Food Preferences Clinical Trial
Official title:
Examining the Influence of Cultural Immersion on Willingness to Try Fruits and Vegetables Among Children in Guam: the Traditions Study
The purpose of the Traditions study was to examine the influence of cultural immersion on
willingness to try fruits and vegetables among children, 3-12 y, in Guam. The primary
objective of this study was to examine willingness to try fruits and vegetables and fruit
and vegetable intake among children attending three existing summer camp programs: a
cultural immersion camp, a university day camp, and a recreational sports camp. The primary
hypothesis was that children attending the cultural immersion camp would have higher
willingness to try fruits and vegetables (WillTry score) and a higher intake of fruits and
vegetables compared to children attending both, the university day camp and recreational
sports camp, without cultural immersion.
A pre-post, quasi-experimental design was used to evaluate 3 summer camps with different
exposure levels of cultural immersion. High, moderate, and zero (cultural) exposure was
provided by a cultural immersion camp (CIC), a university-based day camp (UDC), and a
recreational sports camp (RSC), respectively. CIC delivered 4 culturally adapted nutrition
lessons within the context of Chamorro cultural traditions as part of the cultural immersion
camp activities. The UDC delivered the same lessons within a physiology framework. The RSC
was without nutrition lessons and cultural immersion. Children 3-12 years old registered in
any of the three summer camp programs were eligible to participate. Data collection was
primarily administered at two assessment periods: before (± 2 weeks) and after (± 1 week)
each summer camp program. Children's willingness to try fruits and vegetables, the primary
outcome, was assessed with the interview-administered Adapted WillTry tool. The secondary
outcome was fruit and vegetable intake as servings/day in the CIC to UDC only. Fruit and
vegetable intake was assessed using the mobile food record (mFR), which is an app running on
an iPod Touch based on the technology assisted dietary assessment (TADA) protocols. Outcomes
examined Adapted WillTry post-scores for local novel and local common fruits and vegetables
and fruit and vegetable servings/day using multivariate regression models adjusting for the
relevant pre-score, sex, age, ethnicity, dose, BMI percentile, and parent's cultural
affiliation. Therefore, additional measures like sociodemographic information, anthropometry
(i.e. heights and weights), and parent's cultural affiliation were collected to account for
potential confounders.
A pre-post quasi-experimental design was used to observe outcomes (i.e., willingness to try
FV and FV intake) between three existing summer camp programs in Guam: cultural immersion
camp (CIC), university day camp (UDC), and recreational sports camp (RSC). This
natural-setting, multi-arm parallel design was used as an alternative to a resource
intensive infrastructure and the organizations were willing to incorporate activities to
answer the research question.
The CIC and UDC programs were nearly matched for daily activities (e.g., physical activity,
cooking demonstrations/taste testing, crafts). The same four Traditions lessons (Figure 1)
were incorporated into CIC and UDC and delivered by the same educators. These lessons
featured local FV and promoted positive associations with eating FV. In CIC, the context of
Chamorro cultural traditions, practices, and values was tied to FV. Chamorro is the
language, culture, and ethnicity of Guam and the Marianas. In UDC, consuming healthy foods
was introduced within a context of nutrition and human physiology. The four lessons were
adapted with permission from a culturally-relevant Hawaiʻian nutrition curriculum to make
them relevant to Guam and the Chamorro culture. This curriculum complemented Hawaiʻi and
Guam Department of Education K-12 Content and Performance Standards.
The CIC activities perpetuated the Chamorro culture and language through song/chanting,
dance, prayer, arts and crafts, cooking, outdoor activities, and gardening based on
traditional and contemporary practices. Chamorro was spoken about 80% of the time, including
the delivery of key messages in the Traditions lessons. All activities operated on
indigenous values of respect, love, humility, reciprocity, and camaraderie. The UDC
activities focused on promoting healthful present-day recreational activities and global
foods. The activities were an extension of the Expanded Food and Nutrition Education Program
mission. RSC was exclusively physical activity. Upon completion of the last assessments,
educators provided one Traditions lesson for registrants at RSC.
Data collection occurred at two assessment periods: before (± 2 weeks) and after (± 1 week)
each program. The first assessment was completed at each camp setting. The second was also
completed at camp or at a pre-arranged location, such as the children's home or a
child-friendly public space (e.g., the mall). Children completed the interview-administered
Adapted WillTry tool, which measures children's willingness to try FV and was previously
validated for children 3-11 years old in Guam. FV intake was assessed using the mobile food
record (mFR). The mFR is an app that has been shown to be a useful method for dietary
assessment with adolescents. Only participants in CIC and UDC were asked to use the mFR due
to a limited number of iPods.
Other Measures: Parents completed a questionnaire that included information about the
child's age, sex, language spoken, religion, and birthplace. Parent's cultural affiliation
was determined using their responses reported on a cultural affiliation questionnaire, which
assesses one of four modes of acculturation: traditional, integrated, assimilated, or
marginalized. The same scoring system was used as described by Kaholokula and others.
Anthropometric assessments were completed at a time designated as least disruptive to camp
activities. Height and weight were measured using a portable Seca scale and stadiometer
(PE-AIM 101) using centimeters and kilograms, respectively. These measurements were
converted to body mass index (BMI) as [kg/(height, m)2]. Dose was assessed by recording
attendance at camp and at each Traditions lesson.
For participation, all children were given a gift card, in $5 or $10 denominations, one
before and one after camp assessments. Remuneration varied due to the different types and
lengths of involvement for participants depending on camp program.
