research paper about cooking skills

Community Interventions to Improve Cooking Skills and Their Effects on Confidence and Eating Behaviour

Public Health and Translational Medicine (MEJ Lean, Section Editor)
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Published: 17 October 2016
Volume 5 , pages 315–322, ( 2016 )

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Ada L. Garcia 1 ,
Rebecca Reardon 2 ,
Matthew McDonald 1 &
Elisa J. Vargas-Garcia 3

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Purpose of Review

Community-based interventions aiming to improve cooking skills are a popular strategy to promote healthy eating. We reviewed current evidence on the effectiveness of these interventions on different confidence aspects and fruit and vegetable intake.

Recent Findings

Evaluation of cooking programmes consistently report increased confidence in cooking skills in adults across different age groups and settings. The effectiveness of these programmes on modifying eating behaviour is less consistent, but small increases in self-reported consumption of fruit and vegetables are also described. Lack of large samples, randomization and control groups and long-term evaluation are methodological limitations of the evidence reviewed.

Cooking skill interventions can have a positive effect on food literacy, particularly in improving confidence on cooking and fruit and vegetable consumption, with vulnerable, low-socieconomic groups gaining more benefits. Consistency across study designs, delivery and evaluation of outcomes both at short and long terms are warranted to draw clearer conclusions on how cooking programmes are contributing to improve diet and health.

Prevalence and socio-demographic correlates of cooking skills in UK adults: cross-sectional analysis of data from the UK National Diet and Nutrition Survey

Wider impacts of a 10-week community cooking skills program - Jamie’s Ministry of Food, Australia

Nutrition and culinary in the kitchen program: a randomized controlled intervention to promote cooking skills and healthy eating in university students – study protocol.

Avoid common mistakes on your manuscript.

Introduction

Poor diet is a major risk factor linked to obesity and other comorbidities. Low education attainment, low income and high socioeconomic deprivation are main factors associated with poor diet [ 1 , 2 ]. These factors tend to increase the likelihood of inadequate food access, low food and nutrition literacy and lack of practical cooking skills in economically deprived households [ 3 ]. Currently, there is growing evidence linking home cooking with healthier dietary choices, particularly for higher intakes of fruits, vegetables, and whole grains [ 4 ]; whilst eating outside the home has been associated with an increased consumption of ready-to-eat meals and calorie-dense convenient foods [ 5 ]. Considering that ‘not knowing how to cook’ stands as barrier to healthful food preparation [ 6 ], the delivery of community cooking skill programmes has gained attention in public health agendas as a vehicle to improve and promote confidence, well-being, and enhance meal quality and preparation practices [ 7 ••, 8 ]. These programmes have increased and continue to increase in popularity because they offer a valuable channel to engage with vulnerable groups via inclusive social activities, whilst positively impacting their dietary profiles and health outcomes [ 8 ].

The term ‘cooking skills’, within public health nutrition, has been generally used to portray a combination of mechanistic and physical skills that are applied during home food preparation, such as ‘chopping vegetables’, ‘stir-frying’, or ‘cooking rice’ [ 9 ]. Nevertheless, the term has also been recognised to encompass the accomplishments beyond technical activities, including preparation, conceptual and perceptual abilities on food handling, safety and storage, and other factors related to chemistry and nutrition [ 9 , 10 ]. Likewise, the emerging concept of ‘cooking competence’, as a shift from the traditional technical-centred approach, has been proposed as a merge between knowledge and skills to enable nutritious meal preparations whilst concomitantly incorporating aspects of planning, budgeting, storing, eating, and waste disposing [ 10 ]. Condransky and Hegler refer to the former as ‘culinary nutrition’ [ 11 ] and have further emphasised that pairing nutritional knowledge with practical demonstrations is warranted to achieve changes in eating behaviours, as the provision of information alone has been found to be ineffective to bring about behavioural change [ 12 ]. Recently, the term ‘food literacy’ has been proposed as a concept that covers all definitions described above: cooking skills, cooking competences, and culinary nutrition. Indeed ‘food literacy’ encompasses a more holistic approach to describe the practicalities needed to meet nutrition recommendations: plan, management, selection, preparation, and consumption.

The emerging interest on cooking skills has coincide with a concern in the marked declines in home cooking as reported in the UK in the 1980s [ 13 ]. These reductions were also observed in the in the UK [ 14 ] and the USA [ 15 ] after curricular culinary lessons were removed from educational platforms. In Canada, the re-introduction and reinforcement of cooking skill programmes using the ‘school as a community’ approach showed effective on engaging children, adolescents, and parents in food literacy and meal preparation whilst strengthening local ownership [ 16 ]. Additionally, a number of national and local campaigns have been established in several Western countries to promote cooking skill strategies amongst vulnerable, low-income communities such as, ‘What’s Cooking’ [ 17 ], ‘Get cooking’ [ 18 ], ‘Cooking Matters’ [ 19 ], ‘Jamie’s Ministry of Food’ [ 20 ], and the ‘Stephanie Alexander Kitchen Garden (SAKG) Program’ [ 21 ].

Whilst the evaluation of public health interventions is necessary to identify their effectiveness, accountability, and adaptation, the evidence on the short- and long-term impacts and sustainability of community cooking skill programmes remains limited [ 22 ••]. Evidence suggests large heterogeneity in the structure and delivery of cooking programmes, and this varies in target populations, settings, course content and length, modes of delivery, and the outcomes measured; nevertheless, most of these initiatives include outcome elements related to confidence, skills, and eating behaviours. The present narrative review provides an overview on the effectiveness of community cooking skill interventions on cooking confidence and eating behaviours namely fruit and vegetable intake, which is often used as a proxy for a healthy diet.

Main Outcomes of Cooking Skill Programmes: Eating Behaviours

Interventions have been heterogeneous in the activities delivered to meet groups’ needs, which is inherent to their own planning and funding [ 22 ••]. However, as portrayed in Tables 1 and 2 , most of the initiatives have been conducted in the UK, Australia, and USA, with adults often being a secondary target to reach children. Indeed, there is emphasis placed over parental involvement on delivery of school-based interventions, as they are perceived as a key feature to impacting children’s eating behaviours and confidence in home cooking [ 31 ]. Alternatively, approaches, like in the Jamie’s Ministry of Food [ 20 ] initiative, which focus on teaching young adults basic food preparation skills and nutritional knowledge to influence healthfulness of meal preparation within the family home, can be modelled and transferred to others. Yet, debate still exists [ 13 ] over which targeted populations—children, adolescents, adults, or seniors—would most require and benefit from these interventions and so as to tailor programme development (gaining a ‘best fit’) and resource allocation (a ‘best buy’).

The duration of cooking courses has varied from a week to 2 years, with all of them being group-based, which emphasises the social relevance of this mode of delivery to enhance stronger support networks, building capacity and feelings of cohesion and efficacy [ 32 ]. Alongside the variability of intervention components, the tools used to measure the progress on food-related outcomes and dietary practices are diverse. Most tools used, albeit validated, are comprised of self-administered questionnaires on dietary behaviours, completed by the participants or child’s parents; but some studies have used mixed methods to further explore the participants’ experiences of the programmes [ 25 , 28 , 33 ]. Some items captured included perceived changes in confidence to applying different cooking techniques, following a recipe, making a meal from raw ingredients (widely referred to as ‘from scratch’), the willingness to try new foods, changes in self-esteem, and questions on dietary practices reflected in usual intakes of snacks, take-away meals, and fruits and vegetables. All of the former reported on likert/agreement scales varying in point scores, which accentuate the lack of consistency in the development and evaluation of cooking skill-based health initiatives [ 34 ].

Effects on Fruit and Vegetable Consumption

Increasing fruit and vegetable consumption is a key strategy to improve diet, yet intakes remain significantly below recommended levels, especially across socially disadvantaged groups who constitute a majority of the targeted populations for cookery initiatives [ 3 , 9 ]. Cooking skill programmes have aimed to expose participants to new foods, as a means to increase variety and facilitate adherence to current dietary guidelines for fruit and vegetable consumption. In a study evaluating the impact of a 4–8-week cooking skill programme in a mainly rural adult population in Ayrshire and Arran, Scotland, sustained improvements in fruit and vegetable intakes were documented [ 27 •]. Similarly, recent evidence has highlighted significant self-reported increases in daily fruit and vegetable intakes by 1.5 portions in adults after attendance to an 8-week cooking course in urban Leeds, England [ 25 ]. Nevertheless, the lack of randomisation to a comparator or control group in both studies does not allow causality between exposure to the cooking sessions and outcomes to be established, as confounding is likely. Participants who attend cooking classes might be more motivated to change their behaviours, and reporting bias is a limitation in most cooking skill interventions, due to the self-reported nature of the questionnaires administered [ 22 ••, 35 •]. Additionally, individuals from lower socioeconomic groups might have a lower baseline intake and, thus, are prone to exhibit greater benefits/changes; however, this can also be considered a strength because these are the desired target groups.

A commonly shared feature across most cooking interventions is the opportunity to taste the foods produced at the end of each session. This strategy has shown promising outcomes for social bonding, linkage and encouragement of group discussion, whilst also offering a starting point for the modification of neophobic responses towards disliked, rejected or foods not eaten [ 36 ] such as fruit and vegetables. Exposure itself, or watching peers eating certain foods, provides participants with a modelling experience in which the behaviour can be enacted or copied. Qualitative results from the evaluation of the SAKG school-based programme highlighted an increase in children’s willingness to try new foods with exposure strategies, particularly vegetables [ 21 ]. Nevertheless, in the SAKG programme, parental reports highlighted only small improvements in consumption patterns, with 70 % of the children still not having at least two daily servings of fruit and less than 10 % meeting the Australian recommendation of five portions of vegetables per day. The ‘Edible School Garden’ at the Berkeley School district in the USA offers another example which integrates gardening activities together with a food preparation component [ 15 ]. This programme, founded by celebrity chef Alice Waters, seeks the exposure of children to growing, cooking and tasting new foods whilst slowly integrating these activities into the regular school curriculum. Three-year follow-up results revealed that children at schools with higher involvement in the initiative (offering up to 1.5 h per week for cooking and gardening instruction vs no practical cooking sessions) had increased fruit and vegetable intake by more than one serving daily in comparison to students with lesser developed school activities. However, as effects weakened during the transition from elementary to middle school, maintenance of this initiative was emphasised as part of the programme enhancements through pre-adolescence. Furthermore, evidence from two systematic reviews [ 35 •, 37 ] has also indicated the short-term success of cooking initiatives to increase participants’ range of preferences and self-reported intakes of fruit and vegetables after repeated exposures.

Cooking Confidence: What Is It and How Is It Measured?

One of the main aims of cookery programmes has been to increase participants’ cooking confidence. The concept varies in meaning as it may involve the ability to adequately measure ingredients, cut up fruits and vegetables, follow a recipe, use fresh ingredients or be comfortable with basic culinary techniques [ 38 ].

In two studies evaluating the effectiveness of Jamie’s Ministry of Food 10-week community-based cooking skill programme in Ipswich, Australia [ 7 ••, 23 ], results showed an increase in cooking confidence, psychosocial factors, food procurement behaviour, healthier cooking and enjoyment in meal preparation at the end of the programme and 6-month follow-up. Evaluation of the same initiative in the UK also highlighted increases in confidence scores for both assessment periods [ 25 ]. However, the latter study may have had a skewed sample with participants having previous cooking experience, as expressed by certain comments on advanced culinary sessions desired and considered that a fee was required to be enrolled in the course.

Work from Laska and colleagues [ 39 ] on a cohort of 1321 individuals living in urban Minnesotta, USA followed from youth until adulthood also highlighted that a higher frequency of food preparation during adolescence was associated with increased likelihood of enjoying cooking in their mid-late twenties (β=0.18, p < 0.01). Furthermore, adolescents that assisted with dinner preparation at least once or twice per week, in comparison to those that did not, were significantly more likely to buy fresh vegetables (19.4–33.9 %, p < 0.001) and prepare a meal with chicken, fish or vegetables (44.9–52.4 %, p = 0.01) in emerging adulthood. Though some behaviours did not appear to track in later years, it is suggestive that exposure to cooking in teenage years could influence confidence and other health behaviours in subsequent years to some extent.

Evaluation of a single-arm cooking intervention in male seniors from a retirement centre in Canada [ 29 ] indicated modest improvements at follow-up (8 months after commencement of the programme) in attitude towards healthful meal preparations, increased confidence in cooking more complex dishes and decreased food neophobia. Whilst changes from baseline to follow-up remained non-significant, interviews with participants emphasised that the majority gradually had developed multiple skills and healthier culinary strategies. The authors attributed a failure to detect significant differences after the programme to the small sample size ( n = 19) and difficulties to bring about change in men’s perception of their own culinary abilities. It is also possible that these results were influenced by participants’ initial description of their own skills, with 70 % of them indicating knowing how to prepare basic dishes. A further study in older adults also in Canada used a larger sample ( n = 144) and showed small but significant increases from baseline to post-intervention in nutritional knowledge, confidence to eat healthy and eating behaviours, including a higher number of participants achieving five or more fruit and vegetables a day [ 26 ]. Interestingly, the reported baseline values were already high and a high completion rate was reported. This could have been due to a monetary incentive offered for completion. Nevertheless, the reviewed studies aimed at senior participants show positive outcomes in both confidence and eating behaviours.

Previous systematic reviews [ 22 ••, 31 , 35 •, 37 , 38 ] have shown short-term improvements in cooking confidence both in children and adults taking part in culinary interventions. Nevertheless, measurement of confidence remains problematical as self-perceived level of confidence by participants may not coincide with their actual skill level, and so evaluation of skills parallel to attitudes has been highlighted as a more objective indicator of programme outcomes [ 31 ].

In 2015, Community Food and Health Scotland (CFHS) published a report documenting a comprehensive review of the grey literature, using a realist synthesis approach, to seek out which strategies/approaches aided the most in achieving the outcomes/goals of cooking skill programmes targeting vulnerable and low-income populations. The results identified course practitioners as key elements in delivering evidence-based practice to strengthen, target, tailor and reinforce programmes via multiple and diverse strategies in a variety of settings. These included, but not limited to, encouraging participants to influence content/recipe selection, adjusting session focuses, having tasting periods, eating together at the end of class and supporting peers in the learning process through social interactions. They also found that the theories of outcome expectance, personal relevance, positive attitudes, self-efficacy and descriptive and subjective norms were used more regularly to strengthen and focus behavioural changes. Whilst positive, the review did uncover that most of the literature lacked clarity in the plans, implementation and evaluation (methods and tools) of the cooking skills programmes, which in turn can impede outcome measure conclusions, duplicability and ultimately further funding of the programme. They concluded that cooking activities delivered by community-based initiatives were successful on targeting and reaching low-income and vulnerable groups and that good practice by deliveries was consistent, and some of them used specific concepts related to behaviour change theory, ie. self-efficacy, salience and social norms were used more frequently than goal setting [ 19 ].

The introduction of new technologies (such as those integrating image-based methods including videos or photos) could possibly provide another approach to measure outcomes of cooking interventions; yet, considering the vulnerability of the targeted groups, the use of such methods (often more invasive) could be detrimental to follow-up rates, as keeping ‘captive audiences’ remains one of the main challenges across most studies.

Implications for Future Research

There is a plethora of public health nutrition interventions using the delivery of cooking skills as a practical element of nutrition promotion, which shows positive results on food literacy. However, the quality of the studies published until now reflects the complexity of performing studies involving free living individuals. The lack of interventions with rigorous study designs that use randomization or have control groups is an emerging problem faced by health practitioners who wish to improve their practice based on evidence. However, this needs to be considered in the context of complex interventions in free living subjects in which a rigorous RCT design proves impossible, thus finding alternative ways for generating evidence is guaranteed. Furthermore, evaluation plans are often not incorporated within programme delivery, resulting in a lack of data on process and longer term outcomes to support their sustainability [ 32 ]. Most evaluation tools used across studies have not been validated, are subjected to selection bias, are highly reliant on self-reporting or use varying definitions and measurements of eating/cooking behaviours [ 34 ]. These factors can make drawing conclusions on the effectiveness of cooking skill interventions to improve food preparation and health behaviours difficult [ 8 ].

Process evaluations are important to undertake to ensure that programmes are being implemented as planned, yet the assessment of cooking programmes competences is infrequently reported in the literature [ 8 ]. A study examining participatory experience, appeal, effectiveness and the operations of a cooking course 6 months to 5 years post-intervention in Aboriginal Australians with diabetes revealed that some areas of the intervention design may have reduced the course’s appeal, impacted on the objectives negatively, and were considered too structured for the population of interest [ 28 ].

Currently, the availability of long-term impact and process evaluation studies of cooking skill programmes is limited, and the needed for more is essential in order to help improve the success of present programmes, help better develop new programmes and sustain funding. Although randomised controlled trials are considered as the ‘gold standard’, the use of quasi-experimental designs inclusive of a comparator group may be more achievable whilst still enhancing statistical rigour, particularly when targeting hard-to-reach groups [ 40 ]. This approach could help clarify the potential for cooking skills to affect dietary behaviours, lead to healthy weight achievements and other health outcomes. Research projects could additionally benefit from the development of a theory of change in the context of evaluation of complex interventions. This means to develop an a-priory understanding of how and why a programme operates via involvement of all stakeholders, in particular the target population, should be at the core of this process. A further key feature is a thorough development and implementation of process evaluation. A theory of change will aid understand and refine the links across activities, assumptions in place and indicators of change as the intervention is developed [ 41 ].

Population targets for cooking skill interventions are often living in areas of social deprivation; but skill development alone will not reverse affordability constraints nor directly achieve behaviour change. However, these interventions do stand as a potential vehicle to improve dietary quality, particularly if used with nutrition promotion and incorporating behaviour change techniques. Indeed, whilst heterogeneous and small effects have been noted for increases in fruits and vegetables and other proxies of healthful eating, budgeting skills have been raised as a positive outcome following the programmes [ 8 ], despite existing financial barriers not being removed entirely.

Conclusions

Our review suggests that brief cooking programmes are modestly effective on increasing confidence to perform skills that improve some aspects of food literacy, in particular those relevant to cooking meals (preparation). Interventions appear to be providing more benefits to vulnerable, low-income and socially deprived adults and their families, often one of the main target groups of cooking initiatives. Curricular food preparation sessions can positively expose and influence children to try new foods. However, variation in the content, definition and assessment of eating and cooking behaviours across studies limits current understanding of their likely efficacy and sustainability to impact other short-term dietary outcomes, including changes in fruit and vegetable intake.

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Garcia, A.L., Reardon, R., McDonald, M. et al. Community Interventions to Improve Cooking Skills and Their Effects on Confidence and Eating Behaviour. Curr Nutr Rep 5 , 315–322 (2016). https://doi.org/10.1007/s13668-016-0185-3

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Food, cooking skills, and health: a literature review

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1 Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, SK.
PMID: 20825697
DOI: 10.3148/71.3.2010.141

Over the past century, a major shift in North American food practices has been taking place. However, the literature on this topic is lacking in several areas. Some available research on food and cooking practices in the current context is presented, with a focus on how these are affecting health and how they might be contributing to health inequalities within the population. First, cooking and cooking skills are examined, along with the ambiguities related to terms associated with cooking in the research literature. Food choice, cooking, and health are described, particularly in relation to economic factors that may lead to health inequalities within the population. The importance of developing an understanding of factors within the wider food system as part of food choice and cooking skills is presented, and gaps in the research literature are examined and areas for future research are presented. Cooking practices are not well studied but are important to an understanding of human nutritional health as it relates to cultural, environmental, and economic factors.

