tailoring for post-condition effects; and (III) the coverage of all disease-specific culinary nutrition aspects.

Assessing Acceptability: The Role of Understanding Participant, Neighborhood, and Community Contextual Factors in Designing a Community-Tailored Cooking Intervention

BACKGROUND

Cooking is an identified dietary strategy that is positively associated with optimal diet quality. Prior to initiating cooking interventions, evaluating the prospective acceptability of the intervention among community members living within low food access areas and understanding geospatial food shopping locations may aid in designing community-tailored interventions.

METHODS

A sequential mixed methods study was conducted to determine the prospective acceptability of a planned community-located cooking intervention among African American adults living in a low food access area and with at least one cardiovascular disease risk factor. A semi-structured guide was used to conduct five virtual focus groups. Qualitative data were analyzed using thematic analysis and validated through participant check-in interviews. Survey responses were analyzed based on descriptive data. Geospatial analysis of participant locations that were reported for food shopping was conducted to show food environment utilization.

RESULTS

Focus groups with study participants (n = 20, all female, mean age 60.3, SD 9.3, mean cooking frequency per week 4.0, food insecure n = 7) were conducted between March and April, 2021. Thematic analysis of the focus group transcripts identified five main themes as follows: (A) Barriers to Cooking (family and caregiving, transportation, COVID-19 pandemic, time availability, household composition); (B) Motivators for Cooking (family, caregiving, health, enjoyment, COVID-19 pandemic); (C) Strategies (food shopping, social support, social media, meal planning); (D) Neighborhood (gentrification, perceived safety, stigmatization, disparities in grocery stores); (E) and Acceptability of the Intervention (reasons to participate, barriers, recruitment, intervention delivery). Participant validation interviews confirmed the themes and subthemes as well as the illustrative quotes. Geospatial analysis showed a majority of locations were outside of the participants' residential areas.

CONCLUSIONS

Prospective acceptability of a community-tailored cooking intervention found that the planned intervention could be modified to address individual level factors, such as caregiving and health, community contextual factors, such as perceived safety, and the general health needs of the community.

Introducing the Staff-Administered Meal Independence Rating Scale for Use Among Patients With Serious Mental Illnesses

ABSTRACT

For individuals living with serious mental illnesses (SMIs), inadequate meal preparation skills can hinder the ability to live independently; yet rating scales tailored for this population are lacking. We describe development, item analysis, and initial reliability and validity of the Staff-Administered Meal Independence Rating Scale (SAMIRS). After item development involving expert consultation, two rounds of pilot testing ( n = 188, n = 293) were conducted in inpatient and residential settings (transitional living residences [TLRs] and community residences [CRs]). For initial testing of convergent validity, Pearson correlations with Specific Levels of Functioning (SLOF) scale items were computed. Exploratory factor analysis revealed a single factor; Cronbach's alpha was high (0.98). The mean SAMIRS score varied by setting: CR residents scored higher than those in TLRs or inpatient units. Scores were highly correlated with SLOF items measuring community living skills. Although further study is warranted, the SAMIRS could be a useful tool in rating functional needs pertaining to meal independence among individuals with SMI.

The association of highly processed food consumption with food choice values and food literacy in Japanese adults: a nationwide cross-sectional study

BACKGROUND

Highly processed food (HPF) consumption is increasing globally and has become a prominent public health concern. However, the relationship between HPF consumption and food choice values and food literacy is unknown. This study aimed to examine the association of HPF consumption with food choice values and food literacy.

METHODS

This cross-sectional study used data from a nationwide questionnaire survey conducted in 2018 among 2232 Japanese adults aged 18-80 years. We assessed eight food choice values (accessibility, convenience, health/weight control, tradition, sensory appeal, organic, comfort, and safety) using a 25-item scale, and food literacy characterised by nutrition knowledge (using a validated 143-item questionnaire), cooking and food skills (using 14- and 19-item scales, respectively), and eight eating behaviours (hunger, food responsiveness, emotional overeating, enjoyment of food, satiety responsiveness, emotional undereating, food fussiness, and slowness in eating, using the 35-item Adult Eating Behavior Questionnaire). HPF consumption was estimated using a validated brief diet history questionnaire. The associations between HPF consumption and age, body mass index, energy intake, and each score on food choice values and food literacy were evaluated by multiple linear regression.

RESULTS

In males, one standard deviation increase in scores for cooking skill and satiety responsiveness was associated with an increase in HPF consumption by 22.1 g/4184 kJ (95% confidence interval (CI): 6.6 to 37.5) and 15.4 g/4184 kJ (95% CI: 6.0 to 24.7), respectively. In females, one standard deviation increase in age and scores for safety and nutrition knowledge corresponded to a decrease in HPF consumption by - 16.4 g/4184 kJ (95% CI: - 23.4 to - 9.3), - 9.9 g/4184 kJ (95% CI: - 19.1 to - 0.7), and - 11.1 g/4184 kJ (95% CI: - 17.0 to - 5.3), whereas one standard deviation increase in the satiety responsiveness score corresponded to an increase in HPF consumption by 13.1 g/4184 kJ (95% CI: 6.8 to 19.4).

CONCLUSIONS

This cross-sectional study suggests that several aspects of food choice values and food literacy were associated with HPF consumption in Japanese adults. Further studies are needed to confirm our findings in a broader context.

Associations of food choice values and food literacy with overall diet quality: a nationwide cross-sectional study in Japanese adults

To date, a limited number of studies have examined aspects of food choice values and food literacy in relation to some aspects of dietary behaviours. The aim of this cross-sectional study was to comprehensively examine the associations of food choice values and food literacy with diet quality. In total, 2231 Japanese adults aged 19-80 years completed questionnaires asking about food choice values (accessibility, convenience, health/weight control, tradition, sensory appeal, organic, comfort and safety) and food literacy characterised by nutrition knowledge, cooking skills, food skills and eating behaviours (hunger, food responsiveness, emotional overeating, enjoyment of food, satiety responsiveness, emotional undereating, food fussiness and slowness in eating). As a measure of diet quality, the Healthy Eating Index-2015 (HEI-2015) was calculated using a brief-type diet history questionnaire (BDHQ) or a food combination questionnaire (FCQ). In males, after adjustment for potential confounding factors (including age, BMI and the ratio of reported energy intake to estimated energy requirement), the HEI-2015 derived from BDHQ and that derived from FCQ were associated significantly (P ≤ 0·02) and positively with the food choice values of organic and inversely with food fussiness. In females, the HEI-2015 showed positive associations with the food choice values of health/weight control, nutrition knowledge and cooking skills and an inverse association with food fussiness, irrespective of the dietary assessment questionnaire (P ≤ 0·03). In conclusion, this study suggests that several aspects of food choice values and food literacy were associated with diet quality, and the aspects related differed between males and females.

Cooking behaviours after Diabetes Prevention Program (DPP) participation among DPP participants in Baltimore, MD

OBJECTIVE

The Diabetes Prevention Program (DPP) is a widely implemented 12-month behavioural weight loss programme for individuals with prediabetes. The DPP covers nutrition but does not explicitly incorporate cooking skills education. The objective of the current study is to describe food and cooking skills (FACS) and strategies of recent DPP participants.

DESIGN

Photo-elicitation in-depth interviews were conducted from June to August, 2021.

SETTING

Baltimore, MD, USA.

