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1、Contents lists available at ScienceDirectPhysiology Received in revised form 4 April 2018; Accepted 4 April 2018E-mail address: fulke001@umn.edu.Physiology less frequently they indicated that pre-packaged processed mea

2、ls were the “only thing the whole family wouldeat”. These findings demonstrate the influences of time scarcity, bud-getary concerns and lack of cooking skills. Study findings did not differby receipt of economic assistan

3、ce, work-life balance, marital status orthe number of individuals in the household. Similarly, a study by Bauerand colleagues [39] showed that work-life stress of parents was notsignificantly associated with frequency of

4、 fast food family meals. Ad-ditionally, data from the USDA [10] showed that households withchildren had the largest difference in meal preparation time betweenthose that purchased fast food and those that did not. Thus,

5、it could bethat adults in households with children who do not spending much timeon meal preparation are more likely to purchase fast food. In the studyby Horning and colleagues, self-efficacy for cooking and meal plannin

6、gability were significantly associated with 5 out of the 6 reasons forpurchasing prepackaged processed meals [38]. These findings indicatethat if self-efficacy and meal planning ability were increased, we maysee less pre

7、packaged processed meal purchasing. Research by Thorntonand colleagues [40] also showed that confidence in shopping forhealthful foods and confidence in cooking healthful foods were sig-nificantly associated with infrequ

8、ent fast food consumption so the moreconfidence someone had to shop for healthful foods or cook them, theless likely they were to eat fast food. The lure and ease of fast food maybe difficult to overcome but parents have

9、 suggested specific obstaclesthat research and health promotion programs should address. Pressureon families to eat more healthfully with little time for meal preparationhas led to a plethora of cookbooks and websites to

10、 reduce preparationtime on busy nights for busy families. These are supportive resourcesbut not everyone has the skills to take advantage of them.9. Possible solutionsBased on the literature, there are some solutions to

11、the dilemma ofreliance on fast food by both reducing access to these unhealthful foodsand increasing access to healthful foods. At the policy level, researchhas been conducted to estimate the effectiveness of federal pol

12、iciesrelated to sugar-sweetened beverages (SSB) excise taxes and bans onchild-directed fast food TV advertising and suggest that SSB taxes maybe the most impactful on obesity prevalence [41,42]. There are alsolocalized e

13、xamples of zoning regulations restricting opening/re-modeling of standalone fast food establishments [43]. In addition torestrictions and bans, the impacts of calorie labeling on consumer andrestaurant behavior has been

14、studied [44]. Unfortunately, the reviewconcluded that the results were mixed owing to a lack of well-poweredstudies with strong designs [44]. Yet, a recent study indicates menulabeling in fast food establishments may res

15、ult in healthier food andbeverage selection patterns [45]. In direct attempts to reduce marketingof unhealthful, competitive foods to children, federal nutrition stan-dards were developed for schools (citation) and compl

16、iance does notappear to require vast monetary resources [46]. These policy solutionsare important for public health. However, with the exception of someschool-based fruit and vegetable promotion programs [47], they do no

17、tnecessarily empower families to make healthful changes within theirhomes (except when fast food is brought home for a meal).Specifically for families, easy access to healthful and affordablefoods can be accomplished by

18、using farmers markets and gardens andpromotion programs already exist [48]. We also need to counteractmarketing to children and reduce purchases of unhealthful foods andreduce conflict between parents and children as not

19、 many positivechanges can be seen from industry [49]. We need to educate families onthe health consequences of fast food consumption and give them otheralternatives. Lastly, and importantly, we need to assist parents inm

20、aking healthier choices for their families using practical and fun so-lutions.One fun and practical solution to address the lack of self-efficacyand meal planning described by parents is to develop effective inter-ventio

21、ns that increase self-efficacy for meal planning and cooking, ef-fectively build skills, and promote serving of appropriate portion sizes.A review of cooking interventions of research published between 1980and 2011 evalu

22、ated intervention effectiveness when cooking or homefood preparation was the primary aim [50]. The review included 28studies of varying design and quality. Because of the differences in thestudies, it was difficult for t

23、he authors to make substantial re-commendations on the effectiveness; however, overall the findingssuggested a positive influence on the main outcomes.Since 2011, several interventions have been developed to teachcooking

24、 skills to families. Our team recently health promotion inter-vention research with families of 8 to 12 year old children and theirfamilies. The Healthy Home Offerings via the Mealtime Environment(HOME) Plus study was a

25、family meals-focused obesity preventionprogram with a randomized controlled trial design [51,52]. Our goalwas to promote healthful eating through fun nutrition education and byinvolving children in meal preparation throu

26、gh the use of family meals.It was an interactive, experiential, nutrition education program withhands-on meal preparation [53]. We delivered the program in com-munity settings to multiple groups of families at one time.

27、Parents inthe program supported each other by providing advice and their ownlessons learned, and all families were able to cook meals together. Theywere taught how to meal plan and cook using recipes and suppliesprovided

28、 for them at the sessions. The program produced a significantand sustained increase in parent self-efficacy for identifying appropriateportion sizes [54]. We also demonstrated significant differences bytreatment group in

29、 sugar-sweetened beverage consumption, with lessconsumption among children in the intervention group [54]. The mainoutcome of the randomized trial was children's BMI z-score. Un-fortunately, we did not see significan

30、t group differences between in-tervention and control groups in BMI z-scores [51]. However, we didsee statistically significant pubertal onset-by-treatment group interac-tions in both post-intervention and follow-up mode

31、ls. Subsequent sub-group analysis indicated a treatment group effect among prepubescentchildren only at both post-intervention and follow-up time points [51].This work has led us to focus our current family meals interve

32、ntionswith younger children before they initiate puberty to see if the programwill impact weight outcomes by treatment group with a youngersample. The HOME Plus program will be refined and modified for fu-ture use with t

33、he goal of developing and delivering an effective obesityprevention program.Since our research focuses on promoting family meals, some of ourrecent research has been conducted to learn more about the mealtimecontext to a

34、ssist with improvements in the program. We have foundthat dinner time routines (i.e., roles at dinner time, structure arounddinner time, expectations for being at dinner, people feel strongly aboutJ.A. Fulkerson Physiolo

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