Research Article
Impact of Cooking and Home Food Preparation Interventions Among Adults: Outcomes and Implications for Future Programs
Introduction
The importance of away-from-home meals and convenience foods in the American diet may relate to a lack of time to plan and prepare meals at home.1 A recent review also implicates a lack of cooking skills and food preparation knowledge as barriers to preparing home-cooked meals.2 The percentage of total household food dollars spent on food eaten away from home is now higher compared with 30 years ago (33% in 1970 to 47% in 2010).3
Consumption of fast food and food from away-from-home locations is associated with lower diet quality and obesity among adults.4, 5, 6, 7, 8 National dietary intake data from 1994–1996 and 2003–2004 show that each meal away from home is related to an increase in calories by 130/d and a reduction in diet quality by 2 points on the Healthy Eating Index scale.9 Food prepared at home provides fewer calories per eating occasion and, on a per-calorie basis, provides less total and saturated fat, cholesterol, and sodium, and more fiber, calcium, and iron compared with food prepared away from home.10 Among low-income women, increased frequency of consuming foods prepared from scratch over a 3-day period is associated with an increase in fruit and vegetable, protein, vitamin C, iron, zinc, and magnesium intakes.11
Furthermore, time usage data show that time spent on food preparation and cleanup is less for the average household compared with 30 years ago. In 1995, time spent on food preparation and cleanup was about half (41 min/d) that spent in 1965 (85 min/d) by working women in the US.12, 13 More recent time usage data (2003–2004) also show that time spent in food preparation decreases as time spent working outside the home increases,14 with a greater number of women in the US workforce (an increase of 44% from 1984 to 2009).15 This rise in working women, an amplified perception of time scarcity,1 and increased availability of convenience foods based on technological advances and societal demands contribute to the decline in cooking and home food preparation. An observational study of 64 home-cooked dinner meals shows that most meals contain processed, commercial foods possibly because of limited cooking skills.16
Several cross-sectional, observational studies show a relationship between food preparation skills among adults and associated outcomes. Among mothers of school-aged children, confidence in the ability to prepare a healthy meal is positively associated with healthfulness of the meal.17 A survey of German adults indicates that ready-meal consumption (ie, consumption of complete, main course meals prepared externally) is inversely associated with cooking skills.18 A high perceived value of food preparation is associated with greater intake of fruits and vegetables among women in Australia,19 and when the main home cook is confident in preparing vegetables, households buy a greater variety of vegetables.20
Given the potential positive outcomes related to cooking skills, nutritionists and public health professionals are promoting cooking interventions as a way to improve health. For example, 1 large-scale cooking initiative known as Cooking Matters is under way in at least 45 states. Through the program, local chefs partner with community organizations to teach cooking skills.21 Even though the programs are becoming more popular and well-established, an extensive review of the literature that examines the short- and long-term impacts of cooking interventions for adult populations is not available. A review of this type can provide information to improve the effectiveness of current programs and inform the development of new programs. The purpose of the current study was to review previous research on cooking/home food preparation interventions and diet and health-related outcomes among adults. Relevant studies include interventions that focus primarily on home food preparation/cooking as the primary aim. Studies are also reviewed to identify implications for practice and future research.
Section snippets
Methods
The researchers identified relevant research studies published between January, 1980 and December, 2011 via searches of Ovid MEDLINE, Agricola, and Web of Science databases. The following terms were used in various combinations to perform searches: “intervention,” “demonstration,” “health promotion,” “education,” or “class”; and “food preparation,” “home food preparation,” “cooking or cookery”; and “food habits,” “food intake,” “eating patterns,” “diet,” “dietary intake,” “dietary outcomes,” or
Study Type and Outcome Measures
Of the 28 studies, 16 did not include a control group. Of these, 4 used post-assessment measures only,22, 23, 24, 34 whereas 12 had pre- and postintervention assessments.25, 26, 27, 28, 29, 30, 31, 32, 33, 35, 36, 37 Of the 12 studies that included a control group, 6 did not randomize group assignment38, 39, 40, 41, 42, 43 and 6 did.44, 45, 46, 47, 48, 49 The total number of sessions in each intervention varied widely, from 335 to 4,33, 45 6,26, 27, 28, 30 8,31, 32, 36 12–13,29, 37 and 38
Discussion
This review indicates that interventions involving home food preparation and/or cooking may result in favorable dietary outcomes, food choices, and other health-related outcomes among adults. However, the results should be interpreted with caution based on weaknesses in study design, varying study populations, and the lack of rigorous assessment.
Interpretation of Results Based on Evaluation/Outcome Assessment
A wide assortment of measurement tools were used to evaluate effectiveness of the cooking/home food preparation interventions, many of which were neither validated nor well-established measures of dietary intake, such as the 24-hour dietary recall. The wide range of nonvalidated, unique surveys, and questionnaires makes it difficult to compare results across studies. Few validated instruments exist for measurement of cooking intervention outcomes including cooking knowledge, self-efficacy, and
Implications for Research and Practice
Regardless of the lack of definitive evidence to support a relationship between cooking instruction and long-term cooking behavior or health outcomes, public health professionals have aggressively moved forward with cooking initiatives. Many programs exist at the national, state, and community levels that promote cooking as a necessary and appropriate response to overweight/obesity and food insecurity, such as the Cooking Matters program.21 To enhance the impact of these types of popular
Acknowledgments
Salary support was provided in part by Award K07CA126837 from the National Cancer Institute (NCI). The content of the current article is solely the responsibility of the authors and does not necessarily represent the official views of NCI. The NCI did not have a role in designing the study, collecting the data, or analyzing/interpreting the results. Lori Roth-Yousey, PhD, MPH, RD, Postdoctoral Research Associate, University of Minnesota, served as the external reviewer for the Evidence Analysis
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