Abstract
Background
Research has demonstrated a significant positive association between frequent family
meals and children’s dietary intake; however, the promotion of healthful family meals
has not been rigorously tested for key food environment and nutrition-related behavioral
outcomes in a randomized trial.
Objective
To describe family home food environment and nutrition-related parent and child personal
and behavioral outcomes of the Healthy Home Offerings via the Mealtime Environment
Plus program, the first rigorously tested family meals intervention targeting childhood
obesity prevention.
Design
Randomized controlled trial. Baseline, postintervention (12 months, 93% retention),
and follow-up (21 months, 89% retention) data (surveys and dietary recalls) were collected.
Participants/setting
Children aged 8 to 12 years (N=160) and their parents were randomized to intervention
(n=81) or control (n=79) groups.
Intervention
The intervention included five parent goal-setting calls and 10 monthly sessions delivered
to families in community settings that focused on experiential nutrition activities
and education, meal planning, cooking skill development, and reducing screen time.
Main outcome measures
Family home food environment outcomes and nutrition-related child and parent personal
and behavioral outcomes.
Statistical analyses performed
Analyses used generalized linear mixed models. Primary comparisons were contrasts
between intervention and control groups at postintervention and follow-up, with adjustments
for child age and parent education.
Results
Compared with control parents, intervention parents showed greater improvement over
time in scores of self-efficacy for identifying appropriate portion sizes, with significant
differences in adjusted means at both post-intervention (P=0.002) and follow-up (P=0.01). Intervention children were less likely to consume at least one sugar-sweetened
beverage daily at post-intervention than control children (P=0.04).
Conclusions
The Healthy Home Offerings via the Mealtime Environment Plus program involved the
entire family and targeted personal, behavioral, and environment factors important
for healthful changes in the home food environment and children’s dietary intake.
The intervention improved two nutrition-related behaviors and this may inform the
design of future family meal interventions.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of the Academy of Nutrition and DieteticsAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Nutrition and Your Health: Dietary Guidelines for Americans, 2015-2020. 8th edition. US Government Printing Office, Washington, DC2015
- Correlates of fruit and vegetable intakes in US children.J Am Diet Assoc. 2009; 109: 474-478
- Trends in energy intake among US children by eating location and food source, 1977-2006.J Am Diet Assoc. 2011; 111: 1156-1164
- Trends in food and beverage sources among US children and adolescents: 1989-2010.J Acad Nutr Diet. 2013; 113: 1683-1694
- Creating healthy food and eating environments: Policy and environmental approaches.Annu Rev Public Health. 2008; 29: 253-272
- Associations between the home food environment and obesity-promoting eating behaviors in adolescence.Obesity (Silver Spring). 2007; 15: 719-730
- Correlates of fruit and vegetable intake among adolescents. Findings from Project EAT.Prev Med. 2003; 37: 198-208
- Availability, accessibility, and preferences for fruit, 100% fruit juice, and vegetables influence children's dietary behavior.Health Educ Behav. 2003; 30: 615-626
- National trends in soft drink consumption among children and adolescents age 6 to 17 years: Prevalence, amounts, and sources, 1977/1978 to 1994/1998.J Am Diet Assoc. 2003; 103: 1326-1331
- Characteristics of the home food environment that mediate immediate and sustained increases in child fruit and vegetable consumption: Mediation analysis from the Healthy Habits cluster randomised controlled trial.Int J Behav Nutr Phys Act. 2015; 12: 118
- Is frequency of shared family meals related to the nutritional health of children and adolescents?.Pediatrics. 2011; 127: e1565-e1574
