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Culinary medicine is a popular approach to health promotion, but most programs focus on patient or provider-facing education. While laudable, these efforts do not represent the full potential for culinary medicine to impact community health. We describe a novel approach to culinary medicine at a federally qualified health center (FQHC), the HOPE Clinic: Bite of HOPE Small Food Business Development (SFBD) program. Describe the design and implementation of the Bite of HOPE SFBD program and examine initial response to the program through interviews and focus groups with past participants. The SFBD program aims to create healthy food outlets by supporting local small businesses with education, resources, and mentorship support. Former participants in the SFBD program were invited to participate in focus groups and interviews exploring their experience and perceived program impact. Three focus groups (n = 10) and nine in-depth interviews were conducted. Most participants were Black or Hispanic and all operated their businesses in the community surrounding HOPE Clinic. Five themes emerged from the data including perceived program purpose, program discovery, motivating factors to participation, perceived program impact, and suggestions for improvement. Participants expressed high satisfaction with the program and positive changes in both business development and personal eating habits. There is an opportunity to leverage the culinary medicine model to support local small food business and improve community health. The Bite of HOPE SFBD program offers an example of how clinic-based resources can expand into the surrounding environment.

The objective of this study was to investigate changes in physical activity patterns associated with the COVID-19 pandemic in individuals with overweight and obesity who were participating in a school district worksite weight loss program. We conducted comparative design interrupted time series analyses on physical activity device (Fitbit) data from the 2018-2019 and 2019-2020 school years (N = 211). We administered a questionnaire in 2020 to supplement device data. After the stay-at-home orders in 2020, participants tended to decrease their weekly step count (B = -1315.7, SE = 627.7, p = .045), decrease their weekly "Lightly active minutes" (B = -39.1, SE = 12.6, p = .007), and increase their weekly "Very active minutes" compared to their counterparts from the year before (B = 7.6, SE = 3.2, p = .020). Decreased motivation, gym closures, and safety concerns were cited as barriers to physical activity. Having more time and health consciousness were cited as facilitators of physical activity. The COVID-19 pandemic was related to changes in physical activity in both positive and negative ways, revealing opportunities to promote healthy lifestyle behaviors in this population. More research is needed to determine optimal approaches to health promotion in the post-COVID-19 era.

Objective:To identify dietary self-monitoring implementation strategies in behavioural weight loss interventions.Design:We conducted a systematic review of eight databases and examined fifty-nine weight loss intervention studies targeting adults with overweight/obesity that used dietary self-monitoring.Setting:NA.Participants:NA.Results:We identified self-monitoring implementation characteristics, effectiveness of interventions in supporting weight loss and examined weight loss outcomes among higher and lower intensity dietary self-monitoring protocols. Included studies utilised diverse self-monitoring formats (paper, website, mobile app, phone) and intensity levels (recording all intake or only certain aspects of diet). We found the majority of studies using high- and low-intensity self-monitoring strategies demonstrated statistically significant weight loss in intervention groups compared with control groups.Conclusions:Based on our findings, lower and higher intensity dietary self-monitoring may support weight loss, but variability in adherence measures and limited analysis of weight loss relative to self-monitoring usage limits our understanding of how these methods compare with each other.

A cancer diagnosis can upend work and family life, leading patients to reallocate resources away from essentials such as food. Estimates of the percentage of people navigating a cancer diagnosis and food insecurity range between 17% and 55% of the cancer patient population. The complexity of addressing food insecurity among those diagnosed with cancer during different phases of treatment is multifactorial and often requires an extensive network of support throughout each phase. This commentary explores the issue of food insecurity in the context of cancer care, explores current mitigation efforts, and offers a call to action to create a path for food insecurity mitigation in the context of cancer. Three programs that address food insecurity among those with cancer at various stages of care are highlighted, drawing attention to current impact and actionable recommendations to make programs like these scalable and sustainable. Recommendations are grounded in the National Academies of Sciences, Engineering, and Medicine social care framework through 5 essential domain areas: awareness, adjustment, assistance, alignment, and advocacy. This commentary seeks to highlight opportunities for the optimization of cancer care and reframe food access as an essential part of treatment and long-term care plans.

Patients with cancer and caregivers increasingly use the internet to find health and lifestyle information, yet online recipes, diet, and nutrition content are unregulated and may be confusing or even misleading. We describe cancer-related nutrition and meal planning information from Pinterest.In June 2020, we searched Pinterest using "cancer recipe" and "recipe for cancer" at 3 times daily for 2 weeks. Duplicates were removed for a final sample of n = 103 pins. Each pin was coded for 58 variables including descriptives, cancer claims (eg, treatment, prevention, and cure), and nutrition claims (eg, "turmeric cures cancer"). We summarized each variable to describe the content of cancer nutrition claims on Pinterest and examined associations between claim types and contextual factors, including the use of academic citations, disclaimers, and personal anecdotes.Pinners had on average 116,767 followers (range, 0-1.5 million). Almost half of content sites were for profit (48.5%) and 34% were selling a product. Health claims were common, with content that purported to prevent (41.8%), treat (27.2%), or cure (10.7%) cancer. Vague phrases such as "anti-cancer," "cancer-fighting," or "cancer-busting" were also used. The inclusion of validity indicators including academic citations, disclaimers, and personal anecdotes varied significantly by the types of claims made. Together, these analyses informed the development of a conceptual framework of cancer-related nutrition misinformation.There are clear financial incentives for the promotion of cancer nutrition information online. More research is needed to understand how exposure to nutrition information can influence patient/caregiver behavior and downstream clinical and psychosocial outcomes.

