Journal of Nutrition Education and Behavior - Articles in Press

Measuring Me: Using Nutrition Education Curriculum Activities to Teach Elementary Mathematics - Corrected Proof

Sara McLeod, Virginia Carraway-Stage, Jana Hovland, Melani Duffrin — 2012-01-27

Understanding basic functions of mathematics can greatly improve individuals’ future health risk. Numeracy skills help people understand medication prescriptions, nutrition plans, and which treatment option is best for them. However, one of the largest obstacles health professionals face is patient compliance to interventions; one reason is lack of mathematical proficiency among the population.

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.

BodyWorks: A Parent-Focused Program to Promote Healthful Eating and Physical Activity for Children and Adolescents - Corrected Proof

2012-01-16

Research has shown that if children see their parents and caregivers enjoying healthful food and being physically active, they are more likely to do the same. Therefore, parents and caregivers, one of the pillars of First Lady Michelle Obama’s Let’s Move! Campaign, represent an important target for initiatives designed to promote healthful eating and increase physical activity among children. BodyWorks is an accessible, research-driven, community-based parent and caregiver program designed to help improve the eating and activity behaviors of children aged 9-14 years throughout the United States.

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.

Managing Clustered Data Using Hierarchical Linear Modeling - Corrected Proof

2012-01-12

Abstract: Researchers in nutrition research often use cluster or multistage sampling to gather participants for their studies. These sampling methods often produce violations of the assumption of data independence that most traditional statistics share. Hierarchical linear modeling is a statistical method that can overcome violations of the independence assumption and lead to correct analysis of data, yet it is rarely used in nutrition research. The purpose of this viewpoint is to illustrate the benefits of hierarchical linear modeling within a nutrition research context.

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.

Associations of Built Food Environment with Dietary Intake among Youth with Diabetes - Corrected Proof

2012-01-12

Abstract: Objective: To evaluate the associations of supermarket and fast-food outlet accessibility and availability with dietary intake among youth with diabetes.Design: Subjects’ residential location and dietary intake was obtained from the SEARCH for Diabetes in Youth study. Food outlet data obtained from the South Carolina Department of Health and Environmental Control and InfoUSA were merged based on names and addresses of the outlets. The comprehensive data were then used to construct accessibility and availability measures for each participant.Setting: State of South Carolina.Participants: Three hundred fifty-nine youths with diabetes (10 years old and older) from the SEARCH for Diabetes in Youth study.Phenomena of Interest: Supermarket and fast-food outlet accessibility and availability; dietary intake represented by Dietary Approaches to Stop Hypertension (DASH) score.Analysis: Generalized estimating equations analyses.Results: Increased availability and accessibility of supermarkets were significantly associated with higher DASH score, even after adjusting for individual-level correlates, urbanicity, and fast-food outlet accessibility or availability. Fast-food accessibility, however, was associated only with specific food groups (meat, sweets, and low-fat dairy intake), not with the DASH score.Conclusions and Implications: Efforts to promote environments conducive to healthful eating may significantly improve the overall dietary intake and reduce diet-related health complications among youth with diabetes.

Parent-reported Social Support for Child's Fruit and Vegetable Intake: Validity of Measures - Corrected Proof

Jayna M. Dave, Alexandra E. Evans, Marge D. Condrasky, Joel E. Williams — 2012-01-09