Sample size was determined using estimates for the Adapted WillTry local novel and local
common FV scores from data representing children similar to children recruited for this
study. The main outcomes, model 1 and model 2 were powered at 0.8 for a minimum detectable
difference (MDD) of 0.43 for the local novel score and 0.41 for the local common score which
corresponded to proposed sample sizes of n=60 for CIC, n=30 for UDC, and n=30 for RSC. For
Model 3, based on the UDC and RSC sample sizes MDD was 0.49 and 0.47 for local novel and
local common, respectively. For the secondary outcome, post-FV intake, the MDDs were 0.877,
0.3132, and 0.6265 per day dependent on the baseline FV consumption being 2, 1 or 1.5 which
yielded sample sizes for CIC (n=60) and UDC (n=30).
Data were entered using a Microsoft Access (Microsoft Corp) tool specifically designed for
this study. Double-data entry procedures were used and PROC COMPARE in SAS 9.3 (SAS
Institute, Inc.) was performed until both data entries achieved 100% matching. A trained
analyst examined images, identified all whole FV (e.g., FV mixed dishes, fruits,
vegetables), and amounts consumed. FV (100%) juices were excluded. FV intake was calculated
by dividing the total FV by the total number of days eating occasions were captured using
the mFR.
Categorical variables were examined using frequencies and for quantitative variables means
and standard deviations were used. Differences between camps in Adapted WillTry FV
post-scores (i.e. local novel, local common, and imported) were examined using univariate
ANOVA adjusted for pre-scores. To examine the previously observed incremental trend of the
Adapted WillTry FV scores, where each score was statistically significantly different from
one another, the paired t-tests for each pre- and post-assessment score in all camps were
performed. Analytical analyses were conducted using IBM SPSS Statistics version 21 (IBM
Corporation, Armonk, NY).
Potential confounders were included in models using indicator variables for age (i.e., 3-6y,
7-8y, 9-12y), ethnicity (i.e., Chamorro, Chamorro Mixed, Other), and sex. Categories of
parent's cultural affiliation were analyzed as traditional and integrated. In these models,
children whose parents were categorized as marginalized (n=2) or assimilated (n=1) were
eliminated due to small numbers. Lesson and camp attendance dose for CIC and UDC were
calculated using the sum of days participants attended lessons and camp days divided by the
total possible lesson and camp days, respectively. A dichotomous variable was created for
high and low dose using the 50th percentile cut-point for lessons and camp dose. BMI was
modeled as a continuous variable.
To examine the primary hypothesis, indicator variables were created for each camp for
relevant comparisons in Models 1, 2, and 3. Multiple linear regression models for the three
Adapted WillTry post-scores (dependent variables) were fit separately to examine whether and
how much the Adapted WillTry scores differed by camp program accounting for potential
confounders (i.e., pre-scores, participant's age, sex, ethnicity, BMI, parent's cultural
affiliation, and lesson and camp days dose). The final model included Adapted WillTry
pre-scores, sex, age, and ethnicity. For whole FV intake, multiple linear regression models
were used to examine differences in post-FV intake/day (dependent variable) between UDC and
CIC. The final model included pre-FV intake/day, age, ethnicity, and parent's cultural
affiliation (independent variables).
;
Allocation: Non-Randomized, Intervention Model: Parallel Assignment, Masking: Open Label
Status | Clinical Trial | Phase | |
---|---|---|---|
Completed |
NCT03003923 -
Promoting Vegetable Intake in Preschool Aged Children
|
N/A | |
Completed |
NCT03113474 -
Profiling the Endocannabinoid Response to Hedonic Eating
|
N/A | |
Recruiting |
NCT04662606 -
Neurofunctional Correlates of Intentional Actions Towards Food Stimuli
|
N/A | |
Recruiting |
NCT06015490 -
The Impact of the Physiological Response to Sugar on Brain Activity and Behavior
|
N/A | |
Recruiting |
NCT05652842 -
Assessing the Impact of Rotational and Shift Work on Sleep, Activity, Energy Balance, and Food Choice in Adults
|
||
Completed |
NCT05079477 -
Online Study of the Effects of Sugary Drink Warning Labels on Consumption
|
N/A | |
Recruiting |
NCT05977348 -
Increasing Food Literacy in Preschoolers to Reduce Obesity Risk
|
N/A | |
Completed |
NCT04544332 -
The GAIN Study: Understanding What Helps Children Learn to Like and Eat New Foods
|
||
Completed |
NCT04497974 -
Sweet Tooth: Nature or Nurture? Role of Long-term Dietary Sweetness Exposure on Sweetness Preferences
|
N/A | |
Completed |
NCT03400566 -
Effects of Experiential Learning on Vegetable Intake in Preschool Children
|
N/A | |
Active, not recruiting |
NCT04262102 -
The Dastatuz Project
|
N/A | |
Completed |
NCT05592340 -
Restaurant Menu Carbon Footprint Labeling
|
N/A | |
Recruiting |
NCT02005003 -
Cognitive and Metabolic Effects of a Probiotic Supplement
|
N/A | |
Completed |
NCT05432271 -
Online Food and Beverage Labels and Vending Machine Selections
|
N/A | |
Active, not recruiting |
NCT04788836 -
How Altered Gut-Brain-Axis Influences Food Choices: Part 2 (BrainFood)
|
||
Completed |
NCT05175391 -
Improving Protein Intake in Older Adults
|
N/A | |
Not yet recruiting |
NCT06324630 -
Implementation of Innovative Food Prescription Programs in Older Adults
|
N/A | |
Recruiting |
NCT02931812 -
Feeding Behavior and Taste Sensitivity Before and After Liver or Renal Transplantation
|
||
Recruiting |
NCT06432517 -
Sources and Mechanisms of Energy Compensation
|
N/A | |
Not yet recruiting |
NCT06377956 -
The Associations Between Gut Length, Gut Microbiota and Food Assimilation
|