PARTICIPANTS

Thirteen Black women who participated in DPP.

RESULTS

The DPP curriculum influenced participants' healthy cooking practices. Many participants reported shifting from frying foods to air-frying and baking foods to promote healthier cooking and more efficient meal preparation. Participants also reported that their participation in DPP made them more mindful of consuming fruits and vegetables and avoiding foods high in carbohydrates, fats, sugars and Na. With respect to food skills, participants reported that they were more attentive to reading labels and packaging on foods and assessing the quality of ingredients when grocery shopping.

CONCLUSIONS

Overall, participants reported changing their food preferences, shopping practices and cooking strategies to promote healthier eating after completing the DPP. Incorporating hands-on cooking skills and practices into the DPP curriculum may support sustained behaviour change to manage prediabetes and prevent development of type 2 diabetes among participants.

Are Future Doctors Prepared to Address Patients' Nutritional Needs? Cooking and Nutritional Knowledge and Habits in Medical Students

Background. Many diseases are linked to lifestyle in the United States, yet physicians receive little training in nutrition. Medical students' prior knowledge of nutrition and cooking is unknown. Objective. To determine incoming medical students' prior nutrition knowledge, culinary skills, and nutrition habits. Methods. A dual-methods study of first-year medical students. Cross-sectional survey assessing prior knowledge, self-efficacy, and previous education of cooking and nutrition. Interviews of second-year medical students explored cooking and nutrition in greater depth. Results. A total of 142 first-year medical students participated; 16% had taken a nutrition course, with majority (66%) learning outside classroom settings. Students had a mean score of 87% on the Nutritional Knowledge Questionnaire versus comparison group (64.9%). Mean cooking and food skills score were lower than comparison scores. Overall, students did not meet guidelines for fiber, fruit, vegetables, and whole grains. Interviews with second-year students revealed most learned to cook from their families; all believed it important for physicians to have this knowledge. Conclusions. Medical students were knowledgeable about nutrition, but typically self-taught. They were not as confident or skilled in cooking, and mostly learned from their family. They expressed interest in learning more about nutrition and cooking.

A Rural Delivery-Based Produce Prescription Intervention Improves Glycemic Control and Stress

OBJECTIVE

We examined the impact of a pilot 24-week delivery-based produce prescription (PRx) intervention with tailored education and culinary resources for rural patients (n = 40) with type-2 diabetes in underresourced communities on behavioral and clinical outcomes.

METHODS

We used a single group pretest-posttest design that included a home-delivered PRx, culturally tailored recipes, and health/nutrition education handouts. Measures included hemoglobin A1c (HbA1c), self-reported fruit/vegetable consumption, and stress. Descriptive statistics, t-tests, and Wilcoxon signed rank tests were conducted.

RESULTS

Mean HbA1c decreased from 7.6 ± 1.6% to 7.1% ± 1.4% (P = 0.001). Self-reported consumption of fruit/vegetables improved, including frequency and serving size of beans (P = 0.01 and P = 0.01), serving size of lettuce salad (P = 0.02), and serving size of vegetable soup (P = 0.001). Perceived stress decreased (P = 0.01).

CONCLUSION AND IMPLICATIONS

Findings from this pilot PRx intervention suggest a delivery-based PRx with tailored educational resources has the potential to reduce HbA1c and stress while improving fruit/vegetable consumption within rural patients with type-2 diabetes in underresourced communities.

Do cooking and food preparation skills affect healthy eating in college students?

The aim of this study is to investigate the relationship between food and cooking skills and healthy eating attitudes in college students. The demographic characteristics, anthropometric measurements, nutritional habits, attitudes toward healthy eating, and cooking and food preparation skills were questioned. 16.2% of the students have moderate, 63.5% high, and 20.3% ideally high attitudes toward healthy eating. While a positive and significant correlation was found between the total score and sub-factor scores of the "Cooking Skills and Food Skills" scale and the total score of the "Attitude Scale for Healthy Nutrition"; a negative statistically significant correlation was found between the total score and sub-factor scores of the "Cooking Skills and Food Skills" scale and the frequency of consumption of fast-food, processed meat products, packaged foods, and bread types (p < .05). Cooking and food preparation skills seem to be positively associated with healthy attitudes and habits. Considering this positive association, interventions to improve food and cooking skills may help promote healthy eating attitudes in college students. Developing these skills can shed light on increasing the frequency of cooking at home, consuming healthier foods, and as a result, providing a healthy eating attitude. Therefore, more comprehensive intervention studies are needed in this area.

Factors That Predict Food Skills in Canadian Gym Members: A National Cross-Sectional Survey

This study determined predictors of food skills in Canadian gym members. A random sample of gym members were invited to complete a validated Food Skills Questionnaire with supplementary questions. All questions/variables significantly associated (p < 0.05) and fair-to-moderately correlated (r ≥ 0.40) with Total Food Skills (TFSs) were analyzed by multiple regression. The respondents' (n = 576) mean ± SD age was 41.3 ± 14.8 years, with 67.3% females and 13.2% students. The mean TFSs score was 77.1 ± 11.9 (maximum 100). Females reported higher TFSs than males; however, this did not remain significant when nutrition-related beliefs were considered. Increasing age, taking a nutrition/cooking course, teen meal preparation, primary cook, time preparing weekend meals, believing that preparing healthy food is important, and self-reported nutritional quality of diet and nutrition knowledge were positively associated with TFSs (p < 0.05). Purchasing food/beverages from convenience stores, buying pre-prepared dinners, and being a student were negatively associated with TFSs (p < 0.05). The strongest predictors of TFSs were self-reported nutrition knowledge and nutritional quality of diet. The adjusted R2 increased by 0.30 when food-related experiences/behaviours and nutrition-related beliefs were included in the final model, which accounted for 50% of the variance in TFSs. Food experiences/behaviours and nutrition beliefs, which are associated with food skills, are potential intermediary targets for programs and/or research to improve food skills.

Addressing schoolteacher food and nutrition-related health and wellbeing: a scoping review of the food and nutrition constructs used across current research

BACKGROUND

Teachers form a large and essential workforce globally. Their wellbeing impacts personal health-related outcomes with flow on effects for the health, and wellbeing of their students. However, food and nutrition (FN) interventions that include teachers, typically neglect the impact of personal FN factors on a teachers' ability to achieve optimal nutrition-related health and wellbeing, and successfully fulfil their professional FN roles as health promoters, gate keepers, educators', and role models. The aim of this review was to scope FN constructs that have been studied internationally regarding teacher FN-related health and wellbeing.

METHODS

Six databases were searched, and papers extracted in June/July 2021. Eligibility criteria guided by the population, concept, context mnemonic included studies published after 2000, in English language, with an aspect of personal FN-related health and wellbeing, among in-service (practising) and pre-service (training), primary, and secondary teachers. Screening studies for inclusion was completed by two independent researchers with data extraction piloted with the same reviewers and completed by lead author, along with complete descriptive and thematic analysis.

RESULTS

Ten thousand six hundred seventy-seven unique articles were identified with 368 eligible for full text review and 105 included in final extraction and analysis. Sixty-nine descriptive studies were included, followed by 35 intervention studies, with the main data collection method used to assess both personal and professional FN constructs being questionnaires (n = 99 papers), with nutrition knowledge and dietary assessment among the most commonly assessed.