Abstract: Objective: To develop and validate measures of parental social support to increase their child’s fruit and vegetable (FV) consumption.Design: Cross-sectional study design.Setting: School and home.Participants: Two hundred three parents with at least 1 elementary school-aged child.Main Outcome Measure: Parents completed a questionnaire that included instrumental social support scale (ISSPS), emotional social support scale (ESSPS), household FV availability and accessibility index, and demographics.Analysis: Exploratory factor analysis with promax rotation was conducted to obtain the psychometric properties of ISSPS and ESSPS. Internal consistency and test-retest reliabilities were also assessed.Results: Factor analysis indicated a 4-factor model for ESSPS: positive encouragement, negative role modeling, discouragement, and an item cluster called reinforcement. Psychometric properties indicated that ISSPS performed best as independent single scales with α = .87. Internal consistency reliabilities were acceptable, and test-retest reliabilities ranged from low to acceptable. Correlations between scales, subscales, and item clusters were significant (P < .05). In addition, ISSPS and the positive encouragement subscale were significantly correlated with household FV availability.Conclusions and Implications: The ISSPS and ESSPS subscales demonstrated good internal consistency reliability and are suitable for impact assessment of an intervention designed to target parents to help their children eat more fruit and vegetables.

Healthful Eating and Physical Activity in the Home Environment: Results from Multifamily Focus Groups - Corrected Proof

Jerica M. Berge, Aimee Arikian, William J. Doherty, Dianne Neumark-Sztainer — 2011-12-22

Abstract: Objective: To explore multiple family members’ perceptions of risk and protective factors for healthful eating and physical activity in the home.Design: Ten multifamily focus groups were conducted with 26 families.Setting and Participants: Community setting with primarily black and white families. Family members (n = 103) were aged 8 to 61 years.Main Outcome Measures: Risk and protective factors for healthful eating and physical activity in the home environment.Analysis: A grounded hermeneutic approach.Results: Ten major themes were identified by family members related to health behaviors in the home environment, including accessibility to healthful foods and activity, time constraints, stage of youth development, individual investment in health behaviors, family investment in health behaviors, family meals and shared activities, parent modeling, making health behaviors fun, making health behaviors part of the family lifestyle, and community investment in family health behaviors.Conclusions and Implications: This study identified the importance of the family system and the reciprocal influences within the home environment on health behaviors. In addition, individual and community-level suggestions were identified. Insights from the families provide leads for future research and ideas for the prevention of youth obesity.

Maternal Dietary Counseling Reduces Consumption of Energy-Dense Foods among Infants: A Randomized Controlled Trial - Corrected Proof

2011-12-22

Abstract: Objective: To evaluate the impact of a dietary counseling in reducing the intake of energy-dense foods by infants.Design: A randomized controlled trial.Setting and Participants: São Leopoldo, Brazil. Mothers and infants of a low-income-group population were randomized into intervention (n = 163) and received dietary counseling during 10 home visits, or control (n = 234) groups.Main Outcomes Measures: Child consumption of sugar-dense (SD) and lipid-dense (LD) foods at 12 to 16 months.Analysis: The effect of the intervention was expressed by relative risks and 95% confidence intervals. Poisson regression analysis was used to determine the association between exclusive breastfeeding and the energy-dense foods intake.Results: A smaller proportion of infants from the intervention group consumed candy, soft drinks, honey, cookies, chocolate, and salty snacks. In the intervention group, there was a reduction of 40% and 50% in the proportion of infants who consumed LD and SD foods, respectively. Being breastfed up to 6 months reduced the risk for consumption of LD and SD foods by 58% and 67%, respectively.Conclusions and Implications: Dietary counseling to mothers may be effective in reducing the consumption of energy-dense foods among infants, and it is helpful in improving early dietary habits.

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.

Family Ties to Health Program: A Randomized Intervention to Improve Vegetable Intake in Children - Corrected Proof

2011-12-09

Abstract: Objective: Evaluate a home-based intervention targeted toward parents to improve vegetable intake in preschool-aged children.Methods: Four-month feasibility study of home-based intervention consisting of 4 tailored newsletters and 2 motivational phone calls compared to control; 4 children's books for the control group; and measured pre and post parent-reported physical and social home environment and child vegetable intake in 22 intervention and 21 control homes with a child 2-5 years old assessed with linear regression of group predicting home environment and diet characteristics post-intervention, adjusting for baseline (P < .05 significant).Results: Intervention increased availability of vegetables (+1.5 ± 2.5 vegetable types vs -0.3 ± 2.7 vegetable types, P = .02), offering fruits and vegetables for snacks (+0.95 ± 1.5 d/wk vs -0.05 ± 1.9 d/wk, P = .04), and self-efficacy (+2.4 ± 4.1 vs -0.3 ± 2.0, P = .02).Conclusions and Implications: The data suggest potential for home-based interventions to alter parent behaviors such as feeding practices and the home physical environment, which may be steps toward increasing vegetable intake in children.

