Watching TV Cooking Programs: Effects on Actual Food ... · a cooking program with unhealthy foods...

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Research Article Watching TV Cooking Programs: Effects on Actual Food Intake Among Children Frans Folkvord, PhD 1,2 ; Doeschka Ansch utz, PhD 3 ; Marieke Geurts, MSc 3 ABSTRACT Objective: To test the effects of a cooking program on healthy food decisions. Design: An experimental between-subjects design with 3 conditions: healthy, unhealthy, and control. Setting: Class settings in 5 different schools. Participants: One hundred twenty-five children between 10 and 12 years of age. Interventions: Video clips of cooking program containing healthy foods versus cooking program contain- ing unhealthy foods versus control program. Main outcome measures: Healthy versus unhealthy food choice. Analysis: Logistic regression analysis, with the control condition as a reference in the first contrast test and the unhealthy food condition as a reference in the second contrast, to examine effects on food choice between conditions. Results: Children who watched the cooking program with healthy foods had a higher probability of select- ing healthy food than children who watched the cooking program with unhealthy foods (P = .027), or with the control condition (P = .039). Conclusions and Implications: These findings indicated a priming effect of the foods the children were exposed to, showing that nutrition education guided by reactivity theory can be promising. Cooking pro- grams may affect the food choices of children and could be an effective method in combination with other methods to improve their dietary intake. Key Words: children, eating behavior, cooking programs, food cues (J Nutr Educ Behav. 2020; 52:3-9.) Accepted September 24, 2019. Published online November 7, 2019. INTRODUCTION To date, increasing attention is being paid to establish effective intervention techniques that can modify children’s eating behavior toward a positive and beneficial outcome. 1 Poor dietary habits during childhood and adoles- cence have multiple negative effects on several health and wellness indica- tors, such as achievement and main- tenance of healthy weights, growth and development patterns, and dental health. 2 Although most people are well aware of the negative consequen- ces of an unhealthy dietary intake, a large number of studies have consis- tently shown that dietary intake pat- terns of children and adolescents are still poor and do not meet inter- national dietary standards. 3-5 Conse- quently, childhood overweight and obesity is a serious public health con- cern, particularly considering its alarming prevalence and global in- crease in recent decades. 6 A plethora of interventions have been used to increase positive atti- tudes, preferences, and eventually con- sumption of healthier foods, such as fruits and vegetables. 7-12 Prompted by the trend of highly popular cooking programs on television, researchers have started to study cooking pro- grams as a way to positively affect par- ticipants’ food-related behavior. 13-17 For example, a recent systematic review 13 has shown that cooking pro- grams in general positively influence children’s food-related preferences, attitudes, and healthy eating behav- iors. However, most of the studies included in the review employed dif- ferent measurements. For instance, none of the included studies differ- entiated between the type of foods being prepared in the cooking pro- grams (eg, comparing fruits and veg- etables with more unhealthy dishes). This limitation is important, as the depiction of unhealthy foods in cooking programs might stimulate unhealthy eating behaviors, as pre- viously reported by Neyens and Smits. 17 Research has shown that when youth are involved in the preparation of healthy foods, such as vegetables and salads, they are more likely to consume nutrient-rich foods (includ- ing fruits and vegetables), have higher 1 Open Evidence Research, Barcelona, Spain 2 Tilburg School of Humanities and Digital Sciences, Tilburg University, Tilburg, Netherlands 3 Behavioural Science Institute, Radboud University, Nijmegen, Netherlands Conflict of Interest Disclosure: The authors have not stated any conflicts of interest. Address for correspondence: Frans Folkvord, School of Humanities and Digital Sciences, Til- burg University, 5000 LE, Warandelaan 2, Tilburg, The Netherlands; E-mail: [email protected] Ó 2019 Society for Nutrition Education and Behavior. Published by Elsevier Inc. All rights reserved. https://doi.org/10.1016/j.jneb.2019.09.016 Journal of Nutrition Education and Behavior Volume 52, Number 1, 2020 3

Transcript of Watching TV Cooking Programs: Effects on Actual Food ... · a cooking program with unhealthy foods...

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Research Article

Watching TV Cooking Programs: Effects on Actual FoodIntake Among ChildrenFrans Folkvord, PhD1,2; Doeschka Ansch€utz, PhD3; Marieke Geurts, MSc3

ABSTRACT

Objective: To test the effects of a cooking program on healthy food decisions.

Design: An experimental between-subjects design with 3 conditions: healthy, unhealthy, and control.

Setting: Class settings in 5 different schools.

Participants: One hundred twenty-five children between 10 and 12 years of age.

Interventions: Video clips of cooking program containing healthy foods versus cooking program contain-

ing unhealthy foods versus control program.

