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Citation:

Bannon K, Schwartz MB. Impact of nutrition messages on children's food choice: Pilot study. Appetite. 2006 Mar; 46(2): 124-129. Epub 2006 Jan 26.


PubMed ID: 16442667
Study Design:
Randomized Crossover Trial
Class:
A - Click here for explanation of classification scheme.
NEUTRAL: See Research Design and Implementation Criteria Checklist below.
Research Purpose:

To examine the effectiveness of gain-framed vs. loss-framed nutrition messages on short-term snack choices among kindergartners, based on the Prospect Theory. 

Inclusion Criteria:
  • Children in kindergarten from Connecticut's Economic Reference Group 'F'
  • Written parental consent.
Exclusion Criteria:
  • Food allergies
  • Sent to school nurse
  • Refused to choose a snack.
Description of Study Protocol:

Recruitment

The schools agreed to participate. Parents were sent a letter asking for permission for their children to participate. 

Design Group

Randomized controlled trial. 

Intervention

School children were randomly assigned to one of three groups to watch a 60-second video. One group of children watched a gain-framed nutrition message, one group of children watched a loss-framed nutrition message and the control group watched a neutral message unrelated to nutrition. Each class was exposed to one video only once. After viewing the video, the children had a short 10- to 15-minute play break. Then they were given the option to choose a snack. The choices were a snack-sized bag of animal crackers or an apple.

Statistical Analysis

  • Frequency analyses were conducted on the food health and food preference questionnaires, and chi-square analyses were used to test for significance between groups
  • Tests for significant changes in health ratings and preferences over time using repeated measures ANOVAs, using a Bonferroni correction for multiple comparisons
  • Fisher’s exact test was used to determine whether a pre-test preference for apples significantly predicted snack choice. The same analyses was used for the relationship between the children’s pre-test preference for animal crackers in the loss frame condition (Fisher’s exact) in the control condition.

 

Data Collection Summary:

Timing of Measurements 

Data collection was done within three days. Children viewed the video once and completed a Food Preference Questionnaire and Healthy Food Questionnaire, given at baseline and post-intervention. The order of the questionnaires was randomly assigned and counterbalanced pre- and post-video.

Dependent Variables

  • Snack choice after video
  • Food Preference Questionnaire
  • Healthy Food Questionnaire.

Independent Variables

Video type

  • Gain-framed nutrition message
  • Loss-framed nutrition message
  • No nutrition message.
Description of Actual Data Sample:
  • Initial N: N=53 in three classes 
  • Attrition (final N): N=50 (23 girls, 27 boys); 14 in gain-framed nutrition message class, 18 in loss-framed nutrition message class and 18 in the control class
  • Age: Not reported, but subjects were in kindergarten
  • Ethnicity: 46 white, two black, two Hispanic or Latin
  • Location: Connecticut.
Summary of Results:

Key Findings 

  • Among the children who saw one of the nutrition message videos, 56% chose apples rather than animal crackers; in the control condition only 33% chose apples
  • When the gain and loss frame conditions were combined and compared to the control group, the increase in the number of children choosing apples over animal crackers reached statistical significance X2 (1, 32)=7.56, P<0.01.  
Other Findings 
  • A significant majority of children indicated that the following foods were healthy at both the pre- and post-assessments: Apples, bananas, corn, eggs, milk, pizza and peppers
  • A significant majority of children also considered the following foods unhealthy at both time points: Ice cream, candy and animal crackers
  • Surprisingly, the number of children who considered French fries and soda unhealthy at both the pre- and post-test was not significantly greater than the number of children that considered these foods healthy.
Author Conclusion:

The findings of this study suggest that both gain- and loss-framed messages promoting healthy snacks have the potential to positively influence children’s behavior. The children in the gain-frame condition were more likely to choose apples than the children in the control group; however, because of the smaller sample size they did not have enough power to adequately detect this difference.

Reviewer Comments:
  • Self-report of kindergartners were all from same elementary school
  • Small numbers of subjects in groups, inadequate power
  • Length of study: Only short-term effect of the video was measured
  • Adequate amount of exposure: Video was only 60 seconds; researchers did not include if their attention was turned to something else
  • Moderating variables like typical dietary intake, parental feeding strategies and access to nutritious food were not taken into account
  • Review of literature is based on adults and gain- or loss-framed messages.

 


Research Design and Implementation Criteria Checklist: Primary Research
Relevance Questions
  1. Would implementing the studied intervention or procedure (if found successful) result in improved outcomes for the patients/clients/population group? (Not Applicable for some epidemiological studies)
Yes
  2. Did the authors study an outcome (dependent variable) or topic that the patients/clients/population group would care about?
Yes
  3. Is the focus of the intervention or procedure (independent variable) or topic of study a common issue of concern to nutrition or dietetics practice?
Yes
  4. Is the intervention or procedure feasible? (NA for some epidemiological studies)
Yes
 
