Fruit and vegetable availability: a micro environmental mediating variable?

Understanding barriers to implementing the Norwegian national guidelines for healthy school meals: a case study involving three secondary schools

The main goal of the present study was to investigate the barriers to implementing the Norwegian national guidelines for healthy school meals as perceived by principals, project leaders, teachers and students. This study employed a multiple-case design using an explorative approach. Data were collected at three secondary schools in Norway participating in the intervention project Physical activity and healthy school meals. Individual interviews were conducted with school principals and project leaders, and focus group interviews were conducted separately with teachers and students. Four categories of barriers were identified: (1) lack of adaptation of the guidelines to the target group; (2) lack of resources and funding; (3) conflicting values and goals; and (4) access to unhealthy food outside school. The research identified differences in perceived barriers between the staff responsible for implementation and the students as the target group of the measures. All staff groups perceived barriers relating to both resources, and conflicting values and goals. The teachers were more concerned about issues of relevance for adaptation to the target groups than were the principals and project leaders. The students were concerned mostly with issues directly affecting their experience with items offered in the canteen.

Intakes and perceived home availability of sugar-sweetened beverages, fruit and vegetables as reported by mothers, fathers and adolescents in the HEIA (HEalth In Adolescents) study

Objective

To investigate the intakes of sugar-sweetened beverages (SSB), fruit and vegetables (FV) among adolescents and their parents and to explore differences in the perceived availability by gender and parental education.

Design

Baseline data from the HEIA (HEalth In Adolescents) study.

Setting

Data on intake of SSB were collected assessing frequency and amounts, whereas consumption of FV was assessed on the basis of frequency. Further, perceived availability at home and at school (taken from home) was reported.

Subjects

Participants were 1528 Norwegian adolescents aged 11 years, as well as 1200 mothers and 1057 fathers.

Results

The adolescents’ intake of SSB was low on weekdays but doubled during weekend days. This pattern was observed among parents as well. There were significant differences in intake between boys, girls, mothers and fathers, except for vegetables. Fathers reported the lowest frequency of FV intake. Compared with adolescents, mothers reported lower availability of SSB and higher availability of FV. Compared with their sons, fathers reported higher availability of vegetables and lower availability of sugar-sweetened fruit drinks at school. Significant differences in adolescents’ intake of SSB and in the perceived availability of both SSB and FV by parental education were found.

Conclusions

The intake of SSB was higher during weekend days than during weekdays, whereas the frequency of FV intake was low. Differences in adolescents’ perceived availability of both SSB and FV on the basis of parental education were found, whereas the differences in intake were significant only for SSB. Increasing parental awareness of availability and their potential as role models across parental gender and educational level could improve adolescents’ dietary habits.

Maternal feeding practices predict fruit and vegetable consumption in young children. Results of a 12-month longitudinal study

This study aimed to explore the prospective relationship between maternal feeding practices and young children's frequency of consumption of fruits, vegetables and sweets, and also child weight-for-height z-scores. Participants were 60 mothers who completed questionnaires when their children were 1 year old and again when their children were 2 years old. Regression analyses were performed. After controlling for availability and prior child consumption of the target food, maternal use of pressure to eat at 1 year predicted lower child frequency of fruit consumption at 2 years and approached significance for lower vegetable consumption. Maternal modelling of healthy eating at 1 year predicted higher child frequency of vegetable consumption at 2 years. Restriction did not significantly predict child frequency of consumption of fruits, vegetables or sweets over time. Child weight-for-height scores at 2 years were predicted by weight-for-height at 1 year but not by feeding practices. The findings suggest that maternal feeding practices can influence child eating at a very young age. Interventions should focus on encouraging parents to model healthy eating to promote healthy eating in children.

Behavioral science in video games for children's diet and physical activity change: key research needs

Innovative intervention programs are needed to overcome the limitations in previous programs that promoted change in diabetes risk behaviors in children. Serious video games show promise of changing dietary and physical activity behaviors, but research is needed on the optimal design of behavior-change procedures in video games, the mechanisms that account for changes obtained, and the groups in which these interventions work best. Such research will permit the optimal design of serious video games for diabetes and obesity prevention in the future.

