Journal of Nutrition Education and Behavior - Articles in Press

Examining Multiple Parenting Behaviors on Young Children’s Dietary Fat Consumption - Corrected Proof

2012-05-16

Abstract: Objective: To understand the association between parenting and children’s dietary fat consumption, this study tested a comprehensive model of parenting that included parent household rules, parent modeling of rules, parent mediated behaviors, and parent support.Design: Cross-sectional.Setting: Baseline data from the MOVE/me Muevo project, a recreation site-based obesity prevention and control intervention trial.Participants: Five hundred forty-one parents of children between the ages of 5 and 8 years and living in San Diego County.Main Outcome Measure: Children’s fat consumption based on parent report using a short food frequency questionnaire.Analysis: A hierarchical linear regression was conducted. In exploratory analyses, a stepwise backward elimination approach was used.Results: Children’s fat consumption was positively associated with parent household rules (P < .01) and negatively associated with parent modeling of rules (P < .01).Conclusions and Implications: Controlling parenting behaviors, such as rule setting, are associated with more frequent fat consumption, whereas role modeling healthful behaviors is associated with less frequent fat consumption. Changing parenting behaviors with regard to how they feed their children is a logical avenue for improving eating behaviors.

Results from the 2009 Michigan Farm to School Survey: Participation Grows from 2004 - Corrected Proof

Kathryn J.A. Colasanti, Colleen Matts, Michael W. Hamm — 2012-05-16

Abstract: Objective: This study investigated changes in Michigan school food service directors’ farm to school (FTS) participation levels and perspectives since a 2004 survey and factors that would facilitate FTS expansion.Design: Electronic survey census of all Michigan school food service directors.Setting: Michigan kindergarten-12th grade schools.Participants: Food service directors of National School Lunch programs in Michigan.Variables Measured: Survey respondents were asked about local food purchasing behaviors, interests, motivations, concerns, and barriers.Analysis: Data were analyzed through descriptive statistics. Wilcoxon signed rank tests were calculated to compare 2004 and 2009 results.Results: Participation in FTS was more than 3 times higher (41.5%) than in 2004 (10.6%), and the vast majority of school districts (77.0%) had taken at least 1 step to connect students with local food. Budget and cost issues were ranked higher as barriers to FTS than in 2004, but the desire to help Michigan farms had also substantially increased. Fresh and whole produce items were generally preferred for local procurement over frozen or canned items.Conclusions and Implications: Education to reverse perceived limits of procurement regulations, food safety assurances, and strategies to mitigate tight school food budgets are needed to encourage FTS expansion.

Do We Provide Meaningful Guidance for Healthful Eating? An Investigation into Consumers' Interpretation of Frequency Consumption Terms - Corrected Proof

2012-05-16

Abstract: Objective: To investigate consumers' understanding of terms commonly used to provide guidance about frequency and quantity of food consumption.Methods: A survey of 405 shoppers explored how frequently consumers thought food labeled with the terms “eat often,” “eat moderately,” “eat occasionally,” “a sometimes food,” and “an extra food” should be eaten. In a separate phase, 30 grocery buyers responded to open-ended questions about their interpretation of these terms.Results: Responses indicated significant differences in meaning between the terms. However, the specific interpretation of each term varied considerably across respondents. The qualitative research found the terms to be highly subjective, and there was a high degree of uncertainty about the meaning of the term “an extra food” in particular.Conclusions and Implications: Food frequency and descriptive terms currently used do not provide meaningful or consistent nutritional guidance. There is a need for simple, unambiguous terminology.

Decrease in Television Viewing Predicts Lower Body Mass Index at 1-Year Follow-Up in Adolescents, but Not Adults - Corrected Proof

Simone A. French, Nathan R. Mitchell, Peter J. Hannan — 2012-05-16

Abstract: Objective: To examine associations between television viewing, sugar-sweetened beverage consumption, eating out, physical activity, and body weight change over 1 year.Design: Secondary data analysis from randomized intervention trial.Setting: Households in the community.Participants: Adults (n = 153) and adolescents (n = 72) from the same households.Intervention: Households were randomized to a home-based obesity prevention intervention or to a no-intervention control group for a 1-year period.Main Outcome Measures: Self-reported television viewing (TV) hours, diet, and physical activity. Body mass index (BMI) computed from measured weight and height (primary outcome measure).Analysis: Mixed-model regression.Results: Among adolescents, a significant prospective association was observed between decreases in television viewing hours and lower BMI z score at 1-year follow-up (decreased TV hours: BMI z score mean = 0.65; no change or increase TV hours: BMI z score = 0.92; P < .02). No significant prospective associations were observed among adults.Conclusions and Implications: Reducing television viewing may be an effective strategy to prevent excess weight gain among adolescents.