Main outcome measures: Healthy versus unhealthy food choice.

Analysis: Logistic regression analysis, with the control condition as a reference in the first contrast test and

the unhealthy food condition as a reference in the second contrast, to examine effects on food choice

between conditions.

Results: Children who watched the cooking program with healthy foods had a higher probability of select-

ing healthy food than children who watched the cooking program with unhealthy foods (P= .027), or with

the control condition (P= .039).

Conclusions and Implications: These findings indicated a priming effect of the foods the children were

exposed to, showing that nutrition education guided by reactivity theory can be promising. Cooking pro-

grams may affect the food choices of children and could be an effective method in combination with other

methods to improve their dietary intake.

Key Words: children, eating behavior, cooking programs, food cues (J Nutr Educ Behav. 2020; 52:3−9.)Accepted September 24, 2019. Published online November 7, 2019.

INTRODUCTION

To date, increasing attention is beingpaid to establish effective interventiontechniques that can modify children’seating behavior toward a positiveand beneficial outcome.1 Poor dietaryhabits during childhood and adoles-cence have multiple negative effectson several health and wellness indica-tors, such as achievement and main-tenance of healthy weights, growthand development patterns, and dentalhealth.2 Although most people arewell aware of the negative consequen-ces of an unhealthy dietary intake, a

large number of studies have consis-tently shown that dietary intake pat-terns of children and adolescentsare still poor and do not meet inter-national dietary standards.3−5 Conse-quently, childhood overweight andobesity is a serious public health con-cern, particularly considering itsalarming prevalence and global in-crease in recent decades.6

A plethora of interventions havebeen used to increase positive atti-tudes, preferences, and eventually con-sumption of healthier foods, such asfruits and vegetables.7−12 Prompted bythe trend of highly popular cooking

programs on television, researchershave started to study cooking pro-grams as a way to positively affect par-ticipants’ food-related behavior.13−17

For example, a recent systematicreview13 has shown that cooking pro-grams in general positively influencechildren’s food-related preferences,attitudes, and healthy eating behav-iors. However, most of the studiesincluded in the review employed dif-ferent measurements. For instance,none of the included studies differ-entiated between the type of foodsbeing prepared in the cooking pro-grams (eg, comparing fruits and veg-etables with more unhealthy dishes).This limitation is important, as thedepiction of unhealthy foods incooking programs might stimulateunhealthy eating behaviors, as pre-viously reported by Neyens andSmits.17

Research has shown that whenyouth are involved in the preparationof healthy foods, such as vegetablesand salads, they are more likely toconsume nutrient-rich foods (includ-ing fruits and vegetables), have higher

1Open Evidence Research, Barcelona, Spain2Tilburg School of Humanities and Digital Sciences, Tilburg University, Tilburg, Netherlands3Behavioural Science Institute, Radboud University, Nijmegen, Netherlands

Conflict of Interest Disclosure: The authors have not stated any conflicts of interest.

Address for correspondence: Frans Folkvord, School of Humanities and Digital Sciences, Til-

burg University, 5000 LE, Warandelaan 2, Tilburg, The Netherlands; E-mail:

[email protected]

� 2019 Society for Nutrition Education and Behavior. Published by Elsevier Inc. All rights

reserved.

https://doi.org/10.1016/j.jneb.2019.09.016

Journal of Nutrition Education and Behavior � Volume 52, Number 1, 2020 3

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intakes of key nutrients, and lowerintakes of sugary and fatty foods,than when they are not involvedin this process themselves.18−20 Inaddition, joint cooking by parentsand children has been reported toincrease children’s vegetable con-sumption.21,22 Such results mightpartly explain the positive effects thatcooking shows have on attitudes andbehaviors. Cooking together withothers is quite often an essential partof such shows, and this might posi-tively affect the viewer. In addition,cooking programs on television (TV)naturally display a lot of visual foodcues. These communicate and zoomin on the foods and portions that areserved, thereby inducing increasedattention to food-related cues amongrecipients.

According to cue reactivity theory,such food cues trigger food cravingsfor the primed food and subsequentlylead to actual eating behavior.12,23,24

This theory would suggest that prim-ing children with fruit and vegetablesin cooking programs would inducethe actual consumption of thesefoods, whereas unhealthy food cuesmight trigger less healthy choices.The effect of exposure to healthierfood products on eating behavior ofchildren is strongly influenced bypersonality traits, which function as aselective barrier to children’s respon-siveness to (healthy) eating mes-sages.9 For example, Dovey et al25

demonstrated that children with lowlevels of food neophobia (fear ofnovel foods) appear to respond posi-tively to healthy food messages,while children with higher levels offood neophobia did not. Childrenbegin to feel more responsible fortheir food habits with age and getmore health-related attitudes andcognitions, which affect their eatingbehavior into adult life.26 Foodknowledge about habits and eatingbehavior of children and adolescentsturns out to be a very important fac-tor in promoting good health andwell-being in adult life.27,28 There-fore, cooking programs can be a use-ful tool to improve children’s dietaryintake.