Cancer survivors are a growing population that may particularly benefit from nutrition and lifestyle interventions. Community-based programs teaching healthy cooking skills are increasingly popular and offer an opportunity to support survivors within communities. The objective of this study is to describe the curriculum and implementation of a cooking class program designed for cancer survivors, housed within an established community-based organization. First, we evaluated the class curriculum for specific constructs. An evidence-based measure of healthy cooking constructs, the Healthy Cooking Index (HCI), was used to analyze included recipes and revealed both summative cooking quality scores and individual constructs underlying the overall curriculum. Second, a self-report questionnaire based on the HCI was conducted during the first and last class of the six-week series. This allowed for a comparison between baseline cooking practices of participants and class curricula, as well as changes in reported practices after class participation. Using the HCI items and coding system, we found the curriculum focused on seven recurring constructs (measuring fat and oil, using citrus, herbs and spices, low fat cooking methods, olive oil, and adding fruit and vegetables). Baseline reports demonstrated that many participants already practiced the main constructs driving the curriculum. As a potential result of this overlap, no changes in practices were found between the first and last session among class participants. Cooking classes for cancer survivors should be structured to not only reinforce positive existing behaviors, but also to promote other healthy cooking practices and reduce less healthy behaviors such as using red meat and animal fats. The HCI can be used to understand the underlying constructs of existing cooking class curricula and current practices of survivor populations, allowing for a more tailored approach to practical nutrition education in this high-risk group.

BACKGROUND: Food preparation interventions are an increasingly popular target for hands-on nutrition education for adults, children and families, but assessment tools are lacking. Objective data on home cooking practices, and how they are interpreted through different data collection methods are needed. OBJECTIVE: The goal of this study was to explore the utility of the Healthy Cooking Index in coding multiple types of home food preparation data and elucidating healthy cooking behavior patterns. DESIGN: Parent-child dyads were recruited between October 2017 and June 2018 in Houston and Austin, Texas for this observational study. Food preparation events were observed and video recorded. Participants also wore a body camera (eButton) and completed a questionnaire during the same event. PARTICIPANTS/SETTING: Parents with a school-aged child were recruited as dyads (n=40). Data collection procedures took place in participant homes during evening meal preparation events. MAIN OUTCOME MEASURES: Food preparation data were collected from parents through direct observation during preparation as well as, eButton, and paper questionnaires completed immediately after the event. STATISTICAL ANALYSES PERFORMED: All data sets were analyzed using the Healthy Cooking Index coding system, and compared for concordance. A paired sample t-test was used to examine significant differences between the scores. Cronbach’s alpha and principal components analysis (PCA) were conducted on the observed Healthy Cooking Index items to examine patterns of cooking practices. RESULTS: Two main components of cooking practices emerged from the PCA: one focused on meat products and another on health and taste enhancing practices. The eButton was more accurate in collecting Healthy Cooking Index practices than the self-report questionnaire. Significant differences were found between participant reported and observed summative Healthy Cooking Index scores (p < .001), with no significant differences between scores computed from eButton images and observations (p=.187). CONCLUSIONS: This is the first study to examine nutrition optimizing home cooking practices by observational, wearable camera and self-report data collection methods. By strengthening cooking behavior assessment tools, future research will be able to elucidate the transmission of cooking education through interventions, and the relationships between cooking practices, disease prevention and health.

Weight gain is common among breast cancer patients and may contribute to poorer treatment outcomes. Most programs target breast cancer survivors after the completion of therapy and focus on weight reduction. This study examined the feasibility and preliminary efficacy of an intervention designed to prevent primary weight gain among women receiving neoadjuvant chemotherapy for breast cancer. Thirty-eight newly diagnosed stage II or III breast cancer patients were randomized to the BALANCE intervention or usual care within 3 weeks of starting neoadjuvant chemotherapy. The intervention used a size acceptance-based approach and encouraged home-based resistance and moderate-intensity aerobic exercise as well as a low energy-dense diet to prevent weight gain. Assessments were conducted at baseline, mid-chemotherapy (3 months), and post-chemotherapy (6 months). Intervention feasibility, acceptability, and preliminary effects on anthropometric, quality of life, and circulating biomarker measures were evaluated. Intervention participant retention (100%) and in-person session attendance (80%) were high during the intervention period, although attendance dropped to 43% for telephone-delivered sessions. The majority of participants reported being satisfied with the intervention during chemotherapy (88%). Participants in the intervention group had greater reductions in waist circumference (p = .03) and greater improvements in self-reported vitality scores (p = .03) than the control group at the end of chemotherapy. Significant effects on biomarkers were not observed. A size acceptance weight management program is feasible during neoadjuvant chemotherapy among breast cancer patients and may have beneficial effects on waist circumference and patient vitality. This study was registered as a clinical trial at www.clinicaltrials.gov (NCT00533338).

