Fuel for Fun: A cluster-randomized controlled study of cooking skills, eating behaviors, and physical activity of 4th graders and their families
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BACKGROUND: Childhood obesity remains a serious concern in the United States and in many other countries. Direct experience preparing and tasting healthful foods and increasing activity during the school day are promising prevention approaches. Engaging parents and families remains an important challenge. Fuel for Fun: Cooking with Kids Plus Parents and Play is a multi-component school- and family-based intervention for 4th graders and their families intended to promote positive food and activity environments, policies and behaviors at the individual, family and school levels. This paper describes the design and evaluation plan. METHODS/DESIGN: Four cohorts of 4th-graders and their parents from 8 schools in 2 districts in the same Northern Colorado region are participating in a 4-arm cluster randomized controlled trial. Theory-based Fuel for Fun consists of 5 components delivered over 1 school year: 1) Cooking with Kids - Colorado; an experiential classroom-based cooking and tasting curriculum, 2) Cafeteria Connections; cafeteria-based reinforcements of classroom food experiences using behavioral economic strategies, 3) SPARK active recess; a playground intervention to engage children in moderate to vigorous activity, 4) Fuel for Fun Family; multi-element supports targeting parents to reinforce the 3 school-based components at home, and 5) About Eating; an online interactive program for parents addressing constructs of eating competence and food resource management. Outcomes include child and parent measures of fruit and vegetable preferences and intake, cooking, physical activity, sedentary behaviors and attitudes. School level data assess lunch plate waste and physical activity at recess. In-depth diet and accelerometry assessments are collected with a subsample of parent-child dyads. Data are collected at baseline, immediately post-intervention at 7 months, and at 12 month follow-up. We anticipate recruiting 1320-1584 children and their parents over the length of the project. DISCUSSION: The Fuel for Fun study design allows for impact assessment of school-, family- and online parent-based intervention components separately and in combination. Study strengths include use of theory- and evidence-based programs, valid child and parent self-report instruments, and objective measures of food, cooking, and physical activity behaviors at the individual, family and school levels. Parent involvement and engagement is examined through multiple strategies. TRIAL REGISTRATION: Clinicaltrials.gov registration number NCT02491294 . Registered 7 July, 2015.
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Seventeen of the included studies were assessed as high risk of detection bias.
“Seventeen of the included studies were assessed as high risk [26, 28, 37, 41, 43, 44, 46–49, 52, 54–56, 58, 66, 67] and seven studies were assessed as low risk of detection bias [27, 42, 51, 53, 60, 62, 63].”
From Improving implementation of school-based healthy eating and physical activity policies, practices, and programs: a systematic review (2021) · cites this paper as [44]
Thirteen studies, including four RCTs, were assessed as unclear risk of selection bias as methods of sequence generation and allocation were not reported.
“Thirteen studies, including four RCTs were assessed as unclear risk of selection bias as methods of sequence generation and allocation were not reported [44, 46, 47, 50, 51, 54–56, 58, 64, 66, 67].”
From Improving implementation of school-based healthy eating and physical activity policies, practices, and programs: a systematic review (2021) · cites this paper as [44]
Ten studies were assessed as low risk of selective reporting as a trial registration or a published protocol paper was identified and all a priori determined outcomes were reported.
“Ten studies were assessed as low risk of selective reporting as a trial registration or a published protocol paper was identified and all a priori determined outcomes were reported [26, 44, 51, 53, 54, 60, 62–64, 67].”
From Improving implementation of school-based healthy eating and physical activity policies, practices, and programs: a systematic review (2021) · cites this paper as [44]
Cunningham et al. reported reductions in the percentage of energy from fat provided at school breakfast and lunch from -3.3% to -2.7%.
“For example, Cunningham et al. reported reductions in the percentage of energy from fat provided at school breakfast and lunch from –3.3% to –2.7% [44].”
From Improving implementation of school-based healthy eating and physical activity policies, practices, and programs: a systematic review (2021) · cites this paper as [44]
Among studies reporting other continuous implementation outcomes (e.g., quantity of physical activity lessons), findings were mixed.
“Among studies reporting other continuous implementation outcomes (e.g., quantity of physical activity lessons), findings were mixed [43, 44, 46, 48, 49, 59, 64, 66].”