Exploring the Theory of Planned Behavior to Explain Sugar-sweetened Beverage Consumption - Corrected Proof

2011-12-09

Abstract: Objective: To describe sugar-sweetened beverage (SSB) consumption and to establish psychometric properties and utility of a Theory of Planned Behavior (TPB) instrument for SSB consumption.Methods: This cross-sectional survey included 119 southwest Virginia participants. Most of the respondents were female (66%), white (89%), and had at least a high school education (79%), and their average age was 41.4 ± 13.5 years. A validated beverage questionnaire was used to measure SSB. Eleven TPB constructs were assessed with a 56-item instrument. Analyses included descriptive statistics, 1-way ANOVA, Cronbach α, and multiple regression.Results: Sugar-sweetened beverage intake averaged 457 ± 430 kcal/d. The TPB model provided a moderate explanation of SSB intake (R2 = 0.38; F = 13.10, P < .01). Behavioral intentions had the strongest relationships with SSB consumption, followed by attitudes, perceived behavioral control, and subjective norms. The 6 belief constructs did not predict significant variance in the models.Conclusions and Implications: Future efforts to comprehensively develop and implement interventions guided by the TPB hold promise for reducing SSB 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.

From Paper to Practice: Barriers to Adopting Nutrition Guidelines in Schools - Corrected Proof

2011-11-28

Abstract: Objective: To explore the barriers associated with the adoption of the Alberta Nutrition Guidelines for Children and Youth in schools according to characteristics of the innovation (guidelines) and the organization (schools).Design: Cross-sectional telephone survey.Setting and Participants: Schools in Alberta, Canada. Principals from 357 schools.Main Outcome Measure: Barriers to adopting the nutrition guidelines.Analysis: A 19-question telephone survey, including open- and closed-ended questions, was used to obtain information regarding schools’ characteristics and barriers to adopting the guidelines. Qualitative data were coded according to common themes a priori, based on constructs from the Diffusion of Innovations framework.Results: Schools reported many barriers related to the relative advantage, compatibility, and complexity of adopting the guidelines. Parents' resistance to change and cost were the key reported barriers. Lack of knowledge, student preferences, the physical location of the school, and barriers related to the provision of healthful food were also reported.Conclusions and Implications: Disseminating guidelines without providing adequate support for their implementation may not promote change within the school setting. School nutrition initiatives need to involve the parents and have access to sufficient financial and human resource support.

Engaging Youth in Learning about Healthful Eating and Active Living: An Evaluation of Educational Theatre Programs - Corrected Proof

2011-11-28

Abstract: Objective: To compare knowledge gains and knowledge retention of healthful eating and active living behaviors in elementary school children participating in Educational Theatre Programs (ETP).Methods: The study sample included 47 schools (2,915 third- or fourth-grade students) in 8 Kaiser Permanente regions. Children's knowledge of 4 healthful behaviors was measured using a brief survey before and immediately after performances, followed by a post-delay survey 3 weeks later.Results: Statistically significant increases in knowledge pre/post for individual topics (P < .01). The percentage of children who answered all 4 questions correctly increased from 17% to 63% immediately after ETP performances (P < .01). Knowledge was retained over the short term; the proportion of students who correctly identified recommended healthful eating/active living practices had declined only slightly 3 weeks later.Conclusions and Implications: The ETP significantly improved participating students' knowledge of healthful eating and active living concepts. Theatre programs should be considered for inclusion in elementary school health curricula.

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.