CONCLUSION

FN constructs are used within interventions and studies that include teachers, with diversity in constructs included and how these terms are defined. The evidence from this scoping review can be used to inform data collection and evaluation in future epidemiological and interventional research that addresses teacher FN-related health and wellbeing.

Home-prepared meals among college students at-risk for food insecurity: A mixed-methods study

The ability to prepare meals at home is an important life skill with potential to improve dietary quality and reduce costs and thus may be particularly important for college students with food insecurity. However, heavy time demands, limited financial resources, and therefore other barriers such as lack of motivation to follow a healthy diet may constrain meal preparation skills. To gain greater insight into this issue, we conducted a mixed-methods study. The quantitative component assessed relationships among food security, motivation, and meal preparation skills. The qualitative component used focus groups to more closely consider college students' perceptions, values, and barriers surrounding preparing meals at home, including current practices, desired future practices, and the ways in which the campus could support their efforts. The survey (n = 226) assessed food security, meal preparation skills, and motivation (i.e., perceived ability and willingness) to consume a healthy diet. Ten focus groups (n = 60) discussed food choice, meal preparation practices, and ways in which the campus could help students develop meal preparation skills. Students with food insecurity had lower meal preparation skills and lower perceived ability to consume a healthy diet. However, a) willingness to consume a healthy diet and b) the impact of both willingness and perceived ability did not differ by food security status. Focus group data indicated that in-person and online cooking classes, information cards in the food pantry, and incentives (e.g., kitchen equipment and vouchers from local grocery stores) were popular ideas for improving home-meal preparation. A greater understanding of meal preparation skills and their interconnectedness to food choice and the campus environment may inform effective ways to support the ability and willingness of college students with food insecurity to prepare meals at home.

Re-Licious: Co-Design with Adolescents to Turn Leftovers into Delicious and Healthy Meals-A School-Based Pilot Intervention

One-third of the food produced globally is lost or wasted, and one cause is consumer leftovers. Re-licious was an eight-week pilot intervention aiming to increase awareness of food waste and healthy eating by building adolescents' ability to prepare and cook leftovers. Re-licious used a co-design approach and was piloted in a secondary school, half of which was during a COVID-19 lockdown period. Students watched videos on food waste and healthy eating during class. They identified leftover ingredients at home and repurposed ingredients to create recipes. Students co-created recipe criteria to ensure the personal relevance of the recipes. They completed pre- and post-intervention questionnaires (n = 40) about food waste and motivation and interest in healthy eating. Four group interviews were conducted. The factors identified as important in the co-creation sessions were preparation time, cost, healthiness, and sustainability. Participants with low motivation and interest in healthy eating decreased, and participants with high interest increased (p < 0.001). The intention to reduce food waste increased (p = 0.007), as did resourcefulness (p < 0.001) and personal norms (p = 0.048). Interviews highlighted the students' increased awareness of food waste and enjoyment of the intervention. With improvements based on this pilot, Re-licious could be adapted and re-trialled in a face-to-face format to educate young people about food waste.

Complex, Varied and Evolving Manifestations of Food Agency in Daily Life Among Diabetes Prevention Program Participants in Baltimore, Maryland

OBJECTIVE

To characterize food agency (one's capacity to procure and prepare food in particular contexts) among Diabetes Prevention Program (DPP) participants and gather perspectives about experiences with DPP.

DESIGN

Photograph-elicitation in-depth interviews and survey measures.

SETTING

Baltimore, Maryland (June-August 2021).

PARTICIPANTS

Black women (n = 13) who participated in DPP.

PHENOMENON OF INTEREST

Food agency and strategies used to procure and prepare food and the influence of DPP on daily food behaviors. Surveys measured food agency using the Cooking and Food Provisioning Action Scale and cooking behaviors.

ANALYSIS

Thematic analysis of qualitative in-depth interviews and descriptive statistics for quantitative measures.

RESULTS

As quantitative and qualitative data revealed, participants were frequent and confident cooks with high food agency. Participants viewed cooking as a key strategy for healthy eating and desired more hands-on cooking instruction within DPP to develop new healthy cooking skills. The primary barriers identified were related to lack of time or energy. Food procurement and preparation practices shifted over time, and DPP was a key influence on current behaviors.

CONCLUSIONS AND IMPLICATIONS

Food agency is complex and manifests heterogeneously in daily life. A life course, contextual, and food agency-based approach could be considered for future diabetes prevention interventions.

Impact and evaluation of an online culinary nutrition course for health, education and industry professionals to promote vegetable knowledge and consumption

BACKGROUND

Poor diet, including inadequate vegetable intake, is a leading risk factor for noncommunicable disease. Culinary and nutrition education provided to trainee and practising health and education professionals is an emerging strategy to promote improved dietary intake, including vegetable consumption. We evaluated the impact and feasibility of an online culinary medicine and nutrition (CM/CN) short course for health, education and vegetable industry professionals. The course aimed to improve participants' skills and confidence to prepare vegetables, knowledge of evidence-based nutrition information and recommendations for improving vegetable consumption and diet quality.

METHODS

A pre-post study consisting of two separate groups participating in two course rounds recruited practising professionals (n = 30) working in health; community, adult and/or culinary education; and the vegetable industry. Evaluation assessed diet quality, vegetable consumption barriers, cooking and food skill confidence, nutrition knowledge and process measures.

RESULTS

Seventeen participants (68%) completed the programme. Pre- to postintervention statistically significant increases in vegetables (M 1.3, SD 2.2), fruit (M 1.6, SD 3.1), and breads and cereal (M 1.1, SD 1.7) intakes were observed. Statistically significant increases and large effect sizes for mean food skill confidence scores (M 8.9, SD 15.4, Cohen's d 0.56) and nutrition knowledge scores (M 6.2, SD 15.4, Cohen's d 0.83) were also observed pre- to postintervention.

CONCLUSIONS

The short online course was feasible and improved diet quality, food skill confidence and nutrition knowledge. Online CM/CN education for practising professionals represents a promising area of research. Future research involving a larger study sample and a more rigorous study design such as a randomised control trial is warranted.

Participant Preferences for the Development of a Digitally Delivered Gardening Intervention to Improve Diet, Physical Activity, and Cardiovascular Health: Cross-sectional Study

BACKGROUND

Low dietary intake of fruits and vegetables and physical inactivity are 2 modifiable risk factors for cardiovascular disease. Fruit and vegetable gardening can provide access to fresh produce, and many gardening activities are considered moderate physical activity. This makes gardening interventions a potential strategy for cardiovascular disease risk reduction. Previously developed gardening interventions have relied on in-person delivery models, which limit scalability and reach.

OBJECTIVE

The purpose of this study was to ascertain participant insight on intervention components and topics of interest to inform a digitally delivered, gardening-focused, multiple health behavior change intervention.

METHODS

A web-based survey was delivered via Amazon Mechanical Turk (MTurk), including quantitative and open-ended questions. Eligible participants were aged ≥20 years, could read and write in English, were US residents, and had at least a 98% MTurk task approval rating. A multilevel screening process was used to identify and exclude respondents with response inattention, poor language fluency, or suspected automated web robots (bots). Participants were asked about their interest in gardening programming, their preferences for intervention delivery modalities (1-hour expert lectures, a series of brief <5-minute videos, or in-person meetings), and what information is needed to teach new gardeners. Comparisons were made between never gardeners (NG) and ever gardeners (EG) in order to examine differences in perceptions based on prior experience. Quantitative data were summarized, and differences between groups were tested using chi-square tests. Qualitative data were coded and organized into intervention functions based on the Behavior Change Wheel.