Food retailer practices, attitudes and beliefs about the supply of healthy foods

Objective

Non-supermarket food retailers can be a promising channel for increasing the availability of healthy foods in underserved communities. The present paper reports on retailer practices, attitudes and beliefs about the supply of healthy foods before and after the introduction of new subsidies for healthy foods by the US Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in October 2009.

Design

We designed and conducted in-person standardized interviews with store owners and managers to assess perceptions of demand and profits for different foods, supply networks, barriers to stocking healthy foods and their changes following implementation of the new WIC packages.

Setting

Non-supermarket retailers in five towns of Connecticut, USA (n 68 in 2009 and n 58 in 2010).

Subjects

Owners and managers of WIC-authorized and non-WIC convenience stores and non-chain grocery stores.

Results

Retailers identified customer demand as the primary factor in stocking decisions. They reported observing a significantly weaker demand for healthy foods compared with unhealthy foods, although it improved for certain foods with the new WIC subsidies. Less healthy foods were also perceived as more profitable. Supplier networks varied by product from convenient manufacturer delivery for salty snacks to self-supply for produce. WIC retailers were able to quickly adapt and supply healthy foods required under the new WIC programme guidelines.

Conclusions

Retailers other than supermarkets currently perceive little demand for healthy foods, but new WIC subsidies have the power to change these perceptions. Supply barriers seem secondary in the limited offerings of healthy foods by stores and could be overcome when policy changes generate new demand for healthy foods.

Direct and indirect association between environmental factors and fruit intake, mediation by psychosocial factors: the Pro Children study

OBJECTIVES

To explore direct associations between home and school availability of fruit and fruit intake, and the mediating role of attitude towards fruit, liking, perceived barriers and self-efficacy.

DESIGN

Cross-sectional study.

SETTING

Primary schools in nine European countries.

SUBJECTS

Within the Pro Children study, data were collected on perceived home and school availability of fruit, psychosocial factors related to fruit intake and its frequency among 13 305 11-year-old schoolchildren.

RESULTS

Significant overall associations were found between child-reported home availability of fruit and fruit intake in all countries and in the total sample. School availability of fruit was associated with fruit intake in the pooled sample and in country-specific analyses in Sweden and the Netherlands. Liking (13·2-49·4 %) and self-efficacy (14·0-25·1 %) were the strongest mediators in the home availability-fruit intake relationship, but there was also a direct association between home availability and fruit intake, except in Spain and the Netherlands. Mediating pathways of the school availability-fruit intake relationship could only be assessed for Norway, Sweden and the total sample. Attitude was a significant mediator in Norway (80·4 %) and in Sweden (25·3 %), while in the total sample also liking (38·7 %) and self-efficacy (23·0 %) were identified as significant mediators.

CONCLUSIONS

The association between home availability of fruit and fruit intake is at least partly mediated by personal factors such as liking and self-efficacy indicates that fruit intake is not a complete automatic or unconscious behaviour.

Food consumption patterns of infants and toddlers: where are we now?

OBJECTIVES

To describe current infant-feeding practices and current food group consumption patterns of infants and toddlers and to compare 2008 data with 2002 data to identify shifts in these practices and food consumption over time.

DESIGN

The Feeding Infants and Toddlers Study (FITS) 2008 is a cross-sectional survey of a national random sample of US children from birth up to age 4 years. Data for three age subgroups (infants 4 to 5.9 months and 6 to 11.9 months and toddlers 12 to 23.9 months) were used from the 2002 (n=2,884) and 2008 surveys (n=1,596).

STATISTICAL METHODS

All analyses use sample weights that reflect the US population aged 4 to 24 months. Descriptive statistics (means, proportions, and standard errors) and t tests were calculated using SUDAAN (release 9, 2005, Research Triangle Park Institute, Research Triangle Park, NC).