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Published: 26 June 2020

Cooking skills related to potential benefits for dietary behaviors and weight status among older Japanese men and women: a cross-sectional study from the JAGES

Yukako Tani ORCID: orcid.org/0000-0001-5533-2844 1 ,
Takeo Fujiwara 1 &
Katsunori Kondo 2 , 3

International Journal of Behavioral Nutrition and Physical Activity volume 17 , Article number: 82 ( 2020 ) Cite this article

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Poor cooking skills have been linked to unhealthy diets. However, limited research has examined associations of cooking skills with older adults’ health outcomes. We examined whether cooking skills were associated with dietary behaviors and body weight among older people in Japan.

We used cross-sectional data from the 2016 Japan Gerontological Evaluation Study, a self-report, population-based questionnaire study of men ( n = 9143) and women ( n = 10,595) aged ≥65 years. The cooking skills scale, which comprises seven items with good reliability, was modified for use in Japan. We calculated adjusted relative risk ratios of unhealthy dietary behaviors (low frequency of home cooking, vegetable/fruit intake; high frequency of eating outside the home) using logistic or Poisson regression, and relative risk ratios of obesity and underweight using multinomial logistic regression.

Women had higher levels of cooking skills, compared with men. Women with a moderate to low level of cooking skills were 3.35 (95% confidence interval [CI]: 2.87–3.92) times more likely to have a lower frequency of home cooking and 1.61 (95% CI: 1.36–1.91) times more likely to have a lower frequency of vegetable/fruit intake, compared with women with a high level of cooking skills. Men with a low level of cooking skills were 2.56 (95% CI: 2.36–2.77) times more likely to have a lower frequency of home cooking and 1.43 (95% CI: 1.06–1.92) times more likely to be underweight, compared with men with a high level of cooking skills. Among men in charge of meals, those with a low level of cooking skills were 7.85 (95% CI: 6.04–10.21) times more likely to have a lower frequency of home cooking, 2.28 (95% CI: 1.36–3.82) times more likely to have a higher frequency of eating outside the home, and 2.79 (95% CI: 1.45–5.36) times more likely to be underweight, compared with men with a high level of cooking skills. Cooking skills were unassociated with obesity.

Conclusions

A low level of cooking skills was associated with unhealthy dietary behaviors and underweight, especially among men in charge of meals. Research on improving cooking skills among older adults is needed.

There are increasing calls to return to home cooking to prevent poor diets and chronic diet-related diseases [ 1 ]. A systematic review has reported the dietary benefits of eating home-cooked meals, including greater consumption of fruits and vegetables, enhanced nutrient intake, and higher diet quality [ 2 ]. A recent cross-sectional study showed that eating home-cooked dinners was associated with greater dietary guideline compliance, without significantly increasing food expenditures [ 3 ]. Although studies related to the effects of home cooking on health outcomes are limited, a recent large population-based study in the United Kingdom showed that more frequent consumption of home-cooked meals was associated with a greater likelihood of having normal weight and body fat status [ 4 ]. Furthermore, a cohort study targeting older people in Taiwan demonstrated that older adults who cooked more than five times per week had approximately 40% lower risk of death, compared with those who did not cook [ 5 ]. The study also showed a dose–response relationship, meaning that the risk of death decreased as the frequency of home cooking increased. Despite the benefits of home cooking, the consumption of home-cooked meals has declined and the consumption of out-of-home foods, such as fast food and convenience food, has increased in recent decades in developed countries [ 6 , 7 ].

Cooking skills are one important modifiable factor that can encourage people to cook [ 2 ]. In addition to increasing the frequency of home cooking, strengthening people’s cooking skills can improve their diet quality. For example, cross-sectional studies have shown an association between high levels of cooking skills and lower consumption of ready meals, convenience food, and ultra-processed food among adults [ 8 , 9 , 10 ]. Intervention studies have also shown improving cooking skills to increase cooking confidence and consumption of vegetables and fruits [ 11 , 12 ]. Most existing studies have focused on dietary benefits among adults, and limited work has examined the associations between cooking skills and health outcomes among older adults.

Population aging is increasing dramatically, and the percentage of the world’s population aged over 60 years is projected to nearly double from 12% in 2015 to 22% in 2050 [ 13 ]. Overall, older adults do not meet the recommendations for a healthy diet [ 14 ]. Physiological, social, economic, and psychological factors affect older people’s food choices. Physiological factors, such as age-related decline in taste and smell, can lead to decreased appetite and poor dietary habits [ 15 ]. Social factors, including lower social engagement and living alone, are also associated with poor diet quality [ 15 , 16 ]. Economic factors such as low income and retirement can negate older people’s ability to meet their nutritional needs [ 17 , 18 ]. Finally, psychological factors including wellbeing and depression are also associated with eating behaviors [ 16 ]. However, although cooking skills are a fundamental factor in preparing meals, the effects of cooking skills on dietary behaviors do not seem to have been evaluated among older adults. A systematic review demonstrated associations between culinary interventions and improved dietary factors, including attitudes, self-efficacy, and healthy dietary intake among adults [ 19 ]. Focusing on cooking skills as a modifiable factor among older adults is an innovative approach.

The rationales described above indicate that having sufficient cooking skills may be important for healthy aging. More older adults live alone, compared with other age groups: In 43 developing countries, only 1.6% of people were found to live alone overall, compared with 8.8% of older adults [ 20 ]. In Japan, most older people live alone or with their spouses [ 21 ]. Thus, older adults are faced with the task of preparing own meals. Because of changes in living arrangements or spouses becoming unable to cook, the person responsible for cooking at home may change in older age. For example, a widowed man may be in charge of cooking for the first time. Because it is mainly women who are in charge of preparing meals, men have been found to be less confident in their cooking and to have lower levels of cooking skills [ 9 , 22 ]. Therefore, men, especially widowed men or men whose spouses are unable to cook, may be at risk of diet-related problems because of their poor cooking skills. To our knowledge, no study has examined the associations between cooking skills and health outcomes among older people who are in charge of meals.

One reason for the limited evidence relating to cooking skills may be the difficulty of assessing cooking skills. Cooking skills have been defined as a set of mechanical or physical skills used in meal preparation, such as chopping, mixing, and heating basic ingredients, as well as conceptual skills related to understanding how food will react when cooked [ 23 ]. In addition to the various aspects of cooking skills, the cooking skills required vary depending on culture: For example, cooking methods (e.g., grilling, steaming, stewing, and stir-frying) differ by culture. Several methods have been used to measure cooking skills, but there are few validated and reliable measures of cooking skills [ 23 ]. Hartmann et al. conducted a test-retest analysis and designed a reliable cooking skills scale comprising seven items related to the ability to prepare different foods that is applicable to most European cultures [ 9 ]. Because this scale rates the ability to prepare general food groups (e.g., bread), it is more versatile than scales that rate the ability to prepare specific meals (e.g., spaghetti Bolognese). Therefore, for the present study, we modified this scale for application in a Japanese population. The first aim of our study was to assess the reliability of this scale in a large-scale Japanese population-based study. The second aim was to examine the associations of cooking skills with the frequency of home cooking, the frequency of eating outside the home, the frequency of vegetable/fruit consumption, and body weight status.

Study design and participants

The Japan Gerontological Evaluation Study (JAGES), a large nation-wide research project on aging, was established in 2010 to evaluate the social determinants of healthy aging among older people in Japan [ 24 , 25 ]. We used data from the 2016 JAGES, which covered 39 municipalities across Japan and was administered to community-dwelling older adults who were physically and cognitively independent (i.e., without functional disabilities, defined as not being certified as eligible to receive long-term public care insurance system services [ 26 ]). From October 2016 to January 2017, self-report questionnaires were mailed to 279,661 older adults aged ≥65 years. The survey was conducted using random sampling in 22 large municipalities and was administered to all eligible residents in 17 small municipalities. A total of 196,438 participants returned the questionnaire (response rate: 70.2%). In some municipalities, recipients receiving long-term public care insurance benefits were included in the survey by request of the local government, so the target sample was 180,021 older adults, after excluding those who received these benefits. One-eighth of the sample ( N = 22,219) were randomly selected to receive a survey module on cooking skills. The present analysis was carried out using data for 19,738 participants (9143 men and 10,595 women), after the following exclusions: participants with missing information on gender ( N = 2); participants who did not complete the questions related to height and weight ( N = 660) or dietary behaviors (frequency of home cooking, eating outside the home, and vegetable/fruit intake) ( N = 1475); participants with missing data on the cooking skills scale ( N = 145); and participants who were included in this study accidentally who reported limitations in activities of daily living ( N = 199) to ensure that the sample was actually physically and cognitively independent. Limitations in activities of daily living were assessed with the Independence in Activities of Daily Living index [ 27 ] using the following questionnaire item: “Do you need any nursing care or assistance from someone in your daily life?” We excluded participants who answered “I need and receive nursing care or assistance.” Participants were informed that participation in the study was voluntary and that completing and returning the questionnaire indicated their consent to participate in the study. The JAGES protocol was approved by the Ethics Committee in Research of Human Subjects at the National Center for Geriatrics and Gerontology (No. 992) and Chiba University Faculty of Medicine (No. 2493).

Body weight status and dietary behaviors

Participants reported their height in centimeters and weight in kilograms. Body mass index (BMI) was calculated as weight divided by the square of height (kg/m 2 ). We defined underweight as having a BMI < 18.5 kg/m 2 and obesity as having a BMI ≥ 27.5 kg/m 2 , following the suggested cutoff points for Asians [ 28 ]. The evaluated dietary behaviors were the frequency of home cooking, eating outside the home, and vegetable/fruit intake. The frequency of home cooking was assessed using the question “How often do you cook by yourself? Do not include ready-to-eat food” (responses: more than five times a week , three to five times a week , one to two times a week , less than once a week , and never ). Respondents who cooked less than two times a week were categorized as having a low cooking frequency for women because more than three times a week has been shown to predict survival among older women [ 5 ]. For men, respondents who never cooked were categorized as having a low cooking frequency because more than half of the men indicated that they never cooked (Table 1 ). The frequency of eating outside the home was assessed using the question “How often do you eat outside the home?” The responses for this item were the same as those for the frequency of home cooking. Respondents who ate outside the home more than three times a week were categorized as having a high frequency of eating outside the home because eating outside the home more than three times a week has been shown to be related to higher BMI and lower serum concentrations of nutrients [ 29 ]. The frequency of vegetable and fruit intake was assessed using the question “How often did you eat vegetables and fruits over the past month?” (responses: not at all , less than once a week , once a week , two to three times a week , four to six times a week , once a day , and at least twice a day ) [ 30 , 31 ]. Respondents who ate vegetables and fruits less than once a day were categorized as having a low frequency of vegetable and fruit intake. This cutoff point was defined by prevalence to be under 25% of subjects included (Table 1 ) because being in the lowest quartile for vegetable and fruit intake has been shown to be associated with poor health outcomes [ 32 , 33 , 34 ].

Cooking skills

As mentioned above, based on the cooking skills scale for European cultural regions [ 9 ], we adapted Hartmann’s a cooking skills scale for use in Japanese populations. In Japan, a typical meal—known as ichi-ju san-sai —consists of a staple food (such as rice), a soup (usually miso), and three dishes (one main dish and two side dishes) [ 35 ]. The basic Japanese cooking methods— Gohou (five methods)—are raw food, boiling, grilling, steaming, and frying [ 36 ]. We adopted stewing instead of steaming to reflect contemporary cooking practices [ 37 ]. Therefore, we included these elements and designed the following seven items for the Japanese version of the cooking skills scale: “How do you assess your overall cooking skills?”; “Can you peel fruits and vegetables?”; “Can you boil eggs and vegetables?”; “Can you grill fish?”; “Can you make stir-fried meat and vegetables?”; “Can you make miso soup?”; and “Can you make stewed dishes?” Participants were asked to evaluate their own cooking skills on a six-point scale (ranging from 1 for unable to 6 for very well ). Cronbach’s α for these seven items was 0.96. Cronbach’s α was calculated using an unstandardized approach for respondents answering five or more of the seven items. The mean of the seven items was calculated for each respondent to reflect their overall cooking skills; the midpoint was 3.5, and a high score meant that the respondent had high confidence in their cooking skills (Table 2 ). The mean cooking skills score was divided into three categories—high (> 4.0), middle (2.1–4.0), and low (≤ 2.0)—to examine the associations of cooking skills with body weight status and dietary behaviors. For women, because the distribution of the cooking skills score was skewed to the left (leaning towards higher scores), the middle and low groups were merged into one category. Therefore, women were classified into two cooking skills categories: high (> 4.0) and middle/low (≤ 4.0).

Person in charge of meal selection

Participants were asked “In what way are your daily meals mainly prepared?” The responses to this item were as follows: cook by myself , a family member cooks , buy packaged lunches or cooked meals , use catering or home-delivery services , and other . Participants except for those who reported that a family member did the cooking were defined as being in charge of preparing or selecting meals.

Covariates were assessed using the self-report questionnaire. Age was divided into four categories (65–69, 70–74, 75–79, and ≥ 80 years). The duration of education was divided into three categories (≤ 9 years, 10–12 years, and ≥ 13 years). Annual household income was adjusted for household size, dividing the household income by the square root of the number of people in the household. This variable was then divided into three categories (< 2.00, 2.00–3.99, and ≥ 4.00 million yen). Marital status was divided into five categories (married, widowed, divorced, single, and other). To assess comorbidity, the participants were asked whether they were currently under medical treatment for any of the following conditions (multiple responses were allowed): cancer, heart disease, stroke, hypertension, diabetes mellitus, and hyperlipidemia. Covariates with missing data were categorized as “missing.”

Statistical analysis

The analyses were stratified by gender because a previous study reported different associations between cooking skills and dietary behaviors by gender and distinct patterns of potential confounders for men and women [ 9 ]. First, participants were stratified by cooking skill level, and differences between groups were tested using Pearson’s chi-squared tests. Second, multiple comparisons for the cooking skills scale were analyzed using the mixed linear model procedure to examine which cooking skills participants rated as difficult. The model adjusted for age, education, annual normalized household income, marital status, and medical treatment (cancer, heart disease, stroke, diabetes mellitus, hypertension, and hyperlipidemia), and peeling was used as the reference category. Participant identification code was included as a random effect. Third, we calculated adjusted odds ratios with 95% confidence intervals (CIs) of high frequency of eating outside the home using logistic regression. For low frequency of home cooking and vegetable/fruit intake, we calculated adjusted prevalence ratios (APRs) with 95% CIs using Poisson regression because participants with low frequencies of home cooking and vegetable/fruit intake were not uncommon, so the odds ratios derived from logistic regression would have been unable to approximate the prevalence ratio [ 38 , 39 ]. For the association with weight status, we calculated adjusted relative risk ratios (ARRRs) with 95% CIs of underweight and obesity using multinomial logistic regression, with the body weight category of BMI of 18.5–27.4 kg/m 2 as the reference category. The models were adjusted for the following potential confounding factors: age, education, annual normalized household income, and medical treatment for cancer, heart disease, stroke, hypertension, diabetes mellitus, and hyperlipidemia. Participants with missing data on the covariates were included in the analysis. All analyses were conducted using Stata, Version 14 (Stata Statistical Software: Release 14. College Station, TX: StataCorp LP).

The participants’ characteristics are summarized in Table 1 . A total of 46% of the participants were men, about 20% were aged over 80 years, 30% had under 9 years of education, and 40% had annual incomes below two million yen. Of the male respondents, about 10% were widowed or divorced. When cognitive function was assessed with three items from the Kihon Checklist–Cognitive Function scale, for which predictive validity for dementia incidence has previously been confirmed [ 40 ], only 0.9% of participants had three cognitive complaints. The majority of women (94.1%) were classified as having a high level of cooking skills (Table 1 ). For men, the level of cooking skills was classified as high for 52.0%, middle for 35.8%, and low for 12.3%. For women, 8.9% cooked less than two times a week, 3.5% ate out more than three times a week, 14.6% ate vegetables/fruits less than once a day, 9.3% were underweight, and 7.3% were obese. For men, 53.8% never cooked, 7.7% ate out more than three times a week, 27.5% ate vegetables/fruits less than once a day, 4.7% were underweight, and 7.3% were obese. Women with middle/low-level cooking skills tended to be older, have a low level of education, have low income, not be married, and list a family member as the main meal preparer (Table 1 ). For men, in addition to being older, having a low level of education, and having a family member as the main meal preparer, men who were married tended to have a low level of cooking skills (Table 1 ).

The mean cooking skills score was higher for women (5.6 points) than for men (4.1 points) (t (19736) = − 99.6, p < 0.001) (Table 2 ). For psychometric testing, one factor with an eigenvalue over 1 was found, and this accounted for 80.5% of the variance. All factor loadings were 0.8 or higher. Men rated stewing and stir-frying as more difficult than peeling. Although women had statistically significant differences between the assessed cooking skills, in terms of substantive significance, they rated all the methods assessed on the cooking skills scale as being of similar difficulty (Table 2 ).

There were gender differences in the associations of cooking skills with unhealthy dietary behaviors and body weight status (Table 3 ). Women with a middle/low level of cooking skills were 3.35 times (95% CI: 2.87–3.92) more likely to have a lower frequency of home cooking and 1.61 (95% CI: 1.36–1.91) times more likely to have a lower frequency of vegetable/fruit intake, compared with women with a high level of cooking skills. As for weight status, women with a middle/low level of cooking skills were 1.29 (95% CI: 0.99–1.67) times more likely to be underweight, compared with women with a high level of cooking skills. For men, compared with those with a high level of cooking skills, men with a middle or low level of skill were 1.98 (95% CI: 1.86–2.11) times more likely and 2.56 (95% CI: 2.36–2.77) times more likely, respectively, to have a lower frequency of home cooking. Regarding eating outside the home, compared with men with a high level of cooking skills, men with a low level of cooking skills were 1.30 (95% CI: 1.01–1.67) times more likely to have a higher frequency of eating outside the home. There was a significant association with a low frequency of vegetable/fruit intake only among men with a middle level of cooking skills (APR: 1.15, 95% CI: 1.06–1.26). As for weight status, compared with men with a high level of cooking skills, men with middle or low skill levels were 1.29 (95% CI: 1.04–1.60) times more likely and 1.43 (95% CI: 1.06–1.92) times more likely, respectively, to be underweight. There was no significant association between cooking skills and obesity for either men ( p = 0.33) or women ( p = 0.40). Using the cutoff point of BMI ≥ 23.0 kg/m 2 as overweight, we found that a low level of cooking skills was not associated with an increased risk of overweight (Supplementary Table 1 ).