A Point-of-Purchase Intervention Featuring In-Person Supermarket Education Affects Healthful Food Purchases - Corrected Proof

Brandy-Joe Milliron, Kathleen Woolf, Bradley M. Appelhans — 2011-11-21

Abstract: Objective: This study tested the efficacy of a multicomponent supermarket point-of-purchase intervention featuring in-person nutrition education on the nutrient composition of food purchases.Design: The design was a randomized trial comparing the intervention with usual care (no treatment).Setting and Participants: A supermarket in a socioeconomically diverse region of Phoenix, AZ. One hundred fifty-three adult shoppers were recruited onsite.Intervention: The intervention consisted of brief shopping education by a nutrition educator and an explanation and promotion of a supermarket point-of-purchase healthful shopping program that included posted shelf signs identifying healthful foods, sample shopping lists, tips, and signage.Main Outcome Measures: Outcomes included purchases of total, saturated, and trans fat (grams/1,000 kcal), and fruits, vegetables, and dark-green/yellow vegetables (servings/1,000 kcal) derived through nutritional analysis of participant shopping baskets.Analysis: Analysis of covariance compared the intervention and control groups on food purchasing patterns while adjusting for household income.Results: The intervention resulted in greater purchasing of fruit and dark-green/yellow vegetables. No other group differences were observed.Conclusions and Implications: Long-term evaluations of supermarket interventions should be conducted to improve the evidence base and to determine the potential for influence on food choices associated with decreased chronic disease incidence.

Concepts of Healthful Food among Low-income African American Women - Corrected Proof

Elizabeth B. Lynch, Shane Holmes, Kathryn Keim, Sylvia A. Koneman — 2011-10-31

Abstract: Objective: Describe beliefs about what makes foods healthful among low-income African American women.Methods: In one-on-one interviews, 28 low-income African American mothers viewed 30 pairs of familiar foods and explained which food in the pair was more healthful and why. Responses were grouped into codes describing concepts of food healthfulness.Results: Nutrient content, physical effects of food, and food categories were used to judge the healthfulness of foods. Fruits, vegetables, and dairy foods were considered the most healthful and starchy foods the least healthful because they were believed to cause weight gain. Beliefs about which foods contain which nutrients and which foods have particular physical effects varied widely across participants.Conclusions and Implications: Participants demonstrated awareness of which foods are healthful but lacked understanding of why those foods are more healthful than others. Knowledge about the health effects of foods may be necessary to motivate individuals to choose healthful foods.

Nutrition Program Quality Assurance Through a Formalized Process of On-site Program Review - Corrected Proof

Joan Doyle Paddock, Jamie Dollahite — 2011-10-17

Abstract: A protocol for a systematic onsite review of the Expanded Food and Nutrition Education Program and Supplemental Nutrition Assistance Program–Education was developed to support quality programming and ensure compliance with state guidelines and federal regulations. Onsite review of local nutrition program operations is one strategy to meet this goal. Observation and interaction with staff allow a comprehensive understanding of strengths, weaknesses, and emerging issues. This information provides managers with timely feedback to strengthen and improve all aspects of nutrition programming.

Increasing Fruit and Vegetable Consumption among Preschoolers: Evaluation of Color Me Healthy - Corrected Proof

Kendra E. Witt, Carolyn Dunn — 2011-09-19

Abstract: Objective: Determine whether Color Me Healthy (CMH), an interactive nutrition and physical activity program for preschool children, increases fruit and vegetable consumption.Design: Intervention study. Data were collected at baseline, 1 week post-intervention, and 3 months post-intervention.Setting: Child care centers.Participants: Preschool children (n = 263) in 17 child care centers.Intervention: Child care centers were randomly assigned to 1 of 2 conditions; children (n = 165) in 10 centers received the CMH curriculum, and children (n = 98) in 7 centers acted as comparisons and did not receive the curriculum.Main Outcome Measures: Process and outcome evaluation. Consumption of fruit and vegetable snacks.Analysis: Data were analyzed using repeated-measures analysis of variance and hierarchical linear modeling.Results: Children who received CMH significantly increased their consumption of fruit snacks by approximately 20.8% and vegetable snacks by approximately 33.1% between baseline assessment and the assessment conducted 3 months after the completion of the CMH program. Hierarchical linear modeling determined that group assignment (ie, CMH or control) was the only significant predictor of fruit and vegetable consumption.Conclusion and Implications: Findings suggest that CMH may be used in child care settings for developing healthful eating habits.