The current study was designed toinvestigate the effects of a cookingprogram on healthy food decisionsand to determine whether exposure

to this cooking program could stimu-late healthier food choices amongchildren. The expectation is thatchildren who are exposed to a cook-ing program with healthy foods willhave a higher probability of choosinghealthier foods in a subsequent foodchoice task than children who watcha cooking program with unhealthyfoods or a control program.

METHODS

Study Design

The current study employed a 1-fac-tor experimental between-subjectdesign to test the effects of videoclips (ie, cooking program containinghealthy foods vs. energy-dense foods)versus a control program on foodchoice. Randomization took place onthe classroom level. Conditions wererandomized over classes within par-ticipating schools to avoid havingmore than 1 class of a particularschool in the same condition. Foodchoice was measured by asking par-ticipants which food options theywould choose as a reward for partici-pating in the study (2 healthyoptions [apple or cucumbers] and 2unhealthy [crisps or salted mini pret-zels] options).

Participants and Recruitment

Participants in this study consisted ofeligible school-aged children rangingfrom 10−12 years of age (children inthe last 2 grades of primary school inthe Netherlands). The present studywas approved by the InstitutionalReview Board of the Behavioural Sci-ence Institute at Radboud University.The study followed the standards ofthe Ethics Committee of the Facultyof Social Sciences. Because the studyinvolved testing minors, the requiredactive parental consent was obtained.Schools were invited to participate inthe study by way of a social mediapost that mentioned the study topic(ie, the effect of watching televisionon food choices in children). Five pri-mary schools agreed to participate,and the parents and caregivers of 202children were informed about thestudy, of which 61.8% gave consentfor their child’s participation. Beforethe start of the study, children were

told that the data would remain con-fidential and that they could ceaseparticipation at any moment withoutconsequences. In total, 125 childrenfrom 8 classes across 5 differentschools in different Dutch countiesparticipated (50% girls; 11.2 § 0.69)and 50% were boys. An a prioriG*Power (version 3.1.9.4, HeinrichHeine University, Dusseldorf, Ger-many, 2017) analysis (effect size =0.10; alpha = 0.05; power = 0.95; and2 predictors) determined a minimumsample size of 110 participants.29,30

Power analysis did not take intoaccount clustering effects.

Instruments

The children’s cooking show that wasselected for the present study was KROKookschool (ie, KRO Cooking School).This television program comes from aDutch public broadcasting channel.The official show was broadcast bet-ween April 2013 and November 2013.In this program, 24 schools from 12different Dutch provinces battle eachother, and participants have to answerquestions about food as well as cook adish themselves.

Two 10-minute compilations ofvideo clips of the same cooking pro-gram were constructed for the benefitof experimental exposure. Onefocused only on healthy foods (toma-toes, onions, brussels sprouts, radi-shes, cucumbers, melon, beans, redbell peppers, cabbage, and apples), theother only on unhealthy foods (ham-burger in a bun, french fries withmay-onnaise, croissants). The coding ofthese foods as either healthy orunhealthy was based on the DutchNutrition Centre recommendationsfor children. The video clips in thecompilations showed peers answeringquestions about certain foods. Con-testants also tasted some of thesefoods. For example, in the unhealthyfood condition, the participants inthe video clip were asked to taste aplate of fries with mayonnaise, andsubsequently, list all ingredients theythought were needed to make thedish. Thus, the video clips providedinformation about (and showedactual eating of) healthy or unhealthyfoods. In the healthy food condition,healthy foods were reflected in thequestions and subsequent tasks (ie,

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cooking) that were conducted. In theunhealthy food condition, unhealthyfoods were reflected.

Children in the control conditionwatched a 10-minute video clip of aDutch children’s program unrelatedto food, De Beste Vrienden Quiz (ie,The Best Friends Quiz). The generalformat of this show was similar tothe format of the cooking program;peers battled each other by answer-ing questions and doing taskstogether. No reference to food wasmade in the video clip used in thecontrol condition. An older episodefrom 2015 was chosen to ensure thatchildren in this condition were notfamiliar with the show.

Measures

Dependent variable. Food choice (dep-endent variable) was measured bypresenting the children with 4 pic-tures of the foods they could select asa reward for participating in theexperiment, was done on paperto keep children’s choices private(children did receive the chosensnack after the experiment had fin-ished). The offered choice wasbetween an apple, a few pieces ofcucumber, a handful of crisps, or ahandful of salted mini pretzels. Thechoice that children made was codedas either healthy (apple or cucumber)or unhealthy (crisps or mini pretzels)based on the Dutch Nutrition Centrerecommendations for children.