Next, we focused on men in charge of meals. Over 90% of women ( n = 9618) but only 26% of men ( n = 2358) were in charge of daily meals. In contrast to men not in charge of preparing meals, most men in charge of meals rated their cooking skills as high (Supplementary Table 2 ). Men in charge of meals tended to have low levels of education and low income and to be unmarried (e.g., widowed or divorced) (Supplementary Table 2 ). When the associations with unhealthy dietary behaviors and weight status were examined for men in charge of meals, the effect size increased (Table 4 ). Compared with men with a high level of cooking skills, men with middle- or low-level cooking skills were 4.22 (95% CI: 3.42–5.21) times more likely and 7.85 (95% CI: 6.04–10.21) times more likely, respectively, to have a lower frequency of home cooking (Table 4 ). Regarding eating outside the home, compared with men with a high level of cooking skills, men with a low level of cooking skills were 2.28 (95% CI: 1.36–3.82) times more likely to have a higher frequency of eating outside the home. In relation to low frequency of vegetable/fruit intake, the APR for men with a middle level of cooking skills was 1.32 (95% CI: 1.15–1.53). Furthermore, compared with men with a high level of cooking skills, men with middle or low skill levels were 1.59 (95% CI: 1.04–2.45) times more likely and 2.79 (95% CI: 1.45–5.36) times more likely, respectively, to be underweight.

To the best of our knowledge, this is the first study to examine the associations of cooking skills with unhealthy dietary behaviors and weight status by gender and meal preparer status among older adults. Using an adapted version of an existing cooking scale for use in Japanese populations, we confirmed that women had higher levels of cooking skills than did men and that the associations of cooking skills with dietary behaviors and weight status differed by gender. For both men and women, a low or middle/low level of cooking skills was associated with a low frequency of home cooking. Having low- or middle/low-level cooking skills was found to be significantly associated with high frequency of eating outside the home and with being underweight for men but not for women. The association between low or middle/low level of cooking skills and low frequency of vegetable/fruit intake was found for both men and women, but among men there was no dose–response relationship. The associations of low level of cooking skills with unhealthy dietary behaviors and underweight status were especially pronounced among men in charge of meals. Cooking skills were unassociated with obesity among both women and men.

In this study, a cooking skills scale for use in Japanese populations was designed with consideration of basic Japanese cooking methods and typical meals. Although we did not confirm the validity of this newly designed cooking skills scale by objective assessment, we were able to obtain plausible results, with the same trends observed with the original cooking skills scale for European populations [ 9 ]. Our cooking skills scale had appropriate internal consistency (Cronbach’s α = 0.96) and showed higher values for women and those with higher education levels, which is consistent with previous findings [ 9 , 41 ]. This result also supports previous findings of a gender difference in confidence in cooking skills indicating that women are more confident in their cooking skills than are men [ 9 , 22 , 42 ]. The differences in cooking skills by gender and educational attainment among Japanese older adults may be explained by opportunities to learn cooking skills in school. In Japan, cooking education in schools was conducted exclusively for women until 1989; therefore, the men in this study (born before 1958) had less opportunity to learn cooking in school [ 43 ]. Another factor is that older age is associated with a stronger belief in the gender role ideology holding that men should work outside the home and women should do housework inside the home. In earlier years, there was even a cultural idea that men should not so much as enter the kitchen. This idea is reflected in the saying “ Danshi-chubo-ni-hairazu ” (“A man would be ashamed to be found in the kitchen”) [ 44 ]. However, men’s mean (SD) cooking skills score of 4.1 (1.42) was higher than the midpoint of 3.5, indicating that older Japanese men have above-average confidence in their cooking skills. In line with previous studies on adults showing that levels of cooking skills tend to be high in multiple-person households [ 8 , 9 ], we found that women’s cooking skills were higher when they were married than when they were not. However, in contrast, men’s cooking skills were higher when they were not married (e.g., widowed or divorced). This result is intuitive because unmarried men do not have a spouse who is responsible for the cooking. We speculate that unmarried women have a moderate level of cooking skills because they were taught to cook in home economics classes and by their mothers, but their cooking skills may not have continued to improve because there was no need to cook for another person. Interventions earlier in the life course, such as at retirement, may be effective because men have a high risk of unhealthy eating behavior caused by their poor cooking skills if they are later widowed or divorced.

We included five basic cooking methods in the cooking skills scale, finding that men rated stewing and stir-frying as more difficult, compared with peeling and boiling. A previous study that examined eight cooking methods in the United Kingdom showed that men were more confident about boiling, compared with stewing or stir-frying [ 42 ]. This result is plausible because stewing and stir-frying require adjusting the level of heat and adding seasoning to prepare the dish properly. In interventions targeting men, it might be most beneficial to focus on simple cooking methods using stewing and stir-frying.

As expected, having a low or middle/low level of cooking skills was significantly associated with having a low frequency of home cooking for both men and women. People with high levels of cooking skills may enjoy cooking and feel self-confident regarding their cooking, leading to a high frequency of home cooking [ 9 , 42 ]. However, a significant association between a low level of cooking skills and high frequency of eating outside the home was found only among men. This result may reflect the gender difference in the prevalence of eating outside the home. The percentage of respondents who ate out at least once a week was 15.5% for women and 23.6% for men (Table 2 ). A previous nationally representative survey in Japan reported that this gender difference exists across all age groups in the country, suggesting that men tend to prefer eating outside the home [ 45 ]. The same national survey also reported that the percentage of people who consume packaged lunches or cooked meals is the same for both men and women [ 45 ]. Therefore, women may consume these meals rather than eating outside the home, even if they have a low level of cooking skills. Another possible reason for the gender difference in eating outside the home is that there is a fundamental difference in cooking ability between men and women. In other words, the men who were categorized as having a low level of cooking skills cannot prepare any kind of meal, but the women who were categorized as having a middle/low level of cooking skills may be able to make basic meals. In our study, 79% of the women categorized as having a middle/low level of cooking skills were originally in the middle-level cooking skills category (Table 1 ). Therefore, women may not have to rely on eating outside the home even if they have a middle/low level of cooking skills.

Unlike home cooking and eating outside the home, no dose–response relationship between cooking skills and low vegetable/fruit intake was observed among men. In a previous study using the original cooking skills scale in Switzerland, favorable associations between cooking skills and various food groups including vegetables and fruits were evident for women, but these associations were weak or nonexistent for men [ 9 ]. This gender difference may be explained by nutritional knowledge [ 22 , 46 ]: Men may not have sufficient nutritional knowledge regarding healthy food choice, even if they have a high level of cooking skills. Additionally, men may be more likely to choose foods because of their sensory appeal rather than for health reasons [ 47 ]. Future work should investigate food skills, including meal planning, food safety, and nutrition knowledge [ 23 ].

A low level of cooking skills was associated with underweight but not with obesity. Although a low level of cooking skills was associated with a high frequency of eating outside the home among men, which is generally associated with obesity, the majority of older Japanese people participating in this study did not rely on eating outside the home. The percentage of people who ate out more than three times a week was only 5% for the study participants, compared with 35% for older Americans aged 60 years or older [ 29 ]. In our sample, more than 90% of the participants reported that their daily meals were mainly cooked by themselves or a family member (Table 1 ). Therefore, for older Japanese people, a low cooking frequency because of a low level of cooking skills may mean that they skip meals or eat simple meals or meals with poor nutritional value instead of eating outside the home. This would be more likely to lead to underweight than to obesity. A study examining the amount of rice served at local and chain restaurants in Japan found that most restaurants set the rice potion at an appropriate quantity for middle-aged and older people (> 160 g and < 200 g) [ 48 ]. Therefore, those eating outside the home in Japan may be unlikely to consume a high number of calories. When we additionally included frequency of home cooking and vegetable/fruit intake as potential mediators in our model, the ARRR of underweight decreased and became statistically non-significant among men, although it remained significant among men in charge of meals (Supplementary Table 3 , Model 2). Another possible explanation for the association between cooking skills and underweight is that cooking skills may be a surrogate indicator of physical capacity in daily living. To examine this hypothesis, we included limitations in instrumental activities of daily living status [ 49 , 50 ] in our model as a confounding factor, confirming that the ARRR of underweight remained significant (Supplementary Table 3 , Model 3). Contrary to expectations, a low level of cooking skills was associated with underweight but not with obesity among older adults. For Asian people, underweight is a consistent risk factor for death, and this risk is higher than that associated with obesity [ 51 ]. Underweight has also been reported to be associated with frailty [ 52 ], fracture, and bone loss [ 53 ], which are critical obstacles to maintaining quality of life among older people [ 54 , 55 ]. Therefore, it may be important for health policy makers to identify people with poor cooking skills and organize programs to enhance cooking skills to prevent underweight.

The association between cooking skills and underweight was especially prominent among men in charge of meals, and this association remained significant in this group even after accounting for limitations in instrumental activities of daily living, frequency of home cooking, and vegetable/fruit intake (Supplementary Table 3 , Model 4). This finding is plausible because many men have family members—often their wives—who prepare meals for them. Among the men in our study sample, 74% reported that a family member prepared their daily meals (Table 1 ). Considering that many men in charge of meals are widowed or divorced (Supplementary Table 2 ), these men may have difficulty preparing meals because they had few opportunities to prepare meals before losing their spouse. These men may thus be less motivated to cook and to eat, which can lead to a lower appetite [ 56 ]. Additionally, appetite decreases with age, and poor appetite has been shown to be related to, for example, lower intake of energy, protein, and vegetables/fruits; lower dietary diversity [ 57 , 58 ]; and higher risks of malnutrition [ 59 ] and mortality [ 58 ]. Further studies are needed to examine the potential mechanisms of the risk of underweight caused by low levels of cooking skills for men. About half of older Japanese men who cook at home started cooking when they were over 50 years old [ 60 ]. Considering that cooking classes for men have increased over the past few decades in Japan, intervening at an older age may be feasible and acceptable.

This study had several limitations. First, we used self-reported weight and height to calculate BMI, which may have led to an under- or over-estimate of BMI [ 61 ]. A previous study demonstrated that, when calculated from self-reported weight and height, the BMI of older Japanese people was underestimated, compared with objective measures of weight and height; however, the same study showed that the BMI of underweight men and women was overestimated by 0.7 and 0.3, respectively, because these groups tended to over-report their weight [ 62 ]. Therefore, we may have underestimated the association of cooking skills with underweight. Second, we defined home cooking simply, excluding only the preparation of ready-to-eat food. Therefore, people who cooked low-quality meals or used some prepared foods in their cooking may have been included in the high frequency of home cooking category. This may have led to an underestimate of the association of cooking skills with low frequency of home cooking. Third, frequency of vegetable/fruit intake was assessed using a single, simple item. Future studies should use more detailed questions to assess which food groups are associated cooking skills. Fourth, we observed a ceiling effect for women’s cooking skills, as has been reported in a previous study using the original cooking scale [ 9 ]. Considering the reduction in the available time for cooking in recent years, it may be beneficial to investigate cooking skills not only in terms of methods (e.g., boiling and stewing), but also in terms of the ability to prepare a variety of meals in a short time. Moreover, a thorough psychometric assessment of the modified cooking scale should be performed if it continues to be used. More comprehensive, validated measures for assessing food and cooking skill confidence are now available [ 63 ]. Therefore, it is possible to use these measurement methods in the future. Fifth, we could only evaluate a limited number of eating behaviors. Future work should examine associations between cooking skills and other aspects of diet, such as dietary pattern, food components, and portion size, to understand the mechanisms of the relationship between cooking skills and weight status. Sixth, because the municipalities that participated in the JAGES survey were not randomly selected, the generalizability of our findings to other populations in Japan is limited. Finally, because this study was cross-sectional, we could not assess causality: Reverse causation is possible, and unmeasured factors such as personality may confound the examined associations. For example, underweight may be accompanied by frailty or low muscle strength, which may make it difficult to cook some foods or to cook for a long time while standing, resulting in low confidence in one’s cooking skills. However, more than half of the adult respondents in a previous study said that they had learned most of their cooking skills when they were teenagers and that they had learned these cooking skills mainly from their mothers [ 64 ]. Future randomized controlled trials comparing cooking, eating behaviors, and weight status among older adults with and without cooking skills interventions would clarify the causal association.

Using a large-scale cross-sectional study, we confirmed that women had higher levels of cooking skills than did men and that the associations of cooking skills with dietary behaviors and weight status differed by gender. Moreover, the associations of cooking skills with unhealthy dietary behaviors and weight status were especially pronounced among men who were in charge of meals. Considering the possibility that the person in charge of meals may change in older age, research on support to improve cooking skills among older people is needed.

Availability of data and materials

The datasets used and analyzed in the current study are from the JAGES study. All enquiries are to be addressed to the JAGES data management committee via e-mail: [email protected] . All JAGES datasets have ethical or legal restrictions for public deposition because of the inclusion of sensitive information from the human participants.

Abbreviations

confidence interval

body mass index

Japan Gerontological Evaluation Study

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Acknowledgments

We are particularly grateful to the staff members in each study area and in the central office for conducting the survey.

This study used data from the JAGES, which was supported by a Japan Society for the Promotion of Science KAKENHI Grant (JP15H01972, 20H00557 and 19 K14029), a Health Labour Sciences Research Grant (H28-Choju-Ippan-002, H30-Junkanki-Ippan-004, 19FA1012 and 19FA2001), grants from the Japan Agency for Medical Research and Development (JP18dk0110027, JP18ls0110002, JP18le0110009, JP19dk0110034 and JP20dk0110034), Research Funding for Longevity Sciences from National Center for Geriatrics and Gerontology (29–42), and a JST-OPERA program grant (JPMJOP1831).

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Yukako Tani & Takeo Fujiwara

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Katsunori Kondo

Department of Gerontological Evaluation, Center for Gerontology and Social Scienc, National Center for Geriatrics and Gerontology, 7-430 Morikoka-cho, Obu-shi, Aichi, 474-8511, Japan

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YT conceived the design, analyzed the data, reviewed the literature, and wrote the first draft of the article. KK collected the data. TF revised the first draft. KK edited the manuscript. All authors approved the final version of the manuscript.

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The JAGES participants were informed that participation in the study was voluntary and that completing and returning the questionnaire via mail indicated their consent to participate in the study. The JAGES protocol was approved by the Ethics Committee in Research of Human Subjects at the National Center for Geriatrics and Gerontology (No. 992) and Chiba University Faculty of Medicine (No. 2493).

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Additional file 1: table s1..

Adjusted relative risk ratios of underweight and overweight according to the cooking skills of older Japanese men ( n =9,143) and women ( n =10,595). Table S2. Characteristics of older Japanese men by cooking responsibility status ( n = 9,203). Table S3. Adjusted relative risk ratios of underweight by cooking skill among older Japanese men.

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Tani, Y., Fujiwara, T. & Kondo, K. Cooking skills related to potential benefits for dietary behaviors and weight status among older Japanese men and women: a cross-sectional study from the JAGES. Int J Behav Nutr Phys Act 17 , 82 (2020). https://doi.org/10.1186/s12966-020-00986-9

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Improving Cooking and Food Preparation Skills: A Synthesis of the Evidence to Inform Program and Policy Development

This report was prepared by Cathy Chenhall, M.H.Sc., P.Dt for the Healthy Living Issue Group (HLIG) of the Pan-Canadian Public Health Network . The HLIG's Strategic Collaboration Working Group facilitates multi-sectoral, multi-lateral collaborations annually to advance the goals of the Integrated Pan-Canadian Healthy Living Strategy . In their 2009/10 workplan, the HLIG agreed to support a collaborative project on healthy eating, specifically examining cooking and food preparation skills among children and families. This project was the result of a collaboration between the Public Health Agency of Canada , Health Canada , the Federal/Provincial/Territorial Group on Nutrition and the HLIG.

1.0 executive summary, 2.0 introduction & purpose, 3.0 methodology/search strategy, 4.1.1 a culinary transition or consumer deskilling, 4.1.2 describing the state of food preparation and cooking skills: challenges & implications, 4.1.3 highlights of existing research describing food preparation and cooking skills, 4.2 implications of a transition in cooking and food preparation skills, 4.3 improving cooking and food preparation skills within the context of the family environment: challenges and opportunities, 5.0 conclusion and knowledge gaps, 6.0 references.

Food choices, eating behaviours and resulting nutritional health are influenced by a number of complex and inter-related individual, collective and policy-related determinants. A growing body of research is supporting the relationship between food preparation and cooking skills and food choices of children and adolescents within the family context.

Over the past several decades, a transition or change in cooking and food preparation skills has been hypothesized and observed, which could have an important impact on healthy eating and the health of Canadians, presently and in the future. This transition in cooking and food preparation skills involves the increased use of pre-prepared, packaged and convenience foods, which require fewer and/or different skills than what is often referred to as traditional or 'from scratch' cooking. Several technological, food system-related and broader shifts within the social, economic, physical and cultural environments have been identified as factors influencing the culture of cooking and food preparation within the home or domestic environment, including the following:

increased availability of food commodities (basic/raw and processed);
improved and advanced technology for food storage, preparation and cooking; resulting in changes in the level of knowledge and skill required to cook;
time and financial demands/ realities related to labour market participation;
shifting family priorities and values; and
decreased opportunities for cooking and food preparation skill acquisition both within the home and public education environments.

The purpose of this paper is to synthesize the state of knowledge and research gaps related to cooking and food preparation skills among children and families. The paper describes the state of cooking and food preparation skills, nationally and internationally; implications of a transition in cooking and food preparation skills and challenges and opportunities related to the improvement of cooking and food preparation skills within the context of the family environment.

The literature search strategy resulted in the identification of approximately 40 publications having direct relevance to the paper. Of the over 40 publications, approximately two-thirds could be described as being descriptive or contextual and one-third described the results of cooking and food preparation skill interventions across population subgroups.

In terms of the suggested 'transition', limited national and international quantifiable and generalizable data exists to confirm the state of, and changes to, cooking and food preparation skills within populations, children and families. Despite the inherent limitations associated with comparing data collected from different populations using different methodologies at different times, the following common themes emerged from the review and synthesis of available and relevant research:

women, including adolescents, young adults and mothers, are primarily responsible for food preparation functions within the home environment and generally report greater self-confidence/efficacy with cooking and food preparation skills compared to men;
mothers are the primary role models and teachers of cooking and food preparation skills across age and socioeconomic groups ( SES ), followed by school-based education;
those primarily responsible for food-related activities in the home place value on these activities, despite complexities associated with the need to balance different nutrition needs, preferences of family members and schedules;
frequency of family meals and involvement in food preparation activities among adolescents and young adults is associated with dietary quality;
self-efficacy with basic food preparation skills generally increases with age across gender groups; data related to self-efficacy across SES groups is somewhat conflicting;
taste, nutritional value, cost and time are the primary and often conflicting factors influencing food choice and preparation decisions across SES groups;
pre-prepared and convenience foods have become normalized within patterns of eating for children of all ages and families;
adolescents report involvement in food purchasing and preparation activities, however, most do not help out more than once or twice per week with female adolescents and those from lower SES groups reporting greater involvement than those from mid and high SES groups;
young adults report minimal involvement in food purchasing and preparation activities, despite indicating that their skills and resources are adequate; and
respondents from low SES groups report greater meal preparation from 'scratch' and lower use of convenience foods compared to those from other SES groups.

In terms of the implications of a change or transition, information is limited to substantiate a direct relationship between cooking and food preparation skills and health. Research and food purchasing and consumption data, nationally and internationally, do confirm that food choice and consumption patterns have transitioned with increased processed, pre-prepared and convenience foods being purchased, 'assembled' and consumed across population subgroups on a daily basis. The results of several research studies support the normalization of processed, pre-prepared and convenience foods within the eating patterns of individuals and families, again across population subgroups. Related to this normalization is the potential lack of transference of basic, traditional or 'from scratch' cooking and food preparation skills from parents (primarily mothers) to children and adolescents, which has traditionally been the primary mode of learning. Without the opportunity to observe and practice basic or 'from scratch' cooking and food preparation skills within the home environment, many argue that children and adolescents will not be equipped with the necessary skills to make informed choices within an increasingly complex food environment. In support of this argument, low self-efficacy and self-perceived inadequate cooking and food preparation skills have been identified as barriers to food choice within several recent research initiatives, potentially resulting in a greater reliance on pre-prepared or convenience foods, reduced variety in food choice and consumption and the atrophy of cooking and food preparation skills.