RESULTS

These data show a higher percentage of infants receiving breast milk from 4 to 11.9 months of age with a concurrent decreasing percentage of infants receiving formula, which is significantly different from data for the 9- to 11.9-month-old age group. The use of complementary foods also appears to be delayed in FITS 2008: There is a significantly lower proportion of infants consuming infant cereal at 9 to 11.9 months in FITS 2008 compared to 2002 data. Fruit and vegetable consumption remains lower than desired. Significant reductions in the percentage of infants and toddlers consuming any desserts or candy, sweetened beverages, and salty snacks were seen in 2008.

CONCLUSIONS

The findings presented here provide important insights to the content of messages and types of interventions that are still needed to improve the diets of infants and toddlers.

The use of a commercial vegetable juice as a practical means to increase vegetable intake: a randomized controlled trial

BACKGROUND

Recommendations for daily dietary vegetable intake were increased in the 2005 USDA Dietary Guidelines as consumption of a diet rich in vegetables has been associated with lower risk of certain chronic health disorders including cardiovascular disease. However, vegetable consumption in the United States has declined over the past decade; consequently, the gap between dietary recommendations and vegetable intake is widening. The primary aim of this study is to determine if drinking vegetable juice is a practical way to help meet daily dietary recommendations for vegetable intake consistent with the 2005 Dietary Guidelines and the Dietary Approaches to Stop Hypertension (DASH) diet. The secondary aim is to assess the effect of a vegetable juice on measures of cardiovascular health.

METHODS

We conducted a 12-week, randomized, controlled, parallel-arm study consisting of 3 groups of free-living, healthy volunteers who participated in study visits at the Ragle Human Nutrition Research Center at the University of California, Davis. All subjects received education on the DASH diet and 0, 8 or 16 fluid ounces of vegetable juice daily. Assessments were completed of daily vegetable servings before and after incorporation of vegetable juice and cardiovascular health parameters including blood pressure.

RESULTS

Without the juice, vegetable intake in all groups was lower than the 2005 Dietary Guidelines and DASH diet recommendations. The consumption of the vegetable juice helped participants reach recommended intake. In general, parameters associated with cardiovascular health did not change over time. However, in the vegetable juice intervention groups, subjects who were pre-hypertensive at the start of the study showed a significant decrease in blood pressure during the 12-week intervention period.

CONCLUSION

Including 1-2 cups of vegetable juice daily was an effective and acceptable way for healthy adults to close the dietary vegetable gap. Increase in daily vegetable intake was associated with a reduction in blood pressure in subjects who were pre-hypertensive at the start of the trial.

TRIAL REGISTRATION

Clinicaltrials.gov NCT01161706.

Health professionals' and dietetics practitioners' perceived effectiveness of fruit and vegetable parenting practices across six countries

Fruit and vegetable intake may reduce the risk of some chronic diseases. However, many children consume less-than-recommended amounts of fruit and vegetables. Because health professionals and dietetics practitioners often work with parents to increase children's fruit and vegetable intake, assessing their opinions about the effectiveness of parenting practices is an important step in understanding how to promote fruit and vegetable intake among preschool-aged children. Using a cross-sectional design, collaborators from six countries distributed an Internet survey to health and nutrition organization members. A self-selected sample reported their perceptions of the effectiveness of 39 parenting practices intended to promote fruit and vegetable consumption in preschool-aged children from May 18, 2008, to September 16, 2008. A total of 889 participants (55% United States, 22.6% Mexico, 10.9% Australia, 4.4% Spain, 3.3% Chile, 2.2% United Kingdom, and 1.6% other countries) completed the survey. The fruit and vegetable intake-related parenting practices items were categorized into three dimensions (structure, responsiveness, and control) based on a parenting theory conceptual framework and dichotomized as effective/ineffective based on professional perceptions. The theoretically derived factor structures for effective and ineffective parenting practices were evaluated using separate confirmatory factor analyses and demonstrated acceptable fit. Fruit and vegetable intake-related parenting practices that provide external control were perceived as ineffective or counterproductive, whereas fruit and vegetable intake-related parenting practices that provided structure, nondirective control, and were responsive were perceived as effective in getting preschool-aged children to consume fruit and vegetables. Future research needs to develop and validate a parent-reported measure of these fruit and vegetable intake-related parenting practices and to empirically evaluate the effect of parental use of the parenting practices on child fruit and vegetable consumption.