The link between home cooking and health is being actively explored in both observational and experimental studies. However, research on this topic is limited by the lack of cooking behavior metrics. Most existing assessment tools focus only on cooking frequency or one’s ability to complete specific a priori food preparations. Cooking is a complex and multifaceted behavior that is influenced by culture, environment, and social norms. More flexible and adaptable measurement approaches are needed to elucidate the spectrum of cooking ability in the population and, in turn, develop meaningful recommendations and interventions.

Individuals at increased hereditary risk of cancer are an important target for health promotion and cancer prevention interventions. Health-4-Families uses the Multiphase Optimization STrategy (MOST) framework and is designed to pilot digital delivery strategies for a distance-based, 16-week intervention to promote weight management, healthy diet, and increased physical activity among individuals with BRCA1/BRCA2 or DNA mismatch repair (MMR) pathogenic germline variants. This communication describes participant recruitment and the design of the Health-4-Families pilot study.Health-4-Families is a full-factorial (16 condition) randomized pilot study of four lifestyle intervention components: social networking, telephone or email coaching, text messaging, and self-monitoring. The primary outcome was feasibility and satisfaction with these study components. Participants with pathogenic germline variants were identified via clinic surveillance lists and advocacy organizations and were invited to participate with family members. All participants had to report meeting at least one of the following criteria: (1) having a BMI ≥ 25 kg/mThe majority of screened potential participants with pathogenic variants (83%) were eligible; 86% of those eligible provided informed consent and 79% (n = 104) completed baseline. A total of 206 family members were nominated by study participants and 49% (n = 102) completed baseline.Recruitment data suggest that individuals with pathogenic germline variants, who are at increased risk for hereditary cancers, are motivated to participate in digital lifestyle interventions. This recruitment success highlights the importance of identifying and prioritizing effective and efficient intervention components for hereditary cancer families. We intend to use the outcomes of our pilot study to inform a fully-powered factorial study for this community.

PURPOSE: Increased cardiovascular disease and second cancer risks among childhood cancer survivors (CCS) makes them and their families important audiences for nutrition intervention. Family meals and home cooking practices have been associated with improved diet and health, but there is a gap in the literature on understanding these behaviors and their motivating values among CCS families. This study qualitatively explores family meal values and behaviors in a sample of CCS parent-child dyads. METHODS: This observational and qualitative study recruited a convenience sample of 11 parent-CCS dyads. Data collection included audio and video recording of food preparation events in participant homes, which were analyzed with an inductive coding technique to examine meal related values in CCS families. RESULTS: Analyses revealed four major categories of meal values. Effort, including time and difficulty, as well as budget, healthfulness and family preferences emerged as recurrent values impacting meal preparation. These values were impacted by the cancer experience upon diagnosis, during treatment and into survivorship. CONCLUSIONS: A better understanding of CCS family meal planning values, the impact of the cancer experience on these values, and the inclusion of CCS in food preparation reveals potential intervention targets, facilitators, and barriers for future interventions to improve dietary behaviors among CCS.

Mobile applications and paired devices allow individuals to self-monitor physical activity, dietary intake, and weight fluctuation concurrently. However, little is known regarding patterns of use of these self-monitoring technologies over time and their implications for weight loss. The objectives of this study were to identify distinct patterns of self-monitoring technology use and to investigate the associations between these patterns and weight change. We analyzed data from a 6-month weight loss intervention for school district employees with overweight or obesity (N = 225). We performed repeated measures latent profile analysis (RMLPA) to identify common patterns of self-monitoring technology use and used multiple linear regression to evaluate the relationship between self-monitoring technology use and weight change. RMLPA revealed four distinct profiles: minimal users (n = 65, 29% of sample), activity trackers (n = 124, 55%), dedicated all-around users (n = 25, 11%), and dedicated all-around users with exceptional food logging (n = 11, 5%). The dedicated all-around users with exceptional food logging lost the most weight (X2[1,225] = 5.27, p = .0217). Multiple linear regression revealed that, adjusting for covariates, only percentage of days of wireless weight scale use (B = -0.05, t(212) = -3.79, p.001) was independently associated with weight loss. We identified distinct patterns in mHealth self-monitoring technology use for tracking weight loss behaviors. Self-monitoring of weight was most consistently linked to weight loss, while exceptional food logging characterized the group with the greatest weight loss. Weight loss interventions should promote self-monitoring of weight and consider encouraging food logging to individuals who have demonstrated consistent use of self-monitoring technologies.Mobile applications and paired devices now enable users to track their physical activity levels, dietary intake, and weight fluctuations all in one user interface. We know that tracking each of these behaviors generally facilitates weight loss, but it is not clear how people with overweight or obesity may tend to use these multiple functions together when trying to lose weight. In a sample of 225 school district employees with overweight or obesity, we investigated whether there were common patterns in tracking these behaviors over time, and whether patterns were associated with weight loss. We identified groups reflecting four common patterns, which we termed the minimal users (n = 65, 29%), activity trackers (n = 124, 55%), dedicated all-around users (n = 25, 11%), and dedicated all-around users with exceptional food logging (n = 11, 5% of sample). The dedicated all-around users with exceptional food logging was the only group that reliably lost weight and was characterized by high tracking of activity, diet, and weight. Overall, regular use of the weight scale was most strongly associated with weight loss. It may be useful to broadly encourage self-monitoring of weight, and selectively encourage food logging to individuals amenable to this self-monitoring technology.