Energy Density, Nutrient Adequacy, and Cost per Serving Can Provide Insight into Food Choices in the Lower Mississippi Delta - Corrected Proof

2011-09-12

Abstract: Objective: To compare differences across food groups for food cost, energy, and nutrient profiles of 100 items from a cross-sectional survey of 225 stores in 18 counties across the Lower Mississippi Delta of Arkansas, Louisiana, and Mississippi.Methods: Energy, nutrient, and cost profiles for food items were calculated by using Naturally Nutrient Rich methodology and converting price per 100 g edible portion to price per serving. Foods were grouped into 6 food groups. Mean differences were compared with ANOVA.Results: Significant differences existed by food group for each measure. Energy density was highest for fats/oils/sweets, whereas nutrient density was highest for vegetables. Price per serving was lowest for fats/oils/sweets and highest for meats.Conclusions and Implications: Educational messages focusing on a complete diet should consider the role of food costs and provide specific recommendations for increasing nutrient-dense foods by replacing a portion of the meat serving at meals with culturally acceptable lower-cost nutrient-dense foods.

The Effect of a Recessionary Economy on Food Choice: Implications for Nutrition Education - Corrected Proof

Carla K. Miller, Paul Branscum — 2011-09-07

Abstract: Objective: To determine the effect of an economic recession on food choice behaviors.Design: A qualitative study using semistructured, in-depth interviews followed by completion of a nutrition knowledge questionnaire and the Food Choice Questionnaire was conducted.Setting and Participants: A convenience sample from a metropolitan city in the Midwest. Women with children younger than 18 years in the household who had experienced unemployment, underemployment, or loss of a house because of foreclosure in the previous year participated (n = 25).Main Outcome Measure: Reported behaviors for food choices when grocery shopping and dining out and educational resources requested to inform nutrition education programs.Analysis: Interviews were coded with a matrix derived from participant statements. Common behaviors were grouped and broad themes were identified.Results: Numerous shopping strategies were recently used to save money (eg, buying only sale items, using coupons). Participants believed a healthful diet included a variety of foods with less sugar, salt, and fat. Recipes and menus that required little cost or preparation time and resources to track food expenditures were desired.Conclusions and Implications: Nutrition education should include money-saving shopping strategies, facilitate menu planning and cooking skills, and address food resource management to enable participants to acquire sufficient, acceptable, and nutritionally adequate food.

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.

An Examination of Sex Differences in Relation to the Eating Habits and Nutrient Intakes of University Students - Corrected Proof

2011-07-18

Abstract: Objectives: To examine sex differences in eating habits and nutrient intakes and explore whether eating habits mediate the effects of sex on nutrient intakes and whether sex moderates the effects of eating habits on nutrient intakes.Methods: Cross-sectional survey of eating habits and food-intake frequency in a convenience sample of college students.Results: Male students (n = 172) consumed a higher energy content from fat, a larger amount of fiber, and more fruits and vegetables, and engaged less often in various healthful eating habits (eg, reading food labels, having breakfast) than female students (n = 316). Sex predicted the 3 dietary nutrient intakes partially through eating habits. Interactions between sex and eating habits were nonsignificant.Conclusions and Implications: Results reinforce that university students’ nutrient intakes are less than ideal. Women and men may have different needs for nutritional improvement. However, the effects of health promotion concerning eating habits may be similarly effective between the sexes.

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.