Manipulation check. For validationpurposes, a manipulation check wasconducted to test whether the chil-dren perceived the foods in the cook-ing program as being healthy orunhealthy as intended by the experi-menters. Children in both food pro-gram conditions were asked toindicate how healthy they perceivedthe foods shown in a program usinga 10-point Likert-scale (ranging fromvery unhealthy to very healthy).

Descriptive and control variables. Sev-eral descriptive and control variableswere examined that could influenceconceptual relations tested in thisstudy. First, the extent to which chil-dren experienced hunger or thirstwas measured by 2 questions with a

10-point Likert-scale, ranging fromnot at all to very much.10 Second, theywere asked how often they watchedcooking programs at home (responseoptions: 1 = never, 2 = sometimes,3 = often). Third, they were askedwhether they were familiar with theshow or the episode shown (1 = yes,2 = no) and whether they liked theprogram (1 = no, not at all, 2 = no,not really, 3 = yes, a bit, 4 = yes, a lot).

Procedure

Data collection took place in a class-room setting in which the experi-menter was present. First, childrenwere asked to individually fill outthe first part of the questionnaire,containing questions about demo-graphics, hunger and thirst, andsome filler questions to mask these 2measurements. When all childrenhad finished, the experimenter exp-lained that they were going to watcha 10-minute video clip of eitherKRO Kookschool or The Best FriendQuiz (depending on the conditionassigned). Children were told thatthe show’s producers were interestedin their opinion regarding the showand that they would be asked somequestions regarding the show afterwatching the video clip. After expo-sure to the video clip, children filledout the second part of the question-naire. Each question was shown on adigital screen, and the experimenterread each question out aloud, afterwhich children recorded their res-ponses on a paper-and-pencil answer-ing sheet. They were told not tointeract with each other during thefilling out of the questionnaire toavoid social influencing. Subse-quently, their food choice wastracked by letting them choose 1 outof 4 snacks (2 healthy, 2 unhealthy)as a reward for participating. Afterthis, children filled out the manipu-lation check question and controlvariables. Upon finishing the lastquestion, children were thankedand received the reward they hadselected. The experiment took appro-ximately 30 minutes per class.

Data Analyses

First, data were tested for normalityand homogeneity of variance

(Levene’s test). Second, to check forpotential covariates, a randomizationcheck was performed with MANOVAto investigate whether there were dif-ferences in the distribution betweenconditions. Moreover, correlationswere examined for age, gender, hun-ger, thirstiness, or frequency of watch-ing cooking programs with foodchoice. Third, a manipulation checkwas conducted to check whetherproducts shown in the healthy foodcondition were perceived as beingmore healthy than the products inthe unhealthy food condition. Fourth,to test the hypotheses, logistic regres-sion analyses (SPSS version 25.0, IBMCorporation, Armonk, NY; 2017) withWald tests were conducted to estab-lish the effects of condition on foodchoice. The adjusted 1-sided P < .05was considered significant.

RESULTS

The distribution of the data was nor-mal, and Levene’s test showed nosignificant differences for the homo-geneity of variance. Furthermore,MANOVA showed that there wereno differences between conditionson gender, hunger, and liking of thetelevision program (Table 1). However,the mean age differed significantlybetween conditions (F[2,120] = 10.43;P < .001). Children in the healthy(11.4 § 0.58) and unhealthy (11.4 §0.55) food conditions were older thanchildren in the control condition(10.8 § 0.75). As randomization wasnot fully successful concerning age, itwas included as covariate in the mainanalyses.

Correlations

In addition, to examine whether thesevariables should be included as con-trol variables, correlations betweenage, gender, hunger, thirst, or fre-quency of watching cooking programsand food choice was analyzed. Corre-lation analyses showed that genderand frequency of watching cookingprograms were not related to a foodchoice (Cramer’s V < 0.21), next toage, hunger and thirst (h2 < 0.098). Asa result, no other control variable wasincluded in the main analyses apartfrom age.

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Manipulation Check

Children in the experimental condi-tions were asked to indicate on a 10-point scale how healthy they per-ceived the foods shown in the cookingprogram (ranging from 0 [veryunhealthy] to 10 [very healthy]) tocheck whether the manipulation ofthe video clip was in line with theassumptions. Children in the healthyfood condition had a mean score of8.7 (SD, 1.16) on the perceived healthi-ness of the foods; whereas, children inthe unhealthy food condition had amean score of 2.6 (SD, 1.80). The dif-ference between conditions was signif-icant (F[1, 79] = 345.54; P < .001),indicating that manipulation was suc-cessful. Children noticed the differ-ence between the healthiness of theproducts shown in the cooking pro-gram.