Family influence: key to fruit and vegetable consumption among fourth- and fifth-grade students

OBJECTIVE

To assess social and familial environmental influences on fruit and vegetable (FV) consumption of fourth- and fifth-graders living in a culturally diverse, urban setting.

DESIGN

In 2006, students from 9 fourth- and fifth-grade classrooms from a public school in the Washington-Baltimore Metropolitan Region were recruited as part of the Food Stamp Nutrition Education's initiative to increase FV consumption among school-aged children in low-income schools. This intervention was conducted in partnership with the school.

PARTICIPANTS

Ninety-three fourth- and fifth-grade students and their parents.

MAIN OUTCOME MEASURE

The average daily FV consumption of elementary school students was the dependent variable. Home engagement (eg, student participation in menu planning and food selection at home), parental modeling, school environment, peer influences, and individual characteristics were the independent variables.

ANALYSIS

Multiple regression analysis.

RESULTS

Family and home environment factors explained more than 50% of the variance in students' FV consumption.

CONCLUSIONS AND IMPLICATIONS

Interventions designed to influence school-aged children's FV consumption should target family members and consider incorporating strategies to reach families and promote meal planning activities with the children in their homes.

The use of mentoring programs to improve energy balance behaviors in high-risk children

This study tested the impact of a multicomponent intervention entitled "Partners of all Ages Reading About Diet and Exercise" (PARADE) a child-focused energy balance intervention incorporated into mentoring programs. We used a group randomized nested cohort design randomizing mentoring program sites (n = 119) and children (N = 782; females = 49%; African American = 37%; mean (s.d.) age = 8.5 (1.5) years) to intervention or usual care conditions. PARADE mentors delivered eight lesson plans addressing key concepts related to diet and activity; eight child-focused computer-tailored storybooks with messages targeting that child's diet and activity patterns and eight parent action support newsletters. When compared to the control group, PARADE children were more knowledgeable of diet and activity guidelines (P < 0.01), challenged themselves more to eat five fruits and vegetables (FV) (P < 0.01) and be active 1 h daily (P < 0.01), and to ask for FV for snack (P = 0.015). Calories from high fat foods decreased in overweight/obese children, but not for normal weight children (P = 0.059). There were no significant differences in fruit and vegetable intake, total calories, percent time being active, or BMI z-score. The combination of one-to-one mentoring, child-focused computer based tailoring, and parent support may impact important behavioral change precursors in environments over which the child has control, especially among normal weight children. Further, work is needed to evaluate the impact of family-focused multicomponent interventions, including computer-tailored approaches, directed toward both the parent and the child.

Correlates of availability and accessibility of fruits and vegetables in homes of low-income Hispanic families

Availability and accessibility (AA) has been consistently shown across studies as the most important correlate of fruits and vegetables (FV) intake. However, there is little data on factors that influence AA of FV, especially in Hispanic families. The objective of this cross-sectional study was to examine the association between parental factors, child's preferences for FV and AA of FV in homes of low-income Hispanic families with children 5-12 years old. A convenience sample of 184 parents of low socioeconomic status recruited through public elementary schools completed a self-administered questionnaire about demographics, language spoken at home and food insecurity (FI). Parental factors and child's preferences were measured using a 16-item questionnaire, which was developed specifically for the study. AA of FV was measured using a validated nine-item index. Hierarchical multiple regression analysis indicated that language spoken at home, parental practices that promote consumption of FV, parental role modeling and perceived benefits of fast food had significant and independent associations with AA of FV at home. Intervention programs should take into consideration the language spoken at home and target at improving parental factors in order to improve AA of FV.