BACKGROUND Children with cancer experience a myriad of nutritional challenges that impact their nutrition status during treatment and into survivorship. Growing evidence suggests that weight at diagnosis impacts cancer outcomes, but provider guidance on nutrition and diet during treatment varies. Nutrition literacy and culinary resources may help mitigate some common nutritional problems; however, many patients may face barriers to accessing in-person classes. Along with dietitian-led clinical interventions, web-based resources such as the newly updated electronic cookbook (e-cookbook) created by The University of Texas MD Anderson Cancer Center, @TheTable, may facilitate access to nutrition and culinary education during treatment and into survivorship. OBJECTIVE We sought to define and describe the features and content of the @TheTable e-cookbook and compare it with analogous resources for a lay audience of patients with childhood cancer and childhood cancer survivors as well as their families. METHODS We evaluated freely available web-based resources via a popular online search engine (ie, Google). These searches yielded three web-based resources analogous to @TheTable: the American Institute for Cancer Research’s Healthy Recipes, The Children’s Hospital of San Antonio’s Culinary Health Education for Families Recipe for Life, and Ann Ogden Gaffney and Fred Hutchinson Cancer Research Center’s Cook for Your Life. These sites were analyzed for the following: number of recipes, search functionality, child or family focus, cancer focus, specific dietary guidance, videos or other media, and miscellaneous unique features. RESULTS Cook for Your Life and Culinary Health Education for Families Recipe for Life were the most comparable to @TheTable with respect to cancer focus and family focus, respectively. Healthy Recipes is the least user-friendly, with few search options and no didactic videos. CONCLUSIONS The @TheTable e-cookbook is unique in its offering of child- and family-focused content centered on the cancer and survivorship experience.

Background: Subtypes of pediatric oncology patients and childhood cancer survivors who are overweight or obese have worse prognosis than their healthy-weighted peers. Several studies have examined weight status in either pediatric patients or survivors with acute leukemia, but few have compared these data across various diagnoses. Objectives: We examined BMI from oncology diagnosis or presentation, through treatment, and into survivorship across the most common cancer types seen in pediatric oncology. Methods: Patients were categorized into three oncologic diagnoses: leukemia and lymphoma (n = 69), neural tumors (n = 80), and non-neural solid tumors (n = 80) at yearly intervals over the course of 11 years. To allow for comparisons across age groups, BMI percentiles were calculated with

Home cooking programs are an increasingly popular approach to nutrition education and have the potential to promote diet quality among pediatric cancer survivors. A cornerstone of many programs is the use of fresh fruits and vegetables, which may support increased intake of many food components, including carotenoids, to improve survivor health. However, most dietary carotenoids in the United States currently come from processed vegetables, and it is unclear if the emphasis on fresh fruits and vegetables common in cooking education programs is associated with the total carotenoid content of meals. The objective of this analysis is to examine the relationship between fresh produce usage, practices commonly taught in healthy home cooking classes, and the carotenoid content of prepared meals among 40 parents with school-aged children. This is a secondary analysis of an observational study examining the quality of home cooking practices using an evidence-based index of behaviors, the Healthy Cooking Index (HCI). Nutrition-optimizing cooking practices, as quantified by the HCI, were not associated with the carotenoid content of meals (r = &minus, 0.24, p = 0.13). Further, total fruit and vegetable content of meals was not associated with total carotenoids (r = 0.14, p = 0.38), indicating heterogeneity in the carotenoid profiles of foods used by this population. High-carotenoid meals tended to use more canned and/or frozen tomato and vegetable products, and carotenoid content was associated with meals with sugar (r = 0.32, p = 0.04), and servings of refined grains (r = 0.49, p &lt, 0.01). Our findings indicate an opportunity to educate pediatric cancer survivors and families on the incorporation of high-carotenoid food products while reducing refined grain and sweetener intake through a tailored home cooking intervention.