Hypothesis Testing

A logistic regression analysis was con-ducted to test for differences inthe probability of choosing healthyfood between the levels of cookingprogram and control (Table 2). Thecontrol condition was used as a refer-ence in the first contrast test, whilethe unhealthy food condition wasused as a reference in the second

contrast. This approach enabled thecomparison between the 2 experi-mental conditions. As such, the con-dition had a significant effect onfood choice (P = .04). Investigation oflevels of cooking and control showedthat the probability of choosing ahealthy snack was 2.4 times higherfor children in the healthy food con-dition compared with children in thecontrol condition (b = 0.894; 95%CI, 0.905−6.607; Wald x2 = 3.108;P = .04). In the healthy food condi-tion, 41.3% of all children chose ahealthy snack; whereas, in the con-trol condition, 22.7% of the childrenchose a healthy snack.

Furthermore, the probability thatchildren in the healthy food condi-tion chose a healthy snack was2.7 times that of children in theunhealthy food condition (b = 1.001;

95% CI, 0.982−7.529; Wald x2 =3.709; P = .03; Table 3). In theunhealthy food condition, 20.0% ofthe children chose a healthy snack.The difference between food choicedid not differ significantly betweenthe unhealthy food condition andthe control condition (P = .86). Assuch, the initial hypothesis was con-firmed. The model explained 6.4% ofthe variance in total. Age as a covari-ate had no significant relation withfood choice (P = .91).

DISCUSSION

The current study sought to deter-mine whether children who watcheda cooking program during schooltime with healthy foods would havea higher probability of choosinghealthier foods in a subsequent foodchoice task compared with childrenwho watch a cooking program withunhealthy food or are in the controlcondition. The main finding was thatcooking programs could positivelyaffect healthy food consumption ofchildren.

The results showed that primingchildren with healthy foods are effec-tive in inducing healthy snack intake,which is in line with the cue reactivitytheory.12,23,24 The mere sight or smellof foods are associated with cravingfor these foods.31 This reaction is aform of food cue reactivity, a condi-tioned response to foods that are fre-quently accompanied by increasedsalivation, physiological arousal, andheightened neural activity in brainareas related to reward.12 Childrenwho were exposed to healthy foodvideos chose an apple or pieces ofcucumber more often compared withthe children in other conditions. Inaddition, Social Cognitive Theory,32

which posits that children learn by

Table 1. Variables Measured for Healthy Food Condition, Unhealthy Food

Condition, and Control (n = 125)

VariableHealthy FoodCondition

Unhealthy FoodCondition Control

Children (n) 46 35 44Gender (boy) 50% 49% 52%

Age (y), mean§ SD 11.4 § 0.6 11.4 § 1.5 10.8 § 0.8*Hunger, mean§ SD 3.0 § 1.7 3.0 § 1.9 3.6 § 2.3Liking of the TV program, mean§ SD 2.3 § 0.8 2.4 § 0.7 2.5 § 0.8

*P = .0003Note: Data presented as mean § SD.

Table 2. OR, SE, and 95% CI for the Logistic Regression Analysis WithControl as Reference (n = 125)

Variable OR SE 95% CI

Constant 0.436 3.528Age 0.964 0.324 0.511—1.820

Healthy cooking program 2.445* 0.507 0.905—6.607Unhealthy cooking program 0.899 0.584 0.286—2.822

CI indicates confidence interval; OR, odds ratio.*P = .039.

Table 3. OR, SE, and 95% CI for the Logistic Regression Analysis WithUnhealthy Cooking Program as Reference (n = 125)

Variable OR SE 95% CI

Constant 0.392 3.711

Age 0.911 0.324 0.511—1.820Healthy cooking program 2.720* 0.520 0.982—7.529Control 1.112 0.584 0.354—3.491

CI indicates confidence interval; OR, odds ratio.*P = .027.

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observing behaviors of others (medi-ated), is consistent with the currentfindings. In particular, this applieswhen children perceive peersexperiencing pleasure from cookingor eating foods. As Marty et al33 dem-onstrated, providing children withnutritional information alone, is notvery effective in promoting healthyeating behaviors. More recent strate-gies, which emphasize pleasure fromeating or the preparation of food,could be more effective andefficient.34

In the cooking program used inthis study, the peers that wereinvolved in the program might haveserved as role models for the chil-dren. The findings from this studyindicate that cooking programs canbe a promising tool for promotingpositive changes in children’s food-related preferences, attitudes, andbehaviors, which is the most impor-tant target group for such educa-tional cooking programs.13 Althoughother studies have shown that actualcooking classes are useful in posi-tively modifying food-related prefer-ences, attitudes, and behaviors ofschool-aged children,13 this studyshowed that a televised cookingshow was also useful in improvingchildren’s eating behavior. Impor-tantly, however, this only applies tocooking programs presenting healthyfoods.