Validity Questions
1. Was the research question clearly stated?
Yes
  1.1. Was (were) the specific intervention(s) or procedure(s) [independent variable(s)] identified?
Yes
  1.2. Was (were) the outcome(s) [dependent variable(s)] clearly indicated?
Yes
  1.3. Were the target population and setting specified?
Yes
2. Was the selection of study subjects/patients free from bias?
No
  2.1. Were inclusion/exclusion criteria specified (e.g., risk, point in disease progression, diagnostic or prognosis criteria), and with sufficient detail and without omitting criteria critical to the study?
Yes
  2.2. Were criteria applied equally to all study groups?
Yes
  2.3. Were health, demographics, and other characteristics of subjects described?
Yes
  2.4. Were the subjects/patients a representative sample of the relevant population?
No
3. Were study groups comparable?
Yes
  3.1. Was the method of assigning subjects/patients to groups described and unbiased? (Method of randomization identified if RCT)
Yes
  3.2. Were distribution of disease status, prognostic factors, and other factors (e.g., demographics) similar across study groups at baseline?
Yes
  3.3. Were concurrent controls used? (Concurrent preferred over historical controls.)
Yes
  3.4. If cohort study or cross-sectional study, were groups comparable on important confounding factors and/or were preexisting differences accounted for by using appropriate adjustments in statistical analysis?
N/A
  3.5. If case control or cross-sectional study, were potential confounding factors comparable for cases and controls? (If case series or trial with subjects serving as own control, this criterion is not applicable. Criterion may not be applicable in some cross-sectional studies.)
N/A
  3.6. If diagnostic test, was there an independent blind comparison with an appropriate reference standard (e.g., "gold standard")?
N/A
4. Was method of handling withdrawals described?
Yes
  4.1. Were follow-up methods described and the same for all groups?
Yes
  4.2. Was the number, characteristics of withdrawals (i.e., dropouts, lost to follow up, attrition rate) and/or response rate (cross-sectional studies) described for each group? (Follow up goal for a strong study is 80%.)
Yes
  4.3. Were all enrolled subjects/patients (in the original sample) accounted for?
Yes
  4.4. Were reasons for withdrawals similar across groups?
Yes
  4.5. If diagnostic test, was decision to perform reference test not dependent on results of test under study?
N/A
5. Was blinding used to prevent introduction of bias?
No
  5.1. In intervention study, were subjects, clinicians/practitioners, and investigators blinded to treatment group, as appropriate?
No
  5.2. Were data collectors blinded for outcomes assessment? (If outcome is measured using an objective test, such as a lab value, this criterion is assumed to be met.)
No
  5.3. In cohort study or cross-sectional study, were measurements of outcomes and risk factors blinded?
N/A
  5.4. In case control study, was case definition explicit and case ascertainment not influenced by exposure status?
N/A
  5.5. In diagnostic study, were test results blinded to patient history and other test results?
N/A
6. Were intervention/therapeutic regimens/exposure factor or procedure and any comparison(s) described in detail? Were interveningfactors described?
Yes
  6.1. In RCT or other intervention trial, were protocols described for all regimens studied?
Yes
  6.2. In observational study, were interventions, study settings, and clinicians/provider described?
N/A
  6.3. Was the intensity and duration of the intervention or exposure factor sufficient to produce a meaningful effect?
Yes
  6.4. Was the amount of exposure and, if relevant, subject/patient compliance measured?
No
  6.5. Were co-interventions (e.g., ancillary treatments, other therapies) described?
N/A
  6.6. Were extra or unplanned treatments described?
N/A
  6.7. Was the information for 6.4, 6.5, and 6.6 assessed the same way for all groups?
N/A
  6.8. In diagnostic study, were details of test administration and replication sufficient?
N/A
7. Were outcomes clearly defined and the measurements valid and reliable?
No
  7.1. Were primary and secondary endpoints described and relevant to the question?
Yes
  7.2. Were nutrition measures appropriate to question and outcomes of concern?
Yes
  7.3. Was the period of follow-up long enough for important outcome(s) to occur?
No
  7.4. Were the observations and measurements based on standard, valid, and reliable data collection instruments/tests/procedures?
Yes
  7.5. Was the measurement of effect at an appropriate level of precision?
No
  7.6. Were other factors accounted for (measured) that could affect outcomes?
No
  7.7. Were the measurements conducted consistently across groups?
Yes
8. Was the statistical analysis appropriate for the study design and type of outcome indicators?
Yes
  8.1. Were statistical analyses adequately described and the results reported appropriately?
Yes
  8.2. Were correct statistical tests used and assumptions of test not violated?
Yes
  8.3. Were statistics reported with levels of significance and/or confidence intervals?
Yes
  8.4. Was "intent to treat" analysis of outcomes done (and as appropriate, was there an analysis of outcomes for those maximally exposed or a dose-response analysis)?
N/A
  8.5. Were adequate adjustments made for effects of confounding factors that might have affected the outcomes (e.g., multivariate analyses)?
Yes
  8.6. Was clinical significance as well as statistical significance reported?
Yes
  8.7. If negative findings, was a power calculation reported to address type 2 error?
N/A
9. Are conclusions supported by results with biases and limitations taken into consideration?
Yes
  9.1. Is there a discussion of findings?
Yes
  9.2. Are biases and study limitations identified and discussed?
Yes
10. Is bias due to study’s funding or sponsorship unlikely?
Yes
  10.1. Were sources of funding and investigators’ affiliations described?
Yes
  10.2. Was the study free from apparent conflict of interest?
Yes
 
 

Copyright American Dietetic Association (ADA).