Purpose: We aimed to identify potential intervention strategies to mitigate the influence of online cancer misinformation among young adult cancer patients and caregivers. Adolescent and young adult (AYA) patients and caregivers suffer from health disparities throughout the cancer experience, including lack of knowledge about resources and support available. Methods: Participants completed an online survey and semi-structured interviews over the telephone, which lasted 19-40 minutes (average= 33.7 minutes). We calculated descriptive statistics on sociodemographic and cancer factors. Participant's expectations and suggestions for interventions that mitigate cancer misinformation were categorized through qualitative description. Results: Of 50 screened participants, 17 completed an interview and an online survey (34% participation rate). Participants were 64.7% female, and relatively diverse: 52.9% White, 29.4% Black, 11.8% Asian, 5.9% American Indian/Alaska Native, and 5.9% preferred not to answer. Participants had multiple suggestions on how to improve social media cancer information for patients and caregivers in three areas: platform suggestions, clinician suggestions, and concerns about privacy. Feedback to resolve platform problems included adding filters/warnings to platforms to block insensitive or inaccurate information, adding more virtual events for cancer patients and caregivers (e.g., zoom calls or online conferences that share resources, personal stories, and provide interaction with fellow AYA patients/caregivers), and having an option to mute ads or suggested pages that contained cancer information. Participants also suggested that clinicians should be more vocal about recommending high quality cancer-based social media pages and online resources. Finally, some participants worried about the confidentiality of their cancer online. For example, some were concerned that online information seeking would lead their cancer diagnoses to be exposed to employers on social media. One suggestion to ameliorate this issue was to have an option of blocking specific accounts from seeing posts or group statuses that contained sensitive information about the cancer experience. Conclusions: Young cancer patients and caregivers are exposed to online cancer misinformation, and this may negatively influence their engagement in cancer care, relationships with others, and self-perception. We identify potential opportunities for social media businesses, health care teams, and legal entities to intervene with young patients and caregivers. Citation Format: Ashley J. Green, Keely Smith, Jennifer Traslavina Jimenez, Margaret Raber, Terry Badger, Echo L. Warner. Online cancer misinformation interventions for young adult cancer patients and caregivers [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-014.

Purpose: Adolescent and young adult (AYA) patients and caregivers identify unmet information needs as a top priority, in part, because they experience disparities throughout cancer, including higher mortality, financial toxicity, lack of support, and late diagnosis. While the Internet is increasingly used by this population for cancer information seeking, the perception of online information among AYAs is not well studied. We describe AYA patients and caregivers' experiences with online cancer information. Methods: From March-July 2021, we recruited participants via online repositories (e.g., ResearchMatch), posted flyers on social media, and a large AYA conference. We conducted telephone interviews with AYA cancer patients and caregivers who spoke English and were ages 18-39 (N=17). We summarized sociodemographic and cancer factors, then categorized feedback about participant's experiences with 1) cancer information/misinformation and 2) the influence of misinformation on their decisions and behaviors. Results: Average age was 32 years (SD: 3.9), 65% identified as female and 53% had a graduate degree. Daily social media use was common: Facebook (65%), Instagram (65%), YouTube (53%), Twitter (47%), LinkedIn (23%), TikTok (23%), Snapchat (18%) and Pinterest (18%). Participants noted that cancer information on social media is problematic because it is non-specialized, inaccurate and/or unhelpful. Over one-third felt cancer information on social media remains very inaccessible because it is vague or not relevant to their cancer diagnosis (e.g., rare cancers). Three participants experienced unsolicited advice or rude/insensitive comments online, including judgements about delaying treatment or pressure to maintain a toxic positivity about the cancer experience. The majority reported online misinformation focused on diet and lifestyle changes including using essential oils, taking supplements-like ESSIAC (e.g., herbal tea alternative to chemotherapy), changing to a vegan or sugar free diet, and/or drinking alkaline water. Misinformation exposure led participants to engage other online sources (i.e., WebMD) and their healthcare providers to investigate online claims. Some participants experimented with diet-related claims they deemed would have no detrimental effect on their health or treatment (i.e., drinking alkaline water). Participants who experienced unsolicited and insensitive comments blocked the user or unadded them from their personal pages, while one participant chose to completely stop posting their cancer experience on social media. Conclusions: AYAs may be especially vulnerable to online information that seeks to alter their perceptions of cancer, cancer treatment, and cancer caregiving, particularly in the context of lifestyle behaviors. If they felt it was safe, participants acted upon information of questionable legitimacy from social media. Other negative aspects of online cancer interactions influenced caregivers' decisions to leave online support communities and modify relationships with their social networks. Citation Format: Echo L. Warner, Margaret Raber, Ashley Green, Keely Smith, Jennifer Traslavina Jimenez, Terry Badger. An examination of online experiences among young adult cancer patients and caregivers reveals the pervasiveness and influence of diet and supplement-related misinformation [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-020.

Over and under nutrition are associated with worse outcomes for children with leukemia and lymphoma, however, the molecular basis for this clinical observation is not well understood. Many chemotherapeutics used for leukemia treatment are known to generate oxidative stress in vitro, therefore, we evaluated redox status and diet in pediatric leukemia patients during therapy in order to ascertain relationships between nutrition and oxidative stress. Dietary intake and redox measures in peripheral blood mononuclear cells from 32 pediatric leukemia and lymphoma patients were collected over six months during treatment. Baseline measures when patients were off chemotherapy and subsequent assessments were collected after one, two and six months. Oxidative stress increased over time in all patients, consistent with chemotherapy-induced redox effects. Older and younger children showed significantly different baseline levels of reactive oxygen species, which increased over time in all age ranges. Diet was assessed at points proximal to oxidative stress measurements and revealed a novel association with consumption of animal protein, vegetable protein, and total protein intake. Our findings demonstrate that chemotherapy increases oxidative stress in pediatric leukemia patients, and raises the possibility that dietary protein or altered protein metabolism could contribute to clinical outcomes.