RESULTS

A total of 465 participants were included (n=212, 45.6% NG and n=253, 54.4% EG). There was a high level of program interest overall (n=355, 76.3%), though interest was higher in EG (142/212, 67% NG; 213/253, 84.2% EG; P<.001). The majority of participants (n=282, 60.7%) preferred a series of brief <5-minute videos (136/212, 64.2% NG; 146/253, 57.7% EG; P=.16) over 1-hour lectures (29/212, 13.7% NG; 50/253, 19.8% EG; P=.08) or in-person delivery modes (47/212, 22.2% NG; 57/253, 22.5% EG; P=.93). Intervention functions identified were education and training (performing fundamental gardening and cooking activities), environmental restructuring (eg, social support), enablement (provision of tools or seeds), persuasion (offering encouragement and highlighting the benefits of gardening), and modeling (using content experts and participant testimonials). Content areas identified included the full lifecycle of gardening activities, from the fundamentals of preparing a garden site, planting and maintenance to harvesting and cooking.

CONCLUSIONS

In a sample of potential web-based learners, participants were interested in a digitally delivered gardening program. They preferred brief videos for content delivery and suggested content topics that encompassed how to garden from planting to harvesting and cooking. The next step in this line of work is to identify target behavior change techniques and pilot test the intervention to assess participant acceptability and preliminary efficacy.

Examining Nutrition Knowledge, Skills, and Eating Behaviours in People with Severe Mental Illness: A Cross-Sectional Comparison among Psychiatric Inpatients, Outpatients, and Healthy Adults

Compared to the general population, people with severe mental illness (SMI) have an increased risk of weight gain and metabolic syndrome, but also of malnutrition, in part due to unhealthy lifestyle behaviours. The aim of this cross-sectional study was to identify barriers to healthy eating, including nutrition knowledge and skills in people with SMI. For this purpose, we compared the means of anthropometric data such as body mass index, waist-to-hip ratio, and interview data on nutrition knowledge and skills, health-related variables, eating behaviours, personality, motivation, and attitudes in 65 inpatients and 67 outpatients of the Psychiatric Hospital of the University of Zurich and 64 healthy adults using ANOVA and chi-squared tests. The results showed that patients with SMI had worse nutritional status and lifestyle compared to the healthy controls, including disordered (e.g., night eating) and unhealthy (e.g., high intake of sugary foods) eating habits. However, levels of nutrition knowledge, cooking and food skills, and motivation to eat healthily were not significantly lower in the psychiatric patients than in the healthy adults and were not associated with weight change. Based on our findings, nutritional support for people with SMI is urgently needed and should include not only educational but also behavioural and long-term approaches.

New measures to assess the "Other" three pillars of food security-availability, utilization, and stability

BACKGROUND

In recent reviews of available measures, no existing measures assessed all four pillars of food security and most only assessed one or two pillars-predominantly the access pillar. The purpose of this study was to preliminarily develop novel measures of availability, utilization, and stability that are complementary to the USDA's household food security survey measure (HFSSM).

METHODS

A formative phase included an expert advisory group, literature scans, and interviews with individuals experiencing food insecurity. From April-June 2021, the new measures were piloted in five states (California, Florida, Maryland, North Carolina, and Washington). The cross-sectional pilot survey included the new measures (perceived limited availability, utilization barriers, and food insecurity stability), scales and items for validation (e.g., food security, and self-reported dietary and health outcomes), and demographic questions. Exploratory factor analysis was used to assess dimensionality, internal consistency was assessed using Kuder-Richardson formula 21 (KR21), and convergent and discriminant validity were assessed using Spearman's correlation coefficients. Also, a brief screener version was created for the utilization barriers measure that may be necessary for certain applications (e.g., clinical intake screening to inform referrals to assistance programs).

RESULTS

The analytic samples (perceived limited availability (n = 334); utilization barriers (n = 428); food insecurity stability (n = 445)) were around 45 years old on average, most households had children, over two-thirds were food insecure, over three-fourths were women, and the samples were racially/ethnically diverse. All items loaded highly and unambiguously to a factor (factor loadings range 0.525-0.903). Food insecurity stability showed a four-factor structure, utilization barriers showed a two-factor structure, and perceived limited availability showed a two-factor structure. KR21 metrics ranged from 0.72 to 0.84. Higher scores for the new measures were generally associated with increased food insecurity (rhos = 0.248-0.497), except for one of the food insecurity stability scores. Also, several of the measures were associated with statistically significantly worse health and dietary outcomes.

CONCLUSIONS

The findings support the reliability and construct validity of these new measures within a largely low-income and food insecure sample of households in the United States. Following further testing, such as Confirmatory Factor Analysis in future samples, these measures may be used in various applications to promote a more comprehensive understanding of the food insecurity experience. Such work can help inform novel intervention approaches to address food insecurity more fully.

Effectiveness of a School-Based Culinary Programme on 9- and 10-Year-Old Children's Food Literacy and Vegetable, Fruit, and Breakfast Consumption

School-based culinary courses may increase children's food literacy and improve their eating behaviours. This study assessed the impact of a school-based culinary programme on 9- and 10-year-old students' food literacy and vegetable, fruit, and breakfast consumption. This cluster quasi-experimental trial compared 88 grade 4 and 5 students who participated in the Apprenti en Action programme to 82 students who did not. Students' food literacy and eating behaviours were assessed with a self-administered questionnaire. The programme's impact on vegetable and fruit consumption, cooking skills, food skills, and food knowledge was measured using MANOVA, and the odds of eating breakfast at least five times per week were assessed with logistic regression. Students who participated in the programme reported a greater increase in their cooking skills (p = 0.013) and food knowledge (p = 0.028) than students in the control group. No effect was found on food skills and vegetables, fruit, and breakfast consumption (p-values > 0.05). Boys improved their cooking skills (p = 0.025) and food knowledge (p = 0.022), but girls did not. The programme improved students' cooking skills and food knowledge, especially among boys; however, modifications are needed to improve students' food skills and eating behaviours.

Facilitators and barriers to providing culinary nutrition, culinary medicine and behaviour change support: An online cross-sectional survey of Australian health and education professionals

BACKGROUND

An Australia wide cross-sectional online survey examined facilitators and barriers of health and education professionals to providing culinary nutrition (CN) and culinary medicine (CM) education and behaviour change support in usual practice, in addition to identifying continuing professional development (CPD) needs in this domain.

METHODS

Survey items included socio-demographic characteristics, cooking and food skills confidence, nutrition knowledge (PKB-7), fruit and vegetable intake (FAVVA) and CPD needs. Data were summarised descriptively.

RESULTS

Of 277 participants, 65% were likely/somewhat likely to participate in CN CPD. Mean (SD) cooking and food skill confidence scores were 73 (17.5) and 107.2 (24), out of 98 and 147, respectively. Mean PKB-7 score was 3.7 (1.4), out of 7. Mean FAVVA score was 98 (29), out of 190.