Evaluation of a School-based Multicomponent Nutrition Education Program to Improve Young Children's Fruit and Vegetable Consumption - Corrected Proof

2012-05-14

Abstract: Objective: To assess the impact of a multicomponent nutrition education program on student knowledge, attitudes, and behaviors related to consumption of fruits and vegetables (FVs).Design: Quasi-experimental pretest/posttest research design; 3 study conditions (Intervention+, Intervention, Comparison).Setting: Six schools from the Los Angeles Unified School District (LAUSD).Participants: Three hundred ninety-nine low-income third-, fourth-, and fifth-grade students.Intervention: The Intervention+ condition included 4 components: traditional Network–LAUSD program, new standardized nutrition curriculum, teacher training workshops, and parent nutrition education workshops. The Intervention condition included 2 components: traditional Network–LAUSD program and teacher training workshops.Main Outcome Measures: Fruit and vegetable consumption, knowledge of food groups, attitudes and beliefs toward FVs, and parent/teacher influence on students’ attitudes toward FVs.Analysis: Linear mixed models.Results: The Intervention+ resulted in a positive change in knowledge (P < .05), attitudes and beliefs toward vegetables (P < .01), and teacher influence on students’ FV attitudes (P < .05).Conclusions and Implications: Although this study influenced knowledge and attitudes regarding FVs, a significant increase in students’ FV consumption was not observed. Given the ultimate aim of the LAUSD nutrition efforts is to increase FV consumption, future studies should consider adopting new intervention strategies, such as focusing on changing the school food environment.

Six Characteristics of Nutrition Education Videos That Support Learning and Motivation to Learn - Corrected Proof

Samantha A. Ramsay, Laura Holyoke, Laurel J. Branen, Janice Fletcher — 2012-05-14

Abstract: Objective: To identify characteristics in nutrition education video vignettes that support learning and motivation to learn about feeding children.Methods: Nine focus group interviews were conducted with child care providers in child care settings from 4 states in the western United States: California, Idaho, Oregon, and Washington. At each focus group interview, 3-8 participants (n = 37) viewed video vignettes and participated in a facilitated focus group discussion that was audiorecorded, transcribed, and analyzed.Results: Primary characteristics of video vignettes child care providers perceived as supporting learning and motivation to learn about feeding young children were identified: (1) use real scenarios; (2) provide short segments; (3) present simple, single messages; (4) convey a skill-in-action; (5) develop the videos so participants can relate to the settings; and (6) support participants' ability to conceptualize the information.Conclusions and Implications: These 6 characteristics can be used by nutrition educators in selecting and developing videos in nutrition education.

Building Recipes and Understanding Nutrition for Cancer-survivor Health (BRUNCH) - Corrected Proof

2012-05-14

A diagnosis of cancer can result in lifestyle changes. Cancer survivors (CS) often modify food choices to improve outcomes, quality of life, and survival rates. Most CS make at least some dietary changes, which may reduce risk of cancer recurrences and second primary cancers. Successful behavior change is dependent on understanding the importance of the changes and providing education to support those changes. A study was conducted to (1) test the feasibility of registered dietitians (RDs), professional culinary chefs, and food scientists working as a team to develop recipes to support CS for healthful eating and (2) to test whether cooking demonstrations performed by the chef/RD team supported by educational materials would help CS improve their eating habits. Results of this research will help guide future development of nutrition education to support CS.

Effectiveness and Efficiency of Different Shapes of Food Guides - Corrected Proof

Rebecca Hess, Vivianne H.M. Visschers, Michael Siegrist — 2012-05-11

Abstract: Objective: To compare the influence of a food guide’s shape on its effectiveness and efficiency to convey nutritional information.Methods: A between-subjects experiment was conducted by manipulating the graph’s shape (circle, pyramid, or rainbow). Nutrition tasks were used to assess the effectiveness and eye-movement data (number/duration of fixations) to examine the efficiency of the formats. The data were quantitatively analyzed (chi-square, ANOVA).Results: There were no overall differences between the formats regarding effectiveness and efficiency. However, there were differences between the formats in effectiveness regarding 3 of the 5 nutrition tasks (χ2s ≥ 7.044, Ps < .05). Furthermore, viewers' attention was drawn to different parts of the graph, depending on the format.Conclusions and Implications: The results suggest that choosing different formats for practical nutrition communication does not play a major role in effectiveness or efficiency of this communication. However, different parts of the graph are more salient in various food guide formats.

Cooking Schools Improve Nutrient Intake Patterns of People with Type 2 Diabetes - Corrected Proof

2012-05-10

Abstract: Objective: To determine whether cooking classes offered by the Cooperative Extension Service improved nutrient intake patterns in people with type 2 diabetes.Design: Quasi-experimental using pretest, posttest comparisons.Setting: Community locations including schools, churches, and senior centers.Participants: One hundred seventeen people with type 2 diabetes, from diverse ethnic and socioeconomic backgrounds.Intervention: Series of classes for people with type 2 diabetes and their family members that incorporated Social Cognitive Theory tenets. The classes featured current nutrition recommendations for people with type 2 diabetes and hands-on cooking, where participants prepared and ate a meal together.Main Outcome Measures: Three-day food records, completed prior to attending cooking schools and 1 month after, were used to measure changes in energy intake and selected nutrients.Analysis: Program efficacy was assessed using the Wilcoxon signed-rank test to compare differences between pre-training and post-training variables. ANCOVA was used to determine whether program efficacy was affected by sociodemographics.Results: Participants decreased (P < .05) intakes of energy, fat grams, percentage of calories from fat, saturated fat grams, cholesterol (mg), sodium (mg), and carbohydrate grams.Conclusions and Implications: Nutrition education incorporating hands-on cooking can improve nutrient intake in people with type 2 diabetes from diverse ethnic and socioeconomic backgrounds.