Comprehensive cancer centers are an important community resource for cancer prevention education in their catchment areas. Colorectal cancer remains one of the most commonly diagnosed cancers in the United States, making prevention a priority. Colorectal cancer prevention targets include lifestyle modifications that are influenced by cultural norms, such as diet change, physical activity and screening behavior. Cancer centers must tailor prevention efforts to multiethnic catchment areas. This paper describes the development and feasibility of a comprehensive cancer center's approach to community-based colorectal cancer prevention in Houston, Texas, specifically targeting Hispanic and Asian populations. Sites were recruited through a city-wide network of partnerships between the community relations department in the hospital and community organizations. The program consisted of three workshop-style classes per community site. Each class had a similar overall structure, but cultural and site-specific adaptations were made for each group. A total of 33 classes were taught at nine distinct community sites to 1054 participants over 9 months. This program structure may be adapted for the future dissemination of other cancer prevention tools to communities in the area.

Eating out of the home has been positively associated with body weight, obesity, and poor diet quality. While cooking at home has declined steadily over the last several decades, the benefits of home cooking have gained attention in recent years and many healthy cooking projects have emerged around the United States. The purpose of this study was to develop an evidence-based conceptual framework of healthy cooking behavior in relation to chronic disease prevention. A systematic review of the literature was undertaken using broad search terms. Studies analyzing the impact of cooking behaviors across a range of disciplines were included. Experts in the field reviewed the resulting constructs in a small focus group. The model was developed from the extant literature on the subject with 59 studies informing 5 individual constructs (frequency, techniques and methods, minimal usage, flavoring, and ingredient additions/replacements), further defined by a series of individual behaviors. Face validity of these constructs was supported by the focus group. A validated conceptual model is a significant step toward better understanding the relationship between cooking, disease and disease prevention and may serve as a base for future assessment tools and curricula., Highlights • A conceptual model of healthy cooking based on the extant literature is proposed. • There is no standardized definition of healthy cooking behaviors. • The model is a first step in the development of assessment tools in this field.

Food insecurity is associated with limited food resources that may lead to poor nutritional intake and diet-related chronic disease. Food prescription programs offer an avenue for facilitating access to fresh and healthy nonperishable food while reducing food insecurity. The purpose of this pilot study is to examine the feasibility, perceptions, and impact of a collaborative food prescription program in an area with a high rate of food insecurity. The study was a single group pre-post evaluation design. Participants were recruited from two school-based clinics and one Federally Qualified Health Center in north Pasadena, an area with a high rate of food insecurity in Harris County, TX. Adult, food insecure participants were screened at health clinics for eligibility. Participants received nutrition education materials and 30 pounds of a variety of fresh produce plus four healthy, nonperishable food items every 2 weeks for up to 12 visits at a local food pantry. Surveys and tracking tools monitored food insecurity, program dosage, reach, fidelity, acceptability, and program costs. Surveys and key informant interviews assessed perceptions of health care providers, implementation staff, and participants. Participants (n = 172) in the program reported a 94.1% decrease in the prevalence of food insecurity (p < .01) at the end of the program. An average of 29.2 pounds of fruits and vegetables were distributed per family per distribution, and 99% of participants reported eating "all" or "most" of the food provided. Program costs were $12.20 per participant per redemption. Interviews revealed that providers and participants felt the program was well received and highly needed. This pilot study demonstrates the framework and feasibility of a collaborative clinic-based food prescription program to address food insecurity. Future research should examine the sustained impact of such programs on behavioral and health outcomes.

Objective:Survival rates for paediatric cancers have increased dramatically since the 1970s, but childhood cancer survivors (CCS) are at increased risk for several chronic diseases throughout life. Nutrition interventions promoting healthy family meals may support wellness for survivors, but little research has explored CCS family food preparation habits. The goal of the present study was to describe and compare food preparation practices of CCS and non-CCS families.Design:Observational.Setting:Typical evening meal preparation events were observed and recorded in participant homes. Recordings and notes were analysed using the Healthy Cooking Index (HCI), a measure of nutrition-optimizing food preparation practices relevant to survivor wellness. Demographics, BMI and nutrient composition of prepared meals were also collected.Participants:Forty parents with a CCS or non-CCS child aged 5–17 years were recruited.Results:There were no major differences between the CCS and non-CCS families with regard to summative HCI score or specific food preparation behaviours. Meals prepared by CCS and non-CCS families had similar nutrient compositions.Conclusions:The study revealed areas for practical nutrition intervention in CCS and non-CCS families. Future studies should consider adopting and tailoring nutrition intervention methods that have been successful in non-CCS communities.