The most common potential challenges identified related to the development of successful strategies or interventions to enhance cooking and food preparation skills among children within the context of families include time, individual/familial food choice and the diminished value placed on 'cooking from scratch' or traditional cooking skills. An even greater challenge is associated with the lack of clear evidence describing the characteristics of successful intervention strategies for specific age and population subgroups. While the results of published interventions are generally quite moderate, several researchers believe that some studies do indicate that food skills interventions may be a useful starting point for initiating dietary change, while acknowledging that addressing any one barrier to change is unlikely to radically alter established eating behaviours among adults, in particular. In the absence of definitive direction, available evidence and experience indicates that programs/interventions specifically designed for children, and having some involvement of adults/parents have the following characteristics:

a stated theoretical basis or at a minimum, a set of defendable community-relevant assumptions upon which the program or activity is based;
opportunities for experiential/hands-on learning to promote and build self-confidence and self-efficacy through skill development and encourage children and youth to become involved in food preparation activities within the home environment;
include self-assessment of eating patterns and behaviour change for middle and high school students as well as parents/adults;
involve parents, either actively or as intermediaries depending on the age of the child, in program implementation and evaluation;
be community-based and tailored for specific population groups, giving consideration to the social context of food choice and cooking practice;
content to assist learners in intervening in broader physical and social environments to address barriers to improved food choice and cooking practices;
a supportive learning environment, including a social support component and regular positive reinforcement;
be based on measurable, specific goals set by participants;
capitalize on interest in learning and demonstrate that healthy, cost-effective foods and meals can be planned, prepared and served in limited time; and
be longer versus shorter in duration.

The information presented within the synthesis indicates that despite noted limitations in surveillance and intervention-related data, concerns related to a transition in cooking and food preparation skills and the potential impact on food choice, health and health inequalities are not unfounded. Furthermore, the information synthesized supports the need for further research and surveillance to strengthen understanding and potential to influence the determinants, prevalence and characteristics of cooking and food preparation skills among children and families in Canada. In addition, the influence of cooking and food preparation skills on food choice, dietary quality and nutritional health across and within population subgroups of interest requires further exploration.

Food choices, eating behaviours and resulting nutritional health are influenced by a number of complex and inter-related individual, collective and policy-related determinants Footnote 1 . There is a growing body of research supporting the relationship between food preparation and cooking skills and food choices of children and adolescents within the family context.

Paralleling the nutrition transition which has been occurring over the past several decades in the developed world, and more recently in the developing world, a transition or change in cooking and food preparation skills has been hypothesized and observed, which could have an important impact on healthy eating and the health of Canadians, presently and in the future. This "nutrition transition" is characterized by consumption patterns that have higher energy (versus nutrient) density, total fat, saturated fat, added sodium and sugar, and simple carbohydrates and a decreased or changing proportion of fruit and vegetables, whole grains, and pulses Footnote 2 - Footnote 5 . The corresponding transition in cooking and food preparation skills involves the increased use of pre-prepared, packaged and convenience foods, which require fewer and/or different skills than what is often referred to as traditional or 'from scratch' cooking Footnote 6 .

Not unlike the worldwide nutrition transition, changes in cooking and food preparation skills have been influenced by factors within complex, shifting social, economic and physical environments nationally and globally, notably changes within global food systems, labour market participation of women and decreased opportunities for cooking and food preparation skill development within the home and school environments Footnote 6 . These trends and issues have resulted in a growing interest in the state of cooking and food preparation skills across the population and within specific subgroups and the implications of, in most cases, presumed changes on food choice and potentially nutritional and overall health.

The purpose of this paper is to synthesize the state of knowledge and research gaps related to cooking and food preparation skills among children and families. This paper describes the state of cooking and food preparation skills, nationally and internationally, based on largely contextual and limited quantifiable data; implications of a transition in cooking and food preparation skills; and challenges and opportunities related to the improvement of cooking and food preparation skills within the context of the family environment.

This literature review is one component of the project titled, "Improving Cooking and Food Preparation Skills: A Synthesis of the evidence and lessons learned to inform program and policy development." The second component of the project profiles selected national and international programs and activities aimed at improving cooking and food preparation skills to gather lessons learned.

The literature search focused on identifying publications that describe the state of knowledge and research gaps as they relate to cooking and food preparation skills, particularly among children and families.

Searches were conducted on the electronic computer indexed databases MEDLINE/Pubmed/NLM Gateway, EMBASE , CINAHL , Cochrane Library, and ERIC. The following key words and phrases were used: determinants of cooking skills, determinants of food preparation skills, cooking skills and transition, food preparation skills and transition, cooking skills and children, food preparation skills and children, cooking skills and families, food preparation skills and families, food deskilling and children, food deskilling and families, cooking skills and food security, food preparation skills and food security, cooking skills and health, food preparation skills and health. A generalized internet search using Google, Google-Scholar and Bing was also conducted using a subset of the search terms.

Grey literature was accessed through a variety of mechanisms including project authority staff, members of the Strategic Collaboration Working Group ( SCWG ) of the Healthy Living Issue Group, and via the generalized internet search. Reference lists and "related article" links within electronic indexed databases were used to identify additional sources of literature.

The search was limited to English language literature and included articles published from 2002 to the present, with exceptions made for seemingly sentinel articles. In addition, to focus the search and synthesis, the following criteria were determined and applied, in consultation with the SCWG:

documents/publications having specific relevance for generally healthy, free-living children and families free of specific medical conditions or illnesses (e.g. autism, eating disorders, learning disabilities, brain injuries) having relevance for the Canadian/North American context were given priority;
publications exploring the relationship between cooking and food preparation skills and childhood obesity issues were included within the search, while not a specific focus of the synthesis; and
recognizing that children live within the context of families, the term children was not defined using a specific age-range to be as inclusive as possible; terms used and the overall search strategy was inclusive of ethnic minorities and groups having varying socio-economic status.

4.0 Findings

The search of the indexed databases using all search terms and the inclusion criteria identified many citations. Titles and abstracts were reviewed for relevance and over 55 publications were retrieved. Of these publications, approximately 40 were of direct relevance to the paper. Of the over 40 publications, approximately two-thirds could be described as being descriptive or contextual and one-third described the results of cooking and food preparation skill interventions across population subgroups.

As described within the search strategy, identifying literature related to cooking and food preparation skills and childhood overweight and obesity while not a focus, was of interest in light of the significance of this public health issue and linkages with the Integrated Pan-Canadian Healthy Living Strategy. Several publications were identified, however, upon review it was determined that they were not of direct relevance to the stated purpose of the synthesis. That being said, all publications reviewed related to the prevention of childhood overweight and obesity reinforced the importance and significance of parental influence in the development and maintenance of healthy eating (and physical activity) behaviours of children from birth to young adulthood, which will be addressed in section 4.1.3 , Highlights of Existing Research Describing Food Preparation and Cooking Skills, specifically under the adult heading.

Efforts to identify research related to food security status and food preparation and cooking skills were included within the search strategy as a result of growing interest in the potential inter-relationship between cooking skills and health disparities. While often viewed as matters of individual behaviour, as will be discussed further within the synthesis, the acquisition of cooking skills relies on structural factors, for example, cultural norms and education policy Footnote 7 . Several relevant publications were identified, the highlights of which are included within the subsection of section 4.1.3 , Highlights of Existing Research Describing Food Preparation and Cooking Skills,specifically under the preschool/young children and adults headings. Generally speaking, the majority of articles identified via inclusion of food security as a search term reported the results of research initiatives involving individuals and families from low socioeconomic groups, without always specifically quantifying their food security status.

4.1 The State of Cooking and Food Preparation Skills among Populations, Children and Families

Overall, there is limited national and international quantifiable and generalizable data to describe the state of, and changes to, cooking and food preparation skills within populations, children and families. This information gap, however, has not limited the growing discourse and concern within public/popular and academic sectors over the past decade and has, in fact, stimulated research in a number of jurisdictions. Of note is the United Kingdom, where food skill-related changes to the National Curriculum for public schools in the late 1990s stimulated considerable research and dialogue Footnote 6 - Footnote 8 , relevant components of which are included within this synthesis.

As noted earlier, several technological, food system-related and broader shifts within the social, economic, physical and cultural environments have been identified as factors influencing the culture of cooking and food preparation within the home or domestic environment. These include:

advances in technology for food storage, preparation and cooking, resulting in changes in the level of knowledge and skill required to cook;
shifting time and financial demands/ realities related to labour market participation;
decreased opportunities for cooking and food preparation skill acquisition both within the home and public education environments Footnote 6 , Footnote 9 - Footnote 11 .

In addition to the factors noted above, the "nutrition transition" that has been taking place globally over the past several decades has had a notable influence on cooking and food preparation skills, primarily as a result of the increased availability of processed, pre-prepared and convenience foods within the retail and foodservice environments. Consequently, this transition has involved fundamental dietary shifts within entire cultures (developing and developed countries), resulting in negative implications for nutritional and overall health, specifically, significant increases in diet-related chronic diseases and conditions, including overweight and obesity Footnote 2 - Footnote 5 . Further to the influences on cooking and food preparation skills noted above, Lang and Caraher Footnote 6 propose that a 'culinary' transition, ".... the process in which whole cultures experience fundamental shifts in the pattern and kind of skills required to ..." choose, prepare and consume food, has occurred. Concerns related to this culinary transition and its presumed impact on consumer control of food choice, healthy eating behaviours and resulting nutritional health and food sovereignty led to recommendations for enhanced professional and state support to ensure widespread basic cooking proficiency within at least one jurisdiction Footnote 6 . Short Footnote 12 - Footnote 14 and Lyon Footnote 9 , from somewhat differing perspectives, acknowledge a continual shift and change in the culture of cooking and food preparation skills which they argue is inevitable with ongoing social, environmental and technological changes and should not necessarily be a barrier to efforts to empower healthy food choices, dietary habits and enjoyment in food preparation.

In contrast, several other researchers Footnote 10 , Footnote 11 view changes in cooking and food preparation skills as a largely negative process of deskilling. They argue that significant and planned restructuring within the agri-food industry and food systems has resulted in both worker deskilling in food manufacturing and food-related consumer deskilling which, they contend, has and will have significant consequences on consumer choice, diet and health. Further to this point, Jaffe and Gertler Footnote 10 and Kornelson Footnote 11 argue this trend will continue resulting in increased distance between consumers and the sites and processes of food production, including basic commodities, which they believe is profitable for industry. As a result of this food deskilling and the parallel availability of increasingly complex packaged, processed and "industrially transformed" foodstuffs, many consumers have lost the knowledge necessary to make informed food decisions from the perspectives of quality, health, environmental sustainability and local economic development Footnote 10 , Footnote 11 .

Having some similarity with aspects of both perspectives described above, the 2005 report prepared for Agriculture and Agri-Food Canada, Consumer Food Trends to 2020: A Long Range Consumer Outlook , identifies the following as being among the top trends to 2020:

increased disconnection between consumers and food preparation, including sporadic shopping and eating habits, decreased meal preparation time and cycles, and increased snacking and further increases in portable foods, with the latter having implications for food and packaging waste;
shifting food expenditure patterns to include a greater proportion of prepared meals and take-outs; and
increased product differentiation to meet consumer expectations related to quality and freshness, taste, nutritional value to address health concerns, ethnic diversity and value in the most convenient form possible Footnote 15 .

In addition to food system related trends and influences on cooking and food preparation skills, the social change resulting from the rise in the number of women in the waged labour force over the past several decades has been linked to changes in food choice, eating habits and food preparation activities. While women are still primarily responsible for food and meal planning, selection and preparation with the home and family environment, across socioeconomic groups Footnote 6 , Footnote 7 , Footnote 9 , Footnote 10 , Footnote 16 , Footnote 17 , the time constraint introduced through workforce participation facilitated the development of a market for pre-prepared and convenience foods Footnote 6 which food manufacturers and retailers have been quick to respond to, and some argue, exploit Footnote 6 . As a result, social and food system trends suggest a move from cooking in the home with basic ingredients and commodities to a society that relies on the labour of others with ready-prepared foods Footnote 10 , Footnote 11 . Some have further argued that the ready availability of prepared food has made traditional cooking skills (i.e. transforming raw ingredients into complete, culturally appropriate dishes and meals) unnecessary and redundant Footnote 6 , Footnote 9 . While typically presented as food system innovations unfairly imposed on those primarily responsible for food preparation, several researchers note that use of increasingly prepared foods has provided comparative or competitive choices for consumers/families who did not enjoy, feel confident or skilled or place value/priority on traditional food and meal preparation Footnote 6 , Footnote 9 , Footnote 12 , Footnote 14 . Related to time constraints, which are often reported as barriers to cooking and healthy eating, several sources have reported that time 'saved' through the use of pre-prepared and convenience foods has been essentially replaced by time spent making food-related decisions and purchases from largely suburban supermarkets and grocery stores and re-heating and assembling food Footnote 6 , Footnote 18 .

The role of players within the food system, notably processors, retailers and restaurants, on food choice and food consumption patterns is undeniable. According to Cash, Goddard and Lerohl Footnote 19 the food industry is essentially the gatekeeper of food choice, determining the products consumers can choose and modifying behaviours through available offerings and marketing practices. Innovation based on market research and science is integral to the food industry. In recent years, industry has worked with and responded to recommendations and policy directives from non-government organizations, national and international governments and associated research institutes to develop healthier alternatives for consumers, aiming for consistency with national and international dietary guidelines, standards and policy. To be successful, however, new, healthier products must continue to be reasonably priced, tasty and convenient; traditional factors that remain important to consumers Footnote 19 . In addition, and as noted above, the food industry has actively responded through product development, innovation and industry-led information and education to societal trends which have impacted how children and families learn about and choose food Footnote 20 . In recognition of the importance of public policies that enable positive outcomes for both industry (i.e. profit) and public health (i.e. improved health outcomes), over the past decade in many jurisdictions, national and international food industry trade associations have been invited to, and have actively participated in, food and nutrition-related health policy initiatives Footnote 19 .

Related to, but somewhat in contrast with, the gendered and time constrained context within which daily or regular food and meal preparation occurs, a growing interest in creative/recreational/leisure cooking is emerging, with some bias among men and young adults Footnote 9 . As noted earlier, Lyon et al Footnote 9 argue that emphasizing the creative aspects of domestic food preparation skills may be essential within the current context where "... we do not have to acquire cooking skills in order to survive, and where we can easily convince ourselves that our health will not be affected by the menu we have in front of us ....".

Opportunities for children and youth to acquire 'traditional', basic or 'from scratch' food preparation and cooking skills from parents (primarily mothers) and extended family members, the primary route of transmission from a historical perspective, has been cited as a casualty of changes within the home food environment Footnote 6 , Footnote 9 . Research does support that populations, with some subgroups being more effected than others, are unsure of specific cooking techniques and lack the confidence to apply techniques and cook certain foods. This is a result of limited time, opportunity and exposure within the family environment, thereby limiting food choice Footnote 6 , Footnote 7 , Footnote 16 , Footnote 17 . Building on these culinary transitions versus deskilling perspectives, one perspective within the literature argues that processes need to be developed to ensure that current and future generations learn and pass down "traditional" food preparation and cooking skills to protect consumer choice and nutritional health Footnote 6 , while the other argues that convenience foods can play a role in the intergenerational transference of skills Footnote 12 - Footnote 14 .

Changes within public school curricula in several national jurisdictions, including Canada, has stimulated further concern related to the development of cooking and food preparation skills among children and youth, as learning within the education system has traditionally been identified as the second most common route for the acquisition of skills and knowledge Footnote 6 , Footnote 7 . Stitt Footnote 8 details that when nutrition and food-related course content have been maintained within curricula, they are 'options' (versus requirements) for students, and have been adapted to place greater emphasis on technology, food production and marketing from an industry or commercial perspective as opposed to the development of an essential, domestic life-skill. Consistent with concerns noted above, the anticipated consequence of these changes is even greater reliance on generally pre-prepared and convenience foods which are nutritionally inferior and more expensive than food traditionally prepared within the home environment, a concern which has potentially greater implications for low income families Footnote 8 . Stitt Footnote 8 concludes that deskilling within the education curriculum will have widespread implications for the entire food and eating culture as a missed opportunity to maintain one of the most effective health promotion strategies which protects the ability of individuals and families to make informed food choices.

Regardless of the perspective from which the issue is viewed, a decline in cooking and food preparation skills has been noted within the popular and published literature for some time, with only limited quantifiable data to support this trend. Several initiatives report cross-sectional data, however, longitudinal or surveillance data is lacking which would enable trends in cooking and food preparation skills within and across population subgroups to be monitored and reported.

In cases where data does exist, the lack of use of a definition of cooking skills and the use of inconsistent definitions across research initiatives, differing methodologies and differing indicators limits comparisons Footnote 6 , Footnote 7 , Footnote 9 , Footnote 12 , Footnote 13 . Several authors Footnote 9 , Footnote 12 , Footnote 13 argue that the often assumed definitions need to evolve from a perceived "Golden Age" of cooking (specifically post World War II when basic commodities and technology were limited thus requiring enhanced knowledge and skill) to reflect the current food and social/societal contexts. Short Footnote 12 , Footnote 13 contends that modern cooking incorporates greater skills in timing, planning, judgement and organization in addition to traditional cooking abilities and use of techniques, often described as being largely mechanical and practical.

The Region of Waterloo Public Health (Ontario) recently articulated the following working definition for food skills, as part of their evidence and practice-informed planning, in response to the 2008 Ontario Public Health Standards, which require the provision of "opportunities for skill development in the areas of food skills and healthy eating practices for priority populations" Footnote 21 . Their definition, which follows, largely inspired by Short's Footnote 12 research and perspective, addresses the full scope of how they interpret "food skills" for planning programs and services, noting that the food skills are described in a household context and that these skills are necessary to accomplish the goal - food for the household. Foods skills are defined as follows:

"At an individual and household level, food skills are a complex, inter-related, person-centred, set of skills that are necessary to provide and prepare safe, nutritious, and culturally acceptable meals for all members of one's household." Footnote 21 .

Food skills include:

Knowledge (i.e. about food, nutrition, label reading, food safety, ingredient substitution)
Planning (i.e. organizing meals, food preparation on a budget, teaching food skills to
Conceptualizing food (i.e. creative use of leftovers, adjusting recipes)
Mechanical techniques (i.e. preparing meals, chopping/mixing, cooking, following recipes)
Food Perception (i.e. using your senses- texture, taste, when foods are cooked)" Footnote 21 .

To achieve the stated purpose of the literature synthesis, the search strategy identified several relevant references, many of which report research data specific to age subgroups within a broader definition of children. In addition, as a result of potential research and intervention implications for children and families, broadly defined, the findings of research initiatives involving young adults as well as parents of children experiencing food insecurity were included within the synthesis. As well, a recent, unpublished source of survey data describing self-perceived cooking and food preparation skills within the Canadian context was included.