The Relationship between Practices and Child Care Providers’ Beliefs Related to Child Feeding and Obesity Prevention - Corrected Proof

Jane D. Lanigan — 2012-05-07

Abstract: Objective: To examine the association between child care practices and child care provider knowledge and beliefs about their role in supporting children’s healthful eating.Design: Longitudinal design using survey and observation data from baseline and year 1 of the Encouraging Healthy Activity and Eating in Childcare Environments (ENHANCE) pilot project.Participants: Seventy-two child care providers from 45 child care settings.Main Outcome Measures: Child care setting variables included the feeding environment, nutrition education, and family communication. Child care provider variables were efficacy, knowledge, and misconceptions about child feeding; and the priority placed on supporting children’s healthful eating.Data Analysis: Correlation and multiple linear regression were used to examine the association between variables.Results: Models indicated that changes in efficacy and feeding knowledge accounted for a significant portion of the variance in nutrition education changes (R2 = 0.59) and family communication changes (R2 = 0.29). A reduction in misconceptions was significantly associated with improved feeding practices (β = .71; P < .01; R2 = 0.40).Conclusions and Implications: Understanding child care providers’ knowledge and beliefs regarding their role in children’s healthful eating is an essential component of child care-based obesity prevention initiatives. Training should assess and address provider efficacy and misconceptions as well as educate providers about evidence-based practices related to child feeding, nutrition education, and family communication.

Physical Activity and Beverages in Home- and Center-based Child Care Programs - Corrected Proof

Pooja S. Tandon, Michelle M. Garrison, Dimitri A. Christakis — 2012-05-07

Abstract: Objective: To describe and compare obesity prevention practices related to physical activity and beverages in home- and center-based child care programs.Methods: A telephone survey of licensed home- and center-based child care programs in Florida, Massachusetts, Michigan, and Washington between October and December 2008.Results: Most programs reported almost universal access to outdoor play areas and staff who frequently engage in and lead physical activities. About half of the programs reported ≤ 60 minutes of outdoor play time per day for preschoolers. Fewer home-based programs offered a variety of fixed and portable play equipment. Over a third of the programs did not have adequate indoor space for all physical activities. Over two thirds of programs offered juice 3 or 4 times per week or more.Conclusions and Implications: Many child care programs could increase active opportunities (by increasing outdoor time and providing better spaces for indoor physical activity) and decrease juice provision.

Evaluation of Supplemental Nutrition Assistance Program Education: Application of Behavioral Theory and Survey Validation - Corrected Proof

Brett A. Wyker, Patricia Jordan, Danielle L. Quigley — 2012-04-16

Abstract: Objective: Application of the Transtheoretical Model (TTM) to Supplemental Nutrition Assistance Program Education (SNAP-Ed) evaluation and development and validation of an evaluation tool used to measure TTM constructs is described.Methods: Surveys were collected from parents of children receiving food at Summer Food Service Program sites prior to SNAP-Ed participation.Results: Item analysis of survey data (n = 149) suggests the survey is valid and reliable. Structural Equation Modeling confirmed the use of the TTM constructs in predicting SNAP-Ed participants' fruit and vegetable consumption. Perceived barriers (P = .04) and self-efficacy (P = .006) were associated with fruit and vegetable consumption, whereas perceived benefits were not.Conclusions and Implications: Application of theory and survey validation can enhance SNAP-Ed evaluation.

Exploring Parent Perceptions of the Food Environment in Youth Sport - Corrected Proof

Megan Thomas, Toben F. Nelson, Eileen Harwood, Dianne Neumark-Sztainer — 2012-04-16

Abstract: Objective: To examine parent perceptions of the food environment in youth sport.Methods: Eight focus group discussions were held with parents (n = 60) of youth aged 6-13 years participating in basketball programs in Minnesota. Key themes and concepts were identified via transcript-based analysis.Results: Parents reported that youth commonly consume unhealthful food and beverages during sports. According to parents, few healthful food and beverage options are available in sport settings, whereas unhealthful options are widely available. Parents were generally dissatisfied with food available in youth sport settings and wanted sport-specific nutrition knowledge. Time constraints and low availability of nutritious food at sport venues were barriers to healthful eating.Conclusions and Implications: Youth sport is a promising setting for promoting nutrition. Potential interventions may include advice about healthful eating to overcome the challenges associated with youth sport and policy changes that promote greater availability of healthful food at concessions stands.

How Medical Students’ Behaviors and Attitudes affect the Impact of a Brief Curriculum on Nutrition Counseling - Corrected Proof

2012-03-15

Abstract: Objective: To evaluate a nutrition curriculum and explore the influence of medical students’ own nutrition practices on its impact.Methods: An anonymous survey was given to first-year medical students attending a required course immediately prior to and 2 weeks after a 2-hour interactive nutrition curriculum intervention in a large private urban medical school in New York, New York. Main outcomes included self-reported nutrition counseling confidence, ability to assess diet, and nutrition knowledge measured using 4-point Likert scales.Results: One hundred eleven students completed surveys pre-curriculum (69%) and 121 completed them post-curriculum (75%). The authors found overall pre-post differences in dietary assessment ability (2.65 vs 3.05, P < .001) and counseling confidence (1.86 vs 2.22, P < .001). In addition to the curricular impact, students’ nutrition-related behaviors and attitudes were positively associated with outcomes.Conclusions and Implications: A nutrition curriculum for medical students improves students’ nutrition counseling-related confidence, knowledge, and skills even when controlling for personal nutrition-related behaviors.