Boy Scout 5-a-Day Badge: outcome results of a troop and Internet intervention

OBJECTIVES

The effects of a Boy Scout Five-A-Day Badge program on fruit juice (FJ) and low-fat vegetable (LV) consumption were evaluated using a two-condition (treatment, active-attention-placebo-control) group randomized trial, with three data collection periods (baseline, immediate post, 6-month post).

METHODS

Forty-two Boy Scout troops (n=473, 10- to 14-year-old Scouts) in Houston, TX, were randomly assigned to condition. The 9-week program included approximately 30 min of weekly troop time, plus approximately 25 min of weekly Internet programming. The intervention was delivered in two waves (Spring and Fall). Data were collected in 2003-2004, and analyses were completed in 2008. Main outcomes were FJ and LV consumption (validated food frequency questionnaire). FV self-efficacy, preferences, and home availability were also measured.

RESULTS

Significant increases in FJ consumption (p=.003), FJ home availability (p=.009), and LV self-efficacy (p=.004) were observed among the intervention group immediately following the intervention but were not maintained 6 months later.

CONCLUSION

A Boy Scout troop-plus-Internet intervention promoting FJ and LV consumption resulted in short-term changes in FJ consumption among U.S. Boy Scouts. Future research should investigate ways to extend these results to LV and maintain the increases over time.

Creating healthful home food environments: results of a study with participants in the expanded food and nutrition education program

OBJECTIVE

To evaluate a modified curriculum for the 6-session Texas Expanded Food and Nutrition Education Program (EFNEP) promoting healthful home food environments and parenting skills related to obesity prevention.

DESIGN

Two-group randomized control trial; intervention versus usual EFNEP curriculum.

SETTING

Texas EFNEP classes.

PARTICIPANTS

1,104 EFNEP clients in 100 classes.

INTERVENTION

Six short videos, with goal setting, problem solving, guided discussion, and handouts, incorporated into existing EFNEP classes.

MAIN OUTCOME MEASURES

Body mass index (BMI), diet, psychosocial variables with baseline measurements, immediately post, and 4 months later.

ANALYSIS

Mixed-model repeated measures analysis of variance.

RESULTS

100 classes were randomized (54 intervention/46 comparison), with 1,006 participants at baseline (582 intervention, 424 comparison, 97% women, 89% Hispanic). Significant improvements over time were found for both groups' consumption of most food items and nutrients, and nearly all psychosocial variables, regardless of study group. Only the intervention group had a significant BMI decrease at post. Fidelity to the intervention class session structure was high, and comments from intervention staff and clients were positive.

CONCLUSION AND IMPLICATIONS

Existing EFNEP programs in local communities could have a significant impact on family dietary behaviors for populations at risk of obesity. Replication with similar populations is warranted.

Fruit and vegetable intake in Austrian adults: intake frequency, serving sizes, reasons for and barriers to consumption, and potential for increasing consumption

OBJECTIVE

To assess the intake frequency of fruit and vegetables, serving sizes, reasons for and barriers to consumption, and the potential for increasing fruit and vegetable intake.

DESIGN

A nationwide postal questionnaire survey was conducted in 2006 over all four seasons. The participants were stratified according to occupation and sex. The response rate for 5130 questionnaires sent out was 52.7 %.

SETTING

Austria.

SUBJECTS

Austrian adults, aged 19-64 years.

RESULTS

Daily fruit consumption was reported by 57.1 % of the participants and daily vegetable consumption by 36.2 %. On average, 2.1 (SD 1.9) servings (250 (SD 225) g) of fruit and 1.7 (SD 1.3) servings (198 (SD 159) g) of vegetables were consumed daily. Women ate fruit and vegetables both more frequently and in greater quantities than men. Both intake frequency and the number of fruit and vegetable servings were largely independent of seasonal fluctuations. The primary reason for the consumption of both fruit and vegetables was taste. The greatest barrier to higher intake was the perception that current individual consumption was already sufficient. Price did not constitute a relevant barrier in Austria. At present, the potential for increasing fruit and vegetable intake can be estimated at two servings.