The national Supplemental Nutrition Assistance program (SNAP) has been successful in reducing food insecurity among low-income Americans. However, the program has also been criticized as unhealthy food choices, and rates of diet-related chronic diseases remain high among SNAP beneficiaries. Recently, several multi-component interventions have targeted SNAP beneficiaries, aiming to improve how benefits are utilized to support a healthful diet. The aim of this scoping review is to examine the breadth of published interventions that have targeted SNAP beneficiaries, and their reported impact on diet and nutrition related outcomes. Using key search terms, a literature search of government and peer review databases was conducted. Twelve unique interventions were identified and categorized based on the type of intervention delivered: 1) monetary incentives 2) nutrition education, and 3) combined nutrition education plus monetary incentives. Across all interventions, monetary interventions showed modest improvements in reported fruit and vegetable intake among SNAP beneficiaries. While nutrition education interventions showed improvement in psychosocial correlates of diet, changes in dietary intake were inconsistent. Combination programs demonstrated the strongest improvements in dietary change among beneficiaries. Variability in types of outcomes measured limits comparability of findings across studies, and our findings calls for further evaluation in this area. This scoping review suggests using financial incentives combined with nutrition education may be effective in improving dietary intake among SNAP beneficiaries. Future research should integrate more robust study designs and consider multiple levels of intervention to effectively change beneficiary habits and in turn, reduce diet related disease in this population.

Objective: To determine whether a 10-week cooking and physical activity pilot intervention could be delivered in a health care setting. Development and feasibility of the program with a small sample size are explored. Methods: The MUNDO (Moviéndonos hacia Una Nutrición Divertida y Óptima) program was delivered weekly at a local primary care clinic. The curriculum included culturally sensitive cooking demonstrations, tastings, and organized physical activity sessions for children and their parents. Questionnaires and measurements were completed at baseline and completion of the study. Outcomes were feasibility, anthropometrics, and behavior change. Results: Four families were recruited, and 3 families attended 74% of the sessions. No significant changes in outcomes were reported. Families provided positive feedback about most aspects of the program. Conclusions: Future research is needed to understand how delivery of MUNDO could be optimized, within and beyond a clinic setting. Low-cost meal planning and cultural sensitivity of this program are unique features of MUNDO, which suggest that a larger trial with a greater number of participants and more rigorous recruitment would be warranted.

ObjectiveChildhood cancer survivors (CCS) have been shown to practise suboptimal dietary intake and may benefit from nutrition interventions during and after treatment. Cooking classes have become popular for encouraging healthy eating behaviours in community-based programming and academic research; however, literature on teaching cooking classes in CCS is limited. The purpose of the present study was to address the development and implementation of classes for CCS based on a recently developed framework of healthy cooking behaviour.DesignA conceptual framework was developed from a systematic literature review and used to guide healthy cooking classes for CCS in different settings.SettingOne paediatric cancer hospital inpatient unit, one paediatric cancer in-hospital camp programme and two off-site paediatric cancer summer camp programmes.SubjectsOne hundred and eighty-nine CCS of varying ages and thirteen parents of CCS.ResultsSeventeen classes were taught at camps and seven classes in the hospital inpatient unit. Healthy cooking classes based on the conceptual framework are feasible and were well received by CCS.ConclusionsCooking classes for CCS, both at the hospital and at camp, reinforced the principles of the conceptual framework. Future trials should assess the dietary and anthropometric impact of evidence-based healthy cooking classes in CCS.

Hispanic families are at elevated risk for certain diet related illnesses including obesity and diabetes. Brighter Bites is a 16-week school-based program that delivers produce and nutrition education to high-need areas. The purpose of this study was to explore the adoption of Brighter Bites healthy eating strategies in low-income Spanish-speaking families as well as barriers to the sustainability of improved dietary behaviors using Photovoice. Two researchers worked with a predominately Hispanic, low-income public school to conduct the project. Spanish speaking parents participating in Brighter Bites were recruited and five mothers completed the study. Participants developed research questions, took documentary photos, attended group analysis sessions, and organized a community event. Photos from participants were gathered at two time points: i) during the Brighter Bites produce distributions, and ii) when the distributions were no longer in session. Participants organized resulting photos into themes during discussion groups that proceeded each photo-taking period. Themes that emerged during the produce distribution period included: cost savings, increased variety and accessibility of fresh produce, and ability to practice healthy eating. Themes that emerged when the weekly produce distributions were no longer in session included: increased costs, lack of variety, the continued effect of Brighter Bites, and innovative ways to cook with produce. Overall, participants were enthusiastic about the benefits they experienced with the program, but noted hardships in accessing nutritious food without the produce distributions in session. Innovative approaches are needed to create sustainable pathways to healthful food access after community nutrition interventions are complete.

The purpose of this study was to evaluate the effectiveness of a new school-based food co-op program, Brighter Bites (BB), to increase fruit and vegetable intake, and home nutrition environment among low-income 1st graders and their parents. This was a non-randomized controlled comparative effectiveness trial (2013-2015). Six schools received BB (n=407 parent-child dyads); six comparison schools implemented a coordinated school health program (n=310 parent-child dyads) in Houston, Texas, 2013-2015. Brighter Bites (BB) is a 16-week school-based food co-op comprising weekly distribution of fresh produce (50 servings); nutrition education in schools and for parents; and weekly recipe tastings. Measurements included parent-reported home nutrition environment surveys, and food frequency questionnaires for parent and child. Intervention effects were examined using multivariate analyses. At baseline, the sample was 71% Hispanic, 24% African American; 43% of 1st graders were overweight/obese. Children receiving BB had significant increases in intake of fruit servings (P=0.046), vegetable servings (P=0.049), and decreased intake of added sugars (P=0.014). Among parents, there were significant increases in fruit consumed (P=0.032); vegetable intake increased baseline to midpoint but not post-intervention. Among BB families, there were significant improvements in the home environment including understanding and usage of nutrition facts labels to make food purchases (P

