Examining the Influence of Cultural Immersion on Willingness to Try Fruits and Vegetables Among Children in Guam: the Traditions Study

A pre-post quasi-experimental design was used to observe outcomes (i.e., willingness to try FV and FV intake) between three existing summer camp programs in Guam: cultural immersion camp (CIC), university day camp (UDC), and recreational sports camp (RSC). This natural-setting, multi-arm parallel design was used as an alternative to a resource intensive infrastructure and the organizations were willing to incorporate activities to answer the research question.

The CIC and UDC programs were nearly matched for daily activities (e.g., physical activity, cooking demonstrations/taste testing, crafts). The same four Traditions lessons (Figure 1) were incorporated into CIC and UDC and delivered by the same educators. These lessons featured local FV and promoted positive associations with eating FV. In CIC, the context of Chamorro cultural traditions, practices, and values was tied to FV. Chamorro is the language, culture, and ethnicity of Guam and the Marianas. In UDC, consuming healthy foods was introduced within a context of nutrition and human physiology. The four lessons were adapted with permission from a culturally-relevant Hawai'ian nutrition curriculum to make them relevant to Guam and the Chamorro culture. This curriculum complemented Hawai'i and Guam Department of Education K-12 Content and Performance Standards.

The CIC activities perpetuated the Chamorro culture and language through song/chanting, dance, prayer, arts and crafts, cooking, outdoor activities, and gardening based on traditional and contemporary practices. Chamorro was spoken about 80% of the time, including the delivery of key messages in the Traditions lessons. All activities operated on indigenous values of respect, love, humility, reciprocity, and camaraderie. The UDC activities focused on promoting healthful present-day recreational activities and global foods. The activities were an extension of the Expanded Food and Nutrition Education Program mission. RSC was exclusively physical activity. Upon completion of the last assessments, educators provided one Traditions lesson for registrants at RSC.

Data collection occurred at two assessment periods: before (± 2 weeks) and after (± 1 week) each program. The first assessment was completed at each camp setting. The second was also completed at camp or at a pre-arranged location, such as the children's home or a child-friendly public space (e.g., the mall). Children completed the interview-administered Adapted WillTry tool, which measures children's willingness to try FV and was previously validated for children 3-11 years old in Guam. FV intake was assessed using the mobile food record (mFR). The mFR is an app that has been shown to be a useful method for dietary assessment with adolescents. Only participants in CIC and UDC were asked to use the mFR due to a limited number of iPods.

Other Measures: Parents completed a questionnaire that included information about the child's age, sex, language spoken, religion, and birthplace. Parent's cultural affiliation was determined using their responses reported on a cultural affiliation questionnaire, which assesses one of four modes of acculturation: traditional, integrated, assimilated, or marginalized. The same scoring system was used as described by Kaholokula and others. Anthropometric assessments were completed at a time designated as least disruptive to camp activities. Height and weight were measured using a portable Seca scale and stadiometer (PE-AIM 101) using centimeters and kilograms, respectively. These measurements were converted to body mass index (BMI) as [kg/(height, m)2]. Dose was assessed by recording attendance at camp and at each Traditions lesson.