In addition, dietary behaviorchanges among children are basedon a progression of tasks involvingthe selection of food, its preparation,and subsequently, the consumptionof healthy foods such as fruit andvegetables.35 Improved food prepara-tion knowledge and skills are criticalcomponents that can positively facil-itate dietary changes, in particular ifchildren acquire the knowledge andskills positively and joyfully.35 Thelikelihood of consuming fruits andvegetables among youth and adultsis strongly related to knowing how toprepare most fruits and vegeta-bles.14,36 Therefore, several calls haverecently been made for culinary skillseducation programs for children,based on the assumption thatincreased cooking skills positivelyinfluences the consumption of fruitand vegetables and will persist intoadulthood.16,37

Based on a review from Reickset al,35 several promising strategieshave emerged from interventionstudies designed to test the effects ofthe implementation of cooking pro-grams. For example, integratingcooking programs and culinary skillsinto the existing curriculum of chil-dren and students, or teaching tech-niques in which peer leaders are usedfor guiding cooking and informingabout nutritional intake, has yieldedpositive outcomes on healthy eatingbehavior.38−40 Schools represent themost effective and efficient way toreach a large section of an importanttarget population, which includeschildren as well as school staff andthe wider community.41 Positive peerand teacher modeling can encouragestudents to try new foods for whichthey exhibited distaste previously.

The current study has severalstrengths. For instance, it is the firstto distinguish with experimentalrigor (ie, controlled design) the dif-ference between exposure to healthyversus unhealthy food cues in a TVcooking program targeted at chil-dren. Second, actual food choiceswere measured instead of just atti-tudes, preferences, or intentions. Incontrast, one of the limitations of thestudy was the classroom setting, as itis not a particularly naturalistic set-ting for children to choose a snackafter watching TV. An intriguing ideawould be to replicate the currentstudy in a home setting in whichchildren can eat while watching TVto see the results are comparable.Another limitation of the currentstudy was that it only assessed directfood choices. As such, repeated expo-sure and longitudinal intake is some-thing future research will need toaddress. Finally, because the currentstudy did not take into account clus-tering effects, significance may beoverstated, although separate analy-ses with class or schools included asfactors did not lead to differentresults.

Overall, the present study contrib-utes to an existing and growing bodyof knowledge that shows that TVcooking programs can influencechildren’s food choices by emphasiz-ing the importance of the types offoods that are displayed in the pro-cess of cooking. When the program

involves healthy foods, this mightstimulate healthier food choices, espe-cially in children, who are susceptibleto developing unhealthy attitudes andbehaviors that track into adulthoodand adolescence.34

IMPLICATIONS FOR

RESEARCH AND PRACTICE

The current work indicates a need forfuture research to focus on the effec-tiveness of cooking programs to affectlong-term food choices, as these strate-gies contain an essential educationalcomponent.

Another potential beneficial out-come is the transfer of knowledge ar-ound healthy nutrition from a schoolenvironment to a home environmentthrough peers and teachers as agentsof change. Nevertheless, existing evi-dence to support a relationship bet-ween cooking instructions and long-term cooking behavior, or lasting ben-eficial health outcomes, is lacking.Additional research with robust studydesign, with the inclusion of controlgroups, is needed.

Furthermore, cooking programscan also be used to increase food lit-eracy, skills, and capacities to grow,select, prepare, cook, and servefoods.41 The present-day relianceon ready-prepared foods and thelack of modeling by parents in pre-paring fresh foods is an underlyingreason for a reduction in cookingskills among youth,42 which inturn, could lead to food refusal bythe child.43 Thus, providing nutri-tional education in school environ-ments may have an importantpositive influence on the knowl-edge, attitudes, skills, and behaviorsof children.

Building on established programs,Reicks et al35 reported that cookingprograms could have positive out-comes on healthy eating behavior ofchildren and students.38−40 Impor-tantly, schools represent the mosteffective and efficient way to reachthe target population.41 Based on theSocial Cognitive Theory,32 peer andteacher modeling could be an effec-tive method of improving dietaryintake. In addition, the importanceof the ideal number and duration ofexposure to food, whether nutrition

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education should be paired withactual cooking lessons, the role ofparental involvement, and the use-fulness of additional tasting or gar-dening activities should be assessed.Mixed methods will be necessaryto conduct randomized controlledtrials to establish the effectiveness ofcooking programs in a more compre-hensive intervention44 conducted ina variety of environments, includingschools, community centers, and athome.45,46

ACKNOWLEDGMENTS

The authors thank Radboud Univer-sity Nijmegen for its support.