CONCLUSIONS

Gaps in knowledge and limited time were the greatest modifiable barriers to providing CM/CN education and behaviour change support in practice. Health and education professionals are interested in CPD conducted by dietitians and culinary professionals to enhance their knowledge of CM/CN and behaviour change support.

The relationship between food and cooking skills, and eating behaviors in people with overweight or obesity

BACKGROUND

In the present study, the authors aimed to determine food skills and cooking skills, and eating behaviors, and to evaluate the relationship between food skills and cooking skills, and eating behaviors in people with overweight or obesity.

METHODS

This cross-sectional study was conducted with 185 people with overweight or obesity. The researchers collected the study data using the face-to-face interview method through a questionnaire including the Descriptive Information Form, Cooking Skills and Food Skills Scale, and Three-Factor Eating Questionnaire-R21. Numbers, percentages, arithmetic mean, standard deviation, Student's t-test, Pearson Chi-Square test, and multiple linear regression analysis were used in the analysis of the data.

RESULTS

The mean scores of the individuals obtained from the overall Cooking Skills and Food Skills Scale, and cooking skills, food skills, uncontrolled eating, cognitive restraint, and emotional eating sub-dimensions were 148.17 ± 52.20, 70.45 ± 27.48, 77.84 ± 28.90, 43.90 ± 22.74, 36.95 ± 23.93, and 38.94 ± 29.17 respectively. Multiple linear regression was fitted to determine the association between food skills and cooking skills and eating behaviors while adjusting for sociodemographic and health-related characteristics. Food skills and cooking skills were positively associated with uncontrolled eating (β = 0.213, p = 0.030), cognitive restraint (β = 0.245, p = 0.009), and emotional eating behaviors (β = 0.338, p = 0.001).

CONCLUSION

In people with overweight or obesity, cognitive restraint and emotional eating behaviors improve as their food preparation and cooking skills improve. Therefore, education and public health practices on eating awareness, food skills, and cooking skills can play an important role in bringing healthy behavior change into practice in society.

Fun with food - A parent-child community cooking intervention reduces parental fear and increases children's perceived competence

Cooking is being promoted as a preventative strategy for numerous health outcomes. However, there has been a reported decline in opportunities for children to learn in the home environment due to parental barriers such as time and concerns around children conducting certain skills. Therefore, this study aimed to understand the impact of a parent-child community cooking intervention on children's perceived cooking competence and interest in cooking and parental perceptions around including children in cooking. 'Fun with Food' was a four-week parent-child cooking intervention based on Experiential Learning Theory and designed by Home Economists. A mixed-method approach was undertaken to understand the effectiveness of the community-based intervention. Parents completed pre and post focus group discussions that were analyzed using Thematic Analysis. Pre and post surveys were used to investigate children's perceived cooking competence and analyzed with paired-samples t-tests and Cohen's d. Children's perceived cooking competence significantly increased after the intervention (P < 0.001, effect size -0.92). Parental fears around children performing certain skills, such as chopping and cutting, were reduced. Additionally, both children and parents found it an enjoyable experience, and appreciated the time spent together, which may be an indicator for positive wellbeing. Parents reported that children have been more actively involved in cooking since the intervention. Further, parents felt strongly that children should be cooking from as young as possible and that Home Economics should be introduced in primary school and made compulsory for older students in secondary school. The parent-child format for cooking has shown to be effective for increasing children's perceived cooking competence and reducing parental fears, highlighting it as a promising method for future interventions.

How Can We Support Healthy Eating in Young Adults with Low Diet Quality? A Survey of Users of the 'No Money No Time' Healthy Eating Website

Nutrition interventions to support young adults are needed due to low diet quality. The aims were to explore the (1) circumstances and (2) barriers regarding dietary habits of the young adult users of the No Money No Time (NMNT) healthy eating website with the lowest diet quality scores. An online cross-sectional survey was conducted from August-September 2022 with a sample of NMNT users aged 18-35 years with low diet quality (defined as Healthy Eating Quiz score 0-38/73). The survey included demographics (e.g., gender), circumstances (6-item US Food Security Survey, Cooking and Food Skills Confidence Measures), and challenges and resources used in relation to healthy eating (open-responses). Theoretical thematic analysis was used to analyse open-response questions and derive main themes. The study sample (n = 108; 71.3% female, median age 28; 28.7% food insecure) had a mean (standard deviation) Cooking Skills score 70.2 (17.5)/98, and median (interquartile range) Food Skills score 96.0 (83.5-107.5)/133. The main challenges regarding healthy eating were (1) time and (2) cost, and the main resources to support healthy eating were (1) online resources (e.g., websites, Google) and (2) recipes. Findings identify possible targets for future interventions to support healthy eating in this vulnerable group (e.g., supporting cooking and food skills).

Use of a focus group-based cognitive interview methodology to validate a cooking behavior survey among African-American adults

Disparities in diet-related diseases persist among African-Americans despite advances in risk factor identification and evidence-based management strategies. Cooking is a dietary behavior linked to improved dietary quality and cardiometabolic health outcomes. However, epidemiologic studies suggest that African-American adults report a lower frequency of cooking at home when compared to other racial groups, despite reporting on average cooking time. To better understand cooking behavior among African-Americans and reported disparities in behavior, we sought to develop a survey instrument using focus group-based cognitive interviews, a pretesting method that provides insights into a survey respondent's interpretation and mental processing of survey questions. A comprised survey instrument was developed based on input from a community advisory board, a literature review, and a content review by cooking behavior experts. The cognitive interview pretesting of the instrument involved African-American adults (n = 11) at risk for cardiovascular disease who were recruited from a community-based participatory research study in Washington, D.C., to participate in a focus group-based cognitive interview. Cognitive interview methodologies included the verbal think-aloud protocol and the use of retrospective probes. Thematic analysis and evaluation of verbalized cognitive processes were conducted using verbatim transcripts. Five thematic themes related to the survey were generated: (1) Clarity and relevancy of question items; (2) influence of participants' perspectives and gender roles; (3) participant social desirability response to questions; (4) concern regarding question intent. Eleven survey items were determined as difficult by participants. Cooking topics for these items were: cooking practices, cooking skills, cooking perception (how one defines cooking), food shopping skills, and socialization around cooking. Question comprehension and interpreting response selections were the most common problems identified. Cognitive interviews are useful for cooking research as they can evaluate survey questions to determine if the meaning of the question as intended by the researcher is communicated to the respondents-specific implications from the results that apply to cooking research include revising questions on cooking practice and skills. Focus-group-based cognitive interviews may provide a feasible method to develop culturally grounded survey instruments to help understand disparities in behavior for culturally relevant diet behaviors such as cooking.

Food Values, Food Purchasing, and Eating-Related Outcomes Among a Sample of Quebec Adults During the COVID-19 Pandemic

Purpose: This investigation evaluated food values, food purchasing, and other food and eating-related outcomes during the COVID-19 pandemic in Quebec, Canada. The role of stress in eating outcomes was also examined.

Methods: An online household survey was conducted among Quebec adults aged ≥18 years (n = 658). Changes in outcomes during, as compared to before, the pandemic were evaluated using descriptive statistics and thematic analysis of free text responses. Eating outcomes by daily stress level (low, some, high) were assessed using Cochran–Armitage test for trend.