- A review of associations between family or shared meal frequency and dietary and weight status outcomes across the lifespan.J Nutr Educ Behav. 2014; 46: 2-19
- Family meals and adolescents: What have we learned from Project EAT (Eating Among Teens)?.Public Health Nutr. 2010; 13: 1113-1121
- A review of family meal influence on adolescents' dietary intake.Can J Diet Pract Res. 2008; 69: 14-22
- Quality of children's diets at and away from home: 1994-96.Food Rev. 1999; 22: 2-10
- Associations between watching TV during family meals and dietary intake among adolescents.J Nutr Educ Behav. 2007; 39: 257-263
- Interventions for preventing obesity in children.Cochrane Database Syst Rev. 2011; 12: CD001871
- Mothers and meals. The effects of mothers' meal planning and shopping motivations on children's participation in family meals.Appetite. 2010; 55: 623-628
- Focus groups with working parents of school-aged children: What's needed to improve family meals?.J Nutr Educ Behav. 2011; 43: 189-193
- Family meals: Perceptions of benefits and challenges among parents of 8- to 10-year-old children.J Am Diet Assoc. 2008; 108: 706-709
- What's for dinner? Types of food served at family dinner differ across parent and family characteristics.Public Health Nutr. 2014; 17: 145-155
- Modifying children's food preferences: The effects of exposure and reward on acceptance of an unfamiliar vegetable.Eur J Clin Nutr. 2003; 57: 341-348
- Development of food preferences.Annu Rev Nutr. 1999; 19: 41-62
- Correlates of fruit and vegetable consumption among 11-year-old Belgian-Flemish and Dutch schoolchildren.J Nutr Educ Behav. 2006; 38: 211-221
- Nutrition and body weights of Canadian children watching television and eating while watching television.Public Health Nutr. 2009; 12: 2457-2463
Utter J, Denny S, Lucassen M, Dyson B. Who is teaching the kids to cook? Results from a nationally representative survey of secondary school students in New Zealand [published online ahead of print August 10, 2016]. Int J Adolesc Med Health. http://dx.doi.org/10.1515/ijamh-2016-0064.
- Consensus through Conversation.Berrett-Koehler Publishers, Inc, San Francisco, CA2006
- The impact of cooking classes on food-related preferences, attitudes, and behaviors of school-aged children: A systematic review of the evidence, 2003-2014.Prev Chronic Dis. 2014; 11: E193
- Healthy Home Offerings via the Mealtime Environment (HOME): Feasibility, acceptability, and outcomes of a pilot study.Obesity (Silver Spring). 2010; 18: S69-S74
- Involving children in meal preparation. Effects on food intake.Appetite. 2014; 79: 18-24
- Adolescent cooking abilities and behaviors: Associations with nutrition and emotional well-being.J Nutr Educ Behav. 2016; 48: 35-41.e1
- The Healthy Home Offerings via the Mealtime Environment (HOME) Plus study: Design and methods.Contemp Clin Trials. 2014; 38: 59-68
- Social Foundations of Thought and Action: A Social Cognitive Theory.Prentice-Hall, Englewood Cliffs, NJ1986
- Promoting healthful family meals to prevent obesity: HOME Plus, a randomized controlled trial.Int J Behav Nutr Phys Act. 2015; 12: 154
- Family meal patterns: Associations with sociodemographic characteristics and improved dietary intake among adolescents.J Am Diet Assoc. 2003; 103: 317-322
- Food preparation and purchasing roles among adolescents: Associations with sociodemographic characteristics and diet quality.J Am Diet Assoc. 2006; 106: 211-218
- Family dinner meal frequency and adolescent development: Relationships with developmental assets and high-risk behaviors.J Adolesc Health. 2006; 39: 337-345
- Fast food for family meals: Relationships with parent and adolescent food intake, home food availability and weight status.Public Health Nutr. 2007; 10: 16-23
- HOME Plus: Program design and implementation of a family-focused, community-based intervention to promote the frequency and healthfulness of family meals, reduce children's sedentary behavior, and prevent obesity.Int J Behav Nutr Phys Act. 2015; 12 (53-015-0211-7)
nQuery Advisor [computer program]. Version 6.01. Cork, Ireland: Statistical Solutions, Ltd.