From Improving implementation of school-based healthy eating and physical activity policies, practices, and programs: a systematic review (2021) · cites this paper as [44]
There is an accumulating body of evidence to suggest that implementation strategies have resulted in small improvements in the availability and provision of healthy foods in schools.
“While limited, there is an accumulating body of evidence to suggest that implementation strategies have resulted in small improvements in the availability and provision of healthy foods in schools [40, 44, 52].”
From Improving implementation of school-based healthy eating and physical activity policies, practices, and programs: a systematic review (2021) · cites this paper as [44]
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- [58]Cunningham-Sabo L, Hanika-Ortiz A, Walters L, Stacey J, Lohse B. Process evaluation measures of experiential foods program for elementary schoolchildren. In: American Public Health Association Annual Conference: 2008. San Diego: American Public Health Association; 2008. https://apha.confex.com/apha/136am/webprogram/Paper178625.html.
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Camp‐Spivey, L. J., Newman, S. D., Stevens, R. N., & Nichols, M. G. (2022) · Journal of School Health · doi:10.1111/josh.13228 · Cited by 1 · see citing works
Perdew, M. (2019) · UVic’s Research and Learning Repository (University of Victoria) · Cited by 1 · see citing works
Randall, J. L. (2016) · DigitalCommons (California Polytechnic State University)
Interviews Define Face Validity of Physical Activity Survey Items with Fourth Graders
Wayman, E. (2017) · RIT Scholar Works (Rochester Institute of Technology)
Perceptions of a community-based cooking skills and nutrition education class
Powell, M. C. (2020) · UTC Scholar (University of Tennessee at Chattanooga)
Quantifying Parent Engagement in Fuel for Fun Identified Design Considerations and BMI RelationshipsPreprint
Lohse, B., & Cunningham-Sabo, L. D. (2021) · Research Square · doi:10.21203/rs.3.rs-211232/v1
Self-citationInvolving parents in lifestyle interventions for children
Harms, L. S. E. (2024) · doi:10.26481/dis.20240524lh
An exploratory pre-post test evaluation of an online family cooking intervention: Up for Cooking
Harms, L. S. E., Gubbels, J. S., van Assema, P., Gerards, S. M. P. L., & Bessems, K. M. H. H. (2025) · Journal of Nutritional Science · doi:10.1017/jns.2025.10034
- Authors
- Cunningham-Sabo, L., Lohse, B., Smith, S., Browning, R., Strutz, E., Nigg, C., Balgopal, M., Kelly, K., & Ruder, E.
- Affiliations
- Colorado State University (US)
- Rochester Institute of Technology (US)
- Nike (United States) (US)
- Aims Community College (US)
- University of Hawaiʻi at Mānoa (US)
- Corresponding author
- Cunningham-Sabo, Leslie
- ORCID
- Venue
- BMC Public Health
- Published
- 2016-05-26
- Volume
- 16
- Issue
- 1
- Pages
- 444-444
- ISSN
- 1471-2458 (ISSN-L)
- PMC
- PMC4882848
- OpenAlex
- W2407558766
- Cited by
- 36
- References
- 61
- Citations by year
- 2025: 1 · 2024: 4 · 2023: 3 · 2022: 4 · 2021: 7 · 2020: 4 · 2019: 6 · 2018: 3 · 2017: 3 · 2016: 1
- FWCI
- 4.30
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- BMC Public Health (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Bern Open Repository and Information System (University of Bern) (submittedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Open Access CRIS of the University of Bern
- Funders
- National Institute of Food and Agriculture (2012-68001-19603)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
- Health Sciences › Nursing › Nutrition and Dietetics › Nutrition, Health and Food Behavior
- Health Sciences › Health Professions › Speech and Hearing › School Health and Nursing Education
- Keywords
- childhood obesity prevention, cooking skills, family intervention, school-based intervention, dietary habits, physical activity, recess, sedentary behavior, fruit and vegetable intake, food preferences, parental involvement, behavioral economics, eating competence, food resource management
- MeSH terms
- Child, Child Health Services, Colorado, Cooking, Family Characteristics, Feeding Behavior, Female, Humans, Male, School Health Services, Exercise, Pediatric Obesity
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