Further to the description above, the following research highlights are organized by age group (preschool, school-aged, adolescent, young adult and adult) for the ease of the reader. The highlights are presented for the most part as annotations in light of previously described variations in methodology and indicators and the resulting comparison challenges.

Preschool/Young Children

For perhaps obvious reasons, publications which specifically reported research findings documenting food preparation and cooking skills among very young children were not identified. This section therefore highlights the findings of several references reporting relevant food choice-related research of mothers (as primary influencers and gatekeepers) of very young children.

Byrd-Bredbenner and Abbot Footnote 17 recruited a sample of mothers of children aged one to twelve years (n=201) from around the state of New Jersey to complete an on-line survey assessing demographic characteristics, food decision influencer constructs and dietary intake. Respondents had a moderate income, were food secure, in stable domestic relationships and lived in a single geographic region. Additional relevant demographic characteristics assessed included time spent weekly on food shopping and meal preparation activities, self-reported knowledge of nutrition and food preparation, food preparation and skill and the health and nutrition status of herself and each family member. Food decision influencer constructs assessed included the following: outlook on life (i.e. goal orientation, stress management, life satisfaction), health characteristics (i.e. health-related values, locus of control, healthy eating self-efficacy, health protective behaviours), food-related activities (i.e. meal planning and associated enjoyment, use of food product information, food price consciousness, health-related food preparation values and beliefs, family involvement), interest in learning about meals, food characteristics (i.e. food quality and purity-related values, beliefs about healthy and convenience foods, and use of convenience foods), eating/food relationships and family meals (i.e. participant's responsibility for healthy family meals, value placed on family meals, importance of positive feedback, managing food preferences, and beliefs about the healthfulness of one's family diet) Footnote 17 .

Findings specifically relevant to cooking and food preparation skills included the following:

family members ate together most often and meals were prepared at home significantly more often than eaten out, mothers reported high nutrition knowledge, health and family diet-quality. However more than half of the parents in the study were overweight or obese and one-third of children over two years of age had a BMI at or above the 85th percentile;
respondents somewhat agreed that they planned meals and enjoyed meal preparation activities and that these were worth the time and effort; families were not frequently involved in meal-related activities;
participants were interested in learning how to make more nutritious meals, but were less interested in learning how to make meals more quickly;
respondents agreed that nutritious foods were appealing, were a good value and can be prepared quickly and disagreed that convenience foods had the same attributes. Convenience foods were not used frequently;
factors typically guiding food choices were taste, value, time available and concerns about health/weight control; and
participants believed that they were responsible for serving healthy meals, valued eating together as a family and felt that it was important to receive positive feedback about meals served Footnote 17 .

To increase the application of these findings, Byrd-Bredbenner and Abbot Footnote 17 translated them into goals for nutrition education interventions for mothers of young children. Highlights of these interventions have been incorporated into section 4.3 Improving Cooking and Food Preparation Skills within the Context of the Family Environment: Challenges and Opportunities .

Broughton, Janssen, Hertzman, Innis and Frankish Footnote 22 assessed the association between various environmental predictors and household food security among a convenience sample of families (n=142) with children two-five years of age in Vancouver. Contextual factors of relevance to the relationship between food preparation and cooking skills and food security assessed included number of cooking appliances, self-rated cooking skill and access to quality food. Related to food, one of the most common concerns among food insecure parents was reliance on a few kinds of low cost foods for their children. As well, households with less-equipped kitchen facilities had three times the odds of reporting food insecurity compared to households with the greatest resources after adjusting for household income. Parents with less personal capacity in terms of self-rated cooking skill had eight times the odds of reporting food insecurity, also as compared to households with the greatest resources after adjusting for household income. Furthermore, households with the least access to food of reasonable quality had ten times the odds of reporting food insecurity relative to those reporting greatest access to quality food. These researchers conclude that the results suggest that cooking skills and appliances play a role in providing choice and control over food, as food insecure parents manage the conflicting priorities of taste, nutritional value, cost and convenience in food selections. Government produced publications that promote consumption of unprocessed foods were criticised as lacking necessary programs and supports to increase parents' food-related skills and capacities. Concerns related to the marketing of cost-effective, palatable, but unhealthy food choices to children, and lack of access to full-service grocery stores in low-income neighbourhoods were also cited as issues, particularly for food insecure families Footnote 22 .

The international Institute for Grocery Distribution ( IGD ) conducted small discussion groups with convenience groups of seven to nine year old children (n= 400 children) in the UK to "uncover what children think about food, cooking and meal times" Footnote 20 . The discussion groups were followed by a web-based quantitative survey, also completed by 400 children aged seven to nine years old in the UK to test themes which emerged from the discussion groups. Highlights of the research included the following:

children chose their favourite foods on the basis of taste and texture and also liked foods that entertained and amused them;
children indicated that their parents have the greatest influence on learning about food, followed by their teacher;
in contrast, including a free toy or game would have the greatest effect among respondents to encourage them to try a new healthy food;
while the children had a general understanding of the terms healthy and healthy eating, most had an inadequate understanding of the specifics of population-based dietary guidance (i.e. number of recommended servings per food group per day);
74% of children said their family mostly or always ate at the same time and 71% said their family mostly or always ate the same food with some variation between specific geographic locations; and
82% of children enjoyed cooking at home and 41% indicated an interest in cooking more, noting that they particularly enjoyed cooking with a food that was unusual or a novelty versus the everyday task of preparing food for a family Footnote 20 .

Related to the last finding above, the author concludes that stimulating curiosity about food is essential in securing the interest of children in cooking and healthy eating. Furthermore, children's views seem to be consistent with a recent trend noted among adults where cooking as an everyday task or chore is distinguished from cooking for entertainment Footnote 20 .

Caraher, Baker and Burns Footnote 18 conducted a series of consultations with eight and nine year old children in three schools in England and Wales to determine how children "view the world of cooking and food". The draw and write technique was used to identify children's experience and perceptions of cooking and food preparation, allowing them to express themselves in either words or pictures. To achieve this research aim, participating children were first asked to draw a picture of or write about a food/meal that they wanted to share with a friend/creature from outer space who was visiting Earth to learn how to cook. Secondly, the children were instructed to draw a picture of someone cooking at home and then tell the story of what was happening in their picture. A purposive sampling technique was employed to represent a range of urban and rural communities and those coming from families with varying levels of affluence. Qualitative analysis of the children's creations based on a description of the content of the drawings and all words included in the drawings resulted in the identification of the following themes or categories: ethnicity; traditional foods and the proper meal; fried foods; pizzas, burgers and "McFoods"; tea and coffee; mums and dads in the kitchen; and celebrity chefs Footnote 18 .

Specifically, the children:

identified ethnicity as having a direct bearing on food choice and cooking (theme resulting from findings from one school sample located in a highly ethnically diverse urban neighborhood);
expressed a preference for a meal structure which the researchers describe as "traditional" British and consisting of a "proper meal" represented as having a main part (e.g. meat) supported by two accompanying components, most often two vegetables;
attempted to construct a proper meal by combining foods such as pizza or spaghetti with other foods so a "proper meal" could be formed;
tended to draw pictures and tell stories of preparing a meal with fried food as the central element, even when other foods were illustrated on the plate;
favoured serving pizza and burgers themselves and also as a food/meal to serve to their guest from outer space; with branded fast-food products identified as being consumed both within and outside the home; children in all three schools identified visits to McDonald's as being part of their everyday food culture;
identified tea and coffee as something they prepared (and felt proud about preparing) at home for their parents with a minimum of supervision from their parents;
identified their mother for their envisioned meal, next to themselves, as being the family member most often preparing food and meals, followed by older sisters who helped children in the kitchen. A minority of fathers or step-fathers were included within illustrations; and
mentioned and drew celebrity chefs with reference to where they would take their guest from outer space to eat Footnote 18 .

These researchers conclude that the children who participated in their research are exposed to, engaged with and interested in, cooking within the home environment Footnote 18 . The findings support that food preparation and food choice are influenced by social, regional, cultural and family circumstances. Concern is expressed about the influence and normalization of fried, fast and prepared foods on eating within and outside of the home environment, while acknowledging children's attempts to create or complete a traditional or "proper meal" with the addition of vegetables and other healthier food choices. As well, the results raise concern about the early development of taste preferences for processed foods and foods high in fat as well as the influence of media and branding on the same. Mothers and older sisters were identified as the primary persons responsible for the transmission of cooking skills. However, stories provided evidence that men/fathers are becoming more involved in the kitchen, as is the role of celebrity chefs in perceptions of food preparation. These findings highlight the role of food as a means of expressing love and caring within families and the related importance of children exploring and learning cooking food preparation skills Footnote 18 .

Adolescents

Findings from a 1993 poll of seven-sixteen year olds for the UK Department of Health Get Cooking! project suggests that young peoples' food skills rise with greater technological inputs in the preparation of food (i.e. using a microwave versus preparing a food from basic or raw ingredients) Footnote 6 . Findings from a subsequent survey in 1998 for the UK-based Good Food Foundation found that young people identified the following as cookery skills in order of popularity: making a sandwich, making toast, opening cereal boxes, cooking chips, preparing cake mixes from a packet, cooking eggs and cooking a pizza Footnote 6 . The authors of this study point out that what they term 'hands-on' cooking or cooking from scratch are only minimally included within the findings and that the most frequently reported skills require assembly of ingredients and/or the opening of packages Footnote 6 .

An analysis of adolescent involvement (middle and high school students in one US city) in food shopping and preparation was conducted to determine if a relationship exists between involvement and dietary quality Footnote 23 . The frequency of involvement in food shopping and preparation over the past week was self-reported using the Project EAT (Eating Among Teens) survey and dietary intake was assessed using the Youth/Adolescent Food Frequency Questionnaire, both of which demonstrated validity and reliability. Frequency of family meals was also assessed. The findings were based on Project EAT surveys completed by 4,746 adolescents (81.5% of eligible students) and Youth/Adolescent Food Frequency Questionnaires completed by 4,206 adolescents (89% of the sample). Participants were equally divided by sex and the mean age of respondents was 14.9 years. Relevant results included the following:

68.6% and 49.8% of students reported helping prepare dinner and shop for groceries, respectively, over the past week; although the majority of students did not report helping out more than one to two times per week;
family meal frequency was associated with diet quality; adolescents who participated in regular family meals reported greater involvement in food preparation and storage;
female adolescents helped more frequently with both shopping for and preparing food than male adolescents;
middle school students helped more often with food-related tasks than high school students;
Asian American students had greater involvement in both food shopping and preparation;
low-income students helped out more with food-related tasks compared to students from families having middle and high socioeconomic status;
mothers' employment status was not related to food task involvement;
preparation was generally related to healthier food choices; in contrast, participation in food shopping was mostly unrelated to dietary intake and in some cases, it was related to less healthy food choices; and
involvement in food preparation was associated with lower intakes of fat and higher intakes of key nutrients Footnote 23 .

The authors conclude that the results of this research parallel other research findings relating household responsibilities and positive psychosocial outcomes, notably self-efficacy, among adolescents. Self-efficacy is enhanced when opportunities to practice behaviours exist and furthermore, greater self-efficacy in food preparation skills can enhance dietary quality. Support for community and school-based programs to enhance practical and health-oriented food preparation and purchasing skills among children and youth is stated as is promoting the involvement of adolescents in food-related tasks within the home/family environment Footnote 23 .

Young Adults

Building on research reported in the previous section, Larson, Perry, Story, and Neumark-Sztainer Footnote 24 conducted an analysis of food-preparation behaviours, cooking skills, resources for preparing food and associations with diet quality among a sample of males (n=764) and females (n=946) aged 18-23 years (mean=20.4 years) in one US city. Participants were mailed the Project EAT (Eating Among Teens) survey, which includes self-assessment of frequency of involvement in food shopping and preparation over the past week, and the Youth/Adolescent Food Frequency Questionnaire to assess dietary intake. Via the two survey tools, young adults were specifically asked to report how often they performed five food preparation and purchasing behaviours over the past 12 months, their perceived skill and resources to perform household food tasks, and dietary intake and fast food consumption. Demographic information and weight status were also self-reported Footnote 24 .

Relevant findings included:

most food preparation behaviours assessed (i.e. buying fresh vegetables, writing a grocery list, preparing a green salad, a dinner for self or for two or more people) were not performed by the majority of young adults even weekly;
as an exception, 55.8% of young women reported preparing a dinner with chicken, fish or vegetables at least once per week;
the majority of young adults perceived their skills and resources for food preparation were adequate or very adequate (62.8% - 92.1% for discrete skills as assessed separately for males and females);
greater involvement in the purchasing and preparation of food was related to sex (females almost twice as likely as males), race/ethnicity (Asian, Hispanic or white), living situation (rent/own followed by living with parents) and fast food restaurant use (less than three times per week);
preparation and purchasing frequency were not significantly related to socioeconomic, weight or student status;
respondents who reported more frequent food preparation skills used fast food less often and were more likely to meet the national dietary objectives, however, no differences in dietary quality were observed according to perceived adequacy of skill or resources for food preparation; and
perceived inadequacy of appliances for food preparation and food selection in local stores were barriers to preparation for a minority of young adults, however, cooking skills, money to buy food and time available for food preparation were reported as being inadequate for up to one-third of respondents Footnote 24 .

The authors conclude that while young adult males and females may have basic skills in food purchasing and preparation (as indicated by perceived self-adequacy), they were not using them on a regular basis Footnote 24 . As a result of the demonstrated link between food preparation skills and dietary quality, the authors recommend that young adults be encouraged to improve and practice their food preparation skills at home. Further to the finding that time constraints and cost were identified as barriers to preparation, the authors suggest that programs focusing on developing skills for preparing quick and economical meals may be warranted, however further intervention research is required to confirm program specifics Footnote 24 .

While their status as parents of children was not necessarily declared within the findings of all of the following research annotations, a decision was made to include this information given its relevance to the general population in Canada and also vulnerable population subgroups. As well, several annotations or summaries do not detail the extent of cooking and food preparation skills among adults/parents. However, the findings do illuminate the influence of parents' food and nutrition related knowledge, perspectives and resulting behaviours on those of their children.

Using data from the 1993 Health and Lifestyles Survey of England, Caraher, Dixon, Lang and Carr-Hill Footnote 7 report findings on "how, why and when people using cooking skills; (and) where and from whom people learn these skills". The survey sample consisted of 5,553 interviews with randomly selected (by address) 16-74 year olds in England, stratified by National Health Service Region. Data was weighted to make the results more representative, as a result of several noted biases. The authors note that the survey was conducted before cooking was excluded from the new English National Curriculum for public schools Footnote 7 .

most respondents learned to cook from their mothers (76% of women and 58% of men), despite class and education differences;
nearly half of 16-19 year old men mentioned learning from cooking classes at school; and
cookery books were more important for those having higher SES (noting association with education, cost and culture), while cookery classes at school were more important for lower social classes.
less than half of respondents reported cooking a meal every day. However, this result could be influenced by the fact that only one respondent per household was surveyed (not necessarily the individual primarily responsible for food preparation) and the variability in perspective in what is meant by "cooking";
68% of women reported cooking daily, compared to 18% of men, responses which were relatively consistent across SES groups; and
the majority of respondents reported eating at least seven main meals at home per week with just over 75% of these meals described as not being ready-prepared or take-aways; those from higher SES groups were more likely to have purchased a ready-prepared meal within the past week as compared to those from lower SES groups.
respondents generally reported confidence in their ability to cook, with 94% of women and 80% of men indicating they were very or fairly confident in their skills; and
7% of women compared to almost 25% of males did not cook or did not feel confident to cook using basic ingredients.
female respondents reported being significantly more confident than men using almost all cooking techniques investigated, especially stewing, braising and casseroling; and
greater confidence in applying most techniques was associated with increased age across and within gender groups and with increased income and social class.
general, social class and income variations existed related to confidence applying general cooking and food preparation skills to particular foods or dishes; and
confidence in cooking most foods, particularly among women, increases with age; across gender groups, confidence in cooking all types of foods increases with income.
most respondents indicated that their food choices were not generally restricted; and
12.7% of men and 5.4% of women cited not knowing how to cook a food as a factor limiting choice.
98.6% of respondents who cooked reported that they had fairly or easy access to cooking facilities; and
respondents from higher income groups compared to those from lower income groups were significantly more likely to have all but one of the following: microwaves, non-stick pans or woks, steamers, food processors and blenders. Whereas, chip pans or deep fat fryers were owned more often by lower income groups.
almost all respondents believe that it was important to teach children to cook; 98.5% of women and 95.3% of men thought it fairly or very important to teach boys to cook and 99.2% of women and 97.6% of men were similarly in favour of teaching girls to cook; and
older respondents attached greater importance to teaching children to cook, especially for girls Footnote 7 .

The authors conclude that the data suggest that there are considerable variations in knowledge about cooking, its application, role and relevance to health, with specific aspects of cooking being related to gender, income and social class. While not supporting a direct relationship between cooking skills and health status from an inequities perspective, the data demonstrate class-related differences between cooking, skills and confidence Footnote 7 .

Four focus groups were conducted with Plains Indians in four reservations to explore access and barriers to food items and food preparation, one component of a larger culturally appropriate research initiative to address diabetes and nutrition among the population Footnote 25 . Relevant findings included:

most participants reported eating fast foods, fried foods, prepared foods, hamburger, and pop (diet and non) on a daily basis, including young children, while some spoke of eating more traditional foods;
participants described unhealthy ways of preparing foods, even if those were the ways they prepared most of their food;
all foods were described as being healthy if consumed in moderation and not cooked in fat; participants easily described traditional foods that they considered to be healthy, including preparation methods which are considered to be healthy, mentally/spiritually and physically;
while agreeing that diet was an important factor in the development of diabetes, participants spoke of the difficulties associated with eating a healthy diet, notably lack of availability and accessibility and price as many lived on very limited incomes; and
participants reported that education was required to motivate change in food choice and eating habits, specifically related to gardening/growing vegetables and hands-on healthy cooking courses Footnote 25 .

The researchers concluded that providing practical education in a culturally appropriate fashion is essential to increase access and reduce barriers to healthy eating, thereby impacting the epidemic of diabetes among Plains Indians Footnote 25 .

Using a participatory, community-based, qualitative research design, Engler-Stringer Footnote 16 explored the cooking practices of a group of young (18-33 years), urban, french-speaking, low-income women with the purpose of contributing to the current understanding of how social and physical food environments shape daily food and cooking practices. Maximum variation sampling was used to seek out participants who could share a variety of perceptions of the experiences related to food preparation on a low-income. Focus group questions were based on the following five broad themes: food and cooking preferences; food skills learning during the formative years; current cooking and grocery shopping practices; participants' understanding of what are pre-prepared foods and basic ingredients; and the effects of low-income on cooking practices. Focus groups were conducted until no new major themes emerged, resulting in a final sample of five groups. Most of the sample women in the focus group were in their twenties and more than half had children. Three-quarters were single and more than one-third of participants were students with just under one-third being employed. The majority of participants had annual household incomes of less than $20,000 Canadian Footnote 16 .