- Guess who's cooking? the role of men in meal planning, shopping, and preparation in US families.J Am Diet Assoc. 1998; 98: 995-1000
- A description of the Social-Ecological framework used in the Trial of Activity for Adolescent Girls (TAAG).Health Educ Res. 2007; 22: 155-165
- Motivation Interviewing: Preparing People for Change.2nd ed. The Guilford Press, New York, NY2002
- An example of how to supplement goal setting to promote behavior change for families using motivational interviewing.Health Commun. 2016; 31: 1276-1283
- The validation of a home food inventory.Int J Behav Nutr Phys Act. 2008; 5: 55
- Validation of a home food inventory among low-income Spanish- and Somali-speaking families.Public Health Nutr. 2013; 16: 1151-1158
- Development and validation of a screening instrument to assess the types and quality of foods served at home meals.Int J Behav Nutr Phys Act. 2012; 9: 10
- Work conditions and the food choice coping strategies of employed parents.J Nutr Educ Behav. 2009; 41: 365-370
- Which food-related behaviours are associated with healthier intakes of fruits and vegetables among women?.Public Health Nutr. 2007; 10: 256-265
- Measurement characteristics of diet-related psychosocial questionnaires among African-American parents and their 8- to 10-year-old daughters: Results from the Girls' Health Enrichment Multi-Site Studies.Prev Med. 2004; 38: S34-S42
- Development of a scale to measure the trait of food neophobia in humans.Appetite. 1992; 19: 105-120
- Development and implementation of a visual card-sorting technique for assessing food and activity preferences and patterns in African American girls.J Am Diet Assoc. 2003; 103: 1473-1479
- Computerized collection and analysis of dietary intake information.Comput Methods Programs Biomed. 1989; 30: 47-57
- The Healthy Eating Index-2010 is a valid and reliable measure of diet quality according to the 2010 Dietary Guidelines for Americans.J Nutr. 2014; 144: 399-407
- Update of the Healthy Eating Index: HEI-2010.J Acad Nutr Diet. 2013; 113: 569-580
- Generation M2: Media in the lives of 8 to 18-year-olds.The Henry J. Kaiser Family Foundation, Menlo Park, CA2010
- Testing for baseline differences in randomized controlled trials: An unhealthy research behavior that is hard to eradicate.Int J Behav Nutr Phys Act. 2015; 12 (4-015-0162-z)
- Assessing response profiles from incomplete longitudinal clinical trial data under regulatory considerations.J Biopharm Stat. 2003; 13: 179-190
- Longitudinal data analysis of continuous and discrete responses for pre-post designs.Indian J Stat. 2000; 62: 134-148
SAS/STAT1. SAS/STAT13.2 user's guide. http://support.sas.com/documentation/cdl/en/statug/67523/HTML/default/viewer.htm#statug_mixed_details58.htm. Accessed January 2, 2015.
- An assessment of estimation methods for generalized linear mixed models with binary outcomes.Stat Med. 2013; 32: 4550-4566
SAS/STAT2. SAS/STAT 13.2 user's guide. http://support.sas.com/documentation/cdl/en/statug/67523/HTML/default/viewer.htm#statug_mixed_syntax08.htm. Accessed January 2, 2015.
SAS/STAT2. SAS/STAT 13.2 user's guide. https://support.sas.com/documentation/cdl/en/statug/63033/HTML/default/viewer.htm#statug_glimmix_sect006.htm. Accessed January 2, 2015.
- The efficiency of simulation-based multiple comparisons.Biometrics. 1987; 43: 913-928
SAS software. SAS Institute Inc, Cary, NC; 2013.