Results: Most respondents reported increased importance and purchasing of local food products (77% and 68%, respectively) and 60% reported increased grocery spending (mean ± standard deviation: 28% ± 23%). Respondents with a higher daily stress level had a higher frequency of reporting eating more than usual compared to before the pandemic (low stress 21%, some stress 34%, high stress 39%, p-trend <0.0001). Free text responses described more time spent at home as a reason for eating more than usual.

Conclusions: To support healthy eating during and post-pandemic, dietitians should consider patients’ mental/emotional well-being and time spent at home. Moreover, support of local food products may provide opportunities to promote healthy eating, sustainability, and post-pandemic resiliency of food systems.

An elective high school cooking course improves students' cooking and food skills: a quasi-experimental study

INTERVENTION

The Professional Cooking (PC) course is an optional 18-week experiential learning course offered in francophone high schools in New Brunswick, Canada. Students are taught how to measure ingredients, read and follow recipes, prepare and cook various foods using different culinary techniques, and apply food safety practices.

RESEARCH QUESTION

What is the effectiveness of the PC course on high school girls' and boys' cooking and food skills, vegetable and fruit consumption, and other eating behaviours?

METHODS

Students enrolled in the PC course (n = 124) or a mandatory Personal and Social Development (PSD) course (n = 202) in five high schools were recruited. Students' food and cooking skills, vegetable and fruit consumption, and other eating behaviours were collected through a self-administered, pre-post questionnaire. Group differences were assessed with mixed-effect regression models, and separate gender analyses were conducted.

RESULTS

Students in the PC course reported greater increases in food (β=5.74, 95% CI 1.65, 9.83) and cooking skills (β=10.33, 95% CI 5.59, 15.06) than students in the PSD course. Girls and boys in the PC course reported greater improvements in cooking skills (β=8.68, 95% CI 2.57, 14.80; β=11.97, 95% CI 4.39, 19.57, respectively) than those in the PSD course. No effect was found for vegetable and fruit consumption or other eating behaviours (all p values > 0.05).

CONCLUSION

The PC course effectively improved students' cooking skills. Curriculum-integrated high school cooking courses provide a foundation for healthier eating by helping students develop food literacy skills and should be mandatory in schools.

Dietary Risk Factors and Eating Behaviors in Peripheral Arterial Disease (PAD)

Dietary risk factors play a fundamental role in the prevention and progression of atherosclerosis and PAD (Peripheral Arterial Disease). The impact of nutrition, however, defined as the process of taking in food and using it for growth, metabolism and repair, remains undefined with regard to PAD. This article describes the interplay between nutrition and the development/progression of PAD. We reviewed 688 articles, including key articles, narrative and systematic reviews, meta-analyses and clinical studies. We analyzed the interaction between nutrition and PAD predictors, and subsequently created four descriptive tables to summarize the relationship between PAD, dietary risk factors and outcomes. We comprehensively reviewed the role of well-studied diets (Mediterranean, vegetarian/vegan, low-carbohydrate ketogenic and intermittent fasting diet) and prevalent eating behaviors (emotional and binge eating, night eating and sleeping disorders, anorexia, bulimia, skipping meals, home cooking and fast/ultra-processed food consumption) on the traditional risk factors of PAD. Moreover, we analyzed the interplay between PAD and nutritional status, nutrients, dietary patterns and eating habits. Dietary patterns and eating disorders affect the development and progression of PAD, as well as its disabling complications including major adverse cardiovascular events (MACE) and major adverse limb events (MALE). Nutrition and dietary risk factor modification are important targets to reduce the risk of PAD as well as the subsequent development of MACE and MALE.

Instrument for measuring home cooking skills in primary health care

OBJECTIVE

To develop and validate an instrument for measuring the home cooking skills of health professionals involved with guidelines for promoting adequate and healthy food in primary health care.

METHODS

This is a methodological study with a psychometric approach, carried out in the city of São Paulo between January and November 2020, to develop and validate a self-applied online instrument. The data of the 472 participants were presented by descriptive statistics. Content validation was performed by expert judgment using the two round Delphi technique and empirical statistics for consensus evidence. Exploratory factor analysis was used for construct validation and reliability analysis, and the model adjustment rates and composite reliability were analyzed.

RESULTS

The instrument presented satisfactory content validity for CVRc indices and 𝜅 in the two rounds of the Delphi technique. After the factor analysis, the final model of the Primary Health Care Home Cooking Skills Scale presented 29 items with adequate factorial loads (> 0.3). Bartlett's and Kaiser-Meyer-Olkin's (KMO) tests of sphericity performed in exploratory factorial analysis suggested interpretability in the correlation matrix, the parallel analysis indicated four domains and explained variance of 64.1%. The composite reliability of the factors was adequate (> 0.70) and the H-index suggested replicable factors in future studies. All adjustment rates proved to be adequate.

CONCLUSIONS

The Primary Health Care Home Cooking Skills Scale presented evidence of validity and reliability. It is short and easy to apply and will make it possible to reliably ascertain the need for qualification of the workforce, favoring the planning of actions and public policies of promotion of adequate and healthy food in primary health care.

Unpacking determinants and consequences of food insecurity for insulin resistance among people living with HIV: Conceptual framework and protocol for the NOURISH-OK study

Background:

Over the past four decades, advances in HIV treatment have contributed to a longer life expectancy for people living with HIV (PLWH). With these gains, the prevention and management of chronic co-morbidities, such as diabetes, are now central medical care goals for this population. In the United States, food insecurity disproportionately impacts PLWH and may play a role in the development of insulin resistance through direct and indirect pathways. The Nutrition to Optimize, Understand, and Restore Insulin Sensitivity in HIV for Oklahoma (NOURISH-OK) will use a novel, multi-level, integrated framework to explore how food insecurity contributes to insulin resistance among PLWH. Specifically, it will explore how food insecurity may operate as an intermediary risk factor for insulin resistance, including potential linkages between upstream determinants of health and downstream consequences of poor diet, other behavioral risk factors, and chronic inflammation.

Methods/design:

This paper summarizes the protocol for the first aim of the NOURISH-OK study, which involves purposeful cross-sectional sampling of PLWH (n=500) across four levels of food insecurity to test our conceptual framework. Developed in collaboration with community stakeholders, this initial phase involves the collection of anthropometrics, fasting blood samples, non-blood biomarkers, 24-hour food recall to estimate the Dietary Inflammatory Index (DII^®) score, and survey data. A 1-month, prospective observational sub-study (total n=100; n=25 for each food security group) involves weekly 24-hour food recalls and stool samples to identify temporal associations between food insecurity, diet, and gut microbiome composition. Using structural equation modeling, we will explore how upstream risk factors, including early life events, current discrimination, and community food access, may influence food insecurity and its potential downstream impacts, including diet, other lifestyle risk behaviors, and chronic inflammation, with insulin resistance as the ultimate outcome variable. Findings from these analyses of observational data will inform the subsequent study aims, which involve qualitative exploration of significant pathways, followed by development and testing of a low-DII^® food as medicine intervention to reverse insulin resistance among PLWH (ClinicalTrials.gov Identifier: NCT05208671).

Discussion:

The NOURISH-OK study will address important research gaps to inform the development of food as medicine interventions to support healthy aging for PLWH.