CONCLUSIONS

Austrian adults still consume less fruit and vegetables than recommended. Strategies to increase intake should pay more attention to the taste instead of the various health aspects.

Parenting practices are associated with fruit and vegetable consumption in pre-school children

OBJECTIVE

Parents may influence children's fruit and vegetable (F&V) consumption in many ways, but research has focused primarily on counterproductive parenting practices, such as restriction and pressure to eat. The present study aimed to assess the association of diverse parenting practices to promote F&V and its consumption among pre-school children.

DESIGN

An exploratory analysis was performed on cross-sectional data from 755 Head Start pre-school children and their parents collected in 2004-5. Data included parent practices to facilitate child F&V consumption (grouped into five categories); parent-reported dietary intake of their child over 3 d; and a number of potential correlates. K-means cluster analysis assigned parents to groups with similar use of the food parenting practice categories. Stepwise linear regression analyses investigated the association of parent clusters with children's consumption of F&V, after controlling for potential confounding factors.

RESULTS

A three-cluster solution provided the best fit (R2 = 0.62), with substantial differences in the use of parenting practices. The clusters were labelled Indiscriminate Food Parenting, Non-directive Food Parenting and Low-involved Food Parenting. Non-directive parents extensively used enhanced availability and teachable moments' practices, but less firm discipline practices than the other clusters, and were significantly associated with child F&V intake (standardized beta = 0.09, P < 0.1; final model R2 = 0.17) after controlling for confounders, including parental feeding styles.

CONCLUSIONS

Parents use a variety of parenting practices, beyond pressuring to eat and restrictive practices, to promote F&V intake in their young child. Evaluating the use of combinations of practices may provide a better understanding of parental influences on children's F&V intake.

Neighborhood retail food environment and fruit and vegetable intake in a multiethnic urban population

PURPOSE

To examine relationships between the neighborhood food environment and fruit and vegetable intake in a multiethnic urban population.

DESIGN

Analysis of cross-sectional survey and observational data.

SETTING

One hundred forty-six neighborhoods within three large geographic communities of Detroit, Michigan.

SUBJECTS

Probability sample of 919 African-American, Latino, and white adults.

MEASURES

The dependent variable was mean daily fruit and vegetable servings, as measured by using a modified Block 98 food frequency questionnaire. Independent variables included the neighborhood food environment: store availability (i.e., large grocery, specialty, convenience, liquor, small grocery), supermarket proximity (i.e., street-network distance to nearest chain grocer), and perceived and observed neighborhood fresh fruit and vegetable supply (i.e., availability, variety, quality, affordability).

ANALYSIS

Weighted, multilevel regression.

RESULTS

Presence of a large grocery store in the neighborhood was associated with, on average, 0.69 more daily fruit and vegetable servings in the full sample. Relationships between the food environment and fruit and vegetable intake did not differ between whites and African-Americans. However, Latinos, compared with African-Americans, who had a large grocery store in the neighborhood consumed 2.20 more daily servings of fruits and vegetables. Presence of a convenience store in the neighborhood was associated with 1.84 fewer daily fruit and vegetable servings among Latinos than among African-Americans.

CONCLUSION

The neighborhood food environment influences fruit and vegetable intake, and the size of this relationship may vary for different racial/ethnic subpopulations.

