A Cluster Randomized Controlled Trial of a Home-Delivered Food Box on Children's Diet Quality in the Chickasaw Nation Packed Promise Project

Abstract

Background: Poor diet quality among children can lead to poor health, development, and academic achievement. Child nutrition assistance programs aim to improve diet quality among children.

Objective: This study tested the impact of the Packed Promise intervention on diet quality among low-income children in Chickasaw Nation territory.

Design: This study was a cluster randomized controlled trial of 40 school districts and 4,750 eligible, consented households within treatment and control districts.

Participants/setting: Household data were collected at baseline (n = 2,859) and follow-up (n = 2,852) in 12 rural Oklahoma counties.

Intervention: Packed Promise treatment households chose from 5 types of home-delivered food boxes that contained nutritious foods ($38 food value) and a $15 check for purchasing fruits and vegetables.

Main outcome measures: Key outcomes included children's daily consumed amounts of fruits and vegetables, whole grains, and added sugars collected by a dietary screener questionnaire. Other outcomes included food shopping frequency, type of grocery store used, distance traveled from home to grocery stores, and the number of weekly family dinners. All outcomes in this article are secondary to the study's primary outcome-food insecurity among children.

Statistical analyses performed: Differences between the treatment and control groups were estimated by a regression model controlling for baseline characteristics and population-based average portion sizes.

Results: Children's mean daily consumption of fruits and vegetables combined was about 2.35-cup equivalents in the treatment group and 2.25-cup equivalents in the control group (P < 0.001). Mean consumption of whole grains was 0.73-ounce equivalents in the treatment group compared with 0.67-ounce equivalents in the control group (P < 0.001). Other outcomes were not statistically significant.

Conclusion: Packed Promise led to significant but small improvements in children's daily consumption of fruits and vegetables and whole grains. Several factors, including household participation levels in Packed Promise, may have moderated the size of impacts.

Funding/support: This article is published as part of a supplement supported by the US Department of Agriculture, Food and Nutrition Service.

Trial registration: ClinicalTrials.gov NCT04318873.

Keywords: Children; Diet quality; Home-delivered food box; Randomized controlled trial; Tribal.