Evaluating the Dissemination of Body & Soul, an Evidence-based Fruit and Vegetable Intake Intervention: Challenges for Dissemination and Implementation Research - Corrected Proof

2012-03-14

Abstract: Objective: To evaluate whether the evidence-based Body & Soul program, when disseminated and implemented without researcher or agency involvement and support, would achieve results similar to those of earlier efficacy and effectiveness trials.Design: Prospective group randomized trial.Setting: Churches with predominantly African American membership.Participants: A total of 1,033 members from the 15 churches completed baseline surveys. Of these participants, 562 (54.4%) completed the follow-up survey 6 months later.Intervention: Church-based nutrition program for African Americans that included pastoral involvement, educational activities, church environmental changes, and peer counseling.Main Outcome Measure: Daily fruit and vegetable (FV) intake was assessed at pre- and posttest.Analysis: Mixed-effects linear models.Results: At posttest, there was no statistically significant difference in daily servings of FVs between the early intervention group participants compared to control group participants (4.7 vs 4.4, P = .38). Process evaluation suggested that added resources such as technical assistance could improve program implementation.Conclusions and Implications: The disseminated program may not produce improvements in FV intake equal to those in the earlier efficacy and effectiveness trials, primarily because of a lack of program implementation. Program dissemination may not achieve public health impact unless support systems are strengthened for adequate implementation at the church level.

Food Label Use and Food Label Skills among Immigrants from the Former Soviet Union - Corrected Proof

Nadia Lubman, Colleen Doak, Sunitha Jasti — 2012-02-29

Abstract: Objective: To assess food label use and skills and to identify their correlates among immigrants from the former Soviet Union (FSU).Design/Setting/Participants: Cross-sectional survey of a convenience sample of 200 FSU immigrants residing in New York City.Variables Measured: Food label use and skills; acculturation; and socioeconomic and psychosocial factors.Analysis: Chi-square tests and multivariate logistic regression analysis assessed relationships among the outcomes and socioeconomic and other characteristics.Results: Fifty-five percent reported using food labels always/often; only 32% had good label skills. FSU immigrants particularly had difficulty understanding servings per package and percent daily value. Food label use was significantly associated with factors such as positive attitude toward food labels, and importance of recommendations such as avoiding too much salt and saturated fat. However, these factors were not related to food label skills, which was positively associated with longer residency in the United States (> 7 y).Conclusions and Implications: There is a need for nutrition education among FSU immigrants to increase their food label use and skills to promote healthful food selection. Developers of new food labels should consider ways to present percent daily value and servings per package in a more consumer-friendly manner. Simplifying the presentation of this information could improve food label skills in FSU immigrants, among others.

The Effect of Food Label Cues on Perceptions of Quality and Purchase Intentions among High-Involvement Consumers with Varying Levels of Nutrition Knowledge - Corrected Proof

Amber Walters, Marilee Long — 2012-02-15

Abstract: Objective: To determine whether differences in nutrition knowledge affected how women (a high-involvement group) interpreted intrinsic cues (ingredient list) and extrinsic cues (“all natural” label) on food labels.Methods: A 2 (intrinsic cue) × 2 (extrinsic cue) × 2 (nutrition knowledge expert vs novice) within-subject factorial design was used. Participants were 106 female college students (61 experts, 45 novices). Dependent variables were perception of product quality and purchase intention.Results: As predicted by the elaboration likelihood model, experts used central route processing to scrutinize intrinsic cues and make judgments about food products. Novices used peripheral route processing to make simple inferences about the extrinsic cues in labels.Conclusions and Implications: Consumers' levels of nutrition knowledge influenced their ability to process food labels. The United States Food and Drug Administration should regulate the “all natural” food label, because this claim is likely to mislead most consumers.

After-School Physical Activity and Eating Behaviors of Middle School Students in Relation to Adult Supervision - Corrected Proof

Wayne C. Miller, Michelle Hering, Carrie Cothran, Kim Croteau, Rebecca Dunlap — 2012-02-10

Abstract: Objective: Examine after-school activity patterns, eating behaviors, and social environment of overweight and normal weight middle school students.Design: Eating and physical activity behaviors of 141 students, ages 10–14, were monitored. Students completed a diary documenting type of activity, location, adult supervision, accompanying participants, and eating habits from 3:00 pm–12:00 am.Setting: Three middle schools, grades 6–8.Main Outcome Measures: Body mass index, estimated energy expenditure, eating behavior, active time, sedentary time, supervised time.Analysis: t tests, ANOVA, chi-square, correlation coefficients. Significance set at P < .05.Results: Children spent 76% of time sedentary, and 85% of sedentary time was under adult supervision (r = 0.76). Active time related to time with friends (r = 0.64) and family (r = 0.46). Children spent 40% of eating time consuming unhealthful food, and adults supervised 86% of children’s eating. Overweight and normal weight children were similarly active (335 ± 156 vs 373 ± 194 counts per minute). Overweight girls spent more eating time (77%) eating healthfully than overweight boys (57%).Conclusions and Implications: Children should be given access to healthful food and encouraged to eat healthfully when alone and with friends. Adults should be more physically engaged with children. Children should be encouraged to eat under adult supervision and with their families.