REFERENCES

1. DeCosta P, Møller P, Frøst MB, Olsen

A. Changing children’s eating behav-

iour - a review of experimental

research. Appetite. 2017;113:327–357.

2. Willett W, Rockstr€om J, Loken B, et al.

Food in the Anthropocene: the EAT-

Lancet Commission on healthy diets

from sustainable food systems. Lancet.

2019;393:447–492.

3. Spence AC, Campbell KJ, Lioret S,

McNaughton SA. Early childhood veg-

etable, fruit, and discretionary food

intakes do not meet dietary guidelines,

but do show socioeconomic differences

and tracking over time. J Acad Nutr

Diet. 2018;118:1634–1643.e1.

4. Birch L, Savage JS, Ventura A. Influences

on the development of children’s eating

behaviours: from infancy to adolescence.

Can J Diet Pract Res. 2007;68:s1–s56.

5. Popkin BM. Global nutrition dynam-

ics: the world is shifting rapidly toward

a diet linked with noncommunicable

diseases. Am J Clin Nutr. 2006;84:289–

298.

6. Vandevijvere S, Chow CC, Hall KD,

Umali E, Swinburn BA. Increased food

energy supply as a major driver of the

obesity epidemic: a global analysis. Bull

World Health Organ. 2015;93:446–456.

7. Alblas EE, Folkvord F, Ansch€utz DJ,

et al. Investigating the impact of a health

game on implicit attitudes towards food

and food choice behaviour of young

adults. Appetite. 2018;128:294–302.

8. Folkvord F, Anastasiadou DT, Ansch€utzD. Memorizing fruit: the effect of a

fruit memory-game on children’s fruit

intake. Prev Med Rep. 2017;5:106–111.

9. Folkvord F, Ansch€utz DJ, Wiers RW,

Buijzen M. The role of attentional bias

in the effect of food advertising on

actual food intake among children.

Appetite. 2015;84:251–258.

10. Folkvord F, Ansch€utz DJ, Buijzen M,

Valkenburg PM. The effect of playing

advergames that promote energy-dense

snacks or fruit on actual food intake

among children. Am J Clin Nutr.

2013;97:239–245.

11. Folkvord F, Anschutz DJ, Nederkoorn

C, Westerik H, Buijzen M. Impulsivity,

“Advergames,” and food intake. Pediat-

rics. 2014;133:1007–1012.

12. Folkvord F, Ansch€utz DJ, Boyland E,

Kelly B, Buijzen M. Food advertising

and eating behavior in children. Curr

Opin Behav Sci. 2016;9:26–31.

13. Hersch D, Perdue L, Ambroz T,

Boucher JL. The impact of cooking clas-

ses 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.

14. Brown BJ, Hermann JR. Cooking classes

increase fruit and vegetable intake and

food safety behaviors in youth and adults.

J Nutr Educ Behav. 2005;37:104–105.

15. Clifford D, Anderson J, Auld G, Champ

J. Good Grubbin’: impact of a TV cook-

ing show for college students living off

campus. J Nutr Educ Behav. 2009;41:

194–200.

16. Nelson SA, Corbin MA, Nickols-

Richardson SM. A call for culinary

skills education in childhood obesity-

prevention interventions: current status

and peer influences. J Acad Nutr Diet.

2013;113:1031–1036.

17. Neyens E, Smits T. Seeing is doing.

The implicit effect of TV cooking

shows on children’s use of ingredients.

Appetite. 2017;116:559–567.

18. Bodenlos JS, Wormuth BM. Watching

a food-related television show and calo-

ric intake. A laboratory study. Appetite.

2013;61:8–12.

19. Aumann M, Briggs M, Link N, Collett

ME, Corrigan K, Hart P. Cuisine for

kids: A nutrition and culinary course

for child nutrition program staff. J Nutr

Educ. 1999;31:121–122.

20. Larson NI, Story M, Eisenberg ME,

Neumark-Sztainer D. Food preparation

and purchasing roles among adoles-

cents: associations with sociodemo-

graphic characteristics and diet quality.

J Am Diet Assoc. 2006;106:211–218.

21. Thonney PF, Bisogni CA. Cooking up

fun! A youth development strategy that

promotes independent food skills. J

Nutr Educ Behav. 2006;38:321–323.

22. van der Horst K, Ferrage A, Rytz A.

Involving children in meal preparation.

Effects on food intake. Appetite.

2014;79:18–24.

23. Wadhera D, Capaldi-Phillips ED. A

review of visual cues associated with

food on food acceptance and consump-

tion. Eat Behav. 2014;15:132–143.