Participants' comments on changes in the revised special supplemental nutrition program for women, infants, and children food packages: the Maryland food preference study

The Institute of Medicine recommended changes in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) food packages to help families from diverse populations establish more healthful dietary patterns. A cross-sectional study conducted during summer 2007 included interviews and focus groups with 223 WIC participants throughout Maryland. The objectives were to examine participants' responses to food package changes, to identify racial/ethnic differences, and to assess costs. All participants (100%) consumed fruits and vegetables. They preferred fresh for taste, but many endorsed canned and frozen for convenience and cost. Most women (56%) and children (69%) consumed whole milk and did not want reduced-fat milk. Few participants (13%) consumed soy products and most were uninterested in future consumption. Participants endorsed whole-wheat bread as more healthful and reported that they (59%) and their children (51%) would increase consumption if provided by WIC. Non-Hispanic participants preferred peanut butter over beans, Hispanic participants reported that they (44%) and their children (57%) would consume more beans (substituting for peanut butter) if provided by WIC. There were few differences in preferences between African-American and white participants. Hispanics differed from non-Hispanics in preference for beans and dislike of frozen and canned vegetables, suggesting the importance of choices. The proposed food packages were cost-neutral, except when extensive substitutions with soy products were allowed. By providing fruits and vegetables, reduced-fat options, and increased opportunities for nutrition education, the revised food packages may reduce the risk of obesity among low-income women, infants, and children.

Variations in fresh fruit and vegetable quality by store type, urban–rural setting and neighbourhood deprivation in Scotland

Objective

Neighbourhood differences in access to fresh fruit and vegetables may explain social inequalities in diet. Investigations have focused on variations in cost and availability as barriers to the purchase and consumption of fresh produce; investigations of quality have been neglected. Here we investigate whether produce quality systematically varies by food store type, rural–urban location and neighbourhood deprivation in a selection of communities across Scotland.

Design

Cross-sectional survey of twelve fresh fruit and vegetable items in 288 food stores in ten communities across Scotland. Communities were selected to reflect a range of urban–rural settings and a food retail census was conducted in each location. The quality of twelve fruit and vegetable items within each food store was evaluated. Data from the Scottish Executive were used to characterise each small area by deprivation and urban–rural classification.

Setting

Scotland.

Results

Quality of fruit and vegetables within the surveyed stores was high. Medium-sized stores, stores in small town and rural areas, and stores in more affluent areas tended to have the highest-quality fresh fruit and vegetables. Stores where food is secondary, stores in urban settings and stores in more deprived areas tended have the lowest-quality fresh produce. Although differences in quality were not always statistically significant, patterns were consistent for the majority of fruit and vegetable items.

Conclusions

The study provides evidence that variations in food quality may plausibly be a micro-environmental mediating variable in food purchase and consumption and help partially explain neighbourhood differences in food consumption patterns.

Social support is a primary influence on home fruit, 100% juice, and vegetable availability

Children tend to eat more fruit and vegetables when more are available in the home. We proposed and tested a model that predicts the availability at home (hereinafter termed "home availability") of fruit, 100% juice, and vegetables, using new measures of frequency of food shopping, purchase, and comparative purchase outcome expectancies (ie, the perceived benefits and costs of purchasing fruit and vegetables), home food pantry management practices, family social support for purchasing fruit and vegetables, food shopping practices, and body mass index (BMI). Participants (N=98) were recruited in 2004 in front of grocery stores and completed two telephone interviews. Cross-sectional hierarchical regression was employed with backward deletion of nonsignificant variables. Despite many statistically significant bivariate correlations between the new variables and home fruit, 100% juice, and vegetable availability, social support was the primary predictor of home fruit availability in multivariate regression. BMI and home 100% juice pantry management were the primary predictors of home 100% juice availability. Social support, BMI, and shopping practices were the primary predictors of home vegetable availability. Social support for purchasing fruit, 100% juice, and vegetables was an important, consistent predictor of home availability. These findings need to be replicated in larger samples.

Home fruit, juice, and vegetable pantry management and availability scales: a validation

Home fruit, 100% juice, and vegetables (FJV) availability is related to increased FJV consumption by children. While FJV must be purchased for use in the home, no scales have been reported on home FJV pantry management practices. A scale for home FJV pantry management practices was generated from focus group discussions with diverse 162 food shoppers. A commonly used scale of home FJV availability was also assessed. A grocery store intercept survey recruited 171 food shoppers with children in front of supermarkets and grocery stores. Survey instruments were administered twice, separated by 6 weeks. Single dimensionality was observed for each scale. Item Response Theory parameter estimates revealed easily interpreted patterns in the sequence of items by difficulty of response. These scales are available to help better understand influences on family FJV purchase decisions.