Focus group data analysis led to the identification of six data categories and themes. Relevant findings included:

the women reported seeing themselves as having gender assumed food-related roles/places within their household such as having food in the refrigerator and cupboards, providing meals that household members and guests enjoy and ensuring that everyone has their nutritional needs met; and
the majority felt that it is their primary responsibility to prepare food for their family (and perform all related tasks), despite it sometimes being described as stressful or challenging.
participants detailed the significant thought and effort that goes into planning, organizing and implementing all of the complex tasks associated with their daily cooking practices;
different types of meals requiring different types of planning and organizing were described by participants including day-to-day meals, meals for company, meals with roommates, elaborate weekend meals, meals made of something they really want to eat and meals based on grocery store specials; and
planning meals was reported as being essential and valuable, although complex, when balancing the nutrition needs, food preferences and schedules of family members, as well as time constraints and available food budgets.
participants described cooking traditional foods from basic ingredients while also expressing a desire to try new foods and meals, despite being limited by the preferences and needs of other family/household members and low self-confidence and efficacy in using specific basic food preparation skills;
concerns related to food going to waste were also a factor if the new food wasn't prepared properly or enjoyed by family members; and
a few participants expressed not seeing the purpose in cooking from scratch when they don't need to and preferring preparing foods having instructions on the box.
most participants spoke of learning how to cook from their mother (or sometimes grandmother) through regular observation;
a number of participants described their own cooking as a contrast to what their mothers had prepared, including preparing more fruit and vegetables and trying foods from other cultures; and
participants also described their use of the internet to learn about food and find recipes; while television was identified as a source of information, many participants found cooking shows to be too complicated.
participants brought up nutrition and health issues throughout the focus group discussions;
specific topics or issues felt to be important when making food choices and cooking decisions included fat and sodium content of foods and eating sufficient vegetables and whole grains and limiting sugar;
participants also discussed feelings of guilt when they do not eat healthy foods and the importance of developing an awareness of nutrition during pregnancy and ensuring that their children eat foods from all four food groups, although some specifically expressed that they weren't concerned about this themselves; and
participants also discussed challenges associated with healthy eating including price, and the perceptions/judgement of others that they don't eat healthy.
most participants spent considerable time and energy purchasing food at the best price and most also had a clear plan in terms where they shop, from the best to worst stores, an assessment based on price of desired items, quality, and lastly, availability. As a result, very few participants did all of their shopping in one store;
price was described as being a significant determinant of food choices and participants willingly travelled significantly further to get what is perceived as the best deal, despite describing transportation as being a challenge to grocery shopping;
grocery store flyers play an important role for those who plan purchases and meals, noting that planning plays a significant role in managing household finances; and
not purchasing expensive foods, detailed budgeting, only buying expensive foods for their children and using the services of food banks were also described as strategies to make their limited incomes last throughout the month Footnote 16 .

The author concludes that the findings support the observed culinary transition, described by Lang and Caraher Footnote 6 , and that the young women in the study have adapted the tasks involved in food acquisition and preparation to their life circumstances, an observation also supported by other research Footnote 12 - Footnote 14 , Footnote 16 . The challenges associated with making decisions between highly available, inexpensive and flavourful, prepared foods and often comparably priced, basic foods requiring food preparation skills were discussed. Engler-Stringer Footnote 16 emphasizes the importance of understanding the context (i.e. food culture) of food choice and cooking practices when designing interventions and strategies to improve the nutritional health of specific population subgroups.

The Region of Waterloo Public Health assessed self-reported cooking and food preparation skills of 703 adult residents (60% response rate) of the Waterloo Regional Area, conducted by the University of Waterloo Survey Research Centre Footnote 26 . While the sample was a random cross-section of Waterloo Region's adult population (Census, 2006) proportionally representative by gender, younger adults and adults living in rental housing (lower income) were under-represented among the survey respondents. The food skills component of the survey was intended to provide baseline surveillance of prevalence of food skills in the community to provide information having potential implications for policies, programs and services. Respondents were asked to rate their skill in 13 food skills/activities using a four point Likert scale. Respondents were also asked to report the time required to prepare the main meal eaten in their home, to identify if they were the main person responsible for meal preparation, how often meals were prepared from 'scratch' using basic ingredients in the previous week and whether any home- or community garden- grown food was consumed by anyone in their household over the past 12 months Footnote 26 .

Highlights of the survey included:

most adults reported having good food skills. However, this was limited to more mechanical techniques;
women reported more skill in food preparation and food-related activities than men. Male respondents reported at least 80% prevalence of good food skills for peeling/chopping/slicing vegetables or fruit, cooking meats properly and cooking soup/stew/casserole from a mix;
fewer men versus women reported being solely responsible for preparing the main meal for their household, "always, almost always or most of the time" (27.4% vs 77.4%);
most households (82.6%) still take more than 30 minutes to cook their main meal, but not many meals are cooked from scratch; 30% of respondents reported spending 30-39 minutes preparing the main meal, followed by 26.5% spending 50 or more minutes;
most adults were not skilled in freezing and canning foods, but those who grow food in their gardens are more likely to have good skills in food preservation than their non-gardening counterparts;
young adults aged 20-34 years reported having lower "good" cooking skills from scratch and canning versus other older adults, but greatest prevalence of good skill in baking using a pre-packaged mix;
fewer adults 65+ years reported good skills in cooking raw meats properly or cooking soup/stew/casserole from a mix, compared to all other age groups surveyed, while the prevalence of "good" skill in cooking soup/stew/casseroles from scratch appeared to increase with age until 65+ years, then decreased;
respondents in the lowest income group reported cooking regularly ("always, almost always or most of the time") more than twice as frequently as respondents in the highest income group, 71.2% compared to 31.5%;
respondents from the lowest income group also reported significantly greater self-reported skills in several areas as compared to those in the highest income group (e.g. baking using a mix, baking from scratch and canning); and
43.6% of respondents reported preparing at least part of a meal prepared from scratch five or more times over the past seven days with a greater proportion of those reporting lower incomes (<$30,000) compared to those having the highest incomes (≥ $70,000) (53.6% versus 30.2%)26.

The authors of this report proposed that continued surveillance of food-related skills will facilitate monitoring changes in food skills and behaviours, providing relevant information for the planning of community-based learning opportunities for food skill development Footnote 26 .

While not reporting specific quantifiable data to illustrate the state of, or trends in cooking and food preparation skills, several publications emphasized the role and influence of parents in developing and maintaining healthy eating behaviours of preschoolers, school-aged children and adolescents Footnote 23 , Footnote 27 - Footnote 35 . With specific role-related behaviours somewhat differing across socioeconomic groups and with a child's development stage, Hart et al Footnote 27 , Hildebrand et al Footnote 28 , Lindsay et al Footnote 33 and Rhee Footnote 34 identify parents as powerful nutrition and food skills educators and educational intermediaries as a result of their impact on children's developing food behaviours. Specifically, research supports parents discrete and interacting roles in ensuring availability and accessibility of healthy food choices, in demonstrating, modelling and reinforcing positive attitudes and beliefs toward nutritious foods and cooking and food preparation, and in ensuring health promoting meal structures and home eating patterns (i.e. home eating environment), on healthy eating patterns and behaviours Footnote 27 , Footnote 28 , Footnote 33 , Footnote 34 . Further to the identification of parental roles, research supports the involvement of parents in comprehensive nutrition and cooking skills education initiatives for children. As well, parent-focused interventions need to recognize and act on existing levels of influence, motivation, knowledge/ understanding, skill and perceived self-efficacy, when behaviour change is the primary goal Footnote 27 , Footnote 28 , Footnote 33 , Footnote 34 .

Despite the inherent limitations associated with comparing data collected from different populations using different methodologies at different times, the following common themes, similar to those described in A Culinary Transition or Consumer Deskilling?, emerged from the research findings presented in this section:

pre-prepared and convenience foods (eaten within and external to the home environment) have become normalized within patterns of eating for children of all ages and families;

The specific implications of a transition in cooking and food preparation skills are difficult to assess given the lack of concrete data detailing that a transition, specifically deskilling, has taken place. However, the research presented generally reports respondents' self-perceived general satisfaction with their cooking and food preparation skills. This finding is presented alongside evidence demonstrating that decisions are being made not to use these skills, presuming a definition of basic, traditional or 'from scratch' cooking, for a variety of reasons.

What is clear and supported by both research and food purchasing and consumption data, nationally and internationally, is that food choice and consumption patterns have transitioned with increased processed, pre-prepared and convenience foods being purchased, 'assembled' and consumed across population subgroups on a daily basis. The results of several research initiatives reported in the previous section support the normalization of processed, pre-prepared and convenience foods within the eating patterns of individuals and families, again across population subgroups Footnote 7 , Footnote 16 , Footnote 18 , Footnote 23 - Footnote 25 . Related to this normalization is the potential lack of transference of basic, traditional or 'from scratch' cooking and food preparation skills from parents (primarily mothers) to children and adolescents, which has traditionally been the primary mode of learning. Without the opportunity to observe and practice basic or 'from scratch' cooking and food preparation skills within the home environment, many argue that children and adolescents will not be equipped with the necessary skills to make informed choices within an increasingly complex food environment Footnote 6 , Footnote 7 . In support of this argument, low self-efficacy and self-perceived inadequate cooking and food preparation skills have been identified as barriers to food choice within several recent research initiatives Footnote 16 , Footnote 22 , potentially resulting in a greater reliance on pre-prepared or convenience foods, reduced variety in food choice and consumption and the atrophy of cooking and food preparation skills Footnote 9 - Footnote 11 . Several authors suggest that this will have greater dietary and overall health implications for those living on a lower income. While the gap is narrowing between the price of pre-prepared foods and whole/raw foods, healthier pre-prepared or convenience foods tend to cost more. Although not completely substantiated by research, several authors suggest that the implications of the culinary transition on food choice and potentially, dietary quality, are not likely consistent across socio-economic groups or gradients. Those from more affluent groups can afford to essentially 'buy their way out of' the health and social implications through the purchase of healthier pre-prepared foods and meals Footnote 6 , Footnote 7 .

Some evidence does exist demonstrating a relationship between decreased use of traditional or basic food preparation skills, increased consumption of pre-prepared, packaged and convenience foods and dietary quality. That being said, several authors point out that the information is limited to substantiate a direct relationship between cooking and food preparation skills and health Footnote 6 , Footnote 7 , Footnote 23 , Footnote 24 , Footnote 35 . While the results of interventions may be quite moderate, Wrieden Footnote 39 and others Footnote 7 , Footnote 23 , Footnote 24 believe that some studies do indicate that food skills interventions may be a useful starting point for initiating dietary change, while recognizing that addressing any one barrier to change (i.e. in isolation of others or a broader context) is unlikely to radically alter established eating behaviours, particularly among adults.

Several authors report that programs are generally received favourably by both children and parents. However, there are limited changes in knowledge and/or behaviour maintained over short periods of time (e.g. willingness to try new foods, increase in one serving of fruit and vegetables, greater knowledge of food safety behaviours, improved self-efficacy). There is a need to better understand how children understand messages communicated, the role of practical skills and parental influence over the same in healthy eating, and the relationship between 'dosage' of nutrition education interventions related to cooking and food preparation skills and movement to higher stages of sustained behaviour change Footnote 23 , Footnote 24 , Footnote 27 - Footnote 30 . The most efficient and effective strategy for achieving the desired/necessary long-term and whole diet behaviour modification among the school-aged population, specifically, has yet to be established. However, the articles reviewed, which reported the limited or moderate results of cooking and food skills interventions, provided recommendations for future research. In addition, adult participants in numerous descriptive research studies indicated an interest in learning new, and/or further developing existing cooking and food preparation skills. As well, within our current society, where we do not have to acquire or use cooking skills 'to survive', some researchers suggest capitalizing on people's interest in the creative (versus 'mundane') aspect of cooking and food preparation when developing and promoting interventions Footnote 9 .

The literature reviewed to inform this section of the synthesis focused on interventions designed to improve cooking and food preparation skills among children Footnote 17 , Footnote 29 - Footnote 31 , improve consumption of specific foods and food groups among children Footnote 28 and explore parental perceptions and perspectives related to both food-related skills development and food consumption Footnote 27 - Footnote 29 , Footnote 32 . With the exception of one intervention program reviewed which used a computer-based multi-media approach Footnote 31 , the remainder were 'traditional' multi-week nutrition education and skills development programs having hands-on food preparation opportunities for children and a parental communication/education involvement or evaluation component. Several programs incorporated activities to increase nutrition-related knowledge, decision-making and problem solving. An almost equal number of programs were delivered within the school (largely extra-curricular) and community environments. All programs were provided free of charge to participants with some providing basic kitchen utensils to participants, most providing recipes of foods prepared during the program and some allowing for food to be brought home for other family members to try. Only one program included within the review was intended for 'full family participation'.

While clear evidence detailing successful intervention strategies for specific age and population subgroups does not currently exist, available evidence and experience indicates that programs/interventions specifically designed for children, and having some involvement of adults/parents, often have common characteristics. These include:

a stated theoretical basis, or, at a minimum, a set of defendable community-relevant assumptions upon which the program or activity is based;
opportunities for experiential/hands-on learning (i.e. ranging from taste testing to demonstrations to cooking and food preparation skills), to promote and build self-confidence and self-efficacy through skill development and encourage children and youth to become involved in food preparation activities within the home environment;
self-assessment of eating patterns and behaviour change for middle and high school students as well as parents/adults;
the involvement of parents, either actively or as intermediaries depending on the age of the child (i.e. emphasize the influence of parents in food choices and food preparation skills of children and youth), in program implementation and evaluation;
community-based programs that are tailored for specific population groups (learner-centred), giving consideration to the social context of food choice and cooking practice;
measurable, specific goals set by participants (largely relevant for adult/parent participants as individuals and, ideally, for their families);
programs that capitalize on interest in learning and demonstrate that healthy, cost-effective foods and meals can be planned, prepared and served in limited time (by teaching time-saving food preparation methods and equipment); and
programs that are longer in duration.

The literature specifically supports the importance of setting goals by participants, which address the following: barriers/negative aspects of performing a desired/favourable behaviour change, increasing availability and accessibility of specific healthy foods, and increasing preferences for specific healthy foods and increasing skills 27<27s27p27a27n27 27c27l27a27s27s27=27"27w27b27-27i27n27v27"27>27F27o27o27t27n27o27t27e27 27<27/27s27p27a27n27>27 27 , 28<28s28p28a28n28 28c28l28a28s28s28=28"28w28b28-28i28n28v28"28>28F28o28o28t28n28o28t28e28 28<28/28s28p28a28n28>28 28 . Related to the last characteristic above, Parris Footnote 30 cites research conducted by Contento et al Footnote 36 , which indicates that nutrition education programs with ample time and intensity of teaching are more effective than shorter programs Footnote 36 . Based on a review of nutrition education programs, Contento et al Footnote 36 discovered that 15 contact hours could be expected to bring about changes in knowledge and 50 hours were required for changes in attitudes and behaviours. The work of Contento et al Footnote 36 and Lytle and Achterberg Footnote 37 , were cited in several of the specific intervention references reviewed.

As noted earlier within the synthesis, nutrition and food-related changes within the UK 's National Curriculum for public schools in the late 1990s stimulated great dialogue, research and action involving government, academics and non-government organizations. One result of this dialogue, research and action having relevance for the development of programs and initiatives that aim to develop and/or strengthen cooking and food preparation skills among children and youth are the "food competencies for young children" Footnote 38 . According to the website, the food competencies for children aged five-sixteen years are organized as a framework of core skills and knowledge for young people to assist young people in choosing, cooking and eating safe and healthy food. While primarily intended for use by schools and community-based organizations in supporting young people in developing a consistent set of food skills and knowledge, supporting wider government health-related initiatives, the competencies can be met at home or through other activities. The theme areas of the detailed competencies are: diet and health, consumer awareness, cooking (food preparation and handling) and food safety. Current users of the competencies are detailed within the information available on the web Footnote 38 .

The information presented within this synthesis indicates that despite noted limitations in surveillance and intervention-related data, concerns related to a transition in cooking and food preparation skills and the potential impact on food choice, health and health inequalities are not unfounded.

Furthermore, the information synthesized supports the need for further research and surveillance to strengthen understanding and potential to influence the determinants, prevalence and characteristics of cooking and food preparation skills among children and families in Canada. In addition, the influence of cooking and food preparation skills on food choice, dietary quality and nutritional health, across and within population subgroups of interest, requires further exploration. The report outlines suggested characteristics of successful knowledge and skills-based food and nutrition education, success being defined as sustained and notable dietary behaviour change among children and families.

To address identified knowledge gaps, the following research questions are suggested for further exploration:

How do Canadian families with children define or describe cooking and food preparation skills?
Do Canadian families with children value basic or 'from scratch' cooking and food preparation skills?
How do Canadian families with children consider or assess the nutritional value of convenience and pre-prepared foods as compared to foods and meals 'from scratch'?
How have cooking and food preparation skills, and their use, changed in Canada primarily among families with children?
What are the evidence-based characteristics of successful interventions that aim to develop and/or enhance the cooking and food preparation skills of children within the context of families?
How do self-reported cooking, food purchasing and food preparation knowledge, skills and related self-efficacy of Canadians vary across socioeconomic groups? How does this compare with that of Aboriginal populations?
Is there a relationship between childhood overweight and obesity and food preparation and cooking skills among children and families?
Is there a difference in macro and micronutrient intake of Canadians who primarily eat food prepared from scratch versus those who regularly incorporate pre-prepared, pre-packaged and convenience foods into their family eating patterns?

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Improving Cooking and Food Preparation Skills: A Profile of Promising Practices in Canada and Abroad

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Can't cook, won't cook: A review of cooking skills and their relevance to health promotion

1999, International Journal of Health Promotion and Education

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Samuthpongtorn C , Nguyen LH , Okereke OI, et al. Consumption of Ultraprocessed Food and Risk of Depression. JAMA Netw Open. 2023;6(9):e2334770. doi:10.1001/jamanetworkopen.2023.34770

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Consumption of Ultraprocessed Food and Risk of Depression

1 Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston
2 Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston
3 Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston
4 Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
5 Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
6 Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
7 Broad Institute of MIT and Harvard, Cambridge, Massachusetts
8 Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
Correction Errors in the Table JAMA Network Open

Increasing evidence suggests that diet may influence risk of depression. 1 - 3 Despite extensive data linking ultraprocessed foods (UPF; ie, energy-dense, palatable, and ready-to-eat items) with human disease, 4 evidence examining the association between UPF consumption and depression is scant. Prior studies have been hampered by short-term dietary data 1 , 2 and a limited ability to account for potential confounders. 1 , 3 Additionally, no study has identified which UPF foods and/or ingredients that may be associated with risk of depression or how the timing of UPF consumption may be associated. Therefore, we investigated the prospective association between UPF and its components with incident depression.

This cohort study was approved by the institutional review board (IRB) at the Brigham and Women’s Hospital and the Harvard T.H. Chan School of Public Health. The return of a completed questionnaire was accepted by the IRB as implied informed consent. The study adhered to the Strengthening the Reporting of Observational Studies in Epidemiology ( STROBE ) reporting guideline.

We conducted a prospective study in the Nurses’ Health Study II between 2003 and 2017 among middle-aged females free of depression at baseline. Diet was assessed using validated food frequency questionnaires (FFQs) every 4 years. We estimated UPF intake using the NOVA classification, 2 which groups foods according to the degree of their processing. In secondary analyses, we classified UPF into their components, including ultraprocessed grain foods, sweet snacks, ready-to-eat meals, fats and sauces, ultraprocessed dairy products, savory snacks, processed meat, beverages, and artificial sweeteners. 4 We used 2 definitions for depression: (1) a strict definition requiring self-reported clinician–diagnosed depression and regular antidepressant use and (2) a broad definition requiring clinical diagnosis and/or antidepressant use.