Perceptions of the Host Country’s Food Culture among Female Immigrants from Africa and Asia: Aspects Relevant for Cultural Sensitivity in Nutrition Communication - Corrected Proof

Lisa Maria Garnweidner, Laura Terragni, Kjell Sverre Pettersen, Annhild Mosdøl — 2012-02-10

Abstract: Objective: To explore how female immigrants from Africa and Asia perceive the host country’s food culture, to identify aspects of their original food culture they considered important to preserve, and to describe how they go about preserving them.Design: Qualitative in-depth interviews.Setting: Oslo, Norway.Participants: Twenty one female immigrants from 11 African and Asian countries, residing in areas of Oslo with a population having a low-to-middle socioeconomic status and a high proportion of immigrants. Participants varied in years of residence, employment status, and marital status.Analysis: Analysis of the interviews was guided by a phenomenological approach.Results: Participants emphasized the importance of preserving aspects of their original food cultures and related these aspects to taste, preparation effort and method, and adherence to religious dietary rules. They often perceived the food of the host country as “tasteless and boring.” The authors observed strict, flexible, or limited continuity with the original food culture. Some elements that possibly influenced participants’ degree of continuity are indicated.Conclusions and Implications: Immigrants may strive to preserve aspects of their original food culture after immigration. Nutrition communication becomes more culturally sensitive when it takes such aspects into account.

Perceptions of Healthful Eating and Influences on the Food Choices of Appalachian Youth - Corrected Proof

Mark Swanson, Nancy E. Schoenberg, Rian Davis, Sherry Wright, Kaye Dollarhide — 2012-01-24

Abstract: Objective: Patterns of overweight and obesity have an unequal geographic distribution, and there are elevated rates in Appalachia. Perceptions of Appalachian youth toward healthful eating and influences on food choice were examined as part of formative research to address these disparities.Methods: Eleven focus groups, averaging 6 youth (n = 68) and moderated by experienced local residents, were conducted with participants aged 8–17. Session transcripts were coded for thematic analysis, using measures to enhance rigor and transferability.Results: Participants discussed numerous internal and external factors affecting dietary choices. They expressed confidence in their own nutritional knowledge, and they stressed the importance of taste preferences, cost, convenience, social influences, and advertising on diet.Conclusions and Implications: Appalachian youth awareness of the multiple influences on diet may create opportunities for multifaceted, ecologically based interventions. In particular, participants stressed the importance of social influences on diet and on successful nutrition programming.

Food Deserts in Leon County, FL: Disparate Distribution of Supplemental Nutrition Assistance Program–Accepting Stores by Neighborhood Characteristics - Corrected Proof

2012-01-12

Abstract: Objective: Examine whether neighborhood characteristics of racial composition, income, and rurality were related to distribution of Supplemental Nutrition Assistance Program (SNAP)–accepting stores in Leon County, Florida.Design: Cross-sectional; neighborhood and food store data collected in 2008.Setting and Participants: Forty-eight census tracts as proxy of neighborhoods in Leon County, Florida. All stores and SNAP-accepting stores were identified from a commercial business directory and a United States Department of Agriculture SNAP-accepting store list, respectively (n = 288).Main Outcome Measures: Proportion of SNAP-accepting stores across neighborhoods.Analysis: Descriptive statistics to describe distribution of SNAP-accepting stores by neighborhood characteristics. Proportions of SNAP-accepting stores were compared by neighborhood characteristics with Wilcoxon-Mann-Whitney and Kruskal-Wallis tests.Results: Of 288 available stores, 45.1% accepted SNAP benefits. Of the 48 neighborhoods, 16.7% had no SNAP-accepting stores. Proportions of SNAP-accepting grocery stores were significantly different by neighborhood racial composition and income. Primarily black neighborhoods did not have any supermarkets. Results were mixed with regard to distribution of food stores and SNAP-accepting stores by neighborhood racial composition, income, and rurality.Conclusions and Implications: This study suggests disparities in distribution of SNAP-accepting stores across neighborhood characteristics of racial composition, income, and rurality.

A Qualitative Study to Explore How Parental Expectations and Rules Influence Beverage Choices in Early Adolescence - Corrected Proof

Lori Roth-Yousey, Yen Li Chu, Marla Reicks — 2012-01-12

Abstract: Objective: To understand parent beverage expectations for early adolescents (EAs) by eating occasion at home and in various settings.Methods: Descriptive study using focus group interviews and the constant comparative method for qualitative data analysis.Results: Six focus groups were completed, and 2 were conducted in Spanish. Participants (n = 49) were mostly female (86%) and non-Hispanic white (49%) and Hispanic (33%). Parent expectations for EA beverage intake were based on health beliefs, EA preferences, and cost, whereas those related to portion sizes and frequency varied by beverage type. Parents managed beverage expectations at home and away from home by making healthful beverages available and accessible, or by offering or allowing only specific beverages.Conclusions and Implications: Results from this qualitative study involving a small sample of parents showed that expectations were influenced by practical concerns and managed primarily through availability practices. These issues could be addressed to improve EA beverage consumption.

Factors Contributing to a School's Decision to Apply for the California Instructional School Garden Program - Corrected Proof

Eric L. Hazzard, Elizabeth Moreno, Deborah L. Beall, Sheri Zidenberg-Cherr — 2012-01-12

Abstract: Objective: To compare the applicant schools (AS) to non-applicant schools (NAS) residing in the same school districts for the California Instructional School Garden Program and identify barriers to the application process.Methods: A case-control, cross-sectional study design was used to compare resources and school environments. Pearson chi-square and logistic regression were conducted.Results: Public schools throughout California participated (n = 1,662). The response rates for AS and NAS were 43.2% and 48.2%, respectively. Applicant schools had greater access to garden coordinators and parent/community volunteers dedicated to school gardens, and they had other sources of funds/grants to support school gardens compared to NAS (P < .001).Conclusions and Implications: Access to certain garden resources played a significant role in predicting whether schools would decide to participate in the California Instructional School Garden Program.