Background Quality of life in survivors of pediatric acute lymphocytic leukemia (ALL) can be compromised by chronic diseases including increased risk of second cancers, cardiovascular disease, and diabetes. Overweight or obesity further increases these risks. Steroids are a component of chemotherapy for ALL, and weight gain is a common side effect. To impact behaviors associated with weight gain, we conducted a randomized nutrition counseling intervention in ALL patients on treatment. Procedure ALL patients on a steroid-based treatment regimen at the MD Anderson Children's Cancer Hospital were recruited and randomized into control or intervention groups. The control group received standard care and nutrition education materials. The intervention group received monthly one-on-one nutrition counseling sessions, consisting of a baseline and 12 follow-up visits. Anthropometrics, dietary intake (3-day 24-hr dietary recalls) and oxidative stress measures were collected at baseline, 6 months, and postintervention. Dietary recall data were analyzed using the Nutrition Data System for Research. Results Twenty-two patients (median age 11.5 years), all in the maintenance phase of treatment, were recruited. The intervention group (n = 12) reported significantly lower calorie intake from baseline to 12-month follow-up and significant changes in glutamic acid and selenium intake (P < 0.05). Waist circumference was significantly associated with calorie, vitamin E, glutamic acid, and selenium intake. Conclusions A year-long dietary intervention was effective at reducing caloric intake in pediatric ALL patients receiving steroid-based chemotherapy, indicating that this is a modality that can be built upon for obesity prevention and management.

BACKGROUND Food co-op models have gained popularity as a mechanism for offering affordable, quality produce. We describe the challenges, successes, and lessons learned from implementation of a school-based program using a food co-op model combined with nutrition education to improve access to and intake of fresh fruits and vegetables among low-income children and their families. METHODS Brighter Bites is a 16-week intervention comprising of fresh produce deliveries, recipe demonstrations, and nutrition education. A mixed-methods approach was used comprising survey and focus group data collected from Brighter Bites staff, parents, and teachers. Descriptive statistics and frequencies were computed for the survey data collected. RESULTS Brighter Bites was implemented across 9 schools, serving a total of 1530 predominantly low-income families in the 2013-2014 school year. Brighter Bites distributed an average 60.2 servings of fresh fruits and vegetables per family per week. Lessons learned included the importance of leveraging existing infrastructure of food banks and schools to implement the program, early school and parent engagement, and incorporating strategies to track and optimize engagement. CONCLUSIONS Clear expectations and reliable partnerships are keys to the delivery of the Brighter Bites program.

Childhood cancer survivors (CCS) are at risk of becoming overweight or obese due to treatment effects and/or post-treatment behaviors. Parents are key agents influencing child diet and physical activity (PA), which are modifiable risk factors for obesity. A systematic literature review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was undertaken to evaluate current interventions that include diet and PA elements for CCS to determine if and to what extent parents were included, and whether parent involvement had a significant effect on behavioral outcomes or adiposity. A total of 2,386 potential articles were reviewed and 25 individual studies fulfilled inclusion criteria. Parental involvement was classified into three categories and varied across studies, although most had indirect or no parental involvement. The studies that included direct parental involvement showed positive outcomes on a variety of measures suggesting that increasing parental involvement in interventions for CCS may be one way to promote long-term lifestyle changes for pediatric cancer patients. However, additional research directly addressing parental involvement in obesity prevention and treatment among CCS is warranted.

BackgroundObesity has been a growing problem among children and adolescents in the United States for a number of decades. Childhood cancer survivors (CCS) are more susceptible to the downstream health consequences of obesity such as cardiovascular disease, endocrine issues, and risk of cancer recurrence due to late effects of treatment and suboptimal dietary and physical activity habits. ObjectiveThe objective of this study was to document the development of a Web-based cookbook of healthy recipes and nutrition resources to help enable pediatric cancer patients and survivors to lead healthier lifestyles. MethodsThe Web-based cookbook, named “@TheTable”, was created by a committee of researchers, a registered dietitian, patients and family members, a hospital chef, and community advisors and donors. Recipes were collected from several sources including recipe contests and social media. We incorporated advice from current patients, parents, and CCS. ResultsOver 400 recipes, searchable by several categories and with accompanying nutritional information, are currently available on the website. In addition to healthy recipes, social media functionality and cooking videos are integrated into the website. The website also features nutrition information resources including nutrition and cooking tip sheets available on several subjects. ConclusionsThe “@TheTable” website is a unique resource for promoting healthy lifestyles spanning pediatric oncology prevention, treatment, and survivorship. Through evaluations of the website’s current and future use, as well as incorporation into interventions designed to promote energy balance, we will continue to adapt and build this unique resource to serve cancer patients, survivors, and the general public.