We estimated hazard ratios (HRs) and 95% CIs for depression according to quintiles of UPF intake using Cox proportional hazards models, with adjustment for known and suspected risk factors for depression, including age, total caloric intake, body mass index (BMI; calculated as weight in kilograms divided by height in meters squared), physical activity, smoking status, menopausal hormone therapy, total energy intake, alcohol, comorbidities (eg, diabetes, hypertension, dyslipidemia), median family income, social network levels, marital status, sleep duration, and pain. In an exploratory analysis, we examined the association between changes in UPF consumption updated every 4 years with incident depression. All analyses were performed using 2-sided tests from SAS (version 9.4). Data were analyzed from September 2022 to January 2023.

Our cohort included 31 712 females, aged 42 to 62 years at baseline (mean [SD] age, 52 [4.7] years; 30 190 [95.2%] non-Hispanic White females). Participants with high UPF intake had greater BMI, higher smoking rates, and increased prevalence of comorbidities like diabetes, hypertension, and dyslipidemia and were less likely to exercise regularly. We identified 2122 incident cases of depression using the strict definition and 4840 incident cases using the broad definition. Compared with those in the lowest quintile of UPF consumption, those in the highest quintile had an increased risk of depression, noted for both strict definition (HR, 1.49; 95% CI, 1.26-1.76; P < .001) and broad definition (HR, 1.34; 95% CI, 1.20-1.50; P < .001) ( Table ). Models were not materially altered after inclusion of potential confounders. We did not observe differential associations in subgroups defined by age, BMI, physical activity, or smoking. In a 4-year lag analysis, associations were not materially altered (strict definition: HR, 1.32; 95% CI, 1.13-1.54; P < .001), arguing against reverse causation.

Next, we examined the association of specific UPF components with risk of depression. Comparing extreme quintiles, only artificially sweetened beverages (HR, 1.37; 95% CI, 1.19-1.57; P < .001) and artificial sweeteners (HR, 1.26; 95% CI, 1.10-1.43; P < .001) were associated with greater risk of depression and after multivariable regression ( Figure ). In an exploratory analysis, those who reduced UPF intake by at least 3 servings per day were at lower risk of depression (strict definition: HR, 0.84; 95% CI, 0.71-0.99) compared with those with relatively stable intake in each 4-year period.

These findings suggest that greater UPF intake, particularly artificial sweeteners and artificially sweetened beverages, is associated with increased risk of depression. Although the mechanism associating UPF to depression is unknown, recent experimental data suggests that artificial sweeteners elicit purinergic transmission in the brain, 5 which may be involved in the etiopathogenesis of depression. 6 Strengths of our study include the large sample, prospective design, high follow-up rate, ability to adjust for multiple confounders, and extensively validated dietary assessment tools. This study had limitations. The cohort primarily included non-Hispanic White females. Additionally, without structured clinical interviews, misclassification of the outcome may be considered.

Accepted for Publication: August 15, 2023.

Published: September 20, 2023. doi:10.1001/jamanetworkopen.2023.34770

Correction: This article was corrected on October 18, 2023, to fix transcription errors in the Table.

Corresponding Authors: Raaj S. Mehta, MD, MPH ( [email protected] ), and Andrew T. Chan, MD, MPH ( [email protected] ), Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, 100 Cambridge St, Ste 1580 Boston, MA 02114.

Author Contributions: Drs Samuthpongtorn and Mehta had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Samuthpongtorn, Chan, Mehta.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Samuthpongtorn, Chan, Mehta.

Critical review of the manuscript for important intellectual content: All authors.

Statistical analysis: Samuthpongtorn, Chan, Mehta.

Obtained funding: Chan.

Administrative, technical, or material support: Samuthpongtorn, Okereke, Song, Chan, Mehta.

Supervision: Chan, Mehta.

Conflict of Interest Disclosures: Dr Okereke reported receiving grants from the National Institutes of Health and royalties from Springer Publishing outside the submitted work. Dr Chan reported receiving grants from Bayer Pharma AG and Zoe and personal fees from Boehringer Ingelheim, Pfizer, and Freenome outside the submitted work. No other disclosures were reported.

Funding/Support: The Nurses’ Health Study II was funded by grant U01 CA176726 from the National Cancer Institute, National Institutes of Health.

Role of the Funder/Sponsor: The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Disclaimer: The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Data Sharing Statement: See the Supplement .

Additional Contributions: We thank the participants and staff of the Nurses’ Health Study II for their valuable contributions. They received no compensation for their contributions.

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Restaurants

I Learned a Lot of Skills Working in Restaurants, but These Are By Far the Most Helpful

Knowing how to hold a ridiculous number of wine glasses has made my life significantly easier.

ShotShare / Getty Images

I learned many things working in restaurants, including big life lessons, like how to multitask, how to be patient, and how to communicate with people from all over. But there are also countless small things — repetitive tasks like carrying three plates in one hand or pulling out a chair without making a screeching noise — that, to this day, have made my life so much easier. So I polled my colleagues, many of whom have also spent years working in restaurants , bars, and coffee shops, to find out which practical skills they learned that they still use every day. From carrying dozens of wine glasses at once, to the most efficient way to peel garlic, these are some of the most underrated, life-changing takeaways from working in the hospitality industry.

The best way to throw away a paper placemat

Whenever I need to throw away a used paper towel — specifically when I’m using one as a makeshift placemat — I find myself repeating a skill that I learned as a backwaiter at abcV in New York City. After a party would finish their meal, I’d clear their plates then return to remove the paper placemats, being careful not to spill a pile of crumbs on the guests’ laps. The technique involved using your dominant hand to fold the bottom half of the paper up, then, using your thumb to repeatedly make small folds from left to right, creating a tight cone-shape. I’d lift it from the bottom, get a good handle on it to contain any food bits, then swiftly transfer it to my other hand to repeat the process with the remaining placemats. Now, it’s a simple trick that has made my desk lunches significantly less messy.

How to have a slip-free cutting board

“Before I started writing, I was a professional chef for nearly a decade. At my first kitchen job in college, I was julienning carrots for my mise en place and the cutting board was moving all around the prep table. It had been through the dishwasher a few times too many so it was a bit warped and was basically spinning on a high point. After about 15 minutes of watching me struggle, one of the chefs wordlessly walked over to my set up, moved my board, flopped down two wet paper towels, and pushed the board to indicate that it wasn’t going anywhere. I was really embarrassed, but you better believe I haven't forgotten to put a wet paper towel under my cutting board since! The wet towel keeps the board from moving, which makes cutting easier and safer. It’s the most important trick I’ve learned and I still use it every day of my life.” — Nick DeSimone, Commerce Updates Writer

The secret to making better sandwiches

“During a stint as a staffer at Bodega Delicatessen in Oxford, Ohio, I picked up sandwich-making fundamentals that I use almost every weekday of the year (namely when putting together lunch for myself or my kids). First among them: be generous with your condiments — use at least a tablespoon per slice of bread — and spread them all the way to the crust. I can always tell when someone hasn't followed this rule, as stingy use of condiments makes for a very sad sandwich.” — Karen Shimizu, Executive Editor

A faster way to peel garlic

“This one’s probably pretty well known by this point, but if you have to peel a ton of garlic at home (or are a prep cook with anxiety issues you need to work out), place all the garlic cloves in a metal mixing bowl. Cover the top of the bowl with a plate or something similar, and shake the hell out of it for 30 seconds or so. Like, however hard you think you need to shake it, go ahead and shake a little bit harder. Remove the plate and voila, all your garlic should be peeled, and you get a nice little workout to boot.” — Dylan Garret, Associate Editorial Director, Drinks

How to carry a ridiculous amount of wine glasses at once

“When I worked at a super busy Italian restaurant off Restaurant Row in the Theater District of New York City, I learned how to carry an obscene amount of wine glasses at once — and not necessarily in any kind of proper way. It was mainly out of necessity and lack of time. We had such an intense turnover there, a second couldn’t be wasted on return trips to the prep station. I often carried a bottle or two of wine under one arm and stacked my fingers with glasses, stem-side up, to various tables at once. If I’m ever tasked with bringing out a stupid amount of glasses to a group, you can count on me to do it well and then boast about it afterward.” — Prairie Rose, Senior Drinks Editor

The correct way to polish glassware

“My first restaurant job was at a bustling sushi spot in Boston. It was one of those places where, as a host, I said things like, ‘We won't be able to accommodate a party of two for the next three hours.’ It was also the kind of place where I'd work a sleepy lunch shift and have to do something to keep myself busy. It was during these quiet shifts where I learned how to properly polish glassware. I'd stand with my co-worker, Nolberto (truly one of the best bussers in the game), and hold cups and wine glasses over a hot tub of water, filling the bowl of the glasses with steam. We'd use microfiber towels to polish the inside and outside of the glassware. I was always shocked by the amount of pressure Nolberto would instruct me to use, but the glasses can really take it!” — Lucy Simon, Assistant Editor

A technique to make farmers market shopping easier

“When I was a line cook in New York City, we'd meet our chef de cuisine four mornings a week at the Union Square Greenmarket to shop for the produce that would become sides, garnishes, and pasta sauces on the menu each day. This taught me how to shop efficiently and look for the best quality fruits and vegetables. To this day, I still make one lap around my local farmers market and take a mental inventory about what looks the best. Then I shop stall by stall, picking produce that looks the most pristine and feels heavy for its weight.” — Hunter Lewis, Editor in Chief

How to clear plates without causing a fuss

“You can see my experience as a waiter and bartender when I clear the table at the end of a dinner party. I can balance four plates on one arm, so we’re not stacking them and dealing with all the silverware at the table (and ruining the conversation at hand). I stash a tall container filled with hot, soapy water in my sink, so all the silverware can go directly in there until I’m ready to deal with it later. It’s a trick I learned while working in restaurants and in catering that makes dinner party cleanup so much easier, without disturbing the night’s vibe. ” — Chandra Ram, Associate Editorial Director, Food

Multitasking like a pro

“So much about cooking and working in a kitchen is time and project management. When I was a line cook, I had to learn how to manage my time well, or I would be in the weeds. This started before service and never really ended because you have so little time out of the kitchen; managing your free time to maximize it is another consideration. I credit my time in the back of house for my ability to have multiple projects going simultaneously and keep my cool while executing. It is something I use everyday.” — Jennifer Zyman, Commerce Testing Editor

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Interdisciplinary Approaches to Higher Education and Food Safety in International Development in Agriculture

The following dissertation contains a series of articles from a diverse set of research experiences over my five years as a PhD student at Purdue University. Each of the following articles relay how my interdisciplinary studies in food safety, gender, and higher education contribute to a comprehensive understanding of international development in agriculture. After an introductory chapter, chapters two and three include systematic literature review articles on the state of food safety in Lao PDR and Cambodia. Each review discusses available knowledge and potential development opportunities surrounding food safety, a significant threat to public health, especially in low- and middle-income countries. Building upon the food safety literature, chapters four and five are based upon research aimed at reducing foodborne illnesses in Cambodia’s informal vegetable value chain. Toward this end, the chapters present two articles that study the lives of Cambodian women vegetable producers to inform future food safety engagement. The final three chapters are a collection of articles based on my experiences working with agricultural higher education in international development contexts. Chapters six and seven present two articles about the employability of Egyptian agriculture university graduates. Chapter eight includes my final research article and explores how a service learning-based study abroad in Romania encouraged agricultural engagement interest and skills in undergraduate agricultural students. Lastly, chapter nine concludes the dissertation with final remarks and reflections about how each discipline provided a different perspective to international development in agriculture, and the value of applying interdisciplinary approaches to complex challenges.

Degree Type

Doctor of Philosophy
Animal Sciences

Campus location

West Lafayette

Advisor/Supervisor/Committee Chair

Additional committee member 2, additional committee member 3, additional committee member 4, additional committee member 5, usage metrics.

Other agricultural, veterinary and food sciences not elsewhere classified

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v.4; 2016 Dec

An evidence-based conceptual framework of healthy cooking

Margaret raber.

a University of Texas, School of Public Health, Division of Epidemiology, Human Genetics and Environmental Sciences, Houston, TX, United States

b University of Texas, MD Anderson Cancer Center, Department of Pediatrics Research, Houston, TX, United States

c University of Texas, School of Public Health, Division of Management, Policy and Community Health, Houston, TX, United States

Joya Chandra

Mudita upadhyaya.

e University of Texas, School of Public Health, Michael and Susan Dell Center for Healthy Living, Austin, TX, United States

Vanessa Schick

Larkin l. strong.

d University of Texas, MD Anderson Cancer Center, Department of Health Disparities Research, Houston, TX, United States

Casey Durand

f University of Texas, School of Public Health, Division of Health Promotion and Behavioral Sciences, Houston, TX, United States

Shreela Sharma

Associated data.

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.

• 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.

1. Introduction

Diet is a modifiable risk factor of particular concern for chronic disease prevention as the US faces an obesity epidemic and population adherence to national diet recommendations remains dismally low ( Levi et al., 2013 ). Diet impacts risk for several major chronic diseases including cancer, heart disease, diabetes and obesity ( Micha et al., 2012 , Kushi et al., 2012 ). Cooking could influence disease risk through its effect on weight status and diet quality as well as carcinogen development during food preparation ( WCRF / AICR, 2007 ). For example, cooking red meat at high temperatures or charcoal grilling facilitates the development of heterocyclic amines and polycyclic aromatic hydrocarbons ( Kushi et al., 2012 ); exposure to these carcinogens may increase cancer risk ( Zheng & Lee, 2009 ). Domestic (as opposed to industrial) cooking processes also impact the bioavailability of some antioxidants in fruits and vegetables ( Harasym & Oledzki, 2014 ).

Eating out of home (OH) foods has been positively associated with body weight, obesity, and poor diet quality ( Smith et al., 2013 , Bezerra et al., 2012 , Lachat et al., 2012 ). An international review of 29 studies found those that consumed high amounts of OH foods also had higher percentages of calories from fat in the diet and lower intakes of iron, calcium and vitamin C ( Lachat et al., 2012 ). Eating foods cooked at home from basic ingredients, however, has been linked to increased intake of fruits, vegetables, and whole grains, reduced BMI, and improved general health ( Larson et al., 2006 , Laska et al., 2012 , McLaughlin et al., 2003 ). A study of young adults found those that cooked more frequently were more likely to achieve nutrition guideline goals for fat, calcium, whole grain, fruit and vegetable intake ( Larson et al., 2006 ). Another study found cooking classes increased intake of fruit and vegetables and improved food safety behaviors ( Brown & Hermann, 2005 ).

Cooking at home has declined steadily over the last 40 years, decreasing by almost a quarter (23%) from 1965 to 2008 ( Smith et al., 2013 ). The benefits of home cooking have gained attention in recent years, however, and many health-promotion cooking projects have emerged. These include international programs such as Jamie Oliver's “Ministry of Food” in the UK and Australia and national programs such as First Lady Michelle Obama's “Let's Move: Chefs Move to Schools” ( Let's Move: Chefs Move to Schools, n.d. ) campaign and Share our Strength's “Cooking Matters” ( Share Our Strength: Cooking Matters, 2013 ). Other US organizations, such as Slow Food ( Slow Food USA, 2000 ) and the National Farm to School Network ( National Farm to School Network, n.d. ) advocate for school gardening programs that incorporate cooking education elements.

In nutrition research, cooking components are often part of nutritional interventions and have been shown to potentially be more effective than nutrition education (knowledge-, attitude-, and awareness-centered approaches) alone in changing diet ( Curtis et al., 2012 ). Two recent systematic reviews examined the impact of some of these interventions. Although the scope of these reviews differs from the work presented here, the noted limitations highlight the variability in this emerging field of research on cooking and health. One review, focusing on children, found cooking interventions that included hands-on food preparation showed promise as a strategy for improving psychosocial factors including food related preferences and attitudes, as well as food behaviors ( Hersch et al., 2014 ). A review of adult intervention studies that consisted of cooking or food preparation as the primary aim found similarly promising results on a range of outcomes including improved diet, positive food choices and other health outcomes ( Reicks et al., 2014 ). However, both reviews noted that significant variability in study curricula, non-rigorous study designs and the lack of standardized assessment tools hindered the replicability of the research ( Hersch et al., 2014 , Reicks et al., 2014 ). This may, in part, be explained by the complexity of defining cooking and lack of clear definitions in the literature ( Engler-Stringer, 2010 ). The absence of a standardized definition of healthy cooking has led many authors to define healthy cooking individually and imprecisely ( Engler-Stringer, 2010 ). Therefore, interventions are building cooking skill education into their curriculum, but failing to identify if the behaviors they teach are impacting dietary habits or health outcomes ( Engler-Stringer, 2010 ).

The purpose of this study was to develop an evidence-based conceptual model outlining healthy cooking behaviors in relation to chronic disease prevention. This is the first conceptual framework of cooking behavior to our knowledge. A validated model is a significant step toward improved understanding of the relationship between cooking, disease and disease prevention and may serve to inform future assessment tools. A unified understanding of key cooking behaviors and ability to measure these behaviors in a reproducible way is critical for the development of quality interventions targeting healthy eating environments.

2. Developing the conceptual framework of healthy cooking.

A conceptual framework of healthy cooking behaviors ( Fig. 1 ) was developed based on the results of a comprehensive literature search (Supplemental Fig. S1). Fifty-nine peer-reviewed, English language quantitative studies evaluating the relationships between cooking behaviors and health were examined. Both observational studies focusing on the associations between certain cooking practices and health, as well as experimental studies examining cooking interventions were included. Outcomes of interest included behavioral (diet quality including specific nutrient intake, cooking frequency/methodology, oil usage) and physiological (chronic disease risk including cancer, diabetes, obesity, and cardiovascular disease, as well as metabolic measures and mortality) factors. Studies focusing exclusively on psychosocial and attitudinal variables were not included as the primary focus of this paper was to build an evidence-based model of cooking behaviors. Key characteristics of 34 observational and 25 experimental studies were reviewed and used to inform the final model (Supplemental Tables S2-S3).

Conceptual Model of Healthy Cooking: Scheme depicting the conceptual framework and the constructs that define healthy cooking in relation to chronic disease. This figure outlines the directionality of these constructs and how they inter-relate to influence dietary behaviors and health

Abbreviations: CVD: Cardiovascular disease; HAA: Heterocyclic aromatic amines.

The proposed model represents the key cooking behaviors shown to impact health outcomes extracted from the literature. These cooking behaviors, gleaned from the included observational and experimental studies (Supplemental Tables S4-S5), were further organized into overarching themes, forming the broad constructs of the model. The initiating construct is the action of cooking, titled ‘Cooking Frequency’, followed by four constructs that occur during food preparation including ‘Techniques/Methods’, ‘Minimal Usage, ‘Additions/Replacements’ and ‘Flavoring’. These broad constructs are further defined by individual behaviors ( Table 1 ) and a detailed description of each construct is provided below. The directional relationship between these constructs and their potential impact on chronic disease including obesity, cardiovascular disease (CVD), diabetes and cancer is put forward.

Constructs and defining behaviors.