The Influence of Cartoon Character Advertising on Fruit and Vegetable Preferences of 9- to 11-Year-Old Children - Corrected Proof

Nandita Bezbaruah, Ardith Brunt — 2011-12-09

Abstract: Objective: The aim of the present study is to determine the influence of cartoon characters in preferences of fruit and vegetables among children.Methods: A 10-item survey was used in this cross-sectional study to determine the factors that influence a child’s likelihood of eating fruits and vegetables. Seven factors influencing consumption of fruits and vegetables were rank ordered by 218 third- and fourth-grade students.Results: Results indicated that the child was more likely to eat fruits or vegetables if they tasted good, followed by whether they were nutritious. Presence of a cartoon character on the label ranked 6 of 7. Sex does not affect the rank order of factors that influence intake of fruits or vegetables.Conclusions and Implications: Future interventions aimed at increasing consumption of fruits and vegetables should take into consideration such factors that influence intake.

Maternal Parenting Behaviors during Childhood Relate to Weight Status and Fruit and Vegetable Intake of College Students - Corrected Proof

2011-12-05

Abstract: Objective: Examine how maternal parenting behaviors in childhood, both general and feeding specific, relate to weight status and fruit and vegetable consumption in college students.Design: Retrospective surveys on maternal behaviors and assessments on the college-aged child's current anthropometric measures and dietary intakes.Participants: College students (n = 424; 66% women).Main Outcome Measures: Students' weight, height, waist circumference, fruit and vegetable intakes, students' reports on mothers' general and feeding-specific parenting behaviors during childhood.Analysis: Correlation and regression analyses tested how maternal behaviors in childhood related to students' body mass index, waist circumference, and fruit and vegetable intake.Results: Mothers' psychological control during childhood was associated with higher body mass index and waist circumference in students, and behavioral control was associated with lower waist circumference. Parent-centered feeding behaviors related to lower fruit and vegetable intakes of students, whereas child-centered feeding behaviors related to higher fruit and vegetable intakes.Conclusions and Implications: Findings suggest that parental use of behavioral control and child-centered feeding practices and minimal use of psychological control and parent-centered feeding practices during childhood may promote a child's healthful weight status and fruit and vegetable consumption in young adulthood, specifically during college.

Food Safety Is a Key Determinant of Fruit and Vegetable Consumption in Urban Beninese Adolescents - Corrected Proof

2011-11-24

Abstract: Objective: To identify the determinants of fruit and vegetable consumption in urban Beninese adolescents and elements to develop a school-based fruit and vegetable program.Design: Sixteen focus groups conducted with a key word guide.Setting and Participants: Two private and 2 public secondary schools in Cotonou, Benin. One hundred fifty-three students aged 13 to 19 years, 54% girls.Analysis: The focus groups were audiotaped, transcribed, and analyzed. Three a priori categories from the Social Cognitive Theory were used for the coding: socioenvironmental, personal, and behavioral factors. Additionally, the data were checked to determine whether new categories should be created.Results: Major determinants in the school were availability and accessibility of fruits and vegetables, nutrition education, and the competition of unhealthful foods. Food safety emerged as a strong barrier to the adolescents’ fruit and vegetable consumption outside home and particularly at school.Conclusions and Implications: Except for food safety, the determinants of fruit and vegetable intake in Beninese adolescents were similar to those in high-income countries. The food safety of fruits and vegetables outside home is a key issue to be studied in detail and integrated in any intervention in Benin and potentially other low- and middle-income countries.

Familiarizing with Toy Food: Preliminary Research and Future Directions - Corrected Proof

Meghan Lynch — 2011-08-22

Abstract: Objective: A qualitative content analysis of children and parents interacting with toy food in their homes in view of recommendations for developing healthful food preferences.Methods: YouTube videos (n = 101) of children and parents interacting in toy kitchen settings were analyzed using qualitative content analysis. Toy food was categorized under 5 food groups, and interactions were compared to literature on developing healthful food preferences in children in real life.Results: The most popular food group represented by the toys was Extras, followed by Fruits/Vegetables, Meats/Alternatives, Grains, and Milk/Dairy. Many parents were also found to encourage behaviors not conducive to healthful food preference development in children.Conclusions and Implications: Future research needs to determine whether familiarization with toy food influences children's real-life food preferences. Nutrition education programs for young children and parents could greatly benefit from future research on this approach. Exploring novel ways of developing children's food preferences is well warranted.

Statewide Evaluation of Local Wellness Policies in Georgia: An Examination of Policy Compliance, Policy Strength, and Associated Factors - Corrected Proof

Rodney Lyn, Sandra O'Meara, Valerie A. Hepburn, Anna Potter — 2011-07-27

Abstract: Objective: To analyze relationships between demographic characteristics of Georgia school systems and: (1) compliance with the Child Nutrition and WIC Reauthorization Act (CNRA); and (2) strength of wellness policy goals in nutrition, physical activity, and other school-based activities.Design: Each local school district submitted their school-board–approved wellness policy to researchers. Each policy was reviewed and coded for compliance with CNRA and evaluated on the strength of its goals.Setting: Public school districts.Participants: One hundred seventy-six of 180 Georgia public school systems participated.Main Outcome Measures: Independent variables were demographic characteristics of Georgia school systems. Dependent variables were ratings from the policy evaluation instrument, grouped into composite indices to compare the strength (ie, ratings) of wellness policy goals.Analysis: Pearson correlation, cross-tabulation.Results: Significant positive associations were found between academic performance and: strength of overall wellness policy goals (P < .05), goals in nutrition education (P < .01), and other school-based activities (P < .01). Economic status of the student population was found to be positively associated with strength of nutrition education goals (P < .05).Conclusions and Implications: Districts with stronger academic performance had more comprehensive overall wellness policy goals and stronger goals in nutrition education and other school-based activities.