Associations between self-reported fruit and vegetable consumption and home availability of fruit and vegetables among Greek primary-school children

OBJECTIVE

To examine whether the self-reported fruit and vegetable consumption of Greek primary-school children is associated with the home availability of fruit and vegetables.

DESIGN

Cross-sectional study.

SETTING

Five primary schools in the city of Pyrgos in south-west Greece.

SUBJECTS

One hundred and sixty-seven students in fifth and sixth grades.

METHODS

Fruit and vegetable consumption was assessed using an FFQ. Home availability of fruit and vegetables was assessed using a modified version of a US home availability questionnaire. Participant BMI was assessed and parental education obtained by self-report. Hierarchical regression models that took account of the clustering of participants in schools were used to examine the relationship between consumption and availability after controlling for parental education and BMI.

RESULTS

Regression analyses showed that home availability of fruit was a significant predictor of consumption (beta=0.524, Z=9.77, P<0.001) in a model that explained 46 % of the overall variance. Home availability of vegetables was a significant predictor of vegetable intake (beta=0.378, Z=6.23, P<0.001) in a model that explained 29 % of the overall variance.

CONCLUSION

Home availability of fruit and vegetables was associated with consumption among Greek primary-school children. The association between home availability of fruit and intake was higher than the associations that have been reported in other samples. Results support focusing on the home availability of fruit and vegetables as a potential mediator of consumption that could be manipulated as a means of increasing fruit and vegetable intake among children.

Playing for real: video games and stories for health-related behavior change

BACKGROUND

Video games provide extensive player involvement for large numbers of children and adults, and thereby provide a channel for delivering health behavior change experiences and messages in an engaging and entertaining format.

METHOD

Twenty-seven articles were identified on 25 video games that promoted health-related behavior change through December 2006.

RESULTS

Most of the articles demonstrated positive health-related changes from playing the video games. Variability in what was reported about the games and measures employed precluded systematically relating characteristics of the games to outcomes. Many of these games merged the immersive, attention-maintaining properties of stories and fantasy, the engaging properties of interactivity, and behavior-change technology (e.g., tailored messages, goal setting). Stories in video games allow for modeling, vicarious identifying experiences, and learning a story's "moral," among other change possibilities.

CONCLUSIONS

Research is needed on the optimal use of game-based stories, fantasy, interactivity, and behavior change technology in promoting health-related behavior change.

Distance to food stores & adolescent male fruit and vegetable consumption: mediation effects

BACKGROUND

The physical environments in which adolescents reside and their access to food stores may influence their consumption of fruit and vegetables. This association could either be direct or mediated via psychosocial variables or home availability of fruit and vegetables. A greater understanding of these associations would aide the design of new interventions. The purpose of this study was to examine associations between distance to food stores and restaurants and fruit and vegetable consumption and the possible mediating role of psychosocial variables and home availability.

METHODS

Fruit and vegetable consumption of 204 Boy Scouts was assessed by a food frequency questionnaire in 2003. Participant addresses were geo-coded and distance to different types of food stores and restaurants calculated. Fruit and vegetable preferences, home availability and self-efficacy were measured. Regression models were run with backward deletion of non-significant environmental and psychosocial variables. Mediation tests were performed.

RESULTS

Residing further away from a small food store (SFS) (convenience store and drug store) was associated with increased fruit and juice and low fat vegetable consumption. Residing closer to a fast food restaurant was associated with increased high fat vegetable and fruit and juice consumption. Vegetable preferences partially mediated (26%) the relationship between low fat vegetable consumption and distance to the nearest SFS.

CONCLUSION

Distance to SFS and fast food restaurants were associated with fruit and vegetable consumption among male adolescents. Vegetable preferences partially mediated the distance to low fat vegetable relationship. More research is needed to elucidate how environmental variables impact children's dietary intake.