Definitions and Assessment Methods of ‘Home Cooking’ in Studies with Dietary Variables: A Scoping Review

Home cooking is a complex idea that involves multiple skills and behaviors and can be interpreted differently. Using six databases (two of which were Japanese), this scoping review examined the definitions and methods used in studies investigating the relationship between home cooking and dietary variables. Of the 40 studies (2 in Japanese) included in this review, 8 provided definitions but did not specify the extent or level that convenience foods can be allowed in food preparation. The methods were classified into two categories, namely, perception-dependent (n = 29) if using a self-reported instrument, or perception-independent (n = 11) if based on investigators’ classification. Subsequently, indicators of home cooking were classified based on survey attributes (e.g., frequency, location). All but five studies used single indicators, primarily the preparation frequency (n = 18). Quality of analysis was also evaluated. Studies that used multiple indicators or perception-independent methods showed high or moderate overall quality. In contrast, studies that used single indicators based on perception-dependent methods tended to have a low overall quality. The consistency of the relationship between home cooking and dietary variables depended on study quality. In conclusion, the definitions of home cooking were inconsistent across studies, and lacked consensus for examining the association between dietary outcomes.

The Assessment of Cooking Skills and Food Skills and Their Relationship with Nutrition Knowledge, Attitude toward a Healthy Diet and Food Intake: Results of a German Validation Study

There is a lack of validated assessment instruments that capture all facets of cooking skills (CS) and food skills (FS). The goal of this study was to validate the German version of a questionnaire to assess a broad range of CS and FS and to examine its relationship with nutrition knowledge, attitude toward a healthy diet, and food intake. The German version was developed using forward−backward translation. An online survey was completed by students (n = 141), participants from the general Swiss population (n = 50), and nutrition experts (n = 18), including the CS and FS items along with nutrition knowledge, food frequency items, attitude toward a healthy diet and sociodemographic variables. The reliability and construct validity were examined. Results: For all of the samples, Cronbach’s alpha was between 0.85 and 0.88 for CS items and between 0.84 and 0.86 for FS items. The scales were strongly correlated (r = 0.60−0.77, p < 0.01). Nutrition experts showed higher confidence in their CS and FS than students and the participants of the general Swiss population (p < 0.001). CS and FS correlated weakly to moderately with practical nutrition knowledge, attitude toward a healthy diet, and the diet quality index. The German version is an efficient, valid, and highly reliable instrument that seems sensitive to changes. FS, compared to CS, might be more important for a healthy diet.

Home Cooking Quality Assessment Tool Validation Using Community Science and Crowdsourcing Approaches

OBJECTIVE

To refine a measure of home cooking quality (defined as the usage level of practices with the potential to influence the nutrient content of prepared foods) and conduct a construct validation of the revised tool, the Healthy Cooking Questionnaire 2 (HCQ2).

DESIGN

Two validation approaches are described: (1) a community science approach used to refine and validate Healthy Cooking Questionnaire (HCQ) constructs, and (2) responses to the revised HCQ (HCQ2) in a sample of Amazon Mechanical Turk (MTurk) workers to determine questionnaire comprehension.

SETTING

The Community Scientist Program at the University of Texas MD Anderson Cancer Center facilitated discussion groups to refine the HCQ questions and validate constructs. MTurk workers were subsequently recruited to complete the refined survey so that comprehension and associations with demographic variables could be explored.

PARTICIPANTS

Ten community scientists participated in the refinement of the HCQ. The revised tool (HCQ2) was completed by 267 adult US-based MTurk workers.

VARIABLES MEASURED

Demographics, HCQ concepts, HCQ2, Self-Reported Questionnaire Comprehension.

ANALYSIS

Comprehension items were examined using descriptive statistics. Exploratory analysis the relationships between cooking quality and demographic characteristics, meal type, cooking frequency, as well as patterns of food preparation behavior was conducted on the MTurk sample RESULTS: The HCQ was refined through activities and consensus-building. MTurk responses to the HCQ2 indicated high comprehension and significant differences in cooking quality scores by demographic factors.

CONCLUSIONS AND IMPLICATIONS

This study refined and validated a self-report measure of cooking quality. Cooking quality measures offer critical evaluation methods for culinary programs.

Food Choice Values and Food Literacy in a Nationwide Sample of Japanese Adults: Associations with Sex, Age, and Body Mass Index

This cross-sectional study of 2231 Japanese adults described food choice values and food literacy in relation to sex, age, and body mass index. We assessed eight food choice values (accessibility, convenience, health/weight control, tradition, sensory appeal, organic, comfort, and safety, using a 25-item scale), as well as food literacy, which was characterized by nutrition knowledge (using a validated 143-item questionnaire), cooking and food skills (using 14- and 19-item scales, respectively), and eight eating behaviors (hunger, food responsiveness, emotional overeating, enjoyment of food, satiety responsiveness, emotional undereating, food fussiness, and slowness in eating, using the 35-item Adult Eating Behavior Questionnaire). Females had higher means of all the variables than males, except for food fussiness. Compared to participants aged 19-39 and/or 40-59 years, those aged 60-80 years had low means of some food choice values (accessibility, convenience, sensory appeal, and comfort), nutrition knowledge, and all the food approach behaviors (hunger, food responsiveness, emotional overeating, and enjoyment of food) and high means of other food choice values (tradition, organic, and safety) and slowness in eating. Age was inversely associated with cooking and food skills in males, whereas the opposite was observed in females. The associations with body mass index were generally weak. These findings serve as both a reference and an indication for future research.

Development of the Cook-EdTM Matrix to Guide Food and Cooking Skill Selection in Culinary Education Programs That Target Diet Quality and Health

Culinary education programs are generally designed to improve participants’ food and cooking skills, with or without consideration to influencing diet quality or health. No published methods exist to guide food and cooking skills’ content priorities within culinary education programs that target improved diet quality and health. To address this gap, an international team of cooking and nutrition education experts developed the Cooking Education (Cook-Ed^TM) matrix. International food-based dietary guidelines were reviewed to determine common food groups. A six-section matrix was drafted including skill focus points for: (1) Kitchen safety, (2) Food safety, (3) General food skills, (4) Food group specific food skills, (5) General cooking skills, (6) Food group specific cooking skills. A modified e-Delphi method with three consultation rounds was used to reach consensus on the Cook-Ed^TM matrix structure, skill focus points included, and their order. The final Cook-Ed^TM matrix includes 117 skill focus points. The matrix guides program providers in selecting the most suitable skills to consider for their programs to improve dietary and health outcomes, while considering available resources, participant needs, and sustainable nutrition principles. Users can adapt the Cook-Ed^TM matrix to regional food-based dietary guidelines and food cultures.

The Association Between Adolescents' Food Literacy, Vegetable and Fruit Consumption, and Other Eating Behaviors

Adolescents’ intake of vegetables and fruits is generally low, and many demonstrate unhealthy eating behaviors. Food literacy may be key to improving adolescents’ nutrition. However, the relationship between food literacy, fruit and vegetable intake, and other healthy eating behaviors remains unclear, as well as how these relationships may differ among boys and girls. This study assessed the relationship between food literacy (including food skills and cooking skills), vegetable and fruit consumption, and other eating behaviors of adolescents. This cross-sectional study included 1,054 students, including 467 boys and 570 girls from five francophone high schools in New Brunswick, Canada. Quantitative data on students’ food and cooking skills, vegetable and fruit consumption, and other eating behaviors were collected with a self-reported questionnaire. Multilevel regressions were used to assess the relationship between food literacy, students’ consumption of vegetables and fruits, and other eating behaviors. Better cooking skills were associated with healthier eating behaviors and greater vegetable and fruit consumption for boys and girls. Better food skills were also associated with healthier eating behaviors and greater vegetable and fruit consumption among both genders. These findings highlight the importance of improving food literacy among adolescents. Public health interventions should focus on increasing cooking and food skills to improve adolescents’ nutrition.