Development and Validation of a Quantitative Food Frequency Questionnaire among Rural- and Urban-dwelling Adults in Colombia - Corrected Proof

2011-07-08

Abstract: Objective: To validate a food frequency questionnaire (FFQ) against multiple 24-hour dietary recalls (DRs) that could be used for Colombian adults.Methods: A convenience sample of 219 individuals participated in the study. The validity of the FFQ was evaluated against multiple DRs. Four dietary recalls were collected during the year, and an FFQ was administered at the end of the study along with the fourth DR.Results: Deattenuated correlation coefficient for FFQ against mean intake of 4 DRs varied from 0.77 for carbohydrate, 0.55 for energy, and 0.51 for protein. In rural areas, lower correlations were observed. The overall extent of agreement in each quartile of estimated nutrient intake varied from 61% to 83%.Conclusions and Implications: The FFQ provides moderate to high estimates for energy and nutrient intake and can be employed to rank individuals based on their habitual intake.

Children’s Perceptions of the Northern Fruit and Vegetable Program in Ontario, Canada - Corrected Proof

2011-07-04

Abstract: Objective: This study examined students’ perceptions of and suggestions for the Northern Fruit and Vegetable Program, a free, school-based fruit and vegetable snack program implemented in elementary schools in 2 regions of northern Ontario, Canada.Methods: This was a qualitative study involving 18 focus groups with students in 11 elementary schools in the Porcupine region and 7 schools in the Algoma region. One hundred thirty-nine students from grades 5-8 participated in this study. Inductive content analysis was used to identify key themes.Results: Children perceived the Northern Fruit and Vegetable Program to be a valuable program that allowed them to try new fruits and vegetables (FVs). Participants stated they now eat more FVs at home and at school. Participants would like the program offered more frequently and with more variety.Conclusions and Implications: Although children identified several areas for program improvement, they generally perceived the program to be positive and valuable in promoting FV consumption.

Beliefs about the Role of Parenting in Feeding and Childhood Obesity among Mothers of Lower Socioeconomic Status - Corrected Proof

2011-07-04

Abstract: Objective: To examine beliefs about the role of parenting in feeding and childhood obesity among mothers of lower socioeconomic status.Methods: Individual semistructured, audiotaped interview with 91 mothers of preschool-aged children (49% of mothers obese, 21% of children obese) in the midwestern United States. Participant comments were transcribed and common themes were identified using the constant comparative method and NVivo software.Results: Mothers often described their parents’ feeding style as authoritarian or neglectful, and their own current style as comparatively indulgent and better. Mothers described parents of overweight children as inept or neglectful, but they never described their own parenting as such.Conclusions and Implications: Encouraging mothers to reflect on how they were fed as children, how it may influence their current parenting, and how the relationship between mothering and child obesity is complex are important nutrition education opportunities.

Measuring Perceived Barriers to Healthful Eating in Obese, Treatment-seeking Adults - Corrected Proof

2011-06-13

Abstract: Objective: To characterize perceived barriers to healthful eating in a sample of obese, treatment-seeking adults and to examine whether changes in barriers are associated with energy intake and body weight.Design: Observational study based on findings from a randomized, controlled behavioral weight-loss trial.Participants: Participants were 113 women and 100 men, mean age 48.8 years, 67% white, and mean body mass index at baseline 34.9 kg/m2.Variables Measured: Perceived diet barriers were assessed using a 39-item questionnaire. Energy intake was assessed with the Block Food Frequency Questionnaire. Body weight (kg) and height (cm) were measured.Analysis: Factor-based scales constructed from exploratory factor analysis. Linear regression models regressed 12-month energy intake and body weight on baseline to 12-month factor-based score changes (α = .05).Results: Exploratory factor analysis yielded 3 factors: lack of knowledge, lack of control, and lack of time. Reported declines in lack of knowledge and lack of control from baseline to 12 months were associated with significantly greater energy restriction over 12 months, whereas reported declines in lack of control and lack of time were associated with significantly greater weight loss.Conclusions and Implications: Results suggest that declines in perceived barriers to healthful eating during treatment are associated with greater energy restriction and weight loss.

Which Food Patterns Are Predictors of Obesity in Tehranian Adults? - Corrected Proof

2011-06-09

Abstract: Objectives: To determine whether changes in food patterns over a period of 6 years were related to obesity in Tehranian adults.Design: Data on dietary intake, using the food frequency questionnaire, and anthropometry were obtained in 2 periods of the survey (1999-2001 and 2005-2007).Setting: Participants of the Tehran Lipid and Glucose Study.Participants: Two hundred six adults.Main outcome measures: Waist circumference, body mass index, and waist-to-hip ratio.Analysis: Food patterns were derived using factor analysis.Results: Three dietary patterns, the healthful (HDP), the western (WDP), and the mix, were identified. Increased WDP score was directly related to change in body mass index (β = .41, R2 = 0.22, P < .001) among overweight/obese individuals. Alterations in waist circumference was better predicted by increased WDP score (β = .49, R2 = 0.21, P < .01) than by increased HDP score (β = -.20, R2 = 0.11, P < .05). Subjects in the higher quartile of increased HDP score had lesser change in waist-to-hip ratio (β = -.77, R2 = 0.43, P < .01).Conclusion: Results of this study indicate that increased adherence to the WDP and decreased adherence to the HDP could contribute to obesity.