Construct	Defining behaviors (+ positive/− negative)	Example “Did you…

Cooking Frequency	Frequency of preparing meals in the home (+) Preparing meals from “basic” ingredients (+)	Cook dinner at home Make a stew from fresh meat and vegetables, not using canned stock or bouillon


Avoid cooking red meat with high temperature methods	Boiling, grilling, BBQ, broiling, frying red meat (−)	Fry pork chops
Avoid deep frying foods	Foods fully submerged in high temperature liquid fat (−)	Deep fry chicken
Use low fat cooking methodology	Baking, boiling, steaming, grilling (+)	Steam spinach
Accurately measure ingredients	Assign appropriate portions (+) Smaller portions of high fat foods (+) Measure salt/oil (+)	Make a four cup yield soup recipe for four people Serve a smaller portion of macaroni and cheese Measure oil with teaspoons
Avoid cooking meats to well done/well browned	Cook meat and fish to well done (−) Fully browned surface of fried foods (−)	Cook your steak to well-done Fry pork chops so the crust is completely browned


Limit red meat	Limit pork, lamb, beef, vary with plant based foods, eggs, fish or poultry (+)	Make chicken burgers
Limit/avoid processed foods	Limit or avoid all packaged/processed foods (+)	Make chicken stock or use water instead of prepared stock
Limit animal fats	Limit lard/bacon grease/chicken fat/butter/shortening, vary with liquid vegetable based oils (+)	Use liquid vegetable oil instead of shortening while making tortillas
Limit sugar	Use less sugar baking or general cooking (+)	Make a cake with reduced sugar


Add unprocessed fruit/vegetables to main dishes	Incorporate fruit and vegetables into all dishes (not just veg side dishes) (+)	Add fresh carrots or tomatoes to rice
Use olive oil	Use of olive oil for cooking (+)	Specifically use olive oil when cooking
Replace refined grains with whole grains	Use of whole grains (+)	Use brown rice instead of white rice


Using herbs/spices/citrus/alliums	Add herbs/spices/orange/lemon/lime/onion/garlic/shallots while cooking (+)	Use spices, herbs, onions or other low calorie flavorings when cooking
Reducing salt	Use low/no salt while cooking (+)	Did you add a small amount or no salt when cooking
Avoid processed meats when cooking	Bacon/ham hocks/jerky/sausage, hotdogs (−)	Use bacon to flavor a soup
Avoid margarine/cream-based sauces on vegetables	On all vegetable preparations (−)	Serve broccoli with cheese sauce

A table of the key constructs of healthy cooking identified in the literature and their sub-constructs, further defined by examples of individual behaviors.

2.1. Cooking frequency

‘Cooking Frequency’ is defined as the decision to cook at home, as opposed to going to a restaurant or ordering take-out. A sub-construct to cooking frequency is cooking from basic ingredients, sometimes referred to as “cooking from scratch”. The definition of the terms “basic ingredients” and “scratch” vary widely in the literature but generally suggest cooking without the use of ultra-processed foods and using whole foods. Ultra-processed foods have been defined in the literature as those foods which are made with substances extracted from whole foods but little or no actual whole foods included such as frozen heat and serve meals, salad dressings, chips, confections and other products ( Moodie et al., 2013 ). Cooking frequency has been positively associated with diet quality ( Larson et al., 2006 , Laska et al., 2012 , Chen et al., 2012 , Crawford et al., 2007 , Gustafsson et al., 2002 , Sweetman et al., 2011 ), as well as lower mortality ( Chen et al., 2012 ).

2.2. Techniques and methods

‘Techniques/Methods’ refers to cooking approaches that positively impact nutrient content such as avoiding cooking red meat with high temperature cooking methods, avoiding deep frying foods, using low fat cooking methods, accurately measuring ingredients, and avoiding cooking meats until well-done or heavily browned. Techniques refer to actions taken by individuals while in the process of cooking (avoiding browning) and methods refer to procedures applied to ingredients during preparation (deep frying or steaming). ‘Techniques/Methods’ have been shown to positively impact nutrient content through reduced fat intake ( Archuleta et al., 2012 , Newman et al., 2005 ) and reduced sodium intake ( Kitaoka et al., 2013 ). ‘Techniques/Methods’ also impacts biological processes that may occur during cooking. This includes deep frying, high temperature cooking of red meat or heavy browning of fried surfaces which has been shown to increase the development of carcinogenic compounds on foods including heterocyclic amines and polycyclic aromatic hydrocarbons ( WCRF / AICR, 2007 ).

2.3. Minimal usage

‘Minimal Usage’ is defined as the restriction of products when cooking that should be minimized or moderated. Foods to use minimally (or moderately) while preparing meals include added sugars and sweeteners, animal fats, processed foods, and red meat. Reducing these types of foods while cooking is a skill taught in many nutrition-based intervention studies that include cooking components ( Archuleta et al., 2012 , Newman et al., 2005 , Kitaoka et al., 2013 , Bielamowicz et al., 2013 , Kisioglu et al., 2004 , Millett et al., 2012 , Wrieden et al., 2007 ). Excessive use of sugar has been linked to increased body weight, high blood pressure and poor lipid profiles ( Te Morenga et al., 2013 , Te Morenga et al., 2014 ), animal fat consumption has been associated with increased obesity risk ( Milanovic et al., 2009 ) and processed or red meats have been associated with increased risk of cancer, cardiovascular disease and all-cause mortality ( Sinha et al., 2009 , Larsson and Orsini, 2014 ). Processed foods impact nutrient intake as they are typically low in fiber, micronutrients and phytochemicals, yet high in fat, sugar and sodium ( Moodie et al., 2013 ).

2.4. Additions/replacements

Addition foods are defined as healthy foods added during the cooking process and include unprocessed fruit and vegetables (e.g. fresh or frozen as opposed to canned) to meals as well as olive oil to improve the nutritional content of recipes. Increased fruit and vegetable intake has been associated with reduced risk of hypertension, coronary heart disease (CHD) and stroke ( Boeing et al., 2012 ), reduced risk of certain cancers ( WCRF / AICR, 2007 ), and to some extent reduced risk of type II diabetes ( Li et al., 2014 ). The use of olive oil for cooking has been associated with reduced incidence of obesity ( Soriguer et al., 2009 ) and cardiovascular events, as well as cardiovascular and all-cause mortality ( Schwingshackl & Hoffmann, 2014 ).

Replacements are defined as ingredients that are actively removed from recipes and replaced with healthier ingredients, such as refined grains replaced with whole grain alternatives. Whole grain consumption has been associated with reduced risk of type II diabetes ( Aune et al., 2013 ) colorectal cancer ( Aune et al., 2011 ), and cardiovascular disease ( Ye et al., 2012 ).

2.5. Flavoring

‘Flavoring’ refers to the way the taste of food can be enhanced during cooking in a healthful way. ‘Flavoring’ includes increasing the use of spices, citrus, alliums and herbs, avoiding using cream-based sauces or margarine to flavor vegetables, and reducing salt while cooking; behaviors that have been taught in nutrition intervention classes to successfully reduce sodium ( Archuleta et al., 2012 , Millett et al., 2012 ) and fat intake ( Archuleta et al., 2012 ) and improve health and behavior outcomes ( Bielamowicz et al., 2013 , Kisioglu et al., 2004 , Chapman-Novakofski and Karduck, 2005 , Sorensen et al., 2011 ). Avoiding the use of processed meats as flavoring is also included, as processed meat intake has been associated with increased all-cause mortality ( Larsson & Orsini, 2014 ) as well as certain cancers ( WCRF / AICR, 2007 ) and stroke ( Chen et al., 2013 ).

In summary, cooking at home (frequency) has been shown to correlate with improved dietary intake ( Larson et al., 2006 , Laska et al., 2012 , Chen et al., 2012 , Crawford et al., 2007 , Gustafsson et al., 2002 , Sweetman et al., 2011 ). However, myriad behaviors involved in meal preparation can also impact the nutritional quality of food and in turn, health outcomes. This paper proposes using certain methodologies or techniques when preparing food, strategically reducing, replacing or adding ingredients to dishes and using unprocessed flavoring agents as cooking behaviors that may impact health.

3. Validation of the conceptual framework

To assess the face validity of this conceptual framework, a focus group was conducted of experts in the fields of nutrition, culinary arts, epidemiology, and health promotion (faculty at public health school in department of health promotion) to gauge consensus on the identified key healthy cooking constructs and sub-constructs. This portion of the project was reviewed and approved by the Institutional Review Board of the University of Texas Health Science Center HSC-SPH-14-0795.

The objective of this focus group discussion was to review the overarching constructs and defining sub-constructs identified in the literature. Two researchers ran the focus group using a semi-structured interview guide. Focus group discussions were recorded and transcribed. The transcribed interviews were then coded and analyzed using a framework analysis approach. Analysis of the resulting data included both inductive and deductive coding. Inductive coding was used to identify key cooking behaviors not included in the original model. Deductive coding was used to assess the degree of agreement on constructs in the presented model. This qualitative approach has been outlined in other studies ( Bird et al., 2014 , Leamy et al., 2011 ). The transcripts and field notes were analyzed by the first author with NVivo Version 10 (QSR International).

Consensus was established as over 90% of participants reached agreement for each of the overarching constructs. However, a few defining behaviors of certain sub-constructs were clarified or removed, based on feedback from focus group participants. If a particular behavior was consistent in the literature but lacked consensus from the group, it was removed. New behaviors suggested by the group were added to the model if they were also supported by the available literature. One behavior used to define healthy cooking ‘Techniques/Methods’ included modifying meats to be lower in fat (trimming/removing skin of poultry/draining ground beef). This behavior was consistent in the literature but not agreed upon by focus group participants and was, therefore, removed from the model. Regarding ingredient additions, using canola oil and adding extra whole grains to dishes were also removed from the original model due to lack of consensus. Other behaviors including avoiding butter, using low sodium/low fat alternatives and replacing sugar with artificial sweeteners were also removed.

Given the changes in defining behaviors noted above, several of the sub-constructs were re-defined and re-organized under different headings based on feedback from the expert panel. Panel participants also mentioned promoting the use of grass fed beef/butter and limiting/avoiding processed foods. While limiting/avoiding processed foods is in line with published research ( Moodie et al., 2013 ), the literature on use of butter for cooking and grass fed beef is not present to warrant inclusion in the current model. Participants also mentioned several upstream cooking behaviors including food sourcing, grocery shopping, knife skills and ability to read a recipe. While potentially important, these factors were outside the scope of this project, which focused on meal optimization as opposed to basic abilities. Further, specific upstream behaviors such as recipe literacy or grocery shopping vary across cultures.

4. Discussion

This paper proposes a conceptual framework of healthy cooking behavior based on the current literature. Overall, there appears to be sizable variability with regards to the definition and measurement of healthy cooking behaviors in interventions, and thus there are no standard guidelines for the development of healthy cooking programming or evaluation. More specifically, the variability of definitions regarding key terminology such as ‘made from scratch’ and the wide use of non-validated assessment tools negatively impacts the quality and comparability of available literature on healthy cooking, an issue cited by other reviews ( Hersch et al., 2014 , Reicks et al., 2014 , Engler-Stringer, 2010 ). The proposed framework of healthy cooking addresses this issue by offering a comprehensive definition of healthy cooking and could potentially guide the development of standardized tools for measurement in this field.

Dietary research tends to focus on selected outcomes, such as heart health, cancer incidence, obesity, or diabetes. It is important to note that these diets (e.g. cardiac diet, diet for management of diabetes etc.) are not necessarily synonymous. Thus, nutrition education is generally specialized for individual populations depending on their risk of certain diseases. The proposed conceptual framework is dynamic, such that the constructs are defined broadly enough to be applicable to a wide range of cooking behaviors across multiple health outcomes. A model based on existing literature cannot be static as scientific inquiry is by nature progressive. As a dynamic model, the current proposed framework is flexible enough to absorb new nutritional recommendations as research on diet and health outcomes continues to develop.

This framework introduces a comprehensive approach to understanding the impact of cooking in relation to nutrition and health, as the focus is on practical cooking behaviors as opposed to specific foods or nutrients. Because of its skill-based nature, a level of flexibility is inherent in the proposed model. This model could be applicable to culturally diverse populations and continuously and easily improved for generalizability. This project also offers a structure for developing assessment tools in the form of a coding system or survey that could be used to better understand the cooking practices of populations and gauge how those practices are impacted by interventions. During validation, all focus group participants indicated that the proposed constructs of healthy cooking could be used in their professional settings in diverse ways including intervention design, curriculum development, program evaluation and direct nutritional counseling assessments. This further indicates the flexibility of this model and its potential for future applications to research studies as well as in the field (curriculum development, nutrition assessment).

The healthy cooking behaviors outlined here are only one part of a larger social ecological structure that impacts nutrition and health, and includes individual, interpersonal, organizational, environmental (community) and policy level influences ( Richards et al., 2008 ). The proposed framework identifies individual-level behaviors that occur during the cooking process. However, these individual behaviors occur in the context of other environmental or upstream factors such as grocery store access and functional equipment. The framework focuses on individual cooking behaviors, and not environmental predictors of those behaviors, as cooking is an important contribution to diet quality that is poorly understood and under-researched.

This paper has several limitations. The studies on which we based the conceptual model mainly use self-reported dietary data, which have a high level of variability and are subject to misreporting ( Burrows et al., 2010 , Poslusna et al., 2009 ). With regard to experimental studies, cooking classes were offered in conjunction with nutrition education classes in many interventions ( Newman et al., 2005 , Kitaoka et al., 2013 , Chapman-Novakofski and Karduck, 2005 , Davis et al., 2011 , Fulkerson et al., 2010 , McKellar et al., 2007 , McMurry et al., 1991 , Shankar et al., 2007 ) making it difficult to determine the specific program components associated with changes in health and behavioral outcomes. Only two studies directly compared nutrition interventions with and without cooking elements ( Sorensen et al., 2011 , Curtis et al., 2012 ). Hence, the existing literature is limited with regards to cooking and its impact on health. The constructs themselves were challenging to outline and define, and will require further validation. However, the conceptual model is grounded in the extant literature and pulls from several disciplines of chronic disease prevention and control including cancer ( Newman et al., 2005 , Berjia et al., 2014 , Dai et al., 2002 , De Stefani et al., 2012 , Di Maso et al., 2013 , Gerhardsson de Verdier et al., 1991 , Hakami et al., 2014 , Icli et al., 2011 , Joshi et al., 2012a , Joshi et al., 2012b , John et al., 2011 , Kotsopoulos et al., 2006 , Parr et al., 2013 , Polesel et al., 2010 , Sinha et al., 2005 , Tasevska et al., 2009 , Ward et al., 1997 , Xu et al., 2006 ), overweight/obesity ( Milanovic et al., 2009 , Soriguer et al., 2009 , Kisioglu et al., 2004 , Sorensen et al., 2011 , Davis et al., 2011 , Fulkerson et al., 2010 , McKellar et al., 2007 , Kramer et al., 2012 , Nigam et al., 2014 ), cardiovascular disease ( Mozaffarian et al., 2007 , Ramazauskiene et al., 2011 ) and diabetes ( Archuleta et al., 2012 , Bielamowicz et al., 2013 , Chapman-Novakofski and Karduck, 2005 , Nigam et al., 2014 ).

Several notable points came up during the focus group assessment including the potential benefits of using animal fats, grass fed beef/butter, and other unprocessed fats as well as the need to focus on whole/unprocessed foods as opposed to low sodium or low fat alternatives. These constructs were not included in the model due to lack of evidence. However, these are factors that should be considered in future studies. While attitudes about animal products including red meat and animal fat seem to be changing with continued research, the longer-term effects of these products on cancer and other disease risks need to be considered when making recommendations for chronic disease prevention in the general population. Participants also mentioned several upstream cooking behaviors that are important factors in cooking programming, and future iterations of this model should consider adding these factors.

This project sets the stage for several future steps. Additional validation of the framework validity including construct validity and predictive validity will be done in future studies. More focus groups with diverse participants should be conducted to gauge opinions on the constructs of healthy cooking presented. This is a key step as the field of nutrition develops quickly as new research emerges. Once further validation is complete, the conceptual model can be used to develop curricula for healthy cooking programs and serve as the base for an assessment tool to gauge the cooking behaviors of samples, giving researchers and clinicians deeper insight into the dietary habits of participants and patients.

Transparency document

Acknowledgments

The authors would like to acknowledge Laurissa Gann, Dr. Christine Markham, Carolyn and Matt Khourie and the Michael and Susan Dell Center for Healthy Living at the University of Texas School of Public Health as well as all focus group members. This project has been supported by the M.D. Anderson Children's Cancer Hospital Optimizing Nutrition (ON) to Life Program with funding from the Gerber Foundation, MD Anderson's Advance Team and the Children's Art Project and the American Cancer Society (MRSG-13-145-01). Research reported in this publication was supported by the National Cancer Institute of the National Institutes of Health under Award Number R25CA05645, Dr. Shine Chang, Principal Investigator. The content is solely the responsibility of the author and does not necessarily represent the official views of the National Institutes of Health.

The Transparency document associated with this article can be found, in online version.

Appendix A Supplementary data to this article can be found online at http://dx.doi.org/10.1016/j.pmedr.2016.05.004 .

Appendix A. Supplementary data

Supplementary material.

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Food prices have surged by more than 20% under the Biden-Harris administration, leaving many voters eager to stretch their dollars further at the grocery store.
Interdisciplinary Approaches to Higher Education and Food Safety in
The following dissertation contains a series of articles from a diverse set of research experiences over my five years as a PhD student at Purdue University. Each of the following articles relay how my interdisciplinary studies in food safety, gender, and higher education contribute to a comprehensive understanding of international development in agriculture. After an introductory chapter ...
An evidence-based conceptual framework of healthy cooking
In nutrition research, cooking components are often part of nutritional interventions and have been shown to potentially be more effective ... This paper proposes a conceptual framework of healthy cooking behavior based on the current literature. ... Anderson A.S., Longbottom P.J. The impact of a community-based food skills intervention on ...

Community Interventions to Improve Cooking Skills and Their Effects on Confidence and Eating Behaviour

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Purpose of Review

Recent Findings

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Prevalence and socio-demographic correlates of cooking skills in UK adults: cross-sectional analysis of data from the UK National Diet and Nutrition Survey

Wider impacts of a 10-week community cooking skills program - Jamie’s Ministry of Food, Australia

Introduction

Main Outcomes of Cooking Skill Programmes: Eating Behaviours

Effects on Fruit and Vegetable Consumption

Cooking Confidence: What Is It and How Is It Measured?

Implications for Future Research

Conclusions

Papers of particular importance that have been published recently are notes as: • Of importance •• Of major importance

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Food, cooking skills, and health: a literature review

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Cooking skills related to potential benefits for dietary behaviors and weight status among older Japanese men and women: a cross-sectional study from the JAGES

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Study design and participants

Body weight status and dietary behaviors

Cooking skills

Person in charge of meal selection

Statistical analysis

Availability of data and materials

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International Journal of Behavioral Nutrition and Physical Activity

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Improving Cooking and Food Preparation Skills: A Synthesis of the Evidence to Inform Program and Policy Development

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4.0 Findings

4.1 The State of Cooking and Food Preparation Skills among Populations, Children and Families

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Can't cook, won't cook: A review of cooking skills and their relevance to health promotion

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Interdisciplinary Approaches to Higher Education and Food Safety in International Development in Agriculture

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