Parental Information, Motivation, and Behavioral Skills Correlate with Child Sweetened Beverage Consumption - Corrected Proof

L. Suzanne Goodell, Michelle B. Pierce, K. Rivet Amico, Ann M. Ferris — 2011-06-02

Abstract: Objective: To evaluate fit of the Information-Motivation-Behavioral Skills (IMB) model applied to sweetened beverage (SB) consumption in children.Design: Cross-sectional. Parents completed a home beverage inventory and IMB survey regarding SB consumption.Setting: Health fairs, Special Supplemental Nutrition Program for Women, Infants, and Children clinics.Participants: Convenience sample of 198 parents of low socioeconomic status.Main Outcome Measures: Independent variables included scores from 3 indices calculated from the IMB survey, information, motivation, and behavioral skills. The dependent variable was average child daily caloric consumption from SB consumption calculated from the home beverage inventory.Analysis: Structural equation modeling.Results: Parental information had direct and indirect negative relationships with SB consumption. Parental motivation was only indirectly associated with SB consumption mediated through behavioral skills. Parental behavioral skills had a negative correlation with SB consumption.Conclusions and Implications: In applying the IMB model to SB consumption, the authors found preliminary support for relationships between parental information, motivation, behavioral skills, and child SB consumption. Application of this model shows promise in identifying the complex interactions between factors influencing consumption behaviors. As nutrition educators frequently desire to alter behaviors, use of the IMB model may help with both targeting and assessment efforts.

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.

Food Consumption Patterns in Mediterranean Adolescents: Are There Differences between Overweight and Normal-Weight Adolescents? - Corrected Proof

2011-02-08

Abstract: Objective: To quantify food consumption (based on food group classification) during several time periods in a sample of adolescents and to identify potential differences in food patterns between normal-weight and overweight participants.Design: Cross-sectional study. Participants were classified as normal weight and overweight/obese. Dietary intake was assessed by 3-day food records and analyzed at the food group level for 7 different time periods. To exploit the time dimension of the data and to further control for the influence of other covariates, the authors estimated a random effects regression model for panel data.Participants: One hundred twenty students.Setting: Two high schools.Results: In multivariate analysis, no statistically significant differences were found between normal-weight and overweight adolescents with regard to their consumption patterns throughout the day. However, compared to females, male participants had higher intake of all food groups with the exception of fruit, and adolescents engaging in vigorous exercise tended to consume more servings from all food groups during any given time period.Conclusions and Implications: No preferential use of some food or food groups in specific day periods was found among overweight compared to normal-weight high school students.

The Influence of Labeling the Vegetable Content of Snack Food on Children's Taste Preferences: A Pilot Study - Corrected Proof

Lizzy Pope, Randi L. Wolf — 2011-01-24

Abstract: Objective: This pilot study examined whether informing children of the presence of vegetables in select snack food items alters taste preference.Methods: A random sample of 68 elementary and middle school children tasted identical pairs of 3 snack food items containing vegetables. In each pair, 1 sample's label included the food's vegetable (eg, broccoli gingerbread spice cake), and 1 sample's label did not (eg, gingerbread spice cake). Participants reported whether the samples tasted the same, or whether they preferred one sample. Frequency of vegetable consumption was also assessed.Results: Taste preferences did not differ for the labeled versus the unlabeled sample of zucchini chocolate chip bread, χ2 (2, n = 68) = 3.21, P = .20 or broccoli gingerbread spice cake χ2 (2, n = 68) = 2.15, P = .34. However, students preferred the unlabeled cookies (ie, chocolate chip cookies) over the vegetable-labeled version (ie, chickpea chocolate chip cookies), χ2 = (2, n = 68) 9.21, P = .01. Chickpeas were consumed less frequently (81% had not tried in past year) as compared to zucchini and broccoli.Conclusions and Implications: Informing children of the presence of vegetables hidden within snack food may or may not alter taste preference and may depend on the frequency of prior exposure to the vegetable.