Community Food Environment, Home Food Environment, and Fruit and Vegetable Intake of Children and Adolescents - Corrected Proof

2011-05-02

Abstract: Objectives: To determine (1) reliability of new food environment measures; (2) association between home food environment and fruit and vegetable (FV) intake; and (3) association between community and home food environment.Methods: In 2005, a cross-sectional survey was conducted with readministration to assess test-retest reliability. Adolescents, parents of adolescents, and parents of children (n = 458) were surveyed in San Diego, Boston, and Cincinnati.Results: Most subscales had acceptable reliability. Fruit and vegetable intake was positively associated with availability of healthful food (r = 0.15-0.27), FV (r = 0.22-0.34), and ratio of more-healthful/less-healthful food in the home (r = 0.23-0.31) and was negatively associated with less-healthful food in the home (r = -0.17 to -0.18). Home food environment was associated with household income but not with community food environment.Conclusions and Implications: A more healthful home food environment was related to youth FV intake. Higher income households had more healthful food in the home. The potential influence of neighborhood food outlets warrants further study.

Under- and Over-Reporting of Energy Intake in Slovenian Adolescents - Corrected Proof

Helena Kobe, Ciril Kržišnik, Nataša Fidler Mis — 2011-03-21

Abstract: Objective: To examine under- and over-reporting of energy intake (EI) among adolescents and to compare relative food and nutrient intakes of under-reporters (UR), over-reporters (OR), and the whole population to acceptable reporters (AR).Design: All adolescents completed food frequency questionnaires at regional health centers, and a subgroup also completed a 3-day weighed dietary protocol at home.Setting: This study is a part of the first national representative study on dietary habits of Slovenian adolescents.Participants: In total, 2,813 adolescents entering high school (10% of the population); participation rate was 95%.Main Outcome Measures: Absolute EI and relative intakes of food and nutrients.Analysis: Prodi (version 5.2 expert plus, Nutri-Science, Stuttgart, Germany, 2004) software was used to evaluate dietary intakes; t test, analysis of variance, and Mann-Whitney testing were used for differences between means, and chi-square was used for differences between proportions. Level of significance was set at P = .05.Results: The prevalence of UR and OR was 34% and 10% among boys, and 27% and 11% among girls. Under-reporters reported lower energy percentage from carbohydrates, higher energy percentage from fats and proteins, and higher micronutrient densities than AR.Conclusions and Implications: Under-reporting and over-reporting are widespread among Slovenian adolescents. Exclusion of UR and OR does not influence mean value of EI when assessing the diet of a group as a whole.

Predictors of Paternal and Maternal Controlling Feeding Practices with 2- to 5-year-old Children - Corrected Proof

Emma Haycraft, Jackie Blissett — 2011-03-03

Abstract: Objective: This study aimed to identify predictors of controlling feeding practices in both mothers and fathers of young children.Design: Cross-sectional, questionnaire design.Setting: Nursery schools within the United Kingdom recruited participants.Participants: Ninety-six mothers and fathers comprising 48 mother-father pairs of male and female children aged 2 to 5 years.Main Outcome Measures: Parents' child feeding practices, eating psychopathology, general mental health symptomology, and their children's eating behaviors and temperament.Analysis: Preliminary correlations; stepwise regressions.Results: Maternal controlling feeding was predicted by children's eating behaviors (emotional over- and undereating), child temperament (sociability), and maternal general mental health symptoms. Paternal reports of children's eating behaviors (slow eating and emotional undereating) were the only significant predictors of fathers' controlling feeding practices.Conclusions and Implications: Mothers' and fathers' feeding practices seem to be better linked to child characteristics than to the presence of eating psychopathology symptoms. Children's emotional eating predicted all 3 controlling feeding practices in mothers and warrants further study to elucidate the causal nature of this relationship.

Associations between Whole-Grain Intake, Psychosocial Variables, and Home Availability among Elementary School Children - Corrected Proof

Renee A. Rosen, Teri L. Burgess-Champoux, Len Marquart, Marla M. Reicks — 2011-02-21

Abstract: Objective: Develop, refine, and test psychosocial scales for associations with whole-grain intake.Methods: A cross-sectional survey was conducted in a Minneapolis/St. Paul suburban elementary school with children in fourth through sixth grades (n = 98) and their parents (n = 76). Variables of interest were child whole-grain intake, self-efficacy, outcome expectations, preferences, knowledge regarding whole-grain food, and whole-grain availability at home. Correlation analysis and one-way analysis of variance were used to analyze data.Results: Internal consistency and test-retest correlation coefficients for child psychosocial scales were modest or acceptable (α = .55–.70). Parents reported a mean of 15 ± 7 whole-grain products available at home. Child mean daily intake of total grain was about 8 servings, and intake of products containing whole grain was slightly over 2 servings. Reported home availability and refined-grain intake were significantly related to whole-grain intake, whereas psychosocial variables were not.Conclusions and Implications: Home availability may be a more important variable associated with whole-grain intake than psychosocial variables.