- Impact of cooking and home food preparation interventions among adults: Outcomes and implications for future programs.J Nutr Educ Behav. 2014; 46: 259-276
- The ASA's statement on P-values: Context, process and purpose.Am Statistician. 2016; (http://www.tandfonline.com/doi/full/10.1080/00031305.2016.1154108. Accessed August 1, 2016)
- Increased portion sizes from energy-dense foods affect total energy intake at eating occasions in US children and adolescents: Patterns and trends by age group and sociodemographic characteristics, 1977-2006.Am J Clin Nutr. 2011; 94: 1324-1332
- How big is a food portion? A pilot study in Australian families.Health Promot J Austr. 2015; 26: 83-88
- Families' perceptions of and experiences related to a pediatric weight management intervention: A qualitative study.J Nutr Educ Behav. 2015; 47: 427-431
- Sugar and artificially sweetened beverage consumption and adiposity changes: National longitudinal study.Int J Behav Nutr Phys Act. 2015; 12 (137-015-0297-y)
- Consumption of specific foods and beverages and excess weight gain among children and adolescents.Health Aff (Millwood). 2015; 34: 1940-1948
- Sugar-sweetened beverages and children's health.Annu Rev Public Health. 2016; 37: 273-293
- Sugar-sweetened beverages: Children's perceptions, factors of influence, and suggestions for reducing intake.J Nutr Educ Behav. 2016; 48: 27-34.e1
- Systematic review and meta-analysis of school-based interventions to improve daily fruit and vegetable intake in children aged 5 to 12 y.Am J Clin Nutr. 2012; 96: 889-901
- Long-term adherence to health behavior change.Am J Lifestyle Med. 2013; 7: 395-404
- Confidence to cook vegetables and the buying habits of Australian households.J Am Diet Assoc. 2010; 110: S52-S61
- Development of psychosocial scales for evaluating the impact of a culinary nutrition education program on cooking and healthful eating.J Nutr Educ Behav. 2011; 43: 511-516
- Measuring parent time scarcity and fatigue as barriers to meal planning and preparation: Quantitative scale development.J Nutr Educ Behav. 2013; 45: 176-182
- Valid and reliable measures of cognitive behaviors toward fruits and vegetables for children aged 9 to 11 years.J Nutr Educ Behav. 2011; 43: 42-49
Biography
J. A. Fulkerson is a professor, School of Nursing, University of Minnesota, Minneapolis.
Biography
S. Friend is evaluation director, School of Nursing, University of Minnesota, Minneapolis.
Biography
M. Horning is an assistant professor, School of Nursing, University of Minnesota, Minneapolis.
Biography
O. Gurvich is a statistician, School of Nursing, University of Minnesota, Minneapolis.
Biography
A. Garwick is a professor, School of Nursing, University of Minnesota, Minneapolis.
Biography
M. Y. Kubik is an associate professor, School of Nursing, University of Minnesota, Minneapolis.
Biography
M. Draxten is an interventionist, Department of Family Medicine and Community Health, University of Minnesota, Minneapolis.
Biography
C. Flattum is intervention director, Division of Epidemiology and Community Health, University of Minnesota, Minneapolis.
Biography
D. Neumark-Sztainer is a professor, Division of Epidemiology and Community Health, University of Minnesota, Minneapolis.
Biography
M. Story is a professor, Community and Family Medicine and Global Health, Duke University, Durham, NC.
Article info
Publication history
Published online: June 01, 2017
Accepted:
April 4,
2017
Received:
August 9,
2016
Footnotes
STATEMENT OF POTENTIAL CONFLICT OF INTEREST No potential conflict of interest was reported by the authors.
FUNDING/SUPPORT Research reported in this publication was supported by the National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health under award no. R01DK08400. The content is solely the responsibility of the authors and does not necessarily represent the views of the National Institutes of Health. Software support was provided by the University of Minnesota’s Clinical and Translational Science Institute (grant no. UL1TR000114 from the National Center for Advancing Translational Sciences of the National Institutes of Health).
Identification
Copyright
© 2018 by the Academy of Nutrition and Dietetics.