Development of Reliable and Valid Questions to Assess Food Resource Management Behaviors in Adults With Limited Income

OBJECTIVE

Develop reliable, valid questions to assess changes in food resource management (FRM) behaviors in adults with limited incomes.

DESIGN

Questionnaire development using a mixed-methods approach: content validity (subject matter and curricula), face validity, temporal reliability (test-retest), sensitivity to change, and exploratory factor analysis (EFA).

SETTING

Community settings in 12 states.

PARTICIPANTS

Convenience samples of English-speaking Expanded Food and Nutrition Education Program (EFNEP) or EFNEP-eligible adults: 105 (cognitive interviews), 181 (test-retest), 185 (sensitivity), and 389 (EFA) adults.

VARIABLES MEASURED

Behaviors related to FRM skills: planning, shopping, and budgeting.

ANALYSIS

Consistency and agreement in cognitive interviews and temporal reliability; sensitivity at posttest (paired t tests, Wilcoxon signed-rank tests); internal consistency of scales identified in EFA (Cronbach α). P < 0.5.

RESULTS

All questions had acceptable temporal reliability ranges for the intraclass correlation coefficient (0.48-0.74) and Spearman rank-order correlation (0.48-0.73). All questions were sensitive to change at posttest (P < 0.001). Planning and saving scales, revealed by EFA, demonstrated internal consistency (> 0.80 Cronbach α).

CONCLUSIONS AND IMPLICATIONS

The 9 FRM behavior questions have acceptable temporal reliability and content and face validity and can be used nationally by EFNEP to assess participants' self-reported behavior changes. Other nutrition programs with similar audiences and content could use these questions to measure changes in FRM behaviors.

How a 7-Week Food Literacy Cooking Program Affects Cooking Confidence and Mental Health: Findings of a Quasi-Experimental Controlled Intervention Trial

Obesity and mental health disorders are rising simultaneously with shifting dietary behavior away from home cooking, toward typically nutrition-poor and energy-dense convenience meals. Food literacy strongly influences nutrition choices. Community-based cooking interventions target barriers to healthy eating and facilitate development of food literacy skills, thereby potentially increasing preparation of home-cooked meals and positively influencing health. This study of 657 healthy Australian adults explored the efficacy of a 7-week cooking program in improving cooking confidence, whether this transferred to behavior surrounding food, and/or affected mental health. Significant post-program improvements in cooking confidence and satisfaction (all p &lt; 0.001, ηp2 1.12 large), ability to change eating habits (p &lt; 0.001) and overcome lifestyle barriers (p = 0.005) were observed for the intervention group but not control. Participation also improved mental and general health (all p &lt; 0.05, ηp2 0.02 small). No changes were observed for acquisition and consumption of food, or nutrition knowledge in either group. This 7-week cooking program built cooking confidence and improved general and mental health but did not change dietary behavior. To further improve nutrition related behaviors associated with better mental health, more effort is needed to recruit those with below-average nutrition knowledge and interest in cooking.

Development and Validation of a New Home Cooking Frequency Questionnaire: A Pilot Study

Home cooking and the type of cooking techniques can have an effect on our health. However, as far as we know, there is no questionnaire that measures in depth the frequency and type of cooking techniques used at home. Our aim was to design a new Home Cooking Frequency Questionnaire (HCFQ) and to preliminarily assess its psychometric properties. For this purpose we used a five-phase approach, as follows: Phase 1: item generation based on expert opinion, relevant literature and previous surveys; Phase 2: content validity assessed by experts for relevance and clarity (epidemiologists, dietitians, chefs); Phase 3: face validity and inter-item reliability; Phase 4: criterion validity using a 7-day food and culinary record; and Phase 5: test stability and inter-item reliability. The content validity index for scale and item level values provided evidence of the content validity for relevance and clarity. Criterion validity analysis showed intraclass correlation coefficients ranged from 0.31−0.69. Test−retest reliability coefficients ranged from 0.49−0.92, with ƙ values > 0.44. Overall Cronbach’s alpha was 0.90. In conclusion, the HCFQ is a promising tool with sound content and face validity, substantial criterion validity, and adequate reliability. This 174-item HCFQ is the first questionnaire to assess how often people cook and which cooking methods they use at home.

Nutritional Needs in Mental Healthcare: Study Protocol of a Prospective Analytic Observational Study Assessing Nutritional Status, Eating Behavior and Barriers to Healthy Eating in Psychiatric Inpatients and Outpatients Compared to Healthy Adults

BACKGROUND

Mental disorders are often associated with unhealthy eating behaviors and metabolic comorbidities. This can result in reduced life expectancy and poorer quality of life in people with mental disorders. This study protocol describes an observational study that examines the nutritional status and eating behaviors of people with severe mental illness (SMI) and the need for psychiatric treatment who were between 18 and 65 years old. In addition, the study focuses on possible barriers for healthy eating that have not yet been examined in this population.

METHODS

A total of 192 study participants will be recruited: 64 inpatients and 64 outpatients from the Psychiatric Hospital of the University of Zurich with SMI as well as 64 healthy individuals from the general population as a control group. The participants will be interviewed regarding their nutritional status, eating behavior, nutrition knowledge, food and cooking skills, personality, attitudes and feelings toward nutrition. In addition, the severity of symptoms and several control variables (e.g., sociodemographic variables and physical activity) will be assessed. For the patient samples, data will comprise routine medical data, and, if available, routine laboratory data. Inpatients will be interviewed once at the beginning of their treatment. Outpatients will be interviewed at the beginning and after 3 months of treatment (same interview questions). Healthy adults of the control group will be interviewed once at any time during the recruitment period.

DISCUSSION

The described study will identify nutritional needs and possible barriers to healthy eating in patients with mental disorders. The results will help to define recommendations for nutritional risk screening in psychiatric patients and for planning effective nutritional interventions.

Associations of Caregiver Cooking Skills with Child Dietary Behaviors and Weight Status: Results from the A-CHILD Study

We examined whether caregiver cooking skills were associated with frequency of home cooking, child dietary behaviors, and child body weight status in Japan. We used cross-sectional data from the 2018 Adachi Child Health Impact of Living Difficulty study, targeting primary and junior high school students aged 9-14 years in Adachi City, Tokyo, Japan (n = 5257). Caregiver cooking skills were assessed using a scale with good validity and reliability modified for use in Japan. Child heights and weights derived from school heath checkup data were used to calculate WHO standard body mass index z-scores. After adjusting for potential confounders, caregivers with low-level cooking skills were 4.31 (95% confidence interval (CI): 2.68-6.94) times more likely to have lower frequency of home cooking than those with high level of cooking skills. Children with low-level caregiver cooking skills were 2.81 (95% CI: 2.06-3.84) times more likely to have lower frequency of vegetable intake and 1.74 (95% CI: 1.08-2.82) times more likely to be obese. A low level of caregiver cooking skills was associated with infrequent home cooking, unhealthy child dietary behaviors, and child obesity.