24. Nederkoorn C, Jansen A. Cue reactiv-

ity and regulation of food intake. Eat

Behav. 2002;3:61–72.

25. Dovey TM, Staples PA, Gibson EL,

Halford JCG. Food neophobia and

“picky/fussy” eating in children: a

review. Appetite. 2008;50:181–193.

26. Kelder SH, Perry CL, Klepp KI, Lytle

LL. Longitudinal tracking of adolescent

smoking, physical activity, and food

choice behaviors. Am J Public Health.

1994;84:1121–1126.

27. Boyland EJ, Kavanagh-Safran M, Half-

ord JCG. Exposure to ‘healthy’ fast

food meal bundles in television adver-

tisements promotes liking for fast food

but not healthier choices in children. Br

J Nutr. 2015;113:1012–1018.

28. Turconi G, Celsa M, Rezzani C, Biino

G, Sartirana MA, Roggi C. Reliability

of a dietary questionnaire on food hab-

its, eating behaviour and nutritional

knowledge of adolescents. Eur J Clin

Nutr. 2003;57:753–763.

29. Faul F, Erdfelder E, Lang A-G, Buchner

A. G*Power 3: a flexible statistical

power analysis program for the social,

behavioral, and biomedical sciences.

Behav Res Methods. 2007;39:175–191.

30. Erdfelder E, FAul F, Buchner A, Lang

AG. Statistical power analyses using

G*Power 3.1: tests for correlation and

regression analyses. Behav Res Methods.

2009;41:1149–1160.

31. Boswell RG, Kober H. Food cue reac-

tivity and craving predict eating and

weight gain: A meta-analytic review.

Obes Rev. 2016;17:159–177.

32. Bandura A. Self-efficacy: toward a uni-

fying theory of behavioral change. Adv

Behav Res Ther. 1978;1:139–161.

33. Marty L, Chambaron S, Nicklaus S,

Monnery-Patris S. Learned pleasure from

eating: an opportunity to promote

healthy eating in children? Appetite.

2018;120:265–274.

34. Folkvord F, editor. The Psychology of

Food Marketing and Overeating. Abing-

don, UK: Routledge; 2019.

35. Reicks M, Trofholz AC, Stang JS, Laska

MN. Impact of cooking and home food

8 Folkvord et al Journal of Nutrition Education and Behavior � Volume 52, Number 1, 2020

Page 7: Watching TV Cooking Programs: Effects on Actual Food ... · a cooking program with unhealthy foods or a control program. METHODS Study Design The current study employed a 1-fac-tor

preparation interventions among adults:

outcomes and implications for future

programs. J Nutr Educ Behav. 2014;46:

259–276.

36. Chen DY, Gazmararian JA. Impact of

personal preference and motivation on

fruit and vegetable consumption of

WIC-participating mothers and chil-

dren in Atlanta, GA. J Nutr Educ Behav.

2014;46:62–67.

37. Lichtenstein AH, Ludwig DS. Bring

back home economics education.

JAMA. 2010;303:1857–1858.

38. Brown LB, Richards R. Teaching students

to cook: an easily incorporated assignment

in an academic nutrition course. J Nutr

Educ Behav. 2010;42:355–356.

39. Lacey JM. Enhancing students’ under-

standing of whole cereal grains in a

university experimental foods course. J

Nutr Educ Behav. 2007;39:235–236.

40. Woodson JM, Braxton-Calhoun M,

Benedict J. Food for health and soul:

a curriculum designed to facilitate

healthful recipe modifications to

family favorites. J Nutr Educ Behav.

2005;37:323–324.

41. Drummond C. Using nutrition educa-

tion and cooking classes in primary

schools to encourage healthy eating.

J Stud Wellbeing. 2010;4:43–54.

42. McDonald T. Social Responsibility and

Sustainability: Multidisciplinary Perspec-

tives Through Service Learning. Service

Learning for Civic Engagement Series.

Sterling, VA: Stylus Publ LLC; 2011.

43. Binnendyk L, Lucyshyn JM. A family-

centered positive behavior support

approach to the amelioration of food

refusal behavior: an empirical case study.

J Posit Behav Interv. 2009;11:47–62.

44. Hu FB, Satija A, Manson JAE. Curbing

the diabetes pandemic: the need for

global policy solutions. JAMA. 2015;

313:2319–2320.

45. Langellotto GA, Gupta A. Gardening

increases vegetable consumption in

school-aged children: a meta-analytical

synthesis. HortTechnology. 2012;22:430–

445.

46. Ganann R, Fitzpatrick-Lewis D,

Ciliska D, Peirson L. Community-

based interventions for enhancing

access to or consumption of fruit and

vegetables among five to 18-year-

olds: a scoping review. BMC Public

Health